Ants: Swimming

My last post was about cardio by ants. My wife did not believe it was cardio, and I don't know how many of my readers believed it. I don't know if I should believe it myself. But ants around my house are weird. Not only do they march for nothing, but they also swim. Now it is one thing to swim for one's life. It is altogether a different thing when one does it for fun, or as an exercise. If an ant falls in water or is thrown in water, it will swim until it reaches a dry surface again. We have ants which sometimes enter the water that we store for drinking (forcing us to throw it away). They enter it in a large number, and keep swimming on the surface. They often hold onto one another, probably to form a raft and support one another. If any of them break away, they soon find their way back to the swimming group. The only two reasons for this activity I can imagine are to exercise themselves or to have fun. It cannot be that they go there to have a drink and then fall in accidentally. There is plenty of water to drink at the place they come from - the potted plants, which we water regularly. I have not explained this theory to my wife, because I am sure she will give me another look like she did when I told her about their cardio.
If you want to see how they swim, check out the video at the following link.
Swimming Ants

Ants and Cardio

Ants are industrious creatures. They toil from sunup to sundown, and perhaps afterwards too, but I usually sleep at night and don’t notice what they do. I thought they would never do anything other than work, with the exception of the queen, who has other things on its mind. So what happened in my house surprised me no end.

All was well, until one day I found ants running along one of the walls of the second bedroom. There were so many of them. They were going in both directions. This was a cause for concern. They were probably raiding the larder. So I followed them. They went under the door into the hall. At the end of the wall, they turned along the adjacent wall, and again when they reached its end. Here they climbed up to reach the ceiling, turned through 90 degrees to reach the third wall. They reached the fluorescent tube light. There the line stayed a while and turned back to retrace its route. I traced it the other way. It reached the second bedroom, and finally climbed up the cot. It stopped at a nonspecific spot and turned back again. All the ants kept doing this. They were still doing it when I reached home after a day’s work. None carried any food. There was no place to sleep. There was no water source to take a drink. I have shown their route in the following picture.

“What do you think they are doing?” I asked my wife, after explaining all this to her.

“God knows. Perhaps they expect to find the larder en route” she said. “Let us get rid of them, or they might find the larder eventually.”

So I got rid of them. I think getting rid of ants is legal, and no PETA activists should be at my doorstep protesting.

The next day a new batch of them was at it again, this time visiting the remaining rooms. The route is as shown below. Even this time there was no connection to their colony. They were like gypsies, on the go at all times.

I got rid of the whole lot the second time. A week later they repeated the feat, along different walls in the same rooms. I got rid of them too. They have not returned to do something like this since then.

“I don’t think they were looking for food” I told my wife. “That is done by scouts which move randomly here and there. This was organized march.”

“So what is your explanation?” she asked me.

“I think they were doing brisk walk as a cardio” I said. She gave me a look and went back to whatever she was doing.

Invitation to Spend Money

I received an email from the Editorial Assistant of a journal called 'Journal of Clinical Case Report.' It read as follows.

I wonder if you could write a case report or a short commentary of about 500 words (or any type of article) for the Journal of Clinical Case Report.It would be great if you could submit by February 26^th, 2014 so that I could process for the upcoming issue.  If it is not feasible for you in February, then please let me know your feasible time to contribute.  Please provide me your acceptance for the same!  I will be waiting for your positive mail.

I had a feeling about this email invitation. So I visited the journal's home page and found out the following information from a link on questions.

The publication charges for OMICS Group journals range from $900-1800 for low income countries, $1300-2600 for middle income countries and $1800-3600 in USD for high income countries. The publication charges are classified based on the World Bank Economies of countries.

I wrote to the sender of the email as follows.

Thank you for the invitation. I can always write for a journal. Since you have invited me to write, I trust there will be no charges for the same. In fact, I wonder if you will pay me a fee for writing.

