To contact us Click HERE
Bell’s palsy is the abrupt paralysis of the facial nerve (cranial nerve 7, CN7), resulting in an inability to control facial muscles on the affected side. A common condition, Bell’s palsy has an annual incidence of 11-40 cases per 100 ,000 population. Many patients recover without intervention; however, up to 30% have poor recovery of facial muscle control and experience facial disfigurement, psychological trauma, and facial pain.
From the NHS Choices YouTube channel: Bell's palsy is the temporary weakness or paralysis of the muscles in one side of the face. In this video, a speech therapist explains who is most at risk and describes common causes and treatment options available. Helen explains how she dealt with the condition and recovered from it:
Remember:
U MN damage
U pper face is OK (the patient is able to wrinkle his forehead)
LMN damage = patient is unable to wrinkle his forehead (our patient)
The examination of CN 7 palsy can be remembered by the mnemonic COWS:
C lose your eyes
O pen (the examining physician tries to open the patient's eyes)
W rinkle your forehead
S mile
Two main types of pharmacological treatment have been used to improve outcomes from Bell’s palsy:
- steroids
- antivirals.
The rationale for these treatments is based on the presumed pathophysiology of Bell’s palsy, namely inflammation and viral infection.
In a 2009 study published in the BMJ antivirals did not provide an added benefit in achieving at least partial facial muscle recovery compared with steroids alone in patients with Bell’s palsy.
References:
The benefits of steroids versus steroids plus antivirals for treatment of Bell’s palsy: a meta-analysis | BMJ http://bit.ly/YD3iLG
31 Aralık 2012 Pazartesi
Long Live Rock 'n' Roll? Study Shows Risk to Stars (video)
To contact us Click HERE
A new study from the United Kingdom (BMJ) reveals just how risky rock-and-roll can be - WSJ:
The WSJ summarized the findings of the study published in BMJ:
The research examined 1,489 stars of pop, rock, hip-hop and punk, of whom 137, or 9.2%, died during the five-decade period covered by the study. Nearly 39% of those deaths were caused by factors related to violence or alcohol and drug intake.
North American pop stars were 87.6% as likely to be alive as normal people of the same age and ethnicity—the lowest survival rate of any group identified in the study.
In North America, 23% of solo performers died, versus 10% of band-only stars, the study found. The comparable figures for Europe were 10% versus 5%.
The study doesn't address a widely held belief that drummers are more prone to early death than other musicians.
References:
Long Live Rock 'n' Roll? Study Shows Risk to Stars - WSJ.com http://on.wsj.com/V8O79a
The WSJ summarized the findings of the study published in BMJ:
The research examined 1,489 stars of pop, rock, hip-hop and punk, of whom 137, or 9.2%, died during the five-decade period covered by the study. Nearly 39% of those deaths were caused by factors related to violence or alcohol and drug intake.
North American pop stars were 87.6% as likely to be alive as normal people of the same age and ethnicity—the lowest survival rate of any group identified in the study.
In North America, 23% of solo performers died, versus 10% of band-only stars, the study found. The comparable figures for Europe were 10% versus 5%.
The study doesn't address a widely held belief that drummers are more prone to early death than other musicians.
References:
Long Live Rock 'n' Roll? Study Shows Risk to Stars - WSJ.com http://on.wsj.com/V8O79a
"We had a very simple idea, that's to see the warmth"
To contact us Click HERE
This ad was created for a Belgian natural gas company. The purpose was to show the TV audience what "warm looks like", says director Olivier Babinet.
"The idea of the film is simple. How to visualize the warmth of natural gas? By the use of the stop motion technic, we see how warmth spreads through the house as knitted wool."
Here is how they did it, carefully attaching yards of yarn to walls, radiators, and pipes, 40 people working 4 days and nights:
References:
It's December. Brrrr. Is My House Shivering? Krulwich Wonders. NPR http://n.pr/Y97YmJ
A house that knits itself | Colossal http://bit.ly/Y98xNl
This ad was created for a Belgian natural gas company. The purpose was to show the TV audience what "warm looks like", says director Olivier Babinet.
"The idea of the film is simple. How to visualize the warmth of natural gas? By the use of the stop motion technic, we see how warmth spreads through the house as knitted wool."
Here is how they did it, carefully attaching yards of yarn to walls, radiators, and pipes, 40 people working 4 days and nights:
References:
It's December. Brrrr. Is My House Shivering? Krulwich Wonders. NPR http://n.pr/Y97YmJ
A house that knits itself | Colossal http://bit.ly/Y98xNl
27 Aralık 2012 Perşembe
Bell's palsy - NHS video
To contact us Click HERE
Bell’s palsy is the abrupt paralysis of the facial nerve (cranial nerve 7, CN7), resulting in an inability to control facial muscles on the affected side. A common condition, Bell’s palsy has an annual incidence of 11-40 cases per 100 ,000 population. Many patients recover without intervention; however, up to 30% have poor recovery of facial muscle control and experience facial disfigurement, psychological trauma, and facial pain.
From the NHS Choices YouTube channel: Bell's palsy is the temporary weakness or paralysis of the muscles in one side of the face. In this video, a speech therapist explains who is most at risk and describes common causes and treatment options available. Helen explains how she dealt with the condition and recovered from it:
Remember:
U MN damage
U pper face is OK (the patient is able to wrinkle his forehead)
LMN damage = patient is unable to wrinkle his forehead (our patient)
The examination of CN 7 palsy can be remembered by the mnemonic COWS:
C lose your eyes
O pen (the examining physician tries to open the patient's eyes)
W rinkle your forehead
S mile
Two main types of pharmacological treatment have been used to improve outcomes from Bell’s palsy:
- steroids
- antivirals.
The rationale for these treatments is based on the presumed pathophysiology of Bell’s palsy, namely inflammation and viral infection.
In a 2009 study published in the BMJ antivirals did not provide an added benefit in achieving at least partial facial muscle recovery compared with steroids alone in patients with Bell’s palsy.
References:
The benefits of steroids versus steroids plus antivirals for treatment of Bell’s palsy: a meta-analysis | BMJ http://bit.ly/YD3iLG
From the NHS Choices YouTube channel: Bell's palsy is the temporary weakness or paralysis of the muscles in one side of the face. In this video, a speech therapist explains who is most at risk and describes common causes and treatment options available. Helen explains how she dealt with the condition and recovered from it:
Remember:
U MN damage
U pper face is OK (the patient is able to wrinkle his forehead)
LMN damage = patient is unable to wrinkle his forehead (our patient)
The examination of CN 7 palsy can be remembered by the mnemonic COWS:
C lose your eyes
O pen (the examining physician tries to open the patient's eyes)
W rinkle your forehead
S mile
Two main types of pharmacological treatment have been used to improve outcomes from Bell’s palsy:
- steroids
- antivirals.
The rationale for these treatments is based on the presumed pathophysiology of Bell’s palsy, namely inflammation and viral infection.
In a 2009 study published in the BMJ antivirals did not provide an added benefit in achieving at least partial facial muscle recovery compared with steroids alone in patients with Bell’s palsy.
References:
The benefits of steroids versus steroids plus antivirals for treatment of Bell’s palsy: a meta-analysis | BMJ http://bit.ly/YD3iLG
Credit Card Germs: 1 of 10 of cards has fecal bacteria
To contact us Click HERE
Here is what a Cleveland Clinic ID specialist has to say: "You know all that money you're spending over the holidays? It's jam-packed with germs. So keep your hands clean and your credit cards wiped down. Avoid touching your eyes and mouth when out shopping."
What are the 8 germiest places in the mall?
The 8 germiest places in the mall, according to CNN, are:
1. Restroom sinks
2. Food court tables
3. Escalator handrails
4. ATM keypads
5. Toy stores
6. Fitting rooms
7. Gadget shops
8. Makeup samples
The filthiest area in a restroom (and therefore in the whole mall) isn't the toilet handle or the doorknob - it's the sink. The sink area is a moist environment, so bacteria can survive longer there.
Researchers found food, E. coli, urine, mucus, feces, and blood on escalator handrails. Where there is mucus, you may also find cold and flu viruses.
Each key on an ATM contains, on average, 1,200 germs. Protect yourself: "Knuckle" ATM buttons.
References:
The 8 germiest places in the mall. CNN.
12 Germiest Places in America According to Health Magazine
Dirty Money and Credit Card Germs - Health Hub from Cleveland Clinic http://bit.ly/TRLSoQ
What are the 8 germiest places in the mall?
