Heart Attacks in 3 Teens Linked to K2

Designer Drug Mimics the Effects of Marijuana

Nov. 4, 2011 -- Three previously healthy Texas teens had heart attacks after smoking the "legal high" products sold under names such as K2 and Spice.

All three of the 16-year-old boys survived, report Colin Kane, MD, and colleagues at the University of Texas Southwestern Medical Center. Kane's team treated each of the boys. The teens obtained and smoked the K2 products in separate incidents.

"They certainly did damage to their hearts," Kane, a pediatric cardiologist, tells WebMD. "Hopefully there will be no long-term health implications, just a scare. But time will tell."

In an effort to skirt state and federal laws, K2-type products usually are sold as incense, plant food, or even as toy cleaner. With a nod and a wink, they are marked "not for human consumption." But the herbs are spiked with synthetic cannabinoids -- designer drugs that mimic marijuana.

Although the effects of K2 drugs are similar to those of marijuana, the drugs have little in common with the real herb. Synthetic cannabinoids were initially created for lab use only. They are based on chemicals that never would be approved for human use. As a result, most drug screens do not detect these drugs.

Invoking its emergency authority, the Drug Enforcement Administration (DEA) has made five of these drugs illegal. But new versions pop up all the time. And the old ones are still widely available in products sold on the Internet, in specialty shops, and at convenience stores.

"They did comment it was very easy to get. They had no trouble buying it at gas stations, and they said lots of other kids were doing it," Kane says. "But one of the kids was a high school football player, and he was attracted by the idea it never would show up on drug screens."

Each of the boys suffered chest pains one day to one week after smoking a K2 product. Examination at the emergency department showed that they had suffered the same kind of heart attacks.

It's not yet clear exactly how K2-type drugs cause heart attacks. There are reports in the medical literature of healthy young people having heart attacks after smoking marijuana. These reports are relatively rare, given how widely marijuana is used.

The heart effects of marijuana are likely due to the drug's ability to bind to cannabinoid receptors, switches on brain and body cells that trigger different functions. Synthetic cannabinoids bind more strongly to these switches than do the cannabinoids in marijuana. This results in stronger potency and more intense effects.

"We don't know everything about these drugs, but there are certainly health risks," Kane says. "This should not be seen as a safe alternative to marijuana."

Kane and colleagues report the three cases in the December issue of Pediatrics.

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Most Sports Don't Raise Risk of Knee Osteoarthritis

But Study Shows Soccer Puts Nonprofessional Athletes at Increased Risk of Knee OA

Nov. 7, 2011 (Chicago) -- While most sports don't seem to raise the risk of knee arthritis, some sports do seem to be particularly hard on the knees.

Overall, athletes don't have a greater risk for knee osteoarthritis, says researcher Jeffrey Driban, PhD, assistant professor of rheumatology at Tufts Medical Center in Boston.

That's true regardless of whether you participate in recreational or elite-level sports, he tells WebMD.

But both elite and non-elite soccer players were at increased risk of knee osteoarthritis (OA), a new study showed.

So too were competitive long-distance runners, weight lifters, and wrestlers.

There weren't enough data to draw conclusions about nonprofessionals who engage in these sports. In addition, the risk to women is unclear as most research has been on male elite athletes, Driban says.

The researchers found no increased risk of OA with basketball, boxing, cross-country skiing, ice hockey, orienteering, shooting, throwing, and track and field.

The study was presented here at the American College of Rheumatology's annual meeting.

Osteoarthritis, or OA, is characterized by progressive damage to the joint cartilage, the cushioning material at the end of bones.

Nearly 6.5 million Americans between the ages of 35 and 84 will be diagnosed with knee osteoarthritis in the next decade, according to another study presented at the meeting.

Interestingly, other recent studies have not found an increased risk of osteoarthritis in long-distance runners.

Still some experts urge caution. To reduce the risk of OA, consider non-contact, low-impact sports such as doubles tennis, swimming, and cycling, suggests Scott Zashin, MD, clinical associate professor of medicine at the University of Texas Southwestern Medical School in Dallas.

If you like to jog, try to run on a soft surface to limit trauma to the knees, he says.

If you're going to participate in high-risk sports like soccer, or if you already have knee injuries, be sure to maintain a healthy weight, Driban says. Other than aging, obesity is the biggest risk factor for osteoarthritis.

The reviewed studies compared knee osteoarthritis rates among sport participants after they retired to those of people of similar age who didn't participate in those sports.

Among the findings:

Elite and recreational soccer players had a fourfold increased risk of knee OA.Elite long-distance runners had a threefold increased risk of knee OA.Elite-level competitive weight lifting was associated with a sixfold increased risk of knee OA.Elite wrestling was associated with a fourfold increased risk of knee OA.

These findings were presented at a medical conference. They should be considered preliminary as they have not yet undergone the "peer review" process, in which outside experts scrutinize the data prior to publication in a medical journal.

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Pork-Cat Syndrome an Under-Recognized Allergy

People With Cat Allergies May Also Be Allergic to Pork and Other Meats

Nov. 7, 2011 -- Some people with cat allergies may also be allergic to pork and other meats because of a rare type of cross-reactive allergy known as pork-cat syndrome.

A new study describes the first six cases of pork-cat syndrome documented in the U.S. The syndrome has been established in Europe since the late 1990s.

Researchers say the basis for the syndrome appears to be a reaction to a protein of non-primate mammals. Allergic reactions attributed to pork-cat syndrome include itchy mouth, hives, and potentially life-threatening anaphylaxis.

