Month: September 2013

Med Students Who Shadow Surgeons Keener on Surgery

Medical student interest in critical care surgery has fallen since the 1980s, but shadowing surgeons on a busy night bolstered enthusiasm in a small group, researchers found.

Greater interest in pursuing a surgical match was reported by medical students after shadowing general and trauma surgeons for at least one night in an urban, level one trauma center (P<0.005). Compared to only 22% of the previous year’s graduating class, 40% of participants from the shadowing program expressed intent to pursue surgical match, says Elliott R. Haut, MD, of Johns Hopkins University, and colleagues.

“Increasing student interest in trauma surgery is possible through voluntary participation in trauma shadowing experience with engaged residents and dedicated surgical faculty,” Haut and colleagues wrote online in JAMA Surgery.

The researchers cited recent data, which suggested that by the third-year clerkship it may be too late in the medical school process to draw attention towards a surgical specialty.

Since the 1980s, the rate of medical students entering general surgery has dropped by half to only 6.6%, according to the Association of American Medical Colleges.

Data from the National Resident Matching Program in 2011 showed a marked disparity between U.S. medical school graduates choosing other surgical fellowships over critical care with only 25% of colorectal surgery spots left unfilled compared with 64% of critical care spots.

“Although most students were only slightly influenced toward a career in trauma surgery, a select few students had dramatic increases in their interest,” Haut and colleagues wrote.

To test a possible way to spark greater interest in general and trauma surgical matches, the researchers invited 126 first-year medical students to voluntarily shadow trauma residents, fellows, and attending surgeons at the Johns Hopkins Hospital — an urban, level one trauma center.

Outfitted with scrubs, a trauma pager, and call-room accommodations, the students were invited to observe resuscitations, acute care surgery consults, surgical procedures, and ICU and ward rounds with practicing surgeons.

After 3 years, but before graduation or receiving a residency match, the students were asked to fill out an anonymous web-based survey. Roughly half, 68, of the original group responded to the survey.

Even though the majority of students shadowed only once, 13 did so more than once, and a few shadowed up to four separate occasions.

Twenty-five of the students had previous trauma experience as an emergency department volunteer, medical technician, or paramedic. Prior to this shadowing program, 44 of the students had not completed any hospital clerkships.

For the most part, students gave positive feedback about their shadowing experience, stating “Best experience of first year — bar none,” and “Reminded me why I came to medical school.” The most common negative feedback was boredom on a slow night with no trauma patients to treat.

On average, the students were exposed to 2.4 trauma patients (standard deviation 1.5, range 0-6), 1.1 general surgery patients (SD 1.4, range 0-6), 0.5 trauma operations (SD 0.7, range 0-3), and 0.3 general surgery operations (SD 0.5, range 0-2). Overall, 13 of the students witnessed a patient die.

On a 10-point scale, with 10 indicating the highest level of interest, each student rated his or her level of attraction to surgery. Among students that had not initially planned on going into any surgical specialty, 48 reported that participating in the shadowing program increased their interest in trauma surgery significantly (P<0.005) from 4.4 (SD 2.4) points to 5.3 (SD 2.5) points.

Interest in general surgery also increased significantly after shadowing (P<0.05) from 5.5 (SD 2.6) points to 5.9 (SD 2.5) points. A serious increase (>4 points) was reported by three of the students interested in trauma surgery. They had all seen at least three trauma patients and one trauma surgical procedure, and said that they were satisfied with the teaching they received.

Forty percent of the students stated that they intended to match into some type of surgery, and 16% planned to match into general surgery. Reports from the graduating class from the previous year indicated only 22% intended to match into surgery, and only 8% specified general surgery.

“A voluntary overnight shadowing program improves medical students’ perception of trauma surgery and increases their reported likelihood to apply into a surgical residency,” Haut and colleagues concluded.

Haut and colleagues indicated the low response rate and recall bias as possible limitations to the study.

Source: http://www.medpagetoday.com/PublicHealthPolicy/MedicalEducation/40914

Scientists discover gene that controls the birth of neurons

Scientists at A*STAR’s Genome Institute of Singapore discover gene that controls the birth of neurons. (Image: A*STAR)Scientists at A*STAR’s Genome Institute of Singapore (GIS) have discovered an unusual gene that controls the generation of neurons. This important finding, which is crucial in understanding serious diseases of the brain such as Alzheimer’s disease, is reported in the journal Molecular Cell.

The central nervous system is composed of numerous cell types that develop into a complex, higher-ordered structure. The birth of neurons (known as neurogenesis) is a process that requires exquisite temporal and spatial control of hundreds of genes. The expression of these genes is controlled by regulatory networks, usually involving proteins, which play critical roles in establishing and maintaining the nervous system. Problems with neurogenesis are the basis of many neurological disorders, and the understanding of the molecular details of neurogenesis is therefore crucial for developing treatments of serious diseases.

A neuron or nerve cell is an electrically excitable cell that processes and transmits information through electrical and chemical signals. Neurons connect to each other to form neural networks. Neurons are the core components of the nervous system, which includes the brain, spinal cord, and peripheral ganglia.

Researchers at the GIS, led by principal investigator Lawrence Stanton, discovered a key component within a gene regulatory network which controls the birth of new neurons, called RMST. Surprisingly, this new discovery is not a protein. Rather, RMST is an atypical, long non-coding RNA (lncRNA for short; pronounced as “link RNA”). The new findings demonstrate that the RNA does not produce a protein to handle the regulatory process. Instead, it acts directly as a regulatory mechanism. LncRNAs are a newly discovered class of RNA whose functions remain mostly unknown.

The new discovery of how RMST works within a gene regulatory network not only sheds light on the process of neurogenesis, but also generates new insight into how lncRNA works together with protein components to regulate the important biological processes of gene expression.

Lawrence Stanton said, “There is now great excitement about the revelation that RNA is more than just a messenger carrying genetic information that encodes for proteins. New classes of RNA, called long non-coding RNAs (lncRNA), have been discovered, which are capable of unanticipated functional diversity. However, systematic functional investigations of exactly what, and how, lncRNAs do in our cells remain scant. Our study paves the way for understanding a crucial role played by a lncRNA in human neurons.”

Leonard Lipovich, from the Centre for Molecular Medicine and Genetics at the Wayne State University and a member of GENCODE, said, “In their paper in Molecular Cell, Stanton and colleagues show how RMST, a human lncRNA, directly regulates SOX2, a key transcription factor protein that is instrumental for directing the birth of new neurons. Even more intriguingly, they highlight that RMST controls SOX2 by directly interacting with the protein. The paper is therefore an important advance in the still nascent and controversial field of riboregulators, or RNAs that regulate proteins in our cells. DNA-binding proteins that turn genes on and off were traditionally thought to be distinct from RNA-binding proteins. Stanton et al, however, illuminate the cryptic, yet crucial, RNA-binding roles for DNA-binding transcription factors: lncRNAs just might be the definitive regulatory switch that controls these factors’ activity.”

GIS executive director Huck Hui Ng added, “One cannot overemphasize the importance of neurogenesis, which is responsible for the normal functioning of one of the most important biological systems in the body. Larry Stanton and his team have made an exciting finding, one that could lead to new approaches in the treatment of neural diseases. This latest work has built upon their unique, interdisciplinary expertise, developed over the past 10 years at the GIS, in applying cutting-edge genomics technologies to the study of the human body.”

 Source: http://www.indiamedicaltimes.com/2013/08/31/scientists-discover-gene-that-controls-the-birth-of-neurons/

Many neurologists unaware of safety risks related to anti-epilepsy drugs

A study by Johns Hopkins researchers shows that a fifth of US neurologists appear unaware of serious drug safety risks associated with various anti-epilepsy drugs, potentially jeopardizing the health of patients who could be just as effectively treated with safer alternative medications

The findings suggest that the US Food and Drug Administration (FDA) needs a better way to communicate information to specialists about newly discovered safety risks, the researchers say, since the warnings are in many cases not getting through to doctors making important prescribing decisions.

The researchers add that while their new study, reported in the journal Epilepsy and Behavior, was focused on neurologists and anti-epilepsy drugs, they believe their findings are applicable to a wide spectrum of medical specialists and medications.

“There is poor communication from the FDA to specialists, and there’s some risk to patients because of this,” says study leader Dr Gregory L Krauss, a professor of neurology at the Johns Hopkins University School of Medicine. “Unless it’s a major change requiring the FDA to issue a black box warning on a product, important information appears to be slipping through the cracks. We need a more systematic and comprehensive method so that doctors receive updated safety warnings in a format that guarantees they will see and digest what they need to protect patients.”

Dr Krauss and his colleagues surveyed 505 neurologists from across the nation in different types of medical practices between March and July of 2012. They asked about several new safety risks for antiseizure drugs recently identified by the FDA: increased suicidal thoughts or behavior with newer agents; high risks for birth defects and cognitive impairment in offspring of mothers taking divalproex (sold by the brand name Depakote); and risks for serious hypersensitivity reactions in some patients of Asian descent starting treatment with carbamazepine (Tegretol). One in five of the neurologists surveyed said they knew of none of the risks. Those neurologists who treat two hundred epilepsy patients a year or more were most likely to know all of the risks.

Dr Krauss says he was most struck by the lack of understanding of the risk to certain Asian patients who take carbamazepine to control their seizures. The FDA in 2007 recommended that before initiating the drug in patients of Asian heritage, neurologists should screen to see if those patients have a specific haplotype, a specific section of DNA found in a few per cent of Asian people, before prescribing the drug.

The researchers found that 70 per cent of the neurologists who responded knew of the recommendation. While 147 neurologists (29.1 per cent) reported initiating carbamazepine treatment in Asian patients, only 33 of them (22.5 per cent) said they performed haplotype screening. Eighteen neurologists reported that their Asian patients developed carbamazepine-related hypersensitivity reactions — severe skin rashes that can lead to scarring, blisters in the mouth and shredding of the skin — during this time period.

“If their doctors were more educated about the risks,” Dr Krauss says, “these patients may have avoided these severe hypersensitivity reactions.”

Dr Krauss says doctors may not do the screening because it is difficult to find laboratories able to perform the haplotyping, and he notes that it may make more sense to prescribe an alternate drug to Asian patients.

The researchers found that 80 per cent of respondents knew that the FDA had newly warned that the risk of suicide with newer drugs is 4.3 per 1,000, double what had previously been believed. Seventy per cent said they counselled patients about the risk.

As for pregnancy risks related to divalproex, fewer than half of the respondents knew that a warning had been issued noting high risks of birth defects and of developmental risks in offspring (an 8 to 9 point drop in IQ). While 93 per cent of respondents reported counselling women planning pregnancies about the birth defect risks of divalproex, Dr Krauss says safer drugs should be used if possible during pregnancy.

Dr Krauss says part of the problem is the absence of a single place for neurologists to find updated risk information. Neurologists get safety information from scattered sources; only a few get emails from the FDA, while others get the information from neurology societies, from continuing medical education (CME) courses or from newly published journal articles.

“The FDA needs to do better getting the warnings to prescribing doctors,” he says. “There has to be a direct way to communicate risks without overwhelming physicians with messages.”

Source: http://www.indiamedicaltimes.com/2013/08/31/many-neurologists-unaware-of-safety-risks-related-to-anti-epilepsy-drugs/

What every mom needs to know about tonsil surgery

Tonsil exam istock.jpg

, kids who had tonsillectomies using the microdebrider method stopped taking pain medicine and returned to their normal activities sooner than those who had the electrocautery method.

More than 530,000 children under the age of 15 have their tonsils removed each year. About 80 percent have obstructive sleep problems – snoring, irregular breathing – and the rest are because of infection, according to The American Academy of Otolaryngology-Head and Neck Surgery.

If your child needs his or her tonsils removed, you might be worried about the procedure, the pain, and the recovery. Here, learn about the new way tonsillectomies are done, if it’s right for your child, and the important questions you need to be asking.

The new way tonsillectomies are done

There are several ways doctors remove tonsils, with one of the most common being the electrocautery method. Using a handheld metal probe heated by an electric current, the tonsil tissue is destroyed and bleeding is well controlled. Yet, because heat is used, the soft tissue of the throat is burned, which causes more pain and a longer recovery.

However, within the last 10 years, doctors have been using a less painful method known as PITA—Partial Intracapsular Tonsillectomy and Adenoidectomy. Using a microdebrider, the surgeon “shaves” the tonsils with a rotating blade and uses suction to stop the bleeding.

“The surgeon is removing the tonsils from what we call inside out – from the center of the throat to the side wall,” said Dr. Julie L. Wei, a pediatric otolaryngologist who practices at Nemours Children’s Hospital in Orlando, Fla.

So instead of removing all of the tonsils, about 90 percent are removed, leaving the capsule or outermost layer behind.

“There are lots of benefits to doing a partial,” said Dr. Didier L. Peron, an attending physician at Morristown Medical Center who is board-certified in otolaryngology-head and neck surgery.

For starters, the nerve endings are not exposed and there’s no damage to the arches of the throat. As a result, children experience less pain, a shorter recovery, and the chance of bleeding is reduced.

According to a study in the journal Otolaryngology-Head and Neck Surgery, kids who had tonsillectomies using the microdebrider method stopped taking pain medicine and returned to their normal activities sooner than those who had the electrocautery method.

