- Clinical Dementia Rating scale (Level A)
- caregiver’s rating of a patient’s driving ability as marginal or unsafe (Level B)
- history of crashes or traffic citations (Level C)
- reduced driving mileage or self-reported situational avoidance (Level C)
- Mini-Mental State Examination scores of 24 or less (Level C)
- aggressive or impulsive personality characteristics (Level C)

Evaluation of driving risk in dementia (click to enlarge the image).

The following characteristics are not useful for identifying patients at increased risk for unsafe driving:

Walgreens Wound Closure Adhesive Strips: adhesive strips used to secure, close and support small cuts and wounds.

References:
Awake Endotracheal Intubation for Fun and Knowledge. Medgadget, 2010.

Takotsubo cardiomyopathy is characterised by acute, reversible left ventricular dysfunction in a distribution,which does not correlate with the coronary artery blood supply. The left ventricular dysfunction occurs without obstructive coronary artery disease (CAD) and usually resolves spontaneously over a period of weeks.

The characteristic appearances on contrast angiography include:

The overall pooled risk reduction was 19% (RR = 0.81), corresponding to 10% reduced CHD risk (RR = 0.90) for each 5% energy of increased PUFA.

These findings provide evidence that consuming PUFA in place of SFA reduces CHD events in RCTs. This suggests that rather than trying to lower PUFA consumption, a shift toward greater population PUFA consumption in place of SFA would significantly reduce rates of CHD.

These findings support the current treatment algorithm for hyperglycemia management that recommends metformin initiation when diabetes is first diagnosed.

Video: How the Body Works – The Pancreas.

References:

Patients aged 12 years and older who were already receiving the maximum tolerated dose of a lipid-lowering drug, were randomly assigned to mipomersen 200 mg subcutaneously every week or placebo for 26 weeks.

34 patients were assigned to mipomersen and 17 to placebo. Mean concentrations of LDL cholesterol at baseline were 11·4 mmol/L in the mipomersen group and 10·4 mmol/L in the placebo group. The mean percentage change in LDL cholesterol concentration was significantly greater with mipomersen (?24·7%) than with placebo (?3·3%).

The most common adverse events were injection-site reactions in 76% of patients in mipomersen group vs 24% in placebo group. 12% of patients in the mipomersen group had increases in alanine aminotransferase of three times or more the upper limit of normal.

Inhibition of apolipoprotein B synthesis by mipomersen represents a novel, effective therapy to reduce LDL cholesterol concentrations in patients with homozygous familial hypercholesterolaemia who are already receiving lipid-lowering drugs, including high-dose statins.

References:
Mipomersen, an apolipoprotein B synthesis inhibitor, for lowering of LDL cholesterol concentrations in patients with homozygous familial hypercholesterolaemia: a randomised, double-blind, placebo-controlled trial. The Lancet, Volume 375, Issue 9719, Pages 998 – 1006, 20 March 2010.

The non-invasive technology, developed by Chemical and Biochemical Engineering professor Jin Zhang at The University of Western Ontario, uses extremely small nanoparticles embedded into the hydrogel lenses. These engineered nanoparticles react with glucose molecules found in tears, causing a chemical reaction that changes their color.

References:
Nanocomposites could change diabetes treatment. The University of Western Ontario, 2010.

Preventing type 2 diabetes with low-dose combinations: Lifestyle interventions aimed at reducing bodyweight, and use of metformin, thiazolidinediones, acarbose, and orlistat, reduce the risk of diabetes by 25—60% over 3—6 years

The biological passport and doping in athletics: A biological passport monitors an athlete’s blood and body chemistry values over time to assess whether there has been a deviation from an established baseline, thus indirectly detecting illegal manipulation.

A long look at obesity: Even with their primitive understanding of nutrition, our neolithic forebears somehow made the “right choices”, thriving on a wholesome diet of nuts, seeds, and fruits with the occasional piece of meat. And what is more, their rare intake of animal protein could only have been obtained through vigorous exercise, which they would, of course, indulge in every day.

Acupuncture may be risky as needles are inserted up to several centimeters beneath the skin. In the 1970s and 1980s most infections associated with acupuncture were sporadic cases involving pyogenic bacteria.

There is a new syndrome – acupuncture mycobacteriosis – infection caused by mycobacteria that rapidly grow around the acupuncture insertion point as a result of contaminated cotton wool swabs, towels and hot-pack covers. There is a long incubation period and the infection usually leads to large abscesses and ulcers.

References:

Disclaimer: I was a Clinical Assistant Professor of Medicine at the Cleveland Clinic from 2005 to 2008.

2. Write questions down.

3. Make a list of all your medications.

4. Ask the office to check on your test results.

5. Confirm that the office has the correct insurance information.

6. Read something besides the magazines.

References:
6 things to do in a doctor’s waiting room. ConsumerReportsHealth.org.

Latisse is the same formula as Lumigan, Allergan’s eyedrops for glaucoma, which reduces eye pressure but also happens to grow lashes. Both are also known as bimatoprost ophthalmic solution. In early 2009, Allergan introduced the drug as a lash enhancer.

A former primary care doctor runs www.latisse.bz, which boasts that it is the “largest Latisse retailer.” All it takes to get Latisse mailed out — without ever seeing him — is filling out a medical history, which he reviews, and typing in a valid credit card number.

But if people use Latisse without seeing a doctor, the side effects may come as a big surprise.

Eyelid discoloration “may be reversible” according to the manufacturer. A rare side effect that has captured the most attention is the chance that one’s hazel or blue eyes could turn brown — forever.

Since 1997, rates of cigarette smoking have declined by several percentage points, rates of obesity have climbed, and rates of alcohol use, exercise, and sleep have remained relatively unchanged.

Men were more likely than women to be drinkers (68% vs. 55%).

The more educated people were, the more likely they were to drink. 74% of people who have a graduate degree were drinkers, compared with 44% of people with a high school diploma.

Adults with higher levels of education were less likely to be smokers, be physically inactive, and be obese and to sleep six hours or less per night.

Twitter comments:

@kcb704: “The more educated people were, the more likely they were to drink.” http://goo.gl/JDv1 // work hard, play hard..

@BrettLinda: Hold on… good or bad? RT @DrVes Good and Bad Health Habits in U.S.: drinkers outnumber exercisers http://goo.gl/JDv1

References:
Good and Bad Health Habits in U.S. WebMD.

“We’re probably forming microscopic cancers all the time in our body. Autopsy studies from people who died in car accidents have shown that about 40 percent of women between the ages of 40 and 50 actually have microscopic cancers in their breasts. About 50 percent of men in their 50s and 60s have microscopic prostate cancers. And virtually 100 percent of us, by the time we reach our 70s, will have microscopic cancers growing in our thyroid. Yet, without a blood supply, most of these cancers will never become dangerous. Dr. Judah Folkman, who was my mentor, and who was the pioneer of the angiogenesis field, once called this “cancer without disease.”

There is 8-10 percent increase in sun exposure for every thousand feet of elevation. In the summertime, you can get anywhere from 40 percent to 50 percent greater sun intensity than at sea level.

References:
Sunscreen with high SPF needed at high altitudes, Reuters.

Men with cardiovascular disease and ED were twice as likely to die from all causes than men who did not have erectile dysfunction. And those with ED were 1.6 times more likely to suffer from a serious cardiovascular problem such as a heart attack or stroke.

Erectile dysfunction is something that regularly should be addressed in the medical history of patients; it might be a symptom of early atherosclerosis.

Men with ED who are going to a general practitioner or a urologist need to be referred for a cardiology workup to determine existing cardiovascular disease and proper treatment. ED is an early predictor of cardiovascular disease.

References:
Study: Erectile dysfunction may indicate heart disease, death risk – CNN.com.

“How are you? Have you retired?”

The website includes:

- Webcasts
- Articles (full text) and Congress Reports
- Clinical Scenarios
- Expert Interviews
- Online Courses
- Ask the Expert section
- Surgical Video Library
- Teaching Slides
- Multimedia Animations
- Podcasts

This is the link to the Editorial Board of the website – most of the experts are from Europe but a large portion of the content is from U.S.-based conferences. The project is sponsored by Prous Science S.A.U., a part of Thomson Reuters.

The access to most of the resources requires free registration.

References:
Urology Podcast
Urology News
Urology online Courses

“Our favourite foods are making us fat, yet we can’t resist, because eating them is changing our minds as well as bodies

For example, KFC’s approach to battering its food results in “an optimised fat pick-up system”. With its flour, salt, MSG, maltodextrin, sugar, corn syrup and spice, the fried coating imparts flavour that touches on all three points of the compass while giving the consumer the perception of a bargain – a big plate of food at a good price.”

Over 1 year, the cognitive behavioural intervention had a sustained effect on troublesome subacute and chronic low-back pain at a low cost to the health-care provider.

References:

In each TIA cohort in this study, visit-to-visit variability in systolic blood pressure (SBP) was a strong predictor of subsequent stroke (eg, top-decile hazard ratio [HR] for SBP 6·22), independent of mean SBP.

Maximum SBP reached was also a strong predictor of stroke (HR 15).

Visit-to-visit variability in SBP on treatment was also a strong predictor of stroke and coronary events (top-decile HR for stroke: 3·25) independent of mean SBP.

Visit-to-visit variability in SBP and maximum SBP are strong predictors of stroke, independent of mean SBP. Increased residual variability in SBP in patients with treated hypertension is associated with a high risk of vascular events.

References: