Volume 3 Issue 3 March 2013

Our Experience Hydroxyurea: Water for Life: a With Bombay Effective single dip could Blood Group - alternative for make you immune Talk at ISBTI transfusions for to most diseases - Karnataka Annual thalassemia. and a second dip CME in Bellary. could have killed Page 6 Page 11 you. Page 4 Blood from Bangalore Helps Save A Life in Instanbul-Turkey 23rd February 2013: Sankalp Foundation, organised for 3 units of Bombay phenotype for a critical patient receiving treatment at Istanbul University, Turkey.

On 20th February 2013, Sankalp India Foundation received a blood request from the Department of Thoracic Surgery, Istanbul University, Turkey. The hospital identified the patient's blood group as Bombay blood group and for the past 7 days they had been looking for blood donors across Turkey without any success. They came across www.bombaybloodgroup.org, an units were on their way to the patient in Istanbul. initiative of Sankalp India Foundation - which networks Bombay Blood Group donors, needy and associated blood banks in India. Once they Since April 2012 itself, the team has organised approached the organisation to seek help, the first for 101 Bombay Blood Group units for 50 of its kind humanitarian effort to make available patients in various parts of the India - and now the blood units to the patient was initiated. including Turkey! Though Sankalp India Foundation has regularly been organising blood units for patients across the About BombayBloodGroup.org country, this was an exceptional request since the On 1st July last year, a group of individuals who units had to be transferred over a very long shared a uniqueness came together on a lazy distance - across the borders. Thanks to the Sunday afternoon at Rashtrotthana Blood Bank, vibrant Bombay Blood Group donors community Chamrajpet. The event was being called the first in Bangalore, all in a matter of 48 hours the 3 units ever Bombay Blood Group Donor's meet. The of blood were donated and kept ready for the purpose was to explore the possible strategies to patient at Rashtrotthana Blood Bank, Bangalore. network all individuals, organisations and While the family processed the Visa and the specialists relating to Bombay Blood Group so as paperwork, for the very first time temperature to ensure best possible utilisation, awareness and controlled logistics was put to use to enable safe availability of this extremely rare blood group. transfer of blood for up-to 48 hours. With all Little was it known then, that the organised necessary arrangements in place, the patient's attempt to being together individuals who share son came down to Bangalore to collect the units the Bombay Blood Group will bring about a on 22rd February and by the morning of 23rd, the synergy that will achieve remarkable results in the A wise man gets more use from his enemies than a fool from his friends. —Baltasar Gracian Sankalp Patrika Volume 3 Issue 3 Page 2 March 2013 months to come. donors across the country - and now the world! ! steady progress is being made in matters The point to be noted are: that relate to judicious use of Bombay Blood ! several people with this rare blood group Group and minimise inconvenience to who were not donating regularly earlier, are Bombay Blood Group donors. now regular donors ! there is less harassment and psychological Congratulations BombayBloodGroup.Org pressure on the regular Bombay blood group members :-) donors ! several of the requests were resolved by Preparedness: The Key To making use of the advancements in transfusion medicine and blood alternatives Success ! the network has handled blood requests and Receiving emergency requests of extremely

"Well done is better than well said." - Benjamin Franklin Sankalp Patrika Volume 3 Issue 3 Page 3 March 2013 complex nature on a routine With the understanding basis, Sankalp volunteers Sankalp gained in this event, make keen attempts to the organisation has 3 units of outsmart the problems by TCL on a standby for any preparing aggressively. A emergency. The organisation blood request had come from also has the required know- Indore at the same time when how of mass transferring Bal Thackeray died in units of blood up to 72 hours Mumbai. The lady was critical without any kind of battery, and Bombay Blood Group power, refrigeration or special was needed urgently. handling. Maharashtra was on a boil and the probability of getting How Proactive anything moving there was close to 0. From Bangalore or from Hyderabad it would have taken Blood Banking Enables Saving more than 12 hours to transport units since no Lives direct flight was available. Battling the extreme When the request to organise 3 units of Bombay situation, though a solution was found out in an Blood Group for the patient from Instanbul was immediate sense, the organisation took upon itself received, a small meeting was organised on call to the challenge of preparing to transport blood for fix up a fail proof multi-level backup up strategy to more than 12 hours safely. The target was kept at ensure smooth work. While the volunteers 36 hours since that would make it practically demarcated the responsibilities, there was a need possible to reach every corner of the country with to identify one blood bank which could serve as the blood units - safely. the focal point for this activity - and the centre chosen was Rashtrotthana Blood Bank. In next 48 It was a difficult pursuit since nobody in blood hours the blood bank offered exceptional service banking thought that it was feasible to transport which made it possible to handle the blood request units beyond a couple of hours. However, Google of such complexity. Guru gave the solution after intense search - they ! The blood bank accepted donations round call it Temperature Controlled Logistics!. We the clock - which made it feasible for a Bombay needed a solution that would enable blood Blood Group donor who was willing to donate transfer over extended hours without the need of blood late at night to come and donate. battery or power (so that airlines are willing to ship ! The blood bank facilitated the conditioning the units). The solution came in the form of a 14 kg of the TCL packages - The medical officer and box costing more than a thousand rupee. The staff were available round the clock for specifications and test reports showed that it could coordination and logistical support maintain temperature in 2-8 degrees Celsius for ! The additional documents that were 72 hours if conditioned as prescribed. The required to be prepared for shipping of the organisation spoke to the vendors and got the ball units were done effectively. rolling to procure the boxes. ! The blood bank processed the collected units and tested them at a high priority leading In the January, 2013 edition of Sankalp Patrika to minimal time being wasted there was an article on page 3 which indicated how one could achieve transportation of blood The work done by the team at Rashtrotthana units safely over long duration of time. blood bank made it possible to save this life by their exceptional pro-activity at quick and effective Fortunately, once we realised that blood will collection, processing and packaging of blood. require to be transported across the border, we Sankalp thanks them for their continued support. had the correct packaging solution right before us. In 2 hours after the final decision to make an . attempt to help, we had the ice packs undergoing conditioning. The units travelled 26 hours without a glitch in the safety of the TCL packaging.

