Woman gives birth, then loses all 4 limbs to flesh-eating disease

Lindsey Hubley, of Halifax, Nova Scotia, appears with her first child, Myles, and her fiancee Mike Sampson after giving birth on March 2. Days later, she had all four limbs removed because of flesh-eating disease. Photo courtesy of GoFundMe

A Canadian woman was diagnosed with flesh-eating disease four days after her son was born in March and now she is a quadruple amputee.

Last week, the woman and her fiance filed a negligence lawsuit in Nova ScotiaSupreme Court against the hospital where she gave birth, IWK Health Center, and five doctors.

"What Lindsey and her family have gone through over these past seven months is incomprehensible," said Raymond Wagner, Q.C., counsel for Lindsey Hubley. "She is truly a survivor, and remarkably has maintained a positive and determined attitude along her long road to recovery, all while juggling the struggles, and joys, of a newborn."

Hubley is now infection-free but needs more surgeries, including a kidney transplant.

A Go Fund Me account has raised $94,400.

Hubley, 33, gave birth to her first child, Myles, on March 2. She and her fiance, Mike Sampson, 34, brought their child home two days later.

Early the next day, Hubley began feeling a "sharp, distinct, abdominal pain." At 9 a.m., the couple and their newborn returned to IWK Health Center where doctors said she was suffering from constipation. The family went back home.

After the pain increased the next day, Hubley was rushed in an ambulance to Queen Elizabeth II Emergency. She was suffering from secondary septic shock and her organs were failing.

Hubley was diagnosed with necrotizing fasciitis and placed in a medical coma. Her arms and legs were amputated, and doctors performed a total hysterectomy.

According to the Centers for Disease Control and Prevention, the condition occurs rarely when bacteria enters the body through an open wound.

Hubley is still primarily confined to a hospital bed seven months later.

"In addition to the surgeries and life-altering changes Lindsey has had to go through, no mother should have to miss out on the first months of her son's life," Sampson said. "We're grateful she's recovering, but it's a long road ahead."

Fertility tests may not be best gauge of your biological clock

Women in their 30s and early 40s who want to know whether their biological clocks are running out should skip fertility testing, a new study suggests.
Fertility clinics commonly use blood and urine tests to assess the quantity and quality of eggs remaining in a woman's ovaries -- information that clinicians can use in making decisions about treating infertile women.

However, a study in the Oct. 10 issue of the Journal of the American Medical Association found that these tests cannot predict whether a woman in her later reproductive years will get pregnant naturally.

"We were hoping to see that these biomarkers would predict a woman's ability to get pregnant, but we didn't find that," said Dr. Anne Steiner, the study's lead author.

Steiner, a professor of obstetrics and gynecology at the University of North Carolina, Chapel Hill, said there's "huge interest" in such a fertility test.

Women generally have more trouble getting pregnant as they age. The egg supply dwindles later in life, and the quality of the remaining eggs declines. As a result, Steiner explained, women often want assurance that there's still time to start a family or confirmation that they should freeze their eggs for a future pregnancy.

The age at which a woman can no longer conceive varies from person to person. About one-third of couples will have trouble getting pregnant if the female is 35 or older, according to the American Society for Reproductive Medicine.

Low levels of anti-mullerian hormone (AMH) and high levels of follicle-stimulating hormone (FSH) are considered indicators of low "ovarian reserve," meaning that a woman has fewer available eggs. That has fueled women's interest in having blood and urine tests done during annual checkups to monitor their fertility. It's also fueled a market for over-the-counter urine tests that measure FHS.

Consumers may pay well over $100 for FSH testing, depending on where the test is performed and other variables, according to Healthcare Bluebook, which tracks health care cost and quality data. That doesn't include the cost of the physician office visit. A "fair price" is about $49, according to the company's consumer website.

Blood collection and analysis can run from $80 to about $200, Steiner estimated.

Do-it-yourself test kits also are available. One online retailer listed two urine test sticks for $20.

But do blood and urine tests provide an accurate window into a woman's ability to conceive?

To find out, Steiner and her colleagues recruited women 30 to 44 years old with no known history or risk factors for infertility who were just starting to try to get pregnant. The investigators took their blood and urine samples and followed them for a year to see whether the women conceived.

As expected, AMH levels decreased and FSH levels increased with age. But after accounting for age, women with low ovarian reserve were just as likely to get pregnant as were those with normal values.

Thomas Price, a Duke University obstetrician/gynecologist and president of the Society for Reproductive Endocrinology and Fertility, said that "these tests are very good at predicting how many eggs a woman is going to make with injectable fertility drugs."

But, Steiner added, these tests cannot be recommended as a predictor of natural pregnancy.

"Age should really be the driver in their reproductive plans, not these biomarker values," she said.

New vaccine protects against nine types of HPV

    A recent study showed a new vaccine protects against nine type of HPV infection. Photo by Adam Gregor/Shutterstock

Researchers at the H. Lee Moffitt Cancer Center & Research Institute found that an improved vaccine is able to protect against nine types of HPV.

The human papillomavirus, or HPV, is a very common sexually transmitted disease that causes genital and anal warts and is a significant risk factor for cervical cancer.
Cervical cancer is the second most common cause of cancer-related deaths worldwide, with nearly 300,000 deaths each year. More than 80 percent of these deaths happen in developing countries.

There are more than 100 types of HPV, however, only 13 types are associated with cancer development, with HPV 16 and 18 estimated to cause the majority of cervical cancers at 70 percent.

There are two existing HPV vaccines, Cervarix and Gardasil, that are effective at preventing infection from HPV 16 and 18. Gardasil can also protect against HPV 6 and 11. But both Cervarix and Gardasil do not protect against all types of HPV.

Researchers found that the newest HPV vaccine, 9vHPV, is highly effective at preventing HPV infection and protects against HPV 16, 18, 6, 11 and another five types of HPV: 31, 33, 45, 52 and 58. The 9vHPV vaccine or Gardasil was randomized on 14,215 women age 16 to 26.

The study, published Tuesday in The Lancet, found that 9vHPV has long-term effectiveness against HPV and reduced the risk of developing HPV 31, 33, 45, 52 and 58 by 97.7 percent compared to Gardasil.

"Based on epidemiological studies, the 9vHPV vaccine could prevent approximately 90 percent of cervical cancer, 90 percent of HPV-related vulvar and vaginal cancer, 70 to 85 percent of high-grade cervical disease in females, and approximately 90 percent of HPV-related anal cancer and genital warts in males and females worldwide," Anna R. Giuliano, director of the Center for Infection Research in Cancer at Moffitt, said in a news release.

Pregnant women shouldn’t start taking vitamin B3 just yet: reports it prevents miscarriage and birth defects are overblown

Reports on a new study claim supplementation with vitamin B3 during pregnancy could prevent miscarriages and birth defects.

So should all pregnant women start taking B3 supplements? Not so fast. While this is an interesting and well-done study, the researchers didn’t actually give vitamin B3 to any humans, so we need a lot more information before we can recommend it.

What the study found

The study identified genetic causes of a rare type of birth defect called “VACTERL association”. VACTERL stands for vertebral defects, anal atresia (problems with the tissue closing the anus), cardiac defects, tracheo-esophageal fistula (an abnormal connection between the windpipe and the foodpipe), renal anomalies (kidney defects), and limb abnormalities. Affected babies have anomalies in at least three of these.

US statistics show about one in 10,000-40,000 babies are affected by VACTERL association and some of these babies die. There are about 310,000 babies born in Australia each year.

The study authors looked at the genes of 13 families affected by this type of birth defect. For the defect to be passed on to offspring it has to be present in both parents’ genes - if it’s only present in one gene the other healthy one will compensate.

