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Antibiotic choices for inpatients with SSTIs vary by race
– in a national cross-sectional study involving over 1,000 patients in 91 hospitals.
The potential racial disparity in management of SSTI was detected after data were adjusted for penicillin allergy history and for MRSA colonization/infection. The data were also adjusted for hospital day (since admission) in order to control for the administration of more empiric therapy early on.
Clindamycin, a beta-lactam alternative, is not recommended as an SSTI treatment given its frequent dosing requirements and high potential for adverse events including Clostridioides difficile infection (DCI). “Clindamycin is an option but it’s considered inferior. ... It covers MRSA but it shouldn’t be a go-to for skin and soft-tissue infections,” said senior author Kimberly Blumenthal, MD, MSc, assistant professor of medicine at Harvard University, and an allergist, immunologist, and drug allergy and epidemiology researcher at Massachusetts General Hospital, both in Boston.
Cefazolin, on the other hand, does not cover MRSA but is “a guideline-recommended first-line antibiotic for cellulitis SSTI in the hospital,” she said in an interview.
The findings, recently published in JAMA Network Open, offer a valuable portrait of the antibiotics being prescribed in the inpatient setting for SSTIs. Vancomycin, which typically is reserved for MRSA, was the most commonly prescribed antibiotic, regardless of race. Piperacillin-tazobactam, a beta-lactam, was the second most commonly prescribed antibiotic, again regardless of race.
Intravenously administered cefazolin was used in 13% of White inpatients versus 5% of Black inpatients. After controlling for kidney disease, diabetes, and ICU location (in addition to hospital day, penicillin allergy history, and MRSA), White inpatients had an increased likelihood of being prescribed cefazolin (adjusted odds ratio, 2.82; 95% confidence interval, 1.41-5.63) and a decreased likelihood of clindamycin use (aOR, 0.54; 95% CI, 0.30-0.96), compared with Black inpatients.
The investigators utilized the Acute Care Hospital Groups network within Vizient, a member-driven health care performance improvement company, to collect data for the study. Most of the hospitals (91%) that submitted data on adult inpatients with cellulitis or SSTIs (without other infections) were in urban settings and 9% were in rural settings; 60% were community hospitals and 40% were academic medical centers. The researchers accounted for “clustering by hospital” – such as the use of internal guidelines – in their methodology.
Differential management and prescribing practices associated with race and ethnicity have been demonstrated for cardiovascular disease and other chronic problems, but “to see such racial differences play out in acute care is striking,” Utibe R. Essien, MD, MPH, assistant professor of medicine at the University of Pittsburgh and a core investigator with the Center for Health Equity Research and Promotion at the Veterans Affairs Pittsburgh Healthcare System, said in an interview.
“In acute care, we tend to practice pretty similarly across the board ... so the findings give me pause,” said Dr. Essien, an internist and a coauthor of the study, who also works with the University of Pittsburgh’s Center for Pharmaceutical Policy and Prescribing.
Also notable was the prevalence of historical penicillin allergy documented in the dataset: 23% in Black inpatients and 18% in White inpatients with SSTI. It’s a surprisingly high prevalence overall, Dr. Blumenthal said, and the racial difference was surprising because penicillin allergy has been commonly described in the literature as being more common in the White population.
Even though penicillin allergy was controlled for in the study, “given that historical penicillin allergies are associated with increased clindamycin use and risk of CDI, but are often disproved with formal testing, racial disparities in penicillin allergy documentation and assessment require additional study,” she and her coauthors wrote.
Ideally, Dr. Blumenthal said, all inpatients would have access to allergy consultations or testing or some sort of infrastructure for assessing a history of penicillin allergy. At Mass General, allergy consults and challenge doses of beta-lactams (also called graded challenges) are frequently employed.
The study did not collect data on income, educational level, and other structural vulnerability factors. More research is needed to better understand “what’s going on in acute care settings and what the potential drivers of disparities may be,” said Dr. Essien, who co-authored a recent JAMA editorial on “achieving pharmacoequity” to reduce health disparities.
“If guidelines suggest that medication A is the ideal and optimal treatment, we really have to do our best to ensure that every patient, regardless of race or ethnicity, can get that treatment,” he said.
In the study, race was extracted from the medical record and may not have been correctly assigned, the authors noted. “Other race” was not specified in the dataset, and Hispanic ethnicity was not captured. The number of individuals identified as Asian and other races was small, prompting the researchers to focus on antibiotic use in Black and White patients (224 and 854 patients, respectively).
Dr. Blumenthal and Dr. Essien both reported that they had no relevant disclosures. The study was supported with National Institutes of Health grants and the Massachusetts General Hospital department of medicine transformative scholar program.
– in a national cross-sectional study involving over 1,000 patients in 91 hospitals.
The potential racial disparity in management of SSTI was detected after data were adjusted for penicillin allergy history and for MRSA colonization/infection. The data were also adjusted for hospital day (since admission) in order to control for the administration of more empiric therapy early on.
Clindamycin, a beta-lactam alternative, is not recommended as an SSTI treatment given its frequent dosing requirements and high potential for adverse events including Clostridioides difficile infection (DCI). “Clindamycin is an option but it’s considered inferior. ... It covers MRSA but it shouldn’t be a go-to for skin and soft-tissue infections,” said senior author Kimberly Blumenthal, MD, MSc, assistant professor of medicine at Harvard University, and an allergist, immunologist, and drug allergy and epidemiology researcher at Massachusetts General Hospital, both in Boston.
Cefazolin, on the other hand, does not cover MRSA but is “a guideline-recommended first-line antibiotic for cellulitis SSTI in the hospital,” she said in an interview.
The findings, recently published in JAMA Network Open, offer a valuable portrait of the antibiotics being prescribed in the inpatient setting for SSTIs. Vancomycin, which typically is reserved for MRSA, was the most commonly prescribed antibiotic, regardless of race. Piperacillin-tazobactam, a beta-lactam, was the second most commonly prescribed antibiotic, again regardless of race.
Intravenously administered cefazolin was used in 13% of White inpatients versus 5% of Black inpatients. After controlling for kidney disease, diabetes, and ICU location (in addition to hospital day, penicillin allergy history, and MRSA), White inpatients had an increased likelihood of being prescribed cefazolin (adjusted odds ratio, 2.82; 95% confidence interval, 1.41-5.63) and a decreased likelihood of clindamycin use (aOR, 0.54; 95% CI, 0.30-0.96), compared with Black inpatients.
The investigators utilized the Acute Care Hospital Groups network within Vizient, a member-driven health care performance improvement company, to collect data for the study. Most of the hospitals (91%) that submitted data on adult inpatients with cellulitis or SSTIs (without other infections) were in urban settings and 9% were in rural settings; 60% were community hospitals and 40% were academic medical centers. The researchers accounted for “clustering by hospital” – such as the use of internal guidelines – in their methodology.
Differential management and prescribing practices associated with race and ethnicity have been demonstrated for cardiovascular disease and other chronic problems, but “to see such racial differences play out in acute care is striking,” Utibe R. Essien, MD, MPH, assistant professor of medicine at the University of Pittsburgh and a core investigator with the Center for Health Equity Research and Promotion at the Veterans Affairs Pittsburgh Healthcare System, said in an interview.
