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The Center is delighted to highlight our effective therapy for both of these common types of Hepatitis. Hepatitis B treatment for those with chronically active Hepatitis B or the Carrier State have been available for a number of years and are highly effective. Many patients clear Hepatitis B with their caute infection and do not require prolonged treatment. All patients with Hepatitis C who have a measurable viral load are candidates for therapy. The New Hep C drugs are the most exciting development in Infectious Disease since the advent of highly effective anti HIV therapy in the late 1990s–thus about 20 years.These drugs are highly effective with over 95% cure rates and unlike previous interferon based therapy are well tolerated. We have been recently partnering with the VA to treat some of the large number of such patients who come through their facility. If you are either Hepatitis B Surface antigen + or Hepatitis C antibody + please call our office to schedule an appointment so we can discuss these treatment options to see if they apply in your case.Dr. Smith

From MMWR Weekly November 13,2015/64(44); 1233-1240

Tobacco smoking is the leading cause of preventable disease and death in the USA. It results in approximately 480,000 premaure deaths and more than 300 Billion in Direct Health care Costs each year..The CDC report is an update on the “Healthy People 2020” goal of reducing cigarette smoking adults to < 12% by 2020.Smoking adults aged 18=>  decreased from 20.9% in 2005 to 16.8% in 2014–an almost 20% decrease in this 10 year period. or about a .41 decrease in the number smoking per year.At this same rate we should decrease to about 14 % in 2020 suggesting that to reach the desired goal we need to redouble our efforts and develop even more new methods to prevent addiction and to treat addiction once established. Dr Smith

It has been too long since my last Post and I promise to do better through the rest of 2015 and 2016.

New Antibiotics:

      a. Dalvance and Orbactiv (IV).—These are new MRSA Antibiotics. Their unique feature is a very long half life.They can be given 1 time in the case of orbactiv or twice 7 days apart to produce a 14 day blood level. It is intended for MSSA and MRSA Skin and Skin structure infections.The good things are:1.Long half life 2,.Eliminate the need for PICC 3. Useful for patients who have difficulty taking antibiotics by the oral route or in whom compliance is an issue or in whom are not considered good candidates for  a PICC line. The bad thing–These drugs are astronomically expensive 3-4000 .00 a course. They have a narrow sweet spot as per above–that justifies their costs–especially if it can reduce hospital re-admissions.

     b/Silvextro– IV/Oral A new me too drug from Cubist now Merck. Only + is once a day.

Only indication is for Skin and Skin structure infections Gram positive cocci. Astronomically expensive 6 tablets 2,000.00.Now that Zyvox has gone generic with rapidly dropping prices–and a broader package insert–no reason to use.

    c.Mixed bag drugs—Zerbexa and Avycaz—-(IV)  Marketed as Zosyn like drugs. May have a place for multidrug resistant organisms are present.NOt for general use. Not ssure about pricing data on these 2.

Most of these compounds are not on testing batteries for hospitals so without an ability to test for organism susceptibility their usefulness is severely compromised. I do not see them being added to many formularies because of costs and inability to test so that they can be properly utilized.

New Antifungals-Cresembla for Invasive Aspergillosis

New Antiparasitic drugs—Impavido–Leishmaniasis

New Antivirals

       a,HIV–Evotaz and Prescobix

       b.Hepatitis C– A literal explosion of excellent but very expensive drugs. They are cost effective because of their very high cure rates. 95% or greater. Most exciting ID development since the advent of highly effective HIV therapies in the 1990s–at least 20 years. Harvoni, Viekira Pak,Technivie,

Daklinsa

New vaccines—Bexsero—A new vaccine for Type B Meningococcal immunizaiton.

All in all an astonishing 23 months or so with so many new products –it will take a while to determine their places in therapy. Nevertheless as someone who has devoted much of his caeer to antibiotic research—I am delighted to see so many new products come to market.

Questions can be directed to my e mail idelvis2@comcast.net

Dr . Smith

1.WHAT IS EBOLA–It is a Filovirus similar to Marburg Virus. These viruses cause a Hemorrhagic fever syndrome with a high mortality. Ebola was first recognized in 1976 during 2 epidemics in Zaire and with 602 cases and an 88% mortality. There was a recurrence in the Sudan 1n 1979 but then no outbreaks for the next 20 years

2.MODE OF SPREAD—Household contacts with close contact with blood , body ffluids and or wastes. Health care workers spread appears to be similar to household contacts. Monkeys have an element of aerosol particle spread but how important this is in humans is not known.

3.CLINICAL MANIFESTATIONS-Inculbation 2-19 days most commonly 5-10 days.Initial symptoms are nonspecific -fever, headache,muscle aches, nausea and vomiting —  often followed by bleeding manifestations.

4.TREATMENT–Primarily supportive. Several of the health care workers treated in the U.S. have received either an experimental vaccine or plasma transfusions from recovered  Ebola patients. Of the health care workers treated in the USA none have died from the disease  in this recent epidemic.Described mortality in resource limited African countries has been 50-90%.

5.CURRENT EPIDEMIC-West Africa–Guinea, Liberia,Nigeria,Senegal,Sierrra Leone.  6,574 cases.Highest number of cases(thru Oct 3 was in Liberia 3,458 cases.This is the largest outbread ever reported.

6.EFFORTS TO CONTROL THE OUTBREAK–Being led by the involved countries. CDC, WHO, Medicine sans Frontieres, UN Red Cross and many other organizations.

7.KNOWN US CASES—ACQUIRED IN USA FROM INFECTED PATIENTS. 2 Texas Nurses who cared for the patient and had prolonged and intensive exposure to the patients blood, body fluid and waste products.No US cases from non medical non household contact.

