Dr. Soumyadeep B

With Diwali- “the festival of lights” round the corner  I thought of running up a (non) systematic review of medical literature on the effects of Diwali. The review aimed to capture the effects of Diwali on health et al .

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Dr. Soumyadeep B

Scientists from University of Maryland School of Public Health has found the presence of  “superbug” methicillin-resistant Staphylococcus aureus (MRSA) in several wastewater treatment plants in the USA-thus identifying the first environmental source of MRSA bacteria in the United States.

The study by Goldstein et Al published in the November 2012  issue of the journal Environmental Health Perspectives assumes immense significance on account of the fact that reusing reclaimed wastewater (from where these superbugs originate) is fast increasing globally.

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United Nations declares November 10 as ‘Malala Day’.

The United Nations has declared November 10 as ‘Malala Day’ in honour of Pakistani teeenage rights activist Malala Yousafzai, who was shot in the head by the Taliban last month for campaigning for girls’ education.

UN Secretary General Ban Ki-moon‘s Special Envoy for Global Education, former British Prime Minister Gordon Brown, has said November 10 has been declared Malala Day.

“This Saturday (November 10th) will see Malala Day, a global event to show the world that people of all creeds; all sexes, all backgrounds and all countries stand behind Malala,” Brown said.

“We are Malala – This is Malala day. The world to walk in the footsteps of this girl of courage. Malala Yousafzai has become a global icon of hope, an international symbol of courage, a schoolgirl who has won the hearts of millions through her bravery.

“Malala’s dream is a Pakistan where she, her friends and future generations of girls could attend school, walk freely into a classroom, learn and reach their full potential.”

The UN chief said citizens from across the globe are speaking out for Yousafzai and on behalf of the 61 million children who do not go to school.

“I am adding my voice to the messages from over one million people across the globe. Education is a fundamental human right. It is a pathway to development, tolerance and global citizenship,” Ban said in a brief video message posted on the UN website.

He called the international community to join the UN campaign to put education first “for Malala and girls and boys throughout the world”.

Events have been planned in over 100 countries, from the UK and USA to Mexico, India, Australia and Sierra Leone to mark the day.

In the UK where there is a host of local events, the most poignant event will take place in Lozells, Birmingham only a few miles away from Malala’s hospital.

Baroness Sayeeda Warsi, Britain’s Senior Minister of State at the Foreign Office and Minister for faith and communities, hailed Malala Yousufzai’s inspirational activism ahead of Malala Day today.

Baroness Warsi, said: “Through her inspirational activism Malala has bravely highlighted the need for education to be accessible to all children in Pakistan.

“Education is the single most important factor that can transform Pakistan’s future.”

Thousands of people from across the world have signed a global petition calling for her to be awarded the Nobel Peace Prize. Malala is recovering in a British hospital from gun shot wounds and has received messages of support for her cause from global leaders, including US President Barack Obama.



An Animated Adaptation of Carl Sagan’s Pale Blue Dot.

Thirty-five years ago today, the Voyager 1 launched into space in a quest to explore the outer Solar System and carried with it the Golden Record, an ultimate mixtape of humanity’s sounds that was also a record of how Carl Sagan and Annie Druyan fell in eternal love. There’s hardly a better way to celebrate the Voyager’s legacy than with Sagan’s iconic, timeless, infinitely humbling yet awe-inspiring Pale Blue Dot (public library), based on the photograph of the same title taken by the Voyager 1 in 1990.

Look again at that dot. That’s here. That’s home. That’s us. On it everyone you love, everyone you know, everyone you ever heard of, every human being who ever was, lived out their lives. The aggregate of our joy and suffering, thousands of confident religions, ideologies, and economic doctrines, every hunter and forager, every hero and coward, every creator and destroyer of civilization, every king and peasant, every young couple in love, every mother and father, hopeful child, inventor and explorer, every teacher of morals, every corrupt politician, every ‘superstar,’ every ‘supreme leader,’ every saint and sinner in the history of our species lived there — on a mote of dust suspended in a sunbeam.

The Earth is a very small stage in a vast cosmic arena. Think of the endless cruelties visited by the inhabitants of one corner of this pixel on the scarcely distinguishable inhabitants of some other corner, how frequent their misunderstandings, how eager they are to kill one another, how fervent their hatreds. Think of the rivers of blood spilled by all those generals and emperors so that, in glory and triumph, they could become the momentary masters of a fraction of a dot.

Our posturings, our imagined self-importance, the delusion that we have some privileged position in the Universe, are challenged by this point of pale light. Our planet is a lonely speck in the great enveloping cosmic dark. In our obscurity, in all this vastness, there is no hint that help will come from elsewhere to save us from ourselves.

The Earth is the only world known so far to harbor life. There is nowhere else, at least in the near future, to which our species could migrate. Visit, yes. Settle, not yet. Like it or not, for the moment the Earth is where we make our stand.

