Medical Articles by Dr. Ray

Feb

2004

Less Multiple Sclerosis (MS) With Vitamin D Supplement

By Ray Schilling | Multiple sclerosis, Uncategorized

In multiple sclerosis (MS) the body’s immune system appears to attack the insulation material of nerve cells (called “demyelination”) leading to areas of focal inflammation. These areas can be depicted with MRI scans (see white MS lesions, compared to a normal brain). A new study showed that vitamin D supplementation (as part of a multivitamin supplement) was reducing the risk of developing MS in women when compared to women who did not take supplements. This study was published by Munger et al. from the Department of Nutrition, Harvard School of Public Health, Boston/MA, in the Jan. 13, 2004 edition of Neurology.

The study is based on data from two large nurses health studies (NHS with 92,253 women followed from 1980 to 2000 and NHSII with 95,310 women followed from 1991 to 2001). The study material was pooled into one database. Among these 187,563 women 173 developed MS during the course of the original studies. When the group of women who took 400 IU or more of Vit.D supplements (as multivitamins) were compared to the group who took less than 400 IU or none, the investigators found that they were 40% less likely to develop MS. Other factors that can lead to higher frequencies of MS such as smoking or latitude at birth had been adjusted for. There has not been a change in the results of the protective effect of Vit.D. With food being the only source for vitamin D (skim milk, fish) the protective effect against MS was not demonstrable. However, when food vitamin D was combined with additional multiple vitamin tablets (with vitamin D) the protective effect against MS was observed.

Less Multiple Sclerosis (MS) With Vitamin D Supplement

In the introduction the authors pointed out that Vit. D has been shown in other studies to be an immune response modulator weakening autoimmune reactions. This effect has been shown clearly in a mouse model of MS, called experimental autoimmune encephalopathy. There are also data available from human research, which showed that certain cytokines are released in the presence of vitamin D so that the immune cells are less likely to attack the brain tissue. There were also seasonal variations that could be demonstrated in this study, which indicated that MS lesions were progressing at times when vitamin D levels were low and that they were regressing when vitamin D levels were high.

The authors of this study stressed that this is the first study to suggest a protective effect of vitamin D against MS, which would have to be confirmed in other studies that preferably would also include males. It shows a very strong statistical connection, but cannot conclusively prove causation. The investigators said that further studies will also be needed to confirm the notion that vitamin D may be beneficial as part of the treatment in MS patients.

Link regarding vitamins and minerals: http://www.nethealthbook.com/articles/vitaminsmineralsandsupplements.php#vitaminsandminerals

Last edited December 8, 2012

Feb

2004

Cinnamon A Natural Insulin Booster For Diabetics

By Ray Schilling | Diabetes, Health, Heart Disease, Nutrition

In a recent edition of the medical journal Diabetes Care an interesting article appeared regarding the healing effects of the spice cinnamon. A medical research team in Pakistan (Dr. Khan et al.) in collaberation with a U.S. research team divided a group of 60 comparable diabetics (males and females) in the age range of 45 to 55 and fed one half different concentrations of cinnamon while the other half served as a placebo control. There were three different concentrations of capsules of cinnamon given: 1g, 3 g and 6 g. The placebo control group got capsules with inert material. Here are the results:

The placebo control group showed no change in blood values. The effect documented in this table was achieved after 40 days of cinnamon exposure and was “washed out” after 20 days. Other experiments had found that the substance MHCP (methylhydroxychalcone polymer) is the active ingredient in cinnamon that stimulates insulin and also acts on insulin receptors similar to insulin.

Cinnamon A Natural Insulin Booster For Diabetics

Dr. Richard A. Anderson and his colleagues at the Human Nutrition Research Center of the U.S. Department of Agriculture had already published a number of medical papers on the effects of cinnamon. He was the co-author of this study from the Department of Human Nutrition, NWFP Agricultural University of Peshawar, Pakistan.

Effect of cinnamon on blood values of diabetics
Blood component investigated:	% Reduction of blood test:
Blood sugar level	18-29%
Triglycerides (blood fat value)	23-30%
LDL cholesterol (damaging cholesterol)	7-27%
Total cholesterol	12-26%
HDL cholesterol (protective cholesterol)	unchanged

The interesting observation here is that several cardiovascular risk factors (blood sugar, triglycerides and LDL cholesterol) are simultaneously being reduced with something as simple as cinnamon powder. The authors stated that the cinnamon oil is not effective, only the cinnamon powder or a cinnamon stick dipped into tea (the water soluble component of cinnamon or MHCP). Dr. Anderson also warned not to make the mistake to eat more cinnamon buns or apple pie as there would be unhealthy amounts of sugar, starch and fat added. He suggested that the best to do instead would be to simply sprinkle cinnamon powder over whatever you are presently eating, as this will reduce the risk of getting diabetes or will reduce the risk of a heart attack in diabetics.

This article based on: “Cinnamon improves glucose and lipids of people with type 2 diabetes.” Diabetes Care – 01-DEC-2003; 26(12): 3215-8.

Here is a link to diabetes mellitus (type 2 diabetes).

Last edited December 8, 2012

Feb

2004

Kidney Disease, Another Complication Of Metabolic Syndrome

By Ray Schilling | Hormones, Nutrition, Obesity, Prevention

The metabolic syndrome is a new disease entity that is known to be associated with obesity. In order to make the diagnosis of metabolic syndrome at least 3 of the 5 components listed in the table under this link (hypertension, hypertriglyceridemia, low high-density lipoprotein cholesterol level or LDL cholesterol, high glucose level, abdominal obesity) have to be present.

Dr. Jing Chen and colleagues of Tulane University School of Medicine in New Orleans, La., published an analysis of the Third National Health and Nutrition Examination Survey in the Feb.3, 2004 edition of the Annals of Medicine. Patients with chronic kidney disease were identified in this study where 3, 4 or 5 of the metabolic syndrome criteria were positive. Two criteria for chronic kidney disease were measured:

1. if there was a significant reduction of the filtration capacity of the kidney.

2. if there was critical leakage of blood protein into the urine.

Kidney Disease, Another Complication Of Metabolic Syndrome

Depending on how advanced the metabolic syndrome was (all 5 criteria of metabolic syndrome positive versus only 3 or 4) there was a higher or lower risk of developing chronic kidney disease.

I have depicted the results of this study in bar graph form here. It shows clearly that chronic kidney damage occurs in a dose-response curve pattern depending on how severe the degree of the metabolic syndrome is.

Risk of developing kidney disease with various degrees of severity of the metabolic syndrome

Kidney Disease, Another Complication Of Metabolic Syndrome1

With 5 factors of the metabolic syndrome present the risk to develop reduction in filtration capacity of the kidneys is almost 6-fold. This is 3-fold higher than in a person with a milder degree of metabolic syndrome where only two factors are present. Such a person would only have a 2-fold risk for developing chronic kidney damage (dark blue shaded bars in graph). A dipstick urine test can measure protein in urine, which is an alternative way to measure kidney damage due to the metabolic syndrome. These values followed a very similar dose-response curve (light blue shaded bars in graph). The authors of this study believe that the kidney damage inflicted by the metabolic syndrome is different from that caused by high blood pressure or by diabetes. Future studies will have to establish whether this type of kidney damage can be repaired by treating the metabolic syndrome with a low glycemic, calorie restricted diet coupled with exercise.

Based on an article published in: Ann Intern Med 2004:140:167-174.

Last edited December 8, 2012

Feb

2004

Low Testosterone Linked To Alzheimers

By Ray Schilling | Alzheimer’s disease, Hormones, Mental Health

A recent publication in the medical journal Neurology by Dr. Susan Resnick revealed a surprise link between a lack of testosterone and Alzheimer’s disease.

574 men from the Baltimore Longitudinal Study of Aging who had been followed for about 19 years were analyzed with respect to hormonal factors and their neurological status was also observed. Of these men who ranged in age from 32 to 87 years initially 54 were diagnosed with Alzheimers disease.

When the researchers looked at the hormone status of the men whose mental functioning stayed stable versus those who developed Alzheimers, it was clear that the height of the free testosterone level in the blood (expressed by dividing testosterone by the sex hormone-binding globulin) was a significant predictor for not getting Alzheimers. In other words, if men could maintain a stable level of free testosterone with aging they were significantly protected from Alzheimers disease. The effect was so marked that the blood test could predict 10-years in advance whether a man would develop Alzheimers in future or not. There was a 26% reduction in the risk of Alzheimers with each 10-unit increase in free testosterone.

