Medical Education for the Public

One of the intents of this site is to share educational information. The following is a collection of resources for more information on a variety of medical conditions.

“Coming together is a beginning, Keeping together is progress, and Working together is Success." Henry Ford

Education Trust Fund for Needy Children

Scholarships: Only requires USD $100/year to sponsor a child’s education.

The Wimalawansa Education Trust Fund (WETF) is a foundation whose purpose is to provide basic support facilities in primary and secondary education to financially needy students in Sri Lanka, who are bright but have little or no resources to continue their education. Thus, one of the key purposes is to encourage these children (and their parents) to facilitate their education and enable them to pursue their academic or technical studies.

Be a part of the solution to improve the literacy and empower the economically poor, rural families, out of their poverty. Our experience confirms that children going through this education program not only advance their family status, but they bring prosperity back to the entire village.

Education Ends the Cycle of Poverty

Inadequate education leads to poverty and economic stagnation. Inadequate knowledge leads to lack of access to resources for development, empowerment, health, and education of children.

Especially for girls, education prevents their exploitation; educating girls allows them to have a successful, right-size family and more choices; earn a higher income; and make better-informed choices. Education allows children, young adults, and adults to take part in household and community activities with understanding, and to make informed political decisions.

A higher literacy rate improves individual and family health and sanitation, nutrition, vaccination rates, and physical and mental health and is associated with lower morbidity and mortality. An educated individual has a higher chance in increasing his or her value and contributing to the society/workforce and the economy.

Students need more than school supplies for success. They need, support, guidance, medical and dental care, mentorship, love, and hope. These educational scholarships provide most of these to needy children.

100% of your donations made to the “Wimalawansa Education Trust Fund” will go to student sponsorships. We raise separate funds for operational costs, so the effectiveness of your donations is maximized.

Please see below to learn more about the Trust Fund, its selection process and operation. The WETF is a registered non-profit organization in Sri Lanka.

WETF Trust Overview
WETF Trust Objectives, Operations, Selection Procedures and Follow-Up
WETF Application Form
Wimalawansa Foundation: Project Proposals, Member and Donation Information

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Chronic Kidney Disease

Resources and Further Information

Environmental Pollution and Chronic Kidney Disease in NCP, Sri Lanka

https://www.wimalawansa.org/sites/all/files/ckd_nov_2013/CKD-Symposium-University-of-Peradenia-Nov-2013.pdf

Geoenvironmental Factors Related to Chronic Kidney Disease of Uncertain Aetiology in Sri Lanka

https://wimalawansa.org/sites/all/files/ckd_nov_2013/Dr_Chandrajith.pdf

Clean Drinking Water Source for CKDu Effected Areas through Rain Water Harvesting

https://wimalawansa.org/sites/all/files/ckd_nov_2013/Dr_Thanuja-CKDu.pdf

An Engineering Solution to the CKDu

https://wimalawansa.org/sites/all/files/ckd_nov_2013/Mr_Sumanaweera.pdf

Environmental Pollution and Chronic Kidney Disease of “Multi-factorial Origin” in Sri Lanka

https://wimalawansa.org/sites/all/files/ckd_nov_2013/Wimalawansa-Peradeniya-Cleaned.pdf

The Use of Reverse Osmosis Methodology for Potable Water

https://wimalawansa.org/sites/all/files/ckd_nov_2013/Wimalawansa-Peradeniya-Sym-RO_methodology.pdf

Short–Term Measures to Control Chronic Kidney Disease Unknown Etiology – (CKDu)

https://wimalawansa.org/sites/all/files/ckd_dec_2013/Abeygunasekera-slides.pdf

Water Quality and CKDu

https://wimalawansa.org/sites/all/files/ckd_dec_2013/CB-Dissanayake-slides.pdf

Short Term Effects of Crude Extracts of Cynobacterial Blooms of Reservoirs in High Prevalence Area for CKD in Sri Lanka on Mice

https://wimalawansa.org/sites/all/files/ckd_dec_2013/Dhammika-Menike-Dissanayake-slides.pdf

Short term Measures – Improving Community Health Services for CKD-u.

https://wimalawansa.org/sites/all/files/ckd_dec_2013/Dr_Palitha-Bandara-slides.pdf

Role of Fluoride and its Enhancement by Aluminium for the Chronic Kidney Disease in the NCP, Sri Lanka

https://wimalawansa.org/sites/all/files/ckd_dec_2013/Ileperuma-Slides.pdf

Chronic Kidney Disease Financial and Economic Costs

https://wimalawansa.org/sites/all/files/ckd_dec_2013/Palitha-Mahipala-slides.pdf

Potential Link between Ground Water Hardness, Arsenic and Prevalence of CKDu

https://wimalawansa.org/sites/all/files/ckd_dec_2013/Priyani-Paranagama-slides.pdf

Chronic Kidney Disease; Global and Sri Lankan Perspectives

https://wimalawansa.org/sites/all/files/ckd_dec_2013/Shanthi-Mendis-slides.pdf

Chronic Kidney Disease of Uncertain Aetiology - Clinical Features

https://wimalawansa.org/sites/all/files/ckd_dec_2013/Tilak-Abeysekera-slides.pdf

Sociological Aspects of CKD (UE) in Sri Lanka

https://wimalawansa.org/sites/all/files/ckd_dec_2013/Tudor-Silva-slides.pdf

Fertilizer Use in Sri Lanka With Special Reference to CKDu

https://wimalawansa.org/sites/all/files/ckd_dec_2013/Weeraratna-slides.pdf

Lies, Cover-Ups and Complicity Kill - Governments and Corporations: Glyphosate Ban Lifted In Sri Lanka

https://www.srilankaguardian.org/2014/05/lies-cover-ups-and-complicity-kill.html

Possible Impacts Of Soil Chemistry On Chronic Kidney Disease in Dry Zone, Sri Lanka

http://science.sjp.ac.lk/wp-content/uploads/2013/10/Soil-Chemistry-on-KDU.pdf

CKDu and Arsenic Hypocrisy: Response

http://www.island.lk/index.php?page_cat=article-details&page=article-details&code_title=46688

Review of Literature on Chronic Kidney Disease of Unknown Etiology (CKDu) in Sri Lanka

http://www.iwmi.cgiar.org/Publications/Working_Papers/working/wor158.pdf

Centers for Disease Control and Prevention: Chronic Kidney Disease (CKD) in the United States

http://nccd.cdc.gov/CKD/default.aspx

The CDC's New CKD Surveillance System

https://www.youtube.com/watch?v=5nzcujP0_MY

Interview on Chronic Kidney Disease

http://youtu.be/Nb2nhqAyM5E

Kidney Anatomy and Function

https://www.youtube.com/watch?v=zHRGaiFnMGY

Causes and Treatment of Kidney Failure

https://www.youtube.com/watch?v=BodnYcHGtiA

Urinary system - The Nephron

https://www.youtube.com/watch?v=hiNEShg6JTI

Escalating Chronic Kidney Diseases of Multi-Factorial Origin in Sri Lanka: Causes, Solutions, and Recommendations.

http://www.ncbi.nlm.nih.gov/pubmed/25239006

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Chronic Disabilities

The International Foundation for Chronic Disabilities (IFCD) observes that those health conditions frequently occurring in adults with Chronic Brain Disorders (CBD), often go unrecognized and improperly treated. The reasons for this are complex and involve poorly designed social systems and inadequate training (and lack of access to training) of health professionals, primarily physicians, dentists, and nurses. Data suggest a high incidence of vitamin D deficiency, falls and fractures among CBD patients with medically complex developmental disabilities (MCDD). This group consists of people with a variety of neurodevelopment disorders, and developmental-induced physical and intellectual disabilities.

IFCD understands that these conditions are aggravated by the high incidence of vitamin D deficiency noted in these patients. Most MCDD patients take medicines such as anticonvulsant drugs and glucocorticoids that increase the catabolism of vitamin D (25(OH)D), thus decreasing 25 (OH)D serum levels, which further aggravates their comorbidities. It has been the experience of members of the IFCD that when health conditions encountered in persons with CBD/MCDD are properly managed, "disability" can be reduced and quality of life improved.

The mission of the IFCD is to improve the health and quality of life of adults with CBD. In order to accomplish this goal, IFCD is employing various educational strategies, research, and advocacy. You are welcome to join our programs.

For more information please visit http://chronicdisabilities.org

IFCD Informational Movie

https://www.youtube.com/watch?v=y3wj7hOGP0M&feature=youtu.be

Moving Performance by a Disabled Person

https://www.youtube.com/embed/W86jlvrG54o?rel=0

Chronic Disease Management

http://www21.ha.org.hk/smartpatient/en/chronicdiseases_zone.html

Vitamin D Deficiency: How it Relates to Patients with Developmental Disabilities
and Ways to Correct it (AADMD Vitamin D Symposium)

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Vitamin D

How Much Vitamin D is Needed?

For those deficient in vitamin D, a daily intake of 2,000-4,000 IU (international units) or taking 50,000 IU twice a month is necessary to bring the blood vitamin D levels to normal range (more than 30 ng/mL). When taking any medication or larger quantities of supplements, always consults with your healthcare provide to avoid adverse effects and drug-interactions.

Non-dairy foods such as fish, salmon, tofu, beans, kale and almonds (most nuts) are good sources of calcium. Some milk and soy products such as soymilk are fortified with extra calcium.

Resources and Further Information

What We Should Know About Vitamin D?

An interview with Dr. Sunil Wimalawansa on the dangers of Vitamin D deficiency and how to increase one's intake of this essential vitamin.

http://www.nutritionremarks.com/2012/02/13/what-we-should-know-about-vitamin-d/

Vitamin D: Everything You Need to Know - Book Synopsis

A summary of the contents of the book Vitamin D: Everything You Need to Knowby Dr. Sunil J. Wimalawansa

http://www.medreha.com/wp-content/uploads/2012/12/Vitamin-D-Book.Synopsis_H-1.pdf

Vitamin D: Everything You Need to Know (Nutrition and Vitamin D) – by Sunil J. Wimalawansa, MD

A comprehensive look at Vitamin D and how to discern and overcome deficiencies
in this essential nutrient.

http://www.amazon.com/gp/product/9559098942

Should Vitamin D Supplements be Recommended to Prevent Chronic Diseases?

http://www.bmj.com/content/350/bmj.h321/rr-1

Can Vitamin D Protect you Against Flu?

https://www.youtube.com/watch?v=h5oL8MFBJa4

International Conference on Vitamin D & Health Outcomes

http://vitamindinternational.com/index

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Tips for Developing Active Listening

Pay attention: Focus on the speaker or the person you are communicating with. Distractions such as reading, on the phone, or texting will not only prevent you getting the message, but also is distrustful to the other person.

Make eye contact with the speaker:

But do not stare at him or her. Look directly into the eyes (brief contact), and be sure to soften your gaze so that you do not appear to be staring or glaring.

Engage in active listening: Body language is important; engage communication with using appropriate body posture and body language. For example, leaning slightly towards the speaker and making your whole body conveying that you are paying attention is useful for positive communication and development of trust.

Do not interrupt the other person when he/she speaks: Allow the person to finish the sentence or thought process. Be tolerant; “silent is golden and less is more."

If you have to, then interrupt politely: If the story is lengthy, out of focus, or time-consuming, it is OK to say, I apologize if I appear rude, but I have to interrupt because of …” It is OK to ask for clarifications; at the beginning, middle and at the end of your conversation.

Do not make judgments: Refrain formulating your response while the other person is speaking. There is no reason why one should not pause, think and then speak.

