Research and Reviews in the Fastlane 080
This study calls into question the current guidelines and will hopefully lead to more evidence-based recommendations in the future.Recommended by: Zack RepanshekRead More: Antibiotics for community-acquired pneumonia: Is azithromycin out? (Pulm CCM)The Best of the RestOphthalmology, Ultrasound Vrablik ME et al. The diagnostic accuracy of bedside ocular ultrasonography for the diagnosis of retinal detachment: a systematic review and meta-analysis. Ann Emerg Med 2015; 65(2):199-203. PMID: 24680547Nice meta-analysis of bedside US for retinal detachment in Annals of EM showing 97-100% sensitivity, 83-100% specificity, base...
Source: Life in the Fast Lane - April 23, 2015 Category: Emergency Medicine Authors: Anand Swaminathan Tags: Cardiology Education Emergency Medicine Infectious Disease Intensive Care Ophthalmology Psychiatry and Mental Health Resuscitation Trauma critical care R&R in the FASTLANE recommendations research and reviews Source Type: blogs
Why don’t people ask their doctors more questions?
I do not get it. Day in and day out, I ask patients why they take a medicine. Many do not know. “My doctor put me on it,” goes the common response.
Take statin drugs, for example. I often ask a person why they are taking the drug? With rare exception, the person says it is to lower cholesterol.
That’s not the right answer–and herein lies much of the problem with preventative medicine. A statin drug does indeed lower cholesterol but its main purpose is to reduce the risk of heart attack, stroke or death in the future. Cholesterol is just a number. It’s a surrogate that we can measure but itR...
Source: Dr John M - April 22, 2015 Category: Cardiology Authors: Dr John Source Type: blogs
Interpreting the new sore throat article
First, this study required the work of a large team. The main work happened in two places – a research microbiology laboratory and our college health clinic. They took an idea and translated it into an opportunity to collect and analyze data.
Second, the accompanying editorial (written by a friend and excellent researcher Dr. Jeffrey Linder) raises some questions that I will work to answer. He writes that we do not have enough evidence to change practice yet. He postulates that Fusobacterium necrophorum might not actually cause pharyngitis and that linking positive PCR testing to the risk of suppurative complicat...
Source: DB's Medical Rants - February 23, 2015 Category: Internal Medicine Authors: rcentor Tags: Medical Rants Source Type: blogs
Top stories in health and medicine, September 11, 2014
From MedPage Today:
Azithromycin Linked to Belly Blockage in Infants. Infants who received azithromycin (Zithromax) in the early days of life were at an increased risk for developing infantile hypertrophic pyloric stenosis (IHPS).
Singulair Doesn’t Ease Wheeze in Most Kids. Intermittent montelukast (Singulair) didn’t alleviate wheezing in children, except possibly for those with a specific genetic mutation.
Single-Pill HIV Therapy Proves Less Toxic. An investigational single-pill regimen for HIV — the first to be based on a protease inhibitor — was less toxic than a similar regimen using separate ...
Source: Kevin, M.D. - Medical Weblog - September 11, 2014 Category: Journals (General) Authors: MedPage Today Tags: News Infectious disease Pulmonology Source Type: blogs
Increased Heart Risk Linked To Popular Antibiotic
Acute use of the popular macrolide antibiotic clarithromycin has been linked to a small but significant increase in cardiac death. In a report in the BMJ, researchers in Denmark analyzed the effects over a 14-year period of the acute use of penicillin V, roxithromycin, and clarithromycin. Earlier research raised concerns that marcrolide antibiotics in general, and erythromycin and azithromycin in particular, might prolong the QT interval and increase the risk for fatal arrhythmias. In the new study, clarithromycin was associated with a significant increase in the rate of sudden cardiac death compared with the other...
Source: CardioBrief - August 20, 2014 Category: Cardiology Authors: Larry Husten Tags: Heart Rhythms Policy & Ethics Prevention, Epidemiology & Outcomes antibiotics arrhythmias clarithromycin QT interval Source Type: blogs
Feeling a Little Better
Still in the hospital. My temperature seems to have stabilized near normal, I'm coughing a little less, and blood oxygen (without supplemental oxygen) is up in the 94% range. However, pulse rate and respiration rate are unchanged and much higher than normal, so the jury is still out.
For the medically inclined: I was started on a Z-Pak (azithromycin) Monday, then in the hospital they added a cephalosporin IV antibiotic Tuesday. By today (Thursday) we didn't see much progress, so the hospital doctor finally talked me into oral Levaquin, dropping both of the others. That dose was this noon , so it's ...
Source: Myeloma Hope - August 1, 2014 Category: Cancer Tags: pneumonia Source Type: blogs
Top stories in health and medicine, June 9, 2014
From MedPage Today:
Surgeons Not Very Involved in ACOs, Survey Says. Accountable Care Organizations have given little attention to surgery in the early years of the Medicare program, choosing to focus instead on managing chronic conditions and reducing hospital readmissions.
Early Allergen Exposure Cuts Wheeze Risk. A new study confirmed that when inner-city kids were exposed to allergens they had an increased risk of recurrent wheezing and sensitivity to allergens.
Death Risk Down With Pneumonia Antibiotic. Taking into account both death and myocardial infarction (MI), use of antibiotic regimens that included azithromyc...
