CasesBlog - Medical and Health Blog

Best Tweets - Selection of Twitter Favorites

noreply@blogger.com (Ves Dimov, M.D.) — Wed, 08 Feb 2012 05:48:00 PST

Because of a tendency for hands to be near mouths, we recommend #glutenfree hand lotions for celiacs.
— Celiac Disease Ctr (@CureCeliac) February 7, 2012

Btw, is it usual for the receptionist to read out the blood results of a patient in front of the entire waiting room? The poor man!
— richard horton (@richardhorton1) February 7, 2012

When the receptionist read out the cholesterol and blood glucose, the man asked: "Are they normal?" To which she said "Probably."
— richard horton (@richardhorton1) February 7, 2012

Researching a topic is much easier than writing about it...
— Dr. Ronan Kavanagh (@RonanTKavanagh) February 7, 2012

A new paper looks to decipher the ailments tied to eating gluten. More importantly, there's a journal called "Gut" on.wsj.com/AorvDJ
— UChicago Medicine (@UChicagoMed) February 7, 2012

Just did my first #rheumatology Skype consultation with a patient of mine who's temporarily in middle east. Went very well. #rheum
— Dr. Ronan Kavanagh (@RonanTKavanagh) February 3, 2012

Pt just told me she has full faith in me because she has read my blog.
— Bongi (@Bongi1) February 3, 2012

Wow. Crazy pressure! RT @Bongi1: Pt just told me she has full faith in me because she has read my blog.
— GruntDoc (@gruntdoc) February 3, 2012

The inclusion of a Twitter update (tweet) in Best Tweets - Selection of Twitter Favorites does not represent endorsement or agreement of any kind. If you are included in this post but you would like to have your tweet removed for any reason, please email me and will comply with your request the same day.

Drug abuse is changing fast: Old drugs are falling from favor, new ones are growing

noreply@blogger.com (Ves Dimov, M.D.) — Wed, 08 Feb 2012 18:12:37 PST

New psychoactive substances, mainly stimulants and cannabinoids from China sold on the internet, proliferate too quickly for anyone to keep track of them. Websites such as Erowid.org create lists of those drugs.

It is all part of the rapid diversification of recreational drugs, fuelled by chemical ingenuity and by new distribution possibilities opened up by the internet.

"Talk to Frank" is a British government-funded website for drug abuse prevention and treatment tips for the general public available at http://talktofrank.com

The "A to Z" list of substances explains appearance and use, effects, chances of getting hooked, health risks and the UK law. It also includes information on peer pressure, etc.

References:

Drug use and abuse. The Economist, 2011.

Comments from Facebook:

Pierrette Mimi Poinsett: And alcohol and tobacco remain the two most abused drugs eclipsing all the others combined.

Osteoarthritis at the base of the thumb has a 15-30% prevalence in adults

noreply@blogger.com (Ves Dimov, M.D.) — Mon, 06 Feb 2012 05:20:01 PST

What is it?

Patients with osteoarthritis of the thumb carpometacarpal joint, or base of the thumb, commonly seek help for their symptoms. Arthritis at the base of the thumb causes functional disability and pain, particularly with “pinching” actions.

A hand with arthritic changes. Image source: Cicadas, a Creative Commons license.

How common is osteoarthritis of the thumb?

The prevalence of this condition increases with age and is greatest in postmenopausal women. It ranges between 15% prevalence in adults in Finland and a 33% prevalence in postmenopausal women. This is likely to increase as populations age and people stay active for longer.

How to diagnose it?

Pain reproduced on the axial grind test localizes pathology to the base of the thumb.

Trapeziometacarpal and scaphotrapeziotrapezoid joints should be assessed with plain radiographs (X-rays) that typically show degenerative changes. However, X-rays may underestimate the extent of the disease.

What to do?

