Mediterranean Diet May Decrease Diabetes Risk

A Mediterranean diet, already known to protect against heart disease, also appears to decrease risk of developing diabetes according to a prospective study of 13,380 Spanish university graduates without diabetes at baseline followed up for 4.4 years.

Mediterranean diet was defined by features such as a high intake of fibre, a high intake of vegetable fat, a low intake of trans fatty acids, and a moderate intake of alcohol.

People who adhered closely to the diet were 83 percent less likely to develop type 2 diabetes than those who did not. The researchers admit they did not expect such a large reduction.

According to other studies, Mediterranean diet seems to improve cardiovascular risk factors after just 3 months and protect against asthma in childhood.

I try to follow a variant of the Mediterranean/DASH diet as much as possible. After adding 2-3 tablespoons of flax seed flower in the morning, my LDL decreased by 33% (from 136 mg/dL to 91 mg/dL).

My limited experience pales in comparison to John Halamka, the CIO of Beth Israel, Harvard, who literally became a new man by changing his diet and lifestyle. Read more in A Vegan Thanksgiving and check out his medical records available online.

Adherence to Mediterranean diet and risk of developing diabetes: prospective cohort study. BMJ.
Mediterranean diet may also help stop diabetes. Reuters.

Mediterranean diet during childhood may protect against asthma
Mediterranean Diet Seems to Improve Cardiovascular Risk Factors After Just 3 Months
Why to Eat Like a Greek - Mediterranean diet improves heart risk factors
Diet Guidelines: No more than 1.5 gm of sodium/day, get off your "SoFAS" - Solid Fats and Added Sugars
Image source: Olive oil, Wikipedia.

Gingivitis (gum disease) may increase risk of several cancers and heart disease

According to a prospective study published in the Lancet Oncology, U.S. male health professionals with a history of gum disease had a higher overall risk of developing lung, kidney, pancreatic and hematological cancers.

The 50,000 study participants were mostly male physicians aged 40-75 who were followed for 17 years. Those with history of periodontal disease had a 36% higher risk of lung cancer, a 49% higher risk of kidney cancer, a 54% higher risk of pancreatic cancer and a 30% higher risk of having a blood cancer.

Periodontal disease was associated with a small, but significant, increase in overall cancer risk, which persisted in never-smokers. Periodontal disease might be a marker of a susceptible immune system or might directly affect cancer risk.

Oral Health and Cardiovascular Disease

Contradicting evidence from 2012: Flossing Is Good For The Gums, But Doesn't Help The Heart


Periodontal disease, tooth loss, and cancer risk in male health professionals: a prospective cohort study. Lancet Oncology 2008; 9:550-558.
Periodontal diseases and cancer. Lancet Oncology 2008; 9:510-512.
Gum disease may raise cancer risk, study finds. Reuters.
People who consume a lot of omega-3 fatty acids (in oily fish) have a 22% lower risk of developing gum disease
Image source: Cross-section of a tooth with visible gums, or gingiva, Wikipedia, GNU Free Documentation License.

Another Medical School Links to the Clinical Cases Project

The University of the Andes in Chile is the latest medical school to list our online curriculum Clinical Cases and Images and/or the blog among the web resources recommended to students:

Universidad de los Andes > Biblioteca > Recursos Electrónicos > Medicina

The university joins the list of 27 medical schools which link to our projects. Among them are the University of California, San Francisco, University of California, San Diego, University of Michigan, Duke University, Northwestern University and many others.

Screenshot of Clinical Cases and Images

Clinical Cases and Images ( is a free online case-based curriculum of clinical medicine. The project was developed at Cleveland Clinic and Case Western Reserve University and has had more than 2 million page views since 2005. has been featured in 10 peer-reviewed medical journals and other scientific publications including British Medical Journal (3 times), Journal of the American College of Cardiology, Cleveland Clinic Journal of Medicine, Journal of the American Society of Nephrology, BMC Medical Education, Journal of the American Podiatric Medical Association, Nursing Education Perspectives, Baylor College of Medicine Web Digest, Medscape (2 times), Student BMJ, Medical Journal of Australia and Clinical Infectious Diseases. is a collaborative project and contributions are always welcome and acknowledged. CasesBlog is the blog I use to collect ideas, interesting stories and to post relevant news about the Clinical Cases and Images.

Medical Schools Which Link to Our Project Clinical Cases and Images
Image source: (public domain).

How do you backup your computer files?

One approach is described below and it is by no means perfect. I wrote this post long time ago and some of the equipment is outdated but one can still get a general idea.

