Medtronic profit rises on growth in rhythm devices

New way bacterium spreads in hospital

Healthcare workers and patients have yet another source of hospital-acquired infection to worry about, British researchers are reporting. Clostridium difficile, a germ that causes deadly intestinal infections in hospital patients, has long been thought to be spread only by contact with contaminated surfaces. But a new study finds that it can also travel through the air.

The researchers emphasized that there is no evidence that C. difficile can be contracted by inhaling the germs. Rather, they float on the air, landing in places where more people can touch them. The bug is commonly spread by contact with infected feces, and the British scientists said the new study made it even more urgent to isolate hospital patients with diarrhea as soon as possible — even before tests confirm a C. difficile infection.

Healthcare workers who touch contaminated feces can spread the disease by direct contact with other people or just by touching objects. The spores are resistant to disinfectants and can survive in open areas for months.

The British researchers began with a six-month investigation of 50 patients, symptomatic and not, with confirmed infection. The air near 12 percent of them was found to be contaminated with C. difficile. The more active their diarrheal symptoms, the more likely they were to have spores in the air around them. Then the scientists repeatedly tested 10 patients with symptomatic illness over a 10-hour period, and the air near 7 was positive for C. difficile, usually during visiting hours or when there was activity in patient rooms like food delivery, ward rounds or bedding changes. Surfaces around 9 of the 10 patients were also contaminated.

The scientists believe that the movement of people and the opening and closing of doors stir up spores on contaminated surfaces, helping them disperse and increasing the possibility of them spreading.  The finding is unlikely to change current preventive practice, said Dr. L. Clifford McDonald, an epidemiologist at the Centers for Disease Control and Prevention. He said that the study supported putting patients in a single room, “which is the norm here in the U.S.”

The amounts of C. difficile found in the air were generally modest. There were no clouds of germs circulating in patients’ rooms. This may suggest a genuinely low level of airborne contamination, the researchers write, or it may be a result of methodological problems in collecting air samples: the initial location of the sampling devices, their design, or their movement to accommodate patient care or the arrival of visitors. Visit the New York Times for the article.

Toxic spider bite causes woman to lose breast

By the time Victoria Franklin called her twin sister to take her to the hospital in Atlanta on April 9, her breast had turned black and had blown up to the size of a loaf of bread. "Her breast was three times the size, black as tar and had a horrible smell," said Valerie Dapaa, 51, who took her nearly unconscious sister to the hospital, where they removed her breast after finding it ravaged by gangrene.

Doctors told Franklin that she had been bitten by a brown recluse spider, a virulent little arachnid that is seen mainly in the south central part of the United States. The brown recluse occurs in 15 states, one of them the northern part of Georgia where Franklin lives, according to the Burke Museum of Natural History and Culture in Seattle. Inside the home, these spiders can be found in dark spots in the bath, garages, closets and cellars. They can nest in boxes of stored clothes and books.

Franklin's doctors were not available to talk to ABCNews.com, but some experts say these spiders are often erroneously blamed for skin infections turned septic -- and without finding the spider, no one will ever know for sure. Franklin's condition is known as necrotic arachnidism. Patients report "an abrupt stinging or itching sensation," followed in hours by a painful pimple that within 24 to 48 hours becomes black and necrotic.

"It's a nasty little spider that can cause skin destruction and make an ulcer and let infection in, and in some reported cases it can be very dramatic," said Dr. Marcel Casavant, chief of pharmacology and toxicology at Nationwide Children's Hospital in Columbus, Ohio. About 60 percent of all brown recluse spider bites are false reports, according to the Burke Museum.  "Any small infection in a diabetic can turn into that she had," said toxicologist Casavant. "I wouldn't assume it was a spider."

Experts say the brown recluse spider is often cited in medical and pharmaceutical school training, and doctors are often fooled. These types of infections can arise when patients have metabolic, endocrine or autoimmune conditions, but more often they are caused by the superbug MRSA (methicillin-resistant staphylococcus aureus).

"In pharmacy school, everybody has a story: That the brown recluse spider likes to hide in the pockets of long coats in dark places and you reach into the pocket of the coast you haven't worn and get bit," said Paul Doering, professor at the College of Pharmacy at the University of Florida. "But it should be MRSA-phobia and not arachnophobia," he said.

