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October 2016: Click for Credit
Here are 5 articles in the October issue of Clinician Reviews (individual articles are valid for one year from date of publication—expiration dates below):
1. Autism Follow-up Screening by PCPs Yields High Accuracy
To take the posttest, go to: http://bit.ly/2bTLhFS
Expires August 19, 2017
VITALS
Key clinical point:
Primary care providers can conduct the M-CHAT/F following a positive M-CHAT screening for autism spectrum disorders.
Major finding:
Primary care providers and trained interviewers agreed 86.6% of the time on the screening results of the M-CHAT/F for ASDs.
Data source:
A cohort study of 5,071 children, mean age 23 months, screened with the M-CHAT, and a subsequent 197 children screened with the M-CHAT/F in 22 Maryland primary care practices.
Disclosures:
The National Institutes of Mental Health funded the research. Dr. Sturner is director of Total Child Health (TCH), a for-profit subsidiary of the Center for Promotion of Child Development through Primary Care, which conducted the study. Barbara Howard, MD, is president of TCH. Tanya Morrel, PhD, is an employee of and stockholder in TCH, and Paul Bergmann has consulted for the company. The remaining authors had no relevant disclosures.
2. Gallstone Disease Boosts Heart Risk
To take the posttest, go to: http://bit.ly/2c7TP7D
Expires August 18, 2017
VITALS
Key clinical point:
Gallstone disease is associated with an increased risk for coronary heart disease; preventing the former can help mitigate chances of developing the latter.
Major finding:
A meta-analysis revealed a 23% increased chance of CHD in gallstone disease patients.
Data source:
A meta-analysis of seven studies involving 842,553 subjects, and a prospective cohort study of 269,142 participants in three separate studies that took place from 1980 to 2011.
Disclosures:
Funding provided by NIH, Boston Obesity Nutrition Research Center, and United States-Israel Binational Science Foundation. The authors had no relevant financial disclosures.
3. New HER2-testing Guidelines Result in More Women Eligible for Directed Treatment
To take the posttest, go to: http://bit.ly/2cd9llO
Expires July 25, 2017
VITALS
Key clinical point:
New IHC and FISH pathology guidelines categorize more breast cancers as "equivocal" regarding HER2 positivity and ultimately lead to identifying more of them as HER2 positive.
Major finding:
By using 2013 guidelines, 358 additional tumors were interpreted as positive, compared with the 2007 guidelines and 298 additional tumors were considered positive, compared with the FDA criteria.
Data source:
A cohort study involving 2,851 breast cancer samples analyzed according to three different pathology guidelines during a 1-year period.
Disclosures:
This study was supported by the Mayo Clinic. Dr. Shah reported having no relevant financial disclosures; his associates reported ties to Merck, Hospira, Ariad Pharmaceuticals, Abbott Molecular, and Genome Diagnostics.
4. Extreme Alcohol Use Worsens HIV Disease
To take the posttest, go to: http://bit.ly/2coIzG3
Expires August 14, 2017
VITALS
Key clinical point:
A pattern of heavy alcohol use over time in HIV-infected patients was associated with accelerated HIV disease progression.
Major finding:
Long-term heavy alcohol use by middle-aged, HIV-infected military veterans was associated with a 1.83-fold increased likelihood of also being in the highest-risk group for accelerated progression of HIV disease.
Data source:
This study included 3,539 U.S. military veterans receiving care for HIV infection at eight VA centers. The impact of their long-term pattern of alcohol use on HIV disease progression was assessed over an 8-year period by annual assessments using validated instruments.
Disclosures:
The presenter reported having no financial conflicts of interest regarding the study, funded by the National Institute on Alcohol Abuse and Alcoholism and the National Institute of Allergy and Infectious Diseases.
5. Weight Loss Boosts TNFis' Psoriatic Arthritis Efficacy
To take the posttest, go to: http://bit.ly/2chD4M1
Expires July 23, 2017
Here are 5 articles in the October issue of Clinician Reviews (individual articles are valid for one year from date of publication—expiration dates below):
1. Autism Follow-up Screening by PCPs Yields High Accuracy
To take the posttest, go to: http://bit.ly/2bTLhFS
Expires August 19, 2017
VITALS
Key clinical point:
Primary care providers can conduct the M-CHAT/F following a positive M-CHAT screening for autism spectrum disorders.
Major finding:
Primary care providers and trained interviewers agreed 86.6% of the time on the screening results of the M-CHAT/F for ASDs.
Data source:
A cohort study of 5,071 children, mean age 23 months, screened with the M-CHAT, and a subsequent 197 children screened with the M-CHAT/F in 22 Maryland primary care practices.
Disclosures:
The National Institutes of Mental Health funded the research. Dr. Sturner is director of Total Child Health (TCH), a for-profit subsidiary of the Center for Promotion of Child Development through Primary Care, which conducted the study. Barbara Howard, MD, is president of TCH. Tanya Morrel, PhD, is an employee of and stockholder in TCH, and Paul Bergmann has consulted for the company. The remaining authors had no relevant disclosures.
2. Gallstone Disease Boosts Heart Risk
To take the posttest, go to: http://bit.ly/2c7TP7D
Expires August 18, 2017
VITALS
Key clinical point:
Gallstone disease is associated with an increased risk for coronary heart disease; preventing the former can help mitigate chances of developing the latter.
Major finding:
A meta-analysis revealed a 23% increased chance of CHD in gallstone disease patients.
Data source:
A meta-analysis of seven studies involving 842,553 subjects, and a prospective cohort study of 269,142 participants in three separate studies that took place from 1980 to 2011.
Disclosures:
Funding provided by NIH, Boston Obesity Nutrition Research Center, and United States-Israel Binational Science Foundation. The authors had no relevant financial disclosures.
3. New HER2-testing Guidelines Result in More Women Eligible for Directed Treatment
To take the posttest, go to: http://bit.ly/2cd9llO
Expires July 25, 2017
VITALS
Key clinical point:
New IHC and FISH pathology guidelines categorize more breast cancers as "equivocal" regarding HER2 positivity and ultimately lead to identifying more of them as HER2 positive.
Major finding:
By using 2013 guidelines, 358 additional tumors were interpreted as positive, compared with the 2007 guidelines and 298 additional tumors were considered positive, compared with the FDA criteria.
Data source:
A cohort study involving 2,851 breast cancer samples analyzed according to three different pathology guidelines during a 1-year period.
Disclosures:
This study was supported by the Mayo Clinic. Dr. Shah reported having no relevant financial disclosures; his associates reported ties to Merck, Hospira, Ariad Pharmaceuticals, Abbott Molecular, and Genome Diagnostics.
4. Extreme Alcohol Use Worsens HIV Disease
To take the posttest, go to: http://bit.ly/2coIzG3
Expires August 14, 2017
VITALS
Key clinical point:
A pattern of heavy alcohol use over time in HIV-infected patients was associated with accelerated HIV disease progression.
Major finding:
Long-term heavy alcohol use by middle-aged, HIV-infected military veterans was associated with a 1.83-fold increased likelihood of also being in the highest-risk group for accelerated progression of HIV disease.
Data source:
This study included 3,539 U.S. military veterans receiving care for HIV infection at eight VA centers. The impact of their long-term pattern of alcohol use on HIV disease progression was assessed over an 8-year period by annual assessments using validated instruments.
Disclosures:
The presenter reported having no financial conflicts of interest regarding the study, funded by the National Institute on Alcohol Abuse and Alcoholism and the National Institute of Allergy and Infectious Diseases.
5. Weight Loss Boosts TNFis' Psoriatic Arthritis Efficacy
To take the posttest, go to: http://bit.ly/2chD4M1
Expires July 23, 2017
Here are 5 articles in the October issue of Clinician Reviews (individual articles are valid for one year from date of publication—expiration dates below):
1. Autism Follow-up Screening by PCPs Yields High Accuracy
To take the posttest, go to: http://bit.ly/2bTLhFS
Expires August 19, 2017
VITALS
Key clinical point:
Primary care providers can conduct the M-CHAT/F following a positive M-CHAT screening for autism spectrum disorders.
Major finding:
Primary care providers and trained interviewers agreed 86.6% of the time on the screening results of the M-CHAT/F for ASDs.
Data source:
A cohort study of 5,071 children, mean age 23 months, screened with the M-CHAT, and a subsequent 197 children screened with the M-CHAT/F in 22 Maryland primary care practices.
Disclosures:
The National Institutes of Mental Health funded the research. Dr. Sturner is director of Total Child Health (TCH), a for-profit subsidiary of the Center for Promotion of Child Development through Primary Care, which conducted the study. Barbara Howard, MD, is president of TCH. Tanya Morrel, PhD, is an employee of and stockholder in TCH, and Paul Bergmann has consulted for the company. The remaining authors had no relevant disclosures.
