Whoopi Goldberg’s Pneumonia Nightmare

Academy Award-winning actress Whoopi Goldberg, wanting to raise awareness about the dangers of pneumonia, brought her two physicians to her morning talk show “The View” to recount the close call she had with the illness earlier this year.

The physicians, Jorge Rodriguez, MD, an internist and gastroenterologist, and pulmonologist Martin Greenberg, MD, revealed that Goldberg was so severely ill with pneumonia and sepsis when she came into the hospital, that she had a “one in three” chance of dying from the infection.

Goldberg, 63, reports that she originally got a cough back in November 2018 and thought that it would eventually go away on its own. On February 6, Whoopi says she “didn’t feel well” and called her business partner Tommy Leonardis to say she thought she needed to go to a hospital. He contacted her primary doctor, Rodriguez, who told the audience that when he spoke to her: “I could barely understand Whoopi. Her teeth were chattering, she was gasping for air.” When she told him all she wanted to do is lay down and go to sleep, he became even more concerned. “I tried not to sound scared … I was afraid she wasn’t going to wake up because you don’t know if someone, when they give you those clues ― is she really now just tired or is she going to become unconscious and this is it?”

He arranged for an ambulance to take Goldberg to the hospital where she met Greenberg:

“When I first met Whoopi, she was in a bad way. She had a high fever, she was short of breath, very rapid heart rate, and a low oxygen level, which is not a good sign.”

Goldberg was diagnosed with pneumonia and sepsis. She had a pulmonary effusion which was drained twice. When the effusion reoccurred, a radiologist inserted a tube for an ambulatory chest drainage device (see below).

She was hospitalized for three weeks, and did not return to “The View” until April, and even then, on a part-time basis.

Goldberg hoped that talking about her illness with her doctors would motivate others to be more proactive about their health, saying “It’s OK to go to the doctor because you don’t feel good.”

“The crazy thing is people don’t take (pneumonia) seriously,” Goldberg acknowledged, admitting that she didn’t initially. “I just (tried to) fight through it, and you can’t do that. It will kill you. Inactivity, not doing anything, not checking, will kill you.”

“So, get your ego together and say ‘yeah I’m going to the doctor because I don’t feel good.’ You’d rather be alive bitching about it than be dead.”

Pneumonia Basics

Pneumonia is a bacterial, viral, or fungal infection of one or both sides of the lungs that causes the air sacs, or alveoli, of the lungs to fill up with fluid or pus. Pneumonia tends to be more serious for children under the age of five, adults over the age of 65, people with certain conditions such as heart failure, diabetes, or COPD (chronic obstructive pulmonary disease), or people who have weak immune systems due to HIV/AIDS, chemotherapy for cancer, or organ or blood and marrow stem cell transplant procedures.

Bacteria are the most common cause of pneumonia in adults. Many types of bacteria can cause bacterial pneumonia. Streptococcus pneumoniae or pneumococcus bacteria is the most common cause of bacterial pneumonia in the U.S.

The term “atypical pneumonia” is applied to pneumonia caused by:

• Legionella pneumophila. This type of pneumonia sometimes is called Legionnaires disease, and it has caused serious outbreaks. Outbreaks have been linked to exposure to cooling towers, whirlpool spas, and decorative fountains.
• Mycoplasma pneumoniae. This is a common type of pneumonia that usually affects people younger than age 40. People who live or work in crowded places like schools, homeless shelters, and prisons are at higher risk for this type of pneumonia. It’s usually mild and responds well to treatment with antibiotics. However, Mycoplasma pneumoniae can be very serious. It may be associated with a skin rash and hemolysis. This type of bacteria is a common cause of “walking pneumonia”.
• Chlamydia pneumoniae. This type of pneumonia can occur all year and often is mild. The infection is most common in people ages 65 to 79.

The influenza or flu virus is the most common cause of viral pneumonia in adults. Respiratory syncytial virus (RSV) is the most common cause of viral pneumonia in children younger than one year old. Other viruses can cause pneumonia such as the common cold virus known as rhinovirus, human parainfluenza virus (HPIV), and human metapneumovirus (HMPV).

