Friday, September 30, 2005

Phosphate Nephropathy References

Acute Phosphate Nephropathy following Oral Sodium Phosphate Bowel Purgative: An Underrecognized Cause of Chronic Renal Failure. Journal of the American Society of Nephrology. 2005 Nov 1;16(11).
The findings of diffuse tubular injury with abundant tubular calcium phosphate deposits on renal biopsy are referred to as nephrocalcinosis, a condition typically associated with hypercalcemia. During the period from 2000 to 2004, 31 cases of nephrocalcinosis were identified among the 7349 native renal biopsies processed at Columbia University. Among the 31 patients, 21 presented with acute renal failure (ARF), were normocalcemic, and had a history of recent colonoscopy preceded by bowel cleansing with oral sodium phosphate solution (OSPS) or Visicol. Because the precipitant was OSPS rather than hypercalcemia, these cases are best termed acute phosphate nephropathy. The cohort of 21 patients with APhN was predominantly female (81.0%) and white (81.0%), with a mean age of 64.0 yr. Sixteen of the 21 patients had a history of hypertension, 14 (87.5%) of whom were receiving an angiotensin-converting enzyme inhibitor or angiotensin receptor blocker. The mean baseline serum creatinine was 1.0 mg/dl, available within 4 mo of colonoscopy in 19 (90.5%) patients. Patients presented with ARF and a mean creatinine of 3.9 mg/dl at a median of 1 mo after colonoscopy. In a few patients, ARF was discovered within 3 d of colonoscopy, at which time hyperphosphatemia was documented. Patients had minimal proteinuria, normocalcemia, and bland urinary sediment. At follow-up (mean 16.7 mo), four patients had gone on to require permanent hemodialysis. The remaining 17 patients all have developed chronic renal insufficiency (mean serum creatinine, 2.4 mg/dl). Acute phosphate nephropathy is an underrecognized cause of acute and chronic renal failure. Potential etiologic factors include inadequate hydration (while receiving OSPS), increased patient age, a history of hypertension, and concurrent use of an angiotensin-converting enzyme inhibitor or angiotensin receptor blocker.
Renal failure following bowel cleansing with a sodium phosphate purgative. Nephrol Dial Transplant. 2005 Apr;20(4):850-1.

Renal failure due to acute nephrocalcinosis following oral sodium phosphate bowel cleansing. Hum Pathol. 2004 Jun;35(6):675-84.

Acute phosphate nephropathy and renal failure. N Engl J Med. 2003 Sep 4;349(10):1006-7.

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Thursday, September 29, 2005

From the NEJM: Avian Influenza A (H5N1) Infection in Humans

A review from the New England Journal of Medicine:
An unprecedented epizootic avian influenza A (H5N1) virus that is highly pathogenic has crossed the species barrier in Asia to cause many human fatalities and poses an increasing pandemic threat. This summary describes the features of human infection with influenza A (H5N1) and reviews recommendations for prevention and clinical management presented in part at the recent World Health Organization (WHO) Meeting on Case Management and Research on Human Influenza A/H5, which was held in Hanoi, May 10 through 12, 2005. Because many critical questions remain, modifications of these recommendations are likely.
Technorati Tags: Avian Flu, Bird Flu, Avian Influenza A, H5N1

The Physiology of Spam Blogs

From Google Blogoscoped:

"Spam is like the aliens among us. They look like us, dress like us – but they also eat the houseplants."
-- John Holbo

This post may end up on spam blogs. Let me explain why.

In my recent interview with Joe Harris, a keyword blogger, several “high paying” keywords got mentioned (like mortgage, gambling, poker, or mesothelioma). There was an unexpected side-effect to this post, as it was also featured in Google News; many spam bloggers, I suspect, subscribe to Google Alerts for their spam keywords. They then fill their (mostly Blogspot-hosted) plogs with posts sent to them via Google. The final irony is that they’re often using Google AdSense to make this a commercial venture. In other words: someone’s abusing Google to get traffic, on a blog hosted by Google, filled with content automated by Google, and they’re making money from it via Google...

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Doctor Stories #2

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Grand Rounds 53

Grand Rounds 53, this week's best posts of the medical blogosphere -- and the one year anniversary of grand rounds -- is up at Family Medicine Notes.
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Wednesday, September 28, 2005

Neil Gaiman and Joss Whedon Interviewed in Time Magazine

From Time:
Joss Whedon and Neil Gaiman may well be the two most interesting people creating popular culture right now. Whedon is the man behind Buffy the Vampire Slayer and Angel, and he wrote and directed the science fiction film Serenity, which opens Sept. 30th. Gaiman created the instant-classic comic book Sandman, and he's the author of the new novel Anansi Boys, out this month. He has a new movie, Mirrormask, which also opens Sept. 30.
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Post on Google's Blog about Deep Venous Thrombosis ("Economy Class Syndrome")

There's a public service announcement on Google's Blog by Dr. Taraneh Razavi, the staff physician, about deep venous thrombosis in travellers. I presume that someone at Google must have recently developed a DVT. It's written for the general public and is very readable.

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Cory Doctorow's Podcasts

Cory Doctorow, author of Down and Out in the Magic Kingdom, has started a podcast of his works which may be found here. Recommendations and links to free downloads (under a creative common license) are here.

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Tuesday, September 27, 2005

Meterologists to Give Storms First and Last Names

From the Weekly World News:

Hurricane Harvey Goldstein? Tropical Storm Irene Johnson? Brace yourself through the ongoing storm season as the World Meteorological Organization announced that all hurricanes will be given both first and last names.

