Santa gives up smoking in new 'Night Before Christmas'

As a role model, Santa’s got some health issues. He’s overweight, and he zooms around the world in terrible weather and drops down soot-filled chimneys. But worst of all in the mind of anti-smoking crusader Pamela McColl is that “stump of a pipe he held tight in his teeth.”

“I just really don’t think Santa should be smoking in the 21stcentury,” McColl said by telephone. And she did something about it – published a version of the beloved poem “A Visit From St. Nicholas” with the smoking references – including illustrations – excised.

It’s tough to find anyone who would advocate for children to smoke, but that’s not to say the new version of the poem is getting unanimous support. Critics doubt Santa’s pipe will get youngsters to light up, and they say it's not OK to muck with the original poem.

“My fear is not that kids will read 'Twas the Night Before Christmas' and take up smoking. My fear is that kids will take their cues from models I revere nowhere near as much as I revere literature,” said David Kipen, owner of Libros Schmibros bookstore in Los Angeles and a longtime literature advocate.

McColl, a Canadian publisher, said she came across a smoking Santa while browsing in a library. It was, she said, a eureka moment.

“I grew up in the '60s, in the ‘Mad Men’ series,” said McColl, herself a former smoker. And when she looked at her childhood edition of the Christmas Eve story, she found Santa smoking on half of the pages.

“A lot of people my age have lost someone to smoking,” McColl said. “And I thought, ‘Oh my. This is a great project.’”

“… And the smoke, it encircled his head like a wreath,” reads the poem, first published in 1823 and attributed to Clement C. Moore – and called by virtually everyone “Twas the Night Before Christmas.”

So with illustrators Elena Almazova and Vitaly Shvarov, McColl put out the new version (published by Grafton and Scratch, in Spanish, English and French), with a note from Santa on the back flap that says his fur is fake and he has “decided to leave all of that old tired business of smoking well behind us.”

The reaction, McColl said, has been mixed: support from children’s advocates and pediatricians but strong criticism from librarians and those who oppose censorship.

“It bespeaks such a wholesale misunderstanding of what literature is or does,” Kipen said. “Given a choice of kids smoking or not smoking, I would come out on the side of kids not smoking. But I don’t think the means justify the ends.”

He added, "Smoking killed my dad, so it’s not like I'm an apologist for the devil weed."
McColl said she’s not out to eliminate the other versions of the tale.

“I didn’t run into any opposition until someone said he’s a historical figure. He’s not historical to the people I’m worried about. To children, he’s real. He’s coming down the chimney and he’s smoking in the middle of the living room,” she said.

As for Santa’s “chubby and plump” stature, McColl said she’ll leave that to others.

“He doesn’t eat in the story. That’s not my issue," she said. "That’s Jamie Oliver and other people’s issue.”

Bibliography: http://www.latimes.com/health/boostershots/la-heb-santa-smoking-new-night-before-christmas-20121018,0,495035.story?track=rss&utm_source=dlvr.it&utm_medium=twitter&dlvrit=53001

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Fungal meningitis outbreak claims 20 lives

The number of deaths linked to a rare fungal meningitis outbreak rose to 20 on Thursday as health officials announced new evidence tying the illnesses to tainted steroid medication.

According to the Centers for Disease Control and Prevention and the Food and Drug Administration, scientists have confirmed the presence of a fungus known as Exserohilum rostratum in unopened vials of preservative-free methylprednisolone acetate that were packaged by New England Compounding Center in Framingham, Mass.

The vials belonged to one of three lots of medicine that NECC had produced. The company has since been shut down.

"The laboratory confirmation further links steroid injections from these lots from NECC to the multi-state outbreak of fungal meningitis and joint infections," the FDA announced in a news release. "Testing on the other two implicated lots of methylprednisolone acetate and other NECC injectables continues."

CDC and state health departments estimate that approximately 14,000 patients were exposed to the tainted medication. The injections were primarily given as epidural injections to older patients.

The outbreak has focused intense scrutiny on the pharmaceutical compounding industry, which is not regulated by federal authorities. Instead, oversight falls to individual states.

In an article published online Thursday in the Annals of Internal Medicine, Dr. John R. Perfect wrote that physicians and healthcare providers should be prepared to observe patients for a period of months following injection with the tainted medication, as the illness can be extremely slow to develop.

Perfect was among a group of physicians who treated patients who became ill after being injected with the same compounded drug in 2002.

"We learned, or thought we learned, several important lessons," Perfect wrote of that earlier outbreak. "Compounding of preservative-free corticosteroids requires meticulous sterility to ensure lack of fungal contamination; in the absence of that level of sterility and in an environment of highly concentrated steroids, fungi grow aggressively."

