Telling patients to stop antibiotics when they feel better may be preferable to finishing treatment.
Llewelyn MJ, Fitzpatrick JM, Darwin E, SarahTonkin-Crine, Gorton C, Paul J, Peto TEA, Yardley L, Hopkins S, Walker AS. The antibiotic course has had its day. BMJ. 2017 Jul 26;358:j3418. doi: 10.1136/bmj.j3418. PubMed PMID: 28747365.
In what will surely evoke tremendous controversy throughout the clinical world, this BMJ paper argues that telling patients to stop taking antibiotics when they feel better is usually preferable to having them finish the entire treatment course, and that this new policy would be expected to lessen antibiotic resistance.
Both patients and medical students have traditionally been told that one must complete courses of antibiotics, as taking too short a course of threatment will allow the offending bacteria to mutate and become drug resistant. The authors of this paper challenge this time-honored orthodoxy, writing that “for common bacterial infections no evidence exists that stopping antibiotic treatment early increases a patient’s risk of resistant infection” and that “patients are put at unnecessary risk from antibiotic resistance when treatment is given for longer than necessary, not when it is stopped early.”
Want to explore the controversy in some detail? After reading the Open Access article itself , follow up with the numerous insightful “rapid responses” comments . One interesting point made in the commentary section concerns the unexpected finding that bacteria at the bottom of a 1,000 foot cave in New Mexico “although isolated from humans and antibiotic drugs for four million years, are resistant to 14 different commercially available antibiotics” .
 Bhullar K, Waglechner N, Pawlowski A, Koteva K, Banks ED, Johnston MD, Barton HA, Wright GD. Antibiotic resistance is prevalent in an isolated cave microbiome. PLoS One. 2012;7(4):e34953. doi: 10.1371/ journal.pone.0034953. Epub 2012 Apr 11. PubMed PMID: 22509370; PubMed Central PMCID: PMC3324550.
Croley JA, Reese V, Wagner Jr. RF. Dermatologic features of classic movie villains. The face of evil. [Published online ahead of print April 5, 2017]. JAMA Dermatol. doi:10.1001/jamadermatol.2016.5979.
This study suggest that evil characters in Hollywood movies have more “dermatological findings” (facial scars etc.) compared to heroic controls.
This was a cross-sectional study comparing the all-time top 10 American film villains with the all-time top 10 American film heroes as obtained from the American Film Institute, The authors found that “the top 10 villains display a significantly higher incidence of dermatologic findings than the top 10 heroes (60% vs 0%), which include alopecia, periorbital hyperpigmentation, deep rhytides on the face, scars on the face, verruca vulgaris on the face, and rhinophyma.”
The authors offer the following cautionary comment: "Rooted richly in culture, art, and early film history, these dermatologic findings are used primarily to elucidate the dichotomy of good and evil through visual representation and may foster a tendency toward prejudice in our society directed at those with skin disease."
There can be little doubt that supplying clean water to populations experiencing water shortages is a vital public health imperative. Imagine then, a household appliance that extracts all the water a family needs out of thin air, using only solar power.
This article describes the design and testing of a device utilizing a porous metal-organic framework (MOF) that captures water from the atmosphere using only heat from sunlight. The authors’ prototype device was able to extract over 2 liters of water from ambient air over a 12 hour period using one kilogram of a MOF. Additionally, the system operates under conditions as low as 20-30 percent relative humidity, a moisture level common in desert areas.
This is a truly remarkable innovation that could save innumerable lives, especially when droughts develop in remote or desert areas. Read more here and here.
Yesterday I gave a short talk on Respiratory Monitoring at The 1st NYU Biomedical and Biosystems Conference, April 9-11, 2017, NYUAD, Abu Dhabi, UAE. Here are the slides for the talk in PDF format.
New Methods of Respiratory Monitoring: Embracing Technical and Clinical Challenges
The need for simple and reliable means of respiratory monitoring has existed since the time of Hippocrates. This need has become especially strong in recent years with the increased use of opioids such as morphine or fentanyl for acute pain management, as these drugs depress respiration. Despite this important need, no simple and reliable method of continuous respiratory monitoring has come into wide-spread clinical use. In this presentation, I describe the potential of advanced acoustic analysis of breath sounds as one means to meet this need, as well as review the technical and clinical challenges associated with classical methods of respiratory monitoring (capnography, pulse oximetry, arterial blood gas analysis, spirometry, thermistor-based methods, methods based on photoplethysmography, and methods based on electrical impedance). As an example of a novel method of respiratory sound analysis I show how color spectrographic analysis of breath sounds recorded from the external ear canal might serve as a simple, reliable and inexpensive candidate solution to the respiratory monitoring problem. I hypothesize that the real-time display of color spectrogram breathing patterns locally or at a central monitoring station may turn out to be a useful means of respiratory monitoring in patients at increased risk of respiratory depression.