Most cases of viral pneumonia are mild. They get better in about one to three weeks without treatment. Some cases are more serious and may require treatment in a hospital. Having viral pneumonia increases the risk of getting a secondary bacterial pneumonia.

Here are some pneumonia statistics in the U.S. from the CDC.

Mortality:

• Number of deaths/yr: 48,632
• Deaths per 100,000 population: 15.1

Emergency department visits:

• Number of visits to emergency departments with pneumonia as the primary diagnosis: 257,000
• For U.S. adults, pneumonia is the most common cause of hospital admissions other than women giving birth. About 1 million adults in the U.S. seek care in a hospital due to pneumonia every year.

Vaccination:

• Percent of adults ages 65 and over who had ever received a pneumococcal vaccination: 69.0%

Pleural Effusion

A pleural effusion is an excessive accumulation of fluid in the pleural space.

There are two types of pleural effusion:

• Transudative pleural effusion is caused by fluid leaking into the pleural space. This is from increased pressure in the blood vessels or a low blood protein count. Heart failure is the most common cause.
• Exudative effusion is caused by blocked blood vessels or lymph vessels, inflammation, infection, lung injury, and tumors.

Pleural effusions are found in at least 40% of bacterial pneumonias. They are divided into three groups:

1. Uncomplicated parapneumonic effusion: An exudative effusion with neutrophils which forms when more pleural fluid is produced than the pleura can reabsorb. It typically resolves with the resolution of the pneumonia.
2. Complicated parapneumonic effusion: Bacterial and neutrophil invasion of the pleural space leads to pleural fluid acidosis, caused by anaerobic metabolism of glucose by the bacteria and neutrophils. Cultures of this fluid are frequently falsely negative, although Gram stain can identify bacteria being present. A deposition of fibrin on both layers of the pleural can lead to loculation of the fluid.
3. Thoracic empyema: Evident bacterial infection of the pleural fluid either in the form of pus or presence of bacteria on Gram stain. Anaerobic bacteria have been cultured from 36-76% of human empyemas.

In addition to an appropriate antibiotic regimen, many pleural effusions and all empyemas need a drainage procedure. As mentioned above, most uncomplicated effusions will resolve on their own with antibiotic treatment alone. Complicated pleural effusions may require drainage, typically by tube thoracostomy (chest tube), typically placed under CT or ultrasound guidance. Empyema usually requires drainage and many patients also undergo thoracoscopic or open debridement of the pleural space.

Thoracostomy tubes are commonly made from PVC or silicone. The majority are fenestrated along the sides of the insertion end, and the tubes have a radiopaque stripe. After placement, the distal end of the tube is connected to a pleura-evac system. There are three chambers of a pleura-evac: suction chamber, water seal chamber, and the collection chamber. The water seal chamber acts as a one-way valve allowing air to escape from gravity, but not to re-enter the thoracic cavity.

Some patients with persistent pleural effusion may have an ambulatory chest drain device placed. These devices use a mechanical one-way valve as an alternative to the traditional underwater drain. They consist of the flutter valve, flutter bags, chest seals, and stoma bags. They are less bulky and allow the patient to be ambulatory, thus, reducing the risk of complications from immobility.

https://www.medpagetoday.com/blogs/celebritydiagnosis/80606

Urban wildlife may be a significant vector for anti-microbial resistant germs

In the cities of developing nations, where unregulated antibiotic use is common and livestock jostle with people amid often unsanitary conditions, scientists have found a potentially troubling vector for the dissemination of anti-microbial resistant (AMR) bacteria — wildlife.

In a paper published today in The Lancet Planetary Health, scientists from the International Livestock Research Institute and the University of Liverpool show that urban wildlife in Nairobi carry a high burden of clinically relevant AMR bacteria, resistant to recently developed drugs the World Health Organization deems critically important to human medicine. It is the first systematic epidemiological survey of a city with wide and robust messages to learn from.

