Wendy Sue Swanson, who blogs as Seattle Mama Doc, is a pediatrician in Seattle who recently gave a keynote at the Swedish Medical Center as part of their 2010 Health Care Symposium. See for yourself why doctors must use social media to stay uptodate and educate the public:
Link via KevinMD
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Diabetic retinopathy is a common microvascular complication of diabetes, and remains the leading cause of preventable blindness in working-aged people. It is identified in a third of people with diabetes and associated with increased risk of life-threatening systemic vascular complications, including stroke, coronary heart disease, and heart failure.
References:
Diabetic retinopathy [Seminar]. Ning Cheung, Paul Mitchell, Tien Yin Wong. Lancet, 2010.
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Distracted driving has gained much attention lately because of the inflated crash risk posed by drivers using cellphones to talk and text. But phones aren't just distracting drivers; they make pedestrians inattentive too.
Distracted walking combines a pedestrian, an electronic device and an unseen crack in the sidewalk, the pole of a stop sign, a toy left on the living room floor or a parked (or sometimes moving) car.
There are plenty of examples of the dangers of distracted walking in the two videos embedded in this page. These are also examples of "distracted life" in general:
References:
Forget Gum. Walking and Using Phone Is Risky. NYTimes.
Video: Stop texting while driving. Terrifying. All drivers should watch this.
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Dr. Mike Roizen answers the question - What can you do to burm calories at work? Stay awake, have walking meetings, and go to the furthest bathroom to get some extra steps. Visit http://www.letsmoveit.org - Cleveland Clinic | September 23, 2010.
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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 rheumatology:
Lower dose colchicine for treatment of acute gout
A lower dose colchicine may have similar efficacy and fewer side effects than a traditional, higher dose regimen for patients with acute gouty arthritis. Colchicine given as 1.2 mg followed by one additional dose of 0.6 mg an hour later (total dose 1.8 mg) worked similarly to 1.2 mg followed by 0.6 mg every hour for up to six hours.
Nocturnal leg cramps
Quinine is no longer recommended due to the potential for serious side effects, drug interactions, and only modest benefit. Calcium channel blockers and vitamin B complex have limited effect.
Anti-CCP antibody testing in RA
Testing for anti-citrullinated peptide/protein antibodies (ACPA) has become common in the evaluation of patients for rheumatoid arthritis (RA). Second generation anti-cyclic citrullinated peptide (anti-CCP) antibodies had the highest utility, with higher specificity and similar sensitivity to rheumatoid factor (RF). Both RF and anti-CCP testing should be performed in patients suspected of having RA.
Golimumab for RA
Golimumab, a neutralizing human anti-tumor necrosis factor alpha monoclonal antibody, is administered subcutaneously once monthly for the treatment of rheumatoid arthritis, psoriatic arthritis and ankylosing spondylitis.
Rituximab for primary Sjogren's syndrome
Rituximab, which is used for the treatment of B cell lymphomas, rheumatoid arthritis, and other autoimmune and lymphoproliferative disorders, is a chimeric monoclonal antibody directed against the B cell antigen CD20. One course of rituximab treatment resulted in significant improvement in patients with Sjogren's syndrome (SS).
References:
What's new in rheumatology. UpToDate.
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"The Dentist Of Jaipur" - "New teeth, dentures or extractions not a problem at all for Pushkar and his old master Pyara Singh. They treat their patients in front of the train station of Jaipur, on the sidewalk under the pure sky. The short film of filmmaker Falk Peplinski, who has been living in India for three years, is an ironical image-clip for a dentist of its own kind and therefore a homage to the incredibleness of the Indian everyday life. The film had a big success at fim festivals in 2006 and 2007. India, 2006, director & editor: Falk Peplinski, photography: Karsten Hohmann, sound: Valson P.D., producer: Meera Menezes."
Warning: The video contains images that some viewers may find disturbing.
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Dr. Alfredo Quiñones-Hinojosa is the Director of the Brain Tumor Stem Cell Laboratory at Johns Hopkins University School of Medicine.
Twenty years ago, Dr. Quinones-Hinojosa hopped a border fence from Mexico into the United States and became a migrant farm worker, living in the fields in a broken-down camper he bought for $300.
When told he would probably be a farm worker for the rest of his life, he signed up for English classes at a community college, where one of his teachers encouraged him to apply to UC-Berkeley. There, he developed a passion for science, and showed remarkable aptitude.
