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Ear, Nose & Throat Associates |
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News Archives October 2007
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October 2: Painkillers linked to sleep apnea, Deseret Morning News
Salt Lake researcher says disorder may be factor in fatalities
By Lois M. Collins
Patients with severe pain who use opioid-based medications may suffer sleep apnea and its complications, including greater likelihood of death, according to a study in Pain Medicine, the journal of the American Academy of Pain Medicine.
The research shows that three-fourths of patients on chronic opioid therapy have some degree of sleep apnea, said Dr. Lynn R. Webster of Lifetree Clinical Research and Pain Clinic in Salt Lake City, who is lead author on the study. They also found a "direct dose-response relationship" between central sleep apnea and methadone used with benzodiazepines.
Webster said sleep apnea may be an underlying factor in the increase in unintentional overdose deaths linked to opioid pain medications, especially methadone.
The research also showed that as many as one-third of patients being treated with opioids had a component of sleep apnea called central sleep apnea, rather than the more common obstructive sleep apnea. Central apnea is when the body makes no effort to breathe, the part of the brain responsible for respiration malfunctioning. It's also harder to spot, because some of the telltale hints with obstructive sleep apnea, such as being overweight and loud snoring, are absent.
"With central sleep apnea, we don't know what the indicators are," Webster said.
Anyone with sleep apnea is at greater risk of heart disease and stroke. And Webster said it also has been shown that people with sleep apnea have more intense pain, "which makes pain medicine less effective, which leads to more pain medicine, which leads to more sleep apnea, which increases the risk of heart disease and stroke. ... It's a cycle. There are a lot of different factors that are interrelated that can contribute to other problems."
While someone on moderate to high-dose opioid medications may have significant problems with sleep apnea, Webster said, not all of them will. It is important that patients are assessed to spot cases of sleep apnea and treat it.
"If you can't modify the sleep apnea and make sure it's safe, you may have to provide less medication," he said. However, he noted the research is not a call to reduce use of opioids, but rather to understand the risks they may bring and deal with them.
There are a number of treatments for patients with sleep apnea, including a continuous positive airway pressure (CPAP) mask, use of oxygen and others. "The best treatment for this we do not know yet. You can't necessarily use the treatments used for other populations for this problem, because the mechanisms are different for them."
Central sleep apnea in the past has been most strongly linked to heart failure or neurologic disorders like stroke. In these cases it's presumably a combination of chronic pain and the opioid treatment prescribed for it.
The first step is making sure that those who treat patients in chronic severe pain are aware of how common the problem with sleep apnea is, Webster said. He's working to develop protocols looking at the most appropriate treatment for the degrees of both obstructive and central sleep apnea. Treating the sleep apnea may reduce the amount of pain someone experiences and thus the amount of medication needed to cope with it.
"The recent flurry of news reports of deaths associated with methadone use and the synergy of opioids and benzodiazepines in causing respiratory depression highlight the importance of Dr. Webster's research," said Dr. Rollin M. Gallagher, editor of Pain Medicine. "Clearly we need more studies of these mechanisms as well as ways of identifying those at risk. Doctors and patients who are considering opioid medication for pain control must balance this risk against the potential for improved quality of life."
The researchers examined sleep lab data on 140 patients who were taking around-the-clock opioid therapy for chronic pain. All patients had been on the opioid therapy at least six months, with stable dosing for at least four weeks.
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October 7: Insomnia and obesity, Chicago Tribune
STUDIES SHOW A STRONG LINK BETWEEN WEIGHT GAIN AND RESTLESS NIGHTS
BY HARRY JACKSON JR., a reporter for the St. Louis Post-Dispatch
Poor sleep habits have become so closely associated with obesity that some scientists want obesity therapists to address sleep with the same intensity as diet and exercise, according to the National Sleep Foundation.
"There's an association between [inadequate] sleep and obesity," says Dr. Joseph Ojile, head of the Clayton Sleep Institute in St. Louis.
For decades, studies have found that overweight and obese people tend to have poor sleep habits. But the evidence was statistical. The physiological link, albeit in a relatively small study, came in December 2004 when a University of Chicago researcher in endocrinology, Eve van Cauter, found that poor sleep disrupted two hormones associated with appetite.
Sleep and insulin choreograph the dance between one of the hormones, leptin, which tells the brain there's no need for food, and ghrelin, the hormone that tells the brain it's chow time. Poor sleep, researchers learned, causes the dancers to start tripping over one another.
In the study, test subjects slept only four hours rather than eight for several nights. On two nights, the hormones malfunctioned: Leptin production decreased by 18 percent, while ghrelin production increased by 28 percent.
The test subjects--healthy, young, male college students--started eating like they were getting ready to run a marathon. They reported craving more high-calorie, high-density, high-carbohydrate foods, including a 24 percent increase in appetite for candy, cookies, chips, nuts and starchy foods such as bread and pasta.
A week into the experiment, blood tests showed an inability to use insulin that it mimicked that of diabetic patients. Also, lack of sleep increased the production of cortisol, a hormone associated with increased belly fat.