Bibliography: http://www.blogger.com/blogger.g?blogID=5587518269877982406#editor/src=header

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Tuberculosis

Key facts

• Tuberculosis (TB) is second only to HIV/AIDS as the greatest killer worldwide due to a single infectious agent.
• In 2011, 8.7 million people fell ill with TB and 1.4 million died from TB.
• Over 95% of TB deaths occur in low- and middle-income countries, and it is among the top three causes of death for women aged 15 to 44.
• In 2010, there were about 10 million orphan children as a result of TB deaths among parents.
• TB is a leading killer of people living with HIV causing one quarter of all deaths.
• Multi-drug resistant TB (MDR-TB) is present in virtually all countries surveyed.
• The estimated number of people falling ill with tuberculosis each year is declining, although very slowly, which means that the world is on track to achieve the Millennium Development Goal to reverse the spread of TB by 2015.
• The TB death rate dropped 41% between 1990 and 2011.

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Tuberculosis (TB) is caused by bacteria (Mycobacterium tuberculosis) that most often affect the lungs. Tuberculosis is curable and preventable.
TB is spread from person to person through the air. When people with lung TB cough, sneeze or spit, they propel the TB germs into the air. A person needs to inhale only a few of these germs to become infected.
About one-third of the world's population has latent TB, which means people have been infected by TB bacteria but are not (yet) ill with disease and cannot transmit the disease.
People infected with TB bacteria have a lifetime risk of falling ill with TB of 10%. However persons with compromised immune systems, such as people living with HIV, malnutrition or diabetes, or people who use tobacco, have a much higher risk of falling ill.
When a person develops active TB (disease), the symptoms (cough, fever, night sweats, weight loss etc.) may be mild for many months. This can lead to delays in seeking care, and results in transmission of the bacteria to others. People ill with TB can infect up to 10-15 other people through close contact over the course of a year. Without proper treatment up to two thirds of people ill with TB will die.

Who is most at risk?

Tuberculosis mostly affects young adults, in their most productive years. However, all age groups are at risk. Over 95% of cases and deaths are in developing countries.
People who are co-infected with HIV and TB are 21 to 34 times more likely to become sick with TB (see TB and HIV section). Risk of active TB is also greater in persons suffering from other conditions that impair the immune system.
About half a million children (0-14 years) fell ill with TB, and 64 000 children died from the disease in 2011. Tobacco use greatly increases the risk of TB disease and death. More than 20% of TB cases worldwide are attributable to smoking.

Global impact of TB

TB occurs in every part of the world. In 2011, the largest number of new TB cases occurred in Asia, accounting for 60% of new cases globally. However, Sub-Saharan Africa carried the greatest proportion of new cases per population with over 260 cases per 100 000 population in 2011.
In 2011, about 80% of reported TB cases occurred in 22 countries. Some countries are experiencing a major decline in cases, while cases are dropping very slowly in others. Brazil and China for example, are among the 22 countries that showed a sustained decline in TB cases over the past 20 years. In the last decade, the TB prevalence in Cambodia fell by almost 45%.

Symptoms and diagnosis

Common symptoms of active lung TB are cough with sputum and blood at times, chest pains, weakness, weight loss, fever and night sweats.
Many countries still rely on a long-used method called sputum smear microscopy to diagnose TB. Trained laboratory technicians look at sputum samples under a microscope to see if TB bacteria are present. With three such tests, diagnosis can be made within a day, but this test does not detect numerous cases of less infectious forms of TB.
Diagnosing MDR-TB (see Multidrug-resistant TB section below) and HIV-associated TB can be more complex. A new two-hour test that has proven highly effective in diagnosing TB and the presence of drug resistance is now being rolled-out in many countries.
Tuberculosis is particularly difficult to diagnose in children.

Treatment

TB is a treatable and curable disease. Active, drug-sensitive TB disease is treated with a standard six-month course of four antimicrobial drugs that are provided with information, supervision and support to the patient by a health worker or trained volunteer. Without such supervision and support, treatment adherence can be difficult and the disease can spread. The vast majority of TB cases can be cured when medicines are provided and taken properly.
Since 1995, over 51 million people have been successfully treated and an estimated 20 million lives saved through use of DOTS and the Stop TB Strategy recommended by WHO and described below.

TB and HIV

At least one-third of the 34 million people living with HIV worldwide are infected with TB bacteria, although not yet ill with active TB. People living with HIV and infected with TB are 21 to 34 times more likely to develop active TB disease than people without HIV.
HIV and TB form a lethal combination, each speeding the other's progress. Someone who is infected with HIV and TB is much more likely to become sick with active TB. In 2011 about 430 000 people died of HIV-associated TB. Almost 25% of deaths among people with HIV are due to TB. In 2011 there were an estimated 1.1 million new cases of HIV-positive new TB cases, 79% of whom were living in Africa.
As noted below, WHO recommends a 12-component approach to integrated TB-HIV services, including actions for prevention and treatment of infection and disease, to reduce deaths. Through the implementation of this approach, an estimated 1.3 million lives were saved globally between 2005 and 2011.

