Visits

People do come a lot to this blog to know about self-inflicted diseases. I wonder what some people expect to find. Leave me a comment if you want to know something specific.
Sorry for the lack of updates recently but I'm very caught up in exams for my third year residency, trying to go for a cardiology posting.

Feedback

Please leave comments! They won't go unanswered. And perhaps they generate ideas for new posts...

Re-election day

This weekend the second round of brazilian elections is going to take place to decide who will be president for the next four years. In Brazil that decides candidates for executive branch in two rounds, unless a candidate achieves more than 50% of votes in the first round.
Lula failed by less than 1% to reach that tally.
Now electoral campaigns put him at over 20% margin over his opponent Alckmin.
I fail to see how can people sympathize with him. It's true, I did vote for him the last time. But that was before the sheer number of scandals that have taken place during his four year term. Practically all the members of his high echelon have resigned or stepped down (José Dirceu, Palocci, Genoíno, Gushiken, Berzoini, and the list goes on and on...)
And Lula's support only grows!
Imagine if he openly assaulted a bank, people would still applaud him!

That doesn't mean I'd be very happy voting for Alckmin either. Fernando Henrique 2 terms before Lula had me very unhappy.

Which is why I've decide the vote null.

Not because it will nullify the elections. I know that null votes are counted as if you made a mistake. But it's still the only way to show some discontent at the prospect of brazilian politics.

Different perspecitve

This little blue dot through seen through saturn´s rings, this insignificant blue dot, it´s earth.
Credit:Ciclops

Random Country

I´m gonna choose some random country to compare that probably has a lousy health system... uhm... how about Brazil

I don´t know what kind of information Matthew Holt has on Brazil´s health system, but it is definitely untrue. Despite disparities between the states with the state of São Paulo where I live offering perhaps the best public health system in the country, there are some positive points overall. For example we offer all AIDS patients antiretroviral drugs for free, (of course they are seen, admitted , and have CD4 checks performed as needed)!
I work at the public hospital in my city and we have practically the state of the art. When a patient becomes too costly for the private hospitals they will usually send them to us. I think Matthew Holt should use another random example other than Brazil if he doesn´t really know the facts. Or even better, not use any random example at all.
http://www.hcrp.fmrp.usp.br/gxpsites/hgxpp001

Money and winners

Nothing else to be said.

Defining death take 2

As a physician, one of the actions we have to take is to pronounce someone's death. Now this is not as straight-forward as it seems to be. You could maybe attempt to check the patient's vital signs mainly respiratory movements, pulse. But when these stop, as in a respiratory arrest or cardiac arrest, not only this doesn't mean death in most cases, but on the contrary it means that emergency measures may be indicated to revert the condition and trying to keep the person alive, and with a quality of life. So what I'm saying is that at the moment of the arrest his neurons, myocites are still alive and have potential to stay alive.
These emergency measures are an attempt to get new oxygen into your blood and to get your blood flowing in your body taking that oxygen to your organs.
So that doesn't count as death. Patients can also be kept alive through mechanical ventilation, through drugs that keep their blood pressure at a minimum to oxygenate their organs, in hopes that the condition that led them to need these measures will be reversible and the patient will be able to maintain his blood pressure without drugs and be able to breath well without help from a respirator.
Sometimes this condition is not reversible, such as a damage so severe to the brain that there is no hope. In this kind of patient, for example young people who suffer from car accidents, their hearts have no disease and could be kept alive indefinitely with mechanical aid. But sometimes, this patient may brain dead. So maybe this is the best definition of death. How to define this is not easy as well. Because of organ donation, rigid protocols have been estabilished. They usually involve the observation of the absence of primitive reflexes and more elaborate exams such as an electroencephalogram or as my previous post a functional MRI attested by more than one physician.

Visitors!

Hey this is so cool! I just installed statcounter to see what goes on, since nobody has ever left a comment for me. And with just a few days I've had a few visitors.
Thank you very much for your visits! I have even been inspired to write a longer essay about one of the searched topics!

Trust them.

Diebold's election system computers are easily hackable in less than a minute. Makes you wonder if the brazillian version of it (the "urna eletrônica") is any better. In Brazil we have one sole device that is used in the entire nation. Results come up in a couple of hours as 3.5" disk are launched onto the grid. What if somehow these computers can be tampered in the same way? I'm also very surprised at the almost ravenous reaction of diebold, it's almost as if they're saying they're guilty.

How to define death.

As technologies advance further and further something that seems so simple as to say if somebody is dead or not becomes more and more complicated. Enter functional-MRI into the picture.
For people who came into my blog though I wrote a little bit more here.

Grand Rounds 101!!

Got my first link ever, and even better from the 101st Grand Rounds!!! A big thanks to Protect the Airway and tune in to the next grand rounds...

Negligence

Today at work, I was forced to report negligence towards an elderly patient. I feel very sorry for this situation. This is the third time I have seen the same patient in a very short period of time. He always comes in a very poor state of hygiene. It is sad. His family doesn't seem to give him any of the medications necessary, they do not follow our orientations, and most of all they refuse to put him into a home.
They say they have to work and cannot watch him during the day, which is why now he is filled with pressure sores from his occipitus down to his ankles, they do not give him his medications that was prescribed because besides the fact that it is expensive, that will make him evacuate more often (which in fact is part of his treatment), and diapers are expensive as well. Today he came in with two diapers, which the nurse explained to me, make them last longer for the contents of one diaper will spill onto the other.
The most outrageous fact of all is that the family always is hard demanding on the whole staff to watch out for this patient: he is so sick, this is absurd, how could the let him go out of the hospital in this state. He always goes home a little bit better, but a few days later comes back a total wreck.
Which is why I made the choice of reporting him. Doesn't this run away from the medical-patient relationship? Should I have confronted the family more before doing this?

Transparency

Great initiative: http://perfil.transparencia.org.br/

Null Votes

In Brazil, with the growing unhappiness derived from the various political scandals that always result in no punishment to the people involved, people more and more want to find a way to vent their frustration.
This has resulted in a campaign for the null vote. While I agree in part, it is not for the reason that is posted in an email circulation brazil defending the null vote. There they state that 50% plus one vote will lead to the voiding of the whole election process. The brazilian electoral code clearly states in article 219-224 that this is not the case, and it is very clear that null votes simply are not considered for the elections. The president is determined by the majority of the valid votes, and null and blank votes are not valid. So if you get an extreme case where 99% of the votes are null or blank, then the president will be elected on the majority of the 1% of votes left.
OBS:In Brazil we vote using an electronic device that is the same throughout the country. To vote null in it, one must type a number that does not belong to a candidate such as 99, and the confirm it.
To the law, a null vote is a misvote, meaning somebody made a mistake while voting, it is not considered a protest.
But the reason I do support the null vote is that even though it will not be considered, an election won with a high number of null votes, will somehow show the general insatisfaction

Positive de-action

Educafro is an organization in Brazil that is promoting the racial quotas to be established in public universities thinking that will solve racial minorities disparities. I cannot begin to believe how somebody can buy this argument! I mean, establishing the necessity that a racial minority such as indians or blacks need their own special quota to get into an university is saying that their are not as mentally able as the other students who don't need quotas! We could begin by asking what is a race, what is it to be black? Is there going to be someone who's going to look at my skin and say I'm black?! No, it seems you can define yourself however you want to. What if somebody wants to take advantage of this, somebody who is just a little tanned and marks himself as black, what then? Genetic studies of races reveal that there is no such think as a black or white race and that the polymorphisms are much greater than that. This quota politic is pure demagogy! It's just to divert attention to the real problem: the lack of a decent public elemantary and high schools that would naturally raise students who would be capable of going through university admission tests just like any other person. Goverments in the past decades have been seriously dismantling the whole public education: giving lousy wages for teachers, students are so badly prepared that sometimes they can get to eighth grade not knowing how to read!!!!!

