Superbugs
This is an interested isuue discussed at the NewYorker:
“In August, 2000, Dr. Roger Wetherbee, an infectious-disease expert at New York University’s Tisch Hospital, received a disturbing call from the hospital’s microbiology laboratory. At the time, Wetherbee was in charge of handling outbreaks of dangerous microbes in the hospital, and the laboratory had isolated a bacterium called Klebsiella pneumoniae from a patient in an intensive-care unit. “It was literally resistant to every meaningful antibiotic that we had,” Wetherbee recalled recently. The microbe was sensitive only to a drug called colistin, which had been developed decades earlier and largely abandoned as a systemic treatment, because it can severely damage the kidneys…….”
Read the full article here.
Richard Feynman - The Last Journey Of A Genius[1988]
This is a video about Richard Feynman, the great Physicist, author of “Feynman’s lectures on Physics”. I found it in Twitter, @Timoreilly, and @giustini.
I know already feynman as I read two biographies about him. One was ” Surely, you are joking Mr. Feynam”, here the link. also here. The second was ” What do you care what other people think?”. both were very interesting readings, I remember.
The Physical Examination
“This month we introduce a new series, The Physical Examination,
kicked off by a paper by Drs. Diaz-Guzman and Budev on evaluating pleural effusions
(page 297). The series will be managed by David Rolston, MD, our deputy editor”.
This announcement introducing a new section in the cleveland Journal of Medicine that i would like to follow. I have a link to this journal here in the rigth side bar below “Reading room”. But the surprising thing for me is what the editor is pointing out in his presentation to the series:
“The physical examination used to be a foundation of clinical practice, but it is
under assault. A specialist in inpatient medicine here at Cleveland Clinic decried the
inefficiency of time spent by residents performing and documenting the examination
How often, he asked, does the examination actually change the diagnostic workup?……”
read the article here.
I also know about the Jama’s section on the physical examination, but this is much more sophisticated to read as it discusses the evident-base findings to the different manuvers in performing a physical examination.
this is the first article of this section at the Cleveland Journal of medicine:
” accuracy of the physical examination in evaluating pleural effusion”
Leukoaraiosis
I have benn interested in reading this articel in the last period:
Leukoaraiosis
Practical Neurology 2008;8:26-38; doi:10.1136/jnnp.2007.139428
Mike O’Sullivan
ABSTRACT
” Leukoaraiosis describes diffuse white matter abnormalities on CT or MR brain scans, often seen in the normal elderly and in association with vascular risk factors such as hypertension, or in the context of cognitive impairment. The term was introduced to avoid confusing an imaging appearance with a specific pathology. Neurologists often come across this appearance, but its significance is sometimes uncertain. The effects on cognitive function and gait are insidious and can be difficult to detect at the bedside, but are nevertheless important. However, gradually it is becoming clearer how leukoaraiosis relates to cerebrovascular disease, Alzheimer’s and other diseases, and how this appearance should influence treatment decisions. ..
My interest was to know more about the interpretation of this MRI finding which is called “Leukoaraiosis” as I saw it was discussed in the clinic by the neuroradiologists with neurologists, especially when images is done in the elderly. Leukoaraiosis comes from Greek, LEUKO means white while ARAIOSIS: rarefaction.
The Interface of Neurology and Internal Medicine
This is an interesting book review from the NEJM.org.
“In this book, Biller has assembled a group of neurologists and internists skilled in 23 medical specialties and in 171 specific conditions, one for each chapter. The chapters are formatted in a uniform pattern, each focusing on a brief case vignette. The essays are comprehensive, and the coverage of topics is excellent. The book is also attractively produced. A novel feature is that the entire content of the book is posted on the Web; each copy of the book includes a password that allows the purchaser to enter the Web site, making it easier to search for a particular topic.” This review is presented by the renowned Prof. Lewis P. Rowland, M.D. the editor of the Merrit’s textbook of neurology and a famous expert in Motor Neuron Disease.
