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The hurricane in Puerto Rico is leading a shortage in saline bags
“Doc, you mind switching that to an oral preparation?” our clinical pharmacist inquired during multi-disciplinary rounds as intravenous infusion devices beeped annoyingly in the background.  Taking care of ICU patients can be extraordinarily complicated, so doing it as part of a team helps make sure that all bases are covered. Like many hospitals, ours uses a multidisciplinary model which makes rounds on all patients in the ICU.  An ICU nurse, clinical pharmacist, dietitian,  social worker, pastoral care, respiratory therapist, each provides important insight and perspective that guides patient c...
Source: Kevin, M.D. - Medical Weblog - October 17, 2017 Category: General Medicine Authors: < a href="http://www.kevinmd.com/blog/post-author/deep-ramachandran" rel="tag" > Deep Ramachandran, MD < /a > Tags: Physician Critical Care Source Type: blogs

X-Ray Locates a Toy Traffic Cone Stuck in Patient ’s Lungs
Kids have a unique knack for getting toys stuck up their nose or surreptitiously digesting them. As stressful as it might be when they swallow a figurine or trinket, seldom do we imagine that this kind of accident could manifest into a false cancer diagnosis down the road. But, that ’s what happened to one British man who had a Playmobil traffic cone stuck in his lungs for 40 years. The 47-year-old patient struggled with several respiratory issues including coughing and excess mucus. Initially, he was treated for pneumonia, after which his physicians noted some improvement. Yet, the symptoms persisted, so he underwen...
Source: radRounds - October 13, 2017 Category: Radiology Authors: Julie Morse Source Type: blogs

Mastering Intensive Care 018 with John Marshall
LITFL • Life in the Fast Lane Medical Blog LITFL • Life in the Fast Lane Medical Blog - Emergency medicine and critical care medical education blog John Marshall – Getting patients out of the ICU as soon as we can Are your ICU patients ever in a holding pattern? Do you aim to liberate your patients from ICU as soon as possible? Is your caution about moving things forward harmful to our patients? I don’t think we talk often enough about the dangers of conservatism in intensive care. About how if we are cautious in thinking the patient is not quite ready to be extubated, or have the sedation turned off...
Source: Life in the Fast Lane - October 13, 2017 Category: Emergency Medicine Authors: Andrew Davies Tags: Intensive Care Mastering Intensive Care Andrew Davies dangers of conservatism John Marshall Source Type: blogs

Human Metapneumovirus in India
As of October 2017, the Gideon database (www.GideonOnline.com) chronicles 57,331 prevalence- and seroprevalence surveys.  Data relevant to Human metapneumovirus in India follow below. 60% of New Delhi children below age 5 years were found to be seropositive toward Human metapneumovirus, increasing to>80% by age 55 years (2011 publication)   Prevalence surveys: 2004 – 2005 / Delhi / 12% of acute respiratory infections in children below age 5 years 2005 – 2007 / Delhi / 3% of children with acute respiratory infection 2005 – 2007 / Delhi / 3.6% of children (
Source: GIDEON blog - October 12, 2017 Category: Databases & Libraries Authors: Dr. Stephen Berger Tags: Epidemiology Source Type: blogs

This is who ’s to blame for the opioid crisis
“Do not get caught” seems to be the real rule of the law in South Florida, where I live. I was trained to limit the use of controlled substances, narcotics, hypnotics and sedatives. Their use can affect consciousness, ability to drive a car and work.  More severe consequences include respiratory depression and overdose from too high of a dosage or mixing too many medications and over the counter items. The Joint Commission, medicine’s good housekeeping seal of approval authority, along with major medical organizations have accused clinicians of undertreating pain. “Pain is the fifth vital sign,...
Source: Kevin, M.D. - Medical Weblog - October 11, 2017 Category: General Medicine Authors: < a href="http://www.kevinmd.com/blog/post-author/steven-reznick" rel="tag" > Steven Reznick, MD < /a > Tags: Physician Pain Management Primary Care Source Type: blogs

Is “Nonteaching” a Bad Word?
By: Allen B. Repp, MD, MSc, professor and vice chair for quality, Department of Medicine, The Larner College of Medicine at The University of Vermont, Burlington, Vermont For years I’ve been trying to eradicate a word from my vocabulary.  Yet, in my role as an academic hospitalist, I still find myself uttering it almost every day.   Everyone around me is saying it, too.  The word isn’t vulgar.  It’s “nonteaching.” What does it mean? Medicine services at many academic medical centers (AMCs) in the US are divided into teaching and nonteaching services.  Teaching ser...
Source: Academic Medicine Blog - October 10, 2017 Category: Universities & Medical Training Authors: Guest Author Tags: Featured Guest Perspective competencies medical education patient care residency residents Source Type: blogs

