Marathon-associated ailments: “too hot,” “too cold,” “too dry,” “too wet” and “wobble and fall down”

According to the NYTimes, the most common and potentially life-threatening marathon-associated ailments are “too hot,” “too cold,” “too dry,” “too wet” and “wobble and fall down”. These translate into heat stroke, hypothermia, dehydration, low blood sodium and collapse, respectively.

The medical professionals at this year's NYC marathon had ice-water dunk tanks to treat runners who developed high fevers. Handheld i-Stat machines enabled them to analyze the chemistry of the runners’ blood, then dispense the right amounts of intravenous fluids, salts and sugar.

Understanding the Heart Hazards of Marathon Running - Video - TIME.com.

References:
Doctor Prepared for the Worst at Marathon. NYTimes.
Faces at the Finish - Interactive Feature - NYTimes.
Running With the Elites - Slide Show - NYTimes.

Posted at Clinical Cases and Images. Stay updated and subscribe, follow us on Twitter and connect on Facebook.


What’s new in nephrology and hypertension

35% of UpToDate topics are updated every four months. The editors select a small number of the most important updates and share them via "What's new" page. I selected the brief excerpts below from What's new in nephrology and hypertension:

Glomerulonephritis

In idiopathic membranous nephropathy, among patients with protein excretion less than 8 grams/day, treatment with an ACE inhibitor or ARB increased the probability of remission.

Hypertension

There was no difference in the rate of myocardial infarction, stroke or death from cardiovascular causes between the intensive versus standard hypertension therapy groups, nor in the all-cause mortality rate. ('ACCORD BP trial'). Intensive therapy included goal systolic blood pressure less than 120 mmHg, standard therapy included goal systolic blood pressure less than 140 mmHg.

Hyponatremia

Tolvaptan is a vasopressin receptor antagonists. The long-term administration of tolvaptan appears to be safe and effective among patients with chronic hyponatremia. Responses were similar in heart failure and SIADH, and more modest in cirrhosis.

Transplantation

An increased incidence of angioedema has been noted in patients administered angiotensin-converting enzyme (ACE) inhibitors plus either sirolimus or everolimus.

Autosomal dominant polycystic kidney disease (ADPKD)

Activation of the mammalian target of rapamycin (mTOR) protein may contribute to cyst growth in autosomal dominant polycystic kidney disease (ADPKD). The inhibition of mTOR with rapamycin preserved renal function and inhibits epithelial cell proliferation and fibrosis in a mouse model of ADPKD. In a human trial, cyst volume was stable on rapamycin.

The long-acting somatostatin octreotide decreased liver volume by 5% in patients with autosomal dominant polycystic liver disease.

References:
What's new in nephrology and hypertension. UpToDate.

Twitter comments:

@kidney_boy (Joel Topf): UpToDate seems to be misrepresenting the ADPKD mTOR data. See my interpretation here: More ADPKD and sirolimus data: More definitive; less encouraging

Posted at Clinical Cases and Images. Stay updated and subscribe, follow us on Twitter and connect on Facebook.


Liraglutide (Victoza) superior to sitagliptin (Januvia) for reduction of HbA1c in diabetics


Action of DPP-4 inhibitors. Note that DPP-4 normally inactivates GLP-1. DPP-4 inhibitors block DPP-4 which in turn leaves GLP-1 active. Click to enlarge the figure. Created with Gliffy.

What is Glucagon-like peptide-1 (GLP-1)?

Glucagon-like peptide-1 (GLP-1) is a GI peptide that stimulates insulin secretion (similar to sulfonylureas). GLP-1 also inhibits glucagon release, gastric emptying and food absorption. GLP-1 and another similar peptide are called incretins. As noted above, incretins have a dual action which leads to lowering blood glucose:

1. Stimulate insulin release
2. Inhibit glucagon release

Exenatide (Byetta) is a GLP-1 receptor agonist approved for adjunctive therapy for patients with DM 2 who are not well controlled on oral agents. It is available only as injections and has to be administered twice daily.

DPP-4 inhibitors, or gliptins, increase GLP-1 levels by blocking the enzyme which inactivates GLP-1. The enzyme is called DPP-4 (dipeptidyl peptidase-4). They act similarly to Byetta (see figure above) but have the big advantage to be available in oral form (pills). Gliptins used for treatment of DM2 include sitagliptin (Januvia) and vildagliptin (Galvus).

What is Liraglutide?

