The following article on food poisoning and foodborne outbreak disease was obtained from a recent issue of emedicine #175569. It is an overview that covers major topics and issues. It does not address travel medicine. But it would have direct relevance to community acquired disease, assessments for such diseases, and surveillance.
A recent article appeared in the Journal of Emergency Medicine that addresses medical malpractice, medical malpractice prevention, improved quality of care and documentation, and medical malpractice defense. Specific examples are given to illustrate general concepts. Since the article has particular relevance to the practice of emergency medicine, I include it here on my blog for those who are interested in reading it.
The US Food and Drug Administration (FDA) has issued a warning against use of alcohol and central nervous system depressant drugs (CNS), such as benzodiazepines and opioids, with sodium oxybate ( Xyrem, Jazz Pharmaceuticals) because of the risk for impaired consciousness and respiratory depression.
The drug, used to reduce episodes of cataplexy and treat daytime sleepiness in patients with narcolepsy, is already contraindicated for use with insomnia drugs. The new contraindications are reflected in labeling changes for the drug.
The US Food and Drug Administration (FDA) has added several drugs to its list of products to monitor because of possible signs of serious risks or new safety information. The drugs treat conditions that include cancer, epilepsy, hypertension, and malaria.
The agency spotted yellow flags for these drugs in the FDA Adverse Event Reporting System (FAERS) database during April, May, and June 2012.
Making the FDA's watch list does not mean that the agency has concluded that the drug actually poses the health risk reported through FAERS, formerly known as AERS. Rather, the agency will study the drug to determine whether there is truly a causal link. If it establishes a link, the FDA then would consider a regulatory response such as gathering more data to better characterize the risk, revising the drug's label, or requiring a risk-evaluation and mitigation strategy.
The FDA also is not suggesting that clinicians should stop prescribing watch-list drugs, or that patients should stop taking them, according to an agency press release.
The first consensus guidelines on how to evaluate, treat, and prevent carbon monoxide poisoning has recently been released and published in the American Journal of Repiratory and Critical Care Medicine. These guidelines standardize management of carbon monoxide poisoning for clinician, toxicologist, and public health worker, and offer a road map to attorneys prosecuting or defending a carbon monoxide exposure legal action. You can read more about these guidelines by obtaining the actual article from the journal. The citation is Hampson et al, Am J Respir Crit Care Med. 2012, October 18. epub, (ahead of print). The title of the article is: Practice Recommendation in the Diagnosis, Management, and Prevention of Carbon Monoxide Poisoning.
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.
FDA Adds 8 Drugs to Watch List
The US Food and Drug Administration (FDA) has added 8 drugs to its list of products to monitor because of possible signs of serious risks or new safety information. The drugs treat conditions that include cancer, epilepsy, hypertension, and malaria.
The agency spotted yellow flags for the 8 drugs in the FDA Adverse Event Reporting System (FAERS) database during April, May, and June 2012.
Children undergoing computed tomography (CT) scans with cumulative radiation doses of about 50 mGy had about triple the risk for leukemia, and those who received doses of about 60 mGy had nearly triple the risk for brain cancer, according to the results of a retrospective cohort study published online June 7 in the Lancet. Radiation exposure from CT scans in childhood could triple the risk of leukemia and brain cancer.
The study authors note that CT scans are very useful diagnostically, but that children are more radiosensitive than adults and may therefore have additional potential risks for cancer from ionizing radiation. The study goal was to determine the excess risk for leukemia and brain tumors after CT scanning in a cohort of children and young adults.
The American Heart Association (AHA) Stroke Council and other professional societies collaborated on a new guideline for the diagnosis and treatment of aneurysmal subarachnoid hemorrhage (aSAH), based on a formal literature search of MEDLINE from November 1, 2006, through May 1, 2010. Topics highlighted in the guideline included incidence, risk factors, prevention, natural history and outcome, diagnosis, prevention of rebleeding, surgical and endovascular repair of ruptured aneurysms, systems of care, and anesthetic management during repair. Also covered were management of vasospasm and delayed cerebral ischemia, management of hydrocephalus, management of seizures, and management of medical complications.
The objective of this guideline by Connolly and colleagues was to provide recommendations for goal-directed treatment of patients with aSAH. Although aSAH is a serious medical condition, early, aggressive, and expert care can dramatically affect the outcome.
The 5 new class I (level B) recommendations are as follows:
