Health & Fitness (206)
The FDA said Tuesday that Taylor Farms de Mexico could resume operations after investigators found conditions there "in accordance with known food safety protocols." The firm shut down voluntarily after its salad mix served at Olive Garden and Red Lobster restaurants was linked to 242 cyclospora infections in Nebraska and Iowa. Similar illnesses in 20 other states were never definitively linked to the farm.
The federal Centers for Disease Control and Prevention said it is working with Texas to try and discover the source of more than 250 cyclospora infections there.
Q: What chemical weapon are we talking about?
A: It's not clear yet. But experts point to a class of chemical weapons called nerve agents because of the symptoms seen in the victims in Syria. Nerve agents commonly include sarin, soman, VX and taubun. They are called nerve agents because they block nerve cells from sending messages to each other.
Q: What are the symptoms reported and how does that tell us nerve agents were used?
A: The humanitarian organization Doctors Without Borders reported seeing "large number of patients arriving with symptoms including convulsions, excessive saliva, pinpoint pupils, blurred vision and respiratory distress." Dr. Amesh Adalja, a senior associate for the Center for Biosecurity at the University of Pittsburgh Medical Center, said what the group of doctors in Syria is reporting "is what a textbook would list to say nerve-agent poison." Symptoms like incredibly small pupils help indicate that it is not another chemical agent like mustard gas or chlorine gas.
Q: What's the difference between the various nerve agents?
A: Essentially the four nerve agents do the same things to the body. They kill the same way. And they are treated similarly. All are banned by the 1993 international convention signed by 189 countries, so there is no practical difference for the U.S. in planning a response if it was sarin or VX, Adjala said. Sarin, sometimes called GB, is the most volatile of the nerve agents and VX the most lethal.
Q: Why do I hear the name sarin associated with this attack more than the others?
A: Mostly it is based on the Syrian leadership's past likely use and storage of sarin, Adalja said.
Q: Will we ever know which nerve agent it is?
A: Maybe. Weapons inspectors can use relatively simple chemical analysis to determine which compound it was, based on body, soil and weapon samples, Adalja said. But he added that those samples degrade quickly and there's a chance we won't ever know. If they got good samples, we'll know in a day or two probably, he said. But in 1993, Physicians for Human Rights said that its doctors and a lab at Britain's Defense Ministry were able to determine the use of sarin in Iraq four years earlier because of residues of a chemical that had the unique fingerprint of sarin. Q: How do nerve agents kill?
A: They break down an enzyme that allows nerves to talk to each other, so victims become over-stimulated. In addition to other symptoms, there's chest tightening, rapid breathing, vomiting, diarrhea, confusion, headache, changes in heart rate, loss of consciousness, convulsions and paralysis. Eventually, and depending on dose levels it could only be a matter of minutes, you do die of respiratory failure, Adalja said.
Q: Is it painful?
A: "The seizure, being paralyzed, if you are still awake, that can almost be torturous," Adalja said.
Q: If it is sarin, can you see it or smell it?
A: No. As a liquid it is odorless, colorless and tasteless. It's often used in gas form but can kill with liquid content on the skin.
Q: Is it natural?
A: No. It is man-made, created in 1938 as a pesticide and similar to certain kinds of insecticides called organophosphates now used. However nerve agents are much more potent.
Q: Is there a treatment?
A: Yes, if doses are low enough and you catch it in time. There is a dual chemical injection shot that many people in the military carry with them and it must be used quickly. Also if you think you are exposed, you need to remove your clothes and wash thoroughly. The injection of the antidote is complicated. Atropine must be injected every 5 to 10 minutes until secretions stop and the other chemical, pralidoxime chloride only has to be injected a couple times, according to the U.S. Centers for Disease Control and Prevention.
Q: Has sarin been used much in the past?
A: The most famous sarin attack was a 1995 terror attack on the Tokyo subway that killed 13 people and injured about 6,000 people.
Q: How do you get rid of the stuff?
A: Experts say nerve gas has to be disposed of properly in locations with high temperatures and controls to keep gas from escaping to minimize the risk of accidentally gassing other people.
Q: So how can the U.S. military destroy Syria's nerve gas supplies?
A: "Several of the options that are being discussed for military intervention have downside risks," said Amy Smithson, a chemical weapons expert at the Center for Nonproliferation Studies. "Bombing the (weapons storage) site risks releasing the chemicals over nearby population." Making matters worse, Syrian President Bashar Assad has threatened to use the weapons if attacked, she said.
Centers for Disease Control and Prevention on sarin: HTTP://WWW.BT.CDC.GOV/AGENT/SARIN/BASICS/FACTS.ASP
Organisation for the Prohibition of Chemical Weapons (which implements the international chemical weapons convention): HTTP://WWW.OPCW.ORG/
--- Follow Seth Borenstein on Twitter at HTTP://TWITTER.COM/BORENBEARS
"Gerrymandering for the public good" is how Johns Hopkins University transplant surgeon Dr. Dorry Segev describes a proposal to change the map that governs how donated livers are distributed around the country.
The problem: Some areas have fewer donated organs, and higher demand for them, than others. The sickest patients go to the top of the waiting list. But the geographic variation means that someone in California, among the toughest places to get a new liver, waits longer and is a lot sicker before getting transplanted than someone in Ohio or Florida - if they survive long enough.
"This should not be happening," Segev said.
Segev is advising the United Network for Organ Sharing, which runs the transplant network, as its liver specialists consider the novel idea of "redistricting" how livers are allocated - redrawing the nation's 11 transplant regions based on the distribution and demand for donated organs, much like lawmakers set political districts based on the party voting histories of different areas.
The ultimate goal: "That your chance of dying without a liver transplant doesn't depend on your ZIP code," said Dr. John Roberts, transplant chief at the University of California, San Francisco.
The geographic disparity adds another hurdle to the already dire shortage of livers. Just 6,256 patients received a liver transplant last year, all but a few hundred from deceased donors. Nearly 16,000 people are awaiting a liver. About 1,500 people die waiting every year.
Desperate patients sometimes travel across the country to get on a shorter waiting list, if they can afford it or even know it's possible. The best-known example is the late Apple CEO Steve Jobs, who lived in California but in 2009 had a transplant in Memphis, Tenn., which at the time had one of the shortest waits. That's harder for the less wealthy to do.
"I could have withered away here," said William Sherbert, 47, who temporarily moved from California to Florida for a faster transplant.
When hepatitis B caused liver failure, Sherbert spent a year awaiting a transplant from a Los Angeles hospital. He was getting steadily sicker, but was nowhere near the top of the transplant list when his frantic partner finally unraveled how the system works.
Patients who have the highest MELD score - a ranking, based on laboratory tests, that predicts their risk of death - move up the waiting list. But it's not a single national list. The 11 transplant regions are subdivided into local areas that form individual waiting lists, and there are wide variations in organ availability within regions as well as between them. Generally livers first are offered to the sickest patients locally and then regionally. Changes that began this summer will allow some of the sickest patients access to livers from other parts of the country, an initial step to address disparities.
United Network for Organ Sharing figures show that in three regions stretching from Michigan and Ohio down to Florida, adults receiving new livers over the past two years had median MELD scores of 22 to 23. But in the region that includes California, recipients were far sicker, with a median score of 33. Nearly as tough were regions that include New York, and the Dakotas and Illinois.
An Internet database, the Scientific Registry of Transplant Recipients, compares transplant center wait times and success rates so people can choose where to go. They can get on more than one waiting list if they meet each hospital's qualifications, and if they can get to that center within a few hours of being notified that an organ is available. Often, that means moving.
