Friday, November 30, 2007

In the News: Serevent-related deaths and CT scans as a cause of cancer

Some FDA panel members recommend Serevent be taken off the market

Serevent, which is a part of the asthma blockbuster drug Advair, has been linked to sudden death in children. GSK claims there is no increased risk of hospitalization and mortality with Advair.

Serevent (salmeterol) is a long-acting beta2-adrenergic receptor agonist (LABA) which is used for treatment of asthma and COPD. The FDA will look into the safety profile of all LABAs at a future meeting.

Long acting beta-adrenoceptor agonists include salmeterol, formoterol (part of Symbicort) and bambuterol.

Note: The photo on the right shows a Seretide-labeled metered-dose inhaler (MDI). Seretide is the trademark for salmeterol in Europe.

CT scan may increase cancer risk

According to a NEJM review quoted in the NYTimes, in a few decades, 2 percent of cancers in the United States may be due to radiation from CT scans given now.

The average American’s total radiation exposure has doubled since 1980, largely because of CT scans. About 62 million of them were done in the U.S. in 2006 (up from three million in 1980) and studies suggest that a third of CT scans are unnecessary.

References:
Stronger Warnings Advised on Asthma Drug. NYTimes.
Report Links Increased Cancer Risk to CT Scans. NYTimes.
Current Concepts: Computed Tomography — An Increasing Source of Radiation Exposure. D. J. Brenner and E. J. Hall. NEJM.
Image source: Wikipedia, GNU Free Documentation License and public domain.

Thursday, November 29, 2007

A doctor asks which portable computer/PDA/smartphone to choose

A colleague of mine recently asked me which gadget he should choose to replace his HP iPAQ hx 4700 PDA which suddenly stopped working. For those who do not know, iPAQ hx 4700 was a great PDA with the largest screen on the market, Bluetooth and WiFi, and was the top of the line HP model in 2005. He used his PDA for to-do lists, calendars and UpToDate (installed).

What are my friend's options for replacing his PDA? My answer is below. Disclaimer: This information is not comprehensive by any means, please double check the technical specifications and prices yourself.

Regarding the choice of PDA, those type of gadgets seem to be going out of fashion nowadays in favor of smart phones/mini-PCs. Dell stopped making their PDAs and HP reduced their product line to just 2-3 models.

There are several choices on the market right now and I will try to list the pros and cons of 2 of them below:

1. Apple iPhone, price $400.


Pros: easy-to-use, large fonts, zoom-in feature, always-on Internet.

Cons: requires AT&T subscription with data plan ($ 60), programs cannot be installed, small 8 GB hard drive.

2. OQO portable computer, price $ 1,200.


Pros: True Windows computer in the size of PDA, synchronization is very easy, all Windows program can be installed and work seamlessly, 30 GB hard drive.

Cons: relatively expensive, portable Internet requires Verizon or Sprint high-speed data plan ($ 70-80 per month).

Both are excellent options. If I were you, I would go to an Apple store and just see if iPhone works for you. BlackBerry is another alternative but I do not like their tiny screens. Ultra-mobile PCs (formerly known as Origami project) may work for some but they use a TabletPC OS rather than the regular Windows XP or Vista.

OQO seems to be the best option but is also the most expensive one.


Epocrates & iPhone. Link via Doctor Anonymous.

Related:
The New Pocket PCs, PC Magazine, 05/2008.

Updated: 05/12/2008

Tuesday, November 27, 2007

Medicine 2.0 -- A Blog Carnival About Web 2.0 and Medicine

Medicine 2.0 is a weekly blog carnival which collects the most interesting posts about Web 2.0 and Medicine. The latest edition is posted here.


This week's host used blog screenshots and Slide.com very creatively -- see the embedded slideshow above. When I hosted, I tried something similar with Google Presentations but this looks much better.

Past editions and future hosts can be found on the blog carnival index page.

References:
Medicine 2.0, Blog Carnival About Web 2.0 and Medicine, Year 1, Issue 9

Google Trends and Top Hospitals According to U.S. News and World Report

"U.S. News and World Report put 5,462 medical centers through progressively finer screens to create the 16 specialties rankings in the 2007 edition of America's Best Hospitals. Just 173 hospitals made it into the rankings, and of those, a mere 18 displayed the marked breadth of expertise, with high scores in at least six specialties, that qualified them for the Honor Roll."