"The world's weather patterns are becoming more chaotic and extreme," said WMO spokesperson Scott Duncan. "As such, we can expect well over 100 hurricanes and tropical storms each year. We're running out of names, so we've decided to add the last names as a means of avoiding confusion..."

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Doctor Stories #1

For your consideration:Technorati Tags:

Monday, September 26, 2005

Infectious Disease and Dermatologic Conditions in Evacuees and Rescue Workers After Hurricane Katrina

From the CDC:
On August 29, 2005, Hurricane Katrina struck states along the Gulf Coast of the United States. In the days after the hurricane struck, approximately 750 evacuation centers were established in at least 18 states to accommodate more than 200,000 evacuees (1). State and local health departments, with assistance from CDC, initiated enhanced infectious disease surveillance and outbreak response activities, implemented by teams of public health and rescue workers, including military personnel. Outbreak monitoring included direct reporting of conditions of public health significance to public health agencies; daily contact between CDC and local public health officials; canvassing of reports from CDC, public health departments, and news media for potential infectious disease outbreaks; and investigation of reports of infectious disease with outbreak potential. This report summarizes infectious disease and dermatologic conditions reported during the first 3 weeks after the hurricane, before effective local surveillance was fully implemented...

Click here for full resolution.

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Katrina Displaces Nearly 6,000 Doctors

From the AP/ABC News:

Nearly 6,000 doctors along the Gulf Coast were uprooted by Hurricane Katrina in the largest displacement of physicians in U.S. history, university researchers reported Monday.

How many of those doctors will set up shop permanently in other cities, or decide to retire instead of reopening their practices, remains as unclear as New Orleans' future.

"We don't know what this is going to mean to health care," said Dr. Thomas Ricketts, who led the study by researchers at the University of North Carolina-Chapel Hill. "We've never had to deal with something like this before..."

More than half were specialists, with 1,292 in primary care and 272 in obstetrics and gynecology, the study said. Also, about 1,300 medical students at Tulane and Louisiana State University moved to other programs in the region, mostly in Baton Rouge and East Texas.

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Google Leases 270,000 Square Feet in New York

From the New York Post:

Google's move to lease a huge space in Chelsea is part of the technology giant's plan to build its own fiber optic network and become a bigger player in the booming Internet telephone and wireless businesses.

The company is reportedly in talks to lease a whopping 270,000 square feet in the former Port Authority Commerce Building at 111 Eighth Ave. at W. 15th Street...

The massive building is one of New York's most important so-called telecom carrier hotels — home to thousands of Web servers and other critical technology infrastructure...

In a tantalizing hint at its plans for the future, the company has posted a job opening for a "Strategic Negotiator, Global Infrastructure," who will be charged with "identification, selection, and negotiation of dark fiber contracts both in metropolitan areas and over long distances as part of development of a global backbone network..."

Allen Weiner, research director with tech consulting firm Gartner, said a fiber optic network would allow Google to create Wi-Fi networks that would allow users to make calls using Google Talk from their laptops and other mobile devices.

Technorati Tags: Google, News from New York

Hilarious Journal Articles #16: Watching World Series Causes Drop In Hospital Visits

From Scientific American:
When is an emergency not quite an emergency? According to a new study, the answer depends on how well your favorite baseball team is doing. A report published in the October issue of the Annals of Emergency Medicine reveals that the number of visits to emergency rooms in Boston-area hospitals was inversely related to how well the Red Sox performed in the 2004 World Series.
I was unable to find the original reference in the Annals. However, a search for baseball revealed the following other articles:
  • Impact of Yankee Stadium Bat Day on Blunt Trauma in Northern New York City
  • Baseball and Beer: An Analysis of Alcohol Consumption Patterns Among Male Spectators at Major-League Sporting Events
  • Spectator Risk at Professional Sporting Events: An Analysis of the Cleveland Clinic Event Medicine Program
  • 412 Variables Influencing Medical Use Rates in Mass Gathering Events
  • The Puck Stops Here: Spectator Injuries, A Real Risk Watching Hockey Games
  • Testicular dislocation: An uncommon and easily overlooked complication of blunt abdominal trauma
  • 99 Serious Ice Hockey Injuries in Young Athletes
  • Orbital Emphysema: How Common, How Significant?
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Viral Batteries

Via Medgadget:
Copying how red abalone build their shells, Angela Belcher and her team are developing a way to actually "grow" rechargeable batteries with the help of viruses--tiny microbes that multiply by infecting living cells. Their technique would take a matter of weeks, rather than the 15 years the red abalone needs to assemble a full-sized shell.
Technorati Tags: Batteries, Viruses, MIT

Sunday, September 25, 2005

New York City Police Commissioner Objects to Video Game Depicting Cops as Vigilantes

From the New York Daily News:

Police Commissioner Raymond Kelly and the city's largest police union called for a boycott yesterday of a new video game that depicts New York cops as law-breaking vigilantes.

"It's an outrage," Kelly said of the blood-filled video game "True Crime: New York City..."

Christopher Walken plays an FBI agent, Laurence Fishburne gives voice to a crime lord, called The King, and Mickey Rourke is a detective. None of them returned calls yesterday.

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Unusual Names for Places on Mars

Via Slashdot. From the LA Times:

The twin rover missions have forced scientists to come up with more than 4,000 names to mark everything from the majestic Columbia Hills to a few pebbles in the sand.

The result is an extravagantly labeled map punctuated by the scientists' ever-changing preoccupations with history, holidays, monkeys, ice cream, cartoon characters, sushi, Mayan words, Scandinavian fish delicacies … the list goes on and on.

Since everyone at JPL was raiding a freezer of ice cream at the time, Opportunity's controllers took their cue from their stomachs. That's why there is an area of round and chunky pebbles named Cookies N Cream and a lighter patch of soil named Vanilla.

Earlier this year, a pockmarked meteorite in Opportunity's path was named SpongeBob SquarePants. Scientists had to name a spot on the rock and came up with SpongeBob's best friend, Patrick...

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Weekend Photos: Butterfly

Saturday, September 24, 2005

A Shoggoth on the Roof, the Musical

For H.P. Lovecraft fans. The website is here.
There are some things that man was not meant to adapt to musical theatre, and A Shoggoth on the Roof has long been regarded as a musical that cannot and must not be produced. Since 1979, every attempt to produce this monster of a musical has ended in disaster, horror, agony and madness...
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Google Web Accelerator Again Available for Download

Google Web Accelerator is again available for download here. Four months ago, I wrote about it here, and it's been unavailable since then due to high demand. Since I've used it, Google Web Accelerator has apparently saved me "1.9 days."

Update: They've again reached their maximum capacity of users, but hopefully Web Accelerator will be available soon.
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Weekend Photos: Puerto Rico

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Friday, September 23, 2005

Finally, the New England Journal of Medicine has a Podcast

I previously created the NEJM Audio Feed because the New England Journal of Medicine offered high quality MP3 interviews that weren't part of their regular feed. I'm happy to report that the NEJM now offers their own podcast. More information is here.

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130 Kidney Stones Removed from One Patient (a World Record)

From the (aptly named) Star of Mysore Online:
Dr. Deepak Bolabandi, nephrologist, Super Speciality Hospital, Raichur, hailing from the city, has won a place in the Guinness Book of World Records by extracting 130 stones from the kidney of one Mohammed Irfan from Yadavagiri...
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Thursday, September 22, 2005

Nephrology Cases #4

A sixty year old woman, previously healthy, is admitted for acute renal
failure. One week prior to admission she began to feel generally weak with
poor oral intake. There was no diarrhea, abdominal pain, fever, or dysuria.
She did not smoke, drank two gin and tonics daily, and denied any other
drug use. She took no medications. She was seen by a physician two days
prior to admission, was found to have proteinuria and hematuria, and was
placed on amoxicillin for a presumed urinary tract infection. Her labs
subsequently showed a creatinine of 11, platelets of 23, LDH of 4000, and
normal PT and PTT.

The likeliest diagnosis is

1. Acute tubular necrosis related to volume depletion.
2. Thrombotic microangiopathy related to quinine.
3. Interstitial nephritis related to amoxicillin.
4. Hemolytic uremic syndrome related to E. Coli 0157:H7.
5. Thrombotic thrombocytopenic purpura.
6. Renal failure from disseminated intravascular coagulation.

Jet Blue Passengers Watched Their Emergency Landing on Inflight TV

From the AP:

Letting customers watch TV at their seats has been a JetBlue calling card since the airline took flight in 1999. But the frill made for a bizarre experience as passengers aboard an airliner with a crippled nose wheel watched news reports about their own flight even as they prepared for an emergency landing...

"It was absolutely terrifying, actually. Seeing the events broadcast made it completely surreal and detached me from the event," said Zachary Mastoon, a musician heading home on the Burbank-to-New York flight. "It became this television show I was inextricably linked to. It was no longer my situation, it was broadcast for everyone to see. It only exacerbated the situation and my fear."

Mastoon said the JetBlue employees kept passengers informed but that he heard worst-case scenarios from TV news reports. Realizing the risks, he started taking swigs from another passenger's vodka tonic...

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An Unintentional Plague Kills Thousands in World of Warcraft

From the BBC:

Since its launch in November 2004, World of Warcraft has become the most widely played massively multiplayer online game in the world. Its creator, Blizzard, claims that now more than four million people are regular players...

In the last week, World of Warcraft added the Zul'Gurub dungeon which gave players a chance to confront and kill the fearsome Hakkar - the god of Blood.

In his death throes Hakkar hits foes with a "corrupted blood" infection that can instantly kill weaker characters.

The infection was only supposed to affect those in the immediate vicinity of Hakkar's corpse but some players found a way to transfer it to other areas of the game by infecting an in-game virtual pet with it...

Many online discussion sites were buzzing with reports from the disaster zones with some describing seeing "hundreds" of bodies lying in the virtual streets of the online towns and cities...

The "Corrupted Blood" plague is not the first virtual disease to break out in online worlds. In May 2000 many players of The Sims were outraged when their game characters died because of an infection contracted from a dirty virtual guinea pig.

Update: Photos of the plague are here.

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From the CDC: Percentage of Adults In The U.S. That Sleep Less Than 6 Hours Daily

A study by the CDC is here. The results are interesting: about 30% of adults ages 30 - 44 sleep an average of less than 6 hours daily.

