miércoles, 29 de febrero de 2012

CDC Ramps up Support for Final Push in Global Polio Eradication Effort - Polio Eradication - CDC Works For You 24/7

CDC Ramps up Support for Final Push in Global Polio Eradication Effort

On Wednesday, December 14, CDC Director Thomas R. Frieden, M.D., M.P.H., charged the entire CDC community to become active participants in an intensified strategy to eradicate polio, worldwide. The briefing followed Dr. Frieden’s December 2nd announcement activating CDC’s Emergency Operations Center for the agency’s partnership engagement through the Global Polio Eradication Initiative (GPEI). GPEI is committed to eradicating polio by the end of 2012. For more about CDC’s Emergency Operations Center, see http://www.cdc.gov/phpr/eoc.htm.

Isn’t Polio Gone?

Members of CDC's Polio Surveillance Unit in the 1950s: Alexander Langmuir is sitting on the left, Jack Karush (EIS '54) is in the center, and CDC statistician Robert Serfling is on the right.

Polio, or poliomyelitis, is an infectious viral disease that can strike at any age and affects a person's nervous system. In the late 1940s to the early 1950s, in the U. S. alone, polio crippled around 35,000 people each year -- making it one of the most feared diseases of the 20th century. Yet, thanks to a massive vaccination effort, by 1979 the country became polio free. For more about polio and how it was eradicated in the U.S., see “A Polio-Free U.S. Thanks to Vaccine Efforts,” http://www.cdc.gov/Features/PolioFacts/. The eradication of polio from the western hemisphere of the world is one of the most significant public health achievements of all time. But victory over polio cannot be claimed until the entire world is made safe from the disease and this commitment has been made by the global public health community.

The Early Years of CDC’s Fight against Polio

The fight against polio has been part of CDC’s mission since the 1950s, and the global push to eradicate polio is just the latest chapter in CDC’s polio efforts. Shortly after CDC was created, it established a national polio surveillance unit (PSU) headed by CDC’s Epidemic Intelligence Service (EIS) founder Alex Langmuir. CDC worked collaboratively with the two giants in polio eradication, Dr. Jonas Salk, of the University of Pittsburgh who developed the inactivated polio vaccine (IPV) in the early 1950s, and Dr. Albert Sabin, who developed the oral polio vaccine (OPV) in the early 1960s. CDC’s PSU staff and EIS officers worked to administer both the Salk and Sabin polio vaccines and also gather and analyze surveillance data.
CDC’s Chief EIS Officer at the time, Ira L. Myers, M.D., M.P.H., remembers the collaboration of CDC’s PSU and EIS with Salk and Sabin as something monumental, “As I think back on it, to sit in a conference room where Jonas Salk and Albert Sabin were sitting across from each other trying to decide whose vaccine was going to be first, is something that stays with your memory forever.” For more about CDC’s role in the early days of polio vaccine administration and surveillance, see “ ‘Bright, Aggressive, and Abrasive:’ A History of the Chief Epidemic Intelligence Service Officer of the U.S. Centers for Disease Control and Prevention,1951 – 2006

”.

Next Page: Keeping the U.S. Polio-Free

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Chronic lymphocytic leukemia (CLL) in adults (Beyond the Basics)

Official reprint from UpToDate^® www.uptodate.com
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Patient information: Chronic lymphocytic leukemia (CLL) in adults (Beyond the Basics)

Authors Kanti R Rai, MD Michael J Keating, MD

Section Editor Richard A Larson, MD

CHRONIC LYMPHOCYTIC LEUKEMIA OVERVEIW

Chronic lymphocytic leukemia, often referred to as CLL, is a type of cancer of the blood. It is one of a group of diseases that affects a type of white blood cell called a lymphocyte. The lymphocytes help the body fight infection.

CLL and small lymphocytic lymphoma are variants of the same disease. If you have been diagnosed with small lymphocytic lymphoma, abbreviated as "SLL," the information in this article applies to you, too.

In chronic lymphocytic leukemia, abnormally high numbers of ineffective lymphocytes are found in the blood and/or bone marrow (the spongy area in the middle of large bones where blood cells are formed). In SLL, these same cells are commonly found in the lymph nodes. The abnormal cells cannot fight infection as normal lymphocytes do, but instead collect in lymph nodes and other areas, such as the liver and spleen. The accumulation of ineffective lymphocytes can interfere with the production of other blood cells, such as red cells and platelets.

Unlike other types of leukemia, CLL usually progresses slowly. In many cases, it causes the patient little, if any, problems in its early stages. Patients may live with chronic lymphocytic leukemia for decades. Some patients, however, live for a shorter period. Many times, it is diagnosed, only incidentally, by blood tests that are performed during a routine physical exam. In other cases, symptoms cause the person to seek medical care.

Careful analysis of the patient's blood and physical condition help to determine the stage of the disease — a crucial first step in deciding on the proper course of treatment. Unlike patients with many other types of cancer, some patients with CLL do not benefit from early, aggressive treatment, but rather, do better with careful long-term monitoring of the disease.

STAGING OF CHRONIC LYMPHOCYTIC LEUKEMIA

The natural history of CLL may vary considerably from one person to another. Some people become sick within a short time of diagnosis; others live comfortably for years without problems.

Determining which patients are most likely to get sick, and therefore most likely to benefit from treatment, is an important task. (See "Staging and prognosis of chronic lymphocytic leukemia".)
Two systems for staging CLL are now in use. Both systems are based upon results of the physical examination and blood tests.

