Sudden death after arrest

Young men who die suddenly after being arrested by the police may be victims of a new syndrome similar to one that kills some wild animals when they are captured, Spanish researchers said on Tuesday.

Manuel Martinez Selles of Madrid's Hospital Gregorio Maranon reached the conclusion after investigating 60 cases of sudden unexplained deaths in Spain following police detention.

In one third of the cases, death occurred at the point of arrest, while in the remainder death was within 24 hours, Selles told the annual meeting of the European Society of Cardiology.

All but one of the casualties were male and their average age was just 33 years, with no previous history of cardiovascular disease.

"Something unusual is going on," Sells said.

Just why they died remains a mystery but he believes young men, in particular, may experience surges in blood levels of chemicals known as catecholamines when under severe stress.

Adrenaline is one of the most abundant catecholamines.

"We know that when a wild animal is captured, sometimes the animal dies suddenly," he said.

"Probably when these young males are captured it is very stressful and their level of catecholamines goes very high and that can finish their life by ventricular fibrillation (cardiac arrest)."

Selles compiled his study -- the first of its kind in any country -- by scouring Spanish newspapers for cases of unexplained death after police detention over the past 10 years.

Only sudden deaths with no clear causes were included and autopsy reports were checked to exclude the possibility of mistreatment or past serious medical conditions.

Twelve of the victims were drug users but Selles said this was not thought to have contributed to their deaths.

Jonathan Halperin of the Mount Sinai Medical Center in New York, who was not involved in the research, said the concept of a heart stress syndrome triggered by a flood of adrenaline or other chemicals was "a reasonable hypothesis".

"We all know stress is bad for you and this may be stress in the extreme," he said.

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Early weight gain may lead to hypertension

Babies who gain weight rapidly in the first months after birth may have an increased risk of developing high blood pressure as adults, British researchers said on Tuesday.

Researchers have been trying to understand more of the causes of high blood pressure, also called hypertension. Low birth weights also have been associated with an increased risk for high blood pressure later in life.

The new study sought to determine if growth patterns in the first five years of life also were associated with a risk of high blood pressure in adulthood. The researchers tracked 679 young adults around age 25 in Britain.

They found that those who gained weight more rapidly in the first five months after birth and again from about age 2 to 5 were more likely to have high systolic blood pressure.

Immediate weight gain after birth also was linked to higher adult diastolic blood pressure, they found.

Systolic blood pressure is the pressure in the arteries while the heart contracts. Diastolic blood pressure is the pressure when the heart relaxes between beats.

"When trying to understand why some people get high blood pressure in later life, we need to consider a life course approach that considers early life as well as adult life risk factors such as dietary salt and obesity," Yoav Ben-Shlomo of the University of Bristol in Britain, who led the study published in the journal Hypertension, said in a statement.

High blood pressure -- sometimes called the "silent killer" because it can go undetected for years -- raises a person's risk of heart disease and stroke.

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Gastric bypass anatomy leads to diabetes control

The rapid and substantial control of diabetes seen after gastric bypass surgery is due, at least in part, to the intestinal rearrangement involved in the procedure, the results of an animal study suggest.

Besides removing a substantial portion of the stomach, gastric bypass also attaches the output of the stomach to the lower intestines. The lower portion of the gut usually produces little glucose, but because of the direct input from the stomach it increases its production, French researchers report in the research journal Cell Metabolism.

The liver senses the higher level of glucose and reduces its own production of the sugar. Since the liver contributes much more to the body's overall glucose production than do the intestines, the net effect is enhanced glucose control, say Dr. Gilles Mithieux, from Universite de Lyon, and colleagues.

The increase in intestinal glucose formation was only noted with gastric bypass, not with gastric banding, which doesn't re-route the intestines. This may explain why only gastric bypass has been associated with enhanced diabetes control, the investigators conclude.

Furthermore, they note, sensors in the liver detect the elevated glucose and send an appetite-suppressing signal to the brain, which contributes to the satiety and weight loss seen with gastric bypass.

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Virus is passed from parent to child in the DNA

A virus that causes a universal childhood infection is often passed from parent to child at birth, not in the blood but in the DNA, U.S. researchers said on Tuesday.

They found that most babies infected with the HHV-6 virus, which causes roseola, had the virus integrated into their chromosomes. Not only that, but either the father or mother also had the virus in the chromosomes, suggesting it was a so-called germline transmission -- passed on in egg or sperm.

"This is really a unique mechanism for congenital infections," said Dr. Caroline Breese Hall, a pediatrician at the University of Rochester Medical Center in New York who led the study published in the journal Pediatrics.

Her team is now investigating what this means for the children.

"If you have a chromosome that has got a virus integrated into it, what does it mean? What does it do? Can it activate again? Can it start spewing out virus and cause problems? Can you get an immune response to it?" she said in a telephone interview.

The questions are critical because nearly everybody is infected with HHV-6. It is a herpes virus that causes roseola -- an infection marked by high fever and the usual vague virus symptoms that may include respiratory or stomach problems.

About 20 percent of children also have a characteristic sudden rash that appears just as the fever breaks.

Hall's team studied 250 infants, 85 with HHV-6. Of them, 43 were born with the virus and 42 were infected later.

Most of the babies born with the virus -- a congenital infection -- had the virus in the chromosome. Hall said the assumption had been that the virus somehow crossed the placenta from mother to child, but in 86 percent of cases, it was inherited directly in the genetic material.

Just 14 percent were infected across the placenta.

Tests showed either the mother or the father -- but not both -- also had HHV-6 in the chromosomes.

"Because we know a parent already had the virus in the chromosome, we know that it didn't spontaneously wiggle its way in once the baby got it," Hall said.

There were several spots where the virus integrated into the DNA, but usually right at the end of the chromosome, where a key structure called the telomere is found. Telomeres protect the chromosome and are involved in aging and immune response.

The virus is everywhere in people who inherit it, Hall said. "In your hair, your nails, your skin, your blood, and at very high titers (levels)," she said.

The babies infected this way did not appear ill but Hall wants to follow them as they grow up to see if they develop normally. They all had antibodies to HHV-6, which is evidence of an immune reaction of some sort.

There is no drug licensed to treat HHV-6 infection.

Other viruses are known to integrate into the DNA and pass on from parent to child, but these so-called human endogenous retroviruses have never been known to cause symptoms or activate an immune response.

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Exercise may improve memory in older people

Regular, moderate exercise may help improve memory in older people and delay the onset of dementia, a study in Australia shows.

The study, published in the Journal of the American Medical Association, involved 170 participants aged 50 and over who reported some memory trouble but who did not have dementia.

Half engaged in moderate exercise, such as walking, for 50 minutes three times a week, while the others did no exercise.

After six months, the participants were given memory and other tests, including recalling lists of words. Those who exercised fared markedly better than those who did not.

"The trial is the first to demonstrate that exercise improves cognitive function in older adults with subjective and objective mild cognitive impairment," according to the report.

"The benefits of physical activity were apparent after 6 months and persisted for at least another 12 months after the intervention had been discontinued."

With the ageing of populations everywhere, an estimated 37 million people worldwide now live with dementia, with Alzheimer's disease making up the majority of cases, according to the World Health Organization.

That figure is expected to increase rapidly over the next 20 years and researchers are looking for ways to help delay the onset of dementia.

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High blood calcium tied to lethal prostate cancer

Men with elevated levels of calcium in their blood may have a much higher risk of getting fatal prostate cancer, U.S. researchers said on Wednesday.

The findings indicate that a simple blood test may identify men at high risk for the most dangerous prostate tumors, and there already are drugs available that cut calcium levels in the bloodstream, the researchers said.

They tracked 2,814 men in a government health survey in which they gave blood samples that revealed calcium levels.

The men in the top third of blood calcium levels had 2.68 times the risk of developing fatal prostate cancer later in life compared to those in the bottom third, the study found.

