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http://www.bbc.co.uk/news/world-asia-42218612 December 7, 2017

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Why it is so difficult to develop new antibiotics October 27, 2017

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This article is perhaps a bit long and boring but the implications could have serious effects on all of our health so please at least skim through

Blood oxygen measurement overuse leads to over-treatment? August 19, 2017

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“Pulse oximetry as a technology represents a major and significant advance in medicine.… However, its increasing and widespread use in stable infants and young children with bronchiolitis, a self limited disease with a generally benign course, has led to technology driven overdiagnosis of hypoxaemia — fueling uncertainty, increased use of resources, and patient harm,” write Ricardo Quinonez, MD, from Baylor College of Medicine in Houston, Texas, and colleagues.

Babies and young children suffering from bronchiolitis are commonly made to stay in hospital because their blood oxygen as measured by the oximetry machine is lower than an arbitrary threshold that varies from one doctor to another, in spite of the fact that the child may be coping very well with his/her illness. In some cases parents are told that inhalational treatment is necessary and cannot be administered at home therefore hospital stay is necessary, and this in spite of the lack of evidence that such treatment improves outcome.

Australia considers childcare ban on unvaccinated children March 13, 2017

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http://www.bbc.co.uk/news/world-australia-39251585

Clinicians Often Underestimate Harms of Tests and Treatments January 22, 2017

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http://www.medscape.com/viewarticle/874657?nlid=112069_2982&src=wnl_dne_170120_mscpedit&uac=155351MR&impID=1275443&faf=1

French baby death linked to vitamin dose January 6, 2017

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http://www.bbc.co.uk/news/world-europe-38505538

Give peanut to babies early – advice January 6, 2017

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http://www.bbc.co.uk/news/health-38518185

“Finding abnormalities does not always benefit patients, and that’s a really difficult concept for patients and physicians to grasp.” January 6, 2017

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Overuse of medical care remains all too common in pediatric settings, according to the authors of a literature analysis published online January 3 in Pediatrics.

“Overused medical care is not just wasteful, it is potentially harmful,” write Eric R. Coon, MD, from the Division of Inpatient Medicine, Department of Pediatrics, University of Utah School of Medicine Primary Children’s Hospital, Salt Lake City, and colleagues.

I spend a significant amount of time telling parents why medical tests they think their child needs or have been suggested to them may not only be unnecessary and unhelpful, but also potentially harmful. A hard thing to do as it is somewhat counter-intuitive and within the confines of a limited time for consultation, parents can go home feeling disappointed. A few that I know of will go to other, perhaps more “obliging” doctors and get the tests done, and as predicted, get results that are unhelpful.

There has also been a number of patients who have come to see me from other hospitals having been through numerous, increasingly expensive and invasive tests, which have not resulted in gaining information that has improved their child’s condition.

The problem of overdiagnosis has been studied much more extensively in adults than children and it is rife in many places. If offered promotional test packages by private commercial hospitals ask yourself who is really benefiting.

 

 

More antibiotic bad news June 3, 2016

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More bad news on the looming antibiotic resistance crisis. This particular “last resort” antibiotic colistin, is frequently (mis)used in this country to treat diarrhoea for which it is unhelpful and  ineffective.

Physician’s First Watch
David G. Fairchild, MD, MPH, Editor-in-Chief

May 31, 2016
Bacteria Resistant to Last-Resort Antibiotic Discovered in U.S.
By Amy Orciari Herman
Edited by David G. Fairchild, MD, MPH
Escherichia coli resistant to colistin — the last-resort antibiotic used to treat carbapenem-resistant bacteria — has been identified in the U.S. for the first time, researchers report in Antimicrobial Agents and Chemotherapy. If colistin resistance eventually extends to carbapenem-resistant bacteria, those microbes will become “unstoppable,” the New York Times notes.

This week in medical news: stories that are relevant to many of us. May 18, 2016

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I hope to blog on new medical articles that catch my eye 2-3 times a month, with my take on the subject. Questions and discussions welcomed!

 

FDA Calls for More Restrictions on Fluoroquinolone Use

Fluoroquinolone is a class of antibiotic that is very frequently used in this country, in adults and less so but my no means infrequently, in children. It is relatively new and bacterial resistance is not yet widespread but like ALL strong new antibiotics, frequent misuse is leading to it becoming less effective, and from what I have observed, it is misused many  more times than it is appropriately used. But that is not the only problem, this class of medicine has substantial toxicity. This is what the FDA says:

The risks for “disabling and potentially permanent” side effects associated with systemic fluoroquinolone antibacterials (e.g., ciprofloxacin, moxifloxacin) generally outweigh the benefits in patients with sinusitis, bronchitis, and uncomplicated urinary tract infections, the FDA warned late last week. Fluoroquinolones should only be used for these indications when patients don’t have other treatment options, the agency said.

– See more at:

http://www.jwatch.org/fw111568/2016/05/16/fda-calls-more-restrictions-fluoroquinolone-use?query=pfwTOC&jwd=000013394434&jspc=OBG#sthash.bdlOxj1L.dpuf

Should you listen to your doctor and be compliant when she prescribe Ciprobay® or Avelox® to you? Perhaps ask her how often she prescribes it. If she says very rarely, in your case you need it, then may be OK, but if she says oh I use it all the time it works great, then perhaps be a bit sceptical.

 

Peanuts for your baby?

The evidence for massive reduction of severe peanut allergy risk by early introduction of peanuts in infants less than 6 months of age continue to mount and has turned much of established food allergy avoidance practices on its head.  In the past many doctors gave food avoidance advice for babies based only on weak anecdotal evidence, and many still do.  Instructions on how and when to introduce new foods to babies can get as complicated as you like. The evidence for the benefit of early introduction of peanuts to high risk babies is overwhelming now. The question is: which if any high allergy risk food would also be better introduced earlier rather than avoided for years, like egg white, wheat products, dairy and sea food?

When is bellyaching real?

Non-specific abdominal pain NSAP, and Recurrent Abdominal Pain of Childhood are very common diagnoses. Chances are if  you child has a short lasting tummy ache that comes out of nowhere and just as mysteriously disappears, with no associated vomiting diarrhoea weight loss or loss of appetite, and recurring every now and then, then your child probably has non-specific recurrent abdominal pain of childhood, which is often not a very satisfying diagnosis as it gives no clue as to the cause, and consequently what can be done to prevent or treat the condition.

NSAP should be a common diagnosis as it is a common condition but doctors, and patients, mostly prefer more definitive diagnoses that justify specific treatments, and so other labels are often applied, most commonly dyspepsia or stomach ulcer type problems due to excess stomach acid. Dyspepsia can exist in children but it is extremely rare, it is mainly a condition of middle age men who smoke, drink and stress too much.

This paper shows that  cases of NSAP do not often turn out to be something more serious subsequently, which means judicious use of investigations and treatment should be the rule.