February 28, 2010

Interview with Prof David Neary (Neurology)


David Neary is a Professor of Neurology at the University of Manchester, UK, specializing in dementia. He started the Cerebral Function Unit (CFU) in Manchester with a multidisciplinary team of neurologists, neurospychiatrists, neuropathologists, radiologists and biochemists in order to tackle clinical and scientific research into the diagnosis, molecular pathology, pathogenesis and management of dementia. Prof Neary has authored more than 150 publications and three books, two of which are on dementia. In this podcast, we talk about dementia, its subtypes and general management. Finally, we address future challenges facing dementia research and patient care.

Listen to KMS's interview with him (conducted by Ayoub Dakson and Ali Mohsen) now by clicking on the play button in the podbean player below, checking out the podcast on http://kmsukir.podbean.com or searching for the 'Kuwait Medical Society' podcasts on iTunes (where you can subscribe to future podcasts).


Find out more about dementia and its impact on the individual, family, society and scientific research by exploring the following sites;

http://www.hbo.com/alzheimers/
(The Alzheimer's Project contains lots of interesting educational videos about Alzherimer's dementia, the most common of all dementias)




http://alzheimers.org.uk/
(The Alzheimer's society is a large UK organization committed to support patient care and research in dementia, with a wealth of information in their website about the condition)

Selected publications and reading



David Neary.1999. Classification of the dementias. Reviews in clinical gerontology. 9; p 55
(Excellent review the clinical phenotypes and pathology of different dementias from a clinical point of view - highly recommended read)


H. Quefurth and F. LaFerla. 2010. Mechanisms of disease: Alzheimer's Disease.NEJM. 363: p329

(A recent reader friendly review of science's recent advances in understanding the pathogenesis and treatment of Alzheimer's disease)

February 27, 2010

Subscribe to KMS's Video Podcasts on iTunes!


We now have all KMS's videos available on iTunes to view/download for free. Just search for 'Kuwait Medical Society' on iTunes or visit http://kmsukir.blip.tv and click on the link below the video that say 'subscribe to iTunes'.

The videos are formatted so they can watched on your iPods/iPhones or offline. You can subscribe to the podcast to receive our latest offerings. We will use this service to provide more educational material so keep watching this space!





February 26, 2010

Video Coverage from the Careers Days

In addition to photos from the Careers Days (see previous post), we also have... wait for it... VIDEOS of all that took place on Careers Days! So for all KMS's friends in the UK/Ireland who couldn't be home for Christmas to attend, we are sorry you couldn't be there but at least now you can watch all the proceedings from the comfort of your sofa at home. We would be immensely grateful if after watching the videos you e-mail us at kmsukir@gmail.com to let us know what you liked/didn't like about the conference and if you have any suggestions (if you're interested in becoming an active KMS member, or to to learn about future events, let us know in the e-mail).

To watch Careers Day visit our page on blip.tv


You can also watch the videos embedded in this blog if you scroll down to previous posts

Coverage includes:
Day 1: Getting into a Speciality - 4 videos
Day 2: The Specialties Panels + Dean's Speech
(Specialties covered = Medicine, Pediatrics, Surgery and Other Specialties)

The careers event took place at Kuwait University on the 29th-30th December 2009. KMS would like to repeat its appreciation for all the help it received from KuMSA, Kuwait University, Dr. Altayyeb Yousef and his fellow speakers who deserve full credit for Day 1 and the panelist for taking part.

Photos from the Careers Days

Below is the link to the photostream on Flicker


Finally we have coverage from 2009's Careers Days!

Here's a photo of us at the start of the conference:



And at the end of the conference... It seemes like the stress got to some of us:



Many many many many many heartfelt thanks to all the Kuwait University staff, the speakers/panelists, Dr. Altayyeb Yousef and his fantastic four and KuMSA who without this event would not have been possible. We are very grateful for all the support, which made this conference a fun project to work on (special mention to KuMSA's medical education and media committees. You guys rock!)


Careers Day 1-1 of 4

Introduction by Sarah Al Youha from KMS and Fahad Al Hassan from KuMSA. Postgraduate Training Canada Vs USA by Dr. Altayyeb Yousef. The application process: valuable time-saving tips by Dr. Mohammad Al-Bader and Dr. Mohammad Ibraheem. Part of the Careers Days event on the 29th-30th December 2009 at Kuwait University organized by Kuwait Medical Society, UK/Ireland (http://kmsukir.blogspot.com) and Kuwait University's Medical Student's Association.

