Friday, February 12, 2016

Sexual Transmission of the Zika Virus

A recent case of Zika virus infection in a man whose sexual partner returned from Venezuela with a Zika virus infection raises the distinct possibility that it may be possible for the virus to be transmitted sexually. How easily it is transmitted via sexual contact, and at what point during an infection it may be transmitted, isn't known. But the finding is cause for concern because it means that an outbreak could spread beyond areas in which the Zika-transmitting mosquito is found. The World Health Organization (WHO) will be following this latest development closely.

In related news, laboratory tests have detected the Zika virus in the saliva and urine of at least two people with Zika virus infections. Most people don't come in direct contact with urine, but person-to-person saliva contact is another matter. At this time it isn't known whether Zika infection via contact with saliva is even possible. Nevertheless, revelers at Brazil's annual street festival known as Carnival are being urged to forego the common practice of kissing total strangers, just as a precaution.

We need to know a lot more about this virus, that's for sure.

Tuesday, February 9, 2016

CDC Recommends No Alcohol Without Birth Control

The U.S. Centers for Disease Control and Prevention (CDC) is now recommending that women of reproductive age (roughly 15-44) who are not on birth control should not drink ANY alcohol, ever. That may be a tough sell. Many women of reproductive age do not have easy access to birth control; in most states it is available only by a doctor's prescription.

The new recommendation is based on the knowledge that no amount of alcohol is safe for the fetus; alcohol can cause several types of permanent damage to the fetus, collectively called fetal alcohol spectrum disorders (FASD). Many pregnancies are unplanned, and the woman may not know she is pregnant for 4-6 weeks. These 4-6 weeks are critical when it comes to the possible damage done by alcohol.

Waiting to stop drinking until you know you are pregnant is just asking for trouble. If you want to drink and don't want to take a chance of damaging your future child, get on birth control until you're ready to give up alcohol for nine months.

For more, review the CDC web page on the subject.

Wednesday, February 3, 2016

An Effective Treatment for Multiple Sclerosis?

Multiple sclerosis is a progressive disease in which the patient's immune cells (specifically, white blood cells) begin attacking the patient's nerve cells in much the same way that they attack foreign pathogens. No one knows quite why they do that, but once they do, their immune memory becomes fixed on continuing the attack. The disease is often intermittent (the symptoms may come and go) and progressive, leading to more permanent symptoms. Immunosuppressive drugs to treat the disease can cost upwards of $60,000 per year.

Now there may be a way to halt the progression of the disease. The basic idea is to reboot the patient's immune system - to wipe out the immune system's memory and start again. In practice here is how it might be done: First, hemopoietic stem cells are harvested from the patient's bone marrow. As you may recall, hemopoietic stem cells have the capacity to develop into all of the various kinds of blood cells. Next, the patient is treated with low-dose chemotherapy to kill the white blood cells that are attacking his/her nerve cells. Finally, the patient's own stem cells are returned to the patient, where they develop into new white blood cells without the previous white cells' memory.

Preliminary data from clinical trials in three countries (Brazil, Sweden, and Britain) have been very encouraging; most patients feel subjectively as if they have been cured. Only about 10% of the patients suffer a relapse within five years of treatment.

It's an awesome advance if it can be proven to work. Even more exciting is that the same type of therapy (rebooting the immune system) might also work against other autoimmune disorders.

Friday, January 29, 2016

What Should You Do About the Zika Virus?

There's a new "dread disease" to worry about; it's called the zika virus. From its start in Brazil, the zika virus has spread quickly throughout areas of Central and South America. It is transmitted by a strain of mosquitos not currently endemic in the United States. At the moment there is no vaccine to prevent zika infection and no medicine to treat it.

In adults, a zika viral infection causes only mild symptoms such as fever, rash, joint pain, and red eyes. The symptoms typically last for only 4-5 days. If that was all there was to a zika viral infection there wouldn't be much to worry about. But that's NOT all; health officials think that the zika virus is responsible for a substantial uptick in cases of microcephaly (a small head and brain) among infants born to zika-infected mothers. And infant microcephaly is a permanent condition that can lead to serious developmental consequences.

