Iodinizing Salt and global health

In Raising the WorldÂ’s I.Q., the SecretÂ’s in the Salt - New York Times

This article looks at the progress in iodinizing salt in developing countries and what is left to do. Iodinizing salt is one of the most cost effective public health initiatives.

Technorati tags: health, iq, salt, iodine

electronic health record - Google Patents

electronic health record - Google Patents
Search results for "electronic health record" in the patent database at the US Patent Office.

Five big firms to promote electronic health files - U.S. Business - MSNBC.com

Five big firms to promote electronic health files - U.S. Business - MSNBC.com
Walmart, BP, and Intel are promoting a centralized electronic health record system for its employers.

Lure of Great Wealth Affects Career Choices - New York Times

Lure of Great Wealth Affects Career Choices - New York Times
Physicians are switching from their practices to other fields such as finance.

dry patches

Subjective

34 year old white male presents with dry patches on his scalp, back of his elbows, and the front of his knees. They have been present for several months. No itching.

Objective

Vital signs stable. Skin - dry, scaling plaques, well-circumscribed, silver present on scalp, extensor surfaces of elbow and knee

Assessment and Plan

A- Psoriasis P- topical corticosteroids, other options include ultraviolet light (sunlight), lubricants, and keratolytics

Created with SOAP Note

ulcers in the mouth

Subjective

75 year old male presents with ulcers in his mouth. Started five months ago. Ulcers have progressed to around his mouth and on his forearms.

Objective

Vitals signs stable. Oral- multiple bullae in mucosa Skin - multiple bullae Labs - biopsy shows antibody pattern in fish-net immunofluorescence pattern

Assessment and Plan

A- Pemphigus P- corticosteroids

Created with SOAP Note

SOAP Note

SOAP note: "SOAP Note will create a standard patient encounter document. Please comment with any suggestions."

painful red nodules

Subjective

45 year old female presents with painful, red nodules on her shins. Started 1 month ago. Patient was recently diagnosed with ulcerative colitis.

Objective

Vital signs stable Extremities - pretibial, tender, erythematous nodules

Assessment and Plan

DDX - sarcoidosis, coccidiomycosis, ulcerative colitis, streptococcal infection, idiopathic A - erythema nodosum due to ulcerative colitis P - treat ulcerative colitis

Created with SOAP Note

Growth on forehead

Subjective

25 year old patient notes a growth on her forehead which is the color of her skin. It started about 2 months ago and has stopped growing.

Objective

Vital signs stable. Skin - flesh colored lesion on forehead with central crater, crater contains keratinous material

Assessment and Plan

A - Keratocanthoma P - Lesion will likely resolve in a few months, observation for few months, biopsy if needed.

Created with SOAP Note

One for the Ages: A Prescription That May Extend Life - New York Times

One for the Ages: A Prescription That May Extend Life - New York Times
Calorie restriction diet in rhesus monkeys shows health advantages, however other scientists believe the research may not translate to humans as well.

Growing Debate as Doctors Train on New Devices - New York Times

Growing Debate as Doctors Train on New Devices - New York Times

The Genographic Project - Human Migration, Population Genetics, Maps, DNA

The Genographic Project - Human Migration, Population Genetics, Maps, DNA

Forgive Us Our Student Debts - New York Times

Forgive Us Our Student Debts - New York Times

Student loan repayment by serving in underserved areas or working for the NIH as a researcher.

While in Surgery, Do You Prefer Abba or Verdi? - New York Times

While in Surgery, Do You Prefer Abba or Verdi? - New York Times

The benefits of music in the OR are several including improved psychomotor performance.

Cheap Airfare, Hotel Reservations, Car Rentals - Pinpoint Travel

Cheap Airfare, Hotel Reservations, Car Rentals - Pinpoint Travel

Going home for break? Here's AOL meta travel site which will search through 100s of sites to find the best deals. Also try the Deals section and the Fare Buzz section. Under Fare Buzz, you can search for top deals from one airport to any location in the world.

Histology of Cartilage and Bone

Histology of Cartilage and Bone

Body language Tiscali

Body language Tiscali A guide to body language at the work place.

Ripples in Water

Several ripples across a water surface
Changing every moment
Sometimes several, sometimes few
Changed greatly by small influences
Once the disturbance resolves, the surface flattens again
And the water remains
-J. S. 5/29/06

Framingham Study

http://www.nhlbi.nih.gov/about/framingham/

Heart still beats

For research, saw a pig heart being extracted about five minutes after the big was killed. Amazingly, it was still beating by itself when it was removed and placed in a pan. It kept on beating weakly for at least a minute.

