Hello People,

Well, it has been quite a while ago since our last HOWZIT newsletter early this year. Many things have happened along the way. Most of it was on the gearing-up for the 1st Manipal Alumni Global Health, Science and Technology Convention & the 28th MAAM AGM in August 2014. Personally, I must say that the vibe towards this inaugural event is tremendous, not only from inside Malaysia but also from overseas. Everyone involved in this project had put in their own limitless contributions, sweat and time to make this event a successful one. Just look through this newsletter and I am sure you will get to understand what I mean. In this latest issue, we will be looking at some very interesting articles written by our own Manipalites. Just when we thought that we had forgotten our Anatomy days, Dr. Koh Kar Chai brought us back to those glorious days of First Year in Manipal. There is also a Dental Case report in this issue, which I hope it will be useful to all of us. Our Vice President, Dr. Sivaroshan gave us an insight on Estrogen dominance in males. Eventually, I hope that you guys will take some of your precious time and read through this newsletter. I would definitely appreciate any comments or suggestions to make our HOWZIT newsletter a worthwhile reading material. You can e-mail to me at ujintan@ gmail.com if you have anything to say.

Looking back on the months that have passed, I was very fortunate to be able to meet with our Manipal University Chancellor, Padma Bhushan Datuk Dr. Ramdas Pai and his son, Dr. Ranjan Pai in June this year during the Melaka Manipal Medical College 11th Graduation Ceremony in Melaka. Later in August, Assoc. Prof. Dr Rishya and myself were lucky to listen to a lecture by Dr. Unni Krishnan, President of Medicins Sans Frontiers in University Malaya Medical Center. MAAM then gave our support for his quest to collect funds for MSF project in India by cycling around India in October 2013. Lately too, we are also happy to see our Manipalites featured in our local media on medical topics of interest, namely, Dr. Patricia Gomez and Assoc. Prof. Dr. Philip George. Besides that, kudos to Dr. C.S. Kumar who selflessly helped a toddler out from a burning car following a road traffic accident along the highway on August 2013.

Coming to this year end, many things have happened in and around the world. The recent Haiyan Typhoon had caused mayhem in our neighboring country, the Philippines, in which MAAM had successfully contributed some funds towards their relief effort. On November 21st, I was saddened when I was told about the passing away of my Forensic lecturer in Manipal, Prof. Dr. Koodly Yoganarasimha. I am not sure how many of us that were his students before, but I am sure that most of my seniors and batch mates from MMMC would definitely remember him as a great teacher.

Lastly, I would like to wish all of you, Merry Christmas and a very Happy New Year 2014. Make your resolutions quick and work on it as soon as you can. Let me end my editor’s note with a quote that I had personally made: “A hero is the one who knows that there is or may not be a tomorrow if he does not do his part for humanity.”

With best regards,
Dr. Eugene Tan

Organising Chairman’s message

Coming back from Manipal and starting work as a House-officer was both exciting and anxiety provoking. The thought of finally putting to practise what I spent 5 years learning and getting paid for it too, was attractive. Coupled with uncertainty of what to expect from colleagues, seniors, consultants and patients, I started work in February of 1989.

Some of what I hoped and looked forward to did come true, as I reflect back on those important formative months and years but in the first few weeks of every new posting there was an overwhelming anxiety and worry. This worry was, I believe, largely related to the fact that I was an Indian Medical Graduate and not someone from University Malaya or from a British Medical School. There was, sadly, at that time a general view that Indian Medical Graduates were inferior and less capable compared to others. The first question as I reported to a new Consultant or Senior Medical Officer during posting rotations was, “where did you qualify from”. And predictably there was a certain negative facial expression when I replied that I was from Manipal. It was prevalent in most Hospitals where other Alumni reported for work and I heard some resorted to lying and saying that they graduated from Manchester instead of Manipal as in their credentials (Man) could be confused for either.

Years later and working as a Specialist and now as a Consultant and Associate Professor and Associate Dean, I sincerely feel I perservered and showed my fellow colleagues from other so-called Ivy League Universities that I and all other Manipal graduates were no different. In fact, I sense we even have better communication and patient skills as that was a must in the environment we studied in just to survive.

The 1st Global Manipal Alumni Health, Science and Technology Convention, 2014 is hoping to showcase this fact and highlight that we as an Alumni are high achievers and contribute significantly to the nation’s healthcare and biotechnology domains. It is already boasting of 30 plus speakers from around the world who are authorities in their field of speciality. In this day and time of constant development and innovation, keeping abreast, especially as a healthcare profesional is essential to providing quality and appropriate service. The Convention will be a venue to update and enhance professional development and CME points will be awarded to all delegates by Malaysian, USA and Canadian CME provider authorities.

Friends and fellow Alumni, the “1st Global Manipal Alumni Health, Science & Technology Convention” will be held from the 7th to the 8th of August, 2014. It aims to bring together Manipal Medical, Dental, Pharmacy and Engineering Alumni as well as other Healthcare and Engineering Professionals from around the world to share ideas and experiences in their medical, dental, pharmacy, biotechnology and engineering practice as well as to develop collaborations among Alumni in various disciplines and fields. It also aims to bring back people who shared important years together and built bonds and relationships that perhaps distance prevents reunioun.

Invited speakers are authorities and key opinion leaders in their field and many are from the Alumni of Manipal in countries such as India, the United States of America, Canada, South Africa, Malaysia and Australia as well as from Melaka Manipal Medical College, Manipal International University, Nilai and Manipal University, India.

Supported by Manipal University, India, Melaka Manipal Medical College, Manipal International University, Nilai and MNE Solutions, this event promises to be a truly unique and educative experience. There will be Free Paper and Poster Presentations and delegates are encouraged to submit abstracts for these as there are many prizes awaiting the bestpapers. There will also be a Convention Dinner on the first evening with local entertainment open to all delegates giving the opportunity to unwind and catch up with old and new acquaintances.

Book early and tell all your previous batchmates and colleagues. Log-on to www.manipal.org.my for more information and registration details. This Inaugural event is to be held at the prestigious and famous, Royale Chulan Hotel, Kuala Lumpur. It is located in downtown Kuala Lumpur within the Golden Triangle precinct of Bukit Bintang where great shopping and dining opportunities exist. The Royale Chulan Hotel offers guests 5-star Malaysian hospitality just adjacent and walking distance to the Kuala LumpurTwin Towers.

Remember – This is an event about YOU and who YOU are. Manipal Alumni forever!

Look forward to welcoming all of you to this ‘not to be missed’ event.

Regards,
Assoc Prof Dr. Philip George
Organising Chairman

Secretary’s Message

Our 27th MAAM Convention and 28th AGM was held on May 4th 2013, at the Saujana Resort Subang Jaya. It was decided to hold both the convention and the AGM on one day, instead of having the usual 2 night, 3 day affair – this was to trim our expenses, given that our next convention, to be held in August 2014, will make heavy demands on our budget!

Registration started at 8.30 a.m. This was followed by CME sessions, which began at 9.30 a.m. The CMEs were very well attended, with some non-MAAM delegates who were sponsored by Roche. Among the highlights of these sessions was an intensive Ortho session where the speakers took turns to teach delegates about local infiltrating techniques for the various joints, namely shoulders, elbows, wrists, knees and ankles. There was also a very interesting session by some chiropractic doctors, who demonstrated some of the latest treatments for sports injuries.

The CMEs ended by 4 p.m., and then it was time for some fun. A few of us took the opportunity to test drive the latest BMW X1, as well as the BMW 3 and 5 series – we were able to take them for a spin up to the old Subang airport.

After that, it was back to business again with the AGM, which started at about 6.10 p.m. It was not well attended, with only 36 members. But the low turnout was for a very good reason – it was the day before the eagerly anticipated 13th General Elections, and many of our members from Ipoh, Penang, Johor and Seremban had taken the opportunity to head back home, determined to cast their votes and make sure their voices were heard. The AGM was over in an hour; one of the main items on the agenda was to make the decision to postpone the next AGM from May 2014 to August 2014, so that it will coincide with the Global Convention to be held next August.

