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Published on Leave a comment on Time For Doctors To Prescribe Exercise

We all know that exercise is beneficial for health. Research suggests that exercising out in nature is best for several varied reasons -  including that it lowers markers of inflammation, and that it's good for our gut microbiome (community of gut microbes). The following excerpts are written by Dr. John La Puma encouraging other doctors to prescribe exercise for their patients and why.

An important message of his is that exercise is more important than a drug prescription for a number of conditions, including diabetes prevention, reducing the risk of recurrence of several cancers (he mentions breast cancer, but it also holds for prostate cancer). While exercising and walking out in nature may be best, any exercise anywhere is better than no exercise. (Other posts on exercise as prescription medicine are here and here; and check the category exercise for all exercise research posts).

From Medscape: Rx: Exercise Daily -- Outdoors. Doctor's Orders

With dazzling Olympic feats on display all summer, too many of my patients are still literally immobilized. Medically, sitting too long shuts off the enzyme lipoprotein lipase. In people who are sedentary, the enzyme doesn't break down fat to create energy, like it should. But medical prescription for exercise has lagged even the slowest runner. Why? Some reasons are time, training, and money. Time especially is a scarce commodity: The average clinician visit lasts just 20 minutes. Fitness is a shamefully small part of medical training. And as doctors, we don't get paid for discussing exercise, let alone monitoring a prescription and assessing the response. 

Finally, there are practical reasons. Clinicians find it difficult to persuade patients that exercise is more effective than medication for any number of conditions, including stroke recovery, diabetes prevention, and treatment of low back pain. Regular exercise reduces the risk for recurrent breast cancer by approximately 50%. Given all these reasons, it's easy to see why fitness prescriptions are seldom more than an afterthought. Yet even without formally prescribing the frequency, intensity, time, and type of exercise, clinicians can speak with patients and families about fitness in inspiring, life-changing ways.

Because clinicians have a secret weapon to use that most people don't even know about—location. Exercising in nature (in sight of and preferably near water or greenery, whether a deserted beach or an urban park) is better. Walking city streets and the office itself can be harder on your health than you think. In both environments, your attention is demanded and directed—sometimes by digital interruptions, sometimes by vehicles, toxins, or duties. In nature, your attention is drawn, not pushed, to a variety of often unexpected but not unpleasant sounds, colors, aromas, textures, and forms.

A recent Stanford study of nature therapy showed significantly reduced rumination after a 90-minute walk in nature, compared with a 90-minute walk through an urban environment. On MRI, "nature walkers" showed lower activity in an area of the brain linked to risk for mental illness, the subgenual prefrontal cortex, compared with "urban walkers." In other words, nature offers a sense of something bigger than ourselves on which to focus. MRIs show the way the brain changes when that sense occurs to us.

Exercising in nature may improve a person's immune system by enriching the diversity in the microbiota. Microbiota buffer the immune system against chronic stress-related disease. They appear to act as a hormone-producing organ, not simply a collection of beneficial bacteria. Microbiota are sensitive and responsive to physical environmental changes as well as dietary ones. So, exercise in nature may favorably boost microbiota.

And finally, exercise in nature is clinically preferred and calming. A Norwegian study showed that exercise in nature and in view of nature improves both mood and diastolic blood pressure vs exercise without nature. A Chinese study showed higher energy levels, and lower levels of interleukin-6 and tumor necrosis factor (both markers of inflammation), in a forest walking group compared with an urban exercising group. A British study showed significantly improved mood and self-esteem with "green" exercise, with the largest benefits from 5-minute engagements. Five minutes!

Of course, there are areas in our country and world in which it is dangerous to walk, never mind exercise. It may not be as easy to generate sweat and intensity with outdoor exercise as it is with indoor exercise. It may be stormy, or baking hot, or otherwise harsh outside, and the cool recesses of one's own bedroom or the gym may be just perfect for you today. And with the 2013 total cost of inactivity estimated at $24.7 billion for the United States, and with the public sector bearing almost one half of that expense, any exercise anywhere is better than none.  Yet physicians have a therapeutic tool few others in our culture wield—a prescription pad—and we have every patient's attention, at least for a few minutes. Patients try harder when doctors advise them about fitness. 