Self-inflicted diseases

I talked about this a while ago, one in four doctors in the UK are starting to think the same thing: Should we pay for self-inflicted diseases such as lung cancer and cirrhosis... As I mentioned in my post, I think there might be something good out of it if, and only if, you ensure free treatment to whomever is engaged in trying to stop their addiction.
Source: Kevin M.D. weblog

Attack on the congress

I seriously condemn the attack made on the Brazilian congress by dissident MST (movement of the landless) dissident called MLST (movement for the freedom of the landless). Nevertheless, I think people should pay attention to this fact.
There is a global discontentment in this country in relation to the Congress. After all, how many politicians involved in serious corruption scandals have been forgiven by their own peers! >500 people participated in that revolt, and this global sentiment is present throughout. For example, how many people have jokingly said that: we should bomb everybody in Brasilia... even though of course, no one actually wants to do harm, the feeling is there. And the revolt is a symptom of it.
In the same manner that the attack on the world trade center in 2001 is that there is discontentment in the whole world, and maybe specially in islam in regards to america's foreign policy. The least we should do is open our eyes and try to see what is really going on.

Intelligence wins out!

U.S. District Court Judge John E. Jones III has decided the controversial case concerning the teaching of the so called intelligent design (ID) in public schools. He defined ID as being creationism relabeled:

By comparing the pre and post Edwards drafts of Pandas, three astonishing points emerge: (1) the definition for creation science in the early drafts is identical to the definition of ID [intelligent design]; (2) cognates of the word creation (creationism and creationist) which appeared approximately 150 times were deliberately and systematically replaced with the phrase ID; and (3) the changes occurred shortly after the Supreme Court held that creation science is religious and cannot be taught in public school science classes in Edwards.

and that intelligent design isn't science at all.

After a six week trial that spanned twenty-one days and included countless hours of detailed expert witness presentation, the court is confident that no other tribunal in the United States is in a better position than are we to traipse into this controversial area [and] . . . in the hope that it may prevent the obvious waste of judicial and other resources which would be occasioned by a subsequent trial involving the precise question which is before us.

Intelligent design, as well as creationism, and other claims of supernatural intervention in the origin of life or of species are not science because they can not be tested. Their axioms are based on authority, revelation, or religious belief.

source: NEJM 2006 Volume 354:2277-2281.

Human rights

Human rights by far are the most misunderstood rights humans have. These are the most basic rights. We have to defend them at all costs for everyone, because in that is its only argument, the basic right any human should have. People tend to forget that.
So when in Brazil hundreds of inmates start rebellions (which the government in the first place "allowed", by letting them use cell-phone within prison walls to say the least), and they start to do ugly things people just want them shot down...
First of all, to let these rebellions happen was a very stupid thing and it seems, completely avoidable. I mean the state has power to control the inmates very well, but it doesn't do so due to lack of control, of planning, of sheer stupidity, or just members of the government don't care as they are too busy stealing money for themselves.
Now just because one thing is wrong (our loss of the right of security, and to go where we please), when these rebellions happen doesn't mean we can commit another wrongdoing (taking out their human rights). One wrong doesn't justify another! When a government enters into a war situation within its borders or there is political anarchy, one of the first things that risks being lost is the very human rights people so easily tend to forget, exactly for these same people. Which is why society must be very firm and united in relation to its rulers about human rights. That it is an outrageous atrocity to not abide by them.
Second, things should never have been allowed to get this far. People should have access to education! I think this is the main issue. Governments want stupid masses so they can do with them as they wish, but this is the side-effect: unemployment, and mass criminal ratings. So deal with it! Nobody ever wants to start a change in this trend. It would be something for so long in the future it doesn't have any electoral value. I've already stated before the elected people govern to be elected again!!!! Who would want to spend money on something that would take at least 30 years to give fruit and perhaps to a politician who will be on the spot 30 years from now. Nobody wants that, besides the already stated fact that educated masses are much harder to control. So deal with it!
What to do with so many unemployed and so many people in jail right now? That's an unanswearable question... We have to make do with what we have. But it would be imperative to revert the trend, otherwise instead of looking at a distant future with maybe a little light at the end of the tunnel things could get even worse.

