Guidance for diagnosing and managing migraine
Migraine is a major cause of disability, affecting about 12% of people. A 2-part series published in CMAJ (Canadian Medical Association Journal) on diagnosing and managing the condition with both acute and preventive therapy provides guidance for clinicians. https://www.cmaj.ca/lookup/doi/10.1503/cmaj.211969.
“The goal of treatment of migraine attacks is to provide rapid relief from pain and other migraine-related symptoms, to restore patient function and to prevent recurrence,” writes Dr. Tommy Chan, Department of Clinical Neurological Sciences, Western University, London, Ontario, with coauthors.
“A stratified approach to treatment that empowers patients to choose from different options, depending on attack symptoms and severity, and encourages them to combine medications from different classes (e.g., nonsteroidal anti-inflammatory drugs and triptans) for severe or prolonged attacks, is preferred.”
Part 2 of the review, which will be published February 6, focuses on preventive treatment to reduce the frequency and severity of migraine attacks.
Tzankova, V., et al. (2023) Diagnosis and acute management of migraine. Canadian Medical Association Journal. doi.org/10.1503/cmaj.211969.
'Worrisome' deadly fungus spreading through US at alarming rate – Sky News
A drug-resistant and potentially deadly fungus is spreading rapidly through US health facilities, according to a government study.
Researchers from the Centres for Disease Control and Prevention (CDC) reported the fungus, a type of yeast called Candida auris or C. auris, can cause severe illness in people with weakened immune systems.
The number of people diagnosed, as well as the number who were found through screening to be carrying C. auris, has been rising at an alarming rate since the fungus was first reported in the US in 2016.
The fungus was identified in 2009 in Asia, but scientists have said C. auris first appeared around the world about a decade earlier.
Dr Meghan Lyman, chief medical officer of the CDC’s mycotic diseases branch, said the increases, “especially in the most recent years, are really concerning to us”.
“We’ve seen increases not just in areas of ongoing transmission, but also in new areas,” she said.
Dr Lyman also said she was concerned about the increasing number of fungus samples resistant to the common treatments for it.
Dr Waleed Javaid, an epidemiologist and director of infection prevention and control at Mount Sinai Downtown in New York, said the fungus was “worrisome”.
“But we don’t want people who watched ‘The Last Of Us’ to think we’re all going to die,” Dr Javaid said.
“This is an infection that occurs in extremely ill individuals who are usually sick with a lot of other issues.”
Is The Last Of Us’ real ‘zombie’ fungus an actual threat?
The fungus, which can be found on the skin and throughout the body, is not a threat to healthy people.
But about one-third of people who become sick with C. auris die.
The fungus has been detected in more than half of all US states. The number of infections in the US increased by 95% between 2020 and 2021.
Species of fungus discovered in Scotland
Fungal infections ‘increased significantly’ during COVID pandemic
The new research comes as Mississippi is facing a growing outbreak of the fungus.
Since November, 12 people in the state have been infected with four “potentially associated deaths”, according to the state’s health department.
More dead birds found in Caledon could be linked to bird flu
Possible cases of bird flu have been found in Caledon as potential outbreaks of the virus are popping up in Brampton and across southern Ontario.
The City of Brampton issued a warning about two possible avian flu incidents on Friday after dead birds were found in the area of Professor’s Lake and Duncan Foster Valley South.
Now the Town of Caledon says a number of dead birds have also been found in a pond near Coleraine Dr. and Harvest Moon Dr. and that the deaths may be related to bird flu.
The Town has closed a trail in the area out of precaution and says testing is being conducted by the Canadian Wildlife Health Cooperative to determine the birds’ cause of death.
Peel Public Health says that while avian influenza is a threat to birds, the risk to humans is very low.
“Most cases of human avian flu have been traced to handling infected poultry or their droppings,” said Dr. Nicholas Brandon, acting Medical Officer of Health for PPH. “Residents are asked to follow the recommended guidance to limit the spread of avian flu and protect the health and safety of residents and pets.”
Peel Public Health is recommending residents and pet owners are asked to take the following precautions:
- Keep animals away from any waterfowl or fecal matter
- Do not feed or otherwise interact with the waterfowl
- Keep cats indoors
- Keep dogs on a leash (as required under the municipal by-law)
- Do not feed pets (e.g., dogs or cats) any raw meat from game birds or poultry
- Pet birds, if not normally kept indoors, should be restricted to the indoors
- Bird feeders should be removed or washed with soap and water frequently to reduce the chance of bacterial or viral contamination
The cause of the birds’ death in all three of the cases in Peel has not been confirmed but Brampton Animal Services is actively monitoring the areas.
If the birds test negative for Avian Influenza a full necropsy will be conducted to determine the cause of death, the City of Brampton said on Friday.
Last week the Toronto Zoo shut down some of its bird enclosures after an avian flu case was detected at a southern Ontario poultry farm.
A highly pathogenic type of H5N1 avian flu has been tearing through Canadian flocks since early 2022, killing millions of birds and infecting a record number of avian species.
The Canadian Food Inspection Agency detected a case at a commercial poultry operation southeast of Hamilton on Tuesday, the second reported Ontario site in a week after a lull in detected cases going back to the end of December.
With files from The Canadian Press
Developing postoperative delirium associated with a faster rate of cognitive decline, says study
Research published today (March 20) in the JAMA Internal Medicine finds that developing postoperative delirium is associated with a 40% faster rate of cognitive decline over those who do not develop delirium.
“Delirium is associated with faster cognitive decline,” said Zachary J. Kunicki, Ph.D., MS, MPH Assistant Professor located at the Warren Alpert Medical School of Brown University, the first author. “Whether delirium causes this faster rate of decline, or is simply a marker of those who are at risk of experiencing faster rates of decline, is still to be determined.”
“This study has the longest follow-up period of any study examining persons with delirium following surgery,” said Sharon K. Inouye, MD, MPH Director, Aging Brain Center, Hinda and Arthur Marcus Institute for Aging Research, the senior author and principal investigator on the work. “While future studies are needed, this study raises the possibility that delirium may predispose to permanent cognitive decline and potentially dementia. This highlights the importance of delirium prevention to preserve brain health in older adults who undergo surgery,” she said.
Delirium is the most common post-operative complication in older adults and is associated with poor outcomes, including long-term cognitive decline and incident dementia.
Richard N. Jones, ScD, Warren Alpert Medical School of Brown University is co-senior author of the article, “Six-year cognitive trajectory in older adults following major surgery and delirium.”
“The SAGES cohort has followed 560 older adults (age 70 and older), measuring their cognition every six months for 36 months, then annually afterwards for up to six years. Using a detailed cognitive testing battery, comprised of 11 different tests, we found that cognitive changes after surgery are complex and that delirium influences every timepoint. The average cognitive changes seen after surgery include an abrupt drop at one month after surgery, an increase at two months after surgery, a stable period from 6–30 months after surgery, and then steady decline from 3–6 years after surgery.
“Delirium is associated with a sharper drop at one month, greater recovery at two months, and faster decline in all time periods from six months to six years, respectively. The results suggest that either delirium itself may contribute to cognitive decline after surgery, or that delirium may serve to identify those at risk for future more rapid cognitive decline. Future research will be needed to examine whether either or both of these hypotheses best explain the relationship between delirium and cognitive decline,” say the authors.
Six-Year Cognitive Trajectory in Older Adults Following Major Surgery and Delirium, JAMA Internal Medicine (2023). DOI: 10.1001/jamainternalmed.2023.0144
Hebrew SeniorLife Hinda and Arthur Marcus Institute for Aging Research
Developing postoperative delirium associated with a faster rate of cognitive decline, says study (2023, March 20)
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IMF approves Sri Lanka’s $2.9bn bailout – Al Jazeera English
Watch: Bethany Mandel, a conservative author, was asked to define 'woke'. Her response went viral – CNN
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