So how worried should you be? It depends. If you don't ever travel to Central or South America where the zika-transmitting mosquito is found, you can probably forget about the zika virus; you won't become infected. Even if you do travel to an infected area, it's probably no big deal as long as you don't plan on becoming pregnant.

On the other hand, the U.S. Centers for Disease Control and Prevention (the CDC) recommends that pregnant women postpone any travel to zika-infected areas. This may seem extreme, but there are no medications or vaccines to prevent zika infection, and the consequences to the fetus can be severe.

For more on this subject, visit the zika virus page of the CDC's website.

Saturday, January 23, 2016

Hormonal Contraceptives Without a Physician's Prescription

Oregon is the first state to make hormonal contraceptives available without a prescription from a medical doctor (see an article in The New York Times.) Under a new law that took effect January 1, prescriptions for hormonal contraceptives may be written by pharmacists who have completed a state training course. The patient will only need to complete a questionnaire at a participating pharmacy, have it reviewed by the pharmacist, and pay a one-time fee of about $25. It is hoped that increased availability of contraceptives will reduce the rate of unintended pregnancies.

Oregon teenagers under 18 will still have to receive their first prescription from a doctor; after that, they can renew it at a pharmacy. After five years the legislature will review the law and decide whether the age restriction should be lifted.

Hormonal contraceptives have been around for a long time. They are considered so safe that The American Congress of Obstetricians and Gynecologists would like to see them available over-the-counter. However, over-the-counter availability would require approval from the U.S. Food and Drug Administration; not an easy task. To make contraceptives more readily available in their state right away, states are taking the approach of simply licensing their pharmacists to write prescriptions. A similar law will take effect this year in California, with no age restriction. Other states are watching Oregon and California closely as they consider whether to follow suit.

Wednesday, January 13, 2016

The FDA Proposes New Rules for Tanning Beds

Responding to the latest information that tanning in indoor tanning beds increases the risk of melanoma (the deadliest form of skin cancer), the Food and Drug Administration (FDA) is proposing new rules for the use of indoor tanning beds. Under the new rules, persons younger than 18 would not be allowed to use tanning beds, and adults would have to sign a waiver every 6 months documenting that they understood and accepted the risks.

Eleven states already ban minors from using tanning beds. The logic is that although adults can choose to do what they wish (they're allowed to smoke, for example), children need to be protected because they are not mature enough to make such decisions.

The FDA's proposed rule is open for public comment until mid-March, after which a final decision will be made. The FDA press announcement includes instructions on how to comment on the proposed rule if you wish.

Saturday, January 9, 2016

Risks/Benefits of Home vs. Hospital Childbirth

Having a baby at home instead of in a hospital has become increasingly popular in recent years. Why do some women choose to have their baby at home, and what are the risks associated with that decision?

A recent study conducted in Oregon, one of states with highest rate of home (out-of-hospital) childbirth, provides some interesting answers (unfortunately, you'll need to pay for access to the full article). The study examined the outcomes of nearly 80,000 births in Oregon during 2012 and 2013. The individual data were placed in the home vs. hospital statistical group based on where the woman had initially planned to have the delivery, because some planned home deliveries ultimately are conducted in a hospital because of complications early on.

In terms of risks, the study found that although the risk of death is low for both groups, home deliveries were more likely to result in infant death during birth or within the first month after birth (0.39% for home deliveries, vs. 0.19% for hospital deliveries.) Home delivery also increased the risk that the infant would need a ventilator or have a seizure. For the mother, home births also increased the chance that a blood transfusion would be needed. None of these risks was very large, however.

On the other hand, there were also some benefits to out-of-hospital deliveries, which is precisely why some women choose them. Only 5.4% of out-of-hospital deliveries were by cesarean section, compared to 24.7% in a hospital. Home deliveries also resulted in fewer lacerations and fewer measures to stimulate labor.

The authors do not take a stand on the issue of whether home or hospital deliveries are best, and advocates of both options agree that better information such as this study provides will allow women to make the best choices for themselves.