Wednesday, July 26, 2017

Normal of testosterone levels following replacement therapy associated with a decreased incidence of atrial fibrillation


Abnormal p wave axis is a risk factor for stroke



Conclusions—aPWA is independently associated with ischemic stroke. This association seems to be stronger for cardioembolic strokes. Collectively, our findings suggest that alterations in atrial electric activation may predispose to cardiac thromboembolism independent of atrial fibrillation.

Tuesday, July 25, 2017

Disclosing conflicts of interest to patients


Here is another article from JAMA’s theme issue on COI.

Negative cost incentives as COIs have received relative little attention in the past but are dealt with in this piece:

Physicians and hospitals can also participate in financial agreements in which they generate more revenue if less health care or less expensive medications or devices are used…

..considerable evidence suggests that these financial relationships may exert unconscious influences on physician behavior, particularly when the cost of care, rather than patient clinical outcomes, is involved.

That is a real concern and should present a huge problem to those among our leadership who advocate for the “new professionalism” under which the doctor is to simultaneously advocate for the patient and the population. That puts the individual clinician right in the middle of the conflict which, when disclosed (and disclose we must in this age of transparency) has the potential to undermine trust.

Sunday, July 23, 2017

Capillary leak syndrome


From a recent review:

In various human diseases, an increase in capillary permeability to proteins leads to the loss of protein-rich fluid from the intravascular to the interstitial space. Although sepsis is the disease most commonly associated with this phenomenon, many other diseases can lead to a "sepsis-like" syndrome with manifestations of diffuse pitting edema, exudative serous cavity effusions, noncardiogenic pulmonary edema, hypotension, and, in some cases, hypovolemic shock with multiple-organ failure. The term capillary leak syndrome has been used to describe this constellation of disease manifestations associated with an increased capillary permeability to proteins. Diseases other than sepsis that can result in capillary leak syndrome include the idiopathic systemic capillary leak syndrome or Clarkson's disease, engraftment syndrome, differentiation syndrome, the ovarian hyperstimulation syndrome, hemophagocytic lymphohistiocytosis, viral hemorrhagic fevers, autoimmune diseases, snakebite envenomation, and ricin poisoning. Drugs including some interleukins, some monoclonal antibodies, and gemcitabine can also cause capillary leak syndrome. Acute kidney injury is commonly seen in all of these diseases. In addition to hypotension, cytokines are likely to be important in the pathophysiology of acute kidney injury in capillary leak syndrome. Fluid management is a critical part of the treatment of capillary leak syndrome; hypovolemia and hypotension can cause organ injury, whereas capillary leakage of administered fluid can worsen organ edema leading to progressive organ injury. The purpose of this article is to discuss the diseases other than sepsis that produce capillary leak and review their collective pathophysiology and treatment.

Background here.

Saturday, July 22, 2017

Heavy cannabis use: bad for bone health




The effects of cannabinoids on bone mass and bone turnover in humans are unknown.

Using a cross-sectional study design we found that heavy cannabis use is associated with low body mass index, high bone turnover, low bone density, and an increased risk of fracture.

Heavy cannabis use has a detrimental effect on bone health by a direct effect on the skeleton and an indirect effect mediated by low body mass index.

Friday, July 21, 2017

Babesiosis at Stony Brook University Hospital





Background

Babesiosis is a potentially life-threatening, tick-borne infection endemic in New York. The purpose of this study was to review recent trends in babesiosis management and outcomes focusing on patients, who were treated with combination of azithromycin and atovaquone.

Methods

A retrospective chart review of patients seen at Stony Brook University Hospital between 2008 and 2014 with peripheral blood smears positive for Babesia was performed. Clinical and epidemiological information was recorded and analyzed.
Results

62 patients had confirmed babesiosis (presence of parasitemia). Forty six patients (74%) were treated exclusively with combination of azithromycin and atovaquone; 40 (87%) of these patients were hospitalized, 11 (28%) were admitted to Intensive Care Unit (ICU), 1 (2%) died. Majority of patients presented febrile with median temperature 38.5 °C. Median peak parasitemia among all patients was 1.3%, and median parasitemia among patients admitted to ICU was 5.0%. Six patients (15%) required exchange transfusion. Majority of patients (98%) improved and were discharged from hospital or clinic.

Conclusion

Symptomatic babesiosis is still rare even in endemic regions. Recommended treatment regimen is well tolerated and effective. Compared to historical controls we observed a lower overall mortality.