Tuesday, June 25, 2013

Congratulations Drs. Vaughan and Beydoun- VCU Infectious Diseases Fellowship Graduates

Congratulations Drs. Bo Vaughan and Karen Beydoun, recently minted infectious diseases specialists from Virginia Commonwealth University. 

We were honored to serve as your mentors over the last several years. Without doubt, Bo and Karen will do great things in their very promising careers.

As a parting gift, each received our very special black vests, to be used in lieu of white coats for inpatient care. Read more about the black vest as the new white coat here.


Monday, June 24, 2013

The Words- Published in Medical Muse

For those who may be interested, here is a short essay I just published titled The Words, in Medical Muse magazine, Spring 2013 edition. The essay is found on page 6.

A quién le interesa, un ensayo mío, titulado The Words, recién fue publicado en la revista Medical Muse, edición primavera 2013. El ensayo se encuentra en la página 6

Friday, June 21, 2013

Epidemic Surveillance Through Technology- Beyond Google Flu

Source: Bio.Diaspora
Here is an interesting article on the use of technologies to bolster the surveillance and prediction of epidemics and outbreaks. The article features my friend and and colleague Dr. Kamran Khan of St. Michael's Hospital and the University of Toronto.

As the founder of Bio.Diaspora, Dr. Khan utilizes data from global travel, human migration and infectious diseases to predict emerging outbreaks. Here is an article by Dr. Khan, published in the New England Journal of Medicine, on the spread of a novel influenza virus by global airline transportation.

Prediction of epidemics may lead to risk mitigation of health, security and economic activity by governments and health authorities.

Very cool.

Wednesday, June 19, 2013

Hold that Additional Antibiotic! Treatment of Cellulitis Revisited

For the practicing clinicians reading this blog, here is an article published in Clinical Infectious Diseases that gives us much needed data to guide our choice of antibiotics.

Cellutis without the presence of pus, which is the vast majority of cases, is typically streptococcal and not staphylococcal.Despite this, antibiotics targeting community associated MRSA (CA-MRSA) are prescribed commonly.  But what is it needed?

The investigators performed a randomized, multicenter, double-blind, placebo-controlled trial from 2007 to 2011. Patients enrolled had cellulitis, no abscesses, symptoms for <1 week, and no diabetes, immunosuppression, peripheral vascular disease, or hospitalization. All participants received cephalexin. Additionally, and was randomized to trimethoprim-sulfamethoxazole or placebo for a total of 14 days. 
For those receiving cephalexin and   trimethoprim-sulfamethoxazole, 62/73 (85%) were cured versus 60/73 controls (82%), a risk difference of 2.7% (95% confidence interval, -9.3% to 15%; P = .66).

Finally, we have some quality data to suggest that for the management of puss-less cellulitis, in an outpatient setting, there is no need to add an additional antibiotic to cover CA-MRSA.

More is not always better!

Monday, June 17, 2013

Associate Professors: Stressed Out and Depressed

Here is a recent article in the Chronicle of Higher Education on why associate professors are so depressed. Having risen through the ranks of assistant professor, to associate professor and then to full professor of medicine at Virginia Commonwealth University, I am familiar with the promotion and tenure process.

The article highlights the stresses of academic life post tenure, following the promotion to associate professor. At the associate professor level, universities demand more service work, teaching, and  committee responsibilities. Associate professors are the workhorses of many institutions, typically resulting in less time for research and professional growth. Many  colleagues and faculty are intensely competitive,  thereby making the work environment unpleasant. The path from associate professor to full professor seems interminable.The result: a mid career crisis.

I fortunately did not experience the associate professor malaise. Perhaps it is because I have such close friends, colleagues and mentors at Virginia Commonwealth University. My viewpoint may also differ from that of a non-physician faculty member. The care of seriously ill, hospitalized patients along with our ongoing, central american relief work, provides me with a perspective on suffering that makes my academic concerns far less weighty. 

It rings cliché, but stress is in the eye of the beholder.

