Jan Dyer

Patients with diabetes—especially the elderly—are at high risk for morbidity and mortality due to cancer, studies have shown. Researchers from Specialist District Hospital and University of Rzeszow in Poland say their study “sheds some new light” in demonstrating another kind of association between diabetes and cancer in older patients: a higher risk of hospitalization with surgery due to cancer.

They analyzed data on 7,694 patients aged > 45 years hospitalized in a surgery ward. Of those, 652 were diagnosed with cancer and 370 with diabetes; 93 patients had both. The most common kind of cancer was urinary bladder cancer. The researchers note that their surgical unit has a large urology subdivision. Patients with other site-specific cancers are usually referred to more specialized clinical units.

Diabetes was the strongest predictor of risk among the variables analyzed, although urban residence also was a significant predictor. Risk of hospitalization due to cancer doubled among diabetic patients aged 45 to  65 years and was > 5 times higher among patients aged > 65 years, compared with the nondiabetic patients. The highest risk of hospitalization for site-specific cancers was among patients with kidney and breast cancers.

The researchers say their findings suggest that it is “advisable to make major efforts” for early detection and early radical treatment in older patients with diabetes. 

Source:

Dᾳbrowski M, Grindecka A. Arch Med Sci. 2017;13(5):1025-1030.
doi: 10.5114/aoms.2016.58666.

Patients with diabetes—especially the elderly—are at high risk for morbidity and mortality due to cancer, studies have shown. Researchers from Specialist District Hospital and University of Rzeszow in Poland say their study “sheds some new light” in demonstrating another kind of association between diabetes and cancer in older patients: a higher risk of hospitalization with surgery due to cancer.

They analyzed data on 7,694 patients aged > 45 years hospitalized in a surgery ward. Of those, 652 were diagnosed with cancer and 370 with diabetes; 93 patients had both. The most common kind of cancer was urinary bladder cancer. The researchers note that their surgical unit has a large urology subdivision. Patients with other site-specific cancers are usually referred to more specialized clinical units.

Diabetes was the strongest predictor of risk among the variables analyzed, although urban residence also was a significant predictor. Risk of hospitalization due to cancer doubled among diabetic patients aged 45 to  65 years and was > 5 times higher among patients aged > 65 years, compared with the nondiabetic patients. The highest risk of hospitalization for site-specific cancers was among patients with kidney and breast cancers.

The researchers say their findings suggest that it is “advisable to make major efforts” for early detection and early radical treatment in older patients with diabetes. 

Source:

Dᾳbrowski M, Grindecka A. Arch Med Sci. 2017;13(5):1025-1030.
doi: 10.5114/aoms.2016.58666.

Patients with diabetes—especially the elderly—are at high risk for morbidity and mortality due to cancer, studies have shown. Researchers from Specialist District Hospital and University of Rzeszow in Poland say their study “sheds some new light” in demonstrating another kind of association between diabetes and cancer in older patients: a higher risk of hospitalization with surgery due to cancer.

They analyzed data on 7,694 patients aged > 45 years hospitalized in a surgery ward. Of those, 652 were diagnosed with cancer and 370 with diabetes; 93 patients had both. The most common kind of cancer was urinary bladder cancer. The researchers note that their surgical unit has a large urology subdivision. Patients with other site-specific cancers are usually referred to more specialized clinical units.

Diabetes was the strongest predictor of risk among the variables analyzed, although urban residence also was a significant predictor. Risk of hospitalization due to cancer doubled among diabetic patients aged 45 to  65 years and was > 5 times higher among patients aged > 65 years, compared with the nondiabetic patients. The highest risk of hospitalization for site-specific cancers was among patients with kidney and breast cancers.

The researchers say their findings suggest that it is “advisable to make major efforts” for early detection and early radical treatment in older patients with diabetes. 

Source:

Dᾳbrowski M, Grindecka A. Arch Med Sci. 2017;13(5):1025-1030.
doi: 10.5114/aoms.2016.58666.

Currently, treatments for Parkinson disease are only effective in improving motor deficits. But the loss of cognitive abilities is just as devastating. About 25% of patients also experience cognitive deficits that impair function. One problem in developing treatments, however, is that patients with cognitive effects vary widely. Being able to predict the chance that someone with Parkinson disease will develop cognitive deficits could be a useful tool, say researchers from Brigham and Women’s Hospital in Boston, Massachusetts, who conducted a study partly funded by the National Institute Neurological Disorders and Stroke. They think they might have created just the tool: a computer-based risk calculator.

The researchers combined data from 3,200 patients with Parkinson disease, representing more than 25,000 individual clinical assessments. They evaluated 7 known clinical and genetic risk factors associated with developing dementia, then used the information to build the risk calculator.

“By allowing clinical researchers to identify and select only patients at high risk for developing dementia, this tool could help in the design of ‘smarter’ trials that require a manageable number of participating patients,” said Clemens Scherzer, MD, the lead investigator.

By improving clinical trial design, the risk calculator could first help in the discovery of new treatments, the researchers say, then help determine which patients would benefit most from those treatments. “Prediction is the first step,” said Dr. Scherzer.  “Prevention is the ultimate goal, preventing a dismal prognosis from ever happening.”

Currently, treatments for Parkinson disease are only effective in improving motor deficits. But the loss of cognitive abilities is just as devastating. About 25% of patients also experience cognitive deficits that impair function. One problem in developing treatments, however, is that patients with cognitive effects vary widely. Being able to predict the chance that someone with Parkinson disease will develop cognitive deficits could be a useful tool, say researchers from Brigham and Women’s Hospital in Boston, Massachusetts, who conducted a study partly funded by the National Institute Neurological Disorders and Stroke. They think they might have created just the tool: a computer-based risk calculator.