The same edition of Neurology contains a second report by Dr. Gian Benedetto Melis and coworkers (University of Cagliari, Italy) where around 100 patients (males and females) with Alzheimers were compared with a similar number of patients without Alzheimers. All of their body mass index was in the normal range (20 to 22). These researchers found that the Alzheimers group (both male and female) had an extremely high sex hormone-binding globulin.

Low Testosterone Linked To Alzheimers

The testicles in males and the adrenal glands in males and females can produce testosterone. Dr. Resnick remarked that free testosterone can enter the brain tissue (via the blood brain barrier) easily and act directly on the brain or can be converted to estrogen. Estrogen has been shown in other studies to have a protective effect against Alzheimers. Dr. Resnick cautioned that another study where males with low testosterone levels are getting testosterone supplementation has to be done first before a male should be advised to get treated with testosterone for prevention of Alzheimers disease.

This article is based on a publication by Dr. Resnick et al. in Neurology 2004;62:188-193,301-303.

Comments: It is interesting to note that the “old fashioned” remedies such as weight loss, exercise (particularly anaerobic exercises such as weight training) and a low glycemic diet will naturally increase testosterone levels and vitality in both sexes. A comprehensive program such as the zone diet (by Dr. Barry Sears) or a similar such low glycemic program when combined with exercise will automatically make you lose weight down to a normal body mass index and allow you to maintain it without hunger pangs. It will also normalize hormones in most people on its own as previously elevated insulin levels normalize and the sex hormone-binding globulin will normalize as well. This will make the necessary hormones available to you whether female or male, will prevent osteoporosis (from exercise) and provide enough hormones before and after menopause or andropause to most people. Only a minority of patients will need to get blood tests from their doctors depending on symptoms and those need to seek medical advice to see whether they might benefit from bioidentical hormone replacement therapy.

Further information can be found here: bioidentical hormone replacement.

Last edited October 26, 2014

Feb

2004

Worldwide Alert For Avian Influenza (Bird Flu)

By Ray Schilling | Infectious Disease, Lung Disease

There is a new strain of avian influenza that in the beginning was confined to transmission among birds only. However, with 8 deaths in humans reported in Asia by the end of January 2004 (7 children and one adult) there is a fear that the virus is possibly genetically adapting towards transmission between humans, which could cause a worldwide flu epidemic similar to the flu in 1918 where more than 40 million people died.

Presently the avian flu has killed a high percentage of chickens and ducks in Vietnam, China, Thailand, Indonesia, Pakistan, Cambodia, and Laos. Recently Japan, South Korea, and Taiwan have also been added to the countries where the avian flu has arrived in birds. The governments are busy killing chickens off by the millions in an attempt to stop transmission to man.

All of the human cases were found in people who lived close to chicken farms or who handled diseased chickens.
The virus strain has been characterized as the type A, H5N1 strain (= the H5N1 flu), of the avian influenza. This strain has surfaced in the past on two occasions. First, it hit 18 persons in Hong Kong in 1997 of which 8 persons died. With the help of strict isolation methods an epidemic was prevented. Secondly, in March of 2003 a father and son from Hong Kong had traveled to southern China and they returned sick with the flu. The father died, the son recovered. Disease investigation showed that the source of infection in all of these cases was contact with diseased birds or with live, infected poultry in open markets.

Worldwide Alert For Avian Influenza (Bird Flu)

Unfortunately the present flu vaccines will not give protection against this strain. WHO officials had an emergency meeting at the end of January 2004 to discuss the strategy for preventing a worldwide epidemic with
this new influenza strain. Production of a new vaccine will take several months (up to 6 to 8 months), if it is done in the conventional way. The cheaper antiviral antibiotics such as amantadine and rimantadine that normally would cover an A type influenza are ineffective against this new flu strain. There are newer antiviral antibiotics, which are effective, but they are more expensive. With mass production they could become more affordable and this could interfere with the spread between humans, if the virus should adapt to this transmission behavior.

At the present time migratory birds that are infected with the flu virus are spreading the avian flu to birds in other neighboring countries. In the meantime farmers who are not satisfied with only a 10% reimbursement by their governments for forcefully killed chickens are selling chickens on open meat markets, some of which harbor the avian flu, and this is another possible mode of transmission. David A. Halvorson, a veterinary medicine doctor from the University of Minnesota in Saint Paul stated that the risk for avian flu in the US at the present time is low as the US is not importing any live poultry from Asia.

In an interview between Doug Kaufman from MD Consult and the CDC director Dr. Julie Gerberding on Jan. 29, 2004 it was learnt that 10 patients had died so far in Vietnam and Thailand. Six WHO scientist in Vietnam are working with officials to contain the avian flu in Asia so that it won’t migrate similar to another outbreak of the same type of avian flu strain in Hong Kong in 1997. It appears that the killing of chickens has made some difference. On the other hand the spreading of the disease among wild ducks is of some concern.

The CDC and WHO are working together on this and are pushing for accelerated production of live and of inactivated vaccines against avian flu. This is a type of vaccine, which would make it impossible for future avian flu strains to cross into human hosts. The mass production of antiviral drugs is also being pursued. Dr. Gerberding stated that oseltamivir (brand name: Tamiflu), one of the newer antiviral drugs, would be effective in treating this type of avian flu (cited in Medscape Medical News Jan. 29, 2004).

Dr. Neill, an infection specialist and professor of medicine at the Brown University School of Medicine in Providence, Rhode Island, said that in case of a future human breakout of an epidemic with this flu the following instructions should be followed: 1. cover your mouth and nose with paper tissue when you sneeze or cough 2. frequently wash your hands with soap and water 3. use designated containers for disposal of the used paper tissues 4. symptomatic patients should use face masks to prevent the spread of the flu.

This article is based on the Lancet (The Journal) Vol. 363, Vol. 9406 (Jan. 31, 2004), on news stories from MD Consult and on Medscape news stories.

More info about the Flu: http://nethealthbook.com/infectious-disease/respiratory-infections/flu/

Link to Centers for Disease Control and Prevention on avian (bird) flu

Last edited October 26, 2014

Jan

2004

Poverty Still A Threat To Mothers’ Lives

By Ray Schilling | Health, Prevention, Women’s Diseases

Adrienne Germain from the International Women’s Health Coalition, New York, wrote a review in the Lancet (Lancet 363: 65-66, 2004) about the state of health and mortality of pregnant women (maternal death rate) around the world. 500,000 pregnant girls and women die around the globe every year from conditions that are preventable or treatable. 99% of these live in developing countries. At the same time 3.9 million newborns die every year in their first 4 weeks of life!

2004 is the 10-year anniversary of the recommendation for reproductive health from the 1994 International Conference on Population and Development (ICPD). The maternal death rate in Europe is about 1 in 4000 pregnancies; in many African countries (sub-Saharan Africa) it is 1 in 16! Despite some progress that has occurred, still 70% of all deaths associated with pregnancy occur in only 13 countries. In another article in the Lancet (Lancet 2004; 363: 23-27) Prof. Wendy Graham and co-workers used a new familial technique to determine whether there is a statistical association between poverty and the maternal death rate. The answer is not only a clear “yes” for the maternal death rate within one country, but there is a clear association between poverty and maternal death rate in countries all around the world!
A high mortality rate in babies and children in addition to the maternal death rate has traditionally been a grave concern in poor countries. Research in development countries has shown that 70% of the poorest 1.3 billion people in the world are women. The study also shows that these mothers have a high mortality rate. Maternal death can occur during pregnancy or birth, and the poorer the population group, the higher the maternal death rates will be. The reasons are varied: for the poorest of the poor, medical treatment is often unaffordable.

Poverty Still A Threat To Mothers’ Lives

Also seemingly simple measures such as clean drinking water, toilets and whether floors are present in dwellings do have an impact on health. At the same time the level of education determines whether death rates are higher or lower. These results are not only true for one specific country. Even though most of the alarming numbers come from the African countries such as Burkina Faso, Chad, Ethiopia, Kenya, Mali, and Tanzania, other countries like Indonesia and the Philippines show the same troubling picture.
The main causes of maternal deaths were due to the following conditions: bleeding after delivery, early pregnancy bleeding; infections that would lead to sepsis and death; complications surrounding abortions; blood pressure problems such as eclampsia with seizures and kidney damage; and prolonged labor when the baby’s head is too large. This latter condition requires an Cesarean section on an emergency basis, which is not always readily available in rural areas.

