Patient encounters

Today was inspiring.

For a small session in pediatric cardiology, we had three patients. The first was a 12 year old boy with rheumatic heart disease presenting with mitral regurgitation. The second was a 2 year old child with patent ductus arteriosus with pulmonary arterial hypertension and right ventricular hypertrophy. The third boy was 5 years old and had a common condition known as Tetralogy of Fallot.

photo credit: Wen-Yan King
The process of diagnosing for these patients, through palpable and audible heart sounds, along with the group was difficult but altogether exhilirating. It was my first experience with pediatric cardiology patients.

Socrates tells us, through Plato's words, this:
οὖτος μὲν οἴεταί τι εἰδέναι οὐκ εἰδώς, ἐγὼ δέ, ὥσπερ οὖν οὐκ οἶδα, οὐδὲ οἴμαι
the improper abbreviation of which is "I know that I know nothing".

After we broke up since we were already done for the day, one of the clinical professors asked me at random if I learned anything during the session. To which I replied: Yes, Sir, I did, but more importantly I was inspired even more to become a doctor.

Great stuff today.

Curious case of benji bangus

What would you do if you give birth to a fish? Will you not eat fish for the rest of your life? More importantly, what would you feel if you were the impotent husband in this story?

Adolf Alix Jr. returns to form with this powerful film, Isda, an entry to the Cinemalaya 2011 Director's Showcase Category. The film explores the lengths that a mother would do for the sake of her child, even if it were a fish.

The short story, a Palanca winner, is absurd but well-conceived. Screenwriter Jerry Gracio makes us love the characters and feel their individual struggles. Director Adolf Alix Jr is one capable filmmaker by making use of silence as a potent armament to make the audience think. The movie also offers glimpses of many social ills.

Rather than discuss the plot at length, I would instead end this article by affirming that I never really liked alcohol. It gets in your head and makes you vulnerable in so many ways. Alcohol may give a reprieve from your worries, but its effects are temporal.

An internal conflict will not resolve itself unless it is confronted. A person can never be whole if something inside is missing. I say amen to that.

My third TED translation

This was a fun project to do: I got to know a smart person from the other side of the globe who made the initial translated script. He's a fellow Dabaweno who now lives in Canada. In fact, I did not expect him to find me on Twitter.

Together with Kenneth, I reviewed Derek Sivers's anthropological musings on the peculiarities of cultures. He proposes that in order to know what's true, we need to see things on the flip side.

Derek Sivers is an alumnus of the Berklee College of Music and became a tape room technician, guitarist, and professional musician. He sold his 10-year old company CD Baby in 2008, which by that time had over $100M in sales with more than 150,000 musician clients. Sivers currently resides in Singapore.

TEDIndia 2009, Filmed Nov 2009; Posted Jan 2010
Translated into Tagalog by Kenneth Andres
Reviewed by Schubert Malbas

iPhones in Europe

Apple Inc. was recently held under siege by claims on breech of user privacy. It was revealed in news stories for the past months that location data from iPhone users were collected without complete consent from unknowing consumers. Your iPhone basically triangulates your location based on wifi and cell networks nearest your mobile.

Some users, nonetheless, were willing to donate their GIS data with full consent. These were subsequently grouped together by in order to create some beautiful visualizations. Below are videos showing the movement of 880 anonymous iPhones in Europe, mostly in Germany, on April 2011. You can maximize them to full window to get the most authentic effect.

It's amazing how such simple data can be made grand with just a few tweaks. These days of modern computing, data is king.

[videos are created by and are shared under a Creative Commons license]

Weekly trading stats

$1199 weekly gain
$2102 month-to-date gain
$807 on 23,200 AA shares traded
-$97 on 13,400 NWSA shares traded
$489 on 5,300 COP shares traded

A few realizations: Swing trading is probably the easiest way to gain (or lose) a significant amount of money without even thinking. Even with the best technical tools utilized and stop gaps put in place, you can never be 100% sure of tomorrow's outcome.

