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Content 7


The Doctor and the Pharmacist

Radio Show Articles:
March 5, 2016

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Does Vitamin D Reduce Risk for Colorectal Cancer?
Does Vitamin D Supplementation during Pregnancy prevent Childhood Asthma?
Vitamin D Supplementation in Pregnancy might benefit Infants born in Winter
Synbiotics for Atopic Dermatitis: The Evidence is not yet Clear
Profiling the Gut Microbiome in Juvenile Idiopathic Arthritis
Popular Smartphone App gives "Highly Inaccurate" Blood Pressure Readings
Supplemental Iron improves Motor Development in Infants
Chinese Herbal Medicine for Constipation-Predominant
   Irritable Bowel Syndrome
Diet and Risk for Gestational Diabetes: Skip the Spuds?
First Uterine Transplant Performed in U.S.
Androgen Deprivation Therapy linked to Alzheimer Disease
Staphylococcus aureus: Resistance Patterns may be Changing
Does Seafood Consumption lower the risk for Dementia?
Health Officials call for Ban on Powdered Alcohol
New Bacteria Species that causes Lyme Disease Discovered
Briefly Noted: Mice show how High-Fat Diet could cause Intestinal Tumors
Atrial Fibrillation appears Deadlier in Women than Men

Gut 2016 Feb; 65:296
Does Vitamin D Reduce Risk for Colorectal Cancer?
High vitamin D levels were associated with lower risk for CRC, but only for tumors with high-level immune response.
High vitamin D levels have been associated with reduced risk for colorectal cancer (CRC), although recent trials have shown that vitamin D supplementation does not prevent development of colorectal neoplasia.
Given that vitamin D regulates immune function, investigators conducted a nested, case–control trial within the two large cohort studies (the Nurses' Health Study and the Health Professionals Follow-up Study) to determine whether vitamin D plays a greater protective role in tumors with a prominent immune response. The researchers measured plasma 25-hydroxyvitamin D levels in 318 CRC patients and 624 healthy matched controls.
High vitamin D levels were associated with a lower risk for tumors with high-level immune responses, but not for tumors with low-level immune responses.
COMMENT: The vitamin D story continues unresolved despite the recent negative randomized controlled trials. This study suggests a specific mechanism and a specific subtype of colorectal tumor for which vitamin D might be protective.
CITATION(S):Song M et al. Plasma 25-hydroxyvitamin D and colorectal cancer risk according to tumor immunity status. Gut 2016 Feb; 65:296.

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JAMA 2016 Jan 26; 315:353
Does Vitamin D Supplementation During Pregnancy Prevent Childhood Asthma?
In two trials, reduction in asthma incidence in the first 3 years was not significant but trended toward benefit.
Observational studies have yielded mixed results concerning the association of umbilical cord blood levels of 25-hydroxyvitamin D and reduced risk for asthma or recurrent wheezing in early childhood. In pregnant women, low circulating levels of 25-hydroxyvitamin D are common. Based on such epidemiologic observations, two research groups explored the effects on early childhood asthma and wheezing of high-dose vitamin D administration to pregnant women.
In the first study, 806 pregnant U.S. women at high risk for having a child with asthma (based on histories of asthma, allergic rhinitis, or eczema in either parent) were randomized to receive 4400 IU or 400 IU of vitamin D daily starting at 10 to 18 weeks' gestation. Incidence of asthma or recurrent wheeze in 3-year-old children of mothers in the 4400-IU group was 24.3%, compared with 30.4% in the 400-IU group (P=0.051).
In the second trial, 623 pregnant women in Denmark were randomized to receive 2800 IU or 400 IU of vitamin D3 starting at 22 to 26 weeks' gestation. In the first 3 years of their children's lives, rates of persistent wheeze were 16% in the high-dose group and 20% in the 400-IU group (P=0.16), while asthma rates were 12% and 14%, respectively (P=0.45).
COMMENT: Taken together, these results indicate a trend toward reduced wheezing and asthma among children whose mothers received high-dose vitamin D supplements during pregnancy. However, in neither case was statistical significance reached, possibly because smaller-than-anticipated effect sizes lowered statistical power. Editorialists suggest that, pending results of larger trials and given the lack of untoward effects, clinicians may want to offer higher-than-recommended daily vitamin D supplementation to pregnant women at high risk for having children with asthma. Such dosing would be higher than 400 IU but substantially below 4000 IU.
CITATION(S): (1) Chawes BL et al. Effect of vitamin D3 supplementation during pregnancy on risk of persistent wheeze in the offspring: A randomized clinical trial. JAMA 2016 Jan 26; 315:353.