AMR is an increasingly serious threat to public health. Through misuse and overuse of anti-bacterial medication, more and more of the bacterial diseases that were once easily treated with antibiotics have become drug-resistant; these new strains of old germs, sometimes called super-bugs, require expensive and prolonged treatment at best and at worst can be lethal. Public health officials estimate that 700,000 people will die globally this year from AMR and that the annual global death toll could reach 10 million over the next 30 years.

The danger is that an untreatable disease emerges out of the brew of wildlife, livestock and humans that coexist in the urban ecosystems of developing nations. That hasn’t happened yet, but if it were, such a disease is unlikely to remain long in one place. Many cities in Africa, for example, are criss-crossed with rivers, streams and sewage lines that could carry infections throughout the city; beyond that, millions of migratory birds winter in tropical climates and could in a season disperse AMR genes to places as far afield as Norway or Russia.

The scientists involved in the Nairobi study deployed teams of veterinary, medical, environmental and wildlife personnel to sample 99 households randomly chosen from Nairobi’s socio-economically diverse neighborhoods.

The study found higher diversity of AMR in livestock and the environment than humans and wildlife. Rodents and birds were significantly more likely to carry resistance to multiple drugs when exposed to human and livestock waste through poor management practices, a common feature of lower-income neighborhoods.

“This paper shows that contamination of urban environments with AMR is a serious issue. This is not just specific to Nairobi but findings can be extrapolated to other cities in Africa,” said Eric Fèvre, a joint appointee at ILRI and Professor of Veterinary Infectious Diseases at the University of Liverpool. “We tend to think of AMR in primarily medical terms, of developing new drugs and better using old ones. But we need to take an ecological approach to addressing this threat. Urban cities can address this by better urban planning, better waste disposal, better livestock husbandry practices. This can go far toward disrupting AMR exchange between wildlife, livestock and humans.”

James Hassell, lead author of the study, and now working with the Smithsonian Global Health Program says, “Although we found no evidence to suggest that AMR carried by urban wildlife poses a direct threat to human health, that these animals harbor high levels of resistance to drugs used in human and animal medicine is particularly worrisome. Since wildlife are not treated with antibiotics, this is indicative of how pervasive AMR is in urban environments. Species that move freely across cities and further afield could disseminate resistance acquired in urban areas more widely.”

The lesson, says Hassell, is clear: “As many scientists and policymakers are now realizing, we cannot address the rise of antimicrobial resistance without focusing on the environmental, ecological and social settings in which humans exist.”

The research was funded by the Medical Research Council, through the Environmental and Social Ecology of Human Infectious Diseases Initiative (ESEI).

---

Story Source:

Materials provided by University of Liverpool. Note: Content may be edited for style and length.

---

Journal Reference:

1. James M Hassell, Melissa J Ward, Dishon Muloi, Judy M Bettridge, Timothy P Robinson, Sam Kariuki, Allan Ogendo, John Kiiru, Titus Imboma, Erastus K Kang’ethe, Elin M Öghren, Nicola J Williams, Michael Begon, Mark E J Woolhouse, Eric M Fèvre. Clinically relevant antimicrobial resistance at the wildlife–livestock–human interface in Nairobi: an epidemiological study. The Lancet Planetary Health, 2019; 3 (6): e259 DOI: 10.1016/S2542-5196(19)30083-X

https://www.sciencedaily.com/releases/2019/06/190619232337.htm

E-tattoo beats conventional methods at monitoring heart health

ngineers at the University of Texas at Austin have developed a new “e-tattoo” that could enable easier and more accurate heart monitoring than the current technology allows.

Credit: Cockrell School of Engineering, The University of Texas at Austin

According to the National Center for Health, the leading cause of death in Texas is heart disease, which accounted for more than 45,000 deaths across the state in 2017.

Currently, doctors use electrocardiographs (ECG) to monitor the heart – a technology that has not changed in any significant way for almost a century.

