HIV Infections in NYC Three Times National Rate

4800 people, most of them men who had sex with men (MSM) contracted HIV in NYC in 2006. NYC is considered the epicenter of the HIV epidemic, with 100,000 people living with the illness. Black and Latino men in their 30's and 40's have the highest incidence of new infections.

There is discordance among men who self-identify as "straight" men while engaging in same sex activity. A lot of hype and fear has been generated around MSM who are bisexual and secretive about their sexual activities with other men (downlow or DL). A 2006 study however contradicts these myths. While it may make for good YouTube videos and headlines, the prevalence of bisexual black males is estimated to be 2% in the US, while for the general male population, it is estimated to be close to 10%. One in ten self-identifying "straight" males have at least one sexual encounter with another male in a year. While it is true that bisexual black males prefer not to disclose their MSM activities, they do not tend to engage in unprotected sex with multiple partners. The authors found that use of condoms by black heterosexual couples was low and suggest that the increased incidence of HIV in black women was due to high risk sexual activity.

One of the issues that may be being ignored by health professionals is that homosexual males are at increased risk for suicide and suicide attempts, especially youth. That's right - homosexuality is a risk factor for suicide. Studies indicate that 30% to 50% of teenage suicides are bisexual or gay and of course the majority are male. Males face ostracism and loss of social support for disclosure of homosexual behavior. Clearly self-conflict triggers substance abuse and feelings of hopelessness may be leading to risky sexual behaviors. Young black males who engage in sex with other males report high overall stress levels, anxiety about their sexuality and masculinity, feelings of sexual shame and feelings of isolation and loneliness. Substance abuse and cultural expectations of not living beyond the age of 25 years may be contributing to recklessness in many aspects of their lives.


Thank you unkid for use of image Thug Life.

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Hurricane Katrina Death Tally 1000 - Half of them Elderly

With a new hurricane bearing down on New Orleans and the surrounding area, a new report from Disaster Medicine and Public Health Preparedness finally provides us with death toll post Katrina - 3 years on. Hurricane Katrina struck on August 29, 2005 and

• 1000 people - half of them over age 75 years - died.
  
• Most died by drowning
  
• 33% died in homes
• 2% of the deaths were under age 18 years
  
• 51% of the victims were black, 42% were white

The report states this number likely under-represents the total death toll as many more deaths may have been indirectly related to the catastrophe. Authors emphasize the need to reach elderly and vulnerable populations before, during and after disasters to provide assistance, reassurance and relief.

In anticipation of Tropical Storm Gustav, elderly residents are urged to call 211 and register themselves for assistance.


Thank you LauraFries.com for use of image.

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Have the Olympics Inspired You to New Fitness Greatness?

While the US Olympic athletes brought home a record number of Olympic medals, statistics point to continuing rise of obesity in our country. If watching all of these gifted athletes perform has inspired you to greatness, here are some tips to increase your fitness, energy and beauty:

• Take the stairs: walk stairs as much as possible, then take two at a time
• Core strength is the key to more energy and fitness.
  
• LeBron James looks better than ever and he offers this exercise: lie on your back and do bicycle kicks for 15 strokes. Hold your legs out straight about 6" off the ground for count of 10. Do 10 leg raises. Repeat the cycle x 3.
  
• Inverse curls: Lie on incline bench with your head at the top. Grab the bar in the back, bend your knees and pull your legs to your chest for 15 counts for 3 cycles
• Leg raises: Do 20 raises x 3 sets
  
• Tae Kwon Do champion Steven Lopez uses the stationary bike for cardio fitness. Sprint for 6 seconds, then pedal slowly for 12 seconds and repeat this cycle for 5 minutes. Build up to 20 minutes over a month and lose more weight than you would with jogging.
  
• Step Up: Take dumbbells and hold them at your side. Step up onto a bench and stand on one leg. Step down. Do 10 reps for each side for 3 complete cycles.
  

Thank you rick 115 for use of photo Usain Bolt breaks World Record: Men's 100 m Beijing Olympics 2008.

Come on you can do it!

Labels: Beijing Olympics, Bolt, core strength, fitness

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First Medication for Huntington's Chorea Approved

Huntington's disease is a fatal, inherited neurodegenerative disorder marked by disabling chorea. Chorea is a symptom of the disease, manifesting in spasmodic, uncontrollable movements that become disabling. The FDA has now approved the medication tetrabenazine for treatment of chorea offering hope to thousands. Tetrabenazine calms the jerky, uncontrollable movements of the body by its action on amines in the brain. Ninety percent of people with Huntington's disease suffer with chorea, so improvement in their symptoms offers dramatic improvement in their quality of life.

Tetrabenazine does not slow progression of the disease, which affects most people in middle age. Prestwick Pharmaceutical, Inc., a privately held company in Washington D.C., owns the rights to develop and sell tetrabenazine in the US. The company specializes in medications treating chronic CNS disorders. Tetrabenazine has been used in Europe for thirty years.

Xenazine®

Labels: Huntington's

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Achilles Tendon Injury Fells China's Hero Liu Xiang

While the US is riding high on the stunning achievements of Olympic swimmer Michael Phelps, China's 1.3 billion fans are mourning a fallen hero, Liu Xiang. Liu, 25 years old, won gold in the 2004 Athens Olympics, the first Asian to win the 110 m hurdles sprint. Since winning, he has become a superstar in China.

In obvious pain during warm-ups on August 18, 2008, he was unable to participate in the competition due to hamstring injuries and achilles tendon injury in his right foot. The achilles tendon is a broad band of ligamentous tissue that attaches the calf muscle to the bone and allows the foot to flex. The tendon is what gives us the ability to push off of the foot while running or walking.

In Greek mythology, Achilles was the most handsome, swiftest warrior engaged in the battle against Troy. He was made immortal by being dipped in the River Styx, making his body impervious to wounds, except that the goddess Thetis forget about the heel where she held him. So in battle, when an arrow shot him in the heel, he died. His vulnerable spot became immortalized as Achilles heel.

All of China is saddened by the injury of their hero. Dr Feng Shu Yong, the Chinese Athletics Association Team leader, confirmed that Xiang’s withdrawal was caused by the accumulation of two separate injuries: a hamstring injury which he suffered in May 2008 and a chronic right foot injury which has plagued him for seven years. Dr. Feng reports that the pain in Liu's heel was so intense that he was unable to stand and was shivering. Today, one of the world's greatest athletes is struggling with depression, pain and defeat. We offer our condolences and the balm of time passing.


Thank you Jingye for use of photo of poster of Liu Xiang at the Beijing Olympics.

Labels: Beijing Olympics, liu xiang, sports injuries

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Rush Remedy Heals People and the Planet

Rush University Medical Center has come up with an exciting way to go green - recycling unused medical supplies. In a program called Rush Remedy, staff and medical students collect unused medical equipment and supplies and ship them to international hospitals and clinics in need. Since the inception of the program in January 2008, volunteers have donated 12,000 pounds of supplies that would have otherwise ended up in landfills.

It is estimated that the US alone wastes 2000 tons or $200 million dollars worth of unused medical supplies while developing nations suffer shortages in basic equipment we take for granted - like gloves and syringes. The waste is a burden to the environment and represents what the Rush volunteers see as a call to action for a nation wide program of material recovery and reuse.

At Rush, 2000 pounds of materials are collected every month and placed in 40 foot containers and then shipped to areas of need around the world via MedShare International. MedShare is an Atlanta based organization that bridges the gap between surplus and need, developing protocols for safe donation of materials and coordinating redistribution to those in need. Recipient hospitals and clinics must be approved and some nations that have benefited are Afghanistan, Haiti, Kenya, Ecuador, Ukraine and Uganda.


Thank you interplast for use of photo, Medial Supplies in Peru.