Published on Leave a comment on A Fungus May Be Playing A Role In Crohn’s Disease

Image result for ibd Exciting new research about what is going on in the gut microbiome (the community of microbes) of people with Crohn's disease - a debilitating intestinal bowel disease (IBD) which causes severe abdominal pain, diarrhea, weight loss, and fatigue. A number of earlier studies focused on gut bacteria and found dysbiosis (microbial community out of whack) in those with Crohn's disease.

This new research also looked at fungal species and found that there is an "abundance" of 2 species of bacteria (Serratia marcescens and Escherichia coli) and one fungal species (Candida tropicalis) and that these interact in the gut in persons with Crohn's disease. In persons with Crohn's disease the abundance of potentially pathogenic bacteria is increased (Escherichia coli, Serratia marcescens, and Ruminococcus gnavus), while beneficial bacteria (such as Faecalibacterium prausnitzii) are decreased. From Science Daily:

Fungus in humans identified for first time as key factor in Crohn's disease

A Case Western Reserve University School of Medicine-led team of international researchers has for the first time identified a fungus as a key factor in the development of Crohn's disease. The researchers also linked a new bacterium to the previous bacteria associated with Crohn's. The groundbreaking findings, published on September 20th in mBio, could lead to potential new treatments and ultimately, cures for the debilitating inflammatory bowel disease, which causes severe abdominal pain, diarrhea, weight loss, and fatigue. "We already know that bacteria, in addition to genetic and dietary factors, play a major role in causing Crohn's disease," said the study's senior and corresponding author, Mahmoud A Ghannoum, PhD.

Both bacteria and fungi are microorganisms -- infinitesimal forms of life that can only be seen with a microscope. Fungi are eukaryotes: organism whose cells contain a nucleus; they are closer to humans than bacteria, which are prokaryotes: single-celled forms of life with no nucleus. Collectively, the fungal community that inhabits the human body is known as the mycobiome, while the bacteria are called the bacteriome. (Fungi and bacteria are present throughout the body; previously Ghannoum had found that people harbor between nine and 23 fungal species in their mouths.)

The researchers assessed the mycobiome and bacteriome of patients with Crohn's disease and their Crohn's-free first degree relatives in nine families in northern France and Belgium, and in Crohn's-free individuals from four families living in the same geographic area....The researchers found strong fungal-bacterial interactions in those with Crohn's disease: two bacteria (Escherichia coli and Serratia marcescens) and one fungus (Candida tropicalis) moved in lock step. The presence of all three in the sick family members was significantly higher compared to their healthy relatives, suggesting that the bacteria and fungus interact in the intestines. Additionally, test-tube research by the Ghannoum-led team found that the three work together (with the E. coli cells fusing to the fungal cells and S. marcescens forming a bridge connecting the microbes) to produce a biofilm -- a thin, slimy layer of microorganisms found in the body that adheres to, among other sites, a portion of the intestines -- which can prompt inflammation that results in the symptoms of Crohn's disease.

This is first time any fungus has been linked to Crohn's in humans; previously it was only found in mice with the disease. The study is also the first to include S. marcescens in the Crohn's-linked bacteriome. Additionally, the researchers found that the presence of beneficial bacteria was significantly lower in the Crohn's patients, corroborating previous research findings.

Published on Leave a comment on Building Blocks Are Important Toys For Children

This study reinforces (once again) that actively playing with toy blocks is good for developing the spatial skills and spatial abilities of children. Other studies have shown that playing with puzzles and actively going out and exploring their environment (like riding a bicycle around the neighborhood) are also good for developing spatial skills and spatial abilities. For both boys and girls. Even though unfortunately this study only looked at 8 year old boys. (Hey, where were the girls???) Remember that playing is how children learn, and helping develop spatial skills is good for math, science, and technology. So get out the Legos and toy blocks and encourage children to play and build! From Medical Xpress:

Neuroimaging study: Building blocks activate spatial ability in children better than board games

Research from Indiana University has found that structured block-building games improve spatial abilities in children to a greater degree than board games. The study, which appears in the journal Frontiers in Psychology, measured the relative impact of two games—a structured block-building game and a word-spelling board game—on children's spatial processing, including mental rotation, which involves visualizing what an object will look like after it is rotated. The research lends new support to the idea that such block games might help children develop spatial skills needed in science- and math-oriented disciplines.

Block play changed brain activation patterns," Newman said. "It changed the way the children were solving the mental rotation problems; we saw increased activation in regions that have been linked to spatial processing only in the building blocks group." The structured block-building game used for the study was called "Blocks Rock"; the board game was Scrabble.

The research builds upon previous studies that have shown that children who frequently participate in activities such as block play, puzzles and board games have higher spatial ability than those who participate more in activities such as drawing, riding bikes, or playing with trucks and sound-producing toys.

It is also demonstrates that training on one visuo-spatial task can transfer to other tasks. In this instance, training on the structured block-building game resulted in transfer to mental rotation performance.....To conduct the study, IU researchers placed 28 8-year-olds in a magnetic resonance imaging scanner before and after playing one of the two games. Play sessions were conducted for 30 minutes over the course of five days.

There were no differences in mental rotation performance between the two groups in either the brain activation or performance during the first rotation test and scan. But the block play group showed a change in activation in regions linked to both motor and spatial processing during the second scan. The group who played board games failed to show any significant change in brain activation between the pre- and post-game scans, or any significant improvement on the mental rotation test results.

 Scans of the children's brains show increased activation in the anterior lobe of the cerebellum and the parahippocampus during the second mental rotation test, which was administered after they played with blocks. Credit: Indiana University

Published on Leave a comment on Botanical Remedies May Be In Our Future

The big scary question: What will happen after antibiotics cease to work? And people start dying by the millions from infections that used to be easily treated? We are fast approaching that point of total antibiotic resistance, with superbugs that resist all antibiotics. More and more disease-causing bacteria are rapidly evolving immunity to every existing antibiotic (see short video). Soon routine surgeries and minor wounds or even scratches could kill a person. About 70% of antibiotics are currently being used (much of it unnecessary) in farm animals - why aren't governments putting a stop to that? Resistant bacteria already result in the deaths of about 700,000 people globally, but experts predict that by 2050 they will kill 10 million people annually.

What is to be done? New antibiotics? Big pharma generally isn't interested - not enough profit. Using good bacteria and other microbes to dominate over pathogenic microbes? (For example, using  L. sakei to treat chronic sinusitis) Bacteriophages? Essential oils? The following is a wonderful article about another possibility: ethnobotany - the use of medicinal plants. Cassandra Quave is the ethnobotanist based at Emory University discussed in the article. From the New York Times:

Could Ancient Remedies Hold the Answer to the Looming Antibiotics Crisis?

Ethnobotany is a historically small and obscure offshoot of the social sciences, focused on the myriad ways that indigenous peoples use plants for food, shelter, clothing, art and medicine. Within this already-tiny field, a few groups of researchers are now trying to use this knowledge to derive new medicines, and Quave has become a leader among them. Equally adept with a pipette and a trowel, she unites the collective insights of traditional plant-based healing with the rigor of modern laboratory experiments. Over the past five years, Quave has gathered hundreds of therapeutic shrubs, weeds and herbs and taken them back to Emory for a thorough chemical analysis.  ...continue reading "Botanical Remedies May Be In Our Future"

Published on Leave a comment on What’s In Your Household Dust?

Ten chemicals suspected or known to harm human health are present in more than 90% of U.S. household dust samples, according to a new study. The research adds to a growing body of evidence showing the dangers posed by exposure to chemicals we are exposed to on a daily basis. The chemicals come from a variety of household goods, including toys, cosmetics, personal care products, furniture, electronics, nonstick cookware, food packaging, floor coverings, some clothing (e.g., stain resistant), building materials, and cleaning products. How do the chemicals get into the dust? The chemicals can leach, migrate, abrade, or off-gas from the products, which winds up in the dust and  results in human exposure. (That's right:  vacuum a lot and wash your hands a lot, and try to avoid or cut  back use of products with these chemicals,)

