Acute pyelonephritis in women (2011 review)

This is a 2011 review from the official journal of the AAFP, American Family Physician:

Acute pyelonephritis is a bacterial infection of the renal pelvis and kidney most often seen in young women.

Symptoms of acute pyelonephritis

Most patients have fever, although it may be absent early in the illness. Flank pain is nearly universal.

Tests for acute pyelonephritis

A positive urinalysis confirms the diagnosis.

Urine culture should be obtained in all patients to guide antibiotic therapy if the patient does not respond to initial empiric antibiotic regimens.

Escherichia coli is the most common pathogen in acute pyelonephritis. In the past decade, there has been an increasing rate of E. coli resistance to extended-spectrum beta-lactam antibiotics.

Imaging, usually with contrast-enhanced CT is not necessary unless there is:

- no improvement in the patient's symptoms
- symptom recurrence after initial improvement

Treatment of acute pyelonephritis

Outpatient treatment is appropriate for most patients.

Oral fluoroquinolone is the initial outpatient therapy if the rate of fluoroquinolone resistance in the community is less than 10%. If the resistance rate exceeds 10%, an initial IV dose of ceftriaxone or gentamicin should be given, followed by an oral fluoroquinolone regimen.

Oral beta-lactam antibiotics and trimethoprim/sulfamethoxazole (TMP-SMX (Bactrim) are inappropriate for therapy because of high resistance rates.

References:

Diagnosis and treatment of acute pyelonephritis in women. Colgan R, Williams M, Johnson JR. Am Fam Physician. 2011 Sep 1;84(5):519-26.
Nephrology Cases

Crohn's disease - 2011 review

Crohn's disease is a chronic inflammatory condition affecting the GI tract at any point from the mouth to the rectum.

Symptoms and signs may consist of:

- diarrhea
- abdominal pain
- fever
- weight loss
- abdominal masses
- anemia

Extraintestinal manifestations of Crohn's disease include:

- osteoporosis
- inflammatory arthropathies
- scleritis
- nephrolithiasis
- cholelithiasis
- erythema nodosum

Laboratory findings

Acute phase reactants, such as CRP and ESR, are often increased with inflammation and may correlate with disease activity.

Levels of vitamin B12, folate, albumin, prealbumin, and vitamin D can help assess nutritional status.

Procedures often used to diagnose Crohn's disease:

- colonoscopy with ileoscopy
- capsule endoscopy
- computed tomography (CT) enterography
- small bowel follow-through

Diagnostic tools for extraintestinal manifestations or complications (e.g., abscess, perforation):

- ultrasonography
- computed axial tomography (CT)
- scintigraphy
- MRI

Medical management

Mesalamine products are used for mild to moderate colonic disease. Antibiotics (e.g., metronidazole, fluoroquinolones) are often used for treatment.

Patients with moderate to severe Crohn's disease are treated with:

- corticosteroids
- azathioprine
- 6-mercaptopurine
- anti-tumor necrosis factor agents (e.g., infliximab, adalimumab)

References

Diagnosis and management of Crohn's disease. Wilkins T, Jarvis K, Patel J. Am Fam Physician. 2011 Dec 15;84(12):1365-75.

Image source: Colon (anatomy), Wikipedia, public domain.

Best of Medical Blogs - weekly review, blog carnival

What happened to "Grand Rounds" medblog carnival?

It's sad to see the demise of "Grand Rounds" medblog carnival. The weekly summary of the best medical blog posts has been published since 2004, with only few breaks. There have not been any editions for more than a month, and no new ones are scheduled. A new initiative by Health Care SoMedia Review could replace some of it http://goo.gl/73RpE

This blog post is a part of a project to recreate a weekly review, or blog carnival, of the best medical blog posts. Feel free to send your suggestions to my email at clinicalcases@gmail.com. The “Best of Medical Blogs - weekly review, blog carnival” will be published on Tuesdays, just like the old Grand Rounds. The last organizers of the Grand Rounds blog carnival. @DrVal and @NickGenes, are aware of this project.

