Booster Shots

Oddities, musings and news from the health world

Category: disease

Disinfectant misuse could help create superbugs

December 29, 2009 |  3:05 pm
Pseudomonas aeruginosa: A drug-resistant form of a bacterium usually associated with hospital-acquired infections led to the death of Brazilian beauty queen Mariana Bridi Disinfectants may be a double-edged sword in the fight against hospital-borne diseases, scientists say. 

According to a study to be published in January’s issue of Microbiology, researchers from the National University of Ireland in Galway slowly introduced higher levels of disinfectant to lab cultures of Pseudomonas aeruginosa, which lives in the soil and water around us. It can’t seriously hurt healthy people (it’s been implicated in “hot tub itch” and “swimmer’s ear”) but preys on those with compromised immune systems. This opportunistic pathogen can infect the lungs, joints, burn wounds, take advantage of a compromised urinary tract or cause blood diseases. The bacterium can live in man-made environments and colonize catheters and other medical equipment. It’s ideally suited for hospital transmission – the Online Textbook of Bacteriology calls it “the fourth most commonly-isolated nosocomial pathogen accounting for 10.1 percent of all hospital-acquired infections” – but it can infect anyone whose defenses have been weakened, whether from chemotherapy or diabetes, cystic fibrosis or AIDS. 

After gradually upping the dose of benzalkonium chloride, an antiseptic used in products that include eyedrops and wet wipes, researchers had on their hands a Frankensteinian pathogen that showed a 12-fold resistance to the common disinfectant. (Generally, showing four or five times the normal resistance level is enough to earn a newer, nastier disease “superbug” status.)

Even worse, that same variant of P. aeruginosadisplayed a whopping 256-fold increase in resistance to the antibiotic ciprofloxacin – even though it had never been exposed to the drug before. That’s worrisome, since the commonly prescribed Cipro has been used to treat such high-profile pathogens as anthrax spores.

The upshot? That hospitals that don’t use enough disinfectant to kill every last bacterium on a given surface could provide an ideal breeding ground for new superbugs. These mutations could become virtually immune to prevention and treatment.

“The message, for heaven’s sake, is use disinfectants properly,” lead author Gerard Fleming said in an interview. “The first line of defense is disinfection. The second line of defense is antibiotics.”

By misusing disinfectants, he concluded, “You're making an environment where you've now lost the first and second lines of defense.”

There’s a dangerous tendency toward using disinfectants as a clean-all, Fleming said, when there was a much more potent, proven remedy to rid oneself of germs.

“Soap and water. I am not messing with you,” Fleming said. “Why doesn’t the surgeon, when he’s going into the theater, just take a hand sanitizer? Why does he go to the sink and scrub and scrub and scrub? Because he’s physically removing the bacteria.”

-- Amina Khan

Enjoying the holidays, gluten-free

December 21, 2009 |  6:30 am

The holidays are a tough time for anyone who has specific dietary needs, but near the top of the list are people with celiac disease. The autoimmune disease causes digestive symptoms such as intestinal inflammation after eating wheat, rye or barley, which contain gluten. (Read more about new treatments for celiac disease here). Since the holidays are pretty much all about carbs, celiac sufferers and those with a gluten intolerance can have a hard time negotiating parties and family meals.

GlutenScreen-capture-1 But fear not, help is here, in the form of a new website called Gling, a social collaboration community (launched in September) that offers those living gluten-free a way to connect, plus find recipes and restaurants offering gluten-free foods. Founder and Chief Executive Mike Lee said he and some of his family deal with gluten intolerance and have been gluten-free for seven years. With his background in tech start-ups, he decided to start a site dedicated to a gluten-free lifestyle.

Recipes on the site include corn and porcini pudding, gluten-free vegetable latkes, and caramel apple cheesecake. A special "menuzine" for the holidays offers recipes and information on such topics as traveling with gluten-free foods. In one blog post titled "What Not To Do For Your First Gluten-Free Christmas," a woman tells about learning from mistakes she made navigating through the holidays.

Enjoying social gatherings can be a challenge, he said. "And probably for people new to this, it's an even bigger challenge. They're used to eating that family classic they eat once a year, and suddenly they can't. The nice thing about the gluten-free world is that people can start focusing less on avoiding gluten and more on finding good foods they can eat, and things that are fun to make. So you end up starting some new traditions and finding some fun new things to make with your family."

