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Despite concerns, synthetic slings are still ‘standard of care’ in SUI
LAS VEGAS – A few weeks before she was scheduled to speak at the annual Pelvic Anatomy and Gynecologic Surgery Symposium, Beri M. Ridgeway, MD, received an anonymous note about her upcoming presentation. “Someone wanted me to think very carefully about what I’d be talking about during my presentation on synthetics,” she recalled.
The note reflects the deep controversy over the use of transvaginal synthetic mesh products, which have been linked to a long list of serious adverse effects. “There are women who have been harmed, and I take care of a lot of those,” said Dr. Ridgeway, who’s based at Cleveland Clinic. One key distinction is that there is a very different risk profile between transvaginal synthetic mesh prolapse kits and polypropylene midurethral slings. While it’s important to be thoughtful about the use of mesh in synthetic midurethral (MU) slings, she said, they remain well supported as an effective treatment for stress urinary incontinence (SUI).
Even so, she said, the news about the risks of mesh “weighs on our patients’ minds” and spawns fear among physicians. Meanwhile, she said, “there is quite a bit of flux” in the marketplace as companies withdraw products because of their perception of risk.
Even amid the controversy, she said, it’s important to remember how crucial it is to treat women in need. “SUI is a very common problem, and women suffer significantly. With our aging population, the prevalence will increase even more,” she said. “It is critical that we screen patients for SUI and have the ability to offer treatment. Having different treatment options benefit women significantly.”
Dr. Ridgeway offered these pearls about the use of synthetic MU slings and alternative approaches to treating SUI.
It’s helpful to find a single strategy and embrace it.
“For ob.gyn. specialists who treat primary, uncomplicated SUI, I recommend surgeons become comfortable with an approach and focus on becoming high-volume surgeons in that approach,” Dr. Ridgeway said. “It is also good to partner with a female pelvic medicine & reconstructive surgery specialist who can back one up for more complicated cases, complications, or recurrent SUI. These specialists should be able to offer a full array of procedures to treat SUI and tailor the treatment to the individual patient, especially in more complex cases.”
Synthetic MU slings are the “definitive standard of care.”
More than 17 years of research suggest the efficacy of the slings is durable, she said, especially when the goal is to resolve symptoms in patients with pure SUI symptoms. she said, pointing to more than 500 articles and more than 40 randomized controlled trials.
According to her, synthetic slings have similar efficacy to traditional slings but require less time in the operating room and produce less voiding dysfunction and de novo urgency. “The revision rate of synthetic MU slings is very low,” she added. “In large studies, the revision rate at 10 years is 3%-4%.”
It’s important to keep patient consent in mind, she said. “Patients should know and understand the specific risks of any procedure, including MU slings, so that they can share in decision making.”
Transobdurator (TOT) slings offer benefits.
There’s less risk of bladder and vascular injury from the TOT procedure, which is easy to learn and teach, Dr. Ridgeway said. Research suggests the tension-free vaginal tape (TVT) approach is more likely to cause voiding dysfunction, she added.
But TOT is probably less effective in patients with SUI linked to intrinsic sphincter deficiency and in longer-term follow-up, she said. And there are cases of male sex partners injuring their penises during contact with TOT slings during intercourse.
Single-incision slings are up-and-coming options.
These slings offer promising results in short-term studies, but long-term results aren’t available yet. They may be a good option for cases of mild and occult SUI, she said.
Alternative treatments for SUI have limitations.
These include urethral bulking agents, which mainly lead to improvement rather than cure. Autologous fascial pubovaginal slings are another option, especially if patients don’t want a mesh-based treatment or have recurrent SUI following a synthetic mesh complication. However, she noted that research points to morbidity and de novo urinary urgency, she said.
The Pelvic Anatomy & Gynecologic Surgery Symposium was jointly provided by Global Academy for Medical Education and the University of Cincinnati. Global Academy and this news organization are owned by the same company.
Dr. Ridgeway disclosed consulting for Coloplast and having served as an independent contractor (legal) for Ethicon.
LAS VEGAS – A few weeks before she was scheduled to speak at the annual Pelvic Anatomy and Gynecologic Surgery Symposium, Beri M. Ridgeway, MD, received an anonymous note about her upcoming presentation. “Someone wanted me to think very carefully about what I’d be talking about during my presentation on synthetics,” she recalled.
The note reflects the deep controversy over the use of transvaginal synthetic mesh products, which have been linked to a long list of serious adverse effects. “There are women who have been harmed, and I take care of a lot of those,” said Dr. Ridgeway, who’s based at Cleveland Clinic. One key distinction is that there is a very different risk profile between transvaginal synthetic mesh prolapse kits and polypropylene midurethral slings. While it’s important to be thoughtful about the use of mesh in synthetic midurethral (MU) slings, she said, they remain well supported as an effective treatment for stress urinary incontinence (SUI).
Even so, she said, the news about the risks of mesh “weighs on our patients’ minds” and spawns fear among physicians. Meanwhile, she said, “there is quite a bit of flux” in the marketplace as companies withdraw products because of their perception of risk.
Even amid the controversy, she said, it’s important to remember how crucial it is to treat women in need. “SUI is a very common problem, and women suffer significantly. With our aging population, the prevalence will increase even more,” she said. “It is critical that we screen patients for SUI and have the ability to offer treatment. Having different treatment options benefit women significantly.”
Dr. Ridgeway offered these pearls about the use of synthetic MU slings and alternative approaches to treating SUI.
It’s helpful to find a single strategy and embrace it.
“For ob.gyn. specialists who treat primary, uncomplicated SUI, I recommend surgeons become comfortable with an approach and focus on becoming high-volume surgeons in that approach,” Dr. Ridgeway said. “It is also good to partner with a female pelvic medicine & reconstructive surgery specialist who can back one up for more complicated cases, complications, or recurrent SUI. These specialists should be able to offer a full array of procedures to treat SUI and tailor the treatment to the individual patient, especially in more complex cases.”
Synthetic MU slings are the “definitive standard of care.”
More than 17 years of research suggest the efficacy of the slings is durable, she said, especially when the goal is to resolve symptoms in patients with pure SUI symptoms. she said, pointing to more than 500 articles and more than 40 randomized controlled trials.
According to her, synthetic slings have similar efficacy to traditional slings but require less time in the operating room and produce less voiding dysfunction and de novo urgency. “The revision rate of synthetic MU slings is very low,” she added. “In large studies, the revision rate at 10 years is 3%-4%.”
It’s important to keep patient consent in mind, she said. “Patients should know and understand the specific risks of any procedure, including MU slings, so that they can share in decision making.”
Transobdurator (TOT) slings offer benefits.
There’s less risk of bladder and vascular injury from the TOT procedure, which is easy to learn and teach, Dr. Ridgeway said. Research suggests the tension-free vaginal tape (TVT) approach is more likely to cause voiding dysfunction, she added.
But TOT is probably less effective in patients with SUI linked to intrinsic sphincter deficiency and in longer-term follow-up, she said. And there are cases of male sex partners injuring their penises during contact with TOT slings during intercourse.
Single-incision slings are up-and-coming options.
These slings offer promising results in short-term studies, but long-term results aren’t available yet. They may be a good option for cases of mild and occult SUI, she said.
Alternative treatments for SUI have limitations.
These include urethral bulking agents, which mainly lead to improvement rather than cure. Autologous fascial pubovaginal slings are another option, especially if patients don’t want a mesh-based treatment or have recurrent SUI following a synthetic mesh complication. However, she noted that research points to morbidity and de novo urinary urgency, she said.
The Pelvic Anatomy & Gynecologic Surgery Symposium was jointly provided by Global Academy for Medical Education and the University of Cincinnati. Global Academy and this news organization are owned by the same company.
Dr. Ridgeway disclosed consulting for Coloplast and having served as an independent contractor (legal) for Ethicon.
LAS VEGAS – A few weeks before she was scheduled to speak at the annual Pelvic Anatomy and Gynecologic Surgery Symposium, Beri M. Ridgeway, MD, received an anonymous note about her upcoming presentation. “Someone wanted me to think very carefully about what I’d be talking about during my presentation on synthetics,” she recalled.
The note reflects the deep controversy over the use of transvaginal synthetic mesh products, which have been linked to a long list of serious adverse effects. “There are women who have been harmed, and I take care of a lot of those,” said Dr. Ridgeway, who’s based at Cleveland Clinic. One key distinction is that there is a very different risk profile between transvaginal synthetic mesh prolapse kits and polypropylene midurethral slings. While it’s important to be thoughtful about the use of mesh in synthetic midurethral (MU) slings, she said, they remain well supported as an effective treatment for stress urinary incontinence (SUI).
Even so, she said, the news about the risks of mesh “weighs on our patients’ minds” and spawns fear among physicians. Meanwhile, she said, “there is quite a bit of flux” in the marketplace as companies withdraw products because of their perception of risk.
Even amid the controversy, she said, it’s important to remember how crucial it is to treat women in need. “SUI is a very common problem, and women suffer significantly. With our aging population, the prevalence will increase even more,” she said. “It is critical that we screen patients for SUI and have the ability to offer treatment. Having different treatment options benefit women significantly.”
Dr. Ridgeway offered these pearls about the use of synthetic MU slings and alternative approaches to treating SUI.
It’s helpful to find a single strategy and embrace it.
“For ob.gyn. specialists who treat primary, uncomplicated SUI, I recommend surgeons become comfortable with an approach and focus on becoming high-volume surgeons in that approach,” Dr. Ridgeway said. “It is also good to partner with a female pelvic medicine & reconstructive surgery specialist who can back one up for more complicated cases, complications, or recurrent SUI. These specialists should be able to offer a full array of procedures to treat SUI and tailor the treatment to the individual patient, especially in more complex cases.”
Synthetic MU slings are the “definitive standard of care.”
More than 17 years of research suggest the efficacy of the slings is durable, she said, especially when the goal is to resolve symptoms in patients with pure SUI symptoms. she said, pointing to more than 500 articles and more than 40 randomized controlled trials.
According to her, synthetic slings have similar efficacy to traditional slings but require less time in the operating room and produce less voiding dysfunction and de novo urgency. “The revision rate of synthetic MU slings is very low,” she added. “In large studies, the revision rate at 10 years is 3%-4%.”
It’s important to keep patient consent in mind, she said. “Patients should know and understand the specific risks of any procedure, including MU slings, so that they can share in decision making.”
Transobdurator (TOT) slings offer benefits.
There’s less risk of bladder and vascular injury from the TOT procedure, which is easy to learn and teach, Dr. Ridgeway said. Research suggests the tension-free vaginal tape (TVT) approach is more likely to cause voiding dysfunction, she added.
But TOT is probably less effective in patients with SUI linked to intrinsic sphincter deficiency and in longer-term follow-up, she said. And there are cases of male sex partners injuring their penises during contact with TOT slings during intercourse.
Single-incision slings are up-and-coming options.
These slings offer promising results in short-term studies, but long-term results aren’t available yet. They may be a good option for cases of mild and occult SUI, she said.
Alternative treatments for SUI have limitations.
These include urethral bulking agents, which mainly lead to improvement rather than cure. Autologous fascial pubovaginal slings are another option, especially if patients don’t want a mesh-based treatment or have recurrent SUI following a synthetic mesh complication. However, she noted that research points to morbidity and de novo urinary urgency, she said.
The Pelvic Anatomy & Gynecologic Surgery Symposium was jointly provided by Global Academy for Medical Education and the University of Cincinnati. Global Academy and this news organization are owned by the same company.
Dr. Ridgeway disclosed consulting for Coloplast and having served as an independent contractor (legal) for Ethicon.
EXPERT ANALYSIS FROM PAGS
Expert: There’s no single treatment for fibromyalgia
SAN DIEGO – There are many potential treatments for fibromyalgia, but a large number of them – NSAIDs, opioids, cannabis and more – come with caveats and nothing beats an old stand-by: physical rehabilitation.
With exercise, “we’re getting the muscles moving, and we’re getting [patients] used to stimulation that will hopefully deaden that pain response over time,” David E.J. Bazzo, MD, said at Pain Care for Primary Care. Still, “it’s going to take multiple things to best treat your patients.”
Fibromyalgia is unique, said Dr. Bazzo, professor of family medicine and public health at the University of California, San Diego. Diagnosis is based on self-reported symptoms since no laboratory tests are available. For diagnostic criteria, he recommends those released by the American College of Rheumatology in 2010 and 2011 and updated in 2016. The criteria, he said, recognize the importance of cognitive symptoms, unrefreshing sleep, fatigue, and certain somatic symptoms (Semin Arthritis Rheum. 2016;46[3]:319-29).
Poor sleep is an especially important problem in fibromyalgia, Dr. Bazzo said, although it’s “a bit of a chicken-and-egg discussion.” It’s not clear which comes first, but “we know that both happen hand-in-hand. We need to work on people’s sleep as one of the primary targets.”
