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

Confabulations.

There are dreams every night,

Those that promise to be windows to another world,

Dreams where everything is right,

Only that they never return.

There are daydreams that come and go,

With a glimmer of hope but nothing more.

Was it real? I'd never know,

Lost ships without a shore.

And then there is you; as real as ever,

You are no delusion for I've never felt more alive,

Yet I wish you were an illusion,

Because you're the best dream that was never mine. 

Weird, Wild and Wonderful.

It's 1.45AM as I begin this post but this post JUST cannot wait. So I was right here, plonked on my bed, scrimmaging through the web for the Patho assignment and typing out a reply to my Quora friend Preethi (who is incidentally also a blogger, a travel enthusiast and a Pro-Kannada activist :) ) and that's when it all began. An hour or so later, I got a call from an unknown number and it turned out to be Preethi. So there was a plan to ëxplore Bangalore" and she invited me be a part of it. Now, this isn't usually things are in my life. I rushed to get myself ready and presentable and then I realized I had to get Madre-Padre to get on the same page. I convinced Ma that I've known her for a long time and that I'll be absolutely safe (travelling to an unknown place to meet new people) and I set off! 

Unsure of the bus route to Yeshwantpur, I called up a few local dosts and got a fair idea. I hopped on to the bus to Nayandahalli, then took and auto upto Nandini Layout (initially I thought I'd take the auto to Gorguntepalya but I realized that would cost a bomb) and then literally ran and caught a slightly moving bus to Yeshwantpur bus stand. I got a Day Pass done which basically meant that I could travel in any BMTC bus without paying anything more. 

Finally, after what seemed like forever, I met Preethi and for the first time in a long time, it didn't feel like I was meeting a stranger because we've been reading quite a bit of each other's writing. Soon, Apeksha (Preethi's school friend a.k.a Kappe :P ), Preethi and I were on our way to Orion and the chattering session began. We exchanged campus stories, complained about the crowd in our colleges, ranted about the messed up system, raved about Quora, built castles in the air w.r.t. future travel plans and meetups and basically spoke about everything under the sun. We wandered around for a while in Orion, lounged around in Landmark, walked cluelessly to a random bus stop and then realized that we needed to walk back to Yeshwantpur bus stand to travel to our next destination. We trudged back to the bus stand but the Prodigal bus eluded us for a long time. Finally we got into a bus that got us fairly close to New BEL Road. We walked along the IISc campus on a broad road shaded by a green canopy discussing the not-so-rosy life of Engineering students and clearing many myths and misconceptions. Famished,(well, not completely!) we crashed into Pizza Hut and had just placed our orders when Subbu a.k.a Subramanya (Apeksha's friend from MSR) joined us. We hogged, chatted and time seemed to fly! The best part is how we all had an amazing time despite having met for the first time. *FAITH IN HUMANITY RESTORED*

Post lunch, Subbu said he would take us to an interesting place about 2km from MSR and since we were all fed and watered, we felt upto the long walk. En route we spotted a Astrologer's place and weirdos that we are, we did the most amazing thing!! P and A walked in with a complaint that they had feelings for no Y chromosomes but each other. I was P's sister and S was A's brother. It was a tough moment for us as we tried to stifle our laughter and come up with fake names, DOBs, time and location of birth and nakshatra. The astrologer being a hi-tech dude, whipped out his iPhone and keyed in the details and calculated something and peered into his MacBook for some astrological insignia. Several cowrie shells later, he declared that the "problem" was very bad and because of a common enemy known to both of them and plotting for their downfall. he claimed to have "solved" several such cases in the past and offered to identify the person causing the problem and rid them of their problem for a sum of 4.5k. We mumbled a plausible reply, paid him the consultation fee and stumbled out laughing at our antics! One of the strangest things I've been a part of and I loved the spontaneity of it. :D

We walked along through unknown lanes, through cow-trodden paths and wide roads lined by mansions, apartments and trees talking about a great many things like we were long lost siblings (*Kumbh mela me bichde hue behen*). Discussions ranged from Quora personalities, engineering, medicine, singing paeans about our beloved Bengalooru, Marathi descendants in Tamil Nadu, qualitative comparison of animal poops, Apeksha's love for animals and imaginary plans on trying joints while I watch the fun! xD 

