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Total Knee Replacement Appears Cost-Effective In Older Adults
Total knee replacement (arthroplasty) appears to be a cost-effective procedure for older adults with advanced osteoarthritis, according to a report in the June 22 issue of Archives of Internal Medicine, one of the JAMA/Archives journals. The procedure appears to be cost-effective across all patient risk groups, and appeared more costly and less effective in low-volume centers than in high-volume centers.

Louisiana House Approves Bill Allowing Providers To Refuse Certain Reproductive Health Services
The Louisiana House on Tuesday voted 82-13 to approve legislation (HB 517) that would allow some health professionals to refuse to provide certain medical services that they object to on religious or moral grounds, the New Orleans Times-Picayune reports.The House-passed bill is an amended version of a measure, introduced by Rep. Bernard LeBas (D), that a House committee rejected earlier this month. The revised bill narrowed the list of procedures that can be denied, and it applies to health providers only in public facilities, not religious health facilities statewide as in the original bill. Under the bill, public health care employees would be allowed to decline to provide abortions or abortifacient drugs. They also would be allowed to refuse participation in embryonic stem cell research or cloning, euthanasia and physician-assisted suicide. Public employees would be immune from civil lawsuits and have job security under the measure.According to the Times-Picayune, Gov. Bobby Jindal"s (R) administration backed the original bill in committee, although state Health Secretary Alan Levine indicated that the bill"s original provisions were too broad. Under the original measure, health care providers would have been allowed to refuse services such as artificial insemination, sterilization, artificial reproductive technologies and "dispensation of drugs affecting the reproductive process." The original measure also would have covered both public and private health care providers (Barrow, New Orleans Times-Picayune, 5/20).Prior to passage, the House approved an amendment to narrow the scope of the bill offered by Rep. John Bel Edwards (D), who said that the original bill"s provisions were not specific enough and could pose problems for private businesses. He also said that the original bill would have posed barriers to patients seeking access to basic treatments and medications (AP/New Orleans Times-Picayune, 5/19). The measure now advances to the state Senate for debate (New Orleans Times-Picayune, 5/20).
News of the day
NPA Holds Health Inequalities Summit
The National Pharmacy Association is organising a Health Inequalities Summit in the Toynbee Hall lecture theatre, Tower Hamlets on Monday 29 June, 10.00am-4.00pm.
Sexual Health

Yeast Missing Sex Genes Undergo Unexpected Sexual Reproduction

An emerging form of the pathogenic yeast Candida is able to complete a full sexual cycle in a test tube, even though it"s missing the genes for reproduction. And it may also do so while infecting us, according to Duke University Medical Center researchers. "Sex contributes to the Candida yeast species" evolutionary success," said Joseph Heitman, M.D., Ph.D., director of the Center for Microbial Pathogenesis in the Duke Department of Molecular Genetics and Microbiology and co-author of two papers that tell the story in Nature and Current Biology. "I think the fact that it has a complete sex cycle is likely to play a role in the evolution of drug resistance in this emerging pathogenic yeast species. " Yeast infections are notoriously hard to treat and yeast are one of the most successful pathogens and commensals in nature, he said. A commensal is an organism that benefits from associating with another organism without affecting the other. Humans are susceptible to three types of yeast infection: thrush (in the mouth and throat), vaginal infection, and a sometimes fatal systemic infection of bloodstream and organs, such as the kidney. In a paper published online May 24 in Nature, Heitman"s team reports that eight Candida species which have a sexual cycle were missing many of the genes related to reproduction found in other species. "The unrecognized sex cycle could mean we need to develop new treatments to combat what is really happening in humans infected by yeast," said co-author Jennifer Reedy M.D. Ph.D. With co-author Anna Floyd, Heitman and Reedy explored the question further in a study appearing in the May 14 Current Biology. The major question was: how could the yeast sexually produce spores when they lack so many genes responsible for meiosis, the process of sexual cell division that reduces chromosomes to half their number in the progeny? By examining and defining the structure and functions of the mating-type genes in yeast, Reedy learned that forms of Candida yeast undergo meiosis but generate offspring of several types. About two-thirds have the classic 50:50 division of chromosomes from the split parent cell, but a third of them have an extra chromosome or even double copies of all chromosomes. "What we found is that the sexual cycle has a new way to create genetic diversity, and it provides a unique vantage point from which we can explore the mechanisms of sexual reproduction," Reedy said. "This provides a new way to study sexual reproduction and how chromosomal abnormalities arise." Heitman said that Candida"s meiosis without meiotic genes may be what gives rise to the progeny with unusual numbers of chromosomes. "Or maybe the genes were lost for a reason, to provide a route to genetic diversity," Heitman said. "Or maybe these differing types of progeny are the unfortunate consequence of undergoing meiosis without the machinery that species normally have when they reproduce sexually." Humans, too, have their share of oddly paired chromosomes. "Experts estimate that about 10 to 30 percent of human eggs or fusion products may be aneuploid, with chromosomes from mother and father not paired exactly one to one, but the great majority of those fusions of sperm and egg don"t make it to the implantation and pregnancy stage," Reedy said. "That"s why it is important to find models like this, so that we may shed light on related human conditions." The Current Biology study was supported by National Institutes of Health/NIAID grants. Dr. Heitman"s work in the Nature study was supported by grants from the NIH/National Institute of Allergy and Infectious Diseases (NIAID). Mary Jane Gore Duke University Medical Center


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