On UTI Front, Chicken Dinner is No Winner

This is a little bizarre......


For years, researchers have been trying to confirm an apparent link between the Escherichia coli in poultry and urinary tract infections (UTIs) in humans. Now, there's another hint of a connection between contamination back on the farm and nasty germs in our bladders.

Researchers who examined meat from retail stores in California and urine from patients with UTIs found that nearly 25% of chicken and turkey samples shared the same genotypes that were found in the urine samples, according to Reina Yamaji, MD, PhD, of the University of California at Berkeley.

Analysis showed 72 E coli genotypes that were unique to retail meat, 49 genotypes unique to human UTIs, and 12 shared genotypes, Yamaji reported at the annual IDWeek meeting, sponsored jointly by the Infectious Diseases Society of America (IDSA), the Pediatric Infectious Diseases Society (PIDS), the Society for Healthcare Epidemiology of America (SHEA), and the HIV Medicine Association (HIVMA).

Of the six most common E coli genotypes in humans, three of them were found in both retail meat and humans, she said.

The findings don't solve the mystery of whether the meats we eat -- especially poultry -- are directly related to human UTIs, an outside expert told MedPage Today.

"Evidence is growing, but a direct link has not been made yet," according to Amee Manges, PhD, of the University of British Columbia School of Population and Public Health in Vancouver. Still, she said, "these results add to the existing body of research."

Study Questions Durability of MMR Vaccine


The effectiveness of the mumps vaccine wanes at an average of 27 years after the last dose, potentially explaining the resurgence of cases over the past 11 years, researchers said here.

According to an analysis of epidemiological studies, the introduction of the measles-mumps-rubella (MMR) vaccine in the 1960s lowered case rates by more than 99%, according to the CDC, and annual cases in recent years have typically numbered in the hundreds, reported Joseph Lewnard, PhD, and Yonathan H. Grad, MD, PhD, both of the Harvard TH Chan School of Public Health in Boston.

But mumps cases spiked in 2006 and again in 2016 and 2017, they said in a presentation at the annual IDWeek meeting, sponsored jointly by the Infectious Diseases Society of America (IDSA), the Pediatric Infectious Diseases Society (PIDS), the Society for Healthcare Epidemiology of America (SHEA), and the HIV Medicine Association (HIVMA).

The findings point to the need for booster doses in adults, according to Lewnard. "If you want to put mumps on the track to elimination, it's not an unreasonable expectation," he stated.

"We've largely eliminated it, but the [MMR] vaccine is not a perfect dose," said Paul Offit, MD, of the Children's Hospital of Philadelphia, to MedPage Today.

The CDC received reports of more than 6,300 cases in 2016 compared with just 229 in 2012.

Healthcare-Associated Infection Rates Wane Over Time

But notes which infections have declined and which haven't....

Hospitals appear to be doing better at preventing healthcare-associated infections (HAIs), a researcher said here.

A 2015 update of a 2011 point-prevalence survey showed a significant drop in HAIs over time, suggesting that national efforts to prevent the infections are having an effect, according to Shelley Magill, MD, PhD, of the CDC's Emerging Infections Program (EIP) in Atlanta.

The decline was driven by sharp drops in skin and soft tissue infections and urinary tract infections (UTI), Magill said at the annual IDWeek meeting, sponsored jointly by the Infectious Diseases Society of America (IDSA), the Pediatric Infectious Diseases Society (PIDS), the Society for Healthcare Epidemiology of America (SHEA), and the HIV Medicine Association (HIVMA).

But some important conditions, notably pneumonia and Clostridium difficile infection, did not change significantly, suggesting there's more work to be done, Magill said.

You Don’t Need to Do a Prolonged Fast Before Surgery


By the 1960s the term nil by mouth (or its Latin variant NPO, nil per os) after midnight had become the widely accepted guideline for all surgical patients. If you recently had an elective procedure, you might know that it has not changed much since—fasting before surgery, meaning no food and no water, is still advice routinely given to preoperative patients. Yet the evidence—and medical practice, and even the recommendations—have evolved since Mendelson. Medical practice has yet to catch up.

