Urgent Updates – Q2 2023

Pediatric Lyme Disease: Systematic Assessment of Post-Treatment Symptoms and Quality of Life

This study characterized long-term outcomes of pediatric patients with Lyme disease and evaluated the case definition of post-treatment Lyme disease (PTLD) syndrome. Most pediatric patients treated for all stages of Lyme disease reported full resolution of symptoms within 6 months. 22% of pediatric patients reported one or more symptom persisting >6 months, 9% with and 13% without accompanying functional impairment. Full Access: Nature


FDA Approves First RSV Vaccine

On May 3rd, U.S. Food and Drug Administration approved Arexvy, the first respiratory syncytial virus (RSV) vaccine approved for use in the United States. Arexvy is approved for the prevention of lower respiratory tract disease caused by RSV in individuals 60 years of age and older. The safety and effectiveness of Arexvy is based on the FDA’s analysis of data from an ongoing, randomized, placebo-controlled clinical study conducted in the U.S. and internationally. Full Access: FDA


Effects Of Patient Beliefs Regarding the Need for Antibiotics and Prescribing Outcomes on Patient Satisfaction In Urgent-Care Settings

Researchers studied how patient beliefs regarding the need for antibiotics, as measured by expectation scores, and antibiotic prescribing outcome affect patient satisfaction using data from 2,710 urgent-care visits. In this study, patient beliefs regarding the need for antibiotics were significantly associated with patient satisfaction only among patients with moderate-to-high expectation scores for antibiotics. Researchers suggest that decreasing urgent-care patient expectations and beliefs regarding the need for antibiotics may decrease unnecessary prescriptions without negatively impacting patient satisfaction. Full Access: SHEA


Trial of a Multi-Faceted Intervention To Improve Management of Antibiotics for Children Presenting With Respiratory Tract Infections

Amongst children aged 0-9 years presenting to a general practice clinic with respiratory infections, an intervention encompassing risk stratification and caregiver education did not decrease antibiotic dispensing rates or increase hospital admission rates. Full Access: 2minutemedicine


Fentanyl Deaths Have Spiked Among U.S. Children and Teens

In 2021, almost 70,000 US adults fatally overdosed on fentanyl. Little is known about the extent to which the fentanyl crisis has affected the pediatric population. More than 1,500 kids under the age of 20 died from fentanyl in 2021, four times as many as in 2018. The mortality rate from fentanyl soared more than 300 percent during that period, from 0.47 per 100,000 children to 1.92 per 100,000, she found. In 2021, 40 infants and 93 children 1 to 4 years of age died from fentanyl. Full Access: Science News


Outbreak of Suspected Fungal Meningitis in U.S. Patients who Underwent Surgical Procedures under Epidural Anesthesia in Matamoros, Mexico

The Centers for Disease Control and Prevention (CDC) is issuing this Health Alert Network (HAN) Health Update to supplement the CDC HAN Health Advisory issued on May 17, 2023. This Health Update provides updates on the status of the ongoing fungal meningitis outbreak and highlights interim recommendations for diagnosis and treatment. Full Access: CDC


The Rising Importance of Urgent Care in the Fight Against the STI Epidemic

After a brief hiatus during the peak of the COVID-19 pandemic, the rate of new sexually transmitted infections has resumed at epidemic rates in the United States. With many specialty STI clinics having closed, Urgent Care may be better positioned than ever to help curb their spread. Full Access: JUCM


The Mifepristone Case and the Legitimacy of the FDA

Recently, for what appears to be the first time in history, a federal court in Texas invalidated the US Food and Drug Administration’s (FDA) approval of a drug—after more than 20 years on the market with a strong safety and efficacy record. The drug, mifepristone, blocks progesterone and has a range of uses, from treatment for Cushing syndrome to, when used together with misoprostol, ending a pregnancy, and managing miscarriage. The 2-drug regimen is used for more than 50% of abortions in the US. Full Access: JAMA


Ectopic Pregnancy and Lifesaving Care

Ectopic pregnancy accounts for approximately 2% of all reported pregnancies according to the Centers for Disease Control and Prevention.  In the first trimester, ectopic pregnancies are the most common cause of pregnancy-related death, accounting for 2.7% of these deaths. Ectopic pregnancies cannot be relocated to the endometrial cavity and thus lack potential to safely progress to birth. Given these facts, treatment of an ectopic pregnancy is incontrovertibly necessary and lifesaving care; denying or restricting such care would be both unethical and illegal. Full Access: JAMA


Here’s What to Know About Xylazine, aka Tranq, the Animal Tranquilizer Increasingly Found in Illicit Fentanyl Samples

Veterinarians have used this sedative and pain reliever for half a century, but it has never been approved for human use. And yet, it is increasingly being detected in the illicit US drug supply from coast-to-coast—typically combined with fentanyl or heroin—and in drug overdoses. Full Access: JAMA


 Management of Pilonidal Disease – A Review

Pilonidal disease is associated with significant physical and psychosocial morbidity. Optimal treatments will minimize disease and treatment-associated morbidity. There is a need for standardization of definitions used to characterize pilonidal disease and its outcomes to develop evidence-based treatment algorithms. Full Access: JAMA


Notes from the Field: Pediatric Intracranial Infections — Clark County, Nevada, January–December 2022

In October 2022, the Southern Nevada Health District (SNHD) was notified of a higher-than-expected number of pediatric patients hospitalized with intracranial abscesses; similar concerns were previously reported nationally. This rare infection is associated with significant morbidity. Full Access: CDC


Kidney Ultrasonography After First Febrile Urinary Tract Infection in Children – A Systematic Review and Meta-analysis

In this systematic review and meta-analysis of 29 studies and 9170 children, the prevalence of abnormalities detected on kidney ultrasonography was 22.1%. Of the 8 studies with 2569 children that reported clinically important abnormalities, the prevalence was 3.1%. This study results suggest that 1 in 4 to 5 children with a first febrile UTI will have a urinary tract abnormality detected on kidney ultrasonography and 1 in 32 will have an abnormality that changes clinical management. Full Access: JAMA


Are Children with Prolonged Fever at A Higher Risk For Serious Illness? A Prospective Observational Study

Children with fever ≥5 days and their risks for serious bacterial infection (SBI) were compared with children with fever <5 days, including diagnostic accuracy of non-specific symptoms, warning signs and C-reactive protein (CRP; mg/L). Incidence of SBI in children with fever ≥5 days was higher than in those with fever <5 days (8.4% vs 5.7%). Full Access: BMJ