Ebola Survivors Face Complications Months After Treatment, Study Finds
TUESDAY, Dec. 22, 2015 (HealthDay News) — Some Ebola survivors develop vision and hearing problems as well as joint pain months after treatment, suggesting the virus lingers in some body fluids, new research shows.
Records from the Ebola Virus Disease Survivor Clinic in the West African country of Sierra Leone showed the clinic provided care for 603 of the 661 people in the Port Loko district who survived an Ebola outbreak that began in December 2013.
Complications were common among 277 survivors examined in March and April 2015, according to study senior author Dr. Sharmistha Mishra, an infectious disease specialist at St. Michael’s Hospital in Toronto who spent five months as a clinical consultant for the Ebola response in Sierra Leone.
Of those survivors, 76 percent experienced joint pain; 60 percent developed vision problems; and 24 percent developed hearing problems, the research published Dec. 22 in the Lancet Infectious Diseases found. The study also found that 18 percent of the survivors developed inflammation of the eye. In some cases, it was serious enough that it could lead to vision loss.
The patients who had more of the virus in their blood when they were diagnosed were more likely to develop eye problems, Mishra said in a St. Michael’s Hospital news release.
These symptoms were reported at the patients’ follow-up appointment at the survivor clinic. The median time after discharge was 122 days, meaning half were seen sooner, half later.
During initial treatment, the Ebola virus is quickly cleared from most bodily fluids. But the study authors suggested the virus may linger in what they called “immunologically privileged” sanctuaries such as semen and a type of fluid in the eye. They said the findings highlight the need for follow-up care for Ebola survivors who may be struggling with complications of the disease.
The Ebola outbreak in Sierra Leone, Liberia and Guinea — all in West Africa — began in March 2014 and was the largest in history. It sickened nearly 29,000 people and killed 11,315, according to the World Health Organization.
More information
The U.S. Centers for Disease Control and Prevention provides more information on Ebola.
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Slight Signs of Lingering Brain Damage Seen in Young Athletes After Concussion
By Randy Dotinga
HealthDay Reporter
TUESDAY, Dec. 22, 2015 (HealthDay News) — Young children may suffer minor, but lingering, brain damage from a single concussion, a small study suggests.
The findings don’t prove that a single concussion caused the differences that were revealed in brain scans and thinking tests that were given an average of two years after a reported concussion. And even if just one concussion did some damage, it’s not clear that the children suffered any noticeable neurological problems, the researchers added.
But the results raise further questions even if the kids aren’t currently suffering any ill effects, said Dr. Christopher Giza, a professor of pediatric neurology and neurosurgery at David Geffen School of Medicine and Mattel Children’s Hospital in Los Angeles.
“The fact that they can detect this makes you wonder: What about when they get older and they start to have normal age-related cognitive decline? Will they show problems sooner? And what about kids with a history of multiple concussions?” asked Giza, who was not involved in the study.
Concussions have become a major issue over the past few years as the public has learned about brain damage to athletes — from pro players to children. Much focus has been on high school athletes, but younger kids also suffer concussions due to accidents and sports mishaps.
Research is mixed on the prognosis for children who suffer concussions, with some studies suggesting they recover smoothly and others hinting at measurable damage, Giza explained. There’s been less research into the youngest kids, he said, in part because it can be hard to study them.
In the new study, researchers led by Charles Hillman of the University of Illinois at Urbana-Champaign and Davis Moore, an Illinois graduate now at the University of Montreal, gave brain scans and thinking tests to 15 kids aged 8 to 10 who said they had been removed from sports games due to concussions. They had suffered the concussions six months to four years earlier; all but five were male.
The researchers compared the participants to 15 similar kids who hadn’t suffered concussions.
The researchers found that the brains of the concussion sufferers showed signs of “subtle yet pervasive” disruptions in terms of attention and thinking skills.
It’s unclear what this means for the rest of their lives. “My guess is that they don’t notice any difference on a day-to-day basis,” Giza said.
Giza cautioned that the study was very small, making it impossible to generalize the results to kids in general.
Dr. John Kuluz, director of traumatic brain injury and neurorehabilitation at Nicklaus Children’s Hospital in Miami, agreed.
Kuluz said the study findings are fuzzy since there’s no way to know how the kids were before their injuries. In addition, he said, there’s a potential for bias in how the children were chosen for the study. The kids were not randomly selected. Instead, researchers recruited them through an online bulletin and youth athletic organizations.
What should parents do to make sure their kids don’t suffer lasting problems from concussions?
The good news is that kids typically recover, Giza said, but it is crucial to protect them after a head injury.
“When in doubt, sit them out,” he said. “If you suspect a concussion occurred, a parent or coach doesn’t need to diagnosis it on the sidelines. But they should protect the athlete from getting worse and get them evaluated by someone who knows about concussion.”
The study was published in the December issue of the International Journal of Psychophysiology.
More information
For more about concussions in children, visit kidshealth.org.
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Healthy Habits Help Reduce Risk of Heart Failure, Study Finds
TUESDAY, Dec. 22, 2015 (HealthDay News) — Following seven healthy habits might reduce your risk of heart failure, a new study says.
“Even though there is awareness about the importance of a healthy lifestyle, many people don’t act on those messages,” said senior study author Vanessa Xanthakis, an assistant professor of medicine and biostatistics at Boston University.
The study included just over 3,200 Americans, average age 59, who were followed for up to 12 years. During that time, 188 developed heart failure. This is a condition where the heart can’t pump enough blood to meet the body’s needs.
Those who had high scores on the American Heart Association’s Life’s Simple 7 checklist for a healthy heart had a lower risk of heart failure, the study found.
The measures on the checklist are: manage blood pressure, control cholesterol, reduce blood sugar, get physically active, eat better, lose weight and quit smoking.
For each one-point higher score on the checklist, people had a 23 percent lower risk of heart failure. Compared to those who scored in the bottom third, those in the middle third reduced their risk by nearly half, and those in the top third reduced their risk even more, the researchers said.
The study was published Dec. 22 in the journal Circulation: Heart Failure.
“This study points to the importance of knowing your numbers and speaking to your doctor about improving your score on each health metric and trying to get as close to ideal status as possible,” Xanthakis said in a journal news release.
Study lead author Dr. Matthew Nayor, a cardiology fellow at Brigham and Women’s Hospital in Boston, spoke to the benefits of following the Life’s Simple 7 recommendations. “This is a useful [guide] for a healthy lifestyle that may not only help you reduce your chances of heart attack and stroke, but also of developing heart failure in the future,” he said.
About 5.7 million Americans are living with heart failure, the heart association says.
More information
The U.S. National Heart, Lung, and Blood Institute has more about preventing heart failure.
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The Pill, Hormone Therapy Safe for Women Taking Blood Thinners: Study
TUESDAY, Dec. 22, 2015 (HealthDay News) — Women on blood thinners can also take contraceptives that contain estrogen, or hormone replacement therapy, without raising their risk for blood clots or uterine bleeding, a new Italian study finds.
Currently, women diagnosed with blood clots may be advised to stop hormone therapy or use of the contraceptive pill — even if they are already on a blood thinner. The reason: Doctors are often concerned that these drug combinations might raise the patient’s risk for more clots.
However, “there has been no evidence to support this decision,” said the study’s senior author, Dr. Ida Martinelli, of the A. Bianchi Bonomi Hemophilia and Thrombosis Center in Milan.
“We conducted this study to address the fear felt by both the physician and patient when making the decision to stop or continue hormone therapy in this setting,” she explained in a news release from the American Society of Hematology.
In the study, Martinelli’s team compared cases of recurrent blood clots and abnormal uterine bleeding in nearly 1,900 women who were prescribed blood thinners either with or without hormone therapy.
Of all the women involved in the study, 475 used hormone therapy, such as estrogen-only pills, combined estrogen-progestogen contraceptives, and progestin-only pills. The women were asked if they experienced any symptoms or signs of blood clots and bleeding, including uterine bleeding, during each follow-up visit.
Seven recurrent blood clot events occurred while the women were on hormone therapy, while 38 events occurred during a period when patients were not using these treatments, according to the study published online Dec. 22 in the journal Blood.
The researchers calculated that women on blood thinners and hormone therapy experienced recurrent blood clots at a rate of 3.7 percent per year — less than the recurrence rate of 4.7 percent per year for those not on hormone therapy.
Moreover, the rate of abnormal uterine bleeding in those taking hormone therapy was 22.5 percent, compared to 21.4 percent for women not using hormone therapy, suggesting the combined use of these medications is safe, the study authors said.
“For the first time, we demonstrate that women suffering from blood clots can safely take hormone-containing contraceptives or hormone replacement therapy with anticoagulants [blood thinners], providing women the freedom to choose the method of birth control and other hormone-containing medications they prefer,” said Martinelli.
“While further investigation is needed to evaluate the inconvenience of abnormal uterine bleeding with rivaroxaban [Xarelto] and the other direct oral anticoagulants, these results dispel former misconceptions and should allow clinicians to confidently treat their patients who take blood thinners and hormones concurrently,” Martinelli said in the news release.
One expert in the United States believes the findings will be welcome news for women.
“For those women who suffered from clots while on hormones, previous studies have not been clear as to the safety of taking the hormones with blood thinners,” said Dr. Suzanne Steinbaum, director of women’s heart health at Lenox Hill Hospital in New York City. “This trial provides some insight and reassurance that women can safely continue their hormones while being treated for blood clots,” she said.
More information
The American College of Obstetricians and Gynecologists has more about hormone therapy.
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Weight-Loss Surgery Lowered Risk of Heart Attack, Type 2 Diabetes in Study
TUESDAY, Dec. 22, 2015 (HealthDay News) — Weight-loss surgery can reduce the risk of heart attack, type 2 diabetes and other obesity-related health problems, a new study says.
“Bariatric surgery is safe and produces unrivaled health benefits that are life-changing for patients and cost-saving [for Britain’s National Health Service],” said study co-author Rachel Batterham, head of the Bariatric Centre for Weight Management and Metabolic Surgery at University College London Hospital. She is also a professor at the Centre for Obesity Research at University College London in England.
“Unfortunately, less than 1 percent of the patients who could benefit from this surgery currently receive surgery. This represents a major missed opportunity in terms of improving health and economic savings. Action is now needed to remedy this situation,” she said in a news release from the London School of Hygiene & Tropical Medicine. The study resulted from a partnership between the two schools.
The findings suggest that making weight-loss surgery more widely available could improve the health of people who are very obese, the British researchers said.
They reviewed medical records over 3.5 years from more than 3,800 very obese people who had weight-loss surgery. They compared them to a control group of very obese people who didn’t have the surgery.
Weight-loss surgery led to substantial weight loss. The procedure also improved or reduced the risk of serious obesity-related health conditions, the researchers said.
Compared to the control group, those who had weight-loss surgery were 70 percent less likely to have a heart attack and nine times more likely to have major improvements in type 2 diabetes, the study found. Weight-loss surgery also had positive effects on blood pressure, angina and sleep apnea, the researchers added.
The researchers calculated that if the 1.4 million very obese people in the United Kingdom had weight-loss surgery, there would be 80,000 fewer cases of high blood pressure, 40,000 fewer cases of type 2 diabetes, and 5,000 fewer heart attacks over four years.
Also, 110,000 people with type 2 diabetes and 13,000 people with high blood pressure would have significant improvements in their conditions, according to the study in the Dec. 22 PLOS Medicine.
Lead author Ian Douglas, an epidemiologist from the London School of Hygiene & Tropical Medicine, said, “Obesity is one of the biggest health problems of our generation. Rates of cardiovascular disease, although slowly declining, are still alarmingly high while type 2 diabetes is on the rise, affecting 3.5 million people in Britain.
“Finding effective ways to tackle the obesity crisis is therefore a key public health strategy,” he said in the news release.
More information
The U.S. National Institute of Diabetes and Digestive and Kidney Diseases has more about weight-loss surgery.
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Night-Shift Workers May Be Prone to Car Crashes
By Maureen Salamon
HealthDay Reporter
TUESDAY, Dec. 22, 2015 (HealthDay News) — In a study of 16 night-shift workers, more than one-third were involved in near crashes while participating in a test drive after work, researchers report.
The same drivers experienced zero near-crashes after sleeping sufficient amounts the night before the same test drive, according to the study, published online Dec. 21 in the Proceedings of the National Academy of Sciences.
“What is unique about this study is that it (was) done in daytime” and there was a “stupendously increased risk of these near-crash events,” said study author Dr. Charles Czeisler, chief of the division of sleep and circadian disorders at Brigham and Women’s Hospital in Boston.
“It reveals just how dangerous it is to drive home after working all night,” added Czeisler, also a professor of sleep medicine at Harvard Medical School in Boston. “It also shows that these very same people, if they slept the previous night, don’t have any of these incidents, so it’s not that they’re inherently dangerous drivers.”
More than 9.5 million Americans — or 15 percent of the workforce — work overnight or rotating shifts, according to the study. Meanwhile, drowsy drivers were involved in more than one in five fatal crashes and 13 percent of crashes causing severe injury between 2009 and 2013.
The new research is thought to be the first assessing the impact of night-shift work on driving in real-time conditions instead of driving simulators.
Czeisler and his colleagues studied 16 night-shift workers who completed a pair of two-hour driving sessions on a closed driving track. Before one of the driving sessions, participants slept an average of 7.6 hours the previous night and did not work the night shift. Before the other driving session, the same participants worked the night shift.
Both driving sessions took place at about the same time of day, during which physiological measures of drowsiness were collected, such as partial eyelid closures with slow eye movements indicative of the transition from wakefulness to sleep. Additionally, brief micro-sleep episodes were measured on each participant using an electroencephalogram to record brain activity.
Among other results, the researchers found:
- 37.5 percent of night-shift workers used emergency braking maneuvers during their test drive after working all night;
- Nearly half of the test drives after the night shift were terminated early because participants failed to maintain control of the vehicle;
- Sleep-related impairment was evident after the night shift within the first 15 minutes of driving.
“The impairment is similar to being legally drunk,” Czeisler said. “Another issue is the longer the drive, the greater the risk. It gets more and more hazardous as the duration of the drive continues.”
Dr. Nitun Verma, spokesperson for the American Academy of Sleep Medicine, said the number of near-accidents experienced by night-shift workers in the study was about double the amount he would have expected.
“This type of research is really important because we have two pillars of health right now: diet and exercise,” said Verma, also chief medical officer of PeerWell, a San Francisco-based chronic disease treatment company. “It’s reaffirming there’s a third pillar of health, which is sleep.”
Czeisler recommended that night-shift workers find alternate forms of transportation after working an overnight shift instead of driving themselves home.
“Taking public transportation when they finish the night shift, or another form of transportation, so they’re not putting others at risk, is something every night-shift worker should consider,” he said.
“Companies [employing night-shift workers] can provide transportation home for their workers,” he added. “I don’t think companies want to be responsible for the kind of hazards that occur when employees are attempting to drive home in this state.”
More information
The National Sleep Foundation offers more facts about drowsy driving.
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Hormone Therapy Safely Helps Preserve Fertility for Breast Cancer Patients: Study
TUESDAY, Dec. 22 2015 (HealthDay News) — Chemotherapy can affect a young breast cancer patient’s fertility, sending her into premature menopause, so in many cases doctors provide patients with hormonal therapy during chemo to prevent this side effect.
Now, new research suggests that the approach does help these patients without lowering their odds of surviving the cancer.
One expert noted that the issue is a tough one for many young breast cancer patients.
“The most reliable way in 2015 to preserve a patient’s fertility is through egg harvesting prior to chemotherapy and in vitro fertilization,” explained Dr. Charles Shapiro, director of translational breast cancer research at Mount Sinai Medical Center in New York City.
“However, as this procedure is typically not covered by insurance, it is only an option for those of financial means,” he said. “So, those who cannot afford the procedure can choose to receive [hormonal therapy] as it is has higher — but modest — rate of preserving menstrual function and possibly having subsequent pregnancy.”
The new study was led by Dr. Lucia Del Mastro of the National Institute for Cancer Research in Genoa, Italy. It included 281 women, median age 39, with stage 1 to 3 breast cancer who were randomly selected to receive chemotherapy only or chemotherapy plus the hormone drug triptorelin.
Over five years of follow-up, normal menstruation resumed in 73 percent of those in the hormone treatment group and 64 percent of those in the control group, the Italian team reported Dec. 22 in the Journal of the American Medical Association.
Pregnancy rates were 2.1 percent in the treatment group and 1.6 percent in the control group.
Survival didn’t seem to be affected: Five-year cancer-free survival rates were 80.5 percent in the hormone treatment group and 84 percent in the control group — not a statistically significant gap, the researchers said.
Dr. Lauren Cassell is chief of breast surgery at Lenox Hill Hospital in New York City. She noted that the study was well-designed, being prospective in nature and including a wide range of breast tumors that were either sensitive to estrogen or not.
“Our young women who continue to live long and happy lives are concerned about quality-of-life issues, which include the ability to bear a child as well as the negative effects of premature menopause,” Cassell said. She believes that a discussion of these issues, and potential solutions, is vital to breast cancer care.
But Shapiro believes those discussions aren’t happening often enough.
“Only about one-third of medical oncologists’ medical records document a discussion about risks of infertility,” he said, “and about one-fourth of these medical records discussed options or referred to [fertility] specialists. We have to do better.”
More information
The U.S. Office on Women’s Health has more about premature menopause.
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Child Paralysis Cases Spiked During Virus Outbreak: Study
By Dennis Thompson
HealthDay Reporter
TUESDAY, Dec. 22, 2015 (HealthDay News) — Doctors have learned more about a “polio-like” mystery illness that has stricken dozens of American children, but its exact cause remains elusive, according to a new report.
At least 120 children in 34 states have fallen ill with so-called acute flaccid myelitis since August 2014, according to the U.S. Centers for Disease Control and Prevention. The disease involves a sudden onset of paralysis or weakness in one or more limbs.
It turns out that acute flaccid myelitis cases in California spiked significantly during a national outbreak of enterovirus D68, a virus in the same family as polio, researchers report in the Dec. 22/29 issue of the Journal of the American Medical Association.
But doctors were unable to find any traces of the virus in spinal fluid samples taken from kids with muscle weakness or paralysis, and could directly link only a handful of cases to enterovirus infections, said lead author Dr. Keith Van Haren. He is an assistant professor and child neurologist at the Stanford University School of Medicine in Palo Alto, Calif.
“We have to acknowledge the cases are not definitively proven,” Van Haren said. “I think this is the best epidemiologic association we have to date, in the sense that we have data before, during and after the enterovirus D68 outbreak, and we see that the cases did spike.”
For this report, Van Haren and colleagues focused on 59 California children who have acute flaccid myelitis.
California stands at the national forefront of tracking this disease, the researchers said in background notes. That’s because the California Department of Public Health instituted active surveillance of acute flaccid paralysis after receiving three separate case reports in the fall of 2012, following 14 years in which no cases were reported.
California kids developed acute flaccid myelitis nearly six times more often during the enterovirus D68 outbreak — which lasted from August 2014 through January 2015 — than they did before or after the outbreak, researchers determined from the state’s detailed tracking statistics.
However, the research team was unable to find any traces of enterovirus in the stricken children’s spinal fluid, which is the standard for proving that any virus is the cause of a central nervous system disease, Van Haren said.
“The reasons may include that the virus was never in the cerebrospinal fluid, that the virus had been in the cerebrospinal fluid and already left, or that this is not caused by an enterovirus,” he said.
That doesn’t completely rule out one or more enteroviruses as the cause, though, he added.
The researchers found enteroviruses in mucous, stool or blood samples taken from 15 out of 45 California kids with acute flaccid myelitis, and in nine cases out of 15 the virus was enterovirus D68, noted Dr. Amesh Adalja, a senior associate at the UPMC Center for Health Security in Baltimore.
The report also adds a couple of interesting observations, including:
- Symptoms that preceded or accompanied acute flaccid myelitis include respiratory or gastrointestinal illness, fever and muscle pain in the arms or legs.
- The weakness appears to be long-lasting. Follow-up data on 45 kids showed that 38 still had persistent muscle weakness an average of nine months following diagnosis. “Very, very few children recovered full strength. In fact, many of them remain quite weak,” Van Haren said. “Persistent weakness is the prevailing theme of recovery. It gets a little better and a little better, but most cases did not make full recovery.”
- The illness shows up on MRI scans as damage to the spinal cord, which means that MRI could be used to detect future cases. “It looks like a bright spot in the center of the spinal cord, that runs down the length of the spinal cord,” Van Haren said. “It’s an injury to the center of the spinal cord.”
Since these viruses spread by touch, worried parents can teach their kids to wash their hands often and avoid contact with sick children, Van Haren said.
Adalja said that even children infected with the virus run a very low risk of this central nervous system complication.
“Parents should be reassured that this is a rare occurrence and not something that should overly worry them,” Adalja said. “Even during the height of the enterovirus D68 outbreak, the incidence was just 0.16 per 100,000 person-years, so it is not a common complication.”
More information
Learn more about acute flaccid myelitis at the U.S. Centers for Disease Control and Prevention.
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More IVF Tries Improve Odds of Having a Baby
By Steven Reinberg
HealthDay Reporter
TUESDAY, Dec. 22, 2015 (HealthDay News) — Couples having trouble getting pregnant may have a better chance if they have more than the usual three-to-four cycles of in vitro fertilization (IVF), a new British study suggests.
Among more than 150,000 women in the study, 29.5 percent had a baby after the first cycle. The rate remained above 20 percent through the fourth cycle, and 65 percent of women had a live birth by the sixth cycle, the researchers said.
“IVF should be thought of as a relatively long-term treatment, with repeat treatment cycles if success is not immediate,” said lead researcher Debbie Lawlor, a professor of epidemiology at the University of Bristol.
Currently, it’s common practice to assume that further treatment isn’t likely to be successful after three or four embryo transfers, but that’s not true, Lawlor said. “It is also not true that if there is a small egg yield in one treatment cycle it is not worth continuing with more treatments,” she added.
On average, most couples receiving IVF can have a baby if they repeat treatment up to six times, she said.
“This will take on average two years. Not all couples will want this repeat treatment, and some health care systems, insurance companies and individuals may not be able to afford it. But we believe couples should know what the possibilities are,” Lawlor said.
Dr. Evan Myers, chief of clinical and epidemiological research at Duke University Medical Center in Durham, N.C., and author of an accompanying journal editorial, said, “The question is if insurance won’t pay for IVF, are couples willing to spend those resources on repeated attempts?”
Myers said that each attempt can cost thousands of dollars — $12,000 to $15,000 on average — and in most cases insurance doesn’t cover IVF.
In addition, there are psychological aspects to repeated IVF attempts, he said. “Some couples find the experience stressful,” he explained.
Myers added that spending on additional IVF cycles is also a societal question. “It’s a hard question to figure out how we value infertility treatment relative to all the other things we could be spending money on for health care,” he said.
For individuals, it’s also a tough decision, Myers suggested. “Assuming a couple has the resources both financial and emotional to have multiple cycles, there may be a reasonable chance of having a successful live birth beyond the standard three to four cycles,” Myers said. “But whether it’s worth spending the additional resources is something couples have to answer for themselves.”
The study was published in the Dec. 22/29 issue of the Journal of the American Medical Association.
Nearly 157,000 women from the United Kingdom were included in the study. The women had more than 257,000 IVF cycles between 2003 and 2010, and were followed until June 2012. The average age at start of treatment was 35. The average time of infertility for all cycles was four years, according to the study.
Among women under 40, the birth rate for the first cycle was 32 percent and remained above 20 percent up to and including the fourth cycle, the researchers said. The birth rate at six cycles was 68 percent, the findings showed.
Among women 40 to 42, the birth rate for the first cycle was 12 percent, and 31.5 percent at six cycles. For women older than 42, birth rates for all the cycles were less than 4 percent, the researchers found.
No difference was seen when donor eggs were used. Although birth rates were lower when the male partner was infertile, treatment with sperm injections or donor sperm increased the odds of having a baby, the study authors said.
In addition, the researchers found that the number of eggs retrieved after ovarian stimulation in one cycle does not influence the live birth success rate in later cycles. This finding is important because couples are often told their chances of success with future treatments are likely to be poor in subsequent cycles if they have had no or only a small number of eggs retrieved in the current cycle, Lawlor said.
As with many medical procedures, there are potential risks involved with in vitro fertilization.
According to the American Pregnancy Association, risks include: headaches, mood swings, abdominal pain, hot flashes, and bloating. And, though rare, fertility medications may cause ovarian hyper-stimulation syndrome (OHSS). Symptoms of OHSS can include abdominal pain or feeling bloated. More severe symptoms include: nausea, decreased urination, shortness of breath, faintness, severe stomach pains, a 10-pound weight gain within three to five days.
If you experience any of these symptoms, get in touch with your doctor immediately, the association says.
More information
For more on assisted reproduction, visit the U.S. Centers for Disease Control and Prevention.
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