Evolutionary Medicine Conference Tue May 8 at Stanford

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New Opportunities at the Intersection of Evolution and Medicine
A gathering of scientists and entrepreneurs

8:00 – 8:30 Coffee and Registration

8:30 – 8:50 Welcome
Charles Cho, MD, Associate Professor Neurology and Neurological Sciences, Stanford University
Introductory Remarks by Joon Yun, MD, Palo Alto Investors and David Sloan Wilson, Binghamton University

8:50 – 9:30 Keynote Address
Evolutionary Medicine: Envisioning the Opportunities
Keynote Address by Randolph M. Nesse, MD, University of Michigan

9:30 – 10:10 Session One: Infectious Disease
Evolution Proof Pharmaceuticals?
Andrew F. Read, Penn State

Panel discussion to follow moderated by David Sloan Wilson, Binghamton University
Panelists include James Holland Jones, Stanford University, and Nina Kjellson, Interwest

10:10 – 10:40 Break

10:40 – 11:45 Session Two: Cancer
Why Evolution Holds the Key to Curing and Preventing Cancer
Carlo C Maley, University of California at San Francisco

The Evolution and Ecology of Metastasis: Can we Control Cancer by Targeting Dispersal Evolution?
Athena Aktipis, Arizona State University, UCSF Center for Evolution and Cancer

Panel discussion to follow moderated by Randolph M. Nesse
Panelists include Daniel S. Fisher, Stanford University

11:45 – 12:30 Session Three: Application of a Specific Theory
Using Drugs to Induce Adaptation
Introduced and moderated by Joon Yun, MD, Palo Alto Investors

Panelists include Ray Onders, Synapse; Lorenzo DiCarlo, Proteus Biomedical; Richard A. Bond, University of Houston; Kari Nadeau, Stanford University

12:30 – 1:30 Lunch

1:30 – 2:15 Session Four: Behavior
Improving Health by Changing Behavior: Evolution Science Shows How
Steven C. Hayes, University of Nevada

Panel discussion to follow moderated by David Sloan Wilson
Panelists include William H. Durham, Stanford University, and Camille Samuels, Versant Ventures

2:15 – 3:00 Session Five: Genetics and Mental Disorders
Where Darwin meets Freud: Psychiatric Conditions and Therapies at the Dawn of Evolutionary Genomics.
Bernie Crespi, Simon Fraser University

Panel discussion to follow moderated by Randolph M. Nesse
Panelists include Charles Cho, MD, Associate Professor Neurology and Neurological Sciences, Stanford University

3:00 – 3:30 Break

3:30 – 4:15 Session Six: Diet
What did Humans Evolve to Eat? Evolutionary Perspectives on Human Nutritional Health
William R. Leonard, Northwestern University

Panel discussion to follow moderated by David Sloan Wilson
Panelists include Dr. John Morton, Stanford University, and Scott Wolf, Aerin Medical

4:15 – 5:00 Session Seven: Aging
Can we Have it All? What Evolutionary Biology Says about Medically Slowing Aging.
Steven Austad, University of Texas Health Science Center San Antonio

Panel discussion to follow moderated by Joon Yun, MD, Palo Alto Investors
Panelists include Jim Glasheen, Technology Partner

5:00 – 5:15 Wrap

5:30 – 6:30 Cocktails & Networking

Full information available here

 

Levels of Selection, Logical Schemes, Selfish Genes, and Misleading Memes

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Both Nature and Science are currently celebrating the 100th anniversary of the birth of an icon of logic, computer science, and mathematical biology: Alan Turing.  In reading Andrew Hodges’s spectacular biography of Turing (1983) many years ago I came to appreciate that the subject of the book was both a deeply creative and extraordinarily rigorous thinker.  Although Turing is known for seminal achievements in mathematical logic and computer science, his most directly practical and immediately consequential contribution was his facilitation of the Allied cause in World War II through his guidance of the effort to break the Nazi military code.  This effort called primarily on his prodigious talents for far-reaching inference and it was in reading about this effort that I was prompted to consider a concept that might be called “maximum deduction.”  Turing and his able colleagues needed to make every possible deductive inference (or at least very close to every possible inference) supported by the available data on German military communications in order to solve a problem of immense and immediate impact (the saving of Allied ships from devastating German submarine attacks).

In reading Samir Okasha’s thorough and insightful guide to the theoretical debates about multi-level selection, Evolution and the Levels of Selection (2006), I am reminded of Turing’s logical rigor. Like Turing, Okasha possesses the ability to fully explore the implications of an intellectual position.  Of similar value, he makes key distinctions that elude or at least receive inadequate attention from others and fairly assesses alternative conceptual schemes or theoretical approaches.  For example, his examination of the relative merits of the Price equation versus what he refers to as the “contextual analysis” for assessing and partitioning selection in differing evolutionary scenarios reveals that each has important advantages as well as significant weaknesses.  Much to his credit, he does not seek a neat but oversimplified and misleading conclusion.  The figures are simple but effective and substantially aid the exposition.

I cannot attempt to summarize all of the arguments in the book of about 240 pages because Okasha’s arguments are of sufficient intricacy and subtlety that it would be nearly impossible to substantially compress them without causing serious distortions in the reasoning.  Therefore, I will just note the topics addressed and remark on a limited number of particularly interesting points.

Okasha begins the book by introducing and characterizing the levels-of-selection problem and explicating the essence of natural selection in abstract formal terms.  He then addresses the distinction between the synchronic and diachronic perspectives, where the former deals with the hierarchical organization of the living world (e.g. cells, multicellular organisms, communities of multicellular organisms) such as it is and the latter is concerned with how the hierarchy arose.  Next, the author introduces and explains the interpretation of the equation formulated by George Price forty years ago to describe in mathematical terms the evolution of a population from one generation to the next.  He also delves into the sometimes-consequential differences between statistical and causal decompositions of changes in organismal characters across generation.  This chapter ends with an interesting discussion of the connections between the Price equation and the formal conditions for evolution promulgated more than forty years ago by the eminent population geneticist, Richard Lewontin, which were initially described at the beginning of the chapter.

The second chapter explains the fundamentals of multi-level selection, including explorations of life cycles, relevant definitions of fitness, and the distinction between multi-level selection 1 (MLS1) and multi-level selection 2 (MLS2).  For MLS1, what Okasha calls the ‘focal’ level is concerned with the number of offspring, in the next generation, of the particles that constitute a collective or group and for MLS2 the ‘focal’ level is concerned with the number of offspring groups in the succeeding generation.  Another key distinction that Okasha addresses is that between aggregate and emergent properties of collectives.  Okasha then tackles heritability and how the concept differs for MLS1 and MLS2 and includes a discussion of how the Price equation can be applied for the two types of multi-level selection.

Chapter three focuses on notions of causality and deals with the fairly subtle notion of cross-level by-products in which apparent selection on one level can in fact result from selection at another level.  In this portion of the book, the author introduces contextual analysis, which relies on linear regression models, and compares it to the approach associated with the Price equation.

What the author describes as philosophical issues take up the fourth chapter.  The section sub-headings will give a sense of the subject matter being addressed: emergence and additivity, screening off and the levels of selection, realism versus pluralism about the levels of selection, and reductionism.

Chapter five is entitled “The Gene’s-Eye View and its Discontents.”  After tracing the gene-centered perspective back to R. A. Fisher and reviewing the contributions of individuals such as W. D. Hamilton, G. C. Williams, and Richard Dawkins, Okasha makes the critical distinction between a gene’s-eye view of evolution and genic selection.  In this context, Okasha notes what he believes to be a shift in position by Dawkins.  Next the author discusses outlaw genes or selfish genetic elements (SGEs).  These DNA sequences manage to be transmitted at increased frequencies into the gametes (the phenomenon of meiotic drive or segregation distortion) and, therefore, into the next generation thereby exhibiting increased fitnesses relative to non-SGEs.  Thus, I would suggest that selfishness is a quantitative not a qualitative trait.  The Price equation and contextual analysis are then compared as to how these two approaches account for the behavior of SGEs.  Okasha then demonstrates why the gene-centered perspective is not, as sometimes claimed, a completely general way to account for any evolutionary scenario, e.g., when dealing with non-genetic inheritance, plants that produce vegetative entities that are often genetically chimeric (i.e., ramets), and insect colonies founded by multiple queens or multiply-mated queens.  The genic perspective also is less obviously successful when non-additive interactions between genes are present, which is reasonably common.  An interesting point that Okasha makes is that whenever SGEs arise, there is likely to be selection on the unlinked ‘law abiding’ genetic elements to suppress the ‘cheaters’ since SGEs typically enhance their own fitnesses at the cost of diminishing the fitness of the organism with respect to which they may reasonably regarded as parasites of a sort.

The sixth chapter addresses the still active and evolving controversy or group selection as of 2006.  Okasha provides historical background, discusses the distinction between MLS1 and MLS2 in the context of the controversy, explores how ideas about kin selection, reciprocal altruism, and evolutionary game theory feature in the debates, and describes the roles of a number of other concepts in the key disagreements in the literature.