"If serum calcium really does increase your risk for fatal prostate cancer, that's wonderfully exciting because serum calcium levels can be changed," Gary Schwartz of Wake Forest University School of Medicine, who helped lead the study, said in a telephone interview.

"One way to think of it is to think of the tremendous advances in the control of cardiovascular disease that occur from understanding that things like serum cholesterol predict heart attack," Schwartz added.

Doctors have struggled to find ways to predict if a man who gets prostate cancer will have a tumor that poses little danger, as is often the case, or one that is a killer.

Blood calcium was not very predictive of whether a man would get nonlethal prostate cancer, but was highly predictive of whether a man would get a fatal case, the researchers wrote in the American Association for Cancer Research's journal Cancer Epidemiology, Biomarkers & Prevention.

The blood samples on average were given a decade before the cancer appeared, the researchers said.

A COMMON CANCER

Prostate cancer is the second most commonly diagnosed form of cancer in men worldwide, with about 780,000 men diagnosed per year, and the sixth mostly deadly form in men, with about 250,000 deaths per year, the American Cancer Society said.

Schwartz said it is unclear whether it is the actual calcium or blood levels of parathyroid hormone, which is supposed to keep calcium levels at normal levels in the bloodstream, that is raising the risk.

Either way, he said there are drugs that can lower them, including Fontus Pharmaceuticals Inc's Rocaltrol, also called calcitriol; Genzyme Corp's Hectorol (doxercalciferol); Abbott Laboratories' Zemplar (paricalcitol); and Amgen Inc's Sensipar (cinacalcet).

People treated for high blood calcium usually have chronic kidney disease, which is associated with low vitamin D levels. Low vitamin D levels elevate parathyroid hormone levels, Schwartz said.

Halcyon Skinner of the University of Wisconsin, who also worked on the study, said there is little relationship between calcium in the diet and blood calcium levels, so these men would not benefit from eating less food rich in calcium.

Previous research had suggested a role for calcium in prostate cancer. In laboratory studies, parathyroid hormone and calcium promote the growth of prostate cancer cells.

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High doses of vitamin D safe for children

Giving school children very high doses of vitamin D is safe, and may be necessary to bring their blood levels of the nutrient up to the amount necessary for optimum bone growth and health, a new study shows.

Insufficiency in vitamin D is common in children around the world, but there is little data on how much supplementation kids need, or even how much vitamin D they should have in their blood, Dr. Ghada E.-Hajj Fuleihan of the American University of Beirut in Lebanon told Reuters Health. "In the pediatric literature, we don't have a lot to guide us," she said.

In a previous study, Fuleihan and colleagues found that giving 10- to 17-year-olds relatively high doses of vitamin D3 increased their bone mass and bone area, as well as lean mass. In the current study, they report on both the short- and long-term safety of high-dose supplementation.

The short-term study included 25 school children randomly assigned to receive a placebo or 14,000 international units (IU) of vitamin D3 per week for eight weeks. In the long-term study, 340 study participants took placebo, 1,400 IU weekly, or 14,000 IU a week, and were followed up at six and 12 months.

Currently, the Institute of Medicine recommends a daily vitamin D3 intake of 200 IU for children. The high dosage used in the current study was 2,000 IU daily, or 10 times that amount.

No signs of vitamin D intoxication were seen in any of the children, while levels of the vitamin in children treated short-term rose from 44 to 54 nanograms per milliliter (ng/mL).

In the long-term study, levels rose from 15 to 19 ng/mL in children given 1,400 IU weekly and from 15 to 36 ng/mL in the higher-dose group. Levels were initially higher in the short-term study because it was conducted among children in a higher socioeconomic group, and took place in the summer, when kids are likely to get ample sunshine and thus have adequate blood levels of the vitamin, Fuleihan and her team explain in the Journal of Clinical Endocrinology and Metabolism.

Based on studies in adults, Fuleihan said, blood levels of vitamin D below 5 ng/mL are agreed to represent deficiency, while levels above 20 ng/mL are considered adequate and most experts say 30 ng/mL is ideal.

Because every additional 100 IU of vitamin D3 consumed produces a roughly 1 ng/mL increase in blood levels, high doses may be needed for children with vitamin D insufficiency, the researcher said.

Nevertheless, she added, more research is needed to understand how much vitamin D children should be getting, and whether there are health effects of vitamin D insufficiency beyond bone and muscle, as studies in adults suggest.

"The pediatric literature is lagging maybe 10 to 15 years behind the adult literature in understanding the impact of low vitamin D on health," the researcher said.

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Lack of joy in life ups early death risk

People who don't think life is worth living are more likely to die within the next few years, research from Japan shows.

The increased death risk was mainly due to cardiovascular disease and external causes --most commonly, suicide.

The research is the largest to date to investigate how "ikigai," or "joy and a sense of well-being from being alive," affects mortality risk, and only the second to examine death from specific causes, according to Dr. Toshimasa Sone and colleagues from the Tohoku University Graduate School of Medicine in Sendai.

The investigators looked at 43,391 men and women 40 to 79 years old living in the Ohsaki region who were followed for seven years, during which time 3,048 died. All were asked, "Do you have ikigai in your life?" Fifty-nine percent said yes, 36.4 percent said they weren't sure, and 4.6 percent said no.

Those who didn't have a sense of ikigai were less likely to be married or employed, and were also less educated, in worse health, more mentally stressed, and in more bodily pain. They were also more likely to have limited physical function.

But even after the researchers used statistical techniques to adjust for these factors, people with no sense of ikigai were still at increased risk of dying over the follow-up period compared to people who did have ikigai. The relationship also was independent of history of illness and alcohol use.

Overall, people with no sense of ikigai were 50 percent more likely to die from any cause during follow-up compared to those who did have a sense that life was worth living. They had a 60 percent greater risk of death from cardiovascular disease, most commonly stroke, and were 90 percent more likely to die of "external" causes.

Of the 186 deaths due to external causes among study participants, 90 were suicides.

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Kids with older dads at higher bipolar risk

Children born to fathers older than 30 are more likely to develop bipolar disorder, a common condition sometimes known as manic depression, researchers reported on Monday.

The paternal risk also grows with the age of a father, rising to 37 percent by the time a man is 55 years, said Emma Frans, an epidemiologist at the Karolinska Institute in Sweden, who led the study.

The brain disorder causes extreme shifts in mood, energy and ability to function. It is marked by high periods of elation or irritability and low periods of sadness and hopelessness that can last months.

The findings published in the Archives of General Psychiatry bolster evidence that children of older fathers are at higher risk of psychological conditions such as bipolar disorder, autism and schizophrenia, the researchers said.

"Advanced paternal age is a risk factor for bipolar disorder in the offspring," Frans and colleagues wrote.

One explanation could be that a man's degraded sperm quality as he ages could increase the likelihood of genetic mutations that may lead to biopolar disorder, Frans said.

"Despite the robust evidence supporting the association between paternal age and severe mental disorders, the association between advanced paternal age and bipolar disorder has not been investigated," the team added.

The findings are another step toward unraveling the mystery of how the condition affecting an estimated 1 percent to 3 percent of adults worldwide arises, the researchers said.

Last month, an international research team linked two genetic variants to an increased risk for the disease, which is often treated with AstraZeneca Plc's blockbuster drug Seroquel. The condition often runs in families.

The Swedish researchers used a national medical registry to identify nearly 14,000 men and women diagnosed with bipolar disorder. For each person, they also randomly selected five people of the same sex and age without the condition.

After factoring for maternal age, the researchers found that children born to fathers older than 30 had an 11 percent higher risk of developing bipolar disorder compared to younger fathers. Children whose fathers were older than 55 had a 37 percent increased risk.

Frans said the findings did not mean that older men should not father children because the overall risk is still low, she added.

"The study sheds light on the negative effect of older fathers but most older men will still have healthy children," she said in a telephone interview.

