Fifty years ago, Eugene Garfield published the Science Citation Index (SCI), the first systematic effort to track citations in the scientific literature. Nature’s news team wondered which were the most highly-cited papers of all time, so asked Thomson Reuters and Google for their top 100. They are not what you might think. Watson and Crick on DNA structure misses out, along with many other historic discoveries. Instead, methods and software papers dominate the lists.

Find out more at nature.com/top100



The discovery of high-temperature superconductors, the determination of DNA’s double-helix structure, the first observations that the expansion of the Universe is accelerating — all of these breakthroughs won Nobel prizes and international acclaim. Yet none of the papers that announced them comes anywhere close to ranking among the 100 most highly cited papers of all time.

It takes a staggering 12,119 citations to rank in the top 100 — and that many of the world’s most famous papers do not make the cut.

The most cited work in history, for example, is a 1951 paper describing an assay to determine the amount of protein in a solution. It has now gathered more than 305,000 citations — a recognition that always puzzled its lead author...

No drugs cure high blood pressure.

All drugs against hypertension without exception, are toxic and have distressing side effects.
The safest way to cure hypertension is to remove the real cause.

The natural way of dealing with it is to eliminate the poisons from the system which cause it. Persons with high blood pressure should always follow a well-balanced routine of proper diet, exercise and rest.

Diet is of primary importance. Meat and eggs cause the blood pressure to rise more
than any other food. The pressure is lowered and blood clotting diminished by partaking of a
higher fruit content, lower protein and non-flesh diet.

A natural diet consisting of fresh fruits and vegetables, instead of a traditional diet, is helpful in getting rid of the poisons from the body.



A hypertension patient should start the process of healing by living on an exclusive fruit-diet for
at least a week, and take fruits at five-hourly intervals thrice in the day.

Oranges, apples, pears,mangoes, guava, pineapples, raspberry, water-melon are the best diet in such cases. Bananas and jack fruit should not be taken. Milk may be taken after a week of "fruits only"' diet.

The milk should be fresh and should be boiled only once. The patient can be permitted cereals in his food after two weeks.

heart attack, blood pressure,

Heart Disease overview

Heart Disease is one of the world’s largest health problems today. It not only affects the wealthier nations it is also affecting the poorer ones. Heart Disease covers a wide range of health ailments relating specifically to the heart.

There are many theories and ideas that relate to heart disease. One school of thought for the sudden increase in heart disease is the changes within different lifestyles. People are often less active and eat diets high in fats. Takeaway food is abundant today and often people will eat it due to the increased availability. Some takeaway outlets are now helping cater to a healthier lifestyle by offering a variety of healthy dishes such as salads. People are becoming more aware of the risk of heart disease and choosing to change their diets.

Why exercise? Exercise is extremely important in order to avoid heart disease. Exercise helps to keep the heart at its peak performance and is optimum health is easier to maintain. By using a combination of exercise and a balanced diet, the risk of heart disease is greatly decreased.

The term “Cardiovascular Disease” is widely used within today’s society. The term Cardiovascular Disease includes a large number of diseases which directly affect the heart and the blood vessel system. It especially affects the veins and arteries that lead to and from the heart.

Conducted research has suggested that women who suffer with cardiovascular disease usually suffer from forms that affect the blood vessels. While men usually suffer from forms that affect the heart muscle itself. Other known or associated causes of cardiovascular disease include diabetes mellitus, hypertension and hypercholesterolemia.

Heart disease and strokes are other more common cardiovascular diseases. Two independent risk factors that have a major impact for heart diseases plus cardiovascular diseases are high blood pressure and high blood cholesterol.

A collection of some interesting medical articles published recently:

Once-weekly insulin shot - Novo Nordisk's next idea http://buff.ly/1tiUC6v

How Lufthansa Cares for Passengers' Medical Needs http://buff.ly/1pK4ILC

How scammers trick your mind - they repeatedly use one or more of the same 7 persuasion principles. Scammers have used these principles for centuries. For instance, the Nigerian email scam might seem the product of the digital age, but a version of it existed in 16th Century Europe. http://buff.ly/1rIf4jo -- Understanding scam victims: 7 principles for systems security (University of Cambridge report) - PDF http://buff.ly/1uH14df

The prevalence of celiac disease in screening studies is 0.5 to 1%. The serologic test of choice for celiac is IgA anti-tissue transglutaminase - specific (94%), and sensitive (97%) http://buff.ly/1CIEr9x

Why Are Americans So Fascinated With Extreme Fitness? - NYTimes.com http://nyti.ms/1EVWdZ5

History of rheumatology http://bit.ly/1EVWgnC

Why exercise boosts IQ http://buff.ly/1sJqqXp

Cleveland Clinic offers patients virtual visits in walk-in kiosks in the grocery store http://buff.ly/1xQVhjW

3 new antibiotics for skin infections: dalbavancin (Dalvance), tedizolid (Sivextro), oritavancin (Orbactiv) http://buff.ly/1vzabfm

Shift workers and people who get jet lag may gain weight because they disturb their "inside garden" (gut microbes) http://buff.ly/1vzaJSs

Exercise May Help Fight Depression – But low mood can be a barrier to physical activity http://buff.ly/1ps8Elj

When we are able to diagnose rare diseases with smartphones - BBC http://buff.ly/1vzb4Va -- Ebola only has 5 genes

The enduring enigma of Alan Turing : The Lancet http://buff.ly/1vzbevI

A renaissance in surgery - A new and welcome vigour is evident in surgery, writes The Lancet http://buff.ly/1vzbj2r

Robotic surgery: where are we now? : The Lancet http://buff.ly/1ps8Ukv

The articles were selected from Twitter and my RSS subscriptions. Please feel free to send suggestions for articles to clinicalcases AT gmail.com and you will receive acknowledgement in the next edition of this publication.

Would mathematics exist if people didn't? Did we create mathematical concepts to help us understand the world around us, or is math the native language of the universe itself? Jeff Dekofsky traces some famous arguments in this ancient and hotly debated question.

A collection of some interesting medical articles published recently:

Hand-grip strength is an amazingly good predictor of future rates of mortality and morbidity, or sickness http://buff.ly/1BK759H -- Hand grip strength should be considered as a vital sign useful for screening middle-aged and older adults http://buff.ly/1DglFaI -- Measuring hand-grip strength is very simple and cheap. Every primary care doctor should have a dynamometer in their office. At every visit, the doctor could check grip strength for older patients. If someone was in the 45th percentile for their age and the measurements were stable, great. But if that person suddenly dropped to the 25th percentile, then that’s a sign that the doctor should look seriously at what might be going on.

Full fat milk (3%) cut the risk of getting diabetes type 2 by 20% http://buff.ly/1m9ghRL

Urine Test for Diagnosis of HPV Works Well (not yet available in practice) http://bit.ly/1pnswES

Weekly Injectable Drug for DM2 Approved -Trulicity (dulaglutide) a glucagon-like peptide-1 (GLP-1) receptor agonist. http://bit.ly/1pnsyNh

FDA approved for treating fibromyalgia: pregabalin (Lyrica), duloxetine (Cymbalta), milnacipran (Savella) http://reut.rs/1pnsWet

Human Body, According to Venture Capitalists - which body systems stand to benefit most from their decisions - WSJ http://bit.ly/1pntgdp

Sodium conundrum: 9 in 10 U.S. children eat too much salt http://buff.ly/1wdlXx5

With 23andMe, this biologist gave his parents the gift of divorce http://bit.ly/1uvevub

People who spend more time preparing and cooking meals are more likely to have healthier diets http://buff.ly/1DTvZG4

Walking is the superfood of fitness, experts say -- “Walking is a superfood. It’s the defining movement of a human". “Actively sedentary is a new category of people who are fit for one hour but sitting around the rest of the day," Bowman said. “You can’t offset 10 hours of stillness with one hour of exercise.” http://buff.ly/1BxXEbA -- Exercise: “If you’re going to pick one thing, research says it should be walking”

Acupuncture May Not Help Chronic Knee Pain after all http://buff.ly/ZpQw5B

Epic holds the health records of nearly half of all Americans http://buff.ly/ZpRcIc

Gene affects your taste for bitter flavors. People who aren't as sensitive eat 200 more servings of vegetables/year http://buff.ly/YSQRMT

Ebola drug ZMapp is produced in the leaves of tobacco plants. 10 years from now, plants might be the dominant vaccine-production system http://buff.ly/1vzaN4f

The articles were selected from Twitter and my RSS subscriptions. Please feel free to send suggestions for articles to clinicalcases AT gmail.com and you will receive acknowledgement in the next edition of this publication.

Multi-dose flu shot has only 25 mcg of mercury - most commercial fish contain 23 mcg of mercury per 8 ounces of fish http://buff.ly/11CTRPw

Are multi-dose vials less expensive?

Economics are a bit complicated due to wastage with multiple vials:

Single versus multi-dose vaccine vials: an economic computational model
http://www.ncbi.nlm.nih.gov/pubmed/20566395

Most of the Western world, apart from the US, has moved on to single vials:
http://www.medscape.com/viewarticle/733986

Whenever possible, CDC recommends that single-use vials be used and that multi-dose vials of medication be assigned to a single patient to reduce the risk of disease transmission (http://www.cdc.gov/injectionsafety/patients/syringeReuse_faqs.html).

Where to get a thimerosal/mercury-free flu shot?

Many local Costco stores carry only single vials and the cost is $14.99 if no insurance is used. The availability of additional options may improve immunization rates.

Search for a Costco pharmacy near you here, and call them to verify availability: Warehouse Locations - Costco: www.costco.com/warehouse/locator.aspx

Personal Flu Stories - CDC:



Each year in the US, nearly 20,000 children under age 5 are hospitalized due to flu-related complications. CDC recommends that children aged six months through 18 years old get a flu vaccination. Moving personal stories help parents and caregivers learn about the dangers of influenza to children and the benefits of vaccination.

Image source: Influenza virus, Wikipedia, public domain.

Given the importance of a good night's sleep, how do you pick the best possible bedtime? WSJ's Heidi Mitchell and Stanford University's Dr. Rafael Pelayo discuss with Tanya Rivero.



Related:

What Makes A Great Bedtime? | Craig Canapari, MD http://bit.ly/1vstZzJ
Shift workers and people who get jet lag may gain weight because they dusturb their "inside garden" (gut microbes) buff.ly/1vzaXci

A 65-yo female patient received a standard-dose flu shot already this season. Should he get the high-dose shot too? Or try to get a second regular flu shot?

The simple answer is no. The patients should consider herself immunized. Studies show that getting a delayed second dose doesn't necessarily increase antibody response, and there's some concern that it might actually have a negative effect on the immunity. If you've already had the regular seasonal dose, wait until next year for another dose.


Image of the H1N1 Influenza Virus, CDC.

From CDC's Immunize.org website:

Sometimes patients age 65 years and older who have received the standard-dose influenza vaccine hear about the high-dose product (Fluzone High-Dose, sanofi) and want to receive that, too. Is this okay to administer?

No. ACIP does not recommend that anyone receive more than one dose of influenza vaccine in a season except for certain children age 6 months through 8 years for whom two doses are recommended.

Would giving an older patient 2 doses of standard-dose influenza vaccine be the same as administering the high-dose product?

No, and this is not recommended.

References:

New High-Dose Flu Shot for Older Americans: Answers to Flu Season Questions - AARP http://buff.ly/1ttjluQ

Ask the Experts about Influenza Vaccines - CDC experts answer Q&As; http://buff.ly/1ttjn6e

In this video, the BMJ's research team discuss what they look for in a paper submitted for publication.

They discuss some of the pitfalls authors fall into when writing up their research, and how to present some of the information that all journals will require.



More BMJ-specific info here: http://www.bmj.com/about-bmj/resources-authors

What Can Raise Your Blood Pressure

What Can Raise Your Blood Pressure?

Are you concerned about what might increase your blood pressure? There are quite a few things that can factor in to raising your blood pressure. Luckily you can fix many of these with a few lifestyle changes.

If you do not watch your blood pressure frequently, you might not even be aware that you have it. It can creep up on you or just increase over the years. It all depends on many different factors.

If you are overweight you are at an increased risk of developing high blood pressure. You might already know this and you might not. If this is the case for you, consult your doctor and see what he might recommend for you. Losing at least ten pounds can significantly lower your blood pressure.

An unhealthy diet or lack of physical activity or exercise can also put you at risk for high blood pressure. Try to exercise at least thirty minutes a day even if you have to space the time out. Eating less salt and more vegetables and fruits can help lower your blood pressure as well. Try to incorporate this into your present diet and you will see the results rather quickly.

Stress plays a huge factor in high blood pressure and unfortunately everyone is stressed at some point in their lives. If you deal with a high amount of stress, consider relaxation techniques. Do whatever you can that you know will calm you down and help relieve stress.

Using tobacco and alcohol raise your blood pressure. If you use either of these consider quitting. If you are unable to quit right away, limit your consumption of alcohol and use of tobacco. There are many over the counter and prescription products to help rid your self of these habits. Talk with your doctor of any concerns you might have.

Medical conditions also factor into high blood pressure along with your lifestyle. Kidney disease can result in high blood pressure as well as cause it.  Sleeping disorders that interrupt your breathing during sleep will also raise your blood pressure. Talking with your doctor about your condition could benefit your disorder along with your blood pressure.

Certain medications and drugs can also raise your blood pressure. Certain types of anti-depressants will do this as well as certain cold medicines. Be aware of oral contraceptives, nasal decongestants, anorexia drugs and steroids. These can possibly raise your blood pressure as well so talk with your doctor before taking any of them if you are concerned.

While you can control most of the factors that raise your blood pressure there are some you cannot. For instance your race; African Americans are more prone to high blood pressure, people over fifty-five are at a higher risk, and your family history can play a role in your blood pressure as well. While you cannot control these factors you can easily try to help decrease your risk. Watch your diet, exercise, lifestyle habits, etc. Over time this may be very beneficial to you.

High blood pressure can cause strokes and even heart and kidney diseases. Leading a healthier life style can help you live longer and enjoy your time in a healthy state. Talk with your doctor about any questions or concerns you may have concerning your blood pressure. It is never too late to take control.

Here are my suggestions for some of the top articles related to healthcare social media (#HCSM) in the past 2-4 weeks:

15 Lessons from 15 Years of Blogging: Link to everything you create elsewhere on the web. And if possible, save a copy of it on your own blog. Things disappear so quickly, and even important work can slip your mind months or years later when you want to recall it. If it's in one, definitive place, you'll be glad for it.

Always write with the idea that what you're sharing will live for months and years and decades. Having a long-term perspective in mind is an incredibly effective tool for figuring out whether a topic is meaningful or not, and for encouraging a kinder, more thoughtful perspective.

Your blog can change your life in a month. If you want to understand an idea, or become a meaningful voice on a topic, or change your own thinking about a concept, write a little bit about it every day for a month.

http://buff.ly/1pwjuWg

Too many crying babies: a systematic review of pain management practices during immunizations on YouTube http://buff.ly/1j4PHaz

Unprofessional behavior is prevalent among surgical residents who use Facebook (study) http://buff.ly/1j4POCV

Support network: People discussing their weight loss are happier with Twitter (more support, less negativity) than Facebook and in-person relationships http://buff.ly/1j4PUKK

A Facebook teaching forum was set up in a London Hospital for undergraduate medical students: 92% approved http://buff.ly/1j4QacM

Why Wikipedia matters for healthcare: it dominates search results for medical information - BMJ http://buff.ly/1vOMP1Y

YouTube as a source of patient information for lumbar discectomy. http://buff.ly/1qLVd4m

The Anatomy of a Scientific Rumor http://buff.ly/TP1v4K

Email Alerts Services You Should Use http://buff.ly/TP2yBC

Are You Tweeting Your Marriage Away? Time spent on social media can create friction in relationships (study) http://buff.ly/1ooRKmc

Twitter: an opportunity for public health campaigns : The Lancet http://buff.ly/U7drPJ

Do you "like" my photo? Facebook use may increase eating disorder risk http://buff.ly/WqD284

Cleveland Clinic has a blog for patients - Health Hub http://buff.ly/1yHsRtt and a blog for physicians - Consult QD http://buff.ly/1yHsr6g

The articles were selected from Twitter @DrVes and RSS subscriptions. Please feel free to send suggestions for articles to clinicalcases at gmail.com and you will receive an acknowledgement in the next edition of this publication.

