DiversityNursing Blog

By SYDNEY LUPKIN

A court will determine whether a 17-year-old girl, under something called the "mature minor doctrine," can be forced to undergo chemotherapy after she refused treatment for her cancer.

How do you feel about this?

The case will go to the Connecticut Supreme court this week to determine whether the teen, identified in court papers as Cassandra, has "the fundamental right to have a say about what goes on with your [her] body," attorney Michael Taylor, who represents the teen's mother, told ABC News. Taylor was appointed by the public defender's office, and Cassandra has her own court-appointed lawyer, but they've filed joint appeals.

Cassandra was diagnosed with Hodgkin's lymphoma in September, but decided she didn't want to complete the prescribed treatment, according to a court summary. Her mother supported this decision, but the Department of Children and Families stepped in and ordered her mother to comply with the doctor's treatment recommendation.

"It's really for all the reasons you might imagine," said Taylor, adding that he couldn't go into more detail.

Although chemotherapy is a drug that destroys cancer cells, its side effects include hair loss, nausea, pain and fertility changes, according to the National Cancer Institute.

Cassandra underwent two chemotherapy treatments in November and then ran away from home and refused to continue treatments, according to the court summary.

A court hearing ensued in which Cassandra's doctors testified, and she was removed from her mother's home and placed in state custody so that the state could make medical decisions for her.

She has been has been living at Connecticut Children's Medical Center and forced to undergo chemotherapy for about three weeks.

The Hartford Courant reported that Cassandra has an 80 to 85 percent chance of surviving her cancer if she continues with her chemotherapy.

The state Department of Children and Families issued the following statement:

"When experts -- such as the several physicians involved in this case -- tell us with certainty that a child will die as a result of leaving a decision up to a parent, then the Department has a responsibility to take action. Even if the decision might result in criticism, we have an obligation to protect the life of the child when there is consensus among the medical experts that action is required. Much of the improvements in Connecticut's child welfare system have come from working with families voluntarily to realize solutions to family challenges. Unfortunately that can't happen in every situation, especially when the life of a child is at stake."

"No one is disputing that it's very serious," Taylor said. He said there's "a good chance" Cassandra could survive her cancer with treatment, and "there's a good chance she could die if she doesn't. None of us disagree about that."

Taylor said they're trying to argue that because Cassandra is competent, she should be allowed to make this decision for herself through something called the "mature minor doctrine," which has been adopted in Illinois and a few other states but rejected in Texas. The doctrine holds that some children are mature enough to make key life decisions for themselves.

Source: http://abcnews.go.com

By MELENA RYZIK

Artists, it’s fair to say, usually don’t know much about bacteria. Vik Muniz is an exception. Mr. Muniz, the Brazilian-born photographer known for his unorthodox materials, has been working with the M.I.T. bioengineer and designer Tal Danino on a series of trompe l’oeil images of microscopic organisms: cancer cells, healthy cells and bacteria.

At first glance, they look like ornate and colorful patterns. In reality, they represent teeming, living things. Among his latest: a pink print that could pass for floral wallpaper. But it’s made up of liver cells infected with the Vaccinia virus, which is used to make the smallpox vaccine.

“Normally, patterns are soothing structures,” Mr. Muniz said, “and all of a sudden, there’s a lot of drama.”

The work now has another meaning. It will be used in a new online campaign, The Art of Saving a Life, sponsored by the Bill & Melinda Gates Foundation. The intent is to promote vaccination just in time for an international effort to raise funds to inoculate millions, especially in poor nations.

The campaign, to be released online on Wednesday, is the first time that the foundation has commissioned artists in the service of a cause. The global roster includes photographers (Annie Leibovitz, Sebastião Salgado, Mary Ellen Mark); writers (Chimamanda Ngozi Adichie); filmmakers (Luc Jacquet, director of the documentary “March of the Penguins”); and bands (Playing for Change).

The intent is that their work will spread virally — in the digital sense — and be shared on social media with the hashtag #VaccinesWork to inspire a dialogue and donations.

“We want to get the buzz and the conversation going, because it’s easy to take these important lifesaving tools for granted,” said Dr. Christopher Elias, president of the global development program at the Gates Foundation. Art, the foundation hopes, will serve as a reminder to people “who aren’t going to read the editorial in Science,” Dr. Elias said. If the program is successful, he said, it could serve as a model for other Gates Foundation projects.

The idea came from Christine McNab, a consultant to the foundation. In brainstorming new ways to promote vaccines, she considered “what makes me cry, what makes me think,” she said. “It’s films, it’s books, it’s galleries.”

Ms. McNab and her team invited the artists in and suggested which diseases or issues to address. But they had no control over what was created. Some artists were paid a small fee to cover expenses; some retained their copyright, and others donated their work.

Ms. Leibovitz snapped a black-and-white portrait of people involved in vaccine development. Fatoumata Diabaté, a photographer from Mali, captured the last phase of trials for an Ebola vaccine. The German painter Thomas Ganter paid tribute to the little-sung medical aides who administer the shots, with his oil on canvas of “The Unknown Health Worker.”