I have been fascinated by an another book in neurology authored by Prof. Biller:
“Localization in clinical neurology”. Here, but in the recent new edition of this book I read some chapters that was very useful to better understand clinical neurology and its complicated problems. Certainly i’d like to have this new interested book of Prof. Biller
Osteoporosis in Men
This is the last title in the Clinical practice Audioarticles at the NEJM.
“A 65-year-old asymptomatic man is concerned about his risk of osteoporosis. His mother died after a hip fracture at 74 years of age. The patient has no history of fractures but has lost 7.6 cm (3 in.) in height; he does not smoke and has never taken corticosteroids. He drinks two glasses of beer (16 oz, or about 0.5 liter, each) per . . .”.
The audioarticles need now an individual subscription.
Jill Bolte Taylor: My stroke of insight
I liked this post from Clinical cases blog.
I registered to Ted.com now. The video concerns:
“Neuroanatomist Jill Bolte Taylor had an opportunity few brain scientists would wish for: One morning, she realized she was having a massive stroke. As it happened — as she felt her brain functions slip away one by one, speech, movement, understanding — she studied and remembered every moment. This is a powerful story about how our brains define us and connect us to the world and to one another.”
Here is the homepage of Taylor’s site.
PatientsLikeMe Website
The free site, PatientsLikeMe.com, began as a way for patients with amyotrophic lateral sclerosis to share information on symptoms and treatments. It now has sections on multiple sclerosis, Parkinson disease, HIV, and has just started one on mental health.
The article of NewYork Times that inform about this site. I think this will strengthen the relation between patients and their opportunity to know more about their diseases and how physicians are treating them.
Lumbar Spinal Stenosis
Listen to a clinical practice article:
This is the current audio article at the NEJM:
Lumbar Spinal Stenosis
A 72-year-old woman with hypertension presents with a 4-month history of lower back discomfort that radiates to both buttocks and lateral thighs. Previously, she had walked 2 miles (3.2 km) a day; now she has difficulty walking 2 blocks and standing up for more than 15 minutes at a time. Her physical examination is notable only for a slightly stooped posture and . . .
This condition is common in the elderly and important to know and diagnose; I’m annotating it here in my site to return back and read the article.
The NEJM, a very educational site, is giving in its beta form a gadget to add the image challenge to one’s site or to iGoogle. Although wordpress is a very helpful place, I could not add the gadget here using the text boxes in the widgets under presentations and I really don’t know any other way to add it. I added the gadget to IGoogle anyhow.
On medical Wikis
This is an interesting post from David Rothman, where he talks about the importance of medical wikis directed to physicians. David is right when he says that there are many sites which give detailed and excellent information for the consumer, the best of these remains Medlineplus maintaned by the National Library of Medicine, and now it is the time to have free access to some trustable source for rapid and detailed information for the medical professional. I have listed some of the promissed medical wikis in the right bar here. My suggestion is that big and famous institutions such as the Cleveland clinic (where the founder of askdrwiki works and also clinical cases site is established) and other similar institutions have all the potential to build such wikis and to maintain them updated. The other thing I would like to say that thousands of physicians all over the world would applause this and donate to support it.
A Quotation of William Osler
A man cannot become a competent surgeon without the full knowledge of human anatomy and physiology, and the physician without physiology and chemistry flounders along in an aimless fashion, never able to gain any accurate conception of disease, practicing a sort of popgun pharmacy, hitting now the malady and again the patient, he himself not knowing which.
Sir William Osler (1849–1919)
Myths and Facts
Dr. Chudler’s site is very active and known as a teaching site of Neuroscience for kids.
On one of his pages he responds to some of the known myths in neuroscience and medicine:
Myth: We use only 10% of our brains.
Fact: There are no inactive parts of our brains. See the Neuroscience
for Kids Web site for a complete explanation of this myth;
http://faculty.washington.edu/chudler/tenper.html
Dr.Chudler gives this reference for the myths and facts on his above site:
Reference: Vreeman, R.C. and Carroll, A.E., Medical myths, BMJ,
335:1288-1289, 2007.
