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February 13th, 2012 posted by Paul Rega, MD, FACEP February 13, 2012 @ 7:40 am

(Audio) Fuoco a Torino, Febbraio 13, 1983

History.com



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February 13th, 2012 posted by Paul Rega, MD, FACEP @ 6:17 am

Yellow Fever Cases in Senegal

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SENEGAL

Kédougou, 10 fév (APS) – “La région médicale de Kédougou a mobilisé 41 équipes de vaccination, pour une campagne de vaccination contre la fière jaune, a annoncé le médecin chef au cours d’un point de presse.

Selon Dr Habib Ndiaye, qui fait état de trois cas de fièvre jaune, ‘’toute la population des trois districts sanitaires de Kédougou, Saraya et Salémata sont concernées à l’exception des femmes enceintes, des enfants de moins de 9 mois et des personnes déjà vaccinées lors des campagnes précédentes dans les dix dernières années’’……”

CDC-PHILCDC-YF-Vaccine



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February 13th, 2012 posted by Paul Rega, MD, FACEP @ 6:06 am

Chikungunya outreak in Malaysia

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Malaysia

KUALA LUMPUR, Feb 12 (Bernama) — “Twenty-two students and lecturers of a

private college in Selangor have tested positive for Chikungunya after returning

from a course on Pangkor island in Perak, Director-General of Health Datuk Seri

Dr Hasan Abdul Rahman said today.

He said they suffered from fever, headache, cough and pain in the body and

joints a week after their return to Kuang……”

 CDC-PHIL



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February 13th, 2012 posted by Paul Rega, MD, FACEP @ 5:52 am

CDC on Nipah & Hendra Virus

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CDC_Hendra_Nipah-Virus

  CDC-PHIL

 CDC-PHIL

This photomicrograph revealed some of the pathologic changes associated with a Nipah virus infection affecting the central nervous system of a human patient.

Illness with Nipah virus begins with 3-14 days of fever and headache. This is followed by drowsiness and disorientation characterized by mental confusion. These signs and symptoms can progress to coma within 24-48 hours. Some patients have had a respiratory illness during the early part of their infections.

 CDC-PHIL

These three transmission electron micrographs (TEM) reveal some of the ultrastructural morphology found in the Nipah virus (NiV). A pleomorphic virus, the image at the top depicts a single long stranded Nipah virion.

 

NiV is a member of the family Paramyxoviridae, and is related, but not identical to Hendra virus. Nipah virus was initially isolated in 1999 upon examining samples from an outbreak of encephalitis and respiratory illness among adult men in Malaysia and Singapore.

Infection with Nipah virus is associated with an encephalitis (inflammation of the brain) characterized by fever and drowsiness and more serious central nervous system disease, such as coma, seizures, and inability to maintain breathing.

Illness with Nipah virus begins with 3-14 days of fever and headache. This is followed by drowsiness and disorientation characterized by mental confusion. These signs and symptoms can progress to coma within 24-48 hours. Some patients have had a respiratory illness during the early part of their infections.

The natural reservoir for Hendra virus is thought to be flying foxes (bats of the genus Pteropus) found in Australia. The natural reservoir for Nipah virus is still under investigation, but preliminary data suggest that bats of the genus Pteropus are also the reservoirs for Nipah virus in Malaysia.

 



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February 13th, 2012 posted by Paul Rega, MD, FACEP @ 5:42 am

Bangladesh: Nipah Virus Outbreak Due to Drinking Raw Date Sap

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http://www.bdnews24.com/details.php?id=217759&cid=2

BD News, Bangladesh

Tue, Feb 7th, 2012 4:55 pm BdST
 
 

Dhaka, Jan 27 (bdnew24.com) – “As the government grapples to control the highly infectious and fatal nipah virus, health minister AFM Ruhal Haque has said that people do not want to accept health messages by breaking away from tradition.

Experts say a simple practice of not drinking raw date sap, or juice, can prevent the virus from infecting.

“(But) people do not care to abide by the message. We spread messages every year, but they (people) don’t accept. It (drinking raw sap) is an age-old custom in rural Bangladesh,” AFM Ruhal Haque said……..

All six infected people died in Joypurhat in this year’s first outbreak of the disease last month……..
As of Feb 7, nipah has killed 157 people out of 208 infected since 2001……..The virus usually comes from fruit bats. A study using infrared cameras found that fruit bats perch on jars put up on palm trees to collect the sap, and try to drink the juice. They also urinate into the pot.

“Its (bat’s) saliva and urine carry the virus,” Prof Rahman said. But boiled sap, he said, is good enough to drink, as the virus is killed in 70 degrees Celsius. ………”



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February 13th, 2012 posted by Paul Rega, MD, FACEP @ 5:35 am

Clostridium difficile-associated diarrhea can be associated with proton pump inhibitors (PPIs)

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FDA Drug Safety Communication: Clostridium difficile-associated diarrhea can be associated with stomach acid drugs known as proton pump inhibitors (PPIs)

 http://www.fda.gov/Drugs/DrugSafety/ucm290510.htm

Safety Announcement

[02-08-2012] The U.S. Food and Drug Administration (FDA) is informing the public that the use of stomach acid drugs known as proton pump inhibitors (PPIs) may be associated with an increased risk of Clostridium difficile–associated diarrhea (CDAD). A diagnosis of CDAD should be considered for patients taking PPIs who develop diarrhea that does not improve.

 

Patients should immediately contact their healthcare professional and seek care if they take PPIs and develop diarrhea that does not improve.

Facts about Proton Pump Inhibitor (PPI) Drugs

  • Marketed under various brand and generic drug names (see Tables 1 and 2) as prescription and over-the-counter (OTC) products.
  • Work by reducing the amount of acid in the stomach.
  • Prescription PPIs are used to treat conditions such as gastroesophageal reflux disease (GERD), stomach and small intestine ulcers, and inflammation of the esophagus.
  • Over-the-counter PPIs are used to treat frequent heartburn.

Clostridium difficile (C. difficile) is a bacterium that can cause diarrhea that does not improve.1 Symptoms include watery stool, abdominal pain, and fever, and patients may go on to develop more serious intestinal conditions. The disease can also be spread in the hospital. Factors that may predispose an individual to developing CDAD include advanced age, certain chronic medical conditions, and taking broad spectrum antibiotics. Treatment for CDAD includes the replacement of fluids and electrolytes and the use of special antibiotics.

The FDA is working with manufacturers to include information about the increased risk of CDAD with use of PPIs in the drug labels.

FDA is also reviewing the risk of CDAD in users of histamine H2 receptor blockers. H2 receptor blockers are used to treat conditions such as gastroesophageal reflux disease (GERD), stomach and small intestine ulcers, and heartburn. H2 receptor blockers are marketed under various brand and generic drug names (see Tables 3 and 4) as prescription and OTC products.

Today’s communication is in keeping with FDA’s commitment to inform the public about the Agency’s ongoing safety review of drugs. FDA will communicate any new information on PPIs or H2 receptor blockers and the risk of CDAD when it becomes available.

Additional Information for Patients and OTC Consumers:

 

Additional Information for Healthcare Professionals

 

Data Summary

FDA has reviewed reports from the FDA’s Adverse Event Reporting System (AERS) and the medical literature for cases of Clostridium difficile-associated diarrhea (CDAD) in patients undergoing treatment with PPIs. Many of the adverse event reports involved patients who were elderly, had chronic and/or concomitant underlying medical conditions, or were taking broad spectrum antibiotics that could have predisposed them to developing CDAD. Although these factors could have increased their risk of CDAD, the role of PPI use cannot be definitively ruled out in these reviewed reports. Patients who have one or more of these risk factors may have serious outcomes from CDAD with concomitant PPI use.

FDA also reviewed a total of 28 observational studies described in 26 publications. Twenty-three of the studies showed a higher risk of C. difficile infection or disease, including CDAD, associated with PPI exposure compared to no PPI exposure.2-27 Although the strength of the association varied widely from study to study, most studies found that the risk of C. difficile infection or disease, including CDAD, ranged from 1.4 to 2.75 times higher among patients with PPI exposure compared to those without PPI exposure. In the five studies that provided information on clinical outcomes, colectomies, and rarely deaths, were reported in some patients 4,6,11,12,21

The published studies varied in their ability to assess the association between C. difficile infection or CDAD and prior PPI use. There were limited data on the relationship between the risk of C. difficile infection or CDAD and PPI dose and duration of use. There also was little information on the use of OTC PPIs in community settings in these studies. Nevertheless, the weight of evidence suggests a positive association between the use of PPIs and C. difficile infection and disease, including CDAD.