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John Edwards, the Self-Diagnosing Narcissist

Narcissist Personality Disorder (NPD) is no joke. If you remember your Greek mythology, Narcissus was a beautiful young man who fell in love with his own reflection in a pool of water, while rejecting lovers and leaving a trail of broken hearts. Features of NPD are ingrained patterns of feeling special, a sense of entitlement - to the manor born - combined with a need for constant attention and admiration from others and a complete lack of empathy. For any one who has ever dealt with a narcissist up close and personal, the lack of empathy is one of the most difficult aspects of the disorder. Narcissists are superficially warm and charming - until you need them for something - like say, support if you are diagnosed with cancer. The chill behind the narcissist's charming smile can make, say a loving wife question who she has been living with all these years.

People with NPD are drawn to positions of power and like to be in the limelight, anything that feeds their ego. There are also many narcissists in the helping professions. Psychiatrists say that beneath the polished exterior is an angry person masking feelings of emptiness. Narcissists are known to lie to themselves, about themselves and to get worse with age. Aging is particularly hard on narcissists - they just aren't able to move out of the spotlight and make way for the next generation. Narcissists aren't known for having a lot of insight into themselves or for being able to trust others.

ABCNews.com has been running some interesting commentary about Edwards, narcissism and spouses who cheat on their sick partners. Dr. Stephen Berglas, psychiatrist blogger over at Psychology Today, ran a very informative post about Edwards - prognosis: poor. It would be very difficult for a charming, successful middle-aged narcissist diagnosing himself and getting a lot of attention for his sincere mea culpa to have the kind of wake up call needed for any real change.

But who knows, maybe we are being too hard on him, maybe he is in therapy and this is the diagnosis he has been given and is sharing with us. I have difficulty with health care professionals pontificating about the diagnosis of people they have never met. It isn't playing fair, and it seems, well, a bit grandiose ( a feature of narcissism). We all make mistakes, so we wish him and his family well.

Image - Narcissus by Michael Caravaggio.

Labels: narcissism

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Bernie Mac dies of Sarcoidosis Complications

Everyone who has ever laughed at a Bernie Mac joke was saddened to hear of his premature death at age 50 this weekend, due to complications of sarcoidosis. Not many people know what sarcoidosis is. The cause of sarcoidosis remains unknown but it is a systemic disease resulting in inflammation. Granulomas (masses of tissue) are a common feature and are found most often in the lungs. The disease affects women more than men and blacks more than other races.

Sarcoidosis is a more severe disease in blacks than in other races, [Sarcoidosis, Medical Clinics of North America, Volume 89, Issue 4 (July 2005) Cox, Christopher MD, MPH et al] lung involvement is worse as is long term prognosis. Investigators are looking into environmental factors as a possible trigger for the disease as no genetic markers have been found to date.

Over 85% of people with sarcoidosis have pulmonary problems. Some are candidates for lung transplants. Symptoms (if any) of sarcoidosis are similar to those of many other diseases:

1. malaise
2. fever
3. breathing problems
4. skin bumps
5. cough

Treatment, if any is needed, is usually with corticosteroids and immunosuppressive agents. We are all grateful for the joy and laughter Bernie Mac brought to our lives during his all too short stay on this earth.


Thank you Captain Alcoholica for use of photo of Bernie Mac.

Labels: Bernie Mac, sarcoidosis

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Unraveling the Threads in the Amerithrax Case

The FrederickNewsPost.com reports that Jean C. Duley filed a restraining order against her patient, Bruce Ivins, PhD., because an FBI agent suggested it. Wait a minute? A therapist and program director at Comprehensive Counseling Center in Frederick, who treated her patient once a week in group sessions for 6 months was disclosing confidential patient information to the FBI? I'm sorry - can someone help me out here? Therapists, counselors, please speak up on this issue. Is this usual and customary practice? I've been a nurse a long time and have never had any reason to disclose confidential patient information to law enforcement agents. The counseling center specialized in treating patients addicted to prescription pain medications with suboxone. Ms. Duley no longer works at the center. She did, however, have a history of substance abuse problems herself, with a long string of DUI's, one as recently as April of 2008, and a charge of battery.

