Travel can be dangerous

I have not added anything to my blog for several weeks because while a lot of the material is printed in journals now online and in online newsletters most of it is bench research not relevant to current clinical practice or is just repetition of old material apparently under a research title to help maintain academic status.

This time I want to comment on the diseases that are transferred back into the USA by travelers as we had had several incidents recently including MERS, measles, and now mad cow disease. We also have had individuals return recently with rabies acquired overseas and while I haven’t seen Chicungunya identified in the USA is certainly in the Caribbean. I haven’t even bothered to mention trauma/violence which is certainly a risk in many parts of Asia and Africa. Tuberculosis in the United States is mainly introduced along immigrant routes due to poor screening before travel. Physicians need to be more careful about ensuring when patients when planning overseas trips they are immunized properly and told about diseases to which they might be exposed such as TB, malaria, and waterborne diseases such as Schistosomyiasis, polio and food-borne diseases such as Noravirus. Far too many people fail to take simple protection or anticipate exposures when they travel.

Curing Chronic Hepatitis C

The Thursday, April 24 issue of the New England Journal of Medicine contains a fascinating article about the recently discovered cure for chronic hepatitis C. The article tells the story from the discovery of the hepatitis C virus 25 years ago and the role sciences played in developing a treatment that cures 95% of those with the disease. It will take some time to determine whether this is a complete remission and how to use this treatment on a population basis. The medicine can cost $80,000 for treatment and there are hundreds of thousands of individuals just in the USA who carry the hepatitis C virus. The end result of the hepatitis C virus is usually chronic cirrhosis and liver cancer, the question now is should everybody with hepatitis C be treated as soon as it is found. There has been an inadequate cost-effective study that compares the cost of liver transplants which are in the tens of thousands compared to costs for the hundreds of thousands of people needing treatment with this effective antiviral compound. Ethically it is clear that with this treatment we should be screening the majority of adults for this virus and treating those in whom we find it. It will be nice to know competing costs for advances in treating other chronic diseases, this decision will not be easy. The article by Drs. Cheung and Baumert should be required reading for all physicians. Now it is time for the ethicists and health policy makers to advise what is financial and ethically possible.

Lab-Made Vaginas Transplanted Into Patients Whose Own Were Absent Due to Rare Disease

The $6 million man and woman may not be here yet but they are not far off. The quest to make body parts in the lab “regenerative medicine” has just taken a big step forward. Scientists have successfully transplanted laboratory-made vaginas into four teenage girls whose own were absent because of a rare disease. Published Thursday in the journal Lancet along with another study, in which a separate group of researchers transplanted lab-made nostrils into patients whose noses were damaged by cancer. Another step up in complexity are body parts such as the vagina, a highly elastic organ that also secretes mucus. And the final frontier is the quest to make solid organs—such as the heart and liver—that typically don’t have a cavity and have more complex functioning.

DIY Immunizations

Microneedle patch may boost immunization rate, reduce medical costs. The fear of needles when being vaccinated may soon be past memory. There are many reasons some people may not get a flu shot, but would they be more likely to do so if there was a simple device that could be mailed directly to them. A recent study suggests the answer is yes. Nearly 100 healthy adults took part in a study led by Mark Prausnitz, Ph.D., of the Georgia Institute of Technology, on their ability and willingness to use a microneedle patch. (Test of feasibility).. Vaccine, 2014; 32 (16)

Monitoring the Safety of Nutritional Supplements

The FDA’s lack of resources and the complex laws passed by Congress have led to our woefully inadequate system for monitoring supplement safety. Americans spend more than $32 billion a year on more than 85,000 different combinations of vitamins, minerals, botanicals, amino acids, probiotics, and other supplement ingredients. Unlike prescription medications, supplements do not require premarketing approval before they reach store shelves. Under the Dietary Supplement Health and Education Act of 1994, anything labeled as a dietary supplement is assumed to be safe until proven otherwise

Eating seven or more portions of fruit and vegetables a day reduces your risk of death by 42 percent

From the University College, London, we learn that eating seven or more portions of fruit and vegetables a day reduces your risk of death at any point in time by 42 percent compared to eating less than one portion, reports a new study. This is the first study to link fruit and vegetable consumption with all-cause, cancer and heart disease deaths in a nationally-representative population, the first to quantify health benefits per-portion, and the first to identify the types of fruit and vegetable with the most benefit. However, as usual, the nutrition researchers fail to define what a portion is so that readers can understand how it reflects their daily dietary habits. For most people a portion is what they put on their plate!

Weight loss surgery may be better than medication alone for patients with type 2 diabetes.

A study, presented at the American College of Cardiology meeting and published in the New England Journal of Medicine, i “followed 150 patients, one-third of whom were treated for their diabetes with medication and lifestyle changes alone; one-third who also got gastric bypass surgery; and one-third who had a different type of bariatric surgery called a sleeve gastrectomy.” Study participants “were overweight or mildly obese and had diabetes that was not well controlled by medication. Researchers found that “bariatric surgery did more to improve symptoms of diabetes, high blood pressure and high cholesterol after three years than intensive treatment with drugs alone.This is extremely useful research considering how poor we are at changing individual behaviour and ensuring compliance with a recommended medication strategies.

HIV treatment may improve the outcome for individuals with Multiple Sclerosis.

Some researchers in Great Britain and Europe now believe that MS results from activation of “human endogenous retroviruses,” or HERVs — remnants of retroviruses that infected humans eons ago and became incorporated into the germline, such as that it is now part of the human genome. A Danish national registry study published in letter form last year in Epidemiology, comparing 5,018 HIV-positive patients with some 50,000 age- and sex-matched individuals from the general population, found that the rate of MS incidence was markedly lower in the HIV patients (3.1 versus 10.4 per 100,000). A great example of the value of discussing unusual finding in a single patient by an astute physician leading to potential interventions for patients with similar problems.
:Nexo B, et al “Treatment of HIV and risk of multiple sclerosis” Epidemiol 2013; DOI: 10.1097/EDE.0b013e318281e48a.

Males need HPV vaccine as well.

National Cancer Institute data indicates that HPV infections “cause virtually all cervical cancers,” and a study published in yesterday’s Journal of the National Cancer Institute found that vaccinated girls born in Denmark between 1997 and 1999 demonstrated no signs of cervical lesions, concluding that “vaccination with the [four-strain] HPV vaccine is already effective in reducing the risk for cervical precursor lesions at population level among young women in Denmark.” Yet a recent Centers for Disease Control and Prevention study indicates HPV prevalence among vaccinated teenage girls fell 56%, “suggesting the vaccine is highly protective,” but around 25% of parents reported not planning on vaccinating their daughters in 2013. Now a review from the CDC shows that as many as 35,000 oral pharyngeal cancers may be secondary to oral sex and have a higher incidence in males than females indicating that HPV vaccine is important for cancer prevention in males for both oral-pharyngeal and anal cancers.