How Doctors Manage Their Social Media Profiles

Personal vs. Professional: How Doctors Manage Their Social Media Profiles is a blog post by Matt Wood of the University of Chicago Medicine blog http://goo.gl/JNyu1. Matt has published a series of great blog posts recently about physicians’ use social media. The doctors at University of Chicago are clearly the leaders in social media use in a city with a rich history of great medical centers such as UChicago Medicine, Northwestern, Childrens’ Memorial, Rush, Loyola and Northshore. Matt tries to find out what makes the UChicago doctors more comfortable using social media that their peers at other institutions: http://goo.gl/JNyu1

Consumers use social media to make medical decisions

Consumer Expectations for Healthcare Social Media - this is a succinct summary by Ed Bennett, “a maker of lists” of healtchare oragnizations that use social media http://goo.gl/REXqV

Digital Strategies for Healthcare Organisations - a good overview by the Australian blog IV line http://goo.gl/PZtWl

Doctors’ salaries

Dr. Mandrola quotes an experienced colleague on doctors' salaries: “We are all happy with what we make. What upsets us most is seeing what others make.” Since then, I try not to dwell on what others make. http://goo.gl/WBnJq

Healthcare social media is a “moral obligation” for doctors

Healthcare social media is a 'moral obligation', says Farris Timimi, M.D., medical director for the Mayo Clinic Center for Social Media, quoted by “Fierce Health IT” . Social media needs to be grown and nurtured for patients. "Our patients are there. Our moral obligation is to meet them where they're at and give them the information they need so they can seek recovery," Dr. Timimi said. "You've got to be ready for it. You build it for the patients; not for yourself. "This is not marketing," he added. "This is the right thing to do." http://goo.gl/BHzKf

Social media is no more a moral obligation for doctors than it is to appear on TV and radio shows, and to write newspaper columns. It is great if you have the time and aptitude to do it, but the most important things is to focus on what matters most - providing correct diagnosis and best possible treatment to your patients.

Comments from Twitter:

Westby Fisher, MD @doctorwes: Best of Medical Blogs - weekly review, RIP blog carnival bit.ly/KsBSLJ

Laika (Jacqueline) @laikas: After the demise of THE Grand Rounds @DrVes starts his own weekly blog review bit.ly/Iqgcmx Gr8 initiative; but still miss the OLD GR

WB Medical Education @WBmeded: Hope to check out some of these later, looks interesting RT @DrVes: Best of Medical Blogs: weekly review, blog carnival goo.gl/fb/d870P

Mike Cadogan @sandnsurf: Another great way to control the information overload with the Best of Medical Blogs - weekly review bit.ly/K1stxo

The Diet Factor in Attention-Deficit/Hyperactivity Disorder - State-of-the-Art Review Article in Pediatrics

Diets that were tried in attempt to reduce symptoms associated with attention-deficit/hyperactivity disorder (ADHD) include:

- sugar-restricted
- additive/preservative-free
- oligoantigenic/elimination
- fatty acid supplements

Omega−3 supplement is the latest dietary treatment with positive reports of efficacy. Interest in the additive-free diet of the 1970s is occasionally revived.

Provocative reports have drawn attention to the ADHD-associated “Western-style” diet, high in fat and refined sugars, and the ADHD-free “healthy” diet, containing fiber, folate, and omega-3 fatty acids.

Indications for dietary therapy include:

- medication failure
- parental or patient preference
- iron deficiency
- change from an ADHD-linked Western diet to an ADHD-free healthy diet, when appropriate

In practice, additive-free and oligoantigenic/elimination diets are time-consuming and disruptive to the household; they are indicated only in selected patients.

Iron and zinc are supplemented in patients with known deficiencies; they may also enhance the effectiveness of stimulant therapy.

In patients failing to respond or with parents opposed to medication, omega-3 supplements may warrant a trial.

