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		<title>MEDiscuss - Blogs</title>
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			<title>Remembering Steve Jobs</title>
			<link>http://www.mediscuss.org/blogs/shashikiran-1/remembering-steve-jobs-35/</link>
			<pubDate>Sun, 09 Oct 2011 13:34:47 GMT</pubDate>
			<description>Steve Jobs succumbed to pancreatic cancer on October 5, 2011 which is 4 days before I am writing this blog. He has left...</description>
			<content:encoded><![CDATA[<blockquote class="blogcontent restore">Steve Jobs succumbed to pancreatic cancer on October 5, 2011 which is 4 days before I am writing this blog. He has left an indelible mark on the use of gadgets by humans. The way he envisaged the importance of design and form-factor in the production of smartphones and computers is amazing to say the least.<br />
<br />
I am also an Apple fan, owning about 4 apple products as I am writing this, and using one of them to pen this post. All of us in our family really enjoy using these and the image below shows how my daughter expressed her feelings on hearing Steve Job's death.<br />
<div class="img_align_center "><a href="http://www.mediscuss.org/attachment.php?attachmentid=170&amp;d=1318167074" id="attachment170" rel="Lightbox_35" ><img src="http://www.mediscuss.org/attachment.php?attachmentid=170&amp;d=1318167074" border="0" alt="Steve Jobs" class="align_center size_large" title="Steve Jobs" description="Remembering Steve Jobs - Eulogy from a small girl" /></a></div><br />
He was really the 'apple' of the 'i' products. May his soul rest in peace. Hope Apple continues his legacy of design.</blockquote>

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			<dc:creator>Shashikiran</dc:creator>
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			<title>Conserve Water</title>
			<link>http://www.mediscuss.org/blogs/tinkle-1258/conserve-water-34/</link>
			<pubDate>Sun, 11 Jul 2010 16:35:30 GMT</pubDate>
			<description>*Water, water everywhere but not a drop to drink! * 
 
In the last century, several wars were fought over oil. However,...</description>
			<content:encoded><![CDATA[<blockquote class="blogcontent restore"><b>Water, water everywhere but not a drop to drink! </b><br />
<br />
In the last century, several wars were fought over oil. However, in this century, experts predict that majority of wars will be fought over control and use of water bodies. Growing deforestation, melting of glaciers, pollution, etc. have put serious pressure on available water resources. The United Nations celebrate June 5 as World Environment Day. But is one day enough to save the environment?<br />
<br />
Scientists predict that an ancient glacier feeding the River Ganga will melt by the end of the twenty first century due to climatic changes caused by global warming. Initially, this may cause flooding of the river, but eventually, the river may run dry, which can have disastrous effects on the lives of millions.<br />
<br />
Saving water is a big thing, but every little bit helps, so don't think that what you do doesn't matter. Every single person doing at least a little bit adds up to a whole lot. Water conservation should be a way of life, not just something we think about once in a blue moon. Water conservation means using our water wisely and caring for it properly. <br />
Since each of us depends on water for survival, it is our responsibility to learn more about water conservation and also educate other folks who are unaware of what a precious treasure water is. <br />
<br />
Water conservation is not a job that is just for the soil scientist, hydrologist, forester, wildlife manager, plant scientist, city planner, park manager, or farmer alone. It is a job for any ordinary person who just likes to have access to the life sustaining resource of water. We must all recognise that water conservation really is our personal responsibility and we must not just leave it up to others. <br />
<br />
We all enjoy the many ways that we use water, so why not do our part in caring for our water?<br />
<br />
Our water supply is not infinite, if we save water now, we are helping to ensure an adequate water supply for future generations. But how to save water? We can start by taking shorter showers, making sure that there are no leaking taps or pipes near our respective homes, using less water while washing dishes and clothes etc. We can also encourage others to work as a group and start a rainwater harvesting project. <br />
<br />
We use water for many, many different things like making electricity, cleaning, cooking, irrigating, etc. Nowadays one needs to pay for water in the cities. Saving water saves money.  We need to be thoughtful while using water, so that others are not deprived of this very essential commodity.  I see people lavishly wasting water because they think it is plentiful, even when they have to pay for it. <br />
<br />
By the way, the percentage of fresh water is three percent but we can use only one percent as the other two percent is locked up in glaciers and ice caps. After a few decades or centuries, the total percentage of drinking water may fall to about something which is practically nonexistent. <br />
<br />
<b> So hurry and SAVE WATER BEFORE THERE IS NO MORE!!!</b></blockquote>

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			<dc:creator>Tinkle</dc:creator>
			<guid isPermaLink="true">http://www.mediscuss.org/blogs/tinkle-1258/conserve-water-34/</guid>
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			<title>Why does our hair turn gray?</title>
			<link>http://www.mediscuss.org/blogs/shashikiran-1/why-does-our-hair-turn-gray-21/</link>
			<pubDate>Sat, 06 Mar 2010 18:20:30 GMT</pubDate>
			<description>Some scientists poke needles at our bubbles of happiness. Yes, at least they did for me. 
...</description>
			<content:encoded><![CDATA[<blockquote class="blogcontent restore">Some scientists poke needles at our bubbles of happiness. Yes, at least they did for me.<br />
<br />
<div style="text-align: left;"><a href="http://www.mediscuss.org/attachment.php?attachmentid=113&amp;d=1267901865" id="attachment113" rel="Lightbox_21" ><img src="http://www.mediscuss.org/attachment.php?attachmentid=113&amp;d=1267901865" border="0" alt="Click image for larger version