Though Much Maligned, BVM is a Good Tool
​I’ve heard for years in emergency medicine circles that it was impossible to preoxygenate with a bag-valve mask (BVM) unless one is actually compressing the bag and forcing oxygen flow to the patient. I recently did an informal survey of my colleagues at work, and the responses varied from confident affirmation that the BVM was an inadequate tool for preoxygenation to quasi-warnings not to tread on this dogma without first consulting anesthesia or respiratory therapy. What started as a simple quest to clarify whether the dogma about BVMs and preoxygenation was true turned into a fascinating review and new personal...
Source: M2E Too! Mellick's Multimedia EduBlog - October 5, 2017 Category: Emergency Medicine Tags: Blog Posts Source Type: blogs

The Proof is the Bottle
​An 18-year-old woman presented for altered mental status. EMS reported that she was at a beach party when she became unresponsive. Friends said she may have been drinking alcohol, but denied other illicit drug use. Initial vital signs included a blood pressure of 117/69 mm Hg, heart rate of 110 bpm, respiratory rate of 11 bpm, SPO2 99% on room air, and a temperature of 98.9°F. ​The patient was somnolent and reacted intermittently to physical stimuli on exam. She intermittently moved all four extremities. Her gag reflex was intact. Pupils were 4 mm bilaterally reactive without nystagmus. She had tachycardia, her lu...
Source: The Tox Cave - October 2, 2017 Category: Emergency Medicine Tags: Blog Posts Source Type: blogs

A Case of Missing Teeth
​An older man presented to the emergency department for respiratory complaints, and a routine series of studies—blood work, ECG, and a chest x-ray—almost automatically appeared in the orders.​Haziness on the left side—left hilar fullness probably isn't good. A CT scan would likely confirm the fears of cancer.​The large mass wasn't unexpected, but did you see the metallic foreign body in the stomach? There was something on the left side under the diaphragm on the upright chest radiograph. The same thing appeared on the coronal CT image. Did he swallow something?Upon detailed questioning, the patient ...
Source: Lions and Tigers and Bears - October 2, 2017 Category: Emergency Medicine Tags: Blog Posts Source Type: blogs

Masimo ’s Smaller, More Comfy RAS-45 Acoustic Respiration Sensor Released Globally
Masimo is now making fully available its RAS-45 acoustic respiration sensor that works with the company’s rainbow Acoustic Monitoring platform and that is compatible with both adult and pediatric patients. It performs the same as the RAS-125c sensor, but being considerably smaller and featuring a more flexible adhesive, it is easier to put on and more comfortable to wear, particularly for children and adults with stubby necks. The sensor provides continuous respiratory rate, its waveform, as well as the ability to actually listen to the sounds being detected directly from the sensor. It relies on Masimo&rsq...
Source: Medgadget - September 29, 2017 Category: Medical Devices Authors: Editors Tags: Anesthesiology Cardiology Critical Care Medicine Pediatrics Source Type: blogs

Fight Aging! Newsletter, September 25th 2017
Fight Aging! provides a weekly digest of news and commentary for thousands of subscribers interested in the latest longevity science: progress towards the medical control of aging in order to prevent age-related frailty, suffering, and disease, as well as improvements in the present understanding of what works and what doesn't work when it comes to extending healthy life. Expect to see summaries of recent advances in medical research, news from the scientific community, advocacy and fundraising initiatives to help speed work on the repair and reversal of aging, links to online resources, and much more. This content is...
Source: Fight Aging! - September 24, 2017 Category: Research Authors: Reason Tags: Newsletters Source Type: blogs

In Iraq I saved lives. Now, I can ’t give an allergy shot.
I entered the room to see a face that I recognized. As soon as I looked at my chart, I immediately knew this patient. I saved their life last year. I know this because the patient told me so. The teachers and mentors that I was privileged to learn from and train with 25 years ago emphasized the essential principle of osteopathic medicine — we make physical contact with our patients. Some of this is in the form of manual medicine skills to help balance the musculoskeletal, respiratory, lymphatic and digestive systems, and some of this contact is in the form of a thorough, focused physical exam. Some of the contact occ...
Source: Kevin, M.D. - Medical Weblog - September 18, 2017 Category: General Medicine Authors: < a href="http://www.kevinmd.com/blog/post-author/todd-fredricks" rel="tag" > Todd  Fredricks, DO < /a > Tags: Physician Allergies & Immunology Primary Care Public Health Policy Source Type: blogs