The researchers combined data from 3,200 patients with Parkinson disease, representing more than 25,000 individual clinical assessments. They evaluated 7 known clinical and genetic risk factors associated with developing dementia, then used the information to build the risk calculator.

“By allowing clinical researchers to identify and select only patients at high risk for developing dementia, this tool could help in the design of ‘smarter’ trials that require a manageable number of participating patients,” said Clemens Scherzer, MD, the lead investigator.

By improving clinical trial design, the risk calculator could first help in the discovery of new treatments, the researchers say, then help determine which patients would benefit most from those treatments. “Prediction is the first step,” said Dr. Scherzer.  “Prevention is the ultimate goal, preventing a dismal prognosis from ever happening.”

Currently, treatments for Parkinson disease are only effective in improving motor deficits. But the loss of cognitive abilities is just as devastating. About 25% of patients also experience cognitive deficits that impair function. One problem in developing treatments, however, is that patients with cognitive effects vary widely. Being able to predict the chance that someone with Parkinson disease will develop cognitive deficits could be a useful tool, say researchers from Brigham and Women’s Hospital in Boston, Massachusetts, who conducted a study partly funded by the National Institute Neurological Disorders and Stroke. They think they might have created just the tool: a computer-based risk calculator.

The researchers combined data from 3,200 patients with Parkinson disease, representing more than 25,000 individual clinical assessments. They evaluated 7 known clinical and genetic risk factors associated with developing dementia, then used the information to build the risk calculator.

“By allowing clinical researchers to identify and select only patients at high risk for developing dementia, this tool could help in the design of ‘smarter’ trials that require a manageable number of participating patients,” said Clemens Scherzer, MD, the lead investigator.

By improving clinical trial design, the risk calculator could first help in the discovery of new treatments, the researchers say, then help determine which patients would benefit most from those treatments. “Prediction is the first step,” said Dr. Scherzer.  “Prevention is the ultimate goal, preventing a dismal prognosis from ever happening.”

The CDC investigations of 27 outbreaks of Legionnaires’ disease between 2000 and 2014 found health care-associated Legionnaires’ disease accounted for 33% of the outbreaks, 57% of outbreak-associated cases, and 85% of outbreak-associated deaths. Nearly all were attributed to water system exposures that could have been prevented by effective water management programs.

 In 2015, CDC researchers analyzed surveillance data from 20 states and the New York City metropolitan area that reported > 90% of confirmed legionellosis cases to the Supplemental Legionnaires’ Disease Surveillance System. Of 2,809 reported cases, 553 were health care associated. Definite cases accounted for 3%, and possible cases accounted for 17% of all the cases reported. Although only a small percentage were definitely related to health care settings, the fatality rate was high at 12%.

Of the 85 definite health care-associated Legionnaires’ disease cases, 80% were associated with long-term care facilities. Of the 468 possible cases, 13% were “possibly” associated with long-term care facilities, 49% with hospitals, and 26% with clinics.

The CDC says the number of definite cases and facilities reported is “likely an underestimate,” in part because of a lack of Legionella-specific testing. Another explanation is that hospital stays are typically shorter than the 10-day period used in the analysis.

One-fourth of patients with definite health care-associated Legionnaires’ disease die. Health care providers play a critical role in prevention and response, the CDC says, by rapidly identifying and reporting cases. Legionnaires’ disease is “clinically indistinguishable” from other causes of pneumonia, the researchers note. The preferred diagnostic method is to concurrently obtain a lower respiratory sputum sample for culture on selective media and a Legionella urinary antigen test.

In health care facilities, the researchers say, “prevention of the first case of Legionnaires’ disease is the ultimate goal.” The best way to do that, they advise, is to have an effective water management program. Guidelines for developing and monitoring programs are available at https://www.cdc.gov/legionella/WMPtoolkit.

The CDC investigations of 27 outbreaks of Legionnaires’ disease between 2000 and 2014 found health care-associated Legionnaires’ disease accounted for 33% of the outbreaks, 57% of outbreak-associated cases, and 85% of outbreak-associated deaths. Nearly all were attributed to water system exposures that could have been prevented by effective water management programs.

 In 2015, CDC researchers analyzed surveillance data from 20 states and the New York City metropolitan area that reported > 90% of confirmed legionellosis cases to the Supplemental Legionnaires’ Disease Surveillance System. Of 2,809 reported cases, 553 were health care associated. Definite cases accounted for 3%, and possible cases accounted for 17% of all the cases reported. Although only a small percentage were definitely related to health care settings, the fatality rate was high at 12%.

Of the 85 definite health care-associated Legionnaires’ disease cases, 80% were associated with long-term care facilities. Of the 468 possible cases, 13% were “possibly” associated with long-term care facilities, 49% with hospitals, and 26% with clinics.

The CDC says the number of definite cases and facilities reported is “likely an underestimate,” in part because of a lack of Legionella-specific testing. Another explanation is that hospital stays are typically shorter than the 10-day period used in the analysis.

One-fourth of patients with definite health care-associated Legionnaires’ disease die. Health care providers play a critical role in prevention and response, the CDC says, by rapidly identifying and reporting cases. Legionnaires’ disease is “clinically indistinguishable” from other causes of pneumonia, the researchers note. The preferred diagnostic method is to concurrently obtain a lower respiratory sputum sample for culture on selective media and a Legionella urinary antigen test.