After the AGM, at about 7.30, we started on cocktails and light snacks, before moving on to the convention dinner at 8.15. Dr. Thevi provided sophisticated entertainment, showing her prowess as a classical piano player.

Our sponsors BMW generously provided gifts for lucky draws, and many people went home with interesting gift bags. Once this was over, the DJs took to the music machine, and the doctors took to the dance floor! They certainly impressed with their funky moves to the latest dance beats. At midnight, the dancing came to an end and everyone went home. Some of us stayed overnight at the hotel. But we all got up bright and early the next day, excited to cast our ballots and make sure our votes counted.

Dr Thomas John Honorary
General Secretary

FOOD CURES

Medication may seem the most reliable and scientific way to manage health problems, and in some cases it is. But many ailments can be managed more effectively-simply by making some lifestyle changes.

Lifestyle changes can prevent problems and their resultant effects can be much more wide ranging and longer lasting. Exercise, for example, burns energy (which helps control body weight), but it can also improve cardiac efficiency and blood circulation, brain function and mood, and increase insulin sensitivity and bone strength. Likewise FOOD provides plenty of health promoting substances and is one of the most important lifestyle factors that can influence your health. So I will attempt to give you some tips on how to manage common health problems using simple foods and specifically herbs.

COMMON FLU AND COLDS
There’s an old joke that says if you treat a cold aggressively, it will be gone in 7days, but if you do absolutely nothing, it will drag on for a full seven days.

YOUR FOOD PRESCRIPTION

1. Water, juices and tea (decaffeinated)
Drinking plenty of water and fluids help keep your mucous membranes moist so they are better able to trap viruses as flu bugs thrive in dried-out throats and nasal passages.

If you have a sore throat, sip your water hot with a bit of honey (to coat your throat) and lemon juice (to shrink swollen throat tissue and help kill off virus cells). You can also add honey and lemon to tea. Gargling warm salt water helps by clearing away dead white cells and increasing blood flow to the throat. Or squirt saltwater into your nostrils one at a time to help clear nasal mucus. Drink fresh orange juice as it contains much more Vitamin C than the ready-to-drink kind as most of the vitamin C gets oxidized in cartons/bottles.

2. Chicken/Vegetable soup
Hot soups raise the temperature in your nose and throat which produces an inhospitable environment for the viruses that prefer a cool and drier area. Hot soups also thins out mucus, making it easier to blow out.

3. Garlic
The pungent cloves of garlic contain allicin, a potent antimicrobial that fends off bacteria,viruses and fungi. Allicin is formed when garlic is chopped or crushed and is easily destroyed by heat.

Not many of us can stand chewing raw garlic so you can chop it and add them to your soups along with onions. Chop garlic first and let it stand for 10mins as it allows the allicin to form and only add garlic to the soup just before serving to reduce the destructive effect of heat on the allicin. You can even take garlic supplements if you don’t like it in it’s natural form.

4. Spices and spicy condiments
According to Ayuverda, cinnamon, coriander, ginger promotes sweating which help break a fever. You can help unclog stuffy nose by spicing up some dishes with chilli, cayenne pepper or horseradish or even wasabi (Japanese horseradish Paste). Each of these condiments shrink the blood vessels in your nose and throat to relieve congestion. Try this Ayuverdic fever reducer; mix ½ teaspoon each of powdered cinnamon and coriander along with ¼ teaspoon of powdered ginger in a cup of hot water. Allow it to steep for 10mins, then drink.

NUTRIONAL SUPPLEMENTS
1. Vitamin C
Vitamin C doesn’t seem to help prevent a cold, but there is plenty of evidence to suggest that taking moderate amounts of vitamin C help shorten the illness period. Vitamin C acts as an antihistamine and an anti-inflammatory to help dry up a runny nose. Look for a vitamin C supplement that contains bioflavinoids- anti-oxidants found in citrus fruits, tea and other foods.

