Gene Sequencing Yields Picture of Human Gut

THURSDAY, March 4 (HealthDay News) — Researchers have succeeded in sequencing 3.3 million genes from organisms residing in the human gut.

And it appears that each person harbors at least 160 species of bacteria in their gut, far more than originally estimated, according to a paper appearing in the March 4 issue of Nature. The research was led by researchers in China as part of the MetaHIT (Metagenomics of the Human Intestinal Tract) project.

Although this is just the first tiny dent in a mountain of work to be done, the findings should help experts understand both human health and human illness better.

“This is so rich. It could help in so many different ways. It could help us understand diseases like inflammatory bowel disease [IBD], Crohn’s and ulcerative colitis. It could help us with problems like malnutrition and obesity. It could help us understand many different metabolic problems from liver disease to kidney to heart disease,” said Dr. Martin Blaser, chairman of the department of medicine at New York University Langone Medical Center and a professor of microbiology at New York University School of Medicine in New York City. “This is really a landmark study.”

Humans coexist peacefully and sometimes not so peacefully with legions of microorganisms in their gut. An estimated 100 trillion cells make up these microbes. That’s 10 times the number of human cells in the body.

“There are symbiotic relationships with these bacteria,” explained Dr. Brian Currie, vice president and medical director for research at Montefiore Medical Center in New York City. “They make substances we need … and there’s a body of literature that suggests that the interaction with these bacteria may have something to do with immune modulation as well. It’s a largely unexplored area.”

Another expert, Jeffrey Cirillo, a professor of microbial and molecular pathogenesis at the Texas A&M Health Science Center College of Medicine in College Station, said that, “basically the gut functions properly because of the large amount of bacteria that are present within it.”

“In other words, rather than the gut being controlled by us, it’s actually controlled by the bacteria present in it,” he said. “There’s almost a limitless number of diseases and health characteristics that are affected by what we eat and how it gets digested, and the microflora that are present basically determine how that gets handled. It’s a critical component of health overall.”

This research team was able to identify and sequence 3.3 million microbe genes from fecal samples taken from 124 Europeans. This is 150 times more microbial genes than human genes.

The participants, from Spain and Denmark, were either healthy or had inflammatory bowel disease.

More than 99 percent of the genes were bacterial, representing up to 1,150 different bacterial species.

Although most of the 3.3 million genes must be shared among individuals, the study authors were only able to show that 38 percent of the genes seen in each individual were shared with at least half of the other individuals sampled.

And while much has been made of “good” bacteria vs. “bad” bacteria in people’s bodies, the organisms involved may not be either.

“This may have to do more with proportions. Maybe there is a certain ecological balance of certain kinds of organisms, and disease is not necessarily due to having bad bacteria but an imbalance,” Blaser said. “When you take a census and you have schoolteachers, policemen, insurance brokers, etc. That’s kind of healthy. But let’s say you took a census and everybody was a Wall Street stockbroker. That may be less healthy. The proportions of the different kinds of organisms that are present could be more important.”

For instance, patients with inflammatory bowel disease had, on average, 25 percent fewer genes than healthy individuals, indicating that patients suffering from IBD have less diversity in their guts.

“We know that some of these functions are critical for human health and well-being, and these are the first initial baby steps to fully characterize what those are, to get a handle on the diversity,” added Dale Hedges, an assistant professor at the John P. Hussman Institute for Human Genomics and assistant director of the Center for Genome Technology at the University of Miami Miller School of Medicine. “As we start to get a better grasp of the genetic diversity in our gut biome, we can start to ask questions about the relationship between the genetic diversity that’s existing in our microbiome internally and our susceptibility to different diseases and what the interaction is.”

Cirillo is enthusiastic. “A picture is worth a thousand words, and this gives us a picture of what’s going on in the gut,” he said.

More information

Visit the International Human Microbiome Consortium for more on this type of research.

By Amanda Gardner
HealthDay Reporter

SOURCES: Martin Blaser, chairman, department of medicine, Langone Medical Center, and professor, microbiology, New York University School of Medicine, New York City; Dale Hedges, Ph.D., assistant professor, John P. Hussman Institute for Human Genomics, and assistant director, Center for Genome Technology, University of Miami Miller School of Medicine; Brian Currie, M.D., vice president and medical director, research, Montefiore Medical Center, New York City; Jeffrey Cirillo, Ph.D., professor, microbial and molecular pathogenesis, Texas A&M Health Science Center College of Medicine, College Station; March 4, 2010, Nature

Last Updated: March 04, 2010

Copyright © 2010 HealthDay. All rights reserved.

Gut Bacteria May Spur Obesity, Research Suggests

THURSDAY, March 4 (HealthDay News) — Intestinal bacteria may contribute to obesity and metabolic syndrome, a new study in mice suggests.

“It has been assumed that the obesity epidemic in the developed world is driven by an increasingly sedentary lifestyle and the abundance of low-cost, high-calorie foods. However, our results suggest that excess caloric consumption is not only a result of undisciplined eating but that intestinal
bacteria contribute to changes in appetite and metabolism,” senior study author Andrew Gewirtz, an associate professor of pathology and laboratory medicine at Emory University School of Medicine, said in a university news release.

He and his colleagues found that increased appetite and insulin resistance can be transferred from one mouse to another via intestinal bacteria. The findings are published online March 4 in the journal Science.

It’s believed that intestinal bacteria populations in people are acquired at birth from family members and are relatively stable. However, they can be affected by diet and antibiotics.

“Previous research has suggested that bacteria can influence how well energy is absorbed from food, but these [new] findings demonstrate that intestinal bacteria can actually influence appetite,” Gewirtz explained.

He said the findings from mice suggest “that it’s possible to ‘inherit’ metabolic syndrome through the environment, rather than genetically. Do obese children get that way because of bad parenting? Maybe bacteria that increase appetite are playing a part.”

A gene called toll-like receptor 5 (TLR5) plays an important role in controlling intestinal bacteria. Gewirtz and colleagues plan to investigate TLR5 variations in humans and how bacteria in TLR5-deficient mice influence appetite and metabolism.

More information

The American Academy of Family Physicians has more about metabolic syndrome.

— Robert Preidt

SOURCE: Emory University, news release, March 4, 2010

Last Updated: March 04, 2010

Copyright © 2010 HealthDay. All rights reserved.

Scientists Discover How Chemo Can Make Women Infertile

MONDAY, Sept. 28 (HealthDay News) — Italian researchers say they have identified the mechanism by which chemotherapy can rob a woman of her ability to have children.

Intriguingly, the scientists also found that another anti-cancer drug might counteract the negative effects of the chemotherapy drug cisplatin.

The finding, demonstrated in mice and reported in the Sept. 27
online edition of Nature Medicine, raises the hope that there might be a way to protect a woman’s fertility while she undergoes treatment for cancer but, the authors stressed, this is still a long way off.

“The extension of these findings to patients and the design of clinical trials is likely to require the development of targeted drug delivery strategies to avoid any potential interference with anti-cancer systemic therapy,” explained study author Stefania Gonfloni, of the department of biology at the University of Rome.

“I think it’s a great idea. They found a pathway that can be used as a marker to detect which drug would produce cell death as a result of chemotherapy, and they found a repair effect of a drug,” said Dr. George Attia, an associate professor of reproductive endocrinology and infertility at the University of Miami Miller School of Medicine. “[But] it’s very basic science research. It’s still early.”

Because chemotherapy affects the egg cells of the ovary, women often end up with ovarian failure and infertility as a result of cancer treatment.

“We frequently deal with women of childbearing age, and there’s a lot of concern about fertility preservation although as women get older, the chemo induces menopause,” said Dr. Igor Astsaturov, an assistant professor of medical oncology at Fox Chase Cancer Center in Philadelphia. “The standard approach now is egg collection [storing eggs for later use].”

Chemotherapy can also cause genetic defects in offspring. In particular, cisplatin, which was studied in this trial, causes specific types of chromosomal damage.

Cisplatin is primarily usually used to treat ovarian cancer, Attia noted.

In this study, Gonfloni and her colleagues showed that cisplatin promotes the death of oocytes, or female germ cells, by way of the c-Abl enzyme, a protein that, when mutated, can also cause chronic myeloid leukemia (CML).

But targeting the enzyme with imatinib (Gleevec), a drug used to treat CML, protected the oocytes from the ill effects of cisplatin.

“These results raise the possibility of protecting ovarian function during cancer treatments, thereby preserving the fertility in female cancer survivors,” Gonfloni added.

But how to use one drug without compromising the other?

“First, we have to show that imatinib can be used to prevent chemotherapy-induced ovarian toxicity without interfering with anti-cancer treatments,” Gonfloni said. “In other words, we have to prove that tumor-bearing laboratory animals can be cured with a combined cisplatin and imatinib treatment, while at the same time preserving fertility,” she explained.

“Then, for any clinical implications, it will be very important to prove the same protective effect of a specific dosage of imatinib on human oocytes cultured and challenged with chemotherapeutic drugs in vitro,” she added.

And preserving fertility is not always the right thing, Astsaturov said.

“Chemotherapy induces menopause in some hormone-dependent cancers. It has a beneficial effect because it’s withdrawing the stimulants for the cancer cells. Menopause is contributing to the cure,” he said. “It’s still debated whether we should preserve menstrual function at all costs.”

More information

Visit Cancer Research UK for more on chemotherapy and fertility.