In health care facilities, the researchers say, “prevention of the first case of Legionnaires’ disease is the ultimate goal.” The best way to do that, they advise, is to have an effective water management program. Guidelines for developing and monitoring programs are available at https://www.cdc.gov/legionella/WMPtoolkit.

The CDC investigations of 27 outbreaks of Legionnaires’ disease between 2000 and 2014 found health care-associated Legionnaires’ disease accounted for 33% of the outbreaks, 57% of outbreak-associated cases, and 85% of outbreak-associated deaths. Nearly all were attributed to water system exposures that could have been prevented by effective water management programs.

 In 2015, CDC researchers analyzed surveillance data from 20 states and the New York City metropolitan area that reported > 90% of confirmed legionellosis cases to the Supplemental Legionnaires’ Disease Surveillance System. Of 2,809 reported cases, 553 were health care associated. Definite cases accounted for 3%, and possible cases accounted for 17% of all the cases reported. Although only a small percentage were definitely related to health care settings, the fatality rate was high at 12%.

Of the 85 definite health care-associated Legionnaires’ disease cases, 80% were associated with long-term care facilities. Of the 468 possible cases, 13% were “possibly” associated with long-term care facilities, 49% with hospitals, and 26% with clinics.

The CDC says the number of definite cases and facilities reported is “likely an underestimate,” in part because of a lack of Legionella-specific testing. Another explanation is that hospital stays are typically shorter than the 10-day period used in the analysis.

One-fourth of patients with definite health care-associated Legionnaires’ disease die. Health care providers play a critical role in prevention and response, the CDC says, by rapidly identifying and reporting cases. Legionnaires’ disease is “clinically indistinguishable” from other causes of pneumonia, the researchers note. The preferred diagnostic method is to concurrently obtain a lower respiratory sputum sample for culture on selective media and a Legionella urinary antigen test.

In health care facilities, the researchers say, “prevention of the first case of Legionnaires’ disease is the ultimate goal.” The best way to do that, they advise, is to have an effective water management program. Guidelines for developing and monitoring programs are available at https://www.cdc.gov/legionella/WMPtoolkit.

Transgender women are at high risk for HIV, but they are understandably concerned about taking both antiretroviral therapy (ART) drugs and feminizing hormone therapy (HT). In a survey of 87 transgender women at a community-based AIDS service organization in Los Angeles, more than half of those living with HIV were worried about that, and many cited their concerns as a reason for not taking anti-HIV medications, HT, or both, say researchers from National Institutes of Health (NIH) and Gilead Sciences. 

Of the study participants, 69% were on some type of HT (including 25% who reported using HT without supervision from a qualified health professional). Transgender women living with HIV were more likely to use HT without supervision: 34% compared with 13% of those without HIV.

However, while 57% of the women living with HIV were concerned about drug interactions between ART and HT, only 49% of the participants had discussed the possibility with their health care team.

There is no scientific consensus on the safety and effectiveness of any combination of ART and HT in transgender women living with HIV, NIH says. Certain forms of ART and components of hormonal contraceptives interact, but because the drugs used in HT are at different dosages than in contraception, dose modifications or drug substitutions can reduce the risk of interactions.

 The concerns also pose a problem for research, because transgender women may be reluctant to join clinical trials combining HT and ART. “Despite all indications that transgender women are a critical population in HIV care, very little is known about how to optimize coadministration of ART and hormonal therapies in this population,” said Jordan Lake, MD, study leader, who is continuing the research at the University of Texas Health Sciences Center at Houston.

“Making sure we are meeting the needs of transgender women living with HIV is key to addressing this pandemic,” said Judith Currier, MD, co-investigator and vice chair of the NIAID-supported AIDS Clinical Trials Network. “We need to provide an evidence-based response to these understandable concerns so that this key population and their sexual partners may reap the full benefits of effective HIV care.”

Source:
Drug interaction concerns may negatively affect HIV treatment adherence among transgender women.  https://www.nih.gov/news-events/news-releases/drug-interaction-concerns-may-negatively-affect-hiv-treatment-adherence-among-transgender-women. Published July 24, 2017. Accessed August 10, 2017.

Transgender women are at high risk for HIV, but they are understandably concerned about taking both antiretroviral therapy (ART) drugs and feminizing hormone therapy (HT). In a survey of 87 transgender women at a community-based AIDS service organization in Los Angeles, more than half of those living with HIV were worried about that, and many cited their concerns as a reason for not taking anti-HIV medications, HT, or both, say researchers from National Institutes of Health (NIH) and Gilead Sciences. 

Of the study participants, 69% were on some type of HT (including 25% who reported using HT without supervision from a qualified health professional). Transgender women living with HIV were more likely to use HT without supervision: 34% compared with 13% of those without HIV.

However, while 57% of the women living with HIV were concerned about drug interactions between ART and HT, only 49% of the participants had discussed the possibility with their health care team.

There is no scientific consensus on the safety and effectiveness of any combination of ART and HT in transgender women living with HIV, NIH says. Certain forms of ART and components of hormonal contraceptives interact, but because the drugs used in HT are at different dosages than in contraception, dose modifications or drug substitutions can reduce the risk of interactions.

 The concerns also pose a problem for research, because transgender women may be reluctant to join clinical trials combining HT and ART. “Despite all indications that transgender women are a critical population in HIV care, very little is known about how to optimize coadministration of ART and hormonal therapies in this population,” said Jordan Lake, MD, study leader, who is continuing the research at the University of Texas Health Sciences Center at Houston.

