Archive for the ‘Health’ Category
Since 2008 in Tanzania, 77 African giant pouched rats have been taught to sniff out Mycobacterium tuberculosis in human sputum samples in return for a reward. Turns out the rats are much faster and accurate than medical technicians reviewing samples under microscopes. A study from 2012 showed the rats detected TB accurately in nearly 80% of cases. The standard method using evaluation of samples under a microscope was less than 58% accurate. The rats also can evaluate 10 samples in a minute versus a human evaluating 25 samples a day with a microscope.
The rats were trained by a Belgian organization called Apopo. The Apopo’s lab is at Sokoine University in Morogoro, Tanzania. The rats smell 10 samples at a time and scratch with both paws at any sample they believe to be positive for the TB mycobacterium. All the samples have been previously tested at the clinics. If the rat scratches at a sample known to be positive, the rat gets a treat of bananas or peanuts. If a rat scratches at a sample not previously shown to be positive, the sample is marked “suspect” and retested at the clinic. To date, the rats have found 3500 cases missed by the local clinics and have improved the detection rate by 30%.
The species of rat chosen, cricetomys gambianus, is chosen due to its exceptional smell ability, intelligence, low maintenance costs and a long life span of approximately 8 years. The cost to train one of the rats is $7800. Training time takes nine months and starts when the rat is only 4 weeks old.
At the beginning of 2013, Apopo opened a second TB lab in Mozambique. The company hopes to get accreditation for the method eventually from the World Health Organization (WHO).
Source: Aljazeera.com 6/10/2013
Mentally ill people live like “chained dogs” or are locked up in shacks in Indonesia. There are 350 such cases in Bali and around 40,000 in all of Indonesia. The mentally ill live this way due to the overwhelming burden they are on their families, a broken health care system and because mental illness in Indonesia is often seen as “punishment by the gods.”
The Indonesians refer to these mentally ill people as pasung or “in chains.” Other countries that practice pasung are Somalia, Nigeria and Sudan. Pasung is illegal in Indonesia and the country has set a goal of eliminating the practice by 2014. However, there are only 48 psychiatric hospitals with a total of 7,700 beds in all of Indonesia–a country with a population of over 200 million. Furthermore, patient stays in these mental hospitals often are limited; then, the patient is discharged, usually to the family, who may resume putting the family member in chains. Medications which may help the mentally ill family member are mostly too costly for the family to afford.
According to the World Health Organization (WHO) approximately 85% of mental disorders are untreated in developing countries.
Source: spiegel.de 5/10/2013
The H7N9 human cases in China stand at 108 with 22 deaths. Closing of various live poultry markets are thought to be slowing the progression of the avian virus. According to the World Health Organization (WHO), prevention of the transmission of the virus to humans calls for routine “hand and respiratory hygiene” and food safety measures. There are no confirmed cases of human to human transmission. It is still unknown exactly how people are becoming infected with this H7N9 virus. Additionally, there is yet no vaccine for the prevention of H7N9 virus infection.
Previous H7 virus infections in people were reported from the mid-1990′s to 2012 in several countries in Europe as well as Canada, the USA and Mexico. Those infections mainly resulted in conjunctivitis and mild respiratory infections with the exception of one death in the Netherlands. No H7 infections had been reported in China until this new H7N9 outbreak.
Sources: english.peopledaily.com.cn 4/25/2013
Big Pharma made over $700 billion in prescription drug profits overcharging seniors and the disabled
An analysis by Health Care for America Now (HCAN) shows that in just 10 years, eleven of the largest drug companies made $711 billion in profits–largely from overcharging Medicare. Medicare Part D provides prescription drug benefits for seniors and the disabled. Medicare is prohibited from negotiating prices with drug companies or pursuing more cost-effective drugs.
Ethan Rome, executive director of HCAN noted that “per capita drug spending in the US is 40 percent higher than in Canada, 75 percent greater than in Japan, and nearly 300 percent greater than Denmark.” Big Pharma in the US uses the excuse that research and development for drugs is costly; however, these companies spend nearly 20 times their R & D costs on marketing.
The Congressional Budget Office (CBO) projected that if Medicare got bulk-purchasing discounts on drugs like the states do with Medicaid, the federal government would cut its costs by $137 billion over 10 years.
Source: RT.com 4/9/2013
4/14/2013 Update: Total cases at 51 with 11 deaths as two more cases confirmed today in Henan Province.
4/5/2013 Update: Total cases at 14 with 5 deaths including one more case in Zhejiang Province and four more in Shanghai. One of the latest victim deaths was a 48-year-old man from Jiangsu Province who transported poultry as a livelihood.
