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The most viewed discussions on doc2doc this month

Are marathons bad for your health?

Posted in Sport and exercise medicine at Fri, 29 Apr 2016 11:09:55

John D

Posts: 4027
Joined: 01 Feb 2010
News of the sudden death of 30 year old Claire Squires at the end of the London Marathon on Sunday has led to widespread shock,sympthay and donations to the Samaritans for whom she was running. Cause of death of this fit, slim 30 year old hairdresser who had already run a marathon before, is still unknown.

So should we be advising patients to avoid extreme sports and marathon runnning? There have been 10 deaths during the London marathon since its inception in 1981 (no data on the week or so after).  The last death was in 2007 when a 22-year-old fitness instructor died of hyponatraemia,presumably due to overdrinking. Most fatalities are due to undiagnosed underlying heart problems (would that be conduction problems in the young?)

Given the numbers running, the fatality rate is reassuringly low. I suppose the question is whether an ecg to check for conduction defect and/ or echo to look for cardiomyopathy are worthwhile before embarking on training for a marathon. The pick up rate's going to be very low but is there any down side (apart from time,money and false reassurance)? Certainly, if there's a family history of sudden death, should we suggest investigations?

I've just run my first and last marathon at the age of 52. My dad dropped dead of a heart attack at 48 but I figured that if I didnt get any chest pain while training, I'd probably be ok. And I was.  
I didn't really consider having any checkups before. What do you think? Foolhardy or rational?


Should UK junior doctors strike over new contract plans?

Posted in Careers at Wed, 27 Apr 2016 14:18:47


Posts: 581
Joined: 14 Dec 2010

Over 50k people have signed an online petition in support of a junior doctor strike in the UK.

This is a response to the government's plans to impose a new contract for doctors in training which is likely to increase working hours and reduce pay.

It is proposed that basic pay will increase but the definition of "sociable hours" will be changed from 0800-1900 Monday to Friday to 0700-2200 Monday to Saturday which means junior doctors will not be eligible to receive supplemental pay (non-pensionable banding supplements) for work unless it occurs outside these times.

From the Review Body on Doctors’ and Dentists’ Remuneration (DDRB)  paper, "Contract reform for consultants and doctors & dentists in training – supporting healthcare services seven days a week"


It is also implied that doctors on maternity, paternity or sickness leave, those working less than full time, and those without a training number would not be eligible for the annual incremental pay increases that most UK doctors currently receive. Instead, pay increases would correspond with stages of training/increases in responsibility (rather than time served or years of experience).


Kitty Mohan, co-chair of the BMA's Junior Doctors' Committee, suggests the following to juniors doctors: 

1. The DDRB recommendations affect different people in different ways. If you have not yet managed to do so, please do read the juniors section of the DDRB report published on 16th July.  It can be found at: https://www.gov.uk/government/publications/contract-reform-for-consultants-and-doctors-and-dentists-in-training-supporting-healthcare-services-seven-days-a-week

2. Talk to your colleagues at work and make sure they are as informed as you. Start with other junior doctors but please do talk to other doctors, nurses and other health professionals. We are still being contacted by juniors who have no idea what is going on and if this affects them.  Let’s be clear, this affects us all.

3. Talk to your medical students, this will be their future contract, and to non-medical families and friends. Encourage them to spread the words regarding the concerns as well.

4. Many of your Royal Colleges may have already made a statement regarding junior contracts but please continue to lobby your College, Faculty or Royal Colleges. We’ve seen Royal Colleges both speak out strongly against the changes, and those who feel this isn’t their concern. The implications of a disenfranchised and devalued medical workforce affect everyone. Lobby your specialty trainee group as well – the more people who speak out against the changes the better.  

5.  Contact your local and regional BMA junior doctors reps and tell them your thoughts on what the next steps should be. The list of the Regional Junior Doctors Committee Chairs can be found at http://web2.bma.org.uk/rjdc

If you are a local or regional BMA junior doctor rep, please discuss these issues with your local and regional members and canvass their views on next steps over the next few days. We want to hear from as many people as possible.  Or email Andrew and myself at jdcchair@bma.org.uk . Thank you to the many of you who have contacted us so far.

6. Attend one of the NHS Employers junior doctors engagement events. Details of the events can be found at NHS Employers

7. Please take to Facebook and Twitter and share your concerns. On a simple level the more voices heard, and the more concerns raised the better. It is the level of outrage by junior doctors and their supporters that has turned this into a news story. Please get involved in discussions and debates, write blogs or opinion pieces, and generally do everything you can to get out messages out there.

8. Finally, whatever your opinion of the BMA is, the protection BMA membership affords regarding our terms and conditions is unparalleled.  Please remain a member or consider rejoining. This is the single biggest threat to the terms and conditions of current and future junior doctors.

Finding Locum work in London

Posted in GP Locums at Fri, 29 Apr 2016 23:54:08


Posts: 1
Joined: 13 Feb 2009
I have recently moved to London having done 5 years LOCUM work in the North of England. Guess I have to start from scratch here..so what is the best way to find Locum work other than through the usual Locum agencies. Any pointers would be appreciated.

Clinical question of the week: would you change this man’s anti-diabetic treatment?

Posted in Diabetes at Tue, 03 May 2016 01:29:58

Joey Rio

Posts: 1047
Joined: 13 Apr 2011

A 72 year old male has had type 2 diabetes for six years. He is on metformin extended release 2.0 grs per day. He does not have any major cardiovascular disease. His last two routine HBA1C levels, taken within a four month period by his GP prior to this appointment, were stable at 9.1%.

Guidance to work in UK

Posted in Radiology at Tue, 03 May 2016 07:35:54


Posts: 3
Joined: 03 May 2016
I am a Radiologist from Pakistan and completed my 5 years of training in October 2010. Then moved to London UK and got busy with the family and kids. I now want to return to work and currently undergoing GMC registeration through speciality equivalence. I would like to know that what are the chances that registeration will be granted and then how and where to apply for work and at what level????

Your tips and strategies for losing weight

Posted in Public health at Mon, 25 Apr 2016 04:28:19

Vernon T. Mancia

Posts: 3
Joined: 25 Apr 2016

The thread on e-cigarettes threw up a near thread diversion when members compared their attempts at weight loss to stopping smoking.    Both addictions to some extent, and obesity is something that many of us have to battle.  I know I do.

So please offer here your own experience and strategies for achieving weight loss, or at least avoiding weight gain!

My own is two-fold:

1/ Don't eat lunch

2/ Don't eat biscuits!  Especially not with mid-session cups of coffee!

If I can do both, my weight doesn't exactly fall off, but at least stablises at an acceptable level.


Do you Recommend Insulin Pump For Type 2 Diabetes

Posted in Cardiology at Mon, 25 Apr 2016 23:23:54


Posts: 520
Joined: 29 Jul 2010

Many debates and ongoing researches have not yet come to a conclusion to weigh between the advantages and disadvantages for Insulin Pump specially for diabetes type 2, however many diabetic patients are rushing to aquire the device, irrespective of the main serious side effects such as infection and DKA

I think we need  more researches to finalize the usefulness of Insulin Pump , and proper health education for diabetic patients on this subject


Posted in Cardiology at Sun, 01 May 2016 00:21:26

Dr. Haddadi

Posts: 1
Joined: 30 Apr 2016

24 year old patient complains of fatigue, muscle weakness and confusion, examination showed sluggish reflexes and decreased muscle tone, ECG shown below

What is the diagnosis ?



Posted in General clinical at Mon, 02 May 2016 13:21:30


Posts: 1690
Joined: 09 Dec 2011

1 - Florence Griffith Joyner ("Flo-Jo") set the Olympic&World record for the female 100 and 200 meters no-barriers run, since 1988. She retired from Olympic competitions one week after it was officially announced that anti-doping tests would be done at random, in 1989. She became a rich woman. Her Olympic&world records still stand both for the 100 and 200 meters. Her pictures shows a woman with "not a single adipose cell" over her surface. She had a sudden death in 1998, at the age of 38. The sports community suspicion for her performance-enhancement-drug (PED) was anabolic steroids - albeit never proved. Not so long before the 1988 Olympics there was as a dramatic change in her physique that was noticed by others, but she atributted it to a recent change to "new health programs"

2 - Lance Armstrong is another sports celebrity that built his career with erithropoiesis stimulating agents. Sport has also made him a rich man.

