Overall, it seemed like a relatively quiet week in the news world. Winter weather perseveres, Larry Birkhead is the father, and Sanjaya is still singing (or trying to). A perusal of the week’s medicine journals, however, is somewhat uplifting as it reminds us of the expansive scope of medicine.
Beginning on the broad public health front, the CDC announced this week that it was changing its recommendations for the treatment of gonorrhea due to increasing drug resistance. Fluoroquinolones, once recommended as first-line treatment for gonorrhea in the early 1990s, are no longer advised due to widespread fluoroquinolone-resistant gonorrhea among both heterosexuals and men who have sex with men. The CDC now recommends ceftriaxone as the preferred treatment for all types of gonorrhea infections.
CDC Press Release
Narrowing our scope, an interesting article in JAMA addresses the challenges in diagnosing ventilator-associated pneumonia (VAP). Based on a comprehensive review of the medical literature, physical exam findings alone (such as the presence of fever or secretions) do not alter the probability of VAP. However, the presence of an infiltrate on chest X-ray along with at least 2 of fever, leukocytosis, or purulent pulmonary secretions, increases the likelihood of VAP, while the absence of a new radiographic infiltrate makes VAP less likely. Less than 50% neutrophils in lower pulmonary secretions also makes VAP less likely.
Our journey through the news now takes us to the cellular level. JAMA also reports on the findings of a study in which a small number of patients with newly diagnosed Type 1 DM received autologous hematopoietic stem cell transplantation along with high dose immunosuppression. Remarkably, in the majority of patients, beta cell function was increased and prolonged periods of insulin independence were seen over a follow-up between 7 to 36 months, with few adverse effects. The study, though limited by its small size and short follow-up, is a provocative first report of a successful attempt at combating type 1 DM at the cellular level.
Now on to the subcellular level. A report published in Science purporting the first proven link between genes and obesity made headlines worldwide this week. Researchers identified a gene located on chromosome 16, called FTO, which appears to be associated with BMI. Individuals homozygous for a specific mutation of the FTO gene were 1.67 times more likely to be obese than those lacking the mutation. Makes you think twice about the old adage, “You are what you eat.”
And finally, our journey would not be complete without mentioning yet another setback for the pharmaceutical companies. This week, the FDA harshly rejected an application by Merck to sell its Cox-2 inhibitor Arcoxia, a sister to Vioxx, in the United States. The drug is already sold by Merck in 63 countries. The FDA, in a vote of 20 to 1, cited the drug’s increased risk of cardiovascular disease and stroke and noted that the drug is no more effective in treating pain than safer drugs already on the market (although you’ll be happy to know that Arcoxia pens are still readily available on EBay).
-Cara Litvin, MD Associate Editor NYU Clinical Correaltions
Image-Village of Weingarts (between Gräfenberg and Forchheim at the base of the Franconian Swiss mountain range, Germany) Courtesy of Wikimedia Commons