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Modulation of Age- and Cancer-Associated DNA Methylation Change in the Healthy Colon by Aspirin and Lifestyle

July 9, 2014 Comments off

Modulation of Age- and Cancer-Associated DNA Methylation Change in the Healthy Colon by Aspirin and Lifestyle
Source: Journal of the National Cancer Institute

Background
Aberrant DNA methylation in gene promoters is associated with aging and cancer, but the circumstances determining methylation change are unknown. We investigated the impact of lifestyle modulators of colorectal cancer (CRC) risk on the stability of gene promoter methylation in the colonic mucosa.

Methods
We measured genome-wide promoter CpG methylation in normal colon biopsies (n = 1092) from a female screening cohort, investigated the interaction of lifestyle factors with age-dependent increase in methylation with log-linear multivariable regression, and related their modifying effect to hypermethylation in CRC. All statistical tests were two-sided.

Results
Of 20025 promoter-associated CpGs analyzed, 1713 showed statistically significant age-dependent methylation gains. Fewer CpGs acquired methylation in users of aspirin (≥2 years) and hormonal replacement therapy (HRT age ≥50 years) compared with nonusers (43 vs 1355; 1 vs1377, respectively), whereas more CpGs were affected in smokers (≥20 years) and individuals with a body mass index (BMI) of 25kg/m2 and greater compared with control groups (180 vs 39; 554 vs 144, respectively). Fifty percent of the CpGs showing age-dependent methylation were found hypermethylated in CRC (odds ratio [OR] = 20; 95% confidence interval [CI] = 18 to 23; P < 2×10–16). These loci gained methylation with a higher median rate compared with age-only methylated sites (P = 2×10–76) and were enriched for polycomb regions (OR = 3.67). Importantly, aspirin (P < .001) and HRT use (P < .001) reduced the methylation rate at these cancer-related genes, whereas smoking (P < .001) and high BMI (P = .004) increased it.

Conclusions
Lifestyle, including aspirin use, modulates age-associated DNA methylation change in the colonic epithelium and thereby impacts the evolution of cancer methylomes.

See: Cancer risk: Aspirin and smoking affect aging of genes (Science Daily)

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Colorectal cancer statistics, 2014

March 27, 2014 Comments off

Colorectal cancer statistics, 2014
Source: CA: A Cancer Journal for Clinicians

Colorectal cancer is the third most common cancer and the third leading cause of cancer death in men and women in the United States. This article provides an overview of colorectal cancer statistics, including the most current data on incidence, survival, and mortality rates and trends. Incidence data were provided by the National Cancer Institute’s Surveillance, Epidemiology, and End Results program and the North American Association of Central Cancer Registries. Mortality data were provided by the National Center for Health Statistics. In 2014, an estimated 71,830 men and 65,000 women will be diagnosed with colorectal cancer and 26,270 men and 24,040 women will die of the disease. Greater than one-third of all deaths (29% in men and 43% in women) will occur in individuals aged 80 years and older. There is substantial variation in tumor location by age. For example, 26% of colorectal cancers in women aged younger than 50 years occur in the proximal colon, compared with 56% of cases in women aged 80 years and older. Incidence and death rates are highest in blacks and lowest in Asians/Pacific Islanders; among males during 2006 through 2010, death rates in blacks (29.4 per 100,000 population) were more than double those in Asians/Pacific Islanders (13.1) and 50% higher than those in non-Hispanic whites (19.2). Overall, incidence rates decreased by approximately 3% per year during the past decade (2001–2010). Notably, the largest drops occurred in adults aged 65 and older. For instance, rates for tumors located in the distal colon decreased by more than 5% per year. In contrast, rates increased during this time period among adults younger than 50 years. Colorectal cancer death rates declined by approximately 2% per year during the 1990s and by approximately 3% per year during the past decade. Progress in reducing colorectal cancer death rates can be accelerated by improving access to and use of screening and standard treatment in all populations.

Vital Signs: Colorectal Cancer Screening Test Use — United States, 2012

November 8, 2013 Comments off

Vital Signs: Colorectal Cancer Screening Test Use — United States, 2012
Source: Morbidity and Mortality Weekly Report (CDC)

Background:
Strong evidence exists that screening with fecal occult blood testing (FOBT), sigmoidoscopy, or colonoscopy reduces the number of deaths from colorectal cancer (CRC). The percentage of the population up-to-date with recommended CRC screening increased from 54% in 2002 to 65% in 2010, primarily through increased use of colonoscopy.