2. Gallstone Disease Boosts Heart Risk
To take the posttest, go to: http://bit.ly/2c7TP7D
Expires August 18, 2017
VITALS
Key clinical point:
Gallstone disease is associated with an increased risk for coronary heart disease; preventing the former can help mitigate chances of developing the latter.
Major finding:
A meta-analysis revealed a 23% increased chance of CHD in gallstone disease patients.
Data source:
A meta-analysis of seven studies involving 842,553 subjects, and a prospective cohort study of 269,142 participants in three separate studies that took place from 1980 to 2011.
Disclosures:
Funding provided by NIH, Boston Obesity Nutrition Research Center, and United States-Israel Binational Science Foundation. The authors had no relevant financial disclosures.
3. New HER2-testing Guidelines Result in More Women Eligible for Directed Treatment
To take the posttest, go to: http://bit.ly/2cd9llO
Expires July 25, 2017
VITALS
Key clinical point:
New IHC and FISH pathology guidelines categorize more breast cancers as "equivocal" regarding HER2 positivity and ultimately lead to identifying more of them as HER2 positive.
Major finding:
By using 2013 guidelines, 358 additional tumors were interpreted as positive, compared with the 2007 guidelines and 298 additional tumors were considered positive, compared with the FDA criteria.
Data source:
A cohort study involving 2,851 breast cancer samples analyzed according to three different pathology guidelines during a 1-year period.
Disclosures:
This study was supported by the Mayo Clinic. Dr. Shah reported having no relevant financial disclosures; his associates reported ties to Merck, Hospira, Ariad Pharmaceuticals, Abbott Molecular, and Genome Diagnostics.
4. Extreme Alcohol Use Worsens HIV Disease
To take the posttest, go to: http://bit.ly/2coIzG3
Expires August 14, 2017
VITALS
Key clinical point:
A pattern of heavy alcohol use over time in HIV-infected patients was associated with accelerated HIV disease progression.
Major finding:
Long-term heavy alcohol use by middle-aged, HIV-infected military veterans was associated with a 1.83-fold increased likelihood of also being in the highest-risk group for accelerated progression of HIV disease.
Data source:
This study included 3,539 U.S. military veterans receiving care for HIV infection at eight VA centers. The impact of their long-term pattern of alcohol use on HIV disease progression was assessed over an 8-year period by annual assessments using validated instruments.
Disclosures:
The presenter reported having no financial conflicts of interest regarding the study, funded by the National Institute on Alcohol Abuse and Alcoholism and the National Institute of Allergy and Infectious Diseases.
5. Weight Loss Boosts TNFis' Psoriatic Arthritis Efficacy
To take the posttest, go to: http://bit.ly/2chD4M1
Expires July 23, 2017
CDC updates Zika recommendations on preventing sex transmission
Federal health officials are advising men who have possibly been exposed to Zika virus to practice safe sex and delay plans for conception for at least 6 months after exposure.
The Centers for Disease Control and Prevention updated its recommendations for preventing sexual transmission of the Zika virus and its preconception guidance, extending the time frame that men should abstain from unprotected sex to prevent transmission.
Previously, only symptomatic men were advised to wait 6 months before trying to conceive a child, while asymptomatic men had to wait only 8 weeks from last possible exposure. Now, men who have been exposed to the virus should either abstain from sex or use a condom to prevent sexual transmission of the disease for at least 6 months, even if they are asymptomatic. Men who are trying to have a child with their partner should also wait at least 6 months.
For now, recommendations for women have not been changed. Women who have been exposed to Zika virus should wait at least 8 weeks after symptom onset (if symptomatic) or last possible exposure to the virus before attempting to conceive. Women who do not plan to become pregnant but live in, or travel to, Zika-endemic regions should either abstain from sex or use the best possible protection available to them (MMWR. 2016 Sep 30. doi: 10.15585/mmwr.mm6539e1).
“Two new reports describe one presumed and one more definitive case of sexual transmission from men with asymptomatic Zika virus infection to female sex partners,” Emily E. Peterson, MD, of the CDC’s Zika response team, and her colleagues wrote in the Morbidity and Mortality Weekly Report. “Among reported cases of sexually transmitted Zika virus infection, the longest reported period between sexual contact that might have transmitted Zika virus and symptom onset was 32-41 days (based on an incubation period of 3-12 days).”
Zika virus can be transmitted through either vaginal, anal, or oral sexual intercourse. While Zika virus RNA decreases over time after the infection passes, it can linger in semen for as long as 188 days after symptom onset, according to the CDC.
For nonpregnant women, Zika virus RNA has been detected in serum for up to 13 days post-onset of symptoms, and for 58 days in whole blood samples. For pregnant women, it can be detected in serum for as long as 10 weeks after the onset of symptoms.
“Detection of Zika virus RNA in blood might not indicate the presence of infectious virus, and thus the potential risk for maternal-fetal Zika virus transmission periconceptionally is unknown,” the researchers wrote.
Federal health officials are advising men who have possibly been exposed to Zika virus to practice safe sex and delay plans for conception for at least 6 months after exposure.
The Centers for Disease Control and Prevention updated its recommendations for preventing sexual transmission of the Zika virus and its preconception guidance, extending the time frame that men should abstain from unprotected sex to prevent transmission.
Previously, only symptomatic men were advised to wait 6 months before trying to conceive a child, while asymptomatic men had to wait only 8 weeks from last possible exposure. Now, men who have been exposed to the virus should either abstain from sex or use a condom to prevent sexual transmission of the disease for at least 6 months, even if they are asymptomatic. Men who are trying to have a child with their partner should also wait at least 6 months.
For now, recommendations for women have not been changed. Women who have been exposed to Zika virus should wait at least 8 weeks after symptom onset (if symptomatic) or last possible exposure to the virus before attempting to conceive. Women who do not plan to become pregnant but live in, or travel to, Zika-endemic regions should either abstain from sex or use the best possible protection available to them (MMWR. 2016 Sep 30. doi: 10.15585/mmwr.mm6539e1).
“Two new reports describe one presumed and one more definitive case of sexual transmission from men with asymptomatic Zika virus infection to female sex partners,” Emily E. Peterson, MD, of the CDC’s Zika response team, and her colleagues wrote in the Morbidity and Mortality Weekly Report. “Among reported cases of sexually transmitted Zika virus infection, the longest reported period between sexual contact that might have transmitted Zika virus and symptom onset was 32-41 days (based on an incubation period of 3-12 days).”
Zika virus can be transmitted through either vaginal, anal, or oral sexual intercourse. While Zika virus RNA decreases over time after the infection passes, it can linger in semen for as long as 188 days after symptom onset, according to the CDC.
For nonpregnant women, Zika virus RNA has been detected in serum for up to 13 days post-onset of symptoms, and for 58 days in whole blood samples. For pregnant women, it can be detected in serum for as long as 10 weeks after the onset of symptoms.
“Detection of Zika virus RNA in blood might not indicate the presence of infectious virus, and thus the potential risk for maternal-fetal Zika virus transmission periconceptionally is unknown,” the researchers wrote.
Federal health officials are advising men who have possibly been exposed to Zika virus to practice safe sex and delay plans for conception for at least 6 months after exposure.
The Centers for Disease Control and Prevention updated its recommendations for preventing sexual transmission of the Zika virus and its preconception guidance, extending the time frame that men should abstain from unprotected sex to prevent transmission.
Previously, only symptomatic men were advised to wait 6 months before trying to conceive a child, while asymptomatic men had to wait only 8 weeks from last possible exposure. Now, men who have been exposed to the virus should either abstain from sex or use a condom to prevent sexual transmission of the disease for at least 6 months, even if they are asymptomatic. Men who are trying to have a child with their partner should also wait at least 6 months.
For now, recommendations for women have not been changed. Women who have been exposed to Zika virus should wait at least 8 weeks after symptom onset (if symptomatic) or last possible exposure to the virus before attempting to conceive. Women who do not plan to become pregnant but live in, or travel to, Zika-endemic regions should either abstain from sex or use the best possible protection available to them (MMWR. 2016 Sep 30. doi: 10.15585/mmwr.mm6539e1).
“Two new reports describe one presumed and one more definitive case of sexual transmission from men with asymptomatic Zika virus infection to female sex partners,” Emily E. Peterson, MD, of the CDC’s Zika response team, and her colleagues wrote in the Morbidity and Mortality Weekly Report. “Among reported cases of sexually transmitted Zika virus infection, the longest reported period between sexual contact that might have transmitted Zika virus and symptom onset was 32-41 days (based on an incubation period of 3-12 days).”
