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:

• http://brainworldmagazine.com/neuroscience-of-comedy/ 
• http://www.nature.com/news/1998/981217/full/news981217-2.html

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.( http://www.healthy-holistic-living.com/what-you-need-to-know-about-nutella.html?t=SOE )

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

It's Always A Good Time. :)

Hello there! 

There have been a lot of things going on lately. I guess it would make sense to use bullet points.

•  I’ve been making several online purchases and they include:
• Cuckoo’s Calling (Robert Galbraith)
• Paper Towns: John Green
• So basically it made for an okay-ish read. There were some concepts that I liked but the style and language wasn’t really the kind of literature that I would prefer. After reading refined English in classics, it is hard to find that quality of writing in recent authors. The themes may be relevant, the metaphors may be applicable but I find myself intermittently wondering why I am I reading something like this.
• Some of the quotes from the book that I liked:
•  It’s so hard to leave- until you leave. And then it’s the easiest goddamned thing in the world.
• If you don’t imagine, nothing ever happens at all.
• When did we see each other face-to-face? Not until you saw into my cracks and I saw into yours. Before that we were just looking into ideas of each other, like looking at your window shade but never seeing inside. But once the vessel cracks, the light can get in, the light can get out.

• Recently, there has been a growing popularity of the Dubsmash App in the Girl’s hostel. We got this fun app from Sana (Arsikere) and spent several days lip-syncing to some famous actor’s popular dialogue and then laughing over the same for the next few hours! This time, Di and I had a great time bonding over Dubsmash (“Don ko pakadna mushkil hi nahi, na mumkin hai” delivered by an angry Divya :P )

• I’ve been watching some movies lately and most of them have turned out to be good choices.
• Phantom: We watched this in the theatre and it makes for an interesting face paced thriller albeit without much room for emotions or drama but I suppose that’s how it’s got to be.
• Gabbar is Back: Happened to watch it on the way to Bangalore. Not bad, but nothing good either. The scenes regarding the money minded schemes of doctors could have been altered because it potrays the medical profession in poor light.
• Om Shanthi Oshana: A cute Mallu movie
• Shawshank Redemption: Back in Deeksha, I’d heard of this movie while playing dumb charades but never had a chance to watch it. A beautiful movie! 

•  I’d been home for the festival and I did the complete vratha after about 4 years. I’m so glad that I could be a part of the celebrations and the entire pooja went on smoothly all thanks to amma’s preparation that began a week in advance. There’s nothing like the satisfaction of being involved in the festival and wholeheartedly participating in the rituals. What we follow is what has been passed on from one generation to the next. In our quest to eagerly accept modernization/Westernisation we must not conveniently choose to forget tradition and culture. Another thing I sorely missed is singing (the Carnatic/light music kind). Although I sound like a pleasant frog at best, it has always given me some satisfaction to sing these songs. I’ve never really been comfortable to sing the same way back in the hostel so I refrain from bothering my vocal chords. We had a few guests over and when I had to sing, I realized that unlike what I read in textbooks, the songs I’ve learnt are etched as ROM (or is it RAM?! :’) ) in my brain and *touch wood* has not evaporated even though it’s been a decade since I learnt some of the songs.

*Experiments*

Family Selfiee!

Pooja scenes :)

• Some of the latest songs that are reverberating in my mind include:

o   Saaware : Phantom

o   Beautiful Now : Zedd

o   Run Away With Me : Carly Rae Jepson (A carefree, cheerful song)

o   Gulabi: Sachin-Jigar (morning suprabatham)

o   Shut up and dance with me (Such an infectiously happy song!)

o   Zehnaseeb (from the movie Hasee to Phasee)

• These holidays, I also visited a close relative which was pending since a long time. The visit was something I will cherish for a long time but it also brought forth the reality of old age. At no other juncture does one feel so lost and vulnerable. For a person who’s always been actively engaged in work, it’s hard to learn to sit back and relax. It’s hard to accept the limitations that age imposes on you and that eventually take a toll on your confidence. Another aspect is how it’s hard for those around them to also accept that the person they knew is no longer the same. Yet it’s important to remain hopeful and instil confidence on them. I wish I’d made this visit earlier, but I’m happy that it finally materialized after almost 2.5 years.

