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Superbugs threaten to make infections in hospitals impossible to treat. Here’s why

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Glenn Barr was returning from work one long weekend a few years ago, when he suddenly felt terrible.

The Ottawa resident was soon vomiting blood onto his driveway. A trip to his nurse practitioner and then the emergency department eventually led to a diagnosis of end-stage cirrhosis of the liver, landing him on the transplant list.

After waiting four years to qualify and find a match, this Labour Day marked the second anniversary of his liver transplant. His medical teams were never able to determine what caused his liver damage.

But another part of the transplantation experience that caught him off guard were the half-dozen, hard-to-treat infections he endured. Barr faced fever, aches and diarrhea from the infections, both before and after the surgery.

“I was incredibly sick,” Barr recalled. “The doctors would open up my charts, and if it was a new doctor, you’d hear, ‘Oh my. Oh Glenn.'”

Barr, a 67-year-old electrical contractor, needed many blood transfusions for internal bleeding and a series of procedures to get through the transplant and its complications, including an incision infection that couldn’t be seen on the skin.

Doctors had to cut out the infected tissue and give antibiotics through an IV.

Barr is shown receiving assistance in a hospital bed. After his liver transplantation, surgeons had to remove infected tissue from his incision. (Submitted by Glenn Barr)

“They wouldn’t let me out of the hospital for five weeks, until they were happy that the blood work that they saw was good,” he said.

Increasingly, physicians worry that infections that typically kill people with weakened immune systems will expand to hit Canadians going in for routine surgery, especially as cases of drug-resistant bacterial and fungal pathogens become more common.

Drug or antimicrobial resistance occurs when bacteria, viruses or fungi evolve over time and ultimately stop responding to the treatments that once killed them, making infections harder to treat. Also called superbugs, the World Health Organization has declared these pathogens an urgent global public health threat.

According to a study published in The Lancet medical journal, they killed at least an estimated 1.27 million people worldwide in 2019 alone. And in the U.S., the Centers for Disease Control and Prevention (CDC) reports more than 2.8 million antimicrobial-resistant infections each year.

Deaths from impossible to treat infections

For infectious disease physicians like Dr. Ilan Schwartz, the concern is that people coming to hospital for scheduled surgeries will also acquire infections that are untreatable or extremely difficult to control.

Superbugs threaten much of our modern medicine because they’re resistant to the antibiotics used during routine surgeries or treatments, like C-sections, cancer care and joint replacements. Hospitals are rife with opportunities for potential exposure, including surgical cuts or the use of IVs, ventilators or catheters.

The infections can prolong a patient’s hospital stay for weeks or months, adding to backlogs in already-clogged systems.

Some of the medications Barr takes, post-transplant. (Justin Tang/For CBC News)

“We already do have patients in Canada that are dying of untreatable infection,” said Schwartz, who previously worked in Edmonton but moved to Duke University, in Durham, N.C., last year.

“In this arm’s race against the bacteria, we inevitably lose.”

Gerry Wright, a professor of biochemistry and biomedical studies, works to develop new antibiotics at his lab at McMaster University. For Wright, the trillions of bacteria have the upper hand, thanks to how quickly they reproduce to swap DNA and evolve to gain resistance.

Wright said antibiotics saved his life when a “rumbly tummy” from a foodborne illness years ago in Europe got into his bloodstream and wreaked havoc. When Wright returned to Canada, the bacteria were resistant to oral antibiotics. Like Barr, he needed an IV to treat the infection.

Bacteria with a ‘harder’ M&M shell

One class of bacteria known as Gram negatives pose a particular threat, physicians and microbiologists say.

Wright compared Gram positive bacteria like Staphylococcus aureus, to a plain M&M candy, with a thin coating for antibiotics to penetrate. On the other hand, Gram negative bacteria are like peanut M&Ms, he said, with a much harder shell.

Schwartz agrees. “I think the Gram negatives are what is going to ultimately lead to a catastrophe in health care.”

Wright also suggests the rapid spread of COVID-19 should serve as a wake-up call, showing how quickly pathogens without treatment options can spread.

“We had an enormous lesson given to us — a spanking by nature from COVID,” Wright said. “And instead of learning our lesson, I’m very concerned that what we want to do is completely forget the embarrassment that we got caught unprepared.”

Fungal slime poses particular threat

Globally, experts are also particularly worried about one drug-resistant fungal species, Candida auris.

First identified in Japan in 2009, C. auris are widespread overseas and quickly becoming entrenched in some U.S. states. The CDC estimates that cases of infection (and simply carrying the fungi without symptoms) has tripled in recent years, rising from 476 in 2019, to 1,471 in 2021.

