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Harvesting Antibiotics from Muskrat Feces

admin — Mon, 30 Jan 2012 07:19:10 +0000

Turns out that a highly potent antibiotic is a by-product of muskrat feces. Discovered by a team from Pusan National University in South Korea, it kills Salmonella (the pathogen that causes food poisoning), Staph. aureus (which causes opportunistic infections) and has been found to kill termites!

The process involves drying the feces (in the shade – not the sun!), treating it with an organic solvent and then filtering and concentrating the extract in a vacuum.

As fascinating as this is, I can’t help wondering who thought of checking muskrat feces? I mean, how did they know where to look?

You can read about it in New Scientist and if you’re really have some time to kill, the patent describes the process, claims and description in more detail – and it actually makes for interesting, entertaining reading!

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Rural Medicine: A Physician’s Story

admin — Mon, 10 Oct 2011 11:40:28 +0000

This article appeared in a recent issue of the New England Journal of Medicine. I was actually flipping through the pages to read another article when it caught my eye – I’m glad it did. I hope that you find this article by Margaret Seton, M.D., as thought provoking as I did.

Article: Providing for Those Who Have Too Little

The test of our progress is not whether we add more to the abundance of those who have much; it is whether we provide enough for those who have too little.

— Franklin D. Roosevelt

We drove into rural Arkansas to serve 2 years in the Public Health Service, into a town where movie houses had been shuttered when integration became law. I had come to pay my debt to the country in exchange for 2 years’ tuition for medical school. My husband, also a physician, had decided to accompany me, and together we arrived in a flat land where the dusk was alive with mosquitoes and rice and cotton fields bumped up against the houses. My husband’s office would be adjacent to the hospital. Mine would be in a small town along a border of the Mississippi that changed when the river flooded, leaving some lands in Arkansas, some in Tennessee.

There is an implicit privilege in serving as a physician in public health, although I was slow to understand this. We were outsiders to the South by religion, by politics, and by language. For weeks, my nurse translated Arkansan dialect, while I wondered what planet I’d landed on. One of the family practitioners advised me during my first week to buy the morning paper each day and bring it to clinic: “You might need it to deliver a baby.” I had trained in the intensive care unit. I could start a central line, intubate a patient in respiratory failure, and insert a pacemaker. Babies were not on my list.

Nor were fishhooks. My first patient came in with one through his finger, holding up his thumb with the filthy barb penetrating the flesh, fishing line still attached. “Now hold on, Doctor, I’ll run next door and get my husband’s wire cutters,” my nurse said. “You numb up the finger, OK?” At least I think that’s what she said. I put in a digital block. She cut the barb off, I ran the loop through the wound, irrigated it, prescribed antibiotics, and administered a tetanus shot. No training, no supervision — but no one else to do it.

In the hospital, we learned about other aspects of rural medicine. When my husband, reading EKGs, came upon a grossly abnormal tracing with peaked T waves from a patient who was scheduled for surgery, he called the surgeon. “He’s fine,” the surgeon chuckled. “He’s 32, exercises regularly, and I’m fixing his hernia. Housekeeping runs the EKGs; you might ask them if there was any problem.” The “EKG technician,” mop in hand, reported that when the tracing was too small, she would increase the gain to make it easier to read.

Sometimes the epidemics that swept through our population were initiated by drug detailers, who left samples of a new medication in all the primary care offices, making bold claims about efficacy. The first ill effect that we diagnosed was from long-acting digoxin: the tablets caused an epidemic of heart block in the community. At other times, the biggest problems were not in diagnosis but in finding a farm truck that was free for a day to take a child into Little Rock for emergency surgery. Vaccinating the children born uncounted on the islands in the Mississippi, learning about “gigging” frogs by flashlight in the night, eating barbecued goat for the Fourth of July — such activities marked a time of transformation for us.

In the little houses clustered by the fields, there was a rural violence that I’d never seen before, bred by poverty and ignorance. Bullet holes pockmarked every signpost along the road. I learned to recognize the old black men who worked in the cotton gin by their missing fingers. I learned about hard lives and about children who died or disappeared. I hadn’t known that so many black Americans were still living without running water, that physicians could be on call every night, that one could eat squirrel, or that long, well-embroidered country stories could make one double over with laughter.