The final two chapters address macroevolutionary issues that may be less obviously relevant to those focused on the relevance of evolution to medicine.  Therefore, I will refrain from a detailed description of the content of these sections and just note an insight offered therein. Whenever there is a major evolutionary transition, as from individual genes to whole genomes or single-celled to multi-celled organisms, there must be selection against within-group conflict and selfishness of the ‘lower-level’ units and this selection must be effective for the more-complex level of the biological hierarchy to be successfully established.  Thus, one consequence of relentless competition is cooperation and all genes are not, as Dawkins suggested early in The Selfish Gene (1976, 1989), ruthlessly selfish unless ruthless selfishness embodies some measure of cooperativeness.

References

Hodges, A. Alan Turing: The Enigma. A Touchstone Book, Simon & Schuster, Inc., New York, 1983.

Okasha, Samir. Evolution and the Levels of Selection. Oxford University press, 2006.

Dawkins, R. The Selfish Gene. Oxford University Press, Oxford, 1976, 1989 p. 2.

Tags: additive characters, Alan Turing, causal decomposition, cells, computer science, contextual analysis, cooperation, cross-level by-products, diachronic, emergent characters, evolution, evolutionary game theory, focal level, G. C. Williams, gametes, genes, gene’s-eye perspective, genic selection, George Price, hierarchical organization, kin selection, levels-of-selection controversy, logic, macroevolution, mathematics, maximum deduction, meiotic drive, military code, multi-cellular organisms, multi-level selection 1, multi-level selection 2, pluralism, Price equation, R. A. Fisher, realism, reciprocal altruism, reductionism, Richard Dawkins, Richard Lewontin, selfish genetic element, statistical decomposition, synchronic, W. D. Hamilton

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Disease Tolerance as a Defense Strategy

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Abstract
The immune system protects from infections primarily by detecting and eliminating the invading pathogens; however, the host organism can also protect itself from infectious diseases by reducing the negative impact of infections on host fitness. This ability to tolerate a pathogen’s presence is a distinct host defense strategy, which has been largely overlooked in animal and human studies. Introduction of the notion of “disease tolerance” into the conceptual tool kit of immunology will expand our understanding of infectious diseases and host pathogen interactions. Analysis of disease tolerance mechanisms should provide new approaches for the treatment of infections and other diseases.

Posted in Autoimmune disease, evolutionary medicine

 

Emergence and evolution of the renin–angiotensin–aldosterone system

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The renin–angiotensin–aldosterone system (RAAS) is not the sole, but perhaps the most important volume regulator in vertebrates. To gain insights into the function and evolution of its components, we conducted a phylogenetic analysis of its main related genes. We found that important parts of the system began to appear with primitive chordates and tunicates and that all major components were present at the divergence of bony fish, with the exception of the Mas receptor. The Mas receptor first appears after the bony-fish/tetrapod divergence. This phase of evolutionary innovation happened about 400 million years ago. We found solid evidence that angiotensinogen made its appearance in cartilage fish. The presence of several RAAS genes in organisms that lack all the components shows that these genes have had other ancestral functions outside of their current role. Our analysis underscores the utility of sequence comparisons in the study of evolution. Such analyses may provide new hypotheses as to how and why in today’s population an increased activity of the RAAS frequently leads to faulty salt and volume regulation, hypertension, and cardiovascular diseases, opening up new and clinically important research areas for evolutionary medicine.

Posted in evolutionary medicine

 

Vigorous Exercise Might Protect Against Psoriasis

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Women who engage in vigorous activities like running or aerobic exercise may have reduced risk of psoriasis


May 23, 2012 -- Here's yet another reason to exercise: A new study suggests that vigorous physical activity could reduce the risk of psoriasis.
The findings come out of the long-running Nurses' Health Study, which includes only women, but previous research suggests that exercise may also protect men against the chronic skin condition, characterized mostly by inflamed, scaly patches.
As many as 7.5 million Americans have psoriasis, according to the National Psoriasis Foundation, which says it's the most common autoimmune disease. Men and women are equally affected. Previous research has linked higher body mass index, or BMI, family history of psoriasis, alcohol use, and smoking to the risk of psoriasis.
In the new study, scientists followed nearly 87,000 female nurses for 14 years. None of them had been diagnosed with psoriasis at the beginning of the study. Over the course of the study, the nurses completed three detailed questionnaires about physical activity and were asked to report whether they were ever diagnosed with psoriasis. A total of 1,026 women said they were diagnosed during the study period and provided survey information about their physical activity.

Compared with no vigorous physical activity, vigorous exercise -- the equivalent of 105 minutes of running at a 6-mile-per-hour pace every week -- was associated with a 25% to 30% lower risk of psoriasis. The association remained significant after accounting for BMI, age, smoking, and alcohol use. The researchers say theirs is the first study to investigate the independent association between physical activity and psoriasis.
"The intensity of the exercise is the key," says researcher Abrar Qureshi, MD, MPH, vice chair of dermatology at Brigham and Women's Hospital and assistant professor at Harvard Medical School.
Only running and performing aerobic exercise or calisthenics were associated with a reduced risk of psoriasis. Other vigorous activities, such as jogging, playing tennis, swimming, and bicycling, were not. The researchers speculate that the highly variable intensity of the latter group of activities might account for the lack of an association with a lower psoriasis risk.
More than a decade ago, Siba Raychaudhuri, MD, reported that male and female psoriasis patients who exercised were likely to have less severe disease. "Walking was protective also," says Raychaudhuri, a rheumatologist at the University of California, Davis. He says he was "a little bit surprised" that Qureshi did not find that to be the case but added that "this study is more elegant than ours" because it collected more detailed information about exercise intensity.
Qureshi's team speculates that the lower risk of psoriasis in women who exercised vigorously might be due to a reduction in system-wide inflammation. Vigorous exercise also might be protective against psoriasis because it decreases anxiety and stress, which are tied to new cases and exacerbations of the disease, the researchers say.
"A good amount of data show that emotional stress reduction is good for psoriasis reduction," Raychaudhuri says.
Exposure to ultraviolet light is a psoriasis treatment, so time spent outdoors exercising, and not the exercise itself, might have explained the lowered risk of the disease, Qureshi says. But his study found that women who ran for only an hour a week had a significantly reduced risk of developing psoriasis than women who spent at least four hours walking outside at an average pace.
Chris Ritchlin, MD, MPH, a University of Rochester rheumatologist, calls Qureshi's findings "very interesting." Still, Ritchlin says, while exercise is known to be associated with reduced inflammation, "is there something about people who are really athletically inclined that we're not thinking about that would prevent them from getting psoriasis?"
Qureshi says that could be the case, which is why his study needs to be replicated. "You have to interpret the results cautiously because it is a single study," he says. "It is certainly possible that the women who exercise more are just more health-conscious. There could be other factors that could protect them from developing psoriasis."
Qureshi's study appears online in the Archives of Dermatology.
SOURCES: Qureshi, A. Archives of Dermatology, published online May 2012.Abrar Qureshi, MD, MPH, vice chair of dermatology at Brigham and Women's Hospital; assistant professor at Harvard Medical School, Boston.Siba Raychaudhuri, MD, University of California, Davis.Chris Ritchlin, MD, MPH, University of Rochester, New York.

Work-Related Asthma a Significant Problem: CDC

Click Here!THURSDAY, May 24 (HealthDay News) -- About nine percent of all asthma cases in the United States are caused or made worse by work-related exposures, a new federal study says.
That means work-related asthma affects about 1.4 million adults annually, the researchers said.

State-by-state rates of workplace-related asthma ranged from 4.8 percent (Arizona) to just over 14 percent (Florida), according to the study by researchers at the U.S. Centers for Disease Control and Prevention.
The analysis of 2006-09 data from 38 states and the District of Columbia also suggests that older workers and those in certain ethnic or minority groups are most at risk. For example, rates of employment-related asthma were 12.7 percent for people ages 45-64 vs. about 7 percent for people ages 18-44. Among racial groups rates of work-related asthma were 12.5 percent for blacks, 10.5 percent for Hispanics and 8.2 percent for whites, the report found.
The estimated proportion of adults with current asthma who had work-related asthma was similar for men and women, at about nine percent.
Asthma linked to on-the-job exposures is a preventable but under-recognized illness and the new findings highlight the need to expand workplace surveillance to better understand the risk factors and to better focus prevention efforts, the researchers said.
Better surveillance of the problem "would enhance our understanding of work-related asthma epidemiology and enable states, other government agencies, health professionals, employers, workers and worker representatives to better target intervention efforts to reduce the burden of work-related asthma," the researchers wrote in a summary.
The study appears in the May 25 issue of the CDC's Morbidity and Mortality Weekly Report.

Evolutionary Molecular Medicine

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Abstract

Evolution has long provided a foundation for population genetics, but some major advances in evolutionary biology from the twentieth century that provide foundations for evolutionary medicine are only now being applied in molecular medicine. They include the need for both proximate and evolutionary explanations, kin selection, evolutionary models for cooperation, competition between alleles, co-evolution, and new strategies for tracing phylogenies and identifying signals of selection. Recent advances in genomics are transforming evolutionary biology in ways that create even more opportunities for progress at its interfaces with genetics, medicine, and public health. This article reviews 15 evolutionary principles and their applications in molecular medicine in hopes that readers will use them and related principles to speed the development of evolutionary molecular medicine.

Posted in evolutionary medicine

 

Quarantine!

