Registry tracks athletes who have ICDs
Mon, 20 Aug 2007 20:39:56 GMTBy LAURAN NEERGAARD, AP Medical Writer
WASHINGTON - If you have a heart-zapping defibrillator implanted in your chest, you're not supposed to compete in sports any more intense than bowling or golf. Lots of patients ignore those guidelines, trying everything from school basketball teams and community tennis leagues to running marathons and rock climbing — although no one knows if the life-saving implants work as well under that kind of stress.
A new nationwide registry is recruiting these determined athletes, aiming to track them and finally settle whether they're taking a big risk in pursuing a beloved sport.
Do their hearts need shocking more often than if they sat on the sidelines or tried gentler exercise? Do the implants fire hard enough to overcome the physical duress and surge of adrenalin? Could a sport's repetitive motions or a hit to the chest break the implants?
With little scientific evidence to tell, leading cardiac guidelines recommend against most competitive sports for recipients of "implantable cardioverter defibrillators," or ICDs.
But with more teenagers and young adults receiving the implants as a precaution against cardiac arrest — often before they ever have symptoms — how much to curtail activity is becoming a tougher question.
"We all take care of patients with ICDs and we know that lots of them just say, 'I don't care what you say, I'm going to do this anyway,'" says Dr. Rachel Lampert, a heart specialist at Yale University School of Medicine who is leading the new study.
"We should try to gain some data on whether it is or isn't safe."
More than 100,000 defibrillators are implanted a year in people at risk of a life-threatening irregular heartbeat, because of damage from a survived heart attack, genetic disorders or other conditions. An implanted defibrillator constantly checks for abnormal beats and automatically zaps the heart to short-circuit any dangerous arrhythmia it senses forming.
The past decade brought a major shift: Defibrillators once were implanted mostly to prevent a second cardiac arrest in lucky first-time survivors. Now, at least than 60 percent are implanted as a precaution to prevent that first strike, says Dr. Bruce Lindsay of Washington University School of Medicine, president of the Heart Rhythm Society.
That's where the most angst occurs. These so-called "primary prevention" patients tend to be younger, healthier and may never have noticed symptoms.
But even people who have survived a cardiac arrest can be reluctant to quit their sport. Among well-known cases: University of Washington basketball player Kayla Burt was allowed to return to the team after her implant; she quit in January 2006 after the defibrillator fired during a game. In the 1990s, basketball player Nick Knapp sued Northwestern University when team doctors benched him because of his defibrillator; he eventually gave up the court battle and played briefly elsewhere.
Amanda Kurovski, 16, of Ankeny, Iowa, got her parents to sign a release saying they knew the consequences so that she could resume high school track and volleyball after getting a defibrillator in July 2006. She was diagnosed with a genetic abnormality in the heart's electrical system called long QT syndrome after her father found her not breathing.
"I could be shocked during this because my heart would be accelerating," she said. "If we want to take that risk, then we can. I wanted to, because I don't like not doing stuff."
Team physicians disqualify defibrillator recipients in college and professional sports more than in high school or community-level competition, but it's judged case-by-case, says Ron Courson, the University of Georgia's sports medicine director and spokesman for the National Athletic Trainers' Association.
How common are athletes with defibrillators? There are no good counts, but a survey of more than 600 heart specialists last year found almost three-quarters had patients who kept competing, particularly in basketball, running and skiing.
Forty percent reported their athlete-patients had experienced ICD shocks during the sport. There were few reports of serious consequences, including two "shock failures" suggesting further treatment was needed, and two people who fell and suffered head injuries when the ICD zapped.
That survey couldn't assess patient safety. Enter the new registry, which is funded by major defibrillator manufacturers but has researchers at influential heart hospitals guiding the research and recruiting 800 patient-athletes.
The registry does not condone competitive sports for defibrillator patients, Lampert stresses.
But when someone like Amanda Kurovski, the Iowa teen, who's competing anyway signs up, it will track his or her medical history and how the implant fires over two years. .
"It's quite likely that arrhythmias will be more likely during sports," says Lampert, whose previous research shows emotion and stress can trigger them. "But if the defibrillator works and the patients are willing to accept that they might get shocked, it's an issue of quality of life."
Whatever the registry finds, athletic trainer Courson offers an important reminder: Most cardiac arrest victims didn't know they were at risk, so ask if your coaches know what to do when someone collapses. An external defibrillator saves lives, too, but only if used within minutes.
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EDITOR'S NOTE — Lauran Neergaard covers health and medical issues for The Associated Press in Washington.
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On the Net:
Cardiac arrest info: http://www.stopcardiacarrest.org
Registry info: http://www.nata.org/documents/ICDstudy.pdf
Univ. researcher fight over repository
Mon, 20 Aug 2007 20:47:29 GMTWASHINGTON - A cancer researcher is asking the Supreme Court to block a decision handing ownership of thousands of blood and tissue samples to a university.
Dr. William Catalona spearheaded creation of a repository of more than 3,500 prostate tissue samples and 100,000 blood samples during a 27-year career at Washington University in St. Louis.
In 2003, Catalona became director of the Clinical Prostate Cancer Program at Northwestern University in Chicago, asking participants in former research efforts that he oversaw at Washington University if they would consent to transferring their tissue to Northwestern.
Donors of 4,000 tissue samples agreed to the transfer, but Washington University sued to keep the samples there, and won rulings from a U.S. District Court judge and the 8th U.S. Circuit Court of Appeals.
In papers filed with the U.S. Supreme Court, Catalona says he and the research participants could suffer irreparable harm if the appeals court decision is allowed to go into effect.
Washington University could use the tissue in studies the patients would find objectionable, or publish research results in a way that could identify the patients, Catalona's lawyers argued, raising the possibility that participants or their family members might be denied health, life or disability insurance.
In June, Dr. Larry Shapiro, dean of Washington University's School of Medicine, called the appeals court decision a precedent that assures the right of research institutions to use repositories without fear they will be taken or disrupted.
A dozen major research universities, as well as the American Cancer Society and associations of medical colleges and universities, had filed briefs supporting Washington University.
Catalona's lawyers asked Justice Samuel Alito to delay the appeals court decision until the full Supreme Court decides whether it will review the case.
Zero trans fat doesnt always mean zero
Sun, 19 Aug 2007 20:57:47 GMTBy STEPHANIE NANO, Associated Press Writer
NEW YORK - Stroll the aisles of any grocery store and you're sure to spot labels declaring "zero grams trans fat" on the front of snack foods, cookies and crackers. But does zero really mean there's NO artery-clogging fat inside?
Maybe, maybe not.
Federal regulations allow food labels to say there's zero grams of trans fat as long as there's less than half a gram per serving. And many packages contain more than what's considered one serving.
"The problem is that often people eat a lot more than one serving," said Dr. Dariush Mozaffarian of Harvard School of Public Health. "In fact, many people eat two to three servings at a time."
Those small amounts of trans fat can add up, said Michael Jacobson of the consumer advocacy Center for Science in the Public Interest. To find out if there might be some trans fat, he said shoppers can check the list of ingredients to see if partially hydrogenated oil — the primary source of trans fat — is included.
"When it says zero grams, that means something different from no trans fat," said Jacobson. His group has urged the government to bar food producers from using any partially hydrogenated oils at all.
The Food and Drug Administration began forcing food companies to list the amount of trans fat on nutrition labels of packaged foods in January 2006. That led many companies to switch to alternative fats.
Trans fat occurs naturally in some dairy and meat products, but the main source is partially hydrogenated oils, formed when hydrogen is added to liquid vegetable oils to harden them.
Consumer groups and health officials have campaigned to get rid of trans fat because it contributes to heart disease by raising levels of LDL or bad cholesterol while lowering HDL or good cholesterol. Fast-food restaurants are switching to trans fat-free oils and New York City and Philadelphia are forcing restaurants to phase out their use of trans fat.
The American Heart Association recommends that people limit trans fats to less than 2 grams per day.
Julie Moss of the FDA's Office of Nutrition, Labeling and Dietary Supplements, said the half-gram threshold for labeling was adopted because it is difficult to measure trans fat at low levels and the same half-gram limit is used for listing saturated fat. She said the FDA would soon be doing consumer research on trans fat labeling, including whether a footnote such as "Keep your intake of trans fat as low as possible" should be added to food labels.
Robert Earl of the Grocery Manufacturers Association said any trans fat in products labeled zero trans fat is likely to be far less than the half-gram threshold. For example, he said, a little partially hydrogenated oil might be used to help seasoning stick.
"I think the industry has been extremely responsive. Most of them were ahead of the curve to either remove or reduce trans fat in most food products," he said.
Earl said shoppers should be looking at the entire food label.
Jacobson is also concerned that people are focusing too much on the trans fat content alone, and not considering other ingredients such as saturated fat, which also raises the risk of heart disease.
"The bigger problem is foods that have no labels at all," Mozaffarian said, citing food served not only at restaurants, but at bakeries, cafeterias and schools.
New York resident Diana Fiorini said she's just recently started paying attention to labels. Holding a box of microwave popcorn at a Manhattan store, she scanned the label and was happy to see that it listed zero grams trans fat.
"I look at the labels. It's still hard to stop yourself when you know you should," she said.
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On the Net:
American Heart Association: http://www.americanheart.org
U.S. official praises SAfrica AIDS plan
Mon, 20 Aug 2007 06:51:46 GMTBy CELEAN JACOBSON, Associated Press Writer
JOHANNESBURG, South Africa - The top U.S. health official praised South Africa's new national AIDS plan on Sunday, but sidestepped questions about the dismissal of a deputy minister seen as a driving force behind the country's program.
South Africa's five-year plan, launched earlier this year, aims to reduce the number of new HIV infections and to extend treatment to 80 percent of those with AIDS by 2011.
South Africa "has constructed a good plan," Mike Leavitt, the U.S. secretary of health and human services, said at the start of his visit. "Now it must be executed in a way that makes good on the prospects it offers and the hope it can provide."
Nearly 1,000 people die of AIDS each day in South Africa and an estimated 1,400 are newly infected with the virus that causes the disease. The government has said it is concerned about the increasing costs of anti-retroviral drugs.
Leavitt was on a four-nation tour to highlight U.S. health care programs in Africa, with a focus on HIV/AIDS and malaria. His visit follows President Bush's call to Congress to double the initial $15 billion funding of the President's Emergency Plan for AIDS Relief, or PEPFAR.
The program helps provide treatment for 1.1 million people worldwide, with more than a million in Africa. But it has been criticized for emphasizing abstinence and fidelity over the use of condoms in its prevention efforts.
The U.S. has invested $600 million this year in South Africa, where an estimated 5.4 million people are infected with the AIDS virus.
There is concern the government's plan could be undermined after South African President Thabo Mbeki — who has long been accused of playing down the AIDS epidemic — fired Nozizwe Madlala-Routledge as deputy health minister.
Madlala-Routledge had won widespread praise for her work in drawing up the new plan. Her boss, Health Minister Manto Tshabalala-Msimang, has been seen as a destructive force because she has questioned the efficacy of AIDS drugs and instead promoted beets and garlic as a remedy.
Mbeki said he fired Madlala-Routledge because she was incapable of working as part of a team.
Leavitt would not comment on the dismissal, but warned that "any country that does not aggressively move" to address the epidemic "will bear the unhappy results."
Briefing reporters, he said he would not be meeting with Tshabalala-Msimang as he had been informed she would be out of the country, and instead would meet with the minister for social development and officials from the health department.
Leavitt will be in South Africa until Aug. 21 before traveling to Mozambique, Tanzania and Rwanda.
Too fat Common virus may be to blame study
Mon, 20 Aug 2007 19:54:18 GMTBy Julie Steenhuysen
CHICAGO - A common virus caused human adult stem cells to turn into fat cells and could explain why some people become obese, U.S. researchers said on Monday.
The research builds on prior studies of adenovirus-36 -- a common cause of respiratory and eye infections -- and it may lead to an obesity vaccine, they said.
&;We're not talking about preventing all types of obesity, but if it is caused by this virus in humans, we want a vaccine to prevent this,&; said Nikhil Dhurandhar, an associate professor at Pennington Biomedical Research Center at Louisiana State University System.
The virus adenovirus-36 or Ad-36, caused animals to pack on the pounds in lab experiments. &;These animals accumulated a lot of fat,&; Dhurandhar said in a telephone interview.
Dhurandhar also has shown that obese people were three times more likely to have been infected with Ad-36 than thin people in a large study of humans.
Now, researchers in Dhurandhar's lab have shown that exposure to the virus caused adult human stem cells to turn into fat-storing cells.
Dr. Magdalena Pasarica, who led the study, obtained adult stem cells from fat tissue of people who had undergone liposuction. Stem cells are a type of master cell that exist in an immature form and give rise to more specialized cells.
Half of the stem cells were exposed to the virus Ad-36. After a week, most of the infected stem cells developed into fat cells, while the uninfected cells were unchanged.
Pasarica presented her findings at a meeting of the American Chemical Society in Boston.
&;The virus appears to change their commitment to a fat storing cell,&; Dhurandhar said, adding that Ad-36 is just one of 10 pathogens linked to obesity and that more may be out there.
He acknowledged that some people might find it hard to believe that a virus could be responsible for obesity.
&;Certainly overeating has something to do with gaining weight. No doubt about that. But that is not the whole truth,&; Dhurandhar said. &;There are multiple causes of obesity. They range from simple overeating to genes to metabolism and perhaps viruses and infections.&;
Long term, he said he hoped to develop a vaccine and perhaps treatments for the virus. But first, he and colleagues need to better understand the role of Ad-36 in human obesity, he said.
Globally, around 400 million people are obese, including 20 million children under age 5, according to the World Health Organization.
Sarkozy returns to face economic woes
Mon, 20 Aug 2007 16:23:35 GMTBy Anna Willard
PARIS - French President Nicolas Sarkozy returned from holiday on Monday to face a sluggish economy, a court decision to scrap a tax break he promised, and a scandal over a pedophile who says a prison doctor gave him Viagra.
Sarkozy has been riding a wave of popularity since he was elected in May, pushing through a package of fiscal measures to help homeowners and workers on overtime, toughening sentencing for criminals and giving universities more independence.
But there are signs that the honeymoon is coming to an end and that he could face a much tougher autumn.
Economic growth and job creation stumbled in the second quarter, a top court has overturned a mortgage tax break for some homeowners, and questions over the new criminal law were raised by the case of a pedophile accused of reoffending and who says he was on Viagra.
Sarkozy's response was to call three ministerial meetings on his first day back at work after a two-week break in a luxury villa in the United States, to discuss the economy, immigration and dangerous criminals.
At a news conference, he focused on measures to clamp down on sex offenders, saying they would have to accept treatment or move to a secure hospital if doctors judged they were still dangerous after they had served their prison sentence.
&;We cannot leave free predators, sick people, people who can kill and destroy children's lives,&; Sarkozy said.
CLOUDS OVER THE ECONOMY
While Sarkozy and ministers gave little away on the discussions on the economy, Sarkozy's spokesman, David Martinon, said the talks had touched on ways to boost investment and how to respond to the court decision on mortgage tax relief.
&;Economic and financial clouds overshadow Sarkozy's return,&; said a headline on the front page of Les Echos newspaper, and opposition politicians have attacked his economic record.
Economy Minister Christine Lagarde has said the government is sticking to its 2.25 percent growth forecast for 2007, despite the second quarter growth of just 0.3 percent, provoking criticism from opposition politicians.
&;When the economy minister...says that the French economy is doing well, the minister is either missing some information... or there is a lack of transparency,&; Socialist leader Francois Hollande said on Saturday.
One of the first bills expected to come before parliament when it returns in the autumn aims to toughen immigration rules.
Sarkozy also has plans for pension reform for the public sector and a new labor contract. Both of these are likely to be unpopular with unions already angry about public sector job cuts and new rules on maintaining transport service during strikes.
Communist Party leader Marie-George Buffet on Monday called for a &;large popular gathering&; in the autumn to discuss Sarkozy's &;reactionary policies.&;
But the main opposition parties are still having trouble finding a coherent message after the election and have been taken by surprise by Sarkozy's success in continuing to dominate the headlines during the summer break.
&;The Socialist Party is totally destabilized, not knowing how to respond,&; said Gael Sliman of pollster BVA. &;The other strong point of 100 days is that he manages to dictate the news every time.&;
(Additional reporting by Kerstin Gehmlich and Gerard Bon and Swaha Pattanaik)
