{"id":8318,"date":"2017-03-05T18:28:16","date_gmt":"2017-03-05T23:28:16","guid":{"rendered":"http:\/\/blogs.nejm.org\/hiv-id-observations\/?p=8318"},"modified":"2017-03-09T12:16:51","modified_gmt":"2017-03-09T17:16:51","slug":"high-dose-flu-vaccine-robert-de-niro-challenge-antibiotics-colds-march-comes-like-lion-id-link-o-rama","status":"publish","type":"post","link":"https:\/\/blogs.nejm.org\/hiv-id-observations\/index.php\/high-dose-flu-vaccine-robert-de-niro-challenge-antibiotics-colds-march-comes-like-lion-id-link-o-rama\/2017\/03\/05\/","title":{"rendered":"High-Dose Flu Vaccine, Robert De Niro Challenge, Antibiotics for Colds, and More:  March Comes in Like a Lion ID Link-o-Rama"},"content":{"rendered":"<p><a href=\"http:\/\/blogs.nejm.org\/hiv-id-observations\/wp-content\/uploads\/sites\/2\/2017\/03\/antibiotics-for-sneezes.jpg\"><img loading=\"lazy\" decoding=\"async\" class=\"alignright wp-image-8319\" src=\"http:\/\/blogs.nejm.org\/hiv-id-observations\/wp-content\/uploads\/sites\/2\/2017\/03\/antibiotics-for-sneezes.jpg\" alt=\"\" width=\"257\" height=\"193\" srcset=\"https:\/\/blogs.nejm.org\/hiv-id-observations\/wp-content\/uploads\/sites\/2\/2017\/03\/antibiotics-for-sneezes.jpg 1200w, https:\/\/blogs.nejm.org\/hiv-id-observations\/wp-content\/uploads\/sites\/2\/2017\/03\/antibiotics-for-sneezes-300x225.jpg 300w, https:\/\/blogs.nejm.org\/hiv-id-observations\/wp-content\/uploads\/sites\/2\/2017\/03\/antibiotics-for-sneezes-768x576.jpg 768w, https:\/\/blogs.nejm.org\/hiv-id-observations\/wp-content\/uploads\/sites\/2\/2017\/03\/antibiotics-for-sneezes-1024x768.jpg 1024w\" sizes=\"auto, (max-width: 257px) 100vw, 257px\" \/><\/a>Here are a few ID\/HIV items blowing around the neighborhood on\u00a0this, a bitterly cold and windy first weekend of March (at least here in Boston):<\/p>\n<ul>\n<li><strong><a href=\"https:\/\/academic.oup.com\/jid\/article\/3058746\/Comparative-Effectiveness-of-High-Dose-Versus?searchresult=1\" target=\"_blank\">Compared with the standard dose vaccine, the high-dose flu vaccine reduced deaths among older adults.<\/a><\/strong>\u00a0The benefit was seen in the 2012-13 flu season, but not 2013-14. The authors speculate\u00a0that the circulating strain (H3N2) and low overall effectiveness in 2012-113 explain this discordance. Notably, ACIP still\u00a0<a href=\"https:\/\/www.cdc.gov\/mmwr\/volumes\/65\/rr\/rr6505a1.htm\" target=\"_blank\">does not formally endorse any particular vaccine<\/a> for the elderly, but I&#8217;m becoming a believer in the high-dose strategy.<\/li>\n<li><a href=\"https:\/\/www.nytimes.com\/2017\/02\/24\/well\/family\/my-daughters-silent-virus-congenital-cmv.html?partner=rss&amp;emc=rss&amp;smid=tw-nythealth&amp;smtyp=cur&amp;_r=1\" target=\"_blank\"><strong>A mother recounts her experience raising a child with congenital CMV infection.<\/strong><\/a> This is a skillful and moving description of congenital cytomegalovirus, and the strange obscurity of the virus that\u00a0&#8220;causes more birth defects in the United States than any other nongenetic disease.&#8221;\u00a0That it remains so relatively unknown is a perplexing\u00a0paradox (especially in the Zika era) &#8212; one she artfully explores.<\/li>\n<li><a href=\"https:\/\/www.cdc.gov\/media\/releases\/2017\/s0302-zika-birth-defects.html\" target=\"_blank\"><strong>There&#8217;s an estimated 20-fold increase in certain birth defects in pregnancies with Zika infection.