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From the CDC: HIV Transmission in the Adult Film Industry --- Los Angeles, California, 2004

From MMWR:
In April 2004, the Los Angeles County Department of Health Services (LACDHS) received reports of work-related exposure to human immunodeficiency virus (HIV) in the heterosexual segment of the adult film industry in California. This report summarizes an investigation by LACDHS into four work-related HIV-transmission cases among adult film industry workers. The investigation was initiated April 20, 2004, and joined by the California Department of Industrial Relations, Division of Occupational Safety and Health (Cal/OSHA) on April 21, 2004, and by CDC on May 18, 2004. This investigation identified important and remediable gaps in the prevention of HIV and other sexually transmitted diseases (STDs) in the adult film industry...
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"Google's Master Plan"

Photograph of a whiteboard at Google. Click for original on Flickr. From Niall Kennedy's blog.

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Central Park Refugee Camp

From the New York Academy of Sciences:
More than 33 million people around the world have been uprooted by wars and forced into refugee camps that provide shamefully little in the way of nutrition, sanitation or shelter. A three-day interactive Doctors Without Borders exhibit lets New Yorkers in on the misery at a simulated refugee camp in Central Park, complete with temporary housing, a heath care clinic and a food distribution center. Visitors will be able to taste emergency food used to combat malnutrition, learn how basic sanitation is essential to survival, and hear refugees' stories.
Technorati Tags: News from New York, Central Park, New York City, Refugees, Doctors without Borders

The Dog Flu

From the New York Times:

A new, highly contagious and sometimes deadly canine flu is spreading in kennels and at dog tracks around the country, veterinarians said yesterday.

The virus, which scientists say mutated from an influenza strain that affects horses, has killed racing greyhounds in seven states and has been found in shelters and pet shops in many places, including the New York suburbs, though the extent of its spread is unknown.

Dr. Cynda Crawford, an immunologist at the University of Florida's College of Veterinary Medicine who is studying the virus, said that it spread most easily where dogs were housed together but that it could also be passed on the street, in dog runs or even by a human transferring it from one dog to another...

How many dogs die from the virus is unclear, but scientists said the fatality rate is more than 1 percent and could be as high as 10 percent among puppies and older dogs...

Technorati Tags: Dogs, Influenza, Dog Flu, New York Times

Nanotubes Link Immune Cells

From The Scientist:
A number of types of immune cells communicate via a naturally occurring network of nanotubes, investigators report today in this month's Immunity. These findings suggest that nanotubes could serve as a third form of intercellular communication, distinct from gap junctions and synapses, and faster than secreted chemical signals alone...
Technorati Tags: Nanotubes, Immunology

Wednesday, September 21, 2005

The ASCOT Trial Results: Calcium Channel Blockers & ACE Inhibitors vs. Beta Blockers & Thiazide Diuretics

Results from the ASCOT trial were recently published in the Lancet. The results apparently showed that a regimen of a calcium channel blocker and ACE inhibitor was associated with a decreased rate of cardiovascular events and diabetes than a regimen of a beta blocker and thiazide diuretic.

The study was stopped prematurely after 5·5 years median follow-up and accumulated in total 106,153 patient-years of observation. Though not significant, compared with the atenolol-based regimen, fewer individuals on the amlodipine-based regimen had a primary endpoint (429 vs 474; unadjusted HR 0·90, 95% CI 0·79–1·02, p=0·1052), fatal and non-fatal stroke (327 vs 422; 0·77, 0·66–0·89, p=0·0003), total cardiovascular events and procedures (1362 vs 1602; 0·84, 0·78–0·90, p<0·0001), p="0·025).">The amlodipine-based regimen prevented more major cardiovascular events and induced less diabetes than the atenolol-based regimen. On the basis of previous trial evidence, these effects might not be entirely explained by better control of blood pressure, and this issue is addressed in the accompanying article. Nevertheless, the results have implications with respect to optimum combinations of antihypertensive agents.

A major criticism of the study is that patients in the calcium channel blocker arm had a lower blood pressure than patients in the beta blocker arm. In a separate analysis, this accounted for a large percentage of the benefit, and the adjusted results were no longer statistically significant.
Multivariate adjustment accounted for about half of the differences in coronary events and for about 40% of the differences in stroke events between the treatment regimens tested in ASCOT-BPLA, but residual differences were no longer significant. These residual differences could indicate inadequate statistical adjustment, but it remains possible that differential effects of the two treatment regimens on other variables also contributed to the different rates noted, particularly for stroke.
Based on these results, it is uncertain whether current blood pressure guidelines should be changed to favor calcium channel blockers and ACE inhibitors over beta blockers and thiazide diuretics.

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Wednesday Recommendations: Cope's Acute Abdomen

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Chipping the Dead from Hurricane Katrina (to Aid in Identification)

From Red Herring:
A company that makes ID chips for humans said Friday it has started “chipping” corpses in the Katrina-ravaged region of Mississippi to help expedite the identification process.

Florida-based VeriChip said it has already implanted radio frequency identification (RFID) tags into 100 corpses in the state for the Mississippi State Department of Health...
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Tuesday, September 20, 2005

On Call 3

A seventy year old man with advanced prostate cancer develops bilateral
ureteral obstruction and acute on chronic renal failure. His potassium
rises to 7.7 with peaked t waves. His medications include digoxin. The most
appropriate, safest initial therapy is

1. Hemodialysis
2. Percutaneous nephrostomy placement
3. Kayexalate
4. Intraveous glucose and regular insulin
5. Intravenous calcium gluconate

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First Renin Inhibitor in Phase 3 Trials

From the press release:

SPP100 (Aliskiren) is the first-in-class oral renin inhibitor. The development of SPP100 is the result of over 20 years of research on renin. Renin is the key enzyme at the top of the Renin Angiotensin System (RAS), one of the key regulators of blood pressure. The RAS is a cascade, starting with renin, leading to angiotensin I and finally to angiotensin II. Angiotensin- converting enzyme (ACE) inhibitors and angiotensin II receptor antagonists (ARBs) have been developed to block this system "down stream" and have shown clinical efficacy in patients with hypertension and other cardiovascular diseases...

