The advent of stem cell therapy is the future of medicine. These therapies have the potential to treat if not cure degenerative diseases. One natural barrier to stem cell research are the sociopolitical issues relating to stem cells harvested from aborted embryos. Cord blood, however, is another place to harvest stem cells that does no harm to an infant and doesn’t carry the same moral issues. Cord blood is painlessly taken from the umbilical cord and placenta, which is usually discarded as biological waste. With the numerous advantages of this technique, a flurry of hospitals and start up companies are emerging to handle placenta tissue donation.

Placental Marketplace

There are approximately six million pregnancies per year and only a fraction of these are donated or preserved. The gains of these collections are vast. A cord blood match can be injected into a patient to treat leukemia, sickle cell anemia, lymphoma and other diseases to name a few. Private cord blood banks are also popping up to store stem cells for individual patients. With benefits to recipients and potential benefits to a family, it is no wonder that this market is growing. By 2015, 10,000 cord blood transplants are expected to be completed worldwide.

The Process

Cord blood is blood rich in stem cells that is collected from the placenta and umbilical cord after childbirth. Post delivery, the umbilical cord is clamped, and blood from the cord and placenta is collected into a sterile bag called a cord blood unit. In the lab the blood is analyzed for blood forming cells and contamination before being stored in liquid nitrogen.

Private Vs. Public

Along with the science has come an influx of cord blood banks. Cord blood is free to donate at many hospitals. At the same time, there is also a privatized approach to cord blood collection intended for the child and their family.

Private

1. Your child’s heath: Cord blood needs a match to benefit the recipient. While it may be hard to find a match to a cord blood donation there is one recipient that we know is a match: the child it came from. Private banks are now charging to store cord blood encase the designated infant will ever need it.
2. Family recipient: Harvested cord blood is a stem cell match to the infant and also has a better chance to match a family member, which can be stored exclusively at a private bank.

Public

1. Donate to save life: With a public donation you are allowed to easily donate cord blood, free of charge, that will potentially save a life.
2. Science: A cord blood donation may also be used to advance medical science and cure diseases.

Storing or donating cord blood is by no means standard now, but that doesn’t mean that it won’t be someday. In the future, it may be as common as donating blood or getting an ultrasound: two procedures that only became normal practice in the last century. The chances that your stored stem cells will be used is difficult to measure, however, the benefits of this precaution to the patient is continuously developing and represents an exciting prospect for the future of medicine.

Listeria has been continuing to spread from cantaloupe melon over the past few weeks at an increasing pace and subsequently has been causing a lot of chaos, resulting in more deaths across the country. It has been reported that a woman from Louisiana has died after being a victim of Listeria. It is believed the latest outbreak of listeria is the worst to hit the United States in a period of 10 years. So far more than 17 people have fallen victim to the disease and have died as a result. The whole scenario started as contaminated melons which entered the many markets across the country and as the death toll continues to rise, the nationwide worry has also reached epic heights. This is the sort of thing Hollywood makes movies about and now it appears this horror movie is beginning to unfold for real.

A total of more than 85 people have been diagnosed with the illness and the deaths keep rising as time goes by. It is most frequently elderly people, pregnant women and children who are affected most severely by the disease due to their weaker immune systems.

So how did all this start?

The listeria outbreak has been traced to Rocky Ford cantaloupes in Colorado, and since then, 18 states have reported the deadly infection subsequent to 300,000 shipments of the cantaloupes from Jensen Farms. Babies are also vulnerable and they need to be well taken care of to avoid becoming contaminated.

Some of the symptoms to keep an eye out for in kids are:

• children becoming irritated quite easily
• they do not want to be fed and start vomiting easily

When these symptoms start developing, you need to take the infected child or children to seek medical attention immediately before it is too late.

What are the signs and symptoms?

Listeria has an incubation period of about 30 days and so people who show any signs and symptoms should seek medical attention early. It might be difficult to see these signs a week after contamination and  it is preferable you visit a doctor with onset of the earliest signs. The CDC has reported that this disease is deadly compared to other diseases such as salmonella and E.colli.

