Should Labor be Induced in Extra-Long Pregnancies?

Compared to normal-length pregnancies, pregnancies that go on too long carry a slightly greater risk of fetal death at or near the time of birth. For that reason, physicians sometimes recommend that labor be induced when a pregnancy has gone on longer than normal. But induction of labor may also entail a small risk, especially if there is no sign of impending spontaneous labor. Which is the lesser risk?

To find out, researchers combed all the available data from previous studies of inducing, or not inducing, labor after unusually long gestation (usually 41 weeks). In all, they reviewed 30 studies involving a total of over 12,000 women in 14 countries.

The results? Inducing labor after 41 weeks resulted in fewer infant deaths. It also resulted in fewer caesarean deliveries, though on the other hand it did result in more assisted (operative) vaginal births. All in all, induction of labor after 41 weeks of gestation appeared to be a good choice. However, it was not determined in this study whether there is an optimal time of induction - should it be at 41 weeks, or 42, or even 43?

Based on this analysis, women who experience an extra-long gestation can safely consider induction of labor as an option.

Cinnamon-Flavored e-Cigarettes May Pose a Health Risk

The naturally occurring organic compound that gives cinnamon its characteristic flavor and odor is called cinnamaldehyde. It's approved by the FDA as a food additive and is considered to be completely safe in foods. More recently, it's also been used as a flavoring in e-cigarettes, but that just may be a problem. Recent preliminary research suggests that cinnamaldehyde may be harmful when inhaled, according to a report in HealthDay.

In the research, which must be considered preliminary because it has not yet been published in a peer-reviewed journal, human lung cells in cell cultures showed reduced cilia activity when exposed to cinnamaldehyde either in e-liquids and e-liquid vapors. In intact humans, lung cell cilia are responsible for helping to clear the lungs of mucus, dust, and bacteria. If cinnamaldehyde affects the activity of lung cell cilia in intact lungs the same way as it does in cell cultures, it's just possible that it could increase the risk of lung infections.

To be clear, though, an increased risk to your health of vaping cinnamon-flavored e-cigarettes has not yet been proven. So YOU have to decide whether the potential of risk is worth it, if you're ever choosing e-cigarette flavors.

Not All Women With Breast Cancer Will Need Chemotherapy

Nearly 60,000 women a year will benefit from a recent study which shows that not all women with breast cancer should undergo chemotherapy, according to an article in the New York Times. The women who don't benefit from chemotherapy are a subset of women with breast cancer who: 1) are in the early stages of breast cancer, 2) are sensitive to estrogen, 3) test positive for a protein called HER2, and most importantly, 4) have a mid-range score on a genetic test that looks for various genes involved in cancer recurrence. The genetic test, which is now widely available, costs about $3,000.

Cancer is complicated. The newest findings are part of an ongoing effort to fine-tune cancer treatment to each patient's specific situation, so that the patient receives the very best treatment while reducing the risks associated with unnecessary chemotherapy.

California's Death With Dignity Law is Declared Unconstitutional

In 2015, California became the fourth state to pass legislation designed to allow terminally ill patients to end their own life under certain prescribed conditions (see this blog, Sept 17, 2015). The law, called the End of Life Option Act, has always been somewhat controversial. And last week, opponents of the law won a battle in court when a Superior court judge declared the law unconstitutional, according to an article in the LA Times.

On what grounds is the law unconstitutional, you might ask? It turns out that the judge's decision had nothing to do with the law itself; his decision was based solely on the fact that the law was passed during a special session of the legislature devoted solely to health care issues. The judge declared that the law was not a health care issue, and so it was unconstitutional to pass it during the special legislative session.

Really? Not a health care issue when a terminally ill patient is in excruciating pain? California's Attorney General has already filed an appeal to the judge's ruling with the 4th District Court of Appeal. He's also asked that the law stay in place while the matter is under appeal.

The matter could end up with the Supreme Court. Or, the law might need to be considered all over again in a regular session of the legislature.

Ebola Outbreak Spreads to a Nearby City

Health officials at the World Health Organization (WHO) reported this week that the most recent Ebola outbreak, which began in a remote village of the Democratic Republic of the Congo (see this blog, May 12, 2018), has spread to a nearby city of over a million people. Only one case of Ebola has been reported in the city so far, but the fear is that the outbreak could spread more quickly now, making containment more difficult. In a city, tracking down and potentially vaccinating every individual who has been exposed to a patient becomes much more difficult.

Keep your fingers crossed. We'll be watching this outbreak closely.

How DNA Analysis Led to the Golden State Killer

More than 30 years after his last crime, a suspect has finally been arrested in the infamous Golden State Killer case. The suspect, a 76-year-old former police officer named Joseph DeAngelo, is believed to have committed over 50 rapes and 12 murders in California between 1976 and 1986. How did police solve a crime spree that ended more than 30 years ago? (Drum roll, please.....) DNA analysis, that's how!

It turns out that police had DNA samples from the Golden State Killer, collected from several of his crimes many years ago. But they had no suspects to try to match them to. Companies like 23andMe have lots of DNA samples, but they are not searchable by the public or the police. However, there's a small company called GEDmatch that analyzes DNA samples and makes them available for free for research purposes. Police detectives searched the GEDmatch database recently, and identified a DNA sample that was close enough to the killer's DNA that it had to belong to a relative (for more on how that works, see this article). Studying that person's family tree led them to Joseph DeAngelo as a possible suspect in the Golden State Killer case.

To find out for sure, the police covertly collected a DNA sample from Mr. DeAngelo (it wouldn't be hard to do - we discard DNA every day on coffee cups and soda cans, for example). It was a match to the killer's DNA samples that they'd had on file for 30 years!

Case closed, finally.

Another Outbreak of Ebola

The Ebola virus that killed more than 11,000 people in four African countries in 2014-2015 has broken out again - this time in a remote village in the Democratic Republic of Congo. So far, 17 people have died from the newest outbreak, including one nurse who was caring for victims.

The 2014-2015 outbreak was so deadly because the countries involved and various medical aid agencies were slow to respond. This time around, health officials are taking no chances. The World Health Organization is mobilizing a rapid response force that includes medical experts, equipment, and medical supplies, including a new Ebola vaccine. The affected area is just three hours away by road from a city of over a million people. If the virus reaches the city, containment of the outbreak could become much more difficult.

From past experience, health officials believe that by attacking viral disease outbreaks early and hitting them hard, outbreaks can be stopped in their tracks before they can spread very far. It worked (minus the new vaccine) in stopping a previous Ebola outbreak in the Democratic Republic of Congo in 2017. Let's hope it works again.