• We had been to this Bharatanatyam program on Saturday where Adi had a few performances. As always, Adi danced well and so did all the tiny tots with bobbing head movements and wide-eyed expressions. To cultivate any hobby or talent is an achievement and truly noteworthy. As Amma frequently says, it is a “sadhana” and if not done when the opportunity is given, there is no room for regret later.

• September has had several birthdays and this has led to considerable excitement in our group. Abhi’s Birthday was on 20^th and BP and I began hatching a plot a fortnight ago and later Govi and Avm also joined the conspiracy. It all began at 12 AM when she cut a small but delectable chocolate truffle in the hostel. There was nothing eventful after this and the next morning BP and I rushed to breakfast making sure we left the birthday girl behind. After the customary oil drenched dosas we briefed Govi about the Plan Of Action and then the two of us headed to VP’s place who had agreed to play host to us madcaps. Icaboo hovered around and guided us in preparing the relatively simple cooker cake. Later BP left for some purchases with Avm. Icaboo and I saved the cake from becoming a soggy mess by some herculean efforts and I began working on the clues. After the two returned, we began to put everything in place. Meanwhile, Govi was entrusted the responsibility of keeping Abhi engaged (since the 3 of us were ignoring her calls) so they went to a temple and later to a boating site in Bhadravathi. After carefully co-ordinating the timings such that we don’t end up running into each other and after sealing the garnished cake, we rushed to college and set up the clues for the treasure hunt. At long last, we began with the cake cutting and the cake was demolished in no time. Thankfully, it was more than edible!  After this, there was some more running around to ensure that the clues were placed appropriately and then, we began. It included places like the first room that Abhi lived in when they joined the hostel, the perennial source of food and her favourite hangout in the hostel (my room), her native place (the library) and the solitary tree in the middle of the field which was our “Getaway” once upon a time. Having succeeded in making Abhi run around, we sat down and did the next most appropriate thing to do: click pictures! It all ended on a good note to a large extent and after this we retired to the cosy confines of our rooms.

Surprises and gifts, endless selfies, cake baking sessions with Icaboo and
running around for the treasure hunt :)

• In the evening, Abhi decided that she would treat us. The localites managed to arrange an extra vehicle for us and I got the opportunity to ride with Abhi. The best things are reserved for the last, they say and so it was. It began on a shaky start and I’m glad that Abhi had the confidence to sit on the pillion. Gradually I become acclimatized to the darkness, traffic and the chill when we raced against the wind. Nothing can beat the joy of racing (ok, not really because the Purle Road is a bumpy ride with potholes and road humps lurking at every corner) and that too with someone confident enough to sit behind you! :P Yes, I was a teeny bit nervous but all that dissipated soon enough and Govi and Abhilash were kind enough to let me race ahead and scare any poor dog that dared to cross my path. At long last we reached the destination (Pizza Sky) safely and we began hogging. Later we proceeded to Ibaco below for desserts and then it was again time to ride! We had a photo session again (and also another while riding) and it was one amazing experience altogether! I don’t want to exaggerate but honestly, riding against the wind is like setting a caged bird free. The fact that this was at night only made it awesome-er. And the obedient daughter that I am, I did mention to MaPa that “I went on a ride and came back safely.” and received no reprimands. Honestly, the security guards at the gate seem to have given up on us! We’ve become habitual late-comers and because we take the required permission they can’t really complain. It all seemed like the perfect end to the day but there were some more events that threatened to leave a bitter aftertaste but it in the end, it’s all about what we choose to remember. 

