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The Flu Is Back. (It Never Really Left).

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Here’s a tip for those who managed to duck the flu’s first punch: Watch out for the next one.

Many communities are experiencing an increase in flu, part of a second wave that is hitting some regions of the country particularly hard, health officials say. Most of the effects are in the northeast — New England, New York and New Jersey –  but some parts of the mid-Atlantic are seeing increased flu activity.

Federal health officials say it’s common for an uptick in flu to occur in March and April. Often, that is caused by an increase in the influenza B virus, a strain different from the ones that dominated earlier in the flu season.

“We are experiencing a second wave of flu, and that second wave is influenza B,” said Lyn Finelli, chief of influenza surveillance and outbreak response at the U.S. Centers for Disease Control and Prevention. “In some communities in the Northeast, they tell us that they’re experiencing more influenza now than during the peak of the flu season in late December and early January.”

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Six states — Connecticut, Delaware, Maine, New Jersey, New York and Rhode Island — reported widespread influenza activity for the week ending April 12, the most recent data available.

In the Washington, D.C., region, doctors and hospitals say they are seeing patients with flu-like illnesses, some of whom are testing positive for influenza B. George Washington University Hospital has had a slight increase in influenza B cases in the past month and a half, said spokesman Steven Taubenkibel. In March, 11 patients tested positive for influenza B; this month, the hospital has had 16 patients test positive for the illness.

This season’s flu vaccine covers two strains of the influenza A virus, including the H1N1 “swine flu” responsible for the 2009 global pandemic, and two strains of influenza B. All four strains were included in the quadrivalent vaccine available for the first time this season. The H1N1 virus has dominated during this flu season, but influenza B viruses now account for the largest proportion of viruses that are circulating, according to the CDC.

Although it may seem odd to get a flu shot in April, health officials said those who haven’t been vaccinated should do so.

The rest of the country is experiencing fairly normal flu activity for this time of year, according to CDC data. For the week ending April 12, 1.5 percent of patient visits to doctors were for flu-like illnesses nationally. But in New York, flu-like illnesses accounted for more than 4 percent of all visits, increasing slightly over the previous week. In New Jersey, those illnesses accounted for more than 3 percent of visits, also edging up from the previous week, the data show.

The second wave of flu typically ends in May. But even into the summer, flu still lingers. “It never completely disappears,” Finelli said.

Source: Washington Post


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As Statins Boost Erectile Function, Adherence May Rise Too

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Among men with high cholesterol and erectile dysfunction, a short course of statin therapy was associated with improvements in both measures, shows a new meta-analysis. The study was presented at the American College of Cardiology (ACC) 2014 Scientific Sessions and simultaneously published online in the Journal of Sexual Medicine

These findings “may improve adherence to statin therapy . . . [because] we know that in primary prevention a large proportion of patients stop talking [a statin] or take a much lower amount than prescribed,” lead investigator Dr John B Kostis (Rutgers Robert Wood Johnson Medical School New Brunswick, NJ) said during a press briefing. For example, in a 90 000-patient study, 35% took less than a quarter of prescribed statins and 60% took less than half, and in an 11 000-patient study, 47% of patients stopped taking the statin, he said.

Erectile dysfunction is often the first sign of CVD, like the canary in the coal mine, Kostis pointed out. “What do you do with a person who has erectile dysfunction? You evaluate them for CVD.”

“Over the years, it’s become apparent that erectile dysfunction is an indication of decreased vascular health in men and is considered by many to be a significant CV risk factor,” moderator Dr Jeffrey Kuvin (Tufts Medical Center, Boston, MA) echoed. “Whether erectile function improves due to a reduction in LDL-C or perhaps other pleiotropic effects of statins still remains unclear. I think [this] meta-analysis strongly shows that statin therapy improves erectile dysfunction after only a short duration of therapy.”

