2014

Incidences of colorectal cancer have been decreasing by about 1 percent a year since the mid 1980s, but incidences among people under 50 — the recommended screening age — has been increasing sharply, and these younger patients are more likely to present with advanced disease.

The study, published in JAMA Surgery, used a national database of 400,000 patients with colon or rectal cancer. Incidences decreased by about 1 percent a year over all but rose among people 20 to 34, with the largest increase — 1.8 percent a year — in disease that had already progressed to other organs.

Incidence rates today, per 100,000 people, are 3 for ages 20 to 34; 17 for ages 35 to 49; and 300 for people over 50. But by 2030, the researchers estimate, one in 10 colon cancers and one in four rectal cancers will be in people under 50, and rates among those over 50 will be 175 per 100,000.

The study draws no conclusions about whether screening should begin at a younger age. “There are always risks and unintended consequences of screening tests,” said the senior author, Dr. George J. Chang, an associate professor of surgery and health services research at the University of Texas.

For now, he said, “We have to pay attention to symptoms with which our patients present, and work them up by including colorectal cancer as a part of the differential diagnosis.”

Source: New York Times

The Presidential Healthcare Center’s Executive Physicals include cancer screening and tumor marker tracking.

Drinking caffeinated beverages may be associated with a lower likelihood of erectile dysfunction (ED), according to study findings presented at the American Urological Association 2014 annual meeting. Lopez, et al., University of Texas Medical School, Houston, and colleagues analyzed data from 3,724 men aged 20 years and older who participated in the National Health and Nutrition Examination Survey (2001-2004), a cross-sectional survey of the general U.S. population. The researchers looked at 24-hour dietary recall to estimate intake of caffeine and caffeinated beverages. Overall, men in the 3rd quintile of total caffeine intake (85-170 mg/day) and the 4th quintile (171-303 mg/day) were less likely to report ED compared with men in the first (reference) quintile (0-7 mg/day).

Among overweight and obese men and those with hypertension, the researchers found a significantly decreased likelihood of reported ED among men in the 2nd, 3rd, 4th, and 5th quintiles compared with the reference quartile, after adjusting for multiple variables. The authors concluded that total caffeine intake equivalent to about 2-3 cups of coffee (250-375 mg/day) is associated with a significantly lower likelihood to report ED. The team noted that their study is strengthened by the use of a large representative sample of men in the U.S. and validated dietary recall methodology from NHANES. As NHANES is a cross-sectional study, they cannot infer causality or suggest a clinical practice change, the researchers pointed out.

Source: Renal And Urology News

The US Food and Drug Administration (FDA) is warning consumers that fraudulent treatments for Ebola virus disease are being marketed online.

Although some experimental therapies and vaccines are in early phases of development, no products for treating Ebola infection have been approved by the FDA.  So far, only limited data are available about the safety and effectiveness of the products being tested, and only small supplies are available, according to the agency.  Experimental therapies were used to treat 2 US health care workers who were moved to Atlanta after they became infected by Ebola virus while caring for patients in West Africa, where there is an ongoing outbreak.

The US Center for Disease Control and Prevention says there is little threat of Ebola spreading in the United States.  But some online marketers have seized on global concern about the illness to sell fraudulent products, according to the FDA.  It is illegal for companies to market unapproved products claiming to cure or prevent disease.  The FDA is asking the public to report suspect claims about Ebola-related products (https://1.usa.gov/1mS3T3P).

(JAMA)
Read more here.

The Presidential Healthcare Center’s preventative programs include emergency preparedness advice to keep you safe and healthy no matter where you travel.

A new, large-scale study has identified six new genetic variants associated with habitual coffee drinking. The genome-wide meta-analysis, led by Harvard School of Public Health and Brigham and Women’s Hospital researchers, helps explain why a given amount of coffee or caffeine has different effects on different people and provides a genetic basis for future research exploring the links between coffee and health.

“Coffee and caffeine have been linked to beneficial and adverse health effects. Our findings may allow us to identify subgroups of people most likely to benefit from increasing or decreasing coffee consumption for optimal health,” said Marilyn Cornelis, research associate in the Department of Nutrition at Harvard School of Public Health and lead author of the study.