Methods:
Data from the 2012 Behavioral Risk Factor Surveillance System survey were analyzed to estimate percentages of adults aged 50–75 years who reported CRC screening participation consistent with United States Preventive Services Task Force recommendations.

Results:
In 2012, 65.1% of U.S. adults were up-to-date with CRC screening, and 27.7% had never been screened. The proportion of respondents who had never been screened was greater among those without insurance (55.0%) and without a regular care provider (61.0%) than among those with health insurance (24.0%) and a regular care provider (23.5%). Colonoscopy was the most commonly used screening test (61.7%), followed by FOBT (10.4%). Colonoscopy was used by more than 53% of the population in every state. The percentages of blacks and whites up-to-date with CRC screening were equivalent. Compared with whites, a higher percentage of blacks across all income and education levels used FOBT.

Conclusions:
Many age-eligible adults did not use any type of CRC screening test as recommended. Organized, population-based approaches might increase CRC screening among those who have never been screened. Promoting both FOBT and colonoscopy as viable screening test options might increase CRC screening rates and reduce health disparities.

Notes from the Field: Acute Hepatitis and Liver Failure Following the Use of a Dietary Supplement Intended for Weight Loss or Muscle Building — May–October 2013

October 11, 2013 Comments off

Notes from the Field: Acute Hepatitis and Liver Failure Following the Use of a Dietary Supplement Intended for Weight Loss or Muscle Building — May–October 2013
Source: Morbidity and Mortality Weekly Report (CDC)

On September 9, 2013, the Hawaii Department of Health (HDOH) was notified of seven patients with severe acute hepatitis and fulminant liver failure of unknown etiology. Patients were previously healthy and sought medical care during May-September 2013. Clinicians reported that the seven patients had all used OxyELITE Pro, a dietary supplement marketed for weight loss and muscle gain, before illness onset.

The HDOH, with the CDC and the Food and Drug Administration (FDA), initiated a public health investigation including patient interviews, medical chart reviews, and collection of supplement samples for analysis. Subsequently, a case was defined as acute hepatitis of unknown etiology occurring on or after April 1, 2013 in a person who had consumed a weight loss or muscle-building dietary supplement within the previous 60 days and had a serum alanine aminotransferase level greater than or equal to four times the upper limit of normal (>160 IU/L) and a total bilirubin level greater than or equal to two times the upper limit of normal (>2.5 mg/dL) and a negative evaluation for infections including viral hepatitis. Excluded were other etiologies such as pre-existing autoimmune hepatitis, chronic alcohol use, and chronic liver diseases such as primary biliary cirrhosis, primary sclerosing cholangitis, Wilson’s disease, and hemochromatosis.

Clinicians reported 45 possible cases to the Hawaii DOH in response to a public health alert. Of those, 29 have been identified as cases. The patients have a median age of 33 years (range: 16–66); 14 (48%) were male. The date of first reported laboratory test was used as a proxy for illness onset and ranged from May 10 through October 3, 2013 (Figure). The most commonly reported symptoms included loss of appetite, light-colored stools, dark urine, and jaundice. Median laboratory values reported at the peak of illness were: aspartate aminotransferase 1,128 IU/L (range: 104–2,184, upper limit of normal ~40); alanine transaminase 1,793 IU/L (range: 347–3,091, upper limit of normal ~40); alkaline phosphatase 150 IU/L (range: 68–251, upper limit of normal ~120); and total bilirubin 12.6 mg/dL (range: 2.8–39.6, upper limit of normal ~1.2). Ten patients had liver biopsy data available at the time of this report; seven had histology consistent with hepatitis from drug/toxic injury, with findings including hepatocellular necrosis and cholestasis. Eleven (38%) patients were hospitalized, with a median duration of 7 days (range: 1–45). One patient died, two patients received liver transplants, and two remain hospitalized; all other hospitalized patients have been discharged.

FDA defines “gluten-free” for food labeling

August 8, 2013 Comments off

FDA defines “gluten-free” for food labeling
Source: U.S. Food and Drug Administration

The U.S. Food and Drug Administration today published a new regulation defining the term “gluten-free” for voluntary food labeling. This will provide a uniform standard definition to help the up to 3 million Americans who have celiac disease, an autoimmune digestive condition that can be effectively managed only by eating a gluten free diet.

“Adherence to a gluten-free diet is the key to treating celiac disease, which can be very disruptive to everyday life,” said FDA Commissioner Margaret A. Hamburg, M.D. “The FDA’s new ‘gluten-free’ definition will help people with this condition make food choices with confidence and allow them to better manage their health.”

This new federal definition standardizes the meaning of “gluten-free” claims across the food industry. It requires that, in order to use the term “gluten-free” on its label, a food must meet all of the requirements of the definition, including that the food must contain less than 20 parts per million of gluten. The rule also requires foods with the claims “no gluten,” “free of gluten,” and “without gluten” to meet the definition for “gluten-free.”

The FDA recognizes that many foods currently labeled as “gluten-free” may be able to meet the new federal definition already. Food manufacturers will have a year after the rule is published to bring their labels into compliance with the new requirements.

FDA Gives Tips to Prevent Salmonella Infection from Handling Feeder Rodents and Pet Reptiles and Amphibians

March 21, 2013 Comments off

FDA Gives Tips to Prevent Salmonella Infection from Handling Feeder Rodents and Pet Reptiles and Amphibians
Source: U.S. Food and Drug Administration

The Food and Drug Administration is giving consumers, especially reptile owners, tips on how to prevent Salmonella infection from handling feeder rodents and reptiles. Feeder rodents are mice and rats—both frozen and live—used to feed some reptiles, such as certain snakes and lizards, as well as some amphibians. Feeder rodents, reptiles, and amphibians can be sources of Salmonella infection for people.

Salmonellosis is an infection with bacteria called Salmonella. People get salmonellosis by ingesting Salmonella germs. Persons infected with Salmonella develop diarrhea, fever, and abdominal cramps 12-72 hours after infection. The illness usually lasts 4-7 days, and most persons recover without treatment. However, the illness can be serious, even fatal, in some people. Children under 5 years of age, the elderly, and people with weakened immune systems are at higher risk for salmonellosis and may develop more severe illness.

Rodents and reptiles can naturally carry Salmonella in their intestines but show no signs of illness. The animals shed the bacteria in their feces and droppings. These, in turn, contaminate the environment with Salmonella, including the outside of the animals’ bodies and their habitats. Freezing does not kill Salmonella, so both frozen and live feeder rodents can be contaminated with these germs. Over 500 human cases of salmonellosis in three countries, including the U.S., were linked to frozen rodent exposure between 2008 and 2010.

People may become infected with Salmonella after handling feeder rodents, reptiles, or amphibians, surfaces that have been in contact with these animals, or the environment in which the animal lives.

Contaminated surfaces may include countertops, microwave ovens, refrigerators and freezers, kitchen utensils, and glasses and bowls used to store, thaw, and prepare frozen feeder rodents. Reptile and rodent habitats, including their cages or enclosures, bedding, basking rocks, food and water dishes, and other objects in their cages or enclosures may also be contaminated with Salmonella. Germs picked up from touching the animal or habitat can be spread to other people or surfaces. Therefore, people should wash their hands thoroughly with soap and water right after touching these animals, their food, or anything in the area where they live and roam. Running water and soap are best, but hand sanitizers may be used if running water and soap are not available.

Outbreaks of Acute Gastroenteritis Transmitted by Person-to-Person Contact — United States, 2009–2010

December 13, 2012 Comments off

Outbreaks of Acute Gastroenteritis Transmitted by Person-to-Person Contact — United States, 2009–2010

Source: Morbidity and Mortality Weekly Report (CDC)

Problem/Condition:
Approximately 179 million cases of acute gastroenteritis (AGE) occur in the United States each year, and outbreaks of AGE are a substantial public health problem. Although CDC has conducted national surveillance for waterborne and foodborne AGE outbreaks since 1971 and 1973, respectively, no national surveillance existed for AGE outbreaks resulting primarily from person-to-person transmission before implementation of the National Outbreak Reporting System (NORS) in 2009.

Reporting Period:
2009–2010.

Description of System:
NORS is a national surveillance system launched in 2009 to support the reporting of all waterborne outbreaks and enteric disease outbreaks from foodborne, person-to-person, animal contact, environmental, and unknown modes of transmission. State and local public health agencies in the 50 U.S. states, the District of Columbia, five U.S. territories, and three Freely Associated States report these outbreaks to CDC via NORS using a standardized online data entry system. Data are collected on general outbreak characteristics (e.g., dates, number of illnesses, and locations), demographic characteristics of cases (e.g., age and sex), symptoms, case outcomes, and laboratory testing information and results. Only outbreaks reported in NORS with a primary mode of transmission of person-to-person contact are included in this report.

Results:
During 2009–2010, a total of 2,259 person-to-person AGE outbreaks were reported in NORS from 42 states and the District of Columbia. These outbreaks resulted in 81,491 reported illnesses, 1,339 hospitalizations, and 136 deaths. No etiology was reported in approximately 40% (n = 840) of outbreaks. Of the remaining 1,419 outbreaks with a reported etiology, 1,270 (89%) were either suspected or confirmed to be caused solely by norovirus. Other reported etiologies included Shigella (n = 86), Salmonella (n = 16), Shiga toxin-producing Escherichia coli (STEC) (n = 11), and rotavirus (n = 10). Most (82%) of the 1,723 outbreaks caused by norovirus or an unknown etiology occurred during the winter months, and outbreaks caused by Shigella or another suspected or confirmed etiology most often occurred during the spring or summer months (62%, N = 53 and 60%, N = 38, respectively). A setting was reported for 1,187 (53%) of total outbreaks. Among these reported settings, nursing homes and other long-term–care facilities were most common (80%), followed by childcare centers (6%), hospitals (5%), and schools (5%).

Interpretation:
NORS provides the first national data on AGE outbreaks spread primarily through person-to-person transmission and describes the frequency of this mode of transmission. Norovirus is the most commonly reported cause of these outbreaks and, on the basis of epidemiologic characteristics, likely accounts for a substantial portion of the reported outbreaks of unknown etiology. In the United States, sporadic and outbreak-associated norovirus causes an estimated 800 deaths and 70,000 hospitalizations annually, which could increase by an additional 50% during epidemic years. During 2009–2010, norovirus outbreaks accounted for the majority of deaths and health-care visits in person-to-person AGE outbreaks reported to NORS.

Public Health Action:
Prevention and control of person-to-person AGE outbreaks depend primarily on appropriate hand hygiene and isolation of ill persons. NORS surveillance data can help identify the etiologic agents, settings, and populations most often involved in AGE outbreaks resulting primarily from person-to-person transmission and guide development of targeted interventions to avert these outbreaks or mitigate the spread of infection. Surveillance for person-to-person AGE outbreaks via NORS also might be important in clarifying the epidemiology and role of certain pathogens (e.g., STEC) that have been traditionally considered foodborne but can also be transmitted person-to-person. As ongoing improvements and enhancements to NORS are introduced, participation in NORS has the potential to increase, allowing for improved estimation of epidemic person-to-person AGE and its relative importance among other modes of transmission.

Delay to celiac disease diagnosis and its implications for health-related quality of life

February 11, 2012 Comments off

Delay to celiac disease diagnosis and its implications for health-related quality of life
Source:  BMC Gastroenterology

Background
To determine how the delay in diagnosing celiac disease (CD) has developed during recent decades and how this affects the burden of disease in terms of health-related quality of life (HRQoL), and also to consider differences with respect to sex and age.
Methods
In collaboration with the Swedish Society for Coeliacs, a questionnaire was sent to 1,560 randomly selected members, divided in equal-sized age- and sex strata, and 1,031 (66%) responded. HRQoL was measured with the EQ-5D descriptive system and was then translated to quality-adjusted life year (QALY) scores. A general population survey was used as comparison.
Results
The mean delay to diagnosis from the first symptoms was 9.7 years, and from the first doctor visit it was 5.8 years. The delay has been reduced over time for some age groups, but is still quite long. The mean QALY score during the year prior to initiated treatment was 0.66; it improved after diagnosis and treatment to 0.86, and was then better than that of a general population (0.79).
Conclusions
The delay from first symptoms to CD diagnosis is unacceptably long for many persons. Untreated CD results in poor HRQoL, which improves to the level of the general population if diagnosed and treated. By shortening the diagnostic delay it is possible to reduce this unnecessary burden of disease. Increased awareness of CD as a common health problem is needed, and active case finding should be intensified. Mass screening for CD might be an option in the future.

