PARCHMENT

“The senses are gateways to the intelligence. There is nothing in the intelligence which does not first pass through senses “- Aristotle

Hi Guys,

With this new edition of Lexicon , I ,Susmita the director of this edition , welcome you all to the magical world of senses : vision , touch, smell, hearing

and taste. Although senses are one if the most important part of our body, we generally tend to take them for granted . Imagine how hard it must be for a blind for he can never see the beautiful array of flowers that nature has created , or for a deaf as he can never hear the beautiful rustling leaves on a windy afternoon!

Life is indeed difficult without any one of our senses. So, this edition is dedicated to our senses, for making our lives so attractive and glamorous.

Enjoy your life to the fullest and Happy Reading!

CREDENTIALS

I would like to thank the new team of Lexicon, especially our wonderful chief Sonali Mehta and my Assistant director for this edition Tuhina Mishra . Tuhina is an energetic young girl who helped me ring this edition before you on time. She has something to say here: It was indeed a wonderful experience working under Susmita. She is fully equipped with all sorts of innovative ideas possible and of course Sonali always came to my rescue whenever I got stuck. We would like begin our edition with a poem written by our fellow member, Dr. Ankit Sharma, final year Post Graduate, UCMS, Delhi. Here it goes:- Humans are the most intelligent species

We're truly one of a kind. We have a complex body And a very fickle mind. We ignore our gifts by God, nothing less than a crime. Today, let's learn about our senses, one at a time. The first is the sense of vision There's also an avenger by that name. You can waste the sense in watching Rohit Shetty movies Who'll be to blame? Stop for a moment to appreciate nature And view around you the beautiful scenes. If you think ‘it's so overrated', Ask a blind person what it means. Gaze at the mountains, the sea, the faces, it doesn't cost a dime. Let's learn about our senses, one at a time. Madhusudan Foofa says 'hain?' So, let's talk about our ability to hear. The music, the laughter, a waterfall Or just about any sound on this magnificent sphere Thank this sense whenever you appreciate Nirvana, Metallica or Arijit Singh So try and avoid Arnab Goswami For the fear of noise-induced loss of hearing. Enjoy this sense before it starts to decline. Let's learn about our senses, one at a time. Up next is a special one It is mostly ignored, our ability to smell Who did the unthinkable in the elevator Our nose gives us the ability to tell We can guess what's for dinner Even with blindfolds. That's the part of the flavour The part of taste that smell holds. On the first rain of a season, doesn't the air feel divine? Let's learn about our senses, one at a time. The next one is for all the foodies

Because good food makes us high How many times has a dish made you go 'jee lalchaaye, rahaa na jaaye'. Our ability to taste something delicious Makes us feel grand. So eat your heart out and complement the chef Except the Sushi may be, it's just so bland. Our tongue guides us if we want a salty or a mixed 'sweet lime'. Let's learn about our senses, one at a time. The fifth sense we'll talk about Is our ability to feel a contact. Be it the sensual touch of a lover Or a creep standing next to you, shamelessness intact. A baby smiles with a mother's kiss A mode of affection that no one can judge. A face, a hand, a gift, a life There's so much on this earth that we can touch. The touch can be a beautiful thing, or a debate based on society's paradigm. Let's learn about our senses, one at a time. There's also a rumoured sixth sense Mostly limited to Spider-Man We Indians call it gut-feeling Whenever we lack a real plan. Let's know and appreciate the real ones, while we're still in our prime. Today, let's learn about our senses, one at a time.

DIRECTOR OF EDITION: Dr.Susmita Reddy

ASST> DIRECTOR OF EDITION: Tuhina Mishra

THEME FEATURES

AN AROMA OF NOSTALGIA

Manasi Rege

Third minor

Grant Government Medical College, Mumbai

Dr. Tara was done for the day. The number of patients in her clinic normally kept her busy till 10 p.m. but today she was through by 7. She packed her belongings, locked her clinic and began walking towards her house. It was the end of the month of May and the heat in Mumbai was relentless. Suddenly, there was a strong wind and it began to thunder. Soon enough, the first drops of rain hit the ground, first one by one, and then as a downpour. She ran to the nearest bus stop for cover. As she waited for the rain to subside, she could feel the heat from the ground rise, as if releasing all its anguish of having borne the harsh heat of the summers. Just then, a familiar smell hit her nose. And right there, she was transported back in time. She wasn’t forty-year-old Dr. Tara anymore, but was five- year-old Tara. That earthy smell after the first shower indicated, that school was about to begin after a two-month long vacation. The house would be filled with more textbooks and notebooks, sharpened pencils, new schoolbags, new uniforms and renewed enthusiasm of beginning the academic year. And the most important part- meeting Nisha again. They had become best friends since day one of school. The smell after the first shower was a reminder that she would be seeing her soon. Sitting on the same bench, eating their tiffintogether, occasionally visiting each other’s houses, and secretly envying each other’s dolls and that occasional catfight was an indispensable part of their bond that was unbreakable in school. From playing together to gossiping together, they grew up. Numerous pinkie-promises were made. They swore to maintain this bond for the rest of their lives. But that was until they reached the crossroads. And then, life happened. Nisha moved to the U.S. for her studies. The broken bond moistened Dr. Tara’s eyes as she sat reminiscing their memories at the bus stop. But the final blow was their meeting two years ago. As they say, ‘out of sight, is out of mind.’ The once inseparable friends had absolutely nothing to say to each other. The meeting was sadly, but predictably, formal. And though unsaid, it was obvious to both of them, that this chapter, in their life had closed forever. With her tears, the rain also eventually subsided and she reached home. Having reached early, she decided to go through the books of her undergraduate course.

She reached out for her physiology book. From the book, she saw some notes written on loose pages, fall out. There was a question written, in her then neat and tidy handwriting that was asked by her teacher, “why does smell help us to correlate with certain memories?”

Intrigued by her previous experience, she continued reading. The answer said, “Smell has a stronger impact on our memories than most other stimuli. They can strongly trigger our memories almost as if we have been transported in time which is known as ‘odour-evoked autobiographical memories’ or Proust phenomenon. This is because smell gets routed through the olfactory bulb which is the smell analysing region of our brain. This region is closely connected to the hippocampus and amygdala that are parts of the limbic system which handles memory and emotion. However, visual, auditory and tactile information do not pass through these areas which is why they do not trigger emotions and memories as strongly as smell. These memories triggered, are usually those from the earlier stages, mostly the first decade of life. It’s not only positive associations that are brought back, but odours are known to induce trauma related flashbacks as well, and are thought to play a role in triggering Post Traumatic Stress Disorder.”

Haven’t we all experienced this? A smell that transports us back in time? The sweet aroma of a mango reminds us of the summer holidays. A perfume may remind us of a person very close to our heart. Our eyes are the windows to our body. Together with the ears, they store all that colour and music around us as a safe treasure, but it is the smell associated with it; the smell that we never bothered to consider as a part of our memories, that is the key to open this treasure. My eyes saved the picture, my ears, the sound. Together they saved memories so well. But something that makes me relive those memories, Is my unnoticed sense of smell. Together, they make me a kid or a teenager again, And have so many stories to tell.

THE BRAILLE LEGACY

Madhura Mandlik,

Intern ,

Dr V M Government Medical College, Solapur

The mind only knows what the eyes have seen. But unfortunately, a few aren’t bestowed the joy of vision. But this very vision , these eyes ,are they essential for perception? No they aren’t! And this was possible because of a revolutionary, Louis Braille , who changed the world of the blind for the better.

Louis Braille was born on 4th of January 1809 in a beautiful small town , Coupvray , near Paris. Along with his siblings , he lived on a beautiful farmland . His father was a leatherer by occupation and little Braille frequented his father’s workshop very often. At the age of three, while playing with his father’s tool ,Braille faced an unfortunate accident where an awl struck him in one of his eye. Even after receiving prompt treatment , owing to sympathetic ophthalmia the infection spread to the other eye. Alas, Braille lost vision in both his eyes at a tender age of five. But this disability could not deter his sharp and creative mind .

After his initial schooling , Braille set out to the National Institute for Blind Youth in Paris, where later on in his life remained as a professor of algebra, geometry and history. But this institute was where he fist came across the Haüy system for reading. The Haüy system was developed by a philanthropist Valentin Haüy by embossing heavy paper with raised imprints of Latin letters. But these books were heavy and the the whole system too cumbersome to allow the children to write themselves.

( The National Institute for Blind Youth ,Paris ) His father , Simon-René provided him with letters made of thick bits of leather which enabled Louis to trace the letters and to write letters back home.

All of this encouraged Braille to bridge the gap of communication the blind folk had.Braille held a firm opinion that “We (the blind) do not need pity, nor do we need to be reminded we are vulnerable. We must be treated as equals – and communication is the way this can be brought about." Taking inspiration from Captain Charles Barbier who had devised a special code for soldiers called Night Writing , by 1824 Braille came up with his own system of writing. This system consisted of 6 dot patterns which were created by an Awl , the same tool that made him blind. By 1829 he published his system and revised it in 1837. He even devised an ergonomic tool by smouldering two metal strips across a slate. The Braille system was adapted in 1854 two years after Louis Braille’s death. It gained popularity beginning from the French language but soon spread all over the globe. He also came up with Decapoint using which the blind could write letters that could be read by the sighted. Apart from being a professor , Louis Braille was a skilled cellist and organist. He also played the organ in the many churches across France. Due to his passion for music , he also meticulously formulated the Braille musical notation and published Method of Writing Words, Music, and Plain Songs by Means of Dots, for Use by the Blind and Arranged for Them in 1829.

The Braille system of writing has been adapted in various forms like the Braille computer , RoboBraille an email system and Nemeth Braille a mathematical and scientific notation system. Braille believed that access to communication was access to knowledge and knowledge. Louis Braille died on 6thJanuary 1852 but his legacy continues even today when a little blind kid can witness the joy of reading. The blind may have darkness around them ,but Braille, by enriching their sense of touch has given them the light of knowledge. .

DEAFNESS: LIFE, LEARNING, USE OF OTHER

SENSE ORGANS TO COMPENSATE AND LEARN. Mannat kaur Bhatia

Final year Mbbs

Govt medical College, Patiala It is an often repeated idea that deaf people can compensate for their lack of hearing with enhanced vision or other abilities. The musical talents of Ludwig Van Beethoven, who, by the end of his life couldn’t hear his own work, are cited as examples of deafness conferring other advantages. He introduced the world to his most famous symphony, the Ninth Symphony- well after deafness had overtaken him, an irony that produced one of the most poignant moments of his career. As awe-inspiring as Beethoven’s life happens to be in the movies, does that sort of advanced ability have any basis in real life ? It is known that “ by clenching a stick in his teeth, holding it against the keyboard of his piano, he could discern faint sounds “. So, how does this compensation work? The most beautiful thing about the brain is its plasticity. There’s a quirky phenomenon where people who lose one sense can join near-super abilities in others, especially if that sense is lost in early life. The brain is highly adept at re-wiring itself if it thinks it can function more efficiently. Thus, if you lose your sense of hearing, the brain is not going to let this huge territory that is the auditory cortex and its processing go to waste. This energy is shifted to the other senses, deepening these significantly. Thus, although deaf people leaping across rooftops sniffing out bad guys from around the corner might be a bit of a stretch, yet solid research has shown that it is far from impossible. Brain is a miraculous machine and people born deaf have better peripheral vision, motion-detection abilities and a heightened sense of smell. Cochlear implants as a technology has helped improve the quality o f the life of people with hearing loss. A very significant challenge that these people are faced with is being able to juggle work and family. Because after a long day at work lip-reading and making sense of communication, it is a feat to listen to your son’s recount of their day, especially with a lesser support mechanism than usual. To make these less stressful, it is imperative that the deaf be educated on setting communication rules at work as well as home.The sound of silence wouldn’t sound as bad then, isn’t it?

OUT OF THE DARK

Shreeya Mashelkar,

3rd M.B.B.S,

Grant Medical College.

It was the third of March, 1887.She stood on the porch, dumband expectant that

morning. Her brown hair tumbled, pinafore soiled, black shoes tied with white

string. She’d guessed vaguely from her mother's signs and from the hurrying to

and fro in the house that something unusual was about to happen. She was proven

right when she sensed the approaching gentle footsteps on the wooden front porch .The youthful woman made her way towards the child’s parents who had been

waiting to receive her .After the footsteps stopped ,the child heard a dull thud on

the floor .Eager to know more about this guest ,the inquisitive child jerked Sullivan's

bag away from her, rummaged in it for candy and, finding none, flew into a rage.

She banged her hands against the wooden floor. Her other hand grasping tightly at Anne’s, tugging it towards her. She was grunting in anger which wasn’t the usual

way a student would call their teacher. But this wasn’t a usual case either. Anne

flipped the angry child’s palm over, holding it by the wristbefore scribbling D-O-L-L with her index finger across it. Anne gave the child a doll in her hands. This almost

immediately calmed her down. The child began moving her finger across the doll, caressing her hair and moving down her face. On touching the doll’s eyes, she

moved her hands towards her own closed eyes. Almost trying to make a relation

with the inanimate object that lay in her lap now. She ecstatically began pounding at her own chest and then at the dolls’. Anne immediately nodded guiding the child’s

hands near her own face. The kid knew then,Anne’s touch and the doll’s beady eyes would be a window to the world she hadn’t seen before. This was the first

interaction between Anne Sullivan and her student, Hellen; the start of a 49 year old

companionship.

Before meeting her new student, Anne had her own doubts about meeting this

trouble child. She had read her file on the way to Alabama from back at Perkins

Institute for the blind.Alexander Graham Bell had recommended the Keller family to

this institute. Hellen had been healthy at birth, achieving all the milestones appropriate for her age. Until she turned 19 months old. A disease, then called the

“brain fever”, erased not only the child's vision and hearing but also, as a result, her

powers of articulate speech. She tried to understand her surroundings through

touch, smell and taste. However, she began to realize that her family members

spoke to one another with their mouths instead of using signs as she did. Feeling

their moving lips, she flew into a rage when she was unable to join in the

conversation. By the age of six, Keller later wrote in her autobiography, “the need of

some means of communication became so urgent that these outbursts occurred daily, sometimes hourly .”It was days before Miss Sullivan, whom Miss Keller

throughout her life called "Teacher," could calm the rages and fears of the child and

begin to spell words into her hand. Hellen had imbibed numerous new word signs through her unique learning

technique with Anne .But then arose a problem ,the problem was of associating

words and objects or actions: What was a doll, what was water? To this, miss

Sullivan’s method of teaching was a stroke of genius .Anne took Hellen to the well-

house nearby one morning. Kept her hand under the spout, Hellen could feel the gushing stream. She spelled into the other hand the word water, first slowly, then

rapidly while Hellen stood still. Suddenly, she felt a misty consciousness as of

something forgotten -- a thrill of returning thought. She knew then that 'w-a-t-e-r' meant the wonderful cool something that was flowing over my hand. That living

word awakened her soul, gave her light, hope and joy. Helen's next opening into the

world was learning to read.

As soon as she could spell a few words ,Sullivan gave her slips of cardboard on which

were printed words in raised letters. She devoured everything in the shape of a printed page that came within the reach of her hungry fingertips. Helen's progress

was so rapid that in May, 1888, she made her first trip to the Perkins Institution in

Boston, where she learned to read Braille and to mix with other afflicted children.

For several years she spent the winters in the North and the summers with her

family. It was in the spring of 1890 that Helen was taught to speak by Sarah Fuller of the Horace Mann School. Hellen would touch Fuller’s tongue and mouth while she

spoke. She would then try to imitateher actions to reproduce a similar sound. Even so, it took a long time for the child to put her rushing thought into words. Most often

Miss Sullivan was obliged to translate the sounds, for it took a trained ear to

distinguish them accurately. But one had to talk slowly with her, articulating each word carefully. Nonetheless, her crude speech and her lip-reading facility further

opened her mind and enlarged her experience. When she was 14, in 1894, Miss Keller undertook formal schooling, first at the Wright-Humason School for the Deaf

in New York and then at the Cambridge School for Young Ladies. With Miss Sullivan

at her side and spelling in her hand, young Keller prepared herself for admission to Radcliffe, which she entered in the fall of 1900. It was indeed an amazing feat, for

the examinations she took were those given to unhandicapped applicants, but no more astonishing than her graduation cum laude in 1904, with honours in German

and English. Miss Sullivan was with her when she received her diploma, which she

obtained by sheer stubbornness and determination.

