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INTRODUCTION Arrhythmia, simplest put, is an ABNORMAL or IRREGULAR heartbeat. These occur when the electrical impulses controlling your heartbeat malfunction. A normal heartbeat is conducted when electrical impulses start from the natural PACEMAKER of the heart, ie SA NODE located in the right atrium. The electrical impulses then traverse through the entire right and left atrium and both the atria contract. The impulses reach the ATRIOVENTRICULAR NODE where the signals are slowed down(so that ventricles contract later than atria allowing them filling of the blood from the atria). The signals pass through the bundle of his and then the Purkinje fibers and spread throughout the ventricles to make them contract leading to the completion of a normal heartbeat. A normal heart rate is 60-100 beats/minute, though for athletes even less than 60 beats per minute is normal. TYPES OF ARRHYTHMIA #1 Supraventricular arrhythmia– arrhythmia which begins above the ventricles Atrial fibrillation– Many impulses begin and spread through the atrium leading to an increased rate of atrial contraction. The rate is 350-550 beats/minute. Atrial flutter- It is due to a single macro reentry tract, therefore it has a lower rate compared to atrial fibrillation. The rate is 250-350 beats/minute. Premature atrial contractions- Rare. Early, extra heartbeats originating in the atria Paroxysmal supraventricular contractions – A rapid rate rhythm caused by impulse starting from atria bypassing the av node and entering the bundle of his directly. #2 Ventricular arrhythmia- arrhythmia beginning at the level of the ventricles Premature ventricular contractions- Extra heartbeats originating in the ventricles. The most common type of arrhythmia and can be related to stress, caffeine, or nicotine. Ventricular tachycardia- Rapid heart rate originating in the ventricle. Rate is more than 100 beats/minute Ventricular fibrillation- An erratic, disorganized firing of the ventricles. The ventricles fail to pump blood to the body and it is a medical emergency. CAUSES OF ARRHYTHMIA Most common causes of arrhythmia include Myocardial Infarction or heart attack Fibrotic changes in heart tissue post a previous Myocardial Infarction Diabetes mellitus(long-standing) Hypertension Hyperthyroidism Coronary artery disease Cardiomyopathy Congestive Heart Failure Electrical shock Other causes include Smoking Alcohol Caffeine Drug abuse Stress Catecholamines like noradrenaline, adrenaline, dopamine Certain conditions may increase your risk of developing arrhythmia Coronary artery disease and previous heart surgery Congenital heart disease Thyroid Problem Diabetes Obstructive sleep apnea Electrolyte imbalance of sodium, potassium, calcium, and magnesium trigger the arrhythmias. Now to understand how arrhythmia is caused one needs to understand the electro-chemical changes occurring at the microcellular level(refer to images above). Normally a cell has a higher concentration of K+(potassium) ions inside and Na+(sodium) ions outside. Now in a normal heart cell potassium ions keep leaking from the cell to outside depolarising the membrane from the resting membrane potential of -90mV to -70mV which is the action potential and at that value, the impulses fire triggering the heartbeat. This is all done automatic and thus termed automaticity of the heart cells. The role of Ca2+(calcium) ions, in this case, is to stabilize the membrane and prevent from the rapid unwanted firing of signals and the gradual achieving of the action potential. In cases of Myocardial infarction, the blood supply to a part of the heart is stopped killing the cells. In that eventuality, the cells release a lot of potassium ions which depolarise the membrane causing rapid irregular signals leading to arrhythmia. Therefore the combination of hyperkalemia(excess of potassium ions) and hypocalcemia(shortage of calcium ions) is detrimental to the individual and can trigger arrhythmia. The symptoms seen in such cases include Angina(chest pain) Dizziness or fainting Palpitation(able to feel one’s own heartbeat) Breathlessness Sweating Treatment options for arrhythmia include- Vagal maneuvers- Vagal massage is one of the simplest maneuvers a person can do to treat mild irregular heartbeats Medications- It includes many medicines which can be given including Beta-blockers, calcium channel blockers, Digoxin, adenosine but different medications are allotted to different arrhythmia and should be taken only after expert consultation with a cardiologist Cardioversion- In severe cases, electric shock is used to shock the heart back into a rhythm Ablation therapy- For single or few points of erratic origin of electrical signal those particular regions can be ablated for relief from arrhythmias

INTRODUCTION Pneumonia is an infection of the lungs. It can affect any age group but is most common among young children and people older than 65 years and people with underlying medical problems such as heart disease, diabetes, or chronic lung disease. CAUSES Pneumonia can be caused by a variety of micro-organisms, primarily bacteria, and less commonly by viruses and fungi(causing atypical pneumonia). The most common bacterial cause of pneumonia is Streptococcus pneumoniae. Others include Haemophilus influenza and Moraxella catarrhalis. Atypical pneumonia is caused due to viruses and fungi and generally present with subacute symptoms and even subtler pulmonary findings. Fungi involved include Mycoplasma pneumoniae, Chlamydophila pneumoniae whereas the viruses involved include Influenza A and B, Rhinovirus, Respiratory syncytial virus, Adenovirus 4, and 7, Middle eastern respiratory syndrome and most recently CoVID-19 causing coronavirus. HIGH-RISK GROUPS Age>65 years Age<5 years Smoking Malnourishment Underlying lung disease like cystic fibrosis, asthma Underlying medical problems like diabetes, heart disease Weak immune system due to HIV, chemotherapy Recent upper respiratory tract infection TREATMENT CONSIDERATIONS Once the treatment is initiated for pneumonia most people begin to improve after 3-5 days of antibiotic treatment. Improvement is defined on the subjective feeling of patients feeling better or having