Fighting Hubris in Medicine

By ANISH KOKA The weekend started with a tweet about an elderly man with atrial fibrillation.  Atrial fibrillation is an arrhythmia of the heart that predisposes those who suffer with it to strokes.  The strokes are a  result of clots being thrown from the heart into the brain.  The typical treatment for this condition in those deemed high enough risk is to thin the blood to help prevent these clots from forming, and thus reducing the risk of stroke. 101 year old with a history of a stroke stops his Pradaxa. Only other history hypertension. https://t.co/Ai5z519rcX — Anish Koka (@anish_koka) June 3, 2018 The problem with thinning the blood is that the risk of bleeding increases, and it does so especially as one advances in age.  It doesn’t help matters that the risk of having a stroke also increases with age. In a 101 year old deciding on the best course of action is thus a challenging one.  It is easiest when patients are adamant about a certain path.  Far be it from me to tell a centenarian what to do.   In this case, the man who had been alive for two world wars chose to come off the anticoagulant he had been dutifully prescribed. I queried the audience Curious how many would advise him this is a good / bad idea?@AndrewFoy82 @drjohnm @f2harrell @stephensenn @ADAlthousePhD @RogueRad @narrowQRS @rdschaller — Anish Koka (@anish_koka) June 3, 2018 Most leaned towards stopping Pradaxa, and some responded that the...
Source: The Health Care Blog - Category: Consumer Health News Authors: Tags: Uncategorized Source Type: blogs

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Publication date: Available online 25 January 2020Source: Aquatic ToxicologyAuthor(s): Christine Dépatie, Magali Houde, Jonathan VerreaultAbstractLipids play important roles in growth, reproduction, locomotion, and migration of fish. Municipal effluents, which are complex mixtures of biological and chemical compounds including flame retardants, have been shown to alter lipid metabletabolism in environmentally and experimentally exposed fish. Down-regulation of several genes coding for fatty acid metabolism enzymes has previously been reported in male northern pike (Esox lucius) collected in the St. Lawrence River (Q...
Source: Aquatic Toxicology - Category: Toxicology Source Type: research
Discussion The aortic valve usually has 3 leaflets. In bicuspid aortic valve (BAV) there are 2 asymmetric leaflets with a fish-mouthed orifice between them which may not open fully. It occurs in about 0.5-2% of the population making it one of the most common congenital heart anomalies and the most common one in adults. Transmission is autosomal dominant yet males are more likely to have BAV, indicating potential reduced penetrance in females. “BAVs are different, however, in that the tissue pathology is not limited to the valves’ leaflets but extends from the left ventricular outflow tract to the ascending thor...
Source: PediatricEducation.org - Category: Pediatrics Authors: Tags: Uncategorized Source Type: news
ConclusionsA wearable EEG device with 2 bipolar channels simplifies the process of obtaining repeated SI quantification allowing a more accurate follow-up of spike activity in the clinical setting.
Source: Epilepsy and Behavior - Category: Neurology Source Type: research
AbstractTragedy is a founding theme in disability studies. Critical disability studies have, since their inception, argued that understandings of disability as tragedy obscure the political dimensions of disability and are a barrier facing disabled persons in society. In this paper, we propose an affirmative understanding of tragedy, employing the philosophical works of Nietzsche, Spinoza and Hasana Sharp. Tragedy is not, we argue, something to be opposed by disability politics; we can affirm life within it. To make our case, we look to an ongoing ethnography of two Canadian children ’s rehabilitation clinics. Lookin...
Source: Journal of Medical Humanities - Category: Medical Ethics Source Type: research
AbstractThis literature review presents a critical appraisal of the dominant approaches toward the sexuality and relationships of people with acquired brain injury. In particular, we sought to identify and review existing programs focusing on sexuality and relationships which use an educational and/or peer –peer approach. A systematic and comprehensive search of the EBSCOHOST database was conducted within an unlimited time-frame to yield the highest number of relevant results possible, along with hand-searching of key journals and databases. Reports, papers and webpages, documents commonly referred to as ‘grey ...
Source: Sexuality and Disability - Category: Disability Source Type: research
ConclusionErgonomic interventions focusing on modification of workstations, and promoting and delivering ongoing ergonomic education are very important to reduce the problem.
Source: Journal of Public Health - Category: Health Management Source Type: research
ConclusionsPillar suture combined with tonsillectomy may reduce postoperative bleeding incidence despite increasing pillar edema in pediatric tonsillectomy. Postoperative pain-relief, palatal hematoma, palatal discomfort sensation, site infection, and velopharyngeal insufficiency were not significantly altered compared to tonsillectomy alone. However, further studies are needed to corroborate the results of this study.ResumoIntroduçãoDiversas técnicas cirúrgicas têm sido utilizadas na tonsilectomia no intuito de reduzir complicações.ObjetivosAvaliar os efeitos da sutura dos p...
Source: Brazilian Journal of Otorhinolaryngology - Category: ENT & OMF Source Type: research
Publication date: Available online 25 January 2020Source: Molecular and Cellular EndocrinologyAuthor(s): Ayelén Melisa Blanco, Juan Ignacio Bertucci, Cristina Velasco, Suraj UnniappanAbstractGrowth differentiation factor 15 (GDF-15), an anti-inflammatory and anti-tumorigenic cytokine, has been emerging as a regulator of appetite and energy homeostasis in mammals. In fish, the physiological role of this peptide remains to be elucidated. This research aimed to determine the possible role of GDF-15 on food intake in goldfish (Carassius auratus). To achieve our objectives, we first obtained a 595 bp gdf-15 cDNA sequence...
Source: Molecular and Cellular Endocrinology - Category: Endocrinology Source Type: research
ConclusionP. karwinskii leaf extract inhibited reactive oxygen species and exerted an anti-inflammatory effect. Moreover, this extract did not induce gastric damage in the animals. The bioactivity of the species was found to support its traditional use in traditional medicine. This orchid could be used to treat inflammatory diseases without causing the side effects associated with Nonsteroidal anti-inflammatory drugs. It can also be employed to treat other pathological conditions associated with oxidative stress. The findings herein form the basis for the future discovery of natural products that may serve as safe alternat...
Source: Journal of Ethnopharmacology - Category: Drugs & Pharmacology Source Type: research
ConclusionsCMR is a key tool for diagnosing LDAC. Characteristic findings are subepicardial fatty infiltration and midwall-subepicardial late gadolinium enhancement. The prognosis of this population is poor with a high incidence of sudden cardiac death and ventricular arrhythmias.ResumenIntroducción y objetivosRecientemente, la miocardiopatía arritmogénica del ventrículo izquierdo (MCAVI) ha sido reconocida como parte del espectro de la miocardiopatía arritmogénica. Se caracteriza por el reemplazo fibroadiposo de la pared de dicho ventrículo. Se describen las formas de prese...
Source: Revista Espanola de Cardiologia - Category: Cardiology Source Type: research
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