Visible Cracks
it was a clinic day like all the rest until it wasn't she was there with her son and granddaughter winded legs swollen "for a month" afib, fast rate despite cardizem CD 300 mg daily, diabetic meds, norvasc. EKG with LVH, RBBB, LAFB. BP 178/84, HR 124 rales meds to be started, but help? EMR->no doctor a nurse practitioner? 4:45 pm-> all gone see you in two days no appointments. i wake too early (Source: Dr. Wes)
Source: Dr. Wes - January 14, 2020 Category: Cardiology Authors: Westby G. Fisher, MD Tags: Life Source Type: blogs

Are polypills and population-based treatment the next big things?
Cardiovascular disease (CVD), such as heart attack and stroke, is a leading cause of death and disability in the US. High blood pressure and high cholesterol are major risk factors for CVD, and even though they are quite common and highly treatable, they tend to be undertreated. This is especially true among those who are poor or members of a minority. It’s estimated that thousands of lives could be saved each year if more people with high blood pressure and high cholesterol received treatment for these conditions. The appeal of the polypill One reason that high blood pressure and high cholesterol are poorly treated ...
Source: Harvard Health Blog - January 13, 2020 Category: Consumer Health News Authors: Robert H. Shmerling, MD Tags: Drugs and Supplements Health Heart Health Hypertension and Stroke Source Type: blogs

MKSAP: 38-year-old man with dyspnea on exertion
Test your medicine knowledge with the  MKSAP challenge, in partnership with the American College of Physicians. A 38-year-old man is evaluated for a 6-month history of dyspnea on exertion. He has gastroesophageal reflux disease and Raynaud phenomenon. He does not smoke and has no cough or wheezing. Current medications are lansoprazole and amlodipine. On physical examination, vital […]Find jobs at  Careers by KevinMD.com.  Search thousands of physician, PA, NP, and CRNA jobs now.  Learn more. (Source: Kevin, M.D. - Medical Weblog)
Source: Kevin, M.D. - Medical Weblog - November 30, 2019 Category: General Medicine Authors: < span itemprop="author" > < a href="https://www.kevinmd.com/blog/post-author/mksap" rel="tag" > mksap < /a > < /span > Tags: Conditions Pulmonology Source Type: blogs

A poor sense of smell might matter more than you thought
As one of the five major senses, you could argue that our sense of smell is the least important. Sight, hearing, touch, and taste may poll better than smell, but try telling that to someone who has lost their sense of smell entirely. The truth is that loss of the ability to smell comes with a significant cost, because olfaction serves several purposes that affect quality of life and even safety, including stimulation of appetite enhancement of the sense of taste alerting you to which foods should not be eaten (if they’re rotting, for example) warning you of danger (as with smoke warning of fire). Loss of smell can ...
Source: Harvard Health Blog - June 18, 2019 Category: Consumer Health News Authors: Robert H. Shmerling, MD Tags: Alzheimer's Disease Brain and cognitive health Ear, nose, and throat Source Type: blogs

My life time clinical coronary skill went in vain . . . when this patient entered my clinic with chest pain !
Evening cardiac clinic is generally a relaxing place until an occasional patient  with vague chest discomfort present with this sort of an ECG . He was a 68 y old hypertensive and was on Tablet Amlodipine .After a cursory look at his ECG , eyes wandered to look for some specifics. Suddenly ,my  ECG reading skill was stretched . Is it really LVH ? or Ischemia ? I asked for any old ECG which he couldn’t provide. I had to blink  more than a moment , before asking him to describe his chest pain in detail one more time . I got almost convinced it was not ACS  since he was having only localized pa...
Source: Dr.S.Venkatesan MD - November 10, 2018 Category: Cardiology Authors: dr s venkatesan Tags: acute coroanry syndrome acute coronary syndrome Clinical cardiology lvh vs ischemia primary vs secondary st t changes triaging chest pain Source Type: blogs

MKSAP: 47-year-old man with hypertension, type 2 diabetes mellitus, and obstructive sleep apnea
Test your medicine knowledge with the MKSAP challenge, in partnership with the American College of Physicians. A 47-year-old man is evaluated during a follow-up examination. He is obese and has hypertension, type 2 diabetes mellitus, and obstructive sleep apnea. He reports that he has always has been overweight, and over the years, his weight has gradually increased to 123 kg (271 lb). During the past 2 years, he has tried several commercial diets; a dietician-monitored, calorie-restricted diet; increased physical activity; orlistat; and a combination of these interventions, all without achieving sustained weight...
Source: Kevin, M.D. - Medical Weblog - May 26, 2018 Category: General Medicine Authors: < a href="https://www.kevinmd.com/blog/post-author/mksap" rel="tag" > mksap < /a > Tags: Conditions Primary Care Source Type: blogs

Zero tolerance for low blood pressure
Just as we have zero tolerance for hypoglycemia in the Wheat Belly lifestyle, we also have zero tolerance for hypotension, or low blood pressure (BP). Follow the Wheat Belly lifestyle free of ciabattas, penne pasta, and tortellini, and blood sugars plummet. If you are injecting insulin or taking other diabetes drugs, hypoglycemia is a risk and can be dangerous, resulting in loss of consciousness and injury. We therefore urge everyone to talk to their doctor about discontinuing or reducing insulin and diabetes drugs immediately upon starting the Wheat Belly lifestyle. Unfortunately, the majority of doctors don’t under...
Source: Wheat Belly Blog - May 8, 2018 Category: Cardiology Authors: Dr. Davis Tags: Wheat Belly Lifestyle blood pressure blood sugar BP gluten-free grain-free grains health hypertension hypertensive Source Type: blogs

A 33 year old male with acute back pain radiating to the chest
Written by Pendell Meyers, with edits by Steve SmithCaseI was called to the EMS control room to answer an RMA (Refusal of Medical Advice). After the call was over, just before I was about to go back to the grind in our acute emergency department, my fantastic EMS colleague paramedic Jess Boyle asked me for an opinion on these 2 ECGs from a single patient, one done immediately after the other, without any other clinical information:What do you think?Both of the ECGs show sinus rhythm with normal QRS complex morphology. There is ST segment depression in leads III and aVF with inappropriate large " volume " T-wave i...
Source: Dr. Smith's ECG Blog - April 23, 2018 Category: Cardiology Authors: Pendell Source Type: blogs

Government Encourages Third-Party Payment, Which Drives Health Care Prices Higher
Cato adjunct scholarsCharlie Silver andDavid Hyman have an important oped in today ’s Houston  Chronicle  explaining how third-party payment increases prices for drugs and other medical goods and services. An excerpt:If you ’re like us, your health insurance coverage includes a prescription drug benefit. The benefit isn’t free, but you’re willing to pay for it because it saves you money every time you have a prescription filled. You are responsible for your co-pay, and your insurer pays the rest.At least, that ’s how it is supposed to work. But the truth is that your insurer oft...
Source: Cato-at-liberty - April 19, 2018 Category: American Health Authors: Michael F. Cannon Source Type: blogs

MKSAP: 65-year-old man with chronic kidney disease
Test your medicine knowledge with the MKSAP challenge, in partnership with the American College of Physicians. A 65-year-old man is evaluated during a follow-up visit for stage G3b/A3 chronic kidney disease due to diabetic nephropathy. He reports doing well with good baseline exercise tolerance and no shortness of breath. Medical history is also significant for type 2 diabetes mellitus and hypertension. Medications are basal bolus insulin and lisinopril, 20 mg/d. On physical examination, temperature is normal, blood pressure is 145/75 mm Hg, pulse rate is 82/min, and respiration rate is 16/min. BMI is 28. There i...
Source: Kevin, M.D. - Medical Weblog - January 13, 2018 Category: General Medicine Authors: < a href="https://www.kevinmd.com/blog/post-author/mksap" rel="tag" > mksap < /a > Tags: Conditions Nephrology Source Type: blogs

