On MRSA Infections Worldwide

June 20, 2011

Methicillin-resistant Staphylococcus aureus (MRSA) infection has become increasingly common in recent years, due in large part to overuse of antibiotics. According to a 2007 report in Emerging Infectious Diseases, a publication of the Centers for Disease Control and Prevention (CDC), the average number of MRSA infections doubled nationwide between 1999 and 2005 – from 127,000 to 278,000. During the same period, the number of annual deaths from MRSA infection increased from 11,000 to more than 17,000. By increasing awareness about the risk factors associated with and steps that can be taken to avoid MRSA infection, it may be possible to reduce or eliminate its spread.

MRSA infection is caused by a strain of Staphylococcus (staph) bacteria that has become resistant to the antibiotics commonly used to treat staph infections, which include methicillin and penicillin. Generally, MRSA is spread through skin-to-skin contact, openings in the skin (cuts or abrasions), contact with contaminated surfaces, crowded living conditions, or poor hygiene. MRSA frequently manifests first on the skin as a reddish rash with lesions resembling pimples which may begin to drain pus, or lead to cellulitis, abscesses, and impetigo. In addition, the initial skin infection can spread to almost any other organ in the body, resulting in more serious symptoms and potential complications.

Designations are made between types of MRSA infection based on the location where the infection took place. Hospital-acquired MRSA (also called health-care-acquired, HA-MRSA, or HMRSA) remains one of the most common types of infection. Individuals who are hospitalized, those with invasive medical devices such as catheters, and those residing in nursing homes are at an increased risk of acquiring HA-MRSA. Community-acquired MRSA (CA-MRSA or CMRSA) is another common type of infection, and is seen most frequently in individuals participating in contact sports or those living in crowded or unsanitary conditions. While the average adult death rate among individuals with MRSA is estimated at five percent of infected patients, individuals with HA-MRSA are at an increased risk of experiencing complications including organ damage.

Dr. Marc Siegel, an associated professor of medicine at New York University, and others recommend an evaluation of the overuse of antibiotics by humans as well as in livestock as a means of eradicating MRSA and reducing drug resistance in other strains of bacteria. In addition, experts note the importance of good hygiene practices  including washing hands frequently, keeping wounds covered with bandages until they have healed, and washing soiled clothes and sheets in hot water can help to prevent the spread of MRSA. The timely diagnosis of individuals infected with MRSA achieved through an analysis of a skin sample helps to better ensure not only treatment for the individual, but also a decreased risk of infecting others.

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Healthcare Following Chile’s Earthquake

March 8, 2010

While aid organizations continue to support relief efforts in Haiti, some attention has now been diverted by the 8.8-magnitute earthquake which struck Chile on February 27, 2010. As with Haiti’s tragedy, many organizations are accepting donations to benefit relief efforts in Chile via text message, and individuals have banded together on Twitter and Facebook to request help locating loved ones, provide updates, and share information.

Chilean Earthquake

Experts, including Sergio Barrientos, science chief of the Seismology Institute of the University of Chile, indicate that this quake was 50 times bigger than the one that killed thousands and destroyed much of Haiti’s infrastructure on January 12, 2010. Richard Gross, a geophysicist at NASA’s Jet Propulsion Laboratory, indicated that the force of the quake was in fact so strong that it affected the Earth’s figure axis (the axis about which the Earth’s mass is balanced) and caused the length of the day to be shortened by 1.26 microseconds. Compared to Haiti’s relatively shallow earthquake which occurred just 8.1 miles below the surface of the earth, the depth of Chile’s recent quake was 21.7 miles. This increased depth, which allowed some of the quake’s energy to disperse, and Chile’s strict building codes lessened the earthquake’s potential to cause more serious damage.

According to the National Emergency Office, 795 individuals have died as a result of the earthquake, and the 40-foot tsunami and 131 aftershocks of magnitude 5 or greater that have followed. Chilean President, Dr. Michelle Bachelet stated that it is likely that two million people were affected in some way by the recent earthquake. Many lost family and friends, and an estimated 500,000 homes sustained considerable damage, according to reports from the Chilean Red Cross.

Efforts for locate and rescue survivors are ongoing, and it is expected that, as seen in Haiti, medical and rehabilitative care will be needed by many. Information regarding the number of individuals injured or displaced by the earthquake and the aftershocks and tsunami that followed is not yet available. Though current counts of individuals killed or injured are substantially lower than following Haiti’s earthquake, these figures are expected to rise as reports indicate that as many as 500 individuals are still missing in Constitución alone. In addition to the earthquake itself, which hit most strongly in six central regions of Chile, substantial loss of life and damage to infrastructure is due to the subsequent tidal wave which submerged fishing towns on the coast of south-central Chile. More than 20 boats were swept ashore in the port of Talcahuano, and rescue workers have located over 300 bodies in Constitución. Access to drinking water, food, electricity, and other supplies to many towns in these costal areas, including Bio Bio and Concepcion, have been disturbed, leading to tension and looting in some areas.