Name:	&amp;#103;&amp;#114;&amp;#97;&amp;#121;&amp;#95;&amp;#104;&amp;#97;&amp;#105;&amp;#114;&amp;#46;.JPG
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ID:	113" class="align_right size_thumbnail" /></a>I was touting my gray hair as a sign of wisdom for the last 3 to 4 years. But now, some researchers from UK and Germany have 'discovered' the 'real' reason for this graying, thus exposing my 'wisdom'!<br />
</div> <br />
Wood et al [<a href="http://www.fasebj.org/cgi/content/abstract/23/7/2065" target="_blank" rel="nofollow">1</a>] using FT-Raman spectroscopy have proved <b>H<sub>2</sub>O<sub>2</sub>-induced oxidative damage</b> in the entire human hair follicle,<sup> </sup>inclusive of the hair shaft, as a <i>key element </i>in senile hair<sup> </sup>graying.<br />
<br />
Okay, let's take a simpler look at this:<br />
<br />
Our original hair colour is maintained by a complex process. At least 3 enzymes are involved - <i>catalase, methionine sulfoxide reductase (MSR) </i>and<i> tyrosinase</i>. Catalase is an enzyme present in the hair follicles (among other locations) that normally breaks down hydrogen peroxide (H<sub>2</sub>O<sub>2</sub>) into oxygen and water. MSR normally repairs the transient effects of H<sub>2</sub>O<sub>2</sub><b><sub> </sub></b>on hair follicles.<br />
<br />
With age, the level of catalase and MSR is reduced. Catalase reduction results in increased accumulation of H<sub>2</sub>O<sub>2</sub>. MSR is also less, thus H<sub>2</sub>O<sub>2</sub> induced damage is not reversed.<br />
<br />
This accumulation of H<sub>2</sub>O<sub>2</sub> results in the impaired functionality of the third enzyme mentioned, tyrosinase. Tyrosinase is necessary for melanin production that is responsible for our hair (and skin) colour.<br />
<br />
So, the cascade is quite simple:<br />
<br />
<div style="text-align: center;">Reduced catalase and MSR<br />
<br />
|<br />
<br />
Accumulation of hydrogen peroxide<br />
<br />
|<br />
<br />
Hair follicle damage by free radicals <br />
&amp; <br />
Impaired tyrosinase function<br />
<br />
|<br />
<br />
Impaired melanin production<br />
in <i>that </i>hair follicle<br />
<br />
|<br />
<br />
Gradual loss of original colour (graying)<br />
<br />
<br />
<div style="text-align: left;">See, now it has nothing to do with wisdom! And the fact that I am actually blogging about this and letting everyone know the 'secret' behind my gray hair is enough proof!<br />
<br />
<br />
</div> </div></blockquote>

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			<dc:creator>Shashikiran</dc:creator>
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			<title>Genetically Modified Food - BT Brinjal</title>
			<link>http://www.mediscuss.org/blogs/shashikiran-1/genetically-modified-food-bt-brinjal-18/</link>
			<pubDate>Sat, 13 Feb 2010 19:28:13 GMT</pubDate>
			<description>What is BT Brinjal? It is creating so much controversy in India with even the Environment minister going back and forth...</description>
			<content:encoded><![CDATA[<blockquote class="blogcontent restore">What is BT Brinjal? It is creating so much controversy in India with even the Environment minister going back and forth over the issue.<br />
<br />
<a href="http://www.mediscuss.org/attachment.php?attachmentid=109&amp;d=1266125497" id="attachment109" rel="Lightbox_18" ><img src="http://www.mediscuss.org/attachment.php?attachmentid=109&amp;d=1266418280" border="0" alt="Click image for larger version

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ID:	109" class="align_right size_thumbnail" /></a>Like most people assume, BT here does not stand for Bio-Technology! Bt Brinjal is <b>Bacillus thuringiensis Brinjal</b>.   <br />
<br />
Bt Brinjal is a genetically modified brinjal (syn: eggplant, aubergine, begun) created by inserting a gene from the soil bacterium <i>Bacillus thuringiensis </i>(Bt) into brinjal. This has been developed indigenously by the Indian firm Mahyco with the Cry1Ac gene accessed from the US firm Monsanto.<br />
 <br />
The insertion of this gene into the vegetable is supposed to give the brinjal plant resistance against borer insects like <i>Leucinodes orbonalis</i> and <i>Helicoverpa armigera</i>. The Bt toxin produced by this bacterium (and because of genetic modification, by Bt brinjal itself) will impair the digestive processes of these insects with fatal effects on them.<br />
<br />
The Genetic Engineering Approval Committee of India has stated that Bt brinjal will reduce the farmers' dependence on pesticides and enable higher yields.<br />
<br />
After having batted for the commercial introduction of this genetically modified brinjal, Mr Jairam Ramesh, the environment and forests minister, recently withdrew his support and put a moratorium on the introduction.<br />
<br />
This was after concerns about the long-term safety of Bt brinjal consumption as no such studies are available.<br />
<br />
Do you prefer to consume Bt Brinjal or the natural vegetable?</blockquote>

