الــمــعــرفــة الــصــحــيــة

لبيك ربي يا مجيب الدعوة

2011-11-05T11:47:00.001+03:00

لبيك ربي يا مجيب الدعوة

عائشة رضي الله عنها قالت: قال رسول الله صلى الله عليه وسلم: "ما من يوم أكثر
من أن يعتق الله فيه عبدا من النار، من يوم عرفة، وإنه ليدنو ثم يباهي بهم
الملائكة، فيقول: ما أراد هؤلاء؟"

نسأل الله أن يعتقنا وإياكم من النار

ويجعل عيدنا بدخول الجنة

اللهم آمين

اللهم بلغنا رمضان

2011-07-26T11:11:00.007+03:00

خدمة التذكير بمواعيد تطعيم الأطفال من وزارة الصحة في دولة الكويت

2011-06-21T18:27:00.006+03:00

خدمة التذكير بمواعد تطعيم الأطفال

إرسال رسالة باسم الطفل على رقم ٩٩٨٩٩
سيتم الطلب منك إرسال تاريخ ميلاد الطفل
سيتم إرسال رسالة تأكيد اشتراكك بالخدمة

أنشر لتعم الفائدة
خدمة مجانية من وزارة الصحة

Glaxo Antibiotic Scares Taiwan And Hong Kong // Pharmalot

2011-06-13T09:59:00.003+03:00

Glaxo Antibiotic Scares Taiwan And Hong Kong // Pharmalot

Kang Jaw-Jou, director general of the Taiwan Food and Drug Administration tells China Times that, although DIDP levels were limited and could be translated to about 2 micrograms in each dose, which is an amount unlikely to harm human health, his agency will still ask Glaxo to produce proof showing it has not wittingly or maliciously adulterated its antibiotic with the banned substance.

Meanwhile, a spokesman for the Hong Kong Department says this: “DIDP’s safety in man is not well established. However, data on animal studies suggested that long-term consumption of DIDP at high level may affect the liver. It is a fact that the DH has not received any report of adverse events related to the product, but GSK has failed to demonstrate the safety of the tainted product to our satisfaction. The threat to public health cannot be ruled out as this stage.

A Glaxo spokeswoman, however, sends us this statement: “The levels of DIDP that are being investigated are significantly lower than the levels that the US and European authorities deem to present a level of risk. With that in mind, GSK continues to support the safe use of this medicine as prescribed by a health care professional.”

AAP Issues Recommended Childhood and Teen Immunization Schedules

2011-02-03T11:25:00.001+03:00

Specific changes in the 2011 schedules from last year include the following:
•For children who did not receive the recommended birth dose of hepatitis B vaccine, the new recommendations offer guidance for administering the hepatitis B vaccine series. The catch-up schedule now includes a minimal age for dose 3 of hepatitis B vaccine, so that the final (third or fourth) dose in the series should be given no sooner than age 24 weeks.
•New recommendations are included on the use of PCV13, so that a PCV series started with PCV7 should be completed with PCV13. All children 14 through 59 months old who received an age-appropriate series of PCV7 should receive a single supplemental dose of PCV13. All children 60 through 71 months old with underlying medical conditions who have received an age-appropriate series of PCV7 should receive a single supplemental dose of PCV13. The supplemental PCV13 dose should be given at least 8 weeks after the previous dose of PCV7. Children 6 through 18 years old with functional or anatomic asplenia, HIV infection or other immunocompromising conditions, cochlear implant, or cerebrospinal fluid leak may be given a single dose of PCV13. Children at least 2 years old who have certain underlying medical conditions should be given the pneumococcal polysaccharide vaccine (PPSV) no sooner than 8 weeks after the last dose of PCV. Children with functional or anatomic asplenia or an immunocompromising condition should receive a single revaccination with PPSV after 5 years.
•On the basis of the child's history of receiving monovalent 2009 H1N1 vaccine, the new recommendations offer guidance for administering 1 or 2 doses of influenza vaccine. Children 6 months through 8 years old who are receiving influenza vaccine for the first time or who were vaccinated for the first time during the previous influenza season but only received 1 dose at that time should receive 2 doses at least 4 weeks apart. Two doses of 2010-2011 seasonal influenza vaccine should be given to children 6 months through 8 years old who received no doses of monovalent 2009 H1N1 vaccine or in whom the dosing schedule is unknown.
•Adolescents should be routinely immunized with quadrivalent meningococcal conjugate vaccine (MCV4), preferably at ages 11 through 12 years, and the new recommendations call for a booster dose at age 16 years. Adolescents given their first dose at ages 13 through 15 years should receive a booster dose at ages 16 through 18 years. A 2-dose primary series should be given 2 months apart to people at ages 2 through 54 years who are at higher risk for meningococcal disease.
•A single dose of Tdap should be given to children 7 through 10 years old who are not fully immunized against pertussis, including those who were never vaccinated or those with unknown pertussis vaccination status. Children 7 through 10 years old should be vaccinated according to the catch-up schedule if further doses are needed for complete immunization against tetanus and diphtheria. If adolescents 13 through 18 years old have not received the Tdap vaccine, they should receive a dose followed by a tetanus and diphtheria toxoids vaccine (Td) booster dose every 10 years thereafter. For children 7 through 18 years old, there is no longer a specified interval between the Td and Tdap vaccines.
•The policy statement contains guidance for use of Haemophilus influenzae type b vaccine in persons at least 5 years old who are at greater risk. Clinicians should consider giving 1 dose of Haemophilus influenzae type b vaccine to persons who are at least 5 years old who have sickle cell disease, leukemia, or HIV infection or in children who have undergone splenectomy.
•To prevent cervical precancerous lesions and cancers in girls, the new guidelines recommend the quadrivalent HPV vaccine (HPV4) and the bivalent vaccine (HPV2). To help prevent genital warts, HPV4 is also recommended for girls, and boys 9 through 18 years old may be given a 3-dose series of HPV4.

http://www.medscape.com/viewarticle/736487?src=mp&spon=9

نبارك للكويت أيامها الوطنية

2011-02-01T09:40:00.002+03:00

وطني الكويت سلمت للمـجد وعـلـى جبينــــك طـالع السعد

يا مهد آبـاء الأولى كتبـــــوا سفـر الخلود فنادت الشـــهب

اللـــــه أكبــر إنهـــم عــــرب طلعــــت كواكــب جنة الخلـــد

بوركت يا وطني الكـويت لنا سكنا وعشت على المدى وطنا

يفديك حر في حمـــــاك بنى صــرح الحيـــاة بأكرم الأيدي

نحميك يا وطنـي وشــاهدنا شرع الهدى والحــــــق رائدنا

وأميرنــــــا للـــعز قائدنـــــا رب الحميـــة صــــادق الوعــد

وطني الكويت سلمت للمجد وعلى جبينـــــك طـــالع السعد

Vitamin D3 ’87 percent more potent’ than D2: Study

2011-01-12T20:52:00.001+03:00

A new study looks at: which form to use in vitamin D deficiency, D3 or D2?
Vitamin D3 ’87 percent more potent’ than D2: Study:
"Vitamin D3 is 87 percent more potent at raising blood levels of the vitamin than vitamin D2, according to a new study from the US."

أكبر تزوير لدراسة في التاريخ الطبي- Autism and MMR Vaccine Study an 'Elaborate Fraud,' Charges BMJ

2011-01-10T09:54:00.004+03:00

أكبر تزوير في تاريخ الطب

كان نشر الدراسة التي تربط الطعم الثلاثي،

كمسبب رئيسي للتوحد هو:

"أكبر تزوير لدراسة في التاريخ الطبي" على الرغم من انتفاء أي علاقة بين الإثنين.

هذا ولم تثبت أي من الدراسات اللاحقة هذه الصلة.

فإن من تحمل تبعات ذلك التزوير ليس أطفال صغارا مع ذويهم فحسب وإنما مجتمعا بأكمله تفشت فيه الأمراض،

كما والمعلومات الخاطئة التي أثرت سلبا على المجتمع عامة والوسط الطبي خاصة.

نرجو لكم قراءة هادفة ونشر المعرفة الصحيحة، في المجتمع حتى نرتقي بصغارنا.

January 6, 2011 — BMJ is publishing a series of 3 articles and editorials charging that the study published in The Lancet in 1998 by Andrew Wakefield and colleagues linking the childhood measles-mumps-rubella (MMR) vaccine to a "new syndrome" of regressive autism and bowel disease was not just bad science but "an elaborate fraud."

According to the first article published in BMJ today by London-based investigative reporter Brian Deer, the study's investigators altered and falsified medical records and facts, misrepresented information to families, and treated the 12 children involved unethically.

In addition, Mr. Wakefield accepted consultancy fees from lawyers who were building a lawsuit against vaccine manufacturers, and many of the study participants were referred by an antivaccine organization.

In an accompanying editorial, BMJ Editor-in-Chief Fiona Godlee, MD, Deputy BMJ Editor Jane Smith, and Associate BMJ Editor Harvey Marcovitch write that there is no doubt that Mr. Wakefield perpetrated fraud. "A great deal of thought and effort must have gone into drafting the paper to achieve the results he wanted: the discrepancies all led in 1 direction; misreporting was gross."

A great deal of thought and effort must have gone into drafting the paper to achieve the results he wanted: the discrepancies all led in 1 direction; misreporting was gross.
Although The Lancet published a retraction of the study last year right after the UK General Medical Council (GMC) announced that the investigators acted "dishonestly" and irresponsibly," the BMJ editors note that the journal did not go far enough.

"The Lancet retraction was prompted by the results from the [General Medical Council] hearing and was very much based on the concerns about the ethics of the study," Dr. Godlee told Medscape Medical News.

"What we found was that it was definite fraud and that is a very important thing for the world to know. This article shows that the science was falsified and should be discounted," continued Dr. Godlee.

This evidence "should now close the door on this damaging vaccine scare," the editorial authors add.

Damage to Public Health

Although it included only 12 patients, faced almost immediate criticism, and never had its findings replicated, the study received wide media coverage and set off a panic among parents, with the result that MMR vaccinations decreased dramatically.

The 2003 to 2004 vaccination rate of 80% has now recovered slightly in the United Kingdom, but it is still well below the recommended 95% level recommended to ensure "herd immunity." A measles epidemic was also declared in England and Wales in 2008.

"Perhaps as important as the scare's effect on infectious disease is the energy, emotion, and money that have been diverted away from efforts to understand the real cause of autism and how to help children and families who live with it," the editorialists write.

Mr. Deer did his first investigative stories on the Wakefield paper in 2004 for the Sunday Times in London and a UK television network. On the basis of his findings, the GMC's Fitness to Practice panel convened in 2007 and heard from 36 witnesses during a period of 2 and a half years.

At the end of January last year, as reported by Medscape Medical News , the panel used strong language in condemning the study's methods and noted that Mr. Wakefield and 2 other colleagues had broken guidelines.

The Lancet issued its retraction 5 days later, citing the panel's findings that the participants were not consecutive patients seeking treatment and that the study had falsely reported being approved by an ethics committee.

Although the GMC later found that Mr. Wakefield and coauthor John Walker-Smith committed serious misconduct and struck them off the medical register, Mr. Wakefield has repeatedly denied doing anything wrong. In addition, he was not among the 10 of 13 coauthors who disavowed the study's findings in 2004.

"Instead, although now disgraced and stripped of his clinical and academic credentials, he continues to push his views. Meanwhile, the damage to public health continues," the editorialists write.

Multiple Discrepancies Found

Last spring, the BMJ went to Mr. Deer to ask if there was more to this story. In this newest article, he reports that "multiple discrepancies" were found, including the following:

•Only one of the studied 9 children actually had clear regressive autism and 3 did not have a diagnosis of any autism type;
•Five had preexisting development concerns — although all 12 were classified in the study as "previously normal"; and
•The exclusion of important allegations helped create "the appearance of a 14-day temporal link."
In addition, none of the 12 patients were "free of misreporting or alteration," he writes.

It cost a tremendous amount of time and money to penetrate the veil of confidentiality that surrounded just these 12 children. So how on earth would anybody penetrate the veil over other larger medical research? When Wakefield did what he did, it was on the assumption that no one would ever be able to find out the truth.
"My number 1 takeaway is that it cost a tremendous amount of time and money to penetrate the veil of confidentiality that surrounded just these 12 children. So how on earth would anybody penetrate the veil over other larger medical research? When Wakefield did what he did, it was on the assumption that no one would ever be able to find out the truth," Mr. Deer told Medscape Medical News.

BMJ fact-checked Mr. Deer's article against the 6 million–word transcript of the GMC panel's hearing. Dr. Godlee said she is now calling for reexamination of all of Wakefield's past studies to determine whether others should be retracted. "Past experience tells us that research misconduct is rarely isolated behavior," she writes.

But how did a small case-control study like this set off such a panic in the first place? "I think a lot of people would like to know the answer to that," said Dr. Godlee.

"I think Andrew Wakefield is a terrifically good publicist. He managed to convince his institution to run a press conference for this very small piece of research. The media attention for this grew, and concerns were raised with his subsequent publications."

In addition, she said that many parents have questions about why their children have developed autism and are looking for reasons to explain the onset of its behavioral symptoms. "MMR is a very common intervention, it seemed to fit the picture, and it's very hard to prove that something is safe despite overwhelming evidence that there is no link.

"If you're looking for an explanation, this may seem plausible, although the science is nonsense. Overall, I think it's a combination of very desperate parents looking for answers and a very clever man who was willing to lie and cheat, who was willing to try to advance his own career and financial benefits," noted Dr. Godlee.

Editor's Dread

With questions raised almost from the start, how culpable is The Lancet? And how can other journals protect themselves from publishing falsified studies?

"That is the dread of any editor," said Dr. Godlee. "I think editors' main responsibility is to make sure that what is published is valid in terms of being good research. And I think The Lancet's decision to publish this is the first place was a very questionable decision, especially as it dealt with such a serious issue.

"Why publish research that is not going to advance science and is going to create a vaccine scare? I think there is culpability there. But as for fraud, that is very tricky because science is based on trust," she added.

"None of us go back and ask for the case records of patients involved. But we need to become aware that any article that comes in could be fraudulent. And we have to be absolutely vigilant and investigate properly when concerns are raised. It's a constant cycle of oversight that needs to be done."

Medscape Medical News contacted The Lancet for its reaction to the BMJ series of articles, but officials there had "no comment on this."

Dr. Godlee said that she would also hope that coauthors would serve as backup for honesty in reporting and that all of this study's investigators "failed in their duties as authors" — especially since there were only 12 patients involved.

Adding a name to a paper carries a responsibility to ensure that no fraud has been committed. This should serve as a wake-up call for other researchers in the future. It's their reputation that can be damaged if they are found to be associated with someone else's failures of integrity.
"Adding a name to a paper carries a responsibility to ensure that no fraud has been committed. This should serve as a wake-up call for other researchers in the future. It's their reputation that can be damaged if they are found to be associated with someone else's failures of integrity."

Diversion of Research Funds

The editors write that although a breach of trust this large is "almost certainly rare," it raises questions about what could have been done earlier, what further inquiry is needed, and what can be done to keep it from happening again.

Future BMJ articles in the series, to be published during the next 2 weeks, will deal with these questions and The Lancet's actions from study publication through retraction.

"We wanted to also look at what motivated Andrew Wakefield, looking at the commercial schemes he established to exploit the MMR scare, and then we examine what happened when the issues of concern were first raised back in 2004 and why it was not taken more seriously at that time," explained Dr. Godlee.

"To people who might ask why we're interested in all of this now, the answer is that what Brian Deer has unearthed is much more substantial than what most of us knew or what came out in the GMC hearing. This study was not only bad research but fraudulent as well. And it's taken an enormous amount of time and effort and money away from legitimate lines of inquiry," she concluded.

Mr. Deer's original investigation was funded by the Sunday Times of London and the Channel 4 television network. The current articles were funded by the BMJ. He reported receiving no other funding except for legal costs from the Medical Protection Society on behalf of Mr. Wakefield. The editorial authors have disclosed no relevant financial relationships.

BMJ. Published online January 6, 2011.

Influenza Vaccination for Children: A Quick Reference Guide

2010-11-18T08:37:00.003+03:00

Eric J. Kasowski, DVM, MD, MPH

Posted: 11/10/2010

The Advisory Committee on Immunization Practices, or ACIP, and CDC have recommended that everyone 6 months and older, without a contraindication to the influenza vaccine, get vaccinated each year. Children 6 months through 8 years getting a seasonal influenza vaccine for the first time need 2 doses of vaccine, 4 weeks apart, to be fully protected.

The availability of 2 influenza vaccines last season -- the trivalent seasonal vaccine and the monovalent 2009 H1N1 vaccine -- may result in questions from parents and healthcare providers about how many influenza vaccinations children need this season, and there are different answers to those questions depending on a child's vaccination history.

•Children who did not receive the monovalent 2009 H1N1 vaccine last year, even if they have received 2 doses of trivalent seasonal vaccine in the past, need 2 doses of 2010-2011 seasonal vaccine.
•Children who have never received a trivalent seasonal flu vaccine in the past or whose vaccination status is unknown should get 2 doses of 2010-2011 flu vaccine.
•Children who received only 1 dose of the trivalent seasonal influenza vaccine for the first time last year should get 2 doses of 2010-2011 flu vaccine.
Some children will only need 1 dose of this year's flu vaccine.

•Children who received 2 doses of trivalent seasonal 2009-2010 vaccine and either 1 or 2 doses of 2009 H1N1 monovalent vaccine only need 1 dose of 2010-2011 seasonal vaccine.
•Children who got either 1 or 2 doses of monovalent 2009 H1N1 vaccine in addition to 1 dose of the 2009-2010 trivalent seasonal vaccine and who have received at least 1 dose of a seasonal flu vaccine prior to the 2009-2010 flu season need only 1 dose of the 2010-2011 influenza vaccine.
•Lastly, all children aged 9 years and older need only 1 dose of the 2010-2011 flu vaccine.
Vaccination is especially important for children at higher risk for serious flu-related complications. This includes: children younger than 5 years of age, and especially those younger than 2 years of age, and children of any age with chronic health conditions like asthma, diabetes, or heart disease.

In addition, children younger than 6 months old are too young to receive the influenza vaccine, but they have the highest hospitalization rate among children. Therefore, it is important that healthcare workers and other close contacts, such as child care providers and family members, get vaccinated to help protect these children.

Vaccination of pregnant women also is important, and recent studies have shown that influenza vaccination during pregnancy can provide protection for infants for up to 6 months after they are born.

There are 2 types of influenza vaccine: (1) inactivated vaccine, commonly referred to as the "flu shot," and (2) live, attenuated vaccine, which comes as a nasal spray. The inactivated flu shot can be administered to children aged 6 months and older. The live, attenuated nasal spray vaccine is a good option for otherwise healthy people 2-49 years of age. Contraindications to the nasal spray vaccine include:

•A history of asthma or wheezing episodes within the previous 12 months;
•Chronic pulmonary or cardiovascular disease;
•Weakened immune system; and
•Long-term aspirin therapy.
Vaccination should begin as soon as influenza vaccine is available. Early vaccination is especially important for children requiring 2 doses of vaccine.

Most Children With Middle Ear Infections Get Better on Their Own, Study Finds

2010-11-17T21:15:00.002+03:00

By Salynn Boyles
WebMD Health NewsReviewed by Laura J. Martin, MD Nov. 16, 2010 --

The best treatment for many children with middle ear infections may be no treatment at all, a review of the research confirms.

The analysis found antibiotics to be “modestly” more effective than just treating symptoms with pain medication. But use of antibiotics was also commonly associated with side effects like diarrhea and rash.

Researchers say the review, published in the Journal of the American Medical Association, shows the merit of a watch-and-wait approach to managing ear infections.

Pros and Cons of Antibiotics
Current treatment guidelines give doctors the choice of prescribing antibiotics right away or observing children for up to three days with only pain management to see if they get better on their own.
The new analysis found that in most cases they do.

Based on their review of more than 100 studies published over the last decade, the researchers were able to quantify the risks and benefits of treatment with antibiotics.

They estimated that for every 100 otherwise healthy children with uncomplicated middle ear infections, about 80 could be expected to improve without antibiotics within about three days.

An additional 12 children could be expected to improve during this time if all were treated with antibiotics, but three to 10 would develop a treatment-related rash and five to 10 would get diarrhea.

“It is clear that the number of kids who would benefit from treatment with antibiotics is about the same as the number who develop treatment-related side effects,” researcher Tumaini Coker tells WebMD.

Parents OK With No Treatment
A pediatrician with Mattel Children’s Hospital UCLA and a researcher with the nonprofit research group RAND Corporation, Coker says in her experience most parents are willing to try the watch-and-wait approach if their child’s pain is adequately managed.

Brooklyn otolaryngologist Richard Rosenfeld tells WebMD he often gives parents a "safety net" antibiotic prescription to be filled only if the child gets worse or does not improve within a few days.

He says most of the prescriptions never get filled.

Rosenfeld chairs the otolaryngology department at Brooklyn’s Long Island College Hospital.

“I find that parents are delighted to avoid antibiotics when they can, because they are aware of the side effects,” he says. “Parents want their children to feel better and sleep through the night. For that you need ibuprofen, not antibiotics.”

Less treatment would result in big savings to the health care system, the researchers say.

Antibiotics are prescribed more for ear infections than for any other childhood illness. A 2006 government survey found the average cost for treating ear infections to be $350 per child, totaling $2.8 billion a year.

When Antibiotics Are Needed
Not every child with an ear infection will get better without antibiotics. Rosenfeld says children who benefit most from treatment include:

Those with infections in both ears
Children with ruptured eardrums
Children who are 6 months old or younger
Those who have severe ear pain and/or high fever
The analysis was commissioned by the U.S. Agency for Healthcare Research and Quality to assist the American Academy of Pediatrics (AAP) in revising its existing treatment guidelines for middle ear infections.

Among the other major findings:

The evidence suggests that generic antibiotics work just as well as brand name ones. The researchers concluded cost savings would be substantial if more doctors prescribed amoxicillin rather than pricier antibiotics.
Although there is no specific test to confirm or rule out ear infection, looking inside the ear with an otoscope is a key component of diagnosis.

عيدكم مبارك وتقبل الله طاعتكم

2010-11-10T21:58:00.003+03:00

للكلمه ردود
وللفرحه وجود
ولأيام العيد وقت محدود
فلكم تهنئة بلا حدود
تقبل الله طاعتكم

مع دخول ذو الحجة

2010-11-06T10:58:00.001+03:00

إليك وإلا لا تشد الركائـب ومنك وإلا فالمؤمل خائب

وفيك وإلا فالغرام مضيع وعنك وإلا فالمحدث كــاذب

لديك وإلا لا قرار يطيب لي عليك وإلا لا تسيل السواكب

Coffee Boosts Stroke Risk

2010-11-05T23:12:00.005+03:00

November 5, 2010 — A cup of coffee can heighten the risk for ischemic stroke, particularly among infrequent drinkers, report researchers. Their study provides new information that may be useful in stroke prevention and is in line with what is already known about the physiologic effects of coffee.

Investigators led by Elizabeth Mostofsky, MPH, from Harvard Medical School in Boston, Massachusetts, found a 2-fold increased stroke risk in the hour after drinking a cup of coffee. The increased risk returned to baseline within a 2-hour window, which investigators say strengthens the possibility of a causal relationship.

The work appears in the November 2 issue of Neurology.

In this new multicenter crossover study, researchers interviewed 390 people with ischemic stroke. They compared each person's coffee intake the hour before stroke symptoms to his or her usual consumption.

Most people, 78%, said they drank coffee the prior year. More than half of these had a cup of coffee within 24 hours of stroke. Close to 9% of patients had coffee within 1 hour of stroke onset.

Although an increase in stroke risk was seen with coffee, there was no apparent increase in risk in the hour after a cup of caffeinated tea or cola.

The association between ischemic stroke in the hour after coffee consumption was only apparent among those consuming 1 cup or less per day and not for those who drank coffee more regularly (P for trend = .002). Relative risks remained similar when researchers restricted the sample to those who were not simultaneously exposed to other potential triggers, and the results remained significant after stratifying by time of day.

The peak plasma concentration of caffeine is usually less than 2 hours and has several systemic effects, including rapidly increasing epinephrine release, blood pressure, and insulin sensitivity, they explain. "Caffeine has both systemic and cerebral vasoconstrictive effects."

