Monday 27 January 2020

CHINA SNEEZING BUT THE WORLD IS CATCHING COLD!



After breaching the Great Wall of China the dreaded virus has reached Vietnam, Thailand, Sri Lanka, Malaysia, Cambodia, Australia, France, Germany, Canada and the U.S. So by all standards this is no more just a Chinese problem. In an interconnected world, where China plays an important role and with one in every six citizen of the world being Chinese the economic implications of this virus outbreak can be disastrous. At this point, uncertainty about the nature of the virus is so high that it renders quantitative assessments meaningless but alarm bells have started ringing!

The corona virus first emerged in the city of Wuhan, the capital of Hubei province. Both the location of the epicentre and the timing of the year are important to assess the financial implications of this outbreak. Recent estimates indicate that Wuhan is China's sixth-largest city, with a population of about 11 million. It accounts for about 1.6% of national GDP.

Wuhan is an important national transport hub; given its central location and that the city is a stop on the two major north-south and east-west high speed rail lines. Wuhan also sits on the banks of Yangtze River and is a key internal port. It is also an important logistics hub, accounting for 1.2% of national freight traffic by weight in 2018. Restricted movement in the vicinity of Wuhan could therefore have broader effects on the movement of goods and people. So this city is at the nucleus of Chinese financial activity. Then again, the corona virus is hitting China during Lunar New Year, a period when households tend to spend more on travel, entertainment, and gifts. Understandably the initial stages of high uncertainty are likely to affect spending. Consumer spending on entertainment and gifts will also be affected. For entertainment, many will be reluctant to take part in activities outside the home that could lead to exposure to the virus. Many people are sure to have cancelled plans of their own volition to avoid risks of exposure to the disease. The impact is magnified by the fact that Wuhan, the city where it began, is an important transport hub. Travel industries of countries which are heavily dependent on Chinese tourists like Thailand, Australia, Malaysia and many European hot spots will surely suffer as there tourists choose to stay safe and stay home.

Restricted movement of people in and around Wuhan could curtail output in some industries. This would affect both manufacturing and service industries and could trigger temporary production outages or a drop in activity. The supply-side impact, stemming from fewer people going to work, may be limited to the Wuhan area so long as the recorded cases remain concentrated in the city's immediate vicinity. Travel restrictions are also a problem for any business that needs to move goods or people around. Industrial supply chains will be affected. Some deliveries may be disrupted and some will become more expensive.


Stock markets around the world are taking note of this viral outbreak and treading cautiously. Indian financial markets have registered a fall for two successive days naw. China is a much bigger player on the world stage and so any fallout will be amplified. The Nikkei stock market suffered its worst drop in five months yesterday. European markets also slumped. In the U.S., the Dow Jones Industrial Average tumbled more than 450 points. Investors were underestimating the potential fallout initially but now they are all alarmed and cautious.

Sunday 26 January 2020

KOBE BRYANT - A MAGIC AND AN INSPIRATION




The NBA legend Kobe Bryant died on Sunday, January 26, 2020 when a helicopter he was riding in crashed and burst into flames in thick fog, killing all nine people on board including his teenage daughter and plunging the sports world into mourning.

Bryant, 41, was travelling with his 13-year-old daughter Gianna and seven other passengers and crew when their Sikorsky S-76 helicopter slammed into a rugged hillside in Calabasas, west of Los Angeles. He was on his way to the academy to coach his daughter and other children. The academy was hosting the Mamba Cup Tournament Series, a series of tournaments for boys and girls basketball teams from the third through eighth grades.
Kobe brought excitement and joy to basketball fans not just in Los Angeles, but all over the U.S. and around the world. He was drafted to the N.B.A. directly out of high school in 1996. Bryant was named an All-Star in 18 of his 20 seasons for the Lakers and helped lead the team to five championships. His hyper-competitive nature led to occasional public disagreements with coaches and other players, but his commitment to winning was never questioned.

The winner of the N.B.A.’s Most Valuable Player Award for the 2007-8 season, and the N.B.A. finals M.V.P. in both 2009 and 2010, Bryant showed a rare commitment to success on both ends of the court, with a résumé that included two scoring titles — and an 81-point game in 2006 that is the second-highest single-game total in N.B.A. history. He also thrived on the international stage, where he won gold medals for U.S.A. Basketball in the 2008 and 2012 Olympics. He will surely be remembered as the most for inspiring basketball player around the world who always competed to the very best of his ability. He showed us what is possible when remarkable talent blends with an absolute devotion to winning!