What was found in the dust? The main chemicals were: phthalates — a group of chemicals that includes DEP, DEHP, DNBP and DIBP (these were present in the highest concentrations),  highly fluorinated chemicals (HFCs), flame retardants (both old and newer replacement ones), synthetic fragrances, and phenols. These chemicals are known to have various adverse health effects, including endocrine disruption, cancer, neurological, immune, and developmental effects. (See posts on endocrine disruptors and flame retardants) Studies typically study one chemical at a time, but household dust contains MIXTURES of these chemicals with effects unknown. How does it get into us? Inhalation, ingestion, and through skin contact. And while the levels we are exposed to may be low, research is showing that even low level exposure can have adverse health effects. From Medical Xpress:

Potentially harmful chemicals widespread in household dust

Household dust exposes people to a wide range of toxic chemicals from everyday products, according to a study led by researchers at Milken Institute School of Public Health at the George Washington University. The multi-institutional team conducted a first-of-a-kind meta-analysis, compiling data from dust samples collected throughout the United States to identify the top ten toxic chemicals commonly found in dust. They found that DEHP, a chemical belonging to a hazardous class called phthalates, was number one on that list. In addition, the researchers found that phthalates overall were found at the highest levels in dust followed by phenols and flame retardant chemicals....."The findings suggest that people, and especially children, are exposed on a daily basis to multiple chemicals in dust that are linked to serious health problems." ...continue reading "What’s In Your Household Dust?"

Published on Leave a comment on Treat Localized Prostate Cancer Or Not?

This is similar to what Dr. Gilbert Welch and others have been saying for a while - that studies show much cancer screening leads to overdiagnosis and overtreatment with no real differences in rates of mortality (death). Which was the whole point of cancer screening - to catch cancers early and so reduce rates of death. (For more on this topic see here, here, here, and here.) There are harms from overtreatment (unnecessary treatment), and with prostate cancer treatment there can be adverse effects on sexual (erectile dysfunction) , urinary, or bowel function, and sometimes even death from surgery. Remember that many prostate cancers are "indolent" or very slow growing, and may remain asymptomatic throughout the man's lifetime. Currently the U.S. Preventive Services Task Force (USPSTF) recommends against prostate-specific antigen (PSA)-based screening for prostate cancer for these reasons.

This study in the New England Journal of Medicine reported on men diagnosed with prostate cancer, with the men then assigned to either monitoring or treatment (surgery or radiation), and then followed for 10 years. Much to the researchers' surprise, the survival rates from prostate cancer were equally high in all the groups - 99%. Now, as the researchers themselves point out - the groups of men need to be followed for more years. Will there be differences after 15 or 20 years? Also, if there is prostate cancer progression in the monitored group (and more men did have disease progression in this group after 10 years, even though the numbers were low), can it still be treated just as successfully? More studies are needed. Note that there was cancer progression among some men even in both treatment groups.

Other important prostate cancer studies are also needed. Are there differences among those men for whom cancer progresses and for those that it doesn't? Does intense exercise make a difference (as some think)? Dietary differences, such as a plant based diet? Body fat or weight? From Science Xpress: Treat or monitor early prostate cancer? 10-yr survival same

Men with early prostate cancer who choose to closely monitor their disease are just as likely to survive at least 10 years as those who have surgery or radiation, finds a major study that directly tested and compared these options. Survival from prostate cancer was so high—99 percent, regardless of which approach men had—that the results call into question not only what treatment is best but also whether any treatment at all is needed for early-stage cases. And that in turn adds to concern about screening with PSA blood tests, because screening is worthwhile only if finding cancer earlier saves lives.

The study involved more than 82,000 men in the United Kingdom, aged 50 to 69, who had tests for PSA, or prostate specific antigen. High levels can signal prostate cancer but also may signal more harmless conditions, including natural enlargement that occurs with age. Researchers focused on the men diagnosed with early prostate cancer, where the disease is small and confined to the prostate. Of those men, 1,643 agreed to be randomly assigned to get surgery, radiation or active monitoring. That involves blood tests every three to six months, counseling, and consideration of treatment only if signs suggested worsening disease.

A decade later, researchers found no difference among the groups in rates of death from prostate cancer or other causes. More men being monitored saw their cancers worsen—112 versus 46 given surgery and 46 given radiation. But radiation and surgery brought more side effects, especially urinary, bowel or sexual problems....PSA testing remains popular in the U.S. even after a government task force recommended against it, saying it does more harm than good by leading to false alarms and overtreatment of many cancers that would never threaten a man's life. In Europe, prostate cancer screening is far less common.

From the original study in the The New England Journal of Medicine: 10-Year Outcomes after Monitoring, Surgery, or Radiotherapy for Localized Prostate Cancer

The comparative effectiveness of treatments for prostate cancer that is detected by prostate-specific antigen (PSA) testing remains uncertain.  In the United States alone, an estimated 180,890 cases will be diagnosed in 2016, and 26,120 men will die from the disease.1 The widespread use of PSA testing has resulted in a dramatic increase in the diagnosis and treatment of prostate cancer, but many men do not benefit from intervention because the disease is either indolent or disseminated at diagnosis. Prostate cancer often progresses slowly, and many men die of competing causes. In addition, interventions for prostate cancer can have adverse effects on sexual, urinary, or bowel function. Two treatment trials have evaluated the effectiveness of treatment, but they did not compare the most common contemporary methods: surgery, radiotherapy, and monitoring or surveillance

We compared active monitoring, radical prostatectomy, and external-beam radiotherapy for the treatment of clinically localized prostate cancer. Between 1999 and 2009, a total of 82,429 men 50 to 69 years of age received a PSA test; 2664 received a diagnosis of localized prostate cancer, and 1643 agreed to undergo randomization to active monitoring (545 men), surgery (553), or radiotherapy (545). The primary outcome was prostate-cancer mortality at a median of 10 years of follow-up. Secondary outcomes included the rates of disease progression, metastases, and all-cause deaths.

There were 17 prostate-cancer–specific deaths overall: 8 in the active-monitoring group (1.5 deaths per 1000 person-years; 95% confidence interval [CI], 0.7 to 3.0), 5 in the surgery group (0.9 per 1000 person-years; 95% CI, 0.4 to 2.2), and 4 in the radiotherapy group (0.7 per 1000 person-years; 95% CI, 0.3 to 2.0); the difference among the groups was not significant (P=0.48 for the overall comparison). In addition, no significant difference was seen among the groups in the number of deaths from any cause (169 deaths overall; P=0.87 for the comparison among the three groups). Metastases developed in more men in the active-monitoring group (33 men; 6.3 events per 1000 person-years; 95% CI, 4.5 to 8.8) than in the surgery group (13 men; 2.4 per 1000 person-years; 95% CI, 1.4 to 4.2) or the radiotherapy group (16 men; 3.0 per 1000 person-years....). Higher rates of disease progression were seen in the active-monitoring group (112 men; 22.9 events per 1000 person-years; 95% CI, 19.0 to 27.5) than in the surgery group (46 men; 8.9 events per 1000 person-years; 95% CI, 6.7 to 11.9) or the radiotherapy group (46 men; 9.0 events per 1000 person-years....).

At a median of 10 years, prostate-cancer–specific mortality was low irrespective of the treatment assigned, with no significant difference among treatments. Surgery and radiotherapy were associated with lower incidences of disease progression and metastases than was active monitoring.

Published on Leave a comment on Reading Books Linked To Living Longer

 Image result for books wikipedia There are some things we can do that are linked to living longer, such as not smoking and exercising regularly, but could reading books also have such an effect? A study published in the journal Social Science and Medicine concludes that those who regularly read books add several years to their lives. They found this effect in both men and women, found that reading books are "protective regardless of gender, wealth, education", but the effect holds only for books and not magazines and newspapers. Since surveys show that 87% of book readers read fiction, then it is likely that most of the book readers were reading fiction.