That is why some trading firms, including my previous employer, would rather focus on active intra-day trading, no matter how stressful to an equities trader it eventually becomes.

This leads me to a second aha! moment, when active trading this week alone has become fun yet time-consuming. I disappointed myself this past week because I prioritized my active trade positions instead of studying pharmacology. I watched Bloomberg instead of having read Katzung. I slept late a few times instead of waking up early for my morning classes.

Instead of self-flagellating (I meant the whip, not the unicellular kind), I think it is best to stop this happy madness, at least until the semester ends on October. This will probably be my last weekend update for the semester.

Surely I will miss this kind of life, just as much as I long for those days in 2008 when I was officially a stocks trader, holding a real portfolio, betting real dollars, and contributing to the crazy volatility in NYSE.

Working towards being a competent medical doctor has serious demands of its own, and I still have a lot to learn, probably one step at a time.

The Week In Review
  • Early monday, investors were frustated by the sovereign-debt crisis ensuing in Greece, Ireland, Portugal, and Italy. European finance ministers were mulling over the possibility of another Greek bailout. Italy's debt on the other hand stands at 120% of GDP, the second largest ratio behind Greece in the Euro area. National leaders were still uncertain about the passage of essential austerity measures. 
  • The week was also the start of earnings season, with companies churning up second quarter reports to the shareholders.
  • First bellwether firm is Alcoa (NYSE: AA), an aluminum manufacturing giant, which presented huge earnings compared to the period last year but missed analyst estimates by a couple of cents per share. This sent Alcoa's earnings tumbling slightly the day after.
 Investors pulled out of Alcoa Inc. Monday just hours before earnings were released in the afternoon. Alcoa reported strong profit margins compared to last year and expects strong demand from China in the following months. image credits: Google Finance

  • Cisco (NASDAQ: CSCO) also announced cutting 10,000 jobs. It aims to cut at least 5,000 worldwide by the end of August, in order to improve profit margins. Cisco faces increased competition on sales of switches, routers, and other networking hardware from strong companies like Hewlett Packard. Cisco is trading at its lowest levels of this year-to-date.
  • Wednesday saw China's GDP for the second quarter grew by 9.5%, slightly lower from its first quarter by 0.2%. Asian stocks rose on that day, and the healthy contagion spread on European and American bourses.
  • Also, News Corporation (NASDAQ: NWSA) was embroiled in two news-worthy items this week. First, News Corp closed down News of the World over alleged phone hackings in several occasions, including those of phone records of victims of the September 11 attack and 7/7 London Transit System Bombing. Expectedly, NWSA prices tumbled. Second, Rupert Murdoch announced to withdraw his company's bid to acquire British Sky Broadcasting Group on Wednesday, which slightly pulled up NWSA prices off its monthly low.

Price of News Corp. fell dramatically in July of 2011 following allegations of phone hackings. However, it should be noted that the current stock price is just off the peak of its meteoric climb for the past 3 years, similar to September 2008 levels. image credits: Google Finance

  • ConocoPhillips (NYSE: COP) announced Thursday that it will follow Marathon Oil's corporate strategy to split the company apart into smaller groups. This sent COP to almost 5% higher on the opening bell than the previous day's close.
ConocoPhillips announced on July 14th that it will spin-off its exploration-production and refinery-marketing divisions into two separate, publicly-listed companies in order to refocus business strategies. Investors reacted to the news, opening at just above 80 from a previous close of 74. Its intra-day decline was unusually steepimage credits: Google Finance

  • Also, this week, JPMorgan Chase & Co. (NYSE: JPM), Google Inc. (NASDAQ: GOOG) and Citigroup Inc. (NYSE: C) reported strong earnings for the second quarter, raising expectations for both financial and tech sectors in the coming weeks.