Erectile dysfunction affects an estimated 18 to 30 million American men, more often after age 40, and common causes include heart disease, high cholesterol, high blood pressure, diabetes, obesity, tobacco use, depression, and stress, according to an ACC statement.

Many older men have erectile dysfunction along with diabetes and atherosclerotic disease, for which they are frequently prescribed statins, Kostis noted. Previous research has suggested, however, that statin therapy may lower testosterone levels.

The investigators searched for randomized controlled trials that examined the effect of statin therapy on erectile function. They identified 11 such trials in which men completed the International Inventory of Erectile Function survey, which consists of five questions, each scored on a five-point scale, where low values represent poor sexual function.

The trials had an average of 53 patients per study, for a total of 647 patients. Men had an average age of 57.8 years and received statins for about 3.8 months.

During this time, average LDL-C levels dropped significantly from 138 to 91 mg/dL in the treated men but were virtually unchanged in control groups.

In men who took statins, erectile-function scores increased by 3.4 points, from 14.0 to 17.4 points—a 24.3% increase. The increase in erectile-function score was about one-third to one-half of that reported with phosphodiesterase inhibitors, such as sildenafil (Viagra, Pfizer), tadalafil (Cialis, Lilly), or vardenafil (Levitra, Bayer/GlaxoSmithKline), and larger than the effect of lifestyle modification or testosterone, Kostis said.

Some people have called statins a “double-edged sword,” he noted. On one hand, they improve endothelial function, which may improve blood flow to the penis; but on the other hand, they lower the level of cholesterol, a precursor of testosterone. However, these 11 studies showed that “the beneficial effect [of statins on erectile dysfunction] predominates.”

Strengths of the meta-analysis were that it included all published randomized trials about the topic, and the benefit remained after multiple sensitivity analyses. However, limitations were the inclusion of small studies with few participants and diverse statins, treatment duration (1.5 to six months), and patient types.

“A well-powered, placebo-controlled trial with a factorial design (for example, phosphodiesterase inhibitors, testosterone, and statin) would clarify the effect of statins in relevant patient subsets,” Kostis concluded. These drugs are not recommended as a primary treatment for erectile dysfunction in patients with normal cholesterol levels, he cautioned—another potential area for further rigorous research.

Source: Medscape


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Diet Safety Alert: FDA Sends Warning to Maker of CRAZE Dietary Supplement

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A popular and controversial sports supplement widely sold in the USA and other countries is secretly spiked with a chemical similar to methamphetamine that appears to have its origins as an illicit designer recreational drug, according to new tests by scientists in the USA and South Korea.

The test results on samples of Craze, a pre-workout powder made by New York-based Driven Sports and marketed as containing only natural ingredients, raise significant health and regulatory concerns, the researchers said. The U.S. researchers also said they found the same methamphetamine-like chemical in another supplement, Detonate, which is sold as an all-natural weight loss pill by another company: Gaspari Nutrition.

“These are basically brand-new drugs that are being designed in clandestine laboratories where there’s absolutely no guarantee of quality control,” said Pieter Cohen, an assistant professor at Harvard Medical School and a co-author of the analysis of Craze samples being published today in the peer-reviewed scientific journal Drug Testing and Analysis.

“It has never been studied in the human body,” Cohen warned. “Yes, it might make you feel better or have you more pumped up in your workout, but the risks you might be putting your body under of heart attack and stroke are completely unknown.”

Craze, which is marketed as giving “unrelenting energy and focus” in workouts, was named 2012’s “New Supplement of the Year” by Bodybuilding.com. A USA TODAY investigation published in July reported on other tests detecting amphetamine-like compounds in Craze.

While Walmart.com and several online retailers have stopped selling Craze in the wake of USA TODAY’s investigation, the product has continued to be sold elsewhere online and in GNC stores. In recent weeks, Driven Sports’ website, which offers Craze for sale, has said the product is out of stock. Detonate is sold by a variety of online retailers.