Ask open-ended questions: This means that you have to ask questions. The questions beginning with “how”, “what”, “when”, and careful use descriptive word after that… will make the conversation easier and bidirectional. At the end summarize what you understood is correct.

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Alcohol and Smoking are Hazardous to Your Health

Alcohol is no ordinary consumer commodity [1,2]. The social needs and acceptance by some are obvious, but the negative consequences increase linearly with the increasing consumption.

To curb these increasing rates, particularly among the children needs, committed public policies in the form of regulation and enforcement, taxation, truthful advertising and banning these from sensitive places, and healthcare services to cope with the damages that these commodities cause.

To restrain the negative health effects associated with alcohol and smoking, it is necessary to curtail licensing, implement mandatory labeling in all alcohol bottles and cigarette packets with health warnings (particularly the cancer risks) and continuing public education are essential [3].

Messages to disseminate:

  • Education must include total avoidance of alcohol and smoking during pregnancy
  • Limit consumption to 20 g daily for men and 15 g daily for women (1.5 drinks for men and 1 drink for women, by US standards)
  • Zero smoking tolerance
  • Less is more: lower alcohol consumption leads to better health and longevity, and lesser healthcare costs
  • The most cost-effective way to reduce alcohol and smoking in any country is the reduction of consumption.

The interventions should not be confined to high-risk alcohol users, but should address general alcohol consumption, teenagers and young adults, and be population-based.

Controlling the affordability of alcohol through restricting licensing, pricing and taxation can reduce the consumption volume, and thereby related health and social harms, including cancer and premature deaths [4,5,6].

What governments can do to minimize harm to the public?

  • Label the amount of alcohol in grams, just like food labeling, to allow consumers to track the exact amount of alcohol they consume
  • Provide treatment to benefit individuals and society; offer to all people with an alcohol dependence problem.
  • Reduce license to selling outlets and apply a pricing policy to reduce consumption, particularly by young people
  • Limit the times and places alcohol can be purchased to reduce impulsive buying
  • Avoid prominence and advertising alcohol and tobacco in shops and supermarkets
  • Invest and support addiction control centers to assist people to come out of it

References:

  1. Babor T, Caetano R, Casswell S, et al. Alcohol: No Ordinary Commodity. Research and Public Policy. Oxford, UK: Oxford University Press; 2010.
  2. Seitz HK, Becker P. Alcohol metabolism and cancer risk. Alcohol Res Health. 2007;30:38-41, 44-47.
  3. Holman DM, Grossman M, Henley J, Peipins LA, Tison L, White MC. Opportunities for cancer prevention during midlife: highlights from a meeting of experts. Am J Prev Med. 2014;46 (3 Suppl 1):S73-S80.
  4. Rehm J, Shield K. Alcohol consumption. In: Stewart BW, Wild CB, eds. World Cancer Report 2014. Lyon, France: International Agency for Research on Cancer; 2014.
  5. O'Keefe JH, Bhatti SK, Bajwa A, DiNicolantonio JJ, Lavie CJ. Alcohol and cardiovascular health: the dose makes the poison or the remedy. Mayo Clin Proc. 2014;89:382-393.
  6. Homann N, Kärkkäinen P, Koivisto T, Nosova T, Jokelainen K, Salaspuro M. Effects of acetaldehyde on cell regeneration and differentiation of the upper gastrointestinal tract mucosa. J Natl Cancer Inst. 1997;89:1692-1697

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Baby-Caring Tips

Cuddle the newborn on your chest or lay him over your lap frequently. One can place a soft blanket on the floor and encourage him to look at you or a toy.

Let the child play with safe, soft, light toys, and encourage bringing babies hands to midline and to her mouth to explore and develop her oral-motor and eye-coordination skills.

By 4-6 months encourage him to reach and grasp for toys placed in front of him and to the sides while on his back, belly and on side.

Starting around 3 months help the child grasp her feet with her hands, which would help to strengthen baby’s tummy and prepare her for rolling.

Around 4 months start to encourage rolling by placing toys to the side so baby needs to roll to the side to reach/catch it. Allow plenty of floor play. Place a blanket and some toys on the floor to allow the child to play, explore, and develop hand-eye coordination and motor skills.

Around 4 to 5 months help the child learn to sit by supporting him in sitting position with your hands, legs, or a pillow around his full spine. Placing a larger toy in front of would prompt baby to grasp it with both hand while seated.

Read to the child from early age; use books with colorful pictures and show these to baby. Singing and taking to the baby would encourage language, simulate parental actions, and promotes smiling.

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What is Bariatric Surgery? What is it, and When to Consider it?

Bariatric surgery is indicated in those who are morbidly obese and those who are obese and have significant metabolic complications. This weight-loss surgery causes significant reduction of weight, but unless the patient is properly motivated and continues with physical activity and a low-energy/caloric diet, the weight is likely to creep up again, making the whole exercise worthless.

Significant weight-loss associated with bariatric surgery, if maintained, will improve health and prevent future complications. Most weight-loss surgeries limit how much food the stomach can hold, making one feel full even after a small meal; this is called restriction. Some procedures also cause malabsorption, decreasing the absorption of calories and nutrients. In addition, bariatric surgery changes the secretion and action of some hormones, such as ghrelin, the “hunger hormone,” and the glucagon-like peptide.

Bariatric surgery is not the first step in any weight reduction program. Obese people need to try other methods, including behavioral modifications and perhaps medications for some time to see whether they can lose an adequate amount of weight by these non-invasive methods. Although bariatric surgery has benefits, it also has risks: surgical as well as medical risks, including malnutrition and abnormalities in the endocrine system/hormones. Hormones are an important part of maintenance of the energy balance, reproduction, growth and development, and responses to injuries. Different bariatric surgeries have varying risks and benefits.

The common types of bariatric surgeries are adjustable gastric band, gastric sleeve surgery, and roux-en-y gastric bypass. In adjustable gastric band surgery, a band is placed around the upper part of the stomach to create a small pouch holding a small amount of food; this makes eating large amounts of food impossible. Roux-en-y gastric bypass surgery, which is the most effective procedure practiced today, is more involved and has higher surgical risks. It reduces the size of the stomach, bypassing the duodenum, the immediate portion of the gut after the stomach, which leads to major changes in hormones. In addition, the surgery significantly decreases nutrient absorption from the gut.

Vertical sleeve gastrectomy is gaining interest because it is relatively quicker, compared with roux-en-y gastric bypass surgery, has fewer associated complications, and is more effective than gastric banding. It markedly decreases the size of the stomach, leading to less intake of food. The technique also controls how soon food leaves the stomach. This method avoids peaks of nutrient absorption and thus, decrease the abnormal patterns of hormonal release.

In addition to the intended loss of weight, bariatric surgery improves the control of type 2 diabetes, decreases blood pressure, and facilitates controlling elevated blood lipid levels. In women, it also improves fertility, especially for women with polycystic ovary syndrome. Most obese men have lower levels of free testosterone in the blood (i.e., they are hypogonadal). After bariatric surgery and the associated weight loss, their serum cortisol levels decrease and serum testosterone levels increase.

Bariatric surgery induces a malabsorptive status. Therefore, unless patient’s conditions carefully managed after bariatric surgery, most will develop one or more nutritional deficiencies. These can lead to bone loss, vitamin D deficiency, abnormalities of enzymatic functions secondary to micronutrient deficiency, too much lowering of blood glucose levels after eating carbohydrate-containing foods (i.e., development of frequent episodes of hypoglycemia and consequences), and neurological disorders, including peripheral neuropathy. These may manifest fairly soon or many years after the surgery. However, most of these complications are preventable.

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Calcium: Absorption and How to Take it

How Much Calcium is Needed?

The absorption and the safety of dietary calcium are superior to supplements. Calcium is important for bone and muscular health, and several key bodily functions. In addition to dairy products such as low-fat cheese, skim milk and low-fat yogurt, it also be found in spinach, cooked greens, broccoli, soy milk, soy beans and tofu.

For most people, the optimum calcium intake should be around 1,200 milligrams per day (i.e., dietary calcium plus any supplements, if taking). Some prefer calcium citrate (instead of calcium carbonate) as it relatively easily absorbed in the majority of people.

How to Take Calcium

Factors that can affect how your gut is able to absorb the calcium you take:

  • The type you take: Calcium from food is absorbed better than from pills.
  • Type of calcium: While calcium citrate can be taken at anytime, to improve absorption, calcium carbonate should be taken after a meal.
  • Time of taking calcium supplements: To enhance absorption and its biological effects, take calcium supplements in the evening, after a meal.
  • The dose you take: The intestinal absorption decreases with doses more than 500 mg taken at a time. Take divided doses; twice a day, if you are taking more than this. However, rarely one needs to take more than 800 mg of supplemental calcium per day. The total dose (diet + calcium supplements) should not exceed 1,500 mg a day.
  • High of salt (sodium chloride) intake: Ingestion of excessive salt decreases interfere with calcium absorption and calcium retention in the body.
  • A diet containing high quantity of phytic acid decreases calcium absorption: Commonly present in the bran of whole grains (so, in chapatti and similar food made of flour), phytic acid binds with calcium and other minerals, making them insoluble and thus, prevent absorption. If you consume lot of whole-grain bread and cereal, you may consider (A) use calcium-fortified products or (B) take calcium citrate supplements taken in between meals.
  • Inadequate vitamin D: Vitamin D is essential for calcium absorption and bone mineralization. One third of the world’s population is vitamin deficient and would be benefited by sun-exposure or c vitamin D supplementation.
  • Excess consumption of coffee and tea: The caffeine or some other ingredient in (excessive intake of) coffee, tea, and soda are mild diuretics, leading to loss of calcium from the blood.
  • Smoking Interfere with calcium absorption: Smoker has low bone show mass, in part due to reduce calcium absorption and a low rate of bone formation.
  • Celiac Disease: This relatively common inherited health condition, an autoimmune disease is characterized by gluten intolerance. It changes the lining of the intestine and decrease absorption of fat-soluble vitamins such as vitamin D, and minerals like calcium. (For more information please visit http://celiac.org/)
  • Miscellaneous items: Inactive lifestyle and eating large quantities of meat likely to decrease intestinal absorption of calcium.
  • Calcium Absorption

    Physiology of Disuse Osteoporosis in Adults with Chronic Disabilities - Dr. Philip May

    https://www.youtube.com/watch?v=bqwpSRSYr5I&feature=em-upload_owner

    Kidney Stones

    There are two main types of kidney stones – uric acid and calcium stones. Unlike calcium citrate, excessive intake of calcium carbonate may worsen calcium kidney stones. Certain diets may worsen non-calcium kidney stones. Your healthcare practitioner can explain these to you.

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    Diabetes and Pregnancy

    Most women with diabetes undergo normal, safe pregnancy and delivery, especially if they have good blood glucose control before and during pregnancy. Therefore, for women with type 1 or type 2 diabetes, it is imperative to have good blood glucose control, avoiding both hypoglycemia and hyperglycemia, and right nutrition before and throughout the pregnancy. The category of women identified to have gestational diabetes also need better control of blood glucose and weight, and special care during pregnancy to avoid complications for the woman and the fetus.

    Pregnant women with high blood glucose are more likely to experience high blood pressure; deliver babies with birth defects; have miscarriages or stillbirths, premature deliveries, a higher incidence of cesarean section, and/or difficult deliveries. Tight blood glucose control can help avoid these problems.

    Women with diabetes need to plan well their pregnancies. Ideally, before becoming pregnant, they should arrange medical check-ups to correct medical disorders, including eye problems, and attend to oral health and immunizations. This done with the partner via a team of capable health care providers, including endocrinologists or diabetologist, a diabetes educator, a dietitian, and an obstetrician who practices high-risk deliveries.

