Sunday, March 10, 2024

UDLCO: CUBE home lab individual Plant model of vasculopathy and a hospital based individual coronary artery vasculopathy story

Summary/Abstract : We share a plant model as well as human model of vasculopathy encountered in parallel over this week with resultant UDLCO analogies between plant and human pathologies and the similarities and differences in their interventions. 


CUBE Homelab report : Plant model of vasculopathy 

Introduction : In humans, Vasculopathy is the final driver for mortality and morbidity often  in non communicable diseases NCD and sometimes also in  communicable diseases CD. 

Methods : We describe a particular instance of plant gangrene attributed to blockage of plant vascular channels that may have resulted from complex unidentifiable factors either related to NCD or CD. 

Results :


UDLCO from CUBE group  :

[3/10, 6:42 PM] +91 98205 56421: Thank you for introducing a new correlation between humans and plants. 
While travelling from Mumbai to Poona after the first tunnel some champa plants have huge tumors. 
Will read about it. 
Can you share in another format? Not on Facebook🙃

[3/10, 7:52 PM] Rakesh Biswas: There are 20 images as results which was easy to upload with single clicks in facebook whereas in all other platforms that I use it wouldn't have been easy. Anyway to make blogger uploads easier @⁨Metapsychist Number 1 Kims 2015⁩ ?

I'm working on a blogger post where I try to join the above plant home lab model with the human hospital based model encountered this week

UDLCO from the collective medical cognition group:



Contrarian to the expected cardio metabolic phenotype and yet has LVH hfref CCF other than damaged lungs due to old TB





[3/4, 4:44 PM] Rakesh Biswas: Right upper lobe fibrosis, cardiomegaly

[3/4, 4:45 PM] Rakesh Biswas: ecg LVH

[3/4, 4:46 PM] Rakesh Biswas: Echo : Note the LVH and extremely poor contractility of the heart

[3/4, 5:02 PM] Metacognitist Mover and Shaker1: Perhaps severe LV strain and an LAFB sir? Any old ECGs?

[3/6, 3:29 PM] Rakesh Biswas: Afternoon session log :

Update : 

Day 4 

(S)ubjectively: Shortness of breath reduced but can't quantify 

Want's to stay till he becomes fully better 

(O)bjectively: On room Air with normal SpO2 since day 2 

Assessment: CAD CCF COPD secondary to generator pump and bidi poga inspite of a very hardworking and frugal eating life style! Stopped smoking both since 2 years 

Plan : Continue supportive pre load reduction. Should we add an afterload reducing agent? What was the reason for his initial cardiogenic shock?


[3/6, 4:25 PM] Rakesh Biswas: Spent an entire afternoon with this patient but the fascinating insights were well worth it! 

This patient was a stark contrast to the cardio metabolic phenotypes with trunkal obesity NCD we regularly see here. Nevertheless this too is an important NCD responsible for a lot of mortality! 

 Inspite of a very hard working life style leaving him with hardly any fat accumulation in his body! 

While feeling his loins and lumbar regions while doing his complete visceral ultrasound scan, I could hardly see any fat, he was almost skin and bones) and yet he still managed to get such a severe cardiac failure likely due to vasculopathy. 

All because of the genset pump smoke that he used to operate as well as his bidis! 

Also captured a lot about his work and life events graph with the help of @⁨Venkat Sai Kims Med 2021⁩ @⁨Kranthi Kims Med Pg 2021⁩ Can they share it in a event sequential time line here? 

Overall there is a huge requirement for this kind of data capture and sharing around each patient that when mapped appropriately will show more insights, only if we could develop a mechanism to train and compensate people for doing it? 
@⁨Rahul healthcare 2.0⁩ @⁨Metapsychist Number 1 Kims 2015⁩


[3/8, 8:14 PM] Rakesh Biswas: Pending afternoon session logs :

Couldn't meet this man today but I guess he's been shifted to AMC @⁨Pushed Communicator 1N22⁩ ?

Hadn't really logged what was fascinating about the session with him this Wednesday afternoon and I just recalled that there was a lot of discussion around farming and his internal medicine disease producing factors, while one point I had forgotten and that was their family's (including his son and daughter in law's) recent farming entrepreneurship tryst @⁨Rahul healthcare 2.0⁩ @⁨Metapsychist Number 1 Kims 2015⁩ , where they invested their accumulated daily wage labor earnings of many years, into buying a 2 acre farm plot and after using it for some years just for grazing their buffaloes, they recently decided to expand their portfolio by investing in harvesting crops and while last year they had a bounty of 30 quintals of rice, nearly all of which was re invested again this year, they complain that what with his being in the hospital and their also having to be here as well as the extreme dry weather they are bracing for a total crop failure this time and are going to lose a lot of money! 

