30 November 2015

UK DAILY MAIL

Organs can be taken from the dead without any consent: Landmark law change in Wales gives doctors right to assume all adults have agreed to be donors

New system means adults have to 'opt out' from the register to not donate
Health officials argue the change of system will save hundreds of lives
Relatives will still have the right to object to a family member's donation
1,000 people in the UK die every year while they are waiting for a transplant

By Ben Spencer Medical Correspondent For The Daily Mail

Published: 00:25 GMT, 1 December 2015 | Updated: 00:31 GMT, 1 December 2015

Organs will be transplanted from the dead without consent for the first time in Britain from today.

A landmark law change in Wales gives doctors the right to assume that all adults consent to be organ donors after their death.

The new system means that adults have to ‘opt out’ from the register if they do not want to be donors - a dramatic change from the current ‘opt in’ system.

If they have not opted out, they will be treated as if they had given their approval, a principle known as ‘deemed consent’.

A landmark law change in Wales means that doctors have the right to assume that all adults consent to be organ donors after their deaths, and people will have to opt out of the register (file image)

Officials in England are carefully monitoring whether the new system is successful.

Some religious groups have criticised the move, but health officials argue that it will save hundreds of lives.

The Welsh Government predicts the new law could increase the number of organ donors by as much as a quarter.

Under the new system, relatives will still have the right to object to a family member’s organs being removed - but if they cannot be contacted a transplant will go ahead.

According to the latest figures, 1,000 people in the UK die every year while waiting for a transplant.

Organ transplants dropped in number last year for the first time in a decade, NHS figures show.

The number of transplants fell from 4,655 in 2013/14 to 4,431 in 2014/15.

The 5 per cent decrease is the first drop in 11 years, meaning that 224 fewer people received an organ transplant.

The British Heart Foundation last night called for England to follow the Welsh lead.

Simon Gillespie, chief executive at the charity, said organ donation rates in the UK are 40 per cent lower than in other countries in Europe, such as Spain and Croatia, that already use the opt-out system.

According to the latest figures, 1,000 people in the UK die every year while waiting for a transplant (file image)

‘Sadly hundreds of people die every year waiting for a transplant because there is a desperate shortage of organ donors,’ he said.

‘Other European countries that already use an opt-out system have much higher donor rates than the UK.

‘We campaigned strongly in Wales to introduce soft opt-out and now it’s time for the rest of the UK to follow their lead.’

Wales’ health minister Mark Drakeford said: ‘The change to a soft opt-out system for organ donation will deliver a revolution in consent.

‘Organ donation saves lives; increasing the rate of organ donation allows us to save more lives. That’s the key motivation for this significant change.’

Under the new system, those over 18 will become potential donors either by registering their decision to opt in - as they do currently - or by doing nothing at all.

It will apply to adults who have lived in the country for more than 12 months.

Organs available will be the same as the ‘opt-in’ method - including kidneys, heart, liver, lungs and pancreas - and would go anywhere in the UK.

Some 8 per cent of eligible adults in Wales have decided to opt out ahead of the new law today.

Ahead of the new law coming into effect leading Welsh Christian, Jewish and Muslim clerics signed an open letter expressing their unease about the plan.

‘We remain opposed to any weakening of the principle the donation of organs should be free and voluntary,’ they said.

The Archbishop of Wales, Dr Barry Morgan, has warned that the scheme could turn ‘volunteers into conscripts’.

But in an open letter published today, Church of Wales bishops called on people to make a positive decision one way or the other.

It said: ‘As Bishops we are wholeheartedly in favour of organ donation.

‘It is love in action and a wonderful example of what it can mean to love our neighbours, especially those in need. Such generosity is a response to God’s generosity towards us.

‘We urge and encourage you to sign the Organ Donor Register, and tell your families, so that there can be no doubt about your wishes in the event of your death.’

A spokesman for the Department of Health said England had no plans to follow the lead set by Wales - but admitted officials would be watching closely.

He said: ‘Our opt-in system is working well. In 2008 independent experts advised against an opt-out system and recommended more specialist nurses, clinical leads and donation committees. This has seen organ donation rates increase by 60 per cent.

‘We are watching how the change in Wales impacts on donations and continue to work hard to build on the significant increase in organ donations achieved in recent years.’

17 November 2015

DailyMail

Wednesday, Nov 18th 2015 7PM 6°C 10PM 6°C 5-Day Forecast

STD epidemic is sweeping the US with cases of chlamydia reaching 'record levels' - while gonorrhea and syphilis are also on the rise

CDC report warns of STD epidemic rising across the United States
Chlamydia, gonorrhea and syphilis all increased for first time in 9 years
Total of 1.4 million chlamydia cases - highest number of annual cases of any condition ever reported to the CDC
Experts call for better diagnosis, treatment and prevention to stem rise

By Lizzie Parry For Dailymail.com

Published: 19:39 GMT, 17 November 2015 | Updated: 23:52 GMT, 17 November 2015

View comments

A sexually transmitted diseases epidemic is sweeping the US, with cases on the rise as chlamydia infections reaches 'record levels', experts have warned.

