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Potentially fatal bacteria along the coast of Florida

07th Aug 2015 Diseases, Medical News

A potentially deadly bacteria has made it way to Florida beaches. The Vibrio vulnificus bacterium has infected at least seven people and killed two this year in Florida. The two fatal cases have occurred in Brevard and Marion counties.

The bacterium, which appears to be activated by exceptionally warm weather, normally does not pose a risk to a healthy person. However direct contact between seawater and any open cuts or wounds can cause infections and skin ulcers. Sickness can also develop from ingestion of seawater or from eating raw seafood. Abdominal pain, diarrhea, and vomiting are the primary symptoms from ingestion. Redness, swelling, fevers, and chills progressing to life threatening septic shock can occur from a wound infection.

Vibrio vulnificus is a salt requiring gram negative bacteria that is commonly found in marine environments. According to the CDC, bloodstream infections are fatal 50% of the time. Between 1988 and 2006, over 900 cases of Vibrio vulnificus infections were reported along the states that border the Gulf of Mexico. Thirty-two cases of Vibrio vulnificus infection were identified in Florida last year. It is estimated that over 85% of cases occur between May and October when the coastal waters are the warmest.

The diagnosis is made by history assessment and testing. Blood, wound, and stool cultures should be ordered for those who have a history of possible exposure and exhibit clinical symptoms. Medical management includes the use of antibiotics and monitoring of any open wounds. In rare cases, surgical debridement and/or amputation may be necessary for severely infected wounds with extensive soft tissue spread.

Prevention of infection focuses on avoiding entry into the water if any open wounds or cuts are present. Avoid eating raw shellfish. Boiling or frying shellfish for an extended period of time is recommended.

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The combination of gene therapy and an adeno-virus vector to treat eye inflammation

31st Jul 2015 Medical News

More than 12 million American’s suffer from dry macular degeneration. This is an eye disease in which the retina deteriorates from the formation of small yellow deposits known as drusen. This leads to drying out of the macula causing it to lose its function. While many with dry macular degeneration may have good central vision, they may have limitations and difficulty with reading, limited vision at night and loss of vision may still occur. Macular degeneration tends to progress slowly in time. This is a common problem for people over the age of 50 years old.
Recently, researcher’s at the University of Florida have found what they believe is a promising treatment to limit inflammation that leads to macular degeneration. The researcher’s used an adeno-viral vector (AVV) to deliver an inflammation blocking protein into the eye. The protein comes from a myxoma virus that is normally found in rabbits found in parts of Europe in Australia. This gene inhibits the body’s immune response that causes inflammation that leads to eye disease.
Researchers also found that this is effective in cases of uveitis which is an inflammation within the middle levels of the eye.
At present, there is no FDA approved treatment for dry macular degeneration. Some of the published recommendations to manage symptoms of macular degeneration include the use of over-the-counter supplements, specific foods which are rich and antioxidants, the use of Lutein, smoking cessation, controlling hypertension, and the use of blue blocker sunglasses. Uveitis has typically been treated with long-term use of steroids. This does increase risks of developing glaucoma.
This new potential treatment may last a lifetime and only requires a single treatment based on current research. Adeno-associated virus vectors may prove to be the next-generation of treatments for many chronic diseases as they were able to deliver anti-inflammatory genes to diseased and damage parts of the body.
Further research is planned after these recent results in a mouse model were published. The study from the University of Florida was funded by grants from the National Eye Institute, and National Institute of Allergy and Infectious disease, The Macula Vision Research Foundation and the Florida Biomedical Research Foundation.

References:
IIdefonso CJ, Jaime H, Rahman MM, Li Q, Boye SE, Hauswirth WW, Lucas AR, McFadden G, Lewin AS. Gene delivery of a viral anti-inflammatory protein to combat ocular inflammation. Human Gene Therapy. 2015 Jan; 26(1):59-68.

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Identification of Genes that are Associated with Type 1 Diabetes

18th Jun 2015 Diseases, Medical News

Genetic susceptibility to Type 1 diabetes has been an area of intensive research since the 1970s. Despite the literature identifying over 40 different genes that are associated with type 1 diabetes, there has remained missing pieces within the puzzle until now. A University of Florida research group headed by a genetics expert, published a recent study in the journal, Nature Genetic, has narrowed number of genes that are involved in type 1 diabetes.

Type 1 diabetes which is also called juvenile diabetes, as it can occur in children and teenagers, is an insulin-dependent type of diabetes. In Type 1 diabetes, the body attacks its own insulin producing cells of the pancreas known as islets. Without proper functioning islets, the body is unable to normalize blood sugar. As a result, the body’s own cells starve from a lack of glucose. This may result in damage to the eyes, kidneys, nerve cells and heart.

The Research team from UF collected data from over 27,000 people including those with type 1 diabetes and screened for differences in DNA that are involved in Type I diabetes.  Using a technique known as fine mapping, the team was able to narrow down the number of disease causing DNA variations which are known as Single Nucleotide Polymorphisms from the thousands to 5 or less. The findings are considered landmark and can now be used by clinicians and other researchers to direct treatment to prevent the onset of autoimmune disease. This can lead to the development of new treatments and therapeutic agents.

In addition to the research team from the University of Florida, researchers from the Massachusetts Institute of technology (MIT), Harvard University and the University of Cambridge in England were also involved.

According to Dr. Patrick Concannon, Director of the University of Florida Genetics Institute “it’s a game-changer for Type 1 diabetes”

 

Source:

 

University of Florida – March 2014

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Vitamin D: More than just a vitamin

12th Mar 2015 Medical News

While many think of vitamin D as a just another vitamin, the reality is that it is a strong hormonal regulator. The body produces vitamin D from direct exposure to sunlight which trigger synthesis of vitamin D. Vitamin D can also be obtained from food sources and through supplementation. One of the main roles of Vitamin D is to promote calcium absorption and is involved in the formation of new bone. The true significance of vitamin D as a regulator of other functions including modulating cell formation, immune function, and reducing inflammation within the body, has come to light in many recently published studies.

Evidence:

In one of the most recent publications, researchers looked at vitamin D levels in children and teenagers and found that those with low levels had greater risks of atherosclerosis as adults. This study included over 2148 volunteers who had vitamin D levels during childhood years and then had carotid intima-thickness assessed between the ages of 30 to 45. Thickening of the arteries is believed to be a strong risk factor for cardiovascular disease

Juonala M, Voipio A, Pahkala K, Viikari JS et al. Childhood 25-OH levels Vitamin D Levels and Carotid Intima-Media Thickness in Adulthood: The Cardiovascular Risk in Young Finns Study. Journal of Endocrinology and Metabolism. 2015 Feb 10.

Taken from a randomized, double blind, placebo controlled study that was published in the American Journal of Clinical Nutrition looking at the role of Vitamin D in preventing influenza, the group that was given 1200 IU of Vitamin D3 had comparatively lower rates of flu (influenza A) versus placebo. The study also suggested lowered rates of asthma attacks in children.

Urashima M, Segawa T, Okazaki M, Kurihara M, Wada Y, Ida H. Randomized trial of Vitamin D supplementation to prevent seasonal influenza A in schoolchildren. American Journal of Clinical Nutrition. 2010 May; 91(5): 1255-1260.

In a 2014 published study from the University of London, researchers conducted a randomized trial, looking at the use of Vitamin D levels in patients with COPD. The findings of this study which included 240 patients showed that adequate Vitamin D supplementation can reduce COPD flare-ups by 40%

Martineau AR, James WY, Hooper RL, Barnes NC, Jolliffe DA et al. Vitamin D3 supplementation in patients with chronic obstructive pulmonary disease (ViDico): a multicentre double blind, randomized control trial. The Lancet. Respiratory Medicine. 2014 Dec 1. Pii: S2213-2600(14).

A recent study (2015) presented at the American Stroke Association’s annual meeting that looked at 100 patients who suffered an ischemic stroke. Those with low levels of Vitamin D (<30 ng/mL had a greater risk of developing a stroke and had approximately a two times greater area of stroke related brain dead tissue versus those with normal vitamin D levels. http://newsroom.heart.org/news/low-vitamin-d-predicts-more-severe-strokes-poor-health-post-stroke

Researchers from the University of California published a meta-analysis that encompassed over 32 studies that looked at Vitamin D levels and mortality. The findings show that those with inadequate Vitamin D levels (< 30 ng/mL) were 90% more likely to die prematurely when compared with those who had levels over 30 mg/Ml

Garland CF, Kim JJ, Mohr SB, Gorham ED, Grant WB, Givannuci El, Baggerly L, Hofflich H, Ramsdell JW, Zeng K, Heaney RP. Meta-analysis of all-cause mortality according to serum 25-hydroxvitamin D. American Journal of Public Health. 2014 Aug; 104(8):e43-50.

These are just a handful of the studies looking at the interaction between levels of Vitamin D and various disease processes.

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A compound related to Vitamin B3 may prevent hearing loss

10th Mar 2015 Hearing, Medical News, Starkey Hearing Foundation

A recent study published in Cell Metabolism by researchers from Weill Cornell Medical College and the Gladstone Institutes have identified a simple compound that may help prevent hearing loss. The compound nicotinamide riboside (NR) is a precursor to vitamin B3.

Noise induced hearing loss is a problem that can affect anyone at any age. The National Institutes on Deafness and Other Communication Disorders (NIDCD) estimates that more than 26 million Americans between the ages of 20 and 69 suffer from noise induced hearing loss. Hearing loss can result from a one-time exposure to an intense sound or from continuous exposure to loud sounds. Continuous or prolonged exposure to sounds over 85 decibels can cause hearing loss.

The process of hearing is based on a series of events that convert sound waves into electrical signals. Vibrations travel to the inner ear causing wave like ripples within the fluid inside the cochlea. There are tiny hair cells sitting along the top of inner membrane. These hair cells move up and down pushing against the sterocilia which transmits a signal to the auditory system within the brain. It is believed that exposure to loud noise can cause to damage to the junction where the nerves and hair cells meet, resulting in hearing loss.

Previous studies had identified that a chemical compound known as nicotinamide adenine dinucleotide (NAD+), which is chemically related to NR in this study, did protect nerve cells from injury however, it is an unstable compound. Using this information, researchers tested NR in lab mice and found that regardless whether the compound was given before or after exposure, NR did prevent hearing loss. It is believed that NR increases the activity of a protein known as SIRT3 (sirtuin 3) which is located within the mitochondria of the cells and is involved in regulating function.

The results of this study appearing to be promising. The researchers believe that the compound NR may also be useful for treating other disorders that are also mediated by the activity of protein sirtuin 3 such as hypertension, diabetes, and other metabolic syndromes.

References:

National Institutes on Deafness and Other Communication Disorders (NIDCD)

Brown KD, Maqsood S, Huang JY, Pan Y, Harkcom W, Li W, Sauve A, Verdin E, Jaffrey SR. Activation of SIRT3 by the NAD+ precursor nicotinamide riboside protects from noise-induced hearing loss. Cell Metabolism. 2014 Dec 2; 20(6): 1059-1068.

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Scoliosis Associated with Friedreich’s Ataxia

05th Mar 2015 Diseases, Friedreich's Ataxia, Medical News

The incidence of Friedreich’s Ataxia (FA) is approximately one in every 50,000. It is known that most symptoms associated with FA occur during the first decades of life. Many lose their ability to walk by age 25. Friedreich himself noted the presence of scoliosis along with other symptoms in 1875. Scoliosis is associated with FA and is often seen early on in the developmental process. A search of the literature finds that the prevalence of scoliosis among those with FA has been reported in the range of 63 to 100%1, 2, 3

There is some debate noted on whether FA should be classified as a neuromuscular scoliosis or idiopathic type. For the most part, scoliosis associated with FA is similar to other neuromuscular forms such as muscular dystrophy which features a progressive thoracolumbar curve and severe muscle weakness. Labelle et al (1986) concluded that scoliosis associated with FA behaved more like an idiopathic form as the curves were not necessarily rapidly progressive, were similar curve patterns, were not associated with muscle weakness, and age at onset was a key indicator of progression4. This was based on a retrospective review of 56 cases with an average of nine years of follow-up after the diagnosis was made. This is contrary to the findings of Milbrandt et al (2008) who felt the curve patterns were more in-line with neuromuscular type scoliosis.

The current literature does reflect bracing does not appear to halt progression of most curves that have been studied. A posterior spinal fusion has become the main treatment choice for surgical management of progressive curves associated with FA. Previously, hook and wire constructs were utilized but has fallen out of favor due to inability to maintain correction. Many of the curves are double major type with kyphotic deformity. Restricted lung disease associated has been reported as a secondary complication in cases with significant kyposcoliotic deformity. Cardiac co-morbidities are also associated with FA and must be considered when contemplating surgical management.

Despite known complications associated with FA, reported outcomes from posterior fusion surgery have demonstrated successful correction of the major deformity and fusion rates at an average of 3 years of follow-up.

1 Milbrandt TA, Kunes JR, Karol LA. Friedreich’s ataxia and scoliosis: the experience at two institutions. Journal of Pediatric Orthopedics. 2008 Mar; 28(2) 234-238.

2 Daher YH, Lonstein JE, Winter RB, Bradford DS. Spinal Deformities in patients with Friedreich ataxia: a review of 19 patients. Journal of Pediatric Orthopedics. 1985 Sep-Oct; 5(5): 553-557.

3 Cady RB, Bobechko WP. Incidence, natural history, and treatment of scoliosis in Friedreich’s ataxia. Journal of Pediatric Orthopedics. 1984 Nov; 4(6) 673-676.

4 Labelle H, Thome S, Duhaim M, Allard P. Natural history of scoliosis in Friedreich’s ataxia. JBJS. 1986 Apr; 68(4): 568-572.

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Measles in Florida

03rd Mar 2015 Medical News, Viruses

One of the major health headlines in 2015 has been a measles outbreak. The current outbreak is believed to have begun in Disneyland and Disney California Adventure Park in late December 2014. Since that time, well over 115 cases of measles have been reported in multiple states. In Florida, 4 cases have been reported at the time of this writing. Based on information from the Florida Department of Health (DOH), the four individuals identified, traveled to Florida, including Tampa and are not state residents. Two of the individuals are U.S. citizens while two are international visitors. None of the four were vaccinated against the disease. The DOH and local health departments has been aggressive about monitoring individuals who were potentially exposed to the four travelers.

This recent identification of measles in the Sunshine state comes after a prior outbreak in the Orlando area. Case information from the Center for Disease Control and Prevention (CDC) identified a 10 year unvaccinated resident of Orange County as the index case last year. Subsequently, her 3 siblings all contracted measles within a week of the diagnosis. The parents of the children claimed religious exception to vaccination. Nasal specimens that were collected from all of the children by the Florida Department of Health and Bureau of Public Health Laboratories, did test positive for the measles virus RNA. An additional case of confirmed measles was identified by the DOH in Miami-Dade County. This case was identified nearly one month after the Orlando cases. A Brazilian citizen, without evidence of vaccination, reported having visited a theme park in the Orlando area. Genomic sequencing of the Brazilian patient was identical to the cases reported in Orange County. It is believed that this exposure likely came from the same Orlando based theme park where the index patient’s family had visited one month prior.

Measles is a highly contagious disease with an estimated incidence of more than 20 million cases worldwide. Complications occur in about 30% of cases in which over 164,000 deaths occur worldwide yearly. Cases in the U.S. tend to be sporadic and commonly occur from unvaccinated international visitors and from U.S. citizens traveling abroad.

The MMR vaccine has been shown to be highly effective at preventing the spread of measles, however, its use is under scrutiny by subsets of the population that contest that vaccines are harmful and can cause autism. Florida State Surgeon General and State Secretary of Health, Dr. John Armstrong has reported that approximately 93% of kindergartners in Florida have received vaccination for measles, mumps, and rubella (MMR vaccine).

References:

http://www.floridahealth.gov/newsroom/2015/01/013115-measles.html

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A compound related to Vitamin B3 may prevent hearing loss

26th Feb 2015 Hearing, Medical News, Starkey Hearing Foundation

A recent study published in Cell Metabolism by researchers from Weill Cornell Medical College and the Gladstone Institutes have identified a simple compound that may help prevent hearing loss. The compound nicotinamide riboside (NR) is a precursor to vitamin B3.

Noise induced hearing loss is a problem that can affect anyone at any age. The National Institutes on Deafness and Other Communication Disorders (NIDCD) estimates that more than 26 million Americans between the ages of 20 and 69 suffer from noise induced hearing loss. Hearing loss can result from a one-time exposure to an intense sound or from continuous exposure to loud sounds. Continuous or prolonged exposure to sounds over 85 decibels can cause hearing loss.

The process of hearing is based on a series of events that convert sound waves into electrical signals. Vibrations travel to the inner ear causing wave like ripples within the fluid inside the cochlea. There are tiny hair cells sitting along the top of inner membrane. These hair cells move up and down pushing against the sterocilia which transmits a signal to the auditory system within the brain. It is believed that exposure to loud noise can cause to damage to the junction where the nerves and hair cells meet, resulting in hearing loss.

Previous studies had identified that a chemical compound known as nicotinamide adenine dinucleotide (NAD+), which is chemically related to NR in this study, did protect nerve cells from injury however, it is an unstable compound. Using this information, researchers tested NR in lab mice and found that regardless whether the compound was given before or after exposure, NR did prevent hearing loss. It is believed that NR increases the activity of a protein known as SIRT3 (sirtuin 3) which is located within the mitochondria of the cells and is involved in regulating function.

The results of this study appearing to be promising. The researchers believe that the compound NR may also be useful for treating other disorders that are also mediated by the activity of protein sirtuin 3 such as hypertension, diabetes, and other metabolic syndromes.

References:

National Institutes on Deafness and Other Communication Disorders (NIDCD)

Brown KD, Maqsood S, Huang JY, Pan Y, Harkcom W, Li W, Sauve A, Verdin E, Jaffrey SR. Activation of SIRT3 by the NAD+ precursor nicotinamide riboside protects from noise-induced hearing loss. Cell Metabolism. 2014 Dec 2; 20(6): 1059-1068.

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The Lone Star Tick in Florida

24th Feb 2015 Medical News, Viruses

Amblyomma Americanum, also known as the Lone Star tick, has been identified throughout the southeastern U.S. including central Florida.   In fact, this is the most common human biting tick in Florida (Clark KL, Leydet B, Hartman S.  International Journal of Medical Sciences 2013). The ticks are commonly found in wooded and animal resting areas.

The Heartland Virus, also known as Severe Fever with Thrombocytopenia Syndrome Virus (SFTSV), was first discovered in the U.S., in northwestern Missouri, in June 2009.  The virus results from a tick-borne illness from the Phlebovirus genus.   The U.S. Center for Disease Control and Prevention (CDC) has traced the virus to the Lone Star Tick. Current investigations are looking at whether the virus can be transmitted by other vectors including mosquitos and flies.

Most of the cases of the Heartland virus identified so far occurred between 2012 and 2014 and have included two deaths.  All patients who became ill had been bitten by a ticks within the previous 14 days between May and September. Reported symptoms included fever in excess of 100.4 F, headaches, lethargy, and diarrhea, loss of appetite, nausea, and joint pains.  Additionally, low white blood cell counts and low platelets (thrombocytopenia) also were seen in these cases. The diagnosis was made after exclusion of other causes of infectious disease and also through antibody titers.

At present, there is no specific treatment for the Heartland virus. Antibiotics are not effect against the virus. Supportive care to include IV fluids and analgesics are recommended.   Recommendations for prevention includes the use of appropriate clothing such as long sleeve shirts and pants. The use of insect repellents including ones that contain DEET are recommended, however, this is not always effective.

Interestingly, it has been reported that a bite from a Lone Star tick can trigger an immune system response leading to a meat allergy. Dr. Scott Commins and Dr. Thomas Platts-Mills from the University of Virginia, identified the Lone Star tick as the culprit to causing this unusual allergy in 2011 (Current Allergy and Asthma Reports  Feb 2013 13(1): 72-77).  The number of cases have continued to be seen with increasing frequency.  As many of the reactions are often delayed, making the correct diagnosis has been challenging. It is unknown why only some develop the meat allergy.

Some have experienced long term symptoms associated with the Heartland virus from Lone Star tick bites.  It is unknown if the development of a meat allergy from this same tick species is a permanent one.

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Does Coffee Drinking Lower the Risk of Melanoma?

19th Feb 2015 Diseases, Medical News

A study published recently by researchers from the Yale School of Public Health and the Division of Cancer Epidemiology and Genetics at the National Institute of Health (NIH), reported the consumption of coffee was associated with a reduced risk of melanoma.

It is estimated that approximately one in five Americans will develop skin cancer.  Melanoma is currently the leading cause of skin cancer death in the U.S. with an increasing incidence.   Nearly 5000 Floridians are diagnosed with Melanoma annually.

Estimates of coffee consumption reveal that that Americans drink an average of 3.1 cups of coffee daily (NCA Drinking Trends Survey).  Furthermore, 83% of U.S. adults drink coffee.

The recent study looked at 447,357 non-Hispanic whites who were cancer free during at baseline.  They were followed for an average of 10.5 years. During the study period, 2904 developed melanoma.  Using statistical methods to determine risk, those who were in the group with the highest coffee consumption had the lowest risks of developing melanoma. Even after controlling for confounding variables including sex, age, BMI, alcohol intake, smoking status, and ultraviolet radiation exposure, the results held true.

Prior studies looking at the association between coffee consumption and melanoma have had mixed results. In a 2012, published data derived from the Nurses’ Health Study and Health Professionals Follow-up Study found that those women who consumed the most caffeine had an 18% lower risk of basal cell cancer (Song F, Qureshi AA, and Han J.  Cancer Research 2012 Jul 1; 72(13) 3282-3289).  However, caffeine intake was not associated with a lower risk of melanoma. Contrary to this, a prior case control study based out of Italy did show a protective effect of daily coffee consumption on the development of melanoma.

Studies have shown that the components of coffee may protect against oxidative stress and damage to DNA. There is belief that coffee may suppress Ultraviolet (UVB) induced skin cancers. Animal models have shown that caffeine helps to eliminate damaged skill cells before they have a chance to develop into tumors.

Caution should be exercised in considering these results as conclusive.   More research is needed to look at this association.   Differences in populations, possible measurement errors, and other confounding variables must be considered. Furthermore, while the lowest risk of developing melanoma in this study was associated with those who consumed the most coffee, there are known side effects of excessive coffee consumption.

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