Liraglutide (Victoza) is a long-acting glucagon-like peptide-1 (GLP-1) analog that was developed by Novo Nordisk for the treatment of type 2 diabetes. Liraglutide has a half-life after subcutaneous injection of 11–15 hours, making it suitable for once-daily dosing (in contrast to Byetta's twice daily).


Liraglutide. Image source: Wikipedia, public domain.

Liraglutide (Victoza) superior to sitagliptin (Januvia) for reduction of HbA1c in diabetics
This Lancet study assessed the efficacy and safety of the human GLP-1 analogue liraglutide versus the DPP-4 inhibitor sitagliptin, as adjunct treatments to metformin, in individuals with type 2 diabetes who did not achieve adequate glycaemic control with metformin alone.

More than 600 participants (aged 18—80 years) with type 2 diabetes mellitus who had inadequate glycaemic control (glycosylated haemoglobin [HbA1c] 7·5—10·0%) on metformin (more than 1500 mg daily) were enrolled.

Participants were randomly allocated to receive 26 weeks' treatment with 1·2 mg or 1·8 mg subcutaneous liraglutide once daily, or 100 mg oral sitagliptin once daily.

Greater lowering of mean HbA1c (8·5% at baseline) was achieved with 1·8 mg liraglutide (?1·50%) and 1·2 mg liraglutide (?1·24%) than with sitagliptin (?0·90%).

Nausea was more common with liraglutide (27%) on 1·8 mg. Minor hypoglycaemia was recorded in about 5% of participants in each treatment group.

Liraglutide was superior to sitagliptin for reduction of HbA1c, and was well tolerated with minimum risk of hypoglycaemia. These findings support the use of liraglutide as an effective GLP-1 agent to add to metformin.

References:

Posted at Clinical Cases and Images. Stay updated and subscribe, follow us on Twitter and connect on Facebook.


The Person You Love is 72.8% Water – Teagan White

Teagan White

Teagan White

Aside from learning a new anatomical fact, these two wonderful pieces by Teagan White, based on a quote from “The Art of Looking Sideways” by Alan Fletcher, are fantastic! The details in the drawing and translucent paper used for the book really make these pieces pop. Teagan has some mad drawing skills, shown clearly in her portfolio full of intricate and beautiful illustrations. It’s definitely worth a look, and her Behance portfolio also houses a wonderful range of stuff as well.

[thanks Colleen for the link!]

Texas-T

Texas-T package design by Amanda Kulik

Texas-T package design by Amanda Kulik

Fantastic labels for a more “manly” tea, created by designer Amanda Kulik.

Why the need for a manly tea?—

“Forget the sweet smelling stuff that comes in the pretty little jars with the pretty little bows and a flower on the front- Texas-T is for men. Finally there’s a hot tea men don‘t have to be ashamed to drink or buy. It even ships in a discreet crate – so manly.”

Uhhhh, men?  Well slap a trucker hat on me and call me a schizophrenic Buck, cuz I’d totally have this tea.  I didn’t realize slapping anatomical illustrations on something made it manly.  Nerdy, maybe.  Strange, sometimes. But after going to grad school in a program of mostly female medical illustrators, these teas may be better suited for the ladies.

Buck out.

[spotted by the wonderfully talented Leah Tran]

Anatomical Alphabet

Pattraporn Lavunjaruskul anatomy alphabet

A Street Anatomy fan by the nickname Faii, recently submitted this anatomical interpretation of the alphabet.  I love that the letter ‘D’ is the spleen, it’s my favorite little organ!

Two Upcoming Events at the Hunterian Museum in London




I have just been alerted to two wonderful looking events at the Hunterian Museum in London by Jane Hughes, head of learning and access; Full details follow; if you're in London, be sure to check out either or both!

The Hunterian After Dark
Date: Friday, November 12th
Time: 6-9 PM
Admission: Free, with pay bar

A rare late-night opening of the museum and a chance to find out about the role of the College in modern surgical training. Enjoy a drink among the historical specimens collected by John Hunter and other eminent surgeons of the 18th and 19th centuries. Also available is an opportunity to tour the new Eagle Project teaching suite, find out about dissection at the College and try your hand at ‘keyhole’ surgery techniques and surgical suturing.