Lee, a headhunter for software and tech start-ups, says he wants to expand the features on Gling (short for gluten-free living), still in beta mode. "I want to give somebody a place to go where, after a few minutes of surfing, they can find places to go in their neighborhood, people they can connect with, and food they can make tonight."

-- Jeannine Stein

Screenshot of the Gling site courtesy of Mike Lee

The World Health Organization’s Copenhagen pitch on climate change

December 18, 2009 |  5:54 pm

As talks came to an end in Copenhagen, the World Health Organization tried to explain that climate change is about more than the environment -- it's a human health concern too.

As WHO scientist Diarmid Campbell-Lendrum said on the News Hour on Thursday, "Three and a half million die from under-nutrition. That's entirely dependent on agricultural production. And all of those deaths occur in the parts of the world that are going to be most affected by climate change."

Malaria is another heat-sensitive global health threat, which is expected to worsen with changing weather patterns. But, on the bright side, the World Health Organization reported this week that malaria-fighting funds, which went from $300 million in 2003 to $1.7 billion this year, are paying off. In a third of the 108 "malarious" countries, reports of sickness dropped by more than half since 2000.

And the Bill and Melinda Gates Foundation just awarded researchers nearly $10 million to create a malaria vaccine. 

However, in case you're visiting a "malarious" country any time soon, here's some tips from the Centers for Disease Control and Prevention on keeping clear of the mosquito-borne bug.

-- Amina Khan

Asymmetrical arm swings may signal Parkinson's disease

December 10, 2009 |  5:49 pm

Parkinson's disease is a neurodegenerative illness that can have devastating effects on motor skills, including walking. A new study found that arm-swing asymmetry while walking may be one of the first signs of the disease.

J7cyb8nc In this small study, researchers from University of North Carolina at Chapel Hill and Pennsylvania State University did a gait analysis among 12 older people with early stage Parkinson's disease, and eight people without the disease, who served as a control group. Before gait analysis tests, those in the Parkinson's group tapered off their Parkinson's medication so test results wouldn’t be swayed.

Each participant had the movement of their arms, pelvis and lower extremeties analyzed via a 3-D motion capture system as they walked three ways: at a normal gait, at a fast gait and on their heels, the last to minimize push-off.

The Parkinson's group showed more arm-swing asymmetry than the control group in the normal and fast walking variations. But trunk rotation was basically the same for both groups, showing that it didn't factor into the arm-swing asymmetry. Arm-swing magnitude was the same for both groups as well.

"Our data suggests that this could be a very useful tool for the early detection of Parkinson's," Xuemei Huang, associate professor of neurology at Pennsylvania State Hershey College of Medicine, said in a news release. Huang, the study's co-author, added: "There are wide scale efforts to find drugs that slow cell death. When they are found, they could be used in conjunction with this technique to arrest or perhaps cure the disease because they could be given before great damage has occurred."

The study appears in the current issue of the journal Gait and Posture.

-Jeannine Stein

Photo credit: Don Emmert / AFP/Getty Images

What killed Jane Austen?

December 2, 2009 |  8:00 am

Jane Austen’s works continue to be read nearly 200 years after her death, and a new analysis of her personal correspondence has led an expert in Addison’s disease to suggest that the pre-Victorian novelist didn’t die of the condition, as is commonly thought.

Janeausten A careful reading of the letters Austen wrote in the last two years of her life has convinced Katherine White that the author of “Pride and Prejudice” and “Sense and Sensibility” probably died of bovine tuberculosis, which she could have contracted by drinking unpasteurized milk.

Addison’s disease is a hormonal disorder in which the adrenal glands don’t make enough cortisol or aldosterone. These hormones help maintain blood pressure and allow other crucial systems to function properly. Until a treatment was developed in the 1950s, Addison’s disease was fatal.

But several of the key symptoms – including mental confusion and generalized pain – are absent in Austen’s personal writings, says Katherine White, who helps run the Addison’s Disease Self Help Group in the Britain. In fact, in a letter written less than two months before her death, Austen told a friend that “My head was always clear, and I had scarcely any pain.”

Also missing is any reference to weight loss or loss or appetite, which are common symptoms among Addison’s patients, White reported this week in the British journal Medical Humanities.

Dr. Zachary Cope diagnosed Austen with Addison’s disease in 1964 based on the fact that she suffered from exhaustion, rheumatic pains, bilious attacks and discoloration of her skin. Some of those symptoms are also consistent with a diagnosis of lymphoma.

