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November 25, 2014

Why Aren't Medical Research Papers Available for Free?

Policy Guidelines for the Development and Promotion of Open Access, UNESCO
Medical research abstracts are freely available to read from databases like pubmed, but if you want to read the entire paper, only very rarely are they available for free. That's a big bummer for small community physicians as well as lay public who want to know more about a particular medical condition or research findings.

Your options are to drive to a medical school library and copy it... or contact one of the authors and "beg" them to send you a copy (for free)... or buy it from the publisher for $15 to as much as $100 per article.

For those belonging to other scientific disciplines like physics, many of the research articles are available for free as part of the Open Access movement. If you look at the graph, you can see that Clinical Medicine is quite pathetic when it comes free literature.

There is some movement to make medical papers more available, especially when the National Institute of Health in 2008 mandated that any research funded through its grants must be made freely available to the public one year after publication (given it was paid for with taxpayer money). Also, the Gates Foundation has similarly mandated by 2017 that any research funded through its grants must be made publicly available immediately. However, more needs to be done...

As long as medical schools and healthcare organizations are willing to pay big bucks to purchase these expensive journals, I am doubtful that much else will become free for anybody to read.

Of course, there has also been research in how to make scientific publications available for free which you can read more about here.

November 24, 2014

Video of Lempert (BBQ Roll) to Treat BPPV (Horizontal Canal)


This is the fourth in a series of videos our practice is producing on inner ear dizziness. This video demonstrates how the Lempert maneuver is performed to treat horizontal (or lateral) canal BPPV. The Lempert maneuver is also known as the barbecue roll. Also demonstrated is what happens within the inner ear when the maneuver is performed correctly. The first video was on how the inner ear balance system works which can be watched here.

The second video was on the Dix-Hallpike maneuver to diagnose BPPV and which canal type.

The third video was on the Epley maneuver to treat POSTERIOR canal BPPV.

Soon to come are two more videos specifically regarding treatment of superior canal BPPV and Meniere's Disease.

November 21, 2014

Young Girl from 0 to 14 Years Old in 4 Minutes


We all have seen an abbreviated version of this video on TV commercials, but here's the complete video showing a beautiful young girl go from age zero to 14 years in 4 minutes. This time lapse video was taken by filming her for 15 seconds every week from the day she was born. Simply amazing!

November 20, 2014

Hearing the Same Sound at Different Pitches (Diplacusis)

Image courtesy of Stuart Miles at
One day, a musician patient presented to my clinic with a history of hearing the same pitch that sounded significantly differently between the ears. An A# sound in one ear sounded a half-tone lower in the other. This resulted in music sounding out-of-tune.

This phenomenon is known as diplacusis and there are several different flavors.

Diplacusis binauralis occurs when you hear the same sound differently in each ear. This condition is also known as interaural pitch difference IPD. The why and how is complex and more info can be obtained here. Related to diplacusis binauralis, diplacusis dysharmonica is when the sound is perceived normally in one ear and at a different pitch to the other.

Diplacusis echoica is when you hear the same sound repeated as an echo in the affected ear. This condition is typically due to middle ear pathology.

Diplacusis monauralis occurs when one ear hears the same sound as two different sounds at the same time.

Treatment depends on what type of diplacusis is present and localizing the source of the problem leading to the diplacusis. Typically, this would entail an examination of the ear followed by a hearing test. At that point, treatment or further testing may be required.

More info on this condition can be found here.

November 18, 2014

Sulfa vs Sulfate vs Sulfur vs Sulfite Allergy

Having a "sulfa" allergy is quite common... What is uncommon is understanding that being "sulfa" allergic does not necessarily mean that one is also allergic to sulfates, sulfur, and sulfites. Also, when a patient states that have a sulfa allergy, they typically mean is that they have a "sulfonamide" allergy.

Why is this understanding of significance? It's because there is confusion whether a patient with a sulfa allergy can take sulfate containing medications safely. In the ENT world, that commonly means whether a patient can take cortisporin antibiotic ear drops which contains neomycin sulfate, polymyxin B sulfate, and hydrocortisone 10 mg (1%).

The answer is YES... a patient with a sulfa (sulfonamide) drug allergy can safely take drugs containing sulfate which is a completely different unrelated compound. They are NOT the same thing.

For that matter, sulfa allergic individuals should not be considered to be allergic to sulfur and sulfite containing substances either. Sulfite is a common preservative and can be found in small amounts in many fruits and vegetables (see below).

Sulfate allergy does not exist as far as I know, but it can act as a chemical irritant. Same goes for sulfur. Sulfite allergy does exist thru a non-immune mediated mechanism, but is exceedingly rare.

Here's a list differentiating common sulfa, sulfate, sulfur, and sulfite containing substances:

Sulfa (Sulfonamide)
• Bactrim antibiotic
• Sulfacetamide antibiotic eye drops
• Sulfasalazine used to treat IBS
• Thiazide diuretics
• Lasix diuretic
• Gyburide and Glipizide medications for diabetes

Sulfate Containing Drugs/Substances
• Cortisporin ear drops
• Heparin
• Dextran
• Morphine
• Soaps and Detergents (sodium lauryl sulfate)

Sulfite Containing Substances
• Lettuce, avocados, mushrooms
• Grapes, lemon, lime
• Wine
• Peppers, onions, pickles

Sulfur Containing Substances
• Fertilizer

So to summarize, people who react to sulfites do not need to avoid sulfates or sulfur.

People who react to sulfa do not need to avoid sulfites, sulfates or sulfur.

November 17, 2014

How Much Bacteria Gets Transferred During Intimate Kissing?

Researchers in the Netherlands quantified how much bacteria gets transferred from one person to another during an intimate kiss (tongue on tongue action). What they found was that an average of 80 million bacteria gets transferred per 10 seconds of French kissing.

How did they come up with this figure?

Samples were obtained both before and after an intimate kiss of 10 seconds duration. One partner was  than asked to consume 50 ml of a probiotic yoghurt drink which contained organisms not normally found in the mouth, and again tongue and saliva samples were collected before and after a second intimate kiss. An estimate of the number of bacterial transfer was than determined by tracking probiotic bacterial markers.

Clearly, based on these results, one would expect (and this same study confirmed) that intimate partners have similar oral bacterial content compared to unrelated individuals.

This information may explain how kissing may result in HPV being transferred from one partner to another [link]. HPV has now been linked to being one of the most common causes of oral and throat cancer in young adults.

Shaping the oral microbiota through intimate kissing. Microbiome 2014, 2:41. doi:10.1186/2049-2618-2-41
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