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CDC Works To Eradicate Polio Around The World By The End Of 2012

Men painting billboard for polio vaccination campaign

Polio is a crippling and potentially fatal infectious disease that is completely preventable. Since 1988, members of the Global Polio Eradication Initiative (GPEI), including CDC, the World Health Organization (WHO), Bill and Melinda Gates Foundation, Rotary, and UNICEF, have teamed up to eradicate polio world-wide through large scale vaccination efforts. Global polio cases are down more than 99% since GPEI began. We were able to completely eradicate the disease in the Americas by 1994 and protect our children. By 2006, polio was endemic in only four countries: Read more »

*This blog post was originally published at Public Health Matters Blog*

The Perils Of Fetal Sex Selection: Terminating Pregnancies Based On Baby’s Gender

What would you do if you discovered early in your pregnancy that you were pregnant with a girl when you wanted a boy? Would you terminate the pregnancy? With the advent of a new DNA test that can determine the sex of a fetus at 7 weeks gestation with a simple blood or urine test, fetal sex selection is now possible. However, before you proceed to pop the cork on your bottle of champagne, a word of precaution is warranted. The Chinese and India dilemmas present a global warning regarding the perils of fetal sex selection. Boys now outnumber girls in China and India and competition is fierce regarding finding a wife or a mate. According to the Chinese Academy of Social Sciences (CASS), by the year 2020, there will be between 30 to 40 million more boys than girls in China and the statistics in India are equally as alarming. In her book, Sobs In The Night, Xinran describes a scene where a baby girl is born and the father cries out, “Useless thing” and then the baby is dropped in a bucket and dies. This “son preference” is what has caused the unusually large amount of U.S. adoptions of baby Chinese girls.

Clinically, the gender of a baby is only important if Read more »

*This blog post was originally published at Dr. Linda Burke-Galloway*

Case Report: A Third Cerebellar Hemisphere?!

Improved visualization of the posterior fossa structures has led to an increased recognition of cerebellar malformations, including the Dandy-Walker malformation, Joubert syndrome, rhombencephalosynapsis, tectocerebellar dysrhaphia, and so forth. New anomalies continue to be discovered, highlighting the fact that cerebellar anomalies are poorly understood and have largely been ignored in the literature. We present a structural anomaly of the cerebellum, which we believe has not been previously reported.

A 16-month-old girl presented to the pediatric outpatient department with some delayed developmental milestones. She was full-term with a normal vaginal delivery and no history suggestive of perinatal asphyxia. The motor milestones were delayed, and the child could not stand. The other milestones, including language and socialization, were normal. Examination revealed a bony hard swelling in the occipital region, which, according to the mother, was noticed soon after birth. The occipitofrontal circumference was 52 cm, and the anterior fontanelle was open. There was generalized hypotonia, and the deep tendon reflexes were depressed. Mild truncal ataxia was observed, but there was no nystagmus. Read more »

*This blog post was originally published at AJNR Blog*

Cavernous Angiomas: Screening Of A Family Over Three Generations

Cavernous angiomas belong to a group of intracranial vascular malformations that are developmental malformations of the vascular bed. These congenital abnormal vascular connections frequently enlarge over time. The lesions can occur on a familial basis. Patients may be asymptomatic, although they often present with headaches, seizures, or small parenchymal hemorrhages.

In most patients, cavernous angiomas are solitary and asymptomatic. In recent times, increasing MRI has detected several such asymptomatic cases and has prompted a study into the genetics and natural history of this condition.

It is now known that cavernous angiomas have a genetic basis. Familial forms of cavernous angiomas are associated with a set of genes called CCM genes (cerebral cavernous angioma). This is a case report describing the phenotypic expression of a familial form of cavernous angioma.

CASE REPORT

A 54-year-old man was referred for an MRI of the brain with complaints of headache and seizures. A cranial CT scan revealed few hyperdense lesions. A subsequent cranial MRI scan revealed several lesions with features representing cavernous angiomas.

The patient was offered counseling and was treated conservatively. Genetic testing was not possible due to the high prohibitive cost. However, screening of the family members by MRI was recommended.

Cranial MRI of the immediate family members was performed. Four brothers of the patient and his mother were found to have multiple cavernous angiomas. The father, youngest brother, and his younger sister were found not to have any such lesion. Both children of the patient were also found to be free of these lesions. Incidentally, a meningioma was found in the father of the patient. Read more »

*This blog post was originally published at AJNR Blog*

Obesity: On The Rise In Developing Nations

Emerging economies must act immediately to halt rising obesity rates before the epidemic becomes as severe as it is in first-world countries, according to new report by the Organization for Economic Cooperation and Development (OECD).

The OECD report was published in the Lancet. It characterizes the prevalence of obesity in Brazil, China, India, Mexico, Russia and South Africa. Obesity rates were found to vary dramatically across these six countries. In Mexico, a stunning 70 percent of adults were reported to be overweight or obese. Nearly half of all Brazilians, Russians and South Africans fell into these categories. China and India had a lower prevalence of overweight and obesity, but were moving rapidly in the wrong direction, according to the OECD.

Developing nations don’t have enough resources to handle the health consequences of obesity, which include an increased risk of cardiac disease, stroke, cancer, diabetes, arthritis, and disability from all causes.

