Tuesday, July 23, 2013

Something nasty in the Hudson River

The risk of catching some nasty germ in the Hudson River just started looking nastier. Disease-causing microbes have long been found swimming there, but now researchers have documented antibiotic-resistant strains in specific spots, from the Tappan Zee Bridge to lower Manhattan. The microbes identified are resistant to ampicillin and tetracycline, drugs commonly used to treat ear infections, pneumonia, salmonella and other ailments. The study is published in the current issue of the Journal of Water and Health.
"If you find antibiotic-resistant bacteria in an ecosystem, it's hard to know where they're coming from," said study co-author Andrew Juhl, a microbiologist at Columbia University's Lamont-Doherty Earth Observatory. "In the Hudson, we have a strong case to make that it's coming from untreated sewage."
On repeated visits to 10 locations on the Hudson, the researchers found microbes resistant to ampicillin 84 percent of the time, and resistant to tetracycline 38 percent of the time. The stretches harboring the most sewage-indicator bacteria also generally contained the most antibiotic-resistant ones. These were led by Flushing Bay, near LaGuardia Airport, followed by Newtown Creek, on the border of Brooklyn and Queens; and sewage outfall pipes near Piermont Pier in Rockland County, N.Y.; West 125th Street in Manhattan; and Yonkers, in Westchester County, N.Y.. The antibiotic-resistant bacteria found include potentially pathogenic strains of the genera Pseudomonas, Acinetobacter, Proteus and Escherichia.
"They could be difficult to treat in people with compromised immune systems," said Dr. Stephen Morse, an infectious disease epidemiologist at Columbia's Mailman School of Public Health, who was not involved in the study. "If I were inclined to swim in the Hudson, quite truthfully I'd look to this paper for the places to stay away from."
Though people routinely catch infections while swimming, only severe illnesses are typically treated with antibiotics. And an antibiotic-resistant infection would be noted only if the illness failed to respond to treatment - a scenario that probably happens, but is not well documented or reported, said Morse. One exception was an outbreak on the Indonesian island of Borneo in 2000 when 32 athletes competing in a swimming event in the Segama River came down withleptospirosis. Transmitted by animal urine, the infection is marked by fever, chills and pink eye.
Previous studies in the Hudson have shown that microbe counts go up after heavy rains, when raw sewage is commonly diverted into the river. Some 27 billion gallons of raw sewage and rainwater are released into the Hudson each year by wastewater treatment plants. Lacking the capacity during heavy rains to simultaneously pump runoff from city streets and sewage from buildings, many sewage-treatment plants are forced to divert both streams into the river, in what is known as a combined-sewer overflow, or CSO. In an ongoing partnership with the environmental group Riverkeeper, scientists at Lamont-Doherty and Queens College at the City University of New York have been tracking water quality in the Hudson and making their results public on Riverkeeper's website. Their work has confirmed that CSOs remain a serious problem, even though the Hudson is generally cleaner than it has been in the past.
The Hudson has gotten so much better," said the study's lead author, Suzanne Young, a former student at Lamont and Queens College, now at the University of South Florida. "If we came up with a sustainable solution, water quality could continue to improve."
This is not the first time that antibiotic-resistant bacteria have been found in a river. A 2002 study in the journal Emerging Infectious Diseases found ampicillin-resistant bacteria in the Hudson, as well as 15 other U.S. rivers, including the Mississippi, Ohio and Colorado. However, this is the first study to firmly link specific microbes to sewage in the Hudson, and to compare results at different locations.
It is not just a matter of swimming safely. Rivers can incubate bacteria, allowing them to transfer their drug-resistant genes to normal bacteria. "If these resistant genes are transferred, they can develop into disease-causing bacteria," said Ronald J. Ash, a microbiologist and professor emeritus at Washburn University, lead author of the 2002 paper.
Bacteria can also play an important role in the environment. As more antibiotic-resistant microbes replace native bacteria, those changes could eventually have an impact on plants and animals. "Microbial communities can affect the health of the entire ecosystem," said Young, who is now studying how Mississippi water snakes respond to infection with antibiotic-resistant pathogens.
Antibiotic resistance has become a public health crisis. About 100,000 people die each year from hospital-acquired infections, most of which are due to antibiotic-resistant pathogens, according to the Infectious Diseases Society of America. Superbugs resistant to methicillin kill about 19,000 people each year, more than HIV/AIDS. The development of resistance has been linked to overuse of antibiotics to treat minor infections in humans, and to industrial feedlots, where low levels of antibiotics are fed to chicken, cattle and pigs to promote growth and prevent infection. The Natural Resources Defense Council estimates that 80 percent of antibiotics in the U.S. are fed to livestock.
There are signs that the tide is turning, at least in the Hudson. In a landmark deal with the state, New York City agreed last year to spend $187 million to replace some parking lots and city streets with porous pavement, and to plant more vegetation on rooftops and other impervious surfaces to reduce runoff. An additional $2.4 billion will be spent on infrastructure to eliminate 1.5 billion gallons of CSOs by 2030. "There's now a timeline for answering the question, 'How much sewage overflow reduction is needed and when?' " said Larry Levine, a senior attorney at the Natural Resources Defense Council, which pushed for the settlement.
Public awareness may also help. In 2012, New York Gov. Andrew Cuomo signed the Sewage Pollution Right to Know Law requiring public notification of sewage spills in New York waters. Not long after the law passed, Westchester County announced a "controlled discharge" at Sleepy Hollow, sparking a debate about whether the National Ironman competition should cancel its swimming leg 15 miles to the south. (The swim went ahead as planned).
"The results from this study are significant because they help us to understand the processes involved in the spread of antibiotic resistant bacteria through the environment, but also because they provide added incentive to reduce sewage pollution into our waterways" said coauthor Gregory O'Mullan, a microbiologist with joint appointments at Lamont and Queens College who oversees the laboratory where the study was done

New mosquito patch in fight against malaria and West Nile virus

A new mosquito-beating patch is being developed in California that, if successfully rolled out in Africa, could help prevent illnesses such as malaria, West Nile virus and dengue fever.
The Kite patch adheres to clothing, much like a sticker, and uses FDA-approved, non-toxic compounds that block a mosquito's ability to track humans for 48 hours.
The sticker was created by a team based in Riverside, CA, after 7 years of research and development by Olfactor Laboratories, Inc. and the University of California, Riverside.
The company behind the patch, ieCrowd, employed designers to make it withstand tough conditions. The product website for the sticker claims it is "perfectly suited for children in Uganda, professional athletes, families on the soccer field, outdoor enthusiasts, and workers in the suburbs of Manila."
Since mosquitos track humans through carbon dioxide release, the company notes that the Kite should work on all types of mosquitos, citing preliminary field trials that show the patch's effectiveness on many different species of mosquitos.
Though the patch should not replace mosquito nets at night in high-risk areas, the patch is being promoted as a replacement for sprays or lotions currently on the market.

Malaria is a global problem

Humans become infected with malaria when a mosquito carrying the parasite transfers it to the bloodstream through a bite in the skin.
Kite patch
The Kite adheres to clothing like a sticker. For up to 48 hours it can block mosquitos' ability to track humans via carbon dioxide.
According to the Centers for Disease Control and Prevention (CDC), around 219 million people had malaria in 2010 and 660,000 of these people died. Africa was hit the hardest, with 91% of all malaria deaths happening on that continent.
In the US, there are around 1,500 cases of malaria each year, most of which involve people who have traveled to Africa and South Asia.
Symptoms of malaria infection includefever, chills and flu-like illness. If left untreated, sufferers of malaria can eventually die from complications.
The direct costs of malaria - those relating to illness, treatment and premature death - are around $12 billion each year, according to the makers of the Kite. The company claims that costs relating to lost economic growth "are many times more."

Prevention is key for mosquito-borne illnesses

While malaria kills a large number of people each year, it is easily preventable. We know where it comes from (mosquitoes) and we know how to avoid these insects (using nets and repellants).
Grey Frandsen, the project lead and chief marketing officer at ieCrowd, is a surviver of malaria himself. He says:
"We want this small patch to change people's lives. We're designing Kite to deliver everyone protection from mosquitoes, no matter where they are in the world.
It will provide a new level of protection for children in Uganda, for young families in South Africa, and hikers in Seattle or Wyoming or Florida seeking a safer, socially-responsible solution.
We built Kite to be simple and affordable - a small colorful sticker that will appeal to children and adults and survive the rigors of extreme climates, play time, or outdoor recreation."
The company recently launched a crowdfunding campaign to help their first roll out of the potentially life-saving product in Uganda. They will continue to test the patch there, where communities have the highest need for a solution.
A recent study showed that malaria-carrying mosquitos are more strongly attracted to the smell of humans, which is why a patch that blocks their ability to find us in the first place could be an effective weapon against malaria.

