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A team of Indian-origin doctors in the US has found that a drug widely prescribed for a bladder condition for decades globally, now appears to be toxic to the retina.
After an initial report last year that Elmiron (pentosan polysulfate sodium) may be associated with retinal damage, three ophthalmologists conducted a review of patients at Kaiser Permanente in northern California.
They found that about one-quarter of patients with significant exposure to Elmiron showed definite signs of eye damage.
This medication toxicity could masquerade as other known retinal conditions, such as age-related macular degeneration or pattern dystrophy.
“It’s unfortunate. You have a patient with a chronic condition like interstitial cystitis, for which there is no cure and no effective treatment.
“They get put on these medications because it’s thought to have few side effects and few risks, and no one thinks about it again. And year after year, the number of pills they’re taking goes up and up,” said Robin A. Vora from Kaiser Permanente.
Interstitial cystitis causes chronic pain in the bladder and pelvis area.
Elmiron is the only FDA-approved pill to treat it and is being prescribed in India too for years.
As a mainstay of treatment for decades, hundreds of thousands of people have likely been exposed to the drug.
Last year, Nieraj Jain of Emory Eye Center in Atlanta, Georgia, reported that six patients who had been taking Elmiron for about 15 years had developed unusual changes in their macula, the central part of the retina responsible for delivering clear, crisp, central vision.
Dr. Jain and his colleagues raised a warning flag that long-term use of Elmiron may damage the retina.
Vora, Amar P. Patel, and Ronald Melles, ophthalmologists at Kaiser Permanente, heeded that warning and looked at their database of patients.
They found 140 patients who had taken an average of 5,000 pills each over the course of 15 years.
Of those 140 patients, 91 agreed to come in for an exam.
The doctors took detailed images of the back of their eyes.
Twenty-two of the 91 patients showed clear signs of drug toxicity.
The rate of toxicity rose with the amount of drug consumed, from 11 per cent of those taking 500 to 1,000 grams to 42 per cent of those taking 1,500 grams or more.
Because it’s unclear how much medication is too much, Dr Vora recommended patients who show no signs of toxicity be screened for retina damage at least once a year.
For those who do show some signs of damage, he recommended that they speak with their urologists about discontinuing the medication.
If identified early, the damage may be mitigated by stopping the medication, the doctors said.
The research was presented on Saturday at “AAO 2019”, the annual meeting of the American Academy of Ophthalmology at Moscone Center in San Francisco. (IANS)
Tenali Ramakrishna, or Tenali Raman as he is more popularly known is Birbal's equivalent in South India. A court jester and a scholar exuding great wisdom, Tenali Raman was known as one of the greatest courtiers in King Krishnadevaraya's court.
The Vijayanagar Empire ruled a large part of South India between 1336 and 1646. In the 16th century, the kingdom rose to prominence under the eminent leadership of King Krishnadevaraya. His continuous victories against his enemies ensured a successful and peaceful reign for his subjects. As a patron of art and literature, many crafts and cultural assets thrived in the empire.
Krishnadevaraya's beloved courtier, Tenali Raman is the finest example of the splendour of the Vijayanagar empire. He was born in Tenali, a town in Andhra Pradesh. He lived here until he lost his father, after which his mother brought him to Vijayanagar. He was discovered for his excellent wit and wisdom, and appointed in the court. He was one of the king's ashtadiggajas (collective name for the eight poets and scholars).
A statue of Tenali Ramakrishna near a Municipal Office in Andhra Pradesh Image source: wikimedia commons
Tenali Raman as a scholar, published great texts of wisdom, which have now become artefacts of the Kingdom of Vijayanagara. But his fame does not lie in these achievements. He is known for the mischievous jester that mythical folklore portrays him to be. Through stories, many writers have used jokes to impart wisdom and morals to many generations of people. The stories of Tenali Raman are almost legendary in the Southern peninsula.
Textbooks have been written with his moral stories in mind, and these days, many self-help book are also incorporating his wisdom. His most popular stories are, 'Mother Tongue', 'Cursed Face', 'Saluting the Donkeys' and many more. Through these stories, Tenali Raman, in some way, brought about social justice. Perhaps this is why he is most beloved by many people even today.
Keywords: Tenali Raman, Vijayanagar empire, Krishnadevaraya, Jester, Wisdom
It must be noted that different religions and societies in Southeast Asia have alternative narratives of Ramayana, one of the greatest epic.
Here are some of the versions of Ramayana!
Dasaratha Jakarta: The Buddhist Version
Interestingly, this version of Ramayana does not mention Ravana at all and in fact, there’s no mention of Sita’s abduction, too. In this version, Dasaratha is the king of Benaras and not Ayodhya. Also, Rama and Sita leaves kingdom and go to the Himalayas and not forests. Then, after twelve years, Rama and Sita return back to Benaras and get married.
Paumachariya: The Jaina Version
In this version, Lakshamana is the killer of Ravana and not Rama. Here, Rama is an ardent follower of Jainism, and so he cannot be the killer of Ravana. Also, this version states an army of warrior and not monkeys, as stated in Valmiki’s Ramayana. Another interesting feature of this version is that Ramayana is not shown as a villain, rather a magnanimous king and follower of Jainism.
