RED TO GREEN

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Busy streets, honking cars,

Steady stream of smog all hours,

Wide-spread palms,

Begging brazenly for alms.

Seated in a ford,

Listening to tuned cords,

Patient for red to turn green,

Efficient birds smearing preen,

Under the gaze of hypocritical me,

Did I see a small she?

She with audacity,

Knocked at my tinted glass.

An intruder into my daydream,

I wished she would pass.

Awaiting for me to journey,

From reel to real,

Unsure whether to ignore,

Or fill her bowl with cereals.

I fished for a sterling,

I noticed hidden in her bosom a nestling?

Craving for some shade,

And relief from prejudices all man-made?

Provoked by the green,

Did the Ford stir up dust?

Leaving far behind,

Those ebony eyes of lust.

Positive realization dawned upon me,

Of hesitance to meet again.

Albums

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Sparse winter rays filtered through the clouds,

Bestowing its tender warmth on my visage.

Cold waves kissed my lotus shaped feet,

Like a joyous cat lapping milk,

Rendering me happiness greater than all materialistic joy.

I turned into a spectator, to the most spectacular sight.

A positive wave rushed,

Like an enthusiastic army in an impetuous speed,

Prepared to destroy its enemy

Came hurtling, lashing upon me.

She swept me away from the shore into the endless sea.

Dumping me unceremoniously

Amidst sea-horses, sea lions and sea-lilies,

While sometimes was i compelled to ride

Upon her back through corpses and plastic cans, to the middle of nowhere.

Alas! My sorrowful plight went unnoticed,

My cry for help fell on deaf ears.

Frustration and fear began to build,

Hope and patience deplete,

As time and again was i rebuked by a wrathful her.

Was it a grumbling of a helicopter?

Hark; has somebody come to fetch me?

Am i being searched for?

The weary game of perseverance and tranquility did i try to adopt,

As i rested on a capsized boat in a pensive mood.

Parasitic Liaison

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Any living being is never devoid of emotions: be it a rabid tramp on the streets, a drenched kitten on a rainy day, a squeaky rat maundering the city manholes, a migrating ruby-throat-ed hummingbird and unyielding human beings are no different either. We live in a world of political revolutions, economic cataclysms, and disharmony with Mother Nature where emotions range from hope, rhapsody, fear and contrite. 

Homo sapiens have evolved from the era of caves to the technology-oriented epoch of the twenty-first century. Nevertheless one constant factor which has traversed through various period is that humans have lived in a society where men have largely chosen to hunt and protect their clan, while women complete chores inside the house.

Every relationship we forge with people from various walks of life acts as a catalyst for acquiring life experiences. Our relationships with others can either be a symbiotic one or a parasitic one; an immense audacious strength is warranted to address an abusive relationship and redress a parasitic liaison.

The foundation of domestic abuse is based on the fact that one partner feels the need to control and own the other either by generating trepidation, remorse, ignominy or coercion. The probability of men and women both being victims of mistreatment is prevalent, nonetheless there has been an accretion in incidence of women as sufferers of maltreatment. Though there is an accrual of self-reliant, economically independent women who are pillars of strength and inspiration; yet there are countless who are embroiled in the web of several societal evils. Indian women face various hurdles among which domestic abuse strangulates the life out of their bosom.

Abuse by one or both partners in a personal relation as in matrimony and cohabitation is never unpremeditated thus cannot come about by mistake. Those who practice abuse and the sufferers are entangled in a tedious cycle. Individuals who indulge in maltreatment of their partners are relentlessly concocting plans to belittle and cause harm. They pretend to be in good humor  and when the victims fall prey they unleash jaws of death on them. After their ‘castle in Spain’ is fulfilled they appear penitent of the act so as to achieve confidence of the battered victim in order to fulfill an adjunct fantasy.

An abusive association abets in diminishing self-confidence, self-esteem and identity of the victim. Most women who tolerate a violent relation are usually holding onto a feeble strand of hope for reform and redress in their partners’ behavior  Ill-treated women try to put wool over their eyes and frequently fabricate to protect their reputation and partner. However, the abuser only gloats with more confidence to inflict injury.   

Social observation has indicated that predilection of inflicting abuse is correlated to sore and painful experiences in ones own childhood which leaves behind a blemish in the persons’ mind. Those individuals as adults express their anger in an aggressive manner often causing corporal and emotional harm onto their partners. Women caught in such situation have to indeed muster a lot of courage to accept the harsh reality of their situation and confide in people they trust, instead of shielding their tormentor through intermittent lies.

