Lieutenant Commander Manoj Gupta, an Indian Naval Officer presently posted at Indian Naval Academy (INA), Ezhimala here, who is on a solo cycle expedition from Jammu and Kashmir to Kanyakumari, arrived here on Tuesday.
Officers, Midshipmen and family members of INA officers rode with him on bicycles from Payyannur to Pappinissery to bolster his expedition, a press release issued by the INA here on Tuesday said. Lt. Commander Gupta is undertaking the expedition to create awareness of the Armed Forces Flag Day.
The cycle expedition began from Khardung La in Ladakh region of Jammu and Kashmir and was flagged off by Colonel Satish Sharma, Commandant, Ladakh Scouts Regimental Training Centre, on June 6.
The expedition is expected to conclude at Kanyakumari on July 16.
The officer reached Kannur after covering nine States and cycling a distance of 3,500 km.
FIFA 2018: England vs Croatia semifinal: Midfield battle too close to call
But youth has a future. The closer he came to graduation, the more his heart beat. He said to himself: “This is still not life, this is only the preparation for life.” ― Nikolai Gogol
The English youngsters – the second youngest squad in this World Cup – were not meant to have their date with destiny in the land of Gogol – not yet. The temerity of Gareth Southgate to leave the established names of the club games for a more youth-driven, team-centric approach was a means to an end, a larger plan to challenge the world order in the years ahead, breaking away from England’s burden of legacy but little success.
The team, however, has exceeded its potential and is now just a game away from playing in the World Cup final. Southgate’s boys are graduating to the big league early, with years left in professional and national careers.
The manager’s functional 3-5-2 formation has provided stability, with Liverpool’s Jordan Henderson staying behind to offer an extra cushion to the backline, but England has struggled to break deep defences to create chances from open play with eight of its 11 goals coming from set pieces (including three penalties). “England showed from the games I’ve seen so far that they play direct football and they are very fast,” Croatia coach Zlatko Dalic said. “They are really good at set-pieces and their tall players are dangerous at corners.”
However, Croatia – which has Luka Modric, the most skilled playmaker left in the competition – has the propensity to play the passing game that could play to its disadvantage. In Dele Alli and Jesse Lingard England has two midfielders who can run behind the defenders, creating space for Harry Kane and Raheem Sterling – the two strikers – to punish the rivals.
Dalic has been more adventurous, while allowing Modric – the star and inspiration of the team – maximum leeway as the Real Madrid midfielder played higher up the pitch while Barcelona’s Ivan Rakitic sat deep, essaying the role of a deep-lying playmaker – much like Xavi or Xavi Alonso did for the title-winning Spain of 2008 and 2010.
With Mario Mandzukic partnering Andrej Karamaric upfront in a 4-4-2 system (against Russia), Croatia quickly swells its ranks when in possession with Ivan Perisic and Ante Rebic moving forward from the flanks to have a front four that can often overawe the opponents, putting a halt to England’s plan of playing from the back.
They have got some fantastic players. I’ve played with Modric and he is one of the best midfielders in the world.” England defender Kyle Walker said. “But we have to just adapt ourselves to their game plan, but they also have to worry about us.”
Addicted to video games? You may be suffering from new mental health condition, says WHO
Many parents will have thought it for a long time, but they now have a new argument to limit their children’s ‘screen time’ – addiction to video games has been recognised by World Health Organization as a mental health disorder.
The WHO’s latest reference bible of recognised and diagnosable diseases describes addiction to digital and video gaming as “a pattern of persistent or recurrent gaming behaviour” that becomes so extensive that it “takes precedence over other life interests”.
The International Classification of Diseases (ICD), which has been updated over the past 10 years, now covers 55,000 injuries, diseases and causes of death. It forms a basis for the WHO and other experts to see and respond to trends in health.
“It enables us to understand so much about what makes people get sick and die, and to take action to prevent suffering and save lives,” WHO Director-General Tedros Adhanom Ghebreyesus said in a statement as the ICD was published.
The ICD is also used by health insurers whose reimbursements depend on ICD classifications.
This latest version – known as ICD-11 – is completely electronic for the first time, in an effort to make it more accessible to doctors and other health workers around the world.
