Monthly Archives: November 2008

Data Mining


Jimbo’s pretty stressed up.

He is in the midst of converting this:

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… into this:

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The process is tedious (which is an understatement):

1. Extract the raw data from all those forms (there are about 5000 of them, I think)

2. Enter data into Excel

3. Import Excel into SPSS

4. Analyse data

5. Make sense out of it

6. Write up a paper

7. Send abstract for acceptance at International Conference in Bali next year

8. Write the full paper for publication.

Anyone wanna help Jimbo? He will try and get you to Bali or failing that, he will at least place your name on the list of authors! :)

Any one?

Please?

Sat, 291108 @ 0700

Forbidden love


Last Tuesday I had a couple in my clinic who walked in with their 7 year old daughter. The one to be seen was the mother who is HIV+.

As I could not locate her case notes, I decided to just see her without the notes because after going through all the results on the computer prior to calling her number, I deemed her to be stable and would not pose a problem needing her case notes. (It takes forever for the notes to appear, sometimes)

Sure enough, she was well and had no complaints. She was adherent to her medications, having been on HAART for the last 2 years and taking them religiously. By God’s grace, she delivered her daughter 7 years ago without passing the virus to her. Her CD4 was > 500 cells/dL. Her husband, who is HIV -, sat nearby.

As I was about to write her prescription before letting them out, the mother asked me a question (they always have a few more questions to ask especially when they encounter a doctor who speaks their language!):

“Doctor, can I ask you something? Can I share food with my daughter? “

“Why not? It’s perfectly safe”, I replied.

“What about hugging and kissing?”, she went on to ask.

“Yes, even that. You can hug your kid and kiss her too”, I responded.

“See, I told you I can do that!”, she spoke to her husband who was sitting opposite her.

“No la, better be safe than sorry. I think you better not!”, said her HIV- hubby.

It turns out that the patient has never been counseled regarding what she could or could not do after she was diagnosed with HIV and consequently she has been forbidden by her hubby to share food with the family as well as showering her maternal love on her child.

She complained to me that her daughter is lazy and does not listen to her. I suspect that it’s because the kid has never tasted her mother’s love nor shared loving moments with her and therefore do not respect her mum.

That’s a real pity really.

I took some time to explain to both of them the dos and don’ts in HIV and gave her an information booklet to read when she gets home.She has a grateful look on her face when she left. Her hubby didn’t look too happy.

I am hoping her hubby would relent and let his wife to finally release all the pent-up love she has for her daughter.

Fri, 281108 @ 0700

Instant fatness


Last week I bought 2 pair of Bermuda shorts. I tried on one and since it fit pretty well, I didn’t bother to try on the other one and simply picked one with similar measurements and paid for them.

Last Friday, I finished work late and we had a dinner appointment with my father-in-law. I showered quickly and came out to get dressed.

It was past 7 pm then and the room was dark. I didn’t want to switch on the lights. Instead I groped in the cupboard for my newly bought Bermuda pants.

I slipped it on in haste for we were running late. I pulled it all the way up my legs, past my thigh and then, it felt wrong!

I could not buckle the pants! They were like 2-3 inches apart!

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A sickening thought came upon me: “I bought the wrong size!”

I was cursing myself for being stupid enough not to check before paying.

I hobbled to the light switch and flicked it on.

I took off the pants and took a better look at it.

It was the correct color, the correct shape and pattern….

Except it belonged to my wife.

Sigh….

Thurs, 271108 @ 0700

World AIDS Day


NOTE: THIS POST SHALL BE AT THE FRONT PAGE UNTIL THIS SUNDAY. Please scroll down for newer posts.

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If you happen to be in town this Sunday, why not go over to the Berjaya Times Square and take part in the World AIDS Day event there, organised by the Malaysian AIDS Council?

Highlights of the event include:

· Exhibition of ‘One Life Revolution’ from World Vision and POs/MAC/Sponsor’s booths

· Play entitled ‘Fallen Leaves’ by Welcome Home and ‘Youth to Youth’ by FFPAM, Penang

· Children’s Colouring Competition

· Fashion Show by Karl Ng

· Performances by Local Celebrities (Juwita Suwito, Joey G, DJ Gabriel, Bobo)

· Other Performances by Girls Brigade and Diplomats of Drum

· Special Appearance by ‘Condom Man’

Join us?