Multidrug-resistant TB

Standard anti-TB drugs have been used for decades, and resistance to the medicines is growing. Disease strains that are resistant to a single anti-TB drug have been documented in every country surveyed.
Multidrug-resistant tuberculosis (MDR-TB) is a form of TB caused by bacteria that do not respond to, at least, isoniazid and rifampicin, the two most powerful, first-line (or standard) anti-TB drugs.
The primary cause of MDR-TB is inappropriate treatment. Inappropriate or incorrect use of anti-TB drugs, or use of poor quality medicines, can all cause drug resistance.
Disease caused by resistant bacteria fails to respond to conventional, first-line treatment. MDR-TB is treatable and curable by using second-line drugs. However second-line treatment options are limited and recommended medicines are not always available. The extensive chemotherapy required (up to two years of treatment) is more costly and can produce severe adverse drug reactions in patients.
In some cases more severe drug resistance can develop. Extensively drug-resistant TB, XDR-TB, is a form of multi-drug resistant tuberculosis that responds to even fewer available medicines, including the most effective second-line anti-TB drugs.
There were about 310 000 cases of MDR-TB among notified TB patients with pulmonary TB in the world in 2011. Almost 60% of these cases were in India, China and the Russian Federation. It is estimated that about 9% of MDR-TB cases had XDR-TB.

WHO response

WHO's pursues six core functions in addressing TB.

• Provide global leadership on matters critical to TB.
• Develop evidence-based policies, strategies and standards for TB prevention, care and control, and monitor their implementation.
• Provide technical support to Member States, catalyze change, and build sustainable capacity.
• Monitor the global TB situation, and measure progress in TB care, control, and financing.
• Shape the TB research agenda and stimulate the production, translation and dissemination of valuable knowledge.
• Facilitate and engage in partnerships for TB action.

The WHO’s Stop TB Strategy, which is recommended for implementation by all countries and partners, aims to dramatically reduce TB by public and private actions at national and local levels such as:

• pursue high-quality DOTS expansion and enhancement. DOTS is a five-point package to:
• secure political commitment, with adequate and sustained financing
• ensure early case detection, and diagnosis through quality-assured bacteriology
• provide standardized treatment with supervision and patient support
• ensure effective drug supply and management and
• monitor and evaluate performance and impact;
• address TB-HIV, MDR-TB, and the needs of poor and vulnerable populations;
• contribute to health system strengthening based on primary health care;
• engage all care providers;
• empower people with TB, and communities through partnership;
• enable and promote research.

Bibliography: http://www.who.int/mediacentre/factsheets/fs104/en/index.html


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Eating fatten more quickly?

Scientists at the University of Athens (Greece) in a recent study showed that eating fast, compared to doing it slowly reduces segregation of hormones in the gut that cause the feeling of being "full". The reduction of these hormones would lead to overeating and, therefore, to get fat.

In the experiment conducted by Alexander Kokkinos and colleagues Laiko General Hospital, a number of individuals took identical amounts (300 milliliters) of the same ice cream at different speeds. The scientists then took blood samples from all participants in the trial, finding that those who had eaten more slowly had higher concentrations of intestinal reducing appetite. Specifically, when ingested in thirty minutes the ice cream instead of five, concentrations of the gut peptides GLP1 and PYY was greater, which is why the feeling of satiety was presented before.

According to the researchers, these results help explain how the current lifestyle, with its fast pace, could be influencing the excess food we consume.

Bibliography: http://www.muyinteresante.es/iengordamos-mas-comiendo-rapido?utm_source=twitter&utm_medium=socialoomph&utm_campaign=muy-interesante-twitter84519

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E. coli outbreak in Belfast is 'a major crisis' says PHA

An E. coli outbreak linked to a Belfast restaurant has been described as "major public health crisis" by Northern Ireland's Public Health Agency (PHA).

The PHA said there are now 20 confirmed cases and 118 suspected cases of food poisoning following an investigation at Flicks restaurant at Cityside Mall.

Six people have been hospitalised since the start of the outbreak, but most have since been discharged.

Dr Michael Devine from the PHA said it was NI's worst ever E. coli outbreak.
He said that over the past decade, the number of people affected in previous E. coli outbreaks here had never exceeded 20.
The doctor, who is the PHA's consultant in health protection, told BBC Radio Ulster's Nolan Show that the agency was "not in anyway underestimating the scale of what we're dealing with here".
Eight children under the age of 14 are among the suspected cases to date, he said.

Inspections

A separate E. coli outbreak in August affected four people who ate in the same restaurant on York Street.

At the time, the PHA and Belfast City Council environmental health officers carried out an investigation and all tests on the restaurant were negative.