fewer symptoms, such as cough and fever. Fatigue and a persistent but mild cough can last for a month or longer. People may be able to resume light work as early as a week’s time in case of in-home treatment. Adequate rest, hydration, compliance of an antibiotic course, and regular follow-up visits to the health care provider are necessary. POSSIBLE COMPLICATIONS Complications can develop in some people, especially high-risk groups. Complications can be related to pneumonia itself or the drugs for its treatment and can sometimes develop even post-recovery. It includes- Bacteremia and septic shock Lung abscesses Pleural effusion, empyema Respiratory failure Kidney failure Heart failure PREVENTION Healthy habits, which keep the immunity strong may reduce the risk of contracting pneumonia. This includes Smoking avoidance Avoidance of alcohol Frequent hand washing with the complete six steps Alternatively, usage of alcohol-based hand sanitizer when you can’t wash your hands. Avoid exposure to infected people Adequate rest Adequate hydration A healthy diet with fruits, fibers, and lean protein. Teaching to sneeze or cough into the elbow to reduce the spread of germs to others. Supplements in the form of Vitamin C, Zinc to improve the immune system Anti-inflammatory supplements like nano-curcumin(Haldi) Preventive tips for avoiding postoperative pneumonia include Deep breathing exercises (intensive spirometer) from postoperative day 1 of surgery. Regular hand washing and hygiene Oral hygiene using chlorhexidine Increased sitting and walking time VACCINATION The most important point post-recovery of pneumonia is the prevention of its recurrence. Vaccines go a major way in the path for achieving so. Getting the pneumonia vaccine or the “flu shot” greatly reduces the risk of getting pneumonia but mind you it does not completely eliminate its chance of occurring, though a milder form of the disease may be seen. Therefore preventive measures need to be maintained even post-vaccination. There are primarily two vaccines that provide protection from pneumococcal disease, the pneumococcal conjugate vaccine(PCV13) and pneumococcal polysaccharide vaccine(PPSV23) The pneumococcal conjugate vaccine protects against 13 kinds of bacteria. PCV13 is part of standard vaccination given to babies from when they are 6 weeks old. Given at an interval of 4 weeks thrice till 14 weeks followed by a final booster dose given at 18 weeks. In adults aged 65 years and older PCV13 is given as a one-time injection. People of any age group who have risk factors such as a weak immune system should get this vaccine. The pneumococcal polysaccharide vaccine is a one-dose vaccine that protects against 23 kinds of bacteria. Recommended for adults more than 65 years who have already received the PCV13 vaccine. The gap between the two vaccines should be preferably one year. However, the vaccine should be avoided in- People allergic to the vaccine or its component Pregnant women People with a severe cold, flu Some common side effects of the vaccines include- Redness or swelling at the injection site Muscle aches Fever Chills TAKEAWAY Pneumonia is a potentially serious complication of the respiratory tract which is caused by a variety of bacteria, viruses, and fungi. Children below 2 years of age and adults above 65 years are recommended to get the pneumonia vaccine. Elderly and other high-risk age groups should also maintain healthy habits and good hygiene to reduce the risk of getting pneumonia.

Rickets is defective mineralization of the growing bone seen in infants and young children caused due to abnormal calcium and phosphorus levels. This results in soft and weakened bones and bony deformities. It is commonly seen in dark-skinned children or children with inadequate exposure to sunlight. Bone mineralization requires a sufficient supply of the essential mineral ions, calcium, and phosphorus. Vitamin D helps in the absorption of calcium ions from the gut. With insufficient serum calcium concentration caused by either vitamin D deficiency or inadequate dietary calcium intake, parathyroid hormone (PTH) will get activated leading to bone resorption and causing the release of stored bone minerals into the bloodstream thus maintaining normal serum calcium. Bone disease (rickets and osteomalacia) develops once elevated PTH has led to low serum phosphate levels, as a result of impaired renal phosphate conservation. Nutritional Rickets is a disorder of defective growth plate matrix mineralization in children. Osteomalacia is abnormal matrix mineralization in established bone, and although present in children with rickets, it is used to describe bone mineralization defects after completion of growth. With insufficient serum calcium concentration caused by either vitamin D deficiency or inadequate dietary calcium intake, parathyroid hormone (PTH) will get activated leading to bone resorption and causing the release of stored bone minerals into the bloodstream thus maintaining normal serum calcium. The clinical features seen in rickets include- Cranio-tabes(softening of the skull around suture lines) Frontal bossing(forehead bulges out) Wide-open anterior fontanelle Wide wrist Delayed dentition Harrison sulcus visible( Visible retraction of muscles at lower ribs) TREATMENT FOR RICKETS Treatment for rickets is essential to manage a quality life. Treatment may be given gradually over several months or in a single-day dose of 6,00,000 IU of Vitamin D. If the gradual method is chosen 5000-10,000 IU is given daily for 2-3 months until healing is well established and the alkaline phosphatase concentration reaches the reference range If the vitamin D dose is administered in a single day, it is usually divided into 4 or 6 oral doses. An intramuscular injection is also available. Vitamin D is well stored in the body and is gradually released over many weeks. The single-day therapy avoids problems with compliance and may be helpful in differentiating nutritional rickets from familial hypophosphatemic rickets(FHR). In nutritional rickets, the phosphorus levels rise in 96 hours and radiographic healing is visible in 6-7 days. Neither happens with FHR. A study conducted found that a daily calcium intake of 1000mg resulted in more radiographic healing than 500 mg per day dosing. The study also found that complete healing of nutritional rickets may sometimes take more than 24 weeks. Human milk has little vitamin D and very little phosphorus. Infants who are weighing less than 1500gms need special supplementation (Vitamin D, Calcium, Phosphorus) if breast milk is their primary dietary source. Recommending a vitamin D supplement from the first week of life for susceptible infants is safe and effective. The upper level of recommended daily allowance for 0-6 months and 6-12 months infants is 1000 IU/day and 1500 IU/day. However, an adequate intake of 400 IU/day has been suggested for infants 0-12 months while post that 600 IU/day has been recommended. PREVENTION OF RICKETS The three-pronged prevention strategy is employed- A healthy balanced diet having adequate vitamin D sources like fish, cod liver oil, egg yolks, mushrooms, soy milk, almond milk, and orange juices among others can be used in older children. Sunlight exposure- Exposing 12%-18% of body surface area to unprotected sunlight for 30-45 mins is equivalent to taking 600-1000 IU(for older children) of vitamin D which is the dose recommended by experts for the fortification of food. Vitamin D synthesized in the skin lasts twice as long. We as humans can get Vitamin D from abundant sunshine. Vitamin D supplementation-It is used to meet the recommended daily allowance of vitamin D for the individual. RDA for vitamin D is as follows- <1 year- 400 IU 1-70 years- 600 IU >70 years- 800IU

Smoking is one of the leading causes of lung cancer, but many cases of lung cancer are seen in individuals who have never smoked ever in their life! Around 10-15% of lung cancers arise in non-smokers. EPIDEMIOLOGICAL FACTORS Age- Lung cancer risk increases with age among both smokers and non-smokers. The typical age of presentation is beyond 40 years. Gender- Lung cancer incidence rates are higher in women than men among non-smokers for the age bracket of 40-70 years. Race/Ethnicity- Lung cancer incidence rates are higher in African-Americans and Asians than whites. NON-SMOKING CAUSES OF LUNG CANCER #1 Second-hand smoke- It was back in 1981 when published reports from Japan and Greece indicated increased lung cancer risk in non-smoking women married to smoking men. A causal association has been established between passive smoking and lung cancer due to the presence of carcinogens in side stream smoke. #2 Radon- It is a respiratory carcinogen and is important not only for the underground miners but for the general population as well. Radon, an inert gas, is produced from the decay of radium. Radon with a half-life of 3.82 days decays into polonium-218 and polonium-214 which emit alpha particles, which are high-energy and high-mass particles that cause DNA mutations and break in the chromosomal structures. An important thing to notice is that the penetration power of the alpha particles is not related to concentration meaning that the radon particle is equally damaging in low and high concentrations. There can be permanent damage to a cell by just one hit from an alpha particle. High chances of lung cancer are present in underground miners due to radon exposure. In a study of 757 miners, 34 deaths were reported from lung cancer against the expected rate of 10, meaning that 3.4 times higher mortality was observed in these groups of miners. In the 1970’s, there was widespread recognition that radon is present in indoor environments including homes, giving rise to concerns! Studies conducted in both North America and Europe showed a considerably increased risk. #3 Outdoor Air pollution – Vehicles, Industries, and powerplants are the main culprits. Studies have confirmed an increased risk of lung cancer for increasing levels of air pollution. #4 Indoor Air Pollution-  About half of the world population, mostly in low resource countries use solid fuels for cooking in poorly ventilated spaces. Product of incomplete combustion contain carcinogens such as benzopyrene, formaldehyde, and benzene exposure to which has been known to cause lung cancer Coal- Use of coal for cooking and heating was associated with increased lung cancer risk among non-smokers, especially seen in China. Biomass- Studies conducted in Japan, China, and Mexico found an increased risk of lung cancer among non-smoking women exposed to smoke while cooking with various biomass fuels. Cooking fumes- Stir-frying, deep-frying, and pan-frying which involves heating oil to high temperatures is practiced worldwide, especially in China and studies have found a positive correlation between lung cancer in non-smokers and cooking fumes. #5 Occupational Agents Asbestos- Studies have proven an increased risk of lung cancer among non-smokers who were exposed to asbestos especially in shipyard and dock workers. The risk of cancer is determined by the level of exposure to asbestos and also the exposure to the type of fibers. Arsenic- Copper smelter workers from Sweden and Chinese tin mines emitting arsenic have shown an increased risk of lung cancer among the workers. Silica- Several industry-based studies of workers exposed to silica have reported an increased risk of lung cancer among non-smokers. #6 Other risk factors Arsenic in drinking water especially seen in the case study in Chile has shown a positive correlation with lung cancer Human Papilloma Virus(HPV)- HPV 6, 16, and 18 causing infections have been associated with lung cancer. Human immunodeficiency virus(HIV)- HIV has been associated with an increased risk of lung cancer. Ionizing radiations- Many studies have shown an increased risk of lung cancer due to radiation treatment of Hodgkin’s disease or breast cancer. #7 Apart from the above-mentioned causative factors for lung cancer some factors are protective for lung cancer and include- Fish consumption- High fish consumption was found to decrease the risk of lung cancer among non-smokers. Micronutrients-  Consumption of carotenoids, alpha and beta carotene, vitamin A and vitamin C have shown a negative correlation with lung cancer. Hormone replacement therapy- Generally an obsolete form of therapy but when was given earlier showed protective factors from lung cancer.

