A 34-year-old female presented with recurrent episodes of diffuse colicky abdominal pain. She also has an urticarial rash, flushing, and profuse sweating. Bouts of non-bloody, watery diarrhoea accompanied the abdominal pain. No identifiable trigger was identified, and there was no association with a specific food type allergy. She denied any weight loss. On presentation, she was afebrile, normotensive, and slightly tachycardiac. Her abdomen was tender to palpation. Her pelvic exam was normal. She has had a similar episode in the past; the most recent being three months prior, which was also associated with an itchy rash and abdominal pain and diarrhoea.What are your thoughts about the differential diagnosis in this patient?

The physician-patient relationship has always been built on trust, expertise, and communication, but in recent years, doctors are increasingly encountering a new kind of patient—one who is more informed, more skeptical, and more demanding than ever before. With instant access to medical information, direct-to-consumer advertising, and the rise of patient-centered care, many physicians feel that expectations have shifted dramatically, often creating challenges in clinical practice.

One of the biggest drivers of this shift is the internet. Patients now come to appointments armed with Google searches, social media advice, and self-diagnosed conditions, sometimes challenging the doctor’s expertise. While greater patient involvement is generally positive, misinformation has complicated medical decision-making, leading to longer consultations, more second opinions, and even conflicts over treatment recommendations.

A growing concern is that patients increasingly request tests, medications, or procedures that may not be necessary, expecting their doctor to comply. Physicians often find themselves caught between evidence-based medicine and patient expectations, knowing that refusing a request could damage the doctor-patient relationship or lead to dissatisfaction, poor reviews, or even complaints.

The rise of "healthcare consumerism"—where patients view medical care as a service rather than a professional consultation—has further altered expectations. Many patients see themselves as customers rather than just patients, demanding faster access, personalized treatment, and even alternative therapies that may lack clinical support.

For doctors, this creates a dilemma: Should they focus on meeting patient demands, even when they may not be medically necessary, or risk upsetting patients by sticking strictly to guidelines? Some physicians report feeling pressured to overprescribe medications, order unnecessary imaging, or agree to treatments they don’t fully support just to avoid conflict. This shift has led to increased stress, longer working hours, and even physician burnout. Many doctors now feel that patient satisfaction scores and online reviews are influencing medical decisions more than clinical judgment. Others struggle with the balance between providing thorough, evidence-based care while keeping up with increasing demands for availability, responsiveness, and personalized medicine. What are your thoughts?

The physician-patient relationship has always been built on trust, expertise, and communication, but in recent years, doctors are increasingly encountering a new kind of patient—one who is more informed, more skeptical, and more demanding than ever before. With instant access to medical information, direct-to-consumer advertising, and the rise of patient-centered care, many physicians feel that expectations have shifted dramatically, often creating challenges in clinical practice.

One of the biggest drivers of this shift is the internet. Patients now come to appointments armed with Google searches, social media advice, and self-diagnosed conditions, sometimes challenging the doctor’s expertise. While greater patient involvement is generally positive, misinformation has complicated medical decision-making, leading to longer consultations, more second opinions, and even conflicts over treatment recommendations.

A growing concern is that patients increasingly request tests, medications, or procedures that may not be necessary, expecting their doctor to comply. Physicians often find themselves caught between evidence-based medicine and patient expectations, knowing that refusing a request could damage the doctor-patient relationship or lead to dissatisfaction, poor reviews, or even complaints.

The rise of "healthcare consumerism"—where patients view medical care as a service rather than a professional consultation—has further altered expectations. Many patients see themselves as customers rather than just patients, demanding faster access, personalized treatment, and even alternative therapies that may lack clinical support.

For doctors, this creates a dilemma: Should they focus on meeting patient demands, even when they may not be medically necessary, or risk upsetting patients by sticking strictly to guidelines? Some physicians report feeling pressured to overprescribe medications, order unnecessary imaging, or agree to treatments they don’t fully support just to avoid conflict. This shift has led to increased stress, longer working hours, and even physician burnout. Many doctors now feel that patient satisfaction scores and online reviews are influencing medical decisions more than clinical judgment. Others struggle with the balance between providing thorough, evidence-based care while keeping up with increasing demands for availability, responsiveness, and personalized medicine. What are your thoughts?

A recent study published in JAMA Psychiatry has confirmed a troubling trend: female physicians in the U.S. face a significantly higher risk of suicide compared to women in the general population. From 2017 to 2021, female doctors had a 53% higher suicide rate than their non-physician counterparts, Meanwhile, their male counterparts—who also endure the relentless demands of medicine—actually have lower suicide rates than men in other professions.