Notes from the Field: Outbreak of Salmonellosis Associated with Pet Turtle Exposures — United States, 2011

February 3, 2012 Comments off

Notes from the Field: Outbreak of Salmonellosis Associated with Pet Turtle Exposures — United States, 2011
Source: Morbidity and Mortality Weekly Report (CDC)

CDC is collaborating with the Pennsylvania State Health Department in an ongoing investigation of an outbreak of human Salmonella enterica serotype Paratyphi B var. L (+) tartrate + infections associated with pet turtle exposures. Turtles have long been recognized as sources of human Salmonella infections and are a particular risk to young children (1). Although the sale or distribution of small turtles (those with carapace lengths <4 inches [<10.2 cm]) has been prohibited in the United States since 1975 (with exceptions for scientific or educational purposes) (2), they are still available for illegal purchase through transient vendors on the street, at flea markets, and at fairs.

During August 5, 2010–September 26, 2011, a total of 132 cases of human Salmonella Paratyphi B var. L (+) tartrate + infection were reported in 18 states. The median age of patients was 6 years (range: <1–75 years), 66% were aged <10 years, and 63% were female. No deaths were reported. Of the 56 patients interviewed, 36 (64%) reported turtle exposure. For 15 patients who could recall the type of turtle contacted, 14 identified turtles too small to be legally traded. Five samples of turtle tank water from patient homes tested positive for the outbreak strain (four from Pennsylvania and one from South Carolina). Investigation to trace the source of these turtles is difficult because the vendors are transient. These cases illustrate that small turtles remain a source of human Salmonella infections, especially for young children.

Although many reptiles carry Salmonella, small turtles pose a greater risk to young children because they are perceived as safe pets, are small enough to be placed in the mouth, and can be handled as toys. Despite a 30-year ban on small turtles, this ongoing outbreak suggests that ban enforcement efforts, as well as public education efforts, have not been fully successful and should be examined. In 2010, in response to a 2007 lawsuit filed by the Independent Turtle Farmers of Louisiana, Inc. seeking to overturn the ban, a federal district court upheld the Food and Drug Administration's authority to enforce the ban (3). Regulating the sale of small turtles likely remains the most effective public health action to prevent turtle-associated salmonellosis (4,5).

New Guides Compare Benefits and Risks of GERD Treatments

September 26, 2011 Comments off

New Guides Compare Benefits and Risks of GERD Treatments
Source: Agency for Healthcare Research and Quality

New plain-language publications from the U.S. Department of Health and Human Services’ (HHS) Agency for Healthcare Research and Quality (AHRQ) compare the benefits and risks of treatments for gastroesophageal reflux disease (GERD), a digestive condition that affects millions of Americans and can be treated with medications or surgery. The publications are based on an updated evidence report also released today.

The report concluded that established drug-based therapy is effective. It also concluded that a type of surgical treatment known as laparoscopic fundoplication is at least as effective as drug-based medical treatment for some patients, but also had a higher risk of serious side effects. Another surgical treatment using an endoscopic variation of fundoplication also has been used to treat GERD, but AHRQ’s analysis found there is not enough evidence to compare this type of surgery’s effectiveness with other treatments.

GERD affects as many as 4 percent of Americans, making it one of the most common conditions in the United States. Those who have GERD can spend a significant amount of money on treatments—estimated at $3,355 annually per patient, the report noted. Approximately two-thirds of these costs are related to prescription drugs, but it is commonly recognized that some drugs used to treat GERD, such as proton pump inhibitors (PPIs), are overused, according to the report.

“Because it affects so many Americans, GERD is an important disease both in terms of public health and cost,” said AHRQ Director Carolyn M. Clancy, M.D. “These new publications will help patients and their clinicians work together to find the best treatment option based on patient preferences and needs.”

The AHRQ report found that PPIs tend to be more effective than other drugs, but comparisons show few consistent differences between PPI types or dosages. PPIs cause some side effects, such as diarrhea and headaches, but these were generally not serious.