3. A short distance swimmer, and Olympic Golden Medalist - this is very recent. Well..... a few years ago was caught with furosemide in the urine after a competition. Furosemide can dilute the urine for other "stronger" PEDs, but also can make you "less heavier"- I think, for a "short distance competition" over or under the pool water. This person got a very mild punishment, but since then has never got the same good results, and at a young age was not classified for the Rio´s 2016 Olympics. By the way, this person is a well financially succeeded person at a very young age.

And these are just three "case reports" among sports celebrities, not to mention the other athletes that do not get the spotlights.


Up to 3,000 (1 in 4) Pharmacies to Close – Implications for Doctors

Posted in News & media at Sun, 24 Apr 2016 21:44:45


Posts: 2
Joined: 21 Mar 2016

I imagine you have heard about the forced closure of up to 3,000 (1 in 4) pharmacies in the UK from October 2016 – but have you considered the impact on the medical profession? The impact on GP surgeries, A&E departments and the medical profession generally will be MASSIVE. If pharmacies are unable to cope, they could have no choice but to refer patients to their GP and/or A&E. This could lead to a dangerous game of healthcare tennis. The NHS could crumble under the pressure, and the workload increase for doctors and nurses could be incredible, irreparably damaging the medical profession (who would want to work under those conditions?)

As background, the government recently announced cuts to pharmacy funding of £170m over 6 months, equivalent to £340m on an annual basis (a 12.2% cut). NHS prescription items will grow by 2.5% in the same period. Across an entire primary healthcare sector (community pharmacy), that’s HUGE.

Pharmacy minister Alistair Burt said that up to 3,000 pharmacies could close, with smaller independents more likely to suffer. This appears to be anti-small business and could have a dreadful impact on local communities who rely upon the pharmacy.

The remaining pharmacies will be under much greater pressure, which could have a massive impact on patient safety. They will still need to dispense 1 billion NHS items per year between them and will likely cut staff, even if they do have the space to cope with the extra prescriptions. Patients will probably have to travel further and vulnerable patients could be put at risk (e.g. housebound, disabled, blind patients). People could be deprived of accessible medicines advice and support from trusted pharmacists. Free services such as prescription deliveries may be stopped.

A petition against the cuts already has 50,000 signatures but needs 100,000 signatures to get a debate in parliament. Ultimately I’m making this post to ask for your help with the petition and to raise awareness as I’m not sure everyone realises how bad this government decision is - for patients, doctors, pharmacists and the NHS generally.

https://petition.parliament.uk/petitions/116943 (also accessible via the short link bit.ly/savemypharmacy)

Money or health or both?

Posted in General clinical at Fri, 22 Apr 2016 13:04:52

John D

Posts: 4027
Joined: 01 Feb 2010

Currently in the UK there is much publicity over how far politicians play the rules and , like many folk , try to avoid paying tax when there is a legitimate way round this. Assuming there is no tax evasion - and emphasising that I think a tightening of the rules long overdue - much of the controversy seems to reflect the general fascination with the lives of others. One could start with the basic premise that anyone who employs an accountant has something to hide.... Personally , I have never fussed over whether I am paying a bit more tax than is strictly necessary.

 But if we are to go down this road perhaps it would be far more relevant , interesting and at the same time cater even more for the lascivious interests of Joe Public if we insisted that the health records of those in high office were put into the public domain? Along with details of their genome and that of parents and siblings etc... 

Really useful apps?

Posted in General at Mon, 25 Apr 2016 04:23:08

Vernon T. Mancia

Posts: 3
Joined: 25 Apr 2016

I was fascinated recently to read of an app and device for your mobile phone, that is so good that it has received NICE approval!   When so many are trivial, it's good to see something useful in the 'App' world.