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Study finds more allergic reactions after HPV jab

Young women in Australia who got a vaccine to prevent cervical cancer were five to 20 times more likely to have a rare but severe allergic reaction than girls who got other vaccines in comparable school-based vaccination programs, researchers said on Monday.

They said the severe allergic reactions to the human papillomavirus or HPV vaccine were unusual and manageable and that the vaccine remained safe.

The team of Australian researchers led by Dr. Julia Brotherton of The Children's Hospital at Westmead studied 114,000 young women vaccinated with Merck & Co's Gardasil vaccine as part of a 2007 vaccination program in New South Wales.

Of these, 12 had suspected cases of anaphylaxis, a potentially life-threatening allergic reaction that can cause difficulty breathing, nausea and rashes, they reported in the Canadian Medical Association Journal.

Eight out of the 12 young women had confirmed anaphylactic reactions after getting the vaccine, for an estimated rate of reaction of 2.6 per 100,000 doses administered. That compared with a rate of 0.1 per 100,000 doses in a 2003 school-based meningitis vaccination program.

Brotherton and colleagues suspect the higher rates of allergic reaction could be due to better surveillance programs to watch for such reactions, the higher tendency for young women to have such reactions compared with men and an apparent overall rise in the incidence of anaphylaxis in Australia.

Nevertheless, they said that the rates remain rare and should not discourage use of the vaccine, which targets four strains of the human papillomavirus, a common sexually transmitted virus that causes genital warts and most cases of cervical cancer.

"It's just a reminder that there are rare adverse effects," said Dr. Neal Halsey of Johns Hopkins University in Baltimore, who wrote a commentary on the study.

"It doesn't change the strong recommendations for all adolescent girls to get this vaccine but we just have to watch them to make sure they don't have this allergic reaction," he said in a telephone interview.

Last May, the U.S. Centers for Disease Control and Prevention said Gardasil has been associated with a higher risk of fainting, in some cases resulting in injury.

In the United States, Merck has distributed more than 16 million doses of Gardasil, which is approved for women and girls ages 9 to 26.

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High birth weight may raise brain tumor risk

Babies who are heavy at birth -- weighing more than 4000 grams (8.8 pounds) -- may have an increased risk for two of the most common types of brain tumors among children, German researchers report.

Astrocytomas, which form in the large cells of the nervous system, and medulloblastomas, which generally develop in the central part or within the hemispheres of the brain, account for up to about half of childhood brain tumors, note Dr. Thomas Harder and colleagues at Charite-Universitatsmedizin Berlin.

"Remarkably, for both of these types of childhood brain cancer ... high birth weight was significantly associated with increased tumor risk," Harder and colleagues report in the American Journal of Epidemiology.

The investigators found this association after looking at the combined findings from eight studies that involved more than 1.7 million children younger than 19 years old. Over 4000 of these children developed astrocytomas, medulloblastomas, or tumors in the cerebrospinal passageways of the brain known as ependymomas.

In studies reporting the development of astrocytomas, the researchers found that each 1000 gram (2.2 pound) increase in birth weight increased risk by 19 percent.

Studies reporting the development of medulloblastomas also showed a significantly increased risk among children who were heavy at birth, but risk did not appear to increase with increasing birth weight, as found with astrocytomas, the investigators note.

By contrast, they found no association between low birth weight and the development of these two tumor types; nor did they identify a link between birth weight and the development of ependymomas in the small number of studies reporting on this type of tumor.

Should follow up research find causal associations between high birth weight and childhood cancers, measures to decrease the incidence of high birth weight may be needed to curb the risk for brain tumors in children, Harder and colleagues conclude.

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B vitamins fail to curb risks in heart patients

Reducing levels of the amino acid homocysteine with folic acid and B vitamins failed to prevent serious complications in patients with heart disease, Norwegian researchers said on Tuesday.

The study was the latest of several large trials to show that lowering homocysteine through vitamin therapy offered no benefit to people with heart disease.

Other research had found a link between high concentrations of homocysteine in the blood and heart attacks and strokes.

But the researchers said the failure of their study and others like it suggests that homocysteine may be a marker for heart risks, and not a cause.

"Our findings do not support the use of B vitamins as secondary prevention in patients with coronary artery disease," Dr. Marta Ebbing of Haukeland University Hospital in Bergen, Norway, and colleagues wrote in the Journal of the American Medical Association.

Ebbing's team studied 3,096 patients with coronary artery disease in two Norwegian hospitals between 1999 and 2006 who were having procedures to remove blood clots that were blocking the flow of blood to the heart.

They divided patients into four groups, testing different combinations of B6 and B12 vitamins with or without folic acid. The vitamins were given in addition to other treatments.

Patients were scheduled for follow-up visits with an interview, clinical examination and blood sampling at one month, one year, and at a final study visit.

The study was stopped early because preliminary results from a similar study in Norway found no benefits from the therapy and an increased risk of cancer associated with B vitamins.

Based on the data they collected, Ebbing and colleagues found no sign that a combination of folic acid plus vitamin B12 or B6 helped reduce the risk of death or major heart events, such as heart attacks or strokes.

They did find a trend toward fewer strokes and a higher risk of cancer in groups receiving folic acid, but they said the numbers were not statistically significant.

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Prostate enlargement treated by Impotence Drug

Impotence drugs may be able to help reduce the symptoms caused by enlarged prostates, such as trouble urinating, U.S. researchers reported on Tuesday.

Men who took Eli Lilly and Co's Cialis every day had fewer symptoms, such as urinary frequency, urgency, intermittence, straining, incomplete emptying or a weak urinary stream, they reported in the journal Urology.

With about 50 percent of men over 50 suffering from some version of this problem, the study suggests a large potential market for erectile dysfunction drugs.

Researchers at the University of Texas Southwestern Medical Center at Dallas, Northwestern University in Chicago and Lilly Research Laboratories tested more than 1,000 men with enlarged prostates -- a condition known as benign prostatic hyperplasia or BPH.

Some got various doses of Cialis, known generically as tadalafil, while some got a placebo. Those who got Cialis were more likely to report their symptoms had improved, and a relatively low dose of 5 mg a day did the trick, reported the researchers, led by UTSW's Dr. Claus Roehrborn.

Cialis caused relatively few side effects, they added, in contrast to the drugs now used to treat BPH.

"Although they are effective, each of these drug classes can produce unwanted side effects, including dizziness, hypotension (low blood pressure) and sexual dysfunction," they wrote.

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Bacterial pneumonia a deadly killer in 1918

Bacterial pneumonia may have killed most people during the 1918 flu pandemic, and antibiotics may be as crucial as flu drugs to fight any new pandemic, U.S. researchers reported on Tuesday.

Samples of lung tissue taken from soldiers who died in the pandemic, the worst of the 20th century, showed evidence of damage both by the flu virus and by pneumonia-causing bacteria.

Such so-called co-infections also cause many influenza-related deaths today.

"In essence, the virus landed the first blow while bacteria delivered the knockout punch," Dr. Anthony Fauci, director of the National Institute of Allergy and Infectious Diseases, which conducted the study, said in a statement.

Writing in The Journal of Infectious Diseases, Fauci, Dr. Jeffery Taubenberger and colleagues said preparations for future pandemics should include stockpiling antibiotics as well as antiviral drugs and vaccines.

The researchers also reviewed scientific and medical journals for studies on autopsies conducted on influenza victims from the 1918 pandemic, in which between 50 million and 100 million people died around the world over 18 months.

They consistently found evidence of bacterial pneumonia along with flu in the victims, the researchers said.

Most experts agree that another influenza pandemic will come at some time, although no one can predict when and what strain of flu might cause it. Influenza constantly mutates and pandemics usually occur when a completely new strain gains the ability to easily infect humans and then pass from person to person.

The current chief suspect is the H5N1 avian influenza affecting mostly birds in Asia, Europe the Middle East and Africa. It rarely infects people but has killed 243 out of 385 humans infected since 2003.
Many countries are preparing for a pandemic by stockpiling drugs, developing vaccines and making plans to help society function when many people are sick or staying home to avoid infection.



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Stem cells to help treat bowel cancer

Stem cell scientists have developed a new and more accurate way of spotting aggressive forms of bowel cancer, allowing for tailored treatment that should improve patients' chances of survival.

British researchers said on Wednesday those with the most aggressive kind of cancer could be identified early by testing for a stem cell marker protein called Lamin A.

The team concluded that patients testing positive for Lamin A should be given chemotherapy, in addition to surgery, to increase their chances of survival.

The discovery is the latest example of new tests being developed that can help doctors decide how and when to treat different manifestations of cancer.

In the two earliest of the four key stages of bowel cancer, patients normally have an operation to remove their tumor but are rarely given chemotherapy, since the toxic treatment can cause more harm than good.

The new research, however, suggests that around one third of these early-stage patients will have the Lamin A stem cell marker, indicating a more serious form of disease, and they are likely to benefit from chemotherapy.

"Chemotherapy can be very useful but can have a number of side effects, so we only want to use it where we think there's a good chance it will help. This test will help us determine that," said Robert Wilson, a bowel cancer specialist at The James Cook University Hospital, Middlesbrough.

The team from Durham University and the North East England Stem Cell Institute now aims to develop a robust prognostic tool that eventually can be used widely in hospitals.

Their research was published in the Public Library of Science journal PLOS One and is available online here

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Alexander technique benefits back pain

Chronic back pain can be eased by teaching the Alexander technique, an alternative therapy involving learning better posture, British researchers said on Wednesday.

Until now, there has been no real evidence of the long-term benefits of the Alexander technique, although previous research has suggested it may offer short-term relief.

To find out more, a team of researchers from the University of Southampton and the University of Bristol compared the effectiveness of different therapies in more than 500 patients.

After a year of treatment, patients receiving 24 Alexander technique lessons reported experiencing just three days of back pain, compared to 21 days for those given normal care by their doctor, they wrote in the online edition of the British Medical Journal.

Back pain causes more disability than almost any other condition in Western societies but very few effective long-term treatments are available.

The technique was originally developed at the end of the 19th century by the Shakespearean actor Frederick Alexander.

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Joint surgery and cardio risk factors

In addition to confirming previously identified risk factors for cardiovascular complications after total joint replacement surgery, researchers have now found that bilateral (involving both sides of the body, such as two hip or knee replacements), as well as revision operations, are associated with increased risk.

"Revision joint replacement and bilateral surgery are much more prolonged operations than primary unilateral joint replacement," Dr. Jeffrey N. Katz, from Brigham and Women's Hospital in Boston, said in a statement. "These findings suggest an increased risk with more prolonged surgery."

The results, reported in the journal entitled Arthritis and Rheumatism, come from a study of 209 patients with a history of heart attack, heart failure, unstable angina (chest pain), arrhythmia (irregular heart beat), symptoms of low blood pressure, or a blot clot in the lung at admission for total joint replacement, and 209 patients matched to characteristics of the others, but did not have cardiovascular complications.

In line with prior findings, an increased risk of heart disease was 0.7-times greater in older patients, 2.6-greater in those with history of arrhythmia and 1.6-times greater in patients with a history of coronary artery disease, heart attack, heart failure, or valvular heart disease.

The strongest risk factor, however, was one of the newly identified ones, bilateral surgery, which increased the risk by 3.5-fold. Revision surgery also increased the risk by 2.2-fold.

"Clinicians can use this information to better estimate the risk of cardiovascular complications following total joint replacement surgery," Katz said, "and, ultimately, to prevent and better manage these complications."

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Pneumonia vaccination and diabetes

Researchers from Denmark say they have "strong evidence" that diabetes is associated with a 25 percent to 75 percent increase in the relative risk of hospitalization due to pneumonia.

Writing in the journal Diabetes Care, the researchers say these results "emphasize the value of influenza and pneumococcal immunization, particularly for patients with longer diabetes duration, and the importance of improved glycemic control to prevent pneumonia-related hospitalization among diabetic patients."

Using health care databases for northern Denmark, Dr. Jette B. Kornum from Aarhus University Hospital, Aalborg and colleagues identified 34,239 individuals with a pneumonia-related hospital admission and 342,390 individuals from the general population who served as a control group.

The analysis of these data revealed that individuals with diabetes had a 26 percent higher risk of pneumonia-related hospitalization compared with those without diabetes.

The risk of pneumonia-related hospitalization was increased by 4.4-fold in subjects with type 1 diabetes and by 1.2-fold in those with type 2 diabetes.

The longer duration of diabetes with poor glycemic control, the higher the risk of hospitalization for pneumonia became, Kornum and colleagues observed. Compared with the subjects without diabetes, having diabetes for 10 years or more was associated with a 37-percent greater risk.

Diabetes combined with an A1C level of 9 percent or greater, a standard measure of blood glucose, which should be 7 percent or lower, was associated with a 60 percent increased relative risk of pneumonia-related hospital admission, while diabetics who had an A1C of less than 7 percent had a 22 percent risk, compared with nondiabetic subjects.

"Our data extend previous studies suggesting that diabetes is a risk factor for pneumonia," Kornum and colleagues conclude.

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Mental illness may up risk of postpartum suicide

New mothers with a history of depression or other psychiatric disorders appear more likely than other women to attempt suicide soon after giving birth, a new study suggests.

Researchers found that among nearly 1,800 women who recently gave birth, those with a history of a psychiatric disorder were 27 times more likely to attempt suicide in the year after having their baby.

Similarly, women with a history of substance abuse had a six-fold increase in their risk of attempted suicide.

Postpartum suicide is rare, but the new findings point to a group of women who may be at greatest risk, the researchers note in the American Journal of Obstetrics & Gynecology.

Women, their families and their doctors should be aware that past psychiatric disorders and substance abuse are risk factors for postpartum suicide, lead researcher Dr. Katherine A. Comtois, of the University of Washington School of Medicine in Seattle, told Reuters Health.

The findings are based on hospital records from women who gave birth in Washington State between 1992 and 2001. The researchers identified 355 women who were hospitalized for a suicide attempt in the year after giving birth; they matched each of these women with another four who had given birth in the same year but did not attempt suicide.

Overall, Comtois and her colleagues found, the risk of postpartum suicide was markedly higher among women who'd been hospitalized with a psychiatric disorder, substance abuse problem or both 5 years before giving birth.

Such diagnoses are "clearly important risk factors" of which families and medical providers should be aware, Comtois said.

The American College of Obstetricians and Gynecologists recently recommended that women be screened for depression and other "psychosocial risk factors" during prenatal care, Comtois and her colleagues note in the report.

"Future studies," they write, "should evaluate the effectiveness of screening for psychiatric and substance use disorders on decreasing adverse outcomes such as suicide attempts during the postpartum period."

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West Nile patients recover

Patients infected with West Nile virus can develop long-term symptoms such as fatigue, fuzzy thinking and movement difficulties but these symptoms go away after about a year, doctors reported on Monday.

The mosquito-borne virus arrived in the Americas in 1999 and quickly began to sicken patients in New York. It has now spread across the United States, Canada and Mexico and continues to infect people in Africa, Australia, western Asia, Europe and the Middle East.

West Nile causes no symptoms in about 80 percent of cases. About one in 150 people infected with the virus develop severe illness with high fever, headache, neck stiffness, stupor, disorientation, vision loss, numbness, coma, paralysis and other symptoms.

Sometimes the neurological effects last for weeks or months and many doctors had feared this nerve damage was permanent.

Dr. Mark Loeb of McMaster University in Ontario, Canada, and colleagues wanted to see what the long-term effects were.

"This is the first study to comprehensively look at a large population of infected persons to study the long-term effects of West Nile virus," Loeb said in a statement.