Also, I'm sorry, but my understanding is that if a patient is considered a threat to himself or others you keep him hospitalized to protect him and others. A bioweapons expert who is psychologically unstable would not be allowed to check himself out of a psychiatric hospital. Ms. Duley was worried about her own safety. Was she worried about her patient's safety? Now her patient is dead and the American public may never have the answers about our first bioterrorism attack. Where is Homeland Security? According to the FrederickNewsPost.com, Ms. Duley is not a licensed social worker as documented by the FBI. She holds a certified supervised counselor license and must work under the supervision of another clinician. Duley has testified that FBI agents instructed her to file the restraining order against Dr. Ivins. What does her supervising clinician have to say about that?

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Viruses Behaving Badly

Filoviruses can cause severe hemorrhagic fever in primates and humans. It was first recognized in 1967 in an outbreak in laboratories in Germany and Yugoslavia. Did you know Ebola killed 5,000 gorillas in central Africa in 2006?
Family: Filoviradae
Virus: Filovirus
1. Marburg virus
* Europe 1967: 31 cases, 7 deaths
* Africa 1975: 3 cases, 1 death
* DR Congo 1998-2000: 154 cases, 128 deaths
* Netherlands ex Uganda, 2008: 1 case, 1 death
2. Ebola virus
Subtypes:
1. Ivory Coast
* Ivory Coast, 1994: 1 case, 0 deaths
2. Sudan
* 1976: 285 cases, 151 deaths
3. Zaire
* DR Congo, 1976: 318 cases, 280 deaths
4. Reston
* VA, USA 1989: 0 cases - primates only (non-human)
5. New strain
* Uganda 2007: 149 cases, 37 deaths
Multiple outbreaks and many deaths due to Ebolavirus have occurred, in Africa, since the initial cases were reported in 1976. No wildlife reservoir for the virus has been found to date.

RNA viruses:
Family: Bunyaviradae

1. Hantavirus
* USA, 1993- 2007: Hantavirus pulmonary syndrome (HCPS): 465 cases, 168 deaths
* Paraguay 1995: 23 cases
* Argentina 1996: Andes virus, first person-to-person transmission * Chile 1997: 25 cases, person-to-person transmission
* Panama 1999: 11 cases, 3 deaths

*Korea, 1950's: hemorrhagic fever with renal syndrome (HFRS): The classical, severe form of HFRS is characterized by fever, headache, abdominal and lumbar pain, proteinuria, hemorrhage, shock and renal failure and occurs in rural areas of Korea and China with Apodemus mice as reservoir hosts. A less severe form of HFRS occurs in urban areas with the house rat as the main reservoir host. Outbreaks of HFRS in humans involving infected laboratory rat colonies have occurred in several medical centers in various countries. Outbreaks have been reported in Yugoslavia, Greece, Croatia, Russia, Bulgaria.
2. Nairovirus;
Crimean-Congo Hemorrhagic Fever (CCHF): transmitted by ticks and infected blood of febrile patients
* Crimea, 1940's: Congo, 1956.
* Pakistan 1976: 11 nosocomial infections from one infected patient (blood transmission)
* South Africa: 1981 7 cases (transmitted from infected cattle)
* Kosovo,Pakistan, Iran, Afghanistan 2001: exact number of cases unknown
* Turkey, 2003: 1100 cases Mauritania 2003: 38 cases, 3 deaths.
* 2008- cases continue to be reported in Europe and South Africa.
3. Orthobunyavirus:
LaCrosse encephalitis: mosquito-borne viral disease attacking the central nervous system. Also transmitted by blood, body fluids, or tissues of infected animals/humans
* 1963 Wisconsin: about 75 cases annually in the US reported
4. Phlebovirus;
Rift Valley fever (RVFV): mosquito-borne viral disease, also transmitted by blood, body fluids, or tissues of infected animals/humans and aerosol infection in the laboratory
* Mauritania, 1987: 200 deaths
* Saudi Arabia, 2000-2001: multiple cases
* Kenya, Tanzania, Somalia 2006-2007: fatalities


Noroviruses: cause nonbacterial gastroenteritis and are transmitted via contaminated food and water, as well as person to person.
* Increasingly, outbreaks on cruise ships and in hospitals and skilled nursing facilities have resulted in many cases and closures of facilities. Millions have been affected.