He went on to Harvard Medical School and graduated with honors, followed by a residency in neurosurgery at UC-San Francisco, where he completed a postdoctoral fellowship in developmental and stem cell biology.
References:
Dr. Alfredo Quinones-Hinojosa. BigThink.com.
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Telomeres are essential to preserve the integrity of the genome. Critically short telomeres lead to replicative cell senescence and chromosomal instability and may thereby increase cancer risk.
Leukocyte telomere length was measured by quantitative polymerase chain reaction in 787 participants free of cancer at baseline in 1995 from a prospective, population-based study in Italy. The follow-up period was 10 years.
11.7% of participants developed cancer (incidence rate, 13.3 per 1000 person-years).
References:
Telomere Length and Risk of Incident Cancer and Cancer Mortality. Peter Willeit, MD; Johann Willeit, MD; Agnes Mayr, MD; Siegfried Weger, MD; Friedrich Oberhollenzer, MD; Anita Brandstätter, PhD; Florian Kronenberg, MD; Stefan Kiechl, MD. JAMA. 2010;304(1):69-75.
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Hugh Jackman shows his support for R U OK?Day, a national day of action that aims to prevent suicide by encouraging people to connect with colleagues, friends and loved ones and ask: "Are you OK?".
Suicide prevention in Australia: "A conversation could save a life", link via @dreamingspires.
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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 hematology:
Asthma
When evaluating patients for occupational asthma, sputum eosinophil counts at 7 and 24 hours after specific inhalation challenge have a greater sensitivity and positive predictive value than exhaled nitric oxide (eNO).
Critical care
Proton pump inhibitors (PPIs) may be slightly more effective than histamine-2 (H2) blockers at preventing gastrointestinal (GI) bleeding in critically ill patients. However, the difference is small if real.
Idiopathic pulmonary fibrosis
Sildenafil, tyrosine kinase inhibitor imatinib, and pirfenidone, an anti-fibrotic agent, were each no more effective than placebo for treatment of idiopathic pulmonary fibrosis.
Pleural effusion
Using ultrasonography to identify a site for diagnostic thoracentesis is associated with significantly lower risk of pneumothorax, than using the physical exam for site selection.
Pulmonary embolism
PE is frequently asymptomatic. Among 5233 patients with a DVT, 32 percent had asymptomatic PE.
References:
What's new in pulmonary, critical care, and sleep medicine. UpToDate.
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Dyslipidemia increases the risk of atherosclerotic cardiovascular disease and is incompletely reversed by statin therapy alone in many patients. Thyroid hormones lower levels of serum low-density lipoprotein (LDL) cholesterol and has other potentially favorable actions on lipoprotein metabolism. Consequently, thyromimetic drugs hold promise as lipid-lowering agents if adverse effects can be avoided.
In this 12-week trial, the thyroid hormone analogue eprotirome was associated with decreases in levels of atherogenic lipoproteins in patients receiving treatment with statins.
References:
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The satirical $25 million ad campaign is launched by a new alliance of carrot growers - “a bunch of carrot farmers” - and is designed to reposition baby carrots as snacks with sass.
See the rest of the ad campaign videos on YouTube.
References:
Baby carrots: 'Eat 'em like junk food'. Chicago Tribune.
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Monarchs and their heirs are not always noted for their rational medical advice. But James VI of Scotland, who became James I of England in 1603, was different.
Published anonymously in 1604 but immediately credited to the king, A Counterblaste to Tobacco flew in the face of prevailing medical opinion by outlining some of the chief health risks of smoking more than three centuries before scientists made the connection.
Possibly the first official antismoking campaign, the royal pamphlet highlighted cost and passive smoking as two of the most powerful arguments against tobacco, while it lamented that addiction, peer pressure, and fashion were among the most difficult obstacles to overcome.
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As many as 22% of people with type 2 diabetes could have vitamin B-12 deficiency.
This BMJ study evaluated the effects of metformin on the incidence of vitamin B-12 deficiency (lower than 150 pmol/l), low concentrations of vitamin B-12 (150-220 pmol/l), and folate and homocysteine concentrations in patients with type 2 diabetes receiving treatment with insulin.
Compared with placebo, metformin treatment was associated with a decrease in vitamin B-12 concentration of -19%.
The absolute risk of vitamin B-12 deficiency (lower than 150 pmol/l) at study end was 7.2 percentage points higher in the metformin group than in the placebo group with a number needed to harm of 13.8 per 4.3 years.
