You've Got AIDS?

From Family Guy: "You've Got AIDS!"

Hm, the initial reaction, I think, is that this is clearly insensitive, but could one argue that such satire actually serves to raise awareness about AIDS and desensitize the issue, making its acceptance more commonplace? Hmm...

Google: Finding Flus Fast?

Google Flu Trends is a new system set up by Google through its Google.org philanthropy site that tracks American's search queries related to the flu. Apparently, Americans turn to Google before turning to their PCP when trying to decide what their symptoms mean. Now, Google has started to look at this data in the aggregate with Google Flu Trends:

There is a new common symptom of the flu, in addition to the usual aches, coughs, fevers and sore throats. Turns out a lot of ailing Americans enter phrases like “flu symptoms” into Google and other search engines before they call their doctors.

That simple act, multiplied across millions of keyboards in homes around the country, has given rise to a new early warning system for fast-spreading flu outbreaks, called Google Flu Trends.

Tests of the new Web tool from Google.org, the company’s philanthropic unit, suggest that it may be able to detect regional outbreaks of the flu a week to 10 days before they are reported by the Centers for Disease Control and Prevention.

In early February, for example, the C.D.C. reported that the flu cases had recently spiked in the mid-Atlantic states. But Google says its search data show a spike in queries about flu symptoms two weeks before that report was released. Its new service at google.org/flutrends analyzes those searches as they come in, creating graphs and maps of the country that, ideally, will show where the flu is spreading.

The C.D.C. reports are slower because they rely on data collected and compiled from thousands of health care providers, labs and other sources. Some public health experts say the Google data could help accelerate the response of doctors, hospitals and public health officials to a nasty flu season, reducing the spread of the disease and, potentially, saving lives.

Seems like a smart idea. I wonder if Google will apply this to other diseases as well. Going beyond infectious diseases, what if Google were to track search queries related to other potential 'trends' like teen pregnancy? Should raise some interesting questions about how to utilize this technology for public health issues while respecting the privacy of Google users.

13 Things Your Waiter Won't Tell You

Perhaps some of this is common knowledge, but I thought some of the points were well worth reading:

13 Things Your Waiter Won't Tell You

Points #2 and #13 are well worth considering when you think about eating out, especially this time of year.

A Cure for AIDS?

A new case report out of Germany seems to have found a potential cure for AIDS. Yes, I said 'cure.' The doctor, a hematologist-oncologist, was treating an HIV positive patient for leukemia. Here's how he came upon the potential cure for AIDS:

The breakthrough appears to be that Dr. Hütter, a soft-spoken hematologist who isn't an AIDS specialist, deliberately replaced the patient's bone marrow cells with those from a donor who has a naturally occurring genetic mutation that renders his cells immune to almost all strains of HIV, the virus that causes AIDS.

The development suggests a potential new therapeutic avenue and comes as the search for a cure has adopted new urgency. Many fear that current AIDS drugs aren't sustainable. Known as antiretrovirals, the medications prevent the virus from replicating but must be taken every day for life and are expensive for poor countries where the disease runs rampant. Last year, AIDS killed two million people; 2.7 million more contracted the virus, so treatment costs will keep ballooning.

While cautioning that the Berlin case could be a fluke, David Baltimore, who won a Nobel prize for his research on tumor viruses, deemed it "a very good sign" and a virtual "proof of principle" for gene-therapy approaches. Dr. Baltimore and his colleague, University of California at Los Angeles researcher Irvin Chen, have developed a gene therapy strategy against HIV that works in a similar way to the Berlin case. Drs. Baltimore and Chen have formed a private company to develop the therapy.

Back in 1996, when "cocktails" of antiretroviral drugs were proved effective, some researchers proposed that all cells harboring HIV might eventually die off, leading to eradication of HIV from the body -- in short, a cure. Those hopes foundered on the discovery that HIV, which integrates itself into a patient's own DNA, hides in so-called "sanctuary cells," where it lies dormant yet remains capable of reigniting an infection.

But that same year, researchers discovered that some gay men astonishingly remained uninfected despite engaging in very risky sex with as many as hundreds of partners. These men had inherited a mutation from both their parents that made them virtually immune to HIV.

The mutation prevents a molecule called CCR5 from appearing on the surface of cells. CCR5 acts as a kind of door for the virus. Since most HIV strains must bind to CCR5 to enter cells, the mutation bars the virus from entering. A new AIDS drug, Selzentry, made by Pfizer Inc., doesn't attack HIV itself but works by blocking CCR5.