Areas of storage and backup:

1. Desktop PC, 70 GB hard drive.
2nd degree backup. Files are transferred from the primary backup with free programs such as SyncBack Freeware or Toucan.

2. 500 GB second hard drive on desktop PC.
Primary backup -- this is a new drive by Seagate and should last the longest.

3. Seagate Free Agent ToGo portable hard drive, 120 GB.
3rd degree backup. Portable Apps (free) are installed on the Free Agent drive and the files are encrypted with Toucan (part of the portable suite). It is important to encrypt all portable drives because they are often lost.

4. Western Digital external hard drive, 80 GB.
4th degree backup. It also has Portable Apps and files are encrypted with Toucan.

5. Notebook PC (laptop), 30 GB (old).
I use this PC primarily for Internet access when traveling. Not much is stored there, only occasional downloaded files.

6. GMail, 6 GB.
The GMail account has all my emails, some files and music. The emails are downloaded to desktop PC via Mozilla Thunderbird. See how to backup your Gmail account(s) via POP.

7., 1 GB.
Not much free storage but it has a nice interface and is easy to use.

8. DVDs.
Backup photos, music, documents.

9. Picasa Photos, 1 GB.
For public photos.

10. USB drive, 2 GB.
For some files. Similarly to the portable hard drive, the USB drive also has Portable Apps and the documents are encrypted with Toucan.

Pushing Paper Out the Door. NYTimes, 02/2008.
Sleep soundly: Back up your photos. Google Photos Blog, 03/2008.
Image source: Wikipedia, public domain.

Synching Just Became a Cinch. NYTimes, 03/2008.
Bulletproof Backup Strategies. EfficientMD, 08/2008.

Updated: 08/11/2008

Ultrasound-guided Central Line Placement: Embed Several Videos in One Frame

Video: Ultrasound-guided Central Line Placement

Google Docs is a free web-based word processor, spreadsheet, and presentation application.

You can include YouTube videos, images, and text captions into slides to condense and display a “deck” of graphical content in a concise format in your posts.

For example, instead of publishing several videos on one page, you can insert videos and pictures in an embedded presentation slideshow -- see the example above.

I picked the topic of Ultrasound-guided Central Line Placement because this modality is of proven efficacy and safety but is still underutilized. A colleague of mine and I published a A Step-by-Step Procedure Guide with Photos for Central Line Placement with Ultrasound Guidance in an attempt to popularize the approach. A free PDA version of this procedure guide is available from MeisterMed.

Multiple-size Embedded Presentations from Google Docs. Blogger Buzz.
Central Line Placement with Ultrasound Guidance: A Step-by-Step Procedure Guide with Photos
Central Line Placement: A Step-by-Step Procedure Guide with Photos
Ultrasound Guided Vascular Access (USGVA)
SiteRite Video
Ultrasound-guided Central line insertion

Slideshow: Life Hacks for Doctors

Joshua Schwimmer, MD, FACP, FASN presents a useful and entertaining slideshow on Life Hacks for Doctors. Be sure to check the comments on his website as well.

Joshua was very kind to invite me as a collaborator on his new project, The Efficient MD Wiki:

"Wikis — collaborative websites — are powerful tools for education. The Efficient MD Wiki is designed to help healthcare professionals and medical students discover clinical pearls, useful resources, life hacks, and strategies to improve the practice of medicine."

Shortly before the launch, I asked him to list his tips on selecting a wiki platform which he did in My Experience Creating a Medical Wiki.

WSJ: Understanding Sen. Kennedy’s Brain Tumor

From Wikipedia:

"In October 2007, Sen. Kennedy had surgery to clear up a blocked left carotid artery (carotid artery stenosis).

In May 2008, Kennedy was rushed to Cape Cod Hospital from the Kennedy Compound after feeling ill and consulting with his physician, and then was subsequently transferred by helicopter to Massachusetts General Hospital in Boston. It was later reported that Kennedy had suffered two seizures, one initially at his Hyannis Port home and another on a helicopter en route to Massachusetts General Hospital from Cape Cod Hospital.

A few days later, doctors discovered that Kennedy has a malignant glioma, a type of cancerous brain tumor."

WSJ Video

According to WSJ Health Blog:

“Unfortunately, the older you are, the more likely it’s a glioblastoma,” Patrick Wen, clinical director at the Dana-Farber Center for Neuro-Oncology, told the Health Blog. Kennedy is 76. The average survival for a glioblastoma is 14.5 months, but survival tends to be shorter in elderly patients, Wen said.