The Rai system — The Rai system is based on an analysis of how the body is affected by the abnormal lymphocytes [1]. There are five stages. The higher numbers indicate a more advanced stage of disease:

Stage 0: Increased numbers of abnormal lymphocytes are found in the blood or bone marrow; lymph nodes/organs are not swollen; and production of red cells and platelets is normal
Stage I: Increased abnormal lymphocytes and enlarged lymph nodes
Stage II: Increased abnormal lymphocytes with enlarged liver or spleen, with or without enlarged lymph nodes
Stage III: Increased abnormal lymphocytes with anemia (low red blood cell count), with or without an enlarged spleen, liver, or lymph nodes
Stage IV: Increased abnormal lymphocytes with a low platelet count, with or without anemia, enlarged liver, spleen, or lymph nodes

The Binet system — This system considers the five possible sites where lymphocytes can collect (lymph nodes in the neck, armpit, and groin, and lymphocyte-containing channels in the spleen and liver (figure 1)), and also whether anemia or low platelet counts are present [2]. There are three stages:

Stage A: Fewer than three involved sites
Stage B: Three or more involved sites
Stage C: Presence of anemia or low platelet counts

What the CLL stages mean — Staging CLL helps determine how likely it is that you will develop serious problems related to your illness. Patients at Rai stage 0 are considered at low risk, those at stages I or II are at intermediate risk, and those at stage III or IV are at high risk. Similarly, patients characterized according to the Binet system have progressively increasing risk, with Stage A as the lowest and Stage C as the highest risk group.

When is treatment needed? — As noted above, treatment is not always required for chronic lymphocytic leukemia. Some studies have shown that patients without symptoms of CLL (also called "smoldering" disease) are no more likely to die than a similar age/sex person who does not have chronic lymphocytic leukemia. (See 'Management of asymptomatic chronic lymphocytic leukemia' below.)

However, there are certain groups of patients in whom treatment is generally indicated. This includes patients with:

Symptoms of anemia and/or low platelets (Rai stages III or IV, or Binet stage C)
Disease-related symptoms such as weakness, night sweats, weight loss, painful lymph node swelling, or fever
Autoimmune hemolytic anemia and/or low platelets (when the immune system destroys red blood cells or platelets) that does not respond to treatment with glucocorticoids, such as prednisone.
Progressive disease, as demonstrated by rapidly increasing white cells in the blood, and/or rapidly enlarging lymph nodes, spleen, or liver
Repeated infections

MANAGEMENT OF ASYMPTOMATIC CHRONIC LYMPHOCYTIC LEUKEMIA

Although people who do not have symptoms of chronic lymphocytic leukemia are not usually treated for their disease, they should be monitored regularly with blood tests and a physical examination. This is usually performed every three months for at least the first year after diagnosis. Depending upon the results of these tests, it may be possible to estimate how aggressive your disease will be in the future.

TREATMENT OF LOCALIZED CHRONIC LYMPHOCYTIC LEUKEMIA

People who have stage I chronic lymphocytic leukemia (which causes increased abnormal lymphocytes and enlarged lymph nodes) are sometimes treated with radiation therapy. Radiation therapy (RT) refers to the exposure of tissues to high-energy x-rays in order to slow or stop their growth. Exposure to x-rays damages cells. Unlike normal cells, leukemic cells cannot repair the damage caused by exposure to x-rays, particularly when it is administered over several days. This prevents the leukemic cells from growing further and causes them to eventually die. (See "Initial treatment of chronic lymphocytic leukemia".)

TREATMENT OF ADVANCED OR SYMPTOMATIC CHRONIC LYMPHOCYTIC LEUKEMIA

Chemotherapy — People with advanced or symptomatic chronic lymphocytic leukemia are generally treated first with chemotherapy. Chemotherapy refers to the use of medicines to stop or slow the growth of cancer cells. Chemotherapy works by interfering with the ability of rapidly growing cells (like cancer cells) to divide or multiply. Because most of an adult's normal cells are not actively dividing or multiplying, they are not affected by chemotherapy. However, the bone marrow (where the blood cells are produced), the hair follicles, and the lining of the gastrointestinal (GI) tract are all growing. The side effects of chemotherapy drugs are related to effects on these and other normal tissues.

A chemotherapy drug or combination of drugs is referred to as a regimen. Regimens used for the treatment of follicular lymphoma may include a single agent taken by mouth on a daily basis, while other regimens are given intravenously in treatment cycles.

A cycle of chemotherapy refers to the time it takes to give the drugs and the time required for the body to recover. For example, a typical chemotherapy regimen is at least a one-hour IV infusion of two or more different chemotherapy medications given once every three to four weeks. This three- or four-week period is one cycle of therapy. If this regimen were repeated for a total of three or four cycles, it would take up to four months to complete.

People with advanced or symptomatic chronic lymphocytic leukemia are usually treated with a chemotherapy regimen that contains one or more of these agents:

Fludarabine — Fludarabine is a chemotherapy drug that, when used in combination regimens, can often induce partial or complete remission of chronic lymphocytic leukemia. The most common side effects are low blood counts and fever. Older patients seem to be at higher risk of serious side effects from this medicine, including an increased risk of severe infections. (See 'Infection' below.)
Rituximab — Rituximab is a monoclonal antibody that treats chronic lymphocytic leukemia by attacking specific substances (antigens) on the surface of the leukemic cells. This type of treatment has advantages over other cancer treatments such as chemotherapy, which targets all rapidly growing cells.
Cyclophosphamide (Cytoxan) — Cyclophosphamide is a chemotherapy drug that may be used in combination with other drugs in people with chronic lymphocytic leukemia. It can be given by mouth or through an intravenous (IV) line. Side effects include low blood counts, nausea and vomiting, hair loss, and irritation of the bladder.
Alemtuzumab — Alemtuzumab is a monoclonal antibody that can be used to treat CLL by attacking specific substances (antigens) on the surface of leukemic cells. The antigens targeted by alemtuzumab are different from those targeted by rituximab.
Bendamustine — Bendamustine may be given by itself or in combination with rituximab as an initial treatment of advanced or symptomatic CLL, as well as in previously treated CLL patients.
Chlorambucil — Chlorambucil was the primary agent used to treat CLL for decades prior to studies that demonstrated greater tumor shrinkage yet similar survival rates with fludarabine treatment. Chlorambucil may still be an appropriate initial treatment for some patients.
First line treatment — There is no agreed upon standard treatment regimen for symptomatic chronic lymphocytic leukemia. Experts in the field use different treatment approaches. Because experts are not sure which regimen is most effective, all patients with advanced or symptomatic chronic lymphocytic leukemia are advised to enroll in a clinical trial, if possible. (See 'Clinical trials' below.)

The combination of fludarabine and rituximab, sometimes with cyclophosphamide, is often used as a first-line treatment of advanced or symptomatic chronic lymphocytic leukemia [3]. Overall survival rates appear to be the same with these two regimens, but response rates are higher with the combination of fludarabine, cyclophosphamide, rituximab (FCR) while toxicity is lower with fludarabine and rituximab (FR). Complete remission rates of approximately 47 and 70 percent are seen in patients treated with FR or FCR, respectively [4]. Complete remission means that, for three months after treatment ends, the person has no signs or symptoms of their disease.

Other physicians may recommend treatment with alemtuzumab, bendamustine, or chlorambucil. Neither alemtuzumab nor bendamustine have been directly compared to fludarabine in trials therefore it is difficult to know which may be more effective. The choice between treatment regimens is an individual-based decision made by balancing patient characteristics and drug side effects.

Duration of treatment — Treatment with FCR or FR is usually given every day for five days, followed by no treatment for 23 days. Typically, six cycles of this treatment are given. However, treatment may be stopped sooner if:

Symptoms do not improve
Intolerable side effects develop

TREATMENT OF RELAPSED OR REFRACTORY CHRONIC LYMPHOCYTIC LEUKEMIA

Most people with chronic lymphocytic leukemia who undergo chemotherapy treatment respond initially, but then develop relapsed disease at some point after treatment ends. A small number of patients do not respond to chemotherapy at all; this is called refractory disease. (See "Treatment of relapsed or refractory chronic lymphocytic leukemia".)

Relapsed — If relapse occurs six or more months after treatment ends, it is often possible to successfully use the same chemotherapy regimen again or use another chemotherapy treatment. (See 'Chemotherapy' above.)

Refractory — If a person's disease is refractory or relapses sooner than six months after treatment ends, the options for treatment are limited. Depending upon the individual's situation, the following options should be discussed with a physician:

Participation in a clinical trial
Hematopoietic stem cell (also called bone marrow) transplantation
Treatment with alternate chemotherapy regimens
Treatment to reduce chronic lymphocytic leukemia-related symptoms and complications

Removal of the spleen — A number of people with chronic lymphocytic leukemia will develop a very enlarged spleen. While this often responds to treatment with chemotherapy or radiation, removal of the spleen is more likely to provide longer lasting benefits, including increases in red blood cell and platelet counts [5].

Bone marrow transplantation — Bone marrow transplantation (also called hematopoietic cell transplantation) is being more seriously considered as a therapy for CLL, especially for patients under age 55. If bone marrow transplantation is performed, it is usually done after treatment with chemotherapy. Giving chemotherapy often induces a complete or partial remission. (See "Hematopoietic cell transplantation in chronic lymphocytic leukemia".)

Bone marrow transplantation is a treatment in which the patient is given high doses of chemotherapy or radiation. This kills cancer cells but also destroys all normal cells developing in the bone marrow. After the treatment, the patient needs to have a healthy supply of very young blood cells, called stem cells, reintroduced or transplanted. The transplanted cells then reestablish the blood cell production process in the bone marrow. (See "Patient information: Bone marrow transplantation (stem cell transplantation) (Beyond the Basics)".)

There are two main types of stem cell transplant: allogeneic and autologous.

Allogeneic transplant — In allogeneic transplant, the patient is given stem cells from a donor, ideally a brother or sister with a similar genetic make-up. If the patient doesn't have a "matched" sibling, an unrelated person with a partially matched genetic makeup may be used.

Patients who are unable to tolerate high dose chemotherapy may be candidates for a reduced intensity transplant (called a mini-transplant or non-myeloablative transplant) from a relative or a matched unrelated donor, and may achieve long term control of their CLL. Studies using non-myeloablative allogeneic transplants have shown significant promise, even in patients with relatively high risk or refractory disease [6].

Autologous transplant — In autologous transplantation, the patient's own stem cells are removed before the high dose chemotherapy or radiation is given. Because the potential for cure with autologous transplantation is low for people with CLL, it is not usually recommended.

TREATMENT OF CHRONIC LYMPHOCYTIC LEUKEMIA COMPLICATIONS

The major complications of chronic lymphocytic leukemia are caused by the low blood counts and immune system problems that either arise from the disease itself or the treatment.

Infection — Infection is one of the most serious risks of treatment of chronic lymphocytic leukemia, accounting for approximately 50 percent of deaths. The most common infections affect the upper respiratory tract (sinuses, bronchi).

Infection is often related to low levels of infection fighting proteins called gamma globulins. For this reason, patients who have repeated infections may be treated with intravenous immune globulin (IGIV, IVIG) every three to four weeks to decrease the chance of infection.

