Medical News – Health News

Dental patient charges in Wales have been frozen for the fourth year running to help maintain wider access to NHS dentistry, Health Minister Edwina Hart announced today [Thursday, 11 March].

The current level of patient charges in Wales has remained the same since April 2006 and is set to stay at the 2006 level for 2010/11: The charges are:

Band 1 – Diagnosis, treatment planning and maintenance: £12
Band 2 – Treatment: £39
Band 3 – Provision of appliances: £177
Urgent treatment: £12

Health Minister Edwina Hart said:
“Thanks to significant extra investment from the Welsh Assembly Government, access to general dental services continues to improve although I appreciate that there may be particular areas where access is still difficult.

“The latest figures show that more work is being done for the NHS by more dentists in Wales. Areas where access has proved difficult in the past have seen some of the greatest improvements. In the Hywel Dda LHB area for example, there are now over 40,000 more people accessing NHS dental care than in March 2006.

“By freezing dental charges again we are maintaining access to NHS dentistry for Welsh citizens and helping to tackle oral health inequalities.

“In addition to increasing access to dentists, we are also investing in raising awareness of people’s responsibility in taking care of their own oral health as they should for their general health and well-being. Simple steps, such as people brushing their teeth thoroughly with fluoride toothpaste twice a day, can make a significant difference to improve their oral health.”

Notes

The comparable rate in England is £16.50 for Band 1, £45.60 for Band 2 and £198 for Band 3.

Anyone seeking access to an NHS dentist should contact their Local Health Board directly – http://www.wales.nhs.uk/directory.cfm

Scientists in the US who undertook a large study to investigate what biological mechanisms might be behind the already established link between colorectal cancer and consumption of red and processed meat, confirmed that such a link exists and suggested the main players are three compounds: heme iron, nitrate/nitrite, and heterocyclic amines.

You can read a paper on the research behind these findings in the published online first 9 March issue of Cancer Research. Most of the research team members, including corresponding author Dr Amanda J Cross, were from the Division of Cancer Epidemiology and Genetics, at the US National Cancer Institute (NCI) in Rockville, Maryland.

The authors noted that although the link between consumption of red and processed meat and colorectal cancer has been demonstrated in several studies, few have explored the underlying mechanisms.

Cross and colleagues undertook a large prospective study that counted colorectal cancer cases in a cohort of over 300,000 men and women who filled in detailed questionnaires about the types of meat they consumed and how it was cooked.

In their analysis they linked the questionnaire data to information kept in scientific databases about the levels of compounds present in meat cooked at different temperatures. The compounds they were interested in were heme iron, nitrate, nitrite and certain mutagens. (Mutagens are compounds that can alter DNA or other genetic material, thus increasing the rate of rogue cell production which can trigger cancer).

In their analysis the researchers arranged the cohort data in “quintiles”. That is they grouped it into five bands: the bottom quintile contained the data on those who ate the least meat and the top quintile contained data on those who ate the most.

They then compared the hazard ratios (HR) of the top quintile with the bottom quintile: thus working out how much extra risk of developing colorectal cancer was represented in the 20 per cent of the cohort that ate the most meat compared to the 20 per cent that ate the least.

The results showed that:
After 7 years of follow up, there were 2,719 cases of colorectal cancer in the cohort.

Comparing the top quintile (the 20 per cent that ate the most meat) with the bottom quintile (the 20 per cent that ate the least meat) for both red and processed meat showed a significantly higher risk of developing colorectal cancer.

The HR for red meat was 1.24 (24 per cent higher risk) and for processed meat it was 1.16 (16 per cent higher risk).

The potential mechanisms for this that showed statistical significance were intakes of heme iron (HR 1.13), nitrate from processed meats (HR 1.16) and heterocyclic amines (HR 1.19).

In general, the elevated risk was higher for rectal cancer than colon cancer, with the exception of two heterocyclic amines (MeIQx and DiMeIQx), which were only linked to colon cancer.
The researchers concluded that they found:

“A positive association for red and processed meat intake and colorectal cancer; heme iron, nitrate/nitrite, and heterocyclic amines from meat may explain these associations.”

Studies have shown that cooking certain meats at high temperatures produces chemicals that are not present in meats that are uncooked.

Some of these chemicals, such as heterocyclic amines, form when muscle meat is cooked (eg from beef, pork, fowl and fish). HCAs are made when creatine (a chemical found in muscle tissue) combines with amino acids at high temperature.

