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  1. Last 7 days
    1. Hydroxychloroquine is a relatively cheap and readily available drug that has been used for decades to treat malaria. Throughout the COVID-19 pandemic, doctors around the world have vouched for positive results seen in patients who take it.

      Take away: Though chloroquine and hydroxychloroquine showed some effects against SARS-CoV-2 in vitro for vero cells, the FDA removed emergency use authorization for COVID-19 patients due to increased heart problems. No in vitro effect was seen when using human lung cells instead of monkey cells. Many clinical trials are ongoing.

      The claim: Hydroxychloroquine is a relatively cheap and available medication with positive results in patients who have taken the drug.

      The evidence: Chloroquine and hydroxychloroquine inhibited infection of vero E6 cells (African green monkey kidney cell line) by SARS-CoV-2 (1, 2). These drugs did not inhibit SARS-CoV-2 infection in Calu-3 cells (human lung cell line, 3). Several clinical trials have reported positive outcomes with the use of hydroxychloroquine/chloroquine (4, 5). Current evidence is reviewed in (6). Known side effects including cardiovascular, neuropsychiatric, and gastrointestinal exist based on use of hydroxychloroquine and chloroquine in treating malaria and autoimmune conditions (7). These side effects may more severely affect COVID-19 patients due to the average age and comorbidities often present in severe COVID-19 cases and similarity to COVID-19 symptoms. A randomized, double blind placebo-controlled trial did not observe a significant difference between treatment and control groups when hydroxychloroquine was used prophylactically (8). Increased cardiovascular mortality, chest pain/angina, and heart failure occurred when hydroxychloroquine was combined with azithromycin (9). The FDA removed emergency use authorization in June (10). Many clinical trials are currently ongoing (11).

      Disclaimer: This content is not intended as a substitute for professional medical advice. Always seek the advice of a qualified health provider with any questions regarding a medical condition.

      Sources:

      1 https://www.nature.com/articles/s41422-020-0282-0

      2 https://academic.oup.com/cid/article/71/15/732/5801998

      3 https://www.nature.com/articles/s41586-020-2575-3

      4 https://www.jstage.jst.go.jp/article/bst/14/1/14_2020.01047/_pdf/-char/en

      5 https://www.sciencedirect.com/science/article/pii/S0924857920300996?via%3Dihub

      6 https://pmj.bmj.com/content/96/1139/550.long

      7 https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7228887/

      8 https://pubmed.ncbi.nlm.nih.gov/32492293/

      9 https://www.medrxiv.org/content/medrxiv/early/2020/05/31/2020.04.08.20054551.full.pdf

      10 https://www.fda.gov/drugs/drug-safety-and-availability/fda-cautions-against-use-hydroxychloroquine-or-chloroquine-covid-19-outside-hospital-setting-or

      11 https://clinicaltrials.gov/ct2/results?cond=Covid19&term=hydroxychloroquine&cntry=&state=&city=&dist=

  2. Sep 2020
    1. COVID-19 Can Wreck Your Heart, Even if You Haven’t Had Any Symptoms

      Take Away: SARS-CoV-2 infection has been clearly linked to heart muscle injury in those with severe COVID-19 illness. However, at present, there is insufficient data to determine the impact of mild or asymptomatic COVID-19 on the hearts of previously healthy individuals.

      The Claim: COVID-19 can wreck your heart, even if you haven’t had any symptoms.

      The Evidence: Several articles, including this August 31st piece (1), have raised the alarm about dangerous effects of mild or even asymptomatic cases of COVID-19 on the heart of infected individuals.

      In support of this argument, there have been numerous reports, some of which are cited in the article above, documenting severe heart inflammation (myocarditis) and injury (e.g. cardiomyopathy and/or heart failure) in patients with COVID-19. However, most of these documented cases were in individuals with severe cases of COVID-19. At present, the evidence for clinically significant heart injury (requiring treatment or special precautions) from mild or asymptomatic COVID-19, is much less clear, especially in those with no prior evidence of heart disease.

