Author: dreaswar

Consultant Paediatric Orthopaedic & Spine Surgeon,
Coimbatore, Tamil Nadu & Palakkad, Kerala
India

Categories
General Poems

The Empty Rusted Bucket

The Empty Rusted Bucket
The Empty Rusted Bucket

An afternoon walk across my backyard where there is an old well inspired this. I had just strolled amongst the tall grass which grows and almost kicked the rusted neglected bucket `.

Sudden inspiration followed and I composed this poem about neglect of what was once useful, now neglected, still owned, but not cared or sought after. Its rusted, unused, leaking but we still had not disposed it : much like our old and aged who worked their heart out but are now neglected in their own homes, un-listened to, if I may refer to it that way. 

The Empty Rusted Bucket
The Empty Rusted Bucket
Categories
General Others Poems

Of Happiness

of Happiness
Of Happiness

Happiness, as in the context of a Hindu (a cultural, subcontinental cultural expression, rather than a narrow religious term) is something that was thought about my the brightest minds. 

Essays,Books, Schools, Religions have been built and nurtured on it’s name. Avatars created, Saints glorified. 

Yet, for an average human in present day world with it’s plentiful amenities and material distractions, happiness seems as elusive as before; sometimes more so. The Hindu always felt its something that comes from within, our very nature, its always there, not something that’s got from outside. Our cravings, which trouble our mind and if obtained satisfy it merely gives us temporary mental satisfaction which subsides the waves of restlessness in our Chitta (A yogic term, mind-space would be a close translation) which allows the pre-existing happiness to shine through. 

A Hindu, views all material happiness as temporary and bitter sweet since all material pursuits are attaching us with action and thoughts in the direction which opens us up for Karma.

So for a  Hindu, happiness is our native state which we have muddled with our desires and pursuits. 

of Happiness
Of Happiness
Of Happiness
Categories
General Others Poems

Cry of the Zealot

Cry of the Zealot
Cry of the Zealot

It is a time of churn in India, as anywhere else in the world.

The old secular , leftist and liberal schools which was built learning upon the lessons of The World Wars, the Revolutions of Russia, France, the thoughts of Marx, Mao, Lenin and Stalin gradually had gone stale. What once helped the oppressed people solve their day to day issues had become in some cases initiator of violence or oppression themselves. The Right meanwhile is more appealing to people as it promises to take people back to the Good-Old-Days. It promises the glory days.

For almost 6 decades after independence of India the Left Parties, Leftist policies where popular. Over time, increasing conflicts between the once shunned Right and the ubiquitous Left are common place. Narratives are built with cases of return to old glory in the case of Right and of oppression or class struggle in the case of Left.

The society seems to swing between one form of violence and injustice to another, swinging past the midpoint of peace. While this seems to be a post World War phenomenon, in reality, the fight between thought schools are not new; at least to the South of India. Indian Civilization being so ancient, it has seen similar days in the past. It has lived and survived these to tell its tales.

Examples of how the Jains and Buddhists – The Heterodox systems- had frequent conflicts with Shaivas (Worshippers of Lord Shiva ) and Vaishnavas (Worshippers of Lord Vishnu )  – the Orthodox systems – are detailed in Tamil Scripture of Periya Puranam. There are even descriptions of impalement, immersion in lime, drowning a saint in ocean tied to rope, and several such mass attempts at conversion to a school of thought. Well, if one looks critically at these, convert-or-perish instances of those times, it was no different from the crimes committed by the IS terrorists now where they behead non-Islamists. Yet, these beliefs co-existed, albeit with friction, with royal patronage to a particular school of thought.  The Royals were rarely  ‘secular’ , to use today’s terminology. Yet, there seems to be times in past where the saints seem to come from all stratas of society and they were respected equally. In Periyapuranam and elsewhere in South Indian history, there are references to a number of saints who have come from humble social backgrounds ( which now belong to oppressed social classes ) and are equally respected – and in some cases more – by the peer saints and followers alike. This does seem strange when we consider that South India actually required a Temple Entry proclamation to allow the commoners from “lower castes” to enter the temples again in 19-20 century. This was about 500 years after the saints from the very same castes were actually venerated. So we really are not sure when the social degradation happened. One thing is certain. Depending on ones ideology – left or right, one can choose to go back to either a past where caste oppression and persecution existed or to one where they apparently did not . I use the word ‘apparent’ because here I have to go by the scriptural records and not actual rock edicts themselves.

