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Kids with autism face other health problems

April 26, 2017, 12:55 PM

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Opioid-related deaths may be underestimated

America’s prescription drug abuse epidemic may be even more deadly than expected, a new report from the U.S. Centers for Disease Control and Prevention suggests.

Some opioid-related deaths may be missed when people die from pneumonia and other infectious diseases spurred on by drug abuse. Their death certificates may only list the infection as the cause of their demise, explained CDC field officer Victoria Hall.

That means a number of drug-related deaths are not being counted, since surveillance systems mainly track overdose deaths .

“It does seem like it is almost an iceberg of an epidemic,” Hall said. “We already know that it’s bad, and while my research can’t speak to what percent we are underestimating, we know we are missing some cases.”

More than half of a series of drug-related unexplained deaths in Minnesota between 2006 and 2015 listed pneumonia as the cause of death, Hall and her colleagues found.

Twenty-two of these 59 unexplained drug-related deaths involved toxic levels of opioids. But the death certificates didn’t include coding that would be picked up by statewide opioid surveillance systems.

“We found if you have really profound infectious disease, like really bad pneumonia, that may be the only thing written on the death certificate. And thus it’s not going to get picked up in opioid surveillance,” Hall said.

Opioids killed more than 33,000 people in the United States 2015. That’s close to as many deaths caused by traffic crashes that same year, according to federal statistics. Nearly half of all opioid overdose deaths involved a prescription drug.

This spring, the Minnesota Department of Health learned of a middle-aged man who died suddenly at home, Hall said. Two days earlier, he’d seemed ill and was slurring his words, but refused his family’s pleas to go to the hospital.

“He was on long-term opioid therapy for some back pain, and his family was a little bit concerned he was abusing his medications,” Hall said.

Testing revealed that he died of pneumonia brought on by the flu, “but also detected a very toxic level of opioids in his system,” Hall said.

“However, on the death certificate it only listed the pneumonia, and it listed no mention of opioids, so this death wasn’t counted in the state opioid death surveillance system,” she said.

Opioid medications -- codeine, hydrocodone (including Vicoprofen), oxycodone (Oxycontin, Percocet), morphine and others -- can help bring on dangerous respiratory infections or make them even worse, Hall said.

“Opioids at therapeutic or higher than therapeutic levels can impact our immune system, actually make your immune system less effective at fighting off illness,” Hall explained.

The sedative effect of opioids also affects a person’s respiratory system, causing breathing to become slow and shallow, and making the person less prone to cough, Hall said -- “making it easier for something like a pneumonia to really set in.”

A review of Minnesota’s unexplained death database revealed 59 cases with evidence of opioid use. Of those, 22 cases had not been reported to statewide opioid

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Dental clinic reopens after bacterial outbreaks

ANAHEIM, Calif. -- A children’s dental clinic that closed two times due to multiple bacterial infections has reopened in Southern California, CBS Los Angeles reports . Dozens of children were hospitalized due to confirmed or suspected contaminants from the clinic last year.

According to the Orange County Health Care Agency, baby root canals will now be done at the Children’s Dental Group with sterile, bottled water rather than tap water.

Authorities say bacteria was found in the clinic’s water supply twice last year.  

The clinic  was shut down in mid-September , and then again in mid-December, when tests showed bacteria was still in the office’s water system — even though it had been replaced.

Dozens of youngsters were affected by the outbreaks.

According to the Orange County Health Care Agency, 22 cases have been confirmed at this time. Forty-six other patients have been listed as probable. The ages of the affected patients range from 2 to 11 years old.

Health officials say each child was hospitalized at some point. All of the cases were reported between Feb. 4 through Aug. 26 of last year.

“We were really upset, that’s when I became involved, to make sure it got fixed,” said father Fernando Rocha, whose daughter got a serious infection following a root canal.

He said he will never take his daughter to the clinic again.

“No way, it’s just the staff, they just seemed more preoccupied with helping the dentists and the corporation versus kids.”

Children’s Dental Group CEO Sam Gruenbaum told CBS News that the investigation into how the kids got sick continues.

“I don’t think it was,” Gruenbaum responded when asked if he thought the bacterial outbreak was the clinic’s fault.

Mike Lyster, a spokesman for the city of Anaheim, insists that the problem was isolated to the clinic and that the city’s water supply is perfectly safe.

“If there would have been an issue with water contamination coming into the building, none of these businesses would be open here,” Lyster said.

Lyster says the city checks the safety of its water supply thousands of times per year.

In a statement posted on the clinic’s website, Dr. Jerry Minsky, chief dental officer of the Children’s Dental Group, wrote in part: “The health and well-being of our patients remain our top priorities. As always, we will provide them with high quality care in a comfortable, safe, child-friendly environment, and do all that we can to ensure their wellness.”

“We have met all the conditions of the Orange County Health Care Agency’s December 2016 order,” he continued. 

After multiple evaluations from regulatory agencies, Minsky said the clinic has “extraordinary infection control, sterilization, and safety practices — well beyond those required by dental industry standards.”

Attorney Ed Susolik, whose firm represents a 6-year-old boy who lost much of his lower jaw to an infection, said that “we certainly hope they will have made the necessary changes to ensure the safety of the children and other patients.”

The clinic is facing

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Artificial womb for baby lamb raises hope for preemies

Researchers are creating an artificial womb to improve care for extremely premature babies . Remarkable animal testing suggests the first-of-its-kind incubator so closely mimics a human woman that it just might work.

Today, premature infants weighing as little as a pound are hooked to ventilators and other machines inside incubators. Children’s Hospital of Philadelphia is aiming for a gentler solution, to give the tiniest preemies a few more weeks cocooned in a womb-like environment. Their aim is to treat the baby more like a growing fetus than a newborn with the hope of giving a better chance of healthy survival.

The researchers created a fluid-filled transparent container to simulate how a fetus floats in amniotic fluid inside a mother’s uterus . Attached to it is a mechanical placenta that keeps blood in the artificial womb oxygenated.

artifical-womblamb-illustration.jpg

An illustration of the fluid-filled incubation system mimics a mother’s womb. The bag is filled with a substitute for amniotic fluid, while a machine attached to the umbilical cord supplies oxygen to the blood.

Children's Hospital of Philadelphia via AP

In early-stage animal testing, extremely premature lambs grew, apparently normally, inside the system for three to four weeks, the team reported Tuesday.

“We start with a tiny fetus that is pretty inert and spends most of its time sleeping. Over four weeks we see that fetus open its eyes, grow wool, breathe, swim,” said Dr. Emily Partridge, a CHOP research fellow and first author of the study published in  Nature Communications  .

“It’s hard to describe actually how uniquely awe-inspiring it is to see,” Partridge said.

Human testing still is three to five years away, but the team already is in discussions with the Food and Drug Administration.

“We’re trying to extend normal gestation,” said Dr. Alan Flake, a fetal surgeon at CHOP who is leading the project and considers it a temporary bridge between the mother’s womb and the outside world.

Increasingly, hospitals attempt to save the most critically premature infants, those born before 26 weeks gestation and even those right at the limits of viability — 22 to 23 weeks. Extreme prematurity is a leading cause of infant mortality, and those who do survive frequently have serious disabilities such as cerebral palsy.

The idea of treating preemies in fluid-filled incubators may sound strange, but physiologically it makes sense, said Dr. Catherine Spong, a fetal medicine specialist at the National Institutes of Health.

“This is really an innovative, promising first step,” said Spong, who wasn’t involved with the research.

One of the biggest risks for very young preemies is that their lungs aren’t ready to breathe air, she explained. Before birth, amniotic fluid flows into their lungs, bringing growth factors crucial for proper lung development. When they’re born too soon, doctors hook preemies to ventilators to keep them alive but it risks lifelong lung damage.

Flake’s goal is for the womb-like system to support the very youngest preemies just for a few weeks, until their organs are mature enough to better handle regular

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Common nutrient may play role in heart issues

A nutrient in meat and eggs may conspire with gut bacteria to make the blood more prone to clotting, a small study suggests.

The nutrient is called choline. Researchers found that when they gave 18 healthy volunteers choline supplements, it boosted their production of a chemical called TMAO.

That, in turn, increased their blood cells’ tendency to clot. But the researchers also found that aspirin might reduce that risk.

TMAO is short for trimethylamine N-oxide. It’s produced when gut bacteria digest choline and certain other substances.

Past studies have linked higher TMAO levels in the blood to heightened risks of blood clots, heart attack and stroke , said Dr. Stanley Hazen, the senior researcher on the new study.

These findings, he said, give the first direct evidence that choline revs up TMAO production in the human gut, which then makes platelets (a type of blood cell) more prone to sticking together.

Choline is found in a range of foods, but it’s most concentrated in animal products such as egg yolks, beef and chicken.

Hazen said he and his colleagues at the Cleveland Clinic wanted to isolate the effects of choline on people’s levels of TMAO and their platelet function. So they studied supplements.

The researchers had 18 healthy adults --10 meat-eaters and eight vegetarians/vegans -- take choline supplements for two months.

The supplements provided around 450 milligrams of choline daily -- roughly the amount in two or three eggs, Hazen said.

One month in, the study found, the supplements had raised participants’ TMAO levels 10-fold, on average. And tests of their blood samples showed that their platelets had become more prone to clotting.

“This study gives us one of the mechanisms by which TMAO may contribute to cardiovascular disease ,” said Dr. J. David Spence.

Spence, who was not involved in the study, directs the Stroke Prevention & Atherosclerosis Research Centre at Western University in London, Ontario, Canada.

For the healthy people in this study, Spence said, the TMAO rise from choline might not be worrisome. But, he added, it might be a concern for people at increased risk of heart disease or stroke.

Spence suggested those individuals limit egg yolks, beef and other foods high in choline.

Hazen had similar advice. “You don’t have to become a vegetarian,” he said. “But you could try eating more plant-based foods, and more vegetarian meals.”

He also pointed to the Mediterranean diet -- rich in olive oil, vegetables and fish . In an earlier study, Hazen said, his team found that a compound in olive oil seems to inhibit TMAO formation.

The new study uncovered yet another compound that may counter TMAO: low-dose aspirin.

In a separate experiment, the researchers had some participants take 85 milligrams of aspirin (a baby aspirin) a day, in addition to choline supplements. That, it turned out, lessened the rise in TMAO and the change in platelet activity.

Doctors already prescribe low-dose aspirin to certain people at risk of heart disease and stroke.

It’s possible, Hazen said,

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