Category: Infectious Disease
Keywords: avian, influenza, infectious (PubMed Search)
Posted: 10/31/2024 by Visiting Speaker
(Updated: 12/13/2024)
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By Bobbi-Jo Lowie, MD
Assistant Professor
Emergency Medicine
University of Maryland School of Medicine
Since April of 2024 there have been 36 confirmed cases of avian influenza A across the United States. Avian influenza, primarily caused by influenza viruses that infect birds, can pose significant health risks to both animals and humans. The most notable strains include H5N1 and H7N9, with H5N1 being particularly alarming due to its high mortality rate among infected humans. The virus primarily spreads from birds to humans through direct contact with infected birds, their droppings, or contaminated environments. Although there have been recorded cases of human-to-human transmission, this usually occurs only in close-contact situations.
In humans, avian influenza can present with symptoms ranging from mild respiratory illness to severe pneumonia. Patients may experience fever, cough, sore throat, muscle aches, and in severe cases, gastrointestinal symptoms. Those that have more moderate or severe illness may develop shortness of breath, altered mental status, or seizures. Complications include acute respiratory failure, pulmonary hemorrhage among others, with respiratory failure being the most common cause of death in this patient population.
Diagnosing avian influenza involves a combination of clinical presentation, travel history, and exposure to birds and confirmation through PCR testing of upper respiratory tract samples like a nasopharyngeal swab.
Treatment for avian influenza focuses on antiviral medications such as oseltamivir which is most effective when administered early in the course of the illness but still administered after 48 hours of illness. Supportive care is essential for managing severe cases, especially those that progress to acute respiratory distress syndrome.
Category: Administration
Keywords: STI, prophylaxis (PubMed Search)
Posted: 6/24/2024 by Visiting Speaker
(Updated: 12/13/2024)
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Author:
Gabriella Miller (She/Her)
Clinical Instructor
Department of Emergency Medicine
University of Maryland School of Medicine
Doxycycline PEP for the prevention of bacterial STIs.
The CDC now recommends “doxy PEP” for high-risk individuals. Doxycycline post-exposure prophylaxis (doxy PEP) is a prescription for patients to self-administer 200 mg doxycycline by mouth within 72 hours after anal, oral, or vaginal sex to prevent the transmission of chlamydia, gonorrhea, and syphilis. The CDC defines “high-risk” as men who have sex with men (MSM) and transgender women (TGW) who have been diagnosed with a bacterial STI within the past 12 months. They summarize the findings of the French IPERGAY and ANRS DOXYVAC studies, as well as the US DoxyPEP study, which all show promising reductions in risk ratios or hazard ratios of decreasing bacterial STI transmission on high-risk populations, including those who are taking PrEP for HIV. No significant adverse events related to doxy PEP have been reported.
Conclusion:
Counsel patients at high risk for bacterial STIs regarding the prescription of doxy-PEP for patient self-administration within 72 hours after sex.
Bachmann LH, Barbee LA, Chan P, et al. CDC Clinical Guidelines on the Use of Doxycycline Postexposure Prophylaxis for Bacterial Sexually Transmitted Infection Prevention, United States, 2024. MMWR Recomm Rep. 2024;73(2):1-8. Published 2024 Jun 6. doi:10.15585/mmwr.rr7302a1
Category: Misc
Keywords: sleep (PubMed Search)
Posted: 5/29/2024 by Visiting Speaker
(Updated: 12/13/2024)
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Title: Basics of Sleep Physiology and Architecture
By: Youssef Annous, MD
Sleep is integral for physical and mental health and performance. Sleep is extremely well conserved among species. All mammals need sleep to survive.1 A single sleep cycle typically lasts anywhere between 90 and 120 minutes and is broken down into two phases2:
Non-Rapid Eye Movement sleep
Stage 1 (Light Sleep)
This is the lightest form of sleep and the easiest to wake up from. During this stage, it is normal to experience muscle twitching and the sensation of drifting in and out of consciousness. This stage lasts approximately 5 minutes in the beginning of sleep and comprises around 5% of total sleep duration.2
Stage 2 (Light Sleep)
During this stage, you are likely to begin experiencing decrease in body temperature, heart rate (HR), blood pressure (BP) and respiratory rate (RR). Electroencephalography (EEG) during this phase of sleep would show sleep spindles and K complexes.2 These findings have been linked to memory consolidation.3
Stage 3 (Deep Sleep)
This is the deepest stage of sleep. During this phase, body temperature, HR, BP, and RR are at their lowest. This is the most restorative stage of sleep. It is essential for immune health, cardiovascular health, tissue repair, bone growth, and muscle recovery.2 It is also when growth hormone (GH) is at its highest. Physiological (e.g. illness) or psychological (e.g. anxiety) stressors can negatively impact this stage. We experience less deep sleep as we age.4
Rapid Eye Movement (REM) sleep
This stage of sleep is characterized by rapid eye movement, abundance of dreaming and heightened brain activity. During REM, there is total body paralysis with exception of ocular and respiratory muscles. It is theorized that your body is paralyzed during this stage to protect you from dream enactment. You experience more REM the longer you sleep. REM has been shown to be essential for memory consolidation, cognitive function, mood regulation and for coping with stress. This stage is particularly compromised by sedatives including but not limited to alcohol, benzodiazepines, and tetrahydro-cannabinoid (THC). Several studies in animals and humans showed that even modest REM sleep deprivation can result in increased mortality. 2,5,6
All sleep stages are extremely essential. Be careful of self-medicating with sleep aids such benzodiazepines or alcohol as this can be detrimental for your health. In later UMEM pearls, we will discuss protocols, supplements and behavioral ways to improve each stage of sleep for better mental and physical health.
References:
1 Miyazaki S, Liu C-Y, Hayashi Y. Sleep in vertebrate and invertebrate animals, and insights into the function and evolution of sleep. Neuroscience Research. 2017;118:3-12. doi:10.1016/j.neures.2017.04.017
2 JF; PAVK. Physiology, sleep stages. National Center for Biotechnology Information. Accessed May 26, 2024. https://pubmed.ncbi.nlm.nih.gov/30252388/.
3 Antony JW, Schönauer M, Staresina BP, Cairney SA. Sleep spindles and memory reprocessing. Trends in Neurosciences. 2019;42(1):1-3. doi:10.1016/j.tins.2018.09.012
4 El Shakankiry H. Sleep physiology and sleep disorders in childhood. Nature and Science of Sleep. Published online September 2011:101. doi:10.2147/nss.s22839
5 Della Monica C, Johnsen S, Atzori G, Groeger JA, Dijk D-J. Rapid eye movement sleep, sleep continuity and slow wave sleep as predictors of cognition, mood, and subjective sleep quality in healthy men and women, aged 20–84 years. Frontiers in Psychiatry. 2018;9. doi:10.3389/fpsyt.2018.00255
6 Leary EB, Watson KT, Ancoli-Israel S, et al. Association of Rapid Eye Movement Sleep with mortality in middle-aged and older adults. JAMA Neurology. 2020;77(10):1241. doi:10.1001/jamaneurol.2020.2108