The Learning Enemy - Ticking Time-Bomb within us...!

                    Have you ever imagined why defence and offence strategies of our security forces are so Top Secret!? It’s simple because we  don’t want our enemies to be prepared for what all we have in our stock!!! 

                   Same principle applies to the vast world of microbes (pathogenic - disease causing microbes to be specific). We would not like the Salmonellas (typhoid causing bacteria) Vibrios (cholera causing bacteria), E. colis (many gut and urinary tract infection causing bacteria) and many others to be prepared for the gamut of antimicrobial agents (mainly antibiotics) that we today have and which we use in patients suffering form these diseases.

                 Therefore, need of the hour for we as doctors is to use antibiotics (for that matter any antimicrobial agent!) judiciously and cautiously… It’s really distressing to see the use of higher/next generation antibiotics for simple infections that too without any evidence (e.g. Culture sensitivity reports etc). But we all health care providers are more or less aware of this monstrous problem…and frankly speaking bit scared too…at least I am.. Specially after the emergence of ‘SuperBug’ few years back…!

We medical professionals need to USE ANTIBIOTICS WISELY, NOT WIDELY!

                   So, with this article I basically intend to enlighten the 'non-medico’ segment of the society. Why today? Because, Indian Academy of Paediatrics has undertaken this MISSION AAA (Avoid Antimicrobial Abuse) and is celebrating the Rational Antibiotic Use Day (28 September 2014) and Antimicrobial Awareness Week (28 September 2014 - 05 October 2014).

               Most of the common illnesses like Common Cold, Flu, Diarrhoea are basically caused by viruses…and hence use of antibiotics are redundant. They will not help you get back to office any sooner…! And so, for you- as patients its of utmost importance that you get over this inherent urge to buy prescription medicine over the counter from the pharmacist. ALL ANTIBIOTICS ARE PRESCRIPTION MEDICINES meaning thereby, its illegal to buy them without a valid prescription… and its rightly been that way.  Text below will make you understand why its important.

                      In 1953, there were more than 7,50,00,000 cases of malaria per year! And it was a huge public health burden. Govt. of India launched NMEP (National Malaria Eradication Program) and there was free lance use of DDT to kill the mosquitoes. It did work, temporarily though, bringing malaria cases to all time low of  50,000 cases per year in 1962!! But in next 10 years the number of cases rose 12times…leading to catastrophic failure of program. This happened because of the natural selection! Use of DDT killed the susceptible mosquitoes but spared the once which were resistant to DDT and in next 10 years these multiplied and led to increase in cases of malaria. Had other strategies would not have been undertaken, malaria and death due to malaria would have risen back to same 1953 level. Life subsists and so does mosquitoes and malaria. And by the way, this led to change in approach by govt. which reflects in name of malaria programs over the years: started with NMEP---> National Malaria Control Program (NMCP)---> Intensified Malaria Control Program (IMCP)!!

                        There was a period when we, kind of, lost our track as we were so goal oriented.! In order to decrease the cases of malaria and malaria related death we started giving presumptive treatment of malaria to all cases of fever suspected to be due to malaria, specially in malaria endemic regions. And we used Chloroquine the most common drug for malaria. As expected, it did bring the cases down initially but soon number of cases started to rise due to development of Chloroquine resistant Plasmodium spp. (parasite that causes malaria) but fortunately, this time we were intelligent enough to see the trend early and literally stopped the presumptive treatment. Now we use anti-malarials only in proven cases of malaria (either by microscopy or by RDT- rapid diagnostic test Kit). 

                        Another example where inadequate treatment (mainly premature stoppage of medicines prescribed) leading development of such a dreadful disease is: Tuberculosis!! Once easily treatable under DOTS (directly observed treatment short-course) program, TB is now rapidly transforming into difficult to treat MDR (multi drug resistant) TB, even more difficult to treat XDR (eXtremely drug resistant) TB and now there is TDR TB on the horizon...! (totally drug resistant, though WHO avoids the use of acronym TDR as it gives hint of hopelessness!). This is all because we as patient don't stick to the prescribed regimens...the moment we start feeling well we tend to forget about medicines...and leave the treatment mid way!! And remember is a contagious disease. If one has MDR TB, one will spread MDR TB!!! 