(2) Litonjua AA et al. Effect of prenatal supplementation with vitamin D on asthma or recurrent wheezing in offspring by age 3 years: The VDAART randomized clinical trial. JAMA 2016 Jan 26; 315:362.
(http://dx.doi.org/10.1001/jama.2015.18589) -  http://www.ncbi.nlm.nih.gov/pubmed/26813209?access_num=26813209&link_

(3) von Mutius E and Martinez FD.Inconclusive results of randomized trials of prenatal vitamin D for asthma prevention in offspring: Curbing the enthusiasm. JAMA 2016 Jan 26; 315:347. (http://dx.doi.org/10.1001/jama.2015.18963)
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Vitamin D Supplementation in Pregnancy Might Benefit Infants Born in Winter
By Kelly Young, Edited by David G. Fairchild, MD, MPH, and Lorenzo Di Francesco, MD, FACP, FHM
Vitamin D supplementation during pregnancy is not associated with improved bone mineral content in offspring overall, but it may offer some benefit to children born in winter months, suggests a Lancet Diabetes and Endocrinology study.
Roughly 1100 U.K. pregnant women with baseline 25(OH)D concentrations between 25 and 100 nmol/L (10-40 ng/ml) were randomized to receive either daily oral cholecalciferol (1000 IU) or placebo beginning at 14–17 weeks' gestation.
The primary outcome — whole-body bone mineral content of the newborn — did not differ significantly between the groups. However, among infants born in winter months, the cholecalciferol group did have significantly higher bone mineral content than the placebo group. Maternal 25(OH)D declined from 14 to 34 weeks' gestation in women who delivered in winter and spring and took placebo — but not among those who took cholecalciferol.
A commentator writes: "In pregnancy and other contexts, we should be moving to targeted supplementation with vitamin D in individuals likely to have concentrations of lower than 25–30 nmol/L, and away from mass medication, which is without proved benefit."
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JAMA Pediatr 2016 Jan 25
Synbiotics for Atopic Dermatitis: The Evidence Is Not Yet Clear
Though a meta-analysis supports treatment of AD with synbiotics, current evidence is insufficient to guide their use in the clinical setting.
Atopic dermatitis (AD) is one of several chronic illnesses associated with altered gastrointestinal microbiota. Probiotics (beneficial gut bacteria), prebiotics (nonliving material promoting beneficial bacteria), and synbiotics (mixtures of prebiotics and probiotics) could help prevent and treat AD by modulating the gut microbiome, but study results have been mixed.
A meta-analysis of randomized clinical trials of synbiotic use for AD included two prevention studies (1320 patients total) and six treatment studies (369 patients). Treatment intervention (type of prebiotics and probiotics used), control intervention, and participant ages varied between trials. Efficacy was measured consistently, using either AD incidence (prevention) or the SCORAD (SCORing Atopic Dermatitis) severity index (treatment).
Though synbiotics were not shown to prevent AD, treatment of established AD with synbiotics was associated with improved SCORAD scores in children given multiple bacterial species and in children aged 1 year and older. Significant heterogeneity was observed between studies (as highlighted by authors of an accompanying editorial who strongly caution readers about drawing conclusions from this meta-analysis.)
COMMENT: Evidence linking allergic disease and the gut microbiome continues to grow, and early studies offer intriguing glimpses of prevention and treatment possibilities. Nevertheless, the lack of consistent trial methodology prevents confident conclusions. Despite the support for possible treatment effect in this meta-analysis, studies confirming the effect and defining type and dose of prebiotics and probiotics are needed before synbiotics can be recommended for prevention and treatment of AD.
CITATION(S): Chang Y-S et al. Synbiotics for prevention and treatment of atopic dermatitis: A meta-analysis of randomized clinical trials. JAMA Pediatr 2016 Jan 25; [e-pub].
Tang MLK and Lodge CJ.Examining the evidence for using synbiotics to treat or prevent atopic dermatitis. JAMA Pediatr 2016 Jan 25; [e-pub]. (http://dx.doi.org/10.1001/jamapediatrics.2015.4406)
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Eur J Clin Microbiol Infect Dis 2016 Mar; 35:363
Profiling the Gut Microbiome in Juvenile Idiopathic Arthritis
Children with JIA had distinct alterations in the gut microbiome, compared with controls.
The more we learn about the gut microbiome at the phyla and genera level, thanks to advances in microbiology, the clearer it becomes that an altered gut microbiome is implicated in autoimmune and rheumatic diseases. Researchers in Finland analyzed the gut microbiome of children with newly diagnosed juvenile idiopathic arthritis (JIA).
From June 2011 to January 2014, they obtained stool samples from 30 children (aged 1–15 years) with newly diagnosed JIA and from 27 control children who did not have autoimmune diseases. No patients or controls had recently had infections or received antibiotic treatment. Microbiome composition was analyzed with 16S ribosomal RNA hypervariable region V4–V5-based sequence profiling.
The proportion of gut-microbiome bacteria from the phylum Firmicutes was significantly lower in children with JIA than in controls (21% vs. 33%), but the opposite was true for Bacteroides species (78% vs. 65%). Bacteria of the genera Actinobacteria and Fusobacteria were detected only in JIA patients, whereas Lentisphaerae were found exclusively in controls.
COMMENT: It is essentially unclear what these gut-microbiome alterations mean. Similar changes in the gut microbiome have been reported in patients with type 1 diabetes. We can speculate only that such alterations might play a permissive role in the pathogenesis of autoimmune diseases, which are themselves insufficiently understood. Deeper insights about the interplay of gut flora and immune systems will determine how, or even whether, modifying the gut microbiome could be a novel preventive or therapeutic strategy.
CITATION(S): Tejesvi MV et al. Faecal microbiome in new-onset juvenile idiopathic arthritis. Eur J Clin Microbiol Infect Dis 2016 Mar; 35:363.

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Popular Smartphone App Gives "Highly Inaccurate" Blood Pressure Readings
By Amy Orciari Herman, Edited by Susan Sadoughi, MD, and Richard Saitz, MD, MPH, FACP, FASAM
A smartphone app used to measure blood pressure yields "highly inaccurate" results, researchers report in JAMA Internal Medicine.
Some 85 adults had their BPs measured using both the Instant Blood Pressure app and standard protocols. With the app, BP is estimated by placing the top edge of the smartphone on the left side of one's chest and placing the right index finger over the phone's camera.
The app underestimated higher BPs and overestimated lower BPs. Overall, app measurements differed from standard readings by an average of 12.4 mm Hg systolic and 10.1 mm Hg diastolic.
The researchers say that nearly 80% of individuals with hypertensive BPs "will be falsely reassured that their BP is in the nonhypertensive range" with the app. They note that the app sold over 148,000 times before it was pulled from the market in July 2015, and it remains on many smartphones. Also of concern: many similar apps are still being sold.
Dr. Harlan Krumholz of NEJM Journal Watch Cardiology commented: "This sobering study shows that we need an approach to certify applications (and other consumer products) that purport to give information to people about their health. Inaccurate information can certainly lead to unwarranted concerns or complacency — and cause harm."
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Pediatrics 2016 Mar 2
Supplemental Iron Improves Motor Development in Infants
Iron supplementation in the first year (but not during pregnancy) was associated with enhanced motor milestones at 9 months of age.
Iron deficiency in infants is associated with suboptimal motor development, but whether iron supplementation during infancy or pregnancy improves motor development remains unclear.
In a randomized, controlled trial, 1196 term infants received either oral iron supplementation (1 mg/kg elemental iron) or placebo between ages 6 weeks and 9 months. The participants were children of mothers in a rural community in China who had been randomized to take either a folate/iron or folate/placebo supplement during pregnancy. Iron status in mothers and infants was measured by serum ferritin or zinc protoporphyrin/heme. Gross motor development, neurological integrity, and motor performance were measured with standardized tests at 9 months. More than 80% of the infants were breast-feeding at that time.
Iron supplementation in infants but not during pregnancy significantly improved gross motor scores at 9 months of age. The milestones most affected were sitting while manipulating a toy, transitioning from sitting to prone, crawling, and moving from sitting to crawling or standing). Motor development scores were greater by 0.3 standard deviations with iron supplementation during infancy compared with no supplementation during infancy or iron supplementation only during pregnancy. Among infants who received iron supplementation, motor development outcomes were similar regardless of gestational iron supplementation. Neurological integrity and motor performance were not different between groups.
COMMENT: This study was well designed, and motor skills were assessed with standardized instruments. Although the ineffectiveness of gestational iron supplementation on infant motor development has been reported previously, the effect of a universal iron supplement during infancy was unclear prior to this study. I would like to see a similar study conducted in U.S infants before universal iron supplementation is recommended.
CITATION(S):Angulo-Barroso RM et al. Iron supplementation in pregnancy or infancy and motor development: A randomized controlled trial. Pediatrics 2016 Mar 2; [e-pub]. (http://dx.doi.org/10.1542/peds.2015-3547)
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Clin Gastroenterol Hepatol 2015 Nov; 13:1946
Chinese Herbal Medicine for Constipation-Predominant
Irritable Bowel Syndrome

