Doctor Housecalls Blog

Healthcare related news and updates



A New Weapon in the Fight Against Abscesses

A peptide developed by researchers at the University of British Columbia prevented drug-resistant bacteria from forming abscesses, or painful pus-filled lesions.

The peptide is a mini-protein, and works by disrupting the bacterial stress response.

There are 3.2 million emergency room visits each year in the United States due to abscesses. Standard treatment typically involves cutting to remove the infected tissue, or draining it. Antibiotics rarely work as a treatment.

This peptide offers a less invasive alternative.

“Abscesses can occur almost anywhere in the body, and antibiotics aren’t usually effective on them,” said Bob Hancock, a Professor in UBC’s department of microbiology said. “Our peptide offers a new strategy, because its mechanism is completely different from every known antibiotic.”

Hancock is also the senior author of the study published in EBioMedicine.

Hancock and UBC researchers used DJK-5, their synthetic peptide to interfere with the bacteria’s stress response and heal abscesses in mice.

Hancock said he is hoping for clinical trials to begin within a year.

His study “Bacterial Abscess Formation Is Controlled by the Stringent Stress Response and Can Be Targeted Therapeutically” appears online in EBioMedicine.

 



It has long been thought that environmental influences and lifestyle choices were risk factors for cancer incidence.  The Los Angeles Times (12/17, Healy) reports on a research study released this past month that confirms such a premise.  The study, published in Nature, indicates that a large majority of cancers are caused by extrinsic factors.  These are external factors such as cigarette smoking, obesity, ultraviolet radiation, and viruses.

This recent study seems to be at odds with controversial research released by a team at John’s Hopkins in January 2015.  That study seemed to indicate that most incidents of cancer were nothing more than bad luck.  As reported by STAT (12/17, Begley), researchers at Hopkins concentrated on intrinsic factors, concluding that two-thirds of cancers are due to cell division errors.

While the two studies seem to come to opposite conclusions, many believe that they both have merit.  In fact, it is possible that external elements can contribute to intrinsic risk factors, such as cell division.   According to a San Diego Union-Tribune (12/17, Fikes) report, the authors of the studies continue to debate their findings on the origins of certain cancers.   It is the opinion of most experts that both intrinsic and external factors play a role in cancer incidence.  Therefore, those patients who control their environmental factors will have a much more positive outcome overall.

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Steven J. Lipsky MD, FACEP has been a Board Certified Emergency Physician in Arizona for the last 37 years, and a resident of the Town of Paradise Valley for the last 37 years. Steve Lipsky on Google Plus[/author_info] [/author]



A recent article in US News & World Report (10/20, Sternberg) reported on emerging data indicating that it is both safe and beneficial for cancer patients to engage in exercise.  While long thought that cancer patients should take it easy or are much too weak to engage in strenuous activity, one specialist suspected otherwise and put his theories to the test.

Lee Jones, an exercise physiologist at Memorial Sloan Kettering Cancer Center, has been conducting studies in cooperation with Duke University physicians.  Some studies have shown that cancer patients who report exercising at higher levels have lower death rates and few recurrences.  Other studies indicate that exercise could increase the effectiveness of chemotherapy.  Research is still in its infancy, but Jones has 14 studies currently underway.

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Steven J. Lipsky MD, FACEP has been a Board Certified Emergency Physician in Arizona for the last 37 years, and a resident of the Town of Paradise Valley for the last 37 years. Steve Lipsky on Google Plus[/author_info] [/author]



Those who are suffering from cancer and who are in search of better drugs are understandably looking for one of two things – a medicine that will either extend survival rates or will improve quality of life.  While there have been scores of new drugs approved for the treatment of cancer in recent years, it turns out that many of them may not do either.

A recent Milwaukee Journal Sentinel (10/20, Fauber) report tells us that a study published in JAMA Internal Medicine found that two-thirds of the new cancer drugs approved in the past five years won approval based on so-called surrogate measures of effectiveness, such as scans showing tumor shrinkage.   Specifically, 36 of 54 drugs showed no evidence of extending life or improving quality of life of cancer patients, even after some of the drugs had been on the market for up to four years.

The same study looked at the price of many of these drugs and found that, on average, they cost $10,000 per month, with several costing more $20,000 per month and one priced at $40,000 per month.  While the FDA indicates that they are making sure that drugs are “safe and effective”, some of the drugs are not specific about the effectiveness for patients with regards to better survival rates or quality of life.

[author] [author_image timthumb=’off’]http://www.drhousecallsofpv.com/wp-content/uploads/2013/02/sjlphoto1sm.jpg[/author_image] [author_info]
Steven J. Lipsky MD, FACEP has been a Board Certified Emergency Physician in Arizona for the last 37 years, and a resident of the Town of Paradise Valley for the last 37 years. Steve Lipsky on Google Plus[/author_info] [/author]



CBS Evening News is reporting that this year’s flu strain is sending seniors to the hospital in record numbers.  While the flu spread appears to have peaked, the numbers of seniors being hospitalized is the highest in a decade.  NBC Nightly News reported that the alarming numbers are due to the severity of the strain in addition to a low effectiveness rate for this year’s flu vaccine.  The vaccine has been shown to be only about 23% effective.  Bloomberg News is reporting that some areas of the country are facing new surges in the spread of the flu.  This includes regions of the West Coast, New England, and the Northeast.   The CDC has issued a warning to healthcare providers to quickly treat patients with antivirals without waiting for tests to confirm a positive flu diagnosis.  The letter explained that the flu may spread for several more weeks, and anti-viral treatments can help keep high-risk patients from being hospitalized.

We are happy to provide patients with all necessary care and prescriptions to treat this epidemic outbreak.  Call us anytime at 480-948-0102!



Life Threatening Flu Strain

Doctors are warning families this year about a potentially life threatening flu strain.  Mayo Clinic infectious diseases physician Dr. Pritish Tosh explains that this year’s strain of flu can be fatal for even healthy children.  The virus works by entering the blood stream first and eventually the brain, resulting in symptoms such as shortness of breath and a very high fever.  The body may then overcompensate by sending white blood cells into the lungs, resulting in serious complications.  Three children in Minnesota have died due to complications from the virus, with another seven currently in the ICU according to the Minnesota Health Department.  Nationwide, the total deaths for children from this flu is reported to be 15.

This particular strain of flu, H3N2, has accounted for approximately 90% of flu cases this year, according to the CDC.  And while this year’s flu vaccine does not appear to match this particular strain, doctors are advising that patients, especially those in high-risk groups, continue to get the flu shot as some cross-protection may occur



REPRINTED FROM the Arizona College of Emergency Physicians

Periodically, as the AzCEP Executive Team sees fit, we will forward alerts that we deem pertinent to you.

 

At the request of the Arizona Health Alert Network:

In late August, the Centers for Disease Control and Prevention (CDC) was notified by two states of an increase in children hospitalized with severe respiratory illness. Enterovirus D68 (EV-D68) was identified in many of these patients. There are now several other states reporting increases in admissions for severe respiratory illness. It is possible that these are also associated with EV-D68.

EV-D68 appears to spread via close contact (e.g., saliva, sputum, feces) with infected individuals. Currently, there is no vaccine to prevent EV-D68 and no specific antiviral treatment recommended.

However, patients can help protect themselves and others from respiratory illnesses by:
o avoiding close contact with people who are sick;
o avoiding touching eyes, nose, and mouth with unwashed hands;
o washing hands often with soap and water, especially after changing diapers;
o cleaning/disinfecting frequently touched surfaces, such as toys and doorknobs, especially if someone is sick;
o ensuring vaccinations, including the influenza vaccine, are up to date.

Clinicians should be aware of EV-D68 as one of many causes of viral respiratory disease and should report clusters of unexplained respiratory illness to their local public health agency: http://www.azdhs.gov/phs/oids/contacts.htm.

Please refer to this MMWR for more detailed information: http://www.cdc.gov/mmwr/preview/mmwrhtml/mm63e0908a1.htm

Thank you,
Arizona Health Alert Network



The Global Polio Eradication Initiative began in 1988 in order to put an end to one of the world’s most crippling diseases. The initiative is a joint effort by the World Health Organization (WHO), UNICEF, Rotary International, the U.S. Centers for Disease Control and Prevention, the Bill and Melinda Gates Foundation, and governments around the world, with the support of many others globally. So how is it going? Only three endemic countries remain and 2.5 billion children have been immunized against polio. But the fight is far from over.

In May, the WHO declared an international public emergency after outbreaks were cited in 10 countries. Travel has begun to complicate the eradication effort, causing the threat of polio to re-emerge in countries once considered polio free.

We need to step up our efforts against the fight. MSN News (AP, 8/22, Neergaard) reported on a new study released by the World Health Organization in Science Magazine stating that children who received a single vaccine shot after already receiving an oral vaccine greatly boosted their immunity. WHO has begun using the combo oral vaccine and vaccine shot strategy in mass vaccination campaigns targeting hard-hit areas. It is also being introduced in developing countries.

“It could play a major role in completing the job of polio eradication once and for all,” said Dr. Hamid Jafari of the WHO and lead study author.

The key to eradicating polio in the tough-to-reach areas is taking maximum advantage of each vaccination encounter. Inevitably that means fewer doses but the same potency. As reported by the Los Angeles Times (8/22, Healy) “Science Now” blog, “vaccination campaigns are so easily disrupted by conflict, mass migrations and rumors of medical malfeasance, getting the highest level of polio immunity with the fewest vaccine doses delivered is key.”

The WHO’s global polio eradication effort has relied heavily on the oral vaccine due to cost and ease of administering the vaccination. But as revealed in TIME (8/22, Park), places where polio is rampant, such as Northern India, the oral vaccines weren’t doing much to reduce the disease’s burden. Multiple vaccinations were being given above the recommended three doses to control the spread of the disease and limit transmission. Something better had to be done. Researchers conducted a test adding the inactive shot vaccination to the schedule. Among 954 infants and children aged five years to 10 years who had already received several doses of oral vaccine, adding a shot of the inactivated vaccine helped them shed less virus compared to those who received another dose of the oral vaccine, adding strength and longevity to their immunity.

HealthDay (8/22, Preidt), MedPage Today (8/22, Smith), and Medscape (8/22, Hand) also covered the story.



Obama Administration Unveils Plan to Battle Antibiotic Resistance.

by Dr. Steven J. Lipsky MD, FACEP

Antibiotic resistance is on the rise and the Obama Administration has put together a plan to combat the issue. Major newspapers, wire services, and online healthcare-related outlets published coverage of the news conference held late last week. In a news conference, the President’s chief science advisor announced plans to improve antibiotics through new drug development; reining in antibiotic misuse and developing diagnostic testing to help doctors and veterinarians decide when antibiotics are truly needed.

John Holdren, director of the White House Office of Science and Technology Policy sees antibiotic resistance as a potential threat to not only the nation but the world. “The rise in antibiotic-resistant bacteria represents a serious domestic and international challenge to human and animal health, national security and the economy” USA Today (9/19, Weintraub).

According to Tom Frieden, MD, MPH, director of the Centers for Disease Control and Prevention, combating antibiotic resistance is vital to maintaining our current standards of medical care. “Antibiotic resistance is linked to at least 23,000 death and two million illnesses each year.” Frieden also notes that in addition to treating bacterial infections, antibiotics also help with complications arising from conditions like cancer, arthritis and asthma. “If we lose the ability to treat these, we will undermine much of our current medical care system.”

Researchers have been warning for years that antibiotics are losing their strength due to overuse. The New York Times (9/19, A16, Tavernise, Subscription Publication) reports that if this trend of overuse is not “halted, we could return to the time before antibiotics, when it was common for people to die from ordinary infections and for children not to survive strep throat.” According to Holdren, the new strategy – established by an executive order signed by the President – is intended to jolt the federal government into action to begin aggressively addressing a health crisis experts have been slow to recognize.

The President is mobilizing a special task force comprised of key federal agencies. As reported in The Los Angeles Times (9/19, Morin) “Science Now” blog, the task force, co-chaired by the secretaries of Defense, Agriculture and Health and Human Services, “will oversee public, private and academic efforts to minimize the spread of superbugs by promoting the proper use of antibiotics; the acceleration of scientific research into new antibacterial drugs and novel therapies; and the creation of new diagnostic technologies that will identify drug-resistant bacteria.” In addition, the National Institutes of Health and the Biomedical Advanced Research and Development Authority are working in conjunction with the White House to co-sponsor a contestant for the development of diagnostic testing that will rapidly identify superbugs. On the line is a $20 million prize.

The administration’s national strategy with a five-year plan calls for the new presidential advisory council to make special recommendations to the White House by February 2015. It is a strategy with a targeted goal of reducing the overall incidences of Clostridium difficile, also known as C-diff, by 50 percent, and cutting the number of methicillin-resistant Staphylococcus aureus (MRSA) infections by 2020 in half. Additionally, the President’s Council of Advisors on Science and Technology (PCAST) released a 78-page document “outlining practical steps the government can take to both track resistant germs and develop novel antibiotics to treat bacterial infections” as reported in the Washington Post (9/19, Nutt).

Critics had hoped the White House would go one step further and address the use of antibiotics in animals, particularly those used for meat. The AP (9/19, Jalonick) reported that the executive order directs the Food and Drug Administration to “to continue taking steps to eliminate agricultural use of medically important antibiotics for growth-promotion purposes.”

For additional information on the subject, including information pertaining to the use Additional coverage of the issue can be found at the Wall Street Journal (9/19, A5, Tracy, Burton, Subscription Publication),  Reuters (9/19, Huffstutter), the NBC News (9/19, Fox) website, CNN (9/19, Young), CNBC (9/19, Mangan), The Hill (9/19, Goad), Congressional Quarterly (9/19, Gustin, Subscription Publication),Modern Healthcare (9/19, Johnson, Subscription Publication), Newsday (9/19, Ricks), and TIME (9/19, Park)



The American College of Rheumatology has listed five procedures that patients should strongly question: A) Getting tested for Lyme disease as the cause for musculoskeletal problems when there is no exposure history; B) Getting an MRI of peripheral joints to routinely monitor inflammatory arthritis; C) Taking biologic drugs for Rheumatoid Arthritis before a trial of methotrexate or other conventional non-biologic meds; D) Repeating DEXA scans to follow osteoporosis more than once every two years; E) Getting sub-serology ANA blood tests without a previously positive ANA.

 


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