The project is timed to lead up to a Jan. 27 meeting of Gavi, the Vaccine Alliance, an international public-private partnership in Berlin. Some images will be displayed at the conference, which aims to raise $ 7.5 billion from donors for Gavi’s next phase of development. Separately, the Gates Foundation has funded many immunization-related grants, at a cost of millions — far greater, a spokeswoman said, than the budget for the art initiative, which she would not disclose.

As the project developed in the last year, the anti-vaccination movement, in the United States and other Western countries, only gained steam. Though the programs that the Art of Saving a Life supports are targeted elsewhere, “in some ways what we’re hoping for is not just a broader debate about vaccination and immunization, but a more informed debate,” Dr. Elias said.

Countering the anti-vaccination rhetoric was part of the reason that Alexia Sinclair, a photographer from Australia, participated, she said. “I have a young daughter, and it’s quite a hot topic here,” she said, adding that she thought that producing a work of art “allows the conversation to happen in a clearer way.”

After learning that the Chinese characters for smallpox mean “heavenly flowers” — because the pustules bloom on the body, and the sufferers eventually die — Ms. Sinclair, who makes historically-inspired tableaus, created a scene of an 18th-century doctor administering a vaccination, surrounded by grass and blossoms. It brings a fashion-y aesthetic to an ugly disease. “I wanted to create something that looked at smallpox, but did it in a way that didn’t repulse people,” she said.

In an era when viewers are image-saturated, the campaign’s success, and how to measure it, are an open question. “We’ll look at the metrics,” Dr. Elias said. But, he added, the project has already proved valuable inside the Gates Foundation, as a new perspective on old problems.

“The phenomenal response” from artists, he said, “suggests that we have tapped a set of interests and voices that we perhaps should’ve been paying attention to sooner.”

Source: www.nytimes.com

By Catharine Paddock PhD

The rise of drug-resistant bacteria - such as MRSA - is making it increasingly difficult to control even common infections like pneumonia or urinary tract infections with standard antibiotics. After repeated exposure, the bugs mutate into strains that are immune to the drugs that once killed them.

There is clearly a desperate need for new drugs to fight these superbugs. But there is also another option - to extend the useful life of a drug. Now, researchers have developed a computer algorithm that can help in this area.

Imagine the war against a superbug as a chess game, with each move that your opponent makes being a mutation in the superbug that makes it more drug-resistant. 

To stand a good chance of winning, it helps to anticipate your opponent's most likely counter-moves.

Now, a team of researchers - including members from Duke University in Durham, NC - has developed a computer algorithm that stands a good chance of beating a superbug at its own game.

The software - called OSPREY - predicts the most likely mutations that a bug develops in response to a new drug before the drug is even given to patients.

Writing in the Proceedings of the National Academy of Sciences, the team describes how they tested OSPREY with the superbug MRSA (methicillin-resistant Staphylococcus aureus). 

The researchers programmed the algorithm to identify the genetic changes that MRSA would have to undergo in order to become resistant to a promising new class of experimental drug. And when they exposed MRSA to the new drugs, they found some of the genetic changes the software had predicted actually arose.

"This gives us a window into the future to see what bacteria will do to evade drugs that we design before a drug is deployed," says author Bruce Donald, a professor of computer science and biochemistry at Duke.

The team hopes the approach they are developing will give drug designers a head start in the race against superbugs, as co-author and Duke graduate student Pablo Gainza-Cirauqui explains:

"If we can somehow predict how bacteria might respond to a particular drug ahead of time, we can change the drug, or plan for the next one, or rule out therapies that are unlikely to remain effective for long."

Resistant forms of Staphylococcus aureus now kill 11,000 people in the US every year - more than HIV. In 1975, around 2% of infections caused by the bacterium were resistant to treatment - rising to 29% in 1991 - and now the proportion is 55%.

Depending on the drug, it can take up to 20 years for resistant strains to emerge. Sometimes it only takes 1 year.

Ability to anticipate new mutations beats searching 'libraries' of known mutations

The team believes approaches like OSPREY beat the current method where scientists have to look up "libraries" of previously observed resistance mutations - an approach that is not necessarily satisfactory for predicting future mutations. Prof. Donald explains:

"With a new drug, there is always the possibility that the organism will develop different mutations that had never been seen before. This is what really worries physicians."

OSPREY - which stands for Open Source Protein REdesign for You - is based on a protein design algorithm. It identifies changes to DNA sequences in the bacteria that would enable the resulting protein to block the drug while still being able to work normally.

The team tested OSPREY with a new class of drugs called propargyl-linked antifolates that attack a bacterial enzyme called dihydrofolate reductase (DHFR), used for building DNA and other tasks. The drugs - still to be tested in humans - are showing promise as a new treatment for MRSA infections.

Using OSPREY, the team came up with a ranked list of possible mutations. They picked out four - none of which had been seen before.

One predicted mutation reduced drug effectiveness by 58%

When they treated MRSA with the new drugs, they found more than half of the bacteria that survived carried the mutation they predicted would give the organism the greatest amount of resistance: a tiny change in the bacterial DNA that reduced the effectiveness of the new drugs by 58%.