Careers Day 1 - 2 of 4

The USMLE and MCCEE: when to do them? How to ace them by Dr. Ali Al-Ali. After the exams: how to ensure your application gets you the most number of interviews and what different program directors are looking for in your CV by Dr. Altayyeb Yousef and Dr. Mohammad Ibraheem. Part of the Careers Days event on the 29th-30th December 2009 at Kuwait University organized by Kuwait Medical Society, UK/Ireland (http://kmsukir.blogspot.com) and Kuwait University's Medical Student's Association.

Careers Day 1 - 3 of 4

The big interview day: what to expect? what are they looking for? (good/bad examples) by Dr. Sadikah Behbehani and Dr. Mohammad Al-Bader. Part of the Careers Days event on the 29th-30th December 2009 at Kuwait University organized by Kuwait Medical Society, UK/Ireland (http://kmsukir.blogspot.com) and Kuwait University's Medical Student's Association.

Careers Day 1 - 4 of 4

Making up your mind: after doing great in the interview and getting many acceptance letters, which institutions and programs will you choose? by Dr. Altayyeb Yousef. Question and answer session and closing. Part of the Careers Days event on the 29th-30th December 2009 at Kuwait University organized by Kuwait Medical Society, UK/Ireland (http://kmsukir.blogspot.com) and Kuwait University's Medical Student's Association.

Introduction and Dean's Speech

Introduction by Sarah Al Youha from KMS, followed by a talk by Professor Fuad Al Ali, Dean of Kuwait University's medical school. Part of the Careers Days event on the 29th-30th December 2009 at Kuwait University organized by Kuwait Medical Society, UK/Ireland (http://kmsukir.blogspot.com) and Kuwait University's Medical Student's Association.

Medicine Panel 1 of 2

The 'Medicine Panel' was co-ordinated by Waleed Al Duaij a medical student from Manchester University and Dr. Yasser Hassan a graduate of Manchester University. The panel was comprised of Dr. Jabir Al-Ali, Gastroenterology; Dr. Salem Al-Shemmeri, Hematology; Dr. Talal Al-Taweel, Medicine; Dr. Kefaya Abdulmalek, ICU; Dr. Mohammad Shamsah, ICU; Dr. Ibrahim Al-Rashdan, Cardiology; Dr. Raed Al-Hashemi, Emergency Medicine; Dr. Ebaa Al-Ozairi, Diabetology. Part of the Careers Days event on the 29th-30th December 2009 at Kuwait University organized by Kuwait Medical Society, UK/Ireland (http://kmsukir.blogspot.com) and Kuwait University's Medical Student's Association.

Medicine Panel 2 of 2

The 'Medicine Panel' was co-ordinated by Waleed Al Duaij a medical student from Manchester University and Dr. Yasser Hassan a graduate of Manchester University. The panel was comprised of Dr. Jabir Al-Ali, Gastroenterology; Dr. Salem Al-Shemmeri, Hematology; Dr. Talal Al-Taweel, Medicine; Dr. Kefaya Abdulmalek, ICU; Dr. Mohammad Shamsah, ICU; Dr. Ibrahim Al-Rashdan, Cardiology; Dr. Raed Al-Hashemi, Emergency Medicine; Dr. Ebaa Al-Ozairi, Diabetology. Part of the Careers Days event on the 29th-30th December 2009 at Kuwait University organized by Kuwait Medical Society, UK/Ireland (http://kmsukir.blogspot.com) and Kuwait University's Medical Student's Association.

Other Specialties Panel

The 'Other Specialities' panel was co-ordinated by Ayoub Dakson, a medical student from St. Andrews and Manchester University and Dr. Mohammad Ganbar graduate of St. Andrews and Manchester University. The panel was comprised of Dr. Ibrahim Hadi, Anesthesiology; Dr. Asmahan Al Mulla, Pain Management; Dr. Jehad Al Harmi, Obstetrics and Gynecology; Dr. Renu Gupta, Radiology; Dr. Mohammad Al Seaidan, Public Health; Dr. Adel Al Zayed, Psychiatry; Dr. Osamah Al-Baker, Neurology. Part of the Careers Days event on the 29th-30th December 2009 at Kuwait University organized by Kuwait Medical Society, UK/Ireland (http://kmsukir.blogspot.com) and Kuwait University's Medical Student's Association.