An attorney for Driven Sports, Marc Ullman, said the company had no comment on the latest findings that the compounds are actually more closely related to methamphetamine.

Cohen said researchers informed the FDA in May about finding the new chemical compound in Craze. The team found that the compound — N,alpha-diethylphenylethylamine — has a structure similar to methamphetamine, a powerful, highly addictive, illegal stimulant drug. They believe the new compound is likely less potent than methamphetamine but greater than ephedrine.

“There are suggestions about how it’s tweaked that it should not be as addictive as meth,” Cohen said. But because it hasn’t been studied, he said, its dangers aren’t known. The team said it began testing Craze in response to several failed urine drug tests by athletes who said they had taken Craze.

Driven Sports has issued repeated statements in recent months that Craze does not contain any amphetamine-like compounds, including posting test results on its website that it says prove the product is clean. In July, a USA TODAY investigation revealed that a top Driven Sports official — Matt Cahill — is a convicted felon who has a history of selling risky dietary supplements, including products with ingredients linked to severe liver injury and at least one death. Cahill is currently facing federal charges in California involving his introduction of another supplement, Rebound XT, to the market in 2008 that contained an estrogen-reducing drug, and this spring a grand jury was also investigating, USA TODAY has reported.

The newspaper’s investigation, which focused on several products sold over the years by Cahill’s changing series of companies, reported that tests by the U.S. Anti-Doping Agency in June 2012 and a government-affiliated forensic lab in Sweden in April 2013 had detected undisclosed amphetamine-like compounds in samples of Craze.

A month after USA TODAY published its report about Cahill and Craze, a team of South Korean scientists published an article in a journal of the Japanese Association of Forensic Toxicology saying they had found a methamphetamine-like compound in samples of Candy Grape flavor and Berry Lemonade flavor Craze.

The researchers, from the National Forensic Service in South Korea and the National Institute for Public Health and the Environment in the Netherlands, noted that the compound found in Craze was the same as that found in a crystalline powder seized by narcotics agents in December 2011 as a suspected illicit designer drug. In that case the powder was found in an unclaimed lost package shipped from Vietnam to South Korea, according to an earlier journal article published by the team in late 2012. “It appeared that the recipient of this article sought to abuse this chemical in the same way as amphetamines. There is a possibility that this chemical will be widely abused for recreational use in the near future,” they wrote at the time.

Instead, the same team soon found the compound in Craze.

The researchers noted that the compound had been patented in 1988 by Knoll Pharmaceuticals with claims of psychoactive effects, such as enhancing mental activities and pain tolerance. While it was never developed into a medicine, the patent described tests on animals and suggested an intended oral dose of 10 mg to 150 mg, with a target of 30 mg.

A suggested serving size of Craze yielded a dose of the compound of about 23 mg, the Japanese journal article said, and “it could be assumed that NADEP was added to the supplements intentionally for its pharmacological effects without adequate labeling.” The U.S. research team also found the meth-like substance at levels of 21 mg to 35 mg per serving in each of the samples tested from three separate lots of Craze.

Craze’s label does not disclose the compound found by the researchers. Instead it says the product contains dendrobium orchid extract that was concentrated for different phenylethylamine compounds. Phenylethylamines include a variety of chemicals “that range from benign compounds found in chocolate to synthetically produced illicit drugs,” according to the U.S. researchers.

The U.S. researchers noted that an “extensive” search of scientific literature does not find any evidence that the compound listed on Craze’s label has ever been documented as a component of dendrobium orchid extract. The U.S. research team included Cohen; John Travis, a scientist at NSF International, a Michigan-based testing and standards organization that has a dietary supplement certification program; and Bastiaan Venhuis of the National Institute for Public Health and the Environment in the Netherlands.

Although not part of the journal article being published today, NSF International announced that in separate testing they also have detected the same methamphetamine-like compound in the weight-loss supplement Detonate sold by Gaspari Nutrition. “Regulators may want to consider taking action to warn consumers,” NSF International said in a statement. Gaspari markets Detonate as containing “dendrobium extract.”