 

References

  1. U.S. National Library of Medicine. National Institutes of Health. Health topics-Clostridium difficileinfections. http://vsearch.nlm.nih.gov/vivisimo/cgi-bin/query-meta?v%3Aproject=medlineplus&query=clostridium+difficile+infections. Accessed January 31, 2012.
  2. Al-Tureihi FIJ, Hassoun A, Wolf-Klein G, et al. Albumin, length of stay, and proton pump inhibitors: key factors in Clostridium difficile-associated disease in nursing home patients. J Am Med Dir Assoc.2005;6:105-108.
  3. Cunningham R, Dale B, Undy B, et al. Proton pump inhibitors as a risk factor for Clostridium difficile diarrhoea. J Hosp Infect. 2003;(54):243-245.
  4. Dial S, Alrasadi K, Manoukian C, et al. Risk of Clostridium difficile diarrhea among hospital inpatients prescribed proton pump inhibitors: cohort and case-control studies. CMAJ.2004;171(1):33-38.
  5. Dial S, Delaney JAC, Barkun A, et al. Use of gastric acid-suppressive agents and the risk of community-acquired Clostridium difficile-associated disease. JAMA2005;294(23):2989-2995.
  6. Muto C, Pokrywka M, Shutt K, et al. A large outbreak of Clostridium difficile associated disease with an unexpected proportion of deaths and colectomies at a teaching hospital following increased fluoroquinolone use. Infect Control Hosp Epidemiol. 2005;26:273-280.
  7. Pepin J, Saheb N, Coulombe M-A, et al. Emergence of fluoroquinolones as the predominant risk factor for Clostridium difficile-associated diarrhea: a cohort study during an epidemic in Quebec. Clin Infect Dis. 2005;41(9):1254-1260.
  8. Shah S, Lewis A, Leopold D, et al. Gastric acid suppression does not promote clostridial diarrhoea in the elderly. QJM.2000;93:175-181.
  9. Dial S, Delaney JAC, Schneider V, et al. Proton pump inhibitor use and risk of community-acquired Clostridium difficile-associated disease defined by prescription for oral vancomycin therapy. CMAJ. 2006;175(7):745-748.
  10. Dial S, Kezouh A, Dascal A, et al. Patterns of antibiotic use and risk of hospital admission for Clostridium difficile infection among elderly people in Quebec. CMAJ.2008;179:767-772.
  11. Loo VG, Poirier L, Miller MA, et al. A predominantly clonal multi-institutional outbreak of Clostridium diffcile-associated diarrhea with high morbidity and mortality. N Engl J Med. 2005;353:2442-2449.
  12. Akhtar AJ, Shaheen M. Increasing incidence of Clostridium difficile-associated diarrhea in African-American and Hispanic patients: association with the use of proton pump inhibitor therapy. JNatl Med Assoc. 2007;99(5):500-504.
  13. Aseeri M, Schroeder T, Kramer J, et al. Gastric acid suppression by proton pump inhibitors as a risk factor for Clostridium difficile-associated diarrhea in hospitalized patients. Am J Gastroenterol. 2008;103(9):2308-2313.
  14. Beaulieu M, Williamson D, Pichette G, et al. Risk of Clostridium difficile associated disease among patients receiving proton-pump inhibitors in a Quebec medical intensive care unit. Infect Control Hosp Epidemiol. 2007;28(11):1305-1307.
  15. Cadle R, Mansouri M, Logan N, et al. Association of proton-pump inhibitors with outcomes in Clostridium difficile colitis. Am J Health Syst Pharm. 2007;64(22):2359-2363.
  16. Dalton B, Lye-Maccannell T, Henderson E, et al. Proton pump inhibitors increase significantly the risk of Clostridium difficile infection in a low-endemicity, non-outbreak hospital setting. Aliment Pharmacol Ther. 2009;29(6):626-634.
  17. Dubberke ER, Reske KA, Yan Y, et al. Clostridium difficile-associated disease in a setting of endemicity: identification of novel risk factors. Clin Infect Dis. 2007;45(12):1543-1549.
  18. Howell MD, Novack V, Grgurich P, et al. Iatrogenic gastric acid suppression and the risk of nosocomial Clostridium difficile infection. Arch Intern Med. 2010;170(9):784-790.
  19. Janarthanan S, Ditah I, Kutait A, et al. A meta-analysis of 16 observational studies on proton pump inhibitor use and risk of Clostridium difficile associated diarrhea [abstract]. American College of Gastroenterology Conference 2010;Abstract 378.
  20. Jayatilaka S, Shakov R, Eddi R, et al. Clostridium difficile infection in an urban medical center: five-year analysis of infection rates among adult admissions and association with the use of proton pump inhibitors. Ann Clin Lab Sci. 2007;37(3):241-247.
  21. Kazakova SV, Ware K, Baughman B, et al. A hospital outbreak of diarrhea due to an emerging epidemic strain of Clostridium difficile. Arch Intern Med. 2006;166(22):2518-2524.
  22. Kim JW, Lee KL, Jeong JB, et al. Proton pump inhibitors as a risk factor for recurrence of Clostridium-difficile-associated diarrhea. World J Gastroenterol. 2010;16(28):3573-3577.
  23. Leonard J, Marshall JK, Moayyedi P. Systematic review of the risk of enteric infection in patients taking acid suppression. Am J Gastroenterol. 2007;102(9):2047-2056.
  24. Linsky A, Gupta K, Lawler EV, et al. Proton pump inhibitors and risk for recurrent Clostridium difficile infection. Arch Intern Med. 2010;170(9):772-778.
  25. Lowe DO, Mamdani MM, Kopp A, et al. Proton pump inhibitors and hospitalization for Clostridium difficile-associated disease: a population-based study. Clin Infect Dis. 2006;43(10):1272-1276.
  26. Turco R, Martinelli M, Miele E, et al. Proton pump inhibitors as a risk factor for paediatric Clostridium difficile infection. Aliment Pharmacol Ther. 2010;31(7):754-759.
  27. Yearsley K, Gilby L, Ramadas A, et al. Proton pump inhibitor therapy is a risk factor for Clostridium difficile-associated diarrhoea. Aliment Pharmacol Ther. 2006;24(4):613-9.

