Chitra Dhwani

2013, Vol 1; Issue 3Sree Chitra Tirunal Institute for Medical Sciences & TechnologyChitra DhwaniIQuarterly e-magazine of SCTIMST, Trivandrum, Kerala, INDIATELEMEDICINE: THE STEPPING STONE TO HEALTH CARE 2030!World Blood Donor dayVisit:www.sctimst.ac.inii

ContentsFrom Editor….Contents, Letter from EditoriNew DirectionsDirector’s desk, NotionsiiHistorical perspectives: Hospital iiiSpecial Feature—Cover StoryTelemedicine 1-3Emerging Trends in ScienceDrug delivery: Changing trends 4Neuroinformatics 4-5A day at (one facility in each issue)Microbiology 6-8Translational ResearchA conversation with Dr Asha Kishore 8-9Research HighlightsFour Published works 9-11Art in ScienceIn quest of title ! 12Memory Lanes...GS Bhuvaneshwar 13-14New: Faces/Initiatives/ FacilityDirector, Faculty forum 15Doctoral forum, Unmet needs 16Chitra’s STAR:Awards/ Honors/ Recognitions 17– 19Events held: Social, Academic and daysNational & IN Days 19-20Workshops, upcoming events 21-22Alumni portal 23In Focus: International ScDefining death: Current perceptions 24-25Opinions 25Did You know ?Snake venoms, Coconut 26Fun page & Creative contributionsCartoons, pictures, Poems, story 27-29Editorial Team 30Feedbacks.............Dear All,A Letter from the EditorIt is very delighting and gratifying to share that thepioneer issue of our “CHITRA DHWANI” couldreach the hearts and souls of everyone at large.The overwhelming responses from Senior Faculties,Colleagues, Students and all the Staffs furtherenthused and motivated us to progress aheadtogether sharing our innovations and creativities,and to reach newer heights. Our e-zine proved anamazing real-time Treasure-hunt for the Hiddentalents amongst us, paving a scintillating conduitfor the creative and scientific pursuits.The cover story on TELEMEDICINE provides asplendid overview on a futuristic stepping stone inhealthcare undertaken by SCTIMST, narratingoutstanding developments and adding telecommunicationflavor to our knowledge that wouldbe a true delight to read.In the current issue, we have made a beginning toconnect to our ALUMNIs by dedicating a specialcolumn that would highlight their journey ofsuccess that started from SCTIMST one day.Nothing else can be more stimulating for thebudding scientists than to have a face to faceconversation with the eminent Clinician cumResearcher involved in TRANSLATIONALRESEARCH. Memory lanes is special as Er GSBhuvaneshwar agreed to share his initial journeyhere. During this quarter, excellent New Initiativesundertaken by Faculty as well as Doctoral Scholarsforums are aptly stated. We also traversed throughthe biggest mystery of life, that is hard yet the finaldestined dialogue in life, the „Brain Death‟. TheFUN section is packed with remarkable cartoons,incredible poems, astonishing stories etc.We welcome suggestions from you about thisendeavor, and continue to look forward to your cooperation,support and blessings to furtherimprovise and make it a continued success.Thanks and best regardsKamalesh K GuliaEditorSleep Research LabComprehensive Center for Sleep DisordersSCTIMSTi

New Directions…T he Institute‟s heart and soul is oftenreflected in its in house publications as itbrings out not only the achievements of theinstitute but also the hidden talent of itsemployees. The work place is rarely the scenewhere individual talents get expressed and oftenacts as deterrent to its expression. This endeavorto bring a periodical e-magazine with a mix ofscience, medicine and technology interspersed withother art forms and social events will go a longway in further bonding of the Chitra family with aunique work ethos.I am told the e-magazine will have space for all artforms that can be expressed in print and color andit is expected to be of high standard as far as theart forms it will carry, for many years to come.Setting high standard in the initial editions of this e-magazine will provide the bench mark for everysubsequent edition to outperform the previous onein content and quality. The Editorial Board hasdone an excellent job in putting together qualitymaterial and transforming it into this enchantingChitra Dhwani.Jagan Mohan TharakanDirectorSCTIMSTNotions: A need indeed-SCTIMST asSuper-specialized CN healthcare Centern early late 1960s and „70s, there was a surge inI the treatment modalities for the cardio-vascularand neurological diseases. Rapid strides inbiomedical technologies were the main driving forcefor this renaissance.The health care scenario then in India, particularlyin South, was primitive at best. The genesis ofSCTIMST at this crucial juncture was a seed forexcellence in health care and related technologydevelopment “down south”. Our Institute caters tothe people of not only Kerala, but also othersouthern states; some patients come from fartherstates and from abroad.SCTIMST offers superlative and cost-effectivetreatment to the suffering millions of cardiac andneurological lesions. Innovations in treatment keeppace with developments in diagnostics. Healthcarecosts have multiplied manifold. But, our chargesremain one of the lowest and affordable to most ofthe deserving population. Our research efforts havecontributed to development in-house of manydevices and facilities to confer financial solace tothe patients. Various beneficial schemes offered bygovernmental agencies and private initiatives helpus to mitigate hardship to many patients.From a few hundreds of patients in the 1970s, wetoday serve over a lakh of out-patients and performabout 8000 surgical procedures every year, in spiteof limited infrastructure. To meet the everincreasingdemands, efforts are on to augment ourinfrastructure in the near future.We stride ahead with the satisfaction of meetingthe faith reposed in us by our nation, with a resolvethat our tradition of ingenuity and innovation with amix of compassion will continue to serve ourpeople.“The art of progress is to preserveorder amid change, and to preservechange amid order”R Sankar KumarMedical SuperintendentProfessor Senior GradeSCTIMSTii

Historical perspectives..Sree Chitra Tirunal Medical Center:A spark that glittered in service of humanity!Where there is noble will, there is graciousway……..The Maharaja‟s benevolence,Government of Kerala‟s genuine proposal,Department of Science and Technology‟s resolutionwere unprecedented, creating an eternal spark in1973 in Trivandrum that glittered far and wide inservice of humanity healing the Hearts & Brains.Opening of the Out Patient Services by Shri PN Haksar, DeputyChairman, Planning Commission; Shri C Achutha Menon, ChiefMinister of Kerala; Dr M S Valiathan, Director, SCTIMST, andShri NK Balakrishnan, Minister for Health KeralaWind had changed for extraordinary developmenton horizons of Trivandrum and a full fledgedSurgical Center came into existence. In 1980,SCTIMST attained “An Institute of Nationalimportance with a status of University by DST, Govtof India.Opening of the Medical Centre by His Excellency Shri VViswanathan, Governor of Kerala, Shri C Achutha Menon, ChiefMinister presided the eventThe founder Director, Dr MS Valiathan‟s indomitablevirtue, conscientious hard work, inherentmanagement skills and disciplined approach helpedhim to sail smoothly at tremendous pace against theharsh waves of obstacles. A Medical Center startedin 1976 transformed fast into a vibrant superspecialtyCenter serving ailing patients, an hospitalequipped with latest equipments attracting the besttalents. There was no looking back. Dedicated teamsjoined hands, administration strengthened andfinancial support from State and Central Govt beganpouring-in leading to a rapid progress.Opening of Sethu Parvathy Bai Surgical Centre by Mrs IndiraGandhi, Prime Minister. Shri Vakkom Purushothaman, Ministerfor Health, Kerala is sharing dais with Mrs GandhiSree Chitra Tirunal Institute of Medical Sciences & Technologyiii

Special FeatureTELEMEDICINE: THE STEPPING STONE TO HEALTH CARE 2030!he World Health Organization (WHO) definesT Telemedicine as “The delivery of Health careservices, where, distance is a critical factor byall health care professional using information andcommunication technologies for the exchange ofvalid information for diagnosis, treatment andprevention of disease and injuries, research andevaluation, and for the continuing education ofhealth care providers, all in the interest of advancingthe health of individual and their communities”.Telemedicine maximizes utilization of limitedresources, saves travel time and money and thepatient can access resources in a tertiary referralcenter without constraints of distance.Tele Health & Medical Education Project,KeralaWith the help of ISRO and Govt of Kerala, SCTIMSThad anchored a Tele Health & Medical Educationproject aimed to: Enrich the knowledge of medical manpower withthe latest developments in the field through Teleeducation. Provide virtual classroom facility in medicalcolleges in the state of Kerala. Improve availability of quality medical servicesto the patients approaching district hospitals. Connect Medical Colleges in the state with theNational Institutes so as to enable the doctors tohave a network for scientific interaction. Provide training to the Doctors, specialists, andsite administrators in operation and maintenanceof the proposed system.The project incorporates1. Tele Consultation,2. Tele Education,3. Virtual Class room Teaching, and4. Live transmission of Surgeries/ Conferences/CMEs.The pilot consultation was started on December2005. There were two more projects which werefunctioning simultaneously in which SCTIMST is oneof the specialist centers.1. Project by Department of IT2. Development and pilot implementation of HealthCare Delivery System through Telemedicine usingInformation and Communication Technologies(ICT) by C-DACCentres Connected through ISDN Tele-Specialist Centres (TSC) Medical College Hospital, Trivandrum SCTIMST, Trivandrum Regional Cancer Centre (RCC), Trivandrum Tele-Nodal Centres (TNC) Taluk Hospitals at: Neyyattinkara,Mavelikkara, Quilandy, Vythiri, Wayanad Mental Health Centre, TrivandrumCentres Connected through KSWAN Tele-Specialist Centres (TSC) MCH, Trivandrum MCH, Kozhikode SCTIMST, Trivandrum RCC, Trivandrum DH, Malappuram Tele-Nodal Centres (TNC)(MCHDHCHCTHBPHCISDN(Connecting TalukHospitals)BSNLBraodband BPHC, Vettom BPHC, Valavannur CHC, Purathur CHC, Thanur PHC, Valanchery TH, Tirur PHC, AlemcodeVSAT(Connecting MedicalColleges & DistHospitals)Types ofConnectivity– Medical College Hospital– District Hospital– Community Health Centre– Taluk Hospitals– Block Panchayat Health Centre)NKNKSWAN(Connecting CHCs,PHCs, BPHCs)The specialists and peripheral hospitals areconnected in the network within Kerala and India.1

