Per request… passing along the link.

According to CNN, it looks like the H1N1 vaccine is almost here!  Yippee!  Seriously though, I have seen personally a sharp rise in flu admissions to the hospitals I work for and find it quite scary my current patient is a lady in her second trimester with possible H1N1.  It’s not that I am personally scared of H1N1.  I’ve personally never had the flu, I don’t believe… there’s one time where I may have had the flu but it’s sketchy.  College life, you know.

But, the very young and the very old at risk.  Seems to me the obese have a worse case as well.

Here’s a chart that I’ve been following to follow outbreaks.  I hope you find it useful.

Milk of amnesia, propofol, diprivan, whatever you want to label it, diprivan has always been a medication that I put in the category of a medication that definitely needs hospital or long-term care support when administrating. Now because of the latest error a physician made in the case of Michael Jackson, the drug is propelled into the spotlight.

Just recently:

Propofol: Limited Recall Due to Elevated Endotoxin Levels − July 2009

Teva Pharmaceuticals USA has announced a voluntary recall of certain lots of propofol injectable emulsion 10 mg/mL 100 mL vials. The lots identified are being recalled due to elevated endotoxin levels in some of the vials. Teva has received reports of 41 propofol treated patients experiencing postoperative fever, chills, and other flu-like symptoms; most cases reported appeared to be self-limiting. Possible adverse effects associated with elevated endotoxin exposure include fever, chills, and rigors. High endotoxin level exposure may be associated with more serious adverse effects including disseminated intravascular coagulopathy, acute respiratory distress syndrome, and death.

But, that only included certain lots. Sounds scary, huh?

High alert medication: The Institute for Safe Medication Practices (ISMP) includes this medication among its list of drugs which have a heightened risk of causing significant patient harm when used in error.

Um, no brainer. It’s a medication that is an intravenous infusion and has several pharmacological purposes includng induction of anesthesia in patients ≥3 years of age; maintenance of anesthesia in patients >2 months of age; in adults, for monitored anesthesia care sedation during procedures; sedation in intubated, mechanically-ventilated ICU patients.

And straight from the books:

Concerns related to adverse effects:

• Anaphylaxis/hypersensitivity reactions: May rarely cause hypersensitivity, anaphylaxis, anaphylactoid reactions, angioedema, bronchospasm, and erythema; medications for the treatment of hypersensitivity reactions should be available for immediate use.

• Hypertriglyceridemia: Because propofol is formulated within a 10% fat emulsion, hypertriglyceridemia is an expected side effect. Patients who develop hypertriglyceridemia (eg, >500 mg/dL) are at risk of developing pancreatitis. Serum triglyceride levels should be obtained prior to initiation of therapy and every 3-7 days thereafter. Monitoring of serum triglycerides should especially be considered with therapy >48 hours with doses exceeding 50 mcg/kg/minute (Devlin, 2005). An alternative sedative agent should be employed if significant hypertriglyceridemia occurs. Use with caution in patients with preexisting hyperlipidemia as evidenced by increased serum triglyceride levels or serum turbidity.

• Hypotension: The major cardiovascular effect of propofol is hypotension especially if patient is hypovolemic or if bolus dosing is used. Hypotension may be substantial with a reduction in mean arterial pressure occasionally exceeding 30%. Use with caution in patients who are hemodynamically unstable, hypovolemic, or have abnormally low vascular tone (eg, sepsis).

• Injection-site reaction: Transient local pain may occur during I.V. injection; lidocaine 1% solution may be administered prior to administration or may be added to propofol immediately prior to administration to reduce pain associated with injection (see Administration).

• Myoclonus: Perioperative myoclonus (eg, convulsions and opisthotonos) has occurred with administration.

• Propofol-related infusion syndrome (PRIS): PRIS is a serious side effect with a high mortality rate characterized by dysrhythmia (eg, bradycardia or tachycardia), heart failure, hyperkalemia, lipemia, metabolic acidosis, and/or rhabdomyolysis or myoglobinuria with subsequent renal failure. Risk factors include poor oxygen delivery, sepsis, serious cerebral injury, and the administration of high doses of propofol (usually doses >83 mcg/kg/minute or >5 mg/kg/hour for >48 hours), but has also been reported following large dose, short-term infusions during surgical anesthesia. The onset of the syndrome is rapid, occurring within 4 days of initiation. The mechanism of the syndrome has yet to be determined. Alternate sedative therapy should be considered for patients with escalating doses of vasopressors or inotropes, when cardiac failure occurs during high-dose propofol infusion, when metabolic acidosis is observed, or in whom lengthy and/or high-dose sedation is needed (Jacobi, 2002; Corbett, 2008).