At the outset, we Northern doctors had a kind of truce with the mid-South physicians. Young and inexperienced in life, we were swindled on our house, mocked for our politics, and bruised by the apparent indifference to the poverty of blacks — though we had come from Boston, which had its own kind of racism. Through the practice of medicine, these differences were muted by our common purpose — and soon transformed, as our clinics became integrated and our presence in the community welcomed. We learned that medicine is a passport as valuable as citizenship and that goodwill goes far in diminishing political divides. One night near the end of our 2 years in Arkansas, I approached the bedside of a man with unremitting angina to start an IV. We had been at odds forever, over integration, women in medicine, public health, religion, politics, you name it; we had no common ground. As I started the IV and my husband ran in the medication, this moment in a rural emergency room shrank the differences to naught. What language could not bridge, medicine did.

There were other lessons to learn in rural medicine. Our new world was rich with lives, stories from the warm earth, island dialects that chopped words in half, and a sense of time that was distinctly foreign:

Physician: “How long have you had chest pain?”

Patient: “Oh, for quite some time . . . uh huh, quite some time.”

Physician: “For a few weeks?”

Patient, head shaking: “Oh more than that, honey, more than that.”

Physician: “Months?”

Patient, softly chortling: “Not that long.”

I was graced to learn about an America I did not know.

One compelling reason to serve your country in this way is to learn from people you had intended to teach. To stop your car at the side of a road in rural Arkansas as the funeral cars passed, in respect for a country tradition. To yield to a small community’s intrusion on your privacy. And to absorb what you could of the extraordinary medicine. I hadn’t known that a person could live with a serum potassium just over 1, or survive the night when septic with clostridia, a diagnosis made when all the blood-culture bottletops had popped off by morning. The double dose of diuretics prescribed was stopped. The underlying colon cancer was identified and treated. Without an Internet, diagnoses such as histoplasmosis, recluse spider bites, inhalation toxicity from pesticides only slowly dawned on us, as we read chapters in Harrison’s that we once saw as without merit. The experience informed the way I practice medicine. As I cared for patients discharged from Memphis teaching hospitals, I came to respect the time needed for healing, to value listening as much as technology, and to have confidence in my own ability to solve a problem. Later, I learned the quintessential medical skill — to touch patients with a kindness and competence that brings trust and hope to troubled lives.

I often think of Arkansas these days, as I listen to Congress wrangle over health care. I think about the people without voices in this country, the single mothers, the legal immigrants, and the poor. I hope the notion of public service is reconsidered, as Americans struggle for jobs, equity, and economic security — and that it is implemented more thoughtfully, with a plan for longer-term investment of teams in a community. Such experiences expand our understanding of each other and invest life with meaning and insight. That is the enduring legacy of public health service.

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Stepwise Approach to Acne Treatment

admin — Tue, 06 Sep 2011 08:06:14 +0000

It bears repeating that chocolate, stress and dirt are not causes of acne. This article will look at the physiological chain of events that lead to acne and how specific treatments disrupt the different stages in acne formation.

With the onset of puberty, there is an increase in androgen production. This stimulates sebum production, the oil/ waxy substance that is produced by microscopic hair and skin glands whose function is to lubricate the skin. These sebaceous glands are found all over the body except on the palms and soles of the feet.

Acne develops when there is an excess of sebum production combined with abnormal production of keratin, the key ingredient in skin, hair and nail formation. Excess sebum production and keratin plugs cause follicles to become inflamed.

Specific bacteria, Propionibacterium acnes, live off the sebum because it’s high in fats. Once this happens, the follicle becomes even more inflamed until eventually, the follicle wall ruptures and the classic whitehead appears surrounded by a red base.

If the whitehead does not come into contact with the air, it is said to be a “closed comedo”. If it opens up, a blackhead appears and the structure is defined as an “open comedo”.

Treatment is aimed at interfering with any of these various stages in acne production:

ways to unplug the sebaceous ducts
killing the bacteria that live off the sebum
normalizing keratin formation
decreasing testosterone/androgen production via regulating hormones

Unplugging the sebaceous ducts

A good skin cleanser that contains either an alpha-hydroxy acid (glycolic or lactic acid) or a beta-hydroxy acid (salicylic acid) will help dissolve the material that plugs up the duct. By removing the debris, there is nothing for the bacteria to live off.

Salicylic acid 2% is an over-the-counter product that gently dissolves the debris.

Avoid products that are labeled “scrubs”, “exfoliants” or “micro-dermabrasives” – they only irritate an already inflamed skin.