    Experts recommend the following: taking daily 5.0 mg of folic acid and other vitamin supplements, controlling blood pressure, losing weight if you are overweight, checking with physicians whether it is OK to take prescribed medications or change to different medications because some may not be safe for the fetus. Such drugs include blood pressure-lowering agents, such as ACE inhibitors or ARBs, and the cholesterol-lowering agent statin.

    Make sure your thyroid functions are normal because thyroid disease can affect fetal growth and brain development and increase the likelihood of miscarriage or premature delivery. If you had gestational diabetes in a previous pregnancy, inform the physician because the management may need to be altered to minimize pregnancy complications. If you were already using an insulin pump before pregnancy, you should keep using it. You probably should not start using an insulin pump for the first time during pregnancy. However, if other types of insulin treatment do not control your blood glucose levels, your doctor may want you to switch to an insulin pump.

    Women with diabetes are encouraged to breastfeed. Breastfeeding lowers a baby’s risk of infections, childhood obesity, and type 2 diabetes in later life. Women with gestational diabetes have an increased risk of type 2 diabetes, and breastfeeding seems to lower this risk. With careful planning and proper medical and good personal care, women with diabetes can have a safe pregnancy and a healthy baby.

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    Type 1 Diabetes

    Type 1 diabetes develops when there is insufficient or no insulin released from the pancreas. Insulin is the hormone needed to carry glucose from the bloodstream into the body’s cells, where it used to generate energy. With diabetes, there is too much glucose (sugar) in the bloodstream. When there is not enough insulin, glucose builds up in the blood, putting people at risk for serious health problems, including heart attacks and strokes, vision problems and blindness, kidney failure, numbness in the feet, and erectile dysfunction in men. Good control of blood glucose decreases the rate and severity of diabetic complications.

    Type 1 diabetes, which used to be called insulin-dependent diabetes and juvenile diabetes, can develop at any age but commonly occurs in children and young adults. In this condition, the pancreas produces little or no insulin, so treatment with insulin is life saving and essential for everyone with Type 1 diabetes.

    These patients may present with acute onset of lethargy, increased thirst, increased urination, weight loss, and blurred vision. If diabetes remains undiagnosed and untreated, such patients may experience diabetic ketoacidosis, coma, and death.

    In many cases, the body’s immune system attacks and destroys the part of the pancreas that produces insulin, perhaps initiated by a relatively benign viral or other infection. Because type 1 diabetes is an autoimmune disease, people with other autoimmune conditions, such as Hashimoto’s disease or Addison’s disease, are at higher risk for diabetes.

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    Type 2 Diabetes

    Type 2 diabetes, formerly known as adult-onset diabetes, usually develops in adulthood but can appear in overweight children and teens. With increasing childhood obesity, the latter is becoming a common occurrence. In those with type 2 diabetes, the pancreas produces insulin, but there is not enough or the body cannot use it effectively because of resistance at the entry into cells.

    In those with type 2 diabetes, blood glucose (sugar) levels are higher than normal in the morning (fasting), after a meal, or both. In Type 2 diabetes, blood glucose levels go too high.

    Being overweight and inactive markedly increase the risk of prediabetes and Type 2 diabetes. Having high blood glucose levels over time can lead to major health problems, such as heart attack and strokes and eye, nerve, and kidney damage. Keeping the blood glucose, blood pressure, and cholesterol levels under control will decrease such complications. Attention to diet, increased physical activity, and medicines can minimize complications.

    It is worth noting that despite improvement over the past two decades in the morbidity and mortality associated with diabetes, the burden of type 2 diabetes and obesity continues to increase. Statistics show that during the past 20 years, the number of adults with diagnosed type 2 diabetes tripled; an increase from 6.5 million to 21 million. Thus, new cost-effective approaches are needed to combat these two interlinked diseases.

    Resources and Further Information

    Diabetes Public Health Resource: Centers for Disease Control and Prevention

    http://www.cdc.gov/diabetes/

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    Basic Facts about Common Diets

    There are numerous diets available and are advertised. However, three diets have been recognized to help people in reducing weight and keeping healthy. These are the Mediterranean diet, a diet moderately low in carbohydrates, and a vegetarian or vegan diet.

    The Mediterranean Diet:

    The Mediterranean diet is a way of eating that is common in southern European countries: Greece, Spain, southern France, and southern Italy. The Mediterranean diet is low in red meat, cheese, and sweets. It mostly includes unprocessed and fresh, traditional foods, such as fish, beans, nuts, vegetables, fruits, high-in-fiber bread/cereal, whole grains, and monounsaturated and polyunsaturated fats, such as olive oil and canola oil. A Mediterranean diet is thought to decrease heart disease and blood cholesterol and prevent type 2 diabetes and metabolic syndrome.

    Moderately Low-Carbohydrate Diet:

    This diet, similar to the South Beach diet, promotes the use of lean protein foods and high-fiber, nutrient-rich carbohydrates, such as vegetables, fruits, and whole grains. The diet also includes healthy unsaturated fats and low-fat dairy products. It excludes high caloric, white flour products and most starchy carbohydrates, such as potatoes, rice, and pasta. Generally, it is unnecessary to count calories or do any complicated calculations to follow this diet.

    Vegetarian or Vegan Diet:

    A vegetarian diet excludes animal products. However, many consume milk and eggs along with fruits, vegetables, and grains. A vegan diets excludes all animal products. People who follow a vegan diet need to take vitamin B12 supplements and extra protein, such as pulses, beans, and nuts.

    What Should be Considered When Taking a Balanced Diet?

    Limit consuming refined sugar: Try to limit refined sugar, from processed foods and sweets such as candy, soda and fruit juices that containing high content of sugar of any kind including high-fructose corn syrup.

    Use a variety of food: Focus on lean protein (avoid red meat and pork; both contain fat that cannot be seen normally), whole grains, low-fat dairy, fruits and vegetables. Aim to eat a variety of foods that you like.

    Avoid or limit bad fat: Limit foods high in saturated fat and trans fat. Saturated fat is found in red meat, processed meats, sausage, bacon, and high-fat dairy products. Trans fat is typically founds in commercial pastries, cookies, cakes and donuts. Avoid eating charged portions in barbecued food, and using frying in same oil, multiple times; this may increase the trans fat content.

    Alcohol in moderation and eliminate smoking: If taking, alcohol should only be consumed in moderation; this means no more than one drink per day for women and two drinks per day for men; no more than. Smoking is unhealthy and lead to multiple medical disorders including cancer.

    Omega-3: Omega-3 fatty acids have some anti-inflammatory properties. If one eats 3-5 ounces of fatty fish such as herring, mackerel and salmon, three times per week, in general supplementation may not needed. Vegetarians and vegans are more likely to be benefited by omega-s supplements.

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    The Endocrinological Sciences

    Who is an Endocrinologist?

    An endocrinologist is a specially trained doctor who take care of, among others, hormonal disorders. Endocrinologists diagnose diseases that affect your (endocrine) glands. They are trained to treat these conditions, which are often complex and involve many systems and structures within the body. Your regular doctor refers you to an endocrinologist when you have a problem with your endocrine system.

    What do Endocrinologists do?

    Endocrinologists are trained to recognize and uncover hormone problems. They help to restore the natural balance of hormones in your system. Endocrinologists also conduct basic research to learn the secrets of glands. Clinical research helps them learn the best ways to treat patients. Endocrinologists assist developing new drugs and treatments for hormone problems. They take care of many functions and problems, these include:

    • Diabetes
    • Thyroid diseases
    • Metabolism
    • Hormonal imbalances
    • Menopause
    • Osteoporosis & osteomalacia
    • Hypertension
    • Cholesterol (lipid) disorders
    • Infertility and birth control
    • Shortness (short stature)
    • Certain cancers of these glands

    What Type of Medical Training do Endocrinologists Receive?

    Endocrinologists finish four years of medical school. They spend three or four years in an internship and residency program. These specialty programs cover internal medicine, with pediatrics or obstetrics and gynecology. They spend two or three more years learning how to diagnose and treat hormone conditions (endocrine fellowship training).

    What is the Endocrine System?

    Your endocrine system is a system of glands. These glands make hormones. These substances help to control various activities and energy metabolism in your body. In addition, hormones control reproduction, metabolism (food burning and waste elimination), growth and development. Hormones also control the way you respond/ react to your environment. They help to provide the proper amount of energy and facilitate nutrition. The endocrine glands include the thyroid, parathyroid, pancreas, ovaries, testes, adrenal, pituitary and hypothalamus.

    What are the Most Common Endocrine Diseases and Disorders?

    Endocrine diseases and disorders grouped into several areas. Some endocrinologists focus on one or two areas, such as diabetes, obesity, pediatric disorders, thyroid, or reproductive and menstrual disorders. Others take care of all areas of endocrinology.

    The major areas of endocrinology are described below:

    Diabetes:

    Patients with diabetes have too much sugar in their blood. The inability to control sugar and lipids in the blood would lead to serious problems affecting the eyes, kidneys and nerves. Such could lead to blindness, kidney failure requiring dialysis, inability to absorb food, or amputation. Endocrinologists treat diabetes with diet and various medications (usually in combination), including insulin. They also work closely with patients to control blood sugar and monitor them so they can prevent health problems.

    Thyroid:

    Patients with thyroid disorders often have problems with their energy levels. They may also have trouble with muscle strength, emotions, weight control, and tolerating heat or cold. Endocrinologists treat patients with too much or too little of the thyroid hormones. They help patients reach a hormone balance by replacing thyroid hormone. Endocrinologists also receive special training to manage patients with thyroid growths (lumps/nodules), cancer, and swollen thyroid glands (For more information on thyroid disorders please see the PDF handout here.

    Bone:

    Osteomalacia (rickets in children, causing bones to soften) and osteoporosis, Paget’s disease and hyper- and hypo-parathyroid disorders are some of the common bone diseases that endocrinologists diagnose and treat. Osteoporosis is the commonest metabolic bone disease and it weakens the skeleton leading to fractures with minor trauma.

    Certain hormones at right doses protect bone tissue. When these hormone levels drop or increases too high, bones loss occur and weaken. Menopause in women, loss of testicular function in men, and aging might put you at risk for bone weakness. There are many other causes leading to bone loss. Endocrinologists treat other disorders that can affect bones, such as too much parathyroid or thyroid hormones, etc.

    Reproduction/Infertility:

    Endocrine research and services have helped thousands of infertile couples to have children. Endocrinologists diagnose and treat hormone imbalances that cause infertility. Endocrinologists also assess and treat patients with reproductive problems based in glands. They work with patients who need hormone replacement. Problems that they treat include menopause symptoms, irregular periods, endometriosis, polycystic ovary syndrome, premenstrual syndrome, and impotence.

    Obesity and Overweight:

    The incidence of obesity has skyrocketed in recent years. It is also associated with type 2 diabetes. Endocrinologists treat patients who are overweight or obese, often because of metabolic and hormonal problems. Less frequently, obesity is associated with endocrine gland abnormality, such as thyroid, adrenal, ovarian, or pituitary. Endocrinologists also identify other factors linked with obesity; thereby help patients to eliminate causes and risks of weight gain.

    Pituitary Gland:

    The pituitary is often called the master gland of the body because it controls other glands. The pituitary makes several vital hormones. Over- or under- production and secretion of pituitary hormones can lead to a variety of disorders including infertility, menstrual disorders, growth disorders (acromegaly or short stature), and too much cortisol (Cushing's syndrome). Endocrinologists mange these conditions with medications and if appropriate, referring patients for surgery.

    Growth:

    Pediatric endocrinologists treat children with endocrine problems that cause short stature and other growth problems.