Non-operative treatments can ameliorate symptoms and delay surgery in most patients with osteoarthritis of the thumb:

- behaviour modification
- pain relief
- splinting
- corticosteroid injections

No single operative procedure has been shown to be superior:

- simple trapeziectomy has the lowest complication rate
- arthrodesis may be the best option for patients who value pain relief and reliable strength and stability more than mobility (such as younger manual workers)

Piano lesson: "Rachmaninov had big hands". See how one gets 4 million views on YouTube:

References:

Osteoarthritis at the base of the thumb. BMJ, 2011.

Diagnosis of chronic kidney disease: When to refer to a nephrologist?

noreply@blogger.com (Ves Dimov, M.D.) — Wed, 01 Feb 2012 05:09:00 PST

This is another recent review from Am Fam Physician:

Chronic kidney disease (CKD) affects 27 million adults in the U.S. It increases risk of cardiovascular disease and stroke.

Patients should be assessed annually to determine whether they are at increased risk of developing chronic kidney disease (CKD).

Risk factors for CKD include:

- diabetes mellitus
- hypertension
- older age
- cardiovascular disease
- family history of chronic kidney disease
- ethnic and racial minority status

Tests for CKD:

- Serum creatinine levels can be used to estimate the glomerular filtration rate (GFR)
- Spot urine testing can detect proteinuria

Staging of CKD is based on estimated glomerular filtration rate (GFR). Evaluation should focus on the specific type of CKD and identifying complications related to the disease stage.

When to refer to a nephrologist?

The patients with the following characteristics should be referred to a nephrologist:

- estimated glomerular filtration rates less than 30 mL per minute per 1.73 m2
- significant proteinuria
- rapid loss of kidney function

References:

Chronic Kidney Disease: Detection and Evaluation. Baumgarten M, Gehr T. Am Fam Physician. 2011 Nov 15;84(10):1138-1148.
Nephrology Cases

First snowmobile front flip landed and winter sport trauma (video)

noreply@blogger.com (Ves Dimov, M.D.) — Tue, 31 Jan 2012 16:37:41 PST

Heath Frisby lands the first snowmobile front flip in competition:

This is what happens when the things don't go as planned: Colten Moore flies 120 feet into the air and then hits the snow hard in Snowmobile Freestyle Finals... (video below). He not only survived but went on to win Winter X Games Gold later.

Not all extreme winter sport champions are so lucky though, and some of them have barely escaped death, with life-altering injuries: Kevin Pearce reflects on Sarah Burke's death (USA Today).

Chronic Diarrhea - Diagnostic Evaluation

noreply@blogger.com (Ves Dimov, M.D.) — Mon, 30 Jan 2012 05:26:00 PST

Chronic diarrhea is defined as a decrease in stool consistency (loose BM) for more than 4 weeks (Am Fam Physician, 2011).

It can be divided into 3 categories:

- watery
- fatty (malabsorption)
- inflammatory

Watery diarrhea

Watery diarrhea may be subdivided into:

- osmotic
- secretory
- functional, e.g. IBS

Watery diarrhea includes irritable bowel syndrome (IBS), which is the most common cause of functional diarrhea. Another example of watery diarrhea is microscopic colitis, which is a secretory diarrhea affecting older persons.

Laxative-induced diarrhea is often osmotic.

Malabsorptive diarrhea

Malabsorptive diarrhea is characterized by excess gas, steatorrhea, or weight loss. Giardiasis is a classic infectious example of malabsorptive diarrhea.

Celiac disease (gluten-sensitive enteropathy) is also malabsorptive, and typically results in weight loss and iron deficiency anemia.

Inflammatory diarrhea

Inflammatory diarrhea, such as ulcerative colitis (UC) or Crohn disease, is characterized by blood and pus in the stool and an elevated fecal calprotectin level.

Invasive bacteria and parasites also produce inflammation. Infections caused by Clostridium difficile (C. diff.) subsequent to antibiotic use have become increasingly common and virulent.

Image source: Escherichia coli, Wikipedia, public domain.

Not all chronic diarrhea is strictly watery, malabsorptive, or inflammatory, because some categories overlap.