Cases of chlamydia, gonorrhea and syphilis have all increased for the first time since 2006, according to the Centers for Disease Control and Prevention (CDC).

Chlamydia cases had dipped in 2013, but last year's total of more than 1.4 million — or 456 cases per 100,000 — was the highest number of annual cases of any condition ever reported to the CDC.

The chlamydia rate was up almost three per cent from 2013, new figures revealed.

'America's worsening STD epidemic is a clear call for better diagnosis, treatment, and prevention,' said the CDC's Dr Jonathan Mermin.

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A sexually transmitted diseases epidemic is sweeping the US, with rising rates of chlamydia, gonorrhea and syphilis. The map shows the rate of cases of chlamydia in each state in 2014, per 100,000 of the population, with Alabama, Mississippi, Louisiana and Alaska among those with the highest number of cases

Chlamydia cases reached their highest ever levels recorded, for both men and women in 2014, with 1.4 million cases in total across the US

Experts have pointed the finger at dating apps, including Tinder, Happn and Grindr, warning they could trigger an 'explosion' in rates of sexually transmitted diseases.

In May this year, The Rhode Island Department of Health revealed from 2013 to 2014, cases of syphilis rose by 79 per cent, gonorrhea by 30 per cent and HIV by almost 33 per cent.

And in September this year, The AIDS Healthcare Foundation launched a new billboard campaign in Los Angeles, drawing users' attention to the risk of catching chlamydia and gonorrhea during casual sex among young adults.

The charity said a rise in STDs corresponds with the growing popularity of dating or 'hookup' mobile phone apps.

Whitney Engeran-Cordova, senior director, Public Health Division for AHF: said: 'Mobile dating apps are rapidly altering the sexual landscape by making casual sex as easily available as ordering a pizza.'

However, a CDC spokesman told Daily Mail Online: 'There is no single answer to explain why STDs are increasing this year.

These are complex diseases that can be impacted by a number of factors.'

He said increased STD screening, including more extragenital screening, may be increasing detection of chlamydia and gonorrhea infections, especially in men.

The spokesman added: 'We don't have any evidence showing a link between STDs and dating apps.

'Having anonymous partners though, can make it difficult to offer partner services, like expediated partner therapy, or conduct contact tracing for syphilis to interrupt the cycle of transmission.'

The CDC report revealed gonorrhea cases totaled 350,062, up five per cent from 2013, and the most contagious forms of syphilis jumped 15 per cent to 20,000 cases.

As in previous years, the increase in syphilis was largely among gay and bisexual men.

Syphilis among these groups has been increasing since at least 2000.

In 2014, rates of syphilis increased among men who have sex with men, who account for 83 per cent of reported cases among men when the sex of the partner is known.

Also concerning is that more than half of men who have sex with men (51 per cent) diagnosed with syphilis in 2014 were also HIV-positive.

Infection with syphilis can cause sores on the genitals, which make it easier to transmit and acquire HIV.

The CDC report revealed gonorrhea cases totaled 350,062, up five per cent from 2013, and the most contagious forms of syphilis jumped 15 per cent to 20,000 cases. The map reveals the rate of gonorrhea per 100,000 of the population in each state, revealing Louisiana and Mississippi had the highest rates of the STD

The majority of gonorrhea (pictured under the microscope) cases were in young people, aged 15 to 24. The infection can cause infertility in women, but can be treated with antibiotics, the CDC said

Most gonorrhea and chlamydia infections were in 15- to 24-year-olds, an ongoing trend.

Both can cause infertility in women but can be treated with antibiotics.

They often have no symptoms, and while yearly screening is recommended for sexually active women younger than 25, many don't get tested and infections go untreated, the CDC said.

America's worsening STD epidemic is a clear call for better diagnosis, treatment, and prevention

Dr Jonathan Mermin, CDC

Dr Mermin said: 'STDs affect people in all walks of life, particularly young women and men, but these data suggest an increasing burden among gay and bisexual men.'

The 2014 data also reveals young people are still at the highest risk of acquiring an STD, especially chlamydia and gonorrhea.

Despite being a relatively small portion of the sexually active population, young people between the ages of 15 and 24 accounted for the highest rates of chlamydia and gonorrhea in 2014 and almost two thirds of all reported cases.

Additionally, previous estimates suggest that young people in this age group acquire half of the estimated 20 million new STDs diagnosed each year.

Despite recommendations from the CDC and the United States Preventive Services Task Force (USPSTF) for annual chlamydia and gonorrhea screening for sexually active women younger than 25, experts believe far too many young people are not tested, and therefore do not know they are infected.

Gail Bolan, director of the CDC's division of STD prevention, said: 'The consequences of STDs are especially severe for young people.

The most contagious forms of syphilis jumped 15 per cent to 20,000 cases. The map reveals the rates of cases of syphilis by state, with Washington DC, Louisiana, Georgia and Nevada reporting the most cases

The CDC said gay, bisexual and other men who have sex with men, are at greatest risk of contracting syphilis. The graph reveals how, since 2007, while the rates of syphilis among women and men who have sex with women, have remained relatively low, rates for men who have sex with men, the red line, have soared

'Because chlamydia and gonorrhea often have no symptoms, many infections go undiagnosed and this can lead to lifelong repercussions for a woman's reproductive health, including pelvic inflammatory disease and infertility.'

