Free OSCE Revision Videos

Click here to access OSCE revision lectures. They are by delivered by the guy who wrote the Pastest OSCE book. Apparently, they are easygoing and good for quick revision if you have spare time.

Thank you Noura for sharing the link and good luck with your exam!

What does a complex partial seizure look like?

This video illustrates what a complex partial seizure looks like. But what does this even mean? well let's have a close look !

Seizure (fit) is a transient neurological event caused by abnormal electric discharge of neurons within the cerebral hemisphere manifesting as a group of motor/sensory symptoms/signs known as seizure semiology. An individual is said to have epilepsy if he/she has ≥ 2 seizures. Epilepsy is a symptom of an underlying disease process rather than a disease on its own right.

Did you know that about 5% of the population has a single seizure at some point of their lifetime, and if we are to look at every 100,000 people in the UK, about 500 of them will have a diagnosis of epilepsy.

Seizures are often mistaken for syncope or fainting which might be accompanied by general jerkiness just like some seizures. Therefore, it is important to clearly and accurately describe what exactly happened during the event. A witnessed account of what happened is essential since seizures almost always result in memory impairment or loss of consciousness.

So, how can you describe a seizure? let's dissect the event:

PRODROME = alteration of behaviour/mood preceding the attack by hours.

AURA = symptoms occurring immediately before the attack (this is important to indicate a seizure and trace its origin within the brain. For example, unusual sudden strange smell and gut rising feeling localizes to the temporal lobe).

ICTUS = the event itself might present as violent jerky movement affecting the limbs to sudden attacks looking vacant.

POST-ICTUS = this is the period immediately after seizure symptoms. A seizure is often associated with slow recovery (> 5 min) leaving the individual confused and muddled for few minutes even after recovery.

Now we know how to describe seizures, we can move to the next part - classification of seizures. The type of seizure you saw in the video is described as 'partial'. Why is that?

The International League Against Epilepsy (ILAE) classifies seizures according to their origin of onset within the brain. A seizure can be 'generalized' or 'partial'. Generalized seizures arise from a subcortical structure and are associated with synchronized generalized abnormal neuronal firing involving BOTH HEMISPHERES and resulting in impairment of consciousness and bilateral motor manifestations. On the other hand, partial seizures arise from a FOCAL origin within the CEREBRAL CORTEX that may either remain localized or spread more generally to result in a secondary generalized seizure.

A partial seizure can be further classified into 'simple' and 'complex' based on the degree of consciousness. Patients filmed in the video are said to have complex partial seizures because they can't remember what happened and lost awareness of their surroundings. This is due to seizure activity originating in the temporal lobe involving the hippocampus and spreading to the contralateral temporal lobe resulting in amnesia. So, 'complex' means accompanied by alteration of consciousness.

The behavioural features illustrated in the video are involuntary and known as 'automatism' which occurs in 90% of complex partial seizures. As shown above, they present as fumbling movement, rubbing and chewing or as semi-purposeful limb movement (eg opening the curtins and putting on cloths) - other people won't even guess the individual is suffering from a seizure. However, patients experiencing a complex partial seizure often appear distant, staring and unresponsive.

I hope this brief article helped to explain the pattern of symptoms and signs shown in the video, and provided some clarification. Please do not hesitate to ask any questions related to the topic.

Marmots can teach us about obesity

Marmots Can Teach Us About Obesity

ScienceDaily (June 2, 2010) — A nutrient that's common to all living things can make hibernating marmots hungry -- a breakthrough that could help scientists understand human obesity and eating disorders, according to a new study by a Colorado State University biologist.

The study appears in the current issue of the Journal of Experimental Biology.

Professor Greg Florant discovered he could slowly release a molecule called AICAR into yellow-bellied marmots that activates a neurological pathway driving food intake and stimulates appetite. The pathway, which shuts down during hibernation, relies on an important balance between two energy molecules -- ATP and AMP. The lower the ratio between the two cellular molecules, the lower the energy in the cell and the more the appetite is stimulated.

Without this artificial stimulation, awake, hibernating marmots do not eat -- even when researchers place food in front of them.

"The experimental group started to feed because they thought they had this energy deficit," Florant said. "Then when the pumps dispensing the molecule finally stopped, the animals went right back into hibernation. That suggests to us that the animals are still sensing energy levels within cells during the hibernation period."

Tissue samples taken from marmots in Florant's lab allow researchers to identify biochemical processes and genes that are active during hibernation -- as opposed to genes that are active when they're feeding or engaging in other behaviors.

The American Physiological Society has called hibernators such as marmots, bears, woodchucks, hedgehogs and lemurs "medical marvels" because they can turn off their appetites and slow their breathing to a point that would be lethal to other animals.

Marmots typically hibernate for as many as six or seven months.

"You can't eat if you're asleep," Florant said. "We've discovered that perhaps nutrients within the brain, such as fatty acids, can alter the food intake pathway, which normally shuts down when marmots hibernate. The perceived drop in energy nutrients (i.e. low ATP) makes the animals think they've got an energy deficit and want to eat."

Florant said he'll conduct additional research this summer to determine whether the reverse is true: Can he stop the animals from eating when they're not hibernating?

His team will also identify neurons in the particular areas of the hypothalamus that are involved in food intake in animals. The hypothalamus is one of the master regulator areas of the brain and controls such activities as food intake, sex and temperature regulation.

"We know which neurons are driving this process," he said. "We're just trying to identify them within the marmot and distinguish what's different about the neurons in a marmot compared to a rat or other animal that does not go into hibernation."

G. L. Florant, A. M. Fenn, J. E. Healy, G. K. Wilkerson, R. J. Handa. To eat or not to eat: the effect of AICAR on food intake regulation in yellow-bellied marmots (Marmota flaviventris). Journal of Experimental Biology, 2010; 213 (12): 2031 DOI: 10.1242/jeb.039131

KIMS plans a meeting for interns

In light of changing the new regulations describing the pathway of specialty training in Kuwait, the Kuwaiti Institute of Medical Specialties (KIMS) arranged a meeting for the interns in order to address concerns regarding their future career plans (see pictures).

I thank Ali Mohsen for forwarding the above pictured documents from the facebook page of one of the junior doctors working in Kuwait.

Article in Today's Al Qabas about the new KIMS rules

13291 - 30/05/2010, Al Qabas (see below for English version)

لوزير الصحة إلغاء القرار الجائر بحق الأطباء


لكم تمنينا ان يرى النور اقتراحنا بإنشاء «سوبر هاي واي» للاطباء الكويتيين، لتحفيزهم على التخصص والابداع، كما حدث في السبعينات في اميركا، عندما اقترحه الرئيس نيكسون، فكان من بين الاسباب التي جعلت اميركا من اكثر دول العالم تطورا في مجال الطب. ولكننا للأسف سمعنا، من خلال شكوى تقدم بها لنا اطباء متدربون، انه بدلا من ان يكون هناك «سوبر هاي واي»، فإن الوزارة اصدرت قرارا يعتبر «حفرة داون واي» في الشارع الضيق الذي يسير عليه ابناؤنا وبناتنا من الاطباء!
لقد صدر قرار جائر منذ ثلاثة اسابيع من معهد الكويت للتخصصات الطبية التابع للوزارة، الذي يترأسه دكتور ليس طبيبا، يلزم الاطباء المتدربين قبل تاريخ 10 يونيو بأن ينقبلوا في تخصص من بين ثلاثة تخصصات فقط في البورد الكويتي، من غير ان يسمح لهم بالانتقال الى درجة الطبيب المساعد حتى يمارسوا هذه التخصصات لمدة كافية! فكيف يا معالي الوزير يختار هذا الطبيب المتدرب تخصصا غير مقتنع به تماما بسبب ضيق الوقت؟ كما يقول طبيب في شكواه: كيف أختار ولم يمض على تدريبي سوى اسبوعين فقط؟! كيف ولم يعرف الاطباء حتى الآن مدى توافق هذه التخصصات مع ميولهم المهنية؟ ان توافق التخصص مع الميول المهنية هو سر الابداع لدى الطبيب يا معالي الوزير، فجاء قرار الوزارة جائراً محبطاً لا يراعي مصلحة الاطباء.
لقد كان الطبيب في السابق يعطى سنة من التدريب لينتقل بعدها ليكون طبيبا مساعدا، وله ان يبقى طبيبا مساعدا، اما اذا اراد الترقية فعليه ان ينقبل في اي بورد سواء كان الكويتي، غير المعترف به عالميا، او اي بورد خارجي، فتكون للاطباء فرصة للممارسة قبل ان يقرروا تخصصهم وبأي بورد يلتحقون.
ما زاد الطين بلة ان القرار، الذي قيل انه صدر لتوفير اموال عن كل رأس طبيب متدرب للوزارة! قد نُقل للاطباء شفهيا، وبطريقة غير لائقة لا تخلو من الصراخ احيانا عندما يتقدمون للسؤال عن تفاصيل القرار التي يبدو ان رئيس المعهد الذي اصدرها لا يعرفها جيدا، فلا تعميم مكتوب ولا لائحة تنفيذية بالشروط والضوابط، وما زاد الطين بلة، فصار «صبخة»، ان هذا القرار قد ألغى مكانة مصداقية اختبار MRCP المعترف به عالميا، حيث قال المسؤول لطبيبة حاصلة على درجة الاختبار «بلّيها واشربي ماءها»! لان شرط الترقية والبعثة هو دخول البورد الكويتي فقط! فما هذا التخبط يا وزارة الصحة؟! هل يصدق معالي الوزير انه عندما سأل احد الاطباء احد المسؤولين بالوزارة: من سيؤدي العمل اذا صارت درجة الطبيب المساعد فارغة بالمستشفيات بسبب هذا القرار؟ اجاب ببرود: «نجيب هنود من بره يشيلون الشغل بربع معاشكم»!‍!! فيا معالي وزير الصحة ويا سعادة الوكيل الموقر، هذا القرار فيه اجحاف بحق مستقبل أهم مهنة في البلد، مما يستدعي إلغاؤه، لأنه جائر بحق الاطباء.
***
إن أصبت فمن الله وإن اخطأت فمن نفسي والشيطان.