Zika virus can be transmitted through either vaginal, anal, or oral sexual intercourse. While Zika virus RNA decreases over time after the infection passes, it can linger in semen for as long as 188 days after symptom onset, according to the CDC.
For nonpregnant women, Zika virus RNA has been detected in serum for up to 13 days post-onset of symptoms, and for 58 days in whole blood samples. For pregnant women, it can be detected in serum for as long as 10 weeks after the onset of symptoms.
“Detection of Zika virus RNA in blood might not indicate the presence of infectious virus, and thus the potential risk for maternal-fetal Zika virus transmission periconceptionally is unknown,” the researchers wrote.
FROM MMWR
Nonsexual secondary Zika virus case confirmed in Utah
The first case of nonsexual secondary Zika virus transmission has occurred in the United States, according to a research letter published by the New England Journal of Medicine.
“We report a rapidly progressive, fatal [Zika virus] infection acquired outside the United States and secondary local transmission in the absence of known risk factors,” wrote the authors of the report, led by Sankar Swaminathan, MD, of the University of Utah in Salt Lake City.
The individual infected via secondary transmission, dubbed Patient Two in the report, is suspected to have contracted the disease from Patient One, a 73-year-old man who visited the southwestern coast of Mexico – a known hotbed of Zika virus – for a 3-week trip before returning to the United States. Eight days after returning, Patient One was admitted to a Salt Lake City hospital with symptoms consistent with a flavivirus infection and told doctors that he had been bitten by mosquitoes during his trip (N Engl J Med. 2016 Sep 28. doi: 10.1056/NEJMc1610613).
After undergoing tourniquet and laboratory testing, a diagnosis of dengue shock syndrome was made, but Patient One’s condition continued to deteriorate rapidly. Patient One died 4 days after initial hospitalization; real-time PCR assay confirmed Zika virus infection shortly thereafter.
Patient Two came into contact with Patient One during the latter’s hospitalization, reporting that he “assisted a nurse in repositioning Patient One in bed without using gloves,” according to the report. Patient Two began experiencing conjunctivitis, fever, myalgia, and a maculopapular rash on his face 5 days after Patient One died. The rash resolved itself after 7 days, and while PCR analysis of Patient Two’s serum was negative for Zika, his urinalysis was positive.
Because Patient Two had not traveled to a Zika-endemic area within 9 months of experiencing Zika-like symptoms and had not engaged in sexual intercourse with anyone who traveled to a Zika-endemic area, the authors conclude that he contracted the disease from contact with Patient One. The authors posit that, given the high levels of viremia in Patient One, the Zika virus could have been transmitted to Patient Two via sweat or tears, which Patient Two came into contact with while not wearing gloves. Local transmission via Aedis aegypti mosquito bite was highly unlikely to be the cause of transmission because of the lack of such mosquitoes in the Salt Lake City area.
“These two cases illustrate several important points,” the authors concluded. “The spectrum of those at risk for fulminant [Zika virus] infection may be broader than previously recognized, and those who are not severely immunocompromised or chronically ill may nevertheless be at risk for fatal infection.”
The first case of nonsexual secondary Zika virus transmission has occurred in the United States, according to a research letter published by the New England Journal of Medicine.
“We report a rapidly progressive, fatal [Zika virus] infection acquired outside the United States and secondary local transmission in the absence of known risk factors,” wrote the authors of the report, led by Sankar Swaminathan, MD, of the University of Utah in Salt Lake City.
The individual infected via secondary transmission, dubbed Patient Two in the report, is suspected to have contracted the disease from Patient One, a 73-year-old man who visited the southwestern coast of Mexico – a known hotbed of Zika virus – for a 3-week trip before returning to the United States. Eight days after returning, Patient One was admitted to a Salt Lake City hospital with symptoms consistent with a flavivirus infection and told doctors that he had been bitten by mosquitoes during his trip (N Engl J Med. 2016 Sep 28. doi: 10.1056/NEJMc1610613).
After undergoing tourniquet and laboratory testing, a diagnosis of dengue shock syndrome was made, but Patient One’s condition continued to deteriorate rapidly. Patient One died 4 days after initial hospitalization; real-time PCR assay confirmed Zika virus infection shortly thereafter.
Patient Two came into contact with Patient One during the latter’s hospitalization, reporting that he “assisted a nurse in repositioning Patient One in bed without using gloves,” according to the report. Patient Two began experiencing conjunctivitis, fever, myalgia, and a maculopapular rash on his face 5 days after Patient One died. The rash resolved itself after 7 days, and while PCR analysis of Patient Two’s serum was negative for Zika, his urinalysis was positive.
Because Patient Two had not traveled to a Zika-endemic area within 9 months of experiencing Zika-like symptoms and had not engaged in sexual intercourse with anyone who traveled to a Zika-endemic area, the authors conclude that he contracted the disease from contact with Patient One. The authors posit that, given the high levels of viremia in Patient One, the Zika virus could have been transmitted to Patient Two via sweat or tears, which Patient Two came into contact with while not wearing gloves. Local transmission via Aedis aegypti mosquito bite was highly unlikely to be the cause of transmission because of the lack of such mosquitoes in the Salt Lake City area.
“These two cases illustrate several important points,” the authors concluded. “The spectrum of those at risk for fulminant [Zika virus] infection may be broader than previously recognized, and those who are not severely immunocompromised or chronically ill may nevertheless be at risk for fatal infection.”
The first case of nonsexual secondary Zika virus transmission has occurred in the United States, according to a research letter published by the New England Journal of Medicine.
“We report a rapidly progressive, fatal [Zika virus] infection acquired outside the United States and secondary local transmission in the absence of known risk factors,” wrote the authors of the report, led by Sankar Swaminathan, MD, of the University of Utah in Salt Lake City.
The individual infected via secondary transmission, dubbed Patient Two in the report, is suspected to have contracted the disease from Patient One, a 73-year-old man who visited the southwestern coast of Mexico – a known hotbed of Zika virus – for a 3-week trip before returning to the United States. Eight days after returning, Patient One was admitted to a Salt Lake City hospital with symptoms consistent with a flavivirus infection and told doctors that he had been bitten by mosquitoes during his trip (N Engl J Med. 2016 Sep 28. doi: 10.1056/NEJMc1610613).
After undergoing tourniquet and laboratory testing, a diagnosis of dengue shock syndrome was made, but Patient One’s condition continued to deteriorate rapidly. Patient One died 4 days after initial hospitalization; real-time PCR assay confirmed Zika virus infection shortly thereafter.
Patient Two came into contact with Patient One during the latter’s hospitalization, reporting that he “assisted a nurse in repositioning Patient One in bed without using gloves,” according to the report. Patient Two began experiencing conjunctivitis, fever, myalgia, and a maculopapular rash on his face 5 days after Patient One died. The rash resolved itself after 7 days, and while PCR analysis of Patient Two’s serum was negative for Zika, his urinalysis was positive.
Because Patient Two had not traveled to a Zika-endemic area within 9 months of experiencing Zika-like symptoms and had not engaged in sexual intercourse with anyone who traveled to a Zika-endemic area, the authors conclude that he contracted the disease from contact with Patient One. The authors posit that, given the high levels of viremia in Patient One, the Zika virus could have been transmitted to Patient Two via sweat or tears, which Patient Two came into contact with while not wearing gloves. Local transmission via Aedis aegypti mosquito bite was highly unlikely to be the cause of transmission because of the lack of such mosquitoes in the Salt Lake City area.
“These two cases illustrate several important points,” the authors concluded. “The spectrum of those at risk for fulminant [Zika virus] infection may be broader than previously recognized, and those who are not severely immunocompromised or chronically ill may nevertheless be at risk for fatal infection.”
FROM NEW ENGLAND JOURNAL OF MEDICINE
Gonorrhea cluster shows increased antibiotic resistance
ATLANTA – A cluster of gonorrhea cases from the state of Hawaii has been identified as the first in the United States to show decreased susceptibility to ceftriaxone and azithromycin, the two most commonly prescribed drugs used to treat the infection.
“We’re seeing new, troubling signs that our current gonorrhea treatment is losing its effectiveness [but] we’ve not seen a treatment failure in the U.S.,” explained Jonathan Mermin, MD, director of the National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention, during a conference on STD prevention sponsored by the Centers for Disease Control and Prevention.
Isolates were collected from seven individuals in Hawaii during April and May of this year, all of which showed “dramatically higher levels” of resistance to azithromycin in laboratory testing than has normally been seen in the U.S. While large-scale resistance to azithromycin is something the CDC has watched for several months, four of these seven isolates also demonstrated less vulnerability to ceftriaxone, the first time that has occurred. Since 2010, the recommended treatment for gonorrhea has consisted of a single ceftriaxone shot and an oral dose of azithromycin; having a cluster with increased resistance to both is problematic on several levels, infectious disease experts say.
