Linaclotide for treatment of constipation – minimally absorbed peptide agonist of guanylate cyclase C receptor

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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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Tinnitus is perception of sound where there is none

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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."

Early in his career, without protection for his ears, the loud noise began to follow Ulrich off-stage. "It's this constant ringing in the ears," Ulrich said. "It never sort of goes away. It never just stops." This is a classic description of tinnitus, a perception of sound where there is none (phantom ear sounds).
The military is generating a tremendous number of tinnitus patients, according to a recent CNN report on the problem.

Tinnitus differential diagnosis: Q SALAMI mnemonic

Quinidine

Salicylates (aspirin)
Aminoglycoside antibiotics (ABx)
Labyrinthitis
Acoustic neuroma, CN VIII
Meniere’s disease
Increased blood pressure (BP) (HTN)

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A blog can help your career – and even if it doesn’t, it’s still good for you

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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.

Social media use allows you to focus your connections on other top performers, since blogging about career topics probably self-selects for engaged and motivated people.

Social media in medicine: How to be a Twitter superstar and help your patients and your practice

The key concept is TIC, Two Interlocking Cycles:

- Cycle of Patient Education
- Cycle of Online Information and Physician Education

The two cycles work together as two interlocking cogwheels (TIC).

Cycle of Patient Education (click here to enlarge the image). An editable copy for your presentation is available at Google Docs.

Cycle of Online Information and Physician Education (click here to enlarge the image). An editable copy for your presentation is available at Google Docs. Feel free to use the images in your own presentations with credit to AllergyCases.org.

References:

Blog your way to a better career. CNN.

Social media in medicine: How to be a Twitter superstar and help your patients and your practice

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Holiday time can be really stressful for patients with eating disorders – here is what to do

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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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"Family practitioners in the US are facing extinction. In their place must come nurse-practitioners" – The Lancet

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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.

Comments from Twitter:

@scanman: Looks like doctors will be an endangered genus in the US within this century
@MGastorf: so disagree. I know that is being pushed but I can provide far more complete care than nurse practitioner.
@davisliumd: Umm, No -> RT @DrVes Family practitioners in the US are facing extinction. In their place must come nurse-practitioners
@davisliumd: Agree -> RT @drves: @davisliumd that was actually a quote from The Lancet, not my opinion: j.mp/w33Kvq.

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DRACO drug effective against most viruses (Double-stranded RNA Activated Caspase Oligomerizer)

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"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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A doctor admits: "I love to blog but I still don’t really know why"

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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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Library of the future – the new UChicago library has a stunning design and functionality

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The University of Chicago’s new Mansueto Library is a futuristic bubble of a building that uses an automated retrieval systems that holds the books in steel cases 50 feet below ground.

While many academic libraries are digitizing and moving holdings off site, Manseuto is the largest and latest of about 24 libraries that use the system.

The $81 million Mansueto library (Mr. Mansueto founded Morningstar stock info service) has capacity for 3.5 million volumes.

The Mansueto library is also focused on digitizing its collection and has a lab for both digitization and conservation:

- it mends paper and rebinds the university’s books — some of them papyrus
- it also scans books for its partner, Google Books

It takes 5 minutes for a student to get a book after the request is placed electronically:

- 5 cranes run along parallel tracks; one is activated and locates materials using bar codes

- the crane removes one of the 24,000 containers, each weighing up to 200 pounds and transports it to an elevator, which lifts it to a librarian's desk

Some students apparently like the new library so much that they record poetic videos of "Rain in the Mansueto": "A quick capture of what I think was the first rain storm for the new Mansueto Library at the University of Chicago. My phone's mic really couldn't do justice to the sound, but it was a pretty exciting deep almost-rumble. You also can't capture the immersive fish-bowl-ness of it; it really is all around you. I can't wait for a storm during the day... or a blizzard."

References:

The Bibliotech: Library of the Future, Now. NYTimes.

The Joe and Rika Mansueto Library

Building the Joe and Rika Mansueto Library (video)

The loss of the centuries-old idea of a library building as the place to go to read and to look for information. Johns Hopkins Medical Library Is Closing Its Doors to Patrons and Moving to Digital Model (http://goo.gl/BWjjO and http://goo.gl/KN55o). According to the article, Johns Hopkins will transition the current medical librarians to "informaticians" embedded with the clinical teams.

Disclaimer: I am an Allergist/Immunologist and Assistant Professor of Medicine and Pediatrics at the University of Chicago.

Comments from Twitter:

@aptronym: Very impressive but what happens if there's a power outage, eh?
@BiteTheDust: they provide long ladders?
@DrVes: power outage at University of Chicago's Mansueto Library: http://t.co/fHbuIf2A
@aptronym: Ha! Two weeks after opening and a power outage meant #nobooksforanyone. I always ponder the effects of outages.

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