MKSAP: 32-year-old woman with progressive jaundice
Test your medicine knowledge with the MKSAP challenge, in partnership with the American College of Physicians.
A 32-year-old woman is evaluated for a 10-day history of malaise, right upper quadrant discomfort, and progressive jaundice. She has had no recent travel outside of the United States, does not drink alcohol, and has no recent ingestions of drugs, including acetaminophen or herbal remedies. Up until this time, she has been healthy. She has a history of type 1 diabetes mellitus for which she takes insulin glargine and insulin detemir. She has no other medical problems.
On physical examination, temperature is 37.5 Â...
Source: Kevin, M.D. - Medical Weblog - November 9, 2013 Category: Family Physicians Tags: Conditions GI Infectious disease Source Type: blogs
Analysis tackles liver transplant failure
The re-infection of transplanted livers with hepatitis Chemical virus (HCV) – which can irreparably damage the new organ – could be halted by administering a medication which blocks the virus entering the liver, research from the University of Birmingham being presented at the Liver Meeting demonstrates.
People who receive a new liver to replace their own organ previously broken by HCV infection are 95 per cent likely to experience recurrent irritation after the transplant, where virus amounts can surpass the pre-transplant amounts within a few days. Importantly, viral duplication and ensuing injury can be a lo...
Source: My Irritable Bowel Syndrome Story - November 7, 2013 Category: Other Conditions Authors: Ken Tags: IBS News Source Type: blogs
The puzzling edema solved
The answers, both on this blog and on twitter, showed great thought processes. Here is how I discussed it with my team, and the data we used.
The patient had peripheral edema, but had a good oxygen saturation and no dyspnea. We had a previous echocardiogram that showed very mild pulmonary hypertension, so we did not believe that this was the reason for worsening edema.
Next I asked for an albumin level, and it was 2.9 down from 3.9 two weeks earlier. Why would the albumin be so low?
Low albumin must be:
1. Decreased protein intake
2. Decreased albumin production (i.e., cirrhosis)
3. Increased losses – either urine...
Source: DB's Medical Rants - October 21, 2013 Category: Health Medicine and Bioethics Commentators Authors: rcentor Tags: Attending Rounds Source Type: blogs
Caffeine OD
Family of dad who died from massive caffeine overdose after eating MINTS want them removed from saleThe step-daughter of a man who died from a massive caffeine overdose after eating a pack of mints bought from his local sweet shop today demanded that they are immediately removed from sale.Rebecca Court, 23, said there could be further deaths after John Jackson, who was a heavy drinker and had cirrhosis of the liver, was was found dead in his flat in May.“On the box they said one tablet equals one can of energy drink. A kid could go in and buy them and the same thing could happen to him," said Ms Court.“Something should...
Source: PharmaGossip - October 12, 2013 Category: Pharma Commentators Authors: insider Source Type: blogs
Gliadin: The Universal Human Poison
Autoimmunity is the process describing an immune response waged against our own organs. The complex collection of mechanisms consisting of T and B lymphocytes, antibodies, and others, meant to provide protection against viruses, bacteria, and other body invaders, is misdirected against proteins of the body’s organs, such as liver, pancreas, thyroid, or brain. Autoimmune conditions now affect 8% of the American population–it is increasingly looking like diseases of autoimmunity are out of control.
Dr Alessio Fasano was recently awarded the Linus Pauling Award, the highest award from the Institute for Functional...
Source: Wheat Belly Blog - October 7, 2013 Category: Cardiology Authors: Dr. Davis Tags: Autoimmunity Gliadin Source Type: blogs
Medical Mispronunciations and Misspelled Words: The Definitive List.
Hearing medical mispronunciations and seeing misspelled words are an under appreciated joy of working in healthcare. Physicians often forget just how alien the language of medicine is to people who don't live it everyday. The best part about being a physician is not helping people recover from critical illness. The best part is not about listening and understanding with compassion and empathy. Nope, the best part about being a physician is hearing patients and other healthcare providers butcher the language of medicine and experiencing great entertainment in the process. Doctors c...
Source: The Happy Hospitalist - October 2, 2013 Category: Internists and Doctors of Medicine Authors: Tamer Mahrous Source Type: blogs
HPV Vaccines Can Kill And They Do!
Conclusion
Just from the evidence that I have provided, HPV vaccines clearly are not safe, and yet no government to date has ever banned these vaccines. Other products have been banned for far less dangers, so why is a vaccine that has killed 140 women and children and maimed thousands of others been allowed to stay on the market?
To offer the HPV vaccine to newborn babies along with the hepatitis B vaccine is pure evil. Many babies are born prematurely and we have to ask ourselves what the impact of these two highly dangerous and toxic vaccines given at the same time will be. We also need to question why newborn babies ne...
Source: vactruth.com - August 10, 2013 Category: Health Medicine and Bioethics Commentators Authors: Christina England Tags: Christina England Top Stories Writers Adverse Events Cervarix gardasil Hepatitis B vaccine HPV Vaccine Vaccine Death VAERS Source Type: blogs
World Hepatitis Day
July 28th, 2013 marked the 6th World Hepatitis Day, an annual international event to raise awareness and influence change in viral hepatitis prevention and access to testing and treatment.  World Hepatitis Day was launched in response to the concern that chronic viral hepatitis did not have the level of awareness, nor the political priority, seen with other communicable diseases such as HIV/AIDS, tuberculosis and malaria.  In May 2010 the World Health Assembly officially resolved that World Hepatitis Day would be held annually on July 28th. The resolution, supported by all 194 member states, recognized the global impact...
