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Comment by parveen on July 11, 2011 at 5:28am

Acute Mental Status Changes in the Intensive Care Unit
Abnormalities of mental function
Conciousness:
Arousal (awake?)
Awareness (responsive?)

Cognition:
Orientation (accurate perception of experiences)
Judgment and Reasoning (ability to process data and generate meaningful information)
Memory (ability to store and retrieve information)

Etiology of depressed level of consciousness
Substrate deficiencies (glucose, thiamine)
Meningoencephalitis or Mental illness (malingering, psychogenic coma)
Alcohol or Accident (CVA)
Seizures
Hyper-capnia, -glycemia, -thyroid, -thermia OR Hypo-xia, -tension, -thyroid, -thermia
Electrolyte abnormalities (hyperNa, hypoNa, hyperCa) and Encephalopathies
Drugs

Septic Encephalopahthy
Can be caused by any infection aside from CNS infections
Early sign of sepsis
Advanced cases progress to multiple abscesses throughout brain matter
Similar biochemical changes to hepatic encephalopathy
Increased aromatic amino acids, decreased branched chain amino acids in plasma

Delirium
Most common mental disorder in the hospitalized geriatric patient
Up to 87% of elderly pts
As many as 75% are not recognized by the physician caring for the patient
Characterized by: acute mental status change and inattention and disorganized thought or altered level of consciousness -- Hallmark: acute onset and fluctuating clinical course
Most often drug related (40%) - but all other organic causes must be ruled out

Hypoactive delirium:
Characterized by lethargy rather than agitation
Most common form in the elderly

Dementia and Delerium:
Both have attention deficits and disordered thought
Dementia is not acute and is not fluctuating
75% of delirium in hospital is superimposed on dementia
Hospitalization can cause transient or permanent decompensation in the functioning of a patient with preexisting dementia

Important to differentiate Delirium from DTs
Delirium Tremens

Alcohol withdrawal
Do not use haldol (lowers seizure threshold)
Benzodiazepines are primary treatment
Clonidine (alpha-2-agonist) for associated hypertension (also eases withdrawal centrally) \

Valium: Onset 1-2 min, lasts as long as 12 hrs (active metabolite)
10/10/10 (q8 hrs x 3)
Ativan: Slow onset (5-15 min) and longest duration (10-20hrs)
Versed: Fast onset, short acting
Lipid soluble, prolonged sedation if used long term

View Presentation

Comment by ajay on June 13, 2011 at 2:46am

Currently ongoing Escherichia coli O104:H4 bacterial outbreak-Genomic sequencing by BGI Shenzhen confirm a 2001 finding that the O104:H4 serotype has some enteroaggregative E. coli (EAEC or EAggEC) properties, presumably acquired by horizontal gene transfer.

Comment by Dr.Indrajit Rana on June 11, 2011 at 10:59pm

The biochemical factors in the process of coagulation were largely discovered in the 20th century.

A first clue as to the actual complexity of the system of coagulation was the discovery of proaccelerin (initially and later called Factor V) by Paul Owren (1905–1990) in 1947. He also postulated its function to be the generation of accelerin (Factor VI), which later turned out to be the activated form of V (or Va); hence, VI is not now in active use.

Reference:Giangrande PL (2003). "Six characters in search of an author: the history of the nomenclature of coagulation factors". Br. J. Haematol. 121 (5): 703–12.

Comment by Dhiman rudro on June 7, 2011 at 2:03am

we know dt blood clotting factor (1 to13) bt 6th no. is absent.why?plz help me

Comment by Alex Snyder on June 7, 2011 at 1:14am

Human_Amniotic_Membrane_A_Versatile_Wound_Dressing%5B1%5D.pdf

Please take a look at the link above and let me know what you think.

Comment by parveen on May 29, 2011 at 9:22am

Androgen-Deprivation TherapyADT,

ADT, either by means of bilateral orchiectomy or the administration of a
gonadotropin-releasing hormone (GnRH) agonist or antagonist, is the mainstay of treatment for metastatic prostate cancer and for the recurrence of high-risk
“PSA only” disease.

What are the benefits of ADT for patients with recurrent or metastatic prostate
cancer?

ADT is associated with an objective response rate of greater than 80% and a response duration of approximately 2 years. Long-term neoadjuvant treatment with a GnRH
agonist improves the rates of disease-free and overall survival in men receiving
external-beam radiation therapy for locally advanced or high-risk nonmetastatic
prostate cancer. Adjuvant therapy with a GnRH agonist also improves the survival rate in men with node-positive disease after prostatectomy.

When should ADT be initiated?

In a systematic review of immediate ADT versus
ADT that was deferred until clinical progression for men with locally advanced
or metastatic prostate cancer, early ADT was associated with greater 10-year
rates of overall survival. The estimated number needed to treat to prevent one
death at 10 years was approximately 25.

