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4 How could the physician prescribe antibiotics without culture sensitivity tests in an open injury?? How far it is apt?
By Deepak Kumar · Mahatma Gandhi Memorial Hospital, Warangal

Ashok Rai · Xi'an Jiaotong University

Dear Moh, I agree there are no reason to avoid sensitivity test because antibiotics are not under life saving medication in emergency cases "BUT" I t... [more]

Dear Moh, I agree there are no reason to avoid sensitivity test because antibiotics are not under life saving medication in emergency cases "BUT" I think giving Prophylactic Antibiotics has more advantages than not giving it at all. Here, Benefits outweigh the Harm. Timing of Antibiotics is more important. The earlier You give Antbiotics, the better is the result. We cannot wait for 48-72 hrs. I think, later we can change the antibiotics after the report of Antibiotics sensitivity Test. Commonly, We give Second generation Cephalosporin + Aminoglycosides + Metronidazole. But co-morbid condition of the patients are equally important. Thank You.

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24 What is the best treatment of nasal polyposis?
By Javad Ghaffari · Mazandaran University of Medical Sciences

KIRUBA MANOHARAN · Jawaharlal Institute of Postgraduate Medical Education & Research

I feel nasal polyps are irreversibly edematous nasal mucosa resulting from persistent nasal inflammation . I would address the underlying cause than ... [more]

I feel nasal polyps are irreversibly edematous nasal mucosa resulting from persistent nasal inflammation . I would address the underlying cause than to primarily concentrate on removing the polyps. steroids are of good help in treating patients symptoms. with through investigations and functional endoscopic surgery, my recurrence rates have been around 15%

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New What is the best strategy a librarian can use to notify/ library users about some online books that they are unaware of?
The library has so much online literature that is never utilized. This is quite a waste of resources.How can we make sure that this does not go on for... [more]

The library has so much online literature that is never utilized. This is quite a waste of resources.How can we make sure that this does not go on for ever?

By Esther Obachi · University of Nairobi

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2 What are the most important challenges facing medical education nowadays?
By Ahed Alkhatib · Jordan University of Science and Technology

Ahed Alkhatib · Jordan University of Science and Technology

thanks Pedro, that will be kind of you

thanks Pedro, that will be kind of you

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13 Anhidrosis left half of the face.
By Asfandyar Niazi · Shifa College

Ramon Zabalza · Hospital Universitario Donostia

In my opinion this symptoms suggest an Harlequin syndrome.

In my opinion this symptoms suggest an Harlequin syndrome.

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26 What if you could differentiate a haemorrhagic from an ischemic stroke 'in the field' ?
By Thilo Hoelscher · University of California, San Diego

Donny Hamid · Pasar Rebo Province General Hospital

Dear Thilo, It's Very interesting ! Would you please sendi me some articles about micro bubble and how can USG device can differentiate haemorr... [more]

Dear Thilo, It's Very interesting ! Would you please sendi me some articles about micro bubble and how can USG device can differentiate haemorrhagic and ischemic stroke?

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12 How can one interpret the value of ESR? and how valid is it in diagnosis?
By Najla Dar-Odeh · University of Jordan

Ewa Bryl · Medical University of Gdansk

I agree with Robert, however the reference value for control group exists also for ESR. Depending to methods the values can be different. You have to ... [more]

I agree with Robert, however the reference value for control group exists also for ESR. Depending to methods the values can be different. You have to ask the laboratory about their reference value and method they use, and of course to contact doctor to find out the diagnosis. The value of ESR will not tell You the diagnosis, except values above 100, which are really alarming and most often met in cancer patients.

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10 Should airlines ask for a medical report from people of a certain age that indicates if they are able to fly?
By Luis Landin · Hospital Universitario Ramón y Cajal

Madelaine Lawrence · University of North Carolina at Wilmington

Some airlines already restrict pregnant women during their last trimester. American Airlines, for example requires a doctors letter saying they are O... [more]

Some airlines already restrict pregnant women during their last trimester. American Airlines, for example requires a doctors letter saying they are Ok to travel during the last 4 weeks of pregnancy. Yet there is no evidence that flying induces early labor. Most women, I suspect, would not want to travel during the last 4 weeks of pregnancy but emergencies do occur. Women are still targets for this type of discrimination. In a hospice where I was employed, we encouraged our terminally ill patients to fly to see relatives, friends, even places they want to see. The families were encouraged to inform the airlines and we made arrangements for care at the landing site. Airlines are in the business of transporting people from one place to another. I believe they have a responsibility to prepare for people emergencies as well as flight emergencies. However, the choice to take a risk to fly should remain with the person flying. The only people restricted from flying should be those who present a threat to other passengers, like terrorists and those with life threatening communicable diseases.

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7 Are there causes other than allergy and heredity that cause recurrent facial or labial swelling?
By Najla Dar-Odeh · University of Jordan

Najla Dar-Odeh · University of Jordan

Thank you Franҫois for the informative answer. I think that I should check the C1 esterase inhibitor and C4 as you suggested. It may well be attribut... [more]

Thank you Franҫois for the informative answer. I think that I should check the C1 esterase inhibitor and C4 as you suggested. It may well be attributed to allergy.What drew my attention was the color of her oral mucosa. I have not seen in my whole life a brightly red oral mucosa, and the tongue was red, enlarged and fissured. This made me think of amyloidosis although the swelling is recurrent and not persistent.

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18 Is the greatest medical challenge in today's society to develop a more humane system, where human diseases are respected for what they are?
By Geir Bjorklund · Umeå University

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8 Why is it that many preventive tests and interventions don't get performed as preventive measures?
By Oleg Nekrassovski · Royal Military College of Canada

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34 Why does oral cancer in non-smoking females have a worse prognosis than that affecting male smokers?
By Najla Dar-Odeh · University of Jordan

Najla Dar-Odeh · University of Jordan

Thank you Ahmad. I first thought that delayed diagnosis is the reason behind poor prognosis. I asked this question to know if there are other reasons.... [more]

Thank you Ahmad. I first thought that delayed diagnosis is the reason behind poor prognosis. I asked this question to know if there are other reasons. The article I pointed out to (Koo et al, 2013) supports genetic and other reasons that worsen the prognosis. Contrary to what I used to believe, if HPV is implicated in etiology, it worsens the prognosis! I think that researchers should focus on this type of oral cancer because its victims may increase with time.

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New How do we do a primary mouse endothelial cell culture from kidney for a fibrogenesis and endothelial mesenchymal transition study?
The Endothelial cells (HMVEC cells) require various growth factors for its growth. How can it be grown in the conditional media containing negligible ... [more]

The Endothelial cells (HMVEC cells) require various growth factors for its growth. How can it be grown in the conditional media containing negligible amount of growth factors? I think, to study in primary culture is the best way for that. If you have any appropriate way to study, will you please let me know?

By Swayam Srivastava · Kanazawa Medical University

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6 What are the research challenges in data mining for anomaly detection
By Deepthi Prasad · B. N. M. Institute of Technology

Michael Kemmler

Parameter tuning is a big problem, especially in cases where anomalies only occur during test time, which is often the case for really practical probl... [more]

Parameter tuning is a big problem, especially in cases where anomalies only occur during test time, which is often the case for really practical problems.

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17 How to promote research work and scholarly activity in a busy clinical residency program?
By Jason Chan · Singapore Health Services

varun pratap Singh · BP KOIRALA INST OF HELATH SCIENCES

I feel research training is a important component of any residency program. The problem cited here is mostly with clinical program mes where residents... [more]

I feel research training is a important component of any residency program. The problem cited here is mostly with clinical program mes where residents have to attend to a huge number of patients. But at the same time i feel clinical research is best suited in these conditions. Efforts can be made by instituting compulsory participation in certain clinical trials during course of study. Further various treatment commonalities should be supported by current evidences and residents should be encouraged to look after novel approaches and latest advances. A research component can be introduced in the curriculum , let it be a simple clinical audit regarding services, quality of care , patient satisfaction , this will render a platform for research as well as help improve quality of care

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94 Are medical errors a sign of incompetence among physicians or can it be reduced through change in medical culture or attitude of the medical professionals?
By Geir Bjorklund · Umeå University

Kurubaran Ganasegeran · Management and Science University

Current dogmas argue that medical errors are inevitable in practice. Modern medical practice requires health professionals of high competency. With th... [more]

Current dogmas argue that medical errors are inevitable in practice. Modern medical practice requires health professionals of high competency. With the influx of patients and paradigm shift towards patient centred care in many public health facilities and health institutions worldwide, medical professionals are spiked with psychological stress and emotional burnout. These are more prevalent in modern medical practice, as well as in residency training. Studies have found significant correlations between these triadic factors of stress, burnout and medical errors. Indeed, an in-depth approach of possibly amending the Medical Act, which varies between country and regions, should be taken into consideration, and possibly amalgamating a more tolerant and flexible work nature to overcome medical professionals burnout and stress. Stress coping strategies, discussion during pass-over the next working day to understand previous day work challenges and difficulties; thus recording previous mistakes and weaknesses will help to prevent medical errors. As mused Osler, the Father of Modern Medicine, that medicine is a science of uncertainty and an art of probability, possible approach and correct intervention to patients will only be adopted over time with extensive practice and experience; thus reducing medical errors.

