Scientific Research

Subarachnoid Hemorrhage: A Rational Approach

In October of 2010 the prestigious British Medical Journal published the largest, and by far the best, study ever done on the diagnosis of...

SMART Testing

In medicine we love us a good diagnostic test; we're always looking for the next one. It is strange, then, that we should be...

SMART Thrombolytics for Acute Stroke

This week The Lancet published the largest ever randomized trial of thrombolytics for acute stroke. Hands are wringing, teeth are gnashing, and department heads are fighting. It...

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Food to be taken to avoid breast cancer

Vegetables For Cancer

Breast cancer is on the rise – from celebrities to common women, no one has been spared from the wrath of breast cancer. Apart from your lifestyle, your diet plays a vital role in the prevention and reduction of your risk to breast cancer. So what are the foods you need to make sure you eat to keep fit and healthy and kill off those cancer cells?

    1. Garlic: This staple in every Asian, Italian and Thai cuisine, garlic is loaded with antioxidants that destroy all free radicals right there. So what is the preferred manner of garlic intake? You can opt for raw garlic; it has its properties intact and is more effective than it’s cooked counterpart!
    2. Green leafy vegetables: Including a portion of these vegetables in your diet will surely ward off your cancer risk. Every member of the green leafy family is ideally suited to keep your hale, hearty and protected from not only cancer but a whole lot of other diseases.
    3. Salmon: A powerhouse of vitamin B12 and Omega 3 fatty acids, Salmon, is the best bet to place on when it comes to the destruction of cancer cells in your body. Vitamin B12 has shown successful results when used to treat cancer patients. SO why not include it in your diet way ahead to increase your cover against cancer?
    4. Carotenoids: Any fruits and vegetables that are in bright colors – green, yellow, red and orange- are loaded with carotene which is effective in tackling with cancer cells. So on your next trip to the superk=market, make sure you pic carrots, tomatoes, apricots, and their likes
    5. Turmeric: A pinch of turmeric in a glass of warm milk – it’s enough to keep all diseases at bay. More importantly, turmeric consists of curcumin, which primarily fights against cancer cells at destroyed them at the inception itself.
    6. Fruits: Especially foods rich in Vitamin C are perfect – they are loaded with anti-oxidants which are high to boost your immunity against cancer cells. A bit of vitamin C is essential every day, and make sure you keep replenishing your vitamin C reserves on a daily basis.
    7. Cruciferous vegetables: This family is rich in vitamins C, E and K and are perfect to intensify your fight against cancer cells and destroy them right there. The members of this family include the humble cauliflower, sister cabbage, broccoli, and Brussels sprouts. Add them into your diet regime right away!

Greatest Medical Innovations


Antibodies (1796)

All through the 1800s and mid 1900s, different inoculations were made to battle a portion of the world’s deadliest illnesses, including smallpox, rabies, tuberculosis, and cholera. Through the span of 200 years, one of the deadliest illnesses known to man – the little pox – was wiped off the essence of the earth. Today, antibodies keep on sparing a large number of lives every year – including punches that secure against destructive influenza strains and can help keep a few malignant growths.

Anesthesia (1846)

Before the principal utilization of a general soporific in the mid-nineteenth century, medical procedure was attempted just if all else fails, with a few patients deciding on death as opposed to bearing the unbearable trial. Despite the fact that there were endless prior tests with anesthesia dating as far back to 4000 BC – William T. G. Morton left a mark on the world in 1846 when he effectively utilized ether as a soporific amid medical procedure.

Disease Identified

Germ hypothesis (1861)

Before the ‘germ’ hypothesis occurred, doctors of the time felt that ailment could show up out of nowhere, instead of being air-borne or exchanged by means of skin-to-skin contact. In 1861, French microbiologist Louis Pasteur demonstrated through a basic examination that irresistible sickness was an aftereffect of an attack of particular infinitesimal life forms – otherwise called pathogens – into living hosts.

Therapeutic imaging (1895)

The principal restorative imaging machines were X-beams. The X-beam, a type of electromagnetic radiation, was ‘coincidentally’ developed in 1895 by German physicist Wilhelm Conrad Rӧntgen while trying different things with electrical flows through glass cathode-beam tubes. The disclosure changed prescription medium-term and by the next year, Glasgow healing facility opened the world’s first radiology division.

Penicillin (1928)

Alexander Fleming’s penicillin, the world’s first anti-toxin, totally changed the war against lethal microscopic organisms. Broadly, the Scottish scientist inadvertently found the counter bacterial ‘shape’ in a petri dish in 1928. In any case, Fleming’s unfathomable discoveries were not legitimately perceived until the 1940s, when they started being mass-created by American medication organizations for use in World War II. Two different researchers were in charge of the mass appropriation of penicillin, Australian Howard Florey and Nazi-Germany evacuee Ernst Chain, and their advancement of the substance wound up sparing a great many future lives.


Organ transplants (1954)

In December 1954, the primary fruitful kidney transplant was done by Dr Joseph Murray and Dr David Hume in Boston, USA. In spite of numerous past endeavors ever, this was the main case where the beneficiary of an organ transplant survived the task. The defining moment came when different specialized issues were survived, for example, vascular anastomosis (the association between two veins), position of the kidney and safe reaction.