By the way, I am editor-in-chief for Journal of Postgraduate Gynecology & Obstetrics, which is an open access, free, online journal. We do not charge any fee in any form for publication of articles. Perhaps you would like to recommend this journal to your authors/contributors?

With best Regards
I have not received any answer t that email. Now I know how they make money. This is not the first journal to write to me like this. It is beyond me how journal editors believe they can invite people to write for them and then ask them to pay money for that. Some people must be falling for that trick.

Transverse lie - Interactive Learning Tool

I love tinkering with tools - hardware, software, ideas, anything. I believe that self learning is the best form of learning. If one is lucky enough to find a good mentor to help, it is the most satisfying learning experience. Out of this tinkering, I have developed a learning tool that can be applied to any topic. The teacher has to make a decision making algorithm, then put it into a Powerpoint slide show in kiosk mode, and use it as is, or convert it into a Flash movie. the former requires Microsoft Windows and Powerpoint viewer. The latter can be used in any web browser, running on any operating system. It will work even on a mobile phone. One has to select the correct option on any slide, which takes one to the next slide, where more option choosing has to be done. Finally one gets an answer to what is to be done in that given situation. This decision making is different from conventional teaching, which covers a topic under conventional sub headings. One difference between a slide show and a Flash movie is that the former does not move forward on clicking anywhere on the slide, but moves to a particular slide on clicking on an appropriate link. The latter does both - moves forward on clicking anywhere in the slide, and moves to a particular slide on clicking on an appropriate link.If one wants to start over, one has to click on 'Home'  button on any slide and start over again.
Here is a tool I have made for my next teaching session for the undergrads. The topic is 'transverse lie'. Feel free to try it out. You need a fast internet connection, or have to wait a bit until the Flash movie loads.

You can view the tool Here

Fluid for Distension of Foley's Balloon

Foley's catheter is a self retaining balloon catheter for constant drainage of the urinary bladder. There is a main channel, which drains the urine from the bladder. There is a side channel, which communicates with the balloon near the tip of the catheter. When it is in the bladder, it is inflated with sterile normal saline so that the catheter remains in the bladder. One uses sterile saline, so that if the balloon bursts accidentally, its contents will not contaminate the bladder and cause infection. Have a look at my 3D model of the catheter as shown below, before I tell you the story.

I was teaching the undergrads the technique of using a Foley's catheter. I taught them the theory, showed them a video, and then asked them to go see a catheter being passed in a patient preoperatively.. One of them had a difficulty.
"Sir, why use sterile normal saline?"
"What would you like to use instead?" I asked.
"Tap water" he said. "It is freely available, cheap and abundant."
"Won't the woman get cystitis if the balloon bursts and the unsterile water enters the bladder?" a girl from the same batch of students asked him before I could say anything. She seemed to be good at her studies and/or her thinking.
"That is right" I said. "Some people use any fluid anywhere. That can harm patients. I remember one of our professors using milk for checking tubal patency in place of methylene blue. Unfortunately the milk was not sterile evaporated milk, as is the recommendation. It was milk sold by the government's dairy. When I asked him about whether it could cause infection, he said, "No. It is sterile. It is pasteurized." It was sad that he did not know pasteurized milk was free of tubercle bacilli, but not of pathogens that can cause surgical infections. I don't know what happened to that patient, nor do I know what is happening to his patients where is practicing his art now."
They were suitably impressed.
"If we want to save some money by not using 5-10 ml of sterile normal saline" I said, "why not use the patient's urine? We could collect it after passing the catheter, and inject it into the balloon. Since it is the patient's own urine, it will not harm her even if the balloon bursts."
They laughed. No one gave the right answer to that question. Just then a senior consultant in the unit walked by, and said, "shall we put methylene blue solution into the woman's bladder? Then we will know immediately if the bladder gets opened."
I looked at the students, who caught on and laughed.
"Better not" I said. "A filled bladder is more likely to get injured than an empty one. Let us be more cautious during our surgery instead, and let us use methylene blue only if we suspect a bladder injury."
We completed the operation under discussion as usual without opening the bladder and there was no occasion to use any methylene blue solution or milk, and definitely not tap water.

Hey Google: See What Facebook is Doing

I run this blog using a free service given by Google. Besides being free, it is a good service too. I know that web search engines use bots for indexing web pages. Using Statcounter, a web based service, I know who visits my blog. My blog used to be visited regularly by Google bot. Then the frequency waned, and now it rarely visits my blog. Bingbot had started visiting my blog in between, but now I hear Microsoft is trying to cut losses by not working much on Bing. On the other hand, Facebook seems to have developed an interest in search activities. Not only are its visits to my blog increased, but it does it in a very funny way. At a given instant, precise to the second, it visits my blog from four different servers. This has happened not once, but on many occasions. I have shown here just one screenshot of that. I wonder why they have to do it from four places. I wonder if Google knows what Facebook is up to. Facebook has no reason to be interested in my blog. I have practically no presence on Facebook. It must be doing this as a routine. I hope it does not harm Google. Google is a good company. Besides, I want my blog to continue to be too. :-)

23-02-2014
For those who think it could be a coincidence, here is another.

To Respinal or Not to Respinal

I am aware that 'respinal' is not a verb. But one day it will be. Going by the way some of them are doing it, it definitely will be. 'Doing what?' you may want to ask. Well, might as well tell you from the beginning.
Spinal anesthesia is a type of regional anesthesia they use extensively for cesarean sections and gynecologic operations. One of its plus points is that it is reasonably easy to administer, and requires little monitoring after induction as compared to general anesthesia. That means the anesthesiologist is quite free once it is administered. I know anesthesiologists in private practice who open up their newspapers after the operation begins under spinal anesthesia, and start packing their bags when peritoneum is closed and leave the OT when the surgeon starts with suturing the subcutaneous tissue. It is so convenient that some of them want to give spinal anesthesia at any cost.
The other day they had given a woman spinal anesthesia. Unfortunately it failed. I thought they would give her general anesthesia. But they made her sit up and gave spinal anesthesia again.
"is this sort pf thing OK? Giving spinal anesthesia again?" I asked.
"Quite" they said.
"They do that quite often" someone whispered.
"That is nothing" another person said. "Once they gave spinal anesthesia twice. The operation started. The patient started screaming with pain. So the anesthesiologist got the surgeon to cover the incision with a sterile drape, gave position, and administered spinal anesthesia a third time."
I was aghast. I am aware this story does not explain how 'respinal' got to be a verb. I am coming to it. In order to alleviate the trauma of what I had heard, I needed something a little ridiculous. If throwing a harpoon is called 'to harpoon', why not giving spinal anesthesia 'to spinal'? And if to create again is 'to recreate', to think again is 'to rethink', why not call to give spinal anesthesia again 'respinal'?
If any of you witness 're-respinal', do let me know.

Valentine's Day

Hey Guys,

This is the day to forget
The complex structure of the heart
The complex nature of relationships
The complex route to eternal happiness
And just be
With your Valentine
Happy Valentine's Day

Virtual Thyroid Nodule

"Sir, this patient has a nodule in the right lobe of the thyroid gland on ultrasonography. It is 8X10 mm in size."
We were taking round of one of our wards, when the Registrar informed me.
"Why did we ask for an ultrasonic scan of the thyroid, when she has no goiter and no symptoms or signs of thyroid dysfunction?" I asked. "Is the nodule palpable?"
"No, Sir. We did not ask for the scan too. In fact, the patient says they did not even touch the thyroid gland with ultrasonography probe."
"Huh?" I said and looked at the patient. She nodded.
"How can they report such a scan without touching the thyroid gland?" someone asked.
"It must be a mix up" I said. "Two patients may have undergone scans on adjacent tables at the same time, and they might have given report of one patient to the other one."
"So what shall we do now?" the Registrar asked.
"We can ask for a scan by a senior person" I said. "There will be no nodule on that scan. They may report that as the first case of lysis of a thyroid nodule with diagnostic ultrasonic waves."
They took a few seconds to read my sarcasm and laughed.

