Gut Bacteria Play Key Role in Anti Seizure Effects of Ketogenic Diet

UCLA scientists have identified specific gut bacteria that play an essential role in the anti-seizure effects of the high-fat, low-carbohydrate ketogenic diet. The study, published today in the journal Cell, is the first to establish a causal link between seizure susceptibility and the gut microbiota — the 100 trillion or so bacteria and other microbes that reside in the human body’s intestines.

The ketogenic diet has numerous health benefits, including fewer seizures for children with epilepsy who do not respond to anti-epileptic medications, said Elaine Hsiao, UCLA assistant professor of integrative biology and physiology, and senior author of the study. However, there has been no clear explanation for exactly how the diet aids children with epilepsy.

Researchers in Hsiao’s laboratory hypothesized that the gut microbiota is altered through the ketogenic diet and is important for the diet’s anti-seizure effects. Hsiao’s research team conducted a comprehensive investigation into whether the microbiota influences the ability of the diet to protect against seizures and if so, how the microbiota achieves these effects.

Trials Support Emicizumab as Standard Tx in Hemophilia A


$448,000 annual price would actually reduce per-patient costs.

Prophylactic treatment with emicizumab (Hemlibra) could soon replace the current standard treatment for hemophilia A patients without factor VIII inhibitors, and at a largely reduced treatment schedule, results of the manufacturer-sponsored HAVEN 3 and HAVEN 4 trials suggested.

The trials showed that emicizumab prevented or significantly reduced bleeds in these patients. Compared with no prophylaxis, emicizumab every week or 2 weeks yielded 96% and 97% reductions in bleeds requiring treatment (P<0.0001 for both), reported Michael Callaghan, MD, of Children's Hospital of Michigan in Detroit, and colleagues.

In addition, bleeds were reduced by 68% among patients who previously received standard of care factor VIII prophylaxis (P<0.0001).

"In the long run, as long as there aren't any unexpected safety events ... I think this will be the standard of care," Callaghan told MedPage Today.

Results of both trials were presented at the World Federation of Hemophilia's World Congress in Glasgow.

During the study period, 55.6% of patients on the once-weekly emicizumab schedule (95% CI 38.1-72.1) and 60% of those on the every 2-week schedule (95% CI 42.1-76.1) experienced no bleeds. None of the patients randomized to no prophylaxis were free from bleeds.

Callaghan said he did not see many hurdles in terms of emicizumab becoming the preferred first-line therapy for hemophilia A. While the price of the drug is high, annual cost-effectiveness estimates place it lower than current factor VIII prophylaxis.

Hotel Pools and Hot Tubs Are Major Sources of Waterborne Illness Outbreaks, CDC Says

You may want to think twice before taking a dip on your next vacation, according to the results of a new report from the Centers for Disease Control and Prevention (CDC).

Between 2000 and 2014, the CDC recorded 493 disease outbreaks related to treated recreational water, resulting in more than 27,000 illnesses and eight deaths. And in almost a third of those outbreaks, the infections could be traced back to hotel pools, hot tubs and spas, the CDC says. In hotels, pools were a major culprit, but 65 cases stemmed from hot tubs or spas.

Of the outbreaks with a confirmed cause, the vast majority — 94% — were due to pathogens, while the remaining outbreaks were caused by chemicals. Cryptosporidium (also called Crypto) — which is a parasite that causes diarrhea and other gastrointestinal issues — caused 212 outbreaks and more than 21,700 illnesses over the 14 years. It’s typically spread when a person swims while they have diarrhea, putting others at risk of swallowing contaminated water. Legionella, which causes the serious pneumonia-like illness Legionnaires’ disease, as well as the less-severe Pontiac fever, was responsible for 57 outbreaks and 624 illnesses. (At least six of the eight deaths were caused by Legionella, the CDC says.) Pseudomonas, which results in swimmer’s ear or a skin condition known as “hot tub rash,” caused 47 outbreaks and 920 infections.

Outbreaks spiked during June, July and August, but they were observed all year long throughout the study period.

The prevalence of waterborne disease outbreaks highlights how difficult they can be to prevent, the report says. Crypto, for example, can survive even in properly maintained and chlorinated pools, and Pseudomonas and Legionella thrive in slimy areas in hot tubs, pools and water playgrounds. While hotels, water parks and public pools can minimize these risks through adequate maintenance, much of the burden of prevention falls on swimmers, especially when it comes to keeping Crypto out of the water.

Deaths from fungal infections exceeding malaria, say researchers in new drug resistance warning

Common fungal infections are “becoming incurable” with global mortality exceeding that for malaria or breast cancer because of drug-resistant strains which “terrify” doctors and threaten the food chain, a new report has warned.

