Category Archives: Internal Medicine

Georgia officials are warning about an increase in overdose deaths related to new ‘zombie drug’ – WJCL News Savannah

The Georgia Department of Health is alerting the public about an increase in overdose deaths related to a new drug. Theres a new, non-opioid making its way around, causing officials to send out a warning ahead of St. Patricks Day.The more drugs you put into a mix, the more synergistic bad of an outcome you can have, said internal medicine doctor Timothy Connelly.Dr. Connelly, who works for Memorial Health, explains why xylazine is being called the zombie drug and why its being mixed more frequently now with opioids. Its a sedative medication that's a powerful muscle relaxer, said Dr. Connelly. It also drops the blood pressure, and it amplifies the narcotic.According to the Georgia Department of Health, xylazine-involved deaths increased by 1120% from 2020 to 2022 in the state, all involving fentanyl. But, unlike fentanyl, theres no treatment.Its related to opioids in some way, but it doesn't work through the same receptive that the Narcan reverses, said Dr. Connelly. With St. Patricks Day on Friday, Dr. Connelly shares his plea to patrons preparing to celebrate. You have to be very careful nowadays. Drug use is becoming an increasingly more fatal habit to have, said Connelly.

The Georgia Department of Health is alerting the public about an increase in overdose deaths related to a new drug.

Theres a new, non-opioid making its way around, causing officials to send out a warning ahead of St. Patricks Day.

The more drugs you put into a mix, the more synergistic bad of an outcome you can have, said internal medicine doctor Timothy Connelly.

Dr. Connelly, who works for Memorial Health, explains why xylazine is being called the zombie drug and why its being mixed more frequently now with opioids.

Its a sedative medication that's a powerful muscle relaxer, said Dr. Connelly. It also drops the blood pressure, and it amplifies the narcotic.

According to the Georgia Department of Health, xylazine-involved deaths increased by 1120% from 2020 to 2022 in the state, all involving fentanyl. But, unlike fentanyl, theres no treatment.

Its related to opioids in some way, but it doesn't work through the same receptive that the Narcan reverses, said Dr. Connelly.

With St. Patricks Day on Friday, Dr. Connelly shares his plea to patrons preparing to celebrate.

You have to be very careful nowadays. Drug use is becoming an increasingly more fatal habit to have, said Connelly.

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Georgia officials are warning about an increase in overdose deaths related to new 'zombie drug' - WJCL News Savannah

New test quickly identifies patients whose postoperative pain can be … – EurekAlert

image:A: Giant magnetoresistive (GMR) biosensor array in its reusable cartridge. The black boxed area indicates the region magnified and displayed in B. The red line is inserted for scale. The GMR biosensor is 5 mm in length. B: A zoomed-in image of the GMR biosensor array overlaid with the pattern of functionalized probes on the surface of the individual sensors. The chip hosts an array of 80 individually addressable GMR biosensors, which can be seen in the image as red squares, some of which are covered by the overlaid pattern of probes. Each sensor can be individually functionalized with capture probes and is addressed and measured during readouts for sensor-specific changes in resistance due to the GMR effect. In the pattern used in this study, each single nucleotide polymorphism has both a wild-type (WT) and mutant-type (MT) probe set, as indicated by the matching colors above (dark for WT and light for MT), as well as positive and negative control probes. Six GMR biosensors are dedicated to each probe, for a total of six real-time measurements per probe type. view more

Credit: Dana L. Cortade and Shan X. Wang

Philadelphia, March 14, 2023 Hypnosis is an effective treatment for pain for many individuals but determining which patients will benefit most can be challenging. Hypnotizability testing requires special training and in-person evaluation rarely available in the clinical setting. Now, investigators have developed a fast, point-of-care molecular diagnostic test that identifies a subset of individuals who are most likely to benefit from hypnosis interventions for pain treatment. Their study, in The Journal of Molecular Diagnostics, published by Elsevier, also found that a subset of highly hypnotizable individuals may be more likely to experience high levels of postoperative pain.

Since hypnotizability is a stable cognitive trait with a genetic basis, our goal was to create a molecular diagnostic tool for objectively identifying individuals who would benefit from hypnosis by determining treatability at the point-of-care, explained co-lead investigator Dana L. Cortade, a recently graduated PhD in Materials Science and Engineering, School of Engineering, Stanford University, Stanford, CA, USA. The advancement of nonpharmacological adjuvant treatments for pain is of the utmost importance in light of the opioid epidemic.

Prior research established that the genetic basis for hypnotizability includes four specific single-nucleotide polymorphisms (SNPs), or genetic variations, found in the catechol-o-methyltransferase (COMT) gene for an enzyme in the brain that is responsible for dopamine metabolism in the prefrontal cortex. Although SNPs can contain valuable information on disease risk and treatment response, widespread use in clinical practice is limited because of the complexities, costs, and time delays involved in sending samples to laboratories for testing.

The investigators developed a SNP genotyping assay on a giant magnetoresistive (GMR) biosensor array to detect the optimal combination of the COMT SNPs in patient DNA samples. GMR biosensor arrays are reliable, cheaper, sensitive, and can be easily deployed in point-of-care settings using saliva or blood samples.

The study investigated the association between COMT diplotypes and hypnotizability using a clinical hypnotizability scale called the Hypnotic Induction Profile (HIP) in individuals who had participated in one of the three previous clinical trials in which an HIP was administered. An additional exploratory study of the association between perioperative pain, COMT genotypes, and HIP scores was conducted with the patients in the third cohort, who had undergone total knee arthroplasty (TKA). DNA was extracted from blood samples previously collected in the first cohort, and saliva samples were collected by mail from participants in the other two trials. Participants were considered treatable by hypnosis if they had HIP scores of 3 or higher on a scale of zero to 10.

For participants identified with the optimal COMT diplotypes by the GMR biosensor array, 89.5% scored highly on the HIP, which identified 40.5% of the treatable population. The optimal COMT group mean HIP score was significantly higher than that in the suboptimal COMT group. Interestingly, further analysis revealed that the difference was observed only in women.

Although we had expected some difference in effect between females and males, the association between hypnotizability and COMT genotypes was strongest in the females in the cohort, said co-lead investigator Jessie Markovits, MD, Department of Internal Medicine, Stanford School of Medicine, Stanford, CA, USA. The difference may be due to lower numbers of males in the cohort, or because COMT is known to have interactions with estrogen and to differ in activity by sex. Additional gene targets including COMT, with stratification by sex, could be the focus of future study.

In the exploratory analysis of the relationship between COMT genotypes and pain after TKA surgery, the same optimal COMT individuals had significantly higher postoperative pain scores than the suboptimal group, indicating a greater need for treatment. This supports the body of evidence that COMT genotypes impact pain, and it is also known that COMT genotypes affect opioid use after surgery. Pain researchers can use this technology to correlate genetic predisposition to pain sensitivity and opioid use with response to an evidence-based, alternative remedy: hypnosis, Dr. Cortade said.

COMT SNPs alone are not a complete biomarker for identifying all individuals who will score highly on a hypnotizability scale and experience high pain sensitivity. The GMR sensor nanoarray can accommodate up to 80 SNPs, and it is possible that other SNPs, such as those for dopamine receptors, are needed to further stratify individuals.

The investigators observe that this study highlights the utility and potential of the evolving applications of precision medicine. It is a step towards enabling researchers and healthcare professionals to identify a subset of patients who are most likely to benefit from hypnotic analgesia, Dr. Markovits said. Precision medicine has made great strides in identifying differences in drug metabolism that can impact medication decisions for perioperative pain. We hope to provide similar precision in offering hypnosis as an effective, non-pharmacological treatment that can improve patient comfort while reducing opioid use.

Journal of Molecular Diagnostics

Experimental study

Cells

Point-of-Care Testing of Enzyme Polymorphisms for Predicting Hypnotizability and Postoperative Pain

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New test quickly identifies patients whose postoperative pain can be ... - EurekAlert

Letter for the article Long Term Characteristics of Clinical Distribut … – Dove Medical Press

1Department of Nursing Management, Faculty of Public Health, Universitas Muslim Indonesia, Makassar, Indoensia; 2Department of Biochemistry, Faculty of Medicine, Universitas Muslim Indonesia, Makassar, Indoensia; 3Department of Internal Medicine, Faculty of Medicine, Universitas Muslim Indonesia, Makassar, Indoensia

Correspondence: Haeril Amir, Department of Nursing Management, Faculty of Public Health, Universitas Muslim Indonesia, Makassar, Indoensia, Email [emailprotected]

We have read the paper by Wang et al on Long Term Characteristic of Clinical Distribution and Resistance Trends of Carbapenem-Resistant and Extended-Spectrum -Lactamase Klebsiella Pneumoniae Infections.1. We congratulate the authors for providing data in the form of an overview of Klebsiella pneumoniae (KP) infection patterns and KP resistance to several antibiotics, which are useful for the treatment and prevention and control of bacterial infections that are resistant to various antibiotics used in hospitals.

The study conducted by Wang et al showed that carbapenem-resistant KP (CRKP) had the highest proportion of carbapenem-resistant Enterobacteriaceae and most of the infected patients were >60 years old, an increasing trend every year. However, it should be noted that carbapenem resistance is determined when imipenem or meropenem are resistant by antimicrobial susceptibility testing.2 There are several things to be considered, namely virulence factors, drug resistance, and types of KP sequences in different samples to be identified by wire-drawing tests, polymerase chain reactions, drug susceptibility tests, and multi-site sequence typing.3

In the study by Wang et al, they conducted strain identification using the BD PhoenixTM100 system in which the minimum inhibitory concentration of antibiotics was determined by the broth method.1 The method used is appropriate, however we recommend continuing with a modified carbapenem inactivation method in which the isolates studied are determined by multilocus sequence types, and the presence of carbapenemase genes and virulence are examined using the polymerase chain reaction test. In addition, the modified carbapenem inactivation method (mCIM) and the EDTA-carbapenem inactivation method (eCIM) also help to determine the phenotype of the carbapenemase.4 In addition, phenotypic carbapenemase production could also be confirmed by a modified Hodge test, followed by conventional polymerase chain reaction to determine isolates undergoing antibiotic sensitivity test.5

In conclusion, we agree that the level of KP resistance to conventional antibiotics is generally high as well as susceptibility to common antibiotics, especially cefotaxime,1 therefore it is necessary to build a multidisciplinary collaborative mechanism to manage infection and jointly suppress the spread of bacterial resistance. However, with increasing percentage of hypervirulent Klebsiella pneumoniae, the level of antimicrobial resistance of Klebsiella pneumoniae may decrease, therefore we recommend conducting a virulence study of Klebsiella pneumoniae (Shanghai, China) and also creating strategies to combat the persistent challenges created by AMR and developing MDR.5

The authors report no conflicts of interest in this communication.

1. Wang N, Zhan M, Wang T, et al. Long term characteristics of clinical distribution and resistance trends of carbapenem-resistant and extended-spectrum -lactamase Klebsiella pneumoniae infections: 20142022. Infect Drug Resist. 2023;16:12791295. doi:10.2147/IDR.S401807

2. Zhou C, Wu Q, He L, et al. Clinical and molecular characteristics of carbapenem-resistant hypervirulent Klebsiella pneumoniae isolates in a tertiary hospital in shanghai, China. Infect Drug Resist. 2021;14:26972706. doi:10.2147/IDR.S321704

3. Li H-F, Zhang L-X, Zhang W-L, Li J, Y-q L, Hu T-P. Study on virulence genes, drug resistance and molecular epidemiology of Klebsiella pneumoniae with high virulence in inner Mongolia, China. Infect Drug Resist. 2023;Volume 16:11331144. doi:10.2147/IDR.S391468

4. Shen M, Chen X, He J, et al. Antimicrobial resistance patterns, sequence types, virulence and carbapenemase genes of carbapenem-resistant Klebsiella pneumoniae clinical isolates from a tertiary care teaching hospital in Zunyi, China. Infect Drug Resist. 2023;16:637649. doi:10.2147/idr.s398304

5. Gurung S, Kafle S, Dhungel B, et al. Detection of oxa-48 gene in carbapenem-resistant Escherichia coli and Klebsiella pneumoniae from urine samples. Infect Drug Resist. 2020;13:23112321. doi:10.2147/IDR.S259967

