Aeromonas Hydrophila

CNN LINK: So I had to embark upon understanding this flesh eating necrotizing fasciitis causing bacteria that has the life of Aimee Copeland on hold and on a ventilator in a hospital in Augusta, GA.   Only 24 years old, Aimee fell from a zip line and had a gash in her leg that was stitched up only to return to an ER a few days later with a bigger issue.  Necrotizing fasciitis.

Aeromonas hydrophila is a heterotrophic, Gram-negative, rod shaped bacterium, mainly found in areas with a warm climate. This bacterium can also be found in fresh, salt, marine, estuarine, chlorinated, and un-chlorinated water. Aeromonas hydrophila can survive inaerobic and anaerobic environments. This bacterium can digest materials such as gelatin, and hemoglobin. Aeromonas hydrophila was isolated from humans and animals in the 1950s. This bacterium is the most well known of the six species of Aeromonas. It is also highly resistant to multiple medications, chlorine, and cold temperatures.

Because of Aeromonas hydrophila’s structure, it is very toxic to many organisms. When it enters the body of its victim, it travels through the bloodstream to the first available organ. It produces Aerolysin Cytotoxic Enterotoxin (ACT), a toxin that can cause tissue damage.

Most of the time, this organism causes gastroenteritis.

Aeromonas is usually found in freshwater and marine environments; it is most prominent in the Northern Hemisphere during the warmer months. The skin of the lower extremities is the most common site of infection, usually after traumatic exposure to contaminated water or soil. Aeromonas infection and cellulitis often develop within 8 to 48 hours of exposure, and systemic signs are common. Manifestations may include hemorrhagic bullae, subcutaneous bleeding, and purpura.

Aeromonas is typically highly susceptible to penicillins combined with β-lactamase inhibitors, second- and third-generation cephalosporins, aminoglycosides, and fluoroquinolones.

When patients do not respond to antibiotics for presumed common cellulitis, it may be prudent to obtain further imaging such as CT or MRI of the affected limb to rule out soft tissue collections, soft tissue emphysema, and necrotizing fasciitis. Surgical debridement may be indicated for deep soft tissue infection, necrosis, and purulent collections that are inadequately draining.

I do hope Aimee makes a full recovery.  You can follow here progress here.

Depakote and Abbott's $1.6 Billion Mistake

Abbott never had FDA approval to promote Depakote for aggression and agitation in the elderly or schizophrenia. The total includes a criminal fine of $700 million and civil settlements with the states and federal government totaling $800 million. Abbott pleaded guilty to a criminal misdemeanor for misbranding the medication. Abbott is also going to pay 45 states $100 million to resolve liability with consumer protective laws. Luckily the Justice Department found no deaths due to this crime.

The company admitted that from 1998 through 2006, it "maintained a specialized sales force trained to market Depakote in nursing homes for the control of agitation and aggression in elderly dementia patients, despite the absence of credible scientific evidence that Depakote was safe and effective for that use," the Justice Department said in a news release.

"In addition, from 2001 through 2006, the company marketed Depakote in combination with atypical antipsychotic drugs to treat schizophrenia, even after its clinical trials failed to demonstrate that adding Depakote was any more effective than an atypical antipsychotic alone for that use."

Heaphy said Abbott earned about $13 billion from Depakote sales during the period investigated, but he said it was difficult to determine how much of that was the result of sales for illegal purposes. He expressed confidence that, once the fines are factored in, Abbott will not have profited from the improper practices.

Um... Ok. $13 billion minus $1.6 billion equals a profit.

No wonder this will keep happening.

Publication Bias - Antidepressants and Autism

Publication bias: It has long been a problem with medical studies. Studies with outcomes that are positive are more likely to be published than those that are negative.  As a result, the medical literature that establish how diseases and disorders are treated often provides doctors and other healthcare providers a flawed picture of the evidence presented.

Antidepressants are not FDA approved for treating some of autism's symptoms:  hoarding, tapping, head banging and strict adherence to routine.

Read more here.

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Not By the Hair of My Chinny Chin Chin

Chin implants are the fastest-growing cosmetic procedure according to The America Society of Plastic Surgeons (or called the “chinplant”) in 2011. Of course, as aging happens and things begin to drop, the chin is something that helps hold the face in place. A lack of a chin can make the lower half of a person’s profile look weak and unattractive. And now that everyone’s pictures are being plastered all over the internet with Facebook, twitter, and videos like Facetime, it’s no wonder chinplants are on the rise. The humorous part of this tale to me is that I sort of smugly smile. I have a chin. In fact, I have enough chins for a couple of people. I lovingly refer to my chin as a Jay Leno chin, and on a female, it’s not necessarily something so desired.

I used to not think a thing about my chin. I obsessed over my upper lip which sort of dips down like a cupid’s bow (ever see Little Albert on Little House on the Prairie back in the 1980’s?). I remember kids (oh, aren’t they mean?) who would call me bird lip. Even the husband of a friend I haven’t seen in YEARS remarked at dinner just a couple of years ago, “You don’t even have a top lip.” Stop. Where does that even COME from considering he was carrying around an extra forty pounds, and I would NEVER dare say a word about their weight. It just didn’t seem fair.

What was even less fair was the time when I was at the local orthodontist’s office getting my braces off for the second time. I was thrilled. No more cross bite. My teeth were SO straight! The orthodontist to the local celebrities flashed his over whitened straight smile and brought with him the x-ray of my skull. Creepy. He showed it to me and then said while pointing his golden pen toward my chin, “Now if you would just have a smaller chin HERE, you would have the PERFECT profile.” No. He. Didn’t.

I couldn’t believe he said it, but it sent me into a google searching frenzy at home, “Chin reductions, chin shortening, etc….” I tried them all, but all in all, I’ve never had anything changed about my chin.

So today’s news about chinplasty being the fastest rising surgery of today really makes me smile and stick my chin out even further!

Whooping Cough Reaching Record Levels

I remember how I felt about vaccines prior to becoming a mother. They were effective. They were needed. They saved lives. However, my thinking changed the first time I stared at my newborn son seconds after birth, and the reports of the possibility of a link between autism and vaccines and the higher rate in males vs females really challenged my thinking. I ran to the bookstore buying all of Dr. Sears' books, scoured the Internet for information, and joined forums where it was cool to be a home birthing, baby wearing, baby led weaning, crunchy, baby food making, raw milk drinking and cloth diapering momma. I suddenly felt like the worst mother in the world, and all my sense about science left as the prolactin levels rose.

I declined hepatitis B vaccine for my infant. Hell, he was not a IV drug user and wasn't having sex yet.

Over time, he is finally up-to-date, and my daughter received all as scheduled (though I did delay hepatitis B with her as well until she reached three months, I believe. I have definitely been more laid back this time. And I have also seen the stories of the prevalence of diseases previously almost eradicated making a huge comeback. Unfortunately herd immunity is only good if all subscribe. Sporadic cases are becoming more normal... and with that deaths.

Last month, Washington state had 640 confirmed cases of whooping cough (or pertussis) compared to only 94 in the same period last year.

The connection between autism and vaccines have never been confirmed. I cannot think of anything more responsible as a parent than getting your kids vaccinated. I guess you can say my thinking was challenged, but I have reached full circle.

Dick Cheney and the Polarizing Heart Transplant

I suppose my first thought at the news that former Vice President Dick Cheney had received a heart transplant paid for by the taxpayers was, "wait… he’s 71? Isn’t that too old for a heart transplant when I am sure there are younger people on the list that could benefit much more in terms of longevity than Cheney would. Then I read that he was on the transplant list for 20 months. That means he was in his sixties when on the list and also on the list longer than average 6-12 months. The most disturbing thing about the whole thing is the comments that have poured in online, online articles and twitter.

Chimed in Tim Viselli of La Canada Flintridge: After many transplants, the body will reject an incompatible heart. This may be the first time where the heart rejects an incompatible body.

Andrew Rubin of Malibu added: Seeing the headline that Cheney had received a heart transplant, I could not help but think, "Better ten years late than never."

Patricia Coelho of South Pasadena echoed several others when she wondered: Does this mean that Dick Cheney will finally have a heart?

Clearly not a fan, Steve Wollenberg of Los Angeles asked: Dick Cheney had a heart transplant? Really? Did anyone toss in a brain? They usually, but not always, come as a set.

And finally, from Phoenix, Ernie Haas emailed a wish: Just heard that ex-Vice President Dick Cheney had a change of heart. Maybe now he'll become a Democrat.

Or Twitter:

I heard a nurse’s hand slipped and touched Cheney’s original heart and she transformed into a spidergoat and ate 2 babies in the maternity ward. -@robdelaney (who is hilarious, by the way)

MUST READ: Cheney Receives Heart Transplant; Bush Still on Waiting List for Brain. @BorowitzReport

@GerryDuggan said “They’re throwing Cheney’s old heart into a volcano, right?

I suppose for me the biggest issue I have with the operation is the age limit of heart transplants. Is there one?

The indication and contraindications for heart transplantation. Indication for heart transplantation - End-stage heart disease not remediable by more conservative measures Contraindications - Irreversible pulmonary hypertension /elevated pulmonary vascular resistance - Active systemic infection - Active malignancy or history of malignancy with probability of recurrence - Inability to comply with complex medical regimen - Severe peripheral or cerebrovascular disease - Irreversible dysfunction of another organ, including diseases that may limit prognosis after heart transplantation

I don’t believe it’s time to place a value on human life based on politics, decisions in the past, age, etc… I’m not surprised that so many negative thoughts are out there regarding Cheney. We have sort of lost the human filter of sympathy for our fellow man.

And, hey, it's easy when you are behind a keyboard ;)

News of the Weird

Texting may help you quit smoking Diet Coke and weight gain

Montana medical marijuana causes some confusion

--- the last one really does cause confusion, eh?

NSAID news

Taking certain painkillers daily for several years carries a small increased risk of heart attack and stroke, research has suggested.  This information was already released to the public awhile back with the news of Vioxx and eventual withdrawal from the market, so it should really be no surprised that other NSAIDs:  naproxen, ibuprofen, diclofenac, celecoxib, etoricoxib, rofecoxib, and meloxicam (among others) pose the same risk. The researchers found the medicine increased the risk of death from stroke or heart attack by between two and four times, compared with placebo.  The report, published in the British Medical Journal, looked at more than 100,000 patients in 31 clinical trials.

Specifically:  31 trials in 116 429 patients with more than 115 000 patient years of follow-up were included. Patients were allocated to naproxen, ibuprofen, diclofenac, celecoxib, etoricoxib, rofecoxib, lumiracoxib, or placebo. Compared with placebo, rofecoxib was associated with the highest risk of myocardial infarction (rate ratio 2.12, 95% credibility interval 1.26 to 3.56), followed by lumiracoxib (2.00, 0.71 to 6.21). Ibuprofen was associated with the highest risk of stroke (3.36, 1.00 to 11.6), followed by diclofenac (2.86, 1.09 to 8.36). Etoricoxib (4.07, 1.23 to 15.7) and diclofenac (3.98, 1.48 to 12.7) were associated with the highest risk of cardiovascular death.

Taking NSAIDs on a regular daily basis can increase heart risk... add that to the widely known turmoil on the GI system itself.  Risk vs. benefit... the usual see-saw game for most medications on the market.

Pentothal shortage = death row lethal injection cocktail shortage

Yep!  Finally a drug shortage that might make the patient happy!  Pentothal is in shortage which means many of the people on death row are finding their sentences moved forward.  Not a bad thing for them right?  Pentothal is produced by one pharmaceutical company, Humira, who is in fact against the death penalty but supplied by someone else and not available until 2011. "It is necessary that the first drug work. It eliminates the pain for the next two drugs," said Richard Dieter of the Death Penalty Information Center. "Everybody agrees that two-thirds of this process would be excruciating but for the sodium pentothal."

Here's the deal.  Why are veterinarians using the same two drugs without a med like Pentothal?  Can you not just use something like Propofol?  Wouldn't that pretty much mask any pain?

Criminal Charges Pressed Against a Healthcare Provider. A First.

This case has really bothered me.  For the first time that I can find, a pharmacist has been criminally charged in the death of a child in Ohio.  Eric Cropp, a pharmacist, made a fatal error when checking a chemotherapy solution for Emily Jerry.  CLEVELAND — Former pharmacist Eric Cropp was found guilty of involuntary manslaughter Wednesday in the death of a 2-year-old girl killed by a lethal injection of a salt solution during a cancer treatment.

Cropp, 40, of Bay Village, pleaded no contest to the charge at a hearing in Cuyahoga County Common Pleas Court. Judge Brian Corrigan will sentence Cropp on July 17. The maximum sentence is five years in prison and a $10,000 fine.

Prosecutors dropped a reckless homicide charge as part of a plea deal.

Cropp was the supervising pharmacist at Rainbow Babies and Children's Hospital on Feb. 26, 2006, when pharmacy technician Katie Dudash prepared a chemotherapy solution for Emily Jerry that was 23 percent salt. The formula called for a saline base of less than 1 percent.

The child died on March 1 after slipping into a coma.

As the supervising pharmacist, Cropp's duty was to inspect and approve all work prepared by the technicians before it was given to patients. Dudash agreed to testify against Cropp and was never charged.

The Ohio Board of Pharmacy stripped Cropp of his license in 2007. Since then, he has been unable to find steady employment, his attorney Richard Lillie said recently. Cropp has worked odd jobs, cleaning boats and walking dogs.

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Cropp served 6 months in jail, paid fines, has tons of community service hours, lost his license for life, etc...

I realize that this case is very sad in that a little girl has died.  But I have read this case inside and out and it's fairly certain that the hospital hung Cropp out to dry.  The hospital settled for millions with the family.  The mother was on a witch hunt for the pharmacist to pay.  The tech faced NO CHARGES AT ALL.  This is unreal!!  First of all, we are humans.  Humans make mistakes.  I get nervous thinking about cases and situations like this and I look at what happened and wonder "Could this happen to me as a pharmacist?"

Eric's mistakes were that he didn't take a break that day.  He had a friend bring him lunch.  He was way behind because of a printer problem.  The hospital IV setup was not condusive to safety.  There was a bag of NS laying near  where the compound was finished.  WHO in the world makes NS from hypertonic?????  The tech was planning her wedding.  She gets to resume her life with no issues at all.