"Opportunities multiply as they are seized." - Sun Tzu Sankalp Patrika Volume 3 Issue 3 Page 4 March 2013 Water for life Having missed the industrial revolution, we A Swedish research team led by Joakim Larsson have tried hard to catch up with the new-age from the University of Gothenburg conducted a study on the levels of pharmaceutical drugs in the industries, mainly Information Technology water discharged from the Patancheru Enviro and Biotechnology. While the growth of IT in Tech Limited (PETL) - an old and outdated India is universally known, it is noteworthy common effluent treatment plant in the Patancheru area of Hyderabad which treated the that Indian pharmaceutical industry ranks discharge from around 90 bulk drug third in the world in terms of volume and manufacturing units located in the area. The fourteenth in terms of value. Well, lesser shocking results of the study, which were published in 2009, revealed the presence of very known is the fact, that until recently, there high levels of antibiotics such as Ciprofloxacin and existed a river in Hyderabad where a single Cetirizine. In one place, the levels were found to dip could make you immune to most diseases - exceed that of human blood plasma concentrations. The water, consumed and used and a second dip could have killed you. by about 2 lakh people of the area was a floating medicine cabinet - a soup of 21 different active Due to the intense western pharmaceutical ingredients! pressure to hold down prescription drug prices, the One of the scientists quoted - "If production of active you take a bath there, then you pharmaceutical ingredients - have all the antibiotics you need compounds sold in bulk to be for any treatment. The question used in making pills and is for how long?" The biggest capsules - boomed for years in concern was whether the India. The growth of Indian discharge from the waste-water pharmaceutical industry treatment facility was spawning occurred mainly around drug resistance. The treated Hyderabad, after the Patents Act effluent from PETL was getting of 1970 made a distinction discharged into the Iskkavagu between product and process stream, which then flows into the patents in India. Using the Nakkavagu river. The knowledge pool of India, within Nakkavagu river then runs into decades, Hyderabad emerged the Manjeera river (the drinking as one of the worlds largest water source for Hyderabad, with centers for bulk drug production. a population of 6.3 million) which The drugs from here were, and ultimately joins the Godavari are still being exported to major river. markets all across the world. By accident or design, the administrative The pharmaceutical manufacturing units were boundary of Pocharam gram panchayat ended a concentrated in the Patancheru area of the city. few feet before the treatment plant. The treatment The story was all flowery, until it was realized, that plant fell in the jurisdiction of the GHMC (Greater in the global pharma industry, the environmental, Hyderabad Municipal Corporation). Although human, and social costs have been greatly topographically the village and the treatment plant overlooked. In the surrounding areas - abortion were contiguous, they are governed by different rates and skin diseases increased greatly, stunted laws. The villagers had to travel to Hyderabad for growth was reported in children. Patancheru, even the smallest of matter concerning the plant. unknowingly had become the home to the most drug polluted water in the world. Well, after years of fighting and activism, in 2010, all effluents from the Patancheru water plant "There are people in the world so hungry, that God cannot appear to them except in the form of bread." - Mahatma Gandhi Sankalp Patrika Volume 3 Issue 3 Page 5 March 2013 started getting diverted through a pipeline to a Downstream from factories, entire aquatic larger treatment plant 18 kilometers away. That ecosystems are at risk. Even extremely diluted reduced Patancheru's pollution problems simply concentrations of drug residues harm the by diverting the effluents, still drug-laced but reproductive systems of fish, frogs and other diluted, into a different river. The problem, aquatic species. Humans, consuming these although reduced, very much exists even today! wastes are also prone to numerous water borne diseases. Pharmaceutical breach into drinking water is not just a problem in India. Concentrations of SOS! - speaking of solutions! Yes they are very pharmaceuticals have been found in drinking much available, although expensive. Treatment of water provided to at least 46 million Americans. effluents with ozone, ultraviolet light, or activated But the waste-water from Patancheru contained carbon can break down drug compounds. But 150 times the highest levels detected in the U.S. profit driven manufacturers have, over the years Drug factories in the U.S. and Europe have strictly opposed such additional processing that would enforced waste treatment processes. But, with increase their costs. Recently, Swedish lesser infrastructure for greater profits, this has government has proposed an official 'good become a dire situation, being faced by many manufacturing practices' which are required of all developing countries across the world. facilities that produce drugs for sale in Europe, be amended to mandate pollution control, wherever May it be Taiwan, China, Korea or the USA, it is a the production takes place. global problem! The concern is not limited to merely small areas, but to as far as bacterias can Such policies can only be pushed down by the go. In water treatment plants, bacteria-laden governments across the world, driven by active human wastes mingle with high concentrations of citizen activism. It's high time people, antibiotic compounds. The effluents that emerge, governments and businesses understand that can mutate and breed bacteria that are resistant to when they use words like 'one world', 'equality' and treatment by multiple drugs - potentially triggering 'justice', it is equally important they avoid doing global health emergencies. grave harm on one side of the world while doing good on the other, especially when the world is too Drug resistance, although the scariest, is not the small and fragile to be destroyed! only problem of these treatment plants.