A year ago you might have heard about the job title and would have little knowledge  about it or would have jokingly thought “ Yeah the people who put patients to sleep before surgeries?” Well fast forward to today and pretty much everyone would now refer to them as “heroes”, our chief of the ‘corona warriors’. So today I would like to give a little bit of insight into the life of an anesthesiologist, how one achieves the title and what all things they manage and yes obviously would also discuss how COVID has influenced their jobs. HOW TO BECOME AN ANESTHESIOLOGIST The first thing you need to achieve is an MBBS degree. So toiling through 4.5 year of study and 4 professional exams u march into an internship where you are the cheapest and most dedicated labor available to the hospital staff and your seniors. That one year is gruesome but is extremely essential as it manages to teach you the basics of patient management in roughly all fields. Then comes the all important and equally tough PG entrance exams, the gateway to specialisation in medical fields(MD,MS). Once you enter the branch then comes your three year post graduate training. The first year pretty much goes into doing all the petty stuff like preparing drug concentration for preoperative surgeries, doing preanesthetic check up and reviewing with seniors and penning down most of the paperwork. It is from the second year onwards that they start to manage the operative patients, ICU, and most work starts coming at a spinal level to them. The third year is when the graduate is most confident with the work both practically and theoretically. WORK OF AN ANESTHESIOLOGIST They are also called intensivists or the ones who are responsible for managing the ICU to attend to the critically ill and most severe cases of the hospital, the reason why they have become indispensable in the fight against COVID. They manage the patient from all levels starting from neurological assessment( consciousness, responsiveness) then the hemodynamic stability via IV medications like fluids, crystalloids, noradrenaline, and close monitoring of vitals like bp, pulse, hr. They also manage the all important respiratory system the failure of which requires intubation and putting on a ventilator and then managing the patient on the ventilator until he/she can be safely extubated. They are an important cogwheel of all surgeries emergency and elective alike, whether it be neurosurgery, cardiothoracic surgery, orthosurgery, gynae surgery, paediatric surgery or even emergency cesarean surgeries. So in one case where the anesthetist is working on a 30 year old gunshot wound patient, his next case can be a 90 year old diabetic amputee patient and sometimes even a few days old child for tracheo-esophageal fistula. Complete knowledge of the human body across all spectrums is what is demanded from them. In the operating room they are the diabetes specialist, the asthma specialist, the heart disease specialist in short a one stop solution for the patient. So next time you think of the job title remember anaesthetists are not there for the purpose of just  putting people to sleep but for the purpose of bringing them back up safe and sound. ROLE IN COVID-19 PANDEMIC Anaesthesiologist have been called to the front lines of the war on COVID-19 for a very vital yet dangerous job. They operate ventilators, one of the top weapons in fighting severe cases of coronavirus. They have accepted this frontline assignment even though sometimes there is a shortage of vital equipment and always at a risk to them and their family. During the current ongoing pandemic anaesthesiologists are facing long working hours and that too in the all cumbersome, suffocating, skin drenching with sweat PPE kits( complete body cover, shoe cover, head cover, face shield, mask). There is always the constant fear of bringing the sickness home to their families. There is also the additional emotional stress of being the only compassionate bedside friend to seriously ill patients whose family members are not allowed and easily the toughest among all the stresses. Mental health aspect is one of the most neglected aspects of health and more so during this ongoing pandemic. Naturally working in an isolated environment with critically ill patients and losing many of them in each duty while trying your level best does test the most resilient of will powered personalities. Therefore numerous support groups have sprung up to take care of such needs of these bravehearts. So next time around do remember to give that warm smile and extra respect to your anaesthesiologist and just not limited to the pandemic times cause that is one person you would want on your side when you truly require it!

Strangely, the term “hemorrhoids” is a term used both for normal anatomy as well as pathology of the lower rectum and anus. Anatomically, Hemorrhoids are the normal anatomical cushions composed of arterioles, venules, elastic tissue, and fat. The locations are at 3’o clock, 7’o clock, and 11’o clock in the lithotomy position(position used for gynecological examination). Pathologically, they represent dilated veins present in the lower rectum and the anus. They are also referred to as piles. Hemorrhoids are classified by their anatomic origin and by their relative position relative to the dentate line into internal and external hemorrhoids. External hemorrhoids develop from ectoderm(skin) while internal hemorrhoids develop from endoderm(gut). Therefore external hemorrhoids are supplied by cutaneous nerves and experience pain but the deeper structures are pain-free Symptoms of hemorrhoids include-External HemorrhoidsInternal Hemorrhoids1)    Itching around anus1)    Painless bleeding2)    Bleeding during defecation      2)  Prolapse of mass during defecation3)    Pain around anus      3)  Pain due to compressive symptoms Causes of hemorrhoids include Constipation Obesity Pregnancy Low fiber diet Heavy-weight lifting Proctoscopy(to view anal canal) is sufficient for diagnosing external hemorrhoids while anoscopy and flexible sigmoidoscopy are required to diagnose internal hemorrhoids and ruling out any proximal disease. CURE OF HEMORRHOIDS The rule to be followed in hemorrhoids is “To treat them only when the patient complains”, especially applying to the elderly people. Treatment is divided according to the type of hemorrhoids being treated. INTERNAL HEMORRHOIDS- Internal hemorrhoids do not have cutaneous innervation and therefore can be destroyed without anesthetic, and the treatment may be surgical or non-surgical. They often respond to increased fiber and liquid intake and avoidance of straining. The treatment is further divided according to the grade of hemorrhoids- Grade 1 hemorrhoids are treated with conservative medical therapy and avoidance of fatty and spicy food Grade 2 and some grade 3 hemorrhoids are treated conservatively as above Highly symptomatic grade 2 and 3 hemorrhoids are treated by surgical procedures of banding and/or sclerotherapy Grade 4 hemorrhoids generally require removal of the gangrenous and necrosed part, namely via the procedure called hemorrhoidectomy. Stapled hemorrhoid surgery(Longo hemorrhoidectomy) is one of the best methods for treating recurrent prolapsing internal hemorrhoids not responding to conservative treatment. EXTERNAL HEMORRHOIDS- External hemorrhoids symptoms are divided into problems with acute thrombosis and skin tag complaints. The former respond well to excision(not enucleation) whereas operative resection is reserved for the latter. Operative hemorrhoidectomy has a recurrence rate of 2-5%. Non-operative techniques, such as rubber band ligation, produce a recurrence rate of 30-50% in 5-10 years. Acutely thrombosed external hemorrhoids can be safely excised in patients who present within 48-72 hours of symptom onset. In patients presenting more than 72 hours, conservative management is preferred at first. CONSERVATIVE MANAGEMENT If managed well most of the hemorrhoids can be treated by conservative management. Retraining the patient’s toilet habit is extremely important. Decreasing straining and constipation shrink internal hemorrhoids considerably. Conservative management includes the following- Warm Bath- Bathing in a tub with warm water helps in the relaxation of the external sphincter and associated spasm easing painful perianal conditions. High fiber diet- Psyllium seed(Metamucil) and methylcellulose are the most commonly used supplements. High fiber diet includes more than 25gms of fiber per day which includes chia seeds, beans, broccoli, berries, avocados, apple, etc. Antidiarrheal agents, stool softeners- Antidiarrheal agents are required in patients with hemorrhoidal symptoms and loose stools. Stool softeners are used in constipation along with a high fiber diet. Topical agents- Topical steroids help to decrease symptoms of pruritis, inflammation and can sometimes even ease internal hemorrhoid bleeding. Topical nitroglycerine and nifedipine are also used to relieve symptoms associated with anal sphincter spasm.