“In acute care, we tend to practice pretty similarly across the board ... so the findings give me pause,” said Dr. Essien, an internist and a coauthor of the study, who also works with the University of Pittsburgh’s Center for Pharmaceutical Policy and Prescribing.
Also notable was the prevalence of historical penicillin allergy documented in the dataset: 23% in Black inpatients and 18% in White inpatients with SSTI. It’s a surprisingly high prevalence overall, Dr. Blumenthal said, and the racial difference was surprising because penicillin allergy has been commonly described in the literature as being more common in the White population.
Even though penicillin allergy was controlled for in the study, “given that historical penicillin allergies are associated with increased clindamycin use and risk of CDI, but are often disproved with formal testing, racial disparities in penicillin allergy documentation and assessment require additional study,” she and her coauthors wrote.
Ideally, Dr. Blumenthal said, all inpatients would have access to allergy consultations or testing or some sort of infrastructure for assessing a history of penicillin allergy. At Mass General, allergy consults and challenge doses of beta-lactams (also called graded challenges) are frequently employed.
The study did not collect data on income, educational level, and other structural vulnerability factors. More research is needed to better understand “what’s going on in acute care settings and what the potential drivers of disparities may be,” said Dr. Essien, who co-authored a recent JAMA editorial on “achieving pharmacoequity” to reduce health disparities.
“If guidelines suggest that medication A is the ideal and optimal treatment, we really have to do our best to ensure that every patient, regardless of race or ethnicity, can get that treatment,” he said.
In the study, race was extracted from the medical record and may not have been correctly assigned, the authors noted. “Other race” was not specified in the dataset, and Hispanic ethnicity was not captured. The number of individuals identified as Asian and other races was small, prompting the researchers to focus on antibiotic use in Black and White patients (224 and 854 patients, respectively).
Dr. Blumenthal and Dr. Essien both reported that they had no relevant disclosures. The study was supported with National Institutes of Health grants and the Massachusetts General Hospital department of medicine transformative scholar program.
– in a national cross-sectional study involving over 1,000 patients in 91 hospitals.
The potential racial disparity in management of SSTI was detected after data were adjusted for penicillin allergy history and for MRSA colonization/infection. The data were also adjusted for hospital day (since admission) in order to control for the administration of more empiric therapy early on.
Clindamycin, a beta-lactam alternative, is not recommended as an SSTI treatment given its frequent dosing requirements and high potential for adverse events including Clostridioides difficile infection (DCI). “Clindamycin is an option but it’s considered inferior. ... It covers MRSA but it shouldn’t be a go-to for skin and soft-tissue infections,” said senior author Kimberly Blumenthal, MD, MSc, assistant professor of medicine at Harvard University, and an allergist, immunologist, and drug allergy and epidemiology researcher at Massachusetts General Hospital, both in Boston.
Cefazolin, on the other hand, does not cover MRSA but is “a guideline-recommended first-line antibiotic for cellulitis SSTI in the hospital,” she said in an interview.
The findings, recently published in JAMA Network Open, offer a valuable portrait of the antibiotics being prescribed in the inpatient setting for SSTIs. Vancomycin, which typically is reserved for MRSA, was the most commonly prescribed antibiotic, regardless of race. Piperacillin-tazobactam, a beta-lactam, was the second most commonly prescribed antibiotic, again regardless of race.
Intravenously administered cefazolin was used in 13% of White inpatients versus 5% of Black inpatients. After controlling for kidney disease, diabetes, and ICU location (in addition to hospital day, penicillin allergy history, and MRSA), White inpatients had an increased likelihood of being prescribed cefazolin (adjusted odds ratio, 2.82; 95% confidence interval, 1.41-5.63) and a decreased likelihood of clindamycin use (aOR, 0.54; 95% CI, 0.30-0.96), compared with Black inpatients.
The investigators utilized the Acute Care Hospital Groups network within Vizient, a member-driven health care performance improvement company, to collect data for the study. Most of the hospitals (91%) that submitted data on adult inpatients with cellulitis or SSTIs (without other infections) were in urban settings and 9% were in rural settings; 60% were community hospitals and 40% were academic medical centers. The researchers accounted for “clustering by hospital” – such as the use of internal guidelines – in their methodology.
Differential management and prescribing practices associated with race and ethnicity have been demonstrated for cardiovascular disease and other chronic problems, but “to see such racial differences play out in acute care is striking,” Utibe R. Essien, MD, MPH, assistant professor of medicine at the University of Pittsburgh and a core investigator with the Center for Health Equity Research and Promotion at the Veterans Affairs Pittsburgh Healthcare System, said in an interview.
“In acute care, we tend to practice pretty similarly across the board ... so the findings give me pause,” said Dr. Essien, an internist and a coauthor of the study, who also works with the University of Pittsburgh’s Center for Pharmaceutical Policy and Prescribing.
Also notable was the prevalence of historical penicillin allergy documented in the dataset: 23% in Black inpatients and 18% in White inpatients with SSTI. It’s a surprisingly high prevalence overall, Dr. Blumenthal said, and the racial difference was surprising because penicillin allergy has been commonly described in the literature as being more common in the White population.
Even though penicillin allergy was controlled for in the study, “given that historical penicillin allergies are associated with increased clindamycin use and risk of CDI, but are often disproved with formal testing, racial disparities in penicillin allergy documentation and assessment require additional study,” she and her coauthors wrote.
Ideally, Dr. Blumenthal said, all inpatients would have access to allergy consultations or testing or some sort of infrastructure for assessing a history of penicillin allergy. At Mass General, allergy consults and challenge doses of beta-lactams (also called graded challenges) are frequently employed.
The study did not collect data on income, educational level, and other structural vulnerability factors. More research is needed to better understand “what’s going on in acute care settings and what the potential drivers of disparities may be,” said Dr. Essien, who co-authored a recent JAMA editorial on “achieving pharmacoequity” to reduce health disparities.
“If guidelines suggest that medication A is the ideal and optimal treatment, we really have to do our best to ensure that every patient, regardless of race or ethnicity, can get that treatment,” he said.
In the study, race was extracted from the medical record and may not have been correctly assigned, the authors noted. “Other race” was not specified in the dataset, and Hispanic ethnicity was not captured. The number of individuals identified as Asian and other races was small, prompting the researchers to focus on antibiotic use in Black and White patients (224 and 854 patients, respectively).
Dr. Blumenthal and Dr. Essien both reported that they had no relevant disclosures. The study was supported with National Institutes of Health grants and the Massachusetts General Hospital department of medicine transformative scholar program.
FROM JAMA NETWORK OPEN
Make America beautiful: Support mask mandates
In space, no one can hear your red blood cells scream
There are many reasons why space is the final frontier, not least of which are the major health issues space travel places on the human body. So until a shady billionaire finds an alien protomolecule on a Saturnian moon and starts splicing it with human DNA so we can hang out in space all day without a spacesuit, we’re stuck with things like space anemia, a condition many astronauts develop after extended time in space.
Space anemia has been known for many years, but it was assumed that it developed as a reaction to microgravity and was a short-term phenomenon only – a temporary compensation as fluids and blood volume adjusted themselves. But as new research shows, that assumption seems to be wrong.
For the study, published in Nature Medicine, 13 astronauts who were in space for at least 120 days – long enough for all their red blood cells to have been produced in space – had their blood tested consistently. Before their flights, the astronauts created and destroyed 2 million red blood cells per second, but while they were in space, they destroyed 3 million cells per second. Notably, this process continued for the entire duration of the space flight. So, not a temporary reaction.
Consequently, 5 of the 13 astronauts developed anemia when they returned to Earth. (Interesting space fact: Having fewer blood cells isn’t a problem while you’re in space; the effects of anemia only manifest when the body returns to full gravity.) The anemia disappeared after a few months, but the astronauts were still destroying 30% more red blood cells a year after their spaceflight than they were before leaving Earth.
You may be thinking: Well, if they were destroying 50% more red blood cells while in space, how come they didn’t all develop severe anemia? The researchers theorized that production was boosted as well, which sounds like a good thing. The body is compensating, as it should. Unfortunately, that increased production stresses bone marrow function and the demand for energy spikes. That’s not such a good thing. And of course, many of the astronauts got anemia anyway.
To tackle the issue, the researchers emphasized the importance of feeding astronauts a proper diet, plus potential supplements before spaceflight. So don’t worry, Captain Kirk will be able to arm wrestle Klingons and romance suspiciously human-looking aliens without fear of keeling over from anemia-induced fatigue. Earth will stay safe.
Tell me with your eyes
Communication can be hard, even under the best of circumstances, but for many nonverbal patients in the intensive care unit who can’t move, getting a point across to the health care team can be a huge struggle in itself.
Health care professionals have been making do with eye-blinking or head-nodding, but what if that’s just not enough? New research shows that it’s not, and there’s a more effective way for patients to say what they mean just by looking.
In a study published in the Journal of Trauma and Acute Care Surgery, researchers looked into using eye-tracking systems for nonverbal ICU patients to communicate. Eye-tracking isn’t anything new, but using it as a form of communication among nonverbal patients with critical illness hasn’t been looked at before.
How does it work? The eye-tracking system is set up in the patient’s line of sight and its various algorithms and software collect data to calculate where exactly the patient is looking. Established scores and scales assess the patient’s mood, quality of life, pain, and self-esteem.
The researchers found that participating patients were actually experiencing more negative moods, pain, and feelings of frustration than was once believed. Making this tool even more valuable for treatment adjustment and meeting patients’ needs.
In this case, it means that health care providers are getting an eyeful … of communication.
Make America grave again
Here we go again. Somebody just found something else that the United States is not the best at. To go along with math and science education, infrastructure investment, quality of life …
That’s going to go on for a while, so let’s get to the new stuff. An international group of researchers surveyed end-of-life care in 81 countries and ranked them based on the assessment of 181 experts in those countries. They looked at 13 different factors, including proper management of pain and comfort, having a clean and safe space, being treated kindly, lack of cost barriers to appropriate care, and treatments that address quality of life and don’t just extend life.
… press freedom, industrial production, racial equality, Internet connectivity …
Their report card, published in the Journal of Pain and Symptom Management, gave six countries an A, with Great Britain at the top. The other five were Ireland, Taiwan, Australia, South Korea, and Costa Rica. The lowest grade went to Paraguay in 81st place, with Lebanon, Brazil, Senegal, and Haiti just ahead.
… environmental stewardship, body-mass index, social mobility, COVID safeness …
The United States, getting a firm grasp on mediocrity, ranked 43rd. Here are some countries that did better: North Macedonia (7th), Sri Lanka (16th), Uganda (31st), and Uruguay 33rd). In the United States, “we spend so much money trying to get people to live longer, but we don’t spend enough money in helping people die better,” lead author Eric A. Finkelstein, PhD, said in a written statement.
… economic stability, and soccer; we’re also not the best at dying. Wait, did we already say that?
The face mask that launched a thousand ships
Face masks, clearly, have been a source of social strife during the pandemic. People may not agree on mandates, but a mask can be a pretty-low-maintenance face shield if you don’t feel like putting on make-up or want to cover up some blemishes.
Before the pandemic, people thought that those wearing face masks were less attractive because the masks represented illness or disease, according to Dr. Michael Lewis of Cardiff (Wales) University. Back then, no one really wore masks besides doctors and nurses, so if you saw someone wearing one on the street, you probably wondered what they were trying to hide.
Now, though, the subject of face mask attractiveness has been revisited by Dr. Lewis and his associate, Oliver Hies, who found that face masks now make people more attractive.
“Our study suggests faces are considered most attractive when covered by medical face masks. … At a time when we feel vulnerable, we may find the wearing of medical masks reassuring and so feel more positive towards the wearer,” Dr. Lewis told the Guardian.
He suggested that we’re no longer looking at people wearing a mask as disease riddled, but rather doing their part to protect society. Or maybe we focus more on someone’s eyes when that’s all there is to look at. Or, maybe we wind up making up what the rest of someone’s face looks like to meet our attractiveness criteria.
However you feel about masks, they’re cheaper than plastic surgery. And you can go out wearing a new face every day.
In space, no one can hear your red blood cells scream
There are many reasons why space is the final frontier, not least of which are the major health issues space travel places on the human body. So until a shady billionaire finds an alien protomolecule on a Saturnian moon and starts splicing it with human DNA so we can hang out in space all day without a spacesuit, we’re stuck with things like space anemia, a condition many astronauts develop after extended time in space.
Space anemia has been known for many years, but it was assumed that it developed as a reaction to microgravity and was a short-term phenomenon only – a temporary compensation as fluids and blood volume adjusted themselves. But as new research shows, that assumption seems to be wrong.
For the study, published in Nature Medicine, 13 astronauts who were in space for at least 120 days – long enough for all their red blood cells to have been produced in space – had their blood tested consistently. Before their flights, the astronauts created and destroyed 2 million red blood cells per second, but while they were in space, they destroyed 3 million cells per second. Notably, this process continued for the entire duration of the space flight. So, not a temporary reaction.
Consequently, 5 of the 13 astronauts developed anemia when they returned to Earth. (Interesting space fact: Having fewer blood cells isn’t a problem while you’re in space; the effects of anemia only manifest when the body returns to full gravity.) The anemia disappeared after a few months, but the astronauts were still destroying 30% more red blood cells a year after their spaceflight than they were before leaving Earth.
You may be thinking: Well, if they were destroying 50% more red blood cells while in space, how come they didn’t all develop severe anemia? The researchers theorized that production was boosted as well, which sounds like a good thing. The body is compensating, as it should. Unfortunately, that increased production stresses bone marrow function and the demand for energy spikes. That’s not such a good thing. And of course, many of the astronauts got anemia anyway.
To tackle the issue, the researchers emphasized the importance of feeding astronauts a proper diet, plus potential supplements before spaceflight. So don’t worry, Captain Kirk will be able to arm wrestle Klingons and romance suspiciously human-looking aliens without fear of keeling over from anemia-induced fatigue. Earth will stay safe.
Tell me with your eyes
Communication can be hard, even under the best of circumstances, but for many nonverbal patients in the intensive care unit who can’t move, getting a point across to the health care team can be a huge struggle in itself.
