Tuesday, March 31, 2009

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Dr.G.Madhu (patron)
Ph:+919447787255, email: dr_madhuin@yahoo.com

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Ph:+919446072887, email: abhildr@yahoo.co.in

Dr.Nithin Dev.S (Editor in charge)
Ph:+919446541238, email: devnithin@rediffmail.com

Dr.Sankaranarayanan.J (Editor in charge)
Ph:+919446052366, email drsankaranarayanan@gmail.com

Monday, March 30, 2009

What Homoeopathy can offer to AIDS ?

Homoeopathy uses an individualistic and holistic approach towards the sick individuals treats them at the physical, mental,and emotional levels by balancing their constitution. Same medicine may not be indicated in two patients with the same diagnosis as homoeopathy is based on individualization. 

HIV patients are more likely to get viral infection than usual.Even though there are no homoeopathic anti-viral agents, even correctly prescribed homoeopathic medicine has the potential of strengthening person’s own immune and defense system in a way that helps to fight the viral infection.So by using the homoeopathic medicine the patient can be made comparatively less susceptible to the day –to-day infections. since it is free from side effects it can be used as an adjunct with the allopathic treatment. Medical community must give more attention and research toward ways to enhance immune response, rather than ways to inhibit viral replication.
Homoeopathy medicine can provide positive results for people who are HIV positive, for those with early onset of AIDS, and for those with nonextreme cases of AIDS.It is also seen that a specific homoeopathic medicine can delay the onset of AIDS in HIV positive persons, delay the process of depletion of CD4 cells in such patients, increase in the T4 helper cells and a marked weight gain among AIDS patients.

Contribution of Central council for research in Homoeopathy(CCRH)New Delhi, India

A pilot study undertaken at its regional research institute Mumbai(1989-1991) showed homoeopathic medicines were effective in managing intercurrent illness and other clinical events related to HIV

Later, study on the same center (1995-1197) showed that an increase in CD4 cell count in the medicine group. These favourable results made the council to carry out a multicentric clinical trial in HIV infection at its institutes. It was observed that Homoeopathy can be safely used for delaying or slowing down the progression of infection in people who are not covered by anti retroviral therapy.

Council also undertook collaborative study with the university of California and Los angels entitled ‘AIDS prevention with traditional system of medicine

A follow up study in 2005 by the council collaboration with UCLA (University of California, Los Angeles) entitled ‘Delivery of model HIV prevention and health promotion programmes in India by homoeopathivc physician’ in India and abroad.

Further reading

Friday, March 27, 2009

Emerging risk factors of cardiovascular diseases

Most important indicators for cardiac risks are your personal health history. Age, hereditary factors, weight, cigarette smoking, blood pressure, and diabetes. Certain other factors like High-sensitivity C-reactive protein (hs-CRP) Homocysteine, Lipoprotein A Lp(a) and Fibrinogen also have some role  in predicting your cardiac risks.

High-sensitivity C-reactive protein (hs-CRP)   ( This test is different from the regular CRP test, which detects elevated levels of CRP in people with infections and inflammatory diseases. High levels of hs-CRP consistently predict recurrent coronary events in patients with unstable angina and acute myocardial infarction. High normal levels of hs-CRP in otherwise healthy individuals have been found to be predictive of the future risk of heart attack, stroke, sudden cardiac death, and peripheral arterial disease, even when lipid levels are within acceptable ranges. Several groups have recommended that this test be used in people with moderate risk of heart attack over the next 10 years. If hs-CRP is between 1.0 and 3.0 mg/L, a person has an average risk. If hs-CRP is higher than 3.0 mg/L, a person is at high risk.

Homocysteine:It is an amino acid that is produced in the human body. Homocysteine is normally changed into other amino acids for the use by the body. Dietery deficiency of ,folic acid,vitamin B6 and B12 associated with high levels of Haemocystein.To reduce haemocystein level ,you  require foods  rich in folic acid,vitaminB6 &B12.Other possible causes of a high homocysteine levels include low levels of thyroid hormone, kidney disease, psoriasis,some medicines or the condition runs in your family.Homocysteine may be requested as part of a cardiac risk assessment, depending on your age and other risk factors. It may also be used following a heart attack or stroke to determine treatment. Evidence suggests that measurement of homocysteine may be an even better indicator of  having a heart attack or stroke than other tests, such as cholesterol and the lipid profile.