Kobe and another legend, Shaquille O’Neal arrived together in Los Angeles in 1996, proceeded to build a new Lakers dynasty, and then had their extremely public rivalry that resulted in O’Neal being traded to the Miami Heat in 2004. They were an inspiration both on and off the basketball courts and helped so many children to get engaged with the beautiful game and stay away from drugs and trouble.

Kobe's iconic stature made him the brand ambassador of Nike, with which he remained associated for nearly his entire career. The company, which signed him to a $40 million contract in 2003 has lost perhaps the most shining knight of this era whose talent and smile were his most precious armour. Bryant wore the first in his initial line of signature shoes during the 2005-2006 N.B.A. season, including the game in which he scored 81 points in January 2006. In 2011, the company supported his introduction of the nickname The Black Mamba, releasing a commercial in which he was pitched an idea for an action film by the director Robert Rodriguez. And when Bryant was set to retire, the company christened April 13 “Mamba Day.”

On his retirement Kobe wrote a beautiful poem “Dear Basketball” in which he said:
“My heart can take the pounding
My mind can handle the grind
But my body knows it’s time to say goodbye,”
This poem was the basis for the short film which in 2018 won an Academy Award! He also created the web series “Detail” for ESPN in which he analyzed current players. After retirement he became something of a champion for women’s sports and the loss of his beautiful daughter, Gianna, who had a bright future in basketball, makes this moment even more devastating.

He was one of the greatest athletes of his generation and had an immeasurable impact on the world of sport and the community of basketball. Not just Los Angeles or the U.S but the entire world has lost an icon of excellence and a source of inspiration!

Thursday 23 January 2020

FROM POLAR BEARS TO KOALA BEARS – WE ARE KILLING THEM ALL





God created this planet for everyone and not just humans alone. He gave us that extra bit of intelligence and expected us to use it to take care of all His creations. How miserably have we failed Him! Lust for power and greed for materialism has metamorphosed us into monsters and we are about to destroy the only world we have!

Global warming is a reality no matter what the American President rants. Human activities have warmed the Earth’s average temperature from 0.8 to 1 degree Celsius and the polar ice is melting faster than ever, rising the sea levels and inundating the coastal areas and islands. This is effecting us all from the ice capped North Pole to the burning bushlands of Australia. The polar bears need sea ice to hunt seals. If the sea ice melts away faster they and their babies starve to death.

It had not rained in the South-Eastern part of the Australian continent since 2018. These areas were getting hotter and drier and by the end of 2019 the conditions were so hot and tinder dry that lightning strikes that followed prompted the bush to burn at multiple places. High winds made them rage ferociously and travel quickly to adjoining townships and soon the fire was out of control of all human efforts! While human death can still be counted, the loss to the flora and fauna Down Under is simply incalculable! 80,000 koalas have been lost to these fires along with countless other smaller marsupials and birds and insect species found only in this part of the world. Several species of orchids have disappeared from this planet forever.
The commercial bee-keeping industry of New South Wales and Victoria has suffered terminal losses as the bees have been killed and their food source destroyed. The tall Eucalyptus trees would provide food to the koalas and their hollowed trunks would be home to parrots, cockatoos, marsupial gliders and possums. No one would ever know how many of these species are now extinct. The Long Footed Potoroo, a cousin of the kangaroos, are found only in this bit of Australia as are the Black Tailed Antechinus and Silver Haired Antichinus. All three marsupials are probably extinct now! Black Cockatoo, a very rare breed and Dunnart, yet another marsupial are only found in the Kangaroo Island of South Australia and there is no trace left of their habitat after the inferno!  

Ecologists in the University of Sydney estimate that nearly half a billion animals have been impacted and millions of acres of vegetation has been burnt. Will this flora and fauna ever recover?

WHY SHOULD WE BOTHER?
  1. The food we eat and the oxygen we breathe are produced by the biological plant world.
  2. We need healthy bush-lands and rain-forests to keep our planet cool and help regulate global rainfall pattern, which in turn will help our crops.
  3. The loss of pollinator species like the bees and the butterflies and other insects impact the crops which give us cereals, vegetables and fruits. Many others are involved in seed dispersal and spore dispersal. Some contribute to the soil health by digging in the top layers and allowing rainwater in them and enriching the nutrient content of the soil.
  4. Ethically too, the planet is for all the species. How can we act as arrogant fools and selfishly destroy all the flora and fauna on it?