Target the bacteria

There are 2 ways to do this:

using benzoyl peroxide – an over-the-counter antimicrobial agent
using prescription antibiotic topicals or orals

Because Propionibacterium acnes lives in an environment without oxygen, an agent that introduces oxygen in the sebum creates a hostile environment for the bacteria to survive. Benzoyl peroxide does just this. It can be purchased in cream or gel form and in various strengths ranging from 2.5% to 10%. The downside to this is that it can cause skin dryness and because it’s a peroxide, it can bleach hair and clothing. However, it’s inexpensive and effective.

Prescription medications include topical and oral antibiotics. Rather than creating a hostile environment for the bacteria, these agents work by killing the bacteria. Antibiotic choices include:

erythromycin
clindamycin
sulfacetamide
tetracycline
doxycycline
minocycline
trimethroprim/sulfamethoxazole

Taking tetracyclines can cause severe skin burns with minimal sun exposure and patients need to be aware of this. In addition, antibiotic resistance is developing with some of the topical agents. Used in conjunction with benzoyl peroxide, treatment is more effective.

Normalize keratin formation

This is where the retinoids work – they reduce the plugging, normalize sebum excretion and reduce inflammation. Nowadays, if a patient has severe acne, they are referred to the dermatologist for treatment with retinoids because these agents are highly toxic to a developing fetus. The patient, pharmacy and medical provider must register with iPledge, a national database of all isotretinoin users. In addition, women must submit to pregnancy testing and 2 forms of birth control. Prescribers must also carefully document that all safety measures have been met.

Reducing testosterone production

Because high levels of sebum production is linked to testosterone, hormone therapy with oral contraceptives can be helpful since they suppress androgen production in the ovaries.

Sometimes the side effect of a medication helps treat another problem even though the medication was not intended for that particular use. This is the case with spironolactone, a diuretic used to treat high blood pressure. It blocks androgen rather than suppressing the production. As we know, blocking androgen helps decrease sebum production. Because its use in acne treatment is off-label, it is best used by a dermatologist. It is also toxic to a developing fetus so strict birth control measures must also be adhered to.

There are various stages of acne and treatment should be appropriate to the severity. A trial of over-the-counter agents is warranted in mild to moderate cases. Severe acne is scarring both physically and emotionally so seek treatment when needed.

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Medicine on the Move

admin — Wed, 17 Aug 2011 08:00:23 +0000

Just finished an article in Plane & Pilot about an organization I hadn’t heard of: Medicine on the Move. MoM operates out of Ghana, Africa and is a charity for health care education and medical services to rural communities is Ghana. What is amazing is the story of Patricia Mawuli Nyekodzi who went from living in a mud hut to building her own aircraft and becoming the first female to hold the Ghanaian National Pilots License at the age of 22. She now works as a volunteer pilot for MoM.

Melissa Pemberton, a full-time air show performer and a former member of the U.S. Unlimied Aerobatic Team have spent months filming a documentary about MoM called, The Calling.

You can read Melissa’s article about MoM and Patricia Mawuli Nyekodzi at this Plane & Pilot link.

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Subconjunctival Hemorrhage

admin — Fri, 18 Mar 2011 08:20:29 +0000

I had come from a hospital background and although I worked with unusual cases (like the elderly man who got a coat hanger stuck in the opening of his penis) I never saw a case of subconjunctival hemorrhage until I was a visiting nurse. Frightened by its appearance, I called her primary care provider to schedule an appointment for her. That’s when I learned that the condition is quite benign.

In fact subconjunctival hemorrhages can occur spontaneously or as a result of some minor straining – the kind associated with coughing or bearing down when toileting. I’ve only seen it in the elderly and the other day was no exception.

In this elderly woman, there was no trauma but her companion, worried by the look of her eye, insisted she get it checked out. The sclera (the white part of the eye) was blood red and it extended around and under the cornea (the colored part of the eye).

There are several hallmarks of subconjunctival hemorrhage to know in order to make the diagnosis:

There is no trauma associated with the incident
There is no pain
There are no vision changes
The blood appears in the sclera – not the cornea

The patient may experience a sensation of fullness in the eye as a result of the bleed and it may “spread” over the next several days – this is nothing to be concerned about.

As mentioned above, these superficial vessels can rupture and leak blood as a result of coughing, straining, sneezing etc. The condition resolves by itself and no further evaluation is needed.

If the condition continues to reappear or bleeding occurs at other body sites, then the patient needs to be evaluated for clotting disorders or vasculitis (inflammation of blood vessels).

