News Potpourri [*].

KIDNEY STONES MAY BE LINKED WITH SLEEP POSTURE

Source: BMJ 2001; 322:1045

Sleeping in one position may cause kidney stones. Researchers from the University of California in San Francisco studied 100 patients with recurrent nephrolithiasis to determine if there was any relationship between sleep posture and formation of kidney stones. Questionnaires were used to evaluate patients' sleep posture and to correlate the side of stone formation. The positive predictive value of sleep posture and ipsilateral stone formation was 82% for those who slept right-side down and had right-sided stones and was 70% for those who slept on the left side and had left-sided stones.

NEUROPEPTIDE MAY SHIFT RHEUMATOID ARTHRITIS INTO REMISSION

Source: Lancet 2001; 357:1418

Vasoactive intestinal peptide (VIP) may reduce some of the disabling joint problems in rheumatoid arthritis. Researchers at Complutense University, Madrid, Spain, say VIP seems to have therapeutic potential for other chronic inflammatory disease and [T.sub.H]1-dependent autoimmune diseases, such as Crohn's disease, multiple sclerosis, and autoimmune diabetes. The effects of VIP on [T.sub.H]1/[T.sub.H]2 systems in collagen-induced arthritis were studied. Rheumatoid arthritis-like symptoms were induced by immunization of mice with type II collagen. After two immunizations, VIP was administered in different doses, either as a single injection or as multiple injections given every day, or every 2 days for 2 weeks. The mice treated with VIP showed delayed onset, lower incidence, or decreased severity of induced arthritis.

FDA TARGETS SNACK FOODS INDUSTRY OVER ALLERGENS

Source: BMJ2001; 322:883

The US Food and Drug Administration (FDA) is stepping up its drive to improve labeling of snack foods that contain allergens. A study was commissioned by the government agency when a study found undisclosed traces of peanuts in a quarter of all snacks tested. An estimated seven million Americans have food allergies and rely on product labels to avoid ingredients that could trigger an anaphylactic reaction. The FDA investigators examined 85 companies in Wisconsin and Minnesota--manufacturers of snack foods, biscuits, sweets, and ice creams. Twenty-five percent of the companies failed to list all ingredients on their products, and almost half of them did not check the labels to make sure that all ingredients used in a product were listed on the label. Of the products sampled, 25% of them had undisclosed traces of peanuts, and 11% had unlisted traces of eggs, another common food allergy.

STROKE CONTRIBUTES TO WOMEN'S HIGHER MORTALITY AFTER CARDIAC SURGERY

Source: Lancet 2001; 357:1419

Women having cardiac surgery are more likely than men to have a new stroke, transient ischemic attack, or coma. Women! also have higher 30-day mortality than do men when these neurologic complications occur. Researchers at the Barnes-Jewish Hospital at Washington University Medical Center, St. Louis, Mo, reviewed clinical information on about 420,000 (32% female) patients entered into the database of the Society of Thoracic Surgery National Cardiac Surgery Database during 1996-1997. Women had more new neurologic events than did men (3.8% vs 2.4%, P = .001) and had a higher mortality rate at 30 days (5.7% vs 3.5%, P = .001). Since the majority of the women were menopausal, researchers believe estrogen may play a role in the occurrence of neurologic events. However, researchers at the University of California, San Francisco, say the evidence regarding postmenopausal hormone therapy and stroke is inconsistent.

SPAIN REGIONAL GOVERNMENT TRIES TO IMPROVE PUBLIC-PRIVATE HOSPITAL RELATIONS

Source: Lancet 2001; 357:1423

New guidelines are being developed in Spain for the provision of urgent medical care to people who are found near a hospital but who are not patients of that facility. The decision was prompted by the case of a 57-year-old man who died outside a private center without receiving medical care. Currently in Spain there is no law that specifies whether a doctor can or cannot leave a hospital to attend to a nearby street emergency. The laws do state that any citizen is to help a sick individual, and denial of help is considered an offense. A commission of representatives of the Official Medical College of Barcelona, the adviser committee of bioethics of the Health Department, and 15 heads of hospital emergency departments are preparing a series of guidelines and recommendations designed to prevent people who need urgent health care from dying in the street close to the hospital. Although the guidelines will apply only to Catalan public and private centers, other health departments may adopt them.

TUBERCULOSIS OUTBREAK HITS THE UNITED KINGDOM

Source: BMJ2001; 322:884

The United Kingdom is experiencing its most serious outbreak of tuberculosis (TB) in 20 years. Health officials have confirmed 33 cases at a secondary school, the Crown Hills Community College in Evington, Leicester. The Leicestershire Health Authority has screened all close contacts of those diagnosed with TB. Public health officials say they are dealing with a very virulent form of TB. The incidence of the disease has increased in England and Wales over the past few years, with a current annual rate of 5,000 to 6,000 cases. In the year 2000, the Public Health Laboratory Service had a 10.6% increase in notifications over 1999. The rise over the past 10 years, authorities say, is a cause for concern since TB is a disease that had declined 10-fold over the past 40 years. Officials say the increase may be due to the fact that most of the children at the school are from the south Asian community. There is a high incidence of TB in south Asia, so children or their relatives could have been at risk during visits to the region.

US GOVERNMENT LIMITS ABORTION PILL FOR POOR WOMEN

Source: BMJ2001; 322:1015

The US Department of Health and Human Services has informed state Medicaid directors that the abortion pill, mifepristone, just like abortions, will be covered only when a pregnancy has resulted from rape or incest or when a woman's life is in danger. Mifepristone was reviewed by the Advisory Committee on Reproductive Health Drugs and recommended for approval in 1996. However, the Food and Drug Administration did not approve the drug until the year 2000.

DISSOLVING SUGAR HELPS NERVE REGENERATION

Source: BMJ 2001; 322:1014

Nerve regeneration after brain or spinal cord injuries can be improved by dissolving the sugar chains found on the inhibitory protein molecules that fill scar tissue. Neuroscientists at the Brain Repair Center in Cambridge say that by using a bacterial enzyme to dissolve the sugar, they can significantly improve the regeneration of neurons. One of the reasons neurons do not grow back after an acute injury is because the glial cell scar tissue becomes full of inhibitory molecules. These proteins, which are modified by the addition of sulphated sugar chains, prevent neurons from growing back through the damaged area.

(*.) Originally prepared for presentation on Southern Medical Association's Web site (http://www.sma.org) by Elaine McClellan-Holm.