The owner of Flicks, Michael McAdam, said there was "no definitive evidence" in August that the four people had contracted the poisoning at his restaurant.

"I would not dream of opening the doors of a restaurant if we were doing something wrong," he said.

"It would be commercial suicide and apart from that to endanger people would be ridiculous."

He added that hygiene in the kitchen met the highest standards.

"All of our books and health checks are up to date, staff training is all up to date. We have followed every rule and regulation. We take our job seriously and where this came from I have no idea," he said.

In the latest outbreak, the first case was reported to the agency on Tuesday 9 October and, two days later, the PHA had established that a total of four people who had eaten at Flicks had all been infected with E. coli.

Staff at the restaurant were informed and they voluntarily closed to the public at 18:30 BST on 11 October.

Dr Devine told the Nolan Show: "We are dealing with a major public health crisis with these cases and we must ensure that we prevent any preventable cases.

"There will be an investigation, there will be analysis of the results and if any link to the August cases is established then that will have to be looked into."

The doctor explained that in August, judgements had been made based on environmental inspections and the results of food samples tests which had indicated the outbreak "appeared to be contained at that stage".

Incubation period

"There were no further cases from mid-August until we were told about the case on 9 October, which suggested there was no ongoing issue at the restaurant in that time. You can appreciate that if there was an ongoing issue at any facility, you would expect cases to become apparent.
"The incubation period is typically three to five days, but can be up to 10 to 14 days", he said.
"But, in any event, we would have expected to see more cases associated with Flicks restaurant if there had been an ongoing problem."
In a subsequent statement issued by the PHA, Dr Devine said the numbers affected would probably rise in the coming days due to the incubation period.
"We expect therefore to see a further increase in cases as people continue to report symptoms and submit samples for testing. This does not reflect a worsening situation."
The PHA has advised anyone who ate at Flicks restaurant since 24 September, and has symptoms including diarrhoea or abdominal pain, to contact their GP urgently for medical advice.

Bibliography: http://www.bbc.co.uk/news/uk-northern-ireland-19958572#?utm_source=twitterfeed&utm_medium=twitter

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Genital HPV Infection - Fact Sheet

What is genital HPV infection?

Genital human papillomavirus (also called HPV) is the most common sexually transmitted infection (STI). There are more than 40 HPV types that can infect the genital areas of males and females. These HPV types can also infect the mouth and throat. Most people who become infected with HPV do not even know they have it.

HPV is not the same as herpes or HIV (the virus that causes AIDS). These are all viruses that can be passed on during sex, but they cause different symptoms and health problems.

What are the signs, symptoms and potential health problems of HPV?

Most people with HPV do not develop symptoms or health problems from it. In 90% of cases, the body’s immune system clears HPV naturally within two years.  But, sometimes, HPV infections are not cleared and can cause:

• Genital warts
• Rarely, warts in the throat -- a condition called recurrent respiratory papillomatosis, or RRP.  When this occurs in children it is called juvenile-onset RRP (JORRP).
• Cervical cancer and other, less common but serious cancers, including cancers of the vulva, vagina, penis, anus, and oropharynx (back of throat including base of tongue and tonsils).

The types of HPV that can cause genital warts are not the same as the types that can cause cancers. There is no way to know which people who get HPV will go on to develop cancer or other health problems.

Signs and symptoms of HPV-related problems:

Genital warts usually appear as a small bump or group of bumps in the genital area. They can be small or large, raised or flat, or shaped like a cauliflower. Health care providers can diagnose warts by looking at the genital area during an office visit. Warts can appear within weeks or months after sexual contact with an infected partner—even if the infected partner has no signs of genital warts. If left untreated, genital warts might go away, remain unchanged, or increase in size or number. They will not turn into cancer.

Cervical cancer usually does not have symptoms until it is quite advanced. For this reason, it is important for women to get regular screening for cervical cancer. Screening tests can find early signs of disease so that problems can be treated early, before they ever turn into cancer.

Other HPV-related cancers might not have signs or symptoms until they are advanced and hard to treat.  These include cancers of the vulva, vagina, penis, anus, and oropharynx (back of throat including base of tongue and tonsils). For signs and symptoms of these cancers, see www.cancer.gov.

RRP is a condition in which warts grow in the throat. These growths can sometimes block the airway, causing a hoarse voice or troubled breathing.

How do people get HPV?

HPV is passed on through genital contact, most often during vaginal and anal sex. HPV may also be passed on during oral sex and genital-to-genital contact. HPV can be passed on between straight and same-sex partners—even when the infected partner has no signs or symptoms.

A person can have HPV even if years have passed since he or she had sexual contact with an infected person. Most infected persons do not realize they are infected or that they are passing the virus on to a sex partner. It is also possible to get more than one type of HPV.