While still in Radcliffe, Miss Keller wrote her first autobiography, "The Story of My

Life" which was well received by the people. Hellen had always used all the 5

sensations within her, it was natural for her to use the words ‘look, hear and

see”.After college Miss Keller continued to write, publishing "The World I Live In" in

1908, "The Song of the Stone Wall" in 1910 and "Out of the Dark" in 1913. Her

writings, mostly inspirational articles, also appeared in national magazines of the

time. And with Miss Sullivan at her side she took to the lecture platform. Miss Keller

was developing a largeness of spirit on social issues, partly as a result of walks

through industrial slums, partly because of her special interest in the high incidence of blindness among the poor and partly because of her conversations with John

Macy, Miss Sullivan's husband, a social critic. In, 1909 she joined the socialist party in

Massachusetts. For many years she was an active member, writing inclusive articles

in defence of Socialism, lecturing for the party, supporting trade unions and strikes

and opposing American entry into World War I. She was among those Socialists who welcomed the Bolshevik Revolution in Russia in 1917. She travelled to twenty-five

different countries giving motivational speeches about deaf people's conditions. She

had speech therapy in order to have her voice heard better by the public.

She is remembered as an advocate for people with disabilities. She was a suffragette

and pacifist, many of her writings and speeches revolved around the topics concerning wars and women’s rights. She toured across the world on behalf of an

advocate of deaf and blind, meeting eminent people as a consequence. Alexander

Graham Bell ,Charlie Chaplin and Mark Twain being one of her close associates later

on .She used her fame to support and speak about the social causes she worked for. Hellen used her senses not only to change her perception of the world but she

also changed people’s perception of disabled people from being handicapped to

differently ABLED .For her work Keller was honoured by universities and institutions

throughout the world -- the universities of Harvard, Glasgow, Berlin and Delhi, among them. She was received in the White House by every president from Grover

Cleveland to John F. Kennedy. In 1964 she was one of 30 Americans on whom President Johnson conferred the nation's highest civilian recognition, the

Presidential Medal of Freedom.

Step by step my investigation of blindness led me into the industrial world. And what a world it is! I must face

unflinchingly a world of facts—a world of misery and degradation, of blindness, crookedness, and sin, a world

struggling against the elements, against the unknown, against itself. How reconcile this world of fact with the

bright world of my imagining? My darkness had been filled with the light of intelligence, and, behold, the outer

day-lit world was stumbling and groping in social blindness. At first I was most unhappy; but deeper study

restored my confidence. By learning the sufferings and burdens of men, I became aware as never before of the

life-power that has survived the forces of darkness—the power which, though never completely victorious, is

continuously conquering. The very fact that we are still here carrying on the contest against the hosts of

annihilation proves that on the whole the battle has gone for humanity. The world’s great heart has proved equal

to the prodigious undertaking which God set it. Rebuffed, but always persevering; self-reproached, but ever

regaining faith; undaunted, tenacious, the heart of man labours towards immeasurably distant goals.

Discouraged not by difficulties without, or the anguish of ages within, the heart listens to a secret voice that

whispers: “Be not dismayed; in the future lies the Promised Land.”-Hellen Keller

Hellen Keller died on 1st June,1968 at Connecticut in her sleep.Though she has

passed away ,her spirit will endure as long as man can read and stories can be told of the woman who showed the world there are no boundaries to courage and faith.

INDIAN FOOD- WHERE TASTE MEETS HEALTH

Chaitalee Ghosalkar,

Business Analyst,

Sun Pharma

Ever since I’ve learnt cooking, I’ve always marvelled at the complexity of Indian food. I say complex, because there are multiple ingredients that go into the making of a single dish. Many of these ingredients comprise various spices, which in their small amounts contribute to a flavoursome result. But it is not just flavour that they are useful for. Each of these spices possess medicinal properties that make Indian food not just wholesome in taste, but also healthy. In an age where we have come to discover the dangers of free radicals, there are several antioxidants to help combat them, in our very kitchen. Cumin seeds, garlic and cinnamon are known to contain antioxidant properties. And then are superfoods like turmeric that are so packed with nutrients that they are used to treat a wide range of disorders; may it be a wide range of cancers (the jury’s still out on that one), treating wounds, coughs and colds, detoxification of liver, flatulence, jaundice, menstrual difficulties, bloody urine, haemorrhages…whew! The list goes on and on. We all know of the medicinal properties of spices and condiments and use them as our primary medicines. Have a bellyache? Chew some cumin seeds or drink a concoction of ginger. Toothache? Nothing like a dab of clove oil to the affected area. Having trouble with acne? A paste of cinnamon and nutmeg works wonders. Writing about all the spices and covering all their medicinal properties would amount to data enough to fill a book. The benefits are endless, especially in present day scenario where diseases have adapted to allopathic medicines and often trump them. So the next time, you venture into the kitchen, and see those small pouches of spices and condiments lined up on the counter, don’t ignore them. Use them as and when you can, because you might not only end up being praised for your cooking skills but might also be responsible for keeping an ailment or two at bay.

Image source: https://qph.fs.quoracdn.net/main-qimg-

40cb0810450851cb793a2a6dea8a5c67-c

TREACHERY OF IMAGES: DECODING THE SIXTH SENSE

Amogh Nadkarni

Final year, MBBS

Grant Govt. Medical College “ I see dead people!”, whispers Cole Sear to Dr. Malcolm Crowe in the movie ‘The Sixth Sense.” Not unlike the movie, a physicians’ job involves seeing ghosts, struggling at the threshold of life and death, “walking around like regular people, not knowing they’re dead.” Would then one depend on the famed doctors’ intuition, a term used to describe the unconscious, reflexive thinking developed by physicians, a sense of unease that makes physicians seek hospital admissions irrespective of the patient’s presentation, or on the cutting edge technology of evidence based medicine?

What roughly holds the same for most medical consultations? The same approach to the patient, conditioned by years of vivas at the examination table and personal choice. A patient arrives, with a approximate idea of the various symptoms, pains, aches that he/she may have experienced in the past few days, accompanied usually by, but not always, by an overbearing relative. A volley of questions ensues between the doctor and patient, punctuated by infrequent interruptions and not so frequent exaggerations, aimed at making sense of the patient’s unease from a wide variety of pathologies. Further, the physician figures in the patient’s various physical and demographic parameters, and summarily churns out a response. What exactly went physicians head, and would it not be just as easy to order a summary of diagnostic tests and pray for a divine sign?

“Technology drives diagnosis, but it often merely substitutes our fears of uncertainty with delusions of certainty”, is a quote often associated with the professors of Stanford Medical School, highlighting the unease amongst even physicians to jump into the rabbit hole of evidence based pure data, regardless of considerations of logic. Holmes, the eponymous hero of Arthur Conan Doyle novels, is said to have remarked about a particular feat of logic by simply stating, “From long habit the train of thoughts ran so swiftly through my mind that I arrived at the conclusion without being conscious.” Arthur Conan Doyle himself, a physician, likened the work of a doctor to that of a detective, eliciting an illness from a set of mystery diagnoses. The medical world, for all its idealism, suffers from basic deficits at the logistical level, with doctors facing prohibitive cost considerations, ethical dilemmas stemming from subjecting the patients to a wide variety of probing, and the struggles of finding the right resources at the right place at the right time. In this regard, the reflexive intuitiveness spoken about earlier plays an important rule in distilling further treatment regimes.

Recently, at a student conference, I had the privilege of presenting a rare case on behalf of my hospital’s department. A young male patient, presenting with complaints of reddish discoloration of urine and impending renal failure, with pallor, was classified as haemolytic anaemia secondary to an infectious cause, a finding extremely common in a country like India. However, further analysis of the case in the view of negative serum titres for most infections pointed to a more insidious and poorly understood autoimmune cause, with the diagnosis clinched with atypical haemolytic uremic syndrome. The fascinating part, in the whole discussion, lay in the fact that the particular syndrome may have a set of varying aetiologies, itself overlaps in signs and symptoms with different syndromes, and is a death sentence in due to the expenses incurred in the drug regime, deemed to be the most expensive medical management in the world. Further, confirmatory diagnosis is near impossible, hinging on the non-availability of specific tests or their non-feasibility. The patient, managed symptomatically, lived to tell the tale. At the same conference, a colleague of mine presented a slightly different case with a radically different moral. Initially diagnosed as a textbook case of aseptic meningitis, a young patient was later classified as a case of SLE vasculitis, not on virtue of the clinical presentation, which was highly atypical, but by the wonders of a MR angiogram. Two cases, yet two different viewpoints. The first, demonstrating the beauty of an intuitive, reflexive, unconscious thinking pattern that does not rely on set regimes, the latter demonstrating how technological interventions have radically altered and improved on our typical presentations and diagnoses. When doctors admit patients in defiance of strict guidelines, defying the eagle eye of insurance companies set to impose cost cutting algorithms, they often are regarded as a source of mirth. Admitting the patients when their physical findings and inconsistent with complaints, or when the patient is seen to be stoically at peace, may in itself be considered less of an intuition and more pattern recognition. However, in the same breath arguments from the other side of the fence deem evidence-based medicine as big interpretations out of clinically insignificant data, yet ignoring recently developed guidelines which exhort the importance of small changes. For example, keeping the blood pressure in tight control instead of telling the patient it’s a ‘little high’ makes the life and death difference between getting or not getting a stroke. Ultimately, the modern physician treads on a tight rope. In a future that will get more evidence based as the years progress, society needs to find a way to put the art back in medicine and reverse the onset of mechanized assembly lines. Educational attempts, especially at the psychological level, aimed at decoding the mystery art of intuition may ultimately be the solution.

