Brain freeze, senior moment or just exhaustion – CNN video

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From CBS News:

A 2006 study questioned the acceptability of minor episodic memory loss in older adults as normal. Episodic memory loss includes things such as forgetting the name of a new acquaintance, a recent conversation, or an upcoming appointment.

People commonly undergo an age-related slowing of the ability to retrieve information. They might forget where they put their keys, but they usually remember eventually. But when Alzheimer's is involved, new information is never properly stored, meaning the affected person never learned it well enough to be able to retrieve it.

Related:
Senior Moments: Signs Of Alzheimer's? CBS News.
Memory problems not a normal sign of aging: study http://goo.gl/xb9M

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How to identify medical students at risk of subsequent misconduct?

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This small BMJ study suggests the following risk factors for subsequent professional misconduct:

- male sex
- lower socioeconomic background
- early academic difficulties at medical school

59 doctors who had graduated from 8 medical schools in the United Kingdom in 1958-97 and had a proved finding of serious professional misconduct in 1999-2004 (cases) and 236 controls (four for each case) were included in the study.
The findings are preliminary and should be interpreted with caution. Most doctors with risk factors will not come before disciplinary panels.
References:
Image source: OpenClipArt.org (public domain).

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For people with congestive heart failure, a hot dog can trigger a trip to the hospital due to excessive salt

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The average daily salt intake in America is one and 1/2 teaspoon a day. This is 3,400 milligrams of sodium a day, or 1,100 milligrams more then the recommended maximum.

For people with congestive heart failure, a salty hot dog can trigger a trip to the hospital.

The experts say the new target for sodium intake should be set at 1,500 milligrams daily.

In a previous study, reducing dietary salt by 3 gm per day (1200 mg of sodium per day) was projected to reduce the annual number of new cases of coronary heart disease by 60,000 to 120,000, stroke by 32,000 to 66,000, and myocardial infarction by 54,000 to 99,000 and to reduce the annual number of deaths from any cause by 44,000 to 92,000. Such an intervention would be more cost-effective than using medications to lower blood pressure in all persons with hypertension.
77% of the salt in the American diet comes from processed food. Only 6% is shaken out at the table, and only 5% is sprinkled during cooking.
Once people cut back on salt -- whether or not they know they are doing it -- they begin to prefer less salt in their food. This happens in a matter of weeks.
For example, alarmed by high death rates from strokes, Portugal plans to decrease salt in bread, blamed for high blood pressure. Portugal has one of the highest mortality rates from strokes in Europe - double that in Spain and 3 times that in France. http://is.gd/ndNv
The daily salt intake in Portugal is a staggering 12.3 grams (ranging from 5.2 to 24.8 gm) http://is.gd/ndQq

References:
Americans Need Help Shaking The Salt Habit - Shots - NPR Health News Blog.

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Michael Douglas on Having Throat Cancer – Late Show with David Letterman (video)

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Oropharyngeal cancer is increasing at a "dramatic" rate, particularly in the male population http://goo.gl/JAko

Related:
Michael Douglas Has Stage IV Throat Cancer; Experts Weigh In. WebMD.
Catherine Zeta-Jones's fury at the doctors who missed her husband Michael Douglas's throat cancer. Daily Mail.

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When was the earliest journal club?

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The earliest references to journal clubs are in the memoirs and letters of Sir James Paget, a British surgeon, who described a group at St. Bartholomew’s Hospital in London in the mid-1800s as “a kind of club … a small room over a baker’s shop near the Hospital-gate where we could sit and read the journals.”

Sir William Osler established the first formal medical journal club at McGill University in Montreal in 1875. The original purpose of Osler’s journal club was “for the purchase and distribution of periodicals to which he could ill afford to subscribe” (see the excerpts from Google Books below).

References:
Journal clubs as a trigger for ’socializing’. The Search Principle blog.

Comments from Google Buzz:

Laika Spoetnik - Besides the point, but I have good memories of St Bartolomews. Here I learned direct sequencing and did part of my experiments. Very old building btw.

Aidan Finley - the father of Stephen Paget of "seed and soil" hypothesis.

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Doctors blends cardiology and country music

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Listen to the Doctor: Cleve Francis, cardiologist and country singer.

Dr. Francis, who recently turned 65, is a genteel singer of country and pop songs. He favors vintage ballads.

A man inching up the line in a walker can't believe it. "You want his autograph? I get it on a prescription every three weeks," he says.