References:

The Diet Factor in Attention-Deficit/Hyperactivity Disorder. J. Gordon Millichap, MD and Michelle M. Yee, CPNP. PEDIATRICS Vol. 129 No. 2 February 1, 2012, pp. 330 -337, (doi: 10.1542/peds.2011-2199)

Image source: Olive oil, Wikipedia

Best of Medical Blogs - weekly review, blog carnival

What happened to "Grand Rounds" medblog carnival?

It's sad to see the demise of "Grand Rounds" medblog carnival. The weekly summary of the best medical blog posts has been published since 2004, with only few breaks. There have not been any editions for more than a month, and no new ones are scheduled. A new initiative by Health Care SoMedia Review could replace some of it http://goo.gl/73RpE

This blog post is a part of a project to recreate a weekly review, or blog carnival, of the best medical blog posts. Feel free to send your suggestions to my email at clinicalcases@gmail.com. The “Best of Medical Blogs - weekly review, blog carnival” will be published on Tuesdays, just like the old Grand Rounds. The last organizers of the Grand Rounds blog carnival. @DrVal and @NickGenes, are aware of this project.

How Doctors Manage Their Social Media Profiles

Personal vs. Professional: How Doctors Manage Their Social Media Profiles is a blog post by Matt Wood of the University of Chicago Medicine blog http://goo.gl/JNyu1. Matt has published a series of great blog posts recently about physicians’ use social media. The doctors at University of Chicago are clearly the leaders in social media use in a city with a rich history of great medical centers such as UChicago Medicine, Northwestern, Childrens’ Memorial, Rush, Loyola and Northshore. Matt tries to find out what makes the UChicago doctors more comfortable using social media that their peers at other institutions: http://goo.gl/JNyu1

Consumers use social media to make medical decisions

Consumer Expectations for Healthcare Social Media - this is a succinct summary by Ed Bennett, “a maker of lists” of healtchare oragnizations that use social media http://goo.gl/REXqV

Digital Strategies for Healthcare Organisations - a good overview by the Australian blog IV line http://goo.gl/PZtWl

Doctors’ salaries

Dr. Mandrola quotes an experienced colleague on doctors' salaries: “We are all happy with what we make. What upsets us most is seeing what others make.” Since then, I try not to dwell on what others make. http://goo.gl/WBnJq

Healthcare social media is a “moral obligation” for doctors

Healthcare social media is a 'moral obligation', says Farris Timimi, M.D., medical director for the Mayo Clinic Center for Social Media, quoted by “Fierce Health IT” . Social media needs to be grown and nurtured for patients. "Our patients are there. Our moral obligation is to meet them where they're at and give them the information they need so they can seek recovery," Dr. Timimi said. "You've got to be ready for it. You build it for the patients; not for yourself. "This is not marketing," he added. "This is the right thing to do." http://goo.gl/BHzKf

Social media is no more a moral obligation for doctors than it is to appear on TV and radio shows, and to write newspaper columns. It is great if you have the time and aptitude to do it, but the most important things is to focus on what matters most - providing correct diagnosis and best possible treatment to your patients.

Comments from Twitter:

Westby Fisher, MD @doctorwes: Best of Medical Blogs - weekly review, RIP blog carnival bit.ly/KsBSLJ

Laika (Jacqueline) @laikas: After the demise of THE Grand Rounds @DrVes starts his own weekly blog review bit.ly/Iqgcmx Gr8 initiative; but still miss the OLD GR

WB Medical Education @WBmeded: Hope to check out some of these later, looks interesting RT @DrVes: Best of Medical Blogs: weekly review, blog carnival goo.gl/fb/d870P

Mike Cadogan @sandnsurf: Another great way to control the information overload with the Best of Medical Blogs - weekly review bit.ly/K1stxo

Best of Medical Blogs - weekly review and blog carnival

The “Best of Medical Blogs - BMB weekly review and blog carnival” is a weekly summary of the best posts from medical blogs. Feel free to send your suggestions to my email at clinicalcases@gmail.com. Best of Medical Blogs (BMB) is published every Tuesday, just like the old Grand Rounds.

A Medical Educator Joins Social Media: One Year Later

Dr. Djuricich, Program Director in Medicine-Pediatrics at the Indiana University, shares what he has learned in one short year: If physicians and other health care professionals are not becoming involved in social media, they are missing out on a “place” where many of the patients already are. There is a lot of misinformation floating around on the internet. It is a duty of physicians to combat this and provide correct information. Do not let social media take over your life. The important things (family, friends, etc.) are still the important things, so don’t lose the priorities. http://goo.gl/zNfpe

What explains blogging longevity? It's easy: blog for yourself, and share with others

Dr. Centor explains his blogging longevity after 10-years of blogging. I've been blogging for 8 years, and I agreee with him: Why you should write a blog for yourself rather than for a shifting audience http://goo.gl/P8xtz

Here's Dr. Centor again: Explaining longevity is subjective. Mostly, I like blogging. Basically I blog with myself in mind, and am gratified that others find my comments interesting. Blogging is never a chore. One cannot last 10 years doing a chore. http://goo.gl/Jyl2o

Cardiologist Dr. Wes nominates the hardest to read Abstract of the Year at 2012 Heart Rhythm Society

What is the abstract that contributes the smallest amount to our field while demonstrating the worst grammar, the most bureaucratic lingo and, of course, verbosity. The sentence that clinched it? "Conclusions: The harmonization of endpoint definitions, terminology, and clinical trial design paradigms provides consistency across clinical trial studies that can facility (sic) clinician acceptance of results and the evaluation of safety and effectiveness of devices and medicines for atrial fibrillation." http://goo.gl/ZstA0

Harvard Medical School Q&A blog doctor reflects on his readers’ feedback

Dr. Komaroff from the blog Ask Doctor K.: “Since I began this column last September, I’ve received a lot of mail — both emails and “snail mail.” Mostly it’s been health questions. I can’t answer them all, but I try to answer as many as I can. However, I’ve also received complaints. Sometimes they represent an honest difference of perspective. On occasion, they reflect the fact that I’m a man.” http://goo.gl/XK3O1

A complete list of all academic medical journals available for the iPad

The omnipresent blog iMedicalApps makes a good use of Google Docs spreadsheet to list the apps of many academic medical journals available for the iPad. I still have personal preference for the open web rather than apps but that’s just me. http://goo.gl/13Gjz

What is postinfectious cough and how to treat it?

From Dr. Matthew Mintz' blog: While the cause of the postinfectious cough is not known, it has been thought to be due to the extensive damage of cells lining the lung and widespread airway inflammation of the upper and/or lower airways. The good news is that this usually goes away by itself, the bad news is that it can take weeks or even months, and can be quite disruptive to patients lives. Since symptoms are caused primarily by inflammation and hyperresponsiveness/bronchoconstriction in the lungs (which is what we see in asthma), then treatment is likely best with something that treats both inflammation and bronchoconstriction in the lungs, such as an inhaled corticosteroid/long-acting beta agonist like Advair (which is commonly used in asthma). Use of Advair for postinfectious cough may be the single most common off-label use of any prescription product. Since inflammation can persist for weeks, it is important that Advair be used for at least 4 weeks. If symptoms return, the patient should be brought back for pulmonary function testing as this may be a new presentation of asthma. http://goo.gl/RgxLb

Reality Social Media: Live Tweeting Brain Surgery. What is the downside of this marketing push? Dr. Wes explains: http://goo.gl/XbKwv

"Healthcare Going To The Dogs" - a video for training hospital administrators http://goo.gl/hv40a and http://goo.gl/xsW4J

Science blogging and self-promotion? http://goo.gl/yGUqS

Best of Medical Blogs - weekly review and blog carnival

The “Best of Medical Blogs - BMB weekly review and blog carnival” is a weekly summary of the best posts from medical blogs. Feel free to send your suggestions to my email at clinicalcases@gmail.com. Best of Medical Blogs (BMB) is published every Tuesday, just like the old Grand Rounds.