For one thing, anesthesiologists no longer use ether, a substance known to make patients nauseated. They also employ endotracheal tubes, which protect the airways from the aspiration of stomach contents. Knowledge about digestion has increased to the point where the rate of calories leaving the stomach is predictable: A spate of studies on gastric emptying found that patients who consume clear fluids two hours prior to an operation do not have higher gastric volumes than those who fast for longer. In 1999, the tide of mounting evidence pushed the American Society of Anesthesiologists to amend its preoperative fasting guidelines: Patients are now instructed to have a light meal six hours before a procedure and clear fluids—drinks that you can see through, such as pulp-free juices, black coffee, or tea without milk and cream—until two hours prior to the operation. Guidelines in other countries were similarly amended.

Nevertheless, most patients appear to still be getting outdated advice and arrive to surgery thirsty and irritable. A presentation at the 2016 Anesthesiology Annual Meeting found that only 25 percent of hospitals in Michigan adhered to the new guidelines. A 2016 study of oral and maxillofacial surgeons found that 99.1 percent of them did not adopt ASA guidelines, and a worrying analysis of pediatric practices discovered that most children were fasting longer than necessary before their medical procedures, leading to negative experiences. Prolonged fasting can be associated with dehydration, hypoglycemia, and electrolyte imbalance. Some patients experience headaches and nausea before surgery.

Study: C. Diff Cases Tied to Antibiotics for Dental Work


The rise in community-acquired Clostridium difficile appeared to be at least partly fueled by a surprising source -- dentists, according to researchers here.

Analysis of 7 years of surveillance data in five Minnesota counties found that 57% of C. difficile patients had been prescribed antibiotics, something that was assumed to be the cause of the disease, according to Stacy Holzbauer, DVM, a CDC field officer assigned to the Minnesota Department of Health in St. Paul.

But 15% of those patients were given the drugs by their dentists. In many cases that fact didn't find its way into the patient's primary care records, Holzbauer told reporters at the annual IDWeekmeeting, sponsored jointly by the Infectious Diseases Society of America (IDSA), the Pediatric Infectious Diseases Society (PIDS), the Society for Healthcare Epidemiology of America (SHEA), and the HIV Medicine Association (HIVMA).

Dentists are allowed to write prescriptions for antibiotics, and often do when they are performing oral surgery or simply for prophylaxis in some patients, Holzbauer said. Indeed, one estimate suggests they write 10% of all such prescriptions, although the guidelines of the American Dental Association say that relatively few patients need such treatment.

Holzbauer said that at least part of the problem is that dentists, unlike primary care physicians, don't necessarily see the adverse effects of antibiotics, even though they might be aware of the risk in principle.

"No one goes to the dentist when they have diarrhea so [dentists] don't get the feedback," she said.

It's also not clear that dentists are routinely included in discussions about the risks of antibiotics, she said, adding they might be in a "blind spot in the antibiotic stewardship conversation."

HomeFeatured The High Price of the Nocebo Effect


People receiving an inert treatment believed they experienced more severe adverse side effects when the dummy drug was labeled as expensive, scientists report.

The researchers say brain regions responsible for higher-order cognition can influence primal pain sensing at the spinal level.

To study the neurological causes for the so-called nocebo effect (where people in clinical trials sometimes report negative side effects even though they received inactive substances), Alexandra Tinnermann and colleagues developed a new functional magnetic resonance imaging (fMRI) method for simultaneous activity measurements in the entire central pain system throughout the cortex, brainstem, and spinal cord.

For the nocebo treatment, the scientists enrolled 49 people in a trial for a supposed anti-itch cream that, in reality, contained no active ingredients.

All participants were told that increased pain sensitivity was a potential side effect for the inert cream, but some were informed that they were receiving an expensive ointment and others were led to believe that the lotion was cheap (the scientists even created two different packages for the balms, indicating high or low price).

People treated with the “expensive” cream reported greater sensitivity on a heat-tolerance test, and the nocebo effects became more pronounced over time.

Why Medicaid Is The Platform Best Suited For Addressing Both Health Care And Social Needs


The debate about if and how to amend, repeal, or replace the Affordable Care Act has drawn attention to the central role that the Medicaid program plays in providing coverage and access to health care for millions of Americans. This central role positions Medicaid as an ideal platform on which to build an integrated system that simultaneously addresses health care and social needs.

Evidence has been building that social determinants of health have a bigger impact even than health care services on people’s health, functioning, and quality of life. But the United States, while arguably developing some of the world’s most powerful health care technologies, has been slower to systematically address social determinants of health. We spend more than any other country on health care, per capita, but achieve worse health outcomes, Betsy Bradley and Lauren Taylor document in their book The American Health Care Paradox. But when health care and social spending are examined together, the United States ranks 13 in total spending.