INTRODUCTION The chimpanzee and the bonobo are human being’s closest living relatives! We are part of the greater apes family and thus more closely related to the Gorilla, Orangutan, and Chimpanzee rather than the gibbons and the monkeys. The greater apes have a larger brain, bigger body, and lack tail. One of the biggest misgivings is humans having evolved from chimpanzees. However, that is not true as both humans and chimpanzees share a common ancestor some 5-6 million years old. Chimpanzees are the closest genetically to humans sharing about 98.6% of our DNA. Just a mere difference of 2% in DNA and a vast difference in physical, neurological characteristics, and behavior. Chimpanzees are excellent climbers, live social lives, participate in power politics, are ingenious in the making and usage of tools, and are even known to show betrayal and commit homicide. Yet these behaviors don’t remotely come close to the complexity and nuance of human behavior. The chimpanzees are near-incapable of spirituality, irony, or even sarcasm. GENETIC MAKEUP It was just a few years ago with the human genome project that the sequencing of the human genome was completed and soon after the chimpanzee’s DNA was also sequenced which confirmed the similarity to our DNA. Their DNA consists mainly of 4 components namely Adenine, Guanine, Cytosine, and Thymine. Even an error as small as that of a single nucleotide can result in a mutation. It is this difference which when passed down for generations leads to a DNA difference between species. Therefore in genomes which includes hundreds of millions of nucleotides even a small interval of 2% translates into millions of nucleotide differences. Important to understand here is that the bodybuilding material or ‘proteins’ are made from genes which is nothing but a sequence of nucleotides put together. Now, DNA is divided into useful parts (which encode for extrons of RNA and thus participate in protein production) and non-useful parts (which encode for introns of RNA and do not participate in protein production). If nucleotide difference is present in the non-coding region no significant difference is caused, however, even a single nucleotide difference present in the coding part can lead to totally different proteins being produced. DIFFERENCE IN THE GENES In the DNA, important information is stored in a short stretch of nucleotides just before each gene and is also known as the ‘switch’ for the genes. They, in turn, are stimulated by proteins called transcription factors. So say, when you suffer an injury, transcription factors are produced which switch on genes of your fighter cells triggering inflammation. Accurate production of transcription factors is essential and a single nucleotide mutation in the gene producing those factors can turn catastrophic. One of the biggest differences in genes between humans and chimpanzees come among these transcription factors. Furthermore, gene differences come in the type of activity. Chimpanzees have a lot more genes associated with olfaction(sense of smell), some with the immune system giving them protection against malaria(seeing their main habitat is the forest) but the same make them more vulnerable to tuberculosis as compared to humans. This simply means that some genes are more expressed in one species while it is masked in the others just like when you hone a particular skill it takes precedent over the others. THE BIGGEST DIFFERENCE The brain is the single biggest difference between the two species. After careful examination of a neuron across many species be it humans, chimpanzees, frogs were found not to be different and were made up of the same fibrous dendrites and axon trunk, however, the difference was found in the quantity. It involves things as simple as cell division. Neurons starting from one divides into two, then four, then eight, and so on. It takes about 37 rounds of division to reach the size of the human brain. If the division stops just 2 steps less, it gives the equivalent of a chimpanzee brain. So, only a very few genes regulating the rounds of cell division are one of the biggest difference causes between the two species! So, ultimately the vast difference between human beings and chimpanzees comes down to something as small as a couple of percentage differences in DNA, so next time do remember the power that a couple of percentages of DNA hold!