According to Alan Katz, MD, of the University of Hawaii in Honolulu, “the state of Hawaii has been a seminal site for monitoring Neisseria gonorrhoeae resistance, and the Hawaii state Department of Health has been one of the original CDC gonococcal isolate surveillance program surveillance sites since its inception in 1986.” Hawaii typically sees more gonorrhea cases than the rest of the country, partially due its location between the U.S. and Asia, the latter of which Dr. Katz explained is “where we believe many [drug]-resistant strains originate.”
Currently, trials are underway to identify a new treatment that can replace the current regimen, with promising early results. The drug in question, known as ETX0914, is a single-dose oral therapy that would substitute for ceftriaxone in the currently recommended treatment protocol. Stephanie N. Taylor, MD, of Louisiana State University in New Orleans, shared results of a randomized controlled trial, in which 179 subjects – 167 males and 12 females – received either 2g or 3g doses of only ETX0914, or only ceftriaxone.
A total of 47 subjects received the 3g ETX0914 dose, while 49 subjects received the 2g dose, and the rest received ceftriaxone. All patients (47/47) receiving the 3g dose were cured, and 98% (48/49) in the 2g dose were cured, with only 21 subjects (12%) in the entire study population reporting mild side effects.
“We are very pleased with these results and look forward to seeing ETX0914 advance through additional clinical trials,” Dr. Taylor said in a statement.
For now, health care providers are encouraged to continue with the currently recommended drug therapy, which is still effective. In a statement, Gail Bolan, MD, director of the Division of STD Prevention at the CDC, reminded providers that infections should be treated immediately in order for the drugs to have their full impact.
“All health care providers should also promptly report any suspected treatment failure to local health officials and CDC to ensure rapid response to cases or clusters of concern,” she added.
ATLANTA – A cluster of gonorrhea cases from the state of Hawaii has been identified as the first in the United States to show decreased susceptibility to ceftriaxone and azithromycin, the two most commonly prescribed drugs used to treat the infection.
“We’re seeing new, troubling signs that our current gonorrhea treatment is losing its effectiveness [but] we’ve not seen a treatment failure in the U.S.,” explained Jonathan Mermin, MD, director of the National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention, during a conference on STD prevention sponsored by the Centers for Disease Control and Prevention.
Isolates were collected from seven individuals in Hawaii during April and May of this year, all of which showed “dramatically higher levels” of resistance to azithromycin in laboratory testing than has normally been seen in the U.S. While large-scale resistance to azithromycin is something the CDC has watched for several months, four of these seven isolates also demonstrated less vulnerability to ceftriaxone, the first time that has occurred. Since 2010, the recommended treatment for gonorrhea has consisted of a single ceftriaxone shot and an oral dose of azithromycin; having a cluster with increased resistance to both is problematic on several levels, infectious disease experts say.
According to Alan Katz, MD, of the University of Hawaii in Honolulu, “the state of Hawaii has been a seminal site for monitoring Neisseria gonorrhoeae resistance, and the Hawaii state Department of Health has been one of the original CDC gonococcal isolate surveillance program surveillance sites since its inception in 1986.” Hawaii typically sees more gonorrhea cases than the rest of the country, partially due its location between the U.S. and Asia, the latter of which Dr. Katz explained is “where we believe many [drug]-resistant strains originate.”
Currently, trials are underway to identify a new treatment that can replace the current regimen, with promising early results. The drug in question, known as ETX0914, is a single-dose oral therapy that would substitute for ceftriaxone in the currently recommended treatment protocol. Stephanie N. Taylor, MD, of Louisiana State University in New Orleans, shared results of a randomized controlled trial, in which 179 subjects – 167 males and 12 females – received either 2g or 3g doses of only ETX0914, or only ceftriaxone.
A total of 47 subjects received the 3g ETX0914 dose, while 49 subjects received the 2g dose, and the rest received ceftriaxone. All patients (47/47) receiving the 3g dose were cured, and 98% (48/49) in the 2g dose were cured, with only 21 subjects (12%) in the entire study population reporting mild side effects.
“We are very pleased with these results and look forward to seeing ETX0914 advance through additional clinical trials,” Dr. Taylor said in a statement.
For now, health care providers are encouraged to continue with the currently recommended drug therapy, which is still effective. In a statement, Gail Bolan, MD, director of the Division of STD Prevention at the CDC, reminded providers that infections should be treated immediately in order for the drugs to have their full impact.
“All health care providers should also promptly report any suspected treatment failure to local health officials and CDC to ensure rapid response to cases or clusters of concern,” she added.
ATLANTA – A cluster of gonorrhea cases from the state of Hawaii has been identified as the first in the United States to show decreased susceptibility to ceftriaxone and azithromycin, the two most commonly prescribed drugs used to treat the infection.
“We’re seeing new, troubling signs that our current gonorrhea treatment is losing its effectiveness [but] we’ve not seen a treatment failure in the U.S.,” explained Jonathan Mermin, MD, director of the National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention, during a conference on STD prevention sponsored by the Centers for Disease Control and Prevention.
Isolates were collected from seven individuals in Hawaii during April and May of this year, all of which showed “dramatically higher levels” of resistance to azithromycin in laboratory testing than has normally been seen in the U.S. While large-scale resistance to azithromycin is something the CDC has watched for several months, four of these seven isolates also demonstrated less vulnerability to ceftriaxone, the first time that has occurred. Since 2010, the recommended treatment for gonorrhea has consisted of a single ceftriaxone shot and an oral dose of azithromycin; having a cluster with increased resistance to both is problematic on several levels, infectious disease experts say.
According to Alan Katz, MD, of the University of Hawaii in Honolulu, “the state of Hawaii has been a seminal site for monitoring Neisseria gonorrhoeae resistance, and the Hawaii state Department of Health has been one of the original CDC gonococcal isolate surveillance program surveillance sites since its inception in 1986.” Hawaii typically sees more gonorrhea cases than the rest of the country, partially due its location between the U.S. and Asia, the latter of which Dr. Katz explained is “where we believe many [drug]-resistant strains originate.”
Currently, trials are underway to identify a new treatment that can replace the current regimen, with promising early results. The drug in question, known as ETX0914, is a single-dose oral therapy that would substitute for ceftriaxone in the currently recommended treatment protocol. Stephanie N. Taylor, MD, of Louisiana State University in New Orleans, shared results of a randomized controlled trial, in which 179 subjects – 167 males and 12 females – received either 2g or 3g doses of only ETX0914, or only ceftriaxone.
A total of 47 subjects received the 3g ETX0914 dose, while 49 subjects received the 2g dose, and the rest received ceftriaxone. All patients (47/47) receiving the 3g dose were cured, and 98% (48/49) in the 2g dose were cured, with only 21 subjects (12%) in the entire study population reporting mild side effects.
“We are very pleased with these results and look forward to seeing ETX0914 advance through additional clinical trials,” Dr. Taylor said in a statement.
For now, health care providers are encouraged to continue with the currently recommended drug therapy, which is still effective. In a statement, Gail Bolan, MD, director of the Division of STD Prevention at the CDC, reminded providers that infections should be treated immediately in order for the drugs to have their full impact.
“All health care providers should also promptly report any suspected treatment failure to local health officials and CDC to ensure rapid response to cases or clusters of concern,” she added.
AT THE 2016 STD PREVENTION CONFERENCE
Case-control study points to Zika virus as cause of microcephaly
A new study from Brazil demonstrates that microcephaly is strongly associated with congenital Zika virus infections, offering case-control evidence of a causal relationship.
“This is the first case-control study to examine the association between Zika virus and microcephaly using molecular and serological analysis to identify Zika virus in cases and controls at the time of birth,” Thalia Velho Barreto de Araújo, PhD, of the Federal University of Pernambuco, Recife, Brazil, said in a statement. “Our findings suggest that Zika virus should be officially added to the list of congenital infections alongside toxoplasmosis, syphilis, varicella-zoster, parvovirus B19, rubella, cytomegalovirus, and herpes. However, many questions still remain to be answered including the role of previous dengue infection.”
In April, officials at the Centers for Disease Control and Prevention determined that Zika virus infection is a cause of microcephaly, following a systematic review of the available Zika virus research.
In the current study, the investigators looked for cases of infants born with microcephaly at eight public hospitals in Pernambuco, a state in northeastern Brazil. Thirty-two such cases were included for analysis, along with 62 controls. All infants in the study were born between Jan. 15, 2016 and May 2, 2016 (Lancet Infect Dis. 2016 Sep 15. doi: 10.1016/S1473-3099[16]30318-8).
