October 1998

Stomach ulcers may recur despite treatment
September 29, 1998

About 20% of ulcer patients experienced a recurrence of their ulcer within 6 months of being successfully treated for infection with Helicobacter pylori, a bacteria associated with ulcers, according to a new study.

"Results of North American studies of highest methodological quality confirm that H. pylori eradication markedly decreases ulcer recurrence," report Dr. Loren Laine and his colleagues. "Nevertheless, 20% of patients in these studies had ulcer recurrence within 6 months despite successful cure of infection and no reported use of NSAIDs." NSAIDs -- nonsteroidal anti-inflammatory drugs -- cause trauma to the lining of the stomach and are a known risk factor for ulcers.

Helicobacter pylori (H. pylori) is a bacteria that physicians now recognize as the most common cause of peptic ulcer disease. While other studies have shown that recurrence decreases significantly when H. pylori-induced ulcers are successfully treated, the current study in the September issue of the American Journal of Gastroenterology suggests that recurrence may happen more often than these studies have shown.

The researchers, with the division of gastrointestinal and liver diseases at the University of Southern California School of Medicine in Los Angeles and the division of anti-infective drug products with the Food and Drug Administration (FDA) attribute their finding to high levels of smoking and the possible unreported use of NSAIDs. According to the report, NSAID use is common among patients with certain types of ulcers despite the drugs' tendency to increase the risk of developing an ulcer.

For the study, the researchers reviewed 15 years of treatment data, including abstracts from scientific meetings, published and unpublished studies, interviews with companies that manufacture medications for H. pylori therapy in the United States, and presentations to the FDA. Studies were double-blind, randomized North American trials of H. pylori therapy for intestinal ulcers.

The team notes that "the odds of developing a recurrent ulcer if H. pylori infection persists is five times greater than the odds of recurrence if H. pylori infection has been cured." The researchers conclude that patients with ulcers due to H. pylori "will benefit greatly from antibacterial therapy, (but) a significant minority of patients fail to be cured of their ulcer disease despite eradication of H. pylori."

SOURCE: American Journal of Gastroenterology 1998;93:1409-1415.


Nasal spray prevents flu
September 28, 1998

A new nasal spray vaccine can protect people against influenza outbreaks more than 90 percent of the time.

Researchers said today the new FluMist even protected people against an unexpected flu strain that crossed the U.S. during last year's flu season.

Dr. Robert Belshe, professor of internal medicine at the St. Louis University School of Medicine, reported that just 15 children of the more than 900 given the nasal spray vaccine caught the flu, compared to 51 of 440 children who received a placebo spray.

At the Interscience Conference on Antimicrobial Agents and Chemotherapy in San Diego, the annual infectious disease meeting of the American Society of Microbiology, Belshe said that even though the live attenuated virus used in the FluMist wasn't developed to protect against the A/Sydney flu strain, the vaccine still offered high levels of protection.

He said, ''Live weakened virus vaccines such as FluMist are thought to mimic natural infection better than other types of vaccines.''

For the few children who got the flu despite having been vaccinated with the nasal spray, the length of illness was half that - about 2.1 days - compared to children who caught the flu and were not vaccinated. They were ill 4.9 days.

FluMist, is still awaiting approval by Food and Drug Administration, and is manufactured by Aviron, a biopharmaceutical company in Mountain View, Calif.

In other studies, researchers reported on another nasal route of attack in treating the flu. Zanamivir, manufactured by Glaxo Wellcome, London, was found to be successful in reducing the risk of flu by two- thirds.

Dr. Arnold Monto of the University of Michigan said, ''The drug was extremely effective in preventing influenza.''

He said Zanamivir protected patients from getting ill with flu symptoms when given to people at risk during an influenza outbreak. Zanamivir has also been shown previous to be effective in treating flu symptoms.


US foodborne disease cases remain high
September 25, 1998

The number of cases of foodborne diseases in the US remains high, according to a report released Thursday by the Centers for Disease Control and Prevention (CDC) in Atlanta, Georgia.

"Each year, millions of persons become ill from foodborne diseases, though many cases are not reported," CDC officials note.

A program called FoodNet, the Foodborne Diseases Active Surveillance Network, was established in 1995 to track foodborne illnesses in several regions. A collaborative effort of the CDC, the Department of Agriculture, the Food and Drug Administration, and several state health departments, the FoodNet program currently monitors reports from a catchment area of over 16 million people, or about 6% of the US population.

FoodNet tracks infections caused by infectious agents known to cause foodborne disease, including bacteria such as Campylobacter, E. coli O157, Listeria, Salmonella, Shigella, Vibrio, and Yersinia and the parasites Cryptosporidium and Cyclospora.

The CDC reports that 1997 data from FoodNet show that the number of cases showed little change from 1996 figures.

Among the agents under surveillance, Campylobacter was again the most frequently diagnosed, "even though outbreaks caused by this pathogen are rare," CDC officials note. A study of the bacteria begun this year "will identify control points and direct future prevention strategies," they add.

