Tuesday, March 6, 2018

Female cricumcision and problems in chid birth

the TNStar has an article on doctors/ midwives who have to cope with obstructed labor from the scar tissue from "female circumcision"..

a lot of women having their first baby get a small downward cut called an "episiotomy" to make labor shorter. But after the severe type of female circumcision, the scar tissue is so bad you have to cut upward too.

that hasn't stopped the PC feminist types from defending the mutilation:

While WHO is working to eradicated FGM, two U.S. OBGYNs in 2016, published a paper in the Journal of Medical Ethics by seeking to destigmatize FGM by calling it “female genital alteration.” They offer a “compromise solution” that would medicalize FGM if states would “legally permit de minimis FGA in recognition of its fulfillment of cultural and religious obligations…”

Why, yes. We ran into this among our Muslim ladies in Liberia.

the custom predates Islam, and Mohammed, knowing he couldn't eliminate the custom, advised to "just cut a little".

In Arab and North African countries. the removal of all external

genitalia (clitoris, labia minora and labia majora) is still done.

but a small clip of the sheath of the clitoris could be substituted without causing problem.


Rabies: Still a threat: 60 000 cases a year

This article from the CDC is about a few women in VietNam who didn't get anti rabies vaccine after being bitten because they were pregnant or breastfeeding and worried it would harm their fetus.

But the article includes this terrible fact:
Most of the world’s estimated 60,000 annual rabies deaths occur in countries where canine rabies is endemic and where PEP is often inaccessible to bite victims (4).
but cases have decreased in Vietnam thanks to the availability of the antirabies vaccine:

Vietnam has made progress in reducing human rabies deaths. The number of human rabies cases declined 82%, from 505 cases in 1994 to 91 in 2016 (3). The expansion of PEP centers in the country has played a critical role in this reduction by increasing access to PEP. 

this chart is from the Philippine health dept: we have about 200 cases a year here, and there is a push to eliminate cases by providing the shots, and also dog control.


our new mayor has started providing free post exposure rabies vaccine at the local health clinics.

Alas, they keep running out of the free vaccines, so I have provided money for two people in the last three months so their kids can finish the series of shots. (650 pesos a shot, four shots: that is 13 US dollars. But the minimum wage here is 300 pesos or six dollars a day, so you can see the problem).

Stray dogs are a problem: The authorities will pick them up (and kill them, infuriating PETA and their ilk). But stray dogs are miserable: Thin, mangy, and usually shy.

But most of the bites are from neighbor's dogs, who weren't vaccinated.

The government does have rabies shot clinics in our farm areas, for farm dogs to get shots, and you can get free shots here for the dogs if you know when they hold the clinic, but not everyone is doing it.

We usually pay to have the vet come here and give Rabies shots to all our dogs in May each year. It is cheaper than paying for vaccine when a visitor gets bitten. Not just by George, our killer lab (who used to bite anyone who got close to him even though he is chained at all times) but even Joy's masseuse was bitten by one of our small pet dogs who didn't recognize she was a friend.

and this audiobook tells the story of rabies:


Opioid overdoses in the ER


Among approximately 45 million ED visits reported by the 16 ESOOS states from July 2016 through September 2017, a total of 119,198 (26.7 per 10,000 visits) were suspected opioid overdoses. Opioid overdose ED visits increased 34.5% from third quarter 2016 to third quarter 2017 (Table 2). Ten states experienced significant increases in prevalence during this period, although substantial variation was observed among states in the same region. For example, in the Northeast, significant increases occurred in Delaware (105.0%), Pennsylvania (80.6%), and Maine (34.0%), but other states, including Massachusetts, New Hampshire, and Rhode Island experienced nonsignificant (<10%) decreases. In the Southeast, a significant increase (31.1%) occurred in North Carolina, a significant decrease (15.0%) occurred in Kentucky, and a small, nonsignificant decrease (5.3%) was observed in West Virginia. In the West, a significant increase (17.9%) occurred in Nevada. All states in the Midwest reported significant increases, including Wisconsin (108.6%), Illinois (65.5%), Indiana (35.1%), Ohio (27.7%), and Missouri (21.4%).
All urbanization levels experienced large and significant increases in ED opioid overdose visits from third quarter 2016 to third quarter 2017, including large central metropolitan (54.1%), medium metropolitan (42.6%), small metropolitan (36.9%), micropolitan (23.6%), large fringe metropolitan (21.1%), and noncore (20.6%) areas. Large central metropolitan areas experienced significant linear increases (Figure 2).

most are in urban areas in the midwest.

 one interesting item is that xanax laced with fentanyl is now being sold in the street.

