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Re: Medication-induced Dystonic reaction

Posted in General clinical at Thu, 30 Oct 2014 16:35:55


Posts: 644
Joined: 21 Feb 2012

Such reactions ( NeckFace Syndrome) ,common in young girls due  to anti emetics ,egStemetil(Prochlorperazine),Sequil(Trifluperazine).Metoclopramide.It may subside spontaneously as the drug action subsides.It can respond to diazepam also apart from Atropine(Muscaranic acetylcholine receptor antagonists)like drugs.

Hyocine bromide tablet and injection are relatively safer drugs for nausea and vomiting and colicky pain.Ondansetron now days  used by clinicians  for nausea and vomiting because  it is well tolerated.Promethazine(Phenerggen) is used by some clinician with good results to counter dystopia reaction.



Re: Feeding Birds: A Humane Gesture

Posted in General at Thu, 30 Oct 2014 13:49:22

Mukhtar Ali

Posts: 858
Joined: 14 Nov 2010

Modern life is killing our birds - because chicks can't hear their mothers over the constant drone of traffic 

  • Faced with noise, chicks often failed to beg for food when they should
  • They mistook calls warning of danger for ones saying food was on the way
  • This stopped them from taking cover from potential predators

Re: What's your diagnosis? Recurrent fever after a holiday in Turkey.

Posted in General clinical at Thu, 30 Oct 2014 11:49:39


Posts: 1
Joined: 30 Oct 2014

Brucellosis at first place

Re: Colorado Amendment 67

Posted in Medicolegal at Thu, 30 Oct 2014 10:24:20


Posts: 544
Joined: 18 Mar 2014

Is there are a danger that laws dreamt up like this - on the hoof, in response to a horrible accident - may lead to bad law...? 

Re: Time Capsule

Posted in General at Thu, 30 Oct 2014 06:54:25

Mukhtar Ali

Posts: 858
Joined: 14 Nov 2010

Microsoft unveils $199 wearable fitness device


Re: Should patients have the right to record consultations?

Posted in News & media at Wed, 29 Oct 2014 23:57:09


Posts: 8
Joined: 31 Mar 2014

The 'if-uncomfortable-express-your-discomfort' advice brings each individual clinician's personal preferences to bear on patients in consultation in a way which, I suggest, would prove as counter-productive in practice as it is arrogant in theory.

The debate concerning patients who want to take audio-recordings home is no longer young, and patients have become wise to the issue faster than the medical profession.  

If uncertainty is spread in the path of those patients ("Now how will THIS particular medic react when I tell him\her I am recording?") then such as would prefer to be open about it will, very quickly, learn simply not to bother to divulge such information in the first place, and march on in silence, recording.

Which would be a great shame. Both patients and doctors stand to learn a great deal from recorded consultations in my view, and if there is one thing which unites medical responses to date, it is that every clinician, would, naturally, prefer any recordings that are to be taken, be taken overtly.

But, "Once to be in doubt is once to be resolved," and the resolution of it by patients is not likely to favour  recalcitrant doctors following the advice referred to at the outset of this post. 




Definition of health

Posted in General clinical at Wed, 29 Oct 2014 22:23:50


Posts: 3
Joined: 29 Oct 2014
Can you define health in one sentence? If you don't know, ask WHO, they will babble something.

Cardiac tumours

Posted in Cardiology at Wed, 29 Oct 2014 22:18:33


Posts: 3
Joined: 29 Oct 2014
Why do tumours occur less in the heart, is there any factor suppressing it?

Re: Can we finally put to rest the canard that insuin use increases cardiovascular events?

Posted in Diabetes at Wed, 29 Oct 2014 20:21:28


Posts: 4361
Joined: 24 Feb 2009

Very interesting, Doc and thank you, Anne.

It thus may be a bit like Furphy in Australian, meaning a bit of scuttlebutt from the water carriers, GJ Furphy and son on the Wetsern Front. 

Words are leaves which turn colour, fall and fertilise our imaginations. They are forever changing and reappearing.  I am learning Homeric Greek which to my etymological brain is digging through strata of language going back to Mycenaen.

