The Tribune, Chandigarh, India

Mulayam’s ‘mantra’
Keep distance from Cong to win polls

Samajwadi Party (SP) supremo Mulayam Singh Yadav found an appropriate opportunity during the national executive meeting of his party in Kolkata to hit hard at the Congress to improve the SP’s poll prospects in UP and elsewhere. He provided proof of his not being bothered about the outside support the SP gives to the Congress-led UPA government when he said, “First it was the 2G spectrum allocation scam, then came the coal block allotment issue.

There is not a single scam that has been reported during UPA-II rule in which the Congress has not been involved.” He also came down heavily on the Congress for protecting the “tainted faces” rather than “delivering on governance”. Obviously, the SP appears to be not interested in having any truck with the Congress in the 2014 elections.

Mulayam Singh knows better than anybody else that what were once the Congress vote banks in UP, Bihar and other Hindi-speaking states have been captured by caste-based parties like the SP, the BSP of Mayawati, the Rashtriya Janata Dal of Laloo Prasad Yadav and the Janata Dal (United) of Nitish Kumar. For any of these parties to have any electoral arrangement with the Congress amounts to weakening its support base. These parties can afford to have a post-poll tie-up with the Congress, but not any pre-election alliance.

Though Mulayam Singh talked of a third front at the Kolkata meeting of his party, his real objective is something else. His party should emerge so strong after the 2014 parliamentary elections that it remains in the reckoning irrespective of which alliance comes to form a government in the national Capital. His poll strategy is based on the thinking that the SP should be in a position to play the role of the king-maker in Delhi. Of course, this is the maximum that Mulayam Singh can aspire for at this stage as his party’s main battle ground remains UP, where it has captured power. The significance of caste-based parties has increased considerably in this era of coalition politics. But this is not in the long-term interest of the country as the kind of politics these parties indulge in will continue to add to social tensions.

Drug menace
Need for cooperation and diligence

The inflow of narcotics in the border areas of India, especially in the west, is a major cause for concern. The states of Punjab, Haryana and Rajasthan are all affected by narcotics that manage to find their way to consumers.

The police has not been able to stem the flow of banned substances till now, and it is, indeed, a positive step that the police forces of these three states have got together to coordinate their efforts and share information with each other in a bid to gain the upper hand over drug traffickers. The officers have also identified sensitive points which need to be monitored and to set up a mechanism that will allow such police forces of the affected districts to effectively communicate with each other.

The renewed thrust on combating drugs comes at a time when Punjab has become a major consumer of drugs, and not merely a transit point. Drugs worth hundreds of crores of rupees are confiscated each year, and the ravage caused by the widespread availability of drugs can be seen in too many families, both in rural and urban areas. The cat-and-mouse game between policemen and smugglers goes on and thousands of lives are ruined because of consumption of drugs in the state.

While meetings between police officers of different states can help sort out administrative and other issues that crop up in combating drug smuggling, ultimately it is the political will that can empower civil administrators and police officers to take the necessary action. More so, since there have always been murmurs of a nexus between drug smugglers and political leaders. The land of milk and honey cannot be allowed to turn into a place where heroin, opium and poppy husk become staples. Drugs are a threat that needs to be combated, and while this coordination is a good move, it is just one of a series of measures that needs to be taken to fight the menace.

Thought for the Day

If you only have a hammer, you tend to see every problem as a nail. — Abraham Maslow

ARTICLE

Worsening multiple threats
Communal, naxal and other dangers
by Inder Malhotra

WHETER or not they lead to any improvement in the ground situation, annual meetings of state police chiefs and heads of Central paramilitary organisations have their uses. The latest one, for instance, enabled Prime Minister Manmohan Singh to focus the country’s attention on the clear and worrisome increase in its vulnerabilities to multiple threats.

