LIFE AFTER MED SCHOOL: WHAT YOU NEED TO KNOW BEFORE LEAVING MEDICAL SCHOOL

Medic-ALL (23:12:2014) EPISODE 1 by Kayode Kuku

How ironic is it that after spending nearly a decade in the fore walls of medical school, medical graduates leave school and yet remain bereft of information that are crucial to them succeeding in the real world.

The truth remains that there are as many reasons people enter into medical school to study medicine as there are to choose whether or not to practice the profession following graduation. It is common to hear medical students give "passion for helping people or desire to save lives" as their reason for choosing to study medicine after secondary (high) school, and many indeed confess to have found themselves in medical school as a result of parental influences and pressures, while others just loved having the "Dr" title before their names. 

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Ebola Response On Track -WHO

Medic-ALL (19:12:2014) Via MedPage Today

The response to the Ebola epidemic is on track to meet U.N. targets, the World Health Organization said in a mildly optimistic midweek situation report.
By New Year's Day, the agency said, the three hardest-hit countries will likely have the capacity to isolate and treat all cases and to bury all Ebola victims "safely and with dignity."

Guinea, Liberia, and Sierra Leone all now have more available beds than reported patients, the WHO said, although they are not distributed evenly and some regions still have "serious shortfalls." By the same token, each country has enough safe burial teams to handle all people known to have died from Ebola; however, some regions might lack enough capacity.

The U.N. goals are to have 100% of new patients under treatment by Jan. 1 and all known Ebola victims buried safely. Isolating patients breaks the chain of transmission, while safe burials -- avoiding unprotected contact with the highly infectious body of an Ebola victim -- avoid an important risk factor for new cases.
The agency also had a brighter picture of the incidence of cases, suggesting there are signs that the epidemic in Sierra Leone might be starting to slow -- even though the country reported 327 new confirmed cases in the week ending Dec. 14.
Most of the cases are in the western part of the country, with the capital, Freetown, accounting for 125 of the new cases. Teams began house-to-house searches in Freetown yesterday, seeking hidden Ebola patients, according to the BBC.
The searches are part of the so-called Western Area Surge, which aims to get Ebola patients into treatment and also to raise the number of available beds in the capital, the WHO said.

In Guinea, there has been no evident pattern in recent weeks, with the number of new confirmed cases each week fluctuating between 75 and 148. For the week ending Dec. 14, there were 76.
In Liberia, on the other hand, incidence is falling, with only six districts reporting new confirmed or probable cases in the week ending Dec. 14, although data are missing for much of the week.
The cumulative Ebola toll worldwide, to Dec. 14, is 18,603 confirmed, probable, and suspected cases in five affected countries (Guinea, Liberia, Mali, Sierra Leone, and the U.S.) and three previously affected countries (Nigeria, Senegal, and Spain), the agency said.

The U.S. has not had a new Ebola case since Craig Spencer, MD, was reported to be be cured Nov. 9; the country can be declared free of the disease Sunday, which will be 42 days after Spencer tested negative.
Mali also appears to have controlled the disease; all of the contacts of the country's eight confirmed and probable Ebola patients (six of whom died) have now passed the 21-day incubation period without developing the disease.


The last patient tested negative for the disease Dec. 6.

The WHO also reported, for the first time, population-based Ebola rates for Guinea, Liberia, and Sierra Leone:

In Guinea, there have been 22 reported cases and 14 deaths per 100,000 people, with a cumulative total of 2,416 cases and 1,525 fatalities.

Liberia has had 197 reported cases and 83 deaths per 100,000 population, with a total of 7,790 cases and 3,290 deaths.

And Sierra Leone has had 145 cases and 36 deaths per 100,000 people, for a total of 8,356 cases and 2085 deaths.

Meanwhile, researchers are reporting that laboratory tests show that 53 existing and approved drugs have the effect of blocking ebolavirus entry to target cells.

The list includes a wide range of drug classes: microtubule inhibitors, estrogen receptor modulators, antihistamines, antipsychotics, pump/channel antagonists, anticancer drugs, and antibiotics, according to Adolfo Garcia-Sastre, PhD, of the Icahn School of Medicine at Mount Sinai Hospital in New York City, and colleagues.
But more experiments will be needed to understand how useful any of the compounds might be, Garcia-Sastre and colleagues cautioned in Emerging Microbes and Infections.