Source: Kevin, M.D. - Medical Weblog - June 9, 2014 Category: Journals (General) Authors: MedPage Today Tags: News Diabetes Endocrinology Infectious disease Surgery Source Type: blogs
Long QT: Do not trust the computerized QT interval when the QT is long
A middle-aged male with h/o DM was found down. He was hypoglycemic (mild, 45 mg/dl) and had pneumonia with hypoxia. He had this ECG recorded:Sinus rhythm with slight right axis deviation and non-diagnostic T-wave inversionsHe received azithromycin and ceftriaxone for community acquired pneumonia. Then he became very agitated in spite of correction of hypoglycemia, and was given a total of 15 mg of haloperidol. His K returned at 2.8 mEq/L and ionized Calcium at 3.82 mEq/L (normal, 4.4 -5.2). Magnesium was 1.5 mEq/L (normal, 1.3 - 2.0)A troponin returned slightly elevated, so another ECG was rec...
Source: Dr. Smith's ECG Blog - June 3, 2014 Category: Cardiology Authors: Steve Smith Source Type: blogs
The LITFL Review 130
The LITFL Review is your regular and reliable source for the highest highlights, sneakiest sneak peaks and loudest shout-outs from the webbed world of emergency medicine and critical care. Each week the LITFL team casts the spotlight on the best and brightest from the blogosphere, the podcast video/audiosphere and the rest of the Web 2.0 social media jungle to find the most fantastic EM/CC FOAM (Free Open Access Meducation) around.
Welcome to the 130th edition, brought to you by:
Kane Guthrie [KG] from LITFL
Tessa Davis [TRD] from LITFL and Don’t Forget The Bubbles
Brent Thoma [BT] from BoringEM, and ALiEM
Chris Ni...
Source: Life in the Fast Lane - March 25, 2014 Category: Emergency Medicine Doctors Authors: Kane Guthrie Tags: Education eLearning Emergency Medicine Featured Health Intensive Care LITFL review Toxicology LITFL R/V Source Type: blogs
Top stories in health and medicine, March 12, 2014
From MedPage Today:
Docs Unprepared for Payment Reform. A pair of recent reports call into question the ability of physician practices to embrace health reform efforts.
Even a Few Drinks Tied to Poor Birth Outcomes. Women who consumed low levels of alcohol before conception and during pregnancy were more likely to have adverse birth outcomes such as low birth centile, low birth weight, and premature birth than nondrinkers.
Can Antibiotics Trigger Arrhythmias?. Azithromycin and levofloxacin were both associated with elevated risks of death and serious cardiac arrhythmias during standard lengths of prescription.
HIV: More ...
Source: Kevin, M.D. - Medical Weblog - March 12, 2014 Category: Family Physicians Tags: News Heart Infectious disease OB/GYN Source Type: blogs
Oops - Intensive Care
Saturday, February 8, 2014, Breaking News
My sweeties and I ran a lovely marathon in New Orleans last Sunday. On Monday we flew home, and by Tuesday morning I felt a scratchy throat. That came on fast, knocked me flat (weak, fever, aches, severe cough, nausea), and by Thursday it was diagnosed at Mayo as Influenza Type A. Yes, I did get the flu shot, last November. By Friday morning I was having trouble breathing and my local doc found pneumonia. He checked me into the ICU in Lakeview Hospital in Stillwater, MN.
The hospital staff treat me with respect, lots of smiles, but they put on gowns, masks, and ...
Source: Myeloma Hope - February 9, 2014 Category: Cancer Source Type: blogs
The LITFL Review 117
The LITFL Review is your regular and reliable source for the highest highlights, sneakiest sneak peaks and loudest shout-outs from the webbed world of emergency medicine and critical care. Each week the LITFL team casts the spotlight on the best and brightest from the blogosphere, the podcast video/audiosphere and the rest of the Web 2.0 social media jungle to find the most fantastic EM/CC FOAM (Free Open Access Meducation) around.
Welcome to the 117th edition, brought to you by:
Kane Guthrie [KG] from LITFL
Tessa Davis [TRD] from LITFL and Don’t Forget The Bubbles
Brent Thoma [BT] from BoringEM, and
Chris Nickson [C...
Source: Life in the Fast Lane - November 26, 2013 Category: Emergency Medicine Doctors Authors: Kane Guthrie Tags: Emergency Medicine Featured LITFL review LITFL R/V Source Type: blogs
More information on azithromycin and the risk of sudden cardiac death
(Source: Notes from Dr. RW)
Source: Notes from Dr. RW - October 4, 2013 Category: Internists and Doctors of Medicine Tags: pharmacology infectious disease cardiovascular Source Type: blogs
Certain Antibiotics Linked to Blood Glucose Swings
By Diane Fennell
People with diabetes who take a certain class of antibiotics are more likely to experience severe swings in blood glucose, according to new research from Taiwan.
Previous research and case reports have raised concern about the possibility of severe high and low blood glucose associated with the use of fluoroquinolones, a class of antibiotics that includes ciprofloxacin (brand name Cipro), levofloxacin (Levaquin), and moxifloxacin (Avelox). One drug in this class, gatifloxacin (Tequin), was removed from the US market due to the risk of blood glucose fluctuations.
To assess the risk of severe blood gluc...
Source: Diabetes Self-Management - August 16, 2013 Category: Diabetes Authors: Diane Fennell Source Type: blogs
Azithromycin and long QT syndrome: Facts from a cardiologist
Text message: “John, This cough and congestion is killing me. It’s turning thick and green. Can you write me a Z-pak? It always works for me.”
If you write a blog on medical decision-making and heart rhythm matters, it seems an incredible omission not to opine on the FDA warning concerning the commonly used antibiotic azithromycin (the drug in a Z-pak). Quoting directly from the FDA warning:
[Azithromycin] can cause abnormal changes in the electrical activity of the heart that may lead to a potentially fatal irregular heart rhythm.
Should we say this more clearly: that simple antibiotic you are taking for a minor inf...
Source: Kevin, M.D. - Medical Weblog - May 4, 2013 Category: Family Physicians Tags: Meds Cancer Medications Source Type: blogs