ICD-11 also includes changes to sexual health classifications. Previous editions had categorised sexual dysfunction and gender incongruence, for example, under mental health conditions, while in ICD-11 these move to the sexual health section. The latest edition also has a new chapter on traditional medicine.
The updated ICD is scheduled to be presented to WHO member states at their annual World Health Assembly in May 2019 for adoption in January 2022, the WHO said in a statement.
VITILIGO- Associated Myths And Facts – Jammu Voice News
By: Dr. Devraj Dogra , Dr.Mubashar Mir
Vitiligo is a disease characterised mainly by destruction of the melanin producing cells called melanocytes in the skin which impart the skin its natural colour. This loss of melanocytes presents as sharply demarcated bright white or chalky white patches which may appear on any part of our skin including the mucosal surface. It affects around one percent of the Indian population and around half of the patients develop vitiligo before the age of 20 years.
Vitiligo although being a benign disease which is not life threatening or communicable has a huge psychosocial impact. It is said that a patch of vitiligo etches bigger on mind than it appears on the skin implying the potential effect on body image, confidence and self-esteem of the patient. Another problem with vitiligo is that it is often confused with other contagious diseases like leprosy which adds to the social stigma associated with vitiligo, which however is nothing more than a myth. In India, vitiligo holds even more relevance due to the relatively darker skin tone of Indian population as compared to the white race which makes the white lesions of vitiligo even more apparent against a darker background.
IADVL which is the largest association of dermatologists in India celebrates Vitiligo Week every year 25th June onwards to create awareness among public regarding vitiligo. IADVL plays instrumental role in dispelling myths regarding Vitiligo among masses besides organising academic events to update doctors regarding the disease.
Vitiligo is a disease surrounded by stigma and myths from centuries and people often land up in unqualified hands which exposes the patient to the risk of unscientific treatment and high doses of chemicals and drugs which may have long term implications on patient’s health. By approaching a quack, the patient often wastes the crucial time which has a direct bearing on the prognosis of the disease. It is highly advised that whenever any abnormal patch is observed by a patient , a dermatologist should be approached at the earliest since dermatologists are specialist who can correctly diagnose the disease and advise regarding appropriate management of the disease well in time.
Today Is World Vitiligo Day
Misconceptions associated with Vitiligo
1. It must be emphasized that Vitiligo is neither infectious nor communicable. It does not spread from one person to the other. Vitiligo is a disease chiefly limited to depigmentation of human skin and hair. It is absolutely safe to play, share food and items with your friend or relative having vitiligo.
2. Vitiligo does not occur by intake of any food product like fish and milk. It has no relation with intake of milk, fish or both.
3.Vitiligo has no causative relation with leprosy, however both may often be confused with each other due to similar appearance of skin patches and poor understanding of disease causation in the past. Many old books refer to vitiligo as sweta kushta or white leprosy confusing the picture further. However, it is now very clear leprosy is an infectious disease caused by an acid-fast bacillus known as mycobacterium leprae whereas vitiligo is purely a disease of non-infectious etiology.
4.It is wrongly believed that individuals suffering from vitiligo are mentally or physically subnormal. It must be known that vitiligo is purely a condition that affects the skin alone. It has no bearing on the intelligence or health of the people who are affected by it.
5.All white patches are not vitiligo. There are many conditions when the white patches appear on skin. Thus, considering the nature of the disease it is highly recommended that any white patch should be examined by a dermatologist.
6. It must be understood that vitiligo is a disease limited to skin without any direct internal organ involvement. It is not a dangerous or life-threatening problem. Though, most patients have psychological impact, excessive anxiety and depression too. The patients need adequate counselling and reassurance about the nature of disease and that the disease is essentially a cosmetic problem without serious life-threatening complications.
7. About 15-20% of vitiligo patients have one or more affected first-degree relative. This leaves 80-85% of cases which occur without any family history. You don’t need to panic even if someone from your family has vitiligo. There are high chances that u will not have the disease throughout your life.
