CasesBlog - Medical and Health Blog: May 2009

Health News of the Day

Health News of the Day is a daily summary made from the selected links I post on Twitter. It is in a bullet points format with links to the original sources which include 350 RSS feeds that produce about 2,500 items per day.

Exercise "feel-good afterglow" may last as long as 12 hours http://bit.ly/wfM9L
Effects of child head injuries can last for years http://bit.ly/dzd3H
"Elixir of life"? Low vitamin D levels associated with impaired thinking or "cognitive" impairments in older men http://bit.ly/uPDMF
The FDA approved Besivance (besifloxacin ophthalmic suspension) for the treatment of bacterial conjunctivitis http://bit.ly/cPQXV
High levels of the protein HU177, associated with angiogenesis, identifies patients with melanoma with poor prognosis http://bit.ly/q0o3I
Is you pool safe? Use some BLS/ACLS skills: Look, Listen, Feel (and smell) http://bit.ly/1apzH3
U.S. spends more on healthcare than any other country in the world but has higher rates of infant mortality, diabetes http://is.gd/JUMf
Part-time hospitalists: http://bit.ly/xAkaz
For hospitalists: Free MP3s of the major talks from the 2009 SHM Annual Meeting in Chicago http://tinyurl.com/l67chl

Image source: OpenClipArt.org, public domain.

Selection of My Twitter Favorites, Edition 64

Twitter is a microblogging service where people answer the question "What are you doing?" via 140-character messages from their cellphone, laptop or desktop. You can select the messages (called "tweets") that you find interesting, useful, amusing, or disagreeable. Here is the 64th edition of My Twitter Favorites (the oldest post is at the bottom, the newest at the top): Micro-blogging on Twitter is easy, fun and can be very useful and educational if you follow/subscribe to interesting people. You can read more here: A Doctor's Opinion: Why I Started Microblogging on Twitter and visit my account at Twitter/AllergyNotes.

bencasnocha Reading blogs/ RSS is a better use of time than reading Twitter. In gen'l the most interesting thinkers are blogging more than twittering. 5:43 PM May 26th from TweetDeck
jeffjarvis In Des Moines. Solid rain. Good for corn. Bad for my suit. 5:41 PM May 26th from Tweetie
AllergyNotes Why journal editors make font of "methods/statistics" smaller than the rest of the article? Not to discourage you from reading it I hope. 5:39 PM May 26th from web
arrington retweets are going to become serious currency in the new search engines. like hyperlinks in the "old days." 7:51 PM May 25th from web
loic Twitter and Facebook are the revenge of the non bloggers. They can be as influential or more than bloggers without even knowing what a blog is 7:14 PM May 24th from Seesmic Desktop
jeffjarvis Twitter doesn't get the heart-rate up. Twitter keeps me from running. Twitter is not healthy. 7:47 AM May 23rd from Tweetie
bencasnocha The best thing about being famous is the chance to meet other famous people. - Andy Warhol 7:15 PM May 22nd from txt
pkedrosky one of the more terrifying searches you can do on twitter -- people texting and driving http://is.gd/CpU012:45 PM May 22nd from twhirl
KidneyNotes Epocrates Pill Finder on the iPhone correctly identified a patient's small round white tablet with 321 on one side as Ativan 0.5 mg. 10:15 AM May 22nd from TwitterBar
judywriter When I can't sleep, I start thinking of the things I'm grateful for. Haven't gotten to the end of that list even once. 9:20 PM May 21st from TweetDeck
arrington I'll put it this way: The new Terminator movie is so bad you keep hoping the machines will win so the movie will end. 1:47 PM May 21st from web
bencasnocha "Kids don’t want quality time. They want quantity time — big, stinking, lazy, nonproductive quantity time." - Al Franken, advice to parents 2:12 PM May 27th from TweetDeck

The inclusion of a Twitter update (tweet) in Selection of My Twitter Favorites does not represent endorsement or agreement of any kind.

If you are included in this post but you would like to have your tweet removed for any reason, please email me and will comply with your request the same day.

Health News of the Day

A swallowed denture: All objects that have passed the duodenal sweep should be managed conservatively. http://bit.ly/1afHX5
High-Deductible Health Insurance: 50% chose not to seek medical care for minor ailments 4 times in the last year http://bit.ly/a0GSu
WSJ Brutal Gallery: A World of Cigarette Warning Pictures by the WHO: http://bit.ly/19Cu5w
Dermatologists: Skin cancer is colorblind, minorities often believe pigmentation makes them immune to skin cancer http://bit.ly/BlZeQ
Photo of a "heart attack in a box" meal: Three Cheese Mac-N-Cheese Pasta Bread Bowl http://bit.ly/b9UXZ -- 21 million page views and counting - hopefully some people will switch to healthier diet after seeing this: http://bit.ly/57ZPQ
"Medical news is almost always distorted, and leads to false hopes and expectations from patients" - What to do? http://bit.ly/tLSV0

Image source: OpenClipArt.org, public domain.

Playing For Change | Song Around The World "Stand By Me"

From Twitter:

pkedrosky RT @scottblanc: love the stand by me video that's been floating around the web on so many levels - http://bit.ly/zcnrr29 minutes ago from twhirl

Playing For Change | Song Around The World "Stand By Me" from Concord Music Group on Vimeo.

Health News of the Day

In dysplastic Barrett's esophagus, radiofrequency ablation had a high rate of complete eradication http://bit.ly/Kp2dx
Type 2 diabetes is an increasing epidemic in Asia, with an onset at a relatively young age and low body mass index. http://bit.ly/lpx5g
Acid-suppressants associated with 30% increased odds of hospital-acquired pneumonia, stat. significant only for PPIs http://bit.ly/2U20t3
Compared with healthy young-adult men, the substantially larger NFL players had a higher prevalence of hypertension http://bit.ly/z2QfV
Many teenagers routinely get just 3 to 5 hours sleep per night, study shows. Just one in five teens is getting the recommended eight hours of sleep each night. http://bit.ly/j8P7B
Normal human skin is alive with bacteria - a hundred times more kinds of bacteria, in more places, than previously known. Bacteria thriving in "vibrant communities" in healthy skin http://bit.ly/xvvdj
The Most Dangerous Room in the House for Seniors? Many experts believe it's the bathroom. http://bit.ly/L8NQx

Image source: OpenClipArt.org, public domain.

Do you think NEJM or BMJ should create their own "UpToDate"?

Looking at this excerpt from UpToDate:

UpToDate quote: "approximately 15% of the 1,200 patients whom I have seen..." without a reference - is this EBM?! http://bit.ly/VFXiK

I asked some "medtweeps" on Twitter: "Do you think NEJM should create its own UpToDate? eMedicine is not a real competitor and UTD needs improvement." BMJ Publishing Group is behind Clinical Evidence, "the international source of the best available evidence on the effects of common clinical interventions."

Here are some of the responses:

chukwumaonyeije Yep. I've also winced at similar statements on UpToDate. Some reviewers appear to have hobby horses and axes to grind. 3 minutes ago from TweetDeck in reply to AllergyNotes

chukwumaonyeije in my opinion UTD is good for general OB but lacking in high risk OB and internal med. So yes. NEJM should step up. 14 minutes ago from txt

shamsha NEJM's version of UpToDate? would depend on how evidence is graded/presented, price, and UI, just 4 starters! 13 minutes ago from TweetDeck in reply to AllergyNotes

Related:
Are You Dependent on UpToDate for Your Clinical Practice?
Study: UpToDate More Likely than PubMed to Answer Patient Care Questions
NEJM is a Journal (Only) No More

Disclaimer: I am a member of the NEJM Advisory Panel for Medical Students and Residents. However, my responsibilities do not include, did not include, and are not likely to include in the future any work on an "UpToDate-like" project. I am not aware of any such projects being under consideration. I had a brief consulting role with The Lancet in 2007 and the same disclaimer applies.

Health News of the Day

NEJM: The Proposed Government Health Insurance Company — No Substitute for Real Reform, would be more successful in forcing lower reimbursement rates on physicians and hospitals http://bit.ly/loR6D
NEJM: Handguns, Health, and the 27 words of the Second Amendment http://bit.ly/rubSm
Somehow, the NEJM's use of the terms "younger old persons" and "older old persons" doesn't sound quite right... http://bit.ly/k8yW0
Use of acid-reducing drugs was associated with a 30% increased risk for developing pneumonia http://bit.ly/YZYPl
Increase in incidence of type 1 diabetes is 3.9% per year. http://is.gd/I7pK
Radiofrequency Ablation Treats Barrett’s Esophagus, Reduces Cancer Risk http://is.gd/I7rc
Cleveland Clinic Wellness Grand Rounds - video and slides http://www.cchs.net/wellnes...
Dr. Gupta started posting XR/CT/MRIs of his cases weekly - good educational value, he needs a separate blog than CNN's http://is.gd/HKxc
UpToDate quote: "approximately 15% of the 1,200 patients whom I have seen..." without a reference - is this EBM ?! http://bit.ly/VFXiK

Image source: OpenClipArt.org, public domain.

ECG Videos: For Med Students studying the basics of reading an electrocardiogram

ECG Video part 1: For Med Students studying the basics of reading an electrocardiogram, from the University of Wisconsin.

ECG Video part 2.

Related:
Imaging: Electrocardiograms, X-rays, CT scans
A Systematic Approach to Reading an EKG by Using 2 Mnemonics

Health News of the Day

Acne Guidelines: topical retinoids should be first-line treatment and backbone of acne maintenance therapy. Long-term maintenance therapy with antibiotics is not recommended. Benzoyl peroxide (not ABx) may be added to a long-term retinoid regimen to provide antimicrobial action http://is.gd/Fvog
Medical male circumcision reduces the acquisition of HIV by heterosexual men by 38-66% http://is.gd/FwdB
Obese, Diabetic Youths Already Have Artery Plaque, Suggesting Early Heart Disease http://is.gd/FC4O
Professional Football Players Have Higher Rates of Hypertension. “When we compared NFL players weighing 200 pounds to 200-pound people, the NFL players’ blood pressures were much higher” http://is.gd/FCad
Which is the Fittest City in U.S.? Washington, D.C. http://is.gd/FtEt

Image source: OpenClipArt.org, public domain.

Portable doctor? Rovio is a WiFi-enabled mobile webcam - allows you see, hear, and speak from anywhere in the world

What is Rovio?

"Rovio is a WiFi-enabled mobile webcam that allows you see, hear, and speak from anywhere in the world... as if you were right there in the room."

It could potentially be used as a "portable doctor" -- without the physical examination part (an important limitation).

A recent study compared desktop videoconferencing to conventional face-to-face visits for a range of commonly presenting problems in a general practice. A total of 175 patients were recruited.

In the first arm, the patients completed a visit (virtual or face-to-face) with a physician; they then completed a second visit via the other modality with another physician. In the second arm of the study, subjects had both visits face-to-face; different physicians conducted the two face-to-face consultations.

Patients found virtual visits similar to face-to-face visits on most measures, including time spent with the physician, ease of interaction and personal aspects of the interaction. Physicians were also highly satisfied with the virtual visit modality.

The diagnostic agreement between physicians was 84% between face-to-face and virtual visits; it was 80% between the two face-to-face visits.

Rovio at CES 2008, from Engadget.

From Twitter:

vene2ia Rovio is a good idea for a portable doctor. However, it can't be an interventionalist 2 minutes ago from web

References:
A randomized trial of virtual visits in a general medicine practice. Ronald F Dixon and James E Stahl. J Telemed Telecare 2009;15:115-117.

Video of "Mayo Clinic atrium piano, charming older couple" viewed 1 million times, will be subject of case study

From the blog SMUG - Social Media University, Global by Lee Aase:

"The embedded video, which will be the subject of a future case study, cracked the 1 million mark in total views on YouTube. When I embedded it on our Sharing Mayo Clinic blog on April 7, it had been viewed 1,005 times over the preceding six months. As of this writing it’s at 1,108,201 views (and also was featured on the front page of msn.com yesterday, where it has been seen more than 133,000 times)"

Mayo Clinic Piano Story

Related:
A Bite of Life… By Jodi Hume.
Mayo Clinic “Octogenarian Idols” Scheduled to Appear on Good Morning America.