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"Happiness is good health and a bad memory." - Ingrid Bergman Sankalp Patrika Volume 3 Issue 3 Page 6 March 2013 Our Experience With Bombay Blood Group ISBTI Karnataka organised the annual CME enough Bombay Blood Group(BBG) tests. at VIMS Bellary on 23-34 February 2013. There were several instances when blood banks read BBG as O+ve as issued blood Sankalp India Foundation was invited to leading to severe hemolytic reactions. Several give a talk on "Our Experience With Bombay regular Bombay Blood Group donors shared Blood Group". The CME coincided with the the fact that they had donated blood several first ever international transfer of Bombay times before the blood banks discovered and communicated to them that their blood group Blood Group organised by the organisation. was Bombay blood group. This clearly The CME gave the organisation an indicates that several individuals with BBG are opportunity to share with the blood banking going undetected. community of Karnataka, the work done, the ! Testing at time of issue it is futile as it leads to wastage. Several units of BBG essential learning and the roadmap to take expired because they were detected to be care of Bombay Blood Group need in specific BBG at the time of issue, leaving a very short and rare blood groups in general. window for proper utilisation of the units.

The organisation shared the fact that within this (financial) year the organisation had taken up 50 blood requests totalling to 101 units till the date of the presentation. With most of the donors and the needy coming from the Southern states, the current estimates of the prevalence of Bombay Blood Group (1 in 17,000) don't seem accurate. The number of requests has risen multi- fold in last few years. This clearly indicates that in the last few years there is a good reason to believe that there were fewer detection of the cases where Bombay Blood Group was needed. Sankalp also shared the story of the child who is thalassemia and for whom blood is being organised since last 2 years.

Situation and Detection Based upon the findings during the process of handling the blood requests the organisation made the following observations: ! We are not detecting as many BBG as we should The number of requests simply indicate that we must have more people with Bombay blood group getting detected in regular screening. ! Not everyone is doing "It's kind of fun to do the impossible." - Walt Disney Sankalp Patrika Volume 3 Issue 3 Page 7 March 2013

False Detection False detection and improper transfusion has been a major problem with BBG. Not only centres in low resource areas but also in prominent centres have been wrongly detecting blood groups. ! Within 2012-13 we have had 5 instances of incorrect detection of blood group followed by wrong transfusions causing severe haemolytic reaction and more complications. ! The patient ended up needing more units of blood than what would have been required initially. ! Ensure networking and easy information Problems with Availability flow between blood banks about need and With 10 units required each month Sankalp collection of Bombay Blood Group. Helpline pushed the limits to ensure that each willing donor numbers 9880132850 / 9886064563 / and each donated unit was used optimally. 9900161551 are being promoted so that the Following issues were observed: blood banks can exchange information about ! Several small lists of Bombay Blood Group BBG donors were being maintained. Sub-critical ! Get all the donors together to form a larger mass leading to staggered availability. pool. BombayBloodGroup.Org has become ! There were attempts to reserve the donors the common platform for all individuals with for donations for specific institutions. BBG. ! The good donors, who donated regularly ! Setup effective cold chain to enable long were being called by everyone emotional distance transfer of units blackmail was rampant! They were sometimes ! Aggressive usage of methods to minimise donating in less than 90 days simply because blood usage of the pressure. ! Remaining units post procedures were not being utilised and reported proactively. Cold Chain and Logistics Minimum discomfort to donor. Minimum cost to Management patients. ! Educate, motivate and encourage. The following is required and is being worked Sankalp has been persistently working to upon to ensure proper availability of blood across increase the general level of awareness about the geographies. ! matters relating to rare blood groups among all Temperature controlled logistics for 4, 4-12, stakeholders. and more than 12 hours is being put to use. ! ! Sankalp is promoting regular testing for Resolution of regulatory and legal Bombay Blood Group right when O group requirements for transfer ! get's detected. Liaison with airlines and blood banks o BBG screening is done for all donors who nationally. ! donate blood in camps organised by Consideration for poor patients to make Sankalp blood available without additional costs. ! o Sankalp Patrika regularly stresses the Crisis management protocols well need for regular BBG screening. understood by volunteers and organisations to handle difficult situations. "I find that the harder I work, the more luck I seem to have." - Thomas Jefferson Sankalp Patrika Volume 3 Issue 3 Page 8 March 2013