Two new human infections with the H7N9 bird flu virus have been reported in China. The two newest cases came from Zhejiang Province and one of them died March 27. The latest death was a 38-year-old chef who had worked in Jiangsu Province–where 4 other cases have been reported. The other case is an elderly Hangzhou man who has been hospitalized since March 25. This brings the total number of infected in China to 9.
The first case was an 87-year-old male in Shanghai who was hospitalized Feb. 19 and died March 4. On Feb. 27, a 27-year-old butcher/meat processor in Shanghai fell ill with the virus and died March 10. Also on March 10, a 35-year-old woman from Chuzhou City, in Anhui province, was hospitalized with the virus and is in critical condition.
The H7N9 avian flu virus never has been seen before in humans. No connection to the thousands of dead pigs, ducks and swans found in the Huangpu, Yangtze, Xiang and Sichuan rivers around the same time has been established. Additionally, no connection between the 9 infected people has been established, either.
Scientists at Ecole Polytechnique Fédérale de Lausanne (EPFL) in Switzerland have developed a 14 mm medical implant that analyzes up to 5 indicators in the blood for signs of a heart attack. The device tracks troponin, glucose, ATP and lactate. Elevated troponin is one of the first indicators of a heart attack. The device can transmit the analyte levels to a smartphone for tracking.
Power is supplied to the implant by a battery patch outside of the body that provides 100 milliwatts of power. Each sensor is coated with an enzyme that reacts with chemicals in the blood to generate a detectable signal. Currently, the device has a limited amount of sensors but that can change. Additionally, there are other possible enzymatic reactions that could be used with the sensors in the future.
Source: extremetech.com 3/21/2013
Chemicals called secondary amines are found in permanent hair dyes. British scientists are warning that these chemicals can react with tobacco smoke or exhaust fumes in the air to form very dangerous cancer-causing chemicals called N-nitrosamines. N-nitrosamines are already banned from cosmetics.
Professor David Lewis, one of the authors of the study, notes that it is unknown how much of the N-nitrosamines compounds are produced from this chemical reaction or how much of a risk these compounds pose. He further states that it is critical to further investigate the toxicity levels of these chemical compounds and assess their health risks. Results of the study have been published in the journal Materials.
Source: Dailymail.co.uk 2/19/2013
Thousands of children in Great Britain who do not get relief from their asthma by Ventolin inhalers are prescribed Salmeterol (Seretide) which is a longer-acting inhaler. However, the second inhaler may make some children’s asthma worse. A study lead by Prof. Somnath Mukhopadhyay of Brighton and Sussex Medical School found that some children carry a gene which makes the second inhaler ineffective. A simple saliva test may identify which children carry the gene. If carrying the gene, the asthma sufferer can be prescribed Singulair, a type of inhaler which is usually less effective for children with asthma, but it is more effective in children who do not respond to Salmeterol.
Source: Telegraph.co.uk 1/8/2013
Online education is an exciting and new educational tool being used by medical schools. Additionally, new software apps are being developed to help the medical student with his education. The apps vary from drug formularies to ECG waveforms to sample exam questions.
Online Medical Education
No accredited online allopathic or homeopathic medical schools exist. However, medical schools do offer online courses. For example, Stanford offers for free “The Stanford Mini Med School “ which consists of a year-long schedule of three courses. The courses cover human biology, health and disease and changes taking place in medical research and health care. The courses are available on iTunes and YouTube.
Besides the “mini med school,“ Stanford is offering partial classes online for those enrolled in Stanford’s School of Medicine. So far the classes are in the areas of cardiac physiology and endocrinology. Professors at the school estimate that up to 70% of students do not attend lectures in person so the traditional method of teaching could use some change. Spearheading the drive for more online content is Charles Prober, MD, senior associate dean for medical education. He believes that videos should be used to impart basic knowledge to the medical student and that class time should be used for more interactive activities.
An added benefit to video versus in-person classes is that the students can rewind the video if they miss something or don’t quite understand the material and want to go over the material again. Another benefit to the videos is that they can be shared with other medical schools including ones around the world that would not have access to such material otherwise. For example, Stanford’s cardiac physiology course is being shared with students in Rwanda at their medical school.
Another initiative in online medical education was started in 2008 by the non-profit Institute for Healthcare Improvement. Four North American medical schools are using the free online content from the Institute in their medical schools. The content covers such areas as how to measure quality and using technology to prevent medical errors. The students learn how to set goals and how to collect and analyze data as well as how to make system changes in order to improve quality. They also learn how communication and teamwork can be used to prevent harm to patients.