Health News of the Day

Life expectancy is best in Japan (83 years) and worst in Sierra Leone (41 years), notes the WHO. In the U.S., life expectancy for a baby born in 2007 is 78 years. It's the same in Chile, Cuba, Denmark, Slovenia... http://bit.ly/1TpmX
NPR: Decoding The Mystery Of Near-Death Experiences http://bit.ly/wRRJB
17% and 15% reductions in non-fatal myocardial infarction and CAD, respectively, with better control of blood sugar in DM2 http://bit.ly/MO8U5
CNN: Survey showed 1 in 5 adults admitted urinating in public pools http://bit.ly/x9yNp
"Has Google killed the medical riddle?" http://bit.ly/csWO
TIME: "Red Bull's New Cola: A Kick from Cocaine?" Banned in Germany. http://bit.ly/REhIi
More Evidence That Recession Is Bad for Patients and Doctors http://is.gd/Cp5R
Analysis of illness blogs: Reading and incorporating illness blogs into care will enhance patient-provider relationships? http://is.gd/CoZP
Journal of Cell Science: "The importance of stupidity in scientific research" http://is.gd/eJuz
CNN: South Carolina authorities have located a 555-pound teenager and his mother... http://bit.ly/fe37s

Image source: OpenClipArt.org, public domain.

Selection of My Twitter Favorites, Edition 63

Twitter is a microblogging service where people answer the question "What are you doing?" via 140-character messages from their cellphone, laptop or desktop. You can select the messages (called "tweets") that you find interesting, useful, amusing, or disagreeable. Here is the 63rd edition of My Twitter Favorites (the oldest post is at the bottom, the newest at the top): Micro-blogging on Twitter is easy, fun and can be very useful and educational if you follow/subscribe to interesting people. You can read more here: A Doctor's Opinion: Why I Started Microblogging on Twitter and visit my account at Twitter/AllergyNotes.

doctorwes Does anyone know where I can find a pen in the clinic now? No one has thought to buy 'em since pharma no longer delivers. about 4 hours ago from txt
schroncd Thought for the day: Did you ever wonder why wrong numbers are never busy? about 9 hours ago from web
KidneyNotes Anyone else working in the hospital at the stroke of midnight experience the temptation to immediately round on everybody all over again? about 23 hours ago from Birdhouse
schroncd Home Depot's earnings jumped 44%. They finally realized that you make money when your customers can actually find the stuff they want to buy 12:26 PM May 19th from web
EdBennett An interesting data visualization tool for health risk factors - simple, but powerful http://tr.im/lL3l7:39 AM May 19th from web
davewiner Woke up with an insight: Twitter is blogging. It lowers the barrier to entry to personal publishing. That's the common denominator. 5:38 AM May 19th from web
loic RT @martinvars: Prince Charles just said: what´s great about Google is that it helps me as I get old and forget who I am #google #zeitgeist 4:59 AM May 19th from Seesmic Desktop
pyknosis I've done a lot of lymph node exams, but it still makes me squirm when I see others go bare hand to bare pit. Universal pitcautions, people? 9:48 PM May 18th from web
Doctor_V From the bio of @memeticbrand: "Be the person your dog thinks you are"9:29 PM May 18th from TweetDeck

Health News of the Day

Cost Implications of Reduced Work Hours for Residents: Implementing recommendations costly, effectiveness unknown http://bit.ly/b4Zye
NEJM: Fomepizole for Ethylene Glycol and Methanol Poisoning prevents the formation of the toxic metabolites http://bit.ly/6JqKT
JAMA's cartoon on comparative effectiveness research: http://bit.ly/GD56H
A new way of visualising health data http://bit.ly/4tGL9
"Vitamin D may reduce decline in mental agility" http://bit.ly/vmDvt

Image source: OpenClipArt.org, public domain.

Health News of the Day

There are some interesting articles in this week's editions of NEJM and JAMA. Have a look if you have a few minutes. You will not be disappointed. JAMA and NEJM are using more videos to supplement articles http://jama.ama-assn.org - Good move, make them embeddable too...
First NEJM article about Web 2.0 use in medicine? Harnessing the Web for Public Health Surveillance http://bit.ly/occSi
Schizophrenia was associated with an increased risk of violent crime, confounded by substance abuse. In patients with schizophrenia, 13.2% had at least 1 violent offense compared with 5.3% of general population http://bit.ly/NdBQM
Intramyocardial Bone Marrow Cell Injection for Chronic Myocardial Ischemia: modest improvement in myocardial perfusion http://bit.ly/tc1ri
Tamsulosin within 14 days of cataract surgery associated with serious postoperative ophthalmic adverse events. Alpha-blockers used to treat BPH (other than tamsulosin) not associated with postoperative ophthalmic adverse events? http://bit.ly/DQ07m

Image source: OpenClipArt.org, public domain.

