Munchausen's syndrome - NHS video

To contact us Click HERE
From the NHS Choices YouTube channel: A psychiatrist explains the motivation behind Munchausen's syndrome, also known as factitious illness, where someone pretends to be ill or causes symptoms in themselves. This can include inflicting wounds or tampering with blood and urine samples. He also explains the importance of getting treatment and describes another form of the condition where a person fabricates an illness in someone in their care (Munchausen's syndrome by proxy):



Comments from Twitter:

Julie Meadows-Keefe @esq140: Fascinatingly & disturbingly real.

Munchausen's syndrome - NHS video

To contact us Click HERE
From the NHS Choices YouTube channel: A psychiatrist explains the motivation behind Munchausen's syndrome, also known as factitious illness, where someone pretends to be ill or causes symptoms in themselves. This can include inflicting wounds or tampering with blood and urine samples. He also explains the importance of getting treatment and describes another form of the condition where a person fabricates an illness in someone in their care (Munchausen's syndrome by proxy):



Comments from Twitter:

Julie Meadows-Keefe @esq140: Fascinatingly & disturbingly real.

How Do Pain Relievers Work? TED-Education video

To contact us Click HERE
From TED Education series, Jun 26, 2012: Some people take aspirin or ibuprofen to treat everyday aches and pains, but how exactly do the different classes of pain relievers work? Learn about the basic physiology of how humans experience pain, and the mechanics of the medicines we've invented to block or circumvent that discomfort.



Lesson by George Zaidan, animated by Augenblick Studios.

Munchausen's syndrome - NHS video

To contact us Click HERE
From the NHS Choices YouTube channel: A psychiatrist explains the motivation behind Munchausen's syndrome, also known as factitious illness, where someone pretends to be ill or causes symptoms in themselves. This can include inflicting wounds or tampering with blood and urine samples. He also explains the importance of getting treatment and describes another form of the condition where a person fabricates an illness in someone in their care (Munchausen's syndrome by proxy):



Comments from Twitter:

Julie Meadows-Keefe @esq140: Fascinatingly & disturbingly real.

Munchausen's syndrome - NHS video

To contact us Click HERE
From the NHS Choices YouTube channel: A psychiatrist explains the motivation behind Munchausen's syndrome, also known as factitious illness, where someone pretends to be ill or causes symptoms in themselves. This can include inflicting wounds or tampering with blood and urine samples. He also explains the importance of getting treatment and describes another form of the condition where a person fabricates an illness in someone in their care (Munchausen's syndrome by proxy):



Comments from Twitter:

Julie Meadows-Keefe @esq140: Fascinatingly & disturbingly real.

Top medicine articles for July-August 2012

To contact us Click HERE
Here are my suggestions for some of the top articles in medicine for July-August 2012:

Where are you on the global fat scale? BBC calculator: http://goo.gl/ZnI6D

Drug cheating at the Olympics: who, what, and why? 7% of elite athletes admitted to doping ~ 1000 people at each Games http://bit.ly/Mcc1bz

Risk of pneumonia decreased with use of angiotensin converting enzyme (ACE) inhibitors - BMJ meta-analysis http://goo.gl/dE9Ks

One Doctor’s Prescription to Avoid Social Media Overload http://goo.gl/bdtPU

Cents and Sensitivity - Teaching Physicians to Think about Costs - NEJM http://goo.gl/aUQE3

How fat is fat? The Lancet compares CTs with visceral fat vs. subcutaneous fat deposits http://goo.gl/iO9sa

Increasing contraceptive use in developing countries has cut the number of maternal deaths by 40% - The Lancet http://goo.gl/hHjIO

Qsymia is the second new drug for obesity approved by the FDA in the last month, after Belviq http://goo.gl/wCqi7

Mass General knocks Johns Hopkins out of the top hospital spot it's held for 21 years, while at the same time Cleveland Clinic is closing in on Mayo Clinic - U.S. News & World Report's 2012 list of the best U.S. hospitals http://goo.gl/URpei

Feedback of DNA based risk assessments does not motivate behaviour change - BMJ http://goo.gl/3HaRy

The articles were selected from my Twitter and Google Reader streams. Please feel free to send suggestions for articles to clinicalcases@gmail.com and you will receive acknowledgement in the next edition of this publication.

Only 60% of the eligible U.S. population gets screened for colon cancer

To contact us Click HERE
Only 61% of the eligible population in the USA gets screened for this common cancer, according to The Lancet.

Here are some excerpts from the new guidance for colorectal cancer screening by the American College of Physicians (ACP):

- colorectal cancer screening should start at the age of 50 years for people at average risk, and at 40 years (or 10 years before the age of the youngest case of colorectal cancer in a family) for people at high risk

- stool-based tests, flexible sigmoidoscopy, and optical colonoscopy are all acceptable screening options for people at average risk

- the gold standard—optical colonoscopy—is recommended for people at high risk

- screening should be stopped for adults aged over 75 years or who have a life expectancy of less than 10 years

Colorectal cancer screening can lead to harmful outcomes such as perforation, bleeding, and false-negative results.

10 Questions You Need to Ask About Colonoscopy

From The NYTimes:

1. Why is effective bowel preparation important?
2. How can I maximize my chance of an effective bowel preparation?
3. Are there certain medications I should stop taking before colonoscopy?
4. Are all colonoscopists equally effective at finding polyps and cancers during colonoscopy?
5. How can I be sure that my colonoscopist will do a careful examination?
6. How can I reduce the risk of a complication during colonoscopy?
7. Should I try colonoscopy without sedation?
8. If I undergo sedation, should it be given by an anesthesiologist?
9. Do all colonoscopists follow the same rules to determine when my colonoscopy should be repeated?
10. Why aren’t the problems with the delivery of colonoscopy already solved?

Questions # 1, 2, 3, 6, 7 are very important, question # 10 probably not so much.

17% of U.S. hospitals now provide virtual colonoscopy


Medicare does not currently reimburse routine screening with virtual colonoscopy, but it does cover evaluations with "regular" colonoscopy.

