COVID-19 pandemic (2019-21)
3 Tick-borne Diseases, Mpox Added To List Of Notifiable Diseases, Illnesses In N.S.
© CBC Nova Scotia is adding three tick-borne diseases to its list of notifiable diseases and conditions, along with Mpox. Nova Scotia is adding four diseases — three related to tick bites — to the list of illnesses and conditions that health-care professionals and lab staff must report to Public Health upon observation.
The tick-borne diseases anaplasmosis, babesiosis and Powassan virus, along with mpox, are being added to a list that includes other diseases and conditions such as cholera, Ebola, measles, rabies, shellfish poisoning and typhoid.
Jennifer Heatley, executive director of Public Health, said the most recent additions come because they're viewed as emerging issues. There is also a clause in the Reporting of Notifiable Diseases and Conditions Regulations that requires any unusual incidents of disease to be reported to Public Health.
Mpox, previously known as monkey pox, is something that previously fit the latter category because, although it's a known disease, it had not previously been seen in Canada.
"Now that we know it's here, we don't want to forever rely upon that unusual-incidence category," she said.
"We want to actually build it into the regulations and that helps it be clear for health-care providers what their responsibilities are in terms of reporting."
Heatley said the tick-borne diseases are being added on the advice of epidemiologists and Public Health staff.
"It's something we want to watch for," she said.
"We know that the blacklegged tick population is endemic. It's here to stay. It's not going away. So, I think with that knowledge we want to make sure that we're monitoring the situation."
Although Lyme disease is most associated with tick bites, Heatley said Public Health is shifting its education away from being specific to Lyme. Instead, it is focusing on tick-borne diseases because the main goal is to help people avoid any kind of tick bite and the symptoms of the respective illnesses are not all the same.
The QEII Health Sciences Centre laboratory is now testing all samples submitted for Lyme disease for anaplasmosis because it was emerging as a disease of unusual occurrence in Nova Scotia, according to a Health Department spokesperson. There have been no reported human cases of Powassan virus.
Rare But Deadly Melioidosis Is A New Infectious Disease Threat
An analysis of soil and water samples in the southern United States has revealed the presence of a rare bacteria called Burkholderia thailandensis that is capable of causing potentially serious infections.
Investigators detected the microbe in water in Texas and Puerto Rico and soil in Mississippi, making it a public health risk, according to a recent report in Emerging Infectious Diseases, a publication from the Centers for Disease Control and Prevention (CDC).
This bacterium is closely related to Burkholderia pseudomallei, which can cause melioidosis, a disease with a fatality rate of 10 to 50 percent, according to the CDC. Although considered less virulent, B. Thailandensis can make people severely ill.
When Was Melioidosis First Discovered in the U.S.?In 2022, the CDC put out a melioidosis health advisory after the first discovery of B. Pseudomallei in the environment in the continental United States. It was identified through sampling of soil and water in the Gulf Coast region of southern Mississippi during an investigation of two human melioidosis cases. A third case in Mississippi was identified in January of this year.
While the federal health agency is still investigating how widespread the bacteria are within the continental United States, the latest version of the CDC Yellow Book, which provides guidance for travel medicine, now warns that melioidosis is locally endemic in areas of the Mississippi Gulf Coast. Also, a May 2023 CDC report alerted laboratory staff that they may face an increased risk for B. Pseudomallei exposure.
Why Happens if You Get Melioidosis?While rare, melioidosis is garnering attention because it is so dangerous. The discovery in the United States of the microorganisms that cause this disease was an unpleasant surprise.
"This is an environmental bacteria that is associated usually with freshwater and swampy areas, typically in Southeast Asia and northern Australia," says William Schaffner, MD, an infectious disease specialist and professor of preventive medicine and health policy at the Vanderbilt University School of Medicine in Nashville, Tennessee. "To have melioidosis show up here in the United States along the Gulf Coast is pretty unusual."
Dr. Schaffner stresses that the disease can be very serious. According to the Cleveland Clinic, the illness can cause fever, weight loss, vomiting, stomach or chest pain, muscle or joint pain, headache, seizures, and rash on the trunk, abdomen, or face. It can infect the lungs, skin, and blood and affect many organs at once, including the heart, brain, liver, kidneys, joints, and eyes.
In severe cases, the disease may lead to pneumonia, multiple abscesses (collections of pus accompanied by swelling and inflammation), and life-threatening septicemia (blood infection).
How Is Melioidosis Treated?Doctors generally prescribe a long course of antibiotics for melioidosis. Treatment generally starts with intravenous (within a vein) antimicrobial therapy for a minimum of two weeks (but up to eight weeks depending on extent of infection), followed by three to six months of oral antimicrobial therapy.
Prompt diagnosis can improve the chances of recovery. Schaffner suggests that a person who shows symptoms and lives in the Gulf Coast may want to request a lab test to confirm whether the illness is melioidosis.
"The microbiology laboratory is your friend," he says. "Once we have the appropriate diagnosis, then we can treat you."