[ 

Some terminologies I use in the poem I am translating here to stimulate further reading : 

'Austere Potter' : Saint Thiru Neelakanta Kuyavanar, first saint listed by Saint Sundarar in his list of 63

'Shepherd'  : Saint Sri Thirumoolar, composer of Thirumanthiram

'Toddy and fish loving incarnation' : Sri Mutthappan, Kannur, Kerala

'Fearless tiger mounted battlegod of yore'  : Sri Ayyappan of Sabarimala, Kerala

'lowly ox' : Ochira Parabrahmam, Ochira, Kerala

'first monist' : Adi Sankara , Kaladi , Kerala composer of Manisha Panchakam

]

Recent rise of right wing in India has witnessed renewed conflict between Left  and Right at various levels ; political and otherwise. Some of these have been peaceful, but many especially in the district of Kannur, Kerala State  has been especially bloody. The once popular Left movement in India is on the wane as it is losing state after another. The right on the other hand is on the rise. Probably the Left has moved away from the minds of people and Right is occupying the space.

It would be nice if there is no violence and lasting peace. My wish.

Cry of the Zealot
Cry of the Zealot

Categories
Cerebral-palsy Deformity Correction and Limb lengthening Orthopedics Pediatric Orthopedics

#WorldCerebralPalsyDay event !! – wonderful experience at #Palakkad, #Kerala

Dr. Easwar T R addressing the parents on care giving in Cerebral Palsy and treatment options

It was a wonderful experience to be part of the team that organised #WorldCerebralPalsyDay event to bring parents, children, caregivers, NGOs, Doctors, Therapists, Counsellors together for a day and have fun and enrich themselves.

The event was organised by Lifecare #Physiotherapy Centre, #Palakkad, Kerala along with #Sevabharathi, #Kerala at Thrupthi Hall in the centre of town.

The choice of centre was superb as it was right in centre of town allowing easy transit for children coming in from rural areas and those with limited mobility.

We assembled at the centre around 10 am and crowd had already trickled in at that time. In another hour about 40 children, parents, caregivers and health care professionals had assembled. The inauguration was a minimal affair with Dr. Sreeram Shankar starting the welcome address with respects paid to the almighty and the parents who had taken time to get here. This was followed by a medical camp by me, a painting competition and a singing competition for the children. There was a talk after that by Dr. Deepa, Psychaitrist, District Hospital, Palakkad which was followed by my parental awareness on treating #CerebralPalsy children.

Cerebral Palsy inaugural address by Mr. Kalyanaraman, Palakkad, Sevabharathi
Cerebral Palsy Event inaugural address by Mr. Kalyanaraman, Palakkad, Sevabharathi

It was a red-alert day in many places for #Kerala because of fear of inclement weather. However, rain stayed away largely apart from slight drizzle. That was a relief.

Parental counselling on treatment options in cerebral palsy
Painting Competition for Children
Dr. Easwar T R addressing the parents on care giving in Cerebral Palsy and treatment options
Adult Cerebral Palsy is becoming a major issue. I was surprised that patients had pertinent questions on that topic.
Dr. Sreeram Shankar Inaugural address

Dr. Sreeram Shankar Inaugural address
Adult Cerebral Palsy is becoming a major issue. I was surprised that patients had pertinent questions on that topic.
Dr. Easwar T R addressing the parents on care giving in Cerebral Palsy and treatment options
Painting Competition for Children
Parental counselling on treatment options in cerebral palsy

About 40 children took part in the celebrations, competitions, talks and counselling sessions. It was well appreciated by all, many who are experiencing this for the first time.

Positive vibes which would rub off into the child’s care was the key. Parents took strength from one another and participated in the awareness session. Many misconceptions about Cerebral Palsy, Seizure Disorder, Autism, Global Developmental Delay were cleared.

We are planning sessions throughout this month and hopefully improve the quality and participation of these events in the next iteration.

 

Categories
Cerebral-palsy Deformity Correction and Limb lengthening Orthopedics Pediatric Orthopedics

World #CerebralPalsy Day – October 6, 2018

World Cerebral Palsy Day - at Palakkad and Shoranur, 2018
World Cerebral Palsy Day - at Palakkad and Shoranur, 2018

#WorldCerebralPalsyDay is afoot. Like last year, I am planning to conduct month long events across Palakkad and Shoranur to raise parental awareness on treatment of #CerebralPalsy.

Most of the parents who come for care of their children come late, unfortunately with joint contractures, hip subluxations, alteration in knee mechanics and foot deformities. Aside from these the problems these children have with upper limbs, hands and doing activities.

Many of these children have uncontrolled seizures, terrible difficulties communicating, speaking out their issues apart from ambulation.  Ambulation may in fact be least of their issues. This sad fact goes to show how important early referral is and how important it is to enroll the child under a care of a Pediatric Neurologist, Pediatric Physiotherapist who can then co-ordinate care with their colleagues in Pediatric Orthopedics, Pediatric Medicine, Occupational Therapy, Speech Pathology, Audiology etc ..