Gaadi Scenes! :)

• The next day, it was Deepu’s b’day so there was another cooking session at midnight and in the evening it was time for the combined treat of the September borns (Likki, Abhi, Deepu and Hkm)  so we (The kodachadri gang – Nammu’s boyprend and +Sanju and Deepu) headed to Anmol for dinner. After another round of hogging and even chomping on some Chocolate Paan ( Yes, I’ve tasted it and it’s not bad after all) we headed back to college. (7 of us +the driver bundled in one auto!)

•  So today was the Ganesha Visarjan in college and there was music, dance and fireworks. As it has become customary, we did some customary prancing around in the name of dance and here I am now, blogging about the latest updates!

Just like drugs are detoxified in our body to make them less toxic and then removed, one needs to detoxify oneself to prevent accumulation of toxic thoughts and ideas. Irrespective of the surroundings, one must recognize what is toxic to ones’ own progress and what acts as a catalyst.

With the finals approaching in about 2 months, there is considerable tension palpable in the atmosphere and it’s about time I pull up my socks and get down to business.

I’m not sure if I can blog frequently anymore because time has become unbelievably scarce these days. I’ll be heading to Dharwad over the weekend for the Patho quiz so I’m hoping that it all goes well. Hopefully, I’ll complete part 2 of A Story. :)

Novus Actus Interveniens

Currently dormant on the blogosphere for a variety of reasons:

• Paucity of time. (5th term is hectic. A certain Sir’s sudden surge in the subject has led to unexpected assignments cropping up out of nowhere and monopolizing the weekends. What began with a harmless blood donation day related poster presentation then led to making mind maps on assigned topics, giving seminars on clinical pathology topics, writing descriptions for museum specimens and now for the actual (official) assignments in our records! Oh, and I was speaking of only Pathology. 3 other subjects are also demanding to be studied.)

• No 3G in my new room. (I’ve shifted one floor above (that explains for the lack of exercise) and I can barely get 2G in my current location so blogging has suffered a setback.)

• Writer’s block. I haven’t been reading much these days. I’ve realized that in my current schedule, I can’t possibly read classics which require long stretches at a time which I’m not able to devote. All I can do is snatch a few minutes during classes, postings or prior to bed. I’m currently reading The Winner Stands Alone by Paulo Coelho (thanks to Anu :) ) and it seems to be interesting (prompted my previous post) although the style of writing could have been a few notches higher. 

But today I have decided to blog come what may! So we’re currently in 5th term and our exams are fast approaching (all the faculties take great pains to remind us at every possible instant about this alarming fact.) and we’re now in General Medicine postings after a month of General Surgery.

During these Surgery postings we saw a lot of ulcers (traumatic, diabetic ulcers in aged individuals, trophic ulcers, varicose (venous) ulcers, arterial ulcers and so on..) and swellings (in the neck region, in the inguinal region, lump in the breast, etc ). We also had to present cases (where once again I exhibited my unfailing talent of making a flop show (I must say, I’m getting good at this! -_-) and we had classes as well. Some were taught by the new surgeon Dr Nagaraj who’s joined Subbaiah after his stint in McGann and he seemed to give us some orientation from the examination point of view. Some others were taught by Aarthi maám (where once again I was distracted by that haircut), Gopinath Sir (who looks for opportunities to show us that he can he sarcastic) and of course, the HoD and Principal of the college who can be described as enthusiastic and passionate (to say the least. This is an online platform, after all) and he ensured that our lunch breaks were reduced to a 15 minute affair on numerous occasions. Nevertheless, I saw my first (and only) surgery (appendicectomy) performed by him during these postings. (an interesting, yet odd experience)