Some practitioners recommend high doses of vitamin C, such as 1000mg or even more but studies show that 250mg of vitamin C is enough to obtain the above effects.

2. Zinc
Taking zinc gluconate or oxalate lozenges every few hours within the first 2 days of a cold can decrease its duration. When in close contact with your mucous membrane its promotes overall immune function.

Sadly taking zinc supplements preventively doesn’t seem to do much to keep you from catching a cold.

3. Vitamin E
This anti-oxidant vitamin, another immune system booster has shown in clinical studies to prevent the onset of colds. 200mg daily is recommended.

Foods to avoid

It’s always better to skip caffeinated drinks such as coffee, caffeinated tea and cola as these tend to cause dehydration. Lastly, please abstain from alcohol (hate to say this) as we all are aware of the dehydration it causes.

theSun Typhoon Haiyan Relief Fund

“It did not take us too long to decide to set up a fund-raising campaign as it was out of compassion for the needy that moved us to contribute to the victims of Typhoon Haiyan. This should be a similar reason for everyone out there to contribute to this fund,” – said the alumni’s president, Dr Nirmal Singh.

PETALING JAYA (Nov 18, 2013):
It took Manipal Alumni Association Malaysia just one day to raise RM30,000 for theSun Typhoon Haiyan Relief Fund.

Nirmal said the funds were mainly contributed by colleagues and friends of the alumni members.

“The fund-raising will continue. We won’t stop at this amount. However, we hope to speed things up as the victims in the affected area are in need of medical support,” he said

The alumni, which currently has 1,000 members, is calling out to potential members to register as alumni members.

“We have potentially 7,000 members nationwide, but only 1,000 are officially registered. We can raise more funds if our alumni numbers grow. We welcome them to come forward in joining us in this worthy cause,” he said.

Nirmal also urged all Malaysians to come forward and give aid to the Philippines.

“They are our neighbour, and there should not be any show of apathy towards such a crisis happening to a neighbouring country,” he said.

To date, theSun Typhoon Haiyan Relief Fund has successfully raised RM80,000.

These contributions will be channelled to Mercy Malaysia for emergency medical support purposes. These include purchasing of medical supplies, fuel, water and food supplies for volunteers.

Anatomy DAYS

Remember the days spent in the anatomy dissecting hall day in and day out during our early years in the medical course? As if that was not enough, we used to spend hours and hours in the anatomy museum studying the well preserved anatomy specimens.

I still remember my anatomy lecturer telling us that the specimens in the museum are our friends, and that they are there to help us pass our exams and allow us to become doctors. Friends indeed they were, for I used to memorise the specimens and even dreamt of them in my sleep as we near the date of the examinations.

Fast forward into the present time where we have a sudden mushrooming of medical institutions with the sudden deluge of medical students. Cadavers are an expensive commodity and not many lucky students get to spend enough time with a human cadaver to learn the secrets of human anatomy. Many institutions resort to importing cadavers for their students if they are not able to arrange for cadavers from the Ministry of Health, which are mainly unclaimed corpses.

Some institutions also resort to artificial anatomical models. With the modern technique of preserving human body parts through plastination, present day students have access to well preserved anatomy specimens for their study.

Ever heard of the Silent Mentor Programme? I was informed that it is a voluntary donation of the human body to be used by medical students on the demise of the donor. Presumably, it would obviate the need to import cadavers from overseas.

I was then asked what we did with the remains after the medical students had carved up the cadaver. Some of us may remember the sand pit outside our anatomy museum where the remains were buried. As to the claim that the remnants were fed to a crocodile that was kept in the museum, I don’t think that crocodiles would favour meat that has been preserved in formalin.

This brought up the subject of respect towards a human body that has been dedicated by the living person for the use of the medical fraternity on his/her demise. It is not an easy decision to make after envisioning one’s own body being disembowelled and dismembered in the process of study by the students.

