I knew it ! Money makes Man stronger

Having money in hand not only gives confidence and makes you feel stronger but also attenuates physical pain. These are the conclusion from studies publised in Nature

Handling or even contemplating money can relieve both physical pain
and the distress of social rejection, according to a study by Chinese
and American psychologists. But remembering cash one has spent intensifies both types of hurt.

The
findings suggest that the mere thought of having money makes people
feel physically stronger and less dependent on the approval of others
to satisfy their needs. "Money activates a general sense of confidence,
strength, and efficacy," the researchers propose.

Thoughts of money soothe social rejection : Nature News

You can read the whole article here in Psychological Science

cholecystectomy as day-case.

With the advancement in laparoscopic techniques,increasing proficiency of Surgeons in their use and economic pressures there is an increasing trend of cholecystectomy (removal of gall bladder) being done in clinic procedures with the patients being discharged the same day. There is an interesting article in the recent British Journal of Surgery concluding day-case (i.e. no overnight stay in hospital) laparoscopic surgery to be safe and effective.

Meta-analysis of randomized controlled trials on the safety and effectiveness of day-case laparoscopic cholecystectomy.




Br J Surg. 2008; 95(2):161-8 (ISSN: 1365-2168)

Gurusamy K; Junnarkar S; Farouk M; Davidson BR
Hepatopancreatobiliary and Liver Transplant Surgery, University Department of Surgery, Royal Free and University College School of Medicine, University College London and Royal Free Hospital NHS Trust, London, UK. kurinchi2k@hotmail.com

BACKGROUND: Although day-case laparoscopic cholecystectomy can save bed costs, its safety has to be established. The aim of this meta-analysis is to assess the advantages and disadvantages of day-case surgery compared with overnight stay in patients undergoing elective laparoscopic cholecystectomy.
METHODS: Randomized clinical trials addressing the above issue were identified from The Cochrane Library trials register, Medline, Embase, Science Citation Index Expanded and reference lists. Data were extracted from these trials by two independent reviewers. For each outcome the relative risk, weighted mean difference or standardized mean difference was calculated with 95 per cent confidence intervals based on available case analysis.

RESULTS: Five trials with 215 patients randomized to the day-case group and 214 to the overnight-stay group were included in the review. Four of the five trials were of low risk of bias. The trials recruited 49.1 per cent of patients presenting for cholecystectomy. There was no significant difference between day case and overnight stay with respect to morbidity, prolongation of hospital stay, readmission rates, pain, quality of life, patient satisfaction, and return to normal activity and work. In the day-case group 80.5 per cent of patients were discharged on the day of surgery.

CONCLUSION: Day-case laparoscopic cholecystectomy is a safe and effective treatment for symptomatic gallstones.

Such has been the practice at our center for 3 years now and there has been no cause of regret. In patient having excessive adhesions or difficult dissection or having anaesthesia related problems can be held back overnight. The patient can be assessed in the evening at the time of discharge and if comfortable can go home with instructions in case of any difficulty. I suppose the figure of 80 percent is about right.

As this study illustrates there is increasing trend towards shorter stay and early discharge. there are many centers in the US where such operations are done in office setting assisted by recent advances in intraoperative Ultrasound which is replacing cholangiography( unaware of such practice in India). Variations in the anatomy of cystic duct, hepatic duct and CBD and consequent mistakes while cutting the cystic duct can lead to dreadful and expensive complications.

Heart Diseases and Genetics.

As advances in genetics are made the influence of genes on individual's health is all the more apparent. It is quite well known that people of South Asian origin are inordinately susceptible to heart diseases besides diabetes and associated metabolic syndromes.

Today's Genetics Nature carries a paper delineating the high incidence of genetic mutation among Indians which is associated with Cardiomyopathy and heart failure.Heart failure is a leading cause of mortality in South Asians. However, its genetic etiology remains largely unknown¹. Cardiomyopathies due to sarcomeric mutations are a major monogenic cause for heart failure (MIM600958). Here, we describe a deletion of 25 bp in the gene encoding cardiac myosin binding protein C (MYBPC3) that is associated with heritable cardiomyopathies and an increased risk of heart failure in Indian populations (initial study OR = 5.3 (95% CI = 2.3–13), P = 2 10^-6; replication study OR = 8.59 (3.19–25.05), P = 3 10^-8; combined OR = 6.99 (3.68–13.57), P = 4 ^-11) and that disrupts cardiomyocyte structure in vitro. Its prevalence was found to be high (4%) in populations of Indian subcontinental ancestry. The finding of a common risk factor implicated in South Asian subjects with cardiomyopathy will help in identifying and counseling individuals predisposed to cardiac diseases in this region.

This article was further reported in Medical News Today


The Worst Luck In The World? The Heart Disease Mutation Carried By 60 Million

Heart disease is the number one killer in the world and India carries more than its share of this burden. Moreover, the problem is set to rise: it is predicted that by 2010 India's population will suffer approximately 60% of the world's heart disease. Today, an international team of 25 scientists from four countries provides a clue to why this is so: 1% of the world's population carries a mutation almost guaranteed to lead to heart problems and most of these come from the Indian subcontinent, where the mutation reaches a frequency of 4%.

Considering that the mutation is so dangerous; how come it is so common? Well-

The combination of such a large risk with such a high frequency is, fortunately, unique. "How can such a harmful mutation be so common?" asks Chris Tyler-Smith from The Wellcome Trust Sanger Institute, Hinxton, UK. "We might expect such a deleterious change to have 'died out'.

"We think that the mutation arose around 30,000 years ago in India, and has been able to spread because its effects usually develop only after people have had their children. A case of chance genetic drift: simply terribly bad luck for the carriers."

The original advanced online paper is here( in pdf)

Image: topher76

Doctors influenced by Rest and Fluids Industry

This physician enjoyed an all-expenses-paid trip to Aspen, just for telling his patients to "relax."

I have noticed that medical satire from theonion.com is awfully good. Hats off to the writers(?writer). In keeping with the current flaying of pharma-physican backslapping ties; The Onion investigates and finds ulterior motive in prescription of just fluids and rest for common cold rather than antibiotics ;-0

The investigation—the full details of which will be disclosed in this newspaper over the coming months—documented thousands of instances in which sick patients were repeatedly instructed, often verbatim, to "lie down and drink plenty of liquids." This treatment, recommended a staggering 4 out of 5 times on average, was in each case prescribed by a physician known to have recently enjoyed a golf vacation courtesy of Big Rest and Fluids.

"You have no idea how deep this goes," said Dr. X, a physician who wished to remain anonymous. "They've got everyone, from the pediatricians and family doctors, right on down to the school nurses. We've had the cure for the common cold for nearly 40 years, but it's still 'rest and fluids, rest and fluids.' Why? Because these guys are getting paid through the nose, that's why."

The ending of the article is pretty good too...

h/t

The complete article from The OnionTechnorati Tags: Pharma, Humor

End (Edge) of life issues -

Sometime back, when I was a trainee, we used to get patients at the end of their life. They would come to us tired and dejected (and angry) after  treatment from premier hospitals all over the country; having tried various form of alternative therapies and charlatans. And we would evaluate them and send them back to their homes. Some saw the futility and accepted while some fought to be admitted and die in the ICU. Overall there was (is) singular lack of knowledge and guidelines for the patients, their relatives and also among the physicians and health care workers.

I looked around and found there were no institute or place for such people and their families for guidance. The few places that existed were religion affiliated and their outlook was not what was needed. After so many years; even today no such places exist.

