Month: November 2023

Nov 28

Sign up now to donate blood with the Hopewell Township Health Department on December 7th

Help us strengthen our community this holiday season! The Hopewell Township Health Department is partnering with Miller-Keystone Blood Center on December 7, 2023, to hold our first annual blood drive. Registration is available online at https://donor.giveapint.org/donor/schedules/drive_schedule/87109 (or scan the QR code on the flyer). Blood donated through MKBC remains here in our local community to be used in the treatment of cancer patients, accident victims, premature babies, surgery and transplant patients, and others in need of lifesaving blood transfusions. Blood donation is a noble act, no matter where you do it. But when you give through Miller-Keystone, you are doing more to help your family, your friends, and your neighbors by helping to ensure that the blood needs of our regional hospitals are met. Blood donation truly is the gift of life. Please contact Public Health Nurse Debbie Flanders at 609-537-0238 or [email protected] with any questions.

Nov 28

Flu vaccine reduces risk for heart attack, cardiovascular death

November 29, 2023 2 min read Add topic to email alerts Receive an email when new articles are posted on Please provide your email address to receive an email when new articles are posted on . <button type="button" class="btn btn-primary" data-loading-text="Loading ” data-action=”subscribe”> Subscribe Added to email alerts We were unable to process your request. Please try again later. If you continue to have this issue please contact [email protected]. Back to Healio Key takeaways: Influenza vaccination was associated with a 20% reduced risk for cardiovascular death. Researchers said providers should target patients with CVD for vaccination to mitigate risks. Influenza vaccination was linked to significant decreased risks for major cardiovascular events and death, according to a study published in Scientific Reports. “Differing viewpoints exist regarding the impact of influenza vaccination on CVDs,” Fatemeh Omidi, MD, an assistant professor in the department of cardiology at Shahid Beheshti University of Medical Sciences in Iran, and colleagues wrote. “While certain observational investigations suggest a favorable correlation between influenza vaccination and the reduction in occurrences of cardiovascular incidents like acute [myocardial infarction (MI)], contrasting epidemiological studies propose the limited efficacy of influenza vaccines.” The researchers said an updated and comprehensive review on the association between influenza vaccination and CVD outcomes is “imperative.” So, they conducted a systematic review and meta-analysis of five studies with 9,059 patients who were randomly assigned to receive either a standard intramuscular influenza vaccination (n = 4,529) or intramuscular placebo (n = 4,530). Overall, there were 517 cases of major cardiovascular events among patients who received influenza vaccination, compared with 621 cases among those who received placebo (RR = 0.7; 95% CI, 0.55-0.91). The analysis also revealed a risk reduction for MI (RR = 0.74; 95% CI, 0.56-0.97) and a 20% risk reduction for cardiovascular death events (RR = 0.67; 95% CI, 0.45-0.98) among vaccinated patients. Such findings “underscore the potential impact of influenza vaccination in safeguarding against adverse cardiovascular outcomes among vulnerable patient populations,” the researchers wrote. They highlighted several possible mechanisms behind the findings. For example, influenza infections can weaken the immune system and make it susceptible to secondary infections, which “can exacerbate cardiovascular conditions,” Omidi and colleagues wrote. “Influenza vaccination’s role in preventing these secondary infections may indirectly contribute to the reduction in CVDs,” they wrote. The researchers added that influenza infections likely cause systemic inflammation, which can contribute to the progression of CVDs and atherosclerosis. “By targeting patients with recent CVDs for influenza vaccination, health care providers have a potential opportunity to mitigate the risk of cardiovascular death in a cost-effective and widely available manner,” Omidi and colleagues wrote. “Influenza vaccination programs could be tailored to prioritize this high-risk group, thus potentially reducing the overall burden on health care systems and improving patient outcomes.” They concluded that further research is still needed “to elucidate the precise mechanisms driving this association and to explore the long-term impact of influenza vaccination on cardiovascular outcomes.” Read more about Add topic to email alerts Receive an email when new articles are posted on Please provide your email address to receive an email when new articles are posted on . <button type="button" class="btn btn-primary" data-loading-text="Loading ” data-action=”subscribe”> Subscribe Added to email alerts We were unable to process your request. Please try again later. If you continue to have this issue please contact [email protected]. Back to Healio