The 8 germiest places in the mall, according to CNN, are:
1. Restroom sinks
2. Food court tables
3. Escalator handrails
4. ATM keypads
5. Toy stores
6. Fitting rooms
7. Gadget shops
8. Makeup samples
The filthiest area in a restroom (and therefore in the whole mall) isn't the toilet handle or the doorknob - it's the sink. The sink area is a moist environment, so bacteria can survive longer there.
Researchers found food, E. coli, urine, mucus, feces, and blood on escalator handrails. Where there is mucus, you may also find cold and flu viruses.
Each key on an ATM contains, on average, 1,200 germs. Protect yourself: "Knuckle" ATM buttons.
References:
The 8 germiest places in the mall. CNN.
12 Germiest Places in America According to Health Magazine
Dirty Money and Credit Card Germs - Health Hub from Cleveland Clinic http://bit.ly/TRLSoQ
Long Live Rock 'n' Roll? Study Shows Risk to Stars (video)
To contact us Click HERE
A new study from the United Kingdom (BMJ) reveals just how risky rock-and-roll can be - WSJ:
The WSJ summarized the findings of the study published in BMJ:
The research examined 1,489 stars of pop, rock, hip-hop and punk, of whom 137, or 9.2%, died during the five-decade period covered by the study. Nearly 39% of those deaths were caused by factors related to violence or alcohol and drug intake.
North American pop stars were 87.6% as likely to be alive as normal people of the same age and ethnicity—the lowest survival rate of any group identified in the study.
In North America, 23% of solo performers died, versus 10% of band-only stars, the study found. The comparable figures for Europe were 10% versus 5%.
The study doesn't address a widely held belief that drummers are more prone to early death than other musicians.
References:
Long Live Rock 'n' Roll? Study Shows Risk to Stars - WSJ.com http://on.wsj.com/V8O79a
The WSJ summarized the findings of the study published in BMJ:
The research examined 1,489 stars of pop, rock, hip-hop and punk, of whom 137, or 9.2%, died during the five-decade period covered by the study. Nearly 39% of those deaths were caused by factors related to violence or alcohol and drug intake.
North American pop stars were 87.6% as likely to be alive as normal people of the same age and ethnicity—the lowest survival rate of any group identified in the study.
In North America, 23% of solo performers died, versus 10% of band-only stars, the study found. The comparable figures for Europe were 10% versus 5%.
The study doesn't address a widely held belief that drummers are more prone to early death than other musicians.
References:
Long Live Rock 'n' Roll? Study Shows Risk to Stars - WSJ.com http://on.wsj.com/V8O79a
20 Aralık 2012 Perşembe
Bell's palsy - NHS video
To contact us Click HERE
Bell’s palsy is the abrupt paralysis of the facial nerve (cranial nerve 7, CN7), resulting in an inability to control facial muscles on the affected side. A common condition, Bell’s palsy has an annual incidence of 11-40 cases per 100 ,000 population. Many patients recover without intervention; however, up to 30% have poor recovery of facial muscle control and experience facial disfigurement, psychological trauma, and facial pain.
From the NHS Choices YouTube channel: Bell's palsy is the temporary weakness or paralysis of the muscles in one side of the face. In this video, a speech therapist explains who is most at risk and describes common causes and treatment options available. Helen explains how she dealt with the condition and recovered from it:
Remember:
U MN damage
U pper face is OK (the patient is able to wrinkle his forehead)
LMN damage = patient is unable to wrinkle his forehead (our patient)
The examination of CN 7 palsy can be remembered by the mnemonic COWS:
C lose your eyes
O pen (the examining physician tries to open the patient's eyes)
W rinkle your forehead
S mile
Two main types of pharmacological treatment have been used to improve outcomes from Bell’s palsy:
- steroids
- antivirals.
The rationale for these treatments is based on the presumed pathophysiology of Bell’s palsy, namely inflammation and viral infection.
In a 2009 study published in the BMJ antivirals did not provide an added benefit in achieving at least partial facial muscle recovery compared with steroids alone in patients with Bell’s palsy.
References:
The benefits of steroids versus steroids plus antivirals for treatment of Bell’s palsy: a meta-analysis | BMJ http://bit.ly/YD3iLG
From the NHS Choices YouTube channel: Bell's palsy is the temporary weakness or paralysis of the muscles in one side of the face. In this video, a speech therapist explains who is most at risk and describes common causes and treatment options available. Helen explains how she dealt with the condition and recovered from it:
Remember:
U MN damage
U pper face is OK (the patient is able to wrinkle his forehead)
LMN damage = patient is unable to wrinkle his forehead (our patient)
The examination of CN 7 palsy can be remembered by the mnemonic COWS:
C lose your eyes
O pen (the examining physician tries to open the patient's eyes)
W rinkle your forehead
S mile
Two main types of pharmacological treatment have been used to improve outcomes from Bell’s palsy:
- steroids
- antivirals.
The rationale for these treatments is based on the presumed pathophysiology of Bell’s palsy, namely inflammation and viral infection.
In a 2009 study published in the BMJ antivirals did not provide an added benefit in achieving at least partial facial muscle recovery compared with steroids alone in patients with Bell’s palsy.
References:
The benefits of steroids versus steroids plus antivirals for treatment of Bell’s palsy: a meta-analysis | BMJ http://bit.ly/YD3iLG
Physician Communication PEARLS from Cleveland Clinic
To contact us Click HERE
The video features my former colleagues and hospital medicine stars Drs. Moises Auron and Vj Velez:
Some key messages:
- Establish rapport and plan an encounter with the patient
- Elicit the patient perspective using FIFE (function, ideas, fears and
expectations)
- Apply PEARLS (partnership, empathy, acknowledgment, respect,
legitimation and support) to convey empathy
- Incorporate the patient into decision making and education using ART
(ask, respond, tell)
References:
Relationship-Centered Communication for Physicians (PDF) from Cleveland Clinic Academy
Some key messages:
- Establish rapport and plan an encounter with the patient
- Elicit the patient perspective using FIFE (function, ideas, fears and
expectations)
- Apply PEARLS (partnership, empathy, acknowledgment, respect,
legitimation and support) to convey empathy
- Incorporate the patient into decision making and education using ART
(ask, respond, tell)
References:
Relationship-Centered Communication for Physicians (PDF) from Cleveland Clinic Academy
Top medicine articles for December 2012
To contact us Click HERE
Here are my suggestions for some of the top articles in medicine for December 2012:
How doctors on social media are changing the face of medicine - Twitter takes the debate worldwide http://buff.ly/PSRmBv
"The Family Doctor, Minus the M.D." - NYTimes keeps pushing the idea of "The Nurse as Family Doctor" http://buff.ly/R1rbn9
Air travel and chronic obstructive pulmonary disease: a new algorithm for pre-flight evaluation http://buff.ly/RMN37n
Long-term natural history of chronic obstructive pulmonary disease (COPD) http://buff.ly/RMNa2C
Among patients with CAD, CHF or HTN, continuing selective beta blockers during COPD hospitalisation appears to be safe http://buff.ly/RMOJO5
Hepatitis—Do you “C” it? Many infected adults do not know they have HCV http://bit.ly/URgBFx
Do Mentors Know Who They Are Mentoring? Columbia University Medical Center reviews the evidence http://bit.ly/URgVUC
Discovery of “vitamin” D began with childhood rickets. Nonskeletal effects of this hormone are now recognized http://bit.ly/URhdLk
The prevalence of eating breakfast daily was low in boys (47%) and girls (45%). Skipping meals, mainly breakfast, is associated with worse glucose and lipid levels in obese children and adolescents. http://bit.ly/URhGgF
Prevalence of erectile dysfunction in U.S. is 34%, 47% in Middle East. Risk factors: diabetes mellitus, HTN, CAD, obesity, stress, depression http://bit.ly/URjVAC
Phosphodiesterase Inhibitors use for ED in U.S.: 16% of men buy PDEi over the Internet (68% without prescription) http://bit.ly/URkvON
The Cost of Living Longer: The average rent at assisted-living facilities in U.S. is now $3,486 per month. The price of a private room at a nursing home is now $248 a day http://on.wsj.com/VSQ3Fs
Certain phrases in Latin carry both historic and modern significance. Top 10 Latin phrases for hospitalists: http://buff.ly/S2dCpa
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.