MASS EXTINCTION

There have been 5 major mass extinction events in the past in our planet in 540 million years of its life and we may be terribly close to the sixth. In the past these extinctions have occurred because of huge ecological disruptions which in turn annihilated multiple species. The events have been either because of factors external to our planet like Asteroid impact or internal to our planet like major changes in carbon cycle altering our planet’s ecology, volcanic activities, increase greenhouse gases and global warming.

While Australia remains the ‘extinction capital of the world’ other places are not doing any better. The Amazon rainforests suffered massive damage recently while countries like Brazil and France were involved in personality clashes and petty quarrel. Rain-forests are being cut down in Brazil and Indonesia to meet their developmental needs. Even our most close relatives, the Gorillas, Orangutan and the Chimpanzee are threatened. Very soon we will be staring at a phase of loneliness in an empty, barren lifeless world and we, the greedy monsters, will too disappear from the face of earth.

If we work to save other species, we work to save ourselves. We are all interconnected. It is
ridiculous to think that we can destroy so many of earth’s plants, animals and the eco-system and nothing will ever happen to us. This will slowly come back to bite us....sooner than we think. They are not just pretty animals, annoying insects and idyllic landscapes; these are the keys to our future survival. The foundation of our economy – food security, health and quality of life rests on this ecosystem of plants, animals, birds and insects. Any time the last member of a species perishes, we are left a bit more deprived and a bit more closer to an apocalyptic collapse.

GOVERNMENTS SHOULD WAKE UP

The collapse of the Paris Accord and the drama that followed has left us doubting the sanity of a few in positions of power. Reducing greenhouse gases and reducing carbon footprints are non-negotiable. Business leaders the world over are growing increasingly worried and know that climate change will hit their bottom lines. The International Monetary Fund warns global warming is now a major financial risk, and countries could be forced into rescuing the economy and the environment. There are increasing fears among economic policy leaders that climate change could cause the next global financial breakdown. In Australia the Reserve Bank has been warned it may have to take extraordinary action to save the economy from climate change-induced financial disaster, including buying coal mines and fossil-fuel power stations.


India has committed herself to advancing renewable energy and promoting re-forestation. We intend to generate 175 GW of renewable energy, which in turn will generate 2,30,000 jobs by 2022 and improve our air quality. This is how we can manage development and environment as complimentary goals, and create a win-win situation for all stakeholders. In an unprecedented royal intrusion on government policy, Prince Charles has pleaded with world leaders and businesses to shift to a new economic model to save the planet from an "approaching catastrophe".

Tuesday 21 January 2020

AVOID THE WORST SEATS ON A FLIGHT


Have you ever travelled long haul, from our subcontinent to the Americas in seats that were in the back of the aircraft, next to the lavatories, in a middle seat with zero recline - and in the smoking section - A 30B or 30E perhaps? If you have you know the importance of choosing good seats and avoiding the worst ones. Airlines use our collective fear of the worst seat to prod us into paying extra for seats that have the same amount of legroom and even more for extra leg room.

Fortunately, you can steer clear of most of these seats most of the time just by learning which ones to avoid when making your seat selection. For this first you have to know the aircraft in which you are about to fly because the large bodied ones like Airbus A380 has two isles and so the number of isle and middle seats are just double though the number of prized window seats remain limited. But mostly we will be talking about what airlines call their smaller mainline planes: the Airbus A320 and Boeing 737 families of aircraft, and their sub-types the A319, A321, A320neo and Boeing 737 MAX — which have a single aisle with three seats on either side of the aisle.

So which are the good seats you should go out and grab by fair or foul means? At the end, it depends on your style onboard airplanes:
·                     If you plan to sleep during the long haul: Take a window seat, no one will bother you to get out or in and you can rest your head on the side.
·                     If you plan to stay awake to watch a movie or read a book: Take an aisle seat away from toilets. 
·                     If you plane to be awake for other reasons: Get a seat next to lavatories.
So here are the seats you should stay away from every time you travel.

THE SEAT AT THE BACK OF ANY SECTION 
Seats at the back of a section in a large bodied planes — those usually found just in front of a bank of lavatories or a galley — are the absolute best if you refuse to recline on principle, truly can’t stand having your seat kicked by the person in back of you, or if you’re simply an aficionado of discomfort. For the rest of us, these seats should be avoided whenever possible. They sometimes guarantee that you will be the last to get off the plane if it gets connected to the arrival lounge by an aero-bridge or passenger boarding bridge.  Besides being next to the loo these sections are often used by the flight attendants to prepare food and drinks and may be noisy.

