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Maharashtra PGM PGD CET 2010

2010-04-08T09:47:00.000-07:00

Maharashtra Post Graduate Medical Post Graduate Dental Common Entrance Test (MH PGM PGD CET) is an entrance examination for admission to Post Graduate Medical and Post Graduate Dental courses for various medical and dental colleges in Maharashtra. The exam is conducted by Directorate of Medical Education & Research, Maharashtra. A large number of candidates appear for Maharashtra PGM PGD CET from across the Maharashtra.
There are a number of colleges in Maharashtra in which admission is through PGM PGD CET. Students who have obtained their degree form a university outside Maharashtra can also appear for PGM PGD CET through 15% seats reserved for All India candidates. Rest of the seats are reserved for Maharashtra domiciled candidates.
Eligibility criteria:
To apply for PGM PGD CET a candidate must have done MBBS/BDS from a institute recognised by Medical Council of India/Dental Council of India. The candidates who will complete their internship before 31st March, 2010 can also apply.
Courses Offered:
• MD• MS• PG Diploma• MDS
Availability of Application forms:
Forms for PGM CET will be available from the following colleges:
• Grant Medical College, Byculla, Mumbai• B.J. Medical College, Pune• Dr. V.M. Medical College, Solapur• Government Medical College, Miraj• Shri Bhausaheb Hire Govt. Medical College, Dhule• R.C.S.M. Government Medical College, Kolhapur• Government Medical College, Nagpur• Shri Vasantrao Naik Govt. Medical College, Yavatmal• Govt. Medical College, Akola• Government Medical College, Aurangabad• Government Medical College, Nanded• Swami Ramanand Teerth Rural Medical College, Ambajogai, Distt. Beed• Government Medical College, Latur
Forms for PGD CET will be available from the following colleges:
• Govt. Dental College & Hospital, Mumbai• B.J. Medical College, Pune• Dean, Govt. Dental College & Hospital, Aurangabad• Dean. Govt. Dental College & Hospital, Nagpur
Important dates(Tentative):
Date of Entrance Examination:January 4th week, 2010Availability of Application Forms:December 2nd week-December 4th week, 2009
Please note that the dates are only tentative and are not final. The post will be updated as soon as the dates are officially released.
Contact Details:
Directorate of Medical Education & Research,CET Cell, ST.George’s Hospital Compound, Opp Govt Dental College Building,Near Chhatrapati Shivaji Terminus (CST),Mumbai - 400 001.Tel No: +91-22-22620363,(Ext. 317/323), 22652251Fax No: +91-22-22652168, +91-22-22620562,

The styles of interaction under discussion

2010-04-08T09:46:00.000-07:00

The styles of interaction under discussion here owe much to the downtown New York arts scene of the 1980s, by many accounts the heyday of pre-academic postmodernism in the United States. Prefacing Abigail Child's book, Tom Gunning provides a helpful overview of the context giving rise to this community of Ivy League expatriates:
The crashing of the romantic and idealist aspiration of the sixties counter-culture led many American avant-garde artists to look for a rigor of analysis to replace the highly individualistic and 'personalized' aspects of the Beats and of the youth culture the Beats in part inspired. Painting, as it moved into Minimalism, provided one alternative model. Just as important was a rediscovery of the art and theory of the Soviet literary avant-garde of the twenties, the constructivist ethos which proclaimed the importance of the revolutionary political context of artistic practice, and proposed a scientific analysis of the laws of art... (1)
The music group Bang on a Can was formed in New York in 1987 by Michael Gordon and some fellow recent graduates from the Yale School of Music, because their own musical experiences and needs were not reflected in the culture of "new music"--that is, contemporary composition in the academic conservatory tradition, what some might term "post-classical." The working methods of their "band" were similar to those of the rock groups they had listened to since childhood, and they favored a pluralist mentality over fragmenting and isolating style wars. They also embraced improvisation and electronics, as well as the repetitious long durations of "process" music. Usually called minimalism, this genre has been celebrated as "a purely American art, free of modernist angst and inflected with pop optimism." (2) It was partly inspired by the danceable rock grooves of the 1960s. Later, the direction of influence reversed: "... minimalism has marked rock, pop, and dance music from the Velvet Underground onward." (3) Eventually, a style came to be associated with the highly successful, influential, and controversial Bang on a Can: a maximal approach to minimalism, in which very subtle details of timbre are used to articulate and enliven the surfaces of large structures based on very simple harmonic progressions. Morrison's film Decasia, written in close dialogue with Michael Cordon and his music score, is also exemplary of minimalism's slow and repetitious processes.

Textures of collaboration: pop music culture

2010-04-08T09:21:00.000-07:00

Textures of collaboration: pop music culture and the experimental films of Abigail Child and Bill MorrisonCineAction, Winter, 2010 by Carolyn Elerding

Cinema possesses a rich history of collaboration between artists of sound, narrative, and image. However, traditional tendencies to perceive music as a strictly supportive background or accompaniment have been subjected to in-depth critique only recently. Abigail Child's interactions with musicians in Is This What You Were Born For? (1981-89) and Bill Morrison's partnership with composer Michael Gordon in Decasia (2001) exemplify (but by no means exhaust the possibilities of) the broader range of collaborative textures that cinema has always suggested. Not coincidentally, these works represent the influence on cinema of two popular music practices: the ubiquitous re-mixing that has emerged from hip-hop culture and the group composition typical of many rock bands.
[ILLUSTRATION OMITTED]
Abigail Child (also a poet, critic, and scholar) has had an influential career as an experimental filmmaker since the mid-1970s when she turned from professional documentary work to the creation of independent films focusing on gender, sexuality, class, and the critical possibilities of montage. Recycling found footage from a wide variety of sources, such as porn, industrial films, and home movies, and progressing cinematic techniques often associated primarily with the historical avant-garde of the early twentieth century, Child has created an oeuvre of incredible beauty and continuing social relevance. Her films are shown at major art museums and in experimental cinema venues and can be obtained through a variety of distribution channels. Is This What You Were Born For?, the series of short films Child created in the 1980s, underscores her exploration of interdisciplinary collaboration and these endeavors have had on her work.
Michael Gordon's award-winning career as a composer has resulted in a variety of notable intermedia collaborations, including for example operas with diegetic film components progressing beyond the more familiar application of projection as scenery and non-narrative music performances incorporating video. Gordon is a founding member of the highly regarded new music organization Bang on a Can, a group dedicated to facilitating the composition and performance of new music, often with an interdisciplinary dimension and independently of conservative academic contexts. Decasia, Gordon's internationally celebrated collaboration with filmmaker Bill Morrison, is a symphony for full orchestra paired with a montage of archival nitrate footage in various states of intriguing and evocative decomposition. The final version of the film, edited to fit the live recording of the symphony performance, was featured in the 2002 Sundance Film Festival. Decasia synaesthetically elucidates subtleties inherent to myriad generative tensions: progress/tradition, memory/time, darkness/illumination, and mini-malism/totalism.

Goodbyes can be difficult, even excruciatingly painful at times. This is one of those.

2010-04-08T09:20:00.000-07:00

Goodbyes can be difficult, even excruciatingly painful at times. This is one of those.
This week, we here at Goldmine bid a fond adieu to Trevor Lauber. For years, Trevor worked in advertising sales for the magazine. Many advertisers and readers have surely dealt with Trevor over the years.
And if you have, no doubt his friendly, enthusiastic nature and his deep knowledge of the hobby and the music industry in general have left an impression on you.
When I came onboard with Goldmine about three years ago, no one was more helpful than Trevor in assisting me as I tried to learn what I could about our readership, the history of Goldmine and the people involved in the record-collecting hobby as a whole.
Seeing his desk now empty feels surreal. For so long, Trevor has been an instrumental figure in building Goldmine magazine and everything associated with it, from the e-newsletter we send out twice a week to the Web site we have now.
Personally, I will miss Trevor greatly. We had a great time and did a lot of fantastic work together. We will soldier on, however. Onward and upward, as they say. And we wish Trevor nothing but the best.

They rehearse the future as they see it

2010-04-08T09:18:00.000-07:00

They rehearse the future as they see it
"I believe our future is a one-stop shop for decorating. In addition to limited-edition prints and posters, we now offer collectibles, gift items and small occasional furniture pieces," said Christine Knoll of the Art Gallery of Hog Hollow in Chesterfield, Mo.
Successful people move towards the pictures they create in their mind. They can rehearse coming actions or events as they "see" them. They are like chess players who can "feel" the next move of their opponent and have half a dozen responses ready when their time comes to move.

Many successful athletes will say they practice "seeing" themselves winning the race, hitting the home run or scoring the touchdown. They actually visualize a future event which gives them the impetus to achieve the goal.
How many of these six characteristics are yours? The more you have, the higher degree of probability you will be doing more business next year instead of being one of the thousands of retailers listed in the obituary pages of the local paper's business news. ABN
Successful Business People:
--Constantly set higher goals
--Avoid "comfort zones"
--Driven by accomplishments, not money
--Solve problems rather than place blame
--Look at the worst possible scenario
--Rehearse the future as they see it
Murray Raphel is one of the nation's leading marketing experts and author of several business books. Contact him at Raphel Marketing at (802) 751-8802 .

Using The Facility Smartly

2010-04-07T20:25:00.001-07:00

The hybrid accounts can be used smartly by accountholders to make the most of facility. Firstly, it should be noted that since the rate of interest for a tenure of less than 90 days is usually less than the rate of interest available on an SB account, it would be unwise to opt for a short tenure. One should choose the tenure so as to earn a higher rate of interest, but obviously it cannot be less than 90 days as one would stand to lose due to lower rate of interest on FDs of short tenure.
Secondly, while going for an auto sweep facility, it is advisable to keep the threshold limit reasonably high so that the amount converted into FD remains there till maturity to earn higher rate of interest and does not get transferred back to SB account frequently. •

The Terms

2010-04-07T20:24:00.000-07:00

The facilities of sweep-in or reverse sweep-in usually do not cost anything extra, but you may be required to maintain a certain minimum balance in your account to avail the facility. While ICICI Bank requires you to maintain a minimum balance of Rs 10,000 in SB account, HDFC Bank's sweep-in facility without any charges mandates you to maintain a minimum balance of Rs 50,000 in your FD and if the balance falls below Rs 50,000
service charges applicable for savings or current account are levied. Bank of Rajasthan's Flexi Fixed Deposit mandates you to maintain minimum Rs 10,000 in the FD and if do not maintain it, you have to pay Rs 100 pet quartet.

Sweep-In For Liquidity

2010-04-07T20:23:00.002-07:00

Then, there is the sweep-in facility provided by HDFC Bank, Kotak Mahindra Bank, IDBI Bank, Oriental Bank of Commerce, Andhra Bank, Standard Chartered Bank and few other banks. Through this facility, the customer's SB or Current Account is linked with his FDs and any deficit or shortfall in the SB or Current Account is filled by transfer of funds from the linked FD. Hence, the accountholder can avail of cash as when he needs it. For Andhra Bank accounholders, this is called the reverse sweep as money is automatically transferred from FD to meet the deficit in SB or Current Account. In the case of such sweep-in from FD to SB or Current Account, the bank may transfer an amount which is exactly equal to the deficit or may transfer the entire amount of FD, depending on specific rules. In the case multiple FDs are linked to the account, then the bank will first transfer the amount from the last FD to meet the shortfall, and if this does not suffice, then it will transfer amount from the next latest FD, and so on.

while the FDs catry interest ranging from 2.5 per cent for 15 days to 7.5 per cent for a tenure of one year or more

2010-04-07T20:23:00.001-07:00

while the FDs catry interest ranging from 2.5 per cent for 15 days to 7.5 per cent for a tenure of one year or more. Hence, if an accountholder has fixed his threshold limit at, say, Rs 50,000 and has Rs 80,000 in his SB account, the excess amount of Rs 30,000 in his account would be automatically converted into one or more FDs for a tenure which will give him higher rate of interest. For example, ICICI Bank transfers the amount in excess of the threshold limit into FDs in multiples of Rs 5,000 for a period of one year or a tenure of accountholder's choice and the FDs are automatically renewed for a period of one year (or the period decided by the depositor) at the prevailing rate of interest.

HYBRID DEPOSITS

2010-04-07T20:21:00.000-07:00

Auto-Sweep: Amount in excess of threshold limit is automatically transferred from SB Nc to FDw
r----- ---~
Sweep-In: Shorfall in SB or current account is made up from FD Nc
-----------;1----
I Sweep-In: Shorfall in SB or current account is made up from FD~C
Sweep-In: Shorfall in SB or current account is made up from FD Nc
Sweep-In: SB/current account is linked with FD to meet any shortfall
Auto Sweep: Excess funds in SBI current a/c are converted into FD Reverse Sweep: Amount from FD is moved to SB/current a/c
Withdrawal Facility: Available to the extent of combined balance in SBI current account and FDs
Auto Sweep: Excess funds in SB Nc are converted into FD
Sweep-In: Funds are automatically moved from FDs to the linked SB or current a/c

Free Forex Buy And Sell Indicator - Online Forex Tools

2009-11-02T02:03:00.000-08:00

A free Forex Buy and Sell Indicator is a good option if you are someone who trades actively in foreign currencies. This could be a very useful tool for you if you want to keep track of the daily price rises and falls in the forex market. The application can give you precious information regarding currency trading as and when you need this. This will ensure you have the facts with you when you need to make a decision in a fluctuating market.
A free forex buy and sell indicator takes the guesswork out of forex trading. It makes sure you are trading based on solid facts and not just on a whim. It will also ensure you are backed with historical data on trends regarding the currencies you are trading in.
There are many sites where you can check out free forex buy and sell indicators. These sites offer customers software which can help predict whether it is wise to sell or to hold on to the currencies you are trading in. Some sites which offer buy and sell indicators are business4profitsystems and swingcurrency. You might want to try out a few sites and find out which one is best suited to your requirements.
Apart from the free indicators, there are a host of other sites which allow you to download such applications for a fee. Such paid sites might give you superior quality and better features, which a free one cannot offer. Applications like Forex AutoPilot - also called FAPS - are fast gaining popularity among users. This is an automated software which trades at anytime provided you leave your computer on. the software requires you to feed in the basic ranges in which you would like to trade and rest assured the software will take care of the rest. This might sound a little dicey to those of you who would like to be in total control of your forex trading. The Forex Autopilot has an in -built free forex buy and sell indicator. But this comes only in its demo version.
Another well received software for forex buy and sell indication is Doubling stocks. This software also helps you make cardinal decisions in the forex market regarding when to buy, sell or exit a trade. This is not an automated software, so you will need to do the trading yourself on the basis of what the software tells you. This would be reassuring for those of you who need to have complete control over what you are trading. This software application also comes with a free demo package. The demo software is definitely very rich and detailed. It would be a boon for those who are entering the forex trading business and provide valuable support for those who have experience in the forex markets.
Apart from these two there are many other sites which sell forex buy and sell indicators for a price. What you need to keep in mind when you purchase this software is the sensitivity of the software to daily fluctuations in the market. Automated robots like FAPS offer a demo version which allows you to do mock trading without spending a cent. You might want to try this option before you actually buy the software. This way you can be completely sure about the accuracy and the appropriateness of the advice offered.

The Forex Mini Account - The Best Way To Start Off Trading Forex On Low Capital- Part #1

2009-11-02T02:02:00.000-08:00

A lot of people assume that forex trading will require a huge capital base. As a result, they would instantly decline to entertain any proposal to start trading in forex, preferring to remain with trading stocks and shares which is more affordable. This is simply not true, because in forex trading, you can start off with minimal capital when you utilise a forex mini account.
There are four main advantages of a Forex Mini Account.
1. Low Minimum account size
$300 will allow you to start a forex mini account. This is affordable for most people to start off with in forex trading. When you consider forex trading as a business, there are very few businesses costing only $300 as a startup capital offering lucrative prospects of earnings within a very short time.
2. High leverage
You can get leverage of 200:1 In the mini forex account, there is a small margin deposit required fixed at $50 for per lot traded. This amounts to a stunning leverage of 200 to 1. One of the key factors to accelerate profits is to use trading vehicles of high leverage, and a forex mini account certainly meets or fulfils the definition of high leverage.
3. One pip is equivalent to $1
Trading in pips allows the new forex trader to scale down his risk. With such a low denomination, the trader is able to deal with forex trading with less pressure and more discipline. For example, a 20-pip floating loss is approximately $20, so that if you have a 20-pip sudden move against the direction of your trade on a 100K account, that is translated into a $200 floating loss. In every transaction, by using a Mini account, the trader does not end up with a total loss as he loses only a small amount on every losing transaction. This allows him to follow his trading strategy in a disciplined manner.
4. A smaller trade size
The mini forex account trades in smaller contract sizes of 10,000 units which is 1/10 th the size of the standard account. This smaller trade size allows traders an opportunity to trade live with less overall risk. As a result, a beginner can transit or move into forex mini trading quickly from paper trading. While the standard lot is 10,000 units, the beginner trader can increase trading to more lots or units as he gains experience and confidence, and as his profits increase as a result of disciplined trading.
One hidden benefit of trading the mini forex account is that traders can become familiar with the quality and also the reliability of the forex trading platform or trading station of his broker. This is because the forex mini account utilises the same state-of-the art trading software as that for normal sized forex trading.
Mini accounts are recommended for traders with account balances of less than $10,000, allowing them more trading opportunities without over leveraging their account and hence get more staying power in the market.
We will discuss how you can exploit these features of a forex mini account to your advantage in Part #2 of this article so that it is easier to earn a consistent income trading on low capital and lower risk.

Why You Need To Adopt A Forex Trading System To Make Money With Forex

2009-11-02T02:01:00.000-08:00

Trading in currency can be very exciting and also very rewarding but before rushing in find out why you need to adopt a Forex trading system to make money with Forex. There isn’t one right system but you just need to have a system that you stick to so your strategies make sense.
Currency markets are different than stock markets and you will need to spend a little time determining what system works best for you which is why you need to adopt a Forex trading system.
You could adopt a Forex technical approach or a more fundamental approach. Both are successful trading systems but combining the two together results in a much more powerful trading system which is why you need to adopt a Forex trading system. You can plot a very specific trading course while having a look at the bigger picture.
There are many analytical tools that you can use and that is why you need to adopt a Forex trading system. In addition as you gain more experience you will get to better understand each of those tools and how to get the maximum benefit. You’ll suddenly be a pro at trading with Forex.
Consider watching for resistance levels which are prices that are much higher than where the currency generally trades. Just a couple more reasons why you need to adopt a Forex trading system. If a currency price manages to break through either the resistance level or the support level the prices usually continue in that direction. They are seen as bullish and usually continue on this trend.
Moving of averages is another Forex tool that you need. SMA is the simple moving average which shows the average price during a selected period of time which is usually either 7 or 14 days for which it is plotted against. Moving averages are commonly used to eliminate short term price fluctuations and to help give a clearer picture of how the currency prices will move. If you know when and why you need to adopt a Forex trading system you’ll be ahead of the game.
Fundamental analysis is also a helpful tool because it can be used to reinforce the indications that come from your technical analysis. Another reason why you need to adopt a Forex trading system What ever your trading system this is why you need to adopt a Forex trading system that works for you.
Copyright © 2007 Joel Teo. All rights reserved. (You may publish this article in its entirety with the following author's information with live links only.)

Understanding Forex Technical Analysis For Successful Forex Trading

2009-11-02T02:00:00.000-08:00

We are going to look at some of the different varieties of charts used in Forex technical analysis and provide some useful guidelines for readings such charts.
Price Charts contain information regarding FOREX prices at specific time intervals. Intervals range anywhere from one minute to several years. Prices are usually displayed in the form of line graphs, and occasionally the change over each given time period is depicted in the form of a bar graph or candlestick graph.
Line graphs are useful for providing a broad overview of price fluctuations over time. They display the closing price at the end of the given time period. Line graphs possess several advantages when compared to other types of graphs: they are are quite easy to understand and they are useful for finding patterns over a long period of time. However, a key disadvantage is that they lack the degree of detail possessed by bar and candlestick graphs.
In contrast, bar graphs provide a greater amount of information than line graphs. The length of each bar demonstrates the price difference for the specific time interval – a longer bar indicates a bigger separation between high prices and low ones. Furthermore, each bar contains two tabs. The left tab on a given bar displays the price at the beginning of an interval, while the right tab demonstrates the price at the end of an interval. Using this system, it is easy to see price fluctuations over a given time interval, and to understand specifics of the variation in price. At times, it can be difficult to read bar graphs which have been condensed and printed on paper, but most computerized graphs usually possess a zoom feature, which makes it easy to see the specifics.
Candlestick graphs originated in Japan, where they were frequently used in order to analyze rice sales. These resemble bar charts in that they indicate prices at the beginning and end of a certain time interval, as well as the peak and low prices over that interval. Furthermore, these charts are color coded, which assists in the ease of understanding. Green candlesticks are associated with increasing prices, while red candlesticks demonstrate decreasing prices.
Candlestick shapes - these shapes, when viewed in comparison with neighboring candlesticks, provide information regarding market fluctuation. This information is helpful in analyzing graphs. Different shapes of candlesticks come as a result of several values: price diffusion, and the disparity between prices at the beginning and end of a given interval. Candlestick patterns have been dubbed names which correlate with their physical shapes; names including 'morning star' and 'dark cloud cover'. When an individual learns these shapes, he or she is easily able to find them on a graph, and utilize this information in identifying tendencies in the current market.
Price graphs are frequently supplemented with various technical indicators. Many of these technical indicators fall into various differing categories. Some of these categories include trend indicators, strength indicators, volatility indicators, and cycle indicators. Each of these indicators is a tool which can be used to predict fluctuations in the market.
Common technical indicators frequently used in FOREX are as follows:
Average Directional Movement Index or ADX for short – this is utilized in to demonstrate if a market is entering an upward or downward trend, and to indicate the strength of the give trend. For the scale usually used by this index, results above 25 indicate a trend with a greater strength than usual.
Moving Average Convergence/Divergence or MACD for short – this demonstrates the current momentum of the market, as well as displaying the relationship between two fluid averages. A strong market is usually demonstrated when the MACD crosses over the signal line.
Stochastic Oscillator – this demonstrates the strength or weakness of a given market by way of comparing a given ending price to a price range over a specific time interval. A stochastic value under 20 demonstrates a currency that is oversold, while a stochastic value over 80 demonstrates a currency that is overbought.
Relative Strength Indicator or RSI for short – this is a scale from 1-100 which indicates the peak and low prices over a specific time interval. A price which falls below 30 is indicative of an oversold commodity, while a price above 70 is indicative of an overbought commodity.
Moving Average – this refers to the average price over a specific time period when that price is compared with other average prices during the same interval. For instance, ending prices over a 6 day interval would have a moving average of the total of the 6 ending prices divided by 6.
Bollinger Bands – these are bands which contain the great majority of a currency's current value. These bands consist of three horizontal lines. The top and bottom lines display fluctuations in price, while the middle line demonstrates the mean price. During time periods when the price is very volatile, the disparity between upper and lower bands increases. Overbought or oversold times are indicated when a bar or candlestick comes into contact with a Bollinger band.

Average Directional Movement Index or ADX for short – this is utilized in to demonstrate if a market is entering an upward or downward trend, and to indicate the strength of the give trend. For the scale usually used by this index, results above 25 indicate a trend with a greater strength than usual.
Moving Average Convergence/Divergence or MACD for short – this demonstrates the current momentum of the market, as well as displaying the relationship between two fluid averages. A strong market is usually demonstrated when the MACD crosses over the signal line.
Stochastic Oscillator – this demonstrates the strength or weakness of a given market by way of comparing a given ending price to a price range over a specific time interval. A stochastic value under 20 demonstrates a currency that is oversold, while a stochastic value over 80 demonstrates a currency that is overbought.
Relative Strength Indicator or RSI for short – this is a scale from 1-100 which indicates the peak and low prices over a specific time interval. A price which falls below 30 is indicative of an oversold commodity, while a price above 70 is indicative of an overbought commodity.
Moving Average – this refers to the average price over a specific time period when that price is compared with other average prices during the same interval. For instance, ending prices over a 6 day interval would have a moving average of the total of the 6 ending prices divided by 6.
Bollinger Bands – these are bands which contain the great majority of a currency's current value. These bands consist of three horizontal lines. The top and bottom lines display fluctuations in price, while the middle line demonstrates the mean price. During time periods when the price is very volatile, the disparity between upper and lower bands increases. Overbought or oversold times are indicated when a bar or candlestick comes into contact with a Bollinger band.

Since the recent yen cross meltdown started I've been trying to keep from getting caught on the wrong side of any massive downward moves.As I generally trade only the AUDJPY, mostly on the long side, things have been pretty quiet!However, we are now facing some resistance at 74.50 on the 1hr -- which should be illustrative. We have done what might be a triple bounce off of support in the vicinity of 70.90 or so too. I'm thinking we may have another downturn to confirm support but we could certainly get right back to business without it.In any case, as the market is starting to act rational, I'm just about ready to start trading according to my own particular style.

Career in Cartooun

2009-11-02T01:57:00.000-08:00

NIMATION is the design, drawing, layout and production of photographic sequences
that are incorporated in the multimedia products in order to give it a smart appearance. In other words,
aniqlation involves the manipu-

lation of still images to create the illusion of movement. Using computer technology, a sequence of staggered images captured in related positions are made to appear as if they're .really moving.

Multimedia is any combination of text, graphic art, sound, animation and video delivered to us by computer or other electronic means.
More specifically the term "multimedia" is used for the combination ofmatQrials withln a format or medium that can be used by a computerincluding CD-ROM or digital video, interactive touch-screen monitors,

internet or web technology, streamingaudio or video, and data projection system etc. Modern cinema has gained great heights by absorbing the gift of multimedia in Hollywood and Bollywood blockbusters viz., Jurassic park and Krish etc. TeleVision advertisements, cartoon serials, presentations and model -design are no exception.

Animation application areas include many avenues in the following:
Entertainment (movies and television)
Business (product promotions and marketing demos)
Sales (presentations) Education (Computer Based TutorialslWeb Based Tutorials) Publishing (graphics and printing)
Virtuall'eality in Defense Web designing Engineering
Advertising (commercials and print ads)
Fashion designing and interior designing Development of computer
.• ce

try (presentations and models) Studios and training institutes Animation and Cartoon Courses Institutes in India
There are various courses on animation and cartoons offered in colleges all over the country. The major colleges are:
· Global School of Animation & Games,White House, NBCC Plaza Sector - V, Pushp Vihar Saket, New Delhi - 110 017
· National Institute of Design

(NID, Ahmedabad)
· J.J School of Arts

·Zee Institute of Creative Arts (ZICA)

· Industrial Design Center (IDC), IIT - Mumbai & Guwahati Academy of Animation and Gaming
'Even though both diploma and degree courses are available across colleges in India, post graduate degree courses in animation and cartoon is very rare. Among the colleges mentioned above, the Industrial Design Centers in Mumbai and Guwahati ofter po.,t-gradu ate deg-ree courses.
Qualification: For applying for a diploma course in animation, one has to pass the 12th standard examination from any recognized board with a minimum of 45% marks. For the bachelor's degree program the same eligibility criterion is applica-

must have a bachelor's degree.
Benefits: As the animation & multimedia industry is growing rapidly, pursuing a course in these fields can boost your career. Moreover, if you have a knack of drawing or creating characters it would help satisfy your creative spirits.
Animation and Cartoon Courses Career Prospects in India

Scope in India: Animation in India has come a long way with Indian animations catering to.the needs of

several private and public sectors and indigenously produced animated films constituting the bulk.

Various T.V programs, advertisements / commercials and computer games are demanding a nuge quantity of manpower from the Indian market. Animation is also being used in titlingfJ.1ms, creating special effects or in web entertainment programs. Thus the scope for students of animation is huge in the context of the emerging Indian market.

Scope Abroad: Though cartoons and animations hardly seem to be productH meant for outsourcing, yet Indian cartoonists and animators have begun working for foreign companies. Indeed, Indian companies are moving ahead of their SouthEast Asian counterparts in the field of animation. The western countries are favoring India over any other country for outsourcing animation because
.a.A ... £cJl£uAri..n.ai .. :r~J;;l.o.ns.:

Vast base ofEngIiSh speakmg manpower Cost advantage

Abundance of well-equipped studios
Animation Studios in North America There are animation studios in the US that work with Japanese production studios and that may be a way to be involved in animation and Japan as well. I would suggest contacting DIe and Warner Bros. Animation to start with. These companies also work with studios in Korea, China and other countries so they could provide a chance to see and experience many interesting places.
Animation courses in USA have captured thefancyoftheyouth within a very short period of time. Animation is often referred as the art of manipulating the static objects to give the illusion of movements. Thus, the animation courses enable the artists to express their creativity to a fuller extent. But this is not the only reason that has made the animation courses popular in USA. Successful completion of animation courses promises a great career to the budding artists in various creative fields.
Consequently, quite a good number;pf animation schools n USAhave also come up over the years to cater to the growing demands of animation artists.
However, the courses offered by the animation institutes of America vary a lot. Most ofthe animation colleges in USA concentrate on providing popular courses like 3d animation, flash animation, computer graphic animation, cartoon animation and other digital animation courses. The duration of these animation courses can also vary. Therefore, one should be very careful in selecting the animation institute in USA keeping in mind the reputation, prospect and duration ofthe animatiun course in USA. eJl1f can also pursue animation cour::.es 10 America from some of the reputed Art Institutes instead oftaking it up in an Animation School of USA.

. Have a wonderful career as Cartoonist and Explore the successful 1 creativity in Animation Industry .

Job Career 1

2009-11-02T01:56:00.000-08:00

follows a rigorous process of hiring, both laterally and through campus recruitment. Entry-level talent is inducted from the top 30 engineering colleges across the country as well as from some of the premier management schools.

There are various career opportunities currently available in i31. Typical requirements are:

Software Developers: Designation at this profile is that of Software Engineer or Sr. Software Engineer. The requirements of the job are to develop and design software code in various technologies, spanning Microsoft, Java, Oracle, IBM Mainframes, Siebel, Windchill and Interwoven.

Project Leaders & Project Managers: The role of the Project Leader is to lead a team of6 to 8 software developers, provide an estimate of effort, manage resources and deliver a project to the satisfaction of the Project Manager and the customer. The Project Manager 'has the overall accountability for project deliverables both in terms of cost and effort, apart from managing relationships with the customer.

A degree or a relevant diploma or certificate in Hotel Management from a reputed institute can be beneficial in bagging a good job in this field.

Below mentioned is a list of some of the institutes offering 3/4-year Bachelor's degree in Hotel Management and CateringThch. Hotel Management Courses in Nagpur, Maharashtra -

* 1) Youeantar Education Society's Shri Balasaheb Tirpude College of Hotel Management & Catering Thchnology,
Shri Nasikraoji, Tirpude Marg,Civil Line, n ,Sadar Nagpur 440001

] * 2) Institute of Hotel Management & ( C~tering Technology
tl Atrey Layout, Nagpur-22 offers only Jm

CAREER OPPURT AND TOURIST•C•ORPORATIO

2009-11-02T01:54:00.000-08:00

PPORTUNITIES at the middle management level are available from time to time in Manufacturing, Human
Resourc~s, Marketing, Trading, Sourcing and Logistics, Finance andAccounts, Secretarial, Legal, Environment, Health and Safety,
_ Corporate Communications, Merchandising, .. Hospitality and Information Technology in , ,hospital and tourism industry.
-. Opportunities are advertised on the . Company's web-site and interestedcandidates -"are invited to apply on-line. An essentialfocus
.-while inducting talent at the middle and sen.,ior management levels, is the new learning
that the candidate will bring into Indian Tourist Corporation.
Legal
Secretarial
R&D
Hospitality

Lifestyle Retailing Information Technology Legal
lTC's Legal function offers legal professionals exciting careers spanning all branches oflaw. Legal professionals with a keen legal acumen and analytical skills coupled with an understanding of business transactions are exposed to a continuously challenging environment.
Legal managers are encouraged and expected to constantly enhance the breadth and depth of knowledge. They interact closely with lTC's different businesses, understanding issues and providing legal solutions.
Secretarial
lTC's Secretarial function offers exciting careers to professionals who are qualified Company Secretaries. Professionals who join the Secretarial function are members of the Institute of Company Secretaries of India. Additional qualifications could be in Chartered Accountancy or Law.
requirements, SEBI Regulations, statutory compliances, investor services, secretarial procedures and corporate governance norms.
'Research & Development
ITC inducts R&D professionals for its Group R&D Centre located in Bengaluru as well as for its Agricultural Research Centers at Rajahmundry and Sarapaka.
These three Centers for R&D cater to the needs all the Divisions of ITC. R&D at ITC encompasses Biotechnology, Agronomy, Plant Breeding, Plant Pathology, Plant Chemistry, Organic Chemistry, Paper Making, Packaging Development, Process Engineering, Applied Research Initiatives and Quality Assurance Systems. The challenge for the R&D team is to contribute to lTC's strategy of market leadership through innovation in Product and Process development.
ITC recruits MScslB.TechsIM.Techs and PhDs in these areas as Research Associates and Scientists. Individuals could be either fresh graduates or have relevant work experience in other organisations. Candidates should have a strong orientation towards application of knowledge and technical expertise, combined with a high degree of self drive, communi
cation and team working skills.