Healthcare freebies that can make you, and your wallet, feel a little better
“Take the cookies, bring them home to the kids!” Craig always insists, as he pops a few into my lunch bag. It’s a heartwarming gesture that I love about his Sarasota deli — in addition to the killer turkey on whole wheat. You may not be surprised when local businesses throw in a freebie; they often go the extra mile to thank customers. But you may be surprised to know that there are lots of free things out there that can help your health. Okay, not cookies, but things with real value when it comes to improving everything from chronic disease to diet and fitness. Free prescription drugs Some stores (...
Source: Harvard Health Blog - November 27, 2017 Category: Consumer Health News Authors: Heidi Godman Tags: Health Health care Managing your health care Source Type: blogs

MKSAP: 49-year-old man with a family history of type 2 diabetes mellitus
Test your medicine knowledge with the MKSAP challenge, in partnership with the American College of Physicians. A 49-year-old man seeks advice on ways to prevent the development of type 2 diabetes mellitus because of a strong family history (mother, sister, and brother) of the disease. History is significant for hypertension, for which he takes losartan and amlodipine in the morning. On physical examination, temperature is 37.2 °C (99.0 °F), blood pressure is 125/84 mm Hg, pulse rate is 80/min, and respiration rate is 16/min. BMI is 22. There is no S4 gallop. Laboratory studies show a fasting plasma g...
Source: Kevin, M.D. - Medical Weblog - October 14, 2017 Category: General Medicine Authors: < a href="http://www.kevinmd.com/blog/post-author/mksap" rel="tag" > mksap < /a > Tags: Conditions Cardiology Diabetes Endocrinology Source Type: blogs

Weakness and Hypotension, with Bradycardia.
This dialysis patient called 911 for weakness. Medics found the patient to be hypotensive and bradycardic.The patient was taking carvedilol and amlodipine, but denied overdose.The medics recorded this ECG:The medics were considering external pacing.What is a better initial therapy?The patient was stable enough that no therapy was needed, but the correct therapy would be IV Calcium. This ECG represents hyperkalemia until proven otherwise and, if it is due to hyperK, it will often respond immediately to calcium therapy.He arrived and had this ED ECG recorded:There are no visible P-waves. Rate is 35.There is a narro...
Source: Dr. Smith's ECG Blog - May 18, 2017 Category: Cardiology Authors: Steve Smith Source Type: blogs

MKSAP: 51-year-old man with newly diagnosed hypertension and diabetes mellitus
Test your medicine knowledge with the MKSAP challenge, in partnership with the American College of Physicians. A 51-year-old man is evaluated during a follow-up visit for management of newly diagnosed hypertension and diabetes mellitus. He has started a program of lifestyle modification for his diabetes but has not yet started antihypertensive therapy. He is currently taking no medications. On physical examination, blood pressure is 148/92 mm Hg, and pulse rate is 76/min. BMI is 33. The remainder of the examination is unremarkable. Laboratory studies show a serum creatinine level of 1.5 mg/dL (132.6 µmol/L)...
Source: Kevin, M.D. - Medical Weblog - October 1, 2016 Category: Journals (General) Authors: < a href="http://www.kevinmd.com/blog/post-author/mksap" rel="tag" > mksap < /a > Tags: Conditions Diabetes Heart Source Type: blogs

Memo To The President: The Pharmaceutical Monopoly Adjustment Act Of 2017
Since 1980, Congress has enacted many laws granting pharmaceutical manufacturers monopolies that no other industry enjoys. These extra monopolies were created with the expectation that monopoly profits would spur greater investment in research to find important new drugs. In fact, they have caused US consumers to pay higher prices for medicines for longer periods of time while making the pharmaceutical industry far more profitable than any other industry. I believe the next president and Congress should take several key steps, which I outline below, to roll back these costly, unnecessary monopolies. The Current Landscape C...
Source: Health Affairs Blog - September 13, 2016 Category: Health Management Authors: Alfred Engelberg Tags: Costs and Spending Drugs and Medical Technology Health Policy Lab Bayh-Dole Act Big Pharma Gilead Hatch-Waxman Act johnson & johnson pfizer Source Type: blogs

