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Health & Wellbeing

October 27, 2018 - November 2, 2018

Antibiotics for appendicitis? Surgery often not needed

In this 2016 photo provided by the University of Washington, Dr. Linda Vorvick examines Heather VanDusen at UW Neighborhood Clinic in Seattle. When emergency tests showed the telltale right-sided pain in VanDusen’s abdomen was appendicitis, she figured she’d be quickly wheeled into surgery. But doctors offered her the option of antibiotics instead. (Clare McLean/UW Medicine via AP)

Lindsey Tanner

Chicago (AP) - When emergency tests showed the telltale right-sided pain in Heather VanDusen’s abdomen was appendicitis, she figured she’d be quickly wheeled into surgery. But doctors offered her the option of antibiotics instead.

A new study from Finland shows her choice is a reasonable alternative for most patients with appendicitis. Five years after treatment with antibiotics, almost two-thirds of patients hadn’t had another attack.

It’s a substantial change in thinking about how to treat an inflamed appendix. For decades, appendicitis has been considered a medical emergency requiring immediate surgery to remove the appendix because of fears it could burst, which can be life-threatening.

But advances in imaging tests, mainly CT scans, have made it easier to determine if an appendix might burst, or if patients could be safely treated without surgery.

The results suggest that nearly two-thirds of appendicitis patients don’t face that risk and may be good candidates for antibiotics instead.

“It’s a feasible, viable and a safe option,” said Dr. Paulina Salminen, the study’s lead author and a surgeon at Turku University Hospital in Finland.

Her study in adults is the longest follow-up to date of patients treated with drugs instead of surgery for appendicitis and the results confirm one-year findings reported three years ago.

Research has also shown antibiotics may work for some children with appendicitis.

The Finnish results were published Tuesday in the Journal of the American Medical Association.

A journal editorial says “it’s a new era of appendicitis treatment.”

Appendix removal is the most common emergency surgery worldwide, with about 300,000 performed each year in the United States alone, said Salminen. She said the results from her study suggest many of those surgeries could be avoided.

U.S. doctors have started offering antibiotics instead of surgery and Salminen says she occasionally does too. The journal editorial says appropriate patients should be given that option.

The study involved about 500 Finnish adults who had CT scans to rule out severe cases.

Half were treated with antibiotics; the others had surgery.

Among the antibiotics patients, 100 ended up having surgery within five years of treatment - most for a suspected recurrence of appendicitis in the first year. Seven of them did not have appendicitis and likely could have avoided surgery. The results suggest the success rate for antibiotic treatment was almost 64 percent, the authors said.

About 1 in 4 surgery patients had complications, including infections around the incision, abdominal pain and hernias, compared with only 7 percent of antibiotics patients. Antibiotic patients had 11 fewer sick days on average than the surgery group. In the first year, their treatment costs were about 60 percent lower. A cost analysis for the full five years wasn’t included in the published results.

Surgery patients in the Finnish study all had conventional incisions rather than the less invasive “keyhole” surgeries that are more common for appendix removal in the United States. The non-surgery patients received three days of IV antibiotics in the hospital, followed by seven days of pills at home.

Dr. Giana Davidson, a University of Washington surgeon, is involved in a similarly designed multicenter U.S. study that may answer whether similar benefits would be seen for antibiotics versus “keyhole” surgery.

Davidson called the Finnish study “a critical piece to the puzzle but I don’t think it answers all of the questions.”

Heather VanDusen was treated at the University of Washington in 2016. She said she chose antibiotic treatment partly to avoid surgery scars, and now offers advice to patients for Davidson’s study.

“I knew the worst case scenario was ending up back in the hospital so why not try antibiotics first,” said VanDusen, who works in university communications.

She said she has done well since her treatment, but that the biggest drawback “is wondering, with every episode of stomach or bad gas, if it could happen again.”

Genetic glitch increases men’s risk of impotence, study says

Malcolm Ritter

New York (AP) - Scientists say they’ve located the first well-documented genetic glitch that increases a man’s risk of impotence, a step that might someday lead to new treatments.

Most impotence isn’t caused by genetics but rather things like obesity, diabetes, heart disease, smoking, drug and alcohol use, stress or anxiety.

But in a study released Monday by the Proceedings of the National Academy of Sciences, researchers say they located a spot in human DNA where genetic variation might boost a man’s risk by about 25 percent.

They found statistical evidence for that by looking in the genetic makeup of about 36,600 men, and confirmed it in a similar study of 222,300 other men. Lab tests then suggested that variation might affect the activity of a nearby gene that’s known to be involved in sexual functioning.

Now scientists want to explore how such variation affects risk of the condition, said Eric Jorgenson, a researcher at Kaiser Permanente Northern California in Oakland and lead author of the paper. It may interfere with the functioning of certain brain circuits, he said.

He said discovering a biological explanation could give clues to developing new treatments for impotence, also known as erectile dysfunction.