The research team collaborates with relevant Government and non-Government research establishments in the country to derive greater value from its R&D initiatives.
Hospitality

ITC inducts Management 1'rainees every year from Hotel Management Institutes, who
are then trained at the Welcom group Management Institute in Gurgaon.
ITC visits select campuses for the purpose' of inducting entrylevel talent for its Hotels Business. In addition, talent with experience is recruited for placement in the Food and Beverage Service, Sales and Marketing, Front Office, Housekeeping and Kitchen. Middle-level. recruitment takes place primarily from within. the Hotel industry.
While inducting talent, ITC specifically looks for knowledge, skills and attitudes required for the Hospitality industry. Other necessary attributes are a high service-orientation, and the ability to anticipate and meet the needs of others.
Lifestyle Retailing
ITC inducts talent for its Lifestyle Retailing Business on an ongoing basis.

ITC looks for specialised skills in Fashion Design, Merchandising, Sourcing and Quality Control. Talent for these positions is normally sourced from within the industry.
Information Technology

lTC's Information Technology business is carried out through its wholly-owned subsidiary, ITC Infotech India Limited ( i3l). i31
Candidates for this Function are expected to have a strong conceptual base in Corporate Law and be well conversant with listing

NlBOSS is a person incharge of, or employ

2009-11-02T01:52:00.001-08:00

NlBOSS is a person incharge of, or employ. ngothers. Anybody who gives employment even to a single person can call himself a boss or, conversely, relish being called so by that person. Aleader is a person who leads and all bosses are not leaders though the opposite may be true. In good old days,especially . in films, the epithets 'Yes Boss' and 'No Boss' ridiculed the word 'boss' and the word came to be associated with 'bad qualities'. However,modern era and new breed have tried to give a respectful meaning to 'boss'.

A good boss should be an amalgamation of 9 '~s. He or she should be articulate, assiduous, astute, assertive, assessor, accountable, assimilable affectionate and accomodating.
ARTICULATE: AI! ability of correctness in articulation will keep a· boss in good stead. Proper way of putting ideas into a worker is the key for success of an organisation. This will also avoid a feeling of unnecessary ambiguity. If the boss is not in the know how of a worker's language, the services of an interpreter can be used.

ASSIDUOUS: A boss must be a hard worker and set example to employees. He cannot be an armchair couch potato

and bark orders. Whatever work a boss is expected to do must be done by him diligently. Even if there is no work at hand, a boss should know how to invite work.
ASTUTE: Astuteness is a quality which cannot be emphasised more. A shrewd boss will naturally know how to extract work without burdening the employees. Delegation of responsibilities, meticulously, is a hallmark of an astute boss.
ASSERTIVE: Bosses should understand when to assess themselves and when not. He/she should not insist upon things in a harsh tone but use authority with circumspection. When things come to a passe, however, the stamp of a boss should be unequivocal with-
out being dictatorial. .
ASSESSOR: Different

employees have varied capabilities and assessing the strengths and weaknesses should be a child's game to an efficient boss. Shifting of duties should be done purely on yardsticks consideredjust and proper to the boss. A pat on the back will do an employee a world of.good ..
ACCOUNTABLE: A boss is always a boss and this is true in terms of accountability too. Whatever be the omission and commission of an employee, but the boss is held accountable ultimately. He cannot shift

blame on workers. A boss who tries to fix responsibility on subordinates loses their respect.
ASSIMILABLE: Learning from employees and understanding their problems are important to a boss. He should be a fatherly figure and try to imbibe the difficulties faced by the staff and should offer sane solutions to the problems. Suggestions of workers should be absorbed and tried to be in.corporated in office work.
AFFECTION~rE: A great quality of an equally great boss. Bosses should never affront a worker in full view of others and if there any grouse, he should vent his feelings in the confines ofthe four walls of the room. An ideal boss should end any animosity between his workers 'Nobody is a permanent enemy' is the gospel sentence for' a good office atmosphere.
ACCOMODATING: Small errors from subordinates should be treated as minor happenings. Difference between mistake and blunder must be clear to the boss An error from an otherwise good junior must always be excused and repeated mistakes have ·to be open to adjustments.

Above all, a good boss must possess the knack of astonishing his staff with periodic gifts, perques and bonuses.
•

Job Career wanderfull

2009-11-02T01:50:00.000-08:00

becomes simpler as hel she begins to master the skill and learn the art of doing things. Still further down as years' pass on, the work becomes a routine and monotonous task thus becoming boring and uninspiring. It seems somehow that there are no challenges to be met anymore and nothing excites. This is a condition faced by practically all people at all times. Boredom is an unholy emotion that can rob the mind of its enthusiasm thus dulling it miserably.
The art of innovating can be useful at all the stages mentioned above. A person with the ability to think outside the box would look for creative solutions at all times and find his way through thick and thin. He would
face the challenges with a positive mind to enrich himselfwith the first hand experiences. He would make his own decisions and try to
pressures and take on
stress and thrive on it. He
would keep trying to learn by brainstorming on the solutions.
His attitude towards work would
be of treating it as an oPllOrtunity to • his own personal growth and devel-
limitations of the organization such a person would create newer opportunities and excitement for him-self.

But somehow this possibility of excitement is generally missed by many workers. They may be stuck in materialistic thinking and gains. They may ask 'why should I use my head more than it is necessary?-What is the gain? I am going to get the same salary.' That seems to be the

end of their thinking. They never think beyond that as if salary is the sole aim of employment. And since the salary levels never seem to satisfy anybody anywhere they may lose their sense of enthusiasm and happiness. They may forget that earning excitement and joy out of excellent work are the unstated goals of creative work. Yet most people miss the point and thereby deprive

. themselves of the process of creative excitement and joy.

And yes, this becomes an irony. For, if earning more wages is the aim; they forget that their good work is the only investment they possibly can
make to create situations which attract the employer's attention towards them and ultimately make them suitable candidates for higher wages!

Job Career

2009-11-02T01:47:00.000-08:00

ome organizations may systematically encourage innovations at work and create a culture of creativity on the job. They may encourage employees to innovate and look for different solutions to day to day tasks and problems. But a lot depends upon the individual employee and his own capacities to create and innovate. It depends on his attitudes and his values towards work. We observe that some people very effectively use the work place as an opportunity to learn and grow. They would be willing to find newer ways to perform their daily tasks and to think of newer ways to solve their day to day problems. Comparatively we see many other per
sons only grumbling about this and that deficiency in the work situation and punching bigger holes into the already ~xisting structure. The problems of innovation could be external to the individual as well as internal to the individual.

For every beginner the new job as well as the work situation poses a number of challenges as the nature of complexities of the job unfold themselves. The person has to grapple with the challenges by thinking innovatively about
, ways to handle the prob-
lems and find solu
tions to them. Gradually the job

Education And Justice

2009-11-02T01:45:00.000-08:00

Queries for The Hitavada Future's 'Career Helpline' column can be

sent to Dr Sapna Sharma (HRD Trainer and Student Counsellor). Director of lighthouse People Services Pvt. Ltd, 2nd Floor Shubh Complex, WHC Road, Dharampeth, Nagpur.

She can be contacted at sapna@lighthousepeople.in or on -0712·2550920

ustice is the corner stone of the edifice of a democratic gov· ernment. Inculcating the sense of justice among the stu dents has apparently been a difficult task because the edu·
cators have not taken this issue seriously. Unless there is a sen of sympathy for the fellow human being in need of help the senSl of justice cannot be inculcated. Education should teach the students that in a democratic governm~t justice to the weak pan of humanity such as the aged and the weak, people sufferiIl/ from debilitating diseases, discarded and homeless children aged women, poverty stricken people because of consummatiIll illness, require utmost care by a democratic government is jus· tice is to be promoted. Now we see that a democratic form of gov· ernment given rise to the cult of foxes, who by their cunning· ness manipulate the people to keep themselves in political po\\,· er. The students who have the inclination to become leaders 01 tomorrow should, through education, cultivate a sense of jus· tice, and no education in a democratic set-up is worth its name if it fails to foster the sense of justice through selective curricu· lum.
. Education should properly emphasize the value of justice. and why we need it, rather than teaching students to count mono ey. The importance of justice and the ethics of it should be taught to the students as we teach sciences Teaching of science in 3 democratic set-up will be oflittle use if the future scientists are devoid of compassion towards the suffering lot, as compassion is the mainspring of justice.

The greater the justice in the society the more ideal it will tend to become. In the absence of justice the Constitution can be manipulated to garner power by the cunning foxes. Freedom does not mean a freedom to exploit the weak and venerable humanity. But freedom means to promote justice in the soci~ ty.Educationists have. consistently ignored this aspect of civic

administration. and consequent· ly we have a soci· ety engaged in a ruthless strug~! for survival ana power. Unfortunately there is no strug· gle for justice, because the weal: are incapable 01 securing justice
owing to their weakness. The destitute children may be the ca~ in point. Aged and the homeless need justice as much as the minorities.

Justice and selfishness cannot go together. Out of selfish motives children abandon their aged parents, simply finding them of no use. This constitutes a sheer muffling of justice. And in the education it should be emphasized the sin perpetrated by the siblings abandoning their parents. It is surprising that a country which boasts of being a biggest democracy has not fos· tered this element in the youngsters. Cognizance of the impor· tance of justice in their daily life is important. In the absence of this the cQurts would be overflowing with criminal cases.

To reconstruct society of the principles of natural justice is the primary duty of education. Unless education bring in its cur· riculum of schools the programme of how to foster a thorough sense of justice among children one cannot have a just societ)~ rather it will be a society ruled by foxes.

groWld-ef-the cfta:f.acters and-setting the background for the project

2009-11-02T01:44:00.000-08:00

groWld-ef-the cfta:f.acters and-setting the background for the project.
Layout artists - They decide the lighting and camera angles and sketch the background design for the animation.
2D animators - They are involved in the creation of a high volume of separate drawings that define a sequence.

In-between animators - They have to learn all the basics of animation and are at the beginning position in the career.

Scanner operators - They scan the clean up artists&rsquo drawings.

Compositing artists - Layering individual frames of animation . on top of one another to create final images. These images are then strung together to create complete shots or mini animated movies.
Visual effects artists - They integrate live-action footage with computer-generated imagery or other elements.
Audio and video specialists - Designing the sound for animation and also editing the visuals with softwares such as Avid and Final Cut Pro.
Visualisers -Visualise the script and create basic designs for the project.
Texture artists - Apply surface to the 3D character, object or environment.

Rigging artists - They take the modelled, textured 3D character or object and set it up with a skeletal system or joints (if required). Without this step, the 3D model would not be able to animate, talk or move fluidly and correctly.
Clean-up artists - They check the accuracy and consistency of the designs alld drawings. A good clean up artist should have excellent draftsman skill with the knowledge of density, width, volume and mass.
Lighting artists - They create variations of shade, colour intensity and shadows
Digital ink and paint artists - They give colours to each frame. Compositors - They bring together all the different characters and backgrounds into a single frame.
Editors - They edit the visuals with softwares like Avid and Final Cut Pro.
Key frame animators - Draw pictures of a movement&rsquos begiiming and end.
Rendering artists - They take all the data in a scene such as models, textures, animation, lighting, etc and output the correct combination in the form of individual frames of animation. 3D animators - They take the sculpted, textured and rigged 3D model and breathe life into it. This is done by putting in order the key frames so that they appear to be in motion.
Image Editors - They assemble visual and audio components of a film into a coherent and effective whole.
Compositors - They combine visual elements from separate sources into single images, often to create an illusion. It involves the replacement of selected parts of an image with other materials.
Visual effects (commonly shortened to VFX) are the various processes by which imagery is created and/or manipulated outside the context of a live action shoot. Visual effects often involve the integration of live-action foota~ and computer-generated imagery in order to create environmen~ which look realistic, but would be dangerous, or costly, to capture on film. They have become increasingly common in big-budget films, and have also recently become accessible to amateur filmmakers with the introduction of affordable animation and compositing software.

Attrition Rate in Steps to cope with it

2009-11-02T01:41:00.000-08:00

article is an attempt to deal with the increasing Attrition Rate in IT
sector & how to cope with the situation . It is basically to highlight some points to the Freshers as well as the experienced who are continuing or are interested to make career in IT sector . Before dealing with in details one should know what is Attrition
Attrition: A reduction in the number of employees through retirement, resignation or death.
Attrition rate: The rate of shrinkage in size or number.
Introduction: In the best of worlds, employees would love their jobs, like their coworkers, work hard for their employers, get paid well for their work, have ample chances for the advancement, and the flexible schedules so they could attend to personal or family needs as and when necessary.
But then there's the real world. And in the real world, employees ,do leave, either because they want more money, hate their co workers, want
a change or because their spouse gets a dream job in another state.So,what does all the turnover cost? And what employees are likely to ha':e the highest turnover? Who is likely to' stay the longest?
Information Technology as an industry is very dynamic, lots of staunch competitors in the same field. IT as an industry is segmented into Global Consulting or Product Development companies. With the increased offshore projects hitting, a lot of technological companies are trying to acquire as many projects as possible. Lots of Projects coming to INDIA, due to cheap labour and professional excellence proved.
If you ~om pare the increasing demand for the IT professionals and the jobs that need to be offshore in India, there is a huge dissonance in the demand and the supply.Naturally,acquiring talents become difficult in such a situation. Since the inflow of fresh talent is relatively less, the same professionals in the market keep moving from one companies to another. Lot of things attract such
individuals as well as there are reason for attrition as follows:
Salary hike Promotion
Less onsite opportunities Brand
Job satisfaction Facilities
Working Environment Work Pressure.
Work culture and management-IT industry is known for its high pressure work atmosphere and long working hI'S, which create high levels of stresses,employee and high attrition rates.
Transformation in
lifestyles, identity and family
Lack of good leaders who can motivate and guide their team well-IT managers lack both the time and tools needed for assessing their team members and taking corrective action to improve their performance which is directly related to job satisfaction.
Increasing percentage of women employees-Most women leave their job either after marriage or because.of long working hours, work stress and other social pressures.
Attrition is higher because salary is dynamic ...
There is more demand and less supply so people are getting what they want. One sure way to prevent this is to provide excellent working condition and make the organization a people centric place.
PDC-ProductDevelopment Companies(Most of the IT people in IT services would like to move PDC as the kind of work would be challenging & exciting)
Some companies & their domain are exciting.
Quality of the work Some companies are offering its employees the high end quality work.
Mostemployeesdon11eave but quit because they did not like their job, they quit because they did not like their boss ..
Steps to Reduce Attrition:
Focus on Exit-interviews
T

TheHitavada Future1' EDUCATION "JOBS '-CAREER

2009-11-02T01:39:00.000-08:00

Q: How does one enter the animation industry. Could you throw light on the jobs, eligibility and scope?
A: To become an animator, one does not require tilly specific academic qualification, ,Those with a basic sketching skill and

a passion for animation can enter this field. For a better job prospect, one should have a degree or diploma in animation. Degree and diploma courses in animation are now abundant, apart from online services. Minimum qualification for a degree , and diploma course in animation is plus two or equivalent.

Any graduate, preferably arts graduate could apply for postgraduation in animation. But some institutions such as Industrial Design Center, Indian Institute of Technology and Indian Institute of Design follow eligibility criterion that only a graduate of architecture, technology and engineering, fine arts

can apply for the PG course in these institutes.

Besides these graduate and postgraduate courses, there are several professional courses that focus on various styles and techniques. These courses, i.e. courses in Traditional animation, Stop-motion animation, Rotscoping, Computer generated 3D and 2D animation Clay-mation, Photoshop, Human anatomy, Drawing etc. help one to specialize in a particular area. One should also have a basic knowledge in handling a comput
er.

An animator should have an artistic bent with a lot of passion and imaginative skills. Creativity is the most wanted quality as animation starts with developing an idea to a story. The art of sketching or drawing is another basic skill one should possess. Patience, discipline and dedication to work are vital as this field involves a lot of hard work and long hours of thorough planning. He/sll~ should have a sound understanding of anatomy of humans, animals or bi.rds and body movements and lighting effects. Good communication skill is also needed as most of the time it involves teamwork. An animator should have a good sense of colour, proportion, size, design, visualizations, knowledge of background art and layout. They must have expertise in computer design software. Knowledge of programming languages (C++, Java) will be an added benefit. It is advantageol1s to understand photography, lighting and movement for those planning to work in computer animation. Taey must be able to visualise how an object will look in three dimensions and have the know-how to make an animated

object look real.
Job prospects and options

A strong WQfk portfolio is an essential part of landing a job in computer animation. Numerous job opportunities are available in India and abroad. It opens the door to major film industries such as Hollywood, the world of visual effects and imagery:

It is a booming industry with wide job openings and one can work on full length animation movies or any other related field like television, advertising industry etc. An Animated feature film, which offers considerable employment prospects, is a combined talented effort of a wide variety of artists. A typical animation film requires around 500 animators. Some of the jobs

offered in the industry are:
Content developers

Modellers - They make the models for animation. Must have a

solid understanding of anatomy, form and volume.

Story board artists - Those with strong drawing skills, who can

visualize a sequence of events from frame to frame.
Character animators - They bring characters to life and generally have knowledge oftraditional animation, stop-motion ani
mation as well as claymation
e trial and error problem solving methods, sadly still in use, is the equivalent of groping, in
the dark, with no data, no method or no idea. The outcome, quite predictably is little or no improvement. The "just do it" method, where the problem solver is encouraged tajump straight into the process changes, can be effective if the problem and its root cause is understood and the person doing it knows what he is doing, but this method lacks repeatability. Career opportunities are on the rise in the Six Sigma sector at various capaci

ties. With companies putting emphasis on quality as well

as cost management there is a huge upswing
in the demand for the
six sigma profession
als. A recent survey

has shown that Six Sigma professionals have faster career growth as compared to their counterparts.

For Motorola, the originator of Six Sigma, the answer to .the question "Why Six Sigma?" was simple: survival. It would be a mistake to think that Six Sigma is about quality in the traditional sense. Quality, defined traditionally as conformance to internal requirements, has little to do with Six Sigma. Six Sigma is about helping thE! organization make more money.

Six Sigma means something different to every company. For some, it is an effort for continuous process improvement effort designed to reduce costs; for others, it is a management 'philosophy used to transform a business. Regardless of the way it is used within your organization, Six Sigma means data driven decision makipg!

Literally speaking, the 18th letter in the Greek alphabet, sigma, is the symbol for standard deviation. It is a measure of variance. The goal of Six Sigma is to reduce process output variation so that there is six standard deviations (Six Sigma) between the mean and the nearest specification limit. When a process is operating at Six Sigma, nothing more than 3.4 "defects" per million opportunities will be produced. What does that mean? Done properly, Six Sigma ensures that internal processes are running at optimum efficiency.
Six Sigma pmvides you a way of thiilking different fron: ot~ers. You

Culture Shock

2009-11-02T01:37:00.000-08:00

ULTURE can be defined in simple terms as shared values, beliefs and customs. It can be also defmed as shared behavior. This shared behavior is ensured
by system of rewards and punishment. Beliefs are something accepted as truth about some object or situation. Values are independent of object or situation. Values are generally shared by entire section of the society belonging to particular culture or subculture. Customs are accepted ways of behavior in specific situation.
Culture has an impact on all aspects of life. It has an impact on everyday life also. Culture acts as a guide. Components of culture are learnt formally as well as informally. But culture is dynamic. It keeps on evolving with time. Many variables are responsible for this change. To name a few,they can be demographic changes, economic policies ofthe government, globalization, migration, exposure to changing media.
Earlier our country was isolated. Agriculture was the major sector of economy. There was no migration for the jobs. We hadjoint families wherein earnings was the responsibility of males and household was taken care of by housewives. Then it was a male dominated society. Most of the decisions were taken by male members ofthe family. Female members were traditional housewives. Literacy levels were low. At that point of time our corevalues were honestY,integrity, spirituality, socialization, patriotism, discipline; JnYIDty. Marriages lasted till dissolution. Families
lived with team spirit providing emotional support and economic security. Socialization kept society bonded together. Capital available at that point of time was scarce.So families concentrated on savings. Practice of taking loan was strictly not acceptable. Love,respect mattered more than money and worldy possessions. Whatever possessions family had, were preserved for long duration rather than using them for short time and throwing.

Slowly environmental changes started creeping into

our culture. Agriculture was no more dominant sector of the economy. Indian economy started getting industrialized. Government set the ball rolling in the form of PSU's.Private sector picked up the cues and sped up the process. Investments started happening. More and
more jobs were created. Social sector spending was accelerated by government. Results were visible. Literacyrate startedinchingup. With 'improved educationallevels people started migrating to areas where jobs were available.
Urbanization picked up. Jointfamilies gave way to nuclear families. Initially workforce was dominated by males. Government took necessary initiatives, females took to education in big away. This change gave rise to today's career oriented woman who is confident, bold, aggressive. Now composition of workforce has changed drastically. It is very common to see both husband and wife working nowadays. Per capita income has gone up substantially. With increasing income coupled with other changes, our core values have changed. Now we are more materialistic, individualistic, disloyal, egoistic, moneyminded, careless. Earlier we had oriental culture. Now we have culture which is mix of eastern and western values. Divorces rate has gone up. Many couples don't prefer to have child in pursuit of career. This has given birth to new family structures namely single parent, divorcees,coupIe with no child. Team spirit has made way for individualism. Rat race has made person think only about oneself. Extent of socialization has come down. Television set, internet are our best friends. We can call them surrogate friends. We have started chasing material possessions. In the pursuit, we don't mind taking huge loans which was taboo once upon a time.
It's nice ~o pick up good things from other cultures.But mindless copying of values will lead to disintegration of our families and societies. •

ereaing n online presence

2009-11-02T01:35:00.000-08:00

HE Internet enables people all over the world to get information on products and'senices and to use that information to their advantage. In such

- an environment, it is essential that consumers ·are aware of your business, its products and services. Over 81 million Indians now have access to the Internetl and over 1.6 billion2 Internet users exist worldwide, making it a rich and powerful medium to create awareness of your business. Your Web site makes your business visible to these Internet users.

In this series of articles, we have covered many topics that persuade and guide you in creating and promoting your Web site. Here's a quick recap:
An online presence is a business must have. Busting the myths: establish the right presence online. Build a Web site that works for your business. Promote your business online in a cost effective way. An online presence is a business must have: The Internet
helps you reach out to a large number of consumers both in your neighborhood and globally, irrespective of how large or small your business is. In fact it presents a great opportunity for small businesses to play up their strengths and help to compete with their bigger rivals.

A good business Web site can work for you in many different ways. A Web site can help project a more professional and well-established image of your business. A Web site is a great way to keep in touch with customers, disseminate information on your products and solutions and sell products online. It could be your first point of contact with customers and prospects, investors and even people you want to hire. Think of your Web site as your business card in action 24 hours a day, seven days a week.

Establish the right presence online: Prior to conducting business on the Internet, an important first step is to select and register a domain name that helps boost your company's visibility on the Web. A .com domain name offers you one of the best options as it helps provide instant recognition, visibility and credibility for your
brand online. A .com is appropriate for businesses of all sizes and it is currently the most widely used domain name extension around the world.3

Build a Web site that works for your business: A Web site should be visually appealing and professional. A Web site will reflect your company's identity and, in some cases, may be the first impression a potential customer receives of your company. It is usually best to keep away from a complex design, as it detracts from your message. Elements such as content, visual aids and the navigation should be considered carefully as these can lend to making your Web site effective in .terms of being able to capture the attention of visitors who may want to buy your company's products
and services.

Promote your business online in a cost-effec· tive way: Once you have built your Web site, an important phase begins-thatof promoting it so that more people can find

you online. By using tools such as search engine optimizatioD
(SEO)orbyexchang·

ing Web site links with busi· nesses that complement yours, there are a number of things you could do, Do remember to include your Web site address on all company marketing and sales materials. This helps intrproducts.
The time to build your Web site ani leverage it to grow your business is now.
So get started!
(The writer is country manager VeriSign India) 4

POLITICS

2009-11-02T01:34:00.000-08:00

cases. However, the leader who uses power in the service of his/her organization is using power in the most constructive sense. The leader who seeks power for its own sake and for personal satisfaction is at a level of personal maturity that will compromise his/her ethical position,
lit .Organizations also playa political game.
te Organizations seek influence.
lit Influence increases autonomy (freedom
11- to control own assets);
be organizational morale (the ability to main-
lit tain cohesion and effectiveness);
Ie- essence (sanctity of essential tasks and
functions);
in roles and missions (exclusion of options
that would challenge these);
of budgets (increased roles and missions will
od always favor larger budgets)
as Photo two-- leader
m· NATURE OF STRATEGIC
Ire LEADER POWER
Strategist argues that power at the stratewe gic organization level is manifested and exe~, cuted through three fundamental elements: it consensus (general or widespread agreeip, ment among all the members of a group) he cooperation, "Cooperative potential refers to nd an organization's capacity to catalyze coope erative interaction among individuals and to groups." Culture, It refers to the managen· ment culture, its flexibility and adaptabiline ty.
Ii· INDMDUAL SKILLS AND

~. ATIRmUTES AS SOURCES OF POWER ad Research and observations emphasize the ~n following characteristics as being especialh ly important for acquiring and maintaining

strategic power bases:
High energy and physical endurance- It is the ability and motivation to work long and often times grueling hours .Absent this attribute other skills and characteristics may not be of much value.
Direc,ting energy- It is the ability and skill to focus on a clear objective and to subordinate other interests to that objective.

Successfully reading the behavior of others- It is the ability and skill to understand who are the key players, their positions and what strategy to follow in communicating with and influencing them.

Adaptability and flexibility - It s the ability and skill to modify one's behavior. This skill requires the capacity to re-direct energy, abandon a course of action that is not working, and manage emotional or ego concerns in the situation.

Motivation to engage and confront conflict- It is the ability a:Q.d skill to deal with conflict in order to get done what you want accomplished. The willingness to take on the tough issues and challenges and execute a successful strategic decision is a source of power in any organization.

Subordinating one's ego: - It is the ability and skill to submerge one's ego for the collective good of the team or organization. Possessing this attribute is related to the characteristics of adaptability and flexibil- ' ity.
CONCLUSIONS

In corporations, public agencies, universities, and government, the problem is how to get things done; how to move forward, how to solve the many problems facing organizations of all sizes and types. Developing and exercising power require having both will and skill. It is the will that often seems to be missing."

S.B.JAIN IN'STITUTE OF TECHNOLOGY, MANAGEMENT & RESEARCH· Nagpur
(The author is a MBA Coordinator. Department of management technology)
•

ORGANIZATII

2009-11-02T01:30:00.000-08:00

HE challenges faced by strategic leaders in implementing complex and longrange consequential decisions demand that they be sophisticated with respect to issues of leadership, power and influence, The changes that are shaping the nature of work in today' s complex organizations require that we develop the political will, expertise and personal skills to become more flexible, innovative and adaptive, Without political awareness and skill, we face the inevitable prospect of becoming immersed in bureaucratic infighting, parochial. (narrow minded) politics and destructive power struggles, which greatly retard organizational initiative, innovation, morale and performance Making organizations more innovative, responsive and responsible requires focusing on a number of leadership, power and influence issues The issues influence developing teams at the strategic ~evel, as well as managing organizational processes linked to values and ethics, organizational culture, visioning and the management of change, AS A MOTIVE

Power is attractive because i confers the ability to influenct decisions, about who gets whal resources, what goals are pur, sued, what philosophy th\ organization adopts what actions are taken and who suc· ceeds and who fails
Advantages of power in organization
Power also gives a sense of control over Photo one-power and organization '. 1'he concept of organizational politics can be defined as who gets what, when and how. If power involves the employment of stored influence by which events, actions and behaviors are affected, and then politics involves the exercise of power to get something done, as well as to enhance and protect the vested interests of individuals or groups. Thus, the use of organizational politics suggests that political activity is used to overcome resistance and implies
;a conscious effort to organize activity to challenge opposition in a priority decision situation. The preceding discussion indicates that the concepts of power and organizatiOnal politics are related. We define organizationaoutcomes, and enhanced control. Particularly as decision issues become more com, plex and outcomes become more uncertain,

Power becomes more attractive as a tool for reducing uncertainty.

Power and the ability to use it are essential to effective leadership.
The critical issue is why the leader politics as the use of power, with power. viewed as a source of potential energy to manage relation . shipspower as a tool to enhance their abili· ty to facilitate the work of their organizations and groups, Others value power for its own sake, and exercise power for the personal satisfaction it brings. There can be good and bad in both

Discover Some Magic To Beat The Forex: The Elliott Wave Theory For Forex Markets

2009-10-25T07:07:00.000-07:00

One of the best known and least understood theories of technical analysis in forex trading is the Elliot Wave Theory. Developed in the 1920s by Ralph Nelson Elliot as a method of predicting trends in the stock market, the Elliot Wave theory applies fractal mathematics to movements in the market to make predictions based on crowd behavior. In its essence, the Elliot Wave theory states that the market – in this case, the forex market – moves in a series of 5 swings upward and 3 swings back down, repeated perpetually. But if it were that simple, everyone would be making a killing by catching the wave and riding it until just before it crashes on the shore. Obviously, there’s a lot more to it.
One of the things that makes riding the Elliot Wave so tricky is timing – of all the major wave theories, it’s the only one that doesn’t put a time limit on the reactions and rebounds of the market. A single In fact, the theories of fractal mathematics makes it clear that there are multiple waves within waves within waves. Interpreting the data and finding the right curves and crests is a tricky process, which gives rise to the contention that you can put 20 experts on the Elliot Wave theory in one room and they will never reach an agreement on which way a stock – or in this case, a currency – is headed.
Elliot Wave Basics
• Every action is followed by a reaction.It’s a standard rule of physics that applies to the crowd behavior on which the Elliot Wave theory is based. If prices drop, people will buy. When people buy, the demand increases and supply decreases driving prices back up. Nearly every system that uses trend analysis to predict the movements of the currency market is based on determining when those actions will cause reactions that make a trade profitable.
• There are five waves in the direction of the main trend followed by three corrective waves (a "5-3" move).The Elliot Wave theory is that market activity can be predicted as a series of five waves that move in one direction (the trend) followed by three ‘corrective’ waves that move the market back toward its starting point.
And here’s where the theory begins to get truly complex. Like the mirror reflecting a • A 5-3 move completes a cycle. mirror that reflects a mirror that reflects a mirror, the each 5-3 wave is not only complete in itself, it is a superset of a smaller series of waves, and a subset of a larger set of 5-3 waves – the next principle.
• This 5-3 move then becomes two subdivisions of the next higher 5-3 wave.In Elliot Wave notation, the 5 waves that fit the trend are labeled 1, 2, 3, 4 and 5 (impulses). The three correcting waves are called a, b and c (corrections). Each of these waves is made up of a 5-3 series of waves, and each of those is made up of a 5-3 series of waves. The 5-3 cycle that you’re studying is an impulse and correction in the next ascending 5-3 series.

Learn Forex - How To Make Money Trading Forex, The Trade Process

2009-10-25T07:06:00.000-07:00

On the forex market we are trading currencies, exchanging a currency for another. So we buy a currency hoping its value will increase compared to the value of the one we are selling. Yes, we, at the same time, buying a currency and selling another currency. An example may be a little more understandable.
We have dollars and want to buy euros. The pair traded here is EUR/USD, and the exchange rate is 1.25. You can read it like this : 1 euro equals 1.25 dollar. We hope that the euro value will be higher so that later we will buy more dollar. The exchange rate increase to 1.35, in this case we bought 1 euro using 1.25 dollar, and it now equals to 1.35 dollar. So we exchange our 1 euro back into dollars and now have 1.35.
We bought 1 euro for $1.25 and sell it back for $1.35, we made a 10 cents profit. Of course on the forex market you will not buy only one euro, this will be few hundreds or thousands, depending on your budget and the leverage offered by the broker.
Exchange rates are always moving. When I say that you "hope" the value will increase, many factors can be used to predict the rate, based on technical or fundamental analysis. This is not the topic of this article so let's have another example of a selling trade.
We take the same pair (EUR/USD) as above starting with the same exchange rate (1.25). We want to sell euros so we can buy it later at a lower price. Here we hope, or know that the value of the euro will depreciate. We sell one euro for $1.25. The exchange rate drops to 1.15. That means that now we only need 1.15 to buy our euro back. We exchange our dollars back into euros and again, make a 10 cents profit.
When you buy or sell, you always buy or sell the base currecy. The base currency is the first one in the pair. In the pair EUR/USD, the base currency is the euro and the USD is called the quote currency. When you decide to buy, you buy euro and sell dollars. When you decide to sell, you sell euros and buy dollars.
Think that you always need to exchange something two times. If you buy something and want to make a profit from it, you would prefer to sell it at a higher price. And so, if you are selling something that you will need to buy again, you would prefer to have it at a lower price.

Forex Training Education - Learn How to Become a Professional Forex Trader!