Gorgets and Bistouries: An Evening Encounter
Date: Thursday, December 2
Time: 7-9pm
Admission: £8, includes a glass of wine or soft drink

Artist and musician Matthew Robins and photographic artist, Elaine Duigenan collaborate to bring you a magical encounter with ‘instruments’ – both the musical and surgical. Through words, song, live animation and shadow play they will bring you an unforgettable performance in the realm of ‘The Dreadful and The Divine’.

Enjoy an atmospheric late view of the Hunterian Museum and the exhibition and following in the vein of the moving image, create your own zoetrope inspired by Matthew’s unique art.

Numbers are limited so booking is essential on 020 7869 6560

See more of Matthew's work at http://www.sadlucy.com and Elaine's work at http://www.elaineduigenan.com

To find out more about these events, click here and here, respectively. To see some other recent posts about Elaine Duigenan's work on Morbid Anatomy, click here and here.

"Come and See: The Amsterdam Anatomical Collection Dissected," Lecture and Book Signing with with Dr. Laurens de Rooy, Curator of the Museum Vrolik


This Thursday at 8:00 PM at Observatory, please join Morbid Anatomy and curator Dr. Laurens de Rooy for a highly-illustrated ‘dissection’ of the spectacular and fascinating Amsterdam-based Vrolik Anatomical Museum, a specimen of which is pictured above. Copies of the beautiful and lavishly illustrated new book about the collection--entitled Forces of Form-- will also be available for sale and signing.

Full details below; very much hope to see you there!

Come and See: The Amsterdam Anatomical Collection Dissected
An illustrated lecture and book signing with Dr. Laurens de Rooy, Curator of the Museum Vrolik in Amsterdam
Date: Thursday, November 11
Time: 8:00 PM
Admission: $5

Books will be available for sale and signing.

Two skeletons of dwarfs, rare Siamese twins, cyclops and sirens, dozens of pathologically deformed bones, the giant skull of a grown man with hydrocephalus, the skeleton of the lion once owned by king Louis Napoleon, as well as the organs of a babirusa, Tasmanian devil and tree kangaroo – rare animals that died in the Amsterdam zoo ‘Artis’ shortly before their dissection.

Counting more than five thousand preparations and specimens, the Museum Vrolikianum, the private collection of father Gerard (1775-1859) and his son Willem Vrolik (1801-1863), was an amazing object of interest one hundred and fifty years ago. In the 1840s and 50s this museum, established in Gerard’s stately mansion on the river Amstel, grew into a famous collection that attracted admiring scientists from both the Netherlands and abroad.

After the Vrolik era, the museum was expanded with new collections by succeeding anatomists. What motivated the Vroliks and their successors to collect all these anatomical specimens, skulls, skeletons, and monstrosities? were did their material come from? How did these collections help to built up their views on the origins of life forms?

Since 1984 the museum is located in the academic Hospital of the University of Amsterdam. Recently the museum collections were portrayed by the photographer Hans van den Bogaard for the book Forces of Form. These images will form an essential part in this talk, a ‘dissection’ of the Amsterdam anatomical collection.

Dr. Laurens de Rooy (b. 1974) works as a curator of the Museum Vrolik in the Academic Medical Centre in Amsterdam. He studie Medical Biology, specializing in the history of science and museology. during his internship he researched the collection of father and son Vrolik. In 2009 he obtained his PhD in medical history.

You can find out more about theis event on the Observatory website by clicking here. You can get directions to Observatory--which is next door to the Morbid Anatomy Library (more on that here)--by clicking here. You can find out more about Observatory here, join our mailing list by clicking here, and join us on Facebook by clicking here.

33 Plates of Morbid Anatomy Elucidating Dr. Bright’s Works, 1829, The British Museum










33 Plates of Morbid anatomy Ellucidating Dr. Bright's Works
Published in London, 1829
British XVIIIc Mounted Atlas
Paper; stipple ; mezzotint; hand-coloured
Published by Longman; Prints made by William Say

Inscriptions: Lettered within image with letters for identification, and: "Plate/ Drawn by F.R.Say/ Engraved by W.Say/ London Published July 1. 1829, by Longman, Rees, Orme & Brown." Stamped with Say's blind stamp.

Found on the British Museum website; to find out more--and see more images!--click here.