References:

Evaluation of Chronic Diarrhea. Juckett G, Trivedi R. Am Fam Physician. 2011 Nov 15;84(10):1119-1126.
Skin patch vaccine to prevent travelers' diarrhea
Image source: Colon (anatomy), Wikipedia, public domain.

How to evaluate a patient with chronic cough?

noreply@blogger.com (Ves Dimov, M.D.) — Thu, 26 Jan 2012 21:52:55 PST

Initial evaluation of chronic cough (defined as more than 8 weeks' duration in adults and 4 weeks in children) should include a chest radiography (CXR) in most adult patients.

Patients who are taking an angiotensin-converting enzyme inhibitor (ACEi) should switch to a medication from another drug class.

Differential diagnosis of cough, a simple mnemonic is GREAT BAD CAT TOM. Click here to enlarge the image: (GERD (reflux), Laryngopharyngeal Reflux (LPR), Rhinitis (both allergic and non-allergic) with post-nasal drip (upper airway cough syndrome), Embolism, e.g. PE in adults, Asthma, TB (tuberculosis), Bronchitis, pneumonia, pertussis, Aspiration, e.g foreign body in children, Drugs, e.g. ACE inhibitor, CF in children, Cardiogenic, e.g. mitral stenosis in adults, Achalasia in adults, Thyroid enlargement, e.g. goiter, "Thoughts" (psychogenic), Other causes, Malignancy, e.g. lung cancer in adults).

The most common causes of chronic cough in adults are:

- upper airway cough syndrome (post-nasal drip)
- asthma
- gastroesophageal reflux disease (GERD)
- any combination of the above

If upper airway cough syndrome is suspected, a trial of a decongestant and an antihistamine is warranted.

The diagnosis of asthma can be confirmed with a clinical response to empiric therapy with inhaled bronchodilators or corticosteroids (spirometry is generally preferred though).

Empiric treatment for gastroesophageal reflux disease (GERD) should be initiated in lieu of testing for patients with chronic cough and reflux symptoms.

Patients should avoid exposure to cough-evoking irritants, such as cigarette smoke.

Further testing may be indicated if the cause of chronic cough is not identified and includes:

- high-resolution computed tomography (CT) of the chest
- referral to a pulmonologist or an allergist

In children, a cough lasting longer than 4 weeks is considered chronic.

The most common causes of chronic cough in children are:

- respiratory tract infections ("bronchitis" and pneumonia)
- asthma
- rhinitis with post-nasal drip
- gastroesophageal reflux disease (GERD)
- aspirated foreign body is relatively rare but must not be missed

Evaluation of children with chronic cough should include chest radiography (CXR) and spirometry (if older than 5 years of age). Skin prick test for environmental allergies can also be indicated.

References:

Evaluation of the patient with chronic cough. Benich Iii JJ, Carek PJ. Am Fam Physician. 2011 Oct 15;84(8):887-92.

Diagnosis of chronic cough in children

"Doctors make mistakes. Can we talk about that?" ED physician Brian Goldman's TED talk

noreply@blogger.com (Ves Dimov, M.D.) — Thu, 26 Jan 2012 05:45:00 PST

Dr. Goldman asks if you know your surgeon's "batting average" of operations with good outcomes. He mentions the three words you never want to hear: "Do you remember?" It's a good TED talk:

Every doctor makes mistakes (just like everyone does). But, says Dr. Goldman, medicine's culture of denial (and shame) keeps doctors from ever talking about those mistakes, or using them to learn and improve. Telling stories from his own long practice, he calls on doctors to start talking about being wrong.

Here are some simple steps to avoid medical errors from a patient's perspective (source: CNN):

1. Say: "My name is Mary Smith, my date of birth is October 21, 1965, and I'm here for an appendectomy."
2. Say: "Please check my ID bracelet."
3. Say: "Please look in my chart and tell me what procedure I'm having."
4. Say: "I want to mark up my surgical site with the surgeon present."
5. Be impolite (this particular piece of advice is obviously controversial).