Erectile Dysfunction
A 65-year-old man presents to an outpatient clinic, reporting that he can no longer maintain an erection sufficient for intercourse. His medical history includes well-controlled hypertension and stable coronary artery disease. He smokes a pack of cigarettes daily. His medications include atenolol and low-dose aspirin (81 mg daily). On physical examination, his body-mass index (the weight in kilograms divided by the square . .
This is a previous audioarticle at the NEJM.
Listen to the audioarticle
Localized Prostate Cancer
A 68-year-old man presents with newly diagnosed prostate cancer. Over the past 3 years, his serum prostate-specific antigen (PSA) level has been slowly and steadily increasing (from 4.0 ng per milliliter to 4.3 ng per milliliter to 4.7 ng per milliliter). His digital rectal examination is normal; the prostate volume, estimated by means of ultrasonography, is 48 ml, and a needle-biopsy specimen reveals an adenocarcinoma with a Gleason score of 6 (the sum of the numbers associated with the most common and second most common histologic patterns — in this case, 3 plus 3). The adenocarcinoma involves 10% of 1 of the 12 cores. The patient otherwise is well, is taking no medication, and has normal sexual function. How should his case be managed?
It is the theme of the last audioarticle from the NEJM.
Listen to the audioarticle.
HIV Medicine 2007
HIV Medicine is the 15th edition of a medical textbook that provides a comprehensive and up-to-date overview of the treatment of HIV infection (818 pages ) .
This is the source link. A free download.
Late-Life Depression
Late-Life Depression
A 71-year-old man, whose wife died 6 months previously, presents with foot pain from diabetic neuropathy, poor sleep, lack of energy, and increasing frustration about his inability to “keep his diabetes under control.” On examination, he also notes lack of interest in usual activities, decreased appetite, a weight loss of 4.5 kg (10 lb) over the past 3 months, and intermittent thoughts . . .
This is the theme of the last audio article at the NEJM . It is one of the most important subjects in geriatric medicine.
Listen to the audio.
Pathway Interaction Database
I learned to give interest to some important pathways during my studies and reviews in immunology and particularly the process of T and B lymphocyte activation. Now here below is a collaborative database which updates the actions of IL-4.
The Pathway Interaction Database is a highly structured, curated collection of information about known biomolecular interactions and key cellular processes assembled into signaling pathways. It is a collaborative project between the US National Cancer Institute (NCI) and Nature Publishing Group (NPG).
IL4-mediated signaling events
Revision Date: 9-Nov-2007
Source: NCI-Nature Curated
Curated by: Kira Anthony
Reviewed by: Dr. Daniel Hebenstreit, Dr. Shreevrat Goenka
Pathway ID: il4_2pathway
Arthur Kornberg dies
“There have got to be tens of thousands of people around the world today whose eyes are tearing up with the news that he’s gone,”Paul Berg.
Link The Scientist .
Celiac Disease
Under the section of MEDICAL PROGRESS the NEJM is publishing a good review on this condition in its last issue of this week:
NEJM Volume 357: 1731-1743 October 25, 2007 Number 17.
This is the initial:
“Celiac disease is a unique autoimmune disorder, unique because the environmental precipitant is known. The disorder was previously called celiac sprue, based on the Dutch word sprue, which was used to describe a disease similar to tropical sprue that is characterized by diarrhea, emaciation, aphthous stomatitis, and malabsorption.1,2 Celiac disease is precipitated, in genetically predisposed persons, by the ingestion of gluten, the major storage protein of wheat and similar grains.3 Originally considered a rare malabsorption syndrome of childhood, celiac disease is now recognized as a common condition that may be diagnosed at any age and that affects many organ systems. . . .”
I got my personal copy for furthur reading. This condition is diffuse and it was considered an important pediatric condition but now we know it interests many other organs. I am interested in the neurological implications of this disease and have collected a couple of reviews to read about.