Surgery Panel

The 'Surgery Panel' was co-ordinated by Dr. Yousef Al Muhanna, a graduate of Kuwait University, Sarah Al Youha, a medical student from Manchester University and Dr. Talal Al Qaoud, a graduate of Manchester University. The panel was comprised of Prof Adel Ayed, Thoracic Surgery; Dr. Jamal Al Fadhli, Cardiac Surgery; Dr. Fahad Al Asfar, Laproscopic Surgery; Dr. Hisham Burezq, Plastic Surgery; Dr. Manal Bouhaimed, Opthalmology; Dr. Haitham Al-Khayat, Trauma Surgery; Dr. Khalid El Enezi, Trauma Surgery; Dr. Hisham Al-Khayat, Neurosurgery. Part of the Careers Days event on the 29th-30th December 2009 at Kuwait University organized by Kuwait Medical Society, UK/Ireland (http://kmsukir.blogspot.com) and Kuwait University's Medical Student's Association.

Pediatrics Panel

The 'Pediatric Panel' was co-ordinated by Jacob Mathew a medical student from Kuwait University and Dr. Nawal Akbar a graduate of Kuwait University. The panel was comprised of Dr Maitham Hussain, Immunology; Dr. Majeda Abdul-Rasoul, Diabetology Dr. Nawal Makhseed, Metabolic Diseases; Dr. Entisar Hussain, Infectious Diseases; Dr. Eman Mattar, Hemato-Oncology; Dr. Eman Buhamrah, Gastroenterology; Dr. Marzouq Al-Azmi, Emergency Medicine. Part of the Careers Days event on the 29th-30th December 2009 at Kuwait University organized by Kuwait Medical Society, UK/Ireland (http://kmsukir.blogspot.com) and Kuwait University's Medical Student's Association.

February 21, 2010

How can sugar pills cure diseases?



Ben Goldacre, doctor and author of 'Bad Science', explains what the placebo effect is and describes its role in medical research and in the pharmaceutical industry.

For more about this subject, you can buy the bestselling book, 'Bad Science' by Ben Goldacre, from Amazon

February 19, 2010

Philosophy and Medicine

The word philosophy means “Love of Wisdom”. It’s the study of general and fundamental problems concerning matters such as existence, knowledge, values, reason, mind, and language (taken from Wikipedia).  Philosophy is also involved in providing ethical frameworks that outline people’s lives and the tools that one can use to dissect arguments using reason and logic.

In medical school the topic of philosophy is often applicable to ethical principles that outline the day to day dealings of doctors and their patients. But there is much more to philosophy than that, I’m not saying that ethical principles are bad or anything. It’s that philosophy is incredibly undercooked in Medical schools and if taught properly it could aid medical students in critical thinking which in turn is useful in writing literature reviews, performing research and debating people.

My main theme is going to be “arguments” and how to differentiate between “bad” arguments and “good” arguments. A good argument is one that relies on reason, end of story. Sounds easy, you’d think everyone builds arguments on reason but that is not the case. A lot of arguments are fallacious, and do not appeal to reason. I’ll provide some examples, whilst not inclusive of all that critical thinking offers it serve as an introduction into the discipline.

Ad Hominem Argument:

The word Ad Hominem means “the person”. So it is an argument against the person rather than what they’re saying. Unfortunately, this is very common even in day to day arguments. I’ll illustrate this fallacy in a medical context.

Person A:  Prescribing medication that has not been proven to work is unethical and resource draining.
Person B: Look who’s talking! Weren’t you the one who cheated on his wife? It’s ironic that you’re talking about ethics.

 Explanation: This is an ad hominem argument. It does not matter whether Person A cheated on his wife or not. That’s irrelevant to the argument offered.   

Ad nauseum argument:

This means to repeat the argument again and again and again. Just to convince people of it rather than offering evidence of the argument’s validity. This is often encountered in advertisements for products in day to day life.

Person A:  Smoking causes heart disease. Smoking causes heart disease. Smoking causes heart disease.

Explanation: Even though smoking has been linked to coronary artery disease. This person presents no evidence to substantiate his argument. He’s just repeating it over and over again.

Strawman fallacy:

This is a hard one to understand. What it means though is that your opponent diverts themselves from  the original argument and they create one of their own i.e. “a strawman” and then they proceed to destroy it.

Person A: Abortion should be legalized for the sake of the benefit of patients.
Person B: This legalization of murder shows complete disregard for the sanctity of life and will only lead to the corruption of society.

Explanation: the word “Abortion” does not equal “murder” and so the opponent diverted the argument from the original point and said opponent defeated the strawman.

