Video: Diagnosing and Treating Autonomic Disorders

httpvh://youtu.be/St9r4pc2QmE

 

Marc LaDerriere inspecting wine at Vina Robles Winery & Vineyards in Paso Robles.

Stanford Hospital has posted a fascinating video highlighting the complexities of diagnosing autonomic disorder.

Marc LaDerriere, a director of wine sales for the Vina Robles Winery & Vineyards in Paso Robles began noticing strange symptoms – including fatigue, inability to perspirate and fluctuating blood pressure.

“Hot weather sapped his strength and made him dizzy, yet he was sweating less and in cool weather no goose bumps ever appeared when he grew chilled.”

He was eventually referred to Stanford Hospital & Clinics where Neurologist Safwan Jaradeh, M.D. diagnosed Marc with having an autonomic nervous system disorder, brought on by a lyme disease infection that he had carried for years without ever knowing it.

“The autonomic nervous system,” according to Dr. Jaradeh “is the part of the nervous system that controls all the vital functions and organs that are independent of our own will.” This system controls your heartbeat, digestion, respiration, perspiration and all the other things we do without consciously thinking about it.

Safwan Jaradeh, MD is the director of Stanford’s autonomic disorders program — he is board certified in neurology, clinical neurophysiology, electrodiagnostic medicine and autonomic disorders.

Read more about autonomic nervous system disorders at Stanford Hospital’s site.

Cureus People: Matthew LaVelle, Wayne State University School of Medicine

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Matthew LaVelle

Team Cur&#275us talked with Matthew LaVelle, Wayne State University School of Medicine. His entry in the Healthcare Technology category won the Grand Prize in our Cur&#275us Fall 2012 International Poster Competition.

Matthew worked at Columbia University as both a research assistant in the field of cardiothoracic surgery and as a perfusionist with the heart and lung transplant team. He hopes to leverage his ongoing passion for the development and institution of medical technology into a career as a surgeon.

 

Stanford Scientists Create HIV-resistant Cells

Scientists at the Stanford University School of Medicine have developed a technique to genetically engineer key immune system cells and make them resistant to HIV, the virus that causes AIDS, according to a new study.

HIV patients could ultimately be offered an alternative to taking a lifetime of multiple medications if the new approach, described by researchers as “genome editing” proves successful in human subjects.

“We inactivated one of the receptors that HIV uses to gain entry and added new genes to protect against HIV, so we have multiple layers of protection — what we call stacking,” said Matthew Porteus, MD, an associate professor of pediatrics at Stanford and the study’s principal investigator. “We can use this strategy to make cells that are resistant to both major types of HIV.”

Research is still in the early stages and will need to be tested more thoroughly in T-cells taken directly from AIDS patients, then in animals. Stanford scientists hope to begin clinical trials within three to five years — trials which are needed to determine whether the technique would work as a therapy.

Dr. Porteus is convinced that this new approach is an important step forward in developing a gene therapy for HIV and could ultimately replace drug cocktail treatments which are known to have adverse side-effects.

“To develop novel therapies you have to be an optimist,” said Dr. Porteus. “The findings in this study are a proof of concept; we’ve proven this could work. I’m very excited about what’s happened already.”

The study published in the Jan. 22 issue of the journal Molecular Therapy, was funded by the Foundation for AIDS Research.

via Stanford School of Medicine

Cureus People: Jay Gantz, University of Washington

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Jay Gantz

Our video team caught up with Jay Gantz on campus at the University of Washington where he is a graduate student and medical student in a combined degree program completing his fourth year PHD.

Jay Gantz won 2nd place with his Cardiology poster submission entered in the Cur&#275us Fall 2012 Poster Competition. In addition to his passion for medicine, Jay Gantz is also an accomplished cellist who loves the challenge of skiing in the great Northwest.

Yale Scientist Discovers New Tick-Borne Disease

Yale scientists have linked an unexplained febrile disease – first thought of as lymes disease – to a bacteria, Borrelia miyamotoi carried by the common deer tick.

I carry the Borrelia miyamotoi virus.

Even though the symptoms are similar to lymes disease, the Borrelia miyamotoi bacteria will not show up on tests for lymes disease.

In addition to usual lymes disease symptoms such as; fatigue, stiff neck, and joint pain “patients also may experience other symptoms, such as relapsing fever,” said lead author Dr. Peter Krause, senior research scientist at the School of Public Health and primary author of the study.

Although this new, yet to be named disease, is different from lymes disease, the same antibiotic treatment works for both — according to the study published in the New England Journal of Medicine, Jan. 17th 2013.

“Researchers found positive results for the new infection in 21 percent of 14 patients with unexplained summertime febrile illness, 3 percent of 273 patients with Lyme disease or suspected Lyme disease, and 1 percent of 584 healthy people living in areas where Lyme disease is endemic.” Source: Yale News

This Borellia miyatomoi bacteria resides in 2% of ticks who carry lymes disease. What makes this study unique, according to Dr. Durland Fish, professor of epidemiology at the School of Public Health, is that “This is the first time we have found an infectious organism carried by ticks before we have recognized the disease in humans.”

via Yale News

httpvh://youtu.be/6AGZW2zQD7s

Cureus Editorial Board Feature: Robert M. Quencer, MD

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Robert M. Quencer, MD

Cur&#275us met with Robert M. Quencer, MD, Robert Shapiro Professor of Radiology at the University of Miami Miller School of Medicine and Chairman of the Department of Radiology, a position he has held since 1992.

The former Editor-in-Chief of the American Journal of Neuroradiology from 1998-2005, Dr. Quencer brings his vast knowledge and neuroradiology expertise to the Cur&#275us Editorial Board.

In addition to his clinical, academic and leadership roles, Dr. Quencer has published over 150 articles and book chapters in many areas of neuroimaging and has authored two books in neuroradiology.

Blueberries, Strawberries May Decrease Risk of Heart Attack for Women

Younger woman who consumed blueberries and strawberries at least three times a week decreased their risk of suffering a heart attack by as much as one-third according to a new study published in the American Heart Association’s Journal Circulation.

A sub-group of heart-friendly dietary flavenoids called anthocyanins, which give fruits their rich and deep red, purple and blue color—namely strawberries and blueberries—may be responsible for the cardiovascular health benefits revealed in an 18-year study.

According to the study, anthocyanins, counter the buildup of plaque and provide other cardiovascular benefits like helping to dilate arteries.

The prospective study conducted by scientists from the Harvard School of Public Health in the United States and the University of East Anglia, United Kingdom, included 93,600 women ages 25 to 42 who were registered with the Nurses’ Health Study II and completed detailed surveys about their diet every four years for 18 years.

“Blueberries and strawberries can easily be incorporated into what women eat every week,” said Eric Rimm D.Sc., senior author and Associate Professor of Nutrition and Epidemiology at the Harvard School of Public Health in Boston, Mass. “This simple dietary change could have a significant impact on prevention efforts.”

While the authors focused specifically on strawberries and blueberries as some of the most-eaten berries in the United States—researchers said that other berries, including raspberries, cranberries and blackberries, may have similar anti-inflammatory effects.

“We have shown that even at an early age, eating more of these fruits may reduce risk of a heart attack later in life,” said Aedín Cassidy, Ph.D., lead author and head of the Department of Nutrition at Norwich Medical School of the University of East Anglia in Norwich, United Kingdom.

via American Heart Association

Cureus People: Shawna Bellew, University Of Central Florida

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Shawna Bellew

We met with Shawna Bellew, a fourth year med student from the University of Central Florida. Her submissions for the OB/GYN and Internal Medicine categories both won 3rd place in the Cur&#275us Fall 2012 Poster competition.

The OB/GYN poster compares traditional laparotomy to robotic techniques in treating endometrial cancer. Her Internal Medicine entry explores acute pancreatitis and its connection to eating disorders, specifically bulimia in young females.

Growing up in a family of doctors the decision to go to med school came easy, although not obviously. She started her studies as an art major, and even though she switched tracks she still remains a passionate artist.

In 2010 she won first prize at an art competition sponsored by the American Medical Association. Her entry “The Standardized Patient” received top honor in the “Empathy” category.

Watch the whole video here.

Guidelines for Avoiding Authorship Conflicts

Cur&#275us is working to become a valuable resource for medical authors and as such we are always on the look-out for good resources to pass along.