Top 5 hospitals in the 2007 edition of America's Best Hospitals are:

1. Johns Hopkins Hospital, Baltimore
2. Mayo Clinic, Rochester, Minn.
3. UCLA Medical Center, Los Angeles
4. Cleveland Clinic
5. Massachusetts General Hospital, Boston

The list correlates to some extent with the number of searches in Google Trends shown below:



As a form of disclosure, I have to say I am proud to be on staff at Cleveland Clinic which has ranked among the top hospitals for many years.

References:
The Collusion between Media and Hosptials. Dr. Wes.
Cleveland Clinic Advances to Number 3 on the List of America's Best Hospitals. CasesBlog, 07/2006.
Microsoft Blogger Has as Much PR Power as CEO. What Does That Mean for Your Hospital? CasesBlog, 05/2006.

Related:
Google Trends with Numbers. Google Operating System, 06/2008.
A new flavor of Google Trends. Official Google Blog, 06/2008.

Updated: 06/17/2008

Monday, November 26, 2007

"Eosinaphilic" esophagitis on TV

It may be difficult for some reporters to get the facts straight when covering health-related topics, for example:

- "Eosinaphilic" esophagitis is spelled correctly as "eosinophilic," the source of the word is from the cells which cause the inflammation -- eosinophils

- "Pennsylvania Boy Infected With Rare Disease." Actually, eosinophilic esophagitis is not an infection, it is an allergic disorder characterized but eosinophilc inflammation.

This condition is well described in NEJM Images: Adult-Onset Eosinophilic Esophagitis.


"Multi-ring esophagus" in eosinophilic esophagitis (left), infiltration of eosinophils (right). Source: Wikipedia.

References:
Toddler Allergic To Nearly Every Kind Of Food. NewsNet5.

Saturday, November 24, 2007

From zero to hero in one year: what it takes to rise to stardom in medical blogging world

Berci Mesko celebrates the one year anniversary of his medical blog ScienceRoll.com. He started with zero visitors one year ago to reach more than 1,000 page views per day.

He is generous enough to list me among his mentors but in reality I learned far more from him than the other way around. For example, I have never used my SecondLife account and Berci seems to be the medical blogger who knows most about it. I am happy to be one of his 266 FeedBurner subscribers. Currently, this blog still has about 1400 subscribers but with the speed Berci's website is ascending in the medical blogging world, it will surpass this number by its second anniversary.

Berci lists his achievements and some of them are also useful tips on how to start and maintain a popular blog:

I’ve launched two blog carnivals: Gene Genie is dedicated to human genetics and personalized medicine, while Medicine 2.0 is devoted to web 2.0 and medicine.
Tip: Start a blog carnival.

I got a special mention in Medgadget’s Weblog Awards in January.
Tip: Have your blog nominated for blog awards.

Some of my posts have been mentioned by Pharyngula, Blog Around the Clock, Medgadget, Neatorama, Mashable! and Read/Write web.
Tip: Comment on other blogs.

I enjoy the support of HONcode, Healthcare Blogger Code of Ethics and DNA Network.
Tip: Register your blog with different networks and directories.

I’ve hosted some editions of Gene Genie, Medicine 2.0, Mendel’s Garden and Grand Rounds.
Tip: Host blog carnivals.

I’ve had several behind-the-scenes interviews with famous medical bloggers and others as well.
Tip: Interview other bloggers on your website.

References:
The First Birthday of Scienceroll!
12 Important U.S. Laws Every Blogger Needs to Know. Aviva Directory, 02/2008.
A Wikipedia wizard and blogger. BMJ Career Focus, 08/2007.
Image source: BMJ Career Focus.

Updated: 02/23/2008

Thursday, November 22, 2007

Turkey Additives vs. A Vegan Thanksgiving

MarketWatch describes different additives found in Thanksgiving turkeys sold on the market: sodium phosphates, modified food starch, monosodium glutamate, butylated hydroxyanisol and butylated hydroxytoluene...

The alternative is A Vegan Thanksgiving offered by a Healthcare CIO:

"Protein: Tofurky - a tofu and grain-based roast available from Turtle Island Foods . I do not typically eat meat substitutes since I enjoy the inherent food qualities of tofu, tempeh and seitan, but a Tofurky is great for family holiday entertaining."

If you haven't already subscribed to Life as a Healthcare CIO, I think you should. It is an interesting blog with a strong original voice among the more than 600 health-related blogs on the Web.

References:
Thanksgiving additives a real mouthful. Ruth Mantell, MarketWatch.
A Vegan Thanksgiving. Life as a Healthcare CIO.
T-Day! Russell Beattie’s Weblog.
Image source: OpenClipArt.org, public domain.