    Lipid Disorders:

    Patients with lipid disorders have difficulty in maintaining normal levels of body cholesterol and fat. One of the most common lipid disorders is hyperlipidemia―high levels of total cholesterol, low-density lipoprotein cholesterol ("bad" cholesterol), and/or triglycerides (fat) in the blood. High levels of these fats are linked to heart and blood vessel (coronary heart) disease, strokes, and other diseases. Hypertension is common in people with obesity and lipid disorders, and together these factors put patients at higher risk for coronary heart disease.

    Albeit rate, disorders such as hypothyroidism, drug use (steroid use), alcohol abuse, chronic toxins/poisoning, or genetic or metabolic conditions a can also lead to development of lipid abnormalities. In addition, patients with metabolic syndrome, polycystic ovary syndrome (PCOS), and obesity are likely to have lipid disorders.

    Hypertension:

    Hypertension (high blood pressure) is a risk factor for heart disease and stokes. Up to 10% of people have hypertension because of too much aldosterone, a hormone produced in the adrenal glands. Some of these are caused by growths that can be removed with surgery. Conditions such as the metabolic syndrome or a growth called a pheochromocytoma or Cushing’s syndrome may also cause hypertension. These conditions also can be treated successfully.

    Endocrine Glands and Their Controllers

    The hypothalamus and pituitary glands are the key controllers of other hormone-producing glands in the body.

    • Hypothalamus: Located on the lower surface of the brain that controls the release of most of the hormones synthesized and released by the pituitary gland.
    • Pituitary gland: Located at the base of the brain under (and connected to) the hypothalamus area; the master hormone gland that controls the thyroid, adrenal, and gonads. It produces several key hormones:
      • Adrenocorticotropin (ACTH): Directs the adrenal gland to produce stress hormones (glucocorticoids)
      • Antidiuretic hormone (ADH): Controls the amount of water (metabolism) in the body
      • Thyroid-Stimulating hormone (TSH): Controls the synthesis and release of thyroid hormones from the thyroid glands
      • Growth hormone (GH): Growth-controlling hormone in children. In adults, it decreases body fat, increases muscle (fat-free mass) mass, and influences musculoskeletal health.
      • Follicular stimulating hormone (FSH) and luteinizing hormone (LH): Influence both testes and ovaries to work properly and secrete appropriate sex-steroid hormones.
      • Prolactin: Initiates milk production and growth of breasts. It also influences the synthesis and release of gonadotropins that control the secretion of sex-steroid hormones.
      • Oxytocin: Promotes uterine contractions and has effects on the vascular system.
    • Thyroid gland: Located in front of the neck; makes the hormone thyroxin, which controls metabolism in the body.
    • Adrenal glands: Located atop each kidney; three sets of hormones: adrenaline and noradrenalin form the adrenal medulla (from inner part of the adrenal gland), glucocorticoids (steroids), and mineralocorticoids from the adrenal cortical tissues (from outer part of the adrenal gland).
    • Ovaries and testes: Ovaries predominantly produce estradiol and progestogens, and testes produce testosterone.

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    Endocrinology of Persons with Intellectual Disabilities

    There are approximately 3.8 million patients with developmental disability (DD) in the Unites States. Yet in Medical school and physicians get very little exposure to understand and manage patient with DD. These patients have a disproportionately high incidence of endocrine other biochemical abnormalities. The AMA has recently declared that the developmentally disabled as a "Medically Underserved Population" (MUP status), which comes under “Healthcare Disparity”.

    The incidence of fractures among adults’ patients with DD is approximately 15 times higher than ambulatory patients and over 85% suffer from vitamin D deficiency. Endocrinologists should contribute tremendously to help these patients. It is plausible that the high incidence of falls and fractures in these patients (also other highly prevalent chronic illnesses including, epilepsy, GERD, behavioral issues, oral and dental issues) are related to significant vitamin D deficiency, and thus, corrections would likely to decrease the severity of these comorbidities and decrease mortality.

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    Entertainment

    Resources and Further Information

    Awesome Activities

    https://www.youtube.com/embed/Vo0Cazxj_yc

    Great Chinese State Circus - Swan Lake

    https://www.youtube.com/watch?v=4sMc-p19FIk

    A Dog's Best Friend - Nature and Animals are Amazing

    http://www.dogwork.com/ddcv4/

    Visualization of Ancient Anuradhapura

    https://docs.google.com/file/d/0B0KPEJhTPAA7ZGViOTY2NWYtNTVjZC00MjFjLWEyYmUtNDc5YzA0OWI1NWE4/edit?authkey=CKusnbgO&pli=1&hl=en

    Chinese Bicycle Acrobats

    http://www.flixxy.com/chinese-bicycle-acrobatics.htm

    Shark Trainer

    https://www.youtube.com/watch?v=WK2LpUoqX6A&feature=player_embedded

    Dani Lary Magic - Le Taj Mahal

    http://www.flixxy.com/dani-lary-magic-le-taj-mahal.htm

    Magic of Art

    https://www.youtube.com/embed/sKns1uatyNg

    Best International Stage Magicians - "The Twins": Sawing a Woman in Half

    http://www.flixxy.com/best-international-stage-magicians.htm

    Dog Show

    http://www.flixxy.com/dog-show.htm

    Father-Daughter Wedding Dance

    http://www.flixxy.com/father-daughter-wedding-dance.htm

    Bus 62 is Never Late

    http://www.flixxy.com/bus-62-is-never-late.htm

    Wonderful Pictures

    http://www.andiesisle.com/creation/magnificent.html

    Status of the World

    http://www.slideboom.com/presentations/171825/Dunyaheykel---Www.DostlukVadisi.Org

    Pam Rawat, Life

    http://www.wopg.org/en/words-of-peace-media/video-library

    Fireworks in Japan – 2014

    https://www.youtube.com/embed/_LpMB1OZ53g?feature=player_detailpage%22%20frameborder=%220%22%20allowfullscreen%3E%3C/iframe%3E&autoplay=1

    ‪Puppet Seller‬ - A Marionette in Manhattan

    https://www.youtube.com/watch?v=N-lhtB6K-tM&feature=youtube_gdata_player

    Unsung Heroes

    https://www.youtube.com/watch?v=uaWA2GbcnJU&noredirect=1

    Life is Not Money

    https://www.youtube.com/watch?v=7Bvy_11pxzA

    Piano Juggler - Las Vegas Entertainer

    https://www.youtube.com/watch?v=mFfeU85CozU

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    The Ways to Keep You Ergonomically Safe

    Try to maintain keeping the back and neck straight and the head slightly tilted downwards–a neutral posture, when sitting and walking.

    Keep items that you use frequently during the day in a place where you can easily reach them. This includes items such as the phone, stapler, and reading and writing materials.

    Aim to keep feet flat on the floor or flat on a footrest. Avoid crossing legs, wrapping feet under the chair, or dangling feet when seated.

    To avoid repetitive-strain injuries, keep wrists straight when using the keyboard and mouse.

    When using a laptop or a desktop computer, using a larger font size can prevent eyestrain, while the monitor and keyboard should be located ahead of you, monitor at the eye level, 18 to 24 inches in front of you.

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    Role of Estrogen in Women

    Estrogen and progesterone are the two key female sex hormones. Estrogen shapes the female phenotype (physical features) and responsible for reproductive functions.

    Estrogen predominantly produces from the ovaries, but adrenal gland also contributes some. Some testosterone in males is converted to estrogen. In fact, when the circulatory estrogen levels are compared in age-matched males and females (e.g., at age 70), males have higher estrogen levels than females.

    During pubertal period (female sexual characteristics, regulating menstrual cycle), pregnancy and in fact throughout the live, estrogen play a major role in women. In addition, it protect bone, have beneficial effects on cholesterol and influence the health of brain (control mood), heart, skin, etc.

    When birth control pills are taken, natural production of estrogen is suppressed. The commonest reason for low blood estrogen level is the natural or surgical postmenopausal status. This may lead to hot flashes, decreased libido, dryness of vagina, dry skin, alterations of sleep pattern, and unexpected and fluctuating mood.

    Excess estrogen may lead to menstrual irregularities, fibrocystic (lumpy) breasts, weight gain, depression and anxiety, and premenstrual syndrome.

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    Evolution of New Year

    A summary of the evolution of the New Years holiday throughout the world.

    https://www.wimalawansa.org/sites/all/files/New_Years_Evolution.pdf

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    Family Advice

    Dealing With Difficult Relatives and Friends

  1. Spend a few minutes ahead thinking how to behave. If you’ve had unpleasant experiences in the past, think about why they were unpleasant and what you could do to change the dynamics of the situation. Give yourself more travel and thinking time. Pick a seat far away from the trouble makers.
  2. Understand how seemingly innocuous topics to you might upset someone else. You may think you’re showing a polite interest, but some questions will rub a person the wrong way: “So do you have a girlfriend yet?”; “When are you two going to get married or start a family?”; “Didn’t you give up smoking?”; “Can you afford that?”; “When are you going to get a real job?” Instead, show an interest with more open-ended questions; like “What are you up to these days?” or “What’s keeping you busy?”
  3. Dodge strife. Some families enjoy arguing passionately amongst themselves; however, most don’t handle arguments very well. If you know the persons views are going to drive you crazy, don’t bring up the subject! And if he brings it up, you don’t have to engage. Try to make a joke of it, and say something like, “Let’s agree to disagree,” “Let’s not talk about that’, etc.
  4. Don’t drink much alcohol. It can seem festive and fun to fill up your glass, but it’s easy to lose track of how much you’re drinking. Alcohol makes some people feel merry, but it also makes some people feel combative, lowers their inhibitions in a disruptive way. And if other people seem to be trying to avoid or curb their drinking (or their eating, for that matter), don’t make a big deal of it or urge them to indulge. Don’t make someone feel conspicuous or strange in what they’re doing.
  5. Play your part in the tradition. For some people, traditions are very important, while others do not care. Try to be patient and play your part, respect the wishes and values of others. In the long run, traditions and rituals help sustainig happiness and family unity.
  6. If you’re the one who wants everything to be perfect, try to ease up on yourself and everyone else, so you can enjoy the day. Even if the day isn’t exactly the way you hoped it would be, try to enjoy what it is. Too much fussing or attention to detail may sometime ruin it altogether.
  7. Find some fun. Just because something is fun for someone else doesn’t mean it’s fun for you, and vice versa. Working in the kitchen, playing football, sitting around talking, running errands, may or may not be fun for you, no matter how the rest of the family feels.
  8. Find reasons to be grateful. Be thankful that you get to cook, or that you don’t have to cook. Be mindful that you get to travel, or that you don’t have to travel. Be thankful for your family or your friends. Be grateful for electricity and running water. Gratitude is a major happiness booster. Also, feeling grateful toward someone crowds out emotions like resentment and annoyance.

after Gretchen Rubin

An Inspiring Story From “The Life Of Dr. Abdul Kalam

When I was a kid, my Mum cooked food for us. One night in particular when she had made dinner after a long hard day's work, Mum placed a plate of 'subzi' and extremely burnt roti in front of my Dad.

I was waiting to see if anyone noticed the burnt roti. Dad just ate his roti and asked me how was my day at school.

I don't remember what I told him that night, but I do remember I heard Mum apologizing to Dad for the burnt roti.

I'll never forget what he said: "Honey, I love burnt roti."

Later that night, I went to kiss Daddy, good night I asked him if he really liked his roti burnt. He wrapped me in his arms said: "Your mother put in a long hard day at work today and she was really tired”.

"Besides... A burnt roti never hurts anyone but harsh words do!"

"You know, life is full of imperfect things...imperfect people..."

"I'm not the best and I am hardly good at anything!"