ARBOR VITAE

AN ENTRY IN THE DIARY OF DR.V.R.DOUGH Anushka Reddy Marri

Final year, part II

RIMS, Adilabad In a split second, I got teleported to a dimly lit enclosure with oddly mobile walls. The floor was bumpy and slippery. It looked like an endless tube without an escape. Everything I heard was so familiar yet uncanny. I tried to find my way, following any lead that I could see, hear or smell. Suddenly, the floor moved and bounced me around. I got drenched in something mushy. It caused my skin to itch and burn as I tried to get rid of whatever it was. As I was struggling, an unforeseen shadow crawled through the weird tube. SOMETHING WAS RAPIDLY FLOWING THROUGH THE TUBE!!! I ran for my life following any ray of light visible. I ended up at an unstable opening to a tiny hallway. I hopped in only to realize that I'd be walking with my legs immersed in a thick fluid. Using all my strength, I trudged through the dense liquid. After walking for an eternity, I found a pool at the end of the tunnel. I jumped in with thoughts of swimming my way to freedom. But nothing was going to be normal here. The walls of the pool started to move in unison to a monotonous tone which was strangely familiar. The metallic smell of the liquid and the unavoidable movement of the pool triggered a chilling realization. "Holy moly! I'm inside an invertebrate", I yelled in distress. I calmed my nerves and decided to make the best use of my newly acquired knowledge. After all, I only had to find the right sinus out. I swam to the opening that had the brightest illumination and jumped in. It felt like a water slide. With a stroke of good luck, I glided my way into what looked like the mouth of this eerie organism that I was in. Without any delay, I dived out only to discover an awry truth. All along, I had been trapped inside a MAGGOT! Just when I was coming to terms with this gruesome incidence, a tsunami of what smelled like chloroform, hit me and the maggots. Snapping into reality from the alternate universe, I said, "The chloroform will suffocate the maggots to death and I will be able to remove them soon", in an exhausted voice from all the OPD stress.

AN EYE FOR AN EYE MAKES THE WHOLE WORLD

BRIGHT Poonam Nayak,

intern,

MIMER Medical College He opens his eyes and all he sees is darkness. He knows there’s a familiar face

around, but will never know for sure. He can feel the warmth of a hug, but cannot

put a face to it, and maybe never will. All his life, he has felt and heard rather than

seen. He has heard stories of colors appearing in the sky, he knows about the

Festival of Lights, has seen the burst of light and loud sounds when a cracker goes

off but never knows what it is, how it looks. This is not fiction, it is the story of nearly

15 million people in India, 6.8 million o whom can have their blindness reversed. How

you ask? All thanks to the last donation a person makes to the living world before he crosses to the other side.

Eye donation for all the benefits to the recipient is surprisingly not talked about

often. Often people with good intentions are unable to donate their eyes because

they don’t know the proper procedures to do the same. Today, in this article we are going to break down the basics of eye donation and open your

eyes to a whole world of possibilities.

So let’s start with the easiest question: I wear spectacles every day, can I still donate my eyes? Good news is, you can! Even if you have spectacles, had a cataract surgery

in the past, have diabetic retinopathy or hypertension, you still can donate your

eyes. The only time a person cannot is if it is a case of drowning, gangrene, rabies, tetanus, AIDS, jaundice or of course if they are blind.

Next question: what exactly is taken at a time of eye donation, who is benefited from it, will there be a disfigurement in the donor? This question also, can be easily

answered. When a person agrees to donate his eyes after death, the relatives must

inform the doctors immediately. The eyeball must be removed from the body by the surgeon within six hours of death, to make sure that the cornea remains

intact and does not start becoming opaque. This is especially important because it is this very part that is used to cure a person’s blindness. Further, the relatives must

keep the person’s eyes moist to prevent the cornea from drying out till the eye

surgeon arrives. It is interesting to note that not all blindness can be cured with a donor’s eyes. Only corneal blindness (which affect 6.8 million people in India alone)

can be treated with a donor’s cornea. However, one donor can gift sight to two blind people, so not one but two people are going to benefit from your altruism. When the

eye surgeon takes the eyeball from the donor, they make sure to stitch the eyelids

together so that there is no visible disfigurement seen. Although there may be slight bleeding at the time of removing the eyeball, the

surgeons are trained to not cause gross trauma to the donor and to respect the

relatives’ wishes. The eyeball that is excised is stored at the eye bank till further use.

While corneas can be stored for fourteen days till they must be

used for transplant, they are often used within three days of donation due to the

extremely high demand. The remaining eye is used for research and training and tissues that are not useful at all are disposed in an ethical manner.

And for the last question, will my religion allow me to donate my eyes? No religion is

against eye donation. And anyway in the end, the decision is in your hands and you

can always contact your religious leader if you still are in doubt. However, the

biggest question at the end of the day is do you want to help not one, but two blind people see the world? All they want is to see is their loved ones smiling at them, to

see the colours of the sunset, see the light show at the Vrindavan Gardens, to see

the smile on a child’s face, to have what was taken from them unfairly and to live a life of colours.

In conclusion, all we’d like to say that: we live in a dark world, let’s make our small

contribution to change that.

The Foodie Noses!

Natasha Tungare,

Final Year BPTh,

Sancheti Institute college of Physiotherapy I'm such a hardcore foodie that I always keep thinking what should I be eating next. I bet all foodies out there might be able to relate to this very well! After all we are the population who doesn't eat to live, but lives to eat! When you come home all tired and exhausted and you sense the aroma of the food being cooked in the kitchen at that time, you get totally mesmerized. You know your digestive juices specially talking about salivation occurs more just by smelling your food. So you can definitely understand how important our sense of smell is when it comes to eating. Ever happened that you kept your pizza in refrigerator for long time and then didn't feel like eating it later because it smelled like a frozen pizza? This is because our sense of smell is responsible for the wonderful tastes of our delicacies. We actually understand if the food is fresh or stale merely by smelling it. I remember a few months ago when I had gone for a trek. It was around a complete 4 hour trek. We took a little longer due to halts in between. We were completely exhausted and were in desperate need of water or something to eat. After climbing a few distances, I could smell someone cooking Maggie! And yeah there was a small tea stall up there where they served Maggie as well. Your nose plays a huge role in what flavors your tongue. See, how interconnected our senses are! And that's one of the wonderful parts about our senses. And remember? When we had something like super bad cough and cold, we never felt like eating how much ever delicious the dish might have been. At that time our smell and taste gets kicked to the curb and as our nasal cavity gets congested due to mucus, the food tastes bland. Let me tell you why this happens. Our tongue consists of receptors on the taste buds giving us different tastes like sweet, sour, bitter, spicy. On the other hand our olfactory receptors present on the nasal cavity are responsible to sense these tastes send the signal to certain areas in brain which gives us idea about what we consume. In short, our brain perceives what food we eat due to converging effect of our smell and taste. Thus when our nasal passage is blocked, it is unable to send those signals to brain and hence the food seems tasteless even though our taste buds are functioning intact. So now you know that you actually smell your food flavors! Thanks to our interconnected senses!

COCHLEAR IMPLANTS : ADVANCES AND

UPCOMING VARIANTS. Sivapuram Madhava Sai,

Final year, Dr. Pinnamaneni siddhartha institue of medical sciences and research

foundation

In a lay man's terminology, cochlear implants are inserting an electrical bug in the cochlea which stimulates the cochlear nerve and transmits the impulses into the brain which facilitates the hearing; Thanks to Dr. Willam House and Dr. Jon Doyle of Los Angles in 1961 who were the pioneers of the cochlear implant. Later in 1964, Blair Simmons and Robert J White of Stanford University implanted a six-channel electrode in the cochlea. This was the first time patients starting seeing a sense of hope for their hearing loss[1] Cochlear implant as we see have two parts, smaller internal part which is implanted in the inner ear and an externally worn speech processor. The external speech processor has a battery, microphone, and a coil through which it perceives the sound; transfer these signals into the internal part where with the help of electrodes covert into electrical impulses. These electrical impulses transfer it to the brain through the nerve impulses.[2] Initially, the cochlear implants are implanted to those individuals who are suffering from the severe hearing loss in both ears. The latest and most recent experimental trials that are done in 2014, where the implants were done to people who had acquired deafness, only in one ear and has developed it after learning speech. The advantage of a unilateral cochlear implant is sound localization, which is much better than any of the previous according to the studies. The latest advancements are concentrating on hearing outcomes and lifestyle. The hearing outcomes are being improved by the use of the dual microphones called Auditory Sense Classifier which helps ion the better localization of the sounds in the mixed environments. The development of wireless technology has a huge impact on the cochlear implants, these wireless technologies are being used to improve the lifestyles of the patients. These are being used to help them in busy environments such as classrooms, hotels, malls and other places. Here the mini-microphones are given to the opposite person where through the wireless microphones the sound can be easily processed. [3] The very recent approval of Nuclear 7 sound processor by food and drug administration (FDA) by the United States of America, has made the dream come true situations for patients as they can make phone calls, listening to high-quality music and have face time calls directly.[4] References: 1. Mudry A, Mills M. The Early History of the Cochlear ImplantA Retrospective. JAMA Otolaryngol Head Neck Surg. 2013;139(5):446–453. doi:10.1001/jamaoto.2013.293 2. Gabr TA. Mismatch negativity (MMN): indexing auditory discrimination in cochlear implants. Hearing, Balance and Communication. 2018;Feb;16(1):21–8. 3. Technological advancements in hearing implants. www.news-medical.net 4. Nuclear 7 processor. www.cochlear.com

UNILATERAL HEARING LOSS In a feminist world, are we deaf to what men have to say?

Malllika Fonseca

6th Semester,

Grant Medical College

'Keep your ears open, there's going to be some incredible sales next week' 'Why? There's no special festival next week' 'Are you living under a rock? It's women's day next week! All women's clothing stores have sales! And restaurants and pubs! It's a great time to be a woman.’ As I sit writing this article, the futility of women's day comes crashing over me. Is this what we women are asking for through our 'feminist' agenda? The feminist movement first started out as a call to equity between women and men. But now, being called a feminist has become equivalent to being a 'man-hater'. By definition, feminism is "The belief that men and women should have equal rights and opportunities". In 'Equal' lies the crux of the matter. But what is this equality we hear about? Yesterday, as I returned from college, I watched the train pull in. It was peak hours and men were hanging out of the overcrowded compartment in a way only Mumbaikars can. As the ladies compartment pulled up, I stepped into a compartment starkly different from the one beside me. Not more than 10 women in a compartment with the capacity of 130. At that moment I thought..... Is this really fair? Men have, historically 'ruled the world' ever since its inception and now, women say, is our time to show our mettle. But in this feminist world, are the needs of men unheard? The perception that women need reservations, special treatment and the celebration of days like 'Women's day' just drives in the point that women are different from men. It goes against the fundamental principles of feminism. Women only ask for equal opportunity and not special treatment. I put my argument to you with a few examples:

The Dowry prohibition act: Though a rampant custom still practised all over India, dowry had been banned by the Indian government from 1961. But this law was widely abused and in 2014, the Supreme Court found it necessary to issue further guidelines to prevent its misuse. But there have been more than 10,000 cases which have been proven to be false. This law was used as a weapon in the hands of unhappy wives who use the act to harass their husbands and in-laws. The POCSO act: This act was made to prevent sexual abuse of minor girls and protect their rights. But like all laws of India, it soon found itself being misused. There are innumerable cases which are simply registered after an affair gone wrong. Cases of young unmarried women who give their consent to their partner without realizing the consequences and later, on finding that they are pregnant or suffering from any STD, and presumably heavily under the pressure of their parents and family who do not want to face the derision of Society, use the POCSO act to implicate their partner. Again, there are a large number of cases registered by parents whose daughters have eloped. The male partner, in many cases, believing his partner to be of age and having accepted her consent, is suddenly found accused of rape, with a permanent blemish on his record. Is this fair? In these cases, the rightful plea of men nearly always goes unheard. Everyone's sympathy always lies with the 'weaker sex'. Here, no matter what he says, he will not be heard. HE will have to pay the price. Emma Watson in her speech 'HeForShe' as a UN Goodwill Ambassador spoke about Gender stereotypes. From the age of five or six, we hear gender identity reinforcing statements, through our play, through our actions, through everything we do. Boys are told that playing with dolls is 'girly', that crying is 'weak' and that muscles matter. As adults, the role of the male in the household is valued far less than that of a woman by society. In this fashion, males are pressured into carrying out certain ‘set’ goals, the same way that females are. They are pressured into being the breadwinners of the family, into requiring ‘strength’ to protect what belongs to them, and are not permitted to talk about emotions or cry the way women are, or society will not forgive the loss of their masculinity. What we need to truly obtain the 'Equality' that feminism talks about is an equivalent importance to males and

females for all tasks. It is not enough to say 'I care about my daughter as much as I care about my son'. What is required now is to not differentiate at all between the two. For only when there is no distinction and it is only when both sides of the argument are heard that we can truly achieve the height of equality that we all dream of.

SHOUTS AND MURMURS

THE MUSICAL FOETUS

Dr.Susmita Reddy K, TNMC & Nair Hospital, Mumbai

“Change the television channel.” yelled my mom. “You are watching that silly debate on the news channel since an hour. All shouts and no substance! Put on some pleasant music channel so that the little baby in your sister’s tummy can enjoy.”

“MOM” I exclaimed as I rolled my eyes. “Who says that a foetus can hear?”

“Our ancestors say! Our mythology says! Don’t you remember Prahlada’s story? He was an ardent follower of Lord Vishnu even though his parents tried to demotivate him. Do you know why? It is because of Lord Narad’s prenatal divine teachings. The sage sang songs depicting Lord Vishnu’s greatness everyday, which was picked up by Prahlad, while he was in his mother’s womb.”

“I am changing the channel mom.” I smirked. “If you don’t believe me then check it out on Google. Now a day, you seem to trust Google more than your mother. Kids these days think……..”

“Okay Mom, for your satisfaction, I’ll check it online.” I proclaimed as I pulled out my laptop.

“How long will you make love with your laptop girl? Get ready child, we need get some groceries.”

“I am reading about the effects of music on the developing foetus. Do you know that a child can hear and recognise voices while he is in the womb? Also, research shows that children respond positively to mild and melodious music as compared to the other kinds. Furthermore, music is known to improve the neurological development of a foetus. One study also shows that after birth, if an infant is exposed to the same tune which was played prenatally, the baby would become more alert while it was played. It is also believed that babies start learning a language while in the mother’s womb. Isn’t it amazing mom?”

“Yes, it is indeed amazing dear. You weren’t ready to listen to me before. The new generation…….”

“I will be ready in 5 minutes mom. We need to…..”

References: 1. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3813619/ 2. https://www.aptaclub.co.uk/article/pregnancy-music-the-effect-on-unborn-babies

3. https://india.curejoy.com/content/effect-of-music-on-fetus/ 4. https://www.parents.com/pregnancy/my-baby/qa-should-i-play-mozart-for-my-baby/

UNDECIDED

VISIBLE OR NOT?