Bonney's Hood Operation: Inverted T-shaped Incision

Bonney was a genius. His hood operation is an evidence of his genius. It is the only operation available for a posterior wall leiomyoma of the uterine corpus, that leaves the scar on the anterior wall of the uteurus, protected from adhesions with bowel and omentum postoperatively.
It sometimes so happens that the transverse incision on the corpus for enucleation of such a leiomyoma is not wide enough to get the leiomyoma out. Enlarging the incision laterally is not an option, because the uterus is only so much wide. We had such a patient the other day. The incision was not long enough to permit removal of the leiomyoma and there was no place laterally to extend it.. Then I had an idea.
"Make an inverted T-shaped incision" I said.
The operating surgeon, my Registrar made a vertical incision in the midline, starting upwards from the original uterine incision.
"Now raise the two triangular flaps upwards and outwards" I said.
That was done, and the leiomyoma came out. The flaps were too big for reconstruction of the uterus and had to be trimmed. The part cut in the midline got excised and we had a single flap to cover the surface of the uterus. I have shown the steps diagrammatically below, because there was no one to take pictures. Perhaps we will do that the next time.

Uterine incision

Vertical limb of the uterine incision

Flaps have been raised to expose the leiomyoma through an opening in serosa and pseudocapsule big enough to deliver the leiomyoma.

Bonney's Myomectomy Clamp - Reverse Effect

Bonney's myomectomy clamp is used to temporarily occlude uterine blood vessels, so that there is little or no bleeding while the uterus is cut and leiomyomas within it are removed surgically. It is combined with application of an atraumatic clamp (sponge holding forceps) on each infundibulopelvic ligament to occlude the ovarian blood vessels which anastomose with the uterine vessels and supply blood to the uterus too.
We were performing a myomectomy for a large posterior fundal leiomyoma with encroachment on the upper part of the right broad ligament. Bonney's myomectomy clamp and sponge holding forceps were in place. When we opened the right broad ligament, even tiny blood vessels started bleeding furiously. Conventional methods proved inadequate to stop the bleeding. Then I had an idea. I released the Bonney's myomectomy clamp and sponge holding forceps. The bleeding stopped instantly.
"The clamp was occluding only the uterine veins, while the uterine arteries remained open and continued to pump blood into the uterus. That raised the venous pressure and caused such uncontrollable bleeding by back flow through the injured veins" I explained.
"We have not seen this before" they said.
"Nor have I" I said. "There is always a first time. Lucky for you it happened to someone else, so that you did not have to experience it first hand and try to find a solution to that problem."
We completed the myomectomy without any attempt at occluding uterine blood supply. There was not any hemorrhage.

T-Shirt Design to Reduce Maternal Mortality

Our people were so charged by the pep talk and valuable suggestions to reduce maternal mortality given in the maternal mortality reduction meeting (see my previous post), that they were rearing to go. They had a lot of suggestions on how to carry the message far and wide.
"Let us have bumper stickers made. They could read - Zero Maternal Mortality" one of them said.
"We could get BEST and State Transport to carry the message on the back of the buses - Drive Safely, Prevent Maternal Deaths" another one said. "And like they put next to the driver - Today is the Day of Zero Maternal Deaths."
"They write that in buses?" someone asked incredulously.
"Of course not, silly" came the answer. "They write 'Today is the Day of Zero accidents' next to the driver."

"That message for gynecologists about putting stethoscope in the ears seems important" a third person said. "Perhaps we could have T-shirts made to carry that message."
"We could help" one of the students said. "We have this annual college festival going on. There is a T-shirt design competition. If we give this theme, we could have a few good designs to choose from. I could do one right now."
"Please do" a lot of us said. Here is what he made on the fly. It shows the front and the back of the proposed T-shirts.

"Cool" the third person said.
"If we wear it to the maternal death audit meeting of the quality assurance committee, they will know we mean business, and will not harass us unduly" an optimist said.

Civic Advice on Reducing Maternal Mortality

The civic body is doing a phenomenal job on reducing maternal mortality. It has a quality assurance committee, which audits all maternal deaths in the city. Then it keeps making recommendations to reduce maternal mortality. Since the committee is appointed by the state government, its recommendations supersede evidence-based recommendations made by bodies like RCOG and ACOG, or even by local experts like faculty of tertiary level hospitals attached to medical colleges. The other day a meeting was called to educate all stakeholders on methods to reduce maternal mortality. Amongst the most important recommendations were the following.

1. Use a stethoscope: a white haired member stated that gynecologists did not use stethoscopes, and if only they used one, maternal mortality would fall.
2. Switch on the brain: same member also said that gynecologists switched off their brains when they reach home, and did not switch them on again when they went back to work. If thy switched the brains on again, the maternal mortality would fall.
3. A special officer appointed exclusively for maternal and child health administration stated that if one did not perform a sterilization operation on a woman undergoing a cesarean section for complicated conditions like placenta percreta or any other serious disease, mothers would not die.
4. They distributed printed guidelines arranged by an administrative boss, but without any signature of the same or any other authority. Amongst other things, the recipients were told not to induce labor in a patient with a previous cesarean section, as it caused uterine rupture. A cesarean section should be done instead. If any such woman required augmentation of labor, oxytocin should be used with extreme caution and with very close monitoring, as it ruptured uterus. Misoprostol was not to be used for cervical ripening prior to induction of labor.

No one spoke on inadequate number of nurses, servants, medicines, and equipment. Perhaps there was no point in discussing something that had remained stubbornly unchanged for ages. Doctors were supposed to work 24X7X365. everyone went away elated, charged to perform far better than before, with a smile on the face and a song in the heart that a new dawn of change for the better was coming. I went away feeling that the same team should be given the jobs of improving the country’s economy, ending corruption, stopping abuse of women and children. By the time they were done with this list, I would come up with some more things they could do. You all could send me suggestions to be included in the list. The country would become a superpower, envied by all contenders of that title. Thank you, merciful God.

Public Transport Upside: Fun

I chose public transport after using a car for fifteen years. There were many reasons - traffic jams, lines at petrol pumps, parking space crunch, damage to my car by rash drivers and children playing cricket in the parking lot, traffic police needing money, and wisdom. The wisdom came with age. I understood that I should not help use up oil for commuting to and from work alone every day, if the future generations were to have any oil. You must have noticed that none of the reasons is having fun. Well, it was a bonus.
Never before in my life had I had the right of the way when it came to me versus a bus or a truck (come to think of it, any vehicle; no other driver was as gentlemanly or timid as I). Now all vehicles give me the right of the way when I am riding a bus. I do not have to inhale the exhaust of buses and trucks any more. I ride at a higher altitude, breathing pure (!) air.
There are some fun things too. I remember once a biker was following my bus quite close behind. Suddenly the bus driver stepped on the brake and came to a sudden halt. The biker must have braked too, but not fast enough. His front wheel went under the back edge of the bus' body. I was sitting on the last seat and could watch the biker. The expressions on his face were as much as his antics to get the wheel out. The wheel came off only when the bus started moving again, its driver oblivious of the drama at his back end.

I remember another occasion when a smart guy had a tiff with the conductor. He was still talking, proving his smartness, when his destination drew near. He started down the steps, still looking at the conductor and talking.
'What if he does not count the steps and wait on the last step until the bus stops' I thought. I did not want to say anything to him, lest he diverted his attention from the conductor to me.
Just as I was thinking this, he stepped off the last step, did not find any foothold, looked down, found ground rushing back under the foot, hurriedly climbed up the steps and shut up. Studying his face and watching antics were equally rewarding.