Here are my suggestions for some of the top articles in medicine for December 2012:How doctors on social media are changing the face of medicine - Twitter takes the debate worldwide http://buff.ly/PSRmBv
"The Family Doctor, Minus the M.D." - NYTimes keeps pushing the idea of "The Nurse as Family Doctor" http://buff.ly/R1rbn9
Air travel and chronic obstructive pulmonary disease: a new algorithm for pre-flight evaluation http://buff.ly/RMN37n
Long-term natural history of chronic obstructive pulmonary disease (COPD) http://buff.ly/RMNa2C
Among patients with CAD, CHF or HTN, continuing selective beta blockers during COPD hospitalisation appears to be safe http://buff.ly/RMOJO5
Hepatitis—Do you “C” it? Many infected adults do not know they have HCV http://bit.ly/URgBFx
Do Mentors Know Who They Are Mentoring? Columbia University Medical Center reviews the evidence http://bit.ly/URgVUC
Discovery of “vitamin” D began with childhood rickets. Nonskeletal effects of this hormone are now recognized http://bit.ly/URhdLk
The prevalence of eating breakfast daily was low in boys (47%) and girls (45%). Skipping meals, mainly breakfast, is associated with worse glucose and lipid levels in obese children and adolescents. http://bit.ly/URhGgF
Prevalence of erectile dysfunction in U.S. is 34%, 47% in Middle East. Risk factors: diabetes mellitus, HTN, CAD, obesity, stress, depression http://bit.ly/URjVAC
Phosphodiesterase Inhibitors use for ED in U.S.: 16% of men buy PDEi over the Internet (68% without prescription) http://bit.ly/URkvON
The Cost of Living Longer: The average rent at assisted-living facilities in U.S. is now $3,486 per month. The price of a private room at a nursing home is now $248 a day http://on.wsj.com/VSQ3Fs
Certain phrases in Latin carry both historic and modern significance. Top 10 Latin phrases for hospitalists: http://buff.ly/S2dCpa
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.
Credit Card Germs: 1 of 10 of cards has fecal bacteria on them
To contact us Click HERE
Here is what a Cleveland Clinic ID specialist has to say: "You know all that money you're spending over the holidays? It's jam-packed with germs. So keep your hands clean and your credit cards wiped down. Avoid touching your eyes and mouth when out shopping."
What are the 8 germiest places in the mall?
The 8 germiest places in the mall, according to CNN, are:
1. Restroom sinks
2. Food court tables
3. Escalator handrails
4. ATM keypads
5. Toy stores
6. Fitting rooms
7. Gadget shops
8. Makeup samples
The filthiest area in a restroom (and therefore in the whole mall) isn't the toilet handle or the doorknob - it's the sink. The sink area is a moist environment, so bacteria can survive longer there.
Researchers found food, E. coli, urine, mucus, feces, and blood on escalator handrails. Where there is mucus, you may also find cold and flu viruses.
Each key on an ATM contains, on average, 1,200 germs. Protect yourself: "Knuckle" ATM buttons.
References:
The 8 germiest places in the mall. CNN.
12 Germiest Places in America According to Health Magazine
What are the 8 germiest places in the mall?
The 8 germiest places in the mall, according to CNN, are:
1. Restroom sinks
2. Food court tables
3. Escalator handrails
4. ATM keypads
5. Toy stores
6. Fitting rooms
7. Gadget shops
8. Makeup samples
The filthiest area in a restroom (and therefore in the whole mall) isn't the toilet handle or the doorknob - it's the sink. The sink area is a moist environment, so bacteria can survive longer there.
Researchers found food, E. coli, urine, mucus, feces, and blood on escalator handrails. Where there is mucus, you may also find cold and flu viruses.
Each key on an ATM contains, on average, 1,200 germs. Protect yourself: "Knuckle" ATM buttons.
References:
The 8 germiest places in the mall. CNN.
12 Germiest Places in America According to Health Magazine
16 Aralık 2012 Pazar
Gout - Patrick's story - NHS video
To contact us Click HERE
From NHS Choices YouTube channel: Patrick, 54, was diagnosed with gout (a form of arthritis) 22 years ago. He describes the symptoms, treatment options and how he learned to live with the condition:
Here is a list of some of the new drugs for an old disease (gout):
Febuxostat is a non-purine-analogue inhibitor of xanthine oxidase that opened a new era in the treatment of gout.
Modified uricases
The use of modified uricases to rapidly reduce serum urate concentrations in patients with otherwise untreatable gout is progressing. Pegloticase, a pegylated uricase, is in development.
JAMA update, 08/2011: New Treatment Offers Hope for Patients With Severe Gout: pegloticase (Krystexxa) costs $2,500 per dose (http://goo.gl/gz9sO).
Drugs in development
Transport of uric acid in the renal proximal tubule and the inflammatory response to monosodium urate crystals (shown above) are targets for potential new treatments.
Several pipeline drugs for gout related to the targets above include:
- selective uricosuric drug RDEA594
- various interleukin-1 inhibitors. Canakinumab (trade name Ilaris) is a human monoclonal antibody targeted at interleukin-1 beta. It was rejected by the FDA panel in June 2011.
References:
Gout therapeutics: new drugs for an old disease. The Lancet, Volume 377, Issue 9760, Pages 165 - 177, 8 January 2011.
Diuretics, beta-blockers, ACEi, non-losartan ARBs associated with increased risk of gout vs. CCB lower risk. BMJ, 2012.
With FDA Approval, a Gout Drug Now Costs $5 Instead of Pennies - WSJ, 2011.
FDA Panel Rejects Gout Drug Canakinumab on Safety Concerns http://goo.gl/lO9uy
The strange story that links gout with the birth of the cocktail drinks. Lancet, 2012.
Comments from Twitter:
francis berenbaum @Larhumato: Gout explained by a patient. Very informative for medical students.
Here is a list of some of the new drugs for an old disease (gout):
Febuxostat is a non-purine-analogue inhibitor of xanthine oxidase that opened a new era in the treatment of gout.
Modified uricases
The use of modified uricases to rapidly reduce serum urate concentrations in patients with otherwise untreatable gout is progressing. Pegloticase, a pegylated uricase, is in development.
JAMA update, 08/2011: New Treatment Offers Hope for Patients With Severe Gout: pegloticase (Krystexxa) costs $2,500 per dose (http://goo.gl/gz9sO).
Drugs in development
Transport of uric acid in the renal proximal tubule and the inflammatory response to monosodium urate crystals (shown above) are targets for potential new treatments.
Several pipeline drugs for gout related to the targets above include:
- selective uricosuric drug RDEA594
- various interleukin-1 inhibitors. Canakinumab (trade name Ilaris) is a human monoclonal antibody targeted at interleukin-1 beta. It was rejected by the FDA panel in June 2011.
References:
Gout therapeutics: new drugs for an old disease. The Lancet, Volume 377, Issue 9760, Pages 165 - 177, 8 January 2011.
Diuretics, beta-blockers, ACEi, non-losartan ARBs associated with increased risk of gout vs. CCB lower risk. BMJ, 2012.
With FDA Approval, a Gout Drug Now Costs $5 Instead of Pennies - WSJ, 2011.
FDA Panel Rejects Gout Drug Canakinumab on Safety Concerns http://goo.gl/lO9uy
The strange story that links gout with the birth of the cocktail drinks. Lancet, 2012.
Comments from Twitter:
francis berenbaum @Larhumato: Gout explained by a patient. Very informative for medical students.
Bell's palsy - NHS video
To contact us Click HERE
Bell’s palsy is the abrupt paralysis of the facial nerve (cranial nerve 7, CN7), resulting in an inability to control facial muscles on the affected side. A common condition, Bell’s palsy has an annual incidence of 11-40 cases per 100 ,000 population. Many patients recover without intervention; however, up to 30% have poor recovery of facial muscle control and experience facial disfigurement, psychological trauma, and facial pain.
From the NHS Choices YouTube channel: Bell's palsy is the temporary weakness or paralysis of the muscles in one side of the face. In this video, a speech therapist explains who is most at risk and describes common causes and treatment options available. Helen explains how she dealt with the condition and recovered from it:
Remember:
U MN damage
U pper face is OK (the patient is able to wrinkle his forehead)
LMN damage = patient is unable to wrinkle his forehead (our patient)
The examination of CN 7 palsy can be remembered by the mnemonic COWS:
C lose your eyes
O pen (the examining physician tries to open the patient's eyes)
W rinkle your forehead
S mile
Two main types of pharmacological treatment have been used to improve outcomes from Bell’s palsy:
- steroids
- antivirals.
The rationale for these treatments is based on the presumed pathophysiology of Bell’s palsy, namely inflammation and viral infection.
In a 2009 study published in the BMJ antivirals did not provide an added benefit in achieving at least partial facial muscle recovery compared with steroids alone in patients with Bell’s palsy.
References:
The benefits of steroids versus steroids plus antivirals for treatment of Bell’s palsy: a meta-analysis | BMJ http://bit.ly/YD3iLG
From the NHS Choices YouTube channel: Bell's palsy is the temporary weakness or paralysis of the muscles in one side of the face. In this video, a speech therapist explains who is most at risk and describes common causes and treatment options available. Helen explains how she dealt with the condition and recovered from it:
Remember:
U MN damage
U pper face is OK (the patient is able to wrinkle his forehead)
LMN damage = patient is unable to wrinkle his forehead (our patient)
The examination of CN 7 palsy can be remembered by the mnemonic COWS:
C lose your eyes
O pen (the examining physician tries to open the patient's eyes)
W rinkle your forehead
S mile
Two main types of pharmacological treatment have been used to improve outcomes from Bell’s palsy:
- steroids
- antivirals.
The rationale for these treatments is based on the presumed pathophysiology of Bell’s palsy, namely inflammation and viral infection.
In a 2009 study published in the BMJ antivirals did not provide an added benefit in achieving at least partial facial muscle recovery compared with steroids alone in patients with Bell’s palsy.
References:
The benefits of steroids versus steroids plus antivirals for treatment of Bell’s palsy: a meta-analysis | BMJ http://bit.ly/YD3iLG
The #FOAMed revolution (Free Open Access Medical education)
To contact us Click HERE
From Mike Cadogan:
"The net effect of #FOAM has taken me quite by surprise (editor's note: #FOAMed is Free Open Access Medical education). Despite a complete lack of evidence, peer review, mission statements OR Big Pharma backing – the FOAMed revolution continues to infiltrate the psyche of the everyday healthcare professional. The ability to intelligently review, discuss and develop hypotheses, guidelines and issues; the sense of community; the sense of rebellious augmented learning and the joy of independence is rife…and contagious.
There are now an amazing 180 emergency medicine and critical care blogs. Bloggers write from 21 different countries. GMEP – ‘the Facebook of Medicine’ has just welcomed it’s 800th new member, 2 weeks after launch." http://buff.ly/12lzWzs
Here is my comment: Congratulations, Mike! These are amazing stats that illustrate an inspiring success! "Facebook of medicine", indeed. Let's keep it growing.
From Mike Cadogan: "The net effect of #FOAM has taken me quite by surprise (editor's note: #FOAMed is Free Open Access Medical education). Despite a complete lack of evidence, peer review, mission statements OR Big Pharma backing – the FOAMed revolution continues to infiltrate the psyche of the everyday healthcare professional. The ability to intelligently review, discuss and develop hypotheses, guidelines and issues; the sense of community; the sense of rebellious augmented learning and the joy of independence is rife…and contagious.
There are now an amazing 180 emergency medicine and critical care blogs. Bloggers write from 21 different countries. GMEP – ‘the Facebook of Medicine’ has just welcomed it’s 800th new member, 2 weeks after launch." http://buff.ly/12lzWzs
Here is my comment: Congratulations, Mike! These are amazing stats that illustrate an inspiring success! "Facebook of medicine", indeed. Let's keep it growing.
12 Aralık 2012 Çarşamba
Gout - Patrick's story - NHS video
To contact us Click HERE
From NHS Choices YouTube channel: Patrick, 54, was diagnosed with gout (a form of arthritis) 22 years ago. He describes the symptoms, treatment options and how he learned to live with the condition:
Here is a list of some of the new drugs for an old disease (gout):
Febuxostat is a non-purine-analogue inhibitor of xanthine oxidase that opened a new era in the treatment of gout.
Modified uricases
The use of modified uricases to rapidly reduce serum urate concentrations in patients with otherwise untreatable gout is progressing. Pegloticase, a pegylated uricase, is in development.
JAMA update, 08/2011: New Treatment Offers Hope for Patients With Severe Gout: pegloticase (Krystexxa) costs $2,500 per dose (http://goo.gl/gz9sO).
Drugs in development
Transport of uric acid in the renal proximal tubule and the inflammatory response to monosodium urate crystals (shown above) are targets for potential new treatments.
Several pipeline drugs for gout related to the targets above include:
- selective uricosuric drug RDEA594
- various interleukin-1 inhibitors. Canakinumab (trade name Ilaris) is a human monoclonal antibody targeted at interleukin-1 beta. It was rejected by the FDA panel in June 2011.
References:
Gout therapeutics: new drugs for an old disease. The Lancet, Volume 377, Issue 9760, Pages 165 - 177, 8 January 2011.
Diuretics, beta-blockers, ACEi, non-losartan ARBs associated with increased risk of gout vs. CCB lower risk. BMJ, 2012.
With FDA Approval, a Gout Drug Now Costs $5 Instead of Pennies - WSJ, 2011.
FDA Panel Rejects Gout Drug Canakinumab on Safety Concerns http://goo.gl/lO9uy
The strange story that links gout with the birth of the cocktail drinks. Lancet, 2012.
Comments from Twitter:
francis berenbaum @Larhumato: Gout explained by a patient. Very informative for medical students.
Here is a list of some of the new drugs for an old disease (gout):
Febuxostat is a non-purine-analogue inhibitor of xanthine oxidase that opened a new era in the treatment of gout.
Modified uricases
The use of modified uricases to rapidly reduce serum urate concentrations in patients with otherwise untreatable gout is progressing. Pegloticase, a pegylated uricase, is in development.
JAMA update, 08/2011: New Treatment Offers Hope for Patients With Severe Gout: pegloticase (Krystexxa) costs $2,500 per dose (http://goo.gl/gz9sO).
Drugs in development
Transport of uric acid in the renal proximal tubule and the inflammatory response to monosodium urate crystals (shown above) are targets for potential new treatments.
Several pipeline drugs for gout related to the targets above include:
- selective uricosuric drug RDEA594
- various interleukin-1 inhibitors. Canakinumab (trade name Ilaris) is a human monoclonal antibody targeted at interleukin-1 beta. It was rejected by the FDA panel in June 2011.
References:
Gout therapeutics: new drugs for an old disease. The Lancet, Volume 377, Issue 9760, Pages 165 - 177, 8 January 2011.
Diuretics, beta-blockers, ACEi, non-losartan ARBs associated with increased risk of gout vs. CCB lower risk. BMJ, 2012.
With FDA Approval, a Gout Drug Now Costs $5 Instead of Pennies - WSJ, 2011.
FDA Panel Rejects Gout Drug Canakinumab on Safety Concerns http://goo.gl/lO9uy
The strange story that links gout with the birth of the cocktail drinks. Lancet, 2012.
Comments from Twitter:
francis berenbaum @Larhumato: Gout explained by a patient. Very informative for medical students.
Bell's palsy - NHS video
To contact us Click HERE
Bell’s palsy is the abrupt paralysis of the facial nerve (cranial nerve 7, CN7), resulting in an inability to control facial muscles on the affected side. A common condition, Bell’s palsy has an annual incidence of 11-40 cases per 100 ,000 population. Many patients recover without intervention; however, up to 30% have poor recovery of facial muscle control and experience facial disfigurement, psychological trauma, and facial pain.
From the NHS Choices YouTube channel: Bell's palsy is the temporary weakness or paralysis of the muscles in one side of the face. In this video, a speech therapist explains who is most at risk and describes common causes and treatment options available. Helen explains how she dealt with the condition and recovered from it:
Remember:
U MN damage
U pper face is OK (the patient is able to wrinkle his forehead)
LMN damage = patient is unable to wrinkle his forehead (our patient)
The examination of CN 7 palsy can be remembered by the mnemonic COWS:
C lose your eyes
O pen (the examining physician tries to open the patient's eyes)
W rinkle your forehead
S mile
Two main types of pharmacological treatment have been used to improve outcomes from Bell’s palsy:
- steroids
- antivirals.
The rationale for these treatments is based on the presumed pathophysiology of Bell’s palsy, namely inflammation and viral infection.
In a 2009 study published in the BMJ antivirals did not provide an added benefit in achieving at least partial facial muscle recovery compared with steroids alone in patients with Bell’s palsy.
References:
The benefits of steroids versus steroids plus antivirals for treatment of Bell’s palsy: a meta-analysis | BMJ http://bit.ly/YD3iLG
From the NHS Choices YouTube channel: Bell's palsy is the temporary weakness or paralysis of the muscles in one side of the face. In this video, a speech therapist explains who is most at risk and describes common causes and treatment options available. Helen explains how she dealt with the condition and recovered from it:
Remember:
U MN damage
U pper face is OK (the patient is able to wrinkle his forehead)
LMN damage = patient is unable to wrinkle his forehead (our patient)
The examination of CN 7 palsy can be remembered by the mnemonic COWS:
C lose your eyes
O pen (the examining physician tries to open the patient's eyes)
W rinkle your forehead
S mile
Two main types of pharmacological treatment have been used to improve outcomes from Bell’s palsy:
- steroids
- antivirals.