                  Similarly, when we take antibiotics irrationally we put selection pressure over microbial population. Sensitive microbes die…resistant ones survives…and now whole resource is available for the resistant ones which flourish rampantly…and the worst part is Resistant bug replicate into Resistant BugS!! 

             Also, Its important to take antibiotics for prescribed duration and in prescribed dosages. Most of the time you start feeling better just after few doses of medicine. Its because majority (NOT all) of disease causing bacteria are killed by the first few doses of antibiotics (provided right antibiotic has been prescribed!!). But you need to take the complete dose of medicine so that the infection is completely eradicated. If you take meds for sub-optimal duration there is always risk of relapse of illness with greater severity. 

REMEMBER, If we SAVE Antibiotics TODAY, They will SAVE us TOMORROW!!”

                    Other important thing is, microbes are enormous in number. Just 1gram of your faeces may have somewhere around 100 million-1trillions of them!!! And even though rate of mutation (random change in genetic material of an organism leading to change in its characteristics) is very low, mere number of these little bugs make it a significant event for them. Its nature’s experimentation for betterment of the organism. 100 experiment may fail, 1000 may fail, may be million experiments fail…which is unfair for them…but they are in trillions..!! Someday some random iteration in genetic material may work… and nature’s experiment continues creating newer forms of bacteria…some of which are inherently resistant to our antibiotics…but as long as these are in the company of their own 'cousins and nephews’ we have no problem as they have to compete with trillions of bugs to grow and survive with limited resource! 

Problem occurs when we use antibiotics irrationally and sub-optimally! This creates favourable condition for resistant ones by wiping out the billions of competitive sensitive bacteria…now all the resource is available for these dangerous bugs and they multiply!!! 

The other worrisome fact is we have already made antibiotics which act on all known targets of bacterium…there are hardly any novel antibiotics in pipeline. Also, in past decade or so there were only a few antibiotics which were produced. On the other hand bugs have developed resistance to all known antibiotics…fortunately they all are not present in same single bug so far…but if we continue like this with antibiotic abuse that SUPER BUG is not very far from reality…!

            So, irrational-sub-optimal and rampant use of antibiotics must stop. Otherwise, there will be so many superbugs that we probably will not be able to contain them! Instead of self medicating seek the expert and get optimal treatment…

Stay active…stay healthy…Do well!!!

Dr. Virat Kuntalam

Medical Officer

New Delhi Municipal Council

Parliament Street, New Delhi 110001

The Exercising Habit...

         Early morning yesterday...by early morning I mean- around 7-7:30am and please, don’t take it any other way..7:30am is early morning! At least for me!!! :-) I was at Talkatora Garden. Although, I was there for the physical fitness test of security personnels that NDMC (New Delhi Municipal Council, which happens to be my employing body as well) is recruiting and before all the equipments could be set up I had some time to explore the beautiful garden…after all, I had not been an early bird of late…specially on a weekend…! ;-)

         The garden is really beautiful and soul comforting. The chirps of birds, and playful shouts of children, that routine-synchronised-animated but altogether necessary loud laughters which you can hear in any garden/park of Delhi by the group of people mainly in their 60s and beyond…the sound of water at water fountain….the footsteps of jogging individuals…the excerpts of political chat by mostly older people while taking their break after certain amount of physical activity…the panting of competitive youngsters who just dashed the extra 50 meters-or-so after their self-set distance for the day...

          I really had forgotten that there are still so many people who are not only awake but fully functional that too so early!!! And among all these hustle-bustle

of early morning...I saw another of group of individuals at the far east corner of the garden near the cricket ground…this is that side of garden which is adjacent to Mother Teresa Crescent Road…There were individuals of all age groups…The sight at first amazed me..and later pleased me as a doctor! 

          I saw three generations of a family: the Grandfather, the Father and the Son working out together..and no need to mention that this habit inculcates in the younger generation from older generation itself. If you are active, likelihood that your son will lead an active and healthy life is fairly high..and so it is for your grandson provided your son is active too…! 

           Having said this and due credit given to the individual/family…I would not be just if I don’t mention the efforts taken by the NDMC and its staffs to provide and maintain the equipments at public parks/gardens like this one which make exercising fun and not something which is tedious and brings wrinkles on forehead…! These are the equipments which NDMC recently purchased from Garden Gym.