False Dichotomy Fallacy:
This is one when one offers two choices for one matter when there are actually many.

Person A: We can either have a PBL course or a traditional course. PBL is much better, you don’t want to be spoon fed now, do you?

Explanation: Person A didn’t offer us the third option which is an integrated course i.e. a mix of PBL and lectures thus creating a false dichotomy fallacy.

Appeal to ignorance:

This is when a person tries to persuade us of something due to our ignorance regarding a topic.

Person A: Palates are the best treatment option for Meralgia paraesthetica.
Person B: Where is your proof for that?
Person A: There have been no studies conducted but that doesn’t mean it’s not the best treatment.

 Explanation: Absence of evidence is not evidence of absence. But since Person A made that statement the burden of proof falls on them to back it up. If they can’t then we must not take them at face value.

Appeal to Novelty:

Person A: This device is brand new! The company says it uses the latest technology to get rid of varicose veins without the need of an operating theatre. It’s new so it must be good.

Explanation: You’ll see this in the medical world on numerous occasions. Just because a product is new doesn’t mean it’s good.  Where is your evidence?

Appeal to Authority:

This is when someone tries to win an argument by saying that their particular statement has been made by someone who is an authority and thus it should be taken at face value.

Person A: In the case of massive pulmonary embolus the patient might get a chest bruise. The consultant told me!
Person B: First of all, it’s an infarct, not a hemorrhage. Why would blood seep out? Second of all how would the blood seep out through all the muscular layers to the superficial layers of the chest?
Person A: Are you calling the consultant a liar? He told me that’s a sign of a PE!!!!

Explanation: Just because someone is in a position of authority doesn’t mean they can make unsubstantiated claims. If anything, they’ve got a higher responsibility of backing their claims with evidence.

That’s all I’m going to talk about for now. It just serves as an introduction to logic and reason. You can Google “logical fallacies” if you want to learn more. 

February 15, 2010

Sex and its Problems... A Crash Course!! Part 2


Psychosomatic Sex Cycle (adapted from Bancroft (2009))

So we've briefly touched on the components of the sexual response. Let's explore now the problems and their prevalence in males and females.

1/ DISORDERS OF SEXUAL DESIRE
Impairment of sexual desire can occur in both men and women; however lack of desire most commonly affects females with 60-70% prevalence rate.

Sexual desire correlates with the testosterone:oestrogen ratio in both genders so that a higher ratio is associated with increased sexual desire. Inhibition or lack of interest is broadly either psychogenic or organic in origin. Psychological factors include early parental problems, society or past experiences eg rape/incest. Organic causes include hyperprolactinaemia due to a pituitary adenoma (if impaired sexual response co-exists with symptoms of headache and impairment of peripheral vision- think pituitary adenoma!!). Diminished testosterone:oestrogen ratio may lead to lack of desire.

Management includes assessment for an underlying organic problem. Psychological problems are far more common, and a good history taker would be able to identify how patient attitudes of past and current relationships, any guilt or indication of early childhood problems contribute to the problem. Relationship therapy and taught focus exercises might be of benefit.


2/ DISORDERS OF SEXUAL AROUSAL

This is represented by erectile difficulties in men and by lack of lubrication and of general sexual responsiveness in women.

IN MEN

About 85% of cases with erectile dysfunction are organic in origin. Risk factors include obesity, lack of exercise smoking, high cholesterol, hypertension and diabetes.

- organic causes;
VASCULAR= atherosclerotic change in penile blood vessels (accounts for half of cases)

NEUROLOGICAL= can be either central (eg in Parkinson's, MS, spinal cord syndrome) or peripheral in origin (eg peripheral neuropathy like diabetic neuropathy or GBS, alchoholism, uraemia).

HORMONAL= Hypoganadism, Cushing's and thyroid diseases, hyperprolactinaemia

ANATOMICAL= Peyronie's disease

DRUGS = beta blockers, diuretics, Cu channel blockers, hormonal agents eg cyptotenone acetate,LH releasing analogues, H2 antagonists eg cimeetidine, ranitidine.

2/Psychogenic causes
- psychosexual factors (can be general due to a disorder of sexual intimacy and lack of arousability or situational due to partner or stress)
-Psychiatric illness ( Generalized anxiety disorder, depression, alcohol dependency)

Management - involves
- history taking ( ask about current/past sexual relationships, current emotional status, erectile symptoms eg onset and duration, arousal ejaculation and orgasmic difficulties). don't forget drug and social history. Latter is important to look for drinking problems, smoking, home situation, difficulties at work/marriage.

