VOLUME

MARCH 2020 THE GREY MATTER QUARTERLY NEWSLETTER FOR MEDICAL STUDENTS BASED IN M.I.M.E.R. MEDICAL COLLEGE

Something in the air Tuberculosis: The Math

A total of 1.5 million people died from TB in 2018 (including 251 000 people with HIV).

MDR-TB remains a public health Worldwide, TB is one of the crisis and a health security Ending the TB 10 leading causes of death threat. WHO estimates that there epidemic by 2030 is from a single infectious were 484 000 new cases with among the health agent. Above HIV/AIDS. resistance to rifampicin – targets of the Sustainable Development Goals.

In 2018, the 30 high TB Globally, TB incidence is falling at about 2% per year. This needs burden countries accounted to accelerate to a 4–5% annual for 87% of new TB cases. decline to reach the 2020 Eight countries account for milestones of the End TB Strategy. two thirds of the total, with India leading the count.

It creeps up on people everywhere, while they travel in local trains, walk in crowded markets and do so much as breathe the air that an infected person has coughed in. Aside from all of these appalling numbers and grim statistics, this disease is both physically and mentally crippling. We call for pre and post test counselling along with regular follow ups to be included as part of the National Health Programme on Tuberculosis to help patients get through a gruelling treatment period. Through this edition we hope to encourage medical students across the country to diffuse what Dr. Zarir Udwadia says is India’s ticking time bomb.

1 2 Dr. Zarir Udwadia on T UES G IEW ERV TTHHEE PPEERRFFEECCTT PPAATTHHOOGGEENN INT In conversation with Riya Barar & Damini Narkhede, III/II M.B.B.S.

I started publishing articles in journals when I was doing my MBBS. Having the kind of bent towards research that I've always had and having the opportunity of working in a hospital like Hinduja that encourages those interests, I consider myself very lucky. Most private hospitals don't encourage such activities, but I think it would be really boring to be seeing patients from morning to evening. It's these other interests of mine that keep me going.

Q. Tell us about your particular interest in Tuberculosis.

A. For me Tuberculosis was almost fortuitous. At the University of Edinburgh there used to be a really famous professor by the name of Sir John Crofton. He had conducted all the initial research on drug resistance in Dr Zarir Udwadia is a preeminent pulmonologist and tubercle bacilli. He had retired by the time I got there, but researcher. He has contributed extensively to the everyone around would speak about this man in hushed work on drug resistant TB and was the first doctor to tones. I think at every stage of my life a little serendipity has document totally drug resistant TB in India and among always played a role. This was one of those. Here I was, at the first few to do so worldwide. this great hospital where this great man had worked. They He is known recognized widely for his famous TEDTalk would show us the laboratories he used, where he did all his amongst other things. drug sensitivity testing to develop the current regimen for tuberculosis treatment we now use. Though I didn't see many Q. What are some of the reasons you chose medicine tuberculosis patients in my 4-5 years of training in the UK, an as your profession? interest developed.

A. I don't think there's anything else I could've done. So it Q. Is there a case you will always remember? was either, become a doctor or go bust, and I didn't want the latter. Medicine was the conversation at home since I A. Zubain Irani, a young haemophilic who was one of the first come from a family of doctors. I would often wait in the few patients I saw after coming back from the UK. We have hospital while my father was seeing patients, so I think it reports showing that he was resistant to Rifampicin, Isoniazid was in my blood perhaps. Medicine is a nice way of doing and some of the other first line drugs making him one of the well for yourself while doing well for others. first patients with MDR TB. We didn't know how to deal with him, no one did at that time. I wrote to experts across the Q. Why did you choose to specialize in Respiratory globe, in those days there was no email, so I used snailmail. I medicine? got in touch with a world expert on Tuberculosis, Dr. Peter Davis. He gave me advice, sent some drugs and experimental A. It was an interest from my undergraduate days. I finally vaccines. Zubain had extensive cavitatory lesions and kept chose it after a process of elimination. I was dreadful with having major bouts of haemoptysis which were made worse my hands, so surgery was not an option and perhaps I by his haemophilia. We tried everything for 3 years and he wasn't cerebral enough to do neurology. Since cardiology eventually succumbed to his disease and died. I contributed seemed too high-tech for me, I finally chose Respiratory a chapter in Dr. Peter Davis' textbook and wrote on MDR medicine. Tuberculosis. I think Zubain must be the person who gets the

credit for inspiring me to work against tuberculosis more Q. What would be your advice to young future doctors? aggressively. He taught me so much and I'll never forget him. A. It's so important to stress that you need a combination of being very busy clinically, while also developing other academic interests. That's a bug one should catch from an early stage.

3

Q. Can you tell us a little about your passion for A lot of these articles are non-pulmonary but, you’ve got to research? develop an interest in other parts of medicine as well. I believe that's what makes a really good doctor. A. I always had an inclination towards research and publishing articles. Initially, the thrill for publications was Q. What advice would you give your younger self if you strong, but that's long gone now. I don't just observe and could go back in time? treat. I write, research and publish as well. Every Thursday I dedicate 2 hours to a journal club with all my residents and A. To have a little more fun along the way! fellow colleagues. It's a pet project and a passion of mine. I really enjoy pursuing it in addition to being a clinician. I Q. What are the changes you’ve noticed in healthcare deliver lectures all over the world now, mostly about over the last 25 years? tuberculosis. Another disease I specialize in is, interstitial lung disease. It's a very nice feeling when you're asked to A. Sadly, It has gotten extremely commercialized. Sometimes deliver talks in some of the best institutes in the world. I get I get cases in the ICU where I’m only expected to monitor the to talk about what I love while I travel the world. Now I'm a patient’s lungs, while other doctors monitor the other failing little picky with the locations, however. I only go if it's a nice organs. You aren’t completely responsible for a single place like Rome or Vienna. patient anymore. When my residents tell me that a particular case isn’t Respiratory, I always tell them that to be a Chest Q. You've spent a lot of time training abroad. What is physician, you’ve to be a good physician first. Medicine has one thing or practice you saw there that you would like also become more corrupt. It doesn’t just depend on the to see in our country as well? system but, individuals as well. A doctor must stick to his principles. One day you’ll reach a stage like mine when if I A. I spent four years training abroad. Their students are ask the patient who sent him to me, he says I googled you. prepared very well from the beginning. They teach you how When I see doctors announce proudly that they don’t take to talk, how to speak at conferences, inculcate interests in cuts, it makes me sad that we’ve to say these things out loud research, how to write a paper, an abstract and so on. We instead of it being the norm. have all patients here, but often we don't know to talk to them, how to deal with them in the right manner. These are Q. What do you think about the lack of treatment things which could be stressed on in the earlier stages of a monitoring when it comes to TB patients in private student's life. I worked at the Brompton Hospital, which is a setups? centre of excellence in Respiratory Medicine. It was great to use tools like CT Scans, which were not widely known at the A. The lack of monitoring is what has caused resistance. We time. However, I believe after having the kind of clinical once called 104 private practioners of Dharavi, Asia’s most experience this country offers and then inculcating some densely packed and biggest slum. We gave them a sheet of other skills would be the perfect blend for a physician. paper and asked them a single simple question. The question was, “How would you treat a 50kg patient with MDR TB?”. A Q. We noticed a Miles Davis poster in your consultation simple enough question which has an easy answer. There are room. Can you tell us about some other interests of standard guidelines pertaining to it. These were doctors who yours? were treating these patients on a daily basis. Out of the 104 doctors, only 4 could write a correct prescription. The rest of A. I enjoy jazz very much, I play the saxophone. I'm terrible at the prescriptions were so wrong that they would amplify the it, I've got no time to practice. I have a house in Alibaug problem of resistant TB. Making a MDR into XDR and an XDR which is a haven and a retreat for me. I work an intensive 5 into TDR. Just imagine doctors not being able to treat India’s day week and completely shut off over the weekend. I biggest health problem. Supervision is a must. Regardless of recharge and get back to a cauldron of patients, which is your patient’s economic or educational background. Even an just life in Bombay. educated person might fail to take his medication timely. The treatment for MDR TB goes on for about 2 years. It is human Q. Tell us more about your Thursday Journal Club. nature to give up on the treatment once you start feeling better. A. Every Thursday when the New England Journal of Medicine arrives, I send the library a list of references. I Q. Do you think pre-counselling could help with this procure the articles I want to read. I send my fellows a list of problem? articles I want them to read. That’s my sneaky way of not reading an article, but still getting to learn! A. Of-course. I give my patients a typed list of the problems they could encounter and ask them to contact me immediately if they see some particular side effects.

