Sunday, October 18, 2015

Playing With Fire.

How foolish could I be to think that I can dissociate from an intrinsic component of myself and assume that I will be fine? Yes, you can amputate the limb but there's no running away from the Phantom pain. There are some things that have become so ingrained in my persona that any attempt to bring about changes will only lead to chaos.

Exams are approaching and I'm supposed to be in hyper-study mode but that doesn't always happen. There are days when I study and I'm happy with what I've read and there are days when I attempt to study but nothing seems to diffuse through the scalp.

These days I've been reading about pathogenic protozoa like Entamoeba, Trypanosoma, Leishmania, Malaria and so on. Malaria for example has a life cycle in the female anopheles mosquito as well in the human host. The bite of the mosquito transfers the sporozoite to the human and this ends up in the liver where the pre-erythrocytic cycle occurs. The meront is formed which later bursts to release merozoites that penetrate the RBC and develop through 3 stages. The trophozoite that is formed matures and upon the bite of the mosquito, it is transferred to the gut of the mosquito in its blood meal. Here the sexual reproduction (sporogony) occurs and there is a zygote formed from the male and female trophozoite that enters into the salivary gland of the mosquito and is transferred to the human host in its next bite. There are 4 major forms of Plasmodium species, P.Vivax, P. Falciparum, P.Ovale and P. Malariae with Falciparum being associated with the highest mortality (Blackwater Fever) and generally presents with fever, chills and sweats that recur periodically. 

So apart from these there are several other protozoans like Toxoplasma that reaches a dead end in the human host. The definitive host being cats and other felines, the infective sporulated oocyst is transferred to humans through any contamination in food and water and it later develops from bradyzoites to tachyzoites  that later form tissue cysts. These are particularly notorious in the immunocompromised and cause life threatening complications when it is congenital like the 3CS: Chorioretinitis, Cerebral calcifications and Convulsions. 

Apart from these there are also creepy crawlies to deal with, their pathogenicity and clinical features being distinct. Some of them worms I've been reading include Diphyllobothrium latum (Fish Tapeworm- it has 3 hosts. It affects humans and then is transmitted to (as coracidium and then procercoid larva) cyclops from where it reaches fish (pleurocercoid) which is consumed by man and the cycle continues..), Echinococcus Granulosus (Dog Tapeworm- where man is only an accidental host and it results in formation of hydatid cysts in the liver and other sites), Taenia solium, Taenia saginata (beef and pork tapeworm that cause complications like neurocysticercosis through its cytsic forms: cysticercus bovis and cysticercus cellulosae) and so on. There's so much more to do in so little time and what's more important is also revising what I've read instead of just going on and on! -_-

Before this, it was Virology and that was quite interesting. Viruses are usually RNA or DNA or in the rare cases of retro viruses (HIV) it's a DNA:RNA virus that forms the genetic material. Viruses can causes almost all sorts of infections:
CNS: KJD, GSS, Rhabdo, Polio
Respiratory: Adenovirus, Rhinovirus, SARS, Orthomyxovirus,
Diarrhoea: Reovirus? Norwalk, Astrovirus..
Haemorrhagic: Arena virus, Ebola, KFD
and so on...

Coming to Pharmacology, there is SIMPLY WAY TOO MUCH! It's not a problem to read up on the new chapters but what is definitely a problem is revising all the drugs we've been reading in the course of one whole year! Just take the names, they sound so familiar, similar and yet so confusing! Take Amiloride, Amiodarone and Amantadine.
  • Amiloride is a diuretic that acts at the Collecting Ducts and inhibits the renal epithelial Na+ channels and thus causes diuresis. (I think)
  • Amiodarone is a broad spectrum anti-arrhythmic. I think it belongs to class II antiarrythmics and can be used for a wide range of arrhythmias. 
  • Amantadine on the other hand is a multipurpose drug: It was introduced as an antiviral drug for treatment of influenza (mechanism is probably something to do with the Neuraminidase and Hemagglutinin antigens on the virus) but was serendipitously found to have anti-parkinsonian effects. It complements the action of Levo-Dopa and can probably used in the early stages. (I think)
  • Now Amantadine rhymes with Cimetidine and Ranitidine but don't be confused because those are H2 Proton pump blockers which you would prescribe for Peptic Ulcers and gastritis because they reduce the gastric acid secretions. 
  • Similarly, there is Metronidazole, Tinidazole, Satranidazole, Secnidazole that are used in the treatment of amoebic dysentery (E.histolytica) because they have this nitro group that goes inside the Amoeba, gets activated and attracts all the electrons so that the Pyruvate-Ferrodoxin Oxido-Reductase Pathway (PFOR) is inhibited so this ultimately has -cidal action on the pathogen. These are effective in anaerobic conditions if there were to be oxygen they themselves would compete with the nitro group for the electrons.. But don't confuse this with Ketoconazole, Fluconazole, Itraconazole or Voriconazole because these are antifungals that act by inhibiting the cell wall synthesis (I think!)
 I could go on and on and I might actually do more of this sometime :)

