Tuesday, December 27, 2011

Low SDNN helps determine who needs angiography

According to the cut-off values calculated using ROC analysis, SDNN ≤69.63 msec, TO > 0.14%, and TS ≤2.78 msec/RR have high diagnostic accuracy for predicting obstructive coronary artery disease.


Heart rate variability and turbulence to determine true coronary artery disease in patients with ST segment depressionwithout angina during exercise stress testing.

Celik A, Ozturk A, Ozbek K, Kadi H, Koc F, Ceyhan K, Erkorkmaz U.

Clin Invest Med. 2011 Dec 1;34(6):E349.

Abstract

Purpose: ST segment depression without angina during an exercise stress test causes diagnostic problems, particularly in non-diabetic patients.Heart rate variability (HRV) and heart rate turbulence (HRT) are used to evaluate the changes in cardiac autonomic functions and are also both decreased in patients with coronary artery disease. The aim of this study was determine the values of HRV and HRT that discriminate true coronaryartery disease from false positive stress test results. Methods: Ninety non-diabetic patients who underwent diagnostic coronary angiography (CA) due to suspected coronary artery disease after ST segment depression without angina during an exercise stress test were enrolled in the study. Prior to CA, 24 hour ambulatory electrocardiogram recordings were taken and HRV and HRT parameters were calculated. Results: Patients were divided into three groups according to the severity of their coronary lesions: (group 1 normal, group 2 non-obstructive and group 3 obstructive. There were no differences among the groups with regards to age, sex, medical history, medications, systolic and diastolic blood pressures, body mass index, fasting glucose, anemia and thyroid status, lipid profile and creatinine clearance. HRV parameters and turbulence slope (TS) were significantly lower while turbulence onset (TO) was significantly higher in group 3 than groups 1 and 2. According to the cut-off values calculated using ROC analysis, SDNN≤69.63 msec, TO > 0.14%, and TS≤2.78 msec/RR have high diagnostic accuracy for predicting obstructive coronary artery disease. Conclusion: HRV and HRT parameters may provide additional information for discriminating between patients who do and do not truly need CA.

PMID:
22129925
[PubMed - in process]

Monday, December 26, 2011

Christmas 2011

Here is our Out of the Box Holiday Gift to you. The pictures are from Christmas Day. The other links are to articles written about Christmas 2011.

Christmas 2011 Pictures

A Christmas Poem

Out of the Box Holiday Gifts

Keeping Your Heart Healthy During the Holidays

Friday, December 16, 2011

Wednesday, December 14, 2011

Tuesday, December 13, 2011

BISPHOSPHONATES INCREASE JOINT REPLACEMENT SURVIVAL

bisphosphonate appears to be helpful after joint replacement surgery, nearly doubling the time to revision surgery when repeat surgery is necessary. Further studies are required for confirmation before widespread use is recommended.




BISPHOSPHONATES INCREASE JOINT REPLACEMENT SURVIVAL : Tom Heston MD : Free Download & Streaming : Internet Archive
Bisphosphonates increase joint replacement survival http://ping.fm/0AID1

Bisphosphonates Increase Joint Replacement Survival


BACKGROUND: In the United Kingdom in 2009, there were 71,527 total primary arthroplasties of the knee and 64,772 of the hip, which is an overall rate of just over 2 knee or hip replacement surgeries per 1000 population. Revision surgery isn't nearly as effective as primary joint replacement surgery of the hip or knee, and therefore it is important to work to improve the success rates of primary surgery. Bisphosphonates are pharmaceuticals commonly used for osteoporosis, and are theorized to be helpful in the post-op management after hip or knee replacement surgery (arthroplasties). The antiresorptive properties on osteoclast activity that bisphosphonates have potentially could increase bone strength and healing after joint replacement surgery.

METHODS: A study looking at the use of bisphosphonate usage in people in the U.K. undergoing knee or hip replacement therapy was recently published in the British Medical Journal. The primary outcome looked at was implant survival time. They identified over 40,000 people with primary total arthroplasty of the hip or knee and tracked the clinical outcomes.

RESULTS: After 5 years, just over 1% of the patients required revision surgery. Patients taking bisphosphonates had about half the rate of revision surgery. To prevent one revision surgery, the researchers estimated that just over 100 patients would have to take bisphosphonates to avoid one revision at five years. The time to revision surgery was found to be about twice as long in patients taking bisphosphonates.

CONCLUSIONS: bisphosphonate appears to be helpful after joint replacement surgery, nearly doubling the time to revision surgery when repeat surgery is necessary. Further studies are required for confirmation before widespread use is recommended.