October 13, 2018 - October 19, 2018

80,000 people died of flu last winter in US

In this Feb. 26, 2015 photo taken through the eyepiece of a microscope, human cells infected with the flu virus glow green under light from a fluorescence microscope at a laboratory in Seattle. The U.S. government estimates that 80,000 Americans died of flu and flu complications in the winter of 2017-2018 - the highest flu-related death toll in at least four decades. (AP Photo/Ted S. Warren)

Mike Stobbe

New York (AP) - An estimated 80,000 Americans died of flu and its complications last winter - the disease’s highest death toll in at least four decades.

The director of the Centers for Disease Control and Prevention, Dr. Robert Redfield, revealed the total in an interview last month night with The Associated Press.

Flu experts knew it was a very bad season, but at least one found the size of the estimate surprising.

“That’s huge,” said Dr. William Schaffner, a Vanderbilt University vaccine expert. The tally was nearly twice as much as what health officials previously considered a bad year, he said.

In recent years, flu-related deaths have ranged from about 12,000 to 56,000, according to the CDC.

Last fall and winter, the U.S. went through one of the most severe flu seasons in recent memory. It was driven by a kind of flu that tends to put more people in the hospital and cause more deaths, particularly among young children and the elderly.

The season peaked in early February and it was mostly over by the end of March.

Making a bad year worse, the flu vaccine didn’t work very well. Experts nevertheless say vaccination is still worth it because it makes illnesses less severe and save lives.

“I’d like to see more people get vaccinated,” Redfield told the AP at an event in New York. “We lost 80,000 people last year to the flu.”

CDC officials do not have exact counts of how many people die from flu each year. Flu is so common that not all flu cases are reported, and flu is not always listed on death certificates. So the CDC uses statistical models, which are periodically revised, to make estimates.

Fatal complications from the flu can include pneumonia, stroke and heart attack.

CDC officials called the 80,000 figure preliminary, and it may be slightly revised. But they said it is not expected to go down.

It eclipses the estimates for every flu season going back to the winter of 1976-1977. Estimates for many earlier seasons were not readily available.

Last winter was not the worst flu season on record, however. The 1918 flu pandemic, which lasted nearly two years, killed more than 500,000 Americans, historians estimate.

It’s not easy to compare flu seasons through history, partly because the nation’s population is changing. There are more Americans - and more elderly Americans - today than in decades past, noted Dr. Daniel Jernigan, a CDC flu expert.

U.S. health officials on Thursday are scheduled to hold a media event in Washington, D.C., to stress the importance of vaccinations to protect against whatever flu circulates this coming winter.

And how bad is it going to be? So far, the flu that’s been detected is a milder strain, and early signs are that the vaccine is shaping up to be a good match, Jernigan said.

The makeup of the vaccine has been changed this year to try to better protect against expected strains.

“We don’t know what’s going to happen, but we’re seeing more encouraging signs than we were early last year,” Jernigan said.

October 6, 2018 - October 12, 2018

UN: Excessive drinking killed over 3 million people in 2016

The World Health Organization said in a report published Friday Sept. 21, 2018, that drinking too much alcohol killed more than 3 million people in 2016, mostly men, with Europe having the highest global per capita alcohol consumption.  (AP Photo/Alexander F. Yuan, FILE)

Geneva (AP) - Drinking too much alcohol killed more than 3 million people in 2016, mostly men, the World Health Organization said.

The U.N. health agency also warned that current policy responses are not sufficient to reverse trends predicting an increase in consumption over the next 10 years.

In a new report Friday, the agency said that about 237 million men and 46 million women faced alcohol problems, with the highest prevalence in Europe and the Americas. Europe has the highest global per capita alcohol consumption, even though it has already dropped by 10 percent since 2010.

Around a third of alcohol-related deaths were a result of injuries, including car crashes and self-harm, while about one in five were due to either digestive disorders or cardiovascular diseases. Cancers, infectious diseases, mental disorders and other health conditions were also to blame.

“Far too many people, their families and communities suffer the consequences of the harmful use of alcohol through violence, injuries, mental health problems and diseases like cancer and stroke,” said Tedros Adhanom Ghebreyesus, the director-general of WHO. “It’s time to step up action to prevent this serious threat to the development of healthy societies.”

The average daily consumption of alcohol by people who consume it is about two glasses of wine, a large bottle of beer or two shots of spirits. Globally, about 2.3 billion people are current drinkers.

The report, the third in a series after ones in 2010 and 2014, relies on information from 2016 - the latest data available. WHO said the trends and projections point to an expected increase in global alcohol per capita consumption over the next decade, particularly in Southeast Asia and the Americas.

“The policy responses which are currently in place in countries are definitely not sufficient to reverse the trends, which we observe in several parts of the world, or to improve significantly this situation,” Dr. Vladimir Poznyak, coordinator of WHO’s management of substance abuse unit, told reporters.

“When we look at the trends of alcohol consumption in many countries from 2000, you can see ups and downs - which are determined by different factors,” said Poznyak, citing countries’ levels of social development, economic backdrops, policy measures and cultural trends.