In the long-term (12 years) study of 3,635 people, the researchers found that those that read books for more than 3.5 hours per week lived on average two years longer than non-readers, and that there was a dose-response effect (the more one reads, the better). This appeared to be linked to cognitive enhancement rather than any other associated factor, such as age, sex, education, race, health, wealth, etc. The research team from the Yale University School of Public Health divided their subjects into three groups: those who didn’t read at all, those who read for 3.5 hours per week or less, and those who read for more than 3.5 hours per week. They found that the occasional readers were 17 percent less likely to die during the follow-up period than those who did not. This beneficial effect of reading was only linked to books, and not other forms of reading material such as magazines or newspapers. From the journal Social Science and Medicine:

A chapter a day: Association of book reading with longevity

This study examined whether those who read books have a survival advantage over those who do not read books and over those who read other types of materials, and if so, whether cognition mediates this book reading effect. The cohort consisted of 3635 participants in the nationally representative Health and Retirement Study who provided information about their reading patterns at baseline.....based on survival information up to 12 years after baseline. A dose-response survival advantage was found for book reading by tertile.....Book reading contributed to a survival advantage that was significantly greater than that observed for reading newspapers or magazines. Compared to non-book readers, book readers had a 23-month survival advantage at the point of 80% survival in the unadjusted model. A survival advantage persisted after adjustment for all covariates (HR = .80, p < .01), indicating book readers experienced a 20% reduction in risk of mortality over the 12 years of follow up compared to non-book readers. Cognition mediated the book reading-survival advantage. These findings suggest that the benefits of reading books include a longer life in which to read them.

While most sedentary behaviors are well-established risk factors for mortality in older individuals (Wullems et al., 2016; de Rezenade et al., 2014, Katzmaryk & Lee, 2012; Muennig, Rosen, & Johnson, 2013), previous studies of a behavior which is often sedentary, reading, have had mixed outcomes....We speculated that books engage readers’ minds more than newspapers and magazines, leading to cognitive benefits that drive the effect of reading on longevity. 

Reading books tends to involve two cognitive processes that could create a survival advantage. First, it promotes "deep reading,” which is a slow, immersive process; this cognitive engagement occurs as the reader draws connections to other parts of the material, finds applications to the outside world, and asks questions about the content presented (Wolf, Barzillai, & Dunne, 2009). Cognitive engagement may explain why vocabulary, reasoning, concentration, and critical thinking skills are improved by exposure to books (Stanovich, West, & Harrison, 1995; Stanovich & Cunningham, 1998; Wolf, Barzillai, & Dunne, 2009). Second, books can promote empathy, social perception, and emotional intelligence, which are cognitive processes that can lead to greater survival (Bassuk, Wypij, & Berkmann, 2000; Djikic, Oatley, & Moldoveanu 2013; Kidd & Castano 2013; Shipley, Der, Taylor, & Deary 2008; Olsen, Olsen, Gunner-Svensson, & Waldstrom, 1991).

The final sample consisted of 3635 individuals that were followed over 34,496 person years, with 27.4% of the sample dying during an average 9.49 years of follow-up. Consistent with the older population, the sample was predominantly (62%) female.....The average time spent reading per week was 3.92 hours for books and 6.10 hours for periodicals. The two types of reading were not strongly correlated, and 38% of the sample (n=1390) read only books or only periodicals; this allowed them to be treated as separate constructs.....Cognitive engagement was assessed with total cognitive score (available in the supplemental Imputation of Cognitive Function Measures) which is a summary variable based on 8 items, including immediate recall, delayed recall, serial 7s, backwards count from 20, object naming, President naming, Vice President naming, and date naming.

A 20% reduction in mortality was observed for those who read books, compared to those who did not read books. Further, our analyses demonstrated that any level of book reading gave a significantly stronger survival advantage than reading periodicals.....The mediation analyses showed for the first time that the survival advantage was due to the effect that book reading had on cognition....This finding suggests that reading books provide a survival advantage due to the immersive nature that helps maintain cognitive status.

Published on Leave a comment on Laser Pointers Are Not Toys and Can Cause Vision Loss

It has long been known that laser pointers can be damaging to the eyes, but apparently this is not widely known. Injuries to the eyes (retinal injuries) causing irreversible vision loss are rapidly increasing from them, especially among children. Injuries to the eye happen when a person stares directly into the laser pointer, or even into the reflection in a mirror. This can inadvertently happen among children, for example when playing games such as laser tag.