The work is a positive step, commented Ben Neuman, PhD, of England's University of Reading, who was not part of the study.
The research "extends the list of drugs that are safe to use in people, and have been shown to interfere with Ebola in the lab," he said. But, he added, "it takes a lot to stop Ebola and none of the drugs identified in this study has been shown to protect an experimental animal yet."

"We now have a longer list of things that might work, but the list of things that definitely will work still unfortunately stands at zero," Neuman said.
Indeed, there is little evidence of efficacy even for the drugs that have been used experimentally during this current outbreak, according to the European Medicines Agency, which is conducting a continuing review of them.

The agency is looking at such medicines as brincidofovir, favipiravir, TKM-100802, and ZMapp -- all used to treat one or more patients -- but there is nothing to be said so far about their efficacy, according to an interim report.
"Treatments for patients infected with the Ebola virus are still in early stages of development," an agency spokesman said in a statement. "We encourage developers to generate more information on the use of these medicines in the treatment of Ebola patients."

Ref: World Health Organization
Photo Credits
Medpage today
in.pharmatechnologists.com
seattletimes.com

The Reason Future Doctors are choosing Medicine have Changed

Medic-ALL (16:12:2014)

By an Anonymous American Medical Student

Why would anyone want to become a doctor?  Seriously.  Think about it, because this is a very important question for the future of healthcare in our country.

The future of medicine is somewhat unclear in this age of healthcare reform, but we do know a few things. Physician compensation is currently falling while lawsuits and malpractice premiums are rising.  Doctors must see many more patients in a day to maintain their salary, all while dealing with more paperwork in their limited time.  The hours are often long and the training is challenging.  Students must attend four years of medical school after college plus an extra three to seven years of residency depending on their chosen specialty.  So, why on earth would the best and the brightest young minds want to pursue a career in medicine, especially when they’ll be expected to pay in upwards of $200,000 for their education?

As a second year medical student I’m proud to report that the reasons our future doctors are choosing medicine have changed.  The decision is no longer made because of prestige or money, as it commonly was in the past.  Some of our nation’s best students are choosing medicine primarily because they care about others.   I’m not saying that older physicians don’t care about others, but they entered medicine under much different circumstances than what we face today.  Ask any pre-med student who’s shadowed a doctor and the majority will tell you that they were encouraged to choose a different career path.  There are plenty of kind and compassionate doctors out there, but there are also many who went into medicine for the money and recognition.  Personally, I was told that I should become a plumber, “because it pays better and medicine isn’t what it used to be.”

Yet, according to the American Association of Medical Colleges, the number of applicants to medical school has been steadily increasing for the past ten years, and students are choosing medicine despite all the challenges.  They see the challenges that our healthcare system faces and they’re excited to start working on solutions.  As of 2010, there were over 47,000 medical student members of the American Medical Association (AMA), showing their interest in shaping the future of healthcare policy.

So what does all this mean for the future of healthcare?  Overall, we’re going to see more and more doctors who are compassionate and who chose medicine for the right reasons.  These doctors will understand the challenges that are facing them and they will be prepared to fight for the interests of their patients, whether their opponent is an insurance company or a congressman.  That is why I’m optimistic about the future of healthcare.

Courtesy: Kevinmd

Conjoined Twins Sharing a Heart delivered in Atlanta!

Medic-ALL (05:12:2014)

A set of conjoined male twins sharing a heart, torso, arms and legs, were born, early Thursday in an Atlanta hospital, in the United States, marking a medical rarity as many such babies do not survive delivery

Asa and Eli Hamby - who can never be separated as they share a heart and circulatory system - were welcomed into the world at 7.32am(EST) via a pre-planned (elective) Caeserean section to parents Robin (Mum) and Michael (Dad) and according to a dedicated 'Hamby Twins' Facebook page are healthy and well.

The rare and extremely risky pregnancy was carried through to 37 weeks and Robin and Michael traveled from Alabama to Atlanta's Northside Hospital for specialist care.

Born with two heads, but sharing one body, the condition Asa and Eli have is known as dicephalic parapagus - an extremely unusual form of conjoinment, affecting only one-in-a-million births.

Shortly after the birth of the twins however, the Mother of the babies was told there was a slight issue with her sons' heart, but that they are doing well.

"There is an issue with the right side of the heart. The left side is perfect. The right side has like an extra atrium and an extra ventricle, and there's two aortas. One of the arteries is like switched, not in the right place because of having extra ones, but he said that their vital signs are stable,' said the mum to the Ledger Enquirer (a local newspaper).

