BMJ comes out with review article on Febrile seizures

This clinical review summarises how to recognise a febrile seizure and rule out other underlying causes. How to manage febrile seizures and how to deal with common questions posed by parents in this situation.

Comparative effectiveness and tolerance of treatments for H pylori

This network meta-analysis compares different eradication treatments forHelicobacter pylori.This showed that concomitant treatments, 10 or 14 days of probiotic supplemented triple treatment, levofloxacin based triple treatment, hybrid treatment and sequential treatment might be most effective for eradicating H pylori.

Nagging people is a futile exercise

  

Columnist Margaret McCartney argues that nagging people about the need to do exercise to achieve health won’t work. Exercise should be for the people, by the people, she says.

Longer Work Hours Tied To Increased Risk For Stroke

The Los Angeles Times (8/20, Kaplan) reports in “Science Now” that people “who put in long hours at the office were 33% more likely to suffer a stroke than their colleagues who clocked out earlier,” according to study findings published online yesterday in The Lancet. The study also found that even people “who worked just over 40 hours per week saw a significant increase in stroke risk.”

        The New York Times (8/20, Saint Louis) “Well” blog points out that the “new analysis includes data on more than 600,000 individuals in Europe, the United States and Australia, and is the largest study thus far of the relationship between working hours and cardiovascular health.” Included in the analysis were 17 “studies of stroke” that “included 528,908 men and women who were tracked on average 7.2 years,” as well as 25 studies of “coronary heart disease among workers” that involved some “603,838 people.”

        TIME (8/20, Basu) reports that the study authors are not sure why longer work hours appear to be linked to an increased risk for stroke, but posited that “working long hours tends to be correlated with risky health behaviors, like drinking more alcohol or sitting for hours at a time.” Such behaviors, in combination “with the stress associated with working overtime, could be a perfect recipe for a stroke or cardiovascular strain.” The Telegraph (UK) (8/20, Knapton) also covers the study.

CPAP Alternatives For Traveling With Obstructive Sleep Apnea

By Dr Deepu

The Sleep Review (8/20, Wolski) reports on “easy to use, effective, and unobtrusive” alternatives to CPAP for patients with OSA while traveling. Dr. Glenn Adams, medical director and sleep medicine specialist at Sarasota Memorial Health Care System, said one of the most effective options is “Provent, which goes over the nose and creates back pressure to treat OSA,” but is not covered by insurance. The piece also discusses the option of oral appliances.

FDA grants “fast track” designation to pneumonia drug

By Dr Deepu

FDA grants “fast track” designation to pneumonia drug

The Triangle (NC) Business Journal (8/19, deBruyn, Subscription Publication) reports that Chapel Hill-based drug developer Cempra Inc. received “Fast Track” designation from the FDA to expedite the review process for “Cempra’s experimental drug solithromycin, a treatment for community acquired bacterial pneumonia (CABP).” The drug is “currently in Phase 3 development for the treatment of CABP and Cempra plans a New Drug Application submission in 2016.”

Combined use of antidepressants and painkillers linked to bleeding risk

Extra vigilance needed when using both types of drugs together

Taking a combination of antidepressants and common painkillers is associated with an increased risk of bleeding soon after starting treatment, finds a study published in The BMJ this week.

The researchers say their results may have been affected by other unmeasured or unknown factors and should be interpreted with caution. However, they suggest special attention is needed when patients use both these classes of drugs together.

Depression produces the greatest decrement in health of all common chronic conditions and depression in older people is an important public health problem.

But concern exists that antidepressants may interact with common painkillers called non-steroidal anti-inflammatory drugs (NSAIDs) to increase the risk of bleeding inside the skull (intracranial haemorrhage).

So a team of researchers based in Korea compared the risk of bleeding among patients treated with antidepressants with and without NSAIDs.

Using the Korean nationwide health insurance database, their study involved over four million people who were prescribed antidepressants for the first time between 2009 and 2013.

NSAID prescriptions were obtained and hospital records were used to identify time to first admission with intracranial haemorrhage within 30 days of a new prescription. Factors that could affect the results, such as age, sex, and use of other medications, were taken into account.

Compared with use of antidepressants alone, the team found that combined use of antidepressants and NSAIDs was associated with a substantially increased bleeding risk.

They found no statistically meaningful differences in risk of bleeding between different types of antidepressant drugs, or with age. Being male was the most common factor for a higher risk of bleeding with combined use of antidepressants and NSAIDs.

"The addition of NSAIDs to antidepressant treatment increased the risk of intracranial haemorrhage within 30 days of the combination starting, especially in men," conclude the authors. "This result adds to evidence confirming the increase of risk with combination use of antidepressants and NSAIDs."