"I forget birthdays, anniversaries just like everyone else. What I've learnt over the years is:

To accept each other’s faults and choose to celebrate relationships.

Life is too short to wake up with regrets!

Love the people who treat you right and have compassion for the ones who don't."

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Hirsutism – Basic Facts of its Management

Diagnosis of Hirsutism

Hirsutism is having excessive terminal hair that appears as a male pattern in an adult woman. Variation of some sexual hair growth is normal. Physicians diagnose and then grade hirsutism various scales, commonly using Ferriman-Gallwey score of above the 95th percentile for the appropriate population.

Hirsutism must be distinguished from hypertrichosis—a generalized excessive hair growth that usually hereditary (familial) or a result of the use of certain medications such as minoxidil, phenytoin, cyclosporine, etc. Hypertrichosis is a generalized and distributed in non-sexual pattern, predominantly on forearms or lower legs. This condition is not caused or related to excess androgen in blood. Nevertheless, those with hereditary tendency, hyper-androgenism can aggravate it.

In humans, the growth of sexual hair (and the pattern of distribution) is entirely dependent on the presence of androgen. Thus, it is reasonable to test for elevated serum androgen levels (i.e., total serum testosterone level) in women with hirsutism and hypertrichosis.

Assessment and Treatment for Hirsutism

The goal in assessing hirsutism is to determine the specific etiology and to have a baseline assessment and to rule out other rare causes such as androgen secreting tumors. Because of a long growth cycle for hair follicle (usually 4 to 6 months), trial of at least 6 months should be given with any medication or method used before declaring it is ineffective, making changes in the dose, or switching to a new medication.

There are other conditions that an aggravate the situation. For example, conditions such as hypothyroidism must be control well, before starting treatment for hirsutism. Also, condition that directly contribute to hirsutism (secondary causes) such as hypercorticoisum, should be investigated and eliminated.

In the absence of serious underlying problem, most patients with hypertrichosis can be managed conservatively with mechanical methods. Over the past four decades, it was routine to treat these women with metformin. However, eight recent randomized clinical trials reported that metformin has no beneficial effective over placebo as a treatment for hirsutism.

Drugs Used in Controlling Hirsutism

Oral contraceptive that contain 20 or 30 micrograms of ethynyl estradiol or equivalent dose of estrogen. A low-dose of estrogen and a low-dose androgenic progestin, such as desogestrel or gestodene or an anti-androgen (such as DSP or CPA) can be used as a first-line therapy for hirsutism.

Eflornithine, a dermally applied cream/gel, reduces the rate of hair growth by inhibiting ornithine decarboxylase, which catalyzes the rate-limiting step for follicular polyamine synthesis. Eflornithine hydrochloride cream contains 13.9 % active substance (Vaniqa®)

Anti-Androgenic Agents

  1. Spironolactone: 100 to 200 mg/day
  2. Ciproterone acetate: 2 mg with low dose estrogen, contraceptive pill, or use alone at a higher dose of 10-20 mg a day
  3. Finasteride: 2.5 to 5 mg/day

Drugs That Should Not be Used for Hirsutism

  1. Metformin, (still useful for insulin resistance, POS and diabetes, but not for treatment of hirsutism)
  2. Glucocorticoids, (unacceptable adverse effects on multiple body system with very little benefit; except in a rare disease in the childhood, 21-hydroxylase enzyme deficiency)
  3. Flutamide, (because of the liver toxicity)
  4. GnRH agonists, except in women with severe forms of 710 hyperandrogenemia

Mechanical Methods

  1. Electrolysis: Removal of hair
  2. Photoepilation: A method that uses pulses of light (wavelengths between 500-1,200 nm) that is absorbed by skin-pigment melanin in the shaft and hair follicles.

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Inflammatory Bowel Diseases

The etiology is unknown. However, some combined effects of the environment, genetic susceptibility, intestinal bacterial flora, and abnormal (auto)immune responses I the intestine. The peak incidence occurs in people age between 15 and 30 years.

Somewhat common in Western counties, consists of two major types: ulcerative colitis (affecting the large bowel) and Crohn disease (most commonly at the end of the small intestine, but if can affect any part of the bowel).

Symptoms can range from (A) major GI track (diarrhea, blood in stool, fever, fatigue, abdominal pain and nutritional abnormalities, (B) symptoms outside the GI track (arthritis, vision issues, skin rashes, and major organ like liver issues.

Patients would have elevated inflammatory markers, electrolyte abnormality, vitamin deficiencies and low serum abnormality due to diarrhea. Endoscopic evaluation and GI track biopsies can be diagnostic.

Treatment depends on the severity and relapses. Mild disease treated with anti-inflammatory drugs (orally or suppositories), severe cases are treated with immune modulators and/Immunosuppressants (via rally, subcutaneous injections or intravenous infusion). When the disease flares up, it usually controlled using additional short-term steroids; surgery is the last resort. Those how has colon involvement has increased risk of colon cancer; hence regular colonoscopies are recommended.

Irritable Bowel Syndrome (IBS)

This is a common cause of undiagnosed abdominal cramps, stomach pain and change of bowel habits. Its cause is unknown, but it does not leads to higher risks of cancer. It may trigger after a stressful event, infections, or changes in bacterial flora in the large bowel.

Symptoms includes, changes in bowel habits, abdominal cramping, abdominal bloating or distention. Many of these symptoms appear soon after a meal and having a bowel movement relieve some of the symptoms. However, if symptoms started after 50 years of age, and/or presence of unexplained weight loss, blood in stools or iron deficiency, other investigations may be indicated to exclude serious pathologies, especially if there is a family history of bowel disorders.

Eating certain food containing fructose, lactose, or gluten, unusual stress or anxiety, an infection related to stomach or bowel or an episode of food-poisoning, or menstrual period may be associated with the irritable bowel syndrome. Although the history and symptoms are helpful in diagnosis there are no specific tests for specific conclusion. Treatments include, modification of diet (e.g., gluten free of lactose free diets, high fibre diet/fibre supplements) and stress levels, regular exercise, meditation, and treatments that can alter bacterial flora in the gut.

American Gastroenterological Association - Irritable Bowel Syndrome (IBS)

http://www.gastro.org/patient-care/conditions-diseases/irritable-bowel-syndrome

American College of Gastroenterology - Irritable Bowel Syndrome

http://www.gastro.org/patient-care/conditions-diseases/irritable-bowel-syndrome

Irritable Bowel Syndrome Self Help and Support Group

http://www.ibsgroup.org/

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Tips for Safe Lifting

When picking up that heavy package (or grocery), stand close to the package, off the floor keep the feet wide, bend your at the knees and hips as you go towards the floor, while keeping the back straight. Tighten your stomach muscles and lift with your legs (not with back muscles).

As you pick up the package, bring it towards your body and hold it close to you, but do not twist your back. Face the package as you are lifting it and move your body around to face the spot where you are placing the package back down; all the time, keep the balance.

When reaching a top shelf in the kitchen or decorating the top of a tree, cleaning the ceiling, use a steady step stool. If it is too heavy, it is; so, no need to break your back for it. Get help.

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Macroeconomics

Resources and Further Information

Sri Lanka Guardian: Articles on the Current United States Economic Crisis (Shehani Wimalawansa, Dr. Sunil Wimalawansa)

http://www.srilankaguardian.org/search/label/Sunil%20Wimalawansa

Sri Lanka Related Articles on Health, Social and Spiritual Topics by Dr. Wimalawansa

http://www.lankaweb.com/news/items/category/professor-sunil-j-wimalawansa/

Empowering Grameen Bank Scheme

https://www.youtube.com/watch?v=XvwllE33cy4

Confessions of an Economic Hitman

https://www.youtube.com/watch?v=yTbdnNgqfs8

Did You Know? Video on the Progression of Information Technology

https://www.youtube.com/watch?v=cL9Wu2kWwSY

The Myth of Americans Living Beyond Their Means with Robert Reich

https://www.youtube.com/watch?v=uB_Yuo6XNAA

Robert Reich: How Unequal Can America Get?

https://www.youtube.com/watch?v=QCu-XnVxhfk

Interview with Robert Reich on film Inequality for All

https://www.youtube.com/watch?v=q-rpkZe2OEo

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Overcoming Malnutrition

Malnutrition encompasses under-nutrition, over-nutrition, and deficiency of one or more essential nutrients, minerals, or micronutrients. In most Western societies, people are now used to taking over-the-counter multi-vitamins. However, those who are taking multi-vitamins generally are economically well to do and may not need such supplements.

In many instances, malnutrition is a result of the lack of a balanced diet. Occasionally, over-riding amounts of one macronutrient may interfere with absorption of micronutrients, thus leading to malnutrition. However, a balanced diet does not need to contain meat, fish, or eggs. Vegetarian diets can be easily balanced using appropriate vegetables, pulses, and fruits.

It is unfortunate that home gardening has gone somewhat out of fashion. This is an area in which more than 90% of families can grow some vegetables using homemade compost from otherwise wasted leftovers. Almost every house or slum in our country has at least one square yard of land. Most home gardening soils can be made fertile using organic waste, animal manure, and composted leaves. For home gardening, one can conserve water by using water used for washing plates, simple rainwater harvesting, and by eliminating the wasting of water.

We should encourage villagers to plant vegetables, fruits, and semi-permanent trees, such as Murunga, so that they can use the produce for home cooking but sell the surplus. In addition to having a balanced diet, people need to engage in adequate physical activity and exposure to fresh air and sunlight.

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Music

Dil Tadap Tadap | Lara's Theme (Live) - Shillong Chamber Choir featuring Vienna Chamber Orchestra

https://www.youtube.com/watch?v=UOZiXa0ctxo

Kandy Lamissi - Shanudrie Priyasad

https://www.youtube.com/watch?v=f1hQrXqgUuU

Obe Adare - Shanudrie Priyasad - The Music Video

https://www.youtube.com/watch?v=lgEvvZlggjo

Clarence Wijewardena Sihiwatana

https://www.youtube.com/watch?v=hG-GeDnTqjI

Gypsies Nonstop - Sunil Perera

https://www.youtube.com/watch?v=AO4YNKBa2Ic

Classic Sri Lankan Hits - Nonstop Baila

https://www.youtube.com/watch?v=l5L1uum1cAs

Kandy Lamissy- Marriazelle Gunathilake

https://www.youtube.com/watch?v=XL48-jDB2mc

Lassnata Pupuna–Nihal Nelson

https://www.youtube.com/watch?v=2Q2HOiPDKgQ

Desmond Silva - Nonstop Sinhala Songs

https://www.youtube.com/watch?v=bIcIi9sIyj0

Rukantha Gunathilaka

https://www.youtube.com/watch?v=hVyTU723Ddo

W.D. Amaradewa Best Song Collection 2

https://www.youtube.com/watch?v=Be0WzEduVQU

Non Stop - Chandimal Fernando

https://www.youtube.com/watch?v=xfWw7jAgVXA

Desmond De Silva and Manoharan - Ruhune Yaapane

https://www.youtube.com/watch?v=NagOWYB2eTg&feature=player_embedded

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Nature

Resources and Further Information

‪Louie Schwartzberg: Hidden Miracles of the Natural World‬

https://www.youtube.com/watch?v=FiZqn6fV-4Y

‪Gibbon Taunts Tigers - Complete & Best Quality‬‬

https://www.youtube.com/watch?v=fPXkUXXFoCw

‪Gorilla Reunion: Damian Aspinall's Extraordinary Gorilla Encounter on Gorilla School‬‬‬

https://www.youtube.com/watch?v=FZ-bJFVJ2P0

The Bear - Film by Jean-Jacques Annaud

http://www.flixxy.com/bear-animal-nature-film.htm

Kevin Richardson - The Lion Whisperer

http://www.flixxy.com/lion-whisperer-kevin-richardson.htm

Useful Dog Tricks

http://www.flixxy.com/useful-dog-tricks.htm

Baby Elephant Rescued.