"We found that both physical and mental functions, as well as mood and fatigue, seemed to return to normal in about one year."

Writing in the Annals of Internal Medicine, Loeb said his team studied 156 West Nile patients between 2003 and 2007.

They found symptoms and recovery times were similar among patients who had neurological effects and those who did not.
There is no human vaccine for West Nile virus, although one is sold to protect horses. The U.S. Centers for Disease Control and Prevention advises people to use repellents containing DEET and clothing to cover up as the best way to prevent mosquito bites and infection.


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Teens who lack sleep have high blood pressure risks

Poor sleep habits can do more than annoy parents and make teenagers drowsy in school -- they can lead to high blood pressure, U.S. researchers reported on Monday.

Teens who slept fewer than 6 1/2 hours a night had more than twice the risk of high blood pressure and those with troubled sleep had more than triple the risk, the team at Case Western Reserve University in Cleveland, Ohio found.

Writing in the American Heart Association journal Circulation, the researchers found the pattern held even when adjusted for sex, weight and socioeconomic status.

"Our study underscores the high rate of poor quality and inadequate sleep in adolescence coupled with the risk of developing high blood pressure and other health problems," said Dr. Susan Redline, the pediatrician who led the study.

"We also found that a low sleep efficiency may be more consistently associated with pre-hypertension than a shorter sleep period."

High blood pressure can damage arteries and kidneys, causing stroke, kidney disease and other illnesses.

Redline's team studied 238 13-to-16-year-olds and found 14 percent of the adolescents had high blood pressure or readings at the borderline, called pre-hypertension.

For adults, high blood pressure is defined as a reading of 140/90 or above, but for children it is defined as being in the 90th percentile for their age.

They had the volunteers fill out sleep diaries but also measured their movements while in bed to gauge whether they were really asleep. On average, the teens got just 7.7 hours of sleep a night, while they need nine hours at that age.

And 16 percent of the teens had low sleep efficiency, meaning they had trouble falling asleep much of the time or woke up too early. Another 11 percent slept less than 6 1/2 hours a night.

"These associations may have a large public health impact," Redline said in a statement.

"Part of the problem is the technological invasion of the bedroom with computers, cell phones and music," Redline said.

"There are teens who text message or listen to music all night, compounded by early school hours. Adolescents need nine hours of sleep. Parents should optimize sleep quality for their family with regular sleep and wake times and bedrooms should be kept quiet, dark and conducive to sleep."

The National Heart, Lung and Blood Institute said caffeine and too-warm temperatures also keep people awake.

"Signs of not getting enough sleep or sleeping poorly include consistently taking more than 30 minutes to fall asleep, awakening more than a few times or for long periods each night, feeling sleepy during the day, or having trouble concentrating at school or at work," the NHLBI, part of the National Institutes of Health, said in a statement.

Redline said the study may underestimate the problem because it excluded children with known sleep disorders and other illnesses.

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Armchair olympics causes obesity fear in China

Armchair athletics may not be an Olympic sport but it's the most popular activity in China this month, fuelling concerns about rising obesity rates.

Chinese media has even given its army of TV Olympic spectators a name -- otaku -- a Japanese word that means "venerable house" and usually refers to someone nerdy who is totally devoted to a hobby to the point of not leaving home.

Figures have shown about 840 million of China's 1.3 billion population tuned in to watch the August 8 opening ceremony of the Beijing Games and interest is expected to stay high to August 24.

Increased TV viewing, less physical jobs and a shift away from a traditional Chinese diet rich in vegetables and carbohydrates with little animal-sourced food to a more Western diet heavier in meat, eggs and dairy has piled on the pounds.

"Lots of mothers don't know what to feed their children anymore," said Zhao Hua, who was having lunch with her 6-year-old son Tanning at a massive McDonald's in the Olympics site.

"In the past it was good to be a bit fat because it was a sign of strength but now children are getting too fat."

Figures show about a quarter of Chinese adults are obese or overweight, which is lower than many other countries but has jumped from 13 percent in 1991 with forecasts it could double by 2028.

By comparison World Health Organization figures show 65 percent of adult Americans in 2005 were overweight or obese.

A University of North Carolina study, published in the July/August issue of the journal Health Affairs, showed of all developing countries, only Mexico's rate of obesity was growing faster than that of China.

The World Food Program says a 6-year-old boy in China is now 13 pounds (6 kgs) heavier and almost two-and-a-half inches (6.4 cms) taller than a 6-year-old was 30 years ago.

"We need to find the right investments and regulations to encourage people to adopt a healthy lifestyle, or we risk facing higher rates of death, disease, and disability and the related costs," warned researcher Barry Popkin.

The Chinese diet has changed, with hundreds of McDonald's and KFC outlets in China, but experts also blame a drop off in physical activity, with more cars and less bikes on the roads.

Chinese newspaper the People's Daily said China has fewer than seven training fields for every 10,000 Chinese, compared with 200 sports fields for every 10,000 people in United States, and Japan.

"Now all the teenagers just like to play video games and watch television and our children like McDonald's. It is not healthy," said Yu Yanbing who was tucking into some fries at McDonald's with his 3-year-old son Zixi.

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Obesity and diabetes increase heart disease risk

People who are both obese and have diabetes are highly likely to develop heart disease during their lifetime, a new study shows.

Researchers found that of more than 3,400 adults in a long-running U.S. heart study, women who were obese and diabetic had a nearly 80 percent chance of developing heart disease at some point. For their male counterparts, that figure was nearly 90 percent.

Lifetime risk was based on the likelihood that a 50-year-old would develop heart disease in the next 30 years.

Obesity and diabetes commonly go hand-in-hand. The new findings, published in the journal Diabetes Care, show that diabetes on its own significantly raises the lifetime risk of heart disease, and that obesity worsens the situation.

Dr. Caroline S. Fox of the National Heart, Lung and Blood Institute in Bethesda, Maryland, and her colleagues the lifetime heart disease risk of normal-weight women who did not have diabetes was 34 percent. The risk for normal-weight women with diabetes was 55 percent.

Among obese women, those who did not have diabetes had a 47 percent chance of developing heart disease, while the risk for those with diabetes was 79 percent.

The pattern was similar for men, with a lifetime heart disease risk of 49 percent among normal-weight, non-diabetic men, and a 77 percent risk for normal-weight men with diabetes. Obese men without diabetes had a 67 percent lifetime heart disease risk, while the risk for obese diabetic men was 87 percent.

The number of Americans with diabetes is expected to rise to 48.3 million by 2050, the researchers note, and heart disease due to diabetes appears to already be on the rise.

"This trend may continue to worsen if current trajectories do not change," they warn.

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Diabetes caused by exposure to PCB

People who have been exposed to high levels of toxic polychlorinated biphenyls (PCBs) may face an elevated risk of type 2 diabetes, a new study shows.

The findings, reported in the journal Diabetes Care, come from a long-term study of Taiwanese adults who, in the 1970s, had been poisoned by cooking oil contaminated with PCB pollutants.

Once used in products ranging from fluorescent lights and appliances to insulation and insecticide, PCBs were banned in the late 1970s as carcinogens and general health hazards. They linger in the environment, however.

In the new study, Dr. Yueliang Leon Guo, from the National Taiwan University in Taipei, and colleagues examined the incidence of type 2 diabetes among 378 Taiwanese "oil disease" victims and 370 of their neighbors who had not been poisoned.

They found that women who had been exposed to the PCB-laced oil were twice as likely as other women to develop type 2 diabetes over 24 years. And women who had been most severely affected by the PCB exposure had a more than five-times higher diabetes risk.

There were no similar risks seen in men, however.

Other studies have found that people with diabetes tend to have relatively higher levels of organic pollutants, such as PCBs, in their blood. In comments to Reuters Health, Guo said that since "everyone" has detectable PCB levels in his or her body, it's possible that exposure to such pollutants has helped feed the widespread rise in diabetes in recent decades.