Health care professionals have been making do with eye-blinking or head-nodding, but what if that’s just not enough? New research shows that it’s not, and there’s a more effective way for patients to say what they mean just by looking.
In a study published in the Journal of Trauma and Acute Care Surgery, researchers looked into using eye-tracking systems for nonverbal ICU patients to communicate. Eye-tracking isn’t anything new, but using it as a form of communication among nonverbal patients with critical illness hasn’t been looked at before.
How does it work? The eye-tracking system is set up in the patient’s line of sight and its various algorithms and software collect data to calculate where exactly the patient is looking. Established scores and scales assess the patient’s mood, quality of life, pain, and self-esteem.
The researchers found that participating patients were actually experiencing more negative moods, pain, and feelings of frustration than was once believed. Making this tool even more valuable for treatment adjustment and meeting patients’ needs.
In this case, it means that health care providers are getting an eyeful … of communication.
Make America grave again
Here we go again. Somebody just found something else that the United States is not the best at. To go along with math and science education, infrastructure investment, quality of life …
That’s going to go on for a while, so let’s get to the new stuff. An international group of researchers surveyed end-of-life care in 81 countries and ranked them based on the assessment of 181 experts in those countries. They looked at 13 different factors, including proper management of pain and comfort, having a clean and safe space, being treated kindly, lack of cost barriers to appropriate care, and treatments that address quality of life and don’t just extend life.
… press freedom, industrial production, racial equality, Internet connectivity …
Their report card, published in the Journal of Pain and Symptom Management, gave six countries an A, with Great Britain at the top. The other five were Ireland, Taiwan, Australia, South Korea, and Costa Rica. The lowest grade went to Paraguay in 81st place, with Lebanon, Brazil, Senegal, and Haiti just ahead.
… environmental stewardship, body-mass index, social mobility, COVID safeness …
The United States, getting a firm grasp on mediocrity, ranked 43rd. Here are some countries that did better: North Macedonia (7th), Sri Lanka (16th), Uganda (31st), and Uruguay 33rd). In the United States, “we spend so much money trying to get people to live longer, but we don’t spend enough money in helping people die better,” lead author Eric A. Finkelstein, PhD, said in a written statement.
… economic stability, and soccer; we’re also not the best at dying. Wait, did we already say that?
The face mask that launched a thousand ships
Face masks, clearly, have been a source of social strife during the pandemic. People may not agree on mandates, but a mask can be a pretty-low-maintenance face shield if you don’t feel like putting on make-up or want to cover up some blemishes.
Before the pandemic, people thought that those wearing face masks were less attractive because the masks represented illness or disease, according to Dr. Michael Lewis of Cardiff (Wales) University. Back then, no one really wore masks besides doctors and nurses, so if you saw someone wearing one on the street, you probably wondered what they were trying to hide.
Now, though, the subject of face mask attractiveness has been revisited by Dr. Lewis and his associate, Oliver Hies, who found that face masks now make people more attractive.
“Our study suggests faces are considered most attractive when covered by medical face masks. … At a time when we feel vulnerable, we may find the wearing of medical masks reassuring and so feel more positive towards the wearer,” Dr. Lewis told the Guardian.
He suggested that we’re no longer looking at people wearing a mask as disease riddled, but rather doing their part to protect society. Or maybe we focus more on someone’s eyes when that’s all there is to look at. Or, maybe we wind up making up what the rest of someone’s face looks like to meet our attractiveness criteria.
However you feel about masks, they’re cheaper than plastic surgery. And you can go out wearing a new face every day.
In space, no one can hear your red blood cells scream
There are many reasons why space is the final frontier, not least of which are the major health issues space travel places on the human body. So until a shady billionaire finds an alien protomolecule on a Saturnian moon and starts splicing it with human DNA so we can hang out in space all day without a spacesuit, we’re stuck with things like space anemia, a condition many astronauts develop after extended time in space.
Space anemia has been known for many years, but it was assumed that it developed as a reaction to microgravity and was a short-term phenomenon only – a temporary compensation as fluids and blood volume adjusted themselves. But as new research shows, that assumption seems to be wrong.
For the study, published in Nature Medicine, 13 astronauts who were in space for at least 120 days – long enough for all their red blood cells to have been produced in space – had their blood tested consistently. Before their flights, the astronauts created and destroyed 2 million red blood cells per second, but while they were in space, they destroyed 3 million cells per second. Notably, this process continued for the entire duration of the space flight. So, not a temporary reaction.
Consequently, 5 of the 13 astronauts developed anemia when they returned to Earth. (Interesting space fact: Having fewer blood cells isn’t a problem while you’re in space; the effects of anemia only manifest when the body returns to full gravity.) The anemia disappeared after a few months, but the astronauts were still destroying 30% more red blood cells a year after their spaceflight than they were before leaving Earth.
You may be thinking: Well, if they were destroying 50% more red blood cells while in space, how come they didn’t all develop severe anemia? The researchers theorized that production was boosted as well, which sounds like a good thing. The body is compensating, as it should. Unfortunately, that increased production stresses bone marrow function and the demand for energy spikes. That’s not such a good thing. And of course, many of the astronauts got anemia anyway.
To tackle the issue, the researchers emphasized the importance of feeding astronauts a proper diet, plus potential supplements before spaceflight. So don’t worry, Captain Kirk will be able to arm wrestle Klingons and romance suspiciously human-looking aliens without fear of keeling over from anemia-induced fatigue. Earth will stay safe.
Tell me with your eyes
Communication can be hard, even under the best of circumstances, but for many nonverbal patients in the intensive care unit who can’t move, getting a point across to the health care team can be a huge struggle in itself.
Health care professionals have been making do with eye-blinking or head-nodding, but what if that’s just not enough? New research shows that it’s not, and there’s a more effective way for patients to say what they mean just by looking.
In a study published in the Journal of Trauma and Acute Care Surgery, researchers looked into using eye-tracking systems for nonverbal ICU patients to communicate. Eye-tracking isn’t anything new, but using it as a form of communication among nonverbal patients with critical illness hasn’t been looked at before.
How does it work? The eye-tracking system is set up in the patient’s line of sight and its various algorithms and software collect data to calculate where exactly the patient is looking. Established scores and scales assess the patient’s mood, quality of life, pain, and self-esteem.
The researchers found that participating patients were actually experiencing more negative moods, pain, and feelings of frustration than was once believed. Making this tool even more valuable for treatment adjustment and meeting patients’ needs.
In this case, it means that health care providers are getting an eyeful … of communication.
Make America grave again
Here we go again. Somebody just found something else that the United States is not the best at. To go along with math and science education, infrastructure investment, quality of life …
That’s going to go on for a while, so let’s get to the new stuff. An international group of researchers surveyed end-of-life care in 81 countries and ranked them based on the assessment of 181 experts in those countries. They looked at 13 different factors, including proper management of pain and comfort, having a clean and safe space, being treated kindly, lack of cost barriers to appropriate care, and treatments that address quality of life and don’t just extend life.
… press freedom, industrial production, racial equality, Internet connectivity …
Their report card, published in the Journal of Pain and Symptom Management, gave six countries an A, with Great Britain at the top. The other five were Ireland, Taiwan, Australia, South Korea, and Costa Rica. The lowest grade went to Paraguay in 81st place, with Lebanon, Brazil, Senegal, and Haiti just ahead.
… environmental stewardship, body-mass index, social mobility, COVID safeness …
The United States, getting a firm grasp on mediocrity, ranked 43rd. Here are some countries that did better: North Macedonia (7th), Sri Lanka (16th), Uganda (31st), and Uruguay 33rd). In the United States, “we spend so much money trying to get people to live longer, but we don’t spend enough money in helping people die better,” lead author Eric A. Finkelstein, PhD, said in a written statement.
… economic stability, and soccer; we’re also not the best at dying. Wait, did we already say that?
The face mask that launched a thousand ships
Face masks, clearly, have been a source of social strife during the pandemic. People may not agree on mandates, but a mask can be a pretty-low-maintenance face shield if you don’t feel like putting on make-up or want to cover up some blemishes.
Before the pandemic, people thought that those wearing face masks were less attractive because the masks represented illness or disease, according to Dr. Michael Lewis of Cardiff (Wales) University. Back then, no one really wore masks besides doctors and nurses, so if you saw someone wearing one on the street, you probably wondered what they were trying to hide.
Now, though, the subject of face mask attractiveness has been revisited by Dr. Lewis and his associate, Oliver Hies, who found that face masks now make people more attractive.
“Our study suggests faces are considered most attractive when covered by medical face masks. … At a time when we feel vulnerable, we may find the wearing of medical masks reassuring and so feel more positive towards the wearer,” Dr. Lewis told the Guardian.
He suggested that we’re no longer looking at people wearing a mask as disease riddled, but rather doing their part to protect society. Or maybe we focus more on someone’s eyes when that’s all there is to look at. Or, maybe we wind up making up what the rest of someone’s face looks like to meet our attractiveness criteria.
However you feel about masks, they’re cheaper than plastic surgery. And you can go out wearing a new face every day.
Dark plaque on back of ear
Dermoscopic findings were consistent with a melanocytic lesion and a scoop shave biopsy revealed a 2.7 mm thick nodular melanoma.
Melanoma is the most lethal skin cancer in the United States. The likelihood of metastatic spread to lymph nodes statistically increases beyond a probability of 5% when patients have primary lesions thicker than 0.8 mm.1 Thus, for patients with tumors thicker than 0.8 mm, or some other high-risk features such as high mitotic index, a sentinel lymph node biopsy (SLNB) is recommended. This patient underwent wide local excision and reconstruction of his ear. An SLNB was also performed and the results were negative.
The patient returned for a complete skin exam every 3 months. Ten months after the excision, he presented with episodes of headache and confusion. Magnetic resonance imaging revealed metastasis to the brain; a biopsy confirmed that it was melanoma. Two months later, after attempts at resection of the brain metastasis, the patient died.
This case demonstrates that patients with thick melanoma are at continued risk for recurrence and poor outcomes; they benefit from close surveillance and work-up of unusual symptoms that might suggest metastases. Phase 3 trials are currently underway to consider the use of adjuvant therapy in patients with advanced stage II melanoma who, on average, have worse outcomes than patients with early-stage III disease.2
Text courtesy of Jonathan Karnes, MD, medical director, MDFMR Dermatology Services, Augusta, ME. Photos courtesy of Jonathan Karnes, MD (copyright retained).
1. NCCN Guidelines Version 1.2022 Melanoma: Cutaneous. National Comprehensive Cancer Network. December 3, 2021. Accessed January 4, 2022. https://www.nccn.org/professionals/physician_gls/pdf/cutaneous_melanoma.pdf
2. Poklepovic AS, Luke JJ. Considering adjuvant therapy for stage II melanoma. Cancer. 2020;126:1166-1174. doi: 10.1002/cncr.32585
Dermoscopic findings were consistent with a melanocytic lesion and a scoop shave biopsy revealed a 2.7 mm thick nodular melanoma.
Melanoma is the most lethal skin cancer in the United States. The likelihood of metastatic spread to lymph nodes statistically increases beyond a probability of 5% when patients have primary lesions thicker than 0.8 mm.1 Thus, for patients with tumors thicker than 0.8 mm, or some other high-risk features such as high mitotic index, a sentinel lymph node biopsy (SLNB) is recommended. This patient underwent wide local excision and reconstruction of his ear. An SLNB was also performed and the results were negative.
The patient returned for a complete skin exam every 3 months. Ten months after the excision, he presented with episodes of headache and confusion. Magnetic resonance imaging revealed metastasis to the brain; a biopsy confirmed that it was melanoma. Two months later, after attempts at resection of the brain metastasis, the patient died.
This case demonstrates that patients with thick melanoma are at continued risk for recurrence and poor outcomes; they benefit from close surveillance and work-up of unusual symptoms that might suggest metastases. Phase 3 trials are currently underway to consider the use of adjuvant therapy in patients with advanced stage II melanoma who, on average, have worse outcomes than patients with early-stage III disease.2
Text courtesy of Jonathan Karnes, MD, medical director, MDFMR Dermatology Services, Augusta, ME. Photos courtesy of Jonathan Karnes, MD (copyright retained).
Dermoscopic findings were consistent with a melanocytic lesion and a scoop shave biopsy revealed a 2.7 mm thick nodular melanoma.
Melanoma is the most lethal skin cancer in the United States. The likelihood of metastatic spread to lymph nodes statistically increases beyond a probability of 5% when patients have primary lesions thicker than 0.8 mm.1 Thus, for patients with tumors thicker than 0.8 mm, or some other high-risk features such as high mitotic index, a sentinel lymph node biopsy (SLNB) is recommended. This patient underwent wide local excision and reconstruction of his ear. An SLNB was also performed and the results were negative.
The patient returned for a complete skin exam every 3 months. Ten months after the excision, he presented with episodes of headache and confusion. Magnetic resonance imaging revealed metastasis to the brain; a biopsy confirmed that it was melanoma. Two months later, after attempts at resection of the brain metastasis, the patient died.
This case demonstrates that patients with thick melanoma are at continued risk for recurrence and poor outcomes; they benefit from close surveillance and work-up of unusual symptoms that might suggest metastases. Phase 3 trials are currently underway to consider the use of adjuvant therapy in patients with advanced stage II melanoma who, on average, have worse outcomes than patients with early-stage III disease.2
Text courtesy of Jonathan Karnes, MD, medical director, MDFMR Dermatology Services, Augusta, ME. Photos courtesy of Jonathan Karnes, MD (copyright retained).
1. NCCN Guidelines Version 1.2022 Melanoma: Cutaneous. National Comprehensive Cancer Network. December 3, 2021. Accessed January 4, 2022. https://www.nccn.org/professionals/physician_gls/pdf/cutaneous_melanoma.pdf
2. Poklepovic AS, Luke JJ. Considering adjuvant therapy for stage II melanoma. Cancer. 2020;126:1166-1174. doi: 10.1002/cncr.32585
1. NCCN Guidelines Version 1.2022 Melanoma: Cutaneous. National Comprehensive Cancer Network. December 3, 2021. Accessed January 4, 2022. https://www.nccn.org/professionals/physician_gls/pdf/cutaneous_melanoma.pdf
2. Poklepovic AS, Luke JJ. Considering adjuvant therapy for stage II melanoma. Cancer. 2020;126:1166-1174. doi: 10.1002/cncr.32585
Did a switch to a generic antidepressant cause relapse?