Lipoprotein A (Lp(a): Lp(a) is a lipoprotein consisting of an LDL molecule with another protein (Apolipoprotein (a)) attached to it. Since the level of Lp(a) appears to be genetically determined and not easily altered,Lp(a) does not respond to typical strategies to lower LDL such as diet, exercise, or most lipid-lowering drugs. Studies have shown that Lipoprotein(a)act as a risk predictor for cardiac mortality in patients with acute coronary syndrome

Fibrinogen: It is circulating glycoprotein involved in final steps of coagulation,other actions include vasoconstriction at sites of vascular injury,stimulation of platelet aggregation,Influence on blood viscosity It is an acute phase reactant, increasing up to 4-fold after infectious or inflammatory stimuli,levels also increased by cigarette smoking diabetes, hypertension, obesity,sedentary lifestyle.Levels lowered with fibrates and niacin

Besides this, Certain studies reveled that an increased serum uric acid levels were independently and significantly associated with the risk of cardiovascular mortality.Elevated levels of serum uric acid level increases the risk of heart attack.Support has been given to the concept of a bacterial infection component of heart disease. The organisms chlamidia pneumonia and cytomegalovirus  both increase CRP and are associated with increased heart disease risk. 


The annual conference of Indian homoeopathic medical association , karunagappally chapter was held on march 15th at town club hall. A continuing medical education class was also conducted as part of it. The class was on Repertory of mind rubrics by Dr.Narayana Prasad, pg scholar of ghmct.the class was very infotaining. The election of new office bearers for the years 2009 - 2011 was also held. The name and contact details of the newly elected office bearers are posted separately on the blog. The blog of karunagappally chapter was officially inaugurated by Dr.G.Madhu of our chapter.

Wednesday, March 25, 2009


Dr.Nithin dev.S
krishna vihar
pada south 

abhilash sadanam
chavara bridge po

Dr.Rosaline Ninan
karunya homoeo clinic
victory building 
karunagappally po

putenthura po

jyothy nivas
south mynagappally
mynagappally po

thazhava po

kakkakunnu po

vellengattu soubhagya
adinadu north pokarunagappally 

Dr.Sreedevi bose.S.K
amrithapuri po

Dr.Dhanya Raj
sankar vilasam
koivila po

Excerpts from the scientific seminar of cure 2008 ( part 1)

Rheumatic Fever


Diffuse non suppurative  inflammatory disease of connective tissue as a sequalae to Group A beta hemolytic streptococcal infection of the throat by rheumatogenic strains, primarily involving heart, blood vessels, joints, subcut. tissue and CNS

Magnitude of Pattern

Common cause of CV morbidity and mortality in underdeveloped and developing countries

Less in developed world

Prevalence of RHD in school children

USA                          :           0.6 / 1000

JAPAN                      :           0.7 / 1000

ALGERIA                :           15 / 1000 ( WHO 1970)

INDIA                      :           6 – 11 / 1000 (WHO 1970)

                                                6 / 1000 (5 CITIES – 1 Cm2)



Incompletely understood

Non suppurative sequelea to  ‘GAS’

Repeated infection important

Genetic predisposition ?

Autoimmunity – Antigenic mimicry between st.cell wall component and human myocardium, valvular glycoprotein etc.

Delayed immune response to infection with group.A beta hemolytic streptococci.

After a latent period of 1-3 weeks, antibody induced immunological damage  occur to heart valves, joints, subcutaneous tissue & basal ganglia of brain 


Severity of throat infection

Severe exudative infection - upto 3%

Mild sporadic – 0.5 to 1%

Immune response (ASO) – 1 to 5%

GAS persisting in throat

Previous RF : many times

Established RHD – very high

Recurrence rate –  50% - 1st year

                                    10% after 5 years 

Pathologic Lesions

Fibrinoid degeneration of connective tissue,inflammatory edema, inflammatory cell infiltration &  proliferation of specific cells resulting in formation of  Aschoff nodules, resulting in

