Wednesday, December 23, 2015

Lives matter?

BBC has a story of a "Christmas miracle", of a child who lived after her life support was turned off.

then we have the Texas man who kept them from turning off the life support for his "brain dead" son, by holding them off with a gun.

He was drunk, so ended up in jail and not shot by the SWAT team who negotiated hoping he'd sober up, but the really strange part of the story is that his son lived.

then there is the Jahi McMath case... and if you don't think minority patients will start getting suspicious, you are naive.

We had one of our nursing home patients who was alert but with frontal lobe brain damage. She couldn't swallow very well, so had a feeding tube. But frontal lobe damabe meant she cried with tears as if sad when she saw her family, and she could be quite loud. So we sent her to a neurologist to see if there was a medicine that could help her without sedating her.

The neurologist didn't examine her, but spent the whole time advising the family to remove the feeding tube.

The parents and siblings, traditional Indians, kept their silence, but on leaving, the cousin, an LPN who had accompanied her to the doc, turned and told him off saying: That's the difference between you white people and us: We care for our sick and elderly.

Wednesday, December 9, 2015

E Coli and Shigella: Fly, fingers, feces germs

Article on toxic EColi at Chipote restaurants.

If it is from fresh salads, then why not start nuking the lettuce?

 This article is from the wapo 2008:

Food producers can now use radiation to kill bacteria on fresh spinach and iceberg lettuce because of a new Food and Drug Administration ruling meant to help head off outbreaks of foodborne illness.
 This is the first time the agency has allowed produce to be irradiated as a health precaution. Tiny doses of radiation already are used to kill pests on some fruits and vegetables. But the process is most often used on meat -- especially E. coli susceptible ground beef -- and some spices.
The food is exposed to just enough radiation to kill off most, though not necessarily all, harmful germs. For instance, the process won't rid the produce of foodborne viruses.

when we sell our organic salads, we grow the lettuce etc inside greenhouses (to stop bugs) and then clean them off by putting them into a water bath with chlorox type bleach, and then washing them off and air drying them before we make the salad.

And if it is from undercooked meat, then make folks wash hands and counters, and check the meat is cooked properly. Often there is cross contamination from "fresh" meat that dripped on counters and gets onto hands or onto plates or cooked food.


Related item:

Shigella outbreak in Texas schools and daycares.

again, local health officials are checking hand washing and washing down the place with chlorox.

But since kids are not tidy, they might be spreading it to families.

Ordinarily I would blame the failure to screen food workers for being carriers, or blame the failure of checking that hands are properly washed.

But the epidemic is in so many places one wonders if food is the source.

And pet turtles have caused epidemics in the past.

the bad news: Usually you don't treat with antibiotics since the disease clears itself and giving antibiotics only increases the chance of resistant germs

But the disease is now becoming resistant to common antibiotics.

a lot of cases are imported but then spread. CDC report here 

they also add:
Shigella causes an estimated 500,000 cases of diarrhea in the United States annually (1) and is transmitted easily from person to person and through contaminated food and recreational water. Outbreaks of shigellosis frequently are large and protracted. Although diarrhea caused by S. sonnei typically resolves without treatment, patients with mild illness often are treated with antimicrobial medications because they can reduce the duration of symptoms and shedding of shigellae in feces (2)

Reserving antimicrobial treatment for immunocompromised patients and patients with severe shigellosis and using antimicrobial susceptibility data strategically to guide therapy might help preserve the utility of such medications. 

an article that summarizes the treatment of diarrhea type illnesses can be found HERE. 

but with all the resistance, the use of "probiotics" and other things are being looked into.

Heh. Lactulose, the artificial sugar used to treat constipation and as a low cal sweetener, has been investigated and seems to help (but not cure) the carrier state. (but doesn't help acute cases).