Part of the fungus’s hardiness is thanks to the fact it is encased in slime that protects it from disinfectants. The slime, called a biofilm, makes it tough to stamp out in hospitals and long-term care homes. Plus, fungi also pass easily from one patient to another. When it invades the body, it can be hard to treat.

A medical illustration of Candida auris fungal organisms. (Antibiotic Resistance Coordination and Strategy Unit/CDC)

To take Wright’s M&M coating metaphor a step further, the shells on fungi are even thicker than what’s found on bacteria — more like a watermelon rind.

Schwartz helped document when C. auris first landed in Canada in 2012 — though it is currently less prevalent here than in the U.S. It was introduced when a man from India was transferred to hospital in Manitoba and fluid from his ear infection was found to contain the fungi.

As of Sept. 6, the Public Health Agency of Canada (PHAC) said 48 cases of C. auris have been reported across this country since the first case was identified. In a sign of its rise, though, 31 of the 48 cases have been found since 2019.

Spread the word, not the germ

Schwartz said Canada has dodged a bullet by not having more resistant cases of the fungus. He attributes it to:

  • Having fewer highly sick patients at specialized nursing homes than in the U.S.
  • Careful screening of patients hospitalized from countries known to be at high risk for drug-resistant bacteria and fungi.
  • Plain good luck.

Scientists have several lines of thinking on why Candida auris arose in several places in the world all at once, including global warming, overuse of drugs like antibiotics and environmental changes.

Canada already has patients dying of untreatable infections. Dr. Ilan Schwartz, an infectious disease physician, worries that trend will continue with the growth of drug-resistant bacteria and fungi. (CBC)

Fungal expert Shawn Lockhart favours changes in the microbiome — the sum of all the bacteria, viruses and fungi in and on us — as the reason behind the rise.

He points to a study by scientists at the U.S. National Institutes of Health who compared patients with similar conditions who had C. auris to those who didn’t. People with the fungus showed complete changes in the microbiome of their skin, such as switching from Gram positive to Gram negative.

“That’s a clue that these changes in the microbiome allow it to emerge,” said Lockhart, who is a senior clinical laboratory advisor at the CDC’s mycotic diseases branch in Atlanta.

Drug-resistant microbes, like bacteria and fungi, tend to travel in the same circles, Schwartz said, including in health-care settings around the world, where misuse and overuse of antibiotics and antifungals is rampant.

He’s also concerned the increased use of the drugs outside of medicine, such as in livestock agriculture, can also foster microbial resistance to human medications.

Shawn Lockhart looks at the meningitis-causing fungus Exserohilum rostratum at the CDC’s mycotic lab in Atlanta in 2012. Changes in the microbiome may allow another fungal species, Candida auris, to further emerge, Lockhart says. (Pouya Dianat/The Associated Press)

Schwartz compared antibiotics to fire extinguishers, in that both should be held in reserve. “We don’t want to reach for them until we absolutely have to.”

Pharmaceutical companies haven’t created many new antibiotics in years because there’s little incentive for them, Schwartz said.

What’s more, getting new antibiotics to market anywhere in the world is a challenge because they need to work really well, all at once, without harming us.

Infectious disease doctors in Canada in particular have their hands tied when reaching for the newest antibiotics compared with their U.S. counterparts, noted Schwartz. Last week, the Council of Canadian Academies released a report, Overcoming Resistance, on encouraging pharmaceutical companies to make high-value drugs available in this country. 

Until then, the Canadian focus is on keeping superbugs out of vulnerable settings, like hospitals and long-term care, wherever possible.

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What’s the greatest holiday gift: lips, hair, skin? Give the gift of great skin this holiday season

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Give the gift of great skin this holiday season

Skinstitut Holiday Gift Kits take the stress out of gifting

Toronto, October 31, 2024 – Beauty gifts are at the top of holiday wish lists this year, and Laser Clinics Canada, a leader in advanced beauty treatments and skincare, is taking the pressure out of seasonal shopping. Today, Laser Clincs Canada announces the arrival of its 2024 Holiday Gift Kits, courtesy of Skinstitut, the exclusive skincare line of Laser Clinics Group.

In time for the busy shopping season, the limited-edition Holiday Gifts Kits are available in Laser Clinics locations in the GTA and Ottawa. Clinics are conveniently located in popular shopping centers, including Hillcrest Mall, Square One, CF Sherway Gardens, Scarborough Town Centre, Rideau Centre, Union Station and CF Markville. These limited-edition Kits are available on a first come, first served basis.