           Its amazing how simple basic facility encourages people to be active and thereby healthy… Though, initially it may seem like futile investment but as a doctor I can say this small initiative will translate into a greater good for I know a healthier society is a productive society… Not only this initiative will reduce the burden on heath care delivery system but also increase the outcome from each and every involved individuals.

           I would be happier to see more sets of such equipment in different corners of Talkatora Garden and also in other parks/gardens of NDMC and Delhi as well…! :-)

Stay Active...Stay Healthy...!! 

Dr. Virat Kuntalam
Medical Officer,
Palika Kendra,
NDMC

When You Have Wronged...

We all go through the ups and downs of life and the most of us, on average, come out just good...
Majority of us have done 'something' wrong in past...

'something' that intermittently keeps pushing the guilt button ON and we, after a brief moment of resulting-bitterness, constantly keep pushing it OFF...

'something' that we are not so proud of...
'something' that makes the grey  shade of ours one shade darker...

'something' about which we keep mumbling to ourselves "That's it! NEVER AGAIN.." and simultaneously pretending as if it never ever happened at all altogether....or at least, wish  that it never had happened...

'something' that we so desperately WANNA UNDO... but unfortunately we can't...!

'something' for which we often find ourselves knelt down to the almighty, praying for wisdom so that we don't have to bear the same shame and pain again...

It's very important NOT TO DEMEAN ourselves by unnecessary guilts... guilts indicate that at least our "Superego" (the 'angel''; our moral guide, inside us!) is still alive... which is really a good sign..! The Superego judges our deeds mainly based on our 'self-image', moral values and social norms... whenever there is a discrepancy at any level the guilt button is turned On...

The intensity of guilt thus generated, depends on the sphere in which the discrepancy has occurred! Although it varies from individual to individual, discrepancy in 'self-image sphere' usually contributes maximally to guilt...! 

So, the highly you think of yourself... chances are, you are going to feel the deeper guilt if you do something wrong... but the bright side of the story is- the probability of wrong-doing by you, at the same time, is decreased proportionately too... which means you will probably do what you think is RIGHT THING to do most of the time..!! 

The "Id" (the 'devil''; our basic instincts, inside us) on the other hand, is responsible for our survival and pleasure... FOOD, FIGHT or FLIGHT, REPRODUCE (sex)...!!

If Superego is the 'Breaks' of a Ferrari... Id indeed is the 'gas paddle'...! It's main function is to put your survival as the utmost priority..! Left on its own, it will lead you to a path that will do all that is, at least, bodily good..! Majority of Lower animals, specially those, which don't live in herd... are guided by Id only...! 

Since, We human beings live in a highly sophisticated and equally complex social structure and hence all the time, subconsciously though, there is some sort of conflict going on between the 'angel' and the 'devil' inside us...!

In fact, it's the wrong handling of these inner conflicts by 'Ego' (the 'Middle Man' between the 'Devil' and the 'Angel') that are at the base of majority of pervasive psychiatric illnesses, if not all...!

So, in the nutshell how you handle these conflicts in your life decides how mentally healthy you are gonna be..!

Hence, my dear don't whine too much about what wrong you have done or how many times you have wronged... if you are brave enough to acknowledge it and determined enough not to repeat it again... it's okay! For we all know...To err is only human...!!

Having said this, I don't mean that you should forget what you have done...

My suggestion would be: always Apologise to the one whom you have wronged but apologise only IF YOU REALLY MEAN IT...!! 

And, don't expect forgiveness at that very instant... even if you meant every single word of your apology... because you are in no position even to have the slightest of idea about how deep actually their wounds go or how ugly their scars look...
May be your apology is accepted or may be not... in fact, you might face humiliation altogether... but it's still okay... it's still better than having not apologised at all... 

Trust me, what ever be their reaction, if yours apology was a sincere one, you will find your head and heart at peace once again...

Dr. Virat Kuntalam

@viraat_k (twitter)
(+91)9990-22-7677

(The Photographs used here, have been freely downloaded from google and author doesn't claim or has any copyright of them!)

First Love...

First Love...❤❤

First love is blinding and deafening...!

just like that Flash Bomb of SWAT team which fills you and everything around you with light so bright that darkness of any sort seems like an impossibility...and it rings a bell so loud in ur ears that all noises fade except for that one tone...

And if u are among the lucky few, you remain brightly-blinded and deaf for all the tones except for the one...for rest of the lifetime...but if not... well...then, you get the second sight..and u no longer remain deaf... but the thing is the green earth no longer seem that green afterwards..the colours fade, the flowering spring suddenly changes to a leafless autumn and that too not even with a slightest hint of the warmth of the summer or the patterings of the showering rains... music too are not that melodious as it once happened to be...rather it gets damn noisy and you in fact become tone deaf! Tone deaf, to that particular tone which once used to rang in ur ears all the time...24x7! :p :D

So, here is what I suggest... if you happen to be one ignorant 'blind and deaf' fellow...don't screw it up buddy... Chances are, you're not gonna like the sight or the sound once what you have right now is all gone..! So, Cherish it, Protect it...and for your own good Work on it...!

And don't forget...❤❤ Being someone’s first love is good, but being their last is beyond perfect...icing on the cake!! ❤❤

Take care.

Be deaf and blinded for ever...! ❤  :-)  ❤

Virat.

Follow me on Twitter

+91-999-022-7677

Let's save our arse...FIRST!!

It's a sad day. Black Day. We have failed... as a nation, as a society or for that matter...as an individual...

A girl is brutally raped...gang raped...ravaged...and dumped...to die... and she did die! and what did our government do? NOTHING..!! Except to oppress the awakening...!! What a shame.!!!

This whole incident has shown that apathy and selfishness has no nadir...at least in this govt... basically  our 'dear' govt. is currently on "LET'S SAVE OUR A** FIRST!" mission... coz:

1. That's why they first flew the girl out of the country to Singapore...sighting reasons of small bowel transplant... well, at least there are 40 diff hospitals here which are equally good, if not better than Mount Elizabeth Hospital, singapore...

2. This happened the night after Safdarjung Hospital in its Media release stated that 'she' is critical and has developed sepsis... I mean come on yaar... how can you go for transplant if patient is in sepsis...and critically ill!! You don't need to be a Venugopalan or Trehan to know that... and this clearly indicates motive behind transfer was anything BUT MEDICAL !!! (Rumor is, IB has info that if girl dies here in India...that could be outrageous and situation may become difficult to control.)

3. Not only this... then there are likes of Mr. Mukharjee Junior and similar hypocrites who issues statements like

"its the clothes of gal that is the cause of these incidents..." 

"Protests with candle in hand has become fashion" 

"they go to disco at night and to protests in morning.."

that's the kind of mentality we have sent in that 'multi-pillared circus', if I may say so, to represent us...well then, shame on us as well...!

4. the first response of govt. after the death of the victim was not a condolence msg or any assurance or pledge to bring the involved ones to speedy justice...BUT... what they did ...CLOSED THE METRO STATIONS... DEPLOYED 45 UNITS of para military forces...NOT for the protection of Women in the capital... BUT to protect their big fat f**king a**es....!! 

had you have shown even half the sincerity or the effort in ensuring security of your fellow citizens...you would not have to be on your toes saving your arses...in fact people might have kissed your f**king a**es...!! NO kidding..!

Well, jus t a gentle reminder that Mr. Govt. You have only done one thing... made our belief stronger that we can trust you NO MORE... you have only fuelled the anger of WE THE PEOPLE... and if you still don't realise it...ask Mrs. Sheila Dixit..!

Today you can barricade us, force us away from showing our emotions, our pain to you... I promise you tomorrow we may barricade you away when you come begging to our doorsteps for votes...

Today you prevent us from gathering at India Gate...tomorrow we might not gather there when you need such a gathering...

It feels very shameful to believe that we belong to a society which appears to have no humanity left... to be in country whose people's soul, empathy, compassion probably have died... It's becoming even harder to believe that this is the nation which believes in motto of "Vasudhaiv kutumbakam" "atithi devo bhav.." ... how can it be... if it can't respect/protect its own citizens... children...girls...women...!!

I remember, I used to get goose-bumps whenever I heard our national anthem... I still get those goose-bumps... and I want to get those goose-bumps in future as well... I want to be a Proud Indian... who can hold his head high... and can proudly say "I am Indian!"