According to the NCI, scientists have found 17 different heterocyclic amines in cooked muscle meat that may pose a cancer risk in humans.

“A Large Prospective Study of Meat Consumption and Colorectal Cancer Risk: An Investigation of Potential Mechanisms Underlying this Association.
Amanda J. Cross, Leah M. Ferrucci, Adam Risch, Barry I. Graubard, Mary H. Ward, Yikyung Park, Albert R. Hollenbeck, Arthur Schatzkin, and Rashmi Sinha.
Cancer Research, Published online first on March 9, 2010
DOI:10.1158/0008-5472.CAN-09-3929

A new study carried out in Hutterite communities in Canada revealed that giving kids and teenagers flu shots led to lower rates of flu in communities that followed such a strategy compared to similar communities that did not, suggesting that vaccinating children may prevent the virus from spreading and protects members of the community who are not vaccinated, producing a so-called “herd immunity”.

You can read about the study, which was funded by the US National Institute of Allergy and Infectious Diseases (NIAID, part of NIH) and the Canadian Institutes for Health Research, in the 10 March online issue of JAMA. Dr Mark Loeb, of McMaster University, Hamilton, Ontario, led the research.

Flu is a major cause of illness and death that every year kills 36,000 and hospitalizes 200,000 Americans.

At the moment, the US policy is to immunize those at high risk of complications, wrote the authors in their background information (although recently a panel of advisors to the US Centers for Disease Control and Prevention recommended a flu shots for all approach).

The authors argued there could be a case for broadening the policy to use immunization to interrupt spread of the virus in a community, explaining this could protect an entire population, including those at high risk, and since children and adolescents appear to play an important role in spreading the flu, vaccinating this group could be an effective strategy for preventing spread and protecting the non-immunized.

Researchers have already attempted to show that such an approach leads to “herd immunity”, but to build a robust case you need isolated communities so there aren’t others sources of flu coming in.

Loeb and colleagues conducted their investigation in 49 rural Hutterite communities (of the Anabaptist faith) in Alberta, Saskatchewan, and Manitoba in western Canada.

“These tightly knit communities resemble extended families but are composed of single families each residing in their own house, where children and adolescents between the ages of 3 years and 15 years attend school. Approximately 60 to 120 people reside on each colony,” they wrote.

They found that influenza vaccination was 61 per cent effective at indirectly preventing illness in non-immunized people if they lived in a community where about 80 per cent of the children had received flu vaccine.

The researchers designed the study as a cluster randomized trial: thus the communities were randomized so that their children received either the real flu shot (a standard dose of inactivated trivalent influenza vaccine) or a control (which in this case was a hepatitis A vaccine). This allowed the researchers to compare communities where the children had been vaccinated against the flu with communities where they had not.

Overall, the participants involved in the study included the children that received the study vaccine (947 of them, aged from 36 months to 15 years received either the real flu shot or the control, depending on which community they were in), and the other members of the communities (giving a total of 2,326 community members who did not receive either the real flu shot or the control vaccine).

Follow-up began at the end of December 2008, and ended toward the end of June 2009.

The results showed that:
The average vaccine coverage among healthy children in communities where they received the real flu shot was 83 per cent.

This was similar to the average vaccine coverage in the control communities where 79 per cent of the healthy children received the control Hep A vaccine.

Among non-recipients, 3.1 per cent (39 of 1,271) of those in communities whose children received the real flu shot contracted flu (confirmed via lab tests).

This compares with 7.6 per cent (80 of 1,055) in those communities whose children received the control Hep A vaccine.

This resulted in an indirect vaccine protective effectiveness of 61 per cent.

Among all study participants (those who did and those who did not receive the study vaccine) in the communities that had the real flu shots, 4.5 per cent (80 of 1,773 people) had lab-confirmed flu illness.

This compares with 10.6 per cent (159 of 1,500) total study participants in the communities that had the control Hep A vaccine.

This resulted in an overall protective effectiveness of 59 per cent.

The researchers observed no serious adverse events.
The researchers concluded that immunizing children and teenagers significantly protected the non-immunized members of the rural communities.

They wrote this finding is particularly important in the context of the A(H1N1) 2009 pandemic, as it helps us understand the extent to which immunizing children might help prevent rapid spread and thus protect high risk groups such as pregnant women and those found in aboriginal populations.

