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Improving medical students

Archive for December, 2007

Alcohol & Cognition – Binge Drinking Compromises Learning Abilities

Posted by medliorator on December 31, 2007

By psychiatrist Paul Steinberg

The more we have binged — and the younger we have started to binge — the more we experience significant, though often subtle, effects on the brain and cognition.

 

evidence for the impact of frequent binge-drinking comes from some simple but elegant studies done on lab rats by Fulton T. Crews and his former student Jennifer Obernier. Dr. Crews, the director of the University of North Carolina Bowles Center for Alcohol Studies, and Dr. Obernier have shown that after a longstanding abstinence following heavy binge-drinking, adult rats can learn effectively — but they cannot relearn.

 

When put into a tub of water and forced to continue swimming until they find a platform on which to stand, the sober former binge-drinking rats and the normal control rats (who had never been exposed to alcohol) learned how to find the platform equally well. But when the experimenters abruptly moved the platform, the… rats without previous exposure to alcohol, after some brief circling, were able to find the new location. The former binge-drinking rats, however, were unable to find the new platform; they became confused and kept circling the site of the old platform.

 

On a microscopic level, Dr. Crews has shown that heavy binge-drinking in rats diminishes the genesis of nerve cells, shrinks the development of the branchlike connections between brain cells and contributes to neuronal cell death. The binges activate an inflammatory response in rat brains rather than a pure regrowth of normal neuronal cells. Even after longstanding sobriety this inflammatory response translates into a tendency to stay the course, a diminished capacity for relearning and maladaptive decision-making.

 

Studies have also shown that binge drinking clearly damages the adolescent brain more than the adult brain. The forebrain — specifically the orbitofrontal cortex, which uses associative information to envision future outcomes — can be significantly damaged by binge drinking. Indeed, heavy drinking in early or middle adolescence, with this consequent cortical damage, can lead to diminished control over cravings for alcohol and to poor decision-making. One can easily fail to recognize the ultimate consequences of one’s actions.

 

exercise has been shown to stimulate the regrowth and development of normal neural tissue in former alcohol-drinking mice. In fact, this neurogenesis was greater in the exercising former drinking mice than that induced by exercise in the control group that had never been exposed to alcohol.

 

some possible resolutions for the New Year:
-Stop after one or two drinks. Studies of the Mediterranean diet have shown that one or two drinks on a consistent basis leads to a longer life than pure teetotaling.
-If you have binged excessively when younger, follow it up with some regular exercise. Get those brain cells regenerated.

The Hangover That Lasts [NYT]

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How to Sleep Better

Posted by medliorator on December 30, 2007

1. Try not to worry about how much you sleep. Such worrying can… contribute to…”learned insomnia”. Learned insomnia occurs when you worry so much about whether or not you will be able to get adequate sleep, that the bedtime rituals and behavior actually trigger insomnia.

 

2. Don’t force yourself to sleep. The very attempt of trying to do so [makes] it more difficult to sleep.

 

3. Go to bed only when you are feeling really tired and sleepy.

 

4. Don’t look at the alarm clock at night. [It] promotes increased anxiety

 

6. Avoid oversleep. Don’t oversleep to make up for a poor night’s sleep.

 

7. Sex. Sex is a well-known nighttime stress reliever. …it welcomes sleep.

 

9. Associate your bed and bedroom with sleep and sex only. Don’t watch TV, eat, or read in bed.

 

10. If you suffer from insomnia, try not taking a nap. …napping may steal hours desired later on.

10 Foolproof Tips for Better Sleep [Dumb Little Man]

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Diagnosing Color-Blindness

Posted by medliorator on December 29, 2007

the most popular method involves the Ishihara Color Test [which uses] dots of different sizes and colors that form a number that is visible only to people who are not colorblind.

 

the gene for the red and green receptors are on the X chromosome, [and is repsonsible for] the most common form of colorblindness with up to 10% of males having this disability. There other forms of colorblindness like blue-yellow colorblindness, but this has autosomal inheritance and is less common.

How To Assess Colorblindness [Scrub Notes]

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New Cyanide Antidote

Posted by medliorator on December 28, 2007

University of Minnesota Center for Drug Design and Minneapolis VA Medical Center researchers have discovered a new fast-acting antidote to cyanide poisoning.

 

Current cyanide antidotes work slowly and are ineffective when administered after a certain point, said Steven Patterson, Ph.D., principal investigator and associate director of the University of the Minnesota Center for Drug Design.

 

Patterson is developing an antidote that was discovered by retired University of Minnesota Professor Herbert Nagasawa. This antidote works in less than three minutes – meeting the United States Department of Defense “three minute solution” standard. The research will be featured in the Dec. 27, 2007 issue of the Journal of Medicinal Chemistry.

 

The antidote was tested on animals and has been exceptionally effective, Patterson said. Researchers hope to begin human clinical trials during the next three years.

 

The antidote is also unique because it can be taken orally (current antidotes must be given intravenously) and may be administered up to an hour prior to cyanide exposure.

 

Because cyanide occurs naturally in pitted fruits, some grasses and other foods, and the body has mechanisms to detoxify small amounts in the diet. The new antidote takes advantage of this natural detoxification pathway by providing the substance the body naturally uses to convert cyanide to non-toxic thiocyanate.


U of M researchers discover fast-acting cyanide antidote
[EurekAlert]

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Prepare for a Big Exam

Posted by medliorator on December 27, 2007

Kendra Campbell shares valuable test prep advice:

1. Make a schedule, and try to stick to it. Having a schedule provides you with structure, and is a good way to prevent falling into the trap of running out of time in the end. It also ensures that you always have a task at hand.

2. Get up every day at a similar hour. it’s also a good idea to “try” and go to sleep at a reasonable hour every night.

3. Don’t forget to schedule in “fun time” or time off from studying to relax. If you’re somewhat obsessed with cleaning (like I am), take off 20-30 minutes to wash your dishes or do some laundry. Do you enjoy being outside? If so, take a walk around the block or to a nearby park. You may have noticed that all of these activities involve physical activity. We know that moving around and getting your blood flowing is advantageous to both your mind and body.

4. Do questions. This is a great way to learn. Use an online question bank, or one of the thousands of prep books. And don’t just look at the correct answers. Actually figure out why you got the question wrong (and even right), and learn from your mistakes.

5. Don’t study what you already know.

6. Caffeine is your friend. Never forget your friends.

7. Change it up! If you find yourself getting incredibly bored… change the subject you’re studying, how you’re studying it, or where you’re studying.

8. Take the day or night off before your exam… don’t stay up all night before the exam. This might be the worst idea ever. Let all those pharmacology drugs simmer in your brain for a while. Give the information time to cement. Have a nice dinner or go see a movie (preferably a completely mindless comedy) and reward yourself for all your hard work.

How to Study for a Big Exam [The Differential]

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Student Loan Deferment Program Remains Intact

Posted by medliorator on December 26, 2007

The student loan deferment program is intact for now. News can be found on the AMA website here. Basically what this means is that at least for now and until the fall (an unspecified month) of 2008, we will be able to take advantage of the economic hardship deferment. The subsidized student loans will not accrue interest. This is great because over the 4 years…we borrowed in subsidized interest 8.5K x 4 = 34,000 dollars. At an average of 4% (for me) that is 1,360 dollars. For those that borrowed at 6.8%, this is a savings of 2,312 dollars per year.

Good news on medical student loans and deferment [Finance Physician]

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Manage Finances with Less Effort – Mint

Posted by medliorator on December 25, 2007

Most medical students face financial pressure without the time required for planning and tracking. Mint is a integrative solution for efficient money management.

Mint compiles your financial activity in one location accessed with one login. Teach Mint to automatically categorize your financial transactions, and budgets become effortless.

Pros:

  • Account creation is easy & Mint can handle almost any bank or credit institution.
  • Information is secure.
  • Mint will compile transaction histories for all accounts & cards daily.
  • Teach Mint to automatically categorize your transactions.
  • Visualize budgeting effortless.
  • Set alerts & goals.
  • Free.

Cons: (compared to rival Quicken)

  • No check-writing
  • Cannot create custom transaction categories (e.g. “booze” or “landscaping”)

We strongly endorse Mint for student finances. The holidays are an excellent time to get started. Set aside a few hours to add accounts and categorize previous transactions, setting up categorization rules for future transactions. This initial time investment offers immediate benefits. Once configured, your money management will be running on autopilot.

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Time Management Tricks

Posted by medliorator on December 24, 2007

By Marci Alboher

1. Tame the e-mail beast. You never hear anyone say they spent the whole day taking care of voice mail, and e-mail shouldn’t control you in that way either… I adopted a system. Mine is a combination of lessons from David Allen (touch each piece only once and dispose of it) and Tim Ferriss (check at designated times of the day). But the thing that really trained me was watching the video below of a talk given by Merlin Mann, the founder of the 43 Folders blog… If you don’t have time for the video, check in the InboxZero series on 43Folders.

 

3. Put up boundaries. The array of ways we can connect with each other can make us want to hide in a cave to get any work done. On deadline days, I put up an electronic version of the “do not disturb” sign, both for myself and others. No logging into Facebook, …no outgoing e-mail (the less you send, the less you’ll get), and no phone calls until I’m finished.

 

4. Find your rhythm and schedule around it. Observe your schedule and notice the patterns you follow on your productive days. Then build a schedule around those patterns.

 

5. Say no. …you need to recognize when it’s time to focus on one area and decelerate in others.

5 Time-Management Tricks [NYT]

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Med Student’s Drug Guide – Part 2

Posted by medliorator on December 23, 2007

SDN’s Alison Hayward, M.D. and Sarah M. Lawrence present a concise guide to narcotics:

Heroin
marketed by Bayer from 1898-1910 as a cough syrup and as a cure for morphine addiction, until the public discovered that heroin is merely an acetylated form of morphine which is not only converted to morphine as it is metabolized in the liver, but also is approximately twice as potent. Heroin is well-known as a highly addictive substance which can cause withdrawal symptoms after just a few days of use. Its classic effects include CNS/respiratory depression and miosis (pinpoint pupils). Withdrawal from heroin, referred to by patients as being “dope sick”, results in numerous unpleasant symptoms such as malaise, nausea and vomiting, diarrhea, muscle cramping and aches. You may note that your patients also begin yawning as they go into withdrawal. Withdrawal can be abruptly precipitated by the use of naloxone (Narcan), an opiate antagonist. This can have the unfortunate effect of causing the patient to go from a comatose state to an agitated, “dope sick” state which can be followed by the patient’s rapid departure against medical advice to seek more heroin. For this reason it is advisable to titrate naloxone by using small doses. It is important to note that however unhappy those in heroin withdrawal may be, withdrawal from heroin cannot kill you. Heroin is most commonly injected IV but can also be snorted or injected subcutaneously. Heroin plus cocaine injected IV is known as a ’speedball’.

 

Ketamine
a dissociative anesthetic… used in veterinary and human medicine. Classified as an NMDA receptor antagonist, ketamine induces a state known as dissociative anesthesia, in which signals from the conscious mind to other parts of the brain are blocked. Ketamine is primarily used in the induction and maintenance of general anesthesia, usually in combination with a sedative. Because it produces less respiratory depression than other anesthetics, Ketamine is useful in children and in emergency department patients with unknown medical histories. Besides its legitimate medical uses, Ketamine, or “Special K” is often used illicitly. Symptoms of Ketamine intoxication include sedation, hallucinations, a sense of bodily detachment, sensory distortions and unintelligible speech. No antidote exists and treatment is supportive.

 

PCP
phencyclidine is a dissociative hallucinogen that can be used either in crystalline or liquid form. In the liquid form, cigarettes or joints my be dipped in PCP then smoked. Its best known street name (though it has many) is “angel dust”. On a typical exam question, a patient will present to the emergency room with tachycardia, agitation, and potentially nystagmus or ataxia. The hallmark of phencyclidine on an exam question is that the patient will be engaging in highly violent behavior. The drug can cause behavioral disturbances as well as decreased pain sensation, the combination of these two factors increase the risk for violence.

 

GHB
GHB is known on the street as Grievous Bodily Harm, Georgia Home Boy or Liquid Ecstasy. It is a clear liquid that resembles water but has a slightly salty taste. Banned in the United States, GHB is nonetheless available for purchase on the internet or imported from other countries. Often sold in small bottles, GHB can be mixed with water or combined with other beverages to conceal its flavor. The ability to slip this substance into the drink of an unsuspecting victim, along with its sedative and amnestic properties have implicated GHB as a drug used in facilitated sexual assault.
The classic signs of GHB intoxication are CNS and respiratory depression, but GHB also has effects on other organ systems. Symptoms may include nystagmus, ataxia, seizures, vomiting, somnolence and aggression. Extreme CNS depression is most commonly observed in patients presenting to the ED with GHB overdose, but this CNS depression may resolve suddenly due to rebound effects from the drug. A patient may go from completely unresponsive to agitated and combative in a very short time frame.

 

Benzodiazepines
“benzos” are a class of prescription drugs with varying hypnotic, anxiolytic, sedative, anticonvulsant, amnestic and muscle relaxant properties. They are useful in the induction of anesthesia and the treatment of insomnia, anxiety, agitation, seizures, muscle spasms and alcohol withdrawal. Recreational users of stimulants may use benzos as a means of “coming down.”
Benzodiazepines exert their action at the GABA-A receptor in the CNS. Taken alone, benzodiazepines are considered very safe. When combined with other substances such as alcohol, serious or fatal CNS, respiratory or cardiovascular depression may occur. Symptoms of benzodiazepine intoxication include drowsiness, ataxia, confusion and vertigo.
Common benzodiazepines used in practice include alprazolam (Xanax), clonazepam (Klonopin), diazepam (Valium), lorazepam (Ativan), midazolam (Versed) and temazepam (Restoril). Rohypnol (flunitrazepam) is a type of benzodiazepine that is available in Mexico and Latin America and imported illegally into the United States. Particularly insidious are its amnestic properties and its tasteless, odorless formulation. These characteristics make “roofies,” as they are popularly known, a frighteningly effective tool in drug-facilitated sexual assault. The danger of this drug contributed to its inclusion in the Drug-Induced Rape Prevention and Punishment Act of 1996.

 

Drugs used for date rape such as Rohypnol and GHB can only be detected within a short time of ingestion on a drug screen, so if there is any question of their use, patients must be tested as soon as possible. Standard drug screens may not capture these chemicals; practitioners should make sure to specify the need to test for these drugs if their presence is suspected. This can be challenging as part of the drugs’ effectiveness is their ability to cloud the memory of their victims, leaving doubt about the events that transpired.

Raves, Rollin’, & Roofies: Your Guide to Club Drugs [Student Doctor Network]

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Med Student’s Drug Guide – Part 1

Posted by medliorator on December 23, 2007

SDN’s Alison Hayward, M.D. and Sarah M. Lawrence present a concise guide to narcotics:

Alcohol
Alcohol is a CNS depressant that appears to act mainly as an agonist on GABA receptors and a blocker at NMDA receptors. It is more correctly referred to as ethanol or “EtOH” because there are other types of alcohols, including methanol (solvent alcohol), acetone (nail polish remover), and ethylene glycol (antifreeze). All these are part of the classic “MUDPILES” acronym for anion gap acidosis, because they are metabolized to ketoacids.

  • One drink = 1 shot = 1 glass of wine = 1 beer, each drink should elevate the blood ethanol level by approximately 20mg/dL, and coincidentally, this is about the amount that is metabolized by the average person in one hour.
  • You must be able to identify alcohol withdrawal, for two reasons: one, it often presents in hospitalized patients who have not revealed that they are dependent on alcohol, and two, it can kill. Therefore, when a patient on the wards (or in a board question) becomes tachycardic, agitated/tremulous, diaphoretic, and hypertensive, if you are the only one on the team to think of ethanol withdrawal, you’ll look like a superstar. Classically (in a board question) the patient will have been in the hospital for about 3 days, but in reality, onset can be as early as a few hours after the last drink. Another presentation that should raise your antennae is a patient with no history of seizure disorder who has a seizure after a day or two in the hospital. These seizures do usually have a brief post-ictal state, and are often accompanied by the other manifestations of ethanol withdrawal. Ethanol levels are likely to be negligible or zero, but should be drawn.
  • The big names to associate with alcohol are Wernicke and Korsakoff – a.k.a Wernicke-Korsakoff syndrome, which is a result of thiamine deficiency related to alcoholism. Wernicke’s encephalopathy is ataxia, altered mental status, and ophthalmoplegia. It can progress to Korsakoff psychosis, in which patients cannot recall events and so they create improbable stories to explain what has happened. This is called ‘confabulation’. Many a medical student has been fooled by a confabulator. Remember – if a wild tale starts sounding way too wild to be true, you might be dealing with a confabulator.
  • ethanol is the treatment for methanol poisoning, because it competitively inhibits methanol turning into formate.

Cocaine
Cocaine can be used in a number of ways. While chewing on a coca leaf can make a user feel mildly euphoric for a few hours, smoking crack cocaine gives the user a rush before they even have time to exhale. Cocaine use results in tachycardia, but also can cause dangerous arrhythmias, and can precipitate myocardial infarction through coronary vasospasm. The mainstay of treatment is benzodiazepines.

 

Ecstasy
[MDMA] came to prominence in the 1960s and 1970s when it was used as part of psychotherapy, for which it appeared useful to facilitate communication as part of relationship counseling. It is a synthetic drug that is used in pill form. The most common concern for side effects of ecstasy is during its use at dance parties, when users may go for many hours without drinking enough water to stay hydrated. The combination of increased temperature and dancing can cause significant dehydration. Common effects include euphoria and increased appreciation of tactile stimuli. Ecstasy is unlikely to kill users and usually only results in death if combined with other drugs. Treatment is symptomatic.

 

Methamphetamine
known on the street as “speed” or “crank” – or just “meth.” [Methamphetamine is a powerful stimulant that] increases levels of brain dopamine significantly, resulting in increased movement and enhanced mood. Although methamphetamine is classified in DEA Schedule II, it is not widely prescribed
Methamphetamine can be taken orally, by snorting, by injection, or by smoking. Tolerance and addiction are often rapid. Symptoms of methamphetamine use include wakefulness, increased physical activity, loss of appetite, rapid heart and respiratory rates, increased blood pressure and hyperthermia. Users may experience insomnia, anxiety, confusion, tremor, convulsions, aggression, hallucinations, memory loss and severe dental problems. Treatment for methamphetamine addiction is challenging and should include cognitive-behavioral therapy to help break deeply entrenched patterns of abuse.

 

Mushrooms
When you hear people referring to “shrooms” as a hallucinogen, they’re generally referring to Psilocybin mushrooms, also known as “magic mushrooms”. Mushrooms that contain the compounds psilocybin or psilocin cause users to have hallucinations and feelings of euphoria that last about 6-8 hours. Contrary to popular belief, the effects are not due to the “poisonous” nature of the mushrooms. In fact, the National Institute of Occupational Safety and Health’s Registry of Toxic Effects rates psilocybin’s toxicity at 641 (with 1 being most toxic), compared to aspirin at 199 and nicotine at 21. A person would reportedly have to consume his or her own body weight in psilocybin mushrooms to take a lethal dose. Not surprisingly, then, treatment is mainly observation and supportive care until the effects wear off. Psilocybin can be much more dangerous when used with alcohol or marijuana, due to increased amounts of risky behavior. Unpleasant side effects can include nausea and vomiting.

Raves, Rollin’, & Roofies: Your Guide to Club Drugs [Student Doctor Network]

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