What happend to the man who died on an overdose of Viagra?

They couldn’t close the coffin.

But I digress…….

Recent studies have found there’s a higher risk of heart attacks, traffic accidents and workplace injuries on the first Monday of Daylight Savings.  There’s also an increase in the incidene of “Holy Crap.  I’m late!”

http://omniphysicians.com/2010/03/12/daylight-savings-time-health-danger/

Researchers at Columbia evaluated the bone structure of 111 postmenopausal women with primary osteoporosis, 61 of whom had been taking bisphosphonates for a minimum of four years and 50 controls taking calcium and vitamin D supplements.

This study found that bisphosphonate use improved structural integrity early in the course of treatment, but those gains were diminished with long-term treatment.

“In the early treatment period, patients using bisphosphonates experienced improvements in all parameters, including decreased buckling ratio and increased cross-sectional area,” said Melvin Rosenwasser, MD, orthopaedic surgeon for Columbia University Medical Center. “However, after four years of use, these trends reversed, revealing an association between prolonged therapy and declining cortical bone structural integrity.”  Scientists at both institutions noted that the culprit behind the diminishing results may be the fact that bisphosphonates suppress the body’s natural process of remodeling bone. “Recent research suggests that suppressed bone remodeling from long-term bisphosphonate use might result in brittle bone that is prone to atypical fractures,” said Gladnick.

http://omniphysicians.com/2010/03/12/bisphosphonate-treatments-atypical-fractures-of-the-femur/

Throwing arm injuries are on the rise in Little League and other youth baseball programs. After these injuries occur, many players are out for the season; others require surgery and must refrain from play for an even longer duration; still others sustain injuries so severe that they cause permanent damage and are unable to continue playing baseball.  The posterior capsular stretch might help.  Instructions and diagrams showing how to perform the posterior capsular stretch can be found on http://www.safethrow.com.

http://omniphysicians.com/2010/03/12/youth-baseball-throwing-arm-injuries/

Here is information from the FDA about the propofol shortage.  There is also a link to the FDA website that lists all the drug shortages and what the FDA is doing about it.  “FDA is temporarily permitting APP to import and distribute an unapproved Propoven 1% (propofol 1%) within the U.S. to help address the drug shortage.”  “Unproved”?

http://omniphysicians.com/2010/03/12/fda-what-its-doing-about-the-propofol-shortage/

Paul R

Link:  http://healthday.com/Article.asp?AID=636871

Health Day

WEDNESDAY, March 10 (HealthDay News) — Two new studies report a high rate of severe injuries — including amputations, spinal injuries and even death — among children who ride all-terrain vehicles.

“A spine injury is such a devastating injury for a young person,” said Dr. Jeffrey R. Sawyer, an assistant professor of orthopaedics with the Campbell Clinic at the University of Tennessee, and a co-author on both papers.

The same goes for amputations, which, as a result of these types of injuries, have typically been of legs, toes and fingers.

The findings were to be presented Wednesday at the American Academy of Orthopaedic Surgeons annual meeting, in New Orleans.

“ATV [all-terrain vehicle] injuries have been significant; we’ve been noticing increases for a while,” said Dr. Mike Gittelman, an associate professor of clinical pediatrics in the division of emergency medicine at Cincinnati Children’s Hospital.

Gittelman, who was not involved with either study, said ATV-associated fatalities increased nearly 60 percent between 2000 and 2005, while non-fatal injuries rose 48 percent.

Three-wheeled ATVs have been banned (although some do still exist), but four-wheeled, multi-rider ATVs are gaining in popularity and it appears they are not necessarily any safer, the researchers said.

The first set of authors reviewed emergency-room records at a trauma center in California for all patients who had sustained injuries in an off-road vehicle from Jan. 1, 2005 through the end of 2007. There were about 110 patients in total.

People involved in an accident with a multi-rider ATV were more than 10 times as likely to need an amputation as people involved in an accident with a conventional single-rider ATV, the study found.

“It’s night and day. If you get injured on one of these it’s going to be bad,” said study author Dr. Gregg Wendell Schellack, an orthopedic surgery resident at Loma Linda University Medical Center, who races motocross and dirt bikes.

The second study found that almost 4,500 U.S. children were injured in an ATV-related accident in 2006, with 7.4 percent sustaining a spine injury. That represented at least a 140 percent increase in the overall number of children injured since 1997 and a 467 percent increase in spinal injuries.

Seventy percent of these injuries occurred in children under the age of 16. Spinal injuries were more common in older girls.

A third study found severe injuries among children who had participated in motocross, a sport involving off-road, two-wheeled motorcycles.

Half of the children who had sought treatment for this type of injury at a single trauma center were hospitalized and nearly one-third needed surgery. Many had been wearing helmets and other protective gear.

The dramatic increase in the number of ATV-related injuries could be due to any number of factors, including the number of vehicles on the road: In 1985, there were about 400,000 ATVs in the United States, said Sawyer, while today there are an estimated 9.2 million.

There’s also the size and power of the vehicle to be considered. In the 1970s, the typical ATV weighed about 250 pounds and was 7 horsepower. The newer vehicles weigh much more than that and can approach speeds of 100 mph, Sawyer said.

They also have a higher center of gravity, making them more prone to roll over, Schellack explained. “If it starts to roll over, your first instinct is to put your foot down to try to stabilize or brace it, but that’s no match for a 1,000-pound vehicle.”

And children just shouldn’t be riding these vehicles, added Gittelman. “They don’t possess the maturity or ability to operate these vehicles,” he said. “If you’re not going to let a kid drive [a car], why would you let them drive a vehicle that’s just as powerful?”

More information

The American Academy of Orthopaedic Surgeons has more on ATV safety.

SOURCES: Gregg Wendell Schellack, D.O., orthopedic surgery resident, Loma Linda University Medical Center, Loma Linda, Calif.; Jeffrey R. Sawyer M.D., assistant professor, orthopaedics, University of Tennessee, Campbell Clinic, Germantown, Tenn.; Mike Gittelman, M.D., associate professor, clinical pediatrics, division of emergency medicine, Cincinnati Children’s Hospital; March 10, 2010, presentations, American Academy of Orthopaedic Surgeons annual meeting, New Orleans

Last Updated: March 10, 2010

Link:  http://www.fda.gov/NewsEvents/Newsroom/PressAnnouncements/ucm204147.htm

FDA NEWS RELEASE

For Immediate Release: March 11, 2010
Media Inquiries: Michael Herndon, 301-796-4673, Michael.Herndon@fda.hhs.gov
Consumer Inquiries: 888-INFO-FDA

FDA Update on the Investigation into the Salmonella Montevideo Outbreak

As part of the Salmonella Montevideo investigation, the Food and Drug Administration has been actively investigating the supply chain of black and red pepper supplied to Daniele International Inc., Pascoag, R.I.  

The Centers for Disease Control and Prevention reports that 249 people have been infected with a matching strain of Salmonella Montevideo in at least 44 states and the District of Columbia. Analysis of an epidemiologic study comparing foods eaten by individuals who were sickened identified salami/salame as a possible source of illness: http://www.cdc.gov/salmonella/montevideo/index.html¹.

Daniele International Inc. recalled a variety of ready-to-eat Italian-style meats after Salmonella was associated with its products. A complete listing of the recalled products, which are regulated by the U.S. Department of Agriculture’s Food Safety and Inspection Service, can be found at: http://www.fsis.usda.gov/News_&_Events/Recall_006_2010_Products/index.asp.²

As a result of the investigation, a number of spice products are now being recalled by Mincing Overseas Spice Company, Dayton, N.J.; and Wholesome Spice Company, Brooklyn, N.Y. Both supply pepper to Daniele International Inc. Based on recent test results, Mincing Overseas Spice Company and Wholesome Spice Company are conducting new recalls.

• Products Recalled by Mincing Overseas Spice Company
  • Black Pepper Lot 3258 in 50-pound, 25-pound, and 20-pound cartons with Mincing Overseas Spice Company’s name on the outside
  • Black Pepper Lot 3309 in 50-pound, 25-pound, and 20-pound cartons with Mincing Overseas Spice Company’s name on the outside.
• Products Recalled by Wholesome Spice Company
  • Ground Red Pepper sold to Daniele International Inc.
  • Whole Black Pepper sold to Daniele International Inc.
  • Crushed Red Pepper sold from April 6, 2009, to Jan. 20, 2010 in 25-pound boxes (Recalled on Feb. 25.)

Both Mincing Overseas Spice Company and Wholesome Spice Company sell products directly to commercial customers, who may have incorporated them into their own products.

To date, two of Mincing Overseas Spice Company’s distributors, Dutch Valley Food Distributors, Inc. and Frontier Natural Products Co-Op, have announced voluntary recalls of potentially contaminated product.

Dutch Valley Food Distributors, Inc. is voluntarily recalling a variety of seasonings and dip mixes sold under the Bulk Foods Inc. label. The list of products being recalled can be found in the Dutch Valley Food Distributors, Inc.³ press release.

Frontier Natural Products Co-Op is voluntarily recalling several of its products manufactured with non-organic black pepper that were sold under the Frontier brand and under the Whole Foods Market brands. Please check Frontier Natural Products Co-Op⁴ press release for a listing of recalled products.

Restaurateurs, foodservice operators, and consumers should not use the products being recalled by either of these companies.

The FDA continues to work with Mincing Overseas Spice Company and Wholesome Spice Company to identify customers who received the recalled product and determine if further recalls are necessary. Consumers are encouraged to frequently check FDA’s website for the latest company recall information.

The FDA is working with CDC, USDA-FSIS, the state of Rhode Island and other states to determine the extent to which pepper played a role in the Salmonella Montevideo outbreak. The Agency has collected 153 composite pepper samples, which represent more than 3,600 subsamples, at various locations in the supply chain. Samples from four products collected at Daniele International Inc. tested positive for Salmonella. Samples of crushed red pepper have tested positive for the outbreak strain; the FDA is working to determine if the type of Salmonella found in the other products also matches the outbreak strain.
Recalls Based on FDA Samples Collected at Daniele International Inc.

As part of FDA’s investigation, the Agency collected samples of pepper from other customers who received product from Mincing Overseas Spice Company and Wholesome Spice Company. Thus far, two of the samples collected have tested positive for types of Salmonella not associated with the current national Salmonella Montevideo outbreak. These findings prompted Heartland Foods Inc.⁵ to recall course ground pepper and Mincing Overseas Spice Company to recall black pepper lot 3309. 

The FDA is in the process of taking a closer look at the handling of spices from farm to table and in the spring of 2009 began work on a spice risk profile. A risk profile is designed to capture the current state of knowledge related to an issue and identify any knowledge gaps.  This particular risk profile focuses on microbiological contaminants and filth issues related to spices.  Some members of the spice industry have already agreed to provide data to FDA for the risk profile. The risk profile will provide vital information to risk management decision-makers and will help the agency determine the best way to mitigate foodborne illness issues associated with spices.  Specifically it can help FDA determine:  how to allocate resources, whether guidance for industry or for FDA inspectors is appropriate, or even the need for new rulemaking.

Salmonella can cause serious and sometimes fatal infections in young children, frail or elderly people, and others with weakened immune systems. Healthy persons infected with Salmonella often experience fever, diarrhea (which may be bloody), nausea, vomiting and abdominal pain. In rare circumstances, infection with Salmonella can result in the organism getting into the bloodstream and producing more severe illnesses such as arterial infections (infected aneurysms), endocarditis and arthritis. Individuals having consumed any Italian sausage products and who may be experiencing these symptoms should contact a health professional immediately. For details on Salmonella sources, symptoms, and treatment, please refer to the Salmonella page on FoodSafety.gov: http://www.foodsafety.gov/poisoning/causes/bacteriaviruses/salmonella.htm

Medical News Today

Link:  http://www.medicalnewstoday.com/articles/181908.php

The Dangers Of Daylight Savings Time

11 Mar 2010   

Daylight Savings Time can be hazardous for your health.

On average, people go to work or school on the first Monday of Daylight Savings after sleeping 40 fewer minutes than normal. And recent studies have found there’s a higher risk of heart attacks, traffic accidents and workplace injuries on the first Monday of Daylight Savings.

“Many people already are chronically sleep-deprived, and Daylight Savings Time can make them even more tired for a few days,” said Dr. Nidhi Undevia, medical director of the Sleep Program at Loyola University Health System.

Undevia offers these tips for getting enough sleep after moving the clock forward an hour:

– In the days before the time change, go to bed and wake up 10 or 15 minutes earlier each day.

– Don’t nap on the Saturday before the time change.

– To help reset your internal body clock, expose yourself to sunlight in the morning as early as you can.

Loyola offers a comprehensive and multidisciplinary program to help identify and treat sleep disorders. The sleep laboratory and sleep clinic diagnose and treat a full range of sleep disorders, including insomnia, sleep walking, obstructive sleep apnea, narcolepsy, circadian rhythm disorders, restless legs syndrome and periodic limb movement disorders.

Source: Loyola University Health System

Medical News Today

Link:  http://www.medicalnewstoday.com/articles/181856.php

Dramatic Increase Seen In Youth Baseball Throwing Arm Injuries

11 Mar 2010   

Orthopedic surgeons focus on new ways to protect young baseball players’ arms

Throwing arm injuries are on the rise in Little League and other youth baseball programs. After these injuries occur, many players are out for the season; others require surgery and must refrain from play for an even longer duration; still others sustain injuries so severe that they cause permanent damage and are unable to continue playing baseball.

Three new studies presented at the at the 2010 Annual Meeting of the American Academy of Orthopaedic Surgeons (AAOS) address this critical issue, each offering new solutions to help prevent these injuries.

Five-minute stretch after play can help young players avoid throwing-arm pain

Pitchers and catchers under the age of 15 often experience tightness of a shoulder ligament known as the posterior-inferior glenohumeral ligament. If this ligament is not stretched, it will become increasingly tighter and more prone to pain or injury as the player ages, if that player continues to play baseball.

A study of 1,267 youth baseball players, led by Charles Metzger, MD, an orthopaedic surgeon specializing in upper extremities in Houston, Texas, found that a simple stretch known as the posterior capsular stretch can help.

“A posterior capsular stretch is done after play and since it is different from the general stretches players already know, it must be taught,” says Dr. Metzger. “Once learned, however, it is very simple, and takes only five minutes to complete. Nearly 97 percent of young players who performed the stretch properly and consistently reported shoulder improvement.”

Dr. Metzger supports Safe Throw, an injury-prevention and rapid return-to-play program. Instructions and diagrams showing how to perform the posterior capsular stretch can be found on http://www.safethrow.com.

Twenty-five percent of young players experience elbow pain; pitchers have highest rate of osteochondral lesions

The elbow is the most frequently reported area of overuse injury in child and adolescent baseball players. One type of overuse includes osteochondral lesions, which are tears or fractures in the cartilage and underlying bone, covering the elbow joint.

In a study led by Tetsuya Matsuura, MD, Department of Orthopedics, The University of Tokushima Graduate School, Institute of Health Bioscience in Tokushima, Japan, 152 baseball players were observed (ranging in age from 8 to12) for one season to study the injury incidence in relation to their playing positions. These players had no history of problematic elbow pain.

The results were as follows:

• 38 players, or 25 percent complained of elbow pain;
• of these 38 players, 26 (68.4 percent) had limitations of range of motion and/or tenderness on the elbow, and/or valgus stress pain (a stressful force placed upon the ligaments on the inner side of the elbow joint); and
• Of those 26 players, 22 (84.6 percent) had osteochondral lesions, including:

  12 pitchers (54.6 percent)
  6 catchers (27.3 percent)
  3 infielders (13.6 percent)
  1 outfielder (4.5 percent).

Dr. Matsuura concluded, “Twenty-five percent of child and adolescent baseball players have elbow pain and nearly 15 percent sustain osteochodral lesions per year and pitchers have the highest rate of osteochondral lesions. If overuse injuries such as osteochrondral lesions occur, prompt diagnosis and treatment can prevent this injury from causing long-term damage. Better awareness and education among parents, players and especially coaches about risk factors can help prevent these injuries.”

Reviewing – and adhering to – youth baseball throwing guidelines can help prevent injury

In another presentation, led by George A. Paletta, Jr., MD, an orthopaedic surgeon at the Orthopedic Center of St. Louis and Medical Director/Head Team Physician of the St. Louis Cardinals, discussed the increase in elbow injuries of young baseball players, including the increasing number of ligament reconstruction or “Tommy John” procedures performed.

Despite these increases, Dr. Paletta says there are identifiable – and controllable – risk factors of which young athletes, parents and coaches should be aware, to help reduce injury.

“A young athlete should never throw through pain or continue to pitch when he or she is obviously fatigued,” says Dr. Paletta. “Additionally, parents should familiarize themselves with the recommended single game, weekly and season total pitch counts, suggested recovery times, and recommended ages for learning various pitches.”

Dr. Paletta stresses that there must be a greater focus on education and research in this area, or more young baseball players will sustain serious injury.

Disclosures:
No author received compensation for their studies.

Source:
Kristina K. Findlay
American Academy of Orthopaedic Surgeons 

Dramatic Increase Seen In Youth Baseball Throwing Arm Injuries

11 Mar 2010   

Orthopedic surgeons focus on new ways to protect young baseball players’ arms

Throwing arm injuries are on the rise in Little League and other youth baseball programs. After these injuries occur, many players are out for the season; others require surgery and must refrain from play for an even longer duration; still others sustain injuries so severe that they cause permanent damage and are unable to continue playing baseball.

Three new studies presented at the at the 2010 Annual Meeting of the American Academy of Orthopaedic Surgeons (AAOS) address this critical issue, each offering new solutions to help prevent these injuries.

Five-minute stretch after play can help young players avoid throwing-arm pain

Pitchers and catchers under the age of 15 often experience tightness of a shoulder ligament known as the posterior-inferior glenohumeral ligament. If this ligament is not stretched, it will become increasingly tighter and more prone to pain or injury as the player ages, if that player continues to play baseball.

A study of 1,267 youth baseball players, led by Charles Metzger, MD, an orthopaedic surgeon specializing in upper extremities in Houston, Texas, found that a simple stretch known as the posterior capsular stretch can help.

“A posterior capsular stretch is done after play and since it is different from the general stretches players already know, it must be taught,” says Dr. Metzger. “Once learned, however, it is very simple, and takes only five minutes to complete. Nearly 97 percent of young players who performed the stretch properly and consistently reported shoulder improvement.”

Dr. Metzger supports Safe Throw, an injury-prevention and rapid return-to-play program. Instructions and diagrams showing how to perform the posterior capsular stretch can be found on http://www.safethrow.com.

Twenty-five percent of young players experience elbow pain; pitchers have highest rate of osteochondral lesions

The elbow is the most frequently reported area of overuse injury in child and adolescent baseball players. One type of overuse includes osteochondral lesions, which are tears or fractures in the cartilage and underlying bone, covering the elbow joint.

In a study led by Tetsuya Matsuura, MD, Department of Orthopedics, The University of Tokushima Graduate School, Institute of Health Bioscience in Tokushima, Japan, 152 baseball players were observed (ranging in age from 8 to12) for one season to study the injury incidence in relation to their playing positions. These players had no history of problematic elbow pain.

The results were as follows:

• 38 players, or 25 percent complained of elbow pain;
• of these 38 players, 26 (68.4 percent) had limitations of range of motion and/or tenderness on the elbow, and/or valgus stress pain (a stressful force placed upon the ligaments on the inner side of the elbow joint); and
• Of those 26 players, 22 (84.6 percent) had osteochondral lesions, including:

  12 pitchers (54.6 percent)
  6 catchers (27.3 percent)
  3 infielders (13.6 percent)
  1 outfielder (4.5 percent).

Dr. Matsuura concluded, “Twenty-five percent of child and adolescent baseball players have elbow pain and nearly 15 percent sustain osteochodral lesions per year and pitchers have the highest rate of osteochondral lesions. If overuse injuries such as osteochrondral lesions occur, prompt diagnosis and treatment can prevent this injury from causing long-term damage. Better awareness and education among parents, players and especially coaches about risk factors can help prevent these injuries.”

Reviewing – and adhering to – youth baseball throwing guidelines can help prevent injury

In another presentation, led by George A. Paletta, Jr., MD, an orthopaedic surgeon at the Orthopedic Center of St. Louis and Medical Director/Head Team Physician of the St. Louis Cardinals, discussed the increase in elbow injuries of young baseball players, including the increasing number of ligament reconstruction or “Tommy John” procedures performed.

Despite these increases, Dr. Paletta says there are identifiable – and controllable – risk factors of which young athletes, parents and coaches should be aware, to help reduce injury.

“A young athlete should never throw through pain or continue to pitch when he or she is obviously fatigued,” says Dr. Paletta. “Additionally, parents should familiarize themselves with the recommended single game, weekly and season total pitch counts, suggested recovery times, and recommended ages for learning various pitches.”

Dr. Paletta stresses that there must be a greater focus on education and research in this area, or more young baseball players will sustain serious injury.

Disclosures:
No author received compensation for their studies.

Source:
Kristina K. Findlay
American Academy of Orthopaedic Surgeons

Medical News Today

Link:  http://www.medicalnewstoday.com/articles/181980.php

What Is Rabies? What Causes Rabies?

11 Mar 2010   

Rabies is a deadly virus. It is usually transmitted through saliva from the bite of an infected animal, into the bloodstream. The rabies virus is an infection of the central nervous system and causes inflammation of the brain. It is zoonotic, meaning it is transmitted by animals.

If treated immediately after a bite, it is possible to prevent rabies. Once a person begins showing signs and symptoms of rabies, the disease is nearly always fatal. For that reason, vaccines to stop the rabies virus from infecting the body are given to anyone who may have a risk of contracting rabies.

According to Medilexicon’s medical dictionary:

Rabies is “Highly fatal infectious disease that may affect all species of warm-blooded animals, including humans; transmitted by the bite of infected animals including dogs, cats, skunks, wolves, foxes, raccoons, and bats, and caused by a neurotropic species of Lyssavirus, a member of the family Rhabdoviridae, that has tropism for the central nervous system and the salivary glands; inhalation infection possbile (aerosolized virus in bat caves, attics). The symptoms are characteristic of a profound disturbance of the nervous system, excitement, aggressiveness, and madness, followed by paralysis and death. In animals, clinical signs are variable, and sometimes drooling and tongue paralysis are the only signs. Transmission of the virus can occur before clinical signs are expressed. Characteristic cytoplasmic inclusion bodies (Negri bodies) found in many neurons aid rapid laboratory diagnosis.”

The term is derived from the Latin “rabies” meaning “madness”. All human cases of rabies were fatal until a vaccine was developed in 1885 by Louis Pasteur and Émile Roux. Treatment after exposure, known as post-exposure prophylaxis (PEP), is highly successful. A recombinant vaccine called V-RG has been successfully used to prevent outbreaks of rabies in wildlife. Currently pre-exposure immunization has been used in both human and non-human populations. In many countries domesticated animals are required to be vaccinated.

In the United States, animals most likely to transmit rabies include bats, coyotes, foxes, raccoons and skunks. In developing countries of Africa and Southeast Asia, stray dogs are the most likely to spread rabies to people.

Since the widespread vaccination of domestic dogs and cats and the development of effective human vaccines and immunoglobulin treatments, the number of recorded deaths from rabies has dropped in the United States. The reported cases are mostly caused by bat bites, which may go unnoticed by the victim and as a result are untreated.

How common is rabies?

The World Health Organization (WHO) estimates that more than 55,000 people worldwide die from rabies every year, as a result of being bitten by a rabid animal.

A person does not have to be bitten to get rabies; a scratch that is licked by an infected animal is enough to cause the disease.

High risk areas

Rabies is widespread in many countries worldwide, but Asia, Africa and South America report more cases of human deaths from rabies. The largest number of human deaths from rabies is reported in India.

Bat rabies

There are two strains of rabies-like viruses found in bats across Northern Europe. These are known as European Bat Lyssaviruses (EBLVs) 1 and 2. They are commonly referred to as bat rabies. People are not at risk if they have no direct contact with bats.

What are the signs and symptoms of rabies?

A symptom is something the patient senses and describes, while a sign is something other people, such as the doctor notice. For example, drowsiness may be a symptom, while dilated pupils may be a sign.

It can take from one week to more than a year for symptoms of rabies to appear after infection. But the average time of the incubation period is four to eight weeks. The closer the bite is to the head, the shorter the incubation period. A bite to the face, head or neck will have a shorter incubation time than a bite to the arm or leg.

If an animal bite is not treated in time, rabies will start with pain or tingling at the site of the bite with fever, loss of appetite and headache. Early-stage symptoms of rabies are malaise, headache and fever, progressing to acute pain, violent movements, uncontrolled excitement, depression, and hydrophobia. Finally, the patient may experience periods of mania and lethargy, eventually leading to coma. The primary cause of death is usually respiratory insufficiency.

There are two ways in which rabies can develop which can lead to furious rabies or dumb rabies.

Symptoms of furious rabies:

There is a growing sense of anxiety, jumpiness, disorientation, neck stiffness, and sometimes seizures or convulsions. The pupils may appear dilated and there may be an increased sensitivity to sound, light and temperature.

Within a week, many infected people show a fear of swallowing. In spite of overwhelming thirst, any attempt to drink causes spasms of the throat muscles and diaphragm. This is called hydrophobia (fear of water). The patient has difficulty swallowing because the throat and jaw become slowly paralyzed, shows panic when presented with liquids to drink, and cannot quench his or her thirst.

As the disease worsens, there are intervals of deranged behavior with spitting, biting and delirium. It is in this phase that infected animals are highly aggressive and bite.

Delusions and hallucinations develop. These attacks alternate with periods of clear-mindedness when the person suffers acute anxiety and mental distress. Death almost invariably results two to ten days after the first symptoms; the few humans who are known to have survived the disease were all left with severe brain damage.

Symptoms of dumb rabies:

It is less common and affects the spinal cord. It causes muscle paralysis to spread across the body, leading to heart and lung failure. Total paralysis, coma and death follow in almost 100 percent of cases of rabies, usually about a week after the severe symptoms develop.

Rabies does not cause any signs or symptoms at first. It isn’t until late in the disease, often just days before death that signs and symptoms appear:

• Agitation
• Anxiety
• Confusion
• Difficulty swallowing
• Excessive salivation
• Fear of water (hydrophobia) because of the difficulty in swallowing
• Fever
• Hallucinations
• Headache
• Insomnia
• Partial paralysis

If bitten by any animal, seek immediate medical care.

Based on the injuries and situation in which the bite occurred, it will be decided whether treatment to prevent rabies should be received.

Seek medical attention, if you think there is a possibility you have been bitten. For instance, if a bat enters a bedroom at night or a bat has been in contact with a person who cannot report a bite, such as a small child or disabled person, assume that person has been bitten. Finding a bat in the room of a sleeping infant is regarded as an indication for post-exposure prophylaxis. A bite or exposure to the virus may occur while the victim is asleep and unaware or awake and unaware that a bite occurred.

What are the causes of rabies?

Rabies infection is caused by the rabies virus. The virus is spread through the saliva of infected animals. Infected animals can spread the virus by biting another animal or person.

In rare cases, rabies can be spread when infected saliva gets into an open wound or the mucous membranes, such as the mouth or eyes.

Animals that can transmit the rabies virus

The animals most likely to transmit the rabies virus to people include:

Pets and farm animals

• Cats
• Cows
• Dogs
• Ferrets
• Goats
• Horses
• Rabbits

Wild animals

• Bats
• Beavers
• Coyotes
• Foxes
• Monkeys
• Raccoons
• Skunks
• Woodchucks

Domestic dogs and cats can pick up the infection if exposed to wild animals with the disease, such as foxes, wolves, jackals, skunks, mongooses, raccoons and bats. In the United States, animal control and vaccination programs have effectively eliminated domestic dogs as reservoirs of rabies. In several countries, including the United Kingdom, Australia and Japan, the virus has been eradicated entirely. Oral vaccines for animals can be safely distributed in baits, and this has successfully reduced rabies in rural areas.

The virus

The virus remains at the site of the bite, before it enters the body and multiplies in the muscle cells near the bite wound. The virus then enters the nerve endings and travels to the spinal cord and brain. Once in the central nervous system, the virus spreads to the salivary glands, lungs, kidneys and other organs.

Incubation period

The incubation period is the time between the bite and the start of the symptoms. It varies with the distance of the bite from the head.

Bites on the head, face or neck may result in rabies developing over a short period. Bites further from the head are followed by a much longer incubation period.

Children may be at a greater risk from infection, as they are shorter in height. When travelling, they should be discouraged from petting unknown animals.

What are the risk factors of rabies?

Factors that can increase the risk of rabies include:

• Activities involving contact with wild animals that may have rabies, such as exploring caves where bats live or camping where there are wild animals.
• Traveling or living in developing countries where rabies is more common, including countries in Africa and Southeast Asia.
• Working in a laboratory with the rabies virus.
• Wounds to the head or neck. This could increase the risk of the rabies virus travelling to the brain more quickly.

How is rabies diagnosed?

In some cases there is no way to know whether the animal is infected and has transmitted the rabies virus. For this reason, treatment to prevent the rabies virus from infecting the body is recommended if doctors think there is a chance of exposure to the virus.

Blood and tissue tests are used to diagnose rabies in people who have signs and symptoms of the infection.

An animal suspected of having rabies should be captured and watched for 5 to10 days. If no symptoms of rabies have been observed, it can be assumed that the animal is not rabid. If the animal is killed or dies, its brain can be examined for the presence of the rabies virus.

What is the treatment for rabies?

It is important to know that a scratch that is licked by an infected animal is enough to cause rabies.

Treatment after exposure, known as post-exposure prophylaxis (PEP), is highly successful in preventing the disease if administered promptly. Treatment should be immediate after the bite of an animal possibly infected with rabies. Rabies is fatal once symptoms develop. Medical advice should be sought for any animal bite, and a tetanus injection given.

Immediately after an animal bite

Symptoms can usually be prevented from developing if proper treatment is started immediately after being bitten. Early treatment is especially important following bites on the face. Immediately after being bitten:

• wash the wound thoroughly with soap and water under a running tap
• use antiseptic or alcohol to clean the wound
• leave the wound open, do not attempt to stitch it
• go to the nearest doctor or hospital and explain you have been bitten

The suspect animal should be captured, if possible, and observed for 5 to10 days. The police and relevant authorities should be informed.

If you have not been vaccinated

If you have not been vaccinated before you were bitten, human rabies immunoglobulin (HRIG), also known as passive immunization, will be injected around the bite to neutralize the virus before it gets into the body.

This substance binds to the virus so that the immune system can destroy it. In addition, a longer-lasting rabies vaccine (active immunization) should be given in 5 to 6 doses over 30 days. The vaccine is given into the arm and is relatively painless with minimal side effects.

If you are abroad and have been bitten by a suspect animal and cannot get the vaccine, you should return to your home country immediately for medical treatment.

If you have been vaccinated

If you have already been vaccinated before being bitten with the pre-exposure vaccine, two doses of the rabies vaccine will be given: one at the time of the bite, and one 3 to 7 days later. The body should respond to treatment quickly.

Anyone who has had intimate contact with an infected person should also be treated with the vaccine.

If the infected person is not treated and symptoms have developed, rabies is said to be established. In this situation, nothing can be done, except to keep them comfortable. They should be nursed in a darkened room and their symptoms kept under control with equipment and medication. Death is almost inevitable.

There is no specific treatment for rabies infection. Though a small number of people have survived rabies, the disease is usually fatal. For that reason, anyone thought to have been exposed to rabies receives a series of shots to prevent the infection.

Determining whether the animal that bit you has rabies

In some cases, it is possible to determine whether the animal has rabies before beginning the series of rabies shots. If it is determined that the animal is healthy, the shots are not needed.

Procedures for determining whether an animal has rabies vary by situation:

• Pets and farm animals. Cats, dogs and ferrets that bite can be observed for 10 days to see if they show signs and symptoms of rabies. If the animal remains healthy during the observation period, then it does not have rabies and the rabies shots are not needed. In some cases, pets and farm animals are considered on a case-by-case basis.
• Wild animals that can be caught. Wild animals that can be found and captured (such as a bat that came into a home) can be killed and tested for rabies. Tests on the animal’s brain may reveal the rabies virus. If the animal does not have rabies, the shots will not be needed.
• Animals that cannot be found. If the animal cannot be found, the situation should be reviewed with a doctor and the local health department. In certain cases, it may be safest to assume that the animal had rabies and proceed with the rabies shots. In other cases, it may be unlikely that the animal had rabies and it may be determined that rabies shots are not necessary.

Seek medical advice even if you were bitten several weeks ago and have not shown any signs of the disease yet.

How is rabies prevented?

People travelling to an area where there is a risk of rabies or engaging in activities putting them at risk, may need a pre-exposure anti-rabies vaccination.

The vaccination slows the development of rabies. If bitten by an infected animal, there will be more time to seek treatment.

The pre-exposure anti rabies vaccination consists of three injections over the course of a month. Booster injections every two years are needed for continued protection after that.

If travelling to a country where rabies exists, three injections will be needed (day 0, day 7 and day 28). Allow at least a month to finish the course before departure. The injections are given into the skin on the upper arm.

Pregnant women should avoid any unnecessary vaccinations. But if at risk of being exposed to rabies, it is recommended to have the vaccine.

Do not touch unknown animals

When travelling abroad, do not touch any unknown animals. Educate children about the dangers of petting unknown animals. This is especially true for animals that appear unusually tame, as this is an early sign of rabies in animals. Examine children daily for cuts and scratches and ask them how they got them. Make sure they know that being bitten by an animal is dangerous and they need to tell you about it.

Reduce the risk of coming in contact with rabid animals by following these recommendations:

• Do not approach wild animals. Wild animals with rabies may seem unafraid of people. It is not uncommon for a wild animal to be friendly with people. Stay away from any animal that seems unafraid.
• If traveling, consider the rabies vaccine. If traveling to a country where rabies is common and for a long period of time, ask your doctor whether you should receive the rabies vaccine.
• Keep bats away. Seal any cracks and gaps where bats can enter the home. If you know you have bats in your home, seek assistance from experts to find ways to keep bats out.
• Protect small pets from predators. Keep rabbits and other small pets, such as guinea pigs, inside or in protected cages so that they are safe from wild animals. Small pets cannot be vaccinated against rabies.
• Report stray animals to local authorities. Call local animal control officials or other local law enforcement to report stray dogs and cats.
• Supervise pets. Keep pets inside and supervise them when outside. This will help keep pets from coming in contact with wild animals.
• Vaccinate pets. Cats, dogs and ferrets can be vaccinated against rabies. Ask your veterinarian how often your pets should be vaccinated.

Facts about rabies

Reliable data on rabies is scarce in many areas of the world, making it difficult to assess its full impact on human and animal health.

General advice for all countries:

Medical advice should be sought for any animal bite, and a tetanus injection given.

The UK: Strict quarantine regulations keep the country rabies-free. But bat bites should be medically treated.

Europe: In general, dogs in urban areas in mainland Europe are not rabid, but foxes can be. To combat rabies in foxes, vaccines are left in bait or dropped from helicopters onto fields.

India, Afghanistan, Vietnam, Africa, Central and South America and Thailand: Many dogs in these areas are infected with rabies, but there have been recent decreases in human rabies, due to improved vaccination programs. Any bite from an animal, particularly dog, cat, monkey or bat, should be treated as a possible rabies risk.

Australia: Australia is mostly rabies-free, but some bats may be infected so precautions should be taken.

Ireland, Japan, Norway, Sweden, New Zealand, the Antarctic, some Caribbean and Pacific islands, some parts of Europe: do not harbor rabies.

Written by Stephanie Brunner (B.A.)
Copyright: Medical News Today

Medical News Today

Link:  http://www.medicalnewstoday.com/printerfriendlynews.php?newsid=181860

Study Of Long-Term Use Of Bone-Building Osteoporosis Drugs

11 Mar 2010   

Bisphosphonate treatments, proven to enhance bone density and reduce fracture incidence in post-menopausal women, may adversely affect bone quality and increase risk of atypical fractures of the femur when used for four or more years, according to preliminary research presented at the 2010 Annual Meeting of the American Academy of Orthopaedic Surgeons (AAOS).

Bisphosphonates are designed to slow or stop the bone loss that occurs during the body’s bone remodeling cycle, or the natural process that involves removal and replacement of bone tissue.

Two separate studies by researchers from Hospital for Special Surgery (HSS) and Columbia University Medical Center revealed data suggesting that long-term suppression of bone remodeling by bisphosphonate treatments may alter the material properties of bone, potentially affecting the bone’s mechanical integrity and potentially contributing to the risk of atypical fractures.

“Although bisphosphonates have demonstrated an improvement in bone quantity, little if anything is known about the effects of these drugs on bone quality,” said Brian Gladnick, BS, representing a team of investigators at HSS in New York.

Researchers at Columbia evaluated the bone structure of 111 postmenopausal women with primary osteoporosis, 61 of whom had been taking bisphosphonates for a minimum of four years and 50 controls taking calcium and vitamin D supplements.

This study found that bisphosphonate use improved structural integrity early in the course of treatment, but those gains were diminished with long-term treatment.

“In the early treatment period, patients using bisphosphonates experienced improvements in all parameters, including decreased buckling ratio and increased cross-sectional area,” said Melvin Rosenwasser, MD, orthopaedic surgeon for Columbia University Medical Center. “However, after four years of use, these trends reversed, revealing an association between prolonged therapy and declining cortical bone structural integrity.”

Scientists at both institutions noted that the culprit behind the diminishing results may be the fact that bisphosphonates suppress the body’s natural process of remodeling bone. “Recent research suggests that suppressed bone remodeling from long-term bisphosphonate use might result in brittle bone that is prone to atypical fractures,” said Gladnick.

The investigators added that more research is needed to determine the true efficacy of the long-term clinical use of bisphosphonates for the treatment of osteoporosis, and that the results of their studies will not likely affect clinical practice in the near future.

“Bisphosphonate use still is a very effective solution that prevents bone loss in most patients and no one is recommending that physicians avoid prescribing these,” said Dr. Rosenwasser. “However, as baby boomers age and continue to remain active, it is important that we conduct more research and develop sustainable, safe and effective treatments for osteoporosis.”

In a second unrelated prospective pilot study, conducted at HSS and funded in part by the NIH, researchers evaluated the bone composition of 21 post-menopausal women who were treated for femoral fractures. Of these, 12 patients had a history of bisphosphonate treatment for an average of 8.5 years, while nine had not had bisphosphonate treatment.

Samples of bone were removed from each patient’s femur during surgical placement of a femoral nail. Both micro-architecture and material properties of the bone were analyzed.

The study found that, although there were no differences in bone micro-architecture between groups, the material properties of bone in bisphosphonate-treated patients displayed reduced bone tissue heterogeneity, which may be associated with reduced strength and potentially may contribute to the presentation of atypical fractures.

“Patients who had been treated with bisphosphonates showed a reduction in tissue heterogeneity, specifically with mineral content and crystal size compared with the control group,” Gladnick said. “This tells us that there may be some measurable differences in bone quality parameters in patients on long-term bisphosphonate therapy, which might contribute to the development of atypical fractures.”

Disclosures:
The HSS study was supported by NIH grant AR041325 to Dr. Adele Boskey. Dr. Rossenwasser and his co-authors received no compensation for their research.

Source:
Kristina K. Findlay
American Academy of Orthopaedic Surgeons 

Study Of Long-Term Use Of Bone-Building Osteoporosis Drugs

11 Mar 2010   

Bisphosphonate treatments, proven to enhance bone density and reduce fracture incidence in post-menopausal women, may adversely affect bone quality and increase risk of atypical fractures of the femur when used for four or more years, according to preliminary research presented at the 2010 Annual Meeting of the American Academy of Orthopaedic Surgeons (AAOS).

Bisphosphonates are designed to slow or stop the bone loss that occurs during the body’s bone remodeling cycle, or the natural process that involves removal and replacement of bone tissue.

Two separate studies by researchers from Hospital for Special Surgery (HSS) and Columbia University Medical Center revealed data suggesting that long-term suppression of bone remodeling by bisphosphonate treatments may alter the material properties of bone, potentially affecting the bone’s mechanical integrity and potentially contributing to the risk of atypical fractures.

“Although bisphosphonates have demonstrated an improvement in bone quantity, little if anything is known about the effects of these drugs on bone quality,” said Brian Gladnick, BS, representing a team of investigators at HSS in New York.

Researchers at Columbia evaluated the bone structure of 111 postmenopausal women with primary osteoporosis, 61 of whom had been taking bisphosphonates for a minimum of four years and 50 controls taking calcium and vitamin D supplements.

This study found that bisphosphonate use improved structural integrity early in the course of treatment, but those gains were diminished with long-term treatment.

“In the early treatment period, patients using bisphosphonates experienced improvements in all parameters, including decreased buckling ratio and increased cross-sectional area,” said Melvin Rosenwasser, MD, orthopaedic surgeon for Columbia University Medical Center. “However, after four years of use, these trends reversed, revealing an association between prolonged therapy and declining cortical bone structural integrity.”

Scientists at both institutions noted that the culprit behind the diminishing results may be the fact that bisphosphonates suppress the body’s natural process of remodeling bone. “Recent research suggests that suppressed bone remodeling from long-term bisphosphonate use might result in brittle bone that is prone to atypical fractures,” said Gladnick.

The investigators added that more research is needed to determine the true efficacy of the long-term clinical use of bisphosphonates for the treatment of osteoporosis, and that the results of their studies will not likely affect clinical practice in the near future.

“Bisphosphonate use still is a very effective solution that prevents bone loss in most patients and no one is recommending that physicians avoid prescribing these,” said Dr. Rosenwasser. “However, as baby boomers age and continue to remain active, it is important that we conduct more research and develop sustainable, safe and effective treatments for osteoporosis.”

In a second unrelated prospective pilot study, conducted at HSS and funded in part by the NIH, researchers evaluated the bone composition of 21 post-menopausal women who were treated for femoral fractures. Of these, 12 patients had a history of bisphosphonate treatment for an average of 8.5 years, while nine had not had bisphosphonate treatment.

Samples of bone were removed from each patient’s femur during surgical placement of a femoral nail. Both micro-architecture and material properties of the bone were analyzed.

The study found that, although there were no differences in bone micro-architecture between groups, the material properties of bone in bisphosphonate-treated patients displayed reduced bone tissue heterogeneity, which may be associated with reduced strength and potentially may contribute to the presentation of atypical fractures.

“Patients who had been treated with bisphosphonates showed a reduction in tissue heterogeneity, specifically with mineral content and crystal size compared with the control group,” Gladnick said. “This tells us that there may be some measurable differences in bone quality parameters in patients on long-term bisphosphonate therapy, which might contribute to the development of atypical fractures.”

Disclosures:
The HSS study was supported by NIH grant AR041325 to Dr. Adele Boskey. Dr. Rossenwasser and his co-authors received no compensation for their research.

Source:
Kristina K. Findlay
American Academy of Orthopaedic Surgeons

Link:  Medical News Today

Gastric Bypass Surgery Increases Risk Of Kidney Stones

11 Mar 2010   (http://www.medicalnewstoday.com/articles/181911.php)

Patients who undergo gastric bypass surgery experience changes in their urine composition that increase their risk of developing kidney stones, research from UT Southwestern Medical Center investigators suggests.

A new study, published in the March issue of The Journal of Urology, found that some of these urinary changes place weight-loss surgery patients at higher risk for developing kidney stones than obese patients who do not undergo the procedure.

For the study, researchers collected urine samples from 38 study participants. There were 16 women and three men in each of two groups. One group had undergone Roux-en-Y gastric bypass (RYGB) surgery; the second group contained normal obese individuals. RYGB, which is one of the most commonly performed weight-loss procedures, involves the creation of a small gastric pouch and allows food to bypass part of the small intestine.

The researchers found that the excretion of a material called oxalate in urine was significantly greater in the participants who had the surgical procedure than those who did not (47 percent, compared with 10.5 percent, respectively). In addition, the amount of a chemical called citrate in the urine was low in many gastric bypass patients in comparison to the obese nonsurgical group (32 percent to 5 percent).

Oxalate is found in the majority of kidney stones, while citrate inhibits stone formation.

“Almost half of the patients who had undergone gastric bypass and did not have a history of kidney stones showed high urine oxalate and low urine citrate factors that lead to kidney-stone formation,” said Dr. Naim Maalouf, assistant professor of internal medicine in the Charles and Jane Pak Center for Mineral Metabolism and Clinical Research and the study’s lead author.

The cause for stone formation after bariatric surgery is not entirely clear, but the study reinforces the message that weight-loss surgery patients and their physicians should be alert to the heightened risk, Dr. Maalouf said.

“These findings illustrate that the majority of patients are at risk for kidney-stone formation after RYGB,” Dr. Maalouf said. “This complication may not be well-recognized in part because it tends to occur months to years after the bypass surgery.”

Other UT Southwestern researchers involved in the study were Dr. Eve Guth, assistant professor of internal medicine; Dr. Edward Livingston, chief of GI/endocrine surgery; and Dr. Khashayar Sakhaee, chief of mineral metabolism and the study’s senior author.

The research was supported by the National Institutes of Health.

Source: UT Southwestern Medical Center

Main News Category: Urology / Nephrology

Propofol Injection 10mg/ml, 20ml 25s, 50ml 20s, 100ml 10s

FDA Drug Shortage link:   http://www.fda.gov/Drugs/DrugSafety/DrugShortages/ucm050792.htm

updated
3/11/2010

Teva Pharmaceuticals  1-800-545-8800

Hospira Inc.  1-877-946-7747

APP  (1-888-386-1300)

Teva Pharmaceuticals does not currently have propofol available. Teva manufactures propofol injection 10 mg/mL in 20 mL vials (NDC 00703-2856-04), 50 mL vials (NDC 00703-2858-08), and 100 mL vials (NDC 00703-2859-03).

 Hospira Pharmaceuticals reports they have addressed the issue that led to the recall last year and are working to restore availability. Hospira manufactures Propofol injection 10 mg/mL, in 20 mL vials (NDC 00409-4699-30), 50 mL vials (NDC 00409-4699-33), and 100 mL vials (NDC 00409-4699-24).

FDA is temporarily permitting APP to import and distribute an unapproved Propoven 1% (propofol 1%) within the U.S. to help address the drug shortage. FDA is announcing today no other entity except APP is authorized by FDA to import or distribute Propoven 1% (propofol 1%). Please see the Dear Healthcare Professional Letter (PDF – 490KB)¹⁶ from APP regarding the Agency’s steps to alleviate the drug shortage. 

Accordingly, any sales of Propoven 1% vials from any entity other than APP will be considered a violation of the Food, Drug and Cosmetic Act and will be subject to enforcement.

On this day in 1955, Sir Alexander Flemming, the discoverer of penicillin, passed away (see below).  A little known fact was that his first wife received the first dose ever of the antibiotic on June 21, 1929.  On June 22, she got her first yeast infection.  In 1944, he was knighted ad received the Nobel Prize.  His wife didn’t attend.  She was scratching.

But I digress……

This is the original BBC news article announcing Sir Alex’ death.

http://omniphysicians.com/2010/03/11/on-this-day-in-1955-sir-alexander-fleming-died/

Here is a little review on hydrocephalus: signs, symptoms and what-not.  Some of you may think you know all there is to know about hydrocephalus.  Nobody knows everything.  So, don’t get a swelled head!

http://omniphysicians.com/2010/03/11/what-is-hydrocephalus/

The Supreme Court will see if vaccine manufacturers can be held liable by parents who claim their children suffered serious health problems from vaccines.  The justices on Monday agreed to hear an appeal from parents in Pittsburgh who want to sue Wyeth over the serious side effects their daughter, six months old at the time, allegedly suffered as a result of the company’s diphtheria, tetanus and pertussis vaccine.  The 3rd U.S. Circuit Court of Appeals in Philadelphia ruled against Robalee and Russell Bruesewitz, saying a 1986 federal law bars their claims.

That law set up a special vaccine court to handle disputes as part of its aim of insuring a stable vaccine supply by shielding companies from most lawsuits.

Wyeth, now owned by Pfizer Inc., prevailed at the appeals court but also joined in asking the court to hear the case, saying it presents an important and recurring legal issue that should be resolved.  The Obama administration joined the parties in calling for high court review, although the government takes the side of the manufacturers.

http://omniphysicians.com/2010/03/10/supreme-court-to-hear-vaccine-liability-case/

This is one doc’s opinion about DNR and DNI cases.  This guy successfully resuscitated someone and then goes back to see the family and tell them the good news. 

‘“Where’s the family?” I ask. “I need some history.” They’re waiting outside. I wipe the smile of success off my face and walk out slowly. I introduce myself, and before I can go further, a woman interrupts and hands me papers. “He has DNR and DNI orders,” she says.

It’s a bit of a shock, and I take a deep breath. The papers clearly show that both CPR and intubation should have been off-limits. I didn’t know this, and I erroneously saved my patient’s life….’

http://omniphysicians.com/2010/03/10/dnr-dni/

Paul R

Link:  http://www.medicalnewstoday.com/articles/181739.php

Medical News Today

Grandfathered Drug For High Potassium Has No Proven Benefit

10 Mar 2010   

For more than half a century, products containing ion exchange resins have been used in patients with dangerously high levels of potassium. However, there is no convincing evidence that these products are actually effective, according to an article appearing in an upcoming issue of the Journal of the American Society Nephrology (JASN). “We suspect that if ion exchange resins were introduced today, they would not be approved,” comments Richard H. Sterns, MD (Rochester General Hospital, University of Rochester School of Medicine and Dentistry, Rochester, NY).

High potassium levels (hyperkalemia) are a potentially life-threatening problem, commonly occurring in patients with kidney disease. Ion exchange resins, mixed with a cathartic called sorbitol, have long been used to treat hyperkalemia. Millions of doses of this product are prescribed every year in the United States yet it has never been studied with controlled trials to prove it works. Explains Sterns, “these agents came into widespread use in 1958 four years before drug manufacturers were required to prove the effectiveness of their products before gaining FDA approval. Their approval was essentially ‘grandfathered.’”

Last year, the FDA issued a warning against giving ion exchange resins with sorbitol, based on reported cases of potentially fatal bowel injury. Yet pre-mixed preparations of the resin with sorbitol are still marketed and widely used. Sterns asks, “If ion exchange resins were presented to the FDA today, with the data available, would the agency rule them safe and effective?”

The answer, according to Sterns, based on a review of the available data is “probably not.” “We found no rigorous scientific evidence that ion exchange resins are effective in ridding the body of excess potassium,” says Sterns. “In fact, we found some evidence showing that, on rare occasions, they might be harmful.”

“We found no evidence that would meet modern standards for drug approval,” Sterns and coauthors conclude. They call for further studies to weigh the harms versus benefits of these products. Meanwhile, they believe that doctors should first try other alternatives to managing high potassium levels, “before turning to these largely unproven and potentially harmful therapies.”

Study co-authors are Maria Rojas, Paul Bernstein, and Sreedevi Chennupati, all of Rochester General Hospital.

Disclosures: The authors reported no financial disclosures.

The content of this article does not reflect the views or opinions of The American Society of Nephrology (ASN). Responsibility for the information and views expressed therein lies entirely with the author(s). ASN does not offer medical advice. All content in ASN publications is for informational purposes only, and is not intended to cover all possible uses, directions, precautions, drug interactions, or adverse effects. This content should not be used during a medical emergency or for the diagnosis or treatment of any medical condition. Please consult our doctor or other qualified health care provider if you have any questions about a medical condition, or before taking any drug, changing your diet or commencing or discontinuing any course of treatment. Do not ignore or delay obtaining professional medical advice because of information accessed through ASN.

Call 911 or your doctor for all medical emergencies. Founded in 1966, the American Society of Nephrology(ASN) is the world’s largest professional society devoted to the study of kidney disease. Comprised of 11,000 physicians and scientists, ASN continues to promote expert patient care, to advance medical research, and to educate the renal community. ASN also informs policymakers about issues of importance to kidney doctors and their patients. ASN funds research, and through its world-renowned meetings and first-class publications, disseminates information and educational tools that empower physicians.

Source: American Society of Nephrology (ASN) 

Link:  http://www.medicalnewstoday.com/articles/181738.php

Medical News Today

Elevated Levels Of Cobalt And Chromium Found In Offspring Of Moms With Metal-on-Metal Hip Implants

10 Mar 2010   

Women with metal-on-metal hip implants, where both the ball of the joint and the surface of the socket are made of metal, pass metal ions to their offspring during pregnancy, according to a study by researchers at Rush University Medical Center. The ions are the result of wear and corrosion as the metal parts rub against one another.

The data showed a correlation between levels of cobalt and chromium components of metal implants in mothers and their babies at the time of delivery.

The study will be presented March 9 at the 2010 Annual Meeting of the American Academy of Orthopaedic Surgeons in New Orleans.

“We don’t know whether metal ions pose any health risks for pregnant women and their babies,” said Dr. Joshua Jacobs, professor and chairman of orthopedic surgery at Rush, “but as metal-on-metal implants increase in popularity and use, especially among young, active patients, women of child-bearing age and their doctors need to be aware of these findings when considering options for hip replacements.”

Jacobs and his colleagues evaluated three women who had metal-on-metal hip implants and gave birth two to six years after their surgeries.

Maternal and umbilical cord blood was obtained at the time of delivery and tested for blood serum concentrations of titanium, nickel, cobalt and chromium using inductively coupled plasma mass spectrometry, a highly sensitive technique that can detect trace amounts of metals in biological samples.

The researchers found that mothers with metal-on-metal implants and their offspring had significantly higher levels of chromium and cobalt compared with a control group of seven women and their offspring who were also tested at the time of delivery. Moreover, the levels of these metals in the blood of mothers with implants correlated with the levels found in the umbilical cords. Cobalt levels in newborns were about half that in the mothers’ blood, while chromium levels were about 15 percent of the mothers’ chromium levels. In the control group, no correlation existed.

The lower levels in the umbilical cords indicated that the placenta provided at least some barrier to the transfer of metal ions from mother to fetus, but not a complete barrier, Jacobs said.

Levels of titanium or nickel showed no significant difference between the two groups.

It is unknown whether metal ions in the bloodstream for pregnant mothers, developing fetuses or newborns pose any significant health risk. According to Jacobs, medical device companies are working to improve the wear and corrosion properties of metal implants to reduce the release of metal ions.

“Any advancements in this area will directly benefit patients,” Jacobs said. Rush University Medical Center has an active research program testing different materials for components in joint replacement devices.

Total joint replacement is a surgical procedure in which the patient’s natural joint is replaced with an artificial one, made of a combination of plastic, metal, and/or ceramic. Over 300,000 first-time total hip replacements are performed each year in the U.S.

Rush University Medical Center includes a 674-bed (staffed) hospital; the Johnston R. Bowman Health Center; and Rush University (Rush Medical College, College of Nursing, College of Health Sciences and the Graduate College).

Source: Rush University Medical Center

Link:  http://www.medicalnewstoday.com/articles/181727.php

Medical News Today

What Is Hydrocephalus (Water On The Brain)? What Causes Hydrocephalus?

10 Mar 2010   

Hydrocephalus, also called Water on the Brain is a condition in which there is an abnormal build up of CSF (cerebrospinal fluid) in the cavities (ventricles) of the brain. The buildup is often caused by an obstruction which prevents proper fluid drainage. The fluid buildup can raise intracranial pressure inside the skull which compresses surrounding brain tissue, possibly causing progressive enlargement of the head, convulsions, and brain damage. Hydrocephalus can be fatal if left untreated.

The damage to the brain can cause headaches, vomiting, blurred vision, cognitive problems, and walking difficulties.

The term water on the brain is incorrect, because the brain is surrounded by CSF (cerebrospinal fluid), and not water. CSF has three vital functions:

• It protects the nervous system (brain and spinal cord) from damage
• It removes waste from the brain
• It nourishes the brain with essential hormones

The brain produces about 1 pint of CSF each day. The old CSF is absorbed into blood vessels. If the process of replenishment and release of old CSF is disturbed, CSF levels can accumulate, causing hydrocephalus.

There are three types of hydrocephalus:

• Congenital hydrocephalus – this is present at birth. According to the National Health Service (UK), approximately 1 in every 1,000 babies are born with congenital hydrocephalus, while The Mayo Clinic, USA, says 1 in every 500 US babies are born with it. It may be caused by an infection in the mother during pregnancy, such as rubella or mumps, or a birth defect, such as spina bifida. It is one of the most common developmental disabilities, more common than Down syndrome or deafness.
• Acquired hydrocephalus – this develops after birth, usually after a stroke, brain tumor or as a result of a serious head injury.
• Normal pressure hydrocephalus – only affects people aged 50 years or more. It may develop after stroke or injury. In most cases doctors do not know why it occurred. 2 in every 100,000 people are affected by normal pressure hydrocephalus in England each year.

According to the National Institutes of Health (NIH), USA, approximately 700,000 American children and adults live with hydrocephalus. Hydrocephalus is also the leading cause of brain surgery for children in the USA. The NIH adds that over the past 25 years death rates linked to hydrocephalus have dropped from 54% to 5%, while the occurrence of intellectual disability has dropped from 62% to 30%.

The NIH says there are more than 180 different possible causes of hydrocephalus; a common cause being brain hemorrhage linked to premature birth.

A prenatal ultrasound examination can sometimes detect hydrocephalus in the developing baby.

According to Medilexicon’s medical dictionary:

Hydrocephalus is ” A condition marked by an excessive accumulation of cerebrospinal fluid resulting in dilation of the cerebral ventricles and raised intracranial pressure; may also result in enlargement of the cranium and atrophy of the brain.”

The outlook for a patient with hydrocephalus depends mainly on how quickly the condition is diagnosed and treated, and whether there are any underlying disorders.

Treatment for hydrocephalus often involves using a shunt – a thin tube that is implanted in the brain to drain away excess cerebrospinal fluid (CSF).

What are the signs and symptoms of hydrocephalus?

A symptom is something the patient senses and describes, while a sign is something other people, such as the doctor notice. For example, drowsiness may be a symptom, while dilated pupils may be a sign.

Signs and symptoms of congenital hydrocephalus (present at birth):

• Breathing difficulties.
• Muscles in the baby’s arms and legs may be stiff and prone to contractions.
• Some of the developmental stages may be delayed, such as sitting up or cradling.
• Tense fontanelle – an outward curving of an infant’s soft spot (fontanelle). The soft part of the top of the baby’s head bulges outwards.
• The baby may be irritable and/or drowsy
• The baby may be unwilling to bend or move his/her neck or head.
• The baby may feed poorly.
• The baby’s head seems larger than it should be.
• The baby’s scalp is thin and shiny. There may be visible veins on the scalp.
• The pupils of the baby’s eyes may be right close to the bottom of the eyelid; sometimes known as the setting sun.
• There may be a high-pitched cry.
• There may be seizures.
• There may be vomiting.

Signs and symptoms of acquired hydrocephalus (develops after birth):

• Bowel incontinence (rare)
• Confusion and/or disorientation
• Drowsiness
• Headaches
• Irritability, which may be progressive
• Lack of appetite
• Lethargy
• Nausea
• Personality changes
• Problems with eyesight, such as blurred or double vision
• Seizures (fits)
• Urinary incontinence
• Vomiting
• Walking difficulties (more common in adults)

Signs and symptoms of normal pressure hydrocephalus (affects people aged 50+) – signs and symptoms may take many months or years to develop.

• Changes in gait – the patient may feel as if they are frozen on the spot when taking their first step to start walking. The individual may appear to shuffle rather than walk.
• Normal thinking process slows down – the patient may respond to questions more slowly than normal, there may be delayed reactions to situations. The individual’s ability to process information slows down.
• Urinary incontinence – this usually comes after changes in gait.

What are the risk factors for hydrocephalus?

A risk factor is something which increases the likelihood of developing a condition or disease. For example, obesity significantly raises the risk of developing diabetes type 2. Therefore, obesity is a risk factor for diabetes type 2. The following are possible risk factors for hydrocephalus:

• Being born prematurely – infants born prematurely have a higher risk of intraventricular hemorrhage (bleeding within the ventricles of the brain), which may result in hydrocephalus.
• Problems during pregnancy – an infection in the uterus during pregnancy may increase the risk of hydrocephalus in the developing baby.
• Problems with fetal development, such as incomplete closure of the spinal column. Some congenital defects may not be detectable at birth – but the baby may be at increased risk of developing hydrocephalus when he/she is older (still during childhood).
• Lesion and tumors of the spinal cord or brain.
• Infections of the nervous system.
• Bleeding in the brain.
• Having a severe head injury.

What are the causes of hydrocephalus?

Hydrocephalus occurs when too much fluid builds up in the brain; specifically, excess CSF (cerebrospinal fluid) accumulates in the cavities (ventricles) of the brain.

How does CSF (cerebrospinal fluid) circulate through the brain?

The brain is like gelatin and floats in CSF. CSF flows through the brain through chambers; these chambers are known as ventricles, and they lie deep inside the brain. The fluid-filled ventricles protect the brain; like a cushion. Most of the CSF is made in the choroid plexus, a part of the brain.

Surplus CSF is removed from the brain through the dural venous sinuses; a series of channels. The dural venous sinuses run down the arachnoid villi, a layer of tissue which is like a one-way valve. The arachnoid villi allow excess CSF to leave the brain and filter into the bloodstream, while at the same time preventing blood from getting into the brain and causing damage.

It is important that the production, flow and absorption of CSF occur in such a way that normal pressure is maintained inside the skull – it is a delicate balance.

Hydrocephalus may occur if:

• Too much CSF is produced in the choroid plexus.
• One of the ventricles in the brain is blocked or narrowed, stopping or restricting the flow of CSF, which means it cannot leave the brain.
• CSF cannot filter into the bloodstream because there is something wrong with the arachnoid villi.

Causes of congenital hydrocephalus (present at birth):

The baby is born with a blockage in the cerebral aqueduct, a long passage in the midbrain that connects two large ventricles. This is the most common cause.

The choroid plexus produces too much CSF.

Health conditions in the developing baby can cause problems in how the brain develops. According to the National Health Service (NHS), UK, 70% of children with severe spina bifida develop hydrocephalus.

Infections during pregnancy – if the pregnant mother develops some infections, there is a risk that the normal development of the baby’s brain may be affected. Examples include:

• CMV (Cytomegalovirus) - a virus which infects over 50% of American adults by the time they are 40 years old. Also known as the virus that is most commonly transmitted to a child before birth. This virus is responsible for glandular fever.
• German measles (rubella) – an infectious disease caused by the rubella virus. The virus passes from person-to-person via droplets in the air expelled when infected people cough or sneeze – the virus may also be present in the urine, feces and on the skin. The hallmark symptoms of rubella are an elevated body temperature and a pink rash.
• Mumps – an acute (short-term) viral infection in which the salivary glands, particularly the parotid glands (the largest of the three major salivary glands) swell.
• Syphilis – an STD (sexually transmitted disease) caused by a bacterium Treponema pallidum.
• Toxoplasmosis – in infection caused by a single-celled parasite – Toxoplasma gondii.

Causes of acquired hydrocephalus (develops after birth) – usually caused by an injury or illness that results in blockage between the ventricles. The following may be causes:

• Brain hemorrhage – bleeding inside the brain.
• Brain lesions – areas of injury or disease within the brain. There are many possible causes, including injury, infection, exposure to certain chemicals, or problems with the immune system.
• Brain tumors – benign (non-cancerous) or malignant (cancerous) growths in the brain. A primary brain tumor originates in the brain, while a secondary brain tumor comes from a cancer that has spread to brain tissue from another part of the body.
• Meningitis – inflammation of the membranes of the brain or spinal cord (inflammation of the meninges).
• Stroke – a condition where a blood clot or ruptured artery or blood vessel interrupts blood flow to an area of the brain. A lack of oxygen and glucose (sugar) flowing to the brain leads to the death of brain cells and brain damage, often resulting in impairment in speech, movement, and memory.

Causes of normal pressure hydrocephalus (affects people aged at least 50 years) – in most cases doctors don’t know what caused it (idiopathic normal pressure hydrocephalus). Sometimes it may develop after a stroke, infection or injury to the brain.

There are two theories:

• There is something wrong with the arachnoid villi and CSF (cerebrospinal fluid) is not reabsorbed into the bloodstream properly. Consequently the brain starts to produce less new CSF, resulting in a gradual rise in intracranial pressure over a longer period compared to other forms of hydrocephalus. The gradual rise in pressure may cause progressive brain damage.
• An underlying condition, such as heart disease, a high blood cholesterol level, or diabetes is affecting normal blood flow, which may lead to a softening of brain tissue. The softened brain tissue may result in increasing pressure.

Diagnosing hydrocephalus

Babies and young children (congenital hydrocephalus):

• A routine prenatal ultrasound scan may detect hydrocephalus during pregnancy in the developing fetus.
• After birth, the head of the baby is measured regularly. Any abnormalities in head size will probably lead to further diagnostic tests. If a baby’s head is seen to be too big, or is growing more rapidly than it should, the doctor may order an ultrasound scan of the head. If the ultrasound scan shows any abnormality, further tests will be ordered, such as an MRI (magnetic resonance imaging) scan or a CT (computerized tomography) scan, which give more detailed images of the brain.

Acquired hydrocephalus (occurs after birth) – if the child or adult develops the signs and symptoms of hydrocephalus the doctor may:

• Examine the patient’s medical history carefully.
• Carry out a physical and neurological examination.
• Order an imaging scan, such as a CT or MRI scan. If imaging tests reveal hydrocephalus or any other faults, the doctor will refer the patient to a brain surgeon for further evaluation and treatment.

Normal pressure hydrocephalus (occurs in patients aged 50 years and over) – diagnosing this type of hydrocephalus is more tricky because symptoms are more subtle and do not appear suddenly. Also, normal pressure hydrocephalus shares symptoms with some other common conditions, such as Alzheimer’s disease.

Making a correct diagnosis is important, because treatment for normal pressure hydrocephalus does relieve symptoms, unlike Alzheimer’s.

Doctors in the UK have devised the following checklist for diagnosing normal pressure hydrocephalus. The checklist looks at:

• The patient’s gait (how he/she walks)
• The patient’s mental ability
• Any signs of urinary incontinence
• The results of the imaging scans show moderately higher levels of cerebrospinal fluid than normal

A combination of these four characteristics will most likely lead to a diagnosis of normal pressure hydrocephalus.

What are the treatment options for hydrocephalus?

Treatment for congenital and acquired hydrocephalus – both types of hydrocephalus require urgent treatment to alleviate intracranial pressure (pressure on the brain), otherwise there is a serious risk of damage to the brainstem. Our automatic functions, such as breathing and our heartbeat are regulated by the brainstem.

• A shunt, the surgical insertion of a drainage system – this is a catheter (a thin tube with a valve) that is placed in the brain to drain away excess fluid into another part of the body, such as the abdomen or a chamber in the heart. One end is placed in one of the brain’s ventricles; it is tunneled under the skin to another part of the body which is better able to absorb the fluid. Usually, this is all that is needed and no further treatment is required. Sometimes shunt repair surgery may be needed if it gets blocked or infected.

  Patients with hydrocephalus will usually need to have a shunt system in place for the rest of their lives. If the shunt is placed in a child, additional surgeries may be needed to insert longer tubing as he/she grows.

• Ventriculostomy – the surgeon makes a hole in the bottom of a ventricle so that the excess fluid flows towards the base of the brain. Normal absorption occurs at the base of the brain. This procedure is sometimes performed when the flow of fluids between ventricles is obstructed.

Treatment for normal pressure hydrocephalus – shunts may also be used. However, shunts may not be suitable for some patients. The surgeon needs to carefully assess the potential risks involved in surgery against the possible benefits.

• Lumbar puncture – some of the cerebrospinal fluid is removed from the base of the spine. If this improves the patient’s gait or mental abilities, fitting a shunt will probably help him/her.
• Lumbar infusion test – a needle is inserted through the skin of the lower back into the spine. Measurements are then taken of cerebrospinal fluid pressure (CSF) as fluid is injected into the spine. The surgeon will then be able to determine the pressure of the CSF. Patients usually benefit from having a shunt fitted if their CSF pressure is over a certain limit.

What are the complications of hydrocephalus?

Hydrocephalus severity depends on several factors, including at what age it developed and how it progressed. If the condition is advanced when the baby is born, it is more likely there will be brain damage and physical disabilities. If cases are not so severe and treatment is proper and prompt, the outlook is much better.

Problems with the shunt – shunt blockage occurs in 20% of cases during the first year; after that the risk drops to 5%. Approximately 3% to 12% of shunts may have an infection; experts say the risk is linked to the patient’s age and general state of health.

A patient with a malfunctioning shunt will have hydrocephalus symptoms and should be treated immediately.

Babies with congenital hydrocephalus may experience some kind of permanent brain damage, which may result in long-term complications. Examples include:

• A limited attention span
• Autism
• Learning difficulties
• Physical coordination problems
• Problems with memory
• Speech problems
• Vision problems

Prevention of hydrocephalus

Pregnancy – regular prenatal care can significantly reduce the risk of having a premature baby, which reduces the risk of the baby developing hydrocephalus.

Infectious diseases – make sure you have had all your vaccinations and attended all the screenings that are recommended for you.

Meningitis vaccine – meningitis used to be a common cause of hydrocephalus. Ask your doctor whether you should be vaccinated. Vaccination is recommended for individuals who are travelling to parts of the world where meningitis is common, people with terminal complement deficiency (an immune system disorder), patients who either had their spleen removed or have a damaged spleen, and military personnel.

Preventing head injuries

• Car seat belts:
  • Wear a seatbelt every time you drive your car or ride as a passenger.
  • Make sure children are buckled up using either a safety seat, booster seat, or a seat belt that is suitable for the child’s size and age. When children outgrow their safety seats – usually when they weight about 40 pounds (18 kilos) – they should start using a booster seat.
  • Children should continue using the booster seat until the lap/shoulder belts fit properly; usually when they are about 4ft 9inches (1meter 45 centimeters) tall.
• Drinking and driving – never drive when you are under the influence of alcohol.
• Helmets or specific protective headgears should always be worn when:
  • Batting in baseball/softball or cricket (and running bases in baseball)
  • Engaged in contact sports, such as karate, boxing, or American football
  • Riding a horse
  • Riding on a motorbike, snowmobile, scooter, or all-terrain vehicle (both riders and passengers)
  • Skiing
  • Snowboarding
  • Using a skateboard
  • When roller-skating or in-line skating
• Living areas for seniors (UK: elderly people):
  • Grab bars should be installed next to the bathtub, shower and/or toilet
  • Seniors should keep physically active to make sure lower body strength and balance is adequate (thus lowering the risk of falls)
  • Make sure lighting in the house is bright enough
  • On bathtub and shower floors use nonslip mats
  • Remove throw rugs and other objects which may be cause tripping
  • Stairways should ideally have handrails on both sides
• Living areas for children:
  • Install window guards
  • Place safety gates at the bottom and top of stairs if the children are young
• Children’s play areas – the ground surface of a child’s playground should be made of hardwood mulch, sand or some specific shock-absorbing material.
• Firearms – Firearms should be stored, unloaded, in a locked safe or cabinet. Bullets should not be stored in the same location.

Written by Christian Nordqvist
Copyright: Medical News Today

Link:  http://news.bbc.co.uk/onthisday/hi/dates/stories/march/11/newsid_2538000/2538043.stm

BBC, 1955:   Sir Alexander Fleming – the man who first discovered the life-saving drug penicillin – has died of a heart attack. He was 73.

Sir Alexander died suddenly at his home in London. He was married only two years ago to Dr Amalia Coutsouris, from Athens, who worked at St Mary’s Hospital in Paddington. His first wife, with whom he had a son, died in 1949.

For many years, Sir Alexander was Professor of Bacteriology in the University of London and until last year was head of the Wright-Fleming Institute of Micro-Biology at St Mary’s hospital, Paddington.

The young scientist served in a battlefield hospital laboratory in France during World War I. When he saw how many soldiers were dying from infections he became determined to find a cure.

His first notable discovery was lysozyme in 1922. It is a naturally-occurring antibacterial substance, found in tears and other body fluids.

Knighthood

But his biggest discovery – penicillin – was made by chance in 1929. During some routine research, he noticed a mould had developed on a culture plate left forgotten under a microscope. Where the new mould had grown the bacteria around it had faded away.

Further tests showed the fluid in which the mould had grown was strongly antibacterial – but non-toxic to animals and human beings. It was crude penicillin.

The discovery prompted further research but it was scientists at Oxford who managed to harness its full potential as a life-saving drug and penicillin was ready for commercial use by 1940.

Honours were heaped upon him. He was knighted in 1944 and the following year he shared the Nobel prize for medicine with Sir Howard Florey and Dr Ernst Chain, the two Oxford scientists who did most to develop the drug.

In a BBC radio programme broadcast in 1945, Sir Alexander spoke of his discovery: “Penicillin is not a cure-all, while it has the most remarkable action on many common microbes which infect us, it has no effect on many others, like tuberculosis, typhoid fever, dysentery, influenza, measles and many others.”

He also foresaw the problems which would arise once certain bacteria developed an immunity to the drug.

The number two cause of death among teenagers in America today are guns. You know the number one cause of death?

Not having a gun.

But I digress…….

Here is a little soundbite on antiphospholipid syndrome.  Somebody says they have it — think PE, MI, DVT.

http://omniphysicians.com/2010/03/10/antiphospholipid-syndrome/

Children who have been abused psychologically, physically or sexually are more likely to suffer unexplained abdominal pain and nausea or vomiting than children who have not been abused.

http://omniphysicians.com/2010/03/10/unexplained-abdominal-pain-nausea-or-vomiting-in-kids/

Link:  http://www.acha.org/ILI_Project/ILI_LatestWeek.cfm

Paul R