Manuchehrabadi N, Gao Z, Zhang J, Ring HL, Shao Q, Liu F, McDermott M, Fok A, Rabin Y, Brockbank KG, Garwood M, Haynes CL, Bischof JC. Improved tissue cryopreservation using inductive heating of magnetic nanoparticles. Sci Transl Med. 2017 Mar 1;9(379). pii: eaah4586. doi: 10.1126/scitranslmed.aah4586. PubMed PMID: 28251904.
Cryopreservation has been around for ages, but while it is effective for very small tissue samples such as sperm and ova, scientists have mostly come up dry in attempting cryopreservation of entire organs. The problem is that unless rewarming occurs exactly right, ice crystals destroy everything. One part of “exactly right” is that the rewarming must be uniform, with the avoidance of “hot spots.” In the present study, the authors infused tissue test samples of porcine heart valves and carotid blood vessels with a cryoprotectant (VS55) mixed with silicon-coated iron oxide nanoparticles and cooled everything with liquid nitrogen. To achieve uniform thawing, the tissue was subsequently placed inside a special electromagnetic coil producing an alternating magnetic field that heated up the tissue rapidly and uniformly as a result of the electromagnetic effect (“eddy current heating”) on the nanoparticles. After thawing and a nanoparticle washout process, studies of the thawed tissue showed no signs of damage. Noted the authors: “The nanowarmed artery smooth muscle cells in the media showed well-defined normal nuclear morphology and structure. In contrast, the [control sample] slowly warmed devitrified tissues appeared disrupted, presumably by ice crystals, with shrunken nuclei and condensed chromatin, presumably due to osmotic dehydration during extracellular ice formation.”
While the implications of this development for organ transplantation are obviously significant, the authors emphasize that much more work needs to be done before the procedure becomes part of routine transplant protocols, noting that in future studies nanowarming might “be applied to larger tissues and organs up to volumes of 1 liter and possibly beyond” but that “these larger volumes will require introduction of the nanoparticles directly into the tissue by perfusion to distribute the heat generation sufficiently."
Imagine being completely unable to move - or even breathe on your own - but being completely awake. This is the horrifying experience some patients undergo when anesthesia for surgery goes horribly wrong. But occasionally, very occasionally indeed, this is done deliberately to advance scientific knowledge. Two decades ago I participated in such an experiment. Read on.
Perioperative fluid therapy remains controversial. The emphasis is now on less fluids and more generous use of pressors. I spoke on this topic in the context of enhanced recovery after surgery (ERAS) at the Second Pan Arab ERAS meeting in Cairo on February 25, 2017. My PowerPoint slides may be downloaded here. Use as you wish.
Transhumanism is a relatively recent intellectual and cultural movement that promotes an interdisciplinary approach to understanding and evaluating potential means for enhancing the human organism, the human race and the human condition. Expressed in broad strokes, transhumanism seeks to produce “posthumans” who will variously live longer, be smarter, be stronger, be more peace-loving, or otherwise constitute an improvement over regular humanity in some nontrivial manner. It aims to achieve its goals primarily through technological innovation in fields such as genetic engineering, neuropharmacology, computer technology, artificial intelligence, and molecular nanotechnology. Some of the less mainstream transhumanist themes include efforts to develop conscious, self-aware computers, efforts to reanimate individuals deemed to be dead by ordinary clinical criteria, and even altering humans with a view to facilitating space colonization.
Transhumanist issues have been the subject of a considerable number of books; I have listed many of these in a short bibliography. While the list is not exhaustive, it is highly representative of the transhumanist literature. The list is presented in order of publication date and includes both works aimed at the intelligent layman as well as works aimed at the professional academic philosopher. Note that this list is not offered as a kind of hermeneutic key or guide to the field but rather merely provided to acquaint the reader with some of the more readable accounts. In each case in this list I have tried to summarize the key message of the book in one or two sentences.