MKSAP: 74-year-old woman with peripheral arterial disease
Test your medicine knowledge with the MKSAP challenge, in partnership with the American College of Physicians. A 74-year-old woman is evaluated during a routine examination. Her medical history is significant for hypertension and obesity. She is a former smoker, stopping 5 years ago. Medications are amlodipine, lisinopril, and aspirin. On physical examination, she is afebrile, blood pressure is 136/78 mm Hg, pulse rate is 68/min, and respiration rate is 15/min. BMI is 32. The lungs are clear to auscultation, and no murmurs are noted. A bruit is heard over the left femoral artery. The right ankle-brachial index is...
Source: Kevin, M.D. - Medical Weblog - September 3, 2016 Category: Journals (General) Authors: < a href="http://www.kevinmd.com/blog/post-author/mksap" rel="tag" > mksap < /a > Tags: Conditions Heart Source Type: blogs

CMS Releases New Prescription Drug Cost Data
On August 18, 2016, the Centers for Medicare and Medicaid Services (CMS) released new prescription drug data, physician-level data on prescriptions for drugs paid for by Medicare Part D in 2014. This new data set “describes the specific medications prescribed for 38 million Medicare Part D enrollees, who represent about 70 percent of all Medicare beneficiaries.” This is the second annual release of the data. According to Niall Brennan, CMS Chief Data Officer, “With this data release, patients, researchers and providers can access valuable information about the Medicare prescription drug program. Today&rs...
Source: Policy and Medicine - September 2, 2016 Category: American Health Authors: Thomas Sullivan - Policy & Medicine Writing Staff Source Type: blogs

Dyspnea and Convex ST elevation, Marked LVH, with Bedside Echos
Case 1.Chief complaint: A 60-something African American male with 5 days of increasing SOB with dyspnea on exertion.This male in his 60's has a PMH of CAD with MI and CABG, HTN with LVH, hyperlipidemia, and mild HF with only moderately reduced ejection fraction (and some diastolic dysfunction as well).He presents with 5 days of worsening shortness of breath with orthopnea as well as chest pain.  His BP is 191/90.  He also has a history of venous thromboembolism and has not been taking his anticoagulants.  He was also off of his BP meds (lisinopril, amlodipine and carvedilol).Here is his ED ECG (ECG #1):...
Source: Dr. Smith's ECG Blog - July 14, 2016 Category: Cardiology Authors: Steve Smith Source Type: blogs

MKSAP: 86-year-old woman with pain
Test your medicine knowledge with the MKSAP challenge, in partnership with the American College of Physicians. An 86-year-old woman is evaluated in her assisted-living facility for pain. Four weeks ago, she developed herpetic lesions on her right posterior thorax in a T7 distribution. She was treated with acyclovir, and the lesions healed; however, she has persistent severe burning pain. The pain is so severe that she is unable to leave her bed to attend meals. Medical history is remarkable for hypertension, mild cognitive impairment, and osteoporosis. She ambulates short distances but uses a walker for longer di...
Source: Kevin, M.D. - Medical Weblog - July 2, 2016 Category: Journals (General) Authors: Tags: Conditions Neurology Source Type: blogs

STEMI with Life-Threatening Hypokalemia and Incessant Torsades de Pointes
A late middle-aged man presented with one hour of chest pain.  He had significant history of CAD with CABG x5, and repeat CABG x 2 as well as a subsequent PCI of the graft to the RCA (twice) and of the graft to the Diagonal.   Most recent echo showed EF of 60%.  He also had a history of chronic kidney disease, stage III.He had recently had a NonSTEMI. Angio had shown some acute disease in the saphenous vein graft to the posterior descending artery off of the RCA.  He was managed medically with Clopidogrel.  Medics stated that he had not been taking his clopidogrel for 2 weeks.He appeared to be in s...
Source: Dr. Smith's ECG Blog - April 8, 2016 Category: Cardiology Authors: Steve Smith Source Type: blogs

What Accounts For The Lower Growth In Health Care Spending?
Several recent studies have examined the factors accounting for the recent slowdown in growth in real per capita health care spending. The most recent entrant to this literature is the newly published work of Dunn, Rittmueller, and Whitmire. Earlier work has identified two large categories of change as contributors to slower growth: the 2007-2009 recession, and other structural changes in the delivery and payment of health care. Understanding the relative role of these two factors is important in determining whether the slowdown is temporary or will be sustained. The new paper by Dunn and colleagues builds on a framework t...
Source: Health Affairs Blog - February 18, 2016 Category: Health Management Authors: Kenneth Thorpe Tags: Costs and Spending Drugs and Medical Technology Featured Organization and Delivery Diabetes hyertension off patent drugs Prescription Drugs Source Type: blogs