Patients treated with certain chemotherapy agents can develop low white blood cell counts, which increases the risk of infections. In some cases, medications that promote the growth of new blood cells may be given to boost the white cell count and decrease the infection risk.

Anemia — Anemia, or low red blood cell counts, is common in chronic lymphocytic leukemia. Red blood cells are needed to carry oxygen to all the cells in the body. Patients with anemia may experience fatigue, weakness, and chest pain. Treatment options include blood transfusion and use of a medicine called erythropoietin, which can boost the red cell count in patients with certain types of anemia. Other forms of anemia may be treated with glucocorticoids (also called steroids).

Low platelet counts — Platelets are important components of the blood's clotting mechanism. Without adequate numbers of platelets, internal and external bleeding can occur. Patients with chronic lymphocytic leukemia and low platelet counts may see their counts improve with treatment of the CLL. In some cases, platelet transfusions are needed. Removal of the spleen or use of steroids or other treatments that suppress the immune response (as part of the treatment for CLL) usually improves the platelet counts.

Psychological aspects — Patients with chronic lymphocytic leukemia are forced to live with the uncertainties associated with a chronic illness. It can be puzzling and frightening to hear that you have leukemia and that no treatment is recommended. You and your healthcare providers must speak frequently and honestly to deal with any fears and clarify any misunderstandings about this sometimes confusing disease. Some patients and families benefit from psychological counseling to help them cope with the strong emotions that can accompany this diagnosis.

CLINICAL TRIALS

Many patients with leukemia will be asked about enrolling in a clinical (research) trial. A clinical trial is a carefully controlled way to study the effectiveness of new treatments or new combinations of known therapies. Ask your doctor for more information, or read about clinical trials at:

WHERE TO GET MORE INFORMATION

Your healthcare provider is the best source of information for questions and concerns related to your medical problem.

This article will be updated as needed on our web site (www.uptodate.com/patients). Related topics for patients, as well as selected articles written for healthcare professionals, are also available. Some of the most relevant are listed below.

Patient level information — UpToDate offers two types of patient education materials.

The Basics — The Basics patient education pieces answer the four or five key questions a patient might have about a given condition. These articles are best for patients who want a general overview and who prefer short, easy-to-read materials.

Patient information: Leukemia (The Basics)

Patient information: Chronic lymphocytic leukemia (CLL) (The Basics)

Beyond the Basics — Beyond the Basics patient education pieces are longer, more sophisticated, and more detailed. These articles are best for patients who want in-depth information and are comfortable with some medical jargon.

Patient information: Bone marrow transplantation (stem cell transplantation) (Beyond the Basics)

Professional level information — Professional level articles are designed to keep doctors and other health professionals up-to-date on the latest medical findings. These articles are thorough, long, and complex, and they contain multiple references to the research on which they are based. Professional level articles are best for people who are comfortable with a lot of medical terminology and who want to read the same materials their doctors are reading.

Classification of the hematopoietic neoplasms

Epidemiology and clinical manifestations of chronic lymphocytic leukemia

Clinical manifestations, pathologic features, and diagnosis of small lymphocytic lymphoma

Evaluating response to treatment of chronic lymphocytic leukemia

Hematopoietic cell transplantation in chronic lymphocytic leukemia

Initial treatment of chronic lymphocytic leukemia

Overview of infectious complications following purine analog therapy

Overview of the complications of chronic lymphocytic leukemia

Pathologic features, diagnosis, and differential diagnosis of chronic lymphocytic leukemia

Pathophysiology and genetic features of chronic lymphocytic leukemia

Randomized clinical trials of chemotherapy in chronic lymphocytic leukemia

Staging and prognosis of chronic lymphocytic leukemia

Treatment of relapsed or refractory chronic lymphocytic leukemia

The following organizations also provide reliable health information.

National Library of Medicine

(www.nlm.nih.gov/medlineplus/healthtopics.html)

National Cancer Institute

(www.cancer.gov/cancertopics/pdq/treatment/CLL/patient/)

American Cancer Society

(http://www.cancer.org)

The Leukemia & Lymphoma Society

(www.leukemia-lymphoma.org)

National Marrow Donor Program

(www.marrow.org)

The American Society of Clinical Oncology

(www.cancer.net/portal/site/patient)

Eastern Cooperative Oncology Group

(http://ecog.dfci.harvard.edu/general/intro.html)

Southwest Oncology Group

(www.swog.org/Patients/Index.asp)
[1-6]

Literature review current through: 20.3: ene 2012

This topic last updated: nov 30, 2011

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The content on the UpToDate website is not intended nor recommended as a substitute for medical advice, diagnosis, or treatment. Always seek the advice of your own physician or other qualified health care professional regarding any medical questions or conditions. The use of this website is governed by the UpToDate Terms of Use (click here) ©2012 UpToDate, Inc.

References

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Treating Arrhythmias in Children

Treating Arrhythmias in Children

Many options are available to treat rhythm abnormalities in children. Most treatment is directed at a specific problem. A detailed discussion of all the options isn't possible here.

Medications
Many rhythm disorders, especially tachycardias, respond to medications. Several drugs are now available and more are being developed. These drugs can't cure the arrhythmia, but they can improve symptoms. They do this by preventing the episodes from starting, decreasing the heart rate during the episode or shortening how long the episode lasts.

Sometimes it's hard to find the best medication for a child. Several drugs may need to be tried before the right one is found. Some children must take medication every day; others need medications only when they have a tachycardia episode. It's very important to take the medication as prescribed.

