whats wrong with this woman!

JOHANNESBURG, South Africa, Sept. 13 (UPI) -- Health authorities in South Africa were on high alert Wednesday after a woman with a deadly strain of tuberculosis left a hospital against doctor's orders.
Doctors later located and quarantined the HIV-positive woman -- who had refused treatment and walked out of a Johannesburg hospital -- but they fear she infected other people with extremely drug-resistant tuberculosis.
Sometimes known as XDR tuberculosis, the virulent disease already has killed 52 people in the neighboring KwaZulu-Natal province, the U.N. Integrated Regional Information Network reported.
"We will now trace her contacts ... and test them for the XDR tuberculosis strain," said Dr. Abdul Rahman, the health department's chief of operations. "If there are any signs she has spread the disease, we will isolate those patients and begin treatment immediately."
The emergence of XDR tuberculosis has put health officials on high alert across South Africa, where one in nine people is HIV-positive and 900 die every day from AIDS.

now its TB resistance!

South African health authorities went on high alert on Wednesday after officials confirmed a case of a new, deadly strain of tuberculosis (TB) in Johannesburg, the country's economic hub.Officials said the case, a woman, had refused to stay in hospital -- stoking fears the TB strain could spread rapidly through communities already weakened by HIV/Aids."We are really treading carefully. We don't want to create a scare," Sybil Ngcobo, head of the Gauteng department of health, told a news conference.Laboratory tests confirmed the case of a highly drug-resistant strain of TB on Friday but authorities only took action today [Wednesday] after a story in The Star, a local daily newspaper, reported that the disease had been detected in Johannesburg.Ambulances and police cruisers were dispatched to the home of the woman, who had ignored doctor's orders to stay put at Johannesburg's Sizwe Hospital.Officials said they plan to take court action if the woman refuses to go into isolation to prevent spread of the highly contagious airborne illness.Authorities are asking family, friends, health workers and anyone else who may have come into contact with the affected woman -- whom they not identified -- to get tested.The Johannesburg alert marks the first confirmed case of XDR-TB (extremely drug resistant tuberculosis) outside of the eastern province of KwaZulu-Natal, where it has been blamed for the deaths of about 60 people.Doctors in KwaZulu-Natal said the TB threat continued to mount there."We are seeing two or three new cases each month," said Dr Tony Moll, who detected the first case at a Durban hospital. "We know it's everywhere."Revised figures show KwaZulu-Natal saw a total of 63 people diagnosed with the extremely virulent form of TB, Moll said. Of the 60 who died almost all tested for HIV were positive.Tuberculosis is especially dangerous for those with immune systems sapped by HIV, the virus that causes Aids. South Africa has one of the highest caseloads of HIV in the world, with an estimated five million of the country's 45-million people infected.The only other documented outbreak of the deadly strain in South Africa was several years ago when six people died in the central Gauteng province and were later found to be carriers of XDR-TB.Medical experts have said South Africa must quickly stamp out the TB virus, although it remained unclear when or if effective antibiotic treatments might be widely available. -- Reuters

same hiv drug resistant srain.Read it!

