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Podcast Recommendation: EM Clerkships
I love this podcast -- binge-listened the first seven rounds of The Game, in which an attending tests a resident in oral-board format. Each episode is a case: "You are working nights at ABEM General, and the nurse hands you a patient chart. Chief complaint: weakness." And then they walk us through the case, beginning to end.
It's interesting, dynamic, easy to follow and lots of fun. Linked here.
HSV encephalitis in neonates may be due to serotype 1 or 2, whereas HSV encephalitis in children and adults is usually due to serotype 1. Pro-tip: Treat with IV acyclovir, which can cause AKI and a reversible crystalline nephropathy, and IVF for renal protection. Image: Borrowed from Loony Labs.
This week on Teaching Rounds the topic is slavery and the history of medicine. Let's start with history of medicine Diana Ramey Berry's piece in the New York Times about the use of enslaved African Americans not only as cadavers for dissection in medical schools, but as grave robbers and body snatchers. Diana Ramey Berry, "Beyond the Slave Trade, the Cadaver Trade," The New York Times (3 Feb. 2018), https://www.nytimes.com/2018/02/03/opinion/sunday/cadavers-slavery-medical-schools.html
In 2015, enzyme replacement therapy with a recombinant human TNSALP enzyme called asfotase alfa was approved for moderately and severely affected patients with congenital hypophosphatasia. It is given subcutaneously q3-6 weeks. Other treatment modalities include physical and occupational therapy, NSAIDs for bone pain. The most common drug used to treat osteoporosis, bisphosphonates, are NOT used, because they inhibit bone remodeling in much the same way that HPP leads to accumulation of inorganic pyrophosphate, which blocks mineralization. Finally, dentists and oral surgeons are also developing more and better approaches to maintaining adult teeth or providing durable replacements despite the soft alveolar bone of the jaw.
Source: Lothar Seefried, "Treatment of hypophtosphatasia,"
Pro Tip on opportunistic infection prophylaxis in individuals with HIV/AIDS: Trimethoprim-sulfamethoxazole prophylaxis against Pneumocystis jiroveci pneumonia (PJP, previously P. carinii pneumonia or PCP) can ALSO help keep toxoplasmosis in check if one double-strength (800mg/160mg) tablet is taken daily. MWF dosing has fewer side effects but only protects against PCP, not toxo. If the patient has a sulfa allergy, G6PD, or otherwise does not tolerate TMP-SMX, give dapsone-pyrimethamine plus leucovorin. p.s. Yesterday was National HIV Testing Day--did you get tested?
"Blood donation is associated with iron deficiency among adolescent and adult females in the United States. These national data call for further development and implementation of blood donation practices aimed toward mitigating iron deficiency."
Eshan U. Patel, et alia, "Association of blood donation with iron deficiency among adolescent and adult females in the United States: a nationally representative study," Transfusion (18 February 2019), https://doi.org/10.1111/trf.15179.
A. Ever wonder what "an appropriate response" to blood transfusion means?
Q. In children, 10cc/kg of transfused blood should raise hemoglobin by 2.5-3.0g/dL and hematocrit by 7-9%. In adults, 1 unit of packed red blood cells (PRBCs) should raise hemoglobin 1g/dL and hematocrit by 3%.
Substance use is today's topic for #TeenHealthWeek2019. The National Institute of Drug Abuse (NIH) shared this graphic on teen use of cigarettes, marijuana, and vaping from a recent survey.
