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Health Capsules: Nov. 1

Barnes-Jewish kidney transplant program passes 5,000 mark

Surgeons on the transplant team at the Washington University and Barnes-Jewish Transplant Center recently performed their 5,000th adult kidney transplant. The successful surgery, performed on a male kidney failure patient who received a living donation from his wife, marks a significant milestone for the program, which is one of the oldest and largest in the nation as well as one of the highest-ranked in terms of excellent patient outcomes.

“We are honored to have taken care of 5,000 kidney patients over more than 50 years and look forward to having a positive impact on the lives of many more,” said Jason Wellen, M.D., surgical director of the kidney and pancreas transplant programs.

The Barnes-Jewish transplant team currently averages more than 230 kidney transplant surgeries annually, and performs more than half of all kidney transplants in Missouri. For patients at Barnes-Jewish, the rate of acute organ rejection following a kidney transplant is less than 5 percent, one of the lowest rejection rates in the world. The hospital’s nephrology division, an integral part of the kidney transplant program, was ranked ninth in the country by U.S. News & World Report in 2017.


Vitamin D may help prevent asthma attacks

Asthma affects more than 300 million people worldwide, and is estimated to cause almost 400,000 deaths annually. Deaths from asthma primarily happen during episodes of sudden, acute worsening of symptoms, known as asthma “attacks,” which are commonly triggered by viral upper respiratory infections along with exposure to allergens and airborne irritants.

A recently published British study has found that taking oral vitamin D supplements in addition to prescribed asthma medication could cut in half the risk of severe asthma attacks requiring a visit to the hospital. Vitamin D protects against these attacks by strengthening immune responses to respiratory viruses and reducing dangerous airway inflammation, according to research led by Queen Mary University of London [QMUL].

The new study, which was published in The Lancet Respiratory Medicine, looked at data obtained from 955 participants in seven different randomized trials investigating vitamin D’s effects on asthma. The researchers found that vitamin D supplementation resulted in a 50-percent reduction in the risk of having at least one asthma attack requiring either an emergency room visit or hospitalization. They also found a 30-percent reduction in the rate of asthma attacks requiring treatment with either oral or injectable steroids. The vitamin D supplements were found to be completely safe, with no serious adverse events noted among people who took them.

“These results add to the ever-growing body of evidence that vitamin D can support immune function as well as bone health,” professor Adrian Martineau, who led the research team, said. “Vitamin D is safe to take and relatively inexpensive, so supplementation represents a potentially cost-effective strategy to reduce this problem.”

The study also found that vitamin D supplementation had an even more significant protective effect in study participants who had low blood levels of vitamin D to start with. These participants saw a 55 percent-reduction in the rate of asthma attacks which required steroid treatment. However, due to relatively small numbers of patients studied, the researchers said they could not definitively prove that effects of vitamin D supplementation differ according to baseline vitamin D levels. They also noted that further study is be necessary to show vitamin D’s effects in children and adults with very severe cases of asthma.


Whooping cough’s return may be due to vaccine failure

Before a vaccine against pertussis, also known as whooping cough, became available in the late 1940s, the common childhood illness was a significant cause of death among young children in the United States. From 1940–1945, for example, over one million cases of pertussis were reported. Widespread vaccination nearly eradicated the disease by the mid-1970s, when it reached a low of 1,010 reported cases nationwide in 1976.

Since the 1980s, however, whooping cough again has been on the rise, especially among babies younger than 6 months old and teenagers. In some states, outbreaks have reached epidemic levels, and many children, primarily infants under the age of 3 months, have died of the disease in recent years. According to the most recent statistics available from the U.S. Centers for Disease Control and Prevention, there were 246 reported cases of whooping cough reported in Missouri during 2016, and more than 15,700 reported cases nationwide.

The first pertussis vaccines introduced worldwide were called whole-cell vaccines. Later, as these vaccines raised concerns of possible rare neurologic reactions among some who received them, new acellular vaccines were licensed for use in many countries, including the U.S., starting in the early 1990s. As the medical community works to understand the reasons behind whooping cough’s return and get the disease back under control, researchers from the Boston University School of Public Health [BUSPH] have argued in a new journal article, published recently in F1000 Research, that whooping cough’s resurgence may largely be due to the immunological failure of acellular vaccines.

“This disease is back because we didn’t really understand how our immune defenses worked against whooping cough, and did not understand how the vaccines needed to work to prevent it,” said Christopher J. Gill, associate professor of global health at BUSPH and lead author of the article. “Instead, we layered assumptions upon assumptions, and are now finding ourselves in the uncomfortable position of admitting that we may have made some crucial errors. This is definitely not where we thought we’d be in 2017.”