Amid civil unrest in areas with destroyed highways and collapsed bridges, the spread of disease and the delivery of healthcare is also a concern. According to UN Humanitarian spokeswoman Elisabeth Byrs, Chile’s government has identified its emergency needs as temporary bridges, field hospitals, satellite telephones, electric generators, damage assessment teams, water purification systems, field kitchens, and dialysis centers. While reports indicate that the health network in northern Chile is operating normally, in the south access to heath services has been disrupted by the collapse of six hospitals and damage to two others. To provide some assistance, the United Nations will be sending 45 satellite phones to Chile for officials coordinating relief efforts, and is prepared to send 30 tons of food and other aid. U. S. Secretary of State Hillary Clinton has indicated that the United States will offer “not only solidarity but specific supplies” to help Chile recover. Aid from the U.S. will include 62 satellite phones, eight water purification systems, and a mobile field hospital with surgical capability. Argentina has already sent medical supplies including three tent hospitals, water processing equipment, medications, and satellite telephones to Chile. Other nations including Canada, which has pledged $2 million to support relief efforts, and Singapore, which will supply $50,000, have also offered contributions. In addition to the need for facilities and supplies, the Pan American Health Organization (PAHO)/WHO noted a shortage of healthcare personnel and has assembled an emergency response team of 80 trained specialists.

As the outpouring of support for Chile begins, governmental agencies, non-governmental organizations, aid organizations, and individuals face the daunting task of coordinating their relief efforts and some areas are still awaiting support. It remains unclear how many individuals have been affected by the earthquake, both directly and indirectly, but it is of great import that they get the care and assistance they need.

Find out about how the iCons in Medicine teleconsultation program can help following natural disasters and what iCons in Medicine and the Center for International Rehabilitation are doing to ensure the provision of rehabilitation services in Haiti.

Medical Social Networking

May 12, 2009

Social networking websites have become increasingly popular in recent years. Kerri Breen of the CBC News reports that YouTube has become the third most popular website in the world, Facebook now has over 200 million users, and Twitter has grown 2,565 percent in the past year. Through the new channels offered by these social networking websites and tools, users can discuss anything from cat toys to a bothersome rash on their arms.

Fighting a Cold Online
The ever-increasing popularity of these Web 2.0 sites offers new opportunities for their application to improve health and medical care. The New York Times reports that during the last week of April, “Swine Flu” was the most searched term on Yahoo, the Wikipedia page on “Swine influenza” received 1.3 million page views, and an estimated 125,000 tweets a day on Twitter mentioned the illness. Despite this increase in discussion about the virus, Alessio Signorini, a PhD candidate in Computer Science at the University of Iowa, told the NYT that this “noise” does not indicate actual trends in the spread of the virus. Dr. Philip Polgreen further explained that by tracking indicators within popular search terms, such as symptoms of a condition or virus, it is possible to better track its spread and plan more effectively for inoculations.

Growth in Internet use has also led to a rise in self-diagnosis and/or self-prescription. Through tools like Twitter or Facebook, individuals can simply state that they do not feel well, and are much more likely to do so than to visit a doctor. While this could potentially lead to their not getting necessary treatment, other forms of web use may help to ease discomfort, physical and/or psychological, caused by certain conditions. A number of websites have been introduced which allow patients with specific conditions (e.g., MS, diabetes, eczema) to form a community. ABC Health and Wellbeing reports that research indicates that patients with psoriasis indicated their perceived quality of life had improved following the use of these online support websites. Center for Connected Health and Boston’s Massachusetts General Hospital researchers have also found that these online networks provide a valuable base of information and support to patients, and that health outcomes can be further improved through physician involvement.

A number of social networking websites have also been developed to allow physicians, clinicians, researchers, and medical specialists to link to one another and discuss various areas of their practice. In addition to sites which allow doctors to create social connections, others, like iCons in Medicine, provide the opportunity for healthcare providers in remote or medically underserved areas to request assistance on difficult cases from physicians in 30 medical specialties. Through these teleconsultations and the social networking tools provided by programs like iCons in Medicine, doctors can collaborate on difficult cases and improve patient health at the point of care.

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