Speedel believes that it is the first company to establish successfully a clinical proof of concept in Phase II and to have developed and filed for patent protection a commercially viable manufacturing process for a renin inhibitor, an area of industry research for over 20 years. In a Phase II study of 200 patients conducted by Speedel, it was demonstrated that SPP100 achieves dose-dependent blood pressure reduction. The study also showed that 150mg and 300mg SPP100 once daily were comparable to Losartan 100mg, which is double the starting dose of this ARB...

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New England Journal of Medicine Audio Feed: Depression in Medical School

Until the New England Journal of Medicine creates an audio feed to keep track of their excellent MP3 interviews, I've created my own at (I have no affiliation with the NEJM other than as a regular reader. Technical details on turning a search into a feed are here.) The latest interview is on "White Coat, Mood Indigo: Depression in Medical School."

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The "Second Disaster" from Katrina -- Accidents

From the Washington Post:

Doctors are bracing themselves for what they call a "second disaster" as residents of New Orleans and surrounding areas return to their devastated city.

While environmentalists fear the long-term danger to health from possibly polluted floodwaters and rumors of disease swirl, front-line emergency doctors say the actual health danger will come from accidents...

Technorati Tags: Katrina, Hurricane Katrina, Accidents, New Orleans

Monday, September 19, 2005

Grand Rounds 52

Grand Rounds 52, this week's best posts of the medical blogosphere, is at

Technorati Tags: Grand Rounds, Medicine

News from New York: The First Suicide of the Semester

From Mr. Schrathe, the blog of a New York City Police Officer:
I was called to my first suicide of the semester. You can usually set your watch to when the first kid will decide he/she cannot live without their beau or nobody undrstands them because they are gay or they failed a med exam or something along those lines. Last night was the first of them. Now in the last three days I've done three shootings, half a dozen gun point robberies, a stabbing turned immolation and the usual number of laptop and/or i-Pod burglaries... The suicide last night was a white American kid who committed Seppuku...
Via Warren Ellis.

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Sunday, September 18, 2005

Observation: Antiperspirants, Aluminum and Kidney Disease

I often tell patients to read labels of products for warnings about kidney
disease. It turns out that antipersipirants say to "Ask your doctor before
using if you have kidney disease," so someone did. Presumably this is
because of the aluminum content, and there is a small (and probably
insignificant) risk of aluminum accumulation with decreased kidney function.

Sent via mobile device

Saturday, September 17, 2005

Weekend Photos: Five-Spice Duck Kidney

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Friday, September 16, 2005

Mice Infected With Bubonic Plague Missing

Via Warren Ellis. From the AP:

Three mice infected with the bacteria responsible for bubonic plague apparently disappeared from a laboratory about two weeks ago, and authorities launched a search though health experts said there was scant public risk.

The mice were unaccounted-for at the Public Health Research Institute, which is on the campus of the University of Medicine and Dentistry of New Jersey and conducts bioterrorism research for the federal government.

Federal official said the mice may never be accounted for. Among other things, the rodents may have been stolen, eaten by other lab animals or just misplaced in a paperwork error...

Technorati Tags: Mice, Bubonic Plague, Plague

Thursday, September 15, 2005

Inventor Denies Using Dead Cats for Fuel

Headline of the day. From MSNBC:
A German inventor said he has developed a method to produce crude oil products from waste that he believes can be an answer to the soaring costs of fuel, but denied a German newspaper story implying he also used dead cats...
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Wednesday, September 14, 2005

Medical Blogosphere Tag Cloud

From This Week in the Medical Blogosphere:
The subset of medical blogs, the "medical blogosphere," has been created by a growing number of physicians, nurses, students, patients, scientists, social workers, administrators, engineers, IT professionals, consultants, and many other people involved in health care. One way of seeing at a glance what people are talking about is the Medical Blogosphere Tag Cloud, an abstraction of the most common keywords from medical blogs.
I've lately been interested in the abstraction and visual representation of information from blogs. (A post on visualizing visitor traffic is here.)

A tagcloud is an abstraction of keywords from a site or feed, and the size of each keyword in the cloud is proportional to its frequency. Tagclouds allow you to see at a glance what people are talking about. As an experiment, I've used, a site that allows the creation of continuously updated tagclouds from feeds, to create a tagcloud of all the medical blogs in my blogroll. A small tagcloud of medical blogs is at the top of the home page. A larger tagcloud of the top 250 keywords of the medical blogosphere is here. (If you aren't in my blogroll and would like to be added to this tagcloud, please email kidneynotes [at]

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Wednesday Recommendations: William Gibson

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Hurricane Katrina Evacuee Medical Intake Form

The PDF is here. From the CDC:
This interim form is intended to be used for medical intake assessment and triage of evacuees entering a shelter facility or evacuation center. The form can be used to identify evacuees who may need additional medical evaluation and treatment. The first page contains registration information for use by facility, local and state authorities. The remaining pages can be used to anonymously report medical conditions among evacuees.
Technorati Tags: Katrina, Hurricane Katrina, Medicine

Tuesday, September 13, 2005

Grand Rounds 51

Grand Rounds 51, this week's best posts of the medical blogosphere, is up at SneezingPo.

