Stop the hostility among health care professionals

         The amount of hostility among health care professionals seems to be at an all-time high.  Are “scope of practice” and “turf” battles really escalating, or is it just more palpable in the modern era of anonymous comments?  I don’t know for sure, but lately, the conversation seems louder and uglier to me.
         Patients are complex, and medical care is multifaceted.  Patients show up with a host of pre-existing problems (some known, and some yet to be diagnosed), have an operation that may be short or long, hugely invasive or minimally so, have good luck or bad, receive care from probably at least 20 different clinicians by the time they reach you, all of whom are most likely well-trained and well-intended.  Patients are sometimes resilient and get better even when we make mistakes, and patients sometimes are so ill or injured that they simply can’t be fixed even when everything is done right.
Let us Stop the hostility among us and have collaborative Care System.

Tale of the Tails, PPIUCD STRINGS

https://issuu.com/dr.sujnanendramishra/docs/tale_of_the_tail

CDC declares Zika virus teratogenic

Officials from the Centers for Disease Control and Prevention (CDC) have declared that Zika virus is a teratogen that causes microcephaly and other serious brain anomalies. That conclusion was announced in a special report in The New England Journal of Medicine which outlined the investigator’s systematic analysis of epidemiologic evidence on the virus to date.

The goal of the effort by CDC researchers was to determine whether cause and effect could be established between prenatal Zika virus and subsequent birth defects. The data on Zika virus were evaluated against the criteria proposed by Shepard in 1994 as a “yardstick” for establishing human teratogenicity. 

The 4 key criteria of Shepard’s that the Zika virus has met, said the CDC authors, and which justify the new classification, are as follows:

·       Exposure to Zika virus occurs at a critical time in prenatal development, as documented in a report of laboratory-confirmed transmission in specific areas of Brazil and an increase in the number of cases of microcephaly identified in the first trimester;

·       Clinical cases with the teratogenic effect have been clearly delineated, as seen in what the authors described as descriptions of the typical pattern of findings in Zika-exposed fetuses and infants, such as severe microcephaly, intracranial calcifications, and other brain abnormalities; and

·       Verification that the association involves a rare exposure and a rare defect, as supported by evidence indicating that microcephaly is rare in the United States, with an incidence of 6 per 10,000 live births, and that adverse birth outcomes have been seen in offspring of women who spent only a limited period of time in an area where Zika virus was endemic.

With Zika virus confirmed as teratogenic, the CDC authors said, the focus of research can now shift to “understanding the full spectrum of defects caused by congenital Zika virus infection; if Zika virus is similar to other teratogens…, quantifying the relative and absolute risks among infants who are born to women who were infected at different times during pregnancy…and identifying factors that modify the risk of an adverse pregnancy or birth outcome.”

Do ovary-sparing hysterectomies lead to early menopause?

Published in Obstetrics & Gynecology, the findings are based on a comparison of baseline antimullerian hormone levels and absolute change and percentage change in levels of the hormone from baseline to 1 year follow-up in premenopausal women who underwent ovary-sparing hysterectomy for benign indications versus a cohort of similar age but with intact reproductive organs.  Overall, the women who underwent hysterectomy but retained their ovaries entered menopause 1.9 years earlier than the reference cohort. Baseline median antimullerian hormone levels were similar in the referent group (n = 172) and the hysterectomy group (n = 148).

A year later, the hysterectomized women had a much greater median percentage decrease (-40.7% compared with -20.9%; P<.001). A higher proportion of this group also had undetectable antimullerian hormone (12.8% compared with 4.7%; P=.02), and their antimullerian hormone levels averaged 0.77 that in the reference cohort (P=.001). The differences were attenuated among white women, but were still significant among black women. Comparisons between women with a low ovarian reserve at baseline and women with a high ovarian reserve at baseline showed similar findings.

The researchers concluded that while women who underwent ovary-sparing hysterectomy had similar levels of antimullerian hormone levels at baseline, they experienced a greater percentage decrease in those levels after 1 year than the reference cohort. That suggests, the authors said, that hysterectomy may lead to ovarian damage that is unrelated to a woman’s baseline ovarian reserve.

OTC Cough Liquid Found to Contain Morphine

The Food and Drug Administration (FDA) is warning consumers to not use Licorice Coughing Liquid due to the presence of morphine.
Licorice Coughing Liquid is sold over-the-counter and is manufactured by Ma Ying Long Pharmaceutical Group in China and distributed by Master Herbs USA, Inc. It is sold online and in some retail stores, the distributor has now recalled the product in light of the FDA warning.

The product's labeling contains information written in English and Chinese, the presence of morphine is not mentioned in the English text. The labeling only states guaifenesin 5% as an active ingredient intended for coughs caused by upper respiratory tract infections, bronchitis, and cold. If taken, consumers who are hypersensitive to morphine could experience severe allergic reactions. Other reactions can include respiratory depression and possible death.
The recalled product is supplied as 3.38 floz (100mL) bottles.
RELATED: Children's Cough Medicines Recalled Due to Incorrect Dosing Cups

Elizabethkingia in Illinois" A rare bloodstream infection"

 

(HealthDay News) — A cluster of rare bloodstream infections was discovered by Illinois health officials while investigating an outbreak in Wisconsin.
An additional 10 cases of infection from the bacterium Elizabethkingia were announced Wednesday by the Illinois Department of Public Health, including 6 deaths, the Associated Press reported. Most cases occurred this year, but some date back to 2014.
RELATED: Rare Bacteria Implicated in 18 Deaths, CDC Investigating Outbreak
The strain of Elizabethkingia in the Illinois cases is different from the one in the Wisconsin outbreak. One death in Illinois linked to the same strain in Wisconsin was previously confirmed, the AP reported.
The cases in Illinois were identified when hospitals in that state were asked to help with the investigation into the Wisconsin outbreak.

Elizabethkingia bacteria are rarely reported to cause illness in humans.  Symptoms among people diagnosed with Elizabethkingia infection can include fever, shortness of breath, chills or cellulitis. Confirmation of the illness requires a laboratory test.
IDPH is currently investigating a cluster of bacterial infections caused by Elizabethkingia anophelis.  The majority of patients acquiring these infections are over 65 years old, and all patients have a history of at least one underlying serious illness.
To date, Wisconsin is reporting 59 confirmed cases, including 18 deaths; Michigan is reporting one confirmed case, including one death.  Illinois has one case matching the strain found in Wisconsin.  The remaining 10 cases in the current cluster are of a different strain.