مهرجان الجري في الكويت- RunQ8

2010-11-01T17:25:00.000+03:00

عيدكم مبارك وتقبل الله طاعتكم

2010-09-09T18:47:00.000+03:00

مبارك عليكم الشهر

2010-08-10T11:57:00.001+03:00

مبارك عليكم الشهر

http://www.medscape.com/viewarticle/721810?sssdmh=dm1.616851&src=nldne&uac=6966HK

2010-05-25T10:50:00.003+03:00

Michael O'Riordan
May 14, 2010 (Loma Linda, California) — The consumption of nuts of nearly any type improves blood lipid levels, lowering total- and LDL-cholesterol levels, and improves important lipid ratios, according to the results of a new meta-analysis [1]. The cholesterol-lowering effects of nuts are dose related and more pronounced in individuals with higher baseline LDL-cholesterol levels and in those with a lower body-mass index (BMI), according to investigators.
"Our findings confirm the results of epidemiological studies showing that nut consumption lowers coronary heart disease risk and support the inclusion of nuts in therapeutic dietary interventions for improving blood lipid levels and lipoproteins and for lowering coronary heart disease risk," write lead investigator Dr Joan Sabaté (Loma Linda University, CA) and colleagues in the May 11, 2010 issue of the Archives of Internal Medicine.
The authors add that a recent summary of these previous epidemiological studies suggested that the risk of coronary heart disease was nearly 40% lower among individuals who ate at least four servings of nuts per week, compared with those who rarely or never ate nuts. In 2003, the Food and Drug Administration issued a qualified claim stating that the consumption of specific nuts--almonds, hazelnuts, pecans, pistachios, walnuts, and peanuts--might reduce the risk of heart disease [2].
Reducing Total- and LDL-Cholesterol Levels, check table
http://www.medscape.com/viewarticle/721810?sssdmh=dm1.616851&src=nldne&uac=6966HK

In this meta-analysis, the researchers examined the effect of nut consumption on blood lipid levels and whether these effects varied, in different populations, by type of nuts, by diet, and by BMI. Overall, 25 studies of 583 men and women with normal lipid levels and blood pressure who were not taking lipid-lowering medications were included in the analysis. Across the different studies, daily nut consumption ranged from 23 g to 132 g (approximately 0.8 oz to 4.8 oz) and included various types of nuts, such as almonds, walnuts, pistachios, macadamias, almonds, and pecans.
Consuming 67 g of nuts per day, the mean daily consumption across the 25 studies, reduced total- and LDL-cholesterol levels 10.9 mg/dL and 10.2 mg/dL, respectively. It also significantly improved the ratio of LDL to HDL cholesterol and the ratio of total cholesterol to HDL cholesterol. There was no significant effect on HDL-cholesterol levels and no effect on triglycerides, although a reduction in triglyceride levels was observed among individuals with higher baseline levels.
Changes in Blood Lipid and Lipoproteins Levels
The effect of consuming nuts was similar in men and women and across different age groups and was observed regardless of the specific nut consumed and regardless of the study funding source.
The cholesterol-lowering effects, however, were larger among individuals with higher baseline LDL-cholesterol levels. For example, among those with LDL cholesterol levels <130>160 mg/dL. Conversely, the cholesterol-lowering effects were largest among individuals with a BMI <25>30 kg/m2.
In the paper, Sabaté and colleagues note that estimated reductions in the pooled analysis are similar to those of a recent meta-analysis of pooled walnut consumption studies. "The similarity of the results obtained by different methodologic approaches confirms the validity of our findings," they write. The results, according to the group, confirm that increasing the consumption of nuts as part of an "otherwise prudent diet can be expected to favorably affect blood lipid levels (at least in the short term) and have the potential to lower coronary heart disease risk."
Sabaté and Dr Emilio Ros (Instituto de Salud Carlos III, Barcelona, Spain) have received research funding from the California Walnut Commission, the Almond Board of California, the National Peanut Board, and the International Tree Nut Council; they are also unpaid members of the scientific advisory council of the California Walnut Commission. Sabaté has received an honorarium from the Pistachio Scientific Advisory Board.
References

Guard Kids' Eyes Against Long-Term Sun Damage

2010-05-25T10:47:00.000+03:00

Guard Kids' Eyes Against Long-Term Sun DamageYoungsters are especially vulnerable to harmful rays, experts warn

SATURDAY, May 15 (HealthDay News) --

With May designated as UV awareness month, experts are calling on parents to pay special heed to the safety of their children's eyes this summer.
Although eye protection is a concern for people of all ages, Prevent Blindness America, the nation's oldest eye health and safety organization, warns that children are particularly vulnerable to the harmful ultraviolet A and B (UVA and UVB) damage that can accompany sun exposure.
For one, children generally spend more time in the sun, the group noted. In addition, the organization highlights the American Optometric Association's cautionary finding that the lenses of young eyes are more transparent than that of adults, risking retinal exposure to a greater degree of short wavelength light.
"We need to remember to protect our eyes from UV every day of the year," Hugh R. Parry, president and CEO of Prevent Blindness America, said in a news release. "UV rays reflecting off the water, sand, pavement and even snow are extremely dangerous. We can encourage our children to wear the proper eye protection by leading by example."
UV exposure has been linked to the onset of cataracts, macular degeneration and a wide array of eye health issues, the experts noted.
Prevent Blindness America advises that everyone who goes out in the sun should wear sunglasses that block out 99 percent to 100 percent of both UVA and UVB radiation -- noting that sunglasses without such protection can actually cause the pupils to dilate, thereby doing more harm than good.
A wide-brimmed hat or cap also offers some measure of eye protection, the group suggested.
With specific respect to children, Prevent Blindness America further encourages parents to ensure that sunglasses fit their child's face properly and shields the sun's rays from all directions. The group points out that wrap-around sunglasses might be optimal in the later regard, because they additionally protect the skin immediately surrounding a child's eyes.
Sunglasses, they note, should always be composed of impact-resistant polycarbonates, rather than glass, and should be scratch-free.
More information
For more on eyes and sun exposure, visit American Optometric Association.
-- Alan Mozes
SOURCE: Prevent Blindness America, news release, May 2010
Last Updated: May 16, 2010
Copyright © 2010 HealthDay. All rights reserved.

FDA says GlaxoSmithKline's Rotarix vaccine is safe

2010-05-25T10:45:00.001+03:00

The Associated Press May 16, 2010, 5:07PM ET NEW YORK
The Food and Drug Administration has cleared the use of GlaxoSmithKline PLC's Rotarix vaccine, which is designed to protect babies against a leading cause of diarrhea.
In March, the FDA had urged pediatricians to temporarily stop using the rotavirus vaccine after discovering that doses of Rotarix were contaminated with bits of an apparently benign pig virus. They suggested doctors use Merck & Co.'s RotaTeq vaccine instead. The agency reversed its decision Friday, saying there is no evidence that porcine circovirus can infect or sicken humans.
The European Medicines Agency in March also had suggested pediatricians not use Rotarix, but reversed its recommendation after a few days.
Rotavirus causes severe diarrhea and is a leading child killer in developing countries. Merck's vaccine was introduced in 2006 and Glaxo's in 2008. Glaxo's oral vaccine has been used in millions of children worldwide, including 1 million in the U.S., with no signs of safety problems, health officials have said.

Meaningful Conversations and Language skills

2010-05-25T10:34:00.000+03:00

Meaningful Conversations Boost Kids' Language SkillsGive-and-take discussions help them gain skills needed for school success, study shows
WEDNESDAY, May 19 (HealthDay News) -- Parents who engage their young children in conversational give-and-take help their offspring gain a significant leg up in terms of language acquisition, new Dutch research reveals.
The boost to childhood language proficiency appears to be predicated on allowing children to engage in so-called "serious" conversations with their family members -- dialogues that permit them to make meaningful contributions to the subject at hand.
The findings are based on the results of a study that tracked 150 Dutch children aged 3 to 6 for a follow-up period of three years. The children were from a mixture of families of Turkish, Moroccan-Berber, and Dutch backgrounds.
Lead researcher Lotte Henrichs noted that as soon as children start school, they are confronted with a need to follow difficult and sometimes abstract concepts, expressed by their teachers through the routine use of complex sentence structures and summed up by the term "academic language."
By its nature, academic language is part of the normal student-teacher discourse, and has a scientific texture that is typically marked by multiple clauses and conjunctions, Henrichs explained.
The study revealed that parents who encourage their kids to contribute to conversations are preparing their children for gaining a natural proficiency in this particular sort of linguistic skill.
Additionally, parents who read to their children, tell them stories and initiate conversations on interesting subjects also give their kids a head start in being able to acquire the kind of academic language skills they will need throughout their education.
The work was funded by the Dutch Programme Council for Educational Research, part of the Netherlands Organization for Scientific Research, based in Den Haag.
More information
For more on childhood language skills, visit the U.S. National Institutes of Health.
-- Alan Mozes
SOURCE: Netherlands Organization for Scientific Research, news release, May 12, 2010
Last Updated: May 19, 2010
Copyright © 2010 HealthDay. All rights reserved.

IVF, Fertility Drugs Might Boost Autism Risk

2010-05-25T10:31:00.001+03:00

Two studies show a link, but experts say risk to any one child remains low
By Jenifer GoodwinHealthDay Reporter
WEDNESDAY, May 19 (HealthDay News) -- Children whose mothers took fertility drugs were almost twice as likely to have autism as other children, new research finds. Being conceived by in vitro fertilization (IVF) or born prematurely also seemed to up the risk of autism, according to another study.
In the first study, researchers asked 111 women taking part in the Nurses' Health Study II who had a child with an autism spectrum disorder about their history of fertility problems and use of ovulation-inducing drugs, such as Clomid or gonadotropins.
About 34 percent of moms with an autistic child had used fertility drugs compared to about 24 percent of some 3,900 mothers without an autistic child, the researchers found.
Clomid and gonadotropins are often used as a first-line treatment for infertility, defined as trying for a year or longer to get pregnant without success, said lead study author Kristen Lyall, a postdoctoral research fellow at the Harvard School of Public Health.
Nearly 47 percent of moms of autistic kids reported infertility, compared to about 33 percent of the other mothers, her team found.
One caveat to those statistics is that older women are both more likely to have fertility problems and to take ovulation-inducing drugs, and prior research has shown older moms are also more likely to have autistic children.
In the study, the median maternal age at the time the first child was born was 35, compared to about 25 for the general U.S. population, Lyall noted.
Even so, when the age of the mother and pregnancy complications were taken into account -- which can also heighten the risk of autism -- women with infertility and who used ovulation drugs still had a twofold greater chance of having a child with an autism spectrum disorder.
The absolute risk for any one mother to have a child with autism remained relatively low, the authors noted. In the study, about 4 percent of mothers who took fertility drugs had a child with an autism spectrum disorder, compared to about 2 percent of moms who didn't take fertility drugs.
Still, "we found that a history of infertility and use of ovulation-inducing drugs was significantly associated with an increased risk of having a children with an autism spectrum disorder," said Lyall, who noted that the findings are preliminary, involved a relatively small sample of women and needed to be confirmed by future research.
The autism risk was less pronounced among younger mothers who took fertility drugs, Lyall added. Among women aged 25 to 34, about 3.1 percent who had infertility and took fertility drugs had an autistic child, compared to 2.6 percent of women in that age group who didn't.
The study was to be presented on Thursday at the International Meeting for Autism Research in Philadelphia.
Another study to be presented at the meeting, this time by Israeli researchers, found that in vitro fertilization and pre-term birth were both associated with an increased risk of autism in offspring.
About 10.2 percent of 461 children diagnosed with an autism spectrum disorder were conceived using IVF, while about 3.5 percent of children in the general Israeli population are conceived that way, according to the study.
Moms who had IVF tended to be older, with a median age of 32.6 years compared to just under 31 years of age for mothers who didn't get IVF, the study authors noted.
Nearly 4 percent of the kids with autism were born prematurely, while nearly 5 percent had a low birth weight, compared to about 1 percent in the general population.
"Prematurity and low birth weight also adversely affect the child's functioning in adaptive skills," noted study lead author Dr. Ditza Zachor, who is director of the Autism Center at Assaf Harofeh Medical Center at Tel Aviv University. "This means that these two risk factors act as 'second hits' that affect the child more than just having autism."
Zachor stressed that the findings are preliminary and more widespread research is needed. "This will give us the answer if these procedures carry any risk for the baby."
So what does all this mean for couples struggling to conceive? Dr. Andrew Zimmerman, director of medical research at Kennedy Krieger Institute's Center for Autism and Related Disorders in Baltimore, said that women taking fertility drugs or undergoing IVF should not be unnecessarily alarmed.
The vast majority of children conceived in this way will not end up with autism, and most children who have autism were not conceived using IVF or with the help of fertility drugs, he said.
However, many physicians who work with kids with autism have remarked that lots of their patients seem to have been conceived via IVF. Prior to these studies, the observation was largely anecdotal, he said.
"I don't think we are at a point yet where we can make recommendations, but we are getting to a point where we are beginning to understand there probably is a relationship," Zimmerman said.
The reasons for the connection are not known, but it may be something about the process of in vitro fertilization, in which a sperm and egg are joined outside the womb, an embryo is created and implanted, or sometimes frozen and stored, then thawed for later use. Taking fertility drugs in early pregnancy could also contribute, Zimmerman said.
Autism is a neurodevelopmental disorder that's characterized by problems with social interaction, verbal and nonverbal communication, and restricted interests and behaviors.
More information
The U.S. National Institute of Neurological Disorders and Stroke has more on autism.
SOURCES: Kristen Lyall, Sc.D., postdoctoral research fellow, Harvard School of Public Health, Cambridge, Mass.; Andrew Zimmerman, M.D., director, medical research, Kennedy Krieger Institute's Center for Autism and Related Disorders, Baltimore; Ditza Zachor M.D., senior lecturer and director, Autism Center, Assaf Harofeh Medical Center, Tel Aviv University, Israel; presentations, International Meeting for Autism Research, May 20, 2010, Philadelphia
Last Updated: May 19, 2010
Copyright © 2010 HealthDay. All rights reserved.

Breast-Feeding Linked to Lower Incidence of Fever After Immunizations

2010-05-25T10:26:00.001+03:00

Laurie Barclay, MD
May 20, 2010 — Breast-feeding is linked to a lower incidence of fever after immunizations, according to the results of a prospective cohort study reported online May 17 in Pediatrics.
"Immune response to some vaccines is different among breastfed infants compared with those who are not breastfed," write Alfredo Pisacane, MD, from Università Federico II in Napoli, Italy, and colleagues. "The objective of this study was to evaluate the effects of breastfeeding on the risk for fever after routine immunizations."
At a pediatric vaccination center in Naples, Italy, mothers of infants scheduled for routine vaccinations were told how to measure and record infant temperature on the evening that the immunization was administered and for the next 3 days. On the third day after vaccination, mothers were phoned to determine the incidence of fever. After adjustment for vaccine dose, maternal educational level and smoking status, and number of other children in the household, multivariate analyses allowed estimation of the relative risk for fever in relationship to the type of breast-feeding.
Of 460 infants recruited, outcome data were available for 450 (98%). Fever was reported in 30 (25%) of exclusively breast-fed infants, in 48 (31%) of partially breast-fed infants, and in 94 (53%) of infants who were not breast-fed at all (P < .01). Among infants who were exclusively breast-fed, the relative risk for fever was 0.46 (95% confidence interval [CI], 0.33 - 0.66), and it was 0.58 (95% CI, 0.44 - 0.77) among partially breast-fed infants.
"The protection conferred by breastfeeding persisted even when considering the role of several potential confounders," the study authors write. "In this study, breastfeeding was associated with a decreased incidence of fever after immunizations."
Limitations of this study include body temperatures taken by the mothers rather than by health professionals and the possibility that fever after immunization could be an infective episode.
"Breastfeeding seems to be associated with a reduced risk for fever after immunization, but additional, well organized studies are needed," the study authors conclude. "The design of such studies should include more objective research methods, such as measurements taken by health care professionals at the same time of the day or night, and should evaluate the role of mild intercurrent infections by medical monitoring."
The study authors have disclosed no relevant financial relationships.
Pediatrics. Published online May 17, 2010.

Yogurt Found to Reduce Children's Infections

2010-05-25T10:17:00.003+03:00

A Study Found Probiotic Yogurt Could Cut Rates of Common Infections in Children
By LAUREN COX
May 19, 2010
Parents who want to reduce the number of coughs, stomach aches and infections in their children may want to reach for the probiotic yogurt, according to the results of a new study.
Researchers from Georgetown University Medical Center enrolled more than 600 children, ages 3-6, in a study to see if the strain of bacteria, Lactobasillus casei DN 114-001, could have an effect on common infectious diseases.
Parents in the study agreed to feed a drinkable yogurt regularly to their children. Half of the families received traditional yogurt and half received the probiotic yogurt, or yogurt that has beneficial bacteria. The parents did not know which type of yogurt they had.
By the end of the three-month study, the children who received the probiotic yogurt had 24 percent fewer gastrointestinal infections and 18 percent fewer upper respiratory infections than children who were getting regular yogurt.
"While it's probably the largest study [of its kind] in the U.S., it really wasn't done in the lab stetting," said Dr. Daniel Merenstein, lead author of the study published today in the European Journal of Clinical Nutrition.
Merenstein said the advantage of the study, which was funded by The Dannon Company, was that they didn't measure for markers of disease, but actual coughs and stomach troubles that parents would notice.
"It's data that's interesting to parents, this is data they reported," he said.
In February, The Dannon Company was ordered by a judge in Cleveland, Ohio, to pay up to $45 million for allegedly making unsupported claims about the health benefits of its probiotic yogurt.
The study didn't examine exactly how the beneficial bacteria in the yogurt prevented infections. But, Merenstein said, other studies have shown probiotics to have a general effect on the immune system and have improved asthma and eczema symptoms.
"Most yogurt has starter cultures, they have two probiotics that make it easier for people who have problems digesting milk," said Merenstein. "Besides that they don't do much for infections because they die pretty much when they hit the stomach."
Dannon has an obvious interest in selling yogurt, but Dr. Clifford Bassett, medical director of Allergy and Asthma Care of New York, said he's not terribly bothered by the fact that the company funded the study.
Parents Didn't Know Which Yogurt Went to Their Kids
"Any time you have a placebo controlled study, that's very powerful, that's the best you can have," said Bassett, who is also a clinical professor of medicine at Long Island College Hospital.
"Most, if not all of the studies done in the U.S. for drugs up for approval by the FDA are done with pharmaceutical backing," he said.
However, Bassett said the study opened up more questions about probiotics.
"It falls in the area of alternative or integrative medicine," said Bassett.
Related
So far he said he has been convinced that other dietary measures such as omega 3 fatty acids and antioxidants have shown enough of an effect on the immune system to help with allergies. But Bassett said he's not yet convinced by this study to recommend probiotics to his allergy patients.
"We have to repeat it, we have to look at probiotics with different doses, and children of different ages," he said. "The question is, is it a probiotic effect, is it another effect?"
Merenstein himself had some questions after the study -- particularly why parents reported fewer infections, but they did not report fewer sick days.
"That's one of the goals," said Merenstein. "If you prevent parents from missing work, then you get into some interesting data."

Swim lessons for toddlers get doctors' approval

2010-05-25T10:10:00.001+03:00

By CARLA K. JOHNSONThe Associated Press Monday, May 24, 2010; 8:11 AM
CHICAGO -- The nation's largest pediatricians group is relaxing its stance against swimming lessons for children younger than 4.
In the past, the American Academy of Pediatrics has said swim classes might give toddlers and parents a false sense of security. Now the group says it's fine to enroll children as young as 1.
A few small studies suggest toddlers may be less likely to drown if they've had swim lessons. The doctors aren't recommending lessons for every young child. Some parents may feel their little ones aren't ready and that's OK.
Parents should choose classes that emphasize water safety and require a parent or other adult to be in the water with the child, said Connie Harvey who heads aquatics development for the American Red Cross and wasn't involved in the doctors' policy update.
Classes should have at least one instructor for every 10 students, she said.
The updated policy, released online Monday by the journal Pediatrics, also recommends fences around all pools, even popular inflatable ones. Kids can drown by leaning over the soft sides and falling in.
And the group warns that children can drown when their hair or hands get sucked into the drains of pools or spas without drain covers or proper filter-pump equipment.
The rate of childhood drowning deaths has declined in recent years. About 1,100 U.S. children drowned in 2006.
Parents know they should be vigilant while children swim, but trouble can occur in an instant of inattention, said Dr. Jeffrey Weiss of Phoenix Children's Hospital and lead author of the policy.
"It's not a lack of supervision, it's a lapse of supervision," Weiss said.

Diet Free of Gluten and Casein Has No Effect on Autism Symptoms

2010-05-25T09:55:00.001+03:00

Daniel M. Keller, PhD
May 24, 2010 (Philadelphia, Pennsylvania) — A gluten-free, casein-free (GFCF) diet or challenges with these food substances did not alter sleep or activity patterns in preschool children with autism spectrum disorder (ASD) who were also receiving intense behavioral therapy, suggests the first study to control for nutritional sufficiency and other interventions.
Slight differences in social language, approach, and play that were seen at 2 hours after gluten or casein exposure were not apparent at 24 hours, lead author Susan Hyman, MD, chief of the Division of Neurodevelopmental and Behavioral Pediatrics and associate professor of pediatrics at the University of Rochester in New York, reported here at the 9th Annual International Meeting for Autism Research.
Although dietary interventions are often used with children with ASD, have a popular image among the public, and result in anecdotal reports of improvement, prior trials have not borne out such positive outcomes. Dr. Hyman explained that she and her colleagues therefore designed a study to test whether a commonly used dietary intervention was safe and effective.
Study Population Stable at Baseline
Researchers recruited 22 children (age, 30 - 54 months) who were very consistent in their clinical presentations (positive on the Autism Diagnostic Interview and the Autism Diagnostic Observation Schedule), their medical conditions, and the therapies they were receiving, which was an early intensive behavioral intervention program. "This is important because if you're changing other parameters, you want to have other effective treatments stable," Dr. Hyman said. Children were excluded from the study if they had celiac disease, food allergies, or deficient iron stores.
The investigators formulated and monitored a nutritionally sound, strict GFCF diet, which they maintained children on for a minimum of 4 weeks. A staff of dieticians worked with the families to identify a food that their child would eat and that could be formulated to be indistinguishable with or without the test ingredients.
Fourteen of the children were able to maintain the diet and allow data collection. They remained on the diet and were observed and then challenged with the food substances (20 g wheat flour, 20 g evaporated milk, both, or placebo) only if they were at their behavioral baselines. Challenges were administered in a randomized, double-blind fashion. Each child received a food challenge on 3 separate occasions over 12 weeks.
To ensure nutritional adequacy, laboratory monitoring, body mass index, weight, and growth recording occurred at baseline, 6, 8, and 30 weeks. The researchers also collected behavioral data at these times, as well as the day before and 2 and 24 hours after each food challenge.
No Difference in Activity Levels After Dietary Challenge
Dr. Hyman reported that there was no difference in the length of sleep recorded by parents over the course of the study before and after challenges and compared with baseline. There were also no changes in the number of night wakings or in the number or consistency of stools.
Compared with placebo challenges, no significant differences occurred in length of sleep or waking with gluten (P = .21 and P = .10, respectively), casein (P = .48 and P = .15, respectively), or both (P = .99 and P = .18, respectively). Similarly, there were no differences in stool consistency compared with placebo.
Children's activity levels recorded by parents, researchers, or applied behavior analysis program teachers did not differ after placebo, gluten, casein, or gluten/casein challenges. These observations were consistent with recordings from actigraphs — watch-like devices that measure activity.
Dr. Hyman noted that these measures are not specific to autism. Thus, the play-based Ritvo-Freeman Real Life Rating Scale for autism was used to gauge sensory motor behaviors, social approach, and language. "With correction for multiple comparisons, there was no difference with the challenges compared to placebo, and there was no difference with introduction of the diet," she said.
To see whether any individual responses were obscured by group statistics, the researchers examined the single subject data but did not identify any child with significant effects after dietary challenges or who had improvements in core features of autism during the trial.
In summary, Dr. Hyman said, "The data that we have do not demonstrate effect of the GFCF diet on the behaviors we measured." However, she said that study limitations include the study's small size and that all the included children were in an effective early intervention program (≥10 hours/week), were of similar age, and were all stabilized on a monitored diet. Furthermore, none of the children was iron- or vitamin D-deficient.
Dr. Hyman said a question remains whether any autistic children could respond to the diet used in the study. For example, children with celiac disease or bad gastrointestinal symptoms were not included. "So could it be that children who have more significant [gastrointestinal] symptoms are the ones that drive the anecdotal reports?" she asked. Another possibility is that foods designed to exclude gluten could also then lack food preservatives or dyes, which is another open question.
Dr. Hyman concluded, "The data that we have do not offer support for the [GFCF] diet in young children who carry a diagnosis of autism and who are receiving other effective behavioral and educational interventions." She cautioned that these data should not be extrapolated to any child with food allergies or intolerances or other gastrointestinal problems, and that "any child who is on the diet needs to be monitored from a nutritional standpoint to make certain that all of the things that we know about typical child development are monitored for."
Jonathan Green, MD, professor of child and adolescent psychiatry at the University of Manchester, United Kingdom, commented that "studies of dietary interventions like this are extremely difficult to do." He calls himself "an interventionist" and leads the Medical Research Council preschool autism communication trial, currently the largest intervention trial internationally in this subject area.
"The [University of Rochester] study is of significance even though sample size is really small, but they really took a lot of trouble to blind the dietary intervention, and that's the really difficult thing to do," he said. He also commended Dr. Hyman's rigor in recording even what she called "oops events," where the child got a bit of food that was not planned, such as a cookie from grandma.
Dr. Green said that although there are hundreds of foods and ingredients that could be tested, he thought that Dr. Hyman addressed well 2 of parents' concerns by testing gluten and casein. "She's done the right test. She's used the right kind of methodology, which is really difficult on a small group of kids, and her results are pretty clear," he said.
Addressing the possibility that an autistic child with a preexisting gut problem would feel better on a gluten-free diet, he warned, "That, however, does not mean it's having an effect on the autism itself, and that's the point of what Dr. Hyman did.... What she's suggesting is that the diet in itself doesn't have a specific effect on autism as such." He said this kind of information should reach parents, who should see that autism researchers take their concerns seriously, and who thus need to believe the science.
In Dr. Hyman's opinion, "The real future of autism treatment is going to be informed by science. It's going to be informed by what we really do know about the brain and the designer interventions," she said. "What we have now in terms of intervention is empiric observation."
Dr. Hyman and Dr. Green have disclosed no relevant financial relationships.
9th Annual International Meeting for Autism Research: Abstract 140.007. Presented May 22, 2010.

Challenging the Nature & BBC Brain Games Study

2010-04-22T12:35:00.002+03:00

This is a challenge to previous post

Challenging the Nature & BBC Brain Games Study
By Dr. Bernard Croisile, posted on April 21, 2010 at 1:32 pm
As you may have read, the BBC just published the results of a ‘brain training’ study in Nature magazine. The show “Bang goes the Theory” funded and conducted a study with 8,600 subjects using a simple set of light-weight computer games, played them for a minimal time and declared to the world that “brain games don’t work”. With so many willing subjects involved, it is unfortunate that it was a wasted opportunity to apply depth and rigor to the study and do a serious and responsible job. The ill-founded experiment ultimately throws the baby out with the bath water. It is great propaganda for hyping a popular TV show with sound-bites, however, the hype and rhetoric generated by it is a disservice to those that could benefit from serious scientific work.
To be specific, the study only uncovered that the specific brain games they developed for use in the test were no more efficient than the tasks they used in their control group. The results should not surprise anyone when you consider the tools and methods used. Let’s review a few points here:
1) The duration of the training program was very short (6 tasks for a minimum of 10 minutes a day, three times a week, over a six-week period). In 2008, the BBC contacted HAPPYneuron for early advice in designing the experiment. At the time we advised the BBC that the training duration was too short and that no reportable conclusion could be drawn from an experiment of this duration. This opinion was a direct result of other studies and our own extensive experience and analysis. It is well established that the minimal engagement time to see any statistically significant effect from brain training is 90 days, with 3 sessions per week of at least 30 minutes in duration.
2) The study was seeking to demonstrate ‘transferability’, that is to see a correlation between task improvement and benchmarking improvement. The application of meta-cognition is essential for transferability. It is a complex process (indeed the subject of many a Ph.D. theses) and must be intently and explicitly designed into the training exercises. Two key factors that are necessary to achieve transferability were absent from BBC experiment. These are:
a) a didactic approach which shows the strategies and mechanisms that help develop meta-cognition abilities for improvementb) a multiplicity of situations (large variety of exercises ) where the acquired meta-cognition abilities can be re-applied in different exercises
The BBC experiment had just 6 exercises, certainly not enough for a subject to reapply the approaches that they may have learned.
3) The control group was an interesting choice and arguably stacked the odds in favor of the conclusion from the onset. To determine if an activity is effective, the ideal situation is to compare the activity with what people are likely to do in real life. Will people systematically and regularly perform the same type of explorative internet searches on an ongoing basis of the caliber that was given to the control subjects? The subjects were asked to explore a set of obscure questions (e.g. in what year did Henry VIII die?) and then to order them chronologically. This required systematic Web research and exercised sequencing skills, language skills, reasoning, working memory and other cognitive functions… arguably a cognitive task at least on par with the training exercises. So we are not surprised to also see improvements within the control group, or a reduction in the difference between the trained groups and the control group. The study’s claim is that “in all three groups the standardized effect sizes of the transfer effects were, at best, small, suggesting that any comparison (even with a control group who did nothing) would have yielded a negligible brain training effect in the experimental groups.” Yes, but all this suggests is that if you jointly use a poor brain training program at a light dose and you are compared against a stimulated control group, you limit the chance to see real improvement! Optimistically, the study might have had the honesty and scientific integrity to conclude “That said, the possibility that an even more extensive training regimen may have eventually produced an effect cannot be excluded.” Lastly, the experiment’s reasoning benchmark is a grammatical reasoning test, in which no training test included language materials (which was not the case of the control group).
To conclude, designing an efficient brain training platform is a complex task that requires many important and essential elements you cannot simply get by compiling basic games and expecting positive results with a minimal training duration. This is the difference between leisure gaming activity and a properly designed brain training program. It is important to note, as shown by many published studies*, brain training software is not the only way of receiving broad cognitive stimulation and preventing cognitive decline. Cognitive stimulation can also be achieved with a highly cognitive stimulated way of life (traveling, gardening, reading, learning, etc). What brain training software offers is another way to achieve this stimulation, a simple and inexpensive solution to compensate for the decrease in cognitive activity that happens to most people as they age.
So, we encourage people interested in the benefit of brain training to see though all of the the sound bites and the veneer of what has been this highly publicized conclusion by a poorly designed study and to continue to support the serious cognitive research going on at universities and hospital systems around the world.
Bernard Croisile, MD, Ph.D and the HAPPYneuron scientific team
* Research Studies
Long-term Effects of Cognitive Training on Everyday Functional Outcomes in Older Adults; Willis et al, JAMA, Dec , 2006—Vol 296, No. 23
Effects of Cognitive Training Interventions With Older Adults; Ball et al, JAMA Nov 2002 – Vol 288, 18
Stimulating Leisure-Time Activities Could Stave Off Mild Cognitive Impairment; Valeo, Neurology Today 2006
Influence of leisure activity on the incidence of Alzheimer’s Disease, N. Scarmeas, NEUROLOGY 2001;57:2236–2242
An active and socially integrated lifestyle in late life might protect against dementia; Fratiglioni, Lancet Neurol 2004; 3: 343–53
Cognitive activity and cognitive decline in a biracial community population; Wilson, NEUROLOGY 2003;61:812–816
This entry was filed under Brain Research, Brain games, Cognitive Training and tagged BBC, Brain games, Brain Research, brain science, Nature. Bookmark the permalink. Follow any comments here with the RSS feed for this post. Post a comment or leave a trackback: Trackback URL.

No gain from brain training

2010-04-22T12:32:00.000+03:00

Computerized mental workouts don't boost mental skills, study claims.
Alla Katsnelson
The largest trial to date of 'brain-training' computer games suggests that people who use the software to boost their mental skills are likely to be disappointed.
The study, a collaboration between British researchers and the BBC Lab UK website, recruited viewers of the BBC science programme Bang Goes the Theory to practise a series of online tasks for a minimum of ten minutes a day, three times a week, for six weeks. In one group, the tasks focused on reasoning, planning and problem-solving abilities — skills correlated with general intelligence. A second group was trained on mental functions targeted by commercial brain-training programs — short-term memory, attention, visuospatial abilities and maths. A third group, the control subjects, simply used the Internet to find answers to obscure questions. A total of 11,430 volunteers aged from 18 to 60 completed the study, and although they improved on the tasks, the researchers believe that none of the groups boosted their performance on tests measuring general cognitive abilities such as memory, reasoning and learning.
"There were absolutely no transfer effects" from the training tasks to more general tests of cognition, says Adrian Owen, a neuroscientist at the Medical Research Council (MRC) Cognition and Brian Sciences Unit in Cambridge, UK, who led the study. "I think the expectation that practising a broad range of cognitive tasks to get yourself smarter is completely unsupported."
It's unlikely that the study, published online in Nature this week1, will quell the brain-training debate. "I really worry about this study — I think it's flawed," says Peter Snyder, a neurologist who studies ageing at Brown University's Alpert Medical School in Providence, Rhode Island. Snyder agrees that data supporting the efficacy of brain training are sparse. Although some earlier studies — such as one2 funded by Posit Science, a brain-training software company in San Francisco, California — showed modest effects, Snyder recently published a meta-analysis that found little benefit3.
But he says that most commercial programs are aimed at adults well over 60 who fear that their memory and mental sharpness are slipping. "You have to compare apples to apples," says Snyder. An older test group, he adds, would have a lower mean starting score and more variability in performance, leaving more room for training to cause meaningful improvement. "You may have more of an ability to see an effect if you're not trying to create a supernormal effect in a healthy person," he says.
Indeed, the subjects in this study were a self-selected group "who would have had a natural inclination to play this sort of game", says David Moore, director of the MRC Institute of Hearing Research in Nottingham, UK, and a founder of MindWeavers, a company in Oxford, UK, selling the brain-training program MindFit.
Moore and Snyder add that the training time may not have been long enough. Subjects completed an average of 24 sessions — at ten minutes a session, that's just four hours of training, says Snyder. "Four hours of testing over six weeks isn't a lot to create meaningful change." Brain-training exercises such as treatments for lazy eye or some post-stroke training regimens require more time to work, says Moore.
Owen counters that several similar studies have used a six-week training period. Although the average number of sessions in his trial was 24, the actual number ranged from two to "some real diehards doing it several hundred times", he says, and he saw no difference in performance between the extremes. "There is no psychological theory that could account for [no effects at all] for six weeks, and then suddenly at week 22 an effect," he says.
Owen concedes that his findings don't necessarily mean that training in young children or elderly patients is pointless. But "the evidence is not strong", he says. "And someone needs to go and test it." *
References
Owen, A. M. et al. Nature advance online publication doi:10.1038/nature09042 (20 April 2010).
Smith, G. E. et al. J. Am. Geriatr. Soc. 57, 594-603 (2009). Article PubMed
Papp, K. V., Walsh, S. J. & Snyder, P. J. Alzheimers Dement. 5, 50-60 (2009). Article PubMed

من الطب النبوي ( التداوي بالقسط ) العود الهندي

2010-03-24T10:10:00.002+03:00

قال صلى الله عليه وسلم ( إن أمثل ما تداويتم به الحجامة والقسط البحري ) رواه البخاري .
وقال صلى الله عليه وسلم ( عليكم بهذا العود فإن فيه سبعة أشفيه يستعط به من العذرة ويلد به من ذات الجنب ) .
( القسط): هو العود وهو نوعان : الأول هو البحري أو الأبيض أو الحلو – والثاني هو الهندي أو الأسود أو المر .. في حديث أخرجه أحمد وأصحاب السنن من حديث جابر مرفوعاً ( أيما أمرأة أصاب ولدها عذرة أو وجع في رأسه فلتأخذ قسطاً هندياً فتحكه بماء ثم تسعطه إياه ) يحتوي القسط على مادة الهلينين ، وحمض البنزوات ، وكلاهما من المواد المطهرة للجراثيم ، إن الجمع بين الحجامة والقسط يكون وقاية من التشوهات والندبات ، دواء مثالي لمعظم الأمراض ..
لا شك أن الكلمة الجامعة والحكمة المختصرة في أحاديث النبي صلى الله عليه وسلم تعني أن القسط البحري دواء مثالي بدون الأضرار الكيميائية و الأثار الجانبية ( سبعة أشفية لمعظم أمراض الإنسان ) ..
طريقة الإستعمال : من مجموع الأحاديث الصحيحة التي ذكرنا والأحاديث الأخرى ، قال صاحب فتح الباري : أن السبعة أشفية هي سبعة أصول صفة للتداوي بها إما شرب أو لدود أو سعوط أو طلاء أو تبخير أو تكميد أو تنطيل ..
الشرب : وذلك بطحنه وخلطه مع الماء والشرب منه بمقدار 5 جرام قسط مع عسل أو ماء يومياً، وهذا لمعظم الأمراض كأصل مشترك هو واللدود مع الأصول الأخرى ونذكر منها ما ذكر من إذابته للجلطة وفائدته للإخصاب ومشاكل الطمث ولإدرار البول وأمراض الكلى والكبد وسائر أعضاء الجهاز الهضمي ولسرطان الفم والكوليرا وللرعشة ومحرك للشهوة ومنشط للجسم ، وللحمى وتقوية المعدة وللأورام ولتقوية جهاز المناعة وللنفساء و لمعالجة الإمساك والإسهال وفاتح للشهية وضبط السكر وبفضل عدم تحليته بالسكر .
اللدود : وهو وضع جزء مطحون منه أو شرابه من أحد شقي الفم وهذا لأمراض الجنب وأمراض الرئة عامة..
السعوط : وهو استنشاق جزء مطحون منه أو من ماؤه بقطاره وهذا لأمراض الجهاز التنفسي عامة كالربو والسل ونزلات البرد والتهاب اللوز ( العذرة ) والتهاب الحلق والبلعوم وللسعال والحمى ..
الطلاء أو الدهان : يحول القسط البحري إلى دهان كالآتي: ملعقة طعام مليئة بالقسط الهندي المطحون على كوب زيت زيتون حار وتطبخ على النار لمدة خمس دقائق ثم يصفى ويدهن المكان المصاب كالمفاصل والعظام ويوضع في الأذن والآلام العامة..
التبخير : قال رسول الله صلى الله عليه وسلم ( ولا تمس طيبا إلا أدنى طهرها إذا طهرت نبذة من قسط أو إظفار ) ، فبخور القسط طيب و إذا وضع عليه إظفار كافور يطيب رائحته أكثر ، ولذا سماه الرسول صلى الله عليه وسلم ( طيبا) ، ولا مانع أن يتبخر به الرجال ، وتبخير المكان الموبوء ..
التكميد : وهو طحنه وخلط قدر مطحون منه مع قليل من الماء أو العسل ويمكن إن يوضع بمفرده على أماكن الحروق والجروح والبثور والدمامل وذلك ككماد ويوضع أيضا على جراح مريض السكر التي تنزف فيتوقف النزيف ويوضع أيضا على أماكن الكلف فيزيله بإذن الله..
التنطيل : وهو رش وغشل الجسم بالماء ، وإن كان هذا الماء مشوب بالقسط البحري فإنه سيكون مفيد لقتل الجراثيم والبكتريا العالقة بجسم الإنسان كذلك يستخدم كمطهر بصفة عامة ..
ملاحظة: من أراد الإكثار من أكل القسط بنوعيه وتجنب أضراره فيشربه باليانسون..
هذا والحمد لله رب العالمين ونتمنى العافية للجميع ..
متوفر في الكويت لدى أم داوود الشطي نقال 99328185

الجليس لإحياء القراءة

2010-03-23T14:04:00.004+03:00

مشروع الجليس لإحياء القراءة

www.jalees.org

شاكرة لمدونة بوحسين الذي وضع رسالة حول الموضوع
http://bohsain.blogspot.com/

U.S. court rules again against vaccine-autism claims

2010-03-15T22:27:00.002+03:00

Maggie Fox, Health and Science Editor
WASHINGTON
Fri Mar 12, 2010 5:51pm ESTRelated NewsUS court rules again against vaccine-autism claims
Court to decide if vaccine makers can be sued
Mon, Mar 8 2010WASHINGTON (Reuters) - Vaccines that contain a mercury-based preservative called thimerosal cannot cause autism on their own, a special U.S. court ruled on Friday, dealing one more blow to parents seeking to blame vaccines for their children's illness.
U.S. Health
The special U.S. Court of Federal Claims ruled that vaccines could not have caused the autism of an Oregon boy, William Mead, ending his family's quest for reimbursement.
"The Meads believe that thimerosal-containing vaccines caused William's regressive autism. As explained below, the undersigned finds that the Meads have not presented a scientifically sound theory," Special Master George Hastings, a former tax claims expert at the Department of Justice, wrote in his ruling.
In February 2009, the court ruled against three families who claimed vaccines caused their children's autism, saying they had been "misled by physicians who are guilty, in my view, of gross medical misjudgment".
The families sought payment under the National Vaccine Injury Compensation Program, a no-fault system that has a $2.5 billion fund built up from a 75-cent-per-dose tax on vaccines.
Instead of judges, three "special masters" heard the three test cases representing thousands of other petitioners.
They asked whether a combination vaccine for measles, mumps and rubella, or MMR, plus a mercury-containing preservative called thimerosal, caused the children's symptoms.
MYSTERIOUS CONDITION
More than 5,300 cases were filed by parents who believed vaccines may have caused autism in their children. The no-fault payout system is meant to protect vaccine makers from costly lawsuits that drove many out of the vaccine-making business.
Autism is a mysterious condition that affects as many as one in 110 U.S. children. The so-called spectrum ranges from mild Asperger's Syndrome to severe mental retardation and social disability, and there is no cure or good treatment.
The U.S. Institute of Medicine has reported several times that no link can be found between vaccines and autism.
Supporters of the scientific community welcomed the ruling.
"It's time to move forward and look for the real causes of autism," said Alison Singer, president of the Autism Science Foundation. "There is not a bottomless pit of money with which to fund autism science. We have to use our scarce resources wisely."
But advocates for the idea that vaccines are dangerous said they would not give up. "We hope that Congress will intervene in what is clearly a miscarriage of justice to vaccine-injured children," said Jim Moody of the Coalition for Vaccine Safety.
Autism Speaks, another advocacy group, said it would also not completely abandon the theory that vaccines might cause autism.
The organization said it would invest "in research to determine whether subsets of individuals might be at increased risk for developing autism symptoms following vaccination."
But the group also said it was clear that if such a link did exist, it would be rare.
"While we have great empathy for all parents of children with autism, it is important to keep in mind that, given the present state of the science, the proven benefits of vaccinating a child to protect them against serious diseases far outweigh the hypothesized risk that vaccinations might cause autism," Autism Speaks said in a statement.
(Editing by Philip Barbara)

Effectiveness Of Stem Cells As Cerebral Palsy Treatment Set For Test

2010-02-14T17:52:00.001+03:00

By Shaun Heasley
February 11, 2010 Researchers are set to begin the first federally-approved clinical trial on the effectiveness of stem cells from stored umbilical cords in treating symptoms of cerebral palsy.
In select cases, doctors are already using stem cells from umbilical cord blood to improve mobility in children with cerebral palsy, which has shown success anecdotally. But the research set to be conducted at the Medical College of Georgia will be the first clinical trial approved by the Food and Drug Administration.
The study will focus on 40 children with cerebral palsy ages 2 to 12 whose umbilical cords were stored at an Arizona stem cell bank at birth. Half of the study participants will be infused with stem cells from their own umbilical cord and half will receive a placebo.
Scientists believe that stem cells can help repair injured brain cells and replace dead cells.
Doctors will examine the children three months into the study, when significant improvement is expected. At that point, patients who received the placebo will be infused with stem cells.
Then at the six and nine month marks, doctors will reexamine all of the patients as well.
“Evidence up to this point has been purely anecdotal,” said Dr. James Carroll, chief of pediatric neurology at the Medical College of Georgia and principal investigator on the study. “While a variety of cord blood stem cell therapies have been used successfully for more than 20 years, this study is breaking new ground in advancing therapies for brain injury.”
Though the stem cells show promise, researchers say they do not expect the treatment to serve as a cure for cerebral palsy.
Copyright © 2010 Disability Scoop, LLC. All Rights Reserved. For reprints and permissions click here.

For Chocolate Lovers

2010-02-13T14:10:00.002+03:00

Chocolate Linked to Lower Stroke and Stroke Mortality Risk
Susan Jeffrey
February 12, 2010 — Just in time for Valentine's Day, a new systematic review from Canadian researchers suggests higher chocolate consumption may be associated with a lower risk for incident stroke and stroke-related mortality.
Results of 2 prospective cohort studies showed, respectively, a 22% reduction in stroke risk for those who had 1 serving of chocolate per week and a 46% reduction in stroke mortality from weekly consumption of flavonoids in 50 g of chocolate vs no consumption. A third study showed no association between chocolate intake and stroke or death.
However, the number of studies looking at this relationship was small, senior author Gustavo Saposnik, MD, from St. Michael's Hospital and the University of Toronto, Canada, told Medscape Neurology. "We need more prospective studies that specifically identify the type of chocolate and the amount, including the amount of flavonoids included in the composition of the chocolate, to make more valid conclusions," he said.
The results were released February 11 in advance of their planned presentation at the upcoming American Academy of Neurology 62nd Annual Meeting in April. The abstract will post to http://www.aan.com on February 17.

Varying Effects

Chocolate contains cocoa butter, flavonoids, carbohydrates, and vitamins. Previous studies, most of them epidemiological, have shown varying effects of chocolate consumption on the risk for cardiovascular disease, the researchers, with first author Sarah Sahib, BScCA, from McMaster University in Hamilton, Ontario, Canada, write. "Less is known about the risk of stroke in association with flavonoid intake," they note.
To examine this association, the authors carried out a systematic review of studies published between 2001 and 2009, using search terms including flavonoids, flavanols, isoflavones, and anthocyanidins, as well as stroke and mortality.
"We found 88 publications, among them 3 prospective studies, and another retrospective study providing some information on the effect of chocolate consumption on the incident risk of stroke," Dr. Saposnik said. "Two of these studies show a reduction in the incident risk of stroke, and the other 2 didn't show any substantial difference."
For example, of the 3 prospective studies, 1 found no association between flavonoid intake and the risk for stroke or death when 3% of catechin intake came from chocolate (relative risk [RR], 0.92; 95% confidence interval [CI], 0.51 - 1.68).
However, a second study found a reduction in incident stroke for chocolate consumption once per week vs no consumption (RR, 0.78; 95% CI, 0.65 - 0.94).
The third study looked at the association between flavonoid intake and stroke mortality and found a suggestion of protection against stroke mortality from 50 g of chocolate (hazard ratio, 0.54; 95% CI, 0.30 - 0.96).
The authors conclude that further prospective studies are needed "to assess whether the benefit of chocolate-based flavonoid consumption truly lowers stroke risk, or whether the apparent benefit is biased by a healthy user effect."

Investigation a Challenge

However, although more data on this link would be helpful, Dr. Saposnik pointed to several challenges to doing these kinds of studies. First, it is important to document the actual content of flavonoids or other substances thought to be active in the chocolate being consumed.
"There are some studies that compare the content of flavonoids for different food elements and antioxidant capacity," he said. Dark chocolate is one with the highest flavonoids and procyanidins, which have been associated with lower cardiovascular risk, and in addition, dark chocolate has the highest antioxidant capacity.
Still, there are varying types of chocolate, and the amounts that are required to affect stroke risk may bring a load of sugar and fats that may work counter to the beneficial effects. "50g of chocolate per day is a significant amount," Dr. Saposnik notes.
Finally, large longitudinal studies are also expensive, and funding for them scarce, which may explain why much of the evidence is coming from epidemiologic studies, he added. One alternative may be to conduct smaller studies, looking the effects of consuming controlled amounts of chocolate on some intermediate biomarker of stroke risk.
The study received no commercial support. The authors have disclosed no relevant financial relationships.

American Academy of Neurology 62nd Annual Meeting. April 10-17, 2010. Published online February 11, 2009.

منتدى قلب الكويت

2010-02-13T13:53:00.000+03:00

يقدم لكم اختبارات ونماذج وتلخيصات ومذكرات لجميع فصول الثانوي
http://q8qlb.com/vb/forumdisplay.php?f=101

A Spoonful of Medicine? Mary Poppins Can Be Dangerous

2010-02-12T17:32:00.000+03:00

http://www.medscape.com/viewarticle/715862?src=mp&spon=9&uac=6966HK

Study Linking Autism to Vaccine Retracted

2010-02-04T10:29:00.002+03:00

Daniel J. DeNoon

February 2, 2010 — The venerable British medical journal The Lancet has retracted a 1998 study suggesting a link between autism and childhood vaccination with the measles-mumps-rubella MMR vaccine.
The Lancet tells WebMD that it has retracted "10 or 15" studies in its 186-year history. The retraction follows the finding of the U.K. General Medical Council (GMC) that says study leader Andrew Wakefield, MD, and two colleagues acted "dishonestly" and "irresponsibly" in conducing their research.
The Lancet specifically refers to claims made in the paper that the 12 children in the study were consecutive patients that appeared for treatment, when the GMC found that several had been selected especially for the study. The paper also claimed that the study was approved by the appropriate ethics committee, when the GMC found it had not been.
"We fully retract this paper from the published record," The Lancet editors say in a news release.
The retraction means the study will no longer be considered an official part of the scientific literature.
BMJ, formerly known as the British Medical Journal, has competed with The Lancet since 1840. BMJ editor Fiona Godlee says she welcomes the Lancet retraction.
"This will help to restore faith in this globally important vaccine and in the integrity of the scientific literature," Godlee says in a news release.
In 2004, 10 of Wakefield's 13 co-authors disavowed the findings of the 1998 study. Although the study never claimed to have definitively proven a link between the MMR vaccine and autism, sensational media reports ignited a public panic. MMR vaccinations fell dramatically.
More rigorous studies have found no link between autism and the MMR vaccine. Last year, the U.S. "vaccine court" rejected U.S. lawsuits claiming that there was a plausible link between the vaccine and autism.
Wakefield continues to proclaim his innocence and defends his earlier work. He now resides in Texas, where he is executive director of an alternative medicine center for autism treatment and research.
SOURCES:
The Lancet, published online Feb. 2, 2010.
News release, The Lancet.
News release, BMJ.
Thoughtful House web site.
General Medical Counsel: "Fitness to Practise Panel Hearing, 28 January 2010."

WHO Addresses Media Misconceptions About H1N1 Pandemic

2010-01-20T10:02:00.001+03:00

Emma Hitt, PhD
January 14, 2010 — Several "misconceptions" about the H1N1 influenza pandemic were addressed at today's press conference held by the World Health Organization (WHO).
Dr. Keiji Fukuda, special adviser on pandemic influenza to the director-general, addressed 4 issues pertaining to the H1N1 pandemic: whether this is a real pandemic, whether the definition of the pandemic has changed, whether the WHO overplayed the pandemic, and whether the WHO was inappropriately influenced by the pharmaceutical industry.
Regarding whether the H1N1 influenza outbreak resulted in a real pandemic, Dr. Fukuda noted that the answer is very clearly yes. "The allegation by some that the H1N1 pandemic is fake is both scientifically wrong and historically inaccurate," he said.
To date, 13,000 deaths worldwide have been attributed to H1N1, although Dr. Fukuda noted that the final estimate will be much larger. He also pointed out that calling the pandemic fake is "somewhat disrespectful" to the people affected by the pandemic, as well as to the healthcare workers who participated in the effort.
Dr. Fukuda also maintained that the WHO has not changed its definition of a "pandemic," which is defined as the worldwide spread of disease. Guidelines were developed in 1999, and scientists worked with the WHO to revise the definition in 2005 and in 2009. "There is discussion about these pandemic definitions, and there is some continual attempt to try to make them clearer, but severity itself was not part of the definition."
He also stated that the WHO has not overplayed the pandemic. When Dr. Margaret Chan, the WHO director-general, first announced the H1N1 as a pandemic, she stated that the pandemic would be of "moderate" severity, Dr. Fukuda pointed out.
"From the very beginning, WHO has gone out of its way to let everybody know that the future course of the pandemic was uncertain." He added that this remains as true today as it did back then and that the WHO has been very consistent in the information that it has given. "We've worked very hard to neither overplay nor underplay the situation."
According to Dr. Fukuda, the severity of H1N1 can change midstream, so "we have adopted a precautionary approach — preparing for the worst and hoping for the best."
Last, he denied that the WHO has been influenced by the pharmaceutical industry. Although the WHO reached out to a variety of scientists and experts, including those in industry, experts providing advice are required to provide full disclosure, he said. "Any allegations of conflicts of interest are taken very seriously by the WHO, and we respond immediately and appropriately to them."
The WHO will be conducting a self-review process regarding H1N1 influenza, which Dr. Fukuda said is something that any organization that cares about its performance would do. In addition, the Council of Europe has asked the WHO to participate in hearings about pandemic influenza.
"I want to emphasize the world is going through a real pandemic." he said. "WHO has been balanced and truthful in the information it has provided" and has taken great care to "make sure that the advice received has not been unduly influenced by commercial or non–public health interests."