Another interesting update that I must mention is about Pathology. So in an earlier post I’d mentioned about the preliminary round of a Pathology quiz held in our class. As luck would have it, 10 of us were selected for the next round and a quiz was conducted for 5 teams of two participants. We weren’t really given much help regarding the quiz but we just told to read as we normally would and prepare for some embarrassment. As things unfolded, BP and I were a team while Abhi and Bharat were another. The formation of teams was a major confusion created quite a bit of pandemonium. In the weekend leading up to the quiz, the tension was palpable in the air and I was at my wit’s end given that there was also a CSF analysis to be presented on the same afternoon. BP and I spent a good part of the weekend reviewing people and topics of interest over the internet and that proved to be a boon to us the following day. The quiz was interesting we managed to open our account in the first round with a few guesses of the names of the scientists and other famous people. (Giemsa, Barbara McLintock, Papanicolou, Henrietta Lacks..) We faltered in the following rounds, partly due to our carelessness (Fat Embolism) and partly due to stupidity (Etiology) but we tried to cover up for it in the Rapid Fire. We came a close second with 80 points after Abhi and Bharat with 85, and this means that come 26th September, we will head to SDM Medical College, Dharwad for the Pathology Quiz. About the quiz, we need to study a LOTLOTLOT more than what we’re doing right now but Time is just not with us these days given that there is barely time to breathe in the midst of classes, postings, labs studies, records, assignments and yes, some time to unwind with friends..

As for the CSF analysis, we were a group of 5 and there was some or the contribution from 80% of us. 

(Not many people actually caught this bit. :P )

Technical Support:
Script: Karthik BV and Pawan
Videography: Harshit Krishna and Rajesh KH
Narrator: Jayashree Rao

I spoke about the indications for analyzing CerebroSpinal Fluid, the procedure and instruments used in Lumbar Puncture, the physical and biochemical analysis of CSF to differentiate between various etiologies of meningitis, CSF rhinorrhea and some other pointers that must be remembered while examining CSF (eg: one must analyze the sample within an hour of collection, one must not refrigerate the sample and so on.. ) Unfortunately for him, V Sir had to leave the middle of it but luckily for me it came an end without any major hiccup (or cough, literally speaking!)

Recently watched Phantom with friends and we followed this up with dinner at Anmol where we discussed the most controversial topics over the meal but it was an interesting evening on the whole. Off late, I haven’t been too choosy about the movies I’ve watched but we generally have a good time as we go as a group and have fun. Phantom made for a mildly interesting watch although it seems to be too fast paced with minimal room for interpersonal interaction. 

My current soundtrack includes:

• Gulabi (A slightly old song, from Shuddh Desi Romance but I’ve developed a fondness for it recently. The MTV unplugged version has a vibrant twinge to it so that’s better than the original in my opinion)
• Saware (by Arijit Singh, from Phantom)
• Chal Wahaan Jathe Hai (Arijit Singh)
• Tu Hi Re (an old song sung by Hariharan and Chitra)
• E Sanje and Dennana Dennana (Flute version) from the movie Rangitaranga

Often, I wonder how is it that some can let go and adapt so instantaneously while others take longer and some take forever. Is it all so ephemeral and fake? Is that what life really is about? Moving from one character to another from time to time? It comes down to this: There are some who attach much meaning to their relations with others, relationships, events, places and everything adds on to their memories. You could say they value every little thing in life, from a broken gift from a now distanced friend which they will refuse to throw away to every person whom they befriend /get acquainted with. And there are others who also have the same friendships, relations and so on, except that they do not attach meaning to everything in life. In such instances, it is easier to walk in and out of situations because there is a lot less baggage and bother. They are also less affected by changes, sudden shift of circumstances and any oscillations. Often, I wonder, which is the path to tread? In this fast paced world, it may seem appropriate to choose the second path because the first path is a classic case of thinking from the heart and not from the brain (although being a medical student, I must refrain from using such unscientific terms) and often only leads to disappointment. But the second one seems too mechanical and business-like to me. It might be the smarter decision but it may not be the one that makes me happy. It takes the innocence out of life if we can be so dissociated from what we feel and what we do. It might make me seem like a fool, but more often than not, I end up in the first case.

