Archive for March, 2012

Influenza Genetic Susceptibility Gene?

Thursday, March 29, 2012 // Uncategorized

Why do some people seem to get sicker from the flu?  Some strains seem to be more virulent and this has been the focus of research in the past, but ProMED digest reports on research published in Nature that indicates that there may be differences inthe way some people respond.

 

 

INFLUENZA (20): HOST SUSCEPTIBILITY GENE IDENTIFIED
***************************************************
A ProMED-mail post
<http://www.promedmail.org>
ProMED-mail is a program of the
International Society for Infectious Diseases
<http://www.isid.org>

[1]
Date: Sun 25 Mar 2012
Source: BBC News Health [edited]
<http://www.bbc.co.uk/news/health-17474197>
Gene flaw linked to serious flu risk
– —————————–
Scientists have identified a genetic flaw that may explain why some
people get more ill with flu than others. Writing in Nature, the
researchers said the variant of the IFITM3 [interferon-inducible
transmembrane (IFITM) protein] gene was much more common in people
hospitalised for flu than in the general population. It controls a
malformed protein, which makes cells more susceptible to viral
infection. Experts said those with the flaw could be given the flu
jab, like other at-risk groups.

Researchers removed the gene from mice. They found that when they
developed flu, their symptoms were much worse than those seen in mice
with the gene. Evidence from genetic databases covering thousands of
people showed the flawed version of the gene is present in around one
in 400 people.

The scientists, who came from the UK and US, then sequenced the IFITM3
genes of 53 patients who were in hospital with flu. 3 were found to
have the variant — a rate of one in 20. The researchers say these
findings now need to be replicated in bigger studies. And they add it
is probably only part of the genetic jigsaw that determines a person’s
response to flu.

Professor Paul Kellam of the Wellcome Trust Sanger Institute, who
co-led the research, said: “At the moment, if someone is in a more
vulnerable group because of co-morbidity [another health problem],
they would be offered the flu vaccine. But he said having this variant
would not make any difference to how people were treated. Prof Kellam
added: “Our research is important for people who have this variant as
we predict their immune defences could be weakened to some virus
infections. Ultimately as we learn more about the genetics of
susceptibility to viruses, then people can take informed precautions,
such as vaccination to prevent infection.”

Professor Peter Openshaw, director of the Centre for Respiratory
Infection at Imperial College London, said: “This new discovery is the
1st clue from our detailed study of the devastating effects of flu
hospitalised patients. It vindicates our conviction that there is
something unusual about these patients.” Sir Mark Walport, director of
the Wellcome Trust, said: “During the recent swine flu pandemic, many
people found it remarkable that the same virus could provoke only mild
symptoms in most people, while, more rarely, threatening the lives of
others.

“This discovery points to a piece of the explanation: genetic
variations affect the way in which different people respond to
infection. This important research adds to a growing scientific
understanding that genetic factors affect the course of disease in
more than one way. Genetic variations in a virus can increase its
virulence, but genetic variations in that virus’s host — us — matter
greatly as well.”

– —
Communicated by:
ProMED-mail Rapporteur Mary Marshall

[The following is the Nature press re-release relating to this paper
(<http://www.nature.com/nature/journal/vaop/ncurrent/abs/nature10921.html>).

Everitt AR, Clare S, Pertel T, et al: IFITM3 restricts the morbidity
and mortality associated with influenza. Nature. 2012 Mar 25. doi:
10.1038/nature10921.
– ———————————————————————-

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Healthy Habits Associated with Reduced Mortality from Heart Disease

Tuesday, March 20, 2012 // Uncategorized

Sounds like common sense, right?  This is a Journal Watch summary of an study published in the Journal of the American Medical Association.  According to one study  75% of health care costs are a result of unhealthy habits.

Trends in Cardiovascular Health Metrics and Associations With All-Cause and CVD Mortality Among US Adults

  1. Quanhe Yang, PhD;
  2. Mary E. Cogswell, DrPH;
  3. W. Dana Flanders, MD, ScD;
  4. Yuling Hong, MD, PhD;
  5. Zefeng Zhang, MD, PhD;
  6. Fleetwood Loustalot, FNP, PhD;
  7. Cathleen Gillespie, MS;
  8. Robert Merritt, BA, MA;
  9. Frank B. Hu, MD, PhD

Healthy Habits Associated with Reduced Mortality Risk
People who meet more of the healthy goals recommended by the American Heart Association are less likely to die of cardiovascular causes, according to a JAMA study.
Researchers used NHANES surveys and physical exams of 13,000 people to study the prevalence of seven ideal cardiovascular health factors promoted by the AHA, including:
not smoking;
moderate exercise at least 5 times a week;
untreated blood pressure under 120/80;
HbA1c under 5.7%;
total cholesterol under 200 mg/dL;
BMI less than 25;
a diet high in produce, fish, and whole grains, and low in sodium and sugary beverages.
Less than 2% of people reached all seven ideals. Over a 15-year median follow-up, the proportion meeting zero or one goal increased from 7.2% to 8.8%. Those who met six or seven goals had reduced risks for all-cause mortality (adjusted hazard ratio, 0.49), compared with participants meeting zero or one goal.

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Colon Cancer Screening Guidelines

Wednesday, March 7, 2012 // Uncategorized

The following is a summary from Journal Watch of the American College of Physician’s Guidelines on screening for colorectal cancer.  It’s not a lot of new information.  The main take home point is the upper age consideration for patients who are not at high risk.  This doesn’t include patients who are symptomatic such as someone who is having bleeding.