Sound familiar???

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Just as we all suspected… and knew.

If the plain Atkins diet weren’t disgusting enough with what I call a greasy tongue from all the butter, meats, fats, etc… now there is something called a vegetarian version that lowers heart risks. Can you think of any other diet you’d rather do? (Pun intended)

A small, month-long study of the so-called Eco-Atkins diet, which stresses plant proteins, worked better than a high-carb diet at reducing levels of low-density lipoprotein or LDL, which raises the risks of heart attacks and strokes.

…though the media has dropped the story from their front page headlines. Perhaps there weren’t enough people dying from it as originally was feared, but having the flu in the summer (for Americans now) is very strange!

There are 25,288 confirmed cases worldwide, according to the World Health Organization’s latest briefing Monday, with 73 countries having at least one case. There have been 139 deaths confirmed caused by Swine Flu worldwide, according to the WHO. Mexico, where the illness is believed to have originated, has 5,717 cases and 106 deaths, according to the WHO.

The U.S. has the most cases, with 13,217 confirmed and probable — up from just more than 10,000 last week. There are cases now in all 50 states plus Washington, D.C., as of 11 a.m. Monday, according to the Federal Centers for Disease Control and Prevention. There have been 27 confirmed deaths in the U.S., with three in Texas, five in Illinois, four in Arizona, two in Utah, eight in New York and one in Connecticut, Missouri, Michigan, Virginia and Washington.

If you are tempted to delay any vaccinations for your children, it’s critical that you educate yourself about the diseases those vaccinations are intended to prevent. As an increasing number of parents are delaying or forgoing certain vaccinations, it’s no longer possible to simply assume these diseases will remain so rare that they are not a threat. Exit herd immunity.

Find out about the diseases themselves…. tetanus not spread person to person but spores in dirt as a source. Mumps can cause issues with males later on.

Oh, sorry… I meant to say H1N1.  I wouldn’t want the farmers to have to slaughter their swine since people aren’t eating swine with the thoughts of pigs passing this disease to us.

Stop the presses.  You mean farmers are killing pigs because of the Swine Flu?

And you are upset?

Aren’t the pigs going to get slaughtered anyway?  *sigh*

Here we are in the middle of a mild case of the flu hitting the US in the spring.  Glad it didn’t hit in the fall.

Underlying conditions like asthma, diabetes, heart disease or tuberculosis appear to put swine flu victims at greater risk of hospitalization or death, doctors from the World Health Organization and the Centers for Disease Control and Prevention said Friday.

** so does the regular flu **

Swine flu tally reaches 3,440 in 29 countries: from the World Health Organization.

There is a big debate online in certain mother forums about circumcision and “why would you want to operate on something that God created?” along with big icons “NO CIRC” and references to mutilation when it comes to the practice in the US. It’s amazing to me that mothers become so heated in discussing something already proven to reduce the incidence of HIV infection in men and now, according to the New York Times, reduces the transmission of both herpes simplex virus Type 2 and human papilloma virus. The study was a randomized clinical trial published in The New England Journal of Medicine assigned more than 3,000 uncircumcised Ugandan men who were not infected with HSV-2 to undergo immediate circumcision or to be circumcised 24 months from the start of the investigation. A subgroup was similarly evaluated for HPV infection. The study showed a 25% reduced risk of infection. Of course, the results don’t apply to their partners. For the types of HPV that cause genital cancer, the results were about 18 percent of circumcised men were infected at the end of two years, compared with almost 28 percent in the control group making a 35 percent reduced risk of infection.

Unfortunately, when you are in the hospital or at home with a midwife giving birth to a baby boy, the full information isn’t given to the parents (the ones making the decision) concerning the benefits or risks in either. In fact, in the US, the rates of circumcision are declining, especially among black and Hispanic patients, the same groups with high rates of HIV, herpes infection, and cervical cancer. Sixteen states don’t allow Medicaid to pay for routine circumcision.

FDA notified healthcare professionals that a boxed warning had to be added to drug labels about the risk of long-term or high-dose use of metoclopramide (reglan) and the possibility of tardive dyskinesia.    There is no reversal of tardive dyskinesia and no treatment available.

What is tardive dyskinesia?