“Making sure we are meeting the needs of transgender women living with HIV is key to addressing this pandemic,” said Judith Currier, MD, co-investigator and vice chair of the NIAID-supported AIDS Clinical Trials Network. “We need to provide an evidence-based response to these understandable concerns so that this key population and their sexual partners may reap the full benefits of effective HIV care.”

Source:
Drug interaction concerns may negatively affect HIV treatment adherence among transgender women.  https://www.nih.gov/news-events/news-releases/drug-interaction-concerns-may-negatively-affect-hiv-treatment-adherence-among-transgender-women. Published July 24, 2017. Accessed August 10, 2017.

Transgender women are at high risk for HIV, but they are understandably concerned about taking both antiretroviral therapy (ART) drugs and feminizing hormone therapy (HT). In a survey of 87 transgender women at a community-based AIDS service organization in Los Angeles, more than half of those living with HIV were worried about that, and many cited their concerns as a reason for not taking anti-HIV medications, HT, or both, say researchers from National Institutes of Health (NIH) and Gilead Sciences. 

Of the study participants, 69% were on some type of HT (including 25% who reported using HT without supervision from a qualified health professional). Transgender women living with HIV were more likely to use HT without supervision: 34% compared with 13% of those without HIV.

However, while 57% of the women living with HIV were concerned about drug interactions between ART and HT, only 49% of the participants had discussed the possibility with their health care team.

There is no scientific consensus on the safety and effectiveness of any combination of ART and HT in transgender women living with HIV, NIH says. Certain forms of ART and components of hormonal contraceptives interact, but because the drugs used in HT are at different dosages than in contraception, dose modifications or drug substitutions can reduce the risk of interactions.

 The concerns also pose a problem for research, because transgender women may be reluctant to join clinical trials combining HT and ART. “Despite all indications that transgender women are a critical population in HIV care, very little is known about how to optimize coadministration of ART and hormonal therapies in this population,” said Jordan Lake, MD, study leader, who is continuing the research at the University of Texas Health Sciences Center at Houston.

“Making sure we are meeting the needs of transgender women living with HIV is key to addressing this pandemic,” said Judith Currier, MD, co-investigator and vice chair of the NIAID-supported AIDS Clinical Trials Network. “We need to provide an evidence-based response to these understandable concerns so that this key population and their sexual partners may reap the full benefits of effective HIV care.”

Source:
Drug interaction concerns may negatively affect HIV treatment adherence among transgender women.  https://www.nih.gov/news-events/news-releases/drug-interaction-concerns-may-negatively-affect-hiv-treatment-adherence-among-transgender-women. Published July 24, 2017. Accessed August 10, 2017.

Male veterans who reported mild-to-moderate psychological distress in the previous year had 61% higher odds of experiencing sleep apnea, according to a California State University study. Those with serious psychological distress had 138% higher odds. The average prevalence of sleep apnea was 5.9%, but the proportions rose from 3.7% in 2005 to 8.1% in 2014.

The researchers analyzed data from the 2005-2014 National Survey on Drug Use and Health. They cite other research that found the age-adjusted prevalence of sleep apnea among U.S. veterans increased almost 6-fold from 2000 to 2010. They also point to an evaluation of veterans of Operation Enduring Freedom, Operation Iraqi Freedom, and Operation New Dawn that found that 69.2% of 159 veterans screened were at high risk for obstructive sleep apnea.

An even stronger risk factor was asthma. Veterans with a past-year diagnosis of asthma had 256% higher odds of experiencing sleep apnea than among those without asthma. The researchers note that men and women may be asymptomatic when they are recruited but develop asthma due to environmental factors during deployment. The researchers urge more and better screening regardless of whether the service member had asthma symptoms during recruitment.  

Their study is unique, the researchers say, in that it demonstrates a putative relationship between sleep apnea and mental illness. They suggest multidisciplinary interventions, including peer-support strategies to improve veterans’ mental health and community-based resources to help improve access to health care. Above all, the researchers urge more rigorous screening of sleep apnea and better sleep apnea treatment for veterans. 

Male veterans who reported mild-to-moderate psychological distress in the previous year had 61% higher odds of experiencing sleep apnea, according to a California State University study. Those with serious psychological distress had 138% higher odds. The average prevalence of sleep apnea was 5.9%, but the proportions rose from 3.7% in 2005 to 8.1% in 2014.

The researchers analyzed data from the 2005-2014 National Survey on Drug Use and Health. They cite other research that found the age-adjusted prevalence of sleep apnea among U.S. veterans increased almost 6-fold from 2000 to 2010. They also point to an evaluation of veterans of Operation Enduring Freedom, Operation Iraqi Freedom, and Operation New Dawn that found that 69.2% of 159 veterans screened were at high risk for obstructive sleep apnea.

An even stronger risk factor was asthma. Veterans with a past-year diagnosis of asthma had 256% higher odds of experiencing sleep apnea than among those without asthma. The researchers note that men and women may be asymptomatic when they are recruited but develop asthma due to environmental factors during deployment. The researchers urge more and better screening regardless of whether the service member had asthma symptoms during recruitment.  

Their study is unique, the researchers say, in that it demonstrates a putative relationship between sleep apnea and mental illness. They suggest multidisciplinary interventions, including peer-support strategies to improve veterans’ mental health and community-based resources to help improve access to health care. Above all, the researchers urge more rigorous screening of sleep apnea and better sleep apnea treatment for veterans. 

Male veterans who reported mild-to-moderate psychological distress in the previous year had 61% higher odds of experiencing sleep apnea, according to a California State University study. Those with serious psychological distress had 138% higher odds. The average prevalence of sleep apnea was 5.9%, but the proportions rose from 3.7% in 2005 to 8.1% in 2014.

