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January 25th, 2012 posted by Paul Rega, MD, FACEP January 25, 2012 @ 12:32 pm

Way to go, SEALs!

LA Times

“U.S. officials on Wednesday were providing some new details on the dramatic helicopter rescue of an American aid worker and her Danish colleague in Somalia.

The Pentagon released a statement Wednesday morning on the U.S. military’s rescue, saying that Jessica Buchanan, 32, and Poul Hagen Thisted, 60, were not hurt in the operation. 

The Pentagon also said there were no injuries to any of the U.S. troops involved….”


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January 25th, 2012 posted by Paul Rega, MD, FACEP @ 1:25 am

Rapid point-of-care HIV test with oral versus whole-blood specimens


Source reference:
Pant Pai N, et al “Head-to-head comparison of accuracy of a rapid point-of-care HIV test with oral versus whole-blood specimens: a systematic review and meta-analysis” Lancet Infect Dis 2012.

Although Oraquick had a high PPV in high-prevelence settings in oral specimens, the slightly lower sensitivity and PPV in low-prevalence settings in oral specimens should be carefully reviewed when planning worldwide expanded initiatives with this popular test.

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January 25th, 2012 posted by Paul Rega, MD, FACEP @ 1:20 am

Hospitals buying doctors


Miami Herald

Hospitals hiring doctors to get ready for reform

By John Dorschner       The Miami Herald     

Hospitals made disastrous decisions in the 1990s in hiring doctors. Now, they’re again buying physician practices — saying better management will make the difference this time.


“……It’s a national trend. The American Hospital Association reports that the number of doctors working for hospitals has increased by 32 percent since 2000, a trajectory that’s accelerating as medical companies prepare for healthcare reform……

Executives at Baptist and Holy Cross say the physicians’ practices on their own do not break even after being purchased, but ancillary income from such measures as diagnostic tests boost the bottom line. The recent hiring of physicians hasn’t worked everywhere. The community doctors hired in the past several years by Jackson Health System, Miami-Dade’s public hospitals, have been persistent money losers. The unaudited financial statements for fiscal 2011 show that the doctors’ practices lost $4.4 million…..”


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January 25th, 2012 posted by Paul Rega, MD, FACEP @ 1:16 am

Where the rich go when they get sick


NY Times

January 21, 2012
Chefs, Butlers, Marble Baths: Hospitals Vie for the Affluent

“The feverish patient had spent hours in a crowded emergency room. When she opened her eyes in her Manhattan hospital room last winter, she recalled later, she wondered if she could be hallucinating: “This is like the Four Seasons — where am I?”

The bed linens were by Frette, Italian purveyors of high-thread-count sheets to popes and princes. The bathroom gleamed with polished marble. Huge windows displayed panoramic East River views. And in the hush of her $2,400 suite, a man in a black vest and tie proffered an elaborate menu and told her, “I’ll be your butler.”

It was Greenberg 14 South, the elite wing on the new penthouse floor of NewYork-Presbyterian/Weill Cornell hospital. Pampering and décor to rival a grand hotel, if not a Downton Abbey, have long been the hallmark of such “amenities units,” often hidden behind closed doors at New York’s premier hospitals. But the phenomenon is escalating here and around the country, health care design specialists say, part of an international competition for wealthy patients willing to pay extra, even as the federal government cuts back hospital reimbursement in pursuit of a more universal and affordable American medical system….”

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January 25th, 2012 posted by Paul Rega, MD, FACEP @ 1:14 am

Investigating docs who are over-prescribing antipsychotics, anti-anxiety drugs and painkillers to Medicaid patients


Senate Watchdog Targets High-Prescribing Medicaid Docs

by Charles Ornstein and Tracy Weber
ProPublica, Jan. 24, 2012, 2:04 p.m.

“An influential U.S. senator is grilling officials in nearly three-dozen states, demanding to know how they are cracking down on physicians who prescribe massive amounts of potentially dangerous prescription drugs.