The rationale for these treatments is based on the presumed pathophysiology of Bell’s palsy, namely inflammation and viral infection.
In a 2009 study published in the BMJ antivirals did not provide an added benefit in achieving at least partial facial muscle recovery compared with steroids alone in patients with Bell’s palsy.
References:
The benefits of steroids versus steroids plus antivirals for treatment of Bell’s palsy: a meta-analysis | BMJ http://bit.ly/YD3iLG
New additions to Diagnostic and Statistical Manual of Mental Disorders (DSM-5)
To contact us Click HERE
From TIME:
Doctors use the the Diagnostic and Statistical Manual of Mental Disorders (DSM)'s definitions to diagnose more 300 other conditions. Insurance companies use it to justify reimbursements; without a DSM code, mental-health patients and doctors usually don't get paid. DSM-5 is already so famous that it has its own website: http://dsm5.org
On Dec. 1, the American Psychiatric Association approved the fifth edition of the DSM which took 13 years and 1,500 mental-health experts to complete. They tried to approach mental disorders less as discrete illnesses, like leukemia, and more as problems on a continuum, like hypertension.
Here are a few of the new additions in DSM-5:
- Hoarding is included as a diagnosis, meaning those who can't get rid of ephemera can now seek reimbursement for therapy
- Binge eating was in the appendix for more than a decade, but now it's an official diagnosis
- Bereavement. The previous DSM said those in mourning don't necessarily qualify for depression therapy or medication. DSM-5 eliminates that exclusion.
- Excoriation, or skin picking, should be considered a mental illness according to DSM-5
References:
Redefining Mental Illness. TIME, 2012.
From TIME:Doctors use the the Diagnostic and Statistical Manual of Mental Disorders (DSM)'s definitions to diagnose more 300 other conditions. Insurance companies use it to justify reimbursements; without a DSM code, mental-health patients and doctors usually don't get paid. DSM-5 is already so famous that it has its own website: http://dsm5.org
On Dec. 1, the American Psychiatric Association approved the fifth edition of the DSM which took 13 years and 1,500 mental-health experts to complete. They tried to approach mental disorders less as discrete illnesses, like leukemia, and more as problems on a continuum, like hypertension.
Here are a few of the new additions in DSM-5:
- Hoarding is included as a diagnosis, meaning those who can't get rid of ephemera can now seek reimbursement for therapy
- Binge eating was in the appendix for more than a decade, but now it's an official diagnosis
- Bereavement. The previous DSM said those in mourning don't necessarily qualify for depression therapy or medication. DSM-5 eliminates that exclusion.
- Excoriation, or skin picking, should be considered a mental illness according to DSM-5
References:
Redefining Mental Illness. TIME, 2012.
11 Aralık 2012 Salı
Gout - Patrick's story - NHS video
To contact us Click HERE
From NHS Choices YouTube channel: Patrick, 54, was diagnosed with gout (a form of arthritis) 22 years ago. He describes the symptoms, treatment options and how he learned to live with the condition:
Here is a list of some of the new drugs for an old disease (gout):
Febuxostat is a non-purine-analogue inhibitor of xanthine oxidase that opened a new era in the treatment of gout.
Modified uricases
The use of modified uricases to rapidly reduce serum urate concentrations in patients with otherwise untreatable gout is progressing. Pegloticase, a pegylated uricase, is in development.
JAMA update, 08/2011: New Treatment Offers Hope for Patients With Severe Gout: pegloticase (Krystexxa) costs $2,500 per dose (http://goo.gl/gz9sO).
Drugs in development
Transport of uric acid in the renal proximal tubule and the inflammatory response to monosodium urate crystals (shown above) are targets for potential new treatments.
Several pipeline drugs for gout related to the targets above include:
- selective uricosuric drug RDEA594
- various interleukin-1 inhibitors. Canakinumab (trade name Ilaris) is a human monoclonal antibody targeted at interleukin-1 beta. It was rejected by the FDA panel in June 2011.
References:
Gout therapeutics: new drugs for an old disease. The Lancet, Volume 377, Issue 9760, Pages 165 - 177, 8 January 2011.
Diuretics, beta-blockers, ACEi, non-losartan ARBs associated with increased risk of gout vs. CCB lower risk. BMJ, 2012.
With FDA Approval, a Gout Drug Now Costs $5 Instead of Pennies - WSJ, 2011.
FDA Panel Rejects Gout Drug Canakinumab on Safety Concerns http://goo.gl/lO9uy
The strange story that links gout with the birth of the cocktail drinks. Lancet, 2012.
Comments from Twitter:
francis berenbaum @Larhumato: Gout explained by a patient. Very informative for medical students.
Here is a list of some of the new drugs for an old disease (gout):
Febuxostat is a non-purine-analogue inhibitor of xanthine oxidase that opened a new era in the treatment of gout.
Modified uricases
The use of modified uricases to rapidly reduce serum urate concentrations in patients with otherwise untreatable gout is progressing. Pegloticase, a pegylated uricase, is in development.
JAMA update, 08/2011: New Treatment Offers Hope for Patients With Severe Gout: pegloticase (Krystexxa) costs $2,500 per dose (http://goo.gl/gz9sO).
Drugs in development
Transport of uric acid in the renal proximal tubule and the inflammatory response to monosodium urate crystals (shown above) are targets for potential new treatments.
Several pipeline drugs for gout related to the targets above include:
- selective uricosuric drug RDEA594
- various interleukin-1 inhibitors. Canakinumab (trade name Ilaris) is a human monoclonal antibody targeted at interleukin-1 beta. It was rejected by the FDA panel in June 2011.
References:
Gout therapeutics: new drugs for an old disease. The Lancet, Volume 377, Issue 9760, Pages 165 - 177, 8 January 2011.
Diuretics, beta-blockers, ACEi, non-losartan ARBs associated with increased risk of gout vs. CCB lower risk. BMJ, 2012.
With FDA Approval, a Gout Drug Now Costs $5 Instead of Pennies - WSJ, 2011.
FDA Panel Rejects Gout Drug Canakinumab on Safety Concerns http://goo.gl/lO9uy
The strange story that links gout with the birth of the cocktail drinks. Lancet, 2012.
Comments from Twitter:
francis berenbaum @Larhumato: Gout explained by a patient. Very informative for medical students.
Bell's palsy - NHS video
To contact us Click HERE
Bell’s palsy is the abrupt paralysis of the facial nerve (cranial nerve 7, CN7), resulting in an inability to control facial muscles on the affected side. A common condition, Bell’s palsy has an annual incidence of 11-40 cases per 100 ,000 population. Many patients recover without intervention; however, up to 30% have poor recovery of facial muscle control and experience facial disfigurement, psychological trauma, and facial pain.
From the NHS Choices YouTube channel: Bell's palsy is the temporary weakness or paralysis of the muscles in one side of the face. In this video, a speech therapist explains who is most at risk and describes common causes and treatment options available. Helen explains how she dealt with the condition and recovered from it:
Remember:
U MN damage
U pper face is OK (the patient is able to wrinkle his forehead)
LMN damage = patient is unable to wrinkle his forehead (our patient)
The examination of CN 7 palsy can be remembered by the mnemonic COWS:
C lose your eyes
O pen (the examining physician tries to open the patient's eyes)
W rinkle your forehead
S mile
Two main types of pharmacological treatment have been used to improve outcomes from Bell’s palsy:
- steroids
- antivirals.
The rationale for these treatments is based on the presumed pathophysiology of Bell’s palsy, namely inflammation and viral infection.
In a 2009 study published in the BMJ antivirals did not provide an added benefit in achieving at least partial facial muscle recovery compared with steroids alone in patients with Bell’s palsy.
References:
The benefits of steroids versus steroids plus antivirals for treatment of Bell’s palsy: a meta-analysis | BMJ http://bit.ly/YD3iLG
From the NHS Choices YouTube channel: Bell's palsy is the temporary weakness or paralysis of the muscles in one side of the face. In this video, a speech therapist explains who is most at risk and describes common causes and treatment options available. Helen explains how she dealt with the condition and recovered from it:
Remember:
U MN damage
U pper face is OK (the patient is able to wrinkle his forehead)
LMN damage = patient is unable to wrinkle his forehead (our patient)
The examination of CN 7 palsy can be remembered by the mnemonic COWS:
C lose your eyes
O pen (the examining physician tries to open the patient's eyes)
W rinkle your forehead
S mile
Two main types of pharmacological treatment have been used to improve outcomes from Bell’s palsy:
- steroids
- antivirals.