+ Management Strategies for Gastroesophageal Reflux Disease: An Update

Diet and risk of diverticular disease in Oxford cohort of European Prospective Investigation into Cancer and Nutrition (EPIC): prospective study of British vegetarians and non-vegetarians

July 21, 2011 Comments off

Diet and risk of diverticular disease in Oxford cohort of European Prospective Investigation into Cancer and Nutrition (EPIC): prospective study of British vegetarians and non-vegetarians
Source: British Medical Journal

Objective To examine the associations of a vegetarian diet and dietary fibre intake with risk of diverticular disease.

Design Prospective cohort study.

Setting The EPIC-Oxford study, a cohort of mainly health conscious participants recruited from around the United Kingdom.

Participants 47,033 men and women living in England or Scotland of whom 15 459 (33%) reported consuming a vegetarian diet.

Main outcome measures Diet group was assessed at baseline; intake of dietary fibre was estimated from a 130 item validated food frequency questionnaire. Cases of diverticular disease were identified through linkage with hospital records and death certificates. Hazard ratios and 95% confidence intervals for the risk of diverticular disease by diet group and fifths of intake of dietary fibre were estimated with multivariate Cox proportional hazards regression models.

Results After a mean follow-up time of 11.6 years, there were 812 cases of diverticular disease (806 admissions to hospital and six deaths). After adjustment for confounding variables, vegetarians had a 31% lower risk (relative risk 0.69, 95% confidence interval 0.55 to 0.86) of diverticular disease compared with meat eaters. The cumulative probability of admission to hospital or death from diverticular disease between the ages of 50 and 70 for meat eaters was 4.4% compared with 3.0% for vegetarians. There was also an inverse association with dietary fibre intake; participants in the highest fifth (≥25.5 g/day for women and ≥26.1 g/day for men) had a 41% lower risk (0.59, 0.46 to 0.78; P<0.001 trend) compared with those in the lowest fifth (<14 g/day for both women and men). After mutual adjustment, both a vegetarian diet and a higher intake of fibre were significantly associated with a lower risk of diverticular disease.

Conclusions Consuming a vegetarian diet and a high intake of dietary fibre were both associated with a lower risk of admission to hospital or death from diverticular disease.

Vital Signs: Colorectal Cancer Screening, Incidence, and Mortality — United States, 2002–2010

July 9, 2011 Comments off

Vital Signs: Colorectal Cancer Screening, Incidence, and Mortality — United States, 2002–2010
Source: Morbidity and Mortality Weekly Report (CDC)

Background: Screening lowers colorectal cancer (CRC) incidence and mortality. CRC is preventable through the removal of premalignant polyps and is curable if diagnosed early. Increased CRC screening and reduced CRC incidence and mortality are among the Healthy People 2020 objectives.

Methods: CRC screening data are reported using information from 2002–2010 Behavioral Risk Factor Surveillance System surveys. State-specific CRC incidence and mortality data were drawn from the United States Cancer Statistics. Annual percentage changes (APCs) in incidence and death rates from 2003 to 2007 were calculated by state.

Results: From 2002 to 2010, the percentage of persons aged 50–75 years who were adequately screened for colorectal cancer increased from 52.3% to 65.4%. In 2007, CRC incidence ranged from 34.3 per 100,000 population in Utah to 56.9 in North Dakota; death rates ranged from 12.3 per 100,000 in Utah to 21.1 in the District of Columbia (DC). From 2003 to 2007, CRC incidence declined significantly in 35 states, and mortality declined in 49 states and DC, with APCs ranging from 1.0% per year in Alabama to 6.3% per year in Rhode Island.

Conclusions: CRC incidence and mortality have declined in recent years throughout the United States, and CRC screening has increased.

Implications for Public Health Practice: Continued declines in incidence and mortality are expected as past and current public health emphasis on the importance of CRC screening become evident with the increase in screening. To ensure these gains continue, CRC screening should be accessible and used as recommended by all eligible persons in the United States.

FDA approves treatment for Clostridium difficile infection

May 30, 2011 Comments off

FDA approves treatment for Clostridium difficile infection
Source: U.S. Food and Drug Administration

The U.S. Food and Drug Administration today approved Dificid (fidaxomicin) tablets for the treatment of Clostridium difficile-associated diarrhea (CDAD).