References:

CNN video: Steps to avoid medical errors

The Rise of the ePatient - presentation by Pew Internet Project

noreply@blogger.com (Ves Dimov, M.D.) — Tue, 24 Jan 2012 05:20:00 PST

Director Lee Rainie presented at Providence St. Joseph Medical Center in Burbank, California on January 12, 2012 on understanding social networking and online health information seeking:

The Rise of the e-Patient

View more presentations from Pew Research Center's Internet & American Life Project

Link via via e-patients.net

Here is how to facilitate the Rise of the ePhysican who works hand in hand with the ePatient:

References:

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

Blogging is good for you - and for most people who read blogs

noreply@blogger.com (Ves Dimov, M.D.) — Sat, 21 Jan 2012 09:36:18 PST

From The Economist:

"Academic papers cited by bloggers are far more likely to be downloaded. Blogging economists are regarded more highly than non-bloggers with the same publishing record.

The back-and-forth between bloggers resembles the informal chats, in university hallways and coffee rooms, that have always stimulated economic research, argues Paul Krugman, a Nobel-prize winning economist who blogs at the New York Times. But moving the conversation online means that far more people can take part.

Despite the low barriers to entry, blogs do impose some intellectual standards. Errors of fact or logic are spotted, ridiculed and corrected. Areas of disagreement are highlighted and sometimes even narrowed."

Similar dynamics are in work on many medical blogs authored by physicians.

WIN-WIN, as the author of the blog "The Happy Hospitalist" likes to say.

References:

Economics blogs. A less dismal debate. The Economist, 01/2011.

Lung cancer - Lancet review

noreply@blogger.com (Ves Dimov, M.D.) — Fri, 20 Jan 2012 05:12:00 PST

Small-cell lung cancer

Diagnosis relies on histology, with the use of immunohistochemical studies to confirm difficult cases.

Typical patients are men older than 70 years who are current or past heavy smokers and who have pulmonary and cardiovascular comorbidities.

Patients often present with rapid-onset symptoms due to:

- local intrathoracic tumour growth
- extrapulmonary distant spread
- paraneoplastic syndromes
- a combination of these features

Staging aims ultimately to define disease as metastatic or non-metastatic:

- Combination chemotherapy (platinum-based plus etoposide or irinotecan) is the mainstay first-line treatment for metastatic small-cell lung cancer.

- For non-metastatic disease, early concurrent thoracic radiotherapy is indicated.

Prophylactic cranial irradiation should be considered for all patients, even without metastases, whose disease does not progress after induction chemotherapy and radiotherapy.

Despite high initial response rates, most patients eventually relapse. Except for topotecan, few treatment options then remain.

Non-small-cell lung cancer (NSCLC)

The recently introduced 7th edition of the TNM classification relates better to other prognostic factors such as biological markers.

The advances in treatment include:

- a new generation of chemotherapy agents
- a proven advantage to adjuvant chemotherapy after complete resection for specific stage groups
- new techniques for radiotherapy
- new surgical approaches

References:

Small-cell lung cancer. The Lancet, Volume 378, Issue 9804, Pages 1741 - 1755, 12 November 2011

Non-small-cell lung cancer. The Lancet, Volume 378, Issue 9804, Pages 1727 - 1740, 12 November 2011

Image source: A CXR shows a right upper lobe (RUL) mass due to lung cancer. Source: Finger Clubbing due to Lung Cancer. Clinical Cases and Images.

Sleepwalking: Lee's story

noreply@blogger.com (Ves Dimov, M.D.) — Wed, 18 Jan 2012 05:59:00 PST

From NHS Choices YouTube channel: Lee started sleepwalking at the age of four. In this video he describes his sleepwalking episodes, including doing artwork despite having no interest in art, plus the physical side effects when he wakes up.

Also watch Sleepwalking in children.

How to investigate mildly elevated liver transaminase levels

noreply@blogger.com (Ves Dimov, M.D.) — Tue, 17 Jan 2012 05:39:00 PST

Mild elevations in the liver enzymes alanine transaminase (ALT) and aspartate transaminase (AST) are commonly found in asymptomatic patients.

The most common cause is nonalcoholic fatty liver disease (sometimes called nonalcoholic steatohepatitis or NASH), which can affect up to 30% of the U.S. population.

Other common liver causes include:

- alcoholic liver disease
- medication-associated liver injury
- viral hepatitis (hepatitis B and C)
- hemochromatosis

Pale stool and dark urine (click to enlarge the images). This is an example of "obstructive" jaundice with the classic constellation of tea-colored urine and clay-colored stool.

Less common liver causes include:

- alpha-1-antitrypsin deficiency (AAT)
- autoimmune hepatitis
- Wilson disease

Extrahepatic conditions can also cause elevated liver transaminase levels:

- thyroid disorders
- celiac disease
- hemolysis
- muscle disorders

Initial testing should include:

- fasting lipid profile (FLP)
- measurement of glucose
- serum iron and ferritin; total iron-binding capacity (TIBC)
- hepatitis B surface antigen and hepatitis C virus antibody

If above test results are normal, a trial of lifestyle modification is appropriate.

Additional testing may include:

- ultrasonography (USG) of liver
- alpha-1-antitrypsin (AAT) and ceruloplasmin
- serum protein electrophoresis (SPEP)
- antinuclear antibody (ANA), smooth muscle antibody (ASMA), and liver/kidney microsomal antibody type

GI evaluation and possible liver biopsy is recommended if transaminase levels remain elevated for more than 6 months.

References:

Causes and evaluation of mildly elevated liver transaminase levels. Oh RC, Hustead TR. Am Fam Physician. 2011 Nov 1;84(9):1003-8.

Evaluation of suspected dementia: 2-visit approach is effective

noreply@blogger.com (Ves Dimov, M.D.) — Mon, 16 Jan 2012 12:34:04 PST

Prevalence of dementia will increase as the U.S. and the world population ages. The text below is based on a recent review in the journal Am Fam Physician:

Risk factors for dementia include:

- age
- family history of dementia
- apolipoprotein E4 genotype
- cardiovascular comorbidities
- chronic anticholinergic use
- lower educational level

A two-visit approach is time-effective for primary care physicians.

During the first visit, the physician should administer a screening test such as:

- verbal fluency test
- Mini-Cognitive Assessment Instrument
- Sweet 16

The tests above have relatively high sensitivity and specificity for detecting dementia, and can be completed in as little as 60 seconds (Note by editor: this one-minute time estimate sounds too optimistic, it usually takes considerably longer).

If the screening test result is abnormal or another disease is suspected, laboratory and imaging tests should be ordered, and the patient should return for additional cognitive testing.

A second visit should include:

- Mini-Mental State Examination
- Geriatric Depression Scale
- verbal fluency
- clock drawing tests

For patients with dementia, the following characteristics are useful for identifying
patients at increased risk for unsafe driving:

- Clinical Dementia Rating scale (Level A)
- caregiver’s rating of a patient’s driving ability as marginal or unsafe (Level B)
- history of crashes or traffic citations (Level C)
- reduced driving mileage or self-reported situational avoidance (Level C)
- Mini-Mental State Examination scores of 24 or less (Level C)
- aggressive or impulsive personality characteristics (Level C)

Evaluation of driving risk in dementia (click to enlarge the image).

References:

Evaluation of suspected dementia. Simmons BB, Hartmann B, Dejoseph D. Am Fam Physician. 2011 Oct 15;84(8):895-902.

Premenstrual syndrome and premenstrual dysphoric disorder (review)

noreply@blogger.com (Ves Dimov, M.D.) — Fri, 13 Jan 2012 05:25:00 PST

Premenstrual syndrome

Premenstrual syndrome is defined as recurrent psychological and physical symptoms that occur during the luteal phase of menses and resolve with menstruation. It affects 20-30% of premenopausal women.

Premenstrual dysphoric disorder

Premenstrual dysphoric disorder includes affective or somatic symptoms that cause severe dysfunction in social or occupational activity. It affects 3-8% of premenopausal women.

Proposed etiologies (causative factors) include:

- increased sensitivity to normal cycling levels of estrogen and progesterone
- increased aldosterone and plasma renin activity
- neurotransmitter abnormalities, particularly serotonin

The Daily Record of Severity of Problems is one tool with which women may self-report premenstrual symptoms.

Symptom relief is the goal, and there is limited evidence for the use of:

- calcium
- vitamin D
- vitamin B6 supplementation

Serotonergic antidepressants (SSRIs) (citalopram, escitalopram, fluoxetine, sertraline, venlafaxine) are first-line pharmacologic therapy.

References:

Premenstrual syndrome and premenstrual dysphoric disorder. Biggs WS, Demuth RH. Am Fam Physician. 2011 Oct 15;84(8):918-24.

Image source: OpenClipArt.org, public domain.

Scabies - NHS patient education video

noreply@blogger.com (Ves Dimov, M.D.) — Thu, 26 Jan 2012 21:52:38 PST

From the NHS Choices YouTube channel: Scabies is a contagious skin infection which itches intensely. A GP talks about the causes, symptoms and treatment.

From the memorable medical textbooks of the past: Medical textbooks were not always as dreary and as bland as they are now, according to BMJ.

Some examples of lively, first person didactic tone come from J L Burton’s Essentials of Dermatology: "The simultaneous occurrence of scabies in a doctor and a nurse may mean that they have shared nothing more exciting than a patient with Norwegian scabies."

References:

Memorable medical textbooks of the past

How to avoid hidden sodium - a Johns Hopkins dietitian walks through the aisles of a grocery store with you (video)

noreply@blogger.com (Ves Dimov, M.D.) — Thu, 12 Jan 2012 05:38:00 PST

Join Johns Hopkins registered dietitian, Arielle Rosenberg, as she walks through the aisles and offers suggestions on how to lower salt intake -- but not compromise flavor.

Cutting U.S. salt intake by just half a teaspoon (3 grams) a day would prevent up to 92,000 deaths, 99,000 heart attacks, and 66,000 strokes -- a benefit as big as smoking cessation. A 3-gm per day reduction in salt (1,200 mg of sodium) will result in 6% fewer new cases of heart disease and 3% fewer deaths.

The average U.S. man gets about 10.4 grams a day and the average U.S. woman gets about 7.3 grams a day.

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.

References:

"Cutting Salt as Good as Quitting Smoking"

94% of Americans score at “poor” level on at least one of the 7 factors defining ideal cardiovascular health

noreply@blogger.com (Ves Dimov, M.D.) — Wed, 11 Jan 2012 05:20:00 PST

More than 90% of Americans score poorly on at least one of the American Heart Association’s 7 factors defining ideal cardiovascular health.

The 7 factors (with lack of a diagnosis of heart or blood vessel disease) include:

- smoking status
- weight
- physical activity
- healthy diet
- cholesterol concentration
- blood pressure
- fasting glucose concentration

The new data by CDC and NIH show that 94% of US adults score at a “poor” level on at least one of those factors and that 38% have at least 3 factors at a poor level.

References:

US citizens score poorly on ratings of cardiovascular risk factors. BMJ 2012; 344 doi: 10.1136/bmj.e22 (Published 4 January 2012).

Depression treatment is as effective in older (over 65) as in younger adults

noreply@blogger.com (Ves Dimov, M.D.) — Tue, 10 Jan 2012 05:50:00 PST

Depression in later life, traditionally defined as age older than 65, is associated with disability, increased mortality, and poorer outcomes.

Compared to younger adults with depression:

- cognitive and functional impairment and anxiety are more common in older adults

- older adults with depression are at increased risk of suicide

Depression is associated with cognitive impairment and an increased risk of dementia.

