Corticosteroids May Speed Pneumonia Recovery in Some

TUESDAY, May 31 (HealthDay News) -- Patients with an inflammatory lung condition known as community-acquired pneumonia appear to recover faster when treated with corticosteroids in addition to the standard regimen of antibiotics, Dutch researchers say.

Those treated with a combination of corticosteroids and antibiotics also required a shorter hospital stay than patients treated with antibiotics alone, the study authors found.

The observations stem from what is believed to be the largest study to date focused on the potential of corticosteroids for the treatment of community-acquired pneumonia, or CAP.

Dr. Sabine Meijvis, from the St. Antonius Hospital in Nieuwegein, the Netherlands, and colleagues reported their findings in the May 31 online edition of The Lancet.

Meijvis and her team noted that, currently, CAP is typically treated with antibiotics following an early diagnosis.

To explore whether corticosteroids might reduce the risk for complications and fatalities, the team focused on just over 300 Dutch CAP patients. Half of the patients were placed on a standard antibiotic protocol coupled with 5 milligrams a day of the corticosteroid dexamethasone. The other half were given antibiotics plus a placebo (an inactive treatment).

After four days, the research team found that those given the corticosteroid experienced less lung inflammation, and recovered more quickly than those who were just given antibiotics.

The corticosteroid group also required one less day of hospitalization than the antibiotic group (6.5 days versus 7.5 days). In addition, by the end of one month, the corticosteroid group had experienced better "social functioning" relative to the antibiotic group, the investigators found.

"Serious adverse events were rare" among the corticosteroid group, the study team noted in a journal news release, while at the same time cautioning that "the benefits of corticosteroids should be weighed against the potential disadvantages of these drugs, such as superinfections and gastric disturbances."

Dr. Len Horovitz, a pulmonary specialist at Lenox Hill Hospital in New York City, said the findings were in line with what he might expect.

"It doesn't surprise me because corticosteroids are used as nuclear anti-inflammatories," he said, noting they might suppress an otherwise lingering fever within 24 hours. "And they would mask a lot of symptoms and make a patient feel generally better whether they're asthmatics or have some inflammatory disease."

"But the downside," he cautioned, "is that we know that corticosteroids are immune-suppressive. And so the possibility exists that when you use them, you could be prolonging the actual recovery time even as you are masking the symptoms, although this study doesn't say that."

This is a potential danger for otherwise healthy people and especially so for those who have high blood pressure or diabetes, he said. "So any medication is a double-edged sword," he added. "And the use of corticosteroids in this case has to be weighed against possible complications."

More information

For more on pneumonia, visit the U.S. National Library of Medicine.

SOURCE: Len Horovitz, M.D., pulmonary specialist, Lenox Hill Hospital, New York City, and Northshore-LIJ Health System; The Lancet, news release, May 31, 2011Copyright

Childhood Cancer Therapies Tied to Gastrointestinal Issues

WEDNESDAY, May 25 (HealthDay News) -- Children who are successfully treated for cancer are at greater risk of developing mild to severe gastrointestinal problems down the road, a new study finds.

Researchers from the University of California, San Francisco analyzed the self-reported gastrointestinal (GI) problems of 14,358 patients who survived at least five years following treatment for cancers such as lymphoma, leukemia, brain tumors or bone tumors.

More than 40 percent experienced some type of GI problem -- including ulcers, esophageal disease, indigestion, polyps, chronic diarrhea, colitis, gallstones and jaundice -- within two decades of their treatment, the investigators found.

Moreover, people diagnosed with cancer at an older age and who had to undergo more rigorous therapy (chemotherapy, radiation, surgery) were more likely to experience long-term GI issues, according to the study in the May issue of Gastroenterology.

About one in 500 young adults in the United States is a survivor of childhood cancer, the study authors noted in a UCSF news release.

