Dr. Barry Gustin - Medical-Legal Expert Services

Deaths from Narcotics

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Deaths due to narcotic abuse typically occur by overdose, and consequent respiratory failure.  New data demonstrates a novel cause of death associated with narcotic abuse.  On October 12, 2012 the US Food and Drug Administration (FDA) warned that individuals who abuse the prescription pain medication oxymorphone hydrochloride extended-release tablets (Opana ER, Endo Pharmaceuticals) are at serious risk of developing thrombotic thrombocytopenic purpura (TTP), a blood disorder that can result in kidney failure and death.

According to the FDA, cases of TTP linked to Opana appear to occur only when the drug is injected intravenously.

The FDA notes that in TTP, blood clots form in small blood vessels throughout the body. The clots can limit or block blood flow to the body’s organs, such as the kidneys, brain, and heart.

Platelets help the blood to clot. In TTP, as platelets form blood clots, fewer of them are available to assist with clotting in other parts of the body. This can lead to bleeding under the skin and internal bleeding.

TTP can cause death or lead to other complications with permanent damage, such as kidney failure, brain damage, or stroke.

 

Recommendations for the Treatment of Cardiac Ischemia and Infarct

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Governing Cardiology organizations lately met and conferred and produce new guidelines for the evaluation and management of patients who present with cardiac ischemia and certain types of myocardial infarctions.  These guidelines constitute the current acceptable standard of practice, and should be generally followed by all medical practitioners.  In any medical-legal action, these standards with constitute the benchmark against which any alleged malpractice will be judged.  The full paper is listed below.

 

 

ACCF/SCCT/ACR/AHA/ASE/ASNC/NASCI/SCAI/SCMR 2010 Appropriate Use Criteria for Cardiac Computed Tomography

Cardiac Computed Tomography Writing Group; Technical Panel

 

Posted: 12/29/2010; J Am Coll Cardiol. 2010;56(22):1864-1894. © 2010 Elsevier Science, Inc.

A Report of the American College of Cardiology Foundation Appropriate Use Criteria Task Force, the Society of Cardiovascular Computed Tomography, the American College of Radiology, the American Heart Association, the American Society of Echocardiography, the American Society of Nuclear Cardiology, the North American Society for Cardiovascular Imaging, the Society for Cardiovascular Angiography and Interventions, and the Society for Cardiovascular Magnetic Resonance

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Cardiovascular Risk Guidelines in Asymptomatic Adults: AHA

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Paradigms of care are important for many reasons, the least of which, has to do with standardization, so that medical practitioners understand what constitutes the standard of practice, and know what the recommendations are for myriad medical presentations.  Who amongst us are at risk for sudden cardiac events, and what can be done about it, to identify these people and to prevent adverse health outcomes?  The American Heart Association along with the American College of Cardiology Foundation have determined new guidelines.  These guidelines are listed below and will constitute new cardiology paradigms for making healthcare needs assessments.

 

 

 

2010 ACCF/AHA Guideline for Assessment of Cardiovascular Risk in Asymptomatic Adults: Executive Summary

A Report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines

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Bath Salts Banned by the DEA

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In the wake of a growing number of overdose visits to emergency departments, the US Drug Enforcement Administration (DEA) has moved to make psychoactive "bath salts" (PABS) a controlled substance.

In a statement released today, the DEA announced it is using its emergency scheduling authority to temporarily control methylenedioxypyrovalerone and 2 other synthetic stimulants: mephedrone and methylone.

As of September 7, 2011, possessing and selling these chemicals or the products that contain them are both illegal in the United States for at least 1 year while the DEA and the US Department of Health and Human Services mull over whether the substances should be permanently controlled.

To get the full story from Medscape:  Click here

 

Listeria Outbreak Kills Many-deadliest outbreak in years

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At least 13 people have died, and many more have become critical ill after eating cantaloupe contaminated with Listeria, in the deadliest outbreak of food-borne illness in the United States in more than a decade.  The outbreak has been reported in 18 states so far.