                        -Pancarditis in the heart

                        -Arthritis in the joints

                        -Aschoff nodules in the subcutaneous tissue

                        -Basal gangliar lesions resulting in chorea 

Rheumatic fever licks the joint & bites the heart 

Incubation period

1 to 5 weeks

Shortest for Arthritis

Longest for Chorea 

Clinical features

Commonest age – 5- 15 years


Migratory polyarthritis

Mainly - major joints, no residual deformity

Usually mild in young children esp. <>

Prominent in older children and adolescents

Occur upto 30%, more in girls

May appear even 6 m after the attack of RF

Clumsiness, deterioration of handwriting, emotional lability or grimacing of face

Clinical signs- pronator sign, jack in the box sign, milking sign of hands

Occur in 2 %

Painless, pea-sized, palpable nodules:- 0.5 - 2 cm, mainly over extensor surfaces of  

  joints, spine, scapulae & scalp

Typically appear > 3 wk after the onset

Always associated with severe carditis

Rarely seen in our population -.5 to 2%

Transient, serpiginous, non-itchy, pale center with red irregular margin, mainly trunks/ limbs

Often associated with carditis

Carditis - Pancarditis

Endocarditis – Valvulitis, Mitral & /or aortic

Significant murmur – MR, AR, Carey Coombs


 Cardiomegaly–Clinical, X-Ray CCF, Prolonged PR, relative Tachycardia, Soft S1, S3


Pericardial rub  ± effusion 

Diagnosis of RF

No single symptom

No single sign

No single lab test 

Revised Jones Criteria for Guidance in Diagnosis

1994 – by Dr. T. Duckett Jones

Modified by AHA in 1956, 1965, 1982, 1992

1987 – WHO study group accepted 1982 AHA criteria

Revised Jones Criteria, AHA 1992





            Erythema marginatum

            Subcutaneous nodules


            Clinical:    Arthralgia


            Lab:   ­ level of acute phase reactants –ESR & C-reactive protein

                          Prolonged PR interval 

Essential criteria:

            Evidence of antecedent group A Streptococcal infection


Diagnosis of rheumatic fever highly probable


Two major criteria      


One major & two minor criteria


Essential criteria satisfied

Relaxation of Criteria

Chorea as sole manifestation (other causes excluded)

Insidious onset / Late onset carditis

Established RHD

One major criteria

Fever with arthralgia + increased acute phase reactants

If evidence of recent GAS infection present

Acute Carditis in Chronic RHD often difficult

New murmur

Sudden increase in heart size

Recent onset CHF

Pericardial rub

Erythema marginatum / Subcutaneous nodules

            Previous carditis – recurrence of RF ® Carditis almost always present

Supportive evidence of Streptococcal infection

ASO + others

Throat culture – positive

Recent scarlet fever

History of sore throat – commonest viral


Laboratory Findings

High ESR, Elevated C-reactive protein

Anemia, leucocytosis

ECG - prolonged PR interval, non specific ST-T changes  rarely heart blocks

2D Echo cardiography - valve edema, mitral regurgitation, LA & LV dilatation, decreased contractility, pericardial effusion,

Streptococcal antibody tests

ASO - most commonly used

> 200 IU  suggestive, rising titre in 2 to 4 wks

Peaks in 4to 6  wks , remain high for 4 to 6 wks and comes down

Sensitivity- 80%

Specificity low – skin infection, other strep. Inf.


Antistreptokinase, Antihyaluronidase

Anti DNAse, Antistreptozyme(most sensitive)

Throat Culture

Positive in minority (latency, antibiotic Use)

About 20 % school children – carrier state


Differential Diagnosis

Rheumatoid Arthritis


Infective Endocarditis

Serum sickness

Gonococcal Arthritis


Viral myopericarditis


Overdiagnosis - Problems

Trauma + anxiety – parent + children

Unnecessary prophylaxis – risk

Missing another disease


Under Diagnosis

No prophylaxis

Risk of reactivation

Natural History of RF

Period of activity 

                        75%          - 6 weeks

                        90%          - 12 weeks

                        < style="mso-spacerun:yes">     - upto 6 months (Chronic RF) 


                        > 12 years – 80%

                        3 to 6 years – 50% 



                        14 to 17 years – 30%

Natural History – RF with Carditis

Initial attack, no carditis – excellent prognosis

Initial attack, mild carditis – 70% normal heart after 10 years

Initial attack, severe carditis – 40% normal heart at 10 years



How to minimize cellphone radiation exposure

Mobile phones have really changed our lives with their amazing features like Bluetooth, megapixel cameras and MP3 players.They have truly transformed our lives.On the other side the damaging effects of cell phone radiation and wireless radiation pose an extreme public health risk. Take appropriate action and protect yourself and your family

