Boxing and brain disease - Cleveland Clinic video

Boxing and Brain Health - a video from the Cleveland Clinic YouTube channel.

What are the 8 germiest places in the mall?

The 8 germiest places in the mall, according to CNN, are:

1. Restroom sinks
2. Food court tables
3. Escalator handrails
4. ATM keypads
5. Toy stores
6. Fitting rooms
7. Gadget shops
8. Makeup samples

The filthiest area in a restroom (and therefore in the whole mall) isn't the toilet handle or the doorknob - it's the sink. The sink area is a moist environment, so bacteria can survive longer there.

Researchers found food, E. coli, urine, mucus, feces, and blood on escalator handrails. Where there is mucus, you may also find cold and flu viruses.

Each key on an ATM contains, on average, 1,200 germs. Protect yourself: "Knuckle" ATM buttons.

How some hotels clean drinking glasses (video):



References:

The 8 germiest places in the mall. CNN.

12 Germiest Places in America According to Health Magazine

Beethoven's deafness and his three styles (video)

That Beethoven suffered from deafness is well known, but how did the progression of the condition affect his composition? In this 8-minute video the Isola string quartet demonstrate how his style changed over time:

Read about the science behind the video in the paper, Beethoven's deafness and his three styles, from BMJ.



Switch to lower notes

Details of Beethoven’s hearing loss can be derived from his own letters. His left ear was affected first, and he reported bilateral tinnitus, high tone hearing loss associated with poor speech discrimination, and recruitment with loud noises. After 1812 people had to shout to make themselves understood.

In 1818 Beethoven started to communicate through notebooks.

There are no reports that he could still understand spoken conversation after 1825, and his deafness was almost complete by then.

The symptoms suggest a sensorineural hearing loss with its origin in the organ of Corti.

The BMJ article claims that Beethoven's progressive deafness shaped his later musical style as he switched to lower notes as he had difficulty hearing higher ones.

Lead poisoning

The famous composer's health has been a focus of research in recent years. "Lead poisoning made Beethoven grumpy", summarized Chicago-Sun Times profoundly in 2005.

Asthma

In addition to a number of other chronic diseases, Beethoven apparently had asthma too. He is listed among the "Faces of Asthma", on the "Breath of Life" website maintained by the NLM.

References:

Beethoven’s deafness. BMJ 2011; 343 doi: 10.1136/bmj.d7589 (Published 20 December 2011). Cite this as: BMJ 2011;343:d7589
Noise Chart as It Relates to Hearing Damage and Hearing Loss http://goo.gl/tjZh1

Gambling disorders affect 0.2-5% of adults

Gambling opportunities have expanded around the world and consequently gambling disorders (pathological gambling and problem gambling) have received increased attention.

Gambling disorders affect 0.2-5.3% of adults. They are highly comorbid with other mental health and substance use disorders.

Several treatment approaches have been favorably evaluated:

- cognitive behavioral models
- brief treatment models
- pharmacological interventions

Although promising, family therapy and support from Gamblers Anonymous are less well empirically supported.

References:

Gambling disorders. The Lancet, Volume 378, Issue 9806, Pages 1874 - 1884, 26 November 2011.

Image source: United States one-dollar bill. Wikipedia, public domain.

4 medication classes linked to 67% of drug-related hospitalizations

Adverse drug events are important preventable causes of hospitalization in older adults.

4 medications linked to 67% of drug-related hospitalizations

Four medications or medication classes were implicated alone or in combination in 67% of hospitalizations:

- warfarin, 33%
- insulins, 14%
- oral antiplatelet agents, 13%
- oral hypoglycemic agents, 11%

High-risk medications were implicated in only 1.2% of hospitalizations.

50% of these hospitalizations were among adults 80 years of age or older. 65% of hospitalizations were due to unintentional overdoses.

Classification of adverse reactions to drugs: "SOAP III" mnemonic (click to enlarge the image):



Adverse drug reactions (ADRs) affect 10–20% of hospitalized patients and 25% of outpatients.

Rule of 10s in ADR:

10% of patients develop ADR
10% of these are due to allergy
10% of these lead to anaphylaxis
10% of these lead to death

Insulin is one of the top 10 high risk medications

Insulin has been identified as one of the top 10 high risk medicines worldwide. Errors are common - the first national audit in England and Wales showed prescribing errors in 19.5% of cases.

Not only are mistakes common, they often lead to harm - 3% of medication errors are related to insulin, but these errors were also twice as likely to cause harm as errors for other prescribed drugs.

Over 20 different types of insulin are in use, in various strengths and forms, and with a range of delivery devices, including insulin syringes (from vials), insulin pens (prefilled or reusable), or infusion pumps.