Now, Nanshu Lu from the Cockrell School of Engineering and colleagues have developed an electronic tattoo technology – a wearable, graphene-based device that is placed on the skin surface where it measures various electrical and biochemical parameters.

As recently reported in the journal Advanced Science, the lightweight, stretchable device can be placed on skin across the heart for long periods, without causing any significant discomfort. It tracks heart health by simultaneously taking electrocardiograph (ECG) or seismocardiography (SCG) measurements.

With ECG, the rates of electrical activity in the heart are measured for each heartbeat, while SCG measures the associated chest vibrations. The e-tattoo, which is connected to and powered by a Smartphone is the first device to incorporate both ECG and SCG for monitoring of heart health.

Monitoring the heart using ECG alone is not accurate enough to determine heart health properly. However, it does provide useful additional data once combined with SCG measurements, which serve as form of quality control by indicating the accuracy of ECG.

“We can get much greater insight into heart health by the synchronous collection of data from both sources,” says Lu.

Although e-tattoos that take ECG readings are not a new technology, other technologies such as the SCG sensor are usually non-stretchable devices that are awkward and uncomfortable to wear. Now, Lu and colleagues have used a piezoelectric polymer that generates electric charge when it senses mechanical stress to incorporate SCG measurements into the soft stretchy e-tattoo.

The device also includes 3D digital imaging technology that maps chest vibrations so that the optimal position for the device can be identified.

A further advantage over conventional technologies is that unlike ECG, the tattoo eliminates the need to attend a doctor’s appointment, where heart health would only be assessed for a couple of minutes at a time. With the e-tattoo, heart health con be monitored constantly over the course of days.

Lu and colleagues are now working to improve the data collection and storage the device provides, as well as how it is powered; a wireless form of powering would mean the device can be worn for even longer periods.

Recently, the researchers developed a smartphone app that safely stores data and also displays images of the heart beating in real-time.

Source:

https://www.eurekalert.org/pub_releases/2019-06/uota-nee062019.php

https://www.news-medical.net/news/20190621/New-e-tattoo-beats-conventional-methods-at-monitoring-heart-health.aspx

ContraVir Rebounds From Record Low On Positive FDA Feedback

ContraVir Pharmaceuticals Inc CTRV 22.14% shares have been highly volatile of late, with the promise offered by its non-alcoholic steatohepatitis drug cushioning any downside for the stock.

The shares were making a strong upward move Friday from the all-time low reached in the previous trading session.

What Happened

ContraVir, a thinly traded nanocap biotech, said Thursday after the close the FDA has given it positive feedback in response to its pre-IND meeting about its NASH pipeline asset CRV431.

The positive feedback pertained to preclinical data for CRV431, with the regulatory body agreeing with ContraVir’s proposed plan for further preclinical studies to support the development of the asset. The FDA also supported the study design for the NASH IND opening study, the company said.

“We are pleased with the FDA’s positive feedback on the preclinical work we’ve completed to-date, as well their feedback on additional planned studies that will support an IND submission for CRV431 in NASH,” ContraVir CEO Robert Foster said in a statement.

In addition to NASH, the company also has an existing IND for CRV431 in the treatment of hepatitis B virus, or HBV.

An Eventful June

ContraVir effected a 1-for-70 reverse stock split in early June.

Later, on June 6, the company reported preclinical data for CRV431 that showed a significant reduction in the extent of fibrosis in a second animal model of liver fibrosis, which led to a roughly 42% jump in the stock.

The stock also received support from a company release on the publication of a research article on CRV431’s effectiveness in treating HBV in animal models. This sent the stock soaring about 36% on June 11.

Most recently, ContaVir pulled back by about 44% to $5.30 on June 18 on the news of a common stock offering.

The positive regulatory feedback on CRV431 has once again lent support to the stock.

https://www.benzinga.com/general/biotech/19/06/13956160/contravir-rebounds-from-record-low-on-positive-fda-feedback

Conservative legal expert calls surprise bill proposals unconstitutional

A prominent conservative legal expert is warning that congressional moves to regulate surprise out-of-network billing by physicians are unconstitutional and could be challenged in court.