A selective serotonin reuptake inhibitor (SSRI) should be the first line pharmacological treatment for depression for most older adults.

Psychological and drug treatment is as effective in older as in younger adults

References:

Depression in older adults. Rodda et al. BMJ, 2011.

Image source: Vincent van Gogh's 1890 painting At Eternity's Gate. Wikipedia, public domain.

Why Mayo Clinic is a power user of social media: "Our patients are doing it, so this is where we need to be"

noreply@blogger.com (Ves Dimov, M.D.) — Sun, 15 Jan 2012 17:06:40 PST

Mayo Clinic's first-ever Social Media Residency took place October 20-21, 2011. At the end of the first day, the attendees went out on a video interview assignment. Check out some of the videos they returned with.

The best interest of the patient is the only interest to be considered

The Mayo Clinic CEO, John Noseworthy, M.D., pointed out recently that Mayo intends to be the leader in social media in healthcare but this is not about competitive advantage, it is about the patient. The best interest of the patient is the only interest to be considered. Social media makes the union of forces more broadly practical than at any time in human history.

References:

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

Hands-only CPR videos - The American Way vs. The British Way - Celebrity edition

noreply@blogger.com (Ves Dimov, M.D.) — Thu, 05 Jan 2012 05:44:01 PST

The American Heart Association (AHA) recruited Kendrick Kang-Joh Jeong, MD (a trained physician and an actor from the Hangover) to demonstrate ‘hands only CPR’ to the metronomic beat of the Bee Gees 1977 disco hit ‘Stayin’ Alive’:

The British Heart Foundation recruited footballer-turned-actor Vinnie Jones to show how hard and fast hands-only CPR to Stayin' Alive by the Bee Gees can help save the life of someone who has had a cardiac arrest. The Hollywood hardman is starring in a TV advert urging more people to carry out CPR in a medical emergency:

Ken Jeong Behind the Scenes - AHA CPR video:

Comments from YouTube:

Sure, the beat to "Staying Alive" works, but so does "Another One Bites The Dust" by Queen......... just saying!

Related reading:

Disco Still Saves Lives. Life in the Fast Lane.

The Third Component of Genetic Blueprint - Writing in Pen (DNA) vs. Pencil (Epigenetics)

noreply@blogger.com (Ves Dimov, M.D.) — Wed, 04 Jan 2012 09:04:04 PST

The term epigenetics refers to changes in phenotype (appearance) or gene expression caused by mechanisms other than changes in the underlying DNA sequence, hence the name epi- (Greek: over; above) -genetics. There is no change in the underlying DNA sequence of the organism; the phenotype is expressed by activating some genes while inhibiting others. Epigenetics includes changes in gene function that occur without a change in the sequence of DNA. These changes occur as a result of the interaction of the environment with the genome. Epigenetic determinants activate or silence fetal genes through alterations in DNA, histone methylation and acetylation.

DNA associates with histone proteins to form chromatin. Image source: Wikipedia, GNU Free Documentation License.

From the National Geographic magazine:

"Mother Nature writes some things in pencil and some things in pen. Things written in pen you can't change. That's DNA. But things written in pencil you can. That's epigenetics. Now that we're actually able to look at the DNA and see where the pencil writings are, it's sort of a whole new world."

If you think of our DNA as a piano keyboard and our genes as keys - each key symbolizing a segment of DNA responsible for a particular note, or trait, and all the keys combining to make us who we are - then epigenetic processes determine when and how each key can be struck, changing the tune being played.

Recent studis focuses on a particular epigenetic process called DNA methylation, which is known to make the expression of genes weaker or stronger.

The good news is that some of these processes, unlike our DNA sequences, can be altered. Genes muted by methylation, for example, sometimes can be switched back on again relatively easily. And though it may not happen soon, the hope is that someday epigenetic mistakes will be as simple to repair as a piano that's out of tune. "

Human chromosomes (grey) capped by telomeres (white). Image source: Wikipedia, public domain.

References:

Twins. National Geographic magazine, 01/2012.