Top 10 most prescribed medications

According to a report from the IMS Institute for Healthcare Informatics, the top 10 most-prescribed drugs in the U.S. are:

- hydrocodone (combined with acetaminophen)
- simvastatin
- lisinopril
- levothyroxine
- amlodipine
- omeprazole
- azithromycin
- amoxicillin
- metformin
- hydrochlorothiazide

References:

Emergency Hospitalizations for Adverse Drug Events in Older Americans. Daniel S. Budnitz, M.D., M.P.H., Maribeth C. Lovegrove, M.P.H., Nadine Shehab, Pharm.D., M.P.H., and Chesley L. Richards, M.D., M.P.H. N Engl J Med 2011; 365:2002-2012, November 24, 2011.
Insulin is one of the top 10 high risk medications worldwide for prescription errors
Top 10 Most Prescribed Medications
Drug Allergy: Introduction and Epidemiology
Drug Allergy
Image source: Wikipedia, public domain.

Comments from Google Plus and Twitter:

Wendy Hemken - I noticed that opioids weren't on that list. All the talk seems to be about how deadly they are. Is this not the case?

Aaron Sparshott @IVLINE: An important one for #medstudents

Best Tweets - Selection of Twitter Favorites

The general point is this: "humans are biologically programmed for narrative." So tell stories, don't just publish papers.

— richard horton (@richardhorton1) February 14, 2012

Thanks to all who sent congrats on mother's 103 rd bray.Long way to go,I hope!

— Rupert Murdoch(@rupertmurdoch) February 15, 2012

It's my only free time RT @MrJaredBarnes: doesn't working out at night give you so much energy that you can't go to sleep?

— Anderson Cooper (@andersoncooper) February 15, 2012

Nothing like being on the Code Team to help put your life in perspective.

— Jonathan,DO,MS,NCC (@DrJonathan) February 13, 2012

Thanks for chatting @PracticalWisdom continued to be impressed how rich conversations in 140 character length can be!

— Farris Timimi, MD (@FarrisTimimi) February 13, 2012

Seven people offered to help me in five minutes when I asked for help here. I could write a book on how wonderful twitterville is.

— shel israel (@shelisrael) February 11, 2012

Watch a T-cell attack and kill a cancer cell. Beautiful and magnificent. bit.ly/wShGPY

— ben goldacre (@bengoldacre) February 12, 2012

The inclusion of a Twitter update (tweet) in Best Tweets - Selection of Twitter Favorites does not represent endorsement or agreement of any kind. If you are included in this post but you would like to have your tweet removed for any reason, please email me and will comply with your request the same day.

Running Marathons and Staying Injury Free - Mayo Clinic Video

Mayo Clinic Florida sports medicine physician Daniel Montero, M.D., provides tips on avoiding injuries while running in a marathon. He also addresses tips on:

- safely keeping up when running in large crowds
- staying hydrated
- dressing for weather conditions
- running the way you were trained to do

100-year-old doctor, still practicing, shares longevity secret: "Fall in love and get married"

Even though he recently turned 100, Dr. Engleman still sees arthritis patients regularly at the University of California San Francisco (UCSF). He has some rather unconventional longevity secrets to share:

"I think exercise is mostly overrated. And the use of vitamins, forget it. And I don't encourage a lot of doctors.

Fall in love and get married. Sex is to be encouraged. Children are a priority."

His two sons are physicians. His daugher, a lawyer, is a married to a doctor, and their son is a physician.

From NBC’s Nightly News:

Visit msnbc.com for breaking news, world news, and news about the economy

The extended 17-minute version of the report is embedded below:

Visit msnbc.com for breaking news, world news, and news about the economy

References:

100-year-old doctor still practicing at UCSF, shares unconventional longevity secrets

Comments from Twitter:

Mauna @MissMauna: How many times? RT @DrVes: 100-year-old doc, still practicing, shares longevity secret: "Fall in love and get married" goo.gl/fb/cw0ge

Jamie Carracher @JamieCa: That might be the hardest doctor's orders to follow of them all!

Michelle Kane @mishysmosh: I'm doomed.

Best Tweets - Selection of Twitter Favorites

Because of a tendency for hands to be near mouths, we recommend #glutenfree hand lotions for celiacs.

— Celiac Disease Ctr (@CureCeliac) February 7, 2012

Btw, is it usual for the receptionist to read out the blood results of a patient in front of the entire waiting room? The poor man!

— richard horton (@richardhorton1) February 7, 2012

When the receptionist read out the cholesterol and blood glucose, the man asked: "Are they normal?" To which she said "Probably."

— richard horton (@richardhorton1) February 7, 2012

Researching a topic is much easier than writing about it...