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Filed under: Comics, Medicine

A nice hopefully-we’ll-never-see-this-again scene from an old time Little Angel comic.

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House — Episode 21 (Season 8): “Holding On”

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While the soap opera aspect of this penultimate episode of House was outstanding, the actual medicine left much to be desired

Derrick is a 19 year-old cheerleader who was admitted after suffering from dizziness and a massive nosebleed (and dropping his partner). A head CT was normal. Taub suggests a “mini-stroke” (though you’d think a doctor would use the correct term TIA, especially when talking to other physicians), but House tells them it is a midline granuloma and has them check a PET scan. The scan is negative for any cancer, but it does show activity in the auditory area, suggesting that Derrick is hearing to something, though no sounds are present. He denies hearing voices, but the team suspects otherwise. They suggest schizophrenia or drug use. His dorm room is searched, and though his roommate is an active participant in the drug culture, he insists Derrick is clean. A thorough exam of the room finds a picture of a young boy hidden in the back of a drawer. Confronted with this evidence, Derrick explains that the picture is of his long dead brother, and reluctantly admits to hearing his voice for the past ten years.

The differential diagnosis now consists of viral encephalitis (though, as pointed out on the show, an infection of the brain wouldn’t persist for ten years) or temporal lobe epilepsy. The team runs tests on Derrick trying to trigger a seizure, but nothing happens — except that he suffers a sudden blindness in his right eye which Adams diagnoses as a “clot in the artery behind the eye” (i.e. a retinal artery occlusion, and massage is one of the treatments supported by anecdotal evidence) and rubs out of existence. The team debates how many of Derrick’s symptoms are physical, and how many are psychological. Park is a firm believer that years of purposefully avoiding grief over the death of his brother has left Derrick with an anxiety disorder that appears as physical symptoms (though this wouldn’t explain the clot). Taub is more prosaic and believes in a physical cause. He suggests polycythemia vera (blood that is thicker than normal), Hodgkin’s lymphoma, or DIC (disseminated intravascular occlusion) due to some trauma suffered in cheerleading (I can believe this: I see more injuries due to cheerleading than any other high school activity. Basketball is second, and football a distant third.). A spinal tap is obtained. It shows no evidence of bleeding (and therefore, no trauma), but an abnormally high opening pressure (reflecting the intracranial pressure) tells them something else is going on. The suspect a “extreme” migraine as the cause. An MRI is obtained, but shows no evidence of migraine – and then the ceiling collapses due to a prank House pulled on Foreman. Before the collapse, Park noticed that he misidentified her as Adams, and that is enough for House to deduce that Derrick has a persistent stapedial artery. This is a small artery in the fetus that should fade away before birth, but sometimes it remains. In Derrick’s case, this artery has been pressing against his temporal lobe causing dizziness and hallucinations. After surgery to remove the artery, his symptoms should resolve.

Neither House nor Wilson is doing well now that they’ve learned that the chemotherapy didn’t work and the tumor remains. Wilson decides to go without any more chemo, figuring he has five months left to live. House refuses to accept this. He wants Wilson to take the chemotherapy and extend his life another couple of years. He tries a number of tricks on Wilson to get him to agree: he doses him with Propofol (a potent IV general anesthetic – what killed Michael Jackson) to mimic death, he fills a room with former patients, he has a quiet nostalgic dinner with him – but nothing he does convinces Wilson to try chemotherapy. Instead, it drives a wedge between them.

Foreman buys House season tickets to the New Jersey Devils, with seats next to his, in a bid to help House get over Wilson, but House decides to stuff the tickets down the hospital bathroom drain. This leads to a massive water overflow, ultimately collapsing the ceiling over the MRI and requiring the city emergency crew to be brought it (apparently, there is no way to shut the water off at Princeton Plainsboro).

In the end, Wilson decides to go through with the chemo for House’s sake, but House tells him not to, and they’ll just enjoy the time left. They are making plans for the next few months, when the Foreman and the hospital lawyer walk in (but why is the hospital lawyer acting as an accusing officer hear? He should be protecting his doctors, not acting like a DA), telling House his plumbing stunt was severe enough to draw police attention and his parole is being revoked and he must server the remainder – six months – of his sentence.

As usual, with a soap opera heavy show (not that I’m necessarily complaining, just noting), the patient and medicine are given short shrift. Major complaints are in red (red caduceus), modest complaints are in blue (blue Vicodin), and nit-picking ones in green (green pencils):

The main issue with this week’s diagnosis is what I call the “have your cake and eat it too” problem — commonly seen on House — but not usually this blatantly. In this case, Derrick has a persistent stapedial artery significant enough to cause a rise in intracranial pressure (leading to clots and bloody noses) and large enough to press against the temporal lobe causing hallucinations – yet, this large artery is not seen on CT or MRI, and the patient has none of the common symptoms such as hearing loss or tinnitus (ringing in the ears). The writers want to have it both ways — bad enough to cause extreme symptoms, but yet small enough to be missed by every exam until the last minute.

TA midline granuloma would have been seen on CT.

I see little evidence (really noevidence) in the literature of a migraine, even an extreme migraine, causing an elevated intracranial pressure. Now, an elevated ICP can cause a headache, sometimes even a migraine, but that’s the opposite of what’s suggested here.

I notice they make no effort to actually lower the elevated ICP – other than the initial spinal tap.

How did misidentifying Park as Adams lead House to the final diagnosis?

Here’s one I have no answer to, and so I’m not really calling it an error; I’m just wondering. Would an auditory hallucination light up the same areas of the brain as actually hearing something would, or would it light up different areas?

The medical mystery would be boring for any medical show, but was particularly pedestrian for House. It earns a meager D. The final solution made a little sense, but not much when you consider the so big to cause major symptoms, yet too small to be noticed paradox. I give it another D. The medicine overall was just OK. Not horrible, but not particularly brilliant. I give it a C. Once again, the soap opera was quite good. Both Laurie and Leonard deserve kudos for their scenes. I give it an A.

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A list of all prior House reviews

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Monday PSA: The Flushing Remonstrance

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Filed under: Comics

What seems at first to be a rather dry “history lecture” public service ad is actually a subtly pointed affirmation of the Freedom of Religion — a lesson that could bear repeating today.

Click on the image for the full ad

The PSA presents a fairly abridged version of the Flushing Remonstrance, but then it is only a five panel PSA intended for 8 to 12 year old boys.
Wikipedia has a nice summation of the Remonstrance.
The full text of the Flushing Remonstrance

Since this PSA was published just the one time, and because it is more political than most, I wonder what was going on in the country in 1957 that prompted Schiff to write it?

Remonstrance is a fun word to say; flushing is too.

This PSA can be found in DC comics from February, 1958. The script was by Jack Schiff, with the art by Bob Brown.

More PSAs

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House — Episode 20 (Season 8): “Post Mortem”

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Another episode with the team being mostly on their own while House and Wilson do their own thing. Not a bad episode, overall.

Dr. Treiber is the hospital’s outspoken pathologist. In the middle of an autopsy, he suddenly decides to cut his own scalp open with a scalpel and complains of being cold. He is admitted to House’s service — but House quickly runs off on a buddy trip with Wilson, so the team is left to solve the case on their own. Before he leaves, House suggests Treiber may be suffering from the Cotard delusion (a mental disorder where people believe they are dead — therefore House thinks Treiber was trying to perform an autopsy on himself), but the history doesn’t fit well. Other suggestions include liver failure due to hepatitis C, toxin exposure in the morgue (in particular, dimethyl sulfate), or blood clots. An ultrasound is obtained but shows no clots, and an examination of the lab turns up no toxins, but does reveal that Dr. Treiber is a big fan of energy drinks, the team now suspects he is suffering from stimulant psychosis, due to all the caffeine he consumes.

Treiber soon develops abdominal pain and distention, meaning that something else besides stimulant psychosis is going on. Adams still suspects the caffeine is behind most of his symptoms, except the abdominal ones, which she believes are caused by a bowel obstruction. Other thoughts are diabetes or ulcerative colitis (a type of inflammatory bowel disease). Chase finally suspects an intussusception (a collapsing of the bowel in on itself) due to cancer. They obtain an x-ray which is normal, but Treiber wants Chase to go ahead and check the small bowel surgically for the intussusception. Chase agrees to perform the surgery, but no abnormalities are found.

The team now decides that Treiber must have intermittent porphyria (an inherited metabolic disorder) and starts him on hemin (a treatment for acute intermittent porphyria). Despite the treatment, Treiber continues to decline and develops bilateral pleural effusions (fluid build up around the lungs). At this point, Treiber finally learns that House is nowhere to be found, and Foreman is brought on to the case. He immediately suspects a cardiac cause (not unreasonable, given the pleural effusions) and obtains a cardiac MRI which shows an enlarged left ventricle. Foreman takes this to mean that Treiber has an infiltrative disease of the heart (an accumulation of some substance in the heart muscle that is not supposed to be there), probably sarcoidosis, and wants a heart biopsy. Chase suspects a prion disease (a neurological disease spread by infected proteins) and wants a brain biopsy; he also wants to start him on amphotericin to treat the suspected prion disease. Unfortunately, only one biopsy can be performed and Foreman elects to go with the heart biopsy. Chase heads down to the morgue to find the source of his suspected prion disease The cardiac biopsy shows fibrosis, not infiltration, meaning Foreman was wrong about sarcoid, but Chase was also wrong about a prion cause (because no prion disease causes fibrosis in the heart). Foreman now suspects a viral infection (like a viral cardiomyopathy) and obtains cultures and starts antivirals, but Chase remains in the morgue, convinced the answer is down there. Overnight, Treiber falls into a coma, making Foreman and the rest of the team rethink their diagnosis. They come to the morgue to talk to Chase who has reluctantly decided that Treiber is too fastidious to have caught a disease in the morgue – but then he realizes it is that fastidiousness – or more specifically, the antibacterial soap he repeatedly uses – that is the source of the problem. The repeated exposure to Triclosan (an antibacterial in soap), plus a high dose of caffeine from the energy drinks, caused Treiber’s thyroid to shut down and Treiber ended up in a myxedema coma (a severe form of hypothyroidism).

