Atty Woman wasnt told donor was a risk
Sat, 17 Nov 2007 00:55:11 GMTBy LINDSEY TANNER, AP Medical Writer
CHICAGO - A woman in her 30s who is one of the four organ transplant patients infected with HIV and hepatitis was not told that the infected donor was high risk, and had previously rejected another donor "because of his lifestyle," her attorney said.
Attorney Thomas Demetrio filed a petition Thursday in Cook County Circuit Court on behalf of the woman, asking officials to keep a hospital and an organ procurement center from destroying or altering any records involving the donation.
"She's really a mess right now," Demetrio said of the Chicago-area woman. "She's still in shock."
The patient, identified in court documents as Jane Doe, received a kidney transplant at the University of Chicago Medical Center on Jan. 9, Demetrio said.
Gift of Hope Organ & Tissue Donor Network in Elmhurst and the University of Chicago both knew the kidney donor was high-risk and did not inform the patient, Demetrio said.
University of Chicago spokesman John Easton responded in an e-mail: "We believe we follow guidelines, and of course with the patient's consent we will provide necessary records and documents, as is consistent with our open process."
Gift of Hope did not immediately respond to requests for comment.
The woman had been told the donor was a healthy young man, her attorney said. But on Tuesday, hospital officials disclosed to the woman that he was actually high-risk, a 38-year-old gay man, Demetrio said. CDC guidelines say that gay men who are sexually active should not be used as organ donors unless the patient is in imminent danger of death.
The woman was told she had HIV and hepatitis on Nov. 1, he said.
"The procurement group knew, the hospital knew, but the most important person did not know," he said. "The people that dedicate their lives to these transplant surgeries, they're just great people, but they need to bring the patient into the mix and let them make an informed decision."
U.S. Centers for Disease Control and Prevention guidelines were violated twice, the attorney said. One violation was not informing the woman about the donor's status and then not testing her afterward for HIV until just recently, after HIV and hepatitis were found during tests on another patient who was being evaluated for a second transplant.
The woman had been "doing great" on dialysis and had been on the donor waiting list for over six years, Demetrio said. In fact, she had rejected a potential donor two years ago "because of his lifestyle," the attorney said.
The woman developed renal failure seven years ago but he did not know what caused it.
"The fact is the transplant took very well. She'd been bumping along" doing fine, "then she gets this phone call on Nov. 1."
She's been started on an HIV drug regimen "and unfortunately one of the side effects is it's not good for the kidneys," Demetrio said. She's not hospitalized.
Dr. Dan Berger, medical director of a large HIV-AIDS clinic in Chicago, said U.S. doctors have had several years of experience treating HIV-infected patients who went on to get transplant organs. Such patients need an HIV specialist and a transplant specialist to monitor their medications, which include anti-rejection drugs for the transplant and antiretrovirals for HIV, he said.
The four patients infected by the high-risk donor's organs have extra medical concerns, Berger said.
"When a patient first becomes infected with HIV there's a huge spike in viral load and severe immune compromise," he said. "The fact that they also are on immune-suppressive medications may put them at extreme risk for opportunistic infection."
Four patients got organs in January at three Chicago hospitals from a donor who died after a traumatic injury. The donor had engaged in high-risk behaviors, according to a screening questionnaire, but standard testing showed the donor did not have AIDS or hepatitis C.
Gift of Hope tested the organs and approved them for donation, telling the three hospitals that they came from a high-risk donor.
Several months later, when one of the patients was being evaluated, blood tests showed the patient had HIV and hepatitis C. The other three patients were notified and tested, showing they had both viruses.
The CDC says it's the first time ever that both viruses were transmitted simultaneously through an organ transplant. It's also the first known time since 1986 that HIV was transmitted through organ donation.
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Associated Press Writer Carla K. Johnson in Chicago contributed to this report.
Md. schools get tough on vaccinations
Fri, 16 Nov 2007 22:56:45 GMTBy STEPHEN MANNING, Associated Press Writer
UPPER MARLBORO, Md. - Two months into the school year, more than 2,000 students in this suburban county outside the nation's capital had yet to get the shots they needed to attend class. So the school system decided it was through playing nice.
Parents in Prince George's County have been ordered to appear at a special court hearing Saturday where they will be given a choice: Get their children vaccinated on the spot or risk up to 10 days in jail and fines.
It is one of the strongest efforts made by a U.S. school system to ensure its youngsters receive their shots.
Prince George's County school officials and prosecutors said parents have been duly warned about the need for vaccinations over the past year. They said the goal isn't to throw parents in jail but to protect public health and get kids who have been barred from school back to class.
"How can you in good conscience allow your child to miss school and their education for no particular reason?" said John White, spokesman for the 132,000-student school system.
At the courthouse, the health department will have a makeshift clinic to administer vaccines. Parents will be given the chance to offer the judge an excuse for why they didn't get their kids vaccinated. Under Maryland law, parents can obtain exemptions for religious or medical reasons.
Those who fail to show up — and those who fail to offer a valid excuse and still refuse the shots — could be prosecuted under truancy laws and face possible jail time and fines of $50 per day. Prosecutors do not expect to actually charge anyone on Saturday.
"The message is get your kids vaccinated or get an exemption," said Prince George's County State's Attorney Glenn Ivey. "You can't just sit on the fence."
Barbara Loe Fisher, head of National Vaccine Information Center, a vaccine skeptic group, complained: "It is terrorizing parents. When you have the threat of going to jail, it is hard to make an informed decision."
Even the judge who opened his court is somewhat skeptical about hauling parents into court.
William Missouri, administrative judge for the county circuit court, agreed to the Saturday session and said it would probably prod some parents to comply. But the problem "may have been ratcheted up to a level it should not have been at this time."
School officials said that it is not clear why parents are not complying, but that some may have religious or medical objections, while others may have failed to turn in the paperwork, or their kids' addresses were outdated.
The prospect of stiff penalties appears to have worked already. Last week, when the court notices were sent to parents, 2,300 students had not been properly immunized. As of Friday afternoon, only about 1,100 remained on the list.
Maryland, like all states, requires children to be immunized against several childhood illnesses, including polio, mumps and measles. In recent years, it has required that students up to high-school age be vaccinated against hepatitis B and chicken pox.
After that, thousands of students — most of them high schoolers — were found to lack the required immunizations. Parents were sent letters and visited at home, and the school system even offered free vaccinations.
"Once the word gets out, it will definitely work," Bob Ross, head of the parent-teachers association at Surrattsville High School in Clinton, said of the new get-tough approach. "Parents are going to have to set aside some time. Parents have a responsibility to help protect the public health."
Formerly conjoined twins doing very well
Sat, 17 Nov 2007 01:45:44 GMTBy RACHEL KONRAD, Associated Press Writer
SAN FRANCISCO - Formerly conjoined twins have "excellent" chances of survival after a grueling separation surgery, and one of the toddlers is even breathing on her own, doctors said Friday.
Two-year-olds Yurelia and Fiorella Rocha-Arias of San Jose, Costa Rica, were conjoined at the chest and abdomen and shared an oversize liver until Monday, when doctors in Palo Alto separated them during a 9-hour surgery.
Fiorella — who has always been slightly larger and stronger than Yurelia — was taken off her ventilator Wednesday and has been breathing on her own for two days.
"We are very happy with the outcome so far," said lead surgeon Dr. Gary Hartman of Lucile Packard Children's Hospital. "These are two very strong little girls."
Although Yurelia is still on a ventilator and heavily sedated, the twins' cardiovascular intensive care physician said chances for survival are higher than the 50-50 odds doctors gave them earlier this week.
"Current chances for survival are excellent," said Dr. Gail Wright, who would not provide a specific odds for survival.
On Wednesday, surgeon Dr. Frank Hanley performed a six-hour surgery on Yurelia to correct a life-threatening congenital heart defect that prevented enough oxygen from getting to her tissue. Doctors then reconstructed her chest wall.
The girls' parents, Maria and Jose Luis Rocha-Arias, have requested privacy and declined to comment.
The girls arrived in San Francisco on July 25 and received weekly injections of sterile saltwater into balloons placed under their skin. The procedure stretched their skin to compensate for the holes surgeons cut into their abdomens.
Packard doctors are donating their time to treat Yurelia and Fiorella, who have nine older siblings. Mending Kids International, a faith-based nonprofit based in Santa Clarita that helps sick children, arranged transportation and housing.
CDC New respiratory bug has killed 10
Fri, 16 Nov 2007 22:58:01 GMTBy MIKE STOBBE, AP Medical Writer
ATLANTA - A mutated version of a common cold virus has caused 10 deaths in the last 18 months, U.S. health officials said Thursday. Adenoviruses usually cause respiratory infections that aren't considered lethal. But a new variant has caused at least 140 illnesses in New York, Oregon, Washington and Texas, according to a report issued Thursday by the U.S. Centers for Disease Control and Prevention.
CDC officials don't consider the mutation to be a cause for alarm for most people, and they're not recommending any new precautions for the general public.
"It's an uncommon infection," said Dr. Larry Anderson, a CDC epidemiologist.
The illness made headlines in Texas earlier this year, when a so-called boot camp flu sickened hundreds at Lackland Air Force Base in San Antonio. The most serious cases were blamed on the emerging virus and one 19-year-old trainee died.
"What really got people's attention is these are healthy young adults landing in the hospital and, in some cases, the ICU," said Dr. John Su, an infectious diseases investigator with the CDC.
There are more than 50 distinct types of adenoviruses tied to human illnesses. They are one cause of the common cold, and also trigger pneumonia and bronchitis. Severe illnesses are more likely in people with weaker immune systems.
Some adenoviruses have also been blamed for gastroenteritis, conjunctivitis and cystitis.
There are no good antiviral medications for adenoviruses. Patients usually are treated with aspirin, liquids and bed rest.
Some people who get infected by the new bug probably would not suffer symptoms, and some may just feel a common cold. Sick people should see a doctor if they suffer a high fever or have trouble breathing, Anderson said.
In the CDC report, the earliest case of the mutated virus was found in an infant girl in New York City, who died last year. The child seemed healthy right after birth, but then became dehydrated and lost appetite. She died 12 days after she was born.
Tests found that she been infected with a form of adenovirus, called Ad14, but with some little differences, Su said.
It's not clear how the changes made it more lethal, said Linda Gooding, an Emory University researcher who specializes in adenoviruses.
Earlier this year, hundreds of trainees at Lackland became ill with respiratory infections. Tests showed a variety of adenoviruses in the trainees, but at least 106 — and probably more — had the mutated form of Ad14, including five who ended up in an intensive care unit
In April, Oregon health officials learned of a cluster of cases at a Portland-area hospital. They ultimately counted 31 cases, including seven who died with severe pneumonia. The next month, Washington state officials reported four hospitalized patients had the same mutated virus. One, who also had AIDS, died.
The Ad14 form of adenovirus was first identified in 1955. In 1969, it was blamed for a rash of illnesses in military recruits stationed in Europe, but it's been detected rarely since then. But it seems to growing more common.
The strain accounted for 6 percent of adenovirus samples collected in 22 medical facilities in 2006, while none was seen the previous two years, according to a study published this month in the medical journal Clinical Infectious Diseases.
The new bug could have implications for the military. Other forms of adenoviruses have been a common cause of illness in recruits. Military officials are bringing back an adenovirus vaccine — administered as a pill — that was given to recruits from 1971 to 1999, CDC officials said.
A Barr Pharmaceuticals vaccine for the military, currently being tested, is expected to be licensed in 2009. Like the old pill, it focuses on adenovirus serotypes 4 and 7, because those bugs have been persistent problems, said Col. Art Brown, an Army physician involved in the product's development.
Some CDC officials said a vaccination against the mutant Ad14 might be needed. Brown said it isn't clear if the mutant Ad14 will be an enduring threat, but the military will monitor illness reports.
"If it persists, then we'd consider if the vaccine needs to be modified further," said Brown, of the U.S. Army Medical Materiel Development Activity.
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On the Net:
Morbidity and Mortality Weekly Report: http://www.cdc.gov/mmwr
Infants of obese mothers have higher mortality risk
Sat, 17 Nov 2007 00:18:51 GMTBy Will Boggs, MD
NEW YORK - Obese women are at increased risk of having their infant die soon after birth, especially if premature rupture of membranes occurs before full-term, according to a report in the journal Obstetrics & Gynecology.
These findings may indicate there is a problem in how obese women with preterm PROM births are treated, Dr. Ellen A. Nohr from University of Aarhus, Denmark told Reuters Health. It is also possible that &;preterm infants of obese mothers may be more susceptible when they are not protected by the membranes.&;
PROM occurs when the membranes rupture before labor begins, which is usually followed by labor and delivery. Umbilical cord compression is the primary risk for the fetus, while infection within the uterus is the major complication in the woman.
Nohr and colleagues used the Danish National Birth Cohort to investigate the association between prepregnancy obesity and infant mortality, with focus upon different types of preterm births.
The infant mortality rate was higher in infants of overweight and obese mothers than in infants of normal-weight mothers, the authors report, even after consideration of other maternal and infant risk factors.
Mortality in infants born after preterm PROM was more than tripled in infants of overweight women and was increased nearly six-fold in infants of obese women, the report indicates.
High body mass index was not, however, associated with mortality in infants born after spontaneous preterm births without preterm PROM.
The results were similar in infants with or without malformations and after exclusion of infants born to women with obesity-related diseases or infants born to subfertile women, the researchers note.
&;This is the first study indicating an elevated mortality in infants of obese mothers after preterm PROM, and it is therefore too early to suggest changes in the management of pregnancies in obese women,&; Nohr said.
&;However, if these findings are causal and we understand the mechanisms behind them, it may be possible to suggest preventive measures,&; she added.
SOURCE: Obstetrics & Gynecology, November 2007.