ACP Issues Guidance on Colorectal Cancer Screening
A guidance statement on screening for colorectal cancer, issued by the American College of Physicians, appears in the Annals of Internal Medicine.
The ACP evaluated four existing U.S. guidelines, and on that basis makes these recommendations:
Clinicians should assess patients’ risk individually.
Patients at average risk should be screened starting at age 50.
Those at higher risk should undergo screening beginning either at age 40 or at 10 years younger than the age at which the youngest relative was diagnosed with colorectal cancer.
No single test is favored over another for average-risk patients, but optical colonoscopy is recommended for those at high risk.
Patients older than age 75 or with a less than 10-year life expectancy should not be screened.

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Why Doctor’s Die Differently

Thursday, March 1, 2012 // Uncategorized

This is an interesting article from the weekend Wall Street Journal.  It reminded me of my father, a pediatrician, who was one of the first hospice patients in San Antonio in 1985.  He died of prostate cancer at age 63.  Doctor’s think of the diseases that they most fear like pancreatic cancer and ALS and wonder what they would do if they were in their patient’s place.

Why Doctors Die Differently

Careers in medicine have taught them the limits of treatment and the need to plan for the end

By KEN MURRAY

Years ago, Charlie, a highly respected orthopedist and a mentor of mine, found a lump in his stomach. It was diagnosed as pancreatic cancer by one of the best surgeons in the country, who had developed a procedure that could triple a patient’s five-year-survival odds—from 5% to 15%—albeit with a poor quality of life.

[DOCTORS] Arthur GironWhat’s unusual about doctors is not how much treatment they get compared with most Americans, but how little.

Charlie, 68 years old, was uninterested. He went home the next day, closed his practice and never set foot in a hospital again. He focused on spending time with his family. Several months later, he died at home. He got no chemotherapy, radiation or surgical treatment. Medicare didn’t spend much on him.

It’s not something that we like to talk about, but doctors die, too. What’s unusual about them is not how much treatment they get compared with most Americans, but how little. They know exactly what is going to happen, they know the choices, and they generally have access to any sort of medical care that they could want. But they tend to go serenely and gently.

Doctors don’t want to die any more than anyone else does. But they usually have talked about the limits of modern medicine with their families. They want to make sure that, when the time comes, no heroic measures are taken. During their last moments, they know, for instance, that they don’t want someone breaking their ribs by performing cardiopulmonary resuscitation (which is what happens when CPR is done right).

 

In a 2003 article, Joseph J. Gallo and others looked at what physicians want when it comes to end-of-life decisions. In a survey of 765 doctors, they found that 64% had created an advanced directive—specifying what steps should and should not be taken to save their lives should they become incapacitated. That compares to only about 20% for the general public. (As one might expect, older doctors are more likely than younger doctors to have made “arrangements,” as shown in a study by Paula Lester and others.)Why such a large gap between the decisions of doctors and patients? The case of CPR is instructive. A study by Susan Diem and others of how CPR is portrayed on TV found that it was successful in 75% of the cases and that 67% of the TV patients went home. In reality, a 2010 study of more than 95,000 cases of CPR found that only 8% of patients survived for more than one month. Of these, only about 3% could lead a mostly normal life.

Unlike previous eras, when doctors simply did what they thought was best, our system is now based on what patients choose. Physicians really try to honor their patients’ wishes, but when patients ask “What would you do?,” we often avoid answering. We don’t want to impose our views on the vulnerable.

The result is that more people receive futile “lifesaving” care, and fewer people die at home than did, say, 60 years ago. Nursing professor Karen Kehl, in an article called “Moving Toward Peace: An Analysis of the Concept of a Good Death,” ranked the attributes of a graceful death, among them: being comfortable and in control, having a sense of closure, making the most of relationships and having family involved in care. Hospitals today provide few of these qualities.

Written directives can give patients far more control over how their lives end. But while most of us accept that taxes are inescapable, death is a much harder pill to swallow, which keeps the vast majority of Americans from making proper arrangements.

It doesn’t have to be that way. Several years ago, at age 60, my older cousin Torch (born at home by the light of a flashlight, or torch) had a seizure. It turned out to be the result of lung cancer that had gone to his brain. We learned that with aggressive treatment, including three to five hospital visits a week for chemotherapy, he would live perhaps four months.

Torch was no doctor, but he knew that he wanted a life of quality, not just quantity. Ultimately, he decided against any treatment and simply took pills for brain swelling. He moved in with me.

We spent the next eight months having fun together like we hadn’t had in decades. We went to Disneyland, his first time, and we hung out at home. Torch was a sports nut, and he was very happy to watch sports and eat my cooking. He had no serious pain, and he remained high-spirited.

One day, he didn’t wake up. He spent the next three days in a coma-like sleep and then died. The cost of his medical care for those eight months, for the one drug he was taking, was about $20.

As for me, my doctor has my choices on record. They were easy to make, as they are for most physicians. There will be no heroics, and I will go gentle into that good night. Like my mentor Charlie. Like my cousin Torch. Like so many of my fellow doctors.

—Dr. Murray is retired clinical assistant professor of family medicine at the University of Southern California. Adapted from an article originally published on Zocalo Public Square.A version of this article appeared Feb. 25, 2012, on page C2 in some U.S. editions of The Wall Street Journal, with the headline: Why Doctors Die Differently.

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