Cerebral Palsy care is a great team effort. No part of the team is greater than other, but the role of the General Practitioner / Pediatric Medicine Doctor, Pediatric Physiotherapist is central, at least in India. They determine the sole referral entity, a person with whom the parents spend their maximum time and trust with. They are the ones in whom they confide most of their issues with.

World Cerebral Palsy Day is a wonderful concept to reinforce these simple care giving principles. Parent education and empowerment being central to the cause of care of these children. Like 2017, we are organising activities across the district of Palakkad – in Palakkad town and neaby rural areas and Shoranur town to educate parents and also conduct early detection and intervention camps to identify children who need care.

World Cerebral Palsy Day - at Palakkad and Shoranur, 2018
World Cerebral Palsy Day – at Palakkad and Shoranur, 2018

Activities planned :

  • Free medical camps for underpriviliged children
  • Special clinics with Gait Analysis
  • Funded Orthotic programme for poor children
  • Pediatric Physiotherapy advice
  • Custom made Wheel Chair fitting
  • Parent awareness of Cerebral Palsy – lectures and symposias in rural areas
  • Notices and public handouts to improve general awareness
  • Involvement of other NGOs , social service organisations to improve public outreach

These activities would be done throughout Ocotober 2018 under aegis of the Cerebral Palsy Clinic at Rajiv Gandhi Cooperative Hospital & Research Centre and ICCONS, Shoranur

Contact Numbers for Clinic bookings  and more information:

  1. Rajiv Gandhi Cooperative Hospital, Kallekkad, Palakkad : 0491-250-9000
  2. ICCONS, Shoranur, Palakkad                                                   : 0466-222-4869
  3. Contact me                                                                                  : EMAIL

 

Categories
AuShadha EMR Open Source & Programming Python

#PySangamam presentation on #AuShadha done !


Had a lovely day at @PySangamam where I presented my experiences developing @aushadha_emr #ElectronicMedicalRecords or #EMR . Attaching below are some pictures of the event. https://t.co/hJteYzw822

I was pleasantly surprised on how open the crowd and organisers were to a talk delivered by a developer who’s primarily a doctor. It was organised beautifully and thanks specially Mr. Vijayakumar , Mr Abhishek and his team for all the encouragement.

Looking forward to #pysangamam next year at #Coimbatore , my home town

My Presentation : Creating Pluggable Electronic Medical Records

Git Hub : AuShadha Open Source Electronic Medical Records 

https://www.linkedin.com/feed/update/urn:li:activity:6443989732329394176

Categories
General

Ode to The Monkey


India’s tryst with Yoga is deep rooted in symbolism and runs deep into its spiritual classics, poetry, theory, ritualistic practice, grand-mother story telling and visual art forms. The pervasive, repetitive and at times outwardly silly, unreal, mythical symbolism is probably one of the factors that has prevented the pillages, marauders and missionaries from destroying what India now offers to the world. They probably thought its too silly to be having anything worth annihilating.

Breath, the Monkey mind are common symbolisms in the epic written by sage Valmiki – The Ramayana. Hanuman,  the ‘monkey God’, is literally  Hanu (kill) and Man (mind).  He is the symbol of Yoga and since he is the son of Wind ( Vaayu-Putra) . He is also the symbolism for halting the mind, going beyond it by practicing breathing techniques and meditation which enables the union of estranged devotee ( the Sita, literally born of earth) and eternal soul (Rama, The God, literally one who charms) held apart in an Island by the forces of darkness ( habits of body, mind and the Ego )

All observing non-changing soul bound is thus dipped into the erroneous identity with the body by the chord of breath. This identity can be reclaimed by tracing its origins back via the breath, the Hanuman, and killing the mind enables the realization that one is nothing but the never changing, unborn, undying unary eternal soul.

This is union we seek. This is the union that brings peace.

To the Monkey Mind and quietening breath which kills it then , 

ode-to-monkey

Categories
General

I am Shiva : A tribute to an unmoving belief


It has been a tough month for the home state of Kerala, which is grappling with the worst flood in a century.  It has been a testing time for humanitarian work, for beliefs, for politics … for everything.  Theories abound as to what caused the floods ranging from human disruption of natural ecosystem, divine wrath, Solar Minimum year, weak El-Nino/a effect, a mix of these and several other variations of these theories.

I distinctly remembered on morning in #Palakkad as it rained. This was before the floods. The first day of several that were to follow that first drenched and then drowned the state. As I drove from Coimbatore, a border city of Tamil Nadu to Palakkad, Kerala for work at about 8 am. As I drove past the western ghats I saw that the rain clouds hung so low and it was an eerie drive to say the least. Never in my memory have I seen clouds so low. I knew something was amiss. I called my wife and told her something was not right. Nothing however prepared me or my state for what was to come.