"The fact that we actually found the new predicted mutations in bacteria is very exciting," Prof. Donald says, adding that the approach could be expanded to anticipate the bug's responses more than one move ahead:

"We might even be able to coax a pathogen into developing mutations that enable it to evade one drug, but that then make it particularly susceptible to a second drug, like a one-two punch."

The team is now enhancing OSPREY to predict resistance mutations to drugs designed to treat E. coli and Enterococcus infections.

They believe OSPREY will be useful for predicting drug resistance in cancer, HIV, flu and other diseases where culturing resistant strains is harder than it is with bacteria.

Prof. Donald and colleagues are developing OSPREY in open source format so it is freely available for any researcher to use.

In September 2014, Medical News Today learned about a study that showed how an  old drug may lead to a potential new class of antibiotics . The study showed that lamotrigine - currently used as an anticonvulsant - can inhibit the assembly of ribosomes in bacteria.

Source: www.medicalnewstoday.com

By Sanjay Gupta

So, in no particular order, here's my take on the nine big health stories to watch for, and the questions they will likely raise, in 2015.

Doctor shortage. There aren't nearly enough of us to care for the U.S. population. By some estimates, the country is already short of tens of thousands of doctors, a problem that will only get worse as the demand for care increases with our aging population. That could mean longer wait times for you when you need to make an appointment. But that also means policy makers will have to consider questions like: Is there a way to increase the number of residency training slots? Are there other health care professionals who can reasonably fill in the gaps? Will the nation's quality of care go down? How can the country avoid a situation where only the wealthy will be able to afford quality care? 

Hospital errors and infections. Hospital mistakes and infections are still one of the leading causes of preventable death (indeed, some studies suggest "hospital-acquired conditions" kill more people than car accidents or diabetes). 

True, a recent study showed the rate did get better this year, saving tens of thousands of lives. But what else can hospitals do to prevent these mistakes and infections? Can technology like e-prescriptions and electronic health records prevent problems that most often occur: the mistakes caregivers make with a patient's drugs? 

Antibiotic resistance. It has been called public health's "ticking time bomb."The World Health Organization calls antibiotic resistant infections one of the biggest threats to global health today. Each year, at least 2 million peoplebecome infected with bacteria that are resistant to antibiotics, and at least 23,000 people die each year. Most of these deaths happen in health care settings and in nursing homes. How can we respond? Well, research teams around the world have already started searching for the next generation of infection-fighting drugs. But it remains to be seen if time will run out, sending us back to the beginning: a time before antibiotics, where even a cut that becomes infected could kill you. 

More do-it-yourself health care: apps and technology. Technology has made do-it-yourself patient care much easier. This goes beyond just a patient's ability to look up their symptoms online. There are apps to help with autism, apps that can simulate a check-up, apps that can monitor conditions. Wearables can motivate you to walk more or sleep more or check a diabetic's glucose level. But how does all this helping yourself make your health care better? How much is too much? And what does this mean for your privacy? After all, the health care industry accounted for 43% of all major data breaches in 2013. Meanwhile, although 93% of health care data requires protection by law, some surveys suggest only 57% of it is "somewhat protected." What could this mean for your privacy and personal information if security doesn't get better? 

Food deserts. While not everyone agrees with the term food desert, the USDA still estimates 23.5 million people live in these urban neighborhoods and rural towns with limited access to fresh, affordable, healthy food. Without grocery stores in these areas, residents often have to rely on fast food and convenience stores that don't stock fresh produce. It takes a real toll on their health. Families who live in these areas struggle more with obesity and chronic conditions, and they even die sooner than people who live in neighborhoods with easy access to healthy food. More farmers markets are now accepting food stamps and many nonprofits have stepped in to try to bring community gardens and healthy food trucks to these areas, but so far it's not enough. Will cities offer incentives to grocery store chains to relocate to these neighborhoods?  How else can this system be helped? 

Caregivers for the aging population. We are heading into a kind of caregiver crisis. The number of people 65 years and older is expected to rise 101%between 2000 and 2030, yet the number of family members who can provide care for these older adults is only expected to rise 25%. This raises a series of related questions, not least who is going to step up to fill the gaps? Will cities that don't traditionally have strong public transportation systems add to their routes? Will developers create more mixed-use buildings to make shopping and socializing easier to access? Could the government create a kind of caregiver corps that could check in on the isolated elderly? Who will pay for this expensive kind of safety net? 

The cost of Alzheimer's. Currently about 5.2 million Americans have Alzheimer's. That number is expected to double every 20 years. With a cure some way off, what can be done to ease the emotional and financial burden on families and communities affected by the disease? The Alzheimer's Association predicts that by 2050, U.S. costs for care will total $1.2 trillion, making it the most expensive condition in the nation. How will we be able to afford the costs of caring for this population? What can the country do to achieve the goal the White House set for preventing and effectively treating Alzheimer's by 2025?

Marijuana. With the growing acceptance of weed, we can expect that more laws will change to allow medical and recreational use of marijuana. How will the rest of the laws in this country adjust? For instance, Washington state is coming up with a Breathalyzer-type device to check if drivers are high. But it will be interesting to see how readily available these devices are going to be. Will legalization improve the scientific understanding of the long-term consequences of the drug? What other uses could this drug have to help those who may need pain relief most?

