Mammography availability linked to breast cancer mortality rate

More women die of breast cancer in areas where mammography centers are few and far between, according to research by a Medical College of Georgia radiology resident.

Breast cancer mortality rates ranged from 34.1 per 100,000 women in counties with no mammography facilities to 27.5 in those with at least one, said Dr. Kandace Klein, a fourth-year radiology resident.

Drs. Klein and James Rawson, Warren professor and chair of the Department of Diagnostic, Therapeutic and Interventional Radiology, presented their findings at the recent annual conference of the Radiology Society of North America. Dr. Klein also received the society’s Trainee Research Prize for the project.

Researchers used mapping and statistical software to determine the relationship between the number of sites in a specific geographical area and the number of breast cancer deaths. While this phase of the research did not account for variables such as race, education or socioeconomic status, a noticeable pattern emerged.

“The number of sites within a county is related to the population,” Dr. Klein said. “Increasing access to a facility correlates with a decrease in mortality.”

Researchers could not account for mobile mammography units and any transfer cases, such as when a patient went to another county to receive mammography services. The next phase of the project will analyze other factors that could affect breast cancer mortality rates, she said.

Dr. Klein, a graduate of the Texas College of Osteopathic Medicine, will complete her residency this spring and begin an MCG fellowship in body imaging.

By Jennifer Hilliard
MCG

-----
www.fayettefrontpage.com
Fayette Front Page
www.georgiafrontpage.com
Georgia Front Page
Follow us on Twitter: @GAFrontPage

Nanotechnology may increase longevity of dental fillings

ooth-colored fillings may be more attractive than silver ones, but the bonds between the white filling and the tooth quickly age and degrade. A Medical College of Georgia researcher hopes a new nanotechnology technique will extend the fillings' longevity.

"Dentin adhesives bond well initially, but then the hybrid layer between the adhesive and the dentin begins to break down in as little as one year," says Dr. Franklin Tay, associate professor of endodontics in the MCG School of Dentistry. "When that happens, the restoration will eventually fail and come off the tooth."

Half of all tooth-colored restorations, which are made of composite resin, fail within 10 years, and about 60 percent of all operative dentistry involves replacing them, according to research in the Journal of the American Dental Association.

"Our adhesives are not as good as we thought they were, and that causes problems for the bonds," Dr. Tay says.

To make a bond, a dentist etches away some of the dentin's minerals with phosphoric acid to expose a network of collagen, known as the hybrid layer. Acid-etching is like priming a wall before it's painted; it prepares the tooth for application of an adhesive to the hybrid layer so that the resin can latch on to the collagen network. Unfortunately, the imperfect adhesives leave spaces inside the collagen that are not properly infiltrated with resin, leading to the bonds' failure.

Dr. Tay is trying to prevent the aging and degradation of resin-dentin bonding by feeding minerals back into the collagen network. With a two year, $252,497 grant from the National Institute of Dental & Craniofacial Research, he will investigate guided tissue remineralization, a new nanotechnology process of growing extremely small, mineral-rich crystals and guiding them into the demineralized gaps between collagen fibers.

His idea came from examining how crystals form in nature. "Eggshells and abalone [sea snail] shells are very strong and intriguing," Dr. Tay says. "We're trying to mimic nature, and we're learning a lot from observing how small animals make their shells."

The crystals, called hydroxyapatite, bond when proteins and minerals interact. Dr. Tay will use calcium phosphate, a mineral that's the primary component of dentin, enamel and bone, and two protein analogs also found in dentin so he can mimic nature while controlling the size of each crystal.

Crystal size is the real challenge, Dr. Tay says. Most crystals are grown from one small crystal into a larger, homogeneous one that is far too big to penetrate the spaces within the collagen network. Instead, Dr. Tay will fit the crystal into the space it needs to fill. "When crystals are formed, they don't have a definite shape, so they are easily guided into the nooks and crannies of the collagen matrix," he says.

In theory, the crystals should lock the minerals into the hybrid layer and prevent it from degrading. If Dr. Tay's concept of guided tissue remineralization works, he will create a delivery system to apply the crystals to the hybrid layer after the acid-etching process.

"Instead of dentists replacing the teeth with failed bonds, we're hoping that using these crystals during the bond-making process will provide the strength to save the bonds," Dr. Tay says. "Our end goal is that this material will repair a cavity on its own so that dentists don't have to fill the tooth."

-----
www.fayettefrontpage.com
Fayette Front Page
www.georgiafrontpage.com
Georgia Front Page

Agent Orange exposure increases veterans' risk of aggressive recurrence of prostate cancer

Veterans exposed to Agent Orange are at increased risk of aggressive recurrence of prostate cancer, researchers report.

A study of 1,495 veterans who underwent radical prostatectomy to remove their cancerous prostates showed that the 206 exposed to Agent Orange had nearly a 50 percent increased risk of their cancer recurring despite the fact that their cancer seemed relatively nonaggressive at the time of surgery. And, their cancer came back with a vengeance: the time it took the prostate specific antigen, or PSA, level to double – an indicator of aggressiveness – was eight months versus more than 18 months in non-exposed veterans.

"There is something about the biology of these cancers that are associated with prior Agent Orange exposure that is causing them to be more aggressive. We need to get the word out," says Dr. Martha Terris, chief of urology at the Charlie Norwood VA Medical Center in Augusta and professor of urology at the Medical College of Georgia School of Medicine.

Dr. Terris, corresponding author on the study published in the May issue of British Journal of Urology International, says she wants her colleagues following prostate cancer patients with Agent Orange exposure to know those patients may need more meticulous scrutiny and so-called salvage therapy quickly if their prostate cancer returns. "Not only are their recurrence rates higher but their cancers are coming back and growing much faster when they do come back," the Georgia Cancer Coalition Distinguished Scholar says.

The PSA of prostate cancer patients is typically measured every three months for two years after surgery then every six months for life. After surgery to remove the diseased prostate, the PSA should be zero, but any prostate cancer cells left behind continue to make PSA, a red flag of recurrence, Dr. Terris says. The PSA often "percolates along" so physicians tend to watch it for a while to determine if additional therapy is needed. However in patients with Agent Orange exposure, radiation or hormone therapy to kill remaining cells may need to be done sooner rather than later, she says.

Increasing evidence is emerging that exposure to Agent Orange, a herbicide and defoliant used during the Vietnam War, increases risk for a variety of health problems, including prostate cancer, although the exact mechanism is unclear. Dioxin, its known carcinogen, also is found in herbicides and pesticides used by U.S. farmers, forestry and chemical plant workers who studies have shown to have an increased cancer risk. Scientists suspect dioxin activates regulatory regions of genes to enable the uncontrolled cell division that is a cancer hallmark.

Dr. Terris led a separate study of 1,653 veterans at VA medical centers in five cities between 1990 and 2006 that also showed recurrence rates were higher and recurring cancers were more aggressive with Agent Orange exposure. Dr. Sagar R. Shah, MCG urology resident, presented the findings at the 2007 annual meeting of the American Urological Association.

This new study – which includes the VA Medical Center in Augusta, Veterans Affairs Greater Los Angeles Healthcare System, Veterans Affairs Palo Alto Healthcare System and six affiliated medical schools – included new patients as well as longer follow up on many of the original study patients. As with the previous study, prostate cancer seemed to have a similar course in blacks and whites, but Agent Orange exposure was more common in blacks, who were more likely to be ground troops in Vietnam.

Plenty of questions remain, such as what happens to patients whose primary treatment is standard radiation or brachytherapy, where rice-size radiation pellets are implanted in the prostate, rather than surgery, Dr. Terris says.

She also wants to know whether the veterans' degree of exposure is related to the severity of their cancer. Everyone has some dioxin exposure; "Even if you never set foot in Vietnam or outside the United States," she says. So she is now measuring levels in the body fat – which is like a repository for what the body has been exposed to – to determine how levels correlate to their cancer severity.

Prostate cancer is the most common cancer in men and trails lung cancer as the second leading cause of cancer death.

The study was funded by the Department of Veterans Affairs, the National Institutes of Health, the Georgia Cancer Coalition, the Department of Defense Prostate Cancer Research Program and the American Urological Association/Astellas Rising Star in Urology Award.

-----
www.fayettefrontpage.com
Fayette Front Page
www.georgiafrontpage.com
Georgia Front Page
Follow us on Twitter and Facebook

Male impotence drugs may deserve a second look in women

New studies indicate the three drugs used to treat male impotence also appear to work in females, albeit a little differently, and should give the scientific community pause to take a second look at their potential in the 40 percent of women who report sexual dysfunction, researchers say.

In one of the first studies of the effect of phosphodiesterase Type 5 inhibitors - Viagra®, Levitra® and Cialis® - on the pudendal arteries that supply the penis, vagina and clitoris the blood needed to produce a satisfying sexual experience, Medical College of Georgia researchers showed the drugs relax the artery in male and female rats.

"It shows the drugs need to be investigated more for women and small alterations could make these compounds more effective for women living with these disorders," says Dr. Kyan J. Allahdadi, postdoctoral fellow in physiology at MCG. He's presenting the findings during the 122nd Annual Meeting of the American Physiological Society held in New Orleans April 18-22 as part of the Experimental Biology 2009 scientific conference.

Although there was talk years ago of a pink pill for women to parallel the blue Viagra for men, early clinical trials found essentially no response in women.

MCG researchers decided to look again, first giving a drug to constrict the internal pudendal arteries in male and female rats – as they would be in a non-erect state – then giving doses of each impotency drug to see the impact. The arteries from male rats displayed a relatively standard concentration-dependent relaxation – the more drug they got, the more they relaxed - while in females arteries, there was an initial relaxation then an odd oscillation between relaxation and contraction with subsequent dosing.

While they don't fully understand the swing, the unique female response likely provides more evidence that sexual function is more complex in females, says Dr. R. Clinton Webb, chair of the MCG Department of Physiology and a study author. Scientists define female sexual dysfunction as a multifaceted disorder that includes anatomical, psychological, physiological and social-interpersonal aspects.

MCG researchers have shown part of that complexity may be the smooth muscle cells in the internal pudendal arteries of females communicate, agreeing to contract and relax, while male smooth muscle cells make independent decisions to just relax.

They found one other distinction: females were more sensitive to Viagra®, or sildenafil, while males were most sensitive to Levitra®, or vardenafil.

Previous studies on the effectiveness of these drugs focused on the cavernosal tissue, or penis. The internal pudendal artery actually feeds the penile artery which is buried deep in the penis where numerous caverns enable it to be flaccid when not engorged with blood. Physical stimulation of the area causes the tissue, endothelial cells and nerves to release nitric oxide, a powerful dilator of blood vessels. The system works pretty much the same way in the vagina and clitoris.

"If you have too much constriction or not enough relaxation to allow blood to go through the internal pudendal artery, you are not going to get the net effect of an erection," Dr. Allahdadi says. "That is why we wanted to begin to characterize what was going on in this blood vessel."

Perhaps as importantly, the MCG scientists and others are beginning to believe sexual dysfunction provides an early, or at least visible, clue of vascular disease. Vascular problems, that can result from diabetes, hypertension, high cholesterol and the like, are a major cause of sexual dysfunction in men and women. "You don't feel atherosclerosis but you know darn well if you are not getting an erection," Dr. Webb says. In fact, the MCG scientists are beginning to look at animal models of disease states, such as diabetes, to see what it does to these internal pudendal arteries.

"What we have seen preliminarily is there is big difference in responsiveness in these arteries. The diabetic pudendal arteries are much more sensitive to contraction," Dr. Allahdadi says. They will look at how drugs like Viagra impact that contraction in the days ahead.

In fact MCG scientists suspect one reason that many of the women participants in previous studies of Viagra did not seem to respond is because they did not have vascular problems that could have been circumvented by a drug that relaxes arteries so blood can enter. In men with a healthy vasculature, the drugs likely would still produce a longer erection.

Dr. Rita C. Tostes, associate professor in the MCG Department of Physiology, is a co-author who contributed to the design and analysis of the study.

