Showing posts with label Clinical discussion. Show all posts
Showing posts with label Clinical discussion. Show all posts

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

THE MOST TRUSTED TEXTBOOK IN MEDICINE

Extensively revised and expanded by the world's leading physicians, Harrison's Principles of Internal Medicine continues to set the standard as the pinnacle of current medical knowledge and practice, offering the definitive review of disease mechanisms and management.

All chapters have been completely updated to reflect the latest knowledge and evidence, and important new chapters have been added, including: "Systems Biology in Health and Disease," "The Human Microbiome," "The Biology of Aging," and "Neuropsychiatric Illnesses in War Veterans."

Harrison's covers more global aspects of medicine than any other textbook, and features such chapters as "Global Issues in Medicine," by Jim Yong Kim, Paul Farmer, and Joseph Rhatigan, and new to the 18th edition, "Primary Care in Low and Middle Income Countries."

No other resource delivers coverage of disease mechanisms and management like Harrison's, including world-renowned chapters on HIV/AIDS, STEMI and non-STEMI myorcardial infarction, cancer biology, multiple sclerosis, and diabetes.

DOWNLOAD HERE!!!!

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.”

Saturday, 18 August 2012

Did abortion law killed a pregnant teenager due to delayed chemotherapy?


The mother of a pregnant leukemia patient who died after her chemotherapy was delayed over anti- abortion laws is accusing doctors of not putting her daughter's health first.

The 16-year-old's plight attracted worldwide attention after she had to wait for chemotherapy because of an abortion ban in the Dominican Republic.

Doctors were hesitant to give her chemotherapy because such treatment could terminate the pregnancy -- a violation of the Dominican Constitution, which bans abortion. Some 20 days after she was admitted to the hospital, she finally started receiving treatment.

3 weeks ago, doctors at SEMMA started evaluating the teen for chemotherapy last week, pending an official decision on whether they could proceed with the treatment. Dilemma was pressing on doctors due to the country’s strict anti-abortion law.

Friday, 17 August 2012

Little Couch Potatoes Cannot Run Cannot Jump


Childhood is a critical time for the development of motor coordination skills which are essential for health and well-being.

Little couch potatoes have worse motor coordination than their active peers, which periodic bouts of exercise may not overcome, Portuguese researchers found.

Spending more than three-quarters of the day sedentary appeared to be a significant discriminating factor separating 9- to 10-year-olds with poor coordination from those with good coordination (P<0.05 for both boys and girls) in a study led by Luís Lopes, of Minho University in Braga, Portugal. It is clear that high level of sedentary behaviour is an independent predictor of low motor coordination, regardless of physical activity levels and other key factors.

Chinese Man Builds Himself Bionic Hands After 8 Years

If a man without a hand can build a pair of bionic hands for himself, we all should be able to craft ourselves a bright future as long as determination is present. Sun Jifa, a 51-year-old Chinese man who lost both hands when he was building a bomb for blast fishing, just build a new pair of bionic arms WITHOUT having hands.


Sun Jifa could not afford the hospital's prosthetic limbs after the explosive for blast fishing detonated prematurely, but desperately needed the use of his hands to work on the family farm. Instead of wallowing, though, the 51-year-old man from Guanmashan, Jilin province, northern China, just decided to build his own bionic hands.

Invention: Sun Jifa, lost both his hands when a bomb he was creating for blast fishing in Guanmashan, Jilin province, northern China, exploded prematurely
Invention: Sun Jifa, lost both his hands when a bomb he was creating for blast fishing in Guanmashan, Jilin province, northern China, exploded prematurely
Back to work: Sun Jifa, lost both his hands when a bomb he was creating for blast fishing in Guanmashan, Jilin province, northern China, exploded prematurely
Determined: The 51-year-old spent eight years making his bionic hand

'I survived but I had no hands and I couldn't afford to buy the false hands the hospital wanted me to have - so I decided to make my own,' he explained.

Walking and Running Again After Spinal Cord Injury


An evening round brought a young patient without obvious injury lying with minimal movement, beside him is a 'comfortable looking' wheelchair. It looks like this patient has been wheelchair bound for some time. Further query revealed this young 23 years old patient involved in a freak accident during an inspection of his lorry along the expressway. He was left paralysed since the age of 21 when he first started working. 
Tears build up within this young chap's mother really brought a message that it is time for technology and advancing medical techniques to bring some light to people with spinal cord injury. 