The researchers concluded that sleep deprivation boosted appetite, which led to overeating and weight gain.
Researchers welcomed the report but say they want larger studies with more test subjects before saying poor sleep "causes" obesity.
"But the association is clear," Ojile says. "As a health-conscious society, this is enough data [to suggest that] we should incorporate good sleep health into our total health package. If I'm going to exercise, watch my diet, go low-fat, good sleep should be part of that."
All of the the test subjects from the University of Chicago study returned to normal health after paying their "sleep debt," the amount of sleep they lost during the study.
Obesity is also closely associated with sleep apnea, the collapse of the upper windpipe that interrupts breathing--and therefore sleep--during the night, says Dr. Joseph Espiritu, an expert in sleep medicine at St. Louis University School of Medicine.
Dietitian Lisa Galati of St. Anthony's Medical Center in St. Louis says that, after 25 years of connecting the dots, she found that many of her clients who needed help with obesity also needed help with sleep problems.
One of the first questions she asks her patients is how much sleep they are getting. "They look at me as if to say, 'Why are you asking that?'"
She says she finds a concentration of people with sleep-weight problems in high-tension corporate jobs. She sends them to their doctors for sleep assessments.
"They come back to me and say they're feeling better or they had sleep apnea and didn't know it."
Mothers are especially vulnerable
Mothers with young children rival shift workers for the inability to get regular sleep.
The Academy offers these tips:
- Get out of bed at the same time each morning; that means strive to go to bed at the same time.
- Make your bedroom cool and comfortable.
- Don't stay in bed and try to sleep. If, in 10-15 minutes, you are struggling to fall asleep, get up, move to another room and do something distracting but not stimulating. Read or perhaps listen to soft music.
- Use the bedroom for sleep and sex. Don't pay bills, watch TV or eat.
- Don't clock-watch.
- Avoid alcohol near bedtime; avoid caffeine after noon.
- Relax before bed. Just as you might read to children to help them get to sleep, you need a way to unwind.
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October 8: Tinnitus may originate in the brain, ScienceDaily
BUFFALO, N.Y., Oct. 8 (UPI) -- Researchers at the University at Buffalo have discovered tinnitus -- phantom auditory sensations -- originate somewhere in brain, not in the ear.
Principal investigator Richard Salvi, director of the University of Buffalo Center for Hearing and Deafness, says tinnitus is caused by continued exposure to loud noise, normal aging and, to a much lesser extent, as a side effect of taking some anti-cancer drugs. Thirty percent of Iraq and Afghanistan combat veterans suffer from the condition, Salvi said.
"For many years it was thought that the buzzing or ringing sounds heard by people with tinnitus originated in the ear," Salvi said in a statement.
By using positron emission tomography -- or PET scans -- to view the brain activity of people with tinnitus, the researchers showed the phantom auditory sensations originated somewhere in the brain, not in the ear.
Salvi and colleagues discovered when the brain's auditory cortex begins receiving diminished neural signals from the cochlea in the ear, due to injury or age, the auditory cortex "turns up the volume," increasing weak neural signals from the cochlea. This increased volume of these weak signals may be the buzzing, ringing, or hissing characteristic of tinnitus, the researchers say.
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October 9: I was a grumpy mum from hell until the surgeon cleared my blocked sinuses, The Daily Mail
By ANGELA BROOKS
Six million people live with the pain of chronic-sinusitis. Treatment can involve making incisisions in the face but a minimally invasive operation avoids this.
Claire Bolton, 38, who lives with her husband Andrew, 39, and two children in Tarporley, Cheshire, tells ANGELA EPSTEIN about her condition and her surgeon explains the technique:
THE PATIENT
Since childhood I've had recurrent ear, nose and throat problems. By my teens every cold I got turned into sinusitis as the tissues lining the sinuses became inflamed and the mucus couldn't drain out.
This caused painful pressure around my nose and cheeks (where the sinuses are) for up to three weeks at a time and I used to get sinusitis about six times a year.
My GP tried antibiotics, steroid sprays to reduce inflammation, DRY grumpy sort who struggled even decongestants, antihistamines and painkillers, but these did little to clear it up.
However, it didn't really become a problem until a few years ago when I had children. I wanted to be the sort of mum who could run around the garden with them - instead I was the grumpy sort who struggled even to pick them up because of the painful throbbing in my head.
My husband was a star, but I was sick of relying on him to do what I felt was my job. The last straw was in January when we all came down with an infection. I just couldn't shake it off, even with antibiotics, painkillers and anti-inflammatories. After three weeks I still felt like there was a vice tightening around my head.
I went back to the surgery crying, begging my GP to do something to take the pain away. I felt I could have laid down in the road quite happily and let someone drive their car over my head - anything to release that pressure.
My GP referred me to an ear, nose and throat specialist, who sent me for a CT scan which showed my sinuses were 80 per cent blocked. He said I could benefit from Functional Endoscopic Sinus Surgery to open up the drainage channels from my sinuses to the nose.
