"You need just three things to be truly happy in this world: a person that you love, a job that you like, and a dream that you live for"…….from the book The Accidental Apprentice by Vikas Swarup

Aspirin may reduce coronary thrombosis at the expense of excess bleeding; clonidine may reduce hypertensive swings only to be countered by clinically important hypotension. As observed by Chinese philosophers, the whole is made up of the yin and yang — complementary, interdependent, and conceptually opposing entities that comprise a whole. (quoted from the Editorial:The Yin and Yang of Perioperative Medicine by Prashant Vaishnava, M.D., and Kim A. Eagle, M.D., NEJM: March 31, 2014)

"A high level of cynical distrust — for example, believing that no one cares much what happens to you and that it's safer not to trust anybody — is associated with a higher risk for dementia, and the association is not entirely explained by depressive symptoms, a new study shows" A Medscape article by Pauline Anderson May 28, 2014

MedTutor is an online tutoring site for medical students and young doctors in Internal Medicine. Write to MedTutor at: <moc.liamg|todikiwrotutdem#moc.liamg|todikiwrotutdem>.

August 2014

How things change with time
Question: Will raising HDL cholesterol levels be beneficial?

The answer in the year 2000 was YES. Am J Cardiol. 2000 Dec 21;86(12A):19L-22L. In VA-HIT (Veterans Affairs HDL Intervention Trial), for every 1% increase in HDL-C, there was a 3% reduction in death or MI, a therapeutic benefit that eclipses the benefit associated with LDL-C reduction. American Journal of Cardiology

The answer in the year 2014 is NO. N Engl J Med 2014; 371:271-273. The consistent findings of a lack of benefit of raising the HDL cholesterol level with the use of niacin when added to effective LDL cholesterol–lowering therapy with statins seriously undermine the hypothesis that HDL cholesterol is a causal risk factor……Although higher HDL cholesterol levels are associated with better outcomes, it is time to face the fact that increasing the HDL cholesterol level in isolation seems unlikely to offer the same benefit. New England Journal of Medicine

What is the meaning here?
A quote from Brendon M Reilly, MD (N Engl J Med 2014; 371:293-295): "I remember Mrs. J. in Chicago, whose severe pernicious anemia explained her dyspnea until my intern heard the diastolic rumble I had missed." What is the cause of the patient's dyspnoea?

A rubric for assessment

Dr Vela Menon, MD
Clinical Associate Professor of Medicine
International Medical University, Malaysia

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