Pathology is progressing at snail's pace. I recently read about pathological conditions of the kidney and this itself spanned several days because of its convoluted nature (pun intended). In many cases, the diseases are a classic example of "Subversion from within" as Robbins describes the pathogenicity in HIV-AIDS. For no good reason, antibodies are formed against the basement membrane of the glomeruli and with similar auto-antibodies in the lung, you have your Good-Pasture Syndrome. And then there are immune complexes formed which are deposited giving rise to conditions like HSP and Lupus Nephritis..
Basically there are two clinical presentations:
  • Nephrotic : Proteinuria, Lipiduria and Edema
  • Nephritic  : Proteinuria, Haematuria and Hypertension
Apart from the glomerular, interstitial and tubular dysfunctions there are neoplasms (Renal Cell Ca), cysts (ADPKD ARPKD), hydronephrosis and so on.. 

Recently a strange thought struck my otherwise dormant frontal lobe. The water we drink is said to be "purified" thanks to the aquaguard water purifiers in the hostel as well as in the college. But nobody really looks into the maintenance of these purifiers or the steel containers that store the water. The water we consume no doubt has some bacteria. So what we could do is do a Coliform Count and also culture the bacteria in several media hoping to see which bacteria turns up. So there are two schools of thought with which we could proceed:
  • The water we're drinking is fairly harmless so if the reports show presence of any bacteria it would mean our body has developed some level of resistance of these bacteria over time. This could be compared to water supply in a fairly cleaner source and see if there is any pathogenicity of these bacteria in a different region.
  • The second approach would be to see if the water we're drinking has actually caused any disease in the hostelites and identify the causative bacteria. Has the bacteria evolved to evade the purification and become resistant? Again, one could compare with another water source and observe the trends.
As Uppi Sir said, it is a viable project (that I could attempt after 2nd year even if that means it can't be an ICMR project because the deadline for ICMR would be January when I'd be in the middle of practical exams) and I could work on it with the available resources provided and "define the problem" and then work on it. Whenever we begin any such project, it is very important to ferment the ideas into something definitive. What is the purpose of the project, what do you aim to find on microscopic analysis, how would you choose to analyse the data, how are you going to compare this with other water sources and what's the bottom line? One needs to have definitive answers before embarking on something new like this. 

Moving on to matters of the heart and conveniently ignoring Forensic Medicine which I need to read more of, I seem to be in a perpetual state of confusion and disappointment. 

I either have an inherent genetic defect in maintaining relationships- mutated MHR gene (Maintain Healthy Relationship) that probably explains why sometimes somethings never work out with some people. Or maybe I don't put enough into it or don't make amends or I expect too much from people or I just end up with the wrong people! 

Looking back always brings regret, which is why I try my best to steer my hyperkinetic thoughts in the right direction, but then there are times when you wish you had done things differently. I have this "Äll or None" personality. I either give my 100% and give my best to make things work or I don't try at all. I need to find the comfortable middle ground where you stay at a comfortable distance and maintain a better equation with people. 

There are times when I crave for silence. Silence from the chaos of my thoughts that are constantly in motion like electrons colliding against each other in Brownian motion. I crave for some solidarity of my thoughts, some respite from the constant tug of war that distracts me from anything I do. It stems from disappointment: a feeling of repulsion and disgust to who I've become against the stark contrast of who I wish I would be. Adapting to people and circumstances constantly has suppressed the true nature of me. There are moments like these, in these fleeting moments, in the scribbled notes of a story incomplete or an amateur attempt at poetry that I find myself. It is in this silence that I can sense creativity bubbling within me, hoping to find an outlet.

As someone rightly said (or as I understood it), sometimes you need to talk to people. The world feels less of a burden and much more bearable. In my case, it is my blog that I turn to, sad as it seems that it is a mere virtual entity. An imaginary non-existent figament that purportedly contains my thoughts without any reaction but giving me the satisfaction of having unburdened myself. Words, thoughts and ideas are the fuel of my existence. They define who I am and they help me evolve and discover more.Yet, trying to do away with even this mode of release is just slow asphyxia. Like the Carbon Dioxide that we need to exhale out of our system (before it can stimulate the Respiratory Centre in the brain, preferentially bind to the Hb and wreak havoc), my has invariably become a lifeline. A creative process that has become a part of who I am. In the past, the blog was a mere glimpse of who I am. Over time, it has evolved into something more concrete. It's either that, or I've officially gone NUTS. :D It would only be self-destructive to stifle my voice against the waves of conformity. 