Nov 28

Opinion | CDC Advisors’ Infection Control Guidance Leaves Us Unprotected

Ross is a nurse and co-president of a nurses’ union. Thomason is an industrial hygienist. Earlier this month, the CDC’s Healthcare Infection Control Practices Advisory Committee (HICPAC) voted unanimously to approve its draft infection control guidelines and send it to the CDC for review. This extremely influential document, which was last updated 16 years ago, will be referenced by hospitals and other healthcare facilities to set their infection control policies. However, we’re concerned that the draft offers minimal recommendations to the CDC, and even worse, incorrectly treats surgical masks as respiratory protection. This unscientific guidance puts the U.S. in a weak position to protect patients and staff from currently circulating viruses and will leave us behind the curve in battling future pandemics. One of the biggest issues is with the new “air” category for pathogen transmission. The category includes three levels of precautions based on the transmissibility of a respiratory pathogen: “routine,” “special,” or “extended.” The guidance states that “routine” air precautions — the lowest level — are to be used with “common, often endemic, respiratory pathogens that spread predominantly over short distances.” But any delineation of endemic versus pandemic pathogens is arbitrary because the transmission mode of an aerosol-transmissible pathogen remains the same, so protections should also remain the same. (Note the draft guidelines don’t refer to “pandemic pathogens”; the “special” guidelines refer to “new or emerging” respiratory pathogens for which “effective treatments aren’t available.”) At the “routine” level, HICPAC recommends that masks be worn – but the committee indicates that surgical masks can be used, and healthcare workers may “choose voluntarily” to wear a higher level of protection. At this “routine” level, HICPAC recommends that masks be worn — but they indicate that surgical masks can be used, and healthcare workers may “choose voluntarily” to wear a higher level of protection. Why is HICPAC suggesting that surgical masks offer sufficient respiratory protection? The FDA, the Occupational Safety and Health Administration, the National Institute for Occupational Safety and Health, and even the CDC have indicated that surgical masks do not offer respiratory protection, especially against aerosol particles. These masks are loose fitting and do not filter the air breathed in by the wearer. HICPAC’s “flexible” guidance will result in inadequate protection for healthcare workers. Follow the Science Nurses are scientists. We follow the precautionary principle, which means we do not wait for proof of harm before taking action to protect people’s health. In other words, we should use the highest level of protections when confronted with a novel virus, and ground these decisions in the evidence: numerous studies show that COVID is spread primarily via aerosol transmission. HICPAC members claim that this part of the guidance is written to be “pathogen agnostic,” and a second part on infection control protocols for individual pathogens — including viruses like COVID-19 — is expected to be completed next year. But approving the “pathogen agnostic” guidance leaves us unprotected. Part of the issue stems from the lack of frontline healthcare workers, unions, or patients on the committee. As a result, we are at risk. We feel betrayed by the institutions that are supposed to safeguard our health. HICPAC’s vote lets us know that nurses and other healthcare workers are expendable to our employers — despite the staffing crisis. The message to us: We are not heroes. We are disposable. Flashbacks to Early COVID “We’re following CDC guidance,” was the answer many registered nurses got in 2020 when we were given a surgical mask instead of an N95 respirator or told to reuse single-use disposable N95s, forcing nurses to risk their lives to care for patients. In April 2020, RNs at Providence Saint John’s Health Center in Santa Monica, California were suspended when they refused to go into COVID patient rooms without an N95. That same month, Celia Yap-Banago, RN, who worked in the cardiac telemetry unit at Research Medical Center in Kansas City, Missouri, died because she contracted COVID at work after her employer failed to screen a patient with active COVID symptoms and did not give her an N95. She had previously raised concerns about the lack of personal protective equipment (PPE) at her hospital. Her employer had allegedly moved PPE from all units to one floor of the hospital so it was not available on her unit, which was not “supposed to” have COVID patients. Back then, the CDC gave healthcare employers flexibility to conduct their own risk assessment. Employers were following the CDC’s crisis and contingency standards that said a surgical mask was acceptable. The result was an enormous number of avoidable COVID infections and tragic deaths among healthcare workers at a time when their care was so desperately needed. We Need Stronger Guidance The committee’s new recommendations propose to give employers the same kind of flexibility that we’ve seen lead to needless illness and death. The draft guidance lets employers decide whether to implement the recommendations based on their own risk assessment. If the CDC approves the draft, it will lead to unnecessary infections, deaths, and long-term health consequences from a wide range of pathogens, including COVID, influenza, and RSV. After nearly 4 years of living with the COVID pandemic, we have all learned hard lessons about PPE and how healthcare employers often focus on the bottom line rather than protecting healthcare workers and patients. What healthcare workers need is more protection, guided by clear and specific guidance for employers. The updated infection control guidance must follow the science. We urge the CDC to reject HICPAC’s guidelines and create a new draft. Input from a broad range of stakeholders must be included: frontline nurses, other healthcare workers who will be implementing the infection control guidance, healthcare worker unions, and experts in infection prevention, ventilation engineering, respiratory protection, and industrial hygienists who have previously been excluded and ignored in HICPAC’s process. It’s time to revise, and it’s time to get the science right. Jean Ross, RN, is a nurse and a president of National Nurses United, the largest union