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US Execution by Lethal Injection: The Medicine Behind The Headlines

In defiance of the International Court of Justice ordering the US government to grant a stay of execution to five Mexican nationals facing execution, the US state of Texas executed by lethal injection convicted child rapist and murderer, Jose Medellin. President Bush ordered the state of Texas to honor the order of the International Court of Justice but the US Supreme Court ruled that the President overstepped his authority and voted against a stay of execution.

Texas, like most US states, uses a three drug combination for lethal injection, designed to sedate (sodium thiopental), paralyze (pancuronium bromide) and finally, induce cardiac arrest (potassium chloride). The American Medical Association (AMA) and other professional associations consider participation in capital punishment a breach of professional ethics. Killing a human being to serve the interests of the state has been determined to be outside of the scope of practice for health care professionals. Rapid execution has for centuries been considered humane, but there is some debate over how humane the current methods of lethal injection are. Let's just say there has been no Evidence Based study of how to execute someone humanely. At least nothing that is published. So if medical professionals are not assisting at executions, it means that some other employee of the state is inserting the IV catheters used for the procedures.

Anyone with any clinical experience is familiar with the vagaries of IV catheterization experience - will the technician find a patent vein? Will the technician secure the apparatus to prevent infiltration into the surrounding tissues? Will the drugs be flushed through the system adequately to provide sufficient sedation and rapid death? Will the tubes be kept patent and unkinked throughout the procedure? Does everyone know what they are doing? Anesthesiologists have been asked to monitor executions but have declined to participate in them. In 2006, Orin Guidry, MD, president of the American Society of Anesthesiologists (ASA) “Lethal injection was not anesthesiology's idea. American society decided to have capital punishment as part of our legal system and to carry it out with lethal injection. The fact that problems are surfacing is not our dilemma. The legal system has painted itself into this corner and it is not our obligation to get it out.”

The truth of the matter is that physicians do participate in executions, but are not disclosing these actions to the public. The Journal of Legal Medicine reports that physician participation in execution is required in 17 states, but the exact activities of the physicians are not discoverable. Illinois and Kentucky are the only two US states that forbid physicians from participating in state ordered executions. Oklahoma and Georgia are two US states which have enacted laws protecting medical workers who participate in executions.

Thank you jastacey128 for use of image Lethal injection.

Labels: death penalty, execution, lethal injection, medical ethics

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South Park Meets Grand Rounds - Thank You, Jake Young of Pure Pedantry

Training lab rats was making Jake Young a little whack, so he put together a South Park themed Grand Rounds. If you want to learn the cosmetic science approach to some of your favorite rap songs, don't miss the entry and expand your vocabulary to include the word callipygian.

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More Questions than Answers in US Bioterrorism Case

If the FBI's theory that the only significant bioterrorism case in US history, resulting in 5 deaths and 17 illnesses, originated from the US biodefense program, the implications for the US public are profound. Two US Senators - Patrick Leahy D-VT and former Senate Majority Leader Tom Daschle D-South Dakota were targeted in the unprecedented attacks by letters containing anthrax spores, sent through the US Postal system. Twenty-eight people, twenty of them on Senator Daschle's staff, tested positive for anthrax exposure.

Whether or not Dr. Ivins himself was guilty or innocent, the anthrax strain used in the 2001 attack has been traced to our own biodefense laboratories. What does that say about the security of our biodefense systems? What would be the motive of operators within our own defense system attacking the US public and US congressmen? Why is the FBI not cooperating with Congress in this investigation, especially given the fact that Congress was targeted?

Believe it or not, no one branch of government knows the number and location of bioweapons laboratories in the US, according to a report in the Washington Post. Use of biological weapons was outlawed by the 1925 Geneva protocol, but nations continued development and stockpiling of these agents in the 20th century. The 1972 Biological Weapons Convention (BWC), signed by the US and 155 other nations, prohibits production and acquisition of biological weapons. Efforts to develop protocols for verification broke down in 2001 and spending on biodefense jumped to $3 billion in 2007. The Center for Arms Control and Non-Proliferation reports that 15,000 people have been approved to handle bioweapons. Clearly we need stricter security, oversight and transparency of this expanding branch of the defense industry for public health and safety.