Melissa Broderick of Harvard Medical School recently published a very useful article entitled Six Tips for Avoiding Authorship Conflicts.

You can read Ms. Broderick’s guidelines below but we are also interested in your perspective and input. Have you run into this issue in your publishing experience?

How do you suggest avoiding the issue in the first place and if you do run into the issue how do you suggest handling it?

Authorship is designed to provide appropriate credit for intellectual contributions and can be a source of personal satisfaction, prestige, and a stepping stone toward academic career advancement. In theory, assigning authorship is a straightforward process; however, in practice, it can sometimes produce painful disputes over authorship order and responsibilities.

Considering these challenges, it is not surprising that authorship disputes accounted for nearly 15 percent of all self-reported issues brought to the HMS/HSDM/HSPH Ombuds Office last year.

What’s at stake in these disputes? Fair credit, collegial relationships, future collaborations and reputations, among others. Visitors often report that discussions and decision making didn’t occur until incompatible assumptions had been formed and deadlines for submission were looming, increasing the challenges of these conversations. So what can you do to avoid such conflicts?

1. Familiarize yourself with the HMS Authorship Guidelines and encourage the same of your colleagues and collaborators. If you oversee a lab, provide authorship guidelines to all newcomers to the lab and a description of the lab’s usual ways of deciding authorship and authorship order.

Key Definitions and Responsibilities of the HMS Authorship Guidelines include:

  • An author should have made a substantial, direct, intellectual contribution
  • The funding and provision of technical services, patients, materials alone are not sufficient
  • Everyone making a substantial intellectual contribution to the work should be an author
  • Everyone making other substantial contributions should be acknowledged
  • All authors should review manuscript drafts and approve the final version
  • One author should take primary responsibility for the whole work, including compiling a concise written description of everyone’s contributions that all authors have approved  and filing it with the sponsoring institution
  • Authors should describe each author’s contributions and how order was assigned to help readers interpret roles correctly

2. Talk early about authorship and authorship order for each project’s manuscript(s)

  • the specific criteria to be used for your project
  • the decision making process—who provides what input, how decisions are made, who has final say if a consensus agreement is not reached
  • how to address disagreements if they arise

3. When gathering input about contributions, ask everyone to put in writing and share:

  • her/his contributions
  • what s/he thinks every other author contributed (this can reveal misunderstandings and provides the opportunity for clarification)

4. If authorship determination seems straightforward, set forth authorship designations but with a caveat that this could change if contributions change significantly.

5. Create a culture of transparency and collaboration and revisit the issue of specific authorship periodically in case contributions or assumptions about contributions have changed.

6. If a disagreement arises, make every effort to resolve the dispute locally:

  • among the authors
  • by involving the lab chief or other appropriate person
  • by involving the HMS/HSDM/HSPH Ombuds Office (additional resources exist within Harvard’s affiliate institutions)

Steps Towards An Open Model For Medical Publishing

Thomas Edison

The New Yorker is the latest publication to pick up on the myriad of issues surrounding scientific publishing in their article Cleaning Up Science by Gary Marcus.

Science is no more immune to mistakes and dubious activity than any other discipline because in the end it involves humans. When you add the “publish or perish” pressure to the equation then issues are going to arise.

Introducing more efficient publishing models and systems of checks and balances helps minimize the kinds of issues John Ionnidis, MD of Stanford has revealed for years.

Cur&#275us was created to better serve medical authors in a number of ways including the introduction of a more democratic form of scientific discovery. On Cur&#275us the potential for politics is removed…reviewers are positioned to help an author improve his or her paper without giving this select group of reviewers the ability to “kill” a paper.

Paper quality is determined after a paper is published through our crowd-sourcing system called Scholarly Impact Quotient (SIQ). Authors also retain copyright and their papers are published quickly and at no cost.

For example, papers on Cur&#275us may be rejected for the following reasons; scientific fraud, misleading or potentially clinically dangerous material, as well as obvious copyright violations.

In the end, we believe this open model for medical publishing not only better serves authors, but patients as well.

“The best science is cumulative, not just a list of fun results; as people push deeper, bad ideas that are invalid eventually crumble. Even if nothing changed, we would eventually achieve the deep understanding that all scientists strive for. But there is no doubt that we can get there faster if we clean up our act.” – The New Yorker