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Thursday, July 17, 2008

The Last Post


The Last Post at least on Blogger. Dr Shock is now writing on his own domain name. So please update your bookmarks, RSS Feeds and e-mail subscriptions on ShockMD.com or for Dutch readers easier to remember: DokterShock.nl.

Hope you enjoy the new lay-out and blog, thanks Dr Shock



Wednesday, July 16, 2008

The Brain in Love


Why do we crave love so much, even to the point that we would die for it? To learn more about our very real, very physical need for romantic love, Helen Fisher and her research team took MRIs of people in love -- and people who had just been dumped.


This talk starts slow but soon the information becomes very interesting. More about the Science of Love on the BBC, thanks Dr Confabula
Key Points from the science of love:

  • There are three phases to falling in love and different hormones are involved at each stage

  • Events occurring in the brain when we are in love have similarities with mental illness

  • When we are attracted to somebody, it could be because subconsciously we like their genes

  • Smell could be as important as looks when it comes to the fanciability factor. We like the look and smell of people who are most like our parents

  • Science can help determine whether a relationship will last



The last key point I am not so sure!



Grand Rounds The Tabloid Edition is Up


EXTRA, EXTRA, READ ALL ABOUT IT! That’s right folks, this week I shall be dishing as much dirt on the latest rumours, gossip and scandal that the blogosphere can handle, and all from a rather slanderous angle!


A promising introduction for this weeks Grand Round on Unprotected Text



Tuesday, July 15, 2008

4 Liters of Cola is not Healthy

Coca Cola
Chronic hypokalemia due to excessive cola consumption, a case report in Cases Journal

A 52-year-old man was noted to have severe chronic hypokalemia despite discontinuation of diuretic treatment for hypertension and aggressive oral potassium supplementation. His serum potassium normalized temporarily when he was hospitalized, but hypokalemia recurred after discharge. He complained of generalized weakness and fatigue, and occasional loose stools. Physical examination showed mild generalized muscle weakness. Laboratory testing ruled out renal potassium wasting. A dietary history revealed that he was consuming 4 liters of cola per day, with a calculated fructose load of 396 grams per day. Since fructose absorption in the small bowel is relatively inefficient, this probably led to an osmotic diarrhea and GI potassium wasting. Physicians should ask their patients about soft drink consumption when they encounter unexplained hypokalemia.



Antidepressants have Limited Efficacy in Juvenile Depression

Forest plot of rate ratios (RR, with 95% CI) of responses to drug or placebo in 30 randomised double-blind placebo-controlled comparisons of rates of ‘response’ to antidepressants v. placebo, with overall pooled RR (1.22; 95% CI 1.15–1.31; blue diamond)
A recent systematic review and meta-analysis shows that at worse antidepressants are not effective for juvenile depression and at best better research might proof this conclusion wrong.
Juvenile meaning depression among children and adolescents.

The figure above is the forest plot of this systematic review:Forest plot of rate ratios (RR, with 95% CI) of responses to drug or placebo in 30 randomised double-blind placebo-controlled comparisons of rates of ‘response’ to antidepressants v. placebo, with overall pooled RR (1.22; 95% CI 1.15–1.31; blue diamond).

Antidepressants of all types showed limited efficacy in juvenile depression, but fluoxetine might be more effective, especially in adolescents. Studies in children and in severely depressed, hospitalised or suicidal juvenile patients are needed, and effective, safe and readily accessible treatments for juvenile depression are urgently required.


  • there were 30 contrasts arising from 29 randomised controlled trials for meta-analysis

  • All studies included provided drug doses consistent with contemporary paediatric practice, based on body-weight-adjusted daily dosing (mg/kg) considered standard for treating adult major depressive disorder

  • average exposure time of 8.7 weeks (median=8, range 1–12)

  • primary outcomes for meta-analysis a priori as responder status, based on changes in clinical ratings from intake to last observation point (as defined in each trial) involving substantial improvement, typically a 50% or greater reduction in symptomatic ratings of depression on standardised scales. This is a weak outcome measure, remission should be the aim of treatment mostly defined as a score of 7 or lower on the Hamilton Depression Rating Scale

  • pooled overall effect size, based on meta-analysis to determine a pooled rate ratio and its confidence interval for all 30 trials, yielded a value of 1.22 (95% CI 1.15–1.31)

  • There was no difference in efficacy between different antidepressant classes such as SSRI's or TCAs. Moreover analysis fail to support the possibility that SRIs may be superior in efficacy to tricyclic antidepressants

  • The three age groups yielded an interesting progression in rate differences and corresponding decreases of NNT by age (about 21 for children, 10 juveniles of mixed ages and 8 for adolescents)


Explanations for the disappointing results:

  • Relatively high rates of response to placebo or other non-specific interventions

  • Age-inappropriate or insufficiently sensitive outcome measures

  • Inadequately powered trials

  • Adverse case selection (e.g. minimally ill, uncertain or heterogeneous diagnoses, previous treatment failures, poorly cooperative participants)