A laser pointer is a small handheld device that contains a small diode laser that emits a very narrow beam of light, used to highlight something of interest.during presentations. They are also inappropriately used as toys for some children. The researchers point out that "green laser pointers are becoming increasingly more popular and abundantly available, which is concerning because experiments reveal that green laser pointers (490–575 nm) are more harmful to the retina compared with red laser pointers (630–750 nm)". From Medscape:

Laser Pointers Can Cause Irreversible Vision Loss for Kids

Used incorrectly, laser pointers can damage the retina of the eye and may cause some irreversible vision loss, according to researchers who treated four boys for these injuries. Doctors, teachers and parents should be aware that this can happen, and limit children's use of laser pointers, the authors write.

The authors report on two 12-year-olds, one nine-year-old and one 16-year-old who came to a medical center with central vision loss and "blind spots" within hours to days after looking into or playing with a green or red laser pointer. In one case, the boy looked at the reflection of a laser pointer in a mirror. Two others simply pointed the lasers at themselves, and the fourth was engaged in a "laser war" with a friend.

The researchers report in Pediatrics September 1st that three of the boys had potentially irreversible, although relatively mild, vision loss. One boy's vision continued to worsen two weeks after the injury and eventually decreased to 20/40 best corrected visual acuity in both eyes, which is at or close to the limit for obtaining a driver's license in most U.S. states.

He advises parents to be careful about where they buy laser pointers, as some retailers may not list the power rating or may list it incorrectly, and to limit use for kids under 14. Most consumer laser pointers fall under class II or class IIIA level of safety according to the American National Standard Institute, with a power output of five milliwatts or less. But class 3B or class 4 level lasers may emit up to 500 milliwatts or more and these lasers may cause immediate eye hazard when viewed directly, Almeida and his coauthors write.

Retinal tissue in the back of the eye leads to the brain, and it has no ability to regenerate after tissue loss, Almeida said.

Published on Leave a comment on Poop Pills Work!

The latest development in treating stubborn cases of Clostridium difficile infections (CDI) are "poop pills" - pills that patients can easily swallow rather than having to go through a fecal microbiota transplant (FMT). The "poop pills" are filled with blenderized fecal matter from healthy donors, are much easier for patients to swallow, and they successfully treat C. difficile at almost the same rate as fecal microbiota transplants - about 91% after 1 or 2 treatments for the pills, and 93 to 96% for FMT. This is an amazing success rate for an infection that debilitates people, is resistant to antibiotics in many cases, and even kills people.

Interestingly, these "poop pills" or "Capsule FMT" containing an entire microbiome (bacteria, viruses, fungi, etc) had fantastic results, as compared to a probiotic for the treatment of C. difficile tested by microbiome therapeutics company Seres Therapeutics Inc. In July 2016 Seres announced very disappointing results (no better than a placebo) with its product known as SER-109, a mix of various strains of bacteria.

So why did the Seres probiotic not work in clinical trails? The answer seems to be that the human gut (and so also human fecal matter) contains an entire community of microbes - hundreds of species of bacteria, as well as fungi, viruses, and archaea, but the Seres probiotic was just a mixture of some types of bacteria. This shows how little we know right now. (NOTE: For those interested, the "poop pills" or Capsule FMT is now offered as standard care for recurrent CDI at Massachusetts General Hospital.) From BioMedCentral:

Oral, frozen fecal microbiota transplant (FMT) capsules for recurrent Clostridium difficile infection

Fecal microbiota transplantation (FMT) has been shown to be safe and effective in treating refractory or relapsing C. difficile infection (CDI), but its use has been limited by practical barriers. We recently reported a small preliminary feasibility study using orally administered frozen fecal capsules. Following these early results, we now report our clinical experience in a large cohort with structured follow-up. We prospectively followed a cohort of patients with recurrent or refractory CDI who were treated with frozen, encapsulated FMT at our institution. The primary endpoint was defined as clinical resolution whilst off antibiotics for CDI at 8 weeks after last capsule ingestion. Safety was defined as any FMT-related adverse event grade 2 or above.

