{"id":4873,"date":"2014-01-02T17:56:17","date_gmt":"2014-01-02T22:56:17","guid":{"rendered":"http:\/\/blogs.nejm.org\/?p=4873"},"modified":"2015-06-04T14:32:40","modified_gmt":"2015-06-04T18:32:40","slug":"a-new-years-snowstorm-id-link-o-rama","status":"publish","type":"post","link":"https:\/\/blogs.nejm.org\/hiv-id-observations\/index.php\/a-new-years-snowstorm-id-link-o-rama\/2014\/01\/02\/","title":{"rendered":"A New Year&#8217;s Snowstorm ID Link-o-Rama"},"content":{"rendered":"<p><a href=\"http:\/\/blogs.nejm.org\/hiv-id-observations\/wp-content\/uploads\/sites\/2\/2014\/01\/big-2014-storm1.png\"><img loading=\"lazy\" decoding=\"async\" class=\"alignright  wp-image-4892\" alt=\"big 2014 storm\" src=\"http:\/\/blogs.nejm.org\/hiv-id-observations\/wp-content\/uploads\/sites\/2\/2014\/01\/big-2014-storm1.png\" width=\"358\" height=\"202\" \/><\/a>Some ID\/HIV items jangling around in the inbox, just dying to get out, before they are covered in snow:<\/p>\n<ul>\n<li><span style=\"line-height: 13px\">Interesting, balanced piece in the <em>New York Times<\/em> about the<strong> <a href=\"http:\/\/www.nytimes.com\/2013\/12\/31\/health\/a-resisted-pill-to-prevent-hiv.html?ref=health\" target=\"_blank\">slow uptake for PrEP<\/a>,<\/strong> in particular among gay men. This caught my eye: &#8220;Certainly, fewer people have tried PrEP than many experts had anticipated.&#8221; I wonder who those experts were? Seems this always was going to be a relatively niche intervention.<\/span><\/li>\n<li>Fascinating editorial in the latest <em>New England Journal of Medicine<\/em> about <strong><a href=\"http:\/\/www.nejm.org\/doi\/full\/10.1056\/NEJMp1311479\" target=\"_blank\">preserving antibiotics<\/a><\/strong>, which includes this amazing statistic: \u00a0Almost 80% of antibiotic use in the United States is for livestock. And here&#8217;s a <strong><a href=\"http:\/\/www.nejm.org\/action\/showImage?doi=10.1056%2FNEJMp1311479&amp;iid=f01\" target=\"_blank\">great slide<\/a><\/strong> for your next talk on antibiotic resistance. Don&#8217;t those cows worry about upsetting their microbiome?<\/li>\n<li>Speaking of antibiotic resistance, I neglected to highlight this extraordinary CDC report on <strong><a href=\"http:\/\/www.cdc.gov\/drugresistance\/threat-report-2013\/index.html\" target=\"_blank\">Antibiotic Resistant Threats<\/a> <\/strong>when it first came out this year. The top three, with threat levels of &#8220;Urgent,&#8221; are <em>C. difficile<\/em>, Carbapenem-resistant Enterobacteriaceae (look at<strong> <a href=\"http:\/\/news.yahoo.com\/one-graphic-shows-why-nightmare-172213831.html\" target=\"_blank\">this chilling map<\/a><\/strong>), and Drug-resistant\u00a0<em>Neisseria gonorrhoeae.<\/em>\u00a0Sounds about right &#8212; but I&#8217;d have substituted MRSA for the last one &#8212; way greater clinical impact.\u00a0MRSA&#8217;s threat level, by the way, is listed as &#8220;Serious.&#8221;<\/li>\n<li>Is some chronic low back pain caused by bacterial infection? According to <strong><a href=\"http:\/\/www.ncbi.nlm.nih.gov\/pubmed\/23397187\" target=\"_blank\">this paper<\/a><\/strong>, and this<strong> <a href=\"http:\/\/www.ncbi.nlm.nih.gov\/pubmed\/23404353\" target=\"_blank\">randomized trial of amox-clav<\/a>,<\/strong> the answer is clearly yes! <strong><a href=\"http:\/\/www.ncbi.nlm.nih.gov\/pmc\/articles\/PMC3841939\/\" target=\"_blank\">An editorial<\/a> <\/strong>rightly describes the implications of these studies for spine surgeons and pain specialists &#8212; never mind patients &#8212; as &#8220;momentous.&#8221; Yes, these are the winners of The Most Surprising Studies in ID, 2013.\u00a0Confirmation of these findings by other investigators eagerly awaited. (What an understatement.)<\/li>\n<li>These<strong> <a href=\"http:\/\/www.cdc.gov\/mmwr\/preview\/mmwrhtml\/mm6249a1.htm\" target=\"_blank\">three deaths from Lyme carditis<\/a><\/strong> are most worrisome &#8212; the patients were really young (26\u201338 years old), and though two of three had some pre-existing cardiac disease, they were overall pretty healthy. Fortunately, a review of 20,000 pathology specimens at a tissue bank did not find any additional cases, suggesting that Lyme carditis as a cause of death is rare indeed. Still, wouldn&#8217;t it be great if the Lyme vaccine for humans were available again?