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Medical tourism is gaining momentum as Americans seek cheaper wellness and alternative medicine options from dental work to elective cosmetic or weight loss surgery. A growing number of Americans are willing to travel worldwide, and while risks such as violence towards medical tourists is rare , other risks such as quality of care, infection control and communication challenges with medical staff.

3D-printed organs receive a timetable and surprising price tag. A decade estimate is the soonest these 3D-printed organs could be made available, and costs are expected to be far less expensive and more widely available than traditional organ transplants .

WeightWatchers purchases telehealth platform Sequence, paving way for member access to drugs such as Ozempic and Wegovy. This M&A offers a unique opportunity to pair clinicians with members suffering from obesity and diabetes.

Zavzpret receives FDA approval as a new fast-acting nasal spray to treat acute migraines both with and without aura. Though pricing is still unknown, Pfizer gained the drug through its $11.6 billion buyout of Biohaven Pharmaceuticals last year.

The FDA announces plans to support innovation to prevent, detect, and treat cancer, headlined by strengthening oversight over mammogram facilities. Their latest regulation will require mammography facilities to notify patients about the density of their breasts.

Animal tranquilizer xylazine commanding attention as a mode of street fentanyl supply

The animal tranquilizer xylazine, or tranq, is growing in popularity with ghastly and sickening effect. Tranq causes large wounds incapable of healing despite the way you ingest it, whether injecting, snorting, or smoking it. Infections are highly common and lead to amputation. Another characteristic associated with tranq is the smell of rotting flesh from open and infected wounds, as well as the “tranq walk” where people seem unaware of their surroundings, their sores, and wounds.

• Heroin, being edged out by the more potent and powerful synthetic opioid heroin, was given xylazine as an additive to street fentanyl to make the effects last longer , since fentanyl is not as long lasting as heroin. Xylazine cannot be reversed with Narcan.
  
  
• The White House is looking at xylazine as a potential “emerging threat” , which would trigger the development of a federal plan to address it . Additionally, the US FDA announced it had taken action to stop unlawful imports of xylazine.
  
  
• Xylazine withdrawal can cause intense anxiety and dysphoria. Unfortunately, medications used to treat opioid withdrawal do not work as well with xylazine.

Dr. Joseph D’Orazio, an emergency physician and addiction medicine specialist at Temple University Hospital states: “These wounds were a lot deeper, a lot more severe, there were big necrotic areas,” he said. “They were deep down into tendons. Sometimes you can see the bones, and we were starting to see more patients that were requiring amputations.” He added, “what we’re seeing is the bags of fentanyl sometimes don’t have fentanyl … it’s just xylazine.”

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Assessing ‘super immunity’ Covid claims

Following three years of navigating a pandemic, there are still a group of fortunate people who have never tested positive for Covid. This escape of infection despite repeated exposure deserves further analysis, and perhaps pinpointing genetic cause(s) associated with this heralded super immunity .

Key takeaways

• "We are searching for rare genetic variants that make people resistant to SARS-CoV-2 infection," said Dr. Jean-Laurant Casanova, a pediatric immunologist, geneticist and professor at Rockefeller University in New York. "If we were to discover them, the impact would be significant."
  
  
• "There's a couple of genes that have our attention," said Dr. Andras Spaan, a clinical microbiologist on the team. "One of them, of course, is ACE2," a gene known to help Covid infiltrate the body. An opposing genetic component may exist that prevents ACE2 or similarly functioning genes from allowing a Covid invasion. To identify those protective measures would mean getting closer to developing drugs designed to prevent infection and further spreading of the disease.
  
  
• Jill Hollenbach, a professor in the department of neurology, as well as the department of epidemiology and biostatistics at the University of California, San Francisco, attempts to identify the underlying pathomechanisms explaining asymptomatic Covid cases. To do so, her lab has identified human leukocyte antigen, or HLA, as a target to focus on.

By the digits

• 676 million people around the world have been infected with Covid since March 11th, 2020.
  
  
• 60% of the U.S. population has had Covid according to the CDC.
  
  
• >40% of cases could be asymptomatic.
  
  
• 2 times as likely to have an asymptomatic infection with one copy of the HLA-B*15:01 gene .
  
  
• >8 times as likely to have an asymptomatic infection with two copies of the HLA-B*15:01 gene .
  
  

In summary, NPI numbers are unique identification numbers assigned to healthcare providers in the United States . They are used to identify and track the medical services provided by healthcare providers and to ensure that patients receive the correct medical treatment. Obtaining an NPI number involves completing an application and verifying the provider’s identity and credentials. NPI numbers are important for both healthcare providers and patients , as they help to ensure that healthcare providers are properly compensated for their services and that patients receive the best possible care.

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A 52-year-old man returns to the office for reevaluation of an ulcer on his right great toe. The patient has a 15-year history of diabetes mellitus and takes glipizide and rosiglitazone. He first noticed the ulcer 2 months ago. One month ago, a 14-day course of oral amoxicillin-clavulanate therapy was prescribed. He has smoked one pack of cigarettes daily for the past 37 years. He is 178 cm (5 ft 10 in) tall and weighs 102 kg (225 lb); BMI is 32 kg/m2. Today, vital signs are temperature 38.8°C (101.8°F), pulse 96/min, respirations 12/min, and blood pressure 130/85 mm Hg. Physical examination of the right great toe discloses a 1.5-cm nontender ulcer with a depth of 0.5 cm, a moist base, yellow exudate, and surrounding erythema to the level of the malleoli. Vibration sense and sensation to monofilament examination are absent. Pulses are diminished in both feet. Capillary refill time is 2 seconds in the right great toe. Urinalysis discloses 3+ protein.
Which of the following historical factors or physical examination findings is most strongly associated with development of this patient's foot ulcer?

Which of the following is the most appropriate action at this time?

Seven researchers investigating the prevalence of long Covid in the U.S. determine that the risk is around 5-10% for vaccinated people. Furthermore, they estimate that for unvaccinated people the risk of long Covid is closer to 15-20% .

A large survey of marathon runners found no increased knee or hip osteoarthritis risks associated with the number of years someone had been running, the number of marathons completed, their weekly running mileage, nor their running pace. This new finding goes against the common theory of osteoarthritis as a “wear-and-tear” condition.

Climate change and global warming leading to a stronger, earlier, and longer allergy season, which could eventually trigger a public health emergency. A report released by Climate Central further analyzes the pollen explosion sweeping the country .

Study finds that people with elevated stress levels are more likely to experience a decline in cognitive function. These findings indicate that stress impacts their capacity to remember, concentrate, and learn new things .

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 B) "Neurologic findings" and A) “Begin intravenous antibiotic therapy”

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