— Dr. Ronan Kavanagh (@RonanTKavanagh) February 7, 2012

A new paper looks to decipher the ailments tied to eating gluten. More importantly, there's a journal called "Gut" on.wsj.com/AorvDJ

— UChicago Medicine (@UChicagoMed) February 7, 2012

Just did my first #rheumatology Skype consultation with a patient of mine who's temporarily in middle east. Went very well. #rheum

— Dr. Ronan Kavanagh (@RonanTKavanagh) February 3, 2012

Pt just told me she has full faith in me because she has read my blog.

— Bongi (@Bongi1) February 3, 2012

Wow. Crazy pressure! RT @Bongi1: Pt just told me she has full faith in me because she has read my blog.

— GruntDoc (@gruntdoc) February 3, 2012

The inclusion of a Twitter update (tweet) in Best Tweets - Selection of Twitter Favorites does not represent endorsement or agreement of any kind. If you are included in this post but you would like to have your tweet removed for any reason, please email me and will comply with your request the same day.

Drug abuse is changing fast: Old drugs are falling from favor, new ones are growing

In recent years, hundreds of new drugs have appeared on the recreational drugs market in Europe and the U.S. New psychoactive substances, mainly stimulants and cannabinoids from China sold on the internet, proliferate too quickly for anyone to keep track of them. Websites such as Erowid.org create lists of those drugs.

It is all part of the rapid diversification of recreational drugs, fuelled by chemical ingenuity and by new distribution possibilities opened up by the internet.

New drugs of misuse, including ketamine, gamma-hydroxybutyrate (GHB), and a range of synthetic stimulants, have become part of global recreational drug culture. Use in combination with other substances (especially alcohol) is common and increases the associated health risks.

"A to Z" list of substances

"Talk to Frank" is a British government-funded website for drug abuse prevention and treatment tips for the general public available at http://talktofrank.com

The "A to Z" list of substances explains appearance and use, effects, chances of getting hooked, health risks and the UK law. It also includes information on peer pressure, etc.



References:

Drug use and abuse. The Economist, 2011.

New recreational drugs and the primary care approach to patients who use them. BMJ, 2012.

Comments from Facebook:

Pierrette Mimi Poinsett: And alcohol and tobacco remain the two most abused drugs eclipsing all the others combined.

Osteoarthritis at the base of the thumb has a 15-30% prevalence in adults

What is it?

Patients with osteoarthritis of the thumb carpometacarpal joint, or base of the thumb, commonly seek help for their symptoms. Arthritis at the base of the thumb causes functional disability and pain, particularly with “pinching” actions.


A hand with arthritic changes. Image source: Cicadas, a Creative Commons license.

How common is osteoarthritis of the thumb?

The prevalence of this condition increases with age and is greatest in postmenopausal women. It ranges between 15% prevalence in adults in Finland and a 33% prevalence in postmenopausal women. This is likely to increase as populations age and people stay active for longer.

How to diagnose it?

Pain reproduced on the axial grind test localizes pathology to the base of the thumb.

Trapeziometacarpal and scaphotrapeziotrapezoid joints should be assessed with plain radiographs (X-rays) that typically show degenerative changes. However, X-rays may underestimate the extent of the disease.

What to do?

Non-operative treatments can ameliorate symptoms and delay surgery in most patients with osteoarthritis of the thumb:

- behaviour modification
- pain relief
- splinting
- corticosteroid injections

No single operative procedure has been shown to be superior:

- simple trapeziectomy has the lowest complication rate
- arthrodesis may be the best option for patients who value pain relief and reliable strength and stability more than mobility (such as younger manual workers)

Piano lesson: "Rachmaninov had big hands". See how one gets 4 million views on YouTube:



References:

Osteoarthritis at the base of the thumb. BMJ, 2011.

Diagnosis of chronic kidney disease: When to refer to a nephrologist?

This is another recent review from Am Fam Physician:

Chronic kidney disease (CKD) affects 27 million adults in the U.S. It increases risk of cardiovascular disease and stroke.

Patients should be assessed annually to determine whether they are at increased risk of developing chronic kidney disease (CKD).

Risk factors for CKD include:

- diabetes mellitus
- hypertension
- older age
- cardiovascular disease
- family history of chronic kidney disease
- ethnic and racial minority status

Tests for CKD:

- Serum creatinine levels can be used to estimate the glomerular filtration rate (GFR)
- Spot urine testing can detect proteinuria

Staging of CKD is based on estimated glomerular filtration rate (GFR). Evaluation should focus on the specific type of CKD and identifying complications related to the disease stage.

When to refer to a nephrologist?

The patients with the following characteristics should be referred to a nephrologist:

- estimated glomerular filtration rates less than 30 mL per minute per 1.73 m2
- significant proteinuria
- rapid loss of kidney function

References:

Chronic Kidney Disease: Detection and Evaluation. Baumgarten M, Gehr T. Am Fam Physician. 2011 Nov 15;84(10):1138-1148.
Nephrology Cases