When it comes to treatment, “you have to validate this person’s symptoms and say, ‘Yes, I believe you. I know that you are suffering, and that you’re having pain,’ ” Dr. Bazzo said at the meeting held by the American Pain Society and Global Academy for Medical Education. He advised clinicians to keep in mind conditions that can accompany fibromyalgia, such as depression, that may require other treatment options.
Dr. Bazzo offered advice about these approaches to treatment:
- Exercise. Research supports treadmill and cycle ergometry (BMJ 2002;325:185).
- Opioids. “There’s no convincing evidence that opioids have a role in treating fibromyalgia initially. If you’ve tried everything and patients have had problems, are just not responsive or had side effects, you could consider opioids. But that should be at the tail end of everything because the data is not there,” he said.
- Tramadol. “It’s like an opioid with potential for addiction,” he said. “Don’t just use it willy-nilly. Make sure you have a reason and a good plan. Would it be my first thing? No. Is it something that I keep in my back pocket when other things aren’t working? Perhaps. Would I use it before an opioid? For sure.”
- Second-line therapies. According to Dr. Bazzo, these include antiepileptics such as gabapentin and pregabalin, low-dose cyclobenzaprine, and dual reuptake inhibitors such as duloxetine. There are many other second-line options, he said, from behavioral approaches to yoga to guided physical therapy.
- NSAIDs. Not helpful.
- Cannabis. May interact with other medications.
- Pain clinics. Make sure you refer patients to a pain clinic that embraces a multidisciplinary approach, he said, not one that only offers “pain pills or shots.”
Dr. Bazzo reported no relevant conflicts of interest. The Global Academy for Medical Education and this news organization are owned by the same parent company.
SAN DIEGO – There are many potential treatments for fibromyalgia, but a large number of them – NSAIDs, opioids, cannabis and more – come with caveats and nothing beats an old stand-by: physical rehabilitation.
With exercise, “we’re getting the muscles moving, and we’re getting [patients] used to stimulation that will hopefully deaden that pain response over time,” David E.J. Bazzo, MD, said at Pain Care for Primary Care. Still, “it’s going to take multiple things to best treat your patients.”
Fibromyalgia is unique, said Dr. Bazzo, professor of family medicine and public health at the University of California, San Diego. Diagnosis is based on self-reported symptoms since no laboratory tests are available. For diagnostic criteria, he recommends those released by the American College of Rheumatology in 2010 and 2011 and updated in 2016. The criteria, he said, recognize the importance of cognitive symptoms, unrefreshing sleep, fatigue, and certain somatic symptoms (Semin Arthritis Rheum. 2016;46[3]:319-29).
Poor sleep is an especially important problem in fibromyalgia, Dr. Bazzo said, although it’s “a bit of a chicken-and-egg discussion.” It’s not clear which comes first, but “we know that both happen hand-in-hand. We need to work on people’s sleep as one of the primary targets.”
When it comes to treatment, “you have to validate this person’s symptoms and say, ‘Yes, I believe you. I know that you are suffering, and that you’re having pain,’ ” Dr. Bazzo said at the meeting held by the American Pain Society and Global Academy for Medical Education. He advised clinicians to keep in mind conditions that can accompany fibromyalgia, such as depression, that may require other treatment options.
Dr. Bazzo offered advice about these approaches to treatment:
- Exercise. Research supports treadmill and cycle ergometry (BMJ 2002;325:185).
- Opioids. “There’s no convincing evidence that opioids have a role in treating fibromyalgia initially. If you’ve tried everything and patients have had problems, are just not responsive or had side effects, you could consider opioids. But that should be at the tail end of everything because the data is not there,” he said.
- Tramadol. “It’s like an opioid with potential for addiction,” he said. “Don’t just use it willy-nilly. Make sure you have a reason and a good plan. Would it be my first thing? No. Is it something that I keep in my back pocket when other things aren’t working? Perhaps. Would I use it before an opioid? For sure.”
- Second-line therapies. According to Dr. Bazzo, these include antiepileptics such as gabapentin and pregabalin, low-dose cyclobenzaprine, and dual reuptake inhibitors such as duloxetine. There are many other second-line options, he said, from behavioral approaches to yoga to guided physical therapy.
- NSAIDs. Not helpful.
- Cannabis. May interact with other medications.
- Pain clinics. Make sure you refer patients to a pain clinic that embraces a multidisciplinary approach, he said, not one that only offers “pain pills or shots.”
Dr. Bazzo reported no relevant conflicts of interest. The Global Academy for Medical Education and this news organization are owned by the same parent company.
SAN DIEGO – There are many potential treatments for fibromyalgia, but a large number of them – NSAIDs, opioids, cannabis and more – come with caveats and nothing beats an old stand-by: physical rehabilitation.
With exercise, “we’re getting the muscles moving, and we’re getting [patients] used to stimulation that will hopefully deaden that pain response over time,” David E.J. Bazzo, MD, said at Pain Care for Primary Care. Still, “it’s going to take multiple things to best treat your patients.”
Fibromyalgia is unique, said Dr. Bazzo, professor of family medicine and public health at the University of California, San Diego. Diagnosis is based on self-reported symptoms since no laboratory tests are available. For diagnostic criteria, he recommends those released by the American College of Rheumatology in 2010 and 2011 and updated in 2016. The criteria, he said, recognize the importance of cognitive symptoms, unrefreshing sleep, fatigue, and certain somatic symptoms (Semin Arthritis Rheum. 2016;46[3]:319-29).
Poor sleep is an especially important problem in fibromyalgia, Dr. Bazzo said, although it’s “a bit of a chicken-and-egg discussion.” It’s not clear which comes first, but “we know that both happen hand-in-hand. We need to work on people’s sleep as one of the primary targets.”
When it comes to treatment, “you have to validate this person’s symptoms and say, ‘Yes, I believe you. I know that you are suffering, and that you’re having pain,’ ” Dr. Bazzo said at the meeting held by the American Pain Society and Global Academy for Medical Education. He advised clinicians to keep in mind conditions that can accompany fibromyalgia, such as depression, that may require other treatment options.
Dr. Bazzo offered advice about these approaches to treatment:
- Exercise. Research supports treadmill and cycle ergometry (BMJ 2002;325:185).
- Opioids. “There’s no convincing evidence that opioids have a role in treating fibromyalgia initially. If you’ve tried everything and patients have had problems, are just not responsive or had side effects, you could consider opioids. But that should be at the tail end of everything because the data is not there,” he said.
- Tramadol. “It’s like an opioid with potential for addiction,” he said. “Don’t just use it willy-nilly. Make sure you have a reason and a good plan. Would it be my first thing? No. Is it something that I keep in my back pocket when other things aren’t working? Perhaps. Would I use it before an opioid? For sure.”
- Second-line therapies. According to Dr. Bazzo, these include antiepileptics such as gabapentin and pregabalin, low-dose cyclobenzaprine, and dual reuptake inhibitors such as duloxetine. There are many other second-line options, he said, from behavioral approaches to yoga to guided physical therapy.
- NSAIDs. Not helpful.
- Cannabis. May interact with other medications.
- Pain clinics. Make sure you refer patients to a pain clinic that embraces a multidisciplinary approach, he said, not one that only offers “pain pills or shots.”
Dr. Bazzo reported no relevant conflicts of interest. The Global Academy for Medical Education and this news organization are owned by the same parent company.
EXPERT ANALYSIS FROM PAIN CARE FOR PRIMARY CARE
Training in pathology and a good microscope help vulvar disorder diagnosis
LAS VEGAS –
In a presentation at the Pelvic Anatomy and Gynecologic Surgery Symposium, Dr. Baggish ran through some tips about diagnosing and treating vulvar conditions. He discussed routine disorders (such as pubic lice), potentially dangerous disorders (such as lichen sclerosis, an inflammatory skin condition that can develop into squamous cell carcinoma), and rare disorders (such as Behçet’s syndrome, an inflammation of the blood vessels that can cause genital sores, and Fox-Fordyce disease of the vulva, which produces intense itching).
Dr. Baggish, a professor at the University of California, San Francisco, who treats patients in the Wine Country town of Saint Helena, elaborated on the treatment of vulvar disease in an interview at the meeting jointly provided by Global Academy for Medical Education and the University of Cincinnati. Global Academy and this news organization are owned by the same company. The following are a few of his tips for gynecologists who want to expand their expertise and treat more patients with vulvar disorders.
- Get training in pathology. “That has made a big difference in my ability to intercept different kinds of vulvar and skin diseases,” he said. “You also need to see a lot of abnormalities so you can recognize the kinds of changes that you’re seeing.”
- Take a closer look with a microscope. “I have an operating microscope like an ophthalmologist would use, and it’s on a stand, not a table,” he said. “It always provides magnification with good light. This is a big advantage because misdiagnoses can be made when you can’t see the lesion well.” He added that he projects what he sees in the microscope onto a monitor so the patient can take a look herself. “I’ve found that very valuable,” he said.
- Be alert for chemical burns. “I’ve seen chemical burns when patients have had fungal infections and treated it with certain topical treatments like gentian violet. Somebody may also get a chemical burn from putting some kind of deodorant on their vulva,” Dr. Baggish said. “If you have a chemical burn, you’ll want to treat it with a cream to cover the lesion until it heals on its own. Silvadene is soothing, and patients find it very comfortable.”
- Get the right kind of biopsy. If you can’t identify a lesion, he said, “it’s better to do a biopsy.” He recommends asking pathologists for a reticulum stain. “It shows the support structure of the underlying tissue in the dermis of the layers of the skin, like the structure of a building before you put the covering on the girders,” he said. “The support structure is broken up in lichen planus [a common inflammatory condition that affects the skin and mucous membranes and can cause pain and itch]. You see that if you do a reticulum stain.” If a patient has an inflammatory condition, ask for relevant stains, he said. “For example, if there’s a question that this could be a viral disease like herpes simplex, I’m going to ask them to do a stain for viral inclusions,” he said. “Likewise, I will always ask for a stain for fungal particles, for yeast particles. Sometimes I’ll pick up something like an infection I otherwise would have missed.”
- Contact a specialist when needed. If a biopsy doesn’t help you identify a lesion, he said, “seek out an expert in this area who could be helpful.”
A number of gynecologists like Dr. Baggish specialize in vulvar disease, and several medical centers in the United States operate specialized vulvar clinics including Oregon Health & Science University, Portland; the University of Michigan, Ann Arbor; and Saint Louis University.
Dr. Baggish said he had no disclosures.
LAS VEGAS –
In a presentation at the Pelvic Anatomy and Gynecologic Surgery Symposium, Dr. Baggish ran through some tips about diagnosing and treating vulvar conditions. He discussed routine disorders (such as pubic lice), potentially dangerous disorders (such as lichen sclerosis, an inflammatory skin condition that can develop into squamous cell carcinoma), and rare disorders (such as Behçet’s syndrome, an inflammation of the blood vessels that can cause genital sores, and Fox-Fordyce disease of the vulva, which produces intense itching).
Dr. Baggish, a professor at the University of California, San Francisco, who treats patients in the Wine Country town of Saint Helena, elaborated on the treatment of vulvar disease in an interview at the meeting jointly provided by Global Academy for Medical Education and the University of Cincinnati. Global Academy and this news organization are owned by the same company. The following are a few of his tips for gynecologists who want to expand their expertise and treat more patients with vulvar disorders.
- Get training in pathology. “That has made a big difference in my ability to intercept different kinds of vulvar and skin diseases,” he said. “You also need to see a lot of abnormalities so you can recognize the kinds of changes that you’re seeing.”
- Take a closer look with a microscope. “I have an operating microscope like an ophthalmologist would use, and it’s on a stand, not a table,” he said. “It always provides magnification with good light. This is a big advantage because misdiagnoses can be made when you can’t see the lesion well.” He added that he projects what he sees in the microscope onto a monitor so the patient can take a look herself. “I’ve found that very valuable,” he said.
- Be alert for chemical burns. “I’ve seen chemical burns when patients have had fungal infections and treated it with certain topical treatments like gentian violet. Somebody may also get a chemical burn from putting some kind of deodorant on their vulva,” Dr. Baggish said. “If you have a chemical burn, you’ll want to treat it with a cream to cover the lesion until it heals on its own. Silvadene is soothing, and patients find it very comfortable.”
- Get the right kind of biopsy. If you can’t identify a lesion, he said, “it’s better to do a biopsy.” He recommends asking pathologists for a reticulum stain. “It shows the support structure of the underlying tissue in the dermis of the layers of the skin, like the structure of a building before you put the covering on the girders,” he said. “The support structure is broken up in lichen planus [a common inflammatory condition that affects the skin and mucous membranes and can cause pain and itch]. You see that if you do a reticulum stain.” If a patient has an inflammatory condition, ask for relevant stains, he said. “For example, if there’s a question that this could be a viral disease like herpes simplex, I’m going to ask them to do a stain for viral inclusions,” he said. “Likewise, I will always ask for a stain for fungal particles, for yeast particles. Sometimes I’ll pick up something like an infection I otherwise would have missed.”
- Contact a specialist when needed. If a biopsy doesn’t help you identify a lesion, he said, “seek out an expert in this area who could be helpful.”
A number of gynecologists like Dr. Baggish specialize in vulvar disease, and several medical centers in the United States operate specialized vulvar clinics including Oregon Health & Science University, Portland; the University of Michigan, Ann Arbor; and Saint Louis University.
Dr. Baggish said he had no disclosures.
LAS VEGAS –
In a presentation at the Pelvic Anatomy and Gynecologic Surgery Symposium, Dr. Baggish ran through some tips about diagnosing and treating vulvar conditions. He discussed routine disorders (such as pubic lice), potentially dangerous disorders (such as lichen sclerosis, an inflammatory skin condition that can develop into squamous cell carcinoma), and rare disorders (such as Behçet’s syndrome, an inflammation of the blood vessels that can cause genital sores, and Fox-Fordyce disease of the vulva, which produces intense itching).
Dr. Baggish, a professor at the University of California, San Francisco, who treats patients in the Wine Country town of Saint Helena, elaborated on the treatment of vulvar disease in an interview at the meeting jointly provided by Global Academy for Medical Education and the University of Cincinnati. Global Academy and this news organization are owned by the same company. The following are a few of his tips for gynecologists who want to expand their expertise and treat more patients with vulvar disorders.
- Get training in pathology. “That has made a big difference in my ability to intercept different kinds of vulvar and skin diseases,” he said. “You also need to see a lot of abnormalities so you can recognize the kinds of changes that you’re seeing.”
- Take a closer look with a microscope. “I have an operating microscope like an ophthalmologist would use, and it’s on a stand, not a table,” he said. “It always provides magnification with good light. This is a big advantage because misdiagnoses can be made when you can’t see the lesion well.” He added that he projects what he sees in the microscope onto a monitor so the patient can take a look herself. “I’ve found that very valuable,” he said.
- Be alert for chemical burns. “I’ve seen chemical burns when patients have had fungal infections and treated it with certain topical treatments like gentian violet. Somebody may also get a chemical burn from putting some kind of deodorant on their vulva,” Dr. Baggish said. “If you have a chemical burn, you’ll want to treat it with a cream to cover the lesion until it heals on its own. Silvadene is soothing, and patients find it very comfortable.”
- Get the right kind of biopsy. If you can’t identify a lesion, he said, “it’s better to do a biopsy.” He recommends asking pathologists for a reticulum stain. “It shows the support structure of the underlying tissue in the dermis of the layers of the skin, like the structure of a building before you put the covering on the girders,” he said. “The support structure is broken up in lichen planus [a common inflammatory condition that affects the skin and mucous membranes and can cause pain and itch]. You see that if you do a reticulum stain.” If a patient has an inflammatory condition, ask for relevant stains, he said. “For example, if there’s a question that this could be a viral disease like herpes simplex, I’m going to ask them to do a stain for viral inclusions,” he said. “Likewise, I will always ask for a stain for fungal particles, for yeast particles. Sometimes I’ll pick up something like an infection I otherwise would have missed.”
- Contact a specialist when needed. If a biopsy doesn’t help you identify a lesion, he said, “seek out an expert in this area who could be helpful.”
A number of gynecologists like Dr. Baggish specialize in vulvar disease, and several medical centers in the United States operate specialized vulvar clinics including Oregon Health & Science University, Portland; the University of Michigan, Ann Arbor; and Saint Louis University.
Dr. Baggish said he had no disclosures.
EXPERT ANALYSIS FROM PAGS
Vulvar disease treatment tips: From lice to lichen sclerosus
LAS VEGAS – at the Pelvic Anatomy and Gynecologic Surgery Symposium.
Pubic lice
Treat with malathion 0.5% lotion (Ovide), permethrin 1%-5% (Nix), or lindane 1% (Kwell). Be aware that the U.S. Library of Medicine cautions that lindane can cause serious side effects, and patients should use it only “if there is some reason you cannot use the other medications or if you have tried the other medications and they have not worked.”
Pruritus (itchy skin)
Eliminate possible contact allergens such as soaps, detergents, and undergarments. Swabs with 2% acetic acid solution can assist with general hygiene. It’s important to address secondary infections, and control of diet and stress may be helpful.
Folliculitis (inflammation of hair follicles)
A salt water bath can be helpful. Try 2 cups of “Instant Ocean” – a sea salt product for aquariums – in a shallow bath twice daily.
It can be treated with silver sulfadiazine (Silvadene) cream (three times daily and at bedtime) or clindamycin (Cleocin) cream (three times daily and at bedtime).
Consider a systemic drug after culture results come back if needed.
Lichen sclerosus (a skin inflammation also known as white spot disease)
“I see a lot of lichen sclerosus,” Dr. Baggish said. “Every single practice day, I’m seeing two or three [cases].”
Topical treatments include testosterone cream (which has low efficacy) and topical corticosteroid creams and ointments (the standard treatment).
Other treatments provide better and more consistent results: Etretinate (Tegison), a retinoid that is expensive and can produce serious side effects, and injectable dexamethasone (Decadron), which can stop progression.
Be aware that 10% of patients with this condition may develop squamous cell carcinoma. Monitor for any changes in appearance and biopsy if needed.
Behçet’s disease (a blood vessel inflammation disorder also known as silk road disease)
This rare condition can cause mouth and genital ulcers and uveitis (eye inflammation). For treatment, start 40 mg prednisone for 2-3 days, then 20 mg for 2 days, then 10 mg for 4 days, then stop. Start treatment immediately if there are signs of an oral lesion.
Fox-Fordyce disease (an inflammatory response that blocks sweat ducts and causes intense itching)
Treatment includes estrogen (2.5 mg per day) and tretinoin (Retin-A, apply once daily), usually given together. Suggest that patients try the Instant Ocean salt water treatment in the bath once daily (see details above under folliculitis entry).
Genital warts
Vaporize the warts via laser. “If they look like they’re recurring, I put them on interferon for 3 months because otherwise they just keep recurring,” Dr. Baggish said. “You could put topical treatments on them, but they’ll recur.”
Dr. Baggish, of the University of California, San Francisco, had no relevant financial disclosures. The meeting was jointly provided by Global Academy for Medical Education and the University of Cincinnati. Global Academy and this news organization are owned by the same company.
LAS VEGAS – at the Pelvic Anatomy and Gynecologic Surgery Symposium.
Pubic lice
Treat with malathion 0.5% lotion (Ovide), permethrin 1%-5% (Nix), or lindane 1% (Kwell). Be aware that the U.S. Library of Medicine cautions that lindane can cause serious side effects, and patients should use it only “if there is some reason you cannot use the other medications or if you have tried the other medications and they have not worked.”
Pruritus (itchy skin)
Eliminate possible contact allergens such as soaps, detergents, and undergarments. Swabs with 2% acetic acid solution can assist with general hygiene. It’s important to address secondary infections, and control of diet and stress may be helpful.
Folliculitis (inflammation of hair follicles)
A salt water bath can be helpful. Try 2 cups of “Instant Ocean” – a sea salt product for aquariums – in a shallow bath twice daily.
It can be treated with silver sulfadiazine (Silvadene) cream (three times daily and at bedtime) or clindamycin (Cleocin) cream (three times daily and at bedtime).
Consider a systemic drug after culture results come back if needed.
Lichen sclerosus (a skin inflammation also known as white spot disease)
“I see a lot of lichen sclerosus,” Dr. Baggish said. “Every single practice day, I’m seeing two or three [cases].”
Topical treatments include testosterone cream (which has low efficacy) and topical corticosteroid creams and ointments (the standard treatment).
Other treatments provide better and more consistent results: Etretinate (Tegison), a retinoid that is expensive and can produce serious side effects, and injectable dexamethasone (Decadron), which can stop progression.
Be aware that 10% of patients with this condition may develop squamous cell carcinoma. Monitor for any changes in appearance and biopsy if needed.
Behçet’s disease (a blood vessel inflammation disorder also known as silk road disease)
This rare condition can cause mouth and genital ulcers and uveitis (eye inflammation). For treatment, start 40 mg prednisone for 2-3 days, then 20 mg for 2 days, then 10 mg for 4 days, then stop. Start treatment immediately if there are signs of an oral lesion.
Fox-Fordyce disease (an inflammatory response that blocks sweat ducts and causes intense itching)
Treatment includes estrogen (2.5 mg per day) and tretinoin (Retin-A, apply once daily), usually given together. Suggest that patients try the Instant Ocean salt water treatment in the bath once daily (see details above under folliculitis entry).
Genital warts
Vaporize the warts via laser. “If they look like they’re recurring, I put them on interferon for 3 months because otherwise they just keep recurring,” Dr. Baggish said. “You could put topical treatments on them, but they’ll recur.”
Dr. Baggish, of the University of California, San Francisco, had no relevant financial disclosures. The meeting was jointly provided by Global Academy for Medical Education and the University of Cincinnati. Global Academy and this news organization are owned by the same company.
LAS VEGAS – at the Pelvic Anatomy and Gynecologic Surgery Symposium.
Pubic lice
Treat with malathion 0.5% lotion (Ovide), permethrin 1%-5% (Nix), or lindane 1% (Kwell). Be aware that the U.S. Library of Medicine cautions that lindane can cause serious side effects, and patients should use it only “if there is some reason you cannot use the other medications or if you have tried the other medications and they have not worked.”
Pruritus (itchy skin)
Eliminate possible contact allergens such as soaps, detergents, and undergarments. Swabs with 2% acetic acid solution can assist with general hygiene. It’s important to address secondary infections, and control of diet and stress may be helpful.
Folliculitis (inflammation of hair follicles)
A salt water bath can be helpful. Try 2 cups of “Instant Ocean” – a sea salt product for aquariums – in a shallow bath twice daily.
It can be treated with silver sulfadiazine (Silvadene) cream (three times daily and at bedtime) or clindamycin (Cleocin) cream (three times daily and at bedtime).
Consider a systemic drug after culture results come back if needed.
Lichen sclerosus (a skin inflammation also known as white spot disease)
“I see a lot of lichen sclerosus,” Dr. Baggish said. “Every single practice day, I’m seeing two or three [cases].”
Topical treatments include testosterone cream (which has low efficacy) and topical corticosteroid creams and ointments (the standard treatment).
Other treatments provide better and more consistent results: Etretinate (Tegison), a retinoid that is expensive and can produce serious side effects, and injectable dexamethasone (Decadron), which can stop progression.
Be aware that 10% of patients with this condition may develop squamous cell carcinoma. Monitor for any changes in appearance and biopsy if needed.
Behçet’s disease (a blood vessel inflammation disorder also known as silk road disease)
This rare condition can cause mouth and genital ulcers and uveitis (eye inflammation). For treatment, start 40 mg prednisone for 2-3 days, then 20 mg for 2 days, then 10 mg for 4 days, then stop. Start treatment immediately if there are signs of an oral lesion.
Fox-Fordyce disease (an inflammatory response that blocks sweat ducts and causes intense itching)
Treatment includes estrogen (2.5 mg per day) and tretinoin (Retin-A, apply once daily), usually given together. Suggest that patients try the Instant Ocean salt water treatment in the bath once daily (see details above under folliculitis entry).
Genital warts
Vaporize the warts via laser. “If they look like they’re recurring, I put them on interferon for 3 months because otherwise they just keep recurring,” Dr. Baggish said. “You could put topical treatments on them, but they’ll recur.”
Dr. Baggish, of the University of California, San Francisco, had no relevant financial disclosures. The meeting was jointly provided by Global Academy for Medical Education and the University of Cincinnati. Global Academy and this news organization are owned by the same company.
EXPERT ANALYSIS FROM PAGS
App aims to detect respiratory failure in opioid overdoses
A new smartphone app under development seeks to detect the first moments of an overdose-related respiratory crisis and summon help before it’s too late.
“We’re hoping a device that most people carry around could be transformed into technology that could save your life in an overdose,” said anesthesiologist Jacob (Jake) E. Sunshine, MD, an assistant professor with the University of Washington, Seattle, and coauthor of a study about the app’s development.
The ultimate goal is “to provide a harm reduction system that can automatically connect naloxone-equipped friends and family or emergency medical services to help prevent fatal overdose events,” Rajalakshmi Nandakumar, and her associates wrote in the study, published in Science Translational Medicine.
An estimated 70,000 people in the United States died from drug overdoses in 2017, according to a 2018 data brief from the Centers for Disease Control and Prevention. On an age-adjusted basis, the overdose death rate in 2017 was more than three times higher than in 1999.