Centres Connected through VSAT (Kerala)National Knowledge NetworkThe NKN is a state-of-the-art multi-gigabit pan-Indianetwork for providing a unified high speed networkbackbone for all knowledge related institutions in thecountry.Tele ConsultationCentres Connected through VSAT (India)SCTIMST has scheduled consultations by variousspecialists on all weekdays. A medical administratoris the nodal officer of the facility. A site administratorwho is qualified in computer operations andnetworking coordinates the programme. Theperipheral hospitals can contact the Telemedicinefacility and obtain an appointment for patientconsultation. The data of the patients and imagescan be sent in advance and subsequently, videoconferencing can be done with the patient anddoctors at both ends. The facility is utilized by someof theMedical Colleges, District and Taluk hospitals andInstitute like JIPMER, Pondicherry and CMC, Vellore.The facility is also utilized for Follow-up consultationsof patients and peripheral outreach programmes.Tele Educational, Tele Radiology and TeleProject DiscussionsThe facility has organized Tele EducationalProgrammes in various specialties. This includesprogrammes organized at SCTIMST and many otherNational Institutes and major hospitals. A series ofTele Radiology programmes with JIPMER, CMCVellore and Medical Colleges of Kerala were alsoorganized.The facility is also utilized for Tele Project discussionsof projects with International collaboration andpresentation of seminars.Village Resource Centre Programme:Till date, total tasks completed are: Tele Consultations – 230 Tele Education sessions – 439 Total project discussions –45 Village resource centre programmes – 5 CME – 11SCTIMST in collaboration with the State PlanningBoard had conducted the Village Resourceprogramme. Accordingly, six consultations of healthrelated issues were handled by the experts of theInstitute. Through this facility, the doctors giveclasses to the public at remote locations through2

video conferencing. It is also decided to provideTelemedicine connectivity to Mobile Unit of MalabarCancer Care Society, Kannur for Tele consultation,follow-up and registration for the poor people ofNorth Kerala.Day Department TimeMonday Neurology 2 PM - 3 PMTuesday Cardiology 2 PM - 3 PMWednesday Neurology 2 PM - 3 PM2 nd Wednesday Physical Med & Rehab. Clinic 2 PM - 3 PMThursday Cardiology 2 PM - 3 PMThursday Epilepsy 3 PM - 4 PMFridayImaging Sciences &Interventional RadiologyTele Consultation ScheduleInternational Connectivity:2 PM - 3 PMThe use of specialized applications allows sharing ofhigh performing computing facilities, and largedatabase which can be transmitted to other Centers.NKN International IP enables the faculty andresidents to listen and interact with other Centersacross the globe.Training - Given to Site Administrators &M.Tech StudentsSCTIMST has provided training to Site Administratorsand M.Tech students in operation and maintenanceof Telemedicine facility.The infrastructure with regard to Telemedicine likevideo conferencing system, software and PC,facilities for networking like VSAT, NKN etc, andtrained manpower for operation of the system areavailable at the Institute.According to Dr SK Jawahar, AMO and Nodal Officer,Telemedicine “It has huge potential inknowledge sharing and networking whichcould be utilized by the faculty, residents andother staff”.Tele EducationInternational Project DiscussionTele Consultation(Contributed by Dr SK Jawahar, Administrative Medical Officer and Nodal Officer, Telemedicine at SCTIMST.Ms Liji SV , the Site Administrator in the project TeleHealth and Medical Education.)“It always seems impossible until its done”3

Emerging Trends in Science….Drug Delivery: Current and Future Trendsver the past several decades, variousO controlled and sustained drug deliveryformulations have been designed, developed andcharacterized for numerous biomedicalapplications. However, most of these injectableformulations deliver drugs passively as they do notactively sense and respond to the dynamicpathological milieu resulting in suboptimal releasekinetics, undesirable differences in biodistribution,and an increased risk of systemic toxicity.Moreover, as the onset and progression of anypathological condition is highly variable, thesubtype and severity of the disease often differswidely among patient subpopulations. Hence,determining effective therapeutic dose and definingthe dosing parameters remain key challenges formaximizing drug efficacy and safety. Consequently,the development of dual-acting biomaterialstermed the „theranostics‟ that could simultaneouslydiagnose and treat a disease condition at the sametime in a single dose holds great promise for thefuture of biomedicine.Employing nanotherapeutic-based approaches incombination with a multitude of non-invasiveimaging modalities, theranostic nanoparticles arecurrently been extensively evaluated for diagnosisand treatment of cancer. Therapeutic strategiessuch as chemotherapy, hyperthermia, andradiation therapy are combined with imagingfunctionalities such as magnetic resonanceimaging, near-infrared fluorescence imaging, andnuclear imaging (PET/SPECT) by incorporatingtherapeutic moieties and imaging markersconcurrently onto a nanoparticle surface forsimultaneous diagnostic imaging and targetedablation of tumors. From a clinical perspective,these strategies provide unique opportunities thatallow for feedback mechanisms to understandcellular phenotypes and heterogeneity of tumors,predict patient‟s response to a specific treatment,and determine on-going efficacy and biodistributionof the therapeutic agent through multimodalimaging.Despite notable progress and enthusiasm,theranostic nanoparticles also face significantchallenges. For example, striking the right balancebetween diagnostic payloads and therapeuticloading, for optimal imaging without diminishingthe therapeutic potency of the nanocomplex, hasbeen proved to be quite a daunting task. Althoughthis shortcoming may be overcome by usingnanoagents that are intrinsically theranostic, thestability, safety and in-vivo efficacy of thesenanosystems need to be addressed for effectiveclinical applications. Nevertheless, theranostictechnologies holds great promise as they possessthe unique ability to diagnose, monitor and treatthe disease condition simultaneously withunprecedented control as opposed to currenttherapies that embrace a „one size fits all‟approach. In addition, advances in thedevelopment of a truly closed-loop, butmonitorable method for delivering therapeutics ondemandwill pave the way towards thedevelopment of fundamentally new, safer andmore effective personalized theranostic therapeuticstrategies for the treatment of cancer.(Contributed by Dr Shivaram Selvam, DST Inspire Faculty D)Neuroinformaticseuroinformatics is an emerging technologyN and a branch of Bioinformatics. It involvesintersection of neuroscience, mathematicsand information technology (IT). Neuroinformaticsseeks to create and maintain web-accessibledatabases of experimental and computationaldata, together with innovative software tools thatare essential for understanding the nervoussystem in its normal function and in neurologicaldisorders. The main goal of neuroinformaticsincludes (a) developing and applyingcomputational methods to study brain structure,function and behavior, (b) applying advanced ITmethods to deal with huge quantity and greatcomplexity of neuroscientific data, (c) exploitingour insights into the principles underlying brainfunction to develop new IT technologies. Themajor areas of neuroinformatics coverscomputational neuroscience, cognitiveneuroscience, neuromorphic and neuralengineering and software systems for variousstudies such as artificial neural network modeling,neural dynamics, sensory, motor, and cognitivemodeling, statistical modeling, sensory prosthesis,4

ain - computer - interfaces, neuromorphicengineering, and robotics. Neuroscience data isdiverse and heterogeneous and hence this crossdisciplinarynature of neuroinformatics requirescollaboration of teams of scientists with mappingefforts and/or hypothesis-driven goals.Neuroinformatics is becoming essential toneuroscience investigators and clinicians forconducting scientific inquiry, and practicingmedicine in our time of rapidly expanding crossdisciplinaryknowledge.(language comprehension) of the dominanthemisphere, which is very clinically relevant inpresurgical evaluation of epilepsy patients.Neuroinformatics @ SCTIMSTIn SCTIMST, current work and experiments relatedto Neuroinformatics has been jointly conductedby research team from Departments of Imagingscience and Interventional Radiology, Neurologydepartment & Biomedical technology wing. Theinstitute has a fully equipped Brain mappinglaboratory which was set up with the funding ofKerala State Council for Science, Technology &Environment (KSCSTE), Govt of Kerala. TheDepartment of Biotechnology, Govt of India hasalso funded projects in the field of functionalneuroimaging. The various projects are donethrough high end computers and sophisticatedsoftware bought through these funding. The mainongoing projects are:Brain mapping by functional magnetic resonanceimaging (fMRI), Diffusion Tensor Imaging (DTI) andVoxel Based Morphometry (VBM) for presurgicallateralization of language function in epilepsypatients.Figure 1: (a) Orthogonal views and (b) rendered views of brainwith left Broca's and Wernicke‟s area activation generated byfMRI language (visual verb generation) task in a right handedsubject. The color scale corresponds to range (red to hot) offMRI activation. Hot color represents high intensity and redcolor represents low intensity activation.Different visual (verb generation, syntax, semantics)and auditory (passive listening, story telling) fMRIparadigms (experimental tasks) are employed togenerate language activation patterns (Fig. 1 & 2)and its most activity usually found in Broca‟s area(language expression) and Wernicke‟s areaFigure 2: 3D visualization of brain structure showing pialsurface, Region of Interests (ROIs), White matter fiber tractsand patterns of functional connectivity.Voxel Based Morphometric (VBM) analysis ofsubcortical brain structures in Fronto TemporalDementia (FTD), Mild Cognitive Impairment (MCI)and Alzheimer‟s Disease (AD) patientsFunctional magnetic resonance imaging combinedelectroencephalography (fMRI-EEG) to studyelectrical activity of brain in correlation with BOLD(Blood Oxygen Level Dependent) haemodynamicchanges during electrical activity associated withepileptic disordersBrain Computer Interface (BCI) based real timefMRI (rtfMRI) study which involves neurofeedbacktraining for self-regulation of Broca‟s area in poststroke Broca‟s aphasia patients.Cerebro Vascular Reactivity (CVR) assessmentusing BOLD fMRI breath hold technique in patientswith large vessel occlusions. This can serve as anon-invasive tool for mapping exhaustedcerebrovascular autoregulation in patients with acompromised cerebral vasculature. This project isfunded through the intramural funding of theinstitute.(Contributed by Ms Jija James & Dr C Kesavadas, Professorat Dept of Imaging Sciences and Interventional Radiology)“D i s c i p l i n e d , i n t e g r a t e d a n dinterconnected dependence is the key ofattaining INDEPENDENCE at large. Weshould learn how to fly with our thoughts,see dreams with open eyes and try to fruitifythem”Chandra P Sharma5