2009-09-10T20:02:00.001-07:00

Forex training education is one of the most sought after training course formulated and specifically tailored for those who want to learn the true dealings of the trade. This becomes popular to a lot of aspiring traders, novice and even professionals. As everyone knows how the trade can move to an intensified state down to its fluctuation, it can never be gleaned that forex trading is an easy market. Reality check, it is not an uncomplicated market however, you can formulate ways on how to weather a complex market into something that will turn all the intricacies and risks as part of a challenging course and in the long run to your advantage.
When you finally come to the conclusion of undergoing forex training education, you will realize that this is something worthwhile as you begin with an investment that you will be carrying on in the duration of your trade and in your future transactions. One might come to ask, what could possibly be the best formula to gain more profit? The answer is simple, learn through forex course training education and be able to apply all the things that you have learned in your actual trade.
Forex training education has a lot of things to offer in helping you become a professional trader. You have to start off in searching for the best and the finest online courses on the net. There are multiplicities of selections provided for those who want to gain further knowledge in the areas of forex market and you will surely come up with the most efficient ones. You can also go by other forex trade software that consists of forex autopilot and forex robots. This software generate favorable outcome and constructive feedback as expediency becomes its major point. When you acquire a forex autopilot or robot, you will no longer have to do the monitoring 24/7 for the forex autopilot will be the one to do all the things that you once been doing. This software will also send forex signals on your database indicating if it is a perfect time to buy, sell or hold your currencies.
Forex training education is also comprise of demo accounts that can serve as your online resources. You can also create an account where you will be given a trial trade with no capital involve until such time that you are ready to face the inner circle and do your first trade at once. Added to this, is the significance of learning forex languages that will also play a big part in your dealings. Terminologies such as hedge, pips, currency pairs, quote currency, base currency, cross currency and the major and minor currency. The chances of coming across with these terms are viable.
Keep in mind that, forex training education should not rest once you get yourself in the forex market circle. Just like any other venture, a continuous learning process is essential to make way for greater challenges to overcome, profits to take pleasure and in due time a professional trader in your own right.

) Forex Trading - Why Forex Traders Prefer Technical Analysis

2009-09-10T20:01:00.001-07:00

Until relatively recently fundamental analysis, or looking at past political and economic events to help them predict price movements in the underlying currencies they traded, is how most traders arrived at trading decisions.
However, fundamental analysis requires a trader to absorb lots of diverse information from many sources and considerable knowledge to interpret it accurately. Couple this with basic disagreements as to what information is important and what weight to assign it and you can begin to see why this method took enormous resources and time. Two characteristics not commonly associated with the individual investor.
The end result was that for years currency trading was the exclusive playground of large banks or other institutions with the resources to accomplish this type of analysis
Now, the rise of computing power and the proliferation of electronic information sources have lead to a fundamental shift in the way most traders analyze the Forex market.
Today most traders employ another, more automated, form of analysis known as technical analysis. This involves the combined charting of real-time and historical price movement data of currencies. Today this is mostly accomplished using computers which have the ability to do the sometimes complex math quickly in near real-time.
Technical analysis really boils down to simply taking the over one hundred years worth of recorded historical price data available from the foreign currency market and running it through a computerized charting application to look for patterns and trends.
Once these patterns or trends are identified they must be quantified in there ability to predict price moves in a particular direction. Once done, a trader can then look at the manner in which a currency's price is currently moving and compare this to similar past patterns to predict the future direction of movement.
So, while technical analysis still requires skill, experience, and judgment the fact that it is more automated and less subjective than the research involved in fundamental analysis contributes to it's popularity. The debate over which method is better will probably never be resolved, but most traders feel that technical analysis is easier to learn and master.
There are three underlying principles one must be familiar with to fully understand technical analysis.
First, there are many factors, such as political or economic events, that will produce price movement in a particular currency pair. However, these factors, or reasons, are not what's important to technical analysis, but rather the price movement itself.
Second, technical analysis assumes that pricing moves follow a trend that can be discerned by tracking the patterns that emerge over time in the market.
Finally, the trends and patterns that emerge from historical charting and analysis of price will also be reflected in future price action movements. This is because, in the view of the technical analyst, the trading psychology of humans remains for the most part constant over time. So market participants will react in similar fashion to similar news in the future the same as they have in the past.
This "wisdom of crowds" or at least the predictability of crowds is dismissed by followers of the fundamental analysis approach. They hold to their belief that a deep understanding of the factors that affect pricing and not a reliance on patterns is the only way to produce reliable long term results.
In spite what the fans of fundamental analysis say the majority of traders today rely almost entirely on a some form of technical analysis for trading currency.
No system, whether based on fundamental and technical analysis, can accurately predict price movements every time but a good technical trader who takes the time to learn a sound methodology can do quite well.

) Forex Trader Forum, Where Forex Traders Talk About Forex

2009-09-10T20:00:00.001-07:00

Forex Trading Strategies in Timing
Savvy forex traders often pinpoint the opportunities in forex trading and persist to time the industry so they know precisely when the right time is to trade, or buy. The problem is many traders buy at the wrong time, although they have monitored, explored, and checked the quotes daily. In addition, these people tend to bank on the notion that buying in forex is best when the market is low and the traders are pulling back.
At the entry level in forex, many traders erroneously time forex marketing without realizing how to fittingly, utilize pullback and the level of support.
Forex marketing has a strategy that many traders overlook. The prime strategy, which many forex traders believe is the key to profiting in the forex industry is the buying low and selling high strategy. Unfortunately, these traders are wrong, since it is a key to loosing instead.
Support in forex industry is when chronological value or pricing comes in from traders who “Buy.”
The mission behind buying is to provide support for the forex market exchange, as well as to analyze, examine, experiment, investigate, etc, the markets in forex currencies and exchange. Each time the traders test forex, it authenticates support.
Resistance becomes sizeable in the forex industry only when the levels of “resistance” is charted, i.e. at what time the levels of forex value, or pricing refuses to give in to jumping to a higher listing.
For this reason, at what time forex traders venture on buying low and selling high, they are making a big mistake. Traders who delay in forex trading markets will often recoil, or retract at the time some of the biggest deals transpire in the forex industry.
In short, the trends are what traders want to stay aware to, yet most traders will resist. Why, because the traders often feel uneasy at the times when other traders resisting buying and selling in forex.
Now, if you want to get ahead in forex trading and use strategies to win, I recommend you read the book on emotions, or the keys to success. No, these are not actual titles, yet visit your library to find relating material because what you are going to have to do to win in forex trading, is become friends to your discomfort.
Most people feel discomfort will experience distress, anxiety, and often it is because they fear embarrassment. The disadvantage of this way of thinking is that, most times the fears are exaggerated and the one fearing is the one who looses at the end.
Another big failure in life is that most people feel that if they are not on the normal level of thinking, they are not accepted and are set apart from the world. Read your history because you will find that the vast majority of those who succeeding in life, where different. That is they did not think on the terms of normal society. These people often win also in forex trading, since they set strategies apart from the rest.
In short, fear is the mechanism behind all failures. Now to sum up the best times to buy in forex trading. The best times to buy in trading industries, such as forex is when the market is “high” and traders are not resisting, or pulling back. In summary, when you use strategies in forex trading such as buying “high” and selling “higher,” you are off to a grand start in winning in the forex industry. As well, you have setup forex trading strategies that set you apart from the rest, which means your chances of winning are higher

) Forex Signals: Effectively Using Forex Signals to Maximize Your Forex Trading Profits

2009-09-10T19:58:00.002-07:00

FOREX trading has some shortcomings; one is the fact that you have to spend a great deal of time scrutinizing the market. Indeed, you may have to spend many hours at your PC, keeping your eyes peeled for entrance and exit situations that will be helpful in your overall investment strategy.
It is possible to utilize automated orders. Limits and stops prevent eye strain by letting you have some time away from your monitor, secure that any potential for loss is minimal. However, you can also lose out on prospective gains, if such orders, in your absence, take effect sooner than you’d like.
To minimize the risk of automated orders, and yet still get away from your desk, a FOREX signal service may be helpful. Someone else does the market watching and analyzing for you, and the results are sent to you directly, by email, cell phone, pager, etc. Such services aren’t free; usually a monthly or annual subscription is required. However, some brokerages have integrated such services into Forex trading software which sends signals to you by screen “pop-up” messages, or by the other direct methods already mentioned.
FOREX signals are usually only to be had in a restricted quantity of currency pairings. Most frequently, one of the following will be offered: EUR/USD, USD/JPY, GBP/USD, or USD/CHF. However, other such duos may be offered by certain specialty services.
A high level of technical market analysis is generally required for FOREX signal creation. Most services utilize a mix of indicators to recognize primary trends and entrance/exit signifiers. Subscribers are then given the option of exercising or foregoing a trade based on the results; some companies may even give you the ability to place trade orders that can be exercised by an analyst without consultation with you, to give you even more freedom from having to monitor the markets – or even the signals – yourself.
A variety of signals are possible as the results of the analysis of currency charts. A Simple Moving Average (SMA) signals to buy if the price for the specified currency moves higher than the line indicating the average price, or to sell if the price goes below the line.
A Moving Average Convergence Divergence (MACD) study also has a signal line where “buy” is indicated if the price goes above, or “sell” if the price goes below, the line.
Market interest may be found using indicators of volume. Especially near the market low, high volume tends to signal that a new trend is beginning. Conversely, low volume may signal that investors are unsure of the wisdom of purchase at this time. The possibility of market change may be signaled by a variety of different indicators.
The utility of such signals can be reinforced with a mixture of additional indicators from a variety of sources. Such a combination provides insight into market behavior that can be fairly dependable. Of course, nothing is 100% certain – if such signals were absolutely reliable, we’d all be rich. No respectable service will ever guarantee absolute success. However, a particular service’s result history can be a good indicator of whether or not you can rely on their currency trading advice being useful to you in the future.
Subscription services that provide such data typically cost between $50 and $200 per month. You may find that the cost outweighs the benefits, or you might find that your profits make the information worth the price. Such data can never take the place of true knowledge, however; signals are simply a form of guidance. If you lack the basic tools to use the information provided, such a service will probably be useless to you until you can obtain some additional training.

) Learn Forex - Is Forex Trading The Ultimate Home Business Opportunity ?

2009-09-10T19:58:00.001-07:00

That's true, you can be a trader at home. Forex, or Foreign Exchange Market is by far the largest financial market in the world. About $2 trillion are traded EVERY DAY. The Forex market is the currency market, where a currency is traded against another. Quick example : you buy a dollar and sell euros. Not that easy to understand. But can we do this from home ? Yes, we can. About ten years ago, you would need millions of dollars to start trading. Now you can start with a few hundreds of dollars.
What you need is your computer and an internet connexion. You can trade from the comfort of your home, without having to deal with any boss or clients. You will only deal with money. Then you can start selling dollars and buying euros and make a profit. You have to find a broker, where you will open an account and funding it. You will also have the possibility to get a demo account and practice, with fake money but in the real time market. I strongly recommend you practice a few months before thinking of "live" trading.
It is not that easy, it is extremely risky if you don't know anything about trading. First rule : don't invest what you can't afford to lose. Forex is not a game, there is a lot of parameters to take in account, and human factor is one of the most important in this business.
You may have already understood it, currencies are traded by pairs. The european Euro versus the US Dollar, The US Dollar versus the Japan Yen, etc. When you buy a currency, you want to sell it later at a higher price. When you sell a currency, you want to buy it later at a lower price. This is how you make profit. Think like you were buying a foreign company share. You always want to buy low, and always want to sell high.
What you are looking to when trading currencies is the exchange rate. This will tell you your next move. Buy or sell. Currencies are part of the economy of each countries. When the value of a currency is increasing, this means the economy is going better as before. The exchange rate can be viewed as the country's economy compared to another economy. This is why economic factors can help you to predict your next move. If you know that a currency will increase, you will buy it and expect to sell it at a higher price, a higher rate.
You can choose the pair you want to trade, but the most people trade the main currencies, Euro, Dollar, British Pound, Japan Yen. And you can only choose to trade one pair only if you want. You are the only person that will make the decision. Hope you are making the good ones, profit can be huge, as well as losses.
Like any business, forex trading has to be taken seriously. Lots of people are trading the forex and some are earning thousands of dollars every day. But it needs a lot of training, education and analysis before reaching such results. It can be the perfect business and actually it is for advanced traders

) Discover Some Magic To Beat The Forex: The Elliott Wave Theory For Forex Markets

2009-09-10T19:57:00.001-07:00

Learn Forex - How To Make Money Trading Forex, The Trade Process

2009-09-10T19:56:00.001-07:00

Forex Training: Deadly Forex Mistakes That Assure Failure

2009-09-10T19:54:00.000-07:00

Before venturing into your trading journey there are some things you need to be aware of, otherwise you could succeed on your trading adventure, and we don't want that to happen, do we? This Forex training guide will help you track the most costly mistakes Forex traders do.
First of all, make sure you don't have a trading system. Having a trading system might increase the odds of your success. If you have a system, you will have an objective way to get in and out the market. When traders create their trading systems they think objectively since there is no position to be taken at the moment. If there is no position to be taken, there is also no money at risk, if there is no money at risk, we do think objectively and are open to every possibility, thus we are able to find low risk trading opportunities. So make sure you don't have a system and trade based on a randomly approach.
If you have already created your system, then don't follow it, be undisciplined. If you follow your system, there is a possibility that you can profit from the Forex market based on the trading opportunities you have found. If you want to fail on your trading, be sure to be undisciplined.
Don't get educated. Most successful traders are very well educated in the market they trade (stocks, Forex, futures, etc.) If you get educated, you might acquire the knowledge and experience you require to master the Forex market. Don't read about the Forex market, don't enroll into Forex training programs and don't even look at historical charts.
Don't use any money management technique. The purpose of money management is to avoid the risk of ruin, but at the same time it helps you boost your profits, allowing them to grow geometrically. For instance, by using no money management techniques, there is a possibility that in loosing 10 trades in a row you could empty your trading account. On the other hand, by applying simple money management techniques you can avoid it. So make sure, if you want to fail, don't even consider money management.
Forget about psychological issues. You need to get every trade to win. Successful traders know that they don't need to win every trade in order to profit from the market. This is one characteristic that is hard to understand and really apply. Why? Because we are taught, since kids, that any number below 70% is a bad number. In the Forex trading environment, this is not true.
Don't even consider using a Risk-reward (RR) ratio greater than 1-1. If you use a RR ratio of 1-2 (willing to make twice the amount risked in one trade) then you only need a system that is right around 50% to make money. If you use a RR ratio of 1-3 (willing to make three times the amount risked in one trade) then you will need a system that is right around 40% of the time to make money. So make sure to use a RR ratio below 1-1.
By applying every point outlined in this Forex training guide, you will almost assure your failure in your Forex trading journey. Do the opposite, and you will have the possibility to achieve what every trader is looking for: consistent profitable results.

Forex Trading Psychology: What Makes A Successful Forex Trader?

2009-09-10T19:53:00.000-07:00

The Forex market has changed through the years, growing in volume and expanding across multiple time zones.
Brokerage houses have changed, too, going online with sophisticated software and powerful servers.
Economic indicators and technical analysis have become more sophisticated, too, until the Forex market of today bears little resemblance to what it used to be.
But there’s one thing that hasn’t changed: most traders lose.
Despite all the advances in the Forex marketplace, the ratio of winners to losers remains low. Experts agree that the most hopeful number that can be advanced is a measly 10%, which means that 90% of all traders on any particular day will lose.
Experts also agree that the reason most traders lose is because they allow their emotions to cloud their judgment.
Most people trade on hope and fear, rather than facts. Rather than basing their trades on what the charts and the indicators actually say, these people trade on what they want them to say. They hang onto a losing trade and follow the graph down, hoping the currency pair will turn around. Or they exit a trade too soon, fearing the trend won’t last, and are satisfied with pennies that even the best Forex money management cannot balance against their losses.
Other people lose through greed, by trying to pick the highs and lows too nicely to maximize their profits to the penny. Rather than waiting to place a trade when the indicators confirm the market’s movement, they jump in too soon and are disappointed when the anticipated break-out never occurs.
Remember, there is no magic software or fool-proof trading scheme. If you cannot control your emotions, then you cannot become a winner despite yourself. But there are things you can do to improve your chances of being one of the winners, and the most powerful is to follow these rules of Forex trading:
strategy of your choice—then trade your plan. Don’t alter your plan or fudge your criteria if you don’t see a good trade for a few days; wait for the market to fulfill your requirements before risking your money. Remember the law of averages: sooner or later, the market will come around.
Prepare a trading plan, using good Forex money management skills and the trading Use stops, and trailing stops when possible, to control losses and protect your profits. Remember to set your stops far enough away from the entry price so that you aren’t closed out by normal market jitters.
Paper trade with a demo account until you are efficient and feel comfortable in the market.
When you move on and start trading with real money, it feels different than paper trading! But this is no time to change your plan. To minimize the effects of emotion, set a small, realistic initial goal and trade until you achieve your goal more often than not. Use small sums in micro or mini accounts. Only when you are comfortable risking your cash and sometimes losing it should you attempt to trade with larger sums of money.
Study your trading record and try to figure out what went wrong when you lost. To put it simply, learn from your mistakes. That alone will put you ahead of the crowd!

1) Easy Forex Trading - How to Trade Forex Easily and Profitably!

2009-09-10T19:49:00.000-07:00

When an individual would hear the word 'Forex' it is expected that the initial reaction is that it is a complicated and mind-bugling issue to take. Although this is true at some point, it does not actually work always that way especially if an individual is aware of all the prerequisites of the game. Now, to open each eye about easy Forex trading, this article was created.
• It is easy Forex trading since you need not to overdo things. If you are just new on the Forex trading arena then you can begin with making a profit of only a 20 pips. Do not try to add up more, instead study the tactic that you will have to do the next day.
• You need not to waste all your time; it could be spent on 15 minute chart as well as 1 hour chart only.
• The 5 miniature chart is not there so you could waste yourself into. If you spend too much of your time here then it will only distract you in making a good trading decision.
• Easy Forex trading also means not using the complicated MACD to buy and sell since it only arrive the individual to meaningless trades which anyone would see as a waste of time.
• You can make use of trailing stops during times when you unstoppably keep on moving your Forex proceeds just to cover all your losses. Also keep in mind to practice first with the demo before actually dipping your toe on the real scene.
through the use of 12-15 pips stop in Forex trading. As expected, you will primarily lose 3 out of 10 trades thus is sensible to hinder your losses to a certain percent and always practice proper money management.
• Some would say that is easy Forex trading given that one can rely only on 'gut feel'. • You can carry out everything that you can probably do in order to protect your cash This is not an intuition game; this is a real thing since your money is at risk. Being very much dependent on 'gut feeling' will only lead to financial dilemma thus it is best to control your emotions.
• You need to have a precise and detailed log of every good or bad trade that you had before to serve as your guidelines not to make any erroneous decision later on.
• Every people has their personal indicators thus what work for your friend may not always work for you, be unique.
• Indeed, it is definitely an easy Forex trading but in case you cant compose yourself to be serious on what you are doing then there is no point of even starting.
There are other lists of guideline that would present why it is known as easy Forex trading. For the trader, you have to practice and study every step that you make. Be patient and do not just rely on your inkling if you really want to bag the money all the time.

C rporate Banking Transformation Banking Frontiers organized a roundtable at the Sahara Star Hotel in Mumbai on 11 June 2009 on the topic 'Corporate B

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Manoj: We have terms like nano seconds nowadays and that is part of business language and not just technology language. Given the economic scenario in the competition, corporates wants things faster and faster. So, how are bankers accelerating corporate banking services?
Vipul Acharya: Today MNC banks give a lot of technological advantage to the corporates, and hence most of the corporate big houses are with MNC banks. But now Indian banks are also competing with them· in terms of service and pricing. People banking is slowly shifting to electronic medium. India is evolVing and I think we will not have clearing system any more and everything will be done through electronic banking only. In 3 to 4 years, all the banks will have ERr integration. So once a company goes for ERr integration with one bank, it is very difficult to move that customer from one bank to another bank.
Vispi: The move is in the right direction. In the days to come, we see payments to be the driver as far as cash management or transaction banking business is concerned. In two years time, all-India clearing will get centralized or it will get divided into four zones only. With just cheque truncation and speed clearing taking shape, we see collection as a dying product two years down the line. It's all going to end up with payments and the banks who get integrated with corporate ERr are going to create a stickiness because this is one business which is highly sticky - no customer wants to move out for a small advantage unless you are able to offer something that is mind-boggling and going to make his life very different from what it is today. The other thing that we see emerging these days among large corporates is the shared service centre concept, where the corporates are trying to centralize the receivables, payments and collections - all this at the group level.
Rajamani: You will see that most of the organizations inIndia are ITenablingthemselves through ERr deployment. What they are looking forward is how much they can connect themselves with the external world, particularly with financial institutions. Right now banks are their daily life and they cannot survive without the banking industry, so they see lot of value in decreasing the cycle ti me of various transactions. With RTGS and NEFT in place, they see lot of value in automation of transactions and that really brings the question of how do we establish the last mile connectivity between the corporate and

• BRGB has provided financial assistance to 15 projects with financial outlay of Rs 53.70 lakh under Venture Capital Scheme for Dairy.

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computerization of the bank's business already completed and further initiatives, including implementation of CBS, (ii) NRE/NRO business being started shortly, (iii) undertaking pension business as sub-agent of sponsor bank, (iv) augmenting non farm sector advances especially MSME
in collaboration with German Financial Corporation, (v) branch expansion -opening of 5 new branches, (vi) WomenDevelopmental Cell for empowering rural women, (vii) social banking, (viii) solar energy project, (ix) debt swap scheme for freeing the families from the clutches of money lenders, (x) financial inclusion for rural empowerment - 835 villages including one district fully covered and (xi) Promotion and revitalization of farmers clubs. This year's motto of the bank is 'Maximization of Profit through Rural Empowerment and Technology Upgradation' and in order to translate the spirit of the motto into reality, the bank has proposed to pursue the following prime corporate objectives and business strategies to achieve the same.

OBJECTIVES & STRATEGIES
Garg said that corporate objectives are to increase gross profit by 50'K" bring down gross NPA to less than 2.5% and NPA to less than 1 %, 2291' growth in deposits (Rs 2,330 cr), 25U/c, growth in advances (Rs 1,474 cr), to attain per branch productivity of Rs 13.63 cr, to attain per staff productivity off Rs 3.40 cr, implementation of CBS in 80 urban, semi urban and other centers, all branches to be a profit making unit, substantial increase in non interest income, recovery of at least Rs ] cr in written off accounts, increase the clientele base to two million, opening of 5 new branches - 3 semi-urban and 2 rural, increasing share of low cost deposits to 58% and achieve cross sell ratio of 2.
l3RG l3 has multiple strategies to achieve its corporate objectives.
The bank plans to maximize its profits by low cost deposit mobilization, diversify loan portfolio with high yielding advances, maintaining asset quality with no slippages, reduction in NPA level at least by 30% through cash recovery and up gradation, at least 20'}(, cash recovery in written off accounts, doubling of non interest income, inter alia, by canvassing non fund business such as bank guarantee and sale of third party products, increasing staff

LOOK IT SHOWS 105 KG-So LAST WEEK IT S~WED 100·

WHICH CAN MEAN ONL'( ONE 1H1NG-.
productivity, bring down the controllable expenses through cost discipline, preventing revenue leakages. Another objective is rural empowerment which will be done through programs for financial inclusion, financial literacy, micro finance,

women development cell and formation of farmers club. As regards technology, CBS will be implemented in the first phase 80 branches in urban and semiurban areas, covering 51% of business of the bank.

GROWTH POTENTIAL OF RAJASTHAN
The pace of financial inclusion has proved to be a good tool for banking extension in the state. BRGB has covered 835 villages under 100% financial inclusion with coverage of whole district of Dungarpur under 'Dungarpur Project' in collaboration with its sponsoring bank, Bank of Baroda. BRGB has associated with its sponsor bank as 40% partner in its endeavor towards 100% financial inclusion and Total Integrated Rural Development of Dungarpur, a tribal district in its area of operation. The 100% financial inclusion has already been achieved by coverage of 250 Villages. The bank has provided financial assistance of Rs 486.20 lacs to 2287 families for dairy, spices cultivation, vegetable production and to rural artisan besides forming 51 Farmers Club and 731 SHGs, Credit Linkage of 442 SHGs and issuing] 951 KCCs.

POTENTIAL SECTORS
Garg added that in terms of potential sectors in the state for banking, there is ample scope in minor irrigation, land development, water management, soil conservation, farm mechanization, horticulture, forestry, waste land development, bio-fuel crops, rural non farm sectors - agro processing, agri exports, contract farming which can be explored for augmenting credit dispensation. Besides there is vast potentials in marble, cement, mica, limestone, mineral crushing, cotton, textile industry which can be explored to add to the economy of Rajasthan state, added Garg.

State Bank of Bikaner and Jaipur (SBBJ) has a strong network of 698 branches in Rajasthan. the largest network among all banks operating in the state.

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Arun Shandilya: SBB) has a strong network of 860 branches. Of these, 698 branches are in Rajasthan which is the largest network among all banks operating in the state. Of these, 524 branches are located in rural and semi-urban areas, which play an important role in rural development and poverty alleviation in the state. Even in terms of number of customers, about 93% of them emanate from Rajasthan. The percentage of SBB) customers (both deposits and advances) is about 9.8% of total population and about 19% of the adult population of the state, which is the highest amongst all banks in Rajasthan. Over the last few years, the bank has made significant progress towards financial inclusion and providing services to hitherto un-banked population of the state.
What are the major changes observed in the pattern of savings, fixed deposits, loan taking, etc, over a period of time?
The interest rates have generally gone up in the financial system (barring the last six months when policy rates have been cut aggressively to combat the economic slowdown). As a result, there has been an increasing preference of our customers towards the term deposits which provides better return to depositors. Between March 2005 and March 2009, the share of term deposits in total deposits of the bank has gone up from 56.9% to 62.2%. The share of savings and current deposits has correspondingly gone down, although in quantitative terms, even CASA deposits have grown by over 80% between March 2005 and March 2009. Likewise in case of advances, over the last few years there has been substantial upscaling of advances in commercial and institutional (C&I) segment particularly by financing of infrastructure sector projects. Accordingly, the proportionate share of C&I segment in total advances has gone up from 36.1% in March 2005 to about 50.4% in March 2009. The share of personal segment and small scale industries has correspondingly gone down, although in quantitative terms advances to these segments too have gone up significantly over the last few years.
Is the NRls' contribution in your bank increasing'? \\ hat is the percentage of the NRls' clientele?
The bank has a customer base of nearly 70,000 NRls. The deposits from NRls have increased from Rs 637 crore in March 2005 to Rs 813 crore in March 2009.
What are the major projects currently at ')BBF
SBB) is amongst the first few public sector banks in the country with all branches on core banking. One of the major projects at hand is to optimize the usage of technology to offer value added services to customers. Amongst the major objective is to migrate more and more customers towards alternate delivery channels particularly internet banking and ATMs. The bank is also implementing BPR exercise whereby most of the bank office functions are being centralized so that branches can focus more on improving customer service, sales and marketing. We are endeavoring to boost non-interest income by cross selling life and non-life insurance, mutual funds and credit cards, besides expanding the coverage of online share trading facility launched during 2008-09.
How does your bank compete with other banks, especiallv cooperative banks, in the statl?
AU branches are on core banking solution and the bank has satellite connectivity even in the remotest corner of the state. Today SBB) offers multiple products and delivery channels which include internet banking at all branches, online funds transfer, B2B payments, utility and other biH payments, online tax payments, railway freight payments, etc. The bank has about 500 ATMs which are connected to State Bank group ATM network. Overall, SBB) is far ahead in terms of network, business size and technology particularly compared to cooperative banks in the state.
Can you explain the strategy of business growth and expansion plans of your bank? What are the targets for 2009-1 O?
Notwithstanding the global economic slowdown, SBB) has maintained a healthy growth in business and profitability in 2008-09 with net profit growth of 28.1%. For the year 200910, the bank is targeting a business growth of Rs 18,600 crore, as against the growth of Rs 9,885 crore in 2008-09. For the purpose, special emphasis is being laid on the retail segment, particularly agriculture, housing, education and SMEs. Branch expansion shaH also be pursued Vigorously keeping in view the potential at select centers.

themselves. The three leading banks that did well were SBl, ICICI Bank followed by Central Bank of India. What we did was display a notice board at th

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advertise their personal messages on the board - anything that they may want to advertise. This has happened 10 years ago.
PK Nair: But the point is that you may 2000 branches and it is hard to replicate the same across all the branches.
Rajesh: What I am trying to say is that informally the PSUs are already doing it. They interact with so many customers daily that it is easy for them to bounce off the information to customers. For instance, if a customer purchases a car and is unhappy with his choice, the bank on hearing about this could pass on the information to other prospective customers. They can then make it formal.
PK Nair: Do you offer the car loan from a branch or do you offer it from a retail asset group?
Asha: It is now a centralized retail asset hub. But the leads are sourced through the branch. When 1 have a wide network of 2000 branches, why do I need to centralize it? Some banks do not have the advantage of a network.
Narayanan: The question is whether your marketing is information driven or transformation driven. Information driven marketing may be able to give you volumes but not values, especially in an era which is either customer convenience or affinity. What is required is to reach the headlines or the heartlines. That's what going to count. If you manage to hit the heartlines of the customer, there is no need to hit the headlines. Information may help you to reach the headlines, but unless your personal relationship at the touchpoint of the customer will only help you to reach the heartlines. And when you reach the heartlines, your relationship with the customer gets strengthened. And that's why it's the greatest relationship for banking because it is almost relationship driven.
Manoj: Heart to heart commerce?
PK Nair: If you analyse the set of customers today, how many of them would be the younger generation and what is the kind of products and services they would ask for in the next five years? Do you have a set of products and services you think you will introduce three years from now? So what happens to that next set of products and services which that generation is going to demand? Where's that coming from?
Venkatramaiah: True to the younger generation today, all banks offer internet banking, mobile banking,
Sunder Rajan: For the Nano car booking loan, we went in for marketing face-to-face. We did not depend much on internet and website. At the branch level, we were driving the branch people to interact with the customers. The results spoke for
themselves. The three leading banks that did well were SBl, ICICI Bank followed by Central Bank of India. What we did was display a notice board at the branches and we encouraged the staff to ask customers whether they were interested in booking the Nano. We even offered tips. Some customers were fussy and don't want to buy a low-end car. So we suggested that they buy it as a gift for their son or wife - a second car. We did well. We also had a relationship with some dealers with whom we exchanged information.
PK Nair: What Tata Motors did was created a mini website within their website and in that they had a series of discussions. What they wanted to find out was whether it should be positioned as a second car for customers or a safety car because the world is increasingly going green. They used the internet as a medium as it can be accessed immaterial of the location. From a banker's perspective, we would be mainly interested in the booking amount and the fee amount. For Tata, it helped them immensely to get better feedback on how to segment the car and the customer segment to target and also the additional functionalities they need to bring. Normally they would have done a huge market research exercise that would have cost them crores of rupees. Here they have got the feedback for free which the customer has come and given to them. That's the differentiation you can bring and the trend we are seeing.
Srinivas: You are aware that the public sector banks are becoming tech-savvy and providing lots of facilities, etc. But we believe that human interaction is more important. Earlier RBI pushed for customer satisfaction; from here they have now moved to customer excellence. Now the buzzword is customer ecstasy. We should be in a position to offer services to customers that they are not expecting. This could be in the form of mutual funds, insurance, etc.
Manoj: 1 am sure all of you must have moved house some time or the other in the past. This means changing addresses with banks, insurance, mutual funds. [ am just wondering whether banks be the agents for various other segments such as mobile phones and others?
Hegde: Even the bank pass book is accepted as one of the proof of address.
Taneja: 1 think there are two aspects to this especially when you are engaging with a client whose contact information or address keep changing regularly. First part is there are some ways in which we can anticipate what is going to happen. As a bank, I will accept change in contact numbers through various channels including the phone, internet banking, etc. The address on the account will not change till the customer gives me a letter because that is the KYC. Customers who like to keep in touch with the bank or like to receive alerts will probably update their phone numbers first because it will be done qUickly because typically banks will accept such requests over the phone, or through email or the internet. Whenever that happens, it is an alert by itself. It could also suggest that the customer has shifted the location itself. Maybe as a bank what I can do is ask the customer whether he has shifted his residence too. Other indicators are that might have stopped issuing cheques which were earlier happening on a monthly basis. The other point raised here is whether banks can help the customer change his address in respect to other things such as magazines, mobile phone operators, etc. I think as far as

When the concentration of serum hormone is high, the color will be more intense and vice versa. ELISA technic may be used to measure the peptide hormo