 

Table 1: Prescription Proton Pump Inhibitor (PPI) Drugs

Generic name Found in brand name(s)
dexlansoprazole Dexilant
esomeprazole magnesium Nexium
esomeprazole magnesium and naproxen Vimovo
lansoprazole Prevacid
omeprazole Prilosec
omeprazole and Sodium bicarbonate Zegerid
pantoprazole sodium Protonix
rabeprazole sodium AcipHex

 

Table 2: Over-the-Counter (OTC) Proton Pump Inhibitor (PPI) Drugs

Generic name Found in brand name(s)
lansoprazole Prevacid 24HR
omeprazole magnesium Prilosec OTC
omeprazole and sodium bicarbonate Zegerid OTC
omeprazole Omeprazole

 

Table 3: Prescription H2 Receptor Blocker Drugs

Generic name Found in brand name(s)
cimetidine Tagamet
famotidine Pepcid, Duexis
nizatidine Axid, Nizatidine
ranitidine Zantac, Tritec

 

Table 4: Over-the-Counter (OTC) H2 Receptor Blocker Drugs

Generic name Found in brand name(s)
cimetidine Tagamet HB
famotidine Pepcid Complete, Pepcid AC
nizatidine Axid AR
ranitidine Zantac

 

 

 

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Related Information

 

 
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Contact FDA

1-800-332-1088
1-800-FDA-0178 Fax
Report a Serious Problem

MedWatch Online3

Regular Mail: Use postage-paid FDA Form 35004

Mail to: MedWatch 5600 Fishers Lane

Rockville, MD 20857



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February 13th, 2012 posted by Paul Rega, MD, FACEP @ 5:34 am

Bath salts: EMS nemesis

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http://www.ems1.com/safety/articles/1234364-Medics-face-challenges-in-treating-those-under-influence-of-bath-salts/

Medics face challenges in treating those under influence of bath salts

States News Service

WASHINGTON — “With death and hospitalization tolls mounting, many states are acting fast to pass laws that combat synthetic drugs such as bath salts…….According to NCSL, 31 states enacted some type of restrictions on synthetic bath salts and their most common ingredients in 2011. However, these are just one of many synthetic drugs that have come to states’ attention in the last few years. Synthetic cannabinoids, called “K2″ or “spice,” mimic the effects of marijuana but have much more dangerous side effects. NCSL says that at least 40 states have banned the drugs, and the federal Drug Enforcement Agency banned five chemicals used to make K2 last year.

In the U.S. Congress, House-passed legislation to prohibit the sale of synthetic marijuana and other drugs known as “bath salts” and “plant food” has been delayed indefinitely in the Senate.”



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February 13th, 2012 posted by Paul Rega, MD, FACEP @ 5:34 am

Acute aortic dissection in the ER

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Acute aortic dissection in the ED: risk factors and predictors for missed  diagnosis
Published online: 10 February 2012
Muiteng Chua, Irwani Ibrahim, Xinyi Neo, Vitaly Sorokin, Liang Shen, Shirley
B.S. Ooi
DOI: 10.1016/j.ajem.2011.11.017
American Journal of Emergency Medicine, The, http://www.ajemjournal.com/article/S0735-6757%2811%2900561-4/abstract

Well-known risk factors for AAD such as age, male sex, and hypertension were not risk factors for missed diagnosis for AAD presenting in the EMD. The absence of pulse deficit or widened mediastinum does not exclude the diagnosis of AAD.



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February 13th, 2012 posted by Paul Rega, MD, FACEP @ 5:31 am

Dark Chocolates: Healthier alternative

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http://www.medicalnewstoday.com/articles/241529.php

MNT

Written By Christine Kearney

Dark Chocolates On Valentine’s Day Are Better For You

 

 


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