‘Take me home and allow me to die peacefully’ – an ethical dilemma of grave concern

To The Editor: Brain death that refers to the irreversible end of all brain activity, including involuntary activity necessary to sustain life, due to total necrosis of the cerebral neurons following loss of blood flow and oxygenation [1,2]. Using brain-death criteria, the medical community can declare a person legally dead even if life support equipment keeps the body's metabolic processes working. However, putting an end to someone’s life createsmany ethical dilemmas. Many patients perceive death as a natural part of life, or relief from pain and they may express a wish to diequickly and painlessly. They often ask the treating physician and their family to be taken home and allowed to die peacefully. However,the next of kin may want the patient to be actively treated and kept alive. The physician hopes that the patient will survive and resortsto technical means to keep the patient alive. Who should decide; the patient, the family or the physician

Infertility, Assisted Methods of Reproduction and Hormonal Assays

Infertility is a major public health concern in developing and developed nations. In certain societies, infertility carries a social stigma and is one of the key factors for breakup of families. The revolution created by assisted reproductive technologies (AIR) in infertility treatment has given hope to childless couples to have children. The quality of diagnosis plays an important role in helping to deliver proper therapy to such couples. Therefore, judicious use of diagnostic tests and its interpretation play a vital role in infertility treatment. The presence of andrologists and gynecologists has helped to identify and guide the patient to take proper treatment for their childlessness. Hormonal assays, its interpretation followed by hormonal stimulation, retrieval of healthy follicle, in vitro fertilization, implantation and growth of embryos require a team of experts to co-ordinate, advocate and advance the treatment to the patient. The promising field of stem cell therapy and storage banks of sperm, oocytes and embryos have opened new avenues of treatment and galvanized the field of reproduction. Therefore, books related to these aspects will help review, relate and redeem the field of infertility treatment. The ethical concerns of AIR will allow for introspection of the existing dilemmas and psychological concerns of the patient

Whether marriage can be free and Ideal

Introduction Marriage is an esteemed institution in India, encompassing a multitude of cultural diversities. It serves as the cornerstone of family units, which are integral components of the social fabric of society. A notable shift has occurred in perspectives on marriage and love, with increased discourse surrounding the concept of free love. Furthermore, considerable attention has been given to advocating for more lenient divorce laws. Surprisingly, however, there appears to be a dearth of initiatives promoting the concept of free marriage. This prompts the question: why [1] hasn’t such a campaign been contemplated? A marriage devoid of restrictions is a blissful union. There is absolutely no doubt about it. Every factor contributing to marital unhappiness can be seen as some form of constraint. These constraints may stem from economic or legal circumstances, but most of them are rooted in personal Issues. While some marriages collapse due to economic factors or oppressive legal frameworks that burden one or both partners, it is indisputable that numerous unions are shattered by the personal deficiencies of the [1-2] individuals involve

A preliminary study of inflammatory markers in non-alcoholic steatohepatitis patients

It was reported that C-reactive protein (CRP) levels increase in parallel with the progression of chronic liver diseases, such as chronic hepatitis and liver cirrhosis. Inflammatory markers, such as high sensitive C-reactive protein (hsCRP), ferritin, transferrin, albumin, alpha-1 acid glycoprotein (AAG), alpha-2 macroglobulin (AMG), alpha-1 anti-trypsin (AAT) and lipoprotein a [Lp(a)] were measured in coronary artery disease patients (CAD) and CAD patients with non-alcoholic steatohepatitis (NASH). In the present preliminary study an attempt was made to study whether there is an increase in the levels of CRP in CAD patients associated with NASH. CAD patients showed an increase in CRP and serum ferritin levels. In CAD patients with NASH along with an increase in the levels of serum ferittin (p<0.001), the levels of serum AMG and ceruloplasmin (CP) were also increased (p<0.01). The CAD patients with NASH had a higher proportion of diabetes, hypertension and dyslipidaemia compared to CAD patients. But how this difference contributes to the elevation in acute inflammatory markers particularly AMG and CP levels in CAD patients with NASH cannot be explained. This study shows that a substantial number of CAD patients may be associated with NASH. Non-invasive simple parameters that reflect the degree of inflammation and fibrosis of the liver in patients with NASH would facilitate improved understanding and treatment of the disease. Further studies may be necessary to evaluate the percentage of NASH patients progressing to CAD

The prevalence of metabolic syndrome in a local population in India

Introduction: People with metabolic syndrome are about twice as likely to develop cerebrovascular disease (CVD) and over four times as likely to develop type 2 diabetes compared to subjects without metabolic syndrome. This cross-sectional population based study was undertaken to explore the prevalence of metabolic syndrome in a local population in India. Materials and methods: The prevalence was assessed in a group of 1,568 patients referred to High Tech Hospital affiliated to Vinayaka Missions University, Salem, India. We have analyzed the overall prevalence of metabolic syndrome, as well as the number of components of the metabolic syndrome present in the individuals in this study. For all subjects following variables were collected: age, gender, waist circumference, blood pressure and fasting clinical chemistry parameters. Blood pressure was monitored and measured in a sitting position by a mercury sphygmomanometer. Blood samples for HDL-cholesterol, triglyceride and fasting glucose were collected after 12h overnight fast. Results: In our group 33.17% of males and 27.04% of females were identified as having the metabolic syndrome. Waist circumference, dyslipidemia and impaired glucose tolerance were significantly more prevalent in our male subjects than in females. Multiple logistic regression analysis showed that increasing age (OR (95% CI) = 1.06 (1.040-1.070); P < 0.001) and male gender (OR (95% CI) = 1.50 (1.190-1.890); P < 0.05) were significant predictors of metabolic syndrome in India. Conclusion: The metabolic syndrome is substantially prevalent in India. Its prevalence increases with age and is higher in men than in women. A further study is required to understand the role and inter-relationship between some more and less known factors possibly associated with the metabolic syndrome