THE LAST ROW
Sit in the last row of a smaller mainline plane and you’ll likely be treated to a custom blend of lavatory aromas, seats that don’t recline, and a constant crowd of impatient bathroom aspirants waiting their turns. And when it’s time to disembark, here’s a tip: Don’t bother getting up for at least 10 minutes after the seatbelt sign dings off. By the time the aisle is clear for you to go, it will just be you and the cleaning crew.

THE SEAT NEXT TO THE MAIN EXIT DOOR
I know this is not an absolute and some of you may put this as your first choice seat, particularly if you are tall, but not me. If legroom is your only consideration, then this might be the seat for you. But if you’re an average-height person, then why sit next to the exit? Do you have a tight connecting flight to catch and need to rush as soon as the exit door opens? You’ll be giving up your arm’s-reach storage (no seat in front of you means no under-seat storage, so you’ll need to put everything in the overhead bins during takeoff and landing). You’ll also come up against — literally — the reduced seat width that comes with the solid metal armrests needed to stow tray tables.
And you will likely remain chilly for the length of the flight, since the air by the door is colder, presumably because the door has inner mechanical workings instead of insulation.

THE DEFECTIVE SEAT
Of all the bad seats to get, this one might be the true worst because it’s the one you can’t plan for. Fly enough and you’ll eventually end up in a broken seat once in a while. Maybe the seat leans at a weird angle. Or it jiggles loosely in its bolts. Perhaps the reclining mechanism is jammed or the headphone jack or the seat back screen is on the fritz.
In the best-case scenario, you can draw attention to it and be reseated, but it’s my experience that broken seats and full flights go hand-in-hand.

BULKHEAD ROWS
Bulkhead seats sit immediately behind either the wall at the front of the cabin (if there is one) or the wall separating business and economy. These have the benefit of nobody reclining into you, but there are two potential downsides: the first is that you probably won’t have as much space to stretch out your legs, and the second is that the seats are a little narrower because the tray tables are in the armrests. For some people, bulkhead is basically the first class of economy. But many people don’t realise its drawbacks until they’ve shelled out extra money for these coveted-but-flawed seats. As with seats by the main exit, bulkhead seats lack under-seat storage, meaning you’ll be stowing all your gear during the long stretches of time around takeoff and landing. There’s also the slightly reduced width of the seat (due to the tray-table-in-armrest configuration) to account for, and the simple fact that some find staring at a wall unpleasant.
Finally, unless you’ve secured that extra space by filling it with an airline-supplied baby bassinet or a bunch of your own junk, you may find that other passengers try to use it as a cut-through to get to the opposite aisle.

SEATS BETWEEN DIFFERENT CONFIGURATIONS
You should be wary of being in that first row when a plane goes from four to three seats per row, or three to two. When a configuration switches to adapt to the tapering of the plane, legroom gets complicated since the optimal leg-stretch zone will be occupied by the seat anchors. Not only does it mean you may encroach on your neighbour’s space to stow and retrieve items placed under the seat, but it can lead to some pretty significant body aches if you’re twisting to reach your allotted leg room. So study the seat map carefully and avoid these rows.

THE SEAT NEAR THE BATHROOM
Questionable aromas aside, the seats closest to the lavatories are still among the worst in the cabin. That’s because there’s nearly always a line for the bathroom, and there’s something about being in line for the bathroom that seems to make passengers take leave of their basic manners. Expect to be treated to a constant stream of passengers steadying themselves on your seat back, jiggling it back and forth — because of turbulence or simply because they’re in the middle of some complicated hamstring stretch. Prepare for getting various body parts brush your shoulder as people try to accommodate two-way traffic in the aisle. And let’s not forget all the projecting-over-the-engine-noise conversations you’ll be treated to while trying to sleep!

THE SEAT WITH THE ENTERTAINMENT BOX
If you get this seat then your chances of stowing away your stuff under the seat in front of you is over because a metal case that takes up the entire under-seat storage area there. This is called the “entertainment box” but I don’t know why because there really is nothing entertaining about it. Those extra few inches of storage and stretching might not seem like they make a huge difference, but they really do when you’re on a long flight when it will feel that your legs are stuffed in a sleeping bag! Maintaining this position for 10 to 14 hours cannot make you feel ecstatic. How can you pick these seats I am not sure but in large jumbo jets rows 76 to 80 seats C and H has these boxes and the hold some equipment.

THE TAPERED WINDOW SEAT
At the back of some planes there are a few rows of two. This might seem like a dream — more space, no middle seat. But ... there are issues. There’s a gap between the seat and the wall of the plane, so you won’t be able to lean to sleep. If you like the feeling of a little room, it can be nice (and it’s a perk to be able to stash your stuff alongside you rather than under the seat in front) but if you leave it empty do not be surprised to find the person in the seat behind you claiming this space as their extra legroom, which could mean enduring malodorous feet wiggling in your peripheral vision for the length of your flight. And believe me when I say this can make any flight seem twice as long!

MISALIGNED WINDOW SEAT
Man proposes…but God disposes, you cannot do much here! The implied promise of the term “window seat” is of course that there’s a window you can actually see through. But many planes have configurations that place some seats between windows. Not only is this disappointing for anyone who likes to look out the window like me, but it can also create complicated lighting issues, as the window in front of and behind you may peek into your row but you won’t be able to control them. And who is in charge of the shade? If you want a dim cabin but the person behind you prefers light, you’re either going to have to negotiate (I suggest bribing with chocolate) or go for a good eye mask.

THE DREADED MIDDLE SEAT
Roes B and E in smaller mainline planes with single isle and roes B, E, F and J in large bodied planes with two isles are middle rows, which are either for couples and family or solo flyers who are losers. On non-assignment airlines, you can see the panic in the eyes of people in later boarding groups as they search for a seat — any seat — that’s not sandwiched between two people. On airlines with seat assignments, dreaded middle seats are always the last to be claimed, meaning the later you book, the more likely you are to have to resign yourself to battling your window and aisle seatmates for the extra few centimeters that armrest domination secures.


My policy is to first try to book my first choice seat from the aircraft seat map online or from the kiosk, failing which I am extra sweet to the booking agents and request to the extent of pleading till I get my way. Good manners and not high headed tantrums and show off, usually win the day. Otherwise you may land up in the non-reclining last row and in a middle seat 30 B or 30 E, next to the toilet and surely be the last to leave the aircraft when the cleaning crew is rushing in and jostling for right of way in the isle.

Saturday 18 January 2020

PRANAM SIR! (SALUTATIONS TO MY DEPARTED TEACHER)






I once read in a cemetery “Carve your name on hearts, not tombstones.”  A legacy is etched into the minds of others and the stories they share about you. The memory of Prof. Amulya Ranjan Sarkar, my teacher of Medicine in King George's Medical College. is one such legacy! 

As a teacher, I have seen him wear many hats. I have seen him being a communicator, a disciplinarian, a conveyor of information, an evaluator, a Unit manager, a counselor, a member of many teams and groups, a decision-maker, a role-model, and a surrogate parent.  Each of these roles requires practice and skills that are often not taught but are acquired by nurturing appropriate temperament, skills, and personality. Professor A. R. Sarkar had them in abundance.

He was a wizard of Internal Medicine and his insistence on the correct way of eliciting a physical sign, repeating the sequence with his students individually till they got it right was absolutely admirable. He loved being with his students and trainees and couldn’t imagine doing anything else. He had unfathomable patience and knew that little steps in learning will go a long way for his students. He provided a non-threatening and welcoming environment in his classes and ward rounds and nurtured each of his students, irrespective of their learning capabilities. Trainees were comfortable and at ease with him, they enjoy having him as their mentor.

I feel he was a very special teacher because he knew what motivates the trainees and also how to scaffold activities to ensure that maximum learning occurs. He would take each trainee from where they are and provide experiences that will maximize success. He was always discovering new things about your trainees and was a teacher both for exceptional learners and learners with diverse needs. He would thrive on challenge and could easily build relationships with his students.

A life-long learner, he was committed to the twin profession of a teacher and a doctor. He had a never-ending willingness to ensure that all his trainees reach their maximum potential. He would constantly strive to 'reach and teach' every student under his care. It was a true privilege to be his student!

Discipline and order came naturally to him. I remember once while teaching he picked up some whisper mongering in the back gallery of our Pharmacology lecture theatre and asked the entire bunch of students to stand up. But instead of scolding or marching them out of the class he asked them individually what they would the like to be known ten years from then, the offspring of successful parents or good doctors. Needless to say silence prevailed thereafter. We were firmly tested on our knowledge almost on a day to day basis. And should we fail to produce the expected results in oral quizzes each morning, we were let known about it… loudly and clearly… often in front of the rest of our entire class.