How Do People Get Melioidosis?Humans may develop melioidosis by inhaling contaminated dust or water droplets, swallowing contaminated water, ingesting soil-contaminated food, or exposing skin abrasions or open wounds to contaminated soil.
The CDC emphasizes that the disease rarely spreads person-to-person.
Specific health conditions such as diabetes, chronic kidney disease, chronic lung disease, or excessive alcohol use may put some individuals at higher risk, the CDC notes. Schaffner points out that drinking to excess can cause chronic liver impairment, which leaves a person susceptible to serious sickness.
How Can You Reduce the Risk of Getting Melioidosis?Environmental conditions of the Gulf Coast states appear to be conducive to the growth of the bacteria that cause melioidosis. For those who live in that area, the CDC recommends these precautions:
In addition, CDC health authorities note that a cluster of four melioidosis cases in four U.S. States in 2021 were linked to an imported contaminated aromatherapy spray.
Because injuries can open the door to severe infection, Schaffner advises thoroughly washing any injury (such as a cut or abrasion) with soap and water and seeking medical attention.
"If you start to see an infection develop at your local site of injury, definitely have it looked at," he says.
AI Use In Pharmacotherapy Still In The Early Stages
Detecting drug interactions, discovering new drugs, predicting treatment response, optimizing doses–the list of the potential benefits of artificial intelligence (AI) for pharmacotherapy is long and promising.
And it's not hard to see why. AI has an insatiable appetite for data and the pharmaceutical field has just what it needs: enormous quantities of data. Just think of all the prescriptions that have been entered into computerized systems over the past few decades, given that a single retail or hospital pharmacy can process 500 to 1,500 prescriptions per day.
Such extensive databases are a valuable resource for developing machine learning models that can identify a therapeutic target or determine the risk of developing a side effect, to give just a couple of examples.
In Quebec, number of initiatives are already underway aimed at harnessing AI for applications in pharmacotherapy, including Valence Discovery, a start-up out of Mila. However, there is still a long way to go.
"AI in pharmacotherapy is an emerging field and it's still too early to say which aspects of pharmacotherapy practice will benefit most," said Jean-François Bussières, a clinical professor in Université de Montréal's Faculty of Pharmacy and director of Ste-Justine Hospital's Pharmacy Practice Research Unit. "Artificial Intelligence in the Service of Pharmacotherapy" was the theme of the Faculty of Pharmacy's recent 2023 centenary conference, at which Bussières was a speaker.
No shortage of potential applicationsBussières and his co-authors recently published a narrative review of studies evaluating the feasibility and impact of AI in pharmacotherapy. The team, which includes pharmacist and clinical informatics specialist Maxime Thibault, also developed a machine learning model based on 10 years of drug prescription data from Ste-Justine Hospital. Another ongoing project is a blog that uses AI to identify and categorize published articles that could be of interest to pharmacists.
The research team noticed early on that while scientific articles were lauding the benefits of AI in pharmacotherapy, it was often simply as a computerized decision support tool.
Their literature review found that using AI to manage chronic diseases is a recurring theme in pharmacotherapy, no doubt because these widespread conditions monopolize a significant share of human, material and financial resources in healthcare. For these diseases, AI can be used to "identify what drugs, lab tests and follow-ups are needed to reduce the risk of morbidity, rehospitalization and mortality," the review concluded.
Pharmacogenomics is another area ripe for AI applications but still underdeveloped in Quebec, added Bussières. Pharmacogenomics uses a person's DNA to predict their response to a drug or the optimal dose for treatment. The goal is personalized medicine that tailors treatment and disease prevention to the individual.
"Imagine if we could determine the genotype of all human beings at birth and then store this information in a massive database. Imagine if we could then use this information to predict that someone with such and such a genetic profile is more likely to develop this disease or respond favorably to that drug," said Bussières. "We could significantly improve the efficacy of drug treatments and increase life expectancy."
However, Bussières is quick to point out that genetic testing will never be the only method for determining the best course of treatment, and the final decision must always be made by the care team in collaboration with the patient.
Like it or not, the future is nowWhile the use of AI in pharmacotherapy is still in its infancy, it is important that we take an active interest in this emerging field, said Bussières. He believes that now is the time for people to think about these new technologies and, especially, for teaching people how they work.
This includes future pharmacists. Bussières, who served as director of pharmacy at Ste-Justine from 1996 to 2022, laments the fact that undergraduate and graduate pharmacy programs do not offer basic courses on using and managing databases.
"It's a major gap in our curriculum! All of the software we use in pharmacy are databases, so students need to know at least the basic concepts behind these tools," Bussières argued. "If you don't know how a system works, you're more likely to use it incorrectly and not know how to fix problems that arise."
Understanding the ethical and legal implications of AI is equally important, as is being able to critically analyze any computer-generated solution, Bussières added.
At the end of the day, integrating AI into pharmacotherapy practice in Quebec will require close collaboration between health professionals and AI researchers and developers, as well as a continued commitment to training and developing new skills.
Citation: AI use in pharmacotherapy still in the early stages (2023, June 21) retrieved 21 June 2023 from https://medicalxpress.Com/news/2023-06-ai-pharmacotherapy-early-stages.Html
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