4 FUN FACT: H e doesn't just have a CV. He has a separate one for his work on TB! T A A Z A

Q. What do you think about the injustice that is K H A B A R prevalent in our society when it comes to receiving TB by Rutuja Pawar, III/I M.B.B.S. treatment?

A. You need to agitate for justice to your patients. The HYDROGELS biggest injustice is that our patients still don’t have access We all know that medicines such as antibiotics have a certain to Bedaquiline, a lifesaving drug. We had a female patient shelf life and have specific storage requirements. What do we who was denied Bedaquiline by the government. Her father do when the shelf life expires or the place doesn’t have had to file a case in the high court. She died at the age of suitable storage conditions? Here’s the solution to refrigeration 18. Fighting for your patients is a must because TB without a refrigerator! A team of chemical engineers led by disproportionately affects the poor. Right now only 3 Hal Alper, Professor at the University of Texas developed a percent of patients of MDR TB have access to it. We are new way to produce medicines and chemicals on demand and pushing to make it available for everyone who needs it. preserve them using hydrogels. The approach could help

Q. What is your view on depression in TB patients? people in remote areas or on military missions, where the absence of pharmacies, doctor's offices or even basic A. It occurs even otherwise! If I told you that you had MDR refrigeration makes it hard to access critical medicines and TB and would have to receive treatment for two years with even daily use chemicals. six months of injections awaiting you, you’d be depressed It is the first hydrogel-based system to organize individual just from knowing that. And on top of that you add the drug microbes for in-the-moment production of high-value Cycloserine which causes morbid depression. We get to see chemical feedstocks used for pharmaceuticals. This system cases where the patient was getting better but the drug effectively uses microbial “biofactories”; basically cells that made him psychotic and he committed suicide. These old are bioengineered to overproduce a product. They are then drugs happen to be very toxic and despite the new drugs, TB continues to be one of our biggest problems. A 1000 embedded into the solid support of a hydrogel. The gel Indians die of TB every single day! A grim statistic that material, along with the cells inside, can flow like liquid and hasn’t changed. The corona virus reported 1000 deaths in then harden upon exposure to UV light. To revive the hydrogel 40 days. Look at the press it has gotten while TB continues and enable the production of the chemical or pharmaceutical, to be a disease of antiquity. one can simply add water, sugar and/or some other basic nutrients, and the cells will then convert into the product just Q. What do you think is the future of Respiratory as effectively as before the preservation process. The huge medicine? benefit is in terms of portability and optimized production.

Products can be produced within a couple of hours to a A. Biomarkers and genomics! It used to take 8 weeks to couple of days. diagnose a case earlier. Now it just takes 8 hours. Thanks to GeneXpert. That’s a huge difference. Even if you’ve diagnosed a case one day earlier you’ve decreased the transmission by a huge number. MOLECULE OFFERS HOPE Q. How well prepared do you think India is if the Corona virus pandemic hits India? FOR HALTING PARKINSON

A. It’s going to be dreadful. Except for ours country’s Parkinson is unfortunately a disease with no halt button temperature we have nothing in our favour. whatsoever. A promising molecule has offered hope for a new treatment that could slow Parkinson, something no modality Q. If there is one message you could give to our Prime can currently do. Typically, by the time people are diagnosed, Minister regarding TB, What would it be? they have already lost 70-80% of their dopamine producing cells. A. The United Nations had a big conference on TB where While current treatment modalities mask the symptoms, there every country was present. Except India. India should’ve is nothing that can halt or slow down its progression. been right up front because we bear the brunt of most of the TB cases in the world.The South African Health Minister Researchers from the University of Helsinki found a molecule said, “You can’t stop TB, if you don’t show up.” How can we 'BT 13' that has shown the potential of boosting dopamine eliminate TB by 2025 then? Knowing the scale of the levels and also activating a specific receptor in the brain to problem, India really has to take some drastic measures and protect cells. BT 13 is a small molecule that has overcome the also have an increased budget for TB. hurdle of not crossing the blood brain barrier.

5 Shutterbug

MANALI GONDIA

Yashodhan Gurav Tranay Maldhe II/II M.B.B.S. II M.B.B.S. GMC Gondia

MANALI MUMBAI

Devashish Negandhi Hait Savla II/II M.B.B.S. II/II M.B.B.S.

NANDED TALEGAON

Shradha Kadam Advait Joshi II/II M.B.B.S. III/II M.B.B.S 6 T A A Z A K H A B A R 2 . 0 Novel Coronavirus by Devanshi Sane, II/II M.B.B.S.

On 31 December 2019, a cluster of pneumonia of unknown their own mouth, nose, or possibly their eyes. Current etiology was reported in Wuhan City, Hubei Province of China. estimates of the incubation period range from 1 to 12.5 days. On 9 January, Chinese authorities reported that the cause of During this period the infected individuals show no signs and this viral pneumonia was identified as a new type of symptoms of the disease, but can possibly transmit the coronavirus, which is different from any other human infection to others. coronaviruses known so far. What are some precautions you can take to prevent What is a coronavirus and how is it different from a novel yourself from getting infected? coronavirus? There is currently no vaccine to prevent COVID-19 infection. Coronaviruses are a large family of respiratory viruses that can The best way to prevent infection is to avoid being exposed cause diseases ranging from the common cold to the Middle- to this virus. The various protective measures are: East Respiratory Syndrome and the Severe Acute Respiratory (1) Avoid travelling to China especially Wuhan city, Hubei Syndrome (SARS). The strain of coronavirus prevalent now is a province which is the epicentre of the epidemic. (2) Avoid close contact with people suffering from acute novel corona virus which is a strain that has not been previously respiratory infections. identified in humans called COVID-19. (3) Wash your hands with soap and water for at least 20

seconds. If your hands are not visibly dirty one can use What was the source of the novel coronavirus? alcohol based hand sanitizers. It’s likely that an animal source from a live animal market in (4) Avoid touching your eyes, nose and mouth with unwashed China was responsible for some of the first reported human hands. infections. The animal source of the COVID-19 has not yet been (5) When sneezing or coughing always cover your mouth with identified. This however does not mean that the coronavirus a tissue or sneeze into you bent elbow. Do not touch any can be transmitted to you by your pets. surfaces without washing your hands. (6) Frequently disinfect surfaces. What are the signs and symptoms of the infection and how (7) Avoid close contact with live or dead farm or wild animals dangerous is it? and avoid consuming raw meat. The clinical manifestations include a runny nose, sore throat, cough, fever, difficulty in breathing and in severe cases it may What is the treatment for the COVID-19? even lead to pneumonia. The infection can be fatal in older Currently there is no specific medicine recommended to people and people with pre-existing medical conditions who prevent or treat the novel coronavirus. However, infected are more vulnerable to becoming severely ill. individuals should receive appropriate care to relieve and treat symptoms. Those who have fever, cough and difficulty How is it transmitted? breathing should seek medical care early to reduce the risk of The COVID-19 can be transmitted from person to developing a more severe infection. Recently, a group of person. Person-to-person spread is thought to occur mainly via researchers tested a number of anti-virals in the lab for their respiratory droplets produced when an infected person coughs effectiveness against the new coronavirus. They found that or sneezes. These droplets can land in the mouth, nose or be Remdesivir stopped the virus from replicating in a lab dish. directly inhaled into the lungs by nearby individuals. It’s Similarly, the group found that Chloroquine was also effective currently unclear if a person can get the virus by touching a in stopping the virus from spreading in human cells in the lab, surface or object that has the virus on it and then touching however clinical trials are yet to be conducted.

7 Coronavirus- BOLO DIDI Radiological Aspect CAMPAIGN

by Rutuja Pawar III/I M.B.B.S. by Anamika Prashant, III/II M.B.B.S.