"While physicians continue to learn about the long-term consequences of pediatric cancer and its therapy, it is essential that we provide comprehensive follow-up care that appropriately addresses the complications cancer survivors may experience," lead study author Dr. Robert Goldsby, pediatric cancer specialist at UCSF Benioff Children's Hospital and director of the UCSF Survivors of Childhood Cancer Program, said in the news release.

"These are serious issues that can have a real impact on a person's quality of life," Goldsby added.

More information

The U.S. National Cancer Institute has more on childhood cancers.

SOURCE: University of California, San Francisco, news release, May 19, 2011Copyright

Scientists Find Molecular Similarities in Brains of Those With Autism

WEDNESDAY, May 25 (HealthDay News) -- The symptoms and severity of autism vary widely, but new research shows remarkable similarities at the molecular level in the brains of people with the disorder.

Researchers from Los Angeles, Toronto and London analyzed post-mortem brain tissue samples from 19 people with autism and 17 without.

In the healthy brains, researchers saw distinct differences in the gene expression in the frontal lobe vs. the temporal lobe of the cerebral cortex -- differences that help determine the structure and function of the two brain regions.

Specifically, between the frontal and temporal lobes in the healthy brains, more than 500 genes were expressed at different levels. Gene expression is the process by which a gene's DNA sequence is copied into RNA to produce proteins, which perform specific tasks within the cell.

But researchers didn't find those same patterns in autistic brains. Instead, researchers found only eight differences in the gene expression in the frontal and temporal lobes.

"In a healthy brain, the frontal and temporal lobes can be differentiated," said principal investigator Dr. Daniel Geschwind, a distinguished professor of neurology, psychiatry and human genetics at the David Geffen School of Medicine at UCLA. "But in autism we didn't see that. Instead, the frontal lobe closely resembles the temporal lobe."

Many of those regional differences in the cerebral cortex are established during fetal development, researchers added.

The study is published in the May 25 online issue of Nature.

Over the past decade, researchers have discovered lots of gene variants that seem to play a role in some cases of autism, but none of the mutations were present in a large percentage of people with the disorder.

Prior research has also implicated regions of the cerebral cortex, which is highly developed in humans, in autism. The frontal lobe is involved with judgment, language, planning, social cognition and personality, while the temporal lobe is important for language and emotions, Geschwind said.

But this is the first study to show differences in the patterns of gene expression between brain regions. It's those patterns of gene expression that enable the brain to function normally and to communicate properly with other regions of the brain, explained Robert Ring, vice president for translational research for Autism Speaks.

"This study allows us to look at the complexity of what's going on at a molecular level in the brain, a step up from the gene," Ring said. "Here we have the opportunity to really see that the development of normal brain physiology requires differences in the regional activity of gene networks. This report provides evidence that the expected pattern of these differences is absent in autism."

Researchers say the findings may help in the development of medications that target the pathways. "The fact that it's shared says there is some hope of beginning to unwind this and develop some treatments that would target those pathways," Geschwind said.

Compared to the healthy brains, autistic brains had less activity in the genes responsible for neuron function and communication, and a heightened level of gene expression in genes involved in immune function and inflammatory response.

Some of those genes have also previously been implicated in autism, researchers noted.

An estimated one in 110 U.S. children -- including one in 70 boys -- has an autism spectrum disorder, according to background information in the study. Autism affects behavior and impairs the ability to communicate and establish social relationships. Diagnoses have increased tenfold in the past decade.

More information

The U.S. National Institutes of Health has more on autism.

SOURCES: Daniel Geschwind, M.D., Ph.D., distinguished professor, neurology, psychology and human genetics, University of California, Los Angeles; Robert Ring, Ph.D., vice president, translational research, Autism Speaks, New York City; May 25, 2011, online, NatureCopyright

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Study Finds Almost 1 in 5 Young Adults Has High Blood Pressure

WEDNESDAY, May 25 (HealthDay News) -- About 19 percent of U.S. adults aged 24 to 32 have high blood pressure, but many of them are unaware that they have the potentially life-threatening condition, new research reveals.

High blood pressure, or hypertension, is associated with a slew of health problems, including coronary heart disease, heart failure, stroke and kidney failure. The study, funded by the U.S. National Institutes of Health (NIH), found the risk for this condition among young adults is actually greater than previously thought.

Researchers analyzed the blood pressure readings of more than 14,000 young adults who took part in the National Longitudinal Study of Adolescent Health (Add Health).

The findings, published in the current online edition of the journal Epidemiology, are a departure from previous study findings. In the recent U.S. National Health and Nutrition Examination Survey (NHANES), only 4 percent of young adults were found to be hypertensive.

"This fivefold increase in the incidence of high blood pressure in a younger, healthier population is the start of a trend of 'un-health' that we are about to see in our youth," said Dr. Suzanne Steinbaum, a preventive cardiologist at Lenox Hill Hospital in New York City. She was not involved in the study.

"As 30 percent of people are overweight or obese, there is a rise in other issues associated with that, such as diabetes and, now high blood pressure," Steinbaum added. "With high blood pressure happening at this younger age, the chances that we will see heart developing earlier is likely."

The reasons for the difference between the new study findings and those from NHANES is unclear.

"We explored several possible explanations for the difference between this study and NHANES, including participant characteristics, where they were examined and the types of devices for measuring their blood pressure," Kathleen Mullan Harris, principal investigator of the new study, said in an NIH news release. "None of these factors could account for the differences in estimates between the two surveys."

The investigators also pointed out that the proportion of young people who had been previously diagnosed with high blood pressure was similar in both studies: 9 percent for NHANES respondents and 11 percent for Add Health respondents.

Whatever the reason for the disparity, the new data "are a call to action," Steinbaum said. "We need to remind our younger population the critical nature of the role of diet and exercise in staying healthy, and that it must begin as early in their lives as possible or it will have negative effects on their health."

More information

The American Heart Association has more on the prevention and treatment of high blood pressure.

SOURCE: Suzanne Steinbaum, M.D., preventive cardiologist, Lenox Hill Hospital, New York City; U.S. National Institutes of Health, news release, May 25, 2011Copyright

Stroke Patients May Regain Function Just as Easily at Home

WEDNESDAY, May 25 (HealthDay News) -- Home-based exercise managed by a physical therapist is just as effective at restoring stroke patients' walking ability as a formal rehabilitation program using a specialized treadmill, a new study indicates.

The results also defy conventional wisdom that stroke recovery peaks at six months, demonstrating that patients who began rehabilitation even six months after their stroke continued to improve their walking for up to a year.

"It's a fantastic study, rigorously done," said Dr. Richard B. Libman, chief of vascular neurology at Long Island Jewish Medical Center in New Hyde Park, N.Y. "It's incredibly important . . . not to write patients off after a certain period of time has elapsed. Patients have the potential to improve way after the point where we thought they couldn't."

Researchers, calling it the largest stroke rehabilitation study ever done in the United States, randomly assigned more than 400 stroke patients with moderate or severe walking impairments to one of three study groups, two involving "locomotor" training and one involving home exercise. The patients were recruited from inpatient rehab facilities in California and Florida and had an average age of 62. Slightly more than half were men.

All received 36 supervised, 90-minute sessions over a period of 12 to 16 weeks, in addition to usual care.

Those in "locomotor" training attended a formal rehabilitation program where they used a treadmill while wearing a harness that offered partial body-weight support. Following treadmill training, they practiced walking. The early locomotor group started training two months post-stroke; the other locomotor participants began six months after their stroke. For the home-exercise group, a physical therapist focused on enhancing patients' flexibility, range of motion, strength and balance to improve walking ability, starting two months post-stroke.