Tips on how to avoid Listeria

The following guidelines have been issued by the CDC on how to avoid Listeria and E. coli contaminations:

• Thoroughly cook food that is sourced from animals such as beef and poultry
• Clean vegetables well before preparing them using running water
• Keep all uncooked food away from the cooked or ready-to-eat meals
• Avoid drinking unpasteurized milk and milk products
• Make a habit of eating perishable foods as soon as possible and avoid keeping them for long

The above ways can help one avoid listeria and other deadly infections such as E. coli.

 Blogging has of late become a regular past-time among various professionals and the medical profession is no exception. Medical Blogging requires serious consideration of the audience and the topics to be covered. Medical Professionals across the globe keep themselves updated through various electronic media and the internet has become the ultimate source of medical information for most of them.

Medical blogs make up a major chunk of the information available on the internet. They cover a range of topics from providing regular medical updates to the peculiar blog that talks about mundane medical terms and nuances. Medical Blogs are either started by individuals, run by some companies and organisations or an amalgamation of both. The vast number of medical blogs made the task of finding the “BEST” a serious business.

It is only true that no single blog could be the same for the entire audience, hence the ranking provided here is arbitrary based on my personal preferences. Without much ado, here is my list of the “TOP 10 MEDICAL BLOGS”

1. KevinMD Blog

2. Science Roll

3. GeriPal

4. Practical Bioethics

5. The Health Care Blog

6. Life in the Fast Lane

7. Creativity in Healthcare

8. Doc Gurley

9. Academic Life in Emergency Medicine

10. CasesBlog – Medical and Health Blog

I enjoyed reading many other medical blogs, but the ones mentioned here really caught my attention. I hope you too enjoy reading and following these blogs.

You will have suggestions to make about the selection or your own collection of favourite medical blogs. If so, post them in the comments section so that I can create another list of “The Best 100 Medical Blogs”.

[box type=”note”]If you want to setup your own medical blog for free or read stories from numerous practitioners and patients check out CausePages.[/box]

Hospital lingo can be dead serious, very serious, serious, not serious, jolly, light hearted, funny, hilarious or absolutely insane. Abbreviations and acronyms make it to the top of the list when it comes to medical humour and sarcasm. I can never get enough of it and I scourged the net to find some interesting ones to add to my kitty of funny medical abbreviations. You can find them in the nurse’s note, the doctor’s scribble, and even the technician’s records, not to forget the graffiti in the rest room of the hospital. Humour finds a special place in the hospital and its daily humdrum. Here is my list of Funny Medical Abbreviations and Acronyms. Enjoy.

ABITHAD – Another Blithering Idiot – Thinks He’s A Doctor.

ADR – Ain’t Doin’ Right.

AGMI – Ain’t Gonna Make It

ART – Assuming Room Temperature (recently deceased).

ATS – Acute Thespian Syndrome (the patient is faking illness)

ATSWWT – Always Thinks Something’s Wrong With Them.

CNS-QNS – Central Nervous System – Quantity Not Sufficient.

CTD – “Circling The Drain”. May also mean “Certain To Die”

DAAD – Dead As A Doornail.

DBI – Dirt Bag Index – multiply the number of tattoos by the number of missing teeth to give an estimate of the number of days since the patient last bathed.

DIC – Death Is Coming, Death In Cage – used by veterinarians describing the complications of Disseminated intravascular coagulation

DRT – Dead Right There.

EFT – Eleventh Floor Transfer (in a 10 floor hospital; refers to patient who is very close to death)

FDGB – Fall Down Go Boom.

FFFFF – Fat, Female, Fertile, Forty and Flatulent

FF or FFY – Frequent Flyer – A patient who returns to a medical provider for everything.

FLD – Funny Looking Dad.

FLK – Funny Looking Kid – used to indicate a child (usually a newborn) whose habitus or overall appearance, while normal in gross anatomy, suggests a need further medical investigation for congenital and genetic anomalies.“Funny”, in this sense, means strange or unusual, not laughable.

