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Dec21
The Power of Dreaming
The Power of Dreaming
Are you a dreamer? I am not talking about the dreams you have when you are sleeping, I am talking about the dreams you see when you are fully awake, the dreams you choose to see consciously.
Have you ever imagined owning something that seems utterly impossible? Have you ever dreamt of owning a million dollars? Have you dreamt of being in love with the most beautiful girl you have known, and she in love with you? Have you dreamt of owning the biggest house you have ever seen? Have you owned a Ferrari in a dream?
Achievement – Practicality vs Dreaming
We have a tendency to be practical. We use logic to define achievable goals for us – ‘this is something I can achieve… that is something very hard to get‘. In our minds, we create some boundaries for ourselves within which we operate.
The point most of us miss is that, achievement comes to those who most want it. All the physical laws and logic bend to make the impossible possible for the one who dares to dream about the same thing, consistently.
Remember Leonardo Di Caprio’s character (Jack) in Titanic? When he is admiring Rose standing on a higher deck, someone tells him she is too high-class for him. But he doesn’t stop dreaming. Notice that he doesn’t fret over how he will get her, he just admires her – he has no idea how he will meet her and what he will say. He just dreams of her, believing in his dream all the time. When a person so completely believes in the inevitability of his success, the Universe has no choice but to start working to manifest his/her desire. When the opportunity presents itself, Jack is ready to receive it with open arms. He does not have to think twice, he does not have to plan what to do, he just acts. The successful results that his actions bear are all evident in the rest of the movie.
All big achievements start with a dream. Before a miracle in your life can materialize, it is created in the realm of your imagination. What we see as miracles in everyday life are only physical manifestations of dreams that were dreamt so passionately, they became beliefs and goals, rather than wishes.
Dreaming Vs Wishful thinking. Dreaming is a positive feeling. It makes you happy. You feel confident that you are going to achieve your desired goal. It is different from wishful thinking, which is wishing for something while holding the belief that it is out of your reach. Wishful thinking is marked by a negative feeling. In dreaming, you imagine you already have what you want and you enjoy it in your imagination.
If you really want to get something, stop just wishing for it, believe that you are going to get it. Dream about it, think about how you will use it once you have it. The way will show itself and you will be ready to grab the opportunity.
Dreaming and the Law of Attraction. Law of attraction states that you get in life what you focus your thoughts on, what you constantly, regularly think about. If you focus on getting a million dollars, the law will manifest it in your life. You don’t have to focus on how you will get it, you just have to imagine having it and enjoying it. This is what dreaming is all about! When you think about your favorite car and can enjoy driving it in your dreams on a regular basis, you are going to enjoy it in real life too!
Don’t focus on how you will get it or how difficult it is to get the money. If you think about how difficult it is to get, the law will keep it difficult for you, since that is what you focused on. Focus on the object of your desire, focus on the feeling of having it.
Courage. Dreaming requires courage. Dreaming is not a denial of reality where you just keep yourself in an imaginary world. Dreaming is acknowledging your current state but refusing to accept it. Dreaming means daring to accept that you are worthy of your goal. This is determination to achieve your goal, although you don’t know your way yet. This is mobilizing the Universe to make that dream a reality.
Have the courage to believe in yourself and your capabilities. If someone, somewhere in the world has got what you want, then you can get it too.
Blocks to dream materialization
A lot of us dream a lot but don’t see those dreams turning into reality. You may wonder why does your dream not materialize?
It is impossible for a dream to not materialize. If you are asking this question, you have already started doubting your dream.
Doubts. Dreams materialize when they remain a passionate dream till they are materialized. Doubts don’t have a place in dreaming. When you were an infant, did you ever doubt that you will learn to walk? Every time you tried to get up, you would fall. But then you would try again. You must have fallen a hundred times before you could even stand. You refused to give in to the falls. Each time, you learned something from the fall till, finally, you could stand on your own, then walk, and even run. These are hard skills to learn but you never sat down to ponder over how hard they are, doubt was never your nature. It still shouldn’t be. Don’t doubt your dreams. Doubts make the dream a mere wish.
Goals someone else set for you. Is your dream really your dream? If you aim is becoming a big investment banker on Wall Street, just because everyone around you says it’s the route to heaven, you are fooling yourself. Look inside yourself, what is it that you really dream of? Do you enjoy sports? acting? writing? Dare to accept your own dream, even if your dream is different from everyone else, even if every one is going in the opposite direction. Crowds really aren’t that smart as we make them out to be. Everyone in a crowd is following what others are doing. It leads to a false sense of security and a lot of confusion. Dare to follow your own dreams.
Sticking to something you don’t want anymore. When was the last time you paid attention to how you feel about your dream? Does it still make you as excited as it did earlier? As we grow as human beings, as we gather new knowledge, what appeared important and worthwhile before, may not look so now. There is no point in running after something you know has no value. Don’t follow something halfheartedly just because you have invested effort in it before. If your new knowledge points in a different direction, let go. Take the new, more exciting path. This is how learning and growth are. Sometimes you have to do the uncomfortable.
You have to be very careful here. If you switch goals, this has to be only because you find more worthy goals to follow, based on new knowledge. This should not be an excuse to keep jumping from one goal to another out of lack of focus. . He started out with aggressive commenting on other blogs. The goal was to be the blogger with the most comments (correct me Oni if I am wrong here – You’re definitely right! More proof on that can be found ). But, as he gathered more information about blogging, he realized it is not the best strategy for promotion and took up other, better methods.
Lack of focus. Do you dream of too many things at the same time? This will result in confusion. If you have multiple goals, all pulling your attention in different directions, the Universe is confused about what you actually want. Focusing towards a single goal is key to success.
*****
Dream and dream big. Don’t keep your dreams small because you feel bigger ones are out of your reach. There is no limitation to what you can dream and achieve. Aim for the highest, the best you can think of. Expect the best for yourself, and others. Remember, you are creating your future reality in your dreams. Why make it any less than fantastic?