The rationale for these treatments is based on the presumed pathophysiology of Bell’s palsy, namely inflammation and viral infection.
In a 2009 study published in the BMJ antivirals did not provide an added benefit in achieving at least partial facial muscle recovery compared with steroids alone in patients with Bell’s palsy.
References:
The benefits of steroids versus steroids plus antivirals for treatment of Bell’s palsy: a meta-analysis | BMJ http://bit.ly/YD3iLG
There are patients with "gluten sensitivity" in whom neither allergic nor autoimmune mechanisms can be identified
To contact us Click HERE
There are 3 main forms of gluten reactions:
- allergic (wheat allergy)
- autoimmune (celiac disease, dermatitis herpetiformis and gluten ataxia)
- possibly immune-mediated (gluten sensitivity)
From BMJ:
It is now becoming clear that, besides those with celiac disease or wheat allergy, there are patients with gluten sensitivity in whom neither allergic nor autoimmune mechanisms can be identified. It has been estimated that, for every person with celiac disease, there should be at least six or seven people with non-celiac gluten sensitivity. Gluten sensitivity may therefore affect 6-10% of the general population.
Patients with gluten sensitivity have negative immuno-allergy tests to wheat and negative celiac disease serology; normal endoscopy and biopsy; clinical symptoms that can overlap with those of celiac disease, irritable bowel syndrome, and wheat allergy; and they show a resolution of symptoms when started on a gluten-free diet.
Currently there are no laboratory biomarkers specific for gluten sensitivity, and the diagnosis is based on exclusion criteria; elimination of gluten-containing foods from the diet followed by an open challenge is most often used to establish whether health improves with the elimination or reduction of gluten from the patient’s diet.
New nomenclature and classifications are proposed (see the figures below).
3 million Americans are living with celiac disease
Celiac disease, an immune system reaction to gluten in the diet, is four times as common today as it was 50 years ago. Lack of awareness of celiac could be contributing to a delay of up to 11 years in diagnosis of adults in North America (http://goo.gl/sy778).
This is an informative and beautifully designed video by the University of Chicago Celiac Disease Center. It looks like an infographic made into video - have a look:
New classification is being proposed for gluten-related disorders: celiac disease; dermatitis herpetiformis; gluten ataxia; wheat allergy; gluten sensitivity. WSJ, 2012.
Recent studies support the existence of the new condition nonceliac gluten sensitivity which is defined as symptoms with negative celiac antibodies and biopsy (http://goo.gl/57IlB).
References:
Non-coeliac gluten sensitivity | BMJ, 2012.
New nomenclature and classification of gluten-related disorders - http://www.biomedcentral.com/1741-7015/10/13/figure/F1
Algorithm for the differential diagnosis of gluten-related disorders, including celiac disease, gluten sensitivity and wheat allergy - http://www.biomedcentral.com/1741-7015/10/13/figure/F4
Spectrum of gluten-related disorders: consensus on new nomenclature and classification. Anna Sapone et al. BMC Medicine 2012, 10:13 doi:10.1186/1741-7015-10-13.
Image source: Colon (anatomy), Wikipedia, public domain.
Disclaimer: I am an Assistant Professor of Medicine and Pediatrics at University of Chicago.
There are 3 main forms of gluten reactions:- allergic (wheat allergy)
- autoimmune (celiac disease, dermatitis herpetiformis and gluten ataxia)
- possibly immune-mediated (gluten sensitivity)
From BMJ:
It is now becoming clear that, besides those with celiac disease or wheat allergy, there are patients with gluten sensitivity in whom neither allergic nor autoimmune mechanisms can be identified. It has been estimated that, for every person with celiac disease, there should be at least six or seven people with non-celiac gluten sensitivity. Gluten sensitivity may therefore affect 6-10% of the general population.
Patients with gluten sensitivity have negative immuno-allergy tests to wheat and negative celiac disease serology; normal endoscopy and biopsy; clinical symptoms that can overlap with those of celiac disease, irritable bowel syndrome, and wheat allergy; and they show a resolution of symptoms when started on a gluten-free diet.
Currently there are no laboratory biomarkers specific for gluten sensitivity, and the diagnosis is based on exclusion criteria; elimination of gluten-containing foods from the diet followed by an open challenge is most often used to establish whether health improves with the elimination or reduction of gluten from the patient’s diet.
New nomenclature and classifications are proposed (see the figures below).
3 million Americans are living with celiac disease
Celiac disease, an immune system reaction to gluten in the diet, is four times as common today as it was 50 years ago. Lack of awareness of celiac could be contributing to a delay of up to 11 years in diagnosis of adults in North America (http://goo.gl/sy778).
This is an informative and beautifully designed video by the University of Chicago Celiac Disease Center. It looks like an infographic made into video - have a look:
New classification is being proposed for gluten-related disorders: celiac disease; dermatitis herpetiformis; gluten ataxia; wheat allergy; gluten sensitivity. WSJ, 2012.
Recent studies support the existence of the new condition nonceliac gluten sensitivity which is defined as symptoms with negative celiac antibodies and biopsy (http://goo.gl/57IlB).
References:
Non-coeliac gluten sensitivity | BMJ, 2012.
New nomenclature and classification of gluten-related disorders - http://www.biomedcentral.com/1741-7015/10/13/figure/F1
Algorithm for the differential diagnosis of gluten-related disorders, including celiac disease, gluten sensitivity and wheat allergy - http://www.biomedcentral.com/1741-7015/10/13/figure/F4
Spectrum of gluten-related disorders: consensus on new nomenclature and classification. Anna Sapone et al. BMC Medicine 2012, 10:13 doi:10.1186/1741-7015-10-13.
Image source: Colon (anatomy), Wikipedia, public domain.
Disclaimer: I am an Assistant Professor of Medicine and Pediatrics at University of Chicago.
8 Aralık 2012 Cumartesi
Gout - Patrick's story - NHS video
To contact us Click HERE
From NHS Choices YouTube channel: Patrick, 54, was diagnosed with gout (a form of arthritis) 22 years ago. He describes the symptoms, treatment options and how he learned to live with the condition:
Here is a list of some of the new drugs for an old disease (gout):
Febuxostat is a non-purine-analogue inhibitor of xanthine oxidase that opened a new era in the treatment of gout.
Modified uricases
The use of modified uricases to rapidly reduce serum urate concentrations in patients with otherwise untreatable gout is progressing. Pegloticase, a pegylated uricase, is in development.
JAMA update, 08/2011: New Treatment Offers Hope for Patients With Severe Gout: pegloticase (Krystexxa) costs $2,500 per dose (http://goo.gl/gz9sO).
Drugs in development
Transport of uric acid in the renal proximal tubule and the inflammatory response to monosodium urate crystals (shown above) are targets for potential new treatments.
Several pipeline drugs for gout related to the targets above include:
- selective uricosuric drug RDEA594
- various interleukin-1 inhibitors. Canakinumab (trade name Ilaris) is a human monoclonal antibody targeted at interleukin-1 beta. It was rejected by the FDA panel in June 2011.
References:
Gout therapeutics: new drugs for an old disease. The Lancet, Volume 377, Issue 9760, Pages 165 - 177, 8 January 2011.
Diuretics, beta-blockers, ACEi, non-losartan ARBs associated with increased risk of gout vs. CCB lower risk. BMJ, 2012.
With FDA Approval, a Gout Drug Now Costs $5 Instead of Pennies - WSJ, 2011.
FDA Panel Rejects Gout Drug Canakinumab on Safety Concerns http://goo.gl/lO9uy
The strange story that links gout with the birth of the cocktail drinks. Lancet, 2012.
Comments from Twitter:
francis berenbaum @Larhumato: Gout explained by a patient. Very informative for medical students.
Here is a list of some of the new drugs for an old disease (gout):
Febuxostat is a non-purine-analogue inhibitor of xanthine oxidase that opened a new era in the treatment of gout.
Modified uricases
The use of modified uricases to rapidly reduce serum urate concentrations in patients with otherwise untreatable gout is progressing. Pegloticase, a pegylated uricase, is in development.
JAMA update, 08/2011: New Treatment Offers Hope for Patients With Severe Gout: pegloticase (Krystexxa) costs $2,500 per dose (http://goo.gl/gz9sO).