Surgeon's smart knife detects cancer cells in tumor operations

When surgeons remove tumor tissue they try to leave a "margin" of healthy tissue to ensure all the cancer is removed. Sometimes this means the patient has to remain under general anaesthetic for another 30 minutes or so while tissue samples are sent for analysis to check if the margin is clear. Even then, it is still possible that some cancerous tissue remains, and the patient has to undergo further surgery to remove it.
Now, a new technique based on an "intelligent knife," called the "iKnife," promises to remove the need for lab analysis and the accompanying delay, and it also helps avoid repeat surgeries.
The iKnife sniffs the "smoke" created by the electrosurgical removal of cancerous tissue and tells the surgeon almost immediately if the tissue it has come from is healthy or cancerous.
This first study appears online this week in Science Translational Medicine, in which the iKnife is tested in the operating room.
In tissue samples from 91 patients, researchers at Imperial College London using the iKnife achieved 100% accuracy in diagnosing whether the samples were cancerous or not.
Study author Dr. Zoltan Takats is the inventor of the iKnife. Asked if his new surgical tool would be confined to use in only certain types of cancer, he told Medical News Today:
"It is a generally applicable tool, we believe it will be useful for many different types of cancer surgeries."
On the question of cost-effectiveness, Dr. Takats told us:
"We believe that it will be a cost-saver - due to elimination of intraoperative histology, shorter intervention times and lower rate of re-operations."

iKnife combines electrosurgery with new mass spectrometry techniques

The iKnife is a combination of an established technology called electrosurgery that was invented in the 1920s and a new technology that is still emerging, called rapid evaporative ionization mass spectrometry (REIMS).
In electrosurgery, the surgeon's knife delivers an electric current that heats the target tissue and cuts through it while causing minimum loss of blood.
The heat from the current vaporizes the tissue, which gives off a smoke that is normally sucked away with an extractor.
The mass spectrometer technology behind REIMS almost instantly identifies the chemicals present in human tissue by analyzing the smoke that is released during electrosurgery.
Cells produce thousands of metabolites in various concentrations, depeding on their cell type. So once the REIMS technology is primed with the profiles of healthy and cancerous cells, it can rapidly use these to screen the sample of smoke and inform the surgeon whether it is from a tumor or healthy tissue.
The iKnife being used by a surgeon
The iKnife device "sniffs" smoke created when cancerous tissue is surgically removed, and it then determines whether the tissue is cancerous or healthy. Photo: Imperial College London

iKnife relies on a library of chemical profiles

In the first stage of the study, the researchers created a reference library of chemical profiles consisting of both healthy and cancerous tissue types for the iKnife. They collected samples from surgery patients, taking note of the characteristics of thousands of cancerous and non-cancerous tissues, including brain, lung, breast, stomach, colon and liver tumors.
In the second stage of the study, the team transferred the technology to the operating room and tested it on 91 patients. In all cases, the iKnife correctly identified the tissue type. The results were confirmed with lab tests on the samples after surgery.

Results delivered in under 3 seconds

By comparing the chemical profile of the tissue it is sampling to the reference library, the iKnife can deliver a result in under 3 seconds, say the researchers.
But for this study, the surgeons carrying out the procedures were not allowed to see the nearly instant readings from the iKnife.
The researchers now hope to run a clinical trial that tests whether giving surgeons access to iKnife readings during operations improves outcomes for patients.
Dr. Takats says in a statement:
"These results provide compelling evidence that the iKnife can be applied in a wide range of cancer surgery procedures."
As the technology delivers almost instant results, it allows "surgeons to carry out procedures with a level of accuracy that hasn't been possible before", he adds, noting that they "believe it has the potential to reduce tumor recurrence rates and enable more patients to survive."

Other applications: "Is this beef or horsemeat?"

