Medical Monday: breaking news from the world of obstetrics and gynecology

Here is some good news on the Zika front. It is been over 45 days without anyone in South Beach Miami contracting Zika virus in from a local mosquito. For this reason Governor Rick Scott has lifted the Zika zone warning in South Beach. Miami's Little River area was cleared earlier this week. Officials are still warning pregnant women to avoid the entire area and to protect against mosquito bites.

Five babies in New York City have been born with Congenital Zika Virus Syndrome. Interestingly, eight other infants have tested positive for Zika virus in New York City but have not shown evidence of the syndrome.

Zika remains a threatening and somewhat mysterious disease. A woman in Columbia has been the subject of study because her Zika virus infection lasted so long. Normally the disease is mild and runs it's course over a few days time. However the pregnant patient in question tested positive for Zika for 107 days after the onset of symptoms. Because of this, researchers speculate that the baby may serve as a reservoir for the virus. When this baby was ultimately born at 37 weeks gestation, it did indeed show microcephaly, indicating that it had been infected by Zika as well. However, interestingly, the baby tested negative for Zika in serum, urine and cerebrospinal fluid. Even though the Zika virus had done it's damage as evidenced by the babies microcephaly, the baby had already developed Zika antibodies prior to birth.

Three experimental Zika vaccines are under development. One of them has finished the first round of human testing then will move to phase 2 trials in the first quarter of 2017. Four or five more Zika vaccines are expected to begin development next year.

Perhaps the most important comments about Zika came from a Dr. Antonio Crespo the Chief Quality Officer at Phillips Hospital at Orlando Health. Writing in the contributors blog for The Hill, Dr. Crespo indicates the northward migration of Zika virus is probably the first of many such diseases. He cautions that the nation's response to Zika and the outcomes that we will see should be studied in preparation for future such threats. 

In other news, youngsters are not the only ones skipping their vaccines. Older people are more vulnerable to influenza, pneumonia and shingles. Vaccines are available for all of these things. 

Young people between the ages of nine and 26 should be vaccinated against the human papilloma virus (HPV). However, vaccination rates in this case fall short of ideal. A new study indicates a counterintuitive result. It turns out that short conversations between Dr. and parents or Dr. and patient are more likely to result in vaccine utilization than are long conversations. Researchers have interpreted this finding by speculating that long conversations raise more doubt than short ones. I would speculate, by contrast, that when a patient shows reluctance or asks questions, the conversation goes longer. Such patients who are disinclined to vaccinate to begin with are less likely to vaccinate even after the conversation takes place. I think the conversations between caregivers and patients need to be as long as they need to be and they certainly very greatly between patients and circumstances. I'm going to file this in the chickens and eggs category.

Also in the chicken and eggs category is the following study. It turns out that researchers have identified a link between pubic hair grooming and sexually transmitted infection (STI) risk. There is a direct relationship between pubic hair grooming and sexually transmitted infection risk. In fact, there is nearly 4 times the likelihood of having an STI among those who are groomed as infrequently as weekly. I ask myself, is this because grooming inherently makes the tissues more vulnerable? Honestly I doubt this. Do those who groom have more partners? Do those who have more partners groom more ? Which comes first?

Officials from the incoming Republican administration have reiterated their plans to repeal the Affordable Care Act (ACA). However reporting on more detailed discussions among leader elect reveals a realistic understanding that this change might take two or three years. They even have a name for their strategy: "repeal and delay".

Meanwhile the American Hospital Association has warned the new administration that "repealing the affordable care act could cost hospitals $165 billion by the middle of the next decade" And "trigger an unprecedented public health crisis". 

Similarly the Urban Institute has reported that 30 million people stand to lose coverage if the Affordable Care Act is repealed without putting anything in place to replace it.

Many women are aware of the likelihood of some form of curtailment of the ACA, particularly of reproductive health care coverage. A Kaiser study indicates that many women are flocking in to obtain contraceptives, including longer acting methods to see them through a longer period of time.

In the good news department, the Senate has passed a landslide vote ratifying the 21st Century Cures Act. This is a $6.3 billion measure to "increased federal support for medical research, mental health care, and controlling the opioid epidemic". The bill had strong bipartisan support and cleared by a vote of 94 to 5.

We will finish with a fantastic study on the relationship between optimism and health.The Nurses Heath Study is a very long running and large study of 70,000 women between 2004 to 2012. It is been mined for all kinds of research. In this most recent study released out of Harvard Public Health, those with the most optimism had 40% lower risk of heart disease and stroke compared to those with the least optimism. Optimism was linked with lower inflammation and healthier biomarker levels including lipid levels. Researchers concluded that the correlation between optimism and longevity was the result of optimistic people having healthier lifestyles such as diet, sleep patterns, and other factors.


Stay tuned for more breaking news from the exciting world of Obstetrics and Gynecology next week on Medical Monday.