Reviewing the Effects of Exercise on Mitophagy and Mitochondrial Function
Mitochondrial damage is important in aging, and many of the means shown to modestly slow aging in various species involve increased cellular maintenance activities directed towards mitochondria. One of these is mitophagy, a specialized form of autophagy that recycles damaged mitochondria. There is plenty of evidence to suggest that more efficient mitophagy is good for long-term health. There is also plenty of evidence for increased autophagy of all sorts to be one of the more important mediating mechanisms in many of the interventions shown to slow aging in laboratory species, including the long-studied and simple approach...
Source: Fight Aging! - September 18, 2017 Category: Research Authors: Reason Tags: Daily News Source Type: blogs

Mastering Intensive Care 016 with Charles Gomersall
LITFL • Life in the Fast Lane Medical Blog LITFL • Life in the Fast Lane Medical Blog - Emergency medicine and critical care medical education blog Charles Gomersall – Training junior doctors in the BASIC practice of intensive care How did you feel the first day you worked in ICU? Was it like walking on the moon? So foreign, because you didn’t understand much about the machines, the techniques, or even the words that were being used. That’s what it felt like for me, all those years ago. Thanks to one of my consultants who really “held my hand” on that first day, I was OK, but I wi...
Source: Life in the Fast Lane - September 18, 2017 Category: Emergency Medicine Authors: Chris Nickson Tags: Education Andrew Davies basic charles gomersall Mastering Intensive Care training doctors Source Type: blogs

Fight Aging! Newsletter, September 18th 2017
In this study, researchers put some numbers to the correlation, and improve on previous attempts to rule out wealth and other effects as significant contributing causes. A study finds that a Chinese policy is unintentionally causing people in northern China to live 3.1 years less than people in the south, due to air pollution concentrations that are 46 percent higher. These findings imply that every additional 10 micrograms per cubic meter of particulate matter pollution reduces life expectancy by 0.6 years. The elevated mortality is entirely due to an increase in cardiorespiratory deaths, indicating that air poll...
Source: Fight Aging! - September 17, 2017 Category: Research Authors: Reason Tags: Newsletters Source Type: blogs

Funtabulously Frivolous Friday Five 205
LITFL • Life in the Fast Lane Medical Blog LITFL • Life in the Fast Lane Medical Blog - Emergency medicine and critical care medical education blog Just when you thought your brain could unwind on a Friday, you realise that it would rather be challenged with some good old fashioned medical trivia FFFF…introducing Funtabulously Frivolous Friday Five 205. Question 1 Meigs’ Syndrome resolves after removal of the tumour. What is the classic triad of Meigs’ Syndrome? + Reveal the Funtabulous Answer expand(document.getElementById('ddet771338363'));expand(document.getElementById('ddetli...
Source: Life in the Fast Lane - September 15, 2017 Category: Emergency Medicine Authors: Neil Long Tags: Frivolous Friday Five allergic bronchopulmonary aspergillosis Argyll Robertson aspergilloma aspergillus Calabar extrinsic allergic alveolitis invasive aspergillosis kartagener's syndrome liver Loa loa worms Meigs syndrome ocular oa Source Type: blogs

Wide Complex Tachycardia: is the patient stable or unstable?
Here is another case written by Pendell Meyers, a G2 at Stony Brook. As I mentioned before, Pendell will be helping to edit and write the blogSpecial thanks to Dr. Atif Farooqi who cracked this case for me.CaseA male in his 50s with history of " SVT with two prior failed ablations " presented for acute onset palpitations and shortness of breath. He appeared mildly short of breath and diaphoretic, but he was mentating perfectly, laughing about how many times he had been in this same situation. His initial automatic BP was 83/51, immediate manual pressure was 98/58.Before we even get to his ECG, is he &qu...
Source: Dr. Smith's ECG Blog - September 14, 2017 Category: Cardiology Authors: Pendell Source Type: blogs

Joint Commission Releases Report Regarding Pain Assessment and Management Standards
The Joint Commission recently released a report to help hospitals better understand and comply with new pain assessment and management standards that will be applicable to all Joint Commission-accredited hospitals, effective January 1, 2018. An independent, not-for-profit organization, The Joint Commission accredits and certifies over 21,000 health care organizations and programs in the United States. Joint Commission accreditation and certification is recognized nationwide as a symbol of quality that reflects an organization’s commitment to meeting certain performance standards. The August 29, 2017, issue of ...
Source: Policy and Medicine - September 14, 2017 Category: American Health Authors: Thomas Sullivan - Policy & Medicine Writing Staff Source Type: blogs