8. Vitiligo is not related to albinism or skin cancers. Albinism is a genetic disorder, the patients born with this have no melanin. These patients have white skin all over, including hair, iris and eyebrows, since birth. On the other hand, vitiligo patients have normal skin at birth. Later in life they develop abnormal immune response towards melanocytes causing their destruction. Similarly, vitiligo has no association with skin malignancies.
9. It would be unfair to believe that vitiligo lacks a satisfactory treatment. Vitiligo is a subject of active research and evolving treatment modalities. In fact, around 70 percent of vitiligo patients can be satisfactorily managed by the currently available options and the success of treatment is dependent on early detection and treatment.
Destruction of melanocytes is central to the pathogenesis of vitiligo. Exact cause remains unknown, however various hypothesis have been put forth to explain this mechanism which include autoimmune destruction of melanocytes. Auto-immune hypothesis is the most widely accepted theory.
Others theories include the neuro-humoral, auto-cytotoxic, oxidative stress and intrinsic defects in the melanocytes.
Convergence theory: According to this theory all these factors may together contribute to the pathogenesis of Vitiligo.
Vitiligo typically presents as bright or milky-white, sharply demarcated patches of complete loss of skin colour which can be few in number or numerous mainly distributed over on sun-exposed sites and trauma prone sites, such as the hands, feet, arms, face elbows, knees etc. Also, over the face these patches are localized more so around the mouth, eyes and nose. Sometime the hair overlying these patches may be depigmented too, a phenomenon known as leukotrichia. Occasionally, lesions of vitiligo may have a raised red border known as inflammatory Vitiligo or may present as multichrome Vitiligo where zones of hypopigmentation surround the depigmented macule.
It may also present as white patches in the mucosal tissue that line the inside of your mouth and nose. It affects both the sexes equally but girls usually develop the disease early. Depending on the type of vitiligo the patches may be seen in different arrangements and configurations.
Patches may be diffusely present and bilaterally symmetrical. This is the most common type, called generalized vitiligo.
In segmental vitiligo, patches involve particular segment of body area unilaterally. This type tends to occur at a younger age, usually progresses for a year or two and then stops.
In focal vitiligo, the white patches cover only a few areas focally.
In Universal Vitiligo, the whole body or almost whole body is left depigmented with only occasional areas of normally pigmented skin left.
It’s difficult to predict how your disease will progress. The forms of vitiligo other than segmental type usually follow a protracted and an unpredictable course. Segmental vitiligo however commonly shows an early onset and rapid progression for some time followed by cessation of further progression of the patches.
Vitiligo can sometimes be associated with autoimmune diseases like thyroid disorders, pernicious anemia, type one diabetes and alopecia areata.
Because of the stigma associated with this less talked about disease there are a number of misconceptions associated and questions which need to be answered and understood clearly.
Current treatment modalities are directed towards stopping progression of the disease, and achieving regimentation and to improve the quality of life of patients
Treatment in vitiligo depends on type of vitiligo, distribution, extent of involvement, disease activity (stability / progression), psychosocial, economic status & concern of patients towards disease.
Treatment approach needs to be individualised. Combination of more than one modality is commonly used to hasten response and prevent side-effects
Medical management forms the front-line treatment with the use of drugs to control the activity of the disease and induce repigmentation. Photochemotherapy forms the backbone of medical management. Surgical and laser assisted techniques aim at re-pigmentation by grafting methods in cases of stable vitiligo and to remove the residual pigment in cases of extensive vitiligo.
Interesting work is being done in the field of targeted gene and stem cell therapy which holds promise in the future management of vitiligo. The concept of inducing resident and perilesional melanocytes and preventing using growth factors holds promise.
For the patients who still fail to achieve satisfactory results with the available options, they must not lose hope and not let the skin patch scar their mind. With this there is need of change in the public perception regarding vitiligo and its sufferers and the superstitions and stigmas associated with it needs to be shunned. (The authors are President IADVL(J&K) ,Professor & Head of Department and M.D Resident Department of Dermatology ,Govt. Medical College Jammu)
Dr. Devraj Dogra
Professor & Head
Department Of Dermatology.
Dr Mubashar Mashqoor Mir
MD resident Dermatology
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