The app, which builds on previous work aimed at detecting disordered breathing in sleep apnea, uses a “short-range active sonar system” to detect respiration in a person within the distance of about 3 feet. The approach is similar to the echolocation strategy used by a dolphin or bat, Dr. Sunshine said, and relies on sending out an audio tone that humans cannot hear.
The app’s microphone detects an “audio reflection” of the tone after it bounces off a nearby person’s body and then analyzes it to calculate the distance to the person’s chest. “We’re able to use those distances to measure when someone is taking a breath, and when they’re not taking a breath,” said Dr. Sunshine, who conceptualized the study.
If a disordered breathing pattern is detected, the app is designed to send a text message with a GPS-pinpointed location to a prespecified contact, Dr. Sunshine said. Or the app could be set to call 911.
In the study, the investigators tested the app’s algorithm at a supervised injection facility – a space designed to allow users to inject illicit drugs safely – in Vancouver. They tested the app on 94 drug users as they injected themselves; half of the users “experienced clinically important respiratory depression,” and two needed to be treated by clinic staff for overdose. Both users survived, reported Ms. Nandakumar, a PhD candidate at the University of Washington, Seattle; Shyamnath Gollakota, PhD, an associate professor at the university; and Dr. Sunshine.
(95% confidence interval, 86.0%-99.5%) with 97.7% specificity (95% confidence interval, 88.2%-99.9%). However, the app was less adept at identifying respiratory depression (respiratory rate equal to or less than 7 breaths per minute): The investigators reported 87.2% sensitivity (95% CI, 74.2%-95.1%) and 89.3% specificity (95% CI, 76.9%-96.4%).
Ms. Nandakumar and her associates also tested the app’s algorithm on patients undergoing anesthesia. It correctly detected disordered breathing in 19 of 20 patients.
It’s not clear how the app would work in environments full of breathing people and, potentially, breathing animals such as pets. And the app has clear limitations. Since it needs to be able to bounce audio signals off a user’s chest, it will not work if a phone is in a pocket or if a user is face down, turns around, or wanders off.
However, the app can detect sudden changes in motion, Dr. Sunshine said, and investigators are developing a way to require users to check in with the app in certain situations that might signal trouble.
“For harm reduction interventions to be efficacious, further studies with participant feedback and human factor testing are needed to ensure that the system meets the needs, values, and preferences of people who use opioids, in addition to establishing the system’s safety vis-à-vis its potential to encourage moral hazard,” the investigators wrote in the article.
The next steps are to refine the app’s user interface and figure out how to connect it to the 911 emergency-response system, Dr. Sunshine said. Meanwhile, researchers have created a company to develop the product. “We’re going to do additional development through that entity and seek [Food and Drug Administration] approval,” Dr. Sunshine said. The investigators do not plan to charge users for the product, which can be used on iPhones and Androids, he said.
The study was funded by the Foundation for Anesthesia Education and Research, the National Science Foundation, and the University of Washington’s Alcohol and Drug Abuse Institute. Dr. Sunshine, Ms. Nandakumar, and Dr. Gollakota are inventors on a provisional patient application related to the project, and all have equity stakes in a company that is developing the technology. Dr. Gollakota is a paid consultant to Jeeva Wireless and Edus Health.
SOURCE: Nandakumar R et al. Sci Transl Med. 2019 Jan 9;11(474). doi: 10.1126/scitranslmed.aau8914.
A new smartphone app under development seeks to detect the first moments of an overdose-related respiratory crisis and summon help before it’s too late.
“We’re hoping a device that most people carry around could be transformed into technology that could save your life in an overdose,” said anesthesiologist Jacob (Jake) E. Sunshine, MD, an assistant professor with the University of Washington, Seattle, and coauthor of a study about the app’s development.
The ultimate goal is “to provide a harm reduction system that can automatically connect naloxone-equipped friends and family or emergency medical services to help prevent fatal overdose events,” Rajalakshmi Nandakumar, and her associates wrote in the study, published in Science Translational Medicine.
An estimated 70,000 people in the United States died from drug overdoses in 2017, according to a 2018 data brief from the Centers for Disease Control and Prevention. On an age-adjusted basis, the overdose death rate in 2017 was more than three times higher than in 1999.
The app, which builds on previous work aimed at detecting disordered breathing in sleep apnea, uses a “short-range active sonar system” to detect respiration in a person within the distance of about 3 feet. The approach is similar to the echolocation strategy used by a dolphin or bat, Dr. Sunshine said, and relies on sending out an audio tone that humans cannot hear.
The app’s microphone detects an “audio reflection” of the tone after it bounces off a nearby person’s body and then analyzes it to calculate the distance to the person’s chest. “We’re able to use those distances to measure when someone is taking a breath, and when they’re not taking a breath,” said Dr. Sunshine, who conceptualized the study.
If a disordered breathing pattern is detected, the app is designed to send a text message with a GPS-pinpointed location to a prespecified contact, Dr. Sunshine said. Or the app could be set to call 911.
In the study, the investigators tested the app’s algorithm at a supervised injection facility – a space designed to allow users to inject illicit drugs safely – in Vancouver. They tested the app on 94 drug users as they injected themselves; half of the users “experienced clinically important respiratory depression,” and two needed to be treated by clinic staff for overdose. Both users survived, reported Ms. Nandakumar, a PhD candidate at the University of Washington, Seattle; Shyamnath Gollakota, PhD, an associate professor at the university; and Dr. Sunshine.
(95% confidence interval, 86.0%-99.5%) with 97.7% specificity (95% confidence interval, 88.2%-99.9%). However, the app was less adept at identifying respiratory depression (respiratory rate equal to or less than 7 breaths per minute): The investigators reported 87.2% sensitivity (95% CI, 74.2%-95.1%) and 89.3% specificity (95% CI, 76.9%-96.4%).
Ms. Nandakumar and her associates also tested the app’s algorithm on patients undergoing anesthesia. It correctly detected disordered breathing in 19 of 20 patients.
It’s not clear how the app would work in environments full of breathing people and, potentially, breathing animals such as pets. And the app has clear limitations. Since it needs to be able to bounce audio signals off a user’s chest, it will not work if a phone is in a pocket or if a user is face down, turns around, or wanders off.
However, the app can detect sudden changes in motion, Dr. Sunshine said, and investigators are developing a way to require users to check in with the app in certain situations that might signal trouble.
“For harm reduction interventions to be efficacious, further studies with participant feedback and human factor testing are needed to ensure that the system meets the needs, values, and preferences of people who use opioids, in addition to establishing the system’s safety vis-à-vis its potential to encourage moral hazard,” the investigators wrote in the article.
The next steps are to refine the app’s user interface and figure out how to connect it to the 911 emergency-response system, Dr. Sunshine said. Meanwhile, researchers have created a company to develop the product. “We’re going to do additional development through that entity and seek [Food and Drug Administration] approval,” Dr. Sunshine said. The investigators do not plan to charge users for the product, which can be used on iPhones and Androids, he said.
The study was funded by the Foundation for Anesthesia Education and Research, the National Science Foundation, and the University of Washington’s Alcohol and Drug Abuse Institute. Dr. Sunshine, Ms. Nandakumar, and Dr. Gollakota are inventors on a provisional patient application related to the project, and all have equity stakes in a company that is developing the technology. Dr. Gollakota is a paid consultant to Jeeva Wireless and Edus Health.
SOURCE: Nandakumar R et al. Sci Transl Med. 2019 Jan 9;11(474). doi: 10.1126/scitranslmed.aau8914.
A new smartphone app under development seeks to detect the first moments of an overdose-related respiratory crisis and summon help before it’s too late.
“We’re hoping a device that most people carry around could be transformed into technology that could save your life in an overdose,” said anesthesiologist Jacob (Jake) E. Sunshine, MD, an assistant professor with the University of Washington, Seattle, and coauthor of a study about the app’s development.
The ultimate goal is “to provide a harm reduction system that can automatically connect naloxone-equipped friends and family or emergency medical services to help prevent fatal overdose events,” Rajalakshmi Nandakumar, and her associates wrote in the study, published in Science Translational Medicine.
An estimated 70,000 people in the United States died from drug overdoses in 2017, according to a 2018 data brief from the Centers for Disease Control and Prevention. On an age-adjusted basis, the overdose death rate in 2017 was more than three times higher than in 1999.
The app, which builds on previous work aimed at detecting disordered breathing in sleep apnea, uses a “short-range active sonar system” to detect respiration in a person within the distance of about 3 feet. The approach is similar to the echolocation strategy used by a dolphin or bat, Dr. Sunshine said, and relies on sending out an audio tone that humans cannot hear.
The app’s microphone detects an “audio reflection” of the tone after it bounces off a nearby person’s body and then analyzes it to calculate the distance to the person’s chest. “We’re able to use those distances to measure when someone is taking a breath, and when they’re not taking a breath,” said Dr. Sunshine, who conceptualized the study.
If a disordered breathing pattern is detected, the app is designed to send a text message with a GPS-pinpointed location to a prespecified contact, Dr. Sunshine said. Or the app could be set to call 911.
In the study, the investigators tested the app’s algorithm at a supervised injection facility – a space designed to allow users to inject illicit drugs safely – in Vancouver. They tested the app on 94 drug users as they injected themselves; half of the users “experienced clinically important respiratory depression,” and two needed to be treated by clinic staff for overdose. Both users survived, reported Ms. Nandakumar, a PhD candidate at the University of Washington, Seattle; Shyamnath Gollakota, PhD, an associate professor at the university; and Dr. Sunshine.
(95% confidence interval, 86.0%-99.5%) with 97.7% specificity (95% confidence interval, 88.2%-99.9%). However, the app was less adept at identifying respiratory depression (respiratory rate equal to or less than 7 breaths per minute): The investigators reported 87.2% sensitivity (95% CI, 74.2%-95.1%) and 89.3% specificity (95% CI, 76.9%-96.4%).
Ms. Nandakumar and her associates also tested the app’s algorithm on patients undergoing anesthesia. It correctly detected disordered breathing in 19 of 20 patients.
It’s not clear how the app would work in environments full of breathing people and, potentially, breathing animals such as pets. And the app has clear limitations. Since it needs to be able to bounce audio signals off a user’s chest, it will not work if a phone is in a pocket or if a user is face down, turns around, or wanders off.
However, the app can detect sudden changes in motion, Dr. Sunshine said, and investigators are developing a way to require users to check in with the app in certain situations that might signal trouble.
“For harm reduction interventions to be efficacious, further studies with participant feedback and human factor testing are needed to ensure that the system meets the needs, values, and preferences of people who use opioids, in addition to establishing the system’s safety vis-à-vis its potential to encourage moral hazard,” the investigators wrote in the article.
The next steps are to refine the app’s user interface and figure out how to connect it to the 911 emergency-response system, Dr. Sunshine said. Meanwhile, researchers have created a company to develop the product. “We’re going to do additional development through that entity and seek [Food and Drug Administration] approval,” Dr. Sunshine said. The investigators do not plan to charge users for the product, which can be used on iPhones and Androids, he said.
The study was funded by the Foundation for Anesthesia Education and Research, the National Science Foundation, and the University of Washington’s Alcohol and Drug Abuse Institute. Dr. Sunshine, Ms. Nandakumar, and Dr. Gollakota are inventors on a provisional patient application related to the project, and all have equity stakes in a company that is developing the technology. Dr. Gollakota is a paid consultant to Jeeva Wireless and Edus Health.
SOURCE: Nandakumar R et al. Sci Transl Med. 2019 Jan 9;11(474). doi: 10.1126/scitranslmed.aau8914.
Gout’s Golden Globe, resistance is fecal, eucalyptus eulogy
Eucalyptus eulogy
(“Taps” quietly plays in the background ... ) In some sad news, Quincy the diabetic koala has passed on to that great eucalyptus tree in the sky. The furry type 1 diabetic lived in San Diego, where he was recently fitted with a cutting-edge continuous glucose monitor (CGM). This allowed Quincy more time for his favorite activities (chewing and sleeping) and less time spent with pesky skin pricks.
Quincy died of pneumonia, and it is unclear whether his death was diabetes related. All we know is that he will be missed greatly. He was beloved by those with diabetes everywhere, animal or otherwise. Quincy’s successful CGM procedure also gives endocrinologists hope that the technology could eventually be used for similarly fragile humans, like babies. R.I.P., Quincy; we loved you. In lieu of flowers, donations may be made to his favorite charity, the Drop Bear Awareness Association.
What’s Latin for ‘poop’?
The study of the human microbiota has become incredibly important in recent years, but there’s no getting away from the fact that it entails experimenting on poop. Remarkably, no one’s come up with a proper technical name for this unsavory activity. However, thanks to a collaboration between a gastroenterologist and a classics professor at the University of North Carolina, that deficiency is no more. You’ve met the in vivo and in vitro study. Now, please welcome the “in vimo” study!
Why in vimo? The term fecal or “in feco” might seem obvious. But the Latin root word never referred to poop, and if there’s one thing scientists can’t have, it’s improper Latin usage. The Romans, it turns out, had lots of words for poop. The root word of laetamen referred to fertility, richness, and happiness – a tempting prospect – but was mostly used to refer to farm animal dung. Merda mostly referred to smell or stench, and stercus shared the same root word as scatology, which refers to obscene literature. Fimus, which specifically refers to manure, was thus the most precise, and it was used by literary giants such as Livy, Virgil, and Tacitus. A clear winner, and the in vimo study flushed the rest of the competition away.
And just in case you think these researchers are no fun, the name they chose for the active enzymes collected from their in vimo samples? Poopernatants. Yes, even doctors enjoy a good poop joke.
The new Breakfast Club
Researchers at the University of Illinois and the University of Texas have collaborated to study something that most of us fear greatly: high school cliques. The researchers, who may or may not have peaked in high school, took a look at high school peer crowds and influences that form those tight-knit bonds that last all of 4 years.
The study found that most of the classic cliques – the jocks, the popular crowd, the brains, the stoners, the loners – are still alive and well in today’s American school system. However, at least one new group has emerged in the last decade: the “anime/manga fans.” Researchers noted that although schools have become much more diverse, racial and ethnic stereotypes are alive and well. Thank God we only have to do high school once.
Resistance is fecal
And now, just in case you were wondering how long it would take to put our newfound knowledge of “in vimo” to use, here comes a study that has “in vimo” written all over it (metaphorically speaking, of course).
Researchers in Sweden and Finland decided to take a look at antibiotic resistance genes in sewage, because “antibiotics consumed by humans and animals are released into the environment in urine and fecal material contained in treated wastewaters and sludge applied to land.” Then they compared the abundance of the mobile antibiotic resistance genes with the abundance of a human fecal pollution marker.
That marker – a virus that infects bacteria in human feces but is rare in other animals – was “highly correlated to the abundance of antibiotic resistance genes in environmental samples,” they said in a separate written statement, which “indicates that fecal pollution can largely explain the increase in resistant bacteria often found in human-impacted environments.” The name of that marker, the virus found in feces, happens to be “crAssphage.” And yes, the A really is capitalized. Really. We are not making this up.
Gout wins a Golden Globe
Gout has a new poster girl: Great Britain’s Queen Anne. She’s been dead for more than 4 centuries, but a Hollywood version of this stout monarch is turning a famously royal affliction into the disease of the moment.
The credit goes to actress Olivia Colman, who just won a Golden Globe award for her brilliant performance in the earthy comedy “The Favourite.” Ms. Colman transforms the pain-wracked Queen Anne into a needy, manipulative, and loopy monarch who still manages to draw our sympathy.
Besides flummoxing American spell-checkers with its title, The Favourite glories in stretching the truth about the queen’s private life. But she really does seem to have had the “disease of kings,” which has long been linked to the rich, fatty diets enjoyed by blue bloods.
Now, there’s talk that high-protein, meat-friendly keto and paleo diets are boosting rates among the young. This theory got an airing last week in a New York Magazine article titled “Why Gout Is Making a Comeback.”
The truth may be more complicated. Over the last few years, researchers have cast doubt on the keto-leads-to-gout theory and suggested that fructose in sugar may be the real culprit. According to this hypothesis, gout afflicted British royals as they developed a communal sweet tooth during the early days of the sugar trade. Gout then spread to the general population as sugar became more accessible.
The gout debate will continue. As for Olivia Colman, she will soon grace smaller screens with her performance as Queen Elizabeth II in Netflix’s series “The Crown.”
QE II isn’t known for having suffered from any major diseases. But at her next checkup, we do think she should have that stiff upper lip looked at.
Eucalyptus eulogy
(“Taps” quietly plays in the background ... ) In some sad news, Quincy the diabetic koala has passed on to that great eucalyptus tree in the sky. The furry type 1 diabetic lived in San Diego, where he was recently fitted with a cutting-edge continuous glucose monitor (CGM). This allowed Quincy more time for his favorite activities (chewing and sleeping) and less time spent with pesky skin pricks.
Quincy died of pneumonia, and it is unclear whether his death was diabetes related. All we know is that he will be missed greatly. He was beloved by those with diabetes everywhere, animal or otherwise. Quincy’s successful CGM procedure also gives endocrinologists hope that the technology could eventually be used for similarly fragile humans, like babies. R.I.P., Quincy; we loved you. In lieu of flowers, donations may be made to his favorite charity, the Drop Bear Awareness Association.
What’s Latin for ‘poop’?
The study of the human microbiota has become incredibly important in recent years, but there’s no getting away from the fact that it entails experimenting on poop. Remarkably, no one’s come up with a proper technical name for this unsavory activity. However, thanks to a collaboration between a gastroenterologist and a classics professor at the University of North Carolina, that deficiency is no more. You’ve met the in vivo and in vitro study. Now, please welcome the “in vimo” study!
Why in vimo? The term fecal or “in feco” might seem obvious. But the Latin root word never referred to poop, and if there’s one thing scientists can’t have, it’s improper Latin usage. The Romans, it turns out, had lots of words for poop. The root word of laetamen referred to fertility, richness, and happiness – a tempting prospect – but was mostly used to refer to farm animal dung. Merda mostly referred to smell or stench, and stercus shared the same root word as scatology, which refers to obscene literature. Fimus, which specifically refers to manure, was thus the most precise, and it was used by literary giants such as Livy, Virgil, and Tacitus. A clear winner, and the in vimo study flushed the rest of the competition away.
And just in case you think these researchers are no fun, the name they chose for the active enzymes collected from their in vimo samples? Poopernatants. Yes, even doctors enjoy a good poop joke.
The new Breakfast Club
Researchers at the University of Illinois and the University of Texas have collaborated to study something that most of us fear greatly: high school cliques. The researchers, who may or may not have peaked in high school, took a look at high school peer crowds and influences that form those tight-knit bonds that last all of 4 years.
The study found that most of the classic cliques – the jocks, the popular crowd, the brains, the stoners, the loners – are still alive and well in today’s American school system. However, at least one new group has emerged in the last decade: the “anime/manga fans.” Researchers noted that although schools have become much more diverse, racial and ethnic stereotypes are alive and well. Thank God we only have to do high school once.
Resistance is fecal
And now, just in case you were wondering how long it would take to put our newfound knowledge of “in vimo” to use, here comes a study that has “in vimo” written all over it (metaphorically speaking, of course).
Researchers in Sweden and Finland decided to take a look at antibiotic resistance genes in sewage, because “antibiotics consumed by humans and animals are released into the environment in urine and fecal material contained in treated wastewaters and sludge applied to land.” Then they compared the abundance of the mobile antibiotic resistance genes with the abundance of a human fecal pollution marker.
That marker – a virus that infects bacteria in human feces but is rare in other animals – was “highly correlated to the abundance of antibiotic resistance genes in environmental samples,” they said in a separate written statement, which “indicates that fecal pollution can largely explain the increase in resistant bacteria often found in human-impacted environments.” The name of that marker, the virus found in feces, happens to be “crAssphage.” And yes, the A really is capitalized. Really. We are not making this up.
Gout wins a Golden Globe
Gout has a new poster girl: Great Britain’s Queen Anne. She’s been dead for more than 4 centuries, but a Hollywood version of this stout monarch is turning a famously royal affliction into the disease of the moment.
The credit goes to actress Olivia Colman, who just won a Golden Globe award for her brilliant performance in the earthy comedy “The Favourite.” Ms. Colman transforms the pain-wracked Queen Anne into a needy, manipulative, and loopy monarch who still manages to draw our sympathy.
Besides flummoxing American spell-checkers with its title, The Favourite glories in stretching the truth about the queen’s private life. But she really does seem to have had the “disease of kings,” which has long been linked to the rich, fatty diets enjoyed by blue bloods.
Now, there’s talk that high-protein, meat-friendly keto and paleo diets are boosting rates among the young. This theory got an airing last week in a New York Magazine article titled “Why Gout Is Making a Comeback.”
The truth may be more complicated. Over the last few years, researchers have cast doubt on the keto-leads-to-gout theory and suggested that fructose in sugar may be the real culprit. According to this hypothesis, gout afflicted British royals as they developed a communal sweet tooth during the early days of the sugar trade. Gout then spread to the general population as sugar became more accessible.
The gout debate will continue. As for Olivia Colman, she will soon grace smaller screens with her performance as Queen Elizabeth II in Netflix’s series “The Crown.”
QE II isn’t known for having suffered from any major diseases. But at her next checkup, we do think she should have that stiff upper lip looked at.
Eucalyptus eulogy
(“Taps” quietly plays in the background ... ) In some sad news, Quincy the diabetic koala has passed on to that great eucalyptus tree in the sky. The furry type 1 diabetic lived in San Diego, where he was recently fitted with a cutting-edge continuous glucose monitor (CGM). This allowed Quincy more time for his favorite activities (chewing and sleeping) and less time spent with pesky skin pricks.
Quincy died of pneumonia, and it is unclear whether his death was diabetes related. All we know is that he will be missed greatly. He was beloved by those with diabetes everywhere, animal or otherwise. Quincy’s successful CGM procedure also gives endocrinologists hope that the technology could eventually be used for similarly fragile humans, like babies. R.I.P., Quincy; we loved you. In lieu of flowers, donations may be made to his favorite charity, the Drop Bear Awareness Association.
What’s Latin for ‘poop’?
The study of the human microbiota has become incredibly important in recent years, but there’s no getting away from the fact that it entails experimenting on poop. Remarkably, no one’s come up with a proper technical name for this unsavory activity. However, thanks to a collaboration between a gastroenterologist and a classics professor at the University of North Carolina, that deficiency is no more. You’ve met the in vivo and in vitro study. Now, please welcome the “in vimo” study!
Why in vimo? The term fecal or “in feco” might seem obvious. But the Latin root word never referred to poop, and if there’s one thing scientists can’t have, it’s improper Latin usage. The Romans, it turns out, had lots of words for poop. The root word of laetamen referred to fertility, richness, and happiness – a tempting prospect – but was mostly used to refer to farm animal dung. Merda mostly referred to smell or stench, and stercus shared the same root word as scatology, which refers to obscene literature. Fimus, which specifically refers to manure, was thus the most precise, and it was used by literary giants such as Livy, Virgil, and Tacitus. A clear winner, and the in vimo study flushed the rest of the competition away.
And just in case you think these researchers are no fun, the name they chose for the active enzymes collected from their in vimo samples? Poopernatants. Yes, even doctors enjoy a good poop joke.
The new Breakfast Club
Researchers at the University of Illinois and the University of Texas have collaborated to study something that most of us fear greatly: high school cliques. The researchers, who may or may not have peaked in high school, took a look at high school peer crowds and influences that form those tight-knit bonds that last all of 4 years.
The study found that most of the classic cliques – the jocks, the popular crowd, the brains, the stoners, the loners – are still alive and well in today’s American school system. However, at least one new group has emerged in the last decade: the “anime/manga fans.” Researchers noted that although schools have become much more diverse, racial and ethnic stereotypes are alive and well. Thank God we only have to do high school once.
Resistance is fecal
And now, just in case you were wondering how long it would take to put our newfound knowledge of “in vimo” to use, here comes a study that has “in vimo” written all over it (metaphorically speaking, of course).
Researchers in Sweden and Finland decided to take a look at antibiotic resistance genes in sewage, because “antibiotics consumed by humans and animals are released into the environment in urine and fecal material contained in treated wastewaters and sludge applied to land.” Then they compared the abundance of the mobile antibiotic resistance genes with the abundance of a human fecal pollution marker.
That marker – a virus that infects bacteria in human feces but is rare in other animals – was “highly correlated to the abundance of antibiotic resistance genes in environmental samples,” they said in a separate written statement, which “indicates that fecal pollution can largely explain the increase in resistant bacteria often found in human-impacted environments.” The name of that marker, the virus found in feces, happens to be “crAssphage.” And yes, the A really is capitalized. Really. We are not making this up.
Gout wins a Golden Globe
Gout has a new poster girl: Great Britain’s Queen Anne. She’s been dead for more than 4 centuries, but a Hollywood version of this stout monarch is turning a famously royal affliction into the disease of the moment.
The credit goes to actress Olivia Colman, who just won a Golden Globe award for her brilliant performance in the earthy comedy “The Favourite.” Ms. Colman transforms the pain-wracked Queen Anne into a needy, manipulative, and loopy monarch who still manages to draw our sympathy.
Besides flummoxing American spell-checkers with its title, The Favourite glories in stretching the truth about the queen’s private life. But she really does seem to have had the “disease of kings,” which has long been linked to the rich, fatty diets enjoyed by blue bloods.
Now, there’s talk that high-protein, meat-friendly keto and paleo diets are boosting rates among the young. This theory got an airing last week in a New York Magazine article titled “Why Gout Is Making a Comeback.”
The truth may be more complicated. Over the last few years, researchers have cast doubt on the keto-leads-to-gout theory and suggested that fructose in sugar may be the real culprit. According to this hypothesis, gout afflicted British royals as they developed a communal sweet tooth during the early days of the sugar trade. Gout then spread to the general population as sugar became more accessible.
The gout debate will continue. As for Olivia Colman, she will soon grace smaller screens with her performance as Queen Elizabeth II in Netflix’s series “The Crown.”
QE II isn’t known for having suffered from any major diseases. But at her next checkup, we do think she should have that stiff upper lip looked at.
For pelvic pain, think outside the lower body
LAS VEGAS – An estimated 15%-25% of women aged 18-50 years suffer from chronic pelvic pain, a condition that commonly leads to sick days, reduced activity, and higher medication use. Treatments like surgery and opioids may seem feasible, but an obstetrician-gynecologist who studies pain urged colleagues to think twice.
In some cases, pelvic pain patients may suffer from centralized pain syndromes, conditions linked to the central nervous system that may not respond well to those common treatments, said Sawsan As-Sanie, MD, MPH, director of the University of Michigan Endometriosis Center, Ann Arbor.
“If we have laser vision on the pelvis, we may help some patients, but many of us will do harm,” said Dr. As-Sanie, who spoke at the Pelvic Anatomy and Gynecologic Surgery Symposium.
Endometriosis is frequently linked to pelvic pain. But, she said, the link between the two is fuzzier than has been assumed.
“It would make sense that endometriosis or pelvic adhesions would activate nociceptive pain, and [there are] a lot of data to support that this is, in part, how endometriosis causes pain,” she said. “But I would argue it really isn’t that simple because the relationship between endometriosis and pelvic pain is very complex and not explained entirely by the lesion.” For example, “we know that pain recurs after medical and surgical therapy, often without evidence of recurrent endometriosis.” And, there’s little relationship between pain symptoms and the location or extent of endometriosis.
What’s going on? Dr. As-Sanie suggested central pain syndromes can play a significant role in pelvic pain. These syndromes are 1.5-2 times more common in women than men, and are triggered or exacerbated by stressors.
She also emphasized the wide-ranging effects of these syndromes. “We focus on pain, but it’s clearly not a just a pain disorder,” noting that patients can report fatigue, poor sleep, greater sensitivity to light and sound, and memory difficulties that produce “fibromyalgia fog.”
Research suggests that patients with central pain syndromes experience changes in both brain structure and function, she said. As for pelvic pain specifically, studies have linked it to increased pain sensitivity and altered central nervous system structure and function regardless of whether endometriosis is present.
How should patients with pelvic pain be treated in light of this information? Dr. As-Sanie suggests first trying “gold standard” approaches to treat contributing factors whether they’re gynecologic, urologic, gastrointestinal, musculoskeletal or nerve related.
If those strategies don’t work, she said, “consider treating centralized pain” with a blend of approaches: behavioral (such as diet and cognitive-behavior therapy), medical (such as hormone modulation), and interventional (such as physical therapy and surgery).
Also consider pharmacologic therapies, said Dr. As-Sanie, who identified dual reuptake inhibitors (venlafaxine [Effexor] and duloxetine [Cymbalta] are a class of antidepressants that block the reuptake of both serotonin and norepinephrine) and anticonvulsants as drugs with strong evidence as treatments for central pain syndromes.
“Start at low doses and titrate up,” she advised, and “if at any point a given medication doesn’t work, we should try another.”
The Pelvic Anatomy and Gynecologic Surgery Symposium was jointly provided by Global Academy for Medical Education and the University of Cincinnati. Global Academy and this news organization are owned by the same company.
Dr. As-Sanie discloses she is a consultant for AbbVie and Myovant.
LAS VEGAS – An estimated 15%-25% of women aged 18-50 years suffer from chronic pelvic pain, a condition that commonly leads to sick days, reduced activity, and higher medication use. Treatments like surgery and opioids may seem feasible, but an obstetrician-gynecologist who studies pain urged colleagues to think twice.
In some cases, pelvic pain patients may suffer from centralized pain syndromes, conditions linked to the central nervous system that may not respond well to those common treatments, said Sawsan As-Sanie, MD, MPH, director of the University of Michigan Endometriosis Center, Ann Arbor.
“If we have laser vision on the pelvis, we may help some patients, but many of us will do harm,” said Dr. As-Sanie, who spoke at the Pelvic Anatomy and Gynecologic Surgery Symposium.
Endometriosis is frequently linked to pelvic pain. But, she said, the link between the two is fuzzier than has been assumed.
“It would make sense that endometriosis or pelvic adhesions would activate nociceptive pain, and [there are] a lot of data to support that this is, in part, how endometriosis causes pain,” she said. “But I would argue it really isn’t that simple because the relationship between endometriosis and pelvic pain is very complex and not explained entirely by the lesion.” For example, “we know that pain recurs after medical and surgical therapy, often without evidence of recurrent endometriosis.” And, there’s little relationship between pain symptoms and the location or extent of endometriosis.
What’s going on? Dr. As-Sanie suggested central pain syndromes can play a significant role in pelvic pain. These syndromes are 1.5-2 times more common in women than men, and are triggered or exacerbated by stressors.
She also emphasized the wide-ranging effects of these syndromes. “We focus on pain, but it’s clearly not a just a pain disorder,” noting that patients can report fatigue, poor sleep, greater sensitivity to light and sound, and memory difficulties that produce “fibromyalgia fog.”
Research suggests that patients with central pain syndromes experience changes in both brain structure and function, she said. As for pelvic pain specifically, studies have linked it to increased pain sensitivity and altered central nervous system structure and function regardless of whether endometriosis is present.
How should patients with pelvic pain be treated in light of this information? Dr. As-Sanie suggests first trying “gold standard” approaches to treat contributing factors whether they’re gynecologic, urologic, gastrointestinal, musculoskeletal or nerve related.
If those strategies don’t work, she said, “consider treating centralized pain” with a blend of approaches: behavioral (such as diet and cognitive-behavior therapy), medical (such as hormone modulation), and interventional (such as physical therapy and surgery).
Also consider pharmacologic therapies, said Dr. As-Sanie, who identified dual reuptake inhibitors (venlafaxine [Effexor] and duloxetine [Cymbalta] are a class of antidepressants that block the reuptake of both serotonin and norepinephrine) and anticonvulsants as drugs with strong evidence as treatments for central pain syndromes.
“Start at low doses and titrate up,” she advised, and “if at any point a given medication doesn’t work, we should try another.”
The Pelvic Anatomy and Gynecologic Surgery Symposium was jointly provided by Global Academy for Medical Education and the University of Cincinnati. Global Academy and this news organization are owned by the same company.
Dr. As-Sanie discloses she is a consultant for AbbVie and Myovant.
LAS VEGAS – An estimated 15%-25% of women aged 18-50 years suffer from chronic pelvic pain, a condition that commonly leads to sick days, reduced activity, and higher medication use. Treatments like surgery and opioids may seem feasible, but an obstetrician-gynecologist who studies pain urged colleagues to think twice.
In some cases, pelvic pain patients may suffer from centralized pain syndromes, conditions linked to the central nervous system that may not respond well to those common treatments, said Sawsan As-Sanie, MD, MPH, director of the University of Michigan Endometriosis Center, Ann Arbor.
“If we have laser vision on the pelvis, we may help some patients, but many of us will do harm,” said Dr. As-Sanie, who spoke at the Pelvic Anatomy and Gynecologic Surgery Symposium.
Endometriosis is frequently linked to pelvic pain. But, she said, the link between the two is fuzzier than has been assumed.
“It would make sense that endometriosis or pelvic adhesions would activate nociceptive pain, and [there are] a lot of data to support that this is, in part, how endometriosis causes pain,” she said. “But I would argue it really isn’t that simple because the relationship between endometriosis and pelvic pain is very complex and not explained entirely by the lesion.” For example, “we know that pain recurs after medical and surgical therapy, often without evidence of recurrent endometriosis.” And, there’s little relationship between pain symptoms and the location or extent of endometriosis.
What’s going on? Dr. As-Sanie suggested central pain syndromes can play a significant role in pelvic pain. These syndromes are 1.5-2 times more common in women than men, and are triggered or exacerbated by stressors.
She also emphasized the wide-ranging effects of these syndromes. “We focus on pain, but it’s clearly not a just a pain disorder,” noting that patients can report fatigue, poor sleep, greater sensitivity to light and sound, and memory difficulties that produce “fibromyalgia fog.”
Research suggests that patients with central pain syndromes experience changes in both brain structure and function, she said. As for pelvic pain specifically, studies have linked it to increased pain sensitivity and altered central nervous system structure and function regardless of whether endometriosis is present.
How should patients with pelvic pain be treated in light of this information? Dr. As-Sanie suggests first trying “gold standard” approaches to treat contributing factors whether they’re gynecologic, urologic, gastrointestinal, musculoskeletal or nerve related.
If those strategies don’t work, she said, “consider treating centralized pain” with a blend of approaches: behavioral (such as diet and cognitive-behavior therapy), medical (such as hormone modulation), and interventional (such as physical therapy and surgery).
Also consider pharmacologic therapies, said Dr. As-Sanie, who identified dual reuptake inhibitors (venlafaxine [Effexor] and duloxetine [Cymbalta] are a class of antidepressants that block the reuptake of both serotonin and norepinephrine) and anticonvulsants as drugs with strong evidence as treatments for central pain syndromes.
“Start at low doses and titrate up,” she advised, and “if at any point a given medication doesn’t work, we should try another.”
The Pelvic Anatomy and Gynecologic Surgery Symposium was jointly provided by Global Academy for Medical Education and the University of Cincinnati. Global Academy and this news organization are owned by the same company.
Dr. As-Sanie discloses she is a consultant for AbbVie and Myovant.
EXPERT ANALYSIS FROM PAGS
Quick tips: How to get your study published
SAN DIEGO – Looking to get your study published in a top medical journal? Bob Löwenberg, MD, PhD, editor-in-chief of Blood, says to start thinking about what appeals to readers.
“What do readers want? They want important information with impact in a clinical or biological sense,” Dr. Löwenberg of Erasmus University Rotterdam (the Netherlands) said at the annual meeting of the American Society of Hematology. “Usually they want to get novel information – new and cutting-edge insights, if possible. And readers want to receive access to information that is right. This is about quality.”
Dr. Löwenberg offered several tips for getting published:
- Make sure your paper has a “clear message” that comes across in both its title and a concisely written abstract. “When your colleagues are going to scan the journal, they should say ‘Hey, this is an interesting title’ or ‘This is an interesting abstract,’ ” Dr. Löwenberg said.
- Avoid jargon and slang. And don’t fill your paper with abbreviations because that will make it unreadable.
- Don’t just cut and paste the abstract from your meeting submission. Update the information and rewrite it before submitting it. “The abstract is so important because it is the part of your manuscript that’s copied by reference systems,” Dr. Löwenberg said. “It’s more broadly published than your manuscript. Write it in such a way that it tells your entire story in a minimal number of words, without changing the overall message of your paper, and in clear language.”
- Focus on providing important background in the introduction, which usually summarizes existing research.
- “Distill the essentials” in the discussion section. “Don’t repeat the results. Discuss the importance of your findings in relation to the state-of-the-art information that you have presented in the introduction,” he said.
- Beware of plagiarism, which includes “self-plagiarism” – duplicating your own previous research without acknowledgment.
- Understand new rules regarding data-sharing requirements developed by the International Committee of Medical Journal Editors. In order to be considered for publication by the committee’s member journals, clinical trials that begin enrolling participants as of Jan. 1, 2019, must include a data-sharing plan in the trial’s registration.
- Don’t be surprised if your paper is turned down. “We all have experience with rejected papers,” he said. “This is part of the game.”
If you are rejected, you may wish to send a rebuttal – a form of appeal – to the journal. Consider this option if the journal “clearly misunderstood or misrepresented the paper,” he said. “Be polite, try to be unemotional and clear, and never [write] it the same day as when you are still angry about this decision.” Once you send a rebuttal, wait for at least a week for a response. If one doesn’t come, he said, feel free to submit the paper elsewhere.
Dr. Löwenberg reported having no relevant financial disclosures.
SAN DIEGO – Looking to get your study published in a top medical journal? Bob Löwenberg, MD, PhD, editor-in-chief of Blood, says to start thinking about what appeals to readers.
“What do readers want? They want important information with impact in a clinical or biological sense,” Dr. Löwenberg of Erasmus University Rotterdam (the Netherlands) said at the annual meeting of the American Society of Hematology. “Usually they want to get novel information – new and cutting-edge insights, if possible. And readers want to receive access to information that is right. This is about quality.”
Dr. Löwenberg offered several tips for getting published:
- Make sure your paper has a “clear message” that comes across in both its title and a concisely written abstract. “When your colleagues are going to scan the journal, they should say ‘Hey, this is an interesting title’ or ‘This is an interesting abstract,’ ” Dr. Löwenberg said.
- Avoid jargon and slang. And don’t fill your paper with abbreviations because that will make it unreadable.
- Don’t just cut and paste the abstract from your meeting submission. Update the information and rewrite it before submitting it. “The abstract is so important because it is the part of your manuscript that’s copied by reference systems,” Dr. Löwenberg said. “It’s more broadly published than your manuscript. Write it in such a way that it tells your entire story in a minimal number of words, without changing the overall message of your paper, and in clear language.”
- Focus on providing important background in the introduction, which usually summarizes existing research.
- “Distill the essentials” in the discussion section. “Don’t repeat the results. Discuss the importance of your findings in relation to the state-of-the-art information that you have presented in the introduction,” he said.
- Beware of plagiarism, which includes “self-plagiarism” – duplicating your own previous research without acknowledgment.
- Understand new rules regarding data-sharing requirements developed by the International Committee of Medical Journal Editors. In order to be considered for publication by the committee’s member journals, clinical trials that begin enrolling participants as of Jan. 1, 2019, must include a data-sharing plan in the trial’s registration.
- Don’t be surprised if your paper is turned down. “We all have experience with rejected papers,” he said. “This is part of the game.”
If you are rejected, you may wish to send a rebuttal – a form of appeal – to the journal. Consider this option if the journal “clearly misunderstood or misrepresented the paper,” he said. “Be polite, try to be unemotional and clear, and never [write] it the same day as when you are still angry about this decision.” Once you send a rebuttal, wait for at least a week for a response. If one doesn’t come, he said, feel free to submit the paper elsewhere.
Dr. Löwenberg reported having no relevant financial disclosures.
SAN DIEGO – Looking to get your study published in a top medical journal? Bob Löwenberg, MD, PhD, editor-in-chief of Blood, says to start thinking about what appeals to readers.
“What do readers want? They want important information with impact in a clinical or biological sense,” Dr. Löwenberg of Erasmus University Rotterdam (the Netherlands) said at the annual meeting of the American Society of Hematology. “Usually they want to get novel information – new and cutting-edge insights, if possible. And readers want to receive access to information that is right. This is about quality.”
Dr. Löwenberg offered several tips for getting published:
- Make sure your paper has a “clear message” that comes across in both its title and a concisely written abstract. “When your colleagues are going to scan the journal, they should say ‘Hey, this is an interesting title’ or ‘This is an interesting abstract,’ ” Dr. Löwenberg said.
- Avoid jargon and slang. And don’t fill your paper with abbreviations because that will make it unreadable.
- Don’t just cut and paste the abstract from your meeting submission. Update the information and rewrite it before submitting it. “The abstract is so important because it is the part of your manuscript that’s copied by reference systems,” Dr. Löwenberg said. “It’s more broadly published than your manuscript. Write it in such a way that it tells your entire story in a minimal number of words, without changing the overall message of your paper, and in clear language.”
- Focus on providing important background in the introduction, which usually summarizes existing research.
- “Distill the essentials” in the discussion section. “Don’t repeat the results. Discuss the importance of your findings in relation to the state-of-the-art information that you have presented in the introduction,” he said.
- Beware of plagiarism, which includes “self-plagiarism” – duplicating your own previous research without acknowledgment.
- Understand new rules regarding data-sharing requirements developed by the International Committee of Medical Journal Editors. In order to be considered for publication by the committee’s member journals, clinical trials that begin enrolling participants as of Jan. 1, 2019, must include a data-sharing plan in the trial’s registration.
- Don’t be surprised if your paper is turned down. “We all have experience with rejected papers,” he said. “This is part of the game.”
If you are rejected, you may wish to send a rebuttal – a form of appeal – to the journal. Consider this option if the journal “clearly misunderstood or misrepresented the paper,” he said. “Be polite, try to be unemotional and clear, and never [write] it the same day as when you are still angry about this decision.” Once you send a rebuttal, wait for at least a week for a response. If one doesn’t come, he said, feel free to submit the paper elsewhere.
Dr. Löwenberg reported having no relevant financial disclosures.
EXPERT ANALYSIS FROM ASH 2018
Don’t leave vaginal hysterectomies behind, surgeon urges
LAS VEGAS –
While “younger trainees are seeing fewer vaginal procedures being done and have less confidence to do the procedure,” research suggests that the vaginal approach can offer major benefits, compared with the alternatives, Rosanne M. Kho, MD, of the Cleveland Clinic, said at the Pelvic Anatomy and Gynecologic Surgery Symposium.
Dr. Kho pointed to several studies suggesting a decline in vaginal hysterectomies as laparoscopic and robot procedures become more common. One study compared hysterectomy surgery approaches during 2007-2010 and found a sharp rise in robotic procedures (0.5% to 10%) and a big decrease in abdominal procedures (from 54% to 40%). The rate of laparoscopic procedures grew (from 24% to 30%), while vaginal procedures dipped slightly (22% to 20%) (JAMA. 2013 Feb 20;309[7]:689-98). Another study tracked hysterectomy strategies at Pittsburgh’s Magee-Womens Hospital in almost 14,000 women during 2000-2010. It found that vaginal hysterectomy rates fell from 22% to 17% while laparoscopic rates grew remarkably from 3% to 43%. Open procedures fell dramatically from 75% to 36% (Am J Obstet Gynecol. 2013 Apr. doi: 10.1016/j.ajog.2013.01.022).
These findings are “telling me that surgeons are steering away from the vaginal approach because the laparoscopic and robotic approach are much more appealing,” Dr. Koh said at the meeting, which was jointly provided by Global Academy for Medical Education and the University of Cincinnati. Global Academy and this news organization are owned by the same company.
Specifically, it appears that surgeons think the vaginal hysterectomy is more “challenging” and “cumbersome,” Dr. Kho said, and they lack inadequate training.
Why should vaginal hysterectomy still be considered? Dr. Kho pointed to two pieces of evidence:
- Expert opinion. A 2017 committee opinion from the American College of Obstetricians and Gynecologists examined routes of hysterectomy in benign disease and declared that, despite the decrease in its use, “evidence supports the opinion that [when feasible] vaginal hysterectomy is associated with better outcomes” than are laparoscopic or abdominal hysterectomy. Also, the decision to perform a salpingo-oophorectomy is not necessarily a contraindication to performing a vaginal hysterectomy, according to the committee opinion (Obstet Gynecol. 2017 Jun;129[6]:e155-e9).The opinion also says, “the vaginal approach is preferred among the minimally invasive approaches. Laparoscopic hysterectomy is a preferable alternative to open abdominal hysterectomy for those patients in whom a vaginal hysterectomy is not indicated or feasible. Although minimally invasive approaches to hysterectomy are the preferred route, open abdominal hysterectomy remains an important surgical option for some patients.”
- Randomized, controlled studies. A 2015 Cochrane Library systematic review examined 47 randomized, controlled trials and found that “vaginal hysterectomy should be performed whenever possible. Where vaginal hysterectomy is not possible, both a laparoscopic approach and abdominal hysterectomy have their pros and cons, and these should be incorporated in the decision-making process” (Cochrane Database Syst Rev. 2015 Aug 12. doi: 10.1002/14651858.CD003677.pub5).
What if a patient has an enlarged uterus? Dr. Kho coauthored a 2017 review that suggested that vaginal hysterectomy may be appropriate in this case. Her report found that in women with large uteri, “vaginal hysterectomy is preferred over laparoscopic and laparoscopic assistance with less operative time and hospital cost. In morbidly obese patients with large uteri, total laparoscopic hysterectomy is superior to vaginal hysterectomy with lesser odds of blood transfusion and lower length of hospital stay” (Clin Obstet Gynecol. 2017 Jun;60[2]:286-95).
What about the removal of fallopian tubes – salpingectomy – during vaginal hysterectomy? Dr. Kho highlighted a 2017 decision analysis that said these procedures are frequently performed for cancer prevention during laparoscopic and open hysterectomies “but [fallopian tubes] are not routinely removed during vaginal hysterectomy because of perceptions of increased morbidity, difficulty, or inadequate surgical training.”
The analysis, however, determined that “salpingectomy should routinely be performed with vaginal hysterectomy because it was the dominant and therefore cost-effective strategy. Complications are minimally increased, but the trade-off with cancer prevention is highly favorable.” (Am J Obstet Gynecol. 2017 Nov;217[5]:603.e1-603.e6).
Dr. Kho reported consulting for AbbVie, Olympus, and Applied Medical.
LAS VEGAS –
While “younger trainees are seeing fewer vaginal procedures being done and have less confidence to do the procedure,” research suggests that the vaginal approach can offer major benefits, compared with the alternatives, Rosanne M. Kho, MD, of the Cleveland Clinic, said at the Pelvic Anatomy and Gynecologic Surgery Symposium.
Dr. Kho pointed to several studies suggesting a decline in vaginal hysterectomies as laparoscopic and robot procedures become more common. One study compared hysterectomy surgery approaches during 2007-2010 and found a sharp rise in robotic procedures (0.5% to 10%) and a big decrease in abdominal procedures (from 54% to 40%). The rate of laparoscopic procedures grew (from 24% to 30%), while vaginal procedures dipped slightly (22% to 20%) (JAMA. 2013 Feb 20;309[7]:689-98). Another study tracked hysterectomy strategies at Pittsburgh’s Magee-Womens Hospital in almost 14,000 women during 2000-2010. It found that vaginal hysterectomy rates fell from 22% to 17% while laparoscopic rates grew remarkably from 3% to 43%. Open procedures fell dramatically from 75% to 36% (Am J Obstet Gynecol. 2013 Apr. doi: 10.1016/j.ajog.2013.01.022).
These findings are “telling me that surgeons are steering away from the vaginal approach because the laparoscopic and robotic approach are much more appealing,” Dr. Koh said at the meeting, which was jointly provided by Global Academy for Medical Education and the University of Cincinnati. Global Academy and this news organization are owned by the same company.
Specifically, it appears that surgeons think the vaginal hysterectomy is more “challenging” and “cumbersome,” Dr. Kho said, and they lack inadequate training.
Why should vaginal hysterectomy still be considered? Dr. Kho pointed to two pieces of evidence:
- Expert opinion. A 2017 committee opinion from the American College of Obstetricians and Gynecologists examined routes of hysterectomy in benign disease and declared that, despite the decrease in its use, “evidence supports the opinion that [when feasible] vaginal hysterectomy is associated with better outcomes” than are laparoscopic or abdominal hysterectomy. Also, the decision to perform a salpingo-oophorectomy is not necessarily a contraindication to performing a vaginal hysterectomy, according to the committee opinion (Obstet Gynecol. 2017 Jun;129[6]:e155-e9).The opinion also says, “the vaginal approach is preferred among the minimally invasive approaches. Laparoscopic hysterectomy is a preferable alternative to open abdominal hysterectomy for those patients in whom a vaginal hysterectomy is not indicated or feasible. Although minimally invasive approaches to hysterectomy are the preferred route, open abdominal hysterectomy remains an important surgical option for some patients.”
- Randomized, controlled studies. A 2015 Cochrane Library systematic review examined 47 randomized, controlled trials and found that “vaginal hysterectomy should be performed whenever possible. Where vaginal hysterectomy is not possible, both a laparoscopic approach and abdominal hysterectomy have their pros and cons, and these should be incorporated in the decision-making process” (Cochrane Database Syst Rev. 2015 Aug 12. doi: 10.1002/14651858.CD003677.pub5).
What if a patient has an enlarged uterus? Dr. Kho coauthored a 2017 review that suggested that vaginal hysterectomy may be appropriate in this case. Her report found that in women with large uteri, “vaginal hysterectomy is preferred over laparoscopic and laparoscopic assistance with less operative time and hospital cost. In morbidly obese patients with large uteri, total laparoscopic hysterectomy is superior to vaginal hysterectomy with lesser odds of blood transfusion and lower length of hospital stay” (Clin Obstet Gynecol. 2017 Jun;60[2]:286-95).
What about the removal of fallopian tubes – salpingectomy – during vaginal hysterectomy? Dr. Kho highlighted a 2017 decision analysis that said these procedures are frequently performed for cancer prevention during laparoscopic and open hysterectomies “but [fallopian tubes] are not routinely removed during vaginal hysterectomy because of perceptions of increased morbidity, difficulty, or inadequate surgical training.”
The analysis, however, determined that “salpingectomy should routinely be performed with vaginal hysterectomy because it was the dominant and therefore cost-effective strategy. Complications are minimally increased, but the trade-off with cancer prevention is highly favorable.” (Am J Obstet Gynecol. 2017 Nov;217[5]:603.e1-603.e6).
Dr. Kho reported consulting for AbbVie, Olympus, and Applied Medical.
LAS VEGAS –
While “younger trainees are seeing fewer vaginal procedures being done and have less confidence to do the procedure,” research suggests that the vaginal approach can offer major benefits, compared with the alternatives, Rosanne M. Kho, MD, of the Cleveland Clinic, said at the Pelvic Anatomy and Gynecologic Surgery Symposium.
Dr. Kho pointed to several studies suggesting a decline in vaginal hysterectomies as laparoscopic and robot procedures become more common. One study compared hysterectomy surgery approaches during 2007-2010 and found a sharp rise in robotic procedures (0.5% to 10%) and a big decrease in abdominal procedures (from 54% to 40%). The rate of laparoscopic procedures grew (from 24% to 30%), while vaginal procedures dipped slightly (22% to 20%) (JAMA. 2013 Feb 20;309[7]:689-98). Another study tracked hysterectomy strategies at Pittsburgh’s Magee-Womens Hospital in almost 14,000 women during 2000-2010. It found that vaginal hysterectomy rates fell from 22% to 17% while laparoscopic rates grew remarkably from 3% to 43%. Open procedures fell dramatically from 75% to 36% (Am J Obstet Gynecol. 2013 Apr. doi: 10.1016/j.ajog.2013.01.022).
These findings are “telling me that surgeons are steering away from the vaginal approach because the laparoscopic and robotic approach are much more appealing,” Dr. Koh said at the meeting, which was jointly provided by Global Academy for Medical Education and the University of Cincinnati. Global Academy and this news organization are owned by the same company.
Specifically, it appears that surgeons think the vaginal hysterectomy is more “challenging” and “cumbersome,” Dr. Kho said, and they lack inadequate training.
Why should vaginal hysterectomy still be considered? Dr. Kho pointed to two pieces of evidence:
- Expert opinion. A 2017 committee opinion from the American College of Obstetricians and Gynecologists examined routes of hysterectomy in benign disease and declared that, despite the decrease in its use, “evidence supports the opinion that [when feasible] vaginal hysterectomy is associated with better outcomes” than are laparoscopic or abdominal hysterectomy. Also, the decision to perform a salpingo-oophorectomy is not necessarily a contraindication to performing a vaginal hysterectomy, according to the committee opinion (Obstet Gynecol. 2017 Jun;129[6]:e155-e9).The opinion also says, “the vaginal approach is preferred among the minimally invasive approaches. Laparoscopic hysterectomy is a preferable alternative to open abdominal hysterectomy for those patients in whom a vaginal hysterectomy is not indicated or feasible. Although minimally invasive approaches to hysterectomy are the preferred route, open abdominal hysterectomy remains an important surgical option for some patients.”
- Randomized, controlled studies. A 2015 Cochrane Library systematic review examined 47 randomized, controlled trials and found that “vaginal hysterectomy should be performed whenever possible. Where vaginal hysterectomy is not possible, both a laparoscopic approach and abdominal hysterectomy have their pros and cons, and these should be incorporated in the decision-making process” (Cochrane Database Syst Rev. 2015 Aug 12. doi: 10.1002/14651858.CD003677.pub5).
What if a patient has an enlarged uterus? Dr. Kho coauthored a 2017 review that suggested that vaginal hysterectomy may be appropriate in this case. Her report found that in women with large uteri, “vaginal hysterectomy is preferred over laparoscopic and laparoscopic assistance with less operative time and hospital cost. In morbidly obese patients with large uteri, total laparoscopic hysterectomy is superior to vaginal hysterectomy with lesser odds of blood transfusion and lower length of hospital stay” (Clin Obstet Gynecol. 2017 Jun;60[2]:286-95).
What about the removal of fallopian tubes – salpingectomy – during vaginal hysterectomy? Dr. Kho highlighted a 2017 decision analysis that said these procedures are frequently performed for cancer prevention during laparoscopic and open hysterectomies “but [fallopian tubes] are not routinely removed during vaginal hysterectomy because of perceptions of increased morbidity, difficulty, or inadequate surgical training.”
The analysis, however, determined that “salpingectomy should routinely be performed with vaginal hysterectomy because it was the dominant and therefore cost-effective strategy. Complications are minimally increased, but the trade-off with cancer prevention is highly favorable.” (Am J Obstet Gynecol. 2017 Nov;217[5]:603.e1-603.e6).
Dr. Kho reported consulting for AbbVie, Olympus, and Applied Medical.
EXPERT ANALYSIS FROM PAGS
Quincy the (diabetic) koala leaves behind more than memories
SAN DIEGO – A miracle of marsupial medicine is no more.
An endocrinologist is no longer checking his blood sugar levels on her smartphone a couple times a day, and zookeepers have stopped responding to glucose alerts by preparing tiny doses of insulin. But Quincy, the recipient of a continuous glucose monitor, has provided valuable insight that may benefit a variety of creatures beyond our furry, eucalyptus-eating cousins.
“Through this experience, I am hopeful that we’ll be able to offer better treatment in the future for any animals that are found to have diabetes,” the endocrinologist, Athena Philis-Tsimikas, MD, of Scripps Whittier Diabetes Institute, said in an interview.
And, she added, the experience of working with Quincy “provided an indication of where remote management of diabetes is going for the future, whether this is humans or animals.”
Quincy, a Queensland koala, reportedly died at the San Diego Zoo on Dec. 13 of pneumonia at the age of about 3 years. (Koalas can live into their teens.)
It’s not clear if his death was related to his diabetes. Dr. Philis-Tsimikas said. “Although infection can worsen with poor glucose control, my understanding from the veterinarian was that his diabetes had stabilized and was being successfully treated with a small dose of daily basal insulin,” she said. “He was not having wide fluctuations in glucose control, and the CGM had been removed to make it easier for him to get around his enclosures.”
Nine months before his death, Quincy was diagnosed with type 1 diabetes and transferred from the Los Angeles Zoo for medical reasons. Last June, after veterinarians consulted with Dr. Philis-Tsimikas, Quincy underwent an operation to fit him with a CGM so zookeepers could avoid having to wake him multiple times a day for skin pricks.
Koalas are among many species that can develop the equivalent of human diabetes. Dogs, cats, pigs, apes, horses, and even dolphins can become diabetic.
“The providers and caretakers could all respond with appropriate interventions based on the real-time readings. Improved treatment decisions were made despite not having any verbal communication,” Dr. Philis-Tsimikas said.
“I found it amazing that the CGM device could be placed on such a small body with very little subcutaneous fat,” she said. “It stayed in place and functioned successfully despite movement of the koala around his enclosure.”
In light of his small body and lack of body fat, could Quincy’s experience offer insight into the use of CGM technology in fragile humans such as babies and the elderly? Absolutely, Dr. Philis-Tsimikas said, noting that babies have been diagnosed with diabetes at as young as 9 months.
She said Quincy’s story, which got extensive media attention, provided another benefit. “His story was very relatable to many people with newly diagnosed type 1 diabetes and how difficult it can be to manage the highs and lows,” she said. “Quincy helped show us how this could be addressed with the new technology of a CGM and new types of basal insulin and pens that deliver half units.”
Dr. Philis-Tsimikas reports that her center conducts research with Dexcom and Novo Nordisk.
SAN DIEGO – A miracle of marsupial medicine is no more.
An endocrinologist is no longer checking his blood sugar levels on her smartphone a couple times a day, and zookeepers have stopped responding to glucose alerts by preparing tiny doses of insulin. But Quincy, the recipient of a continuous glucose monitor, has provided valuable insight that may benefit a variety of creatures beyond our furry, eucalyptus-eating cousins.
“Through this experience, I am hopeful that we’ll be able to offer better treatment in the future for any animals that are found to have diabetes,” the endocrinologist, Athena Philis-Tsimikas, MD, of Scripps Whittier Diabetes Institute, said in an interview.
And, she added, the experience of working with Quincy “provided an indication of where remote management of diabetes is going for the future, whether this is humans or animals.”
Quincy, a Queensland koala, reportedly died at the San Diego Zoo on Dec. 13 of pneumonia at the age of about 3 years. (Koalas can live into their teens.)
It’s not clear if his death was related to his diabetes. Dr. Philis-Tsimikas said. “Although infection can worsen with poor glucose control, my understanding from the veterinarian was that his diabetes had stabilized and was being successfully treated with a small dose of daily basal insulin,” she said. “He was not having wide fluctuations in glucose control, and the CGM had been removed to make it easier for him to get around his enclosures.”
Nine months before his death, Quincy was diagnosed with type 1 diabetes and transferred from the Los Angeles Zoo for medical reasons. Last June, after veterinarians consulted with Dr. Philis-Tsimikas, Quincy underwent an operation to fit him with a CGM so zookeepers could avoid having to wake him multiple times a day for skin pricks.
Koalas are among many species that can develop the equivalent of human diabetes. Dogs, cats, pigs, apes, horses, and even dolphins can become diabetic.
“The providers and caretakers could all respond with appropriate interventions based on the real-time readings. Improved treatment decisions were made despite not having any verbal communication,” Dr. Philis-Tsimikas said.
“I found it amazing that the CGM device could be placed on such a small body with very little subcutaneous fat,” she said. “It stayed in place and functioned successfully despite movement of the koala around his enclosure.”
In light of his small body and lack of body fat, could Quincy’s experience offer insight into the use of CGM technology in fragile humans such as babies and the elderly? Absolutely, Dr. Philis-Tsimikas said, noting that babies have been diagnosed with diabetes at as young as 9 months.
She said Quincy’s story, which got extensive media attention, provided another benefit. “His story was very relatable to many people with newly diagnosed type 1 diabetes and how difficult it can be to manage the highs and lows,” she said. “Quincy helped show us how this could be addressed with the new technology of a CGM and new types of basal insulin and pens that deliver half units.”
Dr. Philis-Tsimikas reports that her center conducts research with Dexcom and Novo Nordisk.
SAN DIEGO – A miracle of marsupial medicine is no more.
An endocrinologist is no longer checking his blood sugar levels on her smartphone a couple times a day, and zookeepers have stopped responding to glucose alerts by preparing tiny doses of insulin. But Quincy, the recipient of a continuous glucose monitor, has provided valuable insight that may benefit a variety of creatures beyond our furry, eucalyptus-eating cousins.
“Through this experience, I am hopeful that we’ll be able to offer better treatment in the future for any animals that are found to have diabetes,” the endocrinologist, Athena Philis-Tsimikas, MD, of Scripps Whittier Diabetes Institute, said in an interview.
And, she added, the experience of working with Quincy “provided an indication of where remote management of diabetes is going for the future, whether this is humans or animals.”
Quincy, a Queensland koala, reportedly died at the San Diego Zoo on Dec. 13 of pneumonia at the age of about 3 years. (Koalas can live into their teens.)
It’s not clear if his death was related to his diabetes. Dr. Philis-Tsimikas said. “Although infection can worsen with poor glucose control, my understanding from the veterinarian was that his diabetes had stabilized and was being successfully treated with a small dose of daily basal insulin,” she said. “He was not having wide fluctuations in glucose control, and the CGM had been removed to make it easier for him to get around his enclosures.”
Nine months before his death, Quincy was diagnosed with type 1 diabetes and transferred from the Los Angeles Zoo for medical reasons. Last June, after veterinarians consulted with Dr. Philis-Tsimikas, Quincy underwent an operation to fit him with a CGM so zookeepers could avoid having to wake him multiple times a day for skin pricks.
Koalas are among many species that can develop the equivalent of human diabetes. Dogs, cats, pigs, apes, horses, and even dolphins can become diabetic.
“The providers and caretakers could all respond with appropriate interventions based on the real-time readings. Improved treatment decisions were made despite not having any verbal communication,” Dr. Philis-Tsimikas said.
“I found it amazing that the CGM device could be placed on such a small body with very little subcutaneous fat,” she said. “It stayed in place and functioned successfully despite movement of the koala around his enclosure.”
In light of his small body and lack of body fat, could Quincy’s experience offer insight into the use of CGM technology in fragile humans such as babies and the elderly? Absolutely, Dr. Philis-Tsimikas said, noting that babies have been diagnosed with diabetes at as young as 9 months.
She said Quincy’s story, which got extensive media attention, provided another benefit. “His story was very relatable to many people with newly diagnosed type 1 diabetes and how difficult it can be to manage the highs and lows,” she said. “Quincy helped show us how this could be addressed with the new technology of a CGM and new types of basal insulin and pens that deliver half units.”
Dr. Philis-Tsimikas reports that her center conducts research with Dexcom and Novo Nordisk.
REPORTING FROM THE DIABETIC KOALA BEAT