http://www.wimp.com/elephantrescued/

The Art of Bear Photography

http://www.flixxy.com/bear-photography-national-geographic.htm

Wild Life Photos (Shamindra Fernando)

https://www.flickr.com/photos/shamindra_fernando/show

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Nutrition, Wellness and Obesity

Resources and Further Information

Aim for a Healthy Weight

Patient and public education materials from the National Heart, Lung, and Blood Institute.

http://www.nhlbi.nih.gov/files/docs/public/heart/aim_hwt.pdf

The American Dietetic Association

An organization of food and nutrition professionals, ADA’s mission is to promote optimal nutrition and well-being for all people.

http://www.eatright.org/

CDC's Nutrition and Physical Activity Program

Addresses the role of nutrition and physical activity in health promotion and the prevention and control of chronic diseases.

http://www.cdc.gov/nccdphp/dnpao/index.html

Center for Science in the Public Interest

Health and nutrition information.

www.cspinet.org

Consumer Nutrition and Health Information

Nutrition and health information from the Food and Drug Administration.

http://www.fda.gov/ForConsumers/

High-Temperature Cooking & The World's Healthiest Foods

Unwanted consequences of high-heat cooking

http://www.whfoods.com/genpage.php?tname=george&dbid=122

America's Workers: Stressed Out, Overwhelmed, Totally Exhausted

http://articles.mercola.com/sites/articles/archive/2014/04/10/workplace-policies.aspx?e_cid=20140410Z1_DNL_art_2&utm_source=dnl&utm_medium=email&utm_content=art2&utm_campaign=20140410Z1&et_cid=DM42308&et_rid=482672186

Dietary Guidelines for Americans

Recommended dietary guidelines from the U.S. Department of Health and Human Services and the U.S. Department of Agriculture.

www.health.gov/dietaryguidelines

Food and Nutrition Information Center

FNIC, located at the National Agricultural Library, collects and disseminates information about food and human nutrition.

www.nal.usda.gov/fnic

Health Information: Weight Loss and Control

FNIC, located at the National Agricultural Library, collects and disseminates information about food and human nutrition

. www.nal.usda.gov/fnic

Healthfinder: Obesity

Links to a variety of sites on obesity.

www.healthfinder.gov/scripts/SearchContext.asp?topic=592

Healthy People Atlanta

To promote health and well-being in the Atlanta's Metropolitan communities.

www.healthypeopleatlanta.com/

MEDLINEplus: Nutrition

www.nlm.nih.gov/medlineplus/nutrition.html

MEDLINEplus: Nutrition

www.nlm.nih.gov/medlineplus/nutrition.html

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Obesity: What Can We Do?

Obesity is a chronic medical problem of having too much body fat (for the body proportion). Health care providers diagnose obesity using various means, including the body mass index (BMI), which is calculated from current height and weight. For most people, the higher the BMI, the more body fat they have. Some bodybuilders and athletes have high BMIs, but they have more muscle mass than average and thus, not considered obese. On the other hand, some people (particularly south Asians), may have normal BMI but high abdominal girth, which puts them at a higher risk for metabolic syndrome and its complications.

Obesity is a disease that causes complications:

Both overweight and obesity can lead to serious complications, such as type 2 diabetes, high blood pressure, heart disease, stroke, high cholesterol, gallstones, gout, osteoarthritis, cancer, and premature death. Obesity makes many other medical and surgical problems harder to treat and complicated.

Why are we getting obese?

Obesity is a complex and not just a simple problem of willpower or self-control; it is a genetic disorder, that manifest when food is abundant. When we consume more calories than able to burn, overweight or obesity occurs. The combination of eating too much and having too little physical activity facilitates a gradual increase in body weight. Nevertheless, some people gain weight more easily than others, inherent metabolic rate may be, at least in part, responsible for this divergence.

There are other uncommon causes of obesity, including hormonal abnormalities, such as hypothyroidism (underactive thyroid gland) and Cushing’s syndrome. However, some medications also cause weight gain, such as those used to treat diabetes, psychiatric illnesses, neurologic disorders, or inflammatory conditions. Some are more prone to increase weight gain than are others.

Treatment of treated:

Obesity needs long-term management approaches that combine diet, physical activity, and lifestyle changes. Some obese patients may benefit from weight loss medication or even bariatric (weight loss) surgery.

No weight loss plans works overnight; thus, there is no quick fix for obesity (except invasive, bariatric surgery). The goal is to lose between 7% and 10% of the initial body weight, which is known to improve metabolic variables and decrease complications. It is important to keep the weight off by adhering to a sensible diet and regimen of physical activities and adopting healthier lifestyles.

Basic principles in losing weight:

The lifestyle changes are the key to losing and keeping off excess weight. These changes include reducing portion sizes of foods and avoiding second servings and cutting down on consumption of refined carbohydrates and foods containing corn syrup and preservatives and those high in saturated fat or sugar. Meanwhile, it is important to increase the quantity and variety of fruits, vegetables, and whole grains, and spend 30 minutes a day in moderate physical activity, such as brisk or fast walking.

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Osteoporosis

Osteoporosis is a silent disease. Susceptible individual with osteoporosis may sustain a fracture(s) following low-impact injury or at time with no injury. Half of the vertebral fractures are painless, or a newly present curvature of the spine or tenderness over that area, or may present as difficulty in breathing (simulating chronic lung disease), gastrointestinal issues, and/or decrease in height of more than two inches (5 cm).

How Serious is it?

Osteoporosis is a common disease, if entered may lead to fractures; commonly in the spine (vertebrae), hip and wrist. In the United States, over 12 million Americans are currently living with osteoporosis and 39 million more have low bone mass, placing them at risk for this disease and vulnerable to sustain fractures. More than 75% of those with osteoporosis are women.

One out of every two women and one in four men over 50 will have an osteoporosis-related fracture in his or her lifetime. Worldwide, an osteoporotic fracture is estimated to occur every 3 seconds, a vertebral fracture every 20 seconds; thus, prevention and early detection of the disease is vital.

Osteoporosis poses risk factors for those with a family history of osteoporosis. Certain commonly used medications increase the risk of having a fracture.

There are no symptoms in those with osteoporosis, until a fracture occurs. Therefore, is is important to screen women following the menopause and men above 60 years of age, preferably using a DXA testing, and if appropriate blood testing.

It is recommended they eat, exercise and avoid smoking. Regular weight bearing exercises, taking diet rich in calcium and vitamin D is important. When dietary amounts are inadequate, supplementations are indicated. Exposure to sunlight is the best source of vitamin D.

Medications for Osteoporosis

There are a number of medications available for the prevention and treatment of osteoporosis. If you have osteoporosis or low bone density, you need to optimize your calcium and vitamin D intake, and engage in weight –bearing physical activities such as fast walking. If anti-osteoporosis medication is required, please discuss these with your healthcare provider.

Prevention of falls and injuries is the key to fracture prevention. Any of the following medications require adequate calcium, vitamin D, and exercise to work best.

Bisphosphonates:

Bisphosphonates are used in the treatment of postmenopausal osteoporosis. They can reduce the incidence of fractures of the spine, hip, and wrist in people with osteoporosis and prevent bone loss for men and women taking steroids. Bisphosphonates work by slowing osteoclasts cells that break down bone, allowing osteoblasts cells that build bone more time to work and reduce the imbalance.

Immediate (or short term) side effects of bisphosphonates include muscle aches, joint aches, stomach upset or heartburn. Longer term sinister adverse effects include osteonecrosis of the jaw (ONJ/OMJ) and atypical hip (sub-trochanteric) fractures [What to Make of Bisphosphonate Drug Risk]. Following the instructions strictly, would markedly decrease the gastrointestinal adverse effects of bisphosphonates.

Weekly dosing:

  • Actonel® (risedronate); Fosamax® (alendronate)
  • Generic Fosamax (alendronate) approved by FDA in 2008
  • Boniva® (ibandronate)

Actonel® and Fosamax® have also been approved by the FDA for the treatment of osteoporosis in men.

Monthly dosing:

  • Actonel® (risedronate); Boniva® (ibandronate)

Yearly (or every other year) dosing:

  • Reclast® (zolendronic acid) infusion

Hormone Replacement Therapy (HRT)

HRT is indicated in postmenopausal women with hot flashes. HRT has a demonstrable benefit on bone, prevent fractures, but may present a risks for some women.

If opted, take the lowest effective HRT dose. HRT can be administer in several forms including oral, transdermal, gels, patches, and lotions. You need to assess the risks and benefits of HRT, just like any other medication. Discuss with your physician the pros and cons before starting and then annually. In a giver person, HRT may be associated with a slightly increased risk of breast cancer, stroke, and deep vein thrombosis.

Brands: Premarin®, Estrace®, Ogen®, Cenestin®, Climara®, Vivelle-Dot®, Menostar®, and others.

Parathyroid Hormone (PTH)

Parathyroid Hormone is an anabolic treatment for osteoporosis that stimulates new bone formation; it reduces fracture risks. PTH, an injectable agent, prescribed for 12-24 months to individuals with severe osteoporosis. It is approved for both men and postmenopausal women with significant osteoporosis (low BMD) or fractures. Adverse effects may include dizziness and leg cramps, and injections site reactions.

Brand: Fortéo

Denosumab

Denasumab is a monoclonal antibody―a biologic, for the treatment of osteoporosis and given by injections, once in six months. It decrease osteoclasts-mediated bone resorption, thus, enhancing osteoblast cells increasing bone strength. Adverse effects may include back, joint, and muscle pain, pain in the extremities, and skin infection, especially patients with eczema.

Brand: Prolia

Selective Estrogen Receptor Modulators (SERMs)

SERMs are in table form, a family of synthetic drugs with some similarity with estrogen on its actions. These drugs block the effects of estrogen in breast and uterus, and thus may reduce the risks of cancer. Evista® (raloxifene) is approved for the prevention and treatment of osteoporosis. Potency is less than bisphosphonates and denosumab, but has the advantage of secondary prevention of breast cancer. Adverse effects may include increase of hot flashes, leg cramps and possibly blood clots.

Brand: Evista®

Calcitonin

Calcitonin is a hormone derived from certain thyroid cells. It protect bones during situation with calcium-stress; such as pregnancy, lactation and during the childhood. It is the least efficacious agent, and has minimal effect on preventing bone loss or fractures. Calcitonin is administered as a nasal spray or an injection. Adverse effects may include a runny nose with the nasal spray or an allergic reaction or other effects with the injectable forms.

Brand: Miacalcin

What Type of Exercise is Good for Prevention of Osteoporosis?

Any weight-bearing exercises such as fast walking and balance improving exercises, can help retaining the bone mass, improvise neuromuscular integrity, prevent falls, and decrease the risk of fracture. Thirty minutes of a weight-bearing exercise (perhaps, done in 15 minutes in AM and PM, five times a week, together with balance improving and strengthening exercises using resistance, few times a week are useful.

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Polycystic Ovary Syndrome

Polycystic ovary syndrome (PCOS) is a common genetic disorder with hormonal abnormalities that affects girls and women during their reproductive years. Normally, women produce small amounts of male hormone androgen, testosterone). However, women with PCOS produce slightly higher amounts of testosterone as well as insulin. This hormone imbalance manifests as subfertility, irregular menstrual periods, type 2 diabetes, excessive growth of face and body hair (hirsutism), and obesity.

