Wednesday, April 18, 2018

Frank's Sign

"First described in 1973, Frank’s sign, also known as diagonal earlobe crease (DELC), was observed to be an aural sign of coronary artery disease (CAD). Since then, there has been much interest in examining this unique association. This may occur as a result of age- or disease-related weakening of dermal and elastic fibers in the ear lobes, making it a dermatological predictor of an underlying coronary vessel insufficiency. Over the years, more insights were gained from studies showing the association of DELC with significantly increased prevalence, extent and severity of CAD, independent of traditional CAD risk factors, with good sensitivity and positive predictive value. Recent studies have also demonstrated DELC’s independent association with increased carotid intima-media thickness as well as cardiovascular events (CVE) comprising not only coronary, but ischemic cerebrovascular and peripheral vascular diseases, suggesting that DELC may be a marker of generalized atherosclerotic disease. Wong et al. in a study of 558 consecutive patients (445 patients had CAD on coronary angiography), found that the presence of DELC is independently associated with 5-fold higher risk of CAD. Of note, there has been proposed classification of DELC based on the characteristics of length, depth, bilateralism and inclination of the crease. Although bilateralism has been shown to have good specificity for CVE association, the significance of the characteristics needs to be further studied."

Full text:
KG Lee. Frank's sign - A dermatological link to coronary artery disease? Med J Malaysia 2017; 72:195-6.

Monday, April 16, 2018

A Golden Buzzer Act that Will Make You Cry

Have you watched Marc Spelmann's brilliant act at Britain's Got Talent? A mentalism prediction of multiple outcomes performed in perfection, revealed with a deeply emotional story - it moved the whole audience and the Golden Buzzer was just well-deserved. "Utterly extraordinary (performance)", told by Amanda Holden, which I just couldn't agree more. Beautiful!

Friday, April 13, 2018

Nephrology Board Exam M'sia

I somehow feel that my Nephrology journey is filled with exams, one after another. After my MRCP and USMLE, I did my SCE Neph exam (UK) in 2012 in preparation to enter the Singapore Renal Fellowship (Senior Residency) program. During the 3-year training, there is annual US in-training exam (ABIM exam in Nephro), and additionally at second year an ACGME-I Graduation Exam, and finally at end of third year there was a Singapore JCST Board Exit Exam as completion of training and for Specialist Board Accreditation.

As now I have returned to home country for family, I was required to obtain the certificate of M'sian Nephro Board Exam, and I'm glad to share that I have successfully completed it.

Pursuing Nephrology has been my dream and passion. Having been exposed to different examination format (UK/ Singapore/ US/ M'sia), I would like to share on a series of Nephrology topics and hope these help if you're also preparing for any Nephro exams:

Nephrology Foundation

Nephrology Guidelines

Nephrology Updates 2017

Nephrology Resources

And many more to come!

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