After examining the eye and reassuring myself that there was no trauma involved, I reassured the pleasantly confused elder and her companion that there was nothing to worry about and that the redness would resolve in several weeks.

Obviously, if there is trauma associated with the bleeding, this constitutes a medical emergency and you should be evaluated right away in the Emergency Department.

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Brown Adipose Tissue Burns More Calories Than White Adipose Tissue

admin — Mon, 10 May 2010 09:00:52 +0000

Brown adipose tissue is located in the neck area and is more physiologically active in this woman than in the man pictured.

We have two types of adipose (fat) tissue in our bodies: brown fat which causes adults to burn calories and white fat which causes us to store it. Up until recently, medical researchers believed that brown adipose tissue was not only scarce in adults but was physiologically irrelevant.

However, research, that was published in the New England Journal of Medicine, is showing that brown adipose tissue helps adults burn more calories than white adipose tissue. In fact, only 50 grams (1.8 ounces) of brown adipose tissue boost the rate at which we burn calories by an astonishing 20%.

Essentially the difference between these two types of tissue is the difference between gaining or losing weight. White adipose tissue is the primary site for energy storage. Simply put, the excess calories we eat and do not use gets stored as potential energy in the form of fat. It also produces hormones which won’t be discussed here. Brown adipose tissue in adults, on the other hand, is involved in energy expenditure rather than in energy storage. It affects the body’s overall metabolism and is responsible for setting the body’s metabolic rate, sensitivity to weight gain and insulin sensitivity.

Previously, brown adipose tissue was known to play a crucial role in infants and young children because it helped them regulate body temperature through thermoregulatory pathways. Adults however, regulate body temperature by different mechanisms based on muscle mass – which infants lack. It was difficult to detect brown adipose tissue in adults partly because researchers were looking in the wrong place, partly because its presence is scarce in adults and partly because brown adipose tissue is less metabolically active in certain conditions. It is activated by cold temperatures and is therefore least active in summer. In addition, certain medications such as benzodiazepines and beta blockers deactivate it.

In another development, scientists at the German Cancer Research Center in Heidelberg have discovered what regulates the development of brown adipose tissue in the body. Their findings were released in the online journal Science last week. In a telephone interview, Stephan Herzig, one of the lead researchers speculated that brown adipose tissue could be grown in a lab and then transplanted back into the body in order to help burn more calories.

Since 67% of Americans in 2005-2006 were overweight (body mass index between 26-29.9) or obese (BMI of 30 or more), the problems that this epidemic creates needs to be dealt with in a number of different ways. Sadly, very few Americans are able to successfully lose weight and keep it off without lap-band or gastric bypass surgery.

Research that may help us treat obesity in novel and creative ways is needed, since Americans are unwilling to pass laws that minimize certain food additives linked to obesity (the ubiquitous high fructose corn syrup for starters) or are simply unable to make sensible food choices (see my post Drug Addiction and Overeating Linked).

If you’re curious to know what your body mass index (BMI) is, follow this link.

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The Cost of Mental Illness

admin — Fri, 30 Apr 2010 09:00:45 +0000

The two mental health disorders that I see most often in our practice are depression and anxiety and treating these disorders require lengthy office visits especially when diagnosing and treating the patient for the first time. In fact, so important is follow up treatment during the first 3 months of treating major depressive disorders that some insurance companies will penalize the provider if 3 office visits are not made within the first 3 months of starting a patient on antidepressants for the first time.

Despite the necessary time involved in treatment, mental health disorders are reimbursed at a lower rate than other medical problems. Ironically, depression and anxiety form the basis for other physical ailments and unless dealt with directly, can often lead to unnecessary and costly medical treatment as illustrated by frequent patient visits for multiple somatic complaints. Mental health and physical health/illness are intricately bound together but because of popular misconceptions, the general public (and by extension, many patients) fail to see the connection between their physical ailments and their mental health. I think back to how ignorant I once was about the mind/body connection – so I don’t blame my patients – I try to educate them. But trying to explain this link without offending and alienating patients requires building trust and confidence – difficult to establish in the 10 to 15 minutes alloted for the office visit.

The patient who comes in complaining of chest pain, shortness of breath, and palpitations – with a dash of numbness and tingling in the limbs – does not want to hear that his/her complaints, which are considerably frightening to them, are the result of anxiety. Indeed, depending on the patient’s age, family history, and co-morbidities, a detailed history needs to be done as well as a thorough exam before asking equally time consuming questions about what is going on in their lives. Can this be done adequately in 10 minutes? A provider running behind and possibly double booked may find it easier simply to order multiple tests rather than start asking about stressors in the patient’s life. For exactly the reasons mentioned, I’ve been guilty of not asking the psychological questions myself.

