My new story for the Medical Post/Canadian Healthcare Network. #Doctors and #pharmacists in Canada can log on for free. Here are a few paragraphs.
Could a century old treatment be an answer to antibiotic resistance?
In a first in Canada, a patient with an #antibiotic resistant artificial joint infection has received treatment with phage therapy and is showing promising early responses.
“This is cutting edge stuff, and a potentially new technology,” said Dr. Marisa Azad, the infectious diseases physician who treated the patient. She is also an assistant professor of medicine at the University of Ottawa.
The patient presented with severe periprosthetic joint infection (PJI) in the summer of 2023. She had already undergone multiple surgeries and had experienced several relapses and infections with the same persistent bacteria.
“She’d been on multiple very prolonged courses of antibiotics and had a severe drug allergy to two major drug classes of antibiotics. I was extremely limited in what I could use to treat her,” Dr. Azad told the Medical Post in an interview.
That’s when the idea arose of trying an experimental treatment course with phage therapy. The team got approval for doing the experimental treatment from Health Canada, and worked with Winnipeg-based Cytophage, which supplied the phages.
“We developed a protocol and gave her therapy over two weeks while she was admitted to hospital. She’s completed her therapy. Now we’re monitoring her closely and giving her adjunctive antibiotics,” she said.
The idea didn’t come out of the blue. In the medical literature, a study from just last year in Clinical #Infectious Diseases provided a review of 33 previously published cases of patients with end-stage, refractory bone and joint infections (BJI) who underwent treatment with phage therapy. The authors found that from those case reports, “29 (87%) achieved microbiological or clinical success, two (5.9%) relapsed with the same organisms, and two (5.9%) with a different organism” with no serious adverse events.
The conclusions of that paper stated there were “important advantages, disadvantages, and barriers to the implementation of phage therapy for BJIs.” Yet, at the same time, the authors added they, “believe that if phage therapy were to be used earlier in the clinical course, fewer cumulative antibiotics may be needed in an individual treatment course.”
The word phage is short for #bacteriophage, a word coined in 1917—literally meaning bacteria-eater. They are viruses whose lifecycle depends on certain types of bacteria.
“They latch on to specific types of bacteria and inject their genetic material into the bacterial cell." Dr. Azad explained. "They take over the bacterial cells’ machinery to produce more little viruses inside and explode or burst open the bacteria,” releasing viral particles that can go and infect other cells of the same type of bacteria.
Intriguingly, each #phage targets a specific type of #bacteria...
The story of phages started over 100 years ago. They were independently discovered, first in 1915 by a British pathologist, Frederick Twort, and then again in 1917 by French-Canadian microbiologist Felix d’Herelle. And...
Any UK #Pharmacists wanting to chime in.... a friend has a month's worth of his ADHD meds left and has said that it's going to be hard to get more as stocks have dried up. It was funny as my own (not ADHD) meds seem to be going that way too.... had to go around five chemists today to find stock. The second chemist was saying it's hard to get even basic meds in.
So..... any pharmacists on here care to share why? My guess is #Brexit striking again.
"The many #menopause myths your patients may believe
A look at the many preconceptions (and their related products) your patients may have about menopause."
This is a new story I wrote for the Medical Post/Canadian Healthcare Network which summarizes a talk at a recent #obgyn conference. The site is password protected but free for #doctors and #pharmacists in #Canada. Here are the first few paragraphs:
Myths, misinformation and questionable products for use in menopause abound.
So, what should doctors say when faced with patients asking about supplements, ‘estrogen imbalance,’ expensive tests, or social-media inspired treatments?
At the recent annual meeting of the Ontario regional conference for the Society for #Obstetricians and #Gynecologists of Canada (#SOGC), Dr. Alison Shea, assistant professor of obstetrics and gynecology at McMaster University, addressed these topics.
She emphasized that while information on the internet is highly accessible, menopausal management is highly individualized.
“What somebody may say on social media that really helped them, may lead someone to ask about (it),” she said, stressing that doctors should explain that “what works for one person might not work for you.”
