Pulse Newsletter Epocrates
April 2012
In This Issue
Drug & Disease Updates
Clinical Editorial: App Happiness
FDA MedWatch Alerts
Clinical Tip of the Month
DocAlert Editor’s Pick
When Pets Cause Human Pathology
The Humorous Humerous
Get In with Epocrates at ACP Internal Medicine 2012!
For You and Your Android
What's This Disease?

“Hilarity and good humor, a breezy cheerfulness…help enormously both in the study and in the practice of medicine. To many of a sombre and sour disposition it is hard to maintain good spirits amid the trials and tribulations of the day, and yet it is an unpardonable mistake to go about among patients with a long face.” — Sir William Osler, Aequanimitas, 1889

In the spirit of celebrating good humor, read on to learn how “in the absence of a willing cohort of oxen to serve as controls, researchers pitted orthopedic surgeons against anesthesiologists in a test of strength and smarts” in this month’s DocAlert Editor’s Pick. You’ll also see why one Epocrates member heard music coming from the dishwasher, how to tickle your funny bone more precisely with Rohen’s Photographic Anatomy app, and more.

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Clinical Editorial

App Happiness
Anne Meneghetti, MD
Director, Clinical Communications, Epocrates

Anyone who has known me for greater than or equal to 15 minutes will attest to the fact that I am obsessed with the handy Electronic Preventive Services Selector (ePSS) app from the U.S. Agency for Healthcare Research and Quality (AHRQ). Whether you meet me in a professional or social setting, I will find some way to smoothly work ePSS into the conversation. Allow me to demonstrate.


An old friend from med school and I entered an uncrowded movie theatre one afternoon. Before the previews began to roll, it became clear that the couple behind us were also doctors.

Me: I work at Epocrates.
Dr. X: Seriously? You actually work at Epocrates? I love Epocrates! I use it all the time!
Me: I’m glad you like it! You're in good company with half the doctors in the U.S.
Dr. X: Hey, I have a great idea…Why don’t we switch jobs? You can take care of my patients, and I will work at Epocrates!
Me: Thanks. I think I’ll keep my day job.
Dr. X: Really? Well, how about a compromise – I will handle all the acute care problems, and you can handle the routine care. It’s hard to keep track of all the health care maintenance.
Me: Oh, you don’t need me, you need the ePSS app from AHRQ! Just enter age and gender, and it will instantly tell you which tests, counseling, and preventive meds are appropriate.
Dr. X: Interesting. Well, here’s my card. Keep it on hand in case you change your mind…

Quod erat demonstrandum. You can imagine how thrilled I was to wake up one morning to find ePSS magically appearing in my Epocrates app on iPhone. iPhone users can find this free tool within the App Directory on your Epocrates home screen. For additional mobile and online use, more information can be found at AHRQ.

If there are other apps that you would be happy to see in the Epocrates app, share your recommendations with us.

Updated Diseases and Conditions
Dry eye
Addison disease
Hemolytic anemia
Infectious mononucleosis
Basal cell carcinoma
Paget disease
Subdural hematoma

New Drug Monographs
Arcapta Neohaler
(indacaterol inhaled)
(first-time generic for Teveten)
(first-time generic for Lexapro)
(first-time generic for Boniva)
(generic for Zenpep)
progesterone micronized
(first-time generic for Prometrium)
(tafluprost ophthalmic)
(first-time generic for Geodon)

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FDA MedWatch Safety Alerts

Prescription drugs: Statin Drugs: Class labeling changes - liver enzyme monitoring, cognitive effects, blood sugar effects. Statins with HIV or Hepatitis C Drugs: Interaction increases risk of muscle injury. Brilliant Blue G: Reports of fungal endophthalmitis. Cytarabine for Injection, 1 gm/vial [Bedford Labs]: Recall - risk of lack of sterility. American Regent Injectable Products: Recall - visible particulates in products. Norgestimate and Ethinyl Estradiol Tablets: Recall - packaging error, potential for incorrect dosing regimen.

OTC products: Skin Creams, Soaps, Lotions Marketed as Skin Lighteners and Anti-aging Treatments: May contain mercury. Gerber Good Start Gentle Powdered Infant Formula: Recall - off-odor. Regenerect: Recall - undeclared drug ingredient (tadalafil, an FDA-approved drug used for male erectile dysfunction). Healthy People Co. Dietary Supplements: Expanding recall due to undeclared drug ingredient.

Medical devices: Acclarent Inspira AIR Balloon Dilation System: Recall - potential for balloon to not deflate or to deflate too slowly. Cardiac Science Powerheart, CardioVive, CardioLife; GE Responder, Responder Pro; Nihon-Kohden Automated External Defibrillators: Recall - defective component may lead to AEDs not delivering defibrillation therapy. Flight Medical V24-00400-29 Cable for Newport HT50 Ventilator: Recall - cable may cause electrical shortage that can cause ventilators to shut down unexpectedly. Nemschoff Chairs Perinatal Pediatric Hospital Bed (Bassinet): Recall - risk of injury to patients. Smiths Medical Bivona Neonatal, Pediatric and Flextend Tracheostomy Tubes: Recall - inadvertent dislodgement. CareFusion Cortical Stimulator Control Unit: Recall - software malfunction and short circuit.

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Clinical Tip of the Month

How to Share a DocAlert Message
Monique Yohanan, MD, MPH

Subject: Requested DocAlert: Does High Caffeine Intake Cause Auditory Hallucinations in Healthy Individuals?

Email: Remember that time we heard music coming from the dishwasher during our study marathon? Now you can find out why! :)

-Lindsay McCoy
Student, University of Georgia College of Pharmacy


Sometimes a DocAlert message contains information you may wish to share with colleagues. On Apple iOS, you can forward the message directly from your device. On those and other devices, you can choose the “Email More Info” button and forward the email sent to your inbox to other recipients.