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Monday, September 12, 2005

On Call 2

An otherwise healthy 30 year old man presents with nausea and fatigue for 2
weeks. He is found to have a BUN of 172, a creatinine of 13, and an albumin
of 4. His urinalysis reveals 3+ protein (quantified at 400 mg per day) and
many RBCs. There is no lower extremity edema. He is nonoliguric.

What is the likeliest diagnosis?

1. HIV associated nephropathy
2. ANCA associated glomerulonephritis
3. Focal segmental glomerulosclerosis
4. Urinary tract obstruction
5. Minimal change disease

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New England Journal of Medicine Audio Feed: "FDA Standards, Good Enough for Government Work?"

Until the New England Journal of Medicine creates an audio feed to keep track of their excellent MP3 interviews, I've created my own at (I have no affiliation with the NEJM other than as a regular reader. Technical details on turning a search into a feed are here.) The latest interview is on "FDA Standards -- Good Enough for Government Work?"

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Towers of Light Memorial

From Flickr. (Click for original.)

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"We Had to Kill Our Patients" -- Reports of Euthanasia in New Orleans

From The Mail:

Doctors working in hurricane-ravaged New Orleans killed critically ill patients rather than leaving them to die in agony as they evacuated hospitals, The Mail on Sunday can reveal.

With gangs of rapists and looters rampaging through wards in the flooded city, senior doctors took the harrowing decision to give massive overdoses of morphine to those they believed could not make it out alive...

Update: Orac points out this may be an urban myth.

Technorati Tags: Katrina, Hurricane Katrina, Euthanasia

Sunday, September 11, 2005

9/11 Video

We watched this again today. It's well done.

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Katrina Fundraisers in New York City

A list of fundraisers in New York City for Hurricane Katrina victims is here.

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September 11, 2001 Victims List

The list of 9/11 victims from
Included are victims for whom AP has confirmed the death with named local or federal government officials, the person's family, a named spokesman for the person's employer or a named funeral home official. In the case of confirmation by family members, victims are included when the family member is definitive that the person is dead or that the family considers the person dead.
Technorati Tags: World Trade Center, 9/11

Weekend Photos: Puerto Rico

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Hurricane Katrina at KodakGallery

A beautiful slideshow by a Nicaraguan photographer and hotel worker of New Orleans before, during, and after Hurricane Katrina is here. Via Enoch Choi at Medmusings, who often has good recommendations. His blog is here, page is here, and rss feed is here.
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Saturday, September 10, 2005

Slate's Dispatches From New Orleans

From Slate's Dispatches from New Orleans:
As the rubber rescue boat launches, I ask our team leader for the name of the street we're heading down. He looks down at his map of the New Orleans lakefront and says we're going south on West End Blvd., a major artery that connects I-10 to the neighborhoods just south of Lake Pontchartrain. It's also part of the route I took to school most mornings. If there weren't blue street signs poking out of the water, you might have convinced me this was underwater Nebraska. It has been tough this week to stare down at battered and sunken landmarks, but that I can no longer recognize a street I've driven down hundreds of times is something else entirely...
Technorati Tags: New Orleans, Katrina, Hurricane Katrina, Slate

Visualizing Visitor Traffic

  • VisitorVille, which displays website visitors as animated characters in a virtual city. For example, if you came to this page from Google, a bus with the Google logo would travel to a building representing this page. (Not quite a stepped scarlet pyramid, but hey.)
  •, a free site tracker with statistics and graphs.
  •, a service which displays visits on a Google world map.
  • Mapstats, another service which displays visits on a Google map and provides detailed statistics.
  • ClustrMaps, an alternative system that displays visits on a map.
  • Site Meter's World Map of Visitors, another system which displays visits on a map which is updated frequently.
Thanks to those who wrote in. Additional suggestions are welcome.

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Health Web Site Ratings by Consumer Reports

Consumer reports just launched Via hospital impact:
Welcome to Consmer Health WebWatch, a joint project of Consumer Reports WebWatch and the Health Improvement Institutute to create a detailed rating system for health web sites of all kinds, and to publish the results...
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Weekend Photos: Queen Victoria Islands

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Chief Justice Rehnquist and Placidyl (Ethchlorvynol)

From Slate:
...and for the nine years between 1972 and the end of 1981, William Rehnquist consumed great quantities of the potent sedative-hypnotic Placidyl. So great was Rehnquist's Placidyl habit, dependency, or addiction—depending on how you regard long-term drug use—that by the last quarter of 1981 he began slurring his speech in public, became tongue-tied while pronouncing long words, and sometimes had trouble finishing his thoughts...
Technorati Tags: Placidyl, Ethchlorvynol, Rehnquist, Slate

On Call

A 65 year old man with diabetes presents with vomiting and weakness. His
baseline creatinine is 2.

He appears dry. His labs reveal potassium 5, bicarb 9, anion gap 24, BUN
115, creatinine 5. The calcium is 4.8 with an albumin of 4. The ECG shows a
prolonged QTc. His phosphorous is 12. An ABG shows a pH of 7.13 with
adequate respiratory compensation.

Your treatments may include one or more of the following: IV fluids,
bicarb, calcium, and dialysis.