Portrait of twins: series one and series two from National Geographic.

Twins Data Reshaping Nature Versus Nurture Debate. NPR.

Epigenetics, Wikipedia.

"The online version is the official journal of record, not the print edition". Start a blog in 2012

noreply@blogger.com (Ves Dimov, M.D.) — Tue, 03 Jan 2012 05:00:08 PST

"The online version is the official journal of record", wrote the Editor-in-Chief and the editorial staff of Pediatrics, the official journal of the the American Academy of Pediatrics:

"As we start 2012, and welcome the more than 6 million annual visitors to our journal's Web site, we remind our readers that the online version, not the shorter print edition, is the official journal of record. Is it time to do away with the print version? Probably not just yet, but it may not be long until we are heading in that direction.

If you are thinking, “there are so many options to peruse and so little time!” you will find some highlights of each issue in our blog - First Read - which contains previews of articles of interest selected by members of our executive editorial board. We are even running some of our most interesting “fillers” from the print journal in the blog so they are not missed by our online readers"

This is the URL of the blog which is hosted for free on Blogger.com by Google: http://pediatricsblog.blogspot.com

All physicians should consider starting a blog in 2012

I would encourage all physicians to start a blog in 2012 - here is why (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."

Don't limit yourself to your blog - use Facebook, Twitter and Google Plus

Blogging can be great for personal growth but there is a lot more interaction on Twitter, Facebook and Google Plus nowadays as compared to blogs. If you have a blog, you must also have a Facebook "like" page (previously called "fan" page), a Twitter account, and probably a Google Plus page. These serve the dual purpose of distribution and commenting channels ("two-way street").

For example, Facebook pages get a lot more interaction than blogs for some medical journals - you can compare the number of comments on the NEJM Facebook updates (the range is 9-180) vs. their blog (0). The blog has comments enabled, of course.

Facebook is the clear "winner" in terms of commenting activity, it is not even close:

NEJM Facebook page vs. NEJM blog

This is a suggested simple project for all doctors in 2012:

1. Start on Twitter (microblog).
2. Continue on Blogger/WordPress.
3. Make an impact. Improve the quality of online health information and tell the public your side of the story.

How to Create a Blog on Blogger in 5 minutes (Google video):

Help your patients and your practice

I developed the concept of Two Interlocking Cycles:

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

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

References:

Taking the Pulse of Pediatrics. PEDIATRICS Vol. 129 No. 1 January 1, 2012, pp. 168 -169 (doi: 10.1542/peds.2011-3288).

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

Risk of heart attack and stroke goes up during holidays - Mayo Clinic video

noreply@blogger.com (Ves Dimov, M.D.) — Sat, 31 Dec 2011 08:44:15 PST

From the Mayo Clinic YouTube channel: Are you at an increased risk of heart attack and stroke? Studies show the incidents rise during December and January, but particularly on Christmas Day and New Year's Day. Stay safe.

Jon Lord (70), a Hammond organ player, and a founding member of Deep Purple, who is currently recovering from cancer, says it very well: "Party hearty but look after yourselves. I wish you success and happiness, and above all I wish you health."

Jon Lord - Child In Time, 4 March, 2009, Palace of Arts (MÜPA), Budapest, Hungary.

Happy New Year!

References:

Jon wishes you a Happy New Year

iPad app tests athletes for concussion - Cleveland Clinic video

noreply@blogger.com (Ves Dimov, M.D.) — Sat, 28 Jan 2012 09:12:05 PST

An iPad app tests athletes for concussions (a Cleveland Clinic video). The players perform a series of balance, memory, vision, and reaction time experiments to obtain a baseline reading. If they receive a blow to the head during a game or practice, these tests can be redone to determine when it is safe for the athlete to return to action.

References:

Concussion Center - Cleveland Clinic.
Cleveland Clinic Treats Concussions With iPad App. Fox News.
Chronic traumatic encephalopathy (CTE): Brain bank examines athletes' hard hits - CNN, 2012.