No improvement seen in HIV-associated lymphoma survival during the antiretroviral therapy era

Main Category: Lymphoma / Leukemia / Myeloma
Also Included In: HIV / AIDS
Article Date: 30 Jul 2013 - 0:00 PDT Current ratings for:
No improvement seen in HIV-associated lymphoma survival during the antiretroviral therapy era

Stable survival rates were observed for HIV-associated lymphoma patients during the antiretroviral therapy (ART) era in the US, according to a new study published in the Journal of the National Cancer Institute.

Studies have shown that HIV infection increases the risk of non-Hodgkin lymphoma (NHL) and Hodgkin lymphoma (HL) and that incidence for many lymphoma types has not decreased in the ART era. Furthermore, lymphoma is the most frequent cancer-related cause of death among HIV-infected persons. However, trends in presentation and survival have not been investigated among HIV-associated lymphoma patients in routine care since the beginning of the ART era.

Satish Gopal, M.D., M.P.H., from the Program in Global Oncology at the Lineberger Comprehensive Cancer Center of the University of North Carolina, and colleagues compared differences in presentation and survival, across histologic subtypes and diagnosis years, among HIV-infected lymphoma patients. They also examined predictors of death in this population. Data from 476 HIV-associated lymphoma patients living in the US who were diagnosed with various types of lymphoma including HL, diffuse large B-cell lymphoma (DLBCL), Burkitt lymphoma (BL), primary central nervous system lymphoma (PCNSL), and other types of NHL, between 1996 and 2010 were analyzed using various statistical methods.

Their results demonstrate that HIV-associated lymphoma is heterogeneous and changing since the ART era began. Clinical presentations across the different lymphoma subtypes was highly variable during the study period (79 HL, 201 DLBCL, 56 BL, 54 PCNSL, and 86 with other NHL). Histologic shifts in the proportion of BL vs other NHL subtypes is increasing consistent with other reports. Data showed that more recently diagnosed patients were older and more likely to be male, of nonwhite/nonblack ethnicity (primarily Latino patients), to be men who have sex with men, and to have prior AIDS-related illness. They were also more likely to be on ART at lymphoma diagnosis with higher CD4 counts and better HIV control. The authors also report that more recent diagnosis year was not associated with decreased mortality and that 61.6% of patients with HIV-associated HL were alive 5 years after lymphoma diagnosis, compared with 50.0% for BL, 44.1% for DLBCL, 43.3% for other NHL, and 22.8% for PCNSL. Of note, lymphomas occurring on ART were associated with a doubling of mortality, which may suggest important biologic differences between tumors developing on and off ART, although these results require confirmation.

Gopal and colleagues conclude, "These results highlight an ongoing need to elucidate lymphoma biology and optimize treatments for this challenging population to reduce deaths from one of the leading causes of mortality in the modern ART era."

Article adapted by Medical News Today from original press release. Click 'references' tab above for source.
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In an accompanying editorial, Kieron Dunleavy, M.D., and Wyndham H. Wilson, M.D., Ph.D., from the Metabolism Branch of the Center for Cancer Research at the National Cancer Institute, state the findings reflect the shifting demographics of the HIV epidemic in the US. However, the shift towards more biologically favorable and curable types of lymphoma has not resulted in improved survival over the study period. They assert, "In conclusion, because HIV-associated lymphomas are potentially as curable as those arising in HIV-negative patients, it is critical that they be approached with the same care as HIV negative cases."

Journal of the National Cancer Institute

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Preventing nerve injury during thyroid surgery by routine exposure of recurrent laryngeal nerve

Main Category: Ear, Nose and Throat
Also Included In: Endocrinology;  Neurology / Neuroscience
Article Date: 25 Jul 2013 - 1:00 PDT Current ratings for:
Preventing nerve injury during thyroid surgery by routine exposure of recurrent laryngeal nerve

Recurrent laryngeal nerve injury is the most common serious complication of thyroid surgery. Therefore, preventing recurrent laryngeal nerve injury is an important goal in thyroid surgery.

A retrospective clinical controlled study from Xinhua Hospital, Shanghai Jiao Tong University School of Medicine demonstrates that dissecting the recurrent laryngeal nerve during thyroid surgery is clinically significant for preventing nerve injury.

To determine the value of dissecting the recurrent laryngeal nerve during thyroid surgery with respect to preventing recurrent laryngeal nerve injury, this study retrospectively analyzed clinical data from 5 344 patients undergoing thyroidectomy. Among these cases, 548 underwent dissection of the recurrent laryngeal nerve, while 4 796 did not. There were 12 cases of recurrent laryngeal nerve injury following recurrent laryngeal nerve dissection (injury rate of 2.2%) and 512 cases of recurrent laryngeal nerve injury in those not undergoing nerve dissection (injury rate of 10.7%). This difference remained statistically significant between the two groups in terms of type of thyroid disease, type of surgery, and number of surgeries.

Among the 548 cases undergoing recurrent laryngeal nerve dissection, 128 developed anatomical variations of the recurrent laryngeal nerve (incidence rate of 23.4%), but no recurrent laryngeal nerve injury was found. In addition, the incidence of recurrent laryngeal nerve injury was significantly lower in patients with the inferior parathyroid gland and middle thyroid veins used as landmarks for locating the recurrent laryngeal nerve compared with those with the entry of the recurrent laryngeal nerve into the larynx as a landmark.

Among the 548 cases, seven of the 442 cases (1.6%) with the inferior parathyroid gland as a landmark for locating recurrent laryngeal nerves showed recurrent laryngeal nerve injury; two of the 79 cases (2.5%) with the middle thyroid vein as a landmark were injured; and three of the 27 cases (11.1%) with the recurrent laryngeal nerve into the larynx as the landmark showed recurrent laryngeal nerve injury.

These findings were published in Neural Regeneration Research (Vol. 8, No. 17, 2013).

Article adapted by Medical News Today from original press release. Click 'references' tab above for source.
Visit our ear, nose and throat section for the latest news on this subject.

Article: " Routine exposure of recurrent laryngeal nerve in thyroid surgery can prevent nerve injury " by Chenling Shen, Mingliang Xiang, Hao Wu, Yan Ma, Li Chen, Lan Cheng (Department of Otolaryngology & Head and Neck Surgery, Ear Institute, Xinhua Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200092, China)

Shen CL, Xiang ML, Wu H, Ma Y, Chen L, Cheng L. Routine exposure of recurrent laryngeal nerve in thyroid surgery can prevent nerve injury. Neural Regen Res. 2013;8(17):1568-1575.

Full text: http://www.sjzsyj.org:8080/Jweb_sjzs/CN/article/downloadArticleFile.do?attachType=PDF&id=625

Neural Regeneration Research

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Device measures changes in breath acetone concentrations as fat is burned during weight loss

Main Category: Obesity / Weight Loss / Fitness
Also Included In: Diabetes;  Medical Devices / Diagnostics
Article Date: 26 Jul 2013 - 1:00 PDT Current ratings for:
Device measures changes in breath acetone concentrations as fat is burned during weight loss

Fitness fanatics may soon be able to gauge if their hard work is paying off without the need for weighing scales thanks to a new device that can instantly tell if your body is burning fat.

The portable, pocket-sized sensor, produced by a group of researchers in Japan, works by measuring increased levels of acetone on the breath - a good indicator of when the body has begun to break down fat.

The device has been presented in IOP Publishing's Journal of Breath Research.

Acetone is primarily produced in the blood when fat is broken down; however, it is also expelled through tiny sacs, called alveoli, in the lungs during exhalation and is therefore present in exhaled breath.

This new device, which is capable of detecting acetone concentrations in the range of 0.2 to 50 parts-per-million, is just 10 cm long, weighs 125 g and requires two AA batteries to operate.