As always, major complaints are in red (red caduceus), modest complaints are in blue (blue Vicodin), and nit-picking ones in green (green pencils):

While triclosan has been implicated in thyroid problems in bullfrogs and mice, human studies haven’t shown this effect (admittedly it was a limited study looking at triclosan in toothpaste).
Similarly, there haven’t been any studies linking high caffeine intake and hypothyroidism in humans (there is a study showing caffeine can interfere with absorption of thyroid medication, but that’s a different situation).

No one thought to check thyroid studies for an unexplained coma?

Studies have suggested that amphotericin may play a role in treating certain prion dieases, but it’s never been tested in humans.

They can’t perform both biopsies because of the amphotericin Chase wants to use because it might theoretically limit the possible prion disease the patient might have. Problem easily solved. Hold the ampho (it’s never been tested in humans for this anyway) then you can perform both biopsies.

That was simply a horrible code, but then, I think it was supposed to be one because it was supposed to be a bad doctor. Just for starters: only two people involved (not counting the patient), and one is just idly looking at IV bags. Shocking a flatline. No airway.

A small amount DMSO applied to the knees got converted to a toxic amount of dimethyl sulfate via several brief shocks to the chest?

Did no one think to ask Treiber why he was cutting his own scalp? The answer would likely have been revealing.
Despite the hypothyroidism/myxedema coma worsening, his mental status was fine in his hospital stay, despite it being his presenting complaint.

Here’s what I could get off of Chase’s whiteboard (or whiteboards) — hopefully someone got a better screenshot. In no particular order: Neimann-Pick disease, Japanese encephalitis, Creutzfeldt-Jakob disease, Q fever, impetigo (really?), typhoid, schistosomiasis, leptospirosis, gastroenteritis, neurofibromatosis, fatal familial insomnia, Tay-Sachs disease, cronobacter, syphilis, kuru, lyme, aortic aneurysm, shigelloisis, malaria, HIV, Klinefelter syndrome, yellow fever, cryptosporidiosis, dengue, German-Straussler-Scheinker syndrome, hypoglycemia.

The medical mystery was interesting, if less so once the patient was admitted. I give it a B+. The final solution made a modest amount of sense, if you accept the fact that the condition has never been seen in humans — that’s a few point off, in my book. I give it a C-. The medicine overall was thorough — on Chase’s end, at least — but missed some obvious possibilities, with myxedema coma topping that list, and easily testable. I give it a weak B. I thought the soap opera was good. The House/Wilson last fling was somewhat cliché, but Chase’s dilemma was well done. I give it an A-.

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A list of all prior House reviews

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A Farewell Toast to Red-Wine Teeth

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A couple days ago, I tried to think of a few things worse than being in a social setting, having a few glasses of wine, and ending up with wine-stained teeth. Let’s see, what did I come up with? Running face first into a bee hive, for one. Dashing out of a restaurant only to see your car being towed. Global warming? Ok, maybe not that bad.

It’s not merely the fact that your teeth have lost their pearly white hue that’s embarrassing. It’s more what having red-stained teeth symbolizes – that you get a little too excited by the thought of wine. So much so, that you’d rather be in a foreign country stomping up and down in a vat of grapes than where you are right now. Or that you’re just a lush.

Up until now, our only solutions were to either stop after one glass (let’s be serious, now) or jet off to the bathroom with toothbrush and toothpaste in hand for a quick touch up. Since both of those options aren’t always convenient, it’s a good thing I stumbled upon a product called “Wine Wipes,” from the makers Borracha LLC.

Wine Wipes uses a combination of salt, baking soda, hydrogen peroxide, calcium, glycerine, and orange blossom to bleach the teeth, neutralize acids, and provide a coating to protect against future gulps. I was ready to test these babies out!

I pulled them out of my bag one night, thinking that these wipes would come in very handy on a date. Picture it: the conversation is going well – you both share a love of cats and long walks in the rain – and he just can’t wait to meet your parents. Then you smile sweetly and watch as his eyes move from your face to your red teeth. And then watch as his face contorts, like he just caught a whiff of something foul.

Thankfully, I wasn’t on a date. I was just at dinner with my friends (read: I don’t care what they think of me. They’re kind of obligated to like me at this point). We all had a couple of glasses of red wine and I pulled out a wipe – a small, circular, moist pad with one textured side for scrubbing, I assume. What immediately put me off was the taste – a combination of sour and salty. A friend had tried one as well and mentioned, ecstatically, that they tasted like boiled peanuts.

Strange taste aside, they did seem to clean my teeth. When I looked at the wipe after I had rubbed it over my teeth, it was noticeably redder. And my teeth did look brighter. The wipes also come in a small, discreet case – easy to take to the bathroom if you’re out in a public setting.

I’ll definitely be keeping Wine Wipes on hand for those occasions I find myself indulging in a few glasses of vino. That or just move to Europe and stomp grapes for a living.

Wine Wipes retail for $6.95 and can be purchased at stores nationwide and online.

Maya Kashyap, Everyday Health Production Editor

 

Hot and Cold Therapy With a Scented Twist

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It’s occurred to me that temperature control has a big impact on my comfort level. If you live in an area dominated by extreme temperatures (read: record-breaking heat wave summers in Manhattan), a cold shower or bubble bath at the end of a long day can be the difference between a breath of relief and a temper tantrum. So when I tried out Carex’s Bed Buddy Hot & Cold Pack, I was hopeful to add a new hot-cold quick fix into my options.  

I tried out a Bed Buddy delightfully scented with “pink bliss,” an aromatherapy blend intended to be “uplifting and healing.” (It’s also available in green fresh – “purifying, invigorating” – and orange balance – “comforting, calming”). It’s bright pink, about a foot-and-some-change long, and filled with natural grain, herbs, and flowers. The pack is bookended with sturdy rope handles.

After checking the package instructions about 17 times to make sure I was reading it correctly, I cooked the Bed Buddy Easy-Mac-style in my microwave for a minute and 15 seconds. To my relief, it did not catch fire.

The reason we use heat for pain relief is because it’s soothing for the aching body. It relieves stiff, sore muscles while stimulating blood flow. I used mine on my shoulders and neck, which were sore from a yoga class the day before. The pack reaches the perfect level of warmth – never hot enough to be scalding but warm enough to earn a resounding “aahhhh.” And it lasts for a while – about an hour to be exact. Within 10 minutes I felt relief. The heated Bed Buddy is my post-workout buddy. I could also use it as a post-day-at-the-office buddy, where my neck is victim to 8 hours in front of a computer screen.

Cold therapy can reduce swelling when pain causes joint inflammation. And while I don’t have any swollen joints to tend to at the moment, I thought the cold pack would be nice for my non-air-conditioned apartment on a hot day. The pack should be stored overnight in the freezer for cold therapy use.

(Note: When the package instructs to place the Bed Buddy in a plastic bag before storing it in the freezer, it’s serious. Upon not being able to find a plastic bag, I left it in the freezer willy-nilly. My Bed Buddy now smells like frozen fish and leftover vodka from last Christmas. The herbs and seeds must absorb the smells around it.)

The cold-acting side of the pack is not a role it plays well. After a night in the freezer, the pack is slightly cool at best. So if you suffer from chronic muscle pain, arthritis, or all-around achiness, you’re better off using an ice pack or bag of frozen vegetables.

At only $12.99 and with plenty of reuse value, the Bed Buddy is worth a try. The comfort of the heated pack is so wonderful that I can forgive the shortcomings of the cold pack attempt.  

And a heads up: If you purchase the “pink bliss” Bed Buddy, a portion of proceeds will support the fight against breast cancer.

Jennifer Paxton, editorial intern at Everyday Health

 

Raising Awareness and Healing Skin

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You may have noticed an influx of breast cancer ads on TV, in stores, and around your neighborhood recently. That’s because October is Breast Cancer Awareness Month. Used as a platform for breast cancer charities across the country to increase support for their cause, this month gets a lot of recognition in the press.

Breast cancer walks and runs are widespread, and landmark buildings worldwide – like the Empire State Building and the Tower of London – are decked out in pink in support of those with the disease. Check out a football game on Sunday and you’ll notice that even burly NFL players have their pink gear on.

Many companies will also be donating a portion of their proceeds to breast cancer charities over the next few weeks. Among them is Pomega5, a skincare line that uses biodynamic botanicals and Omega 5 oils to treat skin imperfections. During October and November, Pomega5 will donate 10% of proceeds from sales of all its products to the California-based To Celebrate Life Breast Cancer Foundation.

