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I HAVE PURCHASED COMPAQ DESK TOP ON 17/08/2008 FROM M/S
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Subject 'change in broker ship ,ACCONT NO.281638/53,NON RECEIPT OF

STATEMENT OF ACCOUNT.'
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Subject:
an appeal to consider the case against state bank of india,jamshedpur mainbranch related
with me.
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Date:
Wed 05/28/08 10:33 AM
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DEAR RESPECTED SIR,
I BEG TO STATE THE FOLLOWING FEW LINES FOR YOUR KIND

CONSIDERATION AND A FAVOURABLE
ORDER.
THIS IS TO BRING YOUR KIND ATTENTION THAT QR. NO.,35/L/4 (2

BR.QUARTER) AT KALINDI ROAD,KADMA,
JSR-5 WAS ALLOTED TO ME BY STATE BANK OF INDIA,JAMSHEDPUR

BRANCH ON 28/02/2006,.
THE TISCO LTD.WANTED BACK THE SAID QUARTER FOR IT'S OWN
REQUIRMENT,FILED A CIVIL SUIT NO.46/99
ON 1st OF JULY 1999 & CASE IS PENDING AT LOCAL MUNSIFF

COURT.JAMSHEDPUR.
SIR,TISCO LTD HAD ALLOTED THE SAME QURTER ON 13/X/1953 VIDE

HOUSE PERMIT NO.34385 TO IMPERIAL BANK LTD.
( LATER NAMED AS STATE BANK OF INDIA IN THE YEAR 1955) JUST TO

QUOTE THE OLD RELATIONSHIP ALTHOUGH SBI IS
THE LEAD BANKERS TO TATA STEEL.CAN'T EXPECT THE FAVOURABLE

ORDER KEEPING IN VIEW OF THE LATEST
REQUIRMENT OF 2 ROOM QUARTERS,AS YOU KNOW BETTER
THAN ME.
SIR,I AM RESIDING IN YOUR SAID QURTER WITH MY FAMILY CONSISTING
OF OLD AGED PARENTS,AND MY MOTHER CAN'T CLIMB OVER
STAIRS,THAT'S WHY I AM INSISTING YOUR GOODSELF TO ALLOW ME TO
STAY IN THE SAID QUARTER.
SIR,IT IS THE FACT THAT IN KADMA FARM AREA I PERSONALLY SAW THE
QR.NO.1,6,8,9. IN FARM AREA RD NO.18 & RD NO.2 QR.NO.16.17,35,36,37,42
ALL L/4 TYPE ARE LYING VACENT FOR MORE THAN 1 YEAR AS I HAD
OBSERVED IN MY MORNIG WALK
& ONE L/5 TYPE QR.NO.22.,KALINDI ROAD ,KADMA. ALLOTED TO POST
OFFICE CLERICAL STAFF STILL LYING VACANT DUE TO PROPOSED HIKE IN
HRA IN 6 thPAY COMMISSION OF CENTRAL GOVT.NOT INTERESTED TO
OCCUPY.
SIR, YOU ARE WELL AWARE OF THE AFFAIRS GOING ON IN THE CITY OF
JAMSHEDPUR,I APPEAL YOU TO WITHDRAW THE EVICTION
SUIT NO.46/99,IT WILL BE A GREAT FAVOUR FOR ME,I CAN'T EXPLAIN YOU
IN WORDS.
SIR,IF YOU THINK THE SAID QR.MUST BE SURRENDERED TO TATA STEEL

FOR ITS OWN EMPLOYEES,AFTER GOING THROUGH MY
THIS LETTER,I PROMISE YOU TO VACATE THE SAME AS PER YOUR WILL
& PLEASURE.
YOUR'S FAITHFULLY,
B.ANAND RAO
SENIOR ASSISTANT,
SBI ,JAMSHEDPUR MAIN BRANCH
BISTUPUR,JAMSHEDPUR-831005.
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The Mahatma Gandhi Series of banknotes contain the Mahatma Gandhi watermark with a
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Security Thread
Rs.1000 notes introduced in October 2000 contain a readable, windowed security thread
alternately visible on the obverse with the inscriptions ‘Bharat’ (in Hindi), ‘1000’ and
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held against the light, the security thread on Rs.1000, Rs.500 and Rs.100 can be seen as
one continuous line. The Rs.5, Rs.10, Rs.20 and Rs.50 notes contain a readable, fully
embedded windowed security thread with the inscription ‘Bharat’ (in Hindi), and ‘RBI’.
The security thread appears to the left of the Mahatma's portrait. Notes issued prior to the
introduction of the Mahatma Gandhi Series have a plain, non-readable fully embedded
security thread.
Latent Image
On the obverse side of Rs.1000, Rs.500, Rs.100, Rs.50 and Rs.20 notes, a vertical band
on the right side of the Mahatma Gandhi’s portrait contains a latent image showing the
respective denominational value in numeral. The latent image is visible only when the
note is held horizontally at eye level.
Microlettering
This feature appears between the vertical band and Mahatma Gandhi portrait. It contains
the word ‘RBI’ in Rs.5 and Rs.10. The notes of Rs.20 and above also contain the
denominational value of the notes in microletters. This feature can be seen better under a
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Intaglio Printing
The portrait of Mahatma Gandhi, the Reserve Bank seal, guarantee and promise clause,
Ashoka Pillar Emblem on the left, RBI Governor's signature are printed in intaglio i.e. in
raised prints, which can be felt by touch, in Rs.20, Rs.50, Rs.100, Rs.500 and Rs.1000
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A special feature in intaglio has been introduced on the left of the watermark window on
all notes except Rs.10/- note. This feature is in different shapes for various denominations
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Diamond) and helps the visually impaired to identify the denomination.
Fluorescence
Number panels of the notes are printed in fluorescent ink. The notes also have optical
fibres. Both can be seen when the notes are exposed to ultra-violet lamp.
Optically Variable Ink
This is a new security feature incorporated in the Rs.1000 and Rs.500 notes with revised
colour scheme introduced in November 2000. The numeral 1000 and 500 on the obverse
of Rs.1000 and Rs.500 notes respectively is printed in optically variable ink viz., a
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See through Register
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in the middle of the vertical band next to the Watermark has an accurate back to back
registration. The design will appear as one floral design when seen against the light.
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Printing and circulation of forged notes are offences under Sections 489A to 489E of the
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4738;year=2000;volume=48;issue=4;spage=321;epage=30;aulast=Saxena" \l
"abstract#abstract"
Abstract
4738;year=2000;volume=48;issue=4;spage=321;epage=30;aulast=Saxena" \l "Eye
Examination in Diabetic Patients#Eye Examination in Diabetic Patients" \o "Eye
Examination in Diabetic Patients"
Eye Examination ...
4738;year=2000;volume=48;issue=4;spage=321;epage=30;aulast=Saxena" \l "Levels of
Diabetic Retinopathy#Levels of Diabetic Retinopathy" \o "Levels of Diabetic
Retinopathy"
Levels of Diabet...
4738;year=2000;volume=48;issue=4;spage=321;epage=30;aulast=Saxena" \l "Non-
proliferative diabetic retinopathy (NPDR): classification and management#Non-
proliferative diabetic retinopathy (NPDR): classification and management" \o "Non-
proliferative diabetic retinopathy (NPDR): classification and management"
Non-proliferativ...
4738;year=2000;volume=48;issue=4;spage=321;epage=30;aulast=Saxena" \l "Diabetic
maculopathy: Classification and Management:#Diabetic maculopathy: Classification and
Management:" \o "Diabetic maculopathy: Classification and Management:"
Diabetic maculop...
4738;year=2000;volume=48;issue=4;spage=321;epage=30;aulast=Saxena" \l "Clinically
significant macular oedema (CSME)#Clinically significant macular oedema (CSME)" \o
"Clinically significant macular oedema (CSME)"
Clinically signi...
"<i>Technique of laser treatment for diabetic maculopathy<a class=ref name=ft5
href=#ref5>[5]</a></i>#<i>Technique of laser treatment for diabetic maculopathy<a
class=ref name=ft5 href=#ref5>[5]</a></i>" \o "<i>Technique of laser treatment for
diabetic maculopathy<a class=ref name=ft5 href=#ref5>[5]</a></i>"
Technique of ...
"<i>Follow-up</i>#<i>Follow-up</i>" \o "<i>Follow-up</i>"
Follow-up
"Proliferative Diabetic Retinopathy (PDR)#Proliferative Diabetic Retinopathy (PDR)" \o
"Proliferative Diabetic Retinopathy (PDR)"
Proliferative Di...
"<i>Panretinal Photocoagulation (PRP)</i>#<i>Panretinal Photocoagulation
(PRP)</i>" \o "<i>Panretinal Photocoagulation (PRP)</i>"
Panretinal Ph...
"Complications of laser treatment#Complications of laser treatment" \o "Complications
of laser treatment"
Complications of...
4738;year=2000;volume=48;issue=4;spage=321;epage=30;aulast=Saxena" \l "Vitreo-
retinal Surgery in Diabetic Retinopathy and the Diabetic Retinopathy Vitrectomy Study
(DRVS)#Vitreo-retinal Surgery in Diabetic Retinopathy and the Diabetic Retinopathy
Vitrectomy Study (DRVS)" \o "Vitreo-retinal Surgery in Diabetic Retinopathy and the
Diabetic Retinopathy Vitrectomy Study (DRVS)"
Vitreo-retinal S...
"Management of Concomitant Cataract and Diabetic Retinopathy#Management of
Concomitant Cataract and Diabetic Retinopathy" \o "Management of Concomitant
Cataract and Diabetic Retinopathy"
Management of Co...
4738;year=2000;volume=48;issue=4;spage=321;epage=30;aulast=Saxena" \l "Peripheral
Retinal Cryoablation#Peripheral Retinal Cryoablation" \o "Peripheral Retinal
Cryoablation"
Peripheral Retin...
4738;year=2000;volume=48;issue=4;spage=321;epage=30;aulast=Saxena" \l "Medical
Management#Medical Management" \o "Medical Management"
Medical Management
4738;year=2000;volume=48;issue=4;spage=321;epage=30;aulast=Saxena" \l "Blood
sugar control#Blood sugar control" \o "Blood sugar control"
Blood sugar control
"<i>Diabetes control and complications trial (DCCT)</i>#<i>Diabetes control and
complications trial (DCCT)</i>" \o "<i>Diabetes control and complications trial
(DCCT)</i>"
Diabetes cont...
4738;year=2000;volume=48;issue=4;spage=321;epage=30;aulast=Saxena" \l "<i>United
Kingdom Prospective Diabetes Study (UKPDS)</i>#<i>United Kingdom Prospective
Diabetes Study (UKPDS)</i>" \o "<i>United Kingdom Prospective Diabetes Study
(UKPDS)</i>"
United Kingdo...
"Antiplatelet Therapy#Antiplatelet Therapy" \o "Antiplatelet Therapy"
Antiplatelet Therapy
4738;year=2000;volume=48;issue=4;spage=321;epage=30;aulast=Saxena" \l "Lipid
reduction#Lipid reduction" \o "Lipid reduction"
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OPHTHALMOLOGY PRACTICE
Year : 2000 | Volume : 48 | Issue : 4 | Page : 321-30
Management of diabetic retinopathy

S Saxena, S Jalali, TA Meredith, NM Holekamp, D Kumar
Department of Ophthalmology and Visual Sciences, King George's Medical College,
University of Lucknow, Lucknow, India
Correspondence Address:
S Saxena
Department of Ophthalmology and Visual Sciences, King George's Medical College,
University of Lucknow, Lucknow
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Source of Support: None, Conflict of Interest: None
Abstract
Diabetic retinopathy remains a major cause of blindness despite increased understanding

of this disease and identification of successful treatments. The Diabetic Retinopathy
Study identified risk factors associated with a high risk of blindness and confirmed the
benefits of panretinal photocoagulation. The Early Treatment Diabetic Retinopathy Study
defined the retinal characteristics, indications of treatment and results of laser treatment
of clinically significant macular oedema. The Diabetic Retinopathy Vitrectomy study
established the benefits and timing of vitrectomy for non-clearing vitreous haemorrhage
and severe proliferative diabetic retinopathy. The Diabetes Control and Complications
Trial and the United Kingdom Prospective Diabetes Study have also demonstrated the
value of tight control of blood sugar and blood pressure in diabetic retinopathy. These
studies developed specific recommendations for the management of diabetic retinopathy.
Optimum use of this information can minimize visual loss due to diabetic retinopathy.
Keywords: Diabetic Retinopathy, diagnosis, surgery, Humans, Laser Coagulation,

methods, Prognosis, Vitrectomy, methods,
How to cite this article:

Saxena S, Jalali S, Meredith TA, Holekamp NM, Kumar D. Management of diabetic
retinopathy. Indian J Ophthalmol 2000;48:321
How to cite this URL:

Saxena S, Jalali S, Meredith TA, Holekamp NM, Kumar D. Management of diabetic
retinopathy. Indian J Ophthalmol [serial online] 2000 [cited 2008 Nov 14];48:321.
Available from:
HYPERLINK "http://www.ijo.in/text.asp?2000/48/4/321/14834"
http://www.ijo.in/text.asp?2000/48/4/321/14834
Diabetic retinopathy (DR) remains a leading cause of visual disability and blindness in
the developed world, accounting for 10% of all new cases of blindness in the United
States.
4738;year=2000;volume=48;issue=4;spage=321;epage=30;aulast=Saxena" \l "ref1#ref1"
In a population-based study in South India,
diabetic retinopathy was detected in 1.78% of the patients screened, and was projected to
become a significant cause of blindness in the coming decade. This blindness usually
results from non-resolving vitreous haemorrhage, fractional retinal detachment and
diabetic macular oedema. Three multi-centre, randomized, collaborative clinical trials,
the Diabetic Retinopathy Study (DRS), the Early Treatment Diabetic Retinopathy Study
(ETDRS) and the Diabetic Vitrectomy Study (DRVS), developed highly specific
recommendations for the appropriate management of DR. These studies are briefly
summarized in
HYPERLINK "javascript:omovimg('viewimaget.asp?
img=IndianJOphthalmol_2000_48_4_321_14834_1.jpg')"
[Table - 1]
[Table - 2]
. This article highlights some of the important management principles and guidelines for
the management of patients to prevent or minimize visual loss due to diabetic
retinopathy.
Eye Examination in Diabetic Patients
4738;year=2000;volume=48;issue=4;spage=321;epage=30;aulast=Saxena" \l "top#top"
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All patients with a history of diabetes need complete eye examination. The eye
examination should be scheduled at the time of diagnosis of diabetes if age of onset of
diabetes is more than 31 years and after 5 years of onset of diabetes if age of onset of
diabetes is less than 30 years.
Pregnant females with diabetes should have an eye examination early in the first
trimester.
Evaluation of the eyes in diabetics is essential to detect not only diabetic retinopathy but
also other commonly associated problems such as cataract and glaucoma. Systemic
conditions that are known to increase the risk of progression of diabetic retinopathy are
nephropathy, pregnancy, history of recent institution of insulin.
[Figure - 1]
briefly outlines the approach to a patient with diabetes. In addition to dilated fundus
evaluation, eye examinations must include evaluation of visual acuity, intraocular
pressure, slitlamp biomicroscopic examination of iris, pupillary reactions, anterior
chamber, angles and the lens. Fundus examination also helps to detect visual loss from
causes other than diabetic retinopathy such as vascular occlusions, ischaemic optic
neuropathy, cerebral strokes, epiretinal membrane, etc., all of which are common in
patients with diabetes. If diabetic retinopathy is detected, the next step is to classify the
level of DR so as to formulate a specific and tailored management plan for treatment and
follow up. If retinopathy is not detected and the visual acuity remains good, the patient is
followed up regularly on yearly basis; or earlier, on appearance of any new symptoms.
A hazy ocular media could be due to cataract, and or vitreous haemorrhage. A careful
ultrasonography (USG) of vitreous and retina is necessary to evaluate the state of vitreous
haemorrhage or any associated tractional retinal detachment. When vitreoretinal
pathology is ruled out and the degree of lens opacity is accurately ascertained, the patient
can undergo extracapsular cataract extraction (ECCE) with posterior chamber intraocular
lens (PC IOL) implantation. Retinal examination after dilatation, should be done one
week postoperatively in such eyes to confirm the presence and measure the level of DR
[Figure - 1]
. Management of eyes with hazy media due to vitreous haemorrhage with or without
associated cataract, is discussed later.
Levels of Diabetic Retinopathy
MERGEFORMATINET
Diabetic Retinopathy often progresses from a mild to severe risk for visual loss. The
retinopathy is hence classified into two broad categories-non-proliferative diabetic
retinopathy (NPDR) and proliferative diabetic retinopathy (PDR).
NPDR is further classified into mild, moderate and severe and each of these may be with
or without involvement of the macula. PDR is classified further into PDR with or without
high-risk characteristics (HRC). The maculopathy, which can occur both in NPDR and
PDR, is classified into: a) non -clinically significant macular oedema, b) clinically
significant macular oedema (CSME) that may be focal or diffuse, c) ischaemic
maculopathy with or without associated CSME and d) cystoid macular oedema.
The baseline level of retinopathy indicates the risk of retinopathy progression and visual
loss. The level and severity of retinopathy is determined by detailed clinical examination
of the retina using the indirect ophthalmoscope for a panretinal view, and stereoscopic
slitlamp biomicroscopy of the disc and macula using +90D + 78 D handheld lens.
Ancillary tests, selectively useful are systematic stereo fundus photography [Figure:1a],
and fluorescein angiography.
Non-proliferative diabetic retinopathy (NPDR): classification and management
MERGEFORMATINET
NPDR is characterized by presence of retinal haemorrhages, exudates and configurational
changes of veins. In some cases there is macular oedema, but characteristically there is
absence of retinal or optic disc new vessels. The severity of retinopathy is further
classified
and managed as
1. Mild NPDR
[Figure - 2]
: Presence of at least one retinal microaneurysm and one or more of the following: retinal
haemorrhage, hard exudate, or soft exudate. These eyes need yearly retinal evaluation.
They do not need other investigations such as fundus fluorescein angiography (FFA).
2. Moderate NPDR
[Figure - 3]
: Haemorrhages or microaneurysms or both, greater than those in standard photograph 2A
of the modified Airlie House Classification of DR
in at least one quadrant, and one or more of the following: soft exudates, venous beading
and intraretinal microvascular abnormality (IRMA). Eyes with moderate NPDR are
followed up every 6-12 months. No FFA is needed and very rarely colour fundus
photography may be used to classify level of DR.
3. Severe NPDR
[Figure - 4]
: Haemorrhages or microaneurysms or both greater than standard photograph 2A in all
four quadrants, venous beading in two or more quadrants, and IRMAs greater than
standard photograph 8A in at least one quadrant
characterize severe NPDR (4-2-1 rule). These eyes need close observation every 3-4
months to check for progression. FFA may be used occasionally along with colour fundus
photographs to assess the risk for progression. Systemic risk factors are also considered
while planning management in such patients. The usefulness of panretinal
photocoagulation (PRP) in such eyes is uncertain and depends on the individual clinical
case and the risk of progression.
The risk factors for progression of NPDR to PDR
on colour fundus photographs have been identified as: (1) IRMA
[Figure - 4]
; (2) venous beading; and (3) haemorrhages and microaneurysms. The FFA risk factors
are: (1) dry leakage, (2) capillary dilatation, and (3) capillary loss. Although the FFA
provides additional prognostic information, the colour fundus photographic grading of
retinopathy levels of both eyes also provides prognostic results.
Diabetic maculopathy: Classification and Management:
MERGEFORMATINET
Involvement of the macula in diabetes can lead to serious and often irreversible visual
loss. Therefore it is essential to detect and treat all sight-threatening macular lesions at
the earliest. Diabetic maculopathy is further classified into CSME which may be focal or
diffuse, ischaemic (non-perfusion of capillaries around the foveal avascular zone) with or
without associated CSME, cystoid macular edema, and Non-CSME.
The visual acuity alone is not considered an important criteria while deciding the
treatment of diabetic maculopathy. The type of maculopathy and its extent are important
factors. If diabetic maculopathy is treated appropriately when the visual acuity is good, it
can prevent serious visual loss in a majority of the patients. Even in eyes with visual loss,
treatment can prevent further visual loss.
Clinically significant macular oedema (CSME)
MERGEFORMATINET
This term was defined in the ETDRS
in an effort to differentiate sight threatening from non-sight threatening macular lesion
and lay guidelines for laser treatment.
[Figure - 5]
is detected on stereoscopic binocular slitlamp biomicroscopic evaluation of the macula
using a + 90 D lens (or any other similar lens) for fundus examination. FFA is not
mandatory for diagnosis of CSME, but may be necessary to detect the treatable lesions.
CSME includes:
HYPERLINK "http://www.ijo.in/article.asp?issn=0301-4738;year=2000
0;volume=48;issue=4;spage=321;epage=30;aulast=Saxena" \l "ref6#ref6"
(1) Retinal thickening involving or within 500¼ͭ of the centre of the macula;
(2) Hard exudate(s) with thickening of the adjacent retina located not more than 500¼ͭ
from the center 潦⁴桥
of the macula; and
(3) A zone of retinal thickening one disc area or larger in size, any part of which is
located within one disc diameter of the centre of the macula.
Laser treatment of CSME
[Figure - 5]
reduces by about 50% the risk of moderate visual loss. It also increases the chance of
improvement in visual acuity of one line or more. Eyes with CSME which need PRP for
severe NPDR/ PDR should always undergo treatment for the macular oedema first
followed by PRP after 2-4 weeks. PRP alone or, simultaneous with macular treatment,
can worsen the macular oedema and lead to severe visual loss. Similarly, while treating
CSME, one should be careful to treat only the treatable lesions (vide infra) and not treat
beyond the macula close to the arcades as this works as a PRP and worsens the visual
acuity considerably
[Figure - 6]
[Figure - 6]
. The treatable lesions
. The treatable lesions
are described as:
1. Focal leaks > 500¼ͭ from the centre of the macula causing retinal thickening or hard
exudates
2. Focal leaks 300 to 500¼ͭ from the centre of the macula causing retinal thickening or
hard exudates if the treatment is not likely to destroy the remaining perifoveal capillary
network
3. Areas of diffuse leakage tha琠桡癥
at have not been treated previously
[Figure - 6]
4. Thickened retinal avascular zones, other than the normal foveal avascular zone, not
treated previously.
Laser is not indicated for eyes with visual loss solely due to ischaemic maculopathy. If
oedema and ischaemia coexist, the oedema should be treated after explaining the guarded
prognosis.
The role of laser in visual loss due to diabetic cystoid macular oedema is also not well
known. Such eyes can be rehabilitated in some cases by low-vision aids and associated
rehabilitation services. Eyes with diabetic maculopathy that do not reach the criteria for
CSME (non-CSME,
[Figure - 2]
), should not be treated with laser. This is especially required if most of the leakage is
close to the fovea increasing the risk of damage to it from direct treatment or subsequent
migration of treatment scars.
[TAG:2]Technique of laser treatment for diabetic maculopathy
[/TAG:2]
The treatment technique is divided into two main categories: (i) focal direct treatment of
fluorescein leaks and (ii) grid treatment of diffuse areas of leakage or non-perfused
retinal thickening.
1. Focal Treatment
Focal treatment
[Figure - 5]
is required for focal lesions located b
etween 500 and 3000¼ͭ from the centre of the macula, believed to be causing the hard
exudates and retinal thickening. Spot size of 100 - 200¼ͭ of 0.lsecond duration is used to
treat all lesions that leak the fluorescein dye; it includes microaneurysms, IRMA, or short
capillary segments. The end point is a whitening or darkening of the treated lesion.
Treatment is optional for focal lesions that do not fill or leak on FFA but are located
beyond 3000¼ͭ from the center of the macula. Treatment of these lesions is considered if
prominent leaks are present and associated with retinal thickening or hard exudates, that
extend closer to the centre. Focal leaks between 300¼ͭ and 500¼ͭ from the centre are
treated in exceptional cases during follow-up treatment sessions
s. Treatment for such leaks is indicated if other leaks have been treated, visual acuity is
6/12 or less and treatment is unlikely to destroy the remaining perifoveal capillary
network.
2 Grid Treatment
Grid laser is applied to areas of thickened retina that show diffuse fluorescein leakage
img=IndianJOphthalmol_2000_48_4
4_321_14834_9.jpg')"
[Figure - 6]
[Figure - 6]
or capillary dropout. Burns of light intensity (above threshold but less intense than PRP
burns) are placed in this area using 100-200¼ͭ spots of 0.1-0.05 seconds duration. Grid
treatment is not applied within 500¼ͭ of the centre of the macula or within 500¼ͭ of the
disk margin, but can be placed in the papillomacular bundle. It may extend in all
directions up to 2 DD from the centre of the macula, or to the border of the PRP
treatment, if present. Any focal leaks within t桥⁺潮攠
the zone of grid treatment are treated focally.
Follow-up
MERGEFORMATINET
About 4-6 weeks after the treatment of the macula, the patients are reviewed, and if some
obvious treatable lesions were missed, they are treated. Should CSME and treatable
lesions persist beyond 4-6 months, repeat treatment is performed after FFA confirmation.
The patients should be explained in detail that laser treatment of diabetic macular oedema
is effective mainly in preventing further visual loss rather than restoring the lost vision.
Proliferative Diabetic Retinopathy (PDR)
MERGEFORMATINET
PDR is characterized by presence of newly formed blood vessels arising from the optic
disc (NVD) or elsewhere on the surface of retina (NVE).
These new vessels may be flat along the surface or elevated into the vitreous cavity
and may be with or without a component of glial cell proliferation fibrovascular
proliferation (FVP/ FP). As the fibrous tissue contracts the eyes develop recurrent
preretinal
[Figure - 7]
and vitreous haemorrhages, tractional retinal detachment and occasionally combined
with rhegmatogenous retinal detachment. Rubeosis iridis is another characteristic of some
eyes with PDR. All such eyes need active treatment with scatter (panretinal) laser
photocoagulation, with or without additional surgery.
Eyes with PDR are further described as those with 'high-risk characteristics' (HRC)
where risk of severe visual loss over two years is very high, and, those with non-high-risk
characteristics which have a lesser risk of severe visual loss. The HRC (described by the
DRS) is based on: (1) presence of preretinal or vitreous haemorrhage
[Figure - 7]
(2) presence of new vessels (3) location of new vessels on or near the disc and (4)
severity of new vessels. The risk grows as the number of risk factors increases. Eyes with
three or more risk factors are at a much higher risk of severe visual loss in two years than
eyes with two or fewer risk factors.
Panretinal Photocoagulation (PRP)
MERGEFORMATINET
PRP involves laser scatter ablation of the retina extending from the retinal vascular
arcades at the posterior pole to the peripheral retina beyond the equator. The aim of PRP
is to prevent the onset or induce regression of neovascularization without vitreous
haemorrhage or fibrovascular proliferation.
Indications
PRP is not recommended
for eyes with mild or moderate NPDR or eyes with burnt out retinopathy or showing
spontaneous regression of retinopathy (which is rare). PRP should not be delayed in eyes
with HRC, rubeosis iridis, or angle neovascularization.
The HRC eyes are those (i) NVD >l/4-l/3 disc area (ii) vitreous or preretinal haemorrhage
with any extent of NVE, observed or assured to be observed by haemorrhage
[Figure - 7]
The role of PRP in eyes with tractional retinal detachment (TRD) is not well defined. The
PRP may increase the extent of traction and lead to a macular detachment. However, one
could consider PRP in eyes with TRD not involving the fovea as the first line of
management. Care should be taken to avoid laser at the areas of vitreoretinal adhesion
and traction, and areas of elevated retina. These eyes need close follow up and if the
macula is threatened or gets detached, they would need early surgical intervention. In
eyes where the TRD involves macula at presentation, early surgical intervention along
with intraoperative PRP may give better visual results.
Various factors known to worsen the retinopathy may influence the decision to initiate
laser treatment in eyes with severe NPDR or early PDR without HRC.
They include pregnancy, nephropathy, cardiac failure, carotid artery disorders, cataract
surgery, YAG capsulotomy, uncontrolled blood sugars, recent institution of insulin in a
patient with NIDDM, poor patient follow up, etc (
[Figure - 1]
-footnote). These factors should be considered in making the decision to treat or not,
besides the guidelines provided in the randomized clinical trials.
Technique of PRP
The pupils are fully dilated and topical anaesthesia is usually sufficient. The most
common wavelengths used are argon green (514 nm) or blue-green, (488 nm) frequency
doubled green laser, (532 nm) or diode laser (810 nm). In case of hazy media due to
cataract or vitreous haemorrhage, krypton red (639 nm) can be used. The slitlamp
delivery system is commonly used and various types of lenses are available to visualize
different areas of the retina, so as to cover as much area of the retina as possible.
However in patients with poorly dilating pupils, poor cooperation, inability to sit at the
slitlamp, peripheral cortical cataract, etc. the indirect ophthalmoscopic delivery system
can be used with greater efficacy.
The frequently used se
ttings of the argon laser are 500¼̠spot size, 0.1 second duration, 200-250 mW power to
give a moderate intensity burn of grayishwhite colour. Burns are placed outside the
arcades and extend peripherally up to the equator and beyond
ttings of the argon laser are 500μ spot size, 0.1 second duration, 200-250 mW power to
give a moderate intensity burn of grayishwhite colour. Burns are placed outside the
arcades and extend peripherally up to the equator and beyond
HYPERLINK "javascript:o浯癩浧
omovimg('viewimaget.asp?img=IndianJOphthalmol_2000_48_4_321_14834_10.jpg')"
[Figure - 7]
. Burns vary in number from 1600-2000 and are spaced one burn-width apart. Treatment
is avoided to areas of vessels, macula, traction, pigments, previous burns etc so as to
avoid large scotomas and haemorrhage.
Follow up
There are no post-treatment physical restrictions following PRP. The patients are
scheduled for follow-up examination in 4-6 weeks to assess the efficacy of laser
photocoagulation
[Figure - 7]
. The following factors are evaluated for any repeat laser treatment.
change in new vessel since last visit/ photocoagulation treatment
appearance of new vessels
frequency and extent of vitreous haemmorhage since last visit/last PRP
status of posterior vitreous detachment
extent of PRP scars
extent of tractional retinal detachment and fibrous proliferations.
Additional laser is applied when there is no regression of new vessels after initial
treatment, presence of active new vessels (tight networks, little fibrous tissue, rapid
growth in size), recurrent vitreous haemorrhage, and presence of skip areas.
Additional laser is less urgent if: fibrous proliferation is already developed, in single
episode of vitreous haemorrhage associated with posterior vitreous detachment (PVD),
lack of skip areas, and near complete PVD. Areas chosen for retreatment are generally
those toward which the new vessels appear to be growing or in which the
photocoagulation scars appear to be less tightly spaced.
The number of additional burns required to cause significant reduction of retinopathy
and decrease incidence of visual loss could range from 1,500 to 12,000.
"ref10#ref10"
"ref11#ref11"
The amount of initial laser treatment required for regression of retinopathy is not well
known but may be considerably higher than that recommended by the DRS.
"ref11#ref11"
If recurrent haemorrhage is due to traction of partially detached posterior hyaloid on
elevated new vessels, then vitrectomy may be indicated since repeated PRP may not stop
recurrent vitreous haemorrhages. Early surgery has been shown to have better anatomic
and visual results in such eyes.
"ref12#ref12"
Complications of laser treatment
MERGEFORMATINET
Laser treatment for diabetic retinopathy, if carried out properly, rarely causes serious
complications. Serious complications reported earlier include occurrence of choroidal
neovascular membrane and cilio-choroidal detachments.
Most of these and other transient complications including photophobia, transient myopia
and impaired accommodation can be reduced by dividing the treatment in multiple
sessions and avoiding very heavy intensity burns.
Another infrequent complication is macular subretinal fibrosis following treatment for
macular oedema, especially seen in eyes with pre-existing severe hard exudates.
"ref13#ref13"
Vitreo-retinal Surgery in Diabetic Retinopathy and the Diabetic Retinopathy Vitrectomy
Study (DRVS)
MERGEFORMATINET
Standard laser treatment cannot be performed in eyes with vitreous haemorrhage
precluding visualization of the retina. Laser does not help in eyes with tractional retinal
detachments (TRD,
[Figure - 8]
) and in fact can worsen pre-existing TRD.
"ref14#ref14"
The DRVS
[Table - 2]
was a randomized controlled clinical trial that evaluated the risks and benefits of surgical
versus conventional treatment for vitreous haemorrhage and very severe PDR.
"ref14#ref14"
Results of this trial demonstrated that eyes managed by vitreoretinal surgery had better
outcome than those treated conservatively, especially when the presenting vision was
good. Early vitrectomy offers the chance for prompt visual recovery which is of greatest
importance to patients who do not have useful vision in the fellow eye. The current
indications and contraindications for vitrectomy in diabetic eye disease15 are shown in
[Table - 3]
. Posterior traction detachments not involving the fovea may remain stable and should be
observed. However, once the fovea is detached, surgery should be performed promptly,
to prevent degenerative changes in the retina and consequent poor visual recovery after
retinal reattachment.
"ref16#ref16"
The basic goals of surgery include removal of all media opacities, release of all vitreous
traction and performing or completing retinal ablation, usually by laser, to prevent
subsequent neovascular proliferation. Retinal tamponade may be required using either
long acting gases or silicone oil depending on the extent and type of retinal pathology
encountered during surgery.
"ref16#ref16"
Owing to improved techniques and instrumentation early surgery is now increasingly
done. Results from recently published reports are encouraging.
"ref16#ref16"
eyes with preoperatively attached macula and recurrent vitreous haemorrhage 40%-62%
cases achieved a visual acuity of 6/60. while in eyes with TRD and detached macula
preoperatively, 21-58% eyes achieved 6/60. Loss of light perception was seen in 5-17%
in the first group (attached macula) and in 11-19% in the second group (detached
macula).
"ref16#ref16"
The visual results are generally stable for a long time. Vitrectomy with removal of the
posterior hyaloid is currently evaluated for diabetic maculopathy
"ref15#ref15"
and hopefully this modality will help selected eyes with maculopathy that are not
suitable for laser treatment.
Management of Concomitant Cataract and Diabetic Retinopathy
MERGEFORMATINET
All diabetics presenting with cataract should undergo a thorough anterior and posterior
segment evaluation. Eyes with CSME and cataract should preferably undergo laser
treatment for the maculopathy first, followed by cataract surgery after six or more weeks
since cataract surgery is known to worsen the maculopathy.
"ref17#ref17"
In case the cataract is too advanced for good visualization of the macula, then there is no
option but to carry out the laser treatment 3-4 weeks after the cataract surgery. In such
cases the situation should be clearly explained pre-operatively to the patient.
In patients, presenting with cataract and proliferative diabetic retinopathy, as much PRP
as possible should be done 4-5 weeks before surgery. If adequate PRP is not possible due
to media opacity, there are several management options. The options include (a) cataract
extraction and IOL implantation followed by PRP (preferably laser indirect
photocoagulation) in early postoperative period; (b) simultaneous IOL and vitreous
surgery (preferably phacoemulsification),
"ref18#ref18"
(c) IOL surgery in first stage, and vitreous surgery in second stage at an internal of 3 to 4
weeks. Eyes with preoperative rubeosis iridis can undergo simultaneous cataract and
vitreous surgery with or without IOL implantation, but the visual recovery is often poor
"ref16#ref16"
and such eyes may be a relative contraindication for surgery.
"ref15#ref15"
Cataract surgery in diabetics who have significant retinopathy must be planned in
conjunction with a retinal specialist.
Peripheral Retinal Cryoablation
MERGEFORMATINET
With improvement in pars plana vitrectomy techniques (particularly use of wide angle
viewing systems) and versatile laser delivery systems, cryoablation of peripheral retina, a
common modality in past, is rarely used now. The main indications include media haze
precluding laser PRP (even with the indirect ophthalmoscope) and repeated vitreous
haemorrhages despite a complete and additional PRP or after vitrectomy.
"ref19#ref19"
The main complication is acceleration of tractional retinal detachment. This treatment
should not be done in eyes with vitreous haemorrhage of unknown aetiology, eyes with
TRD or with areas of strong vitreoretinal adhesions, detected clinically or with
ultrasonography. The treatment is done either transconjunctivally or after a limbal
peritomy. The treatment should be visually monitored with indirect ophthalmoscopy.
Usually 10-15 seconds are needed at a temperature of -60ø C and a total of 18-20 spots
are applied, distributed over the four quadrants of the sclera, extending from ora serrata to
the equator.
"ref19#ref19"
Medical Management
MERGEFORMATINET
Besides laser and surgery to the affected eye (s) adequate attention should be paid by the
treating ophthalmologist to the systemic status of the patient. Systemic risk factors
[Figure - 1]
are known to influence the occurence, progression and effect of treatment on DR.
Blood sugar control
MERGEFORMATINET
Several studies have shown link of hyperglycemia and strict control of blood sugar with
level and progression of retinopathy. Obviously the first line of medical management
should be directed to good control of blood sugar. Control of blood sugar should be
carried out alongwith the appropriate laser therapy. Laser therapy should not be delayed,
particularly in proliferative diabetic retinopathy, while awaiting for adequate blood sugar
control. Two important studies of effect of glycemic control and diabetic retinopathy are
summarized below.
Diabetes control and complications trial (DCCT)
MERGEFORMATINET
The DCCT
"ref20#ref20"
"ref21#ref21"
tested very tight control of blood glucose levels versus standard control of blood glucose
levels to determine the magnitude of decrease in risk of progression of diabetic
retinopathy. The DCCT showed that strict control of blood sugar could reduce the
occurrence of diabetic retinopathy, slow down the progression of any retinopathy and
also lead to a better response to laser therapy in causing regression of new vessels.
"ref20#ref20"
Other complications such as neuropathy and nephropathy were also reduced by strict
control of the blood sugar.
"ref21#ref21"
One recent report
"ref22#ref22"
showed that in long-standing, poor glycemic controlled diabetic patients, there is an
early worsening of moderate NPDR immediately after starting insulin therapy.
Ophthalmologic monitoring before initiation of intensive insulin treatment and periodical
monitering at every three months upto a year thereafter seems appropriate for such a
high-risk stage. In patients whose retinopathy is nearly at high-risk stage, it may be
prudent to delay the initiation of intensive treatment until photocoagulation can be
completed, particularly if Haemoglobin A1C is high.
"ref21#ref21"
United Kingdom Prospective Diabetes Study (UKPDS)
MERGEFORMATINET
The United Kingdom Prospective Diabetes Study has demonstrated that tight control of
blood pressure in Type 2 (NIDDM) patients achieves a clinically important reduction in
the risk of deaths related to diabetes, progression of diabetic retinopathy and deterioration
in visual acuity.
"ref23#ref23"
This study has also shown that DR is common in newly diagnosed cases of NIDDM and
so a careful ophthalmic assessment at the time of diagnosis of diabetes is important.
"ref24#ref24"
Antiplatelet Therapy
MERGEFORMATINET
Various antiplatelet drugs, including aspirin, have been studied for their possible role in
prevention and progression of DR, due to inhibition platelet aggregation. In patients with
mild-to-severe NPDR and early PDR, aspirin had no clinically important beneficial
effects on the progression of DR.
"ref25#ref25"
Aspirin use did not appear to increase the occurrence of vitreous/preretinal haemorrhage
or influence the rate of vitrectomy. There were no ocular contraindications to aspirin
when indicated for cardiovascular disease or other medical conditions.
"ref25#ref25"
Lipid reduction
MERGEFORMATINET
Reducing blood lipids and treating anaemia slow the progression of DR.
"ref26#ref26"
"ref27#ref27"
In patients with extensive hard exudates, the serum lipids should be checked and if found
elevated, should be treated. Lipid lowering may decrease the risk of hard exudate
formation and associated visual loss.
"ref28#ref28"
Agents such as Lovastatin and Pravastatin are useful in lowering the hard exudates in the
macula.
"ref29#ref29"
The lipid lowering therapy is best given in consultation with an internist.
In conclusion, we have outlined the guidelines and management principles for diabetic
retinopathy in this paper. When applied in clinical practice, these. Can lead to substantial
reduction of visual loss. This is based on reduction the current published evidence. New
information on diabetes is rapidly emerging. Ophthalmologists and primary-care
physicians must keep up with these advances.
References
MERGEFORMATINET
4738;year=2000;volume=48;issue=4;spage=321;epage=30;aulast=Saxena" \l "ft1#ft1"
Kahn HA, Hiller R. Blindness caused by diabetic retinopathy. Am J Ophthalmol
1974;78:58-67
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Dandona L, Dandona R, Naduvilath TJ, McCarty CA, Rao GN. Population based
assessment of diabetic retinopathy in an urban population in South India. Br J
Ophthalmol 1999;83:937-940.
PUBMED
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FULLTEXT
The American Academy of Ophthalmology. Preferred Practice pattern:Diabetic
Retinopathy. 1993;l-32.
Early Treatment Diabetic Retinopathy Study Research Group. Grading diabetic
retinopathy from stereoscopic color fundus photographs. An extension of the modified
Airlie House classification. Early Treatment Diabetic Retinopathy Study report Number
10. Ophthalmology 1991;98:786-806.
PUBMED
Bresnick GH. Non-proliferative diabetic retinopathy. In, Ryan SJ, Schachat AP, Murphy
RB, (editors):Retina. St. Louis:CV Mosby Co. 1994. Vol 2, pp 1290-1305.
Early Treatment Diabetic Retinopathy Study Research Group. Photocoagulation for
diabetic macular edema. Early Treatment Diabetic Retinopathy Study Report Number 1.
Arch Ophthalmol. 1985;103:1796-1806.
PUBMED
Davis MD. Proliferative diabetic retinopathy. In, Ryan SJ, Schachat AP, Murphy RB,
(editors). Retina St. Louis CV Mosby Co. 1994. Vol 2, pp 1320-59.
Diabetic Retinopathy Study Research Group. Four risk factors for severe visual loss in
diabetic retinopathy: The third report from the diabetic retinopathy study. Arch
Ophthalmol. 1979;97:654-55.
Diabetic Retinopathy Vitrectomy Study group. Early vitrectomy for severe proliferative
diabetic retinopathy in eyes with useful vision:results of a randomized trial. Diabetic
Retinopathy Vitrectomy Study report 3. Ophthalmology 1988;95:1307-20.
Jalali S, Das TP. Augumented panretinal photocoagulation for proliferative diabetic
retinopathy. Afro-Asian J Ophthalmol. 1993;112:257-59.
Reddy VM, Zamora RL, Olk RJ. Quantitation of retinal ablation in proliferative diabetic
retinopathy. Am j Ophthalmol 1995;119:760-66.
PUBMED
Diabetic Retinopathy Vitrectomy Study Research group. Early vitrectomy for severe
vitreous haemorrhage:two-year results of a randomized trial. Diabetic Retinopathy
Vitrectomy Study report 2. Arch Ophthalmol 1985;103:1644-52.
PUBMED
Early Treatment Diabetic Retinopathy Study Research Group. Subretinal fibrosis in
diabetic macular oedema. ETDRS report 23. Arch Ophthalmol. 1997;115:873-77.
PUBMED
Diabetic Retinopathy Vitrectomy Study Research group. Early vitrectomy for severe
vitreous haemorrhage in eyes with useful vision. Clinical applications of results of a
randomized trial. Diabetic Retinopathy Vitrectomy Study report 4. Ophthalmology.
1988;95:1321-34.
Ho T, Smiddy WE, Flynn HW. Vitrectomy in the management of diabetic eye disease.
Survey Ophthalmol 1992;37:190-202.
Gardner TW, Blankenship GW. Proliferative diabetic Retinopathy: principles and
techniques of surgical treatment. In: Ryan SJ, Schachat AP, Murphy RB, (editors). Retina
St. Louis: CV Mosby Co. 1994. Vol 3, pp 2407-37. 1979;97:1276-80.
Dowler JG, Sehmi KS, Hykin PG, Hamilton AM. The natural history of macular oedema
after cataract surgery in diabetics. Ophthalmology 1999;106:663-68.
PUBMED
Honjo M. Ogura Y. Surgical results of parsplana vitrectomy combined
withphacoemulsification and intraocular lens implantation for complications of
proliferative diabetic retinopathy Ophth Surg Lasers 1998;29:99-105.
Schimek RA, Spencer R. Cryopexy treatment of proliferative diabetic retinopathy. Arch
Ophthalmol 1979;97:1276-80.
PUBMED
The Diabetes Control and Complications Trial Research Group. The effect of intensive
diabetes treatment on the progression of diabetic retinopathy in insulin-dependent
diabetes mellitus. Arch Ophthalmol 1995;113:36-51.
The Diabetes Control and Complications Trial Research Group. The effect of intensive
treatment of diabetes on the development and progression of long-term complications in
Insulin-dependent diabetes mellitus. N Engl J Med. 1993;329(14):977-86.
The Diabetes Control and Complications Trial Research Group. Early worsening of
diabetic retinopathy in the diabetic control and complications trial. Arch Ophthalmol
1998;116:874-86.
United Kingdom Prospective Diabetes Study Group. Tight blood pressure control and
risk of macrovascular and microvascular complications in type 2 diabetes: UKPDS 38. B
M J. 1998;317:703-13.
Kohner EM, Aldington SJ, Stratton IM, Manley SE, Holman RR, Mathews DR et al
United Kingdom Prospective Diabetes Study, 30:diabetic retinopathy at diagnosis of non-
insulin dependent diabetes mellitus and associated risk factors. Arch Ophthalmol
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Early Treatment Diabetic Retinopathy Study Research group. Effect of aspirin treatment
on diabetic retinopathy. ETDRS report No. 8. Ophthalmology 1991;98:757-65.
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Davis MD, Fuller MR, Gangnon RE, Barton F, Aeillo LM, Chew EY, Ferris FL 3rd et al.
Risk factors for high-risk proliferative diabetic retinopathy and severe visual loss. Early
Treatment Diabetic Retinopathy Study Report 18. Inrest Ophthalmol Vis Sci.
1998;39:233-52.
Berman DH, Friedman EA. Partial absorption of hard exudates in patients with end-stage
renal disease and severe anaemia after treatment with erythropoietin. Retina 1994;14:l-
5.
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Chew EY, Klein ML, Ferris FL, Remaley NA, Murphy RP, Chantry K et al. Association
of elevated serum lipid levels with retinal hard exudates in diabetic retinopathy. Early
Treatment Diabetic Retinopathy Study Report 22. Arch Ophthalmol 1997;114:1079-84.
Gordon B, Chang S, Kavanagh M, Berrocal M, Yannuzzi Z, Robertson C, Drexler A. The
effects of lipid lowering on diabetic retinopathy. Am J Ophthalmol 1991;112:385-91.
Figures
[Figure - 1]
[Figure - 2]
[Figure - 3]
[Figure - 4]
[Figure - 5]
[Figure - 6]
[Figure - 7]
[Figure - 8]
[Figure - 9]
Tables
[Table - 1]
[Table - 2]
[Table - 3]
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ISSN: Print -0301-4738, Online - 1998-3689
ITBC2CAB
HbA1c
(%)
Avg. Blood Sugar
(mmol/L)
(mg/dL)
4
3.3
60
5
5.0
90
6
6.7
120
7
8.3
150
8
10.0
180
9
11.7
210
10
13.3
240
11
15.0
270
12
16.7
300
13
18.3
330
14
20.0
360
[
HYPERLINK "http://en.wikipedia.org/w/index.php?
title=Glycosylated_hemoglobin&action=edit&section=5" \o "Edit section: Indications
and use"
] Indications and use
Glycosylated hemoglobin is recommended for both (a) checking blood sugar control in
people who might be pre-diabetic and (b) monitoring blood sugar control in patients with
more elevated levels, termed diabetes mellitus. For a single blood sample, it provides far
more revealing information on glycemic behavior than a fasting blood sugar value. That
being said, fasting blood sugar tests are crucial in making treatment decisions. The
American Diabetes Association guidelines are similar to others in advising that the
glycosylated hemoglobin test be performed at least two times a year in patients with
diabetes who are meeting treatment goals (and who have stable glycemic control) and
quarterly in patients with diabetes whose therapy has changed or who are not meeting
glycemic goals.
HYPERLINK "http://en.wikipedia.org/wiki/HbA1c" \l "cite_note-11#cite_note-11" \o ""
Glycosylated hemoglobin measurement is not appropriate where there has been a change
in diet or treatment within 6 weeks. Likewise the test assumes a normal red blood cell
aging process and
F75A-EC9A
6
124
135
7
156
170
8
188
205
9
219
240
10
251
275
11
283
210
12
314
345
* Plasma glucose is calculated by adding 11% to mean blood glucose estimates
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Small is surely the new big and without saying it in Obama-speak, Ratan Tata and his
team have done it. Adil Jal Darukhanawala, editor of Times of India’s zigwheels.com,
gets behind the wheel of a Tata Nano to bring you exclusive first drive impressions of a
car which is sure to rock the roads
After almost half a decade of anticipation, Ratan Tata’s dream is a reality. The Nano is
real — for everyone to sample in flesh and bone. Just watching the little car roll around
on its own power brings a feeling like none that we’ve experienced hitherto when looking
at a car. It’s more than a sense of joy. It’s a big sense of pride. Critics said it couldn’t be
done. They said it wouldn’t run. Heck, they even said it wouldn’t even be a proper car.
And here it is — more than just a basic car too. In fact, it is probably the cutest thing
we’ve seen on Indian roads yet. Sharp design features coupled with subtly curved
surfaces make the Nano stunning to look at. It may be cheap (as the world was promised),
but it certainly is by no means inferior. The Nano is a feel-good car — just being around
it makes you happy. And if you’ve spotted her in that enticing bright yellow paint job,
there’s no way you wouldn’t want one.
Careful where you park her, you might lose her in the parking lot
The true beauty of the Nano isn’t all about the well-styled visual package. It goes far
beyond that. The miracle lies in the great engineering achievement that the Nano is. If
ever there was a great case study for perfect packaging on a car, the Nano is it. With
external dimensions smaller than any other comparable fourwheeler in the country, the
Nano actually is tiny on the outside. But the way the mechanicals figure within the
minimal structure of the car also make it as spacious, if not more, than other small cars
out there. Yet, it is so compact on the outside that you could almost fit a Nano length-
wise within the width of some family saloons — we know, we’ve tried it. So when you
finally have your Nano, make it a point to remember exactly where you’ve parked it in
the basement of that mall, especially considering the fact that everyone’s going to want to
buy one!
Oh my God! That’s actually four people seated comfortably inside that little car
Yes, you read that right. The Nano is a proper four seater — and she seats that quantity
rather comfortably too. In fact, it seats four adults in better luxury than some of the other
maximinis running on Indian roads today. All that is again accountable to a near perfect
mechanical layout of the car that liberates so much room within the cabin that even with
the fixed co-driver’s seat on the base version, there’s enough room up front (and back) to
seat Goliath. One thing that you won’t find in the Nano though, is boot space. The rear is
taken up by the engine, while the small space between the front tyres is gobbled up by the
space saver spare tyre and other essentials such as the fuel filler pipe (which eliminates a
separate hatch for this and thus saves on cost) and brake fluid and windshield wash-wipe
liquid reservoirs. The lack of a big boot doesn’t really hurt
because the Nano was never meant to be a luggage hauler. Small knickknacks like
grocery, hand bags and other small bags can be easily placed in the smart recesses on the
dashboard both on the driver’s and co-driver’s sides which should be good enough for
city runs.
Ok we’re in it now, but does it go or is it all show?
On the outset, a look at the specification sheet may not be very impressive. After all,
there’s just a 624cc, liquid-cooled, parallel twin aluminium engine sitting snug under the
rear bench. With a maximum power output of 35PS that peaks at 5250 rpm, you’d be
forgiven to think it can’t really move fast enough to get you excited. But truth is, the
Nano is no slouch by any means. The 60 km/h mark comes in at just under 10 seconds
and the car will go on to accelerate to a tested true speed of 106 km/h. The secret behind
Nano’s performance is a rather simple engineering solution that the boffins at Tata have
put to good use. The firing angles for the two cylinders are exactly 180 degrees apart with
both pistons reciprocating exactly in tandem with each other. The result is a very
impressive torque figure — 48 Nm that is available all the way from as low as 2500rpm
to 4000rpm — which is also the meatiest rev range that a car utilises for operation in city
conditions. We’re four of us, not a very light bunch as far as body weight is concerned,
but the Nano just kept pulling so well that all four of us in the Nano began thinking we
were at least 10kg lighter. Like we said, this sure is a feel-good car.
Chitty chitty bang bang on
the move
Smart engineering shows off well in other areas of the car’s dynamics too. Armed with
independent McPherson struts and gas charged dampers front and rear, coupled to 12-
inch wheels, the Nano offers a ride that is adequately plush and comfortable for its
occupants. Add to that the fact that the Nano is a rear wheel drive with the engine fitting
straight between the rear axles, which means there is minimal loss of power through the
gearbox to the wheels. The rear wheels get to perform a concentrated job of putting the
power down while the front wheels stick to their steering duties — a fact so simple that it
puts immense pleasure in driving the Nano as well. For spirited drivers, the Tata Nano
will come across as a light little go-kart — albeit with a little body roll. For others, she is
a compact little runabout that goes where she’s pointed — vital for manoeuvring through
tight spots in clogged city traffic — as close to a bike as a car can get.
Move she does, but just about
sips while at it
The Nano carries just a 600 kg kerb weight — pretty light for a fourwheeled vehicle that
can seat four adults. The brilliant engine design coupled with that light body makes for a
frugal package. The great bunch of engineers at Tata Motors claim that the Nano will
return a fuel efficiency of 25kmpl and, judging by the minimal drop in level on the digital
fuel gauge, we’re in no mood to disagree. The car comes with a 15-litre fuel tank
capacity, which should easily give it more than a 300km operating range — which isn’t
bad at all for a car that will seldom see the highway.
Now that it’s here, is it worth
the hype and the wait?
A one word answer—definitely. Going back to the basics, what more would anyone want
from an effective city car —it’s good looking, spacious, seats four, frugal, decently
powerful and fun to drive. Plus, it’s incredibly cheap. For anyone who was on the
borderline thinking about whether the Nano will deliver or not, all those fears should now
be put to rest. Yes, the Nano is a proper car. Yes, it is safe and yes, it is worth every
second that we’ve spent waiting for it to hit Indian roads.
Want one, then queue up, for it
could be a long wait
Now that we’ve helped make your life simpler by telling all about Nano and now that
you’re excited and decided to get one, here’s some bad news. Bookings start in April and
the procedure is going to be more of a lottery than a ‘walk into the showroom and walk
out with a Nano’ detail. In the mean time figure out which colour you’d want it in. We’ll
go with yellow.
For more on Nano, log on to zigwheels.com
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Andi
I trust you are having a great week, today I would like to talk about
a common misunderstanding about what is meant by sugar free.
Myth: Sugar is forbidden, but sugar free foods are free
Fact: Many so called sugar free foods(such as cookies or candies)
often are not sugar free because they have carbohydrates from the
flour or milk.
Some are made with sugar alcohols such as maltitol or sorbitol.
"people with diabetes absorb about half the carbohydrates listed
as sugar alcohol" says Gillian Arathuzik from the Joslin Diabetes C
Center in Boston.
So if the label says 10 grams of sugar alcohol count it as 5 grams
of carbs. Beware that ;large amounts can cause diarrhea or gas.
I wanted to share this with you to show you that sugar free foods
are not sugar free and just because the food label says sugar free,
IT DOES NOT MEAN THE FOOD ITEM HAS NO SUGAR.
PLEASE READ THE LABELS on anything that purports to be low-carb.
That keeps you from falling prey to a dishonest marketing tactic
implored by many food companies to get people who are
livin' la vida low-carb to buy their products. They use phrases like
"no sugar carbs" or even put "low carb" right on the box and it's
anything but. This is what I call False or deceitful advertising.
Most people find the nasty side effects just a wee bit too uncomfortable
to indulge too often in products containing maltitol. I know I try to
avoid them as much as possible myself because the gas they cause is
very painful and disgusting.
My 3 Step program will help you with making good choices and will
give you everything you need to NORMALIZE your blood sugar level
and re take control of your health.
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Visit me at Melabic.com
to find
out how you can start a new life TODAY!
To your Health
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PS Melabic combined with my 3 step program will change the way you
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and find out how my husband and
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Are you afraid of developing diabetic complications? Many people