Study author Pamela Woods Duncan, a professor of community and family medicine at Duke University School of Medicine, said she and her team were surprised to find that patients in the home exercise group did as well as those in locomotor training, which they thought would produce superior results.

Indeed, at the end of one year, more than half (52 percent) of all study participants had improved their walking ability, with similar gains among all three groups. No differences were found among those who had started treadmill training two months or six months after their stroke.

"I think it's an extremely important study," Duncan said. "Those at home had equal outcomes . . . and fewer minor adverse events," such as dizziness and falls.

She and the other researchers also noted that the progressive home exercise program involved less expensive equipment, less training for physical therapists, fewer clinical staff members and better patient compliance.

"Collectively, our results suggest that home exercise is a more pragmatic form of therapy with fewer risks," they wrote.

Libman called the study, published May 26 in the New England Journal of Medicine, "practically revolutionary" for its potential to change standard stroke rehabilitation care.

"I think it's going to change the management of stroke, and third-party payers are going to be extremely interested in the results of the study," he said. "I think it will save a huge amount of money for the healthcare system and be psychologically and emotionally beneficial for patients."

Participants' improvement measurements were based on how well they could walk independently by the end of the study. Severely impaired patients were considered improved if they were able to walk around the inside of a house, while patients already mobile at home were considered improved if they progressed to walking independently in the community.

Not only did the physical therapy patients recover walking ability as well as the locomotor group, they were also less likely to drop out of treatment -- 3 percent vs. 13 percent of the locomotor group.

Minor adverse events, mostly falls, were reported by about 56 percent of participants, with no significant differences among groups. Patients who started locomotor therapy at two months and were severely impaired, however, were more likely to report multiple falls.

Dr. Walter Koroshetz, deputy director of the U.S. National Institute of Neurological Disorders and Stroke (NINDS), said few studies have compared stroke therapies and provided evidence "in such very rigorous fashion."

"So this is probably the tip of the iceberg," he said. "It's precedent-setting . . . with very practical results."

Funding for the study was provided by NINDS and the National Center for Medical Rehabilitation Research.

More information

To learn more about strokes, visit the U.S. National Institute of Neurological Disorders and Stroke.

SOURCES: Pamela Woods Duncan, Ph.D., professor, community and family medicine, Duke University School of Medicine, Durham, N.C.; Richard B. Libman, M.D., chief, division of vascular neurology, Long Island Jewish Medical Center, New Hyde Park, N.Y.; Walter Koroshetz, M.D., deputy director, National Institute of Neurological Disorders and Stroke, Bethesda, Md.; May 26, 2011 New England Journal of MedicineCopyright

CDC Report Shows Bacterial Meningitis Cases on the Decline

WEDNESDAY, May 25 (HealthDay News) -- The incidence of bacterial meningitis dropped by 31 percent between 1998 and 2007, new government research shows.

The drop was led by reductions in infections by two powerful germs -- Neisseria meningitidis and Streptococcus pneumoniae -- that are covered by available immunizations. With fewer infections among young children, the burden of the disease is now mainly borne by older adults, the study authors found.

"The good news is that fewer people are getting bacterial meningitis. The bad news is that if you get it, it's still a very serious infection," said study co-author Dr. Cynthia Whitney, chief of the bacterial respiratory diseases branch at the U.S. Centers for Disease Control and Prevention in Atlanta.

"There are still at least 4,000 cases a year, including about 500 that are fatal," she noted.

Results of the study are published in the May 26 issue of the New England Journal of Medicine.

Bacterial meningitis is a dangerous bacterial infection that causes inflammation of the membranes that cover the brain and spinal cord, according to the CDC.

Signs of meningitis in people over the age of 2 include fever, headache and stiff neck, according to the CDC, while symptoms in newborns and infants can include fever, seizures, constant crying, a bulge in the soft spot on the head and stiffness in the body and neck. Bacterial meningitis can be contagious.