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Dec21
A ganglion cyst at the foot causing tarsal tunnel syndrome detected by magnetic resonance imaging.
Title:
A ganglion cyst at the foot causing tarsal tunnel syndrome detected by magnetic resonance imaging.
Abstract
Tarsal tunnel syndrome is often misdiagnosed as clinical symptoms of tarsal tunnel syndrome vary and physician must keep this in mind whenever unexpected paresthesias are present in the planter aspect of the foot, in the toes, or over the medial distal calf. . Failure to diagnose and treat neuropathies effectively can cause permanent neuropathic pain and functional disability. We report a case of a ganglion cyst detected by MRI in a 31-year-old man who complained of rapidly aggravating pain, numbness and paresthesia on the great toe and the first metatarsal area in the sole, symptoms that resembled tarsal tunnel syndrome confined to the medial planter nerve. Surgical treatment could be performed early with no permanent sequelae. We could also avoid repeated steroid injections or prescription medications.
Key words: Tarsal tunnel syndrome; Ganglion cyst; Medial planter nerve.

Introduction
Tarsal tunnel syndrome (TTS) is caused by compression of the posterior tibial nerve as it passes through the posterior tarsal tunnel. It is much more common in the posterior tarsal tunnel than in the anterior by compression of the deep peroneal nerve as it passes beneath the superficial fascia of the ankle [1]. TTS may be associated with exacerbation of symptoms at night, by exercise or rest, or by elevating or lowering the extremity, and symptoms confined to the lateral planter nerve, medial planter nerve, or medial calcaneal nerve [2]. Failure to diagnose and treat neuropathies effectively can cause permanent neuropathic pain and functional disability In most cases, TTS develops from unknown causes and can be treated conservatively. However, early surgical intervention is mandatory when neuropathy arises from a progressing occult pathology to avoid, repeated steroid injections, prescription of several medication for neuropathic pain, and to prevent permanent neuropathic pain. MRI and electromyography, together with clinical history and physical examination, can help to make the differential diagnosis.

Case history:
The patient was a 31-year-old man with a 6-month history of pain, numbness, and paresthesia on the left great toe and the first metatarsal area in the sole. The pain was constant and burning. Symptoms were aggravated by pressure on the sole such as walking and weight bearing. Symptoms had initially localized in the great toe and sole but gradually extended to the second and third toes. Patient had been prescribed lot of local steroidal injections but had no permanent relief.
A physical examination did not reveal specific abnormalities except a local tenderness just below and down to the medial malleolus over the foot. There was no palpable swelling. We then performed an MRI which revealed a unilocular, ganglion cyst around the medial planter nerve in the digitorum muscles of the foot. [Fig.1 and 2]. Nerve-conduction studies showed that conduction velocity was reduced in the right medial plantar nerve. There was no apparent weakness of the intrinsic muscles of the right foot, but a subtle T2 high signal change in the abductor hallucis and flexor digitorum brevis muscle was seen on MRI. We suspected subacute muscle denervation and planned the patient for surgery. Intra-operatively, ganglion cyst was found close to the medial planter nerve and after meticulous dissection nerve was freed from the ganglion cyst [Fig. 3 and 4]. After surgery two weeks later, the patient had dramatic response with improved symptoms.



Discussion
The most common cause of compression of the posterior tibial nerve around the tarsal tunnel is trauma to the ankle, but any occult pathology, such as a space-occupying lesion like a ganglion cyst, can cause similar neuropathic pain [3]. Tarsal tunnel syndrome is an entrapment neuropathy caused by compression of the posterior tibial nerve and its branches, between the calcaneum and the medial malleolus under the cover of the flexor retinaculum [4, 5]. TTS can be misdiagnosed as ankle arthritis and lumbar radiculopath [6]. However, patients with ankle arthritis have radiologic evidence of it. TTS can be distinguished from lumbar radiculopathy because patients suffering from TTS have no reflex changes, and motor and sensory changes are localized to the distribution of the distal posterior tibial nerve and its branches. Secondary TTS by a ganglion is unusual,[4,5] but it can occur. Kirby and colleagues [7]) found that ganglion cysts were the most common benign lesion of the foot, accounting for nearly one-third of all cases. The size and location of the ganglion cyst is influences entrapment neuropathy because the volume of the tarsal tunnel compartment ranges from 18 cm3 to 21 cm3 in normal individuals [8]). In addition, Takakura and colleagues (9[] mentioned that a large ganglion can easily be diagnosed by MRI, but is difficult if it is smaller than 0.5 × 0.5 × 0.5 cm. A cystic and completely anechoic fluid collection around the ankle detected by USG commonly represents a ganglion cyst [10].


Conclusion
In conclusion, neuropathy arising from progressing occult pathology should be diagnosed early with high degree of suspicion by modern imaging facilities and treated adequately to avoid permanent neuropathic pain and functional disability. When a suddenly exacerbated case of neuropathy is encountered, a space-occupying lesion such as a ganglion cyst should be considered and clinicians must try to detect it as soon as possible. MRI may be a helpful device for this effort. The unique clinical symptoms and signs of our diagnosis of a ganglion causing medial plantar nerve compression were confirmed by MRI and then operative findings.

Consent
"Written informed consent was obtained from the patient for publication of this case report and accompanying images. A copy of the written consent is available for review by the Editor-in-Chief of this journal."

Competing interests
“The author(s) declare that they have no competing interests’'.
Authors' contributions
“IHWand SS analyzed and interpreted the patient data regarding the disease. YK discussed the case with radiology and pathology experts and formulated the investigative and treatment plan. AQS and SS performed the biopsy. IHW was responsible for followup and prepared the manuscript. All authors read and approved the final manuscript.”



References

1. Waldman SD: Posterior tarsal tunnel syndrome. In: Atlas of Common Pain Syndromes. 2nd ed. Philadelphia,Saunders Elsevier. 2007,pp 337-9.
2. Greer Richardson E.:From Neurogenic disorders: Tarsal Tunnel syndrome. In Campbell’s operative orthopaedics. Volume 4th. Elevanth Edition.Edited by S. Terry Canale, James H. Beaty 2008; 83: 4717-4721.
3. Ferraresi S, Leidi P, Leidi M, Ubiali E, Bortolotti G, Cassinari V: Tarsal tunnel syndrome. Report of a case and review of clinical and surgical aspects. Ital J Neurol Sci 1992; 13: 47-51.
4. Taguchi Y, Nosaka K, Yasuda K, Teramoto K, Mano M, Yamamoto S: The tarsal tunnel syndrome: report of two cases of unusual cause. Clin Orthop Relat Res 1987; 217:247-52.
5. Brown RJ: Tarsal tunnel syndrome due to a ganglion: a case report. Ulster Med J 1982; 51: 127-9.
6. Lam SJ: Tarsal tunnel syndrome. J Bone Joint Surg Br 1967; 49: 87-92.
7. Kirby EJ, Shereff MJ, Lewis MM: Soft-tissue tumors and tumor-like lesions of the foot. An analysis of eighty-three cases. J Bone Joint Surg Am 1989; 71:621-6.
8. Bracilovic A, Nihal A, Houston VL, Beattie AC, Rosenberg ZS, Trepman E: Effect of foot and ankle position on tarsal tunnel compartment volume. Foot Ankle Int 2006; 27: 431-7.
9. Takakura Y, Kumai T, Takaoka T, Tamai S: Tarsal tunnel syndrome caused by coalition associated with a ganglion. J Bone Joint Surg Br 1998; 80: 130-3.
10. Chhem RK, Beauregard G, Schmutz GR, Benko AJ: Ultrasonography
of the ankle and the hindfoot. Can Assoc Radiol J 1993; 44: 337-41.


Figure legends’:
Fig. 1: MRI showing unilocular hyperintense cystic lesion in digitorum muscles of foot.

Fig.2: MRI showing ganglion cyst.
Fig. 3: Ganglion cyst pressing on a medial planter nerve detected intraoperatively.

Fig. 4: Removed ganglion cyst


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Dec18
Should we become a Devotee? Teachings of swami Vivekananda
Should we become a Devotee? Teachings of swami Vivekananda

Prof Gourishankar Patnaik; Bhubaneswar


Swami Vivekananda became one of India's leading social reformers of the modern era and was a champion of humanitarianism and service to God through service to others. He is revered both in the East and West as a rejuvenator of mankind through the eternal truths of Hinduism. He spoke widely on Hinduism and its true meaning as written in the vedas and founded the Ramkrishna Mission, one of India's leading charitable institutions.
What is Life
Each soul is potentially divine. The goal is to manifest this divinity within by controlling nature, external and internal. Do this either by work, or worship, or psychic control, or philosophy---by one or more or all of these--and be free.
Pleasure is not the goal of man, but knowledge. Pleasure and happiness comes to an end. It is a mistake to suppose that pleasure is the goal. The cause of all the miseries we have in the world is that men foolishly think pleasure to be the ideal to strive for. After a time man finds that it is not happiness, but knowledge, towards which he is going, and that both pleasure and pain are great teachers; the ultimate goal of all mankind, the aim and end of all religions, is but one--reunion with God, or what amounts to the same, with the divinity which is every man's true nature.
The ideal of man is to see God in everything. But if you cannot see Him in everything, see Him in one thing, in that thing which you like best, and then see Him in another. So on you can go.
In this world of many, he who sees the One, in this ever-changing world, he who sees Him, who never changes, as the Soul of his own soul, as his own self, he is free, he is blessed, he has reached the goal.
Bhakti Yoga
Bhakti-Yoga is a real, genuine search after the Lord, a search beginning, continuing and ending in Love. One single moment of the madness of extreme love to God brings us eternal freedom. "Bhakti is intense love to God." "When a man gets it he loves all, hates none; he becomes satisfied forever." "This love cannot be reduced to any earthly benefit," because so long as worldly desires last that kind of love does not come. Bhakti-Yoga does not say "give up"; it only says "Love; love the Highest"; and everything low naturally falls off from him, the object of whose love is this Highest.
Purpose of Devotion
Bhakti is its own fruition, its own means and its own end. Those to whom the eternal interests of the soul are of much higher value than the fleeting interests of this mundane life, to whom the gratification of the senses is but like the thoughtless play of the baby, to them, God and the love of God form the highest and the only utility of human existence.
Bhakti admits no elements of fear, no being to be appeased or propitiated. There are even Bhaktas who worship God as their own child, so that there may remain no feeling even of awe or reverance. There can be no fear in true love, and so long as there is the least fear, Bhakti cannot even begin. In Bhakti there is also no place for begging or bargaining with God. The idea of asking God for anything is sacrilege to a Bhakta. He will not pray for health or wealth or even to go to heaven.
Advantages of Devotion
The peace of the Bhakta's calm resignation is a peace that passeth all understanding, and is of incomparable value. The great quality of Bhakti is that it cleanses the mind, and the firmly established Bhakti for the Supreme Lord is alone sufficient to purify the mind.
Of all renunciation, the most natural, so to say, is that of the Bhakti-Yoga. Here, there is no violence, nothing to give up, and nothing to tear off, as it were, from ourselves, nothing from which we have violently to separate ourselves; the Bhakta's renunciation is easy, smooth, flowing, and as natural as the things around us.
"Bhakti is greater than Karma, greater than Yoga, because these are intended for an object in view, while Bhakti is its own fruition, its own means and its own end." The one great advantage of Bhakti is that it is the easiest, and the most natural way to reach the great divine end in view; The path of devotion is natural and pleasant. Philosophy is taking the mountain stream back to its source by force. It is a quicker method but very hard. Philosophy says, "Check everything." Devotion says, "Give up all to the stream, have eternal self-surrender." It is a longer way, but easier and happier.
Bhakti-Yoga does not say "give up"; it only says "Love; love the Highest"; and everything low naturally falls off from him, the object of whose love is this Highest.
With love there is no painful reaction; love only brings a reaction of bliss; if it does not, it is not love; it is mistaking something else for love. When you have succeeded in loving your husband, your wife, your children, the whole world, the universe, in such a manner that there is no reaction of pain or jealousy, no selfish feeling, then you are in a fit state to be unattached.
Disadvantages of Devotion
Its great disadvantage is that in its lower forms it oftentimes degenerates into hideous fanaticism. The fanatical crew in Hinduism, or Mohammedanism, or Christanity, have always been almost exclusively recruited from these worshippers on the lower planes of Bhakti.

That singleness of attachment to a loved object, without which no genuine love can grow, is very often also the cause of the denunciation of everything else. All the weak and undeveloped minds in every religion or country have only one way of loving their own ideal, i.e. by hating every other ideal. Herein is the explanation of why the same man who is so lovingly attached to his own ideal of God, so devoted to his own ideal of religion, becomes a howling fanatic as soon as he sees or hears anything of any other ideal.

Ways of Attaining Devotion
There is Bhakti within you, only a veil of lust-and-wealth covers it, and as soon as that is removed Bhakti will manifest by itself. In Bhakti-Yoga the first essential is to want God honestly and intensely. One way for attaining Bhakti is by repeating the name of God a number of times. Mantras have effect---the mere repetition of words...To obtain Bhakti, seek the company of holy men who have Bhakti, and read books like Gita and the Imitation of Christ; always think of the attributes of God.
But theorizing about God will not do; we must love and work. Give up the world and all worldly things, especially while the "plant" is tender. Day and night think of nothing else as far as possible. The daily necessary thoughts can all be thought through God. Eat to Him, drink to Him, sleep to Him, and see Him in all. Talk of God to others; this is most beneficial.

Get the mercy of God and of His greatest children; these are the two chief ways to God. The company of these children of Light is very hard to get; five minutes in their company will change a whole life, and if you really want it enough, one will come to you. The presence of those who love God makes a place holy, "such is the glory of the children of the Lord". They are He; and when they speak, their words are Scriptures. The place where they have been becomes filled with their vibrations, and those going there feel them and have a tendency to become holy also.
Stages of Devotion
We all have to begin as dualists in the religion of love. God is to us a separate Being, and we feel ourselves to be separate beings also. Love then comes in the middle, and man begins to approach God, and God also comes nearer and nearer to man. Man takes up all the various relationships of life, as father, as mother, as son, as friend, as master, as lover, and projects them on his ideal of love, on his God. To him God exists as all these, and the last point of his progress is reached when he feels that he has become absolutely merged in the object of his worship.

We all begin with love for ourselves and the unfair claims of the little self make even love selfish; at last, however, comes the full blaze of light, in which this little self is seen to have become one with the Infinite. Man himself is transfigured in the presence of this Light of Love, and he realizes at last the beautiful and inspiring truth that Love, the Lover, and the Beloved are one.

When the devotee has reached this point he is no more impelled to ask whether God can be demonstrated or not, whether He is omnipresent and omniscient, or not. To him He is only the God of Love; He is the highest ideal of love, and that is sufficient for all his purposes; He, as love, is self-evident; it requires no proof to demonstrate the existence of the beloved to the lover. The magistrate-Gods of other forms of religion may require a good deal of proof to prove them, but the Bhakta does not and cannot think of such Gods at all. To him God exists entirely as love. The perfected Bhakta no more goes to see God in temples and churches; he knows no place where he will not find Him. He finds Him in the temple as well as out of the temple; he finds Him in the saint's saintliness as well as in the wicked man's wickedness, because he has Him already seated in glory in his own heart, as the one Almighty, inextinguishable Light of Love, which is ever shining and eternally present.
The Bhakta at last comes to this that love itself is God and nothing else. Where should man go to prove the existence of God? Love was the most visible of all visible things. It was the force that was moving the sun, the moon and the stars, manifesting itself in men, women and in animals, everywhere and in everything. It was expressed in material forces as gravitation and so on. It was everywhere, in every atom, manifesting everywhere. It was that Infinite Love, the only motive power of this universe, visible everywhere, and this was God Himself.

"I may know that I am He, yet will I take myself away from Him and become different, so that I may enjoy the Beloved." That is what the Bhakta says.
Feelings of Devotee
If a man does not get food one day, he is troubled; if his son dies how agonising it is to him! The true Bhakta feels the same pangs in his heart when he yearns for God. The great quality of Bhakti is that it cleanses the mind, and the firmly established Bhakti for the Supreme Lord is alone sufficient to purify the mind. "Lord, they build high temples in your name; they make gifts in your name; I am poor; I have nothing; so I take this body of mine and place it at your feet. Do not give me up, O Lord." Such is the prayer proceeding out of the depths of the Bhakta's heart. To him who has experienced it, this eternal sacrifice of the self unto the Beloved Lord is higher by far than all wealth and power, than even all soaring thoughts of renown and enjoyment.

The peace of the Bhakta's calm resignation is a peace that passeth all understanding, and is of incomparable value. When the devotee has reached this point he is no more impelled to ask whether God can be demonstrated or not, whether He is omnipresent and omniscient, or not. To him He is only the God of Love; He is the highest ideal of love, and that is sufficient for all his purposes; He, as love, is self-evident; it requires no proof to demonstrate the existence of the beloved to the lover. The magistrate-Gods of other forms of religion may require a good deal of proof to prove them, but the Bhakta does not and cannot think of such Gods at all. To him God exists entirely as love. I know one whom the world used to call mad, and this was his answer: "My friends, the whole world is a lunatic asylum; some are mad after worldly love, some after name, some after fame, some after money, some after salvation and going to heaven. In this big lunatic asylum I am also mad, I am mad after God. You are mad; so am I. I think my madness is after all the best."
The true Bhakta's love is this burning madness, before which everything else vanishes for him. The whole universe is to him full of love and love alone; that is how it seems to the lover. So when a man has this love in him, he becomes eternally blessed, eternally happy; the blessed madness of divine love alone can cure for ever the disease of the world that is in us.
May we see the reflection of revered Swamiji in every Indian.

Prof Gourishankar patnaik is a consultant Orthopedic and spinal surgeon and social scientist based in Bhubaneswar. He can be contacted at drgsp66@yahoo.com and www.drgspatnaik.com


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Dec18
avoidable tragedy: spurious liquor
Avoidable Tragedy: Spurious Liquor


With more than half of all alcohol drinkers in India falling into the criteria for hazardous drinking, alcohol abuse is emerging as a major public-health problem in the country. The problem becomes more compounded especially where we find the urban poor and rural peasants flocking to the liquor shops with a 10 rupee note and buying death in a sachet as seen in the recent Calcutta tragedy India's reputation as a country with a culture of abstinence especially in matters regarding alcohol is underserved, say experts. The country, which has seen a rapid proliferation of city bars and nightclubs in recent years, is fast shedding its inhibitions about alcohol as a lifestyle choice.
This situation has led to fears of an undocumented rise in alcohol abuse not only among poorer classes but also in sections of society that were previously considered dry. The entire policy regarding the pricing and trading of state sponsored liquor outlets with singular aim of generating revenue needs to be questioned by concerned citizens. The increasing production, distribution, and promotion of alcohol have already seen drink-related problems emerging as a major public-health concern in India. Sales of alcohol have seen a growth rate of 8% in the past 3 years. Officially, Indians are still among the world's lowest consumers of alcohol—government statistics show only 21% of adult men and around 2% of women drink. But up to a fifth of this group—about 14 million people—are dependent drinkers requiring “help”.

The concern, say experts, is that there has been a rapid change in patterns and trends of alcohol use in India. Chief among them is people are beginning to drink at ever-younger ages. The percentage of the drinking population aged less than 21 years has increased from 2% to more than 14% in the past 15 years, according to studies in the southern state of Kerala by Alcohol and Drugs Information Centre India, a non-governmental organization (NGO). Alarmingly, the study found that the “average age of initiation” had dropped from 19 years to 13 years in the past two decades.
The centre points out that a “powerful international and domestic alcohol lobby” is purposely targeting young Indians. The local industry has introduced flavored alcohol drinks to attract previously non-drinking women and young men. Multinational companies have identified India with its vast unexploited markets as one of the worlds most sought after places for investment.
Many alcohol adverts now feature spirited groups of young people having a good time. Although alcohol advertising is banned in the electronic and print media, surrogate advertising is rife, “Drinking water and apple juice is packaged by alcohol companies. It's all about getting young people to start early and be life-long consumers. Bollywood films now glorify alcohol where the good guys drink.”
The shifting composition of Indian drinkers has seen a rise in the number of Indian women drinking regularly and heavily. One recent study in the southern state of Karnataka found young women consumed similar amounts of alcohol to young men on any typical drinking occasion.
What is of particular concern—and an important indicator of health risks—is that the signature pattern of alcohol consumption in India is frequent and heavy drinking. More than half of all drinkers fall into the criteria for hazardous drinking, which is characterized by bingeing and solitary consumption to the point of intoxication. Moreover, spirits account for 95% of the beverages drunk in India.
There is evidence even to suggest that the poor are beginning to drink more than they earn—a deadly spiral of alcohol and debt. Although the Indian constitution includes the prohibition of alcohol among its directive principles, alcohol policy is devolved to individual states—as is the levying of taxes on it. Since most states derive around a fifth of their revenue from alcohol taxation—the second largest source after sales tax—they are generally ambivalent towards stemming its flow. Moreover, there is a long history in India of a powerful alcohol lobby with industry figures influencing the political process, both in the form of party donations and as representatives. But experts argue that Indian society is losing considerably more than it gains.
According to a recent study by researchers from NIMHANS it is shocking to know that the direct and indirect costs attributable to alcohol addiction is more than triple the profits of alcohol taxation and several times more than the annual health budget of Karnataka. These included the tangible costs of health care, occupational, financial, social, and legal factors.
Indian Alcohol Policy Alliance, an NGO aiming to prevent alcohol-related harm through evidence-based policy intervention, says that the key is to break the stranglehold of state revenue departments who see increasing consumption of alcohol as a boon to treasury coffers.
In less than a week after more than 90 women, men, and children died in a calamitous fire at the AMRI hospital in Kolkata, illicit brew has claimed the lives of about 150 people, at Sangrampur in the South 24 Parganas district of West Bengal. The hooch was sold in sachets, priced between Rs.7 and Rs.20, virtually opposite a police post in the area. Starting with a couple of deaths early in the morning, the toll kept rising through the day and touched 80 by daybreak next day. Most of the victims complained of body pain, stomach cramps, vomiting, and a burning sensation. The recurrence of heart-rending tragedies caused by the killer brew only lends credence to the thinking among political parties and State governments that it might be better to introduce legal sale of licensed liquor than let addicts go for the illicit stuff. There is a demand from sections in government to suggest monopolizing sale of government controlled liquor as the Tamil Nadu Model .Of course the protagonist will feel that this step might be catastrophic. But the evidence from across India shows that prohibition just doesn't work; in fact, it brings on all sorts of ill effects, social as well as medical. Although States that still implement prohibition, full or partial, have set up separate wings in the police department to handle cases arising out of prohibition offences and illicit brewing, it is common knowledge that connivance between the brewers and sections of the police makes the hooch flow, particularly in festival season. Most, if not all, victims tend to be poor laborers, and the families end up paying a terrible price. Alcoholism is a social menace that needs to be tackled in a sensitive, intelligent, multi-pronged way. Driving it underground, to dangerous devices, is clearly not the way.


(Prof Gourishankar Patnaik is a senior Consultant in orthopedics based in Bhubaneswar. He can be contacted at drgsp66@yahoo.com)


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Dec15
THERAPEUTIC COMPLIANCE IN DIABETICS- AN OBSERVATIONAL DESCRIPTIVE STUDY
Poor therapeutic compliance is the most important cause of failure to achieve the desired results in the management of chronic ailments and health conditions such as diabetes, hypertension etc. Uncontrolled diabetes increases the risks of associated micro and macrovascular complications. There are many factors responsible for non-compliance such as awareness and knowledge about the disease, its nature and associated complications, number of drugs advised, concerns about side effects, convenience of dosing and the cost of therapy etc. Compliance rates for drug use and life style modifications vary considerably among diabetes patients.
A total of 210 registered, ambulatory Type-2 diabetes patients attending the clinic were included for the study of the level of their therapeutic compliance, and finding recorded based on their case files, their verbal reporting, physician’s assessment and some times by actually counting of pills remaining.
A qualitative review of literature search of Medline database from 1990 onwards was undertaken to assimilate similar findings reported by others for comparison with our findings.
The most common reasons for non-compliance in our study were cost of medication followed by forgetfulness, concerns about side effects, multiplicity of pills and large pill size.


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Dec15
CASE OF RECURRENT FEVER WITH LATE LYMPHADENOPATHY- THINK OF KIKUCHI’S DISEASE: By Dr. M.Abdul Jaleel
Kikuchi's Disease though usually a relatively benign and self-limiting entity, if mistaken for other more serious conditions would result in many avoidable psychological, physical and financial strains for the patients and all others concerned with their care.
Kikuchi’s Disease or histiocytic necrotizing lymphadenitis, a self-limiting entity of varied manifestations including prolonged fever and cervical lymphadenitis at times poses diagnostic problems because of presently non-available specific laboratory tests for its definitive diagnosis. It should be considered in the differential diagnosis of un-explained fever with cervical lymphadenitis in young adults with varied sign and symptoms such as sore-throat, cough, rhinorrhea, chills, cephalgia and non-specific myalgias. Histopathological reports of fine needle aspiration or excision biopsy of accessible lymph node together with immune-histo-chemistry if available, is the means presently available for making a definitive diagnosis of Kikuchi’s disease. It usually runs a benign course, recurrences are very rare and over-all prognosis is generally favorable. Treatment is primarily symptomatic.


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Dec14
International Honours for Dr. Mahesh Desai of MPUH Nadiad
MULJIBHAI PATEL UROLOGICAL HOSPITAL

International Honours for Dr. Mahesh Desai of MPUH Nadiad

It is a matter of great pride not just for the Muljibhai Patel Urological Hospital (MPUH), Nadiad, but the country as a whole, and the Indian Urology in particular, that Dr. Mahesh Desai, MS, FRCS (London), FRCS (Edinburgh), Medical Director and Managing Trustee of MPUH, has been elected as the ‘President-Elect’ of the Endourological Society Inc. at the World Congress of Endourology (WCE) held at Kyoto, Japan during November 30 to December 3, 2011. During the WCE2011 at Kyoto, an MPUH doctor won two prizes – 1st prize for the best video “Micro percutaneous nephrolithotomy: The initial feasibility study”, and the 2nd prize for the best Essay “Staghorn Morphometry: A New Tool for Clinical Classification and Prediction Model for PCNL Monotherapy.”

At the initiative and direction of Dr. Mahesh Desai, MPUH had successfully organized the 12th World Video Urology Congress 2000 at Goa, and the 22nd World Congress on Endourology 2004 at Mumbai.

It may be recalled, in October this year, Dr. Mahesh Desai had become the first Indian to assume the Office of the President of the Société Internationale d'Urologie (SIU) at the SIU World Congress held at Berlin, Germany. It is unprecedented that Dr. Desai is perhaps the only person to hold both these prestigious positions simultaneously or separately. The other positions that Dr Desai has held include President, Urological Society of India (2006-2007); Chairman, Sub-specialties, Society International d’Urologie (SIU) ( 2004-2009); Chairman, Scientific Committee, Endourology Society Inc. (2007 - present); President, Asian Society of Endourology (2008 - present); Chairman, Endourology Education Training Site Committee of Endourology Society Inc. (2008 - 2011); Member, International Committee of American Urological Association (2008 - 2011).

News has also just come in that Dr. Mahesh Desai has been selected for the prestigious ‘St. Paul’s Medal 2012’ by the British Association of Urological Surgeons (BAUS). It is awarded to “distinguished colleagues from overseas whose contributions to the Association in particular, or to Urology in general, BAUS Council particularly wishes to appreciate and honour.” Since the inception of this Medal in 1989, Dr. Mahesh Desai is only the second Indian after Dr. Dara K Karanjavala (1993), to be honoured with this international recognition.


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Dec12
Audiometric profile in patients with chronic renal failure
J Otolaryngol Head Neck Surg. 2011 Apr;40(2):131-6.

Audiometric profile in patients with chronic renal failure.
Pandey S, Gore G, Valame D, Mehta K.

Abstract

OBJECTIVES:

To determine the occurrence of hearing loss and to establish audiometric profiles and patterns of hearing impairment in patients with chronic renal failure (CRF).
METHODS:

A retrospective study examined the relationship between the different stages of CRF and corresponding audiologic findings in those patients. Twenty-three subjects (46 ears) in the age range of 25 to 60 years were included in the study. These subjects were arranged into groups ranging from the second to fifth stages of CRF. Audiologic assessment in each subject was performed using a battery of tests, which included pure-tone audiometry, transient otoacoustic emission (TOAE), distortion product otoacoustic emission, and brainstem evoked response audiometry (BERA).
RESULTS:

Significant differences in the degree of hearing loss were observed among patients with different stages of CRF. It was noted that almost all (95.65%) patients with CRF did not pass the TOAEs. It was important to notice that none of the patients with CRF showed findings on BERA that pointed to retrocochlear involvement. Thus, the present study found that most patients (65.21%) had a cochlear pathology.
CONCLUSIONS:

We observed that (a) there is a high incidence of hearing loss among patients with CRF; (b) the methods of treatment (hemodialysis and conservative treatment) may not influence the impact of the disease on hearing; (c) levels of serum electrolytes and biochemical constituents of blood do not seem to correctly reflect the audiologic status of a CRF patient; and (d) hearing loss in patients with CRF has a distinct audiologic pattern. Given that CRF involves hearing loss, routine audiologic assessment in patients with this condition is essential.

