Project Dosa!

One fine Sunday morning Philip was having several doubts arising in his head. Doubts that were making him restless,doubts that were uncomfortable and demotivating. Doubts whether his life was moving in the direction he wanted it to go, whether there was something more interesting to life he was missing. He started to analyze his thoughts to figure out if he could find an answer. Human nature is such that it will make a person toil hard for something he wants but as soon as he gets the fruit of his labour it tends to make him feel inadequate all over again. Philip was aware of such thoughts but even knowing this beforehand was not of any help, just like the times when you know somethings are bad for you but you do them even then as if forces of nature have conspired against your will and made you do those things. Biggest question that was worrying him was whether he has stopped learning new things. It was a dreadful feeling, he could now empathize with people who could not change things in their lives even though they are aware that things need to be changed. He could relate to an alcoholic who just could not quit even though he realized his organs were failing or that fat lady who could not quit smoking and overeating although she realized they were killing her. Medicine was an art of life long learning, Philip had heard people saying that in medical circles all the time, he could still recall that Professor's voice as if he was still whispering in his ears. The feeling was terrible and Phillip was in distress, but then he suddenly thought of making Indian Dosas. He had no idea why he had such a notion, it was as if some external force implanted this seedling of a thought in his mind. He felt very upbeat about it, although he had never made such a thing before but he looked very determined. He researched it's recipe, collected all the required stuff and started his project. He thought instead of just cooking he would call it a project. After an hour and half he was finished and asked his girlfriend to try the dosas out. His girlfriend was ecstatic that he had cooked something for her and she ate with all her heart and liked it so much that she could hardly believe that Philip was capable of pulling off such a feat. Philip was happy at the outcome of his project and realized that he learnt something that he never thought he would, something so new, something so different.
His learning curve was still up.
Project Dosa was successful.

Japan Detects Antibiotic-Resistant Superbug - Discovery News

http://news.discovery.com/human/superbug-found-in-japan.html

Japan Detects Antibiotic-Resistant Superbug

September 7, 2010 12:03:00 PM

Japan on Monday said it has detected its first case of an antibiotic-resistant "superbug" that surfaced in South Asia and has triggered a global health alert.

A hospital linked to the Dokkyo Medical University in Tochigi prefecture north of Tokyo detected a drug-resistant "superbug," a bacterium carrying the New Delhi metallo-lactamase-1 (NDM-1) gene, in a patient last year, a hospital official told AFP.

The case follows a warning from the World Health Organization (WHO) last month calling on global health authorities to monitor the drug-resistant superbug that is believed to have spread from India.

"A patient who came home from India, in his 50s, had fever symptoms while he was hospitalized in May last year, and after a blood test the hospital detected an antibiotics-resistant bacterium," the official said, adding that the patient fully recovered.

After examination doctors found that the bacterium contained the NDM-1 gene, making it difficult to treat with standard drugs, he said.

The WHO has said research published in The Lancet medical journal on August 11 identified a new gene that enables some types of bacteria to be highly resistant to almost all antibiotics.

"While multi-drug resistant bacteria are not new and will continue to appear, this development requires monitoring and further study to understand the extent and modes of transmission, and to define the most effective measures for control," it said.

Multi-drug resistant bacteria generally "constitute a growing and global public health problem," the UN health agency noted.

The Lancet reported last month that bacteria containing the NDM-1 gene had been found in 37 Britons who had received medical treatment in South Asia.

Researchers said they had identified dozens of cases among Britons who had traveled to South Asia for medical tourism purposes.

Indian doctors warned earlier this year about the threat from the bacteria -- months before the British study -- saying that patients could spread them worldwide.

In August a Belgian man became the first such known fatality.

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Thought Process

Their faces looked tense and they wore an anxious look
Together they swarmed in the long corridors, feeling protected
Each dwelling on the insecurities of the other
White coats were a big help and I wonder who used it for the first time and Why
To hide his limitations along with his new shirt and new tie
The coat gets longer as you climb up the hierarchy
Does it mean the student has less to hide and the resident has more
Probably its true
And a day comes when you are liberated from the shackles of white
You become that old attending who doesn't need that coat
Who doesn't need that tie.

Psychiatry In General Practice of Medicine

Role of Psychiatry in General Practice of Medicine is very well established, specially in developed countries. Residents from Internal medicine as well as family medicine have roatations in Psychiatry during their residency period.
This article intends to be a little dossier for the medicine people who come across various Psychiatric manifestations in their patients.


Group 1: This group consists of the patients with multiple somatic complaints like unexplained and vague body aches, head aches, neck pains and several other pain symptoms which cannot be explained physically.

what to do? These patients require low dose anti depressants in combination with some anxiolytics. Low dose antidepressants have been known to work wonders with this patient population and have been frequently prescribed by the Psychiatrists.
Prescription choices can vary from Tablet Aculip H, Nexito Plus, Censpram Plus and several others. Start with BD dosing and treat for 4 to 6 weeks,most of the patients would show some improvement but if no improvement is observed than the patient should be reassesed for frank depression.

Group 2: This group consists of the patients with mild to moderate depressive symptoms like low mood, low self esteem, crying when alone, feelings of hopelessness and worthlessness.

What to do? Starting the patient on SSRI's is the best bet. Start with Fluoxetine 20 mg od or start on Escitalopram 10 mg od and raise to maximum of 20 mg od according to the patient response. Advise the patient to take these drugs in the morning as they may cause sleep disturbances if taken at bed time.

Word of Caution: Always figure out if your patient has any suicidal ideation or plan or has attempted suicide or self harm however vague it may be, it is a psychiatric emergency and should be best left for the psychiatrist to handle it.

Group 3: This group consists of patients with sexual complaints like erectile dysfunction , Dhaat Syndrome or premature ejaculation.

What to do? These patients are best treated with low dose Paroxetine along with phospodiestrase inhibitors like sildenafil and others. You can start with Paroxetine 12.5 mg and continue for 4 to 6 weeks.

Group 4: This group consists of patients with complaints of Insomnia or sleep disturbances or sleep difficulty.

What to do? Use clonapam instead of Alprazolam as it has low abusive potential than the later.

Thanks to Dr.Anupam Rathod for his valuable inputs.

CONgratuLATIONS

How would you Congratulate if someone you know gets residency in US?

Congratulations #1 " Arrey B*******, Kya baat kar raha hai, maza aa gaya yaar, oye badhai ho yaar, saale party de."

Congratulation #2 "Congrats yaar Saini"

Congratulation #3 " Arey suna hai you did not get into surgery in US, bahut mushkil hai yaar, I know"

Congratulation #4 "Sir, congrats, aapka second step bhi clear ho gaya"

Congratulation #5 "Acchha, aur suna kya chal raha hai, main toh so rahaa tha yaar, bahut sar dard kar raha hai."

Congratulation #6 "Aur phir kab ja raha hai"

Congratulation #7 " Khush toh bahut hoge tum aaj"

Congratulation #8 "Jaanu, I Love You."

Congratulation #9 "No eye contact, no conversation, no smile,completely ignoring the person in lime light."

Congratulation #10 "Just a big smile with earnest happiness showing on the face"

TrainED

It had been a busy day for him in Office but it was not the work that bothered Reddy, it was the train that he had to catch in the evening which was bothering him since he had no reservation for travel and the Tatkal system had left him high and dry without a ticket for the train. He had been warned that it was very cold and foggy in Delhi, where he was headed to so travelling without a reserved seat would be crazy. He had no option though, he had to go come what may, and he knew that.
He decided that he would go the old fashioned way and bribe the TT to get a seat.

Train was on time, Reddy had already checked in the afternoon on his computer. He decided to ask a friend to give him a ride to the railway station.It was evening and road was full of two wheelers competing with each other on their way to home, one beating the other only to get beaten by yet another. Reddy and his friend had left for the station good half an hour in advance although the ride to station was just ten minutes.As they crossed the bridge the old two stroke bike started make funny noises and Reddy knew at once that it ran out of gas, it was not the first time it had happened to him. Behnchod, said Reddy, it has to stop just know, could it wait till had reached the station. Lucky for him the petrol pump was nearby and after a few meters of pulling the bike they reached the filling station and filled the tank to resume their journey to the station. Reddy thanked his friend for the ride and rushed to the ticket counter for the general tickets and took a general ticket till Delhi.
Train was on time, just ten minutes late but on time considering other trains some of which were around ten hours late. Reddy asked the food vendor where the AC coach would halt and stood at the spot which the vendor had told him.
The train arrived whistling and made a halt with a screeching sound of the iron wheels coming to sudden halt with the brakes.
Reddy hopped on to the coach and few seconds later the train started to move. He started looking for a good spot to keep his bag or himself or both. The train was full and he could not find even a single vacant seat. The passenger who were already settled in were giving strand looks to him as if some alien had arrived in their coach. Reddy soon realized that his worst fears might be coming true and he might not get any berth to sleep on in the night.He put down his stuff in corner just outside the entry gate of the AC compartment and stood their. Soon the coach attendant came their and gave Reddy a long curious look as if asking him why he was there and at the same time saying him to pick up his stuff and go to the general coach but the attendant said nothing probably he thought Reddy was some rich guy looking at his well dressed personality, Reddy took advantage of it kept standing there for a while and than found a seat at the attendant's berth.

Next station was a big one and the onboard ticket checking staff was being replaced by the new TT's. Reddy was hopeful of getting a berth so he approached the TT and showed him his general ticket, the TT looked at his face as if gauging him on how much money could he shell out from his potential victim and then looked into his charts, with a shook of his head the TT announced there is no vacant berth and the whole train is packed. Reddy looked at the TT with a disappointed look and TT looked at Reddy with the same expression, one had lost his seat the other had lost his money.

The Interview

A warm welcome
A hearty smile
The day looked good
As he reached in style
The wishes all over
The firm hand shakes
It is the confidence
Which mars or makes.

The first question
The answer instantneous
With the look in his eyes
He looked spontaneous.
You look organized
Your communication good
The interviewer was happy
And the interviewee so should.

A few minutes wait
The next encounter came by
Conversation was so heartening
That the time flew by
She looked glad
And he was beaming
Through his spectacles
Hope was gleaming.