In an accompanying editorial, Dr Stewart Mercer at the University of Glasgow and colleagues at the University of Cambridge, say the results give some cause for concern.

They point out that both types of drug are widely used, and that co-morbidity of the conditions for which these drugs are used is very high - 65% of those with major depression also have chronic pain.

They urge family doctors to be extra vigilant in terms of prescribing behaviour and discussing the risks with patients, especially in deprived areas where "the combination of mental and physical problems (including chronic pain) is very common." And they say further research is required to extend the findings over longer time periods and in differing populations.

Link to full

High-Flow Nasal Therapy Effective As NIV In Preterm Infants

Medscape (8/18) reports that an analysis published in the journal Pediatrics found that high-flow nasal cannula therapy “is as safe and efficacious as conventional modes of noninvasive ventilation (NIV) in preterm infants.” The study, which compared high-flow therapy with nasal continuous positive airway pressure, found “no significant differences between groups with respect to a variety of secondary outcomes,” such as the duration of time in the neonatal unit or respiratory support.

COPD Patients With Comorbid Mental Issue Have Higher Readmission Risk

According to Lung Disease News (8/18, Semedo), a recent study in the journal CHEST found that psychological conditions such as depression anxiety, or psychosis were associated with a higher risk of hospital readmission for COPD complications. “These psychological disorders are more likely to predict early readmission than other significant factors,” said Gurinder Singh of the University of Texas Medical Branch at Galveston. “This is likely related to the limited ability of these patients to handle the COPD, poor social support or community resources and non-adherence with treatment,” Singh added.

E-Cigarettes Not Gateway Drug Among British Youth, Survey Says

The Guardian (UK) (8/17, Meikle) reports that an online survey by the British anti-tobacco group Action On Smoking and Health found that “experimentation with e-cigarettes is rising among 11- to 18-year-olds in Britain but is most common among those who already smoke or who have done in the past.” The group suggests that the results show it is “unlikely” that e-cigarettes are being used as a gateway drug to tobacco. Also covering the story are the Daily Mail (UK) (8/17, Duell) and the Independent (UK). (8/17, Connor)

Helicobacter Pylori May Be Common In Patients With COPD

The Daily Mail (UK) (8/16) reported that “the bacteria helicobacter pylori” may “be common in patients with chronic obstructive pulmonary disease (COPD).” Research has “found that levels of the bacteria are up to three times higher in people with COPD, and one theory is that infection in childhood may affect the growth of the lungs, making them more vulnerable to disease.”

Researcher Identify Factors That May Put COPD Patients At Higher Risk For Falls

Reuters (8/15, Rapaport) reported that research suggests that older individuals with COPD may have a higher likelihood of experiencing falls if they have additional medical conditions, prior falls, or a lengthier smoking history. The findings were published in Respirology.

Regular consumption of sugary drinks associated with type 2 diabetes

Sugar sweetened drinks may give rise to nearly 2 million diabetes cases over 10 years in the US and 80,000 in the UK

Regular consumption of sugar sweetened drinks is positively associated with type 2 diabetes independent of obesity status, finds a study published in The BMJ this week.

Artificially sweetened drinks and fruit juice also showed a positive association with type 2 diabetes, but the quality of evidence was limited. None the less, the authors warn that neither artificially sweetened drinks nor fruit juice are suitable alternatives to sugar sweetened drinks for the prevention of type 2 diabetes.

Artificially sweetened beverages have been seen as possible alternatives to sugar sweetened beverages to reduce intake of sugars and energy, and fruit juice has been considered a healthier alternative. However, evidence was not available to clarify whether or not consumption of each of sugar sweetened beverages, artificially sweetened beverages, and fruit juice is associated with risk of diabetes after taking account of obesity status.

To address this question, an international team of researchers led by the MRC Epidemiology Unit at Cambridge University set out to assess whether or not habitual consumption of sugar sweetened drinks, artificially sweetened drinks, or fruit juice was associated with the incidence of type 2 diabetes, and to estimate the 10-year risk attributable to sugar sweetened drinks in the USA and UK.

They analysed the results of 17 observational studies. Design and quality were taken into account to minimise bias. None of these was funded by industry.

They found that habitual consumption of sugar sweetened drinks was positively associated with incidence of type 2 diabetes, independently of obesity status.

The association between artificially sweetened drinks or fruit juice and incident type 2 diabetes was less evident. Yet, the researchers found little evidence for benefits of these beverages, and therefore concluded these drinks are unlikely to be healthy alternatives to sugar sweetened drinks for preventing type 2 diabetes.

They point out that the studies analysed were observational, so no definitive conclusions can be drawn about cause and effect.

However, assuming a causal association, they estimate that two million new-onset type 2 diabetes events in the USA and 80,000 in the UK from 2010 to 2020 would be related to consumption of sugar sweetened beverages.

“Although more research on cause and effect needs to be carried out, this study indicates the potential health gains that may be achieved by reducing the consumption of sugar sweetened drinks,” they conclude.

Link to article

Miscellaneous Mnemonics

Miscellaneous Mnemonics

Resistor colour codes "Bad Boys Rape 
Our Young Girls But Violet Gives Willingly
- Get Some Now":
· In ascending resistor value order:
Black: 0
Brown: 1
Red: 2
Orange: 3
Yellow: 4
Green: 5
Blue: 6
Violet: 7
Grey: 8
White: 9
Gold: 5%
Silver: 10%
None: 20%

Visible spectrum colors in order ROY G. BIV
· In order from low end of spectrum:
Red
Orange
Yellow
Green
Blue
Indigo
Violet
Alternatively: "Richard Of York Gained Battles
In Vain" (Richard III was an English king defeated in 1485).

Ohm's Law "Virgins Are Rare":
Volts = Amps x Resistance
· Note: can then rearrange to more common form Resistance = Volts / Amps.

Ideal gas law "Pure Virgins Never Really
Tire":
PV=nRT

Electric units "Vaulting John Says: 'Ann
Can Sing OVA'. What Just Sing? And
Vault.":
Volts = Joules/Sec
Amps = Coulombs/Sec
Ohms = Volts/Amp
Watts = Joules/Sec=Amps x Volts

Ideal gas law [for All My Children fans] "Pine Valley
is Not Real Time"
PV=nRt

Work: formula "Lots of Work gets me Mad!":
Work = Mad:
M=Mass
a=acceleration
d=distance

Syncope (fainting) treatment If the face is red,
raise the head.
If the face is pale, raise the tail.

Hospice facets HOSPICE:
Home
Outpatient
Support groups
Pain medication/ Physical needs
Inpatient
Counseling
End-stage (terminal) illness/ Emotional needs

Healthy lifestyle modification DRAINS:
Diet
Reduce weight
Alcohol reduced
Improve circulation (exercise)
No other disease
Smoking stopped

Clinical essay plan "During Exams Please
Say Silently I Must Prepare F***ing 
Well":
Definition
Epidemiology
Pathology
Signs and Symptoms
Investigations
Management
Prognosis
Further Work

Safety factors SETUP:
Stop
Environment
Traffic
Unknown hazards
Protect yourself, patient, bystanders

Admission orders: general ADA VAN DISSEL:
· In order of writing on the hospital admission form:
Admit (to which ward)
Diagnosis
Allergies
Vital signs
Activities
Nursing orders (wind, wound, and water)
Diet
Intravenous
Sedation
Sleep
Elimination
Lab work

Quality of life measurement in patients FIDOH:
Functional status
Impairment
Death/ Duration of life
Opportunity
Health perception
· Functional status: Social function (limitations in usual roles, degree of
social interaction, sexual function); psychological function (affective and
cognitive); physical function.
· Impairment: Symptoms, signs, self reported disease, physiological changes.
· Death/ Duration of life: Mortality, life expectancy, disease adjusted years of
life lost
· Opportunity: How the disease has influenced the patient's ability to
participate in society as well as their psychological resilience
· Health perception: Satisfaction with health; general feeling on a day to day
basis.

Surgery Mnemonics

Surgery Mnemonics

Pancreatitis: treatment MACHINES:
Monitor vital signs
Analgesia/ Antibiotics
Calcium gluconate (if deemed necessary)
H2 receptor antagonist
IV access/ IV fluids
Nil by mouth
Empty gastric contents
Surgery if required/ Senior review

Appendicitis: Alvarado's scoring system for diagnosis 
MANTRELS:
Migratory pain (1)
Anorexia (1)
Nausea (1)
Tenderness (2)
Rebound tenderness (1)
Elevated temperature (1)
Leucocytosis (2)
Shift to left (1)
· Score 3-4 = no appendicitis. Score 5-6 = doubtful. Score 7 or more =
appendicitis is confirmed.

Post operative order list check-up FLAVOR:
Fluids
Laboratories
Activity
Vital signs
Oral allowances
Rx [medications]

Child-Pugh classification "Pour Another Beer
At Eleven":
PT
Albumin
Bilirubin
Ascites
Encephalopathy
·Scoring (each is either 1, 2 or 3 points):
PT (greater than 12 sec.): 1-3 or 4-6 or >6.
Albumin: >3.5 or 2.8-3.5 or less than 2.8
Bilirubin: less than 2 or 2-3 or >3.
Ascities: none or slight or moderate
Encephalopathy: none or 1-2 (subjective) or 3-4 (subjective)
· Interpretation:
Class A: 5-6 points (candidate for surgical liver resection).
Class B: 7-9 points (consider chemoembolization or RFA).
Class C: 10-15 points (consider options in B or no therapy).

Hernias of Abdominal Wall Think of the abdomen as a bucket,
or PAIL that contains the viscera. These are the four groups of hernias:
Pelvic hernias: obturator, perineal, sciatic
Anterior hernias: epigastric, incisional, Spigelian, supravesical,
umbilical
Inguinal hernias: indirect, direct, femoral
Lumbar hernias: inferior lumbar triangle (Petit), superior lumbar
triangle (Grynfelt)

Hernias: abdominal wall: pelvic The end products of
metabolism that are released through the pelvis, are "Pee Or Stool":
Perineal hernia
Obturator hernia
Sciatic hernia

Hernias: abdominal wall: lumbar triangles (with eponyms) 
PIGS:
Petit aka Inferior lumbar triangle
Grynfelt aka Superior lumbar triangle

TPN indications "MISIPPI Burning":
Major visceral injury
IBD
Sepsis
Ileus
Post-op
Paralysis
Intestinal fistula
Burns

Surgical discharge checklist FLAG COUP:
Lucid
Ambulatory
GP letter sent
CVS checked (BP, pulse
Operation site OK
Urinating OK
Prescription

Compartment syndrome: signs and symptoms · 5 P's:
Pain
Palor
P ulseless
Paresethesia
Pressure (increased)

Oesophageal cancer risk factors PC BASTARDS:
Plummer-Vinson syndrome
Coeliac disease
Barrett's
Alcohol
Smoking
Tylosis
Achalasia
Russia (geographical distribution)
Diet
Stricture

Abdominal aortic aneurysm: genetic component AAA (3
A's) is sometimes due to a defect in the gene encoding for type III
procollagen.

Disease description: organization of answer "In A
Surgeon's Gown, Physicians May Make Some
Clinical Progress":
Incidence
Age
Sex
Geography
Predisposing factors
Macroscopic appearance
Microscopic appearance
Spread
Clinical features
Prognosis

Inguinal mass: differential "Hernias Very Much
Like To Swell":
Hernias (inguinal, femoral)
Vascular (femoral aneurysm, sapheno varyx)
Muscle (psoas abscess)
Lymph nodes
Testicle (ectopic, undescended)
Spermatic cord (lipoma, hydrocoele)

Haematocele: etiology 3T's and 2 H's:
Tumor
Torsion
Trauma
Hydrocele as a complication
Haemophilia (blood diseases)

Abdomen: inspection 5 S's:
Size
Shape
Scars
Skin lesions
Stoma

Varicose veins: symptoms AEIOU:
Aching
Eczema
Itching
Oedema
Ulceration/ Ugly (LDS, haemosiderin, varicosities)

Swollen leg: unilateral swelling causes TV BAIL:
Trauma
Venous (varicose veins, DVT, venous insufficiency)
Baker's cyst
Allergy
Inflammation (cellulitis)
Lymphoedema

Ulcers: edge types F PURE:
Flat (eg venous)
Punched-out (eg trophic, arterial)
Undetermined (eg pressure, TB)
Rolled (eg BCC)
Everted (eg SCC)

Post-operative fever causes Six W's:
Wind: pulmonary system is primary source of fever first 48 hours, may
have pneumonia
Wound: infection at surgical site
Water: check IV for phlebitis
Walk: deep venous thrombosis, due to pelvic pooling or restricted
mobility related to pain and fatigue
Whiz: urinary tract infection if urinary catheterization
Wonder drugs: drug-induced fever

Scrotum: scrotum swelling differential THE THEATRES:
Torsion
Hernia
Epididymytis, orchitis
Trauma
Hydrocoele, varicocele, hematoma
Edema
Appendix testes (torsion, hemorrhage)
Tumour
Recurrent leukemia
Epididymal cyst
Syphilis, TB

Post-operative complications (immediate) "Post-op 
PROBS":
Pain
Primary haemorrhage
Reactionary haemorrhage
Oliguria
Basal atelectasis
Shock/ Sepsis

Fistulas: conditions preventing closure FETID:
Foreign body
Epithelialization
Tumor
Infection
Distal obstruction