Tuhina Mishra Grant Government Medical College

“Where are we going , mom?” Rahul asked in his innocent voice, looking at the dense fog anxiously, his eyes really hard to look through ‘ the opaque fog’. Mira hadn’t missed out a single precautionary step- the fog lights were on, speed was as low as 15 kmph, the wiper constantly cleaning the screen to get whatever little view was possible. A question popped up in her mind, “ Is this the future I’m preparing my son for?” Suddenly there was a loud cry, a crashing sound followed by an utter silence. On the fateful day of 17 November 2017, nature vented out its full blown anger on our National Capital, Delhi. The Delhi Smog. “ This way for the gas, ladies and gentlemen “ this is what the Delhi’s signboard should say as city’s air pollution is compared to Hitler’s gas chamber. What was used as a means of torture for the Jew turned out to be a reality for Delhites. Delhi has never failed to come under the scanner when it comes to calculating the pollution levels. Despite being on the top notch , none had ever predicted that such an untimely and ghastly incident would occur. Delhi smog stands out as a testament to the inhumane acts of

human beings and how manipulations done in nature can hit man back, really hard. While some environmentalists blame the indiscriminate burning of crops in Haryana to be the prime reason , others believe that the geographical location of the place has caused the havoc. Whatever the theory be, air pollution is the major factor responsible for the incident. According to the reports, the toxic levels of carcinogenic pollutants in the capital has been recorded as 10 times more than what was recorded in Beijing, the city which is globally infamous for its toxic air quality. Inhaling this air has been equated with smoking 50 cigarettes a day by doctors. So what is worse, chainsmokers or delhiites ? The latter it seems. Health outcomes of such a nightmare portray an equally ugly picture . Exposure to smog can have deleterious effects on health. It can cause/ aggravate health conditions such as chest infections, irritation in eyes, worsen asthma, bronchitis and emphysema. Incidences of low birth weight babies and pre term babies have increased drastically in Delhi. How would one feel if once a beautiful city gets covered with ugly black smoke? Wouldn’t it be the last thing anyone would want to see in his lifetime? Delhi smog has made people realise the value of a healthy life, the value of our senses. Let’s respect ourselves , our senses, our body. Through the glass This is so pretty. Is this the future? It’s stretching in every direction “ where is the car in front of me” is a good question Flurries cloud her vision Swirling and streaming through the the air Its not snowing But the dust is undoubtedly there My eyes are wide Focussed on the sky above

Never have I seen such blazing Colour scorching the night sky.

CAN THERE BE SMOKE WITHOUT FIRE? THE

ORBITA TRIAL CONTROVERSY

Namrata Deshpande

Intern,

MIMER Medical College

The ORBITA trial, I’m sure you have heard a lot about it, but let’s start from

scratch. What was this trial, and what were the inferences drawn from it?

The ORBITA trial was a randomized trial of Percutaneous Coronary Intervention

(PCI) versus a placebo procedure for angina relief in patients with severe single

vessel stenosis. The participants first received medication optimization after which

pre randomization assessments were done. These tests broadly evaluated the

exercise capacity and symptoms of the participants. They were then randomized in

a 1:1 ratio to undergo either PCI or a placebo procedure. These two groups were re

assessed after a follow up period of 6 weeks. The results of this trial were what

baffled the cardiac community and brought this trial into the public eye, where it

faced both critical acclaim as well as strong rejection. Clearly, the participants who

had undergone PCI were expected to have had a better symptom relief as well as

improved exercise capacity in comparison to their counterparts. However, this was

not the case and in a strange twist in the tale, it was found that, there was no

significant difference in the reassessment results of the two groups of individuals.

The results of this trial raised a few serious questions. Was the need for operational

intervention genuine, or was it mere capitalization on part of the medical

community?

The investigators of the trial have put forth their views by saying that PCI has

shown symptom relief in angina patients but this has never been proven through a

blinded Randomized Controlled Trial, to which cardiologists have argued that the

benefit of PCI depends upon several patient variables which cannot be generalized

as done by the said study. According to guidelines, medication optimization is

done with anti anginal drugs before resorting to interventional measures. However,

in clinical practice how often is this followed? Moreover, can one set of guidelines

be applicable to all patients? And how well are the patients informed about the

benefits of any interventional procedure that is done? Does the patient truly have a

choice as to whether he wants to opt for the surgery? Perhaps not. According to

me, they literally see the situation as do or die. Further, to the lay man, drastic

measures such as one of operational intervention obviously sounds more reassuring

as compared to popping pills. Therefore, first and foremost, it is important that the

patient is well aware of the severity of his condition, as well as all the treatment

options available to him, along with the clinician’s take on the recommended

approach. When asked about the trial, several cardiologists had interesting insights

to offer. For instance, it is important to bring to attention that the trial dealt only

with patients of stable angina, who constitute a relatively low risk population as

compared to patients of unstable angina and ischaemia. Therefore, it is imperative

to understand that the findings of this study cannot be extrapolated to patients with

more severe symptoms or those who can actually significantly benefit from PCI.

Another thought provoking argument from the cardiac community is regarding the

period of the trial. Many have argued that 6 weeks is not sufficient time to increase

the exercise duration in the given PCI group which started with an already good

enough baseline. Further, the placebo did not show any effect on the exercise

duration either. Obviously, the reason for the selection of a low risk population and

a shorter study duration was to reduce the risk of leaving the lesions

unrevascularised for longer periods of time.

There have been several arguments that have been put forth, some have been for,

while others have been against this trial. According to me, I do not think that one

can see this issue as black and white, because the answers lie in shades of grey.

This trial personifies ambiguity at its best and differentiating standpoints in an

argument while labelling one as right and the other wrong would be unfair to both

the founders of the trial as well as interventional cardiologists world over.

PANDORA BOX

CATARACT SURGERY: PAST TO PRESENT

Ahana Sen,

Third Major,

Grant Govt Medical College

We all know about cataract. We’ve all seen it. As children we’ve observed the white spot in the black part of the eye of our elders and now as medical students we know that cataract has many causes and could occur in children, adults and elderly. The word ‘Cataract’ stems from the Greek word ‘katarraktes’ meaning ‘waterfall’. People believed that cataracts comprised of an ‘abnormal humour’ that developed and flowed in front of the lens to decrease the vision. Now, cataract refers to the development of any opacity in the lens and its capsule which is of sufficient severity to cause impairment of vision.

There is a statue of a man in some Egyptian museum in Cairo with a left white eye. Created about 2457-2467 BC, it is believed to be the oldest documented case of cataract demonstrating left white pupillary reflex. As is natural with humans, they try to fix something they find wrong. Thus the first form of cataract operation was performed in ancient India. Described by an ancient Indian surgeon,Maharshi Sushruta who described the procedure in ‘Sushruta Samhita’, it is known as ‘couching’and consists of moving the cataractous lens away from the pupil, and letting it sit in the vitreous cavity towards the rear of the eye. The eye would later be soaked with warm clarified butter and then bandaged. This surgery was believed to be introduced in the West by Greek travellers from India and Middle East. The first references to cataract and its treatment in the West are found in 29 BC in De Medicinae by Celsus. This also describes the couching operation. ‘Needling’ or ‘discussion’ was also discussed where the cataract was sliced into multiple particles, allowing them to be easily absorbed.

Finally, the cataract surgery where cataract was actually removed was introduced by Jacques Daniel in Paris. He performed the first Extracapsular Cataract extraction on April 8, 1747. In this form of surgery, the substances from the inner lens are extracted, yet part of the outer covering remains. Many improvements occurred during the 20th century with discussion of ‘couching’ vs ‘extracapular lens extraction. A huge breakthrough occurred in the 1940s in England when Harold Ridley created the IOL- long lasting plastic lens fixed inside the eye as a substitute for the crystalline lens. Sir Nicholas Harold Lloyd Ridley was an English ophthalmologist who pioneered artificial intraocular lens transplant surgery for cataract surgery. He was dissatisfied with the poor acuity and loss of binocular single vision following unilateral cataract extraction and the poor with the contact lens then available. This led to the idea of an artificial lens. The problem was choosing an inert substance that would be used as an intraocular foreign body. Fortunately, he was inspired in his choice of polymethylmethacrylate (PMMA) which became the gold material of implant material. He observed the eyes’ tolerance of PMMA following eye injuries in Royal Air Force pilots. When the pilots’ plastic canopies were struck with bullets, they shattered leaving pieces of PMMA in their eyes. It was seen that the pilots’ eyes were compatible and did not reject the inert PMMA substance. Despite facing strong opposition from the medical community, Ridley developed many comprehensive programmes for cataract surgery with IOL implants. At long last, in 1967, Charles Kelman introduced ‘Phacoemulsification’- the method we mostly see in the hospital. Funnily enough, he was inspired by his

dentist’s ultrasonic probe. This technique used ultrasonic waves to emulsify the nucleus of the lens in order to remove the cataracts without a large incision. Since then there has been dramatic increase in the popularity of Phacoemulsification and why not?

Small incision, less hospital stay, less complications... As we have seen, cataract surgery is a procedure which have been described, modified and described again since ancient times. There have been rapid improvements only recently. There have also been advancements in different areas like the IOL, viscoelastic substance, improved surgical techiniques, etc- all of which promise to further improve the patient’soutcome in the future.

A RAINBOW

Sonali mehta

Intern

TNMC& BYL NAIR CH hospital

On a July morning, Dhruvi finally woke up to switch off the snooze on her alarm. That was not the first time this year when she was bored to attend college. As a part of her daily routine, while still in bed, she pulled out a note and a pen and started remembering how many days has she “bunked” yet. Alas! To her despair, she had missed enough days to touch just the 80% mark on her PSM postings at college. “No rickshaws! Muddy water filled puddles! Crowded trains and buses! And by the time one reaches college, dirty clothes with little splatter marks on the back of the black jeans! All these, just for a god damn attendance”, thought Dhruvi.

This was just the middle of her pre-final year at MBBS. Previous night, Ophthalmology with its altogether new terms that made her feel dyslexic, had inactivated Dhruvi’s Reticular Activating System so strongly that even strongest black coffee wasn’t working. While on her way to her college, Dhruvichecked the schedule where she realized that another journey on a bus was awaiting to test her patience with the rains for the day. “A Trip to the Central Labour Institute” read the schedule! As expected, Dhruvi didn’t find a rickshaw and so she embarked upon her first adventure of her day. While still mentally cursing the rains and of course the rickshaws, she started walking towards the station. Being a responsible citizen, she waited at the zebra crossing till the signal for vehicles turned red and that for pedestrians turned green. However, being an irresponsible “newborn-adult”, checking the phone while crossing is just the most important thing to do! Just then, she heard a honk coming closer to her and she realized that she had a very well co ordinate auditory and ocular pathways! As she turned her head to the other side she saw a huge red monster about to eat her up! Of course, the red coloured BEST bus that was about to take her life away fit perfectly with the analogy! The policemen came rushing to charge the bus driver! “Disat nahi ka? Signal bandh zalaaahe!” Not giving a crap and just thanking the gods for her life, Dhruvi waled away. After all the not-so-romantic walk in the rains, the train travelling, puddle hopping, and finally barely making in time for attendance, Dhruvi reached the Central Labour Institute with her colleagues and the accompanying resident doctor. The first lecture was based on pre employment health testing. “Every field demands its own arena of health status. We are very well aware that if you have refractory error or in layman’s terms Spectacles, you cannot join the defence forces. “, the doctor at CLI started the lecture. At first when it seemed boring, the next part that concerned testing for vision in the bus drivers caught Dhruvi’s attention. Nostalgia from previous night made her focus very well. “Colour Blindness is a very well known and a very common defect that especially occurs in the males due to its X-Linked recessive inheritance. As all know, that in our eyes, cones are the receptors that perceive colours. There are three types of cones for the three primary colours, red, blue, green. When these cones are stimulated in different combinations, all variety of colours can be perceived by us. Now talking about the defects that can occur, are as follows:

Defects in Colour Vision

Complete loss of perception

(anopism)

Monochromatic colour blindness

Dichromatic colour blindness

Partial loss of perception

(anomalism)

Trichromatic colour blindness

Monochromatic colour blindness means that a person can appreciate only a single colour out of the three primary colours. Dichromatic colour blindness means the person can appreciate any two of the three primary colours. When a person cannot see Red, he is called a Protanope; for green Deutranope; and for blue Tritanope.

Red green colour blindness as we know it, is the commonest and leads to inability to differentiate between the two colours. Trichromatic colour blindness means that a person can appreciate all the three primary colours but only partially.”

Interesting. The thoughts that were racing in Dhruvi minds were all due to Dopamine surge that she was experiencing because of first showers of understanding Ophthalmology! What came next, was the part that gave her goosebumps! “Train drivers, bus drivers, applicants for licences for two and four wheelers are all pre screened to rule out colour blindness. Its very important for them to be able to be differentiate between the colours of the signal lights which are inclusive of the red and green colours. Various methods exist that can test colour vision. Ischihara charts are the commonest tools used.”

“In our sytem, where a green and red coloured notes can solve any problem, who will sit to test these drivers? And even if they do, what’s the guarantee the results aren’t forged?”,asked one of her colleagues to the doctor at CLI. “You are right. These rules need to be applied strictly. However, there are some loose strings!”, saying this, he pulled out an article and red it aloud. “153 BEST bus drivers found to be colour blind. At a surprise test visit by the Health services found out that 153 city bus drivers could not differentiate the colours of the signal lights! Although the accidents that have happened in the past could be blamed on rash driving, etc. now are being considered a possible result of colour blindness of the driver!”

Dhruvi was nothing but grateful for her life but angry at the same time, and ashamed of the system that we live in! “These bus drivers are going to be suspended immediately”, further read the doctor. “That’s exactly what should happen to them! ”, thought Dhruvi. The next thought that entered her mind was, if the defect is oddly so common, and a person who has done nothing but drive buses for his entire life, suddenly gets unemployed, how would he earn his living? How would he educate his children so that they at least get a chance to learn about such health issues and thus contribute towards social awareness? “However, due to humanitarian reasons, and no fault of their own, the drivers would be suspended from their duties and instead be offered table front jobs by the government”, read the doctor. A sigh of relief put an end to her thoughts.

“ The skies as wept as the little girl did, and in an attempt to make her glee, sky created the nature’s most beautiful scene!

A Rainbow! Disappointed that the little girl still cried, may be the sky didn’t know, the

rainbow never rose in her eyes

MILK THE FUTURE

By – Dr. Geeta Sundar, MBBS.

“I love okra. You know, with all the spicy ingredients, the curry is fabulous to my taste buds. Thing is, my son is crazy about okra too! I reckon I ate a lot of that when I was pregnant. Maybe it just got transferred to him…”

Research in the last few years has suggested the same. Flavours from the mother's diet during pregnancy and lactation have shown to have a very strong influence on the young one’s diet. Science has shown that flavours from the mother’s intake, is transmitted to the amniotic fluid, which is swallowed by the foetus. But it’s not only during pregnancy. During lactation, those same elements of concoctions in the mother’s food and beverages, transfers to the breast milk and is what impacts the infant’s choices and modifies their acceptance and enjoyment of similar foods at weaning. So, in reality, much before the baby is born and fed solid food, it is exposed to a wide variety of tart, sour, sweet, aroma, essence, zest, salt, tang and spicy extracts. But the bigger picture is not just the taste and how it influences the baby’s fancy. It’s what that taste does to the growing baby! When bared to the diverse pick of available tastes, the baby forms memories of those cuisines and retains them for long. These memories are what form the basis for a baby’s likes and inclinations. Hence, if the mom eats sprouts during pregnancy and lactation, there is a very good chance her baby will like it. Actress Marion Cotillard, once stated when she was pregnant in 2016, that, “I

wanted to eat things I didn't like. I was very worried that my kid would be

conditioned in this world anyway, but then he could have many choices, even the

things I don't like. So everything I didn't like I tried to feed myself with to give him

more choices.”

However, when comparing to the evolutionary timeline, this fact makes complete sense. Mothers tend to feed their babies what they eat themselves and it is speculated that it is nature’s way of inculcating family tastes and traditions into an infant’s life. Thinking ahead, it also explains why children born into a culture can stand that taste and may refuse or avert from tastes of other cultural cuisines.

Inquisitive scientists in Denmark tried to identify what concentration of mother’s diet actually made its way into the breast milk. They found that licorice and caraway seed flavours peaked strongly in two hours after intake. Mint appeared at lower concentrations but peaked at six hours after ingestion, although, banana, never made it into the breast milk. Another set of researchers in Australia, on working on rat models, found that after

exposure to junk food in the womb, and through breast milk, brain reward

pathways became desensitised to those foods – similar to when drug addicts need

increasing doses of drugs to obtain the desired hit.

Short-term alcohol consumption by lactating women was studied by a research

panel. They found that alcohol use significantly and uniformly increased the

perceived intensity of the odour of the breast milk. The infants were found to suck

more frequently during the first minute of feedings after their mothers had

consumed alcohol, but they consumed significantly less milk.