      One recent study reported that 78% of patients from an unselected cohort (including patients with asymptomatic, mild, and severe cases) had evidence of myocarditis (via MRI or blood testing) following COVID-19 infection (2). This study clearly demonstrated the link between COVID-19 and myocarditis by examining tissue from biopsies of the heart (the gold standard definitive diagnosis of myocarditis) of patients with the most severe cases. The study went on to show that, on average, patients who were treated for COVID-19 at the hospital (presumably more severe cases) and patients who were treated at home (presumably asymptomatic to moderate cases) both had blood test levels or MRI findings suggesting elevated myocarditis compared to non-COVID-19 infected patients with similar health profiles.

      A key limitation here is “average”. The study was not designed or powered to look for the rate of myocarditis in only previously healthy patients with mild or asymptomatic COVID-19. This study included asymptomatic patients in the analysis, but without knowing their prior health or comparing their findings to other healthy non-COVID patients, it is not possible to infer the risk of myocarditis to this population. To their credit, the authors of the study discuss this limitation in their conclusions.

      Despite this, the study was widely covered as evidence that ”COVID-19 can wreck your heart, even if you haven’t had any symptoms.“ In order to answer that question, we need research looking selectively healthy patients with mild or asymptomatic COVID-19 as outlined above.

      Until that research is conducted, we might look at COVID within the same context as a number of other well studied viruses, many of which generally cause mild illness, that have also been shown to lead to heart injury and inflammation (3).

      Disclaimer: This content is not intended as a substitute for professional medical advice. Always seek the advice of a qualified health provider with any questions regarding a medical condition.

      Sources:

      1. https://www.scientificamerican.com/article/covid-19-can-wreck-your-heart-even-if-you-havent-had-any-symptoms/
      2. https://jamanetwork.com/journals/jamacardiology/fullarticle/2768916
      3. https://www.ahajournals.org/doi/full/10.1161/CIRCULATIONAHA.108.766022
    1. Take away: People are infectious for only part of the time they test positive. The tests for COVID-19 were granted emergency status by the FDA so some debate concerning the most ideal number of cycles is to be expected. It is worth noting that the FDA has the disclaimer "Negative results do not preclude 2019-nCoV infection and should not be used as the sole basis for treatment or other patient management decisions. Negative results must be combined with clinical observations, patient history, and epidemiological information (2)."

      The claim: Up to 90 percent of people diagnosed with coronavirus may not be carrying enough of it to infect anyone else

      The evidence: Per Walsh et al. (1), SARS-CoV-2 virus (COVID-19) is most likely infectious if the number of PCR cycles is <24 and the symptom onset to test is <8 days. RT-PCR detects the RNA, not the infectious virus. Therefore, setting the cycle threshold at 37-40 cycles will most likely result in detecting some samples with virus which is not infectious. As the PCR tests were granted emergency use by the FDA (samples include 2-9), it is not surprising that some debate exists currently about where the cycle threshold should be. Thresholds need to be set and validated for dozens of PCR tests currently in use. If identifying only infectious individuals is the goal, a lower cycle number may be justified. If detection of as many cases as possible to get closer to the most accurate death rate is the goal, setting the cycle threshold at 37-40 makes sense. A lower threshold will result in fewer COVID-19 positive samples being identified. It is worth noting that the emergency use approval granted by the FDA includes the disclaimer that a negative test does not guarantee that a person is not infected with COVID-19. RNA degrades easily. If samples are not kept cold or properly processed, the virus can degrade and result in a false negative result.

      Source: 1 https://academic.oup.com/cid/advance-article/doi/10.1093/cid/ciaa638/5842165

      2 https://www.fda.gov/media/134922/download

      3 https://www.fda.gov/media/138150/download

      4 https://www.fda.gov/media/137120/download

      5 https://www.fda.gov/media/136231/download

      6 https://www.fda.gov/media/136472/download

      7 https://www.fda.gov/media/139279/download

      8 https://www.fda.gov/media/136314/download

      9 https://www.fda.gov/media/140776/download

  3. Aug 2020
    1. what might be learned from the case. The answer, in part, is that prudent psychiatrists and other therapists will want to be thoughtful about how they arrange follow-up care for patients whom they can no longer see.Sometimes a general suggestion that a patient seek follow-up care will be adequate. However, as the patient's condition warrants, clinicians might choose, in ascending order of time commitment, to provide the patient with the name of a particular practitioner or facility, to contact the facility to ascertain that a clinician is willing to see the patient, to help the patient make an appointment, or, with the patient's permission, to make an appointment on the patient's behalf. In some cases, it may be appropriate to ask for the patient's permission to contact his or her family to indicate a need for follow-up and to encourage the family to make sure that follow-up takes place. But of these approaches, no specific one will always be indicated, and the degree of assistance rendered the patient should be calibrated to his or her individual needs.

      What can be learned from this case?

      • Carefully plan follow up plans with patients (general suggestion about follow up can be enough)
      • Ask patient for family information to help them get involved in the follow up process and help increase compliance.

      Consider:

      • Giving the specific name of a provider to follow up with
      • How to contact the facility,
      • See if who you provided/recommended is avaliable to take the patient
      • Help patient make the appointment or make it on their behalf (with permission)
    2. One final questionable aspect of the jury's verdict relates to the legal requirement that before a judgment of malpractice can be reached, any departures from the standard of care must be shown to have been the proximate cause of the resulting harms. The most common test for whether an act or omission constitutes a proximate cause is whether it was reasonably foreseeable at the time that the negligent act occurred that would result in the consequent harms. Williamson had no history of violent behavior and had never revealed a violent impulse during treatment. It is impossible to conclude that he was foreseeably dangerous at the time he was seen by Dr. Liptzin.

      The test for proximate cause "is whether it was reasonably foreseeable at the time that the negligent act occurred that would result in the consequent harms"

      In this case, Dr. Liptzin, having seen Williamson having no history of violence or anything else, could not reasonably foresee that Williamson was going to do something illegal.

  4. Jul 2020
  5. Jun 2020
  6. May 2020
  7. Apr 2020
    1. Newton, P. N., Bond, K. C., Adeyeye, M., Antignac, M., Ashenef, A., Awab, G. R., Babar, Z.-U.-D., Bannenberg, W. J., Bond, K. C., Bower, J., Breman, J., Brock, A., Caillet, C., Coyne, P., Day, N., Deats, M., Douidy, K., Doyle, K., Dujardin, C., … Zaman, M. (2020). COVID-19 and risks to the supply and quality of tests, drugs, and vaccines. The Lancet Global Health, S2214109X20301364. https://doi.org/10.1016/S2214-109X(20)30136-4

    1. Abdulla, A., Wang, B., Qian, F., Kee, T., Blasiak, A., Ong, Y. H., Hooi, L., Parekh, F., Soriano, R., Olinger, G. G., Keppo, J., Hardesty, C. L., Chow, E. K., Ho, D., & Ding, X. (n.d.). Project IDentif.AI: Harnessing Artificial Intelligence to Rapidly Optimize Combination Therapy Development for Infectious Disease Intervention. Advanced Therapeutics, n/a(n/a), 2000034. https://doi.org/10.1002/adtp.202000034

  8. Mar 2020
    1. Cancer - a symbolic drama between mother and child Bahne-Bahnson (1982) notes that people suffering from cancer experience in a psychosomatic way old emotional deficits that have never been consciously addressed. He suggests that cancer patients have been deprived of being innocent children, and that many of them had to look after and emotionally support their parents. These people missed out on much of the essential emotional nurturing that would have allowed them to develop a strong sense of self.
  9. Jan 2020
  10. Dec 2019
    1. blood circulate

      The early modern English physician William Harvey (1578-1627) made several valuable contributions to the medical sciences, including the circulation of blood in the human body. In De Motu Cordis (1628), Harvey sets down his landmark experiments; in these, Harvey used ligatures to stem blood flow to better understand how the heart works to pump blood throughout the human body. This knowledge will be critical for Victor's creation of the Creature.

