When Bats Attack: New Design Should Improve Safety

Collegiate ballplayers like this athlete from the U.S. Air Force Academy started using the redesigned bats in 2011. Image courtesy Wikimedia Commons/Danny Meyer, USAF/Public Domain

Doctors  know about concussions from football, lacrosse, hockey, and similar contact sports, but what about baseball? Apparently, aluminum baseball bats have been implicated in severe injuries and even deaths in school-aged children.

How? It comes down to physics. According to researchers at Washington University in St. Louis, the aluminum bats currently in use can cause the baseball to rebound so quickly, and with so much force, that even an attentive pitcher can’t always get out of the way in time.  In a tragic example, they cited the 2010 death of a 13-year-old pitcher in Vermont — killed by a line drive off an aluminum bat — and noted there have been other reports of similar fatalities.

To cut down on the risk of serious injuries and deaths from hard-hit line drives, the National Collegiate Athletic Association last season started mandating the use of a new style of aluminum bat. The new bat is engineered to put less energy behind the ball once it’s hit, so it is less likely to cause serious harm.

Here’s one of the researchers explaining of the features of the new bat:

This year, the new bats will be used by high school players as well. The National Federation of State High School Associations will enforce the use of the new bats, so ideally the hazards of school baseball will be limited to bug bites and sore jaws from hours of gum-chewing in the outfield.

–Heidi Splete (@hsplete on Twitter)

The Little Ant With the Big Bite

Just speaking with Dr. Ronald Rapini during the summer meeting of the American Academy of Dermatology  is enough to make you itch. That’s how good he is at describing the vicious attack of the fire ant – as it bites and stings its way northward from its Southern roots.

A native of South America, this aggressive invader established the first Fire Ant Town around Mobile, Ala., in the early 1900s. Rumor has it that the little buggers were stowaways on steamers. Apparently they found American soil so friable (and American flesh so tender) that they have engaged in a relentless northern march, traveling first throughout the southeast and now up both the Eastern and Western seaboards.

Fire ants belong to the same species as wasps and bees. (Photo courtesy Agricultural Research Service, USDA)

Fire ants sport a chillingly descriptive Greek name – Solenopsis invecta, “Unvanquished Channel-Faced.” I leave it to you to decide if the imported red fire ant is “channel-faced,”  but I defy you to deny that it is unvanquished.

These are a species of the Hymenoptera, the insect order that includes wasps and bees, and they share some basic characteristics. Unlike their cousins, fire ants are only winged during the spring, when the await Eros’ call to fly from their nests in a mating frenzy – after which their diaphanous wings drop away and they build ever-more-complicated colonies that can spread throughout entire fields.

They also adhere to their order’s inclination to live in large, hierarchical societies arranged around a queen, with armies of workers bent on aggressive nest defense — much to the dismay of bumbling human feet.

If you invade their space, the ants swarm out with a
double-ended defense, Dr. Rapini, chair of dermatology at the University of Texas Medical School, Houston, said in a video interview.

“Unlike most ants, which just bite you, these guys bite with their huge jaws and then pivot around and sting you,” with a venom filled dagger.

The resulting wounds are painful, itchy, and full of pus.  Although familiar to Southern physicians, who have seen the problem for years, Northerners are just coming to grips with these tiny purveyors of pustular pain.

“Sometimes doctors will even get a biopsy on this because they’ve never seen it before,” Dr. Rapini said.

Because a fire ant bite/sting feels pretty much like someone burning you with a lit cigarette, most  humans are cognizant enough to run hysterically away from a fire ant encounter, doing the “fire ant dance” to shake the critters off their legs and shoes and out of their trousers. But like drinking and driving, drinking and fire ant hills are not a good mix, Dr. Rapini said.

An inebriated man fell asleep on a fire ant hill with dire consequences. (Photo courtesy of Dr. Ronald Rapini)

“My worst case was a guy who got drunk and passed out on a fire ant hill and came in with hundreds of stings,” he said. The patient wound up in the hospital, desperately ill with a bacterial superinfection; treating him required both antibiotics and high-potency corticosteroids.

There have even been reports of fire-ant deaths.

For most folks, though, the bites are painful, but few. A prescription-strength corticosteroid cream will at least help get patients through the worst stages. “It basically is a self-limiting issue; the bites just go away over a week or two,” Dr. Rapini said. “You really have to try not to scratch, though. That’ll make a scab. And pickers get scars.”

And by the way, humans aren’t the only creatures to suffer at the jaws and stingers of fire ants. They can cause terrible injuries in reclining baby animals.

Pets can also be at risk.

As are, apparently  cute little caterpillars and tweeting birdies.

— By Michele G. Sullivan (on Twitter @MGSullivan)

Video of the Week: Celebrating 40 Years of Family Practice, Part I

Family Practice News is celebrating 40 years of covering this primary care medical specialty. Family Practice News was there when the American Academy of General Practice became the American Academy of Family Physicians in 1971.

As family medicine was being formally recognized as a medical specialty in 1971, three young physicians were preparing to enter the field. Family Practice News sat down with the 2nd-year family practice residents at that time to find out what they thought of their training, their newly recognized specialty, and what their careers would hold.

Now, 40 years later, we invited them to look back on how their expectations stacked up to the reality of clinical practice. We’re going to feature their video interviews over the next few weeks. This week, get to know Dr. Alva S. “Buzz” Baker.

The most valuable life lesson from medicine has really been  don’t sweat the small stuff.

Check back weekly to hear more wisdom from the FP class of 1971 and don’t miss our 40th anniversary coverage.

Video of the Week: More Melanoma Treatments on the Way?

A closely watched experimental drug has excited melanoma oncologists and patients with a 63% reduction in the relative risk of death from metastatic melanoma when compared with standard therapy in a phase III trial that had enrolled 675 newly diagnosed patients. Vemurafenib (better known as PLX4032) targets the BRAF V600E mutation found in 40%-60% of melanoma patients. It is only the second melanoma drug to extend the lives of melanoma patients in a randomized clinical study.

The first such agent, ipilimumab (Yervoy), was approved earlier this year, and the melanoma community expects the Food and Drug Administration will award an indication to vemurafenib based on the new data from the BRIM-3 trial. We talked with Dr. Paul Chapman — lead author of the BRIM-3 study — about vemurafenib. He also hypothesized how clinicians would decide which drug — vemurafenib (assuming approval) vs. ipilimumab to use for their patients.

To read more about the BRIM-3 study and the future of melanoma treatment, visit IMNGoncology.

Video of the Week: Has the Time Come for Genetic Testing of Early-Stage Lung Cancer?

Researchers have devised and validated an 11-gene expression test that can distinguish patients with stage I or II lung cancer who have a low, intermediate, or high risk for having micrometastatic disease after primary tumor resection that requires adjuvant chemotherapy. Our reporter Mitchel Zoler asked investigator Dr. Johannes Kratz to discuss the need for and strengths of the test.

The multigene assay can outperform conventional risk factors and staging, and may lead to personalized therapies for patients with early-stage nonsquamous non–small cell lung cancer. [Dr. Krause] 

You can read a more detailed analysis of the test and its implications on the  IMNG Oncology Digital Network.

At 25 Years, NIAMS Celebrates Progress, But Has a Long Way to Go

It’s been 25 years since the establishment of the National Institute of Arthritis and Musculoskeletal and Skin Diseases, and great strides have been made in diagnosis, treatment, and management of numerous conditions, “but you ain’t seen nothing yet,” said Dr. Francis Collins, director of the National Institutes of Health.

Opportunities for medical research have never been as great as they are today, said Dr. Collins, who gave the welcome address for NIAMS’ 25th anniversary at the NIH campus in Bethesda, Md.

Although prominent researchers in the field agreed that research has come a long way in the past 25 years, they stressed that there is still a long way to go. Currently, the molecular basis for 4,000 diseases is known, said Dr. Collins. “But we have effective treatment for only 200.”

In broad strokes, the day-long event touched on the past, present, and future of major diseases of bones, joints, muscles, and skin – including muscular dystrophies, osteoporosis, rheumatoid arthritis, and lupus – through panels and discussion involving prominent researchers, physicians, and patient advocates.

“These diseases are chronic, crippling, and common,” said Dr. Stephen Katz, director of NIAMS, in his opening address. “They affect every family in the United States.”

Among the attendees were many researchers and clinicians who said they felt loyalty and appreciation for receiving funding from NIAMS at some point in their career. For some, the progress in the past 2 decades was quite tangible.

“Public investment in osteoporosis research has really changed how we take care of the patients,” said Dr. Sundeep Khosla, president of the American Society for Bone and Mineral Research. Dr. Khosla, professor at the Mayo Medical School, Rochester, Minn., recalled a time more than 2 decades ago when calcium, vitamin D, and estrogen were the only options he could offer to patients with osteoporosis.

A few years later, bisphosphonates became available, then came anabolic drugs, and now more drugs are in the pipeline. Patient diagnosis also has advanced, he said. Although he agreed that the field still has a long way to go, he was optimistic about more progress. “Who knows what will happen in the next 25 years?” he asked.

There was talk of individualized therapy, balancing research and treatment, and a closer collaboration among scientists, all in the spirit of bringing better diagnosis and treatment to patients.

“We’re in a different world from when all we had was aspirin,” said Dr. Daniel Kastner, a scientific director at the National Human Genome Research Institute. “But what we really want is a cure. And we’re not there yet.”

Naseem S. Miller (@ReportingBack)

Video of the Week: AMA Backs Individual Mandate

The American Medical Association’s House of Delegates voted 326-125 to support the premise that all Americans should be required to buy health insurance if they can afford to do so.

Our reporter Alicia Ault was there to catch AMA President Cecil Wilson’s discussion of the organization’s position on health insurance.

You can read more about the American Medical Association’s House of Delegates activities at Internal Medicine News.

Video of the Week: Good News for Melanoma Finally

For a while, melanoma has been a bit of a red-headed stepchild of oncology. While advances have improved survival in a number of cancers in recent years, little progress had been made in melanoma. At this year’s ASCO annual meeting, new melnoma treatments generated a lot of buzz.

These new drugs are exciting and important because of their activity — meaning that they have an impact and clinical benefit in patients with advanced melanoma.      

Dr. Lynn Schuchter  

Overall survival was 11.2 months in melanoma patients who received  ipilimumab plus dacarbazine group and 9.1 months in the placebo plus dacarbazine group. The study was simultaneously published in the New England Journal of Medicine (2011 June 5 ;doi:10.1056/NEJMoa1104621). Ipilimumab was approved earlier this year as a first-line monotherapy treatment at a dosage of 3 mg/kg.

In another plenary presentation at ASCO, there was a 63% reduction in risk of death with vemurafenib, compared with dacarbazine alone, in metastatic melanoma patients with BRAF mutations. Vemurafenib is an investigational oral drug that inhibits BRAF kinase.

The read more about the results of these drug trials, check out the story in Skin & Allergy News

Video of the Week:

It may be appropriate to forgo dual-energy x-ray absorptiometry scanning and instead use body mass index to rule out osteoporosis in some obese patients, according to the findings of a large study presented by Dr. Thomas Nelson at the annual European Congress of Rheumatology. Our reporter, Heidi Splete, was able to sit down with Dr. Nelson  to talk about the study results.

You can read the story in Internal Medicine News.

Video of the Week: Digestive Disease Week Recap

Digestive Disease Week is billed as the “world’s largest gathering of physicians and researchers in the fields of gastroenterology, hepatology, endoscopy, and gastrointestinal surgery.” Our reporter Heidi Splete has been covering the big stories from the meeting. Here’s her wrap-up of some of yesterday’s important studies: obesity interventions work for preschool-aged children; bariatric surgery is no riskier for older adults.

For more great medical news videos, visit our YouTube page; for in-depth stories and commentary on the latest medical news, visit Internal Medicine News or Family Practice News.