بدر خالد البحر
bdralbhr@yahoo.com

English Version

To the Minister of Health: Cancel the Unjust Decision Towards Doctors

We were hoping that our suggestion, to create a "super highway" career path for Kuwaiti doctors would see light, to encourage Kuwaiti doctors to specialize and innovate. When President Nixon made the same suggestion in America, in the seventies; it became one of the drivers for the advancement of healthcare there. Unfortunately, recent decisions made by the Kuwait Institute of Medical Specialization (KIMS) are the equivalent of digging holes in the career paths of junior doctors, instead of building 'super highways' to help them on the already narrow road of medical specialization

The unjust decision was passed three weeks ago by KIMS, which is headed by a doctor who's not even a physician himself. This decision reads, that all doctors must select three choices for a specialty to pursue in the Kuwaiti board before the 10th of June, of which they'll be accepted into one only. In addition, doctors won't be promoted to the level of assistant registrar without spending a set amount of time in their selected specialty. We pose the question to the Minister of Health, how can a doctor be forced to choose a specialty they are unsure they want to pursue, as is likely to happen when doctors are not given adequate time to think this decision through? A young doctor complained to me, "How can I choose a specialty when I've only been training for two weeks?".

How can doctors choose a specialty when they are yet to figure out which one agrees with their career inclinations? A doctor's innovation is closely tied with the synchrony of his or her career inclinations and the specialty they are enrolled into. I would like to voice my concerns to the Minister of Health that this decision is unjust and goes against the interests of physicians. In the past, a trainee doctor spent one year in training. Next, he or she was promoted to the grade of assistant registrar. Then, the doctor had the right to remain an assistant registrar or seek promotion via the Kuwaiti board, which is not internationally accredited, or any other foreign accredited board. As such, physicians were given an entire year to choose which board and which specialty they would like to be enrolled into.

What makes things worse, is that a trainee doctor was told that this decision was brought in place to decrease the amount of money spent on doctors. It was delivered in an inappropriate manner and questions regarding the minutiae of the decision were met with rude and loud responses. It appears that even the head of the institute is not aware of all the details of the decision. The decision was not put in writing and there are no clear rules and regulations that must be followed. Also, it appears that the MRCP (internationally accredited membership) has been rendered useless, as the only road to a promotion and scholarship is through the Kuwaiti board. What is with all this incompetence? A Kuwaiti doctors asked, "Who will cover the workload delegated to assistant registrars if no Kuwaitis are enrolled in it because of this decision?" The reply from the head of the institute was, "We'll bring Indians from abroad who will work for a quarter of your pay!"

Finally, I say to the Minister of Health; this decision is prejudiced towards the most important profession in the country and it is unjust towards the future generation of physicians; it should be revoked!

By: Bader Khaled Al Bahar
Published: Al Qabas Newspaper

bdralbhr@yahoo.com

(Kindly translated by Mohammad Hassan)

KIMS's new rules?

So word's been going around that KIMS are changing the scholarship rules for people who would like to specialize abroad. To be honest, I'm not well versed on the issue but what I can gather from people (which may not be entirely accurate so don't quote us!):

-High GPA
-High TOEFL score
-You need to get into the Kuwaiti board and pass their exam
-You don't get to choose which country you go to
-You don't get to choose which specialty you get into

I guess what's more frustrating than having new rules is not having a system in place where these regulations are spelt out (on KIMS's website or another regulatory body). Things are a bit murky for junior doctors at the moment with little guidance from administrators to help them plan their future.

Anyway, for interested parties, apparently there's going to be a meeting at Kuwait Medical Association's HQ at 8pm today, Kuwait time.

More information is available if you join this facebook group: http://www.facebook.com/group.php?gid=118389084868775#!/group.php?gid=118389084868775&v=wall

Let us know if you are in possession of any more information!

Dancing Arrythmias!