! Connect and network Aggressive use of alternatives and ! Keep hemoglobin high managing with lesser blood ! Screen all family members whether they Sankalp is promoting the use of blood alternatives can donate or not! aggressively to reduce the number of BBG that are required. Recommendation: Authorities ! Family screening for all eligible and non- ! Make Bombay Blood Group screening at eligible family members is being organised time of collection mandatory. ! Use of EPO(erythropoietin) ! Make it mandatory for airlines to transport ! Autologous donations wherever applicable Bombay Blood Group Units Possibly free of ! Intra-operative blood salvage charge ! Double red cell donations (apheresis) ! Come up with a clear policy for national and ! Move to better centres conservative international transfer of blood and leave procedures and better equipment regulation in the hands of just 1 department. Recommendations: Blood Banks ! Provide facility for cryopreservation But . . ! Do BBG test at time of collection do we have enough units to be able to spare ! Communicate collection of BBG some for cryopreservation? immediately ! If unutilised intimate network From the trends, the demand and the ! Share donor details difficulty in organising for each unit it clearly ! Learn proper packaging and transportation looks like the journey for BBG in specific and essentials rare units in general has just begun. Recommendations: Donors

I’d rather live with a good question than a bad answer. — Aryeh Frimer Sankalp Patrika Volume 3 Issue 3 Page 9 March 2013 News and Updates from February

Let’s see what was happening in the month What the donors say of February in Sankalp. Feels good to donate blood. Aegis *** 5 and 11 Feb 2013: 2 camps were organized in 2 different locations of Aegis. 31 units were collected Its a good duty towards society, should be on 5th and 75 on 11th. There was a good support ready for it. from company and employee participation was *** great. Really Nice Experience. Please come back. I Capgemini would love it if you have platelet donation 7 Feb 2013: 19th Blood donation drive was camp in SAP too. organized in Capgemini, Ecospace campus, As *** always, there was tremendous support from company and a good number of people came planning and publicity we hope to increase this forward to donate including Mr Mahesh, who had number significantly in future drives with Aricent. started donating from one of our camps and this was his 7th donation in Capgemini! More than 150 GSS College, Belgaum people turned up for the cause with 128 of them 23 Feb 2013: Blood donation drive was organised donating blood. at GSS College. The college has been involved with Sankalp for more than a year and was also a SAP part of the Sankalp workshop at Belgaum. Good 12 Feb 2013: SAP organized their first blood drive enthusiasm form team red volunteers and NSS with Sankalp. The venue was great and there was officer resulted in 70 donors coming up and 60 of good support from management. Good publicity them donating blood. KLE blood bank collected was done for the event resulting in good donor the units. turnout. A total of 145 units of blood was collected in the drive. Krishna Greens Apartments 24 Feb 2013: Every year during the month of Feb, Akamai KG Apartments organize a blood donation drive 13 Feb 2013: First blood donation drive at Akamai with us. This year the drive was organized. More was organised. 66 blood donors came forward to than 30 people came forward to donate and 27 donate blood while eventually 52 got an units of blood was collected. Great efforts were put opportunity to donate after a rigorous screening up by camp organizers to motivate people for process. The enthusiasm of the team at Akamai was commendable.

Toshiba 19 Feb 2013: Toshiba organized their 4th blood donation drive. This drive was being planned from long back but kept getting postponed. 62 units of blood was collected in the camp.

Aricent 19 Feb 2013: First blood drive was organized in Aricent. Due to company being shifted from the premises where drive was organized, the response from this camp was below expectation. 22 units were collected in the event. With proper

Believe those who are seeking the truth. Doubt those who find it. — André Gide Sankalp Patrika Volume 3 Issue 3 Page 10 March 2013 spending their Sunday donating blood. Door to 26 Feb 2013: Dr Lawrence Faulkner from door publicity helps in Apartment drives. Cure2Children, Italy was in Bangalore to spend a day with Sankalp India Foundation. Several 'Our Experience with Bombay Blood issues related to the viability of offering BMT as a Group' presentation at ISBTI Karnataka curative option to the low risk category children were discussed and understood. Cure2Children Annual CME has already partnered with Sankalp India Sankalp India Foundation was 24 Feb 2013: Foundation to offer free HLA typing for the children invited to make a presentation about the who are fit to undergo BMT and their siblings. experiences of the organisation with Bombay During his visit, Dr Faulkner also spoke to the Blood Group. It was a very interesting session and families of the 5 children who found a matching the volunteer was happy to have got an sibling. The initial impression he had was that all opportunity to speak on this topic. We thank the five children were in good shape to go for a BMT organizers for giving us an opportunity. with a few months of medication.

