Questions related to Internal Medicine
There are news on COVID-19 outbreak on ship, no matter cruise or military one.
And few aircraft carriers are also involved.
What is special about the ship arrangement that facilitated all these?
Nature 580, 18 (2020)
Limiting spread of COVID-19 from cruise ships - lessons to be learnt from Japan,
QJM: An International Journal of Medicine, , hcaa092,
COVID-19 outbreak on the Diamond Princess cruise ship: estimating the epidemic potential and effectiveness of public health countermeasures,
Journal of Travel Medicine, , taaa030,
Public Health Responses to COVID-19 Outbreaks on Cruise Ships — Worldwide, February–March 2020. MMWR Morb Mortal Wkly Rep 2020;69:347-352. DOI: http://dx.doi.org/10.15585/mmwr.mm6912e3
Estimating the asymptomatic proportion of coronavirus disease 2019 (COVID-19) cases on board the Diamond Princess cruise ship, Yokohama, Japan, 2020.
Euro Surveill. 2020;25(10):pii=2000180.
Chest CT Findings in Cases from the Cruise Ship “Diamond Princess” with Coronavirus Disease 2019 (COVID-19)
COVID-19 is mainly a respiratory disease that affects the lung, although other organ structures with endothelium seems to be affected too.
When should we do imaging?
What is the aim of the imaging?
How can it help with management?
Do you agree with the following consensus statement?
How will you adjust your own practice and difficulties encountered? Why?
The Role of Chest Imaging in Patient Management during the COVID-19 Pandemic: A Multinational Consensus Statement from the Fleischner Society. Chest. 2020 Apr 07.
What are the most common urine and blood tests required for diseases diagnostics and before drug dosing prescriptions?
Under COVID-19, healthcare facilities requests a lot of sterilization to prevent hospital transmission of the disease. Bleach solution and many other disinfection agents may not be effective against such a large scale of usage.
Can ultraviolet light be used to inactivate the virus?
Can it be applied on whole room disinfection?
Can it be used on high turnover medical equipment sterilization? E.g. stethoscope.
Can it be used to inactivate infected donors' blood products or body fluids?
It's 99 days since the first case of COVID-19 in Hong Kong, and we are welcoming the 5th days of 0 new cases of COVID-19 following a week of <10 cases per day.
How should we define the end of a local endemic?
How long should the latent period be defined?
When is it safe to resume social activities?
Should territory wide screening of asymptomatic people be done before declaring the end of endemic?
Under the pandemic of COVID-19, screening becomes important to tackle the spread. Fever is one of the screening criteria for many public places screening for access.
However, how is fever defined?
Is the 0.1 degree change makes the significance?
What is the range of standard deviation being acceptable?
What machine is accurate?
Is those hand held infrared measuring machines reliable?
Is there scenarios giving false negative tha may make a huge consequence?
Normal Body Temperature: A Systematic Review.
Open Forum Infect Dis. 2019;6(4):ofz032. Published 2019 Apr 9.
Is there a complete tutorial for using EHR (Electronic Health Record)?
I mean extracting some data like how many people have specific symptoms?
JAMA. 1990 Sep 26;264(12):1556-9.
The effect of cigarette smoking on hemoglobin levels and anemia screening.
Nordenberg D1, Yip R, Binkin NJ.
How can a patient safely taper off bisoprolol 2.5 mg who used it once daily? What schedule can he follow to taper off gradually? Any reference/paper/textbook for doing this?
I can't seem to find "the American Journal of Internal Medicine"'s impact factor. Does anyone know their IF and if its pubmed indexed.
In general, what are good medical research indexing for journals to have ?
Presenting it in a graph would make it easier for readers to capture the pattern, but no new info is added other that what's mentioned in the table.
Recently I have been assigned several tasks of making presentations for webinar by a superior. The presentations are mainly about treatments in oncology such as immunotherapy and targeted therapy.