As we know from other studies, even closer to home, poverty and rural isolation remain a risk to health and life.
Adrienne Germain in her editorial review pointed out that some poor countries such as Bangladesh have taken the recommendations for reproductive health from the 1994 ICPD-conference seriously and have instituted a nationally sponsored program.

The result has been that between 1988 and 2002 the percentage of women receiving antenatal care has improved from 26% to 47% while the maternal death rates have declined from 410 to 320 per 100,000 women during and after the pregnancy. Childhood mortality also improved significantly as did the mothers life expectancy (from 58 to 60 years). There are success stories in other countries as well.
What is needed is political will around the globe, co-operation between the appropriate agencies such as the WHO, the UNICEF, the International Women’s Health Coalition, and others. Locally in every country it is vital to have an interdisciplinary co-operation to fight poverty and to provide shelter with a certain minimum living standard.

Link to UNICEF. Link to WHO. Link to International Women’s Health Coalition.

Last edited December 8, 2012

Jan

2004

Old-Fashioned Fish Oil Boosts Heart Health

By Ray Schilling | Health, Heart Disease, Nutrition

You do not need to spoil your appetite with the thought of swallowing cod liver oil, but see yourself enjoy a piece of salmon instead. Dr. Jehangir N Din and collegues published an article entitled “Omega 3 fatty acids and cardiovascular disease—fishing for a natural treatment” in the first January edition of the British Medical Journal (BMJ 2004;328:30-35,January 3, 2004). These cardiology researchers from the University of Edinburgh/England have reviewed all of the recent medical literature regarding the beneficial effects of omega-3-fatty acids on heart disease. The following are some facts they found.

The interesting story regarding the omega-3-fatty acids, which have anti-inflammatory qualities, is that they balance the detrimental effects of the omega-6-fatty acids, which lead to inflammation not only in joints, but also in blood vessels. In the standard North American and European foods the omega-6-fatty acids are overconsumed. To counter the bad effects of the omega-6-fatty acids, more omega-3-fatty acids need to be ingested.

Old-Fashioned Fish Oil Boosts Heart Health

So, what should we consume in terms of omega-3-fatty acids? The American Heart Association made the recommendations in the second table below.

Current consumption of omega-3-fatty acids in North America and Europe is low. Recently an expert US panel of nutritionists determined that the US consumption per day is about 0.1 to 0.2 grams per day and should be 0.65 grams per day as a minimum according to the recommendations by the American Heart Association.

Facts regarding omega-3-fatty acids:

Omega-3-fatty acids from fish and fish oils protect against heart disease

Following heart attacks fish oil is helpful in preventing more heart attacks

Hardening of arteries stops when fish oil or fish is eaten regularly

Rapid response critics pointed out that exercise is as important as fish oil

Trials with fish oil showed reduction in death rates from strokes and heart attacks from between 15% and 29% over 2 to 3.5 years (several studies)

The beneficial effects are due to a combination of stabilizing irregular heart beats, preventing clots, countering hardening of arteries, countering inflammation, improving function of lining of arteries, lowering of triglycerides (bad fatty acids) and lowering of blood pressure

The authors of this paper from England disagree and state that at least 1 gram per day would be needed to lower the heart attack risk to the low levels in Asia. The British Nutrition Foundation has recommended to use 1.2 grams of omega-3-fatty acids per day.

Fish or fish oil capsules as a protective effect on blood vessels*

Patients without documented coronary heart disease: Eat a variety of (preferably oily) fish at least twice weekly. Include oils and foods rich in inolenic acid

Patients with documented coronary heart disease: Consume 1 g of eicosapentanoic and docosahexanoic acid daily, preferably from oily fish. Supplements could be considered in consultation with a doctor

Patients with hypertriglyceridemia: Take 2-4 g of eicosapentanoic acid and docosahexanoic acid daily, provided as capsules under a doctor’s care

How does that translate into how much fish you would have to eat to get about 1 gram of omega-3-fatty acids per day? To make things simpler I have categorized fish and seafood in the table below based on the data from this article into low, medium and high marine derived omega-3-acid foods. You obviously need to eat more of the low category seafood to achieve 1 gram of omega-3-fatty acid than of the high category seafood.

How much fish and seafood you need to eat to get 1 gram of omega-3-fatty acids…
Concentration of omega-3-fatty acids in seafood:	Type of fish and seafood consumed:
Low (eat 1 lbs)	Catfish, Haddock
Medium (eat 1/3 -1/2 lbs)	Tuna, Halibut, Oyster, Cod, Flounder, Sole
High (eat 2 or 3oz.)	Atlantic salmon, Sardines, Rainbow trout, Atlantic herring, Mackerel

Before you overindulge in seafood from the low and medium category, check with your doctor first whether you are allowed so much protein. Some people have protein restrictions due to poor kidney function or because of gout. The authors of this study stated that you should eat a seafood meal with 1 gram of omega-3-fatty acid twice per week. Other sources of omega-3-fatty acids (=alpha-linolenic acid) are plant products such as soy beans,flaxseed, walnuts and rapeseed oil. In Asia fish and soy bean products are consumed in much bigger quantities than in the US.

Last edited December 8, 2012

Jan

2004

China Blows Alarm Whistle On Smoking

By Ray Schilling | Cancer, Health, Heart Disease, Lung Disease, Prevention

The risks of smoking are being addressed in China, where roughly 300 million people or one quarter of the population are puffing away. The number is rising by about 3 million new smokers each year, and according to statistics of the WHO 700,000 die each year from smoking.

In November of 2003 China joined the Framework Convention on Tobacco Control (FCTC), a subsidiary of the World Health Organization. As a member China is now obliged to tighten restrictions on cigarette marketing and consumption.
Due to an economic boom in the country foreign tobacco giants are putting their hope into this rising market, as revenue has decreased elsewhere in the world. So far tobacco taxes, which are collected from the 1.7 trillion cigarettes sold in China amount to 8 billion $US or one tenth of government revenue. In the wake of SARS, however, the realization has come to the forefront, that health care cost have a severe impact on the economy of a country. Despite the seemingly enticing short-term gain from tobacco tax revenue, short cuts in health care can economically damage a country in the long run.

Health officials will have a battle with their counterparts in finance, when it comes to implementing tobacco control. In some areas of the country the sale of tobacco products to children has been banned and an attempt has been made to restrict cigarette commercials.

Quit smoking!

Powerful tobacco lobby groups actively undermine these efforts.
It is encouraging to see at least a beginning of public education about the risks of smoking. However, in a nation where cigarette manufacturing and consumption are the highest worldwide, it will be a long and arduous journey to clear the air to better health.

Based on The Lancet 363, No. 9402 (Jan. 3, 2004)

Last edited December 8, 2012

Jan

2004

Flu Season Not Over Yet

By Ray Schilling | Health, Infectious Disease, Lung Disease, Prevention

Influenza type A is the cause of many flu epidemics including the one that recently affected the northern hemisphere. It is known to change its surface characteristics from time to time. This has occurred in the southern hemisphere (Australia and New Zealand) during the summer of 2003 and the same new type has caused the recent epidemic in Canada, the US and Europe.

Prior strains of flu viruses in recent years were variants of the Panama strain, that’s why the infection specialists decided in the beginning of 2003 to suggest a Panama strain type vaccine to be used for protection for this flu winter season. However, 70% of the cases tested in Canada by the end of November turned out to be influenza type A/Fujian,full name A/Fujian/411/2002(H3N2), different from type A/Panama, full name A/Panama/2007/99(H3N2), according to Dr. Theresa Tam. She is a specialist in the division of respiratory diseases at the Health Canada Centre for Infectious Disease Prevention and Control. Similar observations regarding a shift from the type a/Panama to the type A/Fujian strain of the flu virus has also been reported in the US and in Europe. It appears that those who have been vaccinated with the type A/Panama vaccine have had partial protection from this new flu as some of the flu virus characterisitics (e.g. the H3N2 determinants) are the same.

Dr. Tam mentioned that the recent deaths in children from the flu in the US, England and Canada would likely be explained by the fact that in the last 3 years there have not been any H3 type flus and the flus that did circulate were relatively mild. This means that children have not developed enough background resistance to fight a flu when it comes. Most adults have background resistance, but older people are loosing some of the resistance due to aging. Dr. Tam explained that not too many children have had the flu vaccination. One would expect that children are most vulnerable for the flu and this explains why these deaths would have occurred.

Flu Season Not Over Yet

Production of flu vaccines that protect from flus: One of the problems with getting the best match for an upcoming flu season is the lag period between the decision to produce a certain type of flu vaccine and the mass production of the vaccine to serve a world population. This can take 6 to 8 months. A new technique of vaccine production is being investigated, called “reverse genetics”, where the lag period may only be a few weeks.