This wouldn't prevent colds or flu, but because the passageways from the sinuses would be larger, they wouldn't get so blocked and the pressure would be reduced.
I was so desperate to get rid of the pain, I'd have agreed to anything. Four days later I was admitted to the hospital.
It was astonishing how well I felt once I'd slept off the general anaesthetic. Two hours later I had a meal and it was the most delicious thing I'd tasted in years.
Having sinusitis blunts your sense of taste - but I hadn't realised quite how much.
All the surgery was done inside my nose so I had no cuts or marks on my face, not even bruising or swelling. Some of the feeling of pressure disappeared immediately and over a period of months I continued to improve as the internal tissues healed.
Over the summer I caught two little colds - but I shrugged them off just as most people do. I cannot believe the improvement.
THE SURGEON
Mr Robert Temple, consultant ENT surgeon at the Countess of Chester Hospital, says:
Sinustitis is often triggered by a cold or flu. There are four air-filled sinuses on either side of the nose, and these have connecting passages into the nose which become blocked.
People with nasal allergies such as hay fever are particularly vulnerable, as are those with smaller openings from the nose to the sinuses.
With allergies and colds, the delicate lining tissues in the nose become irritated and swollen, obstructing the sinuses. Mucus can't drain, air can't circulate, so they become a breeding ground for bacterial infection.
As well as congestion and feelings of pressure, patients can have a reduced sense of smell, a sense of something foul-tasting in the mouth and bad breath caused by infected mucus running down the back of the throat.
Another cause of sinusitis is grape-like sacs of watery fluid in the nose - nasal polyps. These are more common in men who are heavy nose blowers, which can tear the delicate lining tissue away from the sides of the nose; the tissue then fills with watery fluid, blocking off the drainage channels so that secretions get trapped.
Patients need to have exhausted all the conservative measures - antihistamines, antibiotics, decongestants, nasal sprays and painkillers - before they would be candidates for surgery.
The operation is designed to improve air flow into the sinuses and fluid drainage - basically, we clean out the infected tissues and shave off some of the bone to widen the openings.
We use the patient's CT scan and an endoscope - a tube with a camera which beams pictures back to a monitor - to track precisely what we're doing.
First I slip a microdebrider into the nose; this instrument has a 5mm rotating head that can suck out infected tissues and shave off bone. I use it to widen the opening into the sinuses as well as siphoning out any polyps or infected lining tissue through the instrument's central tube.
Instead of packing the nose at the end of the operation, we put on a dressing - like a nosebag - which catches any secretions and stops the patient rubbing their nose.
There is seldom any post-operative pain but the nose can sting because air is circulating in the sinuses for the first time, and the internal tissues will be raw.
Because the sinus bones are eggshell-fine and extremely close to the eyes and brain, there is a risk of serious complications, although this is very small.
Possible problems include damage to the bone around the eye (causing bruising), which occurs in less than 1 per cent of cases.
It has also been reported that patients have lost their eyesight as a result of this operation - again, this is extraordinarily rare and has never happened to one of my patients.
The vast majority of patients suffer no complications. Most only stay in hospital overnight.
I tell them not to blow their nose for the first couple of weeks, although they can gently sniff.
We also recommend avoiding contact with others for the first couple of weeks to reduce the chances of catching a cold, as sneezing would cause bleeding. Patients will start to feel the benefits of surgery soon afterwards.
The lining of the nose regenerates and any swelling subsides, but they will feel increasingly better over a period of months.
FESS is a highly successful operation. That doesn't mean it will completely banish sinusitis but it should dramatically reduce its severity and frequency.
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October 11: Infant cold medicines pulled for overdose risk, MSNBC
Drugmakers withdraw more than a dozen products for children under age 2
WASHINGTON - Give plenty of fluids and saltwater nose drops.
These old-fashioned remedies for treating colds in small children are poised to make a comeback now that drug makers have pulled cold medicines for babies off the market.
The move Thursday represented a pre-emptive strike by over-the-counter drug manufacturers — a week before government advisers were to debate the medicines’ fate. But it doesn’t end concern about the safety of these remedies for youngsters.
Thursday’s withdrawal includes medicines aimed at children under age 2, after the Food and Drug Administration and other health groups reported deaths linked to the remedies in recent years, primarily from unintentional overdoses.
A remaining question is whether children under 6 should ever take these nonprescription drugs.
Risk for preschoolers
Baltimore city officials filed a petition with the FDA — joined by the Maryland chapter of the American Academy of Pediatrics and prominent pediatricians around the country — arguing that oral cough and cold medicines don’t work in children so young, and pose health risks not just for babies but for preschoolers, too.
“Pediatricians are taught these products don’t work and may not be safe. Yet almost every parent uses them,” said Dr. Joshua Sharfstein, Baltimore’s health commissioner and a pediatrician, who blames ads that overpromise relief.
The challenge, he says, will be to convince parents to try old-fashioned methods, like suctioning out infants’ noses or using salt-water nose drops.
