Doctors prepare to operate on TB patient
Tue, 17 Jul 2007 16:46:24 GMTBy DON MITCHELL, Associated Press Writer
DENVER - Andrew Speaker, the tuberculosis patient who caused an international public health scare in May, underwent successful surgery Tuesday to remove a diseased portion of his right lung, hospital officials said in a statement.
The surgery was performed at the University of Colorado Hospital in suburban Aurora by Dr. John D. Mitchell, chief of general thoracic surgery at the hospital, and took around two hours.
"Doctors say it went well and everything was routine," the statement said.
Speaker, a 31-year-old Atlanta lawyer, was being treated at National Jewish Medical and Research Center in Denver, which specializes in TB. National Jewish and CU have a long-standing program to jointly treat patients with tuberculosis and other diseases.
Speaker became the focus of a federal investigation and prompted an international uproar when he went ahead with a wedding trip in Europe after health officials said they had advised him not to fly. He also became the first American quarantined by the federal government since 1963 before being taken to National Jewish.
Officials at the Centers for Disease Control and Prevention said in May that tests had indicated Speaker had extensively drug-resistant tuberculosis, or XDR-TB, which is extremely difficult to treat. This month, Speaker's doctors said subsequent testing had found only the less dangerous multidrug-resistant TB.
Speaker told CNN the operation would remove the upper lobe of his right lung with the expectation that it would rid him of the disease.
Doctors at National Jewish had described Speaker as "an excellent candidate" for surgery, and Speaker said it would give him peace of mind. Hospital spokesman William Allstetter said Speaker was expected to remain at the CU Hospital for three to six days, then be transferred back.
"If you're developing TB, even after your treatment, it can come back," Speaker told CNN. "With the amount of treatment I'm going to be on, the doctor said, 'If you go ahead and have the surgery, you don't have to worry 10 years from now or 20 years from now or 30 years now if it's ever going to come back.'"
Army to educate troops on brain injuries
Tue, 17 Jul 2007 20:26:54 GMTBy PAULINE JELINEK, Associated Press Writer
WASHINGTON - The Army is launching an education program to teach 1 million soldiers how to recognize symptoms of brain injuries and Post Traumatic Stress disorder, the two signature injuries of the Iraq war.
The program aims to encourage troops to get treatment — and to help erase the stigma of doing so, Army officials said Tuesday.
Beginning next week, the Army will start a program to educate the entire Army within 90 days, whether at home or overseas, and including active military, the Army Reserves and the Army National Guard.
Everyone is to receive a one-hour briefing on brain injuries and stress, in which teachers will be equipped with videos, slides and a list of expected questions and answers. It will be done through a rarely used "chain teach" program, that is, the subject is taught to leaders, who then teach it to soldiers, continuing down through the Army's chain of command.
The program is one of many being taken by the Army and the Department of Defense to try to keep up with the wounded and injured from an Iraq conflict that has gone on longer than expected — and with a rising number of patients that has overwhelmed the system.
The insurgent tactic of using roadside bombs is the top killer in Iraq and also responsible for brain injuries ranging from mild concussions up to severe trauma. Exposure to combat, especially for long and repeated tours, also has caused increasing stress and mental health problems among soldiers.
Officials say as much as 20 percent of troops are returning from Iraq and Afghanistan with stress symptoms or brain injury.
Envoy China makes strides in AIDS fight
Tue, 17 Jul 2007 20:21:48 GMTBy ANITA CHANG, Associated Press Writer
BEIJING - China has taken significant steps to fight HIV and AIDS, but still must reach out to more patients in the vast country and overcome a lack of cooperation from some government officials, a U.N. AIDS official said Tuesday.
There are an estimated 650,000 people living with HIV in China, according to the most recent government statistics from 2005. HIV gained a foothold in the country largely due to unsanitary blood plasma-buying schemes and tainted blood transfusions.
"I believe that over the last few years there have been serious progress and good results in the fight against AIDS in China and now the challenge is to sustain these efforts," said Peter Piot, executive director of UNAIDS.
He said successes in China include top-level government commitment and transparency, as well as proper funding, availability of antiretroviral drugs and outreach programs.
"I've been coming to China for 14, 15 years and I can say in the first five or six years there was basically no receptivity in terms of the issue," Piot said. "And now today a lot is going on. You look at budgets, systems are being put in place, I think it's really very different."
Piot recently returned from Shangcai county in Henan province, where blood-buying businesses passed HIV to thousands of people in the 1990s. He toured a clinic and AIDS orphanage.