The five types of bacteria that were most responsible for bacterial meningitis in the 1970s and 1980s were Haemophilus influenzae, N. meningitidis, S. pneumoniae, group B streptococcus and Listeria monocytogenes, according to the study.

In the late 80s and early 90s, the incidence of bacterial meningitis dropped by 55 percent, likely because an infant vaccine was introduced in 1990 for H. influenzae type B (Hib).

Since that time, other vaccines have been introduced for strains of N. meningitidis and S. pneumoniae that appear responsible for the shrinking infection rate caused by those germs. The rate of one type of S. pneumoniae decreased by 92 percent during the study period, and the incidence of N. meningitidis dropped by 58 percent.

The findings were based on information from the CDC's Emerging Infections Programs Network, which included eight surveillance sites across the United States. These sites include data on about 17.4 million people.

During the surveillance period between 1998 and 2007, the incidence of bacterial meningitis dropped from two cases per 100,000 people to 1.38 cases per 100,000 people. The average age of those affected increased from 30.3 years to 41.9 years.

The incidence of meningitis was highest among blacks and children under 2 months old throughout the study period, the CDC reported.

In addition, rates of death caused by bacterial meningitis didn't change significantly over the study period. Among adults, those aged 65 or older were most likely to die from the illness.

The youngest and oldest people are typically more susceptible to infections from a variety of causes, but Whitney said that the CDC researchers aren't sure why blacks have significantly higher rates of bacterial meningitis.

Kenneth Bromberg, director of the Vaccine Study Center at the Brooklyn Hospital Center, said it can be difficult to tease out the reasons why certain groups have higher rates of some infections: Is it an inherent susceptibility? Is it an access-to-care issue? In this case, he said he thinks that black people may have a genetic susceptibility to certain bacteria that cause meningitis.

There are three different types of vaccines available for bacterial meningitis. These vaccines don't cover every strain that can cause meningitis, but they do offer protection against many of the common strains. The Hib vaccine, which covers H. influenzae, is part of routine childhood immunizations.

The meningoccocal vaccine (MCV4), which protects against N. meningitidis, covers against a form of bacterial meningitis that is often passed from person-to-person when many people are living in close quarters, such as a college dormitory or military barracks. The CDC recommends the first dose of this vaccine be given at 11 to 12 years old, and then a booster at 16 years old; it's also recommended for certain high-risk children aged 2 through 10. If you're over 16 when you first receive this vaccine, the CDC says only one dose is needed.

The pneumococcal vaccine (called PCV-13 for children and PPSV in adults) is part of routine childhood immunizations. People who are at higher risk of developing bacterial meningitis may receive a booster dose. In addition, people who are over 65, or younger people who have chronic health conditions or a compromised immune system, should also receive this vaccination, as should anyone who smokes or has asthma, despite their age, according to the CDC.

"Public health surveillance like this is exceedingly important in evaluating our public health strategies. It's good to see that the rates of bacterial meningitis are going down, but the death rate has not gone down for those who do have it," noted Bromberg.

"The good news is that we're doing something to prevent bacterial meningitis, and we've made a lot of strides in the past decade. But, physicians and patients need to know that bacterial meningitis still occurs and it is still a deadly serious infection," Whitney said.

Besides getting immunized, Whitney noted that staying healthy and not smoking can help keep your immune system primed to fight off these infections. She said it's also important to note that Listeria is a significant cause of meningitis, and that pregnant women need to be especially careful about the foods that they eat to avoid this infection.

More information

To learn more about bacterial meningitis, visit the U.S. Centers for Disease Control and Prevention.

SOURCES: Cynthia Whitney, M.D., M.P.H., chief, bacterial respiratory diseases branch, U.S. Centers for Disease Control and Prevention, Atlanta; Kenneth Bromberg, M.D., chairman, pediatrics, and director, the Vaccine Research Center, The Brooklyn Hospital Center, New York City; May 26, 2011, New England Journal of MedicineCopyright