Missing work-life balance. Americans spend more time on the job than most other developed countries. We don't get as much vacation, we don't take what vacation we have, and we are prone to working nights and weekends. This stress has a negative impact on Americans' health. What are companies doing to help? What technology can change this phenomenon? Will millennials who say work-life balance is a bigger priority than other generations rub off on the rest of us? What can we personally do to find a better balance? 

We may not be able to answer all these questions in 2015, but we sure will try. And the health team and I look forward to exploring these issues with you in the coming New Year.

Source: www.cnn.com

By ALISON BRUZEK

The last thing on your mind while you're home from school for the holidays is avoiding a deadly disease.

But imagine catching a disease as a teenager — a disease so terrible that it takes not just months to recover, but requires sacrificing both your legs.

That's what happened to Amy Purdy at age 19, when she was diagnosed with bacterial meningitis. It affects only about 4,000 people a year in the United States, according to the Centers for Disease Control and Prevention, but more than 10 percent of those people die. Others, like Purdy, suffer devastating consequences, including hearing loss, brain damage, or the loss of limbs from bloodstream infection.

College students are especially vulnerable, because meningitis is spread by living in close quarters and sharing drinking and eating utensils, or kissing. (An outbreak at Princeton University in 2013 sped up approval a new vaccine for the meningitis B strain.)

That's why the CDC recommends meningitis vaccine for all teenagers, especially if they weren't vaccinated as preteens.

Purdy, now 35, went on to become a Paralympic snowboarding champion and contestant in Dancing with the Stars. She's got a new book, On My Own Two Feet: From Losing My Legs to Learning the Dance of Life, coming out Dec. 30. Shots spoke to her about her battle with the disease and people's misconceptions about meningitis. This is an edited version of the conversation.

Had you heard about meningitis before you became sick?

Of course I heard the name meningitis before. I recognized what it was, but I had no idea that I was at risk. And I have to say, my mom actually told me just about a year before I got sick about one of her friends' son's who battled this horrific disease that came out of nowhere. He ended up losing his legs and his kidneys. It was the exact same thing that I got a year later.

Do you know how you got meningitis?

We have no idea how I got it. I was at an age that's more at risk — I was 19 years old. However, I wasn't a college student. I didn't live in a college dorm. I really wasn't even around that environment. They do say that those who are in college dorms are slightly more at risk than the rest of the world. I don't know how I got it, I was incredibly healthy at the time, I was a massage therapist, I worked out every day, I really took care of myself. It's just this invisible killer that kind of comes out of nowhere.

How did you cope with this loss at such a young age?

For me, it was life-changing. I nearly died multiple times in the hospital. I lost my legs, I lost my spleen, I lost my kidney function. I lost the life that I knew. And going through so much in such a small amount of time and so quickly, for me it put my life into perspective. There were certain things I focused on — I focused on how grateful I was for the things I had versus things I lost. I got a second chance at life and I wanted to use it. I didn't want to waste it by dwelling on what happened or why it happened.

One of the ironies is that those losses actually led to a lot of great things, like Dancing With the Stars and the Paralympics.

Definitely. The way I look at it is, we all have disabilities. We all have things that limit us and that challenge us. But really, our real limitations are the ones we believe. And I, from the beginning, believed that I could accomplish my goals and accomplish my dreams and I set out to do that. I'm very grateful that I've had the opportunities I've had.

A new vaccine for meningitis B was approved this fall, and you're now working with the manufacturer, Pfizer, to promote it. How did that happen?

Pfizer's actually teamed up with my nonprofit organization, which is called Adaptive Action Sports. I cofounded this organization in 2005 to help people with physical disabilities get involved in action sports, go snowboarding, skateboarding. Obviously, they want to get the word out there that there's protection against this bacteria.

I'm really proud to be a part of this campaign, though. You hear about rare diseases and weird things happening to people on Oprah and Dateline and you just never think it's going to happen to you. And then come to find out you actually could've protected yourself against it. To me it seems like a no-brainer.

What do you want parents to ask their teen's doctor about meningitis?

The number one question is, "Do you carry the meningococcal meningitis vaccination?" I feel like if parents could vaccinate their kids against car accidents, they would. This is one of those things where there are ways to help protect your kid against this.

Source: www.npr.org

By David McNamee

Between 1990 and 2013, global life expectancy increased by nearly 5.8 years in men and 6.6 years in women, according to a new analysis of the Global Burden of Disease Study 2013 published in The Lancet.

"The progress we are seeing against a variety of illnesses and injuries is good, even remarkable, but we can and must do even better," says lead author Dr. Christopher Murray, professor of Global Health at the University of Washington. 

"The huge increase in collective action and funding given to the major infectious diseases such as diarrhea, measles, tuberculosis, HIV/AIDS and malaria has had a real impact," he says. 

"However, this study shows that some major chronic diseases have been largely neglected but are rising in importance, particularly drug disorders, liver cirrhosis, diabetes and chronic kidney disease."

The analysis suggests that life expectancies in high-income regions have been increased due to falling death rates from most cancers - which are down by 15% - and cardiovascular diseases - which are down by 22%.