Developed by a group of researchers from NTT DOCOMO Research Laboratories, the device consists of a pressure sensor to detect the exhaled breath and two types of semiconductor-based gas sensors to detect acetone.

After a user blows into the device, the acetone concentration levels can be calculated and sent to a smartphone, either by Bluetooth or a cable, within 10 seconds.

In their study, the researchers recruited 17 healthy adult volunteers (11 men and six women), whose body mass indexes (BMIs) were above the Japanese standard, to test the device.

The volunteers were split into three groups, the first of which carried on with their normal life and were not restricted to a specific numbers of calories in their diet and not required to take part in exercise.

The second group were required to take part in light exercise, such as jogging or fast walking, for 30-60 minutes a day and the final group were required to take part in the same exercise routine and also consume a limited number of calories in their diet each day.

The experiment lasted 14 days and on each day before breakfast, the volunteers were required to measure their body weight, body fat percentage and breath acetone concentrations using the portable device and a standard instrument for comparison.

Results showed that the volunteers in the first two groups - those leading a normal life and those performing daily exercise- were not able to lose significant amounts of fat. Their breath acetone concentrations also remained constant.

The volunteers in the third group who followed the exercise regime and had their calorific intake restricted were able to lose significant amounts of fat and their breath acetone concentrations were increased significantly.

Principal investigator of the study, Satoshi Hiyama, said: "Because obesity increases the risk of lifestyle-related illnesses, enabling users to monitor the state of fat burning could play a pivotal role in daily diet management. Current standard methods, however, are still not practically suitable for point-of-care instrumentation for diet-conscious people who wish to monitor their own fat metabolism at home or outside."

"Considering that the effect of dieting could be estimated from changes in breath acetone concentrations, we've shown that our prototype is a practical and alternative cer that can be used in individual dieting programmes."

"It is also known that when diabetes is out of control, patients have elevated levels of breath acetone. It is possible that our prototype could be used to assess how diabetic control is being managed at home."

Article adapted by Medical News Today from original press release. Click 'references' tab above for source.
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Smoking during pregnancy linked to child conduct disorder

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Academic Journal
Main Category: Pregnancy / Obstetrics
Also Included In: Smoking / Quit Smoking
Article Date: 24 Jul 2013 - 13:00 PDT Current ratings for:
Smoking during pregnancy linked to child conduct disorder

Mothers who smoke during pregnancy are more likely to have children with conduct disorder (CD), according to a study published in the journal JAMA Psychiatry.

The study, carried out by researchers at the University of Leicester in the UK, analyzed the relationship between smoking during pregnancy and the risk of the child developing CD.

CD is a behavioral problem where a child can become highly aggressive, antisocial and defiant.

There are two types of the disorder:

Early onset CD occurs when a child shows symptoms of the disorder before the age of 10, and is often associated to ADHD (attention deficit hyperactivity disorder) Adolescent-onset is the most common type of this disorder, when the child shows CD symptoms after the age of 10. This often occurs alongside ADHD.

Researchers compared three studies for this latest research. The Christchurch Health and Development Study (CHDS), which includes biological and adopted children; the Early Growth and Development Study (EGDS), an adoption-at-birth study; and the Cardiff IVF (In Vitro Fertilization) Study (C-IVF), an adoption-at-conception study within genetically related families and genetically unrelated families.

The researchers looked at the levels of smoking during pregnancy, which were measured by the average number of cigarettes pregnant mothers smoked each day. This varied across all three studies.

Results revealed that children had a higher risk of developing CD if their mothers smoked during pregnancy, compared with mothers who did not smoke. This was the finding in both the children who were reared by genetically related mothers and those reared by genetically unrelated mothers.

Additionally, mothers who smoked more than 10 cigarettes a day had an even higher risk of their child developing CD.