Rarely, a pregnant woman with genital HPV can pass HPV to her baby during delivery. Very rarely, the child can develop juvenile-onset recurrent respiratory papillomatosis (JORRP).

How does HPV cause genital warts and cancer?

HPV can cause normal cells on infected skin to turn abnormal. Most of the time, you cannot see or feel these cell changes. In most cases, the body fights off HPV naturally and the infected cells then go back to normal. But in cases when the body does not fight off HPV, HPV can cause visible changes in the form of genital warts or cancer. Warts can appear within weeks or months after getting HPV. Cancer often takes years to develop after getting HPV.

How common are HPV and related diseases?

HPV (the virus). Approximately 20 million Americans are currently infected with HPV. Another 6 million people become newly infected each year. HPV is so common that at least 50% of sexually active men and women get it at some point in their lives.

Genital warts. About 1% of sexually active adults in the U.S. have genital warts at any one time.

Cervical cancer. Each year, about 12,000 women get cervical cancer in the U.S. Almost all of these cancers are HPV-associated.

Other cancers that can be caused by HPV are less common than cervical cancer. Each year in the U.S., there are about:

• 1,500 women who get HPV-associated vulvar cancer
• 500 women who get HPV-associated vaginal cancer
• 400 men who get HPV-associated penile cancer
• 2,700 women and 1,500 men who get HPV-associated anal cancer
• 1,500 women and 5,600 men who get HPV-associated oropharyngeal cancers (cancers of the back of throat including base of tongue and tonsils) [Note: Many of these cancers may also be related to tobacco and alcohol use.]

Certain populations are at higher risk for some HPV-related health problems. This includes gay and bisexual men, and people with weak immune systems (including those who have HIV/AIDS).

RRP is very rare. It is estimated that less than 2,000 children get juvenile-onset RRP every year in the U.S.

How can people prevent HPV?

There are several ways that people can lower their chances of getting HPV:

• Vaccines can protect males and females against some of the most common types of HPV that can lead to disease and cancer. These vaccines are given in three shots. It is important to get all three doses to get the best protection. The vaccines are most effective when given at 11 or 12 years of age.
  • Girls and women: Two vaccines (Cervarix and Gardasil) are available to protect females against the types of HPV that cause most cervical cancers. One of these vaccines (Gardasil) also protects against most genital warts. Gardasil has also been shown to protect against anal, vaginal and vulvar cancers. Either vaccine is recommended for 11 and 12 year-old girls, and for females 13 through 26 years of age, who did not get any or all of the shots when they were younger. These vaccines can also be given to girls beginning at 9 years of age. It is recommended to get the same vaccine brand for all three doses, whenever possible.
  • Boys and men: One available vaccine (Gardasil) protects males against most genital warts and anal cancers. Gardasil is recommended for 11 and 12 year-old boys, and for males 13 through 26 years of age, who did not get any or all of the shots when they were younger.
• For those who choose to be sexually active, condoms may lower the risk of HPV. To be most effective, they should be used with every sex act, from start to finish. Condoms may also lower the risk of developing HPV-related diseases, such as genital warts and cervical cancer. But HPV can infect areas that are not covered by a condom - so condoms may not fully protect against HPV.
• People can also lower their chances of getting HPV by being in a faithful relationship with one partner; limiting their number of sex partners; and choosing a partner who has had no or few prior sex partners. But even people with only one lifetime sex partner can get HPV. And it may not be possible to determine if a partner who has been sexually active in the past is currently infected. That's why the only sure way to prevent HPV is to avoid all sexual activity.

How can people prevent HPV-related diseases?

There are ways to prevent the possible health effects of HPV, including the two most common problems: genital warts and cervical cancer.

• Preventing genital warts: A vaccine (Gardasil) is available to protect against most genital warts in males and females (see above).
• Preventing Cervical Cancer: There are two vaccines (Cervarix and Gardasil) that can protect women against most cervical cancers (see above). Cervical cancer can also be prevented with routine cervical cancer screening and follow-up of abnormal results. The Pap test can find abnormal cells on the cervix so that they can be removed before cancer develops. An HPV DNA test, which can find HPV on a woman's cervix, may also be used with a Pap test in certain cases. Even women who got the vaccine when they were younger need regular cervical cancer screening because the vaccine protects against most, but not all, cervical cancers.
• Preventing Anal Cancers:  A vaccine (Gardasil) is available to protect against most anal cancers in males and females. Screening for anal cancer is not routinely recommended because more information is still needed to find out if screening and follow-up interventions prevent these cancers.  However, some experts recommend yearly anal Pap tests to screen for anal cancer in gay and bisexual men and in HIV-positive persons. This is because anal cancer is more common in those populations.
• Preventing Penile Cancers: There is no approved screening test to find early signs of penile cancer.
• Preventing Oropharyngeal Cancers: There is no approved test to find early signs of oropharyngeal cancer[see www.cancer.org]
• Preventing RRP: Cesarean delivery is not recommended for women with genital warts to prevent juvenile-onset RRP (JORRP) in their babies. This is because it is not clear that cesarean delivery prevents JORRP in infants and children.