"The public health implication of these findings can be huge," Guo added, "considering the burden of diabetes and its multiple long-term complications."

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Stroke treatment often delayed

Stroke victims frequently fail to seek emergency treatment promptly enough, and even when they do get to the ER quickly, their treatment is often delayed, a new study shows.

"Our study shows that most people with stroke symptoms still do not get to the hospital in a timely manner," lead researcher Dr. Kathryn R. Rose, of the University of North Carolina, Chapel Hill, told Reuters Health.

"This precludes them from being considered for time-dependent treatments that can reduce disability and death following a stroke."

In most cases, strokes are caused by a blood clot hindering blood flow to the brain. A drug called tissue plasminogen activator, or tPA, can be used to dissolve the clot and limit stroke damage, but it must be given within three hours of a person's first symptoms.

In their study, Rose and her colleagues found that of 15,177 patients in a North Carolina stroke registry, less than one-quarter arrived at the hospital within two hours of symptom onset. Of these patients, just 24 percent received a CT scan within the recommended time frame.

The researchers report the findings in the journal Stroke.

A CT scan is considered crucial to stroke diagnosis, and one must be done before tPA can be given. National guidelines call for running a CT scan within 25 minutes of a patient's arrival at the hospital, regardless of when their symptoms began.

Yet, Rose and her colleagues found, among stroke patients who arrived at the hospital more than two hours after their symptoms started, only 9 percent received a CT scan within 25 minutes.

"While patients that arrive to the hospital within 2 hours of symptom onset are more likely to receive a timely CT scan than those who do not," Rose said, "most do not. This points to areas where stroke systems of care within hospitals can be improved."
ne way stroke sufferers might improve their odds of prompt treatment is to call an ambulance, the study suggests.

Patients who arrived via emergency medical services were twice as likely to receive a timely scan as those who arrived on their own, the researchers found.

Given the implications of timely arrival, Rose said, "it is important for people to recognize the symptoms of stroke and promptly call emergency services when they occur."

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Birth control pills affect sexiness of man

Birth control pills may affect how appealing a woman finds a man's scent -- potentially steering her toward a mate who is genetically similar to her, according to British researchers.

The sense of smell is thought to be important to mate-seeking animals and humans. Genes of the major histocompatability complex (MHC) play a role in a person's odor, and people tend to be attracted to those with an MHC makeup that is dissimilar to their own.

This could have evolutionary significance, since genetic diversity in a couple increases the chances of having healthy children.

But in the new study, researchers found that after women began using birth control pills, their smell preferences tended to shift -- making them more likely to find the scent of a genetically similar man "sexy."

The findings appear in the journal Proceedings of the Royal Society B: Biological Sciences.

For the study, researchers led by Dr. S. Craig Roberts, of the University of Liverpool, recruited 110 women between the ages of 18 and 35. They had each volunteer rate the odors of six men, using t-shirts that the men had worn overnight.

The women were asked to rate odor "pleasantness" -- considered a correlate of "sexiness" -- and odor intensity. Odor "desirability" was tested with the question, "Based on this smell, how much would you like this man as a long-term partner?"

For each woman, the investigators pre-selected three MHC-similar and three MHC-dissimilar men.

At the time of the first sniffing session, none of the women was using oral contraception. A second session took place three months later, after 40 women had started using birth control pills.

The researchers found that, in general, the more pleasant a woman found a man's odor, the more desirable he was to her. But among women who began using birth control pills, the definition of a sexy odor changed over time.

"The results showed that the preferences of women who began using the contraceptive pill shifted towards men with genetically similar odors," Roberts said in a written statement.

If the sense of smell is in fact a strong player in humans' mate choices, the researchers write, birth control pills just might nudge a woman toward a less-than-ideal man.

"Not only could MHC-similarity in couples lead to fertility problems," Roberts said, "but it could ultimately lead to the breakdown of relationships when women stop using the contraceptive pill, as odor perception plays a significant role in maintaining attraction to partners."

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Asthma risk increased with childhood eczema

Children with the allergic skin condition eczema are at increased risk of developing asthma well into adulthood, according to a decades-long study.

Australian researchers found that among nearly 8,600 study participants followed from the age of 7, those who'd had childhood eczema were roughly twice as likely to develop asthma by middle-age.

It's not clear whether the eczema directly contributed to asthma development in these cases. However, the findings do suggest a cause-and-effect relationship between the two conditions, according to the researchers, led by Dr. John A. Burgess of the University of Melbourne.

They report the results in the Journal of Allergy and Clinical Immunology.

The findings come from a study that began in 1968, when parents of 8,583 7-year-old children in Tasmania were surveyed about their children's health. The children also had a medical exam. At that time, 769 were found to have eczema.

The researchers found that children with eczema were twice as likely as their peers to develop asthma as teenagers, and 63 percent more likely to develop the lung condition as adults.

Other researchers have noted a phenomenon dubbed the "atopic march," which refers to the sequential development of eczema, followed by nasal allergies and finally asthma. The current findings, Burgess and his colleagues write, suggest that this march continues on well past childhood.

It's also possible that eczema directly contributes to asthma development, the researchers say. One theory is that certain immune system cells, primed for an allergic response, might migrate from an eczema patient's skin to tissue of the airways. That could make their airways more likely to inflame in response to an inhaled allergen, leading to asthma symptoms.

"Our data suggest that a causal link is possible," Burgess told Reuters Health.
"If in fact the link was causal," he added, "then aggressive treatment of childhood eczema aimed at really tight control of that disease might have an impact on the development of asthma in adolescence and in adult life."


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Sextuplets birth in Iraq

A woman has given birth to rare sextuplets in southern Iraq, but two of them died because the hospital lacked the proper equipment to keep them alive, her doctor said on Saturday.

Some Iraqi media described it as the first birth of sextuplets -- six children born at once -- in the country, although this could not be verified.

Sextuplet births are extremely rare although fertility treatments have increased the frequency of multiple births.

"Two of the children died because of problems breathing," said Dr Ali al-Jabiri, in charge of premature infants at Al-Habboubi Hospital in the southern Iraqi city of Nassiriya.

"If we had suitable medical equipment then we could have saved them," he added.

The babies all weighed between 700 and 1,200 grams (24-44 ounces). Two boys and two girls survived. Their mother had used fertility drugs.

"The problem is, how can I take care of them? How to feed them?" said their mother, Ibtisam Najim Abid, at the hospital.

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Eye cells may improve sleeping pills

Sleepiness can be controlled by a set of nerve cells in the eye, tests on mice suggest, offering a new target for drug developers that may lead to better sleeping pills, British scientists said on Sunday.

Light levels have long been known to affect alertness, which is why dimly lit rooms lead people to feel drowsy. But the biological mechanism for this has been unclear.

Now University of Oxford researchers have discovered that so-called retinal ganglion cells play a key role. In mice where these cells are turned off genetically, the effects of light on sleep and alertness is completely abolished.

"We have discovered a new pathway that modulates sleep and arousal," lead researcher Russell Foster, of the Nuffield Laboratory of Ophthalmology, said.

"If we can mimic the effect of light pharmacologically, we could turn sleep on and off."

Many drugs have been developed to modify sleep-wake cycles, creating a multibillion-a-year sleeping pill market. But the action of current medicines is relatively crude and the drugs have side-effects.

By targeting the specific mechanism controlling the action of retinal ganglion cells, it may be possible in the future to develop much more sophisticated treatments.

The researchers were able to track the sleep pathway to the brain, showing that two sleep-inducing centers there were directly activated by the cells.

The research, however, is still at an early stage and scientists have yet to establish if the same processes affecting the back-to-front world of the mouse will work in humans.

Because mice are nocturnal, the affects seen in the animal tests were opposite to those that would be expected in humans.

Mice normally sleep when it is light and wake up in the dark -- but those mice in which the light-sensitive cells were turned off stayed wide awake when the lights were on.

