Category Archives: zJournal articles

Low Usefulness of Potassium Monitoring Among Healthy Young Women Taking Spironolactone for Acne

JAMA Dermatol. Published online March 22, 2015. doi:10.1001/jamadermatol.2015.34

Importance  Spironolactone has been shown to be an effective treatment option for hormonally mediated acne but can cause hyperkalemia. The prevalence of hyperkalemia among healthy young women taking spironolactone for acne is unclear.

Objective  To measure the rate of hyperkalemia in healthy young women taking spironolactone for acne or for an endocrine disorder with associated acne.

Design, Setting, and Participants  Retrospective study of healthy young women taking spironolactone for acne. Data from December 1, 2000, through March 31, 2014, were obtained from a clinical data repository. Outpatient data were collected from 2 tertiary care centers in the United States. We analyzed rates of hyperkalemia in 974 healthy young women taking spironolactone for acne. We also analyzed 1165 healthy young women taking and not taking spironolactone to obtain a profile for the baseline rate of hyperkalemia in this population. Exclusion criteria were cardiovascular disease, renal failure, and the use of medications that affect the renin-angiotensin-aldosterone system.

Main Outcomes and Measures  The rate of hyperkalemia in healthy young women taking spironolactone for acne was calculated. Secondary measures included spironolactone prescriber profiles and potassium monitoring practices.

Results  There were 13 abnormal serum potassium measurements in 1802 measurements obtained among young women receiving spironolactone therapy, yielding a hyperkalemia rate of 0.72%, equivalent to the 0.76% baseline rate of hyperkalemia in this population. Repeat testing in 6 of 13 patients demonstrated normal values, suggesting that these measurements may have been erroneous. In the remaining 7 patients, no action was taken.

Conclusions and Relevance  The rate of hyperkalemia in healthy young women taking spironolactone for acne is equivalent to the baseline rate of hyperkalemia in this population. Routine potassium monitoring is unnecessary for healthy women taking spironolactone for acne.

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MERS surges again, but pandemic jitters ease

Science 20 March 2015:  Vol. 347 no. 6228 pp. 1296-1297
DOI: 10.1126/science.347.6228.1296

The number of infections of the deadly Middle East respiratory syndrome virus surges again in Saudi Arabia, but scientists are less worried that the virus will cause a pandemic than they were 3 years ago. Still, many details about the virus discovered in 2012 and harbored by camels are unclear. New research suggests that many more people than previously thought may have been infected with no or little symptoms. The best way to protect people may be a camel vaccine, and experiments to test two candidate vaccines in camels have just been finished in the United States and Europe.

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The Lancet Infectious Diseases – Contents Pages

Table of Contents |  Volume 15, Issue 4, Pages 361-486 (April 2015)

Selected articles: 

Probiotics to prevent early-life infection

Infectious disease surveillance update

Clinical features for diagnosis of pneumonia in children younger than 5 years: a systematic review and meta-analysis

British Society for Medical Mycology best practice recommendations for the diagnosis of serious fungal diseases

 

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Worldwide barriers to organ donation.

JAMA Neurol. 2015 Jan;72(1):112-8. doi: 10.1001/jamaneurol.2014.3083.

IMPORTANCE:

The disparity between patients awaiting organ transplantation and organ availability increases each year. As a consequence, organ trafficking has emerged and developed into a multibillion-dollar-a-year industry.

OBJECTIVE:

To identify and address barriers to organ donation in the United States and globally.

EVIDENCE REVIEW:

Evidence-based peer-reviewed articles, including prospective and retrospective cohort studies, as well as case series and reports were identified in a PubMed search of organ donation, barriers to organ donation, brain death, donation after cardiac death, and organ trafficking. Additional Internet searches were conducted of national and international transplant and organ donation websites and US Department of Health of Health and Human Services websites. Citation publication dates ranged from August 1, 1968, through June 28, 2014.

FINDINGS:

The lack of standardization of brain death and organ donation criteria worldwide contributes to a loss of potential donors. Major barriers to donation include variable clinical and legal definitions of brain death; inconsistent legal upholding of brain death criteria; racial, ethnic, and religious perspectives on organ donation; and physician discomfort and community misunderstanding of the process of donation after cardiac death. Limited international legislation and oversight of organ donation and transplant has contributed to the dilemma of organ trafficking.

CONCLUSIONS AND RELEVANCE:

An urgent need exists for a global standard on the definition of brain death and donation after death by cardiac criteria to better regulate organ donation and maximize transplantation rates. Unified standards may have a positive effect on limiting organ trafficking.

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Matrix Complications in the Determination of Radium Levels in Hydraulic Fracturing Flowback Water from Marcellus Shale [Letter]

Environ. Sci. Technol. Lett.  2014 Feb  volume  1 (3), pp 204–208;
DOI: 10.1021/ez5000379

The rapid proliferation of horizontal drilling and hydraulic fracturing for natural gas mining has raised concerns about the potential for adverse environmental impacts. One specific concern is the radioactivity content of associated “flowback” wastewater (FBW), which is enhanced with respect to naturally occurring radium (Ra) isotopes. Thus, development and validation of effective methods for analysis of Ra in FBW are critical to appropriate regulatory and safety decision making. Recent government documents have suggested the use of EPA method 903.0 for isotopic Ra determinations. This method has been used effectively to determine Ra levels in drinking water for decades. However, analysis of FBW by this method is questionable because of the remarkably high ionic strength and dissolved solid content observed, particularly in FBW from the Marcellus Shale region. These observations led us to investigate the utility of several common Ra analysis methods using a representative Marcellus Shale FBW sample. Methods examined included wet chemical approaches, such as EPA method 903.0, manganese dioxide (MnO2) preconcentration, and 3M Empore RAD radium disks, and direct measurement techniques such as radon (Rn) emanation and high-purity germanium (HPGe) gamma spectroscopy. Nondestructive HPGe and emanation techniques were effective in determining Ra levels, while wet chemical techniques recovered as little as 1% of 226Ra in the FBW sample studied. Our results question the reliability of wet chemical techniques for the determination of Ra content in Marcellus Shale FBW (because of the remarkably high ionic strength) and suggest that nondestructive approaches are most appropriate for these analyses. For FBW samples with a very high Ra content, large dilutions may allow the use of wet chemical techniques, but detection limit objectives must be considered.

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Technologically Enhanced Naturally Occurring Radioactive Materials (TENORM) Study

Pennsylvania Department of Environmental Protection

On Jan. 15, 2015, the Department of Environmental Protection (DEP) announced the results of its TENORM Study, which analyzed the naturally occurring levels of radioactivity associated with oil and natural gas development in Pennsylvania. While the study outlines recommendations for further study, it concluded there is little potential for harm to workers or the public from radiation exposure due to oil and gas development.

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Workplace bullying: exploring an emerging framework

Work Employment & Society March 6, 2015

To date, emphasis within the literature on workplace bullying has been on gathering empirical data with a focus on individual acts, actors (targets and perpetrators) and consequences. This analytical focus has resulted in an understanding of workplace bullying as fundamentally an individualized phenomenon. This article begins with a brief discussion of the theorization that currently predominates in the workplace violence and bullying literature and the outcomes of this theorizing. An emerging framework, conceptualizing violence broadly, is then outlined for understanding violence and bullying. Through this framework, it is argued that the discourse and research on workplace violence – in all its forms – must explore explicit connections between these social phenomena and the interrelatedness of all forms of oppression. Workplace violence must be examined within a framework where power cannot be separated from social dimensions within and outside the workplace.

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