Is the neurological involvement related to the autoimmune mechanism?
This is one of the review articles that consider the neurologic complications of Celiac disease:
http://www.nature.com/ncpneuro/journal/v3/n10/full/ncpneuro0631.html
at Nature clinical practice neurology, it discusses a new manifestation (ALS), that had not been described until now in this contest.
A 44-year-old male presented to a general neurology clinic with a 6-month history of progressive right-sided spastic hemiparesis without sensory symptoms or signs. The thigh muscle in the affected leg showed signs of wasting. The patient had a remote family history of celiac disease.
Investigations Neurological examination, neurophysiological studies, brain MRI scan, routine blood tests, duodenal biopsy, cerebrospinal fluid analysis including polymerase chain reaction test for JC virus DNA, serological testing for HIV and for the presence of serum antibodies to endomysium, gliadin and tissue transglutaminase.
Diagnosis Celiac disease with neurological involvement, mimicking amyotrophic lateral sclerosis.
The second review article is this, at the:
Postgraduate Medical Journal 2002;78:393-398.
It has a comprehensive and detailed descritption of all the neurological complication in Celiac disease.
Hair Loss in Women
This is the subject of the new audioarticle at the New England Journal of Medicine.
“A 45-year-old white woman presents with a 1-year history of scalp-hair loss. She was hospitalized with appendicitis 14 months ago. She has been a vegetarian for 20 years. She takes no medications. Her father was bald. On physical examination, she has diffuse, nonscarring hair thinning with a widened part over the central portion of the scalp. How should this problem be evaluated and treated?”
Interesting knowledge in the section of Hair bilogy:
“The scalp contains, on average, 100,000 hairs. More than 90% of these hairs are actively growing, and they are referred to as anagen hairs. Anagen hairs are anchored deeply into the subcutaneous fat ……..”
The Audioarticle .
Diagnosis and Treatment of Low Back Pain
A Joint Clinical Practice Guideline from the American College of Physicians and the American Pain Society.
“Low back pain is the fifth most common reason for all physician visits in the United States…..Low back pain is also very costly: Total incremental direct health care costs attributable to low back pain in the U.S. were estimated at $26.3 billion in 1998″.
I understand the importance of the above facts about this condition. I was always interested to have a good knowledge about this condition that makes a high number of visits to GP office. Now Annals of Internal Medicine (many times recommended by Clinical cases and images blog especially for the update section of this journal) has issued a new article discussing this condition and a joint clinical practice guidelines about it. I also expect to read about in DB’s blog. DB’s on low back pain.
(Escuse me my English errors)
HHMI Investigator Mario R.Capecchi Wins 2007 Nobel Prize inPhysiology or Medicine
“The Nobel Assembly at the Karolinska Institute announced this morning that the 2007 Nobel Prize in Physiology or Medicine was awarded to Mario R. Capecchi, a Howard Hughes Medical Institute investigator at the University of Utah, Martin J. Evans at Cardiff University, and Oliver Smithies at the University of North Carolina at Chapel Hill”.
“Capecchi is credited with developing a powerful technology known as gene targeting. This technology has allowed scientists to engineer mice with conditions such as cancer, heart disease, Alzheimer’s disease, cystic fibrosis, and high blood pressure—a feat that has revolutionized the study of human disease”.
I received this morning the news from the Howard Hughes Medical Institute HHMI in my inbox ; the detailed news tell many interesting facts about Cepecchi’s life and his great feats.
Osteoarthritis of the Hip
This is the subject of the audioarticle at the New England Journal of Medicine of this week:
Osteoarthritis of the Hip
NEJM Volume 357: 1413-1421 Oct 4, 2007 No 14
A 70-year-old man reports a gradual onset of hip pain that has limited his activities for about a year. The pain initially occurred only with walking and was limited to the anterior hip area but now has spread to the side of the hip and is present at rest. He has no history of injury to the hip, back, or lower back
To listen to the article:
a subject of diffuse interest.