I hear from every day certainly are, and with good reason. Each
one of them can tell you stories about a loved one or acquaintance
who suffered through amputation, became blind, or died at a young
age. They fear the same will happen to them.
Fortunately, diabetes care has changed dramatically in the past few

years. We know more about diabetes than ever before, and can say
with confidence that diabetes complications can be avoided.
Those of you following my 3 step program already know

that there is a better way to healthy living. If you have not had
a chance to check out my 3 Step program.
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Visit me at Melabic.com and take action TODAY!
One of the biggest factors in avoiding diabetes complications
is not to ignore diabetes in the early stages. There are 5 million
people in the United States who have diabetes and don't even
know it.
It is very easy to ignore it , because your body is feeling fine and

your body seems to be working fine.
No Symptoms. No problem. Right?
ABSOLUTELY WRONG Not Even Close
While you're doing nothing, the excess glucose in your blood is

eroding the very fabric of your body, threatening major organs,
including your heart, nerves, eyes and kidneys. You may not
feel the effects right now, but keep your blood sugar high and
you eventually will.
By keeping your blood sugar close to normal, you have a good

chance of avoiding these awful complications.
It is never too late, the minute you start managing your blood
sugar, is the minute you drastically reduce a life of health problems.
Visit me at Melabic.com and find out how my 3 step program can
help you take control of your health by regulating your blood sugar.
To your health
Julia
PS You can place your order today by calling Toll FREE

