Archive for May, 2011
Measuring the wrist bone
http://www.medicalnewstoday.com/articles/222015.php
Medical News Today, 4/12/11
“Measuring the wrist bone may be a new way to identify which overweight children and adolescents face an increased risk of developing cardiovascular disease, according to research in Circulation: Journal of the American Heart Association……..In a study of 477 overweight/obese children and adolescents (average age 10), researchers found that wrist circumferences accounted for 12 percent to 17 percent of the total variance of insulin resistance……Insulin resistance, a condition in which the body makes insulin but can’t use it efficiently to break down blood sugar, is a metabolic risk factor for later development of cardiovascular disease. Higher insulin levels increase the risk of developing insulin resistance, which in turn increases the risk of developing cardiovascular disease……”
Preparedness 101: Zombie Apocalypse
The following was originally posted on CDC Public Health Matters Blog on May 16th, 2011 by Ali S. Khan.http://emergency.cdc.gov/socialmedia/zombies_blog.asp
There are all kinds of emergencies out there that we can prepare for. Take a zombie apocalypse for example. That’s right, I said z-o-m-b-i-e a-p-o-c-a-l-y-p-s-e. You may laugh now, but when it happens you’ll be happy you read this, and hey, maybe you’ll even learn a thing or two about how to prepare for a real emergency.
A Brief History of Zombies
We’ve all seen at least one movie about flesh-eating zombies taking over (my personal favorite is Resident EvilExternal Web Site Icon.), but where do zombies come from and why do they love eating brains so much? The word zombie comes from Haitian and New Orleans voodoo origins. Although its meaning has changed slightly over the years, it refers to a human corpse mysteriously reanimated to serve the undead. Through ancient voodoo and folk-lore traditions, shows like the Walking Dead were born.
In movies, shows, and literature, zombies are often depicted as being created by an infectious virus, which is passed on via bites and contact with bodily fluids. Harvard psychiatrist Steven Schoolman wrote a (fictional) medical paper on the zombies presented in Night of the Living Dead and refers to the condition as Ataxic Neurodegenerative Satiety Deficiency Syndrome caused by an infectious agent. The Zombie Survival Guide identifies the cause of zombies as a virus called solanum. Other zombie origins shown in films include radiation from a destroyed NASA Venus probe (as in Night of the Living Dead), as well as mutations of existing conditions such as prions, mad-cow disease, measles and rabies.
The rise of zombies in pop culture has given credence to the idea that a zombie apocalypse could happen. In such a scenario zombies would take over entire countries, roaming city streets eating anything living that got in their way. The proliferation of this idea has led many people to wonder “How do I prepare for a zombie apocalypse?”
Well, we’re here to answer that question for you, and hopefully share a few tips about preparing for real emergencies too!
Better Safe than Sorry
Some of the supplies for your emergency kit.
So what do you need to do before zombies…or hurricanes or pandemics for example, actually happen? First of all, you should have an emergency kit in your house. This includes things like water, food, and other supplies to get you through the first couple of days before you can locate a zombie-free refugee camp (or in the event of a natural disaster, it will buy you some time until you are able to make your way to an evacuation shelter or utility lines are restored). Below are a few items you should include in your kit, for a full list visit the CDC Emergency page.
* Water (1 gallon per person per day)
* Food (stock up on non-perishable items that you eat regularly)
* Medications (this includes prescription and non-prescription meds)
* Tools and Supplies (utility knife, duct tape, battery powered radio, etc.)
* Sanitation and Hygiene (household bleach, soap, towels, etc.)
* Clothing and Bedding (a change of clothes for each family member and blankets)
* Important documents (copies of your driver’s license, passport, and birth certificate to name a few)
* First Aid supplies (although you’re a goner if a zombie bites you, you can use these supplies to treat basic cuts and lacerations that you might get during a tornado or hurricane)
Once you’ve made your emergency kit, you should sit down with your family and come up with an emergency plan. This includes where you would go and who you would call if zombies started appearing outside your door step. You can also implement this plan if there is a flood, earthquake, or other emergency.
1. Identify the types of emergencies that are possible in your area. Besides a zombie apocalypse, this may include floods, tornadoes, or earthquakes. If you are unsure contact your local Red Cross chapter for more information.
