Protein Bars: What's In It?

Protein Bars | What's In It | The New York Times. Protein bars offer convenience, but they can also contain as much sugar as a candy bar and the calorie count of an entire meal.

Read the story here:

Sarcoidosis - 2014 Lancet review

Sarcoidosis is a systemic disease of unknown cause that is characterised by the formation of immune granulomas in various organs, mainly the lungs and the lymphatic system.

Sarcoidosis might be the result of an exaggerated granulomatous reaction after exposure to unidentified antigens in individuals who are genetically susceptible.

Diagnosis is made by symptoms, PFTs, CXR, CT, endobronchial ultrasound and PET for assessment of inflammatory activity.

Recognition of unexplained persistent disabling symptoms, fatigue, small-fibre neurological impairment, cognitive failure, and changes to health state and quality of life, has improved.

Mortality in patients with sarcoidosis is higher than that of the general population, mainly due to pulmonary fibrosis.


Sarcoidosis - The Lancet
Image source: Lungs, Wikipedia, public domain.


Top medicine articles for April 2014

A collection of some interesting medical articles published recently:

Noninfluenza Vaccination Rates Among U.S. Adults Remain Low - only 16% for Tdap in 2012

Adult Tonsillectomy Shown to Be Safe: 30-day mortality rate was low, at 0.03%. 1.2% had complications

Parabens in Our Lotions and Shampoos - they are in 15,000 personal care products - and mimic estrogen

Counter-intuitive Full-Fat Paradox: Whole Milk May Keep Us Lean - NPR reviews the evidence

Cat Bites May Lead to Serious Infections - they inject harmful bacteria deep into joints and tissue

Having 3 items (TV, computer, car) increases risk of obesity and diabetes 3-4 fold in developing nations

Prognosis of Adolescent Mental Disorders (anxiety, depression) - 40-50% continued to have problems as adults. From ages 21–29, 52% of women and 31% of men met diagnostic criteria at least once for anxiety or depression

12% of U.S. spice imports are contaminated with insect/rodent parts, 7% contain salmonella

Drugs Made in India Set Off FDA Safety Worries: antibiotic and chemotherapy tablets had no active ingredients - NYTimes. India’s pharmaceutical industry supplies 40% of over-the-counter and generic prescription drugs consumed in U.S. The World Health Organization estimated that one in five drugs made in India are fakes

The French way of cancer treatment | Reuters

Genotype-guided personalization may improve cost-effectiveness of prasugrel and ticagrelor for ACS

Driving Under the Influence, of Marijuana - NYTimes -- If you are pulled over on suspicion of drunken driving, the police officer is likely to ask you to complete three tasks: Follow a pen with your eyes while the officer moves it back and forth; get out of the car and walk nine steps, heel to toe, turn on one foot and go back; and stand on one leg for 30 seconds. Score well on all three of these Olympic events, and there’s a very good chance that you are not drunk. This so-called standard field sobriety test has been shown to catch 88 percent of drivers under the influence of alcohol. But it is nowhere near as good at spotting a stoned driver.

How to read articles about health. Most important rule to remember: don’t automatically believe the headline

The articles were selected from Twitter and my RSS subscriptions. Please feel free to send suggestions for articles to clinicalcases AT and you will receive acknowledgement in the next edition of this publication.

Fibromyalgia - An Emerging but Controversial Condition - 2014 JAMA Update

Fibromyalgia is not a rheumatological disease but a central pain syndrome. It is a complicated condition that tends to last a long time, although people do get better.

The syndrome termed fibromyalgia or fibrositis has attracted the interest of investigators for quite some time. Although some authors believe that fibromyalgia is not a discrete condition, rheumatologists now report that fibromyalgia is one of the most common diagnoses in ambulatory practice. Recent estimates of the prevalence of fibromyalgia in the United States have ranged from 3 to 6 million.

This JAMA video introduces a free review article on fibromyalgia from April 2014

What is fibromyalgia?

Fibromyalgia can be thought of as a centralized pain state. Centralized pain is a lifelong disorder beginning in adolescence or young adulthood manifested by pain experienced in different body regions at different times.

How common is fibromyalgia?

Fibromyalgia is present in as much as 2% to 8% of the population, is characterized by widespread pain, and is often accompanied by fatigue, memory problems, and sleep disturbances.

How to treat fibromyalgia?

Numerous treatments are available for managing fibromyalgia that are supported by high-quality evidence:

- nonpharmacological therapies (education, exercise, cognitive behavioral therapy)
- pharmacological therapies (tricyclics, serotonin norepinephrine reuptake inhibitors, and gabapentinoids)

Free content from JAMA:

JAMA | Fibromyalgia:  A Clinical Review
JAMA Patient Page | Fibromyalgia

Related reading:

Fibromyalgia is not a rheumatological disease but a central pain syndrome
JAMA Network | JAMA | Fibromyalgia Syndrome:  An Emerging but Controversial Condition

Male hypogonadism - 2014 Lancet review

Clinical presentations vary dependent on:

- time of onset of androgen deficiency
- whether the defect is in testosterone production or spermatogenesis
- associated genetic factors
- history of androgen therapy

Diagnosis of hypogonadism is made on the basis of:

- signs and symptoms consistent with androgen deficiency
- low morning testosterone concentrations in serum on multiple occasions

Several testosterone-replacement therapies are approved.

Contraindications to testosterone-replacement therapy include:

- prostate and breast cancers
- uncontrolled congestive heart failure
- severe lower-urinary-tract symptoms
- erythrocytosis


Male hypogonadism - The Lancet
Image source: The shield and spear of the Roman god Mars, which is also the alchemical symbol for iron, represents the male sex. Wikipedia, public domain.
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