A highly resistant strain of HIV linked to rapid progression to AIDS has been identified in New York City, US, but AIDS experts have cautioned that it may just be an isolated case and not the harbinger of a "superstrain" outbreak.
The case of a person infected with an HIV-strain resistant to three of the four classes of HIV drugs was announced by New York City's department of health and mental hygiene on Friday. The man had also developed AIDS much faster than most people infected with HIV.
HIV drug resistance is not uncommon in patients who are being treated for HIV, but it is extremely rare in newly diagnosed cases, such as this patient. The man might have contracted the strain from someone who had been receiving treatment.
The time taken for HIV-infected patients to fall ill with AIDS varies. But this is the first time fast progression to illness has been seen in combination with this level of drug resistance - further tests have revealed the strain is resistant to 19 of the 20 licensed anti-retroviral drugs.
Crystal meth
The man is in his forties, had had multiple male sexual partners and also used the drug crystal methamphetamine (crystal meth). He fell ill with AIDS within 2 to 20 months of infection with HIV, says the New York department. Onset of AIDS usually occurs more than 10 years after HIV infection.
Also, the HIV strain seen in this man appears to be able to attach to two different receptors on the CD-4 immune cells - the target cells of the virus, which it hijacks. In the vast majority of HIV patients, the virus first attaches to one of the receptors and later - after several years - attaches to both.
"This patient's infection with an HIV-1 strain not amenable to standard anti-retroviral therapy, along with his rapid clinical and immunological deterioration, is alarming," says David Ho, head of the Aaron Diamond AIDS Research Center in New York, which is investigating the case. "While this remains a single case, it is prudent to closely watch for any additional possible cases."
The development and transmission of a drug-resistant HIV strain is well-documented, says Deenan Pillay, head of HIV research at the UK's Health Protection Agency, as is the fast-progression to AIDS in some people.
"Here's a case where both have come together - but I don't think they are necessarily related to each other," Pillay told New Scientist.
He says the new case is a concern, but adds: "We don't want to draw too much from this. It doesn't necessarily mean that the virus will start to take-off." HIV is "always mutating, always changing", he points out, meaning the virus never becomes fixed as a single strain in the human population.
Unwelcome variant
"The extensive use of anti-retroviral drugs in the community may have selected this unwelcome triple drug-resistant variant," speculates Craig Pringle, viral diseases moderator for the infectious diseases mailing list ProMed Mail. "An outbreak of HIV not amenable to treatment with currently available drugs is in the offing."
Pringle also highlights the possibility that the patient could have been infected with strain of HIV that had spontaneously mutated, and is therefore unique to him.
Another unknown is the effect the patient's drug abuse had on the progression to AIDS. Some experts suggest the crystal meth could have weakened his immune system, allowing AIDS to develop more rapidly. And even his genetic make-up is likely to have some, as yet unspecified, effect

hiv dru resistance. Crazy or what?

A highly resistant strain of HIV linked to rapid progression to AIDS has been identified in New York City, US, but AIDS experts have cautioned that it may just be an isolated case and not the harbinger of a "superstrain" outbreak.
The case of a person infected with an HIV-strain resistant to three of the four classes of HIV drugs was announced by New York City's department of health and mental hygiene on Friday. The man had also developed AIDS much faster than most people infected with HIV.
HIV drug resistance is not uncommon in patients who are being treated for HIV, but it is extremely rare in newly diagnosed cases, such as this patient. The man might have contracted the strain from someone who had been receiving treatment.
The time taken for HIV-infected patients to fall ill with AIDS varies. But this is the first time fast progression to illness has been seen in combination with this level of drug resistance - further tests have revealed the strain is resistant to 19 of the 20 licensed anti-retroviral drugs.
Crystal meth
The man is in his forties, had had multiple male sexual partners and also used the drug crystal methamphetamine (crystal meth). He fell ill with AIDS within 2 to 20 months of infection with HIV, says the New York department. Onset of AIDS usually occurs more than 10 years after HIV infection.
Also, the HIV strain seen in this man appears to be able to attach to two different receptors on the CD-4 immune cells - the target cells of the virus, which it hijacks. In the vast majority of HIV patients, the virus first attaches to one of the receptors and later - after several years - attaches to both.
"This patient's infection with an HIV-1 strain not amenable to standard anti-retroviral therapy, along with his rapid clinical and immunological deterioration, is alarming," says David Ho, head of the Aaron Diamond AIDS Research Center in New York, which is investigating the case. "While this remains a single case, it is prudent to closely watch for any additional possible cases."
The development and transmission of a drug-resistant HIV strain is well-documented, says Deenan Pillay, head of HIV research at the UK's Health Protection Agency, as is the fast-progression to AIDS in some people.
"Here's a case where both have come together - but I don't think they are necessarily related to each other," Pillay told New Scientist.
He says the new case is a concern, but adds: "We don't want to draw too much from this. It doesn't necessarily mean that the virus will start to take-off." HIV is "always mutating, always changing", he points out, meaning the virus never becomes fixed as a single strain in the human population.
Unwelcome variant
"The extensive use of anti-retroviral drugs in the community may have selected this unwelcome triple drug-resistant variant," speculates Craig Pringle, viral diseases moderator for the infectious diseases mailing list ProMed Mail. "An outbreak of HIV not amenable to treatment with currently available drugs is in the offing."
Pringle also highlights the possibility that the patient could have been infected with strain of HIV that had spontaneously mutated, and is therefore unique to him.
Another unknown is the effect the patient's drug abuse had on the progression to AIDS. Some experts suggest the crystal meth could have weakened his immune system, allowing AIDS to develop more rapidly. And even his genetic make-up is likely to have some, as yet unspecified, effect

comm health

i think it should be taken to 2nd year. what do you think?