Walking and Running Again After Spinal Cord Injury

Rats with spinal cord injuries and severe paralysis are now walking (and running) thanks to researchers at EPFL. Published in the June 1, 2012 issue of Science, the results show that a severed section of the spinal cord can make a comeback when its own innate intelligence and regenerative capacity is awakened. The study, begun five years ago at the University of Zurich, points to a profound change in our understanding of the central nervous system. According to lead author Grégoire Courtine, it is yet unclear if similar rehabilitation techniques could work for humans, but the observed nerve growth hints at new methods for treating paralysis.
"After a couple of weeks of neurorehabilitation with a combination of a robotic harness and electrical-chemical stimulation, our rats are not only voluntarily initiating a walking gait, but they are soon sprinting, climbing up stairs and avoiding obstacles when stimulated," explains Courtine, who holds the International Paraplegic Foundation (IRP) Chair in Spinal Cord Repair at EPFL.

Thursday, 16 August 2012

A View From the Other Side of the Hospital Bed


I'm currently typing this article under the influence of some heavy pain killers. I was released yesterday from the hospital, where I had been admitted for the past three days. I'm on bed rest right now and have a surgery scheduled next week.
Now, let me rewind a few days.
Earlier this week, I developed 10/10 (severe) abdominal pain accompanied by nausea, vomiting, chills, and diaphoresis.  To make a long, and miserable story short, I was admitted to a nearby hospital, diagnosed with a ruptured ovarian cyst, placed on morphine for pain control and scheduled for an exploratory laparoscopic surgery.
This was the first time that I had ever been hospitalized, and it happened to be at a hospital at which I worked. As a doctor and an employee, I know that I received more attention and perhaps even better care than the average patient. In spite of this, my experience was far from pleasant, and I had many realizations during my three-day hospitalization. Literally, it was a life-altering experience. I don't have the space here to even scratch the surface of what I discovered from being a patient, but let me try and hit the most important points:

The crisis in diabetes care



25.8 million Children and adults in the United States—8.3% of the population—have diabetes with 7 million people remained undiagnosed. More so, 79 million people are in the prediabetic state!
More than two million Malaysians are unaware that they are diabetic.
In Singapore, one out of 9 people aged 18 to 69 has diabetes. That’s about 11.3% of our population or more than 400,000 people!
Diabetes is the fifth most common medical condition diagnosed and one of the six top killer diseases in the country.
Diabetes – the silent killer within the population. Affecting the growth of workforce in a country, increasing the average medical expenditure among people, leads to chronic end organ dysfuntion. All these above could be controlled by increasing awareness of public towards this disease state.
Let’s see how the condition in UK…is
The crisis in diabetes care in England
In 2001 the National Service Framework for Diabetes set standards for diabetes care in England, with a delivery strategy designed to achieve a world class diabetes service by 2013.1 However, a series of recent reports from various sources show just how far we are from delivering the standards by the 2013 deadline. A “state of the nation” report from Diabetes UK declares that diabetes care is “in a state of crisis,” and a damning National Audit Office (NAO) report accuses the Department of Health of failing to hold NHS commissioners to account for poor performance and of failure to deliver the recommended standards of care.2 3 Both reports are based on the department’s own commissioned audits.

Nail abnormalities


Terry's Nails
Proximal paleness extending halfway up the nail, often eliminating the lunula. Darker distal band. Seen in states of stress (e.g. advanced age, liver disease/cirrhosis, CHF, DM2)



Lindsay's Nails (Half-and-half Nails)
Distal brown transverse band seen in kidney disease. Caused by increased pigment deposition.



Beau's Lines
Transverse depressed ridges seen in severe infection, MI, hypotension/shock, hypocalcemia, post-surgical, malnutrition and with certain chemotherapy. 


Muehrcke's Lines (Leukonychia striata)
Narrow while transverse lines (Not depressed, compared to Beau's lines). Usually 2 or more lines on one nail. Seen in states of decreased protein synthesis or increase protein loss such as with hypoalbunemia (usually less than < 2.2 g/dL), certain chemotherapy and nephrotic syndrome. 


