New NICE guidelines on antibiotic prescribing for pneumonia

National Institute for Health and Care Excellence (NICE) and Public Health England (PHE) have published draft guidance on antimicrobial prescribing for hospital-acquired and community-acquired pneumonia.

1. Antibiotics should be given to people with community- and hospital-acquired pneumonia within four hours of establishing a diagnosis.

2. Treatment should be reviewed after five days, and stopping the antibiotic if the person is clinically stable.​​​​​​​

3. In community‑acquired infections, new recommendations say that antibiotics should be stopped after five days unless the person is not clinically stable.

4. In patients where there is a suspected case of pneumonia, it’s important that they are given the antibiotics they need as soon as possible. Microbiological testing helps determine what antibiotic will be most effective and helps limit antimicrobial resistance.

5. Shorter courses of antibiotics should be prescribed where appropriate to limit the risk of antimicrobial resistance.

If you have disrupted sleep, you can end up with heart blockages

In an NIH mice study researcher have discovered a mechanism between the brain, bone marrow, and blood vessels that protect against atherosclerosis when sleep is healthy and sound. The study will appear in the journal Nature.

The study has zeroed down a brain hormone, hypocretin, that controls production of inflammatory cells in the bone marrow in a way that helps protect the blood vessels from damage. This anti-inflammatory mechanism is regulated by sleep, and it breaks down when you frequently disrupt sleep or experience poor sleep quality.

The researchers focused on a group of mice that were genetically engineered to develop atherosclerosis. They disrupted the sleep patterns of half the mice and allowed the other half to sleep normally. Over time, the sleep-disrupted mice developed arterial plaques, or fatty deposits, that were up to one-third larger than the mice with normal sleep patterns.

The sleep-disrupted mice also produced twice the level of certain inflammatory cells in their circulatory system than the control mice — and also lower amounts of a hypocretin, a hormone made by the brain that is thought to play a key role in regulating sleep and wake states.

Sleep-deficient, atherosclerotic mice that received hypocretin supplementation tended to produce fewer inflammatory cells and develop smaller atherosclerotic lesions when compared to mice that did not get the supplementation.

Hypocretin loss during disrupted sleep contributes to inflammation and atherosclerosis.

Heavy Use of CT Raises Concerns About Radiation Exposure

(Keep your radiation account)

The use of radiation-based imaging is rising.  Most critically-ill patients are subjected to many CT scans and x-rays. In many ICUS one may exceeded 100 millisieverts within a week of admission, a limit otherwise should not exceed in five years.

Abdominal CTs are one of the highest radiation risk tests and should not be repeated unless a must. It contains 10 millisieverts (mSv) of radiation, the rough equivalent of 200 chest X-rays or 1,500 dental X-rays.

Incidentalomas, are found unexpectedly, include benign lung and thyroid nodules etc that can lead to unnecessary and expensive workups.

X-rays, PET scans and CT scans use ionizing radiation, which can damage DNA and cause cancer. MRI scans and ultrasound, do not use radiation.

The National Cancer Institute estimates that the additional risk of developing a fatal cancer from a scan is 1 in 2,000, while the lifetime risk of dying of cancer is 1 in 5.

Studies published in 2007 and 2009 by teams from Columbia University and the NCI predicted that up to 2 percent of future cancers might be caused by CT scans.

A 2011 report by the Institute of Medicine found that the two environmental factors most strongly associated with breast cancer were radiation exposure and the use of post-menopausal hormones.

A 2009 study by researchers at Brigham and Women’s Hospital in Boston found that among 31,000 patients who had a diagnostic CT scan in 2007, 33 percent had more than five during their lifetime, 5 percent received 22 or more, and 1 percent underwent more than 38 scans.

Some doctors perform double scans — one with a contrast agent and a second without it.

Others sometimes refuse to accept or are unable to access radiology studies done elsewhere and send patients for duplicate tests.

Doctors who have a financial interest in radiology clinics or who own scanners use imaging substantially more often than those who don’t.

And increasingly, specialists are requiring that patients get a scan before they first see a patient.

The effective doses from diagnostic CTs are “not much less than the lowest doses of 5 to 20 mSv received by some of the Japanese survivors of the atomic bombs” dropped over Hiroshima and Nagasaki in 1945.

Radiation exposure is cumulative, and children, who undergo between 5 million and 9 million CT scans annually, are much more vulnerable to its effects.