Dr. Webster, an infectious disease specialist at the St. Jude Children’s Research Hospital in Memphis, has produced a vaccine with this method against an avian flu with the characteristics H5N1(different from the others mentioned above). This is an older flu transmitted by birds that has resurfaced earlier in 2003 again. However, this vaccine that has been produced in cell culture and not in egg cultures, has only been tested in animal models, not in humans yet. Both Dr. Webster and Dr. Tam agree that human trials under FDA guidelines are needed to test these newer vaccines utilizing reverse genetics. Regulatory and patent issues need to be settled for this to happen.

Use of antiviral drugs: Another issue is that type A influenza can be treated with antiviral antibiotics, but every flu season these types of drugs tend to run short. Each country should have a national stockpile of these antiviral drugs (such as Tamiflu) so that enough stock is available in case of a serious epidemic where the vaccine may not fit the flu strain that comes around. This is not happening at the present.

What is needed is that international discussions take place through the Global Health Security Network (right now consisting of the G7 countries and Mexico), Dr.Tam said.

Conclusion: The flu season has started early this season. Many people have died because of a lack of vaccination. Some of those who were vaccinated against the flu may have caught the flu as the fit this year with regard to the vaccine was not the best. However, they likely survived the flu, whereas those who did not have the vaccine were more likely to have experienced the flu more severely and some of these have died. It is not too late to get the flu vaccine before the spring season. Typically there is another peak of the flu between February and April.

Based in part on The Medical Post, Dec.9, 2003 (p.1 and 73).

Last edited December 8, 2012

Dec

2003

Bystanders Become Lifesavers: Immediate CPR Improves Survival

By Ray Schilling | Health, Heart Disease

Cardio-pulmonary resuscitation (=CPR) is known to save lives, but it has been known for some time that it has to be applied as early as possible to save lives on the longterm. In a recent study in Ottawa/Ont., which was published recently in the medical journal Circulation, the OPALS study checked out survival data.

OPALS is an acronym for Ontario Prehospital Advanced Life Support Study. One of the lead authors, Dr. Ian Stiell, emphasized that CPR done by bystanders (such as immediate family members) right in the beginning of a cardiac arrest will double the probability of having a survivor with quality of life that is very good.

Here are some detailed figures from that study. Only 14% to 15% of patients who suddenly collapse and are in need of CPR actually receive CPR. There were 8,091 cases of cardiac arrest that occurred between 1995 and 2000 in Ontario. Only 5.2% (418 patients) survived until the time of discharge from the hospital. 4% (324 patients) survived until the timeline of 1 year after the event. Of these the researchers were able to interview 268 survivors.

Bystanders Become Lifesavers. Immediate CPR Improves Survival

CPR saves lives

The following are a few observations from the OPALS study:

1. 85% of cardiac arrests happen at home.

2. 43% of cases are witnessed by bystanders, so if they all would know CPR about 3-times more unconscious patients could receive CPR (14% to 15% times 3 equals about 43%).

3. 65% of cardiac arrests in the OPALS study occurred in men. The authors recommended that women over 40 should get trained in CPR.

4. Women usually play a more pivotal role in taking care of elderly parents, of their spouse and of children, which puts them more likely into a situation where bystander CPR is required.

5. Family members of heart attack survivors should be encouraged to take a CPR course as the probability of a cardiac arrest is higher in these patients.

6. All 4 links to successful resuscitation are important: CPR by a bystander; defibrillation; rapid access to care; early advanced cardiac life support.

7. Contrary to rumors the long term outlook of successfully resuscitated patients is good and after 1 year the survivors have a quality of life as good as their healthy peers. However, without CPR initially the quality of life is only half as good as those who had someone provide CPR on them. The authors found it difficult to dispel some of the misconception surrounding CPR. Some of the myths are the notions that a person could do some harm by administering CPR or not performing CPR it correctly. They said it is important to be decisive and administer CPR to an unconscious person and call for an ambulance.

Summary: The OPALS study re-emphasized the importance for everybody to learn CPR. You never know when you need this skill. The more people know it, the more lives will be saved.

Here is a link to the University School of Medicine site entitled “Learn CPR – you can do it!”

Last edited December 8, 2012

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