A day at the Department of Microbiology..Bugs, Bugs, Bugs!Neurologist on his rounds in the ICU: “This encephalitis patient was getting better yesterday.What has happened now?”Senior Resident: “Sir, I think there is a shadow in his right lung and he has purulent secretions.He has pneumonia and we have to find out the bug. A sample of his tracheal aspirate has beensent to the Microbiology lab this morning.”Neurologist: “Good. You have done the right thing. Now, start the best antibiotic available. Wecan change to the appropriate antibiotic after culture report is got. He is a young patient, thebread winner of his family and we cannot afford to lose him. But for the infection he would havebeen off the ventilator…….”istory speaks for itself how time and againH microscopic creatures, which are invisible tonaked eyes, have terrorized the humancivilization. The microbiologists undertake a vitalrole in identification of the disease causingorganisms. The Microbiology Departmentspecializes in testing for all the crucial microbesrelevant to the Super-specialty Cardio-NeuroCenter that functions at SCTIMST. As the microbialworld is very diverse, the task of microbiologistsbecomes more challenging to cover all thedifferent types, each needing their own specificenvironment and growth factors. The departmentconducts the tests in most categories:Bacteriology, Mycology, Serology, Virology andMolecular biology and works round the clock.Bacteriology deals with diseases caused bybacteria. The specimens mainly from patients whohave been admitted here for surgery or formedical conditions that require intensive caretreatment that led to infective complications aretested here. Majority of the specimens receivedhere are aspirates from endotracheal tubes andurinary catheters, blood from cannulas and CSFfrom tubes put to drain CSF from the ventriclesand it is often difficult to decide whether treatmentin the form of antibiotics is really required.Microscopy helps by showing the presence of puscells. An important criterion for urine culture iswhether there is significant growth, i.e. more than10 5 bacteria per ml of urine which is established byquantitative culture. This is called cfu or colonyforming units in the sample.tract and also in case of device implantations likepacemakers and deep brain stimulation devices.These are screened for pathogens likeStaphylococcus aureus, Pneumococcus andHemophilus influenzae that may cause infectionlater. Cerebrospinal Fluid and other sterileaspirates: Being a super-specialty centre, standardpathogens are very rare. Post-operative meningitisis generally caused by gram negatives likePseudomonas, Acinetobacter, Klebsiella etc.For blood culture, aerobic and anaerobic bloodculture bottles are issued. In case of anunexplained fever in a hospitalized patient it isbest to send two samples from two sites in twoaerobic culture bottles. Anaerobes are generallyrecovered only from brain abscesses. Anothercategory is Infective Endocarditis due to someStreptococci that grow only in an anaerobicenvironment. Device tips – The only device tipthat is acceptable according to the lateststandards is the Central line tip, and this has to beaccompanied by a blood culture for seeingwhether the organism has caused real infection oris just colonizing the line.Fungus after growing in special mediaBlood agar with hemolytic coloniesPus and othertissues frominfected sites –Pus swabs arethe commonestspecimens in thiscategory. A singleswab can beRespiratory microbes are isolated from sputum orendotracheal samples, from those on ventilator.The broncho-alveolar lavage specimens are alsoreceived occasionally and they are the best andmost representative samples from a patient onventilator, to diagnose Ventilator-AssociatedPneumonia (VAP). Throat swabs and Nasal swabsare routinely done before neurosurgical proceduresthat have an approach through the respiratorycultured only, while a double swab from the samesite can be stained and reported. However, thebest specimen is a pus aspirate or tissue as suchfrom the infected site.We grind the tissue so that all organisms arereleased from inside and grow in the media.Hence it is best to leave the inoculation intoanaerobic bottles to us.6

Thanks to advancing technology, helping us inBacteriology are the two machines- BacT Alert formaking blood cultures automated and the VITEKthat gives the crucial information on Identificationand sensitivity in MIC of the isolated strain. Somebacteria like Stenotrophomonas are inherentlyresistant to all antibiotics except Co-trimoxazole.VITEK SystemCryptococcus with large capsule in CSF(CRP), antistreptolysin O (ASO) and Rheumatoidfactor. This is done with the help of theNephelometer that gives accurate values whichcharacteristically drop steadily in decimal points asthe infection recedes. This is of immense help tothe clinician in monitoring treatment. Procalcitoninis a new marker of sepsis done on the VIDASmachine. Done serially, it shows response totreatment.In Serology, thereaction of the bodyto the invasion bymicrobes is detectedwith the help of acutephase proteins like C-reactive proteinThey may be mistakenly reported as sensitive byconventional methods. VITEK gives the Identitywithin 24 hrs, which is impossible by manualmethods. Enterococcus gallinarum infectiveendocarditis cannot be treated by Vancomycin dueto inherent resistance and this identification cannotbe done in a routine microbiology lab withoutVITEK. The diagnosis of tuberculosis is usuallydone by the bacteriology lab, but entails a longincubation. There are facilities for bothconventional LJ medium inoculation and the MBBact automated system for sterile fluids. Theautomated system gives quicker results.The CSF, blood, tissue bits and pus are receivedfor fungal culture. Even if Indian ink does notreveal cryptococci, the BacT Alert system yieldsgrowth, hence such a CSF is also inoculated intoblood culture bottles in the laboratory. Moulds takelonger to grow, hence all specimens that do notgrow yeast, are incubated for the next one monthto rule out mould infections.Routine antibody detection for HIV, HCV and forHBsAg are done on serum samples of almost allpatients admitted here, and also in all patients thatundergo invasive procedures on outpatient basis.This is done by the VIDAS machine that can takeindividual samples as they come to the lab and isfully automated. Conventional tissue culture is stilldone for the Coxsackie viruses that causemyocarditis.For Molecular Biology, nowadays a basic PCRsystem is an integral part of every Microbiology lab.Here this system is used mainly in the diagnosis oftuberculosis from CSF and other sterile fluidsdirectly. When an RT-PCR system is establishedmore diseases will be covered in the future.There are three faculty members, two scientificofficers and four technicians to manage thedifferent sections. A unit helper and a G4 employeehelps in the crucial business of decontaminationand sterilization. There is an apprentice traineeprogramme for MSc graduates and an Observershipprogramme for MD students. Those who have justfinished vocational higher secondary (VHS) coursecan also get a feel how it is to work in a laboratoryand decide on their future career. Dr Kavita, HOD,manages the applied microbiology part of relatingthe isolates to the treatment decisions taken, whileDr Molly with the help of the other scientists looksafter quality control and the smooth processing ofsamples.7

Translational ResearchThe Infection Control Team (ICT) meets regularlyand takes decisions on how to reduce infections. TheHead of Microbiology is a member of this team, andhelps in data collection which is essential in anysurveillance and prevention programme. Accordingto Dr Kavita, the Head of Microbiology Dept,“Hospital acquired infections form a good partof the infections diagnosed in themicrobiology lab. Though preventable, theycannot be fully eradicated, especially inchronic and immunosuppressed patients. TheMicrobiology lab supports the HospitalInfection Control Unit by giving timely reportson increasing infections in a particular unit, sothat quick preventive measures are initiatedbefore an outbreak occurs”.The Department also engages actively in theHomograft project. Repairing congenitalmalformations of the heart using a homograft isbased on proper harvesting, testing and storage ofthe valve tissue (using liquid Nitrogen), before it istransferred to a patient. This core function is carriedout by an efficient team attached to the Homograftlab that ensures the sterility and viability of thetissue harvested from the heart of a cadaver. It isdone in collaboration with the Forensic ScienceDepartment of the Govt. Medical College,Trivandrum.Valve tissue with vegetation showing Gram positive cocci in pairs“Team work is the key to every success and isthe motto of the Microbiology Department!”(Contributed by Dr Kavita Raja and her team atDepartment of Microbiology)“Do not go where the path may lead, goinstead where there is no path and leave atrail”A conversation with Dr Asha Kishore..…...r Asha Kishore is the lead clinician and researcher ofD the Comprehensive Care Centre for MovementDisorders Clinic (CCCMD). Her clinical interventionsand research are underpinned by Internationalcollaborations aimed at understanding the occurrence,etiology & possible interventions for Movement Disorders(M.D.). Excerpts of the interview:Q: Describe a typical work day for you at yourmovement disorder center!Reply by AK: It‟s more of a typical week! Theactivities in the Center include the M.D. clinic, preoperativepatient evaluations, Deep Brain Stimulationsurgeries, post operative programming sessions,Botulinum toxin clinic, Non invasive Brain stimulationLab-related clinical and research activities, academicprograms for the PhD & PDF scholars and researchfellows, project development, data analysis,manuscript preparation etc. All these are madepossible by my team of colleagues including Dr Syam& Dr Krishnakumar at the M.D. centre.Q: What makes practicing neurology enjoyable?AK: Like most neurologists, I too enjoy solvingdifficult clinical challenges and translating newtheoretical knowledge to bedside succour. Helpingpatients is particularly rewarding, but distillinginformation from various sources into practicalsolutions has its own thrill!Q: Could you provide an overview of your currentresearch activities?AK: These are aimed at understanding diseasemechanisms underlying various movement disorders.We are investigating the role of disturbances inmotor cortex plasticity and the involvement ofcerebellum in Parkinson‟s disease (PD) dystonia etc.Basic research into mechanisms of cell death relatedto deposition and clearance of alpha-syn-nuclein inPD are the theme of 2 of our PhD scholars‟ projects.8

Q: The best treatment for PD in India, is thatavailable in SCTIMST?AK: Currently there is only symptomatic treatmentavailable. We are interested in developingstrategies aimed at the synaptic mechanisms andnot merely neurotransmitter replacement therapy.Q: Current research scenario of PD in India anddrawbacks? Where does SCTIMST stand?AK: SCTIMST is the pioneer in the field ofmovement disorders with the institute developingthe first comprehensive program and beinginvolved in research in this field. The Non invasivebrain stimulation research work here is also thefirst of its kind in India, and performed at very fewcentres across the world. To be the front runner,SCT need to develop more specialized activities,further strengthen the research and innovationstimulatingenvironment and nurture raw talent.Q: Where do you see SCTIMST after 10 years atour current progress rate?AK: There are general difficulties in breaking newpaths in any environment, unrelated to gender. Iwas able to generate a crore from externalagencies 16 years ago to develop the CCCMD. Theadministration and departments of Neurology andNeurosurgery gave the rest of the support. As awoman, I strongly believe in equality in all spheresof life. I have become aware that women have towork doubly hard and struggle more, to be dulyacknowledged for their work or be givenresponsible positions.Q: A message that you would pass on to futureaspirants who wish to enter neuroscience?AK: Be “a die hard optimist and be inspiredby one‟s aspirations”. The brain is a fascinatingorgan and opportunities are expanding withtechnology progressing so fast. One shouldidentify a key problem, visualize the opportunities,interact with the right people, and find the rightplace. “Keep alive ones curiosity and the zestto find solutions”.AK: To maintain our flagship status, SCTIMST hasto grow strong interdisciplinary teams.International collaborations will help seed newventures, set new standards and develop cuttingedge projects e.g. in genetic epidemiology, thatrequires large capital expenditure.Q: What drives you in work and life?AK: Excellence is an ideal that stimulates me and Ifind the chase for it, in whatever small way, verygratifying.Q: What are the things that you miss the most atthis point of your life?AK: I have started feeling the need for a strongacademic and research environment to grow anyfurther. It is very important to have like-mindedcolleagues and work partners with the samepassion and to be involved in sustainablecollaborative work to broaden one‟s horizons.Q: How do you spend your free time? hobbies?AK:(smiles) I do not have much free time, butwork is enjoyable and that compensates. I‟minterested in trekking, spending time close towater bodies, waterfalls. I also enjoy relaxing witha good book, with preference to readingautobiographies. I liked Chitra Dhwani!Q: As a women scientist and subspecializedneurologist, what challenges do you came across?The interview was conducted on 27 th July 2013 byFrancis, Sudhin, Neelima & Arathi.Research Highlights ….A prospective antibacterial wounddressing from Mukkuti !n recent times, research on plant extracts hasI increased across the globe owing to theirimmense potential to heal life-threateningdiseases. Mukkuti (Malayalam name for Biophytumsensitivum ) is used as traditional medicine to curevariety of diseases. During the last few decades,extensive research has been carried out toelucidate its chemistry, biological activities, andmedicinal applications. Extracts and its bioactivecompounds have been known to possessantibacterial, anti-inflammatory, antioxidant,antitumor, radio-protective, chemo-protective, anti-metastatic, anti-angiogenesis, wound-healing,immunomodulation, anti-diabetic, and cardioprotectiveactivity.9

Research Highlights ….physical activity among the general population,doctors need to engage themselves in physicalactivity and advise physical activity for theirpatients. There is worldwide concern and researchgoing on this issue. A study carried out by thePublic Health Team of AMCHSS found that amajority of doctors in Trivandrum city werephysically inactive, and did not ask or advice theirpatients on physical activity.Figure: Electro-spinning of crude extracts of Mukkuti andPCL to form antibacterial fibro-porous membranes.Dr Ramesh P (In-charge of the Polymer Processinglaboratory) and his team fabricated a fibro-porouswound dressing with anti bacterial activity frompolycaprolactone (PCL) solution containing crudeextract of Mukkuti, a potential antibacterial herbaldrug. They used high resolution scanning electronmicroscopy to prove that the drug loaded PCLmembrane displayed a smooth fibro-porousmorphology with more interconnective junctions withan average diameter between 1 to 3 µm. Physicalcharacterization of the membrane revealed that ithas excellent mechanical stability, water vapourtransmission rate, and that it promoted wateruptake. The release characteristics by totalimmersion method in phosphate buffer and acetatebuffer displayed an increase in drug release withtime. This was followed by testing the anti bacterialactivity of the membrane against standard strains ofbacteria named Staphylococcus aureus (S. aureus)and Escherichia coli (E. Coli). Arjun GN, Seniorresearch fellow, who conducted these experiments,found that PCL membranes loaded with the drugextracts were able to inhibit the growth of bothGram positive & negative bacterial strains. Theimportant finding published in J Appl Polym Sci.(Vol 129: 2280–2286, 2013) indicated that thisfibro porous membrane containing Mukkuti could actas a potential wound dressing material to treatvarious wounds.Kerala Doctors in need of physicalactivity!Call for Exercise Reiterated: Doctors, patients andgeneral populationP h y s i c a linactivity isone of the majorrisk factors for non- c o m m u n i c a b l ediseases. In ordert o p r o m o t eIn this timely and well-conceived study, Dr Patra,Mini, Mathews under proficient leadership of DrThankappan (Head, AMCHSS), conducted a crosssectionalsurvey among 146 doctors (median age42 years; men 59%), selected by multistagerandom sampling. Information on demographicdetails, self- reported physical activity andcounseling offered to their patients was collectedusing a pre-tested structured and selfadministered questionnaire. Multivariate logisticregression analysis was done to find the predictorsof self reported physical activity and counselingpractices. Moderate physical activity was reportedby 37.7% of the doctors and the remaining 62.3%reported being inactive. Doctors who receivedmotivation for physical activity, who used exerciseequipment at home, and those who usedneighborhood facility for physical activity weremore likely to do moderate physical activitycompared to their counterparts. Twenty fivepercent of the doctors always asked and advisedtheir patients on physical activity. Interestingly,the doctors who believed that their own healthylife style influences advice practices, whoconsulted less than 30 patients per day and thosewho engaged in previous sports activities weremore likely to always ask and advice their patientson physical activity compared to theircounterparts. The study recently reported inBritish Journal of Sports Medicine (BritishJournal of Sports Medicine, June 14, 2013,Epub ahead of print) provides crucial insightsinto measures that are required to enhancedoctors‟ own physical activity and counselingpractices.Chitra‟s Movement Disorder Team knocksthe Little Brain:Novel mechanisms identified for the abnormalmovements in Parkinson‟s diseasehe production of normal, smooth movementsT requires complex planning and the timelyinvolvement of numerous areas in the brain. Theconcerted commands required are issued andadapted to a given context, and are integrated10

with the information from within and outside thebody. Impairment in the functioning of anyelement in this chain of command will result inmovements unsuited for the desired aim orunwanted movements. The primary motor area ofbrain (referred as M1) that receives input fromseveral cortical and subcortical regions of the brain(e.g. basal ganglia, cerebellum) controls motorperformance and learning of new motor skills.Plasticity is the ability of brain to enhance ordepress its synaptic function based on the ongoingactivity and this property of M1 is importantboth for motor control and motor learning.Parkinson‟s disease (PD) is a neurodegenerativedisorder in which there is massive loss of dopamine-producing cells (a chemical produced in an area ofbrain called substantia nigra) that leads to severeabnormalities of movements and impaired motorlearning.The energetic and devoted Chitra‟s team ofresearchers at CCC Movement Disorders headed byDr Asha Kishore has elegantly demonstrated howdynamic changes in plasticity occur in the M1 areaduring the course of PD, and in response totreatment using the contemporary, noninvasivebrain stimulation technique of transcranialmagnetic stimulation (TMS). The most acceptedtreatment for PD is dopamine replacement whichhas the side effect of causing disabling involuntarymovements called levodopa-induced dyskinesias(LIDs). LIDs are thought to arise from abnormalsignaling in the basal ganglia due to thenonphysiological release of the exogenouslyadministered dopamine for treatment. M1 plasticityis severely impaired in PD and even worsens withdopamine treatment in patients with LIDs. Dr AshaKishore and her international collaborative teamreported that the plasticity induced in M1 isregulated through the little brain called cerebellumby processing sensory input to M1, based on studyconducted in healthy young adults (published inCereb Cortex 2013: 23: 305–314).The more recent well-designed study by theMovement disorder team produced exciting resultschallenging the prevailing view that little brain hasonly a compensatory role in PD (published inCereb Cortex 2013doi:10.1093/cercor/bht058). Their results suggests that alterations incerebellar sensory processing function in advancedPD plays an important role in generating LIDs andimpairing the plastic properties of M1. It alsohighlights the functional significance of the newlyrevealed anatomical connection between basalganglia circuits and cerebellar circuits in humansthrough which abnormal signals can propagateamong the different motor circuits and causemovement disorders.To study dietary behavior change in ruralKerala:Design & methodology of a community-based trialiets having a high sugar, salt and fatD content are a major risk factor for many non-communicable diseases, and this has motivatedinterest in studying whether it is possible toinfluence these dietary patterns. The “BehavioralIntervention for Diet” study undertaken in ruralKerala attempted to answer this question. Thedesign of this community-based intervention studyto change dietary behavior among middle-incomehouseholds in rural Kerala is elegantly described inthe recently published article in Glob HealthAction (2013, 6: 20993 - http://dx.doi.org/10.3402/gha.v6i0.20993).This was a cluster-randomized control trial toassess the effectiveness of an intervention tobring about changes in household dietarybehavior. It targeted the procurement andconsumption of five dietary components: fruits,vegetables, salt, sugar, and oil. Six out of 22administrative units in northern Trivandrumdistrict were randomly selected and allocated tointervention or control arms. Trained communityvolunteers carried out data collection andintervention delivery. An innovative tool wasdeveloped to assess household readiness-tochange,and a household measurement kit andeasy formulas were introduced to facilitatebehavior change. The 1-year intervention includeda household component with interventions at 0, 6,and 12 months along with counseling, telephonicreminders, home visits and general communityawareness sessions in the intervention arm.Households in the control arm receivedinformation on recommended levels of intake ofthe five dietary components and general dietaryinformation leaflets. Formative research helpedcontextualize the design of the study to groundrealities of current dietary procurement,preparation, and consumption patterns in thecommunities. The study also addressed two keyissues: the central role of the household as thedecision unit and the long-term sustainabilitythrough the use of existing local andadministrative networks & community volunteers.11

Science Images from our researchIn quest of Artistic Titles.......ABDifferentiation of adipose derived stem cells toAdipose Cells characterized by globular accretions oflipidsContributed by TEM group, BMT wingMicro-section of kidney capsuleContributed by Dr Sabareeswaran A (Histopathologylab)CDAdipose cells seen through transmission electron micro.Contributed by TEM group, BMT wingFungus seen in pus from brain abscessContributed by Dr Kavita Raja (Microbiology team)Entries are invited for a suitable artistic title for these scientific pictures. The winnerentries for each picture will be announced in next issue.A Celestial Flowerings Wooden Jewels BC Icy Brinjals Autumn spots DWinner (1st & 2nd issue picture Titles)Thomas TA, Scientific OfficerBiochemistry (Central Clinical Lab)12

