Three Friends Or Three Idiots!!

Once upon a time in a far-far away land in a hostel room of a certain medical college a group of three friends(called idiots in the title to grab some eyeballs!! ) discovered in the internet a call for undergraduate medical research papers by the premier research institute of their nation.
Gung-Ho about their new found passion for research these friends ran to their favourite subject professors to do gather some idea on this..  The professors after much deliberation and thinking came up with simple one line solutions.

1. “Ohh! You  can just copy a part from my PGT’s thesis.”
   That sounded great to Idiot # 1 .Too happy he retires in hostel to dream about the how he can spend the 5000 bucks he is supposed to get as a research grant.
2. “You don’t have a proposal. Please don’t waste my time. Bring the proposal”, shouted the HOD to  Idiot #2 . Not knowing what to respond he stared at the floor (probably to figure out if he can see any microbes there) before the final “get out!!”
3.  “Come on you need to study. These have no value in the future.” , said  Idiot #3’s favourite teacher in a saintly voice. Not convinced that he did not have enough time (since he always found time for lazing round) ran to another  younger (but not so favourite)professor who he thought would share his enthusiasm—bang came the reply –

“That’s great. Tell me your research topic. I will help.”

He returned back promising he would come up with some topic in a day or two but was still as confused as ever.

Back to their rooms the friends (of course leaving Idiot #1 who still could not figure what to do with the money ) set up their own path.

Idiot #2 ran to the all- helping high-on-grass PGT. The PGT true to his reputation told him all about his hypothesis regarding why  “glue gave better hallucinations than ketamine”. Not understanding a word he tried searching about “glue”, “ketamine” & “hallucinations” (key word search individually as well as in all possible combinations!)  frantically over the net. Failed!!He just gave the whole idea a toss.

Idiot#3 could not find anything satisfactory either. He read the instructions over the net again and again. He read a few hundred research papers and wrote a research proposal which his guide threw to the dustbin. He went again and again till the day before the last date of submission when the guide took some mercy and modified his proposal and approved it. He however did not qualify that year. He tried year after year (like the spider in the Bruce story!!) and learnt the fine art(yes ! It’s an art) of doing medical research at the fag end of his UG career in his final year.

Disclaimer : All characters in this story are fictitious and the author has no idea about whether  “glue” gives a better hallucination than “ketamine” since he has never been exposed to either. It is also sincerely recommended that you DO NOT try replicating this act at home as it is actually dangerous and potentially lethal. All addictions are harmful to health.

-Soumyadeep Bhaumik,
Medical Sub-Editor,
Journal of Indian Medical Association

Breaking The Myth Of Medical Research

Well almost every other person on the planet will tell you that research is for the nerds. It’s for the absent minded people who don’t mind if they are under-paid or over-worked or heartless. Then why take up research at all- and that too in the undergraduate level. And medical science which has so much logic, the fun of discovery inculcated in every patient one deals with often blurs the need for students to engage in the (perceived) non-productive venture called research.
Most of the Students will vouch that they are already overstressed. With about 21 topics to gobble up in such a short span most students end up being contended with such syllabi-oriented study. Only about 10-15% students are knowledge hungry and a very small percentage of them (1-2%) interested in research1 So is medical research in the UG level just for this microscopic minority?

Without going into the number game of the situation lets focus on a few facts about medical research:

Medical Research is NOT for the absent minded who don’t wear socks.
Medical Research is NOT for the heartless bastards who get so stuck up with their work that they miss their wedding ceremonies.
Medical Research is NOT for the clinically stupid the ones who fail to diagnose diseases.
Medical Research is NOT for the nervous wrecks who faint at the site of every drop of blood.
Medical Research is NOT for the spectacular bookworms who fail to learn up simple facts.
Medical Research is NOT for the lonely boy sitting in the corner of the class trying to find solace with some absurd thoughts.

And now that I have mentioned so much NOT’s about it I did rather tell you what Medical Research Stands FOR before you snore away to glory :

Medical Research is FOR the absent minded who thinks about the flaws in the pages he just studied while he wears socks.(and are genius enough to match the same pair too!!!)
Medical Research is FOR the heartless bastard who will reschedule a date for just having a talk with the professor about an out of the course exercise.
Medical Research is FOR the clinically stupid who refuse to take an aberrant sign as just a normal variation to the disease process.
Medical Research is FOR the nervous wreck who would go challenge the existing concepts of fainting at the site of blood.
Medical Research is FOR the spectacular bookworms who fail to take each simple fact in the book as the gospel
Medical Research is FOR the lonely corner boy of the class trying to find out the coherence on the many absurdities of science.