1 800 687 0076
PPS You see, in life, lots of people know what to do, but few people
actually do what they know. Knowing is not enough! You must take action
Quote by Anthony Robbins
I hope you are having a great week. Today I would like to share with
you about a couple myths that a lot of people with type 2 diabetes
Myth #1 If I'm using Melabic, insulin or anti diabetic medications,
I can eat what I want.
Absolutely NOT! Taking medications is not a substitute for eating right,
exercising, and maintaining a healthy weight. Do everything you
can to manage your diabetes with healthy lifestyle habits--even if
you are taking diabetes medication. Studies have shown that eating
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To begin your healthy lifestyle today check out Melabic and my 3 step
program by
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visiting me at Melabic.com
Myth #2 People with "prediabetes" (or a family history of Type 2
diabetes) always eventually end up with full-blown Type 2 diabetes.
Not at all. If your doctor has told you that your blood sugar
levels are "borderline" or that you have "prediabetes," this is a
wake-up call! Get serious about losing weight, eating a healthy
diet, and exercising and you can very likely avoid developing
diabetes. Having a family history of Type 2 diabetes also doesn't
mean that you will also get the disease. You're in control!
I hope this has made the myths crystal clear. Have a great weekend
and embrace all the gifts we have in our lives.
To your Health
PS I have developed a 3 step program that will give you a step by
step plan when it comes to diet, exercise and nutritional supplements.
Find out more about
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Biotin
What is it?
Biotin is a B vitamin and is used as a nutritional supplement for seborrheic dermatitis
(cradle cap) in children , diabetes, deficiency syndromes, and vaginal yeast infections.
Other names for Biotin include: Biocytin, Vitamin H, and Coenzyme R.
Ask your doctor, nurse, or pharmacist if you need more information about this medicine
or if any information in this leaflet concerns you.
Before Using:
Tell your doctor if you
are taking medicine or are allergic to any medicine (prescription or over-the-counter
(OTC) or dietary supplement)
are pregnant or plan to become pregnant while using this medicine
are breastfeeding
have any other health problems, such as high blood pressure or heart or blood vessel
disease
Dosage:
Talk with your caregiver about how much Biotin you should take. The amount depends
on the strength of the medicine and the reason you are taking Biotin. If you are using this
medicine without instructions from your caregiver, follow the directions on the medicine
bottle. Do not take more medicine or take it more often than the directions tell you to.
To store this medicine:
Keep all medicine locked up and away from children. Store medicine away from heat and
direct light. Do not store your medicine in the bathroom, near the kitchen sink, or in other
damp places. Heat or moisture may cause the medicine to break down and not work the
way it should work. Throw away medicine that is out of date or that you do not need.
Never share your medicine with others.
Warnings:
Before taking Biotin, tell your doctor if you are pregnant or breastfeeding
Side Effects:
Stop taking your medicine right away and talk to your doctor if you have any of the
following side effects. Your medicine may be causing these symptoms which may mean
you are allergic to it.
Breathing problems or tightness in your throat or chest
Chest pain
Skin hives, rash, or itchy or swollen skin
Other Side Effects:
This medicine may also cause other side effects. Tell your doctor if you have side effects
that you think are caused by this medicine.
HYPERLINK "mailto:deplanning"
deSection 409. Criminal breach of trust by public servant, or by banker, merchant or
agent
Whoever, being in any manner entrusted with property, or with any dominion over
property in his capacity of a public servant or in the way of his business as a banker,
merchant, factor, broker, attorney or agent, commits breach of trust in respect of that
property, shall be punished with 1[imprisonment for life], or with imprisonment of either
description for a term which may extend to ten years, and shall also be liable to fine.
planninSection 420. Cheating and dishonestly inducing delivery of property
Whoever cheats and thereby dishonestly induces the person deceived any property to any
person, or to make, alter or destroy the whole or any part of a valuable security, or
anything which is signed or sealed, and which is capable of being converted into a
valuable security, shall be punished with imprisonment of either description for a term
which may extend to seven years, and shall also be liable to fine.g jsr@yahoo.co.in
Section 472. Making or possessing counterfeit seal, etc., with intent to commit forgery
punishable under section 467
Whoever makes or counterfeits any seal, plate or other instrument for making an
impression, intending that the same shall be used for the purpose of committing any
forgery which would be punishable under Section 467 of this Code, or, with such intent,
has in his possession any such seal, plate or other instrument, knowing the same to be
counterfeit, shall be punished with 1[imprisonment for life], or with imprisonment of
either description for a term which may extend to seven years, and shall also be liable to
fine.
I hope you had a great week end and took a few moments
to give your body some rest. I know it is not easy sometimes
to relax when you are constantly focused on keeping your
blood sugar in check.
Today I would like to talk to you about your energy levels.

***Have you ever wondered why you might be feeling so tired?***
The Truth is that you have lots of potential energy from high
levels of glucose (sugar) in your blood, but your body is unable
to make use of it. You can't produce or properly utilize insulin,
a hormone intended to transmit the blood sugar that cells use for
energy.
Insulin resistance is the underlying problem for the vast majority
of those with diabetes. The reality is that in 90% of all diabetics
(those with Type 2), the pancreas produces plenty of insulin, but
the cells resist the efforts of insulin and won't let the blood sugar
in. In turn the level of sugar (glucose) in the blood begins to rise.
To learn more about how Melabic attacks the major source of

elevated blood sugar visit me at
l=PA6lS&m=1gKAcN6Pvn7.Q9&b=wzo.LKqp1zloYiCwZstD3g" \o "" \t "_blank"
Melabic.com
*The Dangers of High Blood Sugar*
Uncontrolled high blood sugar does more than sap your energy. It
puts you at risk for heart disease, nerve damage, vision problems,
memory loss and a weakened immune system. The good news is that, in
general, for every 1 point reduction in A1c, the risk of developing
diabetic complications is reduced by up to 40%.
This is powerful evidence that shows any progress you make in
controlling your blood sugar will result in tangible health benefits.
Let Melabic help you reach your blood sugar goals. For more
information visit me at
Melabic.com.
Remember stabilizing your blood sugar is a reality and is very
important in maintaining and keeping your health.
To your health
PS. You can start today by calling
Toll FREE 1 800 687 0076
and start taking control
of your health today!
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Top of Form
Bank unions defer strike on fruitful talks with IBA
BS Reporter / Mumbai June 9, 2009, 17:01 IST

United Forum of Bank Unions (UFBU) today deferred the proposed strike on June 12
following fruitful discussions held between Indian Bank Association (IBA) and UFBU
today.
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may-be-releasedjail-tomorrow/64197/on" \o "Sheetal Mafatlal gets bail, may be released
from jail tomorrow"
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4700cr-in-first-2-monthsfy10-report/64203/on" \o "UPDATE:India Inc raises Rs 4,700cr
in first 2 months of FY'10: Report"
UPDATE:India Inc raises Rs 4,700cr in first 2 months of FY'10: Report
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prepared-to-take-credit-risks/64208/on" \o "Commercial banks better prepared to take
credit risks"
Commercial banks better prepared to take credit risks
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HYPERLINK "http://www.business-standard.com/india/news/bank-unions-defer-
strikefruitful-talksiba/21/44/64161/bsheadline.php"
Arising out of the discussions, the following positions have emerged. The precondition
that the unions should agree for new pension scheme to be made applicable to the new
recruits would not be insisted upon, UFBU convener C H Venkatchalam said in
statement.
IBA stated that the existing pension scheme will continue to be applicable to all new
recruits up to 31 March 2010, but UFBU stated that this should be extended up to 31
October 2012, and matter should be reviewed thereafter. The issue will be further
discussed.
In view of the breakthrough in the pre-conditions and the willingness of the IBA to
finalise our demands with a positive approach within a short time, UFBU decided to
defer our proposed strike on 12 June 2009.
Both parties have agreed to meet again very shortly to finalise the understandings on our
demands.
Unions expect to conclude negotiations in this month itself, Venkatachalam told Business
Standard.
Regarding sharing of additional pension cost, forum said, IBA and bank unions have
agreed that banks would take a share of Rs 4,200 crore and employees /officers at Rs
1,800 crore.
There was some movement forward on hike in wage bill also. UFBU said
IBA was willing to improve their offer from 15 per cent to 17 per cent subject to approval
by Managing Committee of association. UFBU wanted IBA to further improve their offer
to 20 per cent.
The rise in wage bill is expected to be Rs 4,700-4,800 crore if the hike around 17 per
cent.
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Bottom of Form
against SBI's merger move
BS Reporter / Chennai June 12, 2009, 0:11 IST
The All-India Bank Employees’ Association (AIBEA) On Thursday said that it was
planning a strike in State Bank of India’s (SBI’s) subsidiary banks in the first week of
July to protest the country’s largest lender’s decision to merge these entities with itself.
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gives poor returns in 2008-09"
Rs 2k-cr divestment corpus gives poor returns in 2008-09
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consolidation of associates next month"
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Excl: Sesa Goa set to buy Dempo Mining
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netthree-fold-at-rs-158-cr/64446/on" \o "Engineers India Q4 net up three-fold at Rs 158
cr"
Engineers India Q4 net up three-fold at Rs 158 cr
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RBI constitutes working group to review BPLR
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growth in FY10"
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500-cr-in-two-years/64443/on" \o "Royal Orchid to invest Rs 500 cr in two years"
Royal Orchid to invest Rs 500 cr in two years
standard.com/india/images/blueArrow.gif" \* MERGEFORMATINET
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strike-against-sbis-merger-move/21/34/360797/bsheadline.php"
AIBEA General Secretary C H Venkatachalam said the SBI management has made it
clear that it would expedite the process of merger. The Association had chalked out the
strike plan in view of this immediate threat, Venkatachalam added.
Yesterday, Finance Minister Pranab Mukherjee had said the government would support
public sector banks’ (PSBs’) plans on consolidation to enhance the competitiveness of
Indian banks globally, he pointed out.
Venkatachalam was of the view that the Indian banking industry did not need
consolidation of banks. Rather, what was required On Thursday was expansion of PSBs.
In order to achieve the objective of total financial inclusion, PSBs have to proliferate and
expand in un-banked areas, he said.
While on the one hand, consolidation and global competition would result in monopoly
of a few big banks and deviation from the needs of the common man and social sectors,
on the other, it would push these banks and their resources towards bailing out corporate
houses – domestic and foreign.
Merger of banks would lead to closure of a large number of bank branches, thereby
curtailing banking services for the masses. The closure of branches would also jeopardise
jobs of bank employees, he said.
Mere merger of banks would not make them financially stronger. Nor were these PSBs
created for global competition, Venkatachalam argued.
So, both from the country’s point of view and the point of view of social objectives of
these banks, the policy of merger was unwarranted and highly retrograde, he contended.
“If the government, or the Reserve Bank of India, or any bank management takes any
unilateral measure towards merger and consolidation of PSBs, it would be protested with
nation-wide strikes by bank employees,” he threatened.
The General Council of AIBEA has been convened in Mumbai on July 9 and 10 to chart
out the future course of action, Venkatachalam said.
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C H Venkatachalam
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I hope you had a great week end, in today's email I want to explain
exactly what insulin resistance is and how you can reverse it.
The Term "insulin resistance" aka Syndrome X is not usually talked
about when doctors speak to their patients about optimal diabetes
management. This is because the term often confuses patients (and
physicians, too, on occasion). Lets take a couple minutes and find
out exactly what it means.
Insulin resistance is an impairment of the body's ability -
specifically the liver, fat and muscle cells - to use insulin to
process glucose (sugar).
As a result glucose is not handled properly by the body, and blood

sugar levels rise.
In the early stages of insulin resistance , the body recognizes that
blood sugar levels are elevated, so the pancreas tries to step up
the secretion of insulin to overcome this cellular resistance.
This over time places stress on the pancreas until, over time, the
pancreas becomes dysfunctional and unable to produce enough insulin
to help control blood sugar levels.
The vast majority of people with type 2 diabetes are also insulin
resistant, as are many people who have high blood pressure and /or
cardiovascular disease, and who are overweight or obese.
The GOOD NEWS is that there are effective , easy-to-adopt ways to
change the course of insulin resistance at the cellular level.
These include lifestyle modifications, learning new ways to prepare
foods, learning the optimal way to exercise and using natural
supplements. I have developed a 3 Step program that combines all these
necessary elements to help you fight Syndrome 'x' to find out more
visit me at
l=PA6lS&m=1h9X7tWEZX7.Q9&b=uI_0eM_qvMfB6CcRU87SkA" \o "" \t "_blank"
Melabic.com
Apart from these common recommendations, an interesting
selection of available remedies can support healthy lifestyle
choices, restore insulin sensitivity, and help counteract the
complications of diabetes.
1. Fenugreek - Clinical and experimental studies find fenugreek
seeds effective in treating Type 2 diabetes, providing significant
improvements in insulin sensitivity while reducing LDL cholesterol.
2. Chromium - This trace mineral is key for controlling blood sugar
and works closely with insulin to move glucose into cells.
Without the proper amount of chromium, insulin activity is blocked
and glucose levels begin to rise. A general chromium deficiency in
the U.S. could be a factor in the skyrocketing number of people with
diabetes.
3. Gymnema - Used for centuries in Ayurvedic medicine, this herb
(taken internally) controls blood sugar levels, reduces blood glucose,
and increases insulin production. In one study of 22 patients with
Type 2 diabetes, all had improved blood sugar control, and all but
one were able to cut their drug intake after supplementing with
gymnema extract
4. Bitter melon - Numerous scientific studies note the effects of its
dried leaves, seeds, and fruit in lowering blood sugar. Researchers
concluded, There are components in bitter melon that possess
anti-obesity properties, which may be helpful for weight control and
glycemic control.
Now for the best part, I have included these four powerful ingredients
all in one place, Visit me at
Melabic.com
to find out how these
ingredients reversed my husbands and many others diabetes.
To your Health
Julia
PS Melabic is a combination of the 9 all natural most effective diabetes
fighting ingredients. To find out more how they can help you normalize
your blood sugar levels and take back your health visit me at
Melabic.com
PPS You can also place your order today by calling Toll FREE
1 800 687 0076
Good day,Andi
Today, I just wanted to write a quick note to say I am amazed at the
wonderful stories I receive each day about how Melabic and the 3
step program is making a difference in your lives.
Please if you have not done so send in your story! I love reading
them, they keep me motivated to continue researching and working to
beat this epidemic. If you have not had a chance to check out
all that Melabic can offer
l=PA6lS&m=1fnKuCdIlX7.Q9&b=xzmvdk9QQ1bDjs5E9_FPjw" \o "" \t "_blank"
visit me at Melabic.com
In this email you will learn about how high blood sugar can affect
your eyesight.
How can diabetes affect the eye?

Your eye has a lens and an aperture (opening) at the front, which
brings objects into focus on the retina at the back of the eye. The
retina is made up of a delicate tissue that is sensitive to light,
like film in the old cameras before the digital age.
At the center of the retina is the macula which is a small area
about the size of a pinhead. This is the most highly specialized
part of the retina and it is vital because it enables us to see
fine detail to read small print. The other parts of the retina give
us side vision (peripheral vision). The rest of the eye in front of
the retina is a clear jelly-like substance called the vitreous
humour.
INCLUDEPICTURE "http://www.melabic.com/diabetic-retinopathy.jpg" \*
MERGEFORMATINET
Diabetes can affect the eye in a number of ways. These usually
involve the fine network of blood vessels in the retina - the most
sever condition that can occur is diabetic retinopathy.
Affect - Temporary blurring
Your vision may become blurred for a few days or weeks while your
diabetes is first being controlled. This is due to the swelling of
the lens of the eye.
Affect - Cataract
This can occur in two forms:
Young people with diabetes can develop a special type of cataract.
Although their vision gets worse, it can be restored by surgery;
older people with diabetes can be especially prone to developing
cataracts. Cataracts can be successfully removed by surgery and
usually it is possible to insert a lens implant. This procedure is
not for everyone.
Affect - Diabetic retinopathy
The most serious diabetic eye condition involves the retina and is
called diabetic retinopathy. This condition is very common in
people who have had diabetes for a long time. Your doctor may be
able to see abnormalities in your eyes, but there is no threat to
your sight.
There are two types of diabetic retinopathy which can damage your
sight. Both involve the fine network of blood vessels in the
retina. They are described below.
Type 1 - Maculopathy
This happens when the blood vessels in the retina start to leak. If
the macula is affected, you will find that your central vision
gradually gets worse. You may find it difficult to recognize
people's faces in the distance or to see details like small print.
The amount of central vision that is lost varies from person to
person. However everyday sight for getting around the house and
outside (navigation vision) will be preserved. It is quite rare for
someone with maculopathy to lose all their sight.
Type 2 - Proliferative diabetic retinopathy
Sometimes diabetes can cause the blood vessels in the retina to
become blocked. If this happens then new blood vessels form in the
eye. This is nature's way of trying to repair the damage so that
the retina has a new blood supply.
Unfortunately these new blood vessels are weak. They are also in
the wrong place - growing on the surface of the retina and into the
vitreous jelly. As a result these blood vessels can bleed very
easily and cause scar tissue to form in the eye. The scarring pulls
and distorts the retina. When the retina is pulled out of position
this is called retinal detachment. This condition is more rare than
background retinopathy and is more often found in people who have
been insulin dependent for many years.
The new blood vessels will rarely affect your vision, but their
consequences, such as bleeding or retinal detachment can cause
your vision to get worse suddenly. Your eyesight may become
blurred and patchy as the bleeding obscures part of your vision.
Without treatment, total loss of vision can happen in proliferative retinopathy.
*** With treatment most sight-threatening diabetic problems can be
prevented if caught early enough.***
To learn more about how Melabic can lower blood sugar and help you
prevent and treat diabetic retinopathy visit me at
Melabic.com
Although your vision may be good, changes can be taking place to
your retina that needs treatment. Most sight loss in diabetes is
preventable: early diagnosis is vital have an eye examination
every year do not wait until your vision has deteriorated to have
an eye test.
Your family doctor or optometrist can examine for diabetic
retinopathy.
Remember, however, that if your vision is getting worse, this does
not necessarily mean you have diabetic retinopathy. It may simply
be a problem that can be corrected by glasses.
I hope this gave you a bit of insight on how important regular eye
exams are. I book Tim & I in a year in advance so there is no
excuses for us!
God Bless and talk to you soon
PS.You can Normalize your blood sugar level and prevent retinopathy
by taking Melabic. Find out more at
Melabic.com
PPS.You can now order Melabic by calling Toll Free
1 800 687 0076
Banks to reimburse in 12 days in failed ATM transactions:RBI

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New Delhi: The Reserve Bank of India today asked banks to reimburse customers the
amount wrongfully debited from their accounts in failed ATM transactions within 12
days of the customer complaint.
Failure to re-credit within 12 working days will require the bank to pay a compensation
of Rs 100 per day and this will be credited on the same day when the bank pays back the
debited amount for the failed ATM transaction, it said.
“It is mandatory for the banks to reimburse the customers, the amount wrongfully debited
on account of failed ATM transactions, within a maximum period of 12 working days,”
the central bank said in a notification.
RBI said it has received a number of complaints regarding non-adherence of banks to the
instructions and that different banks have put in place different cut-off limits for cash
withdrawals for other bank customers.
The issuer bank, RBI said, is entitled to claim such compensation from the acquirer bank
if delay is attributed to the latter. Also, the ATM network operators will have to
compensate the banks for any delay on their part.
The central bank instructed the banks to extend the scope of concurrent audit to cover
cases of delay in reimbursing the customers for failed ATM transactions.
Guidelines for replacement or repair of faulty ADSL modem
1) Q.
What is the policy for replacement /repair in case of outright sale of modems as well
as when taken on monthly fIxed charges?
Ans. In case of outright purchase of modem, the ownership of the modem will be
transferred and
warranty of the CPE will be provided to the customer at the time of sale. Hence, there is
no
Justification for extending CPE AMC to outright , purchase CPEs.
2) Q. Guidelines for replacement of accessories like Power adapters, Splitter etc.
Ans. In other cases, the repair, replacement of modem and accessories will be as per
terms of AMC
signed with the vendor at the time of its purchase and in case there is no AMC clause in
PO, the
Circle may take appropriate action for maintenance/ AMC of CPE.
3) Q. Is the cost of rented modem to be realized from customer if any mishap e.g.
theft,
physical damage is reported bv.the customer?
Ans. In the event of theft, physical damage etc of modem and its accessories, BSNL
will not bear cost of
replacement/ repair of the modem and accessorie.
Trouble shooting in Broadband (Dataone)

Problem
Error-678
Description
This is most common problems. It is due to poor connectivity. Problem can be anywhere
between B.RAS - Tier 2 - DSLAM - Modem - PC of the customer.
Remedy
Switch off / Switch on Modem (Power Switch at the back of modem ) and wait for 2
minutes. Then retry.
If problem is not solved then Reset Modem [Back pin (in the hole) to be pressed in
switched ON condition]
[Note : Link PC in black type Modem or WAN / LAN in white type Modem will go Off
and then ON and system may be stable. Then retry.
If problem is still not solved then

a)Check link lamp in Black type Modem or WAN lamp in White Modem. If it is
blinking, then it is line problem.
b)Check Modem to splitter connectivity.
i) Jack in & Jack out the cable of / to the modem and to the splitter
ii)Jack in & Jack out the telephone connection of the splitter.
If lamp is still blinking - then it is due to poor line condition / fault.

