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Dr Patrick Kamath receives the Distinguished Educator Award from the AGA

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Washington, DC (May 18, 2015) -- The American Gastroenterological Association (AGA) is pleased to recognize the 2015 Research and Recognition Award winners, who were honored this past weekend at Digestive Disease Week ® (DDW) 2015 in Washington, DC.

"AGA is thrilled to announce the 2015 honorees, who are some of the most talented, hard-working and deserving members of our professional community," said John I. Allen, MD, MBA, AGAF, president of the AGA Institute. "We are humbled to be in the company of such innovative GIs, and AGA extends our deepest appreciation to the award recipients for their hard work and commitment to advancing the fields of gastroenterology and hepatology."

Distinguished Educator Awards

The Distinguished Educator Awards acknowledge exemplary educators in the field of gastroenterology. AGA is proud to be awarding this honor to two deserving individuals.

AGA recognizes Patrick S. Kamath, MD, an esteemed educator and gastroenterologist from Mayo Clinic, Rochester, MN, with its first Distinguished Educator Award.Since 1991, Dr. Kamath has mentored more than 100 fellows who have benefited from his intelligent and thoughtful approach to teaching. His educational prowess has been recognized abroad, as Dr. Kamath has been invited to lecture in countries such as Italy, Spain, Austria, United Kingdom and Brazil and several countries in Asia; and at prestigious universities, including Brown University, Virginia Commonwealth University, Indiana University, Stanford University and Columbia University.

About the AGA Institute

The American Gastroenterological Association is the trusted voice of the GI community. Founded in 1897, the AGA has grown to include 17,000 members from around the globe who are involved in all aspects of the science, practice and advancement of gastroenterology. The AGA Institute administers the practice, research and educational programs of the organization.


Back to the BASICS .Osteoarthritis of the knees Dr Vivian D'Almeida

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Dr Vivian Roshan D'Almeida

MBBS, MS(Ortho), MRCS(Eng), MRCS(Ire), MRCPS(Glasgow)

May 18, 2015

As we grow older aches and pains are something that we expect. But for some they are rather a burden which has a bad impact on their quality of life. Arthritis affects all ages. There are more than 1000 different types of arthritis. Among these osteoarthritis is the most common. According to the World Health Organization it is one of the 10 most disabling diseases in the world affecting people of countries like India where agriculture is the main occupation. Researchers have predicted that by 2015 arthritis will be the most common problem in the country.

Osteoarthritis or osteoarthrosis also known as degenerative arthritis, is a disease of the weight bearing joints, caused mainly due to an ageing process. People beyond the age of 60 years are most commonly affected by this condition. As per global statistics 18% of women over the age of 60 suffer from this condition compared to 9.6% of men. 

Occasionally, it may occur in younger people as well, due to trauma to the joint. The hip joint, knee joint and the joints of the thumb are most prone to this disease. It is an incapacitating condition which hampers mobility of the patients thus leading to a non productive life.

Osteoarthritis should not be confused with other forms of arthritis like rheumatoid arthritis (VAATA), psoriatic arthritis and gouty arthritis. The latter conditions are caused by inflammation of the joints, unlike osteoarthritis which is a progressive mechanical joint disease associated with old age. This differentiation is very important as the treatment of these conditions is very different.

Osteoarthritis is of two types:

Primary: There is no exact cause for this. It is seen in older age groups and in weight bearing joints like the hip and knee. Usually joints of both sides are affected, one side more than the other. Obesity is a predisposing factor. There is no hereditary preponderance. People involved in heavy labour are mainly affected.

Secondary: Due to a predisposing factor like trauma, fractures or infection of the joint. Usually one joint is involved and it occurs at a relatively younger age, when compared to primary osteoarthritis.

Pathology: Normally all weight bearing joints consist of bones which are covered with articulate cartilage. This cartilage is healthy in younger people and not sensitive to pain. It's basic function is to protect the underlying pain sensitive bones from coming into contact with each other, something like " a cushion between the joints ".

Osteoarthritis is a disease which causes this cartilage (cushion) to wear off, thus exposing the bony surfaces which rub against each other producing pain.


Pain is the most important symptom. In the early stages pain typically occurs following weight bearing and on walking for a long time. It's more severe while climbing stairs or squatting. It is typically relieved by rest and pain killers.

However in the later and severe stages the pain worsens, thus hampering the movement of the patient. In most severe cases pain is present even at rest.

Pain can also referred to the neighboring joints.
Eg: osteoarthritis of the hip can present as knee pain.

Restriction of mobility: It occurs due to pain and stiffness. Initially the person might not be able to walk long distances, but as severity increases he might not be able to move around, even well within his home. The range of movement of the joint also reduces gradually.

Crepitus: The patient usually complains of "click" like sound on moving the joint which is due to the "loose bodies " formed within the joint due to the disease process.