So, let's all pledge together that 'her' sacrifice will not go in vain... that we will stand for her until justice is served...that will not stand any such incident of whatever magnitude anywhere near us... that we will not let humanity die...and that we are still empathetic, compassionate and caring... that we are a true Indian both at heart and deeds...!! 

Virat.

@viraat_k (twitter.com)

Prayers do get Answered...!

"We pray daily, sometimes quietly and other times aloud... We pray for our near and dear ones' health, direction and salvation in their times of distress and pain. But it's not always that things happen the way we want them to happen...

Despite our prayers, tragedies do happen with all of us! What does this mean? Didn't God hear our prayer or didn't He understand how much it hurt us? Does it mean that we stop praying and give up on God?

NO. Prayer will be more vital now than it was earlier. God's desire to hear from us is still alive. Faith is not demanding of what we want; but is rather trusting God's Goodness in spite of life's tragedies...!

We grieve, we pray and we keep on praying. We should understand that God has His own ways and plans, which is much more supreme. When he takes away something from us, He wants us to have something better...

So, keep on praying and have faith in his supremeness because he will surely answer one day. He will help us wait patiently and to trust Him for His good perfect answer. We know that in the pain and struggle of living without answer, we may find comfort in our Heavenly Father... Something beyond the tears, pain and loss; there is hope where there is praying...!"
Take care...!

PS:  (I read it a few days ago in some news paper and found it soothing and felt like sharing it with you people..)

Virat Kuntalam,

999-022-7677

The Anna Aandhi...

The Anna Aandhi...

Though I don't firmly concur with the ways in which this movement is going on, (by saying this, I am fully aware that most of you reading my blog would have labelled me as "devil's advocate"! Let me clarify right in the beginning only- I AM NOT PLAYING DEVIL's ADVOCATE here... I just have a DIFFERENT OPINION...!), still it's really heartwarming to see people coming out to support Anna on this noble cause. The magnitude of mass movement which has started in past few days is enormous... I just hope it's not just the 'Soda bottle fizz' which fades away in short duration...

The Indian system- Part II

The Indian System- Part II


My schooling is from Nainital, Uttaranchal. And I did my graduation from Shimla, Himachal.. and before that few years of PMT preparation at Delhi... So what I want to convey is I, for most of the time of my life so far, have been away from my home...which is a small town, Forbesganj, in North Bihar, near Indo-Nepalese border.

Keeping the Child alive in YOU...!

"Why small kids usually succeed?

How babies learn first to stand, then to walk and ultimately to run...?"

Well, why am I asking all these today?

An Idea can Change You!

Actually, it had been quite some time since I wrote rather I would say I even visited my blog site... and deep down I was feeling compelled to write some thing... but to write you need ideas and ideas don't come easily... :-(

                So, I was sitting in OPD... day before yesterday (i.e. one day before Holi) and hence it was a relatively lighter day... I was looking out through the window in the waiting hall... thinking what should I write about... and I saw an infant in the common waiting hall of my department and Dept. of Ophthalmology... she (or may be he!) was 11-12 months old...

Lets Recycle...!!

The shock-waves of failure in 1st two encounters of the year have settled now and after amply consoling and motivating myself with words like "Take few step back to leap further.."etc. I was finally back on track with my studies!

But somehow yesterday, I was not able to concentrate on my studies... so to utilise the time, I finally decided to make my messy room bit tidy... Just like every other bachelor's room where the largest chunk of 'mess' comes from the thrown away clothes, missing pairs of dirty socks & of course the boxers and 'chaddies', and dirty plates & coffee-mugs beneath the bed...in fact the only thing which can be found exactly at it's usual place is deodrants and perfumes...! ;-) And Mine too was no exception

NDM 1: New Delhi Metallo-Beta-Lactamase-1

NDM 1 or New Delhi Metallo-beta-Lactamase 1, is a Plasmid mediated gene which confers high degree of antibiotic resistance in bacteria which carries this gene, particularly against Penicillin group, Cephalosporins, Fluoroquinolones and Cabapeneme Group of antibiotics! And thus is a potential threat to the entire health care delivery system!

A parting Note from a Friend....

My dear friends,

            “How time flies by!” We had only heard about it so far... but, a few months back when we left each other after almost 6 years of love and togetherness we actually came to realize the true meaning of the phrase...

Are we still EVOLVING??