Johnson & Johnson issues massive recall of Tylenol

2010-01-20T09:49:00.003+03:00

By MARLEY SEAMAN, AP Health Writer Marley Seaman, Ap Health Writer – Sat Jan 16, 1:10 am ET
NEW YORK – Johnson & Johnson issued a massive recall Friday of over-the-counter drugs including Tylenol, Motrin and St. Joseph's aspirin because of a moldy smell that has made people sick.
It was the second such recall in less than a month because of the smell, which regulators said was first reported to McNeil in 2008. Federal regulators criticized the company, saying it didn't respond to the complaints quickly enough, wasn't thorough in how it handled the problem and didn't inform the Food and Drug Administration quickly.
The recall includes some batches of regular and extra-strength Tylenol, children's Tylenol, eight-hour Tylenol, Tylenol arthritis, Tylenol PM, children's Motrin, Motrin IB, Benadryl Rolaids, Simply Sleep, and St. Joseph's aspirin.
The FDA and Johnson & Johnson's McNeil Consumer Healthcare Products said they did not know the number of bottles recalled. It included caplet and geltab products sold in the Americas, the United Arab Emirates, and Fiji.
Consumers should check the full list at http://us.rd.yahoo.com/dailynews/ap/ap_on_bi_ge/storytext/us_johnson___johnson_tylenol_recall/34750619/SIG=1144vpchf/*http://www.mcneilproductrecall.com to identify the recalled batches.
The FDA said about 70 people have been either sickened by the odor — including nausea, stomach pain, vomiting and diarrhea — or noticed it.
The smell is caused by small amounts of a chemical associated with the treatment of wooden pallets, Johnson & Johnson said. The FDA said the chemical can leach into the air, and traced it to a facility in Las Piedras, Puerto Rico.
The New Brunswick, N.J., company said it is investigating the issue and will stop shipping products with the same materials on wooden pallets. It has asked suppliers to do so as well.
The FDA said McNeil knew of the problem in early 2008 but made only a limited investigation.
"McNeil should have acted faster," said Deborah Autor, the director of the FDA's Office of Compliance of the Center for Drug Evaluation and Research. "When something smells bad, literally or figuratively, companies must aggressively investigate and take all necessary action to solve the problem."
The FDA sent McNeil a warning letter for violating manufacturing standards and failing to report and investigate the problem in a timely way, Autor said.
Johnson & Johnson has 15 days to respond. The FDA says it wants an explanation as to why the problem was not made public sooner.
In November, McNeil recalled some Tylenol Arthritis Caplets due to the smell. Almost three weeks ago, the company expanded its recall to include more batches of Tylenol Arthritis Caplets.
There have been no reports of nausea related to the most recent recall, the company said. McNeil, however, said the expanded recall includes product lots that could be affected by the same problems of nausea.
The company said it is working with the FDA.
Also on Friday, federal prosecutors in Boston said Johnson & Johnson paid tens of millions of dollars in kickbacks so nursing homes would put more patients on its blockbuster schizophrenia drug.
The government's complaint states that J&J gave special rebates to Omnicare Inc., the country's biggest dispenser of prescription drugs to nursing homes, in return for recommendations from its pharmacists that patients be given Risperdal, in many cases when it was inappropriate.
J&J said in a statement it "will address the government's lawsuit in court" and believes its rebates were "lawful and appropriate."

FDA on BPA: 'Some Concern,' No Ban

2010-01-20T09:43:00.001+03:00

Daniel J. DeNoon
January 19, 2010 — Americans should take "reasonable steps" to avoid the plastics chemical BPA, the FDA says.
BPA, or bisphenol A, is everywhere. Created more than 40 years ago, millions of tons are made each year and used in a wide variety of products including plastic bottles and food can liners. More than 90% of Americans have detectable BPA in their bodies.
In 2008, the FDA issued a "draft assessment" finding that BPA was safe. But a short time later, the National Toxicology Program disagreed, noting "some concern" that BPA exposure during pregnancy or infancy might be bad for a person's long-term health.
Now the FDA says it officially agrees there is concern over fetus/infant exposure to BPA. FDA Commissioner Margaret Hamburg, MD, announced the change of course -- and the start of a $30 million BPA research program -- at a news conference.
"At this time, we share the perspective of the NTP of some concern of health effects of BPA. This means we need to know more," Hamburg said. "In the interim, as a precaution, the FDA is taking reasonable steps to help reduce human exposure to BPA."
Exactly what are the "concerns" over BPA? Linda Birnbaum, PhD, director of the National Institute of Environmental Health Sciences, spelled it out.
"There are critical periods of development when exposure to BPA may lead to certain health effects, including behavioral effects, diabetes, reproductive disorders, development of certain kinds of cancers, asthma, cardiovascular disease, and effects that can go from one generation to the next," Birnbaum said at the news conference.
The findings come from two previous National Institutes of Health studies that focused on developmental and reproductive effects. What about the adult health concerns raised by more recent studies?
The National Institutes of Health studies "focused on developmental and reproductive effects," Birnbaum said. "That is what led to our concern. It never looked at effects in adults, which is a different issue."
That's why the National Institutes of Health officially has "negligible concern" over adult health problems from BPA.
Despite it's newly increased concern, the FDA has not banned BPA and does not consider BPA-containing products, such as plastic baby bottles or plastic-lined cans of baby formula, to be unsafe.
In fact, the FDA says the risk of BPA from canned formula is far less than the risk of feeding a baby less nourishing food.
Nevertheless, U.S. health agencies are advising Americans to take "reasonable steps" to avoid BPA. Their advice:
Breastfeed infants for at least 12 months. If breastfeeding is impractical, iron-fortified formula should be used regardless of whether it comes in cans lined with BPA-containing plastic.
Discard scratched baby bottles or scratched sippy cups.
Don't put boiling water in BPA-containing plastic bottles. Mix powdered formula with water boiled in a BPA-free container and cooled to lukewarm.
Warm ready-to-feed liquid formula by running warm water over the outside of the bottle. Do not heat any kind of baby bottle in the microwave.
Make sure plastic bottles and containers are labeled "microwave safe" or "dishwasher safe" before putting them in the appropriate appliance.
Discard all plastic food containers with scratches.
Sharfstein said the FDA is seeking greater regulatory powers to track and control industrial use of the chemical. Current 1960s-era regulations allow manufacturers to use BPA without telling the FDA they are doing so. But the FDA is checking to see whether more recent legislation gives it the power to force manufacturers to notify the FDA of BPA use -- and to allow the FDA to ban products if manufacturers don't perform safety studies.
The plastics industry group American Chemistry Council says it's "disappointed" that the new FDA recommendations are "unfounded."
"Plastics made with BPA contribute safety and convenience to our daily lives because of their durability, clarity, and shatter resistance," the group says in a news release. "Can liners and food-storage containers made with BPA are essential components to helping protect the safety of packaged foods and preserving products from spoilage and contamination."
The FDA says it will help industry seek alternatives to BPA. Some alternatives exist. Sharfstein noted that the six largest manufacturers of baby bottles -- representing more than 90% of the U.S. market -- are now making baby bottles without BPA.
SOURCES:
FDA/Health and Human Services news conference, Jan. 15, 2010, with William Corr, deputy secretary, Department of Health and Human Services; Margaret Hamburg, MD, commissioner, FDA; Linda Birnbaum, PhD, director, National Institute of Environmental Health Sciences, National Institutes of Health; and Robin Ikeda, acting deputy director for non-communicable disease, Environmental Health and Injury Prevention, CDC.
News release, American Chemistry Council.
FDA news release and fact sheet.
Department of Health and Human Services news release and fact sheet.

Tylenol, Motrin, Benadryl, St. Joseph Aspirin, Rolaids Recall

2010-01-20T09:40:00.001+03:00

Daniel J. DeNoon
January 15, 2010 — Because of a sickening smell in some containers, 54 million packages of 27 different over-the-counter remedies now are being recalled.
Products include various types of child and/or adult Tylenol, Motrin, Benadryl, St. Joseph Aspirin, Rolaids, and Simply Sleep. This adds to the 6 million packages of Tylenol recalled late last year, bringing the total number of recalled products to 60 million.
A musty, moldy odor coming from the products has sickened at least 70 people with nausea, stomach pain, vomiting, and diarrhea. The symptoms go away by themselves and no one has been seriously injured.
The FDA says Johnson & Johnson's McNeil Consumer Health Care knew of the problem for more than a year. When the company did act in November and December 2008, it did too little too late, said Deborah M. Autor, director of the FDA's Office of Compliance.
"When something smells bad, literally or figuratively, companies must aggressively investigate and take all actions necessary to solve the problem," Autor said at a news conference. "McNeil should have acted faster."
The odor comes from a chemical, 2,4,6-tribromoanisole or TBA. TBA is produced when fungi break down a commonly used fungicide called 2,4,6-tribromophenol. The full health effects of TBA are not known.
Before being filled with product, product containers were stored on wooden pallets apparently treated with the fungicide. TBA seems to have infiltrated the product containers before they were filled.
The FDA inspected McNeil's main plant at Las Piedras, Puerto Rico, and was not happy with what it found. The FDA says McNeil began receiving complaints in May 2008, but failed to investigate fully or to warn consumers in a timely manner.
The FDA has given McNeil 15 days to respond to its seven-point warning letter. In addition to the contamination issue, the FDA says there are product-quality issues with some Motrin products.
Specific products included in the recall include:
Children's Motrin
Children's Tylenol
Extra Strength Tylenol
Regular Strength Tylenol
Tylenol 8 Hour
Tylenol Arthritis
Tylenol PM
Benadryl
Motrin IB
Rolaids
Simply Sleep
St. Joseph Aspirin
A complete list of the recalled products, including package sizes, product types, lot numbers, and UPC codes, can be seen at www.mcneilproductrecall.com. Consumers with question can call McNeil at 888-222-6036.
Consumers who think they may have suffered ill effects from the products should contact the FDA at www.FDA.gov/medwatch.
SOURCES:
FDA news conference with Deborah M. Autor, director, Office of Compliance (OC), Center for Drug Evaluation and Research (CDER), FDA; Jason Woo, MD, associate director for medical and scientific affairs, OC, CDER, FDA, and Karen Hirshfield, acting branch chief, Recalls and Shortages Branch, OC, CDER, FDA.
PR Newswire, Jan. 15, 2009
News release, J&J McNeil Consumer Healthcare.
FDA warning letter to McNeil, Jan. 8, 2009.
Marc Boston, spokesman, McNeil Consumer Healthcare.

Bisphenol A (BPA) Information for Parents

2010-01-17T09:55:00.001+03:00

WHAT IS BPA?
Bisphenol A, more commonly known as BPA, is a chemical that has been used for more than 40 years in the manufacture of many hard plastic food containers such as baby bottles and reusable cups and the lining of metal food and beverage cans, including canned liquid infant formula. Trace amounts of BPA can be found in some foods packaged in these containers.
In 2008, the Food and Drug Administration conducted a review of toxicology research and information on BPA, and, at that time, judged food-related materials containing BPA on the market to be safe.
But recent studies have reported subtle effects of low doses of BPA in laboratory animals. While BPA is not proven to harm children or adults, these newer studies have led federal health officials to express some concern about the safety of BPA.
WHY ARE THERE CONCERNS ABOUT BPA AND WHAT IS THE GOVERNMENT DOING TO ADDRESS THESE CONCERNS?
It is clear that the government and scientists and doctors need more research to better understand the potential human health effects of exposure to BPA, especially when it comes to the impact of BPA exposure on young children.
The Department of Health and Human Services -- through its Centers for Disease Control and Prevention (CDC), the National Institutes of Health (NIH), and the Food and Drug Administration (FDA) -- is investing in important new health studies in both animals and humans to better determine and evaluate the potential health effects of BPA exposure, including $30 million in studies at NIH. We expect to have the results of this scientific research in approximately 18 to 24 months.
While we learn more, the Food and Drug Administration is supporting current efforts by industry to stop the manufacture of infant bottles and feeding cups made with BPA from the U.S. market. The FDA is also seeking to strengthen its oversight of BPA so the agency can respond quickly, if necessary, when more scientific evidence becomes available.
WHAT YOU CAN DO TO MINIMIZE YOUR INFANT’S EXPOSURE TO BPA?
In the meantime, while scientists are gathering more data, there are some simple, reasonable steps families and parents can take to minimize exposure to BPA.
#1 FOLLOW RECOMMENDED GUIDELINES TO FEED YOUR INFANT.
HHS supports the American Academy of Pediatrics’ recommendations for infant feeding and supports breastfeeding for at least 12 months whenever possible, as breast milk is the optimal source of nutrition for infants.
If breastfeeding is not an option, iron-fortified infant formula is the safest and most nutritious alternative. The benefit of a stable source of good nutrition from infant formula and food outweighs the potential risk of BPA exposure.
Parents should discuss any significant changes to your baby’s diet with your baby’s doctor or nurse.
#2 DISCARD SCRATCHED BABY BOTTLES AND INFANT FEEDING CUPS.
Worn baby bottles and cups are likely to have scratches that harbor germs and - if they contain BPA - may release small amounts of the chemical.
#3 TEMPERATURE MATTERS.
Be careful how you heat up your child’s breast milk or formula. Studies have found there is a very small amount of BPA in plastics and other packaging materials that can transfer to food and liquids. Additional traces of BPA levels are transferred when hot or boiling liquids or foods come in contact with packaging made of BPA.
Do not put boiling or very hot water, infant formula, or other liquids into BPA-containing bottles while preparing them for your child.
Before mixing water with powdered infant formula, the water should be boiled in a BPA-free container and allowed to cool to lukewarm.
Ready-to-feed liquid formula can be served at room temperature or gently warmed up by running warm water over the outside of the bottle.
Always remember: Do not heat baby bottles of any kind in the microwave – the liquid may heat unevenly and burn your infant
Sterilize and clean bottles according to instructions on infant formula labels. They should be left to cool to room temperature before adding infant formula.
#4 CHECK THE LABELS ON YOUR BOTTLES AND FOOD PREPARATION CONTAINERS.
As a good household practice, only use containers marked “dishwasher safe” in the dishwasher and only use “microwave safe” marked containers in the microwave.
As a good household practice, discard all food containers with scratches, as they may harbor germs and may lead to greater release of BPA.
WHAT WE KNOW ABOUT BPA IN FEEDING PRODUCTS FOR INFANTS?
Liquid Infant Formula. There are small amounts of BPA in liquid infant formulas sold in cans. Infant formula in this packaging can offer important health advantages for some infants, and the proven benefit of good nutrition outweighs the potential risk of BPA exposure.
If you are using liquid infant formula in cans:
Do not heat cans of infant formula on the stove or in boiling water. Ready-to-feed liquid formula can be served at room temperature or gently warmed in a nursing bottle by running warm water over the outside of the bottle.
Powdered Infant Formula. FDA has found that powdered infant formula mix typically has no detectable level of BPA.
Infant Bottles Made with BPA. The six major U.S. manufacturers of baby bottles and infant feeding cups have confirmed to FDA that as of January 2009, they have not manufactured these products using BPA for the U.S. market. These manufacturers represent more than 90% of the U.S. market. These manufacturers produce brands that include Avent, Doctor Brown’s Natural Flow, Evenflow, First Essentials, Gerber, Munchkin, Nuk, and Playtex.
Plastic Containers Made with BPA Used in Food Preparation. Plastic containers have recycle codes on the bottom. In general, plastics that are marked with recycle codes 1, 2, 4, 5, and 6 are very unlikely to contain BPA. Some, but not all, plastics that are marked with recycle codes 3 or 7 may be made with BPA.
Do not put very hot or boiling liquid that you intend to consume in plastic containers made with BPA. BPA levels rise in food when containers/products made with the chemical are heated and come in contact with the food.
Discard all bottles with scratches, as these may harbor bacteria and, if BPA-containing, lead to greater release of BPA.
QUESTIONS AND ANSWERS FOR WEB SITE
Q: Should I throw away baby bottles that contain BPA?
A: Parents should examine bottles and discard them if worn or scratched because scratches can both harbor germs and, in BPA-containing bottles, lead to greater release of BPA. For those who want to use baby bottles and feeding cups not made with BPA, consumers should know that such products are now widely available in the U.S. market.
Q: Is liquid infant formula sold in cans safe?
A: There are small amounts of BPA in liquid infant formulas sold in cans. The benefits of good nutrition from liquid infant formula sold in cans far outweigh the potential risk of exposure to a small amount of BPA. As a result, HHS does not advise against the use of liquid infant formula in cans. Families considering alternative feeding approaches should discuss them with their child’s healthcare provider.
Q: Is powdered infant formula sold in cans safe?
A: FDA has found that powdered infant formula mix typically has no detectable level of BPA. In rare cases, small amounts of BPA are found in infant formula sold in powdered form. Families using powdered infant formula need to carefully follow instructions about preparing the formula. Families considering alternative feeding approaches should discuss them with their child’s healthcare provider.
Q: My baby always puts his plastic toys in his mouth. Should I throw them away?
A: No. In general, children’s toys are made of plastics that are not made with BPA.
Q: Is BPA in pacifiers?
A: The part of the pacifier that a child puts in his or her mouth is made from latex or silicone and does not contain BPA. In some pacifiers, the hard plastic shield designed to prevent swallowing might contain BPA; however, the only exposure would come from the child mouthing the shield, and the transfer of BPA is negligible.
Q: Should adults be concerned about exposure to BPA?
A: Concern over potential harm from BPA is highest for young children, because their bodies are early in development and have immature systems for detoxifying chemicals. Adults and older children should follow reasonable food preparation practices to reduce exposure to BPA. The National Institutes of Health is supporting additional studies to better understand BPA and adults.
Q: What is HHS doing to address the concerns regarding BPA?
A: The Department of Health and Human Services -- through its Centers for Disease Control and Prevention (CDC), the National Institutes of Health (NIH), and the Food and Drug Administration (FDA) -- is investing in important new health studies in both animals and humans to better determine and evaluate the potential health consequences of BPA.
New FDA Studies on BPA: As part of its update on BPA, FDA, in collaboration with NIH, is undertaking major studies to address safety issues. These studies are designed to better understand how BPA is metabolized in adults and children and determine, among other things, the effects of BPA on the developing bodies of children. More Information
NIH Funding to Investigate BPA: The National Institute of Environmental Health Sciences is providing $30 million in funding to investigate BPA, which includes support for FDA studies and external grants. More Information
New CDC Research on BPA: CDC uses advanced laboratory science and innovative techniques in its efforts to assess people’s exposure to environmental chemicals. In December 2009, CDC released a report on the human exposure to environmental chemicals, including BPA. More Information

Fat May Help Build Bone Mass in GirlsExcessive weight loss in teen years may increase risk of osteoporosis, findings suggest

2010-01-13T09:02:00.002+03:00

WEDNESDAY, Jan. 6 (HealthDay News) -- Fat mass plays an important role in building bone mass in teenage girls and having too little may increase their risk of osteoporosis later in life, new research has found.
In the study, researchers measured cortical bone mass (the hard outer layer of bone) in 4,005 girls and boys, mean age 15.5 years. The results showed that fat mass had a positive influence on bone mass, particularly in girls, where the effect was about 70 percent greater than in boys.
The study is scheduled for publication in the February issue of the Journal of Clinical Endocrinology & Metabolism.
"The effect of fat mass on bone mass appears to be strongest in girls," study lead author Jonathan Tobias, of the University of Bristol in England, said in an Endocrine Society news release. "Girls clearly have more fat mass than boys and our findings show that whereas the greater lean mass in boys contributes to their greater cortical bone mass, this effect is partly counteracted by the greater fat mass in girls," Tobias explained.
"Fat mass in girls during puberty may have a long-term impact on bone health as they grow into adulthood. Excessive reduction in fat mass could have adverse effects on the developing skeleton particularly in girls, leading to an increased risk of osteoporosis later in life," Tobias said.
More information
The National Osteoporosis Foundation has more about osteoporosis prevention.
-- Robert Preidt
SOURCE: Endocrine Society, news release, Jan. 5, 2010
Last Updated: Jan. 06, 2010
Copyright © 2010 ScoutNews, LLC. All rights reserved.

Misconnections in Developing Brain May Cause Autism Mounting evidence opens possibility of future drug treatment, researchers say

2010-01-13T08:58:00.003+03:00

MONDAY, Jan. 11 (HealthDay News) -- A new study adds to growing evidence that autism is caused by a miswiring of connections in a child's developing brain, resulting in impaired information flow.
According to researchers at Children's Hospital Boston, it may be possible to one day treat the problem with drugs that target the molecular pathways that cause the miswiring.
The study authors looked at a rare disorder called tuberous sclerosis complex (TSC), which causes benign tumors throughout the body, including the brain. Many people with TSC have epilepsy and intellectual disabilities, and about 25 percent to 50 percent of TSC patients have autism spectrum disorders.
In this study, the researchers found that mutations in one of TSC's causative genes (TSC2) prevent growing nerve fibers (axons) from locating their proper targets in the developing brain.
The team focused on a nerve fiber (axon) route between the eye's retina and the visual processing area of the brain in mice. When neurons were deficient in TSC2, their axons failed to end up in the correct locations. That's because the axons' tips, called growth cones, didn't respond to navigation cues from molecules called ephrins.
"Normally, ephrins cause growth cones to collapse in neurons, but in tuberous sclerosis the axons don't heed these repulsive cues, so keep growing," senior investigator Dr. Mustafa Sahin, of the hospital's neurology department, said in a news release.
This loss of axon responsiveness to ephrin signals is caused by activation of a molecular pathway called mTOR. The activity of this pathway increases when neurons are deficient in TSC2, the researchers noted.
This study examined retinal connections to the brain, but Sahin and colleagues said their findings may help improve general understanding of the organization of the developing brain. In autism, it's believed that abnormal wiring may occur in areas of the brain involved in social cognition.
"People have started to look at autism as a developmental disconnection syndrome -- there are either too many connections or too few connections between different parts of the brain," Sahin said in the hospital news release. "In the mouse models, we're seeing an exuberance of connections, consistent with the idea that autism may involve a sensory overload, and/or a lack of filtering of information."
The study was published online Jan. 10 in the journal Nature Neuroscience.
More information
The U.S. National Institute of Neurological Disorders and Stroke has more about autism.
-- Robert Preidt
SOURCE: Children's Hospital Boston, news release, Jan. 10, 2010
Last Updated: Jan. 11, 2010
Copyright © 2010 ScoutNews, LLC. All rights reserved.

التبغ المستخدم في الشيشه - جدير بالمشاهده

2009-12-14T21:14:00.002+03:00

http://quietube.com/v.php/http:/www.youtube.com/watch?v=tBgwbe_s4oE

2009 H1N1: What's New This Week -- December 1, 2009

2009-12-10T16:49:00.000+03:00

Commentary by John G. Bartlett, MD
John G. Bartlett, MD
Editor's Note: The past week's news stories on H1N1 influenza focused on the debate about the use of adjuvants in flu vaccines, reports on viral mutations and oseltamivir resistance, the added protection from previous seasonal flu illness or vaccination, an upswing in pneumococcal disease with H1N1, risk factors for children, and a new vaccine plant for the United States. We provide links to those stories and commentary by infectious diseases expert, John G. Bartlett, MD. For more information on 2009 H1N1, see our H1N1 Influenza A (Swine Flu) Alert Center, where you will find the latest news, expert commentaries, resources for clinicians, and peer-to-peer discussions.
Did US Make a Mistake in Leaving Adjuvants out of H1N1 Vaccines?
Adjuvants are additives with immunostimulatory properties, capable of inducing more rapid seroprotection and longer-lasting immunity. Adjuvants are widely used in European and Canadian flu vaccines, but no new adjuvants have been approved for use in the United States.
Commentary. The use of adjuvant in the H1N1 vaccine would have reduced the antigenic dose and helped solve the supply problem. It was known early in the vaccine development process that the seed strain did not grow well in eggs and rapid production with timely delivery would be a challenge. The "adjuvant decision" was presumably based on 3 assumptions:
That simultaneous vaccine production and clinical trials of safety and efficacy could be accomplished. The clinical trials under the National Institute of Allergy and Infectious Diseases that confirmed safety and efficacy were completed on time.
An assumption that the 5 commercial suppliers could deliver vaccine products according to projections failed for the reasons noted above.
There was concern that the addition of adjuvant would add to the public fear about vaccine safety. We now know that more than 50% of the US public have concerns about the H1N1 vaccine despite the fact that it is manufactured similar to every influenza vaccine for the past 40 years.
Adding adjuvant to the vaccine should not be an issue in terms of product safety because the same adjuvants are used in many routine US vaccines and are also used in the H1N1 vaccines distributed in Canada and England. The issue here is that the public perception of safety with adjuvant is unknown.
What can you tell patients who express frustration that they cannot get the vaccine or anger that they got H1N1 flu because of the vaccine supply deficit? Tell them that there was an assumption that timelines from commercial suppliers would be met and that there was concern that the addition of adjuvant would decrease public acceptance because of safety concerns. In retrospect, it might have been better to have made at least part of the supply of H1N1 vaccine with adjuvant.
Norway Finds H1N1 Mutation in Flu Fatalities
A potentially significant mutation in the H1N1 influenza strain was found in 2 people who died of complications from the virus and in a third person who was seriously ill with influenza. Norwegian health authorities fear that the mutation might enhance the virus' ability to infect the lower respiratory tract.
Commentary. Influenza viruses are expected to mutate. Concern arises when the mutation has clinical consequences in 4 categories:
Resistance to oseltamivir and/or zanamivir. So far, the World Health Organization (WHO) has reported a total of 52 strains of 2009 H1N1 that are resistant to oseltamivir, including 15 in the United States. All of these have been the 274Y codon mutation that confers resistance to oseltamivir but not zanamivir. No strain has proven resistant to zanamivir.
Increased infectivity: 2009 H1N1 already has this property.
Increased virulence: This is the concern expressed in the report from Norway. The implication is that a mutational change could alter pathogenic potential, presumably by its direct effect on the lower respiratory tract where it incites "cytokine storm." Increased virulence is of concern because the mutation was found in 3 serious cases, but analysis of subsequent serious cases did not show the mutation. The association is far from established.
Mutational change sufficient to alter vaccine protection. Mutational change would be compared with the seed strain used to produce the vaccine, and studies to date have shown this change only in a single isolate.
Tell patients who are concerned about viral mutation that this information is being systemically collected, and so far it shows that the vaccine is still effective; oseltamivir is effective against > 99% of strains; and there is no convincing evidence of increased virulence.
Seasonal Flu Vaccine May Cut Swine Flu Risk
A study in military personnel found that people who received a seasonal influenza vaccine last year are at lower risk for H1N1 influenza or serious disease if they do acquire H1N1 infection. However, protection from the seasonal flu vaccine did not appear to be effective for persons aged 25-39 years.
Commentary. A recent publication[1] provides an extraordinarily important observation that may explain why we are seeing a pandemic with a high attack rate and a low mortality rate. It also explains the interesting age distribution in this pandemic. The presumed mechanism is that repeated exposures to different H1N1 antigens by infection or vaccination do not elicit protection from infection through humoral immunity (antibody response), but there is reduced severity of disease because of memory T-cell response that has not been previously measured.
Pre-existing Immunity Against Swine-Origin H1N1 Influenza Viruses in the General Human Population[1]
The 2009 influenza A (H1N1) strain has caused enough infections to be considered a WHO-defined pandemic, but the clinical severity so far is similar to seasonal flu. Neutralizing antibodies to this new strain are found almost exclusively in persons born before 1957; therefore, how do we explain the relatively benign course in most persons under 52 years of age? To answer this question, investigators examined the molecular basis of immunity to this new strain. They found a relatively poor B-cell response with antibody production (the standard method of measuring immunity to influenza viruses). Instead, they found antigen recognition and response in memory T cells. This response was similar to that seen with seasonal influenza. The investigators concluded that the lack of B-cell recognition explains the high attack rate especially in young persons, but the memory cell recognition explains the lower severity than that which might be expected with a pandemic.
Commentary. This appears to be a major advance in understanding the dynamics of this influenza epidemic -- too many cases to count, but a total mortality of about 4000 -- with first and second waves that affected primarily young people. In contrast, the average mortality for seasonal flu in the United States is 36,000/year, and most of the deaths are in the very young and very old. This study provides a plausible explanation for these unusual epidemiologic observations. The scientific explanation doesn't really change the recommendations about management because the clinical impact preceded the science.
You can tell your patients that the more times they have had influenza or influenza vaccine, the less likely they are to contract 2009 influenza A (H1N1).
CDC Warns of Increasing Pneumococcal Disease Associated With H1N1 Flu
Rates of serious pneumococcal infections associated with H1N1 influenza are increasing around the country. Surveillance in the Denver, Colorado, metropolitan area finds that the number of cases of invasive pneumococcal disease has tripled compared with the 5-year average, affecting mostly adults under the age of 60 years.
Commentary. The frequent association between Streptococcus pneumoniae superinfection in patients with viral respiratory tract infections has been well established for decades, and is presumably a result of dysfunctional alveolar macrophages. The classic presentation with influenza is typical flu symptoms followed by improvement, and then deterioration as a result of pneumococcal pneumonia.[2] This association was also emphasized in the retrospective analysis of 8398 lethal cases of influenza in the 1918-1919 pandemic when S pneumoniae was the major lethal pathogen.[3] The association was emphasized again in the US Centers for Disease Control and Prevention (CDC) review of tissue specimens in 77 lethal cases from the current 2009 (H1N1) pandemic, which showed 22 cases of bacterial pneumonia with the pneumococcus as the dominant strain.[4]
What does this mean for practitioners?
When should you suspect pneumococcal superinfection with confirmed or suspected infection with pandemic 2009 influenza A (H1N1)? The following course of action includes:
Clinical and laboratory clues A course characterized by clinical improvement, then deterioration. (Note that not all patients have this biphasic course)
Lab clues often show S pneumoniae by sputum Gram stain, culture of blood, or sputum or urinary antigen; elevated white blood cell count with shift (uncommon with uncomplicated influenza); and imaging showing focal consolidation
Diagnosis: Physicians are urged to establish this diagnosis with cultures of sputum, blood, and urinary antigen tests
Treatment: The preferred drugs for pneumococcal pneumonia in 2009-2010 are the beta-lactams. More than 95% of strains are sensitive to penicillin G, amoxicillin, ceftriaxone, cefotaxime, etc. Macrolides are inferior for this infection. Fluoroquinolones are virtually always active. Vancomycin and linezolid are also active but used only when there is concern for methicillin-resistant Staphylococcus aureus (MRSA)
Prevention: This association emphasizes the potential utility of pneumococcal vaccine polyvalent (Pneumovax®) in adults with CDC-defined risks and pneumococcal 7-valent conjugate vaccine (Prevnar®) in children. The data on efficacy of pneumococcal 7-valent conjugate vaccine in children are simply amazing -- not only for the children who get it, but for the herd immunity impact that protects adults as well.[5] The benefit of pneumococcal vaccine polyvalent in adults is far less striking, and it seems better at preventing pneumococcal bacteremia than pneumococcal pneumonia.[6]
WHO Probing Drug Resistant H1N1 Flu in Britain and U.S.
WHO is looking into reports in the United Kingdom and the United States that the H1N1 influenza virus may have developed resistance to oseltamivir. In Wales, oseltamivir-resistant H1N1 has been confirmed in 5 patients who had severely compromised immune systems. Four similar cases have been identified at Duke University, Durham, North Carolina.
Commentary. The frequency of oseltamivir resistance is very low. Data from isolates collected by WHO indicate just 52 resistant strains; the data for the United States for September 1-November 14, 2009 showed resistance to oseltamivir in 10 of 1209 (0.8%). No one has detected a zanamivir-resistant strain. The unique feature of this case is that it apparently represents transmitted resistance because this patient had no prior exposure to oseltamivir. In the United States, 1 patient with oseltamivir resistance without exposure to the drug for either treatment or prophylaxis has been identified.[7]
What clinicians need to know:
Oseltamivir is active against > 99% of strains of 2009 influenza A (H1N1) and remains the preferred drug;
This could change rapidly as it did with seasonal flu and H1N1 last season when 99% of strains became resistant, but there has been little evidence so far that the pandemic strain of H1N1 will do this;
The low level of oseltamivir resistance noted through November 14, 2009 is expected, and nearly all cases involving resistant strains in the United States have been associated with documented oseltamivir exposure for treatment or prophylaxis; and
Zanamivir continues to be active against all tested strains of 2009 (H1N1), but the delivery system is somewhat complicated, and chronic lung disease and asthma are contraindications to its use.
Risk Factors and Outcomes Among Children Admitted to the Hospital With Pandemic H1N1 Influenza[8]
Investigators reviewed 58 cases of pandemic H1N1 influenza in hospitalized children in Ontario, Canada, from May 8 to July 22, 2009. These cases were compared with 200 cases in children with seasonal flu admitted to the hospital during the 5 previous years. The results showed that in more children with pandemic H1N1 influenza, asthma was the underlying condition (13/58 [22%] vs 11/200 [6%]; P < .001), and more children admitted to the intensive care unit required mechanical ventilation (5/12 [42%] vs 2/28 [7%]; P = .02). The conclusion is that the current pandemic of H1N1 is different from seasonal flu in terms of the risk associated with asthma and severity of disease in children. Commentary. The message for pediatricians and others who care for children: Children with asthma should be a high priority for H1N1 pandemic flu vaccine and preemptive antiviral treatment; The injected vaccine is considered safe in children and adults with asthma; These children should not receive the live virus vaccine; The investigators noted that other reports also implicate asthma as an associated or predisposing condition in 21%-30% of hospitalized patients during this pandemic, so this report is not an outlier; and The risk in the report from Canada did not appear to be related to the severity of asthma. In other words, mild asthma is as big a risk as serious asthma. Next-Generation Flu Vaccine Plant to Open in the United States[9]
Novartis Pharmaceuticals Corporation plans to open a flu vaccine plant in Holly Hill, North Carolina, in 2011. The plant will use cell-based cultures of influenza virus, have a production capacity of 50 million doses of seasonal flu vaccine, and up to 150 million doses of pandemic vaccine within 6 months. The inoculum will be 3.75 mg antigen with adjuvant.
Commentary. This will be the only flu vaccine produced in the United States. Local production is important because severe pandemics or bioterrorism events are likely to put pressure on companies that produce vaccines to preferentially serve nationalistic needs rather than honor contracts with distant countries. Also, the plant will use cell-based cultures to grow influenza virus rather than eggs, which is the standard for all contemporary flu vaccines. This will result in a reduction in egg dependency and faster production. Vaccine authorities have talked about the need for cell-based vaccines for 10 years.

How it feels to have a stroke? Sent by a colleague

2009-12-08T09:41:00.002+03:00

This video is worth watching
http://www.youtube.com/watch?v=UyyjU8fzEYU

No Adverse Events Reported So Far With H1N1 Influenza Vaccine

2009-12-03T12:03:00.000+03:00

2009 H1N1: What's New This Week -- Commentary by John G. Bartlett, MD

No adverse events have been reported as yet from the H1N1 influenza vaccine, according to experts who are tracking the vaccine's safety through several postmarketing surveillance programs. Experts caution, however, that the 2009 H1N1 influenza vaccines have only recently begun to be administered, and the data are insufficient to assess safety of the vaccine.
Commentary
The experience so far is with careful analysis of adverse events with 10 million doses of the 2009 influenza A (H1N1) vaccine already administered in the United States. The director of the program, Bruce Gellin, MD, MPH, claims that in regard to safety, there are "no signals yet." A major concern is the "background noise" -- adverse events that would happen anyway, but are implicated because they are temporally tied to the vaccine. For example, within 6 weeks of vaccination there will be:
22 cases of Guillain-Barré syndrome/10 million vaccinations;
16,684 spontaneous abortions/1 million vaccinated pregnant women; and
6 sudden deaths/10 million vaccinations.[3]
The voluntary Vaccine Adverse Reporting System (VAERS) has summarized results through November 2, 2009 on the basis of reports after 33.7 million doses were administered. This showed 84 reactions considered serious, including 6 deaths that are currently under review and 4 cases of Guillain-Barré syndrome. All of these are currently under investigation, but the numbers are not striking and the analysis so far is not showing any concern

CDC Warns of Increasing Pneumococcal Disease Associated With H1N1 Flu

2009-12-01T10:05:00.000+03:00

Emma Hitt, PhD
November 25, 2009 — Rates of serious pneumococcal infections associated with H1N1 influenza are increasing around the country, the Centers for Disease Control and Prevention (CDC) announced today.
Anne Schuchat, MD, director of the CDC's National Center for Immunization and Respiratory Diseases, led a press briefing.
According to Dr. Schuchat, in the Denver metropolitan area, 1 of 10 active bacterial core surveillance sites where investigation into this issue is ongoing, the number of cases of invasive pneumococcal disease has tripled compared with the 5-year average for the month of October.
"Most of that increase has been in adults under the age of 60," Dr. Schuchat noted. "The findings in Denver probably reflect findings that are occurring in other parts of the country where the surveillance hasn't been as intensive," she added.
The findings highlight the fact that "pandemics put us at risk for not just flu problems but also bacterial pneumonia problems," and they also point to the need for prevention efforts, Dr. Schuchat said.
Only about 25% of high-risk adults younger than 65 years have received the vaccine that protects against pneumococcal disease, she said.
Dr. Schuchat also commented on the H1N1 influenza vaccine supply, stating that supplies continue to increase, with an estimated 21.2 million doses available for the states to order, with less than a quarter of doses available as an intranasal spray.
Several states are planning major activities after Thanksgiving to promote more vaccination in targeted groups such as adults with chronic health conditions and children, Dr. Schuchat said.
Regarding the safety of the H1N1 vaccine, Dr. Schuchat noted that "so far, everything that we've reviewed is extremely reassuring," with patterns similar to that observed with the seasonal flu vaccine.
Of all the reports that have come into the Vaccine Adverse Event Reporting System (VAERS), about 94% of adverse events were classified as not serious and mostly involve redness at the injection site. To date, there are no indications of Guillain-Barré syndrome or allergic reactions to the H1N1 vaccine.
A total of 10 reports to the VAERS have come in about possible Guillain-Barré syndrome cases potentially related to the vaccine, which, considering the number of doses administered, is not considered notable, she said.

CDC Commentary: Seasonal and H1N1 Influenza Vaccines -- Timing of Doses

2009-12-01T10:00:00.000+03:00

http://www.medscape.com/viewarticle/711568?src=mp&spon=9&uac=6966HK

Virus mutation spreads as swine flu deaths leap

2009-11-28T11:25:00.002+03:00

Swine flu virus mutations are spreading in Europe, French health officials said Friday as the World Health Organisation reported a leap in deaths from the disease by more than 1,000 in a week.

Two patients who were infected by a mutation that was also recently detected in Norway have died in France, the government's Health Surveillance Institute (InVS) said in a statement.

"This mutation could increase the ability of the virus to affect the respiratory tracts and, in particular, the lung tissue," said a statement from "For one of these patients, this mutation was accompanied by another mutation known to confer resistance to oseltamivir," it added, referring to the main drug being used to treat swine flu, under the brand name Tamiflu.

The case was the first drug-resistant strain found in France among the 1,200 strains experts have analysed here, the InVS said, adding that "the effectiveness of vaccines currently available is not being questioned."

The two patients were not related and had been hospitalised in two different cities in France, it said.

The WHO said Friday the death toll had reached at least 7,826 worldwide since the A(H1N1) flu virus was first uncovered in April.

The number of deaths reported to the UN health agency showed the biggest rise in the Americas, where 5,360 deaths have now been recorded compared to 4,806 a week ago.

But Europe also posted a substantial increase percentage-wise with at least 650 fatalities now reported, representing a surge of 300 deaths or 85 percent from data posted a week ago.

The WHO said Thursday it was investigating reports of mutations in the virus, after half a dozen countries recorded such cases.

"The question is whether these mutations again suggest that there is a fundamental change going on in viruses out there -- whether there's a turn for the worse in terms of severity," said Keiji Fukuda, WHO's special adviser on pandemic influenza.

"The answer right now is that we are not sure," he added following reports from China, Japan, Norway, Ukraine and the United States.

He noted, however, that mutations are common in influenza viruses, and "if every mutation is reported out there it would be like reporting changes in the weather."

"What we're trying to do when we see reports of mutations is to identify if these mutations are leading to any kinds of changes in the clinical picture -- do they cause more severe or less severe disease?

"Also we're trying to see if these viruses are increasing out there as that would suggest a change in epidemiology," he added.

China said earlier Thursday that it had discovered eight people with mutated versions of swine flu while Norway reported last week that it had detected one case.

Fukuda also said that the UN health agency was looking into Tamiflu-resistant cases reported in Britain and the United States but noted they concerned people who are already undergoing treatment for other diseases or who have underlying health issues.

The health agency was therefore maintaining its assessment that Tamiflu, produced by Swiss drugmaker Roche, remained "effective" as a treatment for swine flu, but that "we do have to be vigilant in these very susceptible people."

اللهم أغثنا اللهم أغثنا

2009-11-27T18:51:00.004+03:00

(مطرنا بفضل الله وبرحمته)
(اللهم صيبا نافعا)
( اللهم سقيا رحمة ولا سقيا عذاب ولا بلاء ولا هدم ولا غرق )

عن النبي صلى الله عليه وسلم قال

( اطلبوا استجابة الدعاء عند التقاء الجيوش وإقامة الصلاة ونزول الغيث)

أسأل الله عز وجل بأسمائه الحسنى وصفاته العلى كما أحيا الأرض بوابل خيره

أن يحي قلوبنا بالإيمان

و يغيثنا برحمته و رضوانه

وأن يؤمننا بأوطاننا و يجعل هذا البلد سخاءا رخاءا هو ولي ذلك و القادر عليه

عيدكم مبارك

2009-11-25T11:17:00.002+03:00

عيدكم مبارك وتقبل الله منا و منكم

Vaccine call over 'new' swine flu

2009-11-21T22:01:00.002+03:00

People in Wales at risk of contracting swine flu have been urged to get vaccinated against the virus after it emerged five people have been diagnosed with a strain resistant to Tamiflu.

Vaccine call over 'new' swine flu .The advice came from Dr Roland Salmon, director of the Communicable Disease Surveillance Centre at the National Public Health Service for Wales (NPHS).

He was speaking after it was announced five patients at University Hospital for Wales in Cardiff have been diagnosed with a strain resistant to the antiviral drug.

Dr Salmon said: "Vaccination is the most effective tool we have in preventing swine flu, so I urge people identified as being at risk to look out for their invitation to be vaccinated by their GP surgery."

More than three million healthy children under five across the UK are also to be offered the swine flu jab, it was announced earlier this week.

Parents will be invited by their GPs to bring their children into surgeries, with vaccinations expected to start in December.

The Tamiflu-resistant strain will become much more common as the virus mutates, according to a flu expert.

Three out of the five patients diagnosed at the University Hospital for Wales remain in hospital, after it was revealed they could be the world's first cases of person-to-person transmission of the virus, the NPHS said.

Professor Nigel Dimmock, a virologist at the University of Warwick, said: "This is just the beginning. You have got a lot of viruses and if you use Tamiflu at the level they are using it you get resistance.

"However, they probably aren't resistant to Relenza, the other anti-viral. You need other mutations to make it resistant to Relenza. Also, the vaccine is coming on so people regard Tamiflu as a stop gap and there's no need to panic."

Expert warning over new swine flu

2009-11-21T21:48:00.001+03:00

Tamiflu-resistant swine flu which has broken out in Wales will become much more common as the virus mutates, a flu expert said. Skip related content
Related photos / videos
Expert warning over new swine flu .Three out of five patients diagnosed with the Tamiflu-resistant strain remain in hospital, after it was revealed they could be the world's first cases of person-to-person transmission of the virus, the National Public Health Service for Wales (NPHS) said.

Professor Nigel Dimmock, a virologist at the University of Warwick said: "This is just the beginning. You have got a lot of viruses and if you use Tamiflu at the level they are using it you get resistance.

"However, they probably aren't resistant to Relenza, the other antiviral. You need other mutations to make it resistant to Relenza.

"Also, the vaccine is coming on so people regard Tamiflu as a stop gap and there's no need to panic."

He added it was unsurprising person-to-person transmissions had started. He said: "This is the trouble with going into hospitals, where you can get MRSA, C.diff, Norovirus and so on. You go in with something and you come out with a virus, it's a well known problem."

Three of the five people on a unit for severe underlying health conditions at the University Hospital of Wales, in Cardiff, appear to have acquired the infection on the ward, the NPHS said.

Two of the five have recovered and have been discharged from hospital, one is in critical care and two are being treated on the ward.

Professor Dimmock said the likelihood of the cases in Cardiff causing an outbreak of the resistant strain depend on how well the virus has been contained.

Four pilgrim deaths from swine flu at Hajj-Saudia Arabia

2009-11-21T21:43:00.003+03:00

Adel Zaanoun

Swine flu has killed four pilgrims in Saudi Arabia for the annual hajj pilgrimage, the health ministry said in a statement carried by the official SPA news agency on Saturday.
It was the first reported news of fatalities from the disease among pilgrims gathering in the kingdom for the pilgrimage which Muslims are obliged to undertake once in their lifetime if they have the means.

The ministry said a Moroccan woman, a Sudanese man and an Indian man -- all aged 75 -- had died from A(H1N1), as had a 17-year-old girl from Nigeria. It said the four had not followed "recommended procedures, especially vaccination against swine flu."

Health ministry spokesman Dr Khaled Marghlani told AFP the four victims were all suffering from health problems already, including cancer and respiratory illness.

Three of the deaths announced on Saturday were in Medina and the fourth was in Mecca itself, the health ministry statement said.

Marghlani said 16 other cases of swine flu infection among pilgrims had been detected, and that "four are in hospital in critical condition." Twelve people suffering from the disease had recovered completely after treatment, he said.

Health authorities in the kingdom have mobilised for the world's largest gathering since swine flu began spreading across the globe after it was first reported in April.

Hundreds of thousands of pilgrims from across the globe have already gathered in the country to perform the hajj in the holy Muslim cities of Mecca and Medina.

The peak day in the hajj is this coming Thursday, when pilgrims gather at Mount Arafat, where the Prophet Mohammed gave his final sermon.

For the hajj, thermal cameras were installed at air and sea terminals in Jeddah where most pilgrims arrive, some 15,000 health workers are deployed, and hospitals have hundreds of extra beds available.

In Medina and Mecca, as well as in Jeddah, the government has taken measures to identify the virus in suspected cases.

The health ministry also has mobile units which can instantly send to a central monitoring centre the locations of infections, to monitor outbreaks.

On November 11, the Saudi authorities reported 70 people had died in the country from the disease and said more than 7,000 proven cases had been recorded.

On Friday, World Health Organisation data showed around 6,750 people had died from swine flu worldwide since the virus was first uncovered in Mexico and the United States in April.

H1N1 Vaccine as Safe as Seasonal Vaccine, WHO Says

2009-11-21T08:39:00.003+03:00

Emma Hitt, PhD
A November 19, 2009 — The H1N1 2009 pandemic influenza vaccine appears to be as safe as the seasonal flu vaccine, according to the World Health Organization (WHO).

About 1 adverse event is being reported for every 10,000 doses, said Dr. Marie-Paule Kieny, director of the WHO's Initiative for Vaccine Research, at a virtual press briefing today. Of those adverse event reports, about 5 of 100 are considered serious.

According to Dr. Kieny, serious adverse events so far include 30 deaths and about 12 cases of Guillain-Barré syndrome; however, she emphasized that none of the deaths reported to date has been confirmed as being caused by the vaccine. In addition, all cases of Guillain-Barré syndrome have been transient, and only a few have been linked to the vaccine.

Dr. Kieny added that there appears to be no difference between the safety profile of the seasonal and pandemic influenza vaccines, and the number of adverse events is comparable between the 2 vaccines. In addition, the safety profiles of the different forms of pandemic vaccine are also similar.

Adverse reactions associated with the pandemic vaccine include a variety of local reactions including "pain at injection site, swelling, redness, and reactions such as fever, headache, muscle pain, or fatigue," Dr. Kieny said. "These generally resolve within 1 or 2 days."

"No new safety issues have been identified from reports received to date," she said.

At least 80 million doses of vaccines have been distributed and 65 million doses have been administered. "These are figures that we have received from 16 countries, but we think they are conservative estimates because immunization campaigns are under way now in 40 countries," Dr. Kieny added.

The WHO expects to start shipment of the vaccine to developing countries at the end of this month. According to Dr. Kieny, this represents a slight delay, but they expect that all vaccine doses will reach 95 eligible countries during the next 3 months

H1N1 Flu Skepticism Demands Deft Response

2009-11-18T12:19:00.001+03:00

By Kate Kelland
LONDON (Reuters) Nov 13 - European scientists and health authorities are facing angry questions about why H1N1 flu has not caused death and destruction on the scale first feared, and they need to respond deftly to ensure public support.
Accusations are flying in British and French media that the pandemic has been "hyped" by medical researchers to further their own cause, boost research grants and line the pockets of drug companies.
Britain's Independent newspaper this week asked "Pandemic? What Pandemic?"
In their response, scientists are walking a fine line.
They say that although the virus is mild, it can still kill, and that the relatively low fatalities in Europe are in part the result of official response to their advice.
On suggestions of "hyping" the threat to boost research funding, they point out that while we know enough to start to protect the vulnerable, we need to know a lot more to conquer the virus, and funding for new research and drugs is vital to be equipped for future pandemics.
H1N1 is hitting a younger population -- adults in their 20s and 30s and children -- and the global death count so far is more than 6,000, according to the World Health Organization.
While seasonal flu attacks about 20% of the population in an average year, experts estimate that even in Britain -- the worst-hit country in Europe so far -- fewer than 10% of people have had H1N1 flu.
Fred Hayden, influenza research coordinator at the Wellcome Trust and a former World Health Organization expert, said early planning is paying off, but added, "I wouldn't characterize this as a 'mild' pandemic at all. We are seeing some very unfortunate loss of life. I think it a bit early to make that judgment."
Yet the word "mild" is used so often to describe H1N1's impact that it is prompting skeptical publics to ask what all the fuss is about. Why they should care? And why take a vaccine?
France's Le Parisien newspaper ran the headline: "Swine flu: why the French distrust the vaccine" and noted a gap between the predicted impact of H1N1 and the less dramatic reality.
"Although some 30-odd people have died....the disease is not really frightening," it said. "Dangerous liaisons between certain experts, the labs and the government, the obscurity of the contracts between the state and the pharma firms have added to the doubt."
In Britain, health authorities' original worst-case scenario -- which said as many as 65,000 could die from H1N1 -- has twice been revised down and the prediction is now for around 1,000 deaths, way below the average annual toll of 4,000 to 8,000 deaths from seasonal winter flu.
A group of eminent scientists who called a media briefing in London this week to announce 7.5 million pounds ($12.4 million) of new funding for British research into H1N1 found their plans hijacked by reporters asking why the pandemic was so weak.
Scientists say the truth is they can't win.
The World Health Organization has been urging countries to prepare for a flu pandemic since 1997, when H5N1 avian flu infected 18 people in Hong Kong and was stopped only after a mass slaughter of birds. The re-emergence of H5N1 in China and South Korea in 2003 fueled the urgency to get ready.
Now that it has arrived, the apparently low impact of the H1N1 pandemic so far may show that the planning is paying off, the Wellcome Trust's Hayden said.
British officials repeatedly said the nation was well-prepared for a flu pandemic. It had high stocks of antivirals and orders for enough vaccines to cover its population in place very early.
Hayden said comparisons with earlier flu pandemics like the one in 1918, which killed an estimated 230,000 people in Britain and up to 50 million worldwide, were skewed by the fact that there were so few effective treatments at that time.
"We didn't have antivirals then, and we didn't have antibiotics for the high frequency of bacterial complications," he said. "We have these kinds of interventions now and they are making a difference."
At the funding briefing, Peter Openshaw, director of the center for respiratory infection at Imperial College London, dismissed suggestions that scientists were enjoying the fruits of a pandemic in the form of big grants to keep them in work.
"This is not something that we are licking our lips and welcoming," he said. "But there is certainly an enormous outbreak of scientific information that has greatly enriched our understanding of flu."

Risk Reduction Recommendations for Specific Patient Groups

2009-11-09T17:53:00.001+03:00

Asthma
Get vaccinated for seasonal flu as soon as the vaccine is available. Children ages 6 months to 8 years who have never had seasonal flu vaccine need 2 doses.
Persons 6 months to 64 years of age should get the 2009 H1N1 vaccine by injection as soon as it is available where they live
Persons with asthma should not take the intranasal (FluMist) vaccine.
Oseltamivir is recommended for patients with asthma who get 2009 H1N1 infection; it should be started within 48 hours of onset of symptoms if possible.
Diabetes
Patients with diabetes should get both seasonal flu vaccine and H1N1 vaccine.
Diabetes care: Continue insulin or oral hypoglycemics even if the patient cannot eat; monitor blood glucose every 4 hours and record; drink extra calorie-free liquids; weigh daily.
Health provider should be alerted for temperature > 100°F, blood glucose <> 300 mg/dL, moderate or large amount of urine ketones, change in mental status, dyspnea, weight loss of 5 lbs or more, or onset of severe diarrhea.
Pregnancy
Pregnant women are at high risk for serious influenza complications.
Pregnant women should get both seasonal flu vaccine and 2009 H1N1 flu vaccine, both by IM injection when the vaccines become available. Pregnant women should not get the intranasal LAIV (FluMist) vaccine.
Pregnant women with established or suspected influenza should be treated with oseltamivir or zanamivir, preferably within 2 days of the onset of symptoms.