Last year Driven Sports posted a series of blog items on its website alerting customers that counterfeit versions of Craze were being sold. “Could there be counterfeit products, of course,” Cohen said. “Chances are this is more likely an effort by the manufacturer to distract regulators and consumers from what’s really going on here.”

Source: USA Today

Read more at Food Poisoning Bulletin.


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Global Warming May Lead to More West Nile Virus

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The higher temperatures, humidity and rainfall associated with climate change have intensified outbreaks of West Nile virus infections across the United States in recent years, according to a study published this week.

One of the largest surveys of West Nile virus cases to date links warming weather patterns and increasing rainfall–both projected to accelerate with global warming–to outbreaks of the mosquito-borne disease across 17 states from 2001 to 2005.

The authors predict the pattern will only get worse. “If temperature and precipitation are influential in determining West Nile virus infection risk, such changes would likely increase the burden of this disease in coming decades,” the authors note in the study, published online Monday in the journal Environmental Health Perspectives.

In the study, Jonathan Soverow of the Beth Israel Deaconess Medical Center in Boston and colleagues at Toronto’s Hospital for Sick Children and the Harvard School of Public Health matched more than 16,000 confirmed West Nile cases in 17 states to local meteorological data.

The team found that warmer temperatures had the greatest effect on the virus’ transmission to humans.  Higher humidity, heavier rainstorms and increased precipitation were also tied to higher rates of West Nile virus infection, according to the study.

“A lot of the trends we see depend on local conditions,” said Roger Nasci, an entomologist at the U.S. Centers for Disease Control and Prevention who studies vector-borne diseases but was not involved with the study.  “West Nile virus is a very focal disease.  It’s not uniformly distributed across the U.S.”

West Nile virus led to 43 deaths in 2008 in the United States.  More than 1,300 infections were diagnosed last year, according to the CDC.

Humans can become infected if bitten by a mosquito carrying West Nile virus.  Around 20 percent of infected people show symptoms of the disease, such as fever, headache and nausea.  Of those, about one percent develop neurological symptoms such as numbness, convulsions and paralysis.

Warmer weather helps spread West Nile virus because it extends the length of the mosquito season, said Vicki Kramer, chief of the vector-borne disease section at the California Department of Public Health.

Higher temperatures also let mosquitoes reach biting age sooner and speed multiplication of the virus within insects, said Kramer.  Thus in a warmer climate not only are there more biting mosquitoes, but those mosquitoes carry more copies of the West Nile virus, making them more likely to infect their human targets.

“It takes a while for the disease to build up,” says Kramer.  “That’s why we see more cases in August than in June.”

Rainfall’s effects on mosquitoes and West Nile virus are more complicated, cautioned Bill Landesman, an ecologist at Rutgers University.  For example, although their eggs need standing water to hatch, mosquito populations often flourish after a drought because mosquitoes can re-colonize faster than other insects.

“We’re wrestling with this interplay of abiotic (physical) factors, mosquito populations and the West Nile virus,” said Landesman, “and that sometimes makes things difficult to understand.”
The new study by Soverow’s team may help researchers make sense of some of these complex interactions.

For example, the study found that a single rainstorm resulting in at least two inches of rain could increase infection rates by 33 percent, while smaller storms did not.  Heavy rainfall increases humidity, which can stimulate mosquitoes to bite; it also creates pools of water in which mosquitoes can breed.

Total weekly rainfall had a smaller effect on West Nile virus infections, the study found.  An increase of 0.75 inch of rainfall increased the number of infections by about five percent.

Only a few mosquito species carry the West Nile virus, and each has specific habitat requirements, according to Nasci of the CDC.  Warmer, wetter weather patterns will likely expand the niches of these species.

California health officials have already observed this, as some mosquito species carrying the West Nile virus have extended their ranges into higher elevations and coastal areas as temperatures warmed.

