Ariz. TB patient transferred to Denver
Thu, 19 Jul 2007 18:50:59 GMT
DENVER - A man who had been quarantined with a drug-resistant form of tuberculosis for nearly a year was transferred to a hospital in Colorado on Thursday for treatment.
Robert Daniels, 27, has an multiple drug-resistant form of TB. He was placed in a jail ward at Maricopa Medical Center in Phoenix last August under court order after medical authorities complained that he had endangered others.
Thursday morning, Daniels was taken to Denver's National Jewish Medical and Research Center, which specializes in treating respiratory diseases. Under an agreement worked out between Arizona and Colorado authorities, Daniels will have a security guard outside his door around the clock, hospital spokesman William Allstetter said.
Atlanta attorney Andrew Speaker, who caused an international health scare in May after he flew to Europe knowing he had a drug-resistant form of tuberculosis, is being treated at the same Denver hospital and underwent successful surgery this week.
Linda Cosme, a lawyer for Daniels, said her client's transfer to Denver was sought by Maricopa County medical experts because Daniels' condition was deteriorating.
Though Daniels wasn't charged with a crime, Arpaio said his office was examining whether Daniels endangered others by disobeying instructions from health officials such as wearing a mask.
The American Civil Liberties Union filed a lawsuit claiming Daniels was being treated like a criminal while in the Phoenix hospital and his rights were being violated.
Study Clinics overuse lab technique
Thu, 19 Jul 2007 03:07:58 GMT
By MIKE STOBBE, AP Medical Writer
ATLANTA - Fertility clinics are overusing a laboratory technique and costing infertile couples and some insurers hundreds of extra dollars, a new study suggests. At issue is a procedure that injects a single sperm into an egg. The method is considered the best option for couples in which the man has defective sperm or extremely low sperm counts.
But many clinics are using it for other infertile couples, even though it often doesn't work as well as the standard lab dish method, according to a study in Thursday's New England Journal of Medicine.
Sperm injection adds about $1,500 to the $12,400 average cost of an in vitro fertilization treatment cycle, the authors said.
"This paper is particularly troubling because we've got a major shift in practice that isn't evidence driven. The paper suggests it may be driven by money," said Arthur Caplan, director of the University of Pennsylvania's Center for Bioethics.
The study's lead author, Dr. Tarun Jain of the University of Illinois at Chicago, said more research is needed and he couldn't be certain money explains the findings. But the study does indicate routine use of the technique does not benefit many couples, he added.
Dr. Steve Ory, president of the American Society of Reproductive Medicine, said there are many reasons a clinic might use sperm injection to treat an infertile couple, and it's not clear that the technique is overused.
According to the researchers and Ory, some clinics may use it as in cases where there's only a few eggs available, or in cases where the standard method failed. Some may opt to use it for all couples, believing it can increase the chance of success.
"There's a lot of art to this," Ory said.
The research team reviewed a decade of results that hundreds of fertility clinics reported to the federal government. In 2004, about 58 percent of treatment attempts included sperm injection — up from 11 percent in 1995.
But the proportion of couples who have trouble conceiving because of the man's sperm has stayed constant, at around 34 percent. This suggests that the sperm-injection technique is being urged on many couples who do not need it and might be better off with traditional lab dish, or in vitro, fertilization, Caplan said.
In the standard method, eggs are placed in a petri dish with 100,000 to 500,000 sperm in the hope that one will wiggle through an egg's outer membrane and fertilize it. The sperm-injection technique leaves nothing to chance, using a fine glass needle to shoot a sperm inside the egg.
Sperm injection does not increase overall success rates for healthy births. The researchers found that among infertility treatment attempts with successful egg retrievals in 2004, about 31 percent of those involving sperm injection resulted in a live birth. The percentage was higher — 33 percent — for those that did not use the sperm injection.
Perhaps nature is better than doctors at selecting the right sperm to produce a healthy baby, Jain said.
Another problem: A higher risk of birth defects is seen in children produced through sperm injection, although scientists haven't sorted out if that's a result of the technique itself or abnormalities in the fathers' sperm, the authors noted.
They also noted that sperm-injection rates were higher in three states — Illinois, Massachusetts and Rhode Island — that mandate coverage of the technique than in states without such a requirement.
Jain noted he didn't have specific data about each couple or each treatment attempt, so it was hard to determine whether, for example, clinics that did a lot of sperm injection also had disproportionate numbers of patients with more severe cases.
Also, despite a federal requirement that fertility clinics report verifiable data, not all comply, he noted. In 2004, there was no or incomplete data available for 11 percent of clinics.
___
New England Journal of Medicine: http://nejm.org/
Studies Restless legs syndrome is real
Thu, 19 Jul 2007 03:07:46 GMT
By MIKE STOBBE, AP Medical Writer
ATLANTA - Scientists have linked certain genes to restless legs syndrome, suggesting the twitching condition described as "jimmy legs" in a "Seinfeld" episode is biologically based and not an imaginary disorder.
New studies published this week in two top medical journals are being called the first to identify specific genes responsible for restless legs syndrome symptoms. Research in the New England Journal of Medicine linked a common gene variation to nighttime leg-twitching involving people in Iceland and the United States. A second study in Nature Genetics identified the same gene variation and two others in Germans and Canadians with restless legs syndrome.
"This discovery demonstrates the power of genetics not only for uncovering the biological causes of disease, but also for defining diseases such as RLS and establishing them as medical conditions," said Dr. Kari Stefansson, in a prepared statement.
Stefansson is a prominent Icelandic scientist who co-authored the New England Journal study.
Restless legs syndrome is a neurological condition characterized by an irresistible urge to move the legs. Sufferers say it often hits at night, preventing them from sleeping.
"It feels like something crawling inside your legs, biting on you," said Betty Shaw, a 68-year-old florist in Covington, Ga., who was diagnosed with it. So was her 43-year-old daughter.
The condition gained cultural status through an oft-ed episode of the sitcom "Seinfeld," in which the character Kramer is disturbed that his girlfriend has "the jimmy legs" and kicks in bed.
It's commonly treated with two government-approved drugs, including the heavily advertised Requip, made by GlaxoSmithKline PLC. Sales of Requip hit about $500 million last year. Shaw takes the aqua-colored pill and says it's the only thing that's helped her.
The first study looked at blood samples from more than 1,000 Icelanders and Americans, comparing the DNA of leg twitchers to the DNA of people without the symptom. Scientists found a certain variation in the human genome that, they say, probably accounts for 50 percent of restless legs cases.
They also found that the variation was associated with lower iron levels, echoing — but not explaining — a relationship noted in earlier research.
The second study compared the DNA of 400 people with a family history of the syndrome with the DNA of 1,600 who did not. It found variations in three areas of the genome that each were responsible for a 50 percent increase in the risk for the syndrome.
More research is needed to develop a full explanation of the causes of restless legs syndrome. The New England Journal study indicates as many as 65 percent of adults carry the gene variation that can lead to symptoms, said Dr. David Rye, an Emory University neurologist who was another co-author.
"People making the argument that this can't be very common — that's just gone," said Rye, who himself has restless legs.
Others disagreed.
The syndrome is diagnosed through symptoms like periodic limb movements in sleep, but lots of people may have limb movements without having the condition, noted Dr. Steven Woloshin, a Dartmouth Medical School researcher who has argued the diagnosis is overhyped.
He argues that the best evidence puts the U.S. prevalence of restless legs at under 3 percent, less than common estimates of 10 percent.
The new research doesn't pin down what the condition is, who has it, or what medication is needed, he wrote in an e-mail.
___
The New England Journal of Medicine: http://nejm.org/
Canned food recall after botulism cases
Thu, 19 Jul 2007 18:08:59 GMT
By ANDREW BRIDGES, Associated Press Writer
WASHINGTON - Botulism poisoning from commercially canned foods has been virtually eliminated in the United States, making the new cases linked to hot dog chili sauce all the more striking.
On Thursday, the Food and Drug Administration, Agriculture Department and Centers for Disease Control and Prevention were investigating a Castleberry's Food Co. plant in Augusta, Ga., where the suspect product was canned. Four people have been hospitalized; they are expected to survive.
Botulism is a muscle-paralyzing disease caused by a toxin made by a bacterium, Clostridium botulinum. Such bacteria are commonly found in soil.
Typically, commercially canned foods are heated long enough and to high enough temperatures to kill the spores that otherwise can grow and produce the toxin. If canned foods are underprocessed, the bacteria can thrive in the oxygen-poor environment inside the sealed containers.
Food packaged in defective cans, including those with leaky seams, also can become contaminated because the bacteria can be sucked into the containers as the product cools, according to health officials. Contamination with the bacteria can sometimes cause lids to bulge.
Each year, the CDC records roughly 25 cases of foodborne botulism poisoning. Most involve home-canned foods. Some fermented whale and other traditional foods prepared by Alaska natives also have been implicated in outbreaks.
CDC medical epidemiologist Dr. Michael Lynch said the last U.S. case of botulism linked to commercially sold canned food dates to the 1970s.
One food safety expert said the new outbreak was disturbing.
"It raises concerns that the existing food safety programs that have been functioning are losing ground because of gaps in FDA oversight," said Caroline Smith DeWaal, director of food safety for consumer group Center for Science in the Public Interest.
Symptoms of botulism include double or blurred vision, drooping eyelids, slurred speech, difficulty swallowing, dry mouth and muscle weakness that moves down the body. Eventually, paralysis can cause a person to stop breathing and die, unless supported by a ventilator. Botulism is fatal in about 8 percent of cases; most victims eventually recover after weeks to months of care.
Botulinum toxin is extremely potent. Even opening a contaminated can may expose consumers to the toxin if it is inhaled, swallowed or absorbed through the eye or breaks in the skin, health officials said.
Yet small doses of an FDA-approved product made from the toxin are routinely used to paralyze or weaken the muscles that can cause facial wrinkles. The product is best known by its trade name: Botox.
The FDA warned consumers to throw away 10-ounce cans of Castleberry's, Austex and Kroger brands of hot dog chili sauce with "best by" dates from April 30, 2009, through May 22, 2009. Castleberry's, owned by Bumble Bee Seafoods LLC, has recalled the products flagged by the FDA, as well as seven others.
___
On the Net:
Castleberry's Food Co. recall information: http://www.castleberrys.com/
CDC botulism information: http://www.bt.cdc.gov/agent/botulism/index.asp
Study predicts 75 percent overweight in U.S. by 2015
Wed, 18 Jul 2007 22:45:57 GMT
WASHINGTON -
If people keep gaining weight at the
current rate, fat will be the norm by 2015, with 75 percent of
U.S. adults overweight and 41 percent obese, U.S. researchers
predicted on Wednesday.
A team at Johns Hopkins University in Baltimore examined 20
studies published in journals and looked at national surveys of
weight and behavior for their analysis, published in the
journal Epidemiologic Reviews.
&;Obesity is a public health crisis. If the rate of obesity
and overweight continues at this pace, by 2015, 75 percent of
adults and nearly 24 percent of U.S. children and adolescents
will be overweight or obese,&; Dr. Youfa Wang, who led the
study, said in a statement.
They defined adult overweight and obesity using a standard
medical definition called body mass index. People with a BMI of
25 or above are considered overweight, while those with BMIs of
30 or above are obese and at serious risk of heart disease,
diabetes and some cancers.
Studies show that 66 percent of U.S. adults were overweight
or obese in 2003 and 2004. An alarming 80 percent of black
women aged 40 or over are overweight and 50 percent are obese.
Sixteen percent of U.S. children and adolescents are
overweight and 34 percent are at risk of becoming overweight,
according to federal government figures.
Every group is steadily getting heavier, Wang said.
&;Our analysis showed patterns of obesity or overweight for
various groups of Americans,&; said May Beydoun, who worked on
the study.
&;Obesity is likely to continue to increase, and if nothing
is done, it will soon become the leading preventable cause of
death in the United States.&;