Preventing STDs in young people is a key priority, the CDC said.

Among their efforts, the CDC encourage the use of expediated partner therapy, where the sexual partners of anyone diagnosed with chlamydia or gonorrhea are offered treatment without medical exam, where legally permissible.

However, the CDC said key to reducing STDs is Americans taking steps to protect themselves.

Sexually active individuals are encouraged to undergo regular testing and treatment where necessary.

The CDC also advises 'using condoms consistently and correctly, and limiting the number of sex partners' as effective strategies for reducing the risk of infection.

Sexually transmitted diseases are among more than 70 diseases that are reportable to the CDC, including measles, chickenpox and tuberculosis. Flu is reported differently, by hospitalizations.

Pharmacists to join GP surgeries in 2016

By next year more than 400 clinical pharmacists will provide support to almost 700 general practitioner surgeries and more than seven million patients.

11 November 2015

UK UNIVADIS from The GUARDIAN

NHS ‘headed for financial ruin’

International Medical Press
10 Nov 15

The Chair of St George’s NHS Trust warns that the NHS needs at least £4bn more a year between now and 2020 to avoid disaster, according to a Guardian article.
Christopher Smallwood, Chairman of St George's University Hospitals NHS Foundation Trust in London, has described ‘an accelerating financial disaster’ for hospitals, stating that ‘hardened professionals who have worked in the service for decades have never seen anything like it.’
Writing for the Guardian, he said: ‘Two years ago a quarter of hospitals recorded deficits. Last year, this rose to half. This year, three–quarters of hospitals are running deficits, some of them extremely large – and 90%...expect to be in deficit by the end of the year.’
Mr Smallwood also warns of eroding standards of care, writing: ‘Waiting times for cancer treatment, and in A&E departments, are now missed routinely, as is the minimum wait for diagnostic tests. And the waiting target for elective procedures has been abandoned.’ He added: ‘Missed targets trigger fines of many millions of pounds, intensifying financial pressures. The queues will go on lengthening.’
Claiming that ‘Ministers are in denial about what is happening’, Mr Smallwood continued: ‘The past five years have seen the smallest increase in health spending over any parliament since the second world war – 0.8% a year. This compares with an annual increase in demand and cost pressures of between 4% and 5%.’
Mr Smallwood concluded that ‘Those drawing up the autumn statement need to be aware of these realities,’ explaining: ‘Even if the efficiency gains achieved in the next five years matched those of the past five, the government would need to increase annual budgets by £2bn-£3bn a year between now and 2020 to preserve standards. But since the NHS cannot continue to raise productivity at this rate, at least £4bn a year extra will be necessary, starting in April.

09 November 2015

UK FINANCIAL TIMES

Special Report: Risk Management

Bill Gates warns over risk of pandemic precipice

The world is less prepared for disruptions caused by illness and disease than war

yesterday

by: Andrew Ward

Workers wearing masks disinfect the interior of a subway train at a Seoul Metro's railway vehicle base in Goyang, South Korea, June 9, 2015 — Cleaning up: Korean workers disinfecting a subway train

Bill Gates says there could be one benefit from the Ebola epidemic that has killed more than 11,000 people in west Africa since 2014. “It may serve as a wake-up call,” says the Microsoft founder. “We must prepare for future epidemics of diseases that may spread more effectively than Ebola.”
His charitable foundation, the Bill & Melinda Gates Foundation, has been at the heart of the global fight against slower-burning health scourges such as HIV and malaria. However, few things worry him as much as the risk of a sudden global infectious disease outbreak.
“There is a significant chance that an epidemic of a substantially more infectious disease [than Ebola] will occur sometime in the next 20 years,” he wrote in a paper in the New England Journal of Medicine earlier this year. “Of all the things that could kill more than 10m people around the world, the most likely is an epidemic stemming from either natural causes or bioterrorism.”
His paper went on to set out proposals for a “global warning and response system” for pandemics and warned that Ebola had exposed glaring deficiencies in preparedness. His recommendations were aimed primarily at policymakers. But his broader point on the need for readiness should also resonate in boardrooms and human resources departments across the corporate sector.
In the event of a pandemic, private sector employers would be on the front line of the battle to contain its spread and their businesses would be highly exposed to disruption.
The economic case for preparedness is clear. According to the World Bank, a severe pandemic could reduce global wealth by $4tn, or 5 per cent of gross domestic product. But the importance of ensuring business continuity goes beyond the need to minimise lost revenues. It would also be crucial to broader efforts to keep the economy and society functioning.
Some 85 per cent of critical US infrastructure resides in the private sector, according to the Department for Homeland Security.
The danger of business paralysis during a pandemic became clear at the height of the Ebola outbreak when some iron ore mines — an important part of the west African economy — ceased production, and farming and trade were disrupted.
Mr Gates warns that future pandemics could spread much more quickly and widely than Ebola. “Other disease agents — measles and influenza, for example — are far more infectious because they can be spread through the air, rather than requiring direct contact,” he says. “People may not even be aware that they are infected or infectious. Since a person carrying one of these pathogens can infect many strangers in a marketplace or on an airplane, the number of cases can escalate very quickly.”
Public awareness of the risk has increased in recent years. Between 1997 and 2009, six major outbreaks of highly fatal zoonoses — animal-borne diseases that can be transmitted to humans, such as Ebola, Sars, avian and H1N1 flu — caused an estimated $80bn in economic losses, according to the World Bank.

