Hey, Watch your Back!!!, It is not just Swine Flu (H1N1) but much more dangerous HFMD is spreading in China?

Nature, the reputed UK based science magazine posted the following editorial about virus threat in China, oh wait it is not just about H1N1 which is spreading fast world wide. It is not even the SARS that the magazine is reporting about, but "Hand, Foot and Mouth Disorder (HFMD)?. How dangerous this HFMD.........read further!

Editorial

Nature 459, 751-752 (11 June 2009) | doi:10.1038/459751b; Published online 10 June 2009

Watch your back

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Abstract

The H1N1 flu epidemic is not the world's only disease threat.

If you are a health official facing two highly contagious diseases — one that is already killing dozens of people, and another that threatens to kill people by the thousands or millions, but hasn't yet done so — how do you allocate your resources? The answer can be a difficult balancing act, as the situation in China is showing

In 2008, more than 500,000 HFMD infections were reported in China, and 200 people died. This year, as the disease moves through its peak season, similar numbers look possible. There is currently no vaccine to prevent it and no drug to cure it. The best safeguard is good hygiene: HFMD transmission is mainly via saliva and faeces. But even Singapore, renowned for its cleanliness, has had 8,896 cases this year, and had had even more by this time last year. There have also been cases this year in Taiwan, Hong Kong and South Korea.

Lumbar Fusion & Analgesic related Death?

In one of the latest issue of "Spine" (Spine: 1 April 2009 - Volume 34 - Issue 7 - pp 740-747doi: 10.1097/BRS.0b013e31819b2176Surgery), a study related to lumbar fusion and analgesic death been analyzed and reported. The authors claim that the risk of death was higher in those patients who received instrumentation and especially inter vertebral cage placement when compared to bone only fusion??. Though I have not heard any perioperative death or even serious consequences in huge number of spine cases we did in the recent past, this report is a caution to look into the analgesic effect spine fusion, streamlining the usage of analgesics that are less toxic is extremely important.

Mortality After Lumbar Fusion Surgery
Juratli, Sham Maghout MD, MPH; Mirza, Sohail K. MD, MPH; Fulton-Kehoe, Deborah PhD, MPH; Wickizer, Thomas M. PhD; Franklin, Gary M. MD, MPH

Abstract

Study Design. Retrospective population-based cohort study.

Objective. To describe mortality after lumbar fusion surgery in Washington State workers' compensation claimants in the perioperative period and beyond.

Summary of Background Data. Although lumbar fusion surgery can be associated with serious complications, perioperative mortality is generally considered rare. Population-based mortality estimates have been limited to surgery in older adults.

Methods. We identified all Washington State workers' compensation claimants who underwent fusion between January 1994 and December 2001 (n = 2378) and assessed the frequency, timing, and causes of death. Mortality follow-up was concluded in 2004. Death was ascertained from Washington State vital statistics records and from the workers' compensation claims database. Poisson regression was used to obtain age- and gender-adjusted mortality rates. Years of potential life lost, percent of potential life lost, and mean potential life lost were calculated for the leading 5 causes of death and we calculated the risk of death associated with selected predictors.

Results.

Among the 2378 lumbar fusion subjects in the study cohort, 103 were deceased by 2004. The 3-year cumulative mortality rate was 1.93% (95% confidence interval, 1.41%-2.57%). The 90-day perioperative mortality rate was 0.29% (95% confidence interval, 0.11%-0.60%). The risk of perioperative mortality was positively associated with repeat fusions. The age- and gender-adjusted all-cause mortality rate was 3.1 deaths per 1000 worker-years (95% confidence interval, 0.9-9.8).

Analgesic-related deaths were responsible for 21% of all deaths and 31.4% of all potential life lost.

The risk of analgesic-related death was higher among workers who received instrumentation or intervertebral cage devices compared with recipients of bone-only fusions (1.1% vs. 0.0%; P = 0.03) and among workers with degenerative disc disease (age- and gender-adjusted mortality rate ratio, 2.71) (95% confidence interval, 1.17-6.28).

The burden was especially high among subjects between 45 and 54 years old with degenerative disc disease (rate ratio, 7.45).

Conclusion. Analgesic-related deaths are responsible for more deaths and more potential life lost among workers who underwent lumbar fusion than any other cause. Risk of analgesic-related death was especially high among young and middle-aged workers with degenerative disc disease.

© 2009 Lippincott Williams & Wilkins, Inc.