The Huntington’s disease-like syndromes: what to consider in patients with a negative Huntington’s disease gene test
“Huntington’s disease (HD), which is caused by a triplet-repeat expansion in the IT15huntingtin or HD), accounts for about 90% of cases of chorea of genetic etiology. In recent years, several other distinct genetic disorders have been identified that can present with a clinical picture indistinguishable from that of HD. These disorders are termed Huntington’s disease-like (HDL) syndromes. So far, four such conditions have been recognized, namely disorders attributable to mutations in the prion protein gene (HDL1), the junctophilin 3 gene (HDL2), and the gene encoding the TATA box-binding protein (HDL4/SCA17), and a recessively inherited HD phenocopy in a single family (HDL3), the genetic basis of which is currently poorly understood. These disorders, however, account for only a small proportion of cases with the HD phenotype but a negative genetic test for HD, and the list of HDL genes and conditions is set to grow. In this article, we review the most important HD phenocopy disorders identified to date and discuss the clinical clues that guide further investigation. We will concentrate on the four so-called HDL syndromes mentioned above, as well as other genetic disorders such as dentatorubral–pallidoluysian atrophy, neuroferritinopathy, pantothenate-kinase-associated neurodegeneration and chorea–acanthocytosis”.
This is an interested article on Huntington disease published at the Journal: “Nature clinical Practice” :
Nature Clinical Practice Neurology (2007) 3, 517-525
doi:10.1038/ncpneuro0606.
I posted below about this disease, it was an article to elucidate the psychiatric manifeatations of the HD. this article is discussing HD-like syndromes. I remember only a case of Neuroacanthocytosis as a choreic syndrome, I saw in a young adult female during my neurology rotation. Chorea was the principal manifestation in that case.
Medscape is also offering CME credits to the readers of this case report:
Medscape Continuing Medical Education online
Medscape, LLC is pleased to provide online continuing medical education (CME) for this journal article, allowing clinicians the opportunity to earn CME credit. Medscape, LLC is accredited by the Accreditation Council for Continuing Medical Education (ACCME) to provide CME for physicians. Medscape, LLC designates this educational activity for a maximum of 1.0 AMA PRA Category 1 Credits™. Physicians should only claim credit commensurate with the extent of their participation in the activity. All other clinicians completing this activity will be issued a certificate of participation. To receive credit, please go to http://www.medscape.com/cme/ncp and complete the post-test.
“escuse me my English errors”
thalassemia and iron overload
“Thalassemia is an inherited blood disease characterized by the under production of normal hemoglobin, the oxygen-carrying protein in red blood cells. People with severe forms of thalassemia often suffer from anemia, a condition in which the body tissues do not get enough oxygen from the blood, and often require blood transfusions.”
I understood that blood transfusions are the principal cause of iron overload in this disease and i learned the use of deferoxamine ( Desferal is an iron-chelating agent) to chelate the excess of iron in the tissues of patients with thalassemia. The accumulation of iron in the heart is an important cause of death in thalassemia patients as I studied in my hematology course. Now scientists have discovered an another cause of iron excess in thalassemia:
“Blood transfusions contribute to iron overload in people with thalassemia, but these people also suffer from iron overload independent of blood transfusions. Excess iron causes damage to many organs including the heart and liver, and diabetes can develop in severe cases. Patients with thalassemia often require treatment to remove the excess iron to prevent tissue damage.”
Liver normally produces a protein called Hepcidin which regulates the absorption of iron in the intestine. In thalasemia the extremely active bone marrow produce a peptide that suppress the hepcidin in the liver; as a consequence there is a more uptake of iron in the intestine and thus, its overload:
“Thalassemia patients absorb too much iron from food due to abnormally low levels of a small peptide, called hepcidin, which regulates iron uptake from the gut. People with thalassemia should produce hepcidin at high levels. Instead, these patients have reduced levels of hepcidin. This confounded the authors and led them to ask if the low levels of hepcidin were somehow caused by the underlying problem in thalassemia -abnormal development of red blood cells.”