DM / DNB Cardiology Entrance Mock Test 7
Please wait while the activity loads. If this activity does not load, try refreshing your browser. Also, this page requires javascript. Please visit using a browser with javascript enabled. If loading fails, click here to try again Click on the 'Start' button to begin the mock test. After answering all questions, click on the 'Get Results' button to display your score and the explanations. There is no time limit for this mock test. Start Congratulations - you have completed DM / DNB Cardiology Entrance Mock Test 7. You scored %%SCORE%% out of %%TOTAL%%. Your performance has been rate...
Source: Cardiophile MD - January 23, 2016 Category: Cardiology Authors: Prof. Dr. Johnson Francis, MD, DM, FACC, FRCP Edin, FRCP London Tags: Cardiology MCQ DM / DNB Cardiology Entrance Featured Source Type: blogs

A Year in Review: FDA 2015 New Drug Approvals
The approval of first-of-a-kind drugs rose last year to forty-one, resulting in the highest level of newly approved U.S. drugs in nineteen years. The total number of new drugs approved last year was even higher at sixty-nine. The rising figures reflect an industry-wide desire to research and develop drugs for rare and hard-to-treat diseases. The newly approved drugs serve to advance medical care and the health of patients suffering from many ailments, including various forms of cancer, heart failure, and cystic fibrosis. Additionally, more than 40% of the new therapies were approved for treatment of rare or "orphan&...
Source: Policy and Medicine - January 13, 2016 Category: American Health Authors: Thomas Sullivan - Policy & Medicine Writing Staff Source Type: blogs

Diuretic or Calcium Channel Blocker for CKD
It has been suggested by researchers that the diuretic clorthalidone should be the first line of antihypertensive therapy with a few caveats. Firstly in the presence of certain co-morbidities other drugs with a proven track record of reducing end organ damage should be instituted as first line instead. Thus it has been suggested that in patients with diabetic kidney disease and angiotensin receptor blocker (ARB) be commenced early due to its proven reno-protective effects in type 2 diabetics with kidney disease. The results of the ACCOMPLISH trial as reported in the LANCET may change the above approach. From the available ...
Source: All Kidney News - September 29, 2015 Category: Urology & Nephrology Authors: jadhavbca Tags: Kidney News ACCOMPLISH Calcium Channel Blocker CKD DIOVAN Source Type: blogs

Jennifer’s over-the-top Wheat Belly success
Jennifer is wild for the Wheat Belly lifestyle after just her first 4 weeks. Here are her recent comments: “Before Wheat Belly, my blood pressure was 180/90 ON 3 MEDS! “I was on Lisinipril for 8/9 yrs. Had a bad reaction and spent 2 days in the hospital with a transfusion to get it out of my system. Thought I was dying! Ambulance and the whole thing. I told myself in that hospital bed I’m done. I want to NEVER rely on meds again. Then I was on 100 mg Metropolol, 5 mg Norvasc, 12.5 mg HCTZ, 100 mg Zoloft, and 25 mg Vistaril as needed for anxiety. “Thanks to you, Dr. D, I have a life again with my 7-y...
Source: Wheat Belly Blog - February 2, 2015 Category: Cardiology Authors: Dr. Davis Tags: News & Updates Wheat Belly Success Stories grains hypertension joint pain Source Type: blogs

Low atrial rhythm – ECG
Low atrial rhythm Brief Review Abstract: Low atrial rhythm manifests with inverted P waves in inferior leads. It may be seen in sinus venosus atrial septal defect. Low atrial rhythm (Click on the image for an enlarged view) This ECG shows inverted P waves in inferior leads (II, III and aVF). This indicates that the atrial activation is spreading from below upwards. It is suggestive of a focus either in the low atrium or high junction. A mid junctional rhythm will have no visible P waves as the P wave will be within the QRS due to simultaneous activation of the atria and ventricles. In low junctional rhythm the P wave ...
Source: Cardiophile MD - January 24, 2015 Category: Cardiology Authors: Prof. Dr. Johnson Francis, MD, DM, FACC, FRCP Edin, FRCP London Tags: ECG / Electrophysiology Source Type: blogs