The case has to be referred to Area Broadband Team for attending the fault.
Problem
Error-691
Description
User id and Password problem.
Remedy
The case is to be referred to Central Broadband Team (08.00 AM to 08.00 PM). Central
Broadband Team will reset the password and intimate that password has been reset.
Problem
Error-769
Description
LAN not enabled.
Remedy
The LAN Card has to be enabled by following the steps given below.
i)Go to Desktop.
ii)Click "My Network Place".
iii)Select Properties.
iv)Click "Enable the local network".
Problem
Error- 797
Description
Modem or LAN driver problem
Remedy
Reset the Modem (in on condition ) by pressing button available in the backside hole of
the modem and wait for 2 mintues and then log on. If the problem is not solved then call
your vendor to check computer LAN Card driver.
Problem
Error-718
Description
i)Peak Hour - This problem occurs if loading is high on the system and number of
customers exceed the call handling capacity of B.RAS.
ii)Slack Hour -This problem occurs if PPPoE is corrupted.
Remedy
i)Peak Hour - Please try after some time.
ii)Slack Hour - Please load PPPoE again.
Problem
Error - 630-633
Description
Computer LAN Card problem.
Remedy
LAN Card has to be changed.
Problem
OSP Internet is working, Data One is not working
Description
Cable Internet is working. Tata / Reliance is working but Data One is not working. Data
One is working through LAN Card. Problem can be seen by observing PC lamp (in black
modem) LAN lamp ( in white modem) which might not be glowing or may be blinking.
Remedy
LAN Card has to be changed.
Problem
Site not opening from Data One
Description
From VSNL sites are opening, Dial-Up sites are opening but from Data One sites are not
opening. Probable reasons
i)Internet explorer is not supporting the Pope (may be pirated OS).
ii)Virus corrupting Internet explorer.
Remedy
The customer is requested to set it right.
Problem
BSNL BB DNS server may be having problem.
Description
DNS is not responding.
Remedy
Ping-61.1.96.69 or 61.1.96.71 and check up whether DNS is responding.
Broadband Utilities
To see usage details
Log in to Broadband, Go to 10.240.43.216 or 10.150.128.195.
Click on Service Record. Details of the current month usage and previous month will be
shown.
To change password
Log in to Broadband, Go to 10.240.43.216 or 10.150.128.195.
Click on 'change password', give 'Old password', 'New password' and confirm. Password
will be changed.
Trouble shooting of Broadband Modems

White Modem
After switch ON wait for 2 to 3 minutes to get the modem stable.
If telephone line / dial tone problem, contact '198'.

If Broadband / Internet not working, contact '1800-424-1600'.
Lamp features
i)Power - ON - Red
ii)WAN -Yellow
when stable
OK
when blinking
Data transfer
when not stable

Line is faulty
iii) LAN - Green

when stable
OK
when blinking fast

Data transfer
when blinking slow

Modem to PC link problem
iv)PPPoE - No use.
Reset pin is at backside Hole - to be reset whenever required in ON condition of the
modem.
Black Modem
After switch ON wait for 1to 2 minutes to get the modem stable.
If telephone line / dial tone problem, contact '198'.

If Broadband / Internet not working, contact '1800-424-1600'.
Lamp features
i)Power - ON - Red
ii)WAN -Yellow
when stable
line is OK
when blinking
slow, line trouble.
iii)PC - Green when stable OK

PC - Off- PC not connected
iv)Data - Green - Flashing - Data transfer
Reset pin is at backside Hole - to be reset whenever required in ON condition of the
modem.
If still there is problem click the link

HYPERLINK "http://www.calcuttatelephones.com/help/helpex.php"
Existing Customers
For prospective/new Customers
HYPERLINK "http://www.calcuttatelephones.com/help/helpnew.php"
New Customers
Circle: Jharkhand
SSA:Jamshedpur SSA
Name of PG Officer
Address
Email
Phone
Fax
Sri V.K. Jaipuriyar, DE(Admn.)

O/o CGMT, Ranchi
HYPERLINK "mailto:deplanning"
deplanning jsr@yahoo.co.in
0657-2341550
0657-2340042
Tips on using the Dynamic STD Locking Facility of your Phone

Use Dynamic Locking Facility to Control Access from your Telephone
Please check with the DE ( Intl ) and ascertain the type of your Exchange.
FUNCTION
E10B & OCB Exchanges DIAL
EWSD Exchanges DIAL
i) Password Registration
123 xxxx xxxx
( xxxx is your 4 digit password )
( dial twice your 4 digit password )
123 0000 xxxx
( xxxx is your 4 digit password )
ii) Allow all Calls

124 xxxx 0
iii) Bar only STD Calls

124 xxxx 1
iv) Bar STD, Trunk (180) and Internet (172) Calls

124 xxxx 2
v) Allow NSD, Cellular, Local and Trunk Calls

124 xxxx 3
vi) Bar all Out going Calls
124 xxxx 4
vii) Change your Password

123 xxxx yyyy Where, xxxx : Existing Password & yyyy : New Password.
Note : Functions (ii) and (v) are not possible from STD Barred Telephone.
Andi,
Its Julia here, today I want to tell you something about
Diabetes that you may have never heard before!
Almost everyone who has any say in Diabetes will tell you how
important it is for you to control your glucose levels, to keep a
close watch over your condition.
The best way they (the medical professionals) ask you to do

this is, is by flooding your body with alarming amounts of insulin,
or gobbling down tons of medication.
If you have joined my 3 Step program you already know, that

there is a much more healthy way of dealing with your diabetes.
If you haven't check it out yet - you owe it to yourself.
It has worked for my husband and is working for many others.

l=PA6lS&m=1gATnP.m8X7.Q9&b=qGIfR_ZW56YxQJ783Eqtyw" \o "" \t "_blank"
Visit me at Melabic.com and start taking control of your health
today.
However, what they (the pill pushers) neglect to tell you is that
you can achieve results which are quite as effective as these
conventional strategies and even double your benefits by using
natural alternative treatments.
The Fenugreek plant is the seeds of
Trigonella foenum-graecum.
This tall annual herb is native to the

Mediterranean, Ukraine, India and China.
The plant bears pods filled with numerous
light brown, diamond-shaped seeds which
possess a sweet maple aroma, and are
commonly used in cooking and flavoring.
Today, modern science has revealed that

fenugreek helps to control cholesterol and regulate blood glucose.
Fenugreek seed lowers overall serum cholesterol,
and reduces triglycerides.
Don' t just take my word for it, look at the evidence!

Clinical and experimental studies find fenugreek seeds effective in
treating Type 2 diabetes, providing significant improvements in
insulin sensitivity while reducing LDL cholesterol.
In a double-blind, placebo-controlled study, an extract of fenugreek
seeds improved glycemic control in patients with mild to moderate
Type 2 diabetes while decreasing insulin resistance.
Fenugreek is also surprisingly versatile in all the advantages
it has to offer... and these are not solely restricted to maintaining
your blood glucose at an even keel.
Fenugreek also benefits
- contains Choline which helps you think clearer and brighter than
ever before.
- proved its ability at balancing hormone levels to make PMS and
menopause a lot easier for women to deal with (an answer to every womans wish)
- used in the treatment of cancer!
These are only a few of the reasons that I have included Fenugreek
in Melabic. To find out more about fenugreek and the other nine
diabetes fighting ingredients you can visit me at
Melabic.com
Here are a few more reasons to include Fenugreek in your diet!
The amino-acid that fenugreek is abundant in, namely
4-hydroxyisoleucine helps to augment your body's production of
insulin when your blood glucose threatens to shoot skywards.
The stellar qualities of fenugreek don't quite end here... in fact
there are more than a handful of ways in which this plant can
transform your health and life, imbibing you with all the goodness
of nature at her most nurturing.
To find out more about this uncanny nutritional powerhouse,

visit me at
Melabic.com
and learn how easy it can be to give
your health a complete makeover!
Yours in low insulin living,
Julia
PS You can place your order today by calling Toll FREE 1 800 687 0076
PPS
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Mar 08
Bottom of Form
Chairman's Speech
Year : Mar '09
Dear Shareholders,
I consider it an honour to place before you, your Bank’s Annual

Report
for the year 2008-09. I would also like to share with you some of
the
significant achievements and initiatives undertaken by your Bank
during
the year.
During the year, India continued to remain the second

fastest
growing
economy in the world, because of large domestic demand, especially
from
rural India, Govt. investments, a stable financial services sector,
fall in inflation and prompt coordinated policy action on multiple
fronts. This is despite the fact that the scenario of
global
economy
during the year gone by was one of the most challenging. Its
effects
are not going to be completely wiped out even in the current year.
Its
impact on India, however notwithstanding today’s globalised world,
has
not been very severe, though it did somewhat affect industrial
production, GDP growth and exports.
On the macro-economic front, we believe that the worst is over.

The
Indian economy is showing signs of revival with growth reviving
across
sectors like cement, steel, auto, telecom, banking and FMCG.
Further,
demand from the rural sector which was the mainstay of the economy
last
year is expected to continue to propel growth in the current year.
With
a new, stable Government in place, our expectation for the GDP
growth
in 2009-10 is in excess of 7%.
Even in this slowdown, both global and domestic,

your Bank has
turned
in a brilliant performance with a splendid growth of Rs. 3,30,404
crores in total business, impressive rise in profits and containment
of
NPAs. At the same time,
your Bank continued to be on the growth
trajectory during FY-09 in respect of branch expansion with as many
as
807 new branches being opened, a majority of which (481) were in
rural
and semi-urban areas. The Bank also increased its ATM network by an
impressive 44% to 8581 by the end of FY-09. Another important
milestone
achieved by
your Bank during the year was the extension of coverage
under the Core Banking Platform to cover all its 11448 Branches.
This
is one of the largest core banking networks in the world and
growing,
and is no small achievement. Another significant event during
the
year
was acquisition of State Bank of Saurashtra, a wholly owned
Associate
of
your Bank, by
your Bank.
You will be happy to note that

your Bank showed an impressive growth
of
35.55% in Net Profit from Rs.6,729 crores in FY-08 to Rs. 9,121
crores
in FY-09. Operating Profits too posted a smart growth of 36.68% to
Rs.
17,915 crores in FY-09 on the back of a healthy increase of 22.63%
in
Net Interest income to Rs.20,873 crores in FY-09, driven by growth
in
advances and increase in yields as also an increase of 45.96% to
Rs.12,691 crores in other income.
Notwithstanding the economic slow down evidenced in the FY-09,

your
Bank registered an impressive increase in interest income which rose
by
30.31% as also a significant increase in core fee income which
showed a
growth of 28.7%. Even though operating expenses rose by 24.11%,
attributable primarily to increase in staff costs on account of
additional provisions for pension and wage revision and recruitment
of
additional staff during the year; cost to income ratio was brought
down
significantly (2.41%) from 49.03% in FY-08 to 46.62% in FY-09.
Despite
pressure on interest spreads and intense competition,
your Bank
could
still record a Net Interest margin (NIM) of 2.93% in FY-09.
During the year 2008-09,

your Bank saw excellent growth in all
businesses/market segments in which it operates. A significant
feature
during
the year was your Bank’s high growth in both Advances and
Deposits which exceeded the industry average, leading to a

significant
increase in its
market share.
Deposits of
your Bank grew by 38.08% in 2008-09 against Other
Scheduled
Commercial Banks (OSCB) growth of 16.55%, leading to a spurt in its
market share in deposits by 2.31% to 17.72% by March 2009. With
continued focus on low cost CASA deposits which registered a growth
of
23% during the year, your Bank’s
market share in demand deposits
also
rose sharply by 3.67% to 17.53%. As a part of strategy,
your Bank
reduced its reliance on bulk deposits as a percentage of total
deposits
to 10.81% from 14.13% in FY-08.
Similarly, the Bank’s advances portfolio witnessed a robust growth

(30.17%) of Rs.1,25,735 crores. This growth of 30.17% in advances
as
against OSCB growth of 16.13% pushed up your Bank’s
market share in
advances by 0.83 % to 16.03% by the year end. The growth in
advances
was well rounded with every Segment (Large advances 47%, Mid
Corporate advances 23%, SME advances 20%, Retail advances 18%,
Agri. advances 19%, International advances 54%), contributing to
the overall growth in advances. Retail lending continued to occupy
centre stage with a growth in Education Loans (50%), Auto Loans
(36%)
and Housing Loans (21%) during the year. This also helped improve
market share from 17.48% to 19.74% in respect of Home Loans and
from
10% to 12% in respect of
Auto Loans for new vehicles. To offer
timely
help to SMEs, which were reeling under the impact of slow down in
the
economy particularly exports,
your Bank launched two new schemes
SME
CARE and SME HELP offering the affected SMEs, finance on
liberalised
terms at a concessional rate of interest of 8%.
In advances to the Agriculture segment,

your Bank continued to be
above
the 18% benchmark stipulated by RBI for the second time
consecutively.
It also surpassed the targets set by the Govt. of India in respect
of
credit flow by way of fresh disbursements as also the number of new
farmers financed. In pursuit of its desire to be the Banker to
every
Indian,
your Bank has gone in for aggressive expansion in the
number
of Customer Service Points/BCs/BFs to 17,979 which now cater to
52,782
previously un-banked villages, with plans to cover additional
50,000
un-banked villages in the current year.
Your Bank is firm in its
resolve to achieve total financial inclusion through the use of the
latest and best technology. As at the end of 2008-09, as many as
23.61
lakh Smart Cards, which work on biometric validation of the
customers,
had been issued.
In the international arena too,

your Bank, despite the global
meltdown,
achieved a significant growth of 17.7% (in USD terms) in credit to
USD
17.07 billion and continued to focus on its core strategy of
capturing
India related business in high potential countries. While two of
the
Bank’s subsidiaries in Mauritius were merged during the year to
create
a new entity called SBI (Mauritius) Ltd.,
your Bank along with its
subsidiaries and Joint Ventures abroad opened 9 new offices,
including
full-fledged retail operations in Singapore, taking the total
network
of overseas offices to 92 spread over 32 countries. Amidst turmoil
in
global markets, your Bank’s foreign offices maintained a
comfortable
liquidity position and could raise US $ 686 million under Bank’s
Medium
Term Notes (MTNs) programme and bilateral loans.
Another noteworthy feature of your Bank’s performance during the

year
2008-09 has been in the area of controlling NPAs. While Gross NPAs
declined marginally to 2.84% in FY-09 from 3.04% in FY-08, Net NPA
level too was practically stable at 1.76% as against 1.78% in
FY-08.
Similarly, your Bank’s Capital Adequacy Ratio (CAR) in terms of
prescriptions of BASEL-II increased to 14.25% in FY-09. This
healthy
ratio not only meets the requirements of the regulators worldwide
but
is also comparable to the best banks globally.
You will be happy to know that the performance of the Associates of
your Bank during FY-09 has also been noteworthy with an increase of
24.7% in net profit to Rs.2774 crores and 18.95% in total assets.
The
non-banking subsidiaries, too, put up a good show with consolidation
of
their position/ranking in their space in the
financial services
arena.
Your Bank embarked on several new business initiatives during the
last
two years which have started bearing fruit. During the year
2008-09,
your Bank’s wholly owned subsidiary SBI Pension Fund Pvt. Ltd.
started functioning to manage pension funds under New Pension
System
(NPS). A Joint Venture formed with Societe Generale Securities
Services
for undertaking custodial services business is likely to commence
business during the second quarter of 2009-10. Similarly, another
Joint
Venture with Insurance Australia Group (IAG) established by
your
Bank
in November 2008 to undertake business of General Insurance is
likely
to commence business in the last quarter of 2009-10.
Your Bank has already received all regulatory approvals for
establishing a US $ 3 Billion Private Equity Fund jointly with
Macquarie Capital Group of Australia and IFC, Washington. The Fund
will
be investing primarily in infrastructure assets in India. Some
other
funds with Middle East countries are also in various stages of
being
set up.
Your Bank is also working on new initiatives in the area
of
Mobile Banking as also consolidation of Payment Solutions business
to
achieve efficiency in operations, reduce costs and avoid duplication
of
efforts.
As always, customer service and customer satisfaction remains at

the
core of our efforts. In this direction,
your Bank unveiled on the
1st
July 2008, its new Vision, Mission and Values statements, which
were
based on views of the Bank’s staff. The vision statement My SBI,
My
Customer First, My SBI: First in Customer Satisfaction vividly
describes its customer centric focus and shall be the guiding
principle
for your Bank’s plans, activities and strategies in future. Our
mass
international communication programme Parivartan was extended
during
the year to cover all Associate Banks as also 44,000 subordinate
staff
of
your Bank. A new programme named Citizen SBI, which envisages
deep
routed multilevel attitudinal change and transformation in the
organization through waves of HR intervention, is proposed to be
rolled
over in next two years.
Your Bank also opened a contact centre for
providing to customers on a toll free number, information on
products
and account enquiries on 24x7 basis.
Your Bank recruited 33,703 staff during FY-09 which was the largest
such recruitment exercise in the banking sector anywhere in the
world.
This will help
your Bank to maintain its marketing thrust, extend
efficient customer service and reduce the age profile of its staff.
I am happy to announce that the Board of Directors of

your Bank
declared a dividend of 290% for the year ended 31st March 2009.
It is but natural that the efforts and initiatives undertaken by

your
Bank are recognized by Society.
Your Bank was the proud recipient
of
many recognitions/awards during the year, the notable among them
being
Bank of the Year 2008 - India - by the Banker Magazine, Most
Admired
Infrastructure Financier Award by KPMG, Top Public Sector Bank
under
SME Financing by Dun and Bradstreet and Best Executive Award to the
Chairman by Asia Money.
Your Bank also improved its ranking in
Fortune 500 Global List, Forbes list of 2000 largest companies in
the world, Banker list of top 1000 world banks, Brand Finance
Global 500 Financial Brand recognition, to name a few.
Today, India remains among the fastest growing

countries of the
world
and is poised to play a greater role in the global economy in the
year
to come.
Your Bank sees this as an opportunity and a challenge. I
wish
to assure you that
your Bank will try to capitalize on this and
blaze a
new trail of growth in future.
With warm regards,