During infancy and childhood, kids are receptive to sensory and cognitive learning, and the behaviours established in this period are what carry on for future food behaviours. Babies are said to be born with very few hard and fast taste preferences, and breastfed infants tend to have a more adventurous palate and it is around the age of two-five months that mothers can use to ‘prime’ their children’s taste buds. And thus the importance of breast milk, in addition to it being an immune booster is established – for, exposure to different

tastes during early life has an impact on prospective food habits, whereas typical

formula milk is bland and doesn’t cater to a wider acceptance of tastes.

TESTING THE TASTE

Varada Ghadge;

Final Year MBBS;

BYL Nair Ch. Hospital and T.N. Medical College, Mumbai. Being the foodie that I am, I have kind of always taken these amazing perceptive organs called the Taste Buds for granted. Until recently, when thanks to the ‘hygienic’ canteen food, I contracted a gastroenteritis I had never before experienced in my whole 21 years of life! As if ORS, and the bland food was not enough, I had to be started on an antibiotics combination; one of which was, Metronidazole. One of the side effects of the medication being, a metallic taste so weird that your already comatose hunger would worsen even more! That got me thinking as to if it were a side effect like vomiting, headache, or any other for that matter, it would have warranted at least some symptomatic medical intervention, if not complete withdrawal of the drug. I dug in some more and really, among the 5 integral senses; viz., hearing, vision, smell, touch and taste; taste is a relatively neglected one. It is not often that an alteration in taste is considered serious enough. For example, if it is your eye sight, or hearing that gets affected because of a certain medication or some pathology; it warrants a relatively urgent medical attention. I researched some more and there havebeen studies where people have pondered over taste alterations in patients undergoing chemotherapy and its impact on the patients’ quality of life. In a study titled ‘Taste Alterations in Cancer Patients Receiving Chemotherapy: A neglected Side Effect’ by August Zabernigg et al; the prevalence of taste alterations in chemotherapy patients was found to be alarmingly high (69.9%). Different chemotherapeutic agents had varying effects. While the exact mechanism is not known; it might be attributed to distortion of receptor activity and alteration in saliva and mucus production by the cytostatic drugs. The taste changes reported frequently by patients were metallic taste, aguesia (no sense 0f taste), bitter taste, salty taste, to name a few. In addition, 83% of the patients reported dry mouth, while a large proportion reported that the taste changes had affected their appetite negatively. It is a frequently under-recognized side effect which is widely neglected by physicians. These taste alterations are shown to have a substantial effect on various aspects of quality of life in general, and particularly fatigue and appetite loss are major consequences. Appetite loss may be further associated with weight loss and therefore clearly worth further investigations. Also, food strongly serves as a means of social interaction, and so, the taste alterations can also curtail social

life; affecting their ability to grocery shop, make and eat meals, spending leisure time with family and friends. The article also sites need for development of adequate interventions in dealing with the problem such as; dietary approaches involving taste enhancement, food flavouring, avoidance or inclusion of certain food types. The study concludes that the taste alterations are a neglected side effect in chemotherapy patients and must be given more attention in daily practice and research to minimize its adverse effects on the patients’ quality of life. In another study titled ‘Taste changes experienced by patients receiving chemotherapy’ by Wickham RS et al; it was concluded that taste changes are frequent and a significant problem for patients receiving chemotherapy and have negative effects on patients’ quality of life. Even then, it is a widely underestimated problem, with oncology nurses and physicians not offering self-management suggestions to patients. The study emphasized a need of proper pre-therapy counselling and provision of self-management information. ‘Qualitative and Quantitative Assessment of Taste and Smell Changes in Patients Undergoing Chemotherapy for Breast Cancer or Gynecological Malignancies’ by Silke Steinbach et al., is another study which deals with the topic. It states that chemotherapy has a significant but transient effect ongustatory as well as olfactory function, leading to reduced appetite, fatigue and weight loss. It concluded that certain dietary interventions such as additional spices, flavouring may have a compensating effect enhancing patient compliance and quality of life. In summary, taste sensation is really a comparatively neglected domain by health professionals and patients alike, with patients resorting to self-experimenting such as using spices, flavouring, avoiding certain foods etc., to suit the taste alterations. There is a need for pre-therapy counselling and provision of self-management information and a more personalized approach by health professions regarding this adverse effect to improve patient compliance to medication and the quality of life.

MEDICOS FIRST

SENSES Aruna Muthumanickam

Intern Maharashtra Institute of Medical Education and Research (MIMER), Talegaon, Pune

To be able to LOOK at the sky and predict the time of the day, To be able to HEAR the rai

Nn nn chatter noisily against your window,

To able to SMELL the primrose in your garden, To be able to TASTE peppermint on your tongue every Christmas,

To be TOUCH silk and know you’ve got it’s worth, That is life.

But,

To be able to LOOK at cotton-candy skies and forget the time of the day, To be able to HEAR kind words spoken about you in your absence,

To be able to SMELL the jasmine in your mother’s hair, To be able to TASTE the salt in your sweat after a long hard day,

To be able to FEEL loved and love in return, Ah, now that is living.

GRATITUDE

Radhika Ramesh

Final Year MBBS

Grant Government Medical College and Sir JJ Group of Hospitals

You crawl your way out of your mother’s birth canal to settle into your new home. The environment is all set to welcome you and make your stay in it comfortable for life. You are now being held in your mother’s arms. How can you say for sure? You can feel her ‘touch’ on your delicate, pink, flushed skin. You smile as her fingers brush through your rosy cheeks, gently caressing them. You are curious to know what she looks like. Your tiny eyelids open up, unleashing the beautiful ‘sight’ in front of you- your mother’s smile. Your tiny brown eyes, staring at her warm and loving face, only broadening your smile even further. What a great day to be alive, isn’t it?

I am certainly not sure if these are the thoughts running in the head of a newborn child. But certainly painted a beautiful and soothing picture doesn’t it? All said and done, as we jump from covering one age milestone to another, there is no split-second where we stop to extend our gratitude for our ability to perceive the marvels in our surroundings. And why would we? One can never know the value of their possessions till they no longer possess them. Here I am, garnering all the strength in an effort to summarize the importance of the perception of senses. It is rhetorical when I ask, if I will ever be able to summarize something that is as vast and deep. But worth a shot.

“On a good day, I can pick up the cup, take a sip and return it to the saucer, and if you were sitting at the next table, you’d never know I was blind. The

challenge is to see how long I can carry out the deception before the person sitting next to me realizes the truth. And believe me, the moment they do, they give themselves away. Some begin to whisper , and, I suspect, nod or point; some become attentive; while a few are so embarrassed they don’t

speak again. Yes, I can even sense that.” - The Blind Date by Jefferey Archer

Eyes are the gateway to the outside world. The sense of sight adds a certain meaning to our existence. Every sight around is worth seeing. The sight of the birds soaring away into unreachable heights, the sight of the rain pouring down hard onto the muddy earth, the sight of children dancing in the rain, free from all worries and enjoying the moment; these are just some of the many sights we see( though not all are as pleasant, but that is a discussion for another day). For an individual who is deprived of the sense of sight, it’s a curtain drawn to curtail them from watching life’s play. Not a day passes by, when the soul yearns to see the world. That being said, the blind are still

immensely thankful for their other senses, and that for them is their biggest

strength. The ability to hear and speak. The thirst to voice their thoughts. They give a listening ear even if it means they have to resort to lip-reading. The world for the deaf and mute is like a silent film. At times, they form their own subtitles, yet other times, the world gives it to them. Are you resilient enough to sit the whole day watching TV, with the mute button on? In contrast, the deaf and mute are amongst the most expressive people I have had the fortune of bumping into. If nature messed with the wiring of their sound system, they have modalities to work it out as well. Sign language interaction between two people is by far, the most satisfying conversation I have been a witness to. The interaction is so flawless and easy. For these individuals, their gratitude for their senses is enormous. Every adversity is turned into an advantage merely by appreciating what we have and taking efforts to value it, instead of yearning for what we may perceive as better. Gratitude, thankful, respect, appreciation etc. are all the varied synonyms I may have used in this article. Yet the moral remains the same. A human can be complete, irrespective of the presence or absence of every functioning sense. All it takes is the ‘sense of understanding, in appreciating the importance and value of what we have now, for what we may perceive as a disadvantage to one, may infect be their biggest strengths. Be thankful for the existence and learn to appreciate every little aspect of the human body and its par excellence perceptual senses.

“It is not the senses that I have, but what I do with them that is my biggest kingdom.”