A Medical Educator Joins Social Media: One Year Later

Dr. Djuricich, Program Director in Medicine-Pediatrics at the Indiana University, shares what he has learned in one short year: If physicians and other health care professionals are not becoming involved in social media, they are missing out on a “place” where many of the patients already are. There is a lot of misinformation floating around on the internet. It is a duty of physicians to combat this and provide correct information. Do not let social media take over your life. The important things (family, friends, etc.) are still the important things, so don’t lose the priorities. http://goo.gl/zNfpe

What explains blogging longevity? It's easy: blog for yourself, and share with others

Dr. Centor explains his blogging longevity after 10-years of blogging. I've been blogging for 8 years, and I agreee with him: Why you should write a blog for yourself rather than for a shifting audience http://goo.gl/P8xtz

Here's Dr. Centor again: Explaining longevity is subjective. Mostly, I like blogging. Basically I blog with myself in mind, and am gratified that others find my comments interesting. Blogging is never a chore. One cannot last 10 years doing a chore. http://goo.gl/Jyl2o

Cardiologist Dr. Wes nominates the hardest to read Abstract of the Year at 2012 Heart Rhythm Society

What is the abstract that contributes the smallest amount to our field while demonstrating the worst grammar, the most bureaucratic lingo and, of course, verbosity. The sentence that clinched it? "Conclusions: The harmonization of endpoint definitions, terminology, and clinical trial design paradigms provides consistency across clinical trial studies that can facility (sic) clinician acceptance of results and the evaluation of safety and effectiveness of devices and medicines for atrial fibrillation." http://goo.gl/ZstA0

Harvard Medical School Q&A blog doctor reflects on his readers’ feedback

Dr. Komaroff from the blog Ask Doctor K.: “Since I began this column last September, I’ve received a lot of mail — both emails and “snail mail.” Mostly it’s been health questions. I can’t answer them all, but I try to answer as many as I can. However, I’ve also received complaints. Sometimes they represent an honest difference of perspective. On occasion, they reflect the fact that I’m a man.” http://goo.gl/XK3O1

A complete list of all academic medical journals available for the iPad

The omnipresent blog iMedicalApps makes a good use of Google Docs spreadsheet to list the apps of many academic medical journals available for the iPad. I still have personal preference for the open web rather than apps but that’s just me. http://goo.gl/13Gjz

What is postinfectious cough and how to treat it?

From Dr. Matthew Mintz' blog: While the cause of the postinfectious cough is not known, it has been thought to be due to the extensive damage of cells lining the lung and widespread airway inflammation of the upper and/or lower airways. The good news is that this usually goes away by itself, the bad news is that it can take weeks or even months, and can be quite disruptive to patients lives. Since symptoms are caused primarily by inflammation and hyperresponsiveness/bronchoconstriction in the lungs (which is what we see in asthma), then treatment is likely best with something that treats both inflammation and bronchoconstriction in the lungs, such as an inhaled corticosteroid/long-acting beta agonist like Advair (which is commonly used in asthma). Use of Advair for postinfectious cough may be the single most common off-label use of any prescription product. Since inflammation can persist for weeks, it is important that Advair be used for at least 4 weeks. If symptoms return, the patient should be brought back for pulmonary function testing as this may be a new presentation of asthma. http://goo.gl/RgxLb

Reality Social Media: Live Tweeting Brain Surgery. What is the downside of this marketing push? Dr. Wes explains: http://goo.gl/XbKwv

"Healthcare Going To The Dogs" - a video for training hospital administrators http://goo.gl/hv40a and http://goo.gl/xsW4J

Science blogging and self-promotion? http://goo.gl/yGUqS

Best of Medical Blogs - weekly review and blog carnival

The “Best of Medical Blogs - BMB weekly review and blog carnival” is a weekly summary of the best posts from medical blogs. Feel free to send your suggestions to my email at clinicalcases@gmail.com. Best of Medical Blogs (BMB) is published every Tuesday, just like the old Grand Rounds.