References:

New guidance for colorectal cancer screening. The Lancet, Volume 379, Issue 9820, Page 978, 17 March 2012.
Virtual Colonoscopy Gains in Popularity. Is It Right for You? TIME.
Colonoscopy Developer Dies at 94 - NYTimes http://goo.gl/iBnOp - Dr. Wolff was unconventional and surely made headlines in his day.
When President Obama underwent his first-ever colon cancer screening last year, he chose virtual colonoscopy. USA Today.
Cleveland Clinic Colorectal Cancer Risk Assessment Tool. Get your score in 2 minutes (free).
Image source: Colon (anatomy), Wikipedia, public domain.

7 healthy traits linked to lower death risk but only 2% of people have all 7 - are you one of them?

To contact us Click HERE
People who meet the 7 healthy goals recommended by the American Heart Association are less likely to die of cardiovascular causes.

Here there are:

- not smoking
- moderate exercise at least 5 times a week
- untreated blood pressure under 120/80
- HbA1c under 5.7%
- total cholesterol under 200 mg/dL
- BMI less than 25
- a diet high in produce, fish, and whole grains, and low in sodium and sugary beverages

Less than 2% of people reached all 7 ideals.

Those who met 6-7 goals had reduced risks for all-cause mortality (hazard ratio, 0.49), compared with participants meeting zero or one goal.

References:

Healthy Habits Associated with Reduced Mortality Risk - Physician's First Watch http://bit.ly/N9x8ha
Trends in Cardiovascular Health Metrics and Associations With All-Cause and CVD Mortality Among US Adults - JAMA http://bit.ly/N9xzYO
Image source: OpenClipart.org, public domain.

Guidelines for Management of Acute Bacterial Sinusitis by Infectious Diseases Society of America

To contact us Click HERE
A bacterial cause accounts for 2%-10% of acute rhinosinusitis cases.


Nose and nasal cavities. Image source: Wikipedia, public domain.

Recommendations for Management of Acute Bacterial Sinusitis by the Infectious Diseases Society of America (IDSA):

Bacterial rather than viral rhinosinusitis should be diagnosed when any of the following occurs:

- persistent symptoms lasting at least 10 days, without improvement
- symptoms or high fever and purulent nasal discharge or facial pain for 3–4 days at illness onset
- worsening symptoms after an initial respiratory infection, lasting 5–6 days, has started to improve.

Empirical therapy should be started as soon as acute bacterial rhinosinusitis is diagnosed clinically.

Amoxicillin-clavulanate, instead of amoxicillin alone, is recommended for both children and adults.

Macrolides and trimethoprim-sulfamethoxazole are not recommended as empirical therapy, because of high rates of antimicrobial resistance.

References:

Algorithm for the management of acute bacterial rhinosinusitis (figure)
Guideline Issued for Managing Acute Bacterial Rhinosinusitis - Physician's First Watch http://bit.ly/TGn6aM
IDSA Clinical Practice Guideline for Acute Bacterial Rhinosinusitis in Children and Adults http://bit.ly/TGnaHB

The link between stress and heart disease

To contact us Click HERE
In this video from the Cleveland Clinic, Steven Nissen, MD, talks about the important lesson war has taught us about stress and its effect on the heart. One of the best ways to manage stress is regular exercise.



Tips for managing stress (watch the 2-minute BBC video embedded below)

- Take a few deep breaths
- Get plenty of exercise
- Socialize - don't stress alone, talk to someone and have a laugh
- Get out - go to the park



Read more: http://www.bbc.co.uk/scotland/brainsmart 

Participation in sport is associated with a with a 20—40% reduction in all-cause mortality compared with non-participation. Exercise might also be considered as a fifth vital sign, according to the Lancet: http://goo.gl/gyxYf

 If nothing else helps, consider this: Chewing gum may reduce stress and improve memory

Managing perioperative risk in patients undergoing elective non-cardiac surgery - BMJ review

To contact us Click HERE
Non-cardiac surgery has a low overall mortality but is associated with a large number of deaths because so many procedures are performed (250 million major surgical procedures worldwide per year).

Assuming a hospital mortality rate of 1%, non-cardiac surgery will be associated with 2.5 million deaths worldwide each year and complication rates at least five times this figure.

15% of people who undergo inpatient surgery are at high risk of complications, such as pneumonia or myocardial infarction.

Most deaths occur in a group of patients who are at high risk because of:

- advanced age
- comorbid disease
- major surgery

High risk surgical patients account for 80% of all perioperative deaths.

Further research is needed to identify the most effective approaches to perioperative medicine for high risk patients.

References:

Managing perioperative risk in patients undergoing elective non-cardiac surgery. BMJ 2011; 343 doi: 10.1136/bmj.d5759 (Published 5 October 2011), Cite this as: BMJ 2011;343:d5759

Image source: Wikipedia

What are the New Risk Markers for Coronary Heart Disease?

To contact us Click HERE
Traditional CHD risk factors used in the Framingham risk score (FRS) predictions include:

- age
- gender
- systolic blood pressure
- treatment of hypertension
- total and high-density lipoprotein cholesterol levels
- smoking
- diabetes

The newer CHD risk factors include:

- N-terminal fragment of prohormone B-type natriuretic peptide levels
- von Willebrand factor antigen levels
- fibrinogen levels
- chronic kidney disease
- leukocyte count
- C-reactive protein levels
- homocysteine levels
- uric acid levels
- coronary artery calcium [CAC] scores
- carotid intima–media thickness
- peripheral arterial disease
- pulse wave velocity

Adding coronary artery calcium [CAC] scores to the FRS improved the accuracy of risk predictions.

Levels of N-terminal fragment of prohormone B-type natriuretic peptide also improved risk predictions but to a lesser extent.

Improvements in predictions with other newer markers were marginal.

References:

Evaluation of Newer Risk Markers for Coronary Heart Disease Risk Classification: A Cohort Study. Maryam Kavousi et al. Ann Intern Med. 20 March 2012;156(6):438-444.
Image source: Gray's Anatomy, 1918, public domain.

