As many as 22% of people with type 2 diabetes could have vitamin B-12 deficiency.
This BMJ study evaluated the effects of metformin on the incidence of vitamin B-12 deficiency (lower than 150 pmol/l), low concentrations of vitamin B-12 (150-220 pmol/l), and folate and homocysteine concentrations in patients with type 2 diabetes receiving treatment with insulin.
Compared with placebo, metformin treatment was associated with a decrease in vitamin B-12 concentration of -19%.
The absolute risk of vitamin B-12 deficiency (lower than 150 pmol/l) at study end was 7.2 percentage points higher in the metformin group than in the placebo group with a number needed to harm of 13.8 per 4.3 years.
Long term treatment with metformin may increase the risk of vitamin B-12 deficiency, which results in raised homocysteine concentrations. Vitamin B-12 deficiency is preventable; therefore, regular measurement of vitamin B-12 concentrations during long term metformin treatment should be considered.
35% of UpToDate topics are updated every four months. The editors select a small number of the most important updates and share them via "What's new" page. I selected the brief excerpts below from What's new in hematology:
Transplantation in aplastic anemia
In patients with severe aplastic anemia over the age of 40 who received allogeneic hematopoietic cell transplantation from an HLA-identical sibling, overall survival was 65 percent.
Improved survival when rituximab is added to fludarabine plus cyclophosphamide in CLL
There were higher response rates and survival with six courses of FCR (fludarabine, cyclophosphamide, and rituximab) when compared with six courses of FC (fludarabine, cyclophosphamide).
Second generation tyrosine kinase inhibitors (TKIs) for CML
Trials comparing dasatinib or nilotinib to imatinib for chronic myeloid leukemia (CML) demonstrated faster and deeper responses with these second generation tyrosine kinase inhibitors.
Improved understanding of pathobiology of multiple myeloma
Virtually all multiple myeloma (MM) cases are preceded by a premalignant plasma cell proliferative disorder known as monoclonal gammopathy of undetermined significance (MGUS). The pathobiology of myeloma as a two-step process - first there is the establishment of a limited stage of clonal proliferation (MGUS); then there is progression of MGUS to MM.
Denileukin diftitox superior to placebo for relapsed mycosis fungoides
There were better response rates with the recombinant interleukin-2-diphtheria toxin fusion protein denileukin diftitox used for therapy of mycosis fungoides and Sezary syndrome.
Survival in sickle cell disease
The estimated survival at 18 years is now 94 percent for those with HbSS or HbS/beta(0) thalassemia and 98 percent for those with HbSC or HbS/beta(+) thalassemia.
Human subjects are paid in Phase 1 clinical trials to test the toxicity levels of new drugs. Some make a profession out of it, but researchers worry about health risks.
People who get less than 6 hours sleep per night had an increased risk of dying prematurely in a recent study. Those who slept for less than that amount of time were 12% more likely to die early, though researchers also found a link between sleeping more than 9 hours and premature death.
The study aggregated decade-long studies from around the world involving more than 1.3 million people and found "unequivocal evidence of the direct link" between lack of sleep and premature death.
Just one sleepless night can hamper the body's ability to use insulin to process sugar in the bloodstream. Insulin sensitivity is not fixed in healthy people, but depends on the duration of sleep in the preceding night.
"Society pushes us to sleep less and less," one of the study investigators said, adding that about 20% of the population in the United States and Britain sleeps less than 5 hours.
Adults typically need between 7 and 9 hours sleep a night. If you sleep little, you can develop diabetes, obesity, hypertension and high cholesterol.
35% of UpToDate topics are updated every four months. The editors select a small number of the most important updates and share them via "What's new" page. I selected the brief excerpts below from What's new in infectious diseases:
Antibiotics and warfarin Among patients taking warfarin who require antimicrobial therapy for treatment of urinary tract infection, trimethoprim-sulfamethoxazole and ciprofloxacin werer associated with increased risk of upper gastrointestinal tract bleeding.
C. difficile
Symptomatic patients may play a role in airborne dispersal of C. difficile. In a study including 50 patients with confirmed C. difficile infection, air sampling for one hour demonstrated C. difficile organisms in 12 percent of cases.
Community-acquired pneumonia and antipsychotics
Use of atypical or typical antipsychotics was associated with a dose-dependent increased risk for community-acquired pneumonia (CAP).
High-dose flu vaccine
The FDA approved a high-dose inactivated influenza vaccine for individuals older than 65 years of age. Data showed increased immunogenicity of the high-dose vaccine in older adults.
Measles mumps rubella (MMR)
Monovalent vaccines are no longer available in the United States for measles, mumps or rubella.
Meningococcal vaccine
A new quadrivalent meningococcal conjugate vaccine (Menveo) was approved for individuals from 11 to 55 years of age as an alternative to the older quadrivalent conjugate vaccine (Menactra, MCV4). Both formulations protect against the same serogroups (A, C, Y, and W135).
Herpes zoster vaccine
Uptake of herpes zoster vaccine has been 2 to 7 percent in the United States. The reasons are often financial - only 45 percent of PCPs knew that herpes zoster vaccine is reimbursed through Medicare Part D.
35% of UpToDate topics are updated every four months. The editors select a small number of the most important updates and share them via "What's new" page.
The page does not provide RSS feed for the different specialties. One solution is to copy/paste the URL address of each subspecialty page you are interested in the Google Reader "Add a subscription" field (top left corner). Google Reader will automatically create a RSS feed from this "feedless" page.
Lipoprotein-associated phospholipase A2 (Lp-PLA2), an inflammatory enzyme expressed in atherosclerotic plaques, is a therapeutic target being assessed in trials of vascular disease prevention.
Lp-PLA2 activity and mass each show continuous associations with risk of coronary heart disease, similar in magnitude to that with non-HDL cholesterol or systolic blood pressure.
Lipoprotein structure (chylomicron). Image source: Wikipedia, GNU Free Documentation License.
Neurologist John Wapham lives in downtown Chicago, but he can see patients anywhere in the world ... from his apartment. And he does. He's an expert in treating strokes, and with the help of a robot and a broadband connection, he's able to be at a patient's bedside instantly.
"This brings specialists to to the remotest parts of the country, and the world. I've popped open my laptop on Michigan avenue and treated patients in another state, " he says. And in the not too distant future, these robot doctors could be on the battlefield, or at the scene of a horrible car accident: instantly.
Some critics fear that telemedicine may not be accurate enough. For example, the accuracy of teledermatology was inferior to real-life clinic dermatology for melanoma diagnosis in a recent study: http://bit.ly/8A4oiu
This small BMJ study suggests the following risk factors for subsequent professional misconduct:
- male sex - lower socioeconomic background - early academic difficulties at medical school
59 doctors who had graduated from 8 medical schools in the United Kingdom in 1958-97 and had a proved finding of serious professional misconduct in 1999-2004 (cases) and 236 controls (four for each case) were included in the study.
The findings are preliminary and should be interpreted with caution. Most doctors with risk factors will not come before disciplinary panels.
A 2006 study questioned the acceptability of minor episodic memory loss in older adults as normal. Episodic memory loss includes things such as forgetting the name of a new acquaintance, a recent conversation, or an upcoming appointment.
People commonly undergo an age-related slowing of the ability to retrieve information. They might forget where they put their keys, but they usually remember eventually. But when Alzheimer's is involved, new information is never properly stored, meaning the affected person never learned it well enough to be able to retrieve it.
Related reading:
Senior Moments: Signs Of Alzheimer's? CBS News.
Memory problems not a normal sign of aging: study http://goo.gl/xb9M FDA Approves "Alzheimer's CT scan" by Eli Lilly - radioactive agent florbetapir tags clumps of sticky amyloid in brain. WSJ, 2012.
Coffee is the most complex food known to man. It has 1200 flavor components. The nearest comparison is red wine with 450 chemical compounds in the flavor make-up. In most commercial blends there are 10 to 12 different coffees, from different farms (BBC, http://goo.gl/m2LwD).
Caffeine is a drug of abuse, like alcohol or cocaine, because it meets these two criteria: "reinforcing efforts" and "adverse effects which can cause harm to self or society." Reinforcing effects is science talk for "addictive": The more you have, the higher your tolerance levels and the more you need. Take it away, and you experience withdrawal symptoms.
C8H10N4O2 is a chemical compound found in beans, leaves and fruits of some plants. It's a natural pesticide for them, paralyzing and killing insects that try to feed on them. On humans it acts as a stimulant on the central nervous system and has psychotropic effects. It increases heart rate, blood pressure and respiration, and it is mildly diuretic.
Caffeine is structurally similar to adenosine. Image source: Wikipedia, public domain.
Recovering alcoholics or drug addicts will tell you caffeine is a "gateway drug"--it increases the chances of their falling back into addiction.
Overuse can develop into "caffeinism," which may cause muscle twitching, insomnia, headaches and heart palpitations. Even with a mild overdose, about 300 mg or so (3 cups of coffee, 7 cups of chai), you can get "caffeine jitters". You can actually die from an overdose of coffee.
The business of "liquid energy" has grown exponentially, and now 31% of 12-17 year olds regularly consume energy drinks. Most energy drinks contain 80 mg of caffeine per 250 ml can (some as much as 300-500 mg), tea contains 30 mg, coffee 90 mg (http://bit.ly/4Owz2y).
McDonald's | "Don't Talk To Me / Coffee" commercial.
Ves Dimov, M.D. - He had developed tolerance. The same phenomenon is commonly observed in drug addicts.
Vamsi Balakrishnan - Still, I think it's amazing. I wonder what his withdrawal would have been like. Bennie Franklin also had some sort of deal with caffeine.
I think alcohol tolerance would have been better than drug tolerance for analogy...but I'm not really sure. (is the following correct as an analogy?)
Alcohol tolerance = induction of enzymes --> can literally drink more than once could, though still doing damage along the way. --> I'd think caffeine would be like this...
Drug tolerance = like heroin --> more needed for same effects, but once some critical threshold is reached, person will die of OD. (too hungry at the moment to think clearly)
"Death by Caffeine Test: How much of your favorite energy drink, soda, or caffeinated food would it take to kill you?" http://bit.ly/WtL3f
Coffee vs. Tea - Infographic of Health Benefits and Risks http://goo.gl/StIsr
Caffeine is a major source of antioxidant activity in coffee. WebMD, 2011.
At an average of 3 kg of coffee consumption per person per year, Americans are well behind world leader Norway at 11 kg (http://goo.gl/qxgg6).
What’s In Your Energy Drink? INFOGRAPHIC
Michael Douglas says his throat cancer tumor is in complete remission ("gone") after 7 weeks of radiation/chemotherapy, but salivary glands not working http://goo.gl/zfR9Z
As ranks of insured patients expand, the U.S. may face shortage of 150,000 doctors in 15 years, according to the WSJ. That shortfall is predicted despite a push by teaching hospitals and medical schools to boost the number of U.S. doctors, which now totals about 954,000.
The greatest demand will be for primary-care physicians. These general practitioners, internists, family physicians and pediatricians will have a larger role under the new law, coordinating care for each patient.
Comments from Twitter:
@doctorwes Foreign docs are lining up.
@jmphillips Once I get into medical school, I should be OK!
@ddrullinsky ok Dr. Dimov, I'm on my way to help! thanks for posting my tweet! I hope to be there next year! Great blog BTW!
@a_singledrop but # of US residency spots remains flat. Why's this ok?
As many as 22% of people with type 2 diabetes could have vitamin B-12 deficiency.