“These kits combine our best-selling products, bundled to address the most relevant skin concerns we’re seeing among our clients,” says Christina Ho, Senior Brand & LAM Manager at Laser Clinics Canada. “With several price points available, the kits offer excellent value and suit a variety of gift-giving needs, from those new to cosmeceuticals to those looking to level up their skincare routine. What’s more, these kits are priced with a savings of up to 33 per cent so gift givers can save during the holiday season.

There are two kits to select from, each designed to address key skin concerns and each with a unique theme — Brightening Basics and Hydration Heroes.

Brightening Basics is a mix of everyday essentials for glowing skin for all skin types. The bundle comes in a sleek pink, reusable case and includes three full-sized products: 200ml gentle cleanser, 50ml Moisture Defence (normal skin) and 30ml1% Hyaluronic Complex Serum. The Brightening Basics kit is available at $129, a saving of 33 per cent.

Hydration Heroes is a mix of hydration essentials and active heroes that cater to a wide variety of clients. A perfect stocking stuffer, this bundle includes four deluxe products: Moisture 15 15 ml Defence for normal skin, 10 ml 1% Hyaluronic Complex Serum, 10 ml Retinol Serum and 50 ml Expert Squalane Cleansing Oil. The kit retails at $59.

In addition to the 2024 Holiday Gifts Kits, gift givers can easily add a Laser Clinic Canada gift card to the mix. Offering flexibility, recipients can choose from a wide range of treatments offered by Laser Clinics Canada, or they can expand their collection of exclusive Skinstitut products.

 

Brightening Basics 2024 Holiday Gift Kit by Skinstitut, available exclusively at Laser Clincs Canada clinics and online at skinstitut.ca.

Hydration Heroes 2024 Holiday Gift Kit by Skinstitut – available exclusively at Laser Clincs Canada clinics and online at skinstitut.ca.

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Here is how to prepare your online accounts for when you die

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LONDON (AP) — Most people have accumulated a pile of data — selfies, emails, videos and more — on their social media and digital accounts over their lifetimes. What happens to it when we die?

It’s wise to draft a will spelling out who inherits your physical assets after you’re gone, but don’t forget to take care of your digital estate too. Friends and family might treasure files and posts you’ve left behind, but they could get lost in digital purgatory after you pass away unless you take some simple steps.

Here’s how you can prepare your digital life for your survivors:

Apple

The iPhone maker lets you nominate a “ legacy contact ” who can access your Apple account’s data after you die. The company says it’s a secure way to give trusted people access to photos, files and messages. To set it up you’ll need an Apple device with a fairly recent operating system — iPhones and iPads need iOS or iPadOS 15.2 and MacBooks needs macOS Monterey 12.1.

For iPhones, go to settings, tap Sign-in & Security and then Legacy Contact. You can name one or more people, and they don’t need an Apple ID or device.

You’ll have to share an access key with your contact. It can be a digital version sent electronically, or you can print a copy or save it as a screenshot or PDF.

Take note that there are some types of files you won’t be able to pass on — including digital rights-protected music, movies and passwords stored in Apple’s password manager. Legacy contacts can only access a deceased user’s account for three years before Apple deletes the account.

Google

Google takes a different approach with its Inactive Account Manager, which allows you to share your data with someone if it notices that you’ve stopped using your account.

When setting it up, you need to decide how long Google should wait — from three to 18 months — before considering your account inactive. Once that time is up, Google can notify up to 10 people.

You can write a message informing them you’ve stopped using the account, and, optionally, include a link to download your data. You can choose what types of data they can access — including emails, photos, calendar entries and YouTube videos.

There’s also an option to automatically delete your account after three months of inactivity, so your contacts will have to download any data before that deadline.

Facebook and Instagram

Some social media platforms can preserve accounts for people who have died so that friends and family can honor their memories.

When users of Facebook or Instagram die, parent company Meta says it can memorialize the account if it gets a “valid request” from a friend or family member. Requests can be submitted through an online form.

The social media company strongly recommends Facebook users add a legacy contact to look after their memorial accounts. Legacy contacts can do things like respond to new friend requests and update pinned posts, but they can’t read private messages or remove or alter previous posts. You can only choose one person, who also has to have a Facebook account.

You can also ask Facebook or Instagram to delete a deceased user’s account if you’re a close family member or an executor. You’ll need to send in documents like a death certificate.

TikTok

The video-sharing platform says that if a user has died, people can submit a request to memorialize the account through the settings menu. Go to the Report a Problem section, then Account and profile, then Manage account, where you can report a deceased user.