Another study also found that kids were at less risk for bleeding and dehydration after surgery. Pain can cause children to refuse to eat or drink, and many are re-admitted to the hospital with severe dehydration, according to Peron.

Can tonsils grow back?

Not all children are good candidates for a partial tonsillectomy, particularly for those who have repeated infections like strep throat. If the tissue is left behind, “there’s a concern they can still get strep more, even though they’ve had their tonsils out,” Wei said.

And with any kind of surgery, there are risks, which include removing normal tissue like the uvula.

But perhaps one of the most significant drawbacks is regrowth. “There’s no doubt that occasionally the tonsils keep growing,” said Peron, who explained that the chances are more likely in young kids. He estimated a 10 percent chance that tonsils will grow back for 2- and 3-year-olds.

There’s one caveat to the question of re-growth, however. Often times, a pediatrician will look in a child’s mouth and see the tonsils but not the scar they’re used to seeing with the electrocautery method. They tell the family the tonsils are there, but “they never realized it was 10 times as big three years ago,” according to Wei. The family is lead to believe the tonsils grew back when actually, “it has to do with how it looks. Maybe there’s not that much regrowth at all,” she said.

The best thing to do is to return to the doctor who did the surgery for a proper evaluation. And even if they did grow back, if it’s not causing the child any problems, leave it alone.

Source: http://www.foxnews.com/health/2013/09/01/what-every-mom-needs-to-know-about-tonsil-surgery/

 

Go makeup free once a week to delay ageing

Rita Strazinska has urged women to go makeup free one day a week to protect the skin

Most women can’t imagine stepping out of the house without makeup, but avoiding it one day a week, can help in delaying the ageing process, suggests a skincare expert.

Rita Strazinska, founder of Bio2You Organic Seabuckthorn skincare, has urged women to go makeup free one day a week, for a minimum of 24 hours, to help protect the skin and allow it to rejuvenate without being weighed down by cosmetics, reports femalefirst.co.uk.

“By opting to give skin a breather once a week, accompanied by a good skincare routine, women may find their self-confidence levels actually increase as they notice the condition of their skin improving, whilst the world has chance to appreciate their natural beauty,” said Strazinska.

Following are the key reasons behind her tip:

A clearer complexion: No makeup can help in reduction of spots, blemishes and acne. Makeup can also irritate the skin, leading to redness and allergic reactions.

Go chemical free: Most cosmetics have harmful chemicals like parabens, so it is wise to give skin a rest from such ingredients at times.

More time: The average woman spends around 20 minutes every morning putting on makeup. Going makeup free means more time to sleep or eat breakfast!

 

Women over 60 need to exercise only once a week

Doing a little bit of exercise can go a long way,” Gordon Fisher, Ph.D., primary investigator of the study and assistant professor in the Department of Human Studies

A new study has suggests that women over age 60 may need to exercise only one day a week to significantly improve strength and endurance .

The study, by researchers at the University of Alabama at Birmingham (UAB), monitored 63 women performing combined aerobic exercise training (AET) and resistance exercise training (RET) for 16 weeks.

One group performed AET and RET one time per week, a second group two times per week and a third group three times per week.

The study found significant increases in muscular strength, cardiovascular fitness and functional tasks in each group, but there were no significant differences in outcomes among groups.

“One of the biggest barriers to exercise training for the older female population is adherence, and one of the key findings in this study is that doing a little bit of exercise can go a long way,” Gordon Fisher, Ph.D., primary investigator of the study and assistant professor in the Department of Human Studies in the School of Education, with a secondary appointment in Nutrition Sciences in the School of Health Professions, said.

“Telling people that they need to do at least three to five days of exercise to improve their overall health can be a major obstacle.

“Lack of time is the most often-cited barrier to exercise adherence. This study demonstrates that doing as little as one AET and one RET workout each week can provide a lot of benefit for older women`s overall quality of life and health,” he said.

The study is published in The Journal of Strength and Conditioning Research.

 

Statins proved to be best for treating cataracts

Statins are among the most commonly prescribed medications for cataracts, which is the leading cause of visual impairment worldwide affecting more than 20 million people, according to research.

In the USA they are prescribed to 1 in 3 people over 45 years of age at a cost of 35 billion dollars annually.

“There is persistent concern among physicians and other health care providers about the possible cataractogenicity of statins.1 We therefore investigated the relationship of statins and cataracts in a meta-analysis of 14 studies selected after detailed review of the medical literature. To our knowledge this is the first meta-analysis on the topic,” Professor Kostis said.