Drugabuse.com:

Most buyers simply don’t realize they’re getting something totally different than what they intended to purchase, especially when this new counterfeit Xanax is made to look exactly like a 2mg Xanax pill. It even bears the fake “XANAX” label, along with boasting a similar size, shape and color. Some of these fake pills are so good, in fact, even forensic scientists can’t tell the difference just by looking at them. That’s just how good these counterfeiters have become at manufacturing Xanax dupes.

what is not being said: Most of the fentanyl comes from China, as does these "counterfeit" xanax pills.

FoxNews: it is a popular "party" drug and popularized by the hip hop music industry types:

Xans have been glorified by hip hop artists in the music industry, they’ve appeared in numerous of their music videos, and they’re being sold all over social media, especially Instagram, including by a popular DJ in the San Fernando Valley.
“I think the reason Xanax is popular with the kids is it’s being popularized in music, social media platforms, it’s in almost every song, my son even asked me what’s molly Percocet, and he’s nine years old,” Whitfield said. “Fentanyl has been pouring in from China, where there are looser regulations and an abundant amount of pharmaceutical companies...
 The DEA told FOX 11 that fentanyl has been pouring into the United States from China, where there are looser regulations and numerous pharmaceutical companies, and that between 2014 and 2016 the amount that was seized coming into the US went up eighteen fold.
2017 is expected to be even worse.
CNN report here.


Pill presses -- which can easily be bought online -- allow someone to take powder and press it into a pill that looks legitimate. "People have died from ingesting what they think is a legitimate painkiller, (but really) it's a counterfeit pill that contains fentanyl," Martin said.
Across the country, authorities have seen this play out.

The Fentanyl comes from China, often is bought via the dark net, and the pill making machines are also from China.

 Most come from China. That's where much of the illegal fentanyl is manufactured, as well. Clandestine Chinese labs manufacture a synthetic version of fentanyl that is easily bought on the dark Web. Mexican drug cartels later began to buy it and resell it across the border.
the problem? This was not an unforseen problem.

This April 2016 article on STAT warned of the problem. and the article notes that the CDC first noted the problem as far back as 2015...

in other words, while the Obama administration was making it hard for docs to give pain pills to their old folks who were hurting, they knew most of the problem was illicit opioids.

lots of details in the article:

T
he dozen packages were shipped from China to mail centers and residences in Southern California. One box was labeled as a “Hole Puncher.”
In fact, it was a quarter-ton pill press, which federal investigators allege was destined for a suburban Los Angeles drug lab. The other packages, shipped throughout January and February, contained materials for manufacturing fentanyl, an opioid so potent that in some forms it can be deadly if touched.
When it comes to the illegal sale of fentanyl, most of the attention has focused on Mexican cartels that are adding the drug to heroin smuggled into the United States. But Chinese suppliers are providing both raw fentanyl and the machinery necessary for the assembly-line production of the drug powering a terrifying and rapid rise of fatal overdoses across the United States and Canada, according to drug investigators and court documents.
and the article notes that it is also a problem in Canada:

In British Columbia, police took down a lab at a custom car business that was allegedly shipping 100,000 fentanyl pills a month to nearby Calgary, Alberta where 90 people overdosed on the drug last year. The investigation began when border authorities intercepted a package in December containing pharmaceutical equipment. Police would not describe the equipment but told STAT it came from China.
the "opioid" crisis was blamed on doctors, of course. Ignoring that it wasn't patients in pain who were overdosing but druggies, young people who were into the party culture, etc.

Yes, we often hear of all those tragic deaths about a teen/young person who just borrowed a pill to go to sleep and died. But you know, I am cynical: how did that young person know who was selling pills?

It's not like our old ladies who would sell their pain pills when they needed cash, or lend them to a friend who was hurting, but also buy one when their arthