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The sequencing of nearly 100 full genomes from three successive epidemics of flesh-eating bacteria have given scientists the first clear picture of the biological events that contribute to deadly epidemics of severe infection.

The approach can be used to track and help prevent major epidemics in the future, the American and Canadian researchers said.

“The extensive full-genome data provide us with new clues about the bacteria’s ability to take advantage of vulnerabilities in the person who has contracted the bacteria,” Dr. James M. Musser, co-director of the Methodist Hospital Research Institute in Houston and the study’s senior author, said in a hospital news release.

“With this type of unique molecular portrait of the bacterial pathogen, we can more effectively develop drugs to prevent the spread of epidemics and construct novel diagnostic and treatment strategies,” Musser explained.

A study co-author, Dr. Donald Low, chief microbiologist at Mount Sinai Hospital in Toronto, said in the news release that “until now it has been a mystery why sometimes we see two opposing types of infection in patients who appear to have the same strain of flesh-eating bacteria.”

“In some cases, patients suffer from a devastating infection of tissue and muscle requiring extensive surgery, and other patients present with a skin infection readily treated with antibiotics,” Low said. “Now, we understand in part why this happens.”

The study were published online Jan. 25 in the Proceedings of the National Academy of Sciences.

Harsh cleaning chemicals and wooden toilet seats — especially those with varnishes and paints — may be among the reasons why U.S. cases of toilet seat-related skin irritations among children appear to be increasing, researchers say.

Children can develop toilet seat dermatitis after repeated exposure to residue from harsh cleaning chemicals or after several uses of a wooden seat, said Dr. Bernard Cohen, director of pediatric dermatology at Johns Hopkins Children’s Center, and colleagues.

The researchers analyzed five cases of toilet seat dermatitis among children in India and the United States, and report their findings in the February issue of the journal Pediatrics.

“Toilet seat dermatitis is one of those legendary conditions described in medical textbooks and seen in underdeveloped countries, but one that younger pediatricians have not come across in their daily practice,” Cohen said in a Johns Hopkins news release. “If our small analysis is any indication of what’s happening, we need to make sure the condition is on every pediatrician’s radar.”

The study found that missed and delayed diagnoses occurred in every case before a doctor made the correct diagnosis.

Any time a pediatrician sees a child with skin irritation around the buttocks or upper thighs, they should ask about toilet seats and cleansers used at home and at school, Cohen said.

Most cases of toilet seat dermatitis are mild and easy to treat with topical steroids. However, if not treated properly, the inflammation can persist and spread, causing painful and itchy skin eruptions and unnecessary discomfort for children and parents. Skin that’s persistently irritated is vulnerable to bacteria and may lead to more serious infections that require treatment with oral antibiotics.

Cohen and his colleagues offered tips on how to prevent toilet seat dermatitis:
Use paper toilet seat covers in public restrooms.
Replace wooden toilet seats with plastic ones.
Clean toilet seats and bowls daily.
Don’t use harsh cleansers, which often contain skin-irritating chemicals. Instead, use rubbing alcohol and hydrogen peroxide, which is effective and gentler on the skin.

SOURCE: Johns Hopkins Children’s Center

Skiers and snowboarders need to understand that they’re at risk for potentially serious injuries if they don’t take proper safety precautions, advises a trauma injury expert.

“Due to the nature of these sports, many of the injuries that skiers and snowboarders suffer are serious and require immediate medical attention,” orthotraumatologist Dr. Wade Smith, vice chairman of orthopedics for the Geisinger Health System, said in a news release.

Each winter, between 30 and 60 skiers and snowboarders die on U.S. slopes.

Head injuries are the most serious threat, as evidenced by the deaths of several celebrities, including Natasha Richardson and Sonny Bono. Taking a hill too fast or failing to pay attention to their surroundings can leave skiers and snowboarders susceptible to violent falls or collisions that can result in severe head and/or neck injuries.

Smith said skiers and snowboarders need to be mindful of others on the slopes, watch for patches of ice or rocks, and should never attempt a hill too fast or too steep for their ability. He also recommended that skiers and snowboarders of all ages wear a helmet.

Knee injuries are the most common type of injury suffered by skiers and snowboarders, accounting for 25 percent to 40 percent of all injuries.