His class notes and his bed-side teachings were priceless! It is because of teachers like him that learned to read more carefully. A lot more carefully. We learned to pay attention to detail. While case presentations he made us realize that words had power and precision and clinical signs have no substitutes. To the students from vernacular medium ( usually Hindi medium) schools he even taught how to construct sentences, how to put them together in an effective and sometimes, affective sequence, how to create an effective case presentation that would have to stand them in good stead for the rest of their life.

Form Prof. A. R. Sarkar I have learned that when you strive and work to become a good teacher, the four core qualities essential are: knowledge, the skills to convey that knowledge, the ability to make the material you are teaching interesting and relevant, and a deep-seated respect for the student. On countless occasions he had helped his students to set up their practice. He set examples and framed the mind-set of his learners. He had this amazing quality to read the faces of students, be considerate to them, to stand by them in their hour of need and even provide supports to students with financial problems.

I am of the firm opinion that teachers are Nation builders. They are candles which illuminate a society by not just burning themselves but by lighting up several baby beacons! When the teachers render their services with dedication in the making of a nation, it is certain, the younger generation would become better human beings and tomorrow would then be better than today. But the question is how many teachers in schools and colleges teach with dedication and sincerity? The government of the day is opening medical institutions in the drop of a hat, where will they find teachers like Prof. Sarkar, who would teach with passion, love the students like his own children, and provide both academic and emotional supports to the students.

As the teacher in charge of the Clinical Society and Dramatic Society he would encourage us to widen our horizons live life in large scale. He was the main stay of the Sri Sri Saraswati Puja celebrations in our college campus for years together. His teachings away from the confines of wards and classrooms were far more important. He truly believed that medicine was not just a discipline but a way of life and education was what remained with you once you have forgotten the syllabus.

Sir, the effort which you made to have a positive influence in all your trainees by your words and deeds only highlights that who we are and how we show up in life matters, our devotion to brilliance matters, our attitude and levels of passion matter, our good manners and honesty matters and what we are becoming matters …………..more than we can imagine!

Pramam Sir! You will live in our hearts!!

Tuesday 14 January 2020

MONKEY CAP AND OTHER WINTER MYTHS



It is that time of the year when we spend most of our time snuggled up in a blanket, after having piled on layers of warm clothing. Growing up in a Bengali family in the winters of Lucknow we were suddenly remained of the health hazards of cold by our parents, who had spent their youth in the hot and sultry Kolkata and Dhaka. The moment the temperature dropped down to 20°C, doting Bengali moms mummify the apples of their eyes under layers of sweaters and bandor toopis (monkey caps), lest they catch a cold!  Bengalis keep themselves warm by chanting 'kee sheeth kee sheeth' (how cold!). The more the number of times they repeat it, the warmer they feel. This is exactly why the Monkey Cap, a Bengali's armour against winter, that covers the entire face and the scalp, keeps the mouth and eyes free from any obstruction to the chant ‘kee sheeth ke sheeth’. Add to this a wrap around Kashmiri shawl and you have a typical Bengali bhodrolok and bhodro-mahila! But surprisingly how the winter disappears along with the shawl and the cardigan only to show the Benaroshi Shari and the golden jewelry in a winter wedding is a mystery yet to be solved!  


While the winter season may be great for indulging in some pleasant activities, there are also a lot of general myths related to cold weather and its effect on our health, and if you are a Bengali you have had it! Right from your childhood you have worn that monkey cap and that grey muffler because winter is dangerous!! 


Myth 1: Cold air gives you a cold
It is assumed widely that people get sick from being cold. So does cold weather or a drop in outside temperature actually make you catch a cold? There is no certain answer to that. You must understand, though, that germs make you sick, not cold temperatures. 
The fact that it’s cold outside doesn't mean that someone's going to get a cold. Since the weather is changing outside some infections will become more common in winter but just as the winter, the summer too has its share of infections. Researchers also suggest that since during winter people tend to stay indoors more and are huddled together in closer proximity to people, the likelihood of germs being spread is higher.
Some viruses, particularly influenza, do thrive in cooler temperatures, and thus it is advisable to get the flu shot for better safety. 

Myth 2: Sports and exercise outdoors is dangerous when it’s cold
For heaven’s sake, they hold Winter Olympics in the snow, don’t they? The finest and the fittest athletes participate in it, are they getting sick? Yes, exercising during the peak winter season can be cumbersome, but it is not harmful if you are dressed properly for the weather. If you are healthy, and have no significant health issues, and are used to exercising outside during the winter when it’s cold, in truth, there’s really no temperature that is too cold to exercise — if you’re dressed warmly.
People have successfully gone on expeditions to the North and South Poles and have swum across the English Channel. Thus, cold weather is not a barrier to performing physical activity. However, under extremely cold temperatures, adequate precautions should be taken.