My second TED translation

In this talk, Ron Gutman shares about the potent effects of a simple smile. Gutman is a venture capitalist and investor in health-related projects such as those in Harvard, Stanford, and Silicon Valley. He seeks to help build healthier lives, and he has lots of money to do it, I suppose.

Something to look forward to in his presentation is President Barack Obama's old yearbook picture. Gutman ends his talk with Mother Theresa's words: "I will never understand all the good that a simple smile can accomplish." Amen.

TED2011, Filmed Mar 2011; Posted May2011
Translated by Dyan Kristine Miranda
Reviewed by Schubert Malbas

Free-dive at world's deepest

This guy freaks me out completely.

He is Guillaume Néry, a 3-time world record holder for free-diving. He has been the ultimate freediver in 2002, 2004, and 2006. The current record is held by Herbert Nitsch at 124 meters deep. Oh well, whatever floats their boat.

This water facility on the other hand is in Brussels, and its claim to fame comprises a huge waterhole with a maximum depth of 108 feet (33 meters). It has underwater caves too, plus 2.5 million liters of spring water, and a couple of shallow-depth platforms.

It even has a drinking joint just beyond the walls of this waterhole, where hydrophobic visitors can scare their wits while keeping themselves dry and sipping their favorite Martini or Molotov.

My first TED translation

TED has recently published my first-ever contribution to the TED Open Translation Project. The video is about Richard St. John's secrets to success.

It feels great to have given something of value to the online community. There's more to come, I promise!

TED2005, Filmed Feb 2005; Posted Dec 2006
Translated by Ken Sy
Reviewed by Schubert Malbas

Sizing Up Pharmacology 1

software credits:

Freebies from Japan

I went to Shangri-la Mall in Mandaluyong to catch the last day of screening of Japanese films for the Philippines-Japan Friendship Month. I mean, it's a rare care-free weekend in medical school and I have no excuse to miss a free film.

I got a single ticket for the earliest screening. Inside the dimly lit theater I scurried to find a seat while the Harry Potter trailer was on. Clumsily I bumped into one of those posts holding the theater cordon. I apologized to the usher for destroying it.

The film was Summer Days with Coo (2007), a story of a water sprite who survived his father's tragedy from 200 years ago and lived to see present-day Tokyo.

I am not in the best position to review this film; needless to say, it does not starve from adulations:
  • Best Animated Feature Film (nominated) - 2007 Asia Pacific Screen Awards
  • Grand Prize for Animation (won) - 2007 11th Japan Media Arts Festival
  • Notable Feature Film Entry (won) - 2008 Tokyo Anime Awards
  • Best Animation Film (won) - 2008 Mainichi Film Awards
  • Best Animation Film (nominated) - 2008 Japanese Academy Awards
 Animation films endear primarily to the eyes of children, but they will always have sublime adult themes. In 'Coo', as in many animation films of festivals past, the conflicts comprise man v. environment and man v. self.

Japanese film festival organizers are apparently keen at playing the pro-environment card and raise awareness among movie-goers. Their last year's foray included Miyori No Mori (2007), which was about a girl's quest to save a forest from humans.

It might be dangerous to offer comparisons but I will hazard my opinion. Coo is well-written and the audience had a significant share of laughs in between. Miyori was a more difficult film to like because of its silly screenplay. It may also have been overlooked by award-giving bodies that year. However, Miyori had an emotional thug, while I did not have a similar catharsis for Coo. Let's just say that I liked one better.

All in all, free films feel great. Here's to free tickets to Cine Europa and the Taiwanese Film Festival coming soon this year!

Weekly trading stats

$903.00 on 6,400 RIO shares traded

Friday was a bliss for swing traders on short position. The markets were down due to a dismal 18,000 net gain in new jobs in June, while forecasters anticipated higher in the 125,000 to 175,000 range. Investors feared that the economic recovery has stalled, and more than 14 million are left unemployed.