More Evidence That Recession Is Bad for Patients and Doctors

WebMD quotes a survey of the U.S. family physicians by AAFP:

Recession Is Bad for Health: Americans skipping doctor’s appointments, scrimping on drugs, eating more unhealthy foods
90% of family doctors surveyed said their patients have expressed concerns about paying their bills
42% percent planned to buy fewer fruits and vegetables
AAFP’s survey of doctors: 54% reported seeing fewer total patients since January 2008 when the recession began

References:
Recession Is Bad for Health. WebMD.
Image source: United States one-dollar bill. Wikipedia, public domain.

Selection of My Twitter Favorites, Edition 62

Twitter is a microblogging service where people answer the question "What are you doing?" via 140-character messages from their cellphone, laptop or desktop. You can select the messages (called "tweets") that you find interesting, useful, amusing, or disagreeable. Here is the 62nd edition of My Twitter Favorites (the oldest post is at the bottom, the newest at the top): Micro-blogging on Twitter is easy, fun and can be very useful and educational if you follow/subscribe to interesting people. You can read more here: A Doctor's Opinion: Why I Started Microblogging on Twitter and visit my account at Twitter/AllergyNotes.

loic my #1 criteria if something matters or not these days: how often it is talked about on Twitter. 4:51 AM May 18th from Seesmic Desktop
progressnotes Also learned about a remarkable medical device, the retrospectoscope: http://is.gd/ASuz 10:36 PM May 17th from web
grahamwalker Reviewing ventilator management, peak vs plateau pressures, AutoPEEP. (Basically what to do if the vent starts beeping really loud.) 9:44 PM May 17th from web
sanjayguptaCNN today's quote: "I am not nearly as certain about anything, as I used to be about everything"- winston churchill. so true as I get older... 8:08 PM May 16th from TwitterBerry
firehorse Cat amasses 500k followers http://bit.ly/lrto0: Maybe this is because the cat tweets more interestingly than some humans (via @LanceUlanoff)6:21 PM May 16th from web
LanceUlanoff This Is Getting Ridiculous: Cat Amasses Half A Million Twitter Followers In 3 Months http://bit.ly/lrto0 Me: Imagine how this make ME feel. 6:15 PM May 16th from TweetDeck
chrisseper Basking in glow of son's best cello recital ever. Standing in back of auditorium watching other cello parents. Lots are reading the paper. 8:18 AM May 16th from txt
hjluks Operating yesterday... Pink Floyd came on the radio, Rolling Stones next ... residents and students had no idea who they were !! Ouch :-( 7:55 AM May 16th from Power Twitter
aaronwatkins I just woke up sitting in my lounge chair with my laptop on my lap. I think that's enough computing for today. Probably enough day for today 10:40 PM May 15th from TweetDeck
chrisseper Thought telling my son he was getting a bigger cello would cause celebration. Instead he disintegrates into tears. His cello is his friend. 9:51 PM May 15th from txt

Health News of the Day

"Health shock": Patients' stroke risk was 200-480% higher in the week after hospital discharge. Risk factors for stroke: 80-84 yo; never married; multi-story building; DM2, HTN, stroke; difficulty picking up a coin http://bit.ly/TBDlI
Flomax Linked to Cataract Surgery Risks: detached retina or lost lens. Men Who Take Flomax Shortly After Cataract Surgery were 2.3 times more likely to have a serious complication. Cataract surgery is the most common operation in the US. Flomax linked to intraoperative floppy iris syndrome (IFIS) http://bit.ly/frAIH
Assessing moral attributes in med school interviews, premeds preparing for the “right” answers. http://bit.ly/b3Pws
TSA says whole-body imaging machines emit 10,000 times less radio frequency than a cell phone http://bit.ly/4j9j9d
New Tool in the MD's Bag: A Smartphone http://is.gd/BjKY
"Google Calculating Who’s About to Quit: algorithm gets inside people’s heads even before they know they might leave" http://is.gd/Biee

Image source: OpenClipArt.org, public domain.