References:

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Cognitive behavioural treatment may work for low-back pain

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Low-back pain is a common and costly problem. This study estimated the effectiveness of a group cognitive behavioural intervention in addition to best practice advice in people with low-back pain in primary care.

Over 1 year, the cognitive behavioural intervention had a sustained effect on troublesome subacute and chronic low-back pain at a low cost to the health-care provider.

References:

Image source: Different regions (curvatures) of the vertebral column, Wikipedia, public domain.

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Women in US academic medicine earn $13,000 less than male peers

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A survey of 3,000 faculty members at the top 50 US medical schools has shown that women members earned $13,000 less than their male counterparts with the equivalent career position and professional activity.

There were no obvious reasons for the difference.

According to the study authors, "despite increased national attention to gender inequalities in salary, women in the life sciences at all academic ranks, both PhDs and MDs, continued in 2007 to receive lower annual salaries than did their male counterparts."

References:
Image source: OpenClipArt.org, public domain.

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Gene test decreases warfarin-related hospitalizations by 28%

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Patients who received a test of two genes connected to warfarin sensitivity were 28 percent less likely to be hospitalized for a bleeding episode or blood clot than those whose safe and effective warfarin dosing was determined by traditional trial and error method.

The genetic tests, which are easily done with a cheek swab or blood sample, need only be performed once ever for each patient and cost somewhere between $200 and $400 - far less than even a brief hospital stay.

Warfarin Sensitivity Genotype Test - Mayo Clinic Video.

References:
Gene test can cut warfarin hospitalizations | Reuters.

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Alcohol consumption and raised body mass index (BMI) act together to increase risk of liver disease

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Drinkers of 15 or more units per week in any BMI category and obese drinkers had raised relative rates for all definitions of liver disease, compared with underweight/normal weight non-drinkers.

The relative excess risk due to interaction between BMI and alcohol consumption was 5.58.

Raised BMI and alcohol consumption are both related to liver disease, with evidence of a supra-additive interaction between the two.

The occurrence of both factors in the same populations should inform health promotion and public health policies.

References:

Image source: Wikipedia, public domain.

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Episodic hypertension is a strong predictor of stroke risk

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The mechanisms by which hypertension causes vascular events are unclear. Guidelines for diagnosis and treatment focus only on underlying mean blood pressure.

In each TIA cohort in this study, visit-to-visit variability in systolic blood pressure (SBP) was a strong predictor of subsequent stroke (eg, top-decile hazard ratio [HR] for SBP 6·22), independent of mean SBP.

Maximum SBP reached was also a strong predictor of stroke (HR 15).

Visit-to-visit variability in SBP on treatment was also a strong predictor of stroke and coronary events (top-decile HR for stroke: 3·25) independent of mean SBP.

Visit-to-visit variability in SBP and maximum SBP are strong predictors of stroke, independent of mean SBP. Increased residual variability in SBP in patients with treated hypertension is associated with a high risk of vascular events.

References:

Image source: BP device used for measuring arterial pressure. Wikipedia, GNU Free Documentation License.

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Ethosuximide and valproic acid are more effective than lamotrigine in childhood absence epilepsy

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Childhood absence epilepsy, the most common pediatric epilepsy syndrome, is usually treated with ethosuximide, valproic acid, or lamotrigine.

Ethosuximide and valproic acid are more effective than lamotrigine in the treatment of childhood absence epilepsy. Ethosuximide is associated with fewer adverse attentional effects.

References:
Ethosuximide, Valproic Acid, and Lamotrigine in Childhood Absence Epilepsy. NEJM, 2010.

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The Beautiful Game can kill you: soccer/football managers and viewers at high risk for heart disease

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Almost half of England's football managers have "significant" heart problems and their life-consuming, high-pressure jobs are a "recipe for potential disaster" according to cardiovascular experts. This is hardly surprising considering the range of emotions demonstrated by Fabio Capello (age 64), the current manager of the England national football team, in the video below:

A stressful soccer match affects everybody involved including the spectators.

The Fédération Internationale de Football Association (FIFA) World Cup, held in Germany from June 9 to July 9, 2006, provided an opportunity to examine the relation between emotional stress and the incidence of cardiovascular events. Cardiovascular events occurring in 4,000 patients in the greater Munich area were prospectively assessed by emergency physicians during the World Cup.

On days of matches involving the German team, the incidence of cardiac emergencies was 2.66 times that during the control period. For men, the incidence was 3.26 times that during the control period, and for women, it was 1.82 times that during the control period.

On those days, the highest average incidence of events was observed during the first 2 hours after the beginning of each match.