Wed, 261108 @ 2138

Defaulters


One of the bane of practicing medicine are defaulters.

Defaulters are those who either neglect to come for follow up or those who turn up but soon decides not to take their medicine; or those who take their medicine at their own whims and fancies!

Last Friday, I had all three.

Every Friday, my nurse told me that some patients have not turned up. I usually get her to call them by phone and ask why they did not turn up. It’s not always fruitful. A lot of times we couldn’t reach them, either because they have changed their contact numbers, or moved elsewhere or passed away. We never know which it is.

Last Friday I waited for a particular man to turn up. He had advance AIDS and presented in such a wasted condition that I thought he would not survive. But he did and I started him on HAART. His recovery was slow and painful. He was supposed to come for follow up last week. He didn’t show. His phone went unanswered.

And then there was this 30+ year old Malay man whom I’ve been treating for the last 6 months. When he first presented to the hospital, he was severely ill with a CD4 count of only 2 cells/dL (normal > 500). He has AIDS, Hepatitis B and C. He pulled through and was started on HAART. Four months later his CD4 climbed to 74 cells/dL and he was gaining weight.

Last Friday, his CD4 had plunged back to 6 cells/dL! When probed, he confessed that he has stopped taking his medications for the last 2 months because “he lost his prescription slip” and didn’t think to come to the hospital to get a fresh one! His face was pockmarked with what I suspect to be  cutaneous fungal infection. Now I had to restart him on his medications, fervently hoping and praying that he has not developed resistance to his medications. If he does, there would be big trouble ahead.

Just as he walked out of my room, the pharmacist counselor told me that there was another man who has not taken his medications for months!

And then there was this 40+ year old Malay lady. When I first saw her almost 2 years ago, she was wheeled into my room on a stretcher. At the time she was emaciated and suffering from PCP and pulmonary tuberculosis. Her CD4 was in single digit. Her weight was merely 25 kg! Over the last 1 and half years, she made good progress. With HAART, her CD4 climbed to beyond 250 cells/dL; she remarried, put on a decent amount of weight (she is now 54 kg!) and is happy.

Then, over the last few months, her CD4 count started dropping. She swore she was taking her medications regularly. Last Friday, her CD4 count stood at 76 cells/dL. When probed repeatedly, she finally said that she has been omitting one of her medication because “she did not like the new brand that they give now because it gives her pimples!”

Sigh!

It’s going to be tough going with her.

I’ve been reading this book for a couple of weeks now.

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It was written by Randy Shilts who chronicled the early days of HIV and AIDS in an investigative journalism sort of way. To read a sypnosis of the book, click here.

In the early days of the HIV and AIDS, which struck most prominently in the gay population in the USA, people at large, politicians, doctors and even the gay people themselves paid scant heed to what would become world wide scourge. The people and politicians did not want to be associated with a ‘gay disease’; doctors were in denial and those who weren’t were ridiculed. Gay people did not want to acknowledge the disease as it would hurt their movement and the ‘freedom’ they had fought so hard for. As a result, they were slow to catch on to an epidemic spinning out of control.

Today, everyone knows what are HIV and AIDS. Everyone knows how it is transmitted. Everyone knows it can be treated if not cured.

But not everyone knows this…

I believe we are heading for another disaster. There will be an epidemic of defaulters and this would bring us back to the early days of HIV and AIDS.

The only difference is, this time, we will have a lot less options.

I made a remark to the pharmacist counselor when she informed me of the defaulter. I said: “Some times, I don’t know why we are trying so hard to treat them”.

It was not said out of malice. It was said out of frustration and despair. After 25 years or so, we are no nearer to a cure.

For who would want to spend a life time taking medications just to stay healthy?

Wed, 261108 @ 0700

Jimbo goes to Hollywood


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Well, not exactly but Jimbo is about to have a brush with fame (which will last approximately 0.5 seconds)

A couple of weeks ago, some one dropped a comment on this blog requesting Jimbo to contact her. Initially, Jimbo didn’t think too much about it because there are ‘funny’ people out there and the comment could be a spam or, on the other extreme, a concerted effort by the CIA, KGB, Mossad, Mi6, The Red Army, Osama and Co. to entrap Jimbo. (heh heh..)