Numbers: The logic behind the shapes of the Indo-Arabic numerals 1, 2, 3...

Numbers

View more presentations from Vijay Sadasivam.

Numbers: The logic behind the shapes of the Indo-Arabic numerals 1, 2, 3...

Health News of the Day

Hyperkyphosis Predicts Increased Mortality Independent of Vertebral Osteoporosis in Older Women http://is.gd/BaNZ
U.S. Preventive Services Task Force: Screen all pregnant women for syphilis infection. (Grade A recommendation.) http://is.gd/BaPa
The First Use of Penicillin in the United States: it looks like we remember success better than "failure" http://bit.ly/IyPBM
Many people who suffer from sleep apnea continue to suffer excessive daytime sleepiness despite CPAP http://bit.ly/yS6mD
Bipolar disorder has a high relapse rate: 3/4 of hospitalizations for bipolar disorder are repeat admissions. http://bit.ly/DUhsv
5•2•1•0 countdown to healthy weight: 5 fruits/veggies/day, fewer than 2 hr of computer/TV time, 1 hr of active play, 0 sugary drinks http://is.gd/AT0s
"E-Patient Dave, advocates ''participatory medicine,'' in which patients and doctors are collaborators" http://is.gd/AUGf
CNET asks "Why are doctors such Luddites?" http://is.gd/B1Ij - I don't think they are.

Image source: OpenClipArt.org, public domain.

Working Out at the 'Brain Gym' - Outfits Promise to Keep Older Minds Sharp With Computers, Walnuts and Green Tea

Working Out at the 'Brain Gym' - Outfits Promise to Keep Older Minds Sharp With Computers, Walnuts and Green Tea.

"Sip green tea all day; green tea usually contains about 25 percent as much caffeine as coffee and provides a steady stream of antioxidants." -- "Drink coffee for breakfast, tea in the afternoon, wine at 5 p.m." Source: http://www.npr.org/blogs/thesalt/2015/04/28/400156651/tea-tuesdays-tea-drinking-tips-for-a-longer-life

References:

The Latest in Mental Health: Working Out at the 'Brain Gym.' WSJ.

Case of the Week: Anemia with Hemoglobin 4.2 mg/dL. What is the Cause?

The Case of the Week series features a different article from Clinical Cases and Images each week:

A 51-year-old female has had fatigue, weakness, and SOB with exertion during the past 4-5 days. She called her PCP who recommended she had hemoglobin checked. He called her back with the results, and told her to go to the ER for further treatment of severe anemia.

Physical examination

VS: mild tachycardia, no hypotension.
General appearance: pale, non-icteric. The rest of the exam was unremarkable.

Laboratory results

CBC and CMP

What is the most likely diagnosis?

Severe anemia that is symptomatic with fatigue and shortness of breath (SOB).

What are the likely causes of anemia in this patient?

Blood loss?
Hemolytic anemia?
Iron-deficiency?

What laboratory workup would you order? Would you transfuse this patient? How would you treat this patient?

Read the rest of the case here: Hemoglobin 4.2 mg/dL due to Autoimmune Hemolytic Anemia from Clinical Cases and Images.

Keep the feedback coming -- we are listening to you

You can use any comment section under any post or article to submit feedback. All comments are emailed to the editor immediately after you hit the "submit" button. Keep the feedback coming. We are listening to you and our goal is to make the Clinical Cases and Images as useful as possible to all readers around the world.

Submit your own case

Do not forget to use the online form to submit your own case for consideration and inclusion in this collaborative resource which has become the most popular free online case-based curriculum of clinical medicine. You will be credited as an author with each case you submit.

References:
Starting "Case of the Week" Series in Response to Reader Requests. Clinical Cases and Images - Blog, Nov 2008.
Clinical Cases and Images: About Us.
Complete List of Medical Abbreviations and Acronyms.
Image source: Structure of human hemoglobin, Wikipedia, GNU Free Documentation License.

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