Update your device often to receive content updates and DocAlert messages.

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DocAlert Editor’s Pick
Anne Meneghetti, MD

April Fools Day 2012
The supposition that orthopedic surgeons have less brains than brawn has long been the subject of jokes in and out of the operating theatre (e.g., animated short). In the absence of a willing cohort of oxen to serve as controls, researchers pitted orthopedic surgeons against anesthesiologists in a test of strength (hand grip force) and smarts (Mensa Brain Test, iPhone 4). The results may surprise you!

Source: BMJ 2011;343:d7506
Link to free full-text BMJ article PDF


Image c/o Clive Featherstone

Orthopaedic surgeons: as strong as an ox and almost twice as clever? Multicentre prospective comparative study

P Subramanian, et al

Methods: We compared the strength and intelligence of orthopaedic surgeons and anaesthetists during a two week period in 2011. Participants: 36 male orthopaedic surgeons and 40 male anaesthetists.

Results: Orthopaedic surgeons had a statistically significantly greater mean grip strength than anaesthetists. The mean intelligence test score of orthopaedic surgeons was also statistically significantly greater.

Conclusions: Male orthopaedic surgeons have greater intelligence and grip strength than their male anaesthetic colleagues, who should find new ways to make fun of their orthopaedic friends. However, we would recommend caution in making fun of orthopaedic surgeons, as unwary anaesthetists may find themselves on the receiving end of a sharp and quick witted retort from their intellectually sharper friends or may be greeted with a crushing handshake at their next encounter.

© 2012 BMJ Publishing Group Ltd

This is an open-access article distributed under the terms of the Creative Commons Attribution Non-commercial License, which permits use, distribution, and reproduction in any medium, provided the original work is properly cited, the use is non commercial and is otherwise in compliance with the license. See: http://creativecommons.org/licenses/by-nc/2.0/ and http://creativecommons.org/licenses/by-nc/2.0/legalcode.


When Pets Cause Human Pathology
Anne Meneghetti, MD

Patients love their pets. When is the last time your Social History inquiry covered animal contact? Recent outbreaks of human Salmonella infections from pet turtles and aquatic frogs and human rabies cases from feral cats remind us that those zoonoses we learned about in school remain clinically relevant today. Children, pregnant women, and immunocompromised patients are at higher risk for certain infections transmitted between humans and animals. Here’s a zoonosis refresher.


Amphibians (including Frogs), Reptiles (including Turtles, Lizards), and Fish. Salmonellosis: GI illness from water in the environment of amphibians, reptiles, or fish. Fish tank granuloma (Mycobacterium marinum): nodular or ulcerating soft-tissue or bone infections of the finger.

Hamsters, Gerbils, Guinea Pigs, Ferrets and Other Pocket Pets. Lymphocytic Choriomeningitis Virus Infection: mild febrile illness, neurological signs, congenital infections from contact with urine, droppings, saliva, or nesting materials; direct broken skin contact; eye, nose, or mouth contact. Salmonellosis: GI illness from contact with contaminated feces of rodents and other mammals or their environment. Rabies: fever, headache, nervous system signs resulting from a bite from an infected animal, including ferrets (ownership of ferrets and other wild animals as pets is discouraged by the CDC).

Birds. Psittacosis (Chlamydia psittaci): fever, chills, headache, muscle aches, dry cough, severe pneumonia or other serious health problems from inhalation of respiratory secretions or dried feces of infected pet birds (parrots, parakeets, macaws, cockatiels) and poultry (turkeys, ducks). Salmonellosis: GI illness from chicks, ducklings, and other live poultry (chickens, ducks, geese, turkeys). Cryptococcosis: neurological or respiratory illness from pigeon or wild bird droppings.


Cats and Dogs. Salmonellosis, Campylobacteriosis, or Cryptosporidiosis: GI illness from contact with infected feces, contaminated pets or their environments, or contaminated pet food and treats. Ringworm: ring-shaped pruritic rash from direct contact with infected animals. Toxocariasis: vision loss or eye damage (ocular toxocariasis); or fever, abdominal pain, and/or respiratory issues (visceral toxocariasis) from swallowing soil contaminated with Toxocara eggs from dog or cat feces. Hookworm: cutaneous larva migrans from unprotected skin contact with soil contaminated by infected dog or cat feces. Rabies: fever, headache, nervous system signs resulting from a bite from infected animals, including dogs and cats.

Cats can also transmit: Toxoplasmosis: flu-like illness, neurological signs in immunosuppressed persons or in congenital infections; from ingesting contaminated food, water, soil, or from cat litter box feces. Cat Scratch Disease (Bartonella): fever, lymphadenopathy at the site of a cat scratch or bite. Plague (Yersinia): flu-like illness, lymphadenopathy via flea bite transmission of rodent or cat infection.

Dogs can also transmit: Leptospirosis: flu-like or GI illness, jaundice, or rash from contact with water or soil contaminated by urine of infected domestic or wild animals. Lyme Disease: joint, erythema migrans, nervous system signs resulting from tick bite transmission from an infected dog. Rocky Mountain Spotted Fever: fever, rash, GI illness, conjunctival symptoms via tick bite transmission of dog infection.

Source: CDC


The Humorous Humerus

Can you find the funny “bone”? As it passes posterior to the medial epicondyle, the ulnar nerve is unprotected and vulnerable to injury. In this right arm cadaver dissection from the Rohen's Photographic Anatomy app, the ulnar nerve is identified by the second red pin from the left.

The Humorous Humerus

Get in with Epocrates at ACP Internal Medicine 2012!

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