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The Empty Rusted Bucket

The Empty Rusted Bucket

Sudden inspiration followed after seeing an empty rusted bucket in my backyard and I composed this #poem about neglect of what was once useful, now neglected, still owned, but not cared or sought after ..

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

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

#WorldCerebralPalsyDay event !! – wonderful experience at #Palakkad, #Kerala
#CerebralPalsyDay
#CerebralPalsy
#ChildOrtho
#PediatricOrtho

@aacpdm
@CP_info
@CP_Sport

World #CerebralPalsy Day – October 6, 2018

World #CerebralPalsy Day – October 6, 2018

World Cerebral Palsy Day – October 6, 2018.

We are planning to conduct extensive activities in October, 2018 for raising awareness of the issue in association with Cerebral Palsy Clinic, Rajiv Gandhi Cooperative Hospital and ICCONS

#PySangamam presentation on #AuShadha done !

#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.

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

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

AuShadha 2.0 , a new re-write of AuShadha Electronic Medical Records has just had it first major commit . Find the repository at https://github.com/dreaswar/AuShadha2.0 .

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

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

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

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

#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

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

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

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

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

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 ….

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

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

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
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
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.