Tuesday, February 28, 2017

Revenge of Analog! I am no Ludditte.

The past weekend and this week have been busy on  the ID consult service. 

Blogging, and other things, are on the back burner.

This week I have been nosing through the book, The Revenge of Analog, by Paul Sax. Admittedly, I am biased and wedded to my books, vinyl records and notebooks. I even have a turntable and records in my administrative office! 

Sax highlights our need to hold, collect and interact with certain things (such as books, records, polaroid photos, paper notebooks and board games). Not everything that is digital, web-based, streamed or hyperlinked is satisfactory.

I am no Ludditte! I love my i Phone, Apple watch and laptop, particualrly when on the move. Analog serves to slow me down.

Deceleration is the name of the game after a long day of consults.

Thursday, February 23, 2017

Thursday Night at the VCU Department of Medicine Research Conference- The Infectious Diseases Division

It was fine Thursday night at the VCU Department of Medicine Research Conference.

Our very own Dr. Michelle Doll and Dr. Dan Markley presented their latest research, both published and in process on the use of personal protective equipment and antimicrobial stewardship- measuring and normalizing the use of carbapenems.

Kudos to both.

Dr. Dan Markley

Dr. Michelle Doll

Tuesday, February 21, 2017

The Evolution of Bacterial Resistance Video

I am back in the hospital and back to the grind.

Here is a short video from Harvard Medical School with concise commentary and surreal background music. The video documents the development of antibacterial resistance of E.coli on a massive 'mega-plate' petri dish.


Monday, February 13, 2017

At the 43rd Remington Winter Course in Infectious Diseases, Sun Valley, Idaho

I am the 43rd Remington Winter Course in Infectious Diseases this week, in Sun Valley, Idaho. I last attended this course in 2012 and gave a handful of lectures.

This year, I am essentially here to listen and learn, Although I have been a doctor for 20 years now, one is never experienced or knowledgeable enough. There are pearls of wisdom in every presentation and I am thoroughly enjoying the program.

To boot, the conference is well represented by my VCU Colleagues, past and present, making us proud.

Dr. Jane Cecil- VCU Health

Dr. Michael Edmond- Formerly of VCU, Now at University of Iowa

Dr. Richard Wenzel- VCU Health

Wednesday, February 8, 2017

Air Travel and ESBL Acquisition- More of a Threat Than We Realize

Kudos to this group of investigators from Holland who longitudinally followed a cohort of Dutch travelers for the acquisition of extended spectrum beta-lactamase (ESBL) bacteria. The findings were published in Lancet Infectious Diseases. Just completing the study was no small feat. The researchers obtain fecal cultures pre/post travel on 1847 individuals.

Thirty four percent of returning travelers were ESBL enterobacteriaceae colonized with up to 11% exhibiting persistent colonization for up to one year. Transmission was observed in 7.7% of household members.

For the infectious diseases physician, the importance of obtaining a travel history cannot be overstated, particularly for diagnosis and clinical decision making.

The article's discussion goes so far as to raise the issue of screening patients with a significant travel history for ESBL carriage. 

This is controversial and may be fraught with peril, a bacterial Pandora's Box. I am not sure that we are ready to launch into this strategy yet.

Saturday, February 4, 2017

VCU Department of Medicine Celebration of Excellence

L to R: Drs. Abbas, Stevens, Markley and Cecil
Last evening I attended the VCU Department of Medicine Celebration of Excellence award ceremony at the historic Jefferson Hotel.

The Infectious Diseases Division was well represented with awards received by our trainees, Dr. Dan Markley (scholarship recognition), Dr. Salma Abbas (teaching recognition) and faculty member Dr. Mike Stevens (mentorship recognition). 

As always, kudos to Dr. Jane Cecil for running a thriving fellowship program that excels and  fills with excellent trainees year in and year out.

Friday, February 3, 2017

Obesity, The Human Microbiome and the Case Against Sugar

I read with interest this article published in the Annals of Internal Medicine on the disrupted human gut microbiome and obesity. There is some data from animal models that disruption or alteration of the gut microbiome may increase obesity. This is likely not the main driver of obesity in industrialized nations.

I find the argument put fort in The Case Against Sugar, by Gary Taubes, more compelling for explaining our expanding obesity problem.

Obesity does not just come from gluttony and sloth. In addition to genetic and environmental factors, the pervasive use and ever increasing consumption of sugar in the Western diet stimulates insulin secretion, which drives lipogenesis thus facilitating weight gain, obesity, diabetes and heart disease. In other words, sugar consumption is in part causal of diabetes and obesity. 

Obesity, a disease of modernity, arises not just from a calorie/expenditure imbalance. Overconsumption of sugar leads to metabolic changes and hormonal changes (elevated insulin) which drive lipogenesis.

Food for thought.

Thursday, February 2, 2017

Seasonal Variation of Bare Below the Elbows? Definitely.

We practice bare below the elbows (BBE) as an infection adjunct at Virginia Commonwealth University. The measure was initially launched and championed by Dr. Michael Edmond, now at the University of Iowa.

Our compliance with BBE practice varies and can be as high as 70+%.

BBE varies by season, with decreased compliance observed (50%) in the winter months when outdoor temperatures decrease, as reported in our most recent publication in Infection Control and Hospital Epidemiology. The plot of seasonal temperature and BBE compliance tells it all. Due to copyright restrictions I am unable to reproduce it here.

Facilities management keeps the indoor ambient temperature steady, with little variance by season.

The solution, for those that still are cold while practicing BBE?

We have adopted a team vest, for students, residents, doctors and nurses, the concept is nicely summarized here.  

Stay warm.