Antiviral medications (1960s)

Awful infections, for example, little pox, flu and hepatitis have attacked numerous human populaces from the beginning of time. In contrast to the general achievement of anti-microbials in the late 1940s, the improvement of antivirals did not by any means take off until the 1960s. This was for the most part because of the structure of an infection, which was a center of hereditary material encompassed by a defensive protein coat that covers up and replicates inside a man’s cells. As the infection data is so secured, it was hard to treat them without harming the host cell.

Top 10 Deadliest Diseases In The World

PET Image

1. Coronary Arterya Disease

CAD is where vessels providing blood to the heart end up limited. This is normally caused by undesirable slimming down and smoking. The World Health Organization (WHO) gauges that CAD has guaranteed about 7.4 million lives in 2012. That adds to about 12.8% of all passings universally.

2. Stroke

A stroke happens when a course providing blood to the mind is blocked or spilled. The oxygen-denied cells bite the dust close to the blockage. As per WHO, an expected 6.7 million lives are lost to strokes in 2012. This adds to about 10.8% all things considered.

3. Lower Respiratory infections

LRI incorporates flu, bronchitis, and pneumonia. This season’s flu virus season is for the most part predominant in the colder portion of the year for every side of the equator. The WHO assesses that LRI adds to about 6.1% all things considered.

4. Chronic Obstructive Pulmonary Disease

This disease influences the lungs, making it more troublesome for the patient to relax. The primary driver of COPD is tobacco utilize, including second hand smoke. The WHO evaluates that COPD has asserted 3.28 million lives in 2012, which adds to about 5.8% of all passings around the world.Imaging

5. Diarrheal Diseases

Looseness of the bowels is portrayed by discharging fecal issue in excess of three times each day. Having looseness of the bowels throughout a couple of days drains the waterway and salt. The WHO gauges that diarrheal diseases has asserted 2.46 million lives in 2012. It is the second driving reason for death of kids under 5. This adds to about 4.3% of all passings comprehensively.


AIDS is caused by the Human Immunodeficiency Virus (HIV) which is transmitted through natural liquids. HIV enters the body and commandeers T cells which at that point bargains the insusceptible framework. In 2012, about 1.78 million individuals kicked the bucket because of AIDS. This adds to about 3.1% all things considered. It is evaluated that more than 5000 individuals end up contaminated each day.

7. Respiratory Cancers

This class of diseases incorporate lung, tracheal, and bronchial malignancies. The fundamental driver of these diseases are contamination by smoking, used smoking, and different cancer-causing agents as a waste side-effect. An expected 1.39 million individuals have passed on in 2012 from respiratory diseases which adds to about 2.4% everything being equal.

8. Tuberculosis

Tuberculosis (TB) is a bacterial contamination caused by Mycobacterium tuberculosis. Constriction of TB is airborne, however it is hard to get. It is one of the main sources of death for individuals combined with HIV. An expected 1.34 million individuals have tumbled to TB in 2012, adding to about 2.4% all things considered.

9. Diabetes Mellitus

Diabetes Mellitus Type I is portrayed by the pancreatic cells or minuscule delivering insulin or the generation is minuscule. In sort II diabetes, cells lose affability to insulin, in this way getting to be flexible. Type I diabetes can’t be relieved, however type II diabetes can be kept up with a legitimate eating regimen and exercise. An expected 1.26 million individuals have lost their lives to complexities with diabetes in 2012, which adds to about 2.2% everything being equal.

10. Prenatal birth complications

Despite the fact that not a disease, an expected 1 million newborn children are lost to due to pre-development and low birth weight. Most deaths happen after the main seven day stretch of imagining. These complexities for the most part influence creating nations where therapeutic consideration isn’t accessible or is hard to reach. The WHO evaluates that PBC adds to about 1.8% all things considered.

11. Peripheral Neuropathy

Nerve pain affects your feet, arms, legs, and hands. It is a painful condition, which shoots sharp pain in the joint with others experiencing a burning sensation. This condition can disrupt your routine and life, causing you to miss work and preventing you from enjoying day-to-day activities. What makes this condition so deadly is the potential for serious foot injuries due to the numbness and lack of sensation. While there are some natural treatments and supplements like Nerve Renew which can help slow the condition and reduce symptoms, there is no cure.

The Guideline, The Science, and The Gap


The recent release of the American College of Emergency Physicians guideline recommending the use of tPA for ischemic stroke is remarkable. While it is unsurprising that a professional guideline flouts science, the publication is striking for its casual tone and its methodologically inexplicable review of evidence. Scientific thinking is absent. Below, therefore, is a brief description of the relevant data, through the lens of science.

Karl Popper, a 20th century economist and philosopher, is the father of modern scientific thinking. He taught us what we now believe to be obvious: that we find truth by testing theories. More specifically, by proving theories wrong.