Acetaminophen May Be Linked to Asthma Risk

2009-11-08T09:47:00.001+03:00

Study Shows Painkiller Raises Risk of Asthma; Manufacturer Says Drug Is Safe
By Kathleen DohenyWebMD Health News
Reviewed by Louise Chang, MD
Nov. 5, 2009 -- The popular pain and fever reliever acetaminophen may be linked with an increased risk of asthma in children and adults, according to a new research review of previously published studies by Canadian researchers.
But the manufacturer of Tylenol -- the brand-name version of acetaminophen -- says the painkiller has a well-established safety record.
Researchers pooled the results of 19 clinical studies, with a total of more than 425,000 participants, to see if the association between the pain reliever use and asthma (and wheezing in children) held up. It did.
What triggered the review? "Concern over the risk of acetaminophen and asthma highlighted by the 2008 ISAAC study, published in The Lancet," says the review's lead author Mahyar Etminan, PharmD, a scientist at the Vancouver Coastal Health Research Institute in British Columbia and an assistant professor of medicine at the University of British Columbia.
In the ISAAC (International Study of Asthma and Allergies in Childhood) study, researchers looked at more than 205,000 children, ages 6 to 7, in 31 countries and found that acetaminophen use for fever in the first year of life was linked to increased risk of asthma symptoms in children 6 to 7 years old. Current use of acetaminophen was also linked to increased risk of asthma symptoms.
Other studies, Etminan says, have produced conflicting results, so the Canadian team conducted the review.
Sales of acetaminophen products in the U.S. are about $1 billion annually, the researchers estimate.
Calculating Asthma Risk
Etminan's team searched the medical literature to find high-quality published studies, trying to quantify the risk of asthma and wheezing among acetaminophen users, as well as the effect of prenatal exposure to the medicine.
After eliminating studies that weren't scientifically sound enough, the researchers focused on 19 studies. Overall, they found that acetaminophen users were 63% more likely to have asthma than nonusers. Other findings:
The risk of asthma in children given acetaminophen in the year before their asthma diagnosis was increased by 60%.
The risk of asthma in children who used acetaminophen in the first year of life was 47% higher than in those who didn't use it.
The risk of asthma in adults who used acetaminophen was 74% higher than in those who did not.
Prenatal use of acetaminophen boosted the risk of wheezing by 50% and the risk of asthma by 28% in children.
The researchers concede that children with severe asthma may be more likely to get acetaminophen for viral or other infections that may actually be due to asthma or may precede an asthma diagnosis.
The finding of acetaminophen use and asthma is an association, they say, but not necessarily a cause and effect.
The researchers say other mechanisms may explain the link. Acetaminophen, they say, may boost an enzyme involved in the anti-inflammatory response in asthma.
There are other possible mechanisms. ''There isn't enough evidence to favor one over the other," Etminan says. He says more studies are needed to fully understand the association.

Drugmaker's Perspective
In a prepared statement, McNeil Consumer Healthcare, which makes Tylenol, says:
"TYLENOL® (acetaminophen) has over 50 years of clinical history to support its safety and efficacy and, when used as labeled, TYLENOL® has a superior safety profile compared with many other over-the-counter (OTC) pain relievers. The well-documented safety profile for acetaminophen makes it the preferred pain reliever for asthma sufferers."
The statement continues: "There are no prospective, randomized controlled studies that show a causal link between acetaminophen and asthma. The systematic review and meta-analysis published in Chest does not establish a definitive casual relationship between the therapeutic use of acetaminophen and an increased risk of asthma and wheezing in both children and adults. In fact, the study investigators admit that their systematic review is subject to several limitations, one of which is that diagnosis of asthma in most of the studies was through self-reporting and the possibility of misclassification of asthma with other respiratory conditions can't be excluded. The authors also stated that additional studies would be needed in order to verify their findings.''
Second Opinion
Another expert said the review is strong. "This is clearly synthesizing the studies that have been conducted over the past 10 years and is showing the emerging evidence that acetaminophen seems to be associated with the development of asthma and asthma-like symptoms in children and adults," says Matt Perzanowski, PhD, assistant professor of environmental health sciences at the Mailman School of Public Health at Columbia University in New York.
With his colleagues at Columbia, Perzanowski recently found that prenatal acetaminophen exposure boosts the risk of wheezing in inner city, minority children (who have high rates of asthma) at age 5.
They believe that children with a genetic mutation affecting an antioxidant that helps ''detox'' the body may be the ones at risk, Perzanowski tells WebMD.
A practicing allergist, Rebecca G. Piltch, MD, who cares for patients with asthma and allergies in Marin County, Calif., says the association is interesting but points out it does not prove cause and effect.
Perzanowski agrees, saying: "There is still a possibility the association is due to some other mechanism besides the acetaminophen."
Until more research is done, what's a parent or adult to do? "The American Academy of Pediatrics recommends acetaminophen as the drug of choice for controlling fever," Etminan says. "Parents should still follow these guidelines until the recommendations change."
"For adults, ibuprofen is an alternative drug that can be used," he says. "Unlike acetaminophen, ibuprofen has not been shown to be associated with asthma."
Following the recommended dose is important, he says. The question of whether a specific dose is linked with the risk of asthma needs to be studied, Etminan says.
Patients already diagnosed with asthma should check with their own doctor about acetaminophen use, Piltch says. Those who don't have asthma ''but have concerns about acetaminophen should discuss them with their primary care provider."

FDA Warns Against H1N1 Flu Supplements

2009-11-08T09:33:00.001+03:00

Daniel J. DeNoon
October 19, 2009 — Beware fake "Tamiflu" sold over the Internet, the FDA warns.
The FDA recently bought five different products advertised online as "Tamiflu" or as treatments for the 2009 H1N1 swine flu.
Some of the pills contained only talc and acetaminophen. Some had various amounts of oseltamivir, the active ingredient in Tamiflu. None was the real thing; all are illegal in the U.S.
Moreover, all the fake "Tamiflu" products arrived by mail too late to do any good -- even if they had been the real thing.
"Medicines purchased from web sites operating outside the law put consumers at increased risk due to a higher potential that the products will be counterfeit, impure, contaminated, or have too little or too much of the active ingredient," FDA Commissioner Margaret Hamburg, MD, says in a news release.
There are only two drugs approved by the FDA for treatment of H1N1 swine flu: Tamiflu and Relenza. Both drugs are available only by prescription.
SOURCES:
News release, FDA.

New H1N1 vaccine Blog

2009-11-04T09:27:00.003+03:00

H1N1

2009-11-04T09:21:00.002+03:00

2009 H1N1 Flu (Swine Flu)
The following is general information about the 2009 H1N1 flu (influenza). For the latest news including flu vaccine information, visit the American Academy of Pediatrics (AAP) Web site at www.aap.org/advocacy/releases/swineflu.htm.
What is 2009 H1N1 flu?
2009 H1N1 flu is a new influenza A virus first discovered in April 2009. Since then it has spread around the world and has been called different names. You may have heard it called swine flu, pandemic flu, or novel H1N1 flu.
When does 2009 H1N1 flu spread?
2009 H1N1 is expected to spread along with other flu viruses much of this year and next. Seasonal flu viruses usually spread in the fall, winter, and early spring. 2009 H1N1 flu may be the most common form of flu virus causing infection in children this flu season.
How is 2009 H1N1 flu spread?
The 2009 H1N1 virus is mainly spread in 2 ways.
Through the air when an infected person coughs or sneezes
By touching contaminated surfaces or objects like doorknobs, money, and toys and then touching your eyes, nose, or mouth
You cannot get the swine flu from pork or pork products.
Signs or symptoms
Symptoms of the 2009 H1N1 flu are similar to other flu viruses and include
A sudden fever, possibly with chills
Stuffy nose and cough
Older children may complain of
Scratchy, sore throat
Muscle aches and discomfort
Headache
Some children have
Vomiting and diarrhea
Call the doctor if your child. . .
Is younger than 3 months and has a fever (rectal temperature of 100.4°F [38°C] or higher)
Is sick and has a serious chronic health condition, including lung or heart problems, asthma, diabetes, kidney problems, a weakened immune system, or a serious neurologic or neuromuscular condition (not ADHD or autism)
Is more sleepy than usual or not waking up or acting normally
Has little or no energy to play or keep up with daily activities
Is not drinking enough fluids to make urine
Has trouble breathing or is breathing fast
Is very irritable and cannot be comforted
Has skin color that is blue or gray
What to do for 2009 H1N1 flu
Keep germs from spreading.
Make sure everyone washes their hands often. Wash with soap and warm water for at least 20 seconds (about as long as 1 to 2 verses of the "Happy Birthday" song). Alcohol-based hand rubs should be limited to times when soap and water are not available. Keep these products out of the reach of children and supervise their use.
Cough and sneeze into a tissue or into your elbow or upper sleeve.
Use tissues for wiping runny noses and to catch sneezes. Throw them in the trash right after each use.
Try not to touch your eyes, nose, or mouth.
Anyone who is sick should stay home and limit contact with others.
Keep a child home from school or child care until the fever is gone for at least 24 hours without taking fever-reducing medicine. Normal body temperature is different for each child and may range from 97°F (36.1°C) to 100.3°F (37.9°C). In general, a temperature of 100.4°F (38°C) or higher may be a sign of a fever. Note: Schools and child care centers may have different rules about when children need to stay home.
Check with your child's doctor or pharmacist if you have any questions about your child's medicine.
For fever or body aches, your child's doctor may suggest acetaminophen (like Tylenol) or ibuprofen (like Advil or Motrin). NEVER give your child aspirin.
Antiviral medicine for flu generally is given to children who are at higher risk of flu complications (such as those with chronic disease or cancer) or are in close contact with a person who has the 2009 H1N1 flu.

Visit the AAP Web site regularly for the latest information on the 2009 H1N1 vaccine. In the meantime, have your child immunized to protect against seasonal influenza as soon as that vaccine is available.
Other ways to help your child
Make sure your child drinks plenty of liquids to avoid getting dehydrated.
Encourage and help your child rest.
Stay informed because information is continually being updated. Know what's going on in your area and follow the recommendations of public health authorities.

Products are mentioned for informational purposes only. Inclusion in this handout does not imply endorsement by the American Academy of Pediatrics.
Copyright © 2009 American Academy of Pediatrics

The information contained in this publication should not be used as a substitute for the medical care and advice of your pediatrician. There may be variations in treatment that your pediatrician may recommend based on individual facts and circumstances. See also:
Flu (Influenza), The
Flu, The
H1N1 Influenza Vaccine - Inactivated: What You Need to Know (VIS)

60 minutes on CNBC- H1N1 vaccine

2009-11-03T19:01:00.003+03:00

http://www.cbsnews.com/video/watch/?id=5486397n

The Double Flu Vaccine Season Is Here -- Now What Should You Do?

2009-10-29T11:37:00.002+03:00

Sandra A. Fryhofer, MD
Welcome to the first issue of "Staying Well," which will focus on prevention. I know many of us have been bombarded with phone calls and questions about flu and flu vaccination. That's why influenza is my inaugural topic.
First, Take Your Own Medicine. Get Immunized -- It Protects You and Your Patients
The 2009 American College of Physician Adult Immunization Campaign reported a dismal influenza vaccination rate of only 36% for healthcare workers. These vaccination statistics are surprising, shocking, disappointing, and downright embarrassing. What's even worse? The American College of Physicians finds that 70% of sick healthcare workers go to work anyway. Follow the advice you give to your patients. If you do get sick, stay home. Don't pass your flu on to your patients and staff. Many health systems now require flu immunization for healthcare workers. To me, getting vaccinated is professional and being responsible to our patients and our families. The only contraindications to vaccination are egg allergy or history of Guillain-Barré syndrome with previous flu vaccine administration. And of course, this year, all healthcare workers need both seasonal flu and H1N1 flu vaccination.
This Season, Flu Treatments Come in Pairs
Here's what to choose from:
Two types of flu vaccinations: seasonal and H1N1;
Two types of vaccine to choose from: nasal mist and a shot; and
Two doses, 1 month apart, of H1N1 vaccine for kids younger than 10 years of age.
Trials of 2009 H1N1 live attenuated vaccines (LAIVs) nasal mist indicate that 28 days is the appropriate valid interval for the 2 doses. However, there is a little more leeway with the inactivated shot. Centers for Disease Control and Prevention (CDC) guidance says that administering the 2 doses of a 2009 H1N1 inactivated vaccine at least 21 days apart is safe.
Kids younger than 9 years of age receiving their first-ever seasonal flu vaccination also need those 2 doses given 1 month apart. Children younger than 6 months of age are too young for flu vaccination. That's why it is so important for all caregivers of infants to get vaccinated. Adults and children age 10 years and older need just 1 dose of H1N1 flu vaccination. Check the CDC Website[1] as the season progresses for any updated information on ages and intervals.
Nasal mist LAIV should only be given to healthy individuals age 2-49 years old and not to pregnant women. Pregnant women should only be given the flu shot made from inactivated virus.
Simultaneous Dosing of Seasonal and H1N1 Vaccination
Knowing the rules for mixing and matching different types of vaccine means learning the lingo.
LAIV: live attenuated influenza vaccine (nasal mist: 1 for seasonal flu, and 1 for H1N1);
TIV: trivalent inactivated influenza vaccine (the seasonal flu shot). The 2009-2010 seasonal flu vaccine contains:
A/Brisbane/59/2007 (H1N1)-like virus;
A/Brisbane/10/2007 (H3N2)-like virus; and
B/Brisbane/60/2008-like virus.
MIV: monovalent inactivated influenza vaccine (the novel H1N1 flu shot).
For administering inactivated TIV and H1N1 MIV, mixing and matching is not a problem and there are no restrictions. Shots for seasonal TIV and H1N1 MIV can be given on the same day, at the same time. Simultaneous dosing of LAIV at the same time as inactivated TIV or inactivated H1N1 MIV is also not a problem.
Using LAIVs for both vaccines is tricky, however. The CDC says don't give seasonal LAIV and H1N1 LAIV at the same time. Although there are no data on sequential administration of seasonal LAIV and H1N1 LAIV, experts are concerned that simultaneous administration could result in reduced immunogenicity for 1 of the vaccines. This means the vaccines may not work as well. Specific CDC guidance posted October 21, 2009 says doses of seasonal LAIV and 2009 H1N1 LAIV administration should be separated by at least 14 days.[2]
Separate injections and/or separate nasal mist must be used for administering seasonal and H1N1 vaccines. Different products should not be physically mixed before administration. A 2009 study suggested that the TIV might offer some protection against H1N1. At this time, the significance of this finding is unknown.[3]
What Mask Should You Wear?
Interim CDC recommendations for facemask and respirator use were issued on September 24, 2009, which say "no change has been made to guidance on the use of facemasks and respirators for healthcare settings." Current CDC recommendations designate wearing N95 masks (respirators) for healthcare workers with "direct medical care and support activities for patients with confirmed or suspected H1N1 flu."[4]
N95 respirator vs facemask. In choosing personal protective equipment, safety and protection are most important. N95 masks are expensive, and if all healthcare workers are required to wear them, there may not be enough to go around. Surgical masks are cheaper and more comfortable. Furthermore, a Canadian study in the Journal of the American Medical Association suggests that they may work just as well as N95 respirators in protecting healthcare workers from flu exposure in emergency departments and medical units.[5] Of course, when extra protection is needed in droplet exposure-laden settings, such as during intubation or when in a bronchoscopy laboratory, an N95 mask is probably better. Facemasks should be available for patients if they come into the office sick.
Note: At this time some facilities are currently experiencing shortages of respiratory protection equipment, including N95 respirators, and further shortages are expected. In such cases, if all reasonable methods fail to alleviate the shortage, the CDC recommends the use of facemasks. [6]
Flu Antiviral Drugs: Who Needs Them?
The CDC Health Advisory issued recommendations on October 19, 2009 to say that most healthy people who come down with flu will not need antiviral drugs, as long as they seem to be getting better.[7] On the other hand, those who have severe flu symptoms, including those requiring hospitalization, should be started on antiviral drugs as soon as possible. Don't wait for laboratory confirmation before instituting treatment. Antiviral drugs work best if started within 48 hours of onset of symptoms. Groups at increased risk for flu-related complications should also be treated. They include pregnant women, children younger than age 2, people age 65 and older, and patients with chronic medical conditions including immune system problems.
Which antiviral drug should be used? Base your choice on what virus is currently circulating. Virus susceptibility to antiviral drugs can change. At the time this article has been published, almost all circulating viruses are novel H1N1 influenza A, which, at least for now, tend to be sensitive to both oseltamivir and zanamivir. A few cases of oseltamivir resistance to H1N1 have been reported. Keep this in mind if your patient does not seem to be responding to therapy. You best bet is to check the CDC Website at least weekly and look and stay tuned for weekly flu updates.[8]
Antiviral drugs for treatment. For treatment, dosing is twice daily for 5 days. Treatment choices for adults include:
Oseltamivir: 75-mg capsule twice daily for 5 days; and
Zanamivir: 10 mg (two 5-mg inhalations) twice daily for 5 days.
Antiviral drugs for chemoprophylaxis. Chemoprophylaxis is not generally recommended due to concerns that it could exacerbate antiviral resistance. Use for healthcare workers is an exception. Postexposure antiviral chemoprophylaxis with either oseltamivir or zanamivir can be considered for healthcare personnel, public health workers, or first responders who have had a recognized, unprotected close contact exposure to a person with confirmed, probable, or suspected 2009 H1N1 or seasonal influenza during that person's infectious period.[7] Note that viral shedding generally begins 1 day before and continues for 7 days after the onset of symptoms.
In using antiviral agents for chemoprophylaxis, dosing is half as much and they are taken for twice as long as in treatment -- once a day for 10 days. Chemoprophylaxis choices for adults include:
Oseltamivir: 75 mg capsule once a day for 10 days; and
Zanamivir: 10 mg (two 5-mg inhalations) once daily for 10 days.
Diagnosing H1N1: What About Quick Flu Tests?
Rapid flu tests may not be so helpful for diagnosing novel H1N1, because their sensitivity for 2009 H1N1 ranges from 10% to 70%. Use your best clinical judgment to make the diagnosis and to decide who needs treatment. Hospitalized patients should be tested using real-time reverse transcriptase-polymerase chain reaction.[9,10]
Don't Forget About the Pneumococcal Vaccination
Influenza of any type can kill. CDC stats report more than 200,000 hospitalizations and 36,000 deaths from flu and flu-related complications each year, on average. During the 20th century influenza pandemics, secondary bacterial pneumonia was an important cause of illness and death and Streptococcus pneumoniae (pneumococcus) was the most common etiology.[11]
The most recent Advisory Committee on Immunization Practices recommendations add smokers and asthmatics to the pneumococcal vaccination list, which also includes patients with chronic medical conditions and people age 65 and older.[12]
When to revaccinate has always been confusing. The Adult Immunization Schedule says revaccinate once after 5 years for chronic medical conditions (including patients with renal failure, immunocompromised patients, and after splenectomy). Also, people age 65 and older should receive a one-time additional pneumococcal vaccination if they were younger than 65 years of age when first vaccinated and it has been 5 years or more since last vaccination.[13]
Summary: Vaccinate!
I plan to get H1N1 vaccination when available, and I have encouraged my college-age twins to get vaccinated at school. I have already received my seasonal influenza vaccination. Please join me.

Policy Statement—Recommendations for the Prevention and Treatment of Influenza in Children, 2009–2010

2009-10-29T10:09:00.001+03:00

Published online October 1, 2009PEDIATRICS Vol. 124 No. 4 October 2009, pp. 1216-1226 (doi:10.1542/peds.2009-1806)
Committee on Infectious Diseases
Abbreviations: AAP—American Academy of Pediatrics • TIV—trivalent inactivated influenza vaccine • LAIV—live-attenuated influenza vaccine • FDA—Food and Drug Administration • GBS—Guillain-Barré syndrome • CDC—Centers for Disease Control and Prevention
The purpose of this statement is to update current recommendations for routine use of trivalent seasonal influenza vaccine and antiviral medications for the prevention and treatment of influenza in children.

Beware of these INFLUENZA- like symptoms

2009-10-28T19:04:00.003+03:00

Are any of the following signs or symptoms present?

Age 12 weeks to > 5 years:

Fast breathing of difficulty breathing or retractions present.
Dehydration ( no urine output in 8 hours, decreased tears or no tears child is crying, or not drinking enough fluids).
Severe or persistent vomiting / unable to keep fluids down.
Lethargy (excessive sleepiness, significant decrease in activity level, and/or diminished mental status).
Irritability (cranky, restless, does not want to be held or wants to be held all the time).
Flu - like symptoms improved but then returned or worsened within one to a few days.
Pain in chest or abdomen (for children who can reliably report)

Age ≥5 years

Fast breathing or difficulty breathing.
Dizziness or lightheadedness.
Severe or persistent vomiting /unable to keep fluids down.
Flu - like symptoms improved but then returned or worsened within one to a few days.
Pain in chest or abdomen.

Does the ill child have any of the following conditions?
1. Neurological disorders such as:

Epilepsy
Cerebral palsy, especially when accompanied by neurodevelopmental disabilities (e.g., moderate to profound intellectual disability (mental retardation or developmental delay).
Brain or spinal cord injuries.
Neuromuscular disorders (e.g., muscular dystrophy), especially when associated with impairment in respiratory functioning.

2. Chronic respiratory diseases such as :

Conditions associated with impaired pulmonary function and/or difficulty handling secretions.
Technology dependent children (e.g., those requiring oxygen, tracheostomy, or a ventilator).
Asthma.

3.Moderate to profound intellectual disability (mental retardation) or developmental delay, especially when associated with specific conditions ( see 1 & 2 above).
4. Deficiencies in immune function or conditions that require medications or treatments, (e.g., certain cancer treatments, HIV infection) that result in significant immune deficiencies.
5. Cardiovascular disease including congenital heart disease.
6. Significant metabolic (e.g., mitochondrial) or endocrine disorders.
7. Renal, hepatic, hematological (including sickle cell disease) disorders.
8. Receiving chronic aspirin therapy.
9. Pregnancy.

Child falls into a group that appears to be at lower risk for complications from influenza and may not require testing or treatment if their symptoms are mild. Should symptoms worsen (e.g., shortness of breath, unresolving fever) or should the child’s caregiver have further questions or concerns about the child’s health, recommend the caregiver contact the child’s healthcare provider.

In order to help prevent spread of influenza to others, these patients should be advised to:
Keep away from others to the extent possible, particularly those at higher risk for complication from influenza (see box below). This may include staying in a separate room with the door closed.
Cover their coughs and sneezes.
Avoid sharing utensils.
Wash their hands frequently with soap and water or alcohol-based hand rubs.
Stay home (e.g., no school, child care, group activities) until 24 hours after their fever resolves without the use of antipyretics (i.e., acetaminophen, ibuprofen).

More information available at: http://www.cdc.gov/h1n1flu/guidancehomecare.htm

In addition, remember that vaccination for seasonal influenza and pandemic (H1N1) influenza is recommended for all children 6 months through 18 years old and household contacts and out of home caregivers of children less than 6 months old.

WHO Describes Clinical Features of H1N1 Influenza

2009-10-20T17:03:00.003+03:00

October 16, 2009 — The World Health Organization (WHO) today described certain clinical features of the pandemic H1N1 2009 influenza virus and urged clinicians not to delay antiviral treatment so that the risk of severe disease would be reduced.
Dr. Nikki Shindo, a medical officer with the WHO's epidemic and pandemic alert and response team, spoke at a WHO/Pan American Health Organization press conference today in Washington DC.
According to Dr. Shindo, the H1N1 influenza virus can cause severe viral pneumonia in previously healthy people. "The H1N1 virus likes the lower respiratory tract and is more likely to cause viral pneumonia than seasonal flu," she said.
She also noted that previously healthy adult patients with very severe progressive disease typically start to deteriorate on or around day 3 from the onset of symptoms.
There is also increased evidence of bacterial coinfection with H1N1, mostly with staphylococcal and pneumococcal bacteria, estimated to occur in about 30% of hospitalized cases and associated with rapidly progressing disease. "This highlights the fact that antimicrobial treatment is important as well as early antiviral treatment," Dr. Shindo pointed out.
The top 3 groups at increased risk for severe illness and death are pregnant women, children younger than 2 years, and people with underlying lung disease (including asthma), she said.
Widespread Disease in US
According to a US Centers for Disease Control and Prevention (CDC) media briefing today, 41 states are now identifying widespread disease from influenza, representing an increase from 37 states last week.
"The other states are all seeing either regional or local activity," said Anne Schuchat, MD, director of the CDC's National Center for Immunization and Respiratory Diseases. "It's unprecedented for this time of year to have the whole country seeing such high levels of activity."
H1N1 continues to disproportionately affect young people, including children. To date, 86 children in the United States have died from the 2009 H1N1 influenza virus. In week 40, ending October 10, 11 more pediatric influenza deaths (10 confirmed to be due to H1N1) were reported.
According to Dr. Schuchat, about half of the deaths in children since September 1 have occurred in teens between the ages of 12 and 17 years. "These are very sobering statistics, and unfortunately, they are likely to increase," Dr. Schuchat said.
As of Wednesday, 11.4 million doses of the monovalent H1N1 vaccine were available, and 8 million of those doses had been ordered by states. "We're in the very beginning of this program and the numbers will be increasing regularly," she added.

Statement from the American Diabetes Association Related to Studies Published in 'Diabetologia'

2009-10-15T10:54:00.001+03:00

FOR IMMEDIATE RELEASE
Research conflicting and inconclusive; Patients should not stop using insulin and should talk to their doctor
Alexandria, VA (June 26, 2009) — Diabetologia, the journal of the European Association for the Study of Diabetes (EASD), published a series of research papers today examining a possible link between insulin glargine (brand name, Lantus) and cancer. Findings from these research papers are conflicting and inconclusive, and the American Diabetes Association cautions against over-reaction until more information is available.
Four different population based studies were reported and published in Diabetologia and the data within these studies and between these studies are conflicting and confusing. Until more information is available, the American Diabetes Association advises patients using insulin not to stop taking it.
For patients using glargine and considering switching to another form of insulin, the data in these studies make it unclear as to whether any one type of insulin increases the risk of cancer more than other types of insulin.
Patients concerned about these studies or their insulin regimen should talk to their doctor and should not stop taking their insulin on the basis of the findings reported here.
Insulin is a hormone normally produced by the pancreas that helps the body use glucose for energy. All people with type 1 diabetes need to take insulin to survive; many patients with type 2 diabetes also need to take insulin to control their blood glucose.
Glargine insulin, which as been widely used since 2000, is an artificial form of insulin that is typically administered once a day.