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Letter for the article Long Term Characteristics of Clinical Distribut ... - Dove Medical Press

Kayler’s Work Improves Access for Kidney Patients – ubmd.com

Local kidney health activists, transplant recipients and donors met recently at Erie County Medical Center with Liise K. Kayler, MD, clinical professor of surgery and head of the ECMC transplant program, and transplant recipient Barbara Breckenridge, founder of Kidney Health Together,to discuss how to raise awareness about kidney health. From left: Richard Clark, veterans advocate and dialysis patient; Aurelia Keaton, living donor; Esmeralda Sierra, Kidney Health Together board member; Breckenridge; Kayler; Tara Fulgham, dialysis social worker; and Helton Briggs, transplant recipient.

STORY BY ELLEN GOLDBAUM

Of all the organs that can be transplanted, kidneys, by far, are the organ in greatest demand. Kidney failure can take years to develop but there are typically few symptoms until irreparable damage has been done.

After a Transplant, Life Expectancy Doubles

The vast majority of those seeking a kidney transplant are on dialysis. That means that several times a week, individuals must undergo the grueling procedure that does the work that kidneys would normally do, mechanically filtering excess water and waste from the blood.

Less than one-fifth of the 500,000 people in the U.S. currently on dialysis are on the transplant waiting list. And half of the 90,000 patients on the list will die without ever getting a transplant. That reality is all the more devastating in light of this single fact: After a transplant, life expectancy doubles.

As clinical professor of surgery and chief of the Division of Transplant Surgery in the Jacobs School of Medicine and Biomedical Sciences and program director of the Regional Center of Excellence for Transplantation and Kidney Care at Erie County Medical Center, Liise K. Kayler, MD, thinks about that fact every day. She has been laser-focused on how to get more people with end-stage kidney disease transplanted.

Since her arrival, the ECMC transplant program has dramatically improved; the program website states that its kidney transplant waiting times are now some of the shortest in the nation.

But like everyone who works in transplant medicine, Kayler, also a surgeon with UBMD Surgery, was keenly aware of the challenges and cruel ironies that plague kidney transplantation in general. Chief among these is the fact that Black Americans are more than three times as likely as non-Black persons to experience kidney failure but 25% less likely to undergo a transplant, the result of a combination of social and economic disparities.

Kayler saw there were opportunities to make significant improvements.

Standardizing Testing

During the transplant workup period, a patient undergoes a series of medical tests to ensure they are a safe candidate for a transplant. Kayler hired more staff to expedite the requisite testing and standardized the testing so that, wherever possible, it was consistent for all patients.

Brian M. Murray, MD, formerly chief medical officer at ECMC, currently interim chair of the Department of Medicine in the Jacobs School and a physician with UBMD Internal Medicine, explains that Kayler took a comprehensive approach to improving kidney transplant access for all patients.

Dr. Kayler had noticed that the transplant workup period the time from when a patient was referred for transplant to when they were listed for transplant took significantly longer for Black and low-income patients than others, he says. She explored the potential causes for this and suspected that in many cases it was due to social determinants, such as transportation and difficulties accessing care. By assigning patient navigators, the unit was able to improve the speed of workup for all patients.

By 2018, Kayler and her colleagues had built a clinical program that slashed the average time patients spend on the ECMC kidney transplant waiting list. For Black candidates, the number of days spent on the waiting list dropped to 302 from 540.

Dr. Kaylers work has been focused on improving access to transplantable kidneys, both locally and nationwide for patients suffering from advanced chronic renal failure, says Steven D. Schwaitzberg, MD, SUNY Distinguished Professor, chair of the Department of Surgery and president of UBMD Surgery.

Life on dialysis is no picnic, he continues. She is improving the quality of life for many.

Kayler acknowledges these were major improvements. We doubled the rate of timely transplantation for our patients of all races, she says, but if our underserved patients arent at the same level as whites, theres still a disparity.