Is Meaningful Use Killing Us?
It took days to unravel what happened.The patient first presented to her cardiologist a few weeks prior. We figured that she must have doubled her amlodipine dose that morning, because her blood pressure was uncharacteristically low. He dutifully documented the hypotension and discontinued the 5 mg of amlodipine, not realizing that she had accidentally taken too much.Seven days later, her systolic pressure reached the 200 mark. She, of course, didn’t know that. She only knew that her head started to hurt and that she was slurring her speech. By the time she arrived at the emergency room, she could barely move her rig...
Source: In My Humble Opinion - January 12, 2015 Category: Primary Care Authors: Jordan Grumet Source Type: blogs

Updates on a Crowdfunded Mouse Life Span Study
For all that I think it isn't an efficient path forward, one likely to produce meaningful results in moving the needle on human life spans, there is considerable interest in testing combinations of existing drugs and various dietary compounds in mice to see if healthy life is extended. I expect that as public interest grows in the prospects for aging research to move from being an investigative to an interventional field, wherein researchers are actively trying to treat aging, we'll only see more of this. There is certainly a sizable portion of the research community who think that the the best path ahead is in fact the ph...
Source: Fight Aging! - January 1, 2015 Category: Research Authors: Reason Tags: Healthy Life Extension Community Source Type: blogs

Is Malaysia ready for separation of dispensing?
Discussion on Separation of Dispensing in the DOBBS Doctors forum Please note that Dobbs forums discussions are available only to logged in Dobbs members. Membership is FREE for all Malaysian doctors and done in two easy steps 1) Register at http://dobbs.my/daftar – automatic signup and activation link will be sent via email 2) After activating, do LOGIN and VERIFY as a doctor here: http://dobbs.my/verify (Source: Malaysian Medical Resources)
Source: Malaysian Medical Resources - December 22, 2014 Category: Global & Universal Authors: palmdoc Tags: - Nation Dispensing Drugs Pharmacists Pharmacy Source Type: blogs

Cardiology MCQ: Omapatrilat
Omapatrilat inhibits: a) Angiotensin converting enzyme b) Neprilysin c) Aminopeptidase P d) All of the above Correct answer: d) All of the above Omapatrilat inhibits angiotensin converting enzyme, neprilysin, and aminopeptidase P [McMurray JJ et al. Angiotensin-neprilysin inhibition versus enalapril in heart failure. N Engl J Med. 2014 Sep 11;371(11):993-1004]. This would finally cause vasodilation, natriuresis and diuresis. Hence omapatrilat can have potential use in hypertension and heart failure. Since its actions are not confined to the renin-angiotensin system, its antihypertensive effect occurs in both high renin and...
Source: Cardiophile MD - November 28, 2014 Category: Cardiology Authors: Prof. Dr. Johnson Francis, MD, DM, FACC, FRCP Edin, FRCP London Tags: Cardiology MCQ DM / DNB Cardiology Entrance Source Type: blogs

MKSAP: 55-year-old man with nonischemic cardiomyopathy
Test your medicine knowledge with the MKSAP challenge, in partnership with the American College of Physicians. A 55-year-old man is evaluated during a routine examination. He has a 2-year history of nonischemic cardiomyopathy. (Echocardiogram 2 years ago demonstrated a left ventricular ejection fraction of 35%.) He is feeling well and reports no shortness of breath; he walks 2 miles daily without symptoms. Medical history is remarkable for hypertension. Medications are lisinopril, carvedilol, and chlorthalidone. On physical examination, blood pressure is 150/90 mm Hg and pulse rate is 50/min. No jugular venous di...
Source: Kevin, M.D. - Medical Weblog - November 15, 2014 Category: Journals (General) Authors: Tags: Conditions Heart Source Type: blogs

