June 27th, 2013

Testing Out the New Website with an ID Link-o-Rama

Hey, new website is live! Interested to hear what you think about our new-ish look.

In celebration, here are some quick ID/HIV tidbits that have recently crossed my path, or have been sitting in my inbox for a while, dying to get out:

  • Doxycycline shortage. Hardly anything more frightening to a New England ID doc than a shortage of the world’s most versatile antibiotic during peak Lyme season. Shudder. Fortunately, most of my patients have had no trouble getting it from their pharmacies, though I do hear prices are way up.
  • Some HCV news — USPSTF recommends screening baby-boomers (joining CDC, they had already recommended the same), and an HCV genotype test is approved. Here’s the question — why is the latter news at all? We’ve been sending HCV genotypes — “unapproved,” I guess — for years and years.
  • More HCV:  Did you see the CDC study published this Spring showing that around half the people with HCV don’t get a complete evaluation?  Specifically, after a positive antibody test, many have no subsequent HCV RNA (viral load) checked to determine whether they have chronic disease. How is that possible?
  • Another ID competition from John Bartlett. This time, it’s “Most Important Antiviral”. Go over to Medscape and vote and, more importantly, go read John’s fascinating discussion — which I bet he dictated between 4 and 5 a.m. early one day without using notes.
  • A retrospective study says you can stop antibiotics on patients with ventilator-associated pneumonia if sputum cultures are negative. Yeah — RIGHT. (Readers of a certain age will say that with the full Bill Cosby effect.) NEJM Journal Watch summary here.
  • Nice balanced piece in the New Yorker on the Lyme Disease controversy. Kudos to the author for not implying that there are villains on either side — a common mistake when the issue is covered in the lay press.
  • And on the subject of ticks, this time of the Lone Star variety, how about this bizarre connection — tick bites and allergy to red meat. Note that the allergic reaction is delayed, which may make the connection difficult to diagnose. The article includes the inevitable advice about wearing long pants and tucking them into your socks during the summer. Again — RIGHT. Perhaps no public health advice is less heeded than that one, beating out even condom use. (Love the interview at the start of that video, by the way — a young couple doing condom testing for “science”!)
  • The Kaiser Family Foundation has released this fascinating report on the funding sources for global health related to HIV/AIDS. Lots of interesting data, including the fact that the U.S. provides almost two thirds of all HIV/AIDS international assistance (61%), with the next largest donor, the Global Fund, providing one fifth — that’s around 80% of the total, if I’ve done my math right.
  • Wouldn’t it be nice to have something that “eliminates up to 99.9% of airborne bacteria, mold, viruses”? And now, for just $299.95, it can be yours. Good thing it isn’t $300.00, that would be way too expensive.

By the way, wondering how to say “NEJM Group”?  It’s N-E-J-M Group, spelled out, and not preceded by the word “The.” Now we all know. And I guess the Mass Medical Society prefers their doctors to be photographed wearing a tie.

Enjoy this classic comedy!

5 Responses to “Testing Out the New Website with an ID Link-o-Rama”

  1. Andrew C says:

    Enjoy your blog. Let’s see how the comments system is working.

    I wanted to point out that you might be mis-representing the paper on early discontinuation of antibiotics.
    The cultures were from BAL’s, and for patients with suspected VAP. Granted, it was a small retrospective cohort study.

    Raman, K., Nailor, M. D., Nicolau, D. P., Aslanzadeh, J., Nadeau, M., & Kuti, J. L. (2013). Early Antibiotic Discontinuation in Patients With Clinically Suspected Ventilator-Associated Pneumonia and Negative Quantitative Bronchoscopy Cultures*. Critical Care Medicine, 41(7), 1656–1663. doi:10.1097/CCM.0b013e318287f713

    But in any case, could you expound on the last phrase in your statement for us younger, prokaryotic, readers?

    • Paul Sax says:

      But in any case, could you expound on the last phrase in your statement for us younger, prokaryotic, readers?

      Andrew, in the video that I embedded at the bottom of the post, you’ll hear Bill Cosby doing his “Noah” routine. And the conversation between Noah and God is filled with Noah’s saying “RIGHT!” in a very sarcastic way, implying “You gotta be kidding me!”

      I imagine following exchange in an ICU:

      ID doctor: In this patient with suspected VAP, you can stop the antibiotics because the cultures are negative.
      ICU team: RIGHT.


  2. Cathy says:

    Why does the canine Lyme vaccine work (-ish), while the one for humans is a joke? What will it take to develop a decent vaccine?

    • Paul Sax says:

      Why does the canine Lyme vaccine work (-ish), while the one for humans is a joke?


      The human one actually did work, and worked pretty well — only it wasn’t perfect. Furthermore, it got caught up in all the societal controversy that surrounds Lyme Disease, so much so that the maker of the vaccine pulled it off the market. But it DID have a great name — “LYMErix”, as in the plural of “limerick”.

      Here’s more: http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2870557/


  3. Howard Heller says:

    So when we completely run out of doxycycline will someone start up a buyer’s club to import Lymecycline from Europe? http://en.wikipedia.org/wiki/Lymecycline
    I’m still surprised that it hasn’t caught on for treatment of chronic Lyme. And it’s available in generic form now.

    Love the Link-O-Rama.

HIV Information: Author Paul Sax, M.D.

Paul E. Sax, MD

Contributing Editor

NEJM Journal Watch
Infectious Diseases

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