“If you can actually pull a booger out with a suction device, people can feel better,” Sharfstein said.
The Consumer Healthcare Products Association announced Thursday that manufacturers were voluntarily ending sales of over-the-counter oral cough and cold products aimed at infants. The list includes infant drops sold under the leading brand names Dimetapp, Pediacare, Robitussin, Triaminic, Little Colds, and versions of Tylenol that contain cough and cold ingredients.
CVS Caremark Corp. added that it would also end sales of CVS-brand equivalents.
“It’s important to point out that these medicines are safe and effective when used as directed, and most parents are using them appropriately,” said Linda Suydam, president of the industry trade group.
The American Academy of Pediatrics says in general the drugs shouldn’t be used for colds in small children.
What to try instead? Pediatric and public health groups recommend:
- Plenty of fluids and rest.
- Suction bulbs to gently clear infants’ clogged noses. Saline nose drops loosen thick secretions so noses drain more easily.
- A cool-mist humidifier in the child’s bedroom.
- Acetaminophen or ibuprofen, as recommended by your doctor, to alleviate pain or discomfort — but check that they don’t contain extra ingredients.
- Some chest creams can ease stuffiness with menthol or other fragrances, but check labels for age restrictions.
The Associated Press and Reuters contributed to this report
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October 13: Docs failing to treat sleep problems?, The Capital Times
Insomnia shortens lives, is overlooked in primary care
Anita Weier
Madison hospitals have opened free-standing sleep centers to help residents who can't sleep, but local and national experts say many patients, especially the elderly, do not receive treatment for sleep problems because of a communication gap with primary care doctors.
Dr. Kathryn Middleton, a sleep specialist at the new St. Mary's Hospital Sleep Center on Index Road in Fitchburg, said it is important both that patients bring up sleep issues and that primary care doctors ask about them.
"Patients sometimes think this is how they are supposed to feel, and they think it is not important enough to tell their doctor about. But their quality of life is compromised, and large studies show that too little or too much sleep is associated with shorter life expectancy, though it is not clear why," Middleton said.
A report by the International Longevity Center-USA recommends educating older people to recognize that sleep problems are not a normal part of aging, and encouraging them to discuss sleep issues with their doctors and to pursue treatments.
National Sleep Foundation surveys have shown that almost one-fourth of patients think they have a significant sleep problem but don't talk about it with their doctors, Middleton said.
"If that is true, doctors should probably talk about it at intake," she added, referring to the initial part of an appointment when blood pressure, heart rate, temperature and respiratory rate are checked. "It is easy enough to ask. Some primary care doctors do a great job and others may not talk about it."
Issue ignored?
A study by Northwestern University professor Phyllis Zee and others questioned 1,500 people aged 62 to 100 who visited primary care sites in the Chicago area and then checked their medical charts.
They found that 69 percent reported at least one sleep difficulty, 40 percent had two or more and that the number and type of sleep problems were associated with both physical and mental health quality of life. Even when patients reported five different sleep problems, however, their doctors noted the issue in the patients' charts only 19 percent of the time.
"Implementation of a brief sleep history in the routine evaluation of all patients and educational programs on sleep and treatment of sleep disorders are important measures that may help promote health in older adults," the researchers reported in 2006 in the Journal of Geriatric Psychiatry.
"The relationship between sleep and health appears to remain underrecognized by many health care professionals," the study said.
And the consequences for health can be severe.
Short-term sleep restriction in laboratories resulted in impaired blood sugar control, increased appetite, higher blood pressure and inflammation, said Zee, who also directs the Northwestern Memorial Hospital Sleep Disorders Center. Lack of sleep also can affect memory and concentration, and it increases the risk of falls when people who can't sleep get up at night, she said.
A well-known health study of nurses showed that coronary heart disease and diabetes were linked to low sleep durations, and the National Sleep Foundation says sleep loss and obesity are interacting epidemics.
"Proper sleep is as important as nutrition, exercise and social engagement to the health of older people, and poor sleep needs to be addressed diagnosed and treated," said Dr. Robert Butler, president and chief executive officer of the International Longevity Center.
In a statement often quoted by other scientists, pioneering sleep researcher Allen Rechtschaffen said: "If sleep does not serve an absolutely vital function, then it is the biggest mistake the evolutionary process ever made."
Doctors lack training, time
Primary care doctors may not be able to address sleep issues for two reasons: lack of education on the subject and lack of time to deal with it, said Steven Barczi, an associate professor of medicine in the University of Wisconsin-Madison School of Medicine and Public Health.
"There is variable exposure to sleep medicine in their education. There is not a section on sleep in most training institutions," said Barczi, who provides sleep care at the Veterans Hospital and at University Hospital and Clinics.
Taking a formal sleep history takes time, he added, so it's hard for a primary care provider to fit that in, considering other obligations.
Therefore, a tendency might be to ask two or three questions and provide a prescription, although the problem may not be readily solved with medication, according to Barczi.
Insomnia is one of dozens of sleep problems, including sleep apnea (when the airway to the lungs closes during sleep), narcolepsy (excessive daytime sleepiness) and restless leg syndrome.
Barczi oversees a fellowship that prepares doctors for certification as sleep specialists. Psychologists in training also rotate through the VA and UW sleep clinics, he said.
"Even so, it's a little haphazard, and a person could do a residency and not be required to spend time in our sleep program," he said.
All UW medical students are required to take a neuroscience course that includes content on sleep. The psychiatry portion of the curriculum includes training on insomnia and the medical component includes education about sleep apnea.
"The Medical School is heading in the direction of infusing sleep education more comprehensively throughout the curriculum," said Lisa Brunette, a spokeswoman for UW Health. "The new emphasis is to develop a broader understanding of sleep's impact on health."
Almost all sleep disorders are more common in older adults than in younger people, said Barczi, who specializes in geriatrics and sleep medicine.
Chronic illness, medication for other health issues and shifts in the former rhythm of sleep patterns are all factors that can affect sleep in older people.
Poor sleep "hygiene" also may have developed over the years, in which people drink caffeine or alcohol too close to bedtime, do not have regular sleep and wake times or get insufficient exercise.
"It is rare that an older person comes into my office that I can pinpoint one issue. I end up having to tease out contributing factors such as health, medicines, sleep behaviors or primary physical problems such as sleep apnea," Barczi said.
"It is rare that a single medicine or intervention can resolve it. There should be a multifaceted plan, and that is tricky for a busy primary doctor to do."
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October 15: Treating Kids' Snoring Also Benefits Behavior, MedPage Today
By Crystal Phend, Staff Writer, MedPage Today
Reviewed by Zalman S. Agus, MD; Emeritus Professor at the University of Pennsylvania School of Medicine.
Julie L. Wei, M.D., University of Kansas
KANSAS CITY, Kan., Oct. 15 -- Adenotonsillectomy for kids who snore may improve not only sleep quality but also behavior, researchers here found.
Children who underwent surgery for sleep disordered breathing had a clinically significant improvement averaging about one standard deviation for oppositional behavior, inattention, and hyperactivity (all P<0.001), reported Julie L. Wei, M.D., of the University of Kansas here, and colleagues, in the October issue of the Archives of Otolaryngology -- Head & Neck Surgery.
These parental survey findings at six months after surgery were also maintained over three years, Dr. Wei said in an interview.
"While you cannot say the adenoidectomy and tonsillectomy directly translates into behavioral change, it does so through improving sleep," she said. "Quality of sleep and everything about sleep in a child can significantly influence their daytime behavior."
Although the findings support a cause-and-effect relationship between sleep disordered breathing and development of behavioral problems, Dr. Wei and colleagues cautioned that part of the benefits could have been due to caregivers' expectations for improvement.
"Without a control group that did not undergo adenotonsillectomy, we cannot prove definitively that the surgical intervention was the cause of the change in behavior," they wrote.
Adenoid and tonsillar hypertrophy is the most common reason for obstructive sleep apnea in children, and has become the most common indication for adenotonsillectomy, she said.
Dr. Wei and colleagues analyzed behavior and sleep quality of 71 consecutive children with complete follow-up data who had been clinically diagnosed with sleep disordered breathing and underwent adenotonsillectomy. The mean age of the children was 6.5 years.
The researchers prospectively surveyed parents or caregivers with two questionnaires on the day of surgery and six months later.
Every behavioral measure improved after surgery. Among the findings, the researchers reported:
- Oppositional behavior T scores decreased from 59.4 to 51.0 (P<0.001).
- Cognitive problems or inattention T scores declined from an average of 59.5 to 51.2 at six months (P<0.001).
- Hyperactivity T scores fell from 62.0 preoperatively to 52.4 at follow-up (P<0.001).
- Attention-deficit/hyperactivity disorder index T scores decreased from 59.9 to 50.6 (P<0.001).
These average T scores reflected that many of the children would be at risk for problems in each behavioral category, Dr. Wei's group noted.
But, in all categories after surgery, "the T score decreased by close to 10 points between preoperative and postoperative values, which is considered clinically significant," they said.
In further unpublished analysis, the behavior scores continued to be below baseline at three-year follow-up, Dr. Wei said.
The greatest six-month T score improvements were among children with the worst sleep and behavior scores before surgery, which was typically statistically significant between preoperative T score groups.
The group whose baseline T scores in each category were higher than 70.0 consistently had improvements approximating two standard deviations, which would be "expected to be reflected by clinical changes in behavior," they said.
Indeed, one of the six children in the study being treated with methylphenidate (Ritalin) for ADHD before surgery discontinued the medication during follow-up.
Sleep and behavior scores were significantly correlated before surgery (P=0.004 for the ADHD index, P=0.004 for cognitive problems or inattention, and P=0.008 for oppositional behavior) as well as after (P=0.049 for cognitive problems or inattention and P=0.03 for oppositional behavior).
Pediatric Sleep Questionnaire scores averaged 0.5 (0.6 excluding behavior-related questions) before surgery on a one-point scale but dropped below the 0.33 threshold score for obstructive sleep apnea after surgery (0.1, P<0.001).
Polysomnography is considered the gold standard for sleep apnea evaluation, but most otolaryngologists make decisions or recommendations for adenotonsillectomy based on medical history and adenoid or tonsillar hypertrophy on physical examination, the researchers said.
The study also demonstrates that the Pediatric Sleep Questionnaire could be a useful adjunctive screening tool, they said.
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October 16: Fruit compound fights head and neck cancer, Reuters
By Tan Ee Lyn
HONG KONG (Reuters) - Lupeol, a compound in fruits like mangoes, grapes and strawberries, appears to be effective in killing and curbing the spread of cancer cells in the head and neck, a study in Hong Kong has found.
An experiment with mice showed lupeol worked most effectively with chemotherapy drugs and had almost no side effects, scientists at the University of Hong Kong said in a report published in the September issue of the journal Cancer Research.
"It can suppress the movement of cancer cells and suppress their growth and it is found to be even more effective than conventional drugs (eg. cisplatin)," said Anthony Yuen, a professor at the University of Hong Kong's surgery department.
"It's even more effective if we combine it with chemotherapy drugs, and has very little side effects," he said.
The team plans another round of animal test and hopes to proceed eventually to human clinical trials, though it would not commit itself to a timeframe.
Head and neck cancers involve cancers of the nose, oral cavity, throat, voice box, thyroid and salivary glands and they more commonly afflict Asians than Westerners.
Some of the risk factors include smoking, excessive alcohol consumption, chewing betel nut and diets rich in preserved foods, like salted fish.
Such cancers are difficult to treat. Fifty percent of victims are typically diagnosed in advanced stages, when cure rates would be so low they would be considered inoperable.
Surgeries on the head and neck are always difficult because they involve the removal of large areas of diseased skin and soft tissues and surgeons need to first figure out how to cover up these open wounds before they can try to excise the tumors.
Yuen said lupeol - also found in vegetables, olive seed, figs and saw palmeto - appeared to block a natural protein NFkB, which helps cells repair and grow, even cancer cells.
In the experiment, lupeol was given to mice infected with malignant head and neck cancer cells.
"From the animal models, not only did it suppress the spread, the tumor got smaller. Compared to conventional drugs, lupeol reduced the size of the tumor far faster," said Terence Lee, another member of the research team.
"Conventional drugs made the mice a lot thinner, but lupeol mice retained their bulk." Emaciation is usually viewed as a bad sign in the fight against cancer.
Yuen hopes lupeol can be applied to other cancers that are similarly dependent on the NFkB protein to grow and spread.
"It may be possible to use (lupeol) in other cancers because it is able to suppress the NFkB protien, which is activated in many cancers like prostate cancer, breast cancer, liver cancer," Yuen said.
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October 16: Daily Exposure to Thunderous Sounds Can Damage Music Directors' Hearing, The Ledger
By Gary White
The scene inside the band room at Lake Region High School vaguely resembled a firing squad: Students formed a horseshoe, aiming their horns and other instruments toward the spot at the front of the room occupied by Donald West, their band director.
West wasn't wearing a blindfold, but a pair of blue rubber ear plugs hung from an orange string around his neck. West often inserts the plugs during band rehearsals and performances, giving himself protection against the sonic hazards of being around a band known as The Sound of Thunder.
"On a daily basis, I don't have a single moment when I'm in the classroom I'm not aware of sound thresholds and things like that," said West, 37. "Even when you're outdoors, being where the director would be in front of an ensemble, you're like, 'Everybody put your horns up and aim them at my head.'"
West relishes the chance to shape young musicians at the Eagle Lake school, yet he knows daily exposure to sounds coming from horns and drums threatens to damage his hearing. Despite his precautions, West said he has noticed a decline in the hearing in his right ear.
While factory and construction workers, airport employees and lawn crews seem obvious candidates for job-related hearing loss, few would likely put band directors in the same category. But research suggests the sound exposure band directors face can exceed thegovernment's workplace guidelines.
A study conducted at a high school music camp in 2005 found students' sound exposure exceeded the guidelines of the National Institute of Occupational Safety and Health (NIOSH) by as much as 400 percent. NIOSH sets 85 decibels over eight hours as a maximum daily sound dose. A study of the marching band at Duke University in 2003 reached similar conclusions.
Noise-induced hearing loss can result from one-time exposure to a particularly loud sound or long-term exposure to sound at lower volume. Sound exposure also can cause tinnitus, a persistent ringing in one or both ears.
Rob Lambert, who directs a symphony at Lakeland's Harrison Center for the Visual and Performing Arts, recalled the plight of a retired band director who late in his career conducted pieces even though he could no longer hear some of the sounds his students were making. Lambert recently began assisting with the Lakeland High School marching band and was stunned by the decibel levels of their rehearsals. Lambert, who works with mallet players, said he leaves the band room during full rehearsals.
Lambert's boss, Harrison principal Craig Collins, stands as a cautionary example often cited by Polk County band directors. Collins worked as a band director at two junior high schools in Lakeland in the 1980s but was forced to give up a promising career because of hearing problems. Collins said his hearing declined significantly in six months, prompting his sudden departure from the band room in 1988.
Cheryce Harris, band director at Boone Middle School in Haines City, said Collins' story is common knowledge among Polk County band directors, even those who have never met him. She said his experience has made her more aware of the job's hazards.
"I just felt it was a tragedy that someone who loves music can no longer be teaching because he can't hear (well enough) any more," Harris said. "Knowing how much I enjoy teaching, that would be tragic. ... It's definitely an issue I worry about."
Harris and West both said the issue of potential hearing damage didn't come up during their college training. West spent two years as a graduate assistant at Louisiana State University, and he said the sonic assault of the 350-piece Tiger Marching Band could be overwhelming.
Collins, a former drum major at the University of Florida, said he doesn't remember anyone mentioning the risks of sound exposure during his collegiate days.
"I really do believe as part of our course requirement at the post-secondary level something ought to be presented," Collins said.
David Waybright, director of bands and a music professor at the University of Florida, said no college in the country has a course dedicated to hearing health, but he said the issue is likely to be addressed in "methods" courses taken by prospective band directors. Waybright said the UF marching band and the music staff all wear hearing protection during performances.
"Band directors stand in front of a mass of sound coming at them, and it is excessive quite often," Waybright said. "Over the course of 20 years it can do some damage. I think the word is out on that."
West said the issue first came to his attention several years ago when he attended a clinic for band directors in Chicago. The clinic included a seminar on the dangers of sound exposure.
"My wife, who was with me that year, said, 'You really need to go hear what these guys have to say,'" West said. "Sure enough, it was very eye-opening - or ear-opening."
The Florida Bandmasters Association occasionally holds clinics on the subject at its state meetings, executive director Duane Hendon said, but doesn't routinely raise the issue.
"I've heard stories through the years of people who really had been affected by it," Hendon said. "It's not something you think about until probably you're confronted with the problem, and usually by then, I hate to say it, but it's almost too late."
Hendon said he's heard of band directors suing school systems over poorly designed classrooms.
Frank Howes, Polk County's senior director of fine arts and a former band director at Lakeland's Southwest Junior High, recalled spending his first few years in a double-wide portable before the school's band room was built. Howes, who moved into administration in 1989, said he hasn't noticed any hearing problems.
These days, Howes said band rooms are designed to allow maximum dispersal of sound, lessening the potential hearing damage to teachers and students. He said the smaller band rooms of many older schools in the county have been replaced in recent years.
West's room at Lake Region, which opened in 1995, is a spacious 52 feet deep and 70 feet wide, with a 16-foot ceiling. The side walls are pleated, and sound-dampening panels cover the walls and ceiling. The design allows sounds to dissipate and reduces reverberation.
Even so, it can get loud in there. West keeps a hand-held decibel meter at the ready, and as the 14-piece percussion section played a cadence during a morning class the needle spiked above 100 decibels.
West said he sometimes retreats to his office, concealed behind cinder block and a window, during percussion practices. An electronic metronome that plays through speakers allows him to wander away from the front of the room as the brass section blasts away.
West also uses the ear plugs, whose accordion design allows him to adjust the sound blockage. He said he knows other band directors who use custom-fitted ear plugs.
Collins said he tried using the plugs available in the 1980s but found they blocked too much of the musical spectrum. He suggested he might still be in a band room if today's plugs designed specifically for musicians had been available 20 years ago.
West said increased awareness of sound issues is as important as the improved tools for hearing protection.
"It's definitely made me more aware in this environment day in and day out that I can't just sit and allow myself to be blasted away every day for 180 days of the school year and expect 20 years from now to be able to hear my grandchildren call me out and not have to go, 'Huh?'" he said.
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October 17: Drug-Resistant Staph Germ's Toll Is Higher Than Thought, The Washington Post
By Rob Stein
Washington Post Staff Writer
A dangerous germ that has been spreading around the country causes more life-threatening infections than public health authorities had thought and is killing more people in the United States each year than the AIDS virus, federal health officials reported yesterday.
The microbe, a strain of a once innocuous staph bacterium that has become invulnerable to first-line antibiotics, is responsible for more than 94,000 serious infections and nearly 19,000 deaths each year, the Centers for Disease Control and Prevention calculated.
Although mounting evidence shows that the infection is becoming more common, the estimate published today in the Journal of the American Medical Association is the first national assessment of the toll from the insidious pathogen, officials said.
"This is a significant public health problem. We should be very worried," said Scott K. Fridkin, a medical epidemiologist at the CDC.
Other researchers noted that the estimate includes only the most serious infections caused by the germ, known as methicillin-resistant Staphylococcus aureus (MRSA).
"It's really just the tip of the iceberg," said Elizabeth A. Bancroft, a medical epidemiologist at the Los Angeles County Department of Public Health who wrote an editorial in JAMA accompanying the new studies. "It is astounding."