The study analyzed suicide deaths among 448 physicians and 97,467 non-physicians across 30 U.S. states and Washington, D.C. Researchers found that physicians who died by suicide were more likely to have experienced depression, job-related stress, and legal issues than non-physicians. Female doctors, in particular, seem to bear a unique burden, facing systemic gender inequities, workplace stress, and barriers to seeking mental health support.

One of the biggest challenges is the stigma surrounding mental health in medicine. Physicians often fear that seeking help could jeopardize their careers, licensure, or professional reputation. This leads to silent suffering, where doctors—especially women—continue working under immense pressure until it becomes unbearable. Researchers are calling for targeted suicide prevention efforts, including anonymous mental health screenings, improved workplace policies, and cultural shifts within medicine to make seeking help safe and stigma-free.

Despite the growing number of women in medicine, the underlying culture hasn’t changed. The statistics speak for themselves, but the real stories remain hidden...Read More

If you take a step back and look at it objectively, do you really notice when your colleagues are distressed? What signs do you see but rarely talk about?

Medpage Today

Kim Kardashian recently posted about getting a full-body MRI, calling it “life-saving” and a way to detect diseases before symptoms arise. What she didn’t mention is that there’s no evidence this scan benefits healthy people—nor did she acknowledge the risks of false alarms, unnecessary diagnoses, and even harmful treatments.

A recent study published in JAMA Network Open analyzed nearly 1,000 Instagram and TikTok posts about five popular medical tests frequently marketed as essential for healthy individuals. The findings were alarming: most posts were misleading, exaggerating benefits while downplaying or ignoring potential harms. The tests included:

• Full-body MRI scans – Marketed as a way to detect up to 500 conditions, including cancer, these scans often lead to false positives, triggering unnecessary biopsies, surgeries, and anxiety. Despite their appeal, there is no proven benefit of routine full-body MRIs in healthy individuals.
• Multi-cancer early detection blood tests – Often touted as the “holy grail” of cancer screening, these tests claim to detect over 50 cancers from a simple blood sample. However, clinical trials are still ongoing, and there’s no solid evidence that their benefits outweigh the risks of overdiagnosis and overtreatment.
• Testosterone testing in healthy men – Direct-to-consumer testosterone tests have become increasingly popular, leading many men to undergo unnecessary screening and even unwarranted testosterone replacement therapy (TRT)—despite no strong evidence supporting its routine use in healthy individuals.
• The “egg timer” AMH test – This anti-Müllerian hormone (AMH) test is often falsely promoted as a fertility predictor. While it can provide insights in fertility clinic settings, it cannot accurately predict natural conception or menopause timing. Despite this, many women are driven to unnecessary and costly fertility treatments based on misleading claims.

The study found that 87% of social media posts about these tests focused on their benefits, while only 15% mentioned potential risks.  Only 6% of posts cited scientific evidence, while 34% relied on personal stories to promote the tests. 68% of influencers had financial ties to the tests, including sponsorships, partnerships, or direct sales. This wave of misinformation is fueling overdiagnosis, encouraging people to seek out screenings that offer no proven benefit while exposing them to unnecessary medical interventions, increased anxiety, and wasted healthcare resources...Read More

What’s the most absurd or unnecessary test a patient has ever requested—just because they saw it on social media or the internet?

The Conversation

The physician-patient relationship has always been built on trust, expertise, and communication, but in recent years, doctors are increasingly encountering a new kind of patient—one who is more informed, more skeptical, and more demanding than ever before. With instant access to medical information, direct-to-consumer advertising, and the rise of patient-centered care, many physicians feel that expectations have shifted dramatically, often creating challenges in clinical practice.

One of the biggest drivers of this shift is the internet. Patients now come to appointments armed with Google searches, social media advice, and self-diagnosed conditions, sometimes challenging the doctor’s expertise. While greater patient involvement is generally positive, misinformation has complicated medical decision-making, leading to longer consultations, more second opinions, and even conflicts over treatment recommendations.

A growing concern is that patients increasingly request tests, medications, or procedures that may not be necessary, expecting their doctor to comply. Physicians often find themselves caught between evidence-based medicine and patient expectations, knowing that refusing a request could damage the doctor-patient relationship or lead to dissatisfaction, poor reviews, or even complaints.