-Investigations - blood glucose, U&Es, urinarlysis, LFTs if indicated. If patient also has reduced sexual drive or abnormal sexual characterization, check testosterone levels, LH/FSH, prolactine (especially in young men).

Treatment - correct the underlying cause whether organic or psychological. First line symptomatic treatment is with phosphodiesterase inhibitors (sidenafil, tadafil, vardarefil) or vacuum devices eg external cylinder - one study reported that 23% asked for a prescription after a 2-week trial and 52% reported satisfaction (suitable for older patients).

IN WOMEN

Lack of arousal may be caused by inability to respond to sexual stimulation with dilatation of venous vaginal plexuses and lubrication to reach orgasm.

The causes are;
1/psychosexual;
- inhibitions from learned attitudes, past experiences or marriage difficulties.
- situational anxiety eg about a baby, in parental house
- inadequate stimulation from an inexperienced lover is often a cause of early difficulties

2/ organic
- Causes include drug side effects, neurological problems (MS), vascular disease (Diabetes), postmenopause (low oestrogen).

- Inadequate stimulation or lack of arousal may accompany dyspareunia, which is pain during a sexual intercourse. Fear of pain with intercourse causes anxiety with or without sexual reponse leading to vaginismus (contraction of pelvic muscles resulting in failure of penetrative sex) and more painful intercourse thus creating a vicious cycle.

For medical students reading this, dyspareunia is not an uncommon history station in your OSCE. You have to think of a differential. This depends on the site of the pain, which classifies dyspareunia into introital, midvaginal or deep.

Introital dyspareunia is caused by
-inadequate lubrication or vaginitis (eg due to STI)
-vaginismus

Midvaginal caused by
- urethritis, congenital vaginal abnormalities

Deep dyspareunia caused by
- endometriosis (ectopic bleeding uterine tissue outside uterus), adenomyosis (bleeding uterine tissue within uterine muscle layer), leiomyomata (benign uterine cancer), pelvic inflammatory disease, uterine retroversion or ovarian cyst.

Management
- Take a good history; if patient reports painful intercourse, ask about onset, duration and site of pain, and whether pain occurs with arousal or at penetration. Ask about associated symptoms eg rash, irritation, smell (local aetiology), vaginal discharge (STI), heavy periods and menstrual irregularities (endometriosis) and menopausal symptoms and any dragging sensation (prolapse).

- pelvic and speculum examination

-treatment; to correct the underlying cause. The cycle of fear must be broken in order to stop the pain if no evidence of organic aetiology and anxiety/vaginismus induced dyspareunia is suspected. A specialized Kegel exercise of the pelvic muscle is taught to the patient to learn how to relax pelvic muscles during an intercourse. Lubricants may be used in case of indequate lubrication.

3/ ORGASMIC DYSFUNCTION

5-10% of females report anorgasmia, which can either be primary (never been able to achieve orgasm under any circumstances) or secondary (diminished ability to active orgasm despite previous successful attempts). A study by Kinsey in 1953 found that 9% remain unable to experience orgasm throughout their lives.

Psychosexual factors include fear from momentary loss of control experienced during orgasm and unable to relax and let go. Vaginismus can cause orgasmic dysfunction as well as impaired arousal. Other physical factors include lack of normal bulbo-cavernous reflex which causes failure to reach orgasm.

I hope this brief post made a useful introduction into medical problems affecting sexuality, which is normally a big and complicated area. For further reading, please explore the references below.


Information was adapted from;
- www.patient.co.uk (highly recommended for non-medical readers)
- John Bancroft, human sexuality and its problems. 3rd edition. 2009
- David Goldberg, Linda Gask and Richard Morris. Psychiatry in medical practice. 3rd edition. 2008


February 14, 2010

Sex and its Problems... A Crash Course!!


Sexual problems are badly taught in medical school curricula despite their common prevalence, which represent the top of the ice-burg since many choose not to seek medical advice out of embarrassment or lack of awareness.

For example, one large US survey found that 43% of women and 31% of men between the ages of 18-59 complained of some form of sexual problems during the preceding 12 months. Whereas 2/3rds of men referrals were due to erectile dysfunction, women complained of loss of desire and impaired sexual interest, which commonly co-existed with relationship problems and other problems with arousal.

Hence the purpose of this brief report is to raise educational awareness of these problems and outline a general framework for a differential. First, we illustrate how 'sex' normally works in this post followed by an exploration of related problems in a second post later. So keep tuned!!!