SN Arts and Commerce College and There were also meetings with the Government First Grade College, representatives of 2 centres to explore the option Hukkeri of setting up of a 2 bedded BMT unit which would 25 Feb 2013: Blood donation drive was organised offer the treatment at a no profit no loss basis. in a small time called Hukkeri. 2 colleges, SSN Arts Good progress was made in this direction and a and Commerce College and Government First final agreement is likely to happen soon. Grade College teamed up along with us to conduct the first drive there. Although the infrastructure was not very good in either, the spirit and enthusiasm was really good. A lot of pre camp motivation and publicity resulted in more than 45 donors from both colleges turning up. We eventually had 32 donations. Mahaveer blood bank collected the units. All these donors were from rural areas.

ST Ericsson & ST Microelectronics 26 Feb 2013: A camp was organized by ST Ericsson and ST Microelectronics. 95 units of blood was collected in the drive.

Exploring BMT for children with Thalassemia

Always forgive your enemies; nothing annoys them so much. - Oscar Wilde Sankalp Patrika Volume 3 Issue 3 Page 11 March 2013 Hydroxyurea: Effective alternative for transfusions for thalassemia Hydroxyurea has shown great results in patients became transfusion independent reducing the transfusion dependency of (responders) after hydroxyurea therapy, four patients showed a reduction in their transfusion children who have thalassemia intermedia. requirements (partial responders), and three With sufficient medical evidence on it’s side, patients were non-responders. (1) HU is an alternative that should be seriously 2. Department of Medicine, Faculty of Medicine, considered. Siriraj Hospital, Bangkok, Thailand: Examined the hematologic effects of orally administered Beta-thalassemia is a genetic (or "inherited") hydroxyurea in 13 patients with beta- blood disorder that reduces the body’s ability to thalassemia/Hb E, including four patients who had produce "adult" hemoglobin(HbA) and causes been splenectomized. Overall, patients anemia. The people who suffer from this disorder responded with a 32.5% increase in fetal need to take blood transfusions in order to hemoglobin. Concluded that increased Hb F maintain the required hemoglobin level in their production in beta-thalassemia/Hb E patients, body. However, the blood transfusions are with an improvement in the alpha:non-alpha associated with several complications. With each globin ratios and, probably, the effectiveness of transfusion there is more iron being added. erythropoiesis, can be achieved using HU.(2) Chelation therapy is now available to remove the excess iron. However owing to 3. Twenty-three patients with high cost, it is out of reach for beta-thalassemia major received most of the patients. Most deaths HU at a mean dose of 16 due to thalassemia are mg/kg/d. The mean volume of associated with complications PRC transfused was reduced which result from the blood from 2126.45 mL to 1489.59 mL transfusions. (P<0.001). The interval between transfusions was increased by Let's look at what happens in the 68.7%. Hydroxyurea was found body of a child with thalassemia. to be safe in patients with beta- The bone marrow produces hemoglobin which is thalassemia major, and resulted in reduction in the defective. However, there is good news which has transfusion requirements and in increase of the been around of years. Hydroxyurea is a drug intervals between transfusions.(3) which is known to reduce the transfusion requirements of patients with thalassaemia With known complications associated with intermedia. Hydroxyurea stimulates the transfusion therapy, the difficulty in organising for production of healthy hemoglobin HbF. Please blood in several places of the country, high costs see the three studies below which clearly indicate associated with transfusion and chelation and the that hydroxyurea is effective. Hydroxyurea is limited access to proper monitoring of side-effects widely available and is not very expensive. With so of transfusion therapy, hyroxyurea provides an many benefits on it's side there is an urgent need alternative which needs to be looked at seriously. for all clinicians associated with management of Like it has been proved in numerous studies, it is thalassemia to consider the option of hydroxyurea likely to bring down the frequently of transfusion for the children who have thalassemia intermedia. for some children while completely ending transfusion dependence for some others. Look at the following studies: 1. National Institute of Immunohaematology, References Mumbai: 11 patients with HbE-ß-thalassaemia (1)Effect of hydroxyurea on the transfusion requirements in patients with severe HbE-ß-thalassaemia: a genotypic and receiving regular transfusion plus two less phenotypic study frequently transfused patients were selected for Khushnooma Y Italia, Farah F Jijina, Rashid Merchant, Sangeeta hydroxyurea therapy. . Four clinically severe Panjwani, Anita H Nadkarni, Pratibha M Sawant, Sona B Nair, What we think, or what we know, or what we believe is, in the end, of little consequence. The only consequence is what we do. —John Ruskin Sankalp Patrika Volume 3 Issue 3 Page 12 March 2013