Clostridium difficile (C. difficile) is a bacterium that can cause diarrhea and lead to colitis, other serious intestinal conditions, and death in severe cases. C. difficile bacteria are found in the stool of an infected person, and others can become infected if they touch items or surfaces contaminated with the bacteria or spores and then touch their mouths.

The safety and efficacy of Dificid were demonstrated in two trials that included 564 patients with CDAD that compared Dificid with vancomycin, a common antibiotic used to treat CDAD. The clinical response was similar in the Dificid group compared with the vancomycin group in both studies. In some patients with CDAD, symptoms can return. In the Dificid trials, a greater number of patients treated with Dificid had a sustained cure three weeks after treatment ended versus those patients treated with vancomycin.

+ Prevent Clostridium difficile Infection (CDC)

USDA Revises Recommended Cooking Temperature for All Whole Cuts of Meat, Including Pork, to 145 °F

May 25, 2011 Comments off

USDA Revises Recommended Cooking Temperature for All Whole Cuts of Meat, Including Pork, to 145 °F
Source: U.S. Department of Agriculture

The U.S. Department of Agriculture (USDA) is updating its recommendation for safely cooking pork, steaks, roasts, and chops. USDA recommends cooking all whole cuts of meat to 145 °F as measured with a food thermometer placed in the thickest part of the meat, then allowing the meat to rest for three minutes before carving or consuming.

This change does not apply to ground meats, including ground beef, veal, lamb, and pork, which should be cooked to 160 °F and do not require a rest time. The safe cooking temperature for all poultry products, including ground chicken and turkey, remains at 165 °F.

“With a single temperature for all whole cuts of meat and uniform 3 minute stand time, we believe it will be much easier for consumers to remember and result in safer food preparation,” said Under Secretary Elisabeth Hagen. “Now there will only be 3 numbers to remember: 145 for whole meats, 160 for ground meats and 165 for all poultry.”

USDA is lowering the recommended safe cooking temperature for whole cuts of pork from 160 °F to 145 °F and adding a three-minute rest time. The safe temperature for cuts of beef, veal, and lamb remains unchanged at 145 °F, but the department is adding a three-minute rest time as part of its cooking recommendations. Cooking raw pork, steaks, roasts, and chops to 145 °F with the addition of a three-minute rest time will result in a product that is both microbiologically safe and at its best quality.

+ Safety of Fresh Pork…from Farm to Table

Laparoscopic Antireflux Surgery vs Esomeprazole Treatment for Chronic GERD

May 20, 2011 Comments off

Laparoscopic Antireflux Surgery vs Esomeprazole Treatment for Chronic GERD
Source: Journal of the American Medical Association

This multicenter clinical trial demonstrated that with contemporary antireflux therapy for GERD, either by drug-induced acid suppression with esomeprazole or by LARS, most patients achieve and remain in remission at 5 years.

NCCAM Clinical Digest: Irritable Bowel Syndrome and CAM

May 19, 2011 Comments off

NCCAM Clinical Digest: Irritable Bowel Syndrome and CAM
Source: National Center for Complementary and Alternative Medicine

Irritable bowel syndrome (IBS) is a chronic disorder that interferes with the normal functions of the colon. IBS is characterized by symptoms such as abdominal pain, cramping, bloating, constipation, and diarrhea. IBS is challenging to study because its symptoms vary and may disappear for long periods, and because people with IBS tend to respond well to placebos.

This issue summarizes research on some of the most popular complementary and alternative medicine (CAM) therapies people try to treat symptoms of IBS. Overall, although there is some emerging evidence suggesting that some CAM therapies may be helpful for IBS, there have been few large well-designed studies, and most of the studies have had methodological flaws. Systematic reviews generally conclude that more well-designed studies are needed to firmly establish whether CAM therapies are helpful treatments for IBS.

Safety of Probiotics Used to Reduce Risk and Prevent or Treat Disease

April 30, 2011 Comments off

Safety of Probiotics Used to Reduce Risk and Prevent or Treat Disease
Source: Agency for Healthcare Research and Quality

Objectives: To catalog what is known about the safety of interventions containing Lactobacillus, Bifidobacterium, Saccharomyces, Streptococcus, Enterococcus, and/or Bacillus strains used as probiotic agents in research to reduce the risk of, prevent, or treat disease.