Most Hospitalized H1N1 Patients Have Underlying Conditions

2009-10-15T10:49:00.001+03:00

Robert Lowes
October 13, 2009 — More than half of 1400 adults hospitalized with influenza A (H1N1) have had underlying medical conditions, including asthma and other chronic lung diseases, chronic heart disease, and immunosuppressive disorders, an official from the US Centers for Disease Control and Prevention (CDC) said today.
In addition, of more than 500 patients younger than 18 years hospitalized with H1N1 infection, most already had another illness such as asthma, lung disease, neurologic and neuromuscular disorders, and sickle cell disease and other blood disorders, said Anne Schuchat, MD, director of the National Center for Immunization and Respiratory Diseases at the CDC, during a press conference.
The data reflect cases reported from April through August to the agency's Emerging Infections Program network in a group of 10 states and expand on an initial CDC study of 272 patients hospitalized with the virus. Dr. Schuchat said the findings from the larger patient sample mirror those from the first batch.
Of the hospitalized adult patients, 26% had asthma, 10% had diabetes, 8% had other lung diseases, and 7.6% had immunosuppressive disorders. Another 6.1% were pregnant women. (No percentage was cited for chronic heart disease.) Dr. Schuchat noted that the underlying illnesses reported were those that the CDC had identified as risk factors that justified vaccinating such patients before others.
More than 45% of adults hospitalized with the virus had no underlying condition that the CDC considers a risk factor, said Dr. Schuchat, adding that this figure did not take into account whether these patients were obese or not. According to the CDC, obesity has emerged as an underlying medical condition in some hospitalized H1N1 patients, although its importance as a contributing factor to complications is unknown.
Immune System Changes Help Put Pregnant Women at Risk
Dr. Schuchat said the preliminary analysis of the 1400 adults and 500-plus children hospitalized with H1N1 influenza infection did not contain a breakdown by sex. These data take on greater significance in light of a study reported by Medscape Infectious Diseases and published October 12 in the Journal of the American Medical Association of 168 critically ill Canadians who were hospitalized with confirmed or probable cases of H1N1 infection. Of these patients, 67.3% were women.
Dr. Schuchat explained why the H1N1 virus is taking a disproportionately heavy toll on pregnant women: A woman's immune system changes during pregnancy to prevent an immune reaction against the fetus, she explained. "The risk of infections can be greater.
"The other reason is mechanical. As the womb gets larger, with the baby growing, there can be pressing on the airways and a restrictive lung disease. So it's harder to take a deep breath, and it's harder to fight off a lung infection, especially in the later stages of pregnancy," Dr. Schuchat said.
Half of Available H1N1 Vaccine Doses Now Are Injectable Variety
While stressing the importance of vaccinations for pregnant women, Dr. Schuchat noted that the first H1N1 vaccines to reach the public were the intranasal version with live but weak viral material that is not recommended for these women. The CDC recommends that pregnant women receive the injectable form of the vaccine with the inactivated virus.
As of yesterday, Dr. Schuchat said, vaccine manufacturers had 9.8 million doses of H1N1 vaccine available for state and local public health agencies to order, with these agencies having requested 5.8 million doses. Of the 9.8 million doses, half were injectable. Dr. Schuchat said these injectable doses should start reaching vaccine dispensers later this week, although they will not be available on a widespread basis until the end of October.
Meanwhile, some 77 million doses of seasonal influenza vaccine have been distributed, she said. Acknowledging regional shortages, she said more doses would reach the public in November and noted that most influenza cases now involve the H1N1 strain as opposed to the seasonal strain.
"The main message I have is to be patient," said Dr. Schuchat. "We think there's time to be vaccinated against seasonal flu, even if vaccine isn't available until November or December. We think it will be just fine to be vaccinated then."
Dr. Schuchat also reported that the CDC had received reports of 5 more children dying from H1N1 influenza, bringing the total since April to 81.

Daily Nebulizers Advised for Preschoolers With Frequent Wheezing

2009-10-15T10:34:00.002+03:00

NEW YORK (Reuters Health) Oct 09 - The most effective way to manage frequent wheezing in preschool children is regular treatment with nebulized glucocorticoids, according to a report in the October issue of Allergy.
The authors of the report also suggest that as-needed use of a bronchodilator and glucocorticoid combination, which is commonly practiced, may be an alternative.
Dr. Leonardo M. Fabbri, of the University of Modena and Reggio Emilia, Italy, and colleagues conducted a trial in which 276 children ages 1 to 4 years with frequent wheeze were randomized to nebulized treatment with one of three regimens for 12 weeks: 400 mcg beclomethasone twice daily plus 2500 mcg salbutamol as needed; placebo plus a combination of 800 mcg beclomethasone/1600 mcg salbutamol as needed, or placebo plus 2500 mcg salbutamol as needed.
The primary outcome measure -- percentage of symptom-free days -- was significantly higher with daily beclomethasone (69.6%) compared with as-needed salbutamol (61.0%; p = 0.034).
Regular treatment with nebulized beclomethasone also improved several secondary outcomes, including nocturnal wakening and exacerbations.
There was no difference in percentage of symptom-free days between children with or without risk factors for asthma.
Allergy 2009;64:1463-1471.

Daily Nebulizers Advised for Preschoolers With Frequent Wheezing

2009-10-14T08:42:00.003+03:00

NEW YORK (Reuters Health) Oct 09 -

The most effective way to manage frequent wheezing in preschool children is regular treatment with nebulized glucocorticoids, according to a report in the October issue of Allergy.
The authors of the report also suggest that as-needed use of a bronchodilator and glucocorticoid combination, which is commonly practiced, may be an alternative.
Dr. Leonardo M. Fabbri, of the University of Modena and Reggio Emilia, Italy, and colleagues conducted a trial in which 276 children ages 1 to 4 years with frequent wheeze were randomized to nebulized treatment with one of three regimens for 12 weeks: 400 mcg beclomethasone twice daily plus 2500 mcg salbutamol as needed; placebo plus a combination of 800 mcg beclomethasone/1600 mcg salbutamol as needed, or placebo plus 2500 mcg salbutamol as needed.
The primary outcome measure -- percentage of symptom-free days -- was significantly higher with daily beclomethasone (69.6%) compared with as-needed salbutamol (61.0%; p = 0.034).
Regular treatment with nebulized beclomethasone also improved several secondary outcomes, including nocturnal wakening and exacerbations.
There was no difference in percentage of symptom-free days between children with or without risk factors for asthma.
Allergy 2009;64:1463-1471.

Daily Nebulizers Advised for Preschoolers With Frequent Wheezing

2009-10-14T08:42:00.002+03:00

NEW YORK (Reuters Health) Oct 09 - The most effective way to manage frequent wheezing in preschool children is regular treatment with nebulized glucocorticoids, according to a report in the October issue of Allergy.
The authors of the report also suggest that as-needed use of a bronchodilator and glucocorticoid combination, which is commonly practiced, may be an alternative.
Dr. Leonardo M. Fabbri, of the University of Modena and Reggio Emilia, Italy, and colleagues conducted a trial in which 276 children ages 1 to 4 years with frequent wheeze were randomized to nebulized treatment with one of three regimens for 12 weeks: 400 mcg beclomethasone twice daily plus 2500 mcg salbutamol as needed; placebo plus a combination of 800 mcg beclomethasone/1600 mcg salbutamol as needed, or placebo plus 2500 mcg salbutamol as needed.
The primary outcome measure -- percentage of symptom-free days -- was significantly higher with daily beclomethasone (69.6%) compared with as-needed salbutamol (61.0%; p = 0.034).
Regular treatment with nebulized beclomethasone also improved several secondary outcomes, including nocturnal wakening and exacerbations.
There was no difference in percentage of symptom-free days between children with or without risk factors for asthma.
Allergy 2009;64:1463-1471.

H1N1 Flu (Swine Flu) Information

2009-10-11T09:00:00.002+03:00

(Updated: October 2009)
Many people are worried about H1N1 flu (swine flu) but there is no need to panic. Families, schools, health care providers and government agencies need to work together to limit the spread of the virus and protect anyone who is at risk of serious illness from the flu. Tips on how to prevent the spread of germsThe flu (influenza) is spread by coughing, sneezing and unclean hands.

The U.S. Centers for Disease Control and Prevention (CDC) encourages everyone to prevent the spread of germs by doing the following:
Cover your nose and mouth with a tissue when you cough or sneeze.
If you don’t have a tissue, cough or sneeze into your upper sleeve, not your hands.
Put used tissues in the trash.
Clean your hands after coughing or sneezing. Wash with soap and water, or with alcohol-based hand cleaner.
Avoid touching your eyes, nose and mouth.
If you get sick, stay home from work or school, and limit your contact with others to keep from infecting them. People should stay home at least 24 hours after they are free of fever (100°F), or signs of a fever without the use of fever-reducing medications.
Who should get vaccinated

Vaccines play a large role in preventing illness. There are two types of flu vaccine and both are important.
Seasonal flu vaccine. It is important that all children ages 6 months through 18 years receive seasonal flu vaccine now. Call your pediatrician today to schedule an appointment.
H1N1 vaccine.

A separate vaccine to protect against H1N1 flu (swine flu) has been developed. The CDC expects the H1N1 vaccine to be available beginning in October.

The first people who should receive the H1N1 vaccine include:
Children ages 6 months through 24 years
Parents and caretakers of infants younger than 6 months
Pregnant women
Health care workers and emergency services personnel
Adults ages 25 to 64 with chronic health conditions

How families can protect themselves from swine fluExperts from the American Academy of Pediatrics answer questions about the swine flu. The following are links to three audio interviews:
Henry Bernstein, MD, FAAP, member of the AAP Committee on Infectious Diseases (recorded September 2009):
How Parents Can Protect Their Children from H1N1 Information About H1N1 Vaccine How "Common" Are Colds and Flu Treating Colds and Flu Without Drugs
Richard Besser, MD, FAAP, former acting director of the CDC (recorded May 2009)
Joseph Bocchini, MD, FAAP, chairman of the AAP Committee on Infectious Diseases (recorded May 2009) A note about antiviralsMost children will recover with rest and care at home. People in high-risk groups may need antiviral medicine. Antiviral medicine may help shorten the length of illness if taken soon after infection. If your child is in a high risk group and you suspect your child has influenza, or if your child has more severe influenza symptoms, call your pediatrician.Additional online resourcesFor Parents/Caregivers:
AAP 2009 H1N1 Flu (Swine Flu) handout .
AAP Frequently Asked Questions and Answers for Parents and Caregivers About H1N1 Flu (Swine Flu) (AAP)
Vaccine Information Statements (VISs) are information sheets produced by the Centers for Disease Control and Prevention (CDC) that explain to vaccine recipients, their parents, or their legal representatives both the benefits and risks of a vaccine.
2009 H1N1 Live attenuated influenza vaccine (the nasal spray vaccine).
2009 H1N1 inactivated influenza vaccine (the flu shot).
CDC Recommendations for the Amount of Time Persons with Influenza-Like Illness Should be Away from Others (CDC)
Key Facts About Swine Flu (CDC)
Hand Washing (CDC)
H1N1 Flu (Swine Flu): Resources for Pregnant Women (CDC)
Novel H1N1 Flu (Swine Flu) and Feeding your Baby: What Parents Should Know (CDC)
Considerations for Pregnant Women Who are More Likely to be Exposed to H1N1 (Swine Flu) Virus at work; Information for Women in Education, Child Care, and Health Care (CDC)
H1N1 Flu (Swine Flu) and You (CDC)
What to Do If You Get Flu-Like Symptoms (CDC)
Advice for Parents on Talking to Children About H1N1 Flu (Swine Flu) Concerns (CDC)
The CDC will answer questions from the general public about swine flu 24 hours a day, 7 days a week. Contact CDC INFO at 1-800-CDC-INFO (1-800-232-4636).
For Child Care Programs and Schools:
H1N1 Flu (Swine Flu): Resources for K-12 Schools (CDC)
H1N1 Flu (Swine Flu): Resources for Child Care and Early Childhood Programs (CDC)
H1N1 Flu (Swine Flu): Resources for Colleges and Universities (CDC)
Excerpts from “Managing Infectious Diseases in Child Care and Schools: A Quick Reference Guide, Second Edition” (Copyright American Academy of Pediatrics 2009).
Hand Hygiene (AAP)
Outbreaks, Epidemics, and Other Infectious Disease Emergencies (AAP)
Stopping the Spread of Germs at Home, Work and School (CDC)
Information about H1N1 flu (swine flu) in other Languages:
From the Office of Minority Health: Information on H1N1flu (Swine Flu) Multiple languages
CDC Resources in other languages
Spanish Information

Seasonal Flu Vaccine May Help Protect Against H1N1

2009-10-08T12:03:00.002+03:00

Laurie Barclay, MD
October 7, 2009 — Seasonal influenza vaccine may help protect against novel pandemic influenza A (H1N1), according to the results of a frequency-matched, case-control study in Mexico City reported online October 6 in the British Medical Journal. However, the investigators and authors of an accompanying editorial urge that a specific vaccine against H1N1 flu is still needed.
"The viral genomic sequence for several of the novel A/H1N1 strains, including a Mexican isolate, has been made publicly available," write Lourdes Garcia-Garcia, from Instituto Nacional de Salud Pública in Cuernavaca, Mor, Mexico, and colleagues. "Given the new reassortant nature of this virus — that is, unusual mixing of swine, avian, and human influenza genetic sequences — the available evidence, although incomplete, suggests that seasonal vaccines will confer little or no protection against influenza A/H1N1. Mexican guidelines recommend vaccination with trivalent inactivated influenza vaccine (virus strains A/Brisbane/59/2007 (H1N1)-like, A/Brisbane/10/2007 (H3N2)-like, and B/Florida/4/2006-like antigen) for children aged 6-35 months, all adults aged more than 60, and individuals older than 35 months with conditions conferring a higher risk of influenza related complications."
The goal of this study was to examine the association of 2008–2009 seasonal trivalent inactivated vaccine with cases of influenza A/H1N1 during the epidemic in Mexico. From March to May 2009 at a specialty hospital in Mexico City, 60 patients with laboratory-confirmed influenza A/H1N1 were compared with 180 control patients matched for age and socioeconomic status. Control subjects had diseases other than influenza-like illness or pneumonia and were living in Mexico City or the state of Mexico. The primary study endpoints were odds ratio (OR) and effectiveness of trivalent inactivated vaccine against influenza A/H1N1.
Compared with control patients, patients with laboratory-confirmed influenza A (H1N1) had higher rates of hospitalization, invasive mechanical ventilation, and death. However, control patients were more likely than patients with laboratory-confirmed influenza A (H1N1) to have chronic conditions associated with a higher risk for influenza-related complications. H1N1 influenza was independently associated with receipt of trivalent inactivated vaccine (OR, 0.27; 95% confidence interval [CI], 0.11 – 0.66) and with underlying conditions (OR, 0.15; 95% CI, 0.08 – 0.30), based on the multivariate model. Trivalent inactivated vaccine effectiveness against H1N1 influenza was 73% (95% CI, 34% – 89%), and none of the 8 vaccinated patients with laboratory-confirmed influenza A (H1N1) died.
"Preliminary evidence suggests some protection from the 2008-9 trivalent inactivated vaccine against pandemic influenza A/H1N1 2009, particularly severe forms of the disease, diagnosed in a specialty hospital during the influenza epidemic in Mexico City," the study authors write. "These results are to be considered cautiously and in no way indicate that seasonal vaccine should replace vaccination against pandemic influenza A/H1N1 2009. Our data support the hypothesis that partial protection provided by the seasonal vaccine may be explained by the boosting of existing antibodies that were elicited by previous exposure, through either infection or vaccination, to an influenza A/H1N1 virus genetically and antigenically more closely related to the novel influenza virus than contemporary seasonal H1N1 strains."
Limitations of this study include its retrospective design, small sample size, self-reported vaccine status, and lack of blinding of interviewers to the status of patients with laboratory-confirmed influenza A (H1N1) and control patients.
"The estimates for vaccine effectiveness could be inflated owing to a high prevalence of chronic conditions and vaccination in our control population," the study authors conclude. "Similar studies in other settings are needed to confirm or refute our results."
In an accompanying editorial, Menno D. de Jong, from the Academic Medical Centre of the University of Amsterdam, the Netherlands, and Rogier W. Sanders, from Weill Medical College of Cornell University, New York City, also warn that a specific vaccine against influenza A (H1N1) is still needed. Even in countries that have arranged for vaccine production in sufficient quantities, vaccines may not be available in time.
"Antibodies that recognise multiple influenza strains are rare, which explains the frequent lack of cross protection between vaccines and natural infection," Dr. De Jong and Dr. Sanders write. "However, antibodies have been identified that may open possibilities of developing a 'universal flu vaccine.' Traditional flu vaccines have a good track record in terms of efficacy and safety, so it will take years to replace them, but the new techniques and vaccines at various stages of testing are both necessary and promising."
The Mexican Ministry of Health supported this study. Two of the study authors are employed by Laboratorios de Biológicos y Reactivos de México. Dr. De Jong and Dr. Sanders have disclosed no relevant financial relationships.
BMJ. Published online October 6, 2009.

CDC Offers Reassurances on H1N1 Vaccine Safety

2009-10-08T11:56:00.003+03:00

Robert Lowes
October 6, 2009 ( UPDATED October 7, 2009 ) — On the second day of nationwide vaccination for the influenza A (H1N1) virus, the director of the US Centers for Disease Control and Prevention (CDC) reiterated that the vaccine is safe in an effort to assuage public misgivings.
"The vaccine is the best tool to protect against the flu," CDC Director Thomas Frieden, MD, said today during a press briefing. "My children will get it."
As of Monday, some 2.2 million doses of FluMist, the intranasal formulation of the H1N1 vaccine, had been ordered by all 50 states, the cities of Chicago, New York, Philadelphia, and Washington, DC; and 3 overseas public-health jurisdictions. This figure represents 92% of available stock. Next week, the first doses of the injectable H1N1 vaccine will become available for administration, said Dr. Frieden. The CDC will begin taking orders for this vaccine formulation tomorrow.
Despite many physicians reporting that patients have tied up their phones asking to be vaccinated immediately, one poll suggests that a large swathe of the public is reluctant to get vaccinated, in large measure because of safety concerns. A survey conducted in mid-September by the Harvard School of Public Health found that 53% of adults intended to get the H1N1 vaccine for themselves, but only 40% of adults were "absolutely certain" they would. Of the adults who did not intend to get the vaccine, or who were otherwise uncertain, 30% cited possible adverse effects as the reason, while 20% worried about contracting influenza from the vaccine.
Likewise, only 51% of parents were "absolutely certain" that they will have their children vaccinated, and of the remaining parents, 38% cited adverse effects, and 33% were concerned their child might contract another major illness from the vaccine.
Dr. Frieden repeated earlier CDC assertions that the new vaccine is safe. "It's made in the same way that seasonal vaccine is made each year by the same manufacturers using the same methods in the same facilities." And the safety track record of the seasonal flu vaccine, he said, is excellent.
He also addressed a misconception that H1N1 influenza is a benign illness that does not necessarily require vaccination. "The flu isn't always mild," said Dr. Frieden. "It can kill you."
Other individuals, said Dr. Frieden, have contended that it's too late during the H1N1 pandemic to administer the vaccine. "It's too soon to say it's too late," countered Dr. Frieden, noting that the flu season traditionally extends into May. "We don't know what the rest of the season will bring. And even in places where the flu has been widespread, affecting 5% to 10% of the population, 90% to 95% are still susceptible."
Dr. Frieden acknowledged that public-health messages about the H1N1 virus are hard for Americans to balance, especially when it comes to knowing when to go to the hospital emergency department. Infected patients who become seriously ill or have underlying medical problems need to seek care promptly, he said. Otherwise, patients with a mild infection can see a physician or care for themselves at home.

Update on Supplies of H1N1 and Seasonal Flu Vaccines
The doses of H1N1 vaccine administered Monday and Tuesday are the first of 251 million ordered by the Department of Health and Human Services from 5 manufacturers. "We’re making them available as soon as they come off the production line," Dr. Frieden said.
The number of doses that public-health agencies can order will reach 40 to 50 million by mid- to late October, according to the CDC. Vaccine production eventually should average 20 million doses per week through the end of the year.
Because initial supplies are slim, said Dr. Frieden, state and local authorities will allocate the vaccine on a priority basis. The CDC has recommended that healthcare workers, people who care for infants, children aged 6 months through 4 years, and children aged 5 through 18 years with a chronic illness should be the first to receive the vaccine. Dr. Frieden said that there is no order of priority within this group. "It’s up to the states to determine," he said.
Children younger than 10 years need 2 doses of the new vaccine, ideally 4 weeks apart. Dr. Frieden encouraged school vaccination programs not to hold back some of their initial allocation for the second shot, but instead to use it all for the first shot. "They should vaccinate as many people as possible," he said. "More [doses] will be coming."
According to news accounts, emergency production of the H1N1 vaccine has caused spot shortages of the 2009-2010 seasonal flu vaccine, forcing clinics in several states to cancel such immunizations. However, this supply problem will get resolved, said Dr. Frieden. "There will be plenty of both vaccines for those who want to be vaccinated."
Robert Lowes
Freelance writer, St. Louis, MissouriDisclosure: Robert L. Lowes has disclosed no relevant financial relationships.

Rapid Flu Tests Miss Many Swine Flu Cases: CDC

2009-09-28T18:03:00.001+03:00

CHICAGO (Reuters) Sep 24 - A study of rapid influenza tests found they miss many cases of swine flu and U.S. health experts said on Thursday they are not worth the trouble for this flu season.
A study looking at the effectiveness of a rapid flu test in the first few weeks of the H1N1 pandemic in May found it detected less than half of the cases later confirmed by more sophisticated tests.
The findings, which appeared in the U.S. Centers for Disease Control and Prevention's MMWR, confirm the CDC's current guidelines, which stress that people with flu-like symptoms should get quick treatment, before getting a flu test.
Health and Human Services Secretary Kathleen Sebelius told reporters at a briefing that doctors should simply treat symptoms and not bother with testing.
"The flu is the flu is the flu," she said.
In September, the CDC said doctors should not wait for laboratory confirmation of H1N1 because quick treatment is important, and because a negative rapid test does not rule out the flu.
The latest study, conducted by Dr. James Sabetta and colleagues at the Greenwich Hospital and the Greenwich Department of Health in Connecticut, shows why.
They collected data on patients from two school outbreaks of pandemic H1N1 flu in May. They did rapid flu diagnostic tests on 63 patients using the Xpect Flu A&B test by Remel, a unit of Thermo Fisher Scientific, and more sophisticated lab tests.
They found the rapid flu test detected just 47 percent of the pandemic flu cases later confirmed by the slower, but highly accurate real-time reverse transcription-polymerase chain reaction, or rRT-PCR.
The findings confirm an earlier study by the CDC that found quick flu tests caught just 40 to 69 percent of swine flu cases. That study, released in August, looked at three popular flu tests -- BinaxNow, made by Inverness Medical Innovations, Becton Dickinson's Directigen EZ Flu A+B test and Quidel's QuickVue.
The CDC said the findings confirm their current guidelines, and stress that treating flu -- whether seasonal or pandemic -- is more important than knowing what kind a person has.
"Almost everybody will almost certainly not know what kind of flu they had," Dr. Anne Schuchat of the CDC told the briefing.
Many companies are working on better rapid tests including GlaxoSmithKline and Enigma Diagnostics, Seegene, a company based in South Korea and Maryland, DxNA based in Utah, and Osmetech PLC, based in California.
MMWR September 24, 2009.

Hand Sanitizer Alert Email

2009-09-27T18:41:00.001+03:00

Summary:Email forward claims that a four-year-old child became dangerously drunk and required hospitalization after licking Hand Sanitizer from her hands (Full commentary below).
Status:True

Example:(Submitted, May 2007)
Hand Sanitizer AlertYesterday, my youngest daughter, Halle, who is 4, was rushed to the emergency room by her father for being severely lethargic and incoherent. He was called to her school by the school secretary for being "very VERY sick."He told me that when he arrived, Halle was barely sitting in the chair. She couldn't hold her own head up and when he looked into her eyes, she couldn't focus them. He immediately scooped her up and rushed her to the ER, and then called me.When we got there, they ran blood test after blood test and did x-rays, every test imaginable. Her white blood cell count was normal, nothing was out of the ordinary. The ER doctor told us that he had done everything that he could do so he was sending her to Saint Francis for further tests.Right when we were leaving in the ambulance, her teacher came to the ER and, after questioning Halle's classmates, we found out that she had licked hand sanitizer off her hand.Hand sanitizer, of all things.But it makes sense. These days they have all kinds of different scents and when you have a curious child, they are going to put all kinds of things into their mouths.When we arrived at Saint Francis, we told the ER doctor there to check her blood alcohol level, and yes we did get weird looks, but they did it.The results showed her blood alcohol level was 85% -- six hours after we first took her. There's no telling what it would have been if we would have requested it at the first ER.Since then, her school and a few surrounding schools have taken this out of the classrooms of all the lower grade classes, but what's to stop middle and high schoolers from ingesting the stuff?After doing research on the internet, we have found out that it only takes 3 squirts of the stuff to be fatal in a toddler. For her blood alcohol level to be so high was to compare someone her size to drinking something 120 proof. So please PLEASE don't disregard this because I don't ever want anyone else to go through what my family and I have gone through.Please send this to everyone you know who has children or are going to be having children. It doesn't matter what age.