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322 What is the best treatment for fibromyalgia?
By Martha Garcia-Ramirez · National Polytechnic Institute

Max Chartrand · Northcentral University

Good system, Henry, and far better than what we see in most areas of the US. We are more cautious on certain drugs (opiates and neuroleptics, for exam... [more]

Good system, Henry, and far better than what we see in most areas of the US. We are more cautious on certain drugs (opiates and neuroleptics, for example) as their usefulness is very, very short-term compared to the long-term risks of addiction and unintended consequences. In truth, opiates beyond two weeks are not effective for this type of pain management--as a result of the entire medical system not recognition its very stark limitations and serious risks we have millions of pain pill junkies, legal and illegal, creating one of the FBI's largest law enforcement challenges and people who will commit suicide several times more frequently than non-users. I am attaching one of my consumer monographs here for anyone that is interested in the low-down on that aspect. It is so important to approach, as you've well noted, such complex syndroomes and learned behaviors as rehab conditions not as acute conditions. The goal, then, is not to get rid of the pain, but to get rid of the underlying cause and self-perpetuating behaviors. If pain was the goal, we would be like a cat chasing our tail, ever moving but never getting anywhere. Thank you for your cogent remarks and adding great insights into the question at hand.

CGSIRCLE-TruthAboutPainKillersMonograph(WikipediaVersion).pdf ×

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80 What are the qualities of a good doctor?
By Armin Hirbod-Mobarakeh · Tehran University of Medical Sciences

Diana Rodríguez Hurtado · Universidad Peruana Cayetano Heredia

Dear Armin: I think this article is interesting: Good Physicians from the perspective of their patients. Ami Schattner, Dan Rudin and Navah Jellin. B... [more]

Dear Armin: I think this article is interesting: Good Physicians from the perspective of their patients. Ami Schattner, Dan Rudin and Navah Jellin. BMC Health Services Research 2004, 4:26 The conclusions of this study were: Patients studied want their physicians to be highly professional and expert clinicians and show humaneness and support, but their first priority is for the physician to respect their autonomy. Sincerely. Diana Rodríguez Hurtado M.D F.A.C.P

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2 Is there any standardized measurement system for measuring spasticity ?
By Balamurugan L · American Society of Mechanical Engineers

Deborah Brandt · Rocky Mountain University of Health Professions

http://en.wikipedia.org/wiki/Parkinson%27s_disease This is a discussion of Parkinson's Disease and may answer some of your questions. http://www.sl... [more]

http://en.wikipedia.org/wiki/Parkinson%27s_disease This is a discussion of Parkinson's Disease and may answer some of your questions. http://www.slideshare.net/gavinyap/descending-tract-diagram-final This discusses the pyramidal and extrapyramidal tracts. Parkinson's disease is associated with an extrapyramidal tract lesion and spasticity with a pyramidal tract lesion. I do not think it would be appropriate to evaluate a patient with Parkinson's with a measure that is designed to evaluate spasticity. I am a physical therapist and have evaluated people with rigidity and people with spasticity. They feel different to the touch. When passively moving a limb through it's range of motion, spasticity increases with increase in the speed of motion and with speed of changes between flexion and extension of the limb. The rigidity (amount of resistance) in the muscle of a person with Parkinson's, does not change with speed or motion. I hope I have understood your question correctly and that this is helpful.

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97 Are we really drifting towards pre-antibiotic era in view of fast developing antibiotic resistance in pathogens against the current antibiotics?
By Ashok Dubey · Netaji Subhas Institute of Technology

Kambiz Hamadani · University of California, Berkeley

I think Caterina's idea to put our thoughts down on paper might be helpful and useful.

I think Caterina's idea to put our thoughts down on paper might be helpful and useful.

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3 What is your opinion of the biochemical or physiological definition of 'natural death'?
By Rob Streeper · BTNS

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5 Is it still clinically relevant to include antibiotics like amoxicillin and cotrimoxazole, into the empirical treatment regiment for bacterial sepsis?
By Filippus Tshavuka · Polytechnic of Namibia

Ben Olwe · Walden University

Filippus, The choice of an antibiotic depends on many factors, the principle factor being the causative agent. The second factor depends on the preval... [more]

Filippus, The choice of an antibiotic depends on many factors, the principle factor being the causative agent. The second factor depends on the prevalence of drug resistance; for example, Methicillin should not be prescribed in when there is a geographic area with high-prevalence of MRSA. Likewise, empirical TX of a PTB suspect with Isoniazid and Rifampin should be discouraged when treating pts from countries with high prevalence of MDR-TB or XDR-TB. Finally, the choice of an antibiotic should be guided by drug susceptibility tests (DSTs). Thanks, Ben