Genetics have long been suspected of contributing to individual differences in response to coffee and caffeine. However, pinpointing the specific genetic variants has been challenging.

The researchers, part of the Coffee and Caffeine Genetics Consortium, conducted a genome-wide meta-analysis of more than 120,000 regular coffee drinkers of European and African American ancestry. They identified two variants that mapped to genes involved in caffeine metabolism, POR and ABCG2 (two others, AHR and CYP1A2 had been identified previously). Two variants were identified near genes BDNF and SLC6A4 that potentially influence the rewarding effects of caffeine. Two others—near GCKR and MLXIPL, genes involved in glucose and lipid metabolism—had not previously been linked to the metabolism or neurological effects of coffee.

The findings suggest that people naturally modulate their coffee intake to experience the optimal effects exerted by caffeine and that the strongest genetic factors linked to increased coffee intake likely work by directly increasing caffeine metabolism.

“The new candidate genes are not the ones we have focused on in the past, so this is an important step forward in coffee research,” said Cornelis.

“Like previous genetic analyses of smoking and alcohol consumption, this research serves as an example of how genetics can influence some types of habitual behavior,” said Daniel Chasman, associate professor at Brigham and Women’s Hospital and the study’s senior author.

Source: (Harvard School of Public Health)

A growing hazard in the summer backyard can be found in the wire bristle brushes commonly used to clean barbecue grills, a researcher reported here.

A 55-year-old woman came to the emergency department with acute onset pain in the left side of her abdomen. She reported having eaten at a family barbecue the night before, and had a history of cesarean sections and abdominal adhesions, according to Pranith Perera, MD, of Brown University in Providence, R.I.

Her abdomen was distended, and laboratory tests revealed leukocytosis. On a CT examination of the abdomen and pelvis, a 7-mm density was identified in the lower left quadrant with possible perforation of the wall of the jejunum.

Spiral enteroscopy detected a foreign object located about 90 cm from the pylorus. This was removed with forceps and turned out to be a wire brush bristle.

“We’ve had six or seven cases of this just within the last 18 months, all within 24 hours of the patient eating grilled food,” Perera told MedPage Today during a poster session at the annual meeting of the American College of Gastroenterology.

“These bristles are very small and thin, and can stick to the grill. Patients may not even feel it, and there have been cases of neck and tonsil perforation, abscesses, and intestinal perforations requiring rapid surgical intervention,” he said.

“There has been a lot of blame in terms of cheaper products, and how they’re manufactured,” he added.

The Consumer Product Safety Commission is currently collecting data to see if there are specific brands and designs of brushes that are particularly hazardous, if the type of grill matters, such as those made of uncoated or porcelain-coated cast iron, and if there’s an association with particular types of food.

The CDC now recommends that alternative methods of cleaning barbecue grills be employed, or at least that very careful inspection of the grill be done after cleaning to ensure that no bristles adhere to the surface.

If this type of ingestion and potential abdominal injury is suspected, abdominal/pelvic CT scan should be done without oral contrast, which could obscure the bristle, according to Perera.

This patient’s abdominal pain resolved after the foreign body was removed, and there was no evidence of abscess or peritoneal air. She was discharged on oral antibiotics.

“Physician awareness of this potential injury is critical to facilitate timely diagnosis and treatment. Awareness of this potential injury by the general population, manufacturers, and retailers can reduce exposures and decrease the likelihood of occurrence,” CDC has stated.

Source: Medpagetoday

Dr. Elting appeared on News Channel 8 this past Wednesday, October 22^nd, with Bruce Depuyt to discuss Ebola virus. Depuyt asked Dr. Elting, an infectious disease specialist, for insight into the virus; particularly focusing on ways the virus can be contracted, and how we may be at an increased risk when using air travel. 

From the broadcast:

Up first – Answering your questions about Ebola.  The news of late has been good.  The people who came into contact with those who cared for patient Thomas Duncan are said to be symptom-free.  And the potential cases of Ebola that we’ve seen on the news, those have turned out to be false alarms.  Nonetheless, we know there is anxiety about the Ebola virus – how it is spread, how it is treated, and whether it’s likely we’ll see more cases in the days, weeks, months ahead.