  • Incomplete control of substance misuse

  • Inadequate dosing or duration of treatment

  • Simple lack of efficacy in juvenile v. adult mood disorders



My opinion is that selection of juveniles with relatively heterogeneous illnesses can explain the lack of efficacy. Maybe only juveniles with melancholic or psychotic depression respond to antidepressants. This is comparable to depression in adults.
sampling of young patients with depression may include a high proportion of relatively mildly ill patients, who have most probably never received in-patient treatment, and who are more likely to improve spontaneously with or without additional effects of placebo treatment

Moreover, it remains to be seen whether the brain of juveniles is as susceptible to antidepressants as with adults. Depression in a developing brain may be different from depression in an adult brain and the influence of antidepressants on a developing brain might be lacking. This is supported by the finding in this meta-analysis that older juveniles respond better than younger ones. Here is a video about teens and their developing brain, thanks PsychCentral

Importantly, prepubertal children with depression may differ biologically from adolescents or adults, and it remains unclear whether depression in prepubertal children is a substantially different disorder from that found in adolescents or adults, perhaps including developmental differences in either the pharmacodynamics of antidepressants or in their clinical effects.


Related posts on this blog:
Adolescents Brain and Depression
Finally some good news about antidepressants and adolescents
7 Posts about Adolescents and Depression
FDA Warning doesn't put Youth at Increased Risk

ResearchBlogging.org
Tsapakis*, E.M., Soldani*, F., Tondo, L., Baldessarini, R.J. (2008). Efficacy of antidepressants in juvenile depression: meta-analysis. The British Journal of Psychiatry, 193(1), 10-17. DOI: 10.1192/bjp.bp.106.031088



Wine is Healthy

red wine

Digestion breaks down lipids into hydroperoxides. (Cooked meats are worse.) The stomach acts as a "bioreactor"-- the longer time the food/fat spends there, the greater the lipid peroxidation. An experiment with rats found that eating a meal soaked in red wine completely blocked the the generation of malondialdehyde, a common lipid peroxidation cytotoxin.Humans who ate the meal and drank a 200ml (1/4 bottle) of wine had a 75% reduction in MDA as compared to no wine.


From The Last Psychiatrist

He also explains why wine is not healthy due to it's antioxydants, but luckily he found another "healthy" mechanism of action.

So Dr Shock not only has to eat chocolate after dinner but also drink more red wine, or is Port even better? I wonder.......



Monday, July 14, 2008

Visible Magnetic Fields



rTMS is using electromagnetic fields to influence the brain,on this video you can see magnetic fields although not related to rTMS. The comment is very technical but the video is amazing, even scary.
From: Environmental graffiti

Combining their scientific experience with artistic instinct in sound, animation and programming they have created a ‘magnetic magnum opus’ - a ‘tour de force’ of immense invisible force brought down to human scale. And it is precisely the meeting of scale that makes the work so fascinating - to think that these tiny pulsating currents surround our planet on a scale inconceivable to man is not only a humbling thought, but an uplifting one. The inherent beauty of nature is again, in Wordswoth’s words, too much with us.



Sunday, July 13, 2008

22 iPhone Apps for (Med) Nerds

iphone 2.0
The two most important med apps for the new iphone are:


  • Netter's Anatomy Flash Cards: Need some help with your anatomy and physiology class? Check out this slick native app that lets you test yourself on how the knee bone connects to the thigh bone. There's a neuroscience version, too. (iPhone 2.0, $39.99)

  • ePocrates: This app for drug dosing, interaction and pricing is a boon for doctors. (iPhone 2.0, Free)


iPhone is everywhere on the net and blogosphere,couldn't resist posting about the new iphone. Yes, Dr Shock has one, already for 6 months although the iphone came available only 2 days ago in The Netherlands. Where is The Netherlands anyway, who cares.

More apps on Wired Science (thanks)

If you know of any apps for the iphone 2.0 for med nerds please let me know.



Identify brain structures with BrainInfo

brain info

BrainInfo is designed to help you identify structures in the brain. If you provide the name of a structure, BrainInfo will show it and tell you about it. If you don't know the name but can locate the structure in the Template Atlas of the Primate Brain, BrainInfo will tell you its name and other facts about it.



This is what BrainInfo can do for you:
If you type in the name of a brainstructure you can see were it is, you can read recent literature about the structure on PubMed, which species have it and of course you can see it in anatomical pictures. From some structures you can learn about the internal structures, the cells it contains, which genes are expressed there, or the connectivity to other structures.

Thanks Dr Confabula



Friday, July 11, 2008

Medical Animation by Hybrid



Hybrid's illustrations and animations extend beyond the boundary of highly informative graphics: they enter the realm of high art, achieving a combination of Truth and Beauty.
If you're looking for people who will go the extra yard, deliver on time and make you look good, Hybrid Medical Animation is your first stop

These picture are stills from the demo made by Hybrid Medical Animation. It is beautiful. It takes some time to load the site but it is worth your time.



Idiomorf Infographics a Dutch illustration company
Idiomorf is a Graphic Design Company that specializes in designing graphic diagrams, detailed charts, tables, maps and technical illustrations, which are used to illustrate an idea. These illustrations and animations are used to relay information quickly and without words, minimizing the need for costly writing and translation.