Advances in Diabetes and Cardiovascular Care
Real-World Experience With Automated Insulin Pumps
Continuous Blood Glucose Monitoring for T2DM
Statin-Induced Adverse Effects
Long QT and Cardiac Arrest After Pulmonary Edema
And more online
• Clinical Impact of U-500 Insulin Initiation
• Diabetes Self-Management Education
• SGLT2 Inhibitors, T2DM, and Heart Failure
• Alirocumab Use in Statin-Intolerant Veterans
• K Pneumoniae-Induced Aortitis
Real-World Experience With Automated Insulin Pumps
Continuous Blood Glucose Monitoring for T2DM
Statin-Induced Adverse Effects
Long QT and Cardiac Arrest After Pulmonary Edema
And more online
• Clinical Impact of U-500 Insulin Initiation
• Diabetes Self-Management Education
• SGLT2 Inhibitors, T2DM, and Heart Failure
• Alirocumab Use in Statin-Intolerant Veterans
• K Pneumoniae-Induced Aortitis
Real-World Experience With Automated Insulin Pumps
Continuous Blood Glucose Monitoring for T2DM
Statin-Induced Adverse Effects
Long QT and Cardiac Arrest After Pulmonary Edema
And more online
• Clinical Impact of U-500 Insulin Initiation
• Diabetes Self-Management Education
• SGLT2 Inhibitors, T2DM, and Heart Failure
• Alirocumab Use in Statin-Intolerant Veterans
• K Pneumoniae-Induced Aortitis
A Family Physician's Introduction to Lifestyle Medicine
This supplement will teach you about the 6 pillars of Lifestyle Medicine, looks at the future of Lifestyle Medicine, demonstrates the power of Lifestyle Medicine as evidence-based treatment of chronic disease, and describes how you can incorporate Lifestyle Medicine into your practice.
Click here to access this content now
This supplement will teach you about the 6 pillars of Lifestyle Medicine, looks at the future of Lifestyle Medicine, demonstrates the power of Lifestyle Medicine as evidence-based treatment of chronic disease, and describes how you can incorporate Lifestyle Medicine into your practice.
Click here to access this content now
This supplement will teach you about the 6 pillars of Lifestyle Medicine, looks at the future of Lifestyle Medicine, demonstrates the power of Lifestyle Medicine as evidence-based treatment of chronic disease, and describes how you can incorporate Lifestyle Medicine into your practice.
Click here to access this content now
Pandemic weighing on physicians’ happiness outside of work: survey
One of the unexpected consequences of the pandemic is that many people are rethinking their priorities and lifestyles, and physicians are no exception.
Pets, prayer, and partners
The pandemic has taken a toll on physicians outside of work as well as on the job. Eight in 10 physicians (82% of men and 80% of women) said they were “somewhat” or “very” happy outside of work before the pandemic. This is almost exactly the same result as in last year’s survey.
However, when asked how happy they are outside of work currently, only 6 in 10 (59%) reported being “somewhat” or “very” happy. While the pandemic has made life difficult for everyone, health care professionals face particular stresses even outside of work. Wayne M. Sotile, PhD, founder of the Center for Physician Resilience, says he has counseled doctors who witnessed COVID-related suffering and death at work, then came home to a partner who didn’t believe that the pandemic was real.
Still, physicians reported that spending time with people they love and engaging in favorite activities helps them stay happy. “Spending time with pets” and “religious practice/prayer” were frequent “other” responses to the question, “What do you do to maintain happiness and mental health?” Seven in 10 physicians reported having some kind of religious or spiritual beliefs.
The majority of physicians (83%) are either married or living with a partner, with male physicians edging out their female peers (89% vs. 75%). Among married physicians, 8 in 10 physicians reported that their union is “good” or “very good.” The pandemic may have helped in this respect. Dr. Sotile says he’s heard physicians say that they’ve connected more with their families in the past 18 months. Specialists with the highest rates of happy marriages were otolaryngologists and immunologists (both 91%), followed closely by dermatologists, rheumatologists, and nephrologists (all 90%).
Among physicians balancing a medical career and parenthood, female physicians reported feeling conflicted more often than males (48% vs. 29%). Nicole A. Sparks, MD, an ob.gyn. and a health and lifestyle blogger, cites not being there for her kids as a source of stress. She notes that her two young children notice when she’s not there to help with homework, read bedtime stories, or make their dinner. “Mom guilt can definitely set in if I have to miss important events,” she says.
Work-life balance is an important, if elusive, goal for physicians, and not just females. Sixty percent of female doctors and 53% of male doctors said they would be willing to take a cut in pay if it meant more free time and a better work-life balance. Many doctors do manage to get away from work occasionally, with one-fifth of all physicians taking 5 or more weeks of vacation each year.
Seeking a ‘balanced life’
Alexis Polles, MD, medical director for the Professionals Resource Network, points out the importance of taking time for personal health and wellness. “When we work with professionals who have problems with mental health or substance abuse, they often don’t have a balanced life,” she says. “They are usually in a workaholic mindset and disregard their own needs.”
Few physicians seem to prioritize self-care, with a third indicating they “always” or “most of the time” spend enough time on their own health and wellness. But of those who do, males (38%) are more likely than females (27%) to spend enough time on their own health and wellness. Dr. Polles adds that exercising after a shift can help physicians better make the transition from professional to personal life. Though they did not report when they exercised, about a third of physicians reported doing so four or more times per week. Controlling weight is an issue as well, with 49% of male and 55% of female physicians saying they are currently trying to lose weight.
Of physicians who drink alcohol, about a third have three or more drinks per week. (The CDC defines “heavy drinking” as consuming 15 drinks or more per week for men and eight drinks or more per week for women.)
Of those surveyed, 92% say they do not regularly use cannabidiol or cannabis, and a mere 4% of respondents said they would use at least one of these substances if they were to become legal in their state.
A version of this article first appeared on Medscape.com.
One of the unexpected consequences of the pandemic is that many people are rethinking their priorities and lifestyles, and physicians are no exception.
Pets, prayer, and partners
The pandemic has taken a toll on physicians outside of work as well as on the job. Eight in 10 physicians (82% of men and 80% of women) said they were “somewhat” or “very” happy outside of work before the pandemic. This is almost exactly the same result as in last year’s survey.
However, when asked how happy they are outside of work currently, only 6 in 10 (59%) reported being “somewhat” or “very” happy. While the pandemic has made life difficult for everyone, health care professionals face particular stresses even outside of work. Wayne M. Sotile, PhD, founder of the Center for Physician Resilience, says he has counseled doctors who witnessed COVID-related suffering and death at work, then came home to a partner who didn’t believe that the pandemic was real.
Still, physicians reported that spending time with people they love and engaging in favorite activities helps them stay happy. “Spending time with pets” and “religious practice/prayer” were frequent “other” responses to the question, “What do you do to maintain happiness and mental health?” Seven in 10 physicians reported having some kind of religious or spiritual beliefs.