Kennedy’s doctors said his tumor is in the left parietal lobe, a section of the brain that plays a role in sensation for the right side of the body, and in the ability to understand language."

Doctors: Ted Kennedy has malignant brain tumor. CNN.
Understanding Sen. Kennedy's Cancer Diagnosis. NPR.
A grim diagnosis: Kennedy's brain cancer is worst kind. AP.
Senator Kennedy Has a Malignant Brain Tumor. NYT.
Prognosis Usually Bleak for Condition, a Glioma. NYT.
Kennedy Diagnosed With Brain Tumor. WSJ.
Image source: Wikipedia, GNU Free Documentation license.

Google Health (Personal Health Record) Launches for Everybody Today

Screenshot of Google Health

Google Health is an online service which provides personal health record (PHR). The website is live and anybody can sign in, with a Google account, of course. It looks friendlier and easier to use than the competing offering by Microsoft called Health Vault. See the Google Health tour here.

A few excerpts from the "About Google Health" page are listed below:

Google Health allows you to store and manage all of your health information in one central place. And it's completely free. All you need to get started is a Google user name and password.

Why use Google Health:

- Keep your doctors up-to-date
- Stop filling out the same paperwork every time you see a new doctor
- Avoid getting the same lab tests done over and over again because your doctor cannot get copies of your latest results
- Don't lose your medical records because of a move, change in jobs or health insurance

With Google Health, you manage your health information — not your health insurance plan or your employer. You can access your information anywhere, at any time.

With Google Health, you can:

Create a health profile

- Build online health profiles: you can enter your health conditions, medications, allergies, and lab results into your Google Health profile

- Review trusted information on diseases and conditions

Search for doctors and hospitals

Google Health launched. Google Blogoscoped.
Google Health: A View From the Inside. Wachter's World.
Image source: Google Health.

Would you like to see Dr. Google or Dr. Microsoft for your personal health records?
Adam Bosworth, Google Health Architect, Leaves Google
The Ultimate Guide to Google Health: 60+ Tips and Resources.
Microsoft HealthVault and Google Health - The 'Coke and Pepsi' of Online Health (PHR). ReadWriteWeb, 10/2008.

Updated: 10/16/2008

Cases Journal -- Online Open Access Journal by Former BMJ Editor

Cases Journal is a peer-reviewed, open access journal publishing case reports from any area of healthcare. Case reports will be incorporated into a PubMed Central database.

The journal has interactive features typical of Web 2.0:

"Authors are encouraged to invite the patient to contribute to the case report - each article can include an optional 'Patient's perspective’ section, where the patient describes their experience of the disorder and treatment.

We do not see publication of your case report as the end of the process. Once your case report is published, you will be able to add extra information in response to comments from the reviewers. Readers may post questions on your published case report, and we strongly encourage you to post a reply. We will also invite you to share information on any follow-up to the case - we will contact you one year after your case report is published to invite you to share with readers any changes that may have occurred with the patient."

Richard Smith

The Editor-in-Chief Richard Smith is the immediate past editor of BMJ. You can see his video interview and read Why do we need Cases Journal?

In one of the first case reports, Richard Smith describes his own experience with nagging cough in Beijing. As you can see from the text, the style is closer to a blog post than to a journal article.

This new initiative proves the validity and potential usefulness of our Clinical Cases and Images project which is an online case-based curriculum of clinical medicine launched in 2005. The project is hyperlinked in the web sites of 27 medical schools in the U.S., Canada and Europe and was featured in multiple medical journals.

Screenshot of Clinical Cases and Images

We welcome the "competition" and encourage you to the subscribe to the RSS feed of Cases Journal:

Currently, and CasesBlog are the number one and two search results on Google for "clinical cases" among 10 million web pages (have been so for 2 years). I doubt they will continue to rank so highly but let's see what happens in a few years.

Image source: Cases Journal.

A Star Is Born: Scottish Singer and Songwriter Amy MacDonald

Some readers may have noticed that I often publish posts on topics different from medicine and technology during the weekends. This is an example:

This Is The Life, Amy MacDonald

Amy MacDonald
is a Scottish singer and songwriter who has a number one record in the UK and now she is coming to North America. Link via Teresa Lo,

Other videos:
Wish For Something More

Interesting Articles: A Weekly Review of the "Big Five" Medical Journals

This is a collection of articles I have found interesting in the weekly editions of the "big five" medical journals: NEJM, JAMA, Annals, Lancet and BMJ (a few more journals are included occasionally). The review is a weekly feature of Clinical Cases and Images - Blog. Please see the end of the post for a suggested time-efficient way to stay up-to-date with the medical literature.