The new cluster of viral pneumonia cases originating n India shoulders the highest burden of TB Wuhan, China, marks the third time in 20 years that a patients in the world with the maximum number member of the large family of coronaviruses (CoVs) has of drug resistant patients, i.e., patients not jumped from animals to humans and sparked an responding to the first line of drugs. In this outbreak. chaotic system, there is often ignorance about Looking into the radiological findings, majority of the the discrimination and social stigma faced by patients in their initial CT scan showed the following the patients due to which they ultimately choose characteristics: to seek support from their peers in order to deal presence of ground-glass opacities, with issues that the medical system does not fully address such as stigma, marital issues, presence of consolidation, sexual health and depression. number of lobes affected by ground-glass or The stigma associated with it doesn’t allow consolidative opacities, patients to openly talk about their struggles. degree of lobe involvement in addition to overall lung This is especially seen in women who find it difficult to open up to their family. “total severity score,” The Bolo Didi campaign brought about a stir in presence of nodules, our nation when film-maker and TB survivor, presence of a pleural effusion, Rhea Lobo decided to set up what she calls a presence of thoracic lymphadenopathy (lymph nodes ‘pay-it-forward’ programme for women battling TB. Her two minute film on the stories of fellow of abnormal size or morphology), survivors was screened at the 50th Union World presence of underlying lung disease such as Conference on Lung Health held in Hyderabad in emphysema or fibrosis. October 2019. Women who would watch her film on YouTube would contact her via Facebook or Dr. Chung (Assistant Professor in the Department of WhatsApp. The conversations would invariably Diagnostic, Interventional and Molecular Radiology in the start with, “Didi, can you please help me?”. Mount Sinai Health System in New York, N.Y) said, “We Some cries were more desperate, wanting can’t rely on CT alone to fully exclude presence of the contacts of doctors and counsellors — basic virus”. information that should, ideally, not be this hard Moving on to the structure of the virus: SARS-CoV-2 to access. (COVID-19) particles are spherical and have proteins Rhea soon realised that other survivors like called spikes protruding from their surface. These spikes Nandita Venkatesan had also been receiving latch onto human cells, then undergo a structural similar messages, asking “Didis” for any and all change that allows the viral membrane to fuse with the help. While the Indian health system is still cell membrane. The viral genes can then enter the host struggling with the burden of tuberculosis, cell to be copied, producing more viruses. The survivors like Rhea and Nandita are relentlessly researchers found that the SARS-CoV-2 spike was 10-20 working towards their goal of spreading times more likely to bind ACE2 on human cells than the awareness. They are trying to organize patient groups and start virtual institutions for women. spike from the SARS virus from 2002, enabling it to Initiatives like these will help India combat TB spread from person to person more easily. and will especially help those patients who are

falling through the crevices of the health

system.

8 HUMAN RIGHTS AND TB by Sahiba Maniar III/II M.B.B.S.

A gloomy room. A window on one end. Masked mouth. Emaciated body. He stared at the grey walls until food "Treatment begins was served. Over 10 tablets everyday. Not one visitor to check up on him. Doomed. Devastated. Depressed. with cure Such is the life of a TB patient. Tuberculosis (TB) is " caused by Mycobacterium tuberculosis. But that might and continues not be what kills the patient. with care."

Leading globally, India accounts for 27% of the total patients who have contracted tuberculosis, and having the highest number of drug resistant tuberculosis Optimum healthcare requires the patient "to have cases. Ever thought about why this looming sword slits access, availability to the facilities at a cost the the throat of our nation year after year? community can afford. It is essential to streamline healthcare with the rights of people living with and Tuberculosis is mainly identified to be a disease of vulnerable to TB, including but not limited to the rights poverty. A lack of awareness and implementation of to life, health, nondiscrimination, privacy, human rights fuels the spread of TB by creating participation, information, freedom of movement, conducive economic, social and environmental housing, food, water, and benefit from scientific conditions. Vulnerability, poverty, discrimination and progress. It is a powerful deterrent right from when the ignorance blanketed by political superiority and symptoms of TB start developing to the whole process societal negligence limit healthcare to a privileged of treatment and even extending to after complete few. cure.

Hence, the groups most associated include people Isolation, ignorance, lack of empathy and social living in poverty, ethnic minorities, people affected by stigma attached to tuberculosis is the root cause of caste-based discrimination, women, children, HIV depression and loss of motivation to live. A feeling of patients, prisoners, homeless persons, migrants, hopelessness looms over the patients reducing their refugees and internally displaced persons. They are zeal and zest for life and overall mental health more likely to be exposed to conditions that are hampering the treatment and quality of life there on. favourable to acquiring TB and less likely to have Prevention begins with awareness and continues with access to the knowledge and resources necessary to responsibility. Treatment begins with cure and maintain and preserve their health. continues with care.

The principle of nondiscrimination is fundamental to Despite innumerable efforts in the past decade, India public health. Article 25 of the Universal Declaration still leads in the global index of tuberculosis. of Human Rights guarantees each individual the right Everything in the system is questionable. Everything to a standard of living adequate for the health and questionable is a concern. And every concern should well-being of himself, which is often a subject of be addressed. This change starts with you. You owe it neglect in our country. We are calling for equality. to the doctor you yearn to be. You owe it to the patient you hope to treat. You owe it to the society Equality for basic necessities. Equality for life. How you belong to. Until then, your patients shall succumb poorly does this reflect upon us as a society? to TB and the society shall be bulldozed by ignorance.

9 TB, or Not TB- That is the question A Survey conducted by Saneeka Vaidya, II/II M.B.B.S.

Out of all the patients affected by Tuberculosis, India stands first with 27% of the total patients. Lack of adequate healthcare facilities to treat the disease and prevent its spread along with the lack of awareness among masses is responsible for this global dominance. "Tuberculosis is a disease that is transmitted only from human to human, so there are no sources from water, no sources from animals," says Dr. J. Walton Tomford, M.D., staff physician with the Infectious Diseases Department at the Cleveland Clinic. Simply providing non-contaminated food or clean drinking water for eradicating TB is not enough. Spreading awareness about its symptoms for early diagnosis and treatment is necessary. Understanding the ways in which Tuberculosis spreads and it's prevention is beneficial for its eradication. In this edition, team The Grey Matter surveyed over 340 people with no medical background to assess their awareness about Tuberculosis.

According to you, how does Tuberculosis spread? According to you, should a person suffering from Tuberculosis be isolated, i.e., forced to eat and sleep separately?

Yes No Don't Know

According to you, which organs are affected Do you know about the BCG Vaccine given for the by tuberculosis? prevention of tuberculosis?

Yes No Don't Know

According to you, is tuberculosis curable? According to you, what are the primary signs and symptoms of pulmonary (lung) tuberculosis?

Yes No Don't Know

10 Anahita Shroff Final Year M.B.B.S. Grant Govt. Medical College & Sir JJ Group of Hospitals, Mumbai RNTCP to NTEP On the move against TB. Transforming the fight towards elimination. by Gauri Purohit, III/I M.B.B.S.

On January 1, 2020, India's TB control programme got a The strategies included in NSP for awareness and change of name. It is no longer known as the 'Revised implementation are- National Tuberculosis Control Programme (RNTCP)', but has been rechristened as the 'National Tuberculosis 1.Mapping and identification of the priority Elimination Programme (NTEP)'. population across the country 2.Inclusion of map population in NIKSHAY for state The change in name is in line with larger goals like and district specific action plans for the identified eliminating the disease by 2030 and achieving population. betterment of health and well being of the society. With a view towards attaining this ambitious target, a change 3.Established priorities for action which will be based in name of the programme representative of the ultimate on the analysis, need, effectiveness, feasibility and goal of eliminating TB was thought to be necessary. resources. 4.Customised advocacy and communication for the Dr. Raghuram Rao, Deputy Director (TB), Ministry of defined priority population. Health and Family Welfare, has rightly stated that –“TB is 5.Use of rapid molecular technologies and better not just a disease, but a socioeconomic problem”. It requires every section of society to be playing its part in diagnostic modalities. fighting to end the disease. Poverty reduction strategies 6.Early linkage to NTP Spectrum of supportive services are the cornerstone of battling a disease like till the completion of treatment and follow up for up Tuberculosis in India. to 2 years 7.Intersectoral and inter ministerial coordination. To further achieve these targets, the health ministry is 8.Intensive efforts for TB case detection using novel implementing NSP i.e. National Strategic Plan (2017 to approaches. 2025). The NSP aims to deal with the disease with a DETECT- TREAT- PREVENT- BUILD approach. 9.Use a campaign approach to address TB in the priority population. The goals to end TB have received a much needed boost 10.Community encouragement, participation and with the World Health Organisation stating that- engagement. indigenously developed molecular test (TruenatMTB) for diagnosing pulmonary and extrapulmonary tuberculosis Traditional coping strategies will no longer be enough and drug resistant tuberculosis has high diagnostic to compensate the blow to national economy and the accuracy. Being battery operated, it will be a Diagnostic instability of societiy that TB, drug resistant TB and tool to be used in the peripheral TB centres of India. In concomitant HIV / AIDS cause. The deadline for action the first step, TruenatMTB will be available at CHCs and is today and fortunately, we have the means to oppose would slowly be extended to PHCs. the disease.