Can we think of tightening the above biopsychosocial diagnosis further in the fact that we need to now look at generalizeable global reasons and solutions to crop failure? What if they had used permaculture techniques planting more biodiversity generating plants with multiple different varieties of seeds instead of traditional methods that thrive on monoculture? Quite relevant to the Plos one article journal club we recently had?


[3/8, 8:18 PM] Metapsychist Number 1 Kims 2015: "Habitat loss for food production is a key threat to global biodiversity. Despite the importance of dietary choices on our capacity to mitigate the on-going biodiversity crisis, unlike with specific ingredients or products, consumers have limited information on the biodiversity implications of choosing to eat a certain popular dish. Here we estimated the biodiversity footprints of 151 popular local dishes from around the world when globally and locally produced and after calorical content standardization."

"The biodiversity footprint was calculated using three biodiversity indicators, namely species richness, threatened species richness, and range rarity affected by converting natural habitat to cropland or pastureland. Additionally, we considered four scenarios, feedlot-grown and locally produced, feedlot-grown and globally produced, pasture-grown and locally produced, and pasture-grown and globally produced. In the globally produced scenarios, biodiversity footprint was calculated based on the global distribution of species and crops, while the locally produced scenarios were calculated at the country level."

Ambiguous ingredient types and measurements

When an ingredient was specified in a generic manner, the top ingredient of that type in terms of global production was assumed. For instance, soybean oil was assumed when only “oil” was mentioned in the recipe.

High-biodiversity-footprint chicken, rice, and legume dishes tended to be from India and included chicken jalfrezi (type of tomato-based chicken curry), chicken chaat, chana masala, idli (savoury rice cake), and rajma (red kidney beans curry) (Fig 2)."



[3/8, 8:18 PM] Metapsychist Number 1 Kims 2015: The critical aspects of permaculture are (i) site characteristics; (ii) interaction between elements at different levels, at both field and agro-system level; and (iii) the spatial arrangements of these elements to create synergies for various socio-ecological functions. For the agro-system level interactions, permaculture emphasizes the close integration of terrestrial and aquatic systems, animal husbandry, and annual and perennial field crop plants.5,6,7 Other components of permaculture include water harvesting structures, agroforestry, organic farming, social sciences, and animal and plant breeding.8

With the Deccan Development Society's support - a development NGO - the first permaculture demonstration farm was established in 1987 in Zahaeerabad district in Andhra Pradesh. 

In 2016, Aranya Agricultural Alternatives, a Hyderabad-based organization, and now the main center and promoter of the movement in India, organized the first National Permaculture Convergence (NPC), which brought together more than 1,000 farmers, academics, and permaculture practitioners for the first time The India Permaculture Network originated from this event and is currently promoting permaculture in India in a structured way. In 2017 the 13th International Permaculture Convergence (IC) was held in India under the theme "Towards Healthy Societies."1




[3/8, 10:39 PM] Rakesh Biswas: Pending afternoon session logs from yesterday :

Had an interesting "internal medicine" session around this 70 year old man yesterday after the "external medicine" farming session around him day before yesterday (also shared today above). 

He came in cardiogenic shock, evidenced by very low cardiac contractility on Echo, along with his hypotension and the ECGs serially shared here : https://venkanna2023.blogspot.com/2024/03/76-years-old-male-with-cardiogenic.html , were discussed during the afternoon session. 

The first one was similar to what @⁨K. Shiva Sai Nagendra Kims PG 2023⁩ had sent to Nalgonda recently but the next one changed in the subsequent days with ST coving in lateral leads as well as intermittently in V3. The one in V3 appeared three days back as well as yesterday. Day before yesterday he had a transient atrial fibrillation too.







Conclusion : Plant and human animal pathologies of vasculopathy evolving parallely over the week serves to take a better zoomed out view of factors leading to as well as outcomes of vasculopathy and their spectrum of interventions. 