“Knee injuries are often very painful and can require surgery and extensive rehab,” Smith said. “A torn meniscus, for example, a common ski injury, can result in sharp pain and occasionally arthroscopic surgery. A torn ACL [anterior cruciate ligament] requires arthroscopic surgery, rehab and physical therapy that can last from four months to more than one year.”

Keeping your knees bent while skiing and snowboarding can help reduce stress on the knees, and falling when you lose your balance, instead of trying to fight the fall, can help prevent knee injury, Smith said.

Fractures are another common injury suffered by skiers and snowboarders.

SOURCE: Geisinger Health System

“The continued decline in overall cancer rates documents the success we have had with our aggressive efforts to reduce risk in large populations, to provide for early detection, and to develop new therapies that have been successfully applied in this past decade,” said NCI Director John E. Niederhuber, M.D. “Yet we cannot be content with this steady reduction in incidence and mortality. We must, in fact, accelerate our efforts to get individualized diagnoses and treatments to all Americans and our belief is that our research efforts and our vision are moving us rapidly in that direction.”

Among racial/ethnic groups, cancer death rates were highest in black men and women and lowest in Asian/Pacific Islander men and women. Although trends in death rates by race/ ethnicity were similar for most cancer sites, death rates from pancreatic cancer, the fourth most common cause of cancer death in the United States, increased among white men and women but decreased among black men and women.

The three leading causes of cancer death for all men, with the exception of Asian/Pacific Islanders, were lung, prostate and colorectal cancer. Lung, liver and colorectal cancers were the top three causes of cancer death in Asian/Pacific Islander men. For women, the three leading causes of cancer death were lung, breast and colorectal cancer for all racial/ethnic groups except Hispanic women, for whom breast cancer ranked first. The differences and fluctuations in death rates by racial/ethnic group, sex, and cancer site may reflect differences in risk behaviors, socioeconomic status, and access to and use of screening and treatment.

“The continued decline in incidence and death rates for all cancers combined is extremely encouraging, but progress has been more limited for certain types of cancer, including many cancers that are currently less amenable to screening, such as cancer of esophagus, liver and pancreas,” said Betsy Kohler, executive director of NAACCR.

The special section on colorectal cancer rates says that long-term incidence trends for colorectal cancer have been fairly consistent for men and women, with major declines from 1985 to1995, minor increases from 1995 to1998, and significant declines from 1998 to 2006. Since 1984, death rates have also declined for men and women with accelerated rates of decline since 2002 for men and 2001 for women. In the most recent decade for which there are data (1997-2006), rates of newly diagnosed colorectal cancer have decreased for men and women in all racial/ethnic groups examined except American Indian/Alaskan Native (AI/AN) women. Incidence rates declined most rapidly among men and women over 65 years of age and increased most rapidly in people under age 50 in most population groups.

“This report shows that we have begun to make progress reducing colorectal cancer. Yet, colorectal cancer still kills more people than any other cancer except lung cancer,” said CDC Director Thomas Frieden, M.D. “Reducing smoking further can bring lung and other cancer rates down, and improved colorectal cancer screening can prevent colorectal cancer. Through CDC’s Colorectal Cancer Control Program, we have tremendous potential to reduce the disparities that exist in colorectal cancer screening and to save lives.” The CDC program supports population-based screening efforts and provides colorectal cancer screening services to low-income men and women ages 50 to 64 years who are underinsured or uninsured for screening, when no other insurance is available.

Researchers used microsimulation modeling to analyze the historical impact of changes in risk factors, screening and treatment practices, and to project future mortality trends for colorectal cancer. The model, named MISCAN-Colon, which was developed by NCI’s Cancer Intervention and Surveillance Modeling Network (CISNET) consortium, simulates the U.S. population from 1975 through 2020. The model includes factors that could increase risk for colorectal cancer (i.e., smoking, obesity, and red meat consumption), as well as factors that could decrease colorectal cancer risk (i.e., aspirin use, consumption of supplements such as folate and calcium, and physical activity). To calculate screening use, researchers used national data on the use of fecal occult blood testing (which looks for blood in stool samples), and endoscopy (including flexible sigmoidoscopy and colonoscopy, which allows doctors to examine the lower part of the colon or the entire large intestine, respectively). To assess the effects of treatment, researchers assessed data on use of, and disease-free survival rates associated with, four chemotherapy regimens used for advanced colorectal cancer during different historical time periods.