As the daughter of a breast cancer survivor, I’ll admit I favor companies that support this cause, but I was able to test one of their products with an open-mind. According to their website, Pomega5’s Healing Cream is formulated to soothe and moisturize dry, damaged skin with a combination of Omega oils and shea butter.

Sounds like a winner, doesn’t it?

I applied the cream twice a day to the dry patches of skin on my hands, elbows, and legs. It isn’t heavy like most lotions, and it blends in quickly and smoothly. Within a week, I noticed an improvement in my skin. My hands were softer, my elbows weren’t as rough, and my legs felt silky.

Based on my results and the product reviews on their site, it seems like Pomega5 has hit it out of the park with this one… although I do have one gripe.

This 1.7 fl oz bottle of Healing Cream is being sold for $70! Seems like a hefty price for such a small bottle. As someone who has struggled with problematic skin – and has spent a ton of money trying to treat it – I am always frustrated by the cost of good skincare products. We all have a right to beautiful skin, but we shouldn’t have to break the bank for it.

While I applaud Pomega5 for their support of breast cancer, I am disappointed in the price of their products. As a result, I’ll stick to the economy-size lotion I buy in drug stores for $6.99. I may not have perfect skin, but at least I have some cash in my pocket.

Kellie Clark, Everyday Health Production Editor

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Get Rid of Dry Spots Naturally!

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I was pretty excited to try the new addition to the Pomega5 line.

The Pomega5 line infuses antioxidants from pomegranates grown in the Mediterranean, and according to one study, pomegranate seed oil can rejuvenate the skin by boosting cell production. In addition to pure Omega 5, The Daily Revitalizing Concentrate Ampoules contains a blend of oils including jojoba, rosehip, and grapefruit oils, a concentration that the makers claim heals the skin by reducing wrinkles, scars, and dark spots.

I used the Daily Revitalizing Concentrate Ampoules twice a day in lieu of my regular moisturizer for three weeks. I tried the ampoules right before bed, while my face was still damp. The first time, I made the mistake of using an entire capsule on my face, which left my skin shiny. (Luckily, I made that mistake at night, because had it been the morning rush, I would've been waiting impatiently for my skin to dry so I could apply makeup.) My skin did absorb most of the , but it was still left with a bit too much shine, so I decided to use half a capsule each time in the future.

Once I adjusted my dosage, my concerns about using oil on my face were abated. My skin absorbed the oil in about a minute. Within three days, my face was much smoother, specifically near the corners of my mouth, which gets extremely dry.  Also, I noticed that my skin had a glow, though I needed to keep my oil-absorbing sheets handy for my forehead and nose. Unfortunately, these ampoules didn't reduce a small scar on my cheek, which was what I really wanted. (Note: The ampoules are about the size of a pill, and you have to pull at both ends to apply the product. This can get quite tricky if your hands are wet, so keep a pair of scissors nearby if you plan on using the ampoules straight out the shower.)

The Daily Revitalizing Concentrate Ampoules can also be used on cuticles, so I decided to give it a shot. One capsule was enough for all ten fingers, and I was impressed that this product made my cuticles looked softer right away—without leaving an excess of oil behind like other cuticle treatments. The portability of the ampoules was a plus; it took just two minutes to treat both hands while standing on a moving rush-hour subway car.

These ampoules are a good idea if you're looking for a natural product for dry and uneven skin. But if your skin is on the oiler side, follow my lead and use just half at a time. Since these ampoules are essentially oil, it may be best to keep them away from your T-zone if that area tends to get slick. Since my combination skin gets oily during the summer, I won't use this product when the weather gets warmer, but at least I know now what to use next winter.

You can buy the Daily Revitalizing Concentrate Ampoules here.

- Alysha Reid

 

Can You Moisturize Without the Ick Factor?

AppId is over the quota AppId is over the quota When Nivea invited Everyday Health to attend the launch of its new Hydra IQ technology, I was more than skeptical about the new product launch. As a lotion connoisseur, I’ve tried everything before – from the glittery Disney princess lotions from my childhood to the “imported” lotions that I filched from my grandmother’s dresser years later. Despite all my trial and error, I still haven’t committed to a moisturizer – and I have dozens of half-used containers to prove it.

Nonetheless, I decided to go to the event because the name “Hydra IQ” caught my eye on the invitation. I’ve heard plenty of fancy names for beauty products, but I never heard of one referring to its intelligence, so when I saw “IQ” attached to the word “Hydra,” I was curious. Did “IQ” imply that these products are smarter than others? I wondered. But once I saw that Nivea was offering complimentary manicures, I was sold on attending. I figured that pretty nails would console me even if the products turned out to be a disappointment.

Nivea’s Hydra IQ technology claims to penetrate the skin’s layers for even protection and promises to hydrate the skin for more than 24 hours by maintaining the skin’s moisture level. The skin care launch includes four brand-new products, and the ingredients are also included in some of Nivea’s older skin care standbys. I tried three of its brand-new products in total, using at least one daily for two weeks.

I tend to slack off with the lotion when the weather gets warm because I hate when my skin feels greasy and sticky. But because of Nivea’s Express Hydration Freshening Gel, I don’t have that excuse anymore. It was by far my favorite Hydra IQ product because it’s made for the summer! Not only does it absorb quickly (less than two minutes), but its water-based formula makes it very lightweight. Plus, it contains mint extract, which gives your skin a cooling sensation.

I wasn’t as thrilled about Nivea’s Express Hydration Daily Lotion. Sure it kept its promise – the lotion was fast-absorbing and it did last 24 hours – but there are dozens of drugstore lotions that do the same thing for less than $8.99.

Out of the three Hydra IQ products I tried, Nivea’s Touch of Cashmere Body Wash was the only one I really didn’t like. The warm scent was too overpowering, and I expected it to be more moisturizing – especially since the body wash left a slippery residue.

Nivea’s Hydra IQ technology did deliver results, but don’t purchase the entire line if you’re on a budget. The Express Hydrating Freshening Gel was the only product that was worth the fancy moniker, especially with summer heat waves and humidity levels ahead.

You can buy Nivea’s Hydra IQ products in drugstores everywhere.

--Alysha Reid

 

The Saucony Hattori: My Favorite Cross-training Shoe

Saucony’s Celliant Suit Soothes Sore Muscles

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“But really, it’s a recovery suit that Saucony gave me. It’s got this stuff called Celliant in it, and it reflects the photons…”

This is what you might very well say to your friends as they look at you dumbstruck for lounging around in a racing-striped black unitard. They’d probably laugh less if you said “I’m now a masked vigilante.”

Really, I get it. It seemed nuts to me too. Had Saucony not been the company whose shoes enabled me to start running again, I would’ve written this off to snake oil. But Saucony gear almost never fails for me.  I figured I owed it to them to have an open mind to their recovery suit, right?

Aaaand… the suit really works. Seriously. I’m more shocked than you are.

I’m not even willing to admit that it’s because of the space-aged material. I can’t tell if it makes me strangely warm because it’s inducing a sort of self-perpetuated light therapy, or because it’s made from polyester.  I don’t know if my muscles are getting fixed faster because of the Celliant, the compression, or something else.

But, the bottom line is, I recover faster when I wear the Saucony AMP PRO 2 recovery suit after a hard workout.

I was so unprepared to believe that I tried it twice.

Last Tuesday, I ran a sprint drill. I haven’t run sprints since I was maybe 20. I had my friend Courtney with me to help coach my form. But still, we ran 3-4 miles of intermittent sprints. It was a sure recipe for shin splints, cramped calves, aching thighs and the worst-case scenario: reigniting nerve-shattering knee pain. So, I slept in the suit and hoped for the best.

The best happened. The next day I had nothing but a tiny twinge in my right thigh. I was almost completely recovered.

I refused to believe it. I figured that I must not have worked as hard as I thought. So, on Saturday, I hit up the Run A Muck Festival, a 5k mud run with obstacles, boulders, and water. I went as hard as I could in the race (I wore Saucony Razors, by the way – great for bouncing off rocks. Would you believe I can swim well in them?), and I did not wear the suit that night. By Sunday, my legs were stiff and wracked with pain. I didn’t want to get out of bed, much less walk around, with this kind of conditioning pain.

So I put on Saucony’s recovery suit. Usually, if you’re this beat up after a race, you’re stiff and sore at least through the next two days. But after lounging in the suit for three hours, I felt limber again and the pain subsided to a dull ache. I could literally feel the thing working. I was almost recovered by bedtime, and that has never happened to me before, at least not without a masseuse involved.The down side: It is warm, so you might need to crank the AC a little when you wear it. Also, you step in through the shoulders, so there is no fly, adding an extra step to a 3 a.m. bathroom break.

Whether you’re a casual athlete like me, or training for something that makes mortals tremble, you should at least try some of Saucony’s forthcoming Celliant-based products and see if they help you as much as they help me.

Bryan Harris, Everyday Health Fitness Blogger

 

Do These Bite Sized Drops Make Bad Breath Stop?

 

A Simple Way to Save Your Skin

AppId is over the quota AppId is over the quota It's safe to say that SpaFinder wants the public to feel relaxed and refreshed – this organization provides an extensive spa directory in addition to listings of wellness classes and spa resorts. But this worldwide leader in the spa industry also wants the public to be sun smart, and with this new bracelet, they’ve just made it easier.