Kanjaksha Ghosh, Roshan B Colah (PRC) Transfusion Requirement Among Children Having Beta- J Clin Pathol 2010;63:2 147-150doi:10.1136/jcp.2009.070391 thalassemia Major: Karachi HU Trial (KHUT) (2)Hydroxyurea increases hemoglobin F levels and improves Ansari, Saqib H. MBBS, DCH, DPGN, MPhil; Shamsi, Tahir S. the effectiveness of erythropoiesis in beta- MBBS, FRCPath; Siddiqui, Fahad J. MBBS, MSc; Irfan, thalassemia/hemoglobin E disease Muhammad MBBS, FCPS; Perveen, Kausar BSc; Farzana, S Fucharoen, N Siritanaratkul, P Winichagoon, J Chowthaworn, Tasneem MBBS, MCPS; Panjwani, Vinodh K. MBBS; Yousuf, W Siriboon, W Muangsup, S Chaicharoen, N Poolsup, B Ayesha MBBS; Mehboob, Tabassum PhD Chindavijak, P Pootrakul, A Piankijagum, AN Schechter, and GP Journal of Pediatric Hematology/Oncology:November 2007 - Rodgers Volume 29 - Issue 11 - pp 743-746 doi: Blood 1996 87:887-892 10.1097/MPH.0b013e318157fd75