2. Pick a meeting place for your family to regroup in case zombies invade your home…or your town evacuates because of a hurricane. Pick one place right outside your home for sudden emergencies and one place outside of your neighborhood in case you are unable to return home right away.
3. Identify your emergency contacts. Make a list of local contacts like the police, fire department, and your local zombie response team. Also identify an out-of-state contact that you can call during an emergency to let the rest of your family know you are ok.
4. Plan your evacuation route. When zombies are hungry they won’t stop until they get food (i.e., brains), which means you need to get out of town fast! Plan where you would go and multiple routes you would take ahead of time so that the flesh eaters don’t have a chance! This is also helpful when natural disasters strike and you have to take shelter fast.
Never Fear – CDC is Ready
If zombies did start roaming the streets, CDC would conduct an investigation much like any other disease outbreak. CDC would provide technical assistance to cities, states, or international partners dealing with a zombie infestation. This assistance might include consultation, lab testing and analysis, patient management and care, tracking of contacts, and infection control (including isolation and quarantine). It’s likely that an investigation of this scenario would seek to accomplish several goals: determine the cause of the illness, the source of the infection/virus/toxin, learn how it is transmitted and how readily it is spread, how to break the cycle of transmission and thus prevent further cases, and how patients can best be treated. Not only would scientists be working to identify the cause and cure of the zombie outbreak, but CDC and other federal agencies would send medical teams and first responders to help those in affected areas (I will be volunteering the young nameless disease detectives for the field work).
To learn more about what CDC does to prepare for and respond to emergencies of all kinds, visit:
http://emergency.cdc.gov/cdc/orgs_progs.asp
To learn more about how you can prepare for and stay safe during an emergency visit:
http://emergency.cdc.gov/
To download a badge like the one above that you can add to your social networking profile, blog, website, or email signature visit:
http://emergency.cdc.gov/socialmedia/zombies.asp
MRSA, VRE & ICU (http://www.nejm.org/doi/full/10.1056/NEJMoa1000373?query=TOC)
http://www.nejm.org/doi/full/10.1056/NEJMoa1000373?query=TOC
Intervention to Reduce Transmission of Resistant Bacteria in Intensive Care
W. Charles Huskins, M.D., Charmaine M. Huckabee, M.S., Naomi P. O’Grady, M.D., Patrick Murray, Ph.D., Heather Kopetskie, M.S., Louise Zimmer, M.A., M.P.H., Mary Ellen Walker, M.S.N., Ronda L. Sinkowitz-Cochran, M.P.H., John A. Jernigan, M.D., Matthew Samore, M.D., Dennis Wallace, Ph.D., and Donald A. Goldmann, M.D. for the STAR*ICU Trial Investigators
N Engl J Med 2011; 364:1407-1418 April 14, 2011
Background
Intensive care units (ICUs) are high-risk settings for the transmission of methicillin-resistant Staphylococcus aureus (MRSA) and vancomycin-resistant enterococcus (VRE).
Methods
In a cluster-randomized trial, we evaluated the effect of surveillance for MRSA and VRE colonization and of the expanded use of barrier precautions (intervention) as compared with existing practice (control) on the incidence of MRSA or VRE colonization or infection in adult ICUs. Surveillance cultures were obtained from patients in all participating ICUs; the results were reported only to ICUs assigned to the intervention. In intervention ICUs, patients who were colonized or infected with MRSA or VRE were assigned to care with contact precautions; all the other patients were assigned to care with universal gloving until their discharge or until surveillance cultures obtained at admission were reported to be negative.
Results
During a 6-month intervention period, there were 5434 admissions to 10 intervention ICUs, and 3705 admissions to 8 control ICUs. Patients who were colonized or infected with MRSA or VRE were assigned to barrier precautions more frequently in intervention ICUs than in control ICUs (a median of 92% of ICU days with either contact precautions or universal gloving [51% with contact precautions and 43% with universal gloving] in intervention ICUs vs. a median of 38% of ICU days with contact precautions in control ICUs, P<0.001). In intervention ICUs, health care providers used clean gloves, gowns, and hand hygiene less frequently than required for contacts with patients assigned to barrier precautions; when contact precautions were specified, gloves were used for a median of 82% of contacts, gowns for 77% of contacts, and hand hygiene after 69% of contacts, and when universal gloving was specified, gloves were used for a median of 72% of contacts and hand hygiene after 62% of contacts. The mean (±SE) ICU-level incidence of events of colonization or infection with MRSA or VRE per 1000 patient-days at risk, adjusted for baseline incidence, did not differ significantly between the intervention and control ICUs (40.4±3.3 and 35.6±3.7 in the two groups, respectively; P=0.35).