Wednesday, November 21, 2007

"Turkey/Diet" Searches Around Thanksgiving: Human Predictability Revealed by Google Trends

The blog Google Blogoscoped writes about human predictability:

"Google Trends shows an interesting search popularity graph for the queries “turkey” (as in turkey, the food) and “diet.” Searches for the traditional turkey meal peak on Thanksgiving followed by a smaller peak on Christmas. The New Year Day's resolutions bring a surge in queries for "diet" every year, over and over again:



There is an interesting correlation between depression and rain:


Searches for "allergy" peak every spring:


Immunization "shots" searches are most popular in October/November:


The blog AllergyNotes covers some other Recurrent Trends in Allergy-related Searches on Google.

References:

Google Trends Reveals People’s Predictability. Google Blogoscoped.
Microsoft Blogger Has as Much PR Power as CEO. What Does That Mean for Your Hospital?
Google Blogoscoped images under a Creative Commons license.

Tuesday, November 20, 2007

Kindle e-book reader by Amazon: you can have 200 (medical) books on one device

The Kindle is an electronic book reader launched by Amazon.com which uses an E Ink display and downloads content over the free Amazon Whispernet, which uses the Sprint EVDO network. The Kindle weighs 10.3 oz (292 g) and its battery lasts two days with wireless on, one week with wireless off, and charges in two hours. A computer is not required (source: Wikipedia). Read David Pogue' review in the New York Times.

Mike Torres describes it well:

"So far, I'm really liking what I'm seeing with the Kindle. The price is still way too high (as was the price of the original iPod) but the promise of a 10 ounce device that can store 200+ books is really... well, promising.

Digital books are the future. Just like I've cleared my home of all CDs and gone 100% digital, I can't wait to do the same thing with books. It's the side of me that just hates having "stuff" everywhere. When given the option between a physical artifact or a bunch of bytes, I almost always choose bytes."

The Kindle store includes 88,000+ books including some medical titles. We will see how the new device plays on the market but if you are a medical student/resident, it would be nice to have all your favorite textbooks on one 10-once device. Russell Beattie is right that eBooks need more contrast to take off though.

The Kindle has an MP3 player and works with audio books bought from Audible.com. MS Word documents and the common photo formats are also supported via email (it costs 10 cents per file). Amazon will need to add PDF support and a text-to-speech program.

The device has a browser based on NetFront (a mobile browser) but it looks likes using the Internet beyond the Kindle store will incur extra charges according to the Amazon's terms of service.


Video: jkOnTheRun looks at the Amazon Kindle


Walt Mossberg from WSJ reviews the Kindle


References:

An E-Book Reader That Just May Catch On. NYTimes.
Amazon Kindle - a revolution? Torres Talking.
eBooks need more contrast to take off. Russell Beattie’s Weblog.
Amazon Kindle from Wikipedia, the free encyclopedia.
Mowser on Kindle. Russell Beattie’s Weblog.
Kindle, take 2. Diego's weblog.
100 Notable Books of the Year. NYTimes.
The Future of Reading. Newsweek.
Dear Jeff Bezos (one-week Kindle review). Scobleizer, 11/25/2007.
Amazon's Kindle Makes Buying E-Books Easy, Reading Them Hard. Walt Mossberg, WSJ, 11/2007.
Image source: Amazon.com.

Related:

Hack Your Kindle: 100+ Tips, Resources, and Tutorials to Get More Out of the Amazon Kindle. CollegeDegrees.com, 06/2008.
The Kindle for Medical Education. Life as a Healthcare CIO, 10/2008.
Turning Page, E-Books Start to Take Hold. NYTimes, 12/2008.
How to Read Free Books from Project Gutenberg on the Amazon Kindle http://bit.ly/jH8Hy
Investigating the art of the audiobook - Audible founder reports 40% growth in unit sales every year http://goo.gl/q1Iqh

Monday, November 19, 2007

PLoS Medicine: How Drug Reps Make Friends and Influence Doctors

The article title is a word play on Dale Carnegie's bestseller How to Win Friends and Influence People and is co-authored by a former Eli Lilly drug rep who was featured on YouTube describing the tactics used to convince doctors to prescribe Zyprexa:

Following the Script: How Drug Reps Make Friends and Influence Doctors. Fugh-Berman A, Ahari S (2007). PLoS Med 4(4): e150.

"It's my job to figure out what a physician's price is. For some it's dinner at the finest restaurants, for others it's enough convincing data to let them prescribe confidently and for others it's my attention and friendship... but at the most basic level, everything is for sale and everything is an exchange.

During training, I was told, when you're out to dinner with a doctor, “The physician is eating with a friend. You are eating with a client.”

Table 1 in the article lists Tactics for Manipulating Physicians.

In conclusion, the authors claim that "physicians are susceptible to corporate influence because they are overworked, overwhelmed with information and paperwork, and feel underappreciated. Cheerful and charming, bearing food and gifts, drug reps provide respite and sympathy; they appreciate how hard doctor's lives are, and seem only to want to ease their burdens. But... every word, every courtesy, every gift, and every piece of information provided is carefully crafted, not to assist doctors or patients, but to increase market share for targeted drugs."

You just have to love the license of the journal:

"Everything we publish is freely available online throughout the world, for you to read, download, copy, distribute, and use (with attribution) any way you wish. No permission required. Read a detailed definition of open access."


The former pharmaceutical representative Shahram Ahari describes the tactics he was supposedly advised to use in order to convince doctors to prescribe Zyprexa (olanzapine).

References:
Following the Script: How Drug Reps Make Friends and Influence Doctors. Fugh-Berman A, Ahari S (2007). PLoS Med 4(4): e150.
How I Did It: The "Confession" of a Zyprexa Drug Representative on YouTube
Link via The Patient's Doctor.
Image source: Wikipedia

Related reading:
Lilly Considers $1 Billion Fine to Settle Case. NYTimes, 01/2008.
How to be a drug rep. Half MD.com.
Drug company official praises "smoke-and-mirrors job" by Seroquel project physician in emails. NYTimes, 02/2009.

Updated: 02/27/2009

Sunday, November 18, 2007

What Happened to the Marlboro Marine?

His photo was on the front page of more than 150 newspapers and was one of the most memorable images of Iraq war. What happened next?

He was medically discharged with a "personality disorder" exactly one year after this picture made worldwide news and is currently receiving care for PTSD. The Los Angeles Times covers the story in a 2-part series:

Two lives blurred together by a photo
Rescue operation aims to save a wounded warrior
(free registration required or click here and follow the links)

References:
The Marlboro Marine: Reaching out from behind the camera. Omaha World-Herald.
Posttraumatic stress disorder from Wikipedia, the free encyclopedia.
Post-Traumatic Stress Disorder (PTSD), National Institute of Mental Health (NIMH).
Image source: The Los Angeles Times.

Friday, November 16, 2007

Perioperative beta-blockers and POISE trial: Updated

The post on perioperative beta-blocker use in the light of the new data from the POISE trail was updated:

POISE trial seems poised to change perioperative guidelines for beta blocker use

International Day for Tolerance is Today

The International Day for Tolerance is an annual observance declared by UNESCO in 1995 to generate public awareness of the dangers of intolerance. It is observed on November 16.

As a historic and architectural example of religious tolerance, I would point out to the capital of one of the oldest countries in Europe -- Sofia, the capital of Bulgaria, which I visited in 2007. In the very center of Sofia, there are large-scale temples of 3 major religions within 200 meters of each other: a church, one of the largest synagogues in Europe, and one of the oldest mosques in Europe (the majority of the population is associated with the Bulgarian Orthodox Church). See the pictures below:


St Nedelya Church is a cathedral of the Sofia office of the Bulgarian Patriarchate. The initial structure was built in the 10th century.


Sofia Synagogue is one of the largest in Europe.


Banya Bashi Mosque, completed in 1576, is one of the oldest mosques in Europe. It was built over natural thermal spas used since Roman times.


Google maps shows the proximity of the temples. Click to enlarge the screenshot or see the map.

References:
International Day for Tolerance. United Nations.
International Day for Tolerance from Wikipedia, the free encyclopedia.
Image source: USaid.gov.

Updated: 11/16/2009

Thursday, November 15, 2007

Wednesday, November 14, 2007

Clinical Case: Allergic Rhinitis and Conjunctivitis

A 35-year-old female is referred for symptoms of allergic rhinitis and conjunctivitis. She has tried over-the-counter medications with good relief of symptoms but it did not last long enough.

What is the next step?


Mind map diagram of allergic rhinitis.

Read more in Allergic Rhinitis and Conjunctivitis on AllergyCases.org.

Image source: Wikipedia, a Creative Commons Attribution ShareAlike 2.0 License.

Monday, November 12, 2007

Saturday, November 10, 2007

Tesla Road Test on Mahalo Daily Video



The Tesla Roadster is a 100% electric sports car which accelerates from 0-60 mph (100 km/h) in 4 seconds and reaches a top speed of over 150 mph. The car is able to travel 245 miles (394 km) on a single charge and takes 3.5 hours to fully charge. This is one of the "green muscle cars" as Governor Schwarzenegger likes to call them.

The price of the most 2008 Tesla Roadster models is about $ 100,000 but there is no shortage of high-end buyers: the manufacturer has a 600+ person waiting list. They are developing a 5-person fully electric sedan which will be priced lower.

Mahalo Daily is a Rocketboom-type video show which is actually interesting and probably worth-subscribing to. Mahalo is the new "human-powered" search engine/web directory launched by the serial entrepreneur Jason Calacanis who made $ 30 million by selling a collection of popular blogs (Weblogs, Inc.) to AOL.

By the way, "mahalo" means "thank you" in Hawaiian and "pendulum" in Bulgarian.

One more video:


How to Play Guitar for Newbies

References:
Tesla Roadster from Wikipedia, the free encyclopedia.

Further reading:
How to Tie a Tie. Mahalo Daily.
Why I’m buying a Tesla sedan. Scoble, 06/2008.

Updated: 06/29/2008

Friday, November 9, 2007

CIO of Harvard Medical School Explains Why He Writes a Blog

John Halamka, MD, MS, is the Chief Information Officer (CIO) and Dean for Technology at Harvard Medical School, and a practicing emergency physician:

"I've found that I can answer many questions in public forums by referring to postings I've made in my blog. I've posed several questions to the community via my blog and received many helpful responses. The big question will be - it is sustainable?

People who know me well know that I am not driven by fame or fortune, I just want to make a difference. My experience running a software company in my early 20's taught me that judging the value of life by a number in a bank balance, the type of car you drive, or the size of your house is not very satisfying.

I also crave learning. I welcome suggestions on how to become a better blogger."

Dr. Halamka sleeps only 4 hours per night and has been using 30 minutes from that time since he started blogging.

References:
Blogging about Blogging. Life as a Healthcare CIO.
Image source: Life as a Healthcare CIO.

Thursday, November 8, 2007

POISE trial seems poised to change perioperative guidelines for beta blocker use

According to the trial, perioperative beta blockers may decrease the incidence of myocardial infarction but the survival benefits are offset by the increase in strokes.

The study principal investigator, Dr Philip J Devereaux (McMaster University, Hamilton, ON), said he was unable to determine who would be at risk and who would benefit from perioperative beta-blocker use at this stage, but added, "I certainly would not recommend it to my mother."

There was a decrease in nonfatal MI ( 3.6% versus 5.1%) but there were more strokes in the beta-blocker group ( 1.0% versus 0.5%) and a greater total mortality in the treatment arm (3.1 % versus 2.3 %).

Our current practice at Cleveland Clinic is to start long-acting beta-blockers 2-4 weeks prior to noncardiac surgery in patients with Revised Cardiac Risk Index (RCRI) score higher than 2-3 and continue for 2-4 weeks after surgery. We may need to reevaluate practice in the light of the new data from the POISE trial.

Andy Auerbach of UCSF describes how he would change his prescribing pattern regarding perioperative beta-blockers in a post on Wachter's World:

"How is my practice today different than it was before last week? I’ll continue the beta blockers for my patient who was on them previously, I’m more likely to recommend starting beta blockers a couple of weeks before surgery in high risk patients, and I’m less likely to prescribe perioperative beta blockers in the intermediate risk pre-op patient (in whom I might now perform some testing to better define the true risk). I’m also less likely to use a high dose to start, or to titrate up the beta blocker dose for tachycardia unless I am certain that I’m not treating tachycardia due to hypovolemia, bleeding, or infection first."

What other medications can be used to decrease cardiovascular risk in the perioperative period?

Statins looks promising. Researchers from Cleveland Clinic just presented an abstract on the topic at the AHA meeting where the POISE trial results were announced. The retrospective study included more than 5,200 patients who underwent coronary bypass (CABG). Treatment with statins after CABG seemed to reduces a stroke risk.

One of the co-authors of the study is Dr. Peter Zimbwa with whom I am lucky to share an office here at Cleveland Clinic. Peter is a remarkable physician and researcher, and his resume is as impressive as his titles -- he has MD, MSc, PhD, MRCP, DTM (just to name a few).