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Bipolar disorder linked to genetic traits

Two genes that influence the activity of nerve cells in the brain may play a key role in a person's risk for bipolar disorder, marked by dramatic swings from depression to manic behavior, researchers said on Sunday.

The findings are not expected to lead to a genetic test for the risk of the condition but could help unravel the mystery of how it arises and lead to better treatments, they reported in the journal Nature Genetics.

An international team of scientists examined the genomes of 10,596 people mainly from Britain and the United States, including 4,387 with bipolar disorder, also sometimes known as manic-depression.

The researchers found those with bipolar disorder more likely to have certain variants of the ANK3 and CACNA1C genes. Proteins made by the two genes help govern the flow of sodium and calcium ions into and out of neurons in the brain, influencing the activity of these nerve cells.

"The key importance of this is that it gives us a clear idea of the sorts of chemicals and mechanisms in the brain that are involved in bipolar disorder," Nick Craddock of Britain's Cardiff University, who helped lead the study, said in a telephone interview.

"Over a number of years, that will help researchers to develop better approaches to diagnosis and treatment."

Because it tends to run in families, scientists have been trying to pinpoint genes involved in bipolar disorder. This was the largest genetic analysis of its kind on the disease, which affects an estimated 1 percent to 3 percent of adults worldwide, Craddock said.

The brain disorder causes extreme shifts in mood, energy and ability to function. It is marked by high periods of elation or irritability and low periods of sadness and hopelessness that can last months.

EQUILIBRIUM

The proper function of brain neurons depends on a delicate equilibrium between sodium and calcium, the researchers said.

"The brain operates according to how quickly calcium and sodium are going in and out of cells and how much of it goes in and out," Craddock said.

The findings suggest that bipolar disorder may stem at least in part from malfunctions in the flow of these ions, which are electrically charged versions of the chemicals.

There is a need for better treatment, Craddock said. Lithium, the most common, helps only about two-thirds of those with the disorder and can cause drowsiness, weight gain and mild shakiness.

The U.S. government's National Institutes of Health helped fund the research. Dr. Thomas Insel, director of the NIH's National Institute of Mental Health, said the findings may help solve the puzzle that is bipolar disorder.

"It's not going to tell us the whole story -- it doesn't give you the whole puzzle -- but it's something to build on," Insel said in a telephone interview.

Craddock said identifying the two gene variants probably will not be helpful in determining an individual's risk for the disorder because many who do not have the disease will have the genes.

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1918 flu survivors protected by antibodies

Antibodies from survivors of the 1918 flu pandemic, the worst in human memory, still protect against the highly deadly virus, researchers reported on Sunday.

The findings by a team of influenza and immune system experts suggest new and better ways to fight viruses -- especially new pandemic strains that emerge and spread before a vaccine can be formulated.

These survivors, now aged 91 to 101, all lived through the pandemic as children.

Their immune systems still carry a memory of that virus and can produce proteins called antibodies that kill the 1918 flu strain with surprising efficiency, the researchers report in the journal Nature.

"It was very surprising that these subjects would still have cells floating in their blood so long afterward," said Dr. James Crowe of Vanderbilt University in Tennessee, who helped lead the study.

The antibodies also protected mice from the 1918 virus, which swept around the world at the end of World War One killing between 50 million and 100 million people, Crowe's team reports in the journal Nature.

"The antibodies that we isolated are remarkable antibodies. They grab onto the virus very tightly and they virtually never fall off," Crowe said in a telephone interview.

"That allows them to kill the 1918 virus with extreme potency, meaning it takes a very small amount of antibody."

The human body has two systems for fighting off bacterial and viral invaders. One system uses so-called T-cells while the other employs B-cells, made in the bone marrow, which in turn make antibodies to both flag and directly attack the targets.

RESURRECTED VIRUS

Dr. Christopher Basler and colleagues at the Mount Sinai School of Medicine in New York tested the 1918 survivors and found that in most of them, the B-cells made antibodies highly attuned to the 1918 flu strain.

Dr. Terrence Tumpey at the U.S. Centers for Disease Control and Prevention had worked on a team that resurrected the 1918 virus taken from buried victims of the epidemic and tested this virus in mice. Mice given the antibodies from the elderly survivors lived, while those given placebos died.

Crowe said it will now be important to test other people who have had influenza to see if their immune responses are as strong. "The thought is the first influenza that you see during life is the one that you have the best immunity to," he said.

"If we can learn the rules about how these antibodies work we may be able to design antibodies to lots of other viruses."

The 1918 flu was an H1N1 strain that apparently came straight from birds. "This study tells us that human beings can make long lasting immune responses to bird influenza," Crowe said.

Crowe said his team is working to get antibodies from people vaccinated with experimental shots for the H5N1 avian influenza now circulating in Asia, Europe, the Middle East and Africa. H5N1 mostly affects birds but it has infected 385 people since 2003, killing 243.

Experts fear that, like the H1N1 virus did in 1918, H5N1 will mutate into a form that passes easily among people and spark another pandemic. No one knows if the vaccines being made now would protect against whatever form of H5N1 might emerge.
Crowe said antibodies from survivors might make a good interim treatment while a vaccine is formulated, manufactured and distributed -- a process that would take months.


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Obese men with prostate cancer have poor prognosis

Prostate cancer diagnosis tends to be delayed and surgical treatment more difficult in obese men than in lean men, according to two studies published Friday.

The primary reason for the later diagnosis, and consequently poorer prognosis, seems to be that the PSA test used to screen for prostate cancer is "biased" against obese men, according to researchers.

The problem, they explain, may stem from obese men's larger blood volume, which dilutes their PSA levels. High blood levels of PSA -- or prostate specific antigen - can signal the presence of a prostate tumor.

"We know that obese men tend to have lower PSA values than their normal-weight counterparts, possibly caused by larger blood volumes which dilute their readings," Dr. Stephen J. Freedland, who led the studies, said in a written statement.

"Now we know some of the real implications of this -- that these men are at a disadvantage in terms of prognosis compared to normal-weight men."

Freedland, of Duke University Medical Center in Durham, North Carolina, and his colleagues report their findings online in the journal BJU International.

In one study, the researchers looked at the outcomes of nearly 3,400 prostate cancer patients who had undergone surgical removal of the prostate between 1988 and 2007. Some had had their cancer detected by PSA, while the rest had had it discovered during a digital rectal exam.

Overall, Freedland's team found, obese men were more likely to have more-aggressive tumors and to suffer a cancer recurrence after surgery.

However, the link between weight and disease progression was limited to men treated since 2000, when PSA screening had become the norm.

By contrast, obesity had no effect on the risk of progression for cancers detected by digital rectal exam. The findings support the notion that PSA testing, in particular, confers a bias against obese men, according to Freedland.

In the second study, the researchers found that obese prostate cancer patients tend to have a higher rate of "positive surgical margins" after prostate removal -- which means the odds are higher that some tumor cells were left behind.

"The aggressiveness of obese men's tumors, coupled with the fact that they may be more difficult to remove, is like a double whammy for being obese," Dr. Jayakrishnan Jayachandran, another researcher on the studies, said in a statement.

The findings of both studies, according to Freedland, build up the case for developing alternative prostate cancer screening methods for obese men -- or for lowering the PSA threshold for these patients.

"The least we can do is find a way to level the playing field when it comes to diagnostic tools," Freedland said.

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Physical barriers affect India's fight against HIV

Vast distances are a major hurdle to India's efforts to curb its soaring HIV rate.

India, which has the world's third largest HIV-positive caseload, gives drugs for free to HIV/AIDS patients. But doctors say this is not enough to stop the spread of HIV which is making inroads in rural India, especially among women infected by itinerant husbands, and also children.

For three days a month, Sambit squeezes into a crowded and often filthy train for a three hour journey to Delhi to receive HIV treatment.