In recent time this area of end of life issues and hospice care has seen advancement especially in United States. A great series of articles was published in the Dallas News which I would recommend to everybody. Excerpts

Nobody wants to die a slow, lingering death. But many Texans do. Half die in hospitals. One in five passes away in intensive care. Often, their last months of life are expensive, painful exercises in medical futility.


Health care reformers in Dallas and around the nation are pushing for a better way to help people at the edge of life.

Practitioners of "palliative care" combine traditional medicine with pain relief, spiritual counseling, and practical advice for patients and families.

These articles derive from the experiences of palliative care team at the Baylor University Medical Center in Texas.

Unlike hospice, palliative care can continue alongside aggressive, life-sustaining treatments. Palliative doctors, nurses and other clinicians guide patients and families through searingly painful choices, including decisions to avoid overly invasive care. They aim to help patients live as well as possible for as long as possible, and to help grieving families prepare for the inevitable.

Research indicates that such "comfort care" sometimes can prolong life more effectively than aggressive surgical, chemical or radiation therapies. It also can reduce medical expenses; Medicare spends 28 percent of its annual budget on care given in the last year of life.

She describes the families and their emotions so well, highly recommended reading includes video clips.

Mr. Bourque tried telling Michelle that her mom might not make it. The little girl set stuffed animals and a purple-and-orange squirt gun on her mother's emergency-room gurney like talismans.

The Bourques were medical people. Mr. Bourque, 44, was a pediatric ICU technician starting nursing school; Mrs. Bourque, 45, was a pediatric respiratory therapist. They couldn't kid themselves, but it wasn't clear how much their daughter understood.

They'd tried to spare her, and sensed that Michelle was trying to protect them, too. They all needed help to get through what was coming. But nothing else could happen as long as Mrs. Bourque was trapped in agonizing pain.

In this era when nothing is ever enough and the machines can breathe for you; pump your heart; feed you forever; but cannot think for you: read here the series by Lee Hancock.

Drug marketing and dichotomy

When I began my practice following residency I became aware of the cesspool that medical and associated profession have become. Each day was (is) a learning experience. Not that one is completely unaware of the ground realities- but first hand experience is humbling.

I was reading a blog post by Jim Sabin wherein he comments on an article on "Drug promotional practices in Mumbai: a qualitative study" in the Indian Journal of Medical Ethics (April-June 2007 issue) and surmises

All of the issues described in Mumbai are present in the U.S., but in India the pharmaceutical practices are more brazen. Federal and state regulatory capacity is significantly less in India than in the U.S. Perhaps more important, organizations - medical schools, hospitals, medical societies, and more - currently have less capacity to push back against commercial forces than comparable institutions in the U.S.

But the Indian media is sinking its teeth into the issue of commercial corruption of medical decision making (see, for example, "Are your drugs boosting your doctor's lifestyle?" in yesterday's Times of India here). The same ethical drama is playing out globally, just with different timing.

the ground reality and the extent is so so much worse that it is mind boggling. and to be frank the medics/doctors are ending up being bit players.

Pic from offside.com
Technorati Tags: Medical Ethics

Burnout in Medical Students

As every whining medical student knows- life as a medico is tough and trying. This was well documented and analysed in an article in Annals of Internal Medicine(abstract).

The article has been reviewed by Sydney Spiesel at Slate.com

The study included more than 2,000 students at seven medical schools and looked for evidence of burnout and suicidal thinking. About half the medical students reported the feelings that define burnout (emotional exhaustion, a feeling of a loss of personal identity, a sense of poor personal accomplishment). Many showed signs of depression and a decreased mental quality of life compared with peers not in medical school.

He attempts to explain the findings and further offers possible solutions to the problems as in

We need to be alert to the signs of burnout, depression, and suicidal thinking in medical students and to make available the mental-health services needed to help with these problems.

Even though the factors in India are quite different from the US medical schools esp. regarding the debt(largely subsidized); I would be surprised if the findings are much different. the full article is here.

(Thanks to Cartoonstock.com for the pic)