"It's really a shame" that people have to consider such a step, Sherbert said. But he's glad he switched to a Florida hospital's list, possible only because his health insurance paid for the transplant plus the couple's airfare and some living expenses during the seven-month wait. Sherbert is feeling well after his May 2012 transplant, and is back home in Garden Grove, Calif.
In a study published last month in the American Journal of Transplantation, Segev's team used computer modeling to redistrict the transplant regions, better balancing local areas' supply and demand. Segev said 28 percent of Americans live in an area where they'd have a high risk of death before getting a new liver, and redistricting could drop that proportion to as little as 6 percent.
The transplant network's liver committee is considering different map options as it debates how to improve fairness without having to fly organs too far around the country. One big challenge will be turf wars, as transplant centers with shorter waits understandably don't want them to lengthen, said committee chairman Dr. David Mulligan of the Mayo Clinic in Phoenix.
"Every doctor wants the best for their patients. The issue becomes stepping back and looking at the big picture and thinking about all the patients," said Mulligan, who hopes to have a proposal ready for public comment within two years. "Yes, your patient waits a little longer, but they can wait a little longer."
Smaller disparities exist for some other transplants, including kidneys, but the transplant network is focusing first on livers. It wouldn't be a problem if there were more organ donors, Mulligan noted, encouraging people to register: "It's the last chance we have to be a hero in our lives."
As many as 300,000 Americans are actually diagnosed with Lyme disease each year, the Centers for Disease Control and Prevention announced.
Usually, only 20,000 to 30,000 illnesses are reported each year. For many years, CDC officials have known that many doctors don't report every case and that the true count was probably much higher.
The new figure is the CDC's most comprehensive attempt at a better estimate. The number comes from a survey of seven national laboratories, a national patient survey and a review of insurance information.
"It's giving us a fuller picture and it's not a pleasing one," said Dr. Paul Mead, who oversees the agency's tracking of Lyme disease.
The ailment is named after Lyme, Conn., where the illness was first identified in 1975. It's a bacteria transmitted through the bites of infected deer ticks, which can be about the size of a poppy seed.
Symptoms include a fever, headache and fatigue and sometimes a telltale rash that looks like a bull's-eye centered on the tick bite. Most people recover with antibiotics. If left untreated, the infection can cause arthritis and more severe problems.
In the U.S., the majority of Lyme disease reports have come from 13 states: Connecticut, Delaware, Maine, Maryland, Massachusetts, Minnesota, New Hampshire, New Jersey, New York, Pennsylvania, Vermont, Virginia and Wisconsin.
The new study did not find anything to suggest the disease is more geographically widespread, Mead said.
CDC report: HTTP://WWW.CDC.GOV/LYME/
The state Department of Health said a strain of salmonella that's infected more than 300 people in 37 states was found in a duck pen at Privett Hatchery in Portales.
No deaths have been reported, but 51 people have been hospitalized, according to the Centers for Disease Control and Prevention. Children ages 10 and younger account for nearly three-fifths of those who've become ill.
People buy baby chickens and other poultry to keep as pets and to raise the birds for eggs or meat.
Paul Ettestad, state public health veterinarian, said the hatchery was most likely the source of the outbreak. However, he said questions remain because federal officials have found that the people sickened with salmonella had purchased baby poultry at 113 feed store locations that were supplied by 18 mail order hatcheries in several states.
The CDC said more testing is ongoing.
Privett Hatchery said in a statement on its web site that it's cooperating with state and federal officials, and that some of the salmonella cases may be linked to its operation.
The department said the hatchery has agreed not to sell any poultry from the pen where the salmonella strain was found, will administer a vaccine to its birds and include a brochure on the safe handling of baby poultry in all of its shipments.
According to the CDC, the salmonella cases have occurred across the country - from California to New York - since March. Colorado has reported the most cases, 37, followed by Texas with 32.
Salmonella infections can happen when baby chicks are brought inside a home and children handle them. People should thoroughly wash their hands after touching live poultry or anything in the area where they roam, the department said.
