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Portland Chiropractic Neurology - Video

From NHS Choices YouTube channel: Hirsutism causes excess hair growth in women, such as on the face and chest. An expert explains the causes or hirsutism, treatments such as hair-removal and cosmetic techniques, and where to go for help if you're worried about excess hair growth.

The Cleveland Clinic Journal of Medicine published an Update on the management of hirsutism in 2010:

References:

Update on the management of hirsutism. Cleveland Clinic Journal of Medicine June 2010 vol. 77 6 388-398.

A home hair removal laser device is available without prescription from Amazon.com (not a recommendation to buy any product, see the link below). A similar device is available from Costco.

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This BMJ study included 590 people aged 19-20 from a cohort of 4,500 residents of Zurich, Switzerland, interviewed 7 times across 30 years of follow-up.

The one-year prevalence of subtypes of headache were:

- 1% (female:male ratio of 2.8) for migraine with aura
- 11% (female:male ratio of 2.2) for migraine without aura
- 11% (female:male ratio of 1.2) for tension-type headache

The cumulative 30-year prevalence of headache subtypes were:

- 3% for migraine with aura
- 36% for migraine without aura
- 29% for tension-type headache

Despite the high prevalence of migraine without aura, most cases were transient and only 20% continued to have migraine for more than half of the follow-up period.

There was a substantial crossover among the subtypes and no specific pattern of progression.

The longitudinal overlap among subtypes of headache shows the developmental heterogeneity of headache syndromes.

References:

Magnitude, impact, and stability of primary headache subtypes: 30 year prospective Swiss cohort study. BMJ, 2011.

Image source: Openclipart.org, public domain.

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Highlights from the presentation of Dr Roswitha Goetze-Pelka at the 2011 Autoimmunity Congress Asia. She discusses the new data supporting Plato's observation that "the greatest mistake in the treatment of diseases is that there are physicians for the body, and physicians for the soul, although the two cannot be separated."

See more here:
Psychiatric and Neurologic comorbidities as systemic dysfunctions - Video

This summary is based on a recent BMJ review:

Acute altitude illnesses include:

- high altitude headache
- acute mountain sickness
- high altitude cerebral edema
- high altitude pulmonary edema

Typical scenarios in which such illness occurs include:

- a family trek to Everest base camp in Nepal (5,360 m)
- a fund raising climb of Mount Kilimanjaro (5,895 m), shown in the map below
- a tourist visit to Machu Picchu (2,430 m)

View Larger Map

High altitude headache and acute mountain sickness often occur a few hours after arrival at altitudes over 3,000 meters.

Occurrence of acute mountain sickness is reduced by slow ascent. Severity can be modified by prophylactic acetazolamide.

Mild to moderate acute mountain sickness usually resolves with:

- rest
- hydration
- halting ascent
- analgesics

Occasionally people with acute mountain sickness develop high altitude cerebral oedema with confusion, ataxia, persistent headache, and vomiting.

Severe acute mountain sickness and high altitude cerebral edema require urgent treatment with:

- oxygen if available
- dexamethasone
- possibly acetazolamide
- rapid descent

High altitude pulmonary edema is a rare but potentially life threatening condition that occurs 1-4 days after arrival at altitudes above 2,500 meters. Treatment includes oxygen if available, nifedipine, and rapid descent to lower altitude.

References:

Clinical Review: Acute altitude illnesses. BMJ 2011; 343:d4943 doi: 10.1136/bmj.d4943

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From the WSJ:

How patients feel they were treated has always colored their opinions of a hospital. Now, those feelings are being factored into how hospitals get paid.

The Cleveland Clinic CEO, Dr. Cosgrove, says that in his own days as a top cardiac surgeon, he focused so intently on reducing complications from cardiac procedures that he gave little thought to the feelings or experiences of patients.

Times have changed dramatically since then. The Cleveland Clinic has launched a program known as HEART - for hear the concern, empathize, apologize, respond and thank—that empowers employees to handle patient concerns from the moment they arise.

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CRI Canine Neurology Course - Video

Yes, this part had to be re-recorded, in case you couldn't tell from the play time and the choices already highlighted...the next 12 videos are completely blind!

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Let's Play Remember 11 (Blind) Part 16: Neurology Lesson - Video

Dr.