Thursday, June 13, 2013

2013 VCU Department of Medicine Graduation Recognition Ceremony

Congratulations to Dr. Bo Vaughan, our senior infectious diseases fellow, on winning the 2013 Orhan Muran Award for Outstanding Fellow.

Congratulations to Drs. Bo Vaughan and Karen Beydoun for graduating from the VCU infectious disease training program.

Last, kudos to colleagues Drs. Michael Stevens and Jane Cecil for receiving the 2013 Faculty Excellence in Teaching Award.

Olivia McGuire: Patient and Comedian

Here is a stand up comedy act by a patient of mine, Ms. Olivia McGuire. 

Olivia recounts her experience of illness and hospitalization through the prism of a stand up comedy act. Healing through humor. Some of the jokes that made the final cut were test run on my medical team during rounds. Clever, funny and touching.

Olivia, we are honored to be your healthcare providers at VCU.

Wednesday, June 12, 2013

Barefoot Running- Revisited

Honduras is well behind me. I am fully back to work at the hospital and back to my pre-work daily jogs.

Today's blog will take me away from my comfort zone. As a runner (not a real one who competes), I find the concept of barefoot running interesting, partly because of the attempts to substantiate with medical studies  the benefits of running unshod. I have blogged about this before.

Here is a recent article in the New York Times on new studies that cast doubt on the benefits of barefoot running. The data are not robust to support either an orthopedic benefit or an improved running ''efficiency'' by running barefoot or with minimalist shoes.

I wear my minimalist shoes once or twice a week when I jog back and forth to the gym. I find them still intriguing. I do not run barefoot.

There is one benefit of minimalist shoes not mentioned in the literature. Minimalist shoes are thin, flexible, compressible and very light. They pack great in my suitcase and are ideal for running on hotel treadmills! That's enough for me.

Friday, June 7, 2013

Screening for MRSA? Think Again.

The Three Amigos- back in 2004; still together at present at VCU
This blog post makes me proud!  

My VCU colleagues, mentors, and most importantly, close friends, Drs. Michael Edmond and Richard Wenzel recently published an invited editorial in the New England Journal of Medicine on MRSA screening.

The verdict: case closed. Active detection and isolation of MRSA is a flawed infection prevention strategy. 

An earlier argument against MRSA screening was made by us in 2008, published in Infection Control and Hospital Epidemiology.

Perhaps the tide is finally turning on advocates of MRSA active detection and isolation.

Thank you Mike and Dick!

Thursday, June 6, 2013

Honduras 2013: Certificate of Recognition / Pergamino de Reconocimiento

L-R: Dr. Michael Stevens, Jean Rabb, RN (enfermera), Dr. Pat Mason, The Blogger

Every now and then it is nice to be recognized. Thank you to the people of La Hicaca and to the Health Ministry for the generous recognition of our medical relief efforts over the years in La Hicaca, Yoro, Honduras.

De vez en cuando es lindo ser reconocido. Gracias al pueblo de La Hicaca y al Ministerio de Salud por el reconocimiento de nuestro proyecto colaborativo por la salud de los habitantes en La Hiaca, Yoro, Honduras.

Congratulations Gabriela Halder- Manuscript Published on Research in Honduras

Gaby Halder at APHA

Congratulations Gabriela Halder! As a member of our Honduras research and clinical team (2011), Gaby has successfully published a manuscript on water sanitation, access and self reported diarrheal illness in rural, mountainous Honduras.

For the full manuscript in PDF, click here.

Gaby's work was presented at the American Public Health Association national conference in 2011 where she was recognized with a research award.

Fantastic work!

Wednesday, June 5, 2013

Honduras 2013 Summary / Resumen

The 2013 VCU Global Health and Health Disparities (GH2DP) Honduras trip was a resounding success. In collaboration with local community leaders and the local Ministry of Health, the following was accomplished over the week:

  • Nearly 700 patients seen
  • Mass deworming of all clinic attendees with albendazole donated to the La Hicaca Health Center for deworming the rest of the year.
  • 500 new vaginal speculums delivered for ongoing cervical cytology / pap smears 
  • 152 new water filters installed with nearly 75% of all households in La Hicaca and environs with potable water
  • 2 questionnaire based research protocols completed
To view images from the trip, please visit this gallery on the GH2DP website.

La brigada médica de VCU Global Health and Health Disparities 2013(GH2DP) fue sumamente exitosa. En colaboración con la comunidad local y con el Ministerio de Salud, durante una semana logramos:
  • Atender casi 700 pacientes
  • Suministrar desparasitantes para todos los pacientes consultados y para la población entera de La Hicaca y alrededores
  • Entregar 500 espéculos para citología
  • Suministrar 500 filtros de agua para que casi 75% de la poblacion de La Hicaca y alredores tenga agua potable
  • Ejecutar 2 investigaciones de salud pública a través de cuestionarios
Para ver imágenes de la brigada, visite esta galería de fotos de la página del GH2DP.

Monday, June 3, 2013

Honduras 2013 Last Day / Último Día

Last day in Honduras. Pushed off to the airport in our trucks.
Enjoyed a final, cold, granita de cafe from Espresso Americano. Next stop, USA.

Último día en Honduras. Fuimos al aeropuerto temprano en nuestras camionetas. Antes de embarcar, disfrutamos de una granita de café, de Espresso Americano. Próxima parada, EEUU.

Saturday, June 1, 2013

Honduras 2013 Day 2/ Segundo Día Part 2

27th of May

Arrived in La Hicaca on a bumpy country road. Clinic started in the early afternoon and did not end until sundown, about 6 pm. The patients were routine except for an elderly woman who was dehydrated and required IV fluids. Dinner was rice, beans and tortillas.

Llegamos en La Hicaca a través de un camino de campo. Arrancamos las consultas por la tarde y terminamos con el consultorio con la puesta del sol. Los casos eran nada fuera de lo común salvo una paciente que estaba deshidratada y requirió fluido intravenosa. Para la cena, arroz, frijoles y tortillas.

Honduras 2013 Day 3 / Tercer Día

28th of May

Early morning wake up call, thanks to the roosters.
We had a day of clinic with a fair number of patients.
The water filter program is in full effect with 160 water filters to be distributed over the next several days. Potable water systems are our most important public health contribution to la Hicaca. Nightfall came with a torrential downpour.

Amanecemos temprano gracias al canto de las gallinas. Tuvimos un día entero de consultas. También arrancamos nuestro programa de reparto de filtros de agua. Este año, repartimos 160 filtros para que el pueblo de La Hicaca tenga agua potable. Sin dudas, los filtros son sumamente importante para la salud de la comunidad. De noche, el cielo descargó una lluvia torrencial.

Honduras 2013 Days 4 and 5 / Cuarto y Quinto Día

29th and 30th of May

Another early morning. We are off to clinic in neighboring Lomitas for the next two days. Both the patient volume and the high humidity and heat make the experience demanding. One patient needs several liters of IV fluids owing to dehydration. The water filter program is in full swing.

Otra madrugada temprano. Pasamos dos días cargados en Lomitas. Tanto el número de pacientes como la extremada humedad hace que la experiencia sea exigente. Tratamos a un paciente con deshidratación con salina intravenosa. El reparto de filtros de agua sigue a full

Honduras 2013 Day 6 / Sexto Día

31st of May

We are back in La Hicaca for another full day of clinic. Patients from nearly 16 aldeas have been seen. The water filter distribution program continues. In the adjacent building, the Honduran public health nurse is proceeded with PAP smears using the 500 speculums donated by our program. The heat and humidity was nearly intolerable, until the cloudburst at 3:30 pm provided a needed respite.

Estamos de regreso en La Hicaca para un día entero de consultas. Hemos atendidos pacientes de las 16 aldeas hasta la fecha. En el consultorio del lado, la enfermera Hondureña de salud pública hizo citología cervical con los 500 especulas donados por nuestro programa. El calor extremo era casi insorportable hasta qué llego el diluvio para darnos un descanso.