Iowa Republican Charles Grassley sent letters to 34 states [1] Monday asking what steps they had taken to investigate doctors whose prescribing of antipsychotics, anti-anxiety drugs and painkillers to Medicaid patients far exceeds that of their peers……”

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January 25th, 2012 posted by Paul Rega, MD, FACEP @ 1:12 am

Standard vs. Fresh RBCs


Kor DJ, et al “Fresh red blood cell transfusion and short-term pulmonary, immunologic, and coagulation status: A randomized clinical trial” Am J Respir Crit Care Med 2012.
By Shalmali Pal, Contributing Editor, MedPage Today
Published: January 21, 2012”…..There was no difference in short-term pulmonary, immunologic, or coagulation status between 50 patients who received fresh red blood cells (median storage of four days) and 50 who received standard-issue red blood cells (median storage duration of 26.5 days), reported…. in the American Journal of Respiratory and Critical Care Medicine…..”

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January 25th, 2012 posted by Paul Rega, MD, FACEP @ 12:40 am

Barriers to Integrating Crisis Standards of Care Principles into International Disaster Response Plans: Workshop Summary



When a nation or region prepares for public health emergencies such as a pandemic influenza, a large-scale earthquake, or any major disaster scenario in which the health system may be destroyed or stressed to its limits, it is important to describe how standards of care would change due to shortages of critical resources. At the 17th World Congress on Disaster and Emergency Medicine, the IOM Forum on Medical and Public Health Preparedness sponsored a session that focused on the promise of and challenges to integrating crisis standards of care principles into international disaster response plans.


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January 25th, 2012 posted by Paul Rega, MD, FACEP @ 12:29 am

No Whooping Cough Deaths in California During 2011


CDPH Says No Whooping Cough Deaths in California During 2011

First Time in 20 Years Thanks to Statewide Vaccination Efforts

Date: 1/24/2012

Number: 12-005

“……In 2010, 9,000 Californians were diagnosed with pertussis and ten infants died from the disease. ……While whooping cough remained high at more than 3,000 cases in 2011, there have been no deaths since October 13th, 2010……”

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January 25th, 2012 posted by Paul Rega, MD, FACEP @ 12:24 am

Supreme Court: California’s Downer Livestock Law — Down and Out


Food Policy & Law

Supreme Court Blocks California’s Downer Livestock Law

by Helena Bottemiller | Jan 24, 2012
“In a unanimous decision, the U.S. Supreme Court overturned a California law on Monday that required the euthanization of downer livestock, to promote animal welfare and keep them out of the food supply……The Federal Meat Inspection Act prohibits state regulation that goes above and beyond, or is different from the law, which has ruled over the meat industry since the beginning of the 20th century…….In its decision released this week, the Supreme Court noted that the federal meat inspection law “expressly pre-empts” the California law’s application to federally inspected pork facilities……..”

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January 25th, 2012 posted by Paul Rega, MD, FACEP @ 12:15 am

WHO: There may be 50–100 million dengue infections worldwide every year.


Dengue and severe dengue

Fact sheet N°117
January 2012

Key facts

Dengue is a mosquito-borne infection found in tropical and sub-tropical regions around the world. In recent years, transmission has increased predominantly in urban and semi-urban areas and has become a major international public health concern.

Severe dengue (previously known as Dengue Haemorrhagic Fever) was first recognized in the 1950s during dengue epidemics in the Philippines and Thailand. Today, severe dengue affects most Asian and Latin American countries and has become a leading cause of hospitalization and death among children in these regions.

There are four distinct, but closely related, serotypes of the virus that cause dengue (DEN-1, DEN-2, DEN-3 and DEN-4). Recovery from infection by one provides lifelong immunity against that particular serotype. However, cross-immunity to the other serotypes after recovery is only partial and temporary. Subsequent infections by other serotypes increase the risk of developing severe dengue.

Global burden of dengue

The incidence of dengue has grown dramatically around the world in recent decades. Over 2.5 billion people – over 40% of the world’s population – are now at risk from dengue. WHO currently estimates there may be 50–100 million dengue infections worldwide every year.

