STRESS
AND
CAREER



DR.
SHRINIWAS
KASHALIKAR
When we are children we often cherish dreams of being somebody great in terms of being wealthy, powerful, glamorous, popular, and respectable and so on, based on our concepts of progress.

Actually our concepts are distorted and perverted in the whirlwind of superficiality, glamour and glitter! This has leaded us to virulent, infectious and suicidal pursuit of lucrative careers. This pursuit in turn; has resulted into rabid competitions embodying; such violent conflicts such as; pro reservation vs. anti reservation, pro privatization vs. anti privatization, pro donations vs. anti donations, legal procedures vs. illegal tactics, fair means vs. unfair means; and even pro corruption vs. anti corruption for grabbing careers, which give “license to amass wealth and power irrespective of the welfare of others and often at the cost of others”.

The basic fault lies in not realizing the fact that the progress actually means simultaneous blossoming of an individual and the society.

The political, economic and other powers, the literary merits, artistic excellence, the professional expertise, the technical skills, the intellectual competence; all have to subserve this basic theme or core of progress viz. simultaneous blossoming of an individual and the universe; or else; all these facades of “excellence”; nurture and promote indiscriminate conflicts and violence, which is what is happening today.

If we; the policy makers, educationists, teachers, parents, go closer to our heart and our conscience; then we would work for holistic education and ensure blossoming of one and all. If we are children; and go closer to our heart and our conscience; then we would be able to choose and work in a correct field to the best of our satisfaction; ensuring blossoming of one and all!

The way to go to our innate core; i.e. our selves; or our heart; or our conscience; is NAMASMARAN.

Let us take this opportunity to practice NAMASMARAN as a matter of topmost priority; and learn to reach our own conscience at the earliest and achieve the goal of blossoming of individual and the universe. This is also referred to as
AATMNAO MOKSHAARTHAM
JAGAT HITAAYA CHA

Endemic in many developing countries, typhoid fever is a protracted disease that includes bacteremic phase with fever and chills during the first week, widespread reticuloendothelial involvement with rash, abdominal pain and prostration in the second week, ulceration of peyer's patches with intestinal bleeding and perforation during the third week. The infection is caused by bacterium, salmonella typhi. The spread is usually by an oro-fecal route. Contamination of water and edibles are the major source. Infected shellfish can be the source of an outbreak. The incubation period is about 10-15 days. .It is Insidious in onset with fever which rises in a stepladder pattern for 4-5 days , associated with malaise, headache drowsiness and bradycardia .Pulse is often slower than would be expected from the temperature .Complication like perforation of the intestine usually occurs after 10 to14 days of fever.The resulting peritonitis can be rapidly fatal, if not treated promptly and vigorously. It is a challenging surgical emergency in some developing countries. There is a universal consensus that ileal perforations are best treated surgically, contrary to the former belief that they are better managed conservatively. Surgery eliminates the peritoneal soilage and endotoxemia.
After a proper diagnosis is made, perforations are surgically treated depending upon the degree of fecal contamination, general health status of the patient and the number and location of perforations.Surgical techniques are selected on the basis of above factors.Various modalities of surgical options are available, these include primary closure, excision and closure, resection and anastomosis, resection and ileostomy, wedge resection, application of serosal or omental patch, and exteriorization of the perforation.When there is minimum peritoneal contamination with single perforation quite far away from the ileocecal junction and good general health of the patient , the preferred method is primary repair., but in moderate peritoneal contamination with multiple perforations very close to each other, resection anastomosis is usually the choice .Heavily contaminated peritoneal cavity, toxic and moribund patient may require an ileostomy. The mortality and morbidity rate do not depend on surgical techniques, but rather than on the general status of the patient, the virulence of the germs and the duration of the disease before the surgery.Thats why it is very important that the patient gets early initial fluid resuscitation, antibiotic therapy etc for better surgical outcome.
Although there are different methods of cure for typhoid and its complications, it is recommended that every effort be made to prevent the disease in the first place and then to educate the masses to bring the patients to hospital as soon as the symptoms begin. In case where the general condition of the patient is not good, patient has been partially treated and lost many precious hours to seek medical attention, has developed renal shut down, has metabolic and hemodynamic instability, the patients should certainly be managed surgically without delay.