I shorted 600 Rio Tinto shares (NYSE: RIO) on Thursday, and cashed-in with the fall on Friday.

chart credits: Google Finance

In retrospect, trading RIO was a wise move, with share prices in the year-to-date chart indicating an oscillating trend between 65 and 75 a piece. Currently, RIO stands at 72.72, near the midline.

Elsewhere, the account ranked #26 on the virtual contest from a total of 262 portfolios. It's great to know that I still have some trading chops left, and this portfolio is off to a great start.

Paper trading 101

I haven't written anything related to technical analysis for more than two years now. However, this week, I saw a segment on BBC that featured virtual stock trading online, and then I tried it out, just for kicks I suppose.

Then an idea just popped in my brain, and I said, 'hey I can blog this'.

Back then, I had been reporting earnings and losses daily on my dead blog as Manila Trader. Reading through the entries is nostalgia, or probably this is just a crazy infection of rhinovirus that's been spreading in medical school for days already.

I hope this motivates me to do well in the website's July contest. Yes friends, it's also a legit contest. A virtual account starts with $25,000. Whoever makes the most money at the end of the month wins the contest. I started my July account quite late, so I have a lot of catching up to do.

I'd probably post my progress on weekends, that way I won't unnecessarily embarass myself.

Here's hoping to a weekend in green.

Death by bangungot

It's pretty useless when you die of bangungot.

You could have died a hundred different deaths: shot like Rizal who died a patriot, tortured upside down like San Lorenzo in the name of God, or blown to bits after failing to dispose a bomb inside a train carrying at least a hundred innocent lives.

Death by asphyxiation while being trampled upon by a folkloric creature, known as Batibat, pales in comparison to those poetic deaths.

image credits:

Filipinos call it bangungot, while the Thais and Laos refer to it as Brugada Syndrome. Due to current indefinite etiology, researchers would write Sudden Unexpected Death Syndrome, and doctors will cite symptoms of Sleep Paralysis. By experience, though, bangungot is worse than the Western concept of nightmares.

Bangungot is singly the most vivid image in my memories of Lantern Parades in UP Diliman. Batibat is a creature of Ilocos folklore that sits atop the chest and torso of the victim, most usually a young unknowing male, during his long and peaceful lumber.

This young man is asleep, but he is seemingly aware of his surroundings. He starts to struggle to get up from bed, but can't. It's like getting tied to the bed helplessly.

He will probably try to shout at people nearest him, but his voice will not be heard by anyone. The victim will start struggling for air. In some few cases, the victim may die in his sleep.

image credits:

My favorite anthropologist, Dr. Michael Tan, writes in his column that bangungot is probably beyond the biological disease, and reflects psychosocial aspects that we do not usually consider. Particularly, bangungot and similar folk ailments cause real disease, pain, suffering, and even death, which makes it even more crucial to look for preventive equivalents.

I had bangungot several times, and it freaks me out every time. I would wake up clammy, sweaty, and teary-eyed.

Could someone invent a pill please. Know that you'll be rich in no time.

Sources: Sudden Unexpected Death Syndrome, Brugada Syndrome, Sleep ParalysisBatibat

Sizing Up Psychiatry

software credits:

Must stop diet soda

Diet soda is no better than sugar-laden soda, it seems.

At the recently concluded 71st American Diabetes Association (ADA) Scientific Sessions in San Diego, California, it was reported in two separate studies that diet soda causes the body to accumulate abdominal fat, lower circulating insulin levels, increase serum glucose levels, and promote insulin resistance which is bad and may lead to a diabetic condition.

In one longitudinal human study done by researchers at the School of Medicine of the University of Texas Health Science Center San Antonio, diet soda consumers reported a 70 per cent greater waistline circumference (higher abdominal fat) than non-consumers over a period of a decade.

Worse, those who took two or more diet sodas per day increased this measurement by 500 per cent more than the control group.

Excess fat in the belly is a risk factor for several illnesses, such as diabetes, hypertension, and cardiovascular diseases.