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			<dc:creator>Shashikiran</dc:creator>
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			<title>How low should we push LDL cholesterol?</title>
			<link>http://www.mediscuss.org/blogs/shashikiran-1/how-low-should-we-push-ldl-cholesterol-17/</link>
			<pubDate>Thu, 21 Jan 2010 17:42:59 GMT</pubDate>
			<description>We need low-density lipoprotein (LDL) to transport cholesterol (and triglycerides) from liver to the peripheral...</description>
			<content:encoded><![CDATA[<blockquote class="blogcontent restore">We need low-density lipoprotein (LDL) to transport cholesterol (and triglycerides) from liver to the peripheral tissues. Traditionally, LDL is also called <i>bad cholesterol</i> as high levels of this lipoprotein may mean increased transport of cholesterol towards arteries, causing plaques and coronary heart disease (CHD) eventually.<br />
<br />
When we detect high levels of LDL in our patients, we attempt to reduce the levels to an individualized target based on the patient's (cardiovascular) risk profile.<br />
<br />
This is the recommendation on therapeutic goals for LDL:<br />
<br />
<table><tbody><tr><td><b>Risk Profile</b></td><td colspan="2"><center><b>LDL Goal</b></center></td></tr><tr></tr><tr><td>0-1 risk factor </td><td><160 mg/dL </td><td><4.1 mmol/L</td></tr><tr><td>2 or more risk factors </td><td><130 mg/dL </td><td><3.3 mmol/L</td></tr><tr><td>CHD or CHD equivalents* </td><td><100 mg/dL </td><td><2.6 mmol/L</td></tr></tbody></table><br />
* One of the important CHD equivalents in Diabetes<br />
<br />
In addition to these goal levels, another recommendation was to reduce LDL to a level below 70 mg/dL (1.81 mmol/L) in these situations:<br />
<ul><li>primary prevention in "very high risk" patients (<a href="http://www.americanheart.org/presenter.jhtml?identifier=4704" target="_blank" rel="nofollow">1</a>), and</li>
<li>further goal after achieving <100 mg/dL in secondary prevention for all patients (<a href="http://www.americanheart.org/presenter.jhtml?identifier=4723" target="_blank" rel="nofollow">2</a>)</li>
</ul>This recommendation to lower LDL "below 70" was not so well received. Studies (<a href="http://www.annals.org/content/145/7/520.full" target="_blank" rel="nofollow">3</a>, <a href="http://www.annals.org/content/140/8/650.full" target="_blank" rel="nofollow">4</a>) published in the Annals of Internal Medicine criticised this as "not based on available evidence". <br />
<br />
A scientific publication from Israel (<a href="http://www.ncbi.nlm.nih.gov/pubmed/18000291" target="_blank" rel="nofollow">5</a>) claimed increased risk of sepsis and malignancies in patients with LDL below 70 mg/dL.<br />
<br />
The wikipedia page on LDL (<a href="http://en.wikipedia.org/wiki/Low-density_lipoprotein" target="_blank" rel="nofollow">6</a>) , to which I have also contributed, ends with <div class="bbcode_container">
	<div class="bbcode_quote">
		<div class="quote_container">
			<div class="bbcode_quote_container"></div>
			
				The feasibility of these figures has been questioned by sceptics, claiming that many members of the AHA and NIH are heavily associated with pharmaceutical companies giving them bias towards lowering cholesterol levels and such guidelines giving rise to increased use of cholesterol lowering medicine such as statins.
			
		</div>
	</div>
</div> A more balanced view was recommended in a paper in the American Journal of Cardiology (<a href="http://www.ncbi.nlm.nih.gov/pubmed/16442398" target="_blank" rel="nofollow">7</a>) which stated:<br />
<div class="bbcode_container">
	<div class="bbcode_quote">
		<div class="quote_container">
			<div class="bbcode_quote_container"></div>
			
				<u>In men</u>, elevated LDL need not be treated aggressively if the total/HDL cholesterol ratio is low. Conversely, modest elevations of LDL may warrant more aggressive treatment if the ratio is high. <br />
<br />
<u>In women</u>, the ratio is also a good CHD predictor, but a combination of a high ratio accompanied by high LDL cholesterol may warrant more aggressive therapy.
			
		</div>
	</div>
</div> <b>Conclusion: How Low? <br />
<br />
</b>There are conflicting reports on this question. More evidence may hopefully be available soon. In the meanwhile, it is better to be modest and not push the LDL <i>too low, </i>as it is still a relatively unknown zone. <br />
<br />
Remember, <i>primum non nocere</i> (first, do no harm)?<br />
<font color="DimGray"><br />
PS: This topic is somewhat similar to my earlier post "<a href="http://www.mediscuss.org/blogs/shashikiran/iatrogenic-mass-hypochondria-15.html" target="_blank">Iatrogenic mass hypochondria</a>".</font></blockquote>

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			<dc:creator>Shashikiran</dc:creator>
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			<title>Handling workplace politics</title>
			<link>http://www.mediscuss.org/blogs/shashikiran-1/handling-workplace-politics-16/</link>
			<pubDate>Wed, 06 Jan 2010 17:24:20 GMT</pubDate>
			<description><![CDATA[Every office has politics, as long there are at least two employees!  
 
Experienced something which I don't want to...]]></description>
			<content:encoded><![CDATA[<blockquote class="blogcontent restore">Every office has politics, as long there are at least two employees! <br />
<br />
Experienced something which I don't want to discuss here, but while googling about it, found this very well made statement:<div style="margin-left:40px"><font size="2">If you don't know the problem; you are INNOCENT. </font><br />
<font size="2"> If you know the problem, but don't know the solution; you are IGNORANT.</font><br />
<font size="2"> If you know the problem, you know the solution, but you don't want to use or implement; you are a CULPRIT.</font><br />
</div>Perfect.<br />
<br />
Mahatma Gandhi's quote "<b>The weak can never forgive. Forgiveness is the attribute of the strong</b>" comes in handy. <br />
<br />
Perfect again.</blockquote>