The context of this NSP for TB elimination in India is to What we need to do for implementation and success of provide sustained, equitable access to the high quality this programme is to come together and FIGHT BACK. TB treatment, care and support services, responsible to Every Breath counts. Stop TB. Together we can! the community needs without financial loss, thereby protecting the population, especially the poor and those vulnerable to TB related morbidity.

12 Advice to MBBS students? The Yash Factor My advice would be enjoy your MBBS. These days won't come back in your life. Balance work, Dr. Yash Kallurwar hobbies and studies properly. Learn and explore NEET- PG AIR : 24 new things. All these things together give value to your life. Studies should only be a part of your life and not everything. When did you start preparing for NEET and how did you do it? I started my preparation for NEET during internship. I read from the notes that I had made in the classes I had joined, tried to solve as many MCQs as possible and gave tests from time to time. I revised the subjects 2 to 3 times c rtex each. I guess if you are planning for NEET, it is important to revise as many times as possible. Revision is the key for NEET.

How does it feel? At first it felt surreal, but now it feels good. This was something I worked really hard for.

What do you do in your free time? I love to binge watch TV series and sleep during my free time. I also like playing cricket and table tennis, but I am a little lazy when it comes to going out.

How did you manage to balance your work and studies during your internship? I used to motivate myself to study every day after work. The most important thing is to keep going. A lot of people who started studying in the beginning gave up later because of the frustration. I would take a nap after coming back from my duties and then start studying.

If you could go back in time, would you do something differently? I don’t think so. That is not how life works. I have amazing friends and had a fruitful MBBS. I don't want to change anything! ANSWER

What speciality do you hope to pursue? I would love to pursue either Medicine or Radiology.

13 Tuberculosis amongst healthcare ST UE professionals. You’ll get used to it. G CLE RTI by Samira Davalbhakta, III/II M.B.B.S. A B.J. Medical College & Sassoon General Hospital, Pune

Our clinical rotations in the hospital include 15 days of the prevalence of latent TB amongst medical professionals was postings in the TB ward. We were all afraid. What if we get nearly 50%. This means almost half of their study population infected? What will we do? Will we have to spend months, or were unknowingly infected with tubercle bacilli and could maybe years for the treatment? It was only after we realised acquire the active disease at any time. This emphasises the that TB stood for Tracheo-Bronchial and not Tuberculosis that importance of screening amongst healthcare professionals for we were relieved. TB, just as we would screen employees for any other disease acquired at the workplace. This fear of contracting a debilitating disease from patients exists in all healthcare fields and for good reason. Medical In fact, most experts consider it an occupational disease. Then residents have a 15 times higher risk than the general why doesn't Tuberculosis get the importance that it should population of contracting tuberculosis (TB). Despite this, the regarding prevention amongst healthcare professionals? Why practice of protection seems to be lacking. It is very aren’t all students made aware of which patients have active TB uncommon to see resident doctors or nurses wearing N95 and told to wear the N95 masks? Why aren’t all residents masks! treating these patients made to compulsorily take preventive measures? One might ask, what is the big deal? Once diagnosed with TB, the individual can take the proper treatment, be cured and India has the highest burden of TB disease. A report published get back to work. There are three issues with this statement : by the WHO estimated that 10 million people had TB in the One, be cured. The course of treatment could take anything country in 2018. This is more than 3 times the population of Pune between six to eighteen months depending on the resistance city, which follows that the healthcare workers treating these of the TB bacillus. This means taking a break from work for a patients are at a high risk of contracting the disease. long period which can have serious implications on a medical Nonetheless, nationally representative data is lacking. We are career. Two, social stigma : TB comes with its own set of social not aware of how many healthcare workers contract TB in a year problems. People follow the dictum ‘prevention is better than or which regions have the highest incidence of the same. cure’ very strictly when it comes to interacting with individuals who had an infection in the past. Medical personnel who Such data will form the platform upon which effective contract the disease face job application rejections preventive measures can be implemented. According to a study (unofficially) or a decrease in the attendance at their clinics, published in the journal of Emerging Infectious Diseases, by the which defeats their purpose of entering into the medical field introduction of TB transmission control measures the annual in the first place. incidence amongst healthcare workers can be reduced by upto 81% in countries with high incidence of TB. Finally, diagnosis. Most health care personnel who get The insufficient use of preventive measures could possibly stem infected with TB develop a latent disease. Here, the bacilli are from not only the authorities, but also the victims of the disease not actively multiplying, but are kept in check by the person’s themselves. immune system. Though these individuals cannot transmit the infection to others, the lifetime risk of developing active TB Although fear exists, there is a certain sense of denial, or rather disease in the future is 5-10% with most of them developing it a psychological defence mechanism that is displayed by the within the first 5 years of infection. This highlights the necessity healthcare workers. This is encouraged by the ‘invincibility’ that of identifying the latent cases. The impediment to this, is passed on to juniors from their seniors, who believe that however, is in the name itself- latent. If there are no symptoms, contraction of the disease by themselves is highly unlikely. This medical professionals are not likely to come forth. has created an atmosphere of ignorance, which has spread a misguided and fallacious bubble of safety around those Compounded with the absence of compulsory screening responsible for providing the preventive measures, and those procedures amongst them, diagnosing latent TB is quite responsible for implementing them. It is necessary to gradually difficult. In a meta-analysis published in 2016 of 18 studies deflate that bubble with managerial activities and consisting of 10,078 participants regarding the prevalence of administrative and engineering controls along with the adoption latent TB amongst healthcare workers in high burden countries of N95 respirators, before it unwittingly pops.

14 ANANDwAN An account by Jai Jabade, III/II M.B.B.S.

As a kid I wasn’t completely unaware of Anandwan, Hemalkasa The next day, we got an opportunity to dress the ulcers of and the Amte Family. I had heard stories about them from my patients with leprosy. At 5:30 am everyday, all patients would grandparents, yet the knowledge I had was very limited. This was come to the hospital for dressing and only then would they until I visited these places a couple of months ago. resume their daily activities. After that we visited the old age In January this year, I got a wonderful opportunity to visit home, where we met with elderly patients having advanced Anandwan and Hemalkasa. It was a seven day trip and the main stages of leprosy. purpose of which was to socialize with the residents and get to Soon after, we visited Muktangan which was a play school as know their lifestyle. well as an educational centre especially for children of those With a lot of expectations, I, along with 28 other medical disabled by leprosy. One afternoon after lunch all of us students from various colleges, boarded the Sewagram Express distributed cakes and biscuits to the elderly in the old age home from Mumbai. It was a 17 hour journey to Warora, in the and chocolates, slates and colour pencils to the children in Chandrapur district of Maharashtra. From here, Anandwan was Muktangan. The happiness on their faces has been etched into about 5 km away. my memory forever. This is when I realized how such small deeds Anandwan which means 'Forest of Joy' is a community founded by towards those in need can give us immense joy. the legendary Baba Amte for leprosy patients, social outcasts, We also had a discussion with Dr Vikas Amte , the elder son of differently abled people and socially backward tribals. From the Baba Amte. He told us about the hardships Baba Amte had to moment we entered the gates of Anandwan, we felt the peace face while developing Anandwan and the administrative and the positive energy I had heard about as a child. We had difficulties that they are currently facing. Despite being a breakfast at the community mess of Anandwan after which we doctor, he had constructed dams using tyres and buildings with started with the tour. low cost materials without using any iron rods. He told us how We first visited the 'Sita Ratan Leprosy Hospital’. It is a 50 bedded leprosy, a non fatal disease which can get cured if treated in hospital with various health care facilities to treat the needy. We time, is shunned by society while other fatal lifelong diseases left the hospital with a feeling of deep admiration, especially like diabetes and hypertension are openly discussed when we found out that the entire hospital is managed by a everywhere. This was indeed thought provoking. single doctor. Then we visited 'Sandhiniketan' (Home of In the Miyawaki Forest (which is a mini forest created by Opportunities) where vocational training is provided to the Miyawaki method of afforestation), we planted some saplings residents for their empowerment. ourselves. Baba Amte always wanted Anandwan to be self-sufficient and hence agricultural industry, hand-looms, power-looms, woodwork, handicraft and allied industries were developed. Residents work in any of these departments in exchange for free-of-cost food, housing and healthcare. Many women working in the hand-loom industry were blind but the perfection with which they were making clothes, towels was awe-inspiring. Dried banana barks and rice straws were used to make greeting cards and handicrafts were made of plastic waste, saline bottles, cold drink bottle corks. We were fortunate enough to witness one of the most amazing activities- 'Swaranandwan'-Orchestra of Anandwan, where there were beautiful performances by abled and differently-abled people alike. The ease with which they performed inspite of all the difficulties was applauded by all.

15 After having an inspirational, eye-opening trip through Anandwan, we headed to Hemalkasa. It is a small village The Prince about 6 hours away from Anandwan. In 1973, Baba Amte had by Niccolo Machiavelli started 'Lok Biradri Prakalp' in this village which is now supervised by his son Dr Prakash Amte and daughter-in-law Book review by Aryan Dr Mandakini Amte. Kulkarni II/II MBBS We were shown videos of how the Madia-Gond tribe were Writers and poets have always skeptical to interact with Baba Amte when he first met them aspired to achieve a certain degree because they mistook him for a revenue officer who would of immortality through the exploit and harass the tribal people. Language was also a timelessness of the written word. The huge barrier at that time, but Baba eventually made them philosopher, politician, writer and believe that he had come for the betterment of the people diplomat, Niccolo Machhiavelli did by giving up all the comforts of his life and adopting a precisely the same when he wrote rudimentary lifestyle like that of the tribal people. his famous or infamous The next day after visiting the 'Animal Ark', a home to the (depending on how you perceive it), animals which were abandoned by the Madia- Gond tribe, we left for Somnath Prakalp. Somnath is a small village 'The Prince', a book that remains as relevant (if not more) in established by Baba Amte in the Tadoba buffer zone. It was today's day and age as it was in 16th century Europe. set up to rehabilitate those cured of leprosy. Agriculture is No thicker than a handbook, this treatise holds tremendous potential for upheaval, so much so that it remained banned by the the backbone of Somnath and has made Somnath self- Catholic Church for over 200 years. This book lets us leave all our sufficient in food production and the surplus is distributed to traditional notions of morality at the door and delve deep into this the neighbouring villages, including Hemalkasa. beautiful piece of literature. He wrote the book when he was We eventually returned to Anandwan. Having some time on banished from Florence by the Medicis (an affluent banker family our hands before we had to leave for the train, we decided that ruled the city state of Florence). The reader takes on the role to visit Anand School for the Hearing and Speech Impaired. of a prince to whom Machiavelli is preaching his knowledge of It was a lovely and a heartwarming experience to interact polity and of dynamics of power and the actions of men. with them. Then with a heavy heart we had to bid it all In the initial part, he explains the different types of republics, adieu. kingdoms and principalities and how to obtain power and All the experiences I had throughout the trip were unique. maintain the prince's rule over them and gives valuable lessons in Every person I interacted with was different but everyone thwarting one’s enemies, waging wars, conquering and colonizing had one thing in common – they were all content with their newer states. He does so by giving examples of contemporary lives. The impact this trip had on me is something I cannot Europe, the history of Greece and of kingdoms of Alexander and fully express. It taught me lessons of self-sufficiency, humility, Darius. The latter part of the book weighs some of the more self-reliance and selfless service. There can’t be better philosophical questions revolving around power. Here, he examples than Anandwan, Hemalkasa and Somnath of what thoughtfully approaches the famous dilemma of what's better; to perseverance and working in unison can achieve. This trip be loved or feared and which image should a ruler want for has made me realize the importance of working towards himself and ultimately beautifully condenses the entire mediation betterment of society. I am looking forward to participating in one line, “A ruler should be such that men love him according to in more social events like this one. I have experienced their own will and fear according to the will of the prince”. immense happiness in helping others, now it’s your turn. Several similar problems are considered in this section, a few among them being liberality and meanness, clemency and cruelty, piety and craftiness and how to have an even handed temperate view towards all of the above and how and when to use virtues (both good and criminal virtues) as means to achieve certain ends. The essence of Machiavelli, he himself says is this, “One should be a fox to discover the snares and be a lion to terrify the wolves”, a statement that's worth pondering on for ages, in my opinion. In short, the book not only strips us of all pretense and of our rosy view of the world and exposes the bare self, the vileness of men, the immorality of their deeds and the extents to which they go to hide them but also advises us on expert ways of doing all of the above and this according to me is the reason why the book has such shock value. Though traditionally deemed a taboo by the so called holier-than- thou moralists, this book was found in the studies and by the bedsides of several philosophers, politicians, leaders, writers and other men of eminence, and I'm hopeful that after reading this it shall be read more, discussed more and put to application to achieve the ends best for the masses and that there shall emerge newer and worthier princes even from amongst us.

16 Pigment

'BLACK BEAUTY' 'CONTEMPLATION' 'IT'S TIME TO ROAR' Apurva Chaudhari Madhumita Sahoo Apurva Chaudhari I M.B.B.S. II/II M.B.B.S I M.B.B.S

'MAA SARASWATI' 'INFINITE' 'NRITYA' Shruti Kandgave Dnyanada Lolage Madhura Patil II/II M.B.B.S III/II M.B.B.S I M.B.B.S

17 ed muse Soham Sadekar, III/II M.B.B.S, SKNMC

For someone who is a final year M.B.B.S. student, I consider myself just the right amount of fun and serious combined. I’ve been passionate about art ever since I was in school. Be it theatre, elocutions, playing tabla, poetry recitations, I’ve tried it all! After all this time, I’ve learnt that the key to making your way in this world of cut-throat competition and crushing pressure is to try and strike a balance. Undeniably, academic excellence is important, but it is also equally necessary to involve yourself in extra-curricular activities. I, for one, have always loved football. So, I started playing intercollegiate football, taking interest in the organization of the college fest. Becoming the sports secretary really helped me improve numerous aspects of my personality like my communication skills and versatility among others; none of which can be developed in closed lecture halls. I have realized over time that hospitals are large classrooms where we are being transformed from students to doctors. Cultivating communication skills and interpersonal relationships with patients is the best part of learning a subject through the medium of postings.

College life, besides staying on track with studies, is incomplete without the experience of hostel life. It is a beautiful experience. I made friends who stuck by me through thick and thin. My professors, peers and this hostel life changed me from feeling super homesick to feeling at home in a new place. All said and done, I’m someone who takes life one day at a time. So I like to keep exploring, finding what I love and pursuing that with all my heart.

Gautami Kashyap, III/II M.B.B.S, MIMER Medical College

Having parents who are doctors, I was lucky to have grown up listening to medical interactions and ever since then all I have wanted is to be addressed as ‘Dr.’ Now I know that I would rather want to be competent enough to earn it. What fascinates me about medicine is that it’s a science that comes closest to human emotions. I like the empathy that comes with it despite it's stringent clinical protocols and academic demandingness. I feel that, while competition is inevitable and we are all here to excel, we have just begun to understand the vastness of medicine. We need to inculcate in ourselves that, as much as we need to be on our toes, we should have space for ourselves where nobody and no stress can percolate. That space, for me, is Bharatanatyam. While doing my Arengetram in 11th or completing Visharad last year, I have realised that I study better for my lectures after having attended the week’s dance class. I feel more confident as a person under stage lights, be it dancing or anchoring. It doesn’t matter how good you are at any art, what matters is how much you smile through the process.

As my mother tells me, it’s hard to relate to the world when you’re confined to a college campus and fail to explore the beauty of art & other hobbies. So, what life has taught me so far is that while you owe M.B.B.S. the best of your efforts, what makes you a good medical professional is the ability to handle all other aspects of life without getting overwhelmed by it.

18 Dr. Suyash Gore, Alumnus , MAEER's Physiotherapy College

The journey from junior college to graduation teaches us many things. I, for one, chose to learn a selected few and learn them well, and here I am. I completed my graduation at MAEER’s Physiotherapy College in March last year. Since then, I have worked with the national rowing team, with the under 16 FC Pune City team for Hero Juniors league and recently with the North Eastern Warriors in the Premier Badminton league. As a teenager who was strongly influenced by rap culture, poetry and literature, initially that is what I wanted to pursue. It was a time when I had started reading the works of Gulzar, Rumi and others like them. So, I began adapting my love for words into my own writing and considered making a career out of it. However, after much encouragement (and persistence) from my family, I decided to take up the entrance exam to step into the mainstream sciences of medicine. When I started off in first year, I was misled by my own inhibitions about physiotherapy and it took me four years and a short course about sports to realize that this is what I was cut out for. So, while I still aspire to write my way into people’s minds someday, I am as much excited to keep working as a physiotherapist and discover new avenues wherever I go. That’s the take-away message I’d like to share with all the students who will soon find themselves in a world of opportunities when graduation is done and dusted. Explore all possible fields and find your calling. When you do that, you will do justice to yourself and your patients.

Dr. Karan Parikh

I did my undergraduation from Rajiv Gandhi Medical College in Thane. We were a very small batch of just 60 people and it became progressively smaller as the years went by, because you know, MBBS. One of the things that made my experience great was exploring aspects of being a doctor beyond what the text books offered. I became involved with the organization, Medical Students Association of India and worked with organizing exchange programmes in the country. It taught me a lot about how India approaches things differently compared with health systems across the globe and what it has to offer. I did, however, enjoy PSM. I know a lot of people don't see it that way. I always thought there is so much more to the subject than the toilet diagrams we were made to draw. I'm incredibly grateful for those years because it was then that I realized I couldn't see myself being a doctor in an office providing a service that countless others would be providing on the same street. I realized, I would rather fill a gap where it needs to be filled. That's how I decided to involve myself in the field of global health. I've had opportunities to explore health care for a month in Chile, attend the World Health Assembly at the WHO and engage myself even more in understanding public health from a global perspective. I'm so grateful for having had all those experiences because they motivated me even more. I currently work with MSF India (Médecins Sans Frontières/ Doctors Without Borders). It's a different world where I work now. Sometimes patients travel 5-10 km on foot just to get one paracetamol. I see 5-8 dozen or maybe more patients infected with malaria in a day. That's the most heart wrenching of all, but making tough decisions is part of being an MSF doctor. I remember this one time, we traveled by car from far off with a lady whose pregnancy needed monitoring. That day it rained so much that the river we needed to cross by car had become too harsh. We had to wait a whole evening to be able to get her to a medical facility. Experiences like these are shaping me and motivating me even more to work where help is needed. I like to think that I live a dual life now. One is attending big conferences on the other side of the world and the other is trying to learn some Gondi, the language the tribals speak in the area where I work. I know everyone doesn't have this privilege, but I think if each individual involved themselves in something that really gives them a sense of purpose, we'd be seeing a lot of great things happening in the world.

19 Lights, Camera, Br achial Prescription lexus P of The Anatomy Department Do you love watching medicine related movies? Sandeep Ashok Khalkar, Here's a list of movie recommendations compiled by Laboratory Assistant, Anatomy Richa Sinha and Atharva Pawar, I M.B.B.S. In Conversation with Khushboo Doshi & Unnati Shukla, I M.B.B.S. 1. Awakening Based on true events that are documented in the Bronx I have been working in hospital, it's a story about the awakening of encephalitis the Anatomy patients and the hospital staff during a clinical trial, not just department as a laboratory technician from their catatonic states. since the past 15 years. Working in a 2. Coma medical college, I get Indulge in this medical thrill and join Dr. Susan Wheeler as she to see body donations tries to discover the mystery behind the doors of OT 8. Healthy frequently and a part of my job extends young patients operated in that OT are declared brain dead beyond the roles of a and there is definitely more than what the eye can see. lab technician. As a person who meets the 3. Patch Adams relatives of the Bring out your red foam noses and balloon animals because deceased who come for body donation, it is we are heading to the paediatric ward! essential to provide This movie talks about treating patients as humans rather than them with reassurance cases and is the best way to laugh, cry and find yourself & make this procedure excited to work as doctors. simpler for them. 4. A Beautiful Mind Telling them about how this is a great deed for the field of Imagine if the people most important to you weren’t gone, science and education is of utmost importance. It gives me weren’t dead, but never existed. satisfaction to be able to help them through this difficult Experience the compelling journey of Josh Nash discovering process. The best part about my job is the students. One the game theory in A Beautiful Mind. incident that happened in the anatomy department dates back to 2006, when a student was somehow locked in the 5. Something the Lord made dissection hall after the lecture ended and he was locked Watch how a black janitor makes a ground breaking discovery inside for over 30 minutes. How he managed to stay inside to cure the blue baby syndrome shattering walls of racism and after clearing the entire dissection hall is a mystery left discrimination. unsolved. Over the years, I have managed to learn how to identify histology slides, briefings for students have also been 6. One flew over the Cuckoo's Nest helpful to me. Dr. Shashank Vedpathak has helped me in The movie shows the mental trauma suffered by prisoners and identifying histology slides. Dr. Belsare ma'am has helped me in the ill-treatment towards the mentally unstable. Watch this identifying embryo models. Dr. Dhanaji Jadhav, Dr.Vivek struggle of a prison break from the insensitive clutches of the Nirmale and Dr. Sonali Khake have taught me how to recognize system. various bones and body parts. The reason behind the anatomy department being the favourite among students is the faculty. 7. Contagion The professors understand the students'' problems and solve The movie winds personal tragedies to the large scale effects them through their teaching and guidance at every step. A of an epidemic. It is a must watch especially in today's times student's life is all about the fun moments and mischief, but with the buzz of Corona virus in the air. taking education seriously is really important. Medical students are a reflection of the society and should understand their 8. The Diving Bell and the Butterfly responsibilities. My only advice to the students is to respect. It is a film about a man who experiences the"locked-in Respect the cadaver, respect the teachers, respect the non- syndrome," where he is alive and conscious, but only able to teaching staff and everything else that makes your education communicate by blinking an eye. Watch the movie to find out complete. The only way of earning respect in this world is by how he writes his memoir by the only means of communication giving respect. left to him. 20 Q. Would you care to share a case that has left an impact D I A L G U E on your mind? DR. ANEESH BHAT, A second year engineering student who had recently parted HEAD OF DEPARTMENT, PSYCHIATRY ways with her boyfriend, following which she suffered mental trauma and tried to commit suicide. After 17 days of treatment and admission in the hospital, she was referred to psychiatry. In conversation with Aishwarya Puranik During her counselling, I put forth two questions before III/I M.B.B.S. her- "What is the aim of your life?And what do you want to do with your life?". She was blank, even in the subsequent Dr. Aneesh Bhat is a Psychiatrist and Professor in M.I.M.E.R. sessions she didn't have an answer. She was put on treatment Medical College. He did his undergraduation from GMC, and follow-up for 3 months. She came back after 3 years and Nagpur and post-graduation from GMC, Calicut. He is was very happy and had also got a job in an IT company. She currently pursuing his MBA and doing a digital marketing said, "Thank you doctor for saving my life. I have understood course from Manipal University. Previously, he worked as an the aim of my life". I asked her what it was. She continued, "I assistant professor in KS Hegde Medical College, Mangalore need to take care of my parents and also give importance to and joined M.I.M.E.R. in 2016. myself. I want to be a productive individual of the society. That is what I want to do. My aim is to save others like me, who Q. How did you decide to become a psychiatrist? impulsively try to commit suicide for the small bad incidents in life". She has started an organization where she helps IT professionals with depression or with suicidal thoughts. Till I have always enjoyed the subject. I also believed that it suited now she has succeeded in saving 35 lives. They meet every my interests and personality. evening and together teach street children. With just two questions she changed her life. Q. How does it feel to have a close insight of the human mind? Q. Since our edition is about Tuberculosis, what do you think are the effects of long-term treatment of I would say it's a privilege to understand your own mind, Tuberculosis on a patient's mental health? emotions and thoughts first. To be able to manage your mind is something great in itself. In our profession, the mind and Medications of Tuberculosis cause depression and also body are treated as separate entities, with the mind getting a psychotic states. As a psychiatrist, I need to treat both. back seat. Most of the diseases with psychosomatic Deteriorating health and immunity also add to their ill mental components are not given enough attention in terms of health. Few medications themselves like, isoniazid lead to treatment. As a pyschiatrist, I can see how the mind affects depression. Not every patient needs to be treated, only those the body. Diseases like hypertension, diabetes, who show symptoms. However, it is very common, around 2-3 immunological conditions, psoriasis, pain and headaches out of 10 patients go into depression. Daily medications and have a strong mental component associated with them. I feel societal rejections are also other contributing factors. blessed to be in a profession where I can study other's mind and treat them. Q. Could you share with us some effective tips to have a healthy mindset?