In low-income countries, rapidly declining death rates for diarrhea, lower respiratory tract infections and neonatal disorders have boosted life expectancy.

Despite the increases in global life expectancy by nearly 5.8 years in men and 6.6 years in women, some causes of death have seen increased rates of death since 1990.

These increased causes of death include:

• Liver cancer caused by hepatitis C (up by 125%)
• Atrial fibrillation and flutter (serious disorders of heart rhythm; up by 100%)
• Drug use disorders (up by 63%)
• Chronic kidney disease (up by 37%)
• Sickle cell disorders (up by 29%)
• Diabetes (up by 9%)
• Pancreatic cancer (up by 7%).

HIV/AIDS has 'erased years of life expectancy' in sub-Saharan Africa

The report also points to one notable global region where life expectancy is not increasing. Deaths from HIV/AIDS have erased more than 5 years of life expectancy in sub-Saharan Africa, say the authors. HIV/AIDS remains the greatest cause of premature death in 20 of the 48 sub-Saharan countries.

Since 1990, years of life worldwide lost due to HIV/AIDS is reported as having increased by 334%.

In Syria, war is the leading cause of premature death - the conflict caused an estimated 29,947 deaths in 2013, and up to 54,903 and 21,422 deaths in each of the preceding 2 years.

Countries that the authors consider to have made "exceptional gains in life expectancy" over the past 23 years include Nepal, Rwanda, Ethiopia, Niger, Maldives, Timor-Leste and Iran - where, for both sexes, life expectancy has increased by more than 12 years.

Life expectancy at birth in India increased from 57.3 years for men and 58.2 years for women in 1990 to 64.2 years and 68.5 years, respectively, in 2013. The authors say that India has made "remarkable progress" in reducing deaths, with the death rates for children dropping 1.3% per year for adults and 3.7% per year for children.

The report also welcomes dramatic drops in child deaths worldwide over the study period. In 1990, 7.6 million children aged 1-59 months died, but this death rate was down to 3.7 million by 2013.

Igor Rudan and Kit Yee Chan, from the Centre for Population Health Sciences and Global Health Academy at the University of Edinburgh Medical School in the UK, write in a linked comment:

"Estimates of the causes of the global burden of disease, disability, and death are important because they guide investment decisions that, in turn, save lives across the world.

Although WHO's team of experts have been doing fine technical work for many years, its monopoly in this field had removed incentives to invest more time and resources in continuous improvement [...] the competition between WHO and the GBD [Global Burden of Disease Study] has benefited the entire global health community, leading to converging estimates of the global causes of death that everyone can trust."

 

Source: www.medicalnewstoday.com

At birth, a newborn baby is still attached to its mother through the umbilical cord, which is either cut very early - within the first 60 seconds - or later, with some women opting to wait until after the cord has stopped pulsating. Though the right timing for cutting the cord - also referred to as clamping - is widely debated, a new study suggests delaying cord clamping by 2 minutes results in better development for the newborn during the first days of life.

What do you think about it? Do you think the 2 minutes makes a difference? Perhaps you can share a personal and/or professional experience about this.

The research, carried out by scientists from the University of Granada and the San Cecilio Clinical Hospital in Spain, is published in the journal Pediatrics, the official journal of the American Academy of Pediatrics (AAP).

According to the American Congress of Obstetricians and Gynecologists (ACOG), the reason that cord clamping timing is so controversial is that a previous series of studies into blood volume changes after birth concluded that in healthy term infants, more than 90% of blood volume was attained within the first few breaths he or she took after birth.

As a result of these findings, as well as a lack of other recommendations regarding optimal timing, the amount of time between birth and umbilical cord clamping was widely shortened; in most cases, cord clamping occurs within 15-20 seconds after birth.

However, before these studies, in the mid-1950s, cord clamping within 1 minute of birth was defined as "early clamping," and "late clamping" was defined as more than 5 minutes after birth. And the ACOG have stated that "the ideal timing for umbilical cord clamping has yet to be established."

Meanwhile, the World Health Organization (WHO) advocate for late cord clamping (between 1-3 minutes after birth), as it "allows blood flow between the placenta and neonate to continue, which may improve iron status in the infant for up to 6 months after birth."

Waiting 2 minutes increased antioxidant capacity

To provide further evidence in the debate of early versus late cord clamping, the researchers from this latest study, led by Prof. Julio José Ochoa Herrera of the University of Granada, assessed newborn outcomes for infants born to 64 healthy pregnant women to determine the impact of clamping timing on oxidative stress and the inflammatory signal produced during delivery.

All of these women had a normal pregnancy and spontaneous vaginal delivery. However, half of the women's newborns had their umbilical cord cut 10 seconds after delivery and half had it cut after 2 minutes.

Results revealed beneficial effects of late cord clamping; there was an increase in antioxidant capacity and moderation of inflammatory effects in the newborns.

Commenting further, Prof. Ochoa says:


"Our study demonstrates that late clamping of the umbilical cord has a beneficial effect upon the antioxidant capacity and reduces the inflammatory signal induced during labor, which could improve the development of the newborn during his or her first days of life."