Data Sources: We searched 12 electronic databases, references of included studies, and pertinent reviews for studies addressing the safety of probiotics from database inception to August 2010 without language restriction.

Review Methods: We identified intervention studies on probiotics that reported the presence or absence of adverse health outcomes in human participants, without restriction by study design, participant type, or clinical field. We investigated the quantity, quality, and nature of adverse events.

Results: The search identified 11,977 publications, of which 622 studies were included in the review. In 235 studies, only nonspecific safety statements were made (“well tolerated”); the remaining 387 studies reported the presence or absence of specific adverse events. Interventions and adverse events were poorly documented.

+ Full Report (PDF)

Updated Norovirus Outbreak Management and Disease Prevention Guidelines

April 7, 2011 Comments off

Updated Norovirus Outbreak Management and Disease Prevention Guidelines
Source: Morbidity and Mortality Weekly Report (CDC)

Noroviruses are the most common cause of epidemic gastroenteritis, responsible for at least 50% of all gastroenteritis outbreaks worldwide, and a major cause of foodborne illness. In the United States, approximately 21 million illnesses attributable to norovirus are estimated to occur annually. Since 2001, when the most recent norovirus recommendations were published (CDC. “Norwalk-like viruses.” Public health consequences and outbreak management. MMWR 2001;50[No. RR-9]), substantial advances have been made in norovirus epidemiology, immunology, diagnostic methods, and infection control. As molecular diagnostic techniques have improved in performance and become more widely available, detection and reporting of norovirus outbreaks have increased. Although the inability to culture human noroviruses in vitro has hampered progress, assessment of the performance of disinfectants has been facilitated by the discovery of new, cultivable surrogates for human noroviruses. In addition, the periodic emergence of epidemic strains (from genogroup II type 4, GII.4) and outbreaks in specific populations (e.g., the elderly in nursing homes) have been characterized. This report reviews these recent advances and provides guidelines for outbreak management and disease prevention. These recommendations are intended for use by public health professionals investigating outbreaks of acute gastroenteritis, including state and local health authorities, as well as academic and research institutions.

Divergence of gut permeability and mucosal immune gene expression in two gluten-associated conditions: celiac disease and gluten sensitivity

March 15, 2011 Comments off

Divergence of gut permeability and mucosal immune gene expression in two gluten-associated conditions: celiac disease and gluten sensitivity
Source: BMC Medicine

Background
Celiac disease (CD) is an autoimmune enteropathy triggered by the ingestion of gluten. Gluten-sensitive individuals (GS) cannot tolerate gluten and may develop gastrointestinal symptoms similar to those in CD, but the overall clinical picture is generally less severe and is not accompanied by the concurrence of tissue transglutaminase autoantibodies or autoimmune comorbidities. By studying and comparing mucosal expression of genes associated with intestinal barrier function, as well as innate and adaptive immunity in CD compared with GS, we sought to better understand the similarities and differences between these two gluten-associated disorders.

Methods
CD, GS and healthy, gluten-tolerant individuals were enrolled in this study. Intestinal permeability was evaluated using a lactulose and mannitol probe, and mucosal biopsy specimens were collected to study the expression of genes involved in barrier function and immunity.

Results
Unlike CD, GS is not associated with increased intestinal permeability. In fact, this was significantly reduced in GS compared with controls (P = 0.0308), paralleled by significantly increased expression of claudin (CLDN) 4 (P = 0.0286). Relative to controls, adaptive immunity markers interleukin (IL)-6 (P = 0.0124) and IL-21 (P = 0.0572) were expressed at higher levels in CD but not in GS, while expression of the innate immunity marker Toll-like receptor (TLR) 2 was increased in GS but not in CD (P = 0.0295). Finally, expression of the T-regulatory cell marker FOXP3 was significantly reduced in GS relative to controls (P = 0.0325) and CD patients (P = 0.0293).

Conclusions
This study shows that the two gluten-associated disorders, CD and GS, are different clinical entities, and it contributes to the characterization of GS as a condition associated with prevalent gluten-induced activation of innate, rather than adaptive, immune responses in the absence of detectable changes in mucosal barrier function.

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