The researchers examined mathematical models of pertussis transmission, data on animal responses to both types of vaccines, and recent insights into the immune characteristics of pertussis and pertussis vaccines. They found that, although both types of vaccines blocked symptomatic disease, whole-cell vaccines also blocked infections in animals while acellular vaccines did not. While experimental and immunologic data has shown that acellular vaccines do not provide community-wide, or “herd” immunity, mathematical models imply otherwise, a contradictory finding that requires more research to pinpoint a clear explanation, they said.

Citing the growing danger related to pertussis, the authors emphasized the need to go beyond the limitations of animal models and provide human data to study the arguments presented in their article.

“The resurgence of pertussis in the aP [acellular] vaccine era is evolving into a slow-moving global public health crisis. But, with the public’s trust in vaccines waning, this has also become a public relations crisis,” they wrote.


Zika could become brain cancer treatment 

The Zika virus is at its most lethal in the brains of developing fetuses, killing cells and causing some babies to be born with small, mis-shapen heads and other severe neurological damage. However, this deadly power could potentially be harnessed to destroy malignant cells in adult brains, according to new research conducted at Washington University in St. Louis.

Every year, about 12,000 Americans are diagnosed with glioblastoma, the most common form of brain cancer. The standard treatment is surgery to remove the tumor, followed by chemotherapy and radiation. However, most tumors recur within six months because a small number of cells, called glioblastoma stem cells, often survive the onslaught of those drugs and continue to divide. As a result, the cancer often is fatal within a year of diagnosis.

Working with scientists from the University of California San Diego School of Medicine, the Wash U researchers found that the Zika virus actually kills those glioblastoma stem cells while leaving other nearby cells largely unaffected. They theorized that in this way, Zika could potentially be used in conjunction with standard chemotherapy and radiation treatments.

To test their theory, they infected tumors in the lab with one of two strains of Zika. Both strains spread throughout the tumors, infecting and killing the cancer stem cells while largely avoiding other tumor cells. They performed a similar experiment on living animals by injecting either Zika virus or saltwater [a placebo] directly into the brain tumors of mice. Tumors were significantly smaller in the Zika-treated mice two weeks after injection, and those mice survived significantly longer. They also conducted studies of the virus using brain tissue from epilepsy patients, and found that the virus does not infect noncancerous brain cells.

The findings were published earlier this month in The Journal of Experimental Medicine.


Growing opioid crisis straining U.S. healthcare resources

While it is widely known that opioid use has reached epidemic levels in many areas of the U.S., a recent study has, for the first time, quantified that epidemic in terms of its devastating impact on Americans’ health and on healthcare resources nationwide.

Researchers from Harvard Medical School and the University of Chicago, working with others from Ben-Gurion University of the Negev [BGU] in Israel, analyzed nearly 23 million adult hospital admissions at 162 U.S. hospitals in 44 states over a seven-year period between 2009 and 2015. The data showed that deaths from opioid overdoses nearly doubled during that time, while the costs of emergency care and hospitalizations skyrocketed. In many areas, the demand for care also exceeded the available supply.

In the hospitals studied, overdose-related ICU admissions for prescription drugs, methadone or heroin rose by 34 percent, while the cost per admission jumped by 58 percent to more than $92,000. The death rates of patients admitted to the ICU for overdose began to rise at a steeper rate during the latter part of the study, after 2012.

“Our findings raise the need for a national approach to developing safe strategies to care for ICU overdose patients, to providing coordinated resources in the hospital for patients and families and to helping survivors maintain sobriety following discharge,” the researchers’ report concluded. The study was published online in the Annals of the American Thoracic Society.


On the calendar

BJC presents a Staying Home Alone course from 6:30–8 p.m. on Wednesday, Nov. 8 at the McClay Branch Library, 2760 McClay Road in St. Charles.  This parent-child program helps determine a child’s readiness to stay home by themselves and prepares them to do so. The fee is $25 per family. To register, call (636) 344-5437.

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BJC of St. Charles County offers a free flu shot clinic for adults 18 and over from 9:30 a.m.–12:30 p.m. on Thursday, Nov. 9 at the Spencer Road Branch Library, 427 Spencer Road in St. Peters. Preregistration is required by calling (636) 928-9355 or by visiting BJCStCharlesCounty.org.

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