In a second study done on lab mice, it was demonstrated that aspartame, a major sweetener of diet soda, enhances fasting blood glucose levels and reduces the level of circulating insulin after three months. In humans, this is already an indication of a diabetic or a pre-diabetic patient.

I read somewhere too that soda drinkers have a greater risk for stroke incidents. These academics must be telling the truth! They probably do not stand to gain anything by claiming against Coca-Cola or PepsiCo.

Oh, my! I should come clean soon and probably switch to fruit juice.

Sources: TimeCBSnewsDailyMail

Writing about writing

I was kind of awful at writing before, and probably still. It's a good thing that the internet is free, and a lot of experts are willing to exemplify their skills. offers these interesting advice to the gullible.

These rules were written by Frank L. Visco and originally published in the June 1986 issue of Writers' Digest. An alternate set of rules, below, was created by William Safire in his Rules for Writers.

How To Write Good
by Frank L. Visco

My several years in the word game have learnt me several rules:
  1. Avoid alliteration. Always.
  2. Prepositions are not words to end sentences with.
  3. Avoid cliches like the plague. (They're old hat.)
  4. Employ the vernacular.
  5. Eschew ampersands & abbreviations, etc.
  6. Parenthetical remarks (however relevant) are unnecessary.
  7. It is wrong to ever split an infinitive.
  8. Contractions aren't necessary.
  9. Foreign words and phrases are not apropos.
  10. One should never generalize.
  11. Eliminate quotations. As Ralph Waldo Emerson once said: "I hate quotations. Tell me what you know."
  12. Comparisons are as bad as cliches.
  13. Don't be redundant; don't more use words than necessary; it's highly superfluous.
  14. Profanity sucks.
  15. Be more or less specific.
  16. Understatement is always best.
  17. Exaggeration is a billion times worse than understatement.
  18. One-word sentences? Eliminate.
  19. Analogies in writing are like feathers on a snake.
  20. The passive voice is to be avoided.
  21. Go around the barn at high noon to avoid colloquialisms.
  22. Even if a mixed metaphor sings, it should be derailed.
  23. Who needs rhetorical questions?
by William Safire
  1. Parenthetical words however must be enclosed in commas.
  2. It behooves you to avoid archaic expressions.
  3. Avoid archaeic spellings too.
  4. Don't repeat yourself, or say again what you have said before.
  5. Don't use commas, that, are not, necessary.
  6. Do not use hyperbole; not one in a million can do it effectively.
  7. Never use a big word when a diminutive alternative would suffice.
  8. Subject and verb always has to agree.
  9. Placing a comma between subject and predicate, is not correct.
  10. Use youre spell chekker to avoid mispeling and to catch typograhpical errers.
  11. Don't repeat yourself, or say again what you have said before.
  12. Use the apostrophe in it's proper place and omit it when its not needed.
  13. Don't never use no double negatives.
  14. Poofread carefully to see if you any words out.
  15. Hopefully, you will use words correctly, irregardless of how others use them.
  16. Eschew obfuscation.
  17. No sentence fragments.
  18. Don't indulge in sesquipedalian lexicological constructions.
  19. A writer must not shift your point of view.
  20. Don't overuse exclamation marks!!
  21. Place pronouns as close as possible, especially in long sentences, as of 10 or more words, to their antecedents.
  22. Writing carefully, dangling participles must be avoided.
  23. If any word is improper at the end of a sentence, a linking verb is.
  24. Avoid trendy locutions that sound flaky.
  25. Everyone should be careful to use a singular pronoun with singular nouns in their writing.
  26. Always pick on the correct idiom.
  27. The adverb always follows the verb.
  28. Take the bull by the hand and avoid mixing metaphors.
  29. If you reread your work, you can find on rereading a great deal of repetition can be by rereading and editing.
  30. And always be sure to finish what

To tame a shrew

Back in 2008, I was a newbie in the cut-throat world of NYSE and was still learning the ropes. Back then, it was not uncommon that I lose money for my portfolio.
On bad days, and there were several, the manager would advise me to take the time off after I lose my positions. On those days, I would ponder on my minute existence in the big global network that emanates from Wall Street, and wrote on my previous blog, perhaps out of frustration or learned helplessness as psychiatrists would say.