Recently just published Article in a prestigious and reputed Jounal of World fame "LANCET" by an Indian scientist on presence of NDM-1 Bacteria,originating from New Delhi, Called New Delhi Metallo-beta-Lactamase-1,a new Superbug ,is really a new threat to World and our country too.But the way it has been published with an inference at last paragraph issuing a warning to all coutries and persons of World to be ware of going to India as if it is only hub and concentrated centre of this newly discovered Gram Negative Bactria or called BUG and adding name of our capital "NEW DELHI" to its name only on the basis of one patient who got treatment from New Delhi before detection of this Bacteria from his blood in Sudan,having no knowledge whether he was carrying it before treatment in India and then sporidacally adding that it is also found in Pakistan,Bangladesh and even in UK raise seroius question regarding authencity of such publication funded by two multi national Drug companies who make medicines ,Antibiotics for killing Bacterias and secondly by maligning India to prevent Foregners coming to INDIA for Treatment leaving UK and European and America .This bacteria like all bacteria might be prevalet in all parts of World but as no research has been done carefully to identify it in various part of World cannot be accepted as it is found mainly in New Delhi /India/Pakistan/Bangladesh only.
If Journal like Lancet is also manipulated like this then our whole Humanity is under threat ,any body can get any thing published to control or manipulate any thing to market or defame any product but once it is coming to world of Health it is a really serious question for humanity as corruption,manipulation favourism or criticism like such will spoil our Human Enviornment of turst and belief completely.
Therefore ,it is not only limited to Our Politicians,Health Ministry Parliament,ICMR,Medical Associations and Doctors of India but of whole World should protest against it in India and whole world ,serois objection should be stated at WHO level as why such reports were published in this manner to malign the name of a country to check "MEDICAL TOURISM" and such efforts should be nipped in the bud today and even in future sothat Commerce and Market should atleast spare Health System for giving wrong informations otherwise whole Humanity will collapse.
But it does not mean that we shall not take precautions,we should take extra effort in sterilisation of our Operation Theatre,Post up Wards and Preop Wards and post Op care somuch clean and clear that such Bacteria never infect any patient whether Indian or from outside under our treatment.
we know that Bactrias are known for mutations to save its progeny from devastation by bringing change in ts plamid and cell wall proteins. esearchers and is resistant to all known antibiotics. These are not being killed by modern Carbopenams(meropenam)and other Beta Lactamase Inhibitors(Tazobactum,sulbactum,pipercillin) as a result more infection to wounds will come to a normal patients in our hospital and those compromised like diabetics,suffering from cancer,HIV,getting,immunosupressants for transplants, immunological disorders,on steroid,cancer chemotherapy,elderly and childrens.

Lancet Infectious disease journal reports 50 such cases. Most of them have carried this infection from India, Pakistan and Bangladesh. The superbug NDM-1 is named after the national capital, where a Swedish patient was reportedly infected after undergoing a surgery in 2008. It is much more dangerous than the notorious MRSA infection.
MDM-1 is an enzyme produced by certain bacteria, which allows them to neutralize the harmful effects of carbapenem one of the most powerful types of antibiotics. Currently no new types of antibiotics are in the development pipeline that will be effective against it. Enzymes such MDM-1 are produced by strands of DNA which bacteria are known to transfer between one another. Currently E Coli and Klebsiella Pneumoniae are the two bacteria who are host to MDM-1. What makes the superbug more dangerous is its ability to jump across different bacterial species. The superbug has the potential to get copied and transferred between bacteria, allowing it to spread rapidly. If it spreads to an already hard-to-treat bacterial infection, it can turn more dangerous.The current treatment option is to treat them with a cocktail of antibiotics. Most new antibiotics currently under development are effective only against gram positive bacteria like super bug MRSA. Unfortunately, bacteria that carry the NDM-1 enzymes are gram negative.

A joint study was led by Chennai-based Karthikeyan Kumarasamy, pursuing his PhD at University of Madras and UK-based Timothy Walsh from department of immunity, infection and biochemistry, department of medicine, Cardiff University. They found the bug in most of the hospitals in Chennai and Haryana with estimated prevalence of this infection 1.5%. They reported the superbug in 44 patients in Chennai, 26 in Haryana, 37 in the UK and 73 in other places across India, Pakistan and Bangaladesh.gram negative sepsis with culture report: resistant to all antibiotics. We have been seeing such cases in the last few years. Now we have a name for this disease. Many of the doctors are deying its existance and linking it to a move against medical tourism in India. But the ICMR, NICD should work on it and come out with guidelines for this infection as no one can deny the fact that we do see cases of gram negative sepsis with E Coli or Klebsiella with culture report resistant to all antibiotics.

