Brain Tissue Changes In Amebic Meningioencephalitis
A little bit of a chilly and sad story as N fowleri has claimed the life of an Arizona boy. That brings the total for the year throughout the country to 6 deaths. Over the decade before 2007 the average had only been approximately 2 deaths/year.
A 14-year-old Lake Havasu boy has become the sixth victim to die nationwide this year of a microscopic organism that attacks the body through the nasal cavity, quickly eating its way to the brain.
Aaron Evans died Sept. 17 of Naegleria fowleri, an organism doctors said he probably picked up a week before while swimming in the balmy shallows of Lake Havasu.
The amoeba typically live in lake bottoms, grazing off algae and bacteria in the sediment. Beach said people become infected when they wade through shallow water and stir up the bottom. If someone allows water to shoot up the nose — say, by doing a cannonball off a cliff — the amoeba can latch onto the person’s olfactory nerve.
The amoeba destroys tissue as it makes its way up to the brain.
Naegleria is a scary disease. Here’s the CDC fact sheet. One day you’re swimming in typically still, warm, fresh water and 1 to 2 weeks later you’re dead.
Once infected, most people have little chance of survival. Some drugs have been effective stopping the amoeba in lab experiments, but people who have been attacked rarely survive, Beach said.
“Usually, from initial exposure it’s fatal within two weeks,” Beach said.
That being said, realize how rare this is. I’m not trying to spread this public health efforts as terror, which has become so popular in the mainstream media.
Influenza vaccination may save many fewer older patients’ lives than generally claimed, according to researchers here.
The reason is that estimates of a 50% or greater reduction in all-cause mortality have emerged from cohort studies fraught with selection bias, asserted a review article in the October issue of The Lancet Infectious Diseases.
The “illusory” estimates arose primarily from methodologically weak cohort studies, the GWU researchers said.
These studies used nonspecific endpoints, typically all-cause mortality and non-laboratory-confirmed influenza outcomes, while attempting to adjust for selection bias in multivariate models with health-status covariates defined by diagnostic codes.
But, in one study, adjustment for diagnostic codes indicating severe illness and frailty was found to increase the mortality difference between vaccinated and unvaccinated groups even before the flu season. This suggested that the method left uncontrolled bias.
Indeed, two studies revealed that most influenza-related deaths occurred in small subsets of older adults with low vaccine coverage who were hospitalized in autumn.
Without cohort studies, “the remaining evidence is not sufficient to show that vaccination substantially reduces the risk of influenza-related mortality among elderly people,” they wrote.
Perhaps the most damning evidence,
Age-adjusted estimates for influenza-related mortality in excess mortality studies showed no reduction in flu-related deaths during a period when vaccine coverage increased by 50%. Nor was there any increase in mortality during the 1997-1998 flu season when the vaccine completely mismatched circulating strains.
When it comes to public health and vaccinations the health community has already thrown out the premiere-ness (and that is a word) of non-maleficence in favor of utilitarian measurements of benefit. The point is even if the benefit of vaccinating all of the elderly is less than expected it is almost certainly still greater, I imagine, than the complications or bad reactions that come with giving the vaccination. This review, even if confirmed by better designed studies in the future, probably contributes little to the public health policy concerning who gets vaccinations.
And it isn’t like there are other subsets of the population who could benefit more from the vaccine during periods of shortage. As long as it is the providers and the markets doing the rationing (and not the government) I have no problem with it, even if the evidence (as above) doesn’t support the rationing as strongly as we might have once believed.
The State Children’s Health Insurance Program is a joint federal/state program to insure low income children. The least offensive redistribution of wealth imaginable. Here’s a summary of it. Even I’m a a pom-pom waving supporter of the program.
Currently there’s a big fight in Washington over it. In case you somehow missed it, the decade old program was set to expire this year but today the Senate passed HR 976, thus following the lead of the House which had earlier passed the same bill. The House however didn’t pass the bill by enough to overcome President Bush’s threatened veto.
The House on Tuesday passed a bill providing health insurance to more than 10 million children, but supporters of the measure fell short of the two-thirds majority they would need to override a veto repeatedly threatened by President Bush.
Explaining his objections, Mr. Bush said, “The bill goes too far toward federalizing health care and turns a program meant to help low-income children into one that covers children in some households with incomes of up to $83,000 a year.”
And thus lies the real debate. The reauthorization of SCHIP expands the program in several ways. Notably it allows states to increase the eligibility to children of families at 300% of the federal poverty level. That’s potentially an extra 4 million uninsured children and billions of dollars over the next decade. However screwed up the federal poverty level is as a measure of true poverty, is it really appropriate to relieve a family of four, living off >$60,000 of the responsibility of providing insurance for their children?
It is a legitimate debate. I’ve said it before when I was up lobbying the Texas legislature for the state level reauthorization earlier this year, and I’ll say it again…I don’t know where the level should be drawn in terms of eligibility. However even as I admit that, and in a little bit of a shocker for my usual steadfast libertarian position, I’m willing to err on the side of caution in this case and back the legislation sitting in front of Bush, rather than let the SCHIP program expire.
Not often my interest in space flight and medicine kind’ve come together…at least not in the mainstream media, but here we have a prelim story to The Andromeda Strain. I first heard this on NPR, but here’s an AP piece on how salmonella bacteria sent into space returned more potent…
The researchers placed identical strains of salmonella in containers and sent one into space aboard the shuttle, while the second was kept on Earth, under similar temperature conditions to the one in space.
After the shuttle returned, mice were given varying oral doses of the salmonella and then were watched.
After 25 days, 40 percent of the mice given the Earth-bound salmonella were still alive, compared with just 10 percent of those dosed with the germs from space. And the researchers found it took about one-third as much of the space germs to kill half the mice, compared with the germs that had been on Earth.
The researchers found 167 genes had changed in the salmonella that went to space.
The gene changes associated with the increased disease burden aren’t completely understood in terms of how they make the bacteria more potent and why the changes occurred while in space.
“These bugs can sense where they are by changes in their environment. The minute they sense a different environment, they change their genetic machinery so they can survive,” she said.
Executives at the company, based in Whitehouse Station, N.J., said 24 of 741 volunteers who got the vaccine in one segment of the experiment later became infected with HIV, the virus that causes AIDS. In a comparison group of volunteers who got dummy shots, 21 of 762 participants became infected.
More on Merck’s HIV vaccine efforts here and more on HIV vaccine efforts in general at the WHO.
Even if you truly believed you were on the verge of the greatest medical breakthrough in history, wouldn’t you keep expectations somewhat reasonable until you had your definitive results?
Dr Zheng Cui, of the Wake Forest University School of Medicine, has shown in laboratory experiments that immune cells from some people can be almost 50 times more effective in fighting cancer than in others.
Dr Cui, whose work is highlighted in this week’s New Scientist magazine, has previously shown cells from mice found to be immune to cancer can be used to cure ordinary mice with tumours.
The work raises the prospect of using cancer-killing immune system cells called granulocytes from donors to significantly boost a cancer patient’s ability to fight their disease, and potentially cure them.
“If this is half as effective in humans as it is in mice it could be that half of patients could be cured or at least given one to two years extra of high quality life.
“The technology needed to do this already exists, so if it works in humans we could save a lot of lives, and we could be doing so within two years.”
Dr Cui is confident patients could benefit from the technique quickly because the technology used to extract granulocytes is the same as that already used by hospitals to obtain other blood components such as plasma or platelets.
Okay Dr. Cui doesn’t go quite that far but I’m not sure I’d be throwing the word cure around so freely just yet. That’s a tainted word when it comes to cancer.
I’m not sure any statement from a candidate that uses the word required this much can be viewed as a good thing.
Democratic presidential hopeful John Edwards said on Sunday that his universal health care proposal would require that Americans go to the doctor for preventive care.
“It requires that everybody be covered. It requires that everybody get preventive care,” he told a crowd sitting in lawn chairs in front of the Cedar County Courthouse. “If you are going to be in the system, you can’t choose not to go to the doctor for 20 years. You have to go in and be checked and make sure that you are OK.”
A nice sentiment. I am truly of the opinion that preventitive care in this country is one of the keys to lowering cost. That being said, this doesn’t exactly do much to fix Edwards health care proposal.
If you remember Edwards’ plan is probably the most detailed and complex of the major candidates’ to date. That’s something to applaud; Edwards campaign has down a pretty nifty job putting out actual content and plans on pretty touchy issues rather than just dancing around those issues and staying non-committal. As the applause for that dies down though you come to the realization that, when it comes to health care, no matter how detailed Edward’s plan, it is still disgusting.
She said she could envision a day when “you have to show proof to your employer that you’re insured as a part of the job interview — like when your kid goes to school and has to show proof of vaccination,” but said such details would be worked out through negotiations with Congress.
While when the compromise of a full fledged two-tiered system comes, once of the concessions I’d like to see is an individual mandate (such as this), it is still pretty stunning to see her be so blunt. Yikes.
Hillary Clinton has been pretty mum on specifics concerning the 2008 election’s biggest domestic issue - health care. Hard to blame her considering what happened the last time she put forward a comprehensive legislative health care agenda.
She is set to unveil her campaign’s health care proposal today however, and it looks like she’s staying away from the bureaucracy (at least a little bit),
Unlike her earlier attempt, Mrs. Clinton is not proposing a new government bureaucracy. Nor would her new plan strip people of their current health insurance — a fear that helped sink her 1993 and 1994 endeavor. Indeed, even the title of her new proposal — “the American Health Choices Plan” — underscored that this approach would aim to emphasize flexibility and options, and not government-directed coverage.
Under her plan, people could keep their existing coverage or pick new choices, such as an expanded version of the insurance available to federal employees or a new, Medicare-style public plan that would cost people less. Large businesses would be required to help pay for insurance for employees; small businesses and individuals would receive tax subsidies and credits to help purchase insurance.
Still unlikable from where I’m sitting…but nothing unexpected in that response from me.
When health care is free, governments deal with all that increased demand by limiting what’s available.
The reality of “free” health care is that people wait. In the United Kingdom, one in eight patients waits more than a year for hospital treatment and the British government recently set its goal to keep wait times to less than 18 weeks — that’s more than four months! In Canada, almost a million citizens are waiting for necessary surgery and more than a million Canadians can’t find a regular doctor. In the small town of Norwood, Ontario, a weekly drawing is held in which a townsperson wins the right to access the town’s one family doctor.
How close are we to being able to excise the HIV virus genome from infected people’s chromosomes? Maybe such is on the horizon (via Reddit).
Indrani and a team of scientists have developed an enzyme called Tre. Tre is a custom enzyme capable of detecting, recognising and destroying HIV, much like a pair of molecular scissors.
“In laymans terms, it’s an engineered enzyme which recognises sequences in the HIV genome that is duplicated, integrated virus and by the process of recombination, it cuts out the virus from the genome,” says she.
The biggest challenge with treating HIV today is that the virus becomes dormant and often develops resistance to HIV drugs.
The only way then to cure HIV is to get rid of the virus completely and Tre, the enzyme that Indrani constructed after a year and its 126 “cycles of mutation” totally deplete HIV in the human genome in three months in laboratory conditions.
[Tre] recombinase efficiently excised integrated HIV proviral DNA from the genome of infected cells. Although a long way from use in the clinic, we speculate that this type of technology might be adapted in future antiretroviral therapies, among other possible uses.
A new publication in the BMJ says that door #2 is right; although the options above aren’t all mutually exclusive. Approximately 1 fewer case of any type of cancer for every 2200 women who used the pill versus those who did not.
Thanks doc, for being so on the nose. I know Kevin Everett and/or his family told you you could talk to the press; I know the press is clamoring for info. But maybe you should’ve been more…open ended in the initial assesment of Everett’s prognosis. Just kidding.
On Monday, Bills orthopedic surgeon, Dr. Andrew Cappuccino, said Everett likely wouldn’t walk again.
“I believe there will be some permanent neurologic deficit.”
“Based on our experience, the fact that he’s moving so well, so early after such a catastrophic injury means he will walk again,” said Dr. Barth Green, chairman of the department of neurological surgery at the University of Miami school of medicine.
