Ryan White Act Treatment Extension Act Signed by President Obama

This was from the EMS1 online newsletter.

WASHINGTON — Responders will again have the right to be notified of possible HIV or other life-threatening illness exposure following the approval of the Ryan White Act Treatment Extension Act by President Obama on Friday. The bill, which was passed by Congress last month, includes a provision requiring hospitals to alert EMS workers within 48 hours of exposure to infectious diseases. In addition, the bill allows responders to request a determination as to whether or not a particular patient has an infectious disease.The updated law provides new protections not found in the previous version. When the bill was revised in 2006, mandates requiring the notification of responder health hazards by hospitals were eliminated. EMS and public safety professionals and advocates have since been working to reinstate the notification requirements. While many EMS personnel consider the updates an improvement to previous protocol, the bill holds that the HHS secretary can waive the notification requirement in the case of a federally-declared public emergency.

Decrease in Smoking

The prevalence of smoking in the U.S. has decreased to 20.8% in 2006 from a high of 42% in 1965. [4] Nonetheless, tobacco use is still the most common cause of preventable death and disease in the U.S., accounting for approximately 438,000 premature deaths, 5.5 million years potential life lost and $92 billion in productivity losses annually. [1] [4] Smoking reduces the median survival of smokers on average by 10 years, and beyond the age of 40 each additional year of smoking reduces life expectancy by 3 months. [5] Globally, smoking prevalence is rising in the developing countries, and it is estimated that in the 21st century there will be 1 billion deaths due to tobacco use worldwide unless these trends are reversed. [6] By quitting cigarette smoking, a patient reduces the risk of lung cancer and other diseases by 20% to 90%, and improves survival even among those who quit over the age of 50. [5] Image 2 image Nonetheless, habitual smokers find it extremely difficult to successfully stop smoking. Although 70% of smokers would like to quit, and 40% make at least 1 quit attempt per year, only 3% to 4% of smokers per year are successful in quitting long term on their own. [7]

Significant survival benefit of smoking cessation.2
Adapted from Fiore MC, Jaen CR, Baker TB, et al. Treating Tobacco Use and Dependence: 2008 Update. Clinical Practice Guideline. Rockville, MD: U.S. Department of Health and Human Services. Public Health Service; May 2008.
Referenced Articles

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Centers for Disease Control and Prevention (CDC). Cigarette smoking among adults--United States, 2006. MMWR Morb Mortal Wkly Rep. 2007;56:1157-1161.[Abstract] http://www.ncbi.nlm.nih.gov/pubmed/17989644 [Full Text] http://www.cdc.gov/mmwr/preview/mmwrhtml/mm5644a2.htm

1
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Mokdad A, Marks J, Stroup D, et al. Actual causes of death in the United States, 2000. JAMA. 2004;291:1238-1245. [Abstract] http://www.ncbi.nlm.nih.gov/pubmed/15010446

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Doll R, Peto R, Boreham J, et al. Mortality in relation to smoking: 50 years' observations on male British doctors. BMJ. 2004;328:1519.[Abstract] http://www.ncbi.nlm.nih.gov/pubmed/15213107 [Full Text] http://www.bmj.com/cgi/content/full/328/7455/1519

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Peto R, Lopez AD. The future worldwide health effects of current smoking patterns. In: Koop CE, Pearson CE, Schwarz MR, eds. Critical issues in global health. New York, NY: Jossey-Bass; 2001.

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Messer K, Pierce J, Zhu S-H, et al. The California Tobacco Control Program's effect on adult smokers: (1) Smoking cessation. Tob Control. 2007;16:85-90.[Abstract] http://www.ncbi.nlm.nih.gov/pubmed/17400944 [Full Text] http://tobaccocontrol.bmj.com/cgi/content/full/16/2/85

QOD 11 3 09

QOD 11 3 09

Which one of the following therapies is generally recommended for the treatment of severe norovirus gastroenteritis?
		A.	Interferon.
		B.	Parenteral hyperimmune human immune globulin.
		C.	Rehydration with intravenous fluids alone.
		D.	Ribavirin. The treatment for norovirus gastroenteritis, like that for other diarrheal illnesses, is oral rehydration with fluids and electrolytes, if the patient is alert and able to drink, or with intravenous fluids, if vomiting and dehydration are severe. Antimotility and antisecretory agents can be useful in adults to decrease diarrhea in situations in which a person's performance is critical. Although no antiviral agents have yet been developed, the x-ray crystallographic structures of the viral polymerase and proteases are known, as is the binding site of histo-blood group antigens in particles, and these provide potential targets for the development of drugs. Interferons and ribavirin effectively inhibit replication of Norwalk virus in replicon-bearing cells, and their potential therapeutic value needs to be further evaluated. Among patients receiving immunosuppressive therapy, recognition of norovirus infection could optimize case management with respect to long-term therapy for the primary disease. Administration of hyperimmune human immune globulin parenterally or orally has been suggested, but this therapy has never been studied in a clinical trial. Answer: C

Treating Resistant Hypertension: Cut Out the Salt

Treating Resistant Hypertension: Cut Out the Salt

Treating Resistant Hypertension: Cut Out the Salt

In a small randomized crossover study, a low-salt diet had dramatic effects on blood pressure.

Patients with resistant hypertension — elevated blood pressure that persists despite the use of three or more antihypertensive agents — are frequently encountered in clinical practice. To examine the role of salt sensitivity in resistant hypertension, investigators conducted a randomized crossover evaluation of two 7-day diets, one low-sodium (50 mmol/day) and one high-sodium (250 mmol/day), separated by a 2-week washout period. Twelve adults (mean age, 56; 8 women; 6 black patients) completed the study. At baseline, participants were taking an average of 3.4 antihypertensive medications, and the mean office blood pressure was 145.8/83.9 mm Hg. All participants continued taking their medications during the study.

Mean urinary sodium excretion during the low-salt diet was significantly lower than during the high-salt diet, indicating adherence to the dietary salt intake regimen. Compared with the high-salt diet, mean office systolic and diastolic blood pressures were lower by 22.7 mm Hg and 9.1 mm Hg, respectively, during the low-salt diet. After adjustment for multiple testing, the between-diet differences in office systolic blood pressure and in all 24-hour ambulatory blood pressure measurements remained significant.

Comment: According to this small study, excessive dietary sodium intake is an important contributor to resistant hypertension. We are well reminded that ensuring a reduction in sodium ingestion is a crucial component in the care of hypertensive patients.

— Joel M. Gore, MD

Published in Journal Watch Cardiology September 23, 2009

Citation:
Pimenta E et al. Effects of dietary sodium reduction on blood pressure in subjects with resistant hypertension: Results from a randomized trial. Hypertension 2009 Sep; 54:475. [Medline® Abstract] [Free full-text article pdf]

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