treatment of multiple myeloma

Physicians must understand both the natural history of the disease and the limitations of current therapy in the treatment of multiple myeloma.
An important study by Dimopoulos and associates evaluated the risk of disease progression in asymptomatic subjects with multiple myeloma. This study evaluated 638 consecutive untreated subjects with myeloma. Of these subjects, 95 were asymptomatic and were not treated until their M protein value rose to greater than 5 g/dL. These subjects developed increased bone disease or symptoms of bone disease. The subjects in this group were designated as either low risk (ie, no bone disease, M protein level <3>3 g/dL or Bence Jones protein level >5 g/24 h). Intermediate-risk subjects did not have bone disease or an M protein level greater than 3 g/dL or a Bence Jones protein level of greater than 5 g/24 h. The patients were evaluated every 2 months.

The median time for disease progression was 10 months in the high-risk group, 25 months in the intermediate-risk group, and 61 months in the low-risk group. At the time of progression, subjects were treated with standard chemotherapy. The subjects' response rates did not significantly differ from those of unselected populations. The median survival time from the institution of chemotherapy did not differ among the groups. To summarize, asymptomatic subjects did not benefit from early treatment, and delayed treatment did not affect the efficacy of the treatment (ie, survival).

Patients for whom therapy is indicated typically receive chemotherapy. Physicians treat many patients with high-dose therapy and peripheral blood or bone marrow stem cell transplantation. A randomized prospective study shows that this approach results in higher response rates and better disease-free survival rates.

Adjunctive therapy for myeloma includes radiation therapy to target areas of pain, impending pathologic fracture, or existing pathologic fracture. Bisphosphonate therapy serves as prophylaxis (ie, primary, secondary) against skeletal events (eg, hypercalcemia, spinal cord compression, pathologic fracture, need for surgery, need for radiation). Erythropoietin may ameliorate anemia resulting from either myeloma alone or from chemotherapy and has been shown to improve quality of life.

Patients with spinal cord compression due to multiple myeloma should begin corticosteroid therapy immediately to reduce swelling. Urgent arrangements must be made for radiation therapy in order to reverse or maintain neurologic function. Although surgical decompression is sometimes appropriate, posterior laminectomy in this population has been reported to have a mortality rate of 6-10% and to not be superior to radiation. This surgical approach is probably best reserved for patients in whom radiation fails. Newer surgical interventions, such as kyphoplasty, in which cement is injected into compressed vertebrae, have been shown to improve function with few complications, although the studies reported have been small.
Patients presenting with acute renal failure may benefit from plasmapheresis. Hydration (to maintain a urine output of >3 L/d), management of hypercalcemia, and avoidance of nephrotoxins (eg, intravenous contrast media, antibiotics) are also key factors.

Transplantation
Using the patient's own (ie, autologous) bone marrow or peripheral blood stem cells facilitates more intense antimyeloma therapy. Physicians can use otherwise lethal doses of total body irradiation and chemotherapy and then "rescue" patients by infusing patients' own stem cells. This sequence of myeloablative therapy, followed by the reinfusion of stem cells, is termed an autologous stem cell transplantation. This sequence of therapy allows physicians to use melphalan at an approximately 10-20 times higher dose than is used in standard therapy. In autologous transplantation, the reinfused stem cells or bone marrow act as a support to the patient but do not offer additional anticancer effects.
Tandem autologous transplants have been proposed as a way of overcoming the incomplete response to a single transplant. A recently reported 2 arm trial of single versus tandem transplants revealed no difference in overall survival at 54 months (Moreau, 2005).
In highly selected patients with multiple myeloma, physicians may use allogeneic (ie, from someone else) transplantation. In this approach, physicians administer myeloablative therapy and infuse stem cells (ie, peripheral blood or bone marrow) obtained from a donor, preferably an HLA-identical sibling. The advantage of this approach is that the patient is not at risk of being reinfused with myeloma cells. Also, the donor's immune system may fight the recipient's cancer (ie, graft vs myeloma effect). Unfortunately, the donor's immune system also may attack the recipient's body (ie, graft vs host effect).