Viewing a stressful soccer match more than doubles the risk of an acute cardiovascular event. In view of this excess risk, particularly in men with known coronary heart disease, preventive measures are urgently needed.

References:
Nearly half of football managers suffer serious heart problems. Independent, 2005.
Cardiovascular events during World Cup soccer. N Engl J Med. 2008 Jan 31;358(5):475-83.

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New Developments in Treatment of Diabetes Type 2

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From The Lancet theme issue on diabetes:

Diabetes confers a two-fold excess risk for a wide range of vascular diseases - heart disease and stroke. Adjusted HRs with diabetes were: 2·00 for coronary heart disease; 2·27 for ischaemic stroke; 1·56 for haemorrhagic stroke; 1·84 for unclassified stroke; and 1·73 for the aggregate of other vascular deaths. http://goo.gl/ucF0
Increased occurrence of cough and change in pulmonary function in the group receiving inhaled insulin - Lancet http://goo.gl/ve3G
Once weekly exenatide is an important therapeutic option for patients with type 2 diabetes http://goo.gl/UL3e
Dapagliflozin, sodium-glucose cotransporter-2 inhibitor (SGLT2 inhibitor), provides a new therapeutic option for type 2 diabetes http://goo.gl/FqIM

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Oral ivermectin superior to topical malathion lotion in eradicating difficult-to-treat head-lice infestation

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Head-lice infestation is prevalent worldwide, especially in children 3 to 11 years old.

Topical insecticides (i.e., pyrethroids and malathion) used as a lotion, applied twice at an interval of 7 to 11 days, are typically used for treatment. Resistance of lice to insecticides, particularly pyrethroids, results in treatment failure.

For difficult-to-treat head-lice infestation, oral ivermectin, given twice at a 7-day interval, had superior efficacy as compared with topical 0.5% malathion lotion, a finding that suggests that it could be an alternative treatment.

References:
Oral Ivermectin versus Malathion Lotion for Difficult-to-Treat Head Lice. NEJM, 2010.

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Norepinephrine Causes Fewer Adverse Events Than Dopamine in the Treatment of Shock

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Both dopamine and norepinephrine (Levophed) are recommended as first-line vasopressor agents in the treatment of shock. There is a continuing controversy about whether one agent is superior to the other.

Although there was no significant difference in the rate of death between patients with shock who were treated with dopamine as the first-line vasopressor agent and those who were treated with norepinephrine, the use of dopamine was associated with a greater number of adverse events.

References:

Comparison of Dopamine and Norepinephrine in the Treatment of Shock. NEJM, 2010.
Image source: Wikipedia, public domain.

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The Ultimate Social Media in Medicine Presentation (182 Slides)

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The author, Maged Boulos, has published widely on social media uses in medicine and health informatics. He features this website in the presentation as one of the examples of medical blogs but I have had no influence on the inclusion. The link is via Berci.

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P.S.A. testing can’t detect prostate cancer, says its discoverer

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Richard J. Ablin in the NYTimes:

"Approved by the Food and Drug Administration in 1994, the P.S.A. test’s popularity has led to a hugely expensive public health disaster. It’s an issue I am painfully familiar with — I discovered P.S.A. in 1970.

The annual bill for P.S.A. screening is at least $3 billion, with much of it paid for by Medicare and the Veterans Administration.

As I’ve been trying to make clear for many years now, P.S.A. testing can’t detect prostate cancer and, more important, it can’t distinguish between the two types of prostate cancer — the one that will kill you and the one that won’t."

References:
The Great Prostate Mistake. NYTimes.
Image source: Wikipedia, public domain.

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AccessDermatology – free multimedia educational site by Reuters

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According to the website, AccessDermatology is a multimedia educational platform aimed at delivering continuing education to dermatology professionals that follows a yearly academic syllabus.

The Scientific Skills section includes:

- Webcasts of congress and other scientific meetings sessions

- Image Bank - a library of images on several disease areas with an alphabetical search engine

- Breaking News - drug development, diagnosis and treatment, congress highlights, symposia webcasts, keynote speaker interviews

- Core Papers - series of articles on disease, treatment and novel therapeutic approaches

- Clinical Trials - a guide to key clinical trials in dermatology

This is the link to the Advisory Board of the website. The project is sponsored by Prous Science S.A.U., a part of Thomson Reuters.

The access to most of the resources requires free registration.

References:
Dermatology – breaking news
Clinical Trials in Dermatology
Dermatology Full Congress Reports

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