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			<dc:creator>Shashikiran</dc:creator>
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			<title>Iatrogenic Mass Hypochondria</title>
			<link>http://www.mediscuss.org/blogs/shashikiran-1/iatrogenic-mass-hypochondria-15/</link>
			<pubDate>Tue, 05 Jan 2010 16:16:15 GMT</pubDate>
			<description><![CDATA[[ATTACH=CONFIG]82[/ATTACH] 
Are we inducing mass hypochondria? Making even apparently 'normal' persons suspect that...]]></description>
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Are we inducing mass hypochondria? Making even apparently 'normal' persons suspect that they 'may' have some disease? Seek medical attention for diagnosis of <i>prediabetes</i> and <i>prehypertension</i>?<br />
<br />
I wrote a <a href="http://www.bmj.com/cgi/eletters/330/7506/1461#110672" target="_blank" rel="nofollow">response</a> in 2005 to an <a href="http://www.bmj.com/cgi/content/extract/330/7506/1461" target="_blank" rel="nofollow">editorial</a> in the BMJ. Here's the text:<div style="margin-left:40px"> Dear Editor,<br />
<br />
I have read the editorial by Westin &amp; Heath and the subsequent rapid responses to that article with great interest. The extremes of views apparent in some of these are very bothering. At the same time, some of the statistical calculations were very humorous yet hit the bull's eye.<br />
<br />
Let me first make it very clear that my views are very similar to those presented in the editorial. This notion has been bugging me for a long time. If the current trend continues we may reach a time when nobody may be considered 'healthy'. The WHO may need to redefine health in the near future. Currently it goes 'Health is not just absence of sickness, but a state of physical, mental and social wellbeing'. It may be changed to 'Health is not just absence of sickness, but absence of all risk factors for all possible sicknesses'. More than 90% of a population may be considered 'sick'. And then by statistical inference, those who are sick will be considered 'normal' and those who are 'healthy' with no risk factors will be 'abnormal' or 'sick'! How much more paradoxical and paranoid can it get?<br />
<br />
I would also like to take this opportunity to respond to the <a href="http://www.bmj.com/cgi/eletters/330/7506/1461#110458" target="_blank" rel="nofollow">letter</a> by Raymond A Meleady, Consultant Cardiologist, published above. He has suggested that we need not wait for absolute proof, and has interestingly quoted the matter of the cholera epidemic. But Snow just turned off the Broad Street pump. Translating the analogy to cardiovascular risk reduction, we must absolutely turn off the 'Broad Street pump' of cardiovascular risk. I bring to his attention sedentary lifestyle, high fat diet and 'junk' food. Talking of analogies, the 'Broad Street pump' for respiratory illnesses is cigarette smoking, but I don't see anybody actually turning off the pump there!<br />
<br />
Recently during the Iraq 'war', I visited the US for a conference on insulin resistance. One of the speakers, in the middle of the lecture, projected a slide - "Weapons of Mass Destruction Found in US!'. We were all flummoxed. It was a very uncertain moment as the speaker was not American. The next slide showed photographs of the major 'junk' food outlets that have originated in the US and have infested many other countries. It was a point very well made.<br />
<br />
Now, that was another illustration 'Broad Street pump' of cardiovascular disease. But what have we done about it?<br />
<br />
The picture is becoming clearer now. Any recommendation that advocates '<i>consumerism</i>', applying that term even to prescription drugs, is wholeheartedly supported by the industry. Industry is the backbone of any Government. That recommendation becomes national policy. Vice versa is also absolutely true. To the best of my knowledge, there is no country in this World where cigarette sales are illegal.<br />
<br />
What we are inducing is not mass neurosis. It is <b>mass hypochondria</b>. We can afford to have a more balanced and responsible view.<br />
<br />
Regards,<br />
<br />
Shashikiran Umakanth<br />
</div>This <a href="http://www.bmj.com/cgi/eletters/330/7506/1461#110458" target="_blank" rel="nofollow">response</a> by the cardiologist a little above what I have written on the BMJ responses page has the opposite point of view.</blockquote>

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			<dc:creator>Shashikiran</dc:creator>
			<guid isPermaLink="true">http://www.mediscuss.org/blogs/shashikiran-1/iatrogenic-mass-hypochondria-15/</guid>
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			<title>Glycated hemoglobin for diagnosis of diabetes mellitus</title>
			<link>http://www.mediscuss.org/blogs/shashikiran-1/glycated-hemoglobin-diagnosis-diabetes-mellitus-13/</link>
			<pubDate>Sat, 02 Jan 2010 14:55:40 GMT</pubDate>
			<description>The diagnosis of diabetes mellitus is traditionally based on demonstrating high blood glucose.  
  
...</description>
			<content:encoded><![CDATA[<blockquote class="blogcontent restore">The diagnosis of diabetes mellitus is traditionally based on demonstrating high blood glucose. <br />
 <br />
 <div class="size_fullsize"><img src="http://www.mediscuss.org/attachment.php?attachmentid=80&amp;d=1266418280" border="0" alt="Name:  diabetes.png
Views: 1220
Size:  8.4 KB" class="align_right" /></div>The American Diabetes Association (ADA) criteria, 1997:<ol class="decimal"><li>Symptoms of diabetes plus casual/random* plasma glucose (RPG/RBS) concentration ≥200 mg/dl (11.1 mmol/l), <i>or</i></li>
<li>Fasting** plasma glucose (FPG/FBS) ≥126 mg/dl (7.0 mmol/l), <i>or </i></li>
<li>2-hour postload/postprandial*** glucose (PPG/PPBS) ≥200 mg/dl (11.1 mmol/l) during an OGTT.</li>
</ol><i>* Casual/random is defined as any time of day without regard to time since last meal. The classic symptoms of diabetes include polyuria, polydipsia, and unexplained weight loss.<br />
** Fasting is defined as no caloric intake for at least 8 h.<br />
*** The test should be performed as described by WHO, using a glucose load containing the equivalent of 75 g anhydrous glucose dissolved in water. <br />
+ In the absence of unequivocal hyperglycemia, these criteria should be confirmed by repeat testing on a different day. The                            third measure (OGTT) is not recommended for routine clinical use.                         </i><br />
 <br />
In 1997, it was also mentioned that <br />
 <ul><li>                         The FPG is the preferred test to diagnose diabetes in children and nonpregnant adults, and</li>
<li>                         The use of the glycated hemoglobin (HbA1C) for the diagnosis of diabetes is not recommended at this time.</li>
</ul><font color="Navy">Now, in 2010, ADA has released new recommendations for diabetes diagnosis:<br />
 </font><ol class="decimal"><li><font color="Navy"><b>HbA1C ≥6.5%. </b>The test should be performed in a laboratory using a method that is NGSP certified and standardized to the DCCT assay, OR</font></li>
<li><font color="Navy">FPG ≥126 mg/dl (7.0 mmol/l), OR</font></li>
<li><font color="Navy">2-h plasma glucose ≥200 mg/dl (11.1 mmol/l) during an OGTT, OR</font></li>
<li><font color="Navy">In a patient with classic symptoms of hyperglycemia or hyperglycemic crisis, a random plasma glucose ≥200 mg/dl (11.1 mmol/l).</font></li>
</ol><font color="Navy">In addition, HbA1c score of 5.7% to 6.4% indicates prediabetes.</font><br />
 <br />
This is a welcome development. Until now, HbA1C was used only for <i>monitoring</i> of therapy of diabetes. However, I have been using this, though unofficially, for quite sometime for <i>diagnostic </i>purposes too. HbA1c served as a very valuable tool for me in differentiating diabetes mellitus from stress/reactive hyperglycemia in non-diabetics. At times, I have also used it to diagnose diabetes in patients who had blood glucose values in equivocal ranges.<br />
 <br />
As early as in the beginning of 2009 I was discussing with one of my colleagues that HbA1c is should become a diagnostic test for diabetes, just based on logic. Little was I aware that it will come out with evidence too!<br />
 <br />
Now that it is official, the major advantage of HbA1c is that it does not require a fasting state for testing, thereby encouraging more people to undergo testing. <br />
 <br />
On the other hand, it is quite expensive. In most centers, the cost of HbA1C testing is 5-10 times the cost of a plasma glucose testing! Hopefully, with more testing, the costs will come down.<br />
 <br />
Reference: <a href="http://care.diabetesjournals.org/content/33/Supplement_1/S62.full#sec-18" target="_blank" rel="nofollow">Diabetes Care  January 2010   vol. 33  no. Supplement 1  S62-S69</a></blockquote>