COMMENT: A primary question raised by this research is whether or not it is worth it for 100 people to take a pharmaceutical for 5 years in order to avoid one revision surgery. The side-effects from 500 person-years of taking bisphosphonates was not fully addressed in this article. I suspect that ultimately bisphosphonate therapy will prove beneficial as they also appear to be useful in the treatment of osteoporosis, which affects many people who require joint replacement surgery.

REFERENCE

Association between bisphosphonate use and implant survival after primary total arthroplasty of the knee or hip: population based retrospective cohort study. Prieto-Alhambra D, Javaid MK, Judge A, Murray D, Carr A, Cooper C, Arden NK. BMJ. 2011 Dec 6;343:d7222. doi: 10.1136/bmj.d7222.

Treatment of Osteoarthritic Change in the Hip: Joint Preservation or Joint Replacement? Sofue M, Endo N (Eds). Springer; 1 edition (January 12, 2007).

COPYRIGHT: CC0 1.0 Universal

Monday, December 12, 2011

Latest Updates on the Evaluation of Suspected Dementia http://ping.fm/14v0T

Latest Updates on the Evaluation of Suspected Dementia

The percentage of Americans older than 65 years of age is likely to double over the next decade, from just over 10% currently to 20% in 2020. The primary cause of dementia is Alzheimer's disease which is responsible for 70% of all cases of dementia. Other major causes are vascular dementia (17%), Lewy Body disease, Parkinson-related dementia, and frontal lobe dementia. The good news is that people are living longer, however, one of the side-effects is a greater number of people with dementia. Fortunately new research and diagnostic technology has enabled earlier detection of cognitive dysfunction and better treatment.

For people with suspected dementia or early cognitive decline, the medical workup is initiated with obtaining a history from family members or care givers since the person with the condition is likely to be unable to give an accurate history. Important considerations in the differential diagnosis of dementia are depression, substance abuse (primarily alcohol), medication side-effects, nutritional deficiency, and hypothyroidism.

Screening tests can be performed in the clinic, and at least one should be done during the initial visit. These tests are the verbal fluency test, the mini-cognitive assessment, and the Sweet 16. The most sensitive and specific test is the verbal fluency test. Ask the patient to name as many animals as possible in 1 minute. A score of less than 15 is suggestive of dementia. In people with 7 years of education or less, the cut-off score may need to be lowered to 12 or even 9 for people with no education.

In people who test positive, further testing is initiated and includes the mini-mental status exam and clock drawing test. A formal test for depression such as the geriatric depression scale should also be done. Helpful laboratory tests include a metabolic panel, folate and B-12 levels, TSH, CBC, and calcium. An MRI (or CT) of the brain is helpful, and FDG PET scanning can improve management in some cases. Also consider an HIV test, Lyme titer, rapid plasma reagin test (for syphilis) or cerebrospinal fluid analysis in appropriate patients.

Management is directed at the underlying cause. Acetylcholinesterase inhibitors such as donepezil may help slow down the progression of Alzheimer's Disease. Antihypertensives and other cardiovascular agents may help delay the progression of vascular dementia. Depression is very common in the elderly and pharmaceutical therapy can be effective for these patients.

REFERENCES

Evaluation of suspected dementia. Simmons BB, Hartmann B, Dejoseph D. Am Fam Physician. 2011 Oct 15;84(8):895-902. Review.

Pharmacologic treatment of Alzheimer's disease: an update. DeLaGarza VW. Am Fam Physician. 2003 Oct 1;68(7):1365-72. Review.

The 36-Hour Day
. Mace NL and Rabins PV [2006].

Sunday, December 11, 2011

Internet Psychose http://ping.fm/2vqyR
Internet psicosi http://ping.fm/vnS52
La psychose Internet http://ping.fm/2T2xE

La psychose Internet

L'absence de repères sociaux au cours de réseautage en ligne peuvent entraîner un stress émotionnel sévère par les perceptions erronées

Communication médiatisée par ordinateur (CMC) a connu une croissance explosive au cours des deux dernières décennies, puisque le projet World Wide Web dirigé par Tim Berners-Lee au CERN devenir un service accessible au public sur Internet. Cette méthode relativement nouvelle d'interagir avec d'autres, CMC, a l'effet unique de dépouillant de nombreux signaux sociaux que nous normalement ramasser quand parlant avec une personne directement. Cela peut créer des malentendus, malentendus, des erreurs de jugement, et dans les cas extrêmes, le développement de problèmes mentaux comme la psychose Internet.