MRSA is a strain of the ubiquitous bacterium that usually causes staph infections that are easily treated with common, or first-line, antibiotics in the penicillin family, such as methicillin and amoxicillin. Resistant strains of the organism, however, have been increasingly turning up in hospitals and in small outbreaks outside of heath-care settings, such as among athletes, prison inmates and children.
On Monday, Ashton Bonds, 17, of Lynch Station, Va., succumbed to MRSA, prompting officials to shut down 21 Bedford County schools today for cleaning to prevent further infections. The infection had spread to Bonds's kidneys, liver, lungs and the muscle around his heart.
The MRSA estimate is being published with a report that a strain of another bacterium, which causes ear infections in children, has become impervious to every approved antibiotic for youngsters.
"Taken together, what these two papers show is that we're increasingly facing antibiotic-resistant forms of these very common organisms," Bancroft said.
The reports underscore the need to develop new antibiotics and curb the unnecessary use of those already available, experts said. They should also alert doctors to be on the lookout for antibiotic-resistant infections so patients can be treated with the few remaining effective drugs before they develop serious complications, experts said.
MRSA, which is spread by casual contact, rapidly turns minor abscesses and other skin infections into serious health problems, including painful, disfiguring "necrotizing" abscesses that eat away tissue. The infections can often still be treated by lancing and draining sores and quickly administering other antibiotics, such as bactrim. But in some cases the microbe gets into the lungs, causing unusually serious pneumonia, or spreads into bone, vital organs and the bloodstream, triggering life-threatening complications. Those patients must be hospitalized and given intensive care, including intravenous antibiotics such as vancomycin.
In the new study, Fridkin and his colleagues analyzed data collected in California, Colorado, Connecticut, Georgia, Maryland, Minnesota, New York, Oregon and Tennessee, identifying 5,287 cases of invasive MRSA infection and 988 deaths in 2005. The researchers calculated that MRSA was striking 31.8 out of every 100,000 Americans, which translates to 94,360 cases and 18,650 deaths nationwide. In comparison, complications from the AIDS virus killed about 12,500 Americans in 2005.
"This indicates these life-threatening MRSA infections are much more common than we had thought," Fridkin said.
In fact, the estimate makes MRSA much more common than flesh-eating strep infections, bacterial pneumonia and meningitis combined, Bancroft noted.
"These are some of the most dreaded invasive bacterial diseases out there," she said. "This is clearly a very big deal."
The infection is most common among African Americans and the elderly, but also commonly strikes very young children.
"We see these cases all the time," said Robert S. Daum, a pediatric infectious-disease specialist at the University of Chicago. "In the last five weeks, I've taken care of five children who were sick enough to be hospitalized and require intensive care."
Studies have shown that hospitals could do more to improve standard hygiene to reduce the spread of the infection. Individuals can reduce their risk through common-sense measures, such as frequent hand-washing.
In the second paper, Michael E. Pichichero and Janet R. Casey of the University of Rochester in New York documented the emergence of an antibiotic-resistant strain of another bacterium known as Streptococcus pneumoniae, which causes common ear infections. Although all 11 children identified in the Rochester area with the microbe so far were successfully treated, five required an antibiotic approved only for adults, and one child was left with permanent hearing loss.
The researchers attributed the emergence of the strain to a combination of the overuse of antibiotics and the introduction of a vaccine that protects against the infection.
"The use of the vaccine created an ecological vacuum, and that combined with excessive use of antibiotics to create this new superbug," Pichichero said.
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October 24: Suspected Sinus Infections May Be Potentially Deadly Staph Infections, WOIA
Reported by: Kristina De Leon
You may think you have a sinus infection, but it might be staph infection. And if you don’t get treated, it could kill you.
In the last few weeks, several schools, including Judson and Jourdanton have seen an increase in staph infections.
When Buddy De Walt went to see his doctors about his swollen nose, he had no idea what it was.
"It just started getting real sore," said De Walt. "My nose started swelling up real bad. I mean, I knew it wasn't anything I've had before."
Buddy was right. It was a staph infection.
"Staph infections are becoming more common, particularly the more resistant types," said Dr. Charles Biediger, who is treating Buddy De Walt.
De Walt's symptoms were similar to those of a sinus infection.
"I had pains that went up my left nostril, all the way up to my head. And then my eyelids, my eyelids, swelled up they all filled up with fluid up here. And that lasted for, oh, two or three days," said De Walt.
Everyone carries the staph bacteria, but only a select few are likely to come down with an infection. Those most prone to get infected include athletes in a locker room, anyone who has stayed at a hospital, and anyone over 65 or with a low immune system."
"Certainly, if you have an infection, make sure to clean your sheets and your pillow cases," said Dr. Biediger. "Wash your hands carefully after contacting that area and make sure not to spread it to family members."
That includes the most obvious.
"Hand washing is always very important. So just the usual standard precautions," added Dr. Biediger.
"Men especially, aren't as clean as women, and I'm washing my hands all the time," De Walt said laughing.
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