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the intensity of color is measured with a spectrophotometer. When the concentration of serum hormone is high, the color will be more intense and vice versa. ELISA technic may be used to measure the peptide hormones as well as some steroid hormones (eg, progesterone, recall progesterone circulates in the blood being bound with a serum protein). LISA technic can be used to measure any protein in the serum, provided the protein is antigenic. By ELISA technic a screening may be made to detect sufferers from AIDS. Regarding the technology, other variants (other than the mentioned above) of ELISA are also available. Further, a new technic, closely related to ELISA is EMIT (not described here). By EMIT technic, trace quantities of protein (having low molecular wt, hence unsuitable for ELISA) can be measured. 3. Flurimetric analysis Plasma cortisol can be estimated by this method The analysis requires a flurimeter. This is currently the method of choice for plasma cortisol estimation. 4. Cytochemical assay More sensitive than RIA, the method is unfortunately very complicated and requires great expertise. However, its potentiality is great. 5. Dynamic tests In cases, where the endocrine malfunction is only very mild, estimation of concentration of the hormone level in blood may not give clear clue. In such case, a drug, which either stimulates or depresses the hormone's secretion may be given and after the drug administration the hormonal concentration measured. Such tests are called dynamic tests. An example is metyrapone test (chap. 4, sec. VI, in assessment of 'adrenocortical status'). Some older methods 1. Estimation of the urinary metabolites : Progesterone is metabolized and part of the metabolites appear in the urine as pregnanediol. Urinary pregnanediol can be estimated by column chromatography followed by colorimetry. Therefore, from a 24 hour urinary sample, daily secretion of progesterone in the body can be assessed. This method of assessment of progesterone status in the body is still somewhat popular, but similar others are not so. For example, estimation of urinary metabolites of suprarenal cortical hormones (e.g., 17 ketogenic steroids, 17 ketosteroids), for assessment of suprarenal status in the body, was very popular till the 1960s but are now practically obsolete, because superior methods are now available. 2. Whether an endocrine gland is hyper or hypo functioning, or functioning normally, car, be assessed (i.e , endocrinal status determinated) by many indirect methods. Examples are : serum cholesterol/BMR estimation, to assess the thyroid status. With the introduction of the modern methods, importance of the indirect methods have fallen considerably. HORMONE DEGRADATION A portion of the hormone is degraded in the target organ Apart from this, liver is the principal site of hormone degradation and the degraded hormones are often removed via the kidney through urine and are called urinary metabolites of the hormone. SUMMARY & HIGHLIGHTS Hormones may be (i) peptide, (ii) steroid and (iii) amines. Receptors for (i) peptide hormones are in the target cell membrane whereas (ii) those for steroid and thyroxine are in the cytosol or nucleus Membrane receptors combine with the hormone→activate G protein (coupling unit)→activate the catalytic unit --3- now a 2nd messenger is produced. The 2nd messenger ultimately produces the biological effect. However, some peptide messenger hormones are, till now, not known to produce 2nd messenger. cAMP, DAG, Ca++ etc. are examples of 2nd messenger. Adenyl cyclase, PLC etc are examples of catalytic unit. Steroid hormones and thyroxme do not prduce 2nd messengers. Instead they cause increased production of RNA → more proteins (= enzymes and/or structural proteins). Clinically blood concentrations of most hormones can be measured by RIA or ELISA technics. Normally, hormones are present in exact quantities, neither more nor less. Very often, hormones, regulation is achieved by (i) hypothalamus, (ii) ant. pituitary both of which are influenced by feed back (-ve, usually). However, some feed backs do not operate on the hypothalamus. Control of some other hormones (eg. insulin, PTH) is achieved by feed back by blood constituents (glucose, Ca++). I. Functional anatomy 2 Chemistry 3. Bio synthesis 4. Carriage of the thyroid hormones in the blood. 5. Functions 6. Mechanism of action 7. Control of secretion 8. Degradation of thyroid hormones 9. Applied physiology : (a) Hypofunction. (b) Hyperfunction (c) Goiter (d) Drugs used (e) Assessment of the thyroid function (status). FUNCTIONAL ANATOMY The thyroid (from Gk. thyroid, meaning a shield, because it shields the trachea) gland, first described by Wharton in the 19th century, weighs around 20 gms in adult. On its posterior side, there are four parathyroid glands. (Removal of thyroid gland therefore can cause unintended removal of the parathyroid glands as well, this is of clinical significance). The gland is very vascular and the blood vessels receive sympathetic supply. The thyroid begins to function from the midterm of fetal life. Food iodine deficiency in the mother's diet may lead to hypofunction of the thyroid in the fetus and its consequent hazards. Microscopically the gland contains about 3 million follicles (fig 6.2.1), diameter of each follicle being about 200 uM Each follicle contains a structureless material called 'colloid'. Each follicle is lined by epithelial cells When the activity of the gland is low or moderate, the epithelial cells are cuboidal and the amount
FILE NO. 74185325

. FUNCTIONS OF HORMONES. OVERVIEW All the functions can be classified under few headings (see Table No. 6.1.3 - previous page). ESTIMATION OF HORMONES

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of serum acts directly on parathyroid glands lo conlrol parathormone secretion. FUNCTIONS OF HORMONES. OVERVIEW All the functions can be classified under few headings (see Table No. 6.1.3 - previous page). ESTIMATION OF HORMONES AND HORMONAL STATUS Because of the fact that most hormones occur in the blood in exlremely small quantities, conventional chemical analysis (colorimetric estimation) are usually of no avail. It is only in the tast two and half decades, newer and newer technics have been developed and as a result, an explosive amount of informations has been gathered in recent times. The well known modern melhods of hormone estimation are given below. 1 .Radioimmunoassay (RIA). Originally developed by Bershon and Yalow in around 1960, for which they were subsequently awarded a Nobel Prize, the melhod is as follows: For peptide hormones: The peplide hormone is isolated, purified and repealedly injected into an animal's (which belongs to a different species) body. In the recipient animal's body, because of the fact, that the injected hormone is a foreign protein, antibody development begins and attains high liter with time. Blood of this animal is now col-lected, the antibodies isolaled and purified, and stocked. This anlibody can combine with the peptide hormone in question, selectively and with great affinity. Let this sample be called, A Again, a sample of pure peptide hormone in question is obtained and radiolabelled. Let this sample be called B. Such purified specific anybodies (A) and radiolabelled peptide hormones (B) are readily available from big commercial firms, as well as, for India, from 'BARC' (Bhava Atomic Research Center). The anybodies are now mixed with the patient's serum and radiolabelled hormone. If the palient's serum (sample C) contains excess of the hormone, then, on mixing A, B and C, large amount of radiolabelled hormone will remain un combined. Reverse will be the case, when the serum contains too little amount of the hormone. (These anlibodies can combine with the hormones of both the sources, viz, B & C.). Now the uncombined hormone is separated from the combined ones by cenlrifugation (or by eleclrophoresis). In the supernatant solution, thus obtained (containing uncombined hormone) the intensity of the radioactivity is measured by a suitable counter. From the result thus obtained, estimation of the hormone in the patients serum can be made In short, both the radiolabelled hormone (acting as antigen) and the hormone in patient's serum (also acting as antigen) compete with each other and try lo bind with Ihe antibodies. If serum contains more hormone then more radiolabelled hormone will be unbound. The bound hormone, being heavier particles, can be precipitated and removed. With the introduction of RIA, there has been a revolutionary change in the clinical endocrinology. Diagnosis of many endocrmological disorders, today, can be made with impunity. Steroid hormones and Ihyroxine Steroid hormones and thyroid hormones do not elicit antibodies when injected into a different species of animal (not 'antigenic). However, in the blood, these hormones circulate as bound with some proteins. Thus, there are CBG (cortisol binding globulin), TBG (thyroxine binding globulin) and so on, destined to bind cortisol and thyroxine respectively. These proteins are highly specific and elicit antibodies ('antigeinc). Therefore, such proteins (which bind hormones) are used as antigen and the rest of the procedure remains same. However, one inherent flaw of the RIA is this : it measures the amount of immunologically similar molecules. Now, it is possible that a 'prohormone' or a fragment of a hormone is immunologically same as the hormone in question and yet does not otherwise (biologically) behave as the hormone. In such instances, the RIA value will not reflect the biologically active amount of the hormone. Almost all the peplide hormones and many of the steroid and other non-protein hormones, today can be measured by the RIA technic. Because of the simplicity of the procedure, this melhod is extremely popular in clinical endocrinology. 2. ELISA (enzyme linked immuno sorbent assay) technic So far as the principle is concerned, it resembles closely with that of the RIA However, it does not require a counter for measuring the radio activity (inslead only a spectrophotometer to measure the color is sufficient) and therefore, this technic can be used in smaller towns of India. In short, ultimately, instead of measuring the radioactivily (as in RIA), one has to measure the intensity of the color of the final product. Three samples, viz, A, B, C will be required A conlains the slocked highly, purified antibody (obtainable from commercial firms, in the form of 'kit'), B is the serum of the patient containing the hormone which acts here as the an-tigen (whose concentration is to be measured), and C is a purified antigen (ie, a purified specimen of the hormone which is chemically identical in nature with the hormone in B), but conjugated with horse raddish peroxidase. A, B, and C are mixed together. Some of the horse raddish peroxidase leaves C and conjugates with the complex formed by A and B (recall, in the mean time, the antigen of B combines with the antibodies in A so that a complex of A and B is formed). The complex of A and B is now isolated, and washed to remove extraneous materials finally the complex of A & B is stained with a suitable dye, called ABTS (diammonium 2, 2' azino bis (3 - ethyl benzothiozolene 6 sulfonate)] in presence H20
FILE NO .74185324

. Thus sleroid hormones are not stored. In the blood the steroid hormones combine with a prolein, synthesized by the liver. For example, cortisol bind

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mones are immediately released from the cell. Thus sleroid hormones are not stored. In the blood the steroid hormones combine with a prolein, synthesized by the liver. For example, cortisol binds with the cortisol binding globulin, CBG. A part of the circulating hormone, however remains free (= unbound). For example, about 90%, the circulating cortisol remains bound with CBG, but the rest of the cortisol (ie, 10%) remains free. lt is the free cortisol that is active (ie, can bind with the receptor of the target cell). Thus in some conditions (eg, pregnancy) the circulating steroid hormone concentration may be higher than normal but the concentration of the free hormone (say, per ml of blood) remains same and thus no sign of excess mrtisol activity is presented by the subject. [NB. It is imporiant to note that in some forms of malignancies of non endocrinal tissues, peptide hormones may be secreted (eg. peptide hormone secreting lung cancers). This is unknown with steroid hormones]. CONTROL OF HORMONE SECRETION Recall, hormones are one of the fundamental agents of achieving the homeostasis. Therefore, exactly that much hormone is released for circulation which is exactly needed by the body, neither more nor less. That is, only the eustate of secretion is permitted, but not the hyper (excess) nor the hypo (deficient) state of secretion is allowed in the healthy slable states. Question is how this becomes possible ? Answer is, by the feed back mechanism (fig. 1.3.1, chap 3 sec I). As stated there, there are two varieties of feed back, (i) the -ve, and (ii) the +ve feed back. Table 6.1.2 gives a summarized version of control of hormone secretion in general. Explanation of table 6.1.2 Note, there are 4 major controlling agents or factors. Short explanatory note follows : (1) Anterior pituitary controls (a) thyroid, (b) suprarenal cortex and (c) gonadal (= testicular or ovarian) hormones through their 'tropic' (also spelt, trophic, by the British authors) hormones. Thus, there are thyrotropic, gonadotropic, adrenocorticotropic (ACTH) hormones causing stimulation of thyroid, gonads and adrenal cortex respectively. (2) Hypothalamus. 7 This part of brain is on the under surface of the brain (fig. IOD.1.1) and from hypolhalamus hangs the anterior pituitary. The vascular connection (chap 5 sec VI) that exists between the hypothalamus and the anterior pituitary is a portal syslem, ie, it starts (in the hypothalamus) as capillaries, and ends (in the anterior pituitary) as capillaries. Many hormones called hypothalamic releasing factors are produced by the hypothalamic neurons enter the capillaries (of the portal circulation) of the hypothalamus reach the capillaries at the level of anterior pituitary comes out of the blood vessels, to enter the cellular masses of anlerior pituitary. In this way, by a forward flowing blood flow, the hypothalamic hormones reach the anterior pituitary and either stimulate or inhibit their cells (who in turn secrete the tropic and other hormones of the anterior pituitary). A retrograde flow also occurs , that is, hormones of anterior pituitary enter Ihe capillary blood by diffusion reach the hypothalamic level hypothalamic neurons where they (= the anterior pituitary hormones) exert an inhibitory effect; this is also called short loop feed backfrom the anterior pituitary. In short the hypothalamus controls (= stimulates/ inhibits) the anterior pituitary by its releasing hormones (releasing factors of the yesleryears). For details see chap 5, sec VI. (3) Some of the endocrinal secretions (notably the cortisol and the ACTH) occur vigorosly at a predetermined hour of the day and the rate of secretion drops sharply at another given hour of a 24 hr, day night cycle. For example cortisol and ACTH are secreted very vigorosly in the early morning, whereas their secretion is greatly reduced in the night. This occurs in most persons and occurs without any obvious cause (though some cellular level explanations have recently been forwarded, see chap 4, sec VI). This is called circadian rhythm. (4) Stress. As mentioned already (chap 3, sec I) anything which tries to destabilize homeostasis is called a stress. Thus, physical injury, menial injury, disease, sharp changes in the environmental temperature are examples of stress. It is now known, several hormones viz, ACTH, cortisol adrenalin, ADH and thyroxine are secreted in increased rate during stress. Some further details Feed back. The general fealures of feed back mechanism have been described in chap 3 sec I. In endocrinology, most of the feed back mechanism belong to the variety of-ve feed backs allhough +ve feed backs (eg, LH surge) are also known. In -ve feed back mechanism (fig. 1.3.1) as in, say, the control of cortisol secretion, level of plasma hormone (cortisol) is the signal the signal reaches and operates at, usually two levels, anlerior pituitary and hypothalamus higher level of blood cortisol causes inhibition of release of both anterior pituitary tropic hormone(= ACTH) as well as hypolhalamic releasing hormone (= CRH) ultimately low level of anterior pituitary tropic hormone (= ACTH) withdrawal of stimulation on the adrenal cortex. Reverse occurs when the blood hormone level is low. Plasma or blood level of hormone is not the only signal. Feed back signals may be constituted by other conslituents of blood Further, such signals can also operate on glands other than anterior pituitary or hypothalamus. Thus blood sugar levels act as signals and act on a and β cells of islets of pancreas controlling glucagon and insulin secretions. Na+ and K+ levels of serum ultimately act as signals which control the aldosterone secretion by feed back. Ca++ level
FILE NO. 74185323

The RLC eventually causes opening up of channels in the cell membrane (fig. 1.1.2) entry of various ions within the cell biological effects. The recep

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rmed. The RLC eventually causes opening up of channels in the cell membrane (fig. 1.1.2) entry of various ions within the cell biological effects. The receptors of these hormones contain an enzyme lyrosine kinase incorporated within them. The RLC formation causes phosphorylation of the protein tyrosine kinase which leads to the final biological effects [There are strong evidences to suspect that the enzymes having tyrosine kinase activty are involved in growth as well as cancer formation]. WHEN THE R IS IN THE CYTOSOL OR IN THE NUCLEUS (Steroid hormones) Events are as follows : 1. The receptors (R) are present within the cytosol. 2. The R has a special domain called "DNA binding domain" which contains Zn++. 3. The steroid hormone molecules [recall, all steroid hormones conlain a CPP ring structure; being lipid, all steroid hormone molecules can pass through the cell membrane by 'lipid diffusibility', (chap 1 sec I), because cell membrane itself is oily in nature. Also compare this phenomenon with that seen with peptide hormones : peptide hormones cannot cross the cell membrane. Therefore, their receptors must be present in the cell membrane to suit the concept of teleology] enter the cytosol by crossing the cell membrane. 4. The ligand (L), ie, the steroid hormone molecule now binds with the R and RLC is formed. 5. Formation of the RLC causes the DNA binding domain of the R to expose itself fully and to become active. 6. The RLC moves to the nucleus (therefore, these receplors are also called mobile receptors) and the DNA binding domain gets itself attached to a specific region of a specific DNA (this portion of the DNA is called 'enhancer') 7. This attachment with the DNA binding domain and enhancer causes the enhancer to become active and increased transcription of messenger RNA (mRNA) occurs. 8. These mRNAS, in turn, increases the synthesis of their corresponding proteins, which can be either enzymes or structural proteins. The enzymes also can be either degrading enzymes or synthetic enzymes. 9. Now, the biological effect (s) occurs. Eg : Cortisol (steroid hormone) increase in synlhesis oftransminase degradation of amino acids and enhancement of gluconeogenesis. N.B : (i) Sleps 7 and 8, taken together constitute genetic expression. Therefore, the popular phrase, 'the steroid hormone acts by regulating genetic expression' should now be clear. They say regulating (not increasing) because, the genetic expression, with some ligands may be inhibited (instead of accelerated) too. (ii) estrogen and thyroid (recall, thyroid is not a steroid hormone) receptors are also situated within the cell, but these Rs are situated right on the nucleus (not in the cytosol). However, otherwise, estrogen and thyroid hormones behave similarly with the corticosteroids (iii) studies suggest that the DNA binding domain of the R might have strong intrinsic affinily to combine with the enhancer. It is because of the presence of the rest of the R, this intrinsic affinity (to unite with the enhancer) is kept inhibited. The combination of the hormone molecule with the receplor causes withdrawal of this inhibitory effect and the DNA binding domain becomes free to combine with the enhancers. (iv) Sleroid receptors are often, for obvious reasons, called 'gene active' receptors. HORMONE SYNTHESIS GENERAL PRINCIPLES Peptide hormones. In short, peptide hormones are synthesized just as other prolein molecules are. Therefore, from DNA the mRNA (messenger RNA) is transcribed the corresponding peptide hormone produced (for details see protein synthesis, chap 12 sec VII). The special points for peptide hormone synthesis can now be noted 1 Within the cell of the endocrmal gland the peptide molecule prepared first, is usually a much bigger (bigger than the matured peptide hormone molecule) molecule and is called 'preprohormone'. Thus, we have preprohormone for insulin called, preproinsulin. 2. The preprohormone is decimated, a portion, usually called signal sequence, is removed What remains is called a prohormone leg. Preproinsulin proinsulin, chap.6, sec VI). 3. Prohormone is further decimated and a mature hormone molecule is released into the blood. ( However, sometimes, little prohormone may also escape into the blood, see insulin synthesis chap 6 sec VI. These pro hormones of blood have clinical importance, see chap 6, sec VI). This is not the end of the story. Some so called mature hormones may again be further allered at the cellular level and this altered molecule may be the final active agent. Thus, the so called mature hormone, testosterone, in some tissues (eg. proslate) is converted into dihydrotestosterone. For such tissues (prostale), dihydmtestosterone is the final hormone and testosterone is the prohormone. Steroid hormones. Only the salient features will be outlined. The steroid hormone synthesizing cells (eg, cells of the zona glomerulosa or fasciculata of suprarenal cortex) have LDL (low density lipoproteins, LDL conlain cholesterol) receplors. LDL molecules (see chap 8 sec VIII) of the blood plasma get attached with these LDL receptors cholesterol of LDL crosses the cell membrane enters the biosynthetic pathway of steroid hormone synthesis (= steroidogenesis), eg, cholesterol cortisol or aldosterone. Alternatively, steroidogenesis may start from a cholesterol molecule which has been synthesized from active acetate by the cell itself; but this is less preferred. The rate limiting step is the conversion of cholesterol (C27 structure) to pregnanelone (C21 structure) by the enzyme desmolase (table 6.4.1). Once formed, the steroid hor
FILE NO. 74185322

A phosyhorylates the corresponding enzyme (phosphorylation of enzyme protein either inhibits or stimulates Ihe enzyme, depending upon the nature of Ih

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stimulaled protein kinase A phosyhorylates the corresponding enzyme (phosphorylation of enzyme protein either inhibits or stimulates Ihe enzyme, depending upon the nature of Ihe enzyme) the corresponding biochemical reaction is either depressed or stimulated biological effect. What are the chemical events that occur between the combination of R and the L (the 1st messenger) and production of the cAMP (the 2nd messenger) ? Answer is as follows: recall, the R has two domains (i) the ligand bin ding site and (ii) the active site. Also recall, that the RLC formation occurs in the ligand binding site. Once the RLC has formed, the chain of events will be, RLC (ligand binding site) the active site now recognizes that the L of the RLC is an agonist (not antagonist) RLC now stimulates a protein, called Gs (G slimulatory) prolein, situaled close to the RLC and situated within the membrane (fig.6.1.1). Gs is now activated he activated Gs now stimulates an enzyme, adenyl cyclase (also called adenylate cyclase, but adenyl cyclase is more popular), abbreviated AC, also situated in the membrane (fig. 6.1.1) and hence called membrane bound AC AC now acts on ATP to form cAMP cAMP stimulates protein kinase A stimulated protein kinase A phosphorylates enzyme proteins the enzyme(s) is (are) either stimulated or inhibited allered metabolism = biological effect (see also below) More serious readers can note that the Gs protein, when inac tive, remains bound with GDP (guanosine diphosphate) but when the GDP is replaced by GTP (guanosine triphosphate) the Gs becomes active (fig. 6.1.3). The active protein kinase A can, instead of phosphorylating an enzyme, cause opening up of channels present in the cell membrane (fig. 1.1. 2) -> ions enter or leave the ICF. This, therefore, is another biological effect of cAMP. Components of hormone sensitive adenyl cyclase Note (fig. 6.1.1) that the formation of cAMP from ATP requires three components, (i) receptor (ii) Gs prolem (iii) adenyl cyclase. Gs protein is called the coupling unit (as it couples the R with the AC). Adenyl cyclase is called the catalytic cyclase (abbr. C). The three components, viz the R, the coupling unit and the C taken together, is called the membrane bound (hormone sensitive) adenyl cyclase system. Fig. 6.1.1. Mechanism of action at molecular level, of hormones which ad by generating cAMP. For his works on cAMP and for establishing the concept of sec-ond messenger Earl Sutherland was awarded Nobel Prize in 1970. Degradation of cAMP (fig. 6.1.2) The enzyme phosphodiesterase (PDE) degrades the cAMP to 5' AMP. There are several varieties of phosphodiesterases (PDEs). The drugs caffeine and theophylline oppose the PDEs and thus prolong the action of cAMP. Gr. 8. Hormones (fig. 6.1.4) The hormones of this group bind with the R in the target cell membrane and RLC is formed RLC now activates a G protein (present in the membrane) called Gp prolein. Gp protein thus, here, is the coupling unit Gp protein now stimulates a catalytic unit named phospholipase C (PLC) Phospholipase C now hydrolyses phosphalidyl inositol diphosphate (PIP2) forming mositol triphosphate (IP3) and diacylglycerol (DAG). Both IP3 & DAG are 2nd messengers. DAG now activates protein kinase C. Prolein kinase C is an intracellular enzyme. Also IP3 is formed within the cell membrane —> diffuses into the cytosol. Subsequent events are as follows: Fig. 6.1.4. IP3, DAG & Ca++ are 2nd messengers Role of released Ca++ ions Concentration of Ca++ is high in the ECF but very low in the ICF. However, normally the Ca++ ions cannot enter the cell. But when the chemical signal like angiotensin II acts and the membrane bound PLC becomes active, IP3 is formed within the cell membrane diffuses inlo the cylosol triggers off release of Ca++from endoplasmic reticulum. Ca++ entry (from the ECF) into the ICF is also facilitated. The free Ca++ ions, thus available within the cylosol, now bind with a prolein called calmodulin to form what is known as calcium calmodulin complex. This calcium calmodulin complex (C - Ca++ complex) now activates many processes that culminate in various biological effects, like, (i) contraction of muscle, (ii) synaptic transmission, and (iii) glycogenolysis. [ NB. Calmodulin is closely related to the contractile protein in the muscle, troponin C, see figs 5.1.7 and 5.2.1 ]. The G proteins Thus, we have come across with two types of G proteins, viz, (i) Gs and (ii) the Gp proteins. They are coupling units, present in the cell membrane and are also called 'nucleotide regulatory proteins', (because they control the formation of nucleotides like cAMP). They link the RLC with the membrane bound catalytic units like adenyl cyclase phosphohpase C (PLC). Various other G proteins are also known, eg, Gi (i for inhibitory, as s in Gs stands for stimulatory), Gt and Gk. They will however be not described in this text. The 2nd messengers cAMP, Ca++, DAG, IP3 have been described above. Other well known 2nd messengers include cGMP (involved in the action of ANP, atrial natrinretic protem which is a hormone released from the atrium and broadly speaking, opposes the action of renin angiotensin axis). Gr C Hormones Insulin and the various growth factors, like, (i) IGF (insulin like growth factor), (ii) EGF (epidermal growth factor), (iii) PDGF (plalelet derived growth factor), as well as vasopressin fall in this calegory. These hormones bind with_the_R in the_membrane to form the RLC, but no 2nd messenger is formed, or at least, no 2nd messenger is known to be fo
FILE NO. 74185321

MECHANICAL PRESSURE ON NERVES OR ROOTS OR REFERRED PAIN-1. In the spinal cord - Tumours of cauda aquina, arachnoiditis, rarery thrombosis, haemorrhag

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detail Treatment - Minor symptoms can be relieved by appropriate physiotherapy, but progressive neurological deficit calls for
surgical interference. (2) MALIGNANT INFILTRATlON -of brachial plaxus may resut from either upward extension of apical lung carcinoma, or local metastalic spread from mammary carcinoma. Pain and sensory loss in medial aspect of forearm and slowly progressive weakness which starts in the small hand muscles. (3) BRACHIAL NEURALGIA (Neuralgic amyotrophy) -may follow injury, operation, inoculation or specific fever. Pain is usually the first symptom, often severe and of sudden onset, followed after several days or few weeks by weakness and wasting of muscles, especially those innervated by C5 and C6 cord segments. Sensory loss is mild or absent and there are usually few or no constitutional symptoms. Recovery is slow 4. Fibrositis. periarthritis and arthritis of the shoulder - Diseases of shoulder joint and its surrounding structures should be considered. Pain referred to the shoulder, to arm, or to region of elbow, associated with loss of range of movement or pain on movement. Treatment - None specific. In acute stage arm should tie supported in a sling. Physiotherapy as soon as pain subsides. 5. Lesions of median nerve - Carpal tunnel syndrome (See p. 477). 6. Vascular conditions - Those producing sensory disturbances in arm include occlusion of brachial artery due to embolus, or ischemia from polyarteritis nodes a, scleroderma and other conditions grouped under' the term Raynaud's phenomenon. Inspection of the skin, changes in temperature and colour of the limb, and inadequate pulse at the wrist facilitate diagnosis. Coronary insufficiency may be responsible for pain in the ulnar aspect of arm and forearm. THE LUMBOSACRAL PLEXUS Sciatica Defination -Pain in ihe distribution of the sciatic nerve or its component nerve roots. The syndrome is now accepted as being caused by lumbar disc prolapse. However, sciatic nerve lesions can occur due to pressure in the buttock or upper part of thigh. Causes -1 TRUE SClATIC NEURITIS - Leprosy, polyarteritis nodosa, nerve injury due to infections or trauma, post-herpetic neuralgia. II. MECHANICAL PRESSURE ON NERVES OR ROOTS OR REFERRED PAIN-1. In the spinal cord - Tumours of cauda aquina, arachnoiditis, rarery thrombosis, haemorrhage or infection irritating meninges of the cord. 2. In the cord space - Protruded intervertebral disc. extramedullary tumours. 3. In the vertebral column - Arthritis. Tuberculosis, spondylolisthesis. ankylosing spondylitis. primary bone tumours. secondary carcinoma 4. In the back - Fibrositis of posterior sacral ligaments. Compression where the nerve leaves the pelvis in those who he immobile on a hard surface for long time (a form of Saturday nignt palsy). 5. In the thigh and buttock - Fibrositis, sacro-sciatic band, hip joint or sacroiliac joint disease, neurofibroma, haemorrhage within or adjacent to nerve sheath in blood dyscrasias and anticoagutant therapy, misplaced therapautic infection 6. In the pelvis - Sacroiliac arthritis or strain, hip disease, infection of prostate or female genital tract, rectal impactions, tumors of lumbo-sacral plaxus. INVESTIGATION OF A CASE OF SCIATICA I. History - Of irauma, exposure to damp or cold, sphincter control and history of previous attacks. Typs of radiation whether nerve root type or vaguely localised deep aching pain. Paraesthesia will occur in pain from sensory pathways but not in referred pain. Pain down the leg on coughing in root lesions and also acute extraneural disease of spine, pelvis and sacroiliac joints. II. Physical examination - 1. LUMBAR SPINE - Shape, mobility, muscle -spasm, list to one or other side on standing (sclatic scoliosis), local tenderness and presence of trigger points in back and limbs. Sciatica may be the first symptom of spinal caries. 2. SPECIAL SIGNS - (i) SLR test -Restriction of straight leg raising is usually much more marked in lesions affecting the nerve roots than in purely skeletal affections. SLR test gives a useful indication of the severity of the sciatica, and increased capacity for painless SLR is objective measure of improvement. (ii) Tenderness of nerves (iii) Intensification of pain in back and lag during rotatory extension of lumbar spine very suggestive of ruptured disc. (iv) Popliteal compression - Radiating pain can often be aggravated by pressure over the course of the tibial narve through the popliteal fossa. It is an additional finding in favour of root compression. (v) Testing of the sacroiliac joints by pressure on the two anterior superior iliac spines. (vi) Estimation of range and painlessnees or otherwise of hip joint by passive stretching. (vii) Muscle power in the lower limb tested against resistance. (viii) Knee and ankle jerks - When L4 root is involved knee jerk is depressed and there is likely weakness of tibialis anterior muscle. L5 root lesions, both knee and ankle ierks usually brisk but there may be weakness of dorsiflexion of the toes particularly of extensor hallucis longus. S1 root ankle jerk lost and weakness, when present involves the calf muscles (ix) Tone and size of gluteal muscles judged by asking patient to contract both buttocks, in upper sacral root lesions marked wasting may be clearly visible. 3. SENSATIONS -impairment of perception of pin-prick commonly found on dorsurn of foot if implication of 5th lumbar and 1st sacral nerve roots .4.

