Autism Disorder AND Epilepsy (But NO SUDEP!!!) at 6:05 AM
I was awake at 5:30 this morning, had some breakfast, and was enjoying a mug (not a cup, a mug) of coffee when I noticed that the time was 6:05 am. Startled I jumped up to see if everything was OK with my son Conor. Conor suffers from severe autism disorder and epileptic seizures, including half a dozen grand mal or tonic clonic seizures, since last Christmas. One feature of Conor's autism disorder is that he gets up at precisely 6:01 a.m. every morning. He often wakes up before 6:01 but stays in bed until that time and then gets up. Until this morning I can not recall the last time he might have sl...
Source: Facing Autism in New Brunswick - August 22, 2015 Category: Child Development Authors: H L Doherty Source Type: blogs
Praluent, the Next Expensive "Game Changer," Blockbuster," "New Hope," - But Not Yet Shown to Benefit Patients
ConclusionsThe NEJM study was accompanied by an editorial by Stone and Lloyd-Jones(2) which documented that drugs previously shown to lower cholesterol were never proved to do any good for patients, and concluded,it would be premature to endorse these drugs for widespread use before the ongoing randomized trials, appropriately powered for primary end-point analysis and safety assessment, are available. After an FDA advisory committee recommended approval of aliromucab and another PCSK9 inhibitor in June, 2015, John Mandrola entitled a Medscape article,Dear FDA: Resist the Urge on PCSK9 DrugsHis reasons included lack o...
Source: Health Care Renewal - August 5, 2015 Category: Health Management Tags: aliromucab evidence-based medicine health care prices manipulating clinical research PCSK9 inhibitor Praluent Regeneron Sanofi-Aventis Source Type: blogs
Research and Reviews in the Fastlane 091
Welcome to the 91st edition of Research and Reviews in the Fastlane. R&R in the Fastlane is a free resource that harnesses the power of social media to allow some of the best and brightest emergency medicine and critical care clinicians from all over the world tell us what they think is worth reading from the published literature.
This edition contains 7 recommended reads. The R&R Editorial Team includes Jeremy Fried, Nudrat Rashid, Soren Rudolph, Anand Swaminathan and, of course, Chris Nickson. Find more R&R in the Fastlane reviews in the R&R Archive, read more about the R&R project or check out t...
Source: Life in the Fast Lane - July 15, 2015 Category: Emergency Medicine Authors: Jeremy Fried Tags: Airway Cardiology Emergency Medicine Haematology Intensive Care R&R in the FASTLANE Resuscitation critical care EBM literature recommendations research and reviews Source Type: blogs
Open Payments 2014 Data Highlights
The 2014 Open Payments database covers 11.41 million transactions between manufacturers and covered recipients (physicians and teaching hospitals), totaling $6.49 billion. With such an immense amount of data, it can be hard to make meaningful analysis of the information. Open Payments Analytics has put together a very interesting list of insights from their dive into the database. While there are many takeaways from the data, here are three aspects that grabbed our attention:
(1) 49% of the physicians in the database received less than $100 total. Per the Sunshine Act, de minimis transfers of value are ex...
Source: Policy and Medicine - July 14, 2015 Category: American Health Authors: Thomas Sullivan Source Type: blogs
An Interview with BID-Plymouth CIO Ron Rutherford and Clinical Informatics Nurse Jean Marie Grupillion
By MICHELLE RONAN NOTEBOOM
Michelle Noteboom: Give me a bit of background on your hospital.
Ron Rutherford: Jordan Hospital is a 100-plus-year-old, a 155-bed community hospital that actually was acquired and became a part of the Beth Israel Deaconess Health System in January of 2014, so just over a year ago. We’re a full-service community hospital serving 200,000 or so residents in eleven communities. There are few services we don’t provide but mostly we offer all of them.
MN: You recently implemented the Voalte smartphone solution. What led you to seek a new communication platform?
RR: We recognized the need for our ...
Source: The Health Care Blog - May 19, 2015 Category: Consumer Health News Authors: michelle Tags: THCB Uncategorized Voalte BID-Plymouth Source Type: blogs
Emergency Department Syncope Workup: After H and P, ECG is the Only Test Required for Every Patient.....