Read more »

*This blog post was originally published at Pizaazz*

Latest Interviews

How To Make Inpatient Medical Practice Fun Again: Try Locum Tenens Work

It s no secret that most physicians are unhappy with the way things are going in healthcare. Surveys report high levels of job dissatisfaction burn out and even suicide. In fact some believe that up to a third of the US physician work force is planning to leave the profession…

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Caring For Winter Olympians In Sochi: An Interview With Team USA’s Chief Medical Officer Dr. Gloria Beim

I am a huge fan of the winter Olympics partly because I grew up in Canada where most kids can ski and skate before they can run and partly because I used to participate in Downhill ski racing. Now that I m a rehab physician with a reconstructed knee I…

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Latest Cartoon

Richmond, VA – In an effort to simplify inpatient medical billing, one area hospitalist group has determined that “altered mental status” (ICD-9 780.97) is the most efficient code for use in any patient work up.

“When you enter a hospital, you’re bound to have some kind of mental status change,” said Dr. Fishbinder, co-partner of Area Hospitalists, PLLC. “Whether it’s confusion about where your room is located in relationship to the visitor’s parking structure, frustration with being woken up every hour or two to check your vital signs, or just plain old fatigue from being sick, you are not thinking as clearly as before you were admitted. And that’s all the justification we need to order anything from drug and toxin screens, to blood cultures, brain MRIs, tagged red blood cell nuclear scans, or cardiac Holter monitoring. There really is no limit to what we can pursue with our tests.”

Common causes of mental status changes in the elderly include medicine-induced cognitive side effects, disorientation due to disruption in daily routines, age-related memory impairment, and urinary tract infections.

“The urinalysis is not a very exciting medical test,” stated Dr. Fishbinder. “It doesn’t matter that it’s cheap, fast, and most likely to provide an explanation for strange behavior in hospitalized patients. It’s really not as elegant as the testing involved in a chronic anemia or metabolic encephalopathy work up. I keep it in my back pocket in case all other tests are negative, including brain MRIs and PET scans.”

Nursing staff at Richmond Medical Hospital report that efforts to inform hospitalists about foul smelling urine have generally fallen on deaf ears. “I have tried to tell the hospitalists about cloudy or bloody urine that I see in patients who are undergoing extensive work ups for mental status changes,” reports nurse Sandy Anderson. “But they insist that ‘all urine smells bad’ and it’s really more of a red herring.”

Another nurse reports that delay in diagnosing urinary tract infections (while patients are scheduled for brain MRIs, nuclear scans, and biopsies) can lead to worsening symptoms which accelerate and expand testing. “Some of my patients are transferred to the ICU during the altered mental status work up,” states nurse Anita Misra. “The doctors seem to be very excited about the additional technology available to them in the intensive care setting. Between the central line placement, arterial blood gasses, and vast array of IV fluid and medication options, urosepsis is really an excellent entré into a whole new level of care.”

“As far as medicine-induced mental status changes are concerned,” added Dr. Fishbinder, “We’ve never seen a single case in the past 10 years. Today’s patients are incredibly resilient and can tolerate mixes of opioids, anti-depressants, anti-histamines, and benzodiazepines without any difficulty. We know this because most patients have been prescribed these cocktails and have been taking them for years.”

Patient family members have expressed gratitude for Dr. Fishbinder’s diagnostic process, and report that they are very pleased that he is doing everything in his power to “get to the bottom” of why their loved one isn’t as sharp as they used to be.

“I thought my mom was acting strange ever since she started taking stronger pain medicine for her arthritis,” says Nelly Hurtong, the daughter of one of Dr. Fishbinder’s inpatients. “But now I see that there are deeper reasons for her ‘altered mental status’ thanks to the brain MRI that showed some mild generalized atrophy.”

Hospital administrators praise Dr. Fishbinder as one of their top physicians. “He will do whatever it takes to figure out the true cause of patients’ cognitive impairments.” Says CEO, Daniel Griffiths. “And not only is that good medicine, it is great for our Press Ganey scores and our bottom line.”

As for the nursing staff, Griffiths offered a less glowing review. “It’s unfortunate that our nurses seem preoccupied with urine testing and medication reconciliation. I think it might be time for us to mandate further training to help them appreciate more of the medical nuances inherent in quality patient care.”

Dr. Fishbinder is in the process of creating a half-day seminar on ‘altered mental status in the inpatient setting,’ offering CME credits to physicians who enroll. Richmond Medical Hospital intends to sponsor Dr. Fishbinder’s course, and franchise it to other hospitals in the state, and ultimately nationally.

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Click here for a musical take on over-testing.

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Latest Book Reviews

The Spirit Of The Place: Samuel Shem’s New Book May Depress You

When I was in medical school I read Samuel Shem s House Of God as a right of passage. At the time I found it to be a cynical yet eerily accurate portrayal of the underbelly of academic medicine. I gained comfort from its gallows humor and it made me…

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Eat To Save Your Life: Another Half-True Diet Book

I am hesitant to review diet books because they are so often a tangled mess of fact and fiction. Teasing out their truth from falsehood is about as exhausting as delousing a long-haired elementary school student. However after being approached by the authors’ PR agency with the promise of a…

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Unaccountable: A Book About The Underbelly Of Hospital Care

I met Dr. Marty Makary over lunch at Founding Farmers restaurant in DC about three years ago. We had an animated conversation about hospital safety the potential contribution of checklists to reducing medical errors and his upcoming book about the need for more transparency in the healthcare system. Marty was…

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