Nov 28

Enlarged fistulotomy of the papilla as access to the biliary tract during ERCP

This is a cross-sectional study of patients who were referred for ERCP, routine and urgent cases, which were systematically evaluated and performed by operators with experience in the applied procedure. Data collection was performed retrospectively from an electronic database, including exams performed from November 20, 2006 to August 12, 2022 at Endoclinic SP. A total of 2064 patients and 2233 consecutive ERCP exams were included in the initial analysis in this period. Patients underwent ERCP examination with direct cannulation and CP (conventional papillotomy) or, if the latter failed, they migrated to the EFP group. All ERCP cases, both those submitted to CP and EFP, were singly evaluated, and both groups were analyzed in terms of cannulation success and its complications. The evaluated patients underwent the examination and the diagnoses were grouped as follows: a) choledocholithiasis; b) ERCP with minimal changes, such as dilatation of the CBD beyond 12 mm in diameter without an obstructive factor, history of jaundice or pancreatitis, tests indicated by imaging or laboratory tests with unconfirmed suspicion of stones or obstruction. Obstructive bile duct neoplasms were divided and grouped as follows: c) pancreatic head neoplasm; d) neoplasms of the hepatic hilum (cholangiocarcinoma, extrinsic compression by metastases); and e) neoplasms of the papilla of Vater. Benign lesions were grouped into: f) benign fibrotic strictures (undetermined strictures, late postoperative sequelae, papillitis or fibrotic thinning of the distal common bile duct); g) Mirizzi syndrome; h) early postoperative complications of the bile ducts, such as partial or total ligations, fistulas, and strictures; i) sclerosing cholangitis; j) chronic pancreatitis; and k) other diagnoses, such as choledochal cyst, and cholelithiasis. The exam reports and images obtained during this period were recorded and saved in a database (OCRAM® system). The data mined for the composition of the research were extracted from the relational database MySQL Community, version 5.5.40, software, entitled OCRAM Capture of Medical Images and Reports. This system was developed using the Java programming language and was used to capture the photos of the ERCP exams and compose the respective reports during the study period. The ERCP reports were typed using OCRAM software were structured in XML (Extensible Markup Language) format and followed an XML-Schema according to W3C (Worldwide Web Consortium) standards, resulting in a well-formed, valid and standardized structure of the ERCP reports in XML, this allowed the mining of terms referring to diseases to be performed reliably through the declarative search language SQL (Structured Query Language) in conjunction with an XML DOM (Document Object Model) parser [11]. Inclusion criteria All patients were submitted to an attempt at cannulation through the ostium of the papilla with a sphincterotome and guide wire. When direct cannulation of the common bile duct is not achieved and the guide wire goes into the pancreatic duct, we opt for the double guide wire technique. This technique was used in many of the cases described here and these cases were grouped as successful cannulation