The study is being presented at the annual meeting of the American College of Allergy, Asthma & Immunology.

In the study, researchers described six people with pork-cat syndrome. Five of the six people with the syndrome were women, and the average age was 28.

Blood tests showed all of the people tested positive for both cat and pork antibodies.

One person had experienced itchy mouth after eating pork, three had hives, and two had anaphylaxis.

Researcher Jonathon Posthumus, MD, of the University of Virginia, and colleagues say these people with pork-cat syndrome, like those cases reported in Europe, had a wide range of symptoms and inconsistent reactions to eating meat, which is typical of the syndrome.

They say pork-cat syndrome is an unusual and under-recognized food hypersensitivity reaction, and more research is needed to understand the syndrome.

These findings were presented at a medical conference. They should be considered preliminary as they have not yet undergone the "peer review" process, in which outside experts scrutinize the data prior to publication in a medical journal.

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Some Doctors Warming Up to Probiotics

Probiotics May Help Prevent Diarrhea in Patients on Antibiotics

Nov. 4, 2011 (Washington, D.C.) -- May I have a probiotic with that antibiotic please?

That's a question that hospitalized patients being started on antibiotics may want to ask their doctors, according to a panel of doctors convened by the American College of Gastroenterology at its annual meeting here.

A review of 22 studies involving 3,096 patients presented at the meeting showed that taking probiotics while on antibiotics may cut the risk of developing antibiotic-associated diarrhea by about 60%.

Patients took any of a variety of probiotics, most commonly S. boulardii, for an average of one-and-one-half weeks. Most were hospitalized during treatment.

A second analysis that pooled the results of 28 studies involving 3,338 patients showed those given probiotics for at least as long as they were on antibiotics were 56% less likely to develop antibiotic-associated diarrhea than those given placebo.

Why? For all the good they can do, antibiotics kill "good" bacteria along with the bacteria that cause illness. A decrease in beneficial bacteria may lead to digestive problems. Taking probiotics may help replace the lost beneficial bacteria and help prevent diarrhea.

Probiotics also appeared to provide protection against potentially deadly bouts of diarrhea caused by the bug Clostridium difficile, or C. diff., says researcher Rabin Rahmani, MD, a gastroenterologist at Maimonides Medical Center in New York City.

"By giving probiotics, you reduce the risk of antibiotic-associated diarrhea that occurs in 40% to 75% of hospitalized patients on antibiotics," says Fergus Shanahan, MD, of the Alimentary Pharmabiotic Centre, an industry-funded research center at the National University of Ireland at Cork.

In many cases, the diarrhea is mild and short lived; in others, it is severe and persistent, he says.

"We could debate whether all hospitalized patients on antibiotics need probiotics, but certainly the elderly, who are at high risk," Shanahan tells WebMD.

Brian E. Lacy, MD, PhD, a gastroenterologist at Dartmouth-Hitchcock Medical Center and moderator of the panel, went even further. "In my experience, it is certainly rational to offer probiotics [to hospitalized patients given antibiotics]," he says.

"There's no downside, in our experience," Lacy says.

Still, a better solution would be to be more selective in prescribing antibiotics to begin with, says panel member and probiotic researcher Eamonn M.M. Quigley, MD, professor of medicine at the National University of Ireland at Cork. He is co-founder of Alimentary Health Ltd., a biotechnology company that develops probiotic treatments.

The normal human digestive tract contains about 400 types of beneficial bacteria. Probiotic bacteria can be found in yogurt with live cultures and fermented milk and are available as dietary supplements.

Further study is needed to determine what type and dose of probiotic bacteria best prevent diarrhea, Quigley says.

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Study: U.S. Pays More, but Health Care Is Worse

Commonwealth Fund Report Says 'Medical Homes' Are the Key to Better Health Care

Nov. 9, 2011 -- We not only pay a lot more for health care in the U.S. than in other countries, but a new study suggests the care we get is often slower and more poorly coordinated.

That's because other industrialized countries do a better job of giving patients easy access to primary care and to "medical homes" responsible for guiding care and complex treatment, according to a study published today by the Commonwealth Fund.

A medical home is a regular place of care where health care providers are accessible, know the patients' medical history, and help to coordinate care.

The study credits medical homes with lower rates of medical errors, poor information, coordination gaps, and emergency room visits.

For example, 42% of ill American patients reported duplicate tests, gaps in care, or other problems during the last year. That was about double the rate than in the U.K. and Switzerland, where medical homes are in wider use.

"For sicker patients and patients having chronic disease, having a medical home makes a difference. It makes a difference in every country," says Cathy Schoen, MS, senior vice president at the Commonwealth Fund.

The group surveyed roughly 18,000 chronically or seriously ill patients in 11 countries, including Australia, Canada, France, Germany, the Netherlands, New Zealand, Norway, Sweden, Switzerland, the U.K., and the U.S.

It found the rate of patient-reported medical errors to be two to three times higher among U.S. patients than among patients in the U.K. or Switzerland.

The survey also finds that U.S. patients are more likely to forgo care because of cost than are patients in any of the other countries. More than four in 10 reported not visiting a doctor, skipping care, or not filling a prescription because of out-of-pocket costs. It was more than double the rate seen in several other countries.

However, U.S. patients had the most positive experiences concerning the ease of calling to ask a question or get advice from their health care provider between visits.

The Affordable Care Act, signed in 2009, promotes the idea of medical homes as a way to better coordinate care and cut errors. Officials at the Commonwealth Fund say their study backs up the idea.

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