Blood is a specialized body fluid. It has four main components namely plasma, white blood cells, platelets, and red blood cells. The primary function of the blood includes Transportation of oxygen and nutrients to the lungs and tissues Formation of blood clots via clotting factors Mounting an immune response via white blood cells Transportation of waste products to liver and kidneys for excretion Regulation of body temperature INTERESTING FACTS Blood makes up 7% of the weight of the human body. There are 150 Billion red blood cells in one ounce of blood. There are 2.4 Trillion red blood cells in one pint of blood. The human body manufactures 17 million red blood cells per second. If stress precipitates the body can produce 7 times that amount. A red blood cell is 7 microns in size. Red blood cells have a life span of 120 days. RED BLOOD CELLS The red blood cells(RBC) are highly specialized cells, approx 7.8 µm in diameter and in the form of biconcave disc, a shape which provides a large surface to volume ratio for transportation of gases(CO2 and O2). When blood is centrifuged the volume of packed red cell range between 42 and 54 percent in men and between 37 and 47 percent in women. The normal red cell count ranges between 4 million and 6 million per cubic millimeter. The RBC membrane is composed of lipids, proteins, and carbohydrates in an organized manner. The red blood cell undergoes distortion when passing through small passages but once the stress is removed it springs back into shape. The RBC is impermeable to the hemoglobin inside but is permeable to water, oxygen, carbon dioxide, glucose, and urea among other substances. The membrane of the red blood cell has a group of molecules on its surface which confers blood group specificity to it. These molecules are antigens that are capable of producing antibodies if injected in persons lacking them. HEMOGLOBIN About 95% of RBC consists of Hb which is necessary for oxygen transport. There are 4 iron atoms in each molecule of Hb which can bind to 4 atoms of oxygen. The affinity of Hb for oxygen is such that at oxygen concentration present in the lungs nearly 95% of Hb is saturated with oxygen. As it moves through the tissues differential oxygen gradient leads to the transfer of oxygen from the Hb to the tissues. NUTRITION FOR RBC Food rich in iron helps in maintaining healthy red blood cells. Vitamin B2, B3, and B12 found in eggs, whole grains, and bananas are also required as so is Folate. However, it is to be remembered that red blood cells in mammals are anucleate, i.e. devoid of the nucleus and thus have very little reparative ability and no division ability. One of the reasons for absence of the nucleus is that the RBC needs to pass through very narrow capillaries and the presence of the nucleus would have led to size constraint for the same. If the RBC is constrained for space it can release multiple factors including ATP, Nitric oxide, and hydrogen sulfide all of which are directed to the vessel wall for dilation and relaxation, which can provide help only to a little extent. LIFE CYCLE OF RBC RBC is produced via a process named erythropoiesis from stem cells to mature red blood cells in 7 days. Through this process, red blood cells are continuously produced in the bone marrow of large bones. The production is stimulated by the hormone erythropoietin synthesized in the kidney. The functional lifetime of RBC is 120 days. Aged RBC undergoes eryptosis or planned RBC death by making the membrane of RBC susceptible and recognizable to macrophages. RED BLOOD CELL DISORDERS Problems of the red blood cells include different type of anemias and are- Iron deficiency anemia- The most common type of anemia due to low iron in the diet, sudden loss of blood, chronic loss of blood. Sickle cell anemia- An inherited disease in which RBC is half-moon shaped. The change in shape makes the cells sticky and may cause blockage in flow sometimes. The life span of sickle cells is also 1/10th of normal RBC’s. Hemolytic anemia- It occurs when RBCs are destroyed within the body by an abnormal process, for eg: due to G6PD deficiency. Fanconi anemia- Rare inherited disorder where bone marrow isn’t able to make sufficient blood products. Pernicious anemia- It is an autoimmune disorder wherein the body lacks intrinsic factor, required to absorb vitamin b12 from food. #REDBLOODCELLS

INTRODUCTION “Smell is a potent wizard that transports you across thousands of miles and all the years you have lived”- Helen Keller Hellen Keller the famous writer and author, also called ‘miracle worker’ by none other than Mark Twain, was born as a normal child but due to an infection at the age of 19 months, she lost the sense of sight and hearing. She had the ability to differentiate roses on the basis of smell and could smell literally everything from the trees to flowers to soil and even burning wood. She could even differentiate garments belonging to different members of the family just on the basis of smell. She rued in one of her writings the respect not given to smell among all the senses. When one thinks of the sense of smell it evokes powerful memories. Be it the smell of freshly mowed grass transporting you to your childhood, the smell of the earth after rain, the smell of freshly baked bread at your uncle’s bakery, the smell of cologne taking you to your high school days, or the particular smell of the flower transporting you to your grandparents garden. MECHANISM OF OLFACTION/SMELL Firstly, for a smell to be perceived by our noses, it has to be in a gaseous state, ie when we smell flowers we are actually inhaling a mixture of volatile odorants that make their way up the sinus to the olfactory epithelium. The human olfactory epithelium is 9cm2 while that of the canines is about 20 times bigger than humans meaning that they can smell a whole world of smells in their one sniff as compared to ours. The smell gets converted into a signal at the olfactory receptor neurons which then transmits the signal to the olfactory bulb. SMELL AND MEMORY The limbic system is the place where we store emotional memories associated with a particular smell. Olfactory memory is key to our survival instinct and is stored in the amygdala like the smell of something burning. The amygdala is also involved with the formation of emotional memories especially those associated with fear or fight-or-flight. For example, the memory of running helter-skelter when being chased by a dog during childhood. This data is then forwarded to the hippocampus which files and stores it away for long term use to be retrieved when required. NOSE: THE PATHFINDERS The brain connects smell to memories through an associative process where neural networks are linked through brain waves of 20-40Hz. It was proven by a research conducted by the Kavli Institute for Systems Neuroscience. In the research, a maze was designed for rats where they had to poke their nose through a hole. On the other end two distinct smells were provided alternatively with one smell associated with the food being kept on the left side while the other smell with food being kept on the right side. The rats soon learned the smell associated with food on the particular side with 85% accuracy. Furthermore, 16 electrodes were inserted in the hippocampus and the entorhinal cortex to study the pathway in the brain. Immediately after the rat is exposed to the smell there is a burst in the activity of 20Hz waves between the lateral entorhinal cortex and the hippocampus. AGE DISTRIBUTION OF ODOR MEMORIES The age distribution of memories evoked by verbal information (recollection of past events with date) follows a pattern having three components: The childhood amnesia, the bump, and the recency. Childhood amnesia is the dramatic reduction of memories in early childhood. In contrast, a significant number of memories are recalled from ages of 10-30 years, phenomena called the bump. The third component recency reflects better retention of events in the past 10 years. A bump has been seen at an earlier age for odor-evoked memories(<10 years) compared to verbally cued memories(10-30 years). Therefore the oldest memories we have are more often associated with the sense of smell than the other senses. I would like to end the topic by some excerpts from the writing of the great author Helen Keller, again showing the power of smell- “From exhalations, I learn much of people—the work they are engaged in and the places they have been in, for instance, the kitchen, the garden, or the sick-room. I know when certain friends approach me by the cosmetics they use or the cigarettes they smoke. The dear odors of those I love I would not part with for all the perfumes of Arabia.”