The Indian system of justice has formed various laws that can help prevent domestic abuse from culminating into blameworthy homicide. Husbands and their alliances who indulge in harassment of their partners may be booked under various sections of The Indian Penal Code (IPC) such as section 113A of the Indian evidence act of 1872- to determine abetment by a husband or his relative in his wives’ suicide within seven years of marriage. Section 498A and section 304B of the Indian Penal Code (IPC) was instituted to combat accretion in dowry deaths in India, the Dowry Prohibition Act of 1961 and the recently amended the Domestic Violence Act of 2006.

On the other hand, numerous women from all walks of life balk from availing these laws instituted for their protection in a patriarchal India due to stigmatization by the society, defiling family honor  lengthy judicial proceedings, financial woes, tactless institutional response to FIR on domestic abuse. Women welfare organizations like All India Women’s Conference (AIWC), Women Welfare Association of India, and Human Rights Law Network are among numerous who are striving towards justice against perpetrators of domestic abuse.

  

  

Clash of the Titans: Phenobarbitone vs Phenytoin

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Parents are desperate to save their newborn diagnosed with neonatal seizures that causes long-term brain damage. Successful treatment of neonatal seizures in India is yet unachieved for want of deft drugs and ready access to EEG monitoring. Hence, an open label randomised control trial was conducted in a North Indian Level II neonatal government medical college to compare efficiency of phenobarbitone and phenytoin to alleviate neonatal seizures.

109 newborn manifesting neonatal seizures and non-responder to hypoglycaemia and hypocalcemia treatments were recruited. 55 randomized babies in group A received IV infusion of Phenytoin, then injected with phenobarbitone if seizures persisted. Randomized 54 newborns in group B were first treated with phenobarbitone, followed up with phenytoin on relentless seizures.  Additional, newborn with unrelenting seizures were administered higher dose of phenobarbitone. Anticonvulsants save phenobarbitone were stopped on 5 day seizure-free babies while latter was discontinued at discharge of newborn.

14.5 % and 72.2% babies responded to phenytoin and phenobarbitone, respectively. Those babies who didn’t respond to first line drugs showed 80% and 91% improvement respectively at cross over of drugs. The EEG rates were normal in 91.6% while 8.4% babies exhibited ‘burst suppression’ causing abnormal EEG. Phenobarbitone and phenytoin induced-side-effects killed 13 and 16 neonates, respectively.   Maximum dose of phenobarbitone successfully kept seizures at abeyance in 44/55 and 52/54 newborns. Thus, phenobarbitone achieved success in controlling seizures in neonates irrespective of aetiology.

Source: Pathak G et al. Phenobarbitone and phenytoin for treatment of neonatal seizures: Open-label randomized controlled trial. Indian Pediatr 2012;

Mirage!

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Sea of faces swarmed in like locusts in a field,

Some sat on cushioned seats in first class,

Some jostled for space like lesser mortals,

Some perched precariously on the rooftop of shrilling train.

Amidst the cacophony of animated conversations,

The awful news was hearsay again?

She tempted and teased with tresses as long as Rapunzel’s,

Or the fashionista has unshackled lust,

Her painted pink lips as a Venus flytrap tricked,

Or maybe she was of immoral moral fibre after-all!

Scandalous and discomforting all and sundry,

Save for incessant seething protests on roads,

And mirthful observations from elite,

Solemn pledge to counter mounting menace-a mirage!

I ponder over appalling pretexts,

At abysmal attempts to shield,

The unappeasable caprice of patriarchy,

As time and again we incarcerate freedom:

Of expression, of existence, of ethnicity!

Metronomic Chemotherapy-An Arsenal!

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“We have assisted with all plausible prevalent medical facilities to the cancer patient. There is nothing more we can do. We are sorry.”

Some of us have heard these frightful words from able bodied, world-class oncologists who hand over our loved ones into the hands of the Almighty and pray for a least pained exit. Terminally ill cancer patients (adults or children) have little choice of medicines which can aid to prolong their lifetime as they become resistant to the treatment engaged.

We spend billions of money to safe guard fragile boundaries of our countries; fund domestic and international acts of terror; lobby for the acceptance of genetically modified food and finance trips to Mars. However, we need a lot more of financial investments to attain victory in our war against cancer. Cancer is a disease of unregulated mass of cells wherein the natural cycle of cell death is compromised leading to the formation of tumour. A neoplastic growth may be benign, premalignant or malignant. An identified tumour may be removed through surgery followed by various rounds of radiation and chemotherapy to eradicate remaining tumour cells. On the other hand in numerous cases on successive rounds of therapy the tumour aggressively metastasize into other organs ultimately causing demise.