HAPPY RESEARCHING FOLKS …

Soumyadeep Bhaumik
Medical Sub Editor
Journal of Indian Medical Association.

References:

i. Deo MG. Undergraduate medical students’ research in India. J Postgrad Med 2008;54:176-9

So We Are Back

It’s been a long time.

Too long for our liking actually. An explanation for this curious absence is warranted. It was not because we died,had exams,lost interest,ran out of ideas or anything of that sort. Well maybe we died and were re-incarnated, but that’s for another day.

We were not hibernating, but the ‘hivemind’ was deep in thought about how we could better ourselves and thus better serve the interests of medical students in Asia and beyond. That would include streamlining content submission which was always our first priority.

So why are we back now? Well we guess that we had given enough time to the many student journals popping up on the web to build their user base and expand their roots. We were bored really of our rather lonely existence. As some (un)wise man had said, Imitation is the surest form of flattery… Now that we are back though, we plan to keep our ‘breaks’ especially on the blogosphere to zilch.

We usher in a new beginning. Oh did I mention our Journal site has had a major uplift. And we have several surprises too in store for you.

For striving towards infinity and beyond, we o need YOU. Yes Yes I am talking to YOU. You think what you say deserves to be heard, well make yourself heard then…hey…where did you run away?

Rather easy really, drop us a mail AT : pr [AT] asmj.net with your myriad suggestions. Oh the easiest way is to blog for us…

Are you a student? Do you want to shout out? That’s all the CV we need…drop us a line with your blog idea/post or even intent(if you are confused about what to write)at the above mail id or at info[AT]asmj.net and we will get back to you with blogging ideas. You just need the urge to speak your mind and we will do the rest.

Oh dropping a comment here too would be cool.

Btw just to churn up those grey cells, we are now also at www.asmj.net. Oh wait did u commit to memory our earlier location or told your friends about it….fear not good soul…we are also at our previous id…www.asmj.info

Well…okay…awkward silence….its good to be back.

– The ASMJ Hivemind.

A Perfect World

What I don’t intend to write is a sob-story, but if this account gets a bit too teary at times, it’s because some people deserve to be deliberated over, more than others.
The patient, let’s call him Adam was one of the first I saw in my Medicine rotation.

Adam is an 18 year old boy, and like all 18 year olds, he had been immersed in a world of his own; a world occupied by cheap cell-phone speakers blaring cracked film songs and boys with worn-out cricket bats hitting tattered cricket balls across once-green spaces. Adam, you may have guessed, isn’t very well off.

But what a sad awakening from this not so perfect yet familiar world…Adam lost both his parents, one after the other over a period of four months. His mother died of congestive heart failure and his father soon followed, consumed at last by 30 years of chronic alcoholism. He retracted into his shell, and hasn’t been quite out of it since then.

Now, Adam was admitted to the hospital for weakness in the right side of his body. The weakness had set in after his father died, and the family put it down to shock and a lot other reasons. But after 40 days of food dribbling down the side of his mouth, they decided to bring him to us. And that’s when I saw him.

Adam is a very neat boy. I have been to the hospital early in the morning to check on him, only to learn he was in the bathroom taking a bath. And after the daily oiling and combing of his hair, you can find him in his bed, sipping tea and waiting for the line of relatives and friends to come visit him that day.

He never fails to say good morning to me. He never fails to call me ma’am or pull over the stool by his bed so I can sit. He complies eagerly to whatever examinations we subject him to. In fact, he has even started remembering the sequence of the neurologic examination! In a ward where patients grumble at the sight of us pesky medical students, Adam has been always enthusiastic. And never once has he asked us about him getting well.

I don’t know how he feels about his parents dying. I don’t know how he feels about him being in the hospital bed just like his father just a few months ago. His brain CT showed a dense mass in the left parietal lobe. Tuberculoma was being thought of as the most probable differential. Everyone in his family seemed relieved; to them TB sounds like something that can be dealt with…the dreaded cancer word was not mentioned.

But fate, I think has different plans for Adam. The MRI reports came this morning. When I went to visit him, I learned he was to be discharged. Discharge means a good thing for people like Adam. They think they’re healthy again. In this case, he has been referred to a neurosurgeon. For Glioblastoma multiforme. Adam just thinks he’s going to a better hospital with better medicines to make him all fine again. I was left thinking about a perfect world.

-Devika Kapuria,
Lady Hardinge Medical College.

Are doctors the worst patients?