The sexual response consists of 4 essential steps as shown in the diagram;

1/ DESIRE; it is the energy that allows an individual to initiate a response to sexual stimulation

2/ AROUSAL; this is the physical and emotional stimulation leading to breast and genital vasodilatation and clitorial enlargement.

3/ ORGASM; Physical and emotional stimulation maximized allowing the individual to relinquish their sense of control

4/ RESOLUTION; most of congestion and tension resolves within seconds. Complete resolution may take up to 60 minutes.

If you look at the diagram - The frontal cerebral cortex, the thinking part of your brain, feeds positive cognitive stimuli into the limbic system, the seat of your emotions!! ie this loop is where sexual DESIRE is coordinated and governed by individual's attitudes fears and experiences. Through spinal neuronal circuits, the limbic system exerts its stimulating/inhibiting influences on sexual AROUSAL represented by peripheral arousal (respiratory and cardiovascular effects) and genital responses. In order for the individual to know that arousal has taken place, a sensory feedback system sends information to the brain establishing that physical effects of arousal occurred. Tactile/sensory stimulation stimulates the limbic system through spinal centers, and that contributes to ORGASM. Therefore, functional availability of the limbic system and spinal centers are prerequisite for orgasm.

Now, it's easier to think of sexual disorders generally as problems of desire, arousal or orgasm. We'll explore this part next.





Reference

John Bancroft. Human sexuality and its problems. 3rd edition. 2009. Edinburgh

Learn How to Beat Jet Lag!


(Picture from http://www.jetlagtips.com/j0202148.jpg)

Did you once travel across 6-8 time zones and developed the following symptoms;

Insomnia
Daytime sleepiness
Diminished physical performance
Cognitive impairment
GI disturbances

That's right! Jet lag is a sleep disorder, although medically benign and self limited within 1-2 days, symptoms can continue until the biological clock in your brain is adjusted to time in the new destination. Jet lag can cause 'serious misjudgments in business or professional dealings' and knowing how to deal with it will make your life less of a 'sleepy' one!!!

So is there an actual clock ticking in your brain? of course there is!!!

Located in the suprachiasmic nucleus in the hypothalamus, right above your inner nose cavity, is where the 'circadian' clock lies. Circadian is derived from latin for 'around the day'.





The Circadian clock responds to the on-and-off cycles of solar light so that it helps you go to bed during night and increases alertness during daytime. It does that cleverly by special nerve cell pathway which starts from the back of your eyes and goes to the hypothalamus, where circadian cells live. Circadian nerve cells can develop a specific pattern of releasing electrical nerve impulses that is specific to length of day and night. In other words, they memorize when night is going to fall. So, they send messages to another tiny structure in your brain called 'pineal gland', which release the hormone melatonin at night to make you feel sleepy.

The problem with jet lag now is that this clock is very old fashioned and needs lots of time to adjust to time of day and night in the new destination. I am sure you're asking now a very intelligent question; can we make it adjust faster? Yes you can!!!

The simple way is to do the opposite of vampires - get as much bright light exposure in the best time of the day as you can. This is recommended in the morning after eastward travel and in the evening after westward travel. I am afraid readjusting the timing of your sleep does not reset the clock.

However, changing your bedtime before flight can shorten the jet lag; it's recommended to shift your sleep time 1-2 hs in accordance to destination time before take off.

If you're getting an overnight flight, like I always do, then you will feel inevitably sleepy during the first 1-2 days in your destination and might need extra recovery sleep to compensate. It is best to avoid longer naps during daytime because they do no good to your nighttime sleep and will reduce your chance of getting some good quality light exposure necessary for resetting your brain clock. So, 'short' naps are better and more effective in order to make you feel less sleepy during daytime.

Early this month in a review in the New England Journal of Medicine, Dr Robert Sack, a psychiatrist specialized in sleep problems from Oregon University, Portland, suggested an alternative way into reseting your brain clock. He discusses the evidence of using melatonin as a night signal. So you can take 0.5-3 mg melatonin at local bedtime nightly if you're going eastward until you get adapted, or 0.5 mg slow short acting dose in the second half of night if you're going westward.

Another option is to sleep in the plane, which I personally can't do to be honest, unless of course if you force yourself into reading a book of medical statistics - what a powerful hypnotic!!! Of course, you don't have to do this torture to yourself! You can take zaleplon, a sleep pill that has 2-3 hr duration of action. If you want to sleep more, then zolpidem and eszopiclone are preferred- a word of warning though, these two can cause grogginess on arrival and can make you feel grumpy rather than shinny!!