FDA Warns Cipher Over “Misleading” Marketing Materials
The United States Food and Drug Administration (FDA) Office of Prescription Drug Promotion (OPDP) sent a warning letter to Cipher Pharmaceuticals over promotional materials for its combination immediate- and extended-release opioid tramadol hydrochloride, ConZip. The warning letter, addressed to Cipher President and CEO Robert Tessarolo, states that marketing materials for ConZip directed at healthcare providers are “false or misleading” because they omit “important risk information” regarding the use of ConZip and because of other “material facts.” The FDA said the promotional materia...
Source: Policy and Medicine - September 12, 2017 Category: American Health Authors: Thomas Sullivan - Policy & Medicine Writing Staff Source Type: blogs

Guest Post from Dr. PJ Cimino: Blue discoloration of the gray matter in a patient who received methylene blue for respiratory distress prior to death
Dr. PJ Cimino, whom weprofiled when he was a fellow back in November of 2013, is a now faculty member at the University of Washington. I was delighted to receive this email from him today:" I had an autopsy case with interesting gross pathology findings, which made for some nice clinical images (below). The patient received therapeutic methylene blue in the setting of respiratory distress prior to death. The gross pathology showed striking widespread green-blue gray matter discoloration. I thought these images might be of interest to share with the general neuropatholgy community, and thought your blog might be a...
Source: neuropathology blog - September 11, 2017 Category: Radiology Tags: anatomy Source Type: blogs

Follicle-Stimulating Hormone in Long-Lived Mice
It has been quite a number of years since researchers first produced dwarf mice with disabled growth hormone or growth hormone receptors, some of which still hold the record for engineered mouse longevity. Using these mice as a point of comparison to further map metabolism and aging continues to be an ongoing process, as illustrated by this open access paper. In it, the authors discuss the role of just one of many regulatory genes that might be important in many of the methods that have been used to slow aging in mice. Cellular biochemistry is enormously complex, and thus so are the details of the changes that occur...
Source: Fight Aging! - September 11, 2017 Category: Research Authors: Reason Tags: Daily News Source Type: blogs

Fight Aging! Newsletter, September 11th 2017
This study developed the first procedure for the removal of epithelium from the lung airway with the full preservation of vascular epithelium, which could be applied in vivo to treat diseases of lung epithelium. Whole lung scaffolds with an intact vascular network may also allow for recellularization using patient-specific cells and bioengineering of chimeric lungs for transplantation. In addition to the clinical potential, lung scaffolds lacking an intact epithelial layer but with functional vascular and interstitial compartments may also serve as a valuable physiological model for investigating (i) lung development, (ii)...
Source: Fight Aging! - September 10, 2017 Category: Research Authors: Reason Tags: Newsletters Source Type: blogs

The Case For Confronting Long-Term Opioid Use As A Hospital-Acquired Condition
The first principle of medicine is to “do no harm.” Over the past two decades, the medical community has attempted to honor this principle by treating patient pain with opioid prescriptions. Unfortunately, these good intentions have driven an epidemic of opioid addiction and drug overdoses, now the leading cause of accidental death in the United States. Inpatient overprescription of opioids such as morphine, oxycodone, and hydrocodone happens in a variety of ways—doctors prescribe too many doses, too large a dose, or allow patients to continue opioid treatment for too long. And many times, doctors could a...
Source: Health Affairs Blog - September 8, 2017 Category: Health Management Authors: Michael Schlosser, Ravi Chari and Jonathan Perlin Tags: Featured Health Professionals Hospitals Population Health hospital-acquired condition opioid epidemic overprescribing opioids pain management Source Type: blogs

Reduced Mitochondrial Fusion or Increased Fission Slows Aging in Flies
In this study, the condition was delayed after flies were given more Drp1. In another part of the experiment, also involving middle-aged fruit flies, the scientists turned off a protein called Mfn that enables mitochondria to fuse together into larger pieces. Doing so also extended the flies' lives and improved their health. "You can either break up the mitochondria with Drp1 or prevent them from fusing by inactivating Mfn. Both have the same effect: making the mitochondria smaller and extending lifespan." Promoting Drp1-mediated mitochondrial fission in midlife prolongs healthy lifespan of Drosop...
Source: Fight Aging! - September 6, 2017 Category: Research Authors: Reason Tags: Medicine, Biotech, Research Source Type: blogs

SmartTouch for Symbicort Smart Inhaler Cleared by FDA
Adherium, a company out of Auckland, New Zealand, won FDA clearance to introduce its SmartTouch for Symbicort device that monitors and promotes prescribed inhaler usage. Symbicort is an inhaled medication used to treat symptoms of asthma and COPD. The device is placed over the inhaler itself and, once paired with the patient’s smartphone, records every time the inhaler is used. Usage of the medication is shared with the patient’s physician who can make medication changes based on the data. In addition, the app motivates the user to stay on the schedule in the prescription, helping to improve compliance in ...
Source: Medgadget - September 5, 2017 Category: Medical Devices Authors: Editors Tags: Medicine Source Type: blogs