Along with mosquitoes, certain species of birds are reservoirs for the West Nile virus.  Changing weather patterns also affect bird populations, which can impact the number of human infections.

For example, droughts can drive birds into urban areas, making human West Nile virus outbreaks more likely, said Kramer.

Southern states with high home foreclosure rates also face a unique West Nile virus threat, added Kramer and Landesman, since neglected swimming pools act as mosquito breeding grounds.

“The take-home message is that these systems are really complex,” said Landesman.  “Climate changes won’t make them any easier to understand.”

Source: Scientific American


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Are You Programmed to Enjoy Exercise?

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It’s possible that some of us are born not to run. According to an eye-opening new genetics study of lab rats, published in The Journal of Physiology, the motivation to exercise — or not — may be at least partly inherited.

For years, scientists have been bedeviled by the question of why so few people regularly exercise when we know that we should. There are obvious reasons, including poor health and jammed schedules. But researchers have begun to speculate that genetics might also play a role, as some recent experiments suggest. In one, published last year, sets of fraternal and identical adult twins wore activity monitors to track their movements. The results indicated that the twins were more alike in their exercise habits than a shared upbringing alone would explain. Their willingness to work out or sit all day depended to a large extent on genetics, the researchers concluded.

But which genes might be involved and how any differences in the activity of those genes might play out inside the body were mysteries. So scientists at the University of Missouri recently decided to delve into those issues by creating their own avid- or anti-exercising animals.

They accomplished this task by inter-breeding normal rats that had voluntarily run on wheels in the lab. The male rats that had run the most were bred with the female rats that also had run the most; those that had run the least were likewise mated. This scheme continued through many generations, until the scientists had two distinct groups of rats, some of which would willingly spend hours on running wheels, while the others would skitter on them only briefly, if at all.

In their first experiments with these rats, the researchers found some intriguing differences in the activity of certain genes in their brains. In normal circumstances, these genes create proteins that tell young cells to grow up and join the working world. But if the genes don’t function normally, the cells don’t receive the necessary chemical messages and remain in a prolonged, feckless cellular adolescence. Such immature cells cannot join the neural network and don’t contribute to healthy brain function.

In general, these genes worked normally in the brains of the rats bred to run. But their expression was quite different in the non-runners’ brains, particularly in a portion of the brain called the nucleus accumbens, which is involved in reward processing. In humans and many animals, the nucleus accumbens lights up when we engage in activities that we enjoy and seek out.

Presumably as a result, when the scientists closely examined the brains of the two types of rats, they found that by young adulthood the animals bred to run had more mature neurons in the nucleus accumbus than did the non-runners, even if neither group had actually done much running. In practical terms, that finding would seem to indicate that the brains of pups born to the running line are innately primed to find running rewarding; all those mature neurons in the reward center of the brain could be expected to fire robustly in response to exercise.

Conversely, the rats from the reluctant-running line, with their skimpier complement of mature neurons, would presumably have a weaker innate motivation to move.

Those results would be disheartening, except that in the final portion of the experiment the scientists had reluctant runners exercise by setting them on running wheels, while also providing some born-to-run animals with wheels. After six days, the unwilling runners had accumulated far less mileage, about 3.5 kilometers (two miles) per rat, compared to almost 34 kilometers each by the enthusiasts.

But the halfhearted runners’ brains were changing. Compared to others in their family line that had remained sedentary, they now showed more mature neurons in their nucleus accumbens. That part of their brain remained less well developed than among the naturally avid rat runners, but they were responding to exercise in ways that would seem likely to make it more rewarding.

What, if anything, these findings mean for people is “impossible to know at this point,” said Frank Booth, a professor of biomedical sciences at the University of Missouri who oversaw the study. Rat brains are not human brains, and rat motivations are at best opaque.