He said the data showed, for example, that alcohol consumption tends to drop in countries facing an economic crisis.

Poznyak said it was “imperative for the governments to put in place measures that can mitigate the harms associated with this increase.”

The Distilled Spirits Council, which advocates for the industry in the U.S., said in a statement it supports the WHO’s goal to reduce the harmful use of alcohol.

“However, we are concerned that some policy recommendations such as increasing alcohol taxes are misguided and don’t effectively address harmful consumption,” it said.

Ultrasound jiggles open brain barrier, a step to better care

In this March 23, 2017 photo provided by the Sunnybrook Health Sciences Centre, patient Rick Karr is prepared for treatment at the facility in Toronto, Canada. Karr was the first Alzheimer’s patient treated with focused ultrasound to open the blood-brain barrier. (Kevin Van Paassen/Sunnybrook Health Sciences Centre via AP)

Lauran Neergaard

Washington (AP) - A handful of Alzheimer’s patients signed up for a bold experiment: They let scientists beam sound waves into the brain to temporarily jiggle an opening in its protective shield.

The so-called blood-brain barrier prevents germs and other damaging substances from leaching in through the bloodstream - but it can block drugs for Alzheimer’s, brain tumors and other neurologic diseases, too.

Canadian researchers on Wednesday reported early hints that technology called focused ultrasound can safely poke holes in that barrier - holes that quickly sealed back up - a step toward one day using the non-invasive device to push brain treatments through.

“It’s been a major goal of neuroscience for decades, this idea of a safe and reversible and precise way of breaching the blood-brain barrier,” said Dr. Nir Lipsman, a neurosurgeon at Toronto’s Sunnybrook Health Sciences Centre who led the study. “It’s exciting.”

The findings were presented at the Alzheimer’s Association International Conference in Chicago and published in Nature Communications.

This first-step research, conducted in just six people with mild to moderate Alzheimer’s, checked if patients’ fragile blood vessels could withstand the breach without bleeding or other side effects - it didn’t test potential therapies.

More safety testing is needed but “it’s definitely promising,” said Dr. Eliezer Masliah of the National Institute on Aging, who wasn’t involved with the study. “What is remarkable is that they could do it in a very focused way, they can target a very specific brain region.”

Alzheimer’s isn’t the only target. A similar safety study is underway in Lou Gehrig’s disease. And researchers are testing if the tool helps more chemotherapy reach the right spot in people with a deadly brain tumor called glioblastoma.

“We don’t want to broadly open the blood-brain barrier everywhere. We want to open the blood-brain barrier where we want the treatment to be delivered,” explained Dr. Graeme Woodworth of the University of Maryland Medical Center, who will lead a soon-to-begin brain tumor study.

Scientists have long tried different strategies to overcome the blood-brain barrier with little success. The brain’s blood vessels are lined with cells that form tight junctions, almost like a zipper. The barrier lets in select small molecules. Often, treatments for brain diseases are too big to easily pass.

The new approach: Scientists inject microscopic bubbles into the bloodstream. Through an MRI scanner, they aim at a precise brain area. Then they beam ultrasound waves through a helmet-like device to that spot. The pulses of energy make the microbubbles vibrate, loosening those zipper-like junctions in hopes that medications could slip inside.

Within minutes, Lipsman’s team saw a medical dye appear on the Alzheimer’s patients’ brain scans - proof the barrier opened. A repeat scan the next day showed it was closed again. Patients repeated the procedure a month later.

Researchers reported no serious side effects, and no worsening of cognitive function. The study was funded by the non-profit Focused Ultrasound Foundation.

“It’s not painful or anything,” said Rick Karr of Everett, Ontario, the study’s first participant.

A retired truck driver and amateur musician, Karr was diagnosed with Alzheimer’s in 2011. Doctors made clear the study wouldn’t treat his memory problems, but “I feel privileged,” Karr said in an interview. “I could help somebody else down the road.”

A French company, CarThera, is testing a different ultrasound technique for brain tumors, using an implant attached to the skull during surgery.

For the non-invasive ultrasound, device maker InSightec has Food and Drug Administration permission to begin the Maryland tumor trial and a small U.S. Alzheimer’s study.

This time, scientists will aim deeper into Alzheimer’s-affected brains to a key memory region, said lead researcher Dr. Ali Rezai of West Virginia University’s Rockefeller Neuroscience Institute. And they’ll measure if simply opening the barrier could help the body clear away sticky plaques that are a hallmark of Alzheimer’s, after mouse studies suggested that’s a possibility.

But by far the bigger interest is in using ultrasound to deliver drugs - if the next-step studies conclude it’s safe to try.

“The blood-brain barrier’s no longer off-limits,” Rezai said.



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HEADLINES [click on headline to view story]

Antibiotics for appendicitis? Surgery often not needed

Genetic glitch increases men’s risk of impotence, study says

80,000 people died of flu last winter in US

UN: Excessive drinking killed over 3 million people in 2016

Ultrasound jiggles open brain barrier, a step to better care