Health and Disability

In further studies, the researchers found that TIA1 mutations occurred frequently in ALS patients. The scientists also found that people carrying the mutation had the disease. When the investigators analyzed brain tissue from deceased ALS patients with the mutations, the scientists detected a buildup of TIA1-containing organelles called stress granules in the neurons. Such granules form when the cell experiences such stresses as heat, chemical exposure and aging. To survive, the cell sequesters in the granules' genetic material that codes for cell proteins not necessary for survival-critical processes.

The granules also contained a protein called TDP-43, another building block of stress granules, whose abnormality has been implicated in causing ALS. In test tube studies and experiments with cells, the researchers found that the TIA1 mutation causes the protein to become more "sticky," delaying the normal disassembly of stress granules, trapping TDP-43.

Today, as part of our continuing commitment to greater data transparency, Centers for Medicare & Medicaid Services (CMS) unveiled the Hospice Compare website. The site displays information in a ready-to­­-use format and provides a snapshot of the quality of care each hospice facility offers to its patients. CMS is working diligently to make healthcare quality information more transparent and understandable for consumers to empower them to take ownership of their health. By ensuring patients have the information they need to understand their options, CMS is helping individuals make informed healthcare decisions for themselves and their families based on objective measures of quality.

“The Hospice Compare website is an important tool for the American people and will help empower them in a time of vulnerability as they look for information necessary to make important decisions about hospice care for loved ones,” said CMS Administrator Seema Verma. “The CMS Hospice Compare website is a reliable resource for family members and care givers who are looking for facilities that will provide quality care.”

Rheumatoid arthritis (RA) patients who received tocilizumab (Actemra) with methotrexate achieved low disease activity and could discontinue methotrexate while maintaining disease control, researchers said here.

Some patients spend a third of household income on cancer care, despite insurance.

A third of insured people with cancer end up paying more out-of-pocket than they expected, despite having health coverage, researchers at the Duke Cancer Institute have found.

The data showed that costs such as copays and deductibles could lead to financial distress among insured patients of all income levels and with all stages of cancer. Findings will be published in the journal JAMA Oncology.

Many cancer patients can be burdened by 'financial toxicity' that can erode their mental and physical state, especially if they stop pursuing treatment because they feel they can't afford it, said senior author Yousuf Zafar, M.D., a medical oncologist at Duke.

Pain is the most common reason people seek medical care, according to the National Institutes of Health.

“Sometimes we can easily pinpoint what is causing a person pain,” says Richard Harris, Ph.D., associate professor of anesthesiology and rheumatology at Michigan Medicine. “But, there are still 1 in 5 Americans who suffer from persistent pain that is not easily identifiable.”

“Surprisingly, many of the individuals, in addition to having pain located in the pelvic region, had pain also widely distributed throughout their body,” Harris says. “Interestingly, when we put these individuals into the brain imaging scanner, we found that those who had widespread pain had increased gray matter and brain connectivity within sensory and motor cortical areas, when compared to pain-free controls.”

Urological chronic pelvic pain syndrome patients with widespread pain showed increased brain gray matter volume and functional connectivity involving the sensorimotor and insular cortices.

“What was surprising was these individuals with widespread pain, although they had the diagnosis of urological chronic pelvic pain, were actually identical to another chronic pain disorder: fibromyalgia,” Harris says.

Antidepressant use is associated with an increased risk of head injuries and traumatic brain injuries among persons with Alzheimer's disease, according to a new study from the University of Eastern Finland. Antidepressant use has previously been linked with an increased risk of falls and hip fractures, but the risk of head injuries has not been studied before. The results were published in Alzheimer's Research & Therapy.

Antidepressant use was associated with a higher risk of head injuries especially at the beginning of use - during the first 30 days, but the risk persisted even longer, up to two years. The association was also confirmed in a study design comparing time periods within the same person, thus eliminating selective factors. The association with traumatic brain injuries was not as clear as for head injuries, which may be due to a smaller number of these events in the study population. The use of other psychotropic drugs did not explain the observed associations.

Head injuries are more common among older people than younger ones, and they are usually caused by falling. As antidepressant use has previously been associated with an increased risk of falling, the researchers were not surprised that the use of antidepressants also increased the risk of head injuries.

For 6 months, the participants received either shots of the immunotherapy or the placebo at 2- or 4-week intervals. Their C-peptide levels - which are markers of insulin - were tested at 3, 6, 9, and 12 months, and they were compared with baseline levels.

The trial found no evidence of toxicity or negative side effects, and beta cells were not impaired or reduced as a consequence of the therapy. The authors write, "Treatment was well tolerated with no systemic or local hypersensitivity," which led the researchers to conclude that "proinsulin peptide immunotherapy is safe."

Additionally, "Placebo subjects showed a significant decline in stimulated C-peptide (measuring insulin reserve) at 3, 6, 9, and 12 months versus baseline, whereas no significant change was seen in the 4-weekly peptide group at these time points," say the researchers.

I soon overheard our charge nurse mention that a prisoner from a regional correctional facility was in the emergency department (ED) with “really bad sepsis.”

“Ugh,” I muttered in quiet annoyance. In my experience, these patients never fared well. Moreover, my cynical side suspected that more wasteful use of limited health care resources was on the horizon. Perhaps I would have felt differently if the patient were not a prisoner; I have no doubt a large part of my reaction was that part of me assumed that anyone who winds up in prison probably is a “bad person.”

Four heavy-set grizzly men in tan security guard uniforms accompanied the cachectic prisoner into the MICU. I immediately noticed that he was shackled to the hospital bed by numerous cuffs and full-body restraints, all of which seemed unnecessary since he was heavily sedated, intubated, and mechanically ventilated. It seemed as though the excessive correctional paraphernalia were there simply to indicate the misguided and reckless life choices that he presumably chose. They may as well have written on his forehead, “I am deplorable.”

I overheard the signing-off ED nurse say in a monotone voice, “the patient is a 53-year-old male inmate with diffuse large B-cell lymphoma being admitted for presumed septic shock from a necrotic right thigh mass.”

“53? He looks more like 83,” I thought in sheer disbelief. I considered what a grueling life this man must have led to look as feeble as he did.

Once the transfer was complete and the patient was settled in his room, it was obvious that his sepsis was due to a decaying, malodorous mass protruding from his lower extremity, along with a large left pneumonia and empyema. Standard sepsis bundles and protocols were initiated and the patient continued receiving a broad-spectrum of antibiotics, intravenous fluids, and two vasopressors. For source control, general surgery was consulted for debridement of his grossly infected, necrotic thigh mass, and he would require a chest tube to drain the empyema. I immediately cringed at the assuredly onerous process of obtaining informed consent for the invasive procedures. Consent could not be obtained directly from the patient for obvious reasons, and I was dubious that any family members would be reachable. Even if kin could be reached, I knew of the cumbersome hoops that I would need to surmount to obtain the obligatory consent. I had no time for this right now; the patient was now hemodynamically unstable and his respiratory status was deteriorating. I talked with an intern and asked him to tackle the dreaded consent quandary.

Ten minutes later, the intern said to me proudly, “Consents for the procedures are in the chart.” I was flabbergasted and perplexed by the rapidity of the process. Little did I know that the patient was a married man with three children. Also unanticipated was that, despite being incarcerated, the patient was in fairly regular contact with family, which made for an effortless phone conversation between the family and intern, who easily and appropriately obtained consent.