However, I need to clarify that the Silent Mentor Programme is not about donating a human cadaver for the use of medical students to study anatomy. It is about having unpreserved cadavers which will allow our trainee doctors to learn procedures which would otherwise be only possible with a living patient. In the Silent Mentor Programme by UMMC’s Minimally Invasive Laparo-Endoscopic Surgery Training Centre, donated bodies of the recently deceased are used in simulation programmes. Due respect is given to the silent mentors after each session with prayers offered. The bodies are covered up decently during the simulation. At the completion of each programme, the bodies will be prepared to as near natural appearance as possible before being given back to the family of the deceased. Of utmost importance here is the respect and gratitude that is given to the Silent Mentors for their selfless donation of their bodies for the sake of modern medicine.

In the words of a silent mentor, ‘It is better that mistakes are made on my lifeless body than a single mistake made on a living patient”

by Dr Koh Kar Chai

MAAM CPD series

14, December, 2013 saw the debut of our MAAM CPD Series which is aimed at allowing our MAAM members as well as our fellow brothers and sisters in the medical fraternity access to CPD programmes as well as creating a sense of fellowship amongst all.

MAAM aspires to conduct such CPD programmes regularly with the aim of garnering more alumni members to participate in our activities. This MAAM CPD Series is also open to non MAAM members as it will help to dispel the notion that MAAM is an association of “thirsty” members.

We are no doubt still “thirsty”, but the craving now is for professional development. At the rate that the field of medicine is progressing, as well as in the arena of science and technology, it is no easy task for all of us professionals to remain at the forefront of our areas of practice. Hence the need for our MAAM CPD Series.

MAAM has not forgotten our non medical MAAM members. More activities will be introduced that allows for the participation of alumni members that are not within the medical profession.

14, December, 2013 also saw the alliance between Manipal Hospitals Klang (Arunamari Specialist Medical Centre) and MAAM in the last CPD event for this year. Manipal Hospitals aims to make it’s presence known in Malaysia and is set to expand it’s services with the setting up of more hospitals in this country.

A total of four speakers were fielded, namely Dr Anbazhagan Kuppusamy, Consultant Physician and Infectious Disease Specialist; Dr Muthu Kumar Murugesan, Consultant ENT, Head and Neck Surgeon; Dr Baskaran Arunasalam Pillay, Consultant Obstetrician and Gynaecologist; and Dr Krishnakumar a/l Marimutho, Senior Medical officer.

Mr Ramkumar Akella, CEO and Managing Director, Manipal Hospitals, Malaysia did a presentation on what the Manipal Education and Medical Group(MEMG) has done, both within and without Malaysia. He hopes for a continuous alliance with MAAM with a view to increase our alumni members exponentially to the mutual benefit of both MAAM and MEMG.

Avoiding the TAX MAN

The Mention Of Tax Havens

Usually conjures up images of pop stars or wealthy businessmen hoarding their fortunes in remote places where the tax department can’t get access. However. Tax avoidance, as opposed to tax evasion, is perfectly Legitimate – and there are some two hundred so-called tax havens worldwide to help the tax payer achieve this. With rising personal incomes in the region, both among expatriates and local residents, many more people are seeking to invest their assets off-shore, thereby minimizing their tax burdens. However, with so many different destinations offering a wide variety of tax concessions, it is a complex matter deciding who should consider using a tax haven, under which circumstances and where. A tax haven is defined as a country, a republic or an island that offers special tax concessions to investors or companies as a means of attracting overseas money. They are usually places such as the Channel Islands, Luxembourg, or Monte Carlo that has limited indigenous industries. However, what they all have in common is that they provide an opportunity to reduce, eliminate or defer income-tax liabilities to varying degrees. The Bahamas, Bermuda, Virgin Islands, Cayman Islands, Cook Islands and Panama are truly tax free, while Hong Kong and Labuan in Malaysia are low-tax jurisdictions. Often wealthy investors set up companies in tax-haven countries to minimize income tax and estate duties on their assets. But there are other ways to enjoy the tax breaks, including off-shore trusts, insurance products or portfolio management services when considering whether to use a tax haven, investors must first carefully evaluate their short and long-term goals.