About 1% of Europeans, and even more in northern Europe, inherit the CCR5 mutation from both parents. People of African, Asian and South American descent almost never carry it.

Dr. Hütter, 39, remembered this research when his American leukemia patient failed first-line chemotherapy in 2006. He was treating the patient at Berlin's Charité Medical University, the same institution where German physician Robert Koch performed some of his groundbreaking research on infectious diseases in the 19th century. Dr. Hütter scoured research on CCR5 and consulted with his superiors.

Finally, he recommended standard second-line treatment: a bone marrow transplant -- but from a donor who had inherited the CCR5 mutation from both parents. Bone marrow is where immune-system cells are generated, so transplanting mutant bone-marrow cells would render the patient immune to HIV into perpetuity, at least in theory.

Sounds interesting, but given the mortality rate of bone marrow transplants, it probably won't be a widespread treatment for a while.

Bacteria Thrive In Inner Elbow

I honestly have never given much thought to my elbow. Apparently, other people have:

The crook of your elbow is not just a plain patch of skin. It is a piece of highly coveted real estate, a special ecosystem, a bountiful home to no fewer than six tribes of bacteria. Even after you have washed the skin clean, there are still one million bacteria in every square centimeter.

But panic not. These are not bad bacteria. They are what biologists call commensals, creatures that eat at the same table with people to everyone’s mutual benefit. Though they were not invited to enjoy board and lodging in the skin of your inner elbow, they are giving something of value in return. They are helping to moisturize the skin by processing the raw fats it produces, says Julia A. Segre of the National Human Genome Research Institute.

Dr. Segre and colleagues report their discovery of the six tribes in a paper being published online on Friday in Genome Research. The research is part of the human microbiome project, microbiome meaning the entourage of all microbes that live in people.

I think a microbiome project is a great idea. In medical school, we learn about the most common and/or most virulent bugs, but often on clinics I have noticed pathology reports come back with bugs I have never heard of, and wouldn't know how to categorize without the helpful notes from the pathologist. Having a better understanding of all the 'commensuals' can only help to improve not only medical school education but medical knowledge overall.

77 New Cases of Hepatitis Are Identified in Las Vegas

Can you believe that 77 New Cases of Hepatitis C were identified in Las Vegas recently? This marks one of the largest outbreaks in the U.S. in recent times. The cause?

The officials had previously identified seven cases of the disease linked to the gastroenterology practice, one of the largest in southern Nevada, and a single case in one of the practice’s sister clinics. The infections were caused, they said, by the reuse of anesthesia syringes among multiple patients.

How avoidable, ridiculous, and tragic. These poor people are now victims of a chronic potentially fatal disease all due to someone's negligence and likely cost-cutting measure. No wonder many people out there are skeptical of physicians and how they practice.

Books And Resources For USMLE Step 1

Every U.S. medical student must take and pass Step I prior to becoming a licensed physician. Although Step 2 and 3 are also important, Step I ends up being *the* major test since it is the one residency programs look at when a student applies for a particular program. Having recently taken Step I, here are some resources, both online and books, that I found useful:

Books:
First Aid for USMLE Step I 2008 - An ABSOLUTE essential. This book contains the basic information for the entire test. If you can memorize this entire book, you are almost guaranteed a 240+ score.

BRS Physiology - A solid review of all the physiology you need to know for the test

BRS Pathology - A good companion to the physiology book

Microbiology Made Ridiculously Simple - A good review of microbiology. It probably has much more detail than you need for the test, but combine this with First Aid's microbio, and you're golden.

Pharmcards - Probably more detail than you need for pharmacology, and does contain some errors, but overall, if you know these cards, you're set for the pharm parts of the test

There are several other potentially useful books, but if you use the ones listed here and master them, you will do very, very well.

Online:
Ace Step I Without Becoming a Hermit - another guide to books for Step I written by a HMS student

Goljan Notes - the mythical Dr. Goljan apparently runs Step I review courses. His notes and mp3 lectures are heralded by some. I listened to most of the lectures, but looking back on it, they're probably best started early and listened to in one's spare time

Kaplan QBank - Almost every student will end up doing practice questions in addition to studying. There are several QBanks out there, but Kaplan has a reputation for good results. Try it before you buy it:

The Challenge consists of a sample set of questions to let you assess how your studying is going, as well as give you a taste of what Kaplan's questions are like. I used them in my preparation, and definitely found it worthwhile. 