What ’s up with hiccups?
Follow me on Twitter @RobShmerling If you do an Internet search on “hiccups” you’ll find lots of supposed cures for this annoying but usually fast-passing condition — one site lists 250 of them! One thing you won’t find, though, is a good reason for why we hiccup. Hiccupping is a more complex reflex than it might seem: a sudden contraction or spasm of the diaphragm and the muscles between the ribs makes you inhale quickly and involuntarily. It ends with “glottic closure” — the space in the throat near the vocal cords snaps shut, producing the typical hiccup sound. The technic...
Source: Harvard Health Blog - September 5, 2017 Category: Consumer Health News Authors: Robert H. Shmerling, MD Tags: Health Source Type: blogs

Fight Aging! Newsletter, September 4th 2017
In conclusion, KPE delays intrinsic skin aging process by inhibiting cellular senescence and mitochondrial dysfunction. KPE does not only attenuate cellular senescence through inhibition of the p53/p21, p16/pRb, and PI3K/AKT signaling pathways but also improve mitochondrial biogenesis through PGC-1α stimulation. Consequently, KPE prevents wrinkle formation, skin atrophy, and loss of elasticity by increasing collagen and elastic fibers in hairless mice. The Society for the Rescue of our Elders https://www.fightaging.org/archives/2017/08/the-society-for-the-rescue-of-our-elders/ The Society for the...
Source: Fight Aging! - September 3, 2017 Category: Research Authors: Reason Tags: Newsletters Source Type: blogs

How to Be Cool
​A 27-year-old man with an unknown past medical history presented with altered mental status. Bystanders found him on the sidewalk acting strangely, according to EMS. The patient was drowsy with incomprehensible speech on arrival. He was diaphoretic, tachycardic, and combative. No signs of trauma were noted. His heart rate was 130 bpm, blood pressure 169/90 mm Hg, respiratory rate 30 bpm, SPO2 98% on room air, and temperature 105.3°F. His blood glucose was 150. The patient continued to be minimally responsive.​Etiologies of HyperthermiaNeuroleptic malignant syndromeSerotonin syndromeAnticholinergic syndromeSympatho...
Source: The Tox Cave - September 1, 2017 Category: Emergency Medicine Tags: Blog Posts Source Type: blogs

Funtabulously Frivolous Friday Five 203
LITFL • Life in the Fast Lane Medical Blog LITFL • Life in the Fast Lane Medical Blog - Emergency medicine and critical care medical education blog Just when you thought your brain could unwind on a Friday, you realise that it would rather be challenged with some good old fashioned medical trivia FFFF…introducing Funtabulously Frivolous Friday Five 203. Question 1 Which Welsh comedian died on stage whilst performing live at Her Majesty’s Theatre? + Reveal the Funtabulous Answer expand(document.getElementById('ddet899544536'));expand(document.getElementById('ddetlink899544536')) Tommy Coope...
Source: Life in the Fast Lane - September 1, 2017 Category: Emergency Medicine Authors: Neil Long Tags: Frivolous Friday Five beri beri botox botulinum cardiac arrest carolina reaper chillies ghost pepper smoke alarms tommy cooper Source Type: blogs

Podcasting with the Curbsiders – please listen!
I just had the great honor of being a repeat guest for the Curbsiders.  Published today, we discuss #54: Upper Respiratory Infections: Coughs, colds, gargling, and antibiotic underuse?! Regular readers can probably imagine my comments.  I mostly focused attention on defining when upper respiratory infections are not routine.  As I have written previously, while we do not want to prescribe unnecessary antibiotics, we also do not want to withhold necessary antibiotics.  My concern with most guidelines and algorithms is the lack of specificity in defining routine bronchitis, sinusitis or pharyngitis in the...
Source: DB's Medical Rants - August 28, 2017 Category: Internal Medicine Authors: rcentor Tags: Medical Rants Source Type: blogs

More Evidence to Reinforce " Use It or Lose It, " Even in Later Life
Most older people exercise the body and mind far less than they should; as a consequence some degree of the frailty observed in old age in wealthier parts of the world is preventable, a case of neglect rather than unavoidable outcome. You can't choose not to age, yet, but you can choose to exert yourself in order to make matters better than they would otherwise be. There are plenty of studies to show that, even in very late life, greater levels of mental and physical activity produce benefits. In this paper, the researchers dig deeper to see if certain forms of activity can be tied to specific benefits in cognitive functio...
Source: Fight Aging! - August 28, 2017 Category: Research Authors: Reason Tags: Daily News Source Type: blogs

