Grand Rounds 2.23

Grand Rounds 2.23, this week's best posts of the medical blogosphere, is up at A Chance to Cut is a Chance to Cure.

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Avian Flu Survey from Harvard School of Public Health

While Concerned, Most Americans Do Not Expect Widespread Human Cases of Avian Flu in U.S. in the Next Year, press release of Thursday, February 23, 2006, Harvard School of Public Health:

The latest national poll conducted by the Harvard School of Public Health (HSPH) Project on the Public and Biological Security finds that at the moment, the majority of the American public is concerned about the threat of avian flu, but only a small proportion is very concerned. However, should cases of avian flu emerge in poultry or humans in this country, the public reaction could lead to significant disruption of the economy and the health care system.

Technorati Tags: avian flu, harvard school of public health

Chief Complaint of the Day

"Why am I here?"

Google Page Creator

Via Google Blogoscoped:

A new day, a new Google product. Today, Google releases the Page Creator, a tool for easy website creation. You can log-in to it using your Google account, and your site URL will then be yourname.googlepages.com.

Technorati Tags: google, google page creator

Inhalational Anthrax in a New York City Resident who works with Unprocessed Animal Hides

From the New York City Department of Health:

Dear Healthcare Providers:

The New York City Department of Health and Mental Hygiene (NYC DOHMH) was notified on February 21, 2006 of a case of inhalational anthrax in a 44-year-old male resident of Manhattan who makes drums from unprocessed animal hides (cow and goat) in a storage space in downtown Brooklyn. He returned from a two-week trip to Africa on December 21st, where he bought raw animal hides. He last worked on animal raw hides on February 14th and 15th in this storage space. On February 16th while traveling in Pennsylvania, the patient collapsed and was taken to a nearby hospital where he reportedly presented with chills, rigors, and bilateral pleural effusions. His white count was normal and he was afebrile. Four out of four blood cultures grew gram positive rods within 24 hours which were confirmed today by the Pennsylvania Department of Health and the Centers for Disease Control and Prevention as Bacillus anthracis. The patient is reportedly stable on appropriate antibiotic therapy. There are no signs of cutaneous or pharyngeal anthrax lesions.

As the patient works with unprocessed animal hides obtained both locally and from Africa, this appears to be a case of naturally occurring anthrax. However, a joint public health and law enforcement investigation of this case is ongoing, including an environmental assessment to determine whether there is any ongoing risk of exposure at the storage facility in Brooklyn. The DOHMH will be actively reaching out to all people who may have had direct exposure to these animal hides and if indicated, provide them with prophylactic antibiotics. There is no evidence of any risk to the general public...

Technorati Tags: anthrax, new york city

Confusing New Data From Health Studies In The Washington Post

Studies in Confusion, from The Washington Post:

For women confused by the latest flurry of health advice about low-fat diets, calcium, Vitamin D and hormones, there is a good reason: The findings illustrate how unexpected pitfalls during a major scientific study can yield valuable data but few clear answers.

Research frequently moves in unexpected fits, starts and sometimes puzzling increments. In the case of long, complex projects such as the Women's Health Initiative, the 15-year, $725 million federally funded project that produced the latest results, questionable assumptions, design decisions and unexpected developments can conspire to generate perplexing results.

Technorati Tags: washington post, calcium, vitamin d, womens health initiative

Grand Rounds 2.21

Grand Rounds, this week's best posts of the medical blogosphere, is up at intueri.

Technorati Tags: grand rounds, medicine, medical blogosphere

New Orleans Hospital Staff Discussed Mercy Killings

From NPR:

There, on the seventh floor of Memorial Medical Center, doctors and nurses were faced with few options. Conditions were deteriorating rapidly, evacuations were sporadic and security was compromised. Staff agonized whether to attempt to transport critically ill patients who might not survive the arduous evacuation. It appears another choice was considered: whether to end the lives of those who could not be moved. In the court documents reviewed by NPR, none of four key witnesses say they knew who made the decision to administer lethal doses of painkillers to the patients. But all four heard discussions that a decision had been made to end patients' lives. According to the documents, attorneys for LifeCare self-reported all of this to the Louisiana attorney general's office on Sept. 14, 2005.

(Via blog.bioethics.net.)

Technorati Tags: hurricane katrina, new orleans, euthanasia

Ebola Vaccine Passes Initial Test

From The Washington Post:

The first vaccine designed to prevent infection with the lethal Ebola virus has passed initial safety tests in people and has shown promising signs that it may indeed protect people from contracting the disease, government scientists reported Friday.

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How Does a Shotgun Pellet Migrate?

From Slate:

Gravity can move a pellet of birdshot lower in your body, at least until enough scar tissue has built up to hold it in place. If the pellet ends up in a hollow organ like the stomach, it can jostle around or make its way through your digestive tract. Bullets in the brain seem to pose an especially serious risk of further injury—people who get shot in the head have to worry about "moving bullet syndrome."

Bullets or pellets can also move around in your bloodstream. If a pellet manages to pierce one side of a blood vessel but not the other, it might get swept into circulation. The smaller the projectile, the more likely it is to move around in the blood. Heavier bullets tend to migrate downward, while a tiny pellet might be carried along toward the heart. In 1992, the Associated Press described a man who had been shot in the left side of his face. A fragment of the bullet had lodged in his jugular vein; doctors finally removed it from one of the chambers of his heart.

Technorati Tags: slate, cheney, birdshot

"The Brrreeeport Report"

An experiment. See here.

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Company Requires RFID Injection

Via SecurityFocus:

Two employees have been injected with RFID chips this week as part of a new requirement to access their company's datacenter.

Cincinnati based surveillance company CityWatcher.com created the policy with the hopes of increasing security in the datacenter where video surveillance tapes are stored. In the past, employees accessed the room with an RFID tag which hung from their keychains, however under the new regulations an implantable, glass encapsulated RFID tag from VeriChip must be injected into the bicep to gain access, a release from spychips.com said on Thursday.

Technorati Tags: RFID, Privacy

Flickr: Moon again 7Feb2006 Canberra

From Flickr. Uploaded by aaardvaark on 8 Feb '06, 11.29am PST.

Flickr: Lunar New Year 2006 in Taipei, vi

From Flickr. Uploaded by dans.photo on 5 Feb '06, 3.58pm PST.

Flickr: imaconscan2

From Flickr. Uploaded by danatteo on 9 Feb '06, 5.09am PST.

Patient Quote of the Day #9: Unfortunately, You Were Shot...

"How ya doing, doc! Unfortunately, you were one of the people who were fatally shot by the Japanese-Jewish nurse in my dream. BAM! BAM! BAM! Hey, you fucking bitch, I needed that doctor!"

Technorati Tags: Patient Quote of the Day, Quotes

Hilarious Journal Articles #41: Kissing Spreads Meningitis

BMJ is the Monty Python's Flying Circus of journals. Seriously.

Risk and protective factors for meningococcal disease in adolescents: matched cohort study -- Tully et al., 10.1136/bmj.38725.728472.BE -- BMJ

Objective To examine biological and social risk factors for meningococcal disease in adolescents.

Design Prospective, population based, matched cohort study with controls matched for age and sex in 1:1 matching. Controls were sought from the general practitioner.

Setting Six contiguous regions of England, which represent some 65% of the country's population.

Participants 15-19 year olds with meningococcal disease recruited at hospital admission in six regions (representing 65% of the population of England) from January 1999 to June 2000, and their matched controls.

Methods Blood samples and pernasal and throat swabs were taken from case patients at admission to hospital and from cases and matched controls at interview. Data on potential risk factors were gathered by confidential interview. Data were analysed by using univariate and multivariate conditional logistic regression.

Results 144 case control pairs were recruited (74 male (51%); median age 17.6). 114 cases (79%) were confirmed microbiologically. Significant independent risk factors for meningococcal disease were history of preceding illness (matched odds ratio 2.9, 95% confidence interval 1.4 to 5.9), intimate kissing with multiple partners (3.7, 1.7 to 8.1), being a university student (3.4, 1.2 to 10) and preterm birth (3.7, 1.0 to 13.5). Religious observance (0.09, 0.02 to 0.6) and meningococcal vaccination (0.12, 0.04 to 0.4) were associated with protection.

Conclusions Activities and events increasing risk for meningococcal disease in adolescence are different from in childhood. Students are at higher risk. Altering personal behaviours could moderate the risk. However, the development of further effective meningococcal vaccines remains a key public health priority.

Quote of the Day

"May I point out that E. T. Oh. H. has more syllables than alcohol, the word it is abbreviating?"

Exenatide (Byetta) Reviewed by Clinical Cases and Images

From Clinical Cases and Images:

Glucagon-like peptide-1 (GLP-1) is a GI peptide that stimulates glucose-dependent insulin secretion (similar to sulfonylureas). GLP-1 also inhibits glucagon release, gastric emptying and food absorption.

Technorati Tags: Exenatide, Byetta, Drugs

Two Brothers with Type 1 Diabetes, Ages 86 and 90

From The New York Times:

Then his big brother, Gerald, got diabetes at age 16 and also adopted a set of meticulous lifelong habits. He scribbles sugar readings and insulin doses in a logbook, tests the level of sugar in his system seven or eight times a day, avoids desserts and simple starches, exercises and has always stayed reed-thin. "Even so, I never expected to live to be 50," he said.

Both brothers have done a bit better than that: Gerald turned 90 this month, and Robert will be 86 in March, and they are in fairly good health for their ages. Experts say that they know of no other childhood diabetic who has lived to be as old as Gerald, and no one who has survived with the disease as long as Robert has --€” almost 81 years.

Technorati Tags: Diabetes, New York Times

Flickr: Walkers

From Flickr. Uploaded by amorph on 31 Jan '06, 12.02pm PST.

Flickr: Mono Lake Winter Kayaking1

From Flickr. Uploaded by Buck Forester on 18 Oct '05, 2.41am PST.

Flickr: Ghosts at the Grand Central Terminal

From Flickr. Uploaded by Sciamano on 1 Feb '06, 3.23pm PST.

Dietary Approaches to Prevent and Treat Hypertension from the American Heart Association

Dietary Approaches to Prevent and Treat Hypertension: A Scientific Statement From the American Heart Association -- Appel et al. 47 (2): 296 -- Hypertension:

A substantial body of evidence strongly supports the concept that multiple dietary factors affect blood pressure (BP). Well-established dietary modifications that lower BP are reduced salt intake, weight loss, and moderation of alcohol consumption (among those who drink). Over the past decade, increased potassium intake and consumption of dietary patterns based on the "DASH diet" have emerged as effective strategies that also lower BP. Of substantial public health relevance are findings related to blacks and older individuals. Specifically, blacks are especially sensitive to the BP-lowering effects of reduced salt intake, increased potassium intake, and the DASH diet. Furthermore, it is well documented that older individuals, a group at high risk for BP-related cardiovascular and renal diseases, can make and sustain dietary changes. The risk of cardiovascular disease increases progressively throughout the range of BP, beginning at 115/75 mm Hg. In view of the continuing epidemic of BP-related diseases and the increasing prevalence of hypertension, efforts to reduce BP in both nonhypertensive and hypertensive individuals are warranted. In nonhypertensive individuals, dietary changes can lower BP and prevent hypertension. In uncomplicated stage I hypertension (systolic BP of 140 to 159 mm Hg or diastolic BP of 90 to 99 mm Hg), dietary changes serve as initial treatment before drug therapy. In those hypertensive patients already on drug therapy, lifestyle modifications, particularly a reduced salt intake, can further lower BP. The current challenge to healthcare providers, researchers, government officials, and the general public is developing and implementing effective clinical and public health strategies that lead to sustained dietary changes among individuals and more broadly among whole populations.

Technorati Tags: American Heart Association, Hypertension, High Blood Pressure, Cardiology, Diet