Data from the FoodNet program show that there were regional and seasonal differences in reported foodborne illnesses, with most cases of bacterial infections reported in the summer months. For example, an outbreak of Vibrio parahaemolyticus infections in the western US during the summer of 1997 was tied to the consumption of raw oysters from Washington State oyster beds.

And E. coli O157 infections, more common in northern states, were most often due to the consumption of undercooked ground beef. The CDC report notes that burgers consumed at fast-food restaurants were not associated with the E. coli cases reported in 1997, "suggesting that recent changes in that industry may have reduced (E. coli O157) infections from that source."

Data from the program also show that Listeria infections had the highest hospitalization rates and caused nearly half of reported deaths due to foodborne disease. "Because of this, FoodNet will conduct additional studies of Listeria infections to identify food sources and control points," according to the report.

CDC officials estimate that 360 million cases of diarrheal illness occur each year, resulting in 28 million visits to a physician. "Further studies will define the causes and impact of these illnesses and what proportion of them may be related to food," according to a statement issued by the agency.

Additional information about FoodNet is available at http://www.cdc.gov/ncidod/dbmd/foodnet/foodnet.htm.


Potassium lowers stroke risk
September 22, 1998

Middle-aged men -- particularly those with high blood pressure -- are less likely than their peers to have a stroke if they consume a diet rich in potassium, according to a report. A high intake of cereal fiber and magnesium also appear to reduce the stroke risk, according to the report in the journal Circulation: Journal of the American Heart Association.

"In this large prospective study, we found men with diets higher in potassium, cereal fiber, and magnesium had a substantially reduced risk of stroke," concluded lead author Dr. Alberto Ascherio of Harvard School of Public Health in Boston, Massachusetts, and colleagues.

Ascherio and colleagues looked at 43,738 men who were aged 40 to 75 in 1986. Over the next 8 years, more than 300 of those men had strokes, and those with the highest potassium consumption (an intake of about 4.3 grams per day) were 38% less likely to have a stroke than those with the lowest intake (about 2.4 grams per day). Potassium is found at high concentrations in fruit, vegetables, nuts, grains, and seeds.

Men with the highest intake of magnesium (452 milligrams per day) had 30% lower stroke risk than those who consumed the lowest level (243 milligrams per day), as did those with the highest fiber intake (28.9 grams per day compared with 12.4 grams per day). Calcium and sodium intake did not influence stroke risk.

Those with high blood pressure had nearly three times the risk of stroke, but men who took potassium supplements were at lower risk.

"Potassium supplements may also be beneficial, but because of potential risks, use should be carefully monitored and restricted to men taking potassium-losing diuretics," the authors write.

The study could not prove that the dietary intake lowered stroke risk, because it is possible that some other factor associated with a healthy diet lowered the risk, the authors note.

However, the findings "are consistent with the hypothesis that diets rich in potassium, magnesium and cereal fiber reduce the risk of stroke, particularly among hypertensive men," they conclude.

SOURCE: Circulation: Journal of the American Heart Association 1998;98.


Breast pain linked to fatty diet
September 17, 1998

A high-fat diet and elevated cholesterol levels appear to contribute to ``cyclic mastopathy,'' a condition characterized by premenstrual breast swelling, tenderness and pain, according to a study in the American Journal of Obstetrics and Gynecology.

Studies suggest that cyclic mastopathy affects roughly 40% of women in western nations, and 5% of those in Asian countries.

Previous studies have found that women with the condition have elevated high density lipoprotein (HDL) cholesterol levels just before their periods. In some studies, women with cyclic mastopathy have reported fewer symptoms after cutting back on the fat in their diets.

Comparing 34 women with severe cyclic mastopathy and 29 ''control'' subjects, the authors of the new study found that those with the condition ate more fat throughout their menstrual cycles. While the women with mastopathy obtained an average of 37.5% of their calories from fat, the controls obtained 33.7% of their calories from fat. The women with cyclic mastopathy also reported more hunger premenstrually than the controls.

Blood tests confirmed that the women with the condition had higher-than-average HDL levels premenstrually. But the reason for this finding is unclear, write the authors, a team of researchers headed by Dr. Pamela J. Goodwin, of Mount Sinai Hospital in Toronto, Canada.

``Extension of our observations to include an evaluation of hormonal, physiologic, and psychologic factors that might lead to increased appetite and fat intake in women with cyclic mastopathy... is recommended to enhance understanding'' of the disorder, Goodwin and colleagues write.

SOURCE: American Journal of Obstetrics and Gynecology 1998;179:430-437.


Causes of mid-back pain
September 24, 1998

About 80 percent of Americans suffer with some form of back pain.

While it's a relatively mysterious phenomenon, we do know some of its causes. The kind of work you do may also contribute to your problem. Sitting in front of a computer all day is likely to give anyone back pain.

Specifically, it's the chairs we sit in that are the likely culprits. Their design and shape promote back problems in even the healthiest people.

Prolonged sitting not only causes your shoulders to round forward, but it also forces you to sit with your pelvis tilted too far forward as well. Sitting this way compresses the gel -- or cushioning -- in between your vertebra, and this causes back discomfort.

Numerous studies show that strengthening abdominal and back muscles is a good first step toward recovery. Your doctor or physical therapist can advise you on exercises that are best for your individual problem.

Keep in mind that you should always warm up slowly, stretch, and stop doing any activity that makes your back feel worse or causes tingling or numbness in your legs.


Clues to Flo-Jo's death
September 23, 1998

Florence Griffith Joyner, also known as 'Flo-Jo,' was the fastest woman in the world. She was a woman whose style and flair were as dramatic as her athletic ability. CBS News Correspondent John Roberts reports.

Though she was known to suffer from asthma and migraines, the sudden death of an athlete in such great physical condition came as a shock to her fans, and her family.

"There were just no signs that she was ill," said her brother-in-law Bob Kersee.

While the official cause of death has not yet been determined, Flo-Jo is described to have died from a 'heart seizure'. Unlike a heart attack, it's not caused by blocked arteries, but electrical disturbances in the heart that cause it to beat incredibly rapidly--to the point that it actually begins to flutter and can no longer pump blood.

"I would suspect hypertrophic cardiomyopathy as being the most likely probability here," says Dr. Jeremy Ruskin of Mass. General Hospital.

Cardiologist Jeremy Ruskin was one of the team who advised Boston Celtic Reggie Lewis to quit playing basketball shortly before he died from abnormal rhythms caused by hypertrophic cardiomyopathy. He says one in 500 people have this genetically-inherited condition.

"The muscle of the main pumping chamber becomes abnormally thickened. And it predisposes the heart to abnormal rhythms," says Dr. Ruskin.

It's the same abnormality that took the life of college basketball star Hank Gathers in 1990 and in fact, is the No.1 cause of sudden death among young athletes.

The public wasn't aware that behind her glamorous face Flo-Jo may have had a serious heart problem. A seizure Flo-Jo had in 1996 was explained away as exhaustion. But it now appears as a warning sign of another life about to be cut short.


Your Health--The Reason to Control Your Weight
September 22, 1998

Approximately 97 million American adults are overweight. If you are one of them, you are more likely to develop diabetes, heart disease, high blood pressure, gallbladder disease, and certain types of cancer. However, these adverse health effects of being overweight may be minimized, according to a new, free consumer brochure from the National Institutes of Health (NIH).

Do You Know the Health Risks of Being Overweight? provides readers information about the health problems linked to being overweight. The brochure also outlines how people may prevent or reduce the negative effects of weighing more than they should by eating healthier and getting regular exercise.

"A loss of as little as 5 to 10 percent of your body weight can make a difference in your overall health," says Susan Yanovski, M.D., director of the Obesity and Eating Disorders Program, National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK). "The key is a slow and steady weight loss of no more than 1 pound per week so that you minimize muscle loss."

The brochure, provided by the federally funded Weight-control Information Network (WIN), is free and can be obtained by calling WIN's toll-free number, 1-800-WIN-8098, or by visiting its website. In addition to information on weight loss, WIN's toll-free number and website provide information on topics such as childhood obesity, choosing a safe and successful weight-loss program, weight cycling, and binge eating disorder.

In 1994, the National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK), a part of the NIH, established WIN in response to the growing problem of overweight in the United States.


New infection transmitted by fish
Tue, 29 Sep 1998

A new streptococcal infection is being transmitted by a fish growing in popularity throughout North America and being harvested in the United States, according to Dr. Donald Low, of Mount Sinai Hospital in Toronto, Ontario, Canada.

The fish, tilapia, is becoming a staple in many Asian grocery stores.Puncture wounds from its sharp dorsal fin that occur during handling or cleaning allow entry of Streptococcus iniae, which resides in the gellike coating of the scales.The bacteria cause cellulitis at the wound site, and cultures of the aspirate reveal gram-positive chains of the streptococci.

"We think we have a new disease, here," Dr. Low said at the 38th Interscience Conference on Antimicrobial Agents and Chemotherapy.So far 15 cases have been confirmed.The infections largely have been confined to Chinese communities in Canada.In one patient, the infection became systemic, requiring intensive care, he noted.

"The message is that this is totally preventable," Dr. Low said.Protective gloves and careful avoidance of the sharp-edged fins prevent exposure.Treatment with antibiotics such as cephalosporin or penicillin can successfully eradicate the agent, but when untreated, it can become fulminant, he warned.

The incidence of Streptococcus iniae infection is undoubtedly underreported because there is not widespread awareness of the etiology, although it has been reported in the Asian press in Canada.Dr. James M. Hughes of the National Center for Infectious Diseases at the CDC, in Atlanta, Georgia, said, "[t]hat kind of communication needs to be done."One patient, for example, was treated only after making an accurate self-diagnosis that allowed a physician to identify the species.

The American-reared tilapia is not the only carrier of the bacterium.Cultures from bass, salmon and trout also have been positive--but tilapia usually is delivered live to markets and is growing in demand."It is easy to rear [for harvest] because it grows quickly and being a herbivore, is easy to feed," Dr. Low observed.



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