He adds that umbilical cord clamping is one of the most frequent surgical interventions practiced in humans, with proof of the practice dating back centuries. 

Early clamping 'not advised unless newborn needs resuscitation'

With evidence of benefits for delayed cord clamping, however, why are most newborns separated from the placenta within 15-20 seconds after birth? According to the ACOG, there are concerns over universally adopting delayed clamping because it could "jeopardize timely resuscitation efforts, if needed, especially in preterm infants."

"However," the organization states, "because the placenta continues to perform gas exchange after delivery, sick and preterm infants are likely to benefit most from additional blood volume derived from a delay in umbilical cord clamping."

There are also other concerns regarding delayed cord clamping, including an increased potential for "excessive placental transfusion, which can lead to neonatal polycythemia" - an abnormally high level of red blood cells. This is especially of concern in the presence of risk factors including maternal diabetes, intrauterine grown restriction and high altitude.

Another concern stated by the ACOG is that delayed umbilical cord clamping "may be technically difficult in some circumstances."

Still, the WHO say late cord clamping is recommended for all births, and the improved iron status associated with it "may be particularly relevant for infants living in low-resource settings with reduced access to iron-rich foods."

The organization clearly states that early cord clamping - less than 1 minute after birth - is not advised unless the newborn is asphyxiated and needs to be moved for resuscitation.

Source: www.medicalnewstoday.com

By Meera Senthilingam

Its name means "bending over in pain." It has no treatment or vaccine. Its symptoms resemble Dengue fever. And it has infected more than 1 million people -- 155 of them fatally -- since spreading to the Americas one year ago.

The mosquito-borne Chikungunya virus has long been diagnosed in travelers returning from countries in Asia and Africa, where the disease is widespread. But in December 2013, the first people infected by mosquitoes local to the region were reported on the Caribbean island of Saint Martin.

This was the first outbreak of the debilitating disease in the Western hemisphere, health officials said.

All countries in Central America have now reported local transmission of Chikungunya [pronounced chik-un-GOON-ya], and the United States had 11 confirmed cases of local infection this year as of December 12, all in the state of Florida. There also have been 1,900 imported cases across the U.S. in returning travelers.

"It wasn't until 2013 that unfortunately a traveler resulted in local transmission of Chikungunya," said Erin Staples of the U.S. Centers for Disease Control (CDC), referring to the people infected in Saint Martin.

Those infected carry the virus in their bloodstream; it can then be picked up by mosquitoes as they bite, making them carriers. The virus has since spread rapidly and shows no signs of leaving, as ecological conditions are perfect for the disease to flourish.

"We knew it would spread," said Staples, a medical epidemiologist.

The big question perplexing officials: Why now?

Two mosquito species primed to the temperatures of Central and South America carry Chikungunya. The species -- Aedes aegypti and Aedes albopictus -- also carry the virus behind Dengue fever.

"Given the level of Dengue in the region, we knew there could be the same levels of Chikungunya," Staples said. Both diseases can cause joint pain and inflammation, headaches, rashes and fever, and can lead to death in rare cases.

But this tropical disease with an exotic name (which originates from the African Makonde dialect) causes more intense joint pain and inflammation. For some people the pain can last for months or years, resulting in additional psychological strain.

The lack of immunity among people living in the Americas provided a blank canvas for Chikungunya to spread throughout the population this year. As of December 12, more than 1.03 million people have been infected, in addition to the 155 who died, according to the Pan-American Health Organisation (PAHO). Almost all of the fatalities occurred in the Caribbean island countries of Guadaloupe and Martinique.

"Where we saw the biggest jump was after it reached the Spanish-speaking countries in the region," said Staples, referring to the weakened infrastructures and health systems of countries such as the Dominican Republic, which has reported more than 520,000 cases -- more than half of the overall outbreak and 5% of the island country's population.

As South American countries approach their summer, numbers are expected to rise there as the mosquitoes flourish in the heat.

"Brazil, Peru, Paraguay are coming into their summer months and reporting their first local transmission," Staples said. Already, more than 2,000 people have been infected in Brazil.

Is there cause for concern?

Because infection with Chikungunya is rarely fatal, the issue of most concern to officials is the burden on health services and the impact of the debilitating symptoms on the economy.

"The high number of cases can overload health services," says Dr. Pilar Ramon-Pardo, regional adviser for PAHO, the regional office of the World Health Organization. Until recently, monitoring for Chikungunya was not part of routine surveillance in the region.

"Clinicians have to be ready to diagnose," she said

About 20% to 30% of cases are expected to become chronic, with symptoms such as arthritis and other rheumatic manifestations leading to physical disabilities, Ramon-Pardo said. Further long-term effects are psychological as people become more depressed and tired.

All of this can result in missed work and lower school attendance, she said, hurting local economies.

Is it here to stay?

The warm climate of the region offers potential for Chikungunya levels to be maintained for years to come, just like Dengue fever. But areas of most concern are the tropics.

"The areas which have year-round favorable climate for the mosquito are at the greatest risk," says Dr. Laith Yakob of the London School of Hygiene and Tropical Medicine, which is monitoring the spread of the outbreak.