Oedema causes: generalised "HILARI IS SAVE" (Hilary):
Heart failure
Iatrogenic
Liver causes
Aldosterone increased/ ADH increased
Renal cause
Inadequate protein in blood (hypoalbuminaemia)
· Causes for the inadequate protein in blood are:
Intake Inadequate (Kwashiorkor)
Secretion fro pancreas decreased (pancreatitis)
Synthesis decreased (liver failure)
Absorption decreased (Crohn's disease)
Vomit (pyloric stenosis)
Excretion increased (nephrotic)

Oedema causes: localised ALIVE:
Allergic (angio-oedema)
Lymphatic (elephantiasis)
Inflammatory (infection, injury)
VEnous (DVT, chronic venous insufficiency)

GI bleeding: causes ABCDEFGHI:
Angiodysplasia
Bowel cancer
Colitis
Diverticulitis/ Duodenal ulcer
Epitaxis/ Esophageal (cancer, esophagitis, varices)
Fistula (anal, aortaenteric)
Gastric (cancer, ulcer, gastritis)
Hemorrhoids
Infectious diarrhoea/ IBD/ Ischemic bowel

Melanoma sites "Mel SEA" (Pronounced "Mel C" from the
Spice Girls)
· Melanoma sites, in order of frequency:
Skin
Eyes
Anus

Fistulas: conditions preventing closure FRIEND:
Foreign body
Radiation
Infection/ Inflammation (Crohn)
Epithelialization
Neoplasia
Distal obstruction

Appendicectomy: complications WRAP IF HOT:
Wound infection
Respiratory (atelectasis, pneumonia)
Abscess (pelvic)
Portal pyemia
Ileus (paralytic)
Fecal fistula
Hernia (r. inguinal)
Obstruction (intestinal due to adhesions)
Thrombus (DVT)

Social & Preventive Medicine Mnemonics

Social & Preventive Medicine Mnemonics

Cigarette smoke: major carcinogens PANT:
Polynuclear aromatic hydrocarbons
Aromatic amines
Nitrosamines
Tar
· Nicotine and Carbon monoxide are Non-Carcinogenic.

Error: type I (alpha) vs. type II (beta) Type I
(Alpha) Error:
"There Is An Effect" where in reality there is none.

Reliability Random Error
REduces
REliability (REproducibility)

Suicide risk factors in order of risk SOARS:
· Top 6 risk factors in order of highest to lowest risk:
Serious previous attempt
Older than 45
Alcohol
Rage history
Sex (male)

Incidence vs. prevalence Incidence: Initiate
Infection In Interval.
Prevalence: Population's Percentage Positive.

Prevention: primary vs. secondary vs. tertiary Primary:
Predisposing factors decreased.
Secondary: Severity decreased.
Tertiary: Therapy, Training.

Recall bias REcall bias is a problem with
REtrospective studies and is based on ability to
REmember.

Hill criteria for causality " 'Clowns Pursuing
Epidemiology' Commonly Behind The Silly Samples":
Consistency
Plausibility
Experimentation
Biological gradient
Coherence
Temporality
Strength of association
Specificity

Informed consent: requirements, exceptions "Sign this DOC
before we can start":
Discussion
Obtain agreement
Coercion-free
· Exceptions to informed consent are WIPE:
Waiver
Incompetent
Privilege (therapeutic privilege)
Emergency

Accuracy of test: sensitivity vs. specificity seNsitivity
of a test: related to the rate of false Negatives.
sPecificity of a test: related to the rate of false Positives.
· Alternatively written:
seNsitive: No Non-Negatives.
sPecific: Puny Psuedo-Positives.

Poisson distribution formula MNEMONIc: M to
the Nth power times E to the Minus nth Over N
factorial
Formula is: ((m^n) * (e^-n) ) / n!
· Note: the factorial (!) at the end is an inverted lowercase letter i.

Pi: value to 31 decimal places "How I want a drink,
alcoholic of course, after the heavy chapters involving quantum mechanics. One
is, yes, adequate even enough to produce some fun and pleasure for an instant,
miserably brief":
The number of letters in each subsequent word of these two sentences give the
value of pi to 3.141592653589793238462643383279
Alternatively: If only want first 6 decimal places, use the sentence "How I wish
I could calculate Pi! "

Suicide risk factors SAD PERSONS:
Sex: male
Age: young, elderly
Depression
Previous suicide attempts
Ethanol and other drugs
Reality testing/ Rational thought (loss of)
Social support lacking
Organized suicide plan
No spouse
Sickness/ Stated future intent