SAMA's annual meeting was held on July 3rd 2010. It was well attended by many sudanese doctors. SAMA's executive committee presented the progress to date to the attendees.

This was followed by a brainstorming session were different ideas were brought forward (by both SAMA's executive committee and attendees) and discussed pertaining to our 3 main activities: humanitarian, educational and professional development.

We will be posting the final results of the meeting and SAMA's plan for 2010/2011 shortly.

can any one enlight us /me about what happened in the SAMA first annual meeting, topic discussed,future plans,etc .I couldnot make it at the last minute due to some family issues.

thanks

Author's reply

You will only need to get CT of the head in meningitis patient only if there is a clinical suspicion of a space occupying lesion (SOL) and in immunocompromised patients.  The latter have a high incidence of SOL compared to the general population. In addition to that this patient was actually confused during the initial examination as illustrated in the case.
 
This is supported by a prospective study that was published in NEJM in 2001[i]. They did a CT scan on 235 patients with suspected meningitis, 24% of those patients had abnormal CT findings. During the study the risk of abnormal CT scan was associated with specific clinical features, impaired cellular immunity, history of previous central nervous system disease, or a seizure within the previous week, as well as certain findings on neurologic examination (reduced level of consciousness, and focal motor or cranial abnormalities).
 
Based on that study CT of the head was recommended for the following categories:
1)Altered mentation
2)Focal neurologic signs
3)Papilledema
4)Seizure within the previous week
5)Impaired cellular immunity

From a Junior Physician in USA

          Bits & Bytes (3)

Below is a comment on an interesting article in Newsweek magazine April 19th,2010 issue by Daniel Lyons titled: Short-Circuiting Malaria.

 http://www.newsweek.com/id/236139.

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Intellectual Ventures is a Seattle based company that is run by Nathan Myhrvold, the former chief technology officer at Microsoft. With motivation from Bill Gates to develop innovative solutions to help in eradicating malaria; the company has developed some    ideas :

•  Computer software model that can simulate malaria outbreaks. This model can help epidemiologists and researchers assimilate different scenarios in outbreaks and help identify the best approach to treat and eliminate infection, in addition to test effects of potential future vaccines.  

• Artificial food that mosquitoes prefer to human blood. The engineered blood substitute would include the proteins, amino acids, salts, and other nutrients that are naturally found in blood. It would also mimic the temperature and viscosity of the blood and be offered in a thin sac meant to simulate human skin. If this substitute is attractive enough, some of the mosquitoes will feed on it instead of on people. That alone could substantially reduce the spread of malaria from person to person. A chemi­cal or bacterium added to the synthetic blood could also kill mosquitoes that eat it or could prevent them from producing offspring.

• Developing a mechanism that detects the wingbeat frequency of mosquitoes and then shoots them down with laser beams, akin to President Reagan's proposed Star Wars system.  A similar idea is to create a laser “photonic fence” that kills mosquitoes trying to pass through.

•  Spot diagnostic test for malaria: using a finger-prick blood specimen stained to a slide, a laser beamed to the slide detects  hemozoin produced when malaria parasite feeds on hemoglobin. The diagnosis takes seconds and could reduce the overuse of drugs.

•  Researchers are also working on devices that could send laser pulses into blood capillaries in eye or skin and then detect light signals sent back from hemozoin inside red blood cells.

For more details about the projects see links @

http://intellectualventures.co.....epaper.pdf

  http://intellectualventures.co.....epaper.PDF

Great idea and a good way to interact with colleagues.

All the cases are excellent.

Waleed, great case from a nephro/endo ( I would have put endo first, for alphabetical reason, but I do not want to sound biased to my profession!).

Regarding the indications for surgery, hypercalciuria per se is off the list, unless there is associated nephrolithiasis. That being said, as you stated clearly, it is essential to obtain it on the initial evaluation to rule out FHH, to avoid inappropriate surgery. In this patient, since there is nephropathy, if there is the least doubt about FHH, the next best things to do would be genetic testing to look for a receptor mutation (which is expensive), or ti find a close relative, 10 years or younger, and evaluate them for hypercalcemia.

Asem

Endocrine fellow.

Well done, Bushra

Elshami

"Nice case,
 
It does indeed highlight the importance of  pre-test probability scoring. Raised D-dimer does confuse allot of people. Patients presenting with acute illness (were PE is considered) have to have their pre test probability scored and documented, then a D-dimer is to be requested if at all needed. Obviously the selection of further imaging would depend on CXR interpretation (CT or VQ scan). However this is not the case in real live, at least in UK Emergency Departments. Many patients are referred only because they have a chest pain and +ve D-dimer. I don't know about the US!
 
Thanks"

Sudanese Medical  Registrar in the UK

“great idea and a big effort! wouldn't be better, if possible, to create some guidelines for the cases format so they are similar to the USMLE exams and they are useful to the steps takers? otherwise i feel they like medical quiz just to kill time keep it up!”

From a doctor in USA

Thanks for the encouragement, the questions cover a broad area of modern clinical practice, and is part of SAMA's educational program aimed at enhancing the medical/scientific knowledge of its' members. Our audience and is not limited to USA or USMLE takers. However, the majority of trainees worldwide would find them useful, including USMLE takers. This is because we present common clinical scenarios and discuss/present the prevailing standard of care with evidence whether in USA or elsewhere. We hope with time, and the effort and commitment of our members/audience we can make something great of this venture.