(3)Efficacy of Hydroxyurea (HU) in Reduction of Pack Red Cell The Window Two men, both seriously ill, occupied the same everything while I never get to see anything? It hospital room. One man was allowed to sit up in didn't seem fair. As the thought fermented, the his bed for an hour a day to drain the fluids from man felt ashamed at first. But as the days passed his lungs. His bed was next to the room's only and he missed seeing more sights, his envy window. The other man had to spend all his time eroded into resentment and soon turned him flat on his back. sour. He began to brood and found himself unable to sleep. He should be by that window - and that The men talked for hours on end. They spoke of thought now controlled his life. their wives and families, their homes, their jobs, their involvement in the military service, where Late one night, as he lay staring at the ceiling, the they had been on vacation. And every afternoon man by the window began to cough. He was when the man in the bed choking on the fluid in his next to the window could sit lungs. The other man up, he would pass the time watched in the dimly lit by describing to his room as the struggling roommate all the things he man by the window groped could see outside the for the button to call for window. help. Listening from across the room, he never The man in the other bed moved, never pushed his would live for those one- own button which would hour periods where his world would be have brought the nurse running. In less than five broadened and enlivened by all the activity and minutes, the coughing and choking stopped, color of the outside world. The window along with the sound of breathing. Now, there was overlooked a park with a lovely lake, the man had only silence--deathly silence. said. Ducks and swans played on the water while children sailed their model boats. Lovers walked The following morning, the day nurse arrived to arm in arm amid flowers of every color of the bring water for their baths. When she found the rainbow. Grand old trees graced the landscape, lifeless body of the man by the window, she was and a fine view of the city skyline could be seen in saddened and called the hospital attendant to the distance. As the man by the window described take it away--no words, no fuss. As soon as it all this in exquisite detail, the man on the other seemed appropriate, the man asked if he could side of the room would close his eyes and be moved next to the window. The nurse was imagine the picturesque scene. happy to make the switch and after making sure he was comfortable, she left him alone. One warm afternoon the man by the window described a parade passing by. Although the Slowly, painfully, he propped himself up on one other man could not hear the band, he could see it elbow to take his first look. Finally, he would have in his mind's eye as the gentleman by the window the joy of seeing it all himself. He strained to portrayed it with descriptive words. slowly turn to look out the window beside the bed. Unexpectedly, an alien thought entered his head: It faced a blank wall. Why should hehave all the pleasure of seeing …by crushing individuals, they cannot kill ideas. - Bhagat Singh Sankalp Patrika Volume 3 Issue 3 Page 13 March 2013 War If death strikes before I prove my blood, had mobilized 200,000 troops, but due to the I swear to God, I’ll kill death! terrain the mobility was extremely difficult. Pakistani intruders were at high peaks and thus at -Cap. Manoj Kumar Pandey a very advantageous position. They could easily monitor any Indian movement on the highway. was fought between India and Pakistan Also, they were equipped with mortars, artillery between May and July 1999. Main cause of war and anti-aircraft guns and their posts were heavily was the infiltration of Pakistani troops and mined by anti-personnel mines. All this combined militants in the Kargil, and other parts of made Operation Vijay very difficult for India. Indian border. This war was the only instance of a direct armed confrontation between two nuclear First priority of Indian troops was to gain control of states. Indian response to this infiltration was peaks in the vicinity of NH 1D. Thus Tiger Hills and termed Operation Vijay. Tololing Complex in Dras became primary targets for India. Apart from these important peaks, there were numerous points which were merely given a Events Leading to War number for identification. Capture of these points There was a long calm between the two states was important to regain control of highway. By after the war of 1971. During 80’s there was no mid-June, most of these points were captured and major conflict. However, heavy military the Tiger hill was eventually freed on 4th July. involvement along LOC continued from both the countries. During After gaining the late 90’s, control of hills Pakistan over-looking developed a new highway, second strategy to occupy target of Indian Indian side of LOC. troops was to drive Instead of directly invading force engaging in back across LOC. combat with India, To achieve this they started to target, India support infiltrators involved artillery in crossing the Bofors FH-77B border, by giving field howitzers. cover fire. This was However, due to named Operation the inaccessibility Badr. The main of terrain and aim of these enemy being infiltrators, often invisible in most fronts, the Bofors as well as Air Pakistani soldiers, was to occupy barren land and support proved to be ineffective. The only to clear ridges inside India. the posts from intruders was direct frontal attacks on peaks where temperature ranged from -11 to - On 3rd May, 1999, Pakistani intrusion was 15 C. This resulted in some heavy casualties to reported by shepherds. The patrol sent by Indian India. army to investigate this report was captured and executed. On May 9, Pakistani army heavily Two months into the conflict, Indian troops had shelled ammunition dump in Kargil, officially slowly retaken most of the ridges that were beginning the war. encroached by the infiltrators. According to official count, an estimated 75%–80% of the intruded The War area and nearly all high ground were back under Kashmir is a mountainous region with high altitude Indian control. peaks. The only connectivity to captured posts was through National Highway ID. Though India Following the outbreak of armed fighting, Pakistan If there is anything that cannot bear free thought, let it crack Sankalp Patrika Volume 3 Issue 3 Page 14 March 2013 Khalubar, his platoon came under heavy and intense enemy fire from the surrounding heights. Captain Pandey was tasked to clear the enemy positions before day. He quickly sent one section to clear the enemy positions from the right and himself proceeded to clear the enemy positions from the left. Fearlessly assaulting the first enemy position, he killed two sought American help in de-escalating the conflict. enemy personnel and destroyed the second However, President Clinton refused to intervene position by killing two more. He was injured on the until Pakistan had removed all forces from the shoulder and legs while clearing the third position. Indian side of the Line of Control. Following the Undaunted and without caring for his grievous Washington accord on July 4, where Sharif agreed injuries, he continued to lead the assault on the to withdraw Pakistani troops, most of the fighting fourth position urging his men and destroyed the came to a gradual halt, but some Pakistani forces same with a grenade, even as he got a fatal burst remained in positions on the Indian side of the on his forehead. This singular daredevil act of LOC. Captain Pandey provided the critical firm base for the companies, which finally led to capture of The launched its final attacks in the Khalubar. The officer, however, succumbed to his last week of July; as soon as the Drass subsector injuries. had been cleared of Pakistani forces, the fighting ceased on July 26. The day has since been Captain Manoj Kumar Pandey, thus, displayed marked as Kargil Vijay Diwas (Kargil Victory Day) most conspicuous bravery, indomitable courage, in India. By the end of the war, India had resumed outstanding leadership and devotion to duty and control of all territory south and east of the Line of made the supreme sacrifice in the highest Control, as was established in July 1972 as per the traditions of the Indian Army. Simla Agreement. Grenadier Yogender War Heroes Singh Yadav, 18 The war was fought in extremely harsh conditions Grenadiers, in the wee and saw some exemplary display of courage, grit morning hours of 04 and sacrifices from Indian soldiers. As per official July 1999 was part of Indian reports, 527 Indian soldiers laid their lives the Commando protecting their motherland in Kargil War and 1363 'Ghatak' Platoon tasked were wounded. to capture three strategic bunkers on Manoj Kumar Pandey Tiger Hill. The approach Captain Manoj Kumar Pandey was born on 25th was a vertical cliff face, june 1975, in Sitapur, . He was snowbound at 16,500 commissioned in 1/11 Gurkha Rifles. feet. Grenadier Yadav was trained in mountain Captain Manoj Kumar Pandey took part in a series climbing and of boldly led attacks during ‘operation Vijay; volunteered for the job. His task was to fix ropes forcing back the intruders with heavy losses in which could be later used by his company to climb. including the capture of Jabbar Top. On the Half-way up, an enemy bunker opened up night of 2/3 July 1999 during the advance to machine gun and rocket fire. His Platoon Ya toh Tiranga lehrake awunga, ya phir Tirange mein lipta huwa chala awunga, lekin awunga zaroor - Captain Sankalp Patrika Volume 3 Issue 3 Page 15 March 2013 Commander and 2 others fell to the heavy volume crept towards the second enemy bunker. The of automatic fire. He himself was hit by 3 bullets in enemy soldiers, taken completely by surprise, shoulders and groin but displaying superhuman were killed by him as they fled their post. Inspired strength and resolve, he climbed the remaining 60 by his act the rest of the platoon charged, feet, all by himself and reached the top. With rare assaulted the feature and captured Area Flat Top. grit and courage, he crawled up to the bunker critically injured and lobbed a grenade killing four Vikram Batra Pakistani soldiers and neutralising enemy fire. Captain Vikram Batra was born on September Grievously injured, but with reckless disregard to 9, 1974 in Ghuggar personal safety, Grenadier Yadav now charged on village near Palampur, to the second bunker and neutralised it, killing Himachal Pradesh. three Pakistani soldiers in hand to hand combat. Batra joined the Indian This extraordinarily gallant act motivated the rest Military Academy in of the platoon which charged onto the enemy to Dehradun in 1996 in capture Tiger Hill. Jessore Company of Manekshaw Battalion, For his sustained display of the most conspicuous and was commissioned personal bravery and gallantry of the highest order in the Indian Army as a in the face of the enemy, Grenadier Yogender Lieutenant of the 13 Singh Yadav was awarded the , Jammu & Kashmir India's highest medal for gallantry. Due to his Rifles at Sopore, in Jammu and Kashmir. efforts, tri-colour was hoisted on Tiger Hill top on 4th July. This victory proved very vital in the final Captain Vikram Batra and his Delta Company outcome of war. were given the task of recapturing Point 5140. He and his men ascended the sheer rock-cliff, but as the group neared the top, the enemy pinned them R i f l e m a n S a n j a y on the face of the bare cliff with machine gun fire. Kumar of 13 Jammu Captain Batra, along with five of his men, climbed and Kashmir Rifles was up regardless and after reaching the top, hurled the leading Scout of a two grenades at the machine gun post. He single- t e a m t a s k e d t o handedly killed three enemy soldiers in close capturing Area Flat Top combat. He was seriously injured during this, but on July 4, 1999 during insisted on regrouping his men to continue with the Kargil war. The area the mission. Inspired by the courage displayed by was held by Pakistan Captain Batra, the soldiers of 13 JAK Rifles military. Having scaled charged the enemy position and captured Point the cliff, the team was 5140 at 3:30 a.m. on 20 June 1999. His company p i n n e d d o w n b y is credited with killing at least eight Pakistani machine gun fire from soldiers and recovering a heavy machine gun. He an enemy bunker, about 150 meters away. was killed when he tried to rescue an injured officer during an enemy counterattack against Kumar, realizing the magnitude of the problem Point 4875 in the early morning hours of 7 July and the detrimental effect this bunker would have 1999. in the capture of Area Flat Top, crawled alone up the ledge, along a flank, and charged towards the Batra's Yeh Dil Maange More! (My heart asks for enemy bunker through a hail of automatic fire. more!), erstwhile a popular slogan for a Pepsi Almost instantly he took two bullets in his chest commercial, became an iconic battle cry that and forearm that left him bleeding profusely. swept across the country and remains popular with millions of Indians, invoked at patriotic public Though bleeding from the bullet wounds, he events, in memory of the war and the soldiers, and continued the charge towards the bunker. In hand- as a symbol of the indomitable spirit of Indian to-hand fighting, he killed three enemy soldiers. patriotism and valor in face of future attacks. He then picked up an enemy machine gun and Some goals are so worthy, it's glorious even to fail - Major Manoj Pandey Sankalp Patrika Volume 3 Issue 3 Page 16 March 2013 SHAHEED DIWAS Ah! Not for idle hatred, not for honour, fame, nor self applause But for the glory of the cause You did, what will not be Forgot - 560034.