Appropriately, he put on the top of the “danger list” the “erosion in inter-community relations”, especially in Uttar Pradesh, Madhya Pradesh, Maharashtra, Karnataka and Kerala, as witnessed soon after the riots in Assam between the Bodos and non-Bodos (mostly Muslims). For this he blamed the “decline in the capabilities of general and police administration”. What he did not say but should be added is the chilling factor that even after the virulent violence in Mumbai by Muslim mobs, obviously incited to a high pitch of anger, the police of that metropolis was under the impression that the protest was against only the “killings” of their co-religionists in Kokrajhar. It took them more time to discover that the protesters were more enraged by the “massacre of Muslims in Myanmar (Burma)” than what had happened in Assam.

Only then did the penny drop. The authorities realised that what had inflamed the Muslim minority to such a high pitch was a spate of text messages and morphed videos on the social media. By this time tens of thousands of doctored SMSes had caused an exodus of Northeastern people living in southern cities and Mumbai-like riots were replicated in Lucknow and Allahabad.

No wonder then that the Prime Minister has expressed deep concern over this “new factor” that is aggravating an already trying situation. He has, therefore, urged police chiefs to “reorient their forces effectively to track the sentiments of the people and inter-community tensions as they arise”, and to “devise strategies to counter the propaganda carried out by these new means (network of social media)”.

Dr Singh has added that any measures to “control the use of such media must be weighed against the right to express and communicate”. Noble sentiment this, but easier said than done. For one thing, the technological upgrade of the police forces that P. Chidambaram, as Union Home Minister, had started is still a work in progress. Many fear that with his return to the Finance Ministry, the momentum behind the move might be lost. For another, going by the present rate of progress and the fact that law and order is a state subject and the states and the Centre are not always on the same wavelength, strategies to combat the state-of-the-art technologies behind the social media would be hard to devise.

Most importantly, can one be sure whether those assigned the task to “control” the misuse of the social media would act justly? The mess over the arrest of a 25-year-old cartoonist - Justice Markanday Katju has condemned it as “illegal” - could, alas, be the foretaste of the shape of things to come.

A discussion on the “inter-community relations and tensions” cannot be complete without an appeal to both the Congress and the BJP to abandon the kind of politics they are playing over the communal question. What senior Congress leaders, especially Digvijay Singh and even Law Minister Salman Khurshid, have been saying and doing is as wrong as the saffron party’s extravagant attack on the ruling party for “appeasing” the minority for the sake of its vote. Rajiv Gandhi’s attempt to play both sides of the street - first over the Shahbano case and then over “shila nayas” at Ayodhya - had proved disastrous. To repeat it now would be catastrophic.

Nor can a very sensitive aspect of the complex “inter-community” issue be overlooked or brushed under the carpet. The activities of the Indian Mujahideen and SIMI have bred suspicions, as have the arrests of 18 suspected terrorists (all Indians and all educated) at Bangalore and elsewhere. The other side of the same coin is best underscored by the Supreme Court’s recent judgment confirming the death sentence of Kasab. The country has rightly applauded it. But few have taken note that the same judgment has acquitted the two Indian Muslims accused along with him. They should have been released when the trial court had held them innocent. But they were made to languish in prison needlessly.

From day one the Prime Minister has been emphasising that “Left-wing extremism”, his euphemism for Naxalites, is the “biggest internal security threat” to India. But at the end of eight years what is his verdict on this threat? “Maoists,” he says, “are gradually increasing their numbers and enhancing their military potential”. Everybody seems to know the anti-dote to the Maoist menace: Ensure justice to the long-oppressed and suppressed tribal population and win their goodwill and cooperation; at the same time hit hard those avowedly trying to overthrow the lawfully elected government by force. Unfortunately, nothing has been done.

Sadly, the media hasn’t taken adequate notice of something very disturbing that Dr Singh revealed: The “vulnerability” of the sea route that terrorists can use persists. This should be no surprise. For, the last time there was a series of bomb blasts in Mumbai a newspaper had published the photograph of the six patrol boats bought after 26/11to protect the seashore. One was half-submerged in water upside down. Of the others, as reported then, only two were being used for no more than two hours a day. Why, in heaven’s name? Because there was an endless dispute over who would pay the fuel bill, the state government or the Coast Guards!