The rains started barely minutes after I drove into Palakkad. It had been drizzling the night before, but it just got heavier and heavier. Pounding continued for 2 days and flooded north Kerala first. Then it subsided for a day over Palakkad on Saturday leaving it in floods, something that the natives bragged they’d never seen.

But still nothing prepared Kerala for the destruction they were about to witness in the coming week. Rain pounded Kerala (especially middle Kerala) in coming days and left it battling floods, death and destruction.

In midst of the destruction speculation emerged that this maybe a divine wrath (specifically of Sabarimala deity Ayyapan) and other exhorting people to ‘pray for Kerala’. Needless to say, the non-believers camp rejected these with their own rebuttals and even some going to the extent to labelling prayer as useless. Their argument being that prayer at this hour of crisis is useless. What is required is working hands at ground zero.

Of course, these arguments represent a variant of the believer non-believer clash that has been there since time immemorial. At times of crisis like this where any argument of a merciful divine force does not appeal with rampant, apparently unreasonable destruction all-around, it is a time to reflect on ones belief.

These lines were penned before the flood, on the day of heavy rains in Palakkad that preceded the flood. Even just seeing the rains it was amply clear that something was grossly wrong. These rains were not normal. I knew it as going to be trouble. The lines was also partly meditative, as I prayed for rain to ease.

These lines are a tribute to the constant tug of war in nature and in spirit that tests our beliefs : whether it be theistic or atheistic. Man constantly asks God, but…

This was also penned before, this a tribute to the my home state.

 

I_am_shiva_r.png

Categories
General

Kerala Flood : A Tribute to my land


It was late in the day, i was standing at driveway gate turning off the lights to my clinic. I just glanced across the road where the indoor stadia is. This is where young college kids are working round the clock , selflessly for the flood victims. They receive relief materials sent across the border and sort it. Authorities are scant, but I’m told the work is supervised.

I was struck how a fracturing society had gelled by a near cataclysm.

My two lines worth were penned then

I titled it my kerala (ente keralam )

My Kerala

Categories
AuShadha EMR Linux Open Source & Programming Python

AuShadha 2.0 , a re-write of AuShadha Electronic Medical Records


I am happy to inform as promised earlier that AuShadha 2.0, which is a complete rewrite of AuShadha using Python 3.x, PostreSQL, Django 2.x and Dojo1.1x has been started and first major commit pushed.

Please find the repository at https://github.com/dreaswar/AuShadha2.0 

AuShadha 2.0 will use GNU-GPL Version 3.0 License.

Categories
AuShadha EMR Open Source & Programming Python

PySangamam , the first Python Conference at Tamil Nadu


I’m excited to participate at #PySangamam the first Python Conference in Tamil Nadu at chennai Next month to talk on AuShadha EMR

via #Townscript https://t.co/xipWgkYQDF via @townscript
#Python
#Django
#webdevelopment
@aushadha_emr

Categories
Deformity Correction and Limb lengthening Pediatric Orthopedics Spine & Scoliosis Surgery

Spina Bifida and Hydrocephalus Conference 2018 NewDelhi


#IFSBHCON2018
#SPINABIFIDA
#hydrocephalus
#spinabifidafoundation
Lovely conference and lovely to see the so many families and patients viewing life with such a positive attitude https://t.co/eXqZWmuhoa

Dr. Santhosh Karmakar and Spina Bifida Foundation deserve credit for bringing together different professionals -doctors, physiotherapists and families, together for this event

Categories
General

MITRA Medical Trust … our little helping hand to the poor is 3 years old


Boy are we joyous !

Our MITRA Medical Trust is now 4 years old.

This August 5th we are marking this event with the first public function at #Palakkad, #Kerala with dignitaries and beneficiaries.

We started on this journey 4 years ago, just a little band of friends who managed to get together after 20 years of separation after high school thanks to the newly emerging social networking services of Orkut, Facebook and Whatsapp.

The joy of getting back together about 20 years after out 10th class was marked with a reunion function and post-reunion, we sublimated the camaraderie by resolving to form MITRA, a medical trust to help poor people with treatment.

MITRA stands for Medical Intervention Treatment and Rehabilitation Assistance. Our goal is to lend a helping hand via our internal contributions (as much as possible) to the needy for medical treatment and/or rehabilitation.

Overtime, with the grace of almighty, love of our well wishers we could achieve this and much more. We have been blessed to have the good fortune of delivering help to almost 75 poor patient across a range of diseases disbursing as much as 24 lakh of Indian Rupees. No mean effort considering most of this was from our own internal donations.

A celebration was in order !!