Saturday, March 9, 2024

Experience certificates from 2016-1992 : Rakesh Biswas

 Continued from http://userdrivenhealthcare.blogspot.com/2020/01/cv.html?m=0

Professor, Department of Medicine (September 2016 to August 2017) in IQ City Medical College & Hospital, Durgapur, India

This involved taking independent decisions regarding both out and in-patient management and intensive care. Teaching and documenting clinical problem solving experiences through research articles and designing collaborative projects to improve healthcare outcomes in the community forms an important part of this work experience.



Professor and Head, Department of Medicine (July 2014 to September 2016) in LN Medical College and Research Center, Bhopal, India: This involves taking independent decisions regarding both out and in-patient management and intensive care. Teaching and documenting clinical problem solving experiences through research articles and designing collaborative projects to improve healthcare outcomes in the community forms an important part of this work experience.





Honorary appointments:


Founding Chief Editor, International Journal of User Driven healthcare, US



Regional editor: Journal of Evaluation in Clinical Practice, UK.


Current board member and past Deputy Editor: BMJ Case Reports http://casereports.bmj.com/site/about/edboard.xhtml



Reviewer: JAMA Internal Medicine,


Reviewer, Medical Education, UK


Projects: a) Academic collaborator with University of Chicago funded by the Reliance foundation, Mumbai in developing a case based medical education platform called i-Human. http://www.i-human.com/case-authors-and-reviewers/


b) Developing a health care blended learning ecosystem through a network of global multiple learner stakeholders that includes medical students (on electives: http://promotions.bmj.com/jnl/bmj-case-reports-student-electives-2/http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4587042/ ) and health professionals from diverse disciplines. It also includes patients along with their relatives in rural and urban India so that they may benefit from this global learning toward their local caring. The project’s primary focus is on optimization of costs in a manner that can still provide highest quality of care in low resource settings.   

As all these stakeholders are computer users communicating through the web with a user name the network is also known as 'User Driven Health Care' UDHC network. More here: http://www.ncbi.nlm.nih.gov/pubmed/26123908 http://www.pitt.edu/~super1/lecture/lec53081/001.htmhttp://www.igi-global.com/journal/international-journal-user-driven-healthcare/41022

c) Academic collaborator with the Indian Ministry of Health led National Health Sciences and Research Center NHSRC, Delhi in preparing standard treatment guidelines for medical disorders.




Professor (Jun 5, 2008 to July 2014) Associate Professor (From Jan 5th 2008 to Jun 5, 2008): Department of Internal Medicine, People’s College of Medical sciences campus, Bhopal, India. This involved taking independent decisions regarding both out and inpatient management and intensive care. Teaching and documenting clinical problem solving experiences through research articles and designing collaborative projects to improve healthcare outcomes in the community forms an important part of this work experience.










Honorary appointments:


Deputy Editor, BMJ Case reports, UK


Founding Chief Editor, International Journal of User Driven healthcare, US



Regional editor: Journal of Evaluation in Clinical Practice, UK.



Reviewer, Medical Education, UK


Reviewer: Research evaluation panel of National Digital Research Centre, Ireland.


Reviewer: Indian Journal of Medical Informatics


Reviewer and member editorial board: Annals of Neurosciences (India) http://annalsofneurosciences.org/journal/index.php/annal/about/editorialTeamBio/159


Principal investigator in a voluntary unfunded program of exploratory discovery, documentation and interpretation project detailed here further: http://userdrivenhealthcare.blogspot.in/2013/10/reaching-out-hospital-services-to.html


Academic co-investigator in a funded program of research (circa 1,000,000 Euros) on health informatics solutions to chronic disease challenges and user driven healthcare by the National Digital Research Centre, Ireland 2011 More here: http://www.igi-global.com/chapter/patient-journey-record-systems-pajr/49246

Thesis examiner, University of Canterbury, New Zealand, University of Bath,UK

Thesis Supervisor, University of Bath, UK and Sikkim Manipal, India


Relevant work related Publications:

Books:

Biswas R, Martin C, User Driven Healthcare and Narrative Medicine, IGI Global, Hershey PA, September 2010




More here :



Associate professor (From Jan 11, 2006-Dec 31st 2007): Department of Internal Medicine, Melaka-Manipal Medical College and Melaka General Hospital, a large tertiary care center in Melaka, Malaysia. Involved in teaching undergraduate medical students through didactic lecture classes, group discussions, bedside clinics and demonstration of practical procedures apart from ward rounds and OPD consultations along with being deputed as a university examiner for the final university exams held every 6 months. During this time also initiated a collaborative research project with Intel Innovation Center, Kuala Lumpur and Ministry of Health, Malaysia.



