Schistosomiasis (bilharzia) - 2014 Lancet review

Human schistosomiasis—or bilharzia—is a parasitic disease caused by trematode flukes of the genus Schistosoma.

230 million people worldwide are infected with Schistosoma spp.

Schistosomiasis: Ending the Anguish of a Silent Disease - The Carter Center video.

Adult schistosome worms colonise human blood vessels for years, successfully evading the immune system while excreting hundreds to thousands of eggs daily. The eggs must either leave the body in excreta or become trapped in nearby tissues. Trapped eggs induce an immune-mediated granulomatous response that causes:

Systemic effects

- anemia
- growth stunting
- impaired cognition
- decreased physical fitness

Organ-specific effects

- severe hepatosplenism
- periportal fibrosis with portal hypertension
- urogenital inflammation and scarring.

Prevention in endemic regions consist of treatment once every 1 or 2 years with the isoquinolinone drug, praziquantel, to suppress morbidity.


Human schistosomiasis : The Lancet
Living with Schistosomiasis - YouTube
Schistosomiasis (1990) Wellcome Library:

Inflammatory Bowel Disease (IBD) - DocMikeEvans animation video

Dr. Mike Evans is founder of the Health Design Lab at the Li Ka Shing Knowledge Institute, an Associate Professor of Family Medicine and Public Health at the University of Toronto, and a staff physician at St. Michael's Hospital.

Written and Narrated by Dr. Mike Evans.

National Library of Medicine, world's largest medical library, was a shelf of books in Surgeon General office in 1818

National Library of Medicine, the largest medical library in the world, started in 1818 as a shelf of books the office of the Surgeon General

The National Library of Medicine, the largest medical library in the world, began in 1818 as the US Army Medical Library, in Washington, DC, essentially a shelf of books in the office of Joseph Lovell, then Surgeon General and the head of the Army Medical Department. By the time of the Civil War the book collection consisted of about 2000 volumes and, no longer fitting in the office, was moved to a bank building.

The library, then as now, was constantly running out of space.

In 1962, the library would move to a large new building in Bethesda. There were more than 50 miles of underground bookshelves, and a roof in the shape of a hyperbolic paraboloid. The roof was intended to collapse in the event of an atom bomb, thus protecting the books, if not, perhaps, the librarians.

By 1972, librarians used MEDLINE searches about 140 000 times; today, the annual number of searches of its descendent, MEDLINE/PubMed, is over 2 billion.

Read more here:

Information on a global scale: the National Library of Medicine : The Lancet

Image source: (public domain).

Top medicine articles for July 2014

A collection of some interesting medical articles published recently:

Migraines Linked to Increased Risk of 'Silent Strokes'

Doctor’s Salaries Are Not the Big Cost - NYTimes -- "There is a startling secret behind America’s health care hierarchy: Physicians, the most highly trained members in the industry’s work force, are on average right in the middle of the compensation pack. That is because the biggest bucks are currently earned not through the delivery of care, but from overseeing the business of medicine.

The base pay of insurance executives, hospital executives and even hospital administrators often far outstrips doctors’ salaries: $584,000 on average for an insurance chief executive officer, $386,000 for a hospital C.E.O. and $237,000 for a hospital administrator, compared with $306,000 for a surgeon and $185,000 for a general doctor.

Among doctors, there is growing frustration over the army of businesspeople around them and the impact of administrative costs, which are reflected in inflated charges for medical services."

25% of US adults consult online physician-rating sites - Doctors Check Online Ratings From Patients and Make Changes. Online ratings "can be pretty brutal. However, part of being a physician now is having to deal with these.” "When we decided to quit ignoring it and embraced it, it totally changed the game" - WSJ

FDA Approves New Drug for Crohn Disease and UC: vedolizumab (Entyvio), an injectable monoclonal antibody. Vedolizumab, an integrin receptor antagonist

Interferon-free regimen with 3 drugs effective in Hep C with Cirrhosis (ABT-450/r–Ombitasvir, Dasabuvir, Ribavirin) -- Combination of nucleotide polymerase inhibitor sofosbuvir and antiviral ribavirin effective in HCV Genotypes 2 and 3

The relative risk reduction of 20% in breast-cancer mortality associated with mammography comes at a price. Abolish Mammography Screening Programs, says the Swiss Medical Board. The report caused an uproar

In obese patients with uncontrolled DM2, intensive medical therapy plus bariatric surgery was better than drugs alone

First dialysis machine was made with aluminium from a bomber that was shot down and bits from an automobile engine

At least 10% of adults and nearly all children who receive renal-replacement therapy have an inherited kidney disease

Kidney disease in farming communities worldwide remains a mystery: heavy metals and pesticides? indigenous herbs? OTC pain killers? chronic dehydration?

Worldwide, chronic kidney disease affects 8—16% of population, number of deaths almost doubled in the past decade

The articles were selected from Twitter and my RSS subscriptions. Please feel free to send suggestions for articles to clinicalcases AT and you will receive acknowledgement in the next edition of this publication.

Pancreatic Cancer - 2014 update from Am Fam Physician

Pancreatic cancer remains the fourth leading cause of cancer-related deaths in the United States.

Risk factors include:

- family history
- smoking
- chronic pancreatitis
- obesity
- diabetes mellitus
- heavy alcohol use
- possible dietary factors


Because more than two-thirds of adenocarcinomas occur in the head of the pancreas, abdominal pain, jaundice, pruritus, dark urine, and acholic stools may be presenting symptoms.


In symptomatic patients, the serum tumor marker cancer antigen 19-9 can be used to confirm the diagnosis and to predict prognosis and recurrence after resection.

Pancreas protocol computed tomography is considered standard for the diagnosis and staging of pancreatic cancer.



Although surgical resection is the only potentially curative treatment for pancreatic ductal adenocarcinomas, less than 20% of surgical candidates survive five years. The decision on resectability requires multidisciplinary consultation. Pancreatic resections should be performed at institutions that complete at least 15 of the surgeries annually.


Postoperatively, use of gemcitabine or fluorouracil/leucovorin as adjuvant chemotherapy improves overall survival by several months. However, more than 80% of patients present with disease that is not surgically resectable. For patients with locally advanced or metastatic disease, chemoradiotherapy with gemcitabine or irinotecan provides clinical benefit and modest survival improvement.

Palliative care

Palliation should address pain control, biliary and gastric outlet obstruction, malnutrition, thromboembolic disease, and depression.

Jon Lord, the keyboardist of the pioneering British hard-rock band Deep Purple, died of pancreatic cancer in 2012 and at age 71. Here is David Coverdale's eulogy for Jon Lord: David Coverdale remembers his first meetings with Jon Lord - supporting Deep Purple, joining Deep Purple and rehearsing for the Burn album:


Diagnosis and Management of Pancreatic Cancer. De La Cruz MS1, Young AP2, Ruffin MT2. Am Fam Physician. 2014 Apr 15;89(8):626-632.

Jon Lord, Keyboardist With Deep Purple, Dies at 71. NYTimes

Image source: Wikipedia, public domain.
Blog Widget by LinkWithin