The researchers analyzed data from the 2005-2014 National Survey on Drug Use and Health. They cite other research that found the age-adjusted prevalence of sleep apnea among U.S. veterans increased almost 6-fold from 2000 to 2010. They also point to an evaluation of veterans of Operation Enduring Freedom, Operation Iraqi Freedom, and Operation New Dawn that found that 69.2% of 159 veterans screened were at high risk for obstructive sleep apnea.

An even stronger risk factor was asthma. Veterans with a past-year diagnosis of asthma had 256% higher odds of experiencing sleep apnea than among those without asthma. The researchers note that men and women may be asymptomatic when they are recruited but develop asthma due to environmental factors during deployment. The researchers urge more and better screening regardless of whether the service member had asthma symptoms during recruitment.  

Their study is unique, the researchers say, in that it demonstrates a putative relationship between sleep apnea and mental illness. They suggest multidisciplinary interventions, including peer-support strategies to improve veterans’ mental health and community-based resources to help improve access to health care. Above all, the researchers urge more rigorous screening of sleep apnea and better sleep apnea treatment for veterans. 

As the epidemic of opioid use has expanded, so has the incidence of drug-associated endocarditis. North Carolina, where CDC researchers analyzed discharge data from 128 hospitals, saw about a 12-fold jump in hospitalizations for endocarditis combined with drug dependence between 2010-2015.

The incidence of hospitalizations sharply increased, particularly beginning in 2013, from 0.2 cases per 100,000 persons per year in 2010 to 2.7 cases per 100,000 persons in 2015. The rise was fastest among adults aged 18 to 25 years.

About one-third of the patients also were infected with hepatitis C virus (HCV), a not unexpected finding since IV drug use is a recognized risk factor for both endocarditis and HCV infection.

The financial repercussions also are evident. Between 2010 and 2015, the median hospital charge for drug dependence-associated endocarditis hospitalization jumped from $1.1 million to $22.2 million—an 18-fold increase.

The findings suggest a need to focus on preventive interventions, the researchers say, such as fact-based drug education, syringe service programs, safe injection education, and treatment programs offering opioid agonist and antagonist therapies.

As the epidemic of opioid use has expanded, so has the incidence of drug-associated endocarditis. North Carolina, where CDC researchers analyzed discharge data from 128 hospitals, saw about a 12-fold jump in hospitalizations for endocarditis combined with drug dependence between 2010-2015.

The incidence of hospitalizations sharply increased, particularly beginning in 2013, from 0.2 cases per 100,000 persons per year in 2010 to 2.7 cases per 100,000 persons in 2015. The rise was fastest among adults aged 18 to 25 years.

About one-third of the patients also were infected with hepatitis C virus (HCV), a not unexpected finding since IV drug use is a recognized risk factor for both endocarditis and HCV infection.

The financial repercussions also are evident. Between 2010 and 2015, the median hospital charge for drug dependence-associated endocarditis hospitalization jumped from $1.1 million to $22.2 million—an 18-fold increase.

The findings suggest a need to focus on preventive interventions, the researchers say, such as fact-based drug education, syringe service programs, safe injection education, and treatment programs offering opioid agonist and antagonist therapies.

As the epidemic of opioid use has expanded, so has the incidence of drug-associated endocarditis. North Carolina, where CDC researchers analyzed discharge data from 128 hospitals, saw about a 12-fold jump in hospitalizations for endocarditis combined with drug dependence between 2010-2015.

The incidence of hospitalizations sharply increased, particularly beginning in 2013, from 0.2 cases per 100,000 persons per year in 2010 to 2.7 cases per 100,000 persons in 2015. The rise was fastest among adults aged 18 to 25 years.

About one-third of the patients also were infected with hepatitis C virus (HCV), a not unexpected finding since IV drug use is a recognized risk factor for both endocarditis and HCV infection.

The financial repercussions also are evident. Between 2010 and 2015, the median hospital charge for drug dependence-associated endocarditis hospitalization jumped from $1.1 million to $22.2 million—an 18-fold increase.

The findings suggest a need to focus on preventive interventions, the researchers say, such as fact-based drug education, syringe service programs, safe injection education, and treatment programs offering opioid agonist and antagonist therapies.

“Chronic Lyme disease” is sometimes a catchall diagnosis for patients with a wide spectrum of musculoskeletal and neuropsychiatric symptoms, fatigue, and generalized pain. That, in turn, has led to a variety of treatments: courses of antibiotics lasting for months to years, IV infusions of hydrogen peroxide, immunoglobulin therapy, even stem cell transplants. Those treatments, though, may not lead to substantial long-term improvement—in fact, they can be harmful.

Clinicians, health departments, and patients have contacted the CDC reporting life-threatening complications resulting from treatment for chronic Lyme disease, including metastatic bacterial infections, septic shock, Clostridium difficile (C diff) colitis, and abscess. An article in Morbidity and Mortality Weekly Report (MMWR) described 5 cases that “highlight the severity and scope” of adverse effects caused by the use of unproven treatments for chronic Lyme disease.

 One patient with fatigue and joint pain, was diagnosed with chronic Lyme disease, babesiosis, and Bartonella infection. When the symptoms worsened despite multiple courses of oral antibiotics, the patient was switched to IV ceftriaxone and cefotaxime. However, the pain did not lessen; the patient became hypotensive and tachycardic and was placed in intensive care. Her condition continued to worsen, and she died. The patient’s death was attributed to septic shock related to central venous catheter–associated bacteremia.