They pinpointed the variations in two genes responsible for these defects in four of the families. These two genes play a role in making “nicotinamide adenine dinucleotide” or NAD, which helps cells make energy out of glucose. NAD also assists in repairing DNA. NAD is synthesised in the body from tryptophan, an amino acid, or from niacin, also known as vitamin B3.

Then the authors genetically engineered mice and deleted these genes. They found that without them the mice had NAD deficiency, and similar malformations in their offspring.

However, when they provided extra niacin to pregnant mice, the pups were relatively normal despite the absent gene.


What does this mean?

This does NOT mean that taking niacin/vitamin B3 in pregnancy prevents miscarriages and all birth defects.

It means that high levels of niacin in pregnancy compensates for defects in the two selected genes, and prevents mice from experiencing miscarriage and birth defects in offspring. The paper does not report on human miscarriage or on malformations in human organs. The study did not supplement pregnant women with vitamin B3, or with anything else.

There have been previous studies showing mutations in other genes are also associated with VACTERL and it’s likely that different genes contribute to these malformations. Not all babies with VACTERL will have the same mutations.

But it’s important we understand the role of different genes in birth anomalies and this paper has not only identified genetic mutations in two genes, but also the mechanism by which they cause them and an easily obtained potential remedy for these cases.

Other causes of miscarriage

A large number of genes when deleted in mice have been shown to cause miscarriage and malformations. Many of these are not involved in the NAD pathway. Most have not been associated with human miscarriage but a few may be.

For example, deficiency in an immune system molecule (cytokine) called “GM-CSF” has been shown to cause miscarriage and defects in the placenta in mice. Addition of this molecule to IVF embryos prevents miscarriage in mice and in humans prevents miscarriage in high-risk women (those who have previously had a miscarriage following IVF). This is but one example unrelated to NAD.

Can supplements prevent birth defects?

From 1986-2007, 5.9% of South Australian births (so 590 out of 10,000) were complicated by congenital malformations, most of which were not severe or life threatening. The most common malformations are in the urinary and genital systems (164/10,000 births) and the cardiovascular system (119/10,000) and range from mild to severe life-threatening malformations requiring extensive surgery.

For many of these there is no known cause nor remedy. For neural tube (brain and spine/spinal cord) defects such as spina bifida (which occur in 16 in 10,000 births), maternal supplementation with folic acid from one month before conception and in the first trimester of pregnancy has been shown to reduce their incidence.

The Australian population is not considered to be deficient in niacin. Most breakfast cereals have niacin added to them as do some flours for baking; it is also present in meat, green vegetables and whole grain cereals.

A 2010 study in California showed that in women who did not use micronutrient supplements in pregnancy, low dietary intakes of folate, niacin, riboflavin, and vitamins B12, A and E were associated with one specific major heart defect but not another. So not one, but a number of micronutrients are involved in birth defects, notably several B vitamins.

Clearly, folic acid supplementation to prevent neural tube defects has been successful, but emerging evidence suggests a potential downside. Specifically, the babies of women who supplemented with folic acid in late pregnancy were more likely to have persistent asthma in early childhood.

Since 2009 we’ve had mandatory fortification of flour for bread-making with folic acid in Australia and New Zealand. Together with folic acid supplementation in pregnancy, pregnant women are getting high amounts of folic acid. Given folate plays a part in gene expression (the process by which information from a gene is used), it’s possible too much may not be a good thing. But we’re yet to see hard evidence of this.

This new study is scientifically excellent and the authors have great credentials. But media reports, and the research institution itself, have made claims not supported by the science. Whether niacin is useful in human miscarriage has not been studied. The birth defects studied in the paper are rare and whether the findings apply to others is yet to be determined.

So potential parents need to be aware that, no, we have not found a way to prevent miscarriages and birth defects. And potential mothers should not start supplementing their diets with high levels of vitamin B3 because it hasn’t been tested in humans, and we don’t know what effects it will have.