La psychose sur Internet semble se développer quand une personne développe une relation en ligne hyper-personnelle. La personne souffrant de la condition de se méprend fréquemment les intentions de la personne avec qui elles communiquent en ligne et brouiller les frontières personnelles. Les personnes ayant peu d'expérience dans la CMC apparaissent plus vulnérables au développement de la psychose médiatisée Internet.

La psychose Internet comme une condition de diagnostic n'est pas encore assez bien définies pour l'inclusion dans le Manuel diagnostique et statistique des troubles mentaux, cependant, les principes sous-jacents sont forts. CMC, en raison de sa nature impersonnelle, peut créer des malentendus et des grandes attentes déçues. Cela peut entraîner un conflit psychologique et l'angoisse, et a souligné l'esprit des personnes vulnérables pourrait entraîner un point de basculement de la santé mentale normale à des problèmes psychologiques.

Trouble de dépendance à Internet semble être une manifestation de la personnalité addictive avec l'objet de leur dépendance étant l'Internet. Chez ces individus, il n'ya pas de rupture psychologique avec la réalité, mais plutôt une compulsion à utiliser l'Internet existe. Internet à partir d'une psychose CMC, cependant, est différente. Une personne avec une psychose a un tel trouble grave dans la pensée ou l'émotion qu'ils perdent contact avec la réalité. Ils peuvent avoir des hallucinations et voit des choses ou entendre des choses qui ne sont pas présents dans la réalité. Ceci est une condition mentale grave, et si il est possible de prévenir la psychose, alors il doit être fait. Dans le cas de la psychose sur Internet, la psychose semble être provoquée par ou encouragés par les perceptions erronées répétées et majeure de la communication médiatisée par ordinateur dans les salles de chat, réseaux sociaux, messagerie, etc. Si ces s'avèrent conformes déclenche des psychoses Internet, il est possible que cela pourrait être évitable chez certains individus par l'éducation. Peut-être si de nouvelles personnes à l'Internet en apprendre davantage sur ses limites inhérentes dans les communications interpersonnelles, des attentes réalistes seront en place quand on commence à s'engager dans la communication sociale en ligne.

RÉFÉRENCES

Liées à Internet psychose. un signe des temps. Nitzan U, E Shoshan, Lev-Ran S, S. Fennig Isr J Psychiatry Relat Sci. 2011; 48 (3) :207-11.

La psychologie sociocognitive des communication médiatisée par ordinateur: le présent et l'avenir de la technologie basée sur les interactions. Riva G. Cyberpsychol Behav. 2002 Dec; 5 (6) :581-98.

Internet Psicosis http://ping.fm/5HcVK

Saturday, December 10, 2011

Common Causes of a Cough http://ping.fm/0InED

Common Causes of a Cough

Having a cough is a common physical complaint that causes people to go see the doctor. The cause of an acute cough starting within the last few days is usually diagnosed by clinical assessment. Chronic coughs, lasting several weeks and longer, however, can be challenging to determine the exact cause. Usually a chronic cough is a benign condition, however, it also can be due to advanced and severe disease.


The acute cough is typical in the winter with the onset of flu season. It also is common when there is a high allergen load in the air, such as in the spring or with the buildup of smog. The most common reason for these coughs is an inflammatory process such as acute bronchitis, upper respiratory infection, or asthma. Even a runny nose with post-nasal drip can cause the common cough. In some small children, and in the debilitated, an aspirated foreign body such as a toy or a coin should be considered as well.

Chronic coughs are more difficult to diagnosis because of the wide variety of possible underlying etiologies. Of most concern is a lung malignancy or a heart condition. Sometimes the chronic cough can also indicate pneumonia. This is true especially in the elderly, who may on occasion fail to run a fever in response to pneumonia. Asthma is a common cause of a chronic cough as well. Underlying cardiac conditions such as heart failure may also be the etiology of a chronic cough.

Thankfully, many of the conditions causing a cough, especially in those 45 years of age or younger, are self-limited viral infections. In these cases, time is often the cure and no pharmaceutical therapy is necessary.

At the same time, some of the severe diseases that cause a chronic cough can be completely cured with proper medical therapy. In other cases, the disease can be managed in a way that extends a person's healthy life span. Lung cancer, when caught early, can be cut out before it spreads to any other organ, and the result is a cure. Heart disease also frequently can be successfully treated, often with simple pharmaceuticals and lifestyle changes.

Keep in mind, a chronic cough can be a side-effect of something in the diet or in a pill. Some heart disease medications are particularly prone to cause a chronic cough. But if that happens almost always there is an alternative medication that will not have that side effect.

The best treatment for a chronic cough? Prevention. Eat right, exercise, and enjoy life. But if you get a cough, use some common sense and see a doctor if you have any concerns at all.

REFERENCES

Ponka D, Kirlew M. Top 10 differential diagnoses in family medicine: Cough. Can Fam Physician. 2007 April; 53(4): 690-691. This is a nice article on the common causes of a cough and how to diagnose them. Full text free online.

Redington AE, Morice AH. Acute and Chronic Cough (Lung Biology in Health and Disease) . Informa Healthcare; 1 edition (July 13, 2005). For the medical professional.

Domino FJ et al. The 5-Minute Clinical Consult 2012 . This is a top guide for primary care providers, and useful for any physician's reference shelf. Highly recommended.

Thursday, December 8, 2011

Tuesday, December 6, 2011

Out of the Box Holiday Gifts: Tips for Healthy Holiday Giving http://ping.fm/fXah8
Out of the Box Holiday Gifts: 5 Tips for Financial Success http://ping.fm/dbMCG
Out of the Box Holiday Gifts: 5 Tips for Charity http://ping.fm/WOagC
Out of the Box Holiday Gifts: 5 Tips for the Brain http://ping.fm/Tqx1N
Out of the Box Holiday Gifts: 5 Tips for the Health Nut http://ping.fm/HWE1q
Out of the Box Holiday Gifts: 5 Tips for the Techno Nerd http://ping.fm/zjYWG
Risk of Bleeding After Heart Attack http://ping.fm/WJA0m
What to Do If Metformin Monotherapy Doesn't Work http://ping.fm/yQTio
Safety of Home Births http://ping.fm/rln1q
Unintentional Disclosure on Facebook by Professional School Students - Yahoo! Voices - voices.yahoo.com http://ping.fm/EWH2K

Out of the Box Holiday Gifts: 5 Tips for Charity

Charitable giving demonstrates your compassion and enthusiasm for a good cause. During holiday gift exchanges, this compassion and enthusiasm can be shared with your family and friends. Incorporating charitable giving in your out of the box holiday gift giving can give special meaning and importance to the meaning of the season. When you give an out of the box gift, you cannot use a cardboard box or wrapping paper. Anything material at all is not allowed. With that in mind, here are some ideas on how you can share a charitable gift as part of your gift exchange this year.

1. Donate your time to a local charitable group, together with your gift recipient. This charitable gift helps out a local charity, as well as provide you and your friend some quality time together.

2. Give money to a charitable group and have them recognize person you are giving the gift to, in stead of recognizing you. If you give a really big gift, they might name something after your gift recipient. If you give a small amount, the charity may be willing to write a thank you note directly to the gift recipient. Talk to your friend about the charity, why you feel it is so important, and why you donated in their name.

3. Give a monthly donation to a charity in the name of the gift recipient. Often, charities that are setup to accept gifts in this manner will send monthly updates of their charitable work, sometimes individualized update but more often a regular newsletter. Have the charity send the newsletter to the person you are exchanging gifts with, but leave your name as the person to contact for a subscription next year.

4. Spend time with the person you are exchanging gifts with, and identify a charity that they are really interested in. A good place to start your research is Charity Navigator which provides are large listing of charities and some important information about what they do.

5. Make up your own charity with your friend. Together you can help an elderly or disabled person in your neighborhood do some yard work, or shovel some snow. It could even be a relative. Or perhaps you could, without any advance notice, cook up a casserole for a neighbor that is recovering from an illness. The important things to remember are to do the charitable work with your gift recipient, and deliver it together.

These simple ideas can help you include charitable giving as an out of the box holiday gift. It is important to try your best to tailor the gift and make it uniquely special to the gift recipient. You will share with them your passion while together sharing in the spirit of the season.

Out of the Box Holiday Gifts: 5 Tips for Financial Success

Some years, when it is time to give gifts, it is also time to maximize your savings. That's just the nature of up and down cycles. So when you want to save financially but still participate in gift exchanges, why not give some out of the box gifts? These sometimes involve no money, or can save you a lot of money when you do make a purchase. The principle is to give thoughtful gestures. These gestures can take on the form of one-on-one or digital interactions. The key is to make the gift unique and well suited to the recipient.

1. Save money by giving a free electronic book as a thoughtful, and meaningful gift. You can read it together, then blog about it online later. Select a title that is either uniquely funny or uniquely fitting for the recipient.