    2. physiology

      By 1818 physiology had become a controversial branch of medicine at the center of the dispute between vitalism, the idea that a divine spark energized animal life, and materialism, the argument that chemical processes alone give rise to life. Mary Shelley was well aware of the dispute since the Shelleys' family doctor, William Lawrence, was vigorously taking up the materialist argument in works like An Introduction to Comparative Anatomy and Physiology (1816). For a full view of this controversy as it relates to the novel, see Marilyn Butler, "Frankenstein and Radical Science" [1993] reprinted in J. Paul Hunter, Frankenstein, Norton Critical Edition, second ed. (New York: Norton, 2012): 404-416.

    3. scarlet fever

      Scarlet fever is a disease caused by a streptococcus infection, most common among children and young adults. Until the discovery of penicillin in the early 20th Century, it was frequently fatal. Also compare the 1831 edition, in which Elizabeth's condition is more "severe."

  11. Nov 2019
    1. Considerable obstacles remain, however, before the genetic therapy can be tested on human heart attack patients. Most of the treated pigs died after the treatment because the microRNA-199 continued to be expressed in an uncontrolled way.

      My imagination is running wild, but not in a good way. 😞

  12. Oct 2019
    1. Two years ago, when he moved from Boston to London, he had to register with a general practitioner. The doctor’s office gave him a form to sign saying that his medical data would be shared with other hospitals he might go to, and with a system that might distribute his information to universities, private companies and other government departments.The form added that the although the data are anonymized, “there are those who believe a person can be identified through this information.”“That was really scary,” Dr. de Montjoye said. “We are at a point where we know a risk exists and count on people saying they don’t care about privacy. It’s insane.”
    1. hangover

      Hangover is the sickness people experience such headache, nausea, and light sensitivity after comsuming too much alcohol.

      Source from https://www.mayoclinic.org/diseases-conditions/hangovers/symptoms-causes/syc-20373012.

    2. blood poisoning

      Blood Poisoning is a serious infection caused by the bacteria in the bloodstream. The infection has nothing to do with "poison". It actually refers to bacteremia, septicemia and sepsis. Source from https://www.healthline.com/health/blood-poisoning.

  13. Sep 2019
  14. Aug 2019
    1. heIndiansaretakingInninitoLapointeheisverysickIsgoing,tobecuredbythemedicinemenatLapointe

      Innini is being taken to La Pointe to see the doctors there

    2. heTaw-Rouzecameinthismorningtoaskmeforalittlephysio.Itold[him]Iwouldgivehimsomesalts.Wehadverylittleofthat.Hesaidhehadbeensickagoodmanydays.Igave.himsome.Iwenttohislodgethisafternoon,themedecinehadoppor—atedwe

      the Taw-Rouze (Native Doctor?) asks Mrs. Ely for salt because he has been sick

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  15. Jul 2019
    1. Two years ago, when he moved from Boston to London, he had to register with a general practitioner. The doctor’s office gave him a form to sign saying that his medical data would be shared with other hospitals he might go to, and with a system that might distribute his information to universities, private companies and other government departments.The form added that the although the data are anonymized, “there are those who believe a person can be identified through this information.”“That was really scary,” Dr. de Montjoye said. “We are at a point where we know a risk exists and count on people saying they don’t care about privacy. It’s insane.”
  16. Jun 2019
    1. AfterDoct..vaccinatectheIndc.prezent,hoembarkedinacanoeforthenotoVaccinaho.la.werethe

      at an exchange of gifts, the Natives present are vaccinated and those in the gardens are looked for to be vaccinated