We have wandered off from diabetes as the the sick will always be there. 


Re: Should smoking be banned in public parks?

Posted in Respiratory medicine at Wed, 29 Oct 2014 19:14:26

Eman Sobh

Posts: 170
Joined: 02 Jan 2014

In Response to Re: Should smoking be banned in public parks?:[QUOTE]

I can go for banning smoking wherever and whenever. I do see the contribution of smoke to the green house effect, health hazards on smokers, and on second hand smokers (SHS), in addition to the bad odour and waste of manpower in production and subtle advertisment. Actually, I do not see why tobacco is not treated like the rest of illicit drugs as it probably does only hazards.

Posted by Sidhom[/QUOTE]

not only first and second hand smoke but also third hand smoke refers to  residual nicotine and other chemicals left on a variety of indoor surfaces by tobacco smoke.  so it would be excelent to ban smoking in public parks to enjoy fresh air free of smoke

Re: what cough suppressant

Posted in General clinical at Wed, 29 Oct 2014 15:42:36


Posts: 2
Joined: 29 Oct 2014
Only two giagnosis LARYNGITIS ASTHAMATIC GERD For thefirst one try Rotacaps combined with steroids for 1 month+nebulizer with salbutamal for one week For the second one give ppi+Domperidone

Re: The Taxi cab is your professional counsellor

Posted in Psychiatry at Wed, 29 Oct 2014 13:20:18


Posts: 544
Joined: 18 Mar 2014

The report suggests that a therapist would sit in the car with you, rather than the driver being the therapist. In London we have the black cabbie, often seen as a dispenser of racist, sexist views, rather than any shoulder to cry on. There was also the famous case of the black cab driver who drugged and raped women who got into the back of his cab. So maybe they wouldn't be best placed to do this...

When I'm alone in the back of a cab I'm quite happy to have some quiet reflective time... I might also be a bit shocked to get in a cab and have someone trying to counsel me! 

high-intensity statin therapy promotes atheroma regression in patients with diabetes.

Posted in Diabetes at Tue, 28 Oct 2014 20:22:01


Posts: 695
Joined: 15 Apr 2011

High-Intensity Statin Therapy Alters the Natural History of Diabetic Coronary Atherosclerosis: Insights From SATURN

Diabetes Care Online Ahead of Print September 4, 2014


OBJECTIVE Although statins can induce coronary atheroma regression, this benefit has yet to be demonstrated in diabetic individuals. We examined the benefit of high-intensity statin therapy in promoting coronary atheroma regression in patients with diabetes.

RESEARCH DESIGN AND METHODS The Study of Coronary Atheroma by Intravascular Ultrasound: Effect of Rosuvastatin Versus Atorvastatin (SATURN) used serial intravascular ultrasound measures of coronary atheroma volume in patients treated with rosuvastatin 40 mg or atorvastatin 80 mg for 24 months. This analysis compared changes in biochemistry and coronary percent atheroma volume (PAV) in patients with (n = 159) and without (n = 880) diabetes.

RESULTS At baseline, patients with diabetes had lower LDL cholesterol (LDL-C) and HDL cholesterol (HDL-C) levels but higher triglyceride and CRP levels compared with patients without diabetes. At follow-up, diabetic patients had lower levels of LDL-C (61.0 ± 20.5 vs. 66.4 ± 22.9 mg/dL, P = 0.01) and HDL-C (46.3 ± 10.6 vs. 49.9 ± 12.0 mg/dL, P < 0.001) but higher levels of triglycerides (127.6 [98.8, 163.0] vs. 113.0 mg/dL [87.6, 151.9], P = 0.001) and CRP (1.4 [0.7, 3.3] vs. 1.0 [0.5, 2.1] mg/L, P = 0.001). Both patients with and without diabetes demonstrated regression of coronary atheroma as measured by change in PAV (−0.83 ± 0.13 vs. −1.15 ± 0.13%, P = 0.08). PAV regression was less in diabetic compared with nondiabetic patients when on-treatment LDL-C levels were >70 mg/dL (−0.31 ± 0.23 vs. −1.01 ± 0.21%, P = 0.03) but similar when LDL-C levels were ≤70 mg/dL (−1.09 ± 0.16 vs. −1.24 ± 0.16%, P = 0.50).