MEASUREMENT OF BP I. In human subjects in routine clinical practice, BP is determined by the sphygmomanometer, an instrument devised by Riva - Rocci,

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od is, mean BP = DBP + 1/3 pulse pressure. For example, in the above mentioned subject, the mean BP is about 93 mm. Hg. Fig. 5.9.1. Recording of BP in man by the usual method (Riva-Rocci manometer). MEASUREMENT OF BP I. In human subjects in routine clinical practice, BP is determined by the sphygmomanometer, an instrument devised by Riva - Rocci, and subsequently improved by Von Recklinghausen. The sphygmomanometer is essentially a mercury manometer. However, instead of the classical U tube of the manometer, only one of its limbs is long the othar is very short, and acts as a raservoir of mercury (figure 5.9.1). The reservoir is, via a rubber tube, connected with an arm 'cuff the cuff, in turn is, via rubber tube, connected with a hand pump. Air can be introduced into the cuff by pumping the hand pump, a process called 'inflation'. Air from the cuff can be driven out by unscrewing the pump ('deflation'). The determination. The subject lies flat on his back, the cuff is wrapped round his arm (preferably the left arm, as the left subclavian artery unlike the right one, is a direct branch of the aorta). The heart sphygmomanometer and the arm should be at same horizontal plane. Then inflation is started by pressing the pump and the radial arterial pulse palpated concomitantly. A time comes when the radial pulse disappears. 'The height of mercury column at this stage is noted in the side scale. Then the cuff is deflated fully. The ball of the stethoscope is placed lightly on the brachial artery near the elbow. The cuff is again inflated and inflation continued for sometime even after the column of mercury has attained the previous height where the radial arterial pulse disappeared. Then deflation is started, at a rate of 2-3 mm/sec, neither more nor less. At first there is no sound heard by the stethoscope ('grave yard silence), after the deflation has reached a particular stage. a 'tap' sound is heard and this marks the SBP the reading at the side scale (of the height of the mercury column) is noted, deflation continued, till all sounds disappear. Between the 'tap' sound and the, reappearance of silence, a series of sounds, called Korotkov sounds, are heard as follows: For a long time, there was a raging controversy, viz, which phase corresponds, to the true diastolic pressure. Some said it was phase IV ('muffled' sound), some others said, disappearance of all sounds., (phase V). The true diastolic pressure is between the phase IV and phase V, but nearer the phase V of Korotkov sounds. Therefore it is now the official policy to regard phase V as the diastolic BP* According to an American heart association subcommittee report in 1967, it is desirable to mention the readings of both the IVth and Vth phases. Thus, if the SBP is 120 and the readings at phases IV and V be 80 and 70 mm Hg,the BP should be expressed as 120/80/70 mm Hg. Dependability of the clinical method. The precautions. In the same subject, the BP can be measured simultaneously in one arm by the above mentioned clinical method and in the other arm by the direct method. It has been found that, usually the SBP, as measured by the clinical (spliygmamanometric) method, is considerably lower (the difference is usually between 10-25 mm Hg) than the value obtained by the direct method. Further, if the IVth phase (of the sphygmomanometric method) is regarded as the DBP, the clinical method gives about 8 mm higher figure than that obtained by the direct method whereas if the Vth phase is regarded as the DBP, the differences of the values obtained by the two methods is almost nil "Dollery, CT: Arterial Hypertension, in Wyngarden. J 3 dc Smith, LH (Ed), Cecil Text Book of Medicine. Chap. 47 Saunders, 1985. The above method is called, 'auscultatory method' BP can also be determined by palpatory method: inflate the cuff and simultaneously also continue to palpale the pulse. A time comes when the pulse can no longer be felt, continue to inflate for still some time, keeping the fingers an the radial artery. Now begin to deflate the cuff. A time comes when the pulse can again be felt. Note, the value (on the side scale of the mercury column) where the pulse reappears. This is the SBP as recorded by the palpatory method. But the SBP recorded by this method is a trifle lower than that obtained by the auscultatory method. Moreover, by palpatory method, only the SBP (but not the DBP) can be recorded. Auscultatory gap. This is seen sometimes in patients suffering from high blood pressure. A subject has a BP of say, 200/100 mm Hg. The first sound of Korotkov, the 'tap' sound, appears at 200 mm height as expected, but as deflation proceeds all sounds disappear. The sound reappears again at a lower pressure. Thus, in this example, the sound disappears, say, at 190 mm of Hg and reappears, again at 170 mm Hg, the Vth phase (disappearance) remaining at 100 mm Hg. Thus, if the inflation is made only upto say, 180 mm Hg, and a simultaneous palpation of pulse is not done, the clinician will record the BP as 170/100 mm Hg and rhe patient and the clinician may develop a false sense of security. The silent zone, mentioned above, viz. 190 mm Hg to 170 mm Hg is the auseutatory gap. The pulse however can be felt throughout the zone. Of auseultatory gap'. The BP, as will be shown later, is affected by many factors like, excitement, anxiety, exercise, meal and exposure to cold. It is expected that the clinician remembers these factors while determining the BP, and ensures that while recording BP, his subject is at rest (mentally and physically), in a comfortable climate and has not taken a heavy meal

The sympathetic stimulation produces some well known signs of shock, like pallor and sweating

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C sympathetic stimulation elevation of BP and tachycardia perfusion of the tissues is restored. (ii) Sympathetic stimulation also causes carotid chemo receptor stimulation by causing vasoconstriction of the artery feeding the carotid chemoreceptors. Further, hemorrhagic shock produces hypoxia which also causes chemoraceptor stimulation (particularly if the subject is restless). Chemoreceptor stimulation in turn, produces VMC stimulation. Fall of BP, if of sufficient degree, results in ischemia of the VMC and in turn produces stimulation of VMC (CNS ischemic response, chap. 8 sec. V, see also fig 5.8.1). Stimulation of VMC causes stimulation of sympathetic system elevation of BP restoration of perfusion. Also sympathetic stimulation causes redistribution of blood flow, the cutaneous, splanchnic and muscle blood flow are greatly cut down and the blood thus made available are flown to the brain and heart. Recall sympathetic stimulation, (i) has no effect on brain blood vessels, and (ii) causes coronary dilatation. The sympathetic stimulation produces some well known signs of shock, like pallor and sweating (pallor, because of the cutaneous vaso constriction. sweat glands are supplied by the sympathetic fibers, therefore sympathetic stimulation may lead to sweating and cold clammy skin). Endogenous substances like adrenalin are also liberated (as hemorrhage produces 'stress' and stress causes adrenalin secretion). Adrenalin reinforces the sympathetic activity. II. Tissue fluid shift As the BP falls the capillary blood pressure also falls. However, there is no fall of the colloidal osmotic tension. This causes stoppage of flow of fluid from the capillary to the tissue, or if the fall of BP is greater, the return of the tissue fluid to the capillary is enhanced (see Starling's hypothesis, fig. 1.1.9). This corrects the hypovolemia within the vascular compartment increase in cardiac inflow, and the real follows. III. Conservation of body water Fall of BP leads to lowering of perfusion pressure of the kidney production of renin production of angiotensin production of aldosterone [for details, see chapter on aldosterone, chap. 4 (control of sacretion) sec VI] sodium retention body water retention. It is now known, in stress, the hormone ADH is also secreted in greater amount. This reduces the volume of the urinary output body water conserved hypovolemia corrected. [Cardiovascular shock is a farm of stress. Recall, any deviation from homeostasis is a stress (chap 3 sec I). In massive hemorrhage, massive amounts of ADH is secreted. ADM in high concentration acts as vasopressin which is a powerful visoconstrictior. In addition, local autoregulatory mechanisms are also important. Even if the BP is falling for considerable period. the blood flow of the brain or heart does not fall, although blood flow in the other organs are falling. This is called autoregulation, whose mechanisms have been discussed earlier (chap. 6 sec V, see also fig. 5.10.2). However, if the fall of BP is severe, agtoregulation cannot manage. Compensatory mechanisms are often called 'negative feed back mechanisms', negative, because the results (effects) are in the opposite direction of the causes(chap. 3 sec I). For example, withdrawal of baroreceptor stimulation is caused by the fall of BP but effect of the withdrawal of baroreceptor stimulation is rise of BP A -ve feed back mechanism restores homeostasis, whereas a +ve feed back destabilizes the homeostasis irreversible shock if the shock continues and is not treated promptly, the stags of 'irreversible shock, develops, when the patient dies despite the (late) institution of the correct treatment. It will be seen afterwards, the term irreversible is rather misleading, a better term will be advanced stage of shock'. Causes of the irreversibility. At this stage some +ve feed back mechanisms appear in the scene with the result that there develops a vicious cycle [a cycle of 'vices' or sins; example, an individual begins, say, gambling loses money his financial situation deteriorates with a hope to improve his monetary position, he does more gambling further loss of money). These are: (a) Cardiac damage (i) Even normally, the subendocardial region of myocardium is susceptible to anoxia. When the BP is falling, this danger increases and ultimately subendocardial damages occur further fill of cardiac output (due to subendocardial damage) the vicious cycle operates (ii) A factor called, myocardial depressing factor, is suspected to appear in the circulation during advanced stages of shock. This reduces cardiac contractility vicious cycle, (iii) In advanced stages of shock, the acidosis (see below) develops and depresses the myocardial contractility still further further fall of BP vicious cycle. (b) Acidosis Tissue anoxia leads to accumulation of lactic acid acidosis. The fall of pH causes relaxation of the arteriolar and precapillary sphincter muscles vasodilatation operation of vicious cycle. (c)vToxemia Prolonged spasm oar the splanchnic vessels (which develops as a result of compensatory mechanism) intestinal mucosal damage due to lack of 02 massive entry of the intestinal bacteria (through the damaged mucosa) which liberate toxin relaxation of the vascular smooth muscles due to the effect of the bacterial toxin. (Recall, during sympathetic simulation, powerful splanchnic vasospasm develops). (d) VMC ischemia Slight ischemia stimulates the VMC, but massive ischemia kills it. When VMC death sets in, there is sympathetic paralysis precipitate fall of BP. (e) Elderly people generally have artherosclerotic lesions in their coronary"

Urinary reaction in some types of renal disorders. the ability secrete H* is reduced and as a result surfficiently acd urine cannot be formed

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reduced and as a result surfficiently acd urine cannot be formed, causing renal acidosis This may be esiabtehed by adminstratlon of NH4 Ci

symptoms, that the kidneys have started to fail. Some test of kidney (e.g. blood analysis) may or may not reveal the incipient failure

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well as the likely information (s), which can be obtained from a particular test, should be clearly understood. Very often, in the early stages of some renal diseases. it is not apparent from the signs and symptoms, that the kidneys have started to fail. Some test of kidney (e.g. blood analysis) may or may not reveal the incipient failure. However, more sophisticated tests (e.g. clearance tests) may reveal the incipient failure at this stage and the pnysician and the patient, both now being alive to the incoming danger, can take appropriate action. The tests of the kidney functions are Urine examination. Chemical examination of blood. Clearance tests. Concentrating power of the kidney, Radioiogicai and imaging investigations. Udrine examination Features of normal urine have already been deserbed (chap 2, sec VIII) The outstanding features which may be obtaned in a case of kidney dysfunction are mentioned below 1. Volume : Normally the volume, of urire per. day is f. 500 ml (range 800 lo 2,500 ml/day) if he volume is less than 500 ml/day (severe ollguria) waste product cannot be satisfactcrity excreted and they atcurnlate In blood. Conversety, in polyuria, so much water and Na may be lost that symploms may be produced Oliguna may be produced try severe lacK of drinking water, acute giornerlonephritis. cardavastilar shocK cardiac insufficiency and other conditions Diabetes mellitus, diabetes insipidus and chrome pyelonephritis are some of the well known causes of polyura}. 2 Specific gravity (Sp. gr) Very low and fixed sp.gr. (i.e where the kidineys have lost-the power to concentrate the urine) may be obtained r chrome nephrite Very high sp grof urine is found incases ofgtycosuna Proiemuna causes onfy a margnainge of ( HYPERLINKhttp//sp.gr) of urine. 3.

In certain areas of the world, drinking water is deficient in flurine. That is why fluoride ion is added to the water

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water. In certain areas of the world, drinking water is deficient in flurine. That is why fluoride ion is added to the water supply to the extent of 1 ppm (part per million) in some countries. FIBERS AND ROUGHAGE Leafy vegetables containing a cellulose or hemicellulose coating, are indigestible in hunan intestine. Hence if such substances are present, they tend to increase the bulk of the feces and mass peristalsis' (chap. 3.7. defecation) is favored, and constipation can be avoided. Great amounts of leafy vegetables however can produce diarrhea. Plant components (cellulose/nemicellulose/pectins/lignins etc) which cannot be digested by the enzymes of our digestive tract are collectively called fibers. Strong evidences indicate that, lack of fibers in the diet predispose colorectal cancer, breast cancer, diverticulosis and coronary heart disease. Grams, peas and dal contain good deal of indigestible vegetable fibers. FOOD HABITS, TABOOS, COST. Food habits must be considered. Thus a Bengalee likes fish and rice whereas a North Indian non-vegetarian likes wheat and meat. Religious taboos are too well known. Thus, a Hindu nonvegetarian wil not take beef whereas a Muslim will not touch pork. Many Hindus (including Jains and some Sikhs) are strict vegetarians, although most of them take milk. Such religious flats should be remembered and respected while formulating the diet and alternatives to the tabooed food should be priscribed. Cost also is to be consid-ered. Animal proteins in general are costly products. Many fruits are expensive although they have no special advantage over the cheaper fruits. LOSS Cooking, particularly in Indian way, causes much wastage. The classical Bengalee cooking deserves more condemnation. The habit of discarding the water after boiling rice (thus causing loss of water soluble vitamins, some quantities of aibumin and starch). extensive discarding or the skin of vegetables, hard frying in oils all cause variable loss of food vitamins. Digestibility is another important consideration. Some proteins, particularly dal and peas lose some of thaeir values because of lack of easy digestibility. In an average menu, loss due to cooking and indigestibility together may account for about 10% of the food value. THE BALANCED DIET CHART with the background mentioned above, a diet chart for a healthy young adult male may be set as an erample. The term balanced diet means a diet which is complete in all respects. (i e . it is not lacking in any respect) at the same time it contains no excess of any item that may cause harm to the body. The following should be noted :The calorie requirement varies from person to person and in the same person from time to time. To adjust the, carbohydrate (rice, wheat, potato, sugar, jaggery and so on) and fats and oils (butter, ghee, cooking oil) should primarily be adjusted whereas. ordinarily, protien should not be considered for adjustments of calories. SOME COMMON FOODS. Common articles of food may be divided as follows. I. Meat, fish, egg Sources of animal protein (meat about 20%, fish same as meat, egg about 14%). Proteins are of very high quantity. Disadvantage is high cost. However, because of the Government policy of encouraging poultry in most states of India, price of egg is not high. The associated fat (in ordinary butcher's cut of meat) is however saturated and its ingestion predisposes to atherosclerosis. II. Milk, milk products (excludrig ghee/butter). Milk is almost a complete food, very high quality protein (though not as high as in Gr. I), for details, see later. III. Grains (cereal) :Rice and wheat. Rich in starch and contain between 7 to 10% protein. Protein is of good quality. Deficient in fat, cheap. Table 7.16.1: Balanced diet (for non rich and moderately working man) Food vegetarian. Non vegetarian lacto vegetarian gms/day gms/day. Cereals rice/wheat 350 350 Pulses (dal), gram 90 60 Meat/fish . 60 Milk 300 100 vegetables (pulbul, ladies finger, cauliflowers, 100 100 carrot, brinjal etc. Potato 75 75 Green leafy vegetables 100 100 Egg one (about 60 gms) Fats and oils (crooking oil, butter/ghee, fat 50 40 associated with meat) Sugar and jaggery 40 40 Lemon one one Seasonal fruits some helps some helps N.B.: Values are approximate only. Important. See that, (othere is enough fibers in the diet (to prevent colorectal cancer, breast cancer, antherosclerosis), (ii) plenty of carotenoids are taken (to prevent cancer lung, breast cancer). (iii) fat, particularly saturated fat intake is low (iv) NaCl is restricted and finally (v) sugar intake is low. IV. Pulses (dal) and legumes. Dal. Rich in protein but poor in fat. Protein is somewhat less digestible and of lower qualify. It is the most important protein supplier throughout whole of lndia excepting marginal areas of North East india. Because of its impotance to the nation, the Government of India is trying very hard to improve the national yield of dal Protein content of the dry dal is between 20% to 25%, cheap. Byumes, usually the dried peas and beans are meant. Soyabean is also a kind of legume. They contain high amount of vegetable protein. The major protein supplier in Latin American counties is, kidney bean, which they consume in large quantity. Soyabean contains approximately 40% protein and 17% fat V. Nuts (peanuts, alrnonds, walnuts, ground nuts, etc) :very rich in fat (about 40%) and protein (about 25%) content is amost equal to dal. IV. Roots and tubers :Potato and sweet potato are examples oftubers.: They are rich in starch but poor in fat. Carrot and beet roots are examples of roots. Beet is a rich source of sugar like sucrose but not of starch. Protein content is very low. Carrot has protective effects against lung and breast cancers. VII. Green vegetables :Green leafy vegetables are primarily taken to increase the bulk of food and to avoid constipation. Other vegetables Iike brinjai, pulbul,lady's finger etc. are low in calories. MILK Milk is almost a complete food containing protein, carbohydrate and fat as well as the important vitamins and minerals. Milk however. is deficient in iron. Old people living in isolation and depending mostly on milk and bread (not fortified with iron) can thus develop anemia. which is sometimes called 'milk injury'. The protein of milk is of very high biological value(i.e., high quality protein). The composition of milk varies from species to species. Thus,

The small remnants of chylomicron* particles now go to liver where they will be further catabulued

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small remnants of chylomicron* particles now go to liver where they will be further catabulued. The enzyme lipoprotir irpase (clearing factor lipast) is present in the walls of the capillaries of blood and therefore present in sufficient amount in large number of organs which 31 e rich in capillaries. This enzyme is different from (and therefore should not be confused with) the adipose tissue (also called, hormone sensitive") hpase Hepann injection causes release of the plasma hpoprorem lipase from the endothehal cells of capillary walls [Hepann also causes release of another hpase. from The liver, called, heparin releasable hepatic Ijpcprolem It-past, whose function is largely obscure] Applied biochemistry of plasma hpoproteins Disorders of lipid metabolism and lipoproieint Many disorders of lipid metabolism an aitociatid with changes of plasma lipoproteina. Thus atherosclerosis/ coronary heart diseases (CHD) are associated with changes of plasma lipid values as well as llpoprotem pattern, changes include increase of plasma cholesierol values (hypercholesteremia) and rise of p llpoprotem ((JLP) Further, in atheroscleiosis the ratio of pLP/ a LP increses. This 19 underslandable, inspection of Tsble 7 t2 will show that most of the cholesterol is present in the aLP (= LDL) fraction of The hpoproletns Kamholesma is also assoculpd with increase of pLP Idiopalhic
'hyperlipemia. diabetes mellitus. myixedema. nephrotic syndrome are also characterized by rise of plasma hpid values Importance of lipoproiem estimation in diseases in the late 1950s and 60s it began to be suspected strongly that for diagnostic (as well as prognostic) purposes in disorders of lipid metabolism (atheraselerosis. xantholesma. Thanhauser's disease etc J over and above the estimation of plasma cholesterol and triglycendes, estimation of plasma lipoproleins is also imptrative it was suggested N B (i) Sf = Svedberg's ftotation unit Higher the Sf value greater is tha tendency to float in the solution (a) Some authors recognize two furthtr vanties, (a) chylormcron remnants (s*« fool note previous page), (b) IDL, in between LDL and VLDL that value of plasma cnuTesierol may remain almost normal but the ratio of p LP/ a LP might increase. However, now it is usually conceded lhat for routine clinical purposes, estimation of serum (or plasma) cholesterol and Inglycende is reasonably enough, lipoproiem estimation does not give much additional informations. Rectnrly however, estimation of the different types of apohpoprotein, for predicting the possibility of CHD. is becoming popular Further, it is now agreed that persons who have a high cholesterol HDL ratio are specialty prone id atheraseter-asis. Therefore, like smoking, obesily. drabetes and hypertension, bad cholesterol HDL ratio is also a risk factor Free tally acids. The FFA accounts for about 5% of the lotal plasma lipids But because of the exlremely rapid lumover rate, this is a very important sechon of
.plasma lipids FFA in plasma remains bound with plasma albumin (and thus becomes soluble} Within the cells, There is a protein called Z protein (also called. fatty acid binding protein), which binda with the FFA Z protein is thus.tha caunltrpvt of albumin. Fatlora influencing plasma lipid valuta. A Hormones Insulin reduces plasma lipid values (Old standing diabetics nave sometimes abnomially high values of plasma Lipids which however may not always be controlled by insulin and diet control (sec chap 7. 9, diabetes and lipid merabolism)insulin promotes fatty acid synthesis by stimulating HMP which causes
generation of NAOPH. and the H atoms of NADPH can subsequently be utilzed for fitly acid synthesis. Insulin inhibits
inhibiting hormone sensitive Ijpoprolein hpase m adipose tissue and Thus Ihe FFA co

substances including coenzymes which must be present in many eniymatic

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substances including coenzymes which must be present in many eniymatic reactions, in their absence the enzymatic reaction cannot proceed) Thus apo I is a cotactor of lecilhm cholesterol acyl transtecase (LCAT) ativity, CM acts as a cofactor for lipoprotein lipase activity Genetic absence of CM in a family causes the disease familial hypercholesTeremia (b) bin from the pom! of view of medical students the most important fact is that because of the presence of these apoli pop roleins, the hpoproteins can combine with their specific race plots of the largal cells (and subsequently metabolized) Thin apo B binds with LDL and the LDL now can bind with its receptor it is hightly possible that abnormalities of these of such diseases like atherosclerosis and hyperchotesteremia. Structure of a lipoprolein [NB To keep the discussion simple, only 4 classes of lipoproteins have been mentioned above Most authors now include IOL {intermediate density lipoprol em) in addition lo the above 4 categories) Upoprotem lipase. After a meal very rich in fat. the plasma becomes milky. This milkiness is due ret the presence of exces s amount of chylomicron particles In the plasma In due time, or following a heparin injection, the plasma is cleared of its milkiness. This clearing is due to the activity of a clearing factof (.an enzyme] called plasma lipoproiem hpate As a result or the action of this enzyme, the Inglycenda portion of the lipoprotein is hydrulyzed to glycerol and free fatty acids (FFA) Most of the FFA rhus formed enter the ertrahepatic tissues (like the muscles, where they are catabolized) This causes clearing of the plasma. The anginal chylomrcron panicle therefore now becomes much smaller, and contains tha protein cholesterol and phospholipid portions but practically no Inglyceride

specially notable are the neurons, heart, liver, skeletal muscles, adipose tissues, mammary gland) converted

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mammary gland) converted into T3 HR (hormone receptor) complex is formed within The nucleus HR attachment with DMA occurs more mRNA production synthesis of more proteins biological action One single biochemical action of T4 (rather T3) at Ihe molecular level cannot explain all the actions of thyroid hormones (TH) Thus, (i) as stated already (see above), trie idea that TM causes 'uncoupling of oxidative phasphorylaiion' has bsen discarded, (ii)the idea, that. Na+K+ ATPase enzyme is vigorosly synthesized so that TH causes calori genesis, (although still very popular), does not explain all. (iii) TH causes mcreass in the synthesis of many proteins (including enzymes) which explains some of The effects of thyroxine (growth ol neuron/rise in myocaidial contractilily/lung development in tadpoles etc etc ) CONTROL OF THE THYROID SECRETION There are three major ways of controlling [he ihyroid secretion, viz. (i) Tha anterior pituitary, (ii) the hypolhalmus, and (lii) auloregulation Fig.6.2.4 gives a diagramatic representation of the mode of working of the first two factors Besides, some other factors like (iv) sympathetic stimulation (v) exposure to cold are also important. Fig. 6.2.4 Conlrol of Thyroid Secretion. TSH of the anterior pituitary Some details have been discussed previously (in this chapter) in connection with the biosynthesis of Ihe thyroid hormones. Additional details have been given in connection with the antenor pituitary hormones. In short, thyroid stimulating hormone, TSH. is secreted by Ihe specialized cells, tailed thyrotrophs' of the antenor pituitary, (i) TSH stimulates almost all the major steps of Thyromne biosynthesis as well as the release of thyroid hormones Hence, more TSH = more secretion of thyroid. (2) in addition, it causes increased vascuiarity and cellular growth of the thyroid gfarrd. These are the two major actions of the TSH. TSH is controlled by negative feed back mechanism eierted by T4 and T3. The circulating T4 is converted into T3 at the level of the anterior pituitary and thus both T4 and TB are active. Therefore, when Circulating T4 is in high concentration. the pituitary Ihyrolroph is inhibited so that TSH secretion is depressed, resulting in correction of excess T4 in blood Reverse occurs when T4 concentration of blood is low Hence, more T4 =less TSH TSH is the single most important regulator ef the thyroid secretion Hypothalamus From the hypolhalamus, thyrotropin releasing hormone. TRH is secreted (NB. Ihyrotropin = TSH). TRH acts on pituilary thyrc-trophs and stimulates them to secrele TSH Hence more TRH = more TSH Probably T4 and T3 do not operate at the level of the hypolhalamus level for the feed back mechanism Thyioxine and TRH both act at the level of thyrotrophs of ant pituitary where they antagonize each other. Another hormones called somatostatin inhibits the TSH secielion. Somatostatin, in this case, is released from the hypothalamus [somatoslatin is also secreted by the islets of Langerhans and slornach) Autoremulation of thyroid If there is deficiency of the food iodine, The iodine trapping mechanism of The follicular cells become super efficient. Therefore, unless there is frank (severe] food iodine deficiency, supply of iodine to the follicular cells, for synthesis of T4 and T3 continues satisfactorily Conversely, if there is evcess of the food rod

According to some recent works. thyroxine causes increased Ca++

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owever have challenged this idea. According to some recent works. thyroxine causes increased Ca++ ATPase activity of myosin (which in turn may be due to increase in the bulk of myosin in heart muscle due to thyroxine) increased contractility of myocardium. In short, excess thyroxine excess myosin in the myocardium increased contractility of the heart. (ii) Central nervous system In the neonatal slags, up to the age of approximately 1 year, normal amount of thyroxine is required for the satisfactory development of the neive fibers and their myelination. If sufficient thyronine is not available at this stage. the bram becomes small. The child grows in chronological age but his mental development does not occur. On the other hand, if thymune becomes deficient after the full development of the CNS, some mental signs like mental stowing still develops but can be completely cured by thyroid administration. This is not so in the case of hypolhyroidism in the neonatals If the hypolhyroidism is not corrected within about 1 year of birth, no matter how vigoros is the subsequent treatment, satisfactory brain development will not occur( iii) On skeletal system. ThyroHine is required for the growth and maturation of epiphyseal cartilage so that in the absence of this hormone, linear skeletal growth does not occur. Excess thrioxnine causes osleopoiosis because of calcium drainage from the bone (iv)On reproductive system Lack ofthyromne in adult woman of reproducing age usually causes menorrhagia (= excessive menstrual bleeding) but the explanation is not definitely known HypoIhyioidism may be associated with infertility also. (v)0n digestive system. Excess thyrocxine causes increased motitrty of the gastrc intestinal trad (and thus causing diarrhea) and/or, increased appelite. Lack of thyroxine causes reverse symptoms. (vi)0n blood In hypothyroidism a normoeytic normochromic anemia is seen MECHANISM OF ACTION As stated already (chap i, ssc VI, Mechanism of action. Thyroid hormones), thyroid hormones act somewhat like the steroid hormones. The free (not the TBG bound] T4 enters the target cell (almost all tissues are target cells of T4 ,

The TL value can now be determined in human sublets (halthy and diseased) fig

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Illustrating the P02 ai different levels (see also Fig4.4.1) OXYGEN CARRIAGE AND UNLOADING 1 Introduction 2 Oxygen dissociation curve, biological advantages of the aigmoid curve 3. Unloading of 02 in the tissues, coefficient of utilization. 4. Myoglobm 5 A-V 02difference, VQ2 max Introduction In a healthy man, at sea level, the artenal blood contains aboul 19m1 of 02/1O0 ml, of which 0.3 ml is in physical solution and trie rest, i e 18.7 ml is in combination with Hb Therefore, 02 is earned in the blood in two forms; (1)in physical solution, and (ii) as oxyhemagtobin (Hb02) The lension of a gas in blood is produced by only mat portion of gas which is in physical solution it follows that the Hb02 is not directly responsible For the tension produced by 02 (i.e. Pa02) When anenal blood reaches the tissue level, rt is exposed to a Ptissue O2 level which is very low, say <>

pulmonary capillary but the Hb within it becomes saturated with in about 0.3 sec, that is this 1 sec is more than sufficient for full

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however, be quickly formed or dissociated The actual exchange of CO2 therefore, occurs more, From this compound. Time required for oxygen uptake At real, an RBC stays for only about 1 sec in a pulmonary capillary but the Hb within it becomes saturated with in about 0.3 sec, that is this 1 sec is more than sufficient for full oiygenation of Hb During exercise, when the circulation speed is high, the transit time of the RBC may be as low as 0.3 sec. but even this Time as shown above, is sufficient SHUNTS Fig. 4. 4.2 shows that PO2 of oxigenated pulmonary capillary blood is practically same (100 mm Hg) as that of alveolar PO2, yet The PO2 of systemic arterial blood (PaO2) is little lower (95 mm Hg) How to explain this fall Answer is (i) various venous blood, that is. deoxygenated blood, gets mixed with the pulmonary venous Wood Such veins are bronchial veins and the bisian venous system, both carrying de oxygenated blood, (ii) Moreover in some areas of the lung, the alveoli are very poorly ventilated but perfusion of These alveoli (by the blood) is alright Pulmonary capllary blood, draining these poorly ventilated alveoli contains poor quantities of O2 and they too drain in the pulmonary veins All these factors lower the P02 of pulmonary venous blood slightly The total reduction of P02, due to these causes, in health, is only 5 mm Hg. All these factors, collectively, constitute the shunt APPLIED PHYSIOLOGY Pulmonary edema, bronchopneumonia and lobar pneumonia increase the resistance lo the alveolo capillary diffusion by bringing fluid into the alveolo capillary membrane Various industrial hazards like asbestosis. pneumoconiosis etc. also increase the thickness of the alveolocapillary membrane to produce alveolocapillary block. To overcome the block. O2 Therapy may be given For further details, see chapter 6 of section IV Gaseous enchange in the peripheral tissus. Some special problems. Diffusion of 02 and C02 at the level of peripheral capillaries are governed, as in the case of that at lung alveolar level, by Fick's law One important difference is that. the distance between, capillary blood and needy tissue (T in the Fick's law, see earlier this chapter] is usually much greater and therefore oxygenation of peripheral tissues, on theoretical grounds, should nol be easy Yet, the tissues normally show no anona. To explain this, it has been, proposed that there is a facilitated diffusion' of 02 (chap 1 sec I) at this level and myoglobin acts as the earner. Gunng euercise owever many capillaries open up( recruitment) and the vlaue of T therefore falls Perfiiaion inefficiency (reduction of puknonary blood flow) can also lead to hypoxemie. Thus pulmonary embolism is an important cause of this arveolocapillary block ultimately leads lo hyponemia (low P02 in the artenal blood) end hypercapnia (excess PC02 In the artenal blood) with their train of aitendent symptoms (see chapter 6 of sec. IV) SUMMARY The transfer of 02 or C02 across the alveolo capillary barrier is governed by the Fick's Law of diffusition of gases across a membrane. The transfer, normally, almost wholly, depends upon the diffusion, biological processes are not involved to any appreciable extent. All conditions ensling between the alveoli and pulmonary capillary favor a diffusion Provisions also exists so that total volume of transfer of gas (TL) can increase sufficiently during exercise in vanous diseases of the lung or heart, the abilrty lo exchange gas deienorales and symptoms develop.

therefore, is, more vigorous is the respiration, speedier are the venous returning (cardiac inflow) This suction action of respiration is called the r

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therefore, is, more vigorous is the respiration, speedier are the venous returning (cardiac inflow) This suction action of respiration isThe muscle pump When the skeletal muscles contact they exert a squeezing action on the veins Because of the presence of valves in them, when the veins are squeezed, blood moves only towards The heart. Conclusion is. when the skeletal muscles are working hard (e.g. muscular exercise) the venous rectum increases. 4. Gravity On assumption of erect posture. the venous drainage from head and neck is facilitated by gravity where as the same from the inferior extremity is opposed by gravity. 5. Vasomotor tone Veins are supplied by the sympathetic fibers When the sympathetic fibers are stimulated, the vein undergo constriction and The blood within it is driven towards the heart more speedily. Therefore sympathetic, stimulation leads to venison striation and greater cardiac inflow In some organs, veins normally hold great quantities of blood On sympathetic stimulation, the venous blood from these organs are evacuated and Thus the cardiac inflow increases Such organs are called reservoirs of blood ANATOMICAL CONSIDERATIONS AND THE STRUCTURE FUNCTION INTER RELATIONSHIP 1. The Major Division of the Vascular Tree. 2. General Structure of the Vascular Tree. 3. The Individual Segments of the Vascular Tree their functions and structural peculiarities The Vascular tree' begins at the beginning of the aorta. continues at branches of the aorta The branch repeatedly give rise to further branches, which are narrower and narrower and ultimately they become arterioles The areoles eventually open into the capelins. the capillaries into The venues (= very delicate veins) The venues unite with other venues To form veins. the veins unite with other veins and ultimately two great veins, via, the superior and inferior vane cave (singular, vena cava} are formed which open into the right atrium This portion of the vascular tree is called the systemic circuit, and its circulation called greater or systemic Circulation From the right ventricle, arises the main pulmonary artery, which divides into two branches. The right and the left pulmonary arteries, destined to supply the right and the left lung respectively Blood from the two lungs are eventually drained by the four pulmonary veins which open into the left atrium. This portion of The vascular tree is called the pulmonary circuit. and its circulation called, lesser or pulmonary circulation For descriptive purposes end viewed from functional point of view, the vascular tree is usually subdivided into following divisions (segments) or regions (fig. 5.10.4.). 1. Windless vessels', also called elastic arteries. 2. Precapillary resistance vessels' or the arterioles, also called, muscular arteries. 3. precapiltary sphincters .'4. 'Exchange vessels' or capillaries. 5. "Post capillary resistance vessels'chtefly the venues .6. Large veins or the 'capacitance vessels' A term 'microcirculation' is very popular amongst the physiologists and clinicians Micro circulation includes the precapillary sphincter region, capillaries and the smallest venues The name (i.e. 'microcirculation') owes its origin to the fact That they can be seen only under the microscope GENERAL STRUCTURE OF THE VASCULER TREE To start with. a big artery. e.g. the aorta, may be considered Such an artery has three coats, via (I)ton called the respiratory pump

This equilibrium point is relatively viable For example, let at a given moment

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mm Hg. This equilibrium point is relatively viable For example, let at a given moment. I, the CVP is suddenly raised The first heart beat after the , because of the Frank-Starting mechanism, will have a greater stroke volume But because of this greater stroke volume, translocation of blood from the venous side to the arterial side will be greater and so the CVP will be somewhat lesser in the following beat Therefore, immediately after .the equilibrium point will shift no doubt, but it will try. to return to the original point gradually. Fig. 5.5.5. To show that when cardiac output rises, the rap' falls Fig. 5.5.6. See text FACTORS INFLUENCING VENOUS RETURNS 1. When the cardiac output rises, the velocity of circulation raised which results in greater cardiac inflow (= venous return to the. heart) per unit time Explanation (I) as the cardiac output rises, as explained above, the central venous pressure falls hence pressure in the peripheral veins also falls. (II) as the cardiac output rises, a little extra blood is pushed into the arterial system per beat As the arterial system resists distension even a slight increases in blood volume in it (the arterial system). causes a sharp rise of arterial BP When the above two factors, vast (I) and (ii) are considered together, it becomes obvious that the pressure gradients between the arterial and venous system (= the difference between arterial BP and venous BP) rises. This increase in the pressure radiance results in greater rate of flow of blood from the arterial to the venous side, stated simply this means greater venous return per unit time. 2. The respiratory pump During inspiration, the intrapleural pressure as well as (he intrathoracic pressure as a whole becomes more negative The intra abdominal pressure however rises due to the descent of the diaphragm Because of the increasing negativity, the diameters of the vane cave increase, and the BP within them falls So the pressure radiance (the difference of BP s between the intra abdominal part of the inferior vane cava and The right atrium) increases — flow of blood towards the right atrium increases. Conclusion,

in question. if a person has behaved normally previously. and then show behavioural abnormalities.