PMID:
21453648
[PubMed - indexed for MEDLINE]


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Dec12
Role of self-induced sound therapy: Bhramari Pranayama in Tinnitus
Role of self-induced sound therapy: Bhramari Pranayama in Tinnitus

Audiological Medicine, October 2010, Vol. 8, No. 3 , Pages 137-141 (doi:10.3109/1651386X.2010.489694)


Sidheshwar Pandey1, Niladri Kumar Mahato2 & Ravishankar Navale3
Department of E.N.T., Sri Aurobindo Institute of Medical Sciences (SAIMS), Indore-Ujjain State Highway, Bhawrasala, Indore, Madhya Pradesh, India
Department of Anatomy, Sri Aurobindo Institute of Medical Sciences (SAIMS), Indore-Ujjain State Highway, Bhawrasala, Indore, Madhya Pradesh, India
Department of E.N.T., Ashwini Sahakari Rugnalaya and Research Kendra, Solapur, Maharashtra, India


Absract

Objectives: Treatment of tinnitus is not ‘absolute’ in terms of its approach through a single therapy model. The more recent modes of treatment focus on attenuating somatic perception and on synchronizing the emotional component of tinnitus with more ‘positive’ physiological events in the body, so that the person does not correlate the presence of tinnitus with annoyance and a source of disturbance. Both these goals are possible with neurophysiological ‘habituation’ at proper synapses across the auditory pathway. The present study has been conducted to observe the effects of Bhramari Pranayama (BP) on both the physical and emotional aspects of tinnitus. Bhramari Pranayama is a ‘Yogic’ technique that involves the combination of a relaxing posture and a process of producing sub-tinnitus level humming sound during exhalation along with simultaneous pressing of the closed eyelids. Study Design: A group of patients with tinnitus was administered BP as a therapy. Three other groups of similar patients were given Ginkgo biloba, Masking therapy and a combination of all the above-mentioned modalities, respectively, as treatment for tinnitus. The outcome of the study was determined by analysing the pre- and post-therapeutic values measured for parameters such as: 1) Loudness; 2) THI score; and 3) Anxiety and Depression scale. Results: Demonstrated that BP as well as all the other modalities of treatment significantly reduced the post-therapeutic scores in all the parameters, in all the groups. Conclusion: We concluded that BP significantly reduced the irritability, depression and the anxiety associated with tinnitus. It relieved the symptoms in tinnitus possibly by 1) acting as source of self-generated sound; 2) inducing parasympathetic predominance in the neural milieu; and 3) by acting as a relaxation technique. BP may serve as a cost effective, frequently applicable adjuvant therapy for tinnitus that probably acts through neuromodulating principles.

Keywords
habituation, parasympathetic, TRT, Yogic Pranayama



Read More: http://informahealthcare.com/doi/abs/10.3109/1651386X.2010.489694


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Dec03
breast feeding
Breast feeding has been the most natural response of a mother to satisfy the emotional and nutritional needs of her infant. That this can even serve as a natural barrier to infections and even save us money is perhaps not thought of. The effectiveness of the breast milk has long been established for reducing diarrhea, pneumonia, improved child nutrition and development along with its potential as Eco-friendly.
Breastfeeding benefits all sectors of society economically, ecologically and socially. However, over the last decades, women's self confidence in their capacity to nourish their infants has been undermined by many factors, including the power of the infant formula industry and a lack of social support. The major reasons for decline in breast feeding practices in India (50.9% by 3 months) are 1.rapid urbanization. 2. commercial pressure by marketing companies giving false messages. 3. lack of self confidence in mothers & dislike for breast feeding with the fair of loosing charm and beauty. 4. Practical problems of working mothers. 5.Most important improper technique and positioning while breast feeding leading to cracked nipples, engorgement of breasts and thus lactational failure a common problem faced by young mothers.
6. Delayed initiation of first feed leading to failure of lactation reflex.
7. Starting bottle or pacifiers along with breast feeding thus confusing the baby while sucking.
These and many other factors lead to failure to initiate breast feeding and an excuse for the mother to say I don’t have enough milk which is absolutely a myth because nature has been kind enough to provide milk to all the mammals to feed their young ones even to multiple ones at a time.
Benefits of breast feeding:-
There are many positive reasons for women to breastfeed their babies: breast milk is the best and most nutritious food, protecting them from illness and ensuring healthy physical and psychological development. For mothers, breastfeeding provides several health benefits such as reduction in the risk of breast and ovarian cancer, with the decrease in breastfeeding over the past several years one could daily hear the bad news of breast cancer in very young ladies attributed to hormonal imbalance led by stopping breast feeding their babies, a protective mechanism provided by nature. Breast feeding also helps in diminishing post-partum bleeding and iron deficiency anemia, and a natural means of spacing children by delaying ovulation. Breastfeeding also empowers women by increasing their self-confidence in their capacity to nourish and protect as well as nurture their babies and by decreasing their dependence on commercial products.
Millions of babies fall ill every year because they are not breastfed. The World Health Organization (WHO) estimates that more than 1.5 million infant deaths could be avoided every year if all babies were breastfed. It has been observed that infants under 2 months of age are nearly six times more likely to die if not breastfed.
A study from Ghana on 10947 breastfed babies concluded that we could save 22 %( 2.5 lakh) neonates from death if breastfeeding was initiated within one hour of birth.
In Botswana in 2005/06, infant formula feeding was given to all the babies with the aim to prevent transmission of HIV infection fro their mothers suffering from AIDS. This led to increase in diarrheal disease in these children with the increase in national under five mortality by 18%.also hospital admissions increased by 50%. Breast milk being free of contamination, adulteration and available at desired temperature has been proven best anti-infective. This property is being attributed to certain immunoglobins, compliments, macrophages, lysozymes present in breast milk particularly during first few days (colostrum).

Incidence of atherosclerosis and various related heart ailments are on lower side in people, those who are exclusively breast fed in childhood .breast fed babies have also proven highly intelligent than artificially fed babies .