Cell phones work by emitting radio frequency radiation that transmit through the antenna.Potential risk of a mobile phone comes from its emission of low levels of radio frequency radiation (RF), the same type of energy that comes off a microwave oven

When purchasing a cell phone, choose one with low SAR (Specific Absorption Rate). The SAR level is listed in most phone instruction manuals. SAR is a way of measuring the quantity of radiofrequency (RF) energy absorbed by the body. A lower number equals less absorption. All cell phones that are commercially available fall within the prescribed safety standard of 1.6W/Kg in America and 2W/Kg in Europe and Japan. However, SAR ratings vary from over 1.5W/Kg for some phones to less than 0.5W/Kg for others. Buying a cell phone with a low SAR rating is a great way to significantly reduce your exposure to cell phone

Modern cell phones have adaptive power control, which means they uses little power which is necessary to communicate with the nearest base station. So by joining the network with best coverage in your area, you will be reducing the power that your cell isusing, and there by reducing the exposure of radiation.

Similarly if you use cell phone where the signal coverage is poor (down to one bar or less) then you are increasing the exposure to radiation. so before you use the cell phone, make sure that the signal is strong.

Don’t obstruct your cell phone’s antenna. By obstructing the antenna of cell phone you are reducing the efficiency of the cell causing cell to use more power in order to maintain proper signal quality there by emitting more radiation. Moreover by obstructing the antennae reflects some amount of the radiation back in to your hand and head. In order to overcome this,always hold your phone at its base causing minimum obstuction to antenna.

Minimize cell phone calls short and use it only for making essential calls. Just 2 minutes on a cell phone call has been shown to alter the natural electrical activity of the brain for up to an hour. For long conversation consider buying a hands free kit or use landline.

Wait for the call to connect before placing phone next to the ear. More radiation is present during the connection time.

If possible ,Use a speaker on your cell phone. Keeping the phone away from the body and head helps minimize the exposure to radiation.

Body tissues in lower body area absorb radiation more quickly than head,So avoid it keeping near the groin region.

Avoid using cellphones in,vehicles,elevators.By using mobile in these locations,you are making it to work harder to establish the connection,there by exposing to more amount of radiation.

Tuesday, March 24, 2009

Dangerous drugs

These drugs have been globally discarded but are available in India.

Analgin: This is a painkiller

Reason for ban: Bone marrow depression

Brand name: Novalgin


Cisapride: Acidity, constipation

Reason for ban: irregular heartbeat

Brand name: Ciza, Syspride


Droperidol: Anti-depressant

Reason for ban: Irregular heartbeat

Brand name: Droperol


Furazolidone: Antidiarrhoeal

Reason for ban: Cancer

Brand name: Furoxone, Lomofen


Nimesulide: Painkiller, fever

Reason for ban: Liver failure

Brand name: Nise, Nimulid


Nitrofurazone: Antibacterial cream

Reason for ban: Cancer

Brand name: Furacin


Phenolphthalein: Laxative

Reason for ban: Cancer

Brand name: Agarol


Phenylpropanolamine: cold and cough

Reason for ban: stroke

Brand name: D'cold, Vicks Action 500


Oxyphenbutazone: Non-steroidal anti-inflammatory drug

Reason for ban: Bone marrow depression

Brand name: Sioril


Piperazine: Anti-worms

Reason for ban: Nerve damage

Brand name: Piperazine


Quiniodochlor: Anti-diarrhoeal

Reason for ban: Damage to sight

Brand name: Enteroquinol


( Source: Dr C.M. Gulhati, Editor, MIMS India )

Monday, March 23, 2009

Anti-cold pills recipe for stroke

NEW DELHI: Popping that pill from your first-aid box every time you get the sniffles could be fatal. Commonly used cough and cold pills and syrups such as D’Cold, Vicks Action 500, Actifed or Coldarin contain phenylpropanolamine (PPA), an ingredient that could rapidly lead to a stroke. In the West, pharmaceutical companies had quickly recalled drugs using the particular ingredient when reports of their fatal side-effects first emerged about three years ago. However, in India most cough and cold preparations continue to use PPA. Professor and head of cardiology at the All India Institute of Medical Sciences, Dr K Srinath Reddy, says: "Almost 50 per cent of the currently available cough medicines contain PPA. Doctors continue to prescribe them even when there are safer alternatives available." But the number of people who suffer the fatal side-effect would hardly ever be known. "Even when a person suffers a stroke, no one will relate it with a cough syrup," says Reddy. What is causing concern among experts is that these are not some rare side-effects of a drug. Trials reported in The New England Journal of Medicine have pointed out that this ingredient alone could be listed as an independent risk factor for stroke.

