The (Bi!) Monthly Microscope

Mar-Apr -2008

Hello!

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I wonder if our work is the only thing through which we can & should express ourselves, or should we take time to pursue our hobbies too. And if we do give time to our hobbies, is it possible to reach the pinnacle in our work, which most of us are trying. It appears that monolithic personalities can achieve top results in their respective fields, compared to multifaceted (Jack of alls?) because they can devote all their time (& life) to one cause. I don’t know how many of us are able

to choose their priorities to the exclusion of others, but hats off to those who do. Incidentally we are also discussing a related article addressing this very issue on Page 5. Before you start thinking that the guy is going nuts, I will stop my freestyle rambling and come back to medicine. This time we are discussing A) Blood culture in India B) When it' s not appendicitis.C) Plt Transfusion Guidelines D) Success, Regret, and the Struggle for Balance

Blood culture in India: A proposal for a national programme for early detection of sepsis National Health Programme (NHP) 2002 will endeavour to achieve reduction in IMR to 30/1000 live births and MMR to 100/100,000 live births by 2010. This is difficult to achieve without tackling the problem of sepsis. In this paper from IJMM a three-tier level of development is being proposed to develop the blood culture based national programme for early detection of sepsis. The plan envisages the

establishment of manual blood culture based elementary system in the health centre and district hospital level (Level 1),direct Gram stain and direct antibiotic sensitivity testing from the "positive" blood culture broths at the medical college hospital level (Level 2) and development of automated methods, enhancement of quality control and safety measures, clinical liaison and re-orientation of microbiology training at the tertiary care centre level (Level 3). (2)

When it's not appendicitis. While reading about appendix I came upon this paper which says that other pathology besides appendicitis may be found in patients with right lower quadrant pain.

Women of childbearing age and patients > 50 years old have a significant incidence of nonappendiceal pathology. In this group of patients, a diagnostic laparoscopy appears justifiable to identify the cause of the abdominal pain. (Page 3 )

Evidence-Based Platelet Transfusion Guidelines Come viral fever season, and platelets disappear from the blood banks faster than hot Samosas from corner shop. I thought this paper could be useful to all of us who use platelets. It says that a 10,000/µL prophylactic plt transfusion trigger has been documented to be both hemostatically efficacious and cost effective in reducing plt transfusion requirements.

Poor responses to plt transfusions are often multifactorial. For alloimmune plt refractoriness, HLA matching, crossmatching, and identification of the specificity of the patient’s antibodies with avoidance of mismatched donor antigens are all equally effective in identifying compatible plts for transfusion. (4)

Success, Regret, and the Struggle for Balance What is success and how much achievement is enough? This article addresses the challenges facing physicians today as they struggle to strike the proper balance between career and personal life; it also addresses the potential toll to one self and loved ones

when career success is placed above all other concerns. Here, one doctor is admiring the doctors who are able to strike a balance between career and family. And he is regretting that he put his career above the family. Quite a thought provoking piece. ( Page 5 )

Apart from this check out usual sections like Cricket Jokes, ‘Interesting cases’, Sidduisms, ‘Parting Thought’featuring Barry Neil Kaufman. Inability keep up with the schedule, has led me to

make this a Bimonthly Magazine, if you have noticed the change in name! Hope that you enjoy this issue, too! Thanks and regards,

Closer look at health

______Sachin

Dr. Sachin Kale, MD (Pathology), Kale Path Lab, 31, Mitra Nagar, Behind Akashwani, A’bad. Phone: 2340558, 9823244033.

I f y o u t hi n k t hi s i s i nt e r e s t i ng ( o r b or i ng ! ) , a n d w o ul d ( s t i l l ) l i ke t o c h e c k b a c k i s s u e s , t h e y ar e h e r e ht t p: / / s ac h i n ka l e 1 . t r i p o d . c o m You can leave your comments & check others at – http://sachinkale1.tripod.com/comments.htm

(1, Cont. )

Indian J Med Microbiol 2005, Volume : 23, Issue : 4, Page : 220-226

Blood culture in India: A proposal for a national programme for early detection of sepsis

Interesting Cases: From exotic to common

The Monthly Microscope – Mar-Apr /08

Fluorescein Angiography: A strange cause of an enigmatic icteric plasma http://www.flickr.com/photos/sachinkale/2340320958/ Negative (Ghost) images of acid fast bacilli in Gram stain: http://www.flickr.com/photos/sachinkale/2330133225/ Post-spleenectomy thrombocytosis: http://www.flickr.com/photos/sachinkale/2329952231/ Fungal corneal ulcer, KOH Prep of scrapings http://www.flickr.com/photos/sachinkale/2296495906/ Hysterectomy specimen showing Intrauterine Degenerating products of Gestation http://telepath.patho.unibas.ch/ipath/object/view/165707 Entamoeba, Giardia: Jab We Met: Video of these trophozoites together http://www.youtube.com/watch?v=d8CMiBjCvhk http://www.youtube.com/watch?v=9h6ui43s0ks

Congenital Pulmonary Cyst (CCAM: type I): A case report Dr.

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When it's not appendicitis.