Preethi, Apeksha, Subbu and Me :)

We spared Subbu the ignominy of making fools of ourselves in his locality and then he led us through a tiny gate in the compound wall and.. voila! we were in the midst of greenery right in the heart of Bangalore. We walked along the path inside the GKVK campus and Subbu led us to an uspoilt rocky terrain with mini swamps and cacti. After this we realized that since 3/4 of us had to travel to opposite ends of Bangalore, it would be prudent to begin our journey backwards. This is when rain added to the celebration and we were all drenched in a span of minutes. Nevertheless, we raced the nearby shelter and watched Preethi soak in the rain. Afterthis we walked upto the Hebbal bus stand and we said our (temporary!!) goodbyes and parted ways. Preethi and I took a bus to Nagarbhavi while Apeksha traveled towards CV Raman Nagar and Subbu went back to Sanjaynagar. Preethi being the perfect host (but I can take care of myself!!) insisted on accompanying me until I found the best way to travel towards BSK. Finally, I took an auto upto 2nd stage while she took another bus towards Nagarbhavi BDA and then reached home via gaadi. After this, I had a lot more walking (in the rain) to do and my legs feel like logs but it certainly doesn't matter in the least!

At the Rocky Place, GKVK Campus

This meetup will remain in my mind for a long, long time to come because nothing about was planned, there were no expectations and yet I've come back with a treasure trove of memories and friends I really want to meet again at the earliest opportunity. :) Traveling by myself made me realize that it's important to ask when you're not sure. Ask if you are unsure of the route, of the stop you need to alight at, of anything for that matter! Once you get around to asking people when you have a question, you'll realize that most people are willing to help you around. That's the best part. Getting to know like minded people gives me the confidence to stay weird despite everything that forces me to join the bandwagon. Meeting new people is the best way to broaden your horizons, come out of a cloistered shell, exchange thoughts with like minded individuals and understand how others cope with similar issues. Sometimes all we need is the hope that we're all in the same boat and that one day we'll reach the harbor. :)

)

Prettiness by the pavement. :)

That's all for now folks! Toodles. :)

This Too Shall Pass.

So yeah, I’m back again. It’ll probably be a while before I blog again (unless of course, I have a severe attack of Blogospasm)

The famed Paediatric postings have finally begun and it seems to be interesting. I don’t want to say much and jinx myself but the department is well organized and they seem to know what exactly they’re doing. They’ve given us a clear outline of what to expect in the entire course of Paediatric postings, what are the topics to be covered in each postings, the proforma for History Taking, the growth charts for grading the growth of the child and so on. Let’s hope that everything goes well for the next two weeks :)

Too often we get bothered and bogged down by trivial bullshit. (My apologies for the usage of the word but the situation demands it) We let random things clutter our thought process and divert us from the things that matter. We let ourselves get involved in conversations that have no rhyme or reason; we let ourselves think about events that have no consequence in our lives until they actually start to impact us. The more we let ourselves get bogged down by these inhibitors, lesser our efficiency. This happens to me very often. I alternate between cycles of productivity and lackadaisical disinterest. And when realization dawns, regret sets in.

It’s all a façade; behind the smile a hundred lies conceal.

Raw and fresh, the wounds had just begun to heal.

Just when you begin to believe that the storm has passed,

The distant clap of thunder mocks at your ignorance.

Some storms do not end, some battles cannot be won.

Some nightmares have no dawn, some wars cannot be conquered.

The bitter reality awaits and the illusion of perfection shall end.

Knowing that this is the beginning of the end, the pain lies in having to pretend.                                       

The waves come crashing in with all their intensity and rage,

Only to retreat meekly in shame and regret.

Year after year, day after day,

They never seem to learn and make the same mistakes.

Having to watch in despair and do nothing is a pain;

As the rock slowly crumbles to sand and fades,

As the sand melts under the tyranny of the waves,

And what was once a majestic boulder dissolves into nothingness.

Perhaphs one day, I can explain the meaning of this to you, dear readers.. 

No Explanations (3)

The less said the better.

No Explanations.(2)

No Explanations.