Memory Lanes...Chronicle of a Young Biomedical EngineerThe Beginnings of the Chitra Valve DevelopmentDr GS Bhuvaneshwar conducting steadyflow test on artificial heart valveTrivandrum, May 1975 --an‟t believe it is 38 years since my first visitC to Trivandrum! I was writing my MSdissertation at IIT Madras - having designed anddemonstrated the working of a prototypemyoelectric hand prosthesis. Like any other youngdreaming electronics engineer -- my ambition wasto work in a good hospital and develop novelinstrumentation. Sree Chitra Tirunal Medical Centrehad advertised for the post of a BiomedicalEngineer for the hospital.Looking back, the attraction was no doubt hispersonality -- the excitement and positive aura ofgreat opportunity that Dr MS Valiathan gave out.Many may not know - he was also an excellentteacher. During 1973-74, as Visiting professor atIIT Madras, he gave two courses titled“Engineering Physiology - 1 & 2” -- two of the bestI have taken. He taught us the various biologicalsystems -- with a simplicity and clarity that comesonly from great teachers. Cardiovascular systemwas my favorite -- and even today I remember hisvery words explaining how our body controls bloodpressure -- feedback from the baroreceptors, theaction of the arterioles in controlling resistance; orhow cardiac output, heart rate and Starling‟s lawwork; brain perfusion and its link to pCO2, etc, etc.It seems like destiny was at play - preparing mefor my future role.This post of Biomedical engineer seemed a greatopportunity. My good friend Bala, who was doinghis PhD was tipped to be the strongest contender;we all knew that Dr MSV was very impressed withhis hands-on skills with pumps and equipment.But, what Dr MSV did not know was that, he hadapplied for a Canadian immigrant visa, which wasdue anytime. My chance of getting the job lookedpretty good. The interview (conducted in the hallwhich later became the Cardiology ICU) went verywell for both of us. As predicted, Bala did get theoffer first; after a month of dillydallying, hedecided on Canada. I was eagerly waiting for theletter of offer from Trivandrum; but Dr MSV hadother ideas for me. Looking back now, I mustagree that he was absolutely right - the job wasnot for the likes of me.Bombay, November 1975 --I was working for Prof NH Antia, the renownedPlastic surgeon and a leprosy protagonist in hisFoundation for Medical Research, located at the JJHospital. I was tasked with the job of measuringsciatic nerve conduction velocities in rats, infectedwith leprosy bacteria. Bombay, despite itsreputation of being the Mecca for a youngengineer in search of jobs, was a difficult city forme to come to terms with -- very noisy, crowdedand very unlike what I had been used to inBangalore and Chennai. Further, working as ayoung engineer, fresh out of college, without anyexperience, amongst a group of biologists - tryingto dissect out the sciatic nerve in mice -- andmeasure its conduction velocity -- all without anytraining and someone to hold hands was quite a„nerve wracking‟ experience. Maybe, destiny hadother ideas, when this “blue inland letter”,(something we rarely see nowadays) landed in myhands.One evening, on coming back to the flat in Sion,where I was staying with my good friend andclassmate Raman, I got the letter from Dr MSValiathan. He asked me if I would be interested injoining the DST funded project just then beensanctioned for the development of a “Indian heartvalve”. The offer for the post of a BiomedicalEngineer at a handsome salary of Rs.1000/- permonth was quite attractive. I felt very happy andelated to receive this letter at that time and frameof mind. But it also put me in a difficult spot. Just6 months back, I had accepted a similar handsomeoffer from Prof Antia and had moved to Bombay inSeptember 1976. My good friend Raman told methat I would be an idiot to leave Bombay for agodforsaken small town; if I did not like thepresent job, I could easily find another one therein a few months time!! Logic and common sensewas probably on his side, but my heartstrings werepulling in the direction of Trivandrum. It took me aweek to work up the courage and inform ProfAntia of my dislike of Bombay and desire to takethis new opportunity. As many great men, hequietly accepted my decision without anyquestions and agreed to relieve me by the end ofthe week. Dr Antia was later awarded theHunterian like Dr Valiathan and the Padmasree for13

his seminal contributions in the new understandingand treatment of leprosy that he brought out in hisfoundation.Trivandrum, 12th January 1976 --I landed at Trivandrum by the metre-gauge trainfrom Chennai-Egmore and reported to Dr MSV athis temporary office in the first floor ward of theMedical centre block. He briefly told me of theproject and its objectives and asked me tocomplete the formalities for joining. He alsointroduced me to Dr Shanmugam of Microbiology,who took me to see a two-bedroom flat in TagoreGardens and meet the owner. After Bombay, theRs 200 rent seemed very cheap and a godsend - Ireadily accepted and got the keys right there. Hethen took me for lunch at the Medical college cooperativecanteen next door -- where I had myfirst taste of how really “hot” a Kerala hotelsambar and rasam could be and the consequencesof imbibing it heartily.After filling up the forms etc., the ubiquitous MrNarayanaswamy arranged for my medical tests forthe next day. In the evening, I vacated my roomat the lodge near the railway station and movedinto flat - what an unforgettable night it was! Theeffects of the „hot sambar‟ started telling aroundmidnight with severe stomach ache -- I stillremember my Ooohs and Ouchs! I kept drinkingwater from the kitchen tap and by morning thepains abated somewhat. My first lesson on localfood learnt!Trivandrum, 14th January 1976 --Armed with the medical examination reports, Iformally joined the Centre in the morning. As thegreat well wisher he is, Mr Narayanaswamy madesure that the time was right and auspicious to getme wedded to the Centre and Trivandrum -- andlooking back, the time and day must have beenmost auspicious, for me to end up spending thenext 36.5 years there!Once the formalities were done, Dr MSV showedme the rooms he had allotted for the project --one large empty hall of about 1000 sq ft in theground floor of the newly constructedAdministrative Block and a smaller room next to itas a sitting space and asked to me order thenecessary furniture. He also told me aboutVenkatesan, another biomedical engineer whowould be joining the project by the end ofFebruary and that our responsibility in the Heartvalve project was only “Testing”. While NAL,Bangalore would design and prototype the valves,we would be responsible for testing them - both „invitro‟ and „in vivo‟ -- two new words to my growingbiomedical vocabulary. He asked me to read up onPulse duplicator and Accelerated durability testingand start work on the design, development andsetting up of our own systems. He then gave metwo books from his personal collection -- bothpublished in US during the 60‟s -- based on twosymposiums that been held there on heart valves(later he donated these to our library at the timeof his retirement). He also told me to refer theback volumes of the Transactions of the AmericanSociety of Artificial Internal Organs (ASAIO) thathad already been stocked in the library. Thesewere to be my bibles for the next 6 months.Trivandrum, January 1976 onwards ----I got down to reading the books and the ASAIOtransactions. In them I found some excellentarticles on the two test systems. I still vividlyremember how I garnered DW Weiting‟s designdetails from his articles. The accelerated testerwas a bigger challenge -- I could get only thebasic design principles from the articles,particularly one from the Bjork-Shiley group asbeing more suitable for our purposes. So, thedesign of the accelerated test system had to bedone from scratch. My B Tech training inmechanical drawing and design as well theworkshop training and experience in thedevelopment of my myoelectric hand -- all camein handy and provided the foundation for my workat Chitra. Engineering design, I found wassomething I loved doing - a far cry from dissectingmice. The green tranquility of Trivandrum, bookson fiction readily borrowed from the British Libraryand the Water-works swimming pool -- all puttogether, I must have been like Bertie Wooster (ofPG Wodehouse novel‟s), saying “My cup of joyrunneth over”.And that friends, was how the development of theChitra Heart Valve started -- not with the valveitself, but with the design of the two major testsystems. When we look back today, we realizehow Dr Valiathan‟s foresight in setting up the testand evaluation platforms was a major successfactor for the future -- not just for the heart valve- but for all the devices that we have developedand successfully commercialized there.GS BhuvaneshwarChennai24th June 2013(Er Dr GS Bhuvaneshwar served as the head, division ofArtitifial Internal Organs from 1983 to 2002;also as SIC of "Division of Artificial Organs" from 2002to 2012 and as The Head of the BMT wing, SCTIMSTfrom 2000 to 2012. We are grateful to him for sharinghis valuable moments in life through Chitra Dhwani)14

New DirectorDr Jagan Mohan Tharakan, Professor (SeniorGrade) and HOD Cardiology took charge ofDirector from Dr K Radhakrishnan on 16.07.2013New InitiativesIn conversation with game changershe Faculty Forum initiated its “In conversationT with game changers” programme by invitingShri Rajeev Sadanandan, IAS, PrincipalSecretary (Health), Govt of Kerala to share his viewsand have an open discussion on the health issues inKerala. Prof V Ramankutty, AMCHSS was themoderator for this event which commenced sharp at4:00 pm on 1 st July 2013 at the BMT wingNatakashala.The event was designed to be an informal andinteractive discussion with the guest without relyingon a prepared presentation. Mr Rajeev Sadanandan,given his mastery and deep insights on the subjectas well as data at fingertips, soon bowled over theaudience. He described with a historical perspective,the health management practices in the state andanalyzed the reasons for the state being regarded asa model of development globally. However, theslowing of investments in the last few decades inhealth had hampered the health management in thestate. The state continued to be reeling under thepressures of chronic and communicable diseases.The public apathy and lack of communityparticipation in solving problems such as wastemanagement also contributed to the recentwidespread incidences of dengue and otheroutbreaks in the state.He described his efforts in piloting ambitiousprogrammes like an e-health programme forelectronic management of personal healthinformation in the state. The audience showed greatenthusiasm by posing a number of questions onthought provoking issues on health which was verydeft fully answered by the speaker. Dr CP Sharma,Head, BMT wing presented mementoes to speakerand moderator. Dr Anoop Kumar welcomed thegathering and Sri S Balram proposed the vote ofthanks on behalf of the faculty forum.15