By Amanda Gardner
HealthDay Reporter

SOURCES: Stefania Gonfloni, Ph.D., department of biology, University of Rome, Italy; George Attia, M.D., associate professor, reproductive endocrinology and infertility, University of Miami Miller School of Medicine; Igor Astsaturov, M.D., assistant professor, medical oncology, Fox Chase Cancer Center, Philadelphia; Sept. 27, 2009, Nature Medicine, online

Last Updated: Sept. 28, 2009

Copyright © 2009 ScoutNews, LLC. All rights reserved.

Stem Cells Spur New Eggs in Ovaries of Adult Mice

SUNDAY, April 12 (HealthDay News) — Researchers in China have demonstrated that female ovaries may be capable of producing new eggs in adulthood and subsequently producing offspring.

That runs counter to the long-held belief that female mammals, including humans, are born with a finite number of the eggs (oocytes) needed to produce offspring.

According to study senior author Ji Wu, a professor at Shanghai Jiao
Tong University, the findings may lead to techniques for the “generation of new oocytes to postpone normal or premature ovarian failure or for the treatment of infertility.”

Paul Sanberg, a stem cell researcher and distinguished professor of neurosurgery and director of the University of South Florida Center for Aging and Brain Repair in Tampa, called the study “fascinating.”

“These stem cells are continuous,” explained Sanberg, who was not involved in the research. “They were still around through life and actually transformed to make oocytes. Then they were transplanted into infertile females and produced offspring.”

Could doctors someday use stem cells to help adult women produce brand-new oocytes? One reproductive medicine expert isn’t sure.

The new finding is “very, very exciting and opens up a big area of discussion,” said Dr. George Attia, associate professor of reproductive endocrinology and infertility at the University of Miami Miller school of Medicine. “If it would ever come to fruition in humans, I really don’t know. It’s far, far out there,” he said.

Another expert agreed.

“It’s a cute experiment, but I don’t think it’s going to have anything to do with humans,” said Dr. Darwin J. Prockop, director of the Texas A&M Health Science Center College of Medicine Institute for Regenerative Medicine at Scott & White. “There are too many steps, too many things could go wrong.”

But the findings, published online April 12 in Nature Cell Biology, could still have interesting implications for future stem cell and other research, Prockop added. “Any new kind of cell is interesting,” he said.

For years, scientists had believed that the capability to produce oocytes was lost in most mammalian species at birth.

That line of thought was tested with the recent discovery of actively dividing germ cells (those that give rise to sexual reproduction) in the ovaries of both juvenile and adult mice. The presence of these germ cells could indicate reproductive capability.

Still, researchers disagreed as to whether female germline stem cells (FGSCs) do exist in mammalian ovaries after birth.

So, the Chinese team isolated active female FGSCs from adult and five-day-old mice. They say that they were able to generate new FGSC lines that proliferated even after being cultured multiple times.

These FGSCs restored fertility (by producing new oocytes) when transplanted into the ovaries of female mice that were previously rendered infertile by chemotherapy.

The females then gave birth to normal, young mice.

Even if the breakthrough could apply to humans, it likely would only apply to younger women experiencing infertility, Attia said. “Pregnancy is a heavy load on the human body. A 60-year-old might not be able to be pregnant,” he noted.

In other stem cell news, researchers reporting Sunday in the journal Nature Biotechnology said that they were able to use bits of genetic material called microRNA to revert adult mouse cells back into embryonic cells.

These new embryonic cells are, like stem cells, capable of transforming into multiple different types of tissue.

Currently, retroviruses and genes are used to complete this transformation, but this carries the risk of cancer and other problems. Using microRNAs, which regulate gene expression, would be a potentially safer method, said researchers from the University of California, San Francisco.

More information

There’s more on stem cells at the U.S. National Institutes of Health.

SOURCES: Ji Wu, Ph.D., professor, Shanghai Jiao Tong University, Shanghai, China; Darwin J. Prockop, M.D., Ph.D., director, Texas A&M Health Science Center College of Medicine Institute for Regenerative Medicine at Scott & White, and Stearman Chair in Genomic Medicine and professor of molecular and cellular medicine, Texas A&M Health Science Center College of Medicine; George Attia, M.D., associate professor, reproductive endocrinology and infertility, University of Miami Miller School of Medicine; Paul Sanberg, Ph.D., D.Sc., distinguished professor, neurosurgery and director, University of South Florida Center for Aging and Brain Repair, Tampa; April 12, 2009, Nature Cell Biology, Nature Biotechnology

By Amanda Gardner
HealthDay Reporter

 Last Updated: April 13, 2009

Copyright © 2009 ScoutNews, LLC. All rights reserved.

Weight Loss Helps Incontinence

WEDNESDAY, Jan. 28 (HealthDay News) — If you’re among the millions of women who suffer from urinary incontinence, losing weight might just ease your symptoms, a new study suggests.

Published in the Jan. 29 issue of the New England Journal of Medicine, the study found that when women lost about 8 percent of their body weight — an average of 17 pounds for this group — the frequency of incontinence episodes dropped by almost half.


“Weight is one of the biggest risk factors for developing incontinence and for worsening incontinence,” said study author Dr. Leslee Subak, an associate professor in the departments of obstetrics, gynecology, reproductive sciences, urology and epidemiology and biostatistics at the University of California, San Francisco.

More than 13 million American women have urinary incontinence problems, according to background information in the study. Observational studies have found an association between extra weight and incontinence, and other research has suggested that losing weight might be beneficial for relieving incontinence symptoms.

To confirm these findings, Subak and her colleagues recruited 338 women from Rhode Island and Alabama. The women had to be at least 30, with a body-mass index (BMI) between 25 and 50. A BMI over 25 is considered overweight and over 30 is obese, according to the National Institutes of Health. All of the women experienced at least 10 incontinence episodes in a seven-day period.

Two-thirds of the women were randomly assigned to the intervention group, which included diet, exercise and behavior modification, while the remaining one-third (the control group) received four educational sessions about weight loss, healthful eating and physical activity. All of the women received a self-help booklet with tips for improving their urinary incontinence.

The intervention group met for one hour every week for six months and were put on a structured protocol, including diet and exercise, designed to help them lose between 7 percent and 9 percent of their starting weight.

On average, the intervention group lost 8 percent of their body weight, or about 17 pounds each. The control group lost 1.6 percent of their body weight, or a little more than 3 pounds each.

After six months, the weekly number of incontinence episodes dropped by 47 percent for those in the intervention group compared to 28 percent in the control group. The intervention group also reported fewer episodes of stress incontinence — that’s incontinence that occurs due to extra pressure from laughing, coughing or sneezing. This group did not see improvement in urge incontinence — that’s the feeling of a sudden need to urinate.

“The reduced pressure from weight loss causes reduced pressure on the bladder,” Subak explained.

She said these findings confirm that weight loss can be considered a first-line treatment for women with incontinence.

“The weight we carry around affects our bodies in so many different ways,” said Dr. Janet Tomezsko, chief of the section of urogynecology at Northwestern Memorial Hospital in Chicago. “And, the more overweight you are, the more you have to lose to make an impact, but you can make an impact. It’s not an easy thing to do, but I think we’re going to see more and more programs that address weight loss, exercise and pelvic health.”

More information

To learn more about incontinence in women, visit the U.S. National Institute of Diabetes and Digestive and Kidney Diseases.

SOURCES: Leslee Subak, M.D., associate professor, departments of obstetrics, gynecology, reproductive sciences, urology and epidemiology and biostatistics; University of California, San Francisco; Janet Tomezsko, M.D., chief, urogynecology and pelvic reconstructive surgery, department of obstetrics and gynecology, Northwestern Memorial Hospital, Chicago; Jan. 29, 2009, New England Journal of Medicine

By Serena Gordon
HealthDay Reporter

Last Updated: Jan. 28, 2009

Copyright © 2009 ScoutNews, LLC. All rights reserved.

Female Incontinence a Prevalent Problem

TUESDAY, Sept. 16 (HealthDay News) — Almost 25 percent of American women have a pelvic floor disorder, such as urinary incontinence, fecal incontinence or pelvic organ prolapse, according to new research.

“This study showed that pelvic floor disorders are exceedingly common in women in the United States,” said the study’s lead author, Dr. Ingrid Nygaard, a professor in the division of urogynecology and pelvic reconstructive surgery in the department of obstetrics and
gynecology at the University of Utah School of Medicine.

And, though these disorders are prevalent, women don’t always bring them up with their doctors, said Nygaard. “Pelvic floor disorders are not talked about often, and women are often too embarrassed to bring them up” with their doctors, she said.

Said Dr. Victor Nitti, vice chairman of urology at New York University Langone Medical Center: “I don’t think there’s any question that pelvic floor disorders are underreported. Some women are embarrassed, and some think they’re a normal part of aging. Either way, it’s not something women will often report spontaneously.”

The new study, published in the Sept. 17 issue of the Journal of the American Medical Association, reviewed data from almost 2,000 women over the age of 20 who had participated in the 2005-06 National Health and Nutrition Examination Survey. This study group is considered to be representative of the U.S. population. None of the women included in the data analysis was pregnant at the time of the study.

The women were interviewed at home and underwent a physical in a mobile examination center. Urinary incontinence was diagnosed based on scoring more than “three” on an incontinence severity index. Fecal incontinence was diagnosed if women reported having at least once monthly leakage of stool. And pelvic organ prolapse was diagnosed if women reported feeling a bulge inside or outside of the vagina. (Pelvic organ prolapse occurs when one of the pelvic organs, such as the uterus, drops and presses on the vagina.)

Overall, the researchers found that 23.7 percent of women experienced at least one pelvic floor disorder. Almost 16 percent of the women reported urinary incontinence, 9 percent experienced fecal incontinence, and 2.9 percent reported pelvic organ prolapse.

Nygaard pointed out that this study looked at moderate to severe incontinence. She said it’s quite common for women to leak small amounts of urine while laughing or sneezing, but that’s not what was studied here.

Older women were most likely to report a pelvic floor disorder, with almost 50 percent of those 80 and older reporting at least one pelvic floor disorder, compared to just 10 percent of women between 20 and 39 years old.

Having been pregnant increased the odds of pelvic floor disorders, and, with each pregnancy, the likelihood of incontinence or prolapse rose. Being overweight or obese also increased the risk of pelvic floor disorders, according to the study.

Both Nygaard and Nitti said that effective treatments are available for women with pelvic floor disorders. Nygaard recommended that women start with the most conservative treatment options, such as pelvic muscle strengthening and behavioral therapy. Surgery, which can be effective for certain problems, is usually reserved as a last option, she said.

“The most important thing women need to realize is that they’re not alone. Pelvic floor disorders aren’t dangerous and are treatable,” said Nygaard.

Nitti added: “If you have any symptoms related to any of these problems, and they bother you, you shouldn’t be embarrassed to bring it to the attention of your health-care providers. All are, in one way or another, treatable, particularly at the early stages.”

More information

Learn more about pelvic floor disorders from the National Institute of Child Health and Human Development.

SOURCES; Ingrid Nygaard, M.D., professor, division of urogynecology and pelvic reconstructive surgery, department of obstetrics and gynecology, University of Utah School of Medicine, Salt Lake City; Victor Nitti, M.D., vice chairman, urology, and professor, New York University Langone Medical Center, New York City; Sept. 17, 2008, Journal of the American Medical Association

By Serena Gordon
HealthDay Reporter

Last Updated: Sept. 16, 2008

Copyright © 2008 ScoutNews, LLC. All rights reserved.

New Guidelines Issued for Management of IBS

THURSDAY, Dec. 18 (HealthDay News) — A leading organization of gastroenterologists has released new guidelines on the management of irritable bowel syndrome (IBS).

The guidelines, issued by the American College of Gastroenterology and published in the January issue of The American Journal of Gastroenterology, essentially replace a 2002 document.

“The world of IBS is changing quickly because of more therapies and an increased awareness. It is considered a ‘real disease,’
” said Dr. Lawrence Brandt, chairman of the group’s IBS task force and chief of gastroenterology at Montefiore Medical Center in New York City. “A lot of new drugs are being developed, and a lot of work still needs to be done, but there’s enough new information since the last time.”

“From the practitioner’s standpoint, this doesn’t change much about practice and there’s not that much information that’s new, although it is thorough and helpful,” said Dr. Benjamin D. Havemann, an assistant professor of internal medicine at the Texas A&M Health Science Center College of Medicine and director of gastroenterology for the Round Rock University Medical Campus of Scott & White Hospital. “It shows what little has transpired [in terms of new treatments] in the last few years. Some of the breakthroughs we had have been withdrawn or are under strict control.”

“One powerful piece of information is that extensive work-ups are unhelpful,” Havemann said. “It makes sense to me that in the absence of alarm symptoms, the benefit of even basic blood work and other tests is in doubt.”

An estimated 7 percent to 10 percent of people have IBS, which can involve abdominal pain, bloating and other discomfort, including constipation and diarrhea. IBS affects both quality of life and productivity for millions of people.

Most IBS treatments relieve symptoms rather than resolve the condition itself.

The new guidelines encompass existing evidence on conventional treatments for IBS as well as new therapies (probiotics, for example) and alternative therapies (acupuncture and more). In summary, the updated guidelines say:

    Fiber products — including psyllium, anti-spasmodic medications and peppermint oil — may be effective, at least in some people. “The evidence is poor, but some patients say they feel better,” Brandt said. He cautioned that fiber should be used carefully in people with narrowed colons.
    More data is needed on probiotics, live microorganisms (usually bacteria) similar to the “good” organisms found normally in the gut. “This is a very hot topic but an exceedingly complicated subject,” Brandt said. Researchers and practitioners need to consider the species of bacteria used, how many species, and dosages.
    Non-absorbable antibiotics — those targeted to the gut only, such as rifaximin (Xifaxan) — also seem to help some people, especially those who have “diarrhea-predominant IBS.” Brandt said that “the data is not great, but some patients swear they’re helping them dramatically.”
    Tricyclic antidepressants as well as the antidepressants known as selective serotonin reuptake inhibitors (SSRIs) benefit a broad range of people with IBS. This is backed up by quality studies, although with small numbers of participants, and could change as research on larger numbers of people is evaluated. Psychological counseling may also provide some relief.
    Selective C-2 chloride channel activators, notably lubiprostone (Amitiza), are effective for “constipation-predominant IBS.”
    5HT 3 antagonists such as alosetron (Lotronex) relieve symptoms of diarrhea but can cause constipation and colon ischemia, a restriction of blood flow.
    5HT 4 agonists, though effective against constipation, are not available in North America because of a heightened risk of cardiovascular problems.
    There is yet to be conclusive evidence on Chinese herbal mixtures, and the mixtures run the risk of causing liver failure and other problems. Differences in the content of compounds and the purity of ingredients complicate evaluation of benefits.
    Similarly, the evidence on acupuncture remains inconclusive.
    There is no evidence at this point that testing for food allergies or following diets that exclude certain foods alleviates IBS symptoms.
    Routine diagnostic testing for IBS is not recommended, although some testing should be performed in certain subgroups of patients.

Though comprehensive, the guidelines were criticized for not explaining what outside funding was used for in the development process. The document does disclose that support was received from Takeda Pharmaceutical Co. and Salix Pharmaceuticals, which make products targeted to IBS.

Dr. Mark Ebell, deputy editor of American Family Physician, said he would feel more comfortable if the guidelines had been “very clear about what support was provided and what they needed the support for: paying for literature searches, for staff. … It’s common to have support for guidelines. … I think it’s generally unintentional, but when we have a relationship, it creates the potential for problems.”

Ebell said that Brandt had relationships with pharmaceutical companies.

Brandt had a different view. “I don’t have any ties to industry that would have any relevance to this publication,” he said. “I don’t receive money directly from any company. I own no stock and, nor does my family, so this is a totally unbiased thing. I have no conflict of interest whatsoever, and I think that does it.”

Anne-Louise B. Oliphant, a spokeswoman for the American College of Gastroenterology, said: “No company was involved in any way in either structuring or completing the meta-analysis that forms the basis for the College’s evidence-based recommendations on IBS. Furthermore, no company was in any way involved in deciding who served on the task force or in any of its work.”

More information

To learn more about IBS, visit the U.S. National Institute of Diabetes and Digestive and Kidney Diseases online.

SOURCES: Lawrence J. Brandt, M.D., chief, division of gastroenterology, Montefiore Medical Center, and professor of medicine and surgery, Albert Einstein College of Medicine, New York City; Mark H. Ebell, M.D., deputy editor, American Family Physician; Anne-Louise B. Oliphant, spokeswoman, American College of Gastroenterology, Bethesda, Md.; Benjamin D. Havemann, M.D., assistant professor, internal medicine, Texas A&M Health Science Center College of Medicine, and director, gastroenterology, Round Rock University Medical Campus, Scott & White Hospital; January 2009 The American Journal of Gastroenterology

By Amanda Gardner
HealthDay Reporter

Last Updated: Dec. 18, 2008

Copyright © 2008 ScoutNews, LLC. All rights reserved.

Gut Trouble? Peppermint Oil, Soluble Fiber Can Help Relieve IBS Symptoms

THURSDAY, Nov. 13, 2008 (Health.com) — Peppermint oil, soluble fiber, and antispasmodic drugs can indeed help people with irritable bowel syndrome (IBS), according to an analysis of 25 years of research on the condition, which is characterized by bouts of diarrhea and constipation.

About 10% to 15% of people in North America have IBS, and it’s twice as common in women. However, only about one-third of people with the intestinal disorder seek treatment.


The exact cause of IBS remains unknown, and that lack of knowledge has led to the use of a variety of treatments, including fiber supplements, probiotics, antidepressants, behavioral-based therapies, psychotherapy, food modification, acupuncture, and laxatives. However, many treatments are controversial because study results have been mixed.

Newer and more expensive medications have been introduced to the public, but some were ineffective or withdrawn from the market due to side effects. The recent study sheds light on the cheap and readily available treatments that can help patients, says study coauthor Eamonn M. Quigley, MD, a professor of medicine and physiology at University College Cork in Ireland.

“Medical science has tended to ignore IBS; it wasn’t appreciated how much of an impact it can have on a patient’s quality of life,” he says.

In the new analysis, researchers systematically reviewed 38 studies from the last 25 years; more than 2,500 volunteers were involved. That research compared therapies—all relatively cheap, safe, and readily available—to a placebo or to no treatment at all.

The team looked at three treatments—soluble fiber, peppermint oil, and antispasmodics, which are drugs that relax the smooth muscle in the gut and relieve cramping—and found that they were all more effective than a placebo, according to the report in the British medical journal BMJ.