Once an account has been memorialized, it will be labeled “Remembering.” No one will be able to log into the account, which prevents anyone from editing the profile or using the account to post new content or send messages.

X

It’s not possible to nominate a legacy contact on Elon Musk’s social media site. But family members or an authorized person can submit a request to deactivate a deceased user’s account.

Passwords

Besides the major online services, you’ll probably have dozens if not hundreds of other digital accounts that your survivors might need to access. You could just write all your login credentials down in a notebook and put it somewhere safe. But making a physical copy presents its own vulnerabilities. What if you lose track of it? What if someone finds it?

Instead, consider a password manager that has an emergency access feature. Password managers are digital vaults that you can use to store all your credentials. Some, like Keeper,Bitwarden and NordPass, allow users to nominate one or more trusted contacts who can access their keys in case of an emergency such as a death.

But there are a few catches: Those contacts also need to use the same password manager and you might have to pay for the service.

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Is there a tech challenge you need help figuring out? Write to us at onetechtip@ap.org with your questions.

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Pediatric group says doctors should regularly screen kids for reading difficulties

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The Canadian Paediatric Society says doctors should regularly screen children for reading difficulties and dyslexia, calling low literacy a “serious public health concern” that can increase the risk of other problems including anxiety, low self-esteem and behavioural issues, with lifelong consequences.

New guidance issued Wednesday says family doctors, nurses, pediatricians and other medical professionals who care for school-aged kids are in a unique position to help struggling readers access educational and specialty supports, noting that identifying problems early couldhelp kids sooner — when it’s more effective — as well as reveal other possible learning or developmental issues.

The 10 recommendations include regular screening for kids aged four to seven, especially if they belong to groups at higher risk of low literacy, including newcomers to Canada, racialized Canadians and Indigenous Peoples. The society says this can be done in a two-to-three-minute office-based assessment.

Other tips encourage doctors to look for conditions often seen among poor readers such as attention-deficit hyperactivity disorder; to advocate for early literacy training for pediatric and family medicine residents; to liaise with schools on behalf of families seeking help; and to push provincial and territorial education ministries to integrate evidence-based phonics instruction into curriculums, starting in kindergarten.

Dr. Scott McLeod, one of the authors and chair of the society’s mental health and developmental disabilities committee, said a key goal is to catch kids who may be falling through the cracks and to better connect families to resources, including quicker targeted help from schools.

“Collaboration in this area is so key because we need to move away from the silos of: everything educational must exist within the educational portfolio,” McLeod said in an interview from Calgary, where he is a developmental pediatrician at Alberta Children’s Hospital.

“Reading, yes, it’s education, but it’s also health because we know that literacy impacts health. So I think that a statement like this opens the window to say: Yes, parents can come to their health-care provider to get advice, get recommendations, hopefully start a collaboration with school teachers.”

McLeod noted that pediatricians already look for signs of low literacy in young children by way of a commonly used tool known as the Rourke Baby Record, which offers a checklist of key topics, such as nutrition and developmental benchmarks, to cover in a well-child appointment.

But he said questions about reading could be “a standing item” in checkups and he hoped the society’s statement to medical professionals who care for children “enhances their confidence in being a strong advocate for the child” while spurring partnerships with others involved in a child’s life such as teachers and psychologists.

The guidance said pediatricians also play a key role in detecting and monitoring conditions that often coexist with difficulty reading such as attention-deficit hyperactivity disorder, but McLeod noted that getting such specific diagnoses typically involves a referral to a specialist, during which time a child continues to struggle.

He also acknowledged that some schools can be slow to act without a specific diagnosis from a specialist, and even then a child may end up on a wait list for school interventions.

“Evidence-based reading instruction shouldn’t have to wait for some of that access to specialized assessments to occur,” he said.

“My hope is that (by) having an existing statement or document written by the Canadian Paediatric Society … we’re able to skip a few steps or have some of the early interventions present,” he said.

McLeod added that obtaining specific assessments from medical specialists is “definitely beneficial and advantageous” to know where a child is at, “but having that sort of clear, thorough assessment shouldn’t be a barrier to intervention starting.”

McLeod said the society was partly spurred to act by 2022’s “Right to Read Inquiry Report” from the Ontario Human Rights Commission, which made 157 recommendations to address inequities related to reading instruction in that province.

He called the new guidelines “a big reminder” to pediatric providers, family doctors, school teachers and psychologists of the importance of literacy.

“Early identification of reading difficulty can truly change the trajectory of a child’s life.”

This report by The Canadian Press was first published Oct. 23, 2024.

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