This is then the first ever public function of the Trust. Mr. P.R.Seshadri , MD, Karur Vysya Bank , Mr. M. B. Rajesh MP, Mr. Shaif Parambil MLA, Ms. Pramila Sasidharan, Municipal Chairperson, Palakkad and Father Paul Thekkiniyath will grace the function.

37964774_2390314557653176_541042944447086592_n

Categories
Deformity Correction and Limb lengthening Orthopedics Pediatric Orthopedics Spine & Scoliosis Surgery

#CerebralPalsy and #PediatricOrtho #medical #camp at #Palakkad


Had a wonderful #CerebralPalsy and #PediatricOrtho #medical #camp at #Palakkad #Kerala organised by wonderful people at #SevaBharathi . It was well attended with parents and children braving the heavy rain.
@sevakeralam
@sevabharathitn https://t.co/Z3FT9C6RVO

Categories
AuShadha EMR Open Source & Programming Python

AuShadha Electronic Medical Records Development update


AuShadha Electronic Medical Records at https://github.com/dreaswar/AuShadha has been seeing very slow development mostly due to pressures on my personal and professional front.

I could get back to development past few days and I have pushed a commit to master after some gap.

The Prescription App for Outpatient visits is ready.

Next stop is to implement Outpatient Reports.

Do check it out and let me know what you think.

You will need #Django1.7.2, #Python2.7x, #Dojo #Javascript Toolkit 1.13

Categories
Deformity Correction and Limb lengthening Orthopedics Pediatric Orthopedics Spine & Scoliosis Surgery

Free Medical Camp for Children’s Orthopedic Disorders and Cerebral Palsy


I’m conducting a free medical camp for #Childrens #Orthopedic #Disorders and #BoneDiseases , #LimbDeformities and #CerebralPalsy at #Palakkad ,#Kerala . Event is organised by #SevaBharathi .

The event will be held in the premises of Life Care Cerebral Palsy Clinic which is in centre of Palakkad town enabling easy transport to the venue.

Patients and relatives are advised to bring all old records while seeking opinion. All old x-ray, other scans and will also be needed for evaluation.

Phone number for Booking :+91-80759-21075

Contact the phone on last line of notice for appointment.
(Notice is in #Malayalam, local language of Kerala )

https://t.co/smNqhcYRRS

Free Medical Camp for Pediatric Orthopedic Disorders and Scoliosis
Free Medical Camp for Pediatric Orthopedic Disorders and Scoliosis

Moving to Gitlab


With the acquisition of Github by Microsoft, regardless of the promises made now, I thought it would be best to move my repos somewhere else. That somewhere right now seems to be GitLab. Im #MovingtoGitLab.

All my repos across GitHub and BitBucket have been moved there and I intend to continue development there.

AuShadha (Au) which I had worked on for so long had taken a back set for some years now as pressing personal and professional commitments caused interruptions.

ICD 10 parser, ICD10 PCS parser, FDA DrugBankCa medication list parser have all been moved there.

Three variants of AuShadha are being tried by me as I recode Au. These pertain to choices of the front end. All there are embryonic and will continue to remain so until I find more time.

When I started it in 2009 things were a lot different and Django was supreme choice in Python world. Things have gone more Javascript way with a confusing profusion of frontend frameworks , especially ones that play well with NodeJs but don’t play well or needs rewiring to play well with Django. Dojo which was my intial choice also has moved on from 1.7 when I started to 1.11 now and looking ahead at 2.0 with TypeScript usage.

I’ve chosen Dojo 2.0, EmberJS, Polymer as the three front ends to try and hang my hat on at the moment. The old Au with Django 1.7 and Dojo 1.10 would be kept but I don’t plan to update it to new the library versions as it’s too laborious.

I’ve moved Django to 2.x and Python to 3.5. This is a full rewrite. Infact if Django doesn’t play well with JS framework I am open to changing it some other backend.

To those who were wondering about Au and it’s fate -watch this space.

GitLab Repository

Categories
General Linux Open Source & Programming Pediatric Orthopedics

Making Media rich Medical Presentations using Emacs, Org-mode and Reveal.js – Part 1


Scenario

As a practicing Paediatric Orthopaedic Surgeon, I am called to meeting to present my work. This involves presenting to peers, co-workers, patients and parents of children I care for. Each of these presentations will be with a different focus on a particular topic. 

While this is not an uncommon scenario, the solution to create a reusable presentation slides using #OpenSourceSoftware tailored to individual audience is. Most doctors are not familiar with programming environment  and shy away from anything that is not WYSIWYG. They rely on good old #PowerPoint / #Keynote to save them. At the most some of them may try and use the clunkly #LibreOffice or #OpenOffice if they want to stick to OpenSource. Recently with advent of tools like Prezi, media heavy interactive presentations have become popular. The popular presentation softwares of KeyNote, PowerPoint have also spruced up their animations and transitions to enable them to look more attractive. Still the WYSIWYG nature of these and point-and-click makes them very slow. We could achieve better, faster and more attractive results with using #FOSS tools. 