Drugs in development
Transport of uric acid in the renal proximal tubule and the inflammatory response to monosodium urate crystals (shown above) are targets for potential new treatments.
Several pipeline drugs for gout related to the targets above include:
- selective uricosuric drug RDEA594
- various interleukin-1 inhibitors. Canakinumab (trade name Ilaris) is a human monoclonal antibody targeted at interleukin-1 beta. It was rejected by the FDA panel in June 2011.
References:
Gout therapeutics: new drugs for an old disease. The Lancet, Volume 377, Issue 9760, Pages 165 - 177, 8 January 2011.
Diuretics, beta-blockers, ACEi, non-losartan ARBs associated with increased risk of gout vs. CCB lower risk. BMJ, 2012.
With FDA Approval, a Gout Drug Now Costs $5 Instead of Pennies - WSJ, 2011.
FDA Panel Rejects Gout Drug Canakinumab on Safety Concerns http://goo.gl/lO9uy
The strange story that links gout with the birth of the cocktail drinks. Lancet, 2012.
Comments from Twitter:
francis berenbaum @Larhumato: Gout explained by a patient. Very informative for medical students.
Bell's palsy - NHS video
To contact us Click HERE
Bell’s palsy is the abrupt paralysis of the facial nerve (cranial nerve 7, CN7), resulting in an inability to control facial muscles on the affected side. A common condition, Bell’s palsy has an annual incidence of 11-40 cases per 100 ,000 population. Many patients recover without intervention; however, up to 30% have poor recovery of facial muscle control and experience facial disfigurement, psychological trauma, and facial pain.
From the NHS Choices YouTube channel: Bell's palsy is the temporary weakness or paralysis of the muscles in one side of the face. In this video, a speech therapist explains who is most at risk and describes common causes and treatment options available. Helen explains how she dealt with the condition and recovered from it:
Remember:
U MN damage
U pper face is OK (the patient is able to wrinkle his forehead)
LMN damage = patient is unable to wrinkle his forehead (our patient)
The examination of CN 7 palsy can be remembered by the mnemonic COWS:
C lose your eyes
O pen (the examining physician tries to open the patient's eyes)
W rinkle your forehead
S mile
Two main types of pharmacological treatment have been used to improve outcomes from Bell’s palsy:
- steroids
- antivirals.
The rationale for these treatments is based on the presumed pathophysiology of Bell’s palsy, namely inflammation and viral infection.
In a 2009 study published in the BMJ antivirals did not provide an added benefit in achieving at least partial facial muscle recovery compared with steroids alone in patients with Bell’s palsy.
References:
The benefits of steroids versus steroids plus antivirals for treatment of Bell’s palsy: a meta-analysis | BMJ http://bit.ly/YD3iLG
From the NHS Choices YouTube channel: Bell's palsy is the temporary weakness or paralysis of the muscles in one side of the face. In this video, a speech therapist explains who is most at risk and describes common causes and treatment options available. Helen explains how she dealt with the condition and recovered from it:
Remember:
U MN damage
U pper face is OK (the patient is able to wrinkle his forehead)
LMN damage = patient is unable to wrinkle his forehead (our patient)
The examination of CN 7 palsy can be remembered by the mnemonic COWS:
C lose your eyes
O pen (the examining physician tries to open the patient's eyes)
W rinkle your forehead
S mile
Two main types of pharmacological treatment have been used to improve outcomes from Bell’s palsy:
- steroids
- antivirals.
The rationale for these treatments is based on the presumed pathophysiology of Bell’s palsy, namely inflammation and viral infection.
In a 2009 study published in the BMJ antivirals did not provide an added benefit in achieving at least partial facial muscle recovery compared with steroids alone in patients with Bell’s palsy.
References:
The benefits of steroids versus steroids plus antivirals for treatment of Bell’s palsy: a meta-analysis | BMJ http://bit.ly/YD3iLG
7 Aralık 2012 Cuma
Gout - Patrick's story - NHS video
To contact us Click HERE
From NHS Choices YouTube channel: Patrick, 54, was diagnosed with gout (a form of arthritis) 22 years ago. He describes the symptoms, treatment options and how he learned to live with the condition:
Here is a list of some of the new drugs for an old disease (gout):
Febuxostat is a non-purine-analogue inhibitor of xanthine oxidase that opened a new era in the treatment of gout.
Modified uricases
The use of modified uricases to rapidly reduce serum urate concentrations in patients with otherwise untreatable gout is progressing. Pegloticase, a pegylated uricase, is in development.
JAMA update, 08/2011: New Treatment Offers Hope for Patients With Severe Gout: pegloticase (Krystexxa) costs $2,500 per dose (http://goo.gl/gz9sO).
Drugs in development
Transport of uric acid in the renal proximal tubule and the inflammatory response to monosodium urate crystals (shown above) are targets for potential new treatments.
Several pipeline drugs for gout related to the targets above include:
- selective uricosuric drug RDEA594
- various interleukin-1 inhibitors. Canakinumab (trade name Ilaris) is a human monoclonal antibody targeted at interleukin-1 beta. It was rejected by the FDA panel in June 2011.
References:
Gout therapeutics: new drugs for an old disease. The Lancet, Volume 377, Issue 9760, Pages 165 - 177, 8 January 2011.
Diuretics, beta-blockers, ACEi, non-losartan ARBs associated with increased risk of gout vs. CCB lower risk. BMJ, 2012.
With FDA Approval, a Gout Drug Now Costs $5 Instead of Pennies - WSJ, 2011.
FDA Panel Rejects Gout Drug Canakinumab on Safety Concerns http://goo.gl/lO9uy
The strange story that links gout with the birth of the cocktail drinks. Lancet, 2012.
Comments from Twitter:
francis berenbaum @Larhumato: Gout explained by a patient. Very informative for medical students.
Here is a list of some of the new drugs for an old disease (gout):
Febuxostat is a non-purine-analogue inhibitor of xanthine oxidase that opened a new era in the treatment of gout.
Modified uricases
The use of modified uricases to rapidly reduce serum urate concentrations in patients with otherwise untreatable gout is progressing. Pegloticase, a pegylated uricase, is in development.
JAMA update, 08/2011: New Treatment Offers Hope for Patients With Severe Gout: pegloticase (Krystexxa) costs $2,500 per dose (http://goo.gl/gz9sO).
Drugs in development
Transport of uric acid in the renal proximal tubule and the inflammatory response to monosodium urate crystals (shown above) are targets for potential new treatments.
Several pipeline drugs for gout related to the targets above include:
- selective uricosuric drug RDEA594
- various interleukin-1 inhibitors. Canakinumab (trade name Ilaris) is a human monoclonal antibody targeted at interleukin-1 beta. It was rejected by the FDA panel in June 2011.
References:
Gout therapeutics: new drugs for an old disease. The Lancet, Volume 377, Issue 9760, Pages 165 - 177, 8 January 2011.
Diuretics, beta-blockers, ACEi, non-losartan ARBs associated with increased risk of gout vs. CCB lower risk. BMJ, 2012.
With FDA Approval, a Gout Drug Now Costs $5 Instead of Pennies - WSJ, 2011.
FDA Panel Rejects Gout Drug Canakinumab on Safety Concerns http://goo.gl/lO9uy
The strange story that links gout with the birth of the cocktail drinks. Lancet, 2012.
Comments from Twitter:
francis berenbaum @Larhumato: Gout explained by a patient. Very informative for medical students.
The longevity of a rock singer
To contact us Click HERE
Here is Ian Gillan (age 67) from Deep Purple in a recent interview:
You have been screaming rock music for over 40 years. How do you do it?
I think it’s quite natural, I do a lot of it, and so I keep myself fairly fit. My mates who were singers they quit to enjoy their success or raise families and they didn’t continue. Then they tried to come back years later but it was very difficult because vocal cords, unlike guitar strings, are unforgiving, you can’t change them. So I think I’ve been singing all my life, and therefore I’m pretty much fit, so to speak. Most things are within my scope, I sing pretty naturally so it’s not a strain, never has been.
Here is Deep Purple with Maybe I'm a Leo, Mainz, Germany, July 2011:
This is the same band 40 years ago, in 1972:
I have been to two concerts of Deep Purple, the last one was in June 2011 and it was quite impressive. The audience age ranged from 5 to 75 and everyone rose to their feet to the sound of Smoke on the Water.
Here is Mick Jagger on staying fit: "You watch what you eat, you exercise, you have a bit of fun. You keep on going forward. Don’t stop. Do what makes you happy. Don’t look at the clouds of tomorrow through the sunshine of today. That’s it."