Even so, Dr. Booth said, his group’s data would seem to suggest “that humans may have genes for motivation to exercise and other genes for motivation to sit on the couch,” and over generations, one set of these genes could begin to predominate within a family. But predispositions are never dictatorial.

“People can decide to exercise,” whatever their inheritance, Dr. Booth said, and, as his study’s final experiment suggests, they could rewire their brains so that moving becomes a pleasure.

Source: New York Times


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April is National Cancer Control Month

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Cancer Control Month celebrates advances in the fight against cancer. These include all aspects of prevention, early detection, and treatment of this devastating disease.

The best way to fight cancer is to find cancer cells early and get rid of them. The earlier cancer is found, the better the prognosis.

Cancer is the second leading cause of death in America, after heart disease. Today, about half of all men and about 1 in every 3 women will develop cancer at some point in their lives.

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However, cancer rates and deaths have been on the decline since the 1990s. We now know ways to prevent cancer from developing. One third of all cancers detected will be related to obesity or being overweight, physical inactivity, and nutrition choices.

While everyone is at risk for cancer, some factors cause certain people to be at greater risk. Age is the greatest risk factor for cancer, with 77% of cancers being detected at age 55 or older. Smokers, heavy drinkers, the physically inactive, those with a poor diet, and those who have had prolonged and unprotected exposure to sunlight are also all at an increased risk for different types of cancers.

At PHC, we provide the most intensive and thorough cancer screening available. Our preventive executive physicals include tests designed to catch cancer in its earliest stages. Each patient receives a personalized program of studies tailored specifically for individual risk factors, including family history. This April, celebrate Cancer Control Month by scheduling your executive physical as soon as possible!

Read more information here.


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Daylight Savings Time Linked to Heart Attacks

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Switching over to daylight saving time, and losing one hour of sleep, raised the risk of having a heart attack the following Monday by 25 percent, compared to other Mondays during the year, according to a new U.S. study released on Saturday.

By contrast, heart attack risk fell 21 percent later in the year, on the Tuesday after the clock was returned to standard time, and people got an extra hour’s sleep.

The not-so-subtle impact of moving the clock forward and backward was seen in a comparison of hospital admissions from a database of non-federal Michigan hospitals. It examined admissions before the start of daylight saving time and the Monday immediately after, for four consecutive years.

In general, heart attacks historically occur most often on Monday mornings, maybe due to the stress of starting a new work week and inherent changes in our sleep-wake cycle, said Dr. Amneet Sandhu, a cardiology fellow at the University of Colorado in Denver who led the study.

“With daylight saving time, all of this is compounded by one less hour of sleep,” said Sandhu, who presented his findings at the annual scientific sessions of the American College of Cardiology in Washington.

A link between lack of sleep and heart attacks has been seen in previous studies. But Sandhu said experts still don’t have a clear understanding of why people are so sensitive to sleep-wake cycles.

“Our study suggests that sudden, even small changes in sleep could have detrimental effects,” he said.

Sandhu examined about 42,000 hospital admissions in Michigan, and found that an average of 32 patients had heart attacks on any given Monday. But on the Monday immediately after springing the clock forward, there were an average of eight additional heart attacks, he said.

The overall number of heart attacks for the full week after daylight saving time didn’t change, just the number on that first Monday. The number then dropped off the other days of the week.

People who are already vulnerable to heart disease may be at greater risk right after sudden time changes, said Sandhu, who added that hospital staffing should perhaps be increased on the Monday after clocks are set forward.

“If we can identify days when there may be surges in heart attacks, we can be ready to better care for our patients,” he said.

The clock typically moves ahead in the spring, so that evenings have more daylight and mornings have less, and returns to standard time in the fall. Daylight saving time was widely adopted during World War I to save energy, but some critics have questioned whether it really does so and whether it is still needed.

Researchers cited limitations to the study, noting it was restricted to one state and heart attacks that required artery-opening procedures, such as stents. The study therefore excluded patients who died prior to hospital admission or intervention.

Source: Reuters