Stents versus Coronary-Artery Bypass Grafting for Left Main Coronary Artery Disease: No Difference.
NEJM, 04/2008.

There was no significant difference in the risk of death, Q-wave myocardial infarction, or stroke between patients receiving stents and those undergoing CABG. However, stenting, even with drug-eluting stents, was associated with higher rates of target-vessel revascularization than was CABG.


Home Use of Automated External Defibrillators for Sudden Cardiac Arrest: Not Helpful.
NEJM, 04/2008.

The most common location of out-of-hospital sudden cardiac arrest is the home, consequently, home use of an automated external defibrillator (AED) might offer an opportunity to improve survival. In this study of survivors of anterior-wall myocardial infarction, access to a home AED did not significantly improve overall survival.


Carotid bruits as a prognostic indicator of cardiovascular death and myocardial infarction: a meta-analysis. The Lancet 2008; 371:1587-1594.

The rate of myocardial infarction in patients with carotid bruits was 3·69 per 100 patient-years compared with 1·86 per 100 patient-years in those without bruits. Yearly rates of cardiovascular death were also higher in patients with bruits than in those without (2·85 per 100 patient-years vs 1·11 per 100 patient-years). In the four trials in which direct comparisons of patients with and without bruits were possible, the odds ratio for myocardial infarction was 2·15 and for cardiovascular death 2·27. Auscultation for carotid bruits in patients at risk for heart disease could help select those who might benefit the most from an aggressive modification strategy for cardiovascular risk.


Use of Multiple Biomarkers to Improve the Prediction of Death from Cardiovascular Causes: Useful.
NEJM, 05/2008.

The combination of biomarkers reflects myocardial cell damage, left ventricular dysfunction, renal failure, and inflammation (troponin I, N-terminal pro–brain natriuretic peptide, cystatin C, and C-reactive protein). In elderly men (mean age 71), the simultaneous addition of several biomarkers of cardiovascular and renal abnormalities improves the risk stratification for death from cardiovascular causes beyond that of a model that is based only on established risk factors.


Cardiac Troponin and Outcome in Acute Heart Failure: Positive troponin predicts worse outcome.
NEJM, 05/2008.

This is a Cleveland Clinic study and I have the privilege of knowing the principal investigator and author, W. Frank Peacock, IV, who works in our ED.

Patients who were positive for troponin had lower systolic blood pressure on admission, a lower ejection fraction, and higher in-hospital mortality (8.0% vs. 2.7%) than those who were negative for troponin. The odds ratio for death in the group of patients with a positive troponin test was 2.55.

In conclusion, in patients with acute decompensated heart failure, a positive cardiac troponin test is associated with higher in-hospital mortality.


Efficacy and Safety of Recombinant Activated Factor VII for Acute Intracerebral Hemorrhage: No Clinical Difference.
NEJM, 05/2008.

Intracerebral hemorrhage is the least treatable form of stroke. This trial did not confirm a previous NEJM study in which recombinant activated factor VII (rFVIIa) improved survival and functional outcomes. Factor VII still reduced growth of the hematoma though, it just did not make a clinical difference.

The growth in volume of intracerebral hemorrhage was reduced by 2.6-3.8 ml. The frequency of thromboembolic adverse events was similar in the 3 groups; however, arterial events were more frequent in the group receiving 80 µg of rFVIIa than in the placebo group (9% vs. 4%, P=0.04).

Hemostatic therapy with rFVIIa reduced growth of the hematoma but did not improve survival or functional outcome after intracerebral hemorrhage.


Etiquette-Based Medicine. NEJM, 05/2008.

This is a possible checklist for the first meeting with a hospitalized patient:

1. Ask permission to enter the room; wait for an answer.
2. Introduce yourself, showing ID badge.
3. Shake hands (wear glove if needed).
4. Sit down. Smile if appropriate.
5. Briefly explain your role on the team.
6. Ask the patient how he or she is feeling about being in the hospital.


Corticosteroids and Mortality in Children With Bacterial Meningitis: Steroids seem to be helpful in adults but not in children.
JAMA, 05/2008.

In adults, adjuvant corticosteroids significantly reduce mortality associated with bacterial meningitis; however, in children, studies reveal conflicting results.

In this study, of children with bacterial meningitis, adjuvant corticosteroid therapy was not associated with time to death or time to hospital discharge.