Adequate symptom relief occurred in significantly more recipients of an herbal formulation compared with placebo.
Constipation-predominant irritable bowel syndrome (IBS-C) can be managed with fiber, hydration, laxatives, and pharmacologic agents such as lubiprostone, linaclotide, and colchicine; however, patients with incomplete responses sometimes turn to alternative medicines. In a 13-center, double-blind trial in Australia, investigators evaluated a capsule that they developed containing a standardized, validated formulation of seven Chinese herbs. In all, 125 participants were randomized to receive five capsules or placebo twice daily for 8 weeks.
Self-reported adequate symptom relief (the primary endpoint) occurred in 61% of the herbal medicine group and 44% of the placebo group (P=0.06; number needed to treat [NNT], 6). In per-protocol analysis, response rates were 68% in the herbal group versus 43% in the placebo group (P=0.01; NNT, 4). Herbal medicine recipients experienced greater overall satisfaction with bowel movements, reduction in hard lumpy stools, reduction in straining, and improvement on the Bristol stool form scale. Despite trends toward improved quality of life (QOL) with herbal medicine, neither abdominal pain nor distention was improved — and overall QOL scores did not differ between groups.
COMMENT: If reliable, effective formulations of Chinese herbal medicines become available in the U.S. and elsewhere, they could emerge as an important treatment for IBS-C.
CITATION(S): Bensoussan A et al. Efficacy of a Chinese herbal medicine in providing adequate relief of constipation-predominant irritable bowel syndrome: A randomized controlled trial. Clin Gastroenterol Hepatol 2015 Nov; 13:1946. (http://dx.doi.org/10.1016/j.cgh.2015.06.022)

