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Managing Sickle Cell Disease

Managing Sickle Cell Disease

Sickle cell disease (SCD) is a life-threatening genetic disorder that affects approximately 100,000 people in the United States, with African Americans being more commonly affected than others. SCD is associated with many acute and chronic complications that require immediate medical attention. Sickled cells can block blood flow, which can lead to organ damage and pain and increase the risk of infection and strokes, among other problems. In JAMA, an expert panel issued guidelines for managing SCD after reviewing more than 12,000 scientific articles in an effort to provide a blueprint for caring for these patients. Prevention & Treatment A key guideline recommendation is to give children oral penicillin daily until the age of 5 and to vaccinate them against pneumococcal disease, says Barbara P. Yawn, MD, MSc, MSPH, who co-chaired the expert panel that was convened by the National Heart, Lung, and Blood Institute to develop the guidelines. “This is necessary to reduce the risk of pneumonia and other infections,” she says. In addition, the guidelines recommend that children between the ages of 2 and 16 have an annual transcranial Doppler exam to measure blood flow in the brain. If findings are abnormal, long-term transfusion therapy to prevent stroke is recommended. “In acute pain or vaso-occlusive crises (VOCs), pain treatment—often with opioids—needs to begin immediately,” Dr. Yawn say. “Appropriate therapy should be started and clinicians can worry about drug seeking behaviors later.” Incentive spirometry is also advised for those hospitalized with VOCs. The panel stresses greater use of hydroxyurea and long-term blood transfusions, two disease-modifying therapies that are effective but largely underused. The guidelines note that hydroxyurea should be...
CROI 2015

CROI 2015

New research was presented at CROI 2015, the annual Conference  on Retroviruses and Opportunistic Infections, from February  23 to 26 in Seattle. The features below highlight some  of the studies that emerged from the conference. Deferring HCV Treatment in Patients With HIV The Particulars: Studies have shown that successful treatment of hepatitis C virus (HCV) reduces the risk of liver-related complications. However, treatment is often deferred in patients with limited liver fibrosis due to cost considerations and the promise of better treatment options in the future. Little is known about the impact of deferring HCV treatment on liver progression among patients with HIV. Data Breakdown: For a study, researchers compared liver-related events and duration of infectiousness between patients with HIV who were treated for HCV 1 month after an HCV diagnosis, 1 year after a diagnosis, or as they reached fibrosis grades F2, F3, or F4. When compared with treating patients 1 month after diagnosis, delaying treatment until 1 year after diagnosis or until F2, F3, or F4 led to 14, 43, 142, and 418 additional cases of liver-related death per 1,000 HCV infections, respectively. The average length of time that patients were infectious increased from 5 years with treatment started 1 month after diagnosis to 21 years with treatment started at grade F4 fibrosis. Take Home Pearl: Timely treatment of HCV infection among patients with HIV appears to help prevent liver-related death and decrease the length of time that patients are infectious. Incentivizing Linkage to Care & Viral Suppression The Particulars: Data are lacking on the effect of financial incentives for linkage to care and viral suppression (VS)...

A 17-Year-Old Boy Impersonates a Doctor

In case you haven’t heard, a 17-year-old boy was discovered impersonating a doctor in a West Palm Beach, Florida hospital last month. According to one report, a patient told some staff at the hospital’s outpatient obstetrics and gynecology office that “a young male who ‘appeared to be a child’ was dressed as a doctor and was inside an exam room.” The lad was wearing a white coat and had a stethoscope around his neck. Some hospital personnel said a real doctor had been conducting an examination while the boy was in the room. From the police report: “The subject was seen on several floors of the hospital by several hospital employees entering patients [sic] rooms and talking to hospital employees.” He had apparently been walking around the hospital for a month. A security guard said the boy was “known around the hospital as a doctor.” After he was apprehended, a search of his car revealed a white coat with the word “Anesthesiology” embroidered on it as well as documents from another hospital in West Palm Beach. An employee of that institution said he had been seen walking around there at least once. Perhaps he was thinking about expanding his practice. The stories said that the boy had some sort of “condition,” and his mother told the police that he had been refusing to take his medication. He was not charged with a crime. Another account published a statement by the hospital that said, “The individual never had contact with any hospital patients and did not gain access to any patient care areas of the hospital at any time. The...
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