Anxiety disorders affect approximately 40 million Americans 18 and older with 20.9 million suffering from some type of mood disorder. Of the top 5 most costly medical conditions treated in the U.S., mental health expenses ranks number 4 in terms of direct medical spending. In 1996, $35 billion was spent treating mental health disorders compared to $57.5 billion spent in 2006. Indirect costs are also astonishing: mental illness is associated with more lost work days than any other chronic illness. Given that 1 in 4 Americans suffer from some form of mental disorder, it makes economic sense to pay attention to these factors. But a busy provider simply may not have the time and economically, it may not make sense for him or her to do this given the reimbursement rates.

For a psychiatrist’s view of treating mental disorders, the NY TImes this week published an article “Mind Over Meds“. It’s worth taking a look at. In the meantime, there is no easy solution. We do the best we can given the constraints we have.

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Palliative Care: No Easy Answers

admin — Mon, 05 Apr 2010 09:01:32 +0000

I took care of a close relative of mine, who in middle age, died of lung cancer. She struggled for 3 years with cancer before it took her life, but Margie never gave up despite the fact that chemotherapy and radiation were no longer options. She didn’t want to know the full extent of her illness. When any medical professionals tried to talk to her about life expectancy, she refused to hear it saying, “How can they know when I’m going to die?”

It robbed her of hope and initially, I agreed with her. She tried alternative and complementary treatments including visiting a faith healer. But as it became painfully clear that a cure could not be had, I wrestled with uncertainty about my duty to her as my patient and a beloved family member. If I didn’t tell her the full extent of her disease, would death catch her by surprise? Would she resent not being able to plan realistically and enjoy what time she had left? Or would telling her take away her last shred of hope?

To say that she was simply in denial, even now, 9 years later, seems too easy and glib. She had a fierce desire to live and although I had given up on her chances for survival, she had not. In certain ways, Margie had fought more fiercely for her life in the midst of dying than she had done in the midst of living when opportunities were still available to her.

I had witnessed death often in the nursing home where I worked. I comforted families and patients, helping them to reach decisions about code status, the use of IVs or antibiotics, whether to hospitalize – all issues important to discuss. I knew how to have the conversations with families about when to stop treatment and seek palliative care. Although we want a peaceful death for our patients, many of our patients will never accept the harsh reality of their own death with equanimity. And who are we to make them?

Margie’s story is simply a long prelude about another woman’s struggle with her own cancer and her refusal to have palliative care. Her story is in this weekend’s New York Times. What makes this article so compelling is that this 41 year old woman was a palliative care doctor who in the end could not accept palliative care for herself. I encourage people to read about Dr. Desiree Pardi.

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What Is the Cost of No Health Care Reform?

admin — Mon, 15 Feb 2010 09:02:42 +0000

The Urban Institute (UI), an independent non-partisan policy institute, created in the 1960s to examine the problems facing American cities, released a paper in October 2009, entitled, “The Cost of Failure to Enact Health Reform: Implications for States”. The report looks at three scenarios: worst, intermediate and best case. The results are sobering.

According to the report, if health care reform fails in this country, the middle class would be the hardest hit. Within 10 years, the UI estimates that:

In 29 states, the number of people without insurance would increase by more than 30 percent.

Under this worst-case scenario, the number of uninsured could grow by at least 10 percent in every state. All told, the number of uninsured Americans would reach 65.7 million.
Even in the best case scenario, 46 states would see employer premium costs increase by more than 60 percent.
Half of the states would see the number of people with ESI coverage fall by more than 10 percent.
Half the states would face cost increases of more than 100 percent.
Even in the best case, uncompensated care would increase by more than 50 percent in 48 states.
The amount of uncompensated care in the health system would more than double in 45 states.
Every state would see its Medicaid/CHIP spending rise by more than 75 percent by 2019.
Every state would see a smaller share of its population with employer-sponsored insurance (ESI).
Businesses would see their premiums continue to increase—more than doubling in 27 states.

So what is meant by worst, intermediate and best case scneario? The institue defines it as follows:

Worst case – slow growth in incomes and continuing high growth rates for health care costs
Intermediate case – somewhat fast growth in incomes, but a lower growth rate for health care costs
Best case – full employment, faster income growth and even slower growth in health care costs.

