On The Wards has moved to a new server. Please update your bookmarks to http://onthewards.com. Besides all the posts contained herein, the new location also provides newer articles.
I am very grateful to Blogsome for having hosted On The Wards. They made my transition into blogging fairly pleasant. I must, however, leave to be able to grow the blog beyond what Blogsome has to offer.
My first–and hopefully, only–experience as a hospital patient occurred several years ago when I needed a minor surgical procedure performed. Although I would not want to repeat this experience, it was interesting to observe the delivery of medical care from the patient’s standpoint. It was pleasant to receive the attention and respect of the medical staff following my case. I also felt pampered by the ancillary services who did the cooking and cleaning. Regardless of how tempting it may have been to just move in, I was much more eager to leave.
The hospital can be a fairly inhospitable place. The most drug-resistant pathogens wander the halls. Noisy neighbors and their noisier visitors inevitably occupy every other room. Let us not forget the infiltrated IV lines that trigger endless alarms or the monotonous beeps of the telemetry monitors. There are the mass-production renal-cardiac-diabetic diets and bareback paper-thin cloths called “gowns”. As for the hospital odors that permeate throughout the premises? Unique. Then, there is the constant interruption by the army of medicine: phlebotomists, patient care assistants, nurses, nursing students, social workers, medical students, residents, fellows, and attending physicians.
Please don’t get me wrong. The goal of this post is not to lambaste the hospital system. As a cog in the American health care machine, I am endlessly devoted to the promotion and improvement of hospitals. I just continue to be amazed how some truly ill patients can endure their pain, discomfort, and the often unfriendly environment, yet exhibit enormous patience when I awaken them at some odd hour before dawn to do my pre-rounds. My hat goes off to them.
Note: I realize the image shows a building of the University of Michigan Health System. I have no affiliation with the institution and did not target them in this post. Any similarities between this post and a patient’s experience there may be more reflective of hospitals in general and not of the University of Michigan. I have no intention to denigrate any institution or anyone.
Dr. George Lundberg, a pathologist by training and Editor-in-Chief of Medscape General Medicine, presents an intriguing method for treating seborrheic keratosis. He terms the procedure “fingernail surgery”. Dr. Lundberg also provides a helpful hint on how to differentiate seborrheic keratosis from other skin lesions, such as cancer.
Please remember that information from the Internet, including this site, cannot replace the professional opinion of a licensed physician. Consult your medical doctor when you notice a questionable skin lesion, especially if it has irregular borders, non-homogenous appearance, or changed in any way.
Happy 2007! First of all, I wish everyone an enjoyable and rewarding new year. Although the transition from one year to another is essentially an artificial designation, it is accompanied by near-mystical fanfare. Celebrations include fireworks, music, and champagne galore. The new year also compels the general human psyche to reflect on the past and make resolutions for the future.
For many of my colleagues, work continues without skipping a beat. EMS still drives in the gunshot victim at 11:59 PM on New Year’s Eve. Two minutes later, a patient complains of sharp substernal chest pain that radiates to the shoulder. For admitted patients, hospital day 2 becomes hospital day 3.
As for myself, I was lucky to have gotten the day off. This gave me time to reflect on a myriad of thoughts, including the future of OnTheWards. The project is nearing its one-year anniversary, yet the amount of content here is only worthy for a month-old blog. I have not become the prolific blogger as I had originally hoped. Given my myriad of professional and personal responsibilities, I have also had to reassess whether this would be a worthwhile project to continue. And the verdict is … yes.
OnTheWards started as an experiment of sorts. It was my first entry into the blogging world. With some reflection on the past and inspiration from the future, I feel that it will continue to be a fun and educational endeavor for a long, long time. I look forward to sharing useful and interesting tidbits, while working to enrich this blog. Happy New Year!
In this week’s issue of the journal Nature, researchers at the Washington University in Saint Louis reported on bacteria and their contribution to obesity. The mouse studies indicated that certain bacterial species were more abundant in obese mice than their lean counterparts. The “obese” bacteria were also found to harvest energy from food more efficiently with less calorie content excreted as waste. Bacterial flora from obese and lean mice were introduced in “germ-free” mice, and mice with the “obese” microbiota experienced a significantly greater increase in body fat. The group had published a related study several years ago, so the idea is not completely novel. On the other hand, it is an interesting concept that has not yet reached common knowledge.
Before anybody blames their gut bacteria as the source of obesity, recall that the study was performed on mice. The findings may or may not translate to humans. The authors describe a related study (Webb et al.) that involved human subjects. Obese individuals were noted to excrete less fecal energy than lean subjects. Although the results were not statistically significant, more research is still needed before discounting bacterial involvement in human obesity. Let us also remember that obesity results from a combination of factors. Dietary intake, physical activity, and genetic composition strongly influence body weight. In the study, the authors equalized food consumption among groups to minimize this possible confounder. Five Big Macs in the mouths of “lean” mice can still produce more weight gain than in “obese” mice fed peanuts.
The implications of the study are fascinating. Consider the potential for future gut therapy (e.g., GoLytely and antibiotic bowel prep, followed by customized bacterial inoculation) to treat obesity or promote weight loss. Time to file my patent!