The majority of physicians (83%) are either married or living with a partner, with male physicians edging out their female peers (89% vs. 75%). Among married physicians, 8 in 10 physicians reported that their union is “good” or “very good.” The pandemic may have helped in this respect. Dr. Sotile says he’s heard physicians say that they’ve connected more with their families in the past 18 months. Specialists with the highest rates of happy marriages were otolaryngologists and immunologists (both 91%), followed closely by dermatologists, rheumatologists, and nephrologists (all 90%).
Among physicians balancing a medical career and parenthood, female physicians reported feeling conflicted more often than males (48% vs. 29%). Nicole A. Sparks, MD, an ob.gyn. and a health and lifestyle blogger, cites not being there for her kids as a source of stress. She notes that her two young children notice when she’s not there to help with homework, read bedtime stories, or make their dinner. “Mom guilt can definitely set in if I have to miss important events,” she says.
Work-life balance is an important, if elusive, goal for physicians, and not just females. Sixty percent of female doctors and 53% of male doctors said they would be willing to take a cut in pay if it meant more free time and a better work-life balance. Many doctors do manage to get away from work occasionally, with one-fifth of all physicians taking 5 or more weeks of vacation each year.
Seeking a ‘balanced life’
Alexis Polles, MD, medical director for the Professionals Resource Network, points out the importance of taking time for personal health and wellness. “When we work with professionals who have problems with mental health or substance abuse, they often don’t have a balanced life,” she says. “They are usually in a workaholic mindset and disregard their own needs.”
Few physicians seem to prioritize self-care, with a third indicating they “always” or “most of the time” spend enough time on their own health and wellness. But of those who do, males (38%) are more likely than females (27%) to spend enough time on their own health and wellness. Dr. Polles adds that exercising after a shift can help physicians better make the transition from professional to personal life. Though they did not report when they exercised, about a third of physicians reported doing so four or more times per week. Controlling weight is an issue as well, with 49% of male and 55% of female physicians saying they are currently trying to lose weight.
Of physicians who drink alcohol, about a third have three or more drinks per week. (The CDC defines “heavy drinking” as consuming 15 drinks or more per week for men and eight drinks or more per week for women.)
Of those surveyed, 92% say they do not regularly use cannabidiol or cannabis, and a mere 4% of respondents said they would use at least one of these substances if they were to become legal in their state.
A version of this article first appeared on Medscape.com.
One of the unexpected consequences of the pandemic is that many people are rethinking their priorities and lifestyles, and physicians are no exception.
Pets, prayer, and partners
The pandemic has taken a toll on physicians outside of work as well as on the job. Eight in 10 physicians (82% of men and 80% of women) said they were “somewhat” or “very” happy outside of work before the pandemic. This is almost exactly the same result as in last year’s survey.
However, when asked how happy they are outside of work currently, only 6 in 10 (59%) reported being “somewhat” or “very” happy. While the pandemic has made life difficult for everyone, health care professionals face particular stresses even outside of work. Wayne M. Sotile, PhD, founder of the Center for Physician Resilience, says he has counseled doctors who witnessed COVID-related suffering and death at work, then came home to a partner who didn’t believe that the pandemic was real.
Still, physicians reported that spending time with people they love and engaging in favorite activities helps them stay happy. “Spending time with pets” and “religious practice/prayer” were frequent “other” responses to the question, “What do you do to maintain happiness and mental health?” Seven in 10 physicians reported having some kind of religious or spiritual beliefs.
The majority of physicians (83%) are either married or living with a partner, with male physicians edging out their female peers (89% vs. 75%). Among married physicians, 8 in 10 physicians reported that their union is “good” or “very good.” The pandemic may have helped in this respect. Dr. Sotile says he’s heard physicians say that they’ve connected more with their families in the past 18 months. Specialists with the highest rates of happy marriages were otolaryngologists and immunologists (both 91%), followed closely by dermatologists, rheumatologists, and nephrologists (all 90%).
Among physicians balancing a medical career and parenthood, female physicians reported feeling conflicted more often than males (48% vs. 29%). Nicole A. Sparks, MD, an ob.gyn. and a health and lifestyle blogger, cites not being there for her kids as a source of stress. She notes that her two young children notice when she’s not there to help with homework, read bedtime stories, or make their dinner. “Mom guilt can definitely set in if I have to miss important events,” she says.
Work-life balance is an important, if elusive, goal for physicians, and not just females. Sixty percent of female doctors and 53% of male doctors said they would be willing to take a cut in pay if it meant more free time and a better work-life balance. Many doctors do manage to get away from work occasionally, with one-fifth of all physicians taking 5 or more weeks of vacation each year.
Seeking a ‘balanced life’
Alexis Polles, MD, medical director for the Professionals Resource Network, points out the importance of taking time for personal health and wellness. “When we work with professionals who have problems with mental health or substance abuse, they often don’t have a balanced life,” she says. “They are usually in a workaholic mindset and disregard their own needs.”
Few physicians seem to prioritize self-care, with a third indicating they “always” or “most of the time” spend enough time on their own health and wellness. But of those who do, males (38%) are more likely than females (27%) to spend enough time on their own health and wellness. Dr. Polles adds that exercising after a shift can help physicians better make the transition from professional to personal life. Though they did not report when they exercised, about a third of physicians reported doing so four or more times per week. Controlling weight is an issue as well, with 49% of male and 55% of female physicians saying they are currently trying to lose weight.
Of physicians who drink alcohol, about a third have three or more drinks per week. (The CDC defines “heavy drinking” as consuming 15 drinks or more per week for men and eight drinks or more per week for women.)
Of those surveyed, 92% say they do not regularly use cannabidiol or cannabis, and a mere 4% of respondents said they would use at least one of these substances if they were to become legal in their state.
A version of this article first appeared on Medscape.com.
Risk factor-based screening inadequately discriminate parturients with and without elevated lead levels
Key clinical point: A pregnancy-specific questionnaire to perform risk factor-based screening for elevated lead levels during pregnancy identified parturients with elevated blood lead levels with good sensitivity but poor specificity.
Major finding: Almost 78% of participants reported at least 1 risk factor for lead, with the questionnaire showing high sensitivity (100%) but low specificity (22%) for identifying detectable maternal lead levels. The blood lead level was clinically reportable in 2.2% of participants, with 1 of them having a blood lead level above 5 μg/dL.
Study details: Findings are from an analysis of 92 parturients with a singleton pregnancy ≥34 weeks’ gestation who had data recorded for blood lead levels and completed a lead risk factor survey modified for pregnancy.
Disclosures: This work was supported by the Harvard Catalyst, Harvard Clinical and Translational Science Center, Harvard University, and others. The authors declared no conflict of interests.
Source: Johnson KM et al. Matern Child Health J. 2022 Jan 12. doi: 10.1007/s10995-021-03325-x.
Key clinical point: A pregnancy-specific questionnaire to perform risk factor-based screening for elevated lead levels during pregnancy identified parturients with elevated blood lead levels with good sensitivity but poor specificity.
Major finding: Almost 78% of participants reported at least 1 risk factor for lead, with the questionnaire showing high sensitivity (100%) but low specificity (22%) for identifying detectable maternal lead levels. The blood lead level was clinically reportable in 2.2% of participants, with 1 of them having a blood lead level above 5 μg/dL.