The bygone decades has seen many scientists who have challenged their scientific acumen to comprehend biological mechanisms undertaken by cancerous cells in evading cell death and promote multi drug resistance. Cancer patients often need an amendment of chemo drugs due to the phenomena of acquired chemo resistance. Present treatment modalities used often act upon the non-cancerous cells and actively dividing tumour cells alike. However, due to an inefficient removal of circulating tumour cells most often it results in reappearance of tumour and relapse of the disease. Hence, the need of the hour is a combinatorial method to prolong life span of the patient.  

The traditional chemotherapy treatment regimens use chemotherapeutic drugs which act against epithelial growth factor receptors and vascular epidermal growth factor receptors in order to prevent proliferation of circulating cancer cells and metastasis via inactivation of cellular signalling pathways. Both healthy cells and tumour cells are killed indiscriminately. In this mode of chemotherapy clinicians administer high doses of chemo drugs for a limited number of cycles onto patients: to hinder acquired chemo resistance against the drug and harming the organs. Patients’ are subjected to a drug-free interval between successive cycles of chemotherapy which results in revival of healthy and cancer cells equally. Numerous retrospective analyses have revealed that chemotherapy medicines may limit growth of tumour volume but it may also promote the assembly of endothelial cells to form blood vessels in the tumour (angiogenesis) and metastasis. Thus, these regimens haven’t been fool proof and the

need of the hour is for an alternative therapeutic regimen.

A prominent alternative therapy which is gaining recognition to mitigate chemo resistance is metronomic chemotherapy. The concept of metronomic strategy was first tested by Dr. Timothy Browder in Harvard Medical School, USA.  Hanahan and his colleagues from the University of California, San Francisco has defined metronomic chemotherapy: “chronic administration of chemo therapeutic agents at relatively low, minimally toxic doses, and with no prolonged drug-free breaks”. This method uses the same drugs as in the traditional chemotherapy but in different combinations and in low doses on a regular basis. Therefore, consistent short exposures of the medicine hamper growth of endothelial cells: new blood vessels are not formed in the tumour. Consequently angiogenesis is hampered. In turn this strategy induces hypoxia and starves tumour cells off nutrients. Metronomic chemotherapy is a multi targeted therapy: negates migration and proliferation of cancerous cells, induces apoptosis, increases endogenous level of anti-angiogenic factors and enhances anticancer immune response in the human body.

The propensity for critical scrutiny of this strategy is underway through numerous retrospective analyses of clinical trials which have revealed a mixed reaction. For instance, research has revealed that adults prescribed to palliative care that are pre-treated with chemotherapy and are at an advanced stage of colorectal cancer, gastric cancer, vascular tumours have responded to metronomic chemotherapy successfully. Also, children suffering from medulloblastoma have shown a good response to metronomic regimen of temozolomide with radiotherapy. Nonetheless, metronomic chemotherapy in some glioblastoma and advanced stage renal cancer patients’ did not significantly enhance their chances of survival.

The high dose of medicines when injected into patients causes numerous grave side effects due to loss of healthy cells. Repetitive low dose of chemotherapy may cause side effects like nausea, anaemia, neutropenia, fatigue and leucopoenia to dwindle. Metronomic chemotherapy is usually given to patients who cannot bear high doses of chemotherapy. It may be an alternative mode of treatment for patients who have acquired chemo resistance and are prescribed to palliative care. Metronomic chemotherapy may grant that each cancer victim desires: TIME.   

Numerous hospitals like the Oasis of Hope Hospital and Northridge Hospital Medical Centre in the United States of America are trying to prolong the lives of cancer victims by administering metronomic chemotherapy. In India, team lead by Dr. S. D. Banavali at Tata Memorial Hospital, Department of Medical Oncology has assessed the feasibility of using metronomic chemotherapy for palliation in oral cancer. Their research indicates a clinical benefit rate of 66.67% and larger clinical trials are needed to substantiate further in other cancers.

Metronomic chemotherapy is a less traversed route to combat cancer. Consequently, ample clinical trials in different ethnic populations are warranted before it may be globally claimed as a gold standard parapet against cancer. Nevertheless, for those friends and families who are in a dire-famine like situation looking for alternative modes of treatment to keep their loved one alive- metronomic chemotherapy may be an option worth exploring.