In the process of making the presentation, a few graphs such as kaplan-meier survival are needed to be included in the PowerPoint presentation. However, I then suddenly remembered that several speakers in symposiums had this sort of beautiful graph (Picture 1.). When I check the PowerPoint file, it is as if they design or make the graph in the PowerPoint directly, resulting in a well-suited graph for viewing.
On the other hand, the best that I could do was downloading the figure or slides directly from the journal and even then, it was still horrendous occasionally and unsuitable for presentation in my opinion (Picture 2.)
I want to ask whether there is an easy way to make beautiful graph like in picture 1 without allocating significant time. I also want to know how they do it. Do they use professional designers in the firstplace or is there an automatic software to make this?
Many thanks for the help
Many studies and analyes we do require statistics to back up. However, many times the results run out to be statistically significant, yet when interpret it in the clinical context, it is too small to be significant.
This is rather frustrating. Any solution for solving this?
Is those very small interval unit scale more easily affected?
Can we change our analytics method to cope with the results?
Beyond statistical significance: clinical interpretation of rehabilitation research literature.
Int J Sports Phys Ther. 2014;9(5):726–736.
Hello, I am appraising a survey study of nurses. The researchers, who are nurses, have cited that study participants were selected from their own department in a general internal medicine unit. Is this considered a potential selection bias because of the personal association between the researcher and study participants.
Many Thanks for any feedback.
COVID-19 has pull people apart from each other. Social distancing is the main way to prevent spreading of infection. Tele-medicine, once used for rural area remote healthcare model, is the emerging new way of practice under COVID-19.
Different specialties have different practicing needs, what difficulties do you encounter on applying tele-medicine under COVID-19 in your specialty? Will tele-medicine totally uproot the usual face-to-face room consultation of medical practitioners? And becoming the new service model?
What is your view?
Virtually Perfect? Telemedicine for Covid-19
Covid-19 and Health Care’s Digital Revolution
Telemedicine in the Era of COVID-19
The Journal of Allergy and Clinical Immunology: In Practice
Keep Calm and Log On: Telemedicine for COVID-19 Pandemic Response.
‘Healing at a distance’—telemedicine and COVID-19
Public Money & Management
The Role of Telehealth in Reducing the Mental Health Burden from COVID-19
Telemedicine and e-Health
As a public health measures to control the spread of the pandemic coronavirus, social distancing and home quarantine are implemented in some countries.
As a matter of fact, patients are absence from clinic under COVID-19, and clinic-based diabetic control monitoring becomes challenging.
Do you expect a change in diabetic control for these patients when staying home?
They have less exercise, and may eat more snacks at home.
Or in contrast, they are too bored, and have time to develop new exercise without pressure from work? Besides, they are banned from social around, and may eat drink less alcohol and eat less feast.
What do you think?
COVID-19 is spreading around the world, and faeces were popular and agreed for the presence of viral RNA with different studies reported. Its presence mean that the gastrointestinal (GI) tract is one of the hosting organ for such coronavirus.
How are other parts of the GI tract system affected by this virus?
Clinical features of covid-19-related liver damage.
Clin Gastroenterol Hepatol. 2020 Apr 10.
Pancreatic injury patterns in patients with COVID-19 pneumonia.
Gastroenterology. 2020 Apr 01.
COVID-19 is affecting all kinds of human activities, research is not exempted. Many ongoing research studies are not paused because of COVID-19, patient recruitment cannot be continued, follow up visits are not stict to schedule, intervention procedures may be delayed, blood test monitor are postponed.
I would expect a higher loss to follow up rate during this period, which would affect the reliability of research. Even after COVID-19, will the recruited subjects have some difference than those recruited before?
What do you think?
Working in the research field, you will be weighted by your h-index.
However, publications might not be cited by others despite your hard work.
Do you think we should publish only citable research or publish as many as we could to contribute the academic field?
50 years old man who visited Internal medicine clinic doing well without any complain or any other disease. He said to the doctor that he is screening his blood sugar at home (finger prick device)He had family history of DM2 so he was anxious about his situation. All the readings during the day are normal except that at early morning which was around 107 mg/dl in average for the last 30 days. Knowing that he sleep at 11pm and glucocheck done at 9 am.