Doering, who did research on the spider as part of a lawsuit against a pharmacist, said that any infection that becomes systemic is cause for concern. "With skin infections today, especially in the world of resistant organisms, you shouldn't take a chance," he said. "The first sign of something, when you feel poorly and there is a red lesion, go to the ER or the doc-in-box." Visit ABC News for the article.

US aims to reduce drug addiction deaths

For the first time, the federal government has set a goal of reducing diseases and deaths caused by drug addiction, as well as the number of American teens and adults who use illegal substances. The surgeon general will produce a report to try to focus attention on the escalating abuse of legal but dangerous prescription drugs. And federal officials are urging family doctors and public clinics to help detect addictions early by paying closer attention to whether their patients use illicit drugs.

Such emphases, part of the maiden National Drug Control Strategy to emerge from the Obama administration, set a different tone from its predecessors under the Bush administration, which focused more on slowing the flow of illegal drugs. But in the two weeks since the White House issued the 117-page strategy, a growing chorus of drug-policy specialists has begun to complain that President Obama and his aides are not putting enough money behind their efforts to reconfigure the nation’s drug-fighting approach.

Overall, the White House seeks to increase spending next year by 3.5 percent on the broad spectrum of drug-control activities — from curbing drugged driving and expanding drug courts to subsidizing opium and coca farmers in other countries to switch to legal crops.

That increase is less than the 4.1 percent increase that President George W. Bush sought to combat drug abuse in 2002. Visit the Boston Globe for the article.

New threats to U.S. blood supply

Public health officials are battling a host of new infectious threats to the nation's blood supply. Blood centers, which have long tested for risks like hepatitis C and AIDS, have added a number of new tests on donated blood in recent years, including checks for West Nile virus and Chagas, a tropical parasitic disease.

But new screening tests are hard to develop and can take years to win government approval. Currently, for instance, there's no way to screen for newer threats like babesiosis, a parasitic infection that has been linked to 10 U.S. deaths through blood transfusions since 2006. And a dangerous virus known as Chikungunya has spread to the U.S. and Europe from Africa in the last several years.

Blood supply officials are urging the U.S. government to adopt so-called pathogen-reduction technology that can kill a wide range of contaminants in blood after it has been donated. One method already in use in about a dozen countries in Europe, Asia and elsewhere destroys most pathogens with a combination of chemicals and ultraviolet light. The Food and Drug Administration declined to approve the technology several years ago, citing possible side effects. But the agency is continuing to evaluate it.

More pathogens have shown up as people travel more and bugs get ever more resistant to antibiotics. Researchers last year identified 68 emerging infectious agents with a potential to threaten the blood supply. Though some of the infections may cause mild illness in healthy people, they can be fatal in the patients with weakened immune systems who most need donated blood.

Without tests for many risks, blood centers have steadily added new prohibitions for people wanting to give blood as a way to keep out potentially harmful supplies. Donors must answer nearly 50 questions, most of which are required by the FDA and by the American Association of Blood Banks, the lead accrediting body, to determine disease exposures from travel, risky sexual behaviors, medical conditions, and medication and drug use. That's up from about 20 questions in the 1970s. The heightened scrutiny has sharply reduced the pool of eligible donors. In 2006, 12.4 million people showed up to donate blood but nearly 2.6 million were turned away during screening, the most recent government data show.

Donors are rejected if they have traveled to regions where malaria is present or lived in Europe since 1980, which may put them at risk of carrying variant Creutzfeldt-Jakob disease, which causes the human form of so-called Mad Cow disease. Also rejected are would-be donors who have ever taken the psoriasis drug Tegison, which was removed from the market because of the risk it can cause birth defects. Blood found to carry disease after testing is discarded. In 2006, 1.2% of donor blood was thrown out.

Since 2004 most platelets have been tested for bacterial contamination, a danger because they must be stored at room temperature, an environment that encourages bacteria to grow. Red blood cells, by contrast, can be refrigerated. Other new risks from blood transfusion have emerged in recent years, including lung injury and deadly reactions caused by white blood cells and antibodies in donor blood. The Center for Disease Control and Prevention this year began a "hemovigilance" program to encourage hospitals to track such events more closely.

Louis Katz, executive vice president of medical affairs for the Mississippi Valley Regional Blood Center, says that in his blood center, testing accounts for $50 to $60 of the $195 cost of a unit of red blood cells. Still, he says, current testing and questionnaires meant to weed out potentially infected donors are not enough to guarantee safety, especially if there is a potential threat on the scale of HIV, the virus that causes AIDS and was spread in transmitted blood before tests were developed to screen for it.