“Since erythroblasts need iron to make hemoglobin, we reasoned that the increased number of erythroblasts in thalassemia may send stronger messages to the liver to suppress hepcidin and thereby absorb more iron even in the condition of iron overload,” says the study’s lead author, Toshihiko Tanno, Ph.D., an investigator in Miller’s laboratory in the NIDDK’s Division of Intramural Research.”
News from the NIH : released in August 26, 2007 .
(Escuse me my English errors).
here below is the nature medicine citation of the paper:
High levels of GDF15 in thalassemia suppress expression of the iron regulatory protein hepcidin
JA - Nat Med
PY - 2007/09//print
VL - 13
IS - 9
SP - 1096
EP - 1101
SN - 1078-8956
UR - http://dx.doi.org/10.1038/nm1629
Neurology® Content Now Available Via Podcast
After Jama, NEJM, and the Lancet here is the podcasts from Neurology ,the valuable journal of the American Academy of Neurology (AAN):
“Readers of the AAN’s premier science journal Neurology® can download the content via podcast beginning Tuesday, September 4. Each week’s show will feature an introduction by Editor-in-Chief John H. Noseworthy MD, FAAN, highlighting articles in the latest issue of the journal, followed by an in-depth interview with the author of an article published in the issue. Interviews will feature the main findings of the paper discussed and clinical implications for neurologists. The podcasts will conclude with a “Lesson of the Week” on topics such as, a laboratory technique, statistical methods, or historical neurology. Look for a link to podcasts on AAN.com starting September 4!”
Here is the link for the feed.
The protean neurologic manifestations of varicella-zoster virus infection
This review at the CCJM is very interesting :
The protean neurologic manifestations
of varicella-zoster virus infection.
I will go now to print the PDf file and read it as time allows me. I remember a case of myelitis in a young adult women caused by the VHZ virus.
Thanks to Notes from Dr.RW for the link.
Fusobacterium and Pharyngitis
DB’s medical Rants posted some articles on this bacteria and discussed its role in causing serious cases of pharyngitis and the life-threatening condition Lemierre syndrome.
The Canadian Family Physician has an article, a case report, on this condition and the Fusobacterium in its current issue of Sept. First I should finish reading the articles at DB’s site then I will read the case report of the CFP. I think this will support our knowledge on this condition.
Derm Case: Leishmaniasis, Cutaneous
When I saw the ulcer I immediately recognized it : cutaneous leihmaniasis. I did not see any patient yet with this disease but it is characteristic and i remember it in my course in infectious diseases. This is the derm case from the current issue of the Canadian Family Physician. I read the answer to the derm question and was interested with the statistcs reported:
“Cutaneous leishmaniasis (CL) is a serious health problem worldwide and is endemic in nearly 90 countries. The World Health Organization has estimated that there are 1.0 to 1.5 million new cases of CL yearly, and more than 350 million people live in areas where CL is endemic. More than 90% of CL cases are seen in Algeria, Saudi Arabia, Iraq, Iran, Afghanistan, Brazil, and Peru. Cutaneous leishmaniasis is also an increasing threat to travelers visiting these areas. More than 600 cases of Leishmania major acquired in Iraq and a few cases of Leishmania tropica acquired in Afghanistan have been reported in the United States military. Leishmaniasis is a complex and diverse collection of clinical diseases caused by many species, each with its own geographic distribution, ecology, local mammalian reservoir, and sandfly vectors.”
(escuse me my English errors).
About
I’m iskandar m i basal. I come from Jordan(Middle East), from the Christian minority in this small country. I’m now in Rome-Italy at the Università Di Roma La Sapienza-Facoltà Di Medicina.
Things did not go to the right and hoped direction with me in the past and there were obstacles and interruptions in my life and plans for long periods of time. That, though, I’m going to graduate in medicine. This place I hope will be a diary of thoughts, studies, discussions and achievements.
June. 16.2007
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Flickr Photos