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			<dc:creator>Shashikiran</dc:creator>
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			<title>Myths about Diabetes and its Treatment</title>
			<link>http://www.mediscuss.org/blogs/shashikiran-1/myths-about-diabetes-its-treatment-12/</link>
			<pubDate>Wed, 02 Dec 2009 16:03:22 GMT</pubDate>
			<description><![CDATA[[ATTACH=CONFIG]83[/ATTACH] 
This lady came for a general check-up. She was over 40 years of age and overweight, but the...]]></description>
			<content:encoded><![CDATA[<blockquote class="blogcontent restore"><a href="http://www.mediscuss.org/attachment.php?attachmentid=83&amp;d=1262708739" id="attachment83" rel="Lightbox_12" ><img src="http://www.mediscuss.org/attachment.php?attachmentid=83&amp;d=1266418280" border="0" alt="Click image for larger version

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This lady came for a general check-up. She was over 40 years of age and overweight, but the main reason for the visit was that the husband suspected that she had diabetes. After a brief clinical examination at the outpatient clinic, I told her that her blood pressure is slightly high but that may be due to the fact that it was her first visit to the hospital and reassured her.<br />
<br />
The husband took over. "No, no, doctor. I am sure she has high BP. Just order a blood sugar now and I won't be surprised if she has diabetes too." I gave him a warm smile and gently asked him to tell me why he thinks so.<br />
<br />
"Simple. She eats too much sugar and sweets. I have been telling her not to eat much or she will also get diabetes like me. When we go to a marriage or other functions, she takes my share of sweets too!" he continued, "and she gets cold very often. Whenever our son has cold, I somehow escape getting it as my sugar is controlled, but she gets it, see? She must have high glucose, very high."<br />
<br />
The wife was feeling embarrassed and guilty at the same time. She also mumbled that she might have caught diabetes from him!<br />
<br />
It was probably an easy situation to handle. Just send them out for a random blood glucose estimation, wait for a short while the reports are ready and tell them whether glucose is high or normal. <br />
<br />
However, I chose to take the tougher and timetaking path of making the couple understand the situation. It took a while for me to clear the air and get the husband to listen. Afterall, it is possible that the lady had diabetes, but I did not want her to feel unnecessarily guilty about it for the rest of her life, especially with the husband around to keep telling her that diabetes was her own making.<br />
<br />
I had to speak to them about the myths surrounding diabetes related to it's causation, complications, management and monitoring. They did listen intently, but I still had a lurking fear in the back of my mind that she may indeed turn out to be hyperglycemic to my embarrassment.<br />
<br />
<font size="3"><b>The Myths:</b></font><br />
<br />
<b>1. If you eat too much sugar and/or sweets, it causes diabetes.</b><br />
Wish it was as simple as that. It doesn't. Diabetes is caused by a combination of various factors including genetics and environment. Weight gain may significantly increase the risk of getting diabetes, but that alone is not enough.<br />
<br />
<b>2. Persons with diabetes get cold more often.</b><br />
No. The likelihood of getting cold or other illnesses is not more if a person has diabetes. However, such illnesses may increase the glucose levels in diabetics.<br />
<br />
<b>3. You can catch diabetes from your spouse or someone else.</b><br />
No, diabetes is many things, but it's NOT contagious.<br />
<br />
<b>4. Persons with diabetes will get complications, sooner or later.</b><br />
With good control, the chances of getting complications (like damage to eyes, kidneys, heart, brain, nerves, etc) can be significantly reduced and often avoided. Simple measures like avoiding smoking, good control of diabetes and blood pressure, maintaining ideal body weight with an active lifestyle can help in this regard.<br />
<br />
<b>5. Persons wih diabetes should eat a special diabetic diet.<br />
</b>There is no advantage of eating secial diabetic diets. They are more expensive too. The healthy diet for diabetics is the same as that for everyone - diet with adequate cereals (rice, wheat etc), frutis, vegetables and low in salt, sugar and fat.<br />
<br />
<b>6. Persons with diabetes should not eat rice, but instead eat wheat-based food like chapathi and roti.<br />
</b>Not true. Though wheat has slightly lower glycemic index (the speed with which glucose is absorbed from this food), there is no preference for wheat in the diet of a diabetic person.<br />
<br />
<b>7. Persons with diabetes cannot eat fruits.</b><br />
All types of fruits and vegetables are beneficial for everyone, including persons with diabetes. Fruits and vegetables contain fibre, variuos vitamins, minerals and natural antioxidants that are beneficial to the body. At least 2-3 types of fruit should be eaten everyday. <br />
<br />
<b>8. Since fruits are good, persons with diabetes can eat as much fruits as they want.<br />
</b>In spite of being beneficial, it is certainly better to eat everything in moderation, and it applies to fruits too.<br />
<br />
<b>9. Persons with diabetes cannot eat sweets, ice cream and chocolate.</b><br />
Eaten in moderation as a part of a healthy diet, sweets, ice cream and chocolate can be eaten by diabetics and non-diabetics alike. <br />
<br />
<b>10. Sugar-free food can be taken in generous amounts as they don't have sugar.<br />
</b>Sugar-free food has calories too. In addition, the safety of some types of sugar-free chemicals like aspartame are controversial too. It is best to consume as little as possible of these substances.<br />
<br />
<b>11. If persons with diabetes follow the doctor's prescription, they will never have high blood sugar again.<br />
</b>Sorry, but not true. Diabetes is a progressive disease with it's ups and downs. Based on the various changes that take place on a daily basis to our activity level, diet, and our reaction to various stressors, blood sugar will vary. <br />
If a treatment plan is followed, the glucose levels are generally better controlled with fewer major variations.<br />
<br />
<b>12. Diabetes can be cured by some medications, especially if they are expensive and imported or if they are natural.<br />
</b>Sorry again, but not true. There is no known cure for diabetes and your best bet is to control it well with the available well researched medications.<br />
<br />
After having touched upon these myths and answering a few other questions posed by the husband, I sent the lady for a blood sugar examination and to my relief, it was normal, so was her blood pressure on repeat examination. I adviced the couple to follow a healthy diet (same for both of them) and completed the consultation.<br />
<br />
How I wish I get enough time to spend explaining to each patient like this.</blockquote>

