Monday, December 18, 2006

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.

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Thursday, December 14, 2006

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.

Thursday, December 07, 2006

Monday, November 27, 2006

Friday, November 03, 2006

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

Wednesday, November 01, 2006

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.

Sunday, June 11, 2006

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.

Saturday, June 10, 2006

Wednesday, June 07, 2006

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.

Tuesday, May 30, 2006

Monday, May 29, 2006

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

Wednesday, May 10, 2006

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.

Friday, May 05, 2006

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.

Sunday, April 23, 2006

Wednesday, April 19, 2006

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.

Wednesday, April 05, 2006

Sunday, April 02, 2006

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."

Sunday, March 26, 2006

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

Saturday, March 18, 2006

Chemistry 8, SMA 7, Chem-7 Analyzer

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

Tuesday, February 28, 2006

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 3rd ed

Monday, February 27, 2006

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.

Sunday, February 26, 2006

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:

Saturday, February 25, 2006

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."

Monday, January 30, 2006

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.

Sunday, January 29, 2006

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.

Tuesday, January 17, 2006

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.

Monday, January 16, 2006

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.

Sunday, January 08, 2006

Thursday, January 05, 2006

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.