Carbapenemases are carbapenem-hydrolyzing beta-lactamases that confer carbapenem resistance.while Class B enzymes require the presence of zinc for activity (and hence are referred to as metallo-beta-lactamases).Class B beta-lactamases: are also known as the metallo-beta-lactamases (MBLs), which are named for their dependence upon zinc for efficient hydrolysis of beta-lactams. As a result, MBLs can be inhibited by EDTA (an ion chelator), although they cannot be inhibited by beta-lactamase inhibitors such as tazobactam, clavulanate, and sulbactam.
Acquired MBLs consist of genes encoded on integrons residing on large plasmids that are transferable between both species and genera.In a hospital outbreak involving 62 patients (including 40 intensive care unit patients), for example, an MBL gene (bla IMP-4) spread among seven different gram-negative genera (Serratia, Klebsiella, Pseudomonas, Escherichia, Acinetobacter, Citrobacter, and Enterobacter).Laboratory detection of MBL-producing organisms can be especially difficult if the organisms carry "hidden" MBL genes; The MBL E-test (a commercially available assay) cannot consistently identify MBL-producing organisms that are truly resistant to carbapenems. Therefore, MBL-producing organisms should be considered carbapenem-resistant regardless of carbapenem susceptibility results.

Other identification methods take advantage of the zinc dependence of MBLs by using EDTA, which chelates the zinc. Combination disc tests using imipenem and EDTA discs or using two carbapenem discs (including one with EDTA incorporated) have been reported. A more sensitive MBL detection method uses an agar plate with three components: a double disc synergy test with imipenem and EDTA discs, a combined disc test comprising two imipenem discs (with one disc also containing EDTA), and an aztreonam disc to detect aztreonam susceptibility. Carbapenem susceptible isolates that are resistant to both ceftazidime and ticarcillin-clavulanate should be considered for MBL testin Genotypic identification using PCR amplification with primers specific for MBL genes (eg, blaVIM or blaIMP) is an accurate method for the detection of MBL-producing organisms.(Source uptodate)

Therfore,we are not against its finding but its conclusion and attribution to one country India ,more and more reseaches and studies are needed to confirm its real presence in World and how it comes and persist and before doing enough studies such publication with infernces in reputed journals should be avoided otherwise whole Humanity will be at stake and Market and commerce will win over our Human Value.
Dr.d.R.nakipuria
Teacher In North Bengal Medical College for undergarduate and Post Graduate
Ambika Multispeciality Hospital
29 Agrasen roadSiliguri-734005

Radiation and its effects on oral cavity
Oral mucous membrane –during radiation
A- Mucositis—oral mucous membrane show areas of redness and inflammation
B- Desquamated Epithelial Layer—mucous membrane begins to breakdown with the formation of a white to yallow pseudomembrane
C- Infection—it devlopes due to bad oral hygiene Secondary infections by candida albicans
After radiation
Mucosa begins to heal rapidly in about 2 months.Later it becomes atrophic thin,,&avascular.atrophy developes due to obliteration of the fine vasculature&fibrosis of the connective tissue.
Ulcers results from a denture sore,, radiation necrosis or tumour recurrence
Taste Buds---are sensitive to radiation&results in-desquamation of taste buds..
Loss of taste sensation----bitter and acid flavour are more severly affected when posterior2/3of tongue is irradiated .. Ant 1/3 of tongue irradiated ,, causes loss of salt &sweet sensation . Recovery of taste buds requires at least 60-120 days after irradiation
Salivary Glands
Parotid glands are more sensitive than submandibular &sublingual glands
a) progressive loss of salivary secretion
b) xerostomia ---dryness of mouth
c) swallowing is difficult &painful because the residual saliva loses its normal lubricating properties
d) PH &Buffering capacity of saliva falls down
e) Histologically,acute inflammatory response may occur soon after the initiation of therapy. Progressive fibrosis adiposis ,, loss of fine vasculature °enerative parenchyma results in xerostomia
f) Salivary changes influence on the oral microflora leading to radiation caries by increase in strepto-mutans,lactobacillus, candida micro-organisms & thick,, acidic ,, viscous,, small volume of saliva causes radiation caries