Which should you not do first?

Sent via mobile device

Friday, September 9, 2005

Slate's Dispatch From New Orleans

From Slate:
New Orleans is a small town, and it's even smaller when 99 percent of the town goes away. On Broadway near the Tulane campus, I run into a family friend who's just been salvaging some computers from his law office. A minute later we see Dr. Lance Hill, who gained local fame for organizing the grassroots campaign against David Duke in the early '90s. Hill, who's wearing an orange hat with "RELIEF WORKER" written on it in black magic marker, says his elderly neighbors won't leave their homes because they're afraid they'll be seen, rounded up, and forced to leave town. Hill sets out food, water, and mosquito repellant under an overturned above-ground pool nearby and then blows a whistle that he wears around his neck. "It's like feeding feral cats," he says. When some cops tried to get him to leave town by telling him he'd have to go to Houston to get a tetanus shot, Hill stood his ground. "I'd rather get lockjaw than live in Houston," he says...
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Thursday, September 8, 2005

The Toughest Guy in New Orleans

Via Warren Ellis and Flickr.

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Turtles living in the Central Park pond enjoy dry dog food.

Therapeutic Benefit of Sodium Nitrite, the Preservative in Hot Dogs?

From RedNova:

Could the salt that preserves hot dogs also preserve your health?

Scientists at the National Institutes of Health think so. They've begun infusing sodium nitrite into volunteers in hopes that it could prove a cheap but potent treatment for sickle cell anemia, heart attacks, brain aneurysms, even an illness that suffocates babies...

Beyond repairing the reputation of this often-maligned meat preservative, the work promises to rewrite scientific dogma about how blood flows, and how the body tries to protect itself when that flow is blocked. Indeed, nitrite seems to guard tissues - in the heart, the lungs, the brain - against cellular death when they become starved of oxygen...

"We are turning organs into hot dogs," [Dr. Gladwin] said jokingly. Then he turned serious: "We think we stumbled into an innate protection mechanism..."

Technorati Tags: Sodium Nitrite, Hot Dogs, NIH, Medicine

Wednesday, September 7, 2005

Wednesday Recommendations: Developing Clinical Problem Solving Skills

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WSJ Article On Katrina's Death Toll

From the WSJ Numbers Guy Column:
In the weeks ahead, one of the myriad tasks facing the ongoing Gulf of Mexico recovery effort is tallying a grim number: Katrina's death toll.
Technorati Tags: Katrina, Hurricane Katrina, Deaths

Tuesday, September 6, 2005

Grand Rounds 50

Grand Rounds 50, this week's best posts of the medical blogosphere, is up at Corpus Callosum.

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Monday, September 5, 2005

New Orleans Times-Picayune Front Page Headlines

From the Wall Street Journal's Hurricane Katrina Crisis News Tracker:
The New Orleans Times-Picayune's front page headlines for the past week: GROUND ZERO (Monday), CATASTROPHIC (Tuesday), UNDER WATER (Wednesday), HITTING BOTTOM (Thursday), 'HELP US PLEASE' (Friday), FIRST WATER, NOW FIRE (Saturday), HELP AT LAST (Sunday.) 7TH DAY OF HELL (Monday)
Technorati Tags: Katrina, Hurricane Katrina, Times-Picayune, New Orleans, Wall Street Journal

New England Journal of Medicine Audio Feed: Banning Genetic Discrimination

Until the New England Journal of Medicine creates an audio feed to keep track of their excellent MP3 interviews, I've created my own at (I have no association with the NEJM other than as a regular reader. Technical details on turning a search into a feed are here.) The latest interview is on "Banning Genetic Discrimination and the Genetic Information Nondiscrimination Act of 2005."

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Sunday, September 4, 2005

Weekend Photos: Views of New Orleans by Google Earth

Views of New Orleans (Pre-Katrina) by Google Earth

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United States Department of Health and Human Services

From the United States Department of Health and Human Services:

The Office of The Surgeon General and the Office of Public Health Emergency Preparedness are in the process of mobilizing and identifying healthcare professionals and relief personnel to assist in Hurricane Katrina relief efforts. As our nation and global community is now aware, the healthcare needs resulting from Katrina are critical.

We are currently looking for multidisciplinary healthcare professionals and relief personnel with expertise in the following areas...

Please be advised that individuals must be healthy enough to function under field conditions.

This may include all or some of the following:

    12 hour shifts
    Austere conditions (possibly no showers, housing in tents)
    No air conditioning
    Long periods of standing
    Sleep accommodations on bed roll
    Military ready to eat meals
    Portable toilets

These workers will be non-paid temporary Federal employees, and will therefore be eligible for coverage under the Federal Tort Claims Act for liability coverage and Workman’s Compensation when functioning as HHS employees. Although there will not be any salary, travel and per diem will be paid.

Assignments may last 14 days or longer...

Technorati Tags: Katrina, Hurricane Katrina, Medicine

Saturday, September 3, 2005

Recent Satellite Imagery of New Orleans on Google Earth

Google Earth has recently updated their maps to include satellite images of New Orleans from 10 am on August 31. Some of the images include the damaged Superdome, a breached levee, and abandoned cars on Highway 610.

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Weekend Photos: Views of New Orleans by Google Earth

New Orleans (Pre-Katrina) by Google Earth

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Friday, September 2, 2005

Doctors Seek Help As Food, Power Low

From RedNova:

Doctors at two desperately crippled hospitals in New Orleans called The Associated Press on Thursday morning pleading for rescue, saying they were nearly out of food and power and had been forced to move patients to higher floors to escape looters...