It is an odd, early morning hunger-pang induced ranting on a topic that will, at some level, strike a chord with most of us. A close friend often tells me that doctors make the worst kind of patients, doctor wives’ even more so!
Maybe we do
But can we do differently and not make for difficult-patients?
This burst of spontaneous writing is induced by a colleague’s recent harrowing experience with one of the best doctors in one of the best facilities in Delhi, while trying to seek a consult for her brother.
Analyzing her situation I realize that she was not seeking reassurance, she was not being an overanxious medico asking for reassurance. She needed an explanation, not a mere dismissal that she got. She was asking a valid question this time (the ‘this time’ stems from knowing that the validity of the questions wax and wane!)
I know the drill at the doctors’ end. I know how irked we feel when we have to deal with doctors and their ‘known-to’s’ I know how doctor-patients’ just refuse to lay their full trust in the physician; how they go over the top with their own searching and how they are simultaneously running a full set of alternate differentials in their own heads.
But, having been a medico-patient more than once, having not been taken seriously, being pushy with seeking the correct diagnosis I know it feels pathetic. Do I not deserve to know? Does my coterie not know how it feels to be on the other side of the table?
Quoting: “While doctors are often in a better position than most of us to spot the hazards in the hospital and the holes in their care, they can’t necessarily fix them.” (1)

And a doc-patient’s advice: leave the medical degree at home, metaphorically speaking! (2)
Not much I can do but I will as a physician make a wee bit extra effort in making sure that my ‘doctor-patients’ feel at ease. Having said that I shall continue to search the Cochrane meta analysis/ Level 5 evidence for my colleague’s brother and dissect every word of his doctor’s prescription: with her coalition!

PS: A thank you to my people (you know who you guys are)!

– Gurmeen Kaur
Lady Hardinge Medical College

1)http://www.time.com/time/magazine/article/0,9171,1186553,00.html#ixzz1Sb1zhnPC
2)http://www.support4doctors.org/detail.php/61/doctors-as-patients-case-study-cancer?category_id=15

ISCOMS 2011: Not just a conference

There are conferences, and there are conferences.

By a stroke of good luck (and some pretty nasty hard work I did last year), I got the opportunity to present my research in the International Students’ Congress of (Bio) Medical Sciences (ISCOMS)-2011, from June 7-10.

This was the 18th edition of this annual International conference organized by, and held in the University of Groningen, Netherlands. The congress was spread over four days including two days of intense research presentations, workshops and keynote lectures followed by a day of the post congress tour. The event witnessed nearly 350 participants from 55 counties.
We witnessed research presentations from across the globe in the form of plenary presentations (excellently organized, with the audience being a part of the judgment process), and oral and poster presentation sessions in multiple disciplines. I happened to participate in the oral neonatology session. I also attended the oral pediatric session, the cell biology poster session, and neurology poster session. Some research presentations opened the mind to new avenues, others (for example, a few in the Cell Biology session, since I have very little background of the field) left me feeling deeply inadequate in my knowledge of the world! All in all, one only gained through the experience.

The two days of research presentation also included keynote lectures by two Nobel laureates. Sir Tim Hunt, who won the Nobel for physiology in 2001 and discoverer of the cyclins, gave an amazing (and highly interesting) account of cell cycle regulation in his lecture titled “switches and locks”. Professor Harald Zur Hausen, who won the Nobel Prize for medicine in 2008, discussed the role of infectious agents in oncogenesis: a whole new perspective on why certain cancers act the way they do; including differences between sexes, and that even established chromosomal abnormalities in certain cancer cells may have an infectious origin. In addition, Professor Jose Medina Pastana, from Sao Paolo, Brazil talked about access to high cost medical treatments in developing countries; giving the example of the incredible renal transplant program in Brazil.
The organizers had also arranged for very stimulating workshops to be held during these two days. I attended the debate on embryo selection which got pretty intense what with all the moral and religious issues of people from at least 4 continents pitted against the expansion of scientific knowledge, but was peacefully settled and we were left admiring the arrangement for embryo transport between Maastricht and Groningen.

One of the most interesting events I attended was the traumatology workshop titled “are you going to stay and play?” True to the name, Dr. Patrick Nieboer took us through the highs and lows of the life of a trauma surgeon, giving us real life triage situations, confounding us with choices between saving lives: deciding which lives were important enough to be aggressively dealt with in a situation where limited resources are available. The entire hall was in an almost trance like state, almost as if deciding whether they were capable of playing the game. Brilliant session.

Well, one does need to unwind after so much work of the grey cells in such little time. All days had a social program coinciding with dinner: A visit to the Nyenrode castle in Leek, and the global village party were great opportunities to interact with our contemporaries from across the world at a personal level. We also stayed at the house of students of the University, six of the most amazing hosts, and it was a beautiful house. The congress was followed by a tour of De Hogue Veluwe National Park and museum, which included a ten kilometer bike ride, activities like painting clogs (traditional Dutch wooden shoe) and a wholesome Dutch meal of pancakes made from scratch!