SAMA adminstration

a doctor from sudan

 Bits & Bytes   # 3

   e- Patients, Health 2.0 & Participatory Medicine :  or Medicine metamorphosis by the internet in the  era of X-men and  transformers !!

First some definitions : 

e-Patients 

 e-Patients (also known as Internet Patient, or Internet-savvy Patient) are health consumers who use the Internet to gather information about a medical condition of particular interest to them. The term encompasses both those who seek online guidance for their own ailments and the friends and family members (e-Caregivers) who go online on their behalf. e-Patients report two effects of their online health research: “better health information and services, and different (but not always better) relationships with their doctors.”    (From  Wikipedia)

Participatory Medicine 

Participatory medicine is a cooperative model of healthcare that encourages and expects active involvement by all connected parties (patients, caregivers, healthcare professionals, etc.) as integral to the full continuum of care. The ‘participatory’ concept may also be applied to fitness, nutrition, mental health, end-of-life care, and all issues broadly related to an individual’s health.    ( From Society of Participatory Medicine http://participatorymedicine.org/ )

Health 2.0

Health 2.0 is participatory healthcare. Enabled by information, software, and community that we collect or create, we the patients can be effective partners in our own healthcare, and we the people can participate in reshaping the health system itself.  ( From http://www.tedeytan.com)

According to Wikipedia: Health 2.0 (as well as the closely related concept of Medicine 2.0) are terms representing the possibilities between health care , eHealth and Web 2.0, and has come into use after a recent spate of articles in newspapers, and by Physicians and Medical Librarians.  A concise definition of Health 2.0 is the use of a specific set of Web tools (blogs, Podcasts, tagging, search, wikis, etc) by actors in health care including doctors, patients, and scientists, using principles of open source and generation of content by users, and the power of networks in order to personalize health care, collaborate, and promote health education.. A possible explanation for the reason that Health has generated its own “2.0″ term are its applications across health care in general, and in particular it potential in public health promotion. One author describes the potential as “limitless.”     

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Article about e-patients from  Healthcare IT News   ,   Physician Practices & Ambulatory Care Section

   The emergence of e-patients

October 16, 2009 | Robert Rowley, MD

Fresh on the heels of the Health 2.0 conference in San Francisco, a renewed spotlight is shining on empowered “e-patients.” The convention was a showcase for a myriad of online and mobile tools which enable patients to engage in their health and their lives in ways not previously feasible.

But who are these “e-patients,” and do they represent a significant segment of the population? A common belief among physicians is that “e-patients” are a minority of motivated people, but do not represent the bulk of the patients being attended. Is this true? A sentinel report describes e-patients, and what the term means, in some detail.

A recent report by the Pew Internet Project describes the rise of the e-patient. A rapidly growing segment of the population is using Internet and other e-tools for access to health information: 61% of the total population, and 83% of the online population, use the Internet for querying about health information. It is widespread across genders and ethnicities: 64% of men and 57% of women; 65% of whites, 51% of blacks, and 44% of Hispanics use the Internet this way. There is a skewing toward upscale and educated users, and towards parents of young children. Over the past few years, e-patients have become high-speed (using broadband 88% of the time), and mobile (using wireless 89% of the time). E-patients are also more likely to use social media, and build online networks of “patients like me” to discuss their health conditions, find out about resources, or simply vent their frustrations or experiences with the delivery system.

As consumers, e-patients have used the Internet to find out about the health delivery system as purchasers of service: 47% have looked up information about doctors; 38% have gotten information about hospitals; 33% about how to lose weight; 27% about health insurance; 12% about how to stay healthy during overseas travel.

Clearly, as technology has evolved and delivered fast, meaningful, mobile and low-cost (or free) tools, patients are becoming “e-patients.” They are engaging the health delivery establishment in a new way, in what can be described as Participatory Medicine.

Is there a direction towards which this development of “e-patients” and Participatory Medicine is heading? Are there platforms that are in a position to enable this direction? Patients, as consumers, are gathering information themselves over the Internet (sometimes from trusted sources, sometimes from questionable sources), and are forming communities among themselves in order to find meaning, support, and experience in making health decisions. Engagement with physicians, and other health care providers, is the logical next step in this evolution. Health professionals, when actively engaged in the networks that patients are creating anyway, can provide context and meaning.

Practice Fusion is building a platform that will enable this evolution in health care. By building a physician-facing Electronic Health Record (EHR) system that is able to seamlessly share clinical charts between clinicians taking care of the same patient, and by building a patient-facing Personal Health Record (PHR) that is automatically filled and updated real-time by the physician’s EHR, the level of interaction between patients and their clinicians can reach levels not previously witnessed. The consumer-friendly Health Internet, which is still a dream in practicality, is something that the Practice Fusion platform will be able to achieve in the very near future. With widespread adoption of this approach, and with connectivity between many different constituencies and trusted services, the impact on the health of the country can be measurably improved. That is the vision with which we build these tools.

Dr. Rowley is a family practice physician and Practice Fusion’s Chief Medical Officer. Dr. Rowley has a first-hand perspective on the technology needs and challenges faced by healthcare practitioners from his 30 year career in the sector, including experience as a Medical Director with Hill Physicians Medical Group and as a developer of the early EMR system Medical ChartWizard. His family practice in Hayward, CA has functioned without paper charts since 2002.