Writing in a special “resistance” edition of the journal Science, researchers from Imperial College London and Exeter University have shown how crops, animals and people are all threatened by nearly omnipresent fungi.

“Fungal infections on human health are currently spiralling, and the global mortality for fungal diseases now exceeds that for malaria or breast cancer,” the report notes.

While the problem of bacteria becoming resistant to commonly used antibiotics has been widely reported on, and likened to the “apocalypse” by medical leaders, the risks of disease-causing fungi have received far less recognition.

Fungicides share a problem with antibiotics in that the organisms they aim to kill are becoming resistant to treatments faster than they can be developed, and there are growing numbers of people vulnerable to infection.

“We’ve got increasing numbers of immunosuppressed patients, that’s what fungi love to parasitise,” Matthew Fisher, professor of fungal disease epidemiology at Imperial, told The Independent.

“Half a million people a year probably die from fungal meningitis in Africa, which wouldn’t affect them if they didn’t have Aids.

“Similarly in the UK we have transplant patients as well, as soon as you whack them on immunosuppressants they start coming down with fungal infections.”

“Transplant doctors are absolutely terrified of these fungal infections,” he added, and the same issues arise in cancer patients, or people whose immune systems are destroyed by disease or age – leaving them unable to fight off infection on their own.

Our immune systems have evolved alongside fungi for millennia to keep us protected against the ever-present pathogens.

Unlike bacteria on surfaces and water droplets, fungi are much better at getting airborne and there are at least five types of potentially disease-causing spores in every breath.

“Compost heaps are absolutely lethal if you don’t have fully functioning innate immunity,” said Mr Fisher.

“If you dig into a heap and get a puff of powder, that will be aspergillus fumigatus.

“If your lung macrophages [white blood cells], don’t mop those spores up, they’re absolutely happy growing at 37 degrees and they’ll just rot you down as quick as a flash – that’s a heavy-duty pathogen.”

Effect of omega-3 (n-3) fatty acid supplementation in patients with sickle cell anemia


Blood cell aggregation and adherence to vascular endothelium and inflammation play a central role in vaso-occlusive crisis in sickle cell disease. The antiaggregatory, antiadhesive, antiinflammatory, and vasodilatory omega-3 (n-3) fatty acids (DHA and EPA) are significantly reduced in patients with the disease.


The aim was to investigate the therapeutic potential of omega-3 fatty acids for patients with homozygous sickle cell disease in a randomized, placebo-controlled, double-blind trial.


Omega-3 treatment reduced the median rate of clinical vaso-occlusive events (0 compared with 1.0 per year, P < 0.0001), severe anemia (3.2% compared with 16.4%; P < 0.05), blood transfusion (4.5% compared with 16.4%; P < 0.05), white blood cell count (14.4 ± 3.3 compared with 15.6 ± 4.0 ×10(3)/μL; P < 0.05), and the OR of the inability to attend school at least once during the study period because of illness related to the disease to 0.4 (95% CI: 0.2, 0.9; P < 0.05).


The findings of this trial, which need to be verified in a large multicenter study, suggest that omega-3 fatty acids can be an effective, safe, and affordable therapy for sickle cell anemia.

FDA approves novel preventive treatment for migraine

The U.S. Food and Drug Administration today approved Aimovig (erenumab-aooe) for the preventive treatment of migraine in adults. The treatment is given by once-monthly self-injections. Aimovig is the first FDA-approved preventive migraine treatment in a new class of drugs that work by blocking the activity of calcitonin gene-related peptide, a molecule that is involved in migraine attacks.

“Aimovig provides patients with a novel option for reducing the number of days with migraine,” said Eric Bastings, M.D., deputy director of the Division of Neurology Products in the FDA’s Center for Drug Evaluation and Research. “We need new treatments for this painful and often debilitating condition.” 

The effectiveness of Aimovig for the preventive treatment of migraine was evaluated in three clinical trials. The first study included 955 participants with a history of episodic migraine and compared Aimovig to placebo. Over the course of six months, Aimovig-treated patients experienced, on average, one to two fewer monthly migraine days than those on placebo. The second study included 577 patients with a history of episodic migraine and compared Aimovig to placebo. Over the course of three months, Aimovig-treated patients experienced, on average, one fewer migraine day per month than those on placebo. The third study evaluated 667 patients with a history of chronic migraine and compared Aimovig to placebo. In that study, over the course of three months, patients treated with Aimovig experienced, on average, 2 ½ fewer monthly migraine days than those receiving placebo. 

The most common side effects that patients in the clinical trials reported were injection site reactions and constipation. 

