Jewish World Review Nov. 17, 2003 / 22 Mar-Cheshvan, 5764




E. UV lights in the workplace may improve health; E. Coli outbreak associated with a non-food source; early warning symptoms of heart attack in women; Simple test for pre-diabetes

By Robert A. Wascher, M.D., F.A.C.S.

http://www.NewsAndOpinion.com | The current epidemic of obesity in the United States has, not surprisingly, also been accompanied by a rising incidence of diabetes. The rising incidence of obesity in our society is so pervasive that physicians are beginning to see a dramatic upsurge in obesity-related illnesses in children and adolescents, as well. The diagnosis of type II diabetes in adolescents, formerly referred to as adult onset diabetes, is now surprisingly common.

A pre-diabetic condition, termed insulin resistance, is thought to be a serious warning sign that the onset of true diabetes is just around the corner. Insulin resistance occurs when the body's cells no longer respond normally to insulin (insulin stimulates the body's cells to take-up excess sugar from the blood). In full-blown type II diabetes, insulin resistance becomes severe enough to allow blood levels of glucose to rise to dangerously high levels. While not all obese people will develop diabetes (and not all type II diabetics are obese), there is no longer any question but that obesity is the single greatest risk factor for developing type II diabetes. Other obesity-related diseases include cardiovascular disease, high blood pressure, stroke, arthritis, sleep apnea, blood clots and other potentially life-threatening ailments.

A new study in the journal Annals of Internal Medicine looked at 258 overweight volunteers without a history of diabetes. The study sought to identify easily measured blood tests that would reliably identify patients with pre-diabetic insulin resistance (also referred to as the "Metabolic Syndrome"). If patients with insulin resistance could be reliably identified using simple and common laboratory blood tests, then such patients could be singled out for especially rigorous management of their risk factors for diabetes, and before they developed clinical signs of diabetes.

The study determined that three common blood tests accurately identified those overweight patients who had already started to develop insulin resistance, but who had not yet developed type II diabetes. These three tests were: blood triglyceride level, blood insulin level, and the ratio between blood triglyceride and the so-called "good cholesterol" in the blood, HDL. A triglyceride level greater than 130 mg/dl predicted insulin resistance, as did a triglyceride-HDL ratio equal to or greater than 3.0, and a blood insulin level of 109 pmol/L or greater (triglycerides are fat molecules that are absorbed into the blood from the food that we eat, and are particularly abundant in red meat, oils and dairy products). The combination of these three simple blood tests was as accurate in predicting insulin resistance as the current (and far more complicated) clinical standard, the Adult Treatment Panel III. Of course, significant obesity remains the single greatest marker for risk of developing type II diabetes, and both patients and healthcare providers must continue to stress the importance of maintaining a healthy weight through a combination of regular exercise and a well-balanced diet.

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EARLY WARNING SYMPTOMS OF HEART ATTACK IN WOMEN

Women and men may experience different outcomes following heart attacks, based upon previous studies. Several of these studies suggest that women are more likely to die than men following a heart attack. A new study in the journal Circulation also suggests that women may also experience different symptoms than men prior to the onset of a heart attack, as well as at the time of the actual heart attack. The study evaluated 515 women who were diagnosed with an acute myocardial infarction (heart attack). A specialized survey was administered 4 to 6 months after the women were diagnosed with a heart attack.

The survey revealed that 95% of the women had experienced one or more specific symptoms prior to the onset of their heart attacks. The most frequent symptoms experienced more than one month prior to heart attack were unusual fatigue (71% of the women), sleep disturbances (48%), and shortness of breath (42%). Only about 30% of the women reported experiencing chest pain in the months and weeks prior to their heart attacks, unlike the majority of men who report chest pain in the period leading up to their heart attacks.

At the time of their acute heart attacks, fully 43% of the women reported that they did not experience any significant chest pain, a symptom that is the hallmark of men who present with an acute heart attack. At the time of their heart attacks, 58% of the women experienced shortness of breath, 55% experienced physical weakness, and 43% felt excessively fatigued. In contrast to men, women generally experienced more significant symptoms in the weeks and months leading up to their heart attacks than men, while the severity of their symptoms at the time of their heart attacks was considerably less acute than for men. Among the women evaluated in this study, those who experienced more severe prodromal symptoms prior to their heart attacks also tended to have more severe symptoms at the time of their actual heart attacks.

This study concluded that women tend to have more significant prodromal symptoms prior to heart attacks than do men. An important caveat is that the women appear to be significantly less likely to experience the severe chest pain, either before or during a heart attack, than is classically seen in men. This study raises the question of the possible importance of gender-related differences in the symptoms of cardiac ischemia (inadequate blood supply to the heart) and heart attack in the disparate outcomes seen between the two genders following heart attacks. Additional research will be necessary to further tease-out the relevance, if any, between symptom differences between men and women, and the higher mortality rate associated with acute myocardial infarction among women.

E. COLI OUTBREAK ASSOCIATED WITH A NON-FOOD SOURCE

Escherichia coli O157:H7 is a nasty bacterium that has been associated with periodic outbreaks of severe diarrheal illnesses, as well as death due to kidney failure and generalized infection.

Unlike its more benign cousins, his strain of E. coli secretes particularly dangerous toxins (shiga toxins) that injure the lining of the GI tract, resulting in bloody diarrhea. Abdominal cramps, nausea and vomiting are also common. In severe cases, patients may begin to experience breakdown of their red blood cells, loss of blood platelets (cells that allow the blood to form blood clots), and kidney failure. In young children, the elderly, and in patients with other serious chronic illnesses, infection with this bad bug can be lethal.

Escherichia coli O157:H7 has, until now, been thought to be passed via the "oral-fecal" route, most commonly due to the presence of this strain of bacterium in under-cooked meat taken from livestock that carry Escherichia coli O157:H7 in their GI tracts. A new study in the current issue of the Journal of the American Medical Association, however, points to a surprising new finding: Escherichia coli O157:H7 may be present, and capable of causing clinical infections, due to the airborne spread of the bacterium by non-food materials.

This study assessed 23 patients who developed laboratory-confirmed Escherichia coli O157:H7 infections after attending a county fair over a six day period in Ohio. An additional 53 age-matched healthy people who had also attended the same fair, and during the same timeframe, were studied as "controls." Among the patients who developed Escherichia coli O157:H7 infections, 26% required hospitalization, and 9% developed kidney failure. The people who became ill after attending the fair were found, statistically, to have been 21 times more likely to have visited a specific multipurpose building on the fairgrounds when compared to the control patients who did not become ill.

The infected folks were also almost 8 times more likely to have attended a dance in this building, and were 4 to 5 times more likely to have handled sawdust and to have eaten inside of this same building. Based upon this preliminary investigation, the investigators cultured samples of sawdust from within the building, and swabbed the rafters and other physical surfaces within the building, looking for signs of Escherichia coli O157:H7.

They found that 24 of the 54 cultures (44%) of sawdust and physical surfaces taken from within the building were contaminated with the same strain of Escherichia coli O157:H7 that was recovered from the GI tracts of the ill patients. Moreover, sawdust specimens that were collected as long as 42 weeks after the fair still contained viable Escherichia coli O157:H7. No Escherichia coli O157:H7 was identified in any food source served inside of the building during the fair.

Based upon epidemiological analysis of this data, it was determined that the majority of the 23 cases of Escherichia coli O157:H7 infection probably resulted from airborne transmission of the offending bacteria, and not from the ingestion of contaminated food. The authors point-out that Escherichia coli O157:H7 can survive in the environment for more than 10 months. This new finding that Escherichia coli O157:H7 infections can probably arise from the airborne movement of contaminated sawdust (and further suggested by the finding of viable Escherichia coli O157:H7 on the ceiling rafters as well) is worrisome news. It may, therefore, take more than well-done hamburgers to eliminate the risk of becoming infected with this virulent bug.

E. UV LIGHTS IN THE WORKPLACE MAY IMPROVE HEALTH

Ultraviolet light has long been known to have germicidal effects. Unfortunately, prolonged exposure to UV light also has the same potential for damaging the DNA in the cells in your skin and the lens of your eye, increasing your risk of skin cancers and cataracts, respectively.

A well-known source of disease-causing bacteria and viruses in the workplace are the ventilation systems that keep buildings warm in the winter and cool in the summer. (The bacterium that causes Legionnaire's Disease was first discovered in a building's air conditioning system after an outbreak of multiple cases of highly lethal pneumonia that struck elderly attendees of a single convention.) A new study in the British medical journal Lancet looked at the impact of employee health following UV light installation within the drip pans and cooling coils of office building ventilation systems. The UV light sources were alternately turned off for 12 weeks and turned on for 4 weeks for 48 consecutive weeks.

The investigators then studied the impact of these interventions on the employees within the test buildings. The employees were not privy to the timing of the UV light activation in the buildings' cooling systems at any time during the study. The researchers then looked at the incidence and timing of self-reported illnesses by the workers, as well as the prevalence of disease-causing bacteria within the cooling systems of each building included in the study. Their findings were quite interesting.

During the periods when the UV lights were turned on, there was a 99% reduction in the concentration of disease-causing bacteria detected on the surface areas of the ventilation systems subjected to UV illumination. There was also a 20% reduction in the incidence of self-reported employee illnesses during the periods when the UV lights were active. There was a 40% reduction in the incidence of respiratory-related worker complaints while the UV lights were on, as well.

The greatest reduction in work-related health complaints occurred among patients with chronic hay fever, asthma, or other allergy-related conditions. These patients experienced a 60% reduction in allergy-related symptoms while the UV lights were active. Nonsmokers also tended to derive the greatest benefit from the UV lights, and these people experienced 70% fewer allergy-related symptoms during the periods when the UV lights were active. Nonsmokers also experienced a 40% reduction in respiratory-related symptoms overall, and a 50% decline in musculoskeletal symptoms while the UV lights were active.

The researchers concluded that the installation of UV lamps within the ventilation systems of buildings could significantly reduce the incidence of illnesses transmitted by bacterial and viral contamination of workplace environmental control systems. They surmised that the observed significant reduction in workplace illnesses may also actually prove to be cost-effective, despite the expense of installing UV light systems, due to reductions in employee absences and increased worker productivity.

JWR contributor Dr. Robert Wascher is an oncologic surgeon, professor of surgery, oncology research scientist, and author. He lives in Honolulu with his wife and two daughters. Comment by clicking here.

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© 2003, Dr. Robert A. Wascher