When Prozac was introduced in 1988, the pill to treat depression launched a cultural revolution that continues to echo. Read the story here: http://nyti.ms/XMXik9

Halitosis is a generic term used to describe unpleasant odor emanating from the mouth air and breath, independent of the source where the odor substances originate. It affects between 50 and 65% of the population, but despite its frequency, this problem is often unaccepted and declared as taboo.

90% of patients suffering from halitosis have oral causes. A small, but important percentage, of oral malodor cases have an extra-oral etiology, very often falling into the category of "blood-borne halitosis".

Several systemic diseases have been found to provoke malodor or to be a cofactor; bad breath may be an early sign of a serious local or systemic condition.

A psychogenic halitosis also exists including the variant "pseudo-halitosis", when the oral malodor does not exist, but the patient believes he or she is suffering severely from it, and the halitophobia, when, instead, there is an exaggerated fear of having halitosis.

It is important to determine quickly whether the odor comes from an oral cause or not: if so, it requires referral to a dentist; if not (extra-oral origin alone or combined), its management requires the treatment of the underlying causes. Extra-oral disorders can be the cause in up to 15% of cases.

From The WSJ: What really causes bad breath, what can you do to prevent it and can you tell if you have it? WSJ's Heidi Mitchell joins Lunch Break with Tanya Rivero with the answers.



References:

Oral malodour (halitosis) - BMJ 2006 http://1.usa.gov/1sXOO8m
Halitosis: could it be more than mere bad breath? [Intern Emerg Med. 2011] - PubMed - NCBI http://1.usa.gov/1sXOR3U
Image source: Head and neck. Wikipedia, public domain.

Diagnosing Ebola in an person who has been infected for only a few days is difficult, because the early symptoms, such as fever, are nonspecific to Ebola infection and are seen often in patients with more commonly occurring diseases.

However, if a person has the early symptoms of Ebola and has had contact with the blood or body fluids of a person sick with Ebola, contact with objects that have been contaminated with the blood or body fluids of a person sick with Ebola, or contact with infected animals, or suggestive travel history, they should be isolated and public health professionals notified. Samples from the patient can then be collected and tested to confirm infection.

Laboratory tests used in diagnosis include:

Within a few days after symptoms begin
Antigen-capture enzyme-linked immunosorbent assay (ELISA) testing
IgM ELISA
Polymerase chain reaction (PCR)
Virus isolation

Later in disease course or after recovery
IgM and IgG antibodies

Retrospectively in deceased patients
Immunohistochemistry testing
PCR
Virus isolation

Ebola discoverer: 'This is unprecedented'. CNN's Christiane Amanpour speaks with Dr. Peter Piot about an "out of control" Ebola epidemic in West Africa:



References:

Diagnosis | Ebola Hemorrhagic Fever | CDC http://buff.ly/1rIdM81
'In 1976 I discovered Ebola - now I fear an unimaginable tragedy' | World news | The Observer http://buff.ly/1EoqpvD
Image source: OpenClipArt.org, public domain.

Professor Hubert Mönnikes talks about why people with IBS are often mislabeled as hypochondriacs, and how to best treat the symptoms.



Are Dietary FODMAPs a Cause of Irritable Bowel Syndrome? (Fermentable, Oligo-, Di-, Monosaccharides, And Polyols).

IBS symptoms improved with a diet low in short-chain carbohydrates (FODMAPs - fructose, lactose, polyol sweeteners) http://buff.ly/1fdzBWJ -- A Diet Low in FODMAPs Reduces Symptoms of Irritable Bowel Syndrome - the evidence supports its use as a first-line therapy http://buff.ly/1Ch3scU

DOWNLOAD the Handout  Stanford University: Low FODMAP Diet Handout

References:

A Diet Low in FODMAPs Reduces Symptoms of Irritable Bowel Syndrome - supports its use as a first-line therapy http://buff.ly/1Ch3scU