FOS – Full Of Shit, a diagnosis given to a patient that is likely not telling the truth or, alternatively to a patient with a bowel obstruction.

FTD – Fixing To Die.

FTF – Failure To Fly.

FLGD – Familial lack of Genetic Diversity.

FTW – Friggin Train Wreck (patient with multiple problems).

GOK – God Only Knows.

GFPO – Good For Parts Only.

GGTG – Gomers Go To Ground (they fall out of bed or gurneys).

GLM – Good Looking Mum.

GOMER – “get out of my emergency room” – a patient, usually poor or elderly, in the emergency room with a chronic, non-emergency condition. The name was popularized by Samuel Shem in his novel The House of God.

GPO – “Good for Parts Only”

GTO – Gomer Tip Over.

HP – Hispanic Panic, used to describe a Hispanic patient who believes their condition is worse than it actually is. This is generally a result of the perceived over-dramatic and theatrical nature of many Hispanic cultures.

LOBNH – Lights On But Nobody Home

LOLINAD – Little Old Lady In No Acute Distress.

LOLTWO – Little Old Lady Totally Whacked Out.

MFC – Measure For Coffin.

M & Ms – mortality and morbidity conferences where doctors and other health-care professionals discuss mistakes and patient deaths

NAD – Not Actually Done

NFS – Normal For Swindon.

O2T – Oxygen Thief.

ODD&DDR – Out ‘De Door and Down ‘De Road.

PAFO or PFO – Pissed And Fell Over

PBBB – Pine Box By Bedside.

PGT – Pissed and Got Thumped

PIP – Pyjama Induced Paralysis.

PITA – Pain In The A**.

PJAR – Person Just Ain’t Right.

PPP – Piss Poor Protoplasm – a patient endowed with inferior/defective genetic material

SALT – Same As Last Time.

SNEFS – Sub-Normal Even For Suffolk.

SWAG – Scientific, wild-A** Guess.

TBW – Tossed By Wave.

TEETH – Tried Everything Else; Try Homeopathy.

TEON – Two Eyes One Nose.

TMB – Too Many Birthdays.

TOBAS – Take Out Back And Shoot.

TTGA – Told To Go Away.

TTR – Tea Time Review

TUBE – Totally Unnecessary Breast Examination, often used to refer to an EKG done with the sole purpose of looking at a female patients breasts

UBI – “Unexplained Beer Injury”

UDI – “Unexplainable Drinking Injury”

WDWNF – Well Developed Well Nourished Female.

WNL – Used for recording vital signs. It can mean “within normal limits” or “we never looked”.

WTDB (Pronounced “whiskey tango DB”) – White Trash Douchebag

6PFP – 6-pack and a fishing pole, as in “this patient doesn’t need chemo, he needs 6PFP.” – Usually referring to an end-stage patient who should go die somewhere else.

I loved compiling these from various sources. It will be cool if you can send in your suggestions. Feel free to add your own through the comments. I will append the list above to make it more comprehensive.

Pneumonia is an important cause of morbidity and mortality in adults with about 5 million cases reported annually in the United States itself. Hospital-acquired pneumonia (HAP) occurs in 0.5-5% of hospitalized patients, with a higher incidence in certain groups like postoperative patients and patients in ICU. It is also called “Nosocomial Pneumonia” or “Health care-associated pneumonia”. It is defined as pneumonia developing more than 48 hours after admission to a health care facility.

The diagnosis of Hospital-acquired pneumonia may be difficult as the clinical features of pneumonia are non-specific and many non-infectious conditions like atelectasis, pulmonary embolus, aspiration, heart failure and cancer, can cause infiltrates on a CXR mimicking a consolidation. This is made more tricky by the difficulty in identifying the organism responsible for the pneumonia due to the high incidence of oropharyngeal colonisation by Gram-negative bacteria. Only 6% of cases of nosocomial pneumonia exhibit a positive blood culture. Ventilator-associated pneumonia (VAP) is a type of nosocomial pneumonia arising >48-72 hours after intubation. It is associated with a higher incidence of multidrug-resistant organisms.