Two randomized prospective studies compared standard chemotherapy with high-dose autologous transplantation. In the first study of 200 subjects, researchers observed better response rates (ie, 81% for the transplantation group vs 57% for the conventionally treated group) and better 5-year event-free survival rates (ie, 28% vs 10%). The second study also showed a significant improvement in event-free survival rates and superior quality of life for subjects treated with the high-dose approach.

Physicians treat myeloma with allogeneic transplantation less often than autologous transplantation for several reasons.

First, the risks of complications and death from allogeneic transplantation increase with age, and most patients with myeloma are older than the ideal age for allogeneic transplantation.
Second, the transplantation-related mortality rate is quite high in patients with myeloma who undergo allogeneic transplantation. The death rate within 100 days of transplantation ranges from 10-56% in different series.
Third, although some survivors experience long-term disease-free results after allogeneic transplantation, a retrospective case-matched analysis of allogeneic versus autologous transplantation showed a median survival of 34 months for the autologous transplantation group and 18 months for the allogeneic group.
The exception to this rule is the rare patient with a twin donor. In a limited study of 25 transplantations involving twins, outcomes with syngeneic transplantations were superior, with reduced transplantation-related mortality.

The development of a nonmyeloablative preparative regimen for myeloma allogeneic transplantation is changing the equation. A recently republished report of 52 high-risk patients who underwent nonmyeloablative transplants described a 17% mortality rate. Progression-free survival at 18 months was roughly 30% (Gerull, 2005).

Radiation
Myeloma is extremely sensitive to radiation.
Physicians use radiation to treat symptomatic lesions and to stabilize bones at risk for fracture.
Physicians also use radiation to treat spinal cord compression.
Some researchers tried low-dose, double-hemibody irradiation as systemic therapy but did not observe dramatic success.

Surgical Care:
Surgical therapy for myeloma is limited to adjunctive therapy.

Consultations:
Patients often benefit from the expertise of an orthopedic surgeon versed in oncologic management because prophylactic fixation of impending pathologic fractures is occasionally warranted.

Diet: Patients with myeloma who are receiving bisphosphonate therapy should include adequate calcium in their diet.
Activity:
Encourage patients with myeloma to be physically active, as appropriate to their individual bone status. Physical activity may help

medical stories

Completely unaware of a 5 cm
nail stuck in his skull, a South
Korean man sought treatment for
a severe headache at a hospital in
Seoul. Doctors suspect that the nail
had found its destination during an
accident the man had had four years
earlier (www.ananova.com).

Pharmacogenetics may help
smokers quit. Based on the discovery
of a gene that predisposes
to tobacco addiction, a new antismoking
programme has been developed. After
undergoing DNA analysis, smokers who
want to give up receive personalised
advice on which nicotine replacement
therapy may be most appropriate. The
programme developers argue that tailored
therapy increases the chances of
success and reduces the risk of side effects
(www.ananova.com).

Are police stations and law courts soon going to stock
up on magnetic resonance imaging (MRI) scanners
for criminal hearings? American researchers claim
that functional MRI (a technique that determines which part
of the brain is activated during the performance of a given
task) is at least as reliable in detecting liars as a conventional
polygraph lie detector, which basically measures how anxious
someone is. As lots of people may become anxious anyway,
when attached to a polygraph, and as good liars may not
become anxious at all, the latter technique has considerable
limitations, the researchers argue. More and other areas of the
brain were active in people who tried to lie than in those who
told the truth, they showed in a pilot study with 11 participants.
The team thinks that functional MRI has potential as
an accurate test for deception (www.bbc.co.uk).
Eyespy recommends you to shut your baby up
(by consoling it, of course). Leaving children to
cry without offering them any comfort could
result in lasting damage to their brains, psychologist
Margot Sunderland alerts parents and carers in her
new book on raising children. Persistent distress early in
life is associated with agenesis of the corpus callosum (an
area of the brain that links the two hemispheres) on computed
tomography scans, she says. Professor Sunderland
believes that uncomforted weeping during early childhood
is a major cause of the rising prevalence of mental
health problems in adolescents (www.dailymail.co.uk).
Two fifths of the male paramedical students had
had more than 10 sex partners, compared with
only 9% of the male medical students, found a
recently completed study. Having questioned 359 senior students
at a school of health professions in Greece,
researchers presented their findings at the annual congress
of the European Society for Sexual Medicine, recently held
in London. Additionally, 73% of the male paramedics but
only 37% of the male medics had had their first sexual experience
before the age of 18. There was no major difference
between female medics and paramedics. Most female students
had had less than five partners and had started their
sex lives between 18 and 20 years of age. Eyespy leaves the
interpretation of these findings to you.