Coming to other matters of note, it appears that there will be no definitive changes in my boarding and lodging beginning in the near future. There has been a lot of confusion over this recently and I am mentally fatigued by thinking about the possible outcomes. I realized that I must be flexible to change, to adapt and evolve as the circumstances expect me to. I realize that happiness is every person’s birthright and I cannot covet that of another by my stubbornness. When you’re number is up, they’ll find you. I’m trying hard not to think too much or too far ahead or assume too much but just hope for the best and take it as it comes. It might seem irrational, unnecessary and daunting but it might bring the change that we are looking for. If I don’t believe that it will be possible, who else will?  Yet again, being reminded that there is an eerie resemblance to such events that occurred in the past, this whole concept appears daunting. There is a lot at stake and there is the fear of being left in the lurch but if I realize that I must let go of the cloud of negativity hovering above me and prepare to face the challenges as they come. After all, people take turns in a battle. One must enter the warzone when his compatriot is wounded.

It appears that I have blabbered endlessly and bored you all, yet I am filled with contentment. Nothing clears my head like a nice long blog post! :D

Too Little, Too Late.

So last Saturday was the trip to Kodachadri. One memorable trek with friends. We started at 4 AM, spent the early hours at Shivappanayaka Fort in Hosanagara (where we clicked loads of pigs) and then traveled to Kodachadri. We then traveled via jeeps on a bumpy road upto the guest house and had our breakfast and then began the trek uphill. We first visited the Shankaracharya temple and another cave-like temple and then returned to the guesthouse for lunch. After this we began another slippery trek towards Hidlumane falls on a damp drizzly route infested with leeches. After what seemed like forever, after several slips, falls and moments when I was sure I wouldn't make it, we all finally reached the falls and it sure was worth the arduous trek! We rushed into the waterfalls and the force of the water literally hit us like pellets of stones. After spending ample amount of time in the water, it was time to begin the trek back to the starting point and this was another challenge as part of the route was along the course of the rivulet. Thankfully we all made it before nightfall and refreshed ourselves in Hosanagar and then reached college by 10:30 PM. It was one of my first such experiences with friends and I couldn't have possibly made it without their help and support (and even taunts :P ) at every step of the journey! :) Here's wishing that we have many more such excursions in the future and explore uncharted territories. One of the things that made me happiest is the fact that Ma and Pa were glad about the trip. For me, it's a big step that they were happy about the trip and did not reprimand me for being a part of it. It gave me a lot of happiness to see that my parents understand my happiness and share the same. 

Post the trip, all of us were exhausted beyond description. It took us a day or two to get back to normal gait. It was with much reluctance that we submitted the "Patho Assignment" of a Mind Map of Polycythemia on the following Monday.

This weekend I'd been home since Di hadn't been keeping too well. We spent some time over NSO and IMO and then Di transformed into Harshaali Malhotra and I had the honor of a photo session with her. After the customary Baddie, shopping and Paakashala session we also watched a play at KH Kalasouda where Atthe, Mama, Nidhz and Ajji joined us. 

The play "Atheetha" is about a famous criminal lawyer who is presumed to have led a perfect flawless life. He is approached by a young lady for his Biography. After much ado, he agrees and begins the narration of his not-so-innocent life where his spotless record actually was just an illusion because beneath was a man who did not care for anyone but himself and his family suffers the consequences. He is beyond guilt because he rationalizes all his actions and does not seem to have a conscience. He shows no remorse for theft, adultery, forcing an abortion or losing a case on purpose as a favour for a politician. This happened to be the first intense play I've watched and the actors did a superb job and brought tears to many of us with their heartrending performance. 

So we had the Patho quiz today in class and I've done crappily enough to rule out getting selected. I feel unworthy of conversation with Icaboo after everything.

When the present becomes a repeat telecast of the past, it only fills you with dread. Currently using the device that I used in 2012-13 and it brings back some dark memories. Those were times when integrities were questioned, arguments were baseless and nights were endless. There were some terrible days then and I still wonder, why do we put up with it? Will there ever by an answer? Turns out that there isn't much difference between the past and the present except that no one has a clue what to do, no one has the energy left in them to deal with such horrors again and no one will ever voluntarily associate with us in such a state. This time, I'm not even around to do anything significant. When the people around us have metamorphosed beyond recognition, then, my friend, you are truly lost. 

All this seems like a wake up call that reality is not in fact, what I've been living. It is what I've been denying all along. It is indeed sad to hear that there is no use of education or employment when there is no compatibility between individuals. In life, any tide, any storm can be overcome when two individuals believe in each other. Without that, life is a misery to themselves and those around. The very foundations upon which your beliefs rest begin to crumble, leaving you orphaned to the brutalities of the world. It fills me with dread when I think about the future when the present itself is so bleak. There is no greater loss than the loss of hope. When one has lost hope that better days shall come, one is truly lost. It fills me with dread when I think about the ones who depend on me for better days. What am i if I cannot help those who require my presence in the hour of need? A coward? Or a selfish fool? What am I if I cannot give hope to those who have shown me that hope is everything? It is hard to digest that at the end of the day, dreams shall perish after being starved of hope and support. All the things that I had imagined since a child will remain etched as figments of a creative mind. Reality is a brutal whip that slashes across your tender hopes when you least expect it.

There's no running away from reality when it has decided to haunt you for the rest of your life. You might as well tell yourself you've been living a lie all along. 

I never promised to be nice. 

Monsoon Love.

Call me whatever you wish but the weather is so beautiful that it makes you want to sing out loud, tap your feet to the tune in your mind, sway along with the wind and soak in the drizzle that surprises you when you least expect it. Monsoon in Malnad will evoke a happiness in you that cannot be compared, you start appreciating the magic around you, the cool winds its distant echoes add to the aura of the place and the cool, damp earth makes you want to curl up with a warm mug of coffee and a novel..... Alas!! Internals are approaching and it would be wise to begin burning the midnight oil as soon as possible for there aren't many nights left for them to begin.

But then again, Rain has always brought about unequivocal opinions. To the spirited soul, rain is the symphony of the elements of nature, rain is the shower from the heavens above, rain is the aphrodisiac for the ones in love, rain is the harbinger of freshness for those looking to begin again and rain is the atonement for those who let it wash over their past. Yet, rain plays a spoilsport to those who prefer the bright and sunny disposition of the sky, it brings a pall of gloom with its dampness, it may seem like the heavens shedding their tears of sorrow, it evokes memories of a past that cannot be changed, it persists and leaves you damp and chilly without the comfort of the warmth of the Sun. To each person, rains signify something different. To the same person, rain can mean different things at different phases, It's all about perspective. :) Every monsoon, there's a song that I have for it.

• Jeeyein Kyun (2011), 
• Yaariyan (2012)
• Tum Hi Ho (2013)
• Kabhi Jo Baadal Barse (2014)
• Yet to decide! So many on my mind, most likely, the award goes to Hamaari Adhuri Kahaani (2015)

Some evergreen songs on rain are:

• Barso Re Megha (Guru)
• Bhaage Re Mann (Chameli)
• Baarish (Yaariyan)

Apart from my ode to rain, there's more to blog. 

Last Friday, I OD-ed on coffee and stayed up till 4:20AM (-_-) to complete the Peds Case Sheets and on the following afternoon I left for Bangalore enroute the drizzly Arsikere road. The next day passed in a flurry: Bball session with Di and Dad at 6AM, Baddie on the road later, Ele oota session followed by Pizza and some shopping. Short trips like these ensure that not a moment is wasted. The train journey back to Shimoga was an interesting one. There was a group of young corporates (fresh out of college) in our berth and they seemed lively and chatty. Typical Bangalore cosmopolitan crowd of two guys and 3 girls, I couldn't help but reflect on how different I/We had become. One guy was explaining all about Liposuction and the procedure, he seemed to have a fair idea of what happens to the glycogen and the glucose in the Liver, one guy and girl requested me to shift to the other side because they wanted some privacy from the rest (I knowingly smiled and said "I understand" but they thought I was some lost highschool kid and I didn't bother correcting them either. :P After a while, they got bored and took selfies alone, chatted some more and then fell asleep. In the morning, they all woke up bleary eyed and claimed that none of them had slept a wink.("I was watching a movie", "I couldn't sleep at all man, that uncle was snoring so much","I was on the phone till 3.30, see, my battery's almost gone!") Soon, we disembarked from the train and I got back to college at the crack of dawn. :)

So we had this Poster Making "Project?" in college organized by V Sir as a part of World Blood Donor Day (June 14) and the whole class (well, almost) was divided into groups of 4 or 5 and we set about making a poster on a particular aspect of Blood Donation such as Criteria for blood donation, Rh Incompatibility, Major and minor cross matching, Infectious diseases, Adverse Reactions and so on. The topic we chose was Misconceptions on Blood Donation. So we conducted a small survey (among 70 second year students) to assess the knowledge and practices regarding blood donation. All though most of the questions were basic and showed that the students were aware about blood donation and the procedures, the percentage who actually donated blood was a paltry 10%. Rakesh, Raji, Satisha and I were a team and we managed to do a fair job with our poster. It was a good experience and I'm actually glad the Patho Dept came up with something that got the class working in groups. :)

Here's the Poster that we prepared. I hope many more people donate blood after the survey. I'm also contemplating the possibility of taking the survey further. As V Sir advised, it would be interesting to conduct a modified version of the survey on a larger scale here as well as in an engineering college and look at the trends among the students. That would make this the pilot survey since it was done in a smaller scale and now we know some of the flaws in the present survey and how to improvise upon it.

Paediatrics Postings have passed (yet my passing in the end posting remains a valid doubt) and we have now commenced with Dermatology postings. Pathology is weighing heavily upon us and if I were to Stage (depth to which I have read) and Grade (to what extent I remember the basics- That's a way of saying differentiation, okay? :') ) my knowledge, the results would be quite disturbing. 

Yesterday we decided to watch ABCD2 all of a sudden. The fact that it released in Shimoga is in itself a surprising event so we (Nammu, Adi, Likki, Akkamma, Reddy and I) got ready in no time and started towards the city despite the mild shower. The auto could take us only upto a point because the roads were blocked and a makeshift bridge (that could accomodate the width of one person) had been made with drainage (+river water?!) flowing underneath in full flow. We made our way through the squelchy mess only to see the entire Subbaiah community in full attendance! (mostly our batch, truth be told) Funnily enough, I enjoyed the second half of the movie a lot more after I got some insight on the seating arrangement. *grins like a Cheshire Cat*

See, now nobody can make out that Nammu is tanned! :P

After the movie (which is an interesting watch for those who like dance-themed movies) we headed to Mathura Central for a quick bite and then it was back to hostel. All plans of of coffee party were damned and I slept happily ever after. -_-

This isn't how I usually end my blogposts but I've been bitten by a crazy bug of happiness.
Exceptions happen. :')

Drink It Up!

So yesterday V Sir spoke about Gastritis [and a lot of other things such as how women give themselves Peptic Ulcer by excessive use of NSAIDS when all they have is problems with their better half, MIL, FIL and kids whereas the Doctor who prescribed the NSAID (When there was no need for it) is not to blame because he (unlike women) has a LOT of things on his mind.] As usual, there were his jokes and regular insults “Jackasses!”