The CDC last week, for instance, reported the first outbreak of dengue fever in the U.S. outside the Texas-Mexico border region since 1945. Dengue, a debilitating mosquito-borne disease, kills 25,000 people a year world-wide and has been increasingly found in travelers returning from the Caribbean, South America and Asia. The Red Cross currently is using an investigational test to screen blood for dengue in Puerto Rico where it is highly prevalent, but the test is not yet approved for wide use.

The difficulty of developing new screening tests, and the absence in the U.S. of pathogen-reduction technologies, means "the U.S. blood system is becoming more vulnerable to new pathogens," says Richard Benjamin, chief medical officer at the American Red Cross. "We need to take a more proactive approach to emerging infections."

Dr. Katz says pathogen-reduction technology could be the "Holy Grail" for blood safety because it has been shown to kill or inactivate most viruses and bacteria along with potentially harmful white blood cells that naturally occur in donated blood. The white cells, called leukocytes, can carry hidden viruses and can react badly with the recipient's immune system.

The most widely used system, called Intercept, is sold in 11 countries by Concord, CA-based Cerus Corp., and kills most contaminants in platelets and plasma using a combination of chemicals and UV light. Intercept also inactivates white blood cells. Over the last decade, many blood centers and the Red Cross have started using filtering systems to reduce the number of white blood cells, but some of them still remain in blood.

Cerus says Intercept costs about $50 per unit of platelets. The company says the technology saves blood banks about $25 per unit of platelets by allowing them to eliminate various tests and roughly another $25 per unit by lengthening the shelf life of platelets. Cerus says it is developing a version of the technology to use for red blood cells.

Other companies operating overseas offer different technologies to kill pathogens in donated blood. These include adding a mix of vitamin B and various chemicals to the blood or using solvents and dyes to kill pathogens in different blood components.

The FDA declined to approve Intercept in the U.S. after a 2003 clinical trial showed a slight risk of a respiratory injury from blood treated with the system. Cerus Chief Medical Officer Laurence Corash says that in more than 75,000 transfusions in Europe there hasn't been any increased incidence of lung injuries with Intercept-treated platelets. The FDA doesn't accept European data. But Dr. Corash says the company is discussing "requirements for the size of a new clinical trial with the FDA, as well as preparing an alternative clinical study approach." Visit the Wall Street Journal for the article.

As longevity grows, the world might become a better place

The Land of the Rising Sun has become the land of the setting sun with staggering speed. As recently as 1984, Japan had the youngest population in the developed world, but by 2005 it had become the world's most elderly country. Soon it will become the first country where most people are older than 50. This is partly because Japanese people live so long: Men can expect to reach 79 and women 86. It is also partly because the Japanese have almost given up having babies: The fertility rate is just 1.2 children per woman, far lower than the 2.1 needed to maintain a steady population.

The rest of the world is following Japan's example. In 19 countries, from Singapore to Iceland, people have a life expectancy of about 80 years. Of all the people in human history who have reached the age of 65, half are alive now. Meanwhile, women around the world have half as many children as their mothers. And if Japan is the model, their daughters may have half as many as they do.

Homo sapiens are aging fast, and the implications of this may overwhelm all other factors shaping the species over the coming decades -- with more wrinkles than pimples, more walkers than training wheels, and more gray power than student power. The longevity revolution affects every country, every community and almost every household. It promises to restructure the economy, reshape the family, redefine politics and even rearrange the geopolitical order over the coming century.

The revolution has two aspects. First, we are not producing babies at the rate we used to. In just a generation, world fertility has halved, to just 2.6 babies per woman. In most of Europe and much of east Asia, fertility is closer to one child per woman than two, way below long-term replacement levels. The notion that the populations of places such as Brazil and India will go on expanding looks misplaced; in fact, they could soon be contracting. Meanwhile, except in a handful of AIDS-ravaged countries in Africa, people are living longer everywhere.

Some worry that an older workforce will be less innovative and adaptable, but there is evidence that companies with a decent proportion of older workers are more productive than those addicted to youth. This is sometimes called the Horndal effect, after a Swedish steel mill where productivity rose by 15 percent as the workforce got older. Age brings experience and wisdom. Think what it could mean when the Edisons and Einsteins of the future, the doctors and technicians, the artists and engineers, have 20 or 30 more years to give us.