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a casual relationship. (b) Disruption in multiple areas of life such as work, friendship, marriage, finance etc. 5. BORDERLINE PERSONALITY DISORDERS - The long-term functioning of such persons is characterised by preserve of self-damaging impulsivity. unstable interpersonal relationships, undue and inappropriate outbursts of anger, doubts about one's personal identity, variable moods or aftective instability, intoleranca of being left alona, and chronic feelings of emptiness or boredom. 6. SCHlZOTYPICAL PERSONALITY DISORDER - Characteristics include - (a) Magical thinking (superstioness. clairvoyance telepathy. etc.) (b) Social isolation. (c) Referantial thinking in sispiciousness (d)Oddspeech -vague, digressive. overelaborate or metamorphical (e) Recurrent illusions, (f) Undue social anxiety or hypersensitivity to real or imagined critism and (g) being emotionally 'cold' 7. NARCISSISTIC PERSONALITY DISORDER - Grandiose sense of salt importance and preoccupation with fantasies of unlimited success, power or intellectual brillance. They seek attention from others but show few warm Feelings in return These individuate tend to exploit othars for their own salfish needs and seek favours which they do not retum. 8 DEPENDENT PERSONALITY DISORDER - Such persons suffer from lack d self-confidence and passively allow others to assunme responsibillity for major areas of Iife because of their inabillty to functlon Independently Such people appear weak-willed and unduly compliant, falling in passively with the wishes of others. 9. AVOIDANT PERSONALITY DISORDER -Prominent features are - {a) Hypesensitivity to rejaction (b) Unwillingness to enter into Interpersonal relationships (c) Social withdrawal (d) Desire for affection and acceptance and (a) Low self -esteem. 10 COMPULSIVE PERSONALITY DISORDER -Rigid, perfectionstic, unduly conventional. formal. sitngy, undecisive "they show excessive devotion to work to the exclusion of pleasure and the value of interpersonal relationships. 11. PASSIVE-AGGRESSIVE PERSONALLY DISORDER - This term Is applied to those persons, who, when demands are made upon them for adequate performance respond with passive resistance.

constitutional. endocrinal and metabolic dastutbances also contribute to the development of these candhions

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responsible agents but genetic. constitutional. endocrinal and metabolic dastutbances also contribute to the development of these candhions. In an individual case, one or more of these factors may be of greater importancethen the others. It is the complex interactions of all these varied etiological factors which result in a psychosomatic condition. This view has a very important bearing in the treatment procedures of these diseases. Treatment Careful attention has to be given to the emotional and the psychological factors contributing to these illnesses or better therapeutic results, short term as well as long term In this respectT an internist with good orientation Inthe principles of psychological medicine will prove a better physician tothese sutteters. A psychiatrist would have to be included In the medical team managing these patients Paychiatric treatment of the underlying emotional and personality factors may necessitate the use of psychotropic drugs, psychotherapy, behaviour therapy, biofeadback. etc. Treatment of the organic dysfunction by appropriate mathods should be undertaken concurrently. 5 PERSONALITY DISORDERS Definition: The term personality refers to the unique characteristics of an indvidual which predispose to his typical or recurring patterns of behaviour. The presence of certain personality traits make some individuals more vulnerable to develop behavioural abnormalities when faced with stressful events With this degree of vulnerability, abnormal behaviour occurs only in response to environmental stress. In certain other personalities, unusual behaviour occurs even in the absence of stressful events. The latter group is referred to as personality disorders Central to this concept of personality disorders is the duration of abnormal or unusual behaviou

Aden late cycles is activated D camp accumulates intracellular the camp, ultimately speaking

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acts on the cytoskeleton of these cells (for details of cytoskeleton, see chap I sec I) ultimately this causes development of fine intra cellular channels within the cells communicating with the extensor (the tubular lumen) through which water passes for reassertion Control of ADH secretion there are Iowa major means by which the body controls the ADH secretion as described below 1 Amorality of blood Whittle body develops water deprivation (e g . no drinking water for long Time) the osmotic tension of the blood becomes higher than normal, the hypertonic blood stimulates the osmoreceptyors present in the hypothalamus the osmoreceptors now send nerve impulses to the (supraoptic nuclei of the) hypothalamus and the hypothec amuse secretes the ADH the concept of osmoreceptors was first developed by E D Emery of England in the 1940s Subsequently, Verne showed that these oamoreceptois are situated in the regions of supraoptic and par a ventricular nuclei of the hypothalamus Normal values osmolafty of plasma is about 290 m ormolus/kg. Only a slight rise of the amorality from this value triggers off the mechanism to stimulate the secretion of ADH This means as the body is dehydrated even slightly, the osmotic tension of plasma becomes higher, the osmoreceptore then are stimulated D ADH secretion Occurs water loss through the kidney is reduced, i e . body water conserved disturbances in water homeostasis is checked. If there is hypervolemia of the blood, ADH secretion is slopped Mechanism is as follows . the hypervolemia causes distension in the. atnum. the stretch receptors in the atria wall are stimulated and the afferent impulses from these stretch receptors reach the hypo helium* and ADH secretion is stopped This means, during hypervolemia (say due to excess saline transfusion), there is stoppage of ADH dilute and large volume urine is passed correction of hypervolemia Fig6.5.4 Control oath Many other factors can stimulate and inhibit ADH secretion Some such factors are diagrammatically sum married in fig6.5.4 it should be understood, a vary large number of drugs can influence ADH secretion, although they have not been shown in fig 6. 5. 4. Oxytocin its chemistry and biosynthesis

E rises when the concentration of 02, (02). in the inspired air becomes 12% Or lessi. at sea Level Mechanism Fall of PI02 (and thus of Pa 02) causes

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at sea Level Mechanism Fall of PI02 (and thus of Pa 02) causes stimulation of 'peripheral chimoreceptors'(PC')' neural impulses arising fromthese PCa cells go to the RC stimulation of -respiration What causes stimulation of PC? Low Pa O2 is the most important example. Fall of blood pH is another. Rise of Pa C02 also stimulates. Some anatomical (and histological details) of PC can now be discusseld there are two sets of PCs, (l) the caotided body chemreeeptors (fig. 4.3.6) and (ii) The aortic body chemoreceptores. Between them, the carolid body chemoreceptors havt between studied much more extentsively,, no doubt, because of thir easy accessibility But it is safe to presume that the behaviores of and functions of the carotid body (CB) are more or lass same as those of aortic body chemoreceptores. CB At bffurcation of each common carotid artery (fig 4. 3.5), withen the vascular andothelium, in direct contact with the blood, lise the CB. The CB can analyze the Pa 02 f Pa Co2 / H+ concentration if there is )ow Pa 02 or high Pa C02 or low blood pH the CB cells an stimulated nauiral impulses art art up medulary RC stimulated increased repiration homeostasis regained the aortic bodies also behave similar ways (i.e. they also analyze the above mentained chemicals send signals achive homeostasis). The neural from the CB also called glomus caroticum ) travel via nerve Of Hering (a branch Of glossophryngeall or the IXh nerve) the IXlh nerve (fig. 4. 3. 5) 4 medullary RC. Whereas, from the aortic bodies, impulses travel up via (afferent) vagal fiberes medullary R.C There are altogether two CB. one On each side (fig 4.3.5.) There are two types Of Cells in the CB.' type 1 and (ii) Type II cells. Type I cells contain large vesicles and sensory nerve fibers (which eventually constitute the nerve ofHering) emerge from the type I cell Probably the type I cells themsellves or the begining of these nnerves are the detectlores (= receptors ) of the chemical sensation (e.q. anoxial). Three neurotransmitter chemicals are involved in the above mention detection of chemical senses as well as their' tranimiision. They are, (i) dopamine (DA), (ii) subttance P, and (iii) acetyl choline Ach) Of them DA and substance P are present in the vesicles of type I cells Proba- bly DA causes blunting of the sensivity of the chemoresepter cells. whereas substance P increases it. ACh might probably be the neurotransmitter involved in the transmission between the type I cell and the emeging nerve fiber. Thai it, stimutation of lypt I call releaser (locally) ofACh stimulation of the afferent nerves. Molecular level mechanism(s) of action of tha CB (glomius caraticum)
is uncertain and contraversial. Some very popular (and mutually comphmentary) ideas are given below .Any one or all of them may be correct. I
. The CB cells (glomus cells) are metabolically axtremely active Therefore, inspite oft the fact that the CB it tremendously vascular. there.are normally. areas. where there is some hypoxia Of these
-,„-

oxytocin in the Para ventricular nuclei of the hypothalamus at first a large molecule

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Nuclei and the oxytocin in the Para ventricular nuclei of the hypothalamus at first a large molecule, of which the ADH or oxy-tocsin is only a part, is formed. This large molecule contains at least three parts - (i) a peptide called signal sequence. (ii) The ADH (or oxytocin), and (iii) another peptide called neurophysin. Finally the ADH or oxytocin, bound to the neurophysin reaches the neurohypophysis via the hypothalarnico hyperphysical tract and are stored there as Gnomon bodies. When the time for secretion arrives, the ADH (oroxytocin) neurophysin complex is secreted, and after secretion the two components, viz,the hormone and the neurophysin are dissociated. Now the hormone (ADH or oxytocin) is free to act. The functions of neurophysin are unknown: Chemically, the neurophysin whch binds with ADH is not identical with the one that binds with ox-ytocin. Functions ADH. The fundamental function of the ADH is to conserve body water when the body is threatened with dehydration. It has also some vasoconstrictor action. Plasma concentration of ADH in man. with free supply of water is I to 3 pg/ml. Mechanism of action. The ADH acts on the collecting tubules of the nephron. The tubular fluid, as it is delivered into the distal convoluted tubule of the nephron is usually hypotonic (particularly in the junta medullar nephron) So the hypotonic tubular fluid arrives it the, collecting tubule the collecting tubule descends through the nodular interstitial (fig.8.1.2), a region which contains very hypertonic solution. There fare, due to the law of sinuses , water frown the collecting tubule should go to join the medullar interstitial fluid. But if the ADH is absently the permeability (to water) of the epithelial cells lining the collecting tubule is nil. so that no movement of water can occur. If ADH is present, these tubular cells become permeable to water and the water moves out of it (to join the medullar interstitial fluid) and the collecting tubular fluid becomes concentrated. therefore, in short, the ADH concentrates the urine. When the concentration of the ADH is very high in the blood, the ADH causes arteriolar smooth muscle contraction leading to vasocanstnction and elevation of arlenal blood pressure. At this statge, the ADH can be called, the vasopressin there are two types of receptors for AVP (that is, ADH). fi V2 receptors at the collecting tubules of nephron. and (ii)H V1 receptors, on the smooth muscles of artenoles. Combination of AVP (ADH) with V2 makes the cells of the collecting tubule permeable to water Combinations of AVP with V1 receptors cause vasocostriction Possibly the combination with V1 occurs only when AVP is in high concentration At molecular level, the mode of action of ADH (AVP] is as follows there are two sub types of ADH receptors, viz. V1 and V2 receptors the antidiuretic effects of ADH are due To V2 receptors (recall. there are non renal effects of ADH also and these are due to the V1 receptors) the V2 receptors have strong binding affinity for ADH ( in contrast, V1 receptors have only week affinity) V2 receptors are present on the lining cells (notably on the principal cell . for details of principal cells, see chap 1 sec Val), of the collecting Tubules When ADH combines with the V2 receptors, the Aden late cycles is activated D camp accumulates intracellular the camp, ultimately

Therefort these fluids cannot and do not stimulate the CC cell In short

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respiretoary stimulation 3 However, if the P CQ2 of the brain capitary blood remains persistenly high (- exite of excessCQ2 from the blood to CSF or brain tissue fluid is persistenlyy high), same compenatory changes occur liding to regaining of the anginal ph of the CSF thus CSF is no longer acid and it no longer stimulates the CC in l practice. a drammatice example is very advanced case of emphiysema In such case, blood PC02 rremember persistently high but the pH of C5f (and presumably of the bram tissue fluid) remains alkalin Therefort these fluids cannot and do not stimulate the CC cell In short. these patints have high Pa CO2 (and also PA CO2). but the high PaC02 deos not stimulated the respiration yet, for his survivai.the patient requires increased respiratory drive (otherwise he will die of CO2 narcosis) This increased drive cornes from the concomitantl hypxia presenet in such casses. The ultimate conclusion is. inspite of the presented hy poxia in sush cases over enthusiatic correction of hypoxia (by O2 therapy) can kill the patientas as it extingushes the only respiretory stimulus available in this patent Recent wotks indicate that theCC cells are present. in the ventral surfaca of the in three areas. termed tostral, intermidiate and caudal areas. They are also known by their alternate names, viz. areas Mitchell (M). Schlafeke (S) and Loeuhke (L) respectively C02 can also stimulate the respiratory center (RC) via the peripheral chemoreceptares. see bellow. Role ofOxygen What happens in 02 lack (hypoxia) and 02 excess? Between them 02 lack ib much much important and will be described frist . Effects of 02 lack A moderate fall of PI02 (02 tension of inspised air) or PI02 (02 tension ofarterial blood) unlike those with C02, has no appreciable effec evenslight rise of PIC02 or PaC02 causes sharp rise ofE However gross fall ofPl 02 (or concenitration of 02 in the inspired air)leads to sharp rise of Vg which thut Causes correction of the hypoxia

lack of concern ('ta-belle"infterence about those symptoms which may actually provide secondary gains by winning sympathy 2 Dissoclative disorder -

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('ta-belle"infterence about those symptoms which may actually provide secondary gains by winning sympathy 2 Dissoclative disorder - (Hysierlcal neurosis, dtssociative type) Here alterations may occur In the patients state of conaclousness or In his identify to produce such symptoms as amnesia ambullism fugue and multiple personality Etiology Tnere is sufficienavidence to suggest that the symptoms ara psychogenic and that the environmental factors are the important etiologcal faclors 1 Age - The peak Incidence is balween the ages of 20 to 35 years 2 Sex - incidence is higher in females 3 Intellgence - People with low intelligence more Iikely 4 Personality - Commonest is histrionic: personality (characteristcs • dramatizing and exhibitionistic, attention seeking, immature. having shallow andsuperticial emotional relationships] 5 Maritalstatus - Mora comrnon In unmarried widowed and divorcees 6 Socio-cultural factors - More common in primitive, developing and less sophisticated or cultured societies 7 Psychoanalytical theories - Hysterical symptoms are viewed as symbolic representations and distorted expressions of unresolved intrapsychic conflicts about one's sexual drive (libido) When the libidinal energy manifesis itself as somatic symptoms through the ego-defence mechanism of conversion, the resulting disorder is known as conversion disorder When the libidinal energy marifests as psychological symptome through the defense mechanism of disociation, the resulting disorder is labelled dissociaiive disorder Clincal manifestations 1 SYMPTOMS OF CONVERSION DISORDER - These ariee because of the involvement of voluntary neuromuscular system (a) Motor symptoms - These are of two types (i) Akinesia e. g. paresie or paralysis involving a part of the body monoplegia, hemiplegia, paraplegia, etc (ii) Hyperkinesia and dyskinesia e. g .tremors, tortcollis, convulons or fits (b) Sensory symptoms These can be in the form of anaesthesia, hypaaesthesia. hyperaesthesia and paraesesthesia This dtsturbance can affect all the general sensations Special organs of sense, like those for sight, hearingr smell andtastecanalso be disturbed resulting in blindness. deafness. etc (c) Visceral symptoms - Common ones are hiccoughs vomiting, dyspnoea, dysphagia, aphonia, etc 2 SYMPTOMS OF DISSOCIATION DISORDER - (a) Somnambulism and sormiloquy. (b) Amnesia • cicunscribed and covers up the psychologically traumatic event (c) Trance -An altered state of consciousness lasting for a few minutes to a few hours, during which the patientappears to be oblivious of tne surroundings (d) Fugue-An altered state of conslousness wherein the patient travels long distances over a period of days and subsequently has amnesia for the entire episode (e) Multiple parsonalities like those of Dr Jakyl and Mr Hyde (f) Ganser'ssyndrome,a rare disordercharacrisedby giving of "approximate answers", somatic or paychological hysterical symptoms, hallucinations and an apparent clouding of consciousness Characteistics of hysterical symotoms- 1 Absence of organic basis for symptoms 2 Theyserve both primary gain (resolution of intrapsychic confficts) and secondary gain (obtaining sympathy and attention) 3 In conversion disorder - (a) Symptoms seldom occur when patient is alone, on the other hand, symptoms are exaggerated in presence of other persons

manilestations are charactersed by presence ol obsesslons and compulsions Obsesslons are recurrent or perslstent Ideas. thoughts

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manilestations are charactersed by presence ol obsesslons and compulsions Obsesslons are recurrent or perslstent Ideas. thoughts. images or Impulses compulsions are urges or Impulses io action that when put Into operation lead to compulsive acts which ara performed either according to certain rules or in a stereotyped manner Obsessions and compulsion have certain features in common -(a) An idea or impulse Intrudes impellingly into an indvidual'sconsclous awareness (b) A leeling of intense anxiety accompanies the central manilestation and leads the Individual to take counter measures against the Initial idea or Impulse (c) The obsession or compulsion is ego-alien.i,e. Is experienced as being foreign to andnot apart of one's experience of oneself . it isundesirable and unacceptable (d) The indivdual recognises the obsession or compulsion as being absurd or Irrational (e) The suffering indiVidual feels a strong need to resist those obsessions or compulsions When the symptorrs become severe, the patient may develop additional symptoms of anxiety and/or depression PROGNOSIS - Natural remissions of symptoms are known, hence the prognosis Is not always gloomy Prognosis is bad when the personality is obsessional and symptoms are severe and of long-standing Management 1 Drugs - Fluoxetine (20-GQmg/day) or sanraline(50-3cO mo/day) or clomiprarrine (75-200 mg/day) Trazodon (50-400 mg/day) is also effective in some cases 2 Psychotherapy- Supportive as well as analytical gives satisfactory results In some cases 3 Behaviour therapy - Satisfactory results are seen in some cases IV Hysteria Types of hysterical dsorders-1 Conversion dsordesr-fHysterical neurosis, conversion type) Here the special senses or voluniary nervoue system are affected causing symptoms such as blindness, dealness.

treatment should be directed fowards the primary cteorder

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treatment should be directed fowards the primary cteorder. Behavioural therapy may be required for treatment of obsessional symploms. 5 Depressive disorder.tiofogy. Disturbing environmental situations like serious illness of a parant, death of lamily member or parental disharmony. Endogenous depression is extremely rare in children. Clinical features ;A diagnosis of depressive illness In children should be made when there Is clear evidence of depression A depressive mood change is characteristic but may not be obvious at first children become teartful and lose interest and concentration. They may appear to be bored and may eat and sleep poorly. Sometimes, depressive disorder in children may appear in a "masked form1, presenting with avariety of somatic symptoms, enuresis , running away from home or truancy from schoof. Treatment -Reducing unhappy circumstances, if possible, and encouraging the child to take pan in activities. Treatment antidipressant is usually reserved for ofder children with severe depression. 6 .Schoof refusal: This is characterised by repeated absence from schoof when such absences are not due to physcal illness, condut disorder or when children are deliberatety kapt at home by Ihalr parents. Etiofogy - (a) Separation anxiely as In younger children (b) Fear or phobia of certain aspects of school the, or fears of failure and rejection. often associated with depresion Clinical features -Refusal id attnd schoof may besudAn In onset. More often. however,there is an Increasing reluctance to go to school with signs of increasing unhappiness and anxiety. Some cnildren may have somatic complaints like headache, abdominal pain, or vague complaints of feeling ill. This refusal may appear after a period of enforced abserce for another reason, such as illness, change of class or a problem in the family. The school refusal is usually very resistantiant to efforts to send him to school Treatment - (a) Alleviation of stressful aspecis of school life, it possible This may require co-operation of school authorities (b) Counselling of parents (c) Behaviour therapy In which a graded behavioural plan is drawn out 10 help the child overcome his fears (d) Treatment of associated depression if any (e) Psychotherapy wih the child to encourage him to talk about his fears. 7. Functional anurasis and encopresis FUNCTIONAL ENURESIS -is the repealed invotuntary voiding of urine Occurring after the age at which continence is usual, and in the absence

CLINICAL FEATURES Anxious children are abnormally fearful

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Frightening experiences - anxiety state can be precipitated either by a short-lived frightening experience,e.g. hospltalization for surgery, or a profonged experience like conffict between parents. (b) Separation froinparents. (c) Response to chronically anxious parents. (d) Anxious temperaments - Excessive worry abcut stressful events, e.g. examinations, group activities, etc. CLINICAL FEATURES Anxious children are abnormally fearful. They cling to Their parents and are very timd with other children Their sleep pattern may ba ditsturbed and frequent nightmares. may be experienced Somatic symptoms, especially headaches and symptoms referable to Gl tract may occur at time. TREATMENT: (a) Environmental manipulation to reduce stressful factors if possible. e.g. improving relationship between parents. (b) The child should be encouraged to take part in group activities and should be helped to talk over his worries. (c) Counselling to parents. (d) Anxiofytic drugs -are usually avoided except in cases of severe anxiely. 2. Phobic dissorder. Etiofogy. Similar to phobic disordees in adults. Clinical features - Man or phobias are common in childhood and usually concern animals, Insects, darkness, schoof and death. Agoraphobia and phobias of social situations usually begin during adofescence. Treaiment - Meet childhood phobias Improve without specific treatrment Parents should be taught to adopt a firn but reassuring approach. Behaviour therapy techniques by which a child is encouraged to encounter phobic situations may be of help in some. 3 Hysteria Etiofogy Psycho analytical theories postulated for adJlts also apply to children More common In adofescents than in children Clinical features; Similar to those In adults. Treatment - Reducing stressful environmental factors and encouraging the child to talk about his problems. Counselling 10 parents may be required 4. Obsessive compulsive disorder Etiofogy Psychoanalytical theories as in adults. Rare deorder inchildren. Clinical features - Several fonrs of repetitive behaviour are common. These Include a preoccupation with numbers and counting, repeated handing, of certain objects, etc it is also common for children to adopt rituals such as avoiding cracks on apavament. Much of the behaviour cannot strictly be called compulsve, bacause the child does not struggle against these repetitive or rituatelic behaviour patterns as ha should, if he istosatify the dagnostic criteria of obaessive compulsive- dsorder (See under Neurosis) when persistent obsessional thoughts or compulsive symptomrs occur during childhood, they are often part of an anxiety disorder. The pure form
of this disorder is more common during adofescance than during childhood and is usually char acterised by prasence of rllualellc behaviour such as rachecking schoof work or repeated handwashing Trealment - when obsessive compulsion. occur as a part of an anxiety disorder

Subcutaneous fillriasis (onchocerciasis) tramited by biting flies. LIFE CYCLE

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Subcutaneous fillriasis (onchocerciasis) tramited by biting flies. LIFE CYCLE - Adult female worms situated in various (issues in the human host produce embryonic mcrofilariae which are sucked up by mosquitoes or bung flies during a blood meal Microfilariae develop to their larval stage in the insect vector and are passed on to a new human host in which the final maturation to adult worme takes place Adult filarial worms do not multiply in man Periodicity of microfilariae - in most endemic areas the mcrofilarriae of W bancrofit appear in greatest numbers in peripheral blood in the night between 10 p.m. and 2 a.m. during the day they return to the pulmonary capillaries Mcrofilariae of B. malayi exhibit either nocturnal periodcity, or dumal periodcity with ,a peak In the early evenings Lymphatic filarlasis - can be caused by Wuchereria bancrofti, transmited by Anopheles. Culex and Aedes mosquitoes. Brugla malayi, transmited by Mansonia and Anophsles mosquitoes brugia timori, transmited by Manaonia and Anopheles mosquitoes Clinical features - Two syndromes - (a) Lymptiatic frlariasis caused by adult or developing adult worme, producing episodic inflammation of lymphatic vessels, followed by obstrctive lymphatic. lesions (b) Syndrome - caused by immune hyparresponsiveness of human host against microfilaria, producing occut fileriasis (circulating filarial antigens or microfilaraemia). ACUTE CLINICAL FEATURES 1 Filarial lever-Attacks of fever with rigors and with headache and rnalaise, lasting- 3-s recurring at Intervals. and sometimes associated with an attack of filarial adenolymphangitis. 2. Filarial lymphangitis and lymphadenitis - fa) Acute lymphangitis - in extramities with lever with riugors and toxemia. The tender inflamedly lymphatics are seen as red streaks. it may be accompanied by itchy, irregular erythamatous swelling ot the skin scattered over the body, which may sometimes appear In absence of local lymphangitis Lymphatics anywhere in the body may be Involed, Those of spermatic cord and testis are especially susceptible (b) Lymphadanltis - occurs episodically. most often in inguinal area. Other sites are medial aspect of leg. axilla or medial side of arm. Occasionally in the breast Invoivement of intra-abdominal Iymphatic may produce clinical appearances of acute abdomen Secondary grarn-postiive bacterial infections cause suppurative lymphadenitis or abscess formation particullarly in the breast, or in muscle resembling tropical pyomysitis. CHRONIC CLINICAL FEATURES (late obatructive phase) 1. Hydrocele - is conmon with w bancroti. 2. Lymph oedema - is most common in lower limbs but also occurs in the upper limbs or the breast .3. Elephantiasis - results from further progression with drmatasclerotic and papillomatous changes superimposed Lymphoedema and elephantlasis are mush more pronounced on one side of the body, possibly because the parasites tend of congregate Thckening of both skin and overlying tissues. One or both legs and scrotum most commonly involved Upper extremitles, breast and labia may also be affected. 4. Finally rupture of lymphatic varices - into renal pelvis or

CLINICAL FEATURES Stage Iborreliosis Erythema marginatum.

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Meningism (g) Tender muscles (h) Tender enlarged liver and spleen Complictions - Severe are - myocardtlis. hepatic failure, severe bleeding associated with thrombocytopenia, DIC, secondary bacterial infection Tick-borne - Attacks generally milder and shorter, but may be followed by more relapses. DIAGNOSIS -(a) Louse-bome - Appearance of spirochetes In peripheral blood during a paroxysm (b) Tick -borne Infection - intraperitoneal lnjection of blood into mouse or rat produces numerous spirochetes in the rodents tail blood within 3-5 days. TREATMENT - Louse-bome relapsing lever - Adults - Tetracycline 250 mg .IV single dose Children - Erythromycin lactobionate 10 mg/kg IV single dose Tick-bome - Adults- Tetracycline 500 mg. p.o. q.d.s for 10 days Chitfren - Erythromycin 125-250 mg. q.d.s. FOR 10 days. 15. LYME DISEASE Lyme disease is caused by the tick-bome spirochaete Borrelia burgdoferi. Erythema migrans is the early skin lesion, and is the most common clinical mamfestation Transmision usually lakes place when an inlecfed tick (lxodid tick) bites. CLINICAL FEATURES Stage Iborreliosis Erythema marginatum. aofcalized erythematous rash appearing 2-30 days alter a bite. There may beofcal lymphadenopathy Stage II borreliosis After dissemination, the organsm can affect many tissues, principally the nervous, musculoskeletal (persistent arthralgia and small joint arthritis) and cardiovascular system (conduction defects, rarely cardomyopathy), and the skin There may be 'flu-like'illness Multiple areas of erythema migrans can occur. Stage III borreliosis: is unusual Chronic lyme arthritis of knee. Acrodermatitis chronica atrophicans Rarely chronic progressive encephalomyelitis. DIAGNOSIS - Antibody tests Specimens found reactive on Initial testing should be invesiigated using Western blot. TREATMENT - Amoxicillin, doxcyclin and cephalosporin’s, or azithromycin orally. Puerperal antibiotics include benzylpanicillin. cefotaxime and ceftriaxone. 16 WORM INFECTIONS Fllariasis Etiology - Filartal Infections are caused by parasistic tissue-dwelling, filarial nematode warms, which are transmited by blting Insects. Two main types of filariasis are: 1. Lymphatic fallrisis is. Transmited by mosqutoes.

Silverman needs or cutting tip of a Tru-Cut disposable needle may 'bounce' off tne kidney and lacerate

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cutting tip of a Tru-Cut disposable needle may 'bounce' off tne kidney and lacerate it, causing hemorrhage Fine-neede aspiration biopsy (FNAB) - is used in daignosis of renal transplant dysfunction It is less traumatic and analigesa and sedation are normally unnecessary FNAB can diagnose acute cellular reaction, but not early vascular rejaction Also it is not poasibfe to judge aeverfly of allograft damage in order to determine the nature and dose of antirajection therapy Complilcation COMMON -(a)Bleeding is most common complication (b) Artero-venous fistula with in the kidney It can cause bleeding Treatment - Bleeding can be controled with bed rest and transfusion if necessary Identification and control of bleeding point ol A-V llstula by transdermal percutaneous arteriography followed by embolization UNCOMMON -(a) Pneurrcthnra- (b) llaus (c)Lacertion of liver, spleen, mesenteruic artery and bowel. 2. HEMATURIA Causes - 1. In the urinary tract - Kidney - 1. Congenital anomalies. Polycystic disease, anglorna .2. Calculus .3. Mobile kidney .4. Infections - Pyelonephritis. tuberculasis, glomerulonephrltis. 5. neoplasme -Renal carcinoma, wilms tumour. 6. Drugs - Sulphonamied. anticoagulants. 7. Trauma - Ruptured kidney. 9. Oxalurla. 9 Posl-oparative .After naphro or pyelolithotomy or partial nephroiclamy 10 Radation damage 11 Heradrtary nephrite - Airporlfe syndrome, farrtllal recurreni haernaiurla 12 Renal errbollzatfen/infaictlon 13 Analgesic nephropathy 14 Unknown origin -Essential haamaluna 1'renal apblajds"). Loin pain/haemalur[a: syn^ome Urater - (1J Trauma. (2J Calculi (3) Infection (4) Tumours - paplPoma. carcinoma Prostate - Benign hypertrophy, carcinoma Bladder - [1) Dlvertlculum (2)Trauma -following prostatectomy or other operations or Instrumental (3) Calculus or (orejgn body (4) Tuberculosis (5) Tumoura - Simple, papilloma, carcinoma. (6). Ulcers. (7). Chemical cysistis - e.g. after cylophosphamide (8)Parasitic-Schistosomiasis, Bancroftian filariasis Urethra - (1) Malformationgs.(2) lnjuries. (3). Calculus or foreign bady. (4) infectioin .(5) Tumours. (6) Naevus 2. Systemic causes -1 Bleeding dathasis. 2. Collagen disorders - SLE, PAN .3. Subacute Infective endocarditis 4.

Certain forms of nephritis (e.g. focal glomerulosclerosis and mesangocapillary glomerulonaphritis) recur in transplant

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kldney are not small and shrunken, biopsy e useful In detarmining the cause and prognosis. Certain forms of nephritis (e.g. focal glomerulosclerosis and mesangocapillary glomerulonaphritis) recur in transplant, and it is helpful to know this or futures management 8. Special situations - (a) Uncontrolled hypertension may lead to renal impairment, hematuria and protainuria. and this may occasionaly result in nephrotic syndrome. Once hypertension is controlled, renal biopsy may be the sole criterion for datermining Afther the problem is due to pure hypertension or underlying nephritis, (b) In 1O-20% of patients with diabetes melltue. proteinuria and impaired renal function may be due to causes other man diabetic nephrosclerosis, particularly In Those with no other evidence of microvascular disease e.g. diabetic raimopathy. 9 .Renal allograft dysfunction - (a) it provides only reliable method of distinguishing rejection from cyclosporin nephrotoxicity. (b). it helps in daciding the scale of antirejection therapy and differinting allograft nephropathy form recurrent or de novo nephritis. Contraindications - 1 Single kidney or severe malfunction of one kidney. 2. Urgent reliable bleedng diathasis. 3. Small, shrunken kidneys (dificult to locate and information obialned usually nonspecitic). 4 .Presence of cystic diseaes. nephrolathiasis, reflux nephropathy or obstruction or hemangloma. Technique - Localization of the kidney- Lateral border of lower pale ol kidney &the sales part to biopsy. Ultrasound is the preferred imaging technique to mark, tne posltion of the kidney. it is particularly preferred in paitens with impaired function as it avoid use of contrast media (as inIVU) Attachments are available for ultrasound probes which can precisely dlract the needle tothe kidney Biopsy needle - (a) Franklin-modified Vim Sllverman needle (b) Tru-Cut needle are diposable needing and not composed of diffrent parts. (c) .Biopsy gun is a spring-loaded device which Shoots' a variant at tru-cut needle into the organ. (d) Biopsy needles with tips which are easily seen by ultrasound. They are smaller but adequate tissue can usually be obtained. Biopsy of the native kidney - (a] Pre-medication to allay anxiety and pain. (b) 'Fixing' the kidney - so that It does not move significantiy with patient respirations Patient upper abdomen and lower chest should be aupportedd by pillows so adjusted that patients daphragm welI splinted. (c) Sedation -with IV dazepam to produce deep sleep (d) Position ot lower pole of the kidney as determined by ultrasound is marked on the skin and depth of tne kidney measured (e) Biopsy then perfomed Enough Tissue must be taken for light microacopy, elactron microscopy, Imimuno-fluoregcance or imrrxirtopercxidaae tschnlquBS and, IE appropriate for cutlure Biopsy of transplanted kidney - The allograft may be easily palpable in tht iliac fosaa but it should be localised by ultrasound alrring for the lateral border of upper pole Since transplanted kidhey often becomes encased in fibrous issue, this must be penatrated before biopsy is taken If it is not, cutting prongs of a modfied Vim

lower ulnar epiphysis, upper epiphysis of radius, medial epicondyle of humerus. 7-8 years. Lower epiphysis of ulna 9-10 years.

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Olecranon, trachiea of humerus, pisiform 11-12 years. Lateral epicondyle of humerrus. (10) Milestones of development importance, (a) Assessment of step by step age-wise physicomotor and montal development. (b) Early detection of motor disorders, cerabral palsy, mental retardation, speech, auditory andividaual defects. (c) Assessment of etiology of developmental delay -congenital if poor milestones envelopment from beginning, acquired or heraditary/acquired degenerative neuromuscular or CNS disease if arrest occurs after certain stage is reached. (d) Assessment of approximate in time when pathology began,m e.g. age at which malnutrition set in to cause development retardation. Classification (Continued on next page) 1. Motor 2. Adaptive -(a)Fine motor (b) Visual (c) Auditory 3. Social 4. Language-(A) I Parceptive. (b) Expressive. (11) Saxual maturity 2. PREMATURITY AND LOW BIRTH WEIGHT Defination -Babies born before 37 weeks of gestation are called preterm (PM) Those weighing less than 2500 gm (10th percentile for gestational age) are called low birth weight (LBW) babies Low birth waight may be due to prematurity or intra-uterine growth retardation. The latter group are called small for date (SFD) Pramature babies may be small for date also. Clinical picture -1. Length is short (less than 46cm) in preterm. it is relatively normal for weight in SFD babies. 2. Head appears large compared to the rest of the body, particularly in SFD babies 3. Only one of the two transverse creases on sole of the foot upto 37-38 weeks. 4. Breast nodule absent upto 33-34 weeks. 5. Scalp hair tends to be short and fuzzy upto 37 weeks. 6. Ear carilage is poorly developed and the folds of the helix and antii-helix do not stand out till 36 weeks. 7. Taestes descended and the scrotal rughae develop after 36 weeks. 8 Sucking and synchronized deglutition develop after 33 weeks. 9 Moro's reflex develops after 32 weeks 10. Pupillary reaction to light develops after 31 weeks 11. Blink response to glabellar tap develops after 31. weeks. 12. Strong texor response to extension of forearm develops after 35. weeks. Complications. 1. Hypothermia - because of poor subcutaneous fat insulation, increased surface area compaired to weight. immature hypothalamus and lack of brown fat that can be readily burnt for energy 2. Infection - Septicemia. maningitis and sclerema neonatorum. Baby appears Table showing brief classification of milestones - Age 5. Hypoglycemia -Baby becomes lethargic, develops convulsions or cyanosis. 6. Retrolental fibropiasia - due to excess oxygen in the environment, 7.Anemia
developes within 4 weeks in preterm, SFD have polycythemia.8. Hypocalcimia in SFD.9.Pathological jaundice in PM due to liver
immaturity.10. Intraventicular-periventricular haemorrhage - More common in PM Can be spontaneous in babies less than 34 weeks. Aggravated or precipitated by asphyxia. Severe grades die or survive with mental handicap palsy incidence reduced by loading dose of 25 mg/kg. Phenobarbitone in very small prematures. 11. Patent ductus arterious - Higher incidence in

Maximal in first year, reaches 90-95% adult size by 4 years. Birth 32-35 cm (less than 30 cm microcephaly).

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measure of brain growth. Maximal in first year, reaches 90-95% adult size by 4 years. Birth 32-35 cm (less than 30 cm microcephaly). First 3 months. 2 Cm per month (av. 39 cm) 4-6 monts: 1 cm per month (av. 42 cm) 6-12 months. 1/2 cm per month (av. 46-47 cm) 2nd year 2 cm [48-49 cm) 3rd year. 2 cm (50-51 cm) 4th year 2 cm (52-53 cm) Adult 53-56 cm Upto 13 months use formula 1/2 x length (cm) + 10cm +25cm (4) Surface area. It bears constant relation to nutritional factors affecting growth. Best calculated from nomograms involving average weight and height. Crude methods are Lowe's formula. Surface area (m2) -Simpler formula 1-5 kg m2 = (0.05xkg) + 0.056-10kg m2 - (0.04x kg) + 0.10 11-20kg m2 = (0.03x kg) + 0.2021-40 kg M2 = (0.02 x kg) + 0.40 (5) Upp to lower segment ratio: Upper segment measured from vertex to pubic symphisis. Important in assessment of growth distarbances - proportionate or disproportionate dwarfs. Ratio changes with age and height. Marginal difference between males and females. Ratio retarded for age in - hypothyroidism, achondroplasia and other short-limbed dwarfism, rickets with lower limb deformilities. Ratio advanced for age in - Short trunk dwartism, aquired spinal disease. with hyposis or scoliosis, e.g. tuberculosis, hypogonadism (Klinefelter's syndrome). Marfan's syndrome. (6) Chest circumference. Smaller than head circumference by 2-3 cm Cross-over of head and chest circumferences takes place in Indian children at about 2 years of age (about 1 year in white races. (7) Mid-upper arm circumference taken at midpoint of acromion and olecranon index of mainutrition constant at 1-5 years at 16-17 cms. Mild (9) Ossification centre apperances in infancy and childhood Birth. Distal famoral. proximal tibial, cuboid 3 wks. Head of humerus 2-4 mths. Hamate, capitate 4-6 mths: Head of femur 1 year. Distal radial 2 years. Distal tibia and fibula, capitellum of humerus. 3 years. Triquetral bone, treads of metacarpals and phalanges of hand 4 years. Lunate, navicular of foot,. greater trochanter of femur. 5-6 years. Scaphoid, trapezoid, trapezium.

Plain X-ray flims -of kidneny, ureters and bladder (KUB). Renal outline can be difined and calcification may be detected In renal areas, ureteric

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tubular function.1. Tubular concentration of urine - (a) Specifc gravity of urine (range 1.005-1.004). For greater accuracy. (b) Urine osmolality (range 30 -1400 mOsmol). After overnight fluid deprivation, urine osmolality usually exceeds 600 mosmol'/1( sp. gr.>1015) In more formal tests.fluid deprivaiion for upto 24- hrs or injection of antiduratic hormone (vasopressin tannate) should increase urinary osmolality to 750 mOsmol/1 or more. 2. Urinary acidifition - Kidneys must axcrate 70-100 m mol of non-valatile acids/'day. otherwise plasma pH 'falls and urine pH is high. ph of urine can be assessed by dipstic A more formal testl is the add load test Ammonium chloride 100 mg/kg is given orally over 30-60 minutes (to avoid vomiting). Urine pH and plasma bicarbonate are measured over 3 hrs. "the Bicarbonate concerrtration should falI below 18 mmol/1 and urine pH below 5.3. In metabolic acidosisr plasma bicarbonate is allready <>

Technetium dethylamine penta-acetic acid (DTPA) is injected iv;the rate of excretion is followed by surface scanning

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urea generation - (a) High protein diet. (b) Upper Gl bleedng. (c) Catabolic Illness. (d) Corticosteroid or tetracycline

Increased tubular urea resorption -(a) Dehydration (b) Salt depletion. (c) Hypotention Both factors may coexist.radioisotope marker clearance: 51Cr-EDTA and 125I-iothalamate ara excreted entirely by glomerular fiftration The substance is lnjected i.v. and clearance determined by measurement ol radioactivity in plasma or urine the test is most appropriate for assessment of renal function in patients with normal or near normal plasma creatinine. Technetium dethylamine penta-acetic acid (DTPA) is injected iv;the rate of excretion is followed by surface scanning of the kidneys, to determine if renal function is divioded equally between the kidneys Radiocontrast agent clearance Assessing the blood clearance of these agents after i.v. Injection is useful in patients in whom GFR is changing rapidly. (e.g. evolving or recovering acute renal failure). IlI. Assessment of filtration barrier Normal filtration barrier is impervious to molecules of molecular wt. > about 60.000 Daltons. Proteinuria - (a) In glomerular injury, the amount of albumin increases. (b) Microalbuminuria helps early detection of dabetic nephropathy. (c) Assessing the 'selectivity' filtration barrier by calculating the proportional claarance of a large molecule. such as lg-G (150,000 Daltons) compared with a small molecul such as albumin (66.500 Daltons) is of use in childrean with nephrotic syndrome, a selectivity index <0.10>1015) In more formal tests.fluid deprivaiion for upto 24- hrs or injection of antiduratic hormone (vasopressin tannate) should increase urinary osmolality to 750 mOsmol/1 or more. 2. Urinary acidifition - Kidneys must axcrate 70-100 m mol of non-valatile acids/'day. otherwise plasma pH 'falls and urine pH is high. ph of urine can be assessed by dipstic A more formal testl is the add load test Ammonium chloride 100 mg/kg is given orally over 30-60 minutes (to avoid vomiting). Urine pH and plasma bicarbonate are measured over 3 hrs. "the Bicarbonate concerrtration should falI below 18 mmol/1 and urine pH below 5.3. In metabolic acidosisr plasma bicarbonate is allready <>

There is also no maturation of the external genitalia and secondary sex characteristics do not develop [NB

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According to some, cretins should not be called dwarf as there is shortage of intelligence] Treatment of cretinism must commence early and if not started within first year of life.. as explained earlier in this chapter, no matter how thorough is the later day treatment, the child remains idiot Adult hypothyroidism The Full blown picture is known as myxedema because in advanced stage or the disease, hyaluronic acid and protein accumulation occur which in Turn attracts water {see earlier part of this chapter) In less severe forms, the clinical features are there is mental slowing, fall of hairs, excessive feeling ofcold, menstrual abnormality (usually menorrhtgia) and bradycardia Weight gain also occurs The laboratory findings and the physiological basis of drug therapy have been discussed later in this chapter Cause Ultimate cause of hypothyroidism is deficiency of thyroxine (i) In the cretins, this may be due to the fact that the mother suffered from iodine deficiency during the gestation period, a common cause in the sub Himalayan regions of India, and clinically called 'endemic cretinism', severe food iodine deficiency remains a major cause of hypothyroidism in These areas (ii) Another important cause is 'iatrogenic (i. e . produced as a result of treatment) Surgical removal of a part of the thyroid (for treating hypertyroidism) can result in too much removal of thyroid and produce hypothyroidism. Treatment of hyperthyroidism by radioactive iodine can also do this (iii) Autoimmune disease of the thyroid, (Hashimoto's disease) in which specific immunoglobulins, which destroy the thyroid, appear in the body, is another notable cause (iv) Other important causes are hypofunctioning of the anteror pituitary (Simmond's disease) or of hypothalamus. Hyperthyroidism (Grave's disease, Basedow's disease, exophthalmic goiter, thyrotoxicosis) In this condition, there is excess thyroxine in the body. There are three groups of signs and symptoms as follows: Swelling of the gland of oversecretion of thyroxine. There is usually a variable degree of swelling of the gland (goiter) and some protrusion or bulging of the eyeballs (exophtalmos), hence the condition is also clinically called' exophthalmic goiter' The rnajor efftcts of hypersecretion of the thyroidhormones are (A) Cardiovascular system, tachycardia, palpitation, high systolic blood pressure. (B) Nervous system fine tremor, mental restlessness, anxiety and a feeling of excessive heat, (C) General loss of weight. From what has been started in the functions of thyroid hormones (earlirer in this chapter), the explan ations of these symptoms should be reasonably obvious. The laboratory investigational features and the rationality of drug therapy have been discussed later on Cause, In this disease, a specific antibody, called thyroid stimulating antibody (TSAb) or thyroid stimulating immunoglobulin (TSF) is produced by B lymphocytes of the patient. The TSAb biologically behaves like the TSH of the anterior pituitary (i. e , it causes increased secretion of thyroxine) But it ts not influenced by the serum T3 or T4 levels Or in other words, the TSAb combines with the receptors meant for the TSH in the thyroid cells, but unlike the TSH, is not inhibited by the rising concentration of the Thyroxine, However, high concentration of the T4 and T3 m these patients cause suppression of the

organification of extra .amount ofiodine does not occur The whole phenomenon is called

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me. the iodine trapping mechanism becomes less efficient, and organification of extra .amount ofiodine does not occur The whole phenomenon is called auto re gulation of the thyroid gland In this way, the availafability of iodine for thyroxine synthesis remains constant even in the face of wide fluctuation of food iodine content Mechanism of auto regulation may be as follows less iodine makes The thyroid gland more sensitive to the TSH (recall, the TSH helps in iodinetrappping) and vice versa Exposure to cold and thyroid secretion are int err elated, specially in the new born When exposed tothe cold external world, the freshly bom baby shows a rise of TH secretion. It appears that the stimulus of cold acts on the hypothalamus -- increased secretion of TRH rise of TSH rise of T4. Hypothalamus - piturtary - thyroid axis can now be underswood. These three structures (viz hypo-pit_thy) act in a concert and taken together they form an axis. A break down, anywhere in the axis causes a break down of thyroid regulation and causes signs and symptoms (disease). DEGRADATION OF T4 AND T3 Some 20 to 30% of the total thyroid hormones (T4 and T3) are conjugated in the liver usually with glucuronic acid, and is exreted with bile and undergoes enterohepatic circulation. Rest of the hormone (i. e . about 70%) is deaminated. The deaminated products are tetraiodothyro acetic acid and triiodothyroacetic acid, [abbreviated, tetrac and triac respectively] They undergo still further changes and then finally metabolically disposed. APPLIED PHYSIOLOGY Hyp of unction Two forms of hypofunction of the thyroid are known, viz. cretinism and adult hypathyroidism. The clinical Fig. 6.2.5. Summarised view of signs and symptoms of cretinism features are described here,the description of laboratory features has been given later Cretinism it hypothyroidism in the young Clinical features, in a full blown cast, are. retardation of growth of all forms, namely, physical, mental and sexual As a result the child is dwarf, pot bellied (because the muscles of abdomen are weak but abdominal visceral growth not severely restricted) and mentally idiot or imbecile

fibrosn), pleura (pleural effusion), heart (congestive cardiac failure), chest wall (kyphcsis).

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abdominal cavity (ascites) are common diseases known for their ability t0 reduce VC Utility of the VC measurement VC is often of prognostic value (ii) it gives also an idea about the progress of a chronic disease Thus, in a case of emphysema, gross, reduction of VC isof unfavourable prognosis Or, in the same case of emphysema, over a few years, if the VC shows prgressive detenoration, the physician understands that the taease is steadily progressing (iii) In assessment of physical fitness. VC is of some help Thus in highly physically fit perrsons (sportsmen) VC is high, and vice versa Timed vital capaciy In early stages of many chronic diseases, e. o emphysema. the volume of VC may remain withim normal limits but the Timed vital capacity may show

Bronchial tree to collapse particularly during expiration (b) Non-Obstructive ventilator, defects restrictive generalized fibrosis of the lungs atypic

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gory of non-revarsble defect, emphysema is a tipical example in advanced emphysema the negativity of intrapleurral pressure tends to disappear to that traction on the bronchial tubes becomes less than normal This produces a tendency of that Bronchial tree to collapse particularly during expiration (b) Non-Obstructive ventilator, defects restrictive generalized fibrosis of the lungs atypical example, Because of the fibrosis, the lungs do not expand statisfactonly resulting in ventilator defects Hypodynemic Disease of the thoracic wall leading to stiffness of the thoracic wall. Paralysis of the muscles of inspiration lading to weak respiratory movement is good example of this group. Defective gaze out exchange The term alveocapilary block' means a condition where due to ( thickness of the alyeolocapillary barrier the gaseous exchange 11 defective Eumple pulmonary edema, pneumonia. Hamman Rich syndrome (fibrosing alveolitis) and so on Aiveolar hypove ntiIation in This condition. respirtory are reducally due to (fault in the re spirator y center Examples of this type are drug inductd hypofunction of the respiratory center (morphine/ barbiturate), and lesion in the stem Pickwickian syndrome also falts in this category. The extremely rare and fascinating syndrome called Ondine's curse also comes in this category. Alveolar hypoventilation may also be due to hypody namic ventilatory defects like diaphragmatic paralysis: SPlROMETER In this instrument (fig.4.6.3a) a lid, 1. rests over water contained in a container, C. Arrangements ara such that when the subject breathes. he breathes in and out through a tube connected with the spirometer, and when he expires. the lid 1 is pushed up and when he inspires the lid 1. goes down. The movements of the lid (which are up wards and' down wards) are recorded on a graph paper. The graph paper is pasted over a drum and the drum is movad by a motor. The speed of the drum can be regulated and the reconding arrangement is such that when an inspiration is taken, it results in an upward stroke on the graph paper and expiration cause downward stroke. The graph paper is calibhrated so that the investigator can know the volume of air (in ml) equivalent to 1 mm of movement in the upward or downward direction (e.g. 1 mm = 30 ml of air). Similarly the speed of the drum being known the abscissa represents time in seconds. Lung volumes and lung capacities (fig. 4. 6. 4) Tidal volume (VT) is the volume of air inspired or ex-pired b an individual peres irato excursion at rest:. value for normal healthy young adult is about 500 ml. Inspiratory Reserve Volume. From top end of a tidal volume (VT) inspiration phase. the subject makes a maximal inspirtory effort. The extra air that is drawn in (fig 4 .6. 4) is the inspiratory reserve volume (IRV) Normal value is about 2000 to 3000 ml. Expiratrory reserve volume (ERV) From the end expiratory position (fig. 4.6.4) of the tidal volume breathing, the subject makes the hirdest eipiratory effort The exrtra air that comes out isThe EPV Normal value is about 1000 ml. Residual Volume (RV)after even the severest expiratory effort the lungs. sill contain some air. called residual volume. Normal value, about 1500 ml Capacities: Inspiratory capacity (IC) = IRV +VT Functional residual capacity (FRC) = ERV + RV (i) Vital Capacrly = Inspiratory capacity +ERV Note that as a rule, a 'capacity' includes more than one volume Vital capacity (VC. also called forced -vital capacity. FVC) By definition. it is the volume of air breathed out by the most forcible expiratory elrort after a maximal inspiration. As stated eartier VC or FVC = IC + ERV Therefore. in normal persons, its value should be about (2500 to 3500 ml) + 1000 ml, that is between 3. 5 to 4.5 liters, approximately VC depends on many factors, some are given below Age VC is low in old people Size Normally. VC rt about 2. 6 1/sq meter of body surface in male and 2.1 1/sq meter in females. Posture: In lying position it is low. it is highest when the subject is seated in slightly reclined position in a Chair Posture affects the VC because the position of diaphragm and the tone of abdominal muscles change with posture. On lying the diaphragm goes little up whereas on standing. the abdominalc mustles become tense, both reducing the VC Sex As noted already. VC is lower in the females Physical training A well trained stponsman or a hardworkmg manual labourer has a higher VC Following well known condition Cen reduce the VC A Physiological in pregnancy, (pertculariy in advanced stage) VC n low This u due to the inablity of the diaphfagm to go down satisfactonly B PathalogicalDneases of the lungs (emphysema

The arms are flexed and crossed with tightly clenched fists and the toes flexed. The back is very rigid Cyanosis and apnoea accompany the more severe

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respiration. 5. Neonatal tetanus - due to sepsis of the umbilical stump. Typically the weekold infant presents with inability to suck because of spasm of facial and pharyngeal muscles, or with generalized convulsions. Crying is hoarse and the face screwed up, with tightly closed eyes and wrinkled forehead The arms are flexed and crossed with tightly clenched fists and the toes flexed. The back is very rigid Cyanosis and apnoea accompany the more severe spasms. Severity of tetanus: Grading Gr. I (mild) - Mild to moderate lockjaw, generalized spasticity, no spasms or respiratory difficulty. Gr. II (moderate) - Well marked rigidity, brief spasms, mild dysphagia, tachypnoea (>3Q-35/min) Gr III (severe) - Severe trismus, generalized spasticity, prolonged spasms often spontaneous, tachypnoea (>4Q/min), apnoeic spells, marked dysphagia, tachycardia, increased autonomic MS disturbance. Gr. IV (very severe) - (Gr. III features plus severe autonomic storms) - severe hypertension and tachycardia alternating with relative hypotension and bradycardia, or severe persistent hypertension. or hypotension Differential Diagnosis -1 Other causes of trismus - (a) Irritant local lesions of teeth (dental abscess, pericoronitis), throat (peritonsillar abscess), temporomandibular joint, masseter muscle and cervical lymph nodes (b) Occasionally postvaccinial and postinfectious encephalitis, serum sickness and even poliomyelitis. It is commonly observed in patients envenomed by sea snakes . 2. Meningitis - Neck rigidity can occur in both tetanus and meningitis. Signs of meningeal irritation, diagnostic CSF. 3. Rabies - Dysphagia associated with spasms of inspiratory and pharyngeal muscles also occurs in rabies. No trismus. Relaxation of ms. inbetween paroxysms. 4. Tetany - Spasms start in periphery with carpopedal spasm. Usually associated with overbreathing or thyroid surgery. 5. Drug dystonia - Dystonic reactions to drugs such as phenothiazines and metoclopramide. Grimacing, spasmodic neck retraction and torticollis, wide opening of the mouth and eyes Prompt response to diazepam or benztropine. 6. Acute peritonitis - Board-like abdominal rigidity as in tetanus, but in tetanus there is little or no tenderness. 7. Functional muscle spasms - Bizarre movements or posture, absence of constant rigidity of involved muscles, history of previous personality disorder. 8. Catatonic schizophrenia - might cause confusion in absence of background information. CLINICAL COURSE - Most deaths occur by 10th day Spasms usually subside by end of second or third week, but residual muscle stiffness may persist for more than a month. Complications 1 Respiratory - (a) Bronchopneumonia common cause of death, results from aspiration of stomach contents, blockage of airways by sticky secretions and lung collapse. (b) Asphyxia - may be due to one or both of the following - (i) Pharyngolaryngeal spasm - Sudden and unexpected stridor, respiratory distress or cyanosis in an early case of tetanus is due to spasm of muscles of upper airway. (u) Respiratory muscle fixation - A patient without any major reflex muscle spasms may still die from complications of chest fixation in which the general hypertonicity involves pectoral muscles, intercostal muscles and muscles of the abdominal wall reducing vital capacity markedly. (c) ARDS-chiefly due to respiratory sepsis. 2. Due to spasms - Spasms can tear muscles and even avulse their insertions, with subsequent articular and

Late complications - (a) Bronchiectasis. (b) Immuno-suppressive measles encephalopathy - 1-6 months after an attack of mild or atypical measles in chi

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complication. Headache, confusion, coma and convulsions result from autoimmune demyelination. 6 Hepatitis - usually in young adults with severe disease. Frank jaundice may occur. May be giant cells in the liver. Spontaneous resolution. 7. Late complications - (a) Bronchiectasis. (b) Immuno-suppressive measles encephalopathy - 1-6 months after an attack of mild or atypical measles in children receiving cytotoxic drug therapy. Neurological damage is severe. (c) Subacute sclerosing panencephalitis (SSPE) -It occurs about 4-7 years after mild disease, evolves over a period of months or years, almost always ending fatally. Post-measles state - results from powerful immunosuppressive effect which alters immunity and the tissue-destructive effect of measles. Clinical features - Gradual deterioration into chronic illness (a) Growth retardation and diarrhoea - often with anorexia. May precipitate protein-energy-malnutrition. (b) Gingivo-stomatitis - with oral herpes, persistent pyrexia, worsening pneumonia, increasing hepatomegaly and encephalopathy. (c) Corneal ulcers mainly in malnourished children. (d) Other uncommon complications - Gangrene of tips of fingers and toes, cancrum oris, septicemia, candidosis, reactivation of pulmonary tuberculosis, possibly abortion or prematurity if infection occurs during pregnancy. Diagnosis -can be confirmed retrospectively with paired serology, salivary antibody detection is a non-invasive method of confirming the diagnosis. Differential Diagnosis - PRE EXANTHEMATOUS STAGE - Common cold, influenza, catarrhal stage of whooping cough. EXANTHEMATOUS STAGE -1. Rubella - No Koplik's spots, small shotty enlargement of suboccipital, posterior cervical and post-auricular lymphnodes; catarrhal symptoms and systemic disturbances slight. In measles mucous membrane is injected and dirty, in rubella it is pale and clean. 2. Drug eruption - especially that caused by ampicillin. Tends to persist longer and may have an urticarial element. Absence of catarrh and failure of rash to evolve from above downwards. 3. Serum rashes - Rash dense at site of injection, typical wheals. 4. Infectious mononucleosis - Fever, adenopathy, and sore throat. Maculopapular rash, splenomegaly. Atypical lymphocytes in blood smear. 5 Erythema infectiosum - Rash but usually no constitutional symptoms. Rash appears in three phases It begins with livid erythema of the cheeks (slapped cheeks), followed by maculopapular rash on extremities and trunk, and as the rash fades it has a lacy reticular appearance. 6. Roseola infantum (Exanthema subitum) - Acute viral disease of young children. 3 to 4 days of high fever. As fever falls by crisis, pink maculopapules appear on chest and trunk and fade in 1-3 days. 7. Erythema multiforme - Circular or irregular erythematous blotches usually occurring on backs of hands and forearms. Constitutional symptoms may be present. 8. Other exanthemas - (a) Coxsackie virus A. Hand-foot and mouth disease is the most specific syndrome. After a short prodroma of malaise, anorexia and fever, a vesicular exanthem develops involving buccal mucosa. A vesicular exanthem also appears on hands and feet in many patients. (b) Other viral infections - Adenovirus, parainfluenza virus, respiratory syncitial virus may occasionally be associated with macular or maculopapular rashes. 9. Paratyphoid - Sometimes profuse pinkish brown maculopapules. Longer prodromal illness, characteristic temperature chart, agglutination test

Carbamazepine is 5H-dibenz(b,flazepine-5-carboxamide. Category: Anticonvulsant. Dose: 200 mg daily, increasing to 1.2 g daily, in divided doses, in ac

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heating Sucrose or Dextrose until the sweet taste is destroyed. Category: Pharmaceutical aid (colouring agent). Description: Thick, free-flowing, dark brown liquid; odour, slight and characteristic.Solubility Miscible with water, with dilute alcohols (upto 60% v/v), with dilute mineral acids and with solutions of sodium hydroxide; immiscible with chloroform and with ether. It is precipitated by strong alcohols (more than 60% v/v).Storage: Store in tightly-closed containers. STANDARDS Identification: To 20 ml of a 5% w/v solution add 0.5 ml of phosphoric acid; no precipitate is produced Weight per ml: Not less than 1.30 g. Appendix 3.15 pH: Between 3.0 and 5.5, determined in a 10% w/v solution, Appendix 8.11. Acid-stability Dilute 50 ml of a 1 % w/v solution to 250 ml with water, add 5 ml of hydrochloric acid and heat gently to boiling under reflux. Allow to cool and set aside for 24 hours; the solution remains clear. Repeat the test on the same testsolution but boil for 30 minutes; the solution remains clear for 24 hours. Heavy metals Not more than 10 ppm, determined on 2 g by Method B, Appendix 3.12 Iron: Evaporate 0.44 g to dryness, add 0.2 ml of nitric acid, ignite and dissolve the residue in 1 ml of dilute nitric acid: the solution complies with the limit test for iron, Appendix 3.13 (100 ppm). Sulphated ash: Not more than 2.0%, Appendix 3.22. Microbial limits: 1.0 g is free from Escherichia coli andsalmonellae, Appendix 9.4. Carbamazepine is 5H-dibenz(b,flazepine-5-carboxamide. Category: Anticonvulsant. Dose: 200 mg daily, increasing to 1.2 g daily, in divided doses, in accordance with the needs of the patient. Description: White or yellowish-white, crystalline powder; almost odourless; exhibits polymorphism.Solubility Freely soluble in dichloromethane, soluble in ethanol (95%) and in acetone; practically insoluble in water and in ether.Storage: Store in well-closed containers. STANDARDSCarbamazepine contains not less than 97.0 per cent and not more than 103.0 per cent of C15H12N2O, calculated with reference to the dried substance. Identification: A: Heat O I g with 2 ml of nitric acid in a water-bath for 3 minutes; an orange-red colour is produced. B: The light absorption in the range 230 to 360 run of a 0.001 % w/v solution in ethanol (95%) exhibits a maximum only at about 285 ran; absorbance at about 285 nm, about 0.49, Appendix 5.5.C: Exhibits an intense blue fluorescence under ultra-violet light (365 nm). D: Melts between 189° and 193°, Appendix 8.8. Acidity or alkalinity: Stir 1 g with 20 ml of carbon dioxide free water for 15 minutes and filter. Titrate 10 ml of the filtrate with 0.1 M sodium hydroxide using 1 drop of phenolphthalein solution as indicator; not more than 0.5 ml is required Add 3 drops of a 0.05% w/v solution of methyl red and titrate with 0.01M hydrochloric acid until the colour changes to red; not more than 1.0 ml is required Chloride: 1.5 g complies with the limit test for chlorides, Appendix 3.10 (165 ppm). Heavy metals: Not more than 10 ppm, determined on 2.0 g by method B, Appendix 3.12. Related substances: Carry out the method for thin-layer chromatography. Appendix 4.6, using silica gel G as the coating substance and a mixture of 95 volumes of toluene and 5 volumes of methanol as the mobile phase. Apply separately to the plate 10 g1 of (1) a 2.5% w/v solution of the substance being examined in chloroform; (2) a 0.005% w/v solution of iminodibenryl RS in methanol. After removal of the plate allow it to dry in air for 15 minutes and spray with a 0.5% w/v solution of

Another Indonesian maid suffers abuse in Malaysia

2009-07-26T01:20:00.000-07:00

Another Indonesian maid has allegedly been abused by a Malaysian employer.Modesta Rangga, 26, told the Indonesian Embassy on Friday she had been abused almost daily since she started working with her employer in Kampung Ampang Baru, a suburb of Kuala Lumpur, Malaysia, almost two years ago.Modesta claims she suffered a severed right earlobe, and had bruises on her body and thighs as well as scars on her face.She alleged that her employer had hit her with a cane, sticks and even punched her in the face and body, and also claimed she was only given one meal per day, sometimes none at all.“My boss would sometimes throw rice into the drain and make me eat from there,” said Modesta, who was born in Sumba Barat, Nusa Tenggara Timur.Modesta also claimed she had not been paid since she started working with her employer in November 2007. Her salary was supposed to be RM500 (Rp 1.4 million) a month.The latest incident allegedly happened at midnight on Thursday after her employer asked her why she had not done the laundry.“I told my boss it was going to rain and I was afraid the clothes would get wet if I aired them. She just started hitting me and locked me out of the house,” Modesta said, adding that her employer would also make her work in her mother’s house in Kampung Baru.Neighbours who saw the maid outside the house alerted the police.Police picked up the employer for questioning at Pandan Indan police station and later remanded her. Modesta was sent to Ampang Hospital for treatment.Indonesian Embassy spokesman Widyarka Ryananta said doctors confirmed Modesta’s hearing had been impaired. “Her right eye is also damaged,” Widyarka said.

: The infra-red absorption spectrum, Appendix 5.4, is concordant with the reference spectrum of captopril or with the spectrum obtained from captopril

2009-07-26T01:18:00.000-07:00

off-white, crystalline powder; odour, characteristic, sulphide-like. Solubility: Freely soluble in water, in methanol, in ethanol (95%) and in chloroform.Storage: Store in tightly-closed containers STANDARDSCaptopril contains not less than 97.5 per cent and not more than 102.0 per cent of C9H15NO3S, calculated with reference to the dried substance. Identification: A: The infra-red absorption spectrum, Appendix 5.4, is concordant with the reference spectrum of captopril or with the spectrum obtained from captopril RS. B: Carry out the method for thin-layer chromatography. Appendix 4.6, using silica gel G as the coating substance and a mixture of 75 volumes of toluene, 25 volumes of glacial acetic acid and 1 volume of methanol as the mobile phase, -but allowing the solvent front to ascend 12 cm above the line of application. Apply separately to the plate, in the form of 1-cm bancte, 50 ul of each of the two solutions in methanol containing (1) 0.4% w/v of the substance being examined and (2) 0.4% w/v of captopril RS. After removal of the plate, allow it to dry in air and spray with a freshly prepared mixture of 1 volume of strong ammonia solution and 6 volumes of a 0.04% w/v solution of 5,5'-dithiobcte(2-nitrobenzoic acid) in methanol and allow to stand for 5 minutes. The principal band in the chromatogram obtained with solution (1) corresponds to that in the chromatogram obtained with solution (2).C: Melts between 104° and 110°, Appendix 8.8. Specific optical rotation: Between -125° and -134°, determined in a 1 % w/v solution in ethanol, Appendix 8.9. Heavy metals: Not more than 30 ppm, determined on 0.66 g by Method B, Appendix 3.12. Sulphated ash: Not more than 02%, Appendix 3.22. Loss on drying: Not more than 1.0%, determined on 1 g by drying at 60° at a pressure not exceeding 0.7 kPa, Appendix 8.6. Assay: Weigh accurately about 0.3 g, dissolve in 100 ml of water in a stoppered-flask, add 10 ml of 1.8M sulphuric acid and 1 g of potassium iodide. Titrate with 0.0 25M potassium iodate using 3 ml of starch solution, added towards the end-point, as indicator Each ml of 0.025M potassium iodate is equivalent to 0.03308 g of C9H15NO3S.CAPTOPRIL TABLETS Usual strengths: 12.5 mg; 25 mg; 50 mg. Storage: Store in tightly-closed containers. STANDARDSCaptopril Tablets contain not less than 90.0 percent and not more than 110.0 per cent of the stated amount of captopril, C9H15NO3S. Identification: A Comply with test B described under Captopril, using as solution (1) the clear supernatant liquid obtained by extracting the powdered tab lets equivalent to 100 mg of Captopril with 25 ml of methanol and centrifuging. Dissolution: Comply with the dissolution test far tablets and capsules, Appendix 7.3, using Apparatus 2, as the medium 900 ml of 0.1M hydrochloric acid and rotating the basket at 50 rpm for 20 minutes. Withdraw a suitable volume of the sample and filter. Measure the absorbance of the filtrate, suitably diluted with the dissolution medium, if necessary, at the maximum at about 212 nm, Appendix 5.5. Calculate the content of CGH15NO3S in the medium from the absorbance obtained from a solution of known concentration of captopril RS in the same medium and from the declared content of C9H15NO3S in captopril RS. D: Not less than 80% of the stated amount of C9H15NO3S. Other requirements: Comply with the

SBI Mutual Fund Uses IVR to Boost Customer Experience

2009-07-26T01:16:00.000-07:00

An independent IT solutions and services company announced that it's implemented an interactive voice response, or “IVR” solution for an India asset management company to help manage its mutual funds arm.
Datacraft installed IVR technology at SBI Funds Management, a company that manages more than 100 different funds under SBI Mutual Fund, to help improve customer interaction and let customers use their voice to obtain the latest Net Asset Values of SBI’s Mutual Fund schemes.

