CANADA: Treponema pallidum infection in NUNAVUT:territory popn 32,000 ( Iqualuit- 7,000 )

SYPHILIS - CANADA (04): (NUNAVUT) INCREASED CASES, REQUEST FOR INFORMATION ************************************************************************** A ProMED-mail post ProMED-mail is a program of the International Society for Infectious Diseases Date: Thu 5 Dec 2013 Source: CBC News [edited] A syphilis outbreak in Nunavut [territory] that began last year [2012] continues to concern health officials. Nunavut health officials say there have been 74 confirmed cases of the sexually transmitted infection in Nunavut since May 2012 with new cases every week. Most are in Iqaluit [the capital city of Nunavut]. Dr. Maureen Baikie, Nunavut's chief medical officer of health, is urging people to get tested for syphilis even if they don't have symptoms, as the infection can have serious health consequences. "The important things about syphilis are, 1st of all, people can have it and not know they have it, which is why it's so important to go and get tested," said Dr. Maureen Baikie, Nunavut's chief medical officer of health. "The other thing is it can be a lifelong infection, and the longer you have it without treatment, the more serious the consequences can be." The infection is easily cured with antibiotics, but if left untreated it can cause severe damage to the heart, blood vessels and brain, and even death. Health officials are encouraging people to get tested and practice safer sex, by decreasing the number of sexual partners and using a condom during sex. -- Communicated by: ProMED-mail from HealthMap Alerts [Nunavut, the largest federal territory of Canada, is the size of Western Europe; it comprises a major portion of Northern Canada, and has an estimated population in 2010 of about 33 000, mostly Inuit (). The territorial capital Iqaluit, which had a population in 2011 of 6699, is located on the south coast of Baffin Island (). Iqaluit was founded in 1942 as an American airbase to provide a stopover and refueling site to support the war effort in Europe (). Iqaluit is only accessible by aircraft and, subject to ice conditions, by boat. Nunavut did not officially become a territory until 1999; prior to 1999, data for Nunavut was combined with Northwest Territories. In 2008, no cases of infectious syphilis (primary, secondary and early latent stages) were reported in Nunavut (); in 2012, 13 cases of infectious syphilis, all of them in Iqaluit, were reported in a prior ProMED-mail post (Syphilis - Canada (03): (NU) RFI 20120912.1291334), where we were told that "the pattern of transmission in Iqaluit has been largely the same as in other parts of Canada and other countries." The rates of infectious syphilis in Canada, as in the United States, have been increasing since about 2000. In Canada, the male-to-female rate ratio increased from 1.5:1.0 in 1999 to 6.4:1.0 in 2008, reflecting that more males than females were reported with infectious syphilis, and this disparity increased over time (). In 2008, men accounted for 86.1 percent of reported cases. Between 1999 and 2008, the rate in men increased from 0.7 to 7.3 per 100 000 and in women increased from 0.5 to 1.1 per 100 000. In men, the highest reported rate of infectious syphilis was shared between 25-29 year olds and 30-39 year olds (13.3 per 100 000) (). Together, these age groups accounted for almost 40 percent of reported cases in men in 2008. In women, the highest reported rate was in 20-24 year olds (3.6 per 100 000). In males, the greatest increase in reported rates of infectious syphilis between 1999 and 2008 was in 25-29 year olds. Most of the Canadian syphilis outbreaks have been in men who have sex with men (MSM), and other outbreaks were related to the sex trade, but some have been locally acquired infections in heterosexual persons (). In Calgary, Alberta, as in the United States, a syphilis outbreak has been associated with the acquisition of anonymous sex partners through the internet. In a ProMED-mail post in February 2013 (Syphilis - Canada: (NU) RFI 20130214.1542486), we were told that there were more than 30 cases in Iqaluit since the outbreak began in May 2012, and the outbreak was spreading to other "regions." According to the news report above, that number of cases has risen to 74 with new cases every week, again mostly occurring in Iqaluit. Some of this increase could be due to an increase in screening for syphilis, but details of the outbreak such as gender, sexual behavior, ethnicity, use of illicit drugs, or prostitution were again not given then, nor are they given in the news report above. Such information would be greatly appreciated from knowledgeable persons. Inuit comprise about 58 percent of Iqaluit's population (), and they may constitute a large portion of the syphilis cases in Iqaluit, as in the Canadian province of Alberta, where infection rates of infectious syphilis are reported to be 18.6 times higher among young Aboriginal women and 2.8 times higher in Aboriginal men compared to their Caucasian counterparts (). These young Aboriginal women are reported to be largely linked to the "street based" sex trade, are often involved with problematic substance use, and are poor. (Aboriginal peoples in Canada comprise the 1st Nations, Inuit, and Metis; Metis are people with mixed 1st Nations and European ancestry).

PHILADELPHIA: WILLS EYE HOSPITAL : FREE CME

Wills Eye Knowledge Portal www.willseyeonline.org Wills Eye Knowledge Portal Free Registration. Free CME. Sign Up Here! Experience Wills Eye education online at www.willseyeonline.org Learn from top doctors at Wills Eye Institute. Experience web-based medical education. Earn CME credits from world-renowned experts. ---------------------------------- CME Courses Strabismus Disorders 0.5 AMA PRA Credit Strabismus is a common condition in children, occurring in about 4% of children in the United States. If untreated, strabismus can lead to untreatable visual compromise once the child is grown. The treatments for strabismus have evolved with scientific studies. Given the potential to minimize a lifetime of sub-optimal vision, physicians should be aware and up-to-date on this topic as significant practice gaps exist in awareness of strabismus disorders. ------------------------------------ ALL CME COURSES ON THE WILLS EYE KNOWLEDGE PORTAL ARE FREE! ------------------------------------ Wills Eye 39th Annual Ophthalmology Review Course March 1-5, 2014 A comprehensive review of the basic principles and recent advances in ophthalmology for Residents and Fellows. Information: (215) 440-3169 Wills Eye 65th Annual Conference March 6-8, 2014 Philadelphia, PA willsconference.org This is a three day conference designed for comprehensive ophthalmologists, specialists, and allied health personnel. The conference will review clinical, diagnostic and therapeutic approaches to eye problems related to all ophthalmic sub-specialties. Follow us on Twitter Like us on Facebook View our videos on YouTube December 2013 Corneal Trauma, Abrasions, Chemical Burns, Perforating Trauma Presenter: Kristin Hammersmith, MD Dr. Hammersmith is an assistant surgeon on the Cornea Service and Director of the Cornea Fellowship Program at Wills Eye Hospital. She is also an instructor at the Jefferson Medical College of Thomas Jefferson University. Dr. Hammersmith interests include severe ocular surface diseases such as dry eye, blepharitis, ocular cicatricial pemphigoid, chemical burns, and the potential of limbal cell transplantation to help patients with these conditions. Central Retinal Venous Obstruction Presenter: Joseph I. Maguire, MD Dr. Maguire is an attending surgeon on the Retina Service at Wills Eye Hospital and an associate professor of ophthalmology at Thomas Jefferson University. He is a past Retina Service President and Scientific Director of the Eye Reseach Institute (ERI). He is currently a principal investigator in the VEGF-trap clinical trial and the National Institutes of Health sponsored AREDS 2, and has been clinical co-investigator in several completed and ongoing clinical trials evaluating novel treatments for diabetic retinopathy and AMD. Low Vision 101: Custom Refractions, Prisms, and Optics; and Low Vision 201: Rehabilitation Presenter: Scott Edmonds, OD Dr. Edmonds is Co-Director of the Low Vision and Contact Lens Service at Wills Eye Hospital. He has written and lectured extensively on clinical topics of post operative care, low vision, contact lenses, and ocular diseases as well as management topics of managed care and medicare. Dr. Edmonds has been recognized as Optometrist of the year by the Philadelphia Optometric Society, the Chester-Delaware Optometric Society, and Pennsylvania Optometric Association. IOP Variation: Should It Affect Our Management of Glaucoma? Presenter: L. Jay Katz, MD, FACS Dr. Katz is the director of the glaucoma service at the Wills Eye Hospital and professor of ophthalmology at Thomas Jefferson University. He has published more than 160 articles in peer reviewed journals and has authored, coauthored, or edited more than 30 books and book chapters. He has received numerous awards including the Physicians Recognition Award from the American Medical Association and an Honor award from the American Academy of Ophthalmology. Dr. Katz has been an investigator in several landmark multicenter trials. Additional Highlights: Importance of Adherence and Quality of Life in People Under Glaucoma Treatment George L. Spaeth, MD Introduction to Ocular Pathology Ralph C. Eagle, MD Biopsy Techniques Edward H. Bedrossian, MD Contemporary Management of Retinal Detachment Repair Gaurav K. Shah, MD Herpetic Disease of the Anterior Segment Brad Feldman, MD Visiting Professor Lectures and Cases Joshua R. Ehrlich, MD; Timothy V. Johnson, MD; Jared D. Peterson, MD Chiefs' Rounds Anthony W. Farah, MD; Nina Ni, MD; Michael S. Ehrlich, MD; Kristin M. DiDomenico, MD; Blair K. Armstrong, MD