References:
Deep Purple but no blues: US legends top Dubai jazz festival line-up | Al Bawaba http://buff.ly/V520RZ
Mick Jagger's new supergroup with Joss Stone and Dave Stewart. DailyMail.
Redefining age 65 - when your job description is "rockstar"
You have been screaming rock music for over 40 years. How do you do it?
I think it’s quite natural, I do a lot of it, and so I keep myself fairly fit. My mates who were singers they quit to enjoy their success or raise families and they didn’t continue. Then they tried to come back years later but it was very difficult because vocal cords, unlike guitar strings, are unforgiving, you can’t change them. So I think I’ve been singing all my life, and therefore I’m pretty much fit, so to speak. Most things are within my scope, I sing pretty naturally so it’s not a strain, never has been.
Here is Deep Purple with Maybe I'm a Leo, Mainz, Germany, July 2011:
This is the same band 40 years ago, in 1972:
I have been to two concerts of Deep Purple, the last one was in June 2011 and it was quite impressive. The audience age ranged from 5 to 75 and everyone rose to their feet to the sound of Smoke on the Water.
Here is Mick Jagger on staying fit: "You watch what you eat, you exercise, you have a bit of fun. You keep on going forward. Don’t stop. Do what makes you happy. Don’t look at the clouds of tomorrow through the sunshine of today. That’s it."
References:
Deep Purple but no blues: US legends top Dubai jazz festival line-up | Al Bawaba http://buff.ly/V520RZ
Mick Jagger's new supergroup with Joss Stone and Dave Stewart. DailyMail.
Redefining age 65 - when your job description is "rockstar"
Top medicine articles for November/December 2012
To contact us Click HERE
Here are my suggestions for some of the top articles in medicine for November/December 2012:
The Smartphone in Medicine: A Review of Current and Potential Use Among Physicians and Students http://buff.ly/THrvOA
Shocking News: Intraaortic Balloon Pumps May Not Help in Myocardial Infarction with Cardiogenic Shock http://buff.ly/QVzggF
What Your Breath Reveals: Each Patient Has a Unique Breath 'Fingerprint' That Doctors Could Use to Diagnose http://buff.ly/Ravmkd
Rilonacept for Colchicine-Resistant or -Intolerant Familial Mediterranean Fever http://buff.ly/QWJV76
Lowering LDL levels with statin reduces major vascular events regardless of baseline risk http://buff.ly/QWKuxU
Radical prostatectomy and observation did not differ for mortality in localized prostate cancer http://buff.ly/QWLbqM
The Mini-Cog had sensitivity similar to the longer 3MS for detecting cognitive impairment or dementia http://buff.ly/PQkDwL
Risk stratification schemes predict ischemic stroke and bleeding in AF - CHA2DS2-VASc score had 100% sensitivity but only 6% specificty http://buff.ly/QWLu4Z
Deep-Brain Stimulation for Parkinson’s Disease - NEJM summary http://buff.ly/QWNIkR
Update on the management of chronic kidney disease - AFP 2012 http://buff.ly/PQlEol
Chronic fatigue syndrome: diagnosis and treatment - 2012 update from AFP http://buff.ly/QWOePV
Diagnosis and treatment of acne - 2012 AFP update http://buff.ly/QWOmit
Why Some Physician Practices Are Wildly Successful - Medscape http://buff.ly/RFD3Nc
"End-run" lawsuits can blindside physicians. Administrative claims against doctors are likely to rise under the Affordable Care Act - amednews http://buff.ly/S6KU9a
Patients who read doctor notes feel more in control of their health http://buff.ly/RgGPPg
Older patients join crowd consulting "Dr. Internet" http://buff.ly/PNeD7Y
Doctors follow own advice for healthy living http://buff.ly/QYHPDY
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.
Here are my suggestions for some of the top articles in medicine for November/December 2012:The Smartphone in Medicine: A Review of Current and Potential Use Among Physicians and Students http://buff.ly/THrvOA
Shocking News: Intraaortic Balloon Pumps May Not Help in Myocardial Infarction with Cardiogenic Shock http://buff.ly/QVzggF
What Your Breath Reveals: Each Patient Has a Unique Breath 'Fingerprint' That Doctors Could Use to Diagnose http://buff.ly/Ravmkd
Rilonacept for Colchicine-Resistant or -Intolerant Familial Mediterranean Fever http://buff.ly/QWJV76
Lowering LDL levels with statin reduces major vascular events regardless of baseline risk http://buff.ly/QWKuxU
Radical prostatectomy and observation did not differ for mortality in localized prostate cancer http://buff.ly/QWLbqM
The Mini-Cog had sensitivity similar to the longer 3MS for detecting cognitive impairment or dementia http://buff.ly/PQkDwL
Risk stratification schemes predict ischemic stroke and bleeding in AF - CHA2DS2-VASc score had 100% sensitivity but only 6% specificty http://buff.ly/QWLu4Z
Deep-Brain Stimulation for Parkinson’s Disease - NEJM summary http://buff.ly/QWNIkR
Update on the management of chronic kidney disease - AFP 2012 http://buff.ly/PQlEol
Chronic fatigue syndrome: diagnosis and treatment - 2012 update from AFP http://buff.ly/QWOePV
Diagnosis and treatment of acne - 2012 AFP update http://buff.ly/QWOmit
Why Some Physician Practices Are Wildly Successful - Medscape http://buff.ly/RFD3Nc
"End-run" lawsuits can blindside physicians. Administrative claims against doctors are likely to rise under the Affordable Care Act - amednews http://buff.ly/S6KU9a
Patients who read doctor notes feel more in control of their health http://buff.ly/RgGPPg
Older patients join crowd consulting "Dr. Internet" http://buff.ly/PNeD7Y
Doctors follow own advice for healthy living http://buff.ly/QYHPDY
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.
Bell's palsy - NHS video
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Bell’s palsy is the abrupt paralysis of the facial nerve (cranial nerve 7, CN7), resulting in an inability to control facial muscles on the affected side. A common condition, Bell’s palsy has an annual incidence of 11-40 cases per 100 ,000 population. Many patients recover without intervention; however, up to 30% have poor recovery of facial muscle control and experience facial disfigurement, psychological trauma, and facial pain.
From the NHS Choices YouTube channel: Bell's palsy is the temporary weakness or paralysis of the muscles in one side of the face. In this video, a speech therapist explains who is most at risk and describes common causes and treatment options available. Helen explains how she dealt with the condition and recovered from it:
Remember:
U MN damage
U pper face is OK (the patient is able to wrinkle his forehead)
LMN damage = patient is unable to wrinkle his forehead (our patient)
The examination of CN 7 palsy can be remembered by the mnemonic COWS:
C lose your eyes
O pen (the examining physician tries to open the patient's eyes)
W rinkle your forehead
S mile
Two main types of pharmacological treatment have been used to improve outcomes from Bell’s palsy:
- steroids
- antivirals.
The rationale for these treatments is based on the presumed pathophysiology of Bell’s palsy, namely inflammation and viral infection.
In a 2009 study published in the BMJ antivirals did not provide an added benefit in achieving at least partial facial muscle recovery compared with steroids alone in patients with Bell’s palsy.
References:
The benefits of steroids versus steroids plus antivirals for treatment of Bell’s palsy: a meta-analysis | BMJ http://bit.ly/YD3iLG
From the NHS Choices YouTube channel: Bell's palsy is the temporary weakness or paralysis of the muscles in one side of the face. In this video, a speech therapist explains who is most at risk and describes common causes and treatment options available. Helen explains how she dealt with the condition and recovered from it:
Remember:
U MN damage
U pper face is OK (the patient is able to wrinkle his forehead)
LMN damage = patient is unable to wrinkle his forehead (our patient)
The examination of CN 7 palsy can be remembered by the mnemonic COWS:
C lose your eyes
O pen (the examining physician tries to open the patient's eyes)
W rinkle your forehead
S mile
Two main types of pharmacological treatment have been used to improve outcomes from Bell’s palsy:
- steroids
- antivirals.
The rationale for these treatments is based on the presumed pathophysiology of Bell’s palsy, namely inflammation and viral infection.
In a 2009 study published in the BMJ antivirals did not provide an added benefit in achieving at least partial facial muscle recovery compared with steroids alone in patients with Bell’s palsy.
References:
The benefits of steroids versus steroids plus antivirals for treatment of Bell’s palsy: a meta-analysis | BMJ http://bit.ly/YD3iLG
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