All medications have side effects, including drugs to treat arrhythmias. Most of the side effects aren't serious and disappear when the dose is changed or the medication is stopped. But some side effects are very serious. That's why some children are admitted to the hospital to begin the medication. If your child is prescribed medication, it's very important that your child take the medication just the way the doctor prescribes it.

It's often necessary to monitor how much of a drug is in your child's blood. The goal is to make sure there's enough of the drug to be effective, but not so much that harmful side effects occur. These blood tests require taking a small amount of blood from a vein or the finger. It's a good idea to talk to your child about this before the doctor visit.

Other treatments Radiofrequency ablation — Some tachycardias are life-threatening or significantly interfere with a child's normal activities. These problems may warrant more permanent treatment. One procedure, called radiofrequency catheter ablation, is done with several catheters in the heart. One is positioned right over the area that's causing the tachycardia. Then its tip is heated and that small area of the heart is altered so electrical current won't pass through the tissue.

Surgery — Sometimes surgery that interrupts the abnormal connection in the heart is required to permanently stop the tachycardia.

Artificial pacemaker — A variety of rhythm disorders can be controlled with an artificial pacemaker. Slow heart rates, such as heart block, are the most common reason to use a pacemaker. But new technology now lets doctors treat some fast heart rates with a pacemaker, too. An artificial pacemaker is a small device (1 to 2 ounces, 1.5 by 1.5 inches). It's put inside the body and connected to the heart with a thin wire. It works by sending small, painless amounts of electricity to the heart to make it beat.

Inserting a pacemaker is a simple operation. The wires are attached to the heart, and the pacemaker is placed in the abdomen (belly) or under the skin of the chest wall. Sometimes only one wire is attached to the heart. In other cases two wires are used. Many different models and brands of pacemakers exist. Some can sense when your child is active and increase the heart's beating to keep up with exercise.

If your child has a pacemaker, he or she will need regular checkups. It's important to check the pacemaker's battery and make sure the wires are working properly. Pacemaker batteries usually last for years, but the pacemaker will still need to be replaced periodically throughout the user's lifetime. Sometimes the wires also need to be replaced. Regular checkups can show if anything needs replacing.

Most children with pacemakers can engage in normal activities. Your doctor may advise against participating in some contact sports, however. Talk to your child's cardiologist about this.
Learn more about living with a pacemaker
Download a pacemaker ID card

Checklist for Parents of Children with Arrhythmias

Learn CPR and emergency procedures

Parents of all children should learn CPR and how to reduce the risk of injuries and sudden infant death syndrome (SIDS). This information is available with all American Heart Association child and infant CPR courses.
Learn the new 2010 CPR Guidelines
Get an American Heart Association CPR Anytime Personal Learning Program
Find an Emergency Cardiovascular Care class near you

CPR skills, including recognition of signs of breathing difficulties and cardiac arrest, are particularly important if a child has heart disease and is at risk for sudden arrhythmias including sudden death.

Parents should know what to do if their child suddenly collapses and becomes unresponsive. If a child under 8 years old is found unresponsive, the typical sequence of actions for a lone rescuer includes performing about one minute of CPR, then phoning 9-1-1 or other emergency medical services (EMS) number (CPR first, phone fast). The reason for this sequence is that most children who suffer cardiopulmonary arrest have breathing problems and need prompt rescue breathing with other steps of CPR.

However, when a parent is alone with the child with heart disease and that child collapses suddenly, the likely cause of the collapse is sudden cardiac arrest. In this case, the parent should phone 9-1-1 first, then begin CPR (phone first, then CPR).

Learn about Cardiac Arrest in Children: Special Consideration.

Learn to check your child's heart rate

Understand and manage medications

Learn to slow your child's heart rate

Understand and manage your child's pacemaker

Know what to avoid

New Flu Discovered in Guatemalan Fruit Bats: MedlinePlus

MedlinePlus Trusted Health Information for You

New Flu Discovered in Guatemalan Fruit Bats

Virus not a current threat, but should be monitored as a potential source of human illness, experts say

URL of this page: http://www.nlm.nih.gov/medlineplus/news/fullstory_122392.html (*this news item will not be available after 05/28/2012)

By Mary Elizabeth Dallas

Tuesday, February 28, 2012

Related MedlinePlus Pages

TUESDAY, Feb. 28 (HealthDay News) -- A new influenza A virus has been discovered in Guatemalan fruit bats, according to scientists at the U.S. Centers for Disease Control and Prevention.
Although the bat flu does not currently pose a threat to humans, the CDC team cautioned that more research is needed to determine if the virus could be a possible source of human flu.
"This is the first time an influenza virus has been identified in bats, but in its current form the virus is not a human health issue," study lead author Dr. Suxiang Tong, team leader of the Pathogen Discovery Program in the CDC's viral diseases division, said in a CDC news release. "The study is important because the research has identified a new animal species that may act as a source of flu viruses."
For the bat flu to affect humans, the investigators pointed out that it would have to swap genetic information with another flu virus, giving it some genetic properties of a human flu virus. This process, called reassortment, could potentially lead to a new flu capable of infecting humans.
The CDC study, published online Feb. 27 in the Proceedings of the National Academy of Sciences, noted that some initial research revealed that the bat flu genes are compatible with human flu viruses.
"Fortunately, initial laboratory testing suggests the new virus would need to undergo significant changes to become capable of infecting and spreading easily among humans," study co-author Dr. Ruben Donis, chief of the Molecular Virology and Vaccines Branch in the CDC's influenza division, explained in the news release. "A different animal -- such as a pig, horse or dog -- would need to be capable of being infected with both this new bat influenza virus and human influenza viruses for reassortment to occur."
The CDC said it is working with global disease experts to track animal flu viruses that could potentially affect people, such as H1N1, which caused a pandemic in 2009.

SOURCE: U.S. Centers for Disease Control and Prevention, news release, Feb. 27, 2012

HealthDay

More Health News on:: Flu

New Flu Discovered in Guatemalan Fruit Bats: MedlinePlus

BPA Exposure May Raise Risk of Heart Disease: MedlinePlus

BPA Exposure May Raise Risk of Heart Disease

People might come into contact with bispehnol A through packaged foods, drinking water, dental sealants

URL of this page: http://www.nlm.nih.gov/medlineplus/news/fullstory_122396.html (*this news item will not be available after 05/28/2012)

By Mary Elizabeth Dallas

Tuesday, February 28, 2012

Related MedlinePlus Pages

TUESDAY, Feb. 28 (HealthDay News) -- Exposure to bisphenol A (BPA), a controversial chemical commonly used to make plastics, increases a person's risk of developing heart disease later in life, a new study suggests.
People primarily are exposed to BPA through packaged foods and drinks, but also may be exposed through drinking water, dental sealants and inhaling household dust.
Over a 10-year period, researchers compared BPA levels in 758 people who were initially healthy but later developed heart disease to levels in 861 people who did not develop the disease. These subjects were part of a long-term population study led by the University of Cambridge, in the U.K.
The study found that the subjects who developed heart disease had higher levels of the chemical in their urine at the start of the study than those who did not develop the disease.
The researchers, from the Peninsula College of Medicine and Dentistry, the University of Exeter and the European Centre for the Environment and Human Health, noted the findings are limited because only one urine sample from each participant was available at the beginning of the 10-year period.
Although the study, published online Feb. 21 in the journal Circulation, shows an association between BPA and increased heart disease risk, it doesn't prove a cause-and-effect relationship, the researchers pointed out.
"This study strengthens the statistical link between BPA and heart disease, but we can't be certain that BPA itself is responsible," study leader David Melzer, a professor at Peninsula Medical School, said in a news release. "It is now important that government agencies organize drug-style safety trials of BPA in humans, [with] as much basic information about how BPA behaves in the human body is still unknown."

SOURCE: Peninsula College of Medicine and Dentistry, news release, Feb. 23, 2012

HealthDay

More Health News on:: Environmental Health; Heart Diseases

Many Gaps in Fast-Food Nutrition Information: MedlinePlus

Many Gaps in Fast-Food Nutrition Information

Calories can be hard to figure when menu items are meant to serve more than one, researchers say

URL of this page: http://www.nlm.nih.gov/medlineplus/news/fullstory_122399.html (*this news item will not be available after 05/28/2012)

By Robert Preidt

Tuesday, February 28, 2012

Related MedlinePlus Page

Nutrition

TUESDAY, Feb. 28 (HealthDay News) -- Even when fast-food restaurants list calorie counts for menu items, diners may still have a hard time using the information to make healthy meal choices, researchers report.
In the study, the scientists examined the calorie listings for 200 food items on menu boards from 12 restaurant chains in the New York City neighborhood of Harlem.
Too often, calorie counts were listed for combo meals or meals intended to serve multiple people, or had wide ranges in what the calorie count might be.
For example, a bucket of chicken was listed as having 3,240 to 12,360 calories, but the menu board did not provide enough information for consumers to determine the number of pieces of chicken in a serving size.
A listing for a sandwich combo meal said it ranged from 500 to 2,080 calories. However, no information was provided on how to order within the lower range of this menu item.
Under federal law, restaurants with 20 or more locations must provide calorie data and additional nutritional information for menu items and self-serve foods. Although the calorie information complied with U.S. labeling rules, consumers may have a tough time making sense of much of it, the study found.
"Menu postings for individual servings are easily understood, but complex math skills are needed to interpret meals designed to serve more than one person," wrote study author Elizabeth Gross Cohn, an assistant professor at the Columbia University School of Nursing, and colleagues. "In some items, calories doubled depending on flavor, and the calorie posting did not give enough information to make healthier selections."
Researchers suggested that calorie listings should do more than merely comply, but take into account what level of "math literacy" is needed to make use of the information. In a revised system, a breakfast sandwich, for example, would be listed as, "Egg with ham/bacon/sausage: 350/550/750," so consumers could know exactly how many calories various options would add.
"In low-income communities with a high density of chain restaurants, and where educational attainment of consumers may be low, simplifying calorie postings and minimizing the math required to calculate calories would increase menu-board utility," the researchers wrote.
The study was published online Feb. 16 in the Journal of Urban Health.

SOURCE: Columbia University Medical Center, news release, Feb. 23, 2012

HealthDay

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Statin use tied to lower risk of depression: study: MedlinePlus

Statin use tied to lower risk of depression: study

URL of this page: http://www.nlm.nih.gov/medlineplus/news/fullstory_122416.html (*this news item will not be available after 05/28/2012)