Saturday, March 21, 2009

Over view of Road traffic accidents and its first aid

Road traffic accidents are increasing at an alarming rate throughout the world. Accidents are the common cause of death among the age group of below 40 years. Patttern of injury varies considerably depending up on whether the victim is a vehicle occupant,a motor cyclist, a pedal cyclist, or a pedestrian. Accident rate in India is much higher compared to other countries, and that of Kerala it is 8% more compared to India

Accident deaths are divided in to three catogeries.

1.Immediately after the accident.In this group head injury is the most common cause of death.

2.Within four hours after the occurrence of accident. This period is known as Golden hour. Majority of the death occurring in this period is due to blood loss.If proper first aid is given ,they can be saved.

3.Death within three weeks due to multisystem failure.

First aid in road traffic accident is given in the following order ie. airway, breathing, circulation,Bandage,splintage, and transport.

AIRWAY-Examine mouth and nose carefully, look for objects obstructing the airway like artificial dentures,dirt etc.

BREATHING (pulmonary resuscitation) Look for any signs of breathing, with the help of chest movement, stethescope etc. If found absent, go for a mouth to mouth or a mouth to nose resuscitation (if the mouth cannot be opened or if there is injury to the mouth) at a rate of 12 breaths per minute.

CIRCULATION: Examine the radial pulse,if it is absent,look for carotid pulse.Suppose this is also not palpable,then we can make sure that heart is not functioning(cardiac arrest)Do cardiac massage.This is to be done in 72 times /minute.cardiac massage and pulmonary resuscitaion should be performed alternately in the ratio of 4:1.It is useless to continue this process for more than 5-8 minutes.Once heart starts functioning patient is to be kept in semi prone position.

Bandage and splintage: completely cover the wounds with the help of pads and bandages. Give proper support for the fractured parts. Sling/splints can be used for this purpose.

Things to be taken care in road accidents ...
Switch off the ignition of the vehicle after the accident. Otherwise it may flare up the vehicle .

In case, lot persons are involved in the accident. Persons who require immediate medical attention should be given priority. This priority wise separation of the injured persons by means of colour cord known as Triage.This can be done by an expert only. In case of shock, foot end should be raised.

Futher, examine, the head eyes,nose, ear,ribs,hips,extreimities for any injuries. Pain and any unnatural movement of ribs, hip should be noticed, which may be an indication of fracture. Make the victim to lie in semi prone position and examine the spinal cord and cervical spine. Fractured part of the spine may press the spinal cord resulting in paralysis. So always take utmost care in handling such kind of persons. All examinations to be finished in two minutes .

Bleeding from Multiple fractures, lacerated wounds are to be taken care of, because it may lead to severe internal hemorrhage and shock. Never try to pull out any object that got trapped in the body, because of the same reason.

Thursday, March 19, 2009

Cancer UPDATES.....

.Whenever we think of cancer,a sort of fear comes up in our mind as it is incurable.Lot of researches are being made in cancer which go to contribute the treatment . When a person has cancer it indicates that, his immune system is weak due to multiple nutritional deficiencies(esp micronutrients).To overcome these deficiencies,change in the the diet and addition of lot of supplements are necessary.

.Diet made of green leafy vegetables (80%)and cooked food(20%) help to put the body in an alkaline environment. Fresh vegetables, juices provide live enzymes that are easily absorbed and reach down to the cellular levels within minutes to enhance the growth of healthy cells. Eat some raw vegetables two to three times a day. ( dark green and dark yellow vegetables like spinach, beans, carrots and other vegetables like cabbage, soybeans, cauliflower, brinjal, onions (red), peppers, garlic, sweet potatoes, tomatoes etc`)

.Unsaturated fat don't contribute to cancer and may in fact have some anticancer properties. Limiting your diet to unsaturated fats, found in plant foods, such as legumes; vegetable oils peanut and canola oil and seafood, such as salmon and tuna, that is high in omega 3 fatty acids can be of great benefit.