Software cathartic

Why do we feel the need to use windows in our computer systems? Why does it seem that having a computer means having a windows installed as your OS. I have been asking myself more and more that question and I think their days on my system are starting to be numbered. What do I really use that can only be done in a windows only environment? Office style applications? PDF files? Internet? Easier to use/install? Faster??????? Open office is a de facto clone of microsoft office. Besides there being other application which I have considered to be better such as wordperfect. Internet doesn't even need comments, I already don't use internet explorer as my browser, except in the cases where sites have been made to work only with it... Many free linux distributions are very easy to use/install nowadays, and it definitely isn't the fastest. How about Zeta from yellow tab? It boasts a 2 second boot up! The ultimate answer in my case comes down to software made only for windows, mainly, computer games. So I´m just keeping windows in the sake of games?!?

More reading. Try also this. Microsoft even had a site that stated, so called linux myths.... Click this!

Democracy

Who says that democracy is really the best possible way to direct a country? Of course in comparison to previews regimes we have had in the past, it certainly is much better, but democracy holds within itself the possibility of its self-defeat. It only works where the citizens that live in it have at least a moderate/high level of education and culture. Why is that? Let's review how the system works:
Everyone decides what is best for everyone, and since we can't do multiple things at once, we vote and take the course of the majority. Herein already we have a couple of problems. First of all, who says that we know what's best for ourselves? I mean if we get sick, do we take our own decisions on what we should do, like medications we should take, or do we go consult a specialist in the area, a doctor. If we are going to build a house, do we decide for ourselves the plan of the house or does an engineer do that? So when running a country what makes us think that anybody can do that job irrespective of his formation or education?!? Second point, we do what the majority wants, so effectively, the democracy is the dictatorship of the majority, it is a majorcracy. In countries that don't have multiple minorities in it, it probably works well. But imagine in countries like Rwanda where we have two factions, the Hutu's in majority and the Tutsis in minority, and you can see how we are going to have problems there. Think about Iraq!
Because of technical problems (which nowadays may not exist anymore), it is not possible for every single person of a country to make decisions, so democracy also consists of representation, where a group of people is represented in different places by one person, i.e. senators, deputies, governors, mayors and the president. This is a major problem. This person isn't necessarily concerned with the voters who voted for him. Many times this person is concerned only for himself, voting measures that will benefit himself. Seemingly the only time they don't do that in when the public opinion is heavily against them and there is pressure from the media.
To elect these representatives of the people we have elections... The so called feast of democracy. This in itself produces the main bias. The people who get elected, they act out their terms not trying to what might be the best for the people. Instead they plan how to get re-elected or somebody they have appointed. How can anybody take impopular measures this way? How can anybody take measures that will take over 30-50 years to reach results? In countries where the education is low, people want to see things being built, they believe that is what makes a good government! It's the guy who makes the most hospitals, bridges who is a good president! This way he ensures his own election, and the people have suffered the more from it.

Grier's Grief

Can you actually believe this!

Irresponsible freedom in public health

In Brazil health is a right guaranteed by the constitution. What this amounts to in this country is a very heterogenous map of services distributed throughout the country. Whereas in some parts even the most basic service are hard to come by, as well as shortage of even the most basic medications, in other parts patients have access to practically all of the state of the art medicine and expensive medicines for free. An example of this is the AIDS program in my country distributes many of the medications necessary for the first line of treatment and even backups for AIDS treatment in case of resistance(HAART therapy).
Much of the mortality and morbidity of many diseases come from inexpensive measures such as life style changes. A recent report in circulation (see Iestra) shows that these so called life style changes isolated have at least two times effectiveness of an isolated medication! This includes of course excessive consumption of alcoholic beverages and smoking.
Diseases generated by these two conditions generate considerable expenses for health providers. Practically all cases of lung cancer have smoking as its cause. Alcohol is associated with numerous diseases, for example, liver failure and liver cancer.
Changing life styles is very complicated but goverment should start taking its responsibility in offering services to try and help the general population with this problem because of course everyone knows that prevention is much cheaper than treatment. Instead everyone just wants instantaneous solutions, like building a brand new hospital (where, incidentally, a lot of money can be diverted...), instead of long term solutions what I'm proposing would bring.
I would go so far as to suggest that the SUS (sistema único de sáude=unique health system, Brazil's health public system), should not authorize treatment of patients that weren't at least attached to some program of trying to break the drinking or smoking habit.
Probably that wouldn't work either. City halls would pretend to make centers for rehabilitation, patients would pretend to go and hospitals would admit everyone anyway...