Sinus rhythm with a new wide complex QRS
This is another case written by Pendell Meyers, a G2 at Stony Brook. As I mentioned before, Pendell will be helping to edit and write the blog.CaseA middle aged female with type 2 diabetes presented to her endocrinologist for a regularly scheduled follow up appointment for diabetes management. Her history included ischemic cardiomyopathy (CM) with placement of an AICD, CAD s/p CABG, and recent elective LAD stent complicated by ischemic colitis requiring hemicolectomy and colostomy.During the appointment she complained of several days of off and on dizziness and bilateral leg weakness, and she also told the endocrinolo...
Source: Dr. Smith's ECG Blog - August 28, 2017 Category: Cardiology Authors: Pendell Source Type: blogs

Fight Aging! Newsletter, August 28th 2017
In conclusion, CAVD is highly prevalent. Long understood as a passive process, it is now known to be complex and one which involves pathophysiological mechanisms similar to those of atherosclerosis. Understanding these mechanisms could help to establish new therapeutic targets that might allow us to halt or at least slow down the progression of the disease. Early Steps in the Tissue Engineering of Intervertebral Discs https://www.fightaging.org/archives/2017/08/early-steps-in-the-tissue-engineering-of-intervertebral-discs/ In this paper, researchers report on progress towards the manufacture of interver...
Source: Fight Aging! - August 27, 2017 Category: Research Authors: Reason Tags: Newsletters Source Type: blogs

The 2017 Summer Scholars Working at the SENS Research Foundation
Each year, the SENS Research Foundation accepts a group of young life science academics and puts them to work on projects in aging research, both at the foundation and in allied laboratories, creating ties between research groups that can help to advance the state of the art. This year's batch has worked on a diverse set of projects that spread out beyond core SENS initiatives such as allotopic expression of mitochondrial genes. Reading through their projects is a reminder that a great deal can be accomplished these days given a small team, a little funding, and an equipped laboratory. Progress in medical research is no lo...
Source: Fight Aging! - August 26, 2017 Category: Research Authors: Reason Tags: Healthy Life Extension Community Source Type: blogs

An irregularly irregular wide complex tachycardia
This was written by Pendell Meyers, a G2 of the Stony Brook residency who has a keen interest in ECGs and who is going to start to help edit this blog. It was edited by me (Smith).Below is a common and important ECG that somehow hasn't made it onto this blog yet!CaseA middle aged man presented with acute shortness of breath. He was hemodynamically stable but in mild respiratory distress, with diffuse B-lines and requiring BIPAP.Here is his initial ECG:What is your interpretation? What is the rhythm? Are there signs of acute coronary occlusion?This shows an irregularly irregular wide complex tachycardia at a rate ...
Source: Dr. Smith's ECG Blog - August 26, 2017 Category: Cardiology Authors: Pendell Source Type: blogs

What exactly constitute posterior wall of heart ?
Heart is not like a rigid structure built with  bricks . . . . so , its too architectural mindset to describe cardiac chambers to be made up of walls. Rather , Its a four chambered muscle mass moulded together in a complex 3D interface with distinct surfaces rather than walls. It’s also important to realise, since the heart is positioned (rather hanging )delicately in the middle mediastinum resting on the diaphragm , its subjected to one more dynamism due to respiratory motion blurring the definition of surfaces as well. (Vertical vs Horizontal) Posterior surface is now referred to as infero-posterior The poster...
Source: Dr.S.Venkatesan MD - August 24, 2017 Category: Cardiology Authors: dr s venkatesan Tags: Anatomy of heart Cardiology - Clinical Anatomy of the heart inferior vs posterior surface of heart posterior stemi posterior wall of heart what is the posterior surface of heart Source Type: blogs

TWiV 455: Pork and genes
Erin Garcia joins the TWiVirions to discuss a computer exploit encoded in DNA, creation of pigs free of endogenous retroviruses, and mutations in the gene encoding an innate sensor of RNA in children with severe viral respiratory disease.   Click arrow to play Download TWiV 455 (64 MB .mp3, 105 min) Subscribe (free): iTunes, RSS, email Become a patron of TWiV! Show notes at microbe.tv/twiv (Source: virology blog)
Source: virology blog - August 20, 2017 Category: Virology Authors: Vincent Racaniello Tags: This Week in Virology computer security CRISPR/Cas9 DNA based exploit IFIH1 loss of function MDA5 organ transplant PERV PERV free pig porcine endogenous retrovirus remote code execution respiratory syncytial virus rhinovirus se Source Type: blogs