In another case, a woman was first diagnosed with amyotrophic lateral sclerosis, then as a second opinion, with chronic Lyme disease. After 7 months of intensive antimicrobial treatment, the pain improved but she got weaker. She also developed intractable C diff infection that required prolonged treatment. However, the patient died of complications of amyotrophic lateral sclerosis—an example, the researchers say, of a missed opportunity for appropriate treatment due to misdiagnosis.

Antibiotics and immunoglobulin therapies are effective and necessary treatments for many conditions, MMWR emphasized—“however, unnecessary antibiotic and immunoglobulin use provides no benefit to patients while putting them at risk for adverse events.”

“Chronic Lyme disease” is sometimes a catchall diagnosis for patients with a wide spectrum of musculoskeletal and neuropsychiatric symptoms, fatigue, and generalized pain. That, in turn, has led to a variety of treatments: courses of antibiotics lasting for months to years, IV infusions of hydrogen peroxide, immunoglobulin therapy, even stem cell transplants. Those treatments, though, may not lead to substantial long-term improvement—in fact, they can be harmful.

Clinicians, health departments, and patients have contacted the CDC reporting life-threatening complications resulting from treatment for chronic Lyme disease, including metastatic bacterial infections, septic shock, Clostridium difficile (C diff) colitis, and abscess. An article in Morbidity and Mortality Weekly Report (MMWR) described 5 cases that “highlight the severity and scope” of adverse effects caused by the use of unproven treatments for chronic Lyme disease.

 One patient with fatigue and joint pain, was diagnosed with chronic Lyme disease, babesiosis, and Bartonella infection. When the symptoms worsened despite multiple courses of oral antibiotics, the patient was switched to IV ceftriaxone and cefotaxime. However, the pain did not lessen; the patient became hypotensive and tachycardic and was placed in intensive care. Her condition continued to worsen, and she died. The patient’s death was attributed to septic shock related to central venous catheter–associated bacteremia.

In another case, a woman was first diagnosed with amyotrophic lateral sclerosis, then as a second opinion, with chronic Lyme disease. After 7 months of intensive antimicrobial treatment, the pain improved but she got weaker. She also developed intractable C diff infection that required prolonged treatment. However, the patient died of complications of amyotrophic lateral sclerosis—an example, the researchers say, of a missed opportunity for appropriate treatment due to misdiagnosis.

Antibiotics and immunoglobulin therapies are effective and necessary treatments for many conditions, MMWR emphasized—“however, unnecessary antibiotic and immunoglobulin use provides no benefit to patients while putting them at risk for adverse events.”

“Chronic Lyme disease” is sometimes a catchall diagnosis for patients with a wide spectrum of musculoskeletal and neuropsychiatric symptoms, fatigue, and generalized pain. That, in turn, has led to a variety of treatments: courses of antibiotics lasting for months to years, IV infusions of hydrogen peroxide, immunoglobulin therapy, even stem cell transplants. Those treatments, though, may not lead to substantial long-term improvement—in fact, they can be harmful.

Clinicians, health departments, and patients have contacted the CDC reporting life-threatening complications resulting from treatment for chronic Lyme disease, including metastatic bacterial infections, septic shock, Clostridium difficile (C diff) colitis, and abscess. An article in Morbidity and Mortality Weekly Report (MMWR) described 5 cases that “highlight the severity and scope” of adverse effects caused by the use of unproven treatments for chronic Lyme disease.

 One patient with fatigue and joint pain, was diagnosed with chronic Lyme disease, babesiosis, and Bartonella infection. When the symptoms worsened despite multiple courses of oral antibiotics, the patient was switched to IV ceftriaxone and cefotaxime. However, the pain did not lessen; the patient became hypotensive and tachycardic and was placed in intensive care. Her condition continued to worsen, and she died. The patient’s death was attributed to septic shock related to central venous catheter–associated bacteremia.

In another case, a woman was first diagnosed with amyotrophic lateral sclerosis, then as a second opinion, with chronic Lyme disease. After 7 months of intensive antimicrobial treatment, the pain improved but she got weaker. She also developed intractable C diff infection that required prolonged treatment. However, the patient died of complications of amyotrophic lateral sclerosis—an example, the researchers say, of a missed opportunity for appropriate treatment due to misdiagnosis.

Antibiotics and immunoglobulin therapies are effective and necessary treatments for many conditions, MMWR emphasized—“however, unnecessary antibiotic and immunoglobulin use provides no benefit to patients while putting them at risk for adverse events.”

Alcoholic liver disease (ALD) has been associated with bacterial overgrowth in the intestines, as well as a shift in the types of bacteria found there. But until now, according to the National Institute on Alcohol Abuse and Alcoholism, little was actually known about the role of intestinal fungi in ALD. A University of California-San Diego and J. Craig Venter Institute in Rockville, Maryland study offers more evidence to support the connection.

In the study, the researchers found that fungi flourished in the intestines of mice with chronic alcohol exposure, and that fungal overgrowth exacerbated alcohol-induced liver disease. Treatment with amphotericin B reduced levels of liver injury and fat accumulation.

In small preliminary studies with humans, the researchers also linked intestinal fungi to ALD. People with alcohol use disorder and various stages of liver disease tended to have an overgrowth of a specific fungal species, as well as less fungal diversity, compared with healthy control subjects. Moreover, the more prevalent the fungal overgrowth in people with ALD, the higher the risk of death.

The researchers say that if further study confirms that fungi are involved in the worsening of ALD, it may be possible to slow disease progression by adjusting the balance of fungal species in the intestine.

Alcoholic liver disease (ALD) has been associated with bacterial overgrowth in the intestines, as well as a shift in the types of bacteria found there. But until now, according to the National Institute on Alcohol Abuse and Alcoholism, little was actually known about the role of intestinal fungi in ALD. A University of California-San Diego and J. Craig Venter Institute in Rockville, Maryland study offers more evidence to support the connection.

In the study, the researchers found that fungi flourished in the intestines of mice with chronic alcohol exposure, and that fungal overgrowth exacerbated alcohol-induced liver disease. Treatment with amphotericin B reduced levels of liver injury and fat accumulation.

In small preliminary studies with humans, the researchers also linked intestinal fungi to ALD. People with alcohol use disorder and various stages of liver disease tended to have an overgrowth of a specific fungal species, as well as less fungal diversity, compared with healthy control subjects. Moreover, the more prevalent the fungal overgrowth in people with ALD, the higher the risk of death.

The researchers say that if further study confirms that fungi are involved in the worsening of ALD, it may be possible to slow disease progression by adjusting the balance of fungal species in the intestine.

Alcoholic liver disease (ALD) has been associated with bacterial overgrowth in the intestines, as well as a shift in the types of bacteria found there. But until now, according to the National Institute on Alcohol Abuse and Alcoholism, little was actually known about the role of intestinal fungi in ALD. A University of California-San Diego and J. Craig Venter Institute in Rockville, Maryland study offers more evidence to support the connection.

In the study, the researchers found that fungi flourished in the intestines of mice with chronic alcohol exposure, and that fungal overgrowth exacerbated alcohol-induced liver disease. Treatment with amphotericin B reduced levels of liver injury and fat accumulation.

In small preliminary studies with humans, the researchers also linked intestinal fungi to ALD. People with alcohol use disorder and various stages of liver disease tended to have an overgrowth of a specific fungal species, as well as less fungal diversity, compared with healthy control subjects. Moreover, the more prevalent the fungal overgrowth in people with ALD, the higher the risk of death.

The researchers say that if further study confirms that fungi are involved in the worsening of ALD, it may be possible to slow disease progression by adjusting the balance of fungal species in the intestine.

Some studies have suggested that circulating plasma cells (CPCs) might have prognostic value in multiple myeloma (MM), but the findings remain controversial, say researchers from Zhengzhou University in the People’s Republic of China. However, the development of highly sensitive and specific diagnostic methods, such as polymerase chain reaction (PCR) and flow cytometry (FCM), the researchers say, make it possible to explore whether CPCs can serve as a biomarker in MM. To that end, they conducted the first meta-analysis to provide better insight into the prognostic value of CPCs in MM.

The researchers examined findings from 11 studies involving 2,943 patients in 5 countries. Peripheral blood samples were analyzed using FCM, PCR, slide-based immunofluorescence assay (IF), and conventional morphology (CM).

Circulating plasma cell status reflected aggressive disease more than tumor burden, the researchers say. Patients in the CPC-positive groups had more aggressive disease and a worse overall survival (OS) rate compared with patients in the CPC-negative groups. The presence of CPCs was “strikingly” associated with elevated the International Staging System score but not the Durie-Salm staging system (DS) score. This difference may be associated, the researchers suggest, with the fact that the DS stage predominantly reflects tumor burden, which is significantly reduced now by newer therapies.

In subgroup analyses, the patients in the FCM and CM  groups had worse prognosis for both disease progression and OS. The PCR subgroup showed prognostic significance for disease progression but not OS, and the IF subgroup for OS but not disease progression.

One question the researchers were also interested in answering was whether it mattered when the sample was taken. However, pooled hazard ratios for OS and disease progression were “fairly stable,” they say, and not influenced by sampling time. Regardless of whether CPCs are detected in an early stage or in relapse patients, the researchers add, CPC status may serve as a useful tool to guide treatment and prognosis.

Source:
Li J, Wang N, Tesfaluul N, Gao X, Liu S, Yue B. PLoS One. 2017;12(7):e0181447.
doi: 10.1371/journal.pone.0181447.

Some studies have suggested that circulating plasma cells (CPCs) might have prognostic value in multiple myeloma (MM), but the findings remain controversial, say researchers from Zhengzhou University in the People’s Republic of China. However, the development of highly sensitive and specific diagnostic methods, such as polymerase chain reaction (PCR) and flow cytometry (FCM), the researchers say, make it possible to explore whether CPCs can serve as a biomarker in MM. To that end, they conducted the first meta-analysis to provide better insight into the prognostic value of CPCs in MM.

The researchers examined findings from 11 studies involving 2,943 patients in 5 countries. Peripheral blood samples were analyzed using FCM, PCR, slide-based immunofluorescence assay (IF), and conventional morphology (CM).

Circulating plasma cell status reflected aggressive disease more than tumor burden, the researchers say. Patients in the CPC-positive groups had more aggressive disease and a worse overall survival (OS) rate compared with patients in the CPC-negative groups. The presence of CPCs was “strikingly” associated with elevated the International Staging System score but not the Durie-Salm staging system (DS) score. This difference may be associated, the researchers suggest, with the fact that the DS stage predominantly reflects tumor burden, which is significantly reduced now by newer therapies.

In subgroup analyses, the patients in the FCM and CM  groups had worse prognosis for both disease progression and OS. The PCR subgroup showed prognostic significance for disease progression but not OS, and the IF subgroup for OS but not disease progression.

