Omni Health Services, Ltd.

Suprane: Bad news from the FDA

Reuters (3/22) reported that the Food and Drug Administration (FDA) has “recommended updating the prescribing instructions for a Baxter International anesthesia drug,” Suprane (desflurane), “after three reports of cardiac arrest in children,” according to agency documents. The drug’s label “already carries warnings about other cardiac problems including heart attacks, irregular heart beats, and unstable blood pressure.”

Pandemic: Are we better or worse than 1918?

NY Times, 3/24/08:

WHEN an outbreak of the Spanish flu spread worldwide in 1918, a doctor in Newark advised his patients that they could cure their illness with red onions and coffee. In Atlantic City, the authorities closed amusement parks and theaters indefinitely. And in upstate New York, public health officials distributed a poster warning people against “careless spitting, coughing, sneezing.”

Those precautions had mixed results, and an estimated 675,000 Americans died during that outbreak, according to the Centers for Disease Control and Prevention in Atlanta.

Today, New Jersey, Connecticut and New York are much more prepared than they were 90 years ago in the event that an influenza outbreak turns into a pandemic. But five years after an avian flu outbreak in Asia made pandemic flu planning a priority, some experts…

Public Hospitals: Dinosaurs?

NBC News, 3/22/08: (3/22, story 12, 2:25, Holt) reported, “Public hospitals like San Francisco General make up two percent of America’s hospitals,” yet they “take care of 25 percent of patients with little or no medical coverage.” However, they are “disappearing at an alarming rate, down almost 22 percent since 1990.” According to Larry Gage, of the National Association of general hospitals, these closures are due to “a combination of budget cuts at almost every level of government, increased numbers of uninsured, [and] increased demand on the emergency” department “and the trauma systems.”

San Diego speeds up STEMI protocols

San Diego Union Tribune, 3/22/08: Patients with the most lethal type of heart attack are receiving lifesaving care in half the time as before 2007 under a cardiac-response system launched early last year, county officials said yesterday.

EDUARDO CONTRERAS / Union-Tribune

Dr. David Spiegel explained a procedure yesterday to patient Eleanor Kendall at Tri-City Medical Center in Oceanside. Kendall underwent angioplasty and stent placement.

Now, paramedic ambulances carry special equipment that allows them to diagnose these heart attacks in the field. The paramedics then call any of 13 designated hospitals’ heart attack teams to let them know a patient will soon arrive so they can be prepared, said Dr. Bruce Haynes, medical director of the county’s Emergency Medical Services.In the years before the Cardiac System of Care was…

Is this the time for synthetic heparin?

Chicago Tribune, 3/22/08: The pursuit of a synthetic version of heparin, free of animal materials and made with stricter quality controls, is gaining more attention as awareness grows that the blood thinner can be sourced from an unregulated supply chain that starts with hog lots in rural China.

The U.S. Food and Drug Administration this week disclosed that low-cost animal cartilage made its way into Baxter International Inc.’s heparin, raising fears conventional quality-control procedures do not adequately protect American consumers. Baxter’s product, recalled in the U.S. last month, has been linked to hundreds of potentially dangerous allergic reactions and at least four deaths. On Friday, the FDA said another American heparin-maker, B. Braun Medical Inc., recalled, as a precaution, more than 20 lots made by the…

Belgium: Polio shot or jail? Choose!

AP, 3/11/08: Two sets of parents in Belgium were recently sentenced to five months in prison for failing to vaccinate their children against polio. Each was also fined $8,000. The polio vaccine is the only vaccination required by Belgian law, unlike the United States, where immunizations against many other diseases are required. And unlike the United States, where many state laws allow children to opt out if their parents have religious or philosophical objections, Belgium allows exemptions only if parents prove their child might have a bad reaction to the vaccine. Reaction from some ethicists and public health experts backs the hard-line stance. “At the end of the day, the law must be respected,” said Dr. Victor Lusayu, head of Belgium’s international vaccine center. John…

OMNI Postings of 3/23/08

Postings # 704, 707, 711, 714, 715.

This abstract from a recent J. Emerg Med cautions us to think about acute diverticulitis when faced with a person under 40 years of age with atypical belly pain. The incidence of such a disease entity is growing in the younger population. The ones at most risk are males and those who have a pants size as large as Madagascar. 25% may have their pain localized to the RLQ. CT should make the diagnosis for you.
http://omniphysicians.com/2008/03/23/diverticulitis-in-the-young/

This article is for Dr. L., a cheese gourmand par excellance! Reports indicate that some of the mozzarella in the Naples is contaminated with dioxin. The toxicity first came to light when Italians suddenly began talking like Marlon Brando in The Godfather.
http://omniphysicians.com/2008/03/23/malignant-mozzarella/

The FDA is…

A deeper look into PRES

Reversible posterior leukoencephalopathy syndrome is a clinicoradiologic entity characterized by headaches, altered mental status, seizures, and visual loss and is associated with white matter vasogenic edema predominantly affecting the posterior occipital and parietal lobes of the brain.^[1] There has been some controversy about what the proper term should be for this entity because MRI has shown that lesions can occur in both gray and white matter. Therefore, a new name, posterior reversible encephalopathy syndrome (PRES), has been coined.^[2] Most cases of PRES occur with hypertension or immunosuppression, but it can occur with many diverse clinical entities.^[1,3] Since PRES is often unsuspected by clinicians, recognition of the characteristic imaging findings by radiologists is key to diagnosing this syndrome and should prevent deleterious work-ups or therapies.

The pathophysiology of PRES is under debate,…

PRES

Intro: Posterior reversible encephalopathy syndrome (PRES) refers to a clinicoradiological entity characterized by headache, confusion, visual disturbances, seizures and posterior transient changes on neuroimaging. Here is an abstract of a case report involving an eclamptic patient with PRES.

Journal of Emergency Medicine
Volume 33, Issue 4, November 2007, Pages 377-379

Posterior Reversible Encephalopathy Syndrome (PRES) in a Thirty-Six-Week Gestation Eclamptic

Emilie S. Powell MD, MBAand Mitchell J. Goldman DO

Abstract

Posterior reversible encephalopathy syndrome (PRES) is a transient clinical neuroradiological entity characterized by clinical signs and symptoms including hypertension, generalized seizure activity, altered mental status, headache, and vision changes; along with characteristic findings on head computed tomography or magnetic resonance imaging scan. Albeit a rare condition, PRES is most commonly reported in the literature in association with obstetric patients suffering from…

Diverticulitis in the Young

Case Series: Diverticulitis in the Young

Journal of Emergency Medicine
Volume 33, Issue 4, November 2007, Pages 363-366

Christopher D. Cole MDand Allan B. Wolfson MD

Abstract

Diverticulitis has long been regarded as a disease of the elderly, but its incidence has been increasing in those under age 40. Younger patients with diverticulitis are more likely to be male and obese. They often have atypical presentations, and 25% may have right lower quadrant pain. Not surprisingly, the condition is often misdiagnosed, resulting in unnecessary surgery. An abdominal CT scan is the modality of choice for diagnosis, but the most important diagnostic step is simply to include diverticulitis on the differential diagnosis of a young person with lower abdominal pain.