BLOOMBERG BUSINESSWEEK:: DOCTORS ON DEMAND.

In his various professional incarnations, Phillip “Dr. Phil” McGraw has been a practicing psychologist, bestselling author, television personality, and spokesman for weight-loss products of dubious efficacy. Now he’s got a part-time gig as an adviser to a startup called Doctor On Demand, which is announcing itself to the public today. The service will try to increase online access to doctors, which could have far-reaching effects on health care. McGraw helped conceive the San Francisco-based startup with his son Jay McGraw, a reality TV producer. The company has raised $3 million from investors including Google Ventures (GOOG), Andreessen Horowitz, Venrock, and Shasta Ventures. (Bloomberg LP, the parent of Bloomberg Businessweek, is an investor in Andreessen.) The startup seeks to help people bypass costly in-person visits to crowded medical offices and emergency rooms by letting them use mobile devices to set up video chats with doctors. “There are 1.2 billion ambulatory care visits every year, and the vast majority of people are walking in for something like colds or urinary tract infections that are very amenable to an initial consult over video,” says Adam Jackson, the company’s co-founder and chief executive officer. Each online consultation costs $40. Doctors who enlist in the company’s network will collect $30 per session. They can diagnose illnesses, prescribe medicine, or refer a case to a caregiver if it seems like an emergency or requires lab work or an in-person examination. “It’s the bane of my existence, but everyone has a smartphone, which means everyone has a video camera. Everyone is paparazzi,” says McGraw, a shareholder and adviser to Doctor on Demand. “There are also many good things to come from this change in technology and telemedicine is one of them. It’s a giant step forward and a great opportunity to help people live healthier lives.” The service goes live today in 15 states, including California, Florida, New Jersey, New York, Ohio, and Texas. (Many states have laws preventing Doctor on Demand from setting up shop.) The company says it has enlisted more than 1,000 doctors to offer video consults a day or two per week. The company trains physicians to use its service, and it handles all the extras, including patient questionnaires, pharmacy networks, and malpractice insurance.

USA CDC: HISTOPLASMOSIS-infected house in St.-Eustache, PQ.

Morbidity and Mortality Weekly Report (MMWR) Histoplasmosis Outbreak Associated with the Renovation of an Old House — Quebec, Canada, 2013 Weekly January 3, 2014 / 62(51);1041-1044 On May 19, 2013, a consulting physician contacted the Laurentian Regional Department of Public Health (Direction de santé publique des Laurentides [DSP]) in Quebec, Canada, to report that two masons employed by the same company to do demolition work were experiencing cough and dyspnea accompanied by fever. Other workers also were said to be ill. DSP initiated a joint infectious disease, environmental health, and occupational health investigation to determine the extent and cause of the outbreak. The investigation identified 14 persons with respiratory symptoms among 30 potentially exposed persons. A strong correlation was found between exposure to demolition dust containing bat or bird droppings and a diagnosis of histoplasmosis. Temporary suspension of construction work at the demolition site in Saint-Eustache, Quebec, northwest from Montreal, and transport of the old masonry elements to a secure site for burial were ordered, and information about the disease was provided to workers and residents. To prevent future outbreaks, recommendations included disinfection of any contaminated material, disposal of waste material with proper control of aerosolized dust, and mandatory use of personal protective equipment such as gloves, protective clothing, and adequate respirators.

USA NIH: KLINEFELTER SYNDROME 1:500 males.