Yours sincerely,
(OM PRAKASH BHATT)
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FREEDOM AAJ KAL

Has the golden age actually started for the Indian small investor or is it waiting in the
wings Freedom is still a few miles away, says Anand Rawani
THE countdown to Indias 63rd Independence Day has begun and what could be a better
time than this to get into retrospection mode. We at SundayET have always been a step
ahead when it comes to the small investors interest - in other words your interest. And
this time, we decided to try and figure out if the small investor in India had really arrived
big time, as is sometimes made out to be, or are some of the myths around Dalal Street
more hype and hoopla Has the golden age actually started for the Indian small investor -
or is it waiting in the wings How far away are we from financial freedom
At first sight, it surely seems that retail investors have things cut out for them and life was
never so good. From mutual fund investments to putting money in stocks, buying an
insurance policy, buying or investing in real estate or filing tax returns, all the deals that
one can possibly think of are simple and painless. However, the flip side is that this is just
the beginning and a lot remains to be done. In fact, investors can and should expect better
facilities and new products for investment and risk management going forward.
Looking for landmarks that have helped play out the freedom theme for Indian investors -
the recently launched new pension scheme (NPS) immediately comes to mind. It has
brought cheer to many private sector employees, since now they too can avail themselves
of pension facilities, which were earlier available only to government employees. In fact,
one of the most important reasons for seeking out jobs in the government sector was the
assured pension that would come after retirement. But now, any citizen of India can
invest in this product to help secure their old age. There were several pension funds in the
market such as public provident fund (PPF) and employee provident fund (EPF) and
numerous other schemes offered by mutual funds and insurance companies.
But the problem with those was that the returns from PPF and EPF are relatively lower
and schemes offered by mutual fund and insurance companies are costlier than NPS. NPS
is a more efficient product and gives the freedom to investors to participate both in equity
and debt markets depending on their risk profile . The flip side to it is that the returns are
taxable and since, there is not much incentive for distributors, the benefit may remain
confined to a few informed investors only.
Moving to the stock market - theres been a sea change there in the last few decades,
which is all about more power to the investors. Now theres freedom from floor trading
and physical share certificates. In fact, the very hallmark of Dalal Street - where brokers
bought and sold shares by out crying - is, as we all know, a thing of the past. Flashback to
those days - the major difficulty that investors faced was to sell or buy at a particular
price. The prices kept changing and one couldnt sell all shares at a given price. Brokers
used to take a long time to execute the complete trade in case the quantity was big - due
to lack of liquidity. After the execution of trade, investors had to wait for a month for the
share certificate. And then they also faced hassles regarding the transfer of ownership as
investors needed to affix transfer stamps and then had to send them to the respective
registrar & share transfer agents. Investors had no option but to wait for around a month
again for ownership transfer to happen . So surprise really that many investors, preferred
to put money in fixed deposits rather than investing in shares. The average transaction
time was more than a fortnight. Investors could not buy single shares as the lot sizes were
higher and generally, used to be in the range of 50 to 100 shares.
Of course all that is history, today its electronic trading. National Stock Exchange was
first one to go electronic. Investors have the freedom to buy or sell from anywhere with
the help of the Internet. In fact, the impact cost has also come down substantially .
Investors no longer need to struggle with share certificates as all the shares are in
electronic form. And best of all, overall cost of transaction in India is probably the lowest
in the world. Welcome to the world of demat!
Why is it then that every small investor is not jumping into the equity bandwagon. More
than 3/4th of the trading is done by corporates and high net worth individuals and there is
not much participation from retail investors. There is need for more depth and more
participation from retail investors. While the move to bring down promoters holding to at
least 75% will increase the float, it is not yet clear when that will actually happen.
According to Anup Bagchi, ED at ICICI Securities, investors have got freedom in terms
of available instruments and easy and convenient transaction. The overall cost has also
come down. Going forward many new instruments will come, which will help in better
risk management.
While equity has become a buzzword among small investors, the Indian debt market
remains shallow. Although, government bonds are liquid to a great extent but there is not
enough trading volume as far as the corporate debt market is concerned. The total
turnover of the Indian corporate debt market in the Bombay Stock Exchange was merely
around Rs 6 cr on August 6, 2009, against a turnover of around Rs 7,000 in the equity
category. In fact, there is no direct participation from retail investors in the debt market as
the ticket size is very high. Most of the time bonds are issued though private placement
and in general participants are either high net worth individuals or institutional investors.
Thanks to the debt mutual funds, retail investors have the freedom to participate in the
debt market, however, indirectly. Going forward more debt instruments have to be
launched to ensure direct participation of retail investors.
Remember the days of the stranglehold over the market by UTI Mutual Fund MF
investors have surely come a long way. They have seen the journey from a monopoly to
more than a dozen asset management companies today. It was only in the 1990s, when
private sector companies were allowed to set up shop to provide services, that the
monopoly of UTI ended after more than two decades.
In the latter half of the 90s, mutual fund companies started giving account statements,
these statements used to take months to reach to investors. Also, it used to take a fortnight
for a dividend cheque to come to the investor. Investor awareness about the scheme was
very limited as there was no offer document and periodic portfolio disclosure. Thanks to
the Securities & Exchange Board of India (Sebi), which later made it mandatory to
disclose the portfolios regularly.
In fact, the current move by Sebi - that mutual fund investors are not required to pay an
entry load but have the freedom to decide the commission of distributor based on the
quality of service that distributors give - has given more freedom to mutual fund investors
. According to Jaideep Bhattacharya, chief marketing officer at UTI Mutual Fund,
investors have got a lot of freedom during the last few years in terms of transparency and
cost, however, such independence is only available in the mutual fund industry.
Going forward, experts think that there are lot many things to be done in the mutual fund
industry. According to Piyush Surana, CEO at Shinsei Asset Management Company, the
industry needs to grow from just selling products to selling solutions. It has to be a need
based solution provider.
Like mutual fund, the life insurance industry has scripted a similar story. Until recently it
was a onecompany industry. Life Insurance Company was the only player. Now investors
are spoilt for choice and have options to buy an insurance policy from 22 insurance
companies. According to G V Nageswara Rao, MD & CEO at IDBI Fortis Life
Insurance, there has been drastic reduction in the cost. The recent move of Insurance and
Regulatory Development Authority on capping the total cost in ULIP to 300 basis points
of the gross return will further make the industry cost competitive and beneficial for
customers. Going forward investors can expect more simplified and convenient
operational and sales process and hence the cost will be even cheaper.
As far as tax planning is concerned, although it is difficult to get freedom from paying
taxes, but over a period of time rates have come down and exemption limits have gone
up. For instance, now income up to Rs 1.5lakh is exempt, which was merely Rs 1lakh a
couple of years back. Also, no longer its just investments in insurance and public
provident fund give tax benefit but investors have several other options, such as equity
linked saving schemes, ULIPs, NPS and FDs, to choose from. No longer does one need
to stand in queue but can file their tax returns online through e-filing . However, the
system has to improve further as it takes a long time in getting the money back in case
someone has paid more than the actual tax liability.
Buying and investing in real estate was also not so easy before. In fact, the focus on
affordable segment by real estate developers and government has ensured there must be a
house in every range. Until a year back, housing prices were starting from Rs 15 to 20
lakh, currently there are several projects, which assure to provide home at a price, which
is as low as Rs 5 to 7 lakh. Also, with many Internet sites coming into play it is easier to
get virtual tours of the residences. The transaction time has also come down.
While over the years investors have been empowered and given more freedom, yet a lot
remains to be done, to give them full financial freedom.
anand.rawani@timesgroup .com
T1141582
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pulse rate, weight gain even when not eating a lot, constipation, menstrual irregularities,
elevated cholesterol levels, muscle pain, hair loss, dry skin, brittle nails, poor memory
and concentration, depression, low libido, anxiety, and many more. Depending on the
severity of the condition, virtually all body systems slow down because the metabolic rate
of all the cells in the body is lowered.
Links to lists of hypothyroidism symptoms are in our
HYPERLINK "http://www.altsupportthyroid.org/ff/ff3.php" \l "symptoms"
Fast Facts: Symptoms
section.
Treatment options
Synthetic T4
Once a patient is diagnosed with hypothyroidism, the usual treatment is thyroid hormone
replacement of
HYPERLINK "http://www.altsupportthyroid.org/treatment/hypomed.php" \l "t4"
synthetic T4
only. Common brand names are Synthroid, Unithroid, and Levoxyl. For details about
synthetic medications and brand names, see
Hypothyroidism Medication: Synthetic T4
.
Synthetic T4 is a satisfactory treatment for many patients with hypothyroidism. They take
the medication, they get better, and they don't need to go online looking for answers to
their health problems. For the numerous other patients who find relief of only some
symptoms — or none at all — with synthetic T4 alone, we've compiled information about
treatment alternatives.
Synthetic T4 and T3 combination
The theory behind the use of synthetic T4 alone is that since the thyroid gland converts
some T4 to T3, some of the synthetic T4 will be converted to T3 as well. A problem with
this theory is that the thyroid gland of a hypothyroid person is already malfunctioning by
not producing enough or any thyroid hormone, so its ability to convert T4 to T3 may be
hampered too.
On our
HYPERLINK "http://www.altsupportthyroid.org/t3/t3refs.php"
T3 References
pages, we link to studies showing that many patients do much better when they take
synthetic T3 in addition to T4. The
HYPERLINK "http://www.altsupportthyroid.org/t3/t3exp1pr.php"
Patients' Experiences pages
have experiences in patients' own words about the difference T3 made to their health.
T3 can be taken as a separate medication (common brand names Cytomel and Tertroxin)
in addition to synthetic T4, or in a combination T4/T3 synthetic medication (Thyrolar;
available in the US only). For details about synthetic T3 and brand names, see
Hypothyroidism Medication: Synthetic T3
.
Natural desiccated thyroid
Although pharmaceutical company representatives tell doctors that synthetic T4 is
superior to natural,
HYPERLINK "http://www.altsupportthyroid.org/dt.php"
desiccated thyroid
from pigs' thyroids, many patients don't start to feel normal again until they switch from
synthetic to natural thyroid hormone. Desiccated thyroid hormone replacement has been
used
HYPERLINK "http://www.altsupportthyroid.org/treatment/history.php" \l "beg"
since the late 1800s
, and it is one of the safest drugs available. It contains both T4 and T3 and probably the
thyroid hormones T2 and T1 as well. (The latter hormones aren't measured, but they
aren't removed either.)
Our
HYPERLINK "http://www.altsupportthyroid.org/dt/dtrefs.php"
Desiccated Thyroid References
pages have
HYPERLINK "http://www.altsupportthyroid.org/dt/dtmedrefs.php"
medical journal
article excerpts, articles by
HYPERLINK "http://www.altsupportthyroid.org/dt/dtrefs1.php"
doctors
, quotes from
HYPERLINK "http://www.altsupportthyroid.org/dt/dtrefs2.php"
interviews with doctors
, and
HYPERLINK "http://www.altsupportthyroid.org/dt/dtexp1pr.php"
Patients' Experiences pages
.
Armour is the most common brand name of desiccated thyroid, but there are others. For
details about desiccated thyroid and brand names, see
HYPERLINK "http://www.altsupportthyroid.org/treatment/hypomed.php" \l "dt"
Hypothyroidism Medication: Desiccated Thyroid
.
Finding a good thyroid doctor
See our
HYPERLINK "http://www.altsupportthyroid.org/doctor.php"
How to Find
}ÍÁyhÁyby\V\y\yPyÍÁÍ
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oèÕgWgKgKgWgKg
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R a Good Thyroid Doctor
page for tips on finding the best thyroid doctor for you.
Working with your doctor
With the right type and dose of medication for each person, everyone with
hypothyroidism should be able to return to good health. Since medical students often
learn only about synthetic T4 to treat hypothyroidism, many patients are doing their own
research to find what might work for them.
One of the aims of this site is to help patients in this search. Doctors too may find the
information compiled here to be of use to them.
While adequate treatment for hypothyroidism eliminates the symptoms of this condition,
some other health conditions have similar symptoms. People may have more than one
health problem at a time, and it's important to have all the problems diagnosed and
treated. Committed doctors will work with patients to diagnose and treat all the
conditions successfully.
Hypothyroidism Treatment Files
HYPERLINK "http://www.altsupportthyroid.org/hypotreatment.php"
Hypothyroidism Treatment
An overview of treatment for hypothyroidism and the pages in this section
HYPERLINK "http://www.altsupportthyroid.org/treatment/history.php"
Hypothyroidism Treatment History
Early treatment, synthetics until the present, the standardization hoax, and links to more
information
HYPERLINK "http://www.altsupportthyroid.org/treatment/hypomed.php"
Hypothyroidism Medication
Brand names, content, availability, physician knowledge, and other information about
synthetic T4, synthetic T3, synthetic T4/T3 combination, and desiccated thyroid
HYPERLINK "http://www.altsupportthyroid.org/treatment/hypomedcomp.php"
Hypothyroidism Medication Comparison
A side-by-side look at synthetic T4, synthetic T3, synthetic T4/T3 combination, and
desiccated thyroid comparing the above information
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important-txt
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Text or compa
Forms.HTML:Text.1
Embedded Control
Forms.HTML:Text.1
<INPUT TYPE="TEXT" NAME="search" VALUE="Text or company name">
CompObj
CompObj
ObjInfo
ObjInfo
OCXDATA
OCXDATA
OCXNAME
OCXNAME
DefaultOcxName75
DefaultOcxName75
_1312220786
_1312220786
CompObj
CompObj
ObjInfo
ObjInfo
Keyword
Forms.HTML:Select.1
Embedded Control
Forms.HTML:Select.1
<SELECT NAME="select">
<OPTION SELECTED VALUE="keyword">Keyword
<OPTION VALUE="Price">Price
<OPTION VALUE="headline">BS Headlines
<OPTION VALUE="author">Author
<OPTION VALUE="all">BS Entire Site
<OPTION VALUE="
OCXDATA
OCXDATA
OCXNAME
OCXNAME
_1312220787
_1312220787
web">Web
</SELECT>
web">Web
</SELECT>
DefaultOcxName112
DefaultOcxName112
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spacer
spacer
cmPPJCmp0712
Normal
function call_page()
{
if(document.frmsearch.search.value=="Text or company name")
alert("Please Enter the Text

or company name");
return false;
else
if(document.frmsearch.select.value=="Price")
document.frmsearch.action="/stockpage/stock_search.php";
document.frmsearch.submit();
else
if(document.frmsearch.select.value=="web")
document.frmsearch.action="/india/googlesearch/searchhom_google.php";
else
document.frmsearch.action="/india/search_news.php";
function call_page()
if(document.frmsearch.search.value=="Text or company name")
alert("Please Enter the Text

or company name");
return false;
else
if(document.frmsearch.select.value=="Price")
document.frmsearch.action="/stockpage/stock_search.php";
else
if(document.frmsearch.select.value=="web")
document.frmsearch.action="/india/googlesearch/searchhom_google.php";
}
else
document.frmsearch.action="/india/search_news.php";
JavaScript
JavaScript
Normal
src="http://www.business-standard.com/india/js/util-functions.js" type="text/javascript"
src="http://www.business-standard.com/india/js/util-functions.js" type="text/javascript"
3.8Ì´ŒÍìþ(6
jPts
Normal
src="http://www.business-standard.com/india/js/clear-default-text.js"
src="http://www.business-standard.com/india/js/clear-default-text.js"
3.8Ì´ŒÍìþ(6
jPts
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3.8Ì´ŒÍìþ(6
jPts
Normal
_uacct = "UA-3333643-1";
urchinTracker();
_uacct = "UA-3333643-1";
urchinTracker();
3.8Ì´ŒÍìþ(6
jPts
Normal


JavaScript
JavaScript
Normal

3.8Ì´ŒÍìþ(6
jPts
Normal
</td></tr>
<tr><td> </td></tr>
<tr><td> <head>
<script language="javascript" src="/india/js/js.js">

</td></tr>
<tr><td> </td></tr>
<tr><td> <head>

3.8Ì´ŒÍìþ(6
jPts
Normal
src="http://pagead2.googlesyndication.com/pagead/expansion_embed.js"
3.8Ì´ŒÍìþ(6
jPts
Normal
src="http://googleads.g.doubleclick.net/pagead/test_domain.js"
3.8Ì´ŒÍìþ(6
jPts
Normal
src="http://pagead2.googlesyndication.com/pagead/render_ads.js"
3.8Ì´ŒÍìþ(6
jPts
Normal
3.8Ì´ŒÍìþ(6
jPts
redBullet
redBullet
cmPPJCmp0712
leftselected
leftselected
cmPPJCmp0712
rightselected
rightselected
cmPPJCmp0712
subTabs_19
subTabs_19
cmPPJCmp0712
9g\K)x
subTabs_23
subTabs_23
cmPPJCmp0712
redBullet
redBullet
cmPPJCmp0712
subTabs_19
subTabs_19
cmPPJCmp0712
9g\K)x
subTabs_23
subTabs_23
cmPPJCmp0712
leftselected
leftselected
cmPPJCmp0712
rightselected
rightselected
cmPPJCmp0712
blueArrow
blueArrow
cmPPJCmp0712
cH`P``
Normal