Zika-specific immunoglobulin M (IgM) and reverse transcription–polymerase chain reaction (RT-PCR) tests were conducted on serum from both microcephaly and control infants, and cerebrospinal fluid samples only from infants with microcephaly. Mothers underwent serum testing for Zika virus and dengue virus via plaque reduction neutralization assay testing. Odds ratios and 95% confidence intervals were then calculated to determine the association between congenital Zika virus and microcephaly.
Of the 30 women who gave birth to infants with microcephaly, 24 (80%) had Zika virus infections, compared with 39 of the 61 women (64%) in the control group (P = .12). Additionally, while 13 of the 32 infants born with microcephaly had Zika virus infections confirmed by laboratory testing, none of the infants in the control group had laboratory-confirmed Zika virus infection.
A total of 7 out 27 infants with microcephaly who underwent CT scans showed signs of brain abnormalities, suggesting that “congenital Zika virus syndrome can be present in neonates with microcephaly and no radiological brain abnormalities,” according to the investigators.
While the study is still ongoing, the investigators called for more research to assess other potential risk factors and to confirm the strength of association in a larger sample size, as well as to gauge the significance and role of previous dengue infections in the mothers.
The study was funded by the Brazilian Ministry of Health, the Pan American Health Organization, and Enhancing Research Activity in Epidemic Situations. The investigators reported having no relevant financial disclosures.
A new study from Brazil demonstrates that microcephaly is strongly associated with congenital Zika virus infections, offering case-control evidence of a causal relationship.
“This is the first case-control study to examine the association between Zika virus and microcephaly using molecular and serological analysis to identify Zika virus in cases and controls at the time of birth,” Thalia Velho Barreto de Araújo, PhD, of the Federal University of Pernambuco, Recife, Brazil, said in a statement. “Our findings suggest that Zika virus should be officially added to the list of congenital infections alongside toxoplasmosis, syphilis, varicella-zoster, parvovirus B19, rubella, cytomegalovirus, and herpes. However, many questions still remain to be answered including the role of previous dengue infection.”
In April, officials at the Centers for Disease Control and Prevention determined that Zika virus infection is a cause of microcephaly, following a systematic review of the available Zika virus research.
In the current study, the investigators looked for cases of infants born with microcephaly at eight public hospitals in Pernambuco, a state in northeastern Brazil. Thirty-two such cases were included for analysis, along with 62 controls. All infants in the study were born between Jan. 15, 2016 and May 2, 2016 (Lancet Infect Dis. 2016 Sep 15. doi: 10.1016/S1473-3099[16]30318-8).
Zika-specific immunoglobulin M (IgM) and reverse transcription–polymerase chain reaction (RT-PCR) tests were conducted on serum from both microcephaly and control infants, and cerebrospinal fluid samples only from infants with microcephaly. Mothers underwent serum testing for Zika virus and dengue virus via plaque reduction neutralization assay testing. Odds ratios and 95% confidence intervals were then calculated to determine the association between congenital Zika virus and microcephaly.
Of the 30 women who gave birth to infants with microcephaly, 24 (80%) had Zika virus infections, compared with 39 of the 61 women (64%) in the control group (P = .12). Additionally, while 13 of the 32 infants born with microcephaly had Zika virus infections confirmed by laboratory testing, none of the infants in the control group had laboratory-confirmed Zika virus infection.
A total of 7 out 27 infants with microcephaly who underwent CT scans showed signs of brain abnormalities, suggesting that “congenital Zika virus syndrome can be present in neonates with microcephaly and no radiological brain abnormalities,” according to the investigators.
While the study is still ongoing, the investigators called for more research to assess other potential risk factors and to confirm the strength of association in a larger sample size, as well as to gauge the significance and role of previous dengue infections in the mothers.
The study was funded by the Brazilian Ministry of Health, the Pan American Health Organization, and Enhancing Research Activity in Epidemic Situations. The investigators reported having no relevant financial disclosures.
A new study from Brazil demonstrates that microcephaly is strongly associated with congenital Zika virus infections, offering case-control evidence of a causal relationship.
“This is the first case-control study to examine the association between Zika virus and microcephaly using molecular and serological analysis to identify Zika virus in cases and controls at the time of birth,” Thalia Velho Barreto de Araújo, PhD, of the Federal University of Pernambuco, Recife, Brazil, said in a statement. “Our findings suggest that Zika virus should be officially added to the list of congenital infections alongside toxoplasmosis, syphilis, varicella-zoster, parvovirus B19, rubella, cytomegalovirus, and herpes. However, many questions still remain to be answered including the role of previous dengue infection.”
In April, officials at the Centers for Disease Control and Prevention determined that Zika virus infection is a cause of microcephaly, following a systematic review of the available Zika virus research.
In the current study, the investigators looked for cases of infants born with microcephaly at eight public hospitals in Pernambuco, a state in northeastern Brazil. Thirty-two such cases were included for analysis, along with 62 controls. All infants in the study were born between Jan. 15, 2016 and May 2, 2016 (Lancet Infect Dis. 2016 Sep 15. doi: 10.1016/S1473-3099[16]30318-8).
Zika-specific immunoglobulin M (IgM) and reverse transcription–polymerase chain reaction (RT-PCR) tests were conducted on serum from both microcephaly and control infants, and cerebrospinal fluid samples only from infants with microcephaly. Mothers underwent serum testing for Zika virus and dengue virus via plaque reduction neutralization assay testing. Odds ratios and 95% confidence intervals were then calculated to determine the association between congenital Zika virus and microcephaly.
Of the 30 women who gave birth to infants with microcephaly, 24 (80%) had Zika virus infections, compared with 39 of the 61 women (64%) in the control group (P = .12). Additionally, while 13 of the 32 infants born with microcephaly had Zika virus infections confirmed by laboratory testing, none of the infants in the control group had laboratory-confirmed Zika virus infection.
A total of 7 out 27 infants with microcephaly who underwent CT scans showed signs of brain abnormalities, suggesting that “congenital Zika virus syndrome can be present in neonates with microcephaly and no radiological brain abnormalities,” according to the investigators.
While the study is still ongoing, the investigators called for more research to assess other potential risk factors and to confirm the strength of association in a larger sample size, as well as to gauge the significance and role of previous dengue infections in the mothers.
The study was funded by the Brazilian Ministry of Health, the Pan American Health Organization, and Enhancing Research Activity in Epidemic Situations. The investigators reported having no relevant financial disclosures.
FROM THE LANCET INFECTIOUS DISEASES
Key clinical point: The current microcephaly epidemic is a result of congenital Zika virus infection.
Major finding: In total, 41% of infants born with microcephaly had laboratory-confirmed Zika virus infection, compared with none of the infants in the control group.
Data source: Prospective, ongoing case-control study of 32 microcephaly cases and 62 controls at eight hospitals in Brazil between Jan. 15, 2016 and May 2, 2016.
Disclosures: The study was funded by the Brazilian Ministry of Health, the Pan American Health Organization, and Enhancing Research Activity in Epidemic Situations. The investigators reported having no relevant financial disclosures.
VIDEO: Medical apps will disrupt health care in a good way
BOSTON – Smartphones coupled with the rapidly growing number of medical applications are the latest disruptive technologies reshaping the way physicians conduct business and interact with patients, according to Paul Alan Wetter, MD, founder and chairman of the Society of Laparoendoscopic Surgeons.
“The message really is to the physicians out there: We need to be prepared and understand as much about this as we can,” said Dr. Wetter, clinical professor emeritus at the University of Miami. “We don’t want to be, 5 years from now ... wondering what’s going, what is this change?”
In a video interview, Dr. Wetter explained how mobile devices and apps could potentially improve technology-based tools that doctors already use, such as electronic health records, by allowing patients to carry accurate and up-to-date medical information with them.
Dr. Wetter spoke at the annual Minimally Invasive Surgery Week, held by the Society of Laparoendoscopic Surgeons. He did not report any relevant financial disclosures.
The video associated with this article is no longer available on this site. Please view all of our videos on the MDedge YouTube channel
BOSTON – Smartphones coupled with the rapidly growing number of medical applications are the latest disruptive technologies reshaping the way physicians conduct business and interact with patients, according to Paul Alan Wetter, MD, founder and chairman of the Society of Laparoendoscopic Surgeons.
“The message really is to the physicians out there: We need to be prepared and understand as much about this as we can,” said Dr. Wetter, clinical professor emeritus at the University of Miami. “We don’t want to be, 5 years from now ... wondering what’s going, what is this change?”