 

What I use now

For the past few years I’ve been using a combo of 

  1. #LaTeX via #beamer class 
  2. #RevealJS ,
  3. #Emacs, Org-Mode, org-reveal
  4. #HTML5 and #CSS3
  5. FOSS Image and Video editing softwares as required to arrange the media. I mainly use GIMP, InkScape, KdenLive, OpenShot, HandBrake to arrange my media and encode them. 

My choice depends on the demands of the presentation. 

For media heavy, especially video heavy presentations I use RevealJS. For presentations that are more of less static with few videos I tend to use Beamer / LaTeX. What I note below are my experiences as I tried to create a smooth workflow that could replace PowerPoint ( or KeyNote / LibreOffice ) as a tool to create #Medical Presentations. 

Overtime I have refined my workflow and now I find that I am far more productive and my slides can pack much more information than a power point slide. While the more advanced interactions would require some knowledge of JavaScript, and therefore would turn off most doctors, most of what follows require minimal programming use. 

I will detail my workflow to create simple fast layout using Emacs and RevealJS without handcoding of JS and HTML. We will be relying on the RevealJS, Emacs, Org-Mode and ox-reveal package to do the lifting. 

 

Disclaimer : Even though it doesn’t need programming knowledge, ability to use Emacs is a must for this workflow. It is preferable that one is on a Linux OS as the attempt is to go all #FOSS here. 

 

so, here goes ….

 

Aim

To create an visually impressive medical presentation using non Power Point open source (FOSS) softwares.

Tools

  1. Emacs (24.3 or greater)
  2. org-mode
  3. org-reveal
  4. Reveal.js
  5. Chrome Browser
  6. Open source video codecs on the system

Why this and not PowerPoint ?

Over the years Medical Conference presentations have got mature and old tools have got boring. Varied audiences, topics, media content , interactivity required, transitions and animations to keep audiences interested have all changed.

PowerPoint with it’s traditional set of tools is boring to say the least. The point and click interface is slow by comparison to plain text typing. This seems counter intuitive to PowerPoint pandits but I’ve found that once the media is arranged and readied, once can create more far more attractive presentations with the tools mentioned above. 

As far as medical presentations go, the video presentations embedded PowerPoint / LibreOffice have a habit of breaking on stage. I have seen numerous instances of this happening.

And, of course PowerPoint costs 💰💰

It is also Closed Source making it difficult to edit and reproduce when you are with a system where it is not installed.

 

Okay, but why Emacs, why indeed ?

Emacs is Open Source

Emacs is stable

Emacs is good

Emacs is better than #Vim

Emacs has un-paralleled number of extensions and programming support

Emacs has Org-mode… 

 

Okay, So why org-mode, what has that got to do with presentations ?

org-mode is cool

org-mode is simple text

org-mode can be manipulated anywhere with text-editor

Its FOSS

It can be extended with other tools like org-reveal

 

Hm, Okay, but why Reveal.js ?

An actively developed FOSS Tool with a community

Allows 2D stacking of slides permitting nesting

Plugins and all the JS/CSS/HTML5 goodies can be integrated

Very good slider-presenter notes

PDF export option for handouts

Very nice transitions and animations

Good builtin themes and literally infinite customisation options as per CSS

Works very well with slide-projectors and remote tools to advance slides

 

Okay, but why use org-mode / org-reveal with Reveal.js ?

Org-mode is cool, easy, transparent text typing

org-mode is structured and nested just like a regular presentations would be

One can easily do a text-only sketch of a presentations by typing out a few lines of text in org–mode formatting and out put a neatly animated stacked presentation in Reveal.js

If one were to code HTML and JS with Reveal.js, it would be considerably opaque, with HTML markup and JS obscuring the structural details of the presentation.

By integrating org-mode, org-reveal and reveal.js we are integrating all that is good in respective tools while sticking to what the non-programmer user ( an average medical professional ) would like to do – type text and structure the presentation.

 

So, How to go about making one ?

Part 1 : Preparing the ground

Step 1 :

Install GNU-Emacs > 24.3

 

Step 2 :

Update package-archives and use Melpa archive.

Update org-mode.

 

Step 3 :

Install ox-reveal package

 

Step 4 :

‘require(ox-reveal) in your .emacs file

 

Step 5 :

Download and keep the Reveal.js file in a folder.

Note down the path to the folder relative to the folder where the presentation will live.

If you have Bower installed you can just do bower install revealjs

 

Step 6 :

Create a folder where your presentation will live. 

Inside the folder create subfolders for Images, Videos, Scripts, CSS styles and other documents which may be needed for the presentation. 

Now we can create the main file of the presentation – the Org-mode file using Emacs.  Org-mode file is a simple text file which can be opened using any other text-editor. It has the extension of  “.org”. 

While using Emacs and Org-Mode, however, it provides lot of goodies. Org-Mode in Emacs has lot of extensions one can install that extends it functionality. One can for example use the same org-mode file to output HTML, LaTeX, and PDF. 

So let us create the main presentation file. I title my presentations the following way, giving it context, separated by underscores : <topic>_<audience>_<date>_<venue> . For example if I am giving a public talk on Cerebral Palsy at my home town of Palakkad, on July 30th,2019 , I would title my presentation like this : “CerebralPalsy_PublicTalk_Palakkad_30072019.org”

This allows me to keep separate org-mode files for different audience and keep using the same images, videos etc.. Therefore I am fully portable and self-contained when I have to whip up a presentation tailored to any particular audience – technical or non-technical. 

C-x C-f  in Emacs  to the file you want to create with .org extension.

C-C C-# to insert Template for a Reveal.JS presentation.

If you have ‘ox-reveal loaded it should be available as a choice.

Once chosen it will list some options at the top of the org-mode file.

We will need to provide the path to the REVEAL_ROOT directory to the place we have stored the reveal.js library. This path is relative to the folder where the file for presentation lives. 

Once these are done, It is important to get the images, videos ready. They have to be edited using FOSS tools for editing photos and videos. Once edited they’ve to be named properly so that we can reference them in our presentations. 

 

This completes the ground work required to start writing the presentation. While this may seem a lot of work, one must remember this is one time effort.

We will deal with the actual creation of  org-mode file, the options while using Reveal.JS in the next part ….

Categories
Deformity Correction and Limb lengthening Orthopedics Pediatric Orthopedics

DDH – Its June !! It’s Dysplasia Awareness Month

Developmental Dysplasia of Hip - Left hip is dislocated
Developmental Dysplasia of Hip - Left hip is dislocated

DDH otherwise called Developmental Dysplasia of Hip is a condition where the ‘ball-and-socket-joint’ of the hip is not formed well at birth. It used to be called Congenital Dislocation of Hip.

The child is born with a slightly misfitting hip joint where the ball is slightly shifted out of cup or a hip joint where the ball is completely outside the cup and cup is also very shallow. This can occur on one side or both sides.

Developmental Dysplasia of Hip - Left hip is dislocated
Developmental Dysplasia of Hip – Left hip is dislocated

Why does it happen ?

Most times its ‘Idiopathic’ , a medical term which means – cause is not known. In many other patients, the child will be having one of the syndromes (a group of clinical features and disorders in other organs systems and external appearance) or neurological issues in the spine (like meningomyelocele) that also causes this. This second group is sometimes medically referred to as Teratogenic DDH and is much more difficult to treat.

We will discuss below the aspects as related to Idiopathic DDH. They don’t apply to Teratogenic or Neurological DDH.

How do we know the child has DDH ?

Most newborn screening procedures at the hospitals have doctors checking to see if the new born child has clinical signs of DDH. It is easiest to detect and treat it at that early stage.

Once a clinical suspicion of DDH is there the Neonatologist usually refers the child to a Pediatric Orthopedic Surgeon. In addition to establishing the clinical diagnosis by physical examination, the doctor will order an x-ray and an Ultrasound Scan of the Hips to check the dislocated hips. Several measurements need to be taken and ease of dislocation need to be established under Ultrasound scan by a procedure called Dynamic -Ultrasound. The treatment starts after these are done.

In many children, the initial diagnosis may not be made in the immediate post-delivery period. Children may be brought to the OPD by parents with complaints that the thigh skin fold dont look symmetrical and the hips don’t open out fully for parents to change diapers.

In older children parents may notice a limp when the child walks or a limb length difference may also be noted with the dislocated side being shorter.

Limb Length Difference in DDH
Limb Lengths may be noted to be different in DDH when child is older and walking. The limb with the dislocated hip will appear shorter.

How soon should the treatment start ?

As described in previous section, treatment should ideally start in neonatal period once the problem has been detected. After clinical examination and Ultrasound examination, your doctor will suggest usually a belt type device called Pavlik Harness to be applied on the child to keep the hip reduced inside the cup. This harness is to be worn full time. Parents are counselled on how this is applied and how the straps are tightened.