If the 20th century was the teenage century, the 21st will be the age of the old: It will be pioneered by the baby boomers who a generation ago took the cult of youth to new heights. Without the soaring population and so many young overachievers, the tribal elders will return. More boring maybe, but hopefully wiser. Visit the Washington Post for the article.

Pregnancy doubles HIV risk in men; first trial of a microbicide in pregnant women

Young women of reproductive-age are among those at greatest risk of acquiring HIV, and several studies have suggested that during pregnancy women are even more susceptible to infection. Now, a new study finds that pregnancy is a time when men also are at greater risk. In fact, their risk doubles if their partner is both HIV-infected and pregnant.

Between 70 and 90 percent of all HIV infections in women are acquired through heterosexual intercourse, and women are twice as likely as their male partners to acquire HIV during sex, due in part to biological factors that make them more susceptible. Many women remain sexually active during pregnancy. Although correct and consistent use of male condoms has been shown to prevent HIV infection, women often cannot or do not wish to negotiate condom use with their male partners. And for many women, especially those who wish to become pregnant, abstinence is not an option they can consider. Microbicides -- substances designed to be applied topically on the inside of the rectum or vagina – are under active investigation as a method for women to use to protect against HIV.

While a number of studies have shown that during pregnancy women are at increased risk of acquiring HIV from an infected partner, a new study has found pregnancy is a time when men also are at greater risk – double the risk, in fact. The study, which involved 3,321 couples in which one partner was HIV-infected and the other not, is the first to show that a man in a relationship with an HIV-positive woman has a greater chance of becoming infected while she is pregnant than when she is not.

Even after accounting for behavioral and other factors that usually contribute to HIV risk, the increased risk associated with pregnancy remained. Biological changes that occur during pregnancy may make women more infectious than they would be otherwise, explains Nelly Mugo, M.D., M.P.H., of the University of Nairobi & Kenyatta National Hospital in Nairobi and the University of Washington in Seattle, who presented results of the study on behalf of the Partners in Prevention HSV/HIV Transmission Study team. The study was conducted in Botswana, Kenya, Rwanda, South Africa, Tanzania, Uganda and Zambia.

Results of the first study of a vaginal microbicide tested in pregnant women found only small amounts of drug are absorbed into the bloodstream, amniotic fluid and umbilical cord blood. The study, which involved applying a single dose of tenofovir gel hours before women gave birth by cesarean delivery, was conducted as a first step toward determining if use of a vaginal microbicide during pregnancy is safe for women and their babies. The findings support continuing with further studies of tenofovir gel in pregnant women, said Richard Beigi, M.D, MSc., of the University of Pittsburgh and Magee-Womens Hospital of UPMC, who led the study for the Microbicide Trials Network.

The active ingredient in tenofovir gel is an antiretroviral that is approved as an oral drug and used as part of the standard HIV treatment regimen. Both research and clinical experience with the oral drug have indicated its use is safe in HIV-infected women during pregnancy. In previous studies looking at the use of oral tenofovir for the prevention of mother-to-child transmission of HIV, researchers found that low amounts of drug pass to the baby. In the current trial, which involved healthy, uninfected pregnant women, the amount of drug found in umbilical cord blood was 40-times lower than cord blood levels noted in these other studies after oral dosing, and the amount that got absorbed into the maternal blood was at levels 50- to 100-times lower. Based on these results, researchers now plan to conduct a larger study of tenofovir gel in both pregnant and breastfeeding women. Visit here for the article.

Medtronic profit rises on growth in rhythm devices

Medtronic Inc., the biggest maker of heart-rhythm devices, said fourth-quarter profit surged eightfold on higher sales of defibrillators after rival Boston Scientific Corp. had to pull their devices from the market. Net income rose to $954 million, or 86 cents a share, in the three months ended April 30 from $103 million, or 9 cents, a year earlier, the Minneapolis-based company said in a statement. Earnings excluding some items were 89 cents a share beating by one cent the average estimate of 24 analysts surveyed by Bloomberg.

Chief Executive Officer William Hawkins revamped the company’s line of products used in back surgery to revive growth in its second-biggest business unit. The company also benefited from the recall of Boston Scientific’s heart-rhythm devices, which were pulled from the market for a month starting Match 15, said Jan Wald, a Boston-based analyst at Noble Financial Group. Visit Bloomberg for the article.