Other pathology besides appendicitis may be found in patients with right lower quadrant pain. This has led some to advocate diagnostic laparoscopy/laparoscopic appendectomy for all such cases. This policy would substantially raise the costs of care without a priori proof of its efficacy. However, a selective approach on when to proceed with diagnostic laparoscopy will depend on the frequency of finding unexpected, nonappendiceal pathology. To determine this, we reviewed our experience with 202 appendectomies. For females < 50 years old, 33 per cent had normal appendices, 12 per cent had periappendicitis, 47 per cent had acute appendicitis, 12 per cent had perforated appendicitis, and 26 per cent had other nonappendiceal pathology. For males < 50 years old, 13 per cent had normal appendices, 8 per cent had periappendicitis, 67 per cent had acute appendicitis, 15 per cent had perforated appendicitis, and 5 per cent had other pathology. For patients > 50 years old, 7 per cent had normal appendices, 13 per cent had periappendicitis, 33 per cent had acute appendicitis, 60 per cent had perforated appendicitis, and 20 per cent other pathology. Other nonappendiceal pathology was found in 42 per cent of females < 50 with normal appendices, 57 per cent with periappendicitis, and 14 per cent with acute/perforated appendicitis. In males < 50 years, 50 per cent of those with normal appendices, 10 per cent of those with periappendicitis, and 0.7 per cent of those with acute appendicitis had nonappendiceal pathology. In conclusion, women of childbearing age and patients > 50 years old have a significant incidence of nonappendiceal pathology. In this group of patients, a diagnostic laparoscopy appears justifiable to identify the cause of the abdominal pain.

There is no dearth of good Samaritans on the net, when you are in trouble you want some help. I have seen people going out of their way to help someone. I remember, when my Hard Disk went south with some important data on it, a guy from Denmark gave me steps by step advice which helped me recover my data.

The Monthly Microscope – Mar-Apr /08

Peer 2 peer sharing is one more technology which is being used for 1) file sharing 2) telephony 3) media streaming (audio, video) 4) Discussion forums

But I would be lying if I didn' t admit that the most popular use of P2P is probably illegal file sharing (Movies, CDs, DVDs etc.), despite the fact that it is used for many other purposes and was definitely not created for it. You can find more about this here - http://en.wikipedia.org/wiki/Peer-topeer Some of the popular softwares used for P2P sharing are BitTorrent and Emule; these can be downloaded for free from the internet. Just Google for them.

Mrs Jones : I' d like my son to be excused playing cricket. I don' t think he should mix with that sort of person. Teacher: How d' you mean? Mrs Jones: Well; I distinctly heard him say that the man in the white coat was a vampire!

(3, Cont.)

Hematology 2007

Evidence-Based Platelet Transfusion Guidelines

Transfused platelets (plts) are either pooled random-donor platelet (plt) concentrates or single-donor apheresis plts. When stored for 5 days, all of these products are equally efficacious. A 10,000/µL prophylactic plt transfusion trigger has been documented to be both hemostatically efficacious and cost effective in reducing plt transfusion requirements. The optimal plt dose/transfusion is being evaluated in an ongoing clinical trial. Therapeutic plt transfusions to control or prevent bleeding with trauma or surgical procedures require higher transfusion triggers of 100,000/µL for neurosurgical procedures and between 50,000/µL and 100,000/µL for other invasive procedures or trauma. Leukoreduction has been documented to reduce plt alloimmunization rates, cytomegalovirus (CMV) transmission by transfusion, and febrile transfusion reactions. Whether it reduces immunomodulatory effects of transfusion (i.e., decreases infection rates and cancer recurrence) is still controversial, as is universal leukoreduction.

The Monthly Microscope – Mar-Apr /08

Poor responses to plt transfusions are often multifactorial. For alloimmune plt refractoriness, HLA matching, cross-matching, and identification of the specificity of the patient’s antibodies with avoidance of mismatched donor antigens are all equally effective in identifying compatible plts for transfusion. Other causes of poor plt responses are splenomegaly, ABO mismatching, females with 2 or more pregnancies and males, use of heparin or amphotericin, bleeding, fever, graft-vs-host disease (GVHD), and vaso-occlusive disease (VOD).

If one-day cricket was pyjama cricket, then Twenty20 is underwear cricket. Nobody travels on the road to success without a puncture or two. In London they drive on the left, in India we drive on what is left. You can' t squeeze toothpaste back into the tube. Sidhuisms

This is a batsman who is as erratic as the electricity supply in most parts of India. The gap between bat and pad is so much that I would have driven a car through it...!! Pitches are like wives - you never know which way they' ll turn. (4, Cont. )

Annals of Family Medicine 6:171-172 (2008)

Success, Regret, and the Struggle for Balance

"What is success and how much achievement is enough?" I wondered. "People who have millions of dollars want more millions, but how many millions do you really need? The same applies to academic achievement—how many publications are enough for an institutional committee to recommend promotion?" Joe responded, "There are criteria, of course. But really, everybody has to answer that for themselves. For me, the answer to how many papers is enough is whatever I can do given the choices I’ve made about my time and priorities." There will always be people who follow the model of continuous, relentless work to achieve at a potentially great cost to personal and family life. There are others who are happy with a moderate amount of career success, so they may attend to other domains in their lives. Our academic institutions need to be flexible and accommodate more than one approach. They need to recognize a new reality with respect to work-life issues, and they need to reflect that recognition in meaningful ways, such as acknowledging the legitimacy of parttime careers and rewarding faculty accordingly. Criteria for advancement could take into account whether a faculty member is working full time when reviewing his or her accomplishments, allowing for all faculty to be valued and rewarded fairly. We certainly have seen

The Monthly Microscope – Mar-Apr /08

examples of this sort of flexibility from the corporate world.

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Parting Thought… “All dreams appear impossible until someone makes them happen.” - Barry Neil Kaufman, author of Son Rise and the founder of The Option Institute, an internationally recognized learning center. His other books include Happiness is a Choice and To Love Is to Be Happy With. The institute founded by Barry and his wife teaches self-acceptance and empowerment. He lives in Sheffield, Massachusetts. (End, 5)