What would you do for plantar fasciitis?

Plantar fasciitis is a very common complaint that affects 10% of the general population at least once in a lifetime. Here's a video from the Mayo Clinic about what to do about it:

Can You Workout the Diagnosis? Can't walk, Can't talk and failed to respond to antifungals!!!

PRESENTING COMPLAINT

67 year-old gentleman with PMH of T2 diabetes, HTN, OA, bilateral knee replacement (2009) is referred to neurology services for evaluation of difficulty walking and slow progress in mobility after his knee surgery.

HISTORY OF PRESENTING COMPLAINT

The patient had 2 falls in the past 2 months. Progress with physios is very slow. Referred to his GP because of slow movement and slurred speech and symptoms of urinary frequency. GP prescribed antifungal treatment (no idea why? apparently his GP doesn't know that neurology exists;)

A month later, the patient experienced rapid decline of his mobility needing a walking stick initially and using a wheelchair currently. In his letter to neurology, the GP describes that patient is feeling his foot is glued to the floor and has enormous difficulty lifting it off.

Patient has occasional choking on bread and weight loss of 1 Kg over 6 months. But no smell, visual or taste problems. No problems with chewing, sleep disturbance. Upon further questioning, the patient also denies experiencing postural dizziness and there is no sudden bouts of uncontrollable laughter or crying (what do neurologists call this symptom? -Hint: common in patients with stroke)

OTHER HISTORY

Drug History - aspirin, amlodipine, omerprazole, insulin homologue

Family History - irrelevant

Social History - ex-smoker, drinks no alcohol

ON EXAMINATION

The patient appeared relaxed and slightly underdressed. Despite a room full of neurologists, he was very unnerved, and was joking and laughing. Dealing with audience questions, he would answer the question and then say 'Next'!!

His speech is slurred and dysarthric, better described as strangulated speech with words produced from the back of the mouth. In addition, there is an element of staccato speech when asked to say 'British constitution' or 'West Register Street'.

Gait- magnetic with a degree of stamping and difficulty of initiation. Stride is really slow at start, but improved slightly with 3rd and 4th step with increasing speed. Postural instability with stooped posture. Normal base.

CRANIAL NERVES

Normal range of eye movements. No restriction of upward gaze. No diplopia, squint or ptosis. Saccadic eye movement is normal. facial and mastication muscles are not weak or wasted. Absent jaw jerk. No wasting, fasciculation or weakness of the tongue. Rest of exam is also normal.

UPPER AND LOWER LIMB NEURO EXAM

Wasting and fasciculation of right wrist extensors. Tone is increased in upper and lower limbs - it is velocity dependent with a spastic catch. There is mild cogwheel rigidity in upper limbs. Global hyperreflexia (more predominant on R>L upper limbs). Positive Hoffman's reflex. No clonus and upper plantars are equivocal.

Finger-thumb test showed time-dependent reduction of velocity and amplitude of movement with 'fatiguability'.

No dysmetria, intention or resting tremors, dysdiadokokinesia or nystagmus.

INVESTIGATIONS

A number of investigations were performed. Results of investigations are provided upon your request.

What is the diagnosis? and Why?

Hint: Start by naming pathways in the nervous system, the involvement of which may account for this patients signs. Findings from the neuro exam should allow you to localize the lesion.

Johns Hopkins Comes to Kuwait!

This is very interesting. I posted a rant 10 days or so ago complaining how everyone in the Gulf except Kuwait is collaborating with world class hospitals. Someone must be reading our blog at the Ministry because yesterday, an article from KUNA stated that an agreement is being set up with Johns Hopkins to manage 4 Kuwaiti Hospitals (I'm joking, I don't really think anyone at the Ministry of Health is following our blog). This is fantastic! I love optimistic news. Read the article below:

Article from KUNA: -- Kuwaiti Health Minister Dr. Hilal Al-Sayer said Thursday that cooperation agreements have been set with John Hopkins University and Hospital, to manage Al-Farwaniya, Amiri, Addan and Jahra Hospitals in Kuwait.
Al-Sayer told Kuwait News Agency KUNA, that talks with John Hopkins officials included ways to provide technical support services, information systems, laboratories, radiology, and quality of services, in addition to reviewing work policies in technical divisions like emergency, anesthesia and surgery.
He added, discussions also included ways to develop the health sector in the four hospitals, in the fields of therapeutic, diagnostic and training, in addition to sending doctors from Kuwait for training and fellowship in subspecialties.
Al-Sayer said, officials at Johns Hopkins University aim to promote healthy relations with Kuwait, and is ready to provide all possible facilities and better health services.
The Minister of Health had signed a memo of understanding in Canada for the development of services to treat cancer diseases and surgery, in addition to cardiovascular research, education with the largest Canadian health centers and universities in Toronto and Montreal. (end) mah.st.asa KUNA 281344 Jan 10NNNN

Click here to read more

Test Your Clinical Knowledge!

What is the most appropriate liver test to exclude liver cell failure in a routine work-up in elderly patients, especially patients with dementia?

Don't miss: General Surgery Revision Course in RSM this weekend (Sat)

The Royal Society of Medicine near Oxford Road, London is a great resource of learning and clinical development. They have a variety of interesting and very useful revision courses for medical students not to mention a huge range of lectures and talks covering all relevant areas in medicine and surgery running constantly over the year.

I have attended a medical student revision day, which was very helpful indeed. They provide handouts and the speakers are very enthusiastic consultants in London. RSM headquarters is a nice building situated next door to the busy shopping place in Oxford Road. So, you can attend the course and go shopping afterwards!

I highly recommend the surgery course, especially for those of you who are interested in surgery and has finals coming up.

7 year old kid raises more than £150,000 for Haiti

This is really inspirational; seven year old Charlie Simpson decided to raise money for Unicef (who are collecting for Haiti) by doing a sponsored bike ride. He says on his justgiving page that he is, 'going to cycle around South Park as many times as possible…. (at least 10 laps, I hope!)' because he wants to, 'make some money to buy food, water and tents for everyone in Haiti'.

So far he has managed to amass £154, 284.50 (his original target was £500). You can sponsor Charlie here

I think community service should be given more importance in our culture. What do people think: do you think volunteering and community service is valued highly enough in Kuwait or should we be doing more?

How Not to Speak to your Patients!

New Pay Structure for Kuwaiti Doctors

This is the link for decree 5 (2010) for the new pay structure for Kuwaiti Doctors:

Click here to view

Who needs a transplant when you can grow a new organ?

Donate to Haiti: How to Choose a Charity?

As there aren't a lot of volunteering opportunities for unskilled students, you may be wondering what can you do to help Haiti? The best thing you can do is donate money to relief agencies, which are in desperate need of money. Be warned, there are lots of fake sites that don't forward your donation to charities.

InterAction has a list of genuine charities, which are trying to raise money to help the affected people of Haiti. Click here to view the list and donate generously!

Also, if anyone has any ideas what else we can do to help please let us know by leaving a comment or sending an e-mail.

Qatar=Cornell, UAE=Harvard, Saudi=Hopkins, Bahrain=RCSI, Kuwait=Nothing

As I was browsing through medical news today, the headline 'Leading Ophthalmological Centres In The United States and Saudi Arabia Announce Affiliation' caught my eye. Apparently, the Wilmer Eye Institue of John Hopkins (which has held the top spot in USNews' annual hospital ranking since 1990) will be collaborating with King Khaled Specialist Eye Hospital in Riyadh in the following areas: patient care, education and research. Click here to read article

How come every country in the Gulf, except Kuwait, is setting up international medical collaborations? Qatar has an Ivy League medical school, Dubai has Harvard Research Foundation, plus Tawam Hospital has a John Hopkins affiliation and even Bahrain has the Royal College of Surgeons in Ireland. We got zip!

The opportunities such collaborations would open up for patients and doctors are invaluable. Does anyone know why we are so behind?

Volunteer in Haiti

Image from UNICEF.com

Tonic.com has posted links to volunteering opportunities in Haiti (by Diane Herbst):

1. Medical workers are sought by The International Medical Corps, a global nonprofit dedicated to saving lives and relieving suffering through health care training and treatment. IMC is taking applications for volunteer doctors and nurses, with a particular need for nurses. Go to their website atwww.imcworldwide.org and click on the "How You Can Help" tab.

2. The Washington, D.C.-based Visions in Action (www.visionsinaction.org), an international nonprofit committed to achieving social and economic justice in the developing world through grassroots programs, seeks an earthquake relief volunteer immediately for a two to four-week trip to Haiti to assess needs and determine how VIA can best respond to the crisis. Please send a cover letter, CV, and the contact information for three references to: haiti@visionsinaction.org for immediate consideration.

3. The Global Volunteer Network is now working to implement a long-term, sustainable volunteer project in Haiti. Once their team of specialists determines needs, GVN will send in volunteers over the next 12 months, with a likely start date of March onwards. Volunteers are needed from one week to six months to help with working with children; teaching; health/medical; building and construction; counseling; or business development. You can find more information at www.globalvolunteernetwork.org/haiti/

4. Massachusetts-based Ministries of Aides International, a humanitarian organization focusing on needy children worldwide, urgently needs volunteers to help distribute supplies and assist nurses and physicians in their work to help the victims of the earthquake. If you are interested in volunteering, contact Wladimir D. Lahens at 617 -250-8516, email volunteers@ministriesofaidesinternational.org or visit their website at www.ministriesofaidesinternational.org.

5. Over 7,000 registered nurses have already answered the call from their union, the National Nurses United, to volunteer in Haiti. If you are a nurse, you can call 1-800-578-8225, visitwww.nationalnursesunited.org or fill out a volunteer form atwww.calnurses.org/rnrn/rnrn-volunteer-form.html

6. Boston-based Partners in Health (www.pih.org) urgently needs orthopedic surgeons, trauma surgeons, anesthesiologists, nurse anesthetists, nurses, post-op nurses, and surgical technicians. They are unable to accommodate any volunteers without significant surgical or trauma training and experience. Applicants can fill out a form here.

7. While the Red Cross isn't accepting volunteers to travel to Haiti now, there will be a need down the road for more medical personnel, translators and others who need to receive appropriate disaster training now.The Red Cross (www.redcross.org) asks potential volunteers to contact their local Red Cross chapter for this training.

8. Both medical and non-medical workers can register to volunteer their services with the Center for International Disaster Information (CIDI), based in Washington, D.C. Relief agencies browse through the listings to find volunteers who match their needs. The CIDI, funded by the United States Agency for International Development's Office of Foreign Disaster Assistance, promotes activities and donations to help disaster victims around the world. You can visit the CIDI's registration page atwww.cidi.org/reg_off.htm or call 703-276-1914.

9. The Anir Experience, based in Lewisburg, West Virginia, is assembling three teams of volunteers to travel to Haiti July 3-17, 2010. Teams will be 15 members each for either construction, first-aid/health care or child care. For more information go to www.anirfoundation.org/Haitipage2.html or contact them at Programs@anirexperience.org.

10. Habitat for Humanity International is currently assessing response options in Haiti. Once the organization knows the full magnitude of the disaster, Habitat will require support from volunteers. Contactwww.habitat.org to register to volunteer or for updated information on its needs.

11. The American Refugee Committee International, an international humanitarian aid agency that works with 2.5 million people annually, has information for prospective volunteers in Haiti here.

12. The Christian Reformed World Relief Committee (www.CRCNA.org), which has been working with churches and community organizations in Haiti for more than 30 years, is not clear on whether or not additional volunteers will be needed for CRWRC's response. Those who are interested in volunteering should call Carol Sybenga at 1-800-730-3490 or e-mail volunteer@crcna.org.

13. World Hope International (www.worldhope.org), a faith-based relief and development organization based in Alexandria, Virginia, will mobilize volunteers to assist their Haitian staff and communities in clean-up and rebuilding once the work of its first responders ebbs. Visit their website for more information.

14. For more information on volunteer positions as they arise, regularly check Idealist.org. Also, check out InterAction, a coalition of NGO's with a regularly updated list of its member organizations involved with Haiti at www.interaction.org/crisis-list/earthquake-haiti.

You can have open heart surgery whilst wide awake

This is a real image. Click here to read more about it

Apparently, this open heart surgery procedure, which only uses an epidural as an anesthetic was developed in India and you can buy a DVD to learn how to do it.

Medics Challenge!

61 year-old lady with a history of Alzheimer’s dementia develops shortness of breath and coughing.

Her husband explains that she became rather vague and unusual during the last 4-5 days; her speech is incoherent with some rambling and irrelevant chatting, which come and go. She also has difficulty focusing and has become very lethargic.

The patient developed pneumonia twice over the last 2-3 weeks. Her past medical history is significant for hypertension and depression for which she takes vals

artan and paroxetine, respectively. She smokes cigarettes and drinks no alcohol.

Bloods for haematology and biochemistry are shown.

What's going on?!!

NB. please note normal values for lab parameters:

Hb (11.7-15.7), MCV(80-99), WBC (3.5-11), Platelets (150-440), Na (135-145), K (3.5-5), Urea (2.5-6.7), Creatinine (70-120). Glucose (4-6), Albumin (35-50), plasma osmolality (275-295), urine osmolality (rang

e; 100-1000).

CLINICAL LESSONS;

1/ be able to differentiate confusion from dementia using CAM

2/ Be able to recognize SIADH - it is suggested by dilutional hyponatraemia with

3/ Be able to categorize the causes of hyponatraemia (dilutional or salt-losing causes)

Perfect Vision Without Surgery

I don't if others with sub-perfect vision feel the same way but I find it really annoying to have to choose between glasses and contact lenses to be able to function in society. Surgical vision correction has its side effects and even though I have family that have undergone the procedure, as an aspiring surgeon, I'm not sure it's a risk I'm willing to take.

Solution? I've come across an old technique that promises perfect 20/20 vision without surgical correction. It's called Orthokeratology (or Ortho-k for short). You wear contact lenses at night that have been custom designed for your eyes. These contact lenses reshape your cornea so that you wake up everyday with perfect vision (kind of like a retainer for the eyes). Unfortunately, this solution only lasts the day.

The only refractive surgery I would consider is insertion of intrastromal corneal ring segments (Intacs), where a new lens is implanted in your eyes. This avoids damage to your cornea and the lens can be changed as your vision changes. As this procedure has only been approved to low degrees of myopia I will have to wait!

Sing While You're Revising

Powerpoint Slides from Conference's Days 1

This is a link to our Slideshare page, which has the slides from the conference's first day's presentations:

http://www.slideshare.net/kmsukir

The slides are from the following talks:

-Comparing Programs from Different Countries by Dr. Altayyeb Yousef

-How to apply to the Canadian Exam by Dr. Mohammed Al-Bader

-USMLE and Canadian Exams by Dr. Ali Alali

-What to Do After the Exams by Dr. Altayyeb Yousef and Dr. Mohammad Ibraheem

-The Interivew by Dr. Sadikah Behbehani and Dr. Mohammed Al-Bader

-What's after the interview by Dr. Altayyeb Yousef

We plan to post videos from the conference and ethical case studies for the interviews so keep watching this space.

Again, we would like to thank all the speakers and KuMSA for their help.

Doctors in Training

This is an online USMLE Step 1 course that is starting on the 11th January, 2 days from now. The course is divided into 2 parts. The first part of the course assigns you study material from First Aid that you need to cover each week and they e-mail you questions to test your knowledge. The second part is video footage of live lectures that start in March and run for 15 days. At $700, it's much cheaper than Kaplan. Here is a link to their promotional video for people considering using this course:

http://legacy.course.doctorsintraining.com/DEMOplayer.php

Medical Interviews: Resources for Students and Doctors

January marks the beginning of the interview period for a lot of students and junior doctors so here is a run down of useful resources we've come across:

Residents:

Web

www.studentdoctor.net is a fantastic website and the forum has lots of insider information. There are articles dealing with residency interviews http://www.studentdoctor.net/2009/12/acing-your-residency-interview/ and http://www.studentdoctor.net/2009/11/the-successful-match-how-to-succeed-in-your-residency-interview/

Books

For residency applicants there is an excellent book that I highly recommend. It covers the interview very well and has specialty-specific tips. It also has other tips not related to the interview. You can get it from Amazon The Successful Match: 200 Tips to Succeed in the Residency Match by Rajani Katta

For UK applicants this book is good and also useful for general medical interviews with over 120 questions: Medical Interviews: a comprehensive guide to CT, ST and Registrar interview skills by Olivier Picard

Medical Students

Web

For medical students this forum has a wealth of information and you can find university specific past interview questions: http://www.thestudentroom.co.uk/

Books

I also recommend this book from amazon: Medical School Interviews by George Lee

Courses

If you are really not confident about your interview skills there are courses available in the UK (www.medical-interviews.co.uk) and USA (www.mededits.com), which cater for medical students and doctors.

Soon, we will also be posting videos, slides and ethical case studies from our Careers Day, which will have interview tips from junior doctors.

If you know about a good resource we have not mentioned please share it with us by adding a comment to this post. Good luck everyone!

Talk on your mobile phone longer to prevent dementia!

Research led by University of South Florida at the Florida Alzheimer's Disease Research Centre (ADRC) has shown that radiation from mobile phones protected and reversed Alzheimer's disease in mice (published in this issue of the Journal of Alzheimer's Disease). Phone radiation exposure reduced the amount of beta amyloid, which is thought to be the cause of the brain insult in Alzheimer's disease. Amazingly, the radiation not only preserved the memories of the mice but also improved it . Click here to read more

So apparently talking a lot on your mobile phone and smoking are good ways to prevent Alzheimer's disease. Kuwait should have the lowest rates of dementia in the world!

However take all this with a pinch of salt. The ADRC study is very preliminary and only done in a small number of mice that are genetically modified. Human brains are different and the mutant mice might have disease biology that is different to the naturally occurring disease. Also, there's a study that shows that smoking doubles your chances of getting Alzheimer's. Older studies, that demonstrated that smokers are less likely to have Alzheimer's disease were retrospective studies that were aided by the fact that smokers die younger than non-smokers and hence die before they reach old age, which would put them at a higher risk of developing the disease.

Mending bones using trees??

Using small pieces of wood to regenerate broken bones is one of 10 health innovations in CNN's 'Top 10 Health Innovations of 2009'. Time magazine also lists its top '10 Medical Breakthroughs for 2009', including the first mice created from adult cells. Interestingly, the only discovery both lists mention is the swine flu vaccine. Here are both lists; click on the heading to view full article:

CNN's Top 10 Health Innovations in 2009:

1. Swine Flu Vaccine

2. Electric Eye

3. Lyric Hearing Aid

4. Wooden Bones

5. Transcranial Magnetic Stimulation (TMS) Therapy

6. Anti-viral biomask

7. Antimicrobial paint

8. Electronic Stethoscope

9. JaipurKnee

10. Warm Organ Perfusion Device

Time's Top 10 Medical Breakthroughs in 2009:

1. New Mammography Guidlines

2. AIDS vaccine

3. Funding Ban Lifted on Stem-Cell-Research

4. H1N1 Vaccine

5. Stem-Cell-Created Mice

6. Prostate-Cancer Screening

7. New Research on Autism

8. New Drug for Osteoporosis

9. New Alzheimer's Genes

10. Brown Fat in Adults