Before 1970, only nine countries had experienced severe dengue epidemics. The disease is now endemic in more than 100 countries in Africa, the Americas, the Eastern Mediterranean, South-east Asia and the Western Pacific. South-east Asia and the Western Pacific regions are the most seriously affected.

Cases across the Americas, South-east Asia and Western Pacific have exceeded 1.2 million cases in 2008 and over 2.2 million in 2010 (based on official data submitted by Member States). Recently the number of reported cases has continued to increase. In 2010, 1.6 million cases of dengue were reported in the Americas alone, of which 49 000 cases were severe dengue.

Not only is the number of cases increasing as the disease spreads to new areas, but explosive outbreaks are occurring. The threat of a possible outbreak of dengue fever now exists in Europe and local transmission of dengue was reported for the first time in France and Croatia in 2010 and imported cases were detected in three other European countries.

An estimated 500 000 people with severe dengue require hospitalization each year, a large proportion of whom are children. About 2.5% of those affected die.


Aedes aegypti; adult female mosquito taking a blood meal on human skin.


The Aedes aegypti mosquito is the primary vector of dengue. The virus is transmitted to humans through the bites of infected female mosquitoes. After virus incubation for 4–10 days, an infected mosquito is capable of transmitting the virus for the rest of its life.

Infected humans are the main carriers and multipliers of the virus, serving as a source of the virus for uninfected mosquitoes. Patients who are already infected with the dengue virus can transmit the infection (for 4–5 days; maximum 12) via Aedes mosquitoes after their first symptoms appear.

The Aedes aegypti mosquito lives in urban habitats and breeds mostly in man-made containers. Unlike other mosquitoes Ae. aegypti is a daytime feeder; its peak biting periods are early in the morning and in the evening before dusk. Female Ae. aegypti bites multiple people during each feeding period.

Aedes albopictus, a secondary dengue vector in Asia, has spread to North America and Europe largely due to the international trade in used tyres (a breeding habitat) and other goods (e.g. lucky bamboo). Ae. albopictus is highly adaptive and therefore can survive in cooler temperate regions of Europe. Its spread is due to its tolerance to temperatures below freezing, hibernation, and ability to shelter in microhabitats.


Dengue fever is a severe, flu-like illness that affects infants, young children and adults, but seldom causes death.

Dengue should be suspected when a high fever (40°C/ 104°F) is accompanied by two of the following symptoms: severe headache, pain behind the eyes, muscle and joint pains, nausea, vomiting, swollen glands or rash. Symptoms usually last for 2–7 days, after an incubation period of 4–10 days after the bite from an infected mosquito.

Severe dengue is a potentially deadly complication due to plasma leaking, fluid accumulation, respiratory distress, severe bleeding, or organ impairment. Warning signs occur 3–7 days after the first symptoms in conjunction with a decrease in temperature (below 38°C/ 100°F) and include: severe abdominal pain, persistent vomiting, rapid breathing, bleeding gums, fatigue, restlessness, blood in vomit. The next 24–48 hours of the critical stage can be lethal; proper medical care is needed to avoid complications and risk of death.


There is no specific treatment for dengue fever.

For severe dengue, medical care by physicians and nurses experienced with the effects and progression of the disease can save lives – decreasing mortality rates from more than 20% to less than 1%. Maintenance of the patient’s body fluid volume is critical to severe dengue care.


There is no vaccine to protect against dengue. Developing a vaccine against dengue/ severe dengue has been challenging although there has been recent progress in vaccine development. WHO provides technical advice and guidance to countries and private partners to support vaccine research and evaluation. Several candidate vaccines are in various phases of trials.

Prevention and control

Havana: A local health worker uses a torch to check for signs of water and mosquito eggs inside tyres in a tyre depot.


At present, the only method to control or prevent the transmission of dengue virus is to combat vector mosquitoes through:

WHO response

WHO responds to dengue in the following ways:

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