On 23rd March 1931 Bhagat Singh, Rajguru and Sukhdev were hanged in Lahore jail. They left a er er is prohibited. ;legacy behind which till date inspires us to serve the great cause - the cause of the mother land!

The roots of British Imperialism have been shaken, in fifteen years they will leave. A compromise will be reached, but it will not benefit the people. Many years will pass in anarchy. Then once more, the people will remember me.. Bhagat Singh in the year 1931 rd rd B Main, 13th Cross, Cholurpalya, Bangalore - 560023 at at #460, "GOKULA", 8th Main, 4th Block, Koramangala, Bangalore n in whole or in part without permission of the Publish d on 17th of every month at MBC, Bangalore-GPO. | RNI No: KARENG/2010/35892 Total Total Pages: 16 RNI No: KARENG/2010/35892 Registered Registered Newspaper Printed Printed by ShivaPrakash R at Saraswati Binding Works, 1/1, 3 Editor: Editor: Rakesh Dhanya. © All rights reserved. Reproductio Published Published for Sankalp India Foundation by Rajat Kumar Agarwal From: From: Sankalp Sankalp India Foundation #460, "GOKULA", 8th Main, 4th Block, Koramangala, Bangalore Bangalore - 560034. RNP RNP / KA / BGS / 2179 / 2012-14 | Cost of single copy Re. 1/- | Poste