“Our findings offer experimental proof to support selective influenza immunization of school aged children with inactivated influenza vaccine to interrupt influenza transmission. Particularly, if there are constraints in quantity and delivery of vaccine, it may be advantageous to selectively immunize children in order to reduce community transmission of influenza,” they added.

“Effect of Influenza Vaccination of Children on Infection Rates in Hutterite Communities: A Randomized Trial.”
Mark Loeb; Margaret L. Russell; Lorraine Moss; Kevin Fonseca; Julie Fox; David J. D. Earn; Fred Aoki; Gregory Horsman; Paul Van Caeseele; Khami Chokani; Mark Vooght; Lorne Babiuk; Richard Webby; Stephen D. Walter.
JAMA, March 10, 2010; 303: 943 – 950.

Research published on bmj.com today reports that people who are in good health are just about twice as likely to be interested in sex compared to those in poor health.

Sexual activity is recognized as having several health benefits. In addition, it is linked to living longer. In this case, the study investigates how general health impacts on the quality of sex.

Furthermore, this research estimates how many remaining sexually active years healthy men and women have left.

Findings indicate that at the age of 30, sexually active life expectancy is:

• For men: nearly 35 years
• For women: almost 31 years

At the age of 55, this figure changes to:

• For men: almost 15 remaining years
• For women: 10 remaining years

This gender difference diminishes for people with a spouse or intimate partner.

Sexually active life expectancy was longer for men. However, they lost more years of this activity due to poor health than women.

Authors, Stacy Tessler Lindau and Natalia Gavrilova from the University of Chicago, used data from two representative research groups in the US. One group consisted of over 3,000 men and women between the ages of 25 and 74. The other group included over 3,000 men and women between 57 and 85 years of age.

Participants were asked to provide information about their relationship status. They rated the quality of their sex lives and how often they had sex. They also rated the level of their general health between poor and excellent.

The results disclose that men are more likely to be sexually active, report a good sex life and be interested in sex than women. This dissimilarity was most considerable among the 75 to 85 year old group, where almost four out of ten (40 percent) males compared to less than two out of ten (17 percent) women were sexually active.

The authors write in conclusion:”sexually active life expectancy estimation is a new life expectancy tool than can be used for projecting public health and patient needs in the arena of sexual health” and that “projecting the population patterns of later life sexual activity is useful for anticipating need for public health resources, expertise and medical services.”

In an associated editorial, Professor Patricia Goodson from Texas University says Lindau and Gavrilova’s research is both interesting and encouraging. She writes: “the study bears good news in the form of hope … the news that adults in the US can enjoy many years of sexual activity beyond age 55 is promising.”

Goodson remarks that in the field of older people and sexuality, many questions remain unanswered, such as problems with measurement and silence regarding the sexual health of ageing homosexual, bisexual or intersexed people. “They stand as dim reminders of the limitations inherent in applying science to the study of complex human realities, and the cultural values shaping the topics we choose to study, she concludes.”

“Sex, health, and years of sexually active life gained due to good health: evidence from two US population based cross sectional surveys of aging”
Stacy Tessler Lindau, associate professor, Natalia Gavrilova, senior research associate
BMJ 2010; 340:c810
doi:10.1136/bmj.c810

“Sexual activity in middle to later life”
Patricia Goodson
BMJ 2010;340:c850
bmj.com

Scientists in Australia found that when they studied insulin resistance in people with Hepatitis C little or none of it was in the liver and nearly all the insulin resistance occured in muscle, which surprised them because Hepatitis C is a liver disease that not only leads to cirrhosis and cancer, but also makes people three to four times more likely to develop Type 2 diabetes.

You can read about the study that led to these findings in the March 2010 issue of the journal Gastroenterology, which is also available online.

Among the researchers were Dr Kerry Lee Milner and Professor Don Chisholm from Sydney’s Garvan Institute of Medical Research and Professor Jacob George from the Storr Liver Unit, University of Sydney at Westmead Hospital.

Hepatitis C is a virus that lives in the blood and can be passed from one drug user to another by sharing needles: in Australia this is the main route of transmission. However, unsterile tattooing or body piercing is another way the virus can spread.

Unlike Hepatitis A and B, there is no vaccine for Hepatitis C, of which there are 6 strains, the two most common in Australia being Genotype 1 and Genotype 3, which causes significant amounts of fat to deposit in the liver.