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Dr. Schottenstein - NY Spine Medicine - Schottenstein Pain and Neurology - Video

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Neurology at Metropolitan Veterinary Associates - Video

Linaclotide is a minimally absorbed peptide agonist of the guanylate cyclase C receptor. It consists of 14 amino acids. The sequence is:

H–Cys1–Cys2–Glu3–Tyr4–Cys5–Cys6–Asn7–Pro8–Ala9–Cys10–Thr11–Gly12–Cys13–Tyr14–OH

Two randomized, 12-week trials included 1,300 patients with chronic constipation (NEJM, 2011). Patients received either placebo or linaclotide once daily for 12 weeks.

The incidence of adverse events was similar among all study groups, with the exception of diarrhea, which led to discontinuation of treatment in 4.2% of patients in linaclotide groups.

Linaclotide reduced bowel and abdominal symptoms in patients with chronic constipation. Additional studies are needed to evaluate the potential long-term risks of linaclotide in chronic constipation.

References:

Two Randomized Trials of Linaclotide for Chronic Constipation. N Engl J Med 2011; 365:527-536August 11, 2011.

Image source: Colon (anatomy), Wikipedia, public domain.

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Just a few days ago, British newspapers reported that a rock fan committed suicide to relieve tinnitus that he had for 3 months after a supergroup's gig. Tinnitus is characterized as perception of sound where there is none. Read more about tinnitus in this blog post. The Cleveland Clinic Journal of Medicine recently published a review on Tinnitus: Patients do not have to ‘just live with it’ and Tinnitus relief: Suggestions for patients.

From NHS Choices YouTube channel: Tinnitus causes people to hear constant sounds in one ear, both ears or in their head. An audiologist explains the possible causes and effects it often has, such as stress and anxiety, plus how to deal with them. Ashleigh, who was diagnosed with tinnitus in 2005, describes how she copes with it.

Lars Ulrich, the drummer for the heavy metal band Metallica, also struggles with tinnitus and warns his fans that "once your hearing is gone, it's gone. I've been playing loud rock music for the better part of 35 years," said Ulrich, 46. "I never used to play with any kind of protection."

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From CNN:

There is strong evidence that people who use their blog as a career tool do better. In 2005, a Pew survey found that people who blog are generally higher earners. People who use social media end up finding jobs that are a better fit.

Changing your career and skipping entry-level positions can be easier if you have a blog.

Most importantly, a blog is a great platform for networking. Just look at this picture from the annual CME meeting Essentials of EM 2011.

A blog is a good way to meet other people who think like you do and who are in your field. It helps you to make real connections with them based on ideas and passions.

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From Mayo Clinic YouTube channel:

For people with eating disorders such as binge eating disorder, bulimia nervosa and anorexia nervosa, the holiday season can be a nightmare.

People with eating disorders usually begin to worry about food consumption at holiday gatherings weeks sometimes even months - before the event, says Leslie Sim, Ph.D., clinical director of the Mayo Clinic Eating Disorders Program. "It's really a stressful time because there are large amounts of food around."

Dr. Sim suggests a few tips to navigate through holiday gatherings:

- Have a plan. People with eating disorders should eat like they would on a normal day and not skip any meals. Make sure to eat breakfast, lunch, and a light snack in addition to the meal. People who starve themselves are more likely to skip out on the meal entirely or engage in binge eating.

- If family or friends know someone is struggling with an eating disorder, it's not a good idea to comment on their weight during a holiday gathering. Even a compliment can be taken the wrong way.

- If you're hosting a holiday gathering with plenty of food, don't take offense if someone doesn't eat.

- People with eating disorders should have a coping strategy if they begin to feel stressed during a gathering. Such tactics include deep breathing, meditation and talking to a close friend of family member.

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Topics: Vascular Neurology (Strokes), Lung Diseases, Cardiology

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Ask The Doctor: Vascular Neurology (Strokes), Lung Diseases, Cardiology (11/8/11) - Video

Neurology Residency Cedars-Sinai Medical Center

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Neurology Residency - Video

From the Lancet review of the University of Pennsylvania nursing school:

Family practitioners in the US are facing extinction. In their place must come nurse-practitioners. Nurses are better educated to navigate and refer patients to specialists. They don't have any illusions about managing complex illness. Their lower threshold for referral means less risk of missing diagnoses or delaying expert care.