I think YES! We are still evolving!!

But then it's NOT in the purest Darwinian form- The Survival of the Fittest!

WE are indeed transferring our genes of better qualities and efficiency to the future generations but, as opposed to what would have been the Natural Selection in true sense, not losing the genes for weaknesses or traits usually are detrimental for our survival!

Living up to the Expectations....

Living Up to the Expectation… The story of My life...

Before I went to boarding school in Nainital in class sixth… ours was a joint family and for providing best possible education, my parents and I used to live in a small town called Forbesganj in Bihar... and so did my 8 cousins! The city was named after the Britisher Alexander John Forbes, a Military adventurer who later on established many indigo-farms in the nearby areas! 

What alienated me from my Buddy?

I thought of writing this particular post about a year ago when I went to my village soon after my MBBS final prof. exams! But as the result was out... I got busy with the paper works initially and later with hectic, busy and tiring but learning Rotatory Internship Program at IGMC, Shimla and this thought of writing blog was lost somewhere in my brain... And today while waiting to get myself registered @ MCI I fortuitously remembered it while thinking about my friends back there at IGMC and the future ahead...

So, here it is...  

I once had a very good friend...

It's a New Day...

7:45am: My alarm, as usual was ringing incessantly and I, like every other day, as my daily chore, hit the snooze button and rapidly passed from stage II of my sleep (to which the alarm has brought me into!) to stage IV… The clock, as a loyal servant, ignoring my battering, again resumed its duty of bringing me back from stage IV of my sleep to alert state with prominent beta wave emitting form my brain in another 15 min… but got the same treatment from me again…

I AM NOT GONNA SAY GOOD BYE....

"Yeah and its over before you know it,

It all goes by so fast...

Yeah the bad nights takes forever,

And the good nights don't ever seem to last...."

It was Monday... the 13th day of Sep. 2004 when I joined this college as a first year MBBS student. I was almost one and half month late from most of my batch-mates who had already joined this institution in the month of August.

My happiness was soaring high... not only because I had accomplished the long cherished dream of wearing a white coat but also because the most fierce period of ragging was almost over by then...(truly speaking the later one had contributed more to my happiness) And today when I am just few days away from bidding adieu to my alma mater- Indira Gandhi Medical College and Hospital, Shimla,

जी ले खुलके इस पल को...

एक दिन जिंदगी ऐसे मुकाम पर पहुँच जायेगी..

यारी-दोस्ती सिर्फ gtalk तक रह जाएगी..

हर cup coffee की, याद canteen की दिलाएगी ...

और हँसते-हँसते फिर आँखें नम हो जाएँगी...

Office के chamber मे Labs नज़र आएँगी...

पर चाह कर भी proxy नहीं लग पायेगी...

पैसा तो होगा, मगर TREATs की वो वजह खो जाएगी शायद...

जी ले खुलके इस पल को मेरे दोस्त...
क्यूँ कि ज़िन्दगी  इन  लम्हों  को  फिर  से  नहीं  दोहराएगी....!


विराट 

Why I enjoy my Internship?

Why I Enjoy My Internship?

For the last few days I have been quite busy. In the previous week I had to take AIIMS PGMEEE at New Delhi. Soon after my return, I had 4 back to back emergency duties! Well, that all is over now, and I have now been resetting my biological clock back to normal (from nocturnal to diurnal!), meaning thereby I had ample of free time in last couple of days! So, while I was whiling away in last few days, I went through my 10 months’ journey so far, its highs and lows, as an Intern- and without any doubt I can tell I have enjoyed it! That’s why blog is titled “Why I enjoy My Internship?”

My Profession!

In west, by west I usually mean US, they say "Pursuing a career in Medicine, you have to give it your Life-time!" And I used to wonder,"is it so?"

I am standing at the end of, what is often labeled as the 'Golden-Period' of life, my six year long College life! Within less than two months from now I will be gone from here and I am not sure if I will ever have the opportunity again to come back here at my proud alma mater- Indira Gandhi Medical College, Shimla which has made me whatever I'm today!

It has given me a lot but still I feel so inadequate in my abilities that it's sometime difficult to imagine that in a few months' time I'll be shouldering great responsibilities like saving people's lives!! Now I realize that it's not just the saying "...it takes your life-time..."