<\/strong><\/a> Approximately 6% of the babies had microcephaly, neural tube defects, eye defects, or\u00a0other central nervous system (CNS) problems. Long term follow-up, of course, may identify additional abnormalities.<\/li>\n<li><strong><a href=\"https:\/\/academic.oup.com\/ofid\/article\/2982006\/Culture-Proven\" target=\"_blank\">Not all infections related to thorn injuries are sporotrichosis.<\/a><\/strong> In fact, the number of sporotrichosis cases in this series of over 1000 patients with thorn injuries was (wait for it) &#8230;\u00a0<em>zero. <\/em>Oh well, guess common things are common.<\/li>\n<li><a href=\"https:\/\/newrepublic.com\/article\/140702\/medical-theory-donald-trumps-bizarre-behavior\" target=\"_blank\"><strong>Does our president have neurosyphilis?<\/strong><\/a>\u00a0Yes, syphilis is the &#8220;great imposter&#8221;. Yes, it sometimes can be difficult to diagnose. Yes it can cause bizarre behavior.\u00a0But good grief, this is an extreme form of medical speculation. For the record, 5 different\u00a0people sent me this link (you know who you are).<\/li>\n<li><strong><a href=\"http:\/\/www.arv-trials.com\/default.asp\" target=\"_blank\">This site catalogues all the major HIV clinical trials.<\/a><\/strong>\u00a0Under the direction of Fran\u00e7ois Raffi, Anton Pozniak, and Pedro Cahn, <a href=\"http:\/\/www.arv-trials.com\/default.asp\" target=\"_blank\">ARV-Trials.com<\/a> is\u00a0helpful source if you can&#8217;t remember the difference between the MERIT, MOTIVATE, MONET, MONOI, MONARK, and MODERN studies. <em>Of course<\/em> you remember all the ACTG study numbers &#8212; but if not, you can find them there too.\u00a0Site is\u00a0also kind of a throwback to 1990s web design, in case\u00a0you&#8217;re feeling nostalgic.<\/li>\n<li><strong><a href=\"http:\/\/www.fiercebiotech.com\/biotech\/delay-to-hep-c-drug-program-behind-merck-s-write-down-decision-say-analysts\" target=\"_blank\">Drug development for hepatitis C is a risky business.<\/a><\/strong>\u00a0Not only that, even established &#8220;blockbusters&#8221; <a href=\"https:\/\/www.thestreet.com\/story\/13994794\/1\/gilead-hepatitis-c-meltdown-raises-troubling-question-is-curing-disease-bad-for-business.html\" target=\"_blank\">face declining sales.<\/a>\u00a0Incentives in our healthcare &#8220;system&#8221; can sometimes be truly perverse &#8212; and boy,\u00a0is <a href=\"http:\/\/www.condenaststore.com\/-sp\/It-s-fine-to-discover-cures-but-remember-chronic-conditions-are-our-br-New-Yorker-Cartoon-Prints_i8546548_.htm\" target=\"_blank\">this cartoon apt.<\/a>\u00a0(And brilliant.)<\/li>\n<li><strong><a href=\"http:\/\/jamanetwork.com\/journals\/jamainternalmedicine\/fullarticle\/2601079?utm_source=twitter&amp;utm_campaign=content-shareicons&amp;utm_content=article_engagement&amp;utm_medium=social&amp;utm_term=021017#.WJ2lNqF4R2Q.twitter\" target=\"_blank\">Vancomycin is better than metronidazole for C diff &#8212; again.<\/a>\u00a0<\/strong>I can&#8217;t think of any reason to use metronidazole for patients\u00a0who actually <em>have<\/em>\u00a0C diff, the real thing. Those who are just PCR positive with minimal symptoms &#8212; which really should be called pseudo-C diff &#8212; usually don&#8217;t\u00a0require any treatment.<\/li>\n<li><a href=\"http:\/\/www.deathandtaxesmag.com\/318670\/rfk-jr-robert-de-niro-offer-100000-to-anyone-who-can-prove-vaccines-safe\/?utm_source=share-tw&amp;utm_medium=button\" target=\"_blank\"><strong>RFK Jr and Robert De Niro offered $100,000 to anyone who can prove vaccines are safe.<\/strong><\/a> Darn, this pediatrician has\u00a0<a href=\"https:\/\/www.washingtonpost.com\/news\/to-your-health\/wp\/2017\/02\/17\/the-evidence-for-vaccine-safety-is-abundant-that-will-be-100000-please\/\" target=\"_blank\">already nabbed the prize.<\/a>\u00a0Guess De Niro has already made <em>Raging Bull<\/em>, now he&#8217;s making <em>Raging Bulls&#8211;t.<\/em><\/li>\n<li><strong><a href=\"http:\/\/blogs.nejm.org\/hiv-id-observations\/wp-content\/uploads\/sites\/2\/2017\/03\/Capsule_Pharmacy_ridiculed_for_marketing_campaign_telling_New_Yorkers_\u2018I_love_you\u2019_on_the_subway___The_Drum.jpg\"><img loading=\"lazy\" decoding=\"async\" class=\"alignright wp-image-8320\" src=\"http:\/\/blogs.nejm.org\/hiv-id-observations\/wp-content\/uploads\/sites\/2\/2017\/03\/Capsule_Pharmacy_ridiculed_for_marketing_campaign_telling_New_Yorkers_\u2018I_love_you\u2019_on_the_subway___The_Drum.jpg\" alt=\"\" width=\"220\" height=\"185\" srcset=\"https:\/\/blogs.nejm.org\/hiv-id-observations\/wp-content\/uploads\/sites\/2\/2017\/03\/Capsule_Pharmacy_ridiculed_for_marketing_campaign_telling_New_Yorkers_\u2018I_love_you\u2019_on_the_subway___The_Drum.jpg 490w, https:\/\/blogs.nejm.org\/hiv-id-observations\/wp-content\/uploads\/sites\/2\/2017\/03\/Capsule_Pharmacy_ridiculed_for_marketing_campaign_telling_New_Yorkers_\u2018I_love_you\u2019_on_the_subway___The_Drum-300x252.jpg 300w\" sizes=\"auto, (max-width: 220px) 100vw, 220px\" \/><\/a><a href=\"https:\/\/www.buzzfeed.com\/caseygueren\/people-are-calling-out-this-pharmacy-ad?utm_term=.gypJJPexqz#.pg8aaEAwBY\" target=\"_blank\">This pharmacy&#8217;s ad campaign on the NYC subway advocates &#8220;very, very strong antibiotics&#8221; since &#8220;someone sneezed.&#8221;<\/a><\/strong>\u00a0News flash: \u00a0Antibiotics don&#8217;t work for colds, no matter how &#8220;strong&#8221; they are. See image at top of this post, <em>proving<\/em> that\u00a0I didn&#8217;t make that\u00a0up. And it looks like another one of their ads\u00a0<a href=\"http:\/\/www.thedrum.com\/news\/2017\/02\/17\/capsule-pharmacy-ridiculed-marketing-campaign-telling-new-yorkers-i-love-you-the\" target=\"_blank\">isn&#8217;t\u00a0too popular right now either.<\/a>\u00a0I love you too, by the way.<\/li>\n<li><a href=\"https:\/\/academic.oup.com\/ofid\/pages\/podcasts\" target=\"_blank\"><strong>Here&#8217;s an interview with Dr. Brad Spellberg on the importance of antibiotic stewardship.<\/strong><\/a> He&#8217;s one of the top figures in this field right now, and is very compelling on the subject. Imagine a world where all antibiotic use in the hospital is restricted to ID approval, analogous to chemotherapy for oncologists. And no, he wouldn&#8217;t like those NYC subway ads either!<\/li>\n<li><a href=\"https:\/\/academic.oup.com\/cid\/article-abstract\/doi\/10.1093\/cid\/cix186\/3057422\/Short-course-adjunctive-gentamicin-as-empirical\" target=\"_blank\"><strong>Short-course empiric gentamicin added to broad spectrum therapy for patients with sepsis did not improve outcomes.<\/strong><\/a> Gentamicin-treated patients did have more acute\u00a0renal injury, even though the median duration of therapy was only 2 days. This\u00a0was once a common practice in our hospital, where one of our residents used to call it\u00a0&#8220;death gent&#8221;, for obvious reasons. Seems now we can all stop doing it!