In a video interview, Dr. Wetter explained how mobile devices and apps could potentially improve technology-based tools that doctors already use, such as electronic health records, by allowing patients to carry accurate and up-to-date medical information with them.
Dr. Wetter spoke at the annual Minimally Invasive Surgery Week, held by the Society of Laparoendoscopic Surgeons. He did not report any relevant financial disclosures.
The video associated with this article is no longer available on this site. Please view all of our videos on the MDedge YouTube channel
BOSTON – Smartphones coupled with the rapidly growing number of medical applications are the latest disruptive technologies reshaping the way physicians conduct business and interact with patients, according to Paul Alan Wetter, MD, founder and chairman of the Society of Laparoendoscopic Surgeons.
“The message really is to the physicians out there: We need to be prepared and understand as much about this as we can,” said Dr. Wetter, clinical professor emeritus at the University of Miami. “We don’t want to be, 5 years from now ... wondering what’s going, what is this change?”
In a video interview, Dr. Wetter explained how mobile devices and apps could potentially improve technology-based tools that doctors already use, such as electronic health records, by allowing patients to carry accurate and up-to-date medical information with them.
Dr. Wetter spoke at the annual Minimally Invasive Surgery Week, held by the Society of Laparoendoscopic Surgeons. He did not report any relevant financial disclosures.
The video associated with this article is no longer available on this site. Please view all of our videos on the MDedge YouTube channel
AT MINIMALLY INVASIVE SURGERY WEEK
Doctors urge Congress to pass Zika funding
Federal health officials, pediatricians, and ob.gyns. are imploring Congress to pass an appropriations bill with sufficient money to fight the growing threat of the Zika virus.
“Funding for Zika research, for prevention, and for control efforts – including mosquito surveillance and control – is essentially all spent,” Beth P. Bell, MD, director of the CDC’s National Center for Emerging and Zoonotic Infectious Diseases, said during a press conference. The Obama administration “has already transferred millions of dollars from other important programs to help with the Zika response, [but] without additional resources from Congress, critical public health work may not be accomplished.”
President Obama asked Congress in February to appropriate $1.9 billion to address all aspects of the Zika virus situation in the United States; partisan politics surrounding funding for Planned Parenthood have derailed passage of the legislation to date.
Without additional, specific funding, development of a Zika vaccine would be severely limited, and virtually no funds would be available to conduct multitiered studies that are critical for protecting both women and children from the virus’ devastating effects, Dr. Bell said. Additionally, money allocated to state health departments for the management of patients with Zika virus would no longer be available. Development of tests for early diagnosis would be slowed or halted altogether.
“Allowing this to happen needlessly puts the American people at risk, and will result in more Zika infections and potentially more babies being born with microcephaly and other birth defects,” Dr. Bell added. “Congress has come back from their recess, and we hope that they will do the right thing.”
The American Congress of Obstetricians and Gynecologists “continues to develop, update, and issue guidance on the risks, prevention, assessment, and treatment of the Zika virus,” primarily through its practice advisories and resources available jointly through the CDC, ACOG president Thomas Gellhaus, MD, said.
“The biggest impact Zika has is on babies, and they are our future,” said Karen Remley, MD, executive director and CEO of the American Academy of Pediatricians, adding that funding is crucial to continue monitoring children who have been born with birth defects, as the long-term development of these and other issues is new territory for doctors across the United States and its territories.
As Congress prepared to adjourn in advance of the primary elections, Senate Majority Leader Mitch McConnell noted that some progress is being made on Zika funding.
“We’ve made a lot of important progress already,” Sen. McConnell said Sept. 12 on the Senate floor. “I expect to move forward this week on a continuing resolution through Dec. 9 at last year’s enacted levels and include funds for Zika control and our veterans. Talks are continuing, and leaders from both parties will meet later this afternoon at the White House to discuss the progress and path forward.”
Federal health officials, pediatricians, and ob.gyns. are imploring Congress to pass an appropriations bill with sufficient money to fight the growing threat of the Zika virus.
“Funding for Zika research, for prevention, and for control efforts – including mosquito surveillance and control – is essentially all spent,” Beth P. Bell, MD, director of the CDC’s National Center for Emerging and Zoonotic Infectious Diseases, said during a press conference. The Obama administration “has already transferred millions of dollars from other important programs to help with the Zika response, [but] without additional resources from Congress, critical public health work may not be accomplished.”
President Obama asked Congress in February to appropriate $1.9 billion to address all aspects of the Zika virus situation in the United States; partisan politics surrounding funding for Planned Parenthood have derailed passage of the legislation to date.
Without additional, specific funding, development of a Zika vaccine would be severely limited, and virtually no funds would be available to conduct multitiered studies that are critical for protecting both women and children from the virus’ devastating effects, Dr. Bell said. Additionally, money allocated to state health departments for the management of patients with Zika virus would no longer be available. Development of tests for early diagnosis would be slowed or halted altogether.
“Allowing this to happen needlessly puts the American people at risk, and will result in more Zika infections and potentially more babies being born with microcephaly and other birth defects,” Dr. Bell added. “Congress has come back from their recess, and we hope that they will do the right thing.”
The American Congress of Obstetricians and Gynecologists “continues to develop, update, and issue guidance on the risks, prevention, assessment, and treatment of the Zika virus,” primarily through its practice advisories and resources available jointly through the CDC, ACOG president Thomas Gellhaus, MD, said.
“The biggest impact Zika has is on babies, and they are our future,” said Karen Remley, MD, executive director and CEO of the American Academy of Pediatricians, adding that funding is crucial to continue monitoring children who have been born with birth defects, as the long-term development of these and other issues is new territory for doctors across the United States and its territories.
As Congress prepared to adjourn in advance of the primary elections, Senate Majority Leader Mitch McConnell noted that some progress is being made on Zika funding.
“We’ve made a lot of important progress already,” Sen. McConnell said Sept. 12 on the Senate floor. “I expect to move forward this week on a continuing resolution through Dec. 9 at last year’s enacted levels and include funds for Zika control and our veterans. Talks are continuing, and leaders from both parties will meet later this afternoon at the White House to discuss the progress and path forward.”
Federal health officials, pediatricians, and ob.gyns. are imploring Congress to pass an appropriations bill with sufficient money to fight the growing threat of the Zika virus.
“Funding for Zika research, for prevention, and for control efforts – including mosquito surveillance and control – is essentially all spent,” Beth P. Bell, MD, director of the CDC’s National Center for Emerging and Zoonotic Infectious Diseases, said during a press conference. The Obama administration “has already transferred millions of dollars from other important programs to help with the Zika response, [but] without additional resources from Congress, critical public health work may not be accomplished.”
President Obama asked Congress in February to appropriate $1.9 billion to address all aspects of the Zika virus situation in the United States; partisan politics surrounding funding for Planned Parenthood have derailed passage of the legislation to date.
Without additional, specific funding, development of a Zika vaccine would be severely limited, and virtually no funds would be available to conduct multitiered studies that are critical for protecting both women and children from the virus’ devastating effects, Dr. Bell said. Additionally, money allocated to state health departments for the management of patients with Zika virus would no longer be available. Development of tests for early diagnosis would be slowed or halted altogether.
“Allowing this to happen needlessly puts the American people at risk, and will result in more Zika infections and potentially more babies being born with microcephaly and other birth defects,” Dr. Bell added. “Congress has come back from their recess, and we hope that they will do the right thing.”
The American Congress of Obstetricians and Gynecologists “continues to develop, update, and issue guidance on the risks, prevention, assessment, and treatment of the Zika virus,” primarily through its practice advisories and resources available jointly through the CDC, ACOG president Thomas Gellhaus, MD, said.
“The biggest impact Zika has is on babies, and they are our future,” said Karen Remley, MD, executive director and CEO of the American Academy of Pediatricians, adding that funding is crucial to continue monitoring children who have been born with birth defects, as the long-term development of these and other issues is new territory for doctors across the United States and its territories.
As Congress prepared to adjourn in advance of the primary elections, Senate Majority Leader Mitch McConnell noted that some progress is being made on Zika funding.
“We’ve made a lot of important progress already,” Sen. McConnell said Sept. 12 on the Senate floor. “I expect to move forward this week on a continuing resolution through Dec. 9 at last year’s enacted levels and include funds for Zika control and our veterans. Talks are continuing, and leaders from both parties will meet later this afternoon at the White House to discuss the progress and path forward.”
New ELISA better differentiates chronic, acute hepatitis E infection
While real-time polymerase chain reaction (PCR) testing is the standard test for hepatitis E virus infection, an anti-HEV-specific enzyme-linked immunosorbent assay (ELISA) is more effective than is PCR at distinguishing between acute and chronic HEV infections.