However, White said in a statement that she thinks TB is the most likely cause of death because it “would have been more common in Jane Austen’s time and would offer a simpler explanation of her symptoms.”

Austen biographer Claire Tomalin said she finds the new analysis fascinating.

Tomalin said she had spoken with a physician who also questioned the diagnosis of Addison’s disease during her own research for “Jane Austen: A Life.” In a commentary published by The Times of London, she wrote:

I find it extraordinary that Austen, who died in 1817, finished "Persuasion" and that she embarked on "Sanditon," an extremely funny fragment mocking hypochondria, in her last illness. It shows what a sense of humour she had that she could do that when she was dying.

-- Karen Kaplan

Photo: Unpasteurized milk, not Addison’s disease, may have caused the death of British novelist Jane Austen (portrayed here by actress Olivia Williams). Credit: PBS/KCET

Needle sticks can be a job hazard for medical students

November 25, 2009 |  3:25 pm

Almost every job has its hazards, but some have more than others. Case in point: medical students and needle-stick injuries.

Kspcyknc A new study finds that medical students often come in too-close contact with needles, possibly putting them at risk for contracting HIV or hepatitis C. But not all report their injuries. Researchers from Johns Hopkins University School of Medicine and George Washington University School of Medicine & Health Sciences surveyed 699 surgeons-in-training at 17 general surgery residency programs around the U.S.

Almost 60% said they sustained a needle-stick injury as a medical student, with many suffering two injuries. Of the 89 study participants who had their most recent needle-stick in medical school, a little less than half didn’t report the injury to an employee health service. The most common reason? Filling out a report was too time-consuming.

In this group, the vast majority (92%) of injuries that involved high-risk patients were reported, compared with 47% of needle-sticks involving low-risk patients. Also, 72% said the injury was self-inflicted, and more than half believed the injury stemmed from being rushed.

"Medical schools are not doing enough to protect their students and hospitals are not doing enough to make medical school safe," said lead researcher Dr. Martin Makary, in a news release. The associate professor of surgery at the Johns Hopkins University School of Medicine added, "We, as a medical community, are putting our least skilled people on the front lines in the most high-risk situations. Most trainees are still forced to learn to sew and stitch on patients, which puts both providers and patients at risk."

The study appears in the December issue of the journal Academic Medicine. Johns Hopkins has a Summary of Current Practice Guidelines for Occupational Exposures to Bloodborne Pathogens.

Photo credit: Ryan Remiorz / AP

A bit of family medical history with that turkey and gravy?

November 25, 2009 |  1:52 pm

Is your Thanksgiving feast marred by awkward silences, backbiting comments or, worst of all, sports talk?

Your surgeon general, Dr. Regina M. Benjamin, prescribes the cure for these common holiday afflictions: why not take the opportunity presented by the family gathering to gorge on some of the clinical details of your family's medical history?

The resulting conversation will not only enliven any holiday table. It'll remind everyone that the grim reaper may be hiding in the gravy, that the heartburn they're about to experience might not be so benign, and that in addition to inflicting psychological wounds upon their children, parents bequeath a propensity to certain diseases as well.

Now there's no script for getting this conversation started. But here are a few possible icebreakers:

--I'm interested in understanding my family medical history better. But first, how do I know I'm actually related to you?

--Was Uncle Tommy always like that, or did some neurological disease ravage his brain?

--Why does Uncle Bill's frozen hand look like it's clutching a beer bottle? Could it be alcoholism?

--Was Aunt Zelda born male, or is that facial hair the result of hormone imbalance?

--Your face is very red. Are you angry I'm asking these questions, or do you suffer from dangerously high blood pressure?

    As you can see, there's no wrong way to jog memories and tap the flow of colorful family stories. And if you want to write down the health information you collect along the way, that might come in handy someday as well. You can create a "Family Health Portrait" by checking out this site.

 -- Melissa Healy 

Recommendations for new school meal nutrition standards

October 20, 2009 | 12:02 am

The nutrition standards behind the National School Lunch Program and the School Breakfast Program have not been updated since 1995. Today, the federal Institute of Medicine is issuing a report recommending new standards, calling for more produce, more whole grains. And for the first time, a limit to calories.

Thirty million children eat school lunch, and 10 million eat school breakfast -- and the IOM panel says it hopes new standards will help those children develop good habits that they carry into adulthood. That, the panel says, should help curb obesity and other health problems associated with diet.

The panel's recommendations go to the U.S. Department of Agriculture for possible implementation. It was the USDA which requested the report.

The panel says new standards would cost money -- for food as well as for training and capital improvements. But it says food costs would go up by less than 10% for breakfast and 25% or less for lunches. The government now spends $8.7 billion a year in reimbursements for school meals to school districts.

The recommendations are meant to bring school food in line with the dietary guidelines the government issues for Americans. It seeks to have the amount of sodium in school meals reduced by more than half over the next decade.

Among its recommendations: that calories be limited, based on age level, for breakfast and lunch, and that the sodium level for a typical lunch be eventually reduced to 740 milligrams. It also sets out targets for weekly servings of fruits and vegetables, and it calls for more whole grains.

"It's about time," says Matthew Sharp of the California Food Policy Advocates and one of the people who testified before the panel. Meals, he says, should be nutritious and affordable and they also should "teach kids healthy habits" and expose them to a variety of foods.

-- Mary MacVean

The toll of living in a concrete jungle

October 15, 2009 |  6:00 am

Green People who live in rural areas appear to have a major health advantage compared with city-dwellers. Living close to green space improves one's mental and physical health across a wide range of disease states, according to a new study.

Researchers in the Netherlands looked at the health records of people registered with 195 family doctors across the country. The percentages of green space within a 1-kilometer and 3-kilometer radius (that's 0.68 of a mile to 1.86 miles) of their homes were calculated.

Overall, the prevalence of 15 of 24 diseases was lower among people living with more green space, particularly those with more green space within 1 kilometer. The prevalence of anxiety disorders among those living in an area containing 10% green space within a 1-kilometer radius was 26 per 1,000. For those living in an area with 90% green space, the rate was 18 per 1,000. Depression rates in the first group were 32 per 1,000 compared with 24 per 1,000 for people living around more green.

The researchers also found that the impact of living near green space was greatest for people who spent the most time at home, including children and people of lower socioeconomic status.

The presence of green space may influence health through several mechanisms, the authors said. It could assist with recovery from stress, allow for more social interactions with neighbors and create more opportunities for physical activity. Air quality may be better, too.

"Our study shows that the role of green space in the living environment for health should not be underestimated," the authors wrote.

The study was published today in the Journal of Epidemiology and Community Health.

-- Shari Roan

Photo credit: Bryan Chan / Los Angeles Times

Those with less severe symptoms of celiac disease may be at a higher risk of death [Updated]

September 15, 2009 |  1:01 pm

Those who suffer from celiac disease have much to contend with. The immune-related disorder causes digestive symptoms when gluten is eaten, making flour-based foods such as breads and pasta problematic. Eating gluten can injure the surface of the small intestine, not allowing the body to absorb some nutrients. Previous studies have shown an increased risk of death among people with celiac disease.

Kp40i7nc But a new study in this week's Journal of the American Medical Assn.reveals there also might be a moderately increased mortality risk for those who have less significant levels of symptoms related to the disease, such as intestinal inflammation or latent celiac disease.

Researchers from Sweden and England looked at data from biopsies done between 1969 and 2008 that included biopsies on the small intestine. Data on all cases of celiac disease, inflammation and latent celiac disease were matched with controls.

The data revealed 3,049 deaths among patients with celiac disease, 2,967 deaths in patients who had inflammation, and 183 deaths in patients with latent celiac disease. In all three groups the risk of death was higher--those with inflammation had a 72% increased risk of death, those with celiac disease had a 39% increased risk, and those with latent celiac disease had a 35% increased risk of death. Researchers believe that the higher mortality rate for those with inflammation could be due to the fact that they were older at the beginning of the study.

Among causes of death were cardiovascular disease and malignancy.

The same issue of the journal features an editorial by Dr. Peter H.R. Green, director of the Celiac Disease Center at Columbia University College of Physicians and Surgeons. In it, Green emphasizes the importance of doctors diagnosing celiac disease, and argues more attention should be paid to intestinal inflammation and gluten sensitivity.

Recently a new at-home test for celiac disease was introduced. MyCeliacID is a do-it-yourself saliva-based test that uses genetics to determine if someone has a gene that is linked to the disease, but does not diagnose the active disease. [Update 1:40 p.m.: An earlier version of this article said the test determines presence of the disease.]

-- Jeannine Stein

Photo credit: Anne Cusack / Los Angeles Times


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