Wednesday, April 2, 2014

Sunday, January 8, 2012

It's 2012

Lahawla wa laquwata illa billah

This is what they are saying. Too many blogs. Too little time. Its a year less two months since I visited my own blog - blogging about my work and general scientific interest.

Insha Allah I'll do better this year.

See you.

Monday, March 14, 2011

Physionotes 1: Heterotrophic Ossification

Physionotes 1

Heterotrophic Ossifications: Current concepts. (Pape et. al. 2004)

  • No clear mechanism
  • Multifactorial with several risk factors
    • Trauma is a Constant Feature
    • Risk factors for TBI
      • Spasticity of Limbs (Garland et. al. 1988)
      • Decebrate posture (Flin et al 2002)
      • Diffuse Axonal Injury (Gennarelli et al 1988)
      • Prolonged Immobilization (Mielants et al 1975)
      • Respiratory ventilation (Newman et al 1987)
    • Risk factors after THR
      • Male (Ahrengart et al 1989)
      • Previous history of HO (Ritter et al 1977)
      • OA with pre-existing heterotrophic bone (DeLee et al 1976)
      • Ankylosing spondylitis (Sundaram et al 1986)
      • Diffuse idiopathic skeletal hyperostosis (Fahrer et al 1988)
  • Clinical features
    • Accelerated bone healing
    • Biochemical changes – Serunm alkaline phosphatase levels, Prostaglandin E2 (PGE2)
    • Radiological Changes
      • X-ray: extent of ossification (6 weeks to 2 months)
      • Three-phase bone scintigraphy
        • Flow studies
        • Blood pool image
        • Bone scan
  • Pathophysiology
    • Mesenchymal stem cells – ability to generate cartilage, bone, muscle, tendon, ligament and fat.
    • Stimulating Events – proteins presents in soft tissues.
      • Interleukin-1ß
      • Many others
      • Poorly understood
    • Stimulating factors related to injury
      • Serum of TBI patients promoted mitogenesis and cell division in a rat osteoblast cell culture.
    • Local tissue environment
      • Microvascular changes → hypoxemia paraarticular soft tissue → Metabolic changes → HO
      • Mechanical Ventilation → local PH from acid to alkaline → systemic alkalosis → HO
  • Treatment
    • PT (Ellerin et al 1999)
      • Assisted ROM with gentle stretch and terminal resistance training not beyond Pain-free range of movements. (Evans et al 1991)
    • Medical Management
      • No conclusive evidence for etidronate
    • Radiotherapy
      • Prophylactic – effective in preventing HO in arthroplasty
    • Surgical Incision
      • Timings of Surgery
        • Traumatic HO – 6 months
        • SCI – 12 months
        • TBI – 18 months
      • Better neuromuscular control = better outcomes
      • CPM is beneficial after surgery
  • HO continues to be poorly understood. Prevention is better than cure.

Saturday, March 12, 2011

Evidence-based Work and Faith

The first thing I do when I arrived at work is to put my coffee thermo-mug on a shared desk (virtually by everyone including our Aides). Sitting atop this desk is a corporate computer that allows multiple user accounts. As soon as I settle on a synthetic coated cushioning seat of a steel chair, my right hand inavertently reach towards the waiting mouse automatically navigating it on a padless surface and consequently dragging the cursor towards logging into my account. With the username and password logged in, the familiar opening scene of Windows OS appears before me revealing the desktop and its innumerable shortcuts that have been sitting there unused for months.

I find opening my corporate email exciting because of the regular updates I receive from several online research websites like medscape and pubmed. Thus without much effort the exciting new world of medical and scientific updates are there ready to be explored with a single click of the unwary mouse.

Randomized-controlled trials or RCT's are all I'm looking for in a new research. I tend to ask all the basic assumptions of Physiotherapy practice most especially in treatment prescriptions. If I have only enough time in the world, I'd read about every single issue that's affecting my patients. Just recently I have a traumatic brain injury patient with heterotrophic ossification on his right knee just slightly above the medial epcondyle. I couldn't help myself but consult Shaikh Google for a medical fatwa on the subject. Just kidding actually, Google has a 'Scholar' tab where one is supposed to go if one wants to 'stand on the shoulders of the Giants ( I think it was Sir Isaac Newton who said this) and look for Systematic Reviews, Meta analysis, Cochrane Reviews and RCT's. But I don't have all the time in the world to do this to all my patients in all of their concerns.