Toni Baker
Medical College of Georgia

-----
www.fayettefrontpage.com
Fayette Front Page
www.georgiafrontpage.com
Georgia Front Page
Follow us on Twitter and Facebook

Not enough vitamin D in the diet could mean too much fat on adolescents

Too little vitamin D could be bad for more than your bones; it may also lead to fatter adolescents, researchers say.

A Medical College of Georgia study of more than 650 teens age 14-19 has found that those who reported higher vitamin D intakes had lower overall body fat and lower amounts of the fat in the abdomen, a type of fat known as visceral fat, which has been associated with health risks such as heart disease, stroke, diabetes and hypertension.

The group with the lowest vitamin D intake, black females, had higher percentages of both body fat and visceral fat, while black males had the lowest percentages of body and visceral fat, even though their vitamin D intake was below the recommended levels. Only one group – white males – was getting the recommended minimum intake of vitamin D.

“This study was a cross-section so, while it cannot prove that higher intake of vitamin D caused the lower body fat, we know there is a relationship that needs to be explored further," says Dr. Yanbin Dong, a molecular geneticist and cardiologist at the MCG Gerogia Prevention Institute.

Dr. Dong, who also co-directs the MCG Diabetes & Obesity Discovery Institute, and Inger Stallman-Jorgensen, a research dietician at the GPI, present their findings this week at the American Heart Association’s Joint 49th Conference on Cardiovascular Disease Epidemiology and Prevention and Nutrition, Physical Activity and Metabolism in Palm Harbor, Fla.

The pair will next study whether it is feasible for teens to take a daily vitamin D supplement in pill form. Those results will help them design a larger study to explore the relationship between vitamin D intake and body fat levels in teens.

“We already know that encouraging teens to get an adequate amount of vitamin D in their diets will help promote a healthy body as they grow and develop,” Ms. Stallman-Jorgensen says. “Now we need to do intervention studies where we give teens vitamin D supplements to determine if there is a cause and effect relationship between vitamin D intake and fat.”

The American Academy of Pediatrics recommends adolescents get at least 400 units of vitamin D per day – either from milk or sun exposure. There are typically 100 units in one 8-ounce glass of whole milk. The recommended daily dose from the sun would require at least 30 minutes of adequate exposure to direct sunlight two or three times a week at peak hours, between noon and 3 p.m.

Ms. Stallman-Jorgensen said there are many reasons teens don't get enough vitamin D, which has been linked to the prevention of diabetes, cancer and cardiovascular disease.

“As humans, our largest source of vitamin D should be the sun. But we don’t spend enough time outdoors to get enough sun exposure and when we do, we’re often covered up and wearing sunscreen," she said. "We can get vitamin D from certain foods, like fatty fish and liver, but it’s not in a lot of foods that we commonly consume. In this country, our milk is fortified with vitamin D. Unfortunately, teens just don’t drink enough milk to get their daily requirements.”

She points out that low sunlight during the winter months reduces the amount of vitamin D the skin produces, and that darker-skinned people obtain less vitamin D from the sun because the extra melanin in their skin filters out more sunlight.

Some people can't tolerate milk because they lack the enzyme that processes lactose, the natural sugar in milk, though "most people can handle it in small amounts,” Ms. Stallman says.

Cultural issues may also be at play, Ms. Stallman-Jorgensen says.

“Most teens want to drink sodas and sugary drinks. It’s not cool to drink milk – they think of it as more of a food for babies,” she said.

Potential study participants had their weekday and weekend diets tracked by researchers seven times during a three-month period. Those who provided at least four diet reports were included in the final group of 659.

Body fat percentages were measured by dual energy X-ray absorptiometry scans, which can measure total body composition. Visceral fat was measured in a subset of 432 teens.

Jennifer Hilliard
Medical College of Georgia

-----
www.fayettefrontpage.com
Fayette Front Page
www.georgiafrontpage.com
Georgia Front Page

Study Suggests Blood Test for Alzheimer’s Possible

Researchers have revealed a direct relationship between two specific antibodies and the severity of Alzheimer’s disease symptoms, raising hopes that a diagnostic blood test for the devastating disorder is within reach.

Researchers from the University of Georgia, the Charlie Norwood VA Medical Center in Augusta and the Medical College of Georgia compared antibody levels in blood samples from 118 older adults with the participant’s level of dementia. The team, whose results appear in the current edition of Journal of Gerontology: Medical Sciences, found that the concentration of two specific proteins that are involved in the immune response increases as the severity of dementia increases.

“We found a strong and consistent relationship between two particular antibodies and the level of impairment,” said study co-author L. Stephen Miller, professor and director of clinical psychology training in the UGA Franklin College of Arts and Sciences. “The finding brings us closer to our ultimate goal of developing a blood test that can diagnose Alzheimer’s disease or potentially identify if someone is at higher risk for the disease.”

Miller’s co-authors include Jennifer S. Wilson, a former undergraduate student in the UGA Honors program who is now pursing graduate studies at Emory University; Shyamala Mruthinti, research pharmacologist at the VA Medical Center and adjunct professor at MCG; and Jerry Buccafusco, director of the MCG Alzheimer’s Research Center. The team focused on antibodies that the body creates in response to two proteins that are associated with Alzheimer’s disease. One protein, known as amyloid-beta, forms the plaques that are evident in the brains of people with Alzheimer’s upon autopsy. The other protein, known as RAGE, is involved in the normal aging process but is expressed at higher levels in the brains of people with Alzheimer’s.

In a previous study that compared a group of people with Alzheimer’s disease to a healthy control group, Mruthinti and her colleagues found that anti-amyloid beta and anti-RAGE antibodies are significantly higher in the group with Alzheimer’s. The team’s latest study expands on that finding to reveal a direct relationship between severity of Alzheimer’s disease and levels of the two antibodies in the blood.

“Alzheimer’s is an inflammatory disease of the brain, and these two antibodies give us a way to measure that inflammation,” Mruthinti said. “Using them as an early diagnostic marker may allow us to start drug treatment early, when it’s most effective, to increase the patient’s quality of life.”

While optimistic about their findings, the researchers caution that it could still be years before a diagnostic test based on their work is clinically available. The study found that the relationship between the two antibodies and Alzheimer’s severity persists even after controlling for patient age and total antibody levels. To further test the strength of the relationship, the researchers are now working with a sample that controls for other factors that have the potential to influence levels of the two antibodies, such as diabetes and heart disease. Buccafusco and his colleagues are also working to decrease the cost and time involved in the test.

“We’re in the process of trying to reduce the test to a one-day procedure, whereas right now it takes three to four days,” Buccafusco said. “But even now, our test is orders of magnitude cheaper than having people come in every few months to get a functional MRI or PET scan to try to discern brain plaques.”

The team is targeting the two proteins themselves as a possible treatment for Alzheimer’s disease. Mruthinti explains that, individually, amyloid-beta and RAGE proteins don’t provoke an immune response. The trouble begins when the two bind and the immune system attacks, resulting in constant state of inflammation that damages the brain. The researchers recently developed a way to measure levels of amyloid beta-RAGE complex, and preliminary data using transgenic mice that express Alzheimer’s symptoms suggest that an antigen they created to boost the body’s natural immune response to the complex can reduce the formation of the brain plaques.

“The amyloid beta-RAGE complex cuts off the connections between neurons,” Mruthinti explained, “but our hope is that we can protect those connections by preventing those plaques from forming.”

The research was funded by a Merit Review Award from the Veterans Administration to principal investigator Mruthinti and by the Medical College of Georgia Alzheimer’s Research Center.

-----
www.fayettefrontpage.com
Fayette Front Page
Community News You Can Use
Fayetteville, Peachtree City, Tyrone
www.georgiafrontpage.com
Georgia Front Page

Prevalence of Disordered Eating Behaviors in Diabetics Probed

Children with diabetes are at an increased risk for developing eating disorders and researchers want to know if it's their disease or treatment that's to blame.

"Diabetes treatment prescribes obsessive food behavior, such as carbohydrate restriction," said Dr. Deborah Young-Hyman, pediatric psychologist in the Medical College of Georgia's Georgia Prevention Institute. "We want to know if those prescribed behaviors contribute to disordered eating and/or whether there are physiological mechanisms which prevent children with diabetes from controlling their eating behavior. For example, treatment with insulin makes you hungry and can cause you to gain weight."