While the climate and mosquitos have long been present, Ramon-Pardo said, "we don't know why this is happening now." She said globalization is likely to blame, with increased population movement from one country to another. This offers more opportunities for local mosquitos to bite infected humans.

The CDC's Staples said she is temporarily at ease regarding numbers in the U.S. "We're moving into fall and winter periods, which should see activity decrease," she said. Cold temperatures reduce mosquito survival rates.

The rapid spread of Chikungunya this year also could help minimize future infections. "Chikungunya will go through a region quite rapidly and create a level of population immunity which helps mitigate large outbreaks of the disease," Staples said. Unlike Dengue, infection with Chikungunya results in lifelong immunity.

Like many other infections, Chikungunya could, however, remain in the background through animals capable of carrying the virus in their bloodstream and acting as so-called reservoirs of the disease.

"In Asia and Africa there is a transmission cycle in small mammals and monkeys," Ramon-Pardo said, meaning these animals keep the virus present within the population. "In the Americas ... we don't know yet."

Those words -- "we don't know" -- resonate throughout the community of scientists and government officials trying to control the outbreak.

The future risk of spread, levels of future immunity, risk from animal reservoirs, why this is only happening now, and the total economic impact are all unknown.

"Mathematical models are under construction by numerous research groups around the world to improve confidence over projections of future spread," said Yakob, whose team is modeling the disease. As they work, control efforts continue.

Getting it under control

When it comes to controlling Chikungunya, there are two main strategies -- reduce the likelihood of bites and remove the ever-biting mosquito. Prevention is the priority.

Unlike the mosquitoes behind malaria, which bite at night, the species behind Chikungunya bite any time, day or night. Those living in affected areas are asked to use repellent, sleep under bed nets and wear long clothing to avoid getting bitten. The air conditioned and indoor environments of people living in the U.S. mean numbers are likely to stay low there.

But mosquito control is at the heart of it all. Mass spraying of insecticides and removal of any sources of shallow water in which mosquitoes can breed are taking place across the continents. According to the CDC's Staples, Florida has been highly aggressive with its approach to control. "We're only at 11 (cases) due to such proactive measures," Staples said. For now, prevention is all they have as officials wait and see how the outbreak pans out.

"There is no vaccine currently and no good antivirals, so we are trying to control the spread of the disease," Staples said. "There are a lot of questions and only time will tell what we'll see for Chikungunya in the future."

Source: www.cnn.com

By Tony Marco and Catherine E. Shoichet

 It started with a sore throat on Thanksgiving and an antibiotic from a friend who wanted to help.

Now 19-year-old Yaasmeen Castanada is fighting for her life inside a California hospital's burn unit, suffering from an allergic reaction that's so severe she has large open wounds all over her body.

"It is heartbreaking, every day is a different look. Every day, she's like, shedding away. ... Overnight, it's a whole different person that you're looking at," Martha Hughes, Castanada's aunt, told CNN affiliate KABC.

Doctors diagnosed Castanada with Stevens-Johnson Syndrome, a rare disease that can be triggered by antibiotics or other medications.

"When she took the medication, she started having a hard time breathing, and she told her mom that her lips were burning, her throat, her eyes, they got so red that she couldn't talk. So she rushed her to the ER, and that's when they diagnosed her with the disease. And from there it has just spiraled to a nightmare," Hughes said.

Now Castanada, the mother of a 4-month-old, is in critical condition at the University of California, Irvine, burn center.

Her prognosis is good, even though the disease has a high mortality rate, according to Dr. Victor Joe, the center's director.

But the situation, Castanada's family says, has been devastating.

"Just unreal, just watching your daughter burn in front of you, literally, burn in front of you," her mother, Laura Corona, told KABC. "Every day, a new blister, a new burn, a new scar. And she's just, 'Mommy, I want to go home.' And I can't take her home. I can't put water on her lips."

Mom: 'Don't share medication'

On a website created to raise funds for Castanada's care, her mother said the harrowing ordeal began soon after her daughter took the medicine.

"A friend offered her an antibiotic pill that she had from a previous illness," Corona wrote. "She was thinking that it would help her. This would be the biggest mistake of her life."

Now, Corona says she's hoping to spread the word so others don't make the same mistake.

"Don't share medication. Don't give someone else your medication. Don't offer medication," she said.

She also advises parents to find out what their children are allergic to -- before it's too late.

Doctor: Reaction causing skin to separate

At first, doctors diagnosed Castanada with Stevens-Johnson Syndrome, which refers to a condition where between 10% and 30% of the skin on the body is affected, Joe said. Now she's experiencing Toxic Epidermal Necrolysis, the diagnosis when more than 30% of the body is affected. Joe estimates that 65% of Castaneda's skin and mucus membranes have been affected.

The allergic reaction is causing layers of Castaneda's skin to separate, Joe said, creating lesions that grow into large open wounds.

"Patients can experience problems with taste, swallowing, eyesight and sexual functions can be affected. In Yaasmeen's case, we are particularly concerned because her eyes have been affected. This can cause scarring of the corneas, which could lead to permanent blindness," he said. "We are trying to prevent that from happening."

Photos on the fundraising website show Castanada lying in a hospital bed, with openings for her eyes cut from the bandages that cover her.