Conclusions
The intervention was not effective in reducing the transmission of MRSA or VRE, although the use of barrier precautions by providers was less than what was required. (Funded by the National Institute of Allergy and Infectious Diseases and others; STAR*ICU ClinicalTrials.gov number, NCT00100386.)
Afinitor (everolimus) & progressive neuroendocrine tumors in the pancreas (PNET)
http://www.fda.gov/NewsEvents/Newsroom/PressAnnouncements/ucm254350.htm
FDA NEWS RELEASE
For Immediate Release: May 6, 2011
Media Inquiries: Erica Jefferson, 301-796-4988, erica.jefferson@fda.hhs.gov
Consumer Inquiries: 888-INFO-FDA
FDA approves new treatment for rare type of pancreatic cancer
On Thursday, the U.S. Food and Drug Administration approved Afinitor (everolimus) to treat patients with progressive neuroendocrine tumors located in the pancreas (PNET) that cannot be removed by surgery or that have spread to other parts of the body (metastatic).
Neuroendocrine tumors found in the pancreas are slow-growing and rare. It is estimated that there are fewer than 1,000 new cases in the United States each year.
“Patients with this cancer have few effective treatment options,” said Richard Pazdur, M.D., director of the Office of Oncology Drug Products in the FDA’s Center for Drug Evaluation and Research. “Afinitor has demonstrated the ability to slow the growth and spread of neuroendocrine tumors of the pancreas.”
The safety and effectiveness of Afinitor was established a clinical trial in 410 patients with metastatic (late-stage) or locally advanced (disease that could not be removed with surgery) disease. Patients in the study were selected to receive Afinitor or placebo (sugar pill). The trial was designed to measure the length of time a patient lived before their disease spread or worsened (progression-free survival).
In patients treated with Afinitor, the median length of time they lived without the cancer spreading or worsening was 11 months compared with 4.6 months in patients who received placebo. Patients who received placebo were able to receive Afinitor if their disease worsened.
In patients treated with Afinitor for neuroendocrine pancreatic tumors, the most commonly reported side effects included inflammation of the mouth (stomatitis), rash, diarrhea, fatigue, swelling (edema), stomach (abdominal) pain, nausea, fever, and headache.
Afinitor is also approved to treat patients with kidney cancer (advanced renal cell carcinoma) after they fail treatment with Sutent (sunitinib) or Nexavar (sorafenib); and patients with subependymal giant cell astrocytoma (a type of brain cancer) associated with tuberous sclerosis (a disease that causes tumors in various parts of the body), who cannot be treated by surgery.
Afinitor has another trade name, Zortress, and is approved to treat certain adult patients to prevent organ rejection after a kidney transplant. Zortress has a different safety profile in these patients.
Afinitor is marketed by East Hanover, N.J.-based Novartis.
For more information:
FDA: Office of Oncology Drug Products1
FDA: Approved Drugs: Questions and Answers2
,
Snake bite and cardiac tamponade
Cardiac Tamponade in Russell Viper (Daboia russelii) Bite: Case Report with Brief Review Subramanian Senthilkumaran, Ramachandran Meenakshisundaram, Ponniah Thirumalaikolundusubramanian
The Journal of Emergency Medicine – 04 April 2011 (10.1016/j.jemermed.2010.11.052)
http://www.jem-journal.com/article/S0736-4679(11)00258-7/abstract
A case of pericardial hemorrhage with cardiac tamponade after Russell viper bite.
Case report: A 26-year-old man developed breathlessness after being bitten by a Russell viper. The clinical diagnosis of toxin-induced disseminated intravascular coagulation was confirmed. Pericardial hemorrhage with large pericardial effusion was evident clinically as well as onEKG and ECHO.
Conclusion: “Pericardial hemorrhage may be due to toxin-induced myocardial damage or pericardial vessel injury coupled with coagulopathy, possibly in conjunction with vasculitis or endothelial damage…..”
Tradjenta (linagliptin) tablets
http://www.fda.gov/NewsEvents/Newsroom/PressAnnouncements/ucm253501.htm
FDA NEWS RELEASE
For Immediate Release: May 2, 2011
Media Inquiries: Morgan Liscinsky, 301-796-0397; morgan.liscinsky@fda.hhs.gov
Consumer Inquiries: 888-INFO-FDA
FDA approves new treatment for Type 2 diabetes
The U.S. Food and Drug Administration today approved Tradjenta (linagliptin) tablets, used with diet and exercise, to improve blood glucose control in adults with Type 2 diabetes.
People with Type 2 diabetes do not produce or respond normally to insulin, a hormone that regulates the amount of glucose in the blood. Over time, high blood glucose levels can increase the risk for serious complications, including heart disease, blindness, and nerve and kidney damage.
“This approval provides another treatment option for the millions of Americans with Type 2 diabetes,” said Mary Parks, M.D., director of the Division of Metabolism and Endocrinology Products in the FDA’s Center for Drug Evaluation and Research. “It is effective when used alone or when added to existing treatment regimens.”
Type 2 diabetes is the most common form of the disease, affecting between 90 percent and 95 percent of the 24 million people in the United States with diabetes. Tradjenta increases the level of hormones that stimulate the release of insulin after a meal by blocking the enzyme dipeptidyl peptidase-4 or DPP-4, which leads to better blood glucose control.
Tradjenta was demonstrated to be safe and effective in eight double-blind, placebo-controlled clinical studies involving about 3,800 patients with Type 2 diabetes. The studies showed improvement in blood glucose control compared with placebo.
Tradjenta has been studied as a stand-alone therapy and in combination with other Type 2 diabetes therapies including metformin, glimepiride, and pioglitazone. Tradjenta has not been studied in combination with insulin, and should not be used to treat people with Type 1 diabetes or in those who have increased ketones in their blood or urine (diabetic ketoacidosis).
Tradjenta will be dispensed with an FDA-approved Patient Package Insert that explains the drug’s uses and risks. The most common side effects of Tradjenta are upper respiratory infection, stuffy or runny nose, sore throat, muscle pain, and headache.
Tradjenta is marketed by Boehringer Ingelheim Pharmaceuticals Inc., Ridgefield, Conn., and Indianapolis-based Eli Lilly Co.
For more information:
The recovery
Pleasant Grove, AL, May 1, 2011 — Disaster survivors return to their home sites to search for their belongings after a series of tornadoes destroyed homes in areas of rural Northeastern Alabama. President Obama signed Alabama’s Major Disaster Declaration and ordered Federal aid to supplement State and local recovery efforts in area’s struck by severe storms. Adam DuBrowa/ FEMA
AL, May 1, 2011 — Disaster survivors search for their belongings after a tornado destroyed homes in the areas of rural Northeastern Alabama. President Obama signed Alabama’s Major Disaster Declaration and ordered Federal aid to supplement State and local recovery efforts in the area struck by severe storms. Adam DuBrowa/ FEMA
Pleasant Grove, AL, May 1, 2011 — Disaster survivors search through the debris for their belongings created from recent tornadoes that affected the Alabama region. FEMA, through our regional offices in Atlanta, GA and Philadelphia, PA, has been in close contact and coordination with state emergency management officials, and stands ready to support states, if requested. FEMA has personnel on the ground in Alabama, Georgia, Mississippi, Kentucky, and Tennessee. Adam DuBrowa/ FEMA
Not much left
Pleasant Grove, AL, May 1, 2011 — Disaster survivors are left with heavily damaged residences after a series of tornadoes destroyed homes in the areas of rural Northeastern Alabama. President Obama signed Alabama’s Major Disaster Declaration and ordered Federal aid to supplement State and local recovery efforts in the area struck by severe storms. Adam DuBrowa/ FEMA