Ultrasound exam for a child with Hip and Knee dislocation
Ultrasound exam for a child with Hip and Knee dislocation

Once this harness has been applied, the hips are scanned with Ultrasound every 2 weeks to check for improvements. Ideally this has to be kept for about 3 months and taken off after the hip stabilizes inside the socket. A slow weaning period is there before the child can be fully taken off the Pavlik Harness. This is to ensure that the Ball ( head of femur ) stabilizes inside the socket (Acetabulum of Pelvis) and the hip is stable. The tissues around the hip also has to shrink and adapt to the new location of Head of Femur. Otherwise re-dislocation or partial slip (medically called subluxation) is a possibility.

In many cases the parents may not be willing for a device to be applied on the child full time post-delivery or the DDH itself may go undetected. This child eventually may be brought later in life by the parents with complaints necessitating surgical procedures.

What is the treatment options for DDH?

As previously described if the newborn is detected to have DDH the treatment is to apply Pavlik harness on the child after Ultrasound exam proves hip is reducible and stable in what is called a safe zone. Safe Zone is a zone where the position in which the harness has to be applied to the child does not compromise the blood supply the head of femur. This is very important decision to make.

Pavlik Harness for DDH hip needs to be fitted properly
Pavlik Harness for DDH hip needs to be fitted properly

Hip Spica Plaster in child with DDH
Hip Spica Plaster in child with DDH

Application of Hip Spica under anesthesia in DDH

If the child is brought later in life, before 1 year, the hip has to be checked for reducibility as the tissues around the hip would have become contracted and sometimes it is difficult to reduce the hip back into the socket. Usually anaesthesia would be required and the hip once reduced back into the socket is held there by application of the plaster of paris or POP called Hip Spica. This is kept for approximately 3 months until the hip has stabilised inside. A CT scan to verify whether the hip is reduced should be done while child is in POP as slippage of the hip socket is also seen when POP cast becomes loose with time.

Surgery is the only option in older children with DDH. These range from relatively simple procedures to complex hip reconstruction procedures depending on age of the child, slope of cup, angle of rotation of the neck of the thigh bone and shape of the head. These are best evaluated as per the needs of the child.

Arthrogram for DDH

Generally these surgical procedures can be grouped into a few types :

  • Open Reduction of Hip and Capsulorraphy (medical term meaning stitching up of capsule or the covering around the joint)
    • This is basic necessity. Here the hip is reduced back into the socket and the covering, the capsule, which is loose is tightened with several sutures
  • Femur Derotation Osteotomy with shortening
    • This would involve a slight shortening of the hip bone and turning it around. The bone would then be stabilied with a metal plate and screws
    • The need for your child to have this done depends on the age of the child and the angle of the ‘neck of the femur’, something medically known as Anteversion. This procedure essentially de-rotates the femur neck and allows the head of femur (the Ball) to deeply sit inside the Acetabulum (the socket). A slight shortening of the thigh bone may be needed as the child , if old enough, would have developed tightness of the tissues and hip should be sitting inside the socket slightly loose than in tension.
  • Acetabular Osteotomy
    • In many children, when they present to the clinic their Acetabulum would be shallow and not deep enough to receive the Head of Femur. In such children deepening of the Acetabulum by a surgical procedure called Osteotomy (a type called Salter Osteotomy being the most popular) may be done.

The above procedures may be combined along with Open Reduction as the surgeon sees fit after evaulating the child. These options and its pros-and-cons would be discussed with the parents before the surgery.

What happens if we don’t treat DDH promptly ?

Best time to treat the child is in the newborn period. With time the tissues around the hip gets tighter and the bone structure of thigh bone and pelvis alters since the normal growth with moulding of the ball being inside the cup doesn’t happen.

This lack of moulding results in a shallow cup. Additionally the thigh bone’s upper end would be twisted out of shape and the ball also would be misshapen since it has not been moulded by the acetabulum.

All these result in a much more complex procedure to try and restore the hip.

Left untreated DDH causes osteoarthritis or the Hip joint and Hip pain in early adulthood often requiring complex reconstructive procedures.

It is best if the treatment is not postponed and done at the earliest.

Hip Dysplasia Awareness Month – June !!

The Hip Dysplasia Awareness Month of June is to educate parents on Hip Dysplasia and its treatment methods. We hope that parents would bring children to care centers at the earliest if suspicion of hip dysplasia is there.

For more information please visit : http://livingwithhipdysplasia.com/june/ or consult your Pediatric Orthopedic Surgeon.

Categories
Deformity Correction and Limb lengthening Orthopedics Pediatric Orthopedics

Free Medical Camp for World Clubfoot Day 2018


World Clubfoot Day free medical camp concluded well and many patients had the opportunity to consult free and take advise for their child.

Attaching below is the collage .

We have a lovely Clubfoot Care team that made this event and caring for these children over team so much easier.

World Clubfoot Day
World Clubfoot Day with Children, Parents and Clubfoot Care Team