<\/li>\n<li><strong><a href=\"https:\/\/www.fda.gov\/Safety\/Recalls\/ucm544976.htm#recall-photos\" target=\"_blank\">Yes, there&#8217;s an <em>E. coli<\/em>\u00a0O157:H7 outbreak linked to a product called &#8220;I.M. Healthy.&#8221;<\/a>\u00a0<\/strong>It&#8217;s soy nut butter, in case you were wondering. No word on the company&#8217;s web site whether the post-recall I.M. Healthy will be called &#8220;I.M. Now <em>Healthier<\/em>.&#8221;<\/li>\n<li><a href=\"http:\/\/mattiseman.com\/celebrity-apprentice\" target=\"_blank\"><strong>Matt Iseman won <em>Celebrity Apprentice.<\/em><\/strong><\/a> And why, you must be wondering, is that being mentioned in an\u00a0ID blog? Turns out he&#8217;s the son of Mike Iseman, the noted tuberculosis expert. And before he (Matt, not Mike)\u00a0became a comedian, he had another job.<\/li>\n<\/ul>\n<p>Only <a href=\"https:\/\/days.to\/until\/mlb-season-opening-day\" target=\"_blank\">28 days<\/a> until Opening Day!<\/p>\n<p><iframe loading=\"lazy\" title=\"Matt Iseman&#039;s Brief Stint as a Doctor\" width=\"500\" height=\"281\" src=\"https:\/\/www.youtube.com\/embed\/g47pNLIKiKc?feature=oembed\" frameborder=\"0\" allow=\"accelerometer; autoplay; clipboard-write; encrypted-media; gyroscope; picture-in-picture; web-share\" referrerpolicy=\"strict-origin-when-cross-origin\" allowfullscreen><\/iframe><\/p>\n<p>(Hat tip to <a href=\"http:\/\/www.ucdenver.edu\/academics\/colleges\/medicalschool\/departments\/medicine\/InfectiousDiseases\/idfaculty\/Pages\/DaleyCharlesMD.aspx\" target=\"_blank\">Chuck Daley<\/a> for this last item.)<\/p>\n<p><a href=\"https:\/\/secure.jwatch.org\/registerm?cpc=JWATCH&amp;promo=OJFOBLOG&amp;step=1\"><img loading=\"lazy\" decoding=\"async\" src=\"https:\/\/blogs.nejm.org\/hiv-id-observations\/wp-content\/uploads\/sites\/2\/2017\/03\/hivJWAd540x250.jpg\" alt=\"Register Now for more NEJM Journal Watch Content\" width=\"540\" height=\"250\" class=\"aligncenter size-full wp-image-925\" \/><\/a><\/p>\n","protected":false},"excerpt":{"rendered":"<p>Here are a few ID\/HIV items blowing around the neighborhood on\u00a0this, a bitterly cold and windy first weekend of March (at least here in Boston): Compared with the standard dose vaccine, the high-dose flu vaccine reduced deaths among older adults.\u00a0The benefit was seen in the 2012-13 flu season, but not 2013-14. The authors speculate\u00a0that the [&hellip;]<\/p>\n","protected":false},"author":6,"featured_media":0,"comment_status":"open","ping_status":"closed","sticky":false,"template":"","format":"standard","meta":{"footnotes":""},"categories":[3,4,5],"tags":[565],"class_list":["post-8318","post","type-post","status-publish","format-standard","hentry","category-health-care","category-hiv","category-infectious-diseases","tag-link-o-rama"],"post_mailing_queue_ids":[],"_links":{"self":[{"href":"https:\/\/blogs.nejm.org\/hiv-id-observations\/index.php\/wp-json\/wp\/v2\/posts\/8318","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=8318"}],"version-history":[{"count":0,"href":"https:\/\/blogs.nejm.org\/hiv-id-observations\/index.php\/wp-json\/wp\/v2\/posts\/8318\/revisions"}],"wp:attachment":[{"href":"https:\/\/blogs.nejm.org\/hiv-id-observations\/index.php\/wp-json\/wp\/v2\/media?parent=8318"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/blogs.nejm.org\/hiv-id-observations\/index.php\/wp-json\/wp\/v2\/categories?post=8318"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/blogs.nejm.org\/hiv-id-observations\/index.php\/wp-json\/wp\/v2\/tags?post=8318"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}