Feel free to comment on other resources you find helpful!

A Few Interesting Stories

Whew! Done with Step 1! I've enjoyed a few days off, but it's back to the wards tomorrow, specifically the psych wards. I don't have anything in particular to discuss today, so here's a smattering of links with interesting stories:

When a murderer becomes a medical student - a medical school in Stockholm is faced with a dilemma over what to do when a convicted murderer who has served his time is found to be in the student body.

Do statins really prolong a patient's life? - an interesting look at the issue of how to use a drug for a disease versus as prophylaxis.

Who really gets MRSA? - As reports of a new strain of MRSA among homosexual men appeared, the article notes another group that also has a high incidence of such infections.

Hoarseness on the political trail - Find out what the candidates do in their attempts to not lose their voice while being a "voice for the people."

Seven Common Medical Myths - Haha, I must admit, I have held at least 4 of these.

Does a surgeon's gender matter? - Wow, I never would have considered to research this, but it is something to ponder, especially in gender-based operations (ex. mastectomies, prostate surgery)

A Real Life Case for "House, MD"

Dr. Gregory House is the main character of Fox's sitcom House MD. As most of you likely know, each week, he takes his, um, unorthodox approach, makes a few wild guesses, and generally solves some obscure medical mystery. What cracks me up the most about this show is that the entire hospital is apparently run by perhaps 7 doctors max, who are there all the time, do ALL the procedures AND all the lab work, yet still have time to randomly leave the hospital to investigate whatever random hypothesis they have. Anyway, this week, the NYTimes has a case made just for Greg House.

In the article A Medical Mystery Unfolds in Minnesota, the author describes a mysterious illness that has befallen some residents of a small town near Rochester, MN (home of the Mayo Clinic). What the residents had in common is that they all worked at the local meatpacking plant, the aptly named Quality Pork Processors. The patients had similar symptoms: "fatigue, pain, weakness, numbness and tingling in the legs and feet." The nurses at the meatpacking plant noticed the pattern. Doctors and officials in the plant contacted the Minnesota Department of Health as well as the CDC. The Department of Health decided to investigate. Here's what they found:

On Nov. 28, Dr. DeVries’s boss, Dr. Ruth Lynfield, the state epidemiologist, toured the plant. She and the owner, Kelly Wadding, paid special attention to the head table. Dr. Lynfield became transfixed by one procedure in particular, called “blowing brains.”
As each head reached the end of the table, a worker would insert a metal hose into the foramen magnum, the opening that the spinal cord passes through. High-pressure blasts of compressed air then turned the brain into a slurry that squirted out through the same hole in the skull, often spraying brain tissue around and splattering the hose operator in the process.
The brains were pooled, poured into 10-pound containers and shipped to be sold as food — mostly in China and Korea, where cooks stir-fry them, but also in some parts of the American South, where people like them scrambled up with eggs.

Okay, let's stop everything right here. I'm not even sure why this is a mystery anymore. The clues are staring me in the face. I'm no Sherlock Holmes, but just look at the evidence!

1. The place was called "QUALITY" Pork Processors. Come. On. Since when has the word "Quality" meant quality? Can you imagine buying another product.. oh say.. a car from a company called "Quality Car Company"? Anyway, so we've already established that sanitation is probably not Job #1 at QPP.

2. The process was called "Blowing Brains." Um, that by itself says enough. I mean, what else was on this assembly line? "Feces fling"? They might as well have had the workers just gnaw all the unnecessary parts off the carcass in terms of exposing them to whatever the pigs carried.

3. Blasting air into a hole with no other (significant) hole for it to escape from is a dumb idea. Period.

4. Spraying bits of brain matter is a dumb idea. Period.

5. To be fair, by itself, the spraying may not have necessarily caused disease, but:

The person blowing brains was separated from the other workers by a plexiglass shield that had enough space under it to allow the heads to ride through on a conveyor belt. There was also enough space for brain tissue to splatter nearby employees.
“You could see aerosolization of brain tissue,” Dr. Lynfield said.
The workers wore hard hats, gloves, lab coats and safety glasses, but many had bare arms, and none had masks or face shields to prevent swallowing or inhaling the mist of brain tissue.

So, basically, these workers might as well have been licking the insides of the skulls clean themselves. Genius.

Anyway, to make a long story short, once the workers were away from the plant, they recovered, but not fully. The disease (which sounds like some kind of mix between Guillain-Barre Syndrome and a prion disease to my still-in-training eye) was hypothesized to have been caused by an immune reaction the patients were having to the pig brain matter itself.