Source: Disruptive Women in Health Care - July 29, 2013 Category: Health Medicine and Bioethics Commentators Authors: dw at disruptivewomen.net Tags: Access Advocacy Cancer Chronic Conditions Global Health Publc Health Source Type: blogs
Random tips for new interns
The following are my opinions only. Â As I have done ward attending rounds since January 1980, I have developed some thoughts about helping new interns. Â Some practicing physicians may enjoy this list also. Â The list is not inclusive, but rather what comes to mind today.
1. CKD is not a diagnosis without providing the stage. Â If you do not know the staging system and the implications of that system, this Annals of Internal Medicine summary article is free – Evaluation and Management of Chronic Kidney Disease: Synopsis of the Kidney Disease: Improving Global Outcomes 2012 Clinical Practice Guideline
2. CKD staging ...
Source: DB's Medical Rants - July 4, 2013 Category: Health Medicine and Bioethics Commentators Authors: rcentor Tags: Medical Rants Source Type: blogs
Hemopurifier to be Studied as Treatment Option for Hepatitis C
Aethlon Medical out of San Diego, CA has been investigating its Hemopurifier extracorporeal blood filtration device that has the potential to help manage a number of infectious diseases, as well as remove tumor-derived exosomes related to certain cancers.
Now the company has announced that its technology has been given an FDA Investigational Device Exemption (IDE) to be tested in human feasibility studies for treatment of Hepatitis C. The first phase will involve ten patients with end stage renal disease that are infected with Hep. C who’ll receive treatment with the Hemopurifier. Once the safety of the procedure is...
Source: Medgadget - June 26, 2013 Category: Technology Consultants Authors: Editors Tags: in the news... Source Type: blogs
Treating hepatitis C by blocking a cellular microRNA
Miravirsen is a drug that binds to and blocks the function of a cellular microRNA called miR-122 that is required for the replication of hepatitis C virus (HCV). Treatment of chimpanzees chronically infected with HCV with this drug leads to suppression of viral replication. The results of a phase 2b human clinical trial in HCV infected humans indicate that Miravirsen reduces levels of viral RNA without evidence for viral resistance. I asked virologist Stan Lemon (who appeared recently on TWiV 235) his opinion of these findings.
Are you surprised that the antiviral effect of Miravirsen is long lasting?
The Janssen study pub...
Source: virology blog - June 6, 2013 Category: Virology Authors: Vincent Racaniello Tags: Basic virology Information cirrhosis HCV hepatitis C virus hepatocellular carcinoma liver microrna mIR-122 miravirsen viral Source Type: blogs
Peptic Ulcer Disease
Pathophysiology of Peptic Ulcer Disease
1) peptic ulcer disease is marked by a break in mucosal lining of stomach and duodenum
2) main causes are infection with Helicobacter pylori and use of NSAIDs
Signs and Symptoms
1) burning epigastric pain relieved by antacids and eating
2) epigastric pain causing patient to wake up in the middle of the night
3) chest pain mimicking angina
4) epigastric tenderness
5) gastrointestinal bleeding (15%) with coffee-ground emesis or vomiting bright red blood or lower gastrointestinal bleeding
6) perforation (8%) with peritonitis and rigid abdomen
7) duodenal obstruction (3%) with nausea and...
Source: Inside Surgery - February 24, 2013 Category: Surgeons Authors: Editor Tags: Gastroenterology Source Type: blogs
Exercise, alcohol, fruit and veg
There was a strike at the BBC yesterday, so the usual “You and Yours” on Radio 4 was replaced with an annotated compilation of recent in-depth reports by Michael Moseley from past episodes (I believe). It made for an interesting alternative podcast listen on my dog-walk today. He discussed the high-intensity exercise regime he tried for Horizon last year, the ambiguity about alcohol units and whether smoothies and fruit juice count towards your “5-a-day”.
In summary, it seems most of us don’t get enough exercise, and if we do we’re sitting at our desks too long, most of us are not eating...
Source: Sciencebase Science Blog - February 19, 2013 Category: Medical Scientists Authors: David Bradley Tags: Science alcohol exercise fruit veg Source Type: blogs
Healthcare Update 02-18-2013
Some hospital CEOs just don’t like being questioned. When one hospital chief of staff led some other physicians in questioning the manner in which a hospital was being run, hospital CEO Bruce Mogel allegedly had black gloves and a gun planted in the doctor’s car. Then someone called 911 and reported that someone was driving down the street waving a firearm. The doctor was arrested in the hospital parking lot and was strip searched at the jail.
The doctor sued. During depositions, a witness alleged that the CEO claimed “People do not know how powerful I am.”
Now a jury has found the hospital liable for $5.2 million....
Source: WhiteCoat's Call Room - February 18, 2013 Category: Emergency Medicine Doctors Authors: WhiteCoat Tags: Healthcare Update Source Type: blogs