Effect of Folic Acid and B Vitamins on Risk of Cardiovascular Events and Total Mortality Among Women at High Risk for Cardiovascular Disease: Not Useful.
JAMA, 05/2008.

After 7.3 years of treatment and follow-up, a combination pill of folic acid, vitamin B6, and vitamin B12 did not reduce a combined end point of total cardiovascular events among high-risk women, despite significant homocysteine lowering.

The Polypill proposed by BMJ should not include folic acid after all. In the light of recent evidence, it looks like we should skip the beta-blocker too.


National Institutes of Health Consensus Development Conference Statement: Hydroxyurea Treatment for Sickle Cell Disease. Annals of Int Med, 05/2008.

Vaccines and Autism Revisited — The Hannah Poling Case. NEJM, 05/2008.

Like Night and Day — Shedding Light on Off-Hours Care. NEJM, 05/2008.

5 Tips to Stay Up-to-Date with Medical Literature
Make Your Own "Medical Journal" with iGoogle Personalized Page
Share iGoogle Tabs with Medical Journals, Podcasts and Gadgets
Text-to-Speech Programs and Continuous Medical Education
Image source: OpenClipArt, public domain.

Many newspapers have health blogs -- will physician blogs compete with them for readership in the future?

Duty calls. Image source:, Creative Commons license.

USA Today is the latest major newspaper to launch a health-related blog in addition to the NYTimes, WSJ, etc.

Will physician blogs compete with them for readership in the future?

Non-journalist physician blogs will probably do just fine. Blogs written by doctors may not be comprehensive and covering every news story out there but they are authentic and provide a truly professional view (the good ones, at least). Just see Dr. Wes, for example.

Physician blogs have they own niche in keeping up-to-date with the new developments in medicine and I listed them among the 5 tips to stay current in Web 2.0-style.

Newspaper health blogs are useful too. This is why I have 600 subscriptions in my RSS reader.

Image is licensed under Creative Commons.

5 Tips to Stay Up-to-Date with Medical Literature
Too many feeds to read? Time to trim down RSS subscriptions
Image source:, Creative Commons license.

Your spreadsheet becomes a wiki: Let's make a list of best medical podcasts

Google Spreadsheets added an option in the sharing dialog that allows anyone to view or edit the spreadsheet just by knowing the URL.

If you click on the Share tab and enable "Anyone can edit this document WITHOUT LOGGING IN", your spreadsheet becomes a wiki that can be edited by anyone.

The embedded spreadsheet below is an invitation to help make a list of the best medical podcasts. Anybody can edit the list -- give it a try. The original spreadsheet is published here.

You can easily embed spreadsheets and forms in a website by just copying HTML code. Click here for HTML code to embed the Medical Podcasts spreadsheet above in your own website.

Google Spreadsheets Become Wikis. Google Operating System.
Edit Google Spreadsheet With Everyone. Google Blogoscoped.
Top 5 Medical Podcasts I Listen To. Clinical Cases and Images - Blog.

Comprehensive List of Medical Podcasts and Videocasts. UBC Wiki.

Updated: 12/14/2008

ACP Launches a Blog for Its Annual Meeting

At its annual meeting Internal Medicine '08, the ACP is launching a blog: ACP Internist Blog:

"Blogs are now an integral channel to deliver timely, researched information. It's also much more interactive, allowing immediate feedback from our readers. To deliver feedback, click on the comments link that follows each message."

The ACP is using the good old (and reliable) software of by Google -- the same platform that powers this blog.

As I have predicted 2-3 years ago, all future scientific meetings and educational courses will have accompanying blogs, podcasts and YouTube videos. The organizers will either hire medical bloggers or use "home-grown" talent.

The Society of Hospital Medicine (SHM) also published meeting updates on a blog this year.

2008 Annual Hospitalist Meeting Has a Blog with Latest Updates
Image source: ACP.

Topics Discussed During the Internal Medicine Rotation at Cleveland Clinic in May 2008

This is a list of the topics discussed (or considered for discussion) during the Internal Medicine Rotation with residents and medical students at Cleveland Clinic:

Guidelines for treatment of DVT/PE. See the presentation from Google Docs.
A Man with Urinary Tract Infection: Risk Factors
Calciphylaxis, eMedicine, by Dr. Estemalik
Acid-base Balance Cases and Calculators by Dr. Dimov
Different IV catheters and related complications
5 Tips to Stay Up-to-Date with Medical Literature by Dr. Dimov
Podcasts in Medicine:
- Top 5 Medical Podcasts I Listen To
- Annals of Internal Medicine Launches Podcast and Audio Summaries
- Podcasts from Conferences of University of Tennessee IM Residency Program
Listerial Rhombencephalitis, cases from CCF and UPMC
Diabetic Ketoacidosis (DKA): Typical Laboratory Findings and Response to Treatment
Diabulimia: Skipping Insulin to Slim Down
Acute Wiiitis Reported in NEJM
Text-to-Speech Programs and Continuous Medical Education

To be discussed in the future

Neurosarcoidosis, eMedicine: diagnosis, treatment and prognosis
Use of blogs in medicine
How to start a medical blog in 2 minutes
Electrocardiogram (ECG, EKG) Learning Tools
Atrial fibrillation (AFib) with rapid ventricular response (RVR) due to triple lumen catheter
Something you have never seen before -- a rare central line complication in NEJM
What to do if you loose a guide wire during central line placement?

Topics from previous rotations

Web 2.0 in Medicine (from Google Presentations) by Dr. Dimov
Aortic Stenosis and Preoperative Evaluation for Noncardiac Surgery
Which blood pressure medications to take on the morning of surgery?
What is the risk for developing ARF after surgery?
Preoperative Care of Patients with Kidney Disease, mnemonics PAST and HIP
New perioperative guidelines for noncardiac surgery (ACC, Medscape)
Case 2: Does this patient need a beta-blocker? and 4CD mnemonic to remember the risk factors in RCRI
Chest compressions-only CPR works as well as standard technique in adults
Hyponatremia and Hypernatremia:
Hyponatremia - Na 118 - What is the cause?
Syndrome of Inappropriate Antidiuretic Hormone Secretion (SIADH) due to SSRIs
SIADH due to Lung Cancer and Aspiration Pneumonia
Hypernatremia due to Dehydration in Dementia
Wellbeing practices correlated with the feeling of happiness: MOTORS
Keep residents happy -- it is better for patients
A Systematic Approach to Electrocardiogram (EKG) Interpretation by Using 2 Mnemonics: A RARE PQRST/DR III EEE by Dr. Dimov
Case 3: When to correct hyperkalemia before surgery?
Case 4: When to do hemodialysis before surgery in patients with ESRD?
Rates of medication errors among depressed and burnt out residents by Dr. Dimov
How do you define prolonged immobilization?
How many "organ"-renal syndromes are recognized? by Dr. Dimov
Difficult to control asthma - what to do after ICS/LABA/LTRA have failed by Dr. Dimov
When to Use Xolair (Omalizumab) in Asthma? by Dr. Dimov
Mind maps for asthma treatment by Dr. Dimov

The list will be updated periodically as new topics are added by the end of the month. As you can see from the links above, a blog can be used as an educational portfolio for both personal learning and teaching.

Topics Discussed During the Medicine Consult Service Rotation at Cleveland Clinic in March/April 2008
Topics Discussed During the Internal Medicine Rotation at Cleveland Clinic in October/November 2007. CasesBlog, 10/2007.
Topics Discussed During the Internal Medicine Rotation at Cleveland Clinic in September 2007
Using a Blog to Build an Educational Portfolio. CasesBlog, 1/2007.
DB’s thoughts on being a clinical educator. DB’s Medical Rants, 11/2007.
Attending Rounds. DB’s Medical Rants, 02/2008.
Happiness. DB’s Medical Rants, 03/2008.

Updated: 05/29/2008

Clinical Case: Anaphylaxis Due to Bee Sting

A 45-year-old male was taken to the ED with generalized body hives and a decrease in SBP to the 80s per EMS.

He was working on his house when he was attacked by bees.

What is the most likely diagnosis?

Read more in Anaphylactic Shock Due to Bee Sting on

Image source: Wikipedia 1, 2, GNU Free Documentation License.

How to get one million page views per day? Make a website with cute photos of cats

According to CNN:

"The Web site I Can Has Cheezburger gets more than a million page views each day. It features pictures of cats captioned with a unique blend of text speak, fractured grammar and Internet in-jokes. The site is so popular, it now needs a staff of eight to handle traffic and submissions."

A few photos are shown below:

humorous pictures
Source: I Can Has Cheezburger

humorous pictures
Source: I Can Has Cheezburger

The new fame: Internet celebrity. CNN.

How to use a Windows Mobile phone to listen to medical podcasts?

My phone is Moto Q9c, Windows Mobile 6, with a Sprint SERO plan with unlimited data transfer.