Is it wrong to feel elation - well not really elation - but some kind of inexplicable happiness or satisfaction when I get to download free articles in PDF formats (considering that it took at least 3 years for the publishers of these papers to study and write them)? Thus stacks and stacks of unread papers are just piling up on my shelves waiting to be bound according to their year of publishing and topics.

Then I go home...and here is when the crossing over happens; when I enter my car, start its engine, I get reminded that I have to prepare for my Friday lecture at Fanar.

Teaching Islam to new Muslims may sound easy but if one wants to teach properly according to the standards set by the scholars from the days of old up until now, one has to choice but to read about the topics in more scholarly details. If reading about Salah in Fiqhus Sunnah doesn't sound hard enough, what about going deeper and read about it in Bidaayatul Mujtahid written by Ibn Rushd (Averroes). Although there is a standard manual used in the organization, I cannot but help to look for the Takhreej of the Hadeeth mentioned therein in order to ascertain for sure their authencity or not. Good thing alhamdulillah because of this cyber-digital-revolution, one can find thousands of classical books in Arabic packed in a three gigabyte file with a search function in it. This is not called Al Maktabah Ash Shamilah (The Complete Library) for nothing.

Evidence base science is not only in medical practice but also in Religion. Allah repeatedly said in the Qur'an "Haatoo burhanakum in kuntum saadiqeen". "Bring forth your proofs if you are truthful". Thus in Islam, every minute point of belief, every single action of worship, has to have an evidence from the Qur'an and Sunnah and its derivatives (Ijmaa, Qiyas, 'Urf etc).

I guess this insatiable search of mine of truth - whether it is emperical truth or truth by revelation that drives me to dig and delve deep if possible to the bedrock of things. I maybe exploring two separate directions in terms of inquiry, nevertheless I now realize that they are actually one. There is no conflict between science and religion because all the truths came from the same source. One of the names of God is Al Haqq - the Truth.

God told us to say this when we ask Him for something:

Rabbana atina fiddunya hasana wa fil akhirati hasana wa qina adhabannar. O Our Lord give us the best of this life and the next life and save us from the punishment of the fire.

Also in Soorah al Mulk (67) He said, "Alladhee khalaqal mawta wal hayata liyabluwakum ayyukum ahsanu amala'". He it is who has created death and life so that He will test you which of you is the best in Deeds."

Barakallah feekum

Monday, March 7, 2011

Speaking more than 2 languages protects brain

Hi there. I used to complain that I don't have a primary language stored in my brain. I mean I write efficiently in English and not in any other language but I speak fluently in Tagalog more than any other language. When I get really mad I speak Tausug. I speak Arabic when I pray. I do smutter Hindi/Urdu (depends on whom you are talking to) to most of my patients. Alhamdulillah I can say the equivalent of 'how are you - I'm fine' in other languages as well like Croatias, Thailand, Mandarin, Romania, Korean, Tamil, Malayalam, Nepalese, Swede, Japanese, Nigerian, Bangali and Vietnamese and others I forgot now. I guess I shouldn't complain now.

Care to read about the story?

March 7, 2011 — Compared with bilingual seniors, those who speak more than 2 languages appear to be protected from cognitive impairment according to a longitudinal study.

Other Links:

Do you have fatty Liver like me? Asians with lower BMI 23 kg/M2 have the same amount of VISCERAL fat with whites at 27 kg/M2. This means that even though I have a normal BMI and yet having a fatty liver, I'm still considered having excess fats and hence more susceptible to Diabetes Type II and other metabolic abnormalities.

Read on...

"It's clear that Asians cannot afford to gain weight because they will put on more visceral fat, more liver fat, and, as a consequence, they will be at greater risk of developing type 2 diabetes than whites with the same BMI."

More Links:

Kid's Asthma control