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

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
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'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
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. 
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
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
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
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
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 
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
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.

Location of Lyme, CT 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
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
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
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
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
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