There is some unfortunate synergy: diabetes makes it difficult to control blood glucose and disordered eating behavior does as well, Dr. Young-Hyman said.

Over the next three years, with funding from the American Diabetes Association, she and researchers at Emory and Harvard universities will study 90 children age 10-17 newly-diagnosed with diabetes or transitioning to an insulin pump. They will monitor treatment patterns, weight, psychological adjustment and attitudes about weight and eating. They'll also look at changes in eating patterns and blood sugar levels in response to insulin.

Children and their parents will answer computer-based questionnaires about eating behaviors and psychological adjustment - in the context of their disease and its treatment.

These include questions about parental attitudes, family factors, personality of the child and parents and perceived societal attitudes.

"As they are diagnosed and are adjusting to diabetes treatment, children are already dealing with all sorts of issues that put them at an increased risk for eating disorders. The psychological issues that come with the diagnosis can add to that risk," she said. "There is also the existing drive for thinness that exists in our society, dealing with the diagnosis and management of a long-term illness and the psychological adjustment that comes with that."

Even the insulin the children must take may be a factor. "Large doses can lead to uncontrolled hunger, which can be mislabeled as disordered eating behavior. Patients with type 1 diabetes also lose amylin production - a hormone responsible for gastric emptying and associated with feelings of fullness - that can also lead to increased feelings of hunger," Dr. Young-Hyman said.

Study findings could support a different treatment approach.

"We might come to understand that putting a child or adolescent on an insulin pump sooner rather than later and providing them with a more flexible nutrition regimen could decrease their insulin needs and prevent excess hunger," she said. "If we don't approach weight control as dieting, place less emphasis on food restriction and focus on healthy nutrition and usual eating patterns, we can help patients gain more control over their eating behaviors and their treatment without adoption of maladaptive weight management strategies. Studies indicate that feeling in control of your illness is one of the keys to successful treatment and good psychological adjustment."

Jennifer Hilliard
Medical College of Georgia

-----
www.fayettefrontpage.com
Fayette Front Page
www.georgiafrontpage.com
Georgia Front Page

Exercise Helps Overweight Children Reduce Anger Expression

Regular exercise seems to reduce anger expression in overweight but otherwise healthy children, researchers said.

The first published study on the topic looked at 208 typically sedentary 7- to 11-year-olds who participated in a 10-15 week afterschool aerobic exercise program or maintained their usual inactive routine. The Pediatric Anger Expression Scale, used to gauge common anger expressions such as slamming doors and hitting, was given before and after the program.

"Exercise had a significant impact on anger expression in children," said Dr. Catherine Davis, clinical health psychologist in the Medical College of Georgia School of Medicine. "This finding indicates that aerobic exercise may be an effective strategy to help overweight kids reduce anger expression and aggressive behavior."

The finding fits with evidence that exercise reduces depression and anxiety in children and with what's considered common knowledge that exercise helps adults manage anger, she said.

It also gives parents and other caregivers another reason to get and keep children moving. "I think it's reasonable to encourage children to exercise for a lot of good reasons," said Dr. Davis whose research on overweight children has shown regular physical activity not only reduces fatness but improves cognition and reduces insulin resistance – which can lead to diabetes.

"I think if teachers could see that exercise helps kids control their behavior and get along, they would be the top proponents of physical activity for kids," said Dr. Davis, noting that other studies suggests overweight children are more likely to be bullies and to be bullied. High levels of anger and hostility have been associated with delinquency in children, cardiovascular disease in adults and metabolic syndrome - which can lead to heart attack, stroke and diabetes - in adolescents.

The new finding, published in the November issue of Pediatric Exercise Science, appears to apply to overweight children generally, regardless of factors such as race, gender, socioeconomic status or even fitness or fatness levels, the researchers wrote. In fact, even though all participants in the exercise portion lost a significant amount of weight, they remained overweight at the study's conclusion.

With help from a five-year $3.6 million grant from the National Heart, Lung and Blood Institute, Dr. Davis already is looking to see if the finding holds in a similar group of children, who are part of a study on the impact of exercise on cognition. The goal is to determine if it was the exercise or participation in an after-school program that made the difference.

Extra attention from adults and time away from usual routines that could include disagreements with siblings and watching violence on television definitely could have a psychological impact. "With a psychological outcome like cognition or anger control, positive interaction with adults can make a big difference," Dr. Davis said.

In the published study, only the exercising children came to MCG's Georgia Prevention Institute after school. In the new study, both groups are coming to the institute, with non-exercisers enjoying arts, crafts and games. "We are trying to make it so the only difference is exercise," said Dr. Davis.

By Toni Baker
Medical College of Georgia

-----
www.fayettefrontpage.com
Fayette Front Page
www.georgiafrontpage.com
Georgia Front Page

Online Course Gives Physicians Useful Info about Community-Associated MRSA

A new bacterial infection is running rampant in communities because of antibiotic abuse, but ironically it is often misdiagnosed and treated with the wrong antibiotics, says a physician working to stop it.

Physicians regularly mistake the abscesses, or pockets of pus, caused by community-associated MRSA, or CA-MRSA, for spider bites and treat them as such, say Dr. Jim Wilde, pediatric emergency medicine and infectious disease physician at the Medical College of Georgia.

"Don't be fooled into thinking it's a spider bite," he says. "Think MRSA if you see a sore like that on somebody's hand or arm. The problem is that doctors are choosing the wrong oral antibiotics or are just not recognizing it at all."

Now they can log on to a new online lecture through the MCG Division of Continuing Education to learn more about this leading cause of skin and soft-tissue infections in the state.

It's part of a statewide educational campaign sponsored by Georgia United against Antibiotic Resistant Disease, or GUARD, to raise awareness about CA-MRSA.

Doctors and the general public can access the lecture at www.mcg.edu/ce/Online/mrsaonline. Physicians can receive continuing medical education credits for participating.

"The lecture, which is the first online continuing medical education course at MCG, is an excellent opportunity to learn more about this epidemic," says Caro Cassels, director of the continuing education division.

"There is a lot of misinformation and misunderstanding about MRSA, even among practicing physicians," says Dr. Wilde, who directs GUARD. "And we see dozens of cases of CA-MRSA in the emergency room every week here. It is a different type of MRSA than what we've known for the last 40 years and is spreading all over the country very rapidly."

MRSA, or methicillin resistant Staph aureus, cannot be killed by methicillin, a type of penicillin. It is spread by physical contact, not by breathing the same air or coughing. It lives on the skin and can survive on others surfaces for at least 24 hours. Hospital-associated MRSA (HA-MRSA) has been rampant inside hospitals since the early 1960s but was rare among healthy people in the community. CA-MRSA popped up around 2003 and quickly spread nationwide, causing infections primarily in healthy people outside hospitals. Infections caused by either form of MRSA can be treated, but HA-MRSA is much more dangerous. Both are resistant to all beta-lactam antibiotics, which are the most widely used class of antibiotics available.

"And yet, despite the fact that most skin and soft-tissue infections now are caused by CA-MRSA, there are still many doctors who are prescribing these antibiotics," Dr. Wilde says. "We're trying to do is get the word out to everyone in the state to stop using beta-lactams for skin infections."

In addition to the online course, 9,700 primary care physicians received educational packets from GUARD. Each packet contains a CA-MRSA fact sheet, an informational poster, a two-page synopsis of Centers for Disease Control and Prevention recommendations for treating CA-MRSA and a fill-in-the-blank discharge sheet. Dr. Wilde also coordinates a speakers' bureau on CA-MRSA with more than 30 members available to deliver lectures anywhere in the state.

GUARD is the Georgia chapter of the CDC's Get Smart about Antibiotic Use Program. The coalition seeks to reduce antibiotic-resistant disease by decreasing inappropriate antibiotic use. The educational campaign also is sponsored by the Georgia Department of Human Resources.

For more information about the online course and coalition, visit www.ga-guard.org.

By Amy Connell
Medical College of Georgia

-----
www.fayettefrontpage.com
Fayette Front Page
Community News You Can Use
Fayetteville, Peachtree City, Tyrone
www.georgiafrontpage.com
Georgia Front Page