Postings # 758, 759, 760, 761, 763, 766. 

The following links has to do with caution lights coming from the FDA.  HIV patients on Ziagen or Videx may have higher MI rates than similar patients not on the drugs.  Diabetic patients on an ulcer healing gel, Regranex, may have an increased risk for cancer.  The big alert as far as we’re concerned has to do with Singulair.  The FDA has a concern that there may be a link between the drug and mood changes, including suicidal behavior.  “Ah-h-h-h.  I can breathe so much better.  Now, I can go hang myself.  Yay!!!!”
http://omniphysicians.com/2008/03/28/mis-with-ziagenvidex/
http://omniphysicians.com/2008/03/28/regranex-cancer/
http://omniphysicians.com/2008/03/28/fda-caution-singulair/

Here is a case report about a kid with fever, joint aches, a rash.  There’s a photo.  Make the diagnosis.  There is a discussion and references at the end.  Want a hint?  The discoverers of this condition parachuted with Rudolph Hess into Great Britain during the last stages of WW II.
http://omniphysicians.com/2008/03/28/peds-fever-rash-and-knee-pain/
You might think that if you wear a pacemaker and you’re playing Vivaldi on your iPOD, your rhythm will plummet to syncopal levels.  Or if you’re playing Dr. Dre, you might go into V. Tach.  This article reports on a study that shows simultaneous iPOD music does not interfere with your pacemaker.  This conclusion goes against a study published last year.  However, if you’re listening to Rush Limbaugh, your pacemaker will shoot electrical sparks to your GI tract causing intractable vomiting.
http://omniphysicians.com/2008/03/28/pacemakers-ipod/
In the 1990s, the fatality rate from ATV accidents in West Virginia was 8 times the national average.  If this isn’t an argument for strict laws against in-breeding, I don’t know what is!
http://omniphysicians.com/2008/03/28/atv-fatalities-%e2%80%94-west-virginia/
Have a nice weekend.
 

CDC Press Release, 3/27/08: 

All-Terrain Vehicle Fatalities — West

Virginia, 1999–2006

 

During the 1990s, West Virginia led the nation in per capita death rate from all-terrain vehicle (ATV) crashes, with rates approximately eight times higher than the national average, prompting enactment of the first-ever WV ATV law in 2004. To guide further prevention campaigns, temporal, geographic, and socioeconomic trends of ATV fatalities during 1999–2006 were analyzed using data from death certificates. Since the ATV law was enacted, ATV-related fatalities among children have not declined and ATV-related traffic fatalities have increased. Higher annual ATV death rates occurred among males, persons aged 10–17 years, residents of the most impoverished counties, and persons with less education. Further preventive measures to reduce ATV-related fatalities should be considered, such as targeted educational interventions and more stringent provisions of the law.

 CDC Press Release:  “Over the past 25 years, the hospitalization rate for kidney diseases has increased dramatically, especially adults over age 65. From 1980 to 2005, the number of hospitalizations with a diagnosis of kidney disease, including chronic and acute kidney failures, rose from 416,000 to 1.6 million.

The study analyzed data from the National Hospital Discharge Survey, 1980-2005. The study found that hospitalization rates were consistently higher (about 30-40 percent) among men than women, increasing from 25.0 to 66.5 per 10,000 in men and from 17.8 to 45.8 per 10,000 in women.

In 2005, approximately 61.4 percent of patients hospitalized with kidney disease were age 65 and older compared to 49.9 percent in 1980. An increasing number of kidney disease related hospital admissions were associated with diabetes or hypertension.”proxy credit adjusted bankcasino affiliate program marketingfor american fun casino slotscanyon winners andrews casino american tournamenthotel ameristar casinofight 04 casino 14 07merchant account credit offshore card casinoislands charity casino 1000 Map

NY Times, 3/28/08 (http://www.nytimes.com/2008/03/28/us/politics/28clinton.html?_r=1&hp&oref=slogin) reports…

“Senator Hillary Rodham Clinton said in an interview on Wednesday that if elected president she would push for a universal health care plan that would limit what Americans pay for health insurance to no more than 10 percent of their income, a significant reduction for some families…she would like to cap health insurance premiums at 5 percent to 10 percent of income.