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A group at the University of Wurzburg, Germany, and their European colleagues have recently demonstrated moderate reversal of some brain changes due to chronic alcohol abuse. The test subjects included 15 detoxified alcoholics who had been sober for at least 6 weeks. The researchers measured changes in brain volume, neurotransmitter metabolism, and performance on neuropsychological tests. The subjects showed improvement in all three parameters between the time of enrollment in the study and at follow-up. Improvement has been noted to predominantly affect certain regions of the brain. A control group of 10 healthy volunteers did not demonstrate a similar change.
It is worthwhile to note that the test subjects were chosen from an original cohort of 24 alcohol-dependent patients. Some exclusion criteria included concomitant nicotine abuse, alcohol withdrawal, Wernicke-Korsakoff encephalopathy, hepatic disease, or other related disorders. While the data are reassuring for short-term neurologic recovery from alcoholism, we cannot disregard the irreversible effects of chronic alcohol abuse. We do not know whether abuse of additional substances may synergistically cause irreparable damage to the brain. The potential permanency of alcohol-induced Korsakoff’s syndrome has yet to be disproven. Moreover, non-neurologic organ damage (e.g., the liver) may show little to no improvement with abstinence after enough damage has occurred. In any case, the study reaffirms the regenerative capabilities of the brain. These findings prompt further research into brain recovery with hopes for future therapies benefiting patients with brain tumors, head trauma, and chemical toxicity.
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Alzheimer disease is a chronic condition that afflicts more than 14% of the geriatric population. It is the most common cause of dementia, characterized by a progressive decline in cognitive function. Although there are pharmaceutical drugs (i.e., donepezil) that attempt to stave this decline, there is yet no cure.
A recent study published in the American Journal of Clinical Nutrition has correlated green tea consumption with a lower prevalence of cognitive impairment. Although previous animal studies have suggested a protective effect of green tea against neurodegenerative diseases, this is the first study that addresses the topic in humans.
Researchers at the Tohoku University School of Medicine (Sendai, Japan) surveyed 1003 geriatric citizens at ages 70 years or older from the Tsurugaya district of Sendai City. The study examined several variables, including the consumption of certain beverages, the health status, and the social habits of the participants. Their cognitive function was assessed using the Mini-Mental Status Examination (MMSE), a tool commonly used by neurologists and geriatricians.
The study found that participants who routinely consumed greater quantities of green tea generally scored higher on the MMSE. Consumption of black or oolong tea, or coffee did not produce similar trends. The researchers also adjusted the data for several possible confounders, such as presence of different diseases, level of physical activity, educational background, dietary habits, and substance use. The results still demonstrated a positive effect of green tea in cognitive function.
Does green tea hold promise for dementia patients? Can it reverse the cognitive decline in Alzheimer disease? What about using it as prophylaxis by healthy individuals? The findings are exciting, but there is yet much research needed to validate and extend the results of the Tsurugaya Project.
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The Valentine’s Day Edition of Grand Rounds (Vol. 2, No. 21) can be found at intueri. In keeping with the Valentine’s Day ambience, Maria creatively presents each article in the form of a “personal ad”. The On The Wards article on melatonin is listed as follows:
♥ What can I do to make you sleep with me? Perhaps you can help cure me of my insomnia… because melatonin won’t.
On a related note, I have decided to no longer feature each Grand Rounds as a separate blog entry. I feel this may be a redundant effort, as the majority of other medical blogs–some which you probably read–already announce the weekly [Tuesday] arrival of the Grand Rounds. I have nevertheless placed the Grand Rounds schedule as a link on the right-hand column of On The Wards for easy access.
Melatonin is a hormone produced by the pineal gland and associated with regulation of the sleep cycle. There have consequently been melatonin products, and biosynthetic variants (i.e., ramelteon), marketed as sleep aid products. A popular use for melatonin has been to combat jet lag or for adaptation to different time zones. Two recurring questions I have encountered regarding melatonin are whether it actually works and whether there are any adverse side-effects.
The February 10 issue of the British Medical Journal includes a study by a Canadian group that reviewed the efficacy and safety of melatonin use with secondary sleep disorders and sleep restriction. Secondary sleep disorders are sleep problems with a physiologic cause, such as hyperthyroidism or substance abuse (toxicity). Sleep restriction, on the other hand, results from voluntary sleep disruption. On-call physicians or third-shift police officers are examples of people who endure sleep restriction.
According to the meta-analysis (a review of several research efforts examining the same topic) of 15 separate studies (524 participants), melatonin is not effective for both secondary sleep disorders and sleep restriction. Commonly reported side-effects were drowsiness, headache, nausea, and dizziness. Otherwise, the report does not indicate significant adverse effects of short-term melatonin use (3 months or less).
In another meta-analysis performed by the same group, and published two months earlier in the Journal of General Internal Medicine, there is some evidence of efficacy in delayed sleep phase syndrome (DSPS), a shift in the circadian rhythm that makes it difficult for the person to fall asleep and wake up. Study participants who suffered from this disorder were able to fall asleep around 38.8 minutes earlier with melatonin. The study does not however report significant improvement in sleep onset with melatonin use for other sleep disorders. The findings on safety are similar here as in the BMJ article.
In short, melatonin is not effective for most sleep disorders, but it is safe with short-term use.
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This week, Grand Rounds (Vol 2. No. 20) is hosted at Science and Politics. There is a diversity of articles to read. Some categories include research, education, patient care, and of course, politics.