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BMJ 2016 Jan 12; 353:h6898
Diet and Risk for Gestational Diabetes: Skip the Spuds?
Higher prepregnancy potato consumption raised risk for GDM.
In the U.S., an estimated one third of reproductive-aged women consume potatoes daily. With their rapidly absorbable starch content, potatoes have a high glycemic index — and potato intake has been linked to elevated fasting glucose and insulin resistance as well as excess risk for type 2 diabetes mellitus. In an analysis from the Nurses' Health Study, researchers used self-reported dietary information from >116,000 participants to determine whether potato consumption is associated with risk for gestational diabetes mellitus (GDM). Associations between potato consumption and GDM incidence were adjusted for age, race and ethnicity, family history of diabetes, cigarette smoking, physical activity, total energy intake, and body-mass index (BMI).
From 1991 through 2001, 854 of 21,693 singleton pregnancies were complicated by GDM. Compared with women who reported <1 weekly serving of potatoes, those who ate 1, 2 to 4, or ≥5 servings of potatoes weekly had higher risk for GDM by 21%, 34%, and 62%, respectively (P<0.001 for trend). After adjusting for BMI, this increased risk was 20%, 27%, and 50% (P=0.006 for trend). In contrast, rising consumption of vegetables, legumes, or whole-grain foods appeared to lower risk for GDM by 9%, 10%, and 12%.
COMMENT: In this prospective observational study, prepregnancy consumption of potatoes was associated with higher risk for GDM, whereas consumption of vegetables, legumes, or whole grains (low glycemic-index foods) was associated with lower risk for GDM. To continue extending the meaning of “we are what we eat,” clinical trials are warranted to better define the role of maternal dietary composition and risk for GDM.
CITATION(S): Bao W et al. Pre-pregnancy potato consumption and risk of gestational diabetes mellitus: Prospective cohort study. BMJ 2016 Jan 12; 353:h6898. (http://dx.doi.org/10.1136/bmj.h6898)
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First Uterine Transplant Performed in U.S.
By Kelly Young, Edited by Susan Sadoughi, MD, and André Sofair, MD, MPH
The Cleveland Clinic performed the first uterine transplant in the United States last week on a 26-year-old woman with uterine factor infertility.
If the procedure is successful, women who lack a uterus or whose uterus doesn't function could become pregnant through in vitro fertilization. After the procedure, recipients must wait 1 year before a fertilized embryo is implanted in the uterus, which comes from deceased organ donors. Infants would be delivered by cesarean section.
The uterus will be removed after recipients have one or two children, so the patients don't have to continue taking anti-rejection treatment.
The hospital is offering the procedure experimentally and is still screening other potential candidates.
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J Clin Oncol 2016 Feb 20; 34:566
Androgen Deprivation Therapy Linked to Alzheimer Disease
The risk for developing Alzheimer disease increased with the duration of therapy.
Androgen deprivation therapy (ADT) has been the standard of care for management of metastatic prostate cancer for more than 70 years. Its use in locally advanced disease is defined by prospective evidence in a number of clinical settings. However, during the past 25 years, the greatest growth in use has been in the prostate-specific antigen (PSA)-only disease state, for which prospective evidence is lacking. Whereas the metabolic and bone issues related to ADT are well described, the impact on neurocognitive function remains poorly defined.
Using a novel, text-processing pipeline method to interrogate data from electronic medical records, investigators analyzed data from two large academic medical centers to explore a potential association between ADT and the development of Alzheimer disease (AD). During a 19-year period, data from approximately 40 million patient encounters led to identification of 16,888 men with prostate cancer who met the study criteria, which excluded men subsequently treated with chemotherapy or who had a history of dementia or stroke. Of this group, 14% received ADT with a median time from prostate cancer diagnosis to therapy of 36 days.
During a median follow-up of 2.7 years, 125 new diagnoses of AD occurred (median time to diagnosis, 4.0 years). Propensity-score–matched analysis and multivariable cox analysis showed that AD was associated with ADT and that risk for developing AD increased with duration of ADT use.
COMMENT: As noted by an editorialist, the analysis had notable limitations, including a lack of information on possible confounding variables that may affect both prostate cancer and AD risk. However, these results, in combination with a recent prospective study that provided provocative data regarding the potential negative impact of ADT on cognitive function (NEJM JW Oncol Hematol Jul 2015 and J Clin Oncol 2015 33:2021) provide fertile ground for future research.
CITATION(S): (1) Nead KT et al. Androgen deprivation therapy and future Alzheimer's disease risk. J Clin Oncol 2016 Feb 20; 34:566. (http://dx.doi.org/10.1200/JCO.2015.63.6266)

(2) McGinty HL.Unlocking electronic medical record data to identify possible connections between cancer and cognitive declines. J Clin Oncol 2016 Feb 20; 34:530. (http://dx.doi.org/10.1200/JCO.2015.65.2248)

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Pediatrics 2016 Mar 1
Staphylococcus aureus: Resistance Patterns May Be Changing
MRSA is on the decline among children, but clindamycin resistance has increased.
Staphylococcus aureus is a pathogen responsible for a variety of pediatric infections that range from mild to severe. Surveillance of S. aureus resistance patterns in adult U.S. populations has demonstrated recent declines in community-onset methicillin-resistant S. aureus (MRSA). To determine if trends are similar in children, researchers conducted a retrospective analysis of approximately 42,000 S. aureus isolates collected from nearly 40,000 children receiving treatment between 2005 and 2014 at one of 266 U.S. military healthcare facilities.
The majority of isolates were from outpatients with skin and soft-tissue infections. Young children (aged 1–5 years) had the highest rates of MRSA. Susceptibility to oxacillin increased significantly over time, from its lowest level of 54% in 2007 up to 68% by the end of 2014. Susceptibility to clindamycin declined significantly from 91% in 2005 to 86% in 2014 but only in methicillin-susceptible S. aureus (91% to 84%); MRSA had stable clindamycin susceptibility rates (91%) throughout the study period. All strains remained highly susceptible to trimethoprim/sulfamethoxazole.
COMMENT: The susceptibility patterns of S. aureus have changed considerably over the past 20 years. The emergence of community S. aureus isolates resistant to β-lactam antibiotics (MRSA) in the 1990s led to significant changes in empiric antibiotic choices. These data suggest that S. aureus susceptibility to oxacillin is now increasing but susceptibility to alternative antibiotics such as clindamycin and ciprofloxacin may be decreasing. Close attention to these changing susceptibilities and knowledge of local resistance patterns is critical information for all who treat children.
CITATION(S):Sutter DE et al. Changing susceptibility of Staphylococcus aureus in a US pediatric population. Pediatrics 2016 Mar 1; [e-pub].
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JAMA 2016 Feb 2; 315:489
Does Seafood Consumption Lower the Risk for Dementia?
An analysis of autopsied cases suggests an inverse relation between seafood consumption and Alzheimer disease neuropathology.
The main risk factors for late-onset Alzheimer disease (AD), age and the ApoE ℇ4 allele, offer no possibility of prevention, placing a premium on the identification of modifiable environmental factors. Research suggests that regular consumption of seafood is associated with decreased risk for incident dementia, although seafood consumption is also associated with increased levels of mercury in the brain, which is linked to neurocognitive impairment. In a cross-sectional analysis of autopsied cases, researchers examined the associations between seafood consumption, brain levels of mercury and selenium, and dementia pathologies.
The analysis focused on 286 participants in a memory and aging study who completed a dietary assessment, died between 2004 and 2013, and had a brain autopsy performed. Mean age at death was 90 years; 67% were women. Seafood consumption was significantly correlated with less AD neuropathology, including lower density of neuritic plaques and less severe neurofibrillary tangles. Brain mercury levels were correlated with the number of seafood meals consumed per week, but not with levels of brain neuropathology. Higher intake of α-linolenic acid was correlated with decreased risk for cerebral macroinfarcts. Fish-oil supplementation had no statistical correlation with brain neuropathology.
COMMENT: This well-conducted study found that moderate seafood consumption correlates with decreased AD neuropathology — and that, although seafood consumption can correlate with higher brain levels of mercury, there is no relationship between the latter and brain neuropathology. Although it is the first study to report on this relationship, the findings suggest that seafood can be consumed safely without substantial concern of an increased risk for AD or dementia.
CITATION(S):Morris MC et al. Association of seafood consumption, brain mercury level, and APOE 4 status with brain neuropathology in older adults. JAMA 2016 Feb 2; 315:489. (http://dx.doi.org/10.1001/jama.2015.19451);

Kröger E and Laforce R.Fish consumption, brain mercury, and neuropathology in patients with Alzheimer disease and dementia.
JAMA 2016 Feb 2; 315:465.
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Health Officials Call for Ban on Powdered Alcohol
By Amy Orciari Herman, Edited by David G. Fairchild, MD, MPH, and Jaye Elizabeth Hefner, MD
Officials from the Baltimore City Health Department are urging clinicians nationwide to lead efforts to ban the sale of powdered alcohol. Approved in the U.S. in 2015, "Palcohol' contains roughly 55% alcohol by weight and is reconstituted to liquid form by mixing with water.
In the Annals of Internal Medicine, Baltimore's health leaders outline the potential increased risk for misuse, "based on ease of portability and combination with other alcoholic drinks, leading to underage use, increased binge drinking, and illicit 'spiking' of others' beverages." They also note its "concealable nature" and the potential for insufflation and injection.
Palcohol was set to hit the market in the summer of 2015, but given "vehement reaction" to its approval, it has not yet been released. As of November, 27 states had banned its sale.
In Baltimore, public health officials worked with clinicians to get Palcohol prohibited at both the city and state level. In Annals, they call for clinicians to "leverage strong provider coalitions" against Palcohol in their own cities and states.
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New Bacteria Species that Causes Lyme Disease Discovered
By Kelly Young
Scientists report the discovery of a new species of bacteria (Borrelia mayonii) in the upper Midwest of the U.S. that causes a unique presentation of Lyme disease. Their findings appear in the Lancet Infectious Diseases.
Researchers screened over 100,000 clinical samples for the presence of B. burgdorferi bacteria, which causes Lyme disease. Of these, six were flagged as a unique species, which they called B. mayonii. Roughly 20 ticks also tested positive for this bacterium.
The researchers examined medical records and found that patients infected with B. mayonii experienced nausea, vomiting, diffuse macular rashes, and elevated levels of bacteria in the blood, in addition to symptoms typically associated with B. burgdorferi infection (e.g., headache, neck pain). Three patients also experienced neurologic symptoms, including confused speech, profound somnolence, and visual difficulties. All lived in Minnesota, Wisconsin, or North Dakota.
Commentators conclude: "Interestingly, candidatus B. mayonii was only detected in specimens obtained during 2012–2014, although the sample collection dates back to 2003. This suggests that candidatus B. mayonii is a newly-emerged genospecies."
The CDC says that patients infected with B. mayonii should test positive for Lyme disease with current tests.

Briefly Noted: Mice Show How High-Fat Diet
Could Cause Intestinal Tumors

A study in mice shows a possible mechanism for the known link between obesity and colon cancer; the work appears in Nature.
In response to a high-fat diet, mouse intestines showed an increase in the population of stem cells and the number of divisions those cells underwent. Another cell type, called progenitors, showed a susceptibility to transformation by oncogenes; such transformed cells can initiate tumors.

Atrial Fibrillation Appears Deadlier in Women Than Men
By Amy Orciari Herman
Atrial fibrillation (AF) poses a higher risk for cardiovascular morbidity and mortality in women than in men, according to a meta-analysis inThe BMJ.
Researchers examined data from 30 cohort studies that evaluated sex-specific associations between AF and cardiovascular events or death in nearly 4.4 million people. They found that AF was associated with significantly greater risk increases in women than men for the following: all-cause mortality, stroke, cardiovascular mortality, cardiac events, and heart failure. In terms of absolute risk, AF was associated with 1.8 additional deaths per 1000 patient-years in women than men, 3.1 additional strokes, 4.3 cardiovascular deaths, 0.6 cardiac events, and 6.1 heart failure cases.
Dr. Harlan Krumholz of NEJM Journal Watch Cardiology commented: "This is a concerning study that reinforces the presence of sex in the CHA2DS2-VASc score. The findings raise the question of whether there should be sex-specific strategies for treatment of atrial fibrillation and the prevention of complications. At the least, we should be taking sex into account in the risk information we are providing our patients.
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