Myths around menopause are common, and social-media material relating to menopause can be associated with product advertising. On Instagram alone, half of the menopause hashtags are for advertisements. And, according to BNN Bloomberg, the global market for menopausal products hit US$15 billion in 2021.
The selling of products should set off alarm bells, Dr. Shea said.
High profile brands
Some high profile brands associated with menopausal products that patients might mention include GOOP, Stripes, the Galvenston Diet, and the Balance #Health App.
Actor Gwyneth Paltrow’s GOOP, and Naomi Watts’ Stripes, both sell various products with little to no science behind them, she said. Yet, some of the Stripes products are decent, such as vaginal moisturizers which are hylaronic acid based. But its advisory board is lacking, consisting of only one ob-gyn, a dermatologist and a journalist.
The creator of the Galviston Diet has some helpful content, but their goal is to sell various products, Dr. Shea said. Some of the supplements appear to be fine for healthy aging, but they may not do much for menopausal symptoms.
The Balance Health App from the U.K. tracks menopause symptoms. This can be useful, but there are free and paid versions.
The vocabulary of menopause myths
Estrogen imbalance: This is the idea that high #estrogen or “estrogen dominance” are the underlying cause for bothersome menopause symptoms and need to be kept in check.
“We know this is not true,” Dr. Shea said. While fluctuating levels of estrogen can stimulate endometriosis, or stimulate some fibroid growth, lower estrogen levels are more responsible for bothersome menopausal symptoms
"Estrogen dominance" is sometimes used to describing an ‘imbalance’ of estrogen and progesterone. However, this is not a scientific term. Some patients may purchase progesterone cream products to help with the supposed imbalance, but progesterone does not work well through the skin. And if it were absorbed it may contribute to a worsening of mood symptoms in some. The only time estrogen may need so-called balancing is if there is an overgrowth of lining the uterus, or proliferative endometrium, she said.
Probiotics are also being sold claiming to influence estrogen metabolism in the gut, but there’s very little evidence.
"Are cutaneous signs of rheumatic disease missed in darker skin?
Medical textbooks and courses often don’t show diversity.
DEC 2023. A number of rheumatic diseases may be missed because doctors miss cutaneous signs on people of colour.
In a recent editorial in #Rheumatology, authors from the U.K. and Kenya stated: “Many reports, including a systematic review in Rheumatology, indicate underrepresentation of images of cutaneous rheumatological signs in skin of colour, compounded by inappropriate or inaccurate descriptive medical terminology.”
It’s a problem because textbooks, publications and websites tend to be slanted toward lighter skin types and don’t offer much help for real-life practices where patient populations can be quite diverse.
“This observation will come as no surprise to rheumatologists in many countries, from sub-Saharan Africa to Asia, who for years have struggled to create their own libraries of cutaneous signs of rheumatological diseases because textbooks, publications and websites, slanted towards lighter skin types, were not useful in their practice,” the authors wrote...."
Hmmm... Walgreens has just transferred the Boots pension scheme to Legal & General in a major deal... leading the FT to (quite plausibly) suggest that US #pharmacists Walgreens are looking to unravel the Boot/Walgreens 'merger'...
Another UK firm at the mercy of the interests/needs of a foreign owner looks likely to be up for sale (again).
Sometimes it feels like the UK economy is a plaything for executives from global corporations looking for things to do....
What's new in *Lyme disease vaccine research? Here is a story I wrote for the Medical Post/#Canadian Healthcare Network. Sorry, it's password protected for #doctors and #pharmacists in #Canada. But here are the first few paragraphs:
NOVEMBER 2023-- While preventing Lyme disease has been elusive, the research world is alive with efforts to battle this increasingly common scourge.
Three promising approaches are in the pipeline: work on a new, traditional type of vaccine; the injection of antibodies to confer protection, and early work on using mRNA vaccines.
Probably the most novel is LymePrEP (2217LS), being developed by the non-profit MassBiologics of the University of Massachusetts Chan Medical School in Boston.
LymePrEP isn’t exactly a vaccine, rather it’s described as a vaccine-alternative. It's an injection of anti-Lyme antibodies that gives preventative protection by immobilizing the bacterium inside the tick’s gut while it is feeding on its human host.
According to a MassBiologics announcement of phase-1 trails in 2022, an injection delivers a single, human anti-Lyme antibody directly to a person rather than triggering the immune system to make the needed antibodies. And in turn, that antibody is delivered to a biting tick where it stops the cycle of infection.
It is intended as “a transmission-blocking medicine,” said Dr. Mark Klempner, professor of medicine at UMass, in the announcement.
If the ongoing research yields the results hoped, LymePrEP would likely be a yearly injection administered just before the start of tick season. Whether boosters would be needed for this prophylactic approach is still being studied in clinical trials.
The vaccine-alternative uses the outer surface protein A (OspA)-specific monoclonal antibody which, in previous studies, was found to offer protection against infection from Borrelia burgdorferi, the primary cause of Lyme disease in North America. OspA was initially identified as the key antibody that conferred protection in the LYMErix vaccine that emerged some years ago.
LYMErix was a more traditional recombinant vaccine approved by the U.S. FDA in 1998, but was voluntarily withdrawn from the market after three years. The withdrawal was due to a combination of anti-vaccination pressure, a high cost of production, low demand along with lower Lyme disease rates in the 1990s, and a class action lawsuit alleging that LYMErix caused arthritis in small number of #vaccine recipients. It was reported to reduce new infections in vaccinated adults by nearly 80%.
But as to the new LymePrEP, while recruitment was completed for the dose-finding and safety phase-1 trials, results have not yet been released. It is being tested on participants who have not been exposed to Lyme disease.
Another potential approach to protecting against Lyme disease is the VLA15 vaccine being developed by Valneva and Pfizer. This is a more traditional multivalent protein subunit vaccine undergoing a series of safety and efficacy studies,al....
As Tim Hardford (FT) highlights the Goldin's distinction between #lawyers & #pharmacists is indicative of the issue of greedy jobs (in the USA).
Lawyers as a profession, a classic greedy job requiring long hours & prompt travel, are patterned by gender discriminations & inequity.
Pharmacists, however who have organised their profession into teams & so allow the job to be balanced with a 'greedy' home job, have little gender pay gap at all!
I wrote an article about Barbie after an interview with psychiatrist/cultural theorist Dr. Jeanne Randolph for the #MedicalPost/#CanadianHealthcare Network. It's free for #doctors, #pharmacists in #Canada. But here are few salient paragraphs.
"Dr. Randolph is both a #psychiatrist and a cultural theorist who uses a psychoanalytic lens when looking at icons such as Barbie. Studying #Barbie provokes questions about toys' contribution to the #health and ethics in #kids.
Indeed, back in the 1990s, she wrote a chapter for a book, Consuming Fashions: Adorning the Trans-National Body, that included details of a small study she conducted investigating how girls treated their Barbie dolls. The book itself included historical psychological and anthropological aspects of fashion.
What she found in wasn’t pretty.
Indeed, it was common for girls to cut off Barbie’s hair, paint them, poke or burn holes in them, twist their head around backwards, remove limbs, or even swap their head with other dolls.
But, she told the Medical Post, it's healthy for young kids to express aggressive or sadistic behaviours through their toys. It helps them cope with, and understand, their aggression in the long run—better than keeping it all bottled up and having it expressed in something real.
One moment, Barbie is a super model, an ideal parent or a brilliant astronaut, the next she might be beating up other toys, joining a biker gang, or holding up banks. Young kids learn about themselves and the world around them through play, she said.
For a long time, Barbie was marketed with an image of femininity that was devoid of aggression.
Barbie represented a huge cultural shift when she was first introduced in 1959. Prior to that, girls were given dolls that looked like babies, making their play limited to that as moms or caregivers—a fact the new movie points out.
Barbie was the first adult doll girls could identify with, Dr. Randolph said. They could expand the roles they played—except she was presented an exaggerated version of some idealized female form with her tall, slender proportions.
“In a way, Barbie was asking for it. It’s like the Barbie doll is so perfect, so unrealistic that she incited children to resent her or to be anxious because she’s not real,” she said. Hence some of the destructive behaviour.
Yet doing things like removing a Barbie’s head doesn’t mean a child will grow up a sociopath. Often, it’s just because the heads are easy to remove, and more of an exploration of how things work.
When she wrote about Barbie for that book chapter in the 1990s, Dr. Randolph wanted to include a picture of the doll. She looked for an advertising image that showed some aggression in Barbie, but the best she could find was an image of a fishing Barbie holding a large, plastic dead fish. The fish had a smile on it.
She wrote the toy company that produced Barbie for permission to use the image.
“I got a letter back from Mattel’s lawyers. They had read my chapter all about sadism and about how Barbie is asking for it, the doll is too perfect. They said I should seek legal council. They said they entirely rejected the negativity of this chapter and that Barbie is a valuable product which they did not want to be seen in this light,” she said.
There was always a disconnect between how Barbie was marketed and how little girls played with her.
The chapter was published, and the letter from Mattel was included in its entirety in a footnote.
However, the new Barbie movie showed a turnabout in recognition of the dichotomy Barbie represents. It acknowledged the imaginary, perfect world Barbie comes from, the cultural impact of Barbie dolls, that in real-life Barbies are mistreated, that many kids have cynical attitudes about Barbie, and also that some people love her.
“The movie is exactly what you would hope for in terms of the image and the humanity of women,” she said. The #feminist messages are strong, with powerful satirical punch towards #patriarchy."
Ok, i need a #betareader for a #toxicology#shortstory about the untimely death of Dr. Patrice Piebald, who angered a lot of people, and died three times as a result.
I've now written 400 stories for the Canadian Healthcare Network/ #Medical Post. I don't remember most of them as many were quick, short news items. But here is one from 2010 I think was neat.
‘Destination amnesia’ could impair patient encounters.
JUNE 2010 -- If you read this article, then describe it to the same person—several times, without realizing it—you may have a problem with so called destination memory.
In a study of healthy adults, researchers found that this unnecessary repeating of information is a common feature of getting older and likely a part of changes in the aging brain.
“It’s a natural part of aging,” said Dr. Nigel Gopie (PhD), a postdoctoral fellow with the Rotman Research Institute here.
At this point, it’s not known to be an indicator of any medical problem, but there is still research to be done in this area, he said.
And while “destination amnesia” (forgetting you’ve told someone a fact) may or may not indicate a medical or neurological issue, Dr. Gopie speculated it could potentially be a problem in doctor-patient communication.
The study demonstrated that older adults often make mistakes when it comes to remembering to whom they have told information. For example, they may be confident they told Alice about something when in fact they had told Bob.
For physicians, erroneous recollecting could be a problem because patients won’t mention something such as an unusual ache because they believe they had already told the physician all about it.
On the other hand, the researchers found older adults were just as good as younger adults at remembering what other people tell them—what memory researchers refer to as “source memory.”
For the study designed to better understand destination memory impairment, researchers performed two experiments in 40 healthy adults. Twenty were university undergraduates (ages 18 to 24) and 20 were older adults (ages 62 to 83).
The first experiment tested both destination memory and the confidence people had in remembering with whom they shared information.
In this instance, study participants were shown a factual sentence on a computer screen, such as “a shrimp’s heart is in its head.” They were then shown a picture of a famous person (such as Tom Cruise) and told to state the fact aloud to the image. The procedure was repeated 50 times with different facts and faces.
After the exercise, subjects were then shown 20 facts and 20 faces in random order and asked if they had previously seen the particular items or whether they were new (half were new). They were then presented with a series of individual faces, each paired with a separate fact. Subjects were asked if the facts were the specific ones they had told to the specific face earlier.
There were significant differences between the older and younger adults, Dr. Gopie said.
The younger adults had higher accuracy when it came to remembering to whom they told what. The results showed the older adults had destination memory performance that was 24% worse than the younger adults. Additionally, older adults had greater confidence in thinking they remembered who they told what than the younger group, even though they made more mistakes.
The second experiment tested how well subjects remembered where information came from—source memory.
Here, a new set of 40 volunteers were shown images of celebrities, and after each face were shown a fact.
The idea was that the fact came from a particular celebrity. In this case, the younger adults were slightly better at recalling specific factual items, but there was no difference between young and old subjects when it came to remembering from where information came.