Tuesday, February 28, 2012

Related MedlinePlus Pages

By Kerry Grens
NEW YORK (Reuters Health) - People with heart disease who take cholesterol-lowering statins may have a lower risk of depression than those who don't take the drugs, according to a new study from California.
It's still not clear whether the popular medications have anything to do with the brighter mood among users. But the results do support the hypothesis that clogged-up blood vessels in the brain could play a role in depression, said Dr. Christian Otte.
"It is possible that statins exert beneficial effects on depressive symptoms through protective effects on cerebrovascular processes," Otte, of the Charité University Medical Center in Berlin, told Reuters Health by email.
Statins are some of the most widely used drugs worldwide. Between 2005 and 2008, a quarter of U.S. adults over 45 took the drugs, according to the National Center for Health Statistics.
While the drugs are generally considered safe, the U.S. Food and Drug Administration on Tuesday released a warning linking them to a slightly increased risk of diabetes and memory loss.
There have also been rare cases of liver and muscle damage related to statins.
To find out if the medications could have an effect on depression, Otte's group, which published its finding in the Journal of Clinical Psychiatry, tracked 965 people in California for several years. All of the participants had suffered a heart attack or had other signs of heart disease.
At the beginning of the study, 65 percent of the people were taking a statin, such as Lipitor, Crestor or Zocor.
Based on questionnaires about their mental health, 17 percent of statin users screened positive for depression at the beginning of the study compared to 24 percent of people not on the drugs.
Among those who had no mood problems initially, 18 percent of statin users and 28 percent of nonusers became depressed at some point over the six year study.
"I'm not surprised at these findings," said Dr. Charles Blatt of the Lown Cardiovascular Center in Brookline, Massachusetts, who was not involved in the new work.
In a smaller study from 2003, he found a similar link between statin use and lower rates of depression.
"It may point to the fact that this might not be an epiphenomenon, but biologically relevant," Blatt told Reuters Health.
But that's not at all clear, according to Susan Jick, a professor at Boston University School of Public Health, who wasn't linked to the study.
She pointed out that the researchers didn't track the medicine people took over time, meaning they couldn't tell who stopped or began taking statins. Statin users also had a lower risk of depression to begin with, and were less likely to be poor, have a history of depression or smoke.
"All of these things alone could explain the result," Jick told Reuters Health by email.
Although it's never possible to account for all possible differences, Otte countered that his team had ruled out several likely explanations.
Otte, who sits on the speakers board of several pharmaceutical companies, said future studies should look at statins and depression in other patient groups, especially those with risk factors for heart disease that aren't thought to require cholesterol-lowering medications.
Blatt said it's possible statins may also influence depression indirectly.
"We live in such a cholesterol-phobic nation, and if you have something that lowers your cholesterol, you feel better," he told Reuters Health.
But he added that the new study doesn't mean depression should be treated with statins.
"It's always nice to see a long-term study with more people in it wind up with a similar effect and scale of effect (as our study), but I'm not sure this really rocks the boat or changes our approach very much," he said.
SOURCE: http://bit.ly/zq7Y5s Journal of Clinical Psychiatry, online February 21, 2012.

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Selenium Supplements May Help -- or Harm: MedlinePlus

Selenium Supplements May Help -- or Harm

Too much or too little of the mineral can hurt your health, evidence review finds

URL of this page: http://www.nlm.nih.gov/medlineplus/news/fullstory_122401.html (*this news item will not be available after 05/28/2012)

Tuesday, February 28, 2012

Related MedlinePlus Page

Minerals

TUESDAY, Feb. 28 (HealthDay News) -- While getting the right amount of selenium in your diet can boost your immune function and lower your risk of death, you can get too much of a good thing. Higher-than-normal levels of selenium may contribute to the development of type 2 diabetes, hair loss and certain cancers, a new review of evidence finds.
"There is a U-shaped relationship between selenium intake and health. As selenium intake goes up from a low value, health improves until the bottom of the U-shaped curve is reached, but then adverse -- or even toxic -- effects begin to be seen," said Margaret Rayman, the author of the review of selenium research, and a professor of nutritional medicine at the University of Surrey, in England.
Selenium is a mineral found in a variety of foods. The amount of selenium in foods depends largely on where you live, as the selenium content in the soil varies. Selenium enters the food chain through plants, Rayman said. And, when animals consume the plants, they also consume selenium. Common sources of selenium include Brazil nuts, fish, poultry and wheat. Selenium is also available in supplement form.
Intake of selenium is high in Venezuela, Canada, the United States and Japan, according to background information in Rayman's review, while it's lower in Europe and some areas of China.
The average daily intake recommendations for selenium are 60 micrograms per day for men and 53 micrograms per day for women, according to the research.
For the study, Rayman searched medical literature to find previously completed studies on selenium. The results of that review appear online Feb. 29 in The Lancet.
Rayman found that daily intake of selenium varied from as little as 7 micrograms per day to as much as 4,990 micrograms per day. In Europe, the average intake was 40 micrograms per day, and in the United States, the average daily intake was 93 micrograms for women and 134 micrograms for men. Selenium supplements are likely part of this intake, Rayman said. That may be especially true in the United States where about half the population takes dietary supplements. Selenium is often found in multivitamins.
Rayman found several studies linking low selenium intake to a higher risk of dying from all causes as well as from cancer.
There's also some evidence that selenium levels can affect immune system function. Rayman found studies that suggest that selenium supplementation decreased hospital admissions due to infection for people who have HIV.
Selenium also plays an important role in brain function, according to the review. In a study of adults older than 65, performance assessments of coordination were worse in people who had low selenium levels. There was also an increased incidence of Parkinson's disease in people with low selenium. Too little selenium may also increase the risk of dementia, the review found.
"Low selenium status has been associated with higher risk of mortality, poorer immune function and cognitive [brain] decline," Rayman said. "Increasing selenium intake can help our ability to handle viruses, increase successful male and female reproduction, and reduce the risk of autoimmune thyroid disease. There is also some evidence that selenium may reduce the risk of cancer."
But, higher levels of selenium don't come without risk. People with the highest levels of selenium intake may have a greater risk of type 2 diabetes, non-melanoma skin cancers, hair loss and skin rashes, according to Rayman.
A supplement industry spokesman weighed in on the findings.
"There are many established benefits of selenium, and if you don't get adequate intake, you may be forgoing those benefits. There's a small amount of evidence that too much of anything may have a risk, but there's a U-shaped curve, which means with too little, there are clear risks," said Duffy MacKay, vice president of scientific and regulatory affairs for the Council for Responsible Nutrition.
MacKay noted that Americans likely have normal or higher levels of selenium because they take supplements. "I wouldn't want these results to be interpreted to mean that people should stop taking supplements," he said.
So, how can you be sure you're getting adequate levels without getting too much? One way is to get a blood test to assess your current selenium levels.
However, if you don't get a blood test, Rayman said, "One can be fairly confident that in North America, additional selenium isn't needed, but the same may well not be true in Europe."
Rayman said that people generally don't need to be concerned about the amount of selenium in their diets. The only food that might provide higher-than-recommended amounts when consumed frequently is Brazil nuts, she said.