Joining us now is Dr. Jeffrey Elting.  He’s former head of infectious disease control and response for the DC Hospital Association.  He is now the Medical Director at the Presidential Healthcare Center in the National Capitol region. 

“The public health sector has stepped up its game” Dr. Elting said.  “It is important to keep everything in perspective by taking into account that someone dies every 34 seconds of a heart attack.  We have 30,000 people killed in motor vehicle accidents each year, and we have influenza that kills millions of people.  Comparatively, we’ve had 1 person unexpectedly come to the US with Ebola who unfortunately died from the virus, but aside from some initial missteps, the rest of the cases have been managed quite well and people are recovering.” “Ebola is a special case and more deadly than others,” he said.  “That’s why we have decontamination units, isolation rooms, stockpiles of medication, protective suits and face masks.”

Dr. Elting also spoke about how the Ebola virus is transmitted.  “The transmission
method for Ebola is generally from contaminated fluid from infected patients.  It’s not transmitted by respiratory droplets like the flu or a cold.”

He also addressed the symptoms experienced after contracting Ebola.  “The initial symptoms are going to be somewhat flu-like.  You’re going to have a fever, headache, muscle aches, irritation of the throat, and then it will progress.  Ebola is a hemorrhagic virus, therefore, it can cause bleeding into the eyes, lungs and intestinal system.  Distinguishing patients with Ebola may become more challenging as the flu season approaches.”

View the entire interview here.

The Presidential Healthcare Center’s preventative programs include emergency preparedness advice to keep you safe and healthy no matter where you go.

If you’re going to overindulge and gain weight, at least try to make sure the extra calories come from unsaturated fats, a new study suggests.

When lean people pack on even a few extra pounds, heart disease risk factors in the bloodstream change – some for the better if the excess food contains unsaturated fats, versus saturated fats, researchers found.

Even a moderate weight gain of about three pounds for lean, young people clearly increased markers of heart disease risk factors like insulin resistance as well as signs of impaired vascular function, said senior author Dr. Ulf Riserus of the Unit for Clinical Nutrition and Metabolism at Uppsala Science Park in Sweden.

But unsaturated fats in the diet improved cholesterol levels despite the extra calories and weight gain, which is surprising, Riserus told Reuters Health by email.

For seven weeks, two groups of healthy, relatively lean adults ages 20 to 38 were told to keep to their habitual exercise level and daily diets, adding three to four muffins to their diets each day.

The researchers provided the 240-calorie muffins, with half their energy from fats. One group of 19 adults received muffins made with sunflower oil, polyunsaturated fatty acids (PUFA), while the other group of 20 people ate muffins made with palm oil, a saturated fat. The muffins were otherwise identical.

After seven weeks, each group had gained between two and three percent of their body weight, about 3.5 pounds (1.5 kilos) each, and waist girth increased by about one percent, but blood pressure did not change significantly.

This level of weight gain in the short term is probably not dangerous at all, Riserus said, but if weight accumulates over time, especially abdominal fat, there can be health consequences.

Based on blood tests, the sunflower oil group had lower cholesterol and lipid levels at the end of the study than they had at the beginning of the study. For the palm oil group, cholesterol went up, according to the results in the Journal of the American Heart Association.

Both groups showed signs of increased insulin resistance, a diminished ability to process blood sugar that can be a warning sign for diabetes onset.

Riserus and his team had previously found that the type of fat in the diet determined how much of the excess calories were stored as abdominal fat and liver fat, he said.

“If the high-caloric diet was based on unsaturated fats rather than saturated fats, very little fat was stored as liver and abdominal fat, whereas the opposite was true for the diet high in saturated fats,” he said.

Saturated and unsaturated fats have different molecular effects on the liver, he said. Unsaturated fats signal the liver to take up cholesterol from the blood, he said.

“We believe our results are very relevant considering that a large part of most populations are in caloric excess and gradually gain weight over time,” Riserus said. “Although weight gain should be avoided, the results basically tell us that we may benefit from having enough unsaturated fats in our diets, irrespectively of how many calories we eat.”

The results support the American Heart Association recommendation to replace some saturated fats in the diet, like fatty beef, butter and cheese, with unsaturated fats like vegetable oils and nuts, he said.