INTRODUCTION Forget about the friendly neighborhood spiderman and bring on the spider-web!! Did that sound a little gross? Well it, would you believe if I tell you, it is one of the best natural healing and reparative elements out there! It is the constant endeavor of the people around the world to discover agents that can decrease the cost of treatment and also the time of healing. One of the approaches employed since ancient times has been the usage of spider silk in many places like ancient Greece and even in modern places like Bokaro, Jharkhand, India where spider silk is applied on cuts and wounds to stop bleeding and initiate healing. ABOUT THE SPIDER WEB The spider web consists of proteinaceous silk which is extruded out of the spinneret glands of the spider. The spider web is directly applied on to the wound/cut to promote healing. Spider webs are rich in vitamin K, very essential to the activation of the clotting factors and promoting healing. They also increase the number of fibroblast and collagen synthesis to accelerate wound healing. Spiders can produce up to seven unique types of silk. Dragline silk (which is the commonest type used) has a strong tensile strength and thus can absorb a lot of energy. Furthermore, spider silk does not show any allergic or inflammatory reaction as it does not act as a foreign body, thus making it one of the best choices for use as medicine. Spider silk is a hell lot stronger than insect silk. Spider silk is highly resilient and is three times stronger than synthetic fibres like kevlar which is used to make bullet-proof vest! Go figure. USE AS A BANDAGE The ancient Greeks used this ‘mystery silk’ as a medicinal bandage. The Greeks used the webs on the soldiers. They firstly used a combination of honey and vinegar to clean the wounds. Then a wad of spider webs would be placed on top and held until the bleeding stopped. A University in the UK has been able to incorporate the spider silk into a bandage. They produce these silk structures (from E.coli) which have antibiotic properties and add molecules to it to spin it into a bandage. This bandage then disperses the medicine at a constant rate. The silk has been even used for treatment of slow-healing wounds like diabetic ulcers. Using this technique not only was infection prevented due to the antibiotic property of the silk but regeneration was also accelerated as the fibres acted as a temporary structure on which healing occurred before the fibres got biodegraded. Scientists are constantly engaging in new techniques on how to spin spider silk. Till now spinning techniques have produced spider silk which is about 10 times thicker than natural spider silk. They are even being employed in 3D printers now. HEALING DAMAGED NERVES The spider silk is woven and interconnected in a special way which provides for the phenomenal tensile strength. Biologists are working on the production of tiny tubular structures similar to spider silk that can be implanted in patients with damaged nerves. Normally the growth of nerve fibres in the damaged nerve is blocked due to formation of scar tissue. The silk proteins introduced to inhibit the formation of scar tissue allowing regeneration, further, they have a mechanical advantage of bearing strain and body weight and also the human body does not perceive the spider silk as a foreign body. Another material which has a future role in nerve healing is Hydrogels. Injected into the body they imitate the cell’s natural environment and thus encourage cells to regenerate. Furthermore, additional biomolecules can be added to the 3D structure of hydrogel to be delivered at the site of injury. So, do not simply let the primitive instinct of fear and disgust overpower you when you accidentally get caught face on in a spider web as you would be able to appreciate its numerous uses and value! Spider Webtabulous

INTRODUCTION One of the most common precancerous tumours found is in the oral cavity. Cancers of the oral cavity and oropharynx represent 2/3rds of all malignancies in INDIA. A wide array of precancerous tumours have been implicated in the development of oral cancer including leukoplakia, erythroplakia, oral lichen planus, oral submucous fibrosis, and actinic cheilitis. RISK FACTORS The risk of developing oral cancer is 5-9 times greater for smokers than for non-smokers and this may increase to as much as 17 times greater for extremely heavy smokers. Chewing tobacco has also been associated with an increased risk of oral cancer. The chronic use of betel quid(Paan) which consists of a betel leaf that is wrapped around a mixture of areca nut and slaked lime, usually with tobacco has a strong association with oral cancer. The prototypic viruses implicated in oral cancer development are human herpes virus, human papillomavirus, and herpes simplex virus. HPV-16 has been associated with 22% of oral cancers. The clinician should always have a high degree of suspicion especially if the use of tobacco and alcohol is present. These lesions often present as either white or red patches, known as leukoplakia and erythroplakia. It may present early on as a non-healing ulcer. The later stage includes bleeding, loosening of teeth, difficulty wearing dentures, and development of a neck mass. LEUKOPLAKIA First described by Schwimmer in 1877 as a white lesion of the tongue. According to WHO “leucoplakia is a white patch or plaque that cannot be characterized clinically or pathologically as any other disease”. It is a diagnosis of exclusion. The common sites are the buccal mucosa, alveolar mucosa, and lower lip. Early on leukoplakia appears as a slightly elevated greyish-white plaque that may be well defined or may gradually blend into the surrounding mucosa. As the lesion progresses, it becomes thicker and whiter sometimes developing a leathery texture. One of the best treatments for the above is surgical excision. ERYTHROPLAKIA Erythroplakia is defined as “A fiery red patch that cannot be characterized clinically or pathologically as any other definable disease”. The clinical appearance is characterized by flat or even depressed erythematous changes of the mucous. Both red and white changes in the same lesion are referred to as “erythroleukoplakia”. Most commonly seen in males and among the middle-aged and elderly. The most common affected areas reported are soft palate, the floor of the mouth, and buccal mucosa. Chewing tobacco and drinking alcohol are the possible etiological factors for the development of erythroplakia. Clinically, the typical lesion of oral erythroplakia is less than 1.5 cm in diameter. Malignant transformation rate is high(14-50%), so it needs to be treated expeditiously. Treatment