Is there a test for HPV?

The HPV tests on the market are only used to help screen women at certain ages and with certain Pap test findings, for cervical cancer. There is no general test for men or women to check one’s overall "HPV status," nor is there an approved HPV test to find HPV on the genitals or in the mouth or throat.

Is there a treatment for HPV or related diseases?

There is no treatment for the virus itself, but there are treatments for the diseases that HPV can cause:

Visible genital warts can be removed by the patient him or herself with prescribed medications. They can also be treated by a health care provider. Some people choose not to treat warts, but to see if they disappear on their own. No one treatment is better than another.

Cervical cancer is most treatable when it is diagnosed and treated early. But women who get routine Pap tests and follow up as needed can identify problems before cancer develops. Prevention is always better than treatment. [see www.cancer.org]

Other HPV-related cancers are also more treatable when diagnosed and treated early. [see www.cancer.org]

RRP can be treated with surgery or medicines. It can sometimes take many treatments or surgeries over a period of years.

Bibliography: http://www.cdc.gov/std/HPV/STDFact-HPV.htm

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H.I.V./AIDS: Methadone Treatment for Addicts Is Linked to Lower H.I.V. Risk

Offering methadone treatment to drug addicts substantially reduces the risk that they will get H.I.V. or give it to anyone else, a new study has found.

The study, published online on Oct. 4 by the British journal BMJ, pooled data from studies done in nine countries. It concluded that making methadone available reduced H.I.V. risk by 54 percent. 

Many countries, including Russia, have large H.I.V. epidemics among addicts but nonetheless outlaw methadone and buprenorphine treatment for political, religious or other reasons.

Methadone itself does not affect the virus; scientists believe it works because addicts on treatment become better able to stop sharing needles and selling sex for drugs. They are also better able to stay on antiretroviral drugs, which lowers the chance they will infect others. The authors speculated that opiate-substitution therapy was so effective because addicts who are motivated enough to seek treatment are also smart about protecting themselves in other ways.

Contaminated needles cause 5 percent to 10 percent of all the world’s H.I.V. infections, the study estimated. The problem is worst in Eastern Europe and in Central and Southeast Asia on the fringes of opium-growing areas.

Although more people have sex than inject drugs, the risk of catching H.I.V. is 1 in 125 from a syringe, about 1 in 122 from anal sex and less than 1 in 2,000 from vaginal sex, according to an editorial published with the study.

Bibliography: http://www.nytimes.com/2012/10/16/health/methadone-treatment-helps-reduce-risk-of-spreading-hiv-study-finds.html?smid=tw-nytimeshealth&seid=auto

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Meningitis outbreak expands to 15 states with Pennsylvania case

A fungal meningitis outbreak linked to contaminated steroid injections expanded to 15 states on Monday as Pennsylvania reported its first case of the disease that has killed 15 people nationwide.

The Pennsylvania patient, who received an epidural steroid injection in July from medications supplied by New England Compounding Center (NECC) of Framingham, Massachusetts, is being treated in a hospital, the Pennsylvania Department of Health said.

The new case means that all but eight of the 23 states that received suspect medications from the Massachusetts specialist pharmacy have reported at least one case of fungal meningitis, a rare and deadly disease that has proven difficult to treat.

Over the weekend the Centers for Disease Control and Prevention said its tally of cases, which sometimes lags reports from state health departments, showed 205 people stricken with the disease after receiving injections. Illinois and New Hampshire reported their first cases.

The suspect lots of steroid were shipped to 76 facilities in 23 states, including two locations in Pennsylvania.

"We have been working directly with the clinics to ensure that patients who received these injections are monitored and receive any necessary follow-up," said Acting Pennsylvania Secretary of Health Michael Wolf.

Health authorities believe that nearly 14,000 people nationwide received injections from the potentially contaminated medication.

The state worst affected by the outbreak, Tennessee with 53 cases and six deaths, was holding an administrative hearing on Monday to determine whether to suspend the license of NECC.

At one hospital in Tennessee, St. Thomas in Nashville, more than 275 patients have undergone spinal tap tests, a painful procedure to determine if they have meningitis, and 33 people infected with meningitis have been treated.

The company faces an array of federal and state investigations. It has recalled the suspect medicines, surrendered its license to operate in Massachusetts and suspended operations. A sister company, Ameridose, also has suspended operations.

Meningitis is an infection of the membranes covering the brain and spinal cord. Symptoms include headache, fever and nausea. Fungal meningitis is not contagious.

The outbreak raised questions about how the pharmaceuticals industry operates. NECC engaged in a little-known practice called drug compounding that is not regulated by the Food and Drug Administration, which generally oversees drug makers.

In compounding, pharmacies prepare specific doses of approved medications, based on guidance from a doctor, to meet an individual patient's need.

A Reuters investigation found that one NECC customer received solicitations from the company for bulk orders and failed to require proof of individual patient prescriptions as required by state regulations.

The emails support assertions made last week by state pharmacy regulators that the compounding firm, which was authorized to deliver products only in response to patient-specific prescriptions, had violated its license in Massachusetts.

Several states, including Michigan, Massachusetts, Indiana, Minnesota and Ohio, are investigating the company.

The 15 states reporting cases of meningitis are Tennessee, Michigan, Pennsylvania, New Hampshire, Illinois, Indiana, Minnesota, New Jersey, Texas, Idaho, Maryland, North Carolina, Virginia, Ohio and Florida.

Bibliography: http://www.foxnews.com/health/2012/10/15/meningitis-outbreak-expands-to-15-states-with-pennsylvania-case/

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F.D.A. Warns of Further Risk From Tainted Drugs

Health officials are warning that more people may be at risk from contaminated drugs made by a Massachusetts company linked to a growing meningitis outbreak.

The Food and Drug Administration reported on Monday that the company’s products may have also caused other types of infections in patients who have had eye operations or open-heart surgery.

The new warning is based on only two cases, and it was not known for sure whether the company’s drugs had caused the infections. Officials did not say how many people may be at risk, but the number is potentially significant, and a statement from the agency warned doctors, “The F.D.A. recognizes that some health care professionals may receive a high volume of calls from patients or be concerned about having to notify many patients as a result of today’s announcement.”

The company, the New England Compounding Center in Framingham, Mass., has already been linked to a meningitis outbreak that has killed 15 patients and infected 199 others in 15 states. The drug implicated in that outbreak is methylprednisolone acetate, a steroid used in spinal injections for back and neck pain. The drug is believed to have been contaminated with a fungus called Exserohilum, which causes a type of meningitis that is severe but not contagious.

Now, several other drugs made by the company are also possible suspects in infections. A heart-transplant patient exposed to a product that is used during open-heart surgery developed a chest infection with a different fungus, Aspergillus, the Food and Drug Adminstration said. The product is a cardioplegic solution, which is chilled and poured into the opened chest to stop the heart while surgeons work on it. Such solutions have caused problems in the past, according to the F.D.A., which reported that it issued a warning letter in 2006 to a firm that had produced a solution that caused fatal infections in three heart-surgery patients.

The agency emphasized that the heart case was still being investigated, and that it was possible that the infection had come from a source other than the cardioplegic solution. A second heart-surgery patient who had an Aspergillus infection and was initially reported to have received a solution made by the New England Compounding Center had been treated with solution made by another company.

Another patient contracted meningitis after receiving a spinal injection of another one of the company’s steroid solutions, triamcinolone acetonide.

The statement from the F.D.A. also warned of possible contamination in drugs made by the company that are injected into the eye or used during eye surgery.

The agency is recommending to doctors that all patients exposed to any of these products from the New England Compounding Center be notified of the risks and told to be on the alert for signs of infection, even though it is not clear whether the products caused the two additional infections.

Meningitis symptoms that patients are being told to watch for include fever, headache, neck stiffness, nausea, vomiting, sensitivity to light and altered mental status.

Symptoms of other infections may include fever, swelling, increasing pain, and redness and warmth at the injection site. Eye infections may cause vision problems, pain, redness in the eye or discharge from the eye. Patients infected during heart surgery may have chest pain or drainage from their incisions.

The New England Compounding Center has shut down and recalled all its products. At least five states, besides Massachusetts, have suspended the company’s license: Michigan, New Hampshire, Ohio, Maryland and Virginia.

Senator Richard Blumenthal, a Democrat from Connecticut, said on Monday that the fresh information “further underscores the need for an immediate criminal investigation.” The Massachusetts attorney general’s office has declined to comment.

A spokeswoman for the New England Compounding Center said on Monday that the company would “continue to cooperate with the F.D.A.”

The meningitis outbreak has opened a debate among legal scholars about how much authority the Food and Drug Administration has over the compounding industry.

Compounding — traditionally a practice in which pharmacies mix medicine for an individual patient — is regulated by states. But in recent decades, some pharmacies began to push the legal limits, becoming mini-drug companies largely out of reach of federal authorities. Federal officials say they do not know what share of the compounding market large-scale pharmacies represent.

“Our drug experts went into some of these operations, and they said, ‘Whoa, these don’t look like ordinary pharmacies,’ ” said Gary Dykstra, who was the F.D.A.’s deputy associate commissioner for regulatory affairs in the 1990s.

Some scholars argue that the agency had more power than it is willing to admit and simply failed to use it.