Conclusions: Many unnecessary tests are obtained to evaluate syncope. Selecting tests based on history and examination and prioritizing less expensive and higher yield tests would ensure a more informed and cost-effective approach to evaluating older patients with syncope._____________________________________________________________________________4) Reed MJ. The ROSE (Risk Stratification of syncope in the emergency department) Study. J Am Coll Cardiol, 2010; 55:713-721, doi:10.1016/j.jacc.2009.09.049 Objectives: The aim of this study was to develop and validate a clinical deci...
Source: Dr. Smith's ECG Blog - April 8, 2015 Category: Cardiology Authors: Steve Smith Source Type: blogs
ED Syncope Workup: After H and P, ECG is the Only Test Required for Every Patient.....
Conclusions: Many unnecessary tests are obtained to evaluate syncope. Selecting tests based on history and examination and prioritizing less expensive and higher yield tests would ensure a more informed and cost-effective approach to evaluating older patients with syncope._____________________________________________________________________________4) Reed MJ. The ROSE (Risk Stratification of syncope in the emergency department) Study. J Am Coll Cardiol, 2010; 55:713-721, doi:10.1016/j.jacc.2009.09.049 Objectives: The aim of this study was to develop and validate a clinical deci...
Source: Dr. Smith's ECG Blog - April 8, 2015 Category: Cardiology Authors: Steve Smith Source Type: blogs
Atrial fibrillation, the LEGACY study, and obstructive sleep apnea
The LEGACY study found that weight loss improved both symptoms and cardiac arrhythmias in persons with atrial fibrillation.Medscape discusses the findings of the LEGACY trial here:http://www.medscape.com/viewarticle/841515 (for registered users of Medscape)Here is a link to the article's abstract: http://content.onlinejacc.org/article.aspx?articleID=2196400I wonder how much of the improvement in atrial fibrillation came from the treatment (by weight loss) of undiagnosed obstructive sleep apnea???There is strong evidence for a relationship between OSA and atrial fibrillation. Control of obstructive sleep ap...
Source: sleepdoctor - March 23, 2015 Category: Sleep Medicine Source Type: blogs
The Role of Age-Related Extracellular Matrix Restructuring in Heart Conduction Disorders
The extracellular matrix (ECM) is the complex structure of proteins surrounding and supporting cells. The varied mechanical properties of different tissues derive from the particular arrangement and types of molecules making up this structure: the elasticity of skin and blood vessels, the load bearing resilience of bone and cartilage, and so forth. Some of the fundamental forms of cellular and molecular damage that cause aging produce degenerative effects through changes to the extracellular matrix that degrade its properties. For example, cross-links formed by sugary metabolic waste glue together structural proteins. The ...
Source: Fight Aging! - February 27, 2015 Category: Research Authors: Reason Tags: Medicine, Biotech, Research Source Type: blogs
Ignorance based Electro-physiology : Why chronic RBBB is a benign entity ?
In the last few decades we have understood a major concept in the genesis of cardiac arrhythmia.Slowing in the propagation of cardiac impulse is a key trigger to precipitate a reentry circuit and initiate a tachy- arrhythmia.Still , many conditions like first degree AV block, chronic RBBB or even LBBB are benign entities as along as the heart is structurally normal .They seem never increase the incidence or life time risk of cardiac arrhythmia . Longevity is unaffected.( Or do we assume many things ?)
How is this possible ? or is the theory of slow conduction triggering reentry is flawed ?
Think again . . . if ...
Source: Dr.S.Venkatesan MD - February 12, 2015 Category: Cardiology Authors: dr s venkatesan Tags: Cardiology - Electrophysiology -Pacemaker RBBB/LBBB bundle branch reentry eelctrophysiology ers pattern moes theory rentry mechanism sloe conduction and reentry theories on genesis of cardiac arrhythmias Source Type: blogs
Rastelli procedure
Brief Review
Abstract: Rastelli procedure is done in cases of D-Transposition of great arteries with left ventricular outflow tract obstruction and ventricular septal defect, when arterial switch is not feasible.