SpaFinder launched the “I Will Reflect” bracelet to raise awareness about melanoma, the deadliest form of skin cancer. This white bracelet becomes purple when exposed to harmful UVA/UVB sun rays. I wore it for two weeks, and I think it’s a great reminder to wear sunscreen daily. The rubber bracelet is lightweight and convenient, but with the word “reflect” engraved in metal, it’s obvious that this isn’t just a fashion accessory. I expected the bracelet to change colors under the bright sun, but I was surprised to see it turn purple during cloudier days.  

If you often forget to apply sunscreen, I encourage you to give this product a try. The “I Will Reflect” bracelet is available on the SpaFinder Web site for 4.95 – but if it saves you from skin cancer, it could be priceless.

                            

Tips for healthy eating out

By Mayo Clinic staff

Eating out can be fun and healthy. Just keep these tips in mind. 1. choose the smallest size sandwich, not version supersized. 2. Skip the fries and pick fruit or yogurt for an outline. 3. Select lean meats roasted or grilled instead of fried, breaded and fried options. 4. Make the healthiest salad dressing and skipping through Lean extras like cheese and bacon.

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Tongue-Tie (Ankyloglossia)

By Mayo Clinic staff

Tongue-Tie (Ankyloglossia) is a condition that limits the range of motion.

With tongue-tie, an unusually short, often or narrow strip of fabric (frenulum) binds to the underside of the tip of the tongue to the floor of the mouth. A person who has tongue-tie might have difficulty sticking out his tongue. Tongue-tie can also affect how a child eats, speaks, and swallows, as well as interfere with breastfeeding.

Sometimes the frenulum loosens over time and tongue-tie resolves by itself. In other cases, tongue-tie persists without causing problems.

If necessary, tongue-tie can be treated with a simple surgical procedure called a frenotomy. If you require further repair or the frenulum is too thick for frenotomy, a broader procedure known as Frenuloplasty could be an option.

References GC Isaacson. Ankyloglossia (tongue-tie) in infants and children. www.uptodate.com/index. Accessed February 6, 2012. Buryk M, et al. effectiveness of neonatal Ankyloglossia release: a randomized trial. Pediatrics. 2011; 280.128: Suter VG, et al, Ankyloglossia: facts and myths in the diagnosis and treatment. Journal of Periodontology. 2009; 80: 1204. Edmunds J, et al. Tongue-tie and breastfeeding: a review of the literature. Review of breastfeeding. 2011; 19:19. Block SL Ankyloglossia: when frenectomy is the right choice. Pediatric Annals. 2012; 41: 14. Beatty CW (expert opinion). Mayo Clinic, Rochester, Minnesota March 11, 2012.

 

Take time to relax by reading

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One of my favorite ways to relax is to sit with my favorite journal or book and lose myself in the contents.

Reading is a great way to escape to another place and time. In the process, your mind and body have a chance to relax.

How many times have you thought of just doing nothing but curling up on the couch with a good book, a cup of tea and a cozy blanket?

It can be the ultimate way to relax, be with yourself and forget about the stress around you. A book can take you places that you've never been.

As a cancer survivor, you may have used reading to get through the day many times ... while waiting for your doctor, while receiving chemotherapy, or simply as a way to relax your mind during times when your body needs a rest.

There are so many ways to incorporate the simple act of relaxing through reading. Feel free to share your favorite book or your experiences with reading and relaxation. I'd love to hear from you.

Follow me on Twitter at @SherylNess1. Join the discussion at #livingwithcancer.

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Test group b strep

By Mayo Clinic staff

Group B Streptococcus — also called Group B streptococci — is a common bacterium often carried in the gut or lower genital tract. Although Group b streptococci are usually harmless in adults, can cause pregnancy complications and serious illness in infants. If you are pregnant, health care provider will recommend probably a test group b strep during the third quarter.

During a group b strep test, health care provider will buffer your vagina and rectum and send the samples to a laboratory for testing. In some cases, you may be given instructions on how to collect the samples alone. Because it can occur in certain positive and negative moments at other times, it is necessary to repeat that the Group b strep test whenever you are pregnant.

If the test group b strep is negative, no action is required. If the strep test group b is positive, you will be given antibiotics during labor to prevent disease Group b strep in your child.

Refers to Puopolo KM, et al., infection with Group b strep in pregnant women. http://www.uptodate.com/index. The 29 December 2011. Puopolo KM, et al., infection with Group b Streptococcus in young children and infants. http://www.uptodate.com/index. Accessed 29 December 2011. pregnancy and Group b Streptococcus. American College of Obstetricians and Gynecologists. http://www.ACOG.org/~/media/for%20Patients/faq105.ashx?DMC = TS = 1 & 20111229T1430272285. Accessed on 29 December, 2011. Group B strep (GBS): prevention in infants. Centers for Disease Control and Prevention. http://www.cdc.gov/groupbstrep/about/prevention.html. Accessed 29 December 2011. Centers for disease prevention and control. Prevention of perinatal Group B Streptococcal Disease: revised guidelines from CDC, 2010. MMWR. 2010; 59 (Cod. RR-10): 1. http://www.cdc.gov/MMWR/Preview/mmwrhtml/rr5910a1.htm. The 29 December 2011. Murry MM (expert opinion). Mayo Clinic, Rochester, Minnesota February 24, 2012.

 

Tilt table test

By Mayo Clinic staff

A tilt table test is used to evaluate the cause of unexplained fainting (syncope). During a tilt table test, you lie on a table that moves from a horizontal to a vertical position. Heart rate and blood pressure are monitored during the test tilt table.

Your doctor may recommend a tilt table test if you have had repeated, unexplained episodes of fainting. A tilt table test may want to investigate the cause of faint if you have fainted once, but another episode it would risk of injury because of your work environment, medical history, age or other factors.

Doctors use a tilt table test to help diagnose the cause of fainting. During the test, the blood pressure and heart rate are monitored. Begin lying flat on a table. Belts are placed around the body to hold you in place. Then, the table is tilted to lift the body to a position of head up — simulation of a change in position from lying to standing. This test allows doctors to evaluate the cardiovascular response of your body changes position.

References Tilt table test. Heart Rhythm Society. http://www.hrspatients.org/patients/heart_tests/tilt_table.asp. Go to March 1, 2012. Olshansky b. Upright tilt table test in the evaluation of syncope. http://www.uptodate.com/index. Accessed on March 1, 2012. Bonow RO, Braunwald's heart disease et al: a textbook of cardiovascular medicine. 9th ed. Philadelphia, PA: Saunders Elsevier.: 2012. http://www.mdconsult.com/Books/Page.do?Eid = 1.0-4-U-1-4377 B978-0398-6 ...1-00042-s0060-ISBN 978-& = 1-4377-0398-& = 6 321215166-uniqId # 4-9 1.0-U-1-4377 B978-0398-6 ...1-00042-s0090. Accessed March 1, 2012 to. Tilt table test. The Merck Manuals: The Merck Manual for healthcare professionals. http://www.merckmanuals.com/Professional/cardiovascular_disorders/cardiovascular_tests_and_procedures/tilt_table_testing.html. The March 1, 2012. Grogan M (expert opinion). Mayo Clinic, Rochester, Minnesota, April 30, 2012.

 

Migraine: They are triggered by weather changes?

Some people who have headaches seem to be more sensitive to changes in time. Weather related triggers include:
Bright cold temperaturesHigh SunlightHot or humidityDry airWindy or weatherBarometric stormy pressure changes For some people, weather changes can cause imbalance in brain chemicals, including serotonin, which can take a headache. Weather triggers can also worsen a headache caused by other triggers.Click Here!
If you feel your migraines are triggered by time, you may be understandably frustrated. After all, you can't change the time. However, you can learn what changes weather forecast initiate a migraine and take measures to reduce the effects:
Keep a diary of migraine headaches, migraine, list each when it happened, how long it lasted, and what might have caused. This can help determine if you have triggers specific forecasts.Monitor changes to climate and to avoid the trigger if possible. For example, staying indoors during the very cold and windy weather if these factors seem to trigger your headache.Take the migraine medicine at the first sign of a migraine.Make healthy lifestyle — eating healthy foods, exercise regularly, get enough sleep and keeping your stress under control. These factors may help to reduce the number and severity of your migraines.Next question references environmental and physical factors. National Foundation of headaches. http://www.headaches.org/education/Tools_for_Sufferers/Headache_-_Frequently_Asked_Questions/Environmental_and_Physical_Factors. The 21 February, 2012. Friedman DI, et al., migraines and the environment. Headaches. 2009; 49: 941. Migraine headaches. American Academy of Neurology. http://www.aan.com/Professionals/Practice/Guidelines/migraine/Migraine_Guide_Patients.pdf. Accessed February 29, 2012. Hoffman J, et al., weather sensitivity in migraine sufferers. Journal of Neurology. 2011; 258: 596. Migraine. National Foundation of headaches. http://www.headaches.org/education/Headache_Topic_Sheets/migraine. Accessed 1 March 2012.

Myocardial Ischemia

By Mayo Clinic staff
Myocardial ischemia occurs when blood flow to your heart muscle is diminished by a partial or complete blockage of the arteries of the heart (coronary arteries). The decrease in blood flow reduces the oxygen supply to your heart.
Myocardial ischemia, also called cardiac ischemia, can cause damage to the heart muscle, reducing its ability to pump efficiently. A sudden, severe coronary artery can lead to a heart attack. Myocardial ischemia can also cause abnormal heart rhythms.
Treatment for myocardial ischemia is directed at improving blood flow to the heart muscle and can include medications, open proceedings or blocked arteries surgery coronary artery bypass. Make lifestyle choices-healthy heart is important in the treatment and prevention of myocardial ischemia.
PC Deedwanla References. Silent myocardial ischemia: prognosis and therapy. http://www.uptodate.com/Home/index. The March 22, 2012. Deedwanla PC. Silent myocardial ischemia: epidemiology and pathogenesis. http://www.uptodate.com/Home/index. The March 22, 2012. Goldberger al. ECG in diagnosis of myocardial ischemia and infarction. http://www.uptodate.com/Home/index. The March 22, 2012. Deedwanla PC. Silent myocardial ischemia: diagnosis and screening. http://www.uptodate.com/Home/index. The March 22, 2012. Cardiac biomarkers. American Association for clinical chemistry. http://www.labtestsonline.org/Understanding/analytes/cardiac_biomarkers/Glance.html. Accessed March 22, 2012. Bonow RO, Braunwald's heart disease et al: a textbook of cardiovascular medicine. 9th ed. Philadelphia, PA: Saunders Elsevier;. 2012. http://www.mdconsult.com/books/about.do?eid=4-u1.0-B978-1-4377-0398-6 ...Competition-0-6--59734-& Top-1 ISBN = 978-4377-0398-& about 6 = true & = 236798031-10 uniqId. The March 22, 2012. Lanza GA, et al. mechanisms of coronary artery spasm. Circulation. 2011; 124: 1774. View the original article here

Prolactinoma: options for the treatment of pituitary gland tumor

By Mayo Clinic staff Prolactinoma is a condition in which a usually noncancerous tumor (adenoma) in the pituitary gland in your brain overproduces prolactin hormone. The main effect of prolactin is a decrease in the levels of some hormones — estrogen in women and testosterone in men.
Although Prolactinoma is not life-threatening, can impair your vision, cause infertility and produce other effects. Prolactinoma is one of several types of cancer that can develop in your pituitary gland.
Doctors may treat Prolactinoma with medications often effectively to restore your prolactin level to normal. Surgery to remove the pituitary tumor, may also be an option for treating Prolactinoma.
References Prolactinoma. National Institute of diabetes and digestive and kidney diseases. http://endocrine.niddk.nih.gov/pubs/prolact/prolact.htm. Accessed on 17 January 2011., Melmed S, et al., diagnosis and treatment of hyperprolactinemia: clinical practice guideline of An Endocrine Society. The Journal of Clinical Endocrinology Metabolism &. 2011; 273.96: Colao, et al., the aggressive pituitary tumour therapy. Pharmacotherapy specialist opinion. 2011; 12: 1561. Mann WA. Treatment of prolactinomas and hyperprolactinaemia: a lifetime approach. European Journal of Clinical Investigation. 2011; 334.41: a. Klibanski Prolactinomas. The New England Journal of Medicine. 2010; 352: 121. Colao, et al. medical treatment of prolactinomas. Nature reviews Endocrinology. 2011; 7: 267.var shareUrl = encodeURIComponent (window.location); var shareTitle = encodeURIComponent (document.title);
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Sleep aids: Could antihistamines help me sleep?

IP is over the quota

Gli antistaminici possono causare sonnolenza, che potrebbe aiutare a cadere addormentato per un paio di notti — ma non è consigliabile utilizzare sistematiche antistaminici per l'insonnia.

Gli antistaminici inducono sonnolenza lavorando contro l'istamina, una sostanza chimica prodotta dal sistema nervoso centrale. Infatti, più quotato in borsa dormire aiuti contengono antistaminici. Questi prodotti sono destinati ad essere utilizzati per solo due o tre notti in un momento, tuttavia, come quando lo stress, viaggio o da altri disturbi tenervi svegli. Tolleranza agli effetti sedativi di antistaminici in grado di sviluppare rapidamente — così il più a lungo si prendono loro, essi sono meno probabile che ti fanno sonnolenta. Effetti collaterali potrebbero includere sonnolenza durante il giorno, secchezza delle fauci, problemi di memoria e vertigini.

Inoltre, tenete a mente che la difenidramina e doxylamine — sedativo antistaminici trovato in vari-the-Counter dormire aiuti — non sono raccomandati per pazienti affetti da glaucoma ad angolo chiuso, asma, broncopneumopatia cronica ostruttiva, grave malattia epatica o ritenzione urinaria, che può essere preceduta da un flusso di urina debole o problemi di partenza minzione. Inoltre, la maggior parte dei dormire aiuti non sono raccomandati per donne in gravidanza o in allattamento al seno.

Se si sta lottando con l'insonnia cronica, non si basano su antistaminici o altri aiuti sonno da banco per sonno una buona notte di. Iniziare con i cambiamenti di lifestyle invece:

Seguire un programma regolare di sonno. Evitare di caffeina e sonnellini durante il giorno. Includere attività fisica nella vostra routine quotidiana. Gestire lo stress.

Se continui ad avere problemi di caduta o rimanere addormentati, consultare il medico. Oltre a cambiamenti di stile di vita, il medico può raccomandare modi per rendere il tuo sonno ambiente più favorevole al sonno o la terapia comportamentale per apprendere nuove abitudini di sonno. In alcuni casi, uso a breve termine di prescrizione dormire aiuti possa essere raccomandato pure.

Prossima domanda riferimenti Bonnet MH, et al trattamento dell'insonnia. http://www.uptodate.com/index. Principi e la pratica della medicina del sonno, accessibili 30 Gen, 2012.Kryger MH, et al. 5th ed. St. Louis, mo.: Elsevier Saunders; 2011:916.Foral P, et al, insonnia: una revisione terapeutica per i farmacisti. Il consulente farmacista. 2011; 26:332.Chokroverty S, et al manuale di neurologia clinica. 3a ed., Philadelphia, PA.: Elsevier; 2011:723.

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Dermatology Art Contest of Mayo Clinic shows that art can be seen in every aspect of life

A Mayo Clinic Dermatology art shows beauty really is skin deep. From the Mayo Clinic News blog:

A hair follicle or a copy of the skin that doesn't look like much of anything with the naked eye can become a complex artwork, colored with a microscope. The winner of the first contest of art of dermatologists of Mayo in 2011 is "the hair follicle Triplet". Alexander Meves, M.D., used fluorescent dyes to highlight proteins. Winners of the inaugural art appeared in the may issue of the journal of cutaneous pathology.

"Every single day, dermatopathologists get to see beautiful pictures under a microscope, and most people never have the opportunity to see that. So I thought it would be a nice way to show not only the science of dermatopathology, but also art, "says the creator of the contest, Dr. Lehman, a Mayo Clinic dermatopathologist.

Dr. Lehman hopes medical society will run with the idea and keep similar contests to highlight aesthetics in their specialty. People in other lines of work can also celebrate the beauty of what they do every day, she says.

Editor's Note: Allergists should do something similar. We have beautiful pollen allergens highlight on the covers of the magazine monthly ACAAI.

Dr. Lehman, "Art can be seen in every aspect of life," he says. "Enough to have an open mind and be trying."

References

Dermatology Art shows beauty really is skin deep. Mayo Clinic news.

 

Children's ability to "roam" was destroyed, and they gather on social media sites

From The NYTimes:

Danah Boyd, a senior researcher at Microsoft and an Assistant Professor at New York University: "children's ability to roam is basically been destroyed. Leaving the child out to bike around the neighborhood is seen as terrific now, although by all measures, life is safer for children today. "

Children are of course on social media sites for relatively unattended conversations, flirt, immature humor and social exchanges that are a normal teenager stuff hang-out, he said.

In addition, the great panic behavior on-line teenager distracts from potential benefits.

Let children be children-the unstructured play time can be more important than homework, suggests a child psychologist. "Children have lost 8 hours per week of free play, unstructured and spontaneous in the last 2 decades because of homework. Reduction of unstructured play time is partly responsible for slowing cognitive and emotional development of children. 5 Years now had the ability to self-regulation of a 3-year-old in the 1940s; the critical factor seems to be discipline, but he hasn't been playing. "

Video: A life cycle in 90 seconds:

References:

Cracking teen codes online. NYTimes, 2012.

Image source: OpenClipArt.org, in the public domain.

 

Infidelity in men may be associated with higher risk of cardiovascular events

The authors of this study from Italy performed an extensive Medline search for "infidelity," "extramarital", "infidelity" and "men".

Infidelity in men is how common?

As expected, the results were variable. Some surveys reported that 1.5-4% of married men had extramarital coitus in any given year, 23.2% of other men who have cheated during their current relationship.

Lifetime prevalence of infidelity was between 15% and 50%.

What are the factors related to infidelity?

Men with more extramarital affairs have often a dysfunctional primary relationship.

Authorship and conflict within the family are associated with a higher risk of having an affair.