.Cancer cells, nourished by sugar and sugar substitutes that are made with aspartamine, better substitute is manuka honey or molasses but only in small amounts.Table salt has a chemical added to make it white in colour.Better alternative is Bragg’s aminos or sea salt. Further, cancer cells feed on mucous.Milk produces mucous especially in the GIT ,by cutting down the milk intake ,cancer cells can be starved. Instead of that, milk substituted with unsweetened soy milk can be used. Avoid tea, coffee, and chocolate, which have high caffeine. Green tea, is a better alternative and it has cancer fighting properties.

.Meat protein is difficult to digest and requires a lot of digestive enzymes, and undigested meat remaining in the intestine may undergo putrefaction ,which results in toxic accumulation. So it is better to eat fish and little chicken rather than beef or pork.More than that Meat contains lot of antibiotics, growth hormones, parasites which are all harmful.

.Supplements (ip6, flor-essence,Essiac,antioxidants,vitamins ,minerals,EFA..)enable the body’s own killer cells to destroy cancer cell. Supplements like vitamin E are known to cause apoptosis or programmed cell death, which is body’s normal method of disposing damaged unwanted cells. Antioxidants prevent free radicals reactions and faulty metabolism in the cell, which makes the cell becoming carcinogenic. They also protect the membrane of intestinal cells. Vitamin A, Betacarotine, Riboflavin, Selenium, Zinc, Foliate, Vitamin E etc. have antioxidant properties.

·Microwaved foods are chemically and molecularly altered,so they are harmful to health.( by reversing the polarity of water molecules in the food and the friction caused by these repeated changes that emits the heat that cooks the food in microwave oven) Besides that, heating food in microwave oven (especially certain food Stuffs that contain fat) using plastics containers release dioxins in to the food ,ultimately to the cells of the body. Dioxins are carcinogenic.

.Water best to drink is purified water or filtered water to avoid known toxins and heavy metals in tap water. Avoid Distilled water, which is acidic

.Cancer cells cannot survive in an oxygenated environment.So exercise regularly .

.Learn to have a loving and forgiving spirit.Anger,hatred, etc put the body in to a stressful and acidic environment . learn to relax and enjoy life.

manuka honey ,Bragg's aminos


Tuesday, March 17, 2009

Music therapy and its utility in MEDICINE

Music washes away from the soul the dust of everyday life. ~Berthold Auerbach

Music therapy is the prescribed use of music by a qualified person to affect positive response in the psychological, physical, cognitive, or social functioning of individuals with health or educational problems.
Healing power of music therapy was identified in early 20th century, during the I st and 2 nd world war, when the soldiers in Veterans hospital got relieved from the distress of both physical and emotional trauma .There after a demand for a separate curriculam for music therapy grew, The first music therapy degree program was launched at Michigan State University in 1944.

A Music therapist assess emotional well-being, physical health, social functioning, communication abilities, and cognitive skills through musical responses.

Music therapy is cost effective, it addresses the whole person. Goals and techniques are adapted to an individual’s changing needs.

According to US researchers ,patients who have undergone bone-marrow transplantation reduces their reports of pain and nausea and may even play a role in speeding up the rate at which their new marrow starts producing blood cells

Therapeutic utility

In cancer, music therapy not only relieves pain but also reduces the dose of pain killers required for further treatment.

Nervous system/Psychiatric illiness

Alzheimer's disease,Brain injuries ,Shingles , Phantom limb pain , persisting Paralysis of leg or arm after a stroke (cerebral thrombosis) Migraine and other headaches,Developmental disablities,Anxiety disorder,Phobias ,Mood disorders, neuralgia ,Carpal tunnel syndrome ,Travel sickness ,Tiredness etc..

Reproductive system disorders: Menstruation pains, Pain after childbirth

Connective tissue disorders Neck and low back pains Muscle tension ,acute and chronic pain
Pain after operations ,Whiplash injury ETC

In India
Certain ragas like KALYANI, MOHANAM ,PAHADI, ,BHOOP,YAMAN ARE PROVED TO HAVE THERAPEUTIC EFFECT IN RELIEVING depression,insomnia stress and tension.