through the ostium. We defined cannulation failure after performing the following tactics: a) access to the common bile duct was not achieved after at least 4 attempts with a guide wire; b) attempts at cannulation after injection of a small amount of contrast to identify the common bile duct and the pancreatic duct; c) if the guidewire goes only to the pancreatic duct, we perform the double guidewire technique and, if the second guidewire fails to gain access to the biliary tract, we consider it as a failure. The cases of cannulation failure migrated to EFP, according to the criteria of the fistulotomy technique. Exclusion criteria Of the 2064 patients initially evaluated in the electronic system, 105 patients in whom there were anatomical changes that made it impossible to perform ERCP: surgeries such as Roux-en-Y or Billroth II gastrectomy, or esophageal, stomach or duodenal stenosis were excluded. A total of 1959 patients and 2233 exams remained for the final analysis. Intervention All patients had their exams previously evaluated and underwent preparation with a 12-hour fast before the procedure. Patients who were using antiplatelet agents and anticoagulants were instructed to discontinue these medications. The use of ciprofloxacin 500 mg every 12 hours was indicated for all patients, starting from 6 hours when there was no increase in bilirubin and 24 hours previously in cases of bile duct obstruction in patients with elevated bilirubin levels. All patients were initially submitted to the standard cannulation technique, using the 3-way sphincterotome and 0.035 or 0.025 guide wire, depending on the availability of the brands Olympus®, Boston®, Cook®, MediGlobe®, Scitech® or GFE®. The WEM® electrosurgical generator, model SS200A, was used in all cases. In the case of cannulation failure, following the criteria for indicating early fistulotomy, the patients underwent EFP. After cannulation failure (defined as failing to introduce the guide wire into the bile duct five times, even after injecting a small amount of contrast into the papilla ostium, or the guide wire inadvertently being directed into the pancreatic duct), our preference was to perform EFP early, avoiding trauma to the papilla and the injection too much contrast (Fig. 1). Fig. 1 Algorithm for access to the common bile duct Full size image After identification and “palpation” with the tip of the fistulotome of the lateral limits of the papilla and exposure of the infundibulum, a wide, shallow incision only of the papillary mucosa was iniciated and, purely cut, with the fistulotome needle adjusted to approximately 2 mm, from top to bottom, just below the transverse crease, avoiding opening the region of the common channel. With the needle-knife, the needle was retracted, and the mucosal edges were pushed aside to expose the submucosa. Lateral incisions were made to expand the exposure and then superficial incisions were made to open the submucosa and, dissect thin layers one at a time, interspersed by blunt dissection with the tip of the needle-knife retracted; these steps were followed by identification of vessels, hemostasis and exposure of the sphincter muscle of the distal common bile duct. If bleeding occured, washing was performed with pressurized water through the fistulotome catheter