options include surgery either by cold knife or by laser. ORAL LICHEN PLANUS Lichen planus is a chronic, autoimmune, inflammatory disease that may affect the skin, oral mucosa, genital mucosa, scalp, and nails. Involves female gender between the 5th-6th decade. The most commonly affected areas are dorsum of the tongue, buccal mucosa, and gingiva. Clinically, OLP is of 6 types including papular, reticular, plaque-like, atrophic, erosive, and bullous type. The most common type is the reticular pattern which is present as a fine white striae known as “Wickham’s striae”. Patients with reticular and other asymptomatic OLP can be followed without treatment. But if there are any symptoms lesions should be surgically removed. ORAL SUBMUCOUS FIBROSIS Oral submucous fibrosis is a chronic and potentially malignant disorder characterized by fibroelastic change of the lamina propria(intermediate cell layer) and epithelial atrophy leading to stiffness of oral mucosa and inability to eat. Usually seen in the Asian population, occurring in the 2nd-3rd decade and both sexes may be equally affected. The strongest risk factor is the chewing of betel quid containing areca nut. Symptoms such as burning sensation and intolerance to spicy food are the most common symptoms of the initial phase. Over time, it gradually progresses and fibrosis develops that can affect the mouth opening. Three current treatment options include surgical, physical, and medical. Physical treatment includes exercise regimen, splint, and microwave diathermy. Medical therapies include steroids, interferon-gamma, beta-carotene. ACTINIC CHEILITIS Actinic cheilitis is a potentially malignant disease of the lip caused by exposure to solar radiation. In addition tobacco use, poor oral hygiene, and ill-fitting dentures may play a role. Initial stages show erythema and edema though later on can present as leukoplakia and erythroplakia. Malignant transformation is seen in 2-36% of cases. In treatment 5-fluorouracil, scalpel vermillionectomy, electrosurgery, and cryosurgery can be used. CONCLUSION The ability to control precancerous oral tumours will depend on two cornerstones: prevention and early diagnosis. Continuing educational campaigns to educate the public about the early signs/symptoms, individuals encouraged to seek professional oral examinations, and health care workers asked to perform oral examinations as part of their patient care regime.

INTRODUCTION Hepatitis C is an infection caused by the hepatitis C virus(HCV) that attacks the liver and leads to inflammation. The World Health Organization estimates about 71 million people globally having chronic hepatitis C infection with approximately 0.4 million dying from the infection due to cirrhosis and hepatocellular carcinoma. Infection due to HCV accounts for 20% of all cases of acute hepatitis. Because most patients infected with HCV have chronic liver disease which can progress to cirrhosis. In fact, it is regarded as one of the most important causes of chronic liver disease and a common indication for liver transplantation. Most patients with acute and chronic infections are asymptomatic. Although acute HCV infection is usually mild, chronic hepatitis develops in nearly 75% of patients. Surprisingly, blood panel reports of liver enzymes may be in the reference range. Biopsy of the liver will reveal chronic liver disease. Risk of transmission of HCV is increased in the following cases Health care worker exposed to a needle prick or infected blood via the mucosal surfaces Previous history of injections or illicit drug usage Multiple sexual partners Use of uncleaned razors, blades at the barbershop Presence of concomitant HIV Past history of tattoo or piercing done in an unsterile environment Previous history of blood transfusion History of HCV in the family It is difficult to identify the signs and symptoms of HCV infection because it is very subtle, but the ones which can be identified include Fatigue Bleeding easily Poor appetite Yellow discoloration of skin and eyes Itchy skin Swelling of legs Weight loss Spider-like vessels on the forehead HEPATITIS C DIAGNOSIS The recommendations for testing and follow up include- HCV Antibody test If the result turns out to be positive, a confirmatory test of HCV-RNA is compulsory. Even if the test turns out to be negative, HCV-RNA testing is conducted in all the following exceptions- High degree of clinical suspicion HCV exposure occurring in the past 6 months Immunocompromised individuals If there is reinfection after previous spontaneous or treatment-related viral clearance there is need to obtain HCV-RNA test to find out the viral load Always before initiating HCV antiviral therapy a quantitative HCV-RNA test is required to document the baseline viral load If the antibody test is positive but RNA test is insignificant it reveals a past infection which has cleared from the body Furthermore, the WHO recommends HCV-RNA  quantitative and qualitative tests to confirm the cure from HCV by doing them at 12 and 24weeks following antiviral treatment completion. In areas with limited resources the WHO recommends usage of aminotransferase/Platelet ratio index or the fibrosis-4 score for evaluating hepatic fibrosis rather than invasive, costlier tests like biopsy, fibroscan. Serological screening for HCV involves an enzyme immunoassay. These assays are 97% specific and though they cannot distinguish between acute and chronic hepatitis, they are used to find the prevalence of HCV in the community. Other baseline studies which are done for diagnosing HCV include- Complete blood count with differential leukocyte count Liver function test Thyroid function test HCV genotyping for guiding treatment Screening test for coinfection with HIV or Hepatitis B virus Thrombocytopenia(low platelet counts) is documented in up to 10% of the patients. Low thyroxine levels are also found in 10% of the population. Recombinant Immunoblot assay is another test to confirm the HCV infection. A positive immunoblot assay result followed by 2 or more instances of undetectable HCV RNA suggests that HCV infection has resolved. HCV-RNA test includes both qualitative as well as quantitative assays. Qualitative assay means simply the presence or absence of the disease while the quantitative assay determines the viral load. RT-PCR(Reverse transcriptase-Polymerase chain reaction) is the method utilized in these tests for the amplification of viral nucleic acid for detection. Liver Biopsy is the ultimate confirmation for diagnosis. But because of its invasive nature, it is only recommended in the following conditions The diagnosis is uncertain Other co-infections may be present Immunocompromised individual