Although this latest study uses the iKnife to test cancerous tissue, Takats says there is no reason why it couldn't also be used to test for other features, such as whether there is an adequate blood supply, or to identify types of bacteria in the tissue.
Dr. Takats says he has already used the iKnife to distinguish horsemeat from beef.
He first raised the idea of combining electrosurgery with REIMS from real-time identification of tumor tissues in a paper published in 2009.
Funds from the National Institute for Health Research (NIHR) Imperial Biomedical Research Centre, the European Research Council and the Hungarian National Office for Research and Technology helped finance the study

US life expectancy varies from state to state

Forget about football teams, the new state rivalry is all about life expectancy. A report from the Centers for Disease Control (CDC) breaks down healthy life-expectancy (HLE) by state. Hawaii dominates the list, while Southern states fall short.
The report uses data about mortality, morbidity and health status to estimate the expected number of years lived in good health for people, beginning at age 65. These types of estimates are used around the world to predict future health service needs and to identify trends or inequalities in each country.
Until now, very few studies for the US have broken down healthy life expectancy for each state.

Life expectancy varies by sex and race

For males, HLE estimates at 65 years ranged from a low in Mississippi of 10.1 years, to a high in Hawaii of 15 years. But for females, those numbers were 11.4 years in Mississippi and 17.3 years in Hawaii.
According to the report, healthy years lived beyond age 65 were:
  • Greater for females than for males, and
  • The difference ranged from 0.7 years in Louisiana, to 3.1 years in the Dakotas.
Life expectancy - figure 1 diagram
Healthy life expectancy for males and females in years from age 65, by state, 2007-2009. Source: CDC
In terms of information by race, the study admits that "HLE estimates for Hispanics, Asians, and American Indians/Alaska Natives were not presented because sufficient reliable data were not available at the state level."
The report does, however, analyze the state-by-state numbers for both blacks and whites, and it reveals that HLE was greater for whites than blacks in almost every state, with the exceptions of Nevada and New Mexico. Iowa had the largest difference in HLE between whites and blacks at 7.8 years.

Why the state-by-state difference in life expectancy?

While the CDC says it is not possible to flesh out why some states have a higher or lower HLE, the report does, however, suggest that several factors can influence health status later in life:
  • Safe and healthy living environments
  • Healthy behaviors, such as getting exercise and not smoking
  • Receiving proper clinical preventive services, such as vaccines, screenings and blood pressure checks)
  • Having access to good health care when needed.
  • Life expectancy - figure 2 diagram
    As a general trend, HLE rates from 2007-2009 were lowest in the Southeast, with higher rates dotted in the Southwest, Northeast, Northwest, Florida and Hawaii. Source: CDC
    Knowing which regions are falling behind the health care curve is an important component of improving overall health care in the country. A recent study revealed that the US has fallen behind other wealthy nations on health, which is why understanding these health trends is so vital.

    Prescription drug corruption: GSK admits executives in China broke law

    The UK-based pharmaceutical giant GlaxoSmithKline (GSK) has issued a statement that some of its executive employees have acted "outside of Chinese law." The company gave the announcement after a meeting with Chinese police officers who were investigating accusations of corruption.
    China's Ministry of Public Security has been looking into claims that four executives working for GSK in China have been "using a network of more than 700 travel agencies and other firms to channel bribes to hospitals, doctors and government officials since 2007," according to a report from Hong Kong by CNN Money.
    Abbas Hussain, GSK's president for Europe, Japan, emerging markets and Asia Pacific, said in a company statement:
    "Certain senior executives of GSK China who know our systems well appear to have acted outside of our processes and controls which breaches Chinese law. We have zero tolerance for any behavior of this nature."
    "I want to make it very clear that we share the desire of the Chinese authorities to root out corruption wherever it exists."
    The Chinese police has detained the four Chinese executives from GSK after "accusing the firm of bribing officials and doctors to boost sales and raise drug prices by funneling up to 3 billion yuan ($489 million) to travel agencies," reports Reuters, which says GSK has called the allegations "shameful."
    The Reuters report also cites sources who claim Sir Andrew Witty, GSK's chief executive, will use a quarterly financial results presentation tomorrow, Wednesday, to outline the drug developer's action in response to the alleged bribery, which could include price cuts for drugs sold in China.