Nov 28

China’s HIV Infection Rates Shoot Up Among Seniors

What’s new: China’s population of seniors living with HIV more than doubled from 2015 to 2019 and had a higher rate of new diagnoses than in the U.S. or Europe, a recent study showed. The number of people 60 or older with newly reported HIV infections shot up to 37,275 from 17,451 over those five years, according to a study published in the Chinese Journal of Epidemiology on Nov. 17. While that number fell over the next three years, it remained elevated at just over 27,000 last year. Register to read this article for free. Register

Nov 28

Global warming could drive the emergence of new fungal pathogens

Increased heat tolerance in fungi with pathogenic potential due to global warming could bring new fungal diseases. The field of infectious diseases is unique in medicine because it routinely faces new and unexpected syndromes and illnesses. For example, HIV, SARS-CoV, Candida auris and SARS-CoV-2 all emerged in human populations, causing diseases that were previously unknown to medicine. The two major sources of new infectious diseases are likely zoonosis, which refers to the acquisition of infections from non-human hosts, and the environment. Evidence suggests that human infection with HIV, SARS-CoV and SARS-CoV-2 is a result of zoonosis via other mammalian hosts, whereas C. auris is an environmental fungus that has recently emerged as a major human fungal pathogen. 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support Fig. 1: Experimental infection of rabbits and mice provides evidence for a role of temperature in protecting against fungal infection, conferred by endothermy and adaptive immunity. References Fisher, M. C. et al. mBio 11, e00449–20 (2020). PubMed PubMed Central Google Scholar Robert, V. A. & Casadevall, A. J. Infect. Dis. 200, 1623–1626 (2009). Article PubMed Google Scholar Bergman, A. & Casadevall, A. mBio 1, e00212–10 (2010). Article PubMed PubMed Central Google Scholar Casadevall, A. PLoS Pathog. 8, e1002808 (2012). Article CAS PubMed PubMed Central Google Scholar Perfect, J. R., Lang, S. D. & Durack, D. T. Am. J. Pathol. 101, 177–194 (1980). CAS PubMed PubMed Central Google Scholar Meteyer, C. U. et al. J. Wildl. Dis. 47, 618–626 (2011). Article PubMed Google Scholar Rowley, J. J. & Alford, R. A. Sci. Rep. 3, 1515 (2013). Article CAS PubMed PubMed Central Google Scholar de Crecy, E. et al. BMC Biotechnol. 9, 74 (2009). Article PubMed PubMed Central Google Scholar Huang, C. J. et al. Mol. Biol. Evol. 35, 1823–1839 (2018). CAS PubMed Google Scholar Mead, H. L. et al. J. Fungi 6, 366 (2020). Article Google Scholar Robert, V., Cardinali, G. & Casadevall, A. BMC Biol. 13, 18 (2015). Article PubMed PubMed Central Google Scholar McLean, M. A., Angilletta, M. J. & Williams, K. S. J. Therm. Biol. 20, 384–391 (2005). Article Google Scholar Casadevall, A., Kontoyiannis, D. P. & Robert, V. mBio 10, e01397–19 (2019). PubMed PubMed Central Google Scholar Arora, P. et al. mBio 12, e03181–20 (2021). PubMed PubMed Central Google Scholar Desnos-Ollivier, M. et al. PLoS ONE 7, e32278 (2012). Article CAS PubMed PubMed Central Google Scholar Download references Acknowledgements A.C. was supported by National Institutes of Health grants AI052733-16, AI152078-01 and HL059842-19. Author information Authors and Affiliations Department of Molecular Microbiology and Immunology, Johns Hopkins School of Public Health, Baltimore, MD, USA Arturo Casadevall Authors Arturo Casadevall View author publications You can also search for this author in PubMed Google Scholar Corresponding author Correspondence to Arturo Casadevall. Ethics declarations Competing interests The author declares no competing interests. Peer review Peer review information Nature Microbiology thanks Asiya Gusa and the other, anonymous, reviewer(s) for their contribution to the peer review of this work. Rights and permissions Reprints and Permissions About this article Cite this article Casadevall, A. Global warming could drive the emergence of new fungal pathogens. Nat Microbiol (2023). https://doi.org/10.1038/s41564-023-01512-w Download citation Published: 29 November 2023 DOI: https://doi.org/10.1038/s41564-023-01512-w Share this article Anyone you share the following link with will be able to read this content: Get shareable link Sorry, a shareable link is not currently available for this article. Copy to clipboard Provided by the Springer Nature SharedIt content-sharing initiative