Thyroid Problems Boost Glaucoma Risk

WEDNESDAY, Oct. 15 (HealthDay News) — People with a thyroid disorder run an increased risk of developing the eye disease glaucoma, a new study suggests.

In fact, those with glaucoma are 38 percent more likely to have had a thyroid condition at some point in their life, said the study authors, from the University of Alabama at Birmingham. Glaucoma is the leading cause of irreversible blindness worldwide.


“Studies like this are very useful in understanding what causes this disease,” said lead researcher Gerald McGwin, vice chairman of the Department of Ophthalmology at the university’s School of Medicine.

“If we can determine that thyroid problems are related to glaucoma, then we can make some hypotheses about what the mechanism behind that relationship might be and help us understand what might be the cause of glaucoma,” McGwin said. “And that may lead to more effective treatments or preventive measures.”

The findings were published online Oct. 16 in the British Journal of Ophthalmology.

For the study, McGwin’s team collected data on 12,376 people who participated in the 2002 National Health Interview Survey. They were asked if they’d ever been diagnosed with a thyroid problem or glaucoma. Slightly more than 4.5 percent said they had glaucoma, and 12 percent said they had been diagnosed with a thyroid problem.

Among people who had glaucoma, 6.5 percent said they had a thyroid problem, while 4.4 percent said they’d never had a thyroid condition.

People with thyroid problems should see an ophthalmologist or make their ophthalmologist aware of their thyroid condition, McGwin advised. “Somebody who has a history of thyroid problems and has not seen an ophthalmologist may have a heightened level of concern about their eyesight,” he said.

The thyroid produces hormones essential for the functioning of every cell in the body; these hormones help regulate growth and chemical reactions.

In glaucoma, the optic nerve becomes progressively damaged and, if not treated, leads to loss of vision and even blindness.

The study authors suggested that the link between glaucoma and thyroid disorders may owe to chemical deposits in the blood vessels that circulate blood to the eye, causing an increase in pressure within the eyeball. Increased pressure in the eyeball is the main feature of glaucoma.

Dr. Andrew Iwach, a spokesman for the American Academy of Ophthalmology and executive director of the Glaucoma Center of San Francisco, said the potential link between thyroid problems and glaucoma is interesting and should be taken into account, but it still needs to be proven. The best advice is to get your eyes checked, he said.

“If you haven’t seen an ophthalmologist by age 40, that’s a great time to get a baseline exam,” Iwach said.

“People may not know they are at risk for glaucoma. You are functioning fine, and yet slowly, this disease can chip away at the optic nerve, and by the time you have symptoms from glaucoma, oftentimes there’s not really much we can do,” he said.

In a related study, researchers at Rush University Medical Center in Chicago found that many elderly people have undiagnosed thyroid problems, including thyroid cancer. Older patients are twice as likely to be diagnosed with thyroid cancer as younger patients. Thyroid cancer was found in 41 percent of patients over 65, compared with 22 percent among younger patients, the researchers found.

Most thyroid cancer is treatable, and age should not be a barrier to treatment, noted the researchers, who were expected to present their findings Oct. 15 at the 2008 Clinical Congress of the American College of Surgeons, in San Francisco.

More information

For more on thyroid diseases, visit the U.S. National Library of Medicine.

SOURCES: Gerald McGwin, Ph.D., vice chairman, Department of Ophthalmology, University of Alabama at Birmingham School of Medicine; Andrew Iwach, M.D., spokesman, American Academy of Ophthalmology, and executive director, Glaucoma Center of San Francisco; Oct. 16, 2008, British Journal of Ophthalmology, online

By Steven Reinberg
HealthDay Reporter

Last Updated: Oct. 16, 2008

Copyright © 2008 ScoutNews, LLC. All rights reserved.

Could Lowering Blood Pressure Help Stop Dementia?

WEDNESDAY, March 17 (HealthDay News) — In the ongoing struggle to find treatments — and maybe one day even a cure — for dementia, researchers are focusing their attention on high blood pressure, long a culprit for a variety of other ills and an ailment for which many drugs are already available.

This coming fall, the U.S. National Institutes of Health will start enrolling participants in the largest trial thus far to see if lowering blood pressure even below current recommendations can reduce
not only the risk of age-related cognitive decline, but also the risk of cardiovascular and kidney diseases.

The Systolic Blood Pressure Intervention Trial (SPRINT) will involve 7,500 people aged 55 and over who will be followed for a minimum of four years. The NIH is investing $114 million in the endeavor.

“We have a number of effective and safe medications to lower blood pressure,” said Dr. Lawrence Fine, chief of the clinical applications and prevention branch in the division of cardiovascular sciences at the National Heart, Lung, and Blood Institute. “For the average person right now, the recommendation is a blood pressure of 140/90 or lower. SPRINT will compare that with a goal of 120 as the top number. Will the rate of dementia for people in the lower-goal arm be lower than standard?”

Current clinical guidelines recommend systolic pressure (the top number in a blood pressure reading) of less than 140 millimeters of mercury (mm Hg) for healthy adults, and 130 mm Hg for adults with kidney disease or diabetes.

“Hypertension is very easy to medicate and very easy to measure, so they want to see if just by modifying that simple thing they could reduce the incidence of dementia,” said Ian Murray, an assistant professor of neuroscience and experimental therapeutics at the Texas A&M Health Science Center College of Medicine in College Station.

The timing is critical, as over the next several decades huge numbers of aging Baby Boomers will develop Alzheimer’s disease and other forms of dementia.

Besides sparing thousands of Americans needless suffering, “if you could reduce that number by 10 percent, your cost savings would be immense,” said William Thies, chief medical and scientific officer for the Alzheimer’s Association in Chicago.

Although experts have long suspected a link between high blood pressure and dementia, without trial data those suspicions inevitably remain hypotheses.

“What we do know is that there’s an association between high blood pressure and a higher rate of dementia — it’s not a large increased risk but there is some increase,” Fine said.

“A whole bunch of epidemiologic data says there’s a link, and one trial actually showed that if you lowered people’s blood pressure it decreased the amount of dementia,” added Thies.

That particular trial used blood pressure drugs known as calcium-channel blockers, one in an extensive armamentarium of medications for the condition. Still, no one really knows why treating high blood pressure would lower the odds of dementia if, in fact, it really does.

“We’d really like to know the answer because it would give us our first confirmed pathway to modifying the amount of dementia by treating people with known agents,” Thies said. “That would be very important.”

The SPRINT trial will randomize participants — all of whom have systolic blood pressure of 130 mm Hg or higher — either to a group taking more intensive drug therapy (three or four medications) to try to get their blood pressure under 120, or a control group taking about two medications to maintain blood pressure at the currently recommended 140.

“We may discover lower blood pressure will not reduce the rate of dementia, but if the lower goal did reduce the rate of dementia by 10 or 20 or 30 percent, that would be an important observation because we don’t have other good treatments for dementia,” Fine said. “SPRINT should provide some additional science to inform us whether lowering blood pressure to the lower goal will, in fact, reduce the rate of developing dementia.”

“There are a lot of reasons why we ought to control blood pressure anyway, but this gives us another very important reason,” Thies added.

More information

There’s more on high blood pressure at the American Heart Association.

By Amanda Gardner
HealthDay Reporter

SOURCES: Ian Murray, Ph.D., assistant professor, neuroscience and experimental therapeutics, Texas A&M Health Science Center College of Medicine, College Station; Lawrence Fine, M.D., DrPH, chief, clinical applications and prevention branch, division of cardiovascular sciences, U.S. National Heart, Lung, and Blood Institute; William Thies, Ph.D., chief medical and scientific officer, Alzheimer’s Association, Chicago

Last Updated: March 17, 2010

Copyright © 2010 HealthDay. All rights reserved.

Report Calls High Blood Pressure a ‘Neglected Disease’

MONDAY, Feb. 22 (HealthDay News) — Americans eat way too much salt and cutting down on that consumption should be a cornerstone of new public health efforts to curb hypertension.

That’s one of the key messages of an Institute of Medicine (IOM) report, commissioned by the U.S. Centers for Disease Control and Prevention and released Monday, that calls hypertension — or high blood pressure — a “neglected disease,” one that has fallen off the public health radar and needs to be put back on.


“High blood pressure and its consequences are too important to remain a neglected disease,” Dr. David Fleming, chairman of the committee that produced the report, said during a morning news conference. “It’s time to give our complete attention to take full advantage of known and promising interventions, and take concerted actions necessary to achieve prevention and control of hypertension.”

The public-health initiatives described by the report would refocus efforts from individual actions to so-called environmental considerations, such as stocking fresh produce in urban grocery stores, making streets safe to walk on, and enlisting the help of industry in manufacturing foods with lower salt content.

“Congress must give priority to adequate resources to implement a broad sweep of policy-based approaches at the state, local and federal levels,” said Fleming, who is director of public health for Seattle/King County, Washington.

According to the report, nearly one-third of U.S. adults have high blood pressure, and it accounts for about one in six adult deaths annually, a 25 percent increase from 1995 to 2005. High blood pressure usually has no symptoms: You can have it for years without knowing it, even though it can damage the heart, blood vessels, kidneys and other parts of the body, according to the U.S. National Institutes of Health.

“If you live long enough, you are almost guaranteed to get hypertension,” said Dr. Corinne Husten, a committee member who, at the time the report was being prepared, was executive vice president for program and policy at the Partnership for Prevention. She is now senior medical advisor at the U.S. Food and Drug Administration’s Center for Tobacco Products.