This is one vision for nursing to be found at the University of Pennsylvania's extraordinary School of Nursing.

I'm not sure if this is the best model for primary care in the U.S. What do you think?

References:

Offline: Nursing, but not as you know it. The Lancet, Volume 378, Issue 9805, Page 1768, 19 November 2011.
Image source: OpenClipArt.org, public domain.

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cartoon of interaction between ER triage nurse and neurology resident

Excerpt from:
how to think like a neurology resident.mp4 - Video

"New drug could cure nearly any viral infection", proclaimed the media. The drug works by targeting a type of RNA (dsRNA) produced only in cells that have been infected by viruses. “In theory, it should work against all viruses."

Currently there are relatively few antiviral therapeutics, and most which do exist are highly pathogen-specific.

The MIT researchers developed a new broad-spectrum antiviral approach, called Double-stranded RNA (dsRNA) Activated Caspase Oligomerizer (DRACO).

DRACO selectively induces apoptosis in cells containing viral dsRNA, rapidly killing infected cells without harming uninfected cells.

The drugs were nontoxic to mammalian cells and effective against 15 different viruses, including dengue flavivirus, arenaviruses, bunyavirus, and H1N1 influenza.

DRACOs have the potential to be effective therapeutics or prophylactics for numerous clinical and priority viruses, due to:

- broad-spectrum sensitivity of the dsRNA detection domain
- potent activity of the apoptosis induction domain

NPR Video: How a Flu Virus Invades Your Body: "It starts very simply. A virus, just one, latches on to one of your cells and fools that cell into making lots more. Lots, lots more, like a million new viruses. This animation shows you how viruses trick healthy cells to join the dark side".

References:

New drug could cure nearly any viral infection. MIT News.

Rider TH, Zook CE, Boettcher TL, Wick ST, Pancoast JS, et al. (2011) Broad-Spectrum Antiviral Therapeutics. PLoS ONE 6(7): e22572. doi:10.1371/journal.pone.0022572

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From Mike Cadogan, the founder of one the most popular medical blogs Life in The Fast Lane, based in Australia:

I blog to vent, to educate, to converse, to cogitate, to archive thoughts and to stimulate discussion.

I love the concept of a launching a thought, an image, a moment… into the inferno of the blogosphere, and observing the response.

With the average blog-reader attention span being around 90 seconds, I find that most of my ‘good’ posts – thoroughly researched, with well constructed arguments and propositions… are lost on this ‘average‘ reader… Yet, strangely I feel better having taken the time to arrange my thoughts, review the evidence and archive the information.

The advent of Facebook and Twitter has changed the way readers comment and share, and in many cases the promoted discussion continues out-with the confines of the original medium…

I love to blog but I still don’t really know why…

My reply is here:

You blog because you have to, Mike. And we are lucky to have you as a writer.

I have more prosaic and simple reasons to keep several blogs focused on different aspects of clinical practice: internal medicine, allergy and immunology, pediatrics, and IT.

I simply blog as a way to keep track of the new developments in medicine that are relevant to my practice and patients. The blog is a digital notebook and an archive accessible from any place and device with an internet connection.

A lot of people find it useful and that's great but this is an added bonus. If I don't find a blog post interesting and useful, I don't hit the "publish" button. A custom-made Google search engine makes it all searchable in 0.2 seconds. It just works.

Quotes from an interview with Seth Godin and Tom Peters:

"Blogging is free. It doesn’t matter if anyone reads it. What matters is the humility that comes from writing it. What matters is the metacognition of thinking about what you’re going to say.

No single thing in the last 15 years professionally has been more important to my life than blogging. It has changed my life, it has changed my perspective, it has changed my intellectual outlook, it’s changed my emotional outlook.

And it’s free."

Comments from Google Plus:

Neil Mehta - Loved your poetic post. I attempted to reflect on this earlier this year and came up with some reasons http://blogedutech.blogspot.com/2011/05/reflections-on-why-do-i-blog.html but find that it does not come close to your beautiful prose. Thanks for sharing.

References:

Why I Blog?
Why I Blog: Andrew Sullivan from The Atlantic Shares His Thoughts on Blogging
Why Do I Blog?
Why blog? Notes from Dr. RW. A perfectly reasonable list. All doctors should consider blogging. It's do-it-yourself CME.

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