Association between workarounds and medication administration errors in bar-code-assisted medication administration in hospitals

These are the kinds of problems that develop when you try to design a system for a task that really requires human input...

To study the association of workarounds with medication administration errors using barcode-assisted medication administration (BCMA), and to determine the frequency and types of workarounds and medication administration errors.

We included 5793 medication administrations for 1230 inpatients. Workarounds were associated with medication administration errors (adjusted odds ratio 3.06 [95% CI: 2.49-3.78]). Most commonly, procedural workarounds were observed, such as not scanning at all (36%), not scanning patients because they did not wear a wristband (28%), incorrect medication scanning, multiple medication scanning, and ignoring alert signals (11%). Common types of medication administration errors were omissions (78%), administration of non-ordered drugs (8.0%), and wrong doses given (6.0%).

In hospitals using barcode-assisted medication administration, workarounds occurred in 66% of medication administrations and were associated with large numbers of medication administration errors.

History of Morgellons disease: from delusion to definition

Because of medicine's ready leap to victim blaming whenever medicine doesn't have an explanation for a person's complaint, I thought Morgellons was likely a physical disorder. I'm glad I lived long enough to see the truth of that belief....

Morgellons disease (MD) is a skin condition characterized by the presence of multicolored filaments that lie under, are embedded in, or project from skin. Although the condition may have a longer history, disease matching the above description was first reported in the US in 2002. 

Since that time, the condition that we know as MD has become a polemic topic. Because individuals afflicted with the disease may have crawling or stinging sensations and sometimes believe they have an insect or parasite infestation, most medical practitioners consider MD a purely delusional disorder. 

Clinical studies supporting the hypothesis that MD is exclusively delusional in origin have considerable methodological flaws and often neglect the fact that mental disorders can result from underlying somatic illness. 

In contrast, rigorous experimental investigations show that this skin affliction results from a physiological response to the presence of an infectious agent. Recent studies from that point of view show an association between MD and spirochetal infection in humans, cattle, and dogs. These investigations have determined that the cutaneous filaments are not implanted textile fibers, but are composed of the cellular proteins keratin and collagen and result from overproduction of these filaments in response to spirochetal infection. 

Further studies of the genetics, pathogenesis, and treatment of MD are warranted.

Longer Home Health Visits Tied to Lower Hospital Rates

Home health care visits that are longer by just one minute may be tied to lower hospital readmission rates. That’s the key finding from a recent study from the National Bureau of Economic Research (NBER).

“We obviously see an effect,” Guy David, associate professor at the University of Pennsylvania’s Wharton School and author of the research, told Home Health Care News. “Shorter visits tend to increase the likelihood of readmissions.”

However, that doesn’t mean home health care providers should immediately start mandating longer visits.

Length of visit

The study looked at data from an unnamed private, for-profit, multi-state home health care company with 96 offices in 16 states. The data spanned three years and eight months: January 2012 to August 2015.

“An extra minute relative to the average length of a patient’s home health visits reduces their readmission likelihood by approximately 8%,” the study found.

The results were opposite than what researchers expected to find, according to David, who anticipated that longer visits would indicate higher patient acuity and a greater likelihood of heading back to the hospital.

“One [thought] is that longer visits [are] associated with more readmissions—with sicker patients who require more attention and are [therefore] likely to be readmitted,” he said. “It’s interesting that we are seeing the opposite. The causal relationship runs in the other direction.”

The relationship between length of visit and readmission rates is a little more nuanced, though.

CMS Debuts Strategy to Improve Rural Healthcare

According to the agency's fact sheet, CMS is focused on accomplishing five goals through the new strategy: advance telehealth services, apply a "rural lens" to agency policies, improve access to care, empower rural patients to make healthcare decisions, and leverage partnerships to achieve these objectives.

Below are specific actions CMS plans to take to advance its five goals:

  • Reduce barriers to implementing telehealth and telemedicine services. This addresses reimbursement, cross-state licensure issues as well as administrative and financial burdens surrounding set-up.

  • Institute a redesigned checklist with a rural lens to relevant policies, procedures and initiatives.

  • Promote evidence-based practices to improve access to rural service providers.

  • Provide technical assistance to ensure providers participate in CMS programs.

  • Address patient barriers like lack of transportation.

  • Work to develop and distribute materials to citizens through rural communications networks.

  • Bolster health technology and infrastructure to improve patient access to health information.

  • Partner with federal agencies like the Office of the National Coordinator for Health Information Technology to promote interoperability and increased use of EHRs among patients and providers.

  • Increase focus on maternal health, behavioral health, and substance abuse through partnership with Center for Disease Control.

  • Assist state Medicaid agencies to advance rural health strategies to citizens in need.