Rastelli procedure is done in case of D-Transposition of great arteries (D-TGA) with ventricular septal defect and left ventricular outflow obstruction as arterial switch is not feasible. The ventricular septal defect is widened and the infundibular septum resected, followed by baffling of the left ventricle to the aorta.1
In the series of forty patients reported by Brown JW and associates2, the right ventricul...
Source: Cardiophile MD - January 18, 2015 Category: Cardiology Authors: Prof. Dr. Johnson Francis, MD, DM, FACC, FRCP Edin, FRCP London Tags: Cardiac Surgery d-TGA D-TGA with LV outflow obstruction Rastelli procedure Straddling tissue from tricuspid valve across the LV ouflow tract Source Type: blogs
Amiodarone and thyroid dysfunction
Brief Review
Amiodarone is one of the most widely used anti arrhythmic drug. It is well known that amiodarone can induce both hypothyroidism and hyperthyroidism due to the iodine content of the drug. 200 milligrams of amiodarone daily would deliver twenty to forty times the usual daily iodine intake. Amiodarone reduces 5-deiodinase activity and thereby the monodeiodination of T4 to T3. There is decreased generation of T3 and reduced clearance of rT3 (reverse T3), which accumulates. Destructive thyroiditis is due to the direct toxic effect of amiodarone and its metabolite on the thyroid follicular cells.1
It has been menti...
Source: Cardiophile MD - December 21, 2014 Category: Cardiology Authors: Prof. Dr. Johnson Francis, MD, DM, FACC, FRCP Edin, FRCP London Tags: General Cardiology Source Type: blogs
Fridericia formula for QT interval correction
Measurement of QT interval is very important because of the potential for life threatening torsade de pointes in the presence of QT interval prolongation. QT interval measurement is very important in the evaluation of any new drug because several drugs have been withdrawn in the past due to QT prolongation and life threatening cardiac arrhythmias.
QT interval varies with heart rate, shortening with increase in heart rate. Hence it is usual practice to correct the QT interval for a heart rate of 60 per minute. The most commonly used is the Bazett formula while the others are Fridericia, Hodges, and Framingham formulas. Whi...
Source: Cardiophile MD - December 7, 2014 Category: Cardiology Authors: Prof. Dr. Johnson Francis, MD, DM, FACC, FRCP Edin, FRCP London Tags: ECG / Electrophysiology Source Type: blogs
Kounis Syndrome
Kounis syndrome is an acute coronary syndrome associated with a hypersensitivity / anaphylactic phenomenon. Three types of Kounis syndrome have been described:
Type I: Anaphyactic reaction causing coronary spasm in normal or near normal coronary arteries and may progress to myocardial infarction
Type II: Anaphylactic reaction combined with a pre-existing atheromatous coronary lesion can result in acute myocardial infarction
Type III: Hypersensitivity to an intracoronary stent resulting in severe stent thrombosis
Thus anaphylaxis can cause coronary spasm leading to acute myocardial infarction and life threatening c...
Source: Cardiophile MD - December 5, 2014 Category: Cardiology Authors: Prof. Dr. Johnson Francis, MD, DM, FACC, FRCP Edin, FRCP London Tags: General Cardiology Source Type: blogs
Ventricular tachycardia – management
Ventricular tachycardia is a potentially life threatening cardiac arrhythmia. If the rate is very fast, hemodynamic deterioration can occur rapidly. On the electrocardiogram, ventricular tachycardia can be defined as three or more ventricular ectopic beats occurring in a sequence at a rate more than 100 per minute. Ventricular tachycardia which gets spontaneously terminated within 30 seconds is called non sustained ventricular tachycardia (NSVT). Sustained ventricular tachycardia is one which does not get spontaneously terminated within 30 seconds or needs cardioversion before that due to hemodynamic compromise.
Based on ...
Source: Cardiophile MD - December 3, 2014 Category: Cardiology Authors: Prof. Dr. Johnson Francis, MD, DM, FACC, FRCP Edin, FRCP London Tags: ECG / Electrophysiology General Cardiology Source Type: blogs