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4 To what extent can we use rapid test kits for research purposes?
By Ahed Alkhatib · Jordan University of Science and Technology

Ahed Alkhatib · Jordan University of Science and Technology

Thanks for followup

Thanks for followup

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39 Do you calculate salt intake real for hypertension control in your daily activity?
By Manuel Ortega · Servicio Andaluz de Salud

François Brivet · Université Paris-Sud 11

I am not sure that daily 15 grams of sodium chloride is not armful in case of hypertension. I think that a low salt intake, about six grams ( normal... [more]

I am not sure that daily 15 grams of sodium chloride is not armful in case of hypertension. I think that a low salt intake, about six grams ( normal cooking, whitout adding salt during the meal), is perfectly accepted by the patients if they use flavorful herbs, pepper; Furthermore, if they are addict to cheese to eat them with salad instead of bread, which be useful for bodywheigt control . Nearly a cooking class ... during the consultations

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7 Is there any pubMed indexed journal which accepts videos along with medical case reports?
By Gyanshankar Mishra · Government Medical College, Nagpur

Patricia Kahn · Doctors Without Borders

I second the idea of asking for a waiver--most open access journals are receptive to requests coming from low- or middle-income country researchers. T... [more]

I second the idea of asking for a waiver--most open access journals are receptive to requests coming from low- or middle-income country researchers. The author guidelines usually describe how to do this; for BMC's Journal of Medical Case Reports see www.jmedicalcasereports.com/about/apcfaq/waivers. Good luck!

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36 How does one deal with stress in medicine?
By Sonali Vadi · Global Hospitals Group

Delphina Gurav · Balabhai Nanavati Hospital

Well said Harita, I know some Doctors who have not swayed with the flow of unhealthy and adulterated practice and may be have not reached the heights ... [more]

Well said Harita, I know some Doctors who have not swayed with the flow of unhealthy and adulterated practice and may be have not reached the heights matching the competitive world, but at the end of the day have peaceful sleep and a stress free satisfactory life. Being truthful to self and serving with dignity matters a lot, may it be any profession.

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11 What is the current role of Wikipedia in Medical Knowledge?
By Jessica Eberhard · University of South Florida

Sagar Borle · Glasgow Caledonian University

A quick reference for brief understanding but cannot be used as primary reference in any major research work.But one can adapt pictures and pictoral p... [more]

A quick reference for brief understanding but cannot be used as primary reference in any major research work.But one can adapt pictures and pictoral presentations given as a part of explanation in any topic. Also you can cross refer the references which are given below which gives a good initial start for the study.

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3 What are the opinions on an implantable cardioverter defibrilator deactivation in a patient with terminal heart failure?
By Eva Goncalvesova · The National Institute of Cardiovascular Diseases - Národný ústav srdcových a cievnych chorôb, a. s.

François Brivet · Université Paris-Sud 11

a recent study may be helpful for this discussion: J Med Internet Res. 2013 May 30;15(5):e106. doi: 10.2196/jmir.2587. Cost-Utility Analysis of the ... [more]

a recent study may be helpful for this discussion: J Med Internet Res. 2013 May 30;15(5):e106. doi: 10.2196/jmir.2587. Cost-Utility Analysis of the EVOLVO Study on Remote Monitoring for Heart Failure Patients With Implantable Defibrillators: Randomized Controlled Trial. Zanaboni P, Landolina M, Marzegalli M, Lunati M, Perego GB, Guenzati G, Curnis A, Valsecchi S, Borghetti F, Borghi G, Masella C. Source:Norwegian Centre for Integrated Care and Telemedicine, University Hospital of North Norway, Tromsø, Norway. paolo.zanaboni@telemed.no. " RESULTS : Overall, remote monitoring did not show significant annual cost savings for the health care system (€1962.78 versus €2130.01; P=.80). There was a significant reduction of the annual cost for the patients in the remote arm in comparison to the standard arm (€291.36 versus €381.34; P=.01). Cost-utility analysis was performed for 180 patients for whom QALYs were available. The patients in the remote arm gained 0.065 QALYs more than those in the standard arm over 16 months, with a cost savings of €888.10 per patient. Results from the cost-utility analysis of the EVOLVO study show that remote monitoring is a cost-effective and dominant solution. CONCLUSIONS: Remote management of heart failure patients with implantable defibrillators appears to be cost-effective compared to the conventional method of in-person evaluations."

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