As part of her treatment for the disease, doctors have wrapped her body in a special dressing, Joe said.

"We have chosen to place a dressing that adheres to the open wound, which allows her skin to heal without having to remove the bandages to wash the wounds," he said.

Mortality for those suffering from Stevens-Johnson Syndrome and Toxic Epidermal Necrolysis can be as high as 25% in adults, but tends to be lower with early treatment, according to the Merck Manual.

Though it's uncommon, Joe said his hospital has treated around six cases in the past year, because the burn center has experience treating open wounds.

"This is very sobering. The fact that you can get a life-threatening situation from taking a medication. It can happen, and most people don't think twice about taking pills for things," Joe said. "In fact, most of the time you do have some sort of side reaction to medication, just not this severe."

After recovering from Stevens-Johnson Syndrome, patients usually only have minor issues with their skin, such as dryness, Joe said.

"Hopefully new skin will come in," Corona told KABC. "I'm just there watching. All I can tell her is, "Hang on, hang on. It's almost over.'"

Source: www.cnn.com

By Jen Christensen and Elizabeth Cohen

A young Liberian woman who saved three of her relatives by nursing them back to health after they contracted the Ebola virus is coming to the United States to finish her nursing degree.

The news comes as Time magazine announced Wednesday that its "Person of the Year" honors go to the Ebola fighters, the "unprecedented numbers" of doctors and nurses who responded when Ebola overtook an already-weak public health infrastructure this year in West Africa.

Fatu Kekula is not named in the article, but she definitely holds a place among those being honored.

The 22-year-old, who was in her final year of nursing school earlier this year, single-handedly took care of her father, mother, sister and cousin when they became ill with Ebola beginning in July.

And she did so with remarkable success. Three out of her four patients survived. That's a 25% death rate -- considerably better than the estimated Ebola death rate of 70%.

Kekula stayed healthy, which is noteworthy considering that hundreds of health care workers have become infected with Ebola, and she didn't even have personal protection equipment -- those white space suits and goggles used in Ebola treatment units.

Instead, Kekula invented her own equipment. International aid workers heard about her "trash bag method" and taught it to other West Africans who can't get into hospitals and don't have protective gear of their own.

Every day, several times a day for about two weeks, Kekula put trash bags over her socks and tied them in a knot over her calves. Then she put on a pair of rubber boots and then another set of trash bags over the boots.

She wrapped her hair in a pair of stockings and over that a trash bag. Next she donned a raincoat and four pairs of gloves on each hand, followed by a mask.

It was an arduous and time-consuming process, but she was religious about it, never cutting corners.

UNICEF Spokeswoman Sarah Crowe said Kekula is amazing.

"Essentially this is a tale of how communities are doing things for themselves," Crowe said. "Our approach is to listen and work with communities and help them do the best they can with what they have."

She emphasized, of course, that it would be better for patients to be in real hospitals with doctors and nurses in protective gear -- it's just that those things aren't available to many West Africans.

No one knows that better than Kekula.

Her Ebola nightmare started July 27, when her father, Moses, had a spike in blood pressure. She took him to a hospital in their home city of Kakata.

A bed was free because a patient had just passed away. What no one realized at the time was that the patient had died of Ebola.

Moses, 52, developed a fever, vomiting and diarrhea. Then the hospital closed down because nurses started dying of Ebola.

Kekula took her father to Monrovia, the capital city, about a 90-minute drive via difficult roads. Three hospitals turned him away because they were full.

She took him back to another hospital in Kakata. They said he had typhoid fever and did little for him, so Kekula took him home, where he infected three other family members: Kekula's mother, Victoria, 57; Kekula's sister, Vivian, 28, and their 14-year-old cousin who was living with them, Alfred Winnie.

While operating her one-woman Ebola hospital for two weeks, Kekula consulted with their family doctor, who would talk to her on the phone, but wouldn't come to the house. She gave them medicines she obtained from the local clinic and fluids through intravenous lines that she started.

At times, her patients' blood pressure plummeted so low she feared they would die.

"I cried many times," she said. "I said 'God, you want to tell me I'm going to lose my entire family?' "

But her father, mother, and sister rallied and were well on their way to recovery when space became available at JFK Medical Center on August 17. Alfred never recovered, though, and passed away at the hospital the next day.

"I'm very, very proud," Kekula's father said. "She saved my life through the almighty God."

Her father immediately began working to find a scholarship for Kekula, so she could finish her final year of nursing school. But the Ebola epidemic shut down many of Liberia's schools, including hers.

After a story about Kekula ran on CNN in September, many people wanted to help her.

A non-profit group called iamprojects.org also got involved.

With some help, Kekula applied to Emory University in Atlanta, the campus with the hospital that has successfully cared for American Ebola patients. Emory accepted the young woman so that she could complete her nursing degree starting this winter semester.

In order to attend, iamprojects will have to raise $40,000 to pay for her reduced tuition rate, living expenses, books and her travel and visa so that she can travel between Africa and the United States.

Kekula's father has no doubt that his daughter will go on to save many more people during her lifetime.

"I'm sure she'll be a great giant of Liberia," he said.

Source: www.cnn.com