New InitiativesMentor Talks series: Initiatives by SCDSFree Chitra Doctoral Scholars Forum (SCDSF)S hosted a talk entitled “Who is Afraid ofResearch? A Talk on Creativity, ResearchMethodology & Research Process Management” byDr Achuthsankar S Nair, Head, Dept ofComputational Biology & Bioinformatics, University ofKerala at the Seminar Hall, BMT Wing, SCTIMST on26.06.13 at 2pm. The talk is the first of a series ofMentor Talks, which are being planned to enhanceinteraction of budding researchers with experts inthe field of science and technology. The Forumhopes that by providing such a platform youngminds will gain inspiration from valid role models aswell equip them to navigate better the nitty gritty ofsurviving in science.Dr CP Sharma, Head, BMT Wing addressed theassembled faculty members, staff and doctoralscholars from BMT, Hospital & AMCHSS. DrAchuthsankar‟s talk was a journey through theintricacies of research. Beginning from the changingdefinitions of research and picking through theinfluence of current technologies in research, Dr Nairnavigated through the brilliant yet at timesintimidating world of scientific enquiry. Hisexperience & ability to hold the audience in thrallwas in evidence through out the lecture. Rocked bylaughter & sobered by meditation on rejection fromhigh impact factor journals the talk was wellreceived. The talk was followed by a short audienceinteraction session that dealt with areas as diversethe social responsibility of a scientific researcher. TheSCDSF expressed its gratitude to all who helpedmake this talk a success.Dr Achuthsankar with memento: illustrating a solitarytraveler heading in to the horizon, a quiet reference to thesolitary search in the sea of knowledge practiced on a dayto day basis by PhD scholars.16Un-met clinical Needsn-met clinical needs is an integral part ofU medical innovation program worldwide. Thepurpose of medical innovation is to solveeveryday clinical problems, with help fromexperts, which would be beneficial for the clinicianas well as for the patient. Medical innovationprogram may result in a new device or a newstandard of care.Biomedical Technology wing of SCTIMST, whichstands for indigenous medical devicedevelopment, „Un-met clinical needs‟ programoffered a new dimension and approach to dealwith difficulties acutely felt by our clinicians/surgeons on different aspects of medical devicesduring their daily work. This program had anelectrifying emergence from our Senior Residents(SR) Orientation program (OP) which is conductedfor several years now, in which SRs were exposedto the research activities of the BMT wing. DuringSeptember 2011, SROP co-coordinators Dr PRUmashankar and Dr Maya with support of DrBhuvaneshwar, the then Head of BMT Wing,introduced „Un-met clinical needs‟ wherein the SRswere asked to make brief presentations on theirobservations on unmet needs towards the end ofthe orientation program. SRs were called forcritical analysis of the un-met needs which theycame across during their practice. The BMT wingfaculty was taking serious note of individualpresentations (a total of 67) in all the foursessions conducted till now. The minute dissectionof un-met needs provided wealth of information inteasing out and identifying the splendid problems/ideas faced by our clinicians in daily work.The next challenge was how to utilize these ideasfor product development. Dr CP Sharma, ourpresent Head, BMT Wing, introduced a guidelineon assigning projects based on un-met clinicalideas to M.Tech, Clinical Engineering studentsfollowing the recommendation of a committee andadvice of our Director. This guideline covers allthe issues such as funding, protection ofintellectual property, commercialization etc. Inwords of Dr Umashankar “we have reached the„end of the beginning‟ and paved the wayfor the „beginning of the end‟. A goodfoundation has been laid and we can be sure ofreaching there when our „un-met need idea‟ aretranslated into a product and hand it over to theclinicians who posed this need.

Chitra’s Stars: Awards/ Honours/ RecognitionsNightingales Gracyamma Bridget, Senior Staff NurseM joined in SCTIMST on 12-12-1985. Atpresent, she is the infection control Nurse.She achieved post basic BSc degree in nursing in2001 from IGNOU and certificate in HospitalInfection Control 2007 from SNDT University,Mumbai. She has attended 1 international and 7national Conferences, and presented paper andposter in national conferences. In the state levelcontinuing nursing education (CNE) programmes,she has also presented papers/ delivered talk on 19occasions. The Trained Nurses' Association of India,Kerala branch conferred her with "Best NurseAward" for the year 2012. This Award waspresented to her by Shri K Babu, Hon'ble Minister forFisheries, Ports and Excise, Government of Kerala on3rd November 2012 at Kochi.SA Timely Act by Crusaderri Rajendran Nair V,Institute SecurityStaff, vigilant on duty,swiftly set into action,getting the main lawn cumparking area vacated onone drizzling afternoon inthe Sree Chitra Hospital.Technical ExcellenceD r Sureshbabu_Sjoined in Bioceramiclaboratory of BMTWing in 1996. Dr Babu is anative of Thonnakkal(Kerala), renowned as thebirth place of greatMalayalam poet SriKumaran Asan. He received his PhD in Chemistryfrom University of Kerala (2012) for his work in thearea of development of advanced bioceramiccoatings on metallic implants. Dr Sureshbabu is ahard working and intelligent scientific officer. He hascontributed immensely for the chemical synthesisand characterization of a series of materialsdeveloped at the Bioceramic lab. Some of theseworks have resulted in the development of fullfledged technologies which were later transferred tothree Indian companies for the commercialproduction that are sold in various trade names suchas Biograft HA new, Grabio Glascera, B Ostin etc. DrSureshbabu is co-author to many scientificpublications and has more than 6 patents to hiscredit. He has developed expertise in a number ofanalytical test methods such as InfraredSpectroscopy (FTIR), X-ray Difractometry (XRD),Optical Emission Spectroscopy (ICP-OES) and Microhardnessmeasurement.Field placement at GermanyCongratulations! All the Best for a fruitful stay atGermanyThe patients, visitors, bystanders hurriedly taken to asafe space under open sky soon realized how acrusader had saved their lives in nick of time. Thisentire operation was in anticipation of uprooting of adrained tall tree in the campus. Sri Rajendran‟stimely action and careful assessment of situationaverted an imminent disaster in the hospital. Sri Nairis given a Certificate of Appreciation by Director.17

Service Awards: Serving for 1, 2 & 3 decades...25/ 30 years of service20 years of service10 years of service10 years of service18

20 & 30 years of serviceEvents held at SCTMST ….Renovated Animal OTInaugurated at BMT WingWorld Blood Donor dayWorld blood donor day is celebrated everyyear to raise the awareness about theneed for regular, voluntary, nonremuneratedblood donation and its importance inensuring that all patients who need blood are ableto receive it. The theme for this year is “Give thegift of Life, Donate Blood”. The public healthstudents‟ forum recognized the importance ofblood donation in the present scenario wherethere is a demand for platelets due to escalatingnumber of dengue fever cases in the capital. Thefunction was inaugurated Dr R Sankar Kumar,Medical Superintendent, Dr SK Jawahar,Administrative Medical Officer, and faculty fromAchutha Menon Centre for Health Science Studieswere also present. Staff members, students aswell as volunteers from other institutes alsodonated blood and actively participated in theprogramme.Coming together is a beginning; keeping“ together is progress; working together issuccess”19

Independence Day CelebrationsDoctors Day: A Tribute to Doctors!doctors for their critical role in our lives. Doctor‟sprofession is not just a 'job'; it is a challengingcommitment to service that requires high levels ofskill and precision. To make a tough job eventougher, doctors also have to deal with the realitythat even a small professional mistake coulddrastically affect a patient's life. Doctors‟ Day is theperfect time for patients to acknowledge the highpressuredjob and appreciate their Doctors‟ abilityto comfort and heal.Aspecial tribute is extended to all the InstituteDoctors on the “Doctors‟ Day” on 1 st July2013 through Chitra Dhwani. It is a goldenopportunity to applaud and congratulate theFirst proposal on “Doctors‟ Day” In India wasmade by Indian Medical Association, KidderporeBranch; Calcutta in the year 1989 designating 1 stJuly in commemoration of the Birth & DeathAnniversary of Eminent Physician and Patriot DrBidhan Chandra Roy. “National Doctors‟ Day” gotofficial recognition in India in the year 1991 byDept. of Health & Family Welfare, Government ofIndia.20

Workshops held …….Scientific Writing..Workshop on Scientific Writing”“ o r g a n i z e d b y S C T I M S T ,Trivandrum & Kerala State Councilfor Science Technology andEnvironment was held on 12 th and13 th June 2013. Resource personswere Prof B Gitanjali, Prof RRaveendran and Dr S Manikandanf r o m t h e D e p a r t m e n t o fP h a r m a c o l o g y , J I P M E R ,Pudhucherry. More than 40 studentsand faculty participated in theNational Workshop. Dr Renuka Nairexpressed her satisfaction on thesuccess of the workshop, 2 nd inseries (one was held previously onEnglish language skills).Mercury Toxicity: A cause of Concern!Towards an Environment-friendly“ healthcare” is an the burning issue on which aconsultative seminar and workshop was held on25 th May 2013 at the Achuta Menon Center forHealth Sciences Studies, SCTIMST, Trivandrum. Aninsight gained on awareness on mercury toxicity andits proper disposal during the program is described.also lodge in various organs. Its accumulation inthe occipital lobe of the brain causes visualsymptoms, and on being swallowed in certainforms it can cause renal shutdown andhemorrhage. The bio-accumulative nature of thismetal makes one more prone to the toxic effects.Recent studies have shown that autism (adevelopmental disorder) too could be caused, tosome extent, by the mercury in vaccines.To avoid toxicity of mercury, some methods thatcan be employed are:Mercury is a common heavy metal used widely in themodern health sector. Health care workers are oftenexposed to mercury through leaks and breakages ofthermometers and sphygmomanometers and alsodental amalgams. However, for some it would beshocking to know how toxic this metal, Minamatadisease is a live example.Mercury, also known as quick silver, is a heavy metalwhich causes immense harm to human health. Mereinhalation of this volatile metal can be toxic since ithas the potential to accumulate in the lungs causingchemical pneomonitis. It dissolves in blood and can Create a mercury elimination task force of keystakeholders in the hospital community. Conduct an inventory of equipment, instruments andwaste products that contain mercury. Train all healthcare staff in the proper disposal ofleaked mercury. Gradually phase out mercury based thermometersand B.P. apparatuses. Use safe, accurate and affordable alternative devicesand adopt a mercury-free purchasing policy. Use mercury spill kits to handle spills safely. Choose a proper site for dumping of the brokenmercury-containing instruments to avoid any chanceof leakage and contamination of the surroundingenvironment. Conduct a baseline check-up for mercury exposurefor all health care workers and monitor their healthstatus bi-annually.(Contributed by Almas, Joanna and Public HealthStudents Forum)21

Medico-Techno ClubUpcoming events ….Basic Training on „Ethics in HealthResearch‟The first Medico-Techno club of 2013 wasorganized at the Hospital Wing on lastSaturday of June, on 29. The talk by DrGanapathy Krishnamurthy from IIT, Chennai wasentitled “Semi-automatic Renal segmentation fromMR images of Polycystic Kidney Disease Patients”. DrKrishnamurthy‟s talk was focused on the recentadvances in MR imaging for faster diagnosis ofkidney disorders. The second talk was on"Haemodynamic imaging of intracranial aneurysmsusing computational fluid dynamics" delivered by DrJayanand Sudhir, Assistant professor from theNeurosurgery department, SCTIMST and DrJayabharatha Reddy, VSSC, Trivandrum. The projectaimed to derive blood flow simulations in intracranialaneurysms using numerical methods. The talkshighlighted deduction of blood flow patterns,turbulence, wall shear stress and other parameterswhich may prove beneficial in predicting the ruptureof intracranial aneurysms.A Short Course for Researchers and ResearchAdministrators will be organized jointly byAchutha Menon Centre for Health ScienceStudies, SCTIMST & Institute Ethics Committee,SCTIMST. As the emphasis on research in thefield of health gains momentum, it is importantto realize that research and technologydevelopment should be scientifically sound andaddresses the needs of people in underprivilegedcircumstances and enhance equity in access tohealth care. This course fulfills a felt need forresearch ethics training among researchers andresearch administrators in biomedical and publichealth research.Date: August 26-27; 29-31, 2013 (5 days)The Organizers: The Achutha Menon Centre forHealth Science Studies has the experience ofrunning a Research one-credit Ethics Modulefrom 2004 as part of its Masters‟ in Public Health.The Institutional Ethics Committee, SCTIMST isone of the few ethics committees in the countrythat is registered under the Office of HumanResearch Protections and obtained a FederalWide Assurance that has been effective since2004. It is also registered with the CDSCO,Directorate General of Health Services, Ministryof Health and Family Welfare, Govt. of India(RCNo: ECR/189/Inst/KL/2013). It has amandate to undertake research ethics trainingfor researchers within the institution.Venue: AMCHSS Seminar Hall, III Floor,AMCHSS Building, SCTIMST“When we long for life without difficulties,remind us that oaks grow strong incontrary winds and diamonds are madeunder pressure”Contact: Ms Sreepriya CSExe Secretary to the Director cum IECCoordinator, SCTIMST-IECDirector‟s Office, SCTIMST, spr@sctimst.ac.in,22

Alumni portal….Reunion with Alma materThe journey of my research life fromSCTIMST…i, let me introduce myself, I am ThomasH Chandy recipient of the first PhD degreefrom SCTIMST. I am really fascinated tonarrate the story of why I became a biomaterialscientist, and what I‟ve done since becoming one.I joined SCTIMST in 1976 as a Junior ResearchFellow with Prof Subramonia Iyer, BiochemistryDepartment, to work on a project “Effect of dietarytubers in the myocardium of rats”. Being the firstJRF of the Institute, I was asked to meet Prof MSValiathan, founder Director of the Institute andhead of cardiovascular group. I was little nervousabout meeting Prof Valiathan for the first time--Iwas not sure if I would live up to the qualificationsthat he was looking for in a research fellow. But Iwas amazed to meet a dynamic young man withspecific goals and outlook about the Institute andpassion for inventing novel approaches in scienceand patient care. I thought I am in the right placeand was the first step in my life for a researchcareer.I was fortunate to transfer my field towardsresearch and joined in Biosurface Technologydivision with Dr Chandra P Sharma, BiomedicalTechnology wing of the Institute. I learned aboutSurface energetics, protein/platelet interactionsand developed new areas of research inbiomaterials, drug delivery. Grad School taught mehow to learn and recover from “Failure.” I havehonored in on these skills such as initiative, morepassion, more drive, more tenacity, more mentaltoughness, more perseverance and more cogency.It was my bliss when Institute announced the firstPhD degree in Biomaterial Science and Technologyin 1987 for my thesis “Fibrinogen-Polymerinteractions - Influence of plasma components”.After my PhD degree, I received a Scientistposition and started my real professional careerwith Dr CP Sharma itself and managed severalexternal funded projects with him. We publishedover 60 scientific papers in various internationaljournals. I was fortunate to establish my links andleadership capabilities in Biomaterials areanationally and internationally by serving asSecretary to Society for Biomaterials and ArtificialOrgans-India (SBAOI). During my 16-year stint atSree Chitra Tirunal Institute for Medical Sciencesand Technology, I could combine biomaterialsscience, engineering technology, humanphysiology and technology development in aseamless manner with the help of excellentscientists, engineers and doctors in the Institute.At present, I work with Hemostasis LLC, St Paul,as a Lead Scientist and Program Director in thenew product development group. Prior to joiningHemostasis, I shared my skills with many medicaldevice companies including 3M PharmaceuticalDivision (micro-needle transdermal drug delivery),Applied Research group of Boston ScientificCorporation (new product development) andMechanical Engineering division of TransomaMedical (implantable cardiac monitoring device).I was always learning in my life and I believe“knowledge is power and creativity andcompetitiveness is the key to success”. Looking atit from some distance now, my path from JRF toProgram Director was not that easy. I believe, theworld in the 21 st century is a knowledge basedsociety with multiple opportunities. I like toconclude saying “budding researchers - if younurture the seeds of science with sincereefforts, hard work and love, in your life youcan reach the endless sky”.Dr Thomas ChandyMemories cannot be sold, cannot be“ contracted but treasured “23

BRAIN DEATH: In focusA hard yet destined dialogue with Life!eath of the physicalD body is the greatcertainty of life.A c c o r d i n g t o a n c i e n tphilosophy, death is onlydissolution of the material body frame. The soulcontinues to exist and evolve. In its own way,physical science is affirming the validity of lawsdiscovered by the spiritually evolved through themental science. One of the surest axioms of scienceis that energy never dies; it can neither be creatednor destroyed. According to a new scientific theory byRobert Lanza (Scientist and stem cell researcher) -called biocentrism, although individual bodies aredestined to self-destruct, the energy within cannotbecome non-existent.What is brain death?Death is an irreversible, biological event that consistsof permanent cessation of the critical functions of theorganism as a whole. Death of the brain thereforequalifies as death, as the brain is essential forintegrating critical functions of the body. A patientproperly determined to be brain dead is legally andclinically dead. It should not be confused with apersistent vegetative state. Persistent vegetativestate is also characterized by unawareness as incoma, but in this state, patients have normal sleepwakecycles and are arousable. In most adults,trauma and bleeding in brain (subarachnoidhemorrhage) are the most common events leading tobrain death. Others include intracerebralhemorrhage, hypoxic ischemic encephalopathy, andischemic stroke. Any condition causing permanentwidespread brain injury can lead to brain death.Necessity to diagnose brain deathAs a consequence of developments in critical care,clinicians are faced with the prospect of anapparently „alive‟ patient sustained by mechanicalventilation long after brain function had ceased. Theconfirmation of brain death allows the withdrawal oftherapies that can no longer conceivably benefit anindividual who has died. In addition, the developmentof organ transplantation resulted in an associatedneed to determine death before organ retrieval.Controversies regarding brain deathControversies regarding brain death include therelationship between brain death and death of thewhole person, the international differences in thenomenclature and criteria for the determination ofbrain death, and the inextricable links between braindeath and organ donation. Whereas some countries(eg, the United States) understand brain death as"whole brain death" others (eg, the United Kingdom)use the concept of brainstem death.GuidelinesGuidelines are available in many countries tostandardize national processes for the diagnosis ofbrain death. Some brain death guidelines specify thequalification and level of experience of thosedetermining death, and most explicitly excludeanyone involved in organ transplantation. Thenumber of doctors required to determine brain deathalso varies between countries.The diagnosis of brain deathThe diagnosis of brain death needs to be rigorous, inorder to be certain that the condition is irreversible.The diagnosis of brain death is primarily clinical.Neurologic examination to determine whether apatient is brain dead should proceed only after rulingout reversible or treatable causes of coma; drugintoxication or poisoning; the effect of sedatives orother central nervous system (CNS) depressantdrugs; and uraemia or hepatic encephalopathy. Braindeath cannot be declared in the setting ofhypothermia (

2. Loss of Cortical functionThere should be no spontaneous movements andno response to external stimuli (verbal, deeppain).3. IrreversibilityIrreversible brain death is assumed if the cause ofbrain death is known and accepted to be sufficient toaccount for death. Identification of historical orphysical examination findings that provide a clearetiology of brain death is necessary for thecertification of brain death.4. Exclusion of any condition that might confoundthe clinical diagnosis of brain deathMisdiagnosis of brain death is possible if a locked-insyndrome, hypothermia, or drug intoxication is notrecognized.Confirmatory TestsIf there is doubt about the diagnosis or if thepreconditions for brain stem testing cannot be metthen objective tests of cerebral perfusion may benecessary. Indications include:no clear cause for comapossible drug or metabolic effectcranial nerves cannot be adequately testedcervical vertebra or cord injurycardiovascular instability precludes apnea testingThe clinical examination to determine brain deathin children follows the same principles as that inadults. However, many children have hypothermiawhen they become comatose after a severe braininjury. Several of the cranial-nerve responses arenot fully developed in preterm and full-termneonates, and it is difficult to perform a neurologicassessment in an infant who is in an incubator.Because of the limitations on the clinicalexamination of neonates, an observation period of48 hours is recommended, as well as aconfirmatory test. Confirmatory tests are optionalin adults but recommended in children youngerthan one year old. Electroencephalography is usedin many countries and remains one of the mostwell validated confirmatory tests. Recordings areobtained for at least 30 minutes with a 16- or 18-channel instrument. “Love is the bright linkbetween Earth and Heaven. Organ donationis an act of Love transcending grief and painand fate and death”(Contributed by Dr Rupa Sreedhar, Professor ofAnesthesia, SCTIMST)“Death is just life's next big adventure”OpinionsPublic Health Reflections on Chitra Valvehe Sree Chitra valve was instrumental inT bringing down cost of heart valvereplacement surgeries in India. The need for valvereplacement surgeries will continue for a few moredecades in India, as rheumatic fever, the diseaseleading to heart valve lesions, is still around.However, benefits of the Chitra Valve are notreaching to majority of the needy, poor patients,as heart valve replacement surgeries are availableonly in limited super-specialty hospitals in urbanareas. We need to acknowledge this wideningunmet need as a design issue!Changing epidemiology of heart disease in theWest has led to a scale down of research in thisarea. Durability of the prosthetic is not a prioritythere as most of their patients are adults with nonrheumaticetiology. Their present research focus ison bio-prosthetic valves and polymeric flexibleleaflet valves, which would be costlier but saferand more profitable. So we are left to take thelead and reorient our research priorities to developsolutions that suit our health system capabilitiesand resource limitations.As our potential beneficiaries are children andyoung adults, we need more durable and lessinvasive solutions like trans-catheter valves whichcould potentially be provided even in our districthospitals. Prolonged use of anticoagulant therapy,needed for these younger patients, also could bemade more user-friendly and less doctordependent. For example, the ambulatory Thrombo-Check utility electronically measures the heartvalve thicknesses and helps in optimizing anticoagulantdose for the patient.We need to adopt co-design principles wherein allpotential stakeholders, beneficiaries, providers andpolicy makers, are involved in the design process.Such participatory and interdisciplinaryapproaches, building on our frugal innovativecapabilities, shall ensure maximal use of thesolution. Health Technology Assessment (HTA)tools helps in a priori assessment of the economicunderpinnings of various technological options andhelp to prioritize our needs against their costs andscalability. With the richness of ourinterdisciplinary legacy, Sree Chitra can pioneerthis new way of technological innovation tomaximize the public health impact of biomedicaltechnologies.(Contributed by Dr Biju Soman, Associate Professor atAMCHSS, SCTIMST)25

