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Title: Blog by Novelist William S. Frankl, MD

Archive for March, 2013

Antibiotics and Fatal Cardiac Arrhythmias

Saturday, March 16th, 2013

On 3/13/13, The New York Times reported that “Last May, the FDA. announced that it would review” a “study which found a small increase in the likelihood of death by QTc prolongation, Torsade de pointes, ventricular tachycardia and ultimately ventricular fibrillation in people treated with a five-day course of azithromycin, compared with people treated with other antibiotics, such as amoxicillin and ciprofloxacin.” Azithromycin is a favorite antibiotic used in the treatment of otitis media in children, as well as urinary tract infections, bronchitis, pneumonia and chlamydia in adults. As a  result of the New York Times Article and the resultant FDA review, Stephanie Yao, a spokeswoman for the FDA said the language on the labels for the drug had been strengthened to include, among other things, details from the 2012 study, and information from a later study by Pfizer.” Do you suppose that the labels will prevent or treat the arrhythmias, huh? I’m delighted the FDA responded so quickly and effectively (just kidding).
It should be noted that another class of antibiotics, fluorquinolones, are widely used and have been implicated with these same fatal arrhythmias.

What is really needed is effective education of physicians that before any of these drugs are used the patient should be carefully evaluated for underlying cardiac disease, especially long QTc Syndrome, before these agents are used, and that the use is truly indicated.

Calcium Supplements and Mortality in Men

Saturday, March 16th, 2013

On 2/4/13, USA Today reported on research published in JAMA Internal Medicine Online  that indicated “ . . .a high intake of calcium from supplements was correlated with an increased risk of death from heart disease, such as heart attacks, for men, but not for women.”

Calcium intake has been promoted because of its proposed benefit on bone health, particularly among the older population. However, concerns have been raised about the potential adverse effect of high calcium intake on cardiovascular health.

Objective  To investigate whether intake of dietary and supplemental calcium is associated with mortality from total cardiovascular disease (CVD), heart disease, and cerebrovascular diseases.

Design and Setting  Prospective study from 1995 through 1996 in California, Florida, Louisiana, New Jersey, North Carolina, and Pennsylvania and the 2 metropolitan areas of Atlanta, Georgia, and Detroit, Michigan.

Participants  A total of 388 229 men and women aged 50 to 71 years from the National Institutes of Health–AARP Diet and Health Study.

Main Outcome Measures  Dietary and supplemental calcium intake was assessed at baseline (1995-1996). Supplemental calcium intake included calcium from multivitamins and individual calcium supplements. Cardiovascular disease deaths were ascertained using the National Death Index. Multivariate Cox proportional hazards regression models adjusted for demographic, lifestyle, and dietary variables were used to estimate relative risks (RRs) and 95% CIs.

Results  During a mean of 12 years of follow-up, 7904 and 3874 CVD deaths in men and women, respectively, were identified. Supplements containing calcium were used by 51% of men and 70% of women. In men, supplemental calcium intake was associated with an elevated risk of CVD death (RR>1000 vs 0 mg/d, 1.20; 95% CI, 1.05-1.36), more specifically with heart disease death (RR, 1.19; 95% CI, 1.03-1.37) but not significantly with cerebrovascular disease death (RR, 1.14; 95% CI, 0.81-1.61). In women, supplemental calcium intake was not associated with CVD death (RR, 1.06; 95% CI, 0.96-1.18), heart disease death (1.05; 0.93-1.18), or cerebrovascular disease death (1.08; 0.87-1.33). Dietary calcium intake was unrelated to CVD death in either men or women.

Conclusions and Relevance  Our findings suggest that high intake of supplemental calcium is associated with an excess risk of CVD death in men but not in women. Additional studies are needed to investigate the effect of supplemental calcium use beyond bone health.

This is an important piece of work and if confirmed, would have a major effect on many public health and preventive medicine efforts in the USA.

“Superbugs”on a Rampage

Saturday, March 16th, 2013

A warning came this month from the Centers for Disease Control and Prevention that infections from carbapenem-resistant enterobacteriaceae (CRE) are spreading through health facilities. These doom-laden reports were featured in several nightly national news broadcasts. Thomas Frieden, Director of the Centers for Disease Control and Prevention, called the CRE  “nightmare bacteria.” Frieden, along with other CDC officials, urged hospitals to take steps to prevent CRE infections. What are CREs?. They are Enterobacteriaceae that normally live in the gut, but are now carbapenem-resistant, i.e. resistant even to these strong antibiotics. These  so-called superbugs are found, so far, only in hospitals and nursing homes, rather than in the community.  They are a serious and growing health risk inside hospitals. According to Frieden, “These are nightmare bacteria that present a triple threat.” He added, “They’re resistant to nearly all antibiotics. They have high mortality rates, killing half of people with serious infections. And they can spread their resistance to other bacteria.”

“Although these superbugs potentially can infect anyone, they pose an enhanced risk to people with compromised immune systems, such as elderly people, children and people who have other health problems.

So, keep away from hospitals ( a good dictum any time, but especially now ) and hope these bacteria can be eradicated with good public health measures in all hospitals, like keeping patients with this kind of infection in specialized wards with dedicated staff, and by proper handwashing among hospital staff .

Musings On Communications Thus Far in 2013

Saturday, March 16th, 2013

Since January 1, 2013, the airways, the readways, the post-blogways, the newspaperways, and the e-mailways, etc have been filled with venom, nonsense, pseudo- vs real science, special birthdays (3/14 = Einstein and Telemann), political lies, medical threats to survival (I’m kidding), and other wonderful things. I love technology, I love cyberspace, and I love efforts to communicate. But sometimes I wish I were back in a time when radio, snail mail, and old-fashioned newspapers and books were almost the only ways to communicate. Less BS and more well thought out communication.

But, today is today. Thus, I provide you with the following posts which illustrate the reason for my small rant. Enjoy.

William S. Frankl, MD, All Rights Reserved