Archive for October 9th, 2008

OMNI Postings of 10/9/08

by Paul Rega, MD — published on October 9th, 2008
The AP (10/9) reports that a  German farmer who received the world’s first complete double arm transplant said Wednesday that incredulity gave way to joy when he woke from surgery to discover he had arms again.  He is reported to have said, “Ach du lieber!  Now I can shuffle cards.”
But I digress…
1)  Here is a case report from “Consultant”  about a young lady who developed a rash soon after she started using a new cell phone.  Is there a connection?  What’s the diagnosis?  How to treat? 
2)  This news article deals with the perceived increase in ER patients coming in with stress-related ailments — all as a result of the economy.  You agree?
3)  This is the official FDA (Fandango Dance Association) press release regarding OTC cough/cold meds and kids under the age of 4.   Sometimes it’s better to get it right from the horse’s mouth than from Katie Couric. Then again, sometimes it’s hard to distinguish between the two.
4)  A group of ID control fanatics are issuing guidelines in order to pressure hospitals to reduce nosocomial infections.  It’s acknowledged by many that much of what is being suggested is old news.  Yet when there is an announcement that 99,000 Americans die each year from these, arguably preventable infections, then it’s not surprising to see a “push” to do something.  The guidelines for hospital practices call for removing catheters as soon as they are not needed, washing hands vigorously, and routinely cleaning intensive-care patients with a common disinfectant.  A bleach bath?
5)  This is a news story reporting on a medical privacy suit that is being considered by the Ohio Supreme Court.  Can parents of an under-age daughter who received an abortion that they didn’t know about, obtain medical records of other patients from the same abortion clinic in order to demonstrate a pattern?
Comments Off
categories: Emergency Medicine

A Rash & A New Cell Phone

by Paul Rega, MD — published on October 9th, 2008

An 18-year-old girl presented with a red, scaly rash on her cheeks that had been scabbing over, peeling, and draining. She had had similar reactions to earrings and inexpensive jewelry. The appearance of the rash coincided with the use of a new cell phone.

1

1

An allergy to nickel on the cell phone was suspected. A dimethylglyoxime test (Allertest Ni) was performed in which 2 solutions were applied to a cotton swab that was then rubbed over the metal area of the phone. The swab turned pink, confirming the presence of nickel. Results of patch tests applied to the patient’s back showed a strong positive reaction to nickel.

Nickel dermatitis is the most common form of contact dermatitis and has been linked to cell phone use.1 Nickel dermatitis associated with cell phone use should be included in the differential diagnosis of unusual facial rashes. This is true even if the cell phone was not recently purchased, because nickel allergies can take time to develop. Allergic reactions to nickel are easily prevented. For example, patients can use a barrier between the skin and the allergen, wear stainless steel earrings, or paint clear fingernail polish on keys. If it is an occupational exposure (eg, nickel in an industrial compound), rubber gloves may be ineffective; in this case, heavy-duty vinyl gloves may be used.

This patient was treated with triamcinolone ointment, and the rash resolved within a week. She purchased a new cell phone, and no further rashes occurred.

Comments Off
categories: Emergency Medicine

New TB Vaccine Hope

by Paul Rega, MD — published on October 9th, 2008

BBC, 10/9/08 (http://news.bbc.co.uk/2/hi/uk_news/wales/mid_/7656676.stm)

Ground-breaking research by scientists in Wales and Russia is being used to develop a new vaccine for tuberculosis.

Aberystwyth University and the Russian Academy of Sciences have been working in partnership for a decade.

Scientists discovered a new protein in humans in the late 1990s, which is now being developed to control bacteria which cause tuberculosis (TB).

Clinical trials are to begin in 2009 but a charity says it could be 10 years before it is available for general use.

TB kills 1.7m people each year, and there are concerns that the bacteria which causes it are becoming resistant to current drugs.

The only existing TB vaccine, Bacille Calmette-Guérin (BCG), which was created in 1921, is only partially effective.