The number of AIDS deaths declined by 50 percent in Henan province between 2002 and last year, said Wang Longde, China's vice minister of health, who also spoke at the U.N. news conference.
Cases of transfusions using infected blood have dropped since the 1990s. The government has banned blood buying, and forbids blood donations by prostitutes and intravenous drug users.
TB patient who fled Ark. hospital found
Tue, 17 Jul 2007 20:13:20 GMTLITTLE ROCK, Ark. - A man with tuberculosis who fled from medical isolation at a hospital was found Tuesday off Interstate 30 near Little Rock, authorities said.
Pulaski County Sheriff's spokesman John Rehrauer said Franklin Greenwood, 50, was being taken back to the University of Arkansas for Medical Sciences hospital.
A district judge had ordered Greenwood placed in isolation on June 29 after he was seen coughing up blood outside of the city's traffic court. Greenwood fled on July 1.
Health officials said Greenwood is contagious but has a form of TB that can be controlled with treatment. They don't believe his TB is drug-resistant, but they want to test him further to determine if he is a safety risk.
A judge last week said health officials could restrain Greenwood with handcuffs, if necessary, to keep him in the hospital for testing.
London scientists find asthmaobesity hormone link
Tue, 17 Jul 2007 15:34:52 GMTLONDON - British scientists have found a link which could explain why obese people are up to twice as likely to have asthma, they said Tuesday.
And the possible answer is not simply that people with asthma have more trouble exercising, according to the researchers.
The experts from King's College and Imperial College, London have discovered a protein which increases appetite in cells closely associated with asthma.
&;We know that people who are obese often find it harder to manage their asthma symptoms and may even respond less well to their asthma treatments,&; said Jenny Versnel, Asthma UK's executive director of research and policy.
&;This research is important because it could potentially help some people with asthma to gain more effective control of their condition.&;
Both asthma and obesity are on the increase in the West, raising interest in possible connections between the conditions.
The new study pinpoints the link as lying in the molecules produced by so-called Th2 immune system cells.
Th2 cells, reacting to irritants like grass pollen, house dust mites and pet allergens, cause inflammation in the lungs and produce proteins which contribute to the development of asthma.
And the researchers demonstrated, for the first time, that Th2 cells also produce a protein, encoded by the gene PMCH , which is known to increase appetite.
&;Our study provides evidence for a possible mechanism linking obesity and asthma,&; said the lead researcher, Dr David Cousins of King's College.
&;However, as people with asthma aren't always obese, we now plan to look at possible genetic polymorphisms, or variations, of PMCH to see the role they play.&;
Professor Tak Lee, director of the MRC-Asthma UK Centre, added: &;Obesity and asthma are major health problems and clarifying the mechanisms responsible for their linkage provides important potential new opportunities for management of both conditions.&;
Since 1980, obesity rates in Britain had risen from six percent in men and eight percent in women to 23 percent in both sexes by 2004, The Guardian newspaper reported.
The number of people with allergies in Britain has risen approximately three-fold in the last 20 years and the country has one of the highest rates of asthma in Europe, said the researchers.
There is a person with asthma in one in five households in Britain, the Asthma UK charity said.
The report was published by the journal Proceedings of the National Academy of Sciences.
Chlamydia common among young women and men
Mon, 16 Jul 2007 21:20:57 GMTNEW YORK - A large number of people between the ages of 14 and 39 years have chlamydia, a sexually transmitted disease, a new report indicates, while gonorrhea, another STD, is less prevalent.
Based on 6,632 people ages 14 to 39 tested for chlamydia and gonorrhea between 1999 and 2002, researchers estimate that 2.2 percent of Americans in this age range -- a little more than 2 out of every 100 -- have Chlamydia infection and that 0.24 percent -- fewer than 1 out of every 400 - have gonorrhea infection.
Sexually active adolescents, especially girls, bear the brunt of chlamydia and gonorrhea infection, according to Dr. S. Deblina Datta and colleagues from the Centers for Disease Control and Prevention, Atlanta. Almost half of those found to have gonorrhea also had chlamydia.
Young women, who are targeted for chlamydia screening and are at risk for long-term effects of the infection, had an &;unacceptably high burden&; of chlamydia infection, Datta and colleagues report in the Annals of Internal Medicine, released today
The data also show roughly equal prevalence of chlamydia and gonorrhea between males and females and disproportionately high rates among non-Hispanic black persons.
Both chlamydia and gonorrhea infection can cause symptoms such as discharge from the vagina or penis, pain with urination, abdominal pain, or no symptoms at all. In women, chlamydia and gonorrhea can lead to infertility. These STDs can also lead to premature birth, low birth weight and serious infections in newborns.
Antibiotic treatment is needed to clear up these STDs, avoid spreading them to partners, and ward off complications.
The current findings, the CDC team concludes, &;support current recommendations&; to screen sexually active girls and young women age 25 years or younger for chlamydia, to retest those with chlamydia, and to co-treat individuals with gonorrhea for chlamydia.
&;Despite the considerable prevalence of chlamydia in males, the value of screening males needs to be better defined,&; they note.
SOURCE: Annals of Internal Medicine, July 17, 2007.
Libya lifts death sentences on medics in HIV case
Tue, 17 Jul 2007 19:48:17 GMTBy Salah Sarrar
TRIPOLI - Libya lifted death sentences on Tuesday against five Bulgarian nurses and a Palestinian doctor convicted of deliberately infecting children with HIV, paving the way for them to be freed after eight years in jail.
The ruling by Libya's highest judicial body, made possible by a financial settlement of $1 million each to the 460 HIV victims' families, fell short of a hoped-for pardon for the medics, who insist they are innocent.
&;The High Judicial Council decided to commute the death sentences against the five Bulgarian nurses and the Palestinian doctor to life-imprisonment terms,&; the judicial body said in a statement.
Bulgaria's allies the United States and the European Union have demanded the nurses be freed, and the case has been a major stumbling block to Libyan leader Muammar Gaddafi's return to the international stage after decades of diplomatic isolation.
Bulgarian prosecutors said they were working to bring all six medics to the Balkan country, a move allowed under a 1984 agreement with Libya. Officials in Sofia have said Bulgarian President Georgi Parvanov could then pardon them.
&;We will do everything necessary for them to come home,&; said Margarita Popova, spokeswoman of Bulgaria's chief prosecutor's office. She could not say how long the process would take.
The six were sentenced to death last year after being convicted of intentionally starting an HIV epidemic at a children's hospital in the city of Benghazi.
The medics say confessions central to their case were extracted under torture and that they are innocent. Foreign HIV experts say the infections started before the six arrived at the hospital and were more likely to be the result of poor hygiene.
The victims' families have also said the case was part of a Western attempt to undermine Muslims and Libya. Fifty-six of the children have died, arousing widespread anger in the North African country.
STILL NOT OVER
Bulgaria, the EU and the United States say Libya has used the medics as scapegoats to deflect criticism of a dilapidated health care sector. A senior U.S. official said Tuesday's ruling was &;a positive step forward,&; but not an end to the ordeal.
&;We are encouraged at the commutation of the death sentences and we hope they will result in a way to let the medics return home,&; said senior State Department official David Welch.
But reaction among the nurses' families in Bulgaria, a poor Balkan country of 7.8 million people which joined the European Union this year, was one of cautious hope.
&;I feel good. But I will feel even better when I see them come at the airport,&; said Zorka Anachkova, mother of nurse Christiana Valcheva. &;The burden will not fall from my heart until I see them home.&;
A spokesman for the Libyan children's families, Idriss Lagha, said the funds for the financial settlement had come from the Benghazi International Fund, which had been financed by the European Union, United States, Bulgaria and Libya.
He added that the families' acceptance of the payout implied they had dropped their complaint against the medical workers.
&;My personal interpretation is that their move is the equivalent of a pardon because the compensation money is the equivalent in Islam to 'blood money', which entails pardon,&; Lagha said.
Sofia's western allies have suggested that not freeing the nurses would hurt Gaddafi's efforts to emerge from isolation, a process he began by scrapping a prohibited weapons program in 2003.
U.S. joins whistleblower suit vs. Fresenius
Tue, 17 Jul 2007 20:16:29 GMTCHICAGO - The U.S. Justice Department said on Tuesday it joined a whistle-blower lawsuit against Fresenius Medical Care AG, the world's biggest dialysis care company, on claims that it defrauded Medicare.
The suit against two units of the German company called Renal Care Group and Renal Care Group Supply Company alleges that claims submitted between 1999 and 2005 for home dialysis supplies and equipment were false.
Fresenius acquired rival Renal Care Group last year for $3.5 billion to boost its presence in the U.S. market. The company contracts with the U.S. government's Medicare health insurance program for the elderly.
A spokeswoman for Fresenius' North American operations was not available for comment.