What are the adverse effects of androgen-deprivation therapy?
ADT has a variety of adverse effects related to hypogonadism, including
loss of libido, vasomotor flushing, fatigue, anemia, and osteoporosis. ADT also
is associated with a variety of adverse metabolic effects. ADT decreases muscle
mass (by approximately 3% during the first year of treatment) and increases fat
mass (by approximately 10% during the first year of treatment). ADT increases
fasting plasma insulin levels and decreases insulin sensitivity. ADT also
increases the levels of serum triglycerides, low-density lipoprotein
cholesterol, and high-density lipoprotein cholesterol. Consistent with these
adverse metabolic effects, ADT has been linked to increased risks of diabetes
and cardiovascular disease.

Which patients receiving ADT should receive antiresorptive
therapy?
In patients with T scores above –2.5 and no history of osteoporotic
fractures, many experts would recommend treatment with calcium and vitamin D and then assess the fracture risk with the Fracture Risk Assessment Tool (FRAX) to decide whether to add an antiresorptive agent. Most current guidelines recommend antiresorptive therapy if the 10-year risks for major osteoporotic fracture and hip fracture exceed 20% and 3%, respectively.

Comment by parveen on May 29, 2011 at 9:12am

Borderline Personality Disorder

BPD is present in about 6% of primary care patients and persons in
community-based samples and in 15 to 20% of patients in psychiatric hospitals
and outpatient clinics. In clinical settings, about 75% of persons with the
disorder are women, although this percentage is lower in community-based
samples.

How can BPD be recognized?

Recurrent suicidal threats or acts in combination with
fears of abandonment are by themselves strongly indicative of the diagnosis.
The most distinctive characteristics of patients with BPD are their
hypersensitivity to rejection and their fearful preoccupation with expected
abandonment.

What is the prognosis for patients with BPD?

While BPD has long been considered a chronic and
largely untreatable disorder, more recent data indicate a high remission rate
(about 45% by 2 years and 85% by 10 years), as defined by meeting fewer than
two criteria for at least 12 months, and a low relapse rate (about 15%). In
other respects, however, the prognosis remains discouraging. The suicide rate
is about 8 to 10%, with a particularly high proportion of young women.
Moreover, even after remission, most patients with BPD have severe functional
impairment, with only about 25% of patients with full-time employment and about
40% receiving disability payments after 10 years.

What is the primarymethod for treating BPD? Psychotherapy is the primary method for treating BPD.
Randomized trials involving patients with BPD support the efficacy of several
forms of psychotherapy. The best studied of these methods is dialectical behaviour therapy.

Is there a role forpharmacotherapy for patients with BPD? Selective serotonin-reuptake inhibitors and other antidepressants are
frequently prescribed to patients with BPD, but in randomized trials such drugs
have little if any benefit over placebo. In such trials, benefits for patients
with BPD have been shown for atypical antipsychotic agents (e.g., olanzapine)
and mood stabilizers (e.g., lamotrigine), particularly for reducing impulsivity
and aggression. However, these effects are typically modest, and side effects
are common.

Comment by Dr.Indrajit Rana on May 28, 2011 at 4:47pm

FDA Approves Molecular Test For Hepatitis C

Comment by S.UMA DEVI on May 26, 2011 at 12:37am

10 incredible gadgets continued

6) Unified Communications

Though cell phones are pretty much ubiquitous in society and smartphones have proliferated in hospitals, far too many clinicians haven't been able to ditch the old-fashioned pager. But some companies are trying to eliminate the need for multiple devices by promoting what they call unified communications.

For years, Vocera has offered wireless voice-over-Internet protocol (VoIP) phones that send paging, voice, and text messages to portable handsets within a hospital or clinic. So you can get a portable handset that will still page you but also provide other services, including voice and text messages. In the past couple of years, a Sarasota, Florida-based startup called Voalte (pronounced "volt") has packaged similar technology to run on the user's own smartphone, with a single phone number for all communications.

7) Remote Medical Devices and Functions via Smartphone

Some software developers have seized the power of the Apple iOS (iPhone) and Google Android operating systems to design apps that effectively turn smartphones into low-cost medical devices, helping to create a new category of mobile diagnostics.

In June 2010, the FDA cleared DiabetesManager from Baltimore-based WellDoc, a blood glucose measuring system that links to a mobile phone app so patients with type 2 diabetes can collect, track, and share readings with health professionals and learn how to better manage their conditions. Three months later, AgaMatrix of Salem, New Hampshire, won premarket approval for its WaveSense Diabetes app for the iPhone that analyzes data from the device maker's Jazz glucose monitor.

Researchers at the California Institute of Technology have even created a lens-free microscope using a $1.50 digital camera sensor that connects to a smartphone to help remote health workers diagnose malaria in developing countries.

