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The U.S. and Mexico are nearing a deal to secure the southern border by countering the influx of fentanyl into the U.S. and tightening the transfer of firearms crossing from the U.S. into Mexico. Mexican military and police, with the help of U.S. law enforcement, will focus on tracking raw materials for fentanyl being shipped to Mexico, finding and shutting down labs that make the deadly synthetic opioid and going after key players in the illicit fentanyl trade.

Rising shortages of critical drugs pose a serious national security risk. According to a report prepared by Democrats on the Senate Homeland Security and Governmental Affairs Committee, from 2021 to 2022 new drug shortages increased by nearly 30%.

Women with advanced endometrial cancer may find a new opportunity to extend life with drug combination of immunotherapy to standard chemotherapy. The findings, which were also presented Monday at the annual meeting of the Society of Gynecologic Oncology in Tampa, Florida, are expected to transform the way cancer doctors treat women in later stages of their disease.

Four sea otters in California have died from a rare strain of the Toxoplasma gondii parasite that scientists said could pose a risk to human health. No cases have been reported in humans yet, but researchers called the otters “important sentinels” of the circulating strain, which could be a risk to people eating seafood or ingesting contaminated water.

Introducing the slightest amount of high-fat and/or high-sugar foods into an individual’s diet can require brain circuitry. This Yale University conducted study digs into the mechanisms of how these snacks change your brain activity to make you like them more.

Closure of ketamine clinic chain shocks veterans successfully battling severe depression, chronic pain, and PTSD

The abrupt closure of a national ketamine clinic chain in the US has left veterans and others with severe depression and PTSD without access to their treatment, prompting questions about the regulation of ketamine treatment and the responsibility of clinics to their patients. Ketamine Wellness Centers, or KWC, blindsided both patients and employees by closing down all thirteen of its locations across nine states.

• Approximately 50 former service members relied on the existing partnership between the U.S. Department of Veterans Affairs and KWC for free ketamine treatments. All of whom are suddenly scrambling for alternatives to treat their severe depression, chronic pain, or PTSD.
  
  
• A study published in the Journal of Affective Disorders in 2021 found that the IV form appeared to be more effective at treating depression than the nasal spray, while previous studies indicated that the IV form has greater potency and longer-lasting antidepressant effects.
  
  
• Following the fallout, many patients and employees are considering banding together and filing a class-action lawsuit alleging medical abandonment by KWC alongside failure to timely notify in order to find another willing provider and allow a window to obtain relevant medical records.

Travis Zubick, a U.S. Navy veteran, who was a patient at the company’s Minnesota location states: “Without the treatment, you’re in your own psychological jail and with it, you have freedom, so it means everything.”

Overall, the Sunshine Act is a crucial step towards increasing transparency in the financial relationships between pharmaceutical and medical device companies and healthcare providers. By making this information available to the public, patients are better able to make informed decisions about their care, and the healthcare industry can be held more accountable. While there have been some controversies surrounding the implementation of the Sunshine Act, it remains a valuable tool for increasing transparency in the healthcare industry.

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Orchestrating the overdue organ transplant system overhaul

The US organ transplant system is set to undergo a major overhaul to increase the efficiency and fairness of organ allocation. The changes proposed by the government will prioritize factors such as medical urgency and likelihood of success and aim to reduce disparities in access to transplants. The plan’s key element appears to be improving the technology that surgeons, transplant coordinators and others have long complained about.

Key takeaways

• The government’s proposal includes shifting the control and power of the system historically held by the United Network for Organ Sharing, more commonly referred to as UNOS, to other outside organizations. UNOS, a nonprofit organization based in Richmond, Virginia, has been the sole manager of the nation’s organ transplant system since being awarded its first contract in 1986, and has operated as a monopoly ever since.
  