Moore support

All things Michael Moore are very cool, and they are as much as cathartic as anything! So here I am advertising for something that may well become his new documentary
. So go ahead tell him your stories.

Good tidings

Just to change the tide of rantings, i wanted to post this excellent site! It´s fan episodes of star trek (the original one)... They´re very well done.

Four was not enough

After two subpar years with all that temporal cold war nonsense and a whole third year involving a race that never exists later on, Enterprise's fourth year manages to be spectacular. T'pol finally seems to be a real vulcan, and they even try to make up for the fact that she hadn't been up to then. The show's finally concerned with a load of stuff that's supposed to have happened in this period and could generate many stories. That's when they decide to cancel the show!
Perhaps they would have continued it if it hadn't been so great.
At least one good thing may come out of it: Braga is leaving!

Political truth

Even though sometimes we see this sort of stuff in movies, it is always sad to read about in the real world. Dipyrone is a widespread analgesic, antipiretic used in over 100 countries, but it is banned in USA, UK and a few other countries, for the fear of agranulocytosis. This fear has been generated by a couple of works made 50 years ago with serious methodological problems (for example: patients took the drug only once, conclusion for a related drug were extended to dipyrone). There never has been a study to really address this problem with the correct methodology, mostly due to the fact that when this questioning arose, the manufacturers of those drugs had already lost the patent and it would be too costly to perform those studies for such a low cost drug.
There is even an episode in ER where a patient and his parent developed agranulocytosis from using dipyrone!
See also: this

Origami

This seems to be one year old, but nevertheless, it gives some insight into microsoft's newest toy...

Carnaval blues

Brazil celebrates carnaval during this week. Main festivities occur in São Paulo, Rio de Janeiro and Salvador. There is also a massive anti-AIDS campaign during this time, mainly concerned with the use of condoms. Tv, radio and paper ads all remind you the use of condoms. I am not against this campaign, or against methods of preventing the spread of AIDS.
But doesn´t anyone else notice that something another message is being massively sent out as well???:
HAVE SEX, everybody else is having... and if it´s with somebody you´ve never seen, even better.....

Politically correct

People will criticize bands who make apologia for drugs. In this case I agree with them. Many bands determine the conduct and morality of many young people when they are still susceptible to it. But it seems those same critics will lash out at band for making a plea to make poverty history.

Oh please!

I mean even if debt relief may be not be the best way to do it: we see corrupt leaders in the richest nations, even more in "third" world nations. The money could be diverted by the ruling party for themselves or for investments that only benefit the poor. It might be carried out by people who do not know the country and try to do things maybe with good intentions but that could even end up harmful... (See Mike Resnick's collection of A chronicle of a distant planet 1 2 3).

Somebody has to stand out I say these things should happen, the more so because everybody just tends to become more and more deaf to these kinds of pleas.

Mixed feelings on this one:

Google in China

Google's dark side

Is google really keeping track of all your searching habits...?

Should we start using things like: tor or other search engines

Abu Ghraib revisited

It seems that things I was talking about seem very up to date...

Can you believe this comment from Rumsfeld:

He lamented that vast media attention about U.S. abuses at Abu Ghraib prison in Iraq outweighed that given to the discovery of "Saddam Hussein's mass graves."

Of course Saddam Hussein's Mass graves are very serious, and definitely should not exist, but everybody already knows or suspects things like that happened there, or for that matter in any other dictatorial regime. But nobody expects a nation like the U.S. to responsible for the abuses its military comitted in Abu Ghraib. Thus, it deserves the vast media attention it's getting.

"Do what I say but don't do what I do". Is that the message they want to pass on to the world?

Start over

Decided to retake my blogging experiment. Also got a new mail to be contacted: accendo1984@gmail.com.
So after a few years here I go again.