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Why aren’t the medical students in Tamil Nadu protesting? May 14, 2006

Posted by scan man in caste, Life in India, Medicine, News, Politics, reservations.

I am distressed.

There has been an ominous silence in Tamil Nadu's usually spirited medical student community.

Their brethren are being beaten up and water-cannoned by policemen in Mumbai, on hunger strike in Delhi and on protest marches in Mangalore and other cities.

The Mumbai and Delhi chapters of the Indian Medical Association have called for strikes on Monday.

Why isn't there any noise in Tamil Nadu? (more…)


Close Encounters Of The Alternative Medicine Kind – II May 14, 2006

Posted by scan man in Life in India, Medicine.

For those who read Part-I of my Close Encounters, this story is different. This is more in line with the usual kind of stuff that 'real doctors' write about Alternative Medicine.

It ought to be titled "Quactitioner Alert". I refrained from doing so out of deference to Dr. Crippen who coined the phrase.

This story starts with the ringing of my office intercom on a busy morning… (more…)

Rule 49 (O) Update May 12, 2006

Posted by scan man in Life in India, News, Politics.

The Tamil Nadu State election results were declared yesterday. The people have voted for a regime change. So we'll have a new chief minister in a few days.

I had entertained the possibility of opting not to vote for any of the contestants in my constituency. I was not too sure if I would be allowed to do that. The existence of such a provision in the Election Rules has only been talked about in websites and blogs among what the Indian media quaintly calls the 'chatteratti'. I did not think that it had percolated down to the lower bureaucracy. So I chose the lesser evils and voted for the non-communist candidate.

I am glad to say he won. But the alliance that his party was part of lost. The left-of-centre alliance which included the two communist parties won.

My skepticism re. the lower bureaucracy was proved true by news reports of people being refused to entertain their privilege not to vote by opting for Rule 49 (O).

We really do need electoral reforms.

Update: The guy I voted for won with a margin of just 14 votes (total votes polled 240,267).    

A problem too jumbo-sized for Bill Gates to solve? May 12, 2006

Posted by scan man in Computers.
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That is the question posed by John Naughton of The Observer. The problem is the continuing saga of delays that have plagued the launch of Windows Vista.

Why is this on my blog?

The difference between Microsoft and Apple can be largely explained by two factors. One is structural: Apple's OS X is based on Unix, which has a different architecture from Windows, and may be inherently easier to upgrade. The other is that Microsoft is a victim of its past monopolistic success: any new version of Windows has to be 'backwards compatible' with the thousands of programs and hardware devices built to work on earlier versions of the operating system. Apple has much less of a 'legacy' problem in this sense.

He also has good things to say about Linux and Open Source in general. Read the full article here.

Close Encounters Of The Alternative Medicine Kind – I May 11, 2006

Posted by scan man in Life in India, Medicine.

This is the first of two stories based on two incidents that occurred last week.

I am not a fan of any of the systems of Alternative Medicine. My limited experience of the world of medical blogging tells me that I am not alone. For those of you who are familiar with what 'real doctors' write about Alternative Medicine and its practitioners / quactitioners, this is a different kind of story…

..that started with a referral for a Brain CT scan by a Siddha Medical Practitioner from a nearby small town.

The patient was sent to me with a letter which said:

To The Radiologist, Big Town Hospital.

Dear Doctor,

Please do a CT scan of the Brain for Mr. P, a 60-year-old man who is semiconscious and has left-sided hemiplegia. Please admit him in your hospital and do the needful.

signed Dr. Sidha Practioner, B.S.M.S., Small Town.

I was intrigued.

It is not unusual to come across referrals for 'western / allopathic' tests from practitioners of the many alternative medical systems that the Indian Government recognizes (Ayurveda, Siddha, Yoga, Unani, Homeopathy & Naturopathy).

As a Radiologist, I have come across several referrals by these practitioners for various imaging studies. The majority of such referrals have been for questionable indications and for inappropriate imaging studies. In most of those instances, an allopathic practitioner could have come to a reasonable diagnosis based on history, clinical exam and some lab tests.

This referral sounded almost like what I would get from one of my allopathic colleagues. My curiosity was aroused to the extent that I did something that I rarely do for a CT Brain referral. I got out of my comfortable chair and went over to see the patient.

The patient, lying on a stretcher, had a large bandage swathed around his head covering the right side of his face and jaw. He was not arousable. His ABCs were ok. His blood pressure was normal. I could not get any relevant history from the worried-looking rustic old lady who was with him. I assumed it was his wife. After a cursory examination – the only kind that I know – I concluded that he did have a left-sided hemiplegia. I told my nurse and techs to get him into the CT room and went back to my office.

I was worried about the bandage. Was there a history of injury?

I needed more information. So I pulled out the referral letter, checked the number and called Dr. Sidhha Practitioner. I introduced myself, thanked him for the referral and asked him for clinical details. This was his story…

Mr. P had come to see him about a few days ago with a painful swelling on the right side of his jaw. Dr. SP thought it could be a Parotid abscess. Knowing that he would not be able to do anything for it through Siddha, he referred Mr. P to the local Government Hospital. The surgeon there had done an I & D, prescribed some antibiotics and sent him home. His wife and some neighbours brought Mr.P back to Dr. SP today, saying that he had not been arousable in the morning. After examining him, Dr. SP concluded that Mr. P had a stroke, so he referred him to our hospital which he knew had a CT scan and a Neurology Department.

By this time the techs had completed the scan. It showed an acute infarct in the Right Middle Cerebral artery territory. The scan also showed signs of facial cellulitis on the right side and small air pockets in the right Parotid, consistent with a recently drained abscess.

I alerted the Neurologist and sent the patient to the Emergency Department. I saw him again two days later when he was sent for a repeat CT. The infarct had not progressed and his facial cellulitis was subsiding.

In the course of a few days, Dr. SP had correctly identified two different medical conditions in Mr. P, had recognized the need for proper care and had sent him to the appropriate places.

This is one Practitioner that I will not forget. May his tribe increase!