The report outlines several priorities.

The first would be to cut Americans’ salt intake — 80 percent of Americans currently eat more than the recommended amount and that number is growing. But given that 70 percent of Americans’ sodium comes from packaged foods and restaurants — not from the family salt shaker — the food industry needs to play a role here, Fleming said. “These efforts should be focused on making it easier for people to eat less salt,” he said.

Experts also need to better understand why many health-care providers fail to adhere to current treatment guidelines, despite knowing what the stakes are. Some people don’t even know they have high blood pressure, likely a failure of their doctor or other provider. “We are alarmed at the extent to which Americans have undiagnosed hypertension, equally the millions who have been diagnosed and are under the care of a provider but whose hypertension isn’t controlled,” Fleming said. Only one-third of people with the diagnosis have it under control.

The third area involves breaking down economic barriers that prevent patients from taking their medication. The committee recommended that the CDC work with the Centers for Medicare & Medicaid Services, pharmaceutical companies and businesses to help get medication to those who need it.

The committee also recommended that procedures be set up to measure performance in controlling hypertension and how much salt is actually being consumed. “There is really inadequate national data on trends,” said Dr. Walter Willett, chairman of nutrition and epidemiology at the Harvard School of Public Health.

American Heart Association President Dr. Clyde Yancy said in a prepared statement: “This Institute of Medicine report on hypertension now reinforces the need for a broad-based initiative in the science and public health spectrums to help individuals manage hypertension and perhaps even prevent the onset of hypertension.”

Yancy stated, “We support the IOM’s recommendations to make drug therapy more affordable for Medicaid and Medicare beneficiaries and boost funding for prevention programs that provide smoking-cessation counseling and screenings for high blood pressure and cholesterol for underserved populations.”

More information

View the full report at the Institute of Medicine.

By Amanda Gardner
HealthDay Reporter

SOURCES: Feb. 22, 2010, news release, American Heart Association; Feb. 22, 2010 teleconference with David W. Fleming, M.D., director, public health, Seattle/King County, Wash.; Corinne Husten, M.D., former executive vice president for program and policy, Partnership for Prevention, and currently senior medical advisor, Center for Tobacco Products, U.S. Food and Drug Administration; Walter Willett, M.D., Dr.P.H., Fredrick John Stare Professor of Epidemiology and Nutrition, and chair, department of nutrition and epidemiology, Harvard School of Public Health, Boston; A Population-Based Policy and Systems Change Approach to Prevent and Control Hypertension

Last Updated: Feb. 22, 2010

Copyright © 2010 HealthDay. All rights reserved.

New HPV Vaccine Might Stop Vulvar Cancer in its Tracks

WEDNESDAY, Nov. 4 (HealthDay News) — A vaccine that targets human papillomavirus (HPV) is able to stop precancerous lesions in the vulva from progressing into full-blown malignancies, Dutch researchers report.

Two other vaccines — Gardasil and Cervarix — have been approved for young women to prevent infection with HPV, which is also thought to spur precancerous lesions in the cervix and cause 70 percent of cervical cancers.


But the vaccine used in this study, published in the Nov. 5 issue of the New England Journal of Medicine, is not the same as the two existing vaccines.

“This provides a therapeutic effect to a lesion that’s already there,” explained Dr. Eugene P. Toy, an associate professor of obstetrics and gynecology in the division of gynecologic oncology at the University of Rochester Medical Center.

“This shows that it is possible to vaccinate against chronic disease, as well as treat HPV-induced premalignance,” added study co-author Sjoerd H. van der Burg, of the experimental cancer immunology and therapy section at the Leiden University Medical Center in the Netherlands and ISA Pharmaceuticals, which helped fund the study and has licensed the patent for the vaccine from Leiden University Medical Center.

Eventually, clinicians hope the two HPV vaccines on the market will reduce the incidence of vulvar precancerous lesions.

Right now, though, said Dr. Kristine Zanotti, a gynecologic oncologist with University Hospitals Case Medical Center in Cleveland, “there are a lot of potential therapeutic challenges with HPV-related problems, especially vulvar dysplasia, which are multi-focal [they crop up in different places] and recurrent. [This vaccine] is a very exciting tool.”

The HPV-16 virus is implicated in 75 percent of cases of these vulvar lesions. A sexually transmitted pathogen, HPV has also been linked to rare cancers of the throat, genitals and anus, as well as genital warts.

For vulvar lesions, the existing treatments are unpleasant and not altogether effective.

“What we typically do is ablative therapies that destroy the lesion. That involves a surgical procedure or topical agents that essentially slough off the lining of the affected tissue,” Toy explained.

“Complete response rates [from these therapies] are disappointingly low, and we don’t know if they last,” added Zanotti.

For this study, 20 patients with vulvar dysplasia were vaccinated three or four times against certain cancer-related proteins associated with HPV-16.

Three months after the last vaccination, 60 percent of patients reported some kind of response along with fewer symptoms. For the same time period, five women (25 percent) saw their lesions disappear completely and four women had no more signs of HPV-16.

After a year, 79 percent of patients had experienced some kind of response while almost half had a complete response, which lasted at least 24 months, according to the report.

All of the patients showed immune responses to the vaccine.

Unlike Gardasil and Cervarix, which only affect the outside of the virus, the vaccine explored in this study was “trained to sense the proteins that are produced by the virus inside the cell. As such, they can recognize virally infected or virally transformed cells,” van der Burg explained.

Also exciting is the possibility, mentioned in the paper, that the new vaccine could be combined with imiquimod cream to completely erase all signs of the infection and tainted cells.

Next, the researchers want to figure out why the vaccine did not have a complete effect in all patients and they would also like to improve the vaccine so it works in patients with actual cancer or even other, non-HPV-related cancers, van der Burg said.

“In principle, this vaccine gives an enormous stimulation of the immune response against the HPV antigens expressed in infected and transformed cells. As such, it should do the same in patients with other types of HPV-16-induced (pre-)malignancies. However, in cancer patients, other forces may work against the efficacy of this vaccine. These need to be tackled, too, in order to make the vaccine do its job,” van der Burg added.

More information

The U.S. National Cancer Institute has more on human papillomavirus.

By Amanda Gardner
HealthDay Reporter

SOURCES: Eugene P. Toy, M.D., associate professor, obstetrics and gynecology, division of gynecologic oncology, University of Rochester Medical Center, Rochester, N.Y.; Sjoerd H. van der Burg, Ph.D., Experimental Cancer Immunology and Therapy, Leiden University Medical Center, Leiden, The Netherlands and ISA Pharmaceuticals; Kristine Zanotti, M.D., gynecologic oncologist, University Hospitals Case Medical Center, Cleveland; Nov. 5, 2009, New England Journal of Medicine

Last Updated: Nov. 04, 2009

Copyright © 2009 ScoutNews, LLC. All rights reserved.

Increase in Thyroid Cancer Puzzles Experts

TUESDAY, July 14 (HealthDay News) — Intensified screening doesn’t entirely explain the jump in thyroid cancers noted in the United States since 1980, and scientists now believe that other as-yet-unknown factors are to blame.

A new study finds that thyroid tumors of all sizes are being picked up, not just the smaller ones that more aggressive screening would be expected to detect.


“You cannot simply explain this by increased screening, there’s a real increased incidence,” said Dr. Amy Chen, lead author of a study published online July 13 in the journal Cancer.

Although, “some of this increased incidence is due to increased screening finding smaller tumors,” she added.

The findings surprised one expert.

“I wrote a chapter about this for a textbook about a year ago and I came away thinking this [rise in cancers] is a reflection of enhanced diagnostics,” said Dr. Bruce J. Davidson, professor and chairman of otolaryngology-head and neck surgery at Georgetown University Hospital in Washington, D.C. But, “it is more disturbing that it’s not just small tumors; it seems to be all tumors,” he said.

An estimated 37,200 new cases of thyroid cancer will be diagnosed this year, according to the U.S. National Cancer Institute. Fortunately, the cancer is considered highly curable, but the researchers said survival rates have not improved with better detection.

Until now, an uptick in cases seen over the past three decades was attributed to increased use of ultrasound and image-guided biopsy to detect tumors. Some researchers had found that thyroid cancer was diagnosed more often in areas with higher incomes and less in uninsured populations, adding further credence to this theory.

Looking at thyroid cancer cases from 1988 to 2005 reported in a large cancer database, Chen and her team found a higher incidence not just in small tumors, but across all sizes.

The most pronounced increase was seen in primary tumors under 1.0 centimeters — small ones for which many experts consider it safe to take a wait-and-see approach. The rate for these tumors rose almost 10 percent per year in men (1997 to 2005) and 8.6 percent per year in women (1988 to 2005).

But the authors also saw a 3.7 percent annual increase in tumors exceeding 4 centimeters in men and a 5.7 percent yearly rise in these tumors in women.

Cancers that had spread also increased in men by 3.7 percent annually and in women by 2.3 percent.

Thyroid cancer can be caused by exposure to radiation but there has been no evidence of increased exposure to radiation among Americans.

“People have looked at background radiation and nothing really has come of that that’s very useful. And certainly not useful to us in why there would be a bump in incidence in the last 15 years,” Davidson said.

Chen proposed in the study that environmental, dietary and genetic issues be explored.

More information

There’s more on thyroid cancer at the American Cancer Society.