Dr. R.W. Donnell has commented on the projected benefits of statin use in the perioperative period: "look for statins to emerge as the “next beta blockers” for perioperative treatment in the coming years."

References:
POISEd to change the guidelines on perioperative use of beta blockers? The Heart.org.
AHA: Surgery with Beta-Blockers Onboard May Be Risky. MedPage Today.
Peri-operative beta-blockers- A quality indicator or a bad idea? Retired doc's thoughts.
Peri-operative Beta-blockers: Much room for evidence still exists! BMJ.
Perioperative beta blockers may not benefit patients with diabetes (if not used properly)
Case 2: Does this patient need a beta-blocker?
Continue statins as seamlessly as possible before and after vascular surgery. Notes from Dr. RW.
Perioperative beta blockers: not so fast! Notes from Dr. RW.
Three Remarkable Articles Last Week. Wachter's World, 11/2007.
Perioperative Beta Blockers, Redux. Wachter's World, 11/2007.
Image source: OpenClipArt.org, public domain.

Updated 11/16/2007

Wednesday, November 7, 2007

When is lumbar puncture indicated in evaluation of patients with dementia?

A 84 yo female with PMH of CAD s/p stents (on ASA/Plavix), CVA, hypothyroidism, is admitted to the hospital with change in mental status (lethargy) and poor memory for 1 year. She is found to have hyponatremia of 120 mEq/L due to SIADH but no focal signs of infection. MRI/CT scans are unremarkable. EEG shows diffuse encephalopathy. CXR and UA are normal. She is placed on free water restriction and BMP is monitored q 12 hr.

Should a lumbar puncture be done for evaluation of her suspected dementia?

No.

Lumbar puncture (LP) is not needed in the evaluation of most patients with dementia. Some indications for LP in patients with dementia are listed below:
  1. Acute or subacute onset ( less than 8 weeks)
  2. Evidence of immunosuppression
  3. Fever or presence of meningeal signs
  4. Atypical presentation of dementia (e.g., severe headaches, seizures, cranial neuropathies)
  5. Symptoms of normal-pressure hydrocephalus (NPH)
  6. Positive serum fluorescent treponemal antibody absorption test
  7. Abnormalities on CT/MRI brain (e.g., meningeal enhancement)
In conclusion, LP and CSF analysis should not be part of the routine evaluation of patients with dementia and should probably be performed only in the presence of such indications as a subacute duration of dementia (less than 8 weeks), fever, and signs of meningeal irritation.

References:
Initial evaluation of suspected dementia: Asking the right questions. David C. Steffens, MD; Joel C. Morgenlander, MD. Postgrad Med, 1999.
The role of lumbar puncture in the evaluation of dementia: the Durham Veterans Administration/Duke University Study. Becker PM, Feussner JR, Mulrow CD, Williams BC, Vokaty KA. J Am Geriatr Soc. 1985 Jun;33(6):392-6.
Image source: Wikipedia, GNU Free Documentation License.

Tuesday, November 6, 2007

What is Crithidia Luciliae (and what do we use it for)?

Recently, I saw a patient with suspected SLE who had a lab test by the name of "Crithidia Luciliae" and it was negative. In a limited and completely unscientific survey of a few colleagues, nobody was sure what Crithidia Luciliae was, so the short answer is below.

Crithidia are members of the trypanosome protozoa, just like Trichomonas vaginalis. The kinetoplast (in the tail) of the unicellular flagellate Crithidia luciliae is an excellent source of circular dsDNA and provides a substrate when screening for anti-dsDNA autoantibodies.

The presence of these antibodies is almost exclusively associated with a diagnosis of SLE. The anti-dsDNA antibody sensitivity for diagnosing SLE is 66 to 95 percent, specificity is 75 to 100 percent. The titer correlates with disease activity and is a useful marker, both to assess disease severity and to monitor response to therapy.

There are commercially available testing kits using indirect immunofluorescent assay.

References:
Diagnosis and differential diagnosis of systemic lupus erythematosus in adults. UpToDate 15.3.
Image source: Crithidia Luciliae. Bindingsite.co.uk (permission to display, copy, distribute and download for non-commercial use only).
Wikipedia links.

Thursday, November 1, 2007

Medical Blogger Launches Radio Show

Doctor Anonymous is "just a guy working in the American health care system trying to find the lighter side of life." And he does find it in his weekly radio show on BlogTalkRadio.com: Doctor Anonymous Live. Click the play button to listen to the latest show:



Subscribe to the show via RSS:

http://blogtalkradio.com/doctoranonymous/feed