Thursday 23 August 2012

MEDICAL STUDENTS’ SYNDROME

  • In the past year, I had diagnosed myself with HIV, lymphoma, ovarian cancer, head/neck squamous cell cancer, a brain tumor, colon cancer, 
  • One day while voraciously checking out my throat for signs of cancer, I actually saw my epiglottis and though it was a TUMOR! 
  • Whenever I read about parasites, I think all food and my lovely cats around me have the infective stages. 
  • The first symptom Jessica McPherson noticed was a weakness in her arms. Then her muscles began to twitch. She feared the worst, suspecting it might be amyotrophic lateral sclerosis, a fatal neurological disorder also known as Lou Gehrig disease. But her family doctor provided a much less grim diagnosis: medical school syndrome. 
If you are a medical student, especially first year medical student, have you ever been through such situation? Do you usually diagnose yourself, family members, or friends with just simple rash as syphilis? 

MEDICAL STUDENTS’ SYNDROME (MSS) is a condition commonly reported by students of medicine and cognate disciplines (such as psychology) involving health complaints arising from medical knowledge rather than an actual pathology. It is viewed as a form of hypochondria.

Boston neurologist Dr. George Lincoln Walton described the condition in his 1908 book Why Worry? “Medical instructors are continually consulted by students who fear that they have the diseases they are studying … The mere knowledge of the location of the appendix transforms the most harmless sensations in that region into symptoms of serious menace.”

MSS is a constellation of psychiatric symptoms that affect the mood and behaviour of a medical student, especially during the first year of studying medicine.

While Medical students are learning medicine they read lists of symptoms for different diseases daily. Although they are completely healthy, they feel that they are suffering from the symptoms of specific diseases and they have it.

Although some might consider medical school syndrome trivial, even comical, mental health experts insist it's no joke. Imagined health problems can cause real anxiety; students patronized for revealing them may hesitate to seek care under any circumstance. This would not bode well for the medical profession, as doctors are already notoriously reluctant to become patients.

Authors of a 2001 paper on the topic claim first-year medical students are hyperaware of their health but that it should be considered a normal effect of their education, not a form of hypochondriasis

Although some students with post-lecture maladies seek help, many don't. But in some cases they should, says Dr. Derek Puddester, a psychiatrist and director of the wellness program at the University of Ottawa's medical school. “If people are becoming very preoccupied with something they heard and it's bothering them, they need to see their family doctor.”

Puddester often hears from medical students and doctors who fear they have cancer or bipolar disorder or some other illness. The most common question he hears is: “Am I depressed?” He takes each concern seriously, as some self-diagnoses, unfortunately, prove correct.

Even students whose worries are unfounded need a safe place to discuss them, says Puddester. Otherwise, they are more likely to ignore real problems that arise later. And the last thing the medical profession needs is more physicians who refuse to enter a doctor's office that isn't their own. “Healthy doctors practise healthier medicine.”

As we are paying excessive attention to science and symptoms, we became very much aware of our body, which transform the diseases to ourselves. Students are encouraged students to record their emotional responses to curriculum in journals, and later reflect on the emotional responses.

Monday 20 August 2012

Grandparents forgets their verbs - Naming ability changes in physiological and pathological aging


Over the last two decades, age-related anatomical and functional brain changes have been characterized by evidence acquired primarily by means of non-invasive functional neuroimaging. These functional changes are believed to favor positive reorganization driven by adaptations to system changes as compensation for cognitive decline. These functional modifications have been linked to residual brain plasticity mechanisms, suggesting that all areas of the brain remain plastic during physiological and pathological aging.

With emerging expertise in functional neuroimaging, multiple studies have shown positive association between age-related brain changes and changes in cognitive and behavioural function.

Studies at the neuronal level have demonstrated that dopaminergic decline and gray matter atrophy are both correlated with specific cognitive changes in older adults. In addition, it has been clearly demonstrated that processing speed, memory, and executive functions depend on the “well-being” of several neuronal substrates. Structural imaging results have also demonstrated widespread gray and white matter tissue atrophy, which largely occurs in the frontal cortex

Evidence has shown namely four hypotheses in explaining the relationship between age-related neuronal activity changes and cognitive performance.
  • Overactivation of some cortical areas and a reduction in the hemispheric asymmetry of activation has been documented in older adults as compared to younger adults during cognitive task execution. This leads to episodic memory, working memory, and perceptual tasks. 
  • Loss of regional specialization or declining specificity, referred to as dedifferentiation which may lead to reduction of the distinctiveness of within-category representations in the ventral-visual cortex 
  • More prevalent higher prefrontal activation during several cognitive tasks. Neuroimaging studies have revealed an age-related reduction in occipito-temporal activity coupled with an increase in frontal activity, a pattern referred to as the posterior-anterior shift in aging. 
  • Default network theory – the activity in several regions of the default mode network is altered during the execution of several cognitive tasks; these regions include the medial prefrontal cortex and the medial and lateral parietal cortex. 
All of these physiological-aging-induced structural and functional changes have been linked to residual brain plasticity to counteract neural loss, referred to as “NEURAL STRATEGIES”.

Most recent research suggests that the left frontal and temporal areas are crucial during naming. Moreover, it is suggested that in older adults and patients with dementia, the right prefrontal cortex is also engaged during naming tasks, and naming performance correlates with age and/or the degree of the pathological process.

The age-related changes that were observed in this TMS naming study are consistent with other neuroimaging discoveries and theories of cognitive aging. This study underlines the presence of a facilitatory effect on naming following right or left DLPFC stimulation in older adults; this result is in contrast to the unilateral (i.e., left) effect that was previously observed in young adults. This bilateral frontal effect may be attributed to the presence of a compensatory mechanism that is based on the recruitment of right hemisphere resources to maintain task performance. The same mechanisms could underlie the increased naming accuracy induced by both left and right DLPFC TMS in neurodegenerative patients.

To read the study in detailed please visit:

http://www.frontiersin.org/Journal/FullText.aspx?=55&name=&ART_DOI=10.3389/fnins.2012.00120

A bleeding stomach - Dieulafoy's Lesion



A 67-year-old man was admitted after 1 day of melena and hematemesis. Thirty years earlier, he had undergone a Billroth type I operation (gastroduodenostomy) for treatment of peptic ulcer disease. Gastroscopy revealed a spurting vessel in the duodenum, just beyond the gastroduodenal anastomosis. Injection of epinephrine and the use of endoscopic clips (arrow) led to complete cessation of bleeding. Since there was no evidence of duodenal ulceration or varices, the bleeding vessel was diagnosed as a duodenal Dieulafoy's lesion. 

A Dieulafoy's lesion is an aberrantly dilated and tortuous submucosal arteriole, often identified after it erodes through the mucosa of the gastrointestinal tract and begins to bleed. It was named after the French surgeon Paul Georges Dieulafoy, who described the condition in 1898. Dieulafoy's lesions are thought to be congenital vascular malformations and are most frequently found in the stomach. This patient had an uneventful recovery and had had no recurrence of bleeding at a 9-month follow-up visit.

Discussion

Upper gastrointestinal (UGI) bleeding is a common disorder affecting over 100 per 100 000 population yearly. The most common etiologies include peptic ulcer disease, mucosal erosive disease and variceal bleeding.

There is an increasing concern for cost-containment without sacrificing clinical outcomes; there is room to implement emergent care for UGI bleeding with appropriate early discharge for subjects at low risk of rebleeding or death

The Rockall System is an accurate and valid predictor of rebleeding and death in UGI bleeding.

Rockall score should be applied to assess all patients with suspected bleeding peptic ulcer to determine high risk patient, and arrange for early (within 24 hours after presentation) endoscopy for diagnosis as well as hemostasis if there are presence of active bleeding. Forrest I, possibly Forrest IIa requires endoscopic hemostasis. Mr. ABA is of a candidate for admission and monitoring as well as early endoscopy because he has a score of 4 in clinical Rockall score. Only those with score less than 2 are of low risk and managed as outpatient.

Rockall Score
Age

<60 yr
0
60–79 yr
1
­80 yr
2
Shock

Heart rate >100 beats/min

 
1
Systolic blood pressure <100 mm Hg
2
Coexisting illness

Ischemic heart disease, congestive heart failure, other major illness
2
Renal failure, hepatic failure, metastatic  cancer
3
Endoscopic diagnosis

No lesion observed, Mallory–Weiss tear
0
Peptic ulcer, erosive disease, esophagitis
1
Cancer of upper GI tract
2
Endoscopic stigmata of recent hemorrhage

Clean base ulcer, flat pigmented spot
0
Blood in upper GI tract, active bleeding, visible vessel, clot
2

Harrison's Principles of Internal Medicine 18th Edition

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Essential Neuroscience 2nd Edition (Lippincott Williams & Wilkins)

Delivers subject matter simply yet meaningfully . . .

As burgeoning research advances the field of neuroscience, instructors face the formidable challenge of imparting this ever-increasing and heterogenous body of information to students. Essential Neuroscience, Second Edition is the coherent, balanced solution.
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First Aid for the Internal Medicine Boards, 3rd Edition


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Perfect for last minute review as well as recertification, First Aid for the Internal Medicine Boards delivers the high-yield information, mnemonics, and visual aids need for exam success. The third edition is distinguished by a new full-color presentation, new integrated mini-cases that put clinical information in context, more algorithms and tables comparing and contrasting diseases and disorders with similar presentations, and valuable clinical pearls. All content is based on the most recently adminstered in-service and board exams so you know you are studying the most relevant, up-to-date material possible.

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Sunday 19 August 2012

Global tobacco epidemic, urgent and immediate intervention required

Tobacco use has long been a leading contributor to premature death, and causes about 9% of deaths worldwide. Presently, the burden of tobacco use is greatest in high-income countries (18% of deaths are attributable to tobacco use), intermediate in middle-income countries (11%), and lowest in low-income countries (4%).However, because rates of smoking are increasing in many low-income and middle-income countries (and decreasing in most high-income countries), the proportion of deaths from tobacco use could increase in low-income and middle-income countries as the number of tobacco-attributable deaths increases. According to WHO, nearly 6 million people die from tobacco-related causes every year.

If present patterns of use persist, tobacco use could cause as many as 1 billion premature deaths globally during the 21st century

The authors of the new study say the numbers call for urgent changes in tobacco policy and regulation in developing nations. While tobacco use is declining in industrialized countries, it remains strong — or is even increasing — in low- and middle-income countries, a trend the authors attribute to powerful pro-tobacco forces worldwide.

“Our data reflect industry efforts to promote tobacco use,” said lead study author Gary Giovino of the School of Public Health and Health Professions at the University at Buffalo in New York, in the statement. “These include marketing and mass media campaigns by companies that make smoking seem glamorous, especially for women. The industry’s marketing efforts also equate tobacco use with Western themes, such as freedom and gender equality.”

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