To say that it was an experience of a lifetime would be an understatement. The organizing committee deserves accolades for their skills.
They say they’re still learning and growing; I can only imagine what ISCOMS 2012 will be like!

– Sucheta Tiwari,
Lady Hardinge Medical College.

ASMJ Elsevier Essay Competition.

Here at ASMJ we dare to be different. So instead of asking you to write a short treatise on community welfare we ask you to write something original so that the world at large can be a part of your thoughts. Defensive medicine wherein you order a battery of tests in order to prevent yourself from making any crucial errors of judgement has been partly responsible for the escalating costs of healthcare. However the crux of the dilemma lies in the decision making process of where to draw a line. After all tests are the sole way of confirming a diagnosis and our sole objective is to save lives no matter what else.

So dive into this discussion of ‘Defensive medicine as a bane to healthcare’ and let us know your views. You are free to give full rein to your thoughts. Just try to make it within 800 words and mail it to us ASAP at asmjpublicrelations@gmail.com before we have second thoughts of whether we ‘like’ your name.

And the best part the wonderful people at Elsevier share our views and have promised to give gifts (wow) to 3 promising entries.

So get your pens out…err…no get your rickety keyboard out rather and send your entry in. After all everyone loves free gifts don’t they 🙂

ISCOMS Research Fellowship 2011- A Scientific-cum-Cultural Learning Experience in Holland

This summer 2011, I attended the 18th International Student Congress of (bio)Medical Sciences (ISCOMS) in Groningen, The Netherlands. It certainly lived upto its tagline- ‘Science beyond borders’. The conference was attended by (bio)medical students from all around the world- Iran, India, United Kingdom, Singapore, Indonesia, Kenya, Australia, Brazil, Romania- you name a country and a representative was certain to be there. It was an amazing platform to showcase our work and to study the research work going on in other parts of the world. The presenting participants were given an option to apply for the ISCOMS Research Fellowship (IRF). The IRF is a programme that ISCOMS has been organizing in association with the University Medical Center, Groningen (UMCG) since 2005. It gives ISCOMS participants the unique opportunity to participate in a 2 week research project in order to gain first hand experience at doing research in The Netherlands.

I was one of the 23 proud participants in the IRF and I must say that I thoroughly enjoyed the experience. The objective of my IRF project was to determine the effect of a novel drug on a porcine renal ischemia-reperfusion model. It was a part of an ongoing PhD research topic to see whether the drug could be used as protective therapy in renal transplantation. For me, the idea of actually being a miniscule part of a major breakthrough research was very exciting.

We started with getting oriented to the medical center and the surgical and pathological research laboratory (it is huge and I kept getting lost even halfway through my fellowship!). Everything is spic-and-span and very organized- although all manuals and labels are in Dutch, it is pretty simple to figure them out. My project work was mainly in the lab, consisting of chemical assays on serum and urine samples (a lot of micropipetting involved ); and observing kidney sections of the terminated experimental animals. I also visited the new futuristic (out-of-star-wars-kind) animal facility.

The ISCOMS organizing committee made sure we felt at home and organized many social programmes- Dutch dinners, Global dinners, bowling nights, pub nights! Since all the participants were staying at the same accommodation, we also had the opportunity to interact with them, learn more about their culture, their way of education, their system of medical school, their views on global topics! The presentations in the closing ceremony gave us an insight into the work that my fellow participants did during the IRF. Also, I got an idea about the various other researches taking place in UMCG in fields like stem cell technology, pharmaco-economics (which seemed very new and interesting to me), neurological sciences, etc. The possibilities of expanding science are endless!

What I learnt during the IRF was that the Dutch are really sweet and follow the motto- ‘Work hard and party harder!’… and cycling (it’s the best means of transport in most European cities!) But on a more serious note, I learnt some basic laboratory skills like cutting frozen tissue sections, immunohistochemical staining and chemical assays. Also, I participated in the university’s experimental transplantation meetings and got a view of how transplantation medicine-research works about and how clinical trials are actually conducted. All in all the IRF was an enriching experience- both culturally and academically! I made friends forever and have with me memories that will last me a lifetime!