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  17. May 2019
  18. Apr 2019
    1. Balm of Mecca[edit] Forskal found the plant occurring between Mecca and Medina. He considered it to be the genuine balsam-plant and named it Amyris opobalsamum Forsk. (together with two other varieties, A. kataf Forsk. and A. kafal Forsk.).[4] Its Arabic name is abusham or basham, which is identical with the Hebrew bosem or beshem.[6] Bruce found the plant occurring in Abyssinia.[3] In the 19th century it was discovered in the East Indies also.[4] Linnaeus distinguished two varieties: Amyris gileadensis L. (= Amyris opobalsamum Forsk.), and Amyris opobalsamum L., the variant found by Belon in a garden near Cairo, brought there from Arabia Felix. More recent naturalists (Lindley, Wight and Walker) have included the species Amyris gileadensis L. in the genus Protium.[4] Botanists enumerate sixteen balsamic plants of this genus, each exhibiting some peculiarity.[6] There is little reason to doubt that the plants of the Jericho balsam gardens were stocked with Amyris gileadensis L., or Amyris opobalsamum, which was found by Bruce in Abyssinia, the fragrant resin of which is known in commerce as the "balsam of Mecca".[3] According to De Sacy, the true balm of Gilead (or Jericho) has long been lost, and there is only "balm of Mecca".[6] Newer designations of the balsam plant are Commiphora gileadensis (L.) Christ., Balsamodendron meccansis Gled. and Commiphora opobalsamum.
  19. Feb 2019
    1. Cure of those El'ils

      A medicinal model of education. "Hi, I'm Thomas Sheridan. All these dumbasses are hopelessly lost because they don't speak correctly. They'll never do anything good, or see what good is, because bad speech runs rampant. The only hope is to heal them by teaching them to speak well. That is, like me."

    1. Good website explaining PICO including af videotutorial . provided by the University Library of Illinois, Chicago

  20. Jan 2019
    1. A novel is a medicine bundle, holding things in a particular, powerful relation to one another and to us.

      By using the term "medicine bundle, " can a novel be seen a curative method?