In other words, worst case scenario is what we’ve experienced in the last however-many-years and in all likelihood, what we’ll continue to see. Who among us actually believes health care costs will go down without some sort of intervention?

So why is health care reform such a contentious issue? Because middle class people believe that their health insurance benefits will erode if the bill is passed. With health care costs rising two percentage points faster than the gross domestic product, the cost for insurance premiums will continue to rise. Businesses in an attempt to keep costs lower for their employees will be forced to pass some (if not all) of the increased costs on to its employees and/or be forced to select a plan that offers fewer services and higher out-of-pocket expenses for the employee for diagnostics, office visits, referrals to specialists and cost of medications.

As more people become uninsured due to rising unemployment or because they simply can’t afford the cost of health care premiums, the numbers of people on Medicaid/Medicare will swell. Those who wouldn’t qualify for public assistance will simply burden the already over-burdened hospitals whose EDs are swelling with the uninsured.

Case in point are the six hospitals in Massachusetts which have filed a joint lawsuit for insufficient reimbursement for care to Medicaid patients. These six hospitals, known as “disproportionate-share hospitals” are called this because at least 63% of its revenue come from public payors.

Because they serve a disproportionate share of un- or underinsured people and actually lose money in taking care of them, these hospitals run the risk of closing their doors. Holyoke Medical Center, one of the six hospitals has estimated a $10.04 million shortfall in the past 6 years. Who will provide the care for these people then?

Should I agree with Jacob Weisberg of Slate.com who believes that our political and economic problems are the fault of “the childish, ignorant American public – not politicians“? I’ve been sorely tempted to especially when I hear educated middle-class people state they voted for Scott Brown, the Republican winner of Ted Kennedy’s senate seat, because they believed their own health care coverage would deteriorate if Obama’s health care reform bill passed.

Alert: It’s already deteriorated and will only get worse if there is no health care reform.

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2 Promising MS Drugs in Trials

admin — Fri, 29 Jan 2010 09:19:00 +0000

The New England Journal of Medicine (NEJM) recently published 2 studies on some promising new treatment for relapsing/remitting multiple sclerosis (R/R MS). Both medications reduce the number of lymphocytes which play a role in the immune-mediated disease.

The first study, dubbed Clarity, involved 1326 patients and took place over 96 weeks. Cladribine tablets were administered for 8 to 20 days per year, given in 2 or 4 short courses during the first 48 wks, then in 2 short courses starting at week 48 and week 52. The drug was administered in short courses with long gaps between to allow blood cells to recover.

The study results showed significant benefit for patients with R/R MS using 3 measurements of disease progression:

rate of relapse
disability progresssion
MRI measure of disease activity (reduction in brain lesion counts)

The number of patients who remained free of relapse was 79.7% and 78.9% in both doses of cladribine administered compared to placebo (60.9%).

Adverse side effects included lymphocytopenia (decreased lymphocyte counts) and herpes zoster.

The second study (called Freedoms) involved 1272 patients using fingolimod, an oral medication given daily. Fingolimod acts by prohibiting the exit of lymphocytes from the lymph nodes which reduces the chances of aggressive lymphocytes from entering the central nervous system where their inflammatory response is thought to play a role in causing MS. In addition, fingolimod is thought to provide protective and possibly reparative benefits to neurons in the brain.

The study’s success was measured using the same 3 critera used in the Clarity trials: relapse rates, MRI measurements of disease activity and disability progression.

Reductions in relapse rates were 54% and 60% in the respective 0.5 mg and 1.25 mg fingolimod dose. Similar positive results were seen in the time to disability progression and in the MRI results.

Adverse side effects included infections, cardiac related events (bradycardia – heart rate lower than 60 beats/minute, as well as electrical conduction blocks), macular degeneration, abnormal liver function tests, which resolved once the drug was discontinued.

For more information about MS follow this link to the National Institute of Neurological Disorders.

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Starve A Fever » Featured

Harvesting Antibiotics from Muskrat Feces

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Rural Medicine: A Physician’s Story

Article: Providing for Those Who Have Too Little

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Stepwise Approach to Acne Treatment

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Medicine on the Move

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Subconjunctival Hemorrhage

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Brown Adipose Tissue Burns More Calories Than White Adipose Tissue

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The Cost of Mental Illness

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Palliative Care: No Easy Answers

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What Is the Cost of No Health Care Reform?

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2 Promising MS Drugs in Trials

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