Is the “full course of antibiotics” full of baloney?
Follow me on Twitter @JohnRossMD Antibiotic resistance is an emerging threat to public health. If the arsenal of effective antibiotics dwindles, treating infection becomes more difficult. Conventional wisdom has long held that stopping a course of antibiotics early may be a major cause of antibiotic resistance. But is this really supported by the evidence? According to a new study in the BMJ, the answer is no. The notion that a longer course of antibiotics prevents resistance started early in the antibiotic era, when doctors found that patients with staphylococcal blood infections and tuberculosis relapsed after short anti...
Source: Harvard Health Blog - August 17, 2017 Category: Consumer Health News Authors: John Ross, MD, FIDSA Tags: Drugs and Supplements Health Infectious diseases Source Type: blogs

American Heart Association Still Clings to Alternative Facts: Claims that Smoking is No Safer than Vaping
Scientists like myself are often frustrated by " denialists " who refuse to acknowledge global warming, disseminate false information about adverse effects of vaccines, or - historically - failed to acknowledge the severe health effects of cigarette smoking. But I never expected this denialism to be coming from within my own movement in public health.Today, it appears that the American Heart Association is still taking a public denialist stance with regards to the health benefits of quitting smoking by switching to vaping. Despite overwhelming scientific evidence that vaping is much safer than smoking and that qu...
Source: The Rest of the Story: Tobacco News Analysis and Commentary - August 15, 2017 Category: Addiction Source Type: blogs

Who is alive: man or machine?
He had cardiomyopathy and CHF for over 20 years. At the time, doctors told him he could die at any time. That was 20 years ago. His EF was 10 percent — barely livable. Two decades later, this admit kept him on a see-saw with respiratory distress, a bad heart, bad lungs, atrial fibrillation with RVR and heart rate in the 140s all day long. He progressed from nasal cannula to Optiflow to 100-percent BiPAP. A Cardizem drip was added to no avail. His next step would be intubation. I pulled his wife outside of her husband’s room. And I told her that he wasn’t doing well and we may have to progress to a ventila...
Source: Kevin, M.D. - Medical Weblog - July 27, 2017 Category: General Medicine Authors: < a href="http://www.kevinmd.com/blog/post-author/debbie-moore-black" rel="tag" > Debbie Moore-Black, RN < /a > Tags: Conditions Palliative care Source Type: blogs

Systematic review of non invasive positive pressure ventilation (NIPPV) in acute exacerbation of COPD with hypercapnic respiratory failure
(Source: Notes from Dr. RW)
Source: Notes from Dr. RW - July 27, 2017 Category: Internal Medicine Tags: critical care pulmonary Source Type: blogs

Fight Aging! Newsletter, July 24th 2017
In this study, we asked how POD is influenced by different experimental practices and how likely it is that underpowered experiments lead to scientific disputes between two groups conducting identical experiments. To address these questions, we generated a parametric model based on the Gompertz equation using lifespan data of 5,026 C. elegans. We then used this model to simulate lifespan experiments with different conditions to determine how experimental parameters affect the ability to detect lifespan increases of certain sizes. We considered two important experimental features that contribute to the workload of lifespan ...
Source: Fight Aging! - July 23, 2017 Category: Research Authors: Reason Tags: Newsletters Source Type: blogs

Signs of the Spreading Interest in Cellular Senescence as a Cause of Aging
In just a few short years, the study of cellular senescence has grown enormously. It has become an area of intense interest and funding in comparison to its prior status as a thin sideline of cancer research and a yet another of the backwaters of aging research. Sadly, aging research considered as a whole is still a neglected, poorly funded field of medical science in comparison to its importance to all of our futures, but this will hopefully change soon. The 2011 demonstration of a slowing of degeneration in an accelerated aging lineage of mice via removal of senescent cells opened a great many eyes. A growing number of s...
Source: Fight Aging! - July 21, 2017 Category: Research Authors: Reason Tags: Medicine, Biotech, Research Source Type: blogs

Vitamin D: Finding a balance
Over the July 4th weekend, my non-physician husband with a history of skin cancer tried to justify not wearing sunscreen in order to get some vitamin D. My husband, of course, has no idea how much vitamin D he needs or why, and I suspect he is not alone. Why do we need vitamin D? The easy answer is for bones. Vitamin D facilitates absorption of calcium and phosphate, which are needed for bone growth. Without sufficient vitamin D, bones become brittle (in children this is called rickets and in adults it is called osteomalacia) and break more easily. Vitamin D is likely beneficial for other parts of the body as well; studies...
Source: Harvard Health Blog - July 21, 2017 Category: Consumer Health News Authors: Emily S. Ruiz, MD, MPH Tags: Drugs and Supplements Health Prevention Source Type: blogs

