The New York Times, June 29, 2015

Poisonings from a toxin carried by barracuda and other sport fish have been seriously underestimated in Florida, according to a new study — and the problem is far more common in fishing communities around the world than has been recognized, the lead author said.

In Florida, poisonings from the ciguatera toxin were highest among Hispanics, presumably because they are more fond of eating barracuda, according to the study, which was published this week in The American Journal of Tropical Medicine and Hygiene.

Ciguatera (pronounced sig-WAH-terra) is produced by algae that grow in warm water, and there is a risk of it spreading north as ocean waters warm, said Elizabeth G. Radke, an epidemiologist at the University of Florida’s Emerging Pathogens Institute and the lead author of the study.   

The poison is picked up by coral reef fish that eat vegetation and concentrates in larger carnivorous fish that eat them. The highest levels are found in barracuda, but it is also found in grouper, amberjack, hogfish, snapper, mackerel and mahi-mahi. Neither cooking nor freezing affects the toxin.

“We recommend not eating barracuda at all,” Dr. Radke said. For the rest, which are common in fish markets, “it’s a good idea to be aware that you’re taking a risk. If you get ill, see a doctor, tell them you ate fish, and if you have some fish left, freeze it so it can be tested.”

Fish caught in colder northern waters are unlikely to be have the toxin, she said, but the risk is not zero, because fish migrate.

Severe vomiting within three hours is the most common symptom, but some people have pain and tingling in the mouth, hands and feet, and sometimes leg weakness. Most cases recover, but in some people, the neurological symptoms, including hot surfaces feeling cold and vice versa, last for months.

There is no specific treatment, although mannitol, a type of sugar with many medical uses, appears to help, Dr. Radke said.

Dr. Radke’s study combined an analysis of poisoning reports and an email survey of more than 5,000 sport fishermen. Ciguatera poisoning is supposed to be reported to the state by Florida doctors who diagnose it, and the official estimate is one case per 500,000 residents a year.

Dr. Radke’s study estimated that it is 28 times more common. Ciguatera poisoning occurred most frequently in people who fished near Miami, the Florida Keys and the Bahamas, but it was rare in northern Florida. Poisonings were three times more common among Hispanics compared with other ethnic groups.

The illness, often called just “fish poisoning,” is well known in areas around warm water in the Caribbean, the South Pacific and the Indian Ocean, she said. A survey Dr. Radke did in St. Thomas, V.I., found that 25 percent of all residents had experienced it, and half of those had had symptoms that lasted more than three months.


Patients are often exposed to cancer-causing radiation for little medical reason, a Consumer Reports investigation finds.

When James Duncan, M.D., a radiologist at Washington University in St. Louis, experienced intense pain in his abdomen in 2010, he rushed to a local emergency room. His doctors suspected kidney stones, but they wanted to be sure, so they ordered a CT scan. Duncan remained motionless as the machine captured a detailed, 3D image of his abdomen. He knew that the test was done when the machine stopped whirring. So he was surprised when the scanner kicked back on after a few seconds.

“I later learned that the technician running the CT mistakenly believed that the first scan didn’t include the top of my kidneys, and decided to acquire more images ‘just to be sure,’ ” Duncan says. “The irony: I was getting ready to give a lecture on reducing radiation exposure from medical imaging. And there I was, reluctantly agreeing to a CT scan and then getting overexposed.”

Duncan will never know whether that specific scan caused any long-term harm, because it’s almost impossible to link radiation exposure from any one medical test to a future illness. But like other researchers, he knows that doctors today order millions of radiation-based imaging tests each year, that many of them are unnecessary, and that the more radiation people are exposed to, the greater their lifetime risk of cancer.


Read The Full Article - On The Wall Street Journal By Ron Winslow Nov. 16, 2014

CHICAGO—Millions of heart patients whose disease has been treated with tiny devices called stents may need to stay on an aggressive course of blood-thinning drugs longer than current practice to get the most protection against future heart attacks, a major study presented Sunday suggests.

In the study, which involved nearly 10,000 patients, those treated with aspirin plus a second anticlotting drug for 30 months had a sharp reduction in the risk of heart attacks and other complications compared with those who stopped one of the blood thinners after a year.

But prolonged use of a dual-agent strategy comes with increased risk of significant bleeding problems. Some patients experience annoying side effects such as nose bleeds and bruising. Experts said the challenge for doctors and patients alike is weighing the benefits versus risks in determining how long to remain on the therapy.

Current U.S. guidelines call for doctors to prescribe what is called dual-antiplatelet therapy for 12 months, and some cardiologists have urged even shorter treatment.


The Wall Street Journal - January 14, 2013

Stomach, Back or Side? How You Slumber Can Aggravate Pain, Prevent the Body From Bouncing Back

Tossing and turning all night to find that perfect sleeping position? WSJ's Sumathi Reddy joins Lunch Break with new findings on which positions could help you rest up more efficiently. Photo: Getty Images.

Tossing and turning all night to find that perfect sleeping position?

Experts say there is no one right way to sleep. But for people with certain types of pain and medical conditions, there are positions that can help keep problems from getting worse and may even alleviate them. In some cases, sleeping in the same position night after night can itself create pain, such as neck or shoulder problems.

"It's important that people take time to think about how they position themselves when they sleep," said Peggy Brill, a Manhattan orthopedic physical therapist. "Rest is important for the muscular skeletal system to recover" from the day's stresses, she said. "The proteins get back into the muscles, there's rejuvenation of the body, so you want to be in a healthy anatomical position when you sleep."

The most common sleeping position is on the side—57% of us at least start the night in that position, according to a nationwide survey of more than 2,000 people performed for mattress maker Tempur-Pedic TPX +6.36%North America. That's followed by the back—17% of people opt for this position—and the stomach, 11%. Most of the remaining respondents said their position when they first go to bed varies each night.

Moving around during the night is common. Videotaped sleep studies have found that adults might change their position between three and 36 times a night, with the average person switching about a dozen times. The tendency to shift in one's sleep decreases with age.


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