When I say "approval" ,  NICE's MIBs  ("Medtech Innovation Briefing", not "Men In Black"!) are neither guidance in their usual way, nor judgement or recommendation for  the devices.    But the AliveCor does seem to excite them!    It is a plug-in item for your mobile, that has two metal contact pads that will take fingers or palms.   Press them against the pads if you feel queasy, and it will record your ECG, diagnose and transmit the record to your doctor, or let them read the result later on, straight off the phone.   The manufacturers intend it for the detection of paroxysmal AF, and when the device costs less than £70 and is resuable, it has to have cost advantages over the conventional 24 ECG recorder.

I don't intend to advertise this device - I am unqualified to do so - and you can read the NICE briefing at  https://www.nice.org.uk/advice/mib35.     What I'd really like to do is ask you if you know of other 'Really Useful' medical apps?


"what time we supposed to stop gliptin treatment in T2DM Patient is it HbA1c normalization or normal glycemia is there guidance?"

Posted in Diabetes at Sat, 23 Apr 2016 22:21:01

Joey Rio

Posts: 1047
Joined: 13 Apr 2011

dear DM Specialist

        can you guide us in treating an uncontrolled diabetes patient. we add DPP4I  where already the patient on SUs and Metformin .This step is taken up when his A1c is 9.5 %.After 4 weeks of time his blood sugars touches normal range and patient is clinically improved 

         Now can we stop gliptin and continue other medicines?

  Are there guidelines in this aspect?what you would suggest?



The Juniors' Strike - NOT in the UK!

Posted in News & media at Tue, 26 Apr 2016 14:50:03


Posts: 3
Joined: 11 Feb 2016

In our preoccupation with the strike by junior doctors in the UK – excuse me, in England! -we should know of similar industrial disputes between trainee doctors and their employers around the world.

In Zimbabwe, the trainees there are so concerned by the vague wording of their new contract that they have gone on strike: http://www.newsdzezimbabwe.co.uk/2016/03/junior-docs-strike-continues.html

In the Odisha region of India, the Junior Doctors’ Association at the Veer Surendra Sai Institute of Medical Sciences and Research (VIMSAR) has suspended action that demanded better facilities and resources at the Institute.  When those included round-the-clock water and electricity supply at the operation theatre you can see why they were unhappy.    http://odishasuntimes.com/2016/04/01/odishas-vimsar-junior-docs-resume-strike-healthcare-services-affected/

Earlier this year, doctors in Hong Kong threatened to strike in the face of potential appointments by the Chinese Government to the otherwise elected Council of their Association: http://www.chinadailyasia.com/hknews/2016-01/19/content_15374486.html


And that is without going into the history of striking medics around the world!


"acarabose or voglibose which is more preferable in uncontrolled postprandial sugars?which is preferred?"

Posted in Diabetes at Sat, 23 Apr 2016 22:02:05

Joey Rio

Posts: 1047
Joined: 13 Apr 2011

dear diabetes specialis

    In india the staple diet is rice.we come across many uncontrolled diabetes with PPsugars.The market is flooded with both acarbose and voglibose.Studies shows these molecules are good for reducing HbA1c  and weight . These can be combined with metformin or SUs.Good for reducing TGL.

  Now the question is which is having more edge?Are there any head to head studies making one better than other?



Posted in General clinical at Thu, 21 Apr 2016 08:47:06


Posts: 4
Joined: 21 Apr 2016

You’ve probably gotten an X-ray or CT scan at some point in your life. Most likely, your doctor referred you, but then you might start doubting his/her competence. How can a doctor consciously send you to get zapped by gamma rays and X-rays, effectively nuking your cells and DNA? You can’t feel or see radiation but just hearing the word you’ll probably start picturing hazard symbols, nuclear disasters and maybe you’ll even hear the faint ticking of a Geiger counter. Is it all really that scary?

A short introduction on the linear no-threshold model

 The linear no-threshold (LNT) model was proposed in the early 20th century and the first government agency to adopt it was the National Academy of Sciences (NAS) in 1956. Ever since that time, the LNT model has been the subject of controversy. Every couple of years a story breaks about how inaccurate, misleading and simply untruthful the LNT model is. Most recently, a team from Loyola University took a stab at debunking this decades old theory.

 To start off, the LNT theory is a risk model used by practically all government health agencies and nuclear regulators to form a strict policy of dose limits for workers of nuclear facilities and the general public. At its core, the LNT theory proposes that cancer risk is directly proportional to radiation exposure, hence the inclusion of linear in the name. The second half of the name comes from the simple conclusion that can be made from the linear progression. If cancer risk is proportional to radiation exposure, then there is no safe threshold for radiation. This is where many biologists, epidemiologists and others chime in to say that there is no way to prove low-dose radiation exposure of <100 millisieverts (mSv) per year causes cancer. We’ll explore this argument a little later.

How does radiation cause cancer?

 Ionizing radiation is a known and well-quantified risk factor for cancer. To fully grasp the LNT model, one must first have a basic understanding of how radiation can cause cancer. The lowest dose of ionizing radiation is one nuclear particle that goes through one cell. Either the nuclear particle goes through the nucleus and damages the DNA molecule, or it doesn’t affect it at all. The most damaging is believed to be double-strand DNA breaks. The fact that radiation is a carcinogen is backed up by studies of humans (epidemiology), studies of plants and animals (experimental radiobiology) and studies of cells (cellular and molecular biology). To understand the health effects of radiation, the information from these sources must be combined and studied.

Competing theories

 Since many believe the LNT model to be insufficient and incapable of properly assessing cancer risk below 100 mSv, several theories have been proposed and tested.

The hypersensitivity model claims that there are higher risks associated with low-dose radiation compared to LNT. The threshold theory implies that risk is completely absent below certain levels, a bold statement in my opinion. An even more extreme and controversial theory is radiation hormesis, which claims that low-dose radiation is beneficial and may even prevent cancer.

The reader might be wondering if there is any evidence to support the other theories, and the answer is yes. There is evidence to support them, but it’s limited and in many cases it’s either biased or conclusions aren’t supported by the results.

Do we need the LNT?

  All countries with regulatory nuclear agencies and commissions, with a few exceptions, stand by the LNT because it is supported by a mountain of evidence. These agencies base their recommendations and policies on hard science. Even though most of them have at one point or another concluded that the evidence of cancer risk at sub-100 mSv doses is inconclusive, they don’t see a reason to change their stance.

  Is the LNT model really so bad? It has been the tried and true basis for decades of radiation protection measures. If it didn’t exist, there’s no telling what we’d be up to our ears in; solid tumors, ridiculous working conditions for workers at nuclear facilities and possibly more genetic defects than we could ever imagine.

  Anti-LNTers cry out that there is needless spending and unnecessary expenses associated with nuclear energy. But what if take into consideration the rare, yet evident threat of a nuclear disaster, like Chernobyl or the more recent Fukushima meltdown. They could’ve been many times worse if radiation protection was set up according to any of the other theories. Want to jump start your immune system to prevent cancer? In the delusional hormesis world, a doctor would send you to Chernobyl for a rejuvenating radiation cleanse.  If radioactive waste wasn’t disposed of properly, we could have radioactive sludge seeping into our water supply. Doesn’t it make more sense to be as careful as possible?

The experiment that can finally prove or disprove LNT

Because we are constantly exposed to background radiation and other carcinogens, it’s next to impossible to prove that low-dose radiation from say a yearly X-ray or CT increases cancer risk. Although there are studies showing such a correlation, there are as many studies showing the opposite. That’s why in 2006, scientists attending the Ultra-Low-Level Radiation Effects Summit came up with the perfect experiment to test the LNT model. They plan on building a special laboratory that can test the effects of no radiation on lab animals and cell cultures and compare them to control groups exposed to natural radiation levels. 

LNT- Food for thought

The linear no-threshold theory is a theory not a law. Can it be wrong about the effects of cancer risk at low doses of radiation? Of course it can, it’s a theory after all. But it’s simple, accurate beyond 100 mSv and there’s a general scientific consensus that accepts it. Getting an X-ray or CT scan shouldn’t be scary if it’ll have some diagnostic value for you. For those that argue that LNT policies require exorbitant spending, perhaps cutting military expenditure would be more practical. We can argue back and forth all day, but in the end, I believe that keeping radiation levels as low as reasonably achievable should be our priority.

By Dr. Yuriy Sarkisov, BiMedis staff writer




Full text version wil diagrams: http://bimedis.com/latest-news/browse/217/reexamining-the-linear-no-threshold-model

MDU and consent

Posted in News & media at Wed, 20 Apr 2016 18:59:34


Posts: 1305
Joined: 13 Oct 2009

The MDU is currently giving advice on consent following the Montgomery case (reminder : risk of shoulder dystocia in patient with risk factors). As usual much of the MDU advice is impractical in the hustle and bustle of day-to-day life , but there is a very relevant point in emphasising that consent has to be what one might call ad hominem - that is tailored to the individual. This I think is a fundamental point. It means that postal consent , information sheets about procedures etc.. have a more limited value than often supposed even if studies suggest these are acceptable to groups of patients.

 The practicalities and overall functioning of the NHS is not the concern of those giving legal opinions but these judgements do leave the jobbing doctor in a difficult position. 

Just how we cope is unclear but I suspect we will have to go on much as before driven by clinical pressures and weighing these against the risk of legal action. It might be interesting to see just how much operating time would be lost if surgeons , anaesthetists and endoscopists etc.. as well as obstetricians. really did go through full consent rituals every time. What will happen of course is that time will be given to those who demand it , with the usual rider that it will be taken from others. And of course however long one spends on consent and however ideally it is carried out , there will be no guarantees that a complaint will not be forthcoming . 

Good luck to those still working - as a patient on a number of occasions , I can't say that I have ever experienced the level of information suggested nor had an appointment where there would have been anywhere near enough time to go through the issues involved. When having a procedure I see that I am mainly responsible for information gathering and i am very critical of those prepared to leap on to an operating table having done less of this than they would if buying - for example- a new lawnmower. For those lacking capability or capacity other arrangements are needed , but perhaps we should not always take the lowest common denominator as the determinant of good practice ?

Is suicide a synonym of mental illness?

Posted in Psychiatry at Wed, 27 Apr 2016 01:07:29

Joey Rio

Posts: 1047
Joined: 13 Apr 2011

In the practice of mental health, there is an emphasis on risk assessment, and suicidal gestures, attempts are invariably treated as signs of mental illness. I wonder if you think that there are causes for attempting suicide that are not related to mental illness, and how can one determine the difference?

CT or MRI? How to make the right choice?

Posted in General clinical at Fri, 29 Apr 2016 06:06:46


Posts: 2
Joined: 21 Apr 2016
Aren't you sometimes  hesitating whether to choose CT or MRI?  The methodologies of these diagnostic methods don’t differ too greatly from each other: the patient lies down on the exam table and is moved along through the scanner’s opening, where layered images are then acquired and afterwards transferred to a computer. But the essence of the methods is different.
This article will attempt to highlight the differences between these two methods, so that you won’t have any doubts.

Junior Doctors strike

Posted in Sport and exercise medicine at Mon, 25 Apr 2016 18:36:49


Posts: 53
Joined: 04 May 2015

As I understand it, the Junior Doctors in the UK will go on a two day strike tomorrow. I fear that the Government wish to 'break' the BMA. I think that some in the Government would like to see a basically private system of health care in the UK. I feel that the Junior Doctors have been badly treated. But is it a dispute that can be 'won' ?

