Category Archives: Neurology

Obstetrics

Influenza vaccination with inactivated vaccine is recommended for pregnant women, regardless of the stage of pregnancy. The 2010-2011 influenza vaccine is trivalent and includes antigens from both the 2009 pandemic H1N1 influenza virus and seasonal influenza viruses.

Use of acetaminophen during pregnancy was associated with a reduction in neural tube defects, as well as cleft lip/palate and gastroschisis. These data support the safety of acetaminophen for relief of fever and pain.

Gynecology

Like CA 125, human epididymal secretory protein E4 (HE4) is a promising biomarker for ovarian cancer. In contrast to CA 125, HE4 levels do not appear to be elevated in women with endometriosis, and thus can be useful to rule out ovarian cancer in patients with endometriosis and a pelvic mass suspected to be an endometrioma.

Sterilization does not impact sexual function. Sexual function appears to be unchanged or improved in women following tubal sterilization.

Botulinum toxin may be useful for overactive bladder syndrome (onabotulinumtoxinA, Botox®). Detrusor injection of botulinum toxin (BoNT) had a transient effect. The average time between injections was 8 to 12 months.

References:
What's new in obstetrics and gynecology. UpToDate.

The beneficial role of statins in primary and secondary prevention of coronary heart disease has resulted in their frequent use in clinical practice.

However, safety concerns, especially regarding hepatotoxicity, have driven multiple trials, which have demonstrated the low incidence of statin-related hepatic adverse effects. The most commonly reported hepatic adverse effect is the phenomenon known as transaminitis, in which liver enzyme levels are elevated in the absence of proven hepatotoxicity.

"Ttransaminitis" is usually asymptomatic, reversible, and dose-related.

Lovastatin, a compound isolated from Aspergillus terreus, was the first statin to be marketed for lowering cholesterol. Image source: Wikipedia, public domain.

The increasing incidence of chronic liver diseases, including nonalcoholic fatty liver disease and hepatitis C, has created a new challenge when initiating statin treatment. These diseases result in abnormally high liver biochemistry values, discouraging statin use.

A PubMed/MEDLINE search of the literature (1994-2008) was performed for this Mayo Clinic Proceedings review. The review supports the use of statin treatment in patients with high cardiovascular risk whose elevated aminotransferase levels have no clinical relevance or are attributable to known stable chronic liver conditions.

References:
Statins in the Treatment of Dyslipidemia in the Presence of Elevated Liver Aminotransferase Levels: A Therapeutic Dilemma. Rossana M. Calderon, MD, Luigi X. Cubeddu, MD, Ronald B. Goldberg, MD and Eugene R. Schiff, MD. Mayo Clinic Proceedings April 2010 vol. 85 no. 4 349-356.

Materialistic youth seem to be languishing while grateful youth seem to be flourishing.

In this study, 1,000 high school students completed measures of materialism, gratitude, academic functioning, envy, depression, life satisfaction, social integration, and absorption.

Gratitude, controlling for materialism, predicted all outcomes considered: higher grade point average, life satisfaction, social integration, and absorption, as well as lower envy and depression.

In contrast, materialism, controlling for gratitude, uniquely predicts three of the six outcomes: lower grade point average, as well as higher envy and life satisfaction.

References:
Gratitude and the Reduced Costs of Materialism in Adolescents. Jeffrey J. Froh1 , Robert A. Emmons2, Noel A. Card3, Giacomo Bono4 and Jennifer A. Wilson1. Journal of Happiness Studies, 2010.
http://www.springerlink.com/content/21616624m5621673/

Comments from Twitter:

@drjohnm RT @DrVes: In Adolescents, Gratitude Leads to More Success Than Materialism >>It also much better for the heart.

About 7.5 million Americans suffer from psoriasis, a lifelong disorder characterized by inflammation of skin and, often, the joints.

Stelara, Remicade, and Enbrel are all biologics -- drugs made of genetically engineered proteins -- that are generally used to treat patients who aren't responding to traditional therapies such as light therapy and methotrexate.

Remicade and Enbrel both block tumor necrosis factor-alpha (TNF-alpha), a chemical produced by immune cells that fuels inflammation, much like gas on a fire. Stelara targets two proteins, interleukin 12 and interleukin 23, that also drive the inflammatory process.

References:
Study Shows Stelara and Remicade Are Both Effective if Enbrel Stops Working. WebMD, 2010.

He's sold over 150 million records, but Sir Tom Jones has confessed that he dreads the day that he can no longer sing.

The 70-year-old veteran -- whose latest album 'Praise and Blame' is a meditative collection of gospel and blues songs dealing with spirituality and mortality -- was speaking to CBS News when he revealed his fear.

"I dread the day. Time is my enemy. Time will catch up with me vocally. And I dread that,' he said. "I dread to think about life without singing because I can express myself, it's a great release, it's a wonderful feeling to get on stage and pour all this stuff out and for people to go, 'Yeah!'''

From the comments on the YouTube video:

catcando75: I grew up listening to this man who belted out a song like no other & always did it in skin tight pants! His voice was clear & crisp yet deep & raspy.? When you watched him you knew he loved every note because he wore it like a banner on his? face. He pushed tv limits without a pause, his charisma was strong. This is a man so in love with music he knows no boundaries...

References:
Tom Jones: Time Is My Enemy. CBS.
'Time is my enemy': Tom Jones confesses to US TV network CBS that he 'dreads' the thought of retirement. Daily Mail.

Head, Neck and Oral Cancer Examination

This 40-minute video is intended for practitioners of dentistry, medicine, nursing and public health who are responsible for diagnosing and referring patients with head and neck and oral cancer.

Emergency Medicine Ultrasound Simulation (U/SS) Case Scenario Package