A New Pair of Lungs

Treatment of Gut Fermentation Syndrome With Fecal Microbiota Transplantation

Incorporating Planetary Health Into Clinical Guideline Decisions

Tampering With Evidence: Selective Silencing of Timely Public Health Data

How Would You Manage This Patient With Idiopathic Acute Pancreatitis? Grand Rounds Discussion From Beth Israel Deaconess Medical Center

Acute pancreatitis is among the most frequent gastroenterologic reasons for hospitalization in the United States. This condition is associated with significant morbidity, including recurrent acute pancreatitis and chronic pancreatitis. Although most patient cases are due to biliary disease and ethanol, approximately 18% are idiopathic. Diagnostic and management options for idiopathic acute pancreatitis include genetic testing for a number of associated mutations and cholecystectomy to treat subclinical or undetected biliary disease. Endoscopic retrograde cholangiopancreatography, often with concomitant endoscopic sphincterotomy, is also sometimes considered in the management of idiopathic recurrent acute pancreatitis, although the role of this invasive procedure is generally limited. Here, 2 pancreatologists and coauthors of a recent American College of Gastroenterology guideline on the management of acute pancreatitis discuss issues related to genetic testing, cholecystectomy, and endoscopic retrograde cholangiopancreatography with endoscopic sphincterotomy for patients with acute idiopathic pancreatitis in general, and for a young woman recently diagnosed with this condition.

What She Wouldn’t Tell Me

Milking Cows

Don’t Wait: Palliative Care Referrals Can Be Life-Changing

Bolstering the Medication Supply Chain and Ameliorating Medication Shortages: A Position Paper From the American College of Physicians

The U.S. health care system is experiencing numerous supply chain disruptions, including for important medications. Prescription drug shortages have been at record levels and have affected more drugs in recent years, especially generic sterile injectables and other low-margin medications. These shortages arise from a confluence of factors, including the complexity of the entire production and delivery supply chain, quality issues, outdated manufacturing facilities and practices, drug purchasing policies that prioritize lowest price over reliable production, changes in prescribing and usage patterns, geopolitical constraints, and market concentration, among other factors. When prescription drugs are in shortage, patients face negative health outcomes due to being unable to obtain necessary treatments, the stress associated with securing medications, and adverse effects from alternative treatments. Physicians also face substantial burden in navigating drug shortages because they must expend time and resources in identifying alternative treatment options and obtaining prior authorization for the coverage of alternative drugs, negatively affecting the patient–physician relationship. Policymakers, regulators, manufacturers, health systems, health professionals, and other relevant entities must collaborate to further efforts to ameliorate drug shortages and promote equitable access to treatments. In addition to short-term measures to address the immediate effect of drug shortages, policymakers, manufacturers, and drug purchasers should also undertake efforts to prevent future drug shortages by investing in, strengthening, and diversifying prescription drug supply chains and incentivizing procurement practices that emphasize reliable and sustainable production practices. Such efforts must be undergirded by policies to improve monitoring of and transparency into the prescription drug supply chain.

Maternal Influenza-Like Illness and Neonatal Health During the 1918 Influenza Pandemic in a Swiss City

Exposure to the 1918 influenza pandemic may have been associated with preterm birth (<37 weeks). Other outcomes, such as infant size or weight, have rarely been explored. Using 2177 historical birth records from University Maternity Hospital of Lausanne, it was estimated whether in utero exposure to maternal influenza-like illness (ILI) during the 1918 pandemic was associated with pregnancy outcomes and whether associations varied depending on the trimester of ILI during pregnancy or on fetal sex. Generalized linear models and robust linear models were used to analyze the association between ILI and gestational age, stillbirth, and anthropometric measurements, adjusting on covariates. Analyses were stratified by fetal sex. A total of 282 (13%) women developed ILI during pregnancy. Exposure to ILI was associated with lower anthropometric measurements: low birthweight (LBW; <2500 g) (marginally adjusted percentage was 13.3% compared with 6.9% in the unexposed group; difference, 6.4 percentage points [95% CI, 5.5 to 7.2 percentage points]). There was strong evidence that third trimester exposure was associated with worse adverse pregnancy outcomes, including with LBW (difference, 12.8 percentage points [CI, 11.8 to 13.7 percentage points]) and preterm birth rates (difference, 9.4 percentage points [CI, 8.2 to 10.6 percentage points]). Maternal ILI may have triggered premature birth. The magnitude of the declines in anthropometric parameters was higher among male fetuses, and they had a higher stillbirth rate. For instance, males exposed during the third trimester had their birthweight lowered by 228.4 g (CI, −391.0 to −65.8 g) compared with 126.3 g among females [CI, −256.6 to 4.0 g]. Only 41% of infants exposed to first-trimester ILI were males, suggesting a selection against male fetuses through miscarriage. Our findings may not generalize to the entire population of Lausanne, as 34% of births were home births at the time.