Because XXY males do not really appear different from other males and because they may not have any or have mild symptoms, XXY males often don't know they have KS.1,2 In other cases, males with KS may have mild or severe symptoms. Whether or not a male with KS has visible symptoms depends on many factors, including how much testosterone his body makes, if he is mosaic (with both XY and XXY cells), and his age when the condition is diagnosed and treated. KS symptoms fall into these main categories: Physical Symptoms Language and Learning Symptoms Social and Behavioral Symptoms Symptoms of Poly-X KS Physical Symptoms Many physical symptoms of KS result from low testosterone levels in the body. The degree of symptoms differs based on the amount of testosterone needed for a specific age or developmental stage and the amount of testosterone the body makes or has available. During the first few years of life, when the need for testosterone is low, most XXY males do not show any obvious differences from typical male infants and young boys. Some may have slightly weaker muscles, meaning they might sit up, crawl, and walk slightly later than average. For example, on average, baby boys with KS do not start walking until age 18 months.3 After age 5 years, when compared to typically developing boys, boys with KS may be slightly: Taller Fatter around the belly Clumsier Slower in developing motor skills, coordination, speed, and muscle strength Puberty for boys with KS usually starts normally. But because their bodies make less testosterone than non-KS boys, their pubertal development may be disrupted or slow. In addition to being tall, KS boys may have: Smaller testes and penis Breast growth (about one-third of teens with KS have breast growth) Less facial and body hair Reduced muscle tone Narrower shoulders and wider hips Weaker bones, greater risk for bone fractures Decreased sexual interest Lower energy Reduced sperm production An adult male with KS may have these features: Infertility: Nearly all men with KS are unable to father a biologically-related child without help from a fertility specialist.4 Small testes, with the possibility of testes shrinking slightly after the teen years5 Lower testosterone levels, which lead to less muscle, hair, and sexual interest and function Breasts or breast growth (called gynecomastia, pronounced GUY-nuh-kow-mast-ee-uh). In some cases, breast growth can be permanent, and about 10% of XXY males need breast-reduction surgery.6 [top] Language and Learning Symptoms Most males with KS have normal intelligence quotients (IQs)7,8 and successfully complete education at all levels. (IQ is a frequently used intelligence measure, but does not include emotional, creative, or other types of intelligence.) Between 25% and 85% of all males with KS have some kind of learning or language-related problem, which makes it more likely that they will need some extra help in school. Without this help or intervention, KS males might fall behind their classmates as schoolwork becomes harder. KS males may experience some of the following learning and language-related challenges:9 A delay in learning to talk. Infants with KS tend to make only a few different vocal sounds. As they grow older, they may have difficulty saying words clearly. It might be hard for them to distinguish differences between similar sounds. Trouble using language to express their thoughts and needs. Boys with KS might have problems putting their thoughts, ideas, and emotions into words. Some may find it hard to learn and remember some words, such as the names of common objects. Trouble processing what they hear. Although most boys with KS can understand what is being said to them, they might take longer to process multiple or complex sentences. In some cases, they might fidget or "tune out" because they take longer to process the information. It might also be difficult for KS males to concentrate in noisy settings. They might also be less able to understand a speaker's feelings from just speech alone. Reading difficulties. Many boys with KS have difficulty understanding what they read (called poor reading comprehension). They might also read more slowly than other boys. By adulthood, most males with KS learn to speak and converse normally, although they may have a harder time doing work that involves extensive reading and writing. [top] Social and Behavioral Symptoms Many of the social and behavioral symptoms in KS may result from the language and learning difficulties. For instance, boys with KS who have language difficulties might hold back socially and could use help building social relationships. Boys with KS, compared to typically developing boys, tend to be: Quieter Less assertive or self-confident More anxious or restless Less physically active More helpful and eager to please More obedient or more ready to follow directions In the teenage years, boys with KS may feel their differences more strongly. As a result, these teen boys are at higher risk of depression, substance abuse, and behavioral disorders. Some teens might withdraw, feel sad, or act out their frustration and anger. As adults, most men with KS have lives similar to those of men without KS. They successfully complete high school, college, and other levels of education. They have successful and meaningful careers and professions. They have friends and families. Contrary to research findings published several decades ago, males with KS are no more likely to have serious psychiatric disorders or to get into trouble with the law.10 (Comment: Easy to diagnose: no male-type baldness; infertile (may be married).