Myth 3: Vitamin C helps fight cold

Vitamin C is often hailed as a great natural remedy for fighting colds. While Vitamin C is vital for building your immunity, there is conflicting evidence on its ability to prevent a cold. It is true that relatively high doses of Vitamin C can help lessen the duration of a cold. There is not substantial research, however, to suggest that it will offer protection against getting a cold. Having a nutritious diet rich in all kinds of nutrients and minerals will be the perfect way of protecting your body during the cold season rather than depending unduly on Vitamin C.

Myth 4: You lose all your body heat through your head
This is perhaps a typical Bengali myth and hence the “monkey cap”! The monkey cap reminds the bhadrolok of his mom! Every time he yearns for his Maa's warmth, he slips his head inside its womb. Not just the bandor toopi, but also Boroline and Gelusil that symbolise tender motherly
love squeezed in a tube or a bottle, protecting Bengalis from all ills and germs. Most of us frantically cover our heads during the cold weather. While there is nothing wrong with taking precautions for your head from the cold, you shouldn’t go about believing this heat-loss myth blindly anymore. 
The head accounts for only about 9% of the body’s surface area. The heat loss is in proportion to the extent of skin that is exposed. So, for instance, if you are out stuck in the cold weather fully clothed and your head is exposed, then obviously the bulk of the body heat will be lost through your head because the rest of your body is protected. Your head is just another extremity, and it's susceptible to cold and heat loss. Sure you should wear a hat or a cap, but the head doesn't lose any more heat than any other part of your body.

Myth 5: You don’t get dehydrated in winter
Dehydration is most commonly thought of as a health concern for the summer season. This is because diarrhea and intestinal infections are more common in summers. However, it can also be a major health risk in cold weather. During winters, sweat evaporates more quickly in the cold air and that can result in dehydration. When we don’t produce sweat, we assume that we aren’t losing fluids as swiftly as we do during proper hot weather. Furthermore, the cold temperature decreases your body’s thirst response which would lead you to drink less water.
Therefore, the safest approach should be to keep an eye out on how much fluid you lose during wintertime and ensure that you drink adequate liquids throughout the season. And how do you know your fluid intake is adequate? The urine you produce should be colourless and not yellow!

Myth 6: Drinking alcohol keeps you warm
On drinking alcohol a lot of us feel our cheeks getting flushed. That makes it feel like the entire body has been warmed up. According to experts, though, alcohol merely widens the blood vessels (vaso-dilatation) and does not warm the entire body. In fact, alcohol hinders your body's ability to withstand winter air because it decreases the core body temperature, thereby increasing the risk of hypothermia. Spirits divert the blood away from your core toward your skin. While this creates a warm and pleasant sensation it also harms your body’s overall temperature regulation.
So while you can, of course, have alcohol during winter, be careful with the amount you consume and don’t expect it to magically keep you warm against the chill.

Myth 7: You don’t need sun-protection in winter
It’s common for most of us to discard our sunscreen lotion bottles during the winter season. It is only to be used in the summers, right? Well, not really. The piercing UV rays of the sun can cause damage to your skin even when it is winter. In fact, snow can produce more UV damage to the skin as its reflective surface accentuates the harmful rays of the sun. This increases the risk of long-term skin damage and sunburn. Furthermore, you aren’t safe even if you are sitting at home during winter, as UVA rays, which penetrate deeper into the skin, come right through the window.

It would hence be prudent to apply a good broad-spectrum sunscreen of at least SPF 30 during the winter months as well. 

Thursday 9 January 2020

ASSUMPTION IS THE MOTHER OF MISDIAGNOSIS.




A thirty something young executive came to a surgeon with complains of a swelling in the back and was promptly diagnosed as a lipoma (a harmless tumour of fat) because the surgeon could not find a punctum over the swelling. In a busy outdoor clinic, with more than a hundred patients waiting, he saw the patient from a distance and did not touch her. His mind went into a familiar path – back swelling with punctum – sebaceous cyst, without punctum – lipoma, and hence the diagnosis! Not satisfied she came to us and we felt a hard swelling attached to the scapula (a bone in the shoulder girdle). So, instead of a benign tumour of fat now we were dealing with a malignant tumour of muscle! This is what happens if we do not do the clinical drill and start assuming things that we would usually encounter.

There are a wide range of cognitive errors that lead doctors to make serious mistakes. Among them is ascertainment bias: we "see what we expect to see." For example, a dishevelled, homeless man staggering into the emergency room, slurring his speech, is assumed to be "drunk" when he may actually be hypoglycaemic or even urinary tract infection, which frequently manifests as delirium. When a disoriented old man was admitted to our unit, we expected to see someone who was either depressed or showing signs of a covert malignant tumour. We were not expecting to see someone in the early stages of sepsis, which only became obvious once we had the blood counts. We clinicians have this tendency to convince ourselves that what we want to be true is true, and we often blank out the less appealing alternatives.

Posting a specialist in the role of a general physician or an emergency medical officer is very dangerous. The same disoriented old man would be diagnosed by a psychiatry resident in emergency as Clinical depression  probably. Why, because he is more familiar with it and knew how to treat it. Sepsis probably is out of his portfolio of diseases. Whether we see what we expect to see or convince ourselves that what we want to be true is true, we are making unwarranted assumptions. A good medical training involves questioning one’s assumptions and avoids premature diagnostic closure.

The value of a good history and physical examination

The history and physical examination together with the ability to make difficult decisions are the key factors that distinguish the best clinicians. Taking short-cuts (for example failing to undress a child with pyrexia) will inevitably end in poor outcomes (delayed diagnosis of meningococcal septicaemia and loss of limbs or death in this particular example).  These are occasions when the clinician assumed a familiar and more common diagnosis or chose to rely on investigations. As teachers it is our duty to ensure that future generations of clinicians have good ethics and good clinical skills. No short-cuts here please!

Diagnostic acumen is the foundation of good medical care and a detailed history taking and physical examination are essential to sharpen our diagnostic acumen. These twin gems have been the cornerstone of teaching medical students. With the improvement in diagnostic modalities, however, there are some individuals who feel that these may not be as 'helpful' or 'reliable' as previously thought. Good clinical skills however, still protect patients from unnecessary investigations with the risk of false positive results and clinical risks that these investigations entail.

Make no mistakes, investigations are vital but regardless of their use in diagnosing a condition, patients still feel that the element of physical touch between a doctor and them is very important and provides a sense of satisfaction to them. The feel that 'they have been seen'. Medicine has always been an "art" as much as it wants to be a "science".  The "laying of hands" is not only an essential part of the Doctor-Patient Relationship - it may also be part of the treatment and essential for the cure. And most of the time, when a clinician is ‘laying his hand’, his mind opens up a bit more and there are lesser chances of him/her making erroneous assumptions.

Doctors have their own problems

In the developing countries because of a hopeless doctor-population ratio the doctors, particularly in government hospitals, are overburdened. It is not uncommon to find doctors besieged by patients from all sides, much like bees in a beehive, in their out-patient clinics. In such situations listening to a detailed history or conducting detailed physical examination of every patient is a Utopian dream. The doctors in private set ups have their own share of woes. The corporate management and the insurance companies force them to document many metrics, inputting data into their HIS / EHR systems, in order to meet requirements. Patients take this lack of eye-to-eye contact as a sign that doctors are more interested in their digital record than them. They feel that doctors are no longer listening to them. Lack of time and preoccupation with gadgets both are responsible for assuming common ailments and then relying on investigations for course correction at a later date.

Missed opportunities

Diagnostic error result in missed opportunities where something different could have been done to make the correct diagnosis earlier. . . . Evidence of omission (failure to do the right thing) or commission (doing something wrong) exists at the particular point in time at which the ‘error’ occurred. These missed opportunities could be caused by individual clinicians, the care team, the system, or patients. Diagnostic error can be defined as any mistake or failure in the diagnostic process leading to a misdiagnosis, a missed diagnosis, or a delayed diagnosis.

The diagnostic process has seven stages: (1) access and presentation, (2) history taking, (3) the physical examination, (4) investigations, (5) assessment, (6) referral, and (7) follow-up. A diagnostic error can occur at any stage in the diagnostic process, and there is a spectrum of patient consequences related to these errors ranging from no harm to severe harm. While all diagnostic process errors will lead to a missed, delayed, or wrong diagnosis, thankfully not all errors result in patient harm.

Medical diseases are becoming more complex, and people are living longer. There has never been a time where patients need to trust their doctors more. All doctors need to remember their oath and put the patient back in centre focus. Patients too need to learn that the vast majority us care about our patients and have their best interests in mind. We all need to become a team again. Patients need to regain our trust, and our profession needs to re-establish its integrity. We have to stop assuming the familiar and go back to the basics of history and physical examination.