It has been said that astronomy is a humbling and character-building experience. There is perhaps no better demonstration of the folly of human conceits than this distant image of our tiny world. To me, it underscores our responsibility to deal more kindly with one another, and to preserve and cherish the pale blue dot, the only home we’ve ever known.

Understanding the Effect of Healthcare Workers’ Hand Hygiene.

Using a novel method, investigators revealed marked heterogeneity in healthcare worker interactions and in the potential consequences of their hand hygiene.

Attempts to understand disease transmission in healthcare settings have generally assumed that healthcare workers (HCWs) move and interact uniformly. However, observational studies have suggested the possibility of peripatetic “superspreaders” who have greater-than-average mobility and interactivity — and thus more opportunity to spread infection. In a recent study conducted in the medical intensive care unit of a university hospital, researchers assessed this possibility.

The researchers used small electronic badges worn by HCWs, together with fixed-position beacons, to determine patterns of HCW movement and interactions within this 20-bed unit. They then used these data to mathematically model the effect of HCW hand hygiene on pathogen transmission.

During the 48-hour period of analysis, the average number of contacts (HCW–HCW and HCW–patient) per HCW was 80.1 for day shifts and 76.1 for night shifts. However, a few HCWs were responsible for a disproportionately large share of the contacts. Modeling the effect of hand-hygiene activity on disease transmission showed that spread of a pathogen would be significantly greater with noncompliance of a few high-contact staff members than with noncompliance of an equal number of low-contact workers.

Comment: Hand hygiene is a central tenet of infection control, yet since the original work of Semmelweis, there has been relatively little research on the direct effects of hand-hygiene behavior on disease transmission. Hornbeck and colleagues have provided new insights into HCW contacts, which can help us to understand the role of hand hygiene in preventing nosocomial spread of pathogens and thus to develop more-sophisticated approaches for improving its efficacy.

Source: Journal Watch Infectious Diseases










Ketamine Does Not Increase Intraocular Pressure in Children.

No clinically relevant increase in intraocular pressure was noted in children receiving ketamine for procedural sedation for nonocular conditions.

To address the common belief that ketamine increases intraocular pressure, researchers prospectively evaluated the effect of intravenous ketamine on intraocular pressure in previously healthy children ages 1 to15 years who underwent procedural sedation for nonocular complaints at a tertiary care pediatric emergency department. Intraocular pressure was measured with a Tono-Pen XL tonometer immediately after and 2.5, 5, and 10 minutes after ketamine administration. A pressure difference of at least 15% was considered clinically relevant.

Over 16 months, 80 children were enrolled and received a mean ketamine does of 1.6 mg/kg. No clinically relevant difference was found between mean intraocular pressure immediately after and 2.5 minutes after ketamine administration (17.5 mm Hg and 18.9 mm Hg). Analysis of variance between age groups (1–5, 6–10, and 11–15 years) revealed a nonclinically relevant but statistically significant increase in intraocular pressure over the entire 10-minute study period (changes <2.5 mm Hg).

Comment: These authors provide convincing evidence that ketamine does not increase intraocular pressure at doses used for procedural sedation. It is unlikely that the result would differ substantially in children with ocular complaints. When ketamine is the best choice for pediatric sedation, providers can use it without fear of iatrogenic ocular damage.

Source: Journal Watch Emergency Medicine

Acid Suppression and Effectiveness of Ampicillin for Helicobacter Pylori.

At a low pH, H. pylori bacteria stopped dividing, making ampicillin ineffective. More sustained acid suppression might be useful for refractory infections.

Standard therapy for treating Helicobacter pylori infection typically includes ampicillin, a second antibiotic, and a proton-pump inhibitor (PPI). However, the effectiveness of this regimen has been decreasing with increasing antibiotic resistance. Because ampicillin acts on bacterial cell walls and requires actively dividing bacteria to be effective, investigators examined whether H. pylori growth — and, consequently, ampicillin effectiveness — was affected by gastric pH level.

H. pylori were incubated in dialysis chambers with 5 mM urea and varying pH levels with or without ampicillin for 4, 8, or 16 hours. Changes in the expression of genes associated with bacterial growth, viability, and survival were determined.

Ampicillin was bactericidal at pH levels of 4.5 or 7.4, but at a pH level of 3.0, the bacteria seemed to become dormant, with decreased expression of a host of genes associated with cell envelope biosynthesis. In this environment, ampicillin did not affect bacterial viability or survival.

The authors suggest that PPIs are associated with nocturnal acid breakthrough that might reduce the pH level, rendering ampicillin ineffective, and that more persistent acid reduction could potentially improve the clinical effectiveness of amoxicillin therapy.

Comment: This paper provides a compelling argument for the importance of PPI therapy in antibiotic treatment of H. pylori. It further suggests that sustained acid reduction should be the goal to improve the effectiveness of ampicillin or other drugs that require bacterial growth. The frequency of nocturnal acid breakthrough is likely overstated, and the ability of PPI therapy to maintain a pH of 4.5 is likely better than the authors suggest. The decreasing eradication rate is associated with antibiotic resistance, often to the second antibiotic (e.g., clarithromycin). Knowing the patterns of antibiotic resistance in a population will allow for more effective therapy. In refractory cases, higher PPI doses to sustain a high pH might be a reasonable approach to optimizing the effectiveness of the antibiotic that requires active cell growth.