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			<dc:creator>Shashikiran</dc:creator>
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			<title>Humour in Life</title>
			<link>http://www.mediscuss.org/blogs/shashikiran-1/humour-life-10/</link>
			<pubDate>Sat, 28 Nov 2009 17:06:44 GMT</pubDate>
			<description>The purpose of life is to be happy and to be useful to others. To achieve the first purpose, being happy, we should be...</description>
			<content:encoded><![CDATA[<blockquote class="blogcontent restore">The purpose of life is to be happy and to be useful to others. To achieve the first purpose, being happy, we should be open to recognizing subtle humour in routine life that often brings 'happiness', though happiness means much more than just that.<br />
<br />
I enjoy humour, especially when I share it with somebody. I like it even more when my children generate a 'Reader's Digest-worth' humour from their experiences at school, play or interaction with us.<br />
<br />
We came up with this once:<div style="margin-left:40px"><i> Patient: Doctor! I have indigestion.</i><br />
<i> Doctor: Oh, that's easy to treat.</i><br />
<i> Patient: What should I do?</i><br />
<i> Doctor: Just read some books.</i><br />
<i> Patient: And why does that help?</i><br />
<i> Doctor: Because Reader's Digest!</i><br />
</div><font color="DimGray"> (I have submitted this to Reader's Digest, have to wait and see if they accept it)</font><br />
<br />
Some more here:<div style="margin-left:40px"><i>A man goes to a restaurant. He can't pronounce 'r' properly and uses 'l' instead.</i><br />
<i> Waiter: What do you want Sir?</i><br />
<i> Man: Please give me boiled rice (lice!) with soup.</i><br />
</div><font color="DimGray">(This came up after we watched the Hindi movie Kaminey in which the protagonist lisps)<br />
<font color="Black"><br />
Will add more as they are generated...<br />
<br />
Have fun and post your humour too :)<br />
</font></font></blockquote>

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			<dc:creator>Shashikiran</dc:creator>
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			<title>Importance of Good Habits</title>
			<link>http://www.mediscuss.org/blogs/tinkle-1258/importance-good-habits-4/</link>
			<pubDate>Wed, 25 Nov 2009 15:34:39 GMT</pubDate>
			<description>It is important to develop good habits. 
 
 “Habits are either the best of servants or the worst of masters” wrote...</description>
			<content:encoded><![CDATA[<blockquote class="blogcontent restore">It is important to develop good habits.<br />
<br />
 “Habits are either the best of servants or the worst of masters” wrote Emmons. This saying rightfully tells that there are good as well as bad habits. <br />
Habits are routines of behaviour that are repeated regularly and often subconsciously. With each repetition there is an increased automaticity in the behaviour. Scientifically, it takes about three weeks to establish or break a habit.<br />
<br />
<b> Why and when should we develop good habits?</b><br />
<br />
“We first make our habits then our habits make us”. Habits, inculcated from a very early age, determine a person’s character. Good habits make a good individual. Good individuals are necessary for the development of the society and nation. <br />
<br />
Mahatma Gandhi once told -<br />
“Keep your thoughts positive, because your thoughts become your words. <br />
Keep your words positive, because your words become your behavior. <br />
Keep your behavior positive, because your behavior become your habits. <br />
Keep your habits positive, because your habits become your values. <br />
Keep your values positive, because your values become your destiny.”<br />
<br />
Good habits must be learnt in all ages, but most importantly in childhood and early adulthood. One must realize to engage in good habits in pursuit of good deeds and happiness. It is important to possess good habits to gain knowledge, develop skills and acquire positive attitude.<br />
<br />
Eng’s principle states that “the easier it is to do, the harder it is to change”. The same can be said of good habits too. Most of the good habits are perceived to be difficult, for example, getting up early in the morning, eating healthy food, brushing after every meal, going for a walk, etc. A good habit always begins with motivation. For children, sometimes, it may even require incentives. Only perseverance will convert those repeated acts to a habit.<br />
<br />
<b>Why and when should we avoid bad habits?<br />
</b> <br />
Bad habits are like a comfortable bed, we feel tempted to get into it, but it’s very difficult to get out. Once a bad habit has developed, one may realize the ill effects of that quite late and it may be very difficult to break it then. <br />
<br />
Bad habits are generally perceived to be easier and tempting, for example, consuming alcohol and illicit drugs, smoking, procrastination, giving excuses for work not done, etc.<br />
<br />
If we suddenly drop a frog into boiling hot water, it may jump out and avoid death. But if we put in cold water and slowly bring it to boil, we may have it cooked before he knows it. Samuel Johnson once wrote “the chains of habit are generally too small to be felt until they are too strong to be broken.”  Hence it is important to resist the temptation for bad actions every time, at every age. Otherwise we risk developing a bad habit that may spoil our future.<br />
<br />
<i>A cluster of habits determine a person’s character and destiny. It is necessary to develop good habits to be successful and realize our potential and to contribute to the development of our nation. <br />
<b><br />
The time to develop good habits is NOW.</b></i></blockquote>