“They have adequate authority to act, full stop,” said Peter Barton Hutt, a lawyer at Covington & Burling L.L.P. in Washington, who has written extensively on compounding law. “The issue is priorities and resources. Large-scale compounding expanded because the F.D.A. was focusing on other things.”

Even when the United States Supreme Court overturned the first clear legal definition of compounding in 2002, the F.D.A. could still invoke the 1938 Food Drug and Cosmetic Act, which forbids new, unapproved drugs to be sold across state lines, Mr. Hutt argued. The act was passed after more than 100 people died from an antibiotic that was prepared using a poisonous solvent.

But others contended that the agency had been more timid in pursuing compounders since the Supreme Court decision, in part because building a case meant figuring out how to defend it in court, and anchoring an argument is difficult because there are no laws or regulations formally defining compounded medications.

“There’s no bright line in statute distinguishing what the F.D.A. can regulate,” said Daniel Carpenter, a political scientist at Harvard University who specializes in regulatory law. “The only real attempt to draw one was in 1997, and that was struck down. Now to make a case they have to confront an army of industry lawyers.”

Politics were also important. Mr. Dykstra said the industry was adept at applying political pressure, which combined with the litigation, he argued, drained the enthusiasm in F.D.A. leadership to investigate.

“All the inspection work and the amount of time the F.D.A. was putting into it started to dry up,” said Mr. Dykstra, now a professor at the University of Georgia College of Pharmacy.

According to the Center for Responsive Politics, the main trade association, the International Academy of Compounding Pharmacists has spent about $1.1 million on lobbying since 2000. It has also contributed, through a political action committee, to lawmakers’ campaigns.

Bibliography: http://www.nytimes.com/2012/10/16/health/wider-meningitis-risk-from-tainted-drugs-feared.html?_r=1&smid=tw-nytimeshealth&seid=auto

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US meningitis investigation widens to two other drugs

 Two transplant patients developed a fungal infection after receiving a heart drug made by the pharmacy

Two additional drugs made by a US pharmacy may be linked to a deadly fungal meningitis outbreak, US health officials say.

The steroid triamcinolone as well as a heart drug, both made by the New England Compounding Center (NECC), are now under investigation.

The Food and Drug Administration (FDA) has warned doctors not to use any of the company's products.

More than 200 people in 15 states have been affected, and 15 people have died.

Meningitis is an inflammation of the membranes covering the brain and spinal cord. Symptoms include severe headache, nausea and fever as well as slurred speech and difficulty walking.

Fungal meningitis is not contagious, according to US health officials.
Transplant drug link?

The outbreak has raised questions about the practice of drug compounding, where pharmacies prepare specialised doses of medication. Compounding is not regulated by the FDA, which generally oversees drug makers.

NECC has suspended operations and recalled the steroid injection initially linked with the outbreak, methylprednisolone.

In a statement on Monday, the firm said it continued co-operate with the investigation.

The Food and Drug Administration says it is looking into reports of a patient with possible meningitis who received an injection of triamcinolone, a different steroid, from NECC.

Two transplant patients also developed a fungal infection after receiving an unnamed heart drug made by the firm.

The FDA has not confirmed that these three infections were caused by NECC products, and has said that it is very possible that the heart patients were infected by another source.

On Monday, the drug regulator expanded its recommendation for doctors to warn anyone who received any injection made by the company, including drugs used in eye surgery.

Last week, health officials said 12,000 of the roughly 14,000 people in 23 states who received the steroid shots had been contacted.

The CDC has published a list of clinics that received shipments of the drug, which was recalled on 26 September.

Bibliography: http://www.bbc.co.uk/news/world-us-canada-19957735#?utm_source=twitterfeed&utm_medium=twitter

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Why remember faces better than names of people?

Surely more than once you get close to someone easily recognized his face but has been unable to remember his name. Neuroscientists at the University of Bristol (UK) have identified the brain circuitry behind these mechanisms of memory.

In a series of experiments with mice, Clea Warburton and Gareth Barker has shown that when we remember a face or an object involves three brain areas working "team": the perirhinal cortex, which indicates whether an object is familiar or never seen before, the hippocampus, which recognizes places and spaces, and the medial prefrontal cortex, responsible for higher brain functions. If communication breaks down between the three regions of the brain circuitry we fail to remember or the "object in place" (eg where we left the keys) or "temporal order" (where we last saw) as explain the authors of the study in the Journal of Neuroscience.

According to the researchers, if you recognize someone in the street but do not remember his name, chances are you've seen elsewhere, for example at work. Remember where we first saw that person may facilitate us to remember your name.

Bibliography: http://www.muyinteresante.es/ipor-que-recordamos-mejor-las-caras-que-los-nombres-de-las-personas?utm_source=twitter&utm_medium=socialoomph&utm_campaign=muy-interesante-twitter5

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