*Should I consider this reading Abnormal and treat him as a pre-diabetic person ?
*Note: This Q is only to improve my knowledge about DM
I co-authored an article in 2011 on a new effective Migraine treatment (Winter Edition of the Canadian Journal of General Internal Medicine), authored by Kenyon and Phillips yet Research Gate prints that I cannot upload unless I am an author. I am! My name was second but I equally authored and performed the research.
B L Phillips
Helicobacter pylori inhabit the gastrointestinal tract, one person’s poison may be another’s cure. Helicobacter pylori, the bacterium that causes gastric ulcers and stomach cancer in some people, may actually protect against cancer of the esophagus. So, What about your experience in the paradoxical effect of Helicobacter pylori infection? and why their resistance to treatment was increased?
Age-related immune system dysfunction and inflammatory cell signals are prevalent in the geriatric population. Which is more responsible for rhinitis and post-nasal drip, and what other factors may be involved?
Collecting ideas of research regarding the above mentioned field to formulate a phd proposal
For example , instead of heart beating so fast = Palpitations
Faint, pass out = Pre-syncope
What is this process called (Translation of what the patient describes into medical terminology) so I can study it more efficiently and search more info.about it?
When you prescribe a medication, what is your go-to-site/book/reference to check for adverse reactions? And what type of adverse reactions do you check? Is it type A adverse reactions only that you check?
And in other words: what are the most important adverse reactions that you must check?
This is an area I have been involved in for several years with contacts in China, including the Cooper China Center, where I have visited and lectured. Two good friends and esteemed colleagues are doing a lot with the Chinese, and we have a contingent visiting our lab/cardaic rehab program in June. My contacts include: Drs James Skinner, Weimo Zhu, and Wilson Zhu. If I can be of help to your group, or become formally involved, I'd welcome the opportunity.
Barry Franklin, PhD, FAHA, MAACVPR, FACSM
Director, Preventive Cardiology/Cardiac Rehabilitation
Professor, Internal Medicine, OUWB School of medicine
Excuse my naive experience in this area.
Lets assume we have a patient with 2nd degree hemorrhoids, and we want to apply topical product to reduce the swelling of hemorrhoids, do we apply the product on the hemorrhoids after it prolapse or we wait till it return to its position spontaneously then we apply using an applicator? I mean the proper timing for the application of the product.
Second scenario, we have a patient with third degree hemorrhoids, will we apply the product on the prolapsed hemorrhoids or we reduce it manually then we apply the product afterwards using the applicator?
When we sent a project to our ethical committee, they usually ask: 'how can a family physician relevant to this topic?' I would like to know 'what are the limitations of a family physician to study?'. Surgery? Internal medicine? Psychiatry? Genetics? ...
I am working on a forensic case with a psychiatrist regarding a man we evaluated in a psychiatric evaluation who developed complex partial seizures due to clandestine lab exposure, specifically lithium and methamphetamine labs, throughout his career working as a police officer. We reviewed his current list of medications, and he is taking 50 mg of sertraline (Zoloft) once per day.
The research that I found shows that higher doses of sertraline increases the risk of seizure, including partial complex, and that sertraline and methylphenidate (a CNS stimulant) can precipitate seizures. Though, I'm trying to eliminate variables here... 50 mg qd of sertraline is an ordinary prescription. Were the lithium and/or meth vapors interacting with his sertraline, or is there another reason why he was experiencing seizures?
Do you have an idea about the source of light through which we see dreams ? and what is the source of light through which we can see the colors we see in dreams?
I wish you all the best
This question has arisen from contributor Pete Batcheller, who added a response to my question "Is Botox an effective treatment for Episodic Migraines?". Mr Batcheller is a very dedicated believer that high dose Vit D3 is effective in preventing Cluster Headaches (CH).