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			<dc:creator>Tinkle</dc:creator>
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			<title>The ‘F’ word in Medical Course</title>
			<link>http://www.mediscuss.org/blogs/shashikiran-1/%E2%80%98f%E2%80%99-word-medical-course-8/</link>
			<pubDate>Fri, 27 Feb 2009 17:59:00 GMT</pubDate>
			<description><![CDATA[They say "when everything is going fine, nothing goes wrong". Similarly, when we face ‘failure’ in life, everything...]]></description>
			<content:encoded><![CDATA[<blockquote class="blogcontent restore">They say "when everything is going fine, nothing goes wrong". Similarly, when we face ‘failure’ in life, everything seems to be going wrong. The same principle applies to our days of medical studies too (as it would to many other situations).<br />
<br />
However, it is a reality that many students who ‘fail’ in medical course and eventually graduate do ‘well’ in their careers than many others who graduate without any failures during the course. This seems to be an anomaly at the face of it; isn’t our education and evaluation system meant to discriminate such qualities in students?<br />
 <br />
But we often neglect that failure itself is a catalyst for change. The life-changing change.<br />
 <br />
What I am trying to tell is comparable to what happens to a patient with cardiac failure when she is administered a beta-blocker. Initially there is worsening… the patient becomes more breathless and despair sets in. But some magical changes happen ‘within’. The cells express more receptors on their surface enhancing the ’senses’ thus resulting in an ‘awakening’. The awakened cells work better than earlier thus increasing cardiac function and resulting in a clinical improvement.<br />
 <br />
Now <i>you </i>translate that into what would happen to a ‘failed’ student who uses it as a catalyst for change.<br />
 This is also true for most other situations in life which we equate to ‘failure’.</blockquote>

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			<dc:creator>Shashikiran</dc:creator>
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			<title>PDA and Estimated Average Glucose from HbA1c</title>
			<link>http://www.mediscuss.org/blogs/shashikiran-1/pda-estimated-average-glucose-hba1c-7/</link>
			<pubDate>Tue, 24 Feb 2009 17:56:00 GMT</pubDate>
			<description>When I was a medical student, the only PDA that I knew was Patent Ductus Arteriosus. Thank God, I didn’t have it. Now I...</description>
			<content:encoded><![CDATA[<blockquote class="blogcontent restore">When I was a medical student, the only PDA that I knew was Patent Ductus Arteriosus. Thank God, I didn’t have it. Now I know another PDA and thank God, I have it.<br />
 <br />
 <a href="http://www.mediscuss.org/attachment.php?attachmentid=72&amp;d=1259171710" id="attachment72" rel="Lightbox_7" ><img src="http://www.mediscuss.org/attachment.php?attachmentid=72&amp;d=1266418280" border="0" alt="Click image for larger version

Name:	pda.png
Views:	778
Size:	38.3 KB
ID:	72" class="align_right size_thumbnail" /></a>I am talking about Personal Digital Assistants, also called handheld computers or palmtops.<br />
 <br />
It’s a growing trend. More and more clinicians are using this gadget for accessing information at the point of care. While some well-organized hospitals have even daily patient data available through secure Wi-Fi enabling paperless rounds, I use it as a quick reference tool for conditions that are not routinely seen, to refresh my memory about drugs dosages and interactions and as a medical calculator.<br />
 <br />
 <br />
 When talking to patients with diabetes and discussing about their diabetes control, I have always had difficulty in explaining the concept of <i>glycated hemoglobin</i>, with most confusing it with hemoglobin itself and wondering why it should be low!<br />
 <br />
 <br />
 The recent concept of estimated average glucose (eAG) comes in handy now and relieves me of all this discomfort. Instead of telling the patient that her A1c is 10%, I can tell that her average glucose over the last 3 months was 240 mg/dL. It makes a lot of sense to them and they ‘understand’ it, since it is in the same unit as the other glucose values that they are used to.<br />
 <br />
 <br />
Last week, I was looking for a converter (HbA1c to eAG) but did not find any that I could use on my PDA. So I made one myself.<br />
 <br />
 <br />
 <div class="size_fullsize"><img src="http://www.mediscuss.org/attachment.php?attachmentid=73&amp;d=1266418280" border="0" alt="Name:  eag_hba1c.png
Views: 547
Size:  6.2 KB" class="align_center" /></div><a href="http://www.mediscuss.org/downloads.php?do=file&amp;id=3" target="_blank">eAG Calculator</a> uses Microsoft Excel and can be used on a PDA or PC. The format is adjusted so that it fits the screen of the PDA. The screen is shown on the right side. All you need to do is to enter the patient’s <a href="http://www.mediscuss.org/downloads.php?do=file&amp;id=3" target="_blank">HbA1c</a> value in the orange box. The eAG will instantly be presented in both mg/dL and mmol/L.<br />
 <br />
 <br />
In addition, there is also a ready reference list for commonly seen HbA1c values, shown in blue background right under the calculator.<br />
 <br />
 <br />
Now, I just flick my PDA open and show the patient her ‘average glucose level in the last 3 months’. Cool, isn’t it?<br />
 However, it must be remembered that this concept of eAG is not widely accepted as it is estimated based on HbA1c using a formula derived from the <a href="http://www.ncbi.nlm.nih.gov/pubmed/17712546" target="_blank" rel="nofollow">ADAG study</a>, <a href="http://care.diabetesjournals.org/cgi/content/full/32/1/e11" target="_blank" rel="nofollow">whose validity of data was uncertain</a>. When the ADAG trial results were presented in the EASD September 2007 meeting at Amsterdam, I was also in the audience and was convinced about the need for such a tool to replace the HbA1c, especially from the patients’ point of view.<br />
 <br />
 <a href="http://www.mediscuss.org/downloads.php?do=file&amp;id=3" target="_blank"><b>Download the EAG Calculator</b></a></blockquote>