-Ramya Pinnamaneni
Medical Student-Intern
Lady Hardinge Medical College,
New Delhi, India

Delhi’s Dengue Problem

It’s almost time for the monsoons in North India to herald the end of yet another scorching summer. However, instead of the visions of dark clouds and lush trees we invariably dream of in the heat wave; Delhi has to put up with flooded roads, fallen trees and overflowing drains. If the complete annihilation of Delhi’s transport and sanitary system weren’t enough, since the past decade and a half(1), Delhi has also been plagued by alarmingly high rates of Dengue.
The year 2010 was a perfect example of how lack of resources, lack of preparedness and a little bit of help from Mother Nature can turn a previously (somewhat) controlled seasonal disease into a full-blown epidemic. The Municipal Corporation of Delhi reported 6,259 cases of Dengue in the capital last year. The MCD numbers for 2009 were 425 cases. That’s more than a ten times rise in the number of Dengue cases in the year 2010!
Let’s try to find an epidemiological reason for this epidemic…
The Met Department reported a rainfall of 996 mm. for the months of July, August and September 2010, that’s twice the rainfall of 2009. (2) And let’s not forget the villain of the piece, the Commonwealth Games. With the amount of construction going on, there was no dearth of breeding sites for mosquitoes. Add to this an apathetic Government that left everything to the last minute, plenty of corrupt officials who did all they could to prolong the construction work for as long as they could and an MCD that shifted blame on everyone except itself; and there you have it– a perfect recipe for an epidemic! Large collections of stagnant rainwater acted as the breeding environment and huge numbers of migrant labor acted as the hosts, thus enabling the agent Aedes to wreak its havoc amongst the people of Delhi. What better way to see how an epidemiological triad works!
It’s a shame that after so much progress in the health sector, things such as improper drainage and disposal cause the health community years of setback and disappointment.
Water borne diseases are preventable by a simple change in the environment, and as a health professional, it pains me to see a person suffering just because his government couldn’t actually think about his welfare once instead of indulging in its petty, vote-seeking politics.

– Devika Kapuria

References:
1. L. Dar, S. Broor, S. Sengupta, I. Xess, and P. Seth. The First Major Outbreak of Dengue Hemorrhagic Fever in Delhi, India; Emerging Infectious Diseases. 1999; July-Aug, 5-4.
2. Hydromet Division, India Meteorological Department, District Rainfall (Delhi) (mm.) For last five years.

A Lesson in Humility

I could see my consultant walking down the hall to meet me. She smiled pleasantly and we walked together towards the ward where I was to perform a mini-clinical examination. Immediately upon reaching the patient’s room, an all too familiar feeling of anxiety came over me. It was time for me to demonstrate my clinical skills and communicate the findings of a history and exam performed earlier in the week. “No problem,” I said to myself, in a feeble attempt to boost my own confidence before beginning the exam.

It was warmer than normal that afternoon. Thankfully, my white coat cleverly concealed the growing patches of perspiration undoubtedly emerging through my shirt. The patient had come in for a review of splenomegaly, a previous incidental finding. Accordingly, I began with a gastrointestinal exam. I had not yet learned how to properly examine the haematological system; the only exam I knew which included the spleen was the GI exam so off I went.

I started at the patient’s hands and robotically listed all of the “relevant” negatives. Almost as soon as I had begun, I was interrupted by the consultant asking why I had not commented on small muscle wasting. “Ok,” I said to myself. Confused, I carried on with the GI exam. By the time I reached the face I had been interrupted a few times by the consultant asking why I had omitted seemingly obvious pertinent negatives. By this point I am sure the white coat was no longer concealing my hyperhidrosis. I struggled my way though the abdominal portion of the exam until, thankfully, I was stopped by the consultant. She told me I was much better than this and that I would have another go later in the week. I vanished from the room at the speed of light, my tail tucked. As I was leaving I noticed the consultant escorting the patient to a quiet area where they could discuss the recent blood and imaging results.

I knew the results of these tests because I had been around when the team was talking over her case. Apart from the splenomegaly which had increased in size since her last CT two months ago, multiple abdominal lymph nodes were pathologically enlarged. Her blood showed thrombocytopenia and her leucocyte alkaline phosphatase was elevated. A biopsy would later show that the patient indeed had a lymphoma and the doctor was about to tell her the bad news.

I left the hospital that day grumpy due to an embarrassing exam. The only thing I was concerned about was myself. Even though I was supposedly examining the patient, I could have just as easily been failing at an abdominal exam for a turtle. It was not until later that evening I realized the total insignificance of my less than impressive performance. Sure I would have liked to nail that first attempt at the mini-clinical evaluation but I am sure I would not have learned as much if I did. There I was, worrying about a poor score on an exam while this pleasant 70 year old student/mother/grandmother was being told she had cancer. My poor exam did not really seem all that important in comparison.

If the consultant would have evaluated me based on this catastrophic attempt, I bet it would have read: ego – bruised; perspective – gained.

Matthew Carere