Did you know ???Anything other than Science...Snake Venoms: Neurotoxins vs hemotoxinsf you are one who enjoys the nature walkI often, an encounter with snakes becomesinevitable. They are found in almost all parts ofthe world - the tropics, Americas and Australiaalbeit; only a few species actually pose a threat tohumans. However, venomous snakebites claimmany lives and cause serious injuries. Speciesidentification is essential for the right antivenom tobe administered by the physician; the soonertreated, better are the chances of saving a life.In India, major venomous snakes include Cobra,Common Krait, Russell‟s viper and Saw-scaledviper. Cobras usually have a hooded head andwhen threatened, would rear up spreading theirhood. Kraits are conspicuous bluish-black withwhite bands along its body. The Russell‟s viper hasa distinctive triangular head with bold diamondpattern skin whereas; the Saw-scaled viper isrelatively small with large eyes and takes its namefrom the characteristic dusky serrated scales on itsbody.Cobra and Krait venoms are neurotoxic, quicklydisengaging the nervous system causing dizziness,nausea and paralysis. Vipers employ hemotoxicvenom inducing severe pain and swelling especiallyat the bite region and as the toxin spreads throughthe body, victim may feel feverish and nauseas.Subsequent kidney failure and bleeding of gumsand tongue may occur. That said, prevention isbetter than cure. Donning protective foot gear andtreading on clear trails the next time you areoutdoors can surely prevent being at the receivingend of a pair of venomous fangs.(Contributed by Soumya Krishnamoorthy, ProjectAssistant at the Thrombosis Research Unit, BMT wing)Good judgment comes from experience,“ and experience comes from badjudgment.”26A seed from the tree of life– Coconut!coconut is the largest known seed in theA world. Once a coconut falls from a palm tree,it takes about three years for this seed totake root and sprout into a new tree. The coconutpalm Cocos nucifera, is a member of the familyArecaceae (palm family). Coconuts are classified asa fibrous one-seeded drupe. The coconut palm isgrown throughout the tropical and subtropical areafor its many domestic, commercial, and industrialuses; virtually every part of the coconut palm canbe used and has significant economic value.Coconuts' versatility is sometimes noted in itsnaming. In Sanskrit, it is kalpa vriksha "the treewhich provides all the necessities of life". Thevarious parts of the coconut have a number ofculinary uses. The seed provides oil for frying andcooking. The white, fleshy part of the seed, thecoconut meat, is used fresh or dried in cooking,especially in confectionaries and desserts.Desiccated coconut (coconut milk) is frequentlyadded to curries and other savory dishes. Coconutflour has also been developed for use in baking, tocombat malnutrition. Coconut chips, payasam,salads, chocolates, butter, smoothies, puddingsare highly popular dishes made from coconut.Coconut water contains sugar, dietary fiber,proteins, antioxidants, vitamins, and minerals, andprovides an isotonic electrolyte balance. Coconutwater can be fermented to produce coconutvinegar. It has high nutritional value: 100g of inneredible solid part provides 1480kJ energy andcontains 47g of water, 3.33g of protein, 33.3g offat, with 9g of dietary fibers, vitamin B and C andminerals like calcium, iron etc., while 100ml ofcoconut water provides 79kJ energy. Otherinteresting product is coconut toddy. Coconutproduction in Kerala plays an important role in thestate economy and culture of Kerala.Kerala is actually named after the coconut treewith "Kera" meaning Coconut tree and "Alam"meaning land so means "Land of Coconut Trees".Coconut oil is also a main ingredient in Ayurvedicoils. The virgin coconut oil reduces totalcholesterol, triglycerides, phospholipids, LDL, andVLDL cholesterol levels and increased HDLcholesterol in serum and tissues. The coconutwater has estrogen-like characteristics. Coconut isthus a blessing seed in God‟s own country, with itsunique life sustaining qualities.(Contributed by Neelima, PhD student, DTERT, BMTwing)

Fun Page….(Designed by Anil Kumar PR, Scientist C, Tissue Culture Lab, BMT wing)Drawings by children on Independence dayMalavika, Std-IVFour cars bore the brunt of heavy tons of log. SCTIMST put on record deep appreciation to Kerala Fire Force for theirprompt response in clearing the lawn and establishing the normalcy in record time.After-effects of tree uprooting in campus !!27

A story…...Liquor and blood, eau‟d slaughter with highlightsof ammonia. Sweat dripped off Kutti‟s brow as hegawped at Baiju quartering the birds. Rajappan,was a machine, necks being cut with somethingclose to a religious fervor. Life bled out of thebirds as they undertook a final flight into a largeblue bin which shook, as souls dripped out in afinal shiver.Kutti started the de-feathering machine;concentric perforated steel drums startedrotating. Each bird was dunked in boiling waterset on a kerosene burner, and 20 hurled in toload the machine. Night had slipped by fast; itwas 0230 on the clock and morning breezesleaking in through chinks in the walls beckonedto Kutti. He walked out, sank to his haunches,backlit by powerful arc lamps on the perimeter ofthe farm set up to deter any wayward predatorwith a taste for poultry.He lit a beedi, inhaled deeply to keep the “bit”alight, sucking in smoke, dust and the everpresent tang of chicken shit. He felt a warmglow; alight to the tips of his fingers, far betterthan the arrack being doled out behind the shed.He inhaled again, pondering stars in the skies.The real world, let alone a star, felt too far away.The night was rent suddenly by the loud flappingof wings, cackling noises interspersed with theshort barks of tamil expletives. A cage used toferry birds between life and destiny had broken,cooped up birds had tasted the night & taken aliking to it. Baiju yelled at the men, rousing themfrom their work induced torpor to retrieve birds.The men started enjoying the action, a welcomediversion from the daily grind. Kutti moved away& sat down on a small ledge watching them ashe re-lit his beedi.His father had brought him here and borrowedfive thousand rupees against his labor. Hismother had surrendered to T.B. two years ago.The pittance he earned, measured against debtwas a mystery to him as all numbers & writtenwords are.Now the yells were more coherent, a huge yellowlight that flickered and danced lit up the yard.As he ran up to the crowd he saw that theslaughterhouse was on fire. A finger of flamepointed to the sky with dark clouds billowingfrom its base. Then it hit him, the machine hadrun dry soon after he left, overheated drumsigniting the feathers piled in and around it. Thekerosene reserves went up with a soft whoosh,flames devouring nearby hutments.Kutti shrunk to within himself; for a momenthe thought of the aftermath. Running straightto the super‟s hut he kicked in the door,tugging at the cash register which he foundlocked.Taking up an axe from the tool pile in thecorner, he split open the register & grabbed afew notes. He ran out to see the supersprinting towards him; the fire had run thedrink straight out of him leaving him clear andraging.“Da go and help them put out the fire” thesuper yelled, “I will call the fire force”.“There is no fire force, this place never evenhad a license”Blood painted the ground, the earth hungry forlife in its eternal cycle drank it in greedily asflames licked at the sky. Kutti ran, to the gate,to the fence & over it to the blacktopped roadby the fields. If he was lucky he could flagdown a ride on a lorry.The sun gently touched his cheeks as he lay onthe tarpaulin in the cargo bay of a lorry, lulledby the low frequency thrum of the diesel. Thetarp had the smell of spices that he hadsmelled before only when his mother cooked.(Contributed by Francis, PhD scholar, and Presidentof Sree Chitra Doctoral Scholars Forum. Hededicates this poem to the muse).(Dr Manoj K has been a professional cartoonist, some15 years back and has published science cartoons invarious periodicals including The Indian Express)28

(Created by Dr Kavita, Professor and HOD of theMicrobiology Department, SCTIMST)Created by Ms Joanna Sara Valson, MPH student inbatch 2013“The flower that blooms in adversity is the rarest and most beautiful of all.”29

Patron: Dr Jagan Mohan Tharakan, Director, SCTIMSTEditorial Team:Editor: Kamalesh K Gulia (Sleep Res. Lab, Comprehensive Center for Sleep Disorders)Co-Editors: S. Harikrishnan (Cardiology)Sundari Ravindran TK (Achuta Menon Center for Health Science Studies)NeethuMohan (DTERT, Biomedical Technology wing)Our Potential Reporters: Neelima T, Sudhin T, Arathi R, Swapna N, Neena EP, Prashant PNDesigning and layout: Arumugham V and Leena Joseph (Calibration Cell, BMT wing)Special Acknowledgements: Liji Kumar G and Vasanthi S (Medical Illustration Unit )To one and all for their valuable ContributionsE-magazine by Research and Publication Cell, SCTIMST, Trivandrum, Kerala, IndiaFeedback may kindly be sent to: enewsletter@sctimst.ac.in(The articles are invited for the next issue and may kindly be sent to the above mailbox)30