High dose Vit D3 has been researched for its anti-inflammatory functions and it is possible it may help reduce the incidence and severity of CH when used in doses of 10,000 IU a day. Bearing in mind the morbidity of CH and the low price of VitD3 supplements, it suggests it is worth trying provided the potential harmful effects of Hypervitaminosis D are avoided.
He quotes a paper "Burton et al. titled A Phase I/II Safety Trial of High Dose Oral Vitamin D3 with Calcium Supplementation in Patients with Multiple Sclerosis" where doses up to 40,000IU a day were given over 48 weeks and the serum 25(OH)D (along with Serum + Urinary Calcium and other markers were measured)
While it is very clear to me that this is not a sufficiently long period to be certain that the long term dangers of heart attacks and kidney damage due to increased serum 25(OH) are not worsened, the interesting observation from Burton's work was that though there was a significant delayed rise in Serum 25(OH)D to a maximum of 410nmol this fell again to approx 200nmol during the period when 10,000IU was taken, and by extrapolation would probably fall further if the time the 10,000IU was take had been extended
It is now generally accepted that 5,000 IU given long term is safe
So, bearing in mind the intense morbidity of CH and CH may be associated with low serum levels of 30nmol or less of 25(OH)D:-
1. Does anybody have experience of high dose (10,000IU/day) VitD3 for CH
2. What serum level of 25(OH)D would be safe to run at for extended periods? Is 200nmol safe? What papers are there to back up safe levels when adminise
Is that a true organ?
What do you think?
Your body is lined with a network of fluid-filled cavities that—until now—were unknown to science. The team that made that discovery thinks the cavities qualify as a new human organ, which they’ve dubbed the “interstitium,” Live Science reports. The new organ was spotted when researchers looked at live human tissue with a new imaging technique. Previous methods have mostly looked at tissue that’s dead and drained of fluid, so the cavities weren’t visible, the team reports in Scientific Reports.
I would like to belong to this project. Which is the first step?
Diana Rodríguez Hurtado M.D FACP
Full Professor Faculty of Medicine Universidad Peruana Cayetano Heredia.
Internal Medicine - Geriatrics
Master in Clinical Epidemiology.
Mobile: 51 999395806
I was approached by this journal for reviewer/editorial board membership, but not sure if they are legit.
Complications related to viral hepatitis, alcohol-related and non-alcoholic liver disease, are the main reason for seeking gastroenterologists and hepatologists advice. In addition, hepatocellular carcinoma often arise on the ground of hepatitis, representing the fifth most common cancer in men and the ninth in women. In 2015, the World Health Organization estimated that 325 million people were living with chronic hepatitis infections (hepatitis B or C) worldwide and that globally, 1.34 million people died of viral in 2015.
In front of this global health problem, gastroenterologists, hepatologists and hepato-biliary-pancreatic (HBP) surgeons, are daily involved in the clinical routine in taking difficult clinical decisions. As Sir William Osler quoted: “medicine is a science of uncertainty and an art of probability” and no doctor returns home from a busy day at the hospital without the nagging feeling that some of his/her diagnoses may turn out to be wrong, or some treatments may not lead to the expected cure. Probability is a recurring theme in medical practice and the ability of dealing with risk and uncertainty can be elicited through a special kind of intelligence. In 2012, The UK psychologist Dylan Evans defined it as “risk-intelligence” that is "a special kind of intelligence for thinking about risk and uncertainty", at the core of which is the ability to estimate probabilities accurately.
Consequently, doctors are routinely asked to make predictions, and their predictions would lead to a consistent payoff when regarding a patient’s life. At the basis of “wise” medical decisions, physician’s experience surely plays a vital role. However, doctors can assume that their competency in a given area can be significantly higher than it really is. Such illusory superiority, is described as the Dunning – Kruger effect, a meta-cognitive bias leading to a discrepancy between the way people actually perform and the way they perceive their own performance level. The concept of “risk-intelligence” relies on the confidence that each subject has with their own knowledge, thus returning accurate probability estimates, and a “wise” doctor should be aware that he/she do not known, thus, returning high risk-intelligence.
