How Some Generic Drugs Could Do More Harm Than Good
For the 16 years that Dr. Brian Westerberg, a Canadian surgeon, worked volunteer missions at the Mulago National Referral Hospital in Kampala, Uganda, scarcity was the norm. The patients usually exceeded the 1,500 allotted beds. Running water was once cut off when the debt-ridden hospital was unable to pay its bills. On some of his early trips, Westerberg even brought over drugs from Canada in order to treat patients. But as low-cost generics made in India and China became widely available through Uganda’s government and international aid agencies in the early 2000s, it seemed at first like the supply issue had been solved. Then on February 7, 2013, Westerberg examined a feverish 13-year-old boy who had fluid oozing from an ear infection. He suspected bacterial meningitis, though he couldn’t confirm his diagnosis because the CT scanner had broken down. The boy was given intravenous ceftriaxone, a broad-spectrum antibiotic that Westerberg believed would cure him. But after four days of treatment, the ear had only gotten worse. As Westerberg prepared to operate, the boy had a seizure. With the CT scanner working again, Westerberg ordered an urgent scan, which revealed small abscesses in the boy’s skull, likely caused by the infection. When a hospital neurosurgeon looked at the images and confidently declared that surgery was unnecessary and the swelling and abscesses would abate with effective antibiotic treatment, Westerberg was confused. They had already tr...
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Conclusions: In the acute phase of mild TBI a majority of patients has impaired olfactory function. Further patients with olfactory dysfunction are more likely to exhibit post-concussion and anxious symptoms at follow-up. Olfactory testing in the acute phase may therefore serve as a screening tool for long-term outcome. PMID: 31223039 [PubMed - as supplied by publisher]
Conclusions. Patients in AF or SR undergoing CRT demonstrated distinct benefits from device implantation and from HIIT as an adjunctive therapeutic strategy. This suggests that both mainstay and adjunctive therapeutics may need to be managed differently in patients in AF and SR. PMID: 31221002 [PubMed - as supplied by publisher]
Authors: Dy J, DeMeester S, Lipworth H, Barrett J Abstract OBJECTIVE: To provide evidence-based guidelines for the provision of a trial of labour after Caesarean section. OUTCOMES: Fetal and maternal morbidity and mortality associated with vaginal birth after Caesarean and repeat Caesarean section. EVIDENCE: MEDLINE database was searched for articles published from January 1, 1995, to October 31, 2017 using the key words "vaginal birth after Caesarean (Cesarean) section." The quality of evidence is described using the Evaluation of Evidence criteria outlined in the Report of the Canadian Task Forc...
La littérature médicale mondiale : obstétrique. J Obstet Gynaecol Can. 2019 Jul;41(7):908-911 Authors: El-Messidi A PMID: 31227062 [PubMed - in process]
Authors: El-Messidi A PMID: 31227061 [PubMed - in process]
Authors: Balayla J, Tulandi T PMID: 31227060 [PubMed - in process]
Authors: Balayla J, Tulandi T PMID: 31227059 [PubMed - in process]
No 383 - Dépistage, diagnostic et prise en charge des troubles du spectre du placenta accreta. J Obstet Gynaecol Can. 2019 Jul;41(7):1050-1066 Authors: Hobson SR, Kingdom JC, Murji A, Windrim RC, Carvalho JCA, Singh SS, Ziegler C, Birch C, Frecker E, Lim K, Cargill Y, Allen LM PMID: 31227058 [PubMed - in process]
CONCLUSIONS: Interdisciplinary team-based care providing accurate diagnostic services, coordinated planning, and safer surgery deliver effective care with improved clinical outcomes in comparison with alternative management. SUMMARY STATEMENTS: RECOMMENDATIONS. PMID: 31227057 [PubMed - in process]
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