After discussing Gastritis (which is a histological diagnosis; you need to do a biopsy before you declare that the patient has gastritis), he showed us this picture of two men sharing a drink. *Neurons fire and connections are made*

Robin Warren and Barry Marshall after winning the Nobel Prize in 2005

Robin Warren and Barry Marshall are the two men who changed the history of Peptic Ulcers with their discovery that Helicobacter pylori can cause the ulcers. They were awarded the Nobel Prize for Medicine in 2005.

Since time immemorial, scientists considered that gastritis could be due to:

• ·         Heavy use of NSAIDS
• ·         Alcohol Overdose
• ·         Stress (Trauma, emotional, surgical)
• ·         Suicide Attempts
• ·         Uraemia
• ·         Heavy smoking
• ·         Nasogastric Intubation

But nobody considered the possibility of a bacterial infection causing the symptoms.

Why? Well, because how would the Bacteria survive under such high acidity?

I'd read about this when read micro:)

The treatment for this evolved from gastrectomy to vagotomy to several other variants but none of them provided a permanent distress-free solution because the procedures left the patients with many more difficulties.

At this point, Barry Marshall and Robin Warren began working together to study about the Peptic Ulcers in greater detail.

Merely isolating the bacteria cultured from the gastric contents was not indicative since they could always be contaminated species from the environment.In order to consider a species as the causative agent for a disease it must satisfy Koch’s Postulates:

Isolate the infectious agent from the individual. (blood, aspirated contents)

Culture the agent and inoculate them into a healthy individual.

There must be an infection when the agent was introduced in the healthy individual.

It must be possible to isolate the causative agent again from the second individual.

H.pylori doesn't grow in mice or pigs so it was essential to test the Postulates on humans. But this was declined for numerous reasons. The only ethically acceptable person for testing this crazy idea was Barry himself so he collected the fluid and swallowed the broth. Sure enough, the classical symptoms developed and he was sick for a week.10 days later a gastric biopsy confirmed the culprit and this made the gastroenterologists and pharmaceutical companies sit up and take note. Of course, surgeons weren’t happy with this discovery because it meant that they didn’t have to go around doing gastrectomy and other surgeries that claimed to cure Peptic Ulcers.. Slowly, things began to change and today, Peptic ulcers are almost never treated surgically but with antibiotics.

This is a great example of challenging the accepted what we all take for granted. Someone said that ulcers can’t be caused by bacteria so that thought persisted for decades. Progress comes when we question “Why?” at the end of every statement. In this age of cutting edge technology and advanced molecular biology it’s possible to test a lot of theories that we take for granted. Some of the answers to important questions lie right before us, it takes a trained mind to see.

As they say, The eyes cannot see what the mind does not know..

For more:

• http://discovermagazine.com/2010/mar/07-dr-drank-broth-gave-ulcer-solved-medical-mystery
• Wikipedia: To avoid the acidic environment of the interior of the stomach (lumen), H. pylori uses its flagella to burrow into the mucus lining of the stomach to reach the epithelial cells underneath, where the pH is more neutral. H. pylori is able to sense the pH gradient in the mucus and move towards the less acidic region (chemotaxis). This also keeps the bacteria from being swept away into the lumen with the bacteria’s mucus environment, which is constantly moving from its site of creation at the epithelium to its dissolution at the lumen interface.
  H. pylori is found in the mucus, on the inner surface of the epithelium, and occasionally inside the epithelial cells themselves. It adheres to the epithelial cells by producing adhesins, which bind to lipids and carbohydrates in the epithelial cell membrane. One such adhesion, BabA, binds to the Lewis b antigen displayed on the surface of stomach epithelial cells. Another such adhesion, SabA, binds to increased levels of sialyl-Lewis x antigen expressed on gastric mucosa.
  In addition to using chemotaxis to avoid areas of low pH, H. pylori also neutralizes the acid in its environment by producing large amounts of urease, which breaks down the urea present in the stomach to carbon dioxide and ammonia. The ammonia, which is basic, then neutralizes stomach acid.