You should avoid alcohol if taking these pills. Also if you're at risk of deep vein thrombosis (a condition where blood in leg veins is prone to clotting) eg had a knee surgery, previous history or pregnant, then avoid them.

Table below is from Sack (2010), and summarizes the different approaches one can entertain.


We wish you a safe and comfortable journey wherever you're going!!




Reference;
R. Sack. Jet lag. 2010. NEJM.(362); 440-7.



February 12, 2010

Queen's University Belfast Scrubs EM Conference BOOKING NOW

Dear Medical Student,

Just to let you all know that the medical and surgical society QUB Scrubs is now taking bookings for our Emergency Medicine Conference on Tuesday and Wednesday 9th & 10th March. The conference is going to be held at the Medical Biology Centre at Queen's University Belfast.

The conference is the highlight of our calendar- it's a national conference tailored specifically for undergraduates. It is a 2 day event, with delegates coming from all over the UK and the Republic of Ireland as well as from Queen's. It's not just for students in their clinical years either...it is a fantastic learning opportunity for students from all years, so why not come along to learn, to present your research and have some great craic with other medical students from all over the country?!

FULL DETAILS CAN BE FOUND ON OUR WEBSITE BUT HERE IS A BRIEF SUMMARY BELOW!

WHAT'S INCLUDED?
Day 1 of the conference focuses on expert seminars- a huge number of specialties are covered from paediatrics to trauma surgery, and from management of oesophageal varices to acute poisoning. Day 2 is much more hands on- it is the practical skills workshop, focusing on things like ABGs, immediate life support, suturing, radiology (perfect OSCE preparation).

* Food is provided on both days
* Delegates will receive conference bags with goodies from Scrubs, Wesleyan and MPS who will be attending
* Spot prizes throughout both days

WHAT ELSE?

* If you have done an intercalated degree/original research/audit/literature review and wish to come along to present you work you can do so- just submit an abstract to us via email by Tuesday 9th February. Points are awarded on the UKFPO application for presenting work at conferences so why miss out? We are planning to have our conference party on the first night this year, so that anybody travelling won't miss it if they have to dash off for flights after the second day. We are planning to have the meal/party in Victoria Square on the night of the 9th March- all delegates are invited as well as the speakers.

HOW TO BOOK
If you like the sound of that you can book online via our website; the 2010 Conference page at www.scrubs.society.qub.ac.uk has all the details and info on how to book. We have kept the prices the same as last year- £15 for members and £20 for non-members.
However, we now have double the number of members than we had last year, so with limited places it would be a good idea to book quickly. We know not everybody will want to present research or go to the dinner, so you can opt out of those. At the bottom of the 2010 Conference page on the website just follow the simple instructions.

* In the first box select whether you are a member or non-member, and you can add the evening meal ('dinner') for an additional £10, or add a research presentation ('RP') for an additional £5, or both. * Please fill in the second box (just stick in QUB). * Regardless of whether or not you are having the evening dinner put any special dietary requirements in, because we'll be providing lunch on both days.

Payment is via PayPal, which is totally secure. Information about where to stay can be found on the conference page of our website!

If you have any general queries, or any problems booking just send us an email and we'll get back to you as soon as possible.

We'd love to welcome you to Belfast in March!

Luke Boyle
President, QUB Scrubs

Thanks to Yaqoub Al Qattan for the information

February 11, 2010

Don't miss; Psych, Neuro and Ophthalmology this weekend in London




The Royal Society of Medicine in London is planning a medical student revision day on Sunday 14th Feb for the three tricky specialties...

Neurology Ophthalmology Psychiatry


If you feel you are not confident in these areas, then I promise that you won't regret spending the weekend in London! The clinical lectures are of high standard and handouts with power point slides are provided.

http://www.rsm.ac.uk/students/sta16.php

February 10, 2010

Addicted to Video Games? Find out about Video Game Dependency or VGD!!

(Picture from http://s3.hubimg.com/u/271610_f520.jpg)



Three German scientists conducted a psychological survey of more than 15,000 ninth graders in which 3% of male and 0.3% of female students were found eligible for a diagnosis of Video Game Dependency (VGD).

The authors described students with VGD to have high levels of psychosocial stress including increased truancy, less sleeping hours, lower academic performance in school and less leisure activities. In addition, students also reported increased thoughts of committing suicide.