  21. Nov 2018
    1. The hospitalist movement mirrors the health care trend toward ever-increasing specialization. However, hospitalists are fundamentally generalist physicians who provide and coordinate inpatient care, often aided by myriad subspecialists. How can a generalist be a specialist? Specialties in medicine are traditionally defined by organ (eg, cardiology), disease (oncology), population (pediatrics), or procedure/technology (surgery or radiology). The hospitalist, on the other hand, is a "site-defined generalist specialist" (similar to emergency medicine physicians or critical care specialists), caring for patients with a wide array of organ derangements, illnesses, and ages within a specific location.45 Accordingly, the hospitalist should not be seen as a retreat from generalism and its emphasis on coordination and integration9,77 but rather as an affirmation of these values and as a surrogate for the primary care physician in the hospital. The competing pressures resulting from the distance between office and hospital as well as the requirement of around-the-clock availability make the hospital-based generalist a logical evolution. Hospital medicine has already satisfied many of the requirements of a specialty. A large and enthusiastic group of practitioners identify themselves not according to their training background but as hospitalists. The NAIP is almost certainly the fastest growing physician society in the United States. The field hosts several successful meetings each year and has its own clinical textbook.78 To establish themselves as members of a recognized medical specialty, hospitalists must identify a core skill set or body of knowledge and obtain the approval of credentialing organizations. Advocates of specialty status for hospitalists should be encouraged by the history of 2 other site-defined inpatient specialties: emergency medicine and critical care medicine. Like these relatively young fields, it seems probable that hospitalists will ultimately define a unique set of skills and competencies that will distinguish their field. The identification of practice-training mismatches (Table 2) represents an important first step. Credentialing organizations deliver the final stamp of approval on new specialties by creating a board certification or added qualification. Most new fields quickly agitate for such status, their motivation both practical and visceral. However, for unique reasons, few hospitalists are pressing this point. Many physicians—hospitalists and nonhospitalists—worry that if a credentialing body (such as the American Boards of Internal Medicine or Pediatrics) created a hospital medicine credential, health maintenance organizations might require that physicians possess this credential to care for inpatients. This would be unacceptable to many primary care physicians, who would be excluded from the hospital despite their desire and competence to continue practicing there. For this reason, we expect neither NAIP nor the relevant boards to promote separate credentials in the near future. Nevertheless, as evolutionary forces lead to specialized training, some formal specialty designation may emerge.79
    1. And earlier this year, CMS announced that by this time next year hospitalists would be assigned their own specialty designation code. SHM’s Public Policy Committee lobbied for the move for more than two years.
    2. By 2003, the term “hospitalist” had become ubiquitous enough that NAIP was renamed the Society of Hospital Medicine
    3. John Nelson, MD, MHM, and Winthrop Whitcomb, MD, MHM, founded the National Association of Inpatient Physicians (NAIP) a year after the NEJM paper, they promoted and held a special session at UCSF’s first “Management of the Hospitalized Patient” conference in April 1997
    4. Hospitalists are often referred to as the quarterbacks of the hospital. But even the best QB needs a good team to succeed. For HMGs, that roster increasingly includes nurse practitioners (NPs) and physician assistants (PAs).
    5. Aside from NPs and PAs, another extension of HM has been the gravitation in recent years of hospitalists into post-acute-care settings, including skilled-nursing facilities (SNFs), long-term care facilities, post-discharge clinics, and patient-centered homes.
    6. Hospitalists were seen as people to lead the charge for safety because they were already taking care of patients, already focused on reducing LOS and improving care delivery—and never to be underestimated, they were omnipresent, Dr. Gandhi says of her experience with hospitalists around 2000 at Brigham and Women’s Hospital in Boston. “At least where I was, hospitalists truly were leaders in the quality and safety space, and it was just a really good fit for the kind of mindset and personality of a hospitalist because they’re very much … integrators of care across hospitals,” she says. “They interface with so many different areas of the hospital and then try to make all of that work better.”

      role of hospitalists in safety and quality

    7. “When the IOM report came out, it gave us a focus and a language that we didn’t have before,” says Dr. Wachter, who served as president of SHM’s Board of Directors and to this day lectures at SHM annual meetings. “But I think the general sensibility that hospitalists are about improving quality and safety and patients’ experience and efficiency—I think that was baked in from the start.”
    8. “The role of the hospitalist often is to take recommendations from a lot of different specialties and come up with the best plan for the patient,” says Tejal Gandhi, MD, MPH, CPPS, president and CEO of the National Patient Safety Foundation. “They’re the true patient advocate who is getting the cardiologist’s opinion, the rheumatologist’s opinion, and the surgeon’s opinion, and they come up with the best plan for the patient.”
    9. Dr. Merlino says he’s proud of the specialists who rotated through the hospital rooms of AIDS patients. But so many disparate doctors with no “quarterback” to manage the process holistically meant consistency in treatment was generally lacking
    10. Two major complaints emerged early on, Dr. Gorman says. Number one was the notion that hospitalists were enablers, allowing PCPs to shirk their long-established duty of shepherding their patients’ care through the walls of their local hospital. Number two, ironically, was the opposite: PCPs who didn’t want to cede control of their patients also moonlit taking ED calls that could generate patients for their own practice.
    11. Dr. Wachter and other early leaders also worried that patients, used to continuity of care with their primary-care doctors, would not take well to hospitalists. Would patients revolt against the idea of a new doctor seeing them every day?
    12. Some “specialists worried that if hospitalists were more knowledgeable than once-a-month-a-year attendings, and knew more about what was going on, they would be less likely to consult a specialist,” Dr. Goldman explains, adding he and Dr. Wachter thought that would be an unintended consequence of HM. “If there was a reduction in requested consults, that expertise would somehow be lost.”