It is hoped the new vaccine will have more success treating sufferers, particularly in the developing world.

It could work in three ways.

Firstly, by activating the dormant TB allowing it to be treated with drugs. Secondly, by ensuring the bacteria stays dormant and finally by working as a traditional vaccine preventing the bacteria from establishing.

Professor Mike Young, of Aberystwyth’s Institute of Biological, Environmental and Rural Studies, helped lead the research team in mid Wales.

He said: “Current TB treatments can go on for over six months and can still leave bacteria in the body that can cause the disease when they resume active growth and multiplication.

“Our discovery, which is now being developed into a vaccine, might help prevent the establishment of persistent infections in the first place or, alternatively, it might prevent persisting organisms in individuals with latent TB from reawakening at all.

“TB kills around 1.7m people around the world every year. I hope that our research will now be rapidly translated into a vaccine that can help as many of these people as possible.”

‘Positive sign’

Work started on the vaccine in the late 1990s, when researchers discovered a new family of proteins able to “resuscitate bacteria” found harmlessly in and around the human body.

When “awoken from dormancy” researchers found the TB bacteria were much more susceptible to attack from antibiotics.

The Aeras Global TB Vaccine Foundation, which was founded to develop new, cost-effective TB vaccines for use in the developing world, has licensed the discovery of the protein.

The charity TB Alert said this was a “positive sign” but the organisation’s chair Paul Sommerfeld warned that a vaccine was still a long way off.

“We’re very happy that new work is being carried out, but there is a long period of testing, involving some three phases, and we’re not expecting a new vaccine for about 10 years,” he said.

Comments Off
categories: Emergency Medicine

New Guidelines to Prevent Hospital Infections

by Paul Rega, MD — published on October 9th, 2008

Boston Globe, 10/8/08 (http://www.osei.noaa.gov/Events/Current/TRCnorbert282_G11L.jpg):

Healthcare groups yesterday endorsed recommendations in a campaign to intensify hospitals’ efforts to prevent infections that contribute to an estimated 99,000 patient deaths a year in the United States.

The guidelines for hospital practices call for removing catheters as soon as they are not needed, washing hands vigorously, and routinely cleaning intensive-care patients with a common disinfectant.

The endorsement from multiple healthcare groups adds weight to the pressures building on hospitals to comply.

While the guidelines are similar to those developed during the past two decades by a government advisory panel, the health groups aim to encourage hospitals to adopt the safety recommendations faster, Patrick J. Brennan, a University of Pennsylvania epidemiologist, said yesterday.

Moves to force greater disclosure of safety records and the US government’s changing reimbursement policies also are pushing hospitals to use the new standards.

“The slow, prodding progression to success has been accelerated by all of these factors,” said Brennan, president of the Society for Healthcare Epidemiology of America, one of the leading groups behind the effort.

Support from the American Hospital Association and from the Joint Commission, a national organization that accredits hospitals, also should help spur hospitals to use the guidelines, Brennan said. The recommendations released yesterday attempt to provide clear, practical ways for hospitals to put the guidelines in place, he said.

“We know what to do, but it’s how to do it where we fail,” Brennan said. “That is what these documents attempt to address.”

The federal Centers for Medicare and Medicaid Services said it will no longer reimburse hospitals for the costs of treating certain infections as of Oct. 1.

An estimated 1.7 million Americans a year contract an infection while receiving healthcare treatment, according to the Atlanta-based Centers for Disease Control and Prevention.

Comments Off
categories: Emergency Medicine

What FDA Says on OTC Cough&Cold Meds for Kids

by Paul Rega, MD — published on October 9th, 2008

FDA Press Release, 10/8/08:  FDA Statement Following CHPA’s Announcement on Nonprescription Over-the-Counter Cough and Cold Medicines in ChildrenBackground: The Consumer Healthcare Products Association (CHPA), an association that represents most of the makers of nonprescription over-the-counter (OTC) cough and cold medicines in children, recently announced that its members are voluntarily modifying the product labels for consumers of OTC cough and cold medicines to state “do not use” in children under 4 years of age. Additionally, the manufacturers are introducing new child-resistant packaging and new measuring devices for use with the products.

The steps that are being taken by CHPA will not affect the availability of the medicines, but this voluntary action will result in a transition period where the instructions for use of some OTC cough and cold medicines in children will be different from others. FDA does not typically request removal of OTC products with previous labeling from the shelves during a voluntary label change such as this one. Therefore, some medicines will have the new recommendation “do not use” for children under 4 years of age, while others will instruct that they not be used for children under 2 years of age. If parents or caregivers have or purchase a product that does not have the voluntarily-modified labeling, FDA recommends that they should adhere to the dosage instructions and warnings on the label that accompanies the medication. They should not, under any circumstances, give adult medications to children. If parents or caregivers have questions or are just not sure about how to use a product, they should consult with their doctor or pharmacist.

Over the last year, FDA has been working on several fronts to address the safe use of nonprescription OTC cough and cold medicines in children.

FDA has held two public meetings to hear from stakeholders and consumers on the issue, most recently, a public hearing that focused on labeling of these products on Oct. 2, 2008. In January of this year, FDA issued a nationwide Public Health Advisory recommending that these products not be used in children under the age of two because of the risk of serious and potentially life-threatening side effects.

Another part of the agency’s work includes outreach to other public health agencies, consumer and patient groups companies that manufacture these products, and CHPA.

FDA will continue to work with the Centers for Disease Control and Prevention to monitor the ongoing use of these products and to develop educational materials for parents and consumers. The Agency will also continue to reach out to the scientific community to obtain more up-to-date information and scientific data about the effects of these products in children so that it can take the appropriate regulatory steps moving forward.

All these areas are vital to support the development and review of data regarding the safe and effective use of these products.

FDA is proceeding with its rulemaking process to update the existing OTC monograph for cough and cold products for children, and will consider input from the recent hearing of Oct. 2. The rulemaking process affords additional opportunity for the submission of data and public comment.

Until all these issues are resolved, FDA continues to recommend to parents and caregivers the following:

  • Do not give children medications labeled only for adults.
  • Talk to your healthcare professional if you have any questions about using cough or cold medicines in children.
  • Choose OTC cough and cold medicines with child-resistant safety caps, when available. After each use, make sure to close the cap tightly and store the medicines out of the sight and reach of children.
  • Check the “active ingredients” section of the DRUG FACTS label of the medicines that you choose. This will help you understand what symptoms the “active ingredients” in the medicine are intended to treat. Cough and cold medicines often have more than one active ingredient (such as an antihistamine, a decongestant, a cough suppressant, an expectorant, or a pain reliever/fever reducer).
  • Be very careful if you are giving more than one medicine to a child. If you are giving more than one medicine to a child make sure that they do not have the same type of “active ingredients.” If you use two medicines that have the same or similar active ingredients, a child could get too much of an ingredient and that may hurt your child. For example, do not give a child more than one medicine that has a decongestant.
  • Carefully follow the directions for how to use the medicine in the DRUG FACTS part of the label. These directions tell you how much medicine to give and how often you can give it. If you have a question about how to use the medicine, ask your pharmacist or your doctor. Overuse or misuse of these products can lead to serious and potentially life threatening side effects such as rapid heartbeat, drowsiness, suppression of the respiratory system, seizures and other adverse events.
  • Only use measuring devices that come with the medicine or those specially made for measuring drugs. Do not use common household spoons to measure medicines for children because household spoons come in different sizes and are not meant for measuring medicines.
  • Understand that using OTC cough and cold medicines does not cure the cold or cough. These medicines only treat your child’s symptom(s) such as runny nose, congestion, fever and aches and do not shorten the length of time your child is sick.
Comments Off
categories: Emergency Medicine