I cannot run away from the consequence of my actions, I can only make peace with myself. I cannot rebel against what I chose, I can only accept the reality. In the end, we are not defined by those around us because they are never constant. So there is no point pondering infinitely about how we are perceived by people who do not eventually matter.

What I Do In The Library
  • Mature is when you are polite with the people you don’t really get along with because it seems the right thing to do but it’s mistaken as fake.
  • Natural is when someone behaves in a certain way that is perceived to be fake by those around him/her. Example: some people have a fake laugh.
  • Opportunistic Faking is taking advantage of a situation for your benefit by saying things you do not mean. *Sycophants*
  • Synergistic Faking: Two people playing along for a mutual benefit
On a lighter note, I have discovered that I have a rare but seriously awkward condition known as Paroxysmal Laughter Syndrome (PLS). The genetic causes have not yet been established but they occur due to a sporadic mutation in the SNL gene. (Sane and Normal Laughter) Going back to the basics, I read in Vilayanur Ramachandran's neuroscience books that laughter is the body's way of recognizing a false alarm. A mother approaches her 8 month old child with arms outstretched and a serious expression. The baby is surprised and worried that it has done something wrong. As the mother approaches closer, her expression softens and she suddenly takes to tickling the child. The child bursts into peals of laughter at this and creases of fear vanish. Why is it that the child laughed? What is the neurological basis behind this sound produced by the larnyx when we notice a funny incident? The idea is that in the course of evolution over centuries, laughter has evolved as a mechanism of letting the body know that "It's all okay, no harm done". The brain had expected some danger but the turn of events proved contrary and hence we burst into high pitched giggles or happy squeals or sometimes into a loud cackle that causes bystanders some discomfort. So my problem is that I tend to burst out laughing in the most inappropriate circumstances and seem to have no control over it. It might be at a friend's birthday treat, or when I notice two individuals walking or in the middle of class/postings or worse still, while discussing a serious matter with the Principal. A thorough in depth analysis of the reason behind this has brought me to the conclusion that I have a tendency to over-think. When the people around me heard the same sentences, they didn't find anything remotely amusing. But my confounded brain makes some connections that they couldn't imagine (nobody could believe that I would think in that angle) and hence I had a tough time stifling my laughter while the others looked at me in surprise. The other incident could also be attributed to the same cause. The brain processes a simple harmless data into something much more fancy and embellished that appears humorous and hence the intractable giggling in inappropriate situations. What remains now is now I somehow learn the art of keeping a straight face and avoid embarrassment. 

In case you want to know more:
Another thing I discovered recently is the redundancy of Antidepressants. Depression is something many people will claim to have experienced but the few who have been clinically diagnosed with it would know that it is a quagmire of hopelessness that would drag you into its realm and before you know it you are incapable of getting out of the whirlpool of endless thoughts circulating within. From what I know, there are two theories (among others) that are proposed for the pathogenesis of depression.
  • BDNF (Brain Derived Neurotropic Factor) is an important component that has an overall role in controlling emotions and thoughts. Any decrease in BDNF could trigger depression.
  • Monoamine depletion. Seratonin, Dopamine and Noradrenaline are some of the neurotransmitters whose variation could also contribute to depression. Current antidepression therapy is aimed at mainaining the levels of these neurotransmitters at the optimum levels. Drugs include:
    • MAO-B inhibitors: Moclobemide
    • Amitryptilline, Nortryptilline, Imipramine, Desipramine, Doxepin, Dothiepin
    • Fluoxetine and other SNRIs.
    • I can't remember the newer Anti Depressants.
    • NUTELLA. This single substance could alter the treatment of MDD radically if it were administered to all those suffering from disappointment, loss, desperation and hopelessness. As most people who have consumed this sinful delight would know by now, Nutella is fairly addictive and this ensures it has a regular fan base. A casual google search of the science of nutella addiction threw up some results that caution against it's use.( )
My point? Eat Nutella, Live Happily Ever After! :D 

Songs are my refuge when the world shuts its doors or when I choose to shut my doors against the world. Playlist:
  • American Oxygen (Rihanna)
  • Bas Ek Pal (KK)
  • Beetein Lamhein (KK)
  • Naseeba (Sunidhi)
  • Mine (Phoebe Ryan)
  • Khwaishein (Arijit)
Toodles! :D