To Tame A Shrew at Wall Street

I apologize, Mr Shakespeare, for bastardizing your poetic genius.

It only fascinates me that 400 years later, your literature took on a new meaning. Day traders like me can only smile in bemusement, perhaps bewilderment bordering insanity.

In this art of war, I am no warrior of Lancelot. I was not properly trained in the academia of finance or economics. My formal teachers, if I may say so, were Leeuwenhoek, Schleiden, Schwann, Watson, Crick, and Craig Venter, to name a few.

Battlefield was only a vague concept, until they threw me in. Wall Street trampled upon me. Mother Market was a difficult shrew to tame.

Bruised and naked, I was surprised! I had been taught to fish for around 7 days before, but no one told me that fishing was more difficult than textbook drama.

Thus, for the next few days, weeks, months, or even years if I’m still alive, I will build my armor for this war. I will ready my helm and visor (to think logically), chain vest (to control my emotions), and gauntlets (to be quick with my hands). I am still a squire at this stable, ready to obey at will.

Someday, I will be a successful knight of Wall Street, and this is my tale.

Will Smith starred as a salesman turned stockbroker in The Pursuit of Happyness (2006).

Karaoke hazards

Inside a karaoke booth with a few classmates, a brilliant idea popped up, a wicked research topic, which I then suggested to them.

"Detection of Mycoplasma, Legionella, and Chlamydophilia strains causing community-acquired pneumonia from aerosol particles on microphones of selected karaoke booths in the City of Manila"

No one might have thought that karaoke is a health hazard. This health concern will perhaps make you think otherwise.

image credits:
Look at how close Nina keeps her mic to her lips. Aside from inhaling aerosol particles, other possible pathogens include Epstein-Barr virus (EBV), cytomegalovirus (CMV), Herpes Simplex Virus-1, and Coxsackie virus. The list of infectious agents goes on.

Well, you might think it's nonsense. NCBI PubMed, however, has actually indexed a peer-reviewed research about karaoke. In 2003, Yiu & Chan of the University of Hong Kong described the vocal effects of singing for 4-5 hours continuously inside a karaoke booth, and the interventions necessary to keep amateur throats in best shape.

Karaoke singing is a very popular entertainment among young people in Asia. It is a leisure singing activity with the singer's voice amplified with special acoustic effects in the backdrop of music. Music video and song captions are shown on television screen to remind the singers during singing. It is not uncommon to find participants singing continuously for four to five hours each time. As most of the karaoke singers have no formal training in singing, these amateur singers are more vulnerable to developing voice problems under these intensive singing activities.

This study reports the performance of 20 young amateur singers (10 males and 10 females, aged between 20-25 years) on a series of phonatory function tasks carried out during continuous karaoke singing. Half of the singers were given water to drink and short duration of vocal rests at regular intervals during singing and the other half sang continuously without taking any water or rest.

The subjects who were given hydration and vocal rests sang significantly longer than those who did not take any water or rest. The voice quality, as measured by perceptual and acoustic measures, and vocal function, as measured by phonetogram, did not show any significant changes during singing in the subjects who were given water and rest during the singing. However, subjects who sang continuously without drinking water and taking rests showed significant changes in the jitter measure and the highest pitch they could produce during singing.

These results suggest that hydration and vocal rests are useful strategies to preserve voice function and quality during karaoke singing. This information is useful educational information for karaoke singers.

image credits: NCBI PubMed

Basically it says that a glass of water or two wouldn't hurt. Cheers to all karaoke lovers in the world! Kanpai!

Reference: Yiu, EM, & Chan, RM. (2003). Effect of hydration and vocal rest on the vocal fatigue in amateur karaoke singers. Journal of Voice, 17(2), 216-27 (link here).