Source: Journal Watch Gastroenterology

Statins as Anticancer Drugs?

In an observational study with limitations, statin use by cancer patients was associated with lower 3-year mortality.

In some basic science studies, statins inhibit cancer growth through various pathways. These observations raise the following question: Could statins lower cancer-related mortality? Danish researchers used national databases to address this question.

Among nearly 300,000 people who received cancer diagnoses between 1995 and 2007, 6% had used statins regularly before and after their diagnoses. During average follow-up of 3 years (but as long as 15 years in some cases), two thirds of the patients died. In analyses adjusted for several confounding variables, statin use was associated with a significant 15% drop in all-cause and cancer-related deaths. Mortality reductions were noted for most cancer types (although differences did not reach statistical significance for every type).

Comment: This observational study suggests that statins might influence tumor growth favorably in patients with cancer. In contrast, a recent meta-analysis of randomized trials showed that statins did not increase or decrease the incidence of cancer (PLoS One 2012; 7:e29849). An editorialist notes that the current analysis could not be controlled for several potentially important confounding factors and recommends caution in interpreting the findings. Until these results are confirmed or refuted by additional research, clinicians will have to decide whether to apply them to cancer patients; at the least, one might argue that patients who already are taking statins (and tolerating them) at the time of cancer diagnosis should continue.

Source: Journal Watch General Medicine

Asthma Linked To Menstrual Cycle; Hormones Affect Respiratory Symptoms In Women.

A new study suggests that a woman’s menstrual cycle can affect respiratory symptoms, potentially exacerbating conditions such as asthma.

According to the BBC, Norwegian researchers studied thousands of women with regular menstrual cycles and found that respiratory symptoms became more severe around the time of ovulation.

“The effects of the menstrual cycle on respiratory symptoms in the general population have not been well studied,” said lead author Ferenc Macsali of Norway’s Haukeland University Hospital. “In a cohort of nearly 4,000 women, we found large and consistent changes in respiratory symptoms according to menstrual cycle phase, and, in addition, these patterns varied according to body mass index (BMI), asthma, and smoking status.”

Outcome Magazine summarized the findings:

Significant variations over the menstrual cycle were found for each symptom assessed in all subjects and subgroups. Reported wheezing was higher on cycle days 10-22, with a mid-cycle dip near the putative time of ovulation (~days 14-16) in most subgroups.

Shortness of breath was highest on days 7-21, with a dip just prior to mid-cycle in a number of subgroups. The incidence of cough was higher just after putative ovulation for asthmatics, subjects with BMI ≥ 23kg/m2, and smokers, or just prior to ovulation and the onset of menses in subgroups with a low incidence of symptoms.

The BBC notes that “of those studied, 28.5 percent were smokers and 8 percent had been diagnosed with asthma.”

The study was published online Nov. 9 in the American Thoracic Society‘s American Journal of Respiratory and Critical Care Medicine.

“Our finding that respiratory symptoms vary according to the stage of the menstrual cycle is novel, as is our finding that these patterns vary according to BMI and smoking status,” Macsali said in a journal news release, according to HealthDay News. “These relationships indicate a link between respiratory symptoms and hormonal changes through the menstrual cycle.”

Macsali added that the results may help women with asthma better manage their symptoms.

“Our results point to the potential for individualizing therapy for respiratory diseases according to individual symptom patterns,” he said. “Adjusting asthma medication, for example, according to a woman’s menstrual cycle might improve its efficacy and help reduce disability and the costs of care.”

Dr. Samantha Walker of charity Asthma UK concurred.

“This research is really interesting, and could help women with asthma to manage their condition better,” Walker told the BBC. “Asthma can be triggered by many different things, and this varies from person to person — but we always encourage people with asthma to be aware of things that trigger their symptoms so that they can take steps to control them.

Though this study may be “novel” in its findings, it would not be the first to find a link between a woman’s menstrual cycle and changes in asthma symptoms.

In 1996, the New York Times reported that a study published in the Archives of Internal Medicine had provided evidence to support this connection.

The study, which had looked at the menstrual phase of 182 female patients who needed emergency-room treatment for asthma at hospitals in Pennsylvania, found that “hormonal changes that occur as menstruation starts may make some asthmatic women more vulnerable to attacks.” Specifically, researchers found that 20 percent of the patients were preovulatory and 24 percent were in the ovulatory phase when the attacks occurred.

The Times also pointed out that the possibility of such a link had been first reported in a medical journal in 1931, though it was a connection that had “never been proved or studied extensively” before.

According to statistics provided by the Asthma and Allergy Foundation of America, nearly 25 million Americans suffer from asthma and more than 3,300 die from the condition every year. The condition is also said to be more prevalent among adult women than men.