Here are the 4 simple steps to listen to medical podcasts:

1. Download the Opera Mobile browser ($24). Internet Explorer should work fine but Opera is easier to use and has a better zoom feature.

2. Use
Bloglines to subscribe to podcasts from your desktop/laptop.

3. Open Bloglines Mobile from your phone browser. Click on the "enclosure" link in the podcast feed. The podcast mp3 file will be downloaded.

4. Open the file with Windows Media Player. Enjoy listening to your favorite medical podcasts on the go.

Top 5 Medical Podcasts I Listen To
Image sources: Screenshots from websites of Opera Mobile, Bloglines, Bloglines Mobile.

Taking Up Moderate Drinking in Middle Age Decreases Cardiovascular Risk

Internal Medicine News reports some preliminary findings from Atherosclerosis Risk in Communities (ARIC), an ongoing NHLBI-sponsored prospective epidemiologic study:

"Former nondrinkers who initiated moderate alcohol consumption in middle age experienced a 38% reduction in cardiovascular events over 4 years, compared with continued nondrinkers, in the Atherosclerosis Risk in Communities study.

“The current American Heart Association guidelines state that moderate alcohol consumption at this level can be part of a healthy lifestyle, but caution that if you don't already drink, don't start. This research challenges that policy. A 38% lower chance of having an acute MI or stroke is extremely significant. That's a bigger effect than you'd expect with initiation of statin therapy,” said Dr. Dana E. King, professor of family medicine at the Medical University of South Carolina, Charleston."

The study findings were published in the American Journal of Medicine ("The Green Journal"):

Of 7697 participants who had no history of cardiovascular disease and were nondrinkers at baseline, within a 6-year follow-up period, 6.0% began moderate alcohol consumption (2 drinks per day or fewer for men, 1 drink per day or fewer for women) and 0.4% began heavier drinking.

After 4 years of follow-up, new moderate drinkers had a 38% lower chance of developing cardiovascular disease than did their persistently nondrinking counterparts. There was no difference in all-cause mortality between the new drinkers and persistent nondrinkers.


Taking Up Moderate Drinking Slashes CV Risk. Internal Medicine News, 04/2008.
Adopting Moderate Alcohol Consumption in Middle Age: Subsequent Cardiovascular Events. Dana E. King, Arch G. Mainous, Mark E. Geesey. Am. J. Med. 2008;121:201–6.
Alcohol literally kills: Gary Moore had 380mg/dL in his blood, Winehouse 416mg/dL when she died surrounded by 3 empty vodka bottles. Telegraph UK, 2012.
Image source: Wikipedia, public domain.

How to Add a Favicon to the URL of a Site Hosted on

Favicon is short for "Favourite Icon" - a tiny image seen in the URL in the address bar of the browser. It serves as a "symbol" for the site.

How to Add a Favicon to the URL of a Site Hosted on

1. Choose or make an image.

2. Increase the image contrast and color saturation. You can use a free image-editing program such as IrfanView.

3. Go to to create the favicon.

4. Upload the newly-created favicon to Google Pages.

5. Copy the URL of the uploaded image.

6. Log-in to Dashboard of your blog. Copy the code snippet shown here in the template just below the title tags (located at the top).

Update 10/28/2008: Fix for "missing" favicon

How To Add a Favicon to your Blog? Dummies Guide to Google Blogger Beta.
Add Favicon icon to Blogger URL. Tips for New Bloggers.
Favicon generator and free .ico image host: Favicon for your blog. Dummies' Guide to Google Blogger, 06/2008.

How do I include a "favicon.ico" on my Web pages? Ask Dave Taylor, 2009.

Updated: 05/14/2009

This Week's Grand Rounds

Check out Grand Rounds, the weekly summary of the best posts in the medical blogosphere.

Grand Rounds has become the contemporary weekly portrait of medicine through the eyes of the medical bloggers. Pre-Rounds is an article series about the hosts of Grand Rounds on Nick Genes of Blogborygmi, who writes the Medscape column, is the founder of Grand Rounds and the archive host.

This week's host is a plastic surgeon in Little Rock, AR who writes a blog called Suture for a Living. She mixed the posts with links and photos of Arkansas:

"Arkansas actually has a diamond mine open to the public -- you get to keep what you find.

Within five Arkansas state parks are cabins, pavilions, bridges, trails, a lodge, and other works that endure as a legacy to the craftsmanship of the Civilian Conservation Corps, part of Franklin D. Roosevelt's New Deal.

