Salmonella cases rise in Colorado city
Fri, 21 Mar 2008 02:49:16 GMTBy CATHERINE TSAI, Associated Press Writer
DENVER - The number of confirmed salmonella cases rose in a southern Colorado city on Thursday, as health officials investigated whether the outbreak was caused by tainted tap water.
Alamosa spokeswoman Connie Ricci said there were 47 confirmed cases of salmonella among city residents, up from 33 a day before. She said 76 other cases were under investigation.
Health officials said the tap water in Alamosa, a community of 8,500 about 160 miles south of Denver, tested positive for bacteria that are believed to be salmonella, but they were still awaiting final test results for confirmation. The cause of the contamination was under investigation.
Health officials have warned residents to boil tap water for 15 seconds to kill the bacteria, or use bottled water for brushing teeth, washing dishes, making ice, cooking, drinking and making baby formula. They said people can use tap water to bathe, as long as they are careful not to ingest it.
City and county officials set up four centers where residents could get free bottled water or bring containers to fill with safe water, Ricci said. Residents were limited to one gallon of free water per person per day.
State emergency management officials activated an emergency operations center in the Denver suburb of Centennial to help coordinate deliveries of bottled water.
Timothy Rivera, the manager of Mrs. Rivera's Kitchen in a downtown Alamosa, said the restaurant stayed closed Thursday because of the outbreak.
"It takes a lot of manpower for all this stuff. We have to boil water for everything, to wash dishes," he said. "We have to have bottled water, we have to have ice. There's lots of things to take into consideration."
He said he hoped to reopen Friday.
Waterborne salmonella outbreaks are fairly rare, said Mark Salley, a spokesman for the Colorado Department of Public Health and Environment. The bacteria are typically spread by food, he said.
Salmonella can cause diarrhea, fever and stomach pain. Victims typically recover on their own, but the elderly, infants and people with impaired immune systems may require treatment. Untreated, salmonella can cause death in vulnerable victims, the health department said.
City officials plan to start flushing and disinfecting the water system in the next few days, a process that could take a week or more. While the flush is under way, no municipal water should be used, even if it is boiled, they said.
Authorities said the first salmonella victim began showing symptoms around March 8, and state health officials became aware of the outbreak Friday.
Officials tested city water on Monday, and the results showing bacteria in the water system came back Wednesday.
Calif transplant doctor ordered to trial
Fri, 21 Mar 2008 04:30:46 GMTBy LINDA DEUTSCH, AP Special Correspondent
LOS ANGELES - A transplant surgeon accused of hastening the death of a man so his organs could be harvested has been ordered to trial on one count of felony dependent adult abuse, but two other felony charges involving administration of drugs to the dying man were dismissed.
The criminal case against Dr. Hootan Roozrokh of San Francisco is the first such action against a transplant doctor in the United States.
After a preliminary hearing in San Luis Obispo County, Superior Court Judge Martin J. Tangeman issued a ruling Wednesday describing an uncoordinated scene surrounding the 2006 death of Ruben Navarro at Sierra Vista Regional Medical Center, which had never handled a "Donation After Cardiac Death " case.
Navarro, 26, had a debilitating neurological disease and was in a coma when he was admitted to the hospital after a heart attack.
His mother had authorized harvesting of his organs but because he was not brain dead, the judge said, it was determined that the transplant procedure to be used would be DCD, which requires withdrawal of life support leading to death prior to recovery of organs
"Dr. Roozrokh did not make or participate in making any of these decisions," said the ruling, which added that Roozrokh was sent by employer Kaiser Permananente in coordination with the California Transplant Donor Network to perform the transplant surgery after those decisions were made.
But the judge said doctors and nurses present when Navarro died gave conflicting accounts and "the inconsistencies in testimony between the various witnesses cannot be resolved by reference to written records."
His ruling cited the lack of experience in the procedure by everyone involved including Roozrokh, who was less than a year out of his organ transplant fellowship and had observed only one such procedure in training.
Roozrokh is the only person charged criminally in the case. His attorney, M. Gerald Schwartzbach, told The Associated Press he was disappointed the entire case was not dismissed.
"I'm extremely confident that at the end of trial Dr. Roozrokh will be both vindicated and admired. Even if he did everything they said, he was a hero. He saved this man from pain. ... He tried to ensure this young man died pain free. That's all he did," Schwartzbach said Thursday.
Schwartzbach said testimony at the preliminary hearing showed that "the entire system failed."
The judge, in a section of his decision entitled "The absence of experience and guidelines in DCD procedures in 2006," appeared to agree. He highlighted a long line of missteps and noted there was no national DCD protocol in place and the hospital did not have a written DCD protocol.
The prosecutor commented briefly on the ruling.
"The evidence has spoken and we will continue to present our case in court," said San Luis Obispo County Deputy District Attorney Karen Gray.
In his account of testimony, Tangeman said Roozrokh was accompanied to the hospital on Feb. 3, 2006, by an experienced transplant doctor, but he too had never participated in such a procedure.
No one kept a chart of medications administered to Navarro in the operating room, the ruling said, and four witnesses gave different accounts on how many doses of the painkillers morphine and Ativan were given. While various witnesses testified to their observations of Navarro's vital signs, the judge said the transplant coordinator claimed to have lost the records.
The judge said there was no evidence Roozrokh administered or ordered a combination of Betadine, morphine and Ativan for Navarro. He dismissed one count which included that allegation. He also dismissed a count alleging "unlawful controlled substance prescription."
State law prohibits transplant doctors from directing treatment of potential organ donors until they are declared dead.
The judge said no attending physician was available at the hospital and "no medication for comfort care or withdrawal of life support was available in the operating room" when Navarro arrived.
"When the attending physician finally arrived in the operating room, all other participants were already there and she failed to understand that she was the responsible physician in charge of ordering medications," the judge wrote.
The attending physician, Dr. Laura Lubarsky, was granted immunity from prosecution for her testimony. The judge noted that she testified "other than being responsible for declaring death, she believed that her role was limited to being an observer."
Navarro's organs were not successfully harvested.
Good marriage equals good blood pressure
Fri, 21 Mar 2008 00:58:17 GMTBy MALCOLM RITTER, AP Science Writer
NEW YORK - A happy marriage is good for your blood pressure, but a stressed one can be worse than being single, a preliminary study suggests.
That second finding is a surprise because prior studies have shown that married people tend to be healthier than singles, said researcher Julianne Holt-Lunstad.
It would take further study to sort out what the results mean for long-term health, said Holt-Lunstad, an assistant psychology professor at Brigham Young University. Her study was reported online Thursday by the Annals of Behavioral Medicine.
The study involved 204 married people and 99 single adults. Most were white, and it's not clear whether the same results would apply to other ethnic groups, Holt-Lunstad said.
Study volunteers wore devices that recorded their blood pressure at random times over 24 hours. Married participants also filled out questionnaires about their marriage.
Analysis found that the more marital satisfaction and adjustment spouses reported, the lower their average blood pressure was over the 24 hours and during the daytime.
But spouses who scored low in marital satisfaction had higher average blood pressure than single people did. During the daytime, their average was about five points higher, entering a range that's considered a warning sign. .
"I think this is worth some attention," said Karen Matthews, a professor of psychiatry, psychology and epidemiology at the University of Pittsburgh. She studies heart disease and high blood pressure but didn't participate in the new work.
Few studies of the risk for high blood pressure have looked at marital quality rather than just marital status, she said.
It makes sense that marital quality is more important than just being married when it comes to affecting blood pressure, said Dr. Brian Baker, an associate professor of psychiatry at the University of Toronto.
Study Age of blood may affect patients
Fri, 21 Mar 2008 00:00:19 GMTBy MIKE STOBBE, AP Medical Writer
ATLANTA - Heart surgery patients were more likely to die or suffer problems if they received transfusions of blood that is more than two weeks old rather than fresher blood, according to a new study that adds to the debate about the shelf life of blood.
Although not the final word, the study underscores concerns that blood deteriorates with age and that rules allowing blood to be stored for six weeks may pose a safety risk, at least for certain patients.
The findings bolster the argument of those who believe that older blood should be avoided, wrote Dr. John Adamson of the University of California at San Diego, in an editorial accompanying the study in this week's New England Journal of Medicine.
"However, the results of this study will not settle the debate" because the patients studied were not representative of all transfusion recipients, he added.
The report was limited to heart surgery patients, but similar results have been shown in smaller studies that looked at other types of patients.
The Food and Drug Administration's six-week rule allows blood centers to endure shortages in donations and to maintain supplies of rare blood types.
The study's lead author, Dr. Colleen Gorman Koch of the Cleveland Clinic, did not call for an immediate change to the FDA rule. But Koch said a more rigorous study is already under way that could carry the scientific weight to persuade the FDA to reconsider its policy.
In a statement, the FDA said the findings were "provocative," but that more rigorous testing would be needed before it reviews the policy. Still, the agency said, doctors may wish to consider the report in making treatment decisions.
It's not clear exactly why blood stored for longer periods is riskier. Some researchers say stored blood becomes depleted of oxygen-carrying chemicals. Red blood cells also become more rigid in storage, impeding their flow through the body.
Researchers examined the records of 6,000 patients who were given blood transfusions during heart-bypass or heart-valve surgery. All of the patients were treated at the Cleveland Clinic from June 30, 1998, through Jan. 30, 2006.
A little less than half of the patients received blood that had been stored for 14 days or less, and a little more than half got blood that was older. The amount of blood given to patients in both groups was similar.
The study found that the one-year survival rate was 89 percent for those who got older blood, but nearly 93 percent for patients who got fresher blood.
Complication rates were higher in the older blood group, with higher proportions of those patients suffering kidney failure, blood infections or multiple organ failure, or needing ventilator care more than 72 hours after surgery.
The average age of the "old" blood was 20 days, not the full 42 days allowed by the FDA. The average age of the fresher blood was 11 days.
The median age of patients in the study was 70 years, and many had other illnesses in addition to their heart problems.
The findings were similar to smaller studies of colorectal cancer surgery patients in Denmark, cancer surgery patients in Spain, sepsis patients in Canada and trauma patients in Colorado. Each of those studies found higher rates of various complications in patients who received older transfused blood when compared with patients who got fresher blood.
About half of heart surgery patients get transfusions, typically receiving one or two units, according to the study's authors.
A number of hospitals have re-evaluated long-standing practices and taken steps to minimize transfusions. One example: Duke University Medical Center in North Carolina has reduced its use of transfused blood products by 17 percent in the past 3 1/2 years.
Concern about the safety of older blood for cardiac patients is one reason for the change at Duke, said Dr. Sunil Rao, a Duke assistant professor of medicine who runs the cardiac catheterization labs at the Durham VA Medical Center.
Through the years, scientists have made strides in screening donated blood for HIV and other infections, so it's understandable that some may believe the safety of transfused blood is firmly established. But questions about older blood keep recurring, pointing out a need for additional research, Rao added.
"We are only now starting to realize what happens to blood when it is drawn out of a human body and sent to the blood bank for storage," he said.
___
On The Net:
New England Journal: http://nejm.org