A clear plan should be in place before an epidemic erupts — and exercises carried out to test it for flaws

Yet none of these was anywhere close in scale to the 1918 Spanish flu pandemic, which infected 500m people and killed between 50m and 100m, or 3-5 per cent of the world’s population. Today, according to the World Bank, a similarly infectious and deadly virus would kill 33m people in 250 days.
So what measures should companies have in place to protect their businesses and employees? Recommendations issued by the US Centers for Disease Control and Prevention during the 2009 H1N1 swine flu outbreak provide some pointers.
To begin with, businesses should start with a good understanding of their normal seasonal absenteeism. Every winter, nearly 111m workdays in the US are lost due to flu, according to the CDC. Identifying when the usual level of infection and illness becomes something more unusual is an important first step.
Much of the CDC’s advice involves commonsense measures little different to best practice during the regular flu season. Sick employees must stay at home, with plentiful supplies of soap, water and hand rubs provided in the workplace to promote good hygiene.
Other recommendations are more specific to a severe pandemic. These include “social distancing” strategies, such as banning non-essential travel and meetings, increasing physical space between employees in the workplace and allowing people to work from home. IT systems should be checked to make sure they are robust enough to support large numbers of remote users.
Screening of employees when they arrive for work should also be considered and people with symptoms of flu sent back home.
Close communication with employees, business partners and local authorities would be crucial. A clear plan should be in place before an epidemic erupts and exercises carried out to test it for flaws.
Mr Gates says the world’s readiness for an epidemic compares unfavourably with its preparedness for other strategic threats such as war. “NATO countries participate in joint exercises in which they work out logistics such as how fuel and food will be provided, what language they will speak and what radio frequencies will be used. Few, if any, such measures are in place for response to an epidemic.”
The absence of this kind of planning caused delays in the world’s response to Ebola, says Mr Gates. “In the next epidemic, such delays could result in a global disaster.”

03 November 2015

FINANCIAL TIMES

Oliver Sacks, neurologist and writer, 1933-2015

Popular books illustrated the workings of the human mind through vivid case studies

August 30, 2015

by: Clive Cookson

CD6MEW Jan. 16, 2004 - New York, New York, U.S. - K34971RM.DR OLIVER SACKS ADDRESSES CROWD AT BOOK SIGNING AT BARNES AND NOBLE BOOK STORE..UNION SQUARE, NEW YORK New York..1/16/2004. / 2004(Credit Image: A© Rick Mackler/Globe Photos/ZUMAPRESS.com)

Oliver Sacks, who has died in New York aged 82, became the world’s best-known neurologist through popular books published over more than 40 years, illustrating the workings of the human mind through vivid case studies.
In works such as The Man Who Mistook His Wife for a Hat (1985) and The Mind’s Eye (2010) Sacks described case histories from the borderlands of neurological experience, showing what scientists could learn from patients. The struggles of people living with illusions and hallucinations, autism and dementia, schizophrenia and epilepsy were all treated with warmth.
From individual cases of neural abnormality he drew brilliant lessons about the workings of brains in general. In the last years of his life Sacks wrote movingly about his own battle with cancer and partial blindness. He died at home on Sunday after saying in February the disease had spread from a tumour on the eye.
Although Sacks stood out as a writer and populariser, he also made notable contributions to research as a professor of neurology successively at Albert Einstein College of Medicine, Columbia University and New York University. He was an expert on phantom limb pain, the effect of music on the brain, epilepsy and colour vision — among a wide range of academic interests.
Sacks was born on July 9 1933 into a medical and scientific family in the Orthodox Jewish community of Cricklewood, north-west London. His early years feature in the autobiographical book Uncle Tungsten (2001).
He studied medicine at Oxford university and Middlesex Hospital in London. As soon as he qualified as a doctor in 1960, Sacks moved to the US, where he was to spend the rest of his life. After five years in California at San Francisco’s Mount Zion Hospital and the University of California, Los Angeles, he took up a fellowship at Albert Einstein College of Medicine in the Bronx.
Sacks was captivated by New York City life and by the study of neurology. In 1966 he started working at Beth Abraham Hospital in the Bronx, where he encountered an extraordinary group of patients, many of whom had spent decades in frozen states, like statues, unable to initiate movement.
He recognised them as survivors from the “sleepy sickness” pandemic of the early 20th century and treated them with L-dopa, then an experimental drug, which brought some patients back to life — at least for a while. They became the subjects of his 1973 book Awakenings, which inspired a play by Harold Pinter and an acclaimed feature film starring Robert De Niro and Robin Williams.
Although he wrote extensively about his own experiences, Sacks remained remarkably reticent about his personal life until this year. Then, with the author terminally ill, some of the secrets came out. In his final autobiography, On the Move, and searing articles in The New York Times, Sacks confirmed what many readers had suspected: he was gay.
As a teenager he confessed his homosexuality to his father, who then told his mother, despite being asked not to. Sacks saw her harsh reaction — “You are an abomination. I wish you had never been born” — as being rooted in Judaism and made him “hate religion’s capacity for bigotry and cruelty”.
For 35 years of his adult life Sacks was celibate. As he himself recognised, an emotional involvement with his patients was something of a substitute for personal romance: “I had fallen in love — and out of love — and in a sense was in love with my patients.”
But in 2008 romantic life resumed. The writer Billy Hayes became his partner and survives him.
Clive Cookson

