Kaleidoscope #3: 2011 Wk 12

23 03 2011

It has been long since I have posted a Kaleidoscope post with a “kaleidoscope” of facts, findings, views and news gathered over the last 1-2 weeks. There have been only 2 editions: Kaleidoscope 1 (2009 wk 47) and 2 (2010 wk 31).

Here is some recommended reading from the previous two weeks. Benlysta (belimumab) approved by FDA for treatment of lupus.

Belimumab is the first new lupus drug approved in 56 years! Thus, potentially good news for patients suffering from the serious auto-immunity disease SLE (systemic lupus erythematosus).  Belimumab needs to be administered once monthly via the intravenous route. It is a fully human monoclonal antibody specifically designed to inhibit B-lymphocyte stimulator (BLyS™), thereby reducing the number of circulating B cells, and the produced ds-DNA antibodies (which are characteristic for lupus).
Two clinical trials showed that more patients experienced less disease activity when treated with belimumab compared to placebo. Data suggested that some patients had less severe flares, and some reduced their steroid doses (not an impressive difference using “eyeballing”). Patients were selected with signs of B-cell hyperactivity and with fairly stable, but active disease. Belimumab was ineffective in Blacks, which are hit hardest by the disease. The most serious side effect were infections: 3 deaths in the belimumab groups were due to infections.
Thus, overall the efficacy seems limited. Belimumab only benefits 35% of the patients with not the worst form of the disease. But for these patients it is a step forward.

  1. Press Announcement (fda.gov).
  2. Navarra SV, Guzmán RM, Gallacher AE, Hall S, Levy RA, Jimenez RE, Li EK,Thomas M, Kim HY, León MG, Tanasescu C, Nasonov E, Lan JL, Pineda L, Zhong ZJ, Freimuth W, Petri MA; BLISS-52 Study Group. Efficacy and safety of belimumab in patients with active systemic lupus erythematosus: a randomised, placebo-controlled, phase 3 trial. Lancet. 2011 Feb 26;377(9767):721-31. Epub 2011 Feb 4. PubMed PMID: 21296403.
  3. Belimumab: Anti-BLyS Monoclonal Antibody; Benlysta(TM); BmAb; LymphoStat-B. Drugs in R & D (Open Access): 28 May 2010 – Volume 10 – Issue 1 – pp 55-65 doi: 10.2165/11538300-000000000-00000 Adis R&D Profiles (adisonline.com)

Sleep-deprived subjects make risky gambling decisions.

Recent research has shown, that a single night of sleep deprivation alters decision making independent from a shift in attention: most volunteers moved from seeking to minimize the effect of the worst loss to seeking increased reward. This change towards risky decision making was correlated with an increased brain activity in brain regions that assess positive outcomes (ventromedial prefrontal activation) and a simultaneous decreased activation in the brain areas that process negative outcomes (anterior insula). This was assessed by functional MRI.

One co-author (Chee) noted that “casinos often take steps to encourage risk-seeking behavior — providing free alcohol, flashy lights and sounds, and converting money into abstractions like chips or electronic credits”

Interestingly, Chee also linked their findings to empirical evidence that long work hours for medical residents increased the number of accidents. Is a similar mechanism involved?

  1. Venkatraman V, Huettel SA, Chuah LY, Payne JW, Chee MW. Sleep deprivation biases the neural mechanisms underlying economic preferences.  J Neurosci. 2011 Mar 9;31(10):3712-8 (free full text)
  2. Sleep deprived people make risky decisions based on too much optimism (Duke Healthpress release)

Grand Rounds

Grand Rounds is up at Better Health. Volume 7, Number 26 is an “Emotional Edition” where posts are organized into emotion categories. My post about the hysteria and misinformation surrounding the recent Japanese earthquake is placed under Outrage.

There are many terrific posts included. A few posts I want to mention shortly.

First a post by a woman who diagnosed hers and her sons’ disease after numerous tests. Her sons’ pediatrician only tried to reassure, so it seems. (“don’t worry…”).

I was also moved by the South African surgeon, Bongi, who tells the tragic story of a missed diagnosis that still haunts him. “For every surgeon has a graveyard hidden away somewhere in the dark recesses of his mind…”

Bongi’s blog Other Things Amanzi is one of my favorites. Another blog that has become one of my favs is 33 Charts by Dr. Bryan Vartabedian. Included in this Grand Round is “And a child will lead them“. It is a beautiful post about the loss of a young patient:

….”And facing Cooper’s parents for the first time after his passing was strangely difficult for me.  When he was alive I always had a plan.  Every sign, symptom, and problem had a systematic approach.  But when faced with the most inconceivable process, I found myself awkwardly at odds with how to handle the dialog”….

Other Medical Blogs

Another of my recent fav blogs is the blog of cardiologist, dr. Wes. Two recent posts I would especially like to recommend.

The first asks a seemingly simple question: “So which set of guidelines should doctors use?” The answer, however,  may surprise you.

In another post dr Wes describes the retraction of an online-before-print case report entitled “Spontaneous explosion of implantable cardioverter-defibrillator” with dramatic pictures of an “exploded ICD” .(here is the PDF of the cache). This retraction took place after dr. Wes reported the case at his blog. Strange enough the article was republished this February, with another title, “Case report of out-of-hospital heat dissipation of an implantable cardioverter-defibrillator.” (no explosion anymore) and no shocking photos. Food for thought….  The main conclusion of dr Wes? Independent scientific peer-reviewed journals might not be so independent after all. Library matter

Sorry, but I had to laugh about David Rothman’s Common Sense Librarianship: An Ordered List Manifesto. As put it so well by Kathryn Greenhill at her blog Librarians Matter: “It is a hot knife of reason through the butterpat of weighty bullshit that often presses down as soon as we open our mouths to talk about our profession.”

Oh, and a big congrats to Aaron Tay for his  Library Journal moversShakers award. Please read why he deserves this award. What impresses me the most is the way he involves users and converts unhappy users “into strong supporters of the library”. I would recommend all librarians to follow him on Twitter (@aarontay) and to regularly read his blog Musings about Librarianship. Web 2.0

The iPad 2 is here. A very positive review can be found at Techcrunch. The iPad 2 has a camera, is thinner, lighter, and has a much more powerful dual-core chip. Still many people on Twitter complain about the reflective screen. Furthermore the cover is stylish but  not very protective as this blogger noticed 2 days after purchase.
Want to read further: You might like “iPad 2: Thoughts from a first time tablet use” (via @drVes)

It has been five years since Twitter was launched when one of its founders, Jack Dorsey, tweeted “just setting up my twttr’. Now Twitter nearly has 200 million users who now post more than a billion tweets every week. (see Twitter Blog)

Just the other week  Twitter has told developers to stop building apps. It is not exactly clear what this will mean. According to The Next Web it is to prevent confusion of consumers third-party Twitter clients and because of privacy issues. According to i-programmer the decision is mainly driven by the desire of Twitter to be in control of its API and the data that its users create (as to maximize its -future- revenue). I hope it won’t affect Twitter-clients like Tweetdeck and Seesmic, which perform much better (in my view) than Twitter.com.

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One response

24 03 2011
Aaron Tay

Hi Jacqueline

Thanks a lot for your kind words.

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