Vitiligo.... Is it an autoimmune disease?

As we all know, Vitiligo is a loss of skin melanocytes that causes areas of skin depigmentation of varying sizes.

Incidence rate is comparatively higher in laborers of Gujarath, Rajasthan working in dyeing, and printing industry. 50 % of the affected groups are from below 20 yrs. Those affected below 10 yrs of age, Clinical manifestation of the disease - as a single nerve distribution unilaterally, known as dermatomal vitiligo. Family history play some role in about 18-20% of patients.
Vitiligo commonly involves the face, digits, dorsal hands,flexor digits,elbows,knees,shins,dorsal ankles,armpit,inguinal area,anogenital area,umbilicus and nipples.


It may be Generalised Vitiligo: involving most of the skin surface

Segmental Vitiligo: Depigmentation may be localized, involving 1 or 2 spots or entire body segments

Vitiligo and autoimmunity

Etiology is unclear, According to some recent reasearches, the variation in the ratio of different lymphocytes and norepinephrin are the main causative elements .Exacerbation of the illiness noticed after various stressful states of the body such as injuries,pregnancy,delivery ,operations etc.

Vitiligo and autoimmune diseases

About 30% of vitiligo patients are also suffering from thyroid related autoimmune diseases. The strongest association is with hyperthyroidism (Grave's disease) and hypothyroidism (Hashimoto's thyroiditis), besides this existence of diabetis, pernicious anemia, addisons disease are also identified . However, the relationship is unclear and may be coincidental. These all lead to the speculation that it is an autoimmune disease

Saturday, March 14, 2009

New way assesment of long term Glucose control.

A change from Glycosylated Haemoglobin (HbA1c) to A1C Derived Average glucose(ADAG)

Glycosylated Haemoglobin


It’s significance in the treatment of diabetes is commendable,because it shows the glucose status of previous three months. This number tells how well your diet, exercise, and medicine are working.An increase in A1c has been correlated with an increase in the risk of microvascular complications associated with diabetes.

Recommented values set byAmerican Diabetes Association, the Canadian Association of Diabetes and the European Association for the Study of Diabetes are as follows…

HbA1c reported in %.

>7% it iindicates the failure in diabetic treatment



Normal person it is <5.4%


Despite A1c being recognized as the standard measure of glucose control,number of general issues exist with the assay the · Many patients do not understand how to interpret the A1 c value,because it is expressed in % · Accuracy depends on the machines and the standardization method one is following. Though national glyco haemoglobin stanardisation programme have some recommendation in this aspect, it is not been followed all over the world. The above issues led the International federation of clinical chemistry to develop a reference method that is more specific to A1c and could be standardized worldwide.Globally now it’s named as A1 c derived average glucose(ADAG) A1 c derived average glucose(ADAG) or eAG

According to new criteria Hb A1c-derived average glucose or eAG is a new value which is used to assess long-term glucose control. The new system correlates A1c values with long-term control of glucose and is reported in units of mg/dL or mmol/L rather than a
percentage value.

After undergoing several clinical trial The equation identified for the Estimated average glucose is

Average glucose (mg/dL) =28.7 x A1c - 46.7
Average glucose (mmol/L) =1.59 x A1c – 2.59

A1c value / Estimated Average Glucose

5%................................97 mg/dL (5.4 mmol/L)
6%................................126 mg/dL (7 mmol/L)
7%................................154 mg/dL (8.5 mmol/L)
8%................................183 mg/dL (10.1 mmol/L)
9%................................212 mg/dL (11.7 mmol/L)
10%..............................240 mg/dL (13.3 mmol/L)
11%..............................269 mg/dL (14.9 mmol/L)
12%..............................298 mg/dL (16.5 mmol/L)

Problems with eAG
Although it improves patient understanding of their long-term glucose control,The equation utilizes a laboratory reported A1c value ,Inaccurate A1c values should be considered when the patient’s recorded self monitoring blood glucose values do not appear to coincide with the measured A1c value

( Certain other Factors which falsely increase A1c include:
· iron deficiency anemia
· patients without a spleen
A number of factors have inconsistent effects on
A1c and include:
· high vitamin C intake
· high vitamin E intake reduce the life span of a red blood cell.6 Factors

which falsely lower A1c include:
· recent acute blood loss
· hemolytic anemia
· chronic blood loss )