The real lesson here though?

Don't aerosolize dead animals!

In case you're not familiar with the show, you can purchase the season DVDs on Amazon: House MD:

Updated 2015-12-08

Who Was Typhoid Mary?

Since I'm studying infectious diseases, salmonella has been on my mind. Specifically, the "First Lady" of Salmonella, Typhoid Mary. Who exactly was Typhoid Mary?

Mary Mallon (September 23, 1869 – November 11, 1938), also known as Typhoid Mary, was the first person in the United States to be identified as a healthy carrier of typhoid fever. Over the course of her career as a cook, she infected 47 people, three of whom died from the disease. Her fame is in part due to her vehement denial of her own role in causing the disease, together with her refusal to cease working as a cook. She was forcibly quarantined twice by public health authorities and died in quarantine. It was also possible she was born with the disease, as her mother had typhoid fever during her pregnancy.

However, my research also uncovered another Typhoid Mary:

Typhoid Mary (Mary Walker), also known as Typhoid and Bloody Mary, is a fictional mutant character in the Marvel Comics universe, most commonly associated with Daredevil as a supervillainess. She first appeared in Daredevil #254, and was created by Ann Nocenti and John Romita, Jr.

Typhoid Mary is an enemy and former lover of Daredevil with low level psionic powers, including telekinesis. She has been employed by organized crime syndicates as an assassin in the past. She is also truly and gravely mentally ill.

I love how the comic Typhoid Mary does not even come close to sharing the actual disease, which is decidedly much less glamorous. Can you imagine a comic book with the real Typhoid Mary? "Oh no, Superman is ill. All he did was eat at the local cafet... oh no! Typhoid Mary strikes again!"

Anyway, back to the real Typhoid Mary. Salmonella causes enteric fever, which presents with fever (duh), abdominal pain, liver or spleen enlargement and "salmon"/rose colored spots on the abdomen. Salmonella can also cause gastroenteritis, sepsis, and osteomyelitis especially in sickle cell patients. Some individuals enter a carrier state, such as Typhoid Mary:

People catch typhoid fever after ingesting water or food which has been contaminated during handling by a human carrier. The human carrier is usually a healthy person who has survived a previous episode of typhoid fever but in whom the typhoid bacteria have been able to survive without causing further symptoms. Carriers continue to excrete the bacteria in their feces and urine and poor hygiene can lead to its introduction into food and water.

However, it fails to mention how exactly Mary achieved this. Was she a mutant, as the comic book world would like you to believe? Sadly, no. The reality is salmonella can live in the gallbladder for years, and carriers secrete the bacteria in their stool. The best part of the story to me is how Mallon continued to work as a cook even after she was quarantined! She was eventually quarantined again and died in quarantine. You've gotta love the level of denial some people have.


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Robot Dating and STDs

Robot dating probably doesn't make too much sense on a med student blog, but as I was reading this post, I saw this clip from Futurama which showed a futuristic version of a health-ed video:

Haha, that clip just reminded me of those awkward sex-ed videos they used to show back in middle school. I guess I included it on this blog just because of the STD reference at the end ("Electro-gonorrhea: The Noisy Killer"). Don't buy that? Well, just keep in mind that I'm studying for the step, so... yea, this is part of my integrative studying. Um, yea, that's it.

Sadly though, if you think about it a little bit, roboprostitutes (prostitrons? call grids?) could become vectors for STDs. Oh, to remember the days when the only robot one had to worry about was the robotic Richard Simmons! Also, if this is the future, why are they still using VHS? Maybe it's just some inside joke on Futurama that I don't get... anyone know why?

A brief history of French mothers and STDs

Here's a little story I heard from a friend that I found both interesting and educational. I cannot vouch for its veracity, but like Stephen Colbert, my gut says it's true.

Back in 18th century France, French mothers were very concerned about who their daughters consorted with. In order to save them from men of suspect character who may be intent upon sowing their wild oats, the mothers would warn their daughters to avoid men with bobbing heads. The question for modern day medical students is, why?

The answer? The bobbing head, also known as De Musset's sign, is a sign of severe aortic regurgitation caused by syphilitic aortitis. Had the daughters flaunted their mother's warnings and flirted with these loathsome Lotharios and perhaps gone in for the proverbial French kiss, they may have also noted a bobbing uvula, also known as Muller's sign.