CANCER CELL:: Proteasome inhibitor mechanism in MM.

Cancer Cell, Volume 24, Issue 3, 289-304, 9 September 2013 Copyright © 2013 Elsevier Inc. All rights reserved. 10.1016/j.ccr.2013.08.009 Authors Chungyee Leung-Hagesteijn, Natalie Erdmann, Grace Cheung, Jonathan J. Keats, A. Keith Stewart, Donna E. Reece, Kim Chan Chung, Rodger E. Tiedemann Highlights MM tumors contain Xbp1s− progenitors that survive proteasome inhibition Xbp1s absence arrests secretory maturation and ER loading, reducing ERAD dependence PI resistance mechanisms in patients differ from in vitro models These data help explain the failure to cure MM with current therapy Summary Proteasome inhibitor (PI) resistance mechanisms in multiple myeloma (MM) remain controversial. We report the existence of a progenitor organization in primary MM that recapitulates maturation stages between B cells and plasma cells and that contributes to clinical PI resistance. Xbp1s− tumor B cells and pre-plasmablasts survive therapeutic PI, preventing cure, while maturation arrest of MM before the plasmablast stage enables progressive disease on PI treatment. Mechanistically, suppression of Xbp1s in MM is shown to induce bortezomib resistance via de-commitment to plasma cell maturation and immunoglobulin production, diminishing endoplasmic reticulum (ER) front-loading and cytotoxic susceptibility to PI-induced inhibition of ER-associated degradation. These results reveal the tumor progenitor structure in MM and highlight its role in therapeutic failure.

UK: Max HOTOPF "HEALTHCARE EUROPA"

Too little, too late as the health supertankers start to turn What is to be gleaned from the latest OECD Health at a Glance 2013? The healthcare service supertankers are starting to alter course but progress remains slow and icebergs of diabetes, dementia and longer life expectancies dwarf expenditure. News French state plans activity ceilings for hospitals The French private hospital sector is enraged by the government’s latest ploy. Behind the scenes, however, we suspect that there is a deal to be done. Asklepios issues loan note - so what happens next? Asklepios has raised €350m with a promissory note. We talk to President of the company Bernard Broermann, and look at how the Helios-Rhoen deal has reshaped the German hospital sector. Hungary - healthcare reform paying off Hungarian sources say that the healthcare reforms pushed through by minister of state for health, Dr. Miklós Szócska, under the Fidesz government, has succeeded in cutting costs substantially. Meanwhile, the government has upped healthcare expenditure ahead of 2014 elections. Medical Properties plans more deals in Europe Medical Properties Trust (MPT), the US healthcare REIT specialising in hospital property, is scouring Northern and Western Europe for deals, following its purchase of the property portfolio of RHM Kliniken. We take a look at its strategy. MC bids for Slotervaart as Dutch hospital sector opens up The Netherlands is on track to pass legislation which would enable private investors to buy shares in the not-for-profit general hospital sector which provides almost all inpatient acute care in the country. Meanwhile, it looks as though Slotervaart, a privatised hospital whose shareholders have been fighting each other looks likely to be taken over by MC Groep, which is one of the first privatisation players in the country. We talk to Chris Van Den Haak, partner at BDO Netherlands, who has just written a report on the financial health of the Dutch general hospital sector. Are we about to see a tsunami of privatisation? Interview/Feature Interview: Dag Andersson, CEO, Diaverum With close to 300 dialysis centres in 19 countries, Dag Andersson claims to run “the most global healthcare service in the world”. We look at how Diaverum is starting to offer a much wider range of services. The company is majority owned by private equity house Bridgepoint, which hired JP Morgan in January 2013 to review its strategic options.