“It’s totally spectacular, totally unexpected,” Green told The Associated Press by telephone from Miami.
Green said the key was the quick action taken by Cappuccino to run an ice-cold saline solution through Everett’s system that put the player in a hypothermic state. Doctors at the Miami Project have demonstrated in their laboratories that such action significantly decreases the damage to the spinal cord due to swelling and movement.
“We’ve been doing a protocol on humans and having similar experiences for many months now,” Green said. “But this is the first time I’m aware of that the doctor was with the patient when he was injured and the hypothermia was started within minutes of the injury. We know the earlier it’s started, the better.”
I was walking past a patient room the other day (not one with my patient in it mind you) and someone starts hollering from it:
“Doctor! Doctor are you out there?!”
Someone in distress! I turn back and peek my head in. The guy is sitting on the edge of his bed in no acute distress with a tray of food in front of him.
“Can I help you?” I ask.
“Yeah, what is going on here?!” He asks angrily, motioning to the tray in front of him.
“What do you mean?”
“This,” He picks up a limp pancake and drops it back on his plate. “Is not breakfast!”
“Maybe you should call your nurse…” I move on, grateful not to get dragged into that, but ever so remorseful for the BS his nurse is about to get. They take a lot of it unnecessarily but an appropriate full fledged thank you for such probably needs a dedicated post.
Personally I Think The Breakfasts Look Fine Adequate
I’m really fascinated by when public health comes into conflict with personal liberty. You can image where I fall in the debate. The public health risk needs to be remarkable to infringe upon personal liberty. There may be a place for criminalizing knowingly exposing people to a dangerous health risk, but acting preemptively is a slippery slope.
Minority Report?
I bring this up because we have a story of a scared teenager with TB trying to return to his home in Mexico and instead ending up in a Georgia prison.
They put Santos in jail Friday evening, in a rare act of a government agency confining a sick person. Santos is the only inmate in a special medical isolation cell designed for inmates with contagious conditions. The cell, which measures about 15 feet by 20 feet, has a special ventilation system that keeps the air from reaching other inmates.
The 5-foot-5 teenager has a toilet, sink, bed and a mirror made of polished metal. Two deputies guard him and the other medical inmates.
[T]he county health attorney, said Santos was detained because he is a public health threat.
“He has active, contagious TB,” Will said Saturday. “He is at risk of communicating that with anybody he comes in contact with.”
Will said Santos is being held under a court order for confinement. He’ll stay in that cell until either he starts cooperating and accepting treatment, or a judge makes some other decision at a Sept. 5 hearing. At that commitment hearing, the judge could decide to place him in a hospital with security.
In a bit of a surprise I’ve actually cared for my share of TB patients since I’ve started my rotations (here is hoping my ppd doesn’t convert next year) and I think I’ve got a sense of the public health risk.
While ‘casual’ contact is a risk factor for catching TB from someone who is contagious (see here and here) the odds of getting a really bad disease from such are still remarkably small. The role forced treatment, observed treatment has played in killing the great TB epidemics in the first world is minimal. The applause for that instead goes to education, to the fact effective treatment now exists, to sanitation.
Would there be more cases of TB in this country if the government didn’t commit TB patients against their will; if the government didn’t force TB patients to be registered; if the government didn’t force observed treatment on TB patients? Of course. But the speed limit could be 15 miles per hour as well to save lives. We could always be safer at the expense of something else in life.
Even with that out there this kid got to sit in a prison cell because he didn’t want to swallow some pills? Hear the sarcasm: It’s wonderful the value we put on people’s liberty.
I did my undergrad work in USC's School of Cinema-Television Cinematic Arts. I have a Bachelors of Fine Arts in Writing for Screen & Television. I loved it, but a future of waiting tables and taking meetings with B-List producers was not for me.
This blog is ostensibly to discuss healthcare policy and maybe educate a few of my fellow medical students. But it will stray into current events, politics, and other science topics when they draw my interest
Other odd notes about me:
I've skied half the resorts on this list (Squaw Valley/Lake Tahoe, Snowbird/Park City, Whistler, Taos, Vail)
I "played" lacrosse in high school and through a club level team in college
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