<\/li>\n<li>As more HIV drugs become generic, this should mean <strong><a href=\"http:\/\/annals.org\/article.aspx?articleid=1556848\" target=\"_blank\">cost-savings<\/a><\/strong>, right? Not always, according to this <strong><a href=\"http:\/\/www.pbs.org\/newshour\/bb\/health\/july-dec13\/generics_12-23.html\" target=\"_blank\">remarkable (and disheartening) report<\/a>.<\/strong> Lesson: If you don&#8217;t like the price of a generic drug, it pays to <strong><a href=\"http:\/\/www.goodrx.com\/\" target=\"_blank\">shop around for the best price<\/a><\/strong>. And if you live near a Costco Pharmacy, give them a try, even if you&#8217;re not a member &#8212; their pharmacies are available to all, with <strong><a href=\"http:\/\/money.msn.com\/now\/post.aspx?post=4e8c9546-bba6-49f1-a000-5d8281117c36\" target=\"_blank\">consistently low prices<\/a>.<\/strong><\/li>\n<li><strong>SPOILER ALERT &#8212; <\/strong>if you haven&#8217;t seen the movie <strong><em><a href=\"http:\/\/www.metacritic.com\/movie\/philomena\" target=\"_blank\">Philomena<\/a>, <\/em><\/strong>just skip to the trailer below and read no further. But if you&#8217;re on the fence, you must see it, since it could have been the best film of 2013 &#8212; entertaining, well-acted, funny, heartbreaking. Just great. I cite it here on this site because one major plot turn occurs when the main character&#8217;s long-lost son is found to have died of AIDS &#8212; and though she is naturally very sad, her response was completely non-judgmental in a very non-Hollywood way. I was expecting the typical moral outrage, and was pleasantly surprised that it never came.<\/li>\n<\/ul>\n<p>Stay warm, everyone, and Happy New Year!<\/p>\n<p><center><iframe loading=\"lazy\" src=\"\/\/www.youtube.com\/embed\/4DBPqcp6Hc4\" height=\"315\" width=\"560\" allowfullscreen=\"\" frameborder=\"0\"><\/iframe><\/center><\/p>\n","protected":false},"excerpt":{"rendered":"<p>Some ID\/HIV items jangling around in the inbox, just dying to get out, before they are covered in snow: Interesting, balanced piece in the New York Times about the slow uptake for PrEP, in particular among gay men. This caught my eye: &#8220;Certainly, fewer people have tried PrEP than many experts had anticipated.&#8221; I wonder [&hellip;]<\/p>\n","protected":false},"author":6,"featured_media":0,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"footnotes":""},"categories":[5,8,10],"tags":[69,423,565,576,577],"class_list":["post-4873","post","type-post","status-publish","format-standard","hentry","category-infectious-diseases","category-patient-care","category-research","tag-antibiotic-resistance","tag-hiv","tag-link-o-rama","tag-lyme-carditis","tag-lyme-disease"],"post_mailing_queue_ids":[],"_links":{"self":[{"href":"https:\/\/blogs.nejm.org\/hiv-id-observations\/index.php\/wp-json\/wp\/v2\/posts\/4873","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/blogs.nejm.org\/hiv-id-observations\/index.php\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/blogs.nejm.org\/hiv-id-observations\/index.php\/wp-json\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/blogs.nejm.org\/hiv-id-observations\/index.php\/wp-json\/wp\/v2\/users\/6"}],"replies":[{"embeddable":true,"href":"https:\/\/blogs.nejm.org\/hiv-id-observations\/index.php\/wp-json\/wp\/v2\/comments?post=4873"}],"version-history":[{"count":0,"href":"https:\/\/blogs.nejm.org\/hiv-id-observations\/index.php\/wp-json\/wp\/v2\/posts\/4873\/revisions"}],"wp:attachment":[{"href":"https:\/\/blogs.nejm.org\/hiv-id-observations\/index.php\/wp-json\/wp\/v2\/media?parent=4873"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/blogs.nejm.org\/hiv-id-observations\/index.php\/wp-json\/wp\/v2\/categories?post=4873"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/blogs.nejm.org\/hiv-id-observations\/index.php\/wp-json\/wp\/v2\/tags?post=4873"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}