“Ignoring the economic and social circumstances that result in poor health makes treating the resulting health problems much more expensive,” one review of that book summarized. Bradley and Taylor have gone on to argue that a shift towards social services could improve health outcomes and reduce costs for the system overall.

The Medicaid program provides a plausible platform upon which to build a health infrastructure that incorporates the social determinants of health. Medicaid could provide a common entry point that links individuals and families not just to health care services, but also to social services that affect their health. Indeed, state Medicaid leaders have long embraced this concept and are experienced in building bridges that link health and social programs to meet the comprehensive needs of their citizens.

In a First, Gene Therapy Halts a Fatal Brain Disease

While certainly useful to those persons with the condition, this is also a proof of concept for disorders that have straightforward mutations as their underlying cause...


For the first time, doctors have used gene therapy to stave off a fatal degenerative brain disease, an achievement that some experts had thought impossible.

The key to making the therapy work? One of medicine’s greatest villains: HIV.

The patients were children who had inherited a mutated gene causing a rare disorder, adrenoleukodystrophy, or ALD. Nerve cells in the brain die, and in a few short years, children lose the ability to walk or talk.

They become unable to eat without a feeding tube, to see, hear or think. They usually die within five years of diagnosis.

The disease strikes about one in 20,000 boys; symptoms first occur at an average age of 7. The only treatment is a bone-marrow transplant — if a compatible donor can be found — or a transplant with cord blood, if it was saved at birth.

But such transplants are an onerous and dangerous therapy, with a mortality rate as high as 20 percent. Some who survive are left with lifelong disabilities.

Dr. Salzman, with assistance from her sister, Rachel, and from other scientists, was undeterred. She corralled researchers worldwide, asking why a different sort of virus couldn’t be used to slip a good ALD gene into the boys’ cells.

The best choice, it turned out, was a disabled form of HIV, which can insert genes into human cells more safely than other viral carriers.

The CHRONIC Care Act Passes Senate, Obstacles Remain

Some good news....

Late last Tuesday night, only hours after Republican leaders announced they were pulling the Graham-Cassidy repeal and replace bill from Senate consideration, the body unanimously passed the Creating High-Quality Results and Outcomes Necessary to Improve Chronic (CHRONIC) Care Act of 2017 (the Act).

Aiming to improve care for seniors with chronic conditions, the Act first passed the Senate Finance Committee in May of this year. A Health Affairs blog post by former Senators Tom Daschle and Bill Frist, along with in-depth analysis from the Bipartisan Policy Committee, helpfully outline the need for a bipartisan effort to address these issues.

This post will outline the key components of the legislation, assesses its outlook in the House, and considers what its progress may tell us about the prospect for more bipartisan action on health care in the future. The Act includes offsets and has been scored by the Congressional Budget Office (CBO) as being budget neutral, so its sponsors have “checked the boxes” they need to move forward when the political will materializes.

The mysterious rise in knee osteoarthritis


Osteoarthritis is the form of joint disease that’s often called “wear-and-tear” or “age-related,” although it’s more complicated than that. While it tends to affect older adults, it is not a matter of “wearing out” your joints the way tires on your car wear out over time. Your genes, your weight, and other factors contribute to the development of osteoarthritis. Since genes don’t change quickly across populations, the rise in prevalence of osteoarthritis in recent generations suggests an environmental factor, such as activity, diet, or weight.

Osteoarthritis of the knee will affect at least half of people in their lifetime, and is the main reason more than 700,000 people need knee replacements each year in the US.

To explain the rise in the prevalence of osteoarthritis in recent decades, most experts proposed that it was due to people living longer and the “epidemic of obesity,” since excess weight is a known risk factor for osteoarthritis. Studies have shown not only that the risk of joint disease rises with weight, but also that even modest weight loss can lessen joint symptoms and in some cases allow a person to avoid surgery.

But a remarkable new study suggests there is more to the story.

The findings were intriguing:

  • The prehistoric skeletons and early 1900s cadavers had similar rates of knee osteoarthritis: 6% for the former and 8% for the latter.
  • With a prevalence of 16%, the more recent skeletons had at least double the rate of knee osteoarthritis as those living in centuries past.
  • Even after accounting for age, BMI, and other relevant information, those in the post-industrial group had more than twice the rate of knee osteoarthritis as those in the early industrial group.