To date, little is known about risk-intelligence and the Dunning – Kruger effect between doctors, and, especially, among hepatologists, a specialty strongly involved in important clinical decisions. With this aim we conducted a survey to test how risk-intelligence affects medical decision making in this particular clinical setting and whether the Dunning – Kruger bias can effectively affect these physicians.
If you are a gastroenterologist, hepatologist or HBP surgeon please help us in investigate this issue by completing the following survey:
S-1 seems to be seriously useful against a variety of tumors, & my remote research at Yale, on 5-azaorotic acid (pyrimidine antimetabolite, which he calls "Oxo") was cited in Shirakawa's original paper (misspelling my name "Grant" in the text, but correctly as "Granat" in the reference).
We had given it IV; he incorporated it as PO, leading to significant diminution of the side-effects of 5-FU.
I think we need that oral drug here in the US, for gastric & pancreatic cancer; & probably for colon, although it's fairly equivalent to Xeloda.
I did not continue in research or oncology, but became a practicing Family Physician, still in Private Practice, but very interested in what has become of my humble research years ago. And I have patients who I believe could benefit from the advantages of S-1.
I would especially like to hear from any of the Japanese original researchers.
Pepi Granat, MD
Pepi Granat, MD
D-ribose has demonstrated significant enhancing abilities in replenishing deficient cellular energy levels following myocardial ischemia, does the metabolic pathway differ from that of D-glucose? It seems to be more ready for catabolism for the ischemic tissue in the congestive heart failure!!
The effects of Daith ear piercings on migraines was first noticed by chance.
After Dr Thomas Cohn a respected pain physician in the USA noted on his blog in March 2015 that people were reporting improvements in their migraines, increasing numbers of migraine sufferers are having Daith Piercings.
Is anybody studying this effect?
The project is intriguing demonstrating that targeted external irradiation of rabbits or dogs with energetic carbon ions can reduce fatal ventricular arrhythmia via upregulation of gap junction protein connexin 43 and that such antiarrhythmogenic potential persists at least one year after single irradiation.
Heart has long been considered as one of radioresistant tissues. For instance, TD5/5 for the heart (tolerance dose at normal tissue complication provability of 5% within 5 years after fractionated exposures) was considered to be 40-60 Gy depending on the volume irradiated within the heart, for which effect considered was perimyocarditis ( https://www.ncbi.nlm.nih.gov/pubmed/2032882 ).
However, the International Commission on Radiological Protection (ICRP) now classifies circulatory disease (cardio- and cerebrovascular disease) as tissue reactions (formerly called deterministic effects or non-stochastic effects) and has recently recommended the first ever threshold to the heart and brain. The threshold dose recommended was 0.5 Gy independent of dose rate, which was recommended as dose causing 1% circulatory disease mortality at >10 years after exposure.
The dose used in the project is 15 Gy, which is significantly higher than 0.5 Gy (but of course with the caveat that the threshold for humans can not directly be compared with that for rabbits or dogs). In addition, the relative biological effectiveness (RBE) value of carbon ions for circulatory effects, which I do not think is available, may be high.
Therefore, in the short term the recovery from fatal ventricular arrhythmia will surely outweigh the risk of "second" life threatening circulatory effects, but in the long term the impact of such late onset circulatory effects may need to be considered.
Its a very common condition we are encountering. Its difficult to keep patients for long in hospital to control HTN only,
Annals of Internal Medicine published today a very interesting paper introducing the "E-value" as a way of assessing robustness of Relative Risk, Odds Ratios, Hazard Ratios etc which may change how we interpret and present these statistics. I'd like to hear the opinion of statisticians?
If anyone want to play with the E-value I've attached a calculator
Acute pulmonary embolism has varied presentations ranging from asymptomatic, incidentally discovered emboli to massive embolism, causing immediate death. Tumor embolism is a rare but unique complication of malignancies. This uncommon catastrophe of a malignant tumor in a young patient, culminating as a pulmonary embolism, is being reported for the first time
Hi to everyone. I treated with iv iron only (1.5 g of FCM) a 13 years old girl presented with extreme anaemia at Paediatric ER. Starting Hb was 3.3 g/dL and the girl experienced only a mild asthenia and mild tachycardia. After 28 day Hb arose to 11.9 g/dL and general conditions quickly improved.