The meta-analysis included 2,399,200 persons and 25,618 cataracts. The average duration of treatment was 54 months and average age was 61.

Using random effects meta-analysis, a statistically significant decrease in cataracts with statins was observed.

“This corresponds to an approximately 20 percent lower rate of cataracts with statin use compared to no statin use,” professor Kostis said.

Meta-regression showed that younger people were more likely to benefit.

 

Botox can help treat more than just wrinkles

Dr. Matthew Kircher of Loyola University Medical Center is giving patients Botox injections to treat facial nerve disorders that sometimes occur after Bell`s palsy

Botox, which is best known as a cosmetic treatment for frown lines, can also effectively treat the after effects of Bell`s palsy and other serious facial nerve problems.

Bell`s palsy results from damage to the facial nerve that controls muscles on one side of the face.

Ear-nose-throat surgeon Dr. Matthew Kircher of Loyola University Medical Center is giving patients Botox injections to treat facial nerve disorders that sometimes occur after Bell`s palsy, including unwanted facial movements known as synkinesis.

Botox injections work by weakening or paralyzing certain muscles or by temporarily blocking the nerve input into the muscles.

Facial synkinesis is the involuntary movement of one set of muscles when the patient tries to move another set of muscles. For example, when the patient blinks, the mouth smiles or grimaces.

Botox can improve the symmetry of the face and reduce muscle contractures and spasms.

Botox also is effective for platysmal banding – verticle lines that develop in the neck as a result of muscle contractions.

Kircher said that he starts out conservatively, treating patients with dilute doses.

After seeing how well the patient does, Kircher adjusts the dose if necessary.

Botox is not a cure. The drug wears off after three or four months, so patients need repeat injections.

 

Two-drug combo to help in fight against HIV

A combination of decitabine and gemcitabine to be delivered in pill form, marks a major step forward in patient feasibility for the drugs

A research team has devised a new delivery system for a combination of two FDA approved drugs, which could help effectively treat HIV.

The discovery, which allows for a combination of decitabine and gemcitabine to be delivered in pill form, marks a major step forward in patient feasibility for the drugs, which previously had been available solely via injection or intravenous therapy (IV).

Steven Patterson, Ph.D., professor at the Center for Drug Design at the University of Minnesota, said that if a person has a condition that requires them to take a medication every day, as many patients with HIV do, they wouldn`t want to have to take that medication via daily injection.

University of Minnesota researchers first announced decitabine and gemcitabine could potentially combine to treat HIV in research published in August 2010.

The drug combination was shown to work by lethal mutagenesis that could obliterate HIV by causing the virus to mutate to a point where it was no longer infectious. For some patients, HIV`s ability to quickly mutate and evolve can result in drug resistance.

For patients who have developed resistance to currently available HIV treatments, the decitabine-gemcitabine drug combination could prove an effective alternative and secondary line of defense.

In addition to a potentially effective treatment for humans with HIV, the combination also shows potential to treat cats with leukemia.

The study has been published online in the journal Antiviral Chemistry and Chemotherapy.

 

Soon, pill to prevent stroke, heart attack

A pill to prevent stroke, University of North Carolina discover for a new class of antithrombotic therapies

Researchers have uncovered a key platelet protein that may offer a new angle for developing drugs to prevent stroke and heart attack.

Lead study author Stephen Holly , PhD, assistant professor of biochemistry and biophysics at the University of North Carolina School of Medicine, said that I think we’re at the start of an exciting journey of drug discovery for a new class of antithrombotic therapies.
In the human circulatory system, platelets are something of a double-edged sword. Without their clotting abilities, even a minor injury could result in potentially fatal bleeding.

But during a heart attack or stroke, platelets form a clot that can potentially block blood flow through our veins and arteries, a dangerous condition called thrombosis, which can deprive tissues of oxygen and lead to death.

Holly and his colleagues uncovered several potential drug targets using a screening technique that has never before been applied to the cardiovascular system.

The technique, called activity-based protein profiling, has been used in cancer research and allows researchers to track the actual activities of proteins operating within a cell.

The team first pre-screened human platelets to narrow the field of drug-like compounds then generated an activity-based protein profile using one of these compounds to single out proteins that play a role in platelet activation.

This new knowledge of platelets’ natural “on-off” switches could be exploited to develop drugs that keep platelets from forming pathological blood clots. As a next step, the researchers hope to investigate the proteins’ roles in animal models before potentially pursuing clinical trials in humans.

The study has been published online in the journal Chemistry and Biology.