Study details: Findings are from an analysis of 92 parturients with a singleton pregnancy ≥34 weeks’ gestation who had data recorded for blood lead levels and completed a lead risk factor survey modified for pregnancy.
Disclosures: This work was supported by the Harvard Catalyst, Harvard Clinical and Translational Science Center, Harvard University, and others. The authors declared no conflict of interests.
Source: Johnson KM et al. Matern Child Health J. 2022 Jan 12. doi: 10.1007/s10995-021-03325-x.
Key clinical point: A pregnancy-specific questionnaire to perform risk factor-based screening for elevated lead levels during pregnancy identified parturients with elevated blood lead levels with good sensitivity but poor specificity.
Major finding: Almost 78% of participants reported at least 1 risk factor for lead, with the questionnaire showing high sensitivity (100%) but low specificity (22%) for identifying detectable maternal lead levels. The blood lead level was clinically reportable in 2.2% of participants, with 1 of them having a blood lead level above 5 μg/dL.
Study details: Findings are from an analysis of 92 parturients with a singleton pregnancy ≥34 weeks’ gestation who had data recorded for blood lead levels and completed a lead risk factor survey modified for pregnancy.
Disclosures: This work was supported by the Harvard Catalyst, Harvard Clinical and Translational Science Center, Harvard University, and others. The authors declared no conflict of interests.
Source: Johnson KM et al. Matern Child Health J. 2022 Jan 12. doi: 10.1007/s10995-021-03325-x.
Singleton exome sequencing reveals disease-causing variants in fetuses with ultrasound anomalies
Key clinical point: Singleton exome sequencing (sES) could be a valuable prenatal diagnostic tool that offers the opportunity to obtain reliable and rapid prenatal results that reveal novel disease-causing variants in fetuses with ultrasound anomalies.
Major finding: The overall diagnostic yield for detection of pathogenic or likely pathogenic variants was 34.4%, with the diagnostic rate being highest for multiple anomalies (56%), followed by skeletal or renal abnormalities (50%). Furthermore, 20 novel disease-causing variants in different known disease-associated genes were identified.
Study details: Findings are from a retrospective analysis of 90 fetuses with a normal rapid aneuploidy detection but abnormal ultrasound findings, who were further investigated with sES or multigene panel analysis of 6,713 genes.
Disclosures: The study did not receive funds, grants, or other support. The authors declared no competing interests.
Source: Smogavec M et al. Eur J Hum Genet. 2022 Jan 1. doi: 10.1038/s41431-021-01012-7.
Key clinical point: Singleton exome sequencing (sES) could be a valuable prenatal diagnostic tool that offers the opportunity to obtain reliable and rapid prenatal results that reveal novel disease-causing variants in fetuses with ultrasound anomalies.
Major finding: The overall diagnostic yield for detection of pathogenic or likely pathogenic variants was 34.4%, with the diagnostic rate being highest for multiple anomalies (56%), followed by skeletal or renal abnormalities (50%). Furthermore, 20 novel disease-causing variants in different known disease-associated genes were identified.
Study details: Findings are from a retrospective analysis of 90 fetuses with a normal rapid aneuploidy detection but abnormal ultrasound findings, who were further investigated with sES or multigene panel analysis of 6,713 genes.
Disclosures: The study did not receive funds, grants, or other support. The authors declared no competing interests.
Source: Smogavec M et al. Eur J Hum Genet. 2022 Jan 1. doi: 10.1038/s41431-021-01012-7.
Key clinical point: Singleton exome sequencing (sES) could be a valuable prenatal diagnostic tool that offers the opportunity to obtain reliable and rapid prenatal results that reveal novel disease-causing variants in fetuses with ultrasound anomalies.
Major finding: The overall diagnostic yield for detection of pathogenic or likely pathogenic variants was 34.4%, with the diagnostic rate being highest for multiple anomalies (56%), followed by skeletal or renal abnormalities (50%). Furthermore, 20 novel disease-causing variants in different known disease-associated genes were identified.
Study details: Findings are from a retrospective analysis of 90 fetuses with a normal rapid aneuploidy detection but abnormal ultrasound findings, who were further investigated with sES or multigene panel analysis of 6,713 genes.
Disclosures: The study did not receive funds, grants, or other support. The authors declared no competing interests.
Source: Smogavec M et al. Eur J Hum Genet. 2022 Jan 1. doi: 10.1038/s41431-021-01012-7.
Prenatal diagnosis of FGR with polyhydramnios is rare but with a high mortality rate
Key clinical point: Prenatal detection of fetal growth restriction (FGR) combined with polyhydramnios should indicate presence of different etiological groups with different prenatal and postnatal outcomes, necessitating long-term follow-up.
Major finding: The highest proportion of etiology identified was chromosomal abnormalities (41.8%), followed by complex malformation syndromes (24.1%), isolated malformations (15.7%), musculoskeletal disorders (9.2%), and parentally nonanomalous fetuses (9.2%). Overall, the mortality rate in the population was 64.7%.
Study details: Findings are from a single-center, retrospective analysis of 153 cases with FGR and polyhydramnios diagnosed by prenatal ultrasound, identified over 17 years.
Disclosures: No other funding sources were declared, except for open access funding by Projekt DEAL. The authors declared no competing interests.
Source: Walter A et al. Sci Rep. 2022 Jan 10. doi: 10.1038/s41598-021-04371-9.
Key clinical point: Prenatal detection of fetal growth restriction (FGR) combined with polyhydramnios should indicate presence of different etiological groups with different prenatal and postnatal outcomes, necessitating long-term follow-up.
Major finding: The highest proportion of etiology identified was chromosomal abnormalities (41.8%), followed by complex malformation syndromes (24.1%), isolated malformations (15.7%), musculoskeletal disorders (9.2%), and parentally nonanomalous fetuses (9.2%). Overall, the mortality rate in the population was 64.7%.
Study details: Findings are from a single-center, retrospective analysis of 153 cases with FGR and polyhydramnios diagnosed by prenatal ultrasound, identified over 17 years.
Disclosures: No other funding sources were declared, except for open access funding by Projekt DEAL. The authors declared no competing interests.
Source: Walter A et al. Sci Rep. 2022 Jan 10. doi: 10.1038/s41598-021-04371-9.
Key clinical point: Prenatal detection of fetal growth restriction (FGR) combined with polyhydramnios should indicate presence of different etiological groups with different prenatal and postnatal outcomes, necessitating long-term follow-up.
Major finding: The highest proportion of etiology identified was chromosomal abnormalities (41.8%), followed by complex malformation syndromes (24.1%), isolated malformations (15.7%), musculoskeletal disorders (9.2%), and parentally nonanomalous fetuses (9.2%). Overall, the mortality rate in the population was 64.7%.
Study details: Findings are from a single-center, retrospective analysis of 153 cases with FGR and polyhydramnios diagnosed by prenatal ultrasound, identified over 17 years.
Disclosures: No other funding sources were declared, except for open access funding by Projekt DEAL. The authors declared no competing interests.
Source: Walter A et al. Sci Rep. 2022 Jan 10. doi: 10.1038/s41598-021-04371-9.