Naegele's Rule for Pregnancy

Calculates pregnancy due date based on LMP - Calculator.

Doctors Object to Gathering of Drug Data - New York Times

Doctors Object to Gathering of Drug Data - New York Times
California and other states are considering legislation to prevent pharmaceutical representatives access to information about physician prescribing behavior.

Resume Advice - The New York Times Job Market

Resume Advice - The New York Times Job Market

US Senior Match

How US senior medical graduates matched in 2005 by specialty.
http://www.nrmp.org/res_match/tables/table10ab_05.pdf

USMLE faq

USMLE faq provided by uic.edu

A new plastic surgery blog

http://aesthetic-surgery.blogspot.com/

This site has been created to facilitate information sharing for plastic surgeons. See the site for details about e-mailing articles to the blog for publication. Ideas for articles could be interesting news articles, summaries of new research, and interesting patient cases.

A new orthopedics blog

http://orthopaedic-surgery.blogspot.com/

This site has been created to facilitate information sharing for orthopaedic surgeons. See the site for details about e-mailing articles to the blog for publication. Ideas for articles could be interesting news articles, summaries of new research, and interesting patient cases.

Baby Boomers Stay Active, and So Do Their Doctors - New York Times

Baby Boomers Stay Active, and So Do Their Doctors - New York Times
People over 50 want to excercise into their 70s, leading to more wear and tear on their joints.

Baby Boomers Stay Active, and So Do Their Doctors - New York Times

Baby Boomers Stay Active, and So Do Their Doctors - New York Times

Eye Infections May Be Tied to a Solution for Lenses - New York Times

Eye Infections May Be Tied to a Solution for Lenses - New York Times

Medical Specialty Aptitude Test

Medical Specialty Aptitude Test
Questionairre for selecting a residency.

BMI Calculator

BMI Calculator: "Fill in your height and weight, and this BMI calculator will show your BMI. It will also show your ideal weight range."

Cheese Quesadilla Recipe

Ingredients
-Flour Tortilla
-Cheese - American, Cheddar, etc.
-Optional: Meat, Pasta Sauce, hot sauce
Directions
Place tortilla on microwave safe plate and cover one half with cheese. Add meat or sauce if necessary. Microwave on high for 1 minute, and fold tortilla. Cut into fourths with a pizza cutter.
Health Benefits:
Less greasy than fried version.
Cheese is a good source of calcium.
Tortilla can have lower carbs than white bread.
Pasta sauce's tomatos can have heart protective factors.

Bread Recipes:
http://opossumsally.homestead.com/bread.html

BRAIN NEUROTRANSMITTERS

BRAIN NEUROTRANSMITTERS

Chemistry 8, SMA 7, Chem-7 Analyzer

Chem 7 Analyzer - Analyzes analyzes serum sodium, potassium, chloride, carbonate, BUN, creatinine, glucose, and calcium.

Substance Abuse

Substance	Intoxication	Withdrawal
Alcohol	- (1+) Slurred speech - Incoordination - Unsteady gait - Nystagmus - Impairment in attention or memory - Stupor or coma (t) folate 1mg , thiamine 100mg	- (2+) Autonomic hyperactivity - Increased hand tremor - Insomnia - Nausea or vomiting - Transient visual, tactile, or auditory hallucinations - Psychomotor agitation - Anxiety - Grand mal seizures (t) Benzodiazepines - oxazepam, IV; Dilantin; Haldol
Cocaine / Amphetamine	- (2+) Tachycardia or bradycardia - Pupillary dilation - Elevated or lowered blood pressure - Perspiration or chills - Nausea or vomiting - Evidence of weight loss - Psychomotor agitation or retardation - Muscular weakness, respiratory depression, chest pain, or cardiac arrhythmias - Confusion, seizures, dyskinesias, dystonias, or coma (t) self-limited, anti-psychotics	- (2+) Dysmorphic mood - Fatigue - Vivid, unpleasant dreams - Insomnia or hypersomnia - Increased appetite - Psychomotor retardation or agitation (t) self-limited, observation
Opiates - morphine - codeine - meperidine - hydromorphone	- papillary constriction (dilation) - (1+) drowsiness or coma - slurred speech - impairment in attention or memory - euphoria > dysphoria - psychomotor agitation or retardation - impaired judgement (t) Methadone 5-20 mg> 60-100 mg	- (3+) dysphoric mood - nausea or vomiting - muscle aches - lacrimation or rhinorrhea - papillary dilation, piloerection, or sweating - diarrhea - yawning (t) Clonidine