Q. How would you describe the role of a psychiatrist in You have to just do small things for a healthy mind and body one line? like you should exercise regularly. One hour of 'Me Time' is definitely possible, where we can engage in some The mind conducts the orchestra of our body. So I'd say recreational activities like 30 minutes of exercise, 10 minutes psychiatrists are the people who treat the Maestro. of meditation and regular sleep cycles can be followed. Ask yourself For how many hours do you use WhatsApp or mobile Q. Which are the common psychiatric disorders that phone? We can reduce the use of mobile phones and give you've seen and what causes their prevalence? that time to ourselves. Share whatever goes in your mind with someone. You can always write a diary to express your Most commonly we get anxiety disorders and mood thoughts just like Anne Frank did. Lastly , don't have erratic disorders. Depression is also common now. Nowadays, sleeping habits. Normal circadian rhythm keeps everything stress related conditions are on the rise- family problems, normal. burnout syndromes, impulsive suicidal ideations. Even couples come into the OPD often. The causes mainly Q. What are some recreational activities you enjoy? include not giving time to each other, excessive use of digital technology, not giving enough time to oneself and a I enjoy trekking, travelling and spending time with my friends. I complicated relationship status. Absence of recreational love watching good movies and reading good novels. If given activities is also causing these conditions. an hour of free time, I'd prefer to go on a bike ride!

21 Q. What are the common challenges today's students are facing?

Mainly competition, both in education and AN OPEN LETTER professionally. THE OTHER GIRL SERIES Excessive use of social media is damaging. Hey there! Regulated and productive use is I’ve been contemplating the concept of self love a lot. I needed, not excessive. have always believed that being critical of oneself was You release more a good trait. To me, it was always the only way to endorphins by talking Art work by remind myself to keep learning, keep growing and to your friends than by Arshiya Barmare, doing better. meaninglessly scrolling III/I M.B.B.S. through your phone. I recently realized two obvious facts: Substance abuse is another common occurrence now and 1. I am the only person who is going to be with me all would reduce if people have an understanding about peer my life. pressure.Many students are aimless in their life. If you have a 2. A child that is brought up with love and care is charted out aim, then only you can plan your studies and usually more confident than one brought up with career properly. criticism.

Q. What is the one change you would like to see in These two things made me wonder if all the cheesy M.I.M.E.R.? blogs about self love were true. Picture giving yourself MIMER is doing a lot for social causes. I would like to see more all the love and understanding you give to the people being done for community health and students' mental health. around you. Imagine cultivating a healthy internal Volunteers from each batch can be trained to recognize atmosphere. In other words, picture being your own symptoms. We are planning to conduct the same because if a best friend. Letting words like, “You are unstoppable”, student is capable of identifying symptoms, that'll help a lot. “Everything is going to be alright” and “Dude! You don’t know how amazing you are” become your internal dialogue. Q. Why is the suicide rate high among doctors, especially psychiatrists? Hold yourself accountable, but let yourself grow into a Even doctors are not immune to stressors. There's a stigma more fearless individual. Let’s face it, no matter how among doctors, very few approach psychiatrists. Even when a nice anyone is to you, the only thing that matters is doctor gets gastritis, he treats himself. The problem with what you believe about yourself and how you feel treating oneself is many times things go out of hand. Even a about yourself. Imagine what would happen if we all let psychiatrist should approach a psychiatrist. ourselves grow by surrounding ourselves with love.

Some of us are so quick to give our hearts to others, Q. There is increased awareness of mental health in the but what about the person who needs it most? The urban population. Have you noticed this change in the rural population as well? body that is up and about all day, the mind that works and overworks itself for you. We recharge our phones every day, let’s not forget to recharge ourselves. Yes, under certain government schemes, awareness programs are conducted in rural areas; regarding mental The only way to know what all those cheesy blogs are health, mental illness and identification of symptoms. They about, is to try them out for yourself. I know I will, do take it seriously, rather they approach a doctor if definitely. suffering from a mental illness. People in urban areas have more stigma associated with approaching a psychiatrist. If I asked you to make a list of everything you loved, Though rural people feel that it is because of a deity how long would it take you to name yourself? (possessed), they'll approach a doctor in case they feel disturbed. Things are now changing in India. The young Love, generation does approach psychiatrists. The Other Girl

22 TUBERCULOUS OTITIS MEDIA EST GU E Not y TICL everyda AR Your ear discharge

by Dr. Abhishek V. Menon 3rd year ENT resident, KEM Hospital, Mumbai

Tuberculosis as an entity spares few tissues in the human body, and the ear is no exception. On the occasion of World Tuberculosis Day, I thought I’d talk about the various aspects of this fairly uncommon otological variant of the menace that is TB. Do keep in mind that TB otitis media, like any affliction of the middle ear, presents with similar but vague complaints of ear discharge and decreased hearing. On an average, I probably see at least 15-20 patients presenting with ear discharge every day in the OPD, but almost never does one keep the differential diagnosis of TB ear right on top. But there are a few times where one is forced to try and think out of the box in order to try and clinch the diagnosis. I’d like to introduce this 46 year old gentleman, Manu. He presented with chronic left sided ear discharge since 6-7 months. Right Ear- Hearing sensitivity within normal limits. It wasn’t hard to miss the left sided facial paralysis, was it? Left Ear- Profound sensorineural hearing loss That’s what raised more than a few red flags in my head as to what I was going to be dealing with. On asking Manu, he said We went ahead and operated on this patient, and on that his facial asymmetry was present since more than 3 encountering the same granulations in the mastoid months. cavity, excised and sent them for histopathological Mind you, I still hadn’t thought that this could’ve been TB. My examination as well as a GENE XPERT, which surely primary D/D was a left sided unsafe chronic suppurative otitis enough, confirmed the diagnosis of tuberculosis. Manu media (CSOM), which as my 3rd minor friends would was then given a 6 month course of anti-TB drugs, (hopefully!) concur, commonly presents with chronic ear following which he obtained a completely dry ear, discharge and is known to cause facial palsy as well. But although unfortunately his facial nerve function and what really caught my attention were the pale granulations hearing on that side could not be salvaged. that I found in the left ear canal on visualizing with an In hindsight, one could conclude a few pointers from this endoscope. case. Tuberculosis of the middle/ inner ear is almost This along with a profound sensorineural hearing loss on the never a primary disease, and is usually a result of blood- left side further fuelled my suspicion of it being tuberculous otitis media. borne (haematogenous) spread of the TB bacilli from another region of the body harbouring the infection and that makes it imperative to elicit a past history of TB in the patient or his/her immediate family members. Additionally, such a case where the signs on examination, typical as they were, were far more exaggerated than usually seen in CSOM should definitely alarm the Otorhinolaryngologist and think in line of a tuberculous cause. Either way, a clinician must promptly diagnose such a case and immediately administer the appropriate treatment so as to lessen the morbidity of the patient to a bare minimum. Hopefully, this would raise some awareness about the existence of

(*Consent taken before using photographs) such a rare yet important manifestation of tuberculosis. 23 D I A L G U E

DR. VAROON JAISWAL Professor, Physiotherapy

In conversation with Revati Pathak, Final year BPTh

1. Where did you complete your undergraduate and postgraduate studies from? I completed my undergraduate degree from Ravi Nair Physiotherapy College, Wardha (2006) and postgraduate (MPTh) in Cardio-respiratory sciences from Dr. DY Patil College of Physiotherapy, Pune (2009).