Online: Centers for Disease Control and Prevention's salmonella webpage: HTTP://1.USA.GOV/17ZSGBB
CHICAGO (AP) - Gov. Pat Quinn has until Saturday to act on legislation that would ban indoor tanning in Illinois for anyone younger than age 18.
The General Assembly sent Quinn the legislation in June. Its supporters include 51 year old Donna Moncivaiz of Beach Park. Moncivaiz is a former tanner who suffers from late-stage melanoma. She testified at a Senate committee hearing in support of the ban. Her daughter had an early-stage melanoma removed from her hip.
Tanning industry advocates say a ban is bad for small businesses. They say parents, not the government, should decide if children can use tanning equipment.
The American Academy of Dermatology says about 8 percent of those who tan indoors in the U.S. every year are teens.
Chicago and Springfield already ban teen tanning.
David Kwiatkowski (kwiht-KOW'-skee) agreed to plead guilty to 14 drug theft and tampering charges in New Hampshire and two in Kansas in exchange for a 30- to 40-year prison sentence. He will be sentenced Dec. 3.
Kwiatkowski was accused of stealing painkiller syringes from Exeter Hospital and replacing them with saline-filled syringes tainted with his blood. U.S. Attorney John Kacavas said the guilty pleas are too little, too late given the harm Kwiatkowski caused.
A Michigan native, Kwiatkowski worked in 18 hospitals in eight states before his arrest last year. Forty-six people have been diagnosed with the same strain of hepatitis C he carries.
THIS IS A BREAKING NEWS UPDATE. Check back soon for further information. AP's earlier story is below.
A traveling hospital technician accused of causing a multistate outbreak of hepatitis C last year pleaded guilty Wednesday to federal drug charges in New Hampshire under an agreement that calls for him to serve 30 to 40 years in prison.
The judge asked 34-year-old David Kwiatkowski why he wasn't going to trial. "Because I'm guilty," Kwiatkowski responded. He said he was addicted to drugs and alcohol and was recently diagnosed with depression, for which he is taking several medications.
Kwiatkowski pleaded guilty to 14 charges of drug theft and tampering in New Hampshire, along with two similar counts in Kansas, although he was never formally charged there. Sentencing was set for Dec. 3.
At least two dozen civil lawsuits related to his case are pending, most of them against New Hampshire's Exeter Hospital, where he worked for 13 months.
Originally from Michigan, Kwiatkowski worked in 18 hospitals in seven states before being hired in New Hampshire in 2011. As a traveling hospital technician, he was assigned by staffing agencies to fill temporary openings around the country. Along the way, he contracted hepatitis C, and is accused of infecting others by stealing painkiller syringes and replacing them with saline-filled syringes tainted with his blood.
According to the plea agreement filed Monday, Kwiatkowski told investigators he had been stealing drugs since 2002 - the year before he finished his medical training - and that his actions were "killing a lot of people." His lawyers have declined numerous interview requests.
Forty-six people in four states in hospitals where Kwiatkowski worked have been diagnosed with the same strain of hepatitis C he carries: 32 patients in New Hampshire, seven in Maryland, six in Kansas, and one in Pennsylvania. One of the Kansas patients died, and authorities say hepatitis C, which can cause liver disease and chronic health problems, played a contributing role.
In New Hampshire, some of the infected patients have suffered serious physical and emotional issues, according to the plea agreement. Among the seven whose experiences led to the 14 charges, one man hasn't been able to work since developing hepatitis C, another has had trouble controlling his diabetes and sleeping at night and a third is afraid to kiss his wife on the lips, even though the blood-borne virus can't be transmitted that way.
In most of those seven cases, Kwiatkowski was not assigned to assist with the procedures but hospital records showed him accessing the painkillers. In one case, he came in on his day off and insisted on staying even after being told he could go home. One patient remembers not feeling much different after receiving two doses of what was supposed to be a powerful painkiller.