“I do not think people usually plan for weight gain, but, as we know, it just happens quite commonly,” said Ursula Schwab, an associate professor of nutrition therapy at the University of Eastern Finland in Kuopio.

“So, by following the guidelines regarding dietary fat, unintentional weight gain can be less harmful than in cases when the recommendations on the quality of dietary fat is not followed,” Schwab told Reuters Health by email. She was not involved in the new study.

All dietary polyunsaturated fats are beneficial, she said, but that is not necessarily the case for supplements.

In addition to sunflower oil, rapeseed oil and canola oil are good sources of polyunsaturated fats, Riserus said.

Source: Reuters

As questions of how many people the second Dallas nurse infected during her journey to and from Dallas throw scary possibilities, a WHO situation assessment report gives more cause for concern by stating that the incubation period of the virus has been seen to extend to as long as 42 days in some cases.

It says that recent studies conducted in West Africa have demonstrated that 95% of confirmed cases have an incubation period in the range of 1 to 21 days; 98% have an incubation period that falls within the 1 to 42-day interval.

For WHO to declare an Ebola outbreak over, a country must pass through 42 days, with active surveillance supported by good diagnostic capacity and no new cases detected in the period.

The organization has also criticized rapid determination of infection within a few hours, noting that two separate tests 48 hours apart are required before discharging a patient or a suspected one as Ebola negative.

In assessing the situation in West Africa, WHO says fresh cases in Guinea, Liberia and Sierra Leone show that the outbreak is not showing any sign of being controlled.

On the positive side, it is all set to declare later this week that Senegal is Ebola-free, if no new cases are detected.

Nigeria will also get the green signal once it passes the requisite 42 days, with active surveillance and no new cases till Monday, 20 October.

Tracing of people known to have contact with an Ebola patient reached 100% in Lagos and 98% in Port Harcourt, a crucial step in controlling the spread of the virus.

In the case of the American nurse who took a commercial flight with 132 other passengers, the risk factor is multiplied with every contact she made, beginning with the immediate co-passengers, flight attendants and airline baggage handlers to the family members she met.

The Ebola virus is believed to be able to survive outside the body for a week or more during which time anyone who comes in contact with contaminated surface can pick up the virus.

The death rate in the current Ebola outbreak has increased to 70% with the toll at 4,447. There could be up to 10,000 new cases of Ebola per week in two months, WHO has warned.

Source: International Business Times

Lung cancer can lie dormant for more than 20 years before turning deadly, helping explain why a disease that kills more than 1.5 million a year worldwide is so persistent and difficult to treat, scientists said on Thursday.

Two papers detailing the evolution of lung cancer reveal how after an initial disease-causing genetic fault — often due to smoking — tumor cells quietly develop numerous new mutations, making different parts of the same tumor genetically unique.

By the time patients are sick enough to be diagnosed with cancer, their tumors will have developed down multiple evolutionary pathways, making it extremely hard for any one targeted medicine to have an effect.

The findings show the pressing need to detect lung cancer before it has shape-shifted into multiple malignant clones.

“What we’ve not been able to understand before is why this is really the emperor of all cancers and one of the hardest diseases to treat,” said Charles Swanton, an author on one of the papers from Cancer Research UK’s London Research Institute.

“Previously, we didn’t know how heterogeneous these early-stage lung cancers were.”

Lung cancer is the world’s deadliest cancer, killing an estimated 4,300 people a day, according to the World Health Organization. Around 85 percent of patients have non-small cell lung cancer (NSCLC), the type analyzed in the two studies.

To get a clearer understanding of the disease, the two groups of British and American scientists looked at genetic variability in different regions of lung tumors removed during surgery and worked out how genetic faults had developed over time.

What they found was an extremely long latency period between early mutations and clinical symptoms, which finally appeared after new, additional faults triggered rapid disease growth.

In the case of some ex-smokers, the initial genetic faults that started their cancer dated back to the time they were smoking cigarettes two decades earlier. But these faults became less important over time and more recent mutations were caused by a new process controlled by a protein called APOBEC.

The research was published in the journal Science.

Ramaswamy Govindan of Washington University School of Medicine, who was not involved in the studies, said better understanding of such genetic alterations was key to developing more effective treatments.