Darya Gaysina of the University of Leicester says:

"Our findings suggest an association between pregnancy smoking and child conduct problems that is unlikely to be fully explained by postnatal environmental factors (for example, parenting practices) even when the postnatal passive genotype-environment correlation has been removed.

The causal explanation for the association between smoking in pregnancy and offspring conduct problems is not known but may include genetic factors and other prenatal environmental hazards, including smoking itself."

The study authors conclude that further research is needed, looking particularly at psychopathologic conditions to fully understand the association between smoking during pregnancy and conduct disorder.

The authors add that this could have important implications for future intervention and prevention programs aimed at remediating child conduct problems.

Previous studies have suggested that smoking during pregnancy can lead to ADHD. Research from Cincinnati Children's Hospital Medical Center revealed that a child is 2.5 times more likely to develop ADHD if their mother smoked during pregnancy.

Written by Honor Whiteman

Copyright: Medical News Today
Not to be reproduced without permission of Medical News Today Visit our pregnancy / obstetrics section for the latest news on this subject.

Maternal Smoking During Pregnancy and Offspring Conduct Problems: Evidence From 3 Independent Genetically Sensitive Research Designs, JAMA Psychiatry, July 24, 2013.

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Superbug Infections Found During Admission Screenings In Virginia

Main Category: MRSA / Drug Resistance
Also Included In: Infectious Diseases / Bacteria / Viruses;  Public Health
Article Date: 11 Jul 2013 - 1:00 PDT Current ratings for:
Superbug Infections Found During Admission Screenings In Virginia

Antibiotic-resistant superbugs like carbapenem-resistant Enterobacteriaceae (CRE) present a challenge to healthcare professionals as patients move from different care settings and facilities, unknowingly spreading healthcare-associated infections. In a new study, researchers screened all patients for CRE at admission to a long-term acute care hospital (LTACH). They found patients colonized with CRE coming into the LTACH from hospitals, but they also found transmission occurring among patients in the LTACH. LTACHs provide similar care as hospitals but focus on patients who, on average, stay more than 25 days.

The findings of this study provide an indication of the prevalence of CRE in hospitalized patients in one specific region, as well as the frequency of transmission based on transitions between healthcare facilities. The study is published in the August issue of Infection Control and Hospital Epidemiology, the journal of the Society for Healthcare Epidemiology of America.

"Identification of asymptomatic CRE carriers admitted to LTACHs may help identify patients who could benefit from interventions that reduce risks for subsequent CRE transmission and break cycles of resistance that develop when patients move between healthcare facilities," said Costi Sifri, MD, an author of the study.

Recent research has shown that LTACHs can play important roles in the regional transmission of CRE. These facilities are reservoirs of healthcare-associated infections, since patients admitted to these facilities are highly susceptible to CRE colonization due to risk factors such as complex medical conditions, extended hospitalizations, invasive medical devices and unnecessary antibiotic use.

Researchers at the University of Virginia Health System prospectively screened patients admitted to a 40-bed central Virginia LTACH for CRE colonization. Additionally, weekly surveillance for CRE was performed on all patients in the facility. During the 24-month study period, 262 patients received care at the LTACH and 20 had positive CRE cultures.

The investigators identified six patients positive for CRE on admission who had no known history of CRE infection or colonization. Two of these patients were admitted from the affiliated academic hospital and four were admitted from four separate regional hospitals.

Additionally, six patients had a prior history of CRE colonization or infection and seven patients had no known history of CRE infection or colonization, but tested positive during hospitalization.

In a commentary published alongside the study, L. Silvia Munoz-Price, MD, Associate Professor of Medicine at University of Miami notes "healthcare professionals who work in this field are concerned with the inter-facility, inter-regional, and inter-continental spread of CREs. However, we are attempting to solve a population health problem by using snapshots of what occurs in our own hospitals or within a limited set of facilities where we have professional networks - over simplifications are hindering us from determining the extent in which all the contributing factors are affecting this dynamic population model."

Article adapted by Medical News Today from original press release. Click 'references' tab above for source.
Visit our mrsa / drug resistance section for the latest news on this subject.

Jessica D. Lewis, Matthew Bishop, Brenda Heon, Amy J. Mathers, Kyle B. Enfield, Costi D. Sifri. "Admission Surveillance for Carbapenamase-Producing Enterobacteriaceae at a Long-TermAcute Care Hospital." Infection Control and Hospital Epidemiology 34:8 (August 2013).

Society for Healthcare Epidemiology of America

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Superbug Infections Found During Admission Screenings In Virginia

Main Category: MRSA / Drug Resistance
Also Included In: Infectious Diseases / Bacteria / Viruses;  Public Health
Article Date: 11 Jul 2013 - 1:00 PDT Current ratings for:
Superbug Infections Found During Admission Screenings In Virginia

Antibiotic-resistant superbugs like carbapenem-resistant Enterobacteriaceae (CRE) present a challenge to healthcare professionals as patients move from different care settings and facilities, unknowingly spreading healthcare-associated infections. In a new study, researchers screened all patients for CRE at admission to a long-term acute care hospital (LTACH). They found patients colonized with CRE coming into the LTACH from hospitals, but they also found transmission occurring among patients in the LTACH. LTACHs provide similar care as hospitals but focus on patients who, on average, stay more than 25 days.

The findings of this study provide an indication of the prevalence of CRE in hospitalized patients in one specific region, as well as the frequency of transmission based on transitions between healthcare facilities. The study is published in the August issue of Infection Control and Hospital Epidemiology, the journal of the Society for Healthcare Epidemiology of America.

"Identification of asymptomatic CRE carriers admitted to LTACHs may help identify patients who could benefit from interventions that reduce risks for subsequent CRE transmission and break cycles of resistance that develop when patients move between healthcare facilities," said Costi Sifri, MD, an author of the study.

Recent research has shown that LTACHs can play important roles in the regional transmission of CRE. These facilities are reservoirs of healthcare-associated infections, since patients admitted to these facilities are highly susceptible to CRE colonization due to risk factors such as complex medical conditions, extended hospitalizations, invasive medical devices and unnecessary antibiotic use.

Researchers at the University of Virginia Health System prospectively screened patients admitted to a 40-bed central Virginia LTACH for CRE colonization. Additionally, weekly surveillance for CRE was performed on all patients in the facility. During the 24-month study period, 262 patients received care at the LTACH and 20 had positive CRE cultures.

The investigators identified six patients positive for CRE on admission who had no known history of CRE infection or colonization. Two of these patients were admitted from the affiliated academic hospital and four were admitted from four separate regional hospitals.

Additionally, six patients had a prior history of CRE colonization or infection and seven patients had no known history of CRE infection or colonization, but tested positive during hospitalization.

In a commentary published alongside the study, L. Silvia Munoz-Price, MD, Associate Professor of Medicine at University of Miami notes "healthcare professionals who work in this field are concerned with the inter-facility, inter-regional, and inter-continental spread of CREs. However, we are attempting to solve a population health problem by using snapshots of what occurs in our own hospitals or within a limited set of facilities where we have professional networks - over simplifications are hindering us from determining the extent in which all the contributing factors are affecting this dynamic population model."

Article adapted by Medical News Today from original press release. Click 'references' tab above for source.
Visit our mrsa / drug resistance section for the latest news on this subject.

Jessica D. Lewis, Matthew Bishop, Brenda Heon, Amy J. Mathers, Kyle B. Enfield, Costi D. Sifri. "Admission Surveillance for Carbapenamase-Producing Enterobacteriaceae at a Long-TermAcute Care Hospital." Infection Control and Hospital Epidemiology 34:8 (August 2013).

Society for Healthcare Epidemiology of America

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'Superbug Infections Found During Admission Screenings In Virginia'

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