Using the model, the researchers were able to estimate the impact of historical changes in risk factors, screening practices, and treatment advances on past changes in incidence and mortality, as well as predict future trends through 2020.

From 1975 to 2000, colorectal cancer incidence fell 22 percent, half of which was most likely due to changes in risk factors, and half due to screening. Similarly, colorectal cancer deaths fell by 26 percent during that time period, with a 9 percent drop resulting from a change in risk factors, a 14 percent drop from screening, and a 3 percent drop from improved treatment.

The researchers created projections to look at how colorectal cancer mortality trends could change with varying levels of cancer control interventions. If there were no changes in risk factors, screening or treatment (stable since 2000), Americans could expect a 17 percent decline in colorectal cancer mortality from 2000 to 2020. However, if current trends persist, Americans could see a 36 percent decline in colorectal cancer mortality. With accelerated cancer control efforts, there could be an overall colorectal cancer mortality reduction of 50 percent by 2020.

“The extraordinary progress on colorectal cancer shows what can be achieved by coordinated and targeted efforts to apply existing knowledge to cancer control at the state and federal level,” said John R. Seffrin, Ph.D., chief executive officer of the American Cancer Society. “Increases in colorectal cancer screening have been achieved through a variety of efforts, including education of the public and medical community and advocacy for health insurance coverage of the full range of colorectal cancer screening tests. The American Cancer Society is committed to continuing these efforts to get as close as we can to the potential 50 percent colorectal cancer mortality reduction that this report says is possible.”

To view the full report, go to: www.interscience.wiley.com/cancer/report2009.

Rates of new diagnoses and rates of death from all cancers combined declined significantly in the most recent time period for men and women overall and for most racial and ethnic populations in the United States, according to a report from leading health and cancer organizations.

The drops are driven largely by declines in rates of new cases and rates of death for the three most common cancers in men (lung, prostate, and colorectal cancers) and for two of the three leading cancers in women (breast and colorectal cancer). New diagnoses for all types of cancer combined in the United States decreased, on average, almost 1 percent per year from 1999 to 2006. Cancer deaths decreased 1.6 percent per year from 2001 to 2006.

These findings are from a report authored by researchers from the National Cancer Institute (NCI), part of the National Institutes of Health, the Centers for Disease Control and Prevention (CDC), the American Cancer Society (ACS), and the North American Association of Central Cancer Registries (NAACCR). The report was published early online Dec. 7, 2009, in the journal Cancer.

Overall cancer rates continue to be higher for men than for women, but men experienced the greatest declines in incidence (new cases) and mortality (death) rates. For colorectal cancer, the third most frequently diagnosed cancer in both men and women, and the second leading cause of cancer deaths in the United States, overall rates are declining, but increasing incidence in men and women under 50 years of age is of concern, the report said.

In the Special Feature section, the authors used modeling projections of colorectal cancer rates to find that, with accelerated cancer control efforts to get more Americans to adopt more favorable health behaviors (such as quitting smoking) and higher use of screening (such as colonoscopy), as well as optimal treatment outcomes for colorectal cancer (such as more effective chemotherapy), there could be an overall colorectal cancer mortality reduction of 50 percent by 2020.

Other highlights from the report show that in men, incidence rates have declined for cancers of the prostate, lung, oral cavity, stomach, brain, colon and rectum, but continue to rise for kidney/renal, liver, and esophageal cancer, as well as for leukemia, myeloma and melanoma. In women, incidence rates decreased for breast, colorectal, uterine, ovarian, cervical and oral cavity cancers, but increased for lung, thyroid, pancreatic, bladder, and kidney cancers, as well as for non-Hodgkin lymphoma, melanoma and leukemia.

Within 2 years of having sex for the first time, half of teenage girls may be at least one of three common sexually transmitted infections (STIs), according to results of a study published today. Often, those girls are infected by the age of 15.