Anyway, he took a chance and emailed the person.

And she responded double quick. This was what she wrote:

Hi,

I’m contacting you today because I’m working with authors Sep Kamvar
and Jonathan Harris on a book about feelings on the web. We found an
image on your blog that we found beautiful, and we wanted to get your
permission to use it in the book. The book is based on the website We
Feel Fine (We feel fine). In return, we will give you a
free copy of the book, signed by the authors, and an invitation to the
book launch when the book comes out. A description of the site is
below. I’d love to hear back from you and if you provide a mailing
address or email address, we can send you a permissions form.

Since August 2005, We Feel Fine has been studying human feelings from
a large number of weblogs. Every few minutes, the system searches the
world’s newly posted blog entries for occurrences of the phrases “I
feel” and “I am feeling”. When it finds such a phrase, it records the
full sentence, up to the period, and identifies the “feeling”
expressed in that sentence (e.g. sad, happy, depressed, etc.). The
result is a database of several million human feelings, increasing by
15,000 – 20,000 new feelings per day.

Using a series of playful interfaces, the feelings can be searched and
sorted across a number of demographic slices, offering responses to
specific questions like: do Europeans feel sad more often than
Americans? Do women feel fat more often than men? Does rainy weather
affect how we feel? What are the most representative feelings of
female New Yorkers in their 20′s? What do people feel right now in
Baghdad? What were people feeling on Valentine’s Day? Which are the
happiest cities in the world? The saddest? And so on.

At its core, We Feel Fine is an artwork authored by everyone. It will
grow and change as we grow and change, reflecting what’s on our blogs,
what’s in our hearts, what’s in our minds. We hope it makes the world
seem a little smaller, and we hope it helps people see beauty in the
everyday ups and downs of life.

Thank you very much for your time,

Sincerely,

Hannah

Privacy Notice:

We Feel Fine only collects and displays data that was already posted
publicly on the World Wide Web. We Feel Fine never associates
individual human names with the feelings it displays, though it always
provides a link to the blog from which any displayed sentence or
picture was collected. Also, bloggers may make a blog post invisible
to the We Feel Fine crawler by including the following code somewhere
in the post: . Finally, you may request
for an image to be taken down from the site by e-mailing
someone@wefeelfine.org.

We Feel Fine is an independent project conceived and created by
Jonathan Harris and Sepandar Kamvar. It bears no affiliation to any
company or organization.

And the picture from this blog that they are interested to use is this one:

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Cool eh?

Btw, that picture was snapped by Mrs Jimbo a couple of years ago when they went to visit the Aquaria in KLCC, so the credit should go to her. :)

Anyway, Jimbo gave his consent for the picture to be used and now waits with bated breath for the book to be published and bask in his 0.5 seconds of fame and glory! :)

Tues, 251108 @ 0700; Jimbo’s feeling fine.

Dirty Guilty Hands


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I was with the ID team reviewing some patients in the neuro ICU who were referred to us.

While we were there, I saw, with my own eyes, the consultant leading a team of young neurosurgeon-wannabes in the Grand Round, moving from one bed to another; touching and examining one patient after another.

Not once did any of them wash their hands.

Even when the alcohol wash was within arm reach.

They went from one patient (whom we reviewed) who was referred for multidrug resistant Acinetobacter baumanni pneumonia, to the next patient (whom we also reviewed) who has both Methicillin resistant Staphylococcus aureus (MRSA) and Enterococcus before moving on to other beds.

That’s why we get referrals from them ALL the time! For fever, for unresolved infections and for multiresistant bugs in their patients! They are the ones passing the bugs around, like a blardy merry-go-round.

I expect another outbreak soon (and more referrals!)

It pisses me off…. badly.

For your patients’ sake, wash your dirty hands! Please!

Mon, 291108 @ 1746

Case #59: The man with chronic cough


This 62-year-old man presents with dry cough for the past 2 months with mild shortness of breath.  His appetite has been relatively poor and he has lost some weight. He did not complain of any fever. He was a chronic smoker but stopped about 5 years ago.

These are his radiographs:

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Questions:

1. Describe the lesions in the two radiographs.

2. What are the possible differential diagnoses?

Mon, 241108 @ 0700