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			<dc:creator>Shashikiran</dc:creator>
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			<title>A Case of Subcutaneous Cord-like Structure Over the Chest</title>
			<link>http://www.mediscuss.org/blogs/shashikiran-1/case-subcutaneous-cord-like-structure-over-chest-6/</link>
			<pubDate>Fri, 20 Feb 2009 17:50:00 GMT</pubDate>
			<description><![CDATA[[ATTACH=CONFIG]71[/ATTACH]Last week I saw a middle-aged man who complained of pain over the right anterior chest. He...]]></description>
			<content:encoded><![CDATA[<blockquote class="blogcontent restore"><a href="http://www.mediscuss.org/attachment.php?attachmentid=71&amp;d=1259171367" id="attachment71" rel="Lightbox_6" ><img src="http://www.mediscuss.org/attachment.php?attachmentid=71&amp;d=1266418280" border="0" alt="Click image for larger version

Name:	figure_1.jpg
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Size:	24.3 KB
ID:	71" class="align_right size_thumbnail" /></a>Last week I saw a middle-aged man who complained of pain over the right anterior chest. He had done some heavy exertion a few days earlier (extreme Yoga). While examining the painful area of chest, I noticed a feeling of something under the skin. On more careful palpation, it was a vertical cord-like swelling, just under the skin. On making the patient raise his right arm above the head, the swelling became visible too. Check the photograph on the right. You can see a longitudinal swelling with depression near it too.<br />
 <br />
Any guesses on the diagnosis?<br />
 <br />
 <br />
 <br />
 <br />
 <br />
 <br />
 <br />
 <br />
 <br />
 <br />
 <br />
 <br />
 <br />
 <b><b><font color="#000000">Mondor’s Disease, also called “string phlebitis”</font></b></b><br />
 <br />
 Mondor’s Disease is a rare condition of sclerosing thrombophlebitis of the subcutaneous veins of the anterior chest wall. Commonly involved veins are lateral thoracic, thoracoepigastric, and superior epigastric veins. This idiopathic condition that is 3 times more common in females is characterized by a tough, fibrous band that is accompanied by tension and skin retraction. The skin retraction is pronounced on raising the hands as described in a case of subcutaneous cord-like structure over the chest.<br />
 <br />
 It can be caused either by pressure on the veins resulting in stagnation, or due to direct trauma to the vein itself.<br />
 <br />
The condition is known to subside spontaneously in a few weeks. The time course is reported to be between 2 weeks and a few months. A fibrous cord may be evident for as long as a year.<br />
 <br />
The patient needs to be reassured about the benign nature of the condition and adviced to apply local warmth. Anti-inflammatory agents like ibuprofen may be useful to relieve pain.</blockquote>

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			<dc:creator>Shashikiran</dc:creator>
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			<title>Best and Worst Times of the Day</title>
			<link>http://www.mediscuss.org/blogs/shashikiran-1/best-worst-times-day-5/</link>
			<pubDate>Tue, 21 Oct 2008 16:39:00 GMT</pubDate>
			<description><![CDATA[[ATTACH=CONFIG]70[/ATTACH]I am an owl. I feel most active and creative at night. And my ‘low’ times are early in the...]]></description>
			<content:encoded><![CDATA[<blockquote class="blogcontent restore"><div class="size_fullsize"><img src="http://www.mediscuss.org/attachment.php?attachmentid=70&amp;d=1266418280" border="0" alt="Name:  studious-owl.png
Views: 240
Size:  5.3 KB" class="align_right" /></div>I am an owl. I feel most active and creative at night. And my ‘low’ times are early in the morning and evening. But I was always reticent about this because ‘ideally’ a person is ’supposed’ to feel better early in the morning. I was feeling imperfect.<br />
<br />
 If you are also in the same boat, here is some good news.<br />
 <br />
 <b>Creativity at Night<br />
</b><br />
 A <a href="http://www.telegraph.co.uk/news/newstopics/howaboutthat/3228009/Brainwave-most-likely-to-strike-at-10.04pm.html" target="_blank" rel="nofollow">survey</a> done on 1,426 adults has found that the <b>most creative time is at 10.04 PM</b>, and the lowest levels of creativity is at 4.33 PM. This perfectly matches my individual biological rhythm (although I am not correct to the minute on this).<br />
<br />
 Taking a shower also sets our creative juices flowing. Remember Archimedes and his Eureka!?<br />
<br />
 If you are seeking inspiration, try taking a shower at 10PM and go for it. If you have an important presentation for the next day, don’t bother fine tuning it during the day, work on it after dinner.<br />
<br />
 <b>Uninspiring Afternoons</b><br />
<br />
 Ninety-two percent of the people reported that they feel uninspired during the afternoons, the lowest level of creativity being at 4.33 PM. Rather, afternoons are for siesta (mid-day nap) which has also been associated with <a href="http://www.ncbi.nlm.nih.gov/pubmed/17296887" target="_blank" rel="nofollow">reduction in coronary mortality</a>.<br />
<br />
 Now you start wondering why so many meetings are scheduled at 4.30 PM, and nothing useful ever comes out in those meetings! Imagine the plight of students sitting in dark classrooms with PowerPoint slideshows and monotonous lectures to go with it! At least some intelligent ones will opt for a quiet siesta and ‘use’ their time well.</blockquote>

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			<dc:creator>Shashikiran</dc:creator>
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