    Other pharmaceutical firms hit by China's clampdown

    GSK is not the only drugs company to have been rocked by China's clampdown on the pharmaceutical industry. Another drugs giant, AstraZeneca, has confirmed that a sales representative has been questioned by police in a separate investigation in Shanghai, according to a Bloomberg report.
    Chinese state media has aired claims that travel agencies were used by the GSK employees to set up sometimes non-existent conferences to "allocate money for bribes." State media has implicated Shanghai Linjiang International Travel Agency in the alleged scandal.
    The New York Times says it has documents showing this same travel agency arranged events and conferences with at least six other global pharmaceutical firms in the past 3 years, including Merck, Novartis, Roche and Sanofi. The Times report stresses that the documents "contain no indication of wrongdoing" at these other firms.
    But with China's fast-growing market for pharmaceutical products, its government is widening its investigation into fraud and corruption, and these documents suggest big drugmakers other than GSK could come under the scrutiny of Chinese authorities, the Times report adds.

    Pharmaceutical industry woes in other emerging markets

    Global companies that develop, make and sell innovative medicines have come under fire in other fast-growing markets.
    India's courts, for example, have taken a number of decisions that have opened the way for generic makers of new branded drugs to sell their copies of the originals even before patents have expired.
    Worries about the high cost of branded new drugs in emerging markets have driven such moves to allow the cheaper copies. In India, making generic alternatives of drugs is also big business for the country. The developers of new drugs, meanwhile, argue that driving down drug prices will reduce innovation.

    Eat breakfast for a healthy heart

    A new study appears to confirm that when you eat is just as important for health as what and how much you eat.
    US researchers asked men to complete questionnaires about what they ate and when they ate it, then tracked their health for 16 years. Those who said they skipped breakfast were found to have a higher risk of heart attack or fatal coronary heart disease.
    Lead author Leah Cahill, of the Harvard School of Public Health (HSPH), and colleagues, write about their findings in a July 23rd issue of the American Heart Association journal Circulation.
    In a statement, Leah Cahill, who is a postdoctoral research fellow in the department of nutrition at HSPH, explains what may lie behind the findings:
    "Skipping breakfast may lead to one or more risk factors, including obesity, high blood pressure, high cholesterol and diabetes, which may in turn lead to a heart attack over time."
    For their study the researchers analyzed food frequency questionnaires completed by 26,902 male health professionals aged between 45 and 82 years and tracked their health for 16 years from 1992 to 2008. The men were free of heart disease and cancer at the start of the study.
    Over the follow-up, 1,572 men experienced non-fatal heart attacks or died of coronary heart disease.
    When they analyzed the data the researchers found men who said they did not have breakfast had a 27% higher risk of heart attack or death from coronary heart disease than men who said they ate breakfast.

    Men who skipped breakfast had other risk factors

    The men who said they skipped breakfast tended to be younger, single, smokers, who worked full time, did not do much exercise and drank more alcohol.
    The researchers also found when they adjusted the results to take out the effect of body mass index, high blood pressure, high cholesterol and diabetes, the links between skipping breakfast and higher risk for heart attack or death from coronary heart disease became much weaker: they were no longer statistically significant.
    They note this suggests "eating habits may affect risk of coronary heart disease through pathways associated with these traditional risk factors."
    They also found no links between how many times a day the men said they ate and risk of coronary heart disease.

    Eating late at night linked to heart disease

    They did find a link, however, between eating late at night and coronary heart disease. Compared with men who said they did not eat late at night, among those who did, there was a 55% higher risk of coronary heart disease.
    But the authors note that, judging by the few men in the study who ate late at night, this was unlikely to be a major public health concern.
    Leah Cahill says the message from the study, which reinforces previous research, is: "Don't skip breakfast." Eating a healthy meal at the start of the day is linked to lower risk of heart attacks.

    Breakfast tips

    Incorporate many types of healthy foods into your breakfast, Leah Cahill advises - as this is "an easy way to ensure your meal provides adequate energy and a healthy balance of nutrients, such as protein, carbohydrates, vitamins and minerals."
    If eating a bowl of cereal, try adding nuts and chopped fruit, or steel-cut oatmeal. This is a "great way to start the day," Leah Cahill adds.
    Senior author Eric Rimm, associate professor of medicine at the Harvard Medical School, says the team has spent decades looking at the effects of quality and composition of diet on health, and now this new study suggests overall dietary habits should also be considered in lowering risk of heart disease.
    At a conference in 2012, UK scientists presented a study that explained why people who skip breakfast tend to find high calorie food more appealing later in the day: their brain circuits may be primed toward seeking it when fasting.