Researchers followed 386 urban adolescent girls aged 14 to 17 for up to 8 years. Within 2 years of becoming sexually active, half of the girls were infected with at least one of three common sexually transmitted organisms: Chlamydia trachomatis, Neisseria gonorrhoeae, or Trichomonas vaginalis — the organisms that cause chlamydia, gonorrhea and trichomoniasis, respectively.

The researchers found that a quarter of the women had acquired their first STI by age 15, most often Chlamydia.

“Repeated infections were very common,” study investigator Dr. Wanzhu Tu, of Indiana University School of Medicine in Indianapolis told Reuters Health by email. “Within 4 to 6 months (depending on the organism) after treatment of the previous infection, a quarter of the women were re-infected with the same organism.”

Tu said young women are at risk of STIs as soon as they become sexually active, but recommendations are lacking about when it is appropriate to begin screening.

“These young women are vulnerable to STIs, but because of their younger age, they may not be perceived by health care providers as having STI risk, and thus are not screened in a timely manner.”

The current findings, Tu said, highlight the importance of early STI screening and treatment. “For urban adolescent women, STI screening (especially for chlamydia) should begin within 1 year after first intercourse and infected individuals should be retested frequently, preferably every 3 to 4 months,” the researcher said.

“To my knowledge, this study provides the first data on the timing of the initial STI and subsequent STIs following the onset of sexual activity in urban adolescent women,” Tu added.

The study findings appear in the latest issue of Archives of Pediatrics and Adolescent Medicine, published by the American Medical Association.

A companion paper in the journal details a program that proved successful in curbing risky sexual behavior among 15- to 21-year-old African American adolescent girls and young women.

The participants, all of whom where visiting a sexual health clinic in Atlanta, took part in two group counseling sessions and received telephone support and vouchers to give to their partners to encourage them to get tested and treated for STIs.

This study is “exciting” for several reasons, Dr. Bonita Stanton from Wayne State University in Detroit wrote in a commentary. First, the program reduced first and recurrent chlamydia infections and led to higher rates of self-reported condom use, she points out.

Second, it got the teen girls cut back on douching, which has been linked to increased risk of STIs.

But perhaps “most intriguing,” Stanton wrote, is that the young adolescent girls who participated in the program were able to convince their sexual partners to get tested for STIs.

Hot flashes caused by androgen suppression therapy for prostate cancer are best controlled by the hormonal treatments cyproterone acetate and medroxyprogesterone acetate, according to a new study.

Androgen suppression is considered the gold standard treatment for advanced prostate cancer, but about 80 percent of patients undergoing the treatment experience hot flashes. A number of hormonal and non-hormonal drugs are used to treat the hot flashes, but no direct comparisons of the drugs have been made in clinical trials.

The new study included 311 prostate cancer patients in France undergoing androgen suppression therapy. To treat their hot flashes, they received either the non-hormonal drug venlafaxine (102 men), or one of two hormonal drugs — cyproterone acetate (101 men) or medroxyprogesterone acetate (108 men). The patients were assessed at weeks four, eight and 12 and asked to complete a questionnaire about the frequency and severity of their hot flashes for the week before each assessment.

The researchers found that all three drugs reduced the occurrence of hot flashes, but the hormonal drugs were much more effective at reducing them over all time periods.

After receiving treatment for four weeks, 219 patients (nearly 71 percent) reported an improvement of at least 50 percent in their hot flash scores, and 70 patients (nearly 23 percent) said they no longer had hot flashes. By the fourth week, hot flash scores were reduced by 47.2 percent for the venlafaxine group, 83.7 percent for the medroxyprogesterone acetate group and 94.5 percent for the cyproterone acetate group.

Among men receiving gonadotrophin-releasing hormone analogue therapy for prostate cancer, cyproterone acetate and medroxyprogesterone acetate are more effective at 12 weeks for treating hot flashes, the researchers concluded. However, “as cyproterone is a recognized treatment in prostate cancer, and its use could interfere with hormone therapy, medroxyprogesterone should be the standard treatment,” they wrote.

Seniors who eat plenty of fruits and vegetables and who have good cognitive function are much less likely to die from heart disease than those who have poorer cognitive function and eat fewer fruits and vegetables, a new study has found.

Cognitive function refers to the ability to think, remember, plan and organize information.

Researchers at the Drexel University School of Public Health in Philadelphia analyzed diet and cognitive data on 4,879 people (3,101 women and 1,778 men), age 70 and older, who took part in the U.S. Longitudinal Study of Aging. The participants were followed for an average of seven years.

The analysis revealed that:
Those who ate three or more servings of vegetables daily had a 30 percent lower risk for dying from heart disease and a 15 percent lower risk for dying from any cause during the follow-up period than those who ate fewer than three servings of vegetables a day.
There was a significant association between higher consumption of fruits and vegetables and decreased prevalence of cognitive impairment.
People who scored high on cognitive functions tests were less likely to die from heart disease or any other cause during the follow-up than were those with low scores.

The study was to be presented Wednesday at the American Heart Association’s annual meeting in Orlando, Fla.

The U.S. Veterans Administration has taken the lead in improving patient safety, but its efforts are still a work in progress as surgical errors in and out of the operating room persist, a new study shows.

Each day in the United States, there are five to 10 incorrect surgical procedures performed, some with devastating effects, the researchers noted. Typical problems are surgery performed on the wrong site or wrong side of the body, using an incorrect procedure or using it on the wrong patient.

“In 2003, we put out a directive that said this is the way you are going to do it, if you are going to minimize the chance of things happening,” said lead researcher Dr. James P. Bagian, director of the VA National Center for Patient Safety.

“Up until today, I can tell you, we have not had any reports where people have followed the procedures as they’re written and ever had one of these problems,” he said.

The report is published in the November issue of the Archives of Surgery.

For the study, Bagian’s group reviewed 342 surgical problems from 130 VA hospitals from 2001 to the middle of 2006. Problems were divided into those happening in the operating room and those happening outside the operating room. Typically, these procedures were done in VA clinics or at the patient’s bedside.

Among the cases the researchers looked at were 212 adverse events, where wrong procedures were performed or the procedure was performed in the wrong patient, or at the wrong site. In addition, there were 130 “close calls,” where a problem was recognized before the procedure was done.

“A close call, where they said by following the procedure we caught this, I count that as a save,” Bagian noted.

Adverse events occurred once in every 18,000 procedures, Bagian said.

The most common cause of errors was poor communication among the surgical team members, Bagian said. This accounted for 21 percent of the problems. These communication problems often happen early in surgical procedures, and interventions such as a final “time-out” moment before making the first incision may be too late to correct them, the researchers noted.

Of the adverse events, 50.9 percent occurred in the operating room and 49.1 percent occurred elsewhere. The most adverse event reports were in ophthalmology and invasive radiology (21.2 percent). Orthopedics accounted for the second highest rate of problems in the operating room, after ophthalmology.

The most harm was caused by pulmonary cases where fluid was removed from the wrong side of the chest or the procedure was done at an incorrect place on the chest, the researchers said.

Bagian noted that good numbers for evaluating medical errors are hard to come by. It may be that the specialties reporting the most errors are just more honest, he said, or their mistakes are harder to hide.

The VA continues to evaluate problems and work toward an even better safety record, Bagian said.

Dr. Jeffrey M. Rothschild, an associate physician at Brigham and Women’s Hospital, and an instructor in medicine at Harvard Medical School, said the “VA system is further ahead than most places so finding as many as they did makes you wonder how many one would find in community and academic centers.”

Rothschild thinks that more care needs to be taken in making sure the procedure, the patient and the site for the procedure are right before starting any procedure.

“Our systems are still not robust enough to prevent human error from slipping through,” he said.

There is probably more cases of surgical error outside the VA, Rothschild said. “The VA is probably less of an issue, because they were one of the first systems to really take on safety,” he said. “The VA system is better and more advanced.”

Diarrhea in infants is common, often a quick bout caused by a virus. But in some cases among young children, diarrhea can quickly become dangerous, says the U.S. National Library of Medicine.

If you have a newborn younger than 3 months, call your child’s pediatrician at the first sign of diarrhea, the agency advises.

In any child, bloody diarrhea or a case that lasts longer than two days also should prompt a call to the doctor.

While your child has diarrhea, make sure he or she drinks lots of fluids. A drink that contains electrolytes is best to help prevent dehydration. For young infants, continue nursing, and ask your doctor about giving extra fluids.