Overall, 180 patients aged 7–95 years with a minimal follow-up of 8 weeks were included in the analysis. CDI resolved in 82 % of patients after a single treatment, rising to a 91 % cure rate with two treatments. Three adverse events Grade 2 or above, deemed related or possibly related to FMT, were observed. We confirm the effectiveness and safety of oral administration of frozen encapsulated fecal material, prepared from unrelated donors, in treating recurrent CDI. Randomized studies and FMT registries are still needed to ascertain long-term safety.

The epidemiology of Clostridium difficile infection (CDI) is evolving. Rates of infection are increasing and response to standard antimicrobial treatment with metronidazole or vancomycin may be suboptimal [1, 2].....Fecal microbiota transplant (FMT) has been shown to be safe and effective in treating refractory or relapsing CDI [4, 5, 6, 7, 8], but its use has been limited by practical barriers. Among other concerns, the administration of FMT by colonoscope or naso-gastric/duodenal tube exposes the patient to some risk and discomfort. We recently reported a preliminary feasibility study using orally administered frozen fecal capsules, prepared from unrelated donors, to treat 20 patients with recurrent CDI [9]. Following these encouraging results, we have continued treating patients with FMT capsules. We report our clinical experience in a large cohort with structured follow-up.

Donated fecal matter was blenderized, sieved, centrifuged, and suspended in concentrated form in sterile saline with 10 % glycerol. The suspension was double-encapsulated in hypromellose capsules (Capsugel, Cambridge, MA) and stored at –80 °C for up to 6 months pending use. Processing was done entirely under ambient air. FMT recipients discontinued any anti-CDI treatment for 24–48 hours prior to FMT, and were given 15 capsules on each of two consecutive days with water or apple sauce. The 30 capsules contained sieved, concentrated material derived from a mean of 48 g of fecal matter.

Of the 180 patients reaching 8 weeks, 147 were cured of CDI after the first administration of fecal capsules (82 %). Twenty six individuals relapsed within 8 weeks and were re-treated, with 17 responding, resulting in an overall cure rate of 91 % with one or two treatments. Six individuals declined re-treatment (our standard procedure in these cases is to offer long-term suppressive oral vancomycin treatment). Three patients were cured after a third administration, but were considered “non-responders” as per protocol definition. One patient received three treatments, relapsed, and was advised to continue suppressive vancomycin.

Published on Leave a comment on The Development of Antibiotic Resistant Bacteria

Here is an amazing short video for those interested in seeing how bacteria mutate and grow when exposed to antibiotics - and evolving to become superbugs. Researchers filmed an experiment that created bacteria a thousand times more drug-resistant than their ancestors. In the time-lapse video, a white bacterial colony (E.coli bacteria) creeps across an enormous black petri dish plated with vertical bands of successively higher doses of antibacterial drugs (antibiotics).

How they did it: The researchers imaged the E. coli bacteria every 10 minutes for 10 days as the microbes expanded across the plate. You can see that the bacteria paused briefly at the boundaries of increasingly stronger antibiotic concentrations until a mutant bacteria struck out into the stronger antibiotic territory. By challenging the bacteria with differing doses of antibiotic, the team demonstrated that E. coli evolve higher resistance more quickly if they first encounter an intermediate, rather than a high, concentration of antibiotic. It's a beautiful, yet horrifying video. NOTE: the bacteria grows on agar, which is a thick, clear substance that comes from seaweed and is used for growing bacteria in scientific research. From Harvard Medical School, on YOUTUBE:

From NPR:  WATCH: Bacteria Invade Antibiotics And Transform Into Superbugs

In the time-lapse video, a white bacterial colony creeps across an enormous black petri dish plated with vertical bands of successively higher doses of antibiotic. The colony pauses when it hits the first band of antibiotic, creating a stark border between the white colony and the black petri dish. Then the bacteria start to edge their way into the toxic soup. More dots appear and they start growing, racing to the next, stronger band of antibiotic. The bacteria are evolving. After almost two weeks of real time have passed, they've become resistant to the strongest completely taken over the kitchen-table-sized petri dish.

We know dangerous bacteria are getting stronger all the time and that it's our fault because of our excessive and indiscriminate use of antibiotics. Each year, 23,000 people in the U.S. die as a result of superbug infections. But we typically don't get to see superbugs created.... Their video and report were published Thursday in the journal Science.