"There's no seat and I am very weak," said the 30-year-old former tailor, who asked that his full name not be revealed. He can't afford lodging in Delhi and can barely afford the train tickets.

"I need to borrow money from my family for all these trips," he said.

Many patients in the same position simply give up treatment, an anathema in HIV therapy as it gives rise to drug resistance. These patients may then need more powerful second line treatment, which is not freely available in India.

"Travel can affect drug compliance. Patients who don't get family support, women who may not like to travel alone will just give up," said a doctor at a New Delhi hospital, who spoke on condition of anonymity because he did not have permission to speak to reporters.

There are 147 "antiretroviral therapy" or ART centers in the country, part of a government drive that has been encouraged by the World Health Organization in a bid to prevent HIV from becoming a major health problem.

Delhi has nine such centers and is far better served than many other states. Up to 6,000 patients receive treatment in Delhi, nearly half of these live outside the capital.

The government now plans to build "link centers", small facilities that are closer to where patients live so people like Sambit can obtain their medications more easily.

"They just come to pick up the drugs if they have no side effects and they go home ... that saves transport and other costs," Rao said, adding that the plan was to have as many as 500 such centers all over India.

INFECTION FIGURES AREN'T GOING DOWN

India has 2.47 million HIV cases, according to the latest figures, but health workers say the number is rising rapidly and spreading to new population groups.

"Our numbers are going up," said Loon Gangte, South Asia coordinator of the Collaborative Fund for HIV Treatment Preparedness.

"It's not confined to high risk groups, it's going into the general population. It's not a problem of sex workers, drug users or truck drivers. These people have wives and children at home and the disease is making its way into the general population."

Sujatha Rao, director-general of the government's National AIDS Control Organization, says doctors are increasingly seeing women infected by their husbands.

In some clinics, 1 out of 100 women who come for ante-natal care checkups are HIV positive, she said.

"It is a generalized epidemic," she said. "We have pockets where the prevalence is more than 1 percent among ante-natal care mothers, so we need to intensify our work."

Out of India's 611 districts, HIV prevalence is more than 1 percent of the population in 156 districts.

"The epidemic is getting deeper into (certain) rural, general areas of the country ... it is migrant-related. They go to work and then they take back the infection to their homes," she said.

Even though HIV drugs are free, only about 155,000 people have access to retroviral drugs, up from 20,000 just two years ago.

Health expert say there are many people who do not know they are infected or who do not know that treatment is available.

Some health professionals believe India's HIV problem is closely intertwined with poverty and that the government must tackle poverty if it seeks to curb the spread of HIV.

"Many of these people are very poor, they worry about food, shelter. So they may not think their HIV status is a problem because they don't even know where their next meal is coming from," said Errol Arnette of the help group Sahara.

"A lot of AIDS patients die of TB because it's hard for hospitals to keep them (in hospital). HIV patients are just thrown in a corner because of heavy stigma."

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Doctors fall short on heart disease prevention

Some doctors are not making the grade when it comes to helping their patients ward off heart disease, a new survey suggests.

The survey, of nearly 900 U.S. primary care doctors, found that many do not follow practice guidelines on managing patients who are at elevated risk of heart and blood vessel disease.

"Despite the benefits demonstrated for managing cardiovascular risks, gaps remain in primary care practitioners' management of risks according to guideline recommendations," conclude researchers in a report in the journal BMC Family Practice.

"Patients should talk to their physicians about setting goals together for reducing blood pressure and cholesterol and making a plan to achieve the goals," lead researcher Dr. Hamidreza Doroodchi, from Birmingham, Alabama-based Outcomes, Inc., noted in comments to Reuters Health.

Doroodchi and colleagues sent a survey on cardiovascular disease management to a random sample of 12,000 U.S. family physicians and general internists. A total of 888 completed the survey, which contained "case vignettes" for managing adults deemed to be at low or high risk of heart disease.

The study found that in the hypothetical case of a low-risk 45-year-old woman, only 28 percent of family doctors and 37 percent of internists made the "guideline-based preventive choice" of prescribing no aspirin or other antiplatelet therapy -- drugs that help prevent blood clots by keeping platelet blood cells from clumping together. The majority indicated that they would prescribe a daily aspirin for such a patient to reduce the risk of heart attack.

When asked whether they would start drug therapy to combat abnormal cholesterol levels, 51 percent of doctors said they would not do so in this low-risk patient -- which is in accordance with guidelines. On the other hand, 41 percent said they would prescribe a statin.

When it came to basic lifestyle advice, which is appropriate for low- and high-risk patients alike, doctors often fell short.

For example, while experts recommend that all adults limit their intake of artery-clogging trans fats, over one-third of doctors in the survey failed to recommend this measure for the low-risk 45-year-old woman.

For a 50-year-old man at high risk for heart disease, only 59 percent of family doctors and 56 percent of internists correctly identified the guideline-based goal of keeping "bad" LDL cholesterol below 100 milligrams per deciliter.

Similarly, for a 78-year-old woman at high risk for heart disease but no obvious symptoms, only about half of family doctors and internists were in accordance with guidelines to order a stress test should she develop chest pain or shortness of breath.

Doctors in practice for 10 years or less were much more likely than doctors in practice for more than 10 years to make appropriate guideline-based choices for the prevention of heart disease. Younger doctors were also more apt to adhere to guidelines than were more experienced doctors.

Doroodchi and colleagues found it "especially concerning" that doctors who see a greater percentage of patients with high blood pressure and cholesterol abnormalities were significantly less likely to offer guideline-based care.

"Innovative educational approaches," they conclude, "are needed to address barriers, and target specific groups of physicians to facilitate implementation of guideline-based recommendations for cardiovascular management."

The findings should not, however, be taken as a sign that doctors lack concern for their patients, according to Doroodchi.

"Most primary care physicians are concerned about cardiovascular risk in their patients and set goals for their patients to reduce this risk," the researcher said. "Physicians are concerned that their patients do not follow their advice about changes in exercise and diet, and (that) they do not always take the medicine that is prescribed."

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Study shows few HIV patients tested for tuberculosis

A new report suggests that only 1 percent of HIV-positive patients worldwide have been screened for tuberculosis, a curable infection that frequently kills those living with the AIDS virus.

The low TB screening rate is "unacceptable," researchers from the Advocacy to Control TB Internationally (ACTION) coalition said during a press conference at the International AIDS Conference underway here.

"A mere one percent of people living with HIV/AIDS are reported to have been screened for TB," said Dr. Jim Yong Kim, chief of the division of social medicine and health inequalities at Harvard Medical School. "One of the great tragedies of this epidemic is that people who are living with HIV, after hard-fought battles for access to antiretroviral treatment, go on to die needlessly from TB."

Quoting WHO statistics, the report says that of the 33 million HIV-positive people worldwide, only 314,394 individuals had been tested for tuberculosis. Of those who had been screened, over one in four were found to have active tuberculosis, according to a press release issued by ACTION.

"Persons living with HIV/AIDS are 50 times more likely to develop tuberculosis, than those who are HIV negative," the release cautions. "Without treatment, approximately 90% of persons living with HIV/AIDS die within a few months of developing TB."

"We are facing a preventable plague inside a devastating epidemic," said Michel Sidibe, assistant secretary general and deputy executive director of UNAIDS.

Screening for tuberculosis is not mandatory in the programs being funded by the three major international donors -- Global Fund, PREPFAR and the World Bank, the release states.

The ACTION group recommends universal TB screening of all people living with HIV/AIDS and access to the 3 "I"s -- Intensified case finding, Infection control, and Isoniazid preventive therapy.

Screening tests for tuberculosis are inexpensive compared to the cost of the drug cocktails used to treat HIV/AIDS, Kim said in response to a question at the press conference.

An integrated HIV/TB approach is needed, Kim told Reuters Health.

"TB is a curable disease," he said. "It is a crime not to test for tuberculosis."

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