Artificially fed babies have to bear extra financial burden for purchasing milk, bottle, fuel etc., which amounts to almost Rs 1500-2000/month, which is beyond the capacity of average middle class family, which compels them to over dilute the milk, thus leading to malnutrition. at the national level almost Rs 15000-20000 crores (estimated cost of marketed milk)can be saved by breast feeding approximately 22 million babies born per year.
Perhaps the least known of all the advantages of breastfeeding are the ecological benefits. Breast milk is a natural and renewable resource which is often overlooked. Breastfeeding protects the environment by reducing the demands made on it and eliminates sources of waste and pollution. Artificial baby milks and processed baby foods are non-renewable products which create ecological damage at every stage of their production, distribution and use.
Breastfeeding is unique - it causes no pollution and is the best example of how humanity can sustain itself through provision of the first and most complete food for human life. It is vital to increase our efforts to support, protect and promote breastfeeding. All sectors of society need to learn about the advantages of breastfeeding and how to support the natural rights of mothers to breastfeed and babies to be breastfed. All women should have access to information and support in order to be able to make truly informed choices about these natural rights.
The breastfeeding culture is culture of peace, balance and harmony. It involves trusteeship and global responsibility towards our young, and seeks accountability from governments and various spiritual traditions to support families in nurturing children. Almost all great world religions recognize breastfeeding as a essential nurturing the young and respect women's role in doing so.
Processing artificial baby milks wastes energy
Baby milk consists of a mixture of factory-processed substances which may be then added to cow's milk and converted into powder at high temperatures. This wastes a lot of electrical energy. This energy usually comes from hydro-electric or nuclear power plants that are expensive and cause a lot of damage to the environment. Breast milk is naturally produced. A mother's normal low-cost diet is transformed into a natural, invaluable and specialized food for her baby! This is the most energy efficient food production system ever known!
________________________________________
Breast milk needs no extra-packaging
The packaging of manufactured baby milk wastes tin plate, paper and plastic. Bottles, teats and other feeding equipment use plastic, rubber, silicon and glass. To bottle feed all US babies, the 550 million tins sold each year, stacked end to end would circle the earth one and a half times. In 1987, 4.5 million feeding bottles were sold in Pakistan alone. These feeding bottles stacked end to end would reach the top of Mount Everest.
________________________________________
Disposal methods pollute air, land and groundwater
The packages used for baby foods, along with feeding bottles, teats and pacifiers, are commonly thrown away after use. Normally these are not biodegradable. Plastic feeding bottles, teats and pacifiers take 200 to 450 years to break down when disposed in landfills. Glass feeding bottles take an undetermined amount of time to break down. Landfill and incineration are the most common disposal methods. Landfill sites can pollute groundwater, and there is a shortage of suitable sites in some countries. Incineration releases pollutants into the air: if plastic bottles are burned, the fumes may contain dioxin and other toxic substances. The beauty of breast milk is that one need not worry about disposal and it is immediately available without any need for packaging and preparation. Breastfeeding is waste free.
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Transportation pollutes and wastes fuel
The fresh cows' milk, grains and additives used in making baby food travel long distances even before processing, and additional long distances on the way to central, then regional warehouses, and finally, retail outlets. Many countries import baby food and feeding bottles from the other side of the world. This means a great waste of fuel and contributes to air pollution everywhere. Breast milk does not have to be shipped around the world; every mother has a ready supply wherever she goes...
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Preparation - more waste
A 3 month old bottle-fed baby needs a liter of water per day to mix with the formula powder. Another two liters are needed to sterilize the bottles and teats. If the water is boiled over a wood fire, more than 73 kg of wood are needed to prepare a year's feeds. In many parts of the world, water and fuel are so scarce that few mothers have the luxury of keeping the bottles and teats clean and of using only boiled, cooled water to make up the feeds. Breast milk is ready to use at the right temperature, does not need to be sterilized and causes no pollution.
________________________________________
Processed baby milks maybe contaminated
Baby milk is an industrially manufactured food which undergoes multiple processing, additions and alterations as it is converted from cows' milk plus additives to a can full of powder. No wonder that it has proved vulnerable from danger to contamination by harmful bacteria like E. Sakazakii and Salmonella, radio-activity, chemicals, foreign bodies and insect pests. Furthermore, the water mixed with the powder poses another danger of contamination, while problems have also arisen from teats breaking during use. Breast milk is a living substance. Each woman's milk is individually tailored for her own baby. What's more, her milk changes constantly - both during a feed and day by day - to meet her baby's evolving needs. When a mother is exposed to pathogens in the environment, she produces antibodies to combat them. The mother's antibodies are then passed on to her baby via her breast milk.
The dangers of Donations
Many violations of the code have been observed in emergencies with the donations of breast milk substitutes. During earthquake in Indonesia 2006, distribution of donated formula to children under 2 years led to increased prevalence of diarrheal disease to 25%, compared to 12% in breastfed babies.
Similarly in 2005 tsunami in Pondicherry, the occurrence of diarrhea was three times more among children who were fed with free breast milk substitutes than in those who were not fed with the same. These figures clearly show the misuse of these donations.

IMS Act and breast feeding:
To encourage and promote breast feeding various organizations like BPNI,IBFAN etc have been playing a commendable job by providing training people including health personnel ,highlighting benefits and objectives of breast feeding through printed and electronic media and interacting with various government officials for strict implementation of IMS (infant milk substitution act)1992 and amended in 2003 through the act of parliament and as per this act it is illegal:
1. To promote infant milk substitutes and feeding bottles intentionally /unintentionally on pretext of distribution of educational material
2. To make advertisement or exhibition of these products.
3. To sponsor any health official or related to child welfare to any tour, conferences etc.
4. To provide gifts or monitory benefit.
5. To distribute literature which directly or indirectly helps in promotion of their products and thus undermining breastfeeding?
DR.NIYAZ AHMAD BUCH
PROFESSOR (pediatrics).
SKIMS MEDICAL COLLEGE
SRINAGAR.
National trainer for infant and young child feeding
Niyaz_buch@yahoo.co.in


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