Kidney or renal failure patients often require dialysis, a procedure which filters waste products from the blood. Medicare will pay companies selling dialysis supplies to patients only if the firms are independent from dialysis facilities and the patient chooses to receive those supplies.
According to the complaint, the company set up a &;sham&; business that was not independent and that existed &;little more than&; to submit bills to the government.
The suit was filed in the U.S. District Court in St. Louis, Missouri by two former employees of the company, Julie Williams and John Martinez.
In 2004, Gambro Healthcare, now part of Fresenius' major rival DaVita Inc., agreed to pay $350 million in criminal fines and civil penalties to settle health care fraud charges with the U.S. Justice Department.
That earlier case included allegations of a &;shell&; company selling supplies to home dialysis patients, and was also based out of the Justice Department's Missouri office.
At the time, it was one of the largest health care fraud settlements reached by the U.S. government.
Under federal law, a private party can file an action on behalf of the government and receive a portion of any recovery.
Fruits veggies dont stop cancer return
Tue, 17 Jul 2007 20:13:36 GMTBy CARLA K. JOHNSON, Associated Press Writer
CHICAGO - Hopes that a diet low in fat and chock-full of fruits and vegetables could prevent the return of breast cancer were dashed Tuesday by a large, seven-year experiment in more than 3,000 women.
The government study found no benefit from a mega-veggies-and-fruit diet over the U.S. recommended servings of five fruits and vegetables a day — more than most Americans get.
Researchers noted that none of the breast cancer survivors lost weight on either diet. That led some experts to suggest that weight loss and exercise should be the next frontier for cancer prevention research. The study appears in Wednesday's Journal of the American Medical Association.
"It sends us back to the drawing board," said Susan Gapstur of Northwestern University's Feinberg School of Medicine, who wasn't involved in the new study but co-wrote an accompanying editorial in the journal.
"Should we really have focused on dietary components like fruits, vegetables and fat?" Gapstur asked. "Or should we be focusing, in addition to diet, on lifestyle factors including physical activity and weight?"
For now, the message for the 2.4 million breast cancer survivors in the United States is that they don't need to go overboard on veggies, researchers said.
"This should really lift some of the guilt if women are feeling, 'I'm just not doing enough,'" said study co-author Marcia Stefanick of Stanford University.
The research was kicked off by a $5 million grant from the late Wal-Mart heir John Walton and got an additional $30 million in support from the National Cancer Institute.
Walton wanted to support a scientific study so cancer survivors wouldn't have to "rely on folklore," said John Pierce, head of cancer prevention at University of California, San Diego, who led the research.
Earlier research on whether a healthy diet prevents breast cancer has shown mixed results. The new study was designed to be more rigorous.
In this experiment, all the women had been successfully treated for early stage breast cancer. Their average age was 53 when the study began.
A group of 1,537 women were randomly assigned to a daily diet that included five vegetable servings, three fruit servings, 16 ounces of vegetable juice and 30 grams of fiber. In most cases, a serving equaled a half-cup. French fries and iceberg lettuce couldn't be counted as vegetables.
The women were allowed to eat meat, but were told to get no more than 15 percent to 20 percent of their calories from fat, a goal they ultimately were unable to achieve.
"That's a tough diet," said Pierce, who ate that way himself along with his staff and the women in the study.
As a comparison, another 1,551 women were assigned to get educational materials about the importance of eating five servings of fruits and vegetables a day.
The women in both groups kept food diaries regularly, but not daily, through the course of the study.
During the next seven years, the cancer returned in about the same proportion of women in both groups: 256 women of the women on the special diet and 262 women in the comparison group. About 10 percent of both groups died during that time, most of them from breast cancer.
It didn't matter whether the breast cancer was the most common type — fueled by hormones — or not; the special diet didn't prevent the cancer from coming back. Those results run counter to a previous study by different researchers that suggested low-fat diets may help prevent the return of the type of breast cancer that is not linked to hormones.
In the mega-veggies group, the women changed their eating habits substantially, mostly by increasing fruits and vegetables to as much as 11 servings a day. They failed to meet the fat target, but did eat 13 percent less in fat calories than did the comparison group.
After one year, women on the high-vegetable diet had 73 percent higher blood levels of carotenoids than the other women. That indicates they were truthful about how many fruits and vegetables they ate, Pierce said.
But they may not have been so honest about the calories they ate. The super-veggie group gained 1.3 pounds and the comparison group gained 0.88 pound, on average.
"There's no question they were underreporting on calories, especially the heavier women," Pierce said, or they would have lost weight.
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