Wednesday 2 April 2014

PodMed: A Medical News Roundup from Johns Hopkins (with audio)

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Published: Mar 21, 2014

By Rick Lange, MD, and Elizabeth Tracey , Johns Hopkins Medicine

PodMed is a weekly podcast from Johns Hopkins Medicine. In it, Elizabeth Tracey, director of electronic media for Johns Hopkins Medicine, and Rick Lange, MD, professor of medicine at Johns Hopkins and vice chairman of medicine at the University of Texas Health Science Center at San Antonio, look at the top medical stories of the week.

This week's topics include adverse outcomes relative to a common infection during pregnancy, antiviral drug impact, statins and MS, and genetic profiles and fatty food consumption.

Program notes:

0:32 H. influenzae and adverse pregnancy outcomes

1:30 Much more likely to be infected if pregnant

2:35 Diagnosis only when looked for

3:10 Impact of antiviral medications in flu

4:12 Compared outcomes of no treatment or antiviral

5:16 Statins and MS

6:10 Anti-inflammatory effects

7:10 Genetic profile and diet impact

8:07 Clear interaction with genetic risk and fried food consumption

9:07 Medical advice needs to be tailored

10:21 End

Rick Lange, MD, and Elizabeth Tracey

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Morning Break: Tweeting Surgery, Bionic Limbs

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Published: Mar 21, 2014

Cincinnati Children's Hospital Medical Center will live Tweet from the OR as surgeons perform gastric bypass surgery on a 12-year old Texas girl who has had uncontrollable hunger following removal of a brain tumor almost 3 years ago. The girl, Alexis Shapiro, gained a national attention following a story in People.

Physician assistants are in hot demand by hospitals, according to staffing firm.

An oncology patient didn't have 8 months to wait for her daughter's wedding, so the hospital staff brought the wedding to the ICU, as reported in the New York Times.

Also in the Times yesterday, the Well blog tackles the issue of whether today's advances in medicine are generating enough of a benefit to make a difference in patients' outcomes.

A woman whose left leg was partially amputated following the Boston Marathon bombing showed off a new bionic limb by dancing a rumba at TED2014.

American Medical Association President Ardis Hoven, MD, went on C-SPAN this week to talk about how the Affordable Care Act is impacting doctors.

Republicans' Obamacare replacement bill may never see the light of day.

Florbetaben (Neuraceq) became the third PET tracer for beta-amyloid plaques to win FDA approval, following florbetapir (AmyVid) and flutemetamol (Vizamyl).

A new poll shows people want elected officials to try to make the ACA work rather than fail.

A former health official in the Clinton administration wrote in the Huffington Post that we shouldn't be quick to judge medical homes.

The Federal Trade Commission opened a two-day workshop on competition in healthcare Thursday.

Lobbyists want the FDA to hurry up on approving new sunscreen ingredients that could prevent skin cancer.

Health Affairs published a policy brief on the ICD-10 conversion. Check it out here.

Medical marijuana is coming to Alabama.

Meanwhile, debate in Connecticut heats up over a physician-assisted suicide bill. (Subscription required)

The EU's Committee for Medicinal Products for Human Use had a busy week, recommending nine new drugs for approval.

Morning Break is a daily guide to what's new and interesting on the Web for healthcare professionals, powered by the MedPage Today community. Got a tip? Send it to us:  MPT_editorial@everydayhealthinc.com.

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More of the Bugs Kids Get Are Resistant

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Published: Mar 20, 2014

The rate of antibiotic-resistant Gram-negative bacterial infections in children is increasing in inpatient and outpatient settings, a study reports.

The prevalence of third-generation cephalosporin-resistant (G3CR) bacteria increased from 1.39% in 1999-2001 to 3% in 2010-2011, wrote Latania K. Logan, MD, of Rush University Medical Center in Chicago, and her co-authors online in the Journal of the Pediatric Infectious Disease Society.

The prevalence of extended-spectrum B-lactamase-producing (ESBL) bacteria increased from 0.28% to 0.92% in the same time frame, the authors said.

"Blood and respiratory cultures showed a higher proportion of G3CR and ESBL, rising in prevalence across patient settings, U.S. regions, and pediatric age groups represented in the data," the authors said. "Presentation in the ambulatory settings is common."

Respiratory G3CR and ESBL prevalence increased from 7.01% and 2.2% in 1999-2001 to 16.2% and 6.3% in 2010-2011 (P<0.01), respectively, they said.

The researchers used regional and national data from The Surveillance Network Database-USA, a network that includes close to 300 clinical laboratories. The analysis included all isolates of Klebsiella pneumoniae, Escherichia coli and Proteus mirabilis from pediatric patients between the ages of 1 and 17. All specimens were collected in outpatient and inpatient settings, including the intensive care unit, between January 1999 and December 31, 2011.

Out of 368,398 pediatric isolates analyzed, 1.97% (7,255) were identified as G3CR and 0.47% (1,734) were identified as ESBL.

The majority of isolates were E. coli (67.8% for G3CR and 65.2% for ESBL).

"Increasing resistance in Enterobacteriaceae is an emerging public health threat, underscored by recent well-publicized outbreaks and national reports," the authors said.

Resistance to third-generation cephalosporins, they said, "is particularly worrisome when caused by ESBLs, as the spread of these enzymes is plasmid-mediated and can be transferred to other Gram-negative species."

The findings in this paper are consistent with previous reports of the same data in adults, which also report an upward trend, the authors said. The prevalence rate for adults was higher, ranging from 5% to 13% over the same time period used to assess the data in children.

ESBLs have been more of a problem in adult populations, possibly due to adults' greater exposure to hospitalization and indwelling devices, among other factors related to greater healthcare intervention. The clinical risk factors for children may be similar, the authors said; however, the data are limited.

"Additional studies in children to assess risk factors for acquisition, prevalence in ambulatory and long-term healthcare facilities, and the molecular epidemiology of ESBL-producing bacteria are warranted," the authors said.

The study had several limitations. Because the data came from laboratory surveillance, the researchers couldn't account for clinical characteristics or distinguish between confirmed infection and colonization.

Patient location entered in laboratory information systems may not, in fact, correspond to the clinical setting where the patient received care. And though all laboratories applied CLSI methods, "susceptibility testing was not centralized," the authors said.

Interpretive susceptibility breakpoints for cephalosporins were lowered in January 2010, which might have increased cephalosporin resistance for isolates after that date. And the analyzed data does not include Klebsiella oxytoca, which often occurs alongside Klebsiella pneumoniae.

The authors disclosed no relevant relationships with industry.

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