Women may have different combinations of this syndrome. PCOS runs in families. Women and girls who are obese are likely to have PCOS. Most girls have signs and symptoms of PCOS around the start of menstruation, but some women do not get symptoms until their mid-20s. Symptoms such as excessive facial hair, hair loss, and male-pattern baldness can continue, even after a woman goes through the menopause.

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Correct Posture and Keeping Naturally Fit

Age is nothing but a number, by keep active life you can physically and mentally keep younger. Regular walking is one of the best and easiest ways to stay active. One can incorporate fast walking into daily habits, while at home, school or at work.

Staying active is fun, and one should be actively doing what you like to do. Avoid parking closet to the shop or a supermarket; instead of elevator, take the steps, and walk fast from one place (one building) to another. Make sure the exercises include strengthen your back and tummy muscles, every day.

Eliminate bad habits that promote unhealthy postures at all times. Maintain the right posture when you are walking; keep the back and neck straight. Make a regular conscious effort to correct the posture when sitting and walking.

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What is Prediabetes?

Insulin, one of the hormones produced by the pancreas, facilitates blood glucose to enter into cells to be used as energy. This balanced process keeps the amount of blood glucose stable, preventing it from being too high or low.

Prediabetes is a condition in which blood glucose levels are higher than normal but not high enough to be diagnosed as diabetes. However, with time, the levels of blood glucose increase, putting the individual at a higher risk for heart disease and stroke and developing type 2 diabetes.

Who is at risk of developing prediabetes?

According to the Centers for Disease Control and Prevention, in 2013, about 79 million American adults age 20 years or older had prediabetes. As the population ages and becomes more overweight and inactive, the number of adults with prediabetes continues to increase. Consequently, age is positively associated with prediabetes. Risk factors enhancing the development of prediabetes include being overweight or obese, having a family history of type 2 diabetes, and not getting enough exercise. Certain ethnic groups, such as African Americans, Latinos/Hispanics, and Native Americans, and those who have had gestational diabetes (diabetes during pregnancy) or have given birth to a baby weighing more than 9 pounds are at high risk for prediabetes and thus type 2 diabetes.

Prevention of prediabetes:

Prediabetes is preventable. Even for those having a strong family history of diabetes, prediabetes can be reversed. Having regular physical activity, maintaining a healthy weight, and avoiding eating junk food can minimize prediabetes. Several drugs can decrease the risk of progression to diabetes.

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Simple and Practical Instructions
for Better Health

For better health and prosperity, we should proactively initiate programs for selves and the community, including developing self-reliance, encompassing the following basic principles:

1. Healthy Food Choices – Measures to improve health and fitness of the community:

These include healthy natural diets, avoidance of unhealthy food (such as fast, processed, and calorie-rich convenient food). Facilitate people to engage in healthy lifestyles (increasing access to parks and recreation facilities that are safe, encourage individual and group physical activities, such as leisure, sports, yoga, aerobics, and Tai Chi) and workplace breaks. Provide access to physical activities; provide secure sites for cycling and parking; encourage commuters to cycle to work; and encourage staff to use the stairs instead of taking the elevator.

Educate about and encourage and facilitate consumption of healthy food at work and in food stores, facilitate and provide unprocessed and organic foods, replace processed food and soda choices (vending machine) with affordable clean water, tea and coffee, nuts, dried fruits (unsweetened), and other healthy choices.

2. Improve on Mental and Emotional Health:

It would be beneficial to offer on-site health clinics at work sites, universities, and in schools, offering health care advice, preventive health (including immunizations), basic medications and physical therapy, and nutritional advice. Consider the inclusion of employee assistant programs that provide confidential access for employees and their immediate family members to counseling (which provides assistance in personal challenges in their lives, including overcoming depression, emotional distress, marital and family difficulties, alcohol and substance abuse, and financial or legal issues) and referrals to community and private services to overcome long-term individual challenges.

3. Improving Physical Health:

Provide advice and opportunities to avoid obesity and type 2 diabetes. Offer comprehensive weight loss and maintenance programs that lead to sustainable healthful lifestyles, improvements in eating habits, improved hygiene and oral health, assistance in family health (infant and child wellness, risks vs. benefits of vaccines), and so forth.

4. Alleviation of Stress:

Stress causes and contributes to more than 60% of human illnesses. Excessive stresses at the workplace, school, or home are harmful. Before one is burnt out, one should consider moving into another job and learn new skills to prepare for a career change. Other options include requesting flexible hours or working from home and telecommuting to make the work more manageable, which can make a big difference.

It is important to develop ways to manage day-to-day stresses that help prevent burnout, depression, and prematurely leaving jobs. The development of tolerance and avoiding vicious cycles in a proactive manner are keys to success. Using daily meditation, Tai Chi, or a similar well-known activity would help calm nerves and facilitate good health.

Think positive and keep the mind clear of clutter. Watching too much television, movies, or video games and associating with unwholesome people pollutes the mind. Make a commitment to yourself not to engage in gossip, negative self-talk, or thrashing others.

5. Relaxation and Meditation:

Mild to moderate exercise and meditation improves physical and mental health. In part, this is because of healthful changes in brain neurotransmitter and neuromodulators and suppression of harmful hormones and cytokines. Moreover, regular safe physical activities protect us from falls and injuries. Excessive exercises are not physiological and can be harmful.

None of us is going to get younger! Therefore, to sustain a healthy mind and body, in addition to 15 to 20 minutes of reasonable physical activities daily, a regular meditation, even 10 minutes a day (sitting quietly with closed eyes and mindfully breathing), facilitates relaxation of the mind and the body and breaks up the monotony of life.

6. How to achieve these at work⎯Minute of Meditation:

When you are at work or work from home, take a five-minute break every hour (or three-minute breaks every 30 minutes) no matter what. The first one or two minutes, engage in some meditation (or simple observe your breath), and the remaining time, engage in “fast walking,” going up and down the stairs or from one building to another or out of the house to get some fresh air.

In the series of meditation books illustrated in this website, Meditation Book 1 (chapter 12) provides a simple and practical section on “Minute of Meditation.” Engage in one or two minutes every hour, as explained in this chapter, to do meditation; you will see the benefits quickly. Meditation relieves your stress and refreshes your mind quickly; each hour you are starting as if you are starting the day new!

For the remaining three minutes in the break in each hour, consider engaging in fast walking. Whatever you do (preferably walking), do it fast. By the end of the day, you have meditated (at least) eight minutes and engaged in 12 minutes of exercises. Consequently, you may not need to go to a gym or to a temple!

7. Focus on Your Breathing

Most of us routinely take shallow breaths that facilitate building up internal tensions. We do not exercise muscles that are associated with breathing or use the full capacity of our lungs. As meditation teaches us, learning to breathe naturally and mindfully not only relaxes our mind and body, but also improves our intrinsic physiology and energetic mechanisms, thus refreshing the mind and the body. During such activities of mindful breathing, our metabolism and thus the oxygen requirements go down (as does the breath rate), enabling us to achieve or re-establish our internal energy balance and physiology and improve immune responses and clarity of the mind.

8. Respect and Enjoy the Nature and the Environment:

Nature and the fresh air are always refreshing. Spending a few minutes each day in nature can help reduce stress and boost mood. Taking part in outdoor activities in a non-polluted environment is healthy and relieves stress. During such times, the levels of key stress hormones, including blood cortisol and catecholamines, decrease.

9. Ensure That You Have Regular Medical Exams

It is wise to have adequate immunization, and regular mammograms, flu shots and annual medical examinations. We encourage readers to seek care and guidance from their healthcare providers.

10. Be Confident of Who You Are

When you are confident, that is your assessment of your own competence. You have the experience and the wisdom. You know what you can do, and your confidence says that. It is your relationship to yourself and your own expertise.

Generally, confidence that comes with being accomplished and successful does not make someone arrogant. Arrogance has to do with one is judging that other people are inferior. It has more to do with not seeing other people as being up to your standards.

Professionalism is not about putting on a happy face or being someone you are not; it is about providing quality care for the patient, a customer, or a colleague; depending on the situation.

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Social Topics

Resources and Further Information

Seeds of Destruction: The Hidden Agenda of Genetic Manipulation

http://www.globalresearch.ca/seeds-of-destruction-the-hidden-agenda-of-genetic-manipulation-2/9379

Open Letter to President Barack Obama Regarding the Impact of Health-System Reform on Emerging Populations

http://www.nmqf.org/open-letter-to-president-barack-obama-regarding-the-impact-of-health-system-reform-on-emerging-populations/

The Hidden Key to Productivity: Getting Smart About Energy

https://chroniclevitae.com/news/386-the-hidden-key-to-productivity-getting-smart-about-energy?cid=VTEVPMSED1

"The Daily Pulse of Global Innovation": What Sony played at its annual shareholder meeting in 2009

http://www.innovationamerica.us/index.php/innovation-daily/2024-what-sony-played-at-its-annual-shareholder-meeting-this-year

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Sri Lanka

Sri Lanka is an island in the Indian Ocean, previously known as Hela, Serendib, and then Ceylon. Now known as The Democratic Socialist Republic of Sri Lanka. Buddhism brought to Sri Lanka from India over 2,300 years ago, and its history goes back over 3,000 years. Has a population of 21 million in a 64,000 hectare of land. Life expectancy is approximately 80 years.

Sri Lanka consists of unique monuments, including eight well-preserved UNESCO World Heritage sites. The culture and the way of life of Sri Lankan people, goes back centuries. One of the world's first wildlife sanctuaries was established in Mihintale in the 3rd century BC. This has expanded to more than 70 protected nature reserves (approximately 13% of the country’s land) area maintained under the Department of Wildlife Conservation. It has plenty of wild life, unique fauna and flora.

Sri Lanka is a small island but with rich traditions and natural resources. It is a land of serendipity, where you can experience from warm to cold weather, from sea level to over 6,000 feet elevation in the mountains, coconut, rubber and tea estates, all within 3 hours of drive from each other. It also has unique kind of gems and a leads export of high-quality garment industry to the west to well-known name brand sources.

National airline, SriLankan Air (http://www.srilankan.com/en_uk/us) is a partner of the OneWorld program. The majority of people speak English; while all residents speaks either Sinhela or Tamil.