Comments from Twitter:

Michael Mirochna, MD @DocRockne:  unfortunately, no evidence they help with OUTCOMES

Brain Tumor Symptoms

To contact us Click HERE

Brain Tumor Symptoms, the reason that many people nowadays to get a brain tumor is because of the fact that there has been a lot of stress in the people of today, and tumors are generally formed due to such effect. The most common symptom of a brain tumor a splitting headache, that is common with a lot of people who have been suffering from brain tumor. If you have a splitting headache, and you feel that it is migraine, and even after a lot of medication from migraine if you feel that the headache is not yet over, then it is best that you get yourself a cat scan, and get the reason checked out.

In most circumstances, the symptoms of a brain tumor is vomiting, along with splitting headache, and you would also get seizures for a long time, as well as you would find yourself getting strokes, that can result in you spewing out blood from your mouth, and also the vomiting which will take place after wards, will be comprised of solid food from your body, and some acids from the gastric intestines of your body. To be sure that you have a blood tumor, consult with your doctor and get the required tests done.



More For Brain Tumor Symptoms

- Headaches
- Sickness
- Drowsiness
- Problems with your eyes
- Fits (seizures)

Other general symptoms,

* Changes in personality
* Swearing or behaving in a way that you normally wouldn't (loss of inhibitions)
* Losing interest in life (apathy)
* Difficulty with planning and organising
* Being irritable or aggressive
* Weakness in part of the face, or on one side of the body
* Difficulty walking
* Loss of sense of smell
* Problems with your sight or speech

* Forgetting words
* Short term memory loss
* Fits associated with strange feelings, smells or déjà vu (a feeling you have been somewhere or done something before)

* Difficulty speaking or understanding what is said to you
* Problems with reading or writing
* Loss of feeling in part of the body


Brain Tumor Pictures And Images

Breast Cancer Symptoms | Symptoms Of Breast Cancer

To contact us Click HERE

Breast Cancer Symptoms | Symptoms Of Breast Cancer, as the name suggests, breast Cancer is actually the cancerous elements being lodged in the breast. There is a high amount of ratio of breast cancer occurring among women all over the world, and it can be very fatal to the women having it. There are many cases in which there is always a recurrence of breast cancer in the person undergoing treatment, and giving to hormonal therapy, chemotherapy and radiation therapy is not that good an option, but it is our only option that we have against our fight with breast cancer .

The early symptoms of this breast cancer can vary with many people, and even if you do have breast cancer, sometimes they may go undetected for a long period of time until a less they turn cancerous. Most of the breast Cancer symptoms actually are the occurrence of a small lump within the breast, in a very small quantity, and they can actually mutate to become a very large object if left untreated for a long period of time. If you happen to find a small lump in the breast that you cannot explain, then it is high time for you to visit a doctor and get yourself checked out for breast cancer.


More For Breast Cancer Symptoms | Symptoms Of Breast Cancer

* Breast lump or lump in the armpit that is hard, has uneven edges, and usually does not hurt
* Change in the size, shape, or feel of the breast or nipple -- for example, you may have redness, dimpling, or puckering that looks like the skin of an orange
* Fluid coming from the nipple -- may be bloody, clear to yellow, green, and look like pus

Men get breast cancer, too. Symptoms include breast lump and breast pain and tenderness.

Symptoms of advanced breast cancer may include:

* Bone pain
* Breast pain or discomfort
* Skin ulcers
* Swelling of one arm (next to breast with cancer)
* Weight loss


Breast Cancer Pictures And Images

Rosacea - NHS Choices video

To contact us Click HERE
From NHS Choices YouTube channel: Rosacea is a common but poorly understood long-term skin condition that mainly affects the face. It most commonly affects fair-skinned people from northern Europe and is estimated to affect up to 1 in 10 people. In this video, an expert explains what rosacea is, the symptoms to look out for and the various treatments.



Cathelicidin dysfunction may be a central factor in the pathogenesis of several cutaneous diseases, including rosacea.

Cathelicidins are antimicrobial peptides (AMPs) that protect the skin through 2 pathways:

- antimicrobial activity
- cytokine release, inflammation, angiogenesis, and reepithelialization

Top medicine articles for August 2012

To contact us Click HERE
Here are my suggestions for some of the top articles in medicine for August 2012:

Sanofi Announces FDA Approval for Auvi-Q, First Voice-guided Epinephrine Auto-injector http://goo.gl/4GfPr

Medical Journal of Australia: "Clearly, we overestimate our ability to correctly deploy tests and interpret results" http://goo.gl/q8da8

Drug Resistance Claims Another Gonorrhea Treatment: the oral cephalosporin cefixime http://goo.gl/tR2LW

Social media continues to excel at reaching patients and medical peers http://goo.gl/odKGo

New drugs, procedures, and devices for hypertension : The Lancet http://goo.gl/IbwbL

Data challenge the concept that raising of plasma HDL cholesterol will reduce risk of myocardial infarction http://goo.gl/67eZF

10 Ways to Make EMR Meaningful and Useful http://goo.gl/KimDJ

Tiger snake (Notechis spp) envenoming: Australian Snakebite Project (ASP-13) | Medical Journal of Australia http://goo.gl/YCzRg

Bias in clinical history significantly influenced the accuracy of ECG interpretation http://goo.gl/JjRd6

9 Smartphone Apps to Improve Your Medical Practice http://goo.gl/nUjNP -- 15 Smartphone Apps to Improve Your Practice http://goo.gl/s3dnR

How to Raise Successful (and Happier) Children - NYTimes http://buff.ly/MT4BRr

When metformin alone is insufficient, consider adding a dipeptidyl peptidase-4 inhibitor, linagliptin - Lancet http://goo.gl/bdMkG

Ciprofloxacin for 7 days versus 14 d. in women with acute pyelonephritis: Short courses should be favored - Lancet http://goo.gl/oU3uC

Radiation exposure from CT scans in childhood increases subsequent risk of leukemia and brain tumors - Lancet http://goo.gl/44feV

The articles were selected from my Twitter and Google Reader streams. Please feel free to send suggestions for articles to clinicalcases@gmail.com and you will receive acknowledgement in the next edition of this publication.

Thyrotoxicosis - Lancet 2012 review

To contact us Click HERE
Thyrotoxicosis is a common disorder, especially in women. Thyroid disease affects 7 times more women than men.

Etiology

There are 3 main causes of thyrotoxicosis: Graves' disease, toxic nodular hyperthyroidism, and thyroiditis.

Here are some more details about them:

- Graves' disease (autoimmune hyperthyroidism) is the most frequent cause of thyrotoxicosis
- toxic nodular hyperthyroidism, due to the presence of one or more autonomously functioning thyroid nodules
- thyroiditis caused by inflammation, which results in release of stored hormones

Treatment

The available treatments for thyrotoxicosis have been unchanged for 60 years.

Antithyroid drugs are the usual initial treatment. Thionamides such as carbimazole or its active metabolite methimazole are the drugs of choice.

A prolonged course leads to remission of Graves' hyperthyroidism in only 30% of cases.

Because of this low remission rate in Graves' disease (only 30%) and the inability to cure toxic nodular hyperthyroidism with antithyroid drugs alone, radioiodine is increasingly used as first line therapy. It is the preferred choice for relapsed Graves' hyperthyroidism.

Surgery with total thyroidectomy is an option in selected cases. .

References:

Thyrotoxicosis. The Lancet, Volume 379, Issue 9821, Pages 1155 - 1166, 24 March 2012.

Thyroid disease—more research needed. The Lancet, Volume 379, Issue 9821, Page 1076, 24 March 2012.

Image source: Wikipedia, public domain.

Top medicine articles for September 2012

To contact us Click HERE
Here are my suggestions for some of the top articles in medicine for August 2012:

More than 30% of hospital patients have test result pending/not reviewed by the time they're discharged http://goo.gl/CCBxr

Corneal snowflakes due to IgG-kappa multiple myeloma - The Lancet images http://goo.gl/FvGBM

Biliary ileus - The Lancet images http://goo.gl/Iv18H

Erectile Dysfunction (ED) as a Reliable Proxy of General Male Health Status regardless of the etiology of ED http://goo.gl/y3kjA

Higher BPA Levels, More Heart Disease? http://goo.gl/10UUi

More Self-Control as a Child, Lower BMI as Adult (study) http://goo.gl/FElcw

FDA approved the first generic version of Actos (Pioglitazone) to treat adults with type 2 diabetes http://goo.gl/kUq9k

Mississippi has the highest proportion of obese adults at 35%, and Colorado has the lowest at 21% (survey) http://goo.gl/JDD6C

"GSK drug halves attacks in hard-to-treat asthma" - anti-IL5 antibody mepolizumab for eosinophilic asthma http://goo.gl/Be6IU

New Epinephrine Auto-Injector Talks Patients Through Injection Process, has a 5-sec countdown, signaling lights http://goo.gl/rYJZI

Autoinflammatory syndromes: Fever is not always a sign of infection - CCJM http://goo.gl/uTc2X

Genetic counselors: Your partners in clinical practice - CCJM http://goo.gl/ZkJb4

Atrial fibrillation: New drugs, devices, and procedures - CCJM http://goo.gl/O0AQN

The demise of the stethoscope as a metaphor of the “hyposkillia” of our times - CCJM http://goo.gl/xu5qS -- An argument for reviving the disappearing skill of cardiac auscultation - CCJM http://goo.gl/59ikK

Dark chocolate can help decrease blood pressure by 2-3 mmHg http://goo.gl/xTnn1

Eating egg yolks as 'bad as smoking' - NHS Choices blog reviews the evidence http://goo.gl/IosBG

30% of new prescriptions never get filled. Will smart pills boost drug compliance? http://goo.gl/omhjJ

Small practices may be least able to take new Medicaid patients - NJ Medicaid physicians get paid 37% of Medicare rates http://goo.gl/g3RLN

4 ways for practices to benefit from a social media presence: Offer information beyond the appointment, Raise physician profiles, Influence online search, Marketing toolkit http://goo.gl/5mAz4

The articles were selected from my Twitter and Google Reader streams. Please feel free to send suggestions for articles to clinicalcases@gmail.com and you will receive acknowledgement in the next edition of this publication.

Chronic insomnia - Lancet 2012 review

To contact us Click HERE
Insomnia is a common condition that can present independently or comorbidly with another medical or psychiatric disorder.

Treatment of chronic insomnia

Benzodiazepine-receptor agonists (BzRAs) and cognitive-behavioural therapy (CBT) are supported by the best empirical evidence.

Benzodiazepine-receptor agonists (BzRAs) are effective in the short-term management of insomnia, but evidence of long-term efficacy is scarce. Also, most hypnotic drugs are associated with potential adverse effects.

Cognitive-behavioural therapy (CBT) is an effective alternative for chronic insomnia.

CBT is more time consuming than drug management but it produces sleep improvements that are sustained over time.

However, CBT is not readily available in most clinical settings. Access and delivery can be made easier through:

- telephone consultations
- group therapy
- self-help approaches

How to succeed? Get more sleep



In this 4-minute talk, Arianna Huffington (founder of The Huffington Post) shares a small idea that can awaken much bigger ones: the power of a good night's sleep. Instead of bragging about our sleep deficits, she urges us to sleep our way to increased productivity and happiness -- and smarter decision-making.

References:

Chronic insomnia. The Lancet, Volume 379, Issue 9821, Pages 1129 - 1141, 24 March 2012.
Image source: A halo around the Moon. Wikipedia, GNU Free Documentation License.

Rosacea - NHS Choices video

From NHS Choices YouTube channel: Rosacea is a common but poorly understood long-term skin condition that mainly affects the face. It most commonly affects fair-skinned people from northern Europe and is estimated to affect up to 1 in 10 people. In this video, an expert explains what rosacea is, the symptoms to look out for and the various treatments.



Cathelicidin dysfunction may be a central factor in the pathogenesis of several cutaneous diseases, including rosacea.

Cathelicidins are antimicrobial peptides (AMPs) that protect the skin through 2 pathways:

- antimicrobial activity
- cytokine release, inflammation, angiogenesis, and reepithelialization

Top medicine articles for August 2012

Here are my suggestions for some of the top articles in medicine for August 2012:

Sanofi Announces FDA Approval for Auvi-Q, First Voice-guided Epinephrine Auto-injector http://goo.gl/4GfPr

Medical Journal of Australia: "Clearly, we overestimate our ability to correctly deploy tests and interpret results" http://goo.gl/q8da8

Drug Resistance Claims Another Gonorrhea Treatment: the oral cephalosporin cefixime http://goo.gl/tR2LW

Social media continues to excel at reaching patients and medical peers http://goo.gl/odKGo

New drugs, procedures, and devices for hypertension : The Lancet http://goo.gl/IbwbL

Data challenge the concept that raising of plasma HDL cholesterol will reduce risk of myocardial infarction http://goo.gl/67eZF

10 Ways to Make EMR Meaningful and Useful http://goo.gl/KimDJ

Tiger snake (Notechis spp) envenoming: Australian Snakebite Project (ASP-13) | Medical Journal of Australia http://goo.gl/YCzRg

Bias in clinical history significantly influenced the accuracy of ECG interpretation http://goo.gl/JjRd6

9 Smartphone Apps to Improve Your Medical Practice http://goo.gl/nUjNP -- 15 Smartphone Apps to Improve Your Practice http://goo.gl/s3dnR

How to Raise Successful (and Happier) Children - NYTimes http://buff.ly/MT4BRr

When metformin alone is insufficient, consider adding a dipeptidyl peptidase-4 inhibitor, linagliptin - Lancet http://goo.gl/bdMkG

Ciprofloxacin for 7 days versus 14 d. in women with acute pyelonephritis: Short courses should be favored - Lancet http://goo.gl/oU3uC

Radiation exposure from CT scans in childhood increases subsequent risk of leukemia and brain tumors - Lancet http://goo.gl/44feV

The articles were selected from my Twitter and Google Reader streams. Please feel free to send suggestions for articles to clinicalcases@gmail.com and you will receive acknowledgement in the next edition of this publication.

Thyrotoxicosis - Lancet 2012 review

Thyrotoxicosis is a common disorder, especially in women. Thyroid disease affects 7 times more women than men.

Etiology

There are 3 main causes of thyrotoxicosis: Graves' disease, toxic nodular hyperthyroidism, and thyroiditis.

Here are some more details about them:

- Graves' disease (autoimmune hyperthyroidism) is the most frequent cause of thyrotoxicosis
- toxic nodular hyperthyroidism, due to the presence of one or more autonomously functioning thyroid nodules
- thyroiditis caused by inflammation, which results in release of stored hormones

Treatment

The available treatments for thyrotoxicosis have been unchanged for 60 years.

Antithyroid drugs are the usual initial treatment. Thionamides such as carbimazole or its active metabolite methimazole are the drugs of choice.

A prolonged course leads to remission of Graves' hyperthyroidism in only 30% of cases.

Because of this low remission rate in Graves' disease (only 30%) and the inability to cure toxic nodular hyperthyroidism with antithyroid drugs alone, radioiodine is increasingly used as first line therapy. It is the preferred choice for relapsed Graves' hyperthyroidism.

Surgery with total thyroidectomy is an option in selected cases. .

References:

Thyrotoxicosis. The Lancet, Volume 379, Issue 9821, Pages 1155 - 1166, 24 March 2012.

Thyroid disease—more research needed. The Lancet, Volume 379, Issue 9821, Page 1076, 24 March 2012.

Image source: Wikipedia, public domain.

Top medicine articles for September 2012

Here are my suggestions for some of the top articles in medicine for August 2012:

More than 30% of hospital patients have test result pending/not reviewed by the time they're discharged http://goo.gl/CCBxr

Corneal snowflakes due to IgG-kappa multiple myeloma - The Lancet images http://goo.gl/FvGBM

Biliary ileus - The Lancet images http://goo.gl/Iv18H

Erectile Dysfunction (ED) as a Reliable Proxy of General Male Health Status regardless of the etiology of ED http://goo.gl/y3kjA

Higher BPA Levels, More Heart Disease? http://goo.gl/10UUi

More Self-Control as a Child, Lower BMI as Adult (study) http://goo.gl/FElcw

FDA approved the first generic version of Actos (Pioglitazone) to treat adults with type 2 diabetes http://goo.gl/kUq9k

Mississippi has the highest proportion of obese adults at 35%, and Colorado has the lowest at 21% (survey) http://goo.gl/JDD6C

"GSK drug halves attacks in hard-to-treat asthma" - anti-IL5 antibody mepolizumab for eosinophilic asthma http://goo.gl/Be6IU

New Epinephrine Auto-Injector Talks Patients Through Injection Process, has a 5-sec countdown, signaling lights http://goo.gl/rYJZI

Autoinflammatory syndromes: Fever is not always a sign of infection - CCJM http://goo.gl/uTc2X

Genetic counselors: Your partners in clinical practice - CCJM http://goo.gl/ZkJb4

Atrial fibrillation: New drugs, devices, and procedures - CCJM http://goo.gl/O0AQN

The demise of the stethoscope as a metaphor of the “hyposkillia” of our times - CCJM http://goo.gl/xu5qS -- An argument for reviving the disappearing skill of cardiac auscultation - CCJM http://goo.gl/59ikK

Dark chocolate can help decrease blood pressure by 2-3 mmHg http://goo.gl/xTnn1

Eating egg yolks as 'bad as smoking' - NHS Choices blog reviews the evidence http://goo.gl/IosBG

30% of new prescriptions never get filled. Will smart pills boost drug compliance? http://goo.gl/omhjJ

Small practices may be least able to take new Medicaid patients - NJ Medicaid physicians get paid 37% of Medicare rates http://goo.gl/g3RLN

4 ways for practices to benefit from a social media presence: Offer information beyond the appointment, Raise physician profiles, Influence online search, Marketing toolkit http://goo.gl/5mAz4

The articles were selected from my Twitter and Google Reader streams. Please feel free to send suggestions for articles to clinicalcases@gmail.com and you will receive acknowledgement in the next edition of this publication.

Chronic insomnia - Lancet 2012 review

Insomnia is a common condition that can present independently or comorbidly with another medical or psychiatric disorder.

Treatment of chronic insomnia

Benzodiazepine-receptor agonists (BzRAs) and cognitive-behavioural therapy (CBT) are supported by the best empirical evidence.

Benzodiazepine-receptor agonists (BzRAs) are effective in the short-term management of insomnia, but evidence of long-term efficacy is scarce. Also, most hypnotic drugs are associated with potential adverse effects.

Cognitive-behavioural therapy (CBT) is an effective alternative for chronic insomnia.

CBT is more time consuming than drug management but it produces sleep improvements that are sustained over time.

However, CBT is not readily available in most clinical settings. Access and delivery can be made easier through:

- telephone consultations
- group therapy
- self-help approaches

How to succeed? Get more sleep



In this 4-minute talk, Arianna Huffington (founder of The Huffington Post) shares a small idea that can awaken much bigger ones: the power of a good night's sleep. Instead of bragging about our sleep deficits, she urges us to sleep our way to increased productivity and happiness -- and smarter decision-making.

References:

Chronic insomnia. The Lancet, Volume 379, Issue 9821, Pages 1129 - 1141, 24 March 2012.
Image source: A halo around the Moon. Wikipedia, GNU Free Documentation License.

Brain Tumor Symptoms

Brain Tumor Symptoms, the reason that many people nowadays to get a brain tumor is because of the fact that there has been a lot of stress in the people of today, and tumors are generally formed due to such effect. The most common symptom of a brain tumor a splitting headache, that is common with a lot of people who have been suffering from brain tumor. If you have a splitting headache, and you feel that it is migraine, and even after a lot of medication from migraine if you feel that the headache is not yet over, then it is best that you get yourself a cat scan, and get the reason checked out.

In most circumstances, the symptoms of a brain tumor is vomiting, along with splitting headache, and you would also get seizures for a long time, as well as you would find yourself getting strokes, that can result in you spewing out blood from your mouth, and also the vomiting which will take place after wards, will be comprised of solid food from your body, and some acids from the gastric intestines of your body. To be sure that you have a blood tumor, consult with your doctor and get the required tests done.



More For Brain Tumor Symptoms

- Headaches
- Sickness
- Drowsiness
- Problems with your eyes
- Fits (seizures)

Other general symptoms,

* Changes in personality
* Swearing or behaving in a way that you normally wouldn't (loss of inhibitions)
* Losing interest in life (apathy)
* Difficulty with planning and organising
* Being irritable or aggressive
* Weakness in part of the face, or on one side of the body
* Difficulty walking
* Loss of sense of smell
* Problems with your sight or speech

* Forgetting words
* Short term memory loss
* Fits associated with strange feelings, smells or déjà vu (a feeling you have been somewhere or done something before)

* Difficulty speaking or understanding what is said to you
* Problems with reading or writing
* Loss of feeling in part of the body


Brain Tumor Pictures And Images

Breast Cancer Symptoms | Symptoms Of Breast Cancer

Breast Cancer Symptoms | Symptoms Of Breast Cancer, as the name suggests, breast Cancer is actually the cancerous elements being lodged in the breast. There is a high amount of ratio of breast cancer occurring among women all over the world, and it can be very fatal to the women having it. There are many cases in which there is always a recurrence of breast cancer in the person undergoing treatment, and giving to hormonal therapy, chemotherapy and radiation therapy is not that good an option, but it is our only option that we have against our fight with breast cancer .

The early symptoms of this breast cancer can vary with many people, and even if you do have breast cancer, sometimes they may go undetected for a long period of time until a less they turn cancerous. Most of the breast Cancer symptoms actually are the occurrence of a small lump within the breast, in a very small quantity, and they can actually mutate to become a very large object if left untreated for a long period of time. If you happen to find a small lump in the breast that you cannot explain, then it is high time for you to visit a doctor and get yourself checked out for breast cancer.


More For Breast Cancer Symptoms | Symptoms Of Breast Cancer

* Breast lump or lump in the armpit that is hard, has uneven edges, and usually does not hurt
* Change in the size, shape, or feel of the breast or nipple -- for example, you may have redness, dimpling, or puckering that looks like the skin of an orange
* Fluid coming from the nipple -- may be bloody, clear to yellow, green, and look like pus

Men get breast cancer, too. Symptoms include breast lump and breast pain and tenderness.

Symptoms of advanced breast cancer may include:

* Bone pain
* Breast pain or discomfort
* Skin ulcers
* Swelling of one arm (next to breast with cancer)
* Weight loss


Breast Cancer Pictures And Images

Rosacea - NHS Choices video

From NHS Choices YouTube channel: Rosacea is a common but poorly understood long-term skin condition that mainly affects the face. It most commonly affects fair-skinned people from northern Europe and is estimated to affect up to 1 in 10 people. In this video, an expert explains what rosacea is, the symptoms to look out for and the various treatments.



Cathelicidin dysfunction may be a central factor in the pathogenesis of several cutaneous diseases, including rosacea.

Cathelicidins are antimicrobial peptides (AMPs) that protect the skin through 2 pathways:

- antimicrobial activity
- cytokine release, inflammation, angiogenesis, and reepithelialization

Top medicine articles for August 2012

Here are my suggestions for some of the top articles in medicine for August 2012:

Sanofi Announces FDA Approval for Auvi-Q, First Voice-guided Epinephrine Auto-injector http://goo.gl/4GfPr

Medical Journal of Australia: "Clearly, we overestimate our ability to correctly deploy tests and interpret results" http://goo.gl/q8da8

Drug Resistance Claims Another Gonorrhea Treatment: the oral cephalosporin cefixime http://goo.gl/tR2LW

Social media continues to excel at reaching patients and medical peers http://goo.gl/odKGo

New drugs, procedures, and devices for hypertension : The Lancet http://goo.gl/IbwbL

Data challenge the concept that raising of plasma HDL cholesterol will reduce risk of myocardial infarction http://goo.gl/67eZF

10 Ways to Make EMR Meaningful and Useful http://goo.gl/KimDJ

Tiger snake (Notechis spp) envenoming: Australian Snakebite Project (ASP-13) | Medical Journal of Australia http://goo.gl/YCzRg

Bias in clinical history significantly influenced the accuracy of ECG interpretation http://goo.gl/JjRd6

9 Smartphone Apps to Improve Your Medical Practice http://goo.gl/nUjNP -- 15 Smartphone Apps to Improve Your Practice http://goo.gl/s3dnR

How to Raise Successful (and Happier) Children - NYTimes http://buff.ly/MT4BRr

When metformin alone is insufficient, consider adding a dipeptidyl peptidase-4 inhibitor, linagliptin - Lancet http://goo.gl/bdMkG

Ciprofloxacin for 7 days versus 14 d. in women with acute pyelonephritis: Short courses should be favored - Lancet http://goo.gl/oU3uC

Radiation exposure from CT scans in childhood increases subsequent risk of leukemia and brain tumors - Lancet http://goo.gl/44feV

The articles were selected from my Twitter and Google Reader streams. Please feel free to send suggestions for articles to clinicalcases@gmail.com and you will receive acknowledgement in the next edition of this publication.

Thyrotoxicosis - Lancet 2012 review

Thyrotoxicosis is a common disorder, especially in women. Thyroid disease affects 7 times more women than men.

Etiology

There are 3 main causes of thyrotoxicosis: Graves' disease, toxic nodular hyperthyroidism, and thyroiditis.

Here are some more details about them:

- Graves' disease (autoimmune hyperthyroidism) is the most frequent cause of thyrotoxicosis
- toxic nodular hyperthyroidism, due to the presence of one or more autonomously functioning thyroid nodules
- thyroiditis caused by inflammation, which results in release of stored hormones

Treatment

The available treatments for thyrotoxicosis have been unchanged for 60 years.

Antithyroid drugs are the usual initial treatment. Thionamides such as carbimazole or its active metabolite methimazole are the drugs of choice.

A prolonged course leads to remission of Graves' hyperthyroidism in only 30% of cases.

Because of this low remission rate in Graves' disease (only 30%) and the inability to cure toxic nodular hyperthyroidism with antithyroid drugs alone, radioiodine is increasingly used as first line therapy. It is the preferred choice for relapsed Graves' hyperthyroidism.

Surgery with total thyroidectomy is an option in selected cases. .

References:

Thyrotoxicosis. The Lancet, Volume 379, Issue 9821, Pages 1155 - 1166, 24 March 2012.

Thyroid disease—more research needed. The Lancet, Volume 379, Issue 9821, Page 1076, 24 March 2012.

Image source: Wikipedia, public domain.

Top medicine articles for September 2012

Here are my suggestions for some of the top articles in medicine for August 2012:

More than 30% of hospital patients have test result pending/not reviewed by the time they're discharged http://goo.gl/CCBxr

Corneal snowflakes due to IgG-kappa multiple myeloma - The Lancet images http://goo.gl/FvGBM

Biliary ileus - The Lancet images http://goo.gl/Iv18H

Erectile Dysfunction (ED) as a Reliable Proxy of General Male Health Status regardless of the etiology of ED http://goo.gl/y3kjA

Higher BPA Levels, More Heart Disease? http://goo.gl/10UUi

More Self-Control as a Child, Lower BMI as Adult (study) http://goo.gl/FElcw

FDA approved the first generic version of Actos (Pioglitazone) to treat adults with type 2 diabetes http://goo.gl/kUq9k

Mississippi has the highest proportion of obese adults at 35%, and Colorado has the lowest at 21% (survey) http://goo.gl/JDD6C

"GSK drug halves attacks in hard-to-treat asthma" - anti-IL5 antibody mepolizumab for eosinophilic asthma http://goo.gl/Be6IU

New Epinephrine Auto-Injector Talks Patients Through Injection Process, has a 5-sec countdown, signaling lights http://goo.gl/rYJZI

Autoinflammatory syndromes: Fever is not always a sign of infection - CCJM http://goo.gl/uTc2X

Genetic counselors: Your partners in clinical practice - CCJM http://goo.gl/ZkJb4

Atrial fibrillation: New drugs, devices, and procedures - CCJM http://goo.gl/O0AQN

The demise of the stethoscope as a metaphor of the “hyposkillia” of our times - CCJM http://goo.gl/xu5qS -- An argument for reviving the disappearing skill of cardiac auscultation - CCJM http://goo.gl/59ikK

Dark chocolate can help decrease blood pressure by 2-3 mmHg http://goo.gl/xTnn1

Eating egg yolks as 'bad as smoking' - NHS Choices blog reviews the evidence http://goo.gl/IosBG

30% of new prescriptions never get filled. Will smart pills boost drug compliance? http://goo.gl/omhjJ

Small practices may be least able to take new Medicaid patients - NJ Medicaid physicians get paid 37% of Medicare rates http://goo.gl/g3RLN

4 ways for practices to benefit from a social media presence: Offer information beyond the appointment, Raise physician profiles, Influence online search, Marketing toolkit http://goo.gl/5mAz4

The articles were selected from my Twitter and Google Reader streams. Please feel free to send suggestions for articles to clinicalcases@gmail.com and you will receive acknowledgement in the next edition of this publication.

Chronic insomnia - Lancet 2012 review

Insomnia is a common condition that can present independently or comorbidly with another medical or psychiatric disorder.

Treatment of chronic insomnia

Benzodiazepine-receptor agonists (BzRAs) and cognitive-behavioural therapy (CBT) are supported by the best empirical evidence.