Helicopter crews evacuated 400 to 600 patients Thursday, but 1,000 or 1,500 others remained, said Richard Zuschlag, president and CEO of Acadian Ambulance Service.

Earlier, McSwain described horrific conditions in his hospital.

"There is no food in Charity Hospital. They're eating fruit bowl punch and that's all they've got to eat. There's minimal water," McSwain said.

"Most of their power is out. Much of the hospital is dark. The ICU (intensive care unit) is on the 12th floor, so the physicians and nurses are having to walk up floors to see the patients..."

"The physicians and nurses are doing an incredible job, but there are patients laying on stretchers on the floor, the halls were dark, the stairwells are dark. Of course, there's no elevators. There's no communication with the outside world," he said.

"We're afraid that somehow these two hospitals have been left off ... that somehow somebody has either forgotten it or ignored it or something, because there is no evidence anything is being done..."

"Hospitals are trying to evacuate," said Coast Guard Lt. Cmdr. Cheri Ben-Iesan, spokeswoman at the city emergency operations center. "At every one of them, there are reports that as the helicopters come in, people are shooting at them. There are people just taking pot shots at police and at helicopters, telling them, 'You better come get my family...' "

In Houston, 60 doctors and nurses worked in a makeshift clinic in a hangar at Ellington Field, quickly examining evacuees from Gulf Coast cities before sending them to hospitals or releasing them to family members.

"We've seen patients who've recently had transplants, were on ventilators, had serious infections, nursing home patients, patients with pneumonia, patients who've not had kidney dialysis for a week," said Dr. J. Kalavar, director of the patient reception team at Ellington. "Every one of them is anxious and exhausted."

Theadore Hunter and his mother, Henrietta, were among the evacuees. He said they spent two days on the roof of their flooded apartment complex before they were rescued Wednesday afternoon by a helicopter. They were then taken to New Orleans' airport, where they were loaded with other survivors into a military cargo plane Thursday morning...

Technorati Tags: Hurricane Katrina, Katrina, Charity Hospital, Natural Disasters

"Nurses at some hospitals were feeding each other intravenously..."

From the Wall Street Journal Crisis News Tracker:

8:40 p.m.: All but three New Orleans hospitals finished evacuating today, but many hundreds of the city's patients still await transfer to other cities and states, according to the Louisiana Hospital Association. Three New Orleans hospitals -- Ochsner Clinic Foundation, East Jefferson General Hospital and West Jefferson Hospital -- remain open and running, the latter two on emergency electric and water supplies. Power was restored to Ochsner late Friday morning.

The three hospitals still being evacuated are Methodist Hospital and two Louisiana State University-affiliated facilities. There dozens, if not hundreds, of patients still remain trapped. Gun shots ringing outside Charity Hospital Thursday slowed the removal of 250 patients. Television reports came today of nurses at some hospitals feeding each other intravenously so they can remain hydrated and sustain their work...

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Washing Away: 2002 Series on Threat of Hurricane to New Orleans

Found on the Wall Street Journal Hurricane Katrina Crisis News Tracker. From Washing Away, an eerily prescient series in the New Orleans Times-Picayne:
It's only a matter of time before South Louisiana takes a direct hit from a major hurricane. Billions have been spent to protect us, but we grow more vulnerable every day.
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WSJ's Katrina News Tracker

Via Boing Boing:
The Wall Street Journal's Katrina News Tracker is updated several times an hour during the day, gathers hurricane news from wire services, TV news and WSJ reporters in one timeline. No site reg required, unlike the rest of the WSJ.
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GruntDoc: New Orleans Patients Arrive in Fort Worth

GruntDoc blogs here about a group of patients from New Orleans arriving in a hospital in Fort Worth, Texas.

Technorati Tags: New Orleans, Hurricane, Hurricane Katrina, Medicine, ER

Thursday, September 1, 2005

Are Dead Bodies Really Dangerous?

This is from Slate, which usually has an unusual take on things.
New Orleans Mayor Ray Nagin told the press yesterday that "we know there is a significant number of dead bodies in the water" and warned that thousands in the city may have died during Hurricane Katrina and the subsequent flooding. Do these dead bodies pose a threat to the survivors? In August 1999, David Plotz explained that decomposing corpses are "only a danger to public health if the victim dies of an infectious disease," and that the threat posed by the bodies of victims of trauma -- —typically the major cause of death in natural disasters -- —is "negligible."
The original article on the health threats of decomposing bodies, published in 1999 after the earthquake in Turkey, is here.
News reports covering the earthquake in Turkey have emphasized the health dangers posed by the decomposing bodies of its victims. The Turkish government is digging mass graves, and Muslim clerics have suspended Islamic burial rules so that the country can dispose of corpses more quickly. Do these bodies endanger public health?
Technorati Tags: Corpses, Natural Disasters, Slate

New England Journal of Medicine Audio Feed: Patents Versus Patients? Antiretroviral Therapy in India

Until the New England Journal of Medicine creates an audio feed to keep track of their excellent MP3 interviews, I've created my own at (Technical details on turning a search into a feed are here.) The latest interview is on "Patents Versus Patients? Antiretroviral Therapy in India."

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Domain Names from Yahoo! for $1.99/Yr

FYI: Domain names are now available through Yahoo! for $1.99/yr here.

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