Resources and Further Information

Wikipedia Sri Lanka page

http://en.wikipedia.org/wiki/Sri_Lanka

Official Tourist Website

http://srilanka.travel/index.php?route=common/home

Sri Lanka Travel Guide

http://wikitravel.org/en/Sri_Lanka

Beautiful Sri Lanka

http://vimeo.com/20870317

Pictures of Sri Lanka

http://www.greatmirror.com/index.cfm?countryid=376

Awesome Sri Lanka from Fox News

https://www.youtube.com/watch?v=PfmxLiHCzj4&feature=email

Ceylon in 19th Century (Colombo)

https://www.youtube.com/watch?v=Ptn8Jt5u4g8

Ceylon in 19th Century (Buildings and Ruins)

https://www.youtube.com/watch?v=J3qEeZKwuhg

Ceylon in 19th Century (Trade)

http://www.globalimageworks.com/clip.php?id=17365

Exotic Sri Lanka - Absolutely Everything in a Small Space - National Geographic

https://www.youtube.com/watch?v=1-WfXSacm84

Damubulla Temple, Sri Lanka

http://www.ocholeguas.com/en_360/2011/09/sri_lanka/1/1.html

Old Images of Famous Ruins

http://www.imagesofceylon.com/ioc-ruins6.htm

Sri Lanka-The Miracle

http://thelankan3000.webnode.com/

Prevention of Common Diseases Affecting Sri Lankans: A Cost-Effective Approach

View PDF

Beauty of Sri Lanka

https://www.youtube.com/watch?v=1GoZ_HZH_bo

Horton Plains Sri lanka

http://vimeo.com/43240281

Touring Sri lanka 2014

http://vimeo.com/groups/srilankahd/videos/97772550

From Mountains to the Sea: Sri Lanka

http://vimeo.com/groups/srilankahd/videos/96076932

We are Sri Lanka

http://vimeo.com/groups/srilankahd/videos/93508392

Proud of Sri Lanka

https://www.youtube.com/watch?v=XPaQi-nueIE&feature=youtu.be

Investing in Sri Lanka

https://www.youtube.com/watch?v=YrrjMp-WMAU&feature=youtube_gdata_player

Sri Lanka 100 Years Ago

https://www.youtube.com/watch?v=2pCtjnhxXfw

Victor Ratnayake-SA-Musical Show

https://www.youtube.com/watch?v=dPGOaCsQ_7Y&feature=youtu.be

Tour of Sri Lanka in 5 Minutes

http://www.youtube.com/embed/exM8zm3qgTk

Horton Plains – Magnificent Highlands of Sri Lanka

https://www.youtube.com/embed/-UQWsu-KNw0

Beautiful-Sri-Lanka – Most Beautiful Island of the World

http://www.dailymotion.com/video/xm5fuh_beautiful-sri-lanka-most-beautiful-island-of-the-world_travel

Sri Lanka Travel and Tourism, Sri Lanka Holidays, Sri Lanka Tours

http://www.dailymotion.com/video/xm5hwh_sri-lanka-travel-and-tourism-sri-lanka-holidays-sri-lanka-tours_travel

Lion-Rock-of-Sigiriya – Sri-Lanka-World’s Greatest Attraction

http://www.dailymotion.com/video/xm5hwh_sri-lanka-travel-and-tourism-sri-lanka-holidays-sri-lanka-tours_travel

Bird’s Eye View of Sri Lanka Beauty

https://www.youtube.com/watch?v=cvXiEAb0g9A

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How to Avoid Stress Fractures

Stress fractures are a common injury, among young adults, solders, and athletes. One in five, long distance runners develop stress fractures, mostly in women. Weaker bones, lack of adequate caloric intake as in patients with anorexia nervosa, and those who do not have regular monthly period (amenorrhea or oligomenorrhea; commonly develop from low blood estrogen levels) are most susceptible to develop stress fracture, especially when they engages in competitive sports activities.

Wearing appropriate shoes is important to prevent harm, so as the running surfaces and terrain. Increasing training (e.g., preparing running for a marathon, jumping or speed training too quickly) too much, too quickly can cause stress fractures. Thus, to avoid stress fractures, it is important to gradually increase training, incorporate strength training, and maintain a healthy nutrition and safe exercise regimen.

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What Is Traumatic Brain Injury?

Traumatic Brain

Traumatic brain injury (TBI) is caused by a sudden trauma or damage to the brain secondary to a trauma (e.g., explosion, violence, or injury to the head). TBI can occur when the head is hit abruptly against a stationary or moving object, once or multiple times, or an object penetrates the skull and damages the brain or surrounding tissues.

Causes

Common causes include head injuries due to any cause; falls; motor vehicle accidents; any violent act, such as a gunshot injury; and child abuse (shaken baby syndrome). Other common causes include contact sports injury and combat experiences.

Consequences

In addition to the potential brain damage, TBI can directly affect the endocrine system and thus all bodily functions. The hypothalamus and pituitary glands are located in or very close to the brain, so TBI can damage these organs. Therefore, in addition to brain injuries a person with TBI also may experience hormonal abnormalities. These abnormalities may manifest immediately or later.

Anterior pituitary hormonal deficiencies

Depending on the site and the severity of the injury, patients with TBI can experience a variety of hormonal issues. Adrenal insufficiency is the most life threatening. Insufficient production of stress hormones from the adrenal glands leads to low blood pressure (i.e., postural hypotension), fatigue, vomiting, dehydration, increased susceptibility to infections, and marked emotional liability. Subsequent to TBI, patients may experience thyroid function abnormalities, hypogonadism, growth hormone deficiency, or hyperprolactinemia.

Posterior pituitary hormonal deficiencies

Failure of the pituitary gland to make antidiuretic hormone (ADH) leads to marked water loss (frequent urination and extreme thirst) and thus severe dehydration; this entity is called diabetes insipidus. Patients may also present with hyponatremia caused by salt and water imbalance, which may result in confusion, vomiting, dehydration, convulsions, and coma.

Hormonal treatments

Blood test results will indicate the levels of key hormones. It is essential that any hormonal abnormality is corrected with appropriate hormones in adequate doses―hormone replacement therapies. Some patients experience a return to normal hormone levels with time, whereas many others need lifelong hormone replacement therapy.

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Turner Syndrome (TS)

TS is a chromosomal abnormality that occurs in 1 in 2,000 pregnancies affecting females. In this condition, one of the two X chromosomes normally found in females is missing, damaged, or incompletely transferred to the fetus. In most cases, this occur as a random event.

Girls and women with TS have short stature, subnormal bone mass, cardiovascular, kidney and dermal abnormalities, and have increased risks for fracture, especially after the menopause.

Most skeletal abnormalities are correctable with physiological means: proper nutrition, adequate calcium and vitamin D, weight-bearing exercises, and appropriate and timely therapy with GH and estrogen replacement therapies. However, there may be other hormonal abnormalities need correction.

Management of TS patients includes correction of short stature with appropriate use of human recombinant growth hormone (rhGH) and timely administered estrogens. In addition, these patients may also suffer from a variety of skin, cardiac, and kidney issues. With proper medical care, TS patients are able to continue normal and productive life.

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Benefits of Weight Loss

Losing acquired excessive weight improves health in a number of ways. Among others, it can lower the risk of prediabetes and type 2 diabetes, high blood pressure, stroke, and heart disease. Losing weight can also help you feel better, decrease depression, improve sexual dysfunction in men, and improve osteoarthritis.

Changes in eating habits to enhance weight loss:

One of the fundamental approaches to weight loss is lifestyle change. To achieve this, the person must be motivated and willingly take part in such programs. Changes include consuming fewer calories; eating a low-carbohydrate, low-saturated fat diet; and eating foods containing non-starchy vegetables and fruits.

Other healthy diets, such as the low-sodium DASH diet, can help, particularly in controlling high blood pressure. The DASH diet includes fruits, vegetables, whole grain foods, low-fat or non-fat dairy foods, nuts, seeds, and lean meats, poultry, and fish.

Exercise to maintain weight loss and keep fit:

Exercising (physical activity) 30 minutes a day most days of the week will have a major beneficial effect on physical fitness and health. For the average person, losing weight only through exercise is virtually impossible, unless exercise, several hours a day. Exercise plays an important part in helping people who have lost weight maintain the weight loss.

One can get support by attending weekly group meetings or weekly visits with a health care provider, such a registered dietitian. Studies show that anti-obesity medicines can help people lose more weight when combined with lifestyle changes (diet, exercise, and behavior change) than can be lost with lifestyle changes alone. However, all these medications have adverse effects that need to weigh against their benefits.

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Simple and Practical Guidance to Lose Excess Weight:

1. Avoid drinking sugary drinks, instead drink clean water.

Instead of sugary drink and fizzy drinks such as cola (soda), consider drinking plenty of clean water. Drinking water regularly will facilitate flushing out cumulating toxins. Drink at least eight glasses of water a day.

2. Take smaller portions and eat smaller meals:

It is a no brainer that following the above will lead to weight loss. Follow an eating schedule with five little meals every day. Have healthy snacks such as nuts, a glass of skim milk and tea in between meals. Eat unprocessed raw nuts, including almonds, pumpkin seeds, walnut, etc., instead of eating high-calorie snacks.

3. Have a balanced diet:

The diet should be balanced preferably containing of organic sources of lean protein (chicken fish, etc.,) and vegetable (such as dhal, soya, etc.), complex (unrefined) carbohydrates, whole grains, legumes, nuts; and plenty of antioxidant containing fruits, and vegetables. It may help to switch from white rice and pasta, to brown rice, millet, and buckwheat; but the key is to keep the quantity down. Eat more green leaves, such as broccoli, kale, spinach, and asparagus. Avoid sweat and processed food including candy, sugar, soda, and all simple sugars.

4. Adopt a balanced approach to your diet.

Many of the commercial diet programs work; as long as one stick to it. In addition to the costs, most people find it difficult to adhere to such diets in the longer term. Stick to a diet that you design for yourself that you can adhere to in the long term.

5. Augment your weight loss program:

A simple dietary change will help to lose weight. Consider having a light meal in the evening or a bowl of soup or a plate of salad instead a full meal. Homemade soups without preservatives and low salt are far healthier than canned soups that have high salt content and chemical preservatives. Since the body follows a circadian rhythm, and having a light meal for dinner/supper would help to lose weight and improve blood sugar.

6. Diet works better with physical activity:

Consider increasing physical activity such as fast walking, yard work, cycling, etc.. Whatever the items that you enjoy and able to continue long-term. Remember that your weight multiply by the speed of your activity (square root of it), determine how much you burn your calories. Take stairs instead of the elevator. Speeding up walking for example will be great way to use calories. For most people 10 to 15 minutes, twice a day would help. One does not need to spend hours in a gym to lose weight. Instead of staying in indoors, walking outside and getting exposure to sunshine and fresh air would add more benefits to you.

7. Things that would augment your weight loss dream:

(A) Engage in daily some physical activity, (B) Stick to smaller meals and control the portion size, (C) Avoid eating out and eating from fast food restaurants (if you have to, then order grilled chicken instead of fried and try salads; baked potatoes instead of fries), (D) Eat whole grain bread, cereals, rice, and pasta, instead of refined carbohydrates, (E) Avoid or minimize taking high sugar (fructose/corn syrup) and fried or fatty snacks, (E) Stick to common sense approaches to l weight loss. You do not need to spend to lose weight!

Resources and Further Information

Simple Guidelines on Reducing Weight and Cholesterol

weight_reduction_diet.pdf

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Wildlife and Nature Photography

Wildlife and Nature Photos by Sunil Dissanayake

https://www.flickr.com/photos/senerath/

Barn Owl

https://www.flickr.com/photos/senerath/6934037297/in/photostream/
https://www.flickr.com/photos/senerath/6787921950/

Entrance to the Painted Rock

https://www.flickr.com/photos/senerath/6934032693/
https://www.flickr.com/photos/senerath/6787916400/

Soda Lake

https://www.flickr.com/photos/senerath/6934027143/
https://www.flickr.com/photos/senerath/6934024997/

Gofer Snake

https://www.flickr.com/photos/senerath/6787908984/

Barrel Cactus

https://www.flickr.com/photos/senerath/6934019215/

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World History and Geography

Resources and Further Information

World history in two minutes

http://marcbrecy.perso.neuf.fr/history.html

Olcott Oration: A look at the life of Colonel Henry Steele Olcott, Founder of Ananda College

http://www.anandacollege.net/document/14011809Olcott%20Oration%20Book.pdf http://www.anandacollege.net/Olcott%20Oration%202013-10a-42.html

Greatest Places on Earth: IMAX Documentary

http://www.youtube.com/embed/GQ28v0l0kw4

Brief Moments in History

http://www.liveleak.com/ll_embed?f=d6d9d5385aee

Smithsonian National Museum of Natural History: Virtual Tour

http://www.mnh.si.edu/vtp/1-desktop/

Amazing Kaleidoscope

http://inoyan.narod.ru/kaleidoskop.swf

Audio slideshow: Seeing into Space

http://www.bbc.co.uk/news/science-environment-11213528

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