Good news for chocaholics: chocolate may soon be
available on prescription. Probably sponsored by
Swiss chocolate manufacturers, scientists of Imperial
College, London, suggest that theobromine, one of chocolate’s
ingredients, is more effective in treating cough than
codeine. They show that higher concentrations of capsaicin
were required to induce cough in people previously given
theobromine than in those given a placebo or codeine.
Theobromine apparently works by reducing vagus nerve
activity and did not cause any side effects in the 10
volunteers that participated in the study. The researchers
do not say how much chocolate coughers would have to
eat to get a beneficial effect. A reader of the BBC News
website concludes: “There is nothing that chocolate cannot
[help with]. You can even melt it and pour it on ice cream
if things are really bad” (http://news.bbc.co.uk).

Shakespeare, the Bible and Gray’s
Anatomy—this is all a doctor ever
needs to read, according to
American novelist and Nobel prize
winner, Sinclair Lewis. In more
modern times, however, the 146 year
old Gray’s Anatomy has been belittled
as a “slightly updated Victorian
dinosaur.” The anatomical work has,
therefore, undergone major surgery
in its recently launched 39th edition
and has been fully restructured by
body region rather than system.
Various sections have been
expanded, and the number of
illustrations has risen to nearly 2000.
Despite these changes, the volume
has shrunk by more than 20%,
thanks to the removal of unnecessary
“Victorian purple prose”
(www.graysanatomyonline.com).
44 STUDENTBMJ VOLUME 13 JANUARY 2005
eyespy Eyespy brings
you the latest
quirky medical
stories from
around the world
studentbmj.com
Eyespy has at last found a genuine
excuse for her night time
activities: infidelity may have a
genetic origin. In a survey involving
1600 pairs of twins, researchers
from St Thomas’s Hospital in
London found that as much as 40%
of female infidelity could be
explained by heredity. The team is
assessing the impact of genes on
various human behaviours and
medical conditions by comparing
identical with non-identical twins.
They assume that, if genes play a
role, identical twins are more likely
to share a trait than non-identical
twins. The latest study reveals that
22% of women reported being
unfaithful to a regular partner,
although most of them also thought
that infidelity was wrong in every
case. The researchers were unable
to link human behaviour to a
“fidelity gene,” recently identified by
American scientists in voles
(www.guardian.co.uk).
Father Christmas helps boost
children’s social and cognitive
development, a psychiatrist
declared in an article titled “What if
Santa died?” in the Psychiatric Bulletin.
Dr Lynda Breen argues that believing
in Father Christmas may promote
kindness and cooperation in children.
“Many letters to Santa include a
wish for someone else, including the
poor or the sick,” she says. Moreover,
writing to Santa enhanced creative
thinking. In the same issue, another
psychiatrist warns that modern society
is unwisely holding rationality
above all else and that the issue is not
merely about the death of Santa but
rather the death of imagination.
“Why should any child running The
Sims on the home PC need to
believe in Santa Claus, when he or
she can actually be him?” he points
out. Eyespy pleads doctors to do anything
to keep Father Christmas alive
and wishes “Merry Christmas!” to all
her readers (http://pb.rcpsych.org).
AP/YONHAP

diabetes

can any medical guy out there talk on daibetic nephropathy and what treatment is given for the diabetes un this situation. is it insulin or oral hypoglycemics

med students

this is for all med students in kenya