One question the researchers were also interested in answering was whether it mattered when the sample was taken. However, pooled hazard ratios for OS and disease progression were “fairly stable,” they say, and not influenced by sampling time. Regardless of whether CPCs are detected in an early stage or in relapse patients, the researchers add, CPC status may serve as a useful tool to guide treatment and prognosis.

Source:
Li J, Wang N, Tesfaluul N, Gao X, Liu S, Yue B. PLoS One. 2017;12(7):e0181447.
doi: 10.1371/journal.pone.0181447.

Some studies have suggested that circulating plasma cells (CPCs) might have prognostic value in multiple myeloma (MM), but the findings remain controversial, say researchers from Zhengzhou University in the People’s Republic of China. However, the development of highly sensitive and specific diagnostic methods, such as polymerase chain reaction (PCR) and flow cytometry (FCM), the researchers say, make it possible to explore whether CPCs can serve as a biomarker in MM. To that end, they conducted the first meta-analysis to provide better insight into the prognostic value of CPCs in MM.

The researchers examined findings from 11 studies involving 2,943 patients in 5 countries. Peripheral blood samples were analyzed using FCM, PCR, slide-based immunofluorescence assay (IF), and conventional morphology (CM).

Circulating plasma cell status reflected aggressive disease more than tumor burden, the researchers say. Patients in the CPC-positive groups had more aggressive disease and a worse overall survival (OS) rate compared with patients in the CPC-negative groups. The presence of CPCs was “strikingly” associated with elevated the International Staging System score but not the Durie-Salm staging system (DS) score. This difference may be associated, the researchers suggest, with the fact that the DS stage predominantly reflects tumor burden, which is significantly reduced now by newer therapies.

In subgroup analyses, the patients in the FCM and CM  groups had worse prognosis for both disease progression and OS. The PCR subgroup showed prognostic significance for disease progression but not OS, and the IF subgroup for OS but not disease progression.

One question the researchers were also interested in answering was whether it mattered when the sample was taken. However, pooled hazard ratios for OS and disease progression were “fairly stable,” they say, and not influenced by sampling time. Regardless of whether CPCs are detected in an early stage or in relapse patients, the researchers add, CPC status may serve as a useful tool to guide treatment and prognosis.

Source:
Li J, Wang N, Tesfaluul N, Gao X, Liu S, Yue B. PLoS One. 2017;12(7):e0181447.
doi: 10.1371/journal.pone.0181447.

More women are living longer with distant metastatic breast cancer (MBC), according to a National Cancer Institute study. Between 1992-1994 and 2005-2012, 5-year relative survival among women who were diagnosed with MBC at ages 15 to 49 doubled, from 18% to 36%.

Researchers also found that relative survival time increased from 22.3 months to 38.7 months for women diagnosed aged 15 -49 years, and from 19.1 months to 29.7 months for those aged 50 – 64 years.

Moreover, a “small but meaningful” number of women are living years after an initial diagnosis of MBC, the study found. More than 11% of women diagnosed between 2000-2004 aged < 64 years survived ≥ 10 years. Although nearly half of women with MBC have had it for ≤ 2 , one third have lived with it for ≥ 5 years.

The study findings “make clear that the majority of MBC patients, those who are diagnosed with non-metastatic cancer but progress to distant disease, have never been properly documented,” said Angela Mariotto, PhD, chief of the NCI Data Analytics Branch of the Division of Cancer Control and Population Sciences. By including women with recurrence, the study provides a more accurate number of women in the U.S. living with MBC, which can help with health care planning.

More women are living longer with distant metastatic breast cancer (MBC), according to a National Cancer Institute study. Between 1992-1994 and 2005-2012, 5-year relative survival among women who were diagnosed with MBC at ages 15 to 49 doubled, from 18% to 36%.

Researchers also found that relative survival time increased from 22.3 months to 38.7 months for women diagnosed aged 15 -49 years, and from 19.1 months to 29.7 months for those aged 50 – 64 years.

Moreover, a “small but meaningful” number of women are living years after an initial diagnosis of MBC, the study found. More than 11% of women diagnosed between 2000-2004 aged < 64 years survived ≥ 10 years. Although nearly half of women with MBC have had it for ≤ 2 , one third have lived with it for ≥ 5 years.

The study findings “make clear that the majority of MBC patients, those who are diagnosed with non-metastatic cancer but progress to distant disease, have never been properly documented,” said Angela Mariotto, PhD, chief of the NCI Data Analytics Branch of the Division of Cancer Control and Population Sciences. By including women with recurrence, the study provides a more accurate number of women in the U.S. living with MBC, which can help with health care planning.

More women are living longer with distant metastatic breast cancer (MBC), according to a National Cancer Institute study. Between 1992-1994 and 2005-2012, 5-year relative survival among women who were diagnosed with MBC at ages 15 to 49 doubled, from 18% to 36%.

Researchers also found that relative survival time increased from 22.3 months to 38.7 months for women diagnosed aged 15 -49 years, and from 19.1 months to 29.7 months for those aged 50 – 64 years.

Moreover, a “small but meaningful” number of women are living years after an initial diagnosis of MBC, the study found. More than 11% of women diagnosed between 2000-2004 aged < 64 years survived ≥ 10 years. Although nearly half of women with MBC have had it for ≤ 2 , one third have lived with it for ≥ 5 years.

The study findings “make clear that the majority of MBC patients, those who are diagnosed with non-metastatic cancer but progress to distant disease, have never been properly documented,” said Angela Mariotto, PhD, chief of the NCI Data Analytics Branch of the Division of Cancer Control and Population Sciences. By including women with recurrence, the study provides a more accurate number of women in the U.S. living with MBC, which can help with health care planning.