CONCLUSIONS High-intensity statin therapy alters the progressive nature of diabetic coronary atherosclerosis, yielding regression of disease in diabetic and non-diabetic patients.

COMMENT:  Most studies that have examined the benefit of anti-hyperlipidemic therapy have concluded that the benefit in persons with diabetes is equal or superior to those without the disease.  This study yields similar results.  Whether the intravascular ultrasound reduction in coronary atheroma will translate into clinical benefits awaits longer-term studies.


Re: Reducing Alcohol drink drive limit in Scotland

Posted in Medicolegal at Tue, 28 Oct 2014 12:56:38


Posts: 789
Joined: 13 Oct 2009

John D - I am sure you did not intend it and personally I think the point is irrelevant but by using strict Muslim countries as a comparitor you are looking at those countries that try to stop women driving as well. In practice since women currently seem to be some of the safer drivers as regards death rates on the roads this does not seem relevant except that all figures need correcting for numbers of vehicles on the road (or similar) rather than head of population.

In the UK deaths on "country" roads are way above deaths on motorways - but I then realised that "country roads" really seem to refer to non-dual carriageway rather than rural. As much of my driving experience has been on country and "rustic" roads , I am not sure there is so very much we can do. Clearly there are roads where the present speed limits are excessive but some of the driving (a minority) is just so awful that we need to think in terms of monitoring by drone or equivalent and just taking some of the worst drivers off the roads altogether.

Re: child removed from heart transplant list

Posted in General at Tue, 28 Oct 2014 10:42:11

John D

Posts: 3304
Joined: 01 Feb 2010

How do we tell the difference between discrimination and providing help from a limited resource to a limited group?    

In some situations the answer is money - if you have it you can buy the resource  - but in medicine, usually, we try to use better criteria.   To give the resource to those who can make best use of it seems to be a reasonable, and a humane one.


Re: Poll archive 21/10/14 to 28/10/24

Posted in doc2doc feedback at Tue, 28 Oct 2014 00:07:05


Posts: 544
Joined: 18 Mar 2014

Should the NHS be free from political control?

Yes - 186 votes (85.3%)

No - 26 votes (11.9%

Don't know - 6 votes (2.8%)

Re: The Ebola Frontline

Posted in Public health at Mon, 27 Oct 2014 21:53:43


Posts: 789
Joined: 13 Oct 2009

Answering my own question - I gather in Liberia cremation was recommended but was so contrary to local culture that burial seemed preferable. Apparently some folk were not declaring the potential Ebola case to ensure that the individual could be buried. Compromise needed - just as in the rest of medicine.

I am also interested in how our western "ethical" views are modified in the light of pressures in the real world. Apparently for example blood is taken from those who have died to see whether it was Ebola - no mention of informed consent etc... Does anyone else remember the rigmarole we had in the past over ante or post mortem testing for HIV or even anonymous testing to try to test the prevalence ? I have not heard whether there is any triage with scarce resources - so far no-one seems to be discussing the withdrawal of therapy to help a better risk patient , but this possibility was raised when the bird flu panic was at its height. As in war ethical decisions become complex.

Re: Should all adults over the age of 45 be screened for abnormal glucose?

Posted in Diabetes at Mon, 27 Oct 2014 17:05:22


Posts: 695
Joined: 15 Apr 2011

It is important that the publication being referred to in these posts is a draft published in the New England Journal for comments


The draft summarizes the US preventative services sask force current analysis and asked for comments with a closing date of 3 November.  The readers wish to comment the comment site can be found at the above citation.

In addition to deciding to screen or not based upon the analysis of epidemiolgoic data, physicians and public health officials need to consider wheather or not there is the likelihood of benefit to individuals found to have diabetes or to be at risk for diabetes given the resources available to that individual or the health care system.  i generally come down on the side of not doing universal screening; leaving the decision to the individual patient and physician given the partcular risk/benefit ratio of the individual.