Listeria is a common bacteria that can be found in soil, water, decaying plant matter and manure.  A particular strain, called Listeria monocytogenes, is the culprit.  It has a very long incubation period, so it can take more than 2 months from exposure for a person to become ill.  This means that it is quite difficult to identify any particular food that would have carried the pathogen.

To read the full NY Times article about this:  Click Here

 

A Cure for Cancer??? !

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A year ago, when chemotherapy stopped working against his leukemia, William Ludwig signed up to be the first patient treated in a bold experiment at the University of Pennsylvania. Mr. Ludwig, then 65, a retired corrections officer from Bridgeton, N.J., felt his life draining away and thought he had nothing to lose.


Doctors removed a billion of his T-cells — a type of white blood cell that fights viruses and tumors — and gave them new genes that would program the cells to attack his cancer. Then the altered cells were dripped back into Mr. Ludwig’s veins.

At first, nothing happened. But after 10 days, hell broke loose in his hospital room. He began shaking with chills. His temperature shot up. His blood pressure shot down. He became so ill that doctors moved him into intensive care and warned that he might die. His family gathered at the hospital, fearing the worst.

A few weeks later, the fevers were gone. And so was the leukemia.

There was no trace of it anywhere — no leukemic cells in his blood or bone marrow, no more bulging lymph nodes on his CT scan. His doctors calculated that the treatment had killed off two pounds of cancer cells.

To read the full NY Times article:  Click Here

 

E.coli and beef: New Rules Instituted

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The federal government will ban the sale of ground beef tainted with six toxic strains of E. coli bacteria that are increasingly showing up as the cause of severe illness from food. Officials have been under pressure from food safety advocates and some elected officials to do more to keep the potentially deadly bacteria out of meat, but the beef industry said the move was not needed and could force the price of ground beef to rise.


The new rule means that six relatively rare forms of E. coli will be treated the same as their notorious and more common cousin, a strain called E. coli O157:H7. That strain has caused deaths and illnesses and prompted the recall of millions of pounds of ground beef and other products. It was banned from ground beef in 1994 after an outbreak killed four children and sickened hundreds of people.


To read the entire NY Times article:  Click Here

 

FDA Affirms Safety of Breast Implants

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Remember years ago that Dow Corning controversy involving silicon breast implants and the connective tissue syndrome that some women developed?  Over the years much research was done which established the safety of these products.  A new study by the FDA has just been published which affirms the safely of breast implants.

Click Here to read the entire NY Times article.

 

Supplements can be dangerous to your health

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Marketing drugs in the guise of supplements is illegal in the United States. Tainted Pai You Guo found where Chinese supplements are sold is just one small part of that global business. Federal authorities are struggling to identify and intercept these black-market goods, which, they warn, pose grave health risks.

The makers of legal dietary supplements — the kind found at GNC, for example — acknowledge they are reluctant to raise too many alarms. Even though there is little evidence that many dietary supplements provide real health benefits, legal supplements, from multivitamins to ginkgo biloba, are a big and growing business. Americans spent $28.1 billion on them last year, up from $21.3 billion five years ago, according to estimates from Nutrition Business Journal, a market research firm.

Many millions more are also being spent annually on black-market products, particularly those marketed for weight lossbodybuilding and sexual enhancement. Some of these products, according to the F.D.A., contain amphetamines, synthetic steroids, laxatives and compounds like the active drug in Viagra. Officials say such products can cause heart attacks and strokes, and can damage the kidneys and liver. A few people in the United States, they say, have died after taking them.

To read this entire NY Times article, CLICK HERE

 

Vaccine Cleared as Autism Culprit

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Yet another panel of scientists has found no evidence that a popular vaccine causes autism. But despite the scientists’ best efforts, their report is unlikely to have any impact on the frustrating debate about the safety of these crucial medicines.

“The M.M.R. vaccine doesn’t cause autism, and the evidence is overwhelming that it doesn’t,” Dr. Ellen Wright Clayton, the chairwoman of the panel, assembled by the Institute of Medicine, said in an interview. She was referring to a combination against measles, mumps and rubella that has long been a focus of concern from some parents’ groups.

To read the entire NY Times article, CLICK HERE

 
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