Pathogenesis

Nosocomial pneumonia most likely occurs due to microaspiration of bacteria colonising the upper respiratory tract. Other routes of infection include microaspiration of gastric contents, inhaled aerosols, haematogenous spread, spread from pleural space and direct inoculation from Hospital/ICU personnel.

Clinical Diagnosis

The diagnosis of Nosocomial pneumonia is based on the time of onset i.e. it develops more than 48 hours after admission to a health care facility, CXR changes, clinical features and simple laboratory investigations or the result of quantitative microbiology.

Clinically, HAP is diagnosed by the finding of a new infiltrate or a change in an infiltrate on CXR and growth of pathogenic organisms from sputum plus one of the following:

• WBC count: > 12 x 10⁵/Litre
• Core body temperature: ≥ 38.3°C
• Sputum Gram stain Scores: more than 2 on a scale of 4 of polymorphonuclear leukocytes and bacteria.

Investigations

A parallelism exists in the investigations required for the diagnosis of HAP and CAP.

• CXR: Most definitions of nosocomial pneumonia require the presence of new persistent infiltrates on a CXR.
• Respiratory secretions: Certain organisms are always pathogenic and are indicative of an infection when found in tracheal aspirates.
• Blood cultures: This helps in identifying the aetiological agent in 8-20% of patients. Bacteraemia is associated with a worse prognosis. In 50% of patients with severe hospital-acquired pneumonia and positive blood cultures, there is another source of sepsis.

Management

The initial selection of antibiotics is made on the basis of epidemiological clues until quantitative microbiology results are obtained. It is important that antibiotics should be instituted within 1 hour of diagnosis. The microbiological investigations are used to narrow down the microbial cover based on sensitivity. Treatment should be reassessed after 2-3 days or sooner if the patient deteriorates.

Recommended Initial Empiric Treatment for Nosocomial Pneumonia

• No risk factors for multidrug-resistant pathogens : Cefotaxime or Levofloxacin, Moxifloxacin or Ciprofloxacin or Ampicillin/Sulbactam or Ertapenem
• Antimicrobial therapy in previous 90 days or Current hospitalisation for ≥ 5 days or High frequency of antibiotic resistance in the specific hospital unit or Hospitalisation for 2 days or more in previous 90 days or Residence in nursing home or extended-care facility or Home infusion therapy (including antibiotics) or Chronic dialysis within 30 days or Home wound care or Family member with multidrug-resistant pathogen or Immunosuppression or Bronchiectasis : One of: Antipseudomonal cephalosporin (Cefepime or Ceftazidime) or Antipseudomonal Carbapenem (Meropenem or Imipenem-Cilastatin) or β-lactam/β-lactamase inhibitor (Piperacillin-Tazobactam or Cefoperazone-Sulbactam) plus one of: Aminoglycoside or Antipseudomonal quinolone (Levofloxacin or Ciprofloxacin) plus one of the following for patients at high risk of methicillin-resistant Staphylococcus aureus (MRSA) infection: Linezolid or Vancomycin or Teicoplanin

Duration of Therapy

Current ATS guidelines recommend 7 days’ treatment provided the aetiological agent is not P. aeruginosa and the patient has a good clinical response with resolution of clinical features of infection. There is no significant difference in the clinical outcome of those who receive treatment for 8 days or 14 days for ventilator-associated pneumonia.

Response to Therapy

At least 48-72 hours of therapy should have elapsed to notice any clinical improvement. Interestingly, the CXR is of limited value for assessing response as there is an initial deterioration and improvement in CXR often lags behind clinical response. However, a rapidly deteriorating CXR pattern with a > 50% increase in size of infiltrate in 48 hours, new cavitation or a significant new pleural effusion should raise concern.

If the patient fails to respond reconsider the diagnosis, host factors and therapeutic factors. Review the antibiotics and repeat cultures. It may be useful to broaden the antibiotic coverage while waiting for the results of the investigations. Consider invasive sampling of respiratory secretions, CT or ultrasonography of the chest to look for an empyema or abscess, another source of infection, open-lung biopsy to establish diagnosis and aetiology, or administration of steroids.