I would like to write a Case report.
Does anyone know other similar cases in literature? The patient isn't a Jeovah Witness.
I want to calculate the appropriate dose of ferrous sulfate for anemic patient depending on MCV, HB level and his diet ?
In the web from Health university of Utah, it said that the right atrium contracts slightly before the left atrium.
Any references discuss about it?
Can in future combined CT FFR and CT coronary angiography replace invasive coronary angiography for diagnosis of CAD ?
A patient took 4500 mg acetaminophen in 3 days span along with the following drugs prescribed by a homeopath practitioner- Arsenic, Calcium Sulphide and Bryum album (dipped in alcohol). He developed Fulminant Hepatic Failure SGPT rocketed from 1158 U/L to 3796 U/L overnight. No virus detected. Can acetaminophen do such damage at so low dose?
A 21 year old had a strep throat infection 2 months ago. She took two courses of Amoxicillin and clavulanate potassium 875 mg / 125 mg. 2 weeks ago she went to an ENT specialist complaining that her voice has not returned to normal yet. She had a laryngoscopy that revealed the presence of esophageal candidal infection that has ascended to the larynx. She was prescribed Clarithromycin 500mg 1 pill/day for 7 days, Pantover 40mg 1pill/day for 20 days, Fexofenadine hydrochloride 120mg 1pill/day for 10 days.
She had a stool analysis done on the same day same day because she also complained of mucous in her stool. It revealed the presence of yeast. No ova, or cysts were seen. Pus Cells were 0-1/HPF. Erythrocytes were 1-2/HPF. No occult blood was seen.
Some answers come in a recent webinar where my close colleagues from VRCM* cover this question based on their own experience and that from other groups in the field. This recorded talk is available on-demand at: www.stagowebinars.com
*) F. Dignat-George & R. Lacroix from Vascular Research Center of Marseille (F), see corresponding ResearchGate pages
A late event In Constrictive ventricular hypertrophy is a sudden dilatation, which clinicians understand to be a critical sign of impending final heart failure. Linzbach, the famous german Cardiopathologist, introduced into literature the term " Gefügedilatation" hence suggesting that the myocardial alignmrent is rearranged such that the heart dilates. Unfortunately, even his pupil famousWaldemar Hort could explain after Linzbach died, how his teacher had conceived the reallignment might happen.
A long standing hypertensive patient with heart failure of reduced ejection fraction. He is in functional class II and recently presented with bradycardia increasing fatigue.
Is there any guideline or published papers regarding the use of maintenance IV fluids in patients with fluid overload (eg. CKD or HF) who are already using diuretics to relive symptoms of pulmonary congestion??
As many as 20% of patients with community-acquired pneumonia (CAP) worsen despite guideline-adherent antimicrobial therapy; in fact, some cases are caused by viruses (NEJM JW Gen Med Sep 1 2015 and N Engl J Med 2015; 373:415). Systemic corticosteroids might reduce the cytokine and inflammatory responses that can lead to some CAP treatment failures. In two recent randomized controlled trials, researchers found outcome improvements with steroid therapy (NEJM JW Infect Dis Mar 2015 and Lancet 2015; 385:1511; NEJM JW Infect Dis Apr 2015 and JAMA 2015; 313:677); however, these trials were not powered to detect mortality differences.
42 year male, case of Hepatitis C (genotype 3) with very high viral load, was treated with Sofosbuvir 400 mg OD with Ribavirin 800 mg, tolerated well with rapid viral response rate. After 12 wks of therapy, he has started c/o severe weakness, and his baseline blood parameters showed Hb of 5.6 gm/dl amd TC of 5000/cmm with normal DLC. Other parameters are normal. Now, whether to stop Ribavirin or simply reduce the dose? Is there any role of Erythropoitein? If yes, at what dose?