01 November 2015

MEDSCAPE Robert Lowes July 10, 2015. DETROIT: Lebanese Oncologist FARID FATA sentenced to 45 years in Federal prison for giving 553 patients excessive and unnecessary chemotherapy. Netted at least $17-million from Medicare and private insurers.Had seven offices, pharmacy,diagnostic testing and`radiation therapy centres. Also received kickbacks from a hospice and healthcare agency.

24 October 2015

UK DAILY MAIL: PUERTO RICO AS TRANSPLANT CENTRE

Puerto Rico's high murder rate is creating a huge opening in organ transplant industry for Americans who need surgery

Puerto Rico is trying to build its medical tourism industry, from a current level of about $80 million a year to $300 million by 2017
Patients who visit for transplants, and for more common medical procedures, spend thousands on hotels, transportation and food
Puerto Rico's potential as a transplant center is partly based on a macabre statistic
It had a murder and non-negligent manslaughter rate of 19.2 per 100,000 people in 2014 compared to 4.5 per 100,000 in the US, according to the FBI

By Reuters

Published: 18:59 GMT, 22 October 2015 | Updated: 20:19 GMT,

Fearing her husband would die waiting for a heart transplant in Miami, Carmen Concepcion started looking for a faster way to save his life, and found the answer in her native Puerto Rico.

Pablo, 59, could barely walk from the family room to the bathroom without growing short of breath, Carmen said.

She looked across the states for hospitals with shorter wait times until a friend recommended she consider her homeland. Carmen was hesitant but 'gave it a chance.'

In December, Pablo received his heart transplant, becoming the first person to travel from the mainland to the U.S. commonwealth for the procedure, said Dr. Ivan Gonzalez-Cancel, his surgeon and the director of the heart transplant center at the Cardiovascular Center of Puerto Rico and the Caribbean. Pablo is now able to bike about a mile and climb four to five flights of steps.

Puerto Rico is trying to build its medical tourism industry, from a current level of about $80 million a year to $300 million by 2017, as part of efforts to heal its chronically sick economy. A component of that is to encourage more patients to travel for organ transplants.

Patients who visit for transplants, and for more common medical procedures such as orthopedics, dentistry and weight-loss surgery, spend thousands on hotels, transportation and food.

Puerto Rico's potential as a transplant center is partly based on a macabre statistic - the Caribbean island had a murder and non-negligent manslaughter rate of 19.2 per 100,000 people in 2014 compared to 4.5 per 100,000 in the United States, according to Federal Bureau of Investigation data.

Nurses attend to a young patient at the Cardiovascular Center of Puerto Rico and the Caribbean in San Juan. Puerto Rico is trying to build its medical tourism industry, from a current level of about $80 million a year to $300 million by 2017

Puerto Rico's potential as a transplant center is partly based on a macabre statistic

Puerto Rico had a murder and nonnegligent manslaughter rate of 19.2 per 100,000 people in 2014 compared to 4.5 per 100,000 in the United States according to Federal Bureau of Investigation data

That translates into a pool of donors in the 18-30 age range unmatched in the mainland, Gonzalez-Cancel said. 'The donors (are) victims of car accidents or gunshot wounds to the head, because Puerto Rico, sadly, we have a very high crime rate.'

High-crime areas certainly exist among the U.S. states, but Puerto Rico has recently also had organ donation rates higher than expected by the Scientific Registry of Transplant Recipients (SRTR), which analyses data on donated organs.

The cost of care is another attraction, at as much as 60 percent lower than on the mainland, according to the island government. Because Puerto Rico's transplant centers are part of the national organ sharing network, U.S. patients can transfer there as long as doctors admit them, with few other hurdles.

Pablo and Carmen Concepcion moved temporarily to Puerto Rico, and paid out-of-pocket for Pablo's transplant and extended hospital stay beforehand. While that cost about $350,000, it was far less than it would have been on the mainland.

'I'd rather have a debt and he's alive,' said Carmen, a teacher. Pablo, who is now disabled, was a truck driver.

The cost of care is another attraction, at as much as 60 percent lower than on the mainland, according to the island government

Finding a heart donor match depends on a number of factors, including blood type, but Puerto Rico's geographically isolated location within the national organ sharing network can give some patients shorter wait times.

The United Network for Organ Sharing (UNOS) allocates hearts based on medical urgency and location of the patients. Because there are no U.S. transplant centers within 500 miles (800 km) of Puerto Rico, candidates on the island's waiting list have the first opportunity at an organ, according to Roger Brown, director of the organ center at the network.

Patients on the island from 2009 to mid-2014 waited a median of 1.3 months for a heart transplant, versus 8.1 months nationally, according to the SRTR. For livers, the island had the shortest median wait time in the country at about three weeks, compared to over a year nationally, according to the SRTR.

Dr. Juan Del Rio is one surgeon eager to attract more patients. He completed Puerto Rico's first liver transplant in 2012, after moving to the island from New York because of the greater availability of organs.

Surgeon Juan Del Rio poses for a photograph at the hospital Auxilio Mutuo, that houses liver and kidney transplant centers

He originally projected completing around 100 liver transplants a year, but is now doing a little less than half that and he sees attracting people from the mainland United States as one way to achieve full capacity.

Surgeons prefer to transplant organs from nearby, but since the late 1980s, more than 60 percent of the approximately 4,000 organs donated in Puerto Rico have been shared off-island, according to UNOS data. Those are organs surgeons would like to use in Puerto Rico.

Liver transplant candidates should consider Puerto Rico, Del Rio said, 'instead of waiting in New York and (waiting) to be really, really sick with a high risk of dying before transplant.'

Tomas Velez (L), manager of the Howard Johnson hotel at the Cardiovascular Center of Puerto Rico and the Caribbean talks to a guest in San Juan

The hospital Auxilio Mutuo, that houses liver and kidney transplant centers, is seen here

Representatives from Auxilio Mutuo, the hospital that houses the liver and kidney transplant centers, also suggest mainland patients enlist in their kidney program, though the waiting time for a transplant is far longer than for hearts and livers.

The island's government will have spent about $3.3 million on developing the medical tourism industry by mid 2016. Still, some people would be reluctant to travel to the island for such serious surgeries.

'People draw the line at cardiology, (saying) "I can't see myself on an operating table in a strange land,"' said Josef Woodman, the CEO of Patients Beyond Borders, a medical travel information publisher.

Puerto Rico has to show it can offer quality care to compete for heart transplant patients, he said.

Island officials say Puerto Rico's status as a U.S. jurisdiction is an indication of quality. Survival rates for heart transplants match the national figures, while for kidneys, the numbers are slightly higher than nationwide statistics, and for livers, the rates are slightly lower, according to SRTR data.

'Over there, it might be super clean, super sanitized, a little bit older, maybe things not as renovated as we have over here,' Carmen Concepcion said of her husband's care.

Gonzalez-Cancel, the heart surgeon, said the island should show it can excel in complicated surgeries like heart transplants to stoke interest in simpler procedures that are the bread and butter of medical tourism.

'If you do what is big, then you can do what is small,' he said.

People walk in a corridor of the Bone Marrow Transplant Center at the hospital Auxilio Mutuo. Because Puerto Rico's transplant centers are part of the national organ sharing network, U.S. patients can transfer there as long as doctors admit them, with few other hurdles

17 October 2015

BUJADOUX-GARIN-- BANNWARTH SYNDROME :WHONAMEDIT: from CMAJ Oct 6 1071-3. J.M. van HATTEM et al

Related people

Lymphocytic meningoradiculitis probably due to infection by Borrelia burgdorferi, the cause of Lyme disease.

Description

Lymphocytic meningoradiculitis probably due to infection by Borrelia burgdorferi, the cause of Lyme disease. It is an illness characterized by intense pain, mostly in the lumbar and cervical regions, and radiating to the extremities; migrating sensory and motor disorders of the peripheral nerves, peripheral radiculopathies, and cerebrospinal fluid abnormalities in the form of lymphocytic pleocytosis indicating blood-brain barrier damage. The symptoms may include facial paralysis, abducens palsy, anorexia, tiredness, headache, diplopia, paraesthesias, erythema migrans, and other disorders.

Bibliography

Ch. Garin, A. Bujadoux:
Paralysie par les Tiques. Journal de médecine de Lyon, 1922, 71: 765-767.
A. Bannwarth:
Chronische lymphocytäre Meningitis, entzündliche Polyneuritis und "Rheumatismus". Ein beitrag zum Problem "Allergie und Nervensystem".
Archiv für Psychiatrie und Nervenkrankheiten, Berlin, 1941, 113: 284-376. Zur Klinik und Pathogenese der "chronischen lymphocytären Meningitis".
Archiv für Psychiatrie und Nervenkrankheiten, Berlin, 1944, 117: 161-185, 682-716.

We thank René Dreuille for information submitted.

A Brief History of Lyme Disease in Connecticut DPH Conn.

Tick on grass.

The history of Lyme disease in Connecticut began in 1975 when a cluster of children and adults residing in the Lyme, Connecticut area experienced uncommon arthritic symptoms (1976 circular letter). By 1977, the first 51 cases of Lyme arthritis were described, and the Ixodes scapularis (black-legged) tick was linked to the transmission of the disease. During 1982, Borrelia burgdorferi, the bacterium that causes Lyme disease, was discovered and the first brochure addressing Lyme disease was developed by the Arthritis Foundation. Serology testing became widely available in Connecticut during 1984. In 1987, Lyme disease became a reportable disease. All physicians were required to report any and all cases of the disease. By 1988, the news of Lyme disease spread and national media attention began. The first federal funding for Lyme disease surveillance, education, and research became available in 1991. The first Lyme disease vaccine became available in 1997. To help determine the efficacy of the vaccine, Lyme disease was made laboratory reportable in 1998. However, the manufacturer withdrew the vaccine from the market in 2001. In 2002, the vaccine efficacy study ended, and Lyme disease was removed from the list of laboratory reportable findings; however, it remained a physician reportable disease.
Initially, with little known about Lyme disease, studies and surveys were conducted to determine the occurrence of the disease in Connecticut and factors that favor acquiring the disease. This work was done by the Connecticut Department of Public Health in collaboration with the Connecticut Agricultural Experiment Station, the University of Connecticut, Yale University, local health departments, and the federal Centers for Disease Control and Prevention. The current focus of the Program is on prevention.

The emergence of Lyme disease in Connecticut is attributed in large part to changes in land use. That is, land at one time used for farming has become reforested and increasingly developed for suburban residential use. These changes favor expansion of habitat that supports ticks and wildlife and therefore transmission of tick-borne diseases from animals to people in residential areas and among those who work or recreate outdoors. With no vaccine currently available, prevention is based on avoidance of tick bites through a combination of personal protection and environmental measure.

To help meet the program's mission, The Epidemiology and Emerging Infections Program will continue to maintain surveillance for Lyme disease. Public health surveillance is one of the tools that infectious disease epidemiologists use to monitor the occurrence of diseases of public health importance and assess the effectiveness of control measures. In the United States, the system for reportable diseases works best for diseases that are either rare in occurrence, involve hospitalized patients, or for which there are definitive diagnostic laboratory tests. The system works less well for diseases that are common, diagnosed in outpatient settings, and for which there are no definitive diagnostic laboratory tests. The under-reporting of these diseases, including Lyme disease, is common.
Over the years, epidemiologists from the Department of Public Health (DPH) have used a variety of epidemiological methods -- including active surveillance, population-based surveys, and case-control studies -- to augment the information obtained from the traditional passive surveillance system for Lyme disease. The limitations of the traditional passive surveillance system to monitor the public health impact of Lyme disease are well documented. In February 2012, DPH epidemiologists published an article on the “Effect of Surveillance Method on Reported Characteristics of Lyme Disease, Connecticut, 1996–2007” in the journal Emerging Infectious Diseases (http://wwwnc.cdc.gov/eid/article/18/2/10-1219_article.htm).
On average since 1998, the DPH has reported about 3,000 cases annually to the Centers for Disease Control and Prevention (CDC). Recently, the CDC estimated that there are approximately 10 times more people diagnosed with Lyme disease than the yearly reported number. Using the CDC estimate, approximately 30,000 people are diagnosed with Lyme disease each year in Connecticut.

05 October 2015

Three scientists who discovered drugs against malaria and other parasites are awarded Nobel prize for medicine

William Campbell, Satoshi Omura and Tu Youyou share top honour
Scientists found new way of tackling infections caused by roundworm
Professor Youyou created new Malaria drug saving 100,000 lives a year

By Kate Pickles For Mailonline

Published: 12:50 GMT, 5 October 2015 | Updated: 13:31 GMT, 5 October 2015

Three scientists have won the Nobel Prize in medicine for discovering drugs against malaria and other parasitic diseases that affect hundreds of millions of people every year.

Nobel judges in Stockholm, Sweden, awarded the prestigious prize to Irish-born William Campbell, Satoshi Omura, of Japan, and Tu Youyou - the first-ever Chinese medicine laureate.

Professors Campbell and Ōmura found a new way of tackling infections caused by roundworm parasites.

The worms affect a third of the world's population and cause illnesses, including River Blindness and Lymphatic Filariasis.

William C. Campbell, a parasitologist, poses near a collection of microscopes shortly after learning that he was a co-winner of the Nobel Prize for Medicine, at his home in Massachusetts

Professor Tu shares the prize for her discovery of a therapy against malaria, which has been found to significantly reduce deaths from the disease.

The Nobel committee said the scientists' work had changed the lives of the hundreds of millions of people affected by these diseases.

'The two discoveries have provided humankind with powerful new means to combat these debilitating diseases that affect hundreds of millions of people annually,' the committee said.

'The consequences in terms of improved human health and reduced suffering are immensurable.'

River blindness is an eye and skin disease that ultimately leads to blindness. About 90 per cent of the disease occurs in Africa, according to the World Health Organisation.

Lymphatic filariasis can lead to swelling of the limbs and genitals, called elephantiasis, and it is primarily a threat in Africa and Asia.

The WHO says 120 million people are infected with the disease, with about 40 million disfigured and incapacitated.

Mr Campbell is a research fellow emeritus at Drew University in Madison, New Jersey.

Mr Omura, 80, is a professor emeritus at Kitasato University in Japan and is from the central prefecture of Yamanashi.

Kitasato University Professor Emeritus Satoshi Omura arrives for a press conference at the university in Tokyo. He has become the first-ever Chinese medicine laureate for discovering drugs against malaria

Pharmacologist Tu Youyou, pictured at an award ceremony in Beijing, in 2011, jointly won the 2015 Nobel prize for medicine or physiology for her work against parasitic diseases

Ms Tu, 84, is chief professor at the China Academy of Traditional Chinese Medicine.

The last time a Chinese citizen won a Nobel Prize was in 2012, when Mo Yan got the literature award. But China has been yearning for a Nobel Prize in science. This was the first Nobel Prize given to a Chinese scientist for work carried out within China.

The medicine award was the first Nobel Prize to be announced with the winners of the physics, chemistry and peace prizes set to be announced later this week.

The winners will share £633,000 prize money, with one half going to Mr Campbell and Omura, and the other to Ms Tu.

Each winner will also get a diploma and a gold medal at the annual award ceremony on December 10, the anniversary of the death of prize founder Alfred Nobel.

Last year's medicine award went to three scientists who discovered the brain's inner navigation system.

The Nobel committee (pictured) said the work of the scientists, who are picture above) had changed the lives of the hundreds of millions of people affected by these diseases

25 September 2015

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Point prevalence of barotitis in children and adults after flight, and effect of autoinflation. Stangerup SE, Tjernström O, Klokker M, Harcourt J, Stokholm J. Aviat Space Environ Med. 1998 Jan;69(1):45-49.
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Autoinflation as a Tretmentof Secretory Otitis Media. S. E. STANGERUP, MD;J. Sederberg-Olsen, MD; V. Balle, MD. Arch Otolaryngol head Neck Surg. 1992;118:149-152
Effect of nasal balloon autoinflation in children with otitis media with effusion in primary care. Williamson I, CMAJ Sept. 22,2015 967-969

C
Austrian otologist, born October 1, 1835, Alberti, Hungary; died August 10, 1920, Vienna.

Biography of Adam Politzer

Adam Politzer was born in Albertirsa, about 35 km from Budapest. Little is known about his background, except that his father was a well-to-do Jewish merchant (some say he was a teacher), his grandfather a surgeon. As a young man he developed interests in both languages, particularly Latin and Italian, and science. He also had a love of art and had a great deal of artistic talent.
He studied in Vienna, particularly under Josef Skoda (1805-1881), Karl von Rokitansky (1804-1878), Johann Ritter von Oppolzer (1808-1871), and Carl Ludwig (1816-11895). Johann von Oppolzer was a professor who took special interest in Politzer. Oppolzer was an internist who made sickbed teaching, for which the Vienna School was known, so popular. Politzer received his doctorate at Vienna in 1859 and subsequently worked in Carl Ludwig's laboratory, where he undertook experiments in the physical principles involved in the auditory system. It was in Ludwig's laboratory that he introduced the method known as politzerisation. Politzer published his findings in 1861. Due to this experiment, practitioners were now able to treat ear diseases through his innovation of politzerisation rather than trying to do the difficult procedure of passing a catheter into the torus of the eustachian tube. Worldwide use of the politzerisation technique thus made Politzer very well known.
Politzer then trained with Anton Friedrich Freiherr von Troeltsch (1829–1890 in Würzburg, Hermann Ludwig Ferdinand von Helmholtz (1821–1894) in Heidelberg, Claude Bernard (1813–1878) in Paris, and with Karl Rudolf König. Later, under the tutelage of Rudolf Albert von Kölliker (1817–1905) in Würzburg, and Joseph Toynbee (1815–1866) in London, Politzer learned microscopy.

Already four years after graduation, in 1863 he established the first clinic in the world devoted to the treatment of ear diseases. He was joined by Josef Gruber (1827–1900), who was in charge of the male patients, while Politzer housed a ward with only female patients. Politzer became a Dozent of otology at the University of Vienna in 1861, and ausserordentlicher professor of otology in 1870. The same title was awarded Josef Gruber. The two worked jointly, but not without friction, and when The University of Vienna Aural Clinic (Allgemeines Krankenhaus) was established in 1871, Adam Politzer and Josef Gruber were again promoted and appointed joint directors.
His teaching soon attracted large audiences. In 1873 he took over leadership of the university otological clinic at the Wiener allgemeines Krankenhaus, the first specialised otological clinic in the world, and lectured there from 1894 to 1906, becoming full professor in 1895, sole leader from 1898. Besides his hospital and university duties, Politzer attended his private clinic, which attracted patients from all over the world. In order to obtain a larger material for study, Politzer in 1864 persuaded the mayor of Vienna, Dr. Seeler, to allow him to treat indigent ear patients at the charity hospital, along with the population of the local home for the elderly. Politzer retired in 1907. At his retirement celebration 500 physicians from around the world showed up.
Politzer left the University og Vienna a fine collection of pathological-anatomical specimens of the hearing organ. However, he died in poverty, due to personal financial problems and the devaluation of Austrian currency after WWI. The financial situation in Austria at the time was similar to that of Germany a few years later, and no less devastating.

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