MKSAP: 48-year-old man with urinary frequency
Test your medicine knowledge with the MKSAP challenge, in partnership with the American College of Physicians. A 48-year-old man is evaluated during a follow-up visit for urinary frequency. He reports no hesitancy, urgency, dysuria, or change in urine color. He has not experienced fevers, chills, sweats, nausea, vomiting, diarrhea, or other gastrointestinal symptoms. He feels thirsty very often; drinking water and using lemon drops seem to help. He has a 33-pack-year history of smoking. He has hypertension, chronic kidney disease, and bipolar disorder. Medications are amlodipine, lisinopril, and lithium. He has t...
Source: Kevin, M.D. - Medical Weblog - October 11, 2014 Category: Journals (General) Authors: Tags: Conditions Medications Nephrology Source Type: blogs

Japanese Research Scandal Involving Novartis Blood Pressure Drug Widens
The Japanese scandal over research using the Novartis blockbuster hypertension drug Diovan (valsartan) continues to widen. The first major figure brought down in the scandal was Hiroaki Matsubara, a prominent cardiologist and researcher at Kyoto Prefectural University in Japan, who  resigned from his position after numerous retractions and investigations. Then last year accusations surfaced about another prominent researcher, Issei Komuro, a professor at Chiba University. Chiba University has now completed an investigation of one of Komuro’s most important papers, the...
Source: CardioBrief - September 11, 2014 Category: Cardiology Authors: Larry Husten Tags: People, Places & Events Policy & Ethics Diovan Komuro Matsubara Novartis valsartan Source Type: blogs

MKSAP: 72-year-old man with community-acquired pneumonia
Test your medicine knowledge with the MKSAP challenge, in partnership with the American College of Physicians. A 72-year-old man is hospitalized for treatment of community-acquired pneumonia. Despite 4 days of treatment with intravenous fluids and antibiotics appropriate for the bacteria cultured from sputum and blood, he remains febrile with mild tachycardia. The patient subsequently develops mild hypotension and is transferred to the intensive care unit. Results of two subsequent blood cultures are negative for bacteria. Medical history is significant for hypertension treated with amlodipine and recurrent osteo...
Source: Kevin, M.D. - Medical Weblog - August 9, 2014 Category: Journals (General) Authors: Tags: Conditions Endocrinology Hospital Source Type: blogs

Bradycardia, SOB, in a Dialysis Patient
A dialysis patient presented with dyspnea and a heart rate of 33.  His medications included amlodipine and carvedilol.  He has a history of hypertension and DM.  His BP was 150/45 (bradycardia leads to long run-off time after each systolic beat, leading to low diastolic pressure).  He appeared comfortable, in no distress.QRS duration is normal at 97 ms.  What is the diagnosis until proven otherwise?This ECG shows a junctional bradycardia (either sinus arrest with junctional escape, or severe sinus bradycardia with junctional escape), with retrograde P-waves (see the negative deflection just after t...
Source: Dr. Smith's ECG Blog - July 13, 2014 Category: Cardiology Authors: Steve Smith Source Type: blogs

“We deeply regret and apologize for the fact that our promotional activities were partially inappropriate,” - Takeda CEO
The president of Takeda Pharmaceutical Co. just acknowledged that the firm engaged in what has been described as so-called “inappropriate expressions” in the marketing of one of its blood pressure medications.Yasuchika Hasegawa, Takeda Pharmaceutical Co. president, recently announced in a news conference in Tokyo that the firm used what he described as “inappropriate expressions” in the way in which it promoted one of its drugs used in the treatment of high blood pressure, according to a The Wall Street Journal report. Mr. Hasegawa also said that while “inappropriate expressions” were us...
Source: PharmaGossip - March 3, 2014 Category: Pharma Commentators Authors: insider Source Type: blogs

Side Effects of Alzheimer's and Dementia Drugs
This study published in the journal Archives of Internal Medicine caught my attention. In the case of my mother, her heart rate did slow after she was put on the combination of Aricept and Namenda. When I first noticed this (her heart rate came up when I was taking her blood pressure) it disturbed me, and I decided to discuss the issue with her personal care physician. He told me to continue to monitor her heart rate, and let him know if it dropped below 55. My mother was not fainting. However, she did tell me repeatedly each day that she felt like she was going to faint, or she said, I'm dizzy. This is probably the sid...
Source: Alzheimer's Reading Room, The - October 26, 2013 Category: Dementia Authors: Bob DeMarco 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 clear...
Source: DB's Medical Rants - October 19, 2013 Category: Health Medicine and Bioethics Commentators Authors: rcentor Tags: Medical Rants Source Type: blogs