There are many places for rock climbing, hiking, fishing, and boating within Arkansas. Granted we are land-locked so no major sailing for us."

I have visited 28 states (see the travel blog) but have not been to Arkansas yet. It should be on the list next time.

Visited states (28).

Create your own visited states map

Text messaging can help young people manage asthma. How about Twitter and Facebook reminders?

From Allergy Notes:

A research letter published in the BMJ claimed that text message reminders about asthma treatment may be "a medium to allow people to make their disease comply with their lifestyle and not the other way around."

The 30 participants included in the study developed such a rapport with their virtual friend with asthma called Max that they frequently sent text messages back to him:

"Yo dude, its Max reminding U2 takeur inhaler"

"Yep dis mornin" (Alex)"

In the small study, text messaging was probably helpful in asthma management. How about emails, Twitter and Facebook reminders?

This CommonCraft video explains what a microblogging platform is by using Twitter as an example.

Mobile phone text messaging can help young people manage asthma. BMJ 2002;325:600 ( 14 September ), Letters.
Image source:, public domain.
Text messaging can help young people manage asthma. Allergy Notes.
Text messages help teens with asthma. The Enquirer, Cincinnati, 04/2008.

How to Use Second Life Virtual World for Case Presentations

From ScienceRoll:

"We had a meeting in Second Life, the virtual world at the Ann Myers Medical Center. One of our educators did a case presentation by giving us a text file that contained the history and all the important physical signs. It was followed by some brainstorming. We had to discuss what kind of tests we would order and what kind of diagnoses we were thinking about."

Second Life is one of the Web 2.0 services that can be useful in medical education:
  1. Web feeds (RSS)
  2. Podcasts
  3. Blogs
  4. Wikis
  5. Custom search engines
  6. Second Life virtual world
Case Presentation in Second Life.

Cleveland Clinic Alumni Magazine Features Founders of AskDrWiki

The Cleveland Clinic Alumni Magazine (Connection Newsletter, Vol. XXVIX No. 1, 2008, PDF, 20 MB) features the founders of one of the best medical wikis --

"Along with cardiology colleagues Brian Jefferson, MD, Shane Bailey, MD, and Michael
McWilliams, MD, Dr. Civello established, a non-profit, grassroots, physician-run, physician-maintained online community to publish review articles, clinical notes and medical images.

The four cardiologists now are located in different states. Dr. Civello is in Louisiana, Dr. Jefferson is in Tennessee, Dr. McWilliams is in Delaware and Dr. Bailey continues at Cleveland Clinic. keeps them in close contact."

Read the full text of the article on Ken Civello's blog: Cleveland Clinic Alumni Magazine on

Ken, Brian and I met several times during the early stages of the wiki and I was very impressed by their enthusiasm and dedication. The site was featured on the front page of the main Cleveland newspaper, The Plain Dealer and I still stay by my quote in the article: "Sites like AskDrWiki will change the way we study and teach medicine."

Main Cleveland Newspaper Features a Cleveland Clinic-based Wiki, 3/31/2007.
Medical Wikis May Change the Way We Study Medicine, 1/27/2007.
AskDrWiki -- A Collaborative Medical Encyclopedia, 1/01/2007.
Medical Encyclopedia AskDrWiki Expands Collection of Videos and Images, 6/07/2007.

A Blood Test for Idiopathic Pulmonary Fibrosis

Mechanisms of IPF. Image source: PLoS Medicine, Creative Commons license.

Idiopathic pulmonary fibrosis (IPF) is a disease of unknown aetiology and uncertain pathogenesis, and there are no effective therapies. The average survival is less than 3 years from the time of diagnosis.

Matrix metalloproteinases (MMPs) are zinc-dependent endopeptidases. Elevation of plasma matrix metalloproteinases (MMP1 and MMP7) may help to confirm a diagnosis of IPF and probably non-specific interstitial pneumonia (NSIP), and help to distinguish these diseases from hypersensitivity pneumonitis (HP), sarcoidosis, and perhaps other fibrotic lung diseases.

Plasma concentrations of MMP7 may be useful in following disease progression and even in facilitating early diagnosis. Source: PLoS Medicine, Creative Commons license.

Mind map of Interstitial Lung Diseases (ILD). Read more: Interstitial Lung Diseases (ILD). Allergy Cases.

A Blood Test for Lung Fibrosis. Peter J. Barnes. PLoS Medicine, 04/2008.
Interstitial Lung Diseases (ILD). Allergy Cases.