A biker ’s heartbreaking story
A lone figure stood at the entrance to bed 14, intensive care unit 2, floor 15-North. Though it was 2:30 a.m., he stood with rapt attention. He looked out over the hallway, eyes scanning. He looked like a gargoyle brooding over his castle, protecting it. He looked unlike anyone I’d ever seen in an ICU. He was a slightly pudgy yet wholly muscular 5′ 10” or so, with a few days worth of stubble, a handlebar mustache and a tight buzzcut. He looked to be in his early forties. He wore a thick black leather jacket emblazoned with a large “ORIENT: HIGH PERFORMANCE” patch on the back in bright yellow. ...
Source: Kevin, M.D. - Medical Weblog - July 20, 2017 Category: General Medicine Authors: < a href="http://www.kevinmd.com/blog/post-author/ben-gold" rel="tag" > Ben Gold, MD < /a > Tags: Physician Intensive care Source Type: blogs

When the Nurse Becomes the Patient
While nurses have a great deal of experience treating and caring for patients, unforeseen circumstances will occasionally cause the tables to turn, giving the nurse the chance to be a patient. This became my personal reality just last week. Friday, Bloody FridayOn a recent Friday afternoon, I was doing my usual workout at a local gym where I can be found pretty much every other day most weeks of the year. Cardio, weightlifting, various machines, balance exercises, and resistance training all figure in my personalized routine. Early in my workout, I was using thick rubber tubes for resistance training. These bunge...
Source: Digital Doorway - July 17, 2017 Category: Nursing Tags: nurse nurses nursing Source Type: blogs

Fight Aging! Newsletter, July 17th 2017
This study aimed to estimate associations between combined measurements of BMI and waist-to-hip ratio (WHR) with mortality and incident coronary artery disease (CAD). This study followed 130,473 UK Biobank participants aged 60-69 years (baseline 2006-2010) for 8.3 years (n = 2974 deaths). Current smokers and individuals with recent or disease-associated (e.g., from dementia, heart failure, or cancer) weight loss were excluded, yielding a "healthier agers" group. Ignoring WHR, the risk of mortality for overweight subjects was similar to that for normal-weight subjects. However, among normal-weight subjects...
Source: Fight Aging! - July 16, 2017 Category: Research Authors: Reason Tags: Newsletters Source Type: blogs

Innovation for End-of-Life Communication in the ICU
A recent article in the American Journal of Respiratory and Critical Care Medicine offers great advice on communication in the ICU. This is important, because "once the family has expressed a choice, it is much harder to talk them out of it an the process becomes contentious rather than shared." Small tweaks to the words we use can make a big difference. "Family meetings in the ICU aim to facilitate preference sensitive treatment decisions through shared decision making. To elicit information about patient preferences the Society of Critical Care Medicine endorses questions like 'what would she want?'&q...
Source: blog.bioethics.net - July 16, 2017 Category: Medical Ethics Authors: Thaddeus Mason Pope, JD, PhD Tags: Health Care syndicated Source Type: blogs

Recent Epidemiological Research Relevant to the Understanding of Aging
This study aimed to estimate associations between combined measurements of BMI and waist-to-hip ratio (WHR) with mortality and incident coronary artery disease (CAD). This study followed 130,473 UK Biobank participants aged 60-69 years (baseline 2006-2010) for 8.3 years (n = 2974 deaths). Current smokers and individuals with recent or disease-associated (e.g., from dementia, heart failure, or cancer) weight loss were excluded, yielding a "healthier agers" group. Ignoring WHR, the risk of mortality for overweight subjects was similar to that for normal-weight subjects. However, among normal-weight subjects...
Source: Fight Aging! - July 14, 2017 Category: Research Authors: Reason Tags: Medicine, Biotech, Research Source Type: blogs

The Most Important Questions About the GOP ’ s Health Plan Go Beyond Insurance and Deficits
By ROSS KOPPEL and JASMINE MARTINEZ Ending healthcare for those who need it will not make them or their problems disappear. On the contrary, the GOP plan will shatter American families and the economy. Nothing magical happens if we stop caring for the elderly, the ones who need vaccinations, the small infections that can be treated for $2 worth of antibiotics, the uncontrolled diabetics, and those with contagious diseases who clean our schools’ offices and homes. They don’t just get healthy. As George Orwell said in Down and Out in Paris and London, “the more one pays for food, the more sweat and spittle...
Source: The Health Care Blog - July 13, 2017 Category: Consumer Health News Authors: John Irvine Tags: Uncategorized Source Type: blogs