Finally, the bottom line is that it is futile to expect the efficiency and efficacy of the Indian police to increase as long as it continues to be so disgracefully politicised as it has been for at least the last five decades. After a decade-long Herculean struggle, some brave souls secured firm directives for the apex court on police reforms some four years ago. If these were implemented the Indian police would have ceased to be the servant of whichever political party is in power and become, as it should be, servant of the law. The states have simply refused. The Centre shrugs its shoulders helplessly. Why does it not make a beginning with Union territories?

MIDDLE

The ‘Sahab’ of Subathu
by Madan Gupta Spatu

When I came across an article “One man, many passions” by Shaista Siraj-ud-Din, tracing the history of Indian hockey team in Los Angeles and Berlin in 1932 led by Prof GD Sondhi, the first Indian Principal of prestigious Government College, Lahore, I became very nostalgic. I was reminded of my childhood days.

Our country will participate in the prestigious Sondhi Debates Challenge Cup 2012 to be held in Lahore from September 14 to 17.

I have fond memories of Professor Sondhi who coined the idea of the Asian Games Federation at the 1948 London Olympics to organise the Asian Games every four years which fructified in 1953.

After Partition, in 1948, he made my native place Subathu (Simla Hills) his permanent abode and continuously worked from his cottage till he breathed his last here in January 1967. Indira Gandhi was a frequent visitor with her children to his cottage in Subathu between 1950 and 1960. I remember the days when Indira Gandhi would visit our shop with Mrs Sondhi and her two daughters.

Sondhi Sahab, as he was addressed in our town, besides having interest in sports, gardening, art and culture, had a passion for theatre and he got built one in Lawrence Gardens in Lahore. In Subathu, too, he got a mini open air theatre (OAT) built on the premises of Government Higher Secondary School in 1961. I happened to participate in a play based on Chinese aggression in 1962 and Sondhi Sahab used to come in our rehearsals and would guide us in acting with the late Shastri Dharni Dhar. He would share with us how IS Johar and Balraj Sahni would prepare their dramas in Government College, Lahore, under his guidance.

A famous theatre personality, Alkazi, also used to be his guest in Subathu. He would show us slides of gardens of Japan, games, dramas and debates in our school with his typical running commentary. He shuttled between Delhi and Subathu in a very small white car, perhaps Austin, and we would gather to look at the lone vehicle in hills.

I started my theatrical performances from Sondhi’s OAT and was made a judge too to select the best play during the drama competitions of schools at the state level in the 70’s. Another moment came to my mind when I appeared in an interview for an administrative service in 1970. The chairman of the commission, when he saw in my biodata the place I belong to, the first question he fired was , “Do you know Mr GD Sondhi? For which trait he is known for ?”

Later he confided in me that he was his student at Government College, Lahore. So, Sondhi and Subathu became synonymous. He was a very good architect also and remained a keen observer of buildings being constructed. His name got closely associated with construction activity. Today anyone who takes considerable interest in the construction of buildings is satirically called Sondhi Sahab in this town.

Sondhi Sahab was a very good example of communal harmony. He was a Hindu, married a Christian and their daughters went to Muslim families.

In Subathu, all we could do after his death was to name a road leading to his Bamboo Lodge as “Sondhi Road” — that too is not in a good condition. Unfortunately, neither the central government nor the media mentioned the contributions of the Father of the Asian Games during the inauguration of the last Asian Games. His cottage in Subathu should be converted into a museum to portray the contributions of Sondhi Sahab.

OPED HEALTH

When hormones go awry
The incidence of polycystic ovary syndrome is rising in preteens and adolescent girls. The syndrome is linked to changes in the level of certain hormones brought about by rising obesity rates, lack of physical activity, anxiety, erratic food habits and sleep patterns
Dr Umesh Jindal

The “Plus II syndrome”, is a term, which refers to the modern lifestyle of teenage girls studying in plus one and plus two classes. They are busy from 5 a.m. to 10 p.m. every day in attending school and tuitions. The time at home is utilised in preparing for home work and tests. Whatever “free” time they get, is spent in midnight chatting, socialising on social networking sites.