Kayler conferred with people in UBs Clinical and Translational Science Institute (CTSI) who were experienced in community-based participatory research. Her challenge was to find out how patients with kidney failure could be better empowered to navigate the transplant system. The answer was better patient education through videos and peer mentoring.

We knew that the only way to give culturally tailored information to patients was to have it come from someone like them, Kayler says, someone who knows their challenges.

Such efforts would need to involve health communications, patient education and digital media, skills that arent typically the focus of the training that transplant surgeons go through. It would also require funding, since video animations dont come cheap. Kayler identified an animator, as well as people who did grant writing, so she could explore funding possibilities.

Kayler began holding informal focus groups with patients who provided feedback.

She worked with Thomas Feeley, professor of communication, College of Arts and Sciences, who studies campaigns promoting organ donation. Together, they applied for and were awarded a $1.3 million grant from the Health Research Services Administration of the U.S. Department of Health and Human Services. The grant funded a pilot test of videos designed to improve what patients knew about kidney transplant and about getting a kidney from a live donor.

Focus on Live Kidney Donation

Noting that only 6,000 live kidney donations happen every year in the U.S., the focus on live donor kidney transplantation is critical, Kayler notes. Boosting that number could help solve the donor shortage, she says. Low rates of live donor kidney transplantation are largely the result of knowledge gaps and misperceptions about it among patients and members of their social networks.

The intervention Kayler and Feeley developed in collaboration with community input was a series of two-minute animated videos made for sharing called KidneyTIME. The results were more than promising: 98% of the transplant candidates and their social network members found KidneyTIME informative and engaging; at three weeks follow-up, 77% had viewed it again on their own device and 63% had shared it.

But to truly understand whether the videos were having the intended effect, Kayler knew she needed to compare two groups of patients: one that was exposed to the videos and one that was exposed to the patient education that was the current standard of care. She needed to apply to the NIH to fund a randomized clinical trial.

After months of extensive rewriting and revising, the grant application was finally submitted. In August 2021, NIH awarded Kayler $3.6 million. It was funded on the first try.

The grant was a major boost: It would pay for the testing of the videos and dissemination to the community. Kayler knew it was time to add the perspective that as a surgeon she could never provide that of someone whos gone through a transplant.

She thought immediately of Barbara Breckenridge, a passionate patient advocate, founder of the Kidney Foundation of Western New York and a true kidney transplant success story: It has been more than two decades since her kidney transplant in July 1999.

Living a Normal Life

When I was transplanted with a kidney from a deceased donor, they told me I might get five to seven more years, Breckenridge says. And here I am with 23 years. Patients just need to see somebody who has been transplanted who is living a normal life, so they can say, well if she can do it, I can do it.

In 2021, Kayler and Breckenridge were awarded a seed grant from UBs CTSI to create a community advisory board specifically targeting improved transplantation among Black patients. Established during the pandemic, the board, composed of Kayler, Breckenridge, patients, caregivers, donors and a social worker, meets monthly, mostly on Zoom. The members are passionately united in their goal of promoting kidney transplant for Black patients.

The primary focus is to identify barriers to kidney transplant for Black patients and to brainstorm potential solutions. They are launching a peer mentoring effort so that Black transplant recipients can directly educate other Black patients who are considering a transplant.

But the members, so well versed in the needs of the patients, have found other ways to serve as well. Breckenridge createdKidney Health Together, a volunteer-run, 501c3 organization whose mission is to help kidney patients in Western New York live healthier lives. It operates the Healthy Living Pantry, which provides healthy food choices for kidney patients experiencing food emergencies. Many of these patients are in low socioeconomic groups and cannot work.

The connections that Kayler and her teams, consisting of both hospital staff and community members, have established and nurtured are a result of the commitment that she brought with her to Buffalo and that has been intensifying ever since.

In spite of the many challenges, Kayler says she finds transplant surgery the most fulfilling type of surgery she could do.

I want everybody to be able to get a kidney transplant as soon as possible, she says. I chose transplant surgery because it saves the lives of people who are on the brink of dying, some of whom had given up hope. With every transplant we do, everyone is happy and hopeful the patient, the family, the transplant team, even the hospital leadership.

Its a celebration of life.

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Kayler's Work Improves Access for Kidney Patients - ubmd.com