Unfaithful men display a higher testicular volume androgenization, increased sexual desire and sexual functioning better.

What are the clinical implications of infidelity in men?

Some studies have suggested that having an affair could have a negative impact on cardiac morbidity and mortality. Infidelity in men seems to be associated with a higher risk of cardiovascular events.

References

Fisher to Bandini and Rakes G, G, M Crown, Monami and Mannucci and Sexual m. Maggi and cardiovascular correlates of male infidelity. J sex Med, 2012.

Image source: OpenClipart.org, in the public domain.

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Health care social media-more articles

Here are my suggestions for some of the major items relating to social media health in the past 2 weeks:

Medical and social media: http://goo.gl/pIrgh "How to stop worrying and learn to Love the Internet"

Consumer expectations for Healthcare Social Media http://goo.gl/REXqV

Because all hospitals need Twitter accounts: Google ranking of a URL associated with the number of Tweets about this URL http://goo.gl/AYf9t

Interviewed deleted as candidate, because the your Klout score was too low (34), "Have hired a guy whose score was 67". Even if you don't have any idea what the Klout score is, there is a chance that it already is affecting your life. People with formidable Klout will start aboard planes, get free access to VIP lounges airport, stay in hotel rooms better and receive deep discounts retail stores. A two-week vacation social media might cause your Klout score for a dive. http://goo.gl/ABu2S

13 things you never knew you could do on LinkedIn http://goo.gl/mh4da

100 ways to use Twitter In education, the degree of difficulty http://goo.gl/lAs5v

Pack the right gadgets for the road-NYTimes http://goo.gl/SmQgA

A http://goo.gl/kpvJT Review of Living Language and Rocket languages-App Smart-NYTimes

10 Http://goo.gl/24FpW HTML Tags all new bloggers should learn

Is this the future of Khan Academy? http://goo.gl/xtErX-biology Bozeman on YouTube http://goo.gl/GUry5

Many consumers worldwide worry that the technology is overtaking their lives http://goo.gl/cJj5e

Articles were selected from my streams of Twitter and Google Reader.

Comment by Twitter:

Heidi Allen @ dreamingspires: social media health-worth reading-Klout and Google rankings tied to tweets.

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Best medical-review blog, blog carnival week

What happened to Carnival medblog "Grand Rounds"?

It is sad to see that the disappearance of the Carnival medblog "Grand rounds". The weekly summary of the best medical blog post was published from 2004, with only a few breaks. There have been issues for more than a month, and no new ones are planned. A new initiative from Health Care SoMedia review could replace some of them http://goo.gl/73RpE

This post is a part of a project to recreate a weekly review, or the best medical blog carnival blog posts. Feel free to send your suggestions to my email at clinicalcases@gmail.com. "Best of Medical Blogs-weekly review, blog carnival" will be released on Tuesday, just as the old Grand rounds. The organizers of blog carnival Grand Rounds. @ NickGenes, and @ DrVal are aware of this project.

As physicians to manage Social Media profiles

Personal vs. Professional: how doctors handle Their Social Media profiles is a blog post by Matt Wood of http://goo.gl/JNyu1 blog of medicine from the University of Chicago. Matt has posted a series of great blog post recently about using social media. Doctors at the University of Chicago are clearly the leader in using social media in a city with a rich history of great medical centers as medicine UChicago, Northwestern, Childrens ' Memorial, Rush, Loyola and Northshore. Matt tries to discover what makes the UChicago doctors more comfortable using social media that their peers at other institutions: http://goo.gl/JNyu1

Consumers use social media for medical decisions

Consumer expectations for Social Media Healthcare – this is a brief summary by Ed Bennett, "a maker of lists" of using the oragnizations healtchare social media http://goo.gl/REXqV

Digital strategies for health care organizations-a good overview from the Australian http://goo.gl/PZtWl blog IV line

Salaries of doctors

Dr. Mandrola quotes a colleague experienced salaries of doctors: "we are all happy with what we do. What upsets us most is seeing what others are doing. " Since then, I try not to dwell on what others do. http://goo.gl/WBnJq

Health care social media is a "moral obligation" for physicians

Health care social media is a moral obligation, says Farris Timimi, M.D., Medical Director for the Mayo Clinic Center for Social Media, quoted by "Fierce health IT". Social media must be grown and nurtured for patients. "Our patients are there. Our moral obligation is to meet them where they are and give them the information they need so they can try to recover, "said Dr. Timimi. "You have to be ready for this. Builds for patients; not for themselves. "This is not marketing," he added. "This is the right thing to do" http://goo.gl/BHzKf

Social media is no longer a moral obligation for physicians rather than appear on TV and radio shows and write newspaper columns. It's nice if you have the time and the ability to do so, but the most important things is to focus on what matters most — providing the correct diagnosis and the best treatment possible for your patients.

Comment by Twitter:

Westby Fisher, MD @ doctorwes: Best of Medical Blogs-blog carnival week, RIP bit.ly/KsBSLJ

Laika (Jacqueline) @ laikas: after the demise of Grand Rounds @ DrVes begins its weekly blog review bit.ly/Iqgcmx Gr8 initiative; but still missing the old GR

WB Medical Education @ WBmeded: hope to control some of these last, looks interesting RT @ DrVes: Best of Blogs: weekly medical blog carnival, goo.gl/fb/d870P

Mike Cadogan @ sandnsurf: another great way to control your information overload with the Best of Blogs-weekly medical review bit.ly/K1stxo

 

Memory leak-clinical focus on practical Neurology

These are excerpts from a review in the Medical Journal of Australia (MJA):

Elderly with mild cognitive impairment are at increased risk of progression to dementia but no test is useful in evaluating this risk. Medications are not favorable in mild cognitive impairment.

Physical activity and treatment of high blood pressure decrease the risk of dementia.

In people with Alzheimer's disease, a cholinesterase inhibitor or Memantine (a receptor antagonist, N-methyl-D-aspartate) provides a symptomatic relief. Drugs do not change the progression of the disease.

Psychological and behavioral symptoms are common in Alzheimer's disease.

Atypical antipsychotics reduce agitation and psychosis, but increase the risk of cardiovascular events.

Role in the management of depression antidepressant with mild cognitive impairment is uncertain, but they may increase the risk of falls and delirium.

References:

Memory loss. Leon A Flicker, Andrew H Ford, Christopher D beer and Osvaldo p. Almeida Med J Aust 2012; 196 (2): 114-117.

Image source: hippocampus, from Wikipedia, in the public domain.

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How to have a successful blog-with a slow steady growth

Tips from ProBlogger about how to have a successful blog:

-Regular useful content: "how to" Daily Post that solved problems and showed people how to achieve their goals, the 90%

-Content shareable: inspirational post, breaking news, humour, controversy, great list seats, 5%

Community: reader discussions, debates, polls, forums, 5%

-Email newsletters: collect the email addresses of the people and send them weekly updates/newsletter

Here's a great quote from another blog: http://goo.gl/hCpF8 "Blogging is the teaching, whether it's for yourself or others and that is the best feeling in the world"

References:

2 Different stories Blog growth. ProBlogger.

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6 Reasons doctors Blog

Here are 6 reasons why doctors Blog, according to Dr. John m., a cardiologist and hands:

Here are the top six reasons why I and other doctors choose to author blogs:

1. The practice of medicine guides
2. to educate
3. mankind better
4. in order to give you a look behind the curtain
5. to store useful information
6. to view our humanity

My comment is here:

Thanks for the wonderful post and sharing insights, John.

Blogging "better mankind" is beyond reach for me, I think. However, I hope that my blog has helped "educate" at least some of the readers who perused more than 8 million pages from 2005 ...

Doctors are highly skilled experts which limit their impact only to patients they see – if they don't publish, give lessons-and blogs. In most cases, the benefits far outweigh the risks and doctors should be encouraged to make at least one attempt.

I tried to describe a practical approach and efficient in terms of time:

Social media in medicine: how to be a superstar by Twitter and help patients and your practice
http://casesblog.blogspot.com/2011/10/social-media-in-medicine-How-to-be.html

Blogging also keeps grounded and humble. Critical comments require to run your clinical opinion, expressed in a post on the blog, with solid scientific references, and that is a good thing.

Comment by Google Plus:

Gary Levin, January 22, 2012: Ves, I agree with all the above and welcome to g Let's meet sometime soon. Will send you an invitation ...

Sherri Vance, January 22, 2012: Dr. Ves, I love your blog. As regards the reasons why MDs should blog, I think the view behind the curtain (# 4) is the most important. Since our nation weighs a myriad of conflicting viewpoints as solving our health care system, an understanding of these issues from the point of view of the physician is vital. Thank you!

Carlos Caballero-Uribe, January 26, 2012: Excelllent. I'm sharing this post with my residents and students. We will discuss about it in a seminar. Many of # hscm centered on the commitment to patients and its ok but public engagement with your students and peers in a variety of ways that social media offers its very important

As a few examples of some of our use include:
Twitter for Club journal
Google more circles in discussions of clinical cases
Google Docs for editing documents
Slideshare for presentations of seminars
Below in the link on a post about it in my blog. Sorry its in Spanish but the translator helps.
Thanks for your post and example.

http://carvica1.blogspot.com/2011/12/como-podemos-usar-las-redes-sociales-en.html