A Medical Educator Joins Social Media: One Year Later

Dr. Djuricich, Program Director in Medicine-Pediatrics at the Indiana University, shares what he has learned in one short year: If physicians and other health care professionals are not becoming involved in social media, they are missing out on a “place” where many of the patients already are. There is a lot of misinformation floating around on the internet. It is a duty of physicians to combat this and provide correct information. Do not let social media take over your life. The important things (family, friends, etc.) are still the important things, so don’t lose the priorities. http://goo.gl/zNfpe

What explains blogging longevity? It's easy: blog for yourself, and share with others

Dr. Centor explains his blogging longevity after 10-years of blogging. I've been blogging for 8 years, and I agreee with him: Why you should write a blog for yourself rather than for a shifting audience http://goo.gl/P8xtz

Here's Dr. Centor again: Explaining longevity is subjective. Mostly, I like blogging. Basically I blog with myself in mind, and am gratified that others find my comments interesting. Blogging is never a chore. One cannot last 10 years doing a chore. http://goo.gl/Jyl2o

Cardiologist Dr. Wes nominates the hardest to read Abstract of the Year at 2012 Heart Rhythm Society

What is the abstract that contributes the smallest amount to our field while demonstrating the worst grammar, the most bureaucratic lingo and, of course, verbosity. The sentence that clinched it? "Conclusions: The harmonization of endpoint definitions, terminology, and clinical trial design paradigms provides consistency across clinical trial studies that can facility (sic) clinician acceptance of results and the evaluation of safety and effectiveness of devices and medicines for atrial fibrillation." http://goo.gl/ZstA0

Harvard Medical School Q&A blog doctor reflects on his readers’ feedback

Dr. Komaroff from the blog Ask Doctor K.: “Since I began this column last September, I’ve received a lot of mail — both emails and “snail mail.” Mostly it’s been health questions. I can’t answer them all, but I try to answer as many as I can. However, I’ve also received complaints. Sometimes they represent an honest difference of perspective. On occasion, they reflect the fact that I’m a man.” http://goo.gl/XK3O1

A complete list of all academic medical journals available for the iPad

The omnipresent blog iMedicalApps makes a good use of Google Docs spreadsheet to list the apps of many academic medical journals available for the iPad. I still have personal preference for the open web rather than apps but that’s just me. http://goo.gl/13Gjz

What is postinfectious cough and how to treat it?

From Dr. Matthew Mintz' blog: While the cause of the postinfectious cough is not known, it has been thought to be due to the extensive damage of cells lining the lung and widespread airway inflammation of the upper and/or lower airways. The good news is that this usually goes away by itself, the bad news is that it can take weeks or even months, and can be quite disruptive to patients lives. Since symptoms are caused primarily by inflammation and hyperresponsiveness/bronchoconstriction in the lungs (which is what we see in asthma), then treatment is likely best with something that treats both inflammation and bronchoconstriction in the lungs, such as an inhaled corticosteroid/long-acting beta agonist like Advair (which is commonly used in asthma). Use of Advair for postinfectious cough may be the single most common off-label use of any prescription product. Since inflammation can persist for weeks, it is important that Advair be used for at least 4 weeks. If symptoms return, the patient should be brought back for pulmonary function testing as this may be a new presentation of asthma. http://goo.gl/RgxLb

Reality Social Media: Live Tweeting Brain Surgery. What is the downside of this marketing push? Dr. Wes explains: http://goo.gl/XbKwv

"Healthcare Going To The Dogs" - a video for training hospital administrators http://goo.gl/hv40a and http://goo.gl/xsW4J

Science blogging and self-promotion? http://goo.gl/yGUqS