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Candida auris: A mysterious fungus that nobody wants to talk about

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Times Insider explains who we are and what we do, and delivers behind-the-scenes insights into how our journalism comes together.


In 30 years, I’ve never faced so tough a reporting challenge — and one so unexpected. Who wouldn’t want to talk about a fungus?


Last year, I began spade work on a series of articles about drug-resistant microbes: bacteria and fungi that have developed the ability to evade common medicines that we have used for decades.


Early on, I stumbled onto a compelling example. A woman in Alaska named Sari Bailey woke up one morning with green and yellow gunk coming out of her ear. Her doctor told her it was an ear infection and prescribed antibiotics. They didn’t work. Turns out she had a drug-resistant infection that rooted on her mastoid bone, just behind the ear. It nearly killed her and required multiple surgeries to clear.


Her experience showed the pronounced risk of these tenacious bugs and seemed like a good way to draw readers into a story about a very complex scientific topic. But I needed more details, and I needed context: How common was this? What was the science behind it?


When I went looking for answers, I hit my first curious wall. A hospital in Alaska declined my request to speak with a local doctor who has a lot of experience treating people with drug-resistant infections, including another woman who had been hospitalised for seven months fighting a drug-resistant staph infection.


Getting turned away is just another day at work for a reporter. But what made this incident unusual is that, in my experience, the medical community is generally eager to get the word out about public health issues.


From this germ of an observation grew one of the most curious aspects of our series: The rise in resistant bugs is cloaked in widespread and chronic secrecy.


As our reporting continued, we discovered it was common for hospitals, doctors and public health agencies to clam up when it came to talking about their troubles with resistant bugs, though they widely acknowledged the existence of the problem and even encouraged our efforts. This disconnect was at its most extreme when the issue turned to the subject of the first article in our series, which was published online on Saturday — Candida auris.


C. auris is a drug-resistant fungus that has emerged mysteriously around the world, and it is understood to be a clear and present danger. But Connecticut state officials wouldn’t tell us the name of the hospital where they had had a C. auris patient, let alone connect us with her family. Neither would officials in Texas, where the woman was transferred and died. A spokeswoman for the City of Chicago, where C. auris has become rampant in long-term health care facilities, promised to find a family and then stopped returning my calls without explanation.



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Medtronic says won’t recall pacemakers after drug regulator issues alert

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Medtronic India has said it is not recalling its pacemaker models in the country and is in discussion with relevant stakeholders following an alert issued by drug regulator Central Drugs Standard Control Organisation (CDSCO) over the performance of pacemakers.


CDSCO has alerted patients with implants of three Medtronic pacemaker models to seek immediate medical care if they feel certain symptoms that could be signs of the devices’ sudden battery depletion.


Medtronic sells in India, Astra pacemaker, Solara CRT-P and Serena CRT-P.


“We have and continue to communicate proactively with the doctors and relevant stakeholders in India and have informed them about the performance note. There have been no patient issues reported in India related to this performance note,” the statement by the company said.


Stressing that it was “not a case of product recall”, Medtronic India said, “We are in proactive discussion with CDSCO”.


Medtronic has published a performance note about a rare mode in a population of Azure and Astra pacemakers and Percepta, Serena and Solara cardiac resynchronization therapy pacemakers.


“We have received three complaints out of 266,700 devices distributed worldwide since February 2017. The projected rate of occurrence for this issue is 0.0028 per cent, with the most susceptible period being the first 12 months after a device is implanted,” the statement said.


In consultation with company’s independent physician quality panel, “We do not recommend device replacement, and advise physicians to continue normal patient follow-up in accordance with standard practice and, where possible, to continue with remote monitoring,” it added.


“While the devices continue to perform well within reliability projections, Medtronic has implemented additional process and component enhancements that have been reviewed and approved by Food and Drug Administration,” the statement said.


The CDSCO has asked patients with any of the three models to seek immediate medical care if they feel light-headed, dizzy or experience chest pain and loss of consciousness.


The alert by the regulator came after the US Food and Drug Administration raised alarm over the use of the pacemaker models Astra, Serena and Solara.


In its alert on May 7, the USFDA cited a case in which a Medtronic implantable pacemaker or CRT-P battery had fully drained because of a crack in the device’s capacitor, without any warning to the patient or health care provider.


Medtronic’s implantable pacemakers or cardiac resynchronization therapy pacemaker (CRT-Ps) are devices that provide pacing for slow heart rhythms and heart failure pacemakers and CRT-Ps are both implanted under the skin in the upper chest area with connecting insulated wires called leads that go into the heart.


As per the alert by CDSCO, doctors have been recommended to be alert and consider whether elective device replacement is warranted for a pacemaker patient.


“Be aware of sudden battery level drops during follow-up visits and remote transmissions. Watch for decrease in battery level out of proportion to the life of the device from the time of implant even if the level remains within the normal range,” the alert stated.



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India’s drug regulator warns patients against faulty Medtronic pacemakers

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The Indian drug regulator has alerted patients with implants of three Medtronic pacemaker models to seek immediate medical care if they feel light-headed, dizzy or experience chest pain and loss of consciousness, saying these could be signs of the devices’ sudden battery depletion.


The alert by Central Drug Standards Control Organisation (CDSCO) came after the US Food and Drug Administration (USFDA) raised alarm over the use of the pacemaker models Astra, Serena and Solara.


In its alert on May 7, the USFDA cited a case in which a Medtronic implantable pacemaker or CRT-P battery had fully drained because of a crack in the device’s capacitor, without any warning to the patient or health care provider.


If a capacitor in a CRT-P is cracked, it can create an electric short, which can cause the battery to drain earlier than expected.


Medtronic’s implantable pacemakers or cardiac resynchronization therapy pacemakers (CRT-Ps) are devices that provide pacing for slow heart rhythms and heart failure pacemakers and CRT-Ps are both implanted under the skin in the upper chest area with connecting insulated wires called leads that go into the heart.


India’s CDSCO has advised patients to seek immediate medical assistance if they feel dizzy, light-headed, severe short breath or loss of consciousness.


“These may be signs that your device’s battery has had a sudden drop or has drained,” it said.


Doctors have been recommended to be alert and consider whether elective device replacement is warranted for a pacemaker patient.


“Be aware of sudden battery level drops during follow-up visits and remote transmissions. Watch for decrease in battery level out of proportion to the life of the device from the time of implant even if the level remains within the normal range,” the alert stated.


Medtronic reported that healthcare providers were unable to communicate with the device due to battery depletion resulting in loss of pacemaker function. It also reported these events occurred in the US within one year after the patient was implanted with the pacemaker or CRT-P.


One of the reported events resulted in the death of a pacemaker-dependent patient.


In another reported incident, the patient experienced dizziness during follow-up and the healthcare provider was unable to communicate with the device, which resulted in the patient getting their device replaced.


In the third event, there was no harm to the patient because the device was not implanted when the healthcare provider became aware that a connection with the device could not be established.



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Specialised microscope can diagnose skin cancer, perform surgeries: Study

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Scientists have developed a specialised microscope that has the potential to diagnose diseases like skin cancer as well as perform precise surgery without making any incisions in the skin.


According to the study published in the journal Science Advances, the microscope allows medical professionals to pinpoint the exact location of an abnormality, diagnose it and treat it instantly.



“Our technology allows us to scan tissue quickly, and when we see a suspicious or abnormal cell structure, we can perform ultra-precise surgery and selectively treat the unwanted or diseased structure within the tissue — without cutting into the skin,” said Yimei Huang from the University of British Columbia in Canada.


It could be used to treat any structure of the body that can be reached by light and requires extremely precise treatment, including nerves or blood vessels in the skin, eye, brain or other vital structures, researchers said.


“For diagnosing and scanning diseases like skin cancer, this could be revolutionary,” said Harvey Lui, professor at the University of British Columbia.


The study shows that the device allows imaging of living tissue up to about one millimetre in depth using an ultrafast infrared laser beam.


Researchers said that this microscope, however, is different from previous technology due to its capability to not only digitally scan living tissue, but also treat the tissue by intensifying the heat produced by the laser.


“We can alter the pathway of blood vessels without impacting any of the surrounding vessels or tissues,” said Lui.


The researchers also said that their aim is to make multiphoton microscope technology more versatile while also increasing its precision.


“We wanted to be able to identify what was happening under the skin from many different angles and to have the capability of imaging different body sites,” said Haishan Zeng from the University of British Columbia.


Developments of a miniature version of the telescope that could be used to perform microscopic examinations and treatment during endoscopy are also underway, researchers said.


“We are not only the first to achieve fast video-rate imaging that enables clinical applications, but also the first to develop this technology for therapeutic uses,” said Zeng.

(Only the headline and picture of this report may have been reworked by the Business Standard staff; the rest of the content is auto-generated from a syndicated feed.)



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