Vitamin D & Depression

Posted in Psychiatry at Sun, 24 Apr 2016 17:04:38


Posts: 607
Joined: 23 Aug 2013

A Meta Analysis & Systematic Review reviewed case-control, cohort, and case series about the relationship between Vitamin D & Depression, there seems to be a relationship between both. I wonder whether Vitamin D deficiency can be one of the causative factors of depression, a morbid outcome of depression, mere coincidence or would there be an intermediate process to explain the correlation.


Posted in Cardiology at Thu, 28 Apr 2016 13:53:28


Posts: 4
Joined: 21 Apr 2016


CTA or IVUS – which is better?

CTA (computed tomography angiography) is currently the gold standard for evaluating myocardial bridging, because it‘s highly accurate. However, recent research has shown that CTA is not all-seeing and all-knowing. IVUS (intravascular ultrasound) may be the better choice.

The study included 64 patients with symptoms of ischemia who underwent both CTA and IVUS. CTA earned its gold star, but surprisingly missed the majority of septal branches and soft plaques that could potentially cause serious complications.

Interesting? Read more just clicking on the following link:




Motion­-Tracking MRI Peers Into The Left Atrium To Evaluate Stroke Risk

Posted in Stroke at Fri, 29 Apr 2016 12:26:20


Posts: 4
Joined: 21 Apr 2016

A research team from Johns Hopkins University has discovered evidence that abnormal function of the left atrium may lead to an increase in stroke risk. As the study showed, the risk for stroke was not dependent on the presence of atrial fibrillation. The findings go against the universally accepted notion that irregular rhythm in the upper chambers of the heart during atrial fibrillation (AF) causes blood clots to form, eventually finding their way to the brain.

The study was motivated by the knowledge that the current reasoning for stroke doesn’t fit in with what clinicians see on a daily basis – not all individuals with atrial fibrillation have strokes and not all stroke victims have atrial fibrillation. So this means that people with abnormal function of the left atrium are at risk for stroke, not only those with AF. 

Lead author and cardiologist Dr. Hiroshi Ashikaga, PhD, and his team f used a 1.5 Tesla MRI scanner (Magnetom Avanta, Siemens Healthcare) with motion­tracking software called multimodality tissue­tracking (MTT) made by Toshiba to study the movement of the myocardium (cardiac muscle).


Interesting? Follow the link below to read the full article: http://bimedis.com/latest-news/browse/80/motion-tracking-mri-peers-into-the-left-atrium-to-evaluate-stroke-risk

EKG Question

Posted in Cardiology at Tue, 03 May 2016 02:07:33


Posts: 830
Joined: 21 Feb 2012

43 year old man C/O palpitation, Electrocardiogram shown below, the treating physician reduced the dose of  his medication after the ECG result

What  does the ECG show, what medication the patient was taking ?


Retire early - live longer?

Posted in Public health at Mon, 02 May 2016 13:27:14


Posts: 1690
Joined: 09 Dec 2011

   I was always a bit worried by the story that Boeing, the aircraft makers, found that  employees who retired at 55 lived on average until they  were 83 years old, but if they hung on until they were 65 they had only 18 months to live.   But I loved working, even full time,  somehow I had a good life/work balance and I went on until I was 67.      One keen anaesthetist does not a statistical sample make, but was I fated to a short retirement?     I'm still here two years later, so I've bucked that figure, but still?

It's always good to see one's prejudices confirmed, and a recent article has just done that for me.    Wu, Odden,  Fisher et al used the records of 3000 people in the US Health and Retirement Study and, to remove the potential bias of early retirement from illness, divided them into the sick and the well.  http://jech.bmj.com/content/early/2016/03/21/jech-2015-207097.short?g=w_jech_ahead_tab  About a third were in the self-reported sick group and to no one's surprise, slightly more of them died in the study period.  But of the well, those who were a year  older were 11%  LESS likely to die from any cause!   The good statisticians also allowed for socioeconomic status, lifestyle and "health confounders" (no, nor me neither) but the message is that retiring early is not good for one's health, and a moderately late one can let you live longer!

Hooray!   Fire up the Quattro and crack open the Bolly! I'm off hang gliding and bungie-jumping, 'coz I'm immortal!