Nov 28

Supplement lowers risk of higher glucose caused by blood-pressure drug

DALLAS – Nov. 29, 2023 – A dietary supplement developed by a UT Southwestern Medical Center researcher significantly reduced high blood sugar caused by a diuretic used to lower blood pressure while also correcting electrolyte imbalances, UTSW researchers report. The findings, published in Hypertension, could offer a solution for the serious side effects associated with this class of drugs. Wanpen Vongpatanasin, M.D., Professor of Internal Medicine and Director of the Hypertension Section in the Division of Cardiology at UT Southwestern, holds the Norman and Audrey Kaplan Chair in Hypertension and the Fredric L. Coe Professorship in Nephrolithiasis Research in Mineral Metabolism. “When patients take a medication, they want to treat one disease and not cause another. These findings suggest we may be able to reduce the risk of elevated blood sugar caused by thiazide diuretics with a simple supplement,” said Wanpen Vongpatanasin, M.D., Director of the Hypertension Section in the Division of Cardiology at UT Southwestern. Dr. Vongpatanasin co-led the study with Charles Pak, M.D. Both are Professors of Internal Medicine and in the Charles and Jane Pak Center for Mineral Metabolism and Clinical Research. Millions of Americans take thiazide diuretics, a class of medications used to treat high blood pressure, a risk factor for cardiovascular disease. Although these drugs are very effective, Dr. Vongpatanasin said, they come with significant side effects, including reduced levels of the electrolyte potassium in the blood; higher cholesterol, triglycerides, and other circulating lipids; and elevated glucose (blood sugar), a precursor to Type 2 diabetes. The increase in glucose prompted by these drugs has long been attributed to the decrease in potassium levels. Although low potassium is effectively treated with potassium chloride (KCl) supplements, Dr. Vongpatanasin explained, they don’t seem to affect glucose levels. Thiazide diuretics also can reduce levels of magnesium, another important electrolyte, in blood. To help solve this problem, UT Southwestern researchers previously tested a supplement developed by Dr. Pak that combines potassium, magnesium, and citrate – an acidic compound found in fruits and vegetables. After administering this supplement to patients on thiazide diuretics for three weeks, the researchers found it to be effective at raising potassium and magnesium levels. However, that study was too short to examine the supplement’s effects on glucose. A randomized, double-blind study was conducted on 60 patients taking the thiazide diuretic chlorthalidone for 16 weeks, with half also receiving the combination supplement KMgCit and the other half supplemented only with KCl. During an initial three-week period when patients took the diuretic but didn’t take the supplements, both groups experienced significant reductions in potassium and magnesium and increases in fasting glucose levels. However, once the patients began supplementation, those on KCl increased their potassium levels, and those on KMgCit increased both potassium and magnesium levels. Although glucose measurements stayed high for the KCl group, they dipped an average of 7.9 milligrams per deciliter for the KMgCit group – a significant reduction. Although it’s unclear which component in the combination supplement lowered glucose, previous studies have shown that deficiencies in magnesium can have wide-ranging negative metabolic effects. Future studies will examine the effects of magnesium and citrate separately, Dr. Vongpatanasin said, as well as confirm these effects in more patients on thiazide diuretics for longer durations. Other UTSW researchers who contributed to this study are Orson Moe, M.D., Professor of Internal Medicine and Physiology and Director of the Charles and Jane Pak Center for Mineral Metabolism and Clinical Research; Jimin Ren, Ph.D., Associate Professor, Advanced Imaging Research Center and Radiology; Jijia Wang, Ph.D., Assistant Professor of Applied Clinical Research in the School of Health Professions; John M. Giacona, Ph.D., M.P.A.S., PA-C, CHC, Physician Assistant, Internal Medicine; Danielle Pittman, B.S.N., RN, CEN, Senior Business Analyst; Ashley Murillo, B.S.N., RN, Research Nurse; and Talon Johnson, Ph.D., Postdoctoral Fellow. Dr. Vongpatanasin holds the Frederic L. Coe Professorship in Nephrolithiasis Research in Mineral Metabolism and the Norman and Audrey Kaplan Chair in Hypertension. Dr. Pak holds the Alfred L. and Muriel B. Rabiner Distinguished Academic Chair for Mineral Metabolism Biotechnology Research. Dr. Moe holds the Donald W. Seldin Professorship in Clinical Investigation and The Charles Pak Distinguished Chair in Mineral Metabolism. This research was funded by a Pak Center Endowed Professor Collaborative Support Grant. Drs. Pak, Vongpatanasin, and Moe hold a patent for KMgCit. About UT Southwestern Medical Center UT Southwestern, one of the nation’s premier academic medical centers, integrates pioneering biomedical research with exceptional clinical care and education. The institution’s faculty members have received six Nobel Prizes and include 26 members of the National Academy of Sciences, 20 members of the National Academy of Medicine, and 13 Howard Hughes Medical Institute Investigators. The full-time faculty of more than 3,100 is responsible for groundbreaking medical advances and is committed to translating science-driven research quickly to new clinical treatments. UT Southwestern physicians provide care in more than 80 specialties to more than 120,000 hospitalized patients, more than 360,000 emergency room cases, and oversee nearly 5 million outpatient visits a year. Related Stories