Wednesday, 15 August 2012

Chronic Neck Swelling


A young adult male presented with chronic, indolent, inflammatory discharging nodules on the neck of about two years duration. Some older lesions have left scarring behind. Cervical lymph node were enlarged and skin biopsy showed tuberculoid granulomas within the dermis.

What is the clinical condition? 

ARTHRITIS


A young girl with chronic diarrhea develops severe joint pains at the knees and elbows. She is found to be HLA-B27 postitive but is seronegative for RF and ANA. These features suggest?

SPOT DIAGNOSIS #1


What is your spot diagnosis?

Chronic paronychia
Dermatomyositis
Selenium deficiency

Rheumatoid arthritis
Psoriasis

Request for journal here!!!!!


To all fellow colleagues, being in the medical school I always face problem in accessing high impact journals. Those of high yield and latest topics are frequently locked to subscription. 

I am thus providing a journal sourcing service for free here.

Whoever needs to locate a paid journal for free, please send an email to wxwong01@gmail.com.

In your email, please introduce yourself (be it nickname or real name), the full title of the paper, the authors, the link to the paper, and if you have the link of the paper from sciencedirect, lancet etc it'd be much easier. 

Or click on 'Request Journal' on the menu above.

Painful Great Toe


An 84 year old woman presents with pain, redness, and swelling of the left great toe, which makes it difficult for her to walk. She is concerned about possible gout.

What you should cover

Acute gout usually presents as painful inflammation of a single joint. Podagra (inflammation of the first metatarsophalangeal joint) is the most common presentation. Less common presentations include tenosynovitis, bursitis, entrapment neuropathies, and axial gout with back, neck, or radicular pain.1

Spray-On Skin Cells Heal Wounds Fast


Spray-on skin cells significantly improved wound healing versus standard care in patients with venous leg ulcers, results of a randomized trial showed.

The mean reduction in wound area at 12 weeks ranged from 8% to 16% greater with the mix of keratinocytes and fibroblasts versus placebo (P=0.0446), according to Robert S. Kirsner, MD, PhD, of the University of Miami, and colleagues. The best results occurred with the lowest dose of spray-on cells, which resulted in complete healing in almost a third more patients as compared with the placebo group (P=0.0267).
Differences in healing rates emerged within a week after initial treatment, they reported online in The Lancet.

The Growing Role of Emergency Departments in Hospital Admissions



Growing use of U.S. emergency departments (EDs), cited as a key contributor to rising health care costs, has become a leading target of health care reform. ED visit rates increased by more than a third between 1997 and 2007, and EDs are increasingly the safety net for underserved patients, particularly adult Medicaid beneficiaries.1 Although much attention has been paid to increasing ED use, the ED's changing role in our health care system has been less thoroughly examined. EDs serve as a hub for prehospital emergency medical systems, an acute diagnostic and treatment center, a primary safety net, and a 24/7 portal for rapid inpatient admission. Approximately a quarter of all acute care outpatient visits in the United States occur in EDs, a proportion that has been growing since 2001.2 We examined the proportion of hospital admissions that come through the ED, hypothesizing that use of the ED as the admission portal had increased across conditions.

Aspirin a Day Tied to Lower Cancer Mortality








Daily aspirin use is associated with a modest decrease in mortality from cancer, particularly for malignancies of the gastrointestinal tract, a large retrospective study confirmed.
Individuals who were current daily users for 5 years or more at baseline had an 8% decrease in cancer mortality compared with non-users (RR 0.92, 95% CI 0.83 to 1.02), according to Eric J. Jacobs, PhD, and colleagues from the American Cancer Society in Atlanta.
The association was stronger, with a 16% decrease for those with daily use for 5 years or more, when the analysis included data collected periodically during 2 decades of follow-up (RR 0.84, 95% CI 0.75 to 0.95), the researchers reported in the Journal of the National Cancer Institute.
A recent pooled analysis of more than 50 trials involving aspirin use for cardioprotection found a 37% reduction in deaths from cancer among users, which was considerably greater than in observational studies and trials of alternate-day aspirin.

Powered by Blogger.

Share

Twitter Delicious Facebook Digg Stumbleupon Favorites More