8.CHANCES THAT EBOLA MIGHT SPREAD TO THE GENERAL POPULATION-SLIM TO NONE. All evidence still points to prolonged and intense contact with the patient as being necessary for spread.Several family members stayed with the index Texas patient in  a small motel room and none have become infected as of this date.

If you have further questions the following sources are excellent. CDC, Mississippi Department of Health– Epidemiology Section. Center of Infectious Disease Excellence—Use the e mail listed on the web site and or call with questions.

David L. Smith M.D.

A. huge shout out to CVS for discontinuing the indefensible and hypocritical practice of vending cigarettes in a health care institution–a pharmacy. Tobacco use has continued to drop like  a stone -now about 18% nationwide–but still above 20% in Mississippi. Now that many pharmacies have adopted competitive practices with physicians –immunizations and evaluating immunization status–it is more than high time that all pharmacies eliminate

this practice. You would not expect to see cigarettes sold in a doctors office or a hospital.This has all but disappeared entirely. Make sure that your pharmacy does not sell cigarettes.This action should put pressure on all the other big chains such as Walmart and Rite Aid. Vote with your wallet. If your pharmacy sells cigarettes ask them to stop. If they don’t– go to a non-tobacco vending pharmacy for your pharmaceutical needs.

A terrific public health initiative by CVS.Lets all get on board.

Dr. Smith

A recent article in the Journal of Pediatrics revealed to many of us that there is a large traffic in human breast Milk on the Internet.The authors of the above article describe reviewing almost 13,000 posts either for selling or buying of human milk.There is a apparently no regulation of this product whatsoever. The study showed substantial contamination rates of the milk obtained with  Staphylococci,Streptococci and lesss frequently Salmonella.This is not surprising  tothe infectious disease community as “raw” unpasteurized bovine milk has always been a source of a variety of infectious disease problems. This product is generally banned in most states. The unregulated human unpasteurized breast milk market would seem to be more frequent and dangerous than previously known. Congratulations to the authors for exposing the practice and the potential dangers thereof

Best to all Dr. Smith 10/22/2013 1700

1.Obesity as a risk factor for Clostridium difficile infection.-CID-August 15,2013. Israeli Study 6300 patients were hspitalized in this study178 with Clostrdium difficile infection.The only factors that were significant–a. previous intra-abdominal surgery and  b.obesity.They also point out in the discussion that “obesity is an  independent predictor of nosocomial bacteremia in elderly patients and septic shock, ventilator associated pneumonia and catheter associated sepsis in critically ill patients.”Obesity has been associated witha higher rate of intensive care unit admissions and/or death in the 2009 Influenza A pandemic.” Obesity must now be considered as one of the most common immunosuppressive conditions. To add to the above pressure ulcers, earlier need for prosthetic joints and premature disability claims.

2.Safety of Zoster Vaccine in Elderly Patients Following Documented Herpes Zoster—CID Aug 2013 Showed that it is safe to administer vaccine in those who have previously had zoster. This is not too surprising —but needed information.Bigger question is –in an expensive vaccine–does it confer additional protection re occurence of additional episodes of shingles if an individual has had at least 1 episode of shingles. The Current Practice Recommendations are to give a dose of Zostavax to all individual greater than age 60 whether they have had an episode of Zoster or not.

3. CMV and Alzheimers Disease –Interesting observations from the Rush Alzheimers Disease Center in Chicago showing an association between CMV and Alzheimers.

For 2012 CDC received 5,780 reports of Arboviral Infections.WEST NILE accounted for 98% of the reported cases.This is the highest number of WEST NILE cases since 2003.About 1/2 of these cases are neuroinvasive. 92% occurred between July and September. Median age of patients was 56 ,62% were hospitalized and 5% died,Median age of those who died was 77.Texas had the highest number of cases -844. Mississippi had the second highest attack rate 3.45/100,000 for a total of 106 cases.95% of the deaths occurred in the neuroinvasive group.Non-neuroinvasive cases are substantially underreported.CDC estimates that for every 1 case of neuroinvasive WEST NILE

there are 30-70 non neuroinvasive cases.Thus, an estimated 80-200,000 non -neuroinvasive cases may have occurrred during 2012.It is important to consider WEST NILE as a possibility in FUO presentations that occur

from July, Sept 30. For the complete report please go to

MMWR FOR THE WEEK OF JUNE 28,2013   62(25) 513-517 . Available to all on the CDC website.www.cdc.gov

There are thousands of diets out there. Any diet works for a short period of time if one takes

in less calories than one expends. The secret is in having a diet that is easy to get on and stay

on lifetime.Exciting new discoveries in England have now traveled to the USA and make it

possible to safely and easily get down to your ideal body weight.

1.This diet is not designed for

        a.morbidly obese -greater than twice your ideal body weight-BMI

        b.Diabetic

        c. Those patients withMultiple serious medical illnesses

2.No special foods required

3.N0 special supplements

4.No tasteless frozen dinners shipped in in bulk

5.No mega vitamins

6.Guaranteed to work.

7.Count calories only 2 days a week–The rest of the time–eat you normal diet.

Exercise is a plus

Call the Center for Details and To Schedule an Appt.  Dr. Smith

The New York Post published a story of a  jury award to a family of 41 million dollars for a

child who acquired a form of encephalitis while on a school trip to the Far East.This illustrates

the liability that organizations occur when they take groups traveling out of the USA. This

underscores the importance of having such groups visit Travel Medicine Clinics prior

to such trips. This most importantly helps to insure the safety of the traveler and

secondly to protect the organization.