Others have created apps that mimic the functionality of a stethoscope by listening to the heartbeat through a smartphone's microphone, but that approach doesn't work for everyone, according to Husain.

"People should be careful when using applications like that," says Husain. "There is a whole host of variables where you can't use that." For example, Husain says it is difficult to get an accurate reading on overweight patients without an external stethoscope attachment.

8) Automated Medication Adherence

"Smart" pill bottles can emit light and sound when it's time to take a pill and send automatic alerts to caregivers if the patient skips a dose. That gives physicians a new way to monitor medication adherence in populations with chronic disease. Automated text messages can serve a similar function. This is such a promising area that biotechnology billionaire Patrick Soon-Shiong, MD, recently purchased Vitality, maker of the GlowCap wireless Internet-connected medication bottlecap.

9) Electronic Reference Tools and Calculators

Mobile medical reference apps, including Medscape's, have been around for years, but they're becoming more timely and functional. In April, Canadian mobile software vendor QxMD apparently made history by releasing an update to its Calculate by QxMD app to incorporate new scientific knowledge about the risk for renal failure and the need for dialysis in patients with chronic kidney disease at the same time a Tufts Medical Center researcher publicly presented the evidence.

Husain is a fan of a free medical translator called MediBabble. "This is a terrific app," he says, noting that it's particularly useful in international disaster relief. MediBabble is a history-taking and examination application designed to improve the safety and efficiency of care for non-English-speaking patients

10) Social Networking

Facebook has captured the imagination of the world, claiming 500 million active users, half of whom log in on any given day. You can be sure that plenty of physicians are among those masses. But where do you go when you want to discuss medicine or simply connect with other doctors?

LinkedIn, a business-focused networking site, has at least 100 million users worldwide, but there are several social and professional networking sites just for healthcare professionals, some of which offer secure communications suitable for colleagues who already know each other to discuss specific cases. (Medscape's discussion boards are popular landing spots for physicians).

For patients, there's an emerging field called participatory medicine. A group called the Society for Participatory Medicine defines it as "a cooperative model of healthcare that encourages and expects active involvement by all connected parties (patients, caregivers, healthcare professionals, etc.) as integral to the full continuum of care." Patients facing serious health challenges have been flocking to sites such as Organized Wisdom and PatientsLikeMe

Comment by S.UMA DEVI on May 26, 2011 at 12:32am

10 incredible gadgets continued

3) Speech Recognition Programs

Iltifat Husain, MD, Editor-in-Chief and founder of the iMedicalApps.com blog and a new graduate of Wake Forest University School of Medicine, is bullish on speech recognition as a breakthrough technology that makes physicians' lives easier. "I think that doesn't get enough play," he says. It's already easing the transition to electronic medical records (EMRs) by helping physicians document cases and changing medical transcriptionists into higher-skilled editors. Husain says he is looking forward to the day that Nuance Communications comes out with a version of Dragon Medical speech recognition software that supports real-time voice dictation on mobile phones.

"The beauty of real-time mobile speech recognition is that the physician no longer needs a keyboard," Husain says. He notes that one company, DrChrono, already makes an EMR specifically for the iPad that includes real-time mobile dictation.

) Handheld Ultrasound Stethoscope

Goodbye to what has been the symbol of physician care for almost 200 years.

"In 2016, doctors aren't going to be walking around with stethoscopes," cardiologist Eric Topol, MD, Director of the Scripps Translational Science Institute, Chief Medical Officer of the West Wireless Health Institute in La Jolla, California, and Chief Academic Officer at Scripps Health in San Diego, said at the Consumer Electronics Show in Las Vegas. "There’s a whole lot better technology coming."

Topol called the handheld ultrasound the "new stethoscope," something that will become a must-have device for physicians. In 2009, GE Healthcare introduced the Vscan, an ultrasound visualization device that looks like an oversized cell phone with an attached scanning probe.

The Vscan costs about $8000, but that price is expected to come down as the technology improves. Another company, privately held Mobisante, this year gained US Food and Drug Administration (FDA) 510(k) clearance for a similarly priced ultrasound system that runs on a Windows-based Toshiba smartphone.

5) Smart Bandage

The Holter monitor is also on its way out. Topol has called it, "another obsolete technology, soon to be buried." It just contains too many wires and is uncomfortable to wear. Instead, Topol said, patients with serious chronic ailments such as congestive heart failure ought to be wearing a "smart bandage," an adhesive patch containing an array of sensors that measure vital signs.

It's a technology that patients can even take home with them. Wireless transmitters in the bandage send readings either to a patient's smartphone or an Internet gateway such as an in-home wireless router, creating what's known as a "body-area network" that keeps constant tabs on people who might otherwise require hospitalization

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