Commentary:This email forward warns of the danger to children posed by consuming alcohol-based hand sanitizer and cites the case of a four-year-old girl who became very ill after licking sanitizer off her hands.The information in the message is basically true*. According to a May 14 2007 Fox23 News report, four-year-old Halle Butler of Okmulgee, Oklahoma became very ill after eating hand sanitizer. Halle's pre-kindergarten teacher applied hand sanitizer to the child's hands before she ate lunch. However, Halle apparently licked the sanitizer off her hands rather than rubbing it in. The child soon became ill and was rushed to hospital where she showed signs of intense intoxication. Typical hand sanitizer contains 62-percent alcohol, significantly more than most hard liquor. Even a small amount would therefore be enough to make a small child drunk or ill. Thankfully, the child recovered after the alcohol left her system and is now doing well.In the wake of this incident, Halle's parents are trying to raise awareness of the potential danger of hand sanitizers in the hope that similar events can be prevented. The school where the incident occurred has now stopped using hand sanitizers.Halle's is not the only case of hand sanitizer poisoning reported. In another incident in San Diego, a teacher became ill after a 7th grade student spiked his drink with hand sanitizer. In other cases adults, including a prison inmate, have become ill after deliberately drinking hand sanitizer to get drunk.Parents and those who work with children or other "at-risk" groups such as prison inmates should be vigilant when hand sanitizers are being used. Children should be strictly supervised when using such products. As the email notes, young children are apt to taste substances that older children and adults would never consider eating.However, while the danger is real, hand sanitizers are not inherently dangerous if they are used as directed by their manufacturers. Also, it should be noted that, when used correctly, hand sanitizers can effectively reduce the spread of gastrointestinal and other illnesses. Therefore, as long as young children are carefully monitored when using hand sanitizers, their use in schools may be beneficial to students and the wider community as a whole.*

Note: The claim in the message that the child's blood alcohol level was 85% is obviously incorrect - levels of more than 0.45% are almost always fatal - but this is likely to be simply an error and may have been intended to read ".085%".

References:Hand sanitizer makes girl drunk Teacher's drink spiked with sanitizer; seventh-grader arrested Warning: Don't drink the hand sanitizer Using Hand Sanitizer Stops Germs from Spreading
Last updated: 29th May 2007First published: 29th May 2007

Tylenol recall sent by a parent

2009-09-25T11:51:00.000+03:00

You may have heard that McNeil Consumer Healthcare (the makers of TYLENOL®) is voluntarily recalling certain lots of Children's and Infants' TYLENOL® liquid products that were manufactured between April, 2008 and June, 2008. All products manufactured met internal specifications. However, the company is implementing this recall because during this period, an unused portion of one inactive ingredient did not meet all quality standards. Therefore, as a precautionary measure, it was decided to recall all Children's and Infants' TYLENOL® liquid products listed below, which were made during this time. Parents and caregivers who have questions or concerns should contact their child's health care provider or our consumer call center at 1-800-962-5357 (available Monday-Friday 8 a.m. to 8 p.m. Eastern Time). Consumers can find the lot numbers on the bottom of the box containing the liquid product and also on the sticker that surrounds the product bottle. The lot numbers of the affected products are listed below. These actions do not apply to Children's TYLENOL® Meltaways and Junior Strength TYLENOL® Meltaways. The voluntary recall applies only to select lots of Children's and Infants' TYLENOL® liquid products. Recalled Products - Full List
Lot #
Product Description
SBM041, SBM067, SCM037, SDM027, SEM109
Children's Tylenol Plus Cold MS Suspension 4 oz. Grape
SBM042, SCM015, SCM036, SDM034
Children's Tylenol Suspension 4oz. Grape
SBM043, SBM044, SCM029
Children's Tylenol Suspension 4oz. Bubble Gum
SBM045, SCM011, SCM030, SDM035
Children's Tylenol Suspension 4oz. Strawberry
SBM064, SCM033, SDM020
Infant’s Tylenol Grape Suspension Drops 1/4oz.
SBM065, SCM005, SCM006, SDM032
Infant's Tylenol Suspension 1/2oz. Cherry
SBM066, SCM068
Children's Dye Free Suspension 4oz. Cherry
SBM068, SCM035, SCM070, SCM080, SDM005
Children's Tylenol Suspension 4oz. Cherry
SBM069, SBM070, SCM081, SDM006
Children's Tylenol Plus Cough & Runny Nose 4oz. Cherry
SCM012, SCM067, SDM007, SDM068
Infant's Tylenol Suspension Drops 1/2oz. Grape
SCM013, SCM014, SCM069
Children's Tylenol Plus Flu 4oz. Bubble Gum
SCM016, SFM024
Children's Tylenol Plus Cold Suspension 4oz. Grape
SCM017
Children's Tylenol Plus Cough/ST Suspension 4oz. Cherry
SCM082, SDM039, SDM040
Infant's Tylenol Suspension Drops 1oz. Grape
SCM083, SCM084, SDM008
Infant's Tylenol Dye Free Suspension 1oz. Cherry
SDM064
Children’s Tylenol Pediatric Suspension 1oz. Cherry
SDM038, SDM009
Infant's Tylenol Suspension Drops 1oz. Cherry
SDM033
Children's Tylenol Plus Cold/Allergy 4oz. Bubble Gum
SDM078
Infant's Tylenol Drops 1oz. Grape
SCM034
Infant’s Tylenol Grape Suspension Drops H/G 1/2oz.
SDM028
Children's Tylenol Suspension 4oz. Cherry, Hospital Govt.

Autism rates back MMR jab safety

2009-09-24T12:04:00.000+03:00

By Michelle Roberts Health reporter, BBC News
Latest autism figures should dispel any fears about the MMR jab being linked to the condition, say experts.
The NHS Information Centre found one in every hundred adults living in England has autism, which is identical to the rate in children.
If the vaccine was to blame, autism rates among children should be higher because the MMR has only been available since the early 1990s, the centre says.
This is the first time the rate in adults has been evaluated.
Tim Straughan, chief executive of The NHS Information Centre, said: "This landmark report is the first major study into the prevalence of autism spectrum disorders among adults to be carried out anywhere in the world.
The findings do not support suggestions of a link between the MMR vaccine and the development of this condition
Chief executive of The NHS Information Centre Tim Straughan
"While the sample size was small and any conclusions need to be tempered with caution, the report suggests that, despite popular perceptions, rates of autism are not increasing, with prevalence among adults in line with that among children.
"It also suggests that, among adults, rates of autism remain broadly constant across age groups.
"The findings do not support suggestions of a link between the MMR vaccine and the development of this condition."
A Department of Health spokesperson said: "There is no credible evidence to support the link between the MMR vaccine and autism.
"MMR vaccine has been used extensively and safely around the world for over 30 years and is the best way of protecting your child against measles, mumps and rubella."
Concern over the measles, mumps and rubella vaccine was sparked by a paper published in The Lancet in 1998 by Dr Andrew Wakefield.
'Safe' vaccine
This research has since been discredited.
But, until now, little was known about how autism affected people over the course of a lifetime.
The latest findings, based on nearly 7,500 adults, suggests that prevalence of autism spectrum disorder remains broadly level across all age bands.
While 1% of adults had an autism spectrum disorder, which includes autism and Asperger's syndrome, the rate for men was higher (1.8%) than for women (0.2%). This was in line with studies among child populations which show higher rates amongst boys.
And in line with recent report from the National Audit Office, the study also found many of these adults are failing to get the diagnosis and specialist help they need.
Mr Straughan said: "This does beg some questions about whether services, as currently configured, are meeting the needs of this group of people."
Mark Lever, chief executive of the National Autistic Society, said: "The NAS has long campaigned to raise awareness of the fact that services and support for adults with autism are woefully inadequate.
"This study gives us further evidence to demand that more vital support is put in place."
Care Services Minister Phil Hope said: "This study will feed into the first ever adult autism strategy, which we will publish at the end of this year.
"The strategy should kick-start radical improvements in services for all forms of autism."
People with autism spectrum disorder may suffer a range of problems, including difficulty interacting with other people and communicating their feelings.

Early Results: In Children, 2009 H1N1 Influenza Vaccine Works Like Seasonal Flu Vaccine

2009-09-23T11:24:00.004+03:00

Early results from a trial testing a 2009 H1N1 influenza vaccine in children look promising, according to the trial sponsor, the National Institute of Allergy and Infectious Diseases (NIAID), part of the National Institutes of Health. Preliminary analysis of blood samples from a small group of trial participants shows that a single 15-microgram dose of a non-adjuvanted 2009 H1N1 influenza vaccine — the same dose that is in the seasonal flu vaccine — generates an immune response that is expected to be protective against 2009 H1N1 influenza virus in the majority of 10- to 17- year-olds eight to 10 days following vaccination. These results are similar to those recently reported in clinical trials of healthy adults. Younger children generally had a less robust early response to the vaccine.
"This is very encouraging news," says NIAID Director Anthony S. Fauci, M.D. "As we had hoped, responses to the 2009 H1N1 influenza vaccine are very similar to what we see with routinely used seasonal influenza vaccines made in the same way. It seems likely that the H1N1 flu vaccine will require just one 15-microgram dose for children 10 to 17 years of age. The 2009 H1N1 influenza virus is causing widespread infections among children, so these are welcome results."
The ongoing NIAID-sponsored trial began in mid-August at five sites nationwide. The trial is assessing the safety and immune responses to one and two doses of either 15 micrograms or 30 micrograms of vaccine. Data from the trial is being compared for three age groups: children 6 months to 35 months old; 3 to 9 years old; and 10 to 17 years old.
The preliminary results are based on blood samples taken eight to 10 days after the first vaccination. Immune responses were strongest among the oldest children, those 10 to 17 years old. In this group of 25 children, a strong immune response was seen in 76 percent who received one 15-microgram dose of vaccine. The immune responses in children nine years old and younger were not as strong. Among 25 volunteers aged 3 to 9 years old, a strong immune response was seen in 36 percent of those given 15 micrograms of vaccine. In the youngest group, 20 children between 6 months to 35 months old, a single 15-microgram dose of vaccine produced a strong immune response in 25 percent of recipients.

"These results are not unexpected and are both similar to what is seen with seasonal influenza vaccines and consistent with what we and our colleagues at the Food and Drug Administration anticipated," notes Dr. Fauci.
Study investigators are also collecting blood samples from the volunteers approximately three weeks after both the first and second injections. It is anticipated that the immune response to the 2009 H1N1 influenza vaccine will be similar to that of seasonal influenza vaccination and will continue to rise for several weeks following vaccination, says Dr. Fauci. The study is being closely monitored by the trial physicians and staff as well as by an independent safety monitoring committee.
The vaccine being tested in this trial is manufactured by Sanofi Pasteur in Swiftwater, Pa., in the same manner as its licensed seasonal vaccine, which is used every year in millions of children, and is the same formulation recently licensed by the FDA to protect against 2009 H1N1 influenza. Like inactivated seasonal influenza vaccines, the vaccine contains a purified part of a killed virus and cannot cause flu.
NIAID is conducting trials of 2009 H1N1 influenza vaccines through its longstanding vaccine clinical trials network, the Vaccine and Treatment Evaluation Units. Additional information about the NIAID-sponsored clinical trials in children is available in an Aug. 18 Bulletin: http://www3.niaid.nih.gov/news/newsreleases/2009/H1N1pedvax.htm and a Q&A: http://www3.niaid.nih.gov/news/QA/qaH1N1pedvax.htm. A detailed description of the trial protocol is at clinicaltrials.gov: http://clinicaltrials.gov/show/NCT00944073.
For more information on influenza, including pandemic influenza and avian influenza, visit http://www.flu.gov/. Also, see NIAID’s Web portal at http://www3.niaid.nih.gov/topics/Flu/.

عيدكم مبارك و تقبل الله طاعتكم

2009-09-19T11:51:00.001+03:00

يا شهر رمضان ترفق
دموع المحبين تدفق..
قلوبهم من ألم الفراق تشقق..
عسى وقفة للوداع تطفئ من نار الشوق ما أحرق..
عسى ساعة توبة وإقلاع ترفو من الصيام ما تخرق..
عسى منقطع عن ركب المقبولين يلحق..
عسى أسير الأوزار يطلق..
عسى من استوجب النار يعتق

Severe H1N1 Infection in Children Linked to Asthma and Other Diseases

2009-09-19T11:45:00.002+03:00

Barbara Boughton
September 17, 2009 (San Francisco, California) — Although most cases of H1N1 influenza are mild and self-limited, severe disease in children is most likely linked to underlying conditions such as asthma, according to Canadian research presented here at the 49th Interscience Conference on Antimicrobial Agents and Chemotherapy.
In the retrospective review, the case records of 89 children hospitalized with H1N1 were analyzed, and the researchers found that a "disturbing" number of children had serious complications requiring a stay in the intensive-care unit (ICU), said Bruce Tapiero, MD, from the Division of Infectious Diseases, Department of Pediatrics, CHU Sainte-Justine in Montreal, Quebec.
In the study, researchers identified 80 children, of the 89 cases reviewed, who were admitted to Sainte-Justine Hospital with confirmed H1N1, as defined by a positive PCR test. Most of the children hospitalized were older than 6 years, and many were school-aged.

One or more underlying medical conditions was found in 66% of the children, with the most common being asthma, sickle cell disease, and encephalopathy. Other underlying conditions were pneumonia and congenital heart disease.

Although most of the children displayed the usual features of H1N1 —fever, cough, and sore throat — a striking number also had gastrointestinal symptoms (49%). In fact, the 1 death that occurred from H1N1 was attributed to gastrointestinal complications, underlying lung disease, and encephalopathy.

Fever was seen in most of the children, and neurological features of the disease were common, with 7 children experiencing febrile seizures. In addition, 35% of the children had oxygen-saturation levels below 95%, and 4 of the sickest patients required mechanical ventilation.
Thirteen of the children (16%) required admission to the ICU, and most of those children had underlying comorbidities. The findings suggest that the infection might be particularly severe in these children, the investigators say. Despite the severity of illness, length of stay in the ICU was brief. Most of the children did not have extended stays in the hospital. The mean hospitalization for the group was 4 days.
The Canadian team noted that some lessons could be drawn from their study. Most children with H1N1, even those who are hospitalized, have moderate disease, they note. However, gastrointestinal symptoms and febrile seizures are prevalent in children with H1N1. Thus, it is important that clinicians pay attention to these symptoms when evaluating children for H1N1 to improve diagnosis and treatment, the researchers advise.
"This was a descriptive study, so it had some limitations," said Laurent Kaiser, MD, from University Hospital of Switzerland in Geneva, who moderated the session at which the study was presented. "But it shows us some interesting features of children with the most severe disease," he said.
"At the same time, we don't really have documentation about how widespread the disease is in children," Dr. Kaiser said. That kind of information can only come from large national studies, he explained. "What we're seeing here is the tip of the iceberg, but we don't really know the size of the iceberg yet because it's such a new disease."
Dr. Tapiero and Dr. Kaiser have disclosed no relevant financial relationships.
49th Interscience Conference on Antimicrobial Agents and Chemotherapy (ICAAC): Presentation V-1269d. Presented September 14, 2009.

Flu Experts Gear up for Pandemic of Vaccine Worry

2009-09-18T16:04:00.003+03:00

WASHINGTON (Reuters) Sep 16 - One million heart attacks, 700,000 strokes and 900,000 miscarriages -- U.S. public health officials want Americans to know these will happen every single year with or without a swine flu vaccine campaign.
Yet this year, they know a significant number will be blamed on the H1N1 vaccine, which will roll out within weeks, and they are struggling to be ready.
They expect an avalanche of adverse event reports - that is, reports of death, illness or other health trauma that occur within two weeks after receiving treatment -- in this case, the swine flu vaccine.
"We are going to be overwhelmed with potential events," said Mike Osterholm, a public health expert at the University of Minnesota.
"Anything that happens to anybody in the period of seven to 14 days after vaccination will be reported."

And not just to U.S. officials. The World Health Organization is trying to reassure a global audience that vaccines being made by 25 different companies, with various formulations, are all safe.

"If we have a safety signal in one country it could stop vaccination efforts in others," WHO's top flu expert Dr Keiji Fukuda told a meeting of infectious disease specialists organized by the U.S. Institute of Medicine this week.
It is made using precisely the same technology as the annual seasonal flu vaccine, which is given to hundreds of millions of people every year.
But because H1N1 is new, vaccine makers have been testing it to learn what the right dose is.

SPIRIT OF '76
Memories linger of the 1976 swine flu debacle, when 43 million Americans were vaccinated against a virus that never spread, and newspapers filled with reports of Guillain-Barre syndrome.
Guillain-Barre was never definitively linked with the vaccine, but many Americans have viewed immunizations with suspicion ever since.
"We have anticipated that there will be a need for enhanced surveillance for Guillain-Barre as well as other adverse events," Dr Nancy Cox of the U.S. Centers for Disease Control and Prevention told the meeting.
And there will be more to contend with than critical newspaper and television reports. The Internet did not exist in 1976. Nor did blogs, Facebook, Twitter or dozens of other ways for people to communicate globally and instantly.
"Information is the most globalized product of all," Fukuda said. "The ability of blog sites to influence countries' decision-makers and so on -- coming to grips with how we deal with this is going to be a priority."
To address this, CDC and the U.S. Food and Drug Administration are gearing up for one of the biggest surveillance efforts ever. "We know how absolutely essential clear, transparent communications are to the public in order to have a successful vaccination campaign," Cox said.
CDC's weapons of choice -- Facebook, Twitter, Internet RSS feeds, humorous "viral" videos posted on YouTube, iPhone apps such as the CDC News Reader. Children's Hospital Boston has an an app (short for application) called Outbreaks Near Me that allows people to track the pandemic locally.

FDA Approves 4 Vaccines for 2009 H1N1 Influenza

2009-09-17T13:22:00.002+03:00

Kristina Rebelo
September 15, 2009 —The US Food and Drug Administration (FDA) announced today that it has approved 4 vaccines against the 2009 influenza A (H1N1) virus, formerly known as "swine flu." The vaccine lots are expected to be available and distributed within the next 4 weeks.
FDA Commissioner of Food and Drugs Margaret A. Hamburg, MD, said she thought Tuesday's approval was good news for the nation's response to the H1N1 influenza virus. "This vaccine will help protect individuals from serious illness and death from influenza," she said.
The approval comes at a time when the Centers for Disease Control and Prevention (CDC) is reporting that visits to physicians around the country for influenza-like illness are increasing and are higher than expected at this time of year. The vaccines that are currently available against 3 seasonal influenza virus strains will not protect against the 2009 H1N1 virus.
The FDA said that the vaccines, based on early data, effectively elicit an immune response in most healthy adults about 8 to10 days after vaccination. Clinical studies are still underway to produce an optimal dose for children, with results expected in the near future.
Meanwhile, the CDC stresses that influenza is primarily spread through person-to-person contact, by the coughing or sneezing of infected people, and recommends that infected people stay home and limit their contact with others to keep from infecting them.
The newly approved vaccines are being made by CSL Limited, MedImmune LLC, Novartis Vaccines and Diagnostics Limited, and Sanofi Pasteur Inc. All 4 firms reportedly use the same processes to manufacture the H1N1 vaccines. As with the seasonal influenza vaccine, some lots of the H1N1 vaccine will contain the preservative thimerosal and others will not. The FDA has been continuing its efforts toward reducing thimerosal used in vaccines.
The FDA warns that persons with known allergies to chicken eggs or any other substance in the vaccine should probably not be vaccinated, although in the ongoing clinical trials, the vaccines have been well tolerated. The most common adverse effect is soreness at the injection site; other adverse effects can include a mild fever, body aches, and fatigue for a couple of days after vaccination. For the nasal spray delivery system, the most common adverse effects were runny nose, nasal congestion in all ages, sore throats in adults, and fever in children aged 2 to 6 years.
The FDA is working with different organizations regarding adverse event monitoring, information sharing, and an overall analysis during and after the 2009 H1N1 vaccination program, according to the news release. "As with any medical product, unexpected or rare serious adverse events may occur," the FDA notes.

MedImmune Says Swine Flu Vaccine Ready End of September

2009-09-15T03:22:00.002+03:00

By Maggie Fox
WASHINGTON (Reuters) Sep 10 - MedImmune's inhaled vaccine against the pandemic H1N1 virus could be ready to start shipping to the U.S. government by the end of September, a company official said on Thursday.
MedImmune's Dr. Raburn Mallory said the company, a unit of AstraZeneca, has submitted safety data for its nasal spray swine flu vaccine to the U.S. Food and Drug Administration.
"There are no red flags there. We think we can have 5 million doses ready to distribute at the end of September," Dr. Mallory said in an interview. U.S. officials had not expected vaccination to begin until mid-October.
The United States hopes to vaccinate 160 million Americans by the beginning of December.
The company has 5 million doses in spray devices now, a company spokeswoman said, adding that a more conservative estimate would be that 3.5 million doses could be sent out by the end of September.
Dr. Mallory said the company was preparing details on how well the vaccine works.
Last week vaccine makers Novartis and China's Sinovac reported their vaccines elicited protective immune responses in patients with one dose. Infectious disease experts had feared people would need two doses to get full immunity against the virus because it is a new strain.
Earlier on Thursday, Thomas Lonngren, executive director of the European Medicines Agency, said early clinical trial results show swine flu vaccines being rushed through development produce a strong immune response.
Dr. Mallory said he did not know if MedImmune's vaccine would work with a single dose. He noted that the company uses a weakened live virus, compared to the killed viruses used by other flu vaccine makers. Tests have shown MedImmune's live virus seasonal vaccine produces a stronger immune response than killed virus vaccines.
MedImmune has said it can produce about 200 million doses of its needle-free vaccine in bulk. But it can only deliver about 40 million doses of its product because it lacks the sprayers to squirt the vaccine into the nose.
Dr. Mallory said company officials were working with the FDA to perfect a device to drip vaccines into the nose -- technology that has been used with other vaccines.
Other pharmaceutical companies like Sanofi Aventis, GlaxoSmithKline and CSL are also racing to develop H1N1 vaccine as governments scramble to secure supplies.

الــمــعــرفــة الــصــحــيــة

لبيك ربي يا مجيب الدعوة

اللهم بلغنا رمضان

خدمة التذكير بمواعيد تطعيم الأطفال من وزارة الصحة في دولة الكويت

Glaxo Antibiotic Scares Taiwan And Hong Kong // Pharmalot

AAP Issues Recommended Childhood and Teen Immunization Schedules

نبارك للكويت أيامها الوطنية

Vitamin D3 ’87 percent more potent’ than D2: Study

أكبر تزوير لدراسة في التاريخ الطبي- Autism and MMR Vaccine Study an 'Elaborate Fraud,' Charges BMJ

Influenza Vaccination for Children: A Quick Reference Guide

Most Children With Middle Ear Infections Get Better on Their Own, Study Finds

عيدكم مبارك وتقبل الله طاعتكم

مع دخول ذو الحجة

Coffee Boosts Stroke Risk

مهرجان الجري في الكويت- RunQ8

عيدكم مبارك وتقبل الله طاعتكم

مبارك عليكم الشهر

http://www.medscape.com/viewarticle/721810?sssdmh=dm1.616851&src=nldne&uac=6966HK

Guard Kids' Eyes Against Long-Term Sun Damage

FDA says GlaxoSmithKline's Rotarix vaccine is safe

Meaningful Conversations and Language skills

IVF, Fertility Drugs Might Boost Autism Risk

Breast-Feeding Linked to Lower Incidence of Fever After Immunizations

Yogurt Found to Reduce Children's Infections

Swim lessons for toddlers get doctors' approval

Diet Free of Gluten and Casein Has No Effect on Autism Symptoms

Challenging the Nature & BBC Brain Games Study

No gain from brain training

من الطب النبوي ( التداوي بالقسط ) العود الهندي

الجليس لإحياء القراءة

U.S. court rules again against vaccine-autism claims

Effectiveness Of Stem Cells As Cerebral Palsy Treatment Set For Test

For Chocolate Lovers

منتدى قلب الكويت

A Spoonful of Medicine? Mary Poppins Can Be Dangerous

Study Linking Autism to Vaccine Retracted

WHO Addresses Media Misconceptions About H1N1 Pandemic

Johnson & Johnson issues massive recall of Tylenol

FDA on BPA: 'Some Concern,' No Ban

Tylenol, Motrin, Benadryl, St. Joseph Aspirin, Rolaids Recall

Bisphenol A (BPA) Information for Parents

Fat May Help Build Bone Mass in GirlsExcessive weight loss in teen years may increase risk of osteoporosis, findings suggest

Misconnections in Developing Brain May Cause Autism Mounting evidence opens possibility of future drug treatment, researchers say

التبغ المستخدم في الشيشه - جدير بالمشاهده

2009 H1N1: What's New This Week -- December 1, 2009

How it feels to have a stroke? Sent by a colleague

No Adverse Events Reported So Far With H1N1 Influenza Vaccine

CDC Warns of Increasing Pneumococcal Disease Associated With H1N1 Flu

CDC Commentary: Seasonal and H1N1 Influenza Vaccines -- Timing of Doses

Virus mutation spreads as swine flu deaths leap

اللهم أغثنا اللهم أغثنا

عيدكم مبارك

Vaccine call over 'new' swine flu

Expert warning over new swine flu

Four pilgrim deaths from swine flu at Hajj-Saudia Arabia

H1N1 Vaccine as Safe as Seasonal Vaccine, WHO Says

H1N1 Flu Skepticism Demands Deft Response

Risk Reduction Recommendations for Specific Patient Groups

Acetaminophen May Be Linked to Asthma Risk

FDA Warns Against H1N1 Flu Supplements

New H1N1 vaccine Blog

H1N1

Top 10 frequently asked questions on use of influenza A H1N1

60 minutes on CNBC- H1N1 vaccine

The Double Flu Vaccine Season Is Here -- Now What Should You Do?

Policy Statement—Recommendations for the Prevention and Treatment of Influenza in Children, 2009–2010

Beware of these INFLUENZA- like symptoms

WHO Describes Clinical Features of H1N1 Influenza

Statement from the American Diabetes Association Related to Studies Published in 'Diabetologia'

Most Hospitalized H1N1 Patients Have Underlying Conditions

Daily Nebulizers Advised for Preschoolers With Frequent Wheezing

Daily Nebulizers Advised for Preschoolers With Frequent Wheezing

Daily Nebulizers Advised for Preschoolers With Frequent Wheezing

H1N1 Flu (Swine Flu) Information

Seasonal Flu Vaccine May Help Protect Against H1N1

CDC Offers Reassurances on H1N1 Vaccine Safety

Rapid Flu Tests Miss Many Swine Flu Cases: CDC

Hand Sanitizer Alert Email

Tylenol recall sent by a parent

Autism rates back MMR jab safety