Prescription drugs: are they doing you more harm than good? - by Dr Phil Hammond
How do you react to websites that claim they could save your life? Normally I pass, but having recently and reluctantly become a patient, I'm now the proud possessor of a pre-paid NHS prescription card for my two drugs a day for life. So a website pointing out questions we should ask about prescription drugs that could save your life at least got the click through from me. To save you the hassle, here they are: - How does this drug work, how much improvement can I expect, and how soon? - If I don’t take this drug now, and instead wait for a while, what will happen? - What are the most likely side effects? - Are there...
Source: PharmaGossip - October 14, 2013 Category: Pharma Commentators Authors: insider Source Type: blogs

It may have been a flawed #OpenAccess "Sting" but WE ROCKED IT so submit to our journal ...
I suppose I knew this was coming ... but did not expect it so soon ... see the email I received below.  Focus in particular on the part highlighted in yellow ....  Dear Colleague,  British Biotechnology Journal (BBJ) is an OPEN peer-reviewed, OPEN access, INTERNATIONAL journal, inspired from the great OPEN Access Movement. We offer both Online publication as well as Reprints (Hard copy) options. Article Processing Charge is only 50 US$ as per present offer. This journal is at present publishing Volume 4 (i.e. Fourth year of operation).  2. Transparent and High standard Peer review: In order to maint...
Source: The Tree of Life - October 6, 2013 Category: Medical Scientists Authors: Jonathan Eisen 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

Dissection of a needless hospitalization
If Hattie had but one flaw, it was that she held her doctors in too high esteem. It was not unusual for an eighty-year-old woman of her culture to want to please her cardiologist. So when her blood pressure came up a little high, she was too embarrassed to admit that she had forgotten to pick up the Toprol and hadn’t taken it in over a week. The cardiologist hemmed and hawed, he buried his head in the computer, and eventually wrote for Norvasc, a new blood pressure medication. What he didn’t do was ask about whether she had regularly taken her pills. He also forgot to tell her that leg swelling is a side effect...
Source: Kevin, M.D. - Medical Weblog - September 13, 2013 Category: Family Physicians Tags: Physician Heart Hospital Hospitalist Source Type: blogs

The Anatomy Of A Hospital Admission
If Hattie had but one flaw, it was that she held her doctors in too high esteem. It was not unusual for an eighty year old woman of her culture to want to please her cardiologist. So when her blood pressure came up a little high, she was too embarrassed to admit that she had forgotten to pick up the toprol and hadn't taken it in over a week. The cardiologist hemmed and hawed, he buried his head in the computer, and eventually wrote for norvasc, a new blood pressure medication. What he didn't do was ask about whether she had regularly taken her pills. He also forgot to tell her that leg swelling is a side effect of the medi...
Source: In My Humble Opinion - September 2, 2013 Category: Family Physicians Authors: Jordan Grumet Source Type: blogs

Doctors Prescribe, Pharmacists Dispense, Patients Suffer
Spotted in LKS’ blog by Product Of The System Real Life Scenario Madam Ong is a 52-year-old lady with a twelve-year-history of hypertension and diabetes. She complained of generalised lethargy, lower limb weakness, swelling and pain. She brought along her cocktail of medications for my scrutiny. Her regular medications included the oral antidiabetics metformin and glicazide and the antihypertensives amlodipine and irbesatan. Madam Ong also had a few episodes of joint pains three months ago for which she had seen two other different doctors. The first doctor suspected rheumatoid arthritis and started her on a short co...
Source: Malaysian Medical Resources - January 4, 2013 Category: Health Medicine and Bioethics Commentators Authors: palmdoc Tags: - Ethics - Guest - Nation Dispensing doctors MOH Pharmacists Source Type: blogs