The rise of "healthcare consumerism"—where patients view medical care as a service rather than a professional consultation—has further altered expectations. Many patients see themselves as customers rather than just patients, demanding faster access, personalized treatment, and even alternative therapies that may lack clinical support.

For doctors, this creates a dilemma: Should they focus on meeting patient demands, even when they may not be medically necessary, or risk upsetting patients by sticking strictly to guidelines? Some physicians report feeling pressured to overprescribe medications, order unnecessary imaging, or agree to treatments they don’t fully support just to avoid conflict. This shift has led to increased stress, longer working hours, and even physician burnout. Many doctors now feel that patient satisfaction scores and online reviews are influencing medical decisions more than clinical judgment. Others struggle with the balance between providing thorough, evidence-based care while keeping up with increasing demands for availability, responsiveness, and personalized medicine. What are your thoughts?

Patients with irritable bowel syndrome (IBS) on an immunoglobulin (Ig)G-guided elimination diet are more likely to have a 30 percent or greater reduction in abdominal pain intensity (API), according to a study published online Jan. 31 in Gastroenterology.

Prashant Singh, M.B.B.S., from Michigan Medicine in Ann Arbor, and colleagues conducted a randomized, double-blind trial involving patients with IBS from eight centers to examine the efficacy of an elimination diet utilizing a novel IBS-specific IgG assay. A total of 238 patients positive for one or more foods on an 18-food IgG assay and with an average daily API score between 3 and 7.5 on an 11-point scale during a two-week run-in period were randomly assigned to eight weeks of either an experimental antibody-guided diet or sham diet. The modified intention-to-treat analysis included 223 patients.

The researchers found that significantly more patients in the experimental diet group than the sham diet group met the primary outcome of a ≥30 percent decrease in API for two or more of the last four weeks of the treatment period (59.6 versus 42.1 percent). Compared with the sham group, a significantly higher proportion of patients in the experimental group with constipation-predominant IBS (IBS-C) and IBS with mixed bowel habits (IBS-M) met the primary end point (67.1 versus 35.8 percent and 66 versus 29.5 percent, respectively).

"Given our promising results, a larger study, possibly focusing on IBS-C and IBS-M patients, should be considered," the authors write.

Several authors disclosed ties to biotechnology and pharmaceutical companies, including Biomerica, which funded the study.

Abstract/Full Text (subscription or payment may be required)

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The U.S. Food and Drug Administration (FDA) has approved Journavx, a new pain reliever without the risks of addiction or overdose linked to drugs like Vicodin and OxyContin.

The new pill, developed by Vertex Pharmaceuticals, is intended for short-term pain relief following surgery or injury, the Associated Press reported.

While it provides a long-awaited alternative to opioids and over-the-counter painkillers like ibuprofen, research suggests its effectiveness is modest compared to standard opioid treatments.

Unlike opioids, which bind to brain receptors to reduce pain but often lead to dependence and addiction, Journavx works differently.

The medication blocks specific proteins that trigger pain signals before they reach the brain.

“In trying to develop medicines that don’t have the addictive risks of opioid medicines, a key factor is working to block pain signaling before it gets to the brain,” Dr. David Altshuler, Vertex’s executive vice president and chief scientific officer, previously told the Associated Press.

Studies of more than 870 patients who took Journavx after foot and abdominal surgery showed that the drug provided more relief than a placebo but was not more effective than a common opioid-acetaminophen combination pill.

“It’s not a slam dunk on effectiveness,” Michael Schuh of the Mayo Clinic, a pharmacist who was not involved in the research, told the Associated Press. “But it is a slam dunk in that it’s a very different pathway and mechanism of action. So, I think that shows a lot [of] promise.”

One major concern is cost. Journavx will have a list price of $15.50 per pill, compared to generic opioids, which cost $1 or less.

Some reported side effects included nausea, constipation, itching, rash and headache, but no risk of addiction.

“The new medication has side effect profiles that are inherently, not only different, but don’t involve the risk of substance abuse and other key side effects associated with opioids,” Dr. Charles Argoff of the Albany Medical Center in New York, who consulted for Vertex on the drug’s development, told the Associated Press.

The approval marks the first major advancement in pain treatment in more than two decades.

Vertex began developing the drug in the early 2000s, as opioid overdoses surged due to mass prescribing for chronic conditions like arthritis and back pain.

While opioid prescriptions have sharply declined in recent years, the current epidemic is mostly fueled by illicit fentanyl, rather than pharmaceutical opioids, the Associated Press reported.

Vertex has attracted much interest, but the drugmaker's stock took a hit in December after disappointing results in a study of chronic nerve pain.

Despite this, the company plans to continue with another late-stage trial in hopes of getting FDA approval for chronic pain treatment.

More information

The Cleveland Clinic has more on living with chronic pain.

SOURCE: The Associated Press, media report, Jan. 31, 2025

Copyright © 2020 HealthDay. All rights reserved.

A new strain of bird flu, H5N9, has been detected for the first time in the United States, raising concerns about how it continues to spread.

The strain was discovered at a commercial duck farm in California's Merced County, and was reported to the World Organization for Animal Health, which maintains a database of animal disease threats.

The detection comes as the nation continues to battle a growing outbreak of another, more common bird flu strain, H5N1, which is rapidly spreading across poultry farms and infected dairy cows.

While H5N9 is not currently considered a serious threat to humans, experts warn that more mutations could increase the risk of bird flu spreading to people in the future.

Scientists are particularly concerned about a process called "reassortment," The Washington Post reported, where different flu strains mix in infected animals, creating new versions of the virus.

The U.S. Department of Agriculture’s Animal and Plant Health Inspection Service (APHIS) confirmed that the H5N9 strain detected in California is the result of reassortment involving H5N1, the strain that's already spreading rapidly in the U.S.

“It does suggest there’s enough virus around that reassortment might become more frequent,” Angela Rasmussen, a virologist at the Vaccine and Infectious Disease Organization at the University of Saskatchewan in Canada, told The Post. “With enough H5 in these animals and enough seasonal flu in humans, you get them together, and you have a recipe for a potential pandemic virus.”

Past bird flu outbreaks have started due to reassortment, making ongoing monitoring critical.

In late November, both H5N1 and H5N9 cases were discovered in a Merced County commercial duck meat farm, which led to the quarantine of the facility and the culling of more than 100,000 birds.

Genetic sequencing confirmed the presence of H5N9 in January, triggering a formal report to health authorities.

According to The Post, Steve Lyle, director of public affairs for the California Department of Food and Agriculture, said no further action is being taken because the flock has already been euthanized. The farm will undergo cleaning and testing before resuming operations.

While H5N9 is not new, with similar strains detected in other countries, its outbreak in the U.S. highlights ongoing risks posed by the bird flu.

“The fact that these [agricultural] operations are having to cull their flocks is costly. We see that when we look at the cost of eggs in the store,” Jennifer Nuzzo, director of the Pandemic Center at Brown University, told The Post. “The fact that cows can continue to get infected is ultimately going to prove costly.”

More information

The U.S. Centers for Disease Control and Prevention has more on the current situation of bird flu.

SOURCE: The Washington Post, media report, Jan. 28, 2025

Copyright © 2020 HealthDay. All rights reserved.

For women undergoing in vitro fertilization (IVF), artificial intelligence (AI) techniques indicate that intermediately sized follicles are most important to the number of mature oocytes subsequently retrieved and could be used to optimize IVF treatment, according to a study published online Jan. 8 in Nature Communications.

Simon Hanassab, from Imperial College London, and colleagues conducted a multicenter study involving 19,082 treatment-naive female patients from 11 European IVF centers. Explainable AI was harnessed to identify the contribution of follicle sizes to relevant downstream clinical outcomes.

The researchers found that intermediately sized follicles were most important to the number of mature oocytes that were retrieved. The proportion of follicles within 13 to 18 mm was positively associated with the live birth rate (odds ratio, 1.03; 95 percent confidence interval, 1.00 to 1.06) when adjusting for age, total follicle count, and type of trigger administered.

"Our study has shown that AI methods are well suited to analyzing complex IVF data," coauthor Ali Abbara, M.B.B.S., Ph.D., also from Imperial College London, said in a statement. "In future, AI could be used to provide accurate recommendations to improve decision-making and aid in personalization of treatment, so that we can give each couple the very best possible chance of having a baby."

Several authors disclosed ties to the biopharmaceutical industry.

Abstract/Full Text

Copyright © 2020 HealthDay. All rights reserved.

With a sweep of the pen, President Donald Trump has ended a Biden administration effort to lower the cost of prescription drugs for people on Medicare and Medicaid.

Trump's order, signed shortly after his inauguration on Monday, targets policies his administration calls "deeply unpopular" and "radical," NBC News reported.

One of those now-cancelled policies directed Medicare to investigate ways to slash drug costs, including the possibility of a $2 monthly out-of-pocket cap on some generic medications.

Monday's actions also follow through on a key goal of Trump's first term -- weakening the Affordable Care Act. In particular, he nixed a policy that gave uninsured adults in 36 states an extra 12 weeks to sign up for coverage, according to NBC News. He also reversed an order that included more outreach funding to states, which was designed to make Medicaid stronger.

A key provision in former President Joe Biden's Inflation Reduction Act, negotiating Medicare drug prices, remains untouched for now. Last week, Medicare unveiled a list of prescription drugs up for negotiations next. They included Ozempic and Wegovy, the popular weight-loss and diabetes drugs.

A $35-a-month cap on insulin costs and $2,000 annual out-of-pocket cap on prescription drugs were not affected by the executive order signed Monday, NBC News reported.

Arthur Caplan, head of medical ethics at the NYU Grossman School of Medicine in New York City, told NBC News that it appears that Trump is moving with "great caution." Biden's bigger initiatives have so far been left alone, he noted.

He said the president knows that health care costs in the United States are far higher than in other parts of the world and that the government may need to intervene.

"Right now, he seems to be nibbling on the edges," Caplan told NBC News.

Larry Levitt, an executive vice president at KFF, a health policy think tank, offered a similar assessment.

He told NBC News some of the cancelled policies once meshed with Trump's goals, suggesting a possible change in his priorities.

By cancelling Biden's order to investigate new ways to lower out-of-pocket spending on prescription medications, Levitt said Trump may be signaling that he is less serious about addressing health care costs.

"Trump is kind of wiping the slate clean," Levitt concluded. "If you contrast Day 1 of this Trump administration with the last one, it is a different approach to health care."

More information

There's more about seniors' drug coverage at Medicare.gov.

SOURCE: NBC News

Copyright © 2020 HealthDay. All rights reserved.

Self-reported manifestations of topical steroid withdrawal (TSW) in atopic dermatitis (AD) include erythema, desquamation, dryness, and oozing affecting the face, neck, and upper extremities, according to a study published online Jan. 3 in Acta Dermato-Venereologica.

Mikael Alsterholm, M.D., Ph.D., from the Karolinska Institutet in Stockholm, and colleagues conducted an observational cross-sectional study involving adults reporting both AD and TSW. A questionnaire was posted in a Swedish TSW-themed Facebook group and was accessed by 98 participants and completed by 82.

Most respondents were female (95 percent), self-diagnosed with TSW (84 percent), and reported current symptoms of AD and TSW. The researchers note that TSW was defined as dependence on topical glucocorticoids (TGCs) and adverse reactions to their use. The most reported signs were erythema, desquamation, dryness, and oozing affecting the face, neck, and upper extremities. The most reported symptoms were pruritus, sleep disturbance, and signs of anxiety and depression. Sixty percent of respondents reported recurring episodes of manifestations attributed to TSW. Ninety-three percent believed that TGCs were the personal trigger factor, while 33 percent also identified oral glucocorticoids. Twenty-one percent currently use TGCs.

"As of now, TSW remains an exclusion diagnosis after careful ruling out of established causes for adverse reactions to TGCs," the authors write. "This stance requires that the patients' concerns and beliefs are respected by empathic and open-minded health care providers who uphold an evidence-based approach and offer alternatives to TGCs when possible."

Several authors disclosed ties to the pharmaceutical industry.

Abstract/Full Text (subscription or payment may be required)

Copyright © 2020 HealthDay. All rights reserved.

U.S. Food and Drug Administration (FDA) officials have uncovered dozens of violations at a McDonald's supplier tied to last year's deadly E.coli outbreak, which sickened over 100 people and led to a massive recall of onions used in the fast-food giant's signature Quarter Pounder burgers.

The violations were listed in an FDA inspection report of Taylor Farms' Colorado Springs facility, obtained by CBS News through a Freedom of Information Act request.

Inspectors discovered multiple food safety issues, including equipment with biofilm and food debris, incomplete sanitation procedures, and improper handling of ready-to-eat (RTE) produce.

"Production employees handling RTE produce and food contact surfaces were not observed using any of the handwashing sinks in the facility," the FDA's inspectors wrote.

The inspection led the FDA to issue Taylor Farms a Form 483, citing conditions inspectors deemed “injurious to health.”

These findings included employees skipping required handwashing steps and failing to dry sanitized utensils, potentially contaminating produce with hazardous cleaning chemicals. The inspectors also flagged chemical mixtures used for sanitation that exceeded maximum concentrations or lacked proper documentation for safe use.

Taylor Farms, which labels its products as "prep-less kitchen solutions" for different restaurants, supplied onions to McDonald's locations across multiple states before the outbreak. Following the investigation, the company recalled thousands of cases of ready-to-eat onions distributed to food service facilities in six different states.

In a company statement, Taylor Farms said it "immediately took steps to address" the FDA's observations and noted that the inspection did not result in administrative or regulatory actions.

“This is consistent with the fact that no illnesses or public health threat has been linked to these observations,” the company added.

McDonald’s, which had already stopped sourcing from Taylor Farms’ Colorado Springs facility before the inspection, reiterated its commitment to food safety. “We hold our suppliers to the highest expectations and standards of food safety,” the company said in a news release.

“Prior to this inspection, and unrelated to its findings, McDonald’s stopped sourcing from Taylor Farms’ Colorado Springs facility."

In total, 104 people from 14 states were sickened and 34 were hospitalized during the outbreak, while one older person in Colorado died, the FDA said in a previous health update. The likely source of contamination was determined to be raw, slivered onions that were put on the signature burgers.

While the evidence on what triggered the outbreak was slim, one sample from now-recalled onions supplied by Taylor Farms tested positive for E. coli. However, those samples did not match the strain found in those who fell ill, the FDA noted.

Still, investigators said they determined the yellow onions were the likely culprit based on interviews with those who were sickened and from information provided by the distributors of the product. Of the people who recalled what they ate, roughly 84 percent had a menu item with slivered onions, the agency said.

At that point, McDonald's said it would stop using Taylor Farms onions from its Colorado Springs facility.

“The process to reach this point has at times felt long, challenging and uncertain,” Michael Gonda, McDonald’s North America chief impact officer, and Cesar Piña, the company's chief supply chain officer, said in a previous statement. “But it is critical that public officials examine every possible angle, and we are deeply grateful that they moved quickly to identify and, in partnership with McDonald’s, contain the issue.”

The company said recently that it has resumed selling Quarter Pounders with slivered onions from different sources at affected locations.

"McDonald’s identified an alternate supplier for the approximately 900 restaurants that had temporarily stopped serving Quarter Pounder burgers with slivered onions," the company said in a Nov. 14 statement. "Over the past week, these restaurants resumed the sale of Quarter Pounder burgers with slivered onions."

In its statement, McDonald’s added that “food safety is something we will never compromise on, and we remain committed to doing the right thing.”

Still, several lawsuits have been filed against McDonald’s since the outbreak was first announced, including a proposed class action lawsuit, NBC News reported.

Most people infected with the E. coli strain recover without treatment. Milder symptoms often include stomach cramps, bloody diarrhea and vomiting. In more severe cases, people can develop high blood pressure, kidney disease, neurological problems or hemolytic uremic syndrome -- a condition that can trigger kidney failure, according to the CDC.

More information

The CDC has more on E. coli.

SOURCES: CBS News, news release; U.S. Food and Drug Administration, health update, Dec. 4 and Nov. 13, 2024; McDonald's statement, Dec. 4 and Nov. 13, 2024; NBC News

Copyright © 2020 HealthDay. All rights reserved.

For immunocompromised individuals, antibody response to respiratory syncytial virus (RSV) vaccines is heterogeneous and about 40 percent do not seroconvert, according to a research letter published online Dec. 30 in the Journal of the American Medical Association.

Andrew H. Karaba, M.D., Ph.D., from the Johns Hopkins University School of Medicine in Baltimore, and colleagues measured antibody response to RSV vaccinations in immunocompromised individuals in a prospective, national cohort study. Persons with self-reported immunocompromising conditions were enrolled. Those reporting plans to receive adjuvanted RSV prefusion F (preF)3-AS01E­ or nonadjuvanted RSVpreF were asked to provide blood samples prevaccine and at two, four, and 12 weeks after vaccination. The primary outcome was fold rise in antibody titers from baseline to four weeks; seroconversion was defined as a fourfold or greater rise in preF immunoglobulin G (IgG) at four weeks.

Overall, 139 participants reported RSV vaccination during the study period, and of these, 38 submitted paired baseline and four-week postvaccination samples. The researchers found that the median preF IgG increased from 87,292 AU/mL at baseline to 626,280; 439,086; and 464,170 AU/mL at two, four, and 12 weeks postvaccination, respectively. The median four-week preF IgG fold rise was 4.21; 23 of the participants (61 percent) achieved seroconversion.