SOURCES: Margaret Rayman, Ph.D., professor of nutritional medicine, University of Surrey, Guildford, U.K.; Duffy MacKay, N.D., vice president, scientific and regulatory affairs, Council for Responsible Nutrition, Washington, D.C.; Feb. 29, 2012, The Lancet, online

HealthDay

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Family tree may clarify death risk for inherited heart rhythm disorders / American Heart Association

Family tree may clarify death risk for inherited heart rhythm disorders

February 28, 2012

Study Highlights:

By reconstructing family trees dating back to 1811, Dutch researchers have estimated the death risk for people with inherited abnormal heart rhythms.
Doctors can use this information to determine when to screen and treat patients with these syndromes and their relatives.

EMBARGOED UNTIL 3 p.m. CT/4 p.m. ET, Tuesday, Feb. 28

DALLAS, Feb. 28, 2012 ― Reconstructing family trees dating back to 1811, Dutch researchers have estimated the death risk for people with inherited heart rhythm disorders, according to a study in Circulation: Cardiovascular Genetics, a journal of the American Heart Association.

Heart rhythm disorders can result in sudden cardiac death in apparently healthy people because of severe disturbances in the rhythm of the heart. The risk is high for people who carry one of these rare genes and have symptoms such as fainting.

Before the study, the risk in people without symptoms was less certain. Thus, physicians developed preventive measures ― including medications and implanted devices that can cause side effects ― without a clear idea of the death risk.

With greater use of genetic testing for the relatives of people with one of the disorders, questions about how and when to treat people without symptoms now arises frequently.

Using Dutch archives, the researchers reconstructed family trees for patients with different conditions and compared death statistics in 266 people who carried a mutation in a gene linked with arrhythmia, 904 family members with a 50 percent chance of having the mutation, and the general population.

Researchers identified age ranges during which the risk of death increased for people who had the mutations (and their family members) but had not yet been diagnosed or treated for the condition.

“This information can help doctors know when to treat and screen families with arrhythmia syndromes caused by different gene mutations,” said Eline A. Nannenberg, M.D., lead researcher of the study and a clinical geneticist at the Academic Medical Centre in Amsterdam, The Netherlands.

The mutations studied are rare in the population; however, if a person carries one, their children have a 50 percent chance of inheriting it.

Among the researchers’ findings:

In long QT syndrome, a condition related to sudden infant death syndrome, death risk was high throughout childhood (1-19 years old), but particularly in the first 10 years of life for one mutation (LQTS1). For two other mutations that cause this syndrome (LQTS2 and LQTS3), the risk of death doesn’t become significantly increased until the teen years or adulthood.
For SCN5a-overlap syndrome, in which the SCN5A gene mutation affects the way heart cells respond to the heart’s internal electrical current, deaths start to increase at age 5 and become a significant risk between ages 10-59, with a peak between ages 20-39.
For catecholaminergic polymorphic ventricular tachycardia (CPVT), a condition that causes fainting often during exercise or strong emotions, death risk was highest from ages 20-39.
In Brugada syndrome, which causes fainting and a rapid heart rhythm that can lead to sudden cardiac death, excess deaths occurred between ages 40-59 and were primarily in males.

“We have to be careful not to draw conclusions for families with arrhythmias caused by different mutations,” Nannenberg said. “However, this new data can guide screening. In LQTS1, we advise starting genetic and heart screening of first-degree family members (children, siblings, parents) at a very young age.”

In contrast, in Brugada syndrome, females without symptoms may not need invasive treatment for the first three decades, but should follow standard prevention measures, such as fighting fever.

In SCN5a-overlap syndrome, implantation of a pacemaker or ICD may be postponed until after age 5, researchers said.

Co-authors are: Eric J.G. Sijbrands, M.D., Ph.D.; Lea M. Dijksman, M.Sc.; Marielle Alders, Ph.D.; J. Peter van Tintelen, M.D., Ph.D.; Martijn Birnie, M.Sc.; Irene M. van Langen, M.D. Ph.D.; and Arthur A.M. Wilde, M.D., Ph.D.

Author disclosures and funding sources are on the manuscript.

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Statements and conclusions of study authors published in American Heart Association scientific journals are solely those of the study authors and do not necessarily reflect the association’s policy or position. The association makes no representation or guarantee as to their accuracy or reliability. The association receives funding primarily from individuals; foundations and corporations (including pharmaceutical, device manufacturers and other companies) also make donations and fund specific association programs and events. The association has strict policies to prevent these relationships from influencing the science content. Revenues from pharmaceutical and device corporations are available at www.heart.org/corporatefunding External link