As the fan turns on a hot afternoon.

      Summer in Kolkata is perhaps one of the experiences that you should definitely have once in your life. It feels like the sun is shining right over your head (hairless one in my case). The humidity hovering around 90s makes things very bad and running into a shade for respite never helps. As I entered the OPD today on one of these sticky Kolkatan days, the fan seemed to have some personal agenda against me. I am sure that the fan was rotating at not more than 100 RPM (lol!!) and maybe it was adding on to the heat more than reducing it. The aftermath of this was obvious: Hooghly had changed its course and was flowing down my (extended) forehead and joining its tributaries from other parts of my anatomy and not going into the graphic details.....I was drenched in my own sweat. Four and a half hour of mayhem followed and in the midst of a feverish serving of steriods in various forms and doses, a hot cup of tea was served to us. Temp-39 degrees, humidity >90%, and of course the fan at 100 RPM, and a hot cup of day: Totally made my day!! And by the end of the OPD, I encountered this very interesting chap from Bihar who seemed to tell everything under the sun except about his illness.
        He started like this: 4 years back I was working in the field, we grow 5 tonnes of rice every year and sell it in the local mandi, the production has been reasonably good for the last 4 years due to good Monsoon. I am hoping it will be the same this year. My son goes to school and is in class 5................................... At the first break he took , I peeked into the front sheet of the OPD ticket to ensure that he had not strolled in from the Psych OPD. Unfortunately he was Nephrotic and he was probably venting out his inability to have salt for all these years by making me lose more salt sitting under that stupid fan. Showing enormous patience (something which I have in very little "quantum"(this is a IPGMER parlance)), I tried to take the history and I finally gave up. And as it goes when a self respecting physician doesn't understand what to do I wrote down:
Adv: REPEAT ALL!!
        

Its a "Kidney Attack"!!!!

      Acute events of the heart and the brain are known by the lay populace in the form of "heart attack" and "brain attack" and this has made them realize about the severity of the condition by including "attack" in the nomenclature. This has led to development of emergency response teams and therapies along with funding that has led to remarkable decreases in mortality from these diseases. The situation is not the same as far as acute kidney injury is concerned. The number of people dying from some forms of AKI is almost the same as that from MI and AKI in addition has many long term residual defects along with its ability to increase death from other related co-morbidities.
    Not many physicians are very clear about the management of AKI and the therapeutic modalities are limited for treating this disease. The bosses of acute Nephrology: Ronco, Kellum and Bellomo in an article published recently in JAMA conceptualize the term "KIDNEY ATTACK" in order to make the disease better known to the public and to incite better understanding and better research. Lets hope that the failure of improving the mortality rates from AKI in spite of newer therapeutic modalities may improve once the importance and severity of this disease is understood by doctors as well as lay public.

TB becomes a notifiable disease in India

    TB is perhaps one of the most rampant diseases in India that cuts through all the specialties and across all economic strata. Recent reports show that 60% of new cases in India are being treated in the private sector and with not much regulation over the quality of care, there seems to be a surge in the MDR-TB cases with WHO reporting that 2.1% of all new cases and 15 % of re-treatment cases in India being MDR-TB. With effect from May 7th, tuberculosis in India becomes a notifiable diseases in that all the treating physicians and centers need to report cases to the RNTCP. RNTCP being equipped with the state of the art labs for diagnosis of resistant cases as well as keep a register of cases will be nodal in controlling the epidemic of resistant TB cases.
     Let us all co-operate in eradicating this scourge of mankind.

Medscape: Hemodialysis Associated With Sexual ...

	A link to the following Medscape article was sent to you by: vishal golay Hemodialysis Associated With Sexual Dysfunction in Women Medscape Medical News, 2012-04-06 Most Emailed Articles on Medscape 1. Diagnosing and Treating Rhinosinusitis: New Guidelines Medscape Infectious Diseases 2. Sadly Caught Up in the Moment: An Exploration of Horizontal Violence Nurs Econ 3. The Loss of Empathy in Nursing Education Medscape Nurses 4. A Soda a Day Raises CHD Risk by 20% Heartwire 5. Medical Societies List 45 Dubious Tests, Therapies Medscape Medical News

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The "medical symbol"

The rod of Aslepius

     We have all seen the "medical symbol" displayed outside the chamber of doctor's and all the other paraphernalia associated with medical care. But do we know that the common symbol has been misinterpreted by almost all of us?
    The original, ancient symbol associated with medicine and healing is the "Rod of Asclepius", who is considered as the Greek God of healing. This symbol was that of a single staff with a single entwined snake. The serpent in the symbol was meant to symbolize rejuvenation as the snake sheds its skin. It could also denote the duality of the practice of physicians, dealing with life and death, health and sickness.
     The Rod also is supposed to re-emphasize this same principle of resurrection and healing.

 
 

Caduceus

The symbol that is more commonly
misunderstood and thus wrongly

The flag of the WHO with its
depiction
of the  rod of Asclepius

 used is the "Caduceus" which consists of two entwined snakes around a staff along with two wings. Its use as a medical symbol began with its first use as the symbol of the US Army Medical Corps in 1902. However, medical historians believe that this symbol has been traditionally used with commerce, theft and deception and thus it is inappropriate as a symbol of the art of healing. A survey in the US had found that 62% of professional healthcare organisations used the rod of Asclepius as their symbols and 76% of commercial healthcare organisations used the Caduceus as their symbol. The flag of the WHO also uses the rod of Asclepius as the emblem. The Medical Council of India also uses it in their logo.

How would physicians choose to die?

       This one makes for an interesting reading. Time and again we have struggled in the ED and the ICU by shoving pipes and catheters into patients whose survival would entail a huge emotional and economic burden till the short period of extended life. This interesting article from medscape make a good reading of the various life experiences of physicians across the specialties and a study done to find out how they themselves would lie to court death.
Link: http://www.medscape.com/viewarticle/759376

Immune tolerance to unmatched kidneys by inducing Chimerism

     In an article published in the latest issue of  Science Translational Medicine, Joseph Levinthal and his team from Chicago and Louisville have been successful in inducing a chimeric bone marrow by donor stem cell transplantation following nonmyeloablative preconditioning and transplanting non HLA matched living donor kidneys in these patients. The study was conducted in 8 patients, 5 out of whom became completely immunosuppression free at the end of 1 year, 2 were on reduced doses of immunosuppression and 1 had lost the graft to sepsis and subsequently received a standard conventional kidney transplant and doing well. None of the recipients produced anti-donor antibody or exhibited engraftment syndrome or graft-versus-host disease. These results suggest that manipulation of a mobilized stem cell graft and nonmyeloablative conditioning represents a safe, practical, and reproducible means of inducing durable chimerism and donor-specific tolerance in solid organ transplant recipients.
            The idea of combined stem cell and kidney transplantation is not new but this study gives a hope that it is not as impossible as it seems. however the risk of this procedure far outweighs the safety associated with a conventional kidney transplantation and it will be some more time before this procedure becomes acceptable.
Journal link: Sci Transl Med 2012: 124(4), 124-28