Benzodiazepine-receptor agonists (BzRAs) are effective in the short-term management of insomnia, but evidence of long-term efficacy is scarce. Also, most hypnotic drugs are associated with potential adverse effects.

Cognitive-behavioural therapy (CBT) is an effective alternative for chronic insomnia.

CBT is more time consuming than drug management but it produces sleep improvements that are sustained over time.

However, CBT is not readily available in most clinical settings. Access and delivery can be made easier through:

- telephone consultations
- group therapy
- self-help approaches

How to succeed? Get more sleep



In this 4-minute talk, Arianna Huffington (founder of The Huffington Post) shares a small idea that can awaken much bigger ones: the power of a good night's sleep. Instead of bragging about our sleep deficits, she urges us to sleep our way to increased productivity and happiness -- and smarter decision-making.

References:

Chronic insomnia. The Lancet, Volume 379, Issue 9821, Pages 1129 - 1141, 24 March 2012.
Image source: A halo around the Moon. Wikipedia, GNU Free Documentation License.

Brain Tumor Symptoms

Brain Tumor Symptoms, the reason that many people nowadays to get a brain tumor is because of the fact that there has been a lot of stress in the people of today, and tumors are generally formed due to such effect. The most common symptom of a brain tumor a splitting headache, that is common with a lot of people who have been suffering from brain tumor. If you have a splitting headache, and you feel that it is migraine, and even after a lot of medication from migraine if you feel that the headache is not yet over, then it is best that you get yourself a cat scan, and get the reason checked out.

In most circumstances, the symptoms of a brain tumor is vomiting, along with splitting headache, and you would also get seizures for a long time, as well as you would find yourself getting strokes, that can result in you spewing out blood from your mouth, and also the vomiting which will take place after wards, will be comprised of solid food from your body, and some acids from the gastric intestines of your body. To be sure that you have a blood tumor, consult with your doctor and get the required tests done.



More For Brain Tumor Symptoms

- Headaches
- Sickness
- Drowsiness
- Problems with your eyes
- Fits (seizures)

Other general symptoms,

* Changes in personality
* Swearing or behaving in a way that you normally wouldn't (loss of inhibitions)
* Losing interest in life (apathy)
* Difficulty with planning and organising
* Being irritable or aggressive
* Weakness in part of the face, or on one side of the body
* Difficulty walking
* Loss of sense of smell
* Problems with your sight or speech

* Forgetting words
* Short term memory loss
* Fits associated with strange feelings, smells or déjà vu (a feeling you have been somewhere or done something before)

* Difficulty speaking or understanding what is said to you
* Problems with reading or writing
* Loss of feeling in part of the body


Brain Tumor Pictures And Images

Breast Cancer Symptoms | Symptoms Of Breast Cancer

Breast Cancer Symptoms | Symptoms Of Breast Cancer, as the name suggests, breast Cancer is actually the cancerous elements being lodged in the breast. There is a high amount of ratio of breast cancer occurring among women all over the world, and it can be very fatal to the women having it. There are many cases in which there is always a recurrence of breast cancer in the person undergoing treatment, and giving to hormonal therapy, chemotherapy and radiation therapy is not that good an option, but it is our only option that we have against our fight with breast cancer .

The early symptoms of this breast cancer can vary with many people, and even if you do have breast cancer, sometimes they may go undetected for a long period of time until a less they turn cancerous. Most of the breast Cancer symptoms actually are the occurrence of a small lump within the breast, in a very small quantity, and they can actually mutate to become a very large object if left untreated for a long period of time. If you happen to find a small lump in the breast that you cannot explain, then it is high time for you to visit a doctor and get yourself checked out for breast cancer.


More For Breast Cancer Symptoms | Symptoms Of Breast Cancer

* Breast lump or lump in the armpit that is hard, has uneven edges, and usually does not hurt
* Change in the size, shape, or feel of the breast or nipple -- for example, you may have redness, dimpling, or puckering that looks like the skin of an orange
* Fluid coming from the nipple -- may be bloody, clear to yellow, green, and look like pus

Men get breast cancer, too. Symptoms include breast lump and breast pain and tenderness.

Symptoms of advanced breast cancer may include:

* Bone pain
* Breast pain or discomfort
* Skin ulcers
* Swelling of one arm (next to breast with cancer)
* Weight loss


Breast Cancer Pictures And Images

Brain Tumor Symptoms

Brain Tumor Symptoms, the reason that many people nowadays to get a brain tumor is because of the fact that there has been a lot of stress in the people of today, and tumors are generally formed due to such effect. The most common symptom of a brain tumor a splitting headache, that is common with a lot of people who have been suffering from brain tumor. If you have a splitting headache, and you feel that it is migraine, and even after a lot of medication from migraine if you feel that the headache is not yet over, then it is best that you get yourself a cat scan, and get the reason checked out.

In most circumstances, the symptoms of a brain tumor is vomiting, along with splitting headache, and you would also get seizures for a long time, as well as you would find yourself getting strokes, that can result in you spewing out blood from your mouth, and also the vomiting which will take place after wards, will be comprised of solid food from your body, and some acids from the gastric intestines of your body. To be sure that you have a blood tumor, consult with your doctor and get the required tests done.



More For Brain Tumor Symptoms

- Headaches
- Sickness
- Drowsiness
- Problems with your eyes
- Fits (seizures)

Other general symptoms,

* Changes in personality
* Swearing or behaving in a way that you normally wouldn't (loss of inhibitions)
* Losing interest in life (apathy)
* Difficulty with planning and organising
* Being irritable or aggressive
* Weakness in part of the face, or on one side of the body
* Difficulty walking
* Loss of sense of smell
* Problems with your sight or speech

* Forgetting words
* Short term memory loss
* Fits associated with strange feelings, smells or déjà vu (a feeling you have been somewhere or done something before)

* Difficulty speaking or understanding what is said to you
* Problems with reading or writing
* Loss of feeling in part of the body


Brain Tumor Pictures And Images