Eyeglasses for the Developing World- A Vision for the Future

The developing world is full of health problems. One of the many is the lack of prescription eyeglasses. Last year we took 170 pairs of glasses to Honduras on our medical relief trip. They were a hot commodity.

How could prescription glasses be delivered to millions of people in resource poor countries in a cheap and simple fashion? Below is an informative TED video on the subject brought to my attention by a colleague at VCU Medical Center.

Could we do the same for water filters? Specifically, could we teach the campesinos targeted by our yearly medical relief trips to make and maintain their own clay water filters for enhanced water sanitation? This is worth exploring.

To learn more about our ongoing clinical work, public health projects and research in Honduras, visit the the GH2DP website or peruse the slides from our latest presentation, at VCU Internal Medicine Grand Rounds.

Asymptomatic Bacteriuria in Young Women with Recurrent Urinary Tract Infections: Is treatment Necessary

Here is an article that I will discuss with our infectious diseases trainees later in the week.The clinical question is as follows: in young women with recurrent urinary tract infections, should asymptomatic bacteriuria (bacterial colonization of the urine) be treated?

The investigators used a prospective, non-blinded,  randomized  methodology to compare treatment to no-treatment of asymptomatic bacteriuria in a total of 637 women. 

The result? At the last follow-up, 41 (13.1%) in the no treatment group and 169 (46.8%) in treatment group showed showed symptomatic urinary tract infection recurrence (RR, 3.17; 95% CI, 2.55-3.90; P < .0001).

The message: don't treat urinary colonization with bacteria, only treat active infections! 

The indiscriminate use of antibiotics leads to selection of resistant pathogens and likely alters the normal colonic and vaginal flora. The intestinal and vaginal bacteria are important defense mechanisms against invasion of the urinary tract by E.coli.

Fluoroquinolones and the Risk of Cardiac Arrythmia

Fluoroquinolones have been suspected to cause cardiac arrhythmia. I was intrigued by this article that assessed the risk of serious arrhythmia, defined as ventricular arrhythmia or sudden/unattended death related to fluoroquinolones.

The investigators used a cohort of patients treated for respiratory conditions from 1990 to 2005. A nested case-control analysis was performed within this cohort. Cases were matched with up to 20 controls. Conditional logistic regression was used to compute adjusted rate ratios (RRs) of serious arrhythmia associated with fluoroquinolone use.

Of the 605,127 subjects, 1838 cases of arrythmia were identified (incidence = 4.7/10 000 person-years). The rate of serious arrhythmia was elevated with fluoroquinolone use (RR = 1.76; 95% confidence interval [CI], 1.19-2.59), in particular with new current use (RR = 2.23; 95% CI, 1.31-3.80). 

Gatifloxacin use was associated with the highest rate (RR = 7.38; 95% CI, 2.30-23.70); moxifloxacin and ciprofloxacin were also associated with elevated rates of serious arrhythmia(RR = 3.30; 95% CI, 1.47-7.37 and RR = 2.15; 95% CI, 1.34-3.46, respectively).

I have yet to see a case of cardiac arrythmia attributed to a fluroquinolone antibiotic and these are used quite frequently. The risk is very small yet real. Nevertheless, the above study serves to remind us that antibiotics should not be used indiscriminately as there is potential for serious harm.

Like the scalpel, the prescription pad can be lethal if used inappropriately.

VCU Global Health in Rural Honduras: A 7 Year Journey

Today Dr. Stevens and I presented our 7 year Honduras journey at VCU Internal Medicine Grand Rounds.

The lecture, in PDF format, can now be found here.

Disparity in Infection Control Practices for Multi-Drug Resistant Gram Negative Rods

The application of contact isolation precautions can be disparate. Here is a previous blog related to contact isolation uncertainties. 

Today I came across this manuscript reporting on the disparities in infection control practice for the control of multi-drug drug resistant gram negative rods (extended-spectrum β-lactamase-producing Enterobacteriaceae [ESBL-E] and carbapenem-resistant Enterobacteriaceae [CRE]).  The study was a survey based across 15 hospitals in Toronto, Canada. There was wide variation in the use infection control practices including admission screening (53% and 53%), contact precautions (53% and 100%), and isolation (60% and 100%) for ESBL-E and CRE, respectively. For  the hospitals performing admission screening, 75% used risk factor-based screening for ESBL-E and CRE.

Why? Most likely because high quality data and consensus guidelines are lacking on how best to detect and isolate patients colonized or infected with these pathogens. In addition, effective decolonization methods and evidence based protocols for discontinuing isolation are still undefined.

For our recent perspective on contact precautions, click here. 

It is November 6 and the polls just opened. I am walking out to vote. Who will get my presidential vote? You will just have to guess.

Orthorexia nervosa

I am treading well beyond my area of medical expertise today, hence, I will be brief. This morning I came across an article on orthorexia nervosa in an Argentine newspaper.

There are people overly concerned about having a perfect diet, resulting in a maniacal obsession for healthy foods, as summarized here in the journal of Eating and Weight Disorders. I also came across this article, published in Appetite, on the prevalence of orthorexia nervosa in resident physicians in a Turkish hospital. The prevalence seemed disturbingly high.

It is clear from my brief search of PubMed that orthorexia is a relatively new diagnosis with a small corresponding body of medical literature. The adverse health consequences of orthorexia have yet to be fully detailed in the peer reviewed literature. 

Regardless, when seeking healthy foods becomes an overwhelming drive with obsessive-compulsive components, it is time to seek help.

Racial Disparities in HIV Infection in the USA

Here is a recent article that speaks volumes and accurately reflects my day to day observations in the HIV clinic. There is a growing disparity in the rate of HIV/AIDS diagnoses in young men, particularly young, black men ages 15-24. 

This is a sad and disturbing trend, particularly as risk reduction interventions, HIV testing and treatment are all more accessible than ever.

Our ongoing efforts to reduce the incidence and burden of HIV must be focused and prioritized for this high risk group.