Teeth
During tooth developmental period- retards the growth of teeth
Before tooth calcification –destroy the tooth bud
After tooth calcification it inhibit celluar differntiation causing malformation & arresting tooth growth
Children receiving radiation therapy to the jaw shows defects in permanent dentition such as retarded root development,, dwarfing teeth &anodontia
In some instances irradiation of developing teeth after complete calcification causes premature eruption
Irradiation of teeth may retard root formation but no changes in the eruptive mechanism of teeth
Adult teeth are very sensitive to irradiation .. Pulpal tissue shows fibro-atrophy after radiation
Radiation causes no effect on enamel, dentin &cementum

RADIATION CARIES
It is a rampant form of caries that may occur in, individuals who receive radiotherapy .carious lesions results from changes in the salivary glands &saliva.. decrease flow,,decrease PH,,decrease buffering capacity&increase viscocity becauses of reduced or absent cleaning action of normal saliva results in accumulation of debris quickly…Radiation caries has the rapid course &widespread attack which distinguish other caries
BONE
Irradiation of the bone causes damage to the vasculation of periosteum &cortical bone..
Radiation also destroys osteoclasts&to a lesser extent osteoblasts .Bone marrow is replaced with fatty marrow &fibrous connective tissue .. Marrow tissue becomes hypovascular ,, hypoxic,, &hypocellular
Osteoradionecrosis is the critical complication that occur in bone ,, after irradiation The decrease vascularity of the mandible renders it easily infected by micro-organisms from the oral cavity.. This bone infection may result from radiation induced breakdown of mucous membrane from denture sore or tooth extraction ..It is more common in mandible because of less vascular supply &it is more frequently exposed to radiation

Treatment of Osteoradiaonecrosis
A)----prevent radiation caries by restoring all caries lesions before irradiation starts
B)--- maintain good oral hygiene
C)---Removing all poorly supported &badly carious teeth &allow sufficient time to heal up the extraction wounds
D)Daily topical fluride application
E) Adjusting dentures to minimize risk of denture sores
F) hyperbaric oxygen
G) Resction of sequestra or mandibulectomy
H) Nutrition supplements
I) Antibiotics& analgesics can be given
..

Our body makes it all the time and it plays a major role .It is not exclusively a female hormone nor is it only a sex hormone. It is infact the precursor to the sex hormone , estrogen and testosterone.It regulates blood sugar, develops intelligence, builds bone and brain activities. It is secreted primarily by the ovaries in females and testes in males.There are no great quantitative differences between men and women ( atleast outside the luteal phase).It was not until 1943 that progesterone was made from plant steroid diosgenin .Once it was established that it could be made like this, biochemists began converting it into other hormones like cortisone, testosterone, estrogen and ofcourse the unnatural progestins and progestogens that masquerades as natural progesterone. There is a misconception that the difference between the natural one (made out of plant ) and the altered is just in their spelling. There is much confusion in the minds of many and even the medical field about this.This is not meant as a condemnation. They are just a busy bunch and it is a specialized subject. It is just as a caution to not take everything you hear about these hormones at their face value. Progesterone has a unique molecular structure whereas progestin and progestogens have their structure altered but the latter may look similar to the real thing.Just as ivy and spinach are both green and leafy.(Ivy quiche anyone?) need any other proof? The fact is progestin behave in radically different ways in our body than progesterone. The only similarity is their ability to maintain the endometrial lining.This also means that they can be patented and sold for exhorbitant prices. progestins are potentially toxic because of their altered molecular structure. Some of the side effects are increased risk of abortion and congenital abnormalities if taken by pregnant women, fluid retention, migraine, asthma, epilepsy, cardiac and renal dysfunction, depression, breast tenderness, nausea, insomnia, cancer, and a drop in progesterone levels.There are long term side effects on adrenal glands, liver , ovaries and in uterine function The key messsage is natural progesterone is just like what your body makes and is a unique substance with unique properties that cannot be faked !