Thank you Judy Breck for use of photo Bioweapons.

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Untimely Death of Dr. Ivins, Biodefense Scientist Implicated in Anthrax Deaths

It's called The American Anthrax Outbreak of 2001. Following the attacks on the World Trade Center and the Pentagon, envelopes containing spores of Bacillus anthracis were mailed via the US postal system to news media and government officials. These 23 cases (19 confirmed, 4 suspect including 5 deaths) were the first bioterrorism - intentional release - cases of anthrax in the US. Multi-state investigations were coordinated via the CDC's Emergency Operations Center (EOC). The CDC confirmed 11 cases of inhalational anthrax and 12 cases of cutaneous anthrax in the period of 10/2/2001 through 3/2002. 32,000 people were given prophylactic antibiotics due to possible exposure; of those 10,300 people completed 60-day antimicrobial prophylaxis.

Dr. Bruce E. Ivins was an Army microbiologist [U.S. Army Medical Research Institute of Infectious Diseases (USAMRIID)] working on developing an anthrax vaccine in Fort Detrick's biodefense labs. According to his colleague, W. Russell Byrne, MD, FBI agents had focused on Ivins as the prime suspect in the unsolved bioterrorism case after exonerating another colleague, Steven Hatfill, MD. Representative Rush D. Holt (D-NJ) claims the FBI investigation "...was botched from the very beginning. The FBI did a poor job...". Dr. Bryne has stated Dr. Ivins was suffering from depression and he does not believe he was guilty of bioterrorism. In December 2003, Dr. Ivins was awarded the highest honor given to civilian employees of the Department of Defense - the Decoration for Exceptional Civilian Service for his work on the anthrax vaccine.

Emergent BioSolutions [formerly BioPort] (Rockville, MD) manufactures BioThrax - the only FDA approved anthrax vaccine. The vaccine is not available for use by the general public and is only given to "high-risk populations" (military personnel deployed to places of high risk, personnel working in biodefense laboratories, persons who may handle infected animals or animal products). The Project Bioshield Act of 2004 grants the US Department of Health and Human Services (HHS) $5.6 billion to develop vaccines and medications for biodefense. During the August 2006 to July 2007 reporting period, anthrax vaccine developed under a $242.7 million contract was delivered to the Strategic National Stockpile. The NIH is the lead agency within HHS charged with development of safe and effective products for Project BioShield acquisition. The FDA assures the safety and effectiveness of vaccines.

Anthrax vaccinations were mandatory for military personnel in the 1991 Gulf War. DOD reports estimate that 150,000 troops were inoculated with the vaccine but medical records from the Gulf War do not document who received the vaccine, nor the timing of the injections. The Anthrax Vaccine Immunization Program (AVIP) for all US military forces began vaccinations in March 1998. The mandatory vaccine program was halted in October 2004 after a federal judge cited the FDA for failing to follow its own regulations. The mandatory AVIP was launched again in October 2006, despite protests over concerns about vaccine safety, oversight of manufacturing and regulations, and informed consent. Reporting and oversight have greatly improved since then, according to the medical literature. There seems to be plenty of anecdotal reports of adverse effects of the vaccine, but they are not supported by the literature.

We may never know who was responsible for the intentional release of anthrax in 2001, just as we may never know who was responsible for contaminating Tylenol capsules in 1982. Dr. Hatfill was awarded $5.82 million in a settlement with the US government in which he charged the FBI invaded his privacy and ruined his career. But to a casual observer, it seems a career in microbiology, especially for those involved in some capacity with government research, has become a surprisingly dangerous occupation. I don't know about all of you, but I am still haunted by the deaths of Dr. Don Wiley in 2001 (suicide), Dr. Benito Que 2002 (Dr. Wiley's colleague - cause of death unknown), Dr. David Kelly 2003 (UK biological weapons expert), Dr. Larry Bustard 2004 (Sandia Labs, helped develop foam for Haz-Mat cleanup of anthrax spores : cause of death unknown).



Thank you CDC for use of graphic.

Labels: anthrax, anthrax vaccine, bioterrorism

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