Amino acids are latest in growing list of nutrients shown to extend life span

Researchers are zeroing in on specific nutrients and natural therapies that not only can prevent and heal disease but promote longevity. For example, as NaturalNews previously reported, a research team from Nu Skin Enterprises, Inc., and LifeGen Technologies found that Cordyceps sinensis (Cs-4), a traditional Chinese mushroom, is a powerful anti-aging food that could lengthen lifespan (http://www.dreddyclinic.com/forum/viewtopic.php?f=13&t=24075). And University at Buffalo endocrinologists recently documented for the first time that resveratrol, a phytochemical found in red grapes, grape juice and red wine, has anti-inflammatory and antioxidant properties in humans and may promote human longevity, too (http://www.dreddyclinic.com/forum/viewtopic.php?f=21&t=20422). Read more...

Detoxify , detoxifying, holistic detox

Have a Jazzy Thanksgiving on a Mexican Riviera Beach

Playa Mamitas in Playa del Carmen, site of the Riviera Maya Jazz Festival

Thanksgiving is a lovely family holiday, but sometimes, it’s nice to do something a little different. Why not think about spending this Thanksgiving in the Mexican Riviera? It’d be a last-minute trip, but there are lots of last-minute deals flying around at the moment to encourage people to travel. And, if you’re a big fan of jazz, the Riviera Maya Jazz Festival is definitely something to at least check out.

Just imagine…instead of getting stuffed to the brim with turkey and stuffing, you could spend some time with the family in paradise while listening to some fantastic jazz musicians. And the best part? The music is free for four nights — November 25-28. The second best part? You’ll be enjoying the music on stunningly beautiful Playa Mamitas. This is only one of dozens of gorgeous beaches in Playa del Carmen. And there’s so much to see and do during the day near Playa del Carmen. Snorkeling, visiting Tulum and the extraordinary ruins and water park at Xcaret Water Park and learning about Mayan history.

Tempting, isn’t it? Maybe this could be a new family tradition.

Earl Klugh performing at Riviera Maya Jazz Festival

Photos: GersonGC, noticaribe

Oregon Beaches That Allow Bonfires

Cape Blanco State Park

Last week, Sebastien Tobler wrote blogged about Los Angeles beaches that allows bonfires. Being from Southern California, I got very reminiscent of my bonfire days in San Diego. It’s just such a lovely thing to do year-round. The problem is, I now live in Georiga, and apparently, there isn’t a beach for thousands of miles that allows bonfires (as far as I can tell — if you know differently, please let me know!)

It looks as though in the U.S., very few beaches allow bonfires these days, which is sad. I understand it – the safety, trash and maintenance issues – but I don’t like it. Those of you living in Oregon, however, are luckier than most. From what I understand, many Oregon beaches and state parks still permit bonfires and fire pits. Jealous!

Here’s a short list of some of the state parks and beaches in Oregon that allow fire pits. Make sure you call them ahead of time to double-check, as laws do change.

Cape Blanco State Park

Sunset Bay State Park

Cannon Beach

Nhealem Bay State Park

Sand Beach

Cannon Beach, Oregon

Photos: Clinton Steeds, semarr

Top Five Places for Winter Surfing (Coastal Living)

Black's Beach in San Diego

Those of us who haven’t yet learned how to surf (like me) often think that the best time of year to surf is summer. For me, part of the problem stems from the movie The Endless Summer that I must have watched about fifty times as a kid. As it turns out, though, summer is often the best time to go surfing in most of the world. In places like Hawaii and California, that’s from November till March, when the storms are more intense and the waves much larger. No wet suits are required in Hawaii, but you’d better put one on in winter in California!

Coastal Living put out a short list of the best winter surfing spots, and I was surprised to see that I was very familiar with two of them and I’d heard a lot about a third. I’ve from San Diego, and I’ve watched the surfers on Black’s Beach many a time. Man, the waves here are huge! The beach at Oceanside Harbor is indeed super wide, and the surfing competitions there are something to see. They happen in summer and in winter, but in winter the competitions are entered only by seasoned pros — you’ll understand why when you see the size of the waves. I would love to visit Hanalei Bay sometime. A friend who went there said she tried surfing for the first time and she said it was amazing, though a lot harder than it looked.

The winter surf season is coming up. Maybe it’s time to take a lesson, put on a wet suit and try something new!

Photo: Edgephotos78

Atlantic Beach, Florida Finally Approves New Dog Park

Playing Pooches at La Playa

About two weeks ago, the City Commission of Atlantic Beach finally approved plans for a dog park. The funny thing about this is that dog owners have been using this park for months now already. The dog park should be fully functional (and legal) by the end of November.