By Amanda Gardner
HealthDay Reporter

SOURCES: Bruce J. Davidson, M.D., professor and chairman, otolaryngology-head and neck surgery, at Georgetown University Hospital, Washington, D.C.; Amy Chen, M.D., director of health services research, American Cancer Society and associate professor of otolaryngology-head and neck surgery, Emory University, Atlanta; online, July 13, 2009 Cancer

Last Updated: July 14, 2009

Copyright © 2009 ScoutNews, LLC. All rights reserved.

Fewer Genital Warts Thanks to HPV Vaccine Program

THURSDAY, Oct. 15 (HealthDay News) — New cases of genital warts have declined sharply since vaccination of teen girls and young women against the human papillomavirus (HPV) began in Australia in 2007, a new study has found.

Certain types of HPV are linked with the development of cervical cancer.

Researchers analyzed data on new clients receiving treatment for genital warts at the Melbourne Sexual Health Center between 2004 and 2008. During that time, the center had 36,055 clients, and genital warts were diagnosed in 10.6 percent of cases. The number of women under age 28 who were newly diagnosed with genital warts decreased by 25 percent each quarter throughout 2008, the researchers found.

Australia began providing free vaccinations with Gardasil for females ages 12 to 26 in 2007. In the period before the vaccinations began, new cases of genital warts rose by nearly 2 percent each quarter, the study authors noted.

The study also found that newly diagnosed cases of genital warts among young men fell by an average of 5 percent each quarter throughout 2008. Rates of newly diagnosed genital warts among older women and men didn’t decline.

The findings are published in the Oct. 15 online edition of the journal Sexually Transmitted Infections.

“The magnitude of the reduction in women [under] 28 years indicates a potential for substantial reductions in wart-associated morbidity and costs, and has important implications for countries deciding between the [Gardasil and Cervarix] vaccine,” the researchers wrote.

Gardasil protects against HPV types 6, 11, 16 and 18, while Cervarix protects against HPV types 16 and 18. Types 6 and 11 are associated with highly infectious genital warts, while types 16 and 18 are associated with cervical cancer.

More information

The U.S. Food and Drug Administration has more about HPV.

— Robert Preidt

SOURCE: Sexually Transmitted Infections, news release, Oct. 15, 2009

Last Updated: Oct. 15, 2009

Copyright © 2009 ScoutNews, LLC. All rights reserved.

U.S. Barred 33 TB-Infected People From Flying Over Past Year

THURSDAY, Sept. 18 (HealthDay News) — Thirty-three would-be air travelers with suspected or confirmed infectious tuberculosis were placed on the U.S. government’s public health “Do Not Board” list in the first year of its existence, a federal report released Thursday showed.

Authorized under the Aviation and Transportation Security Act of 2001, the list was instituted on June 1, 2007 by the U.S Centers for Disease Control and Prevention
and the Department of Homeland Security, according to an article in the Sept. 19 issue of Morbidity and Mortality Weekly Report, a CDC publication.

“Before June 2007, we had a system to prevent travel which was mostly based on local action,” explained Dr. Francisco Alvarado-Ramy, co-author of the report and a CDC quarantine public health officer based in San Juan, Puerto Rico. “We have moved from predominantly a decentralized system to a centralized one We’re formally tapping all U.S. government resources which add additional layers of protection to prevent persons with serious communicable diseases which pose a serious public health threat from boarding the plane.”

In the year after institution of the list, U.S. state and local or territorial health departments asked the CDC to include 42 people on the list, all of whom had confirmed or suspected tuberculosis (TB), including multi-drug resistant (MDR) TB and extensively drug-resistant (XDR) TB. In the end, 33 individuals met the criteria to be placed on the list. The most requests (seven) came from Texas, followed by California (five).

The issue gained prominence in 2007 after a Georgia man who flew to Europe for his wedding was subsequently quarantined after it was discovered that he had XDR TB. That highly visible case “highlighted some of the vulnerabilities to the existing system,” said Dr. Martin Cetron, director of the CDC’s director of division of global migration and quarantine.

Almost half of those barred from flights over the past year were citizens of countries designated by the World Health Organization as TB “high-burden” countries. Two of the individuals on the list were known to have attempted to evade U.S. air travel restrictions, although it is unclear what, exactly, this meant.

The CDC reviews the list on a monthly basis, determining who is eligible for removal — once a person is deemed to be no longer contagious, his or her name is removed from the Do Not Board list within 24 hours, the report’s authors said. Between June 2007 and May 2008, 55 percent of the 33 people on the list were removed either because they were no longer contagious or did not have TB. Those removed had been on the list for a median of 26 days. Those persons not removed from the list had been on the list for a median of 72 days.

Officials said they are on the look-out for “diseases of consequence,” such as SARS, TB, a pandemic strain of influenza and hemorrhagic fevers such as Ebola, Cetron said.

Many experts were unaware of the existence of such a list and were divided in their reaction. (The agencies involved did not publicly announce the formation of the list, although it was discussed at a variety of open and professional organization meetings, Cetron said.)

Some public health experts found the very idea troubling.

“It’s slightly reassuring that the list hasn’t been used very much but I have grave reservations about this sort of collaboration between agencies who are charged with protecting the public from real disease threats and agencies — and here I’m talking about Homeland Security — that capitalize on people’s fears in the name of protecting the public from unnamed dangers,” said Philip Alcabes, an epidemiologist and associate professor at Hunter College’s School of Health Sciences in New York City.

“Is there a legitimate need to control tuberculosis? Absolutely. Is there a legitimate need to have a DNB list in order to do so? I don’t see how that adds to what the CDC already does,” continued Alcabes, who said he had not known of the existence of such a list. “The CDC knows very well how to control tuberculosis with existing rules and procedures. In fact, they have done a superb job.”

“I think the previous system did need bolstering,” countered Dr. Martin Blaser, chairman of medicine at New York University’s Langone Medical Center and former president of the Infectious Diseases Society of America. “The case from Atlanta . . . was a wake-up call,” he said. ” We live in a smaller world where air travel is very important and also carries the risk of moving contagious diseases from one part of the world to another very rapidly. This, in a sense, is just an extension of the concept of quarantine, which is an old concept and is well-established.”

More information

For a list of communicable diseases that fall under potential quarantine, head to the CDC.

SOURCES: Francisco Alvarado-Ramy, M.D., quarantine public health officer, U.S. Centers for Disease Control and Prevention, San Juan, Puerto Rico; Martin Cetron, director, division of global migration and quarantine, CDC; Philip Alcabes, Ph.D., epidemiologist and associate professor, School of Health Sciences, Hunter College, City University of New York, New York City; Martin Blaser, M.D., chairman, medicine, New York University Langone Medical Center, and former president, Infectious Diseases Society of America; Sept. 19, 2008, Morbidity & Mortality Weekly Report

By Amanda Gardner
HealthDay Reporter

Last Updated: Sept. 18, 2008

Copyright © 2008 ScoutNews, LLC. All rights reserved.

Vaccine Skin Patch Prevents Travelers’ Diarrhea

WEDNESDAY, June 11 (HealthDay News) — A new skin patch containing E. coli toxins seems to help prevent travelers’ diarrhea, researchers report.

Even when people developed diarrhea, the condition was less severe and the agonizing episode shorter, they added.

Consuming E. coli from contaminated food or drink is the main cause of travelers’ diarrhea, which affects some 27 million adult
travelers and 210 million children each year. The disease is responsible for some 380,000 child deaths. Travelers’ diarrhea usually lasts four to five days, and is associated with nausea, vomiting, abdominal cramps and dehydration.

“When people travel to Guatemala or Mexico, they have a 50 percent chance of having a bout of Montezuma’s revenge,” said Dr. Gregory Glenn, the head of IOMAI Corp., the Maryland company that developed the patch. “To date, there is no vaccine for this. People with the condition go to bed and are treated with antibiotics.”

“This is really a big breakthrough,” Glenn said. “For an infectious disease, this has been an extremely challenging area.”

To be effective, two doses of the vaccine are needed, Glenn said. The vaccine takes advantage of the skin’s potent immune system, which gives the vaccine its robust response, he added.

The vaccine is most effective when given two weeks before one travels abroad, Glenn said.

The report is published in the June 12 online issue of The Lancet.

In this phase II trial, 178 people planning trips to Mexico or Guatemala were randomly assigned to the vaccine patch or placebo patches.

Glenn and his study co-author, Dr. Herbert DuPont of the University of Texas School of Public Health in Houston, found that 24 of the 111 travelers who received placebo had travelers diarrhea, of these 11 had diarrhea caused by E. coli. Among the 59 travelers who received the vaccine, 12 had bouts of diarrhea, but only three had diarrhea caused by E. coli.

Among patients who received placebo, the rate of moderate to severe diarrhea was higher (21 percent) than among people who received the vaccine (5 percent). This means the patch was 75 percent effective for people who had moderate to severe diarrhea.

Moreover, the number of cases of severe diarrhea was higher amongst people who received placebo (11 percent), compared with those who received the vaccine (2 percent), Glenn’s group found. Among these patients, the patch was effective 84 percent of the time.

In addition, people who received the vaccine had shorter episodes of diarrhea—half a day, compared with more than two days for people who received the placebo patch.

The vaccine is delivered by a patch, because the active ingredient is too toxic to be delivered orally, nasally, or by injection, the researchers noted.

The vaccine still needs to go through a large, phase III trial, Glenn noted. He is hoping the vaccine will be available to the public by 2011.

One expert thinks the patch could be an important advance in preventing travelers’ diarrhea.

“This is an important advance in the prevention of travelers’ diarrhea. The vaccine is easy to store and administer, and is very well-tolerated,” said Dr. Pablo C. Okhuysen, an associate professor of medicine in the Division of Infectious Diseases at The University of Texas Medical School at Houston. “The patch vaccine approach is novel and opens the door for the future development of vaccines for the prevention of diarrheal disease.”

More information

For more on travelers’ diarrhea, visit the U.S. Centers for Disease Control and Prevention.

SOURCES: Gregory Glenn, M.D., IOMAI Corp., Gaithersburg, Md.; Pablo C. Okhuysen, M.D., associate professor, medicine, Division of Infectious Diseases, University of Texas Medical School at Houston; June 12, 2008, The Lancet, online

By Steven Reinberg
HealthDay Reporter

Last Updated: June 12, 2008

Copyright © 2008 ScoutNews, LLC. All rights reserved.

Statins Might Help HIV Patients, Study Suggests

By Randy Dotinga
HealthDay Reporter

THURSDAY, Feb. 24 (HealthDay News) — Preliminary research suggests that statins restrain the immune systems of HIV patients and may stave off progression of the AIDS-causing virus.

Although it’s too soon to recommend the drug for this purpose, the findings of this small study raise the possibility that “there might be drugs that can help adjust the immune response in HIV patients whether they’re taking AIDS medications or not,” said Dr. Brian Agan, director of HIV research with the Infectious Disease Clinical Research Program at the Uniformed Services University in Bethesda, Md. He works with some of the study’s authors.

It’s not unusual for HIV patients to take these cholesterol-lowering drugs, because the medications commonly used to combat HIV can cause cholesterol levels to skyrocket.

Scientists have wondered if statins’ anti-inflammatory properties might have benefits for HIV patients besides reducing the risk of cardiovascular disease. In the new study, which was funded by the National Institutes of Health, researchers recruited 24 participants to randomly take either a high dose of Lipitor (atorvastatin) or a placebo.

The participants took their pills for eight weeks, stopped for several weeks, and then took the other kind of pills. The patients took no AIDS medications, and their cholesterol levels weren’t high enough to require taking statins. Neither group knew which pills they were taking.

The findings were recently published online in the Journal of Infectious Diseases. The drugs didn’t affect levels of HIV in the 22 patients who remained in the study, but the medications did appear to curb their immune systems, reducing the inflammatory response.

Inflammation caused by the immune system is associated with HIV progression and death. “Persistent inflammation in patients with HIV, especially those on HIV treatment, has been associated with a worse clinical outcome. The cause of this inflammation remains unknown,” said Andrew Carr, a professor of medicine at the University of New South Wales in Sydney, Australia, who wrote a commentary accompanying the study.

Is it feasible to give cholesterol-lowering drugs to HIV patients? They’re definitely inexpensive, Agan said. And the side effects they cause may be mild and go away as time passes.

What comes next?

“For doctors, we should be studying the effects of statins over longer periods in patients with treated HIV disease whose virus is well-controlled but who still have excess inflammation to see if the anti-inflammatory effect of statins is still observed,” said Carr. “If so, we would then need to determine if this anti-inflammatory effect improved health outcomes, which would require a long and very large study.”

For now, both doctors said, physicians shouldn’t change how they prescribe anti-cholesterol drugs.

More information

The American Heart Association has more on anti-cholesterol drugs.

SOURCES: Brian Agan, M.D., director, HIV research, Infectious Disease Clinical Research Program, Uniformed Services University, Bethesda, Md.; Andrew Carr, M.D., M.B.B.S., head, HIV, Immunology and Infectious Diseases Unit, and head, Clinical Research Program, Center for Applied Medical Research, St. Vincent’s Hospital, and professor, medicine, University of New South Wales, Sydney, Australia; Jan. 25, 2011, online, The Journal of Infectious Diseases

Last Updated: Feb. 24, 2011

Copyright © 2011 HealthDay. All rights reserved.

Burden of HIV Highest for Blacks, CDC Reports

By Steven Reinberg
HealthDay Reporter

THURSDAY, Feb. 3 (HealthDay News) — Although blacks make up only 13.6 percent of the U.S. population, they account for 50.3 percent of all diagnosed cases of HIV, federal health officials reported Thursday.

The rate of HIV diagnosis among black men is eight times that of whites, and the rate for black women is 19 times that of whites, finds a new analysis of data from 37 states by the U.S. Centers for Disease Control and Prevention.

“What this study confirms is the severe and disproportionate burden of disease borne by African Americans when it comes to HIV,” said Dr. Kevin Fenton, director of CDC’s National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention.

Compared to Hispanic men, black men have twice the rate of HIV infection, and black women are four times as likely as Hispanic women to have an HIV diagnosis, according to the Feb. 4 edition of the CDC’s Morbidity and Mortality Weekly Report.

The reasons for these disparities are complex, Fenton said. “We are not looking at one core issue. There are many factors interacting with each other at different levels within the society,” he said.

For one thing, the background prevalence of the AIDS-causing virus is higher in the black community, he said.

“This higher background prevalence really continues to drive transmission within the community, because it increases the probability of someone coming into contact with HIV, even with low-risk behaviors,” Fenton said.

Sharing drug materials and having unprotected sex are key ways to spread HIV.

Fenton said there is also a higher rate of sexually transmitted diseases in the black community, noting other STDs facilitate the transmission of HIV.

Disparities in access to health care and poverty also contribute to the increased risk of HIV among blacks, Fenton explained.

High rates of male imprisonment are another factor, he added. “This leads to imbalances in male-to-female ratios in the community, which in turn result in sexual networks which facilitate transmission of HIV,” he said.

In a related report in the same edition, researchers said HIV diagnoses have skyrocketed among young black gay men in Milwaukee, Wis. Among 15- to 29-year-old black gay men in that city, HIV increased 144 percent from 2000 to 2008.

William Jeffries IV, a CDC Epidemic Intelligence Service Officer and co-author of the report, said this spike is not just the result of increased HIV screening, which would by itself uncover many new cases of HIV.

The number of syphilis cases also increased, which suggests a rise in HIV infection, Jeffries said.

The Milwaukee findings probably mirror similar HIV increases in some areas across the country, said the researchers, calling for new or better efforts to educate this group of males.

The CDC already is testing ways to expand HIV testing and referral services within the black community, Jeffries said.

These “intensive behavioral interventions,” he said, combine education, counseling, skills development and esteem building, as well as safer sex promotion.

Apathy about HIV is a problem, Fenton said. “We are really grappling with increased complacency as we enter the fourth decade of this epidemic,” he said. This is particularly true in the black community, where there are so many health and economic concerns that HIV becomes a back-burner issue, Fenton said.

Commenting on the report, Dr. Michael Kolber, professor and director of the Comprehensive AIDS Program at the University of Miami Miller School of Medicine, said that programs to reduce the spread of HIV need to target those communities where transmission rates are highest and take into account various cultural differences.

“In the African American community, we are working with faith-based organizations,” he said. “They really play a major role in daily living.”

The programs Kolber runs go into churches and provide HIV/AIDS education in the context of overall health issues.

“When you discuss these things, you need to do it in a manner which is sensitive to what they are willing to listen to,” Kolber said.

More information

For more information on HIV/AIDS, visit the U.S. Department of Health and Human Services.

SOURCES: Kevin Fenton, M.D., Ph.D., director, National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention, and William Jeffries IV, Ph.D., Epidemic Intelligence Service Officer, both U.S. Centers for Disease Control and Prevention; Michael Kolber, M.D., professor and director, Comprehensive AIDS Program, University of Miami Miller School of Medicine; Feb. 4, 2011, Morbidity and Mortality Weekly Report

Last Updated: Feb. 03, 2011

Copyright © 2011 HealthDay. All rights reserved.

Noncardiac Chest Pain May Warrant More Management: Study

SATURDAY, April 24 (HealthDay News) — People discharged from the hospital with noncardiac (not heart-related) chest pain may require more aggressive cardiovascular risk management than they typically receive, a new study has found.

Noncardiac chest pain can be caused by a number of problems, including panic attack, musculoskeletal pain, gastroesophageal reflux disease (GERD) and esophageal hypersensitivity.


The study included 320 patients who were admitted to the hospital with what was believed to be unstable angina, evaluated and discharged with a diagnosis of noncardiac chest pain. After the initial diagnosis of noncardiac chest pain, 49 percent of patients were re-evaluated in the emergency department and 42 percent underwent repeated cardiology evaluations.

Only 15 percent of the patients had gastrointestinal (GI) consultations. Of those, 38 percent had esophagogastroduodenoscopy, 4 percent had manometry (13 tests) and 2 percent had pH probes (six probes), the study authors reported.

“Patients in this study received few GI consultations and underwent even fewer GI tests. Further study is needed to determine whether patients with noncardiac chest pain would benefit from more frequent GI consultations and more diverse use of GI testing modalities,” study co-investigator Dr. Michael Leise, of the Mayo Clinic, said in a news release.

The study also found that patients with noncardiac chest pain didn’t have a significantly higher overall rate of death than expected, but a substantial number of cardiac deaths occurred in these patients.

“We speculate that cardiac death in patients with noncardiac chest pain may relate to overlapping risk factors for GERD and coronary artery disease, including obesity, obstructive sleep apnea, diabetes mellitus and smoking,” Leise said.