3.8Ì´ŒÍìþ(6
jPts
Normal
</td></tr>
<tr><td> </td></tr>
<tr><td> <head>

</td></tr>
<tr><td> </td></tr>
<tr><td> <head>

src="http脊
src="htt腰
舀
茀
://pagead2.googlesyndication.com/pagead/show_ads.js" type="text/javascript"
://pagead2.googlesyndication.com/pagead/show_ads.js" type="text/javascript"
3.8Ì´ŒÍìþ(6
jPts
Normal
3.8Ì´ŒÍìþ(6
jPts
Normal
3.8Ì´ŒÍìþ(6
jPts
Normal
3.8Ì´ŒÍìþ(6
jPts
Normal
3.8Ì´ŒÍìþ(6
jPts
redBullet
redBullet
cmPPJCmp0712
leftselected
leftselected
cmPPJCmp0712
rightselected
rightselected
cmPPJCmp0712
subTabs_19
subTabs_19
cmPPJCmp0712
9g\K)x
subTabs_23
subTabs_23
cmPPJCmp0712
redBullet
redBullet
cmPPJCmp0712
subTabs_19
subTabs_19
cmPPJCmp0712
9g\K)x
subTabs_23
subTabs_23
cmPPJCmp0712
leftselected
leftselected
cmPPJCmp0712
rightselected
rightselected
cmPPJCmp0712
blueArrow
blueArrow
cmPPJCmp0712
cH`P``
redBullet
redBullet
cmPPJCmp0712
.TUTia
.TUTia
cmPPJCmp0712
redBullet
redBullet
cmPPJCmp0712
redBullet
redBullet
cmPPJCmp0712
redBullet
redBullet
cmPPJCmp0712
redBullet
redBullet
cmPPJCmp0712
redBullet
redBullet
cmPPJCmp0712
diabetic-retinopathy
diabetic-retinopathy
$.' ",#
(7),01444
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t%¤•|Öåär2M\cÜÊzjÑU-nµ)Dš€1F¼¬
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t ôQïü«Y/´¶
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.8Åg_cÊrFC
SWËìP vâ³/Ii bx
CompObj
CompObj
ObjInfo
ObjInfo
OCXDATA
OCXDATA
OCXNAME
OCXNAME
Forms.HTML:Hidden.1
Embedded Control
Forms.HTML:Hidden.1
<INPUT TYPE="hidden" NAME="cid">
DefaultOcxName77
DefaultOcxName77
_1312220788
CompObj
CompObj
ObjInfo
ObjInfo
Forms.HTML:Hidden.1
Embedded Control
Forms.HTML:Hidden.1
<INPUT TYPE="hidden" NAM
OCXDATA
OCXDATA
OCXNAME
OCXNAME
_1312220789
_1312220789
E="mbsearch_str">
E="mbsearch_str">
DefaultOcxName114
DefaultOcxName114
Forms.HTML:Hidden.1
Embedded Control
Forms.HTML:Hidden.1
<INPUT TYPE="hidden" NAME="topsearch_type" VALUE="1">
DefaultOcxName213
DefaultOcxName213
CompObj
CompObj
ObjInfo
ObjInfo
OCXDATA
OCXDATA
OCXNAME
OCXNAME
_1312220790
_1312220790
CompObj
CompObj
ObjInfo
ObjInfo
Type Here
Forms.HTML:Text.1
Embedded Control
Forms.HTML:Text.1
<INPUT TYPE="TEXT" NAME="search_str" VALUE="Type Here">
DefaultOcxName313
DefaultOcxName313
OCXDATA
OCXDATA
OCXNAME
OCXNAME
_1312220791
_1312220791
##############################################################
""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""""
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!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!
!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!
##############################################################
Forms.HTML:Image.1
Embedded Control
Forms.HTML:Image.1
<INPUT TYPE="image" SRC=
CompObj
CompObj
ObjInfo
ObjInfo
OCXDATA
OCXDATA
OCXNAME
OCXNAME
"http://img1.moneycontrol.com/images/mc2008/markets/searchBut.gif"
METHOD="post">
"http://img1.moneycontrol.com/images/mc2008/markets/searchBut.gif"
METHOD="post">
DefaultOcxName413
DefaultOcxName413
-ă_1312220792
_1312220792
CompObj
CompObj
ObjInfo
ObjInfo
qÜQ)6‰nëRv(Ùn¬x4
Hãr®Ðk=D¶*o*qše¬b;
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m3S°Õ¢U-3}"Ç${§i2
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+P
Normal
src="addthis_widget.js" type="text/javascript"
src="addthis_widget.js" type="text/javascript"
3.8Ì´ŒÍìþ(6
jPts
Normal
addthis_pub = 'dhirajminocha';
addthis_pub = 'dhirajminocha';
3.8Ì´ŒÍìþ(6
jPts
button1-bm
button1-bm
`PLTE_
cmPPJCmp0712
IDATHK
mt¾ >w:1F
,
font_minus
font_minus
,É ¾j(73B·[:[Í
,É ¾j(73B·[:[Í
PNG
cmPPJCmp0712
font_plus
font_plus
cmPPJCmp0712
icon_print
icon_print
b`_b^]
cmPPJCmp0712
icon_feedback
icon_feedback
cmPPJCmp0712
Dâ®ñ…¤
òn=)mn1p={ADÐ
icon_email
icon_email
cmPPJCmp0712
icon_discuss
icon_discuss
cmPPJCmp0712
PLTE/Pqþ
cmPPJCmp0712
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searchcurL
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Livequote
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searchcurR
cmPPJCmp0712
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Normal

d of configuration
OAS_version = 10;
OAS_rn = '001234567890'; OAS_rns = '1234567890';
OAS_rn = new String (Math.random()); OAS_rns = OAS_rn.substring (2, 11);
function OAS_NORMAL(pos) {
document.write('<A HREF="' + OAS_url + 'click_nx.ads/' + OAS_sitepage + '/1' +

OAS_rns + '@' + OAS_listpos + '!' + pos + OAS_query + '" TARGET=_top>');
document.write('<IMG SRC="' + OAS_url + 'adstream_nx.ads/' + OAS_sitepage + '/1' +

OAS_rns + '@' + OAS_listpos + '!' + pos + OAS_query + '" BORDER=0
ALT="Click!"></A>');
//-->
3.8Ì´ŒÍìþ(6
jPts
Normal


3.8Ì´ŒÍìþ(6
jPts
Normal
src="http://oas.tech2.com/RealMedia/ads/adstream_mjx.ads/www.moneycontrol.com/m
arkets/internal/1932030940@Top,x16,x17,x18,Right2,x02?"
src="http://oas.tech2.com/RealMedia/ads/adstream_mjx.ads/www.moneycontrol.com/m
arkets/internal/1932030940@Top,x16,x17,x18,Right2,x02?"
JavaScript1.1
JavaScript1.1
3.8Ì´ŒÍìþ(6
jPts
Normal


3.8Ì´ŒÍìþ(6
jPts
Normal


3.8Ì´ŒÍìþ(6
jPts
1932030940@Top,x16,x17,x18,Right2,x02!Top?
1932030940@Top,x16,x17,x18,Right2,x02!Top?
Click!
Click!
morelinks_n
morelinks_n
PLTE+Z
cmPPJCmp0712
RIDATHKÅ
m
7¦ù¡ºÍ¶õäê:¾&zsEš>@«•vf5
\
morelinks_n
morelinks_n
PLTE+Z
cmPPJCmp0712
RIDATHKÅ
m
\
morelinks_n
morelinks_n
PLTE+Z
cmPPJCmp0712
RIDATHKÅ
m
\
morelinks_n
morelinks_n
PLTE+Z
cmPPJCmp0712
RIDATHKÅ
m
\
morelinks_n
morelinks_n
PLTE+Z
cmPPJCmp0712
RIDATHKÅ
m
\
morelinks_n
morelinks_n
PLTE+Z
cmPPJCmp0712
RIDATHKÅ
m
\
morelinks_n
morelinks_n
PLTE+Z
cmPPJCmp0712
RIDATHKÅ
m
\
online_n
online_n
bKGD?>c0u
cmPPJCmp0712
IDAT(SMÎ
n
0
4±
×s+C!c`
morelinks_n
morelinks_n
PLTE+Z
cmPPJCmp0712
RIDATHKÅ
m
\
morelinks_n
morelinks_n
PLTE+Z
cmPPJCmp0712
RIDATHKÅ
m
\
morelinks_n
morelinks_n
PLTE+Z
cmPPJCmp0712
RIDATHKÅ
m
\
CloseIcon
CloseIcon
`PLTE333öö
cmPPJCmp0712
IDAT(SmPA
;m
œ¸™8i‡1‚ùÖltÂ¸4Š¼0Xl>VN
Normal
var IE = document.all?true:false;
var anychange=0;
var bak_price_div;
var matrix=0;
var cnbc_matrix=0;
var IE = document.all?true:false;
var anychange=0;
var bak_price_div;
var matrix=0;
var cnbc_matrix=0;
3.8Ì´ŒÍìþ(6
jPts
Normal
src="http://stat1.moneycontrol.com/mcjs/mc_main_js.js" type="text/javascript"
src="http://stat1.moneycontrol.com/mcjs/mc_main_js.js" type="text/javascript"
3.8Ì´ŒÍìþ(6
jPts
arrowleftmonth
arrowleftmonth
cmPPJCmp0712
!IDAT(S
BôêBd~P&u
arrowrightmonth
arrowrightmonth
cmPPJCmp0712
(IDAT(S
Get Quote
Forms.HTML:Text.1
Embedded Control
Forms.HTML:Text.1
<INPUT TYPE="TEXT" SIZE=
OCXDATA
OCXDATA
OCXNAME
OCXNAME
_1312220793
_1312220793
"27" NAME="search_str" VALUE="Get Quote">
"27" NAME="search_str" VALUE="Get Quote">
DefaultOcxName512
DefaultOcxName512
Forms.HTML:Image.1
Embedded Control
Forms.HTML:Image.1
<INPUT TYPE="image" SRC="http://img1.moneycontrol.com/im
=======================================
"222222222222222222222222222222222222222"
/888888888888888888888888888888888888888/
333333333333333333333333333333333333333
8;;;;;;;;;;;;;;;;;;;;;;;;;;;;;;;;;;;;;;;8
;;;;;;;;;;;;;;;;;;;;;;;;;;;;;;;;;;;;;;;;;
44444444444444444444444444444444444444444
55555555555555555555555555555555555555555
00000000000000&--000000000000000000000000
99999999999.
99999999999999
99999999999.
9999999
99999999999999
=
::::::::::::
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=
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&//////////////////////
:::::::::::::::::::::::::::::::::::::::::
=
77777777777777777777777777777777777777777
=
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<<<<<<<<<<<<<<<<<<<<<<<<<<<<<<<<<<<<<<<<<
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<<<<<<<<<<<<<<<<<<<<<<<<<<<<<<<<<<<<<<<<<
=
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66666666666666666666666666666666666666666
=
!6>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>6!
>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>
>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>
%111111111111111111111111111111111111111%
(=======================================(
=======================================
"222222222222222222222222222222222222222"
/888888888888888888888888888888888888888/
333333333333333333333333333333333333333
8;;;;;;;;;;;;;;;;;;;;;;;;;;;;;;;;;;;;;;;8
;;;;;;;;;;;;;;;;;;;;;;;;;;;;;;;;;;;;;;;;;
44444444444444444444444444444444444444444
55555555555555555555555555555555555555555
00000000000000&--000000000000000000000000
99999999999.
99999999999999
99999999999.
9999999
99999999999999
=
::::::::::::
:::::::::::::::::::::
=
/////////////+
&//////////////////////
:::::::::::::::::::::::::::::::::::::::::
=
77777777777777777777777777777777777777777
=
=
<<<<<<<<<<<<<<<<<<<<<<<<<<<<<<<<<<<<<<<<<
=
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<<<<<<<<<<<<<<<<<<<<<<<<<<<<<<<<<<<<<<<<<
=
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66666666666666666666666666666666666666666
=
!6>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>6!
>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>
>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>
%111111111111111111111111111111111111111%
(=======================================(
CompObj
CompObj
ObjInfo
ObjInfo
OCXDATA
OCXDATA
OCXNAME
OCXNAME
ages/stocks/pc_new/goBut.gif" METHOD="post">
ages/stocks/pc_new/goBut.gif" METHOD="post">
DefaultOcxName611
DefaultOcxName611
_1312220795
CompObj
CompObj
ObjInfo
ObjInfo
matrixplusminus
matrixplusminus
YYYÌÌÌ/u(rrrSŸ
cmPPJCmp0712
IDAT(S=Ð
r
0
dwn_arrowred
dwn_arrowred
bse_img_top
bse_img_top
cmPPJCmp0712
dwn_arrowred
dwn_arrowred
nse_img_top
nse_img_top
cmPPJCmp0712
refreshicon_2008
refreshicon_2008
`PLTEHJLää
{|~ÇÈÉžŸ¡õõõVXZ½¾¿ÿÿÿÔÔÕRRZabd
}~€¥¦§®¯°cckWY[
025
cmPPJCmp0712
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'
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bot_grey_cur
bot_grey_cur
PLTESSS
jjjHHH
cmPPJCmp0712
/IDAT8
c`
top_cur_WT
top_cur_WT
PLTEHHHvvvÆÆÆ
cmPPJCmp0712
+IDAT8
c`
cmPPJCmp0712
Normal
{OAS_AD('x02');}
3.8Ì´ŒÍìþ(6
jPts
1932030940@Top,x16,x17,x18,Right2,x02!x02?
1932030940@Top,x16,x17,x18,Right2,x02!x02?
Click!
Click!
top_cur_WB
top_cur_WB
PLTEHHHvvvÆÆÆﾍ
cmPPJCmp0712
+IDAT8
cPq
Normal
sensex_ajax_auto();
setInterval("sensex_ajax_auto()",20000);
sensex_ajax_auto();
setInterval("sensex_ajax_auto()",20000);
3.8Ì´ŒÍìþ(6
jPts
Normal
var ie=document.all
var enabletip=false
if (ie||ns6)

function ietruebody(){
return (document.compatMode && document.compatMode!="BackCompat")?

document.documentElement : document.body
}
function ddrivetip12(thetext, thecolor, thewidth){
if (ns6||ie){
if (typeof thewidth!="undefined") tipobj1.style.width=thewidth+"px"
if (typeof thecolor!="undefined" && thecolor!="")

tipobj1.style.backgroundColor=thecolor
tipobj1.innerHTML=thetext;
enabletip=true
return false
function positiontip(e){
if (enabletip){
var curX=(ns6)?e.pageX : event.x+ietruebody().scrollLeft;
var curY=(ns6)?e.pageY : event.y+ietruebody().scrollTop;
//Find out how close the mouse is to the corner of the window
var rightedge=ie&&!window.opera? ietruebody().clientWidth-event.clientX-

offsetxpoint : window.innerWidth-e.clientX-offsetxpoint-20
var bottomedge=ie&&!window.opera? ietruebody().clientHeight-event.clientY-

offsetypoint : window.innerHeight-e.clientY-offsetypoint-20
var leftedge=(offsetxpoint<0)? offsetxpoint*(-1) : -1000
//if the horizontal distance isn't enough to accomodate the width of the context menu
if (rightedge<tipobj1.offsetWidth)
//move the horizontal position of the menu to the left by it's width
tipobj1.style.left=ie? ietruebody().scrollLeft+event.clientX-tipobj1.offsetWidth+"px" :
window.pageXOffset+e.clientX-tipobj1.offsetWidth+"px"
else if (curX<leftedge)
tipobj1.style.left="5px"
else
//position the horizontal position of the menu where the mouse is positioned
tipobj1.style.left=curX+offsetxpoint+"px"
//same concept with the vertical position
if (bottomedge<tipobj1.offsetHeight)
tipobj1.style.top=ie? ietruebody().scrollTop+event.clientY-tipobj1.offsetHeight-
offsetypoint+"px" : window.pageYOffset+e.clientY-tipobj1.offsetHeight-
offsetypoint+"px"
else
tipobj1.style.top=curY+offsetypoint+"px"
tipobj1.style.visibility="visible"
function hideddrivetip12(){
if (ns6||ie){
enabletip=false
tipobj1.style.visibility="hidden"
tipobj1.style.left="-1000px"
tipobj1.style.backgroundColor=''
tipobj1.style.width=''
document.onmousemove=positiontip;
var matrix_adunit=1;
setcookie('WATCH_INTER_COUNT','0',1);
var ie=document.all
var enabletip=false
if (ie||ns6)

function ietruebody(){
return (document.compatMode && document.compatMode!="BackCompat")?

document.documentElement : document.body
}
function ddrivetip12(thetext, thecolor, thewidth){
if (ns6||ie){
if (typeof thewidth!="undefined") tipobj1.style.width=thewidth+"px"
if (typeof thecolor!="undefined" && thecolor!="")

tipobj1.style.backgroundColor=thecolor
tipobj1.innerHTML=thetext;
enabletip=true
return false
function positiontip(e){
if (enabletip){
var curX=(ns6)?e.pageX : event.x+ietruebody().scrollLeft;
var curY=(ns6)?e.pageY : event.y+ietruebody().scrollTop;
//Find out how close the mouse is to the corner of the window
var rightedge=ie&&!window.opera? ietruebody().clientWidth-event.clientX-

offsetxpoint : window.innerWidth-e.clientX-offsetxpoint-20
var bottomedge=ie&&!window.opera? ietruebody().clientHeight-event.clientY-

offsetypoint : window.innerHeight-e.clientY-offsetypoint-20
var leftedge=(offsetxpoint<0)? offsetxpoint*(-1) : -1000
//if the horizontal distance isn't enough to accomodate the width of the context menu
if (rightedge<tipobj1.offsetWidth)
//move the horizontal position of the menu to the left by it's width
tipobj1.style.left=ie? ietruebody().scrollLeft+event.clientX-tipobj1.offsetWidth+"px" :
window.pageXOffset+e.clientX-tipobj1.offsetWidth+"px"
else if (curX<leftedge)
tipobj1.style.left="5px"
else
//position the horizontal position of the menu where the mouse is positioned
tipobj1.style.left=curX+offsetxpoint+"px"
//same concept with the vertical position
if (bottomedge<tipobj1.offsetHeight)
tipobj1.style.top=ie? ietruebody().scrollTop+event.clientY-tipobj1.offsetHeight-
offsetypoint+"px" : window.pageYOffset+e.clientY-tipobj1.offsetHeight-
offsetypoint+"px"
else
tipobj1.style.top=curY+offsetypoint+"px"
tipobj1.style.visibility="visible"
function hideddrivetip12(){
if (ns6||ie){
enabletip=false
tipobj1.style.visibility="hidden"
tipobj1.style.left="-1000px"
tipobj1.style.backgroundColor=''
tipobj1.style.width=''
document.onmousemove=positiontip;
var matrix_adunit=1;
setcookie('WATCH_INTER_COUNT','0',1);
3.8Ì´ŒÍìþ(6
jPts
Normal
3.8Ì´ŒÍìþ(6
jPts
Normal
_uacct = "UA-156703-1";
urchinTracker();
_uacct = "UA-156703-1";
urchinTracker();
3.8Ì´ŒÍìþ(6
jPts
Normal
var gaJsHost = (("https:" == document.location.protocol) ? "https://ssl." : "http://www.");
document.write(unescape("%3Cscript src='" + gaJsHost + "google-analytics.com/ga.js'
type='text/javascript'%3E%3C/script%3E"));