Swelling and redness: This might occur occasionally. But is not as severe as the swelling that occurs in other forms of inflammatory arthritis.


X rays are the gold standard to diagnose this condition. The X rays are usually taken in the standing position, from the front and sides.

Normal X ray
X ray with osteoarthritis

A. Showing decreased space between the bones showing wear and tear of the joint
C. Loose bodies

MRI might be occasionally required to see the condition of the cartilage.


"Prevention is the best cure" is a common saying and is true to this condition as well. However one must understand that the process of the joints wearing off is a normal age related process and it cannot be completely avoided. However the extent to which the joint wears off can definitely be controlled.

The following measures would help to protect our joints:

1) Weight reduction: Obesity being an important factor contributing to this disease, weight reduction becomes paramount in avoiding this condition. Though conditions like diabetes and binge eating have no direct bearing on this condition, as they predispose to weight gain, they must be controlled.

2) Activity modification: Activities like climbing and getting down stairs, sitting cross legged, squatting should be avoided whenever possible. Western toilets should be preferred. Walking and jogging should be done using soft footwear and on jogging tracks whenever possible. While jogging, Concrete surfaces should be avoided.

3) Exercises: These are prescribed so that the muscles of the limb become strong so as to reduce the workload on the joints. Light exercises like yoga and swimming are preferred.


There are no medications to reverse the damage that has already occurred in the joint. However medications do help in reducing pain and protecting the joint from wearing off further, to a certain extent.

1) Pain killers: These are prescribed in acute painful episodes. They provide immediate pain relief. However their action is temporary and long term continuous usage is discouraged as they can cause kidney damage and acidity problems.

2) Drugs to protect the cartilage: They help to prevent disease progression.
Commonly used drugs that protect the cartilage are diacerin, glucosamine, pro, collagen peptides.

3) Injections into the joint: Hyaluronate injections into the joint are advised in mild to moderate cases, which improve the lubrication within the joint. These injections are given once a week for 3-5 weeks, depending on the severity. There is a yearly injection available as well, which is expensive.

Surgical treatment: In moderate to severe conditions where the patient depends on pain killers on a regular basis to relieve the pain surgery is indicated.

1) Arthroscopy and debridement: This is done in moderate cases. This is a key hole surgery, where very small surgical wounds are made over the knee. Joint is washed thoroughly with surgical fluid. Following surgery, patient has considerable relief from pain. However it provides temporary relief, usually lasting for around 4-6 months.This surgery is relatively inexpensive and minimally invasive.

2) Osteotomy: This is a protective surgery that is done in mild to moderate cases, in order to prevent the condition from progressing. This is a bone surgery in which the bone us straightened and is fixed with a "plate". The patient needs to walk with a crutch without bearing weight on the operated limb, for 6 weeks following surgery.

3) Total knee replacement: This is done in advanced cases. Following this surgery the patient would have significant pain relief and a reasonably good range of joint movement. The patient can walk around independently. However squatting is discouraged following this surgery, as it would damage the implant. The patient requires physiotherapy and exercises for 4-6 weeks following surgery to attain the best possible result.

With the advances in the field of medicine, life expectancy has improved. Hence many people around the world will continue to develop age related arthritis. Preventive measures are well worth taking. A regular check up and early specialized treatment would go a long way in improving ones quality of life.



Dr Lloyd Vincent awarded a gold medal for presenting a preventive strategy for renal care in India

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Dr Lloyd Vincent  awarded a gold medal for presenting a preventive strategy for renal care in India under "Make in India" program.

He made the presentation to 22 judges from the various organizations on May 12th 2015 in Delhi.To read more click on the link below


The team that helped out in the Nepal earthquake 2015

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May 2nd 2015
Two teams of our volunteers from St Johns Medical College Bangalore depart to Nepal tomorrow to provide medical relief in needy rural areas affected by the earthquake.

They will work in conjunction with 2 partner agencies... Emmanuel Hospital Association and Catholic Hospital Association of India. All the Best Dr Dwayne Mascarenhas,Dr William Wilson Dr Dharamveer Tatwavedi, Dr Frederico Miranda and Dr Aditya... God bless the members of this team... Do keep them in your prayers for their safety and good work!

dated 7th May 2015; 7.30 pm Dwayne Mascarenhas

Sitting on top of a hill in dapcha 75kms south west from katmandu.. tis place has been affected quite severely from t earthquake.. 4 nuns nd me r working from t phc , an old rickety building. Most of t place has No power wid intermittent water supply.. sleeping in a tent wid sleeping bags.. in two day camp seen 448 patients..
Yday v had an aftershock of 4.5 few trauma cases today wid suturing nd dressing.
Been a really humbling experience surviving on basic amenities.. away from r usual " luxurious " lives..
From morrow outreach centers.. 4-18kms away...
NEWS FROM Dwayne Mascarenhas....
"Was supposed to leave with a local team today. .. But the district has anti Indian sentiments. .. so we got left behind. .. Spent the day getting medical supplies . ... sorting out medicines. .. packing it all up for the next camp. .. Tom we heading out. .. into dholaka district. ...6 day camp covering 4-5 different areas. .... trekking, sleeping bags, tents and biscuits. .. Last night to enjoy civilization today...."The last three days were freaking awesome. ... teamed up with docs from an international relief organization called samaritan's purse.... went to a place 150kms away.... 11hrs journey... which included 28kms of bus ride on a river bed.... Houses in the wilderness. ....stayed in tents.... slept in sleeping bags. .. woke up at 5am... saw 260patients from all over (some whod walked 3hrs to get to us....) absolutely amazing experience... just got back to kathmandu.... Now gonna find out what our next 3day trip has in store for us..
May 12 2015
Our teams in Nepal are safe post today's earthquake.... Thank God for it... Take care fellas.... Dwayne Mascarenhas, William Wilson, Adithya Suresh,Frederico Miranda and Dharamveer Tatwavedi.... Hope to see you all home soon... Keep up the good work... The entire Johnite family is proud of your relief efforts...
May 14th 2015
Final update on teams in Nepal...They finally reached Katamandu at 4 am today and are currently at the airport..
Waiting to catch their flight to Delhi in an hours time... God Bless you
Dwayne Mascarenhas, William Wilson, Adithya Suresh, Frederico Mirandaand Dharamveer Tatwavedi.... Waiting to see you all back in St John's... Proud of you all!!!

Diary From Dharamveer Tatwavedi

Nepal Diaries: Day 10- A day after the earthquake, we had a choice to make. Either stay stranded and play victims or be the doctors we were sent out to be. And the real credit lies with two of my seniors on the team: Dr. Dwayne and Dr. Adithya Suresh for choosing the later. With all roads blocked by the landslides, we decided that we would trek out with a small team to provide medical relief as we pass villages on our way. A team of 12- three doctors, five nurses and four volunteers set out by foot on a 18 km trek with 25 kgs of medical supplies on our back, treating victims on the way. Bandaging abrasions to reducing shoulder dislocations. Sometimes we had to trek up hills, sometimes cross rivers on fragile bridges. And at other times we saw ghost towns completely deserted by its people. Rescue Choppers from the UN office failed to find our location . So we walked on. Finally having reached a place with road access, we took a bus to Kathmandu and then a plane the next day to Bangalore. 

In my Last post on Nepal, I would mention my heroes I got to work with - Dr Dwayne and Dr Adithya Suresh. They have been my teachers, friends and most importantly equals. Not one patient goes back without treatment, on their watch. Always willing to work and always selfless while they work.

From Dharamveer Tatawedi. Nepal Diaries: Day 8&9: Its 12.35 pm Nepal time. Had just helped seeing about 100 patients in Malukhola village in Dolakha District and had broken for lunch. Malukhola village is a little sleepy place sitting quietly between mountains on one side and a raging river on the other. Just when I was about to start eating, I heard a rumble. What followed was madness. The earth beneath our feet shook like in a short tempered youth's violent rage. We ran for our lives. And just when I looked back to see if I had left something behind, I saw the walls of our hotel collapse. Tears of fear and helplessness all around. Look around the village and what were homes just 15 seconds ago, were now piles of ruble. Just then someone reminds us that the river on the other side had its source in a glacier called Tsho Rolpa. It is a natural dam held in place by a fragile ice wall. And the after shocks that would follow would be strong enough to cause it to fall and flood the village. Move up and you would be crushed by rolling stones from the landslides. Stay low and be drowned by the floods. We decided to pitch our tents in a place that seemed safe enough, just hoping to wake up alive the next morning. Just then we heard of an old couple who were living uphill whose house had collapsed and had nothing to eat for the night. It is then that a few of us from the team trekked up for 30 minutes in the pitch darkness of the night to meet the couple with tents and and food to eat. I have never met humanity as face to face as I did then. An elderly couple who had just lost everything, actually offered us tea as a token of their gratefulness. Kindness in the face of adversity was just humbling. News trickled in later that it was an earthquake measuring 7.3 on the richter scale whose epicentre was 60kms away from the town we were in. 76 people had died and 2000 injured. No way to go back home as all roads leading to Kathmandu were blocked by huge chunks of stones. In short, we were stranded.


























The passing away of Dr Stanley Williams

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Dear all

Stanley Williams ....GENTLE STRONG STANLEY of batch 1972 has passed away a few hours back

.He was battling pancreatic carcinoma with liver mets for the past 3 months.

He has represented college in Shotput & discus at University level. One of his records still stands Good.

He leaves behind his wife Beena & two daughters .May his soul Rest in Peace.

Stanley practiced cardiology  In Florida

May God give his family the strength to bear this great loss. We miss you dear Stan

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