Re: Advice Needed Please

Posted in General clinical at Mon, 27 Oct 2014 13:58:24

John D

Posts: 3304
Joined: 01 Feb 2010


I wonder if, with the good explanation of your poor result in your BSc, and with letters from your teachers then, saying that the 2:2 wasn't what they expected, you might not need to do that MSc.   But I would hope for opinions from our D2D members from teaching hospitals for their view of that.


Re: New cardiology clinical champions

Posted in Cardiology at Mon, 27 Oct 2014 13:50:58

John D

Posts: 3304
Joined: 01 Feb 2010

Vade, Sadian!  With all good wishes!


And Salute! To Mbittencourt, Heart MattersHeartfeltHeart Doc.

You have a very good act to follow!


Re: MS relapse triggered by stress

Posted in Neurology at Mon, 27 Oct 2014 13:50:19


Posts: 33
Joined: 10 Nov 2013

TNF alpha is an important cytokine in promoting inflammatory activity and may be the missing link in the relationship between stress and heightening of MS activity.



Re: Books

Posted in Medical education at Sun, 26 Oct 2014 17:05:08


Posts: 8
Joined: 23 Jun 2010

The Emporer of All Maladies by Dr Siddhartha Mukherjee is a fascinating history of cancer. Mukherjee well deserves the 2011 Pulitzer Prize he won for this enthralling book. As a professor of medical oncology at Cornell University/Columbia University New York Presbyterian Hospital, I only wonder where he found the time to write such a wonderful  and detailed book given their work load at this hospital. 

Another fascinating book is Phantoms in the Brain by Professor V S Ramachandran of the Center for Brain and Cognition at the University of California, San Diego. While not a very new book (1998), it is still a good read for those interested in probing the human mind. Oliver Sacks wrote an excellent forward.


Re: Should the NHS be liberated from political control?

Posted in News & media at Sun, 26 Oct 2014 15:50:35


Posts: 7
Joined: 25 Dec 2010

NHS cannot operate without political intervention. The benefit of NHS for general public and not for health staff .This nobel institutes must be supervised by independent politically accoutable body.

Re: Are you active everyday?

Posted in General at Sun, 26 Oct 2014 09:09:22


Posts: 1098
Joined: 16 Aug 2012

I walk and cycle a lot , do yoga, also go swimming and hiking but don´t exercise regularly. Some yrs ago I used to play tennis and go cross-country-skiing, but the logistics have changed here ( don´t want to be member in a tennis club anymore, beause they expect you to join social events for which I don´t have time. Skiing has become difficult for lack of snow, too).

However, at work we started a fitness scheme, so I´ll check out a few studios soon.


by the way :

Can sb stop this weekend spammer ??

hiv cure

Posted in Respiratory medicine at Sat, 25 Oct 2014 22:19:30


Posts: 13
Joined: 25 Oct 2014
Hello there! I am Prof Fred Kings, a medical doctor based in the United States of America. I had a patient recently (consiage patient) who had HIV, after several tests that was conducted on Her, and taking the required drugs and supplements, she was leading a normal healthy life. One day , she called me to tell me about some herbal medicine she had found through the internet by a hetbalist named Okougbo Alaba whose email address is: realhomeofspell@outlook.com that claimed to cure HIV/AIDS, i was pessimistic about her taking the herbal medicine, but later gave in after seeing how determined she was. After 3 weeks of taking this herbal medicine, she was totally cured of HIV/AIDS. I was surprised! I have prescribed this herbal medicine to some of my patients and it is working out fine for them. They are getting cured of HIV/AIDS. Spread the word, tell your patients about this magical herbal medicine. Together we can help save a lot of worried lives and get rid of HIV/AIDS. Save lives today, tell your patients about this Herbal Medicine, tell the to contact Okougbo Alaba with email address: realhomeofspell@outlook.com This is 100% real!