“A clinical challenge in the management of immunocompromised patients with HEV infection is to differentiate between the acute and chronic course of infection [as] approximately 60% of infected immunocompromised individuals experience a chronic infection, which might require treatment with ribavirin,” said lead author Patrick Behrendt, Dr.med., of Hannover (Germany) Medical School.
The anti-HEV antigen (Ag) ELISA has recently become commercially available, making it an even bigger matter of interest. Dr. Behrendt and his coinvestigators analyzed sera from 18 patients with acute and 21 patients with chronic HEV, whose samples were collected between 2008 and 2015. The sera were retrospectively analyzed via both real-time PCR and ELISA to compare the efficacy of each in identifying HEV – more specifically, HEV genotype 3 – in each subject. For the ELISA analysis, 100 mcL of serum were added to each well of an ELISA plate, which was subsequently incubated at 37 degrees Celsius for 1 hour.
The researchers analyzed sera from four individuals with chronic HEV using serial dilutions to compare sensitivity of real-time PCR and ELISA. In three out of those four sera (75%), ELISA showed negative results due to HEV RNA levels of fewer than 10,000 copies/mL; on the other hand, real-time PCR showed a “linear reduction in levels,” indicating that it is the better option in detecting HEV genotype 3 (J Infect Dis. 2016 May 27;214[3]:361-8).
ELISA was also used on 20 chronic HEV patients and 17 acute HEV patients to determine its sensitivity at distinguishing between the two types of infection. In this cohort, only 64.7% of RNA-positive patients were deemed positive according to the ELISA testing, while ELISA results were positive in all of the cases of chronic HEV infections. None of the patients with chronic infection registered a false-negative, which indicates “a high reliability of the assay for this cohort,” according to the investigators.
“Comparison of chronically infected individuals with acutely infected patients revealed drastically increased ODs in chronically infected patients, while most of the positive samples from acutely infected patients displayed significantly lower values [which] led to a sensitivity of 100% (20 of 20) [ELISA] results for chronically HEV infected individuals,” the authors concluded. “Our study demonstrates that [ELISA] has a sensitivity of 65% and a specificity of 92% in detecting an ongoing HEV infection in a real-life cohort.”
The German Center for Infection Research, the Helmholtz Center for Infection Research, and the German Ministry for Education and Research funded the study. The researchers reported no relevant financial disclosures.
While real-time polymerase chain reaction (PCR) testing is the standard test for hepatitis E virus infection, an anti-HEV-specific enzyme-linked immunosorbent assay (ELISA) is more effective than is PCR at distinguishing between acute and chronic HEV infections.
“A clinical challenge in the management of immunocompromised patients with HEV infection is to differentiate between the acute and chronic course of infection [as] approximately 60% of infected immunocompromised individuals experience a chronic infection, which might require treatment with ribavirin,” said lead author Patrick Behrendt, Dr.med., of Hannover (Germany) Medical School.
The anti-HEV antigen (Ag) ELISA has recently become commercially available, making it an even bigger matter of interest. Dr. Behrendt and his coinvestigators analyzed sera from 18 patients with acute and 21 patients with chronic HEV, whose samples were collected between 2008 and 2015. The sera were retrospectively analyzed via both real-time PCR and ELISA to compare the efficacy of each in identifying HEV – more specifically, HEV genotype 3 – in each subject. For the ELISA analysis, 100 mcL of serum were added to each well of an ELISA plate, which was subsequently incubated at 37 degrees Celsius for 1 hour.
The researchers analyzed sera from four individuals with chronic HEV using serial dilutions to compare sensitivity of real-time PCR and ELISA. In three out of those four sera (75%), ELISA showed negative results due to HEV RNA levels of fewer than 10,000 copies/mL; on the other hand, real-time PCR showed a “linear reduction in levels,” indicating that it is the better option in detecting HEV genotype 3 (J Infect Dis. 2016 May 27;214[3]:361-8).
ELISA was also used on 20 chronic HEV patients and 17 acute HEV patients to determine its sensitivity at distinguishing between the two types of infection. In this cohort, only 64.7% of RNA-positive patients were deemed positive according to the ELISA testing, while ELISA results were positive in all of the cases of chronic HEV infections. None of the patients with chronic infection registered a false-negative, which indicates “a high reliability of the assay for this cohort,” according to the investigators.
“Comparison of chronically infected individuals with acutely infected patients revealed drastically increased ODs in chronically infected patients, while most of the positive samples from acutely infected patients displayed significantly lower values [which] led to a sensitivity of 100% (20 of 20) [ELISA] results for chronically HEV infected individuals,” the authors concluded. “Our study demonstrates that [ELISA] has a sensitivity of 65% and a specificity of 92% in detecting an ongoing HEV infection in a real-life cohort.”
The German Center for Infection Research, the Helmholtz Center for Infection Research, and the German Ministry for Education and Research funded the study. The researchers reported no relevant financial disclosures.
While real-time polymerase chain reaction (PCR) testing is the standard test for hepatitis E virus infection, an anti-HEV-specific enzyme-linked immunosorbent assay (ELISA) is more effective than is PCR at distinguishing between acute and chronic HEV infections.
“A clinical challenge in the management of immunocompromised patients with HEV infection is to differentiate between the acute and chronic course of infection [as] approximately 60% of infected immunocompromised individuals experience a chronic infection, which might require treatment with ribavirin,” said lead author Patrick Behrendt, Dr.med., of Hannover (Germany) Medical School.
The anti-HEV antigen (Ag) ELISA has recently become commercially available, making it an even bigger matter of interest. Dr. Behrendt and his coinvestigators analyzed sera from 18 patients with acute and 21 patients with chronic HEV, whose samples were collected between 2008 and 2015. The sera were retrospectively analyzed via both real-time PCR and ELISA to compare the efficacy of each in identifying HEV – more specifically, HEV genotype 3 – in each subject. For the ELISA analysis, 100 mcL of serum were added to each well of an ELISA plate, which was subsequently incubated at 37 degrees Celsius for 1 hour.
The researchers analyzed sera from four individuals with chronic HEV using serial dilutions to compare sensitivity of real-time PCR and ELISA. In three out of those four sera (75%), ELISA showed negative results due to HEV RNA levels of fewer than 10,000 copies/mL; on the other hand, real-time PCR showed a “linear reduction in levels,” indicating that it is the better option in detecting HEV genotype 3 (J Infect Dis. 2016 May 27;214[3]:361-8).
ELISA was also used on 20 chronic HEV patients and 17 acute HEV patients to determine its sensitivity at distinguishing between the two types of infection. In this cohort, only 64.7% of RNA-positive patients were deemed positive according to the ELISA testing, while ELISA results were positive in all of the cases of chronic HEV infections. None of the patients with chronic infection registered a false-negative, which indicates “a high reliability of the assay for this cohort,” according to the investigators.
“Comparison of chronically infected individuals with acutely infected patients revealed drastically increased ODs in chronically infected patients, while most of the positive samples from acutely infected patients displayed significantly lower values [which] led to a sensitivity of 100% (20 of 20) [ELISA] results for chronically HEV infected individuals,” the authors concluded. “Our study demonstrates that [ELISA] has a sensitivity of 65% and a specificity of 92% in detecting an ongoing HEV infection in a real-life cohort.”
The German Center for Infection Research, the Helmholtz Center for Infection Research, and the German Ministry for Education and Research funded the study. The researchers reported no relevant financial disclosures.
FROM THE JOURNAL OF INFECTIOUS DISEASES
Key clinical point: An anti-HEV-specific enzyme-linked immunosorbent assay (ELISA) is more effective at identifying acute versus chronic HEV infection than is HEV RNA real-time PCR.
Major finding: ELISA detected significantly higher levels of HEV Ag in chronically infected subjects than in acutely affected ones, but was less sensitive at detecting HEV infection overall than real-time PCR.
Data source: Retrospective cohort study of 21 chronic and 18 acute HEV patients from 2008-2015.
Disclosures: The German Center for Infection Research, the Helmholtz Center for Infection Research, and the German Ministry for Education and Research funded the study. The researchers reported no relevant financial disclosures.
Robot-assisted laparoscopic surgery performed mostly by and for white males
BOSTON – Patients who receive robot-assisted laparoscopic surgery (RALS), an increasingly widespread facet of surgical medicine, tend to be higher income white males, according to an extensive new study presented at Minimally Invasive Surgery Week.
“We wanted to look at how the technology is rolling out ... and what some of those characteristics are that are occurring, not only with the types of patients that are picking up these surgeries but also who the surgeons are that are performing these surgeries,” the study’s lead investigator, Michael A. Palese, MD, of Mount Sinai Health System, New York, explained during a video interview.