Sources : Diagnostic Criteria from DSM-IV, Blueprints Psychiatry 3^rd ed

Is Microsoft Dropping Cryptic Hints About a New Gadget? - New York Times

Is Microsoft Dropping Cryptic Hints About a New Gadget? - New York Times

A tablet style pc with wireless internet access would be good for some of the medical related web pages I've posted.

Prescription Writer

Medsoft : Prescription Writer: "Creates a prescription which can be printed, stored on a USB flash drive, or e-mailed. "

How to write a prescription:
Zoloft 500mg 1 tablet PO qday Dispense: 30 Refill: 2
Drug Dosage tablets route frequency Dispense: Refill:

History and Physical for Paper or USB

History and Physical for Paper or USB: "Create a history and physical document, then store it on a USB key chain drive or print it out to present to healthcare professionals."

Combined Plastics Residencies

http://www.med.nyu.edu/irps/residency/

http://www.surgery.vcu.edu/content/edu-plas.htm

http://www.hopkinsmedicine.org/plasticsurgery/Program/combinedletter.htm

http://www.brighamandwomens.org/surged/Medical/harvardPlasticSurgery.asp

http://www.surgery.upmc.edu/Plastics/Residency/Integrated_Program.htm

http://www.massgeneral.org/plasticsurgery/training/

http://www.mc.uky.edu/surgery/Plasurgery/plasrez.asp

http://www.dhmc.org/plastic_surgery_residency.cfm

http://www.um-surgery.org/education/gme/training/plastic.shtml

http://www.siumed.edu/surgery/plastics/integrated.htm

http://www2.kumc.edu/plastics/gen/resdcy.htm

http://www.siumed.edu/surgery/plastics/resdiency.htm

http://faculty.washington.edu/engrav/PSResLong.htm

http://www.ucdmc.ucdavis.edu/surgery/residency/plastics/index.shtml

http://www.surgery.usc.edu/plastics/Residency.html

http://www.llu.edu/llu/medicine/plastics/resltr.html

http://cpmcnet.columbia.edu/dept/cs/residency/plastics.html

http://www.urmc.rochester.edu/smd/Surg/Plastic_Surgery_Residency.html

Incision

8 AM - My first surgical incision
Made three incisions in the surgery that totaled less than 3 cm. They were for a suburethral sling. Also got to close in both surgeries.

Ovarian Tumors

Ovarian Tumors

1. Introduction

a. Malignant ovarian tumors are the leading cause of death from reproductive tract cancer.

b. Majority of ovarian tumors are benign.

c. General lifetime risk is 1.6% and 5% with a first degree family relative.

d. Lifetime risk with BRCA1 gene is 45% and with BRCA2 gene is 25%.

2. Clinical Findings

a. Symptoms and Signs

i. Most patients are asymptomatic.

ii. Mild nonspecific gastrointestinal symptoms or pelvic pressure

iii. Pelvic exam can detect early disease.

iv. Advanced disease can present with bloating, abdominal pain, ascites, and palpable abdominal mass.

b. Lab Findings

i. CA 125 level greater than 35 units can indicate malignancy.

ii. CA 125 elevated in 80% of epithelial ovarian cancer and only 50% in early disease.

c. Imaging Studies

i. Transvaginal Ultrasound for screening

ii. Ultrasound helps differentiate from benign and malignant neoplasm.

3. Differential Diagnosis for an Ovarian Mass

a. Functional

b. Benign Neoplastic

i. Premenopausal woman, asymptomatic, mobile, unilateral, simple cystic mass less than 7.5 cm

c. Potentially Malignant

d. Predictive factors include age, size of the mass, ultrasound configuration, CA 125 levels, symptoms, and symmetry

4. Treatment

a. Malignant neoplasm – surgical staging, abdominal hysterectomy, bilateral salpingo-oophorectomy

i. Advanced disease

1. removal of all visible tumor

2. post-operative chemotherapy

a. cisplatin or carboplatin with paclitaxel

b. Benign neoplasms – tumor removal or unilateral oophorectomy

5. Prognosis (5 yr survival)

a. Distant metastases – 17%

b. Local spread – 36%

c. Early disease – 89%

Source:

1. Tierney, Jr, Lawrence M., Stephen J. McPhee, and Maxine A. Papadakis. Current Medical Diagnosis & Treatment 2005. 44th ed. New York: McGraw Hill, 2005: 719-722.

Old Main at Penn State

A picture of Old Main, the administrative building at Penn State with snow on the ground. The color picture was changed using the filter photocopy in Adobe Photoshop.

Pregnancy, Preeclampsia, Severe Preeclampsia, Eclampsia

	Normal Pregnancy	Preeclampsia	Severe Preeclampsia
Blood Pressure	Fall in first 24 weeks, rises to baseline by term	140/90 after 20 weeks gestation	>160/100
Kidneys	GFR increases 50%, renal plasma flow increases serum urea and creatinine decrease; enhanced waste metabolite removal; glycosuria	Vasospasm and capillary endothelial swelling -> reduction in GFR Serum uric acid and creatinine increased Proteinuria > 300 mg in a 24 hour collection	proteinuria > 5 g/24h, oliguria (<500cc/24h) Oliguria <>
Edema	Normal	Presenting sign but 1/3 don’t have it
Hemostatic	Venous stasis from hypercoagulable state	Systemic vasospasm, coagulation system activation, abnormal hemostasis Cycle – endothelial injury, platelet activation, platelet consumption
Prostanoid Changes	Both prostacyclin (PGI) and Thromboxane A2 (TXA) elevated, PGI > TXA	TXA > PGI PGI – vasodilator and inhibitor of platelet aggregation TXA – vasoconstriction and platelet aggregation
Autonomic		Increased sympathetic state – vasoconstriction
Nitric Oxide		Reduced
Free radical oxidation products		Increased
Hematologic	Plasma vol inc, RBC mass inc à “physiologic anemia” of pregnancy Hgb 11.5 mg/dl WBC count increases Hypercoagulable state – inc fibrinogen, factor VII to X increase – venous stasis		- Thrombocytopenia - <100,000 class="MsoNormal">- fibrinogen decreased - coagulation time increased (PT, PTT) -Can progress to DIC
Hepatic	Signs of liver disease Spider angiomata and palmar erythema – elev estrogen Serum – dec albumin, elev alk phos, elev cholesterol Estrogen increased proteins – fibrinogen, thyroid hormone binding globulin, ceruloplasmin Hepatic enzymes – AST/ALT, PTT unchanged	10% - transaminase elevation	impaired liver function (AST/ALT >70)
Pulmonary			pulmonary edema
Neurological			Cerebral or visual disturbances Headache
GI			Epigastric pain - hepatic subcapsular hemorrhage -stretch or rupture of liver capsule
Seizures			Severe cases -> Eclampsia

HELLP Syndrome - hemolysis, elevated liver enzymes, low platelets - severe preeclampsia.

Sources:

1. Rubin, Emanuel . Rubin's Pathology: Clinicopathologic Foundations of Medicine. 4th ed. Philadelphia: Lippincott Williams & Wilkins, 2005 : 986-7.

2. Tierney, Jr, Lawrence M., Stephen J. McPhee, and Maxine A. Papadakis. Current Medical Diagnosis & Treatment 2005. 44th ed. New York: McGraw Hill, 2005: 747-9.

Sensitivity Specificity Positive Predictive Value and Negative Predictive Value Calculator

Sensitivity Specificity Positive Predictive Value and Negative Predictive Value Calculator: " calculator will determine these values based on true positives, false positives, true negatives, and false negatives"

First Day of Ob-Gyn

Today was my first day of Ob-Gyn, and I saw two deliveries. One patient was having frequent contractions and she started to have the baby while I was telling a resident about the patient. Actually, she was having such bad contractions, I hurried my interview and told my resident about her. She was rushed into the delivery room, and while my fellow medical student and I were looking for shoe protectors, in two minutes, she had the baby. The second delivery was a caesaraen section which was iminent. The whole process of deciding to do the C-section and taking the baby out took about 15 minutes. It was truly amazing how fast labor and delivery can progress.

Parkland Formula - Fluid Resucitation for Burns

Parkland Formula - Fluid Resucitation for Burns

Nagel's Rule for Pregnancy Due Date

Nagel's Rule for Pregnancy Due Date
Can calculate a due date based on LMP. Similar to a Pregnancy Wheel and Ovulation Calendar.