Brand: DOCTOR of MEDICINE

Brand "DOCTOR of MEDICINE" Image important. Court Lawyers and Judges look the part and are paid accordingly . Trend of (male) Physicians to look "working class" by avoiding ties and white coats. Fashion of draping "shorty" stethoscope around the neck looks absurd. Better to wear Doppler and Pulse-Oximeter. Or ELECTRONIC STETHOSCOPE to visually separate MDs from Nursing assistants.(e.g. LITTMANN # 3200) A profitable 2014 to the Blog's World Readers. Comments welcome. NB: NO ADs. Canada 4188 United States 3926 Russia 1910 Germany 1383 France 1342 Ukraine 1196 Poland 331 United Kingdom 276 China 237 Latvia 210

BUPA Worldwide insurance (since 1947) now covers CANADA

British United Provident Association now offers Canadian coverage. Multiple options.(in USA$) For World Hospital treatment (except USA) 29y-$1584 year; 39y- $2595; 49y- $3417. (Private General Hospitals now exist Montreal ROCKLAND MD; Ontario has one:Homewood Psychiatric in Guelph) RocklandMD MEDICAL CLINIC DOWNTOWN MONTREAL 1538 Sherbrooke ouest, Office 500, Montreal (Quebec) H3A 1L5 Guy-Concordia Metro Opening hours Monday to Friday from 8:00 am. to 4:00 pm Phone 514-667-3383 option 1 Toll Free 1-866-677-3383 Fax : 514-667-3834 EMAIL : info@rocklandmd.com ROCKLANDMD MEDICAL CLINIC VILLE MOUNT-ROYAL 100 Rockland road, suite 110, Ville Mont-Royal (Québec) H3P 2V9 Acadie metro Opening hours Monday to Friday 7:00 am to 6:00 pm Saturday from 8:00 am to 4:00 pm Phone 514-667-3383 option 1 Toll Free 1-866-677-3383 Fax : 514-667-3834 EMAIL : info@rocklandmd.com ROCKLANDMD SURGERY CENTER VILLE MOUNT-ROYAL 100 Rockland road, 115A, Ville Mount-Royal (Quebec) H3P 2V9 Acadie metro Opening hours Monday to Friday from 7:30 am to 18:00 pm Phone 514-667-3383 option 2 Toll Free 1-866-677-3383 Fax : 514-667-3834 EMAIL : info@rocklandmd.com

ONTARIO CHAPTER American College Physicians Anglo-Canadian Nephrologist Prof A.R. MORTON.

Meet Our Governor-elect Designee Ontario Chapter Congratulations to the Ontario Chapter Governor-Elect Designee, Alexander Ross Morton, MD, FACP. Our new Governor-elect Designee will do a year of training as a Governor-elect and then will start his four-year term as Governor in the Spring of 2015. As Governor, Dr. Morton will serve as the official representative of the College for the Ontario Chapter, providing a link between members at the local level and leadership at the national level. In the meantime, Dr. Morton will be working closely with Dr. Feldman (the current Governor) and College staff to learn about the College and his duties as Governor. To learn more about Dr. Morton, feel free to read his bio below. Alexander Ross Morton, MD, FACP Dr. Morton EDUCATION: University of Saint Andrews, University of Manchester POST DOCTORAL TRAINING: University of Manchester, University of Toronto; CERTIFICATION: BSc (Saint Andrews) MB ChB (Manchester) MD (Manchester); FRCP (London) FRCPC (Canada) FACP PRESENT POSITION: Professor of Medicine, Queen’s University, Kingston, Ontario, Canada ACP ACTIVITIES: FACP October 2008 CHAPTER INVOLVEMENT/LEADERSHIP ACTIVITIES: Member of the Governor’s Advisory Council. Queen’s University representative. Frequent Speaker at Chapter Annual Meeting HOSPITAL/COMMUNITY SERVICE: Kingston General Hospital OTHER APPOINTMENTS: Chair, Division of Nephrology AREAS OF PROFESSIONAL INTEREST/EXPERTISE: General Internal Medicine, Nephrology, Mineral Metabolism Vision Statement The Ontario Chapter of the American College of Physicians has forged strong links with the Canadian Society of Internal Medicine this year. These links needs to be maintained and strengthened to include other Chapters across the country. With the President of the Canadian Medical Association due to be appointed from Ontario in the summer of 2014, this is an ideal opportunity to increase dialogue between the two major national organizations using Ontario as a base. The link between the Ontario University and Community Physicians is ripe for strengthening as Social Media communications increases. Issues relevant to the membership can be brought to the attention of the Chapter quickly and dealt with in a timely manner, enhancing the relevance of the ACP to the Ontario membership. Furthermore using such rapid communication techniques, Medical Student and Trainee interest can be engaged, and educational opportunities increased.