Gond Ramayani: The Gond Version
Gond is an adivasi clan belonging from Madhya Pradesh in India. Interestingly, in this version, the story begins from where Valmiki’s Ramayana ended; when Sita is rescued from captivity. Also, Bhima, one of the Pandavas from the epic of Mahabharata, is mentioned in this version. Unlike Valmiki’s Ramayana, Rama is not the protagonist in this version.
Ramakien: The Thai Version
This is considered as Thailand's national epic, and is still taught in some schools in the country. In this version, Ravana is shown as a learned scholar and a noble king in this version. Also, Ravana’s pursuit for Sita is depicted as true love. There are a lot of similarities between this version of Ramayana and Valmiki’s version, but this version lays a lot of emphasis on Hanuman.
When a baby is born in an Indian household-they invite hijra to shower the newborn with their blessings for their blessings confer fertility, prosperity, and long life on the child. But when that child grows up we teach them to avert their eyes when a group of hijras passes by, we pass on the behaviour of treating hijras as lesser humans to our children. Whenever a child raises a question related to gender identity or sexuality they are shushed down. We're taught to believe that anything "deviant" and outside of traditional cis-heteronormativity is something to be ashamed of. This mentality raises anxious, scared queer adults who're ashamed of their own identity, and adults who bully people for "queer behaviour".
Hijras are a community of people who include eunuchs, intersex, and transgender people. They worship the Hindu goddess of chastity and fertility, Bahuchara Mata. Most hijras, but not all, choose to undergo a castration ceremony known as "nirvana" in which they remove their male genitalia as an offering to their goddess. The whole community is vibrant with hundreds of people with hundreds of ways of expression, the true identity of a hijra is complex and unique to each individual. In India, hijras prefer to refer to themselves as Kinner/Kinnar as it means the mythological beings who excel at singing and dancing.
Hijras worship the Hindu goddess of chastity and fertility, Bahuchara Mata.homegrown.co.in
The hijra community works systematically, the community separates itself from the outside world and teaches lessons to the young ones in secret. Each community has a guru and the other hijras are their disciples or chela. The "hijra ways of life" are taught to the disciples in a secluded environment where they leave their families and live with other hijras in the community. More often than not hijras are thought of as nothing different from transgender and often referred to as transgender; however, scientifically these two terms denote a different class of people. Hijras are a part of the whole community of people with various identities and of spiritual and cultural values meanwhile, transgender merely refers to those people whose gender identity differs from the sex assigned to them at birth, they are a part of the community and do not represent the whole community.
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Historically and culturally the community has existed in the Indian subcontinent as long as the civilization has existed. There are mentions of hijra in The Mahabharata, a holy book of Hindus. Shikhandi who was neither male nor female is a mythological legend. In another version of Mahabharata Arjuna, one of the Pandavas was cursed to be the third gender by Urvashi, when he refused to be sexually involved with her. In a story by Padma Purana, it is seen that Arjuna transforms into a woman to take part in Krishna's mystical dance which only women can take part in. The Hijra figures are prominent in Indian Mughal History as well, referred to as Khwaja Siras and known for their loyalty to the ruler, they worked as the sexless watchdogs of the Mughal harems. They held important positions in court and various facets of administration during Mughal-era India, from the 16th to 19th century. The Hijra community is a testament to the sexual diversity that is integral yet often forgotten in Indian culture.
If the whole hijra community was looked upon with enamor and respect in our history, what happened that when we come across the community we look at them with contempt and are filled with a mixture of negative, fear, laughter, and odd emotions. It's owing to the fact that under British Raj, the Criminal tribes Act 1871 hijras were criminalized and the law was made to eradicate the whole community. However, these acts were abolished by the Indian government after independence, and by 2014, India, Nepal, and Bangladesh all had officially recognized third gender people as citizens deserving of equal rights where the third gender means individuals categorizing themselves as neither male nor female. Even though the progress is slow but in 2015 Madhu Kinnar became the first hijra mayor in India was elected in the city of Raigarh.
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Although the hijra community was revered by society and is invited to births and weddings for religious and spiritual ceremonies, they still become victims of abuse and discrimination. Violence and hate crimes against the community have become common. They are deprived of education, job opportunities, seating in restaurants, etc. leading them to live in poor conditions barely surviving. They often have to resort to begging and prostitution to earn a daily living. The government has tried to address this issue by introducing bills for the protection of the hijra community, with prison terms and other punishments for those offending them, but there is little to no less effect on the social stigma against the community.
In India, the hijra community comes under the umbrella term LGBTQ+ and we notice that they lack voice and representation when it comes to LGBTQ+ rights. We need to understand that when we fight for LGBTQ+ rights we fight for the whole community, we fight for hijras who have been victims of violence, hate crimes, and disrespect from none other than the people of our society. And although hijras are a part of the LGBTQ+ community as a whole, they have an independent subculture of their own. It is worth every effort to know about them, to study about them, to befriend them, and to smile at them for they are every bit of human as we are and they have nothing but blessings in their heart.