Archive for February, 2012

Sunday, February 19th 2012

CNS HIV

What area of the brain harbors the highest concentration of HIV?

A. Basal Ganglia
B. Thalamus

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Saturday, February 18th 2012

Growth Hormone Secreting Adenomas

What is the first line pharmalogic treatment for GH secreting tumors?

A. Ketonconazole
B. Bromocriptine
C. Octreotide
D. Cabergoline
E. Pegrisomant

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Saturday, February 11th 2012

The History of Artemisinin

The New York Times has an interesting history of the potent malarial drugs derived from artemisinin.

In the 1960s, [Mao] got an appeal from North Vietnam: Its fighters were dying because local malaria had become resistant to all known drugs. He ordered his top scientists to help.

But it wasn’t easy. The Cultural Revolution was reeling out of control, and intellectuals, including scientists, were being publicly humiliated, forced to labor on collective farms or even driven to suicide. However, because the order came from Mao himself and he put the army in charge, the project was sheltered. Over the next 14 years, 500 scientists from 60 military and civilian institutes flocked to it.

[...]

China’s effort formally began at a meeting on May 23, 1967, and was code-named Project 523, for the date.

Researchers pursued two paths. One group screened 40,000 known chemicals. The second searched the traditional medicine literature and sent envoys into rural villages to ask herbal healers for their secret fever cures.

One herb, qinghao, was mentioned on tomb carvings as far back as 168 B.C. and praised on medical scrolls through the centuries, up to the 1798 Book of Seasonal Fevers. Rural healers identified qinghao as what the West calls Artemisia annua, or sweet wormwood, a spiky-leafed weed with yellow flowers.

Worth a read without a doubt. Interesting stories like this make the New York Times the best newspaper in the world.

Wednesday, February 8th 2012

Neuromonitoring

What anesthetic agents should be avoided during neuromonitoring?

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Monday, February 6th 2012

Physicians Have Negative Views on The Affordable Care Act

A two month old survey by Deloitte [PDF] of physicians opinions on health care reform has drawn some very differing conclusions from partisan commentators.

The 501 physicians answered a number of questions, the most notable of which included a dichotomous question on whether the Affordable Care Act was “A good start” or “A step in the wrong direction”. The question was split 44% to 44%. All respect for Mr. Pollack and Dr. Murthy writing for The New Republic who find the sum of survey data to date equivocal, including the recent small Deloitte survey, but, it seems to me, despite that single question, that physicians, at least as much as the general public, have a distaste for the ACA which is not improving.

In that same Deloitte report 69% of physicians responded “Yes: I think the best and the brightest who might have considered medicine as a career will think otherwise” when posed to rate the “Impact of health reform on the future of the medical profession.” Previous surveys as the debate over health care reform raged last year found similar dissatisfaction amongst physicians with the Affordable Care Act. The act remains very unpopular, with a plurality of Americans opposing it and a large majority continuing to oppose an individual mandate. Despite implementation of more than a few parts of the law, that opposition amongst the public has barely budged. And neither, seemingly, has the opinion of physicians moved.

Attempts to paint widespread support for the act amongst physicians is misplaced.

A better way to gauge these issues is to examine how physicians and the organizations which represent them actually behaved during last year’s health reform. One wouldn’t know from Pipes’ article that the American Medical Association, the American College of Physicians, the American Academy of Family Physicians, the American College of Surgeons, the American Academy of Pediatrics, the American Congress of Obstetricians and Gynecologists, the American Society of Anesthesiologists, the American Osteopathic Association, the American Psychiatric Association, and the American College of Cardiology all endorsed last year’s health reform. These groups represent hundreds of thousands of physicians across a wide range of medical sub-specialties.

Its true that, like physicians as individuals, organized medicine’s reasons for supporting the Affordable Care Act were disparate, but at the highest levels of the largest organizations I promise you, pledges by the Obama administration to work towards a full Sustained Growth Rate formula fix and a feeling that physicians would be left out of the table served as the reasons to support reform far more than any true love for the provisions of the Affordable Care Act.

It’s wishful thinking that the public at large or physicians will come around to the Affordable Care Act, even once the most powerful provisions come online in 2014.

We believe that physicians will embrace the Affordable Care Act because the new law helps to address many critical issues that have long concerned physicians and patients—abuses and market failures in the provisions of health coverage, rising numbers of uninsured patients, variable quality, poor coordination of care, the erosion of primary care, and the lack of focus on prevention and public health. As the law’s main provisions kick in, physicians will see that it is, indeed, a big step in the right direction. We are sure that the new law will attract serious criticism. Real on-the-ground progress will provide the best rebuttal.

Here is how I imagine the next few years as it comes to physician and public opinion on the Affordable Care Act. The Supreme Court hears and decides the challenges to the individual mandate this term and strikes it down but allows the rest of the act to stand. Now you’re left, for the physician, with the bureaucracy of ACOs, CMS pushing pay for performance and best practice trials and independent of the ACA, but tainting the opinion of government’s role in health care in general, no SGR fix.

I can’t imagine a majority of physicians having a truly positive opinion of the ACA anytime soon.

Monday, February 6th 2012

Turcot Syndrome

Describe Turcot Syndrome.

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Sunday, February 5th 2012

Somatosensory Evoked Potentials

What tracts of the spinal cord do somatosensory evoked potentials (SSEPs) monitor?

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Saturday, February 4th 2012

Childhood Glial Tumor

What’s the diagnosis?

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Friday, February 3rd 2012

Take A Pill, Stop Getting Drunk

Want to take the fun out of alochol? A paper in the Journal of Neuroscience reports the effects of dihydromyricetin on ethanol’s ability to get you drunk. The New Scientist write up describes the study,

[Dr. Jiang Ling, primary investigator,] injected rats’ abdomens with a dose of alcohol proportionate to the amount a human would get from downing 15 to 20 beers in 2 hours by a human, they took about 70 minutes, on average, to right themselves. However, when an injection of the same amount of booze included a milligram of DHM per kilogram of rat body weight, the animals recovered their composure within just 5 minutes.

DHM also stopped rats in a maze from behaving in ways resembling anxiety and hangovers. Rats given heavy doses of alcohol cowered away in corners of the maze, whereas those given the extract with their alcohol behaved normally and were as inquisitive as rats given no alcohol at all, exploring the more open corridors of the maze.

Finally, DHM appeared to discourage rats from boozing when they had a free choice between drinking a sweetened solution of alcohol or sweetened water. Over a period of three months, rats will normally get addicted to increasing volumes of the hard stuff. Rats given DHM, though, drank no more than about a quarter of the amount that the “boozers” eventually built up to. Moreover, boozy rats that had worked up to the higher levels suddenly dropped down to a moderate intake when given DHM after seven weeks.

I don’t like the idea of an anti-intoxication pill. Drinking is what it is because of the way it makes you feel. And the ill effects of drinking are what they are to prevent your overconsumption. Taking a pill prophylactically to allow yourself to drink as much as you want without feeling the effects of the alcohol defeats the purpose. As does taking a pill, after the fact, to, with certainty, relieve your hangover and the consequences of drinking too much.

There’s some evidence in the study that dihydromyricetin may help prevent true, physiologic withdrawal symptoms such as tremors, anxiety, delirium and may even work to raise the seizure threshold. Such would be a legitimate use. Otherwise I think I may have a philosophical problem with the development of an anti-booze drug.

Friday, February 3rd 2012

ICA Branches

Name the branches coming off of the C2/petrous portion of the internal carotid artery.

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