Conjoined twins generally occur once in every 200,000 live births and most do not survive, according to the University of Maryland Medical Center. About 40 to 60 percent are stillborn, and about 35 percent live only one day.

The newborn brothers were given medication for their joint heart and intubated to help them breathe, Michael Hamby told the Columbus Ledger-Enquirer newspaper on Thursday morning.

Ebola: Poorer Economies Lose Out

Medic-ALL (23:11:2014) by Kayode Kuku

Having devoted a good percentage of posts on this blog to news on the ravaging impact of the Ebola virus epidemic over the last couple of months, the varying degrees of successes achieved in containing the deadly disease in different parts of the world seems to point indispuatably but not entirely to the inequality in healthcare systems.

Now we know that Ebola had been in existence as early as nearly 4 decades ago, with outbreaks in Sudan and Zaire occurring between June and November 1976. But asides from laymen hearing of "Ebola" in some Hollywood movies or medical students reading a few lines about the disease in their medicine notes, not even the March 2014 outbreak in Guinea  reported by the World Health Organization attracted any real attention either from the media or the World's biggest economies. It can easily be inferred by the closest observers that Ebola in Africa was not taken seriously until it entered into the commercial capital of one of Africa's biggest economies and one of the World's Biggest crude oil producing countries in Nigeria.

About a week following the entry of the Ebola-infected Liberian into Nigeria in July 2014, The WHO On 8 August 2014, the declared the epidemic to be an international public health emergency. Urging the world to offer aid to the affected regions, the Director-General said, "Countries affected to date simply do not have the capacity to manage an outbreak of this size and complexity on their own. I urge the international community to provide this support on the most urgent basis possible. This was after about 4 months of the disease ravaging the West African countries of Guinea, Sierra Leone and Liberia with death toll rising, about 1000 as at early August.


The truth is that the disease which is said to have entered into West Africa in December 2013, had unfortunately hit , "3 of Africa's Poorest economies" (to borrow the CNBC Africa headline from September 2014). The reality of this is that Ebola choose countries whose contributions to the Global Gross Domestic Product could easily be considered negligible by most. In a blog post in August "The Economics of Ebola",
The Liberian Finance Minister, cited the international aid of $200 million recieved via the specially set-up Ebola Fund established by the World Health Organization and World Bank in August to provide support for the 3 West African Countries. The question is how much attention would the the deadly disease have received if the countries affected were some of the region's biggest economies.

The disease however continues to have huge economic impacts even in this so-called poor economies with Ebola itself directly costing the governments of these countries increasingly. The factors  contributing to the growing cost of Ebola include direct costs of the illness (government spending on health care) and indirect costs, such as lower labor productivity as a result of workers being ill, dying or caring for the sick.

But the majority of the costs stem from the higher costs of doing business within countries or across borders. These are largely due to “aversion behavior”, or changes in the behavior of individuals due to fear of contracting the disease, which has also left many businesses without workers, disrupted transportation and led to restrictions on travel for citizens from the afflicted countries.

According to the latest World Bank group report, if the Ebola epidemic is contained by the end of 2014, the economic impacts on West Africa, including on Guinea, Liberia and Sierra Leone, could be lessened and economies would begin to recover and catch up quickly. If the crisis continues into 2015 as predicted, slower growth could cost the region $32.6 billion over 2014 and 2015 and lead to much higher levels of poverty.

There is no doubt that the inadequacies of the health-care systems in the three most-affected countries help to explain how the Ebola outbreak got this far. Spain spends over $3,000 per person at purchasing-power parity on health care; for Sierra Leone, the figure is just under $300. The United States has 245 doctors per 100,000 people; Guinea has ten. The particular vulnerability of health-care workers to Ebola is therefore doubly tragic: as of November 18th there had been 588 cases among medical staff in the three west African countries, and 337 deaths. The hope for these countries therefore lies in the hands of some of the world's bigger economies (who may not necessarily benefit in anyway from the epidemic stricken countries) to help their healthcare sysytem and invariably the "receeding" economy.

Refs: The Economics of Ebola (Medic-ALL blog)

The Economist 

TheWorldBank.org

Sadly, Doctor loses Ebola Battle, Dies in Omaha

Medic-ALL (17:11:2014) Courtesy New York Times 

WASHINGTON — This time, the challenge of Ebola was much steeper for the doctors and nurses at Nebraska Medical Center, one of a handful of hospitals specially designated to handle cases of the deadly virus in the United States.