The fact that residents have been using this dog park already for some time now shows just how much dog parks are now in demand, including those at the beach.  Beaches should provide areas that can be enjoyed by all, including our furry four-legged friends. It doesn’t have to be a huge area, and obviously it has to be sanitary, but offering dog parks at beaches is a wonderful way to encourage communities to enjoy their beaches even more. My dog loves to dig in sand, and it’s hilarious to watch!

Florida has some fantastic dog parks at the beach. Hopefully more are to come!

Photo: Mike Baird

It’s Warming Up on Australia’s Beaches

Here in the Northern Hemisphere, most of us have stored away our summer clothes for good (unless you live in ridiculous Southern California — last week was very warm.) However, in the Southern Hemisphere, the weather is now very late Spring, which means that beach season is right around the corner. Admittedly, Australia is a bit far for most to go just to enjoy beach weather year-round, but the steadily slowing down economy means that great fares can still be found.

Need some more convincing? Step 1: Take a look out your window. Step 2: Look at this picture:

Noosa Beach in Queensland, Australia

That’s Noosa Beach, in Queensland. Gorgeous, right? Australia doesn’t have too many beaches that face North, also called the Sunshine Coast, and this is one of them. Great swimming and snorkeling year-round.

Or how about this one?

Whitehaven Beach, Australia

Definitely not a place I’d want to spend my winters! Just kidding. Look how clear and inviting that water is. And that sand…I can almost hear the lapping waves.

One last one to help convince yourself you need to take a trip to Australia (take me with you):

Kirra Beach, Queensland

Well hello, beautiful. How have I not met you before? Kirra Beach is now on my bucket list.

Photo: Kevgibbo, kevgibbo, kevwhelen

Storms rage

Safe and sound, a Seal pup on the Farnes
Grey Seal pup on Brownsman
Woodcock - one of several moving through today
Tuesday 9th November comments: Its been an epic day as the storm raged and the sea boiled, whilst the warden team stood back and admired the chaos around them. The North Sea is the last place anything or anyone wants to be at this moment in time and for those newly born Seal pups, they must wonder what kind of crazy world they have been born into. Its a fact of nature and the brutal realism of the Farnes, but not all will make it but we'll not know the extent of the damage until we return to the colonies, but that may be some time....the gales continue....
On a positive note, passage of seabirds kept us entertained with good numbers of Little Auks alongside a few other noticeable highlights, including a returning wintering Black Guillemot and our first Glaucous Gull of the autumn. However the star bird of the day was a little Siberian waif, a Pallas's Warbler, which graced Inner Farne. the bird, found early in the morning, is our second of the year and 17th ever.
Tuesday 9th November highlights: Little Auk 1,731 south, Great Northern Diver 2N, Red-necked Grebe, Sooty Shearwater 4N, Common Scoter 226N, Velvet Scoter 8N, Scaup 8N, Long-tailed Duck 20N, Tufted Duck 1N, Goldeneye 5N, Goosander 1N, Red-breasted Merganser 3N, Great Skua 5N, Arctic Skua 1N, Little Gull 1 south, Glaucous Gull immature, Black Guillemot 1N, Merlin 2, Peregrine 2, Woodcock 7, Chiffchaff 2, Pallas's Warbler 1 on Inner Farne all day – our second this year! and Common Redpoll 2
Monday 8th November highlights: Long-tailed Skua 1 juvenile north (a late individual), Little Auk 6N, 13S, Goldeneye 15N, Long-tailed Duck 14N, Woodcock 7 and Jack Snipe.

Fright night…

Staple Island with a difference... (Graeme Duncan)
Keeping pup safe - a mother on Brownsman with Longstone in background (Graeme Duncan)

Monday 8th November comments: If you've seen the forecast, you know what is happening. For those who haven't, look away. Its fright night.
Its storm season and this one is brutal and it couldn't be happening at a worse time. The wind cranked up to 'storm force' overnight from the south-east and by dawn, the sea was raging. Mother Nature was moving through the gears and the Farnes were feeling the full affect. The storm raged all day and the forecast isn't pretty. The radio crackled into life as darkness fell...
"Forth, Tyne, Dogger, Fisher, German Bight, Humber, Thames, Dover; easterly backing northeasterly 6 to gale 8, perhaps severe gale 9 later. Rough or very rough, but high for a time. Rain or squally showers"
I'm not sure what 'high' means, but it doesn't sound good. We're in for a rough ride this week, there is no doubting that. As for the Seal pups, well, we've got trouble ahead....