A talk by Professor Qureshi on hypnosis. He describes how to perform hypnosis and how he has managed to do it with all sorts of people and the benefits to patients. He also teaches patients how to use self hypnosis.

The topic is potentially highly controversial as there is Islamic scholarly resistance to the use of hypnosis: http://islamqa.info/en/pda/ref/islamqa/12631.

Bismillah alhamdulillah:

Professor of many subjects from the USA talking about Atopic Dermatitis. A rather unpredictable choice of subject as I don’t see that much in children here. I wonder how useful the audience found the topic. The slides were overly texty. The talk overran and the take home messages are pretty much the same: stop the itch, emollients, bleach and tars and antibiotics.

Other misc. points:                                                   
IgE testing not done anymore.
Fillagrin gene mutations 9% in Europeans renders them more susceptible.
Treat with antibiotics to reduce colonisation rather then impetigo.     

Trying to put a mind map together of my notes regarding the artificial sweetener called Aspartame. Click here to see it.

Insha Allah will update it as time goes along.

The organising committee of this years Family Medicine symposium is hard at work organinsing this year’s symposium. It is due to be held in Jeddah on Nov 29 and 30 insha Allah.

The Hajj break has started and ends on the 12th of November 2011 (the first working day after the holidays). Some of the organising members will be on hand to monitor comments via the website but the contact us link will not work during this period.

If you have any questions or comments feel free to tweet me at twitter.com/dr_taqi .

Below is an interesting article on funnel plots and the variation in cancer rates in the UK by Dr Ben Goldacre.

http://m.guardian.co.uk/ms/p/gnm/op/stYOph3GmqN02l4Xxzr8kgQ/view.m?id=15&gid=commentisfree/2011/oct/28/bad-science-diy-data-analysis&cat=commentisfree

Treating chronic rhinitis can be a frustrating experience for both the doctor and the patient. The usual regime of antihistamines and allergen avoidance can in some cases bear little fruit. A trip to the immunologist can bear fruit for a patient who has a clearly identified allergen and is willing to undergo immomodulatory therapy which can last for upto 2 years.

It is not uncommon for patients to ask the opinion of their family doctor about alternative therapies. The requirement for double blinded RCTs and their lack leaves the family doctor reliant on their experience to answer the question or they simply play a very straight bat and reply that this is not their field and avoid answering the question.

I came across an alternative therapy based on a hadith by the Prophet Muhammad (S) which used the black seed. They are to be crushed and mixed in oil and then placed in both nostrils. The duration of therapy or the number of doses was not given. The hadith is present both in two collections of hadith called Bukhari and Muslim. Another website stated that the seeds should be crushed, nixed in oil and the medicament should be administered within an hour. According to the site black seed oil should not be used as the black seed is heated.

A bit of reading around shows that black seed oil is known as Nigella Sativa and is available in 3 varieties from India, Saudi Arabia and Ethiopia.

Whether such a prescription is equally applicable to chronic rhinitis is unclear. I wonder if there any studies dealing with this topic. Perhaps you have had some experience with this and would like to share your experience. Feel free to add your comments. Whatever the case the option of an exttra modality of treatment always gives hope to both the patient and physician and deserves to be investigated further.

Doing the medication refills today I saw a patient on a statin aged 38y. I wondered why she was taking a statin and looked for any history of CVD in the notes but found none. She does not have the classic courier risk factors of DHL i.e. diabetes or hypertension or lipidemia reaching a level high enough to justify statins. So I revised the notes again and saw that she had SLE. This led to a question in my mind. How much does SLE increase the risk of CVD disease?

Having been recently introduced to the Trip Database I used it to try and quickly search for an answer and came up with the paper whose abstract is included at the bottom. It looked at the Nurses’ Health Study and concluded that SLE doubled (relatively speaking) the risk of CVD.

Using the Pubmed link there was a free link to an editorial in one of the Arthritis Journals and this gave some further additional insight which was worth reading.

My take home points:

• CVD risk is doubled if you have SLE.
• SLE has a bimodal mortality pattern: mortlaity is raised soon after diagnosis and later on in life
• Try and minimise steroid usage because of the CVD risk.

Abstract Below

Arthritis Rheum. 2009 Oct 15;61(10):1396-402.

Systemic lupus erythematosus and the risk of cardiovascular disease: results from the nurses’ health study.

Hak AE, Karlson EW, Feskanich D, Stampfer MJ, Costenbader KH.

Brigham and Women’s Hospital and Harvard Medical School, Boston, Massachusetts, USA.

OBJECTIVE: Systemic lupus erythematosus (SLE) has been associated with an increased risk of cardiovascular disease. However, prospective population-based data addressing this association have been lacking.

METHODS: We conducted a prospective cohort study among 119,332 women participating in the Nurses’ Health Study who were free of cardiovascular disease and SLE at baseline in 1976. Incident SLE was confirmed by medical record review. Cardiovascular events included fatal and nonfatal myocardial infarction, stroke, coronary artery bypass grafting, and angioplasty. The relative risk (RR) of cardiovascular events among participants with SLE as compared with those without SLE was estimated using Cox proportional hazards models.

RESULTS: Over 28 years of followup (2.9 million person-years), 8,169 cardiovascular events occurred and 148 women developed incident SLE. The mean age at SLE diagnosis was 52.6 years, and 20 participants with SLE developed a subsequent cardiovascular event. After adjusting for potential confounding factors, including age, race, cardiovascular risk factors, and medication use, the RR of a cardiovascular event in women with SLE compared with those without SLE was 2.26 (95% confidence interval [95% CI] 1.45-3.52). When end points were analyzed separately, the RR for coronary heart disease was 2.25 (95% CI 1.37-3.69) and the RR for stroke was 2.29 (95% CI 0.85-6.15).

CONCLUSION: In this prospective population-based study, we found a statistically significant >2-fold increased risk of cardiovascular disease among participants with SLE. The risk was not as high as has been previously reported, which may have been due to the relatively high age at diagnosis of SLE in this cohort.

I have added a page called TOOLS. You can access it from the tabs at the top of the blog and it will give you the links I use on a daily basis during my practice.

Here is the direct link http://drtaqi.wordpress.com/tools/.

Positivity is worth more than its weight in gold when it comes to trial results supporting a particular drug. But what happened to all the negative trials – that were started but never reported. Do we get to know that they exist in the first place?

The Guardian has an article by Ben Goldacre called ‘Drug trial secrecy leaves us dependent on blind faith‘  which is a reminder of the less than transparent world of pharmaceuticals that we live in today.

Heard a nice podcast from the BBC on Dementia. Take home points:

• 35 million have it world wide.
• Singing and music may help but patients point out it is contact with others that matters.
• Goa psychiatrist, Dr Amit Dias, has a new idea: Sangath Dementia Project with a community outreach project for dementia.
• Angst of relatives who promised to keep their elderly relatives at home but who need to send them to an institution.
• Simple ideas from Dementia House: lighting should be increased as yellowing of the cornea causes difficulty in depth perception. Long life bulbs decrease in their luminosity with time and need regular changing! A telephone where the quick dial buttons have pictures of relatives rather than names. Infra red sensor connected near the bed and to an in-house pager, if they wake up at night someone can come to assist them. A little door opening audio prompt that says ‘Don’t forget your keys’. A clock that gives the time, the date, the day, the month and the time of day as in evening or morning and the year.