I see a goose, the goose is white. I generate a theory: all geese are white. If I find one black goose, I can claim truth: all geese are not white. Alternatively, if I find only white geese, my theory is “supported.” There are no proven theories, just supported ones, for we cannot find every goose. This is why we refer to Einstein’s ‘theory of relativity’, or Darwin’s ‘theory of evolution’. They are theories—strongly supported and never disproved, but theories nonetheless.

One theory we have tried many times to disprove, is this: thrombolytics are beneficial for patients with ST-elevation myocardial infarction. In studies of more than 60,000 subjects there is consistent, and unfailing, support for this theory. This theory has the weight of science.

And what of thrombolytics for acute stroke, with trials of 10,000 subjects? On SMART EM last year we examined the theory that thrombolytics benefit acute stroke patients. With a nod to Karl Popper and the logic of science, here is what we found:

In the first major study, the Multicenter Acute Stroke Trial in Italy (MAST-I), streptokinase increased mortality when given within six hours of symptom onset, but also led to a small decrease in disability among survivors. In ECASS-1 which followed, results were the same with t-PA. Later the ASK trial (within 4 hours), and MAST-Europe (6 hours) both increased mortality with streptokinase. Next, the ATLANTIS studies (‘A’ and ‘B’) and ECASS-2 used t-PA within 5 and 6 hours. Again, despite small decreases in disability, deaths increased.

Karl Popper might say that the theory of thrombolytic benefit for acute stroke was disproved—seven times. But hope springs eternal and despite the trade-off of increased mortality, the allure of decreased disability was present. Theory-testing marched forward, with a focus on avoiding the increase in deaths while maintaining the decrease in disability.

In 1995 the two NINDS studies were published, using t-PA within 3 hours in carefully selected patients. In NINDS-1 outcomes were measured at 24 hours and there was no benefit. This was followed by NINDS-2, in which the same investigators shifted the measurement to 90 days, tried again, and showed a 12% decrease in disability, but with no increase in death. It was the first trial showing overall benefit.

Now, results of trials were conflicting. A new theory was needed, both to both explain previous failures and to allow further testing. Thrombolytic supporters theorized that NINDS had used just the right mix, and proposed a new theory: ‘t-PA is beneficial in younger patients with lesser strokes, before 3 hours, but harmful if given after 3 hours or to other patients’.

Then came ECASS-3, which enrolled similar patients and showed a 7% reduction in disability with no increase in death. But the t-PA was administered exclusively after 3 hours and before 4.5 hours. This undermined the theory that time explained early failures, but it supported the patient selection of NINDS. Thus, a new theory emerged: t-PA is beneficial in younger patients with lesser strokes, before 4.5 hours, but harmful if given after 4.5 hours or to other patients.

In June of this year results of the largest ever study, the International Stroke Trial-3, were released. Disappointingly, the trial showed no benefit of t-PA (even despite being unblinded). Notably, however, those treated with t-PA between 0 and 3 hours fared best, while the 3 to 4.5 hour group fared worst. Moreover, those treated after 4.5 hours and up to 6 hours did roughly as well as the 0-3 hour group. And most disconcerting, those over age 80 and those with severe strokes benefited most.

If we were Karl Popper, what might we say? We might say that a theory of overall benefit was disproved in 9 of 11 studies. We might also say that theories designed to explain the apparent success of 2 studies were similarly disproved. But we might add: there is promise. Perhaps severe strokes treated before 3 hours benefit? Perhaps some other subgroup, as yet unidentified, benefits?

‘Thrombolytics save lives in STEMI’, like relativity and evolution, is a strongly supported theory. ‘Thrombolytics benefit acute stroke patients’ is rather conspicuously not supported. There are theories still to test, and subgroups still to study. But if we believe in the philosophy of science we must concede that we have learned a good deal about what does not work—and very little about what does. There is much work to do.

SMART SAH: A Picture is Worth a Thousand LPs

Smart Contract

Subarachnoid hemorrhage is the bogeyman of headache—but it is real. This month we asked what may be medicine’s most fundamental question: how can we ferret out the bogeyman without creating so much collateral damage that we’ve done more harm than good? We have an answer that is simple, surprising, and scientific. This one is a game-changer.

SMART Testing

smart Diagnostic

In medicine we love us a good diagnostic test; we’re always looking for the next one. It is strange, then, that we should be so aloof to the basics of diagnostic testing. This month’s audio is a primer on testing—and it changes everything. We’re going back to basics: if you learn the four axioms of diagnostic testing you’ll know more about how to choose and how to interpret diagnostic tests than just about everyone. Weird thing is that it turns out you knew it all already… you just needed a reminder.

Subarachnoid Hemorrhage: A Rational Approach


In October of 2010 the prestigious British Medical Journal published the largest, and by far the best, study ever done on the diagnosis of SAH in the ED. The data are revolutionary, and they prompted us to take a new look at the classic teaching and modern approach to this diagnosis.

It’s always fun to deep dive on a new topic, and we hoped to combine the newest data with the classic data to find a safe, rational, and smart approach to the evaluation of high risk headache. What we found was more earth shaking than we could have imagined. Come take a journey to the center of the data, new and old… this changes everything.