Prevention

Measures recommended by the Centers for Disease Control (CDC) include:

• hand-washing, nursing patients in a 30° head-up position
• subglottic aspiration of secretions
• orotracheal rather than nasotracheal intubation
• changing the breathing circuit only when visibly soiled or mechanically malfunctioning
• preferential use of non-invasive ventilation.

Last Words

Hospital-Acquired or Nosocomial Pneumonia has been of primary importance in most tertiary health-care facilities due to the rampant use of high-end antibiotics which could otherwise have been avoided. The rampant use of antibiotics has resulted in “superbugs” that are resistant to all existent antibiotics and this has created a growing awareness among health care professionals. We ought to be judicious in our use of antibiotics and should follow recommended guidelines to avoid any more damage that might result out of our complacency.

Enteral feeding is the preferred means of nutritional support. Without any specific surgical contraindication, all patients should  receive enteral feeding  as soon as possible, preferably within 24 hours of admission. Enteral feeding provides nutrition and helps to maintain gastrointestinal tract integrity and function. However, not all patients can receive enteral nutritional support due to some contraindications. This requires the assistance of some extraneous source of energy and nutrients to support the body during times of stress.

Total parenteral nutrition (TPN) support is an important component  of supportive therapy in hospitalized patients, particularly ICU patients. It is generally not necessary if the patient is likely to be able to recommence enteral feeding within a few days, unless the patient is already severely wasted or malnourished.

Typical Composition of  Standard Total Parenteral Nutrition

Volume – 2.5 Litres

Nitrogen Source (9-14 g nitrogen) – L-amino acid solution

Energy Source (1500-2000 kcal) – Glucose and Lipid emulsion

Additives – Electrolytes, Trace Elements, Vitamins

Other Additives – Insulin and H2 blockers may be added if required

Practical Aspects of Parenteral Nutrition

TPN should be customized to a person’s requirements. Advice should be sought from dietitians or a parenteral nutrition team for specialized scenarios but a standard feed will suffice for most. Standard adult feeds are typically 2.5 litres a day, but smaller  volume feeds are available for fluid-restricted patients.

Parenteral feeds are hypertonic and cause thrombophlebitis. Hence, they are preferentially given via central venous lines. However, high volume lower-osmolality feeds are now developed that can be given via peripherally inserted feeding lines called “Peripheral TPN”. It is a good practice to keep one lumen clean and dedicated for TPN.

Parenteral nutrition mixtures make good culture mediums for bacteria, so make sure not to break the line to give anything else. TPN is given by constant infusion over 24 hours and delivered by volumetric infusion pumps.

Monitoring Total Parenteral Nutrition

Advice should be sought from the nutrition team and dietitian. The following should be assessed on a daily basis to provide a well-tailored TPN to the patient.

• Fluid balance
• Urea, Electrolytes, Phosphate
• Glucose: An insulin infusion might need to be instituted to maintain blood sugar levels to an acceptable level. Close control of blood sugar levels have recently been shown to improve the outcome of critically ill patients.
• Adequate energy requirements: Clinical acumen is required to assess adequate energy requirements by degree of catabolism.
• Liver function (albumin, transferrin and enzymes) indicate adequate protein synthesis and give an early indication of TPN-related complications.

Complications of Total Parenteral Nutrition

• All complications of central venous access are an accompaniment of TPN.
• Metabolic derangement, particularly hyper- or hypoglycaemia, hypophosphataemia and hypercalcaemia, are quite common and require adequate adjustment of the feed.
• Hepatobiliary dysfunction, including elevation of liver enzymes, jaundice and fatty infiltration of the liver may occur. This is usually a consequence of the patient’s underlying disease processes and overfeeding. Reduce the volume of TPN and/or energy content in the feed to correct the same. If the serum becomes very lipaemic it may be necessary to reduce the fat content.