3.8Ì´ŒÍìþ(6
jPts
Normal
src="http://www.google-analytics.com/ga.js" type="text/javascript"
3.8Ì´ŒÍìþ(6
jPts
Normal
try {var pageTracker = _gat._getTracker("UA-156703-50");
pageTracker._trackPageview(); } catch(err) {}
try {var pageTracker = _gat._getTracker("UA-156703-50");
pageTracker._trackPageview(); } catch(err) {}
3.8Ì´ŒÍìþ(6
jPts
Normal
src="/mcjs/common/mkt_graph.js" type="text/javascript"
src="/mcjs/common/mkt_graph.js" type="text/javascript"
3.8Ì´ŒÍìþ(6
jPts
Normal
function post_prevnext(year_val)
document.yearsel_frm.sel_year.value = year_val;
document.yearsel_frm.submit();
return false;
}
function post_prevnext(year_val)
document.yearsel_frm.sel_year.value = year_val;
document.yearsel_frm.submit();
return false;
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JavaScript
Normal
src="http://pagead2.googlesyndication.com/pagead/show_ads.js"
src="http://pagead2.googlesyndication.com/pagead/show_ads.js"
JavaScript
JavaScript
Normal
3.8Ì´ŒÍìþ(6
jPts
Normal
3.8Ì´ŒÍìþ(6
jPts
Normal
google_protectAndRun("render_ads.js::google_render_ad", google_handleError,
google_render_ad);
3.8Ì´ŒÍìþ(6
jPts
Normal
src="http://googleads.g.doubleclick.netÿ
src="http://googleads.g.doubleclick.netÿ
Forms.HTML:Hidden.1
Embedded Control
Forms.HTML:Hidden.1
<INPUT TYPE="hidden" NAME="sc_did" VALUE="SBI">
OCXDATA
OCXDATA
OCXNAME
OCXNAME
_1312220796
_1312220796
DefaultOcxName76
DefaultOcxName76
200703
Forms.HTML:Hidden.1
Embedded Control
Forms.HTML:Hidden.1
<INPUT TYPE="hidden" NAME="min_year" VALUE="200703">
DefaultOcxName82
DefaultOcxName82
CompObj
CompObj
ObjInfo
ObjInfo
OCXDATA
OCXDATA
OCXNAME
OCXNAME
_1312220797
_1312220797
CompObj
CompObj
ObjInfo
ObjInfo
200903
Forms.HTML:Hidden.1
Embedded Control
Forms.HTML:Hidden.1
<INPUT TYPE="hidden" NAME="max_year" VALUE="200903">
DefaultOcxName92
DefaultOcxName92
OCXDATA
OCXDATA
OCXNAME
OCXNAME
_1312220798
_1312220798
200903
Forms.HTML:Hidden.1
Embedded Control
Forms.HTML:Hidden.1
CompObj
CompObj
ObjInfo
ObjInfo
OCXDATA
OCXDATA
OCXNAME
OCXNAME
<INPUT TYPE="hidden" NAME="sel_year" VALUE="200903">
DefaultOcxName102
DefaultOcxName102
_1312220799
CompObj
CompObj
ObjInfo
ObjInfo
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Forms.HTML:Hidden.1
Embedded Control
Forms.HTML:Hidden.1
<INPUT TYPE="hidden" NAM
OCXDATA
OCXDATA
OCXNAME
OCXNAME
_1312220800
_1312220800
E="year_str" VALUE="200703,200803,200903,">
E="year_str" VALUE="200703,200803,200903,">
DefaultOcxName113
DefaultOcxName113
Forms.HTML:Hidden.1
Embedded Control
Forms.HTML:Hidden.1
<INPUT TYPE="hidden" NAME="IL_MARKER">
DefaultOcxName122
DefaultOcxName122
CompObj
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OCXDATA
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CompObj
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Forms.HTML:Hidden.1
Embedded Control
Forms.HTML:Hidden.1
OCXDATA
OCXDATA
OCXNAME
OCXNAME
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DefaultOcxName132
DefaultOcxName132
Forms.HTML:Hidden.1
Embedded Control
Forms.HTML:Hidden.1
DefaultOcxName142
DefaultOcxName142
CompObj
CompObj
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ObjInfo
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OCXDATA
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CompObj
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ObjInfo
Forms.HTML:Hidden.1
Embedded Control
Forms.HTML:Hidden.1
OCXDATA
OCXDATA
OCXNAME
OCXNAME
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DefaultOcxName152
Forms.HTML:Hidden.1
Embedded Control
Forms.HTML:Hidden.1
DefaultOcxName161
DefaultOcxName161
CompObj
CompObj
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ObjInfo
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CompObj
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ObjInfo
Forms.HTML:Hidden.1
Embedded Control
Forms.HTML:Hidden.1
OCXDATA
OCXDATA
OCXNAME
OCXNAME
_1312220806
_1312220806
DefaultOcxName171
DefaultOcxName171
Forms.HTML:Hidden.1
Embedded Control
Forms.HTML:Hidden.1
DefaultOcxName181
DefaultOcxName181
CompObj
CompObj
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Embedded Control
Forms.HTML:Hidden.1
OCXDATA
OCXDATA
OCXNAME
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DefaultOcxName191
Forms.HTML:Hidden.1
Embedded Control
Forms.HTML:Hidden.1
DefaultOcxName201
DefaultOcxName201
CompObj
CompObj
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Embedded Control
Forms.HTML:Hidden.1
OCXDATA
OCXDATA
OCXNAME
OCXNAME
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_1312220810
DefaultOcxName212
DefaultOcxName212
Forms.HTML:Hidden.1
Embedded Control
Forms.HTML:Hidden.1
DefaultOcxName222
DefaultOcxName222
CompObj
CompObj
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ObjInfo
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OCXNAME
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CompObj
CompObj
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ObjInfo
Forms.HTML:Hidden.1
Embedded Control
Forms.HTML:Hidden.1
OCXDATA
OCXDATA
OCXNAME
OCXNAME
_1312220812
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DefaultOcxName231
DefaultOcxName231
Forms.HTML:Hidden.1
Embedded Control
Forms.HTML:Hidden.1
DefaultOcxName241
DefaultOcxName241
CompObj
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OCXDATA
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DefaultOcxName251
Forms.HTML:Hidden.1
Embedded Control
Forms.HTML:Hidden.1
DefaultOcxName261
DefaultOcxName261
CompObj
CompObj
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Embedded Control
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OCXDATA
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Forms.HTML:Hidden.1
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DefaultOcxName281
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CompObj
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OCXDATA
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Forms.HTML:Hidden.1
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OCXDATA
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Forms.HTML:Hidden.1
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Forms.HTML:Hidden.1
Embedded Control
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Forms.HTML:Hidden.1
Embedded Control
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DefaultOcxName381
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CompObj
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Forms.HTML:Hidden.1
Embedded Control
Forms.HTML:Hidden.1
OCXDATA
OCXDATA
OCXNAME
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_1312220828
_1312220828
DefaultOcxName391
DefaultOcxName391
Forms.HTML:Hidden.1
Embedded Control
Forms.HTML:Hidden.1
DefaultOcxName401
DefaultOcxName401
CompObj
CompObj
ObjInfo
ObjInfo
OCXDATA
OCXDATA
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_1312220830
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CompObj
CompObj
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Forms.HTML:Hidden.1
Embedded Control
Forms.HTML:Hidden.1
OCXDATA
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/pagead/ads?client=ca-
money_test_js&dt=1249735447968&hl=en&adsafe=high&oe=utf8&lmt=1249735447&n
um_ads=3&output=js&correlator=1249735447968&channel=3882305749&url=http%3A
%2F%2Fwww.moneycontrol.com%2Fannual-report%2Fstatebankindia%2Fchairmans-
speech%2FSBI&kw_type=broad&kw=online%20stock%20trading&ad_type=text,
image, flash&image_size=728x90&region=default&ea=0&ref=http%3A%2F
%2Fwww.moneycontrol.com%2Fannual-report%2Fstatebankindia%2Fauditors-report
%2FSBI&frm=0&ga_vid=544818208.1248665031&ga_sid=1249734949&ga_hid=3420
07945&ga_fc=true&flash=9.0.124.0&w=-1&h=-
1&u_h=768&u_w=1024&u_ah=768&u_aw=1024&u_cd=32&u_tz=330&u_his=9&u_ja
va=true&ifi=1&dtd=16"
/pagead/ads?client=ca-
money_test_js&dt=1249735447968&hl=en&adsafe=high&oe=utf8&lmt=1249735447&n
um_ads=3&output=js&correlator=1249735447968&channel=3882305749&url=http%3A
%2F%2Fwww.moneycontrol.com%2Fannual-report%2Fstatebankindia%2Fchairmans-
speech%2FSBI&kw_type=broad&kw=online%20stock%20trading&ad_type=text,
image, flash&image_size=728x90&region=default&ea=0&ref=http%3A%2F
%2Fwww.moneycontrol.com%2Fannual-report%2Fstatebankindia%2Fauditors-report
%2FSBI&frm=0&ga_vid=544818208.1248665031&ga_sid=1249734949&ga_hid=3420
07945&ga_fc=true&flash=9.0.124.0&w=-1&h=-
1&u_h=768&u_w=1024&u_ah=768&u_aw=1024&u_cd=32&u_tz=330&u_his=9&u_ja
va=true&ifi=1&dtd=16"
JavaScript1.1
JavaScript1.1
3.8Ì´ŒÍìþ(6
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imgad?id=CO3JyP3mt9GaHRDYBRhPMgjsYWx2h3XNyg
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Forms.HTML:Hidden.1
Embedded Control
Forms.HTML:Hidden.1
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DefaultOcxName491
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Forms.HTML:Hidden.1
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DefaultOcxName501
DefaultOcxName501
CompObj
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DefaultOcxName511
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Forms.HTML:Hidden.1
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OCXDATA
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DefaultOcxName531
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Forms.HTML:Hidden.1
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DefaultOcxName541
DefaultOcxName541
CompObj
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_1312220844
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CompObj
ObjInfo
ObjInfo
Forms.HTML:Hidden.1
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OCXDATA
OCXNAME
OCXNAME
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Abstract
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ft2$Eye_Examination_in_Diabetic_Patients
ft2$Eye_Examination_in_Diabetic_Patients
Levels_of_Diabetic_Retinopathy
Levels_of_Diabetic_Retinopathy
ft5(Non-
proliferative_diabetic_retinopathy_((Diabetic_maculopathy:_Classification_and(Clinicall
y_significant_macular_oedema_(C
ft5(Non-
proliferative_diabetic_retinopathy_((Diabetic_maculopathy:_Classification_and(Clinicall
y_significant_macular_oedema_(C
<i>Follow-up</i>(Proliferative_Diabetic_Retinopathy_(PDR)
<i>Follow-up</i>(Proliferative_Diabetic_Retinopathy_(PDR)
ft8(<i>Panretinal_Photocoagulation_(PRP)</i>
ft8(<i>Panretinal_Photocoagulation_(PRP)</i>
ft12 Complications_of_laser_treatment
ft12 Complications_of_laser_treatment
ft13(Vitreo-retinal_Surgery_in_Diabetic_Retin
ft13(Vitreo-retinal_Surgery_in_Diabetic_Retin
ft15(Management_of_Concomitant_Cataract_and_D
ft15(Management_of_Concomitant_Cataract_and_D
Peripheral_Retinal_Cryoablation
Peripheral_Retinal_Cryoablation
Medical_Management
Medical_Management
Blood_sugar_control(<i>Diabetes_control_and_complications_tr
Blood_sugar_control(<i>Diabetes_control_and_complications_tr
ft22(<i>United_Kingdom_Prospective_Diabetes_S
ft22(<i>United_Kingdom_Prospective_Diabetes_S
Antiplatelet_Therapy
Antiplatelet_Therapy
Lipid_reduction
Lipid_reduction
ft29 Reference
ft29 Reference
Indications_and_use
Indications_and_use
finddr
finddr
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hthalmol_2000_48_4_321_14834
atabs#atabs
atabs#atabs
afigs#afigs
afigs#afigs
Reference#Reference
Reference#Reference
Lipid reduction#Lipid reduction
Lipid reduction#Lipid reduction
Antiplatelet Therapy#Antiplatelet Therapy
Antiplatelet Therapy#Antiplatelet Therapy
<i>United Kingdom Prospective Diabetes Study (UKPDS)</i>#<i>United Kingdom
Prospective Diabetes Study (UKPDS)</i>
<i>United Kingdom Prospective Diabetes Study (UKPDS)</i>#<i>United Kingdom
Prospective Diabetes Study (UKPDS)</i>
<i>Diabetes control and complications trial (DCCT)</i>#<i>Diabetes control and
complications trial (DCCT)</i>
<i>Diabetes control and complications trial (DCCT)</i>#<i>Diabetes control and
complications trial (DCCT)</i>
Blood sugar control#Blood sugar control
Blood sugar control#Blood sugar control
Medical Management#Medical Management
Medical Management#Medical Management
Peripheral Retinal Cryoablation#Peripheral Retinal Cryoablation
Peripheral Retinal Cryoablation#Peripheral Retinal Cryoablation
Management of Concomitant Cataract and Diabetic Retinopathy#Management of
Concomitant Cataract and Diabetic Retinopathy
Management of Concomitant Cataract and Diabetic Retinopathy#Management of
Concomitant Cataract and Diabetic Retinopathy
Study (DRVS)#Vitreo-retinal Surgery in Diabetic Retinopathy and the Diabetic
Retinopathy Vitrectomy Study (DRVS)
Study (DRVS)#Vitreo-retinal Surgery in Diabetic Retinopathy and the Diabetic
Retinopathy Vitrectomy Study (DRVS)
Complications of laser treatment#Complications of laser treatment
Complications of laser treatment#Complications of laser treatment
<i>Panretinal Photocoagulation (PRP)</i>#<i>Panretinal Photocoagulation (PRP)</i>
<i>Panretinal Photocoagulation (PRP)</i>#<i>Panretinal Photocoagulation (PRP)</i>
Proliferative Diabetic Retinopathy (PDR)#Proliferative Diabetic Retinopathy (PDR)
Proliferative Diabetic Retinopathy (PDR)#Proliferative Diabetic Retinopathy (PDR)
<i>Follow-up</i>#<i>Follow-up</i>
<i>Follow-up</i>#<i>Follow-up</i>
<i>Technique of laser treatment for diabetic maculopathy<a class=ref name=ft5
class=ref name=ft5 href=#ref5>[5]</a></i>
<i>Technique of laser treatment for diabetic maculopathy<a class=ref name=ft5
class=ref name=ft5 href=#ref5>[5]</a></i>
Clinically significant macular oedema (CSME)#Clinically significant macular oedema
(CSME)
Clinically significant macular oedema (CSME)#Clinically significant macular oedema
(CSME)
Diabetic maculopathy: Classification and Management:#Diabetic maculopathy:
Classification and Management:
Diabetic maculopathy: Classification and Management:#Diabetic maculopathy:
Classification and Management:
Non-proliferative diabetic retinopathy (NPDR): classification and management#Non-
proliferative diabetic retinopathy (NPDR): classification and management
Non-proliferative diabetic retinopathy (NPDR): classification and management#Non-
proliferative diabetic retinopathy (NPDR): classification and management
Levels of Diabetic Retinopathy#Levels of Diabetic Retinopathy
Levels of Diabetic Retinopathy#Levels of Diabetic Retinopathy
Eye Examination in Diabetic Patients#Eye Examination in Diabetic Patients
Eye Examination in Diabetic Patients#Eye Examination in Diabetic Patients
abstract#abstract
abstract#abstract
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The oral drug treatment
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Sat, Nov 14 05:09 AM

Do we need drugs for all patients with diabetes?
In some patients, particularly in the initial phase of diabetes with mild elevated blood
sugar, one could manage with proper diet and exercise. In most of these cases, after
variable period of time, some drug will be needed.
Do we need specific medication for obese diabetics?
A drug called metformin (Glucopahge, glyciphage, glycomet) is the best drug for obese
diabetics. Not only does it brings down the blood sugar and corrects metabolism, it also
helps in losing weight.
I am a diabetic on oral drugs and I frequently get abdominal problems. What are the
medications that should be avoided?
The mostly likely culprit is metformin, and if abdominal upsets are severe or prolonged,
this drug should be avoided. Another group of drugs (acarbose, voglibose) sometimes
used in diabetes could also cause diarrhea.
I have diabetes and hypertension. Could any of the medications cause weight gain and
swelling of the feet?
Thiazolidinediones (rosiglitazone, pioglitazone) can cause weight gain and swelling feet.
While use of rosiglitazone is restricted because it could cause cardiac side-effects,
pioglitazone is popularly prescribed. Use of insulin could also cause similar effects. Anti-
hypertensive drugs calcium channel blockers like amlodepine commonly cause swelling
of the feet.
Could any of the medication lead to deterioration of kidney function in diabetes?
One important complication of prolonged uncontrolled diabetes is kidney dysfunction.
Medications do not cause kidney disease. Metformin, however, should be stopped,
pioglitazone should be avoided, and dose of new medications (galvus, januvia) should be
lowered when the blood creatinine level (indicative of kidney damage) is high. In case of
markedly high creatinine, insulin therapy would be the best option.
I am going for minor surgery (cataract, dental surgery). Should I continue with the oral
medication?
If your blood sugar is high and if you are unable to take food due to the surgery, you may
temporarily be given insulin while monitoring blood glucose levels. Oral medications
should be resumed after you recover from the surgery. Before, during and after the
surgery, insulin should be given to control diabetes.
I am a 70-year-old, with thin bones (osteoporosis) and low heart function as indicated by
echocardiogram. What oral mediciners should I avoid?
Use of metformin could be problematic if heart function is low. Rosiglitazone should be
stopped and pioglitazone should be best avoided. Other oral drugs should also be given
with caution.
Could I stop oral medication once I have started using it?
If you are a recently diagnosed obese diabetic, medications could be tapered off or even
stopped once significant weight loss occurs by diet and exercise. Blood glucose,
however, should be monitored regularly since medications may be required in future.
Why do I feel low and fatigued after these medications?
You could be getting more dose of medications causing relatively low glucose, which
could lead to weakness and fatigue. Check your blood sugar: fasting and 2 hours after
meals. to see if your glucose levels are below 70 and 100 mg/dl respectively. If so your
medication dose may have to be lowered.
Despite proper diet and exercise and same medications, why is my blood sugar not under
control now as
compared to before?
As duration of diabetes increases, body's internal insulin secretion decreases, causing
blood sugar to rise despite following strict diet regime, exercise and drugs. This
necessitates increasing dose of drugs or adding more drugs.
What are new "wonder drugs" in the market?
No drug should be called "wonder drugs" and each has an important place and should fit
a patient's profile. New medications exenatide (byetta, injectable), sitagliptin (januvia,
oral) and vildagliptin (glavus, jalra; oral) have novel mechanisms of actions, and are quite
effective in controlling blood sugar.
These drugs, however, should only be used if other more established drugs, fail to control
diabetes. Although considered safe till now, physicians should use these drugs with
caution and monitor patient carefully. Cost of these drugs could be an issue as well.
The authors are from the Department of Diabetes and Metabolic Diseases Fortis
Hospitals, New Delhi
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Management of diabetic retinopathy

Diabetic retinopathy remains a major cause of blindness despite increased understanding

Keywords: Diabetic Retinopathy, diagnosis, surgery, Humans, Laser Coagulation,

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