Unlike the two Ebola patients they had successfully treated earlier this year at the hospital’s biocontainment unit in Omaha, the man who arrived from Sierra Leoneon Saturday, Dr. Martin Salia, was in extremely critical condition. Dr. Salia, a legal permanent resident of the United States who had been working as a surgeon in Sierra Leone, died early Monday morning, barely into his second day of treatment, but almost two weeks into his illness.

The Late Dr Martin Saila

“Even the most modern techniques that we have at our disposal are not enough to help these patients once they reach a critical threshold,” said Dr. Jeffrey P. Gold, chancellor of the University of the Nebraska Medical Center, the hospital’s academic partner.

Dr. Philip Smith, the medical director of the biocontainment unit, said that Dr. Salia, 44, had initially been tested for Ebola in Freetown, the capital of Sierra Leone, on Nov. 7, but that the test came back negative. He was retested there on Nov. 10, at which point the results were positive. Dr. Smith said such false negatives were not uncommon early in the illness.

Dr. Daniel W. Johnson, a critical care specialist at Nebraska Medical Center, said that Dr. Salia’s kidneys had stopped functioning and that he was laboring to breathe when he arrived at the hospital late Saturday afternoon after a 15-hour flight. Doctors quickly tried two treatments they had used on their other Ebola patients: an experimental antiviral drug and a plasma transfusion from theblood of an Ebola survivor, which researchers believe may provideantibodies against the virus.

But Dr. Salia was already so ill that within hours of his arrival at the hospital, he needed continuous dialysis to replace his kidney function. By the pre-dawn hours of Sunday, he was in respiratory failure and needed a ventilator, Dr. Johnson said on Monday. Around the same time, he added, Dr. Salia’s blood pressure plummeted.

“He progressed to the point of cardiac arrest, and we weren’t able to get him through this,” Dr. Johnson said at a news conference in Omaha. “We really, really gave it everything we could.”

Dr. Smith said he did not know how Dr. Salia had contracted the virus. “He worked in an area where there was a lot of Ebola disease, much of it probably unrecognized,” Dr. Smith said, “and there were many opportunities for him to have contracted it.”

In the frenetic neighborhood of Kissy, on the eastern end of Freetown, an eerie quiet hung over the United Methodist Hospital on Monday as news spread that Dr. Salia had died. He was the chief medical officer and the only surgeon at United Methodist Kissy Hospital, according to United Methodist News Service.

Leonard Gbloh, the administrator of the hospital, said he did not think Dr. Salia could have contracted Ebola there.

“We have not been taking Ebola patients here” he said. “And we had stringent control measures in place to prevent it entering.”

The hospital even stopped all surgical work several months ago as a precaution, Mr. Gbloh said. Now, the hospital is being decontaminated and several staff members who came into contact with Dr. Salia after he fell ill are in quarantine there.

Victory over Ebola-Like Virus in Uganda!

Medic-ALL (14:11:2014)

In what can be regarded as another "win" for humans over the recently "more popular" viral haemorragic diseases, authorities in the east African country of Uganda reported that the country was now free of Marburg, a virus similar to Ebola in many respects, after no new cases had been reported for more than a month after a hospital worker died of the disease in the capital, Kampala. The declaration by the United Nations Health Agency comes after a 42-day Surveillance period.

The virus is transmitted through bodily fluids or by handling infected wild animals, Marburg starts with a severe headache followed by hemorrhaging and kills in 80 percent or more cases within about a week. There is no vaccine or specific treatment for the virus.

A total of 197 people were in contact with the healthcare worker, but none of them were found to have been infected, Junior health minister Sarah Opendi told a news conference.

Opendi said 42 days was the minimum period of monitoring before an outbreak is declared contained, and there had been no new cases reported since the death in Kampala on Sept. 28.

"This implies that the Marburg outbreak in the country has been completely controlled," she said.

The worst outbreak of Ebola on record has killed nearly 5,000 people - all but a handful in West Africa's Guinea, Liberia and Sierra Leone - since March.

Marburg disease virus (MVD) (formerly known as Marburg haemorrahagic fever) was first identified in the 1967 epidemics in Marburg (hence the name) and Frankfurt in Germany and Belgrade in the former Yugoslavia following importation of infected monkeys from Uganda.

Uganda, according to the Health Minister of the country, in 2012, endured an outbreak of Marburg that killed 9 of the 18 people infected

Ref: WHO Global Alert and Response

Medic-ALL.Inc 2014