Relevant work related Publications:

Articles:

Biswas, R., Martin, C., Sturmberg, J., Shankar, R., Umakanth, S., Shanker, & Kasthuri AS. User driven health care - Answering multidimensional information needs in individual patients utilizing post EBM approaches: A conceptual model. Journal of Evaluation in Clinical Practice, 2008, 14, 742-749.
           
*Biswas, R., Maniam, J., Lee, E.W.H., Das, P.G., Umakanth, S., Dahiya, S., & Ahmed S (2008b) User driven health care- Answering multidimensional information needs in individual patients utilizing post EBM approaches: An operational model. Journal of Evaluation in Clinical Practice, 14, 750-760.

Chapters:

*Biswas R, Maniam J, Lee EWH, Umakanth S, et al (2009 ) Electronic collaboration toward social health outcomes, in (Eds.) Salmon J, Wilson L, Handbook of Research on Electronic Collaboration and Organizational Synergy, Hershey, PA: IGI Global publishing, http://www.igi-global.com/chapter/electronic-collaboration-toward-social-health/20208,  http://www.igi-global.com/viewtitlesample.aspx?id=20208&ptid=463&t=electronic%20collaboration%20toward%20social%20health%20outcomes


*Biswas R, Martin C et al., Social Cognitive Ontology and User Driven Health Care, in (Eds) S. Hatzipanagos and S. Warburton. Handbook of Research on Social Software and Developing Community Ontologies, IGI Global: New York


Associate professor (From from 25th March 2004 -Jan7 2006) Dept of Internal Medicine, Vydehi Institute of Medical Sciences and Research Centre (VIMSARC), Bangalore and visiting consultant medicine, Manipal Hospital, Bangalore, two large tertiary care centers in Bangalore, India. Involved in teaching undergraduate and junior residents through didactic lecture classes, group discussions, problem based learning and demonstration of practical procedures. Apart from teaching duties was also involved in taking independent decisions regarding both out and inpatient management and intensive care along with performance of diagnostic echocardiographies. Visited Manipal hospital, Bangalore as a locum consultant after completion of official teaching hours in Vydehi Medical College.

Worked on a qualitative study toward Integrating Hospital-Acquired Lessons into Community Health Practice:

Biswas R, Dineshan V, Narasimhamurthy NS, Kasthuri AS Integrating Hospital-Acquired Lessons into Community Health Practice: Optimizing Anti-Microbial Usage in Bangalore,  J Contin Educ Health Prof. (US) 2007 Jun 18;27(2):105-110




Asst Professor (March 2004-April 2001), Lecturer (April 2001-1999 May), dept of Medicine, Manipal College Of Medical Sciences, Pokhara, Nepal, a large  tertiary care teaching hospital recognized by the Indian and Nepal
medical councils as well as listed in the WHO directory of world
medical colleges. Actively involved in:
Teaching: In this five year tenure, taught undergraduates and junior
residents by planning and delivering didactic lectures, group
discussions and problem-based learning sessions. Also demonstrated to
the junior residents practical procedures like lumbar punctures,
pleural and ascitic taps, liver and renal biopsies as well as
venesection and insertion of central venous pressure lines via
jugular, subclavian & brachial routes, along with
endotracheal-intubation for putting patients on mechanical ventilators
and monitoring them in respiratory care units. Discussing decision
making strategies for both out and inpatient management and intensive
care with junior residents and consultant colleagues was another vital
component of this teaching learning process.
Research: In this 5 year tenure, critically reviewed and communicated
patient data generated in this hospital in the form of peer
reviewed international publications. Most of this work was in the form of case
reports and a few articles using qualitative investigational
narrative.
Management: Demonstrated an ability to work harmoniously in
the organizational structure of the hospital which values teamwork for
the overall benefit of the patient also independently managed wards
allotted along with house officers and interns. Also demonstrated the
ability to diffuse innovative ideas in patient management (some of
which has been published in international journals).
Professional development: Demonstrated an ability to work within a
system of clinical audit which reviews and monitors patient management
decisions with regard to morbidity and mortality. Also utilized skills
in diagnostic fibre optic esaphagogastroduodenoscopi
es (learnt during
senior residency in hepatology, PGIMER, Chandigarh, India) for
providing diagnostic esophagogastrodudenoscopy support service
performing 15-20 procedures per week along with a team of gastro
physicians and surgeons in this hospital. In the last 5 years, till
date performed more than 1000 independent unsupervised diagnostic
fibre-optic esaphagogastroduodenoscopies without any major
complications. Also utilized the training provided in diagnostic
echocardiography by this institute since january 2000, initially with
a professional echocardiologist in Calcutta and subsequently with the
professor of medicine and consultant cardiology to support the rapidly
growing cardiology services in this hospital. Performed on the average
10-15 diagnostic echocardiographies per week and reported them
independently. Also gained a fair understanding of ultrasound and
utilized it in performing ultrasound guided procedures like fine
needle aspiration of tumors, abscess with gratifying results.
An initial interest in wanting to handle all the individual organ
components in the human system was supported by this 5 year working
environment and this led to an advanced overall knowledge of internal
medicine and a decision to remain a lifelong internist physician.