Long term treatment with metformin may increase the risk of vitamin B-12 deficiency, which results in raised homocysteine concentrations. Vitamin B-12 deficiency is preventable; therefore, regular measurement of vitamin B-12 concentrations during long term metformin treatment should be considered.
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Dr. Michael Roizen, Cleveland Clinic Chief Wellness Officer, answers the question "How much exercise is enough?"
Three parts of exercise have been shown to be beneficial to health:
1. Moving the equivalent to 10,000 steps a day.
2. Resistance exercise for 30 minutes a week.
3. 20 minutes of cardiovascular exercise.
The videos are part of the Cleveland Clinic Let's Move It! program. See the CEO promoting it:
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Human subjects are paid in Phase 1 clinical trials to test the toxicity levels of new drugs. Some make a profession out of it, but researchers worry about health risks.
References:
Clinical Trials: Professional Guinea Pigs. TIME.
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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 hematology:
Transplantation in aplastic anemia
In patients with severe aplastic anemia over the age of 40 who received allogeneic hematopoietic cell transplantation from an HLA-identical sibling, overall survival was 65 percent.
Improved survival when rituximab is added to fludarabine plus cyclophosphamide in CLL
There were higher response rates and survival with six courses of FCR (fludarabine, cyclophosphamide, and rituximab) when compared with six courses of FC (fludarabine, cyclophosphamide).
Second generation tyrosine kinase inhibitors (TKIs) for CML
Trials comparing dasatinib or nilotinib to imatinib for chronic myeloid leukemia (CML) demonstrated faster and deeper responses with these second generation tyrosine kinase inhibitors.
Improved understanding of pathobiology of multiple myeloma
Virtually all multiple myeloma (MM) cases are preceded by a premalignant plasma cell proliferative disorder known as monoclonal gammopathy of undetermined significance (MGUS). The pathobiology of myeloma as a two-step process - first there is the establishment of a limited stage of clonal proliferation (MGUS); then there is progression of MGUS to MM.
Denileukin diftitox superior to placebo for relapsed mycosis fungoides
There were better response rates with the recombinant interleukin-2-diphtheria toxin fusion protein denileukin diftitox used for therapy of mycosis fungoides and Sezary syndrome.
Survival in sickle cell disease
The estimated survival at 18 years is now 94 percent for those with HbSS or HbS/beta(0) thalassemia and 98 percent for those with HbSC or HbS/beta(+) thalassemia.
References:
What's new in hematology. UpToDate.
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From NBC Chicago:
Neurologist John Wapham lives in downtown Chicago, but he can see patients anywhere in the world ... from his apartment. And he does. He's an expert in treating strokes, and with the help of a robot and a broadband connection, he's able to be at a patient's bedside instantly.
View more news videos at: http://www.nbcchicago.com/video.
"This brings specialists to to the remotest parts of the country, and the world. I've popped open my laptop on Michigan avenue and treated patients in another state, " he says. And in the not too distant future, these robot doctors could be on the battlefield, or at the scene of a horrible car accident: instantly.
Some critics fear that telemedicine may not be accurate enough. For example, the accuracy of teledermatology was inferior to real-life clinic dermatology for melanoma diagnosis in a recent study: http://bit.ly/8A4oiu
References:
Robot Doctors: Future of Medicine? NBC Chicago.
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Lipoprotein-associated phospholipase A2 (Lp-PLA2), an inflammatory enzyme expressed in atherosclerotic plaques, is a therapeutic target being assessed in trials of vascular disease prevention.
Lp-PLA2 activity and mass each show continuous associations with risk of coronary heart disease, similar in magnitude to that with non-HDL cholesterol or systolic blood pressure.
Lipoprotein structure (chylomicron). Image source: Wikipedia, GNU Free Documentation License.
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People who get less than 6 hours sleep per night had an increased risk of dying prematurely in a recent study. Those who slept for less than that amount of time were 12% more likely to die early, though researchers also found a link between sleeping more than 9 hours and premature death.
The study aggregated decade-long studies from around the world involving more than 1.3 million people and found "unequivocal evidence of the direct link" between lack of sleep and premature death.
Just one sleepless night can hamper the body's ability to use insulin to process sugar in the bloodstream. Insulin sensitivity is not fixed in healthy people, but depends on the duration of sleep in the preceding night.
"Society pushes us to sleep less and less," one of the study investigators said, adding that about 20% of the population in the United States and Britain sleeps less than 5 hours.
Adults typically need between 7 and 9 hours sleep a night. If you sleep little, you can develop diabetes, obesity, hypertension and high cholesterol.
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