ProMed:ZIKA VIRUS- FIRST in EUROPE A SEXUALLY TRANSMITTED DISEASE

PRO/EDR> Zika virus - Germany ex Thailand Inbox x promed@promedmail.org 20:24 (12 hours ago) to promed-post, promed-edr-post ZIKA VIRUS - GERMANY ex THAILAND ******************************** A ProMED-mail post ProMED-mail is a program of the International Society for Infectious Diseases Date: Fri 27 Dec 2013 From: Jonas Schmidt-Chanasit [edited] A previously healthy 53-year-old man consulted at the Saarland University Medical Center on 22 Nov 2013 after returning from travel to Thailand. During his 3-week round trip (31 Oct-20 Nov 2013), including visits to Phuket, Krabi, Ko Jum, and Ko Lanta, he developed joint pain and swelling on his left ankle and foot on 12 Nov 2013 after several mosquito bites, followed by a maculopapular rash on his rear and front trunk that spread to the face and the upper as well as lower extremities over the next 4 days before fading. Accompanying symptoms were malaise, fever, and shivering, of which the latter 2 appeared only for one day. He and his travel partner, who never had any comparable symptoms, were using insect repellent during travel. Upon presenting in Germany, which was intended as a check for tropical diseases and included taking blood samples, no clinical signs could be found, and the only subjective complaint was continuing tiredness. Initially, the 1st serum sample collected 10 days after disease onset gave a positive result in the dengue IgM antibody tests (IFA and rapid test), although tests for dengue IgG antibody (IFA and rapid test) and dengue NS 1 antigen (ELISA and rapid test) were negative. However, the isolated positive result for dengue IgM antibodies prompted us to investigate a probable flavivirus etiology through a serological approach. Serological tests for Japanese encephalitis virus, West Nile virus, yellow fever virus, tick-borne encephalitis virus, and Zika virus were performed by the WHO Collaborating Centre for Arbovirus and Haemorrhagic Fever Reference and Research (WHOCC), Hamburg, Germany. IFAs gave positive results for Zika virus IgG and IgM antibodies, demonstrating an acute or recent Zika virus [ZIKV] infection of the patient. In contrast, IFAs gave negative results for the other flaviviruses tested as well as for chikungunya virus. Real-Time RT-PCR for ZIKV RNA (in-house) was negative. The presence of ZIKV-specific neutralizing antibodies was confirmed by a virus neutralization assay, and an IgM titer decrease in IFA was demonstrated in the 2nd serum sample collected 31 days after disease onset. This is the 1st laboratory confirmed case of ZIKV reported in Germany and Europe and the 2nd case reported from Thailand. Thus, differential diagnosis in febrile returning travelers from the south of Thailand (Phuket, Krabi, Ko Jum, and Ko Lanta) should include Zika virus infection. -- Jonas Schmidt-Chanasit, Petra Emmerich, Dennis Tappe, Martin Gabriel, Stephan Gunther: Bernhard Nocht Institute for Tropical Medicine, WHO Collaborating Centre for Arbovirus and Haemorrhagic Fever Reference and Research, National Reference Centre for Tropical Infectious Diseases, Hamburg, Germany. Jorgen Rissland, Gerhard Held, Sigrun Smola: Saarland University Medical Center, Homburg/Saar, Germany [ProMED thanks Jonas Schmidt-Chanasit and colleagues for sending in this interesting, firsthand report. This is the 2nd ProMED-mail report of a Zika virus infection originating in Thailand. The virus was 1st isolated in 1947 from sentinel rhesus monkey serum in Uganda. Fortunately, the probability of ongoing transmission from this case in Germany is nil. This is another example of long-distance international travel involving an individual who acquired a tropical arbovirus disease who was seen in a temperate zone clinic halfway around the world. The above case is an excellent example of a thorough laboratory approach to establishing a diagnosis of a disease exotic to Germany. It also underscores the importance of taking a good travel history for these types of cases. It also indicates that Zika virus transmission is active in Thailand and could be confused easily with a dengue virus infection without comprehensive laboratory testing. This report along with the earlier one this year [2013] make one wonder how many Zika virus infections in Thailand and other Southeast Asian countries are mistakenly diagnosed as dengue virus infections.