2. What motivated you to choose cardio-respiratory My role models have been the wonderful therapists PT as your speciality? who taught us and helped shape us as human beings Firstly, my UG professor, Dr. Sunitha Narayan’s teaching and as therapists. I aspire to do the same, to make a sowed the seed of my love for cardio-respiratory difference in people’s lives. sciences. Secondly, during my ICU postings at Acharya Vinoba Bhave Rural Hospital, we saw and treated a lot of 5. How has the field of research in physiotherapy oral surgery patients post-op, amongst many others for changed from when you were in college to now? intensive care physiotherapy. During this time, I realized When I was a UG student, MUHS introduced the how big a difference our treatment is making in the concept of research project presentation in final year prognosis of these patients. But it is no cakewalk and is a (in 2004). With limited technology and information on challenge in itself. That was motivation enough for me. I our hands, we were clueless. We did what everyone knew this field would give me satisfaction and at the was doing at the time- look up a research study online, same time, be a feat in itself. and perform it in the best way we could, given the circumstances. 3. What do you think about the current status of the It has been really wonderful to see how far students field in our country? Do you think it needs more have come since then. We have seen them come up advancement/ improvement? with innovative ideas with minimal assistance from The field of cardio-respiratory physiotherapy needs more Google and professors. It won’t be wrong to say that advancement in terms of patient awareness, mass Google has really brought a positive change in the way education and bridging the communication gap between we read about research and everything new that the physicians and physical therapists. People need to be comes up in the field. Once you ensure that an article is authentic and verified, you will be amazed by all the sensitized about the role physical therapy and exercise interesting information you find about your field! plays in prevention of nearly all cardiovascular diseases that are gaining prevalence. To give the simplest 6. What does the current research say about the example, the cardiac rehabilitation programs that our role of physiotherapy in tuberculosis? patients in the cardio-respiratory OPD are undergoing Physiotherapy in tuberculosis has come a long way. are giving us great results. It helped most patients bring There was a time when it was considered to be down their resting blood pressure as well as blood sugar contraindicated. Today, we are trained to weigh the levels to low-risk levels. So, in my opinion, infrastructure potential benefits to harm. More often than not, it so and other advancements are secondary to awareness. happens that the patient leaves the hospital weaker than when he first came in. This is where our role is 4. How did you decide to take up teaching, and how paramount. In an acute care patient who has low O2 has your experience been so far? saturation due to accumulated secretions, chest I have always been passionate about teaching. I started physiotherapy plays an essential role in assisting the teaching as soon as I completed my PG. removal of these secretions.

24 Once a patient is stable and under adequate treatment, it is our responsibility to ensure the patient is ambulatory, his muscle mass is maintained and improved, his strength and endurance are preserved. We, as therapists, are often able to gain the patient’s trust and acceptance towards the treatment he/she is undergoing and that The best kind can pave the way for patient compliance.

6. What has your experience been with tuberculosis of Salary patients? Can you tell us about a case that left an impression? When I was a student, it was very hard-hitting to see the For a doctor, the most valuable payback plight of the patients suffering from tuberculosis. All for their work is patients' appreciation these years of practice has taught me that the cases are and their kind words of gratitude. only the tip of the iceberg (as I’m sure PSM has taught Here's one such incident, Dr. Maya us). I think we fail to see the bigger part of this. The Kshirsagar shared with us. wide-spread practice of spitting, the neglect and ignorance, the stigma, the non-compliance- they’re all a result of lack of awareness and education. As a PG student, one day during the rounds of the Chest ward, we encountered a patient, a young girl who was diagnosed as a case of XDR TB. The physicians had One day, while checking patients in the clustered around, and were discussing the treatment Community Health Centre OPD, an old options. They were debating between palliative care and man came in. As a routine, when I started full-blown multi-drug therapy. After an intense discussion taking down his complaints, he started of the pros and cons, it was decided to go ahead with thanking me for saving his granddaughter. supportive care. I still remember the look of confusion He kept praising the efforts I take for my and helplessness on her face, while the doctors debated patients. His granddaughter was in a over the course of her treatment, and her life. She took a serious condition, when they first came to DAMA in the next few days and did not return. This was me. Due to the unavailability of adequate my foremost first-hand experience and it has stayed with facilities I had suggested them to go to a me. better hospital. Taking the word of a previously cured patient, he trusted us. He 7. What would you like to tell the youth that is going was pretty sure that we'll do everything to be the future of physiotherapy? possible and she'll be out of danger soon. To start with, learn to weigh what you’re giving and what “I have seen your sincerity and the efforts you’re gaining when you pursue something. Set your you take for your patients. I have seen the priorities straight. To all those wishing to pursue a amount of care taken by you for your Master’s abroad, make sure you come back and work for patients. Thank you so much and God your own country. There is so much untapped potential in bless you.” The happiness in his eyes made this country, you’d be surprised. Don’t wait around for me feel proud of my profession. things to work out and for opportunities to spring up, create opportunities wherever you go. If you’re worried about how much respect or validation our field gets in our country, let me tell you that any person doing dedicated, compassionate work in the community earns If you have any such good everyone’s respect. Don’t try to live up to someone else’s appreciation notes or messages definition of success, find your own goal, your own dream and pursue it with all your heart. While you’re at it, don’t from your patients, please write to forget to create a positive, memorable impression in us about them at our mail, people’s lives. [email protected]

25 What did you do this EST GU E TICL 14th Feb? AR by Wiktoria Maria Izdebska Medical University of Bialystok, Poland

"The best way to find yourself is to lose it in the service As they say, real love is sometimes difficult but it is worth of others.” Mahatma Gandhi every single effort. Especially love for medicine, as it equals love to humanity. We recently celebrated St. Valentine's Day, one special day when the entire world wants to feel the thrill of love. St. Valentine was a Christian Bishop and martyr who On that day, being single or in a relationship or being became a patron of lovers and people with mental helplessly in love with someone who has no interest in illnesses. As far-fetched as it may seem, love makes us all you or simply not being interested in anybody, matters. martyrs at times, especially as medical students and physicians. Despite the optimal use of our knowledge to Celebrating St. Valentine’s day is different for save a patient's life, there are times when a patient everybody. Some say, “I don’t need one in three hundred breathes his last. sixty five days to show my affection”, others crave celebrations like those shown in American movies or So what makes us wake up the next day and take another Taylor Swift’s songs. night shift? What makes us study and carry on our medical journey? If it is not doctor’s love, I don’t know what it is. What if I told you that going to a hospital for work on St. Valentine’s day can be the perfect way to spend the day? Why? I feel a hospital is the only place where you can witness such concentration of real love. the

Love is not just about pretty dates and showing affection in conventional ways. I believe it's genuine love when the surgeon checks up on the freshly operated patient, one extra time. Or when a nurse visits the patient, after duty, to make sure they're okay. Love is project seen in a paramedic’s fight against death for a patient’s life or in the teacher's perseverance to help students by Aishwarya Puranik III/I M.B.B.S. understand the human body.

For me, as a medical student, love means dedicating Amidst all the hustle in life, we've got to slow myself to my dream profession, for service of the down and channelize our mind to the simple yet community. Love for medicine, love for research- that’s meaningful thoughts. what makes me wake up on time in the morning and iron my white coat. It is what makes me stay up until morning Analyze it your way, think deeper and you might to finish studying for a test, and unstoppably advocate for changes in medical education and equal access to unveil new aspects of your mind. healthcare. I won’t say that love for medicine is easy- it never was. Medicine broke my heart every time I opened "HOW DEEP ARE YOUR CONNECTIONS?" my exam sheet and didn’t know the answer to the first 10 questions or when the patient I was examining, If actions from those thoughts are set in motion, complained about the terrible state of healthcare in the that'll be a wonderful win. country.

26 Akash Ganesh Wagh III/I M.B.B.S. Grant Govt. Medical College & Sir JJ Group of Hospitals, Mumbai TEAM

Back row (L to R): Saneeka Vaidya, Mohak Tilokchandani, Richa Sinha, Reeya Malankar, Unnati Shukla, Arshiya Barmare, Revati Pathak, Poorva Jage, Sayee Sangamnerkar, Shreya Govalkar, Madhumita Sahoo, Ankit Pal, Nupur Chaturvedi Front row (L to R): Khushboo Doshi, Manasi Joshi, Atharva Pawar, Aishwarya Puranik, Alisha Shaikh

Co-Editors : Saneeka Vaidya & Creative Head : Madhumita Sahoo Nupur Chaturvedi Creative Team : Shreya Govalkar, Associate Editor : Aishwarya Puranik & Manasi Joshi, Ankit Pal, Revati Pathak Poorva Jage Copy Editors : Alisha Shaikh & Cartoonist : Arshiya Barmare Mohak Tilokchandani Public Relations : Atharva Pawar, Junior Editor : Khushboo Doshi Reeya Malankar, Richa Photography : Sayee Sangamnerkar Sinha, Unnati Shukla ADVISORY TEAM

L to R: Avanti Patwardhan, Damini Narkhede, Riya Barar, Siddhi Rangari, Hrushikesh Hendre Co Founders and Co Editors : Damini Narkhede and Riya Barar Copy Editor : Avanti Patwardhan Public Relations : Hrushikesh Hendre Creative Editor : Siddhi Rangari

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