SWISS MEDICINE: BLOOD-BRAIN BARRIER

Breaking and building the wall: The biology of the blood-brain barrier in health and disease 21/11/2013 Blood-brain-barrier The blood-brain barrier (BBB) is a complex feature of brain endothelial cells that restricts the passage of blood-borne molecules into the brain parenchyma, while ensuring the delivery of essential nutrients and selected biomolecules. Brain vasculature is anatomically distinct from that of other organs and comprises endothelial cells, pericytes and astrocytes, which collectively form the neurovascular unit (NVU). This review provides a brief overview of the cellular components of the NVU and BBB characteristics. In addition, the regulation of brain vasculature by peripheral factors such as diet and systemic disease is discussed. Abstract Proper functioning of the brain vasculature is critical for the maintenance of optimal brain function. Brain ­parenchyma is separated from blood within the cerebral vasculature by the blood-brain barrier (BBB). The BBB is a collective term for brain-specific, endothelial cell characteristics that restrict the passage into the brain of blood-borne molecules that ensure delivery of essential nutrients and selected biomolecules. The principal ­features of the vertebrate BBB are closed cell-cell junctions, a low rate of transcytosis, the expression of various solute carriers and ATP-binding cassette transporters. In addition, blood vessels in the brain are anatomically distinct. The capillary bed of brain vasculature has full longitudinal coverage by pericyte processes. Furthermore, brain vasculature is covered by glial processes, the so-called astrocyte end-feet. The term neuro­vascular unit (NVU) is often used to describe brain blood vessels in order to underline the intimate physical and functional connection between the brain tissue and blood vessels. Another special feature of brain vessels is that they are immunologically quiescent. Specifically, the expression of leucocyte-adhesion molecules is low and few peripheral leucocytes enter into the brain parenchyma. The development and maturation of the BBB and NVU is directed by signals from the surrounding neural tissue and cells forming the NVU. The formation of BBB ­specific cell-cell junctions and expression of trans­porters for glucose and biomolecules on endothelial cells is induced by the neuroepithelium, whereas pericytes regulate the low transcytosis rate of brain ­endothelium. Astrocytes have merged as regulators of BBB immune quiescence and brain water transport. Endothelial cell-cell junctions, the most intensively studied component of the BBB, are composed of adherens and tight junctions, which are established by transmembrane proteins mediating homophilic extracellular interaction. The brain endothelium is equipped with a transport system that provides a selective route for nutrients, ions and bioactive macromolecules, and ensures elimination of toxic molecules. These transporters are expressed in a polarised manner that allows the effective exchange of molecules and ions between blood and the brain parenchyma. The list of CNS pathologies (e.g. leucoencephalopathies, arteriopathies, brain calcifications) caused by the ­dysfunction of cellular and acellular components of the NVU is long. In addition, BBB breakdown is associated with common neurodegenerative diseases such as ­Alzheimer’s and Parkinson’s diseases). Pathological changes in the BBB also occur in the setting of peripheral ­diseases, e.g., acute liver failure and hypoxic conditions such as cardiac arrest. A detailed mechanistic understanding of BBB alterations in these conditions is lacking. Even less well understood is how the BBB is maintained and regulated in the healthy organism. The molecular development and regulation of the BBB is currently under intense investigation. Clearly, a collective effort from research groups working in different fields (vascular biologists, physiologists, neurobiologists etc.) is needed to better understand the development and homeostasis of complex structures such as the BBB and NVU. Although the brain vascular development and deregulation during pathological conditions is better understood at the molecular and cellular level, the majority of specific questions remain unanswered. This is a summary of an open access article on www.smw.ch. Must be cited as: Keller A. Breaking and building the wall: the biology of the blood-brain barrier in health and disease. Swiss Med Wkly. 2013,143:w13892. - See more at: http://blog.smw.ch/breaking-and-building-the-wall-the-biology-of-the-blood-brain-barrier-in-health-and-disease/#sthash.Y8ejfNBj.dpuf

EUROPEAN MULTIPLE MYELOMA ACADEMY: FREE CONFERENCE VIDEOS 2013

http://emma.medroom.at/#WSLIST

LANCET: INFECTIOUS DISEASES COMMISSION on ANTIBIOTIC RESISTANCE

http://www.reactgroup.org/uploads/news/Comments-on-The-Lancet-Infectious-Diseases-Commission-on-Antibiotic-Resistance-Nov2013.pdf