Sleep is the main thing that is sacrificed; sleeping at odd hours i.e. past midnight becomes a norm. Meals are generally consumed from cold-packed tiffins or canteens and fast food joints. Chocolates and cold drinks comprise their energy sources for survival. They are often more tense than the adults because of pressures to compete and excel.

The lack of physical activity, presence of anxiety and tension, irregular and erratic food habits and sleep patterns frequently lead to an excess of body weight and obesity. An estimated 50-80 per cent of these obese girls develop irregular menstrual cycles, excessive hair growth and acne/pimples. These are the classic symptoms of the polycystic ovary syndrome (PCOS) in this age group.

The growing rate of PCOS is related to the epidemic of obesity. In a survey conducted in schoolchildren in Delhi, 32 per cent were found to be obese. Out of these, 80 per cent were girls showing signs of PCOS. PCOS is the most common endocrine disorder of women.

There is no accurate data available from Indian population; this may range from 2.8 per cent to as high as 26 per cent, commonly believed to be 7-10 per cent. In a recent survey in South India, the incidence was 9.13 per cent. PCOS is responsible for approximately 20 per cent of all infertility and for 40 per cent cases of abnormal hair growth in women (hirsutism).

Puberty is the transitional period between the immaturity of childhood and maturity of adulthood. Early changes in breast, pubic and axillary hair can be seen as early as 7-8 years of age. Pubertal period ranges from 8 years and completes at 16-18 years. Significant biochemical and hormonal changes occur at puberty which form the background of physical and physiological transformation of an immature baby girl into an adolescent and thereafter to a mature woman. Some of these changes, which are influenced by genetic and environmental factors, lead to the development of PCOS in adult life.

Symptoms

PCOS is a heterogeneous disorder of women of reproductive age. Characterised by irregular or absent menses and dominance of male hormones (androgens) over the female hormones is called hyperandrogenism. PCO is a conglomeration of symptoms. PCOS has multiple potential underlying causes and aggravating factors and variable clinical presentation. The current definition of PCOS is based on the Rotterdam Consensus meeting of the “European Society of Human Reproduction and Embryology” and the “American Society of Assisted Reproduction” on PCOS in 2003. It defines the syndrome of PCOS as the presence of any two of the following three criteria:

Ultrasound appearance of polycystic ovaries

Menstrual irregularity

Excess of male hormones

Ultrasound appearance of polycystic ovaries: Polycystic ovary is a misnomer, causing a lot of unnecessary anxiety. Many girls, their parents and even doctors think that this is a tumour-like growth, and may need surgery. Many are scared of even cancerous change. In fact, it refers to only an ultrasound appearance. These are clusters of fluid-filled, bubble-like structures. These are the normal eggs containing follicles which keep on developing and disappearing all the time. In PCOS, there are more number of these cysts as compared to that in a normal ovary.

Irregular menses: Menses are generally irregular, infrequent or even absent. Sometimes, when menses occur after a long gap, the bleeding can be quite heavy or even very light.

Excess of male hormones: The presence of excessive amount of male hormone may cause severe acne and excessive hair growth. Symptoms may include: Body hair growing on the chest, belly, face, and around the nipples, decreased breast size, thinning of the hair on the head, called male-pattern baldness, voice gets deeper.

There are many skin changes like acne that gets worse or dark or thick skin markings and creases around the armpits, groin, neck, and breasts.

The long-term risks of PCOS include infertility, sub-fertility, diabetes, hypertension, heart disease, high cholesterol, weight gain and obesity and endometrial cancer.

Increasing incidence

The main question is why this incidence is increasing. Can PCOD be treated or prevented?

To answer the question, we have to look into some of the developmental changes which occur in a girl from her birth to complete maturation of the reproductive system. We also need to understand the points where this process is vulnerable. Deviation from normal can lead to the development of PCOS.

Multiple factors and triggers have been identified. PCOS has been described to have a “two-hit” disease evolution. The first hit factors decide the predisposition of an individual girl and second hit factors decide the eventual development of the clinical picture.