Insulin, a hormone that helps the body convert glucose into energy, is made in the pancreas, but the two most important organs that respond to it are the liver and muscle, each responding differently. When it detects insulin, the liver stops making glucose, while healthy muscle responds by using glucose.

A liver that has become insulin resistant overproduces glucose, while muscle that has become insulin resistant does not absorb glucose so well from the bloodstream. In both cases the result is too much circulating glucose.

When they studied the insulin resistance of 29 people with Hepatitis C (14 with Genotype 1 and 15 with Genotype 3) and confirmed they had high insulin resistance, they found to their surprise that nearly all the insulin resistance was in the muscle and hardly any in the liver.

Chisholm also told the media that contrary to expectations, not only did they find no significant insulin resistance in the liver of the study participants: “The fifteen people with very high levels of fat in the liver [the participants with Genotype 3] had the same degree of insulin resistance as the fourteen that didn’t have fatty livers.”

Chisolm said experts around the world have been arguing that fat in the liver is an important factor in the development of insulin resistance, perhaps the most important. But this study shows this may not be the case, he said.

“Before you get Type 2 diabetes, you must become insulin resistant and your insulin producing cells must also fail to compensate. Insulin resistance alone will not give you diabetes,” he explained.

For this study, Chisolm and colleagues gave intravenous glucose, which specifically stimulates insulin secretion, and showed that it was not impaired in the Hepatitis C patients compared to controls.

“This finding tells us that people with Hepatitis C who develop diabetes probably have susceptible insulin-producing cells, and would probably get it anyway — but much later in life,” said Chisolm.

The extra insulin resistance caused by Hepatitis C apparently brings on diabetes at 35 or 40, instead of 65 or 70,” he added.

The researchers suggest further research should now be done to find out why Hepatitis C causes insulin resistance in muscle.

“That will give us better insight into the behaviour of the disease,” said Chisolm.

For people with Hepatitis C, the message from this study is a deeper understanding of insulin resistance, and perhaps, if they have family members with Type 2 diabetes, they would be advised to manage their diets very carefully and take plenty of exercise, as this delays onset.

Estimates suggest there are currently around 212,000 Australians infected with Hepatitis C, with 10,000 new infections a year.

“Chronic Hepatitis C Is Associated With Peripheral Rather Than Hepatic Insulin Resistance.”
Kerry-Lee Milner, David van der Poorten, Michael Trenell, Arthur B. Jenkins, Aimin Xu, George Smythe, Gregory J. Dore, Amany Zekry, Martin Weltman, Vincent Fragomeli, Jacob George, Donald J. Chisholm.
Gastroenterology, March 2010 (Vol. 138, Issue 3, Pages 932-941.e3)

Source: GAVAN Institute.

The first pooled kidney transplants involving three donor-recipient couples where each recipient received a kidney from a donor they did not know, has successfully taken place in the UK.

The transplants took place at the end of 2009 and involved three hospitals, Hammersmith and Guy’s and St Thomas’ in London, and the Royal Infirmary in Edinburgh.

It is now easier, since a new law was introduced in 2006, for living donors to give an organ like a kidney for transplant. However, the process is tightly regulated by an independent watchdog, the Human Tissue Authority (HTA) to ensure that donors are not under pressure to donate.

In this case, each recipient had a donor, related by marriage or a blood relative, who was willing to donate a kidney, but there was no match. So under the new law, they put themselves forward for pooled donation, and a three-way match was found.

One of the couples was a brother and a sister living in Hastings on England’s south coast. Chris Brent, 42, told the BBC that he had spent seven years on dialysis with little hope of finding a matching donor. His sister, Lisa Burton, 45, wanted to give him one of her kidneys but there was not match.

Brent said when he heard of the pooled transplant option he leapt at the chance.

Burton told the BBC that the threefold event created a “feelgood factor” all round:

“I’m absolutely delighted that Chris can have a normal life now, and all the other people can as well.”

This is how it works: couple A (eg Brent and Burton) receive a kidney from couple C and donate a kidney to couple B who donate a kidney to couple C. Thus in each couple the sick person receives a kidney, except it is from from a matching donor from another couple.

The three-way transplant requires considerable planning. Three kidneys have to be removed, transported around the country, and transplanted into the recipients on the same day.

Although this is the first three-way transplant to take place in the UK, 16 two-way transplants, where only two couples are involved, have taken place between April 2008 and March 2009, the HTA said in a statement.

Vassilios Papalois, consultant renal surgeon at Hammersmith said the surgery was a complete success and hoped they could do more paired and pooled transplants:

“In the US they are already doing up to 12 pairs at once; so that’s something to aspire to,” he told the BBC.

Keith Rigg, HTA Authority Member and President of the British Transplantation Society, said:

“As a surgeon, we often see people who want to donate a kidney to a relative, partner or close friend, but they are not able to do so because of a mismatch in blood or tissue type.”

“Paired and pooled donation may offer these people a solution; they can give to another couple in the same situation for a compatible donation in return,” he added.

The HTA checks that the donors have given their consent freely and voluntarily and fully understand the risks involved. Also, the donor-recipient pairs remain anonymous to each other until the transplant takes place to ensure there is no opportunity for coercion.

There are currently 7,000 people in the UK waiting for a new kidney.

Sources: HTA, BBC.

A new study from the US found that normal weight women in their 40s and older who drank a light to moderate amount of alcohol gained less weight and had a lower risk of becoming obese and overweight compared to their non-drinking counterparts.

The researchers, from the Brigham and Women’s Hospital, and the Harvard School of Public Health in Boston, Massachusetts, have written about their study in a paper published online in the 8 March issue of Archives of Internal Medicine.

At 7 calories per gram (equivalent to 199 calories per ounce), alcohol is potentially a significant source of dietary calories, and more than half of adult Americans are alcohol drinkers. Meanwhile obesity is approaching epidemic proportions in the US, yet evidence on the extent to which alcohol consumption contributes to this public health crisis is patchy, suggested the authors.

For their prospective cohort study, which was sponsored by grants from the National Institutes of Health, lead author Dr Lu Wang, of Brigham and Women’s Hospital, and colleagues examined data from 19,220 women living in the US who were aged 39 and over, had no traces of cardiovascular disease, cancer, or diabetes, and whose body mass index (BMI) was in the range classified as normal (18.5 to less than 25). BMI is calculated as weight in kilograms divided by height in meters squared.

At the start of the study the women filled in a questionnaire that asked them about their daily alcohol consumption. After that they filled in questionnaires about their weight every year for an average of 13 years.

The results showed that:
At the start of the study, 38.2 per cent reported drinking no alcohol, 32.8 per cent reported drinking less than 5 grams a day, 20.1 per cent reported drinking 5 to less than 15 grams, 5.9 per cent reported drinking 15 to less than 30 grams, and 3 per cent reported drinking 30 or more grams of alcohol a day.

Over the 13 years of follow up, the women’s average weight went up steadily.

41.3 per cent of the women became overweight (BMI of 25 or more), and 3.8 per cent became obese (BMI of 30 or more).

After adjusting for potential confounders like baseline BMI, smoking, other calorie sources, exercise, and other lifestyle and dietary factors, there was an inverse association between the amount of daily alcohol the women said they drank in their initial questionnaires and the weight gained over the follow up.

Compared with women who did not drink at all, those who consumed some but less than 40 grams of alcohol a day had a lower risk of becoming overweight or obese.

Women who drank 15 to less than 30 grams of alcohol per day had the lowest risk, which was nearly 30 percent lower than that of their non-drinking counterparts.
The authors also looked at four types of alcoholic beverages and found the links to be the same for all, with perhaps the strongest being for red wine.

They concluded that:

“Compared with nondrinkers, initially normal-weight women who consumed a light to moderate amount of alcohol gained less weight and had a lower risk of becoming overweight and/or obese during 12.9 years of follow-up.”

However, the authors stressed that given the potential medical and psychosocial problems of alcohol consumption, recommendations about its use should be made on an individual by individual basis.

They also suggested more studies are needed to find out the biological mechanisms of the role played by alcohol in energy metabolism, and whether any physiological and genetic factors are involved.

Munich, Germany – Contrary to expectations, the opioid receptor antagonist naltrexone is no better than placebo and can be counterproductive in treating substance use disorder in patients with schizophrenia, according to data released at the 18th European Congress of Psychiatry.

“Because naltrexone is commonly prescribed to nonschizophrenic patients to treat substance abuse, we had thought that it might be a useful adjunctive treatment in schizophrenics with comorbid substance abuse,” Ileana Berman, MD, medical director of community counseling of Bristol County in Taunton, Massachusetts and instructor in psychiatry at Harvard Medical School in Boston, said.

Dr. Berman and colleagues randomized 37 patients with schizophrenia or schizoaffective disorder and an alcohol or other substance abuse disorder to six months’ treatment with naltrexone, 50 mg/d, or placebo.

Comorbid substance abuse frequently occurs in patients with schizophrenia and is associated with a poor prognosis, Dr. Berman observed. In an earlier study that included 85 patients with schizophrenia from a long-term psychiatric hospital, her team found that 48% of the cohort also had a substance abuse disorder and that they responded less to treatment.

There are no established therapies that specifically address the treatment of substance abuse in these patients, and no controlled drug trials have assessed the efficacy of medication on substance abuse and psychiatric symptoms in dual diagnosis patients, she said.

Naltrexone has been used in non-schizophrenic patients for the treatment of substance abuse disorder and has been found to be well tolerated and to decrease substance use and help maintain sobriety.

In the present trial, patients had to have at least two episodes of substance use during the prior three months. Most of them were recruited from a long-term psychiatric institution and had a significant social support system consisting of medication monitoring, social services, and close medical and psychiatric monitoring of their daily activities.

Monthly assessments included the Positive and Negative Syndrome Scale for Schizophrenia (PANSS), Global Assessment Scale (GAF), and the Quality of Life Scale (QLS).

Results showed that all patients improved on all psychiatric assessments. However, patients on naltrexone did worse than patients on placebo by the final assessment of PANSS total (F=5.56, p=0.031) and PANSS general symptom subscale (F=4.72, p=0.044) after controlling for scores on the Michigan Alcohol Screening (MAS) test which were significantly higher in the naltrexone group at baseline.

“Our study contradicted the initial hypothesis that naltrexone will improve clinical symptoms over time,” Dr. Berman commented.

“Because patients with schizophrenia have pervasive neuroreceptor deficits, it is possible that they have deficits in the opioid system suggesting that the addition of the opioid blocker naltrexone may be counterproductive,” she said. These patients seem to benefit from appropriate psychotropic treatments for schizophrenia and adequate psychosocial services (case management, residential support, etc.) to ensure compliance with treatment and social integration.

Dr. Berman’s son Jacob, a student who had training in statistics at Moses Brown School in Providence, Rhode Island, performed the data entry, data verification, and statistical analysis.

The study was funded by a grant from the National Alliance for Research in Schizophrenia and Affective Disorders.

Written by Jill Stein
Jill Stein is a Paris-based freelance medical writer.
View drug information on Naltrexone Hydrochloride Tablets

Thousands of types of processed foods containing hydrolyzed vegetable protein or HVP made by Basic Food Flavors Inc in Las Vegas, Nevada, may pose a health risk due to possible contamination with Salmonella Tennessee, said the US Food and Drug Administration last week.

Food companies that use HVP made by Basic Food Flavors have so far said they are voluntarily recalling over 50 products, these include soups, sauces, chillis, stews, hot dogs, gravies, seasoned snack foods, dips and dressings.

However, the recall list is expected to grow: there are few manufacturers of HVP and thousands of product lines contain the additive which is used to enhance flavor.

Jeff Farrar, associate commissioner for food protection at the FDA told the press:

“We don’t know precisely how large this recall will get .. the potential amount of products . . . is very large,” he is said to have told the press, according to a report in the Washington Post on Friday.

Michael Hansen, senior scientist at Consumers Union said:

“This can potentially be in over 10,000 products.”

The first the FDA knew about the contamination was when a food company that uses the HVP product in its own processed food detected the bacteria in a sample last month and reported it on the FDA’s new Reportable Food Registry.

Since then an inspection of the Nevada plant has yielded further evidence of Salmonella Tennessee in the company’s processing equipment, and it is likely that the contamination may date back to HVP powder and paste made since last September.

It will take time to gauge the full extent of the problem because millions of pounds of potentially contaminated HVP have been shipped since September, and the clients it has shipped to have added it to their own products and sold them them to other food producers and retailers. Thus there are several steps in an ever widening network before the HVP reaches the consumer.

The FDA said so far there have been no reports of people falling ill from the contamination and the health risk is likely to be low; however they are monitoring and assessing the situation with other federal agencies.

For an up to date list of US foods affected see the searchable FDA Hydrolyzed Vegetable Protein Containing Products Recall List.

The authorities in Canada are also keeping a close eye on the situation, and so far two product brands have been pulled: two types of T. Marzetti-brand veggie dips and two types of Tim’s Cascade Snacks Hawaiian Kettle Style Potato Chips.

Consumers are informed that products should be safe if they are properly cooked, as this kills the bacteria.

However, many of the ready to eat products affected are not intended for cooking after purchase, at least not at a temperature that would kill the bacteria, so the FDA advised manufacturers to recall them unless they have documented evidence that they themselves cooked the products containing the possibly tainted HVP at a temperature high enough to kill the bacteria.

Eating food containing salmonella causes an illness known as salmonellosis which can lead to serious infection in vulnerable people such as children, the elderly and anyone with a weakened immune system (eg people with HIV or undergoing chemotherapy).

In healthy people, salmonellosis can result in headache, vomiting, nausea and diarrhea.

What is HVP?

Hydrolyzed vegetable protein HVP is used by food manufacturers to enhance flavor. It is made by chemically breaking down proteins into amino acids, for instance by boiling up corn, wheat and/or soya with hydrochloric acid, to isolate the amino acids, then neutralizing with sodium carbonate or sodium hydroxide. The result is a mixture of amino acids, one of which, incidentally, could be monosodium glutamate (MSG).

For US consumers it can be confusing because where MSG is added directly as a flavour enhancer it has to be declared on the label, but if it happens to be present in HVP it does not. (The process of making HVP means that some free glutamate (a non-essential amino acid) may join with free sodium to form MSG: in this case MSG may be present but does not have to be declared on the label).

Researchers in the US have discovered that a latent form of HIV hides in progenitor cells in bone marrow, avoids detection by the immune system and retains the ability to reproduce and spread when the coast is clear (eg when treated people stop taking anti-HIV drugs). The researchers hope their discovery will lead to new and more effective treatments that target these latent reservoirs and that eventually those infected won’t have to take anti-HIV drugs all their lives.

You can read about the research that led to the discovery in the 7 March online issue of Nature Medicine.

Although antivirals that combat HIV (human immunodeficiency virus; the virus that causes AIDS), save lives, they don’t totally eliminate the virus from the body.

Senior author Dr Kathleen L. Collins, associate professor of both internal medicine and microbiology and immunology at the University of Michigan (U-M) Medical School, told the press that:

“Antiviral drugs have been effective at keeping the virus at bay. However once the drug therapy is stopped, the virus comes back.”

She said that their important finding helps to explain why it’s hard to cure the disease:

“Ultimately to cure this disease, we’re going to have to develop specific strategies aimed at targeting these latently infected cells,” she added.

Previous studies have found HIV hiding out in macrophages and some T cells, but Collins and colleagues found evidence that there was still a reservoir somewhere else.

In this study, they examined bone marrow tissue samples of HIV patients who had been treated for at least six months, and found traces of HIV genome. Previously, scientists believed that bone marrow was resistant to HIV.

Collins and colleagues confirmed that the HIV targets long-lived multipotent hematopoietic progenitor cells (HPCs, immature cells that have not yet developed specialized immune functions).

“In some HPCs, we detected latent infection that stably persisted in cell culture until viral gene expression was activated by differentiation factors,” they wrote.

The authors concluded that:

“These findings have major implications for understanding HIV bone marrow pathology and the mechanisms by which HIV causes persistent infection.”

They said further studies would be needed to establish whether the HIV also targets stem cells (cells that have the potential to turn into virtually any cell in the body).

Globally, more than 30 million people, including millions of children, are infected with HIV. Since drugs first became available in the 1990s there have been huge improvements in treatments and a nearly 90 per cent reduction in mortality.

Collins said this has led HIV to become more of a chronic disease than a death sentence. There has been a huge impact on quality of life, however:

“Only 40 percent of people worldwide are receiving anti-viral drugs and unfortunately that means that not everybody is benefiting,” she added.

The hope is that by developing a drug that does not require life-long treatment but only a course of months or a few years, it will be easier to reach and treat more people around the world, especially in countries that are not well resourced.

“HIV-1 infects multipotent progenitor cells causing cell death and establishing latent cellular reservoirs.”
Christoph C Carter, Adewunmi Onafuwa-Nuga, Lucy A McNamara, James Riddell IV, Dale Bixby, Michael R Savona & Kathleen L Collins.
Nature Medicine, Published online 07 March 2010
DOI:10.1038/nm.2109