1998-99 Senior Resident in (Dept of Hepatology) PGIMER, Chandigarh,India
A large referral and teaching hospital in India deemed to be of national
importance. Actively involved in management of acute and
chronic liver diseases, performing liver biopsies and assisting in
endoscopies & ERCPs. Submitted a few papers for publication.
Teaching and research: Actively involved in teaching junior residents
in the form of bedside clinics as well as on the job. Participated in
various clinical meetings and journal clubs by presenting as well as
chairing a few. Published a paper on "Endoscopic Variceal Ligation in
pregnancy", in Jan 2000 in the journal GI Endoscopy and one on
endoscopic sclerotherapy of gastric variceal bleeding with
n-Butyl-2-Cyanoacrylate in the Journal of Clinical Gastroenterology
(2002).




1995-98 Junior Resident (Post graduate training program in Dept of Internal Medicine) PGIMER, Chandigarh, India.
Worked in  Rheumatology, Hematology, Oncology, Nephrology,
Gastroenterology, Endocrinology, Cardiology, Neurology, Hepatology,
Respiratory Medicine, Pediatrics, Psychiatry, Dermatology and
Emergency Medicine and Critical Care, etc. Evaluated both out and in
patients, discussed lines of management with consultants. Gave
chemotherapies, intrathecals, and inserted central venous pressure
lines via jugular, subclavian & brachial routes, apart from
venesection. Intubated and put patients on mechanical ventilators and
monitored them in respiratory care units. Also did lumbar punctures,
pleural and ascitic taps as well as liver and renal biopsies.

Teaching and research:
During junior residency participated in various group discussions,
seminars, grand round, clinical meetings, clinico-pathological
conferences, mortality meetings by attending most of the sessions as
well as presenting and chairing a few.
Completed a thesis on "The predictors of response to endoscopic
dilation in corrosive strictures of esophagus." This was accepted in
June1997 as a requisite for the MD degree.





1993-94 House Job: In Cardiology and Intensive Coronary Care, Calcutta
National Medical College.  Performed OPD, Ward and ICCU duties as a
first on call.




1992-93 Rotating Internship: Exposure to Surgery, Gynecology and
Obstetrics, Community Medicine apart from Internal Medicine.




Technical Proficiencies: Medical Education, Medical problem solving,
Echocardiography and Color Doppler: Independent operations and reporting.
Endoscopy (Diagnostic upper gastro intestinal tract): Independent
operation and reporting.

English language proficiency: IELTS completed with 8 in all the bands

Working knowledge of basic computer applications.

Core Competencies:
Enthusiasm, pro-activity and commitment to professional service. Analytical capabilities, familiarity and comfort with scientific and clinical data. Team collaborator, ability to be successful working in virtual, multi-cultural teams. Flexibility and willingness to learn fast and grow professionally

Extra Curricular Activities:

Wrote an academic novel: "The Conscious Notebook" released June 2009 by Nova Science publishers, New York.

Participated with voluntary non-governmental organizations in providing Medical aid to remote rural areas of the Sunderban Tiger Reserve.

Accompanied mountaineering expeditions to Himalayas as a treating physician. Did a basic mountaineering course from Institute of Mountaineering, Manali, Himachal Pradesh, India. Served as an editor for the grad school literary journal.

Philosophy
View the patient as a whole and work for his/her benefit either in
routine management or in research.

Publications :