HealthDay (3/27, http://healthday.com/Article.asp?AID=613952) reported that “iPods and other digital music players don’t affect pacemaker function,” according to a study published in the April issue of Heart Rhythm.

Dr. Charles Berul, director of the pacemaker service at Children’s Hospital Boston, and colleagues “ran tests on 51 patients,” all of whom “had active pacemakers or implantable cardioverter-defibrillators (ICDs).

A team at the hospital ran tests on 51 patients who came in for appointments. Their average age was 22 years, and they all had active pacemakers or implantable cardioverter-defibrillators (ICDs). The researchers played four different kinds of digital music players (two kinds of iPods, a SanDisk Sansa and a Microsoft Zune) directly over the each patient’s pacemaker or ICD.

The music players caused no interference with the devices’ functioning — electrocardiographic (EKG) recordings showed no changes in any of the 255 separate tests and none of the patients showed any symptoms.

 If this doesn’t cause v. tach, I don’t know what will!

However, this study did find that in 41 percent of patients, the music players interfered with communications between the programmer and the pacemaker or ICD. The programmer is a computerized device used by doctors to check and recalibrate the heart devices. This indicates that patients shouldn’t use digital music devices while a doctor is reprogramming their heart device, the researchers said.”

McKesson Provider Technologies, an Atlanta-based provider of healthcare IT services, will partner with Clorox to produce and disseminate protocols that will lessen the infection potential “for mobile equipment and handheld electronic devices, including wheeled computers, tablet PCs, mobile medication cabinets and hand-held bar-code scanners…According to the U.S. Centers for Disease Control and Prevention (CDC), 2 million hospital patients each year contract a hospital-acquired infection (HAI), leading to 90,000 deaths as a result. Other studies have reported that one in every 20 patients acquires an HAI, and that it costs the U.S. healthcare industry an estimated $20 billion a year to treat them.”

http://www.healthcareitnews.com/story.cms?id=8946&fromRSS=true

FDA MedWatch, 3/27/08: The FDA issued an Early Communication about recent findings of The Data Collection on Adverse Events of Anti-HIV Drugs Study. Data analyses from this study indicate a higher risk of heart attack in patients infected with HIV-1 who were taking Ziagen (abacavir) or Videx (didanosine) as part of their drug therapy. The study is a large observational study of 33,347 HIV-1 infected patients living in North America, Europe and Australia. Patients in this study are being followed to evaluate the short and long term adverse effects of treatment with anti-HIV drugs. FDA continues to evaluate the overall risks and benefits of abacavir and didanosine. This evaluation may result in the need to revise labeling for the products. Until the FDA’s review is complete, health care professionals should evaluate the potential risks and benefits of each HIV-1 antiretroviral drug their patients are taking.

This early communication is in keeping with FDA’s commitment to inform the public about its ongoing safety reviews of drugs. As soon as this review is complete, FDA will communicate the conclusions and recommendations to the public.

Read the complete 2008 MedWatch Safety Summary, including a link to the FDA Early Communication About an Ongoing Safety Review regarding this issue at: http://www.fda.gov/medwatch/safety/2008/safety08.htm#abacavir

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FDA Medwatch, 3/27/08: The FDA is conducting a safety review based on study data suggesting there may be an increased risk of death from cancer in diabetic patients using Regranex (becaplermin) Gel, a skin product used to heal leg and foot ulcers. While the review is ongoing, the FDA recommends health care professionals discuss the potential risks and benefits of using Regranex with their patients.

This early communication is in keeping with FDA’s commitment to inform the public about its ongoing safety reviews of drugs. As soon as this review is complete, FDA will communicate the conclusions and recommendations to the public.

Read the complete 2008 Safety Summary, including a link to the FDA Early Communication About An Ongoing Safety Review regarding this issue at:
http://www.fda.gov/medwatch/safety/2008/safety08.htm#Regranex

FDA Med Watch, 3/27/08: FDA informed healthcare professionals and patients of the Agency’s investigation of the possible association between the use of Singulair and behavior/mood changes, suicidality (suicidal thinking and behavior) and suicide.

Singulair is a leukotriene receptor antagonist used to treat asthma and the symptoms of allergic rhinitis, and to prevent exercise-induced asthma. Patients should not stop taking Singulair before talking to their doctor if they have questions about the new information. Healthcare professionals and caregivers should monitor patients taking Singulair for suicidality (suicidal thinking and behavior) and changes in behavior and mood.
This early communication is in keeping with FDA’s commitment to inform the public about its ongoing safety reviews of drugs.  Due to the complexity of the analyses, FDA anticipates that it may take up to 9 months to complete the ongoing evaluations.  As soon as this review is complete, FDA will communicate the conclusions and recommendations to the public.

Read the complete 2008 MedWatch Safety Summary, including a link to the FDA Early Communication About An Ongoing Safety Review regarding this issue at:  http://www.fda.gov/medwatch/safety/2008/safety08.htm#Singulair

From the March, 08 issue of Infectious Diseases in Children            (Dr. P.A. Treadwell):

Case Report:  This 5-year-old girl presented with a fever, pain and swelling and pain of her knees. Her younger brother had a “cold” last week. She attends preschool. The family has no pets.

What is your diagnosis?

Diagnosis:  Henoch-Schönlein Purpura (HSP) syndrome.

HSP is a hypersensitivity reaction that typically follows an infection. The preceding infection may be streptococcal or viral.

The clinical findings in HSP are petechial or purpuric lesions that are distributed in an acral pattern, most often affecting the lower legs and buttocks. “Palpable purpura” is a term that describes violaceous nonblanching raised papules. On occasion, the lesions can become vesicular or bullous. Infants tend to have more involvement of the face and scalp with accompanying edema. Lesions in areas of pressure (eg, from socks or elastic bands) may produce a pattern similar to the pattern of whatever is producing the pressure on the skin.

Noncutaneous findings include arthralgias and/or arthritis and gastrointestinal abnormalities (abdominal pain, vomiting, bloody stools). The vasculitic process can affect the kidneys and cause nephritis.

A biopsy of a petechial lesion shows a leukocytoclastic vasculitis with extravasated red blood cells. When direct immunofluorescence testing is performed, IgA immune complexes may be demonstrated.

Differential diagnoses include other vasculitic processes, juvenile arthritis, Rocky Mountain spotted fever, which is also a vaculitic disorder and meningococcemia. The lesions in meningucocenic can be similar in appearance to HMS but the distribution is concentrated on the trunk. Children who have meningococcemia are also more ill appearing.

Therapeutic recommendations are elevation of affected areas and anti-inflammatory medications. The urine should be examined for hematuria. If any evidence of renal disease exists in the acute stages of the disease, the renal status should be monitored.

There has been controversy regarding the efficacy of corticosteroid use, however, a recent meta-analysis was published. Weiss et al concluded: “Corticosteroids, given early in the course of the illness, seem to produce benefits for several major clinically relevant Henoch-Schönlein purpura outcomes.”

Bibliography:

• Butani L, Morganstern, BZ. Long-term outcome in children after Henoch-Schonlein purpura nephritis. Clin Pediatr. 2007;46:505-511.
• Chan KH, Tang WY, Lo KK. Bullous lesions in Henoch-Schönlein purpura. Pediatr Dermatol. 2007;24:325-326.
• Dillon MJ. Henoch-Schönlein purpura: recent advances. Clin Exp Rheumatol. 2007;25(1 suppl 44):S66-S68.
• Weiss PF, Feinstein, JA, Luan, X, et al. Effects of corticosteroid on Henoch-Schönlein purpura: a systematic review. Pediatrics. 2007;120:1079-1087.

Intro: What’s interesting is that while this nurse was being investigated for 3 years, he was allowed to work.  I hope that means he was not allowed to be near a patient.

Infection Control Monitor, 3/28/08 ( www.hcpro.com ):   “…at least 15 military service members or their family members are believed to have been infected with hepatitis C by a former nurse who authorities suspect was stealing painkilling medication during surgery at an El Paso, TX military hospital.  The nurse, a retired Army Captain, was arrested this month in Miami on federal charges of assaulting three of those patients and possession of a controlled substance by fraud… Prosecutors believe he spread the disease in 2004 during surgeries by diverting fentanyl from patients.”