When Rare Diseases and Common Diseases Converge to Same Clinical Picture
In June, 2014, my book, entitled Rare Diseases and Orphan Drugs: Keys to Understanding and Treating the Common Diseases was published by Elsevier. The book builds the argument that our best chance of curing the common diseases will come from studying and curing the rare diseases. In yesterday's blog, we discussed by a rare disease and a common disease may both have the same clinical presentation, a phenomenon that I call disease convergence. The short explanation for disease convergence is that there are a limited number of ways that the body can respond to malfunctions. Here is an excerpt from Chapter 10, in which dise...
Source: Specified Life - June 27, 2014 Category: Pathologists Tags: common diseases complex diseases convergence disease convergence disease pathway disease phenotype genetic disease rare disease models of common diseases Source Type: blogs
CHF Exacerbation with Old LBBB: Is There New Infarction or Not?
In this study by Hands et al., QRS criteria were quite specific for MI of indeterminate age.It is unlikely that a fragmented QRS on an isolated ECG with LBBB has good diagnostic utility for acute MI, but it is much more likely to be significant if there is NEW fragmentation. Here is the initial ECG again, annotated:There is sinus rhythm and LBBB. There is still left axis deviation and the QRS is now 193 ms. There are multiple signs of new, acute ischemia. --The black arrow shows concordant ST depression in V3, and it is also clearly changed from the previous.--The blue arrow shows even more co...
Source: Dr. Smith's ECG Blog - November 25, 2013 Category: Cardiology Authors: Steve Smith Source Type: blogs
Worsening edema – a diagnostic puzzle
70-something woman admitted to our service with worsening lower extremity edema. She is “billed” as worsening CHF. We know the following things about this woman:
COPD – but not on home oxygen
Systolic dysfunction – last left ventricular ejection fraction 25%
Type II Diabetes Mellitus for approximately 4 years
history of hypertension
Medications include
Insulin
carvdelilol
amlodipine
furosemide 40 mg daily
She has spent 2 weeks in a nursing home. Does not complain about dyspnea, only about lower leg edema.
Examination slows the patient is afebrile, pulse 68, BP 130/90, respirations 18
lungs are cl...
Source: DB's Medical Rants - October 19, 2013 Category: Health Medicine and Bioethics Commentators Authors: rcentor Tags: Medical Rants 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
Is your high blood pressure drug linked to cancer?
Learn the negative effects of your blood pressure medication and discover alternative solutions.
High blood pressure is one of the most life-threatening illnesses in our country today. This condition can cause heart attack, stroke and other health problems. Hypertension is not to be taken lightly and must be treated with great care.
What causes high blood pressure? Your doctor may not know.
As many as 95% of patients diagnosed with high blood pressure are given no cause for their high blood pressure. Doctors claim the disease is idiopathic (meaning it has no known cause) and rather than find the cause, they turn to prescri...
Source: Doctor Kalitenko antiaging blog - July 9, 2013 Category: Physicians With Health Advice Authors: admin Source Type: blogs
MKSAP: 78-year-old man with worsening heart failure
Test your medicine knowledge with the MKSAP challenge, in partnership with the American College of Physicians.
A 78-year-old man was admitted to the hospital 5 days ago for worsening heart failure.
On physical examination at admission, temperature was normal, blood pressure was 150/88 mm Hg, pulse rate was 108/min, and respiration rate was 22/min. There were bibasilar crackles and dullness to percussion at both posterior lung bases. Jugular venous distention, an S3, and lower extremity edema were present. Chest radiograph revealed cardiomegaly, vascular congestion, and moderate-sized bilateral pleural effusions. He was ma...
Source: Kevin, M.D. - Medical Weblog - June 29, 2013 Category: Family Physicians Tags: Conditions Heart Source Type: blogs
Drug Shortages: Despite Gains, Many Drugs are Still in Short Supply
A recent article from Bloomberg noted that “as shortages of sterile injectables persist, the makeup of that part of the industry is in flux.” To address the current marketplace struggles, Mylan has agreed to buy Agila Specialties, the injectables unit of Strides Arcolab, for $1.6 billion, and analysts think Claris Lifesciences could be next, saying “it is a matter of supply and demand.”
Claris has five (5) FDA-sanctioned manufacturing facilities in Ahmedabad, and an analyst tells Bloomberg it might be worth about $500 million. Claris has “a ready-made facility,” Ranjit Kapadia, an analyst at Centr...
Source: Policy and Medicine - April 8, 2013 Category: Health Medicine and Bioethics Commentators Authors: Thomas Sullivan Source Type: blogs
Congestive Heart Failure
Pathophysiology of Congestive Heart Failure
Congestive heart failure is:
1) inability of heart to deliver sufficient cardiac output to meet physiologic needs
2) both diastolic and systolic phases are abnormal
3) initially, compensatory mechanisms occur(increased catecholamines, increased atrial natriuretic factor, myocardial hypertrophy), but eventual failure of these ensues causing congestive heart failure
4) result is increase in venous pressure with congestion of liver, spleen, and kidney (“backward failure”) and sodium retention, peripheral edema, and pulmonary sequelae (“forward” failure”...
Source: Inside Surgery - March 20, 2013 Category: Surgeons Authors: Editor Tags: Cardiology backward failure enlarged heart foward failure myocardial hypertrophy nutmeg liver peripheral edema Source Type: blogs