In a new legal brief, Paul Clement, a former Republican solicitor general who led the unsuccessful effort to overturn the Affordable Care Act in 2012, said bipartisan congressional proposals to cap out-of-network rates would violate the takings clause of the Fifth Amendment as well as the First Amendment right to freely associate.

Other legal experts said Clement’s arguments are dubious but could convince lawmakers to back off or water down legislation.

“These are extremely weak constitutional claims—the sorts of claims that, if accepted, would threaten the constitutionality of any kind of legislative price controls,” said Nicholas Bagley, a health law professor at University of Michigan.

Nevertheless, Clement’s brief may foreshadow a court challenge by provider groups or conservative legal groups if Congress passes legislation to protect consumers from surprise out-of-network bills and cap the rates insurers pay for out-of-network services.

The Senate health committee is planning to vote next week on a bipartisan bill that would cap payment for out-of-network care at a regional insurer’s typical negotiated rate. House Energy and Commerce Committee leaders have offered a similar proposal.

With public outrage growing over surprise bills, President Donald Trump and lawmakers of both parties have called for protecting patients from these bills. “A very unpleasant surprise,” Trump said last month. “So this must end.”

Clement, a partner at Kirkland & Ellis who has argued nearly 100 cases before the U.S. Supreme Court, said the proposed legislation “threatens to take property from healthcare providers without just compensation” and “threatens to infringe on providers’ associational activity.”

He argued that any legislation should at least ensure that out-of-network providers who treat patients during an emergency or at an in-network facility receive the prevailing market rate as soon as possible after providing the service. In addition, he said Congress also should require a baseball-style arbitration process as an alternative.

Clement’s office did not respond to a question about whether he wrote the brief on behalf of a particular client.

Physician and hospital groups strongly oppose the Senate health committee’s “benchmarked cap” proposal as well as proposals to require hospitals to bring all their physicians into their insurance networks.

Provider groups didn’t immediately indicate whether they agreed with Clement’s legal analysis or would sue to block legislation. But the American College of Emergency Physicians echoed his arguments.

“While we can’t speak to the legal or constitutional implications of the benchmarking approach of the Senate (health committee) bill, we have very strong concerns about the damaging impact that capping out-of-network reimbursement at the median in-network rate would have on patient access to care,” said Laura Wooster, the association’s associate executive director for public affairs.

Clement wrote that capping or eliminating balance billing would rob providers of the negotiating leverage they have with health plans, forcing them to accept unreasonable network rates. Over time, he said, rates would decline and physician practices would become economically non-viable for both network and out-of-network providers.

But those arguments are unlikely to hold up in court, said Tim Jost, an emeritus health law professor at Washington and Lee University.

“It seems to me a real stretch to say that requiring providers to accept a median in-network rate would be a taking prohibited by the Constitution or a violation of freedom of association,” he said. “Government action has to be pretty extreme to constitute a taking.”

Still, Clement’s arguments “may give cover to politicians who are otherwise opposed to addressing surprise medical billing,” he added.

https://www.modernhealthcare.com/politics-policy/conservative-legal-expert-calls-surprise-bill-proposals-unconstitutional

TDOC ‘very close’ to UnitedHealth deal – Piper

Piper Jaffray’s Sean Wieland praises Teledoc (NYSE:TDOC) after meeting with CEO Jason Gorevic.

Wieland praises the Y/Y bookings growth “across all products and channels.”

The analyst says the CFO search is over, and a UnitedHealth deal is “very close” with announcements expected soon on both matters.

Piper reiterates an Overweight rating and $86 price target.

TDOC shares are up 0.4% to $63.04.

Teledoc has a Buy average Sell Side rating.

https://seekingalpha.com/news/3473061-tdoc-very-close-unitedhealth-deal-piper

Iterum started at Buy by Wainwright

Target $17

https://www.benzinga.com/stock/ITRM/ratings