First Hit factors

Genetic: There is a strong evidence of contribution of genetic factors. Daughter of mothers affected with PCOS have a higher chance of developing PCOS. However, no single gene has been identified. There are multiple genes which are involved at many different stages of hormone production and affect the development of the reproductive system. Still these genes need to be supported by second hit factors to be able to result in PCOS i.e. the “switch on or off” of genes theory.

Parental genetic makeup: Besides this, problems like diabetes and obesity during pregnancy also influence the expression of genes of the baby, during intrauterine life, since there is a direct result of hormonal and biochemical environment on the baby. The baby’s organs like pancreas, body fat and genital organs all respond to high sugar or insulin levels secreted because of high-fat levels in mother’s body. Insulin is the hormone which converts sugar into energy.

Substances bio-similar to male hormones: Exposure to medicines, environmental toxins etc. which have male hormone bio-similar properties, can disturb the precarious and immature hormonal system of the developing baby girl. Maternal obesity itself creates a strong androgenic environment. There is strong scientific evidence which is emerging in support of in-utero genesis of adult diseases for PCOS.

Low-birth weight and catch-up growth: Low-birth weight babies have a tendency to catch-up growth and store fat. It is not uncommon to see a small thin infant girl to get obese near puberty. She is also often pampered and overfed by the parents. Higher secretion of insulin to compensate high utilisation of whatever is eaten, leads to development of resistance to the action of insulin which again leads to higher secretion of insulin. This insulin resistance has a direct effect on ovaries and obesity.

High-birth weight and continued obesity: High-birth weight babies have a higher body mass and fat. They need increased insulin production to meet their requirement. Higher levels of insulin cause resistance to insulin and development of PCOS.

Second Hit factors

Late childhood and adolescent obesity: It switches on the genes responsible for the development of PCOS through increased insulin secretion and development of insulin resistance. Maintenance of balanced diet, good playing habits, active lifestyle and optimal weight during the preteen years can perhaps keep these genes in off mode.

Sedentary lifestyle: Physical activity counters the effects of increased insulin and helps in maintaining the balance. Lack of physical activity in girls with sedentary lifestyle increases the development of insulin resistance.

Stress, anxiety and depression: These are also responsible for modifying hormonal secretion. The master hormone gland, pituitary gland, controls all hormone producing glands. It is located in brain and is influenced by all types of emotional signals as well as the sleep pattern.

Food and nutritional deprivation: Even lean and thin girls who are deprived of essential nutrients and calories may secrete more insulin and develop PCOS. This explains the development of PCOS in thin girls.

Exaggerated physiological changes: In some girls there are exaggerated changes in thyroid and pancreas in response to growth and changing environment. This may contribute to development of PCOS.

The individual needs to accept the challenge and face the problem with courage than with stress and depression.

Disease management
The management of PCOS remains a challenge. Unfortunately, the PCO disease, which has developed once, can’t be reversed by any drug. However, with symptomatic management, the body functions, including menstrual problems and infertility can be satisfactorily treated.
Weight gain and obesity is common in women with PCOS. Losing weight can help treat the hormone changes and health conditions such as diabetes, high blood pressure, or high cholesterol.
Losing just 5 per cent of your body weight can help your hormone imbalance.
Plenty of water, fresh and low-sugar fruits, green vegetables and high-fibre diet constitute the ‘mantra’ of any weight-loss programme. A slow and steady decrease of 3 to 4 kg a month will correct the hormonal milieu and set the “hormonal control axis” in order. The weight loss will not only cure the symptoms of PCOS but also boost the confidence of a teenager. Maintenance of optimal body weight at BMI (body mass index) of 20-23 is essential to avoid all short and long-term complications.
Your doctor may recommend birth control pills to make the periods more regular. Such medicines may also help reduce abnormal hair growth after you take them for a few months.
A diabetes medicine called glucophage (metformin) may also be recommended.

—The writer is a Chandigarh-based gynaecologist