A total of 63,725 RALS cases were included, all of which occurred during 2009-2015. In addition to affluent white males being the predominant recipients of this type of surgery, younger white male surgeons tended to be the ones more likely to perform RALS. Across specialties, RALS use has increased substantially over the study period, with the largest increases seen among cardiothoracic surgeons (from 197 cases, 3.1% of all cases per year, to 1,159, 8.7% of all cases). Among general surgeons, RALS use increased from 98 cases (3.2%) to 2,559 cases (19.1%), and for orthopedic surgeons, 55 (0.8%) to 985 (7.4%).
Dr. Palese discussed the genesis of the study, the importance of the study’s findings, and where he foresees RALS heading in the near future. He did not report any relevant financial disclosures.
The video associated with this article is no longer available on this site. Please view all of our videos on the MDedge YouTube channel
BOSTON – Patients who receive robot-assisted laparoscopic surgery (RALS), an increasingly widespread facet of surgical medicine, tend to be higher income white males, according to an extensive new study presented at Minimally Invasive Surgery Week.
“We wanted to look at how the technology is rolling out ... and what some of those characteristics are that are occurring, not only with the types of patients that are picking up these surgeries but also who the surgeons are that are performing these surgeries,” the study’s lead investigator, Michael A. Palese, MD, of Mount Sinai Health System, New York, explained during a video interview.
A total of 63,725 RALS cases were included, all of which occurred during 2009-2015. In addition to affluent white males being the predominant recipients of this type of surgery, younger white male surgeons tended to be the ones more likely to perform RALS. Across specialties, RALS use has increased substantially over the study period, with the largest increases seen among cardiothoracic surgeons (from 197 cases, 3.1% of all cases per year, to 1,159, 8.7% of all cases). Among general surgeons, RALS use increased from 98 cases (3.2%) to 2,559 cases (19.1%), and for orthopedic surgeons, 55 (0.8%) to 985 (7.4%).
Dr. Palese discussed the genesis of the study, the importance of the study’s findings, and where he foresees RALS heading in the near future. He did not report any relevant financial disclosures.
The video associated with this article is no longer available on this site. Please view all of our videos on the MDedge YouTube channel
BOSTON – Patients who receive robot-assisted laparoscopic surgery (RALS), an increasingly widespread facet of surgical medicine, tend to be higher income white males, according to an extensive new study presented at Minimally Invasive Surgery Week.
“We wanted to look at how the technology is rolling out ... and what some of those characteristics are that are occurring, not only with the types of patients that are picking up these surgeries but also who the surgeons are that are performing these surgeries,” the study’s lead investigator, Michael A. Palese, MD, of Mount Sinai Health System, New York, explained during a video interview.
A total of 63,725 RALS cases were included, all of which occurred during 2009-2015. In addition to affluent white males being the predominant recipients of this type of surgery, younger white male surgeons tended to be the ones more likely to perform RALS. Across specialties, RALS use has increased substantially over the study period, with the largest increases seen among cardiothoracic surgeons (from 197 cases, 3.1% of all cases per year, to 1,159, 8.7% of all cases). Among general surgeons, RALS use increased from 98 cases (3.2%) to 2,559 cases (19.1%), and for orthopedic surgeons, 55 (0.8%) to 985 (7.4%).
Dr. Palese discussed the genesis of the study, the importance of the study’s findings, and where he foresees RALS heading in the near future. He did not report any relevant financial disclosures.
The video associated with this article is no longer available on this site. Please view all of our videos on the MDedge YouTube channel
AT MINIMALLY INVASIVE SURGERY WEEK
Congenital Zika virus associated with sensorineural hearing loss
Congenital Zika virus infection may be associated with sensorineural hearing loss, according to the latest Morbidity and Mortality Weekly Report published by the CDC.
“In the majority of cases of hearing loss associated with congenital viral infection, the damage to the auditory system is within the cochlea,” wrote the authors of the MMWR, led by Mariana C. Leal, PhD of the Hospital Agamenon Magalhães in Recife, Brazil. “It is likely that similar lesions account for the hearing deficit in children with congenital Zika virus infection” (MMWR. 2016 Aug 30.65:1-4)
Full auditory function evaluations were performed on 70 children born with microcephaly, all of whom had confirmed laboratory evidence of congenital Zika virus. One child with bilateral profound sensorineural hearing loss was excluded because the child had already received treatment with amikacin (a known ototoxic antibiotic) prior to evaluation for this study. All children were ages 0-10 months; investigators defined Zika-associated microcephaly as head circumference of 32 cm or lower at birth. Gestational ages at birth ranged from 37 weeks to 1 day shy of 42 weeks.
Of the 69 children included for analysis, four (5.8%) were found to have sensorineural hearing loss with no other potential cause, which the investigators noted is “within the range (6%-65%) reported for other congenital viral infections.” The investigators also stated that the auditory issues were mainly evident in children whose mothers experienced a rash illness during the first trimester of their pregnancy.
“Children with evidence of congenital Zika virus infection who have normal initial screening tests should receive regular follow-up, because onset of hearing loss associated with other congenital viral infections can be delayed and the loss can be progressive,” the authors noted.
No disclosures or funding sources were reported.
Congenital Zika virus infection may be associated with sensorineural hearing loss, according to the latest Morbidity and Mortality Weekly Report published by the CDC.
“In the majority of cases of hearing loss associated with congenital viral infection, the damage to the auditory system is within the cochlea,” wrote the authors of the MMWR, led by Mariana C. Leal, PhD of the Hospital Agamenon Magalhães in Recife, Brazil. “It is likely that similar lesions account for the hearing deficit in children with congenital Zika virus infection” (MMWR. 2016 Aug 30.65:1-4)
Full auditory function evaluations were performed on 70 children born with microcephaly, all of whom had confirmed laboratory evidence of congenital Zika virus. One child with bilateral profound sensorineural hearing loss was excluded because the child had already received treatment with amikacin (a known ototoxic antibiotic) prior to evaluation for this study. All children were ages 0-10 months; investigators defined Zika-associated microcephaly as head circumference of 32 cm or lower at birth. Gestational ages at birth ranged from 37 weeks to 1 day shy of 42 weeks.
Of the 69 children included for analysis, four (5.8%) were found to have sensorineural hearing loss with no other potential cause, which the investigators noted is “within the range (6%-65%) reported for other congenital viral infections.” The investigators also stated that the auditory issues were mainly evident in children whose mothers experienced a rash illness during the first trimester of their pregnancy.
“Children with evidence of congenital Zika virus infection who have normal initial screening tests should receive regular follow-up, because onset of hearing loss associated with other congenital viral infections can be delayed and the loss can be progressive,” the authors noted.
No disclosures or funding sources were reported.
Congenital Zika virus infection may be associated with sensorineural hearing loss, according to the latest Morbidity and Mortality Weekly Report published by the CDC.
“In the majority of cases of hearing loss associated with congenital viral infection, the damage to the auditory system is within the cochlea,” wrote the authors of the MMWR, led by Mariana C. Leal, PhD of the Hospital Agamenon Magalhães in Recife, Brazil. “It is likely that similar lesions account for the hearing deficit in children with congenital Zika virus infection” (MMWR. 2016 Aug 30.65:1-4)
Full auditory function evaluations were performed on 70 children born with microcephaly, all of whom had confirmed laboratory evidence of congenital Zika virus. One child with bilateral profound sensorineural hearing loss was excluded because the child had already received treatment with amikacin (a known ototoxic antibiotic) prior to evaluation for this study. All children were ages 0-10 months; investigators defined Zika-associated microcephaly as head circumference of 32 cm or lower at birth. Gestational ages at birth ranged from 37 weeks to 1 day shy of 42 weeks.
Of the 69 children included for analysis, four (5.8%) were found to have sensorineural hearing loss with no other potential cause, which the investigators noted is “within the range (6%-65%) reported for other congenital viral infections.” The investigators also stated that the auditory issues were mainly evident in children whose mothers experienced a rash illness during the first trimester of their pregnancy.
“Children with evidence of congenital Zika virus infection who have normal initial screening tests should receive regular follow-up, because onset of hearing loss associated with other congenital viral infections can be delayed and the loss can be progressive,” the authors noted.
No disclosures or funding sources were reported.
FROM THE CENTERS FOR DISEASE CONTROL AND PREVENTION
Key clinical point: Congenital Zika virus could be associated with sensorineural hearing loss in infants.
Major finding: 4 of 69 children (5.8%) with microcephaly and confirmed congenital Zika virus infection had sensorineural hearing loss without evidence of any other possible causes.
Data source: Retrospective analysis of 70 children born with microcephaly in Brazil from Nov. 2015 through May 2016.
Disclosures: No disclosures or funding source reported.