"In contrast to universal seroconversion and preF IgG fold rises greater than 10 in immunocompetent persons, approximately 40 percent of immunocompromised participants did not seroconvert or achieve a conservative neutralization threshold postvaccination," the authors write.

Several authors disclosed ties to the pharmaceutical industry.

Abstract/Full Text (subscription or payment may be required)

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Specific anaphylactic triggers are associated with symptoms and treatments, according to a study published online Nov. 15 in the International Archives of Allergy and Immunology.

Roy Khalaf, from McGill University in Montreal, and colleagues examined sociodemographic characteristics, clinical symptoms, and management of anaphylaxis among adults in a cross-sectional study. Data were included for 1,135 adults presenting to emergency departments with drug-induced anaphylaxis (DIA), venom-induced anaphylaxis, peanut-induced anaphylaxis, shellfish-induced anaphylaxis, tree-nut induced anaphylaxis (TIA), and nut-induced anaphylaxis (NIA) from April 2011 to November 2023.

The researchers found that 50.3 percent of the patients presented with food-induced anaphylaxis. Hypotension was more likely associated with DIA in terms of symptomatology (adjusted odds ratio, 1.20). Alcohol was more likely associated with NIA when adjusted for age at reaction and male sex (adjusted odds ratio, 1.51). In terms of management, TIA was more likely associated with inpatient epinephrine (adjusted odds ratio, 2.05), while DIA and TIA were less and more likely associated with outpatient antihistamine, respectively (adjusted odds ratios, 0.68 and 1.81, respectively).

"While our findings highlight associations between specific anaphylaxis triggers and symptom presentation, these associations do not imply a universal early warning system for diagnosing anaphylaxis," the authors write.

Abstract/Full Text

Copyright © 2020 HealthDay. All rights reserved.

California Gov. Gavin Newsom declared a public health emergency on Wednesday as bird flu continues to spread among the state’s dairy cattle.

“This proclamation is a targeted action to ensure government agencies have the resources and flexibility they need to respond quickly to this outbreak,” Newsom explained in a news release announcing the move. “While the risk to the public remains low, we will continue to take all necessary steps to prevent the spread of this virus.”

The move comes on the heels of a Louisiana resident being hospitalized with bird flu (H5N1), the first severe case confirmed in the United States.

The country's bird flu outbreak, which began in Texas earlier this year, has now spread to 16 states, with 865 infected herds identified as of Wednesday.

California has been hit particularly hard, with 645 affected dairies, about half of which were reported in just the past 30 days.

While experts maintain that the virus cannot yet spread easily among people, each infection in animals increases the risk of the virus mutating into a form more transmissible between humans.

The U.S. Centers for Disease Control and Prevention has confirmed 61 human cases of H5N1 infection nationwide, with another seven cases deemed “probable.”

Over half of the confirmed cases -- 32 -- are in California. While 37 of these infections have been traced to interactions with infected cattle, others are linked to diseased birds or other animals and several cases remain of unknown origin.

“All these infections in so many species around us is paving a bigger and bigger runway for the virus to potentially evolve to infect humans better and transmit between humans,” Dr. Nahid Bhadelia, director of the Boston University Center on Emerging Infectious Diseases, told the New York Times.

Bird flu has been spreading in poultry since 2022, and cases in dairy cows began to crop up last March. The virus was discovered in a pig for the first time recently.

Earlier this month, Canadian officials announced that a teen in British Columbia had been hospitalized in critical condition with what is believed to be bird flu.

It’s not clear how the teenager picked up the H5N1 virus because the patient is not known to have any contact with infected animals, officials noted. They added that this is the first human case of the virus reported in both the province and Canada.

"The positive test for H5 was performed at the BC Centre for Disease Control’s Public-Health Laboratory," Dr. Bonnie Henry, provincial health officer of British Columbia, said in a statement.

Testing has been performed on about three dozen people who were in contact with the teen, but none show evidence of infection, Henry added.

“We should be very concerned at this point,” Dr. James Lawler, co-director of the University of Nebraska’s Global Center for Health Security, told the Times. “Nobody should be hitting the panic button yet, but we should really be devoting a lot of resources into figuring out what’s going on.”

More information

The CDC has more on bird flu.

SOURCES: Gov. Gavin Newsom's office, news release, Dec. 18, 2024; U.S. Centers for Disease Control and Prevention, health update, Dec. 18, 2024; British Columbia Ministry of Health, news release, Nov. 9, 2024; New York Times

Copyright © 2020 HealthDay. All rights reserved.

Rules-based electronic triggers (e-triggers) are useful for post hoc detection of missed opportunities in diagnosis (MODs) in emergency department visits, according to a study published online Dec. 2 in JAMA Internal Medicine.

Viralkumar Vaghani, M.B.B.S., from the Baylor College of Medicine in Houston, and colleagues assessed the performance of a portfolio of e-triggers for identifying MODs in emergency departments. The analysis included treat-and-release emergency department visits at 1,321 Veterans Affairs health care sites.

The researchers found that 203 trigger-positive records were identified for high-risk stroke, 1,981 for symptom-disease dyads, 170 for high-risk abdominal pain, 116,785 for unexpected emergency department return, 14,879 for unexpected hospital return, and 2,090 for abnormal test results not followed up. From 625 randomly selected patient records, 47 MODs (positive predictive values [PPV], 47.0 percent) were identified for stroke, 31 MODs (PPV, 25.8 percent) for abdominal pain, 11 MODs (PPV, 11.0 percent) for emergency department returns, 23 MODs (PPV, 23.0 percent) for hospital returns, 18 MODs (PPV, 18.0 percent) for symptom-disease dyads, and 55 MODs (PPV, 52.4 percent) for test results. The most common diagnostic process breakdown involved the patient-clinician encounter for 108 of 130 MODs (excluding MODs related to the test result e-trigger). For 20 of 185 total MODs, patients experienced severe harm (10.8 percent), and 54 patients experienced moderate harm (29.2 percent).

"Interventions to target emergency department work system factors are urgently needed to support patient-clinician encounters and minimize harm from diagnostic errors," the authors write.

One author disclosed ties to the health information technology industry.

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An investigation into an E. coli outbreak linked to McDonald's Quarter Pounders has officially been closed, the U.S. Food and Drug Administration announced Tuesday.

In total, 104 people from 14 states were sickened and 34 were hospitalized during the outbreak, while one older person in Colorado died, the FDA said in its health update. The likely source of contamination was determined to be raw, slivered onions that were put on the signature burgers, the agency added.

However, there is no “continued food safety concern” because the affected onions were recalled and there haven't been any new illnesses reported since McDonald’s removed the onions from its menu on Oct. 22, health officials said.

While the evidence on what triggered the outbreak was slim, one sample from now-recalled onions supplied by Taylor Farms, a Colorado-based vegetable and fruit grower, and an environmental sample from an onion grower in Washington State tested positive for E. coli. However, those samples did not match the strain found in those who fell ill, the FDA noted.

Still, investigators said they determined the yellow onions were the likely culprit based on interviews with those who were sickened and from information provided by the distributors of the product. Of the people who recalled what they ate, roughly 84 percent had a menu item with slivered onions, the agency said.

McDonald’s has since said it would stop using Taylor Farms onions from its Colorado Springs facility.

“The process to reach this point has at times felt long, challenging and uncertain,” Michael Gonda, McDonald’s North America chief impact officer, and Cesar Piña, the company's chief supply chain officer, said in a statement issued Tuesday. “But it is critical that public officials examine every possible angle, and we are deeply grateful that they moved quickly to identify and, in partnership with McDonald’s, contain the issue.”

The company said recently that it has resumed selling Quarter Pounders with slivered onions from different sources at affected locations.

"McDonald’s identified an alternate supplier for the approximately 900 restaurants that had temporarily stopped serving Quarter Pounder burgers with slivered onions," the company said in a Nov. 14 statement. "Over the past week, these restaurants resumed the sale of Quarter Pounder burgers with slivered onions."

In its statement, McDonald’s added that “food safety is something we will never compromise on, and we remain committed to doing the right thing.”

Still, several lawsuits have been filed against McDonald’s since the outbreak was first announced, including a proposed class action lawsuit, NBC News reported.

Most people infected with the E. coli strain recover without treatment. Milder symptoms often include stomach cramps, bloody diarrhea and vomiting. In more severe cases, people can develop high blood pressure, kidney disease, neurological problems or hemolytic uremic syndrome -- a condition that can trigger kidney failure, according to the CDC.

More information

The CDC has more on E. coli.

SOURCES: U.S. Food and Drug Administration, health update, Dec. 4 and Nov. 13, 2024; McDonald's statement, Dec. 4 and Nov. 13, 2024; NBC News

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