  
• “Thousands of patients are dying every year and billions of taxpayer dollars are wasted because of gross mismanagement,” said Sen. Charles E. Grassley (R-Iowa). “The system is rife with fraud, waste and abuse, corruption, even criminality.”
  
  
• “UNOS has allowed the organ donation system to become mismanaged, unsafe and self-enriching. Today’s announcement that [the government] will break up UNOS’s monopoly, and bring in competent and transparent new contractors, is a transformative and unequivocal win for patients.”

By the digits

• 104,000 people are on waiting lists for organs, most of them kidneys.
  
  
• 22 of people die each day awaiting transplants, with poor and minority patients generally faring worse than affluent and white people.
  
  
• $6.5 million annual contract between UNOS and HRSA.
  
  
• $67 million has been committed by the Biden Administration’s 2024 budget for modernization of the transplant network.
  
  
• 21.3% of procured kidneys were not transplanted in 2020, according to the Scientific Registry of Transplant Recipients.

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A 2-year-old girl is brought to the office by her mother for evaluation of fever. You have been the girl's physician since birth. While in the office, the girl stiffens and then has bilateral, symmetrical shaking of her upper and lower extremities; she becomes mildly cyanotic. The episode lasts for approximately 45 seconds, after which she becomes relaxed and appears to fall asleep. Vital signs at this time are temperature 40.0°C (104.0°F), pulse 120/min, and respirations 40/min. On physical examination she has a generally pink complexion and flushed cheeks. She is limp and somnolent and responds with a cry to noxious stimulus. Tympanic membranes are inflamed bilaterally, nose has a scant, clear discharge, and throat is mildly erythematous. Lungs are clear to auscultation except for transmitted upper airway sounds. Heart has rapid rate with a grade 1/6 systolic murmur at the left sternal border. Complete blood count, blood culture, lumbar puncture, and catheterized urine specimen are obtained and sent for stat analysis. Acetaminophen is administered by rectal suppository. Thirty minutes later the patient awakens and is smiling. She is afebrile. Additional history discloses that she was born at term, she had an uneventful neonatal course, she has normal growth and development, and vaccinations are up-to-date. She has never had an episode similar to this.

Initial laboratory results are shown: Blood WBC 10,400/mm3
Neutrophils, segmented 25%
Neutrophils, bands 5%
Lymphocytes 65%
Monocytes 5%
Cerebrospinal fluid 0 RBC/mm3
Urinalysis Normal
Other laboratory studies are pending.

Two weeks later the patient is brought to the office for a follow-up visit. Her mother says that she is doing well and she has had no recurrence of her symptoms. Examination of the ears shows resolution of the otitis media. Which of the following is the most important diagnostic step at this time?

Source of eczema could very well be in the air that we breathe, as rates of the itchy and inflammatory skin condition have linked specific chemicals to eczema “hot spots.” These chemicals include those spewing from vehicle exhaust and those used to make common products such as spandex and memory foam mattresses, study finds.

New research shows that birth control methods using one hormone, such as IUDS, raise breast cancer risk as much as those with a combination of estrogen and progestogen. This relative risk of being diagnosed with breast cancer is 20-30% higher among women who use or recently used birth control pills with a two-hormone combination, progestogen-only pills or hormonal IUDs compared to women who did not.

Fascinating research aims to link the effects of Alzheimer’s disease in the human retina. The study found changes in the retina which correlate with areas responsible for memory, navigation, and the perception of time.

New research suggests that co-infection with superbug bacteria can increase the replication of SARS-CoV-2, the virus that causes COVID-19, potentially leading to more severe disease outcomes. The study highlights the importance of addressing antibiotic resistance and preventing co-infection in COVID-19 patients to avoid potential complications.

Thank you for reading! More next week,

My best wishes for a productive and idea-filled week ahead. Thanks for your ongoing efforts to improve the lives of the patients we all serve. Please send any news, comments, suggestions and ideas to hello@morningmed.email.

Quiz answer: The correct answer is D) "No additional testing"

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