The technology features a speech recognition solution powered by Nuance (News - Alert) that's designed to increase users’ experiences. The solution is designed to help SBI Mutual funds enhance customer satisfaction, reduce time to service people and increase agent productivity at the customer support center, the company said.

The speech-enabled IVR service will likely play a key role in improving the end-user interaction, Datacraft said. A touchtone-only environment would have made the system cumbersome and likely would have frustrated customers, officials said.

“The solution will improve customer service by offering more intuitive access to information and streamlining transactions,” said Sunil Manglore, CEO at Datacraft India, in a statement. “In addition, the solution will also increase customer satisfaction by shortening on-hold time and overall call duration.”

SBI Funds Management selected speech-enabled IVR based on surveys of customer calls and an analysis of call patterns. Datacraft India offered consulting and application development services to design and implement the IVR solution, the company said.

IVR services are crucial to ramping up a company’s brand image in the wake of growing competition in India's financial services sector. Datacraft’s deployment of such a service demonstrates the company’s ability to improve the interaction between clients and their customers, Manglore said.

The recent announcement supports a recent report from market research firm T3i Group that found that the global IVR market will grow to $514 million by 2013, up from an estimated $431 million this year. As TMCnet reported, the IVR market is growing because of a resurgence of self-service applications, as well as the power of VXML to link Web applications to voice.

A separate report by market research firm DMG Consulting predicted that the IVR solutions market will see a CAGR of 13.4 percent for the hosted/managed inbound IVR sector and 18.7 percent for the outbound IVR segment over the next four years.

Datacraft, a subsidiary of global IT solutions and services provider Dimension Data, operates more than 50 offices across 13 Asia Pacific countries. The firm helps clients plan, build, support, manage, improve and innovate IT infrastructures.Amy Tierney is a Web editor for TMCnet, covering unified communications, telepresence, IP communications industry trends and mobile technologies. To read more of Amy's articles, please vi

SC to decide on 'dividend stripping' by mutual funds

2009-07-26T01:15:00.000-07:00

The Supreme Court will decide whether mutual fund brokers can resort to a process (dividend stripping) of creating a short-term loss to avoid tax.
A Bench headed by Justice S H Kapadia has issued notice broking firms on a batch of petitions filed by the income-tax department challenging the Bombay High Court judgment that a broker was entitled to have his/her loss set off against income from any other transaction or source.
Dividend stripping happens when a mutual fund declares a tax-free dividend for unit-holders, who after taking the dividend exit the scheme. The net asset value of the scheme declines and unit-holders are able to show a capital loss. As a result, the exchequer misses a chance to tax capital gains.
However, the unit-holder gets the dividend and the mutual fund earns the entry and exit load.
According to the petition, these agents resort to dividend stripping as they know that after the dividend is declared, the net asset value (NAV) of the MF decreases.
Brokers purchase units at a higher price and sell them immediately after the declaration of dividend, knowing that the sale of such units would result in a loss, which they could adjust against the profits derived from the sale and purchase of shares and securities, it added.
In one case, the department alleged that Bang Security had received as dividend more than Rs 14 crore from mutual funds between 1999 and 2001 and had claimed exemption from tax under Section 10 (33) of the Income Tax Act, 1961.
However, at the same time it had shown a loss of Rs 14.35 crore incurred between 2000 and 2002 from purchasing units.

. Acid-insoluble ash: Not more han 1.0% in Sumatra Benzoin and not more than 0.5% in Siam Benzoin, determmed on 2 g, Appendix 3.39 Loss on drying: Not

2009-07-26T01:12:00.000-07:00

75.0% in Sumatra Benzoin and not less than 90.0% in Siam Benzoin, determined by the following method. Weigh accurately about 2 g, in coarse powder, in a tared extraction thimble and insert the thimble in a Soxhlet or other suitable continuous extraction apparatus Place 0.1 g of sodium hydroxide in the receiving flask of the apparatus, extract with ethanol (95%) until extraction is complete (about 5 hours), dry the thimble lo constant weight at 105° and calculate the ethanol soluble extractive from the increase in weight of the thimble. Acid-insoluble ash: Not more han 1.0% in Sumatra Benzoin and not more than 0.5% in Siam Benzoin, determmed on 2 g, Appendix 3.39 Loss on drying: Not more than 10.0%, determined on 2 g, in coarse powder, by drying over phosphorus pentoxide al a pressure not exceeding 2.7 kPa for 4 hours, Appendix 8.6 Assay: Weigh accurately about 1.25 g and boil with 25 ml of dilute ethanolic potassium hydroxide solution under a reflux condenser for 1 hour. Remove the ethanol and digest the residue with 50 ml of hot waler until diffused Cool the liquid, add 150 ml of water and 1.5 g of magnesium sulphate dissolved in 50 ml of water Mix thoroughly and sel aside for 10 minutes. Filter, wash the residue on the filter with 20 ml of water, acidify the combined filtrate and washings with hydrochloric acid and extract with successive quantities of 50, 40, 30, 30 and 30 ml of ether Combine the ether extracts and discard the aqueous portion. Extract with successive quanlilies of 20, 20, 10, 10 and 10 ml of sodium bicarbonate solution, washing each aqueous extract with the same 20 ml of ether. Discard the ether layers, acidify the combined aqueous extracts with hydrochloric acid and extract with successive quantities of 30, 20, 20 and 10 ml of chloroform, filtering each chloroform extract through a plug of cotton wool on which a layer of anhydrous sodium sulphate is placed Evaporate the chloroform on a water-bath until about 10 ml remains and remove the remainder in a current of air stopping immediately when the last trace of solvent is removed. Dissolve the residue by warming with 10 ml of ethanol (95%), previously neutralised lo phenol red solution, cool and titrate with 0. IM sodium hydroxide using phenol red solution as indicator. Each ml of 0.1 M sodium hydroxide is equivalent to 0.01482 g of total balsamic acids, calculated as cinamic acid, C9H8O2, in Sumatra Benzoin and 0.01221 g of total balsamic acids, calculated as benzoic acid, C7H60?, in Siam Benzoin. COMPOUND BENZOIN TINCTURE Friars' BalsamBenzom, in moderatety coarse powder Macerate the Benzoin, Prepared Storax, Tolu Balsam and Aloes with 800 ml of Ethanol (90%n) in a closed vessel for not less than 2 days with occasional shaking Filler and pass sufficient Elhanol (90%) through the filter to produce the required volume Category: Topical protectant, expeclorant and comforting by steam inhalation in acute laryngitis,. Storage Slore in tighlly-closed, hght-resislant containers and avoid exposure to direcl sunlight and lo excessive heat Labelling: The label slates that it is flammable. STANDARDSCompound Benzoin Tincture contains not less lhan 45 per cent w/v of lotal balsamic acids, calculated as cinnamic acid, CgH8Oldentification: A: Complies with lest D described under Benzoin using as solution (1) a solution prepared by diluting 1 ml with 4 ml of elhanol (95°I0) .[The chromatographic profile may vary depending on the variety of Benzoin used). B: Carry out test D described under Benzoin but using Ihe following solutions For solulion. (1) dilute 1 ml with 4 ml of elhanol (95%). Solution (2) is a 0.05% w/v solulion of styrene RS in chloroform. The chromatogram obtained with solution (1) exhibits an intense spot corresponding to the spol in the chromalogram obtained wilh solution (2) (Prepared Slorax). C: Carry out test D described under Benzoin but using the following solutions. For solution (1) dilute 1 ml with 4 ml of ethanol (95%). Solutions (2), (3), (4) and (5) are 0.05% w/v solutions of benzoyl benzoate RS, benzoyl cinnamate RS, eugenol RS and vanillin RS respectively in chloroform. The chromatogram obtained with solution (1) exhibits spots corresponding to the spots in the chromatogram obtained with solutions (2), (3), (4) and (5) (Tolu Balsam). D: Carry out the method for thin-layer chromatography, Appendix 4.6, using silica gel G as the coating substance and a mixture of 100 volumes of ethyl acetate, 13.5 volumes of methanol arid 10 volumes of water as the mobile phase but allowing the solvenl front to ascend 10 em above the line of application Apply separately to the plate 50 ul of each of the following solutions as bands 20 mm long and nol more than 3 mm wide For solulion (1) dilute 1 ml with 4 ml of ethanol (95%). For solution (2) use a 0.5% w/v solution of barbalom RS m methanol. After removal of the plate, allow it to dry in air until the odour of the solvenl is no longer detectable, spray with a 10% w/v solution of potassium hydroxide m methanol and examine under ultra-violet light (365 nm). The chromatogram obtained with solution (1) exhibits a yellow fluorescent band corresponding to the band obtained m the chromatogram obtained with solution (2) and a light blue fluorescent band wilh a lower Rf value due to alcesine. Heat the plate al 110° for 5 minutes; a violet fluorescent band just below the band corresponding to barbaltion may also be seen in the chromatogram obtained with solution (1) (Aloes). Weight per ml: Between 0.870

MFs give arbitrage funds a break, stop fresh inflows

2009-07-26T01:11:00.000-07:00

MUMBAI: At a time when domestic mutual funds continue to aggressively scramble for more money to boost their asset base, they have made an exception
arbitrage funds. Several top arbitrage schemes of mutual funds have stopped accepting fresh money from investors, as lack of sufficient arbitrage opportunities between the cash and futures markets have made it tedious for them to generate competitive returns to the existing unitholders itself. Top schemes in the category, including Kotak Equity Arbitrage, UTI Spread, ICICI Prudential’s Blended Plans and Equity and Derivative Income Optimiser Plans, are no longer taking money, officials at these mutual funds told ET. Mutual fund distributors said HDFC Arbitrage, IDFC Arbitrage Plans and JM Arbitrage Advantage have also been closed to fresh subscriptions, though this could not be independently verified with them. Sandesh Kirkire, CEO of Kotak Mutual Fund, which manages the biggest arbitrage fund of roughly Rs 1,000 crore, said: “We decided to stop accepting fresh money, keeping in mind the interests of the existing holders because the market is hardly conducive for arbitrage.” Arbitrage schemes, considered relatively risk-free, aim to profit from the pricing anomalies between shares and equity futures. While they use at least 65% of their fund corpus to take advantage of such pricing anomalies, these hybrid schemes are structured to invest up to 35% of their corpus in money market papers such as certificate of deposits and commercial paper. Arbitrage opportunities are at its best in a bull market, when futures trade at a premium to the underlying shares or indices. This allows traders to buy the underlying and sell futures. Analysts say nowadays, futures are mostly trading at a discount to the underlying, resulting in fewer opportunities to cash in on the price differentials. The interest rate scenario of late has also not been favourable for these funds, unlike last year when they switched to money market instruments to sustain returns in the absence of arbitrage opportunities. In the bull run, these schemes aimed at returning 9-11%, but in the last year, average returns from this category have been roughly 7%, according to Value Research, a mutual fund tracker. Funds fear that the returns from this category would shrink further if assets grew more, with these schemes finding favour among the risk-averse investors, amid the existing uncertainty. “It did not make sense to accept more applications at the expense of the existing unitholders. This is a temporary measure,” said Nilesh Shah, deputy MD and CIO of ICICI Prudential Asset Management.

an AP develops in the motor nerve released from The nerve terminal EPP de-velops on the post June tonal membrane if it (the EPP) is of sufficient magn

2009-07-26T01:10:00.000-07:00

muscles when repeated contractions are attempted, muscular weakness and even frank neuromuscular transmission block. Besides, DFP. as slated above, heavy dose of corlisol (in the hope of destroying the antibody) is also used for treatment 7. Muscle relaxants During surgical operations in the abdomen. muscles should be satisfactory lelaxed. as this helps adequate re-, traction of the abdominal wound. This, of course can be achieved by deepening the level of anesthesia, but this is not preferred. An alternative procedure is to use the muscle relaxants which (by different mechanisms) can produce a neuromuscuJar block so that the tone of all the skeletal muscfes iincluding the muscles of respiration) are reduced wilhout using a heavy dose of anesthesia. As can be understood, possibility of the respiratory paralysis has to be guarded against. recall, this enzyme destroys ACh. SUMMARY & HIGHLIGHTS Under light microscopes, some differences are seen between skeletal and canjiac muscles, but EM features and mechanism of contraction (called ratchet or sliding theory) of these two types of muscles aie remarkably similar. Contractile elements are. (i) myosin. and (2) actin. When an AP develops on sarcolemma more free Ca++ ions become available within thecytosol of muselee ell uncovering of the active sites of theaclin modules attachment ol the myosin heads into the active sites, occur, New, these heads rotate-> actin filament moves forward (towards the H zone) the head deatlaches ->again reattaches to a new active site and so Ihe sarcomere length reduces and the muscle as a whole shortens. ATPs are required for the rotation and deattachment of the heads.Neuromuscular transmitter is ACh. When an AP develops in the motor nerve released from The nerve terminal EPP de-velops on the post June tonal membrane if it (the EPP) is of sufficient magnitude, an AP of the muscle develops contraction occurs. This neuromuscular transmission can be abolished by succinyl choline [(depalarizing blocker, a twitch followed by paralysis)] curare [(competitive antagonist), no twitch before the paralysis] and so on. 1. Introduction 2 Instruments for study.3. Some commonly used terms. The properties. A. Mechanical (i) Response to a single stimulus. The simple muscle curve. ii. Summation. (@ Clonus and tetanus - Response to repeated stimuli, (iv) all or none' law. v) Fatigue. (9 Effect of terrnpeiature and load. (>o Force of contraction. Factors influencing force of contraction. Length tension relationship. Force velocity relationship. (viii) Lever action of muscles, (ix) Summary. B. Thermal properties.C. Electrical properties.5. EMG 6. Energy expenditure during muscular contraction. Introduction Studying the properties of skeletal muscles, forms the basis of 'nerve muscle physiobgy' of the undergraduate students of medical physiology. In the practical classes it is commonly performed on frog's skeletal muscle. There are a number of reasons why the frog is chosen as an experimental animal for this purpose : (i) the animal is cheap, but more important reason is (ii) a skeletal muscle separated from this animal's body (and thus bereft of its vascular supply) remains alive at room temperatures of Indian laboratories for several hours. A mammalian skeletal muscle preparation. once isolated, dies quickly. For this reason, if experiments are intended on mammalian sketetal muscles, elaborate arrangements, (which are often not very practicable for a mass of students) are necessary. Nevertheless, the informations obtained Irom such isolated nerve muscle preparations of frogs, are reasonably dose to those from the mammalian muscles. In the following pages. properties (Characteristics) of skeletal muscles will be discussed. These properties should be compared and contrasted with those of the cardiac muscles (chap.2. sec. V) and the smooth muscles (chap. 4. sec. IX). Procedure and instruments for study Commonly, the frog is made unconscious by a sharp stun on the laboratory bench (stunning). This is followed by pithing In pithing, a sharp needle is introduced through the foramen magnum of the animal into its cranial cavity. By manipulating the needle, the brain is destroyed. The aim of stunning is to make the animal unconscious in quickest possible time; pithing is done while the animal is still unconscious. The twin procedures ensure that during subsequent procedures the animal does not feel pain and thus an avoidable cruelty is avoided. Subsequently, the spinal cord of the animal is destroyed by introducing the needle within the vertebral canal and rotating it re-peatedly. This destruction ensures loss of all spinal leflexes (which may. otherwise, be elicited in Ihe subsequent procedures) and thus prevents premature fatigue. It also makes the limbs toneless (flaccid) which facilitates dissection. Subsequently, the gastiocnemius soleus ('calf muscles') of one leg. together with the sciatic nerve (with its branch supplying the gastrocnemius soleus) is dissected out and isolated from the body. The branch supplying the gastrocnermius arises just above the knee joint and care must be taken to see that this twig to the calf muscle is not Tom during the preparation. Such a preparation is called the 'gastrocnemius sciatic' preparation. Instruments The aim is to give a single electrical shock to the sciatic nerve. The nerve is thus stimulated and generates an action potential. Eventually the nerve impulse crosses the neuromuscular junction and causes the muscle to contract. Arrangements for giving the electrical shock are as follows : A steady DC current is led off from a source, which is usually a dry cell battery. This current is led to a solenoid called the 'primary coil'. Superimposing the primary coil. there is another solenoid called the 'secondary coil'. The wires of the secondary are apposed but not in physical contact with the primary. As a result, when a DC current starts to flow or stops to flow (i.e. changes

Reliance Mutual Fund declares dividend for two schemes

2009-07-26T01:09:00.000-07:00

Anil Dhirubhai Ambani Group firm Reliance Mutual Fund today announced a dividend of up to 50 per cent for its two schemes: Reliance Regular Savings Fund and Reliance Equity Opportunities Fund
The company would pay a dividend of 50 per cent or Rs 5 per unit and 30 per cent or Rs 3 per piece under the equity and balanced options of Reliance Regular Savings Fund, respectively, it said in a statement.
The fund house has also announced a dividend of 20 per cent or Rs 2 per unit under the retail and institutional plans of Reliance Equity Opportunities Fund. It has fixed July 24 as the record date for dividends.
"Reinforcing the investors' faith, Reliance Mutual Fund has maintained its strategy of giving timely and regular dividends on its schemes," Reliance Capital Asset Management CEO Sundeep Sikka said.At the end of June, Reliance Mutual Fund has a corpus of over Rs 1,08,332 crore for over 71 lakh investors

TERIAL AGENTS - Every patient should receive Inj. Procain penicillin 50,000 U/kg for 10 days once a day IM. If sensitive to penicillin give Erythromyc

2009-07-26T01:08:00.000-07:00

carditis, prolonged bed rest is not necessary. Patients with definite myocarditis and valvulitis should be kept in bed until: (i) the intensity of heart murmur has diminished or has become stabilized, (ii) heart sounds are of good quality, (iii) sleeping pulse rate is below 100 per minute, (iv) hematocrit is rising or normal and the CRP is negative and (v) there is a true weight gain. Convalescence may often take G months or longer. General acceptable rules for bed rest are - Status 2. Diet - Aim is to maintain nutrition. Only fluids if moderate or high fever. Vitamins and minerals. 3. Drugs - control acute exudative manifestations. (a) ANTIBACTERIAL AGENTS - Every patient should receive Inj. Procain penicillin 50,000 U/kg for 10 days once a day IM. If sensitive to penicillin give Erythromycin 40-50 mg/kg for 10 days. (b) ANTI-INFLAMMATORY AGENTS - (i) Salicylates in the form of Aspirin 100 mg per kg body weight per day in 3-4 divided doses taken in milk or after meals. Continued for 2 weeks then scaled down to 75 mg/kg for 4-6 weeks for both arthritis alone, anchor carditis with or without cardiomegaly Signs of aspirin toxicity are - vomiting, tinnitus, and hyperpnoea. If these occur, the drug should be discontinued for one or two days and then restarted in a lower dose. (ii) Steroids - should be given when there is marked cardiac enlargement, failure, pericarditis. They suppress the activity and allow digitalis and diuretics to work, and if there is only potential failure risk of development of failure is minimised. Rebound phenomena (reappearance of clinical or laboratory signs of rheumatic activity) may occur when steroid medication is stopped or the dosage reduced Dosage - Prednisolone 2 mg/kg/day in divided doses for 2 weeks, gradually decreased over another 2 weeks. Aspirin should be started after 2 weeks of steroids and continued for 4 weeks beyond to prevent steroid rebound 4. Symptomatic treatment - (i) Local treatment - Cradle to lift bed clothing from affected joints. Heat, methyl salicylate and counter irritants. (ii) Cardiac failure - Digitalis - 0.03 - 0.05 mg/kg total dose orally, 3/4 this dose if parenteral digitalisation necessary. Give 1/2 dose stat, 1/4 after 8 hours, 1/4 after another 8 hours. Daily maintenance 1/4-1/5th total dose. Frusemide 2 mg/kg/day with oral pot. chloride, oxygen. (iii) Pain and restlessness - Codein for chest pain and cough. (iv) Anaemia - Iron by mouth. 5: Convalescence - Physical activity not undertaken until clinical and laboratory evidence of rheumatic activity have been absent for at least 2 weeks after stopping of salicylates. Restriction of physical exertion is not necessary where there is satisfactory compensation, and moderate degree of physical activity is desirable, but exercise should be increased gradually. PREVENTION AND PROPHYLAXIS -1. Immediate treatment of every suspected case of sore throat orstreptococcal infection with penicillin or erythromydn for 10 days. 2. Change of environment and improvement of nutrition. 3. Antimicrobial prophylaxis - Oral phenoxymethyl penicillin 200,000 units twice daily, or benzathine penicillin G 1.2 million units IM once every 3 weeks, or sulphadiazine 0 5 gm. twice daily in penicillin-allergic patients. For patients sensitive to sulphonamides and penicillin, Erythromycin 40 mg/kg/day can be used Prophylaxis must be continued till the patient is 25 years old, or for 5 years from the last attack of rheumatic fever whichever is longer. Preferably life-long as adults can get recurrences after many years. Must be used even in chorea. Rheumatic Chorea (Sydenhams Chorea, St. Vitus' Dance): Etiology: Age - maximum incidence at 10th year, rare after puberty. Sex - twice more common in girls. Predisposing factors - Mental strain, e.g. overwork at school, fright or shock, or pregnancy in young females Exciting cause - Majority due to acute rheumatic fever. Rarely scarlet fever, diphtheria, encephalitis, chickenpox. Chorea is regarded as a diffuse meningo-encephalitis affecting the basal ganglia, cerebral cortex and piaarachnoid Clinical features: Triad - of emotional instability, muscular weakness and semipurposeful movements Onset - Chorea may appear several weeks or months (usually more than 6 months) after an attack of acute rheumatic fever or it may be the initial symptom of a rheumatic episode. The onset is usually gradual. The child becomes increasingly nervous, tends to drop things and stumbles frequently. Speech becomes indistinct and characteristic purposeless movements of arms and legs develop. 1. Involuntary movements - (i) Face - constant bizarre grimacing. (ii) Tongue - when protruded it may be impossible to hold it quietly (Jack-in-the-box tongue) and its undulating jerky movements are described as those of a bag of worms. When asked to show the tongue, the child puts it out rapidly and may bite it to keep it out, or may jerk it back rapidly with reptilian speed When talking the tongue produces a clucking sound. (iii) Ocular muscles may rarely participate in the involuntary movements (iv) Extremities -Movements appear first in hands, when arms are outstretched in front, the posture is one of flexion at the wrist and hyper-extension at the metacarpo-phalangeal joints If the upper limbs are held above the head, the palm face outwards (pronator sign). Lower extremities less affected Gait may be clumsy. (v) Muscles of abdomen and neck may be involved (vi) Respiration -

Selloff money to go to National Investment Fund

2009-07-26T01:05:00.000-07:00

NEW DELHI: The government on Friday said the disinvestment proceeds of public sector NHPC and Oil India Ltd (OIL) would be credited to the Nation
NIF), and ruled out any plan to restructure the fund. “The process of launching initial public offerings (IPOs) for NHPC and OIL is already in progress. The receipts from the disinvestment would be channelised into NIF,” minister of state for finance SS Palanimanickam said in a written reply to the Lok Sabha. The IPOs of NHPC and OIL are expected to hit the capital markets in August and September, respectively, while the disinvestment of other PSUs would be decided on a case-by-case basis. Asked whether the government proposed to amend the NIF, the minister replied in the negative. Under the existing guidelines, the disinvestment proceeds are deposited in the NIF, which is managed by three public sector mutual funds—UTI Asset Management Company, SBI Funds Management and LIC Mutual Fund Asset Management Company. The NIF currently has a corpus of Rs 1,815 crore. It generated an income of Rs 85 crore in the first year, Mr Palanimanickam said. As per the present rules, stake sale proceeds have to be put into the NIF and are not treated like other tax and capital receipts of the government. The government can use the interest from the fund only for social schemes and restructuring of ailing PSUs. Any change in the way NIF operates will have to be approved by the Cabinet Committee on Economic Affairs. The government is expected to put in place a road map for disinvestment in public sector enterprises by mid-August, for which consultations have already been initiated with various ministries. However, the government has ruled out any plan to go in for strategic sales of companies and would retain a minimum of 51% equity in these entities. The Economic Survey has recommended an annual disinvestment target of Rs 25,000 crore.

A hypersensitive reaction to lymphatic-dwelling parasites and characterised by chronic cough, wheezing and persistent eosinophilic count which may rea

2009-07-26T01:03:00.000-07:00

bladder gives rise to clyluria (when the lymph vessel is draining the intestine) or lymphuria (when it is not) Chyluria occurs intermittently and is more pronounced after a heavy meal It is often symptomless, but may cause fatigue and weight loss due to loss of fat and protein 5 Tropical eosinophilic syndrome - A hypersensitive reaction to lymphatic-dwelling parasites and characterised by chronic cough, wheezing and persistent eosinophilic count which may reach more than 50,000/mm3 Increased specific serum IgE and characteristic histological lesions (Meyers-Kouwennar bodies) in lymph nodes, lungs, spleen and liver Microfilaria are usually absent in blood Diagnosis - (i) Microfilariae in peripheral blood - examined about midnight Microfilariae may be found in fluid obtained from varices, from hydrocele sac and sometimes ascitic and pleural accumulation and joint fluid or sediment of chyluria (ii) X-ray - for calcified filaria (iii) Gland biopsy - to identify adult worm (iv) Intradermal test - About 90% of patients with Wuchereria bancrofti infestation have a positive intradermal test with material prepared from filarial worm of lower animals (v) Complement fixation test- A positive reaction suggests present or past infection Management - 1 SPECIFIC - (a) Diethylcarbamazine produces rapid disappearance of microfilariae from blood stream Dose - 50 mg (G mg/kg) t d s for 4 days to maximum of -200 mg t d s for 2 weeks (Total dose 75 mg/kg body weight) or single dose of G mg/kg is as effective in the long term at killing microfilariae and adult worms Long-term reduction of microfilariae and transmission control - Annual 2-drug regimens of ivermectin (200 mg/kg) co-administered with either DEC (G mg/kg) or albendazole (400 mg) Side effects - Dizziness, nausea and vomiting Fever, bodyache, skin rashes and temporary exacerbation of symptoms may occur in the beginning of treatment as a result of toxic proteins released from dead organisms These allergic reactions do not indicate cessation of treatment and are relieved by corticosteroid drugs (b) Ivermectin - Single dose (150 mg/kg on empty stomach) may be used to clear microfilariae almost as effectively as multiple doses of DEC The drug however does not affect adult worms (c) Coumarin (5, G-benzo-a-pyrone) - 400 mg/day reduces oedema and many symptoms of filarial oedema and elephantiasis Few side effects 2 TREATMENT OF SECONDARY INFECTION - (a) Local, treatment - elevation of limb Calamine or lead lotion Antibiotic ointment if ulcers (b) Antibiotics (c) Eradication of septic focus 3 RELIEF OF LYMPHATIC OBSTRUCTION - (a) Surgical treatment for re-establishment of lymphatic drainage by venonodal shunt or (b) bandaging the limb tightly preferably after a period of rest, and elevation, massage, and exercise 4 PALLIATIVE TREATMENT - (a) Acute lymphangitis - Rest, elevation of limb, hot fomentations, infra-red rays or short wave diathermy Analgesics for relief of pain Broad spectrum antibiotics to control infection (b) Chyluria - Complete rest Omit fat from diet Saline purge Bladder Vvash if clots (c) Elephantiasis -Since bacterial and fungal infections trigger most episodes of adenolymphagitis in tissues with compromised lymphatic function, simple hygiene measures are useful - (a) Twice daily washing of affected parts with soap and water (b) Raising the limb at night (c) Working the foot up and down to promote lymph flow (d) Keeping the nails clean (e) Wearing shoes (f) Use of antiseptic or antibiotic creams to treat small wounds or abrasions Long-term low-dose DEC may also help to reverse chronic lymphoedema and elephantiasis For resistant case lymphonodo-venous shunt operation, followed by surgical removal of excess tissue INTESTINAL HELMINTHS Hookworm -Hookworms are nematodes belonging to the family Ancylostomidae Human infection is caused by Ancylostoma - duodenale and Necator americanus Transmission - may occur wherever faeces' are allowed to remain in contact with damp soil at a suitable temperature. LIFE-CYCLE - The adult worms attach themselves by their mouths to the intestinal mucosa and feed upon blood. The gravid male lays eggs which are passed in the stools. In suitable conditions a larval worm hatches in about 24 hours and takes a week to reach the stage infective to man. These infective larvae can penetrate human skin. Having entered the body the larval worms pass in the blood stream to the lung capillaries. They enter the alveoli, pass up the air passages and down the oesophagus to reach the jejunum where they attach to the mucosa and mature Clinical features Cause DIAGNOSIS - Detection of ova in stool, or of worms after treatment. Treatment - When Hb is less than 5 gm % it is advisable to raise it to about 8 gm. with iron therapy before expelling the worms. Mebendazole - 100 mg. b.d. for 3 days (all age groups) or Albendazole - One dose of 400 mg for all patients over 2 years of age or Pyrantel - 10 mg/kg (maximum 750 mg in adults) in a single dose for 3 days. Roundworm - (Ascaris lumbricoides) LIFE CYCLE -The eggs leave the body tin the faeces. At this stage they consist of unsegmented ova protected by a thick shell, which in suitable conditions will develop into larval worms in 2 or 3 weeks Man acquires the infection by swallowing the larvae, usually on contaminated food. The larvae hatch in

Financial risk from carbon costs is greatest in the Utilities sector, where EBITDA at a company level could fall by 2% to 117%."

2009-07-26T01:02:00.000-07:00

As for mutual funds, they, too, vary widely in terms of their carbon exposure -- sometimes in unexpected ways. Trucost’s report, called Carbon Counts USA, examined the carbon performance of 91 mutual funds in the U.S., including 16 funds that say they focus on sustainability or socially responsible investing. It did not make all the results public, but it said “the footprint of the most carbon-intensive fund is over 38 times larger than the lowest-carbon fund, reflecting the range in potential carbon risk.”As you’d expect, the 16 funds that focus on sustainability or social investing have, as a group, the smallest carbon footprint, but some are much “greener” than others. Trucost found that the Sentinel Sustainable Core Opportunities Fund has a carbon intensity (692 tons of carbon equivalent emissions per $1 million of revenues of the fund’s holdingss) that is seven times as great as the Ariel Appreciation Fund, which has the smallest footprint (98 tons of carbon equivalent emissions per $1 million in revenues.) Green Century, meanwhile, reports that its footprint is 126 tons of carbon per $1 million in revenues, bigger than the Ariel Fund but just a bit more than half of the average of the sustainability funds tracked by Trucost. The 10 biggest holdings of the Green Century Balanced Fund, as of March 31, were IBM, AT&T, Xerox, Federal Home Loan Bank of Chicago, General Mills, SLM Corp., Telfonica SA, Johnson & Johnson, Advance Auto Parts and Oracle. Gustav Knepper Power Station in Dortmund, Germany What does this all mean? It’s too soon to say. Only over time will we be able to see whether low carbon stocks and funds, as a group, outperform those with higher carbon exposure. Already, though, some investors are factoring carbon into their long-term view. Trucost is using its data to develop investable indexes of low-carbon companies. “If enough investors look at carbon intensity,” Krosinsky tells me, “it will create a competitive dynamic and encourage companies to become more efficient.” More capital would then flow to clean tech, and less to coal plants like the one to the left.

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