He said until more is known about cardiac death in patients with noncardiac chest pain, doctors should screen these patients for cardiac risk factors, such as high blood pressure, high cholesterol and diabetes, and aggressively manage these conditions.

The study is published in the April issue of Mayo Clinic Proceedings.

More information

The U.S. National Library of Medicine has more about chest pain.

— Robert Preidt

SOURCE: Mayo Clinic, news release, April 20, 2010

Last Updated: April 25, 2010

Copyright © 2010 HealthDay. All rights reserved.

Heartburn Drugs May Contribute to the Problem

TUESDAY, July 7 (HealthDay News) — Drugs commonly used to treat heartburn and acid reflux may actually cause heartburn.

A new study in the July issue of Gastroenterology found that treatment with a proton pump inhibitor (PPI) actually produced heartburn, acid reflux and indigestion in healthy volunteers who took the medication for eight weeks.


Although the findings don’t necessarily mean that PPIs don’t have a valid place in the gastrointestinal armamentarium, they do strongly suggest that overprescribing may be causing harm, the study authors said.

“It is beyond any doubt that subjects with reflux disease benefit from and need treatment with acid suppressive drugs,” said study lead author Dr. Cristina Reimer of Copenhagen University in Denmark. “But it is equally beyond doubt that PPIs are prescribed more or less uncritically for a wide variety of symptoms where the initial effect of the drug is doubtful.

“The findings in our study [indicate that] this liberal prescribing is likely to create the disease the drugs are designed to treat,” she continued. “Patients who are treated on uncertain indication thus risk developing a true need for continued therapy. Our findings challenge the very liberal prescribing of these drugs, and this study should lead to careful consideration about possible changes in prescribing habits.”

According to an accompanying editorial in the journal, about 5 percent of the developed world’s population now uses PPIs.

And more people are using the drugs long-term, although this should only occur when a person has severe gastroesophageal reflux disease (GERD) or to prevent problems in people taking nonsteroidal anti-inflammatory medications, such as aspirin, which can be hard on the stomach, the researchers said.

But according to the study authors, about one-third of patients who take PPIs renew their prescriptions without one of these indications. And the editorial stated that the drugs are being prescribed without hard evidence that acid is involved with the problem. PPIs work by reducing acid production.

For this study, 120 healthy people were randomly assigned to receive 12 weeks of a placebo or eight weeks of Nexium (esomeprazole, 40 milligrams a day), followed by four weeks of placebo.

Forty-four percent of individuals receiving the PPI reported acid-related symptoms after stopping the medication, compared with 15 percent in the placebo group.

The study authors speculated that the post-treatment effect comes from an acid “rebound” after the period of inhibition. If this does turn out to be the case, the process could end up causing dependency on PPIs, the researchers said.

“Patients need to be informed about the potential effects of the rebound acid hypersecretion and the symptoms it can cause when therapy is initiated,” said Reimer, adding that more research into the phenomenon is needed.

“If both patients and their physicians are aware of this temporary period of time after discontinuation [that might include] aggravation or induction of acid-related symptoms, it is possible that withdrawal of therapy is easier to achieve,” she added.

Blair Hains, a spokesman for AstraZeneca, which makes Nexium, said: “This study was conducted with healthy volunteers, and the authors acknowledge that they can’t be sure that the conclusion can be carried over to patients who have started PPI therapy because of dyspeptic symptoms. A previous systematic review of rebound acid hypersecretion after discontinuation of PPIs concludes that there is no strong evidence for a clinically relevant increased acid production after withdrawal of PPI therapy.”

More information

Visit the U.S. National Institute of Diabetes and Digestive and Kidney Diseases for more on GERD.

By Amanda Gardner
HealthDay Reporter

SOURCES: Christina Reimer, M.D., department of medical gastroenterology, Koge University Hospital, Copenhagen University, Denmark; Blair Hains, spokesman, AstraZeneca; July 2009, Gastroenterology

Last Updated: July 07, 2009

Copyright © 2009 ScoutNews, LLC. All rights reserved.

Fewer Medicare Patients Hospitalized for Heart Trouble

WEDNESDAY, May 11 (HealthDay News) — Over the last decade, the number of Medicare patients hospitalized for cardiac issues dropped, accounting for a smaller slice of the 10-year hospitalization rate than non-heart related issues, new research indicates.

The finding stems from the largest effort launched in the past decade (1998 to 2008) to gauge Medicare hospitalization patterns. In the latest year, Medicare hospitalizations totaled about 13 million patients, the study authors said.


The research is scheduled to be presented Thursday at the American Heart Association’s Quality of Care and Outcomes Research in Cardiovascular Disease and Stroke meeting, in Washington D.C.

“We’re seeing that common cardiac diseases are accounting for a smaller proportion of hospitalizations within the United States,” study lead author Amit H. Sachdev, a fourth-year medical student at New York University School of Medicine, said in a heart association news release. “We believe this may reflect an improvement in medical care and preventive efforts and in delivering health care in the United States over the last decade.”

Sachdev and his colleagues found that while six of the eight major causes for hospital admission have been on a downward trajectory over the past decade, heart disease hospitalization rates have fallen more quickly than those attributed to other causes.

Among heart health issues, they found that coronary artery disease hospitalizations among Medicare patients dropped the most (32 percent), followed by those prompted by heart attacks (down about 22 percent). Heart failure hospitalizations also fell by nearly 17 percent, the report found.

Conversely, hospitalizations because of an irregular heartbeat (cardiac arrhythmia) bucked the trend, going up by more than 10 percent.

The researchers also found that a number of non-heart related issues fell as causes for Medicare hospitalizations, including pneumonia, fluid and electrolyte disorders, and hip fractures.

The researchers speculated that a focused government effort to tackle heart disease may account for the observed drop in related hospitalizations.

“Heart disease is the leading cause of hospitalization in the United States, so you see a lot of government money focused at cardiac conditions,” Sachdev said.

Research presented at meetings is considered preliminary until published in a peer-reviewed journal.

More information

To learn more about heart disease visit the U.S. National Library of Medicine.

– Alan Mozes

SOURCE: American Heart Association, news release, May 11, 2011

Last Updated: May 11, 2011

Copyright © 2011 HealthDay. All rights reserved.

Research Suggests 1 in 7 Strokes Happen During Sleep

TUESDAY, May 10 (HealthDay News) — About 14 percent of strokes happen while people are sleeping, lowering the chance that they’ll be able to get to the hospital in time for a potentially brain-saving treatment, a new study suggests.

“Because the only treatment for ischemic stroke must be given within a few hours after the first symptoms begin, people who wake up with stroke symptoms
often can’t receive the treatment since we can’t determine when the symptoms started,” Dr. Jason Mackey, of the University of Cincinnati and a study co-author, said in a news release from the American Academy of Neurology. “Imaging studies are being conducted now to help us develop better methods to identify which people are most likely to benefit from the treatment, even if symptoms started during the night.”

In the study, published in the May 10 issue of Neurology, researchers examined the medical records of 1,854 adults who suffered from ischemic strokes in a one-year period and were treated at emergency rooms in the Cincinnati area. Ischemic stroke is caused by blocked blood flow in the brain, usually because of a clot.

In 14 percent of the cases, people woke up with symptoms of a stroke. Nationwide, that would account for 58,000 people who visit emergency rooms with stroke systems annually, the study authors pointed out.

Of 273 people who had so-called “wake-up strokes,” at least 98 would have been eligible for treatment with a blood clot-busting drug called tPA if doctors had known when the stroke had begun, the study reported.

“If a stroke started more than a few hours ago, tPA is not indicated because it can cause bleeding that will extend and enlarge the stroke,” explained Dr. Byron K. Lee, associate professor of medicine and director of the Electrophysiology Laboratories and Clinics at the University of California, San Francisco. “In wake-up strokes, it’s nearly impossible to know when the symptoms started [so] tPA is not an option and, therefore, the neurologic deficits have a higher chance of becoming permanent.”

If you wake up feeling strange symptoms, Lee said, don’t sit around. “People should not wait for any new neurologic deficits in the morning to pass or go away as they become less groggy,” he said. “They should seek medical attention immediately. Even though tPA may not be an option in wake-up strokes, there are many other treatments that can be given in an emergency room or hospital.”

According to the National Stroke Association, symptoms of a stroke include:

•     Sudden paralysis or weakness in the face or limbs, especially on one side of the body
•     Sudden problems with balance or walking
•     Sudden vision problems
•     Slurred speech
•     Sudden confusion or problems speaking or understanding simple statements
•     Sudden severe headache with no apparent cause

Stroke experts offer a simple way to help people remember what to look for if they think they are witnessing a stroke: Think FAST (Face, Arms, Speech, Time):

•     Face: See if the person is able to smile, or if one side of their face seems to droop.
•     Arms: Can the person raise both arms, or does one side drift downward?
•     Speech: See if the person is able to speak clearly or repeat a simple phrase.
•     Time: Call 9-1-1 immediately if the person exhibits any of these signs.

More information

For more about the signs of stroke, visit the U.S. National Institutes of Health.

– Randy Dotinga

SOURCES: Byron K. Lee, M.D., associate professor, medicine, and director, Electrophysiology Laboratories and Clinics, University of California, San Francisco; American Academy of Neurology, news release, May 9, 2011

Last Updated: May 10, 2011

Copyright © 2011 HealthDay. All rights reserved.