Dr. David Loxterkamp has been practicing as a primary care physician for over thirty years in Belfast, Maine, United States of America. He is a frequent writer on issues related to primary care and... Show More

Dr. David Loxterkamp has been practicing as a primary care physician for over thirty years in Belfast, Maine, United States of America. He is a frequent writer on issues related to primary care and has recently published a book titled ‘What matters in medicine; Lessons from a life in primary care'. Towards the middle of the book he puts forward fourteen aphorisms for physicians with special relevance for primary care practice. In this manuscript the author briefly examines these aphorisms and describes their profound possible influence on modern medical practice, healthcare and medical education. The author is of the opinion that Dr Loxterkamp's observations and concepts born from and honed by over thirty years of practice as primary care physician in Belfast, Maine, United States should be read by all physicians and especially by medical students in training.

Patient-centered learning and participatory research are emerging movements in the transformation of primary healthcare and research participation. In recent years this focus has extended to the... Show More

Patient-centered learning and participatory research are emerging movements in the transformation of primary healthcare and research participation. In recent years this focus has extended to the utilization of User Driven Health Care (UDHC) networks for patient centered learning in medical education. Technology now makes it possible for patients, medical students, and providers to communicate through the Interneton a secure platform. Student authors experiencing this new brush with technology-supported, patient centered learning experience share how participation in a User Driven Health Care online education experience informed their learning and incited them to develop an interest in evidence based knowledge. They developed a survey tool and conducted interviews over the Internet to report on the experiences of others within the network. The findings were largely positive although some students did not feel the reality of the connection to an actual patient. Others report enjoying the experience and being enriched through the interaction, but, at the same time, expressed doubts whether this was a sustainable way to learn given the volume of information a student has to master to attain to the level of a practicing physician

This is a conversational narrative of the learning experience of a group of medical students around an interesting case that was brought to them through the network of the user driven healthcare... Show More

This is a conversational narrative of the learning experience of a group of medical students around an interesting case that was brought to them through the network of the user driven healthcare (UDHC) system. In addition to the traditional didactic framework of lecture-based clinical medicine, the students were exposed to patient-centered learning exercises where a patient of clinically complex issues was present as a part of the didactic experience in the classroom. As an innovative approach, which has not been trialed in the Indian medical education system, the teaching experience required following up with student narratives that reflected on the learning experience gleaned from the multidimensional clinical-didactic encounter. This paper outlines a case of ranitidine-associated hepatitis, a little known side effect of a vastly prescribed drug, and the associated discussion generated on online forums, mainly driven by the students who were involved in the clinical history of the case. There are reflective accounts of the student and preceptor involved in the teaching-learning exercise discussing the clinical encounter.

The authors discuss the clinical complexities surrounding an 85-year-old male complaining of left sided weakness for one month, along with cough and fever for 20 days. Findings on non-contrast CT... Show More

The authors discuss the clinical complexities surrounding an 85-year-old male complaining of left sided weakness for one month, along with cough and fever for 20 days. Findings on non-contrast CT scan of the brain showed an acute-on-chronic infarct in the right parietal region, in the territory of the right middle cerebral artery, with lacunar infarct in the left thalamus. A chest radiograph showed a heterogeneous opacity in the right lower zone, and air bronchogram with an elevated right dome of the diaphragm. The patient was diagnosed to have suffered a stroke with a subsequent right-sided pneumonia due to diaphragmatic palsy. The patient was put on ventilator and further supportive management was instituted. This article presents the clinical course of the case and the experiential learning associated with it.

Epidemic dropsy is a multi-system disease involving the cardiovascular, hepatic, renal, ocular and other systems. Onset is usually subacute or insidious with watery diarrhea and vomiting. This lasts... Show More

Epidemic dropsy is a multi-system disease involving the cardiovascular, hepatic, renal, ocular and other systems. Onset is usually subacute or insidious with watery diarrhea and vomiting. This lasts from a few days to more than a week. Bilaterally symmetrical pitting edema of the lower limbs extending from the ankles up to the scrotum and abdominal wall is a constant feature. It is a toxic disease caused by the unintentional ingestion of Argemone mexicana (prickly yellow poppy) seeds as an adulterant of wheat flour, or more commonly, of cooking oil such as mustard oil. Sanguinarine and dehydrosanguinarine are two major toxic alkaloids of Argemone oil. It is a rare phenomenon for practicing ophthalmologists to observe cases of epidemic dropsy, and the possibility of glaucoma should be kept in mind in cases of epidemic dropsy, when members of same family or village report with raised IOP, pedal edema and history of use of mustard oil for cooking or massage. Glaucoma is hypersecretory in nature; prostaglandin and histamine release may have significant roles in its pathogenesis. The disease has self limiting course but needs good control of intraocular pressure (IOP) medically till it returns to normal and visual field changes have stabilized. Its early diagnosis is very important to prevent grievous complications; hence, all cases should be followed up regularly for IOP measurement and visual field analysis up to 8-12 weeks, because, if ignored, optic atrophy may develop.

In the developing countries, incidence of systemic tuberculosis is very high, with over 8 million new cases each year. The incidence of tuberculous uveitis is also rising correspondingly. It is... Show More

In the developing countries, incidence of systemic tuberculosis is very high, with over 8 million new cases each year. The incidence of tuberculous uveitis is also rising correspondingly. It is difficult to diagnose ocular tuberculosis because of the lack of specific ocular findings and specific confirmatory laboratory tests. However, in a developing country like India, where the prevalence of latent tuberculosis is high, uveitis of unexplained cause not fitting into known uveitis entities, in presence of Monteux positivity, is more likely to be tubercular in origin. Hence, early diagnosis and prompt treatment with antitubercular treatment may result in dramatic drop in recurrence and improve individual patient outcomes.

Hemangiopericytoma is a slow growing, vascular mesenchymal tumor, which may behave like a malignant tumor, leading to local recurrence, or metastasis, or both. This report is about a 32-year-old... Show More

Hemangiopericytoma is a slow growing, vascular mesenchymal tumor, which may behave like a malignant tumor, leading to local recurrence, or metastasis, or both. This report is about a 32-year-old lady with non-axial proptosis and diminished vision due to a mass lesion in the superomedial quadrant of the right orbit. CT scan and MRI reports showed no intracranial extension. Surgical intervention was done through the roof of the orbit keeping hemangioma, neuroma or schwannoma as the leading differential diagnoses; however, on aspiration, it was not bleeding. It was confirmed to be a hemangiopericytoma on histopathological examination. The unique presentation, where, on tapping, no blood was found, makes this case an example of diagnostic dilemma. This lack of bleeding might be due to vascular insufficiency of the mass. Proptosis disappeared the following day after the surgery and vision also showed significant improvement to 20/20 within a week after surgery. The patient has been kept on regular follow up keeping in mind the recurrent and metastatic behavior of the tumor.