2. You can also use your money wisely by giving it directly as a gift. Money can be sent digitally from one person to another quickly and easily. This way you both benefit. Your recipient gets the money, and you are able to at least keep your money circulation among the people you live and work with. Up to a certain limit, gifts of money are not taxed.

3. How about giving of your time? This is the most valuable thing you have, and thus the most valuable thing you can give. Give someone the gift of time by making time for them. Be sure to spend quality time together. Go on that trip you've been putting off. See that event or make that lunch date. Invest time in your friend.

4. Teach something to your friend. We all have something that we alone have learned. Share that unique part of yourself that will teach your friend something useful or touching. Perhaps you know a good trick on identifying good stocks. Why not share that as a gift? Perhaps you know a special trick on how to hike a trail, or keep your house clean. The range of possibilities is infinite when it comes to what we can teach each other, but one good topic is frequently money management. Share your tips and ideas on how to balance the home budget, where to shop, and how to invest.

5. Finally, you can do some manual labor for your gift recipient. There are lots of small jobs that we all need to get done. Usually, these are more a matter of time and not difficulty. By giving the gift of cleaning up some of these things from a person's chore list will take a huge load off of the gift recipient. They will be truly grateful, and you will have given a gift that saved everyone some money.

These out of the box ideas bring out the true meaning of exchanging gifts. We desire to give a personal gift, from the heart, to someone we care about. It's the thought that counts, and you can do this without breaking the bank or even spending any money at all.

Out of the Box Holiday Gifts: Tips for Healthy Holiday Giving

This year, why not think out of the box and give your friends and family something that will last much longer? These ideas for healthy outside of the box gifts can give your loved ones the best present of all, a new start in a better, healthier direction.

Many people associate gift giving with a present under the Christmas tree. This expectation can be deeply embedded and so to prevent some unmet expectations, let your family know that this year, you will be giving "out of the box" gifts. You still want to surprise them with something heart felt and touching, but it won't come in a box. Let everyone know this ahead of time. It will arouse their curiosity.

Next comes putting together your gifts. Make up a list of your closest family and friends. These very close family and friends will be in the personal category, to whom you want to give very special gifts. Your other friends, coworkers, and community acquaintances don't expect a gift, but give them one anyway- a smile in the hall, a hearty "Merry Christmas" or "Happy Holidays", or perhaps an invitation to go to the gym to workout together. These don't come in a box, but they are meaningful gifts nonetheless.

Now, focus on your closest relationships. Think of and write down the unique out of the box gift you are going to give everyone on that list. These type of gifts typically involve doing something for or something with a person.

To make these out of the box gifts more special and meaningful, do some of actions before exchanging gifts. For example, perhaps it would mean a lot to your spouse if you quit smoking this year. What a healthy gift this would be! If you start a couple of weeks ahead of time, prior to officially announcing the gift, then they will know you are really serious about this health gift. Another example would be to give the gift of more companionship. You could offer to take your spouse out to a small cafe or tavern once a week, to spend some dedicated, quite time together away from the hectic flow of work or home life with a large family. Start doing this before Christmas, and it will make the gift more sincere and meaningful. Maybe you want to give your sister the gift of a newly redesigned website. Work on it ahead of time a bit, and then maybe work on it together with her just after Christmas.

Making out of the box gifts this way, giving them before announcing them, makes it very clear very quickly that the list of people you wish to exchange gifts with should be relatively small and manageable. It takes much more time, energy, and commitment to give an out of the box healthy gift.

Gifts that are out-of-the-box remind us about the true meaning of Christmas and the winter holidays. It is a time to reconnect with family, friends, and the community. It is a time to strengthen your connection with the divine. Giving healthy out of the box holiday gifts will make it even more meaningful for you.
Counseling People to Lose Weight Works http://ping.fm/JQJif
The Digital Extension of Human Sensing http://ping.fm/zJBSG
Social Networking and Legal Liability http://ping.fm/5km4R
Violent Video Games and the Brain http://ping.fm/eF6D9

Violent Video Games and the Brain - Yahoo! Voices - voices.yahoo.com

Functional magnetic resonance imaging technique identifies changes in the brain after playing video games

Violent Video Games and the Brain - Yahoo! Voices - voices.yahoo.com

Can Eating Fish Really Help Your Brain? - Yahoo! Voices - voices.yahoo.com

A study from the University of Pittsburgh says yes, depending on how you prepare it

Can Eating Fish Really Help Your Brain? - Yahoo! Voices - voices.yahoo.com