The study suggests VGD as a clinical phenomenon calling for further descriptive research. This is good news for those who play more often as VGD is considered by authors distinct from excessive playing!!!

Reference;
Florian Rehbein, Matthias Kleimann, Thomas Mößle. Cyberpsychology, Behavior, and Social Networking. -Not available-, ahead of print. doi:10.1089/cpb.2009.0227.

February 04, 2010

Edward Cullen's Disease


Since people have recently gone vampire mad, I thought I'd share some vampire medical trivia.

Some historians claim that the vampire/werewolf folklore emerged from the symptoms of a certain disease. Can anyone guess what condition is linked with tales about vampires?

February 02, 2010

Castration to Stop Criminal Behaviour Dominated by Hypersexuality - should doctors get involved as agents of social control?


medical castration with LHRH agonists (diagram from www.patienthealthinternational.com)


[Prizzi Zarsadias & Josephine Hayes wrote in BMJ Group mailings];

'There are many ways to increase your sex drive, from aphrodisiacs to Viagra. But what about people who need to reduce it? Many European countries and several US states are considering, or already use, chemical castration of sex offenders as part of rehabilitation. Antiandrogenic drugs are used to stop offenders being dominated by sexual thoughts and drive. Some offenders request physical castration to control their sexual urges. But there are questions about doctors' involvement in the process and the side effects of the treatments'


Don Grubin, professor of forensic psychiatry and Anthony Beech, professor in criminological psychology wrote an interesting editorial article in BMJ supporting this case.

Read more;
http://www.bmj.com/cgi/content/full/340/jan12_2/c74?ijkey=rcCG6E9p6AKqY&keytype=ref&siteid=bmjjournals&utm_campaign=6913607&utm_content=40010313952&utm_medium=email&utm_source=Emailvision

Find out the Diagnosis for Neuro Case!!!

The case we discussed below received a diagnosis of Multiple System Atrophy (see clinical details in post below)

MSA is a neurodegenerative disease forming part of the Parkinson's-Plus syndromes. The incidence is sporadic mainly affecting individuals after 50 years of age with 9.3 mean survival years.

Pathology - multiple system atrophy affects three major neuronal systems with neuronal loss and gliosis; 1/ nigro-striatal degeneration ==> pure parkinsonism
(coronal section of brain illustrated above (from Wenning et al 2004)) shows shrinking of basal ganglia structures including putamen and globus pallidus.


2/ Autonomic failure ==>.Shy-Drager syndrome (erectile failure, impotence in men, urinary incontinence, fecal incontinence and postural hypotension)

3/Olivopontocerebellar atrophy = cerebellar features (gait and limb ataxia and incoordination). The initial presentation is usually dominated by one clinical syndrome. However, as the neurodegenerative process progresses, all three systems overlap leading to full blown MSA. UMN signs may also occur. Our patient had Parkinsonism with spasticity and query autonomic features. Autonomic and cerebellar features may occur expectedly as the condition progresses.

Features that are typical of MSA and were not demonstrated in this case are;

1/ Parkinsonism dominates the motor disorder in 80% of patients with MSA.

2/ 50% of patients with MSA have cerebellar signs which were absent or not manifested yet in this case (also 50% have spasticity which is a feature)

3/ Autonomic failure occurs in almost all patients - very severe and early in disease course.
• Men commonly present with impotence as 1st symptom, preceding motor symptoms by months or even years.
• Incontinence> retention common in both sexes (frequency and urgency due to detrusor hyperreflexia in 75%).
• Postual hypotension may occur.

Other features

1/Laryngeal dystonia (sustained muscular contraction) leading to stridor (30% of patients).

2/ Speech - quivering, strained and slurred component. Many develop aphonia.

3/ Dysphagia

4/ Postural instability EARLY in disease.

5/ Dementia is not a feature.

6/ Levodopa response = commonly absent or poor (good in 25%)

The diagnosis is usually clinical without recourse to investigations.


Adapted from;
Hughes, A.J., Ben-Shlomo,Y., Daniel, S.E. & Lees, A.J. 1992, "What features improve the accuracy of clinical diagnosis in Parkinson's disease: A clinicopathologic study", Neurology, vol. 42, no. 6, pp. 1142

Quinn, N. 1995,"Fortnightly Review: Parkinsonism--recognition and differential diagnosis", British medical journal, vol. 310, no. 6977, pp. 447-452

Further Reading; Wenning et al (2004)