Bed Bugs in the City Health Department

This news report has a hint of irony. A single bedbug was discovered at the NYC Department of Health and Mental Hygiene in Queens, forcing a temporary evacuation and fumigation of the facility. Per Health Department officials, this was not an infestation. It is, however, pesky and embarrassing. 

While this may be a figurative black eye on the face of the Health Department, the health consequences of  bedbugs are minimal as they are not known to be vectors of disease transmission. 

The anxiety, however, is real. I have blogged about this before.

Influenza Vaccines at the Airport and Taxi Drivers.

Source: Chicago Tribune

The CDC recommends yearly influenza vaccination for all people ages 6 months and older.Getting the public vaccinated is always a challenge.

Here is a novel approach: vaccinate taxi drivers, for free, at a major transit area, the airport. This is precisely what is being done in Chicago, as reported here by the Chicago Tribune. Taxi drivers are in contact with a wide variety of people, particularly air travelers, who cough, sniffle and sneeze in their cabs. A taxi driver's risk of influenza contagion is not inconsequential.

This is a clever vaccination campaign provided that a large fraction of Chicago's taxi cab drivers are vaccinated. 

Herpes Simplex Virus Infection Following Circumcisions that Included Direct Orogenital Suction

This report in the MMWR caught my eye. An outbreak of Herpes Simplex Virus (HSV) occurred in 11 newborns and resulted in 10 hospitalizations and 2 deaths. 

The cause was attributed to ritual circumcision that involved an ultra-Orthodox Jewish practice known as metzitzah b'peh, in which the circumciser (mohel) places his mouth directly on the newly circumcised penis and sucks blood away from the circumcision wound (direct orogenital suction). 

In the cases where typing was performed in the outbreak, the isolates were HSV-1 (oral herpes). Oral contact with a newborn's open wound risks transmission of HSV and other pathogens.

As circumcision is a surgical procedure and should be performed under sterile conditions. Orogenital suction should be avoided, for obvious reasons.

The Next Pandemic

It should be no surprise that a pandemic or epidemic is looming around the figurative corner, especially for those of us in infectious diseases. Here is a commentary recently published in the New York Times, on the coming plague and why zoonoses (infectious diseases transmitted from animals to humans) will plague us until the end of time. With the widespread access of air travel, the introduction of an infectious disease is only a flight away.

I am studying for my re-certification examination in infectious diseases and came across an interesting reference in my lecture notes on the Sixth Plague of Egypt, a plague of boils (Book of Exodus). This can be no other than our nemesis since time immemorial, Staphylococcus aureus.  

Infectious diseases will continue to vex us. Job security.

Ward Physicians, Hospitalists and the iPatient

There has been a change in the age mix of ward attending physicians.  Medical care is now subject to greater demands on supervision, documentation, efficiency, and, for residents, duty hour restrictions. As a result, supervising physicians now are younger, general internists or hospitalists, and more directly engaged in patient care. The focus is patient throughput. 

The days of subspecialty oversight, by older physicians, with an academic perspective are largely over. The old model allowed for greater resident autonomy in patient care, the new model favors supervision and efficiency.

Here is a commentary, by Robert Wachter and Abraham Verghese, published in JAMA. The authors call for a new balance between resident supervisions and autonomy, one that still allows for more traditional teaching of residents and students, particularly at the bedside.

At risk in the current model, is the loss meaningful and transformational human contact with the patient, in favor greater of efficiency and of managing the virtual patient in the electronic medical record, also dubbed the "iPatient".


Here are my thoughts.  I believe that greater supervision and work hour restriction of residents is likely a good thing although there are no robust data to suggest that this results in improved patient and educational outcomes. There is also no data to suggest that the new model is detrimental to patients and learners. As we are not likely to turn back the clock, the onus is on us to ensure that there is no erosion of the human touch in medicine. Academic, supervising physicians should learn to balance efficiency, work rounds with select bedside teaching rounds, perhaps to highlight and review interesting cases, patient stories and exam findings. 

The task is not simple and, at times, inconvenient, but medical training was never meant to be easy. 

Chronic Fatigue Syndrome- Not Caused by an Infectious Disease

Source: ProHealth.com

Here is a brief commentary in the NY Times on chronic fatigue syndrome. Recently, chronic fatigue syndrome has been linked to infection with xenotropic murine leukemia virus-related virus (XMRV). Many were skeptical. Over the years, the syndrome has been associated with other viruses such as EBV,CMV and HHV6, none of which has held up to scientific scrutiny.  

Journal mBio reported the results of a prospective, multicenter analysis of chronic fatigue and XMRV and found no evidence of XMRV infection. 

The etiology of chronic fatigue syndrome remains elusive. I am sympathetic for those who suffer from chronic fatigue. As a profession, we must not mislead patients by suggesting that the malady is an infectious disease or that a simple cure or treatment is at hand.

It is time to move on.

VCU Global Health Initiative on the new Department of Medicine Website

The Virginia Commonwealth University Department of Medicine has a new website. Dr. Stevens and I are represented on the homepage with a profile about our ongoing work in Honduras,

If you have a moment, check it out.