There are also hopes for a new generation of immunotherapy drugs that boost the immune system’s ability to detect and fight tumors, which could be particularly applicable to lung cancer.

“The large number of mutations may be the tumor’s Achilles heel because every time a new mutation forms there is a chance for the immune system to recognize it,” Swanton told Reuters.

Immunotherapy drugs from companies such as Bristol-Myers Squibb, Merck & Co, Roche and AstraZeneca are already undergoing tests in lung cancer, with data on Bristol’s medicine Opdivo due later this year.

Apart from better drugs, a critical challenge is to find improved ways to detect lung cancer before it develops the multiple genetic faults that eventually trigger rapid tumor growth and spread.

Currently, doctors use computerized tomography (CT) to detect lung cancer — but by the time a nodule is big enough to be spotted it on a scan it may contain a billion genetically diverse cancer cells.

For the future, oncologists are pinning hopes on a new approach, known as liquid biopsy, that may be able to detect signs of cancer much earlier from DNA circulating in the blood.

The current prognosis for NSCLC is grim, with most patients diagnosed when the disease has already spread and only around 15 percent surviving for at least five years after that.

Source: Reuters

A new study suggests that drops of fuel spilled at gas stations — which occur frequently with fill-ups — could cumulatively be causing long-term environmental damage to soil and groundwater in residential areas in close proximity to the stations.

Few studies have considered the potential environmental impact of routine gasoline spills and instead have focused on problems associated with large-scale leaks. Researchers with the Johns Hopkins Bloomberg School of Public Health, publishing online Sept. 19 in the Journal of Contaminant Hydrology, developed a mathematical model and conducted experiments suggesting these small spills may be a larger issue than previously thought.

“Gas station owners have worked very hard to prevent gasoline from leaking out of underground storage tanks,” says study leader Markus Hilpert, PhD, a senior scientist in the Department of Environmental Health Sciences in the Johns Hopkins Bloomberg School of Public Health. “But our research shows we should also be paying attention to the small spills that routinely occur when you refill your vehicle’s tank.”

Over the lifespan of a gas station, Hilpert says, concrete pads underneath the pumps can accumulate significant amounts of gasoline, which can eventually penetrate the concrete and escape into underlying soil and groundwater, potentially impacting the health of those who use wells as a water source. Conservatively, the researchers estimate, roughly 1,500 liters of gasoline are spilled at a typical gas station each decade.

“Even if only a small percentage reaches the ground, this could be problematic because gasoline contains harmful chemicals including benzene, a known human carcinogen,” Hilpert says.

Hilpert and Patrick N. Breysse, PhD, a professor in the Department of Environmental Health Sciences, developed a mathematical model to measure the amount of gasoline that permeates through the concrete of the gas-dispensing stations and the amount of gasoline that vaporizes into the air.

The model demonstrates that spilled gasoline droplets remain on concrete surfaces for minutes or longer, and a significant fraction of spilled gasoline droplets infiltrate into the pavement, as concrete is not impervious.

“When gasoline spills onto concrete, the droplet will eventually disappear from the surface. If no stain is left behind, there has been a belief that no gasoline infiltrated the pavement, and all of it evaporated,” Hilpert says. “According to our laboratory-based research and supported by our mathematical model, this assumption is incorrect. Our experiments suggest that even the smallest gasoline spills can have a lasting impact.”

Since the health effects of living near gasoline stations have not been well studied, Breysse says there is an urgency to look more closely, especially since the new trend is to build larger filling stations with many more pumps. These stations continue to be located near residential areas where soil and groundwater could be affected.

“The environmental and public health impacts of chronic gasoline spills are poorly understood,” says Breysse. “Chronic gasoline spills could well become significant public health issues since the gas station industry is currently trending away from small-scale service stations that typically dispense around 100,000 gallons per month to high-volume retailers that dispense more than 10 times this amount.”

“In a perfect world, it would be ideal to avoid chronic spills,” Hilpert says. “However, if these spills do occur, it is also important to prevent rainwater from flowing over the concrete pads underneath the pumps. Otherwise, storm runoff gets contaminated with benzene and other harmful chemicals and can infiltrate into adjacent soil patches or form storm water that may end up in natural bodies of water.”

Source: Johns Hopkins Bloomberg School of Public Health