Apps to Help the Medical Student
There are various computer applications being developed for medical students to help them with medical school. A list of Harvard Medical School’s five favorite apps is listed below.
• Dynamed is a clinical reference app that can be used in point-of-care situations.
• Unbound Medicine uCentral is a portal that brings medical references to a student’s iPad with the touch of the screen. The medical references include “A to Z Drug Facts,” “5 Minute Clinical Consult,” and “Drug Interaction Facts.”
• Epocrates Essentials is an app with an integrated disease database with different medical conditions, over-the-counter medicines database and hundreds of clinical laboratory and diagnostic tests.
• Visual Dx Mobile shows thousands of medical images and how disease presentation can vary according to age, skin type and stage of disease along with clinical information that has been physician reviewed.
• iRadiology provides concise reviews of classic radiology cases complete with images
There also are apps specific for the iPhone.
• ePocrates is a drug formulary and reference
• Medscape provides drug references and medical news. It is also is a continuing medical education (CME) tool.
• ReachMD delivers CME courses for credit.
Apps for Specific Areas of Medicine
Besides general apps there are also apps for medical specialties like anesthesiology, cardiology, dermatology and pediatrics. A sampling of a few of these apps are below.
• Anesthesia (Vol 1): Physician Board Review Q & A is designed for students, fellows and other health care professionals to prepare for board certification. It offers 100 questions and answers along with detailed explanations.
• Heart Pro: Uses real 3D and allows the user to observe the heart from any angle. With the stroke of a finger, the user can maneuver the heart into different positions, cut it open and label sections.
• iMCQs in Dermatology is designed for students to prepare for exams. The app has 229 multiple choice questions. Explanations or advice are included with answers.
• ECG Rhythms has a selection of 80 different waveforms to identify as they move across the screen.
• Pedi-Safe – ICU, OR, ED Medications is an airway management and resuscitation device for medical professionals in critical care settings that helps them determine weight-based medication dosing, equipment sizes and appropriate patient vital signs
Related topics: Texting app for languages
From the amount of articles being written on the subject, one could easily conclude that there is a lot of hoopla surrounding the Sept. 5, 2012 Lancet journal article which discusses how long hospital personnel should perform cardiopulmonary resuscitation (CPR) after the patient has gone into cardiac arrest. The study findings stated that those who had the longest resuscitation attempts, 25 minutes, had a better survival rate to discharge. The conclusion of the study “suggested that efforts to systematically increase the duration of resuscitation could improve survival in this high-risk population.”
A significant point regarding The Lancet retrospective study is that it included 64,339 patients over 8 years (2000-2008) at 435 hospitals in the US. Of these patients 48.5% were resuscitated and 15.4% survived to be discharged. The ages and comorbidity status of the patients were not mentioned. This is an important point as factors not controlled can influence the results of a study. Of particular note in the conclusion section of the study summary is that the study authors could not define the optimum time for resuscitation efforts (emphasis added). The study also did not look at survival rates past discharge.
What have Other Studies Found?
A 1995 study published in the European Resuscitation journal noted that “on average” 10-15% of patients who undergo cardiac arrest in a hospital survive to discharge. In this study of 266 patients, patients who had poor survival were noted to be over the age of 60 with co-morbid conditions (such as sepsis, renal failure, heart disease, etc.), initial PO2 <50 mmHg and had over 10 minutes of CPR performed on them.
Another study, this one a prospective one published in the Sept. 8, 1983 New England Journal of Medicine looked at 294 consecutive patients resuscitated from cardiac arrest in a teaching hospital. The analysis noted that those patients who had been home-bound or who had comorbidity with pneumonia, hypotension, renal failure or cancer had significant mortality within their hospital stay. Of particular note is that none (emphasis added) of the 179 patients in whom resuscitation took longer than 30 minutes survived to be discharged. The percentage of patients who survived to discharge in this study was 14%. Additionally, unlike the previously mentioned studies, the NEJM study looked at patient outcomes 6 months later. The study authors found that 75% of these patients were still alive 6 months later and 93% were “mentally intact.”
In any study, multiple factors that are not controlled for can skew the results and conclusions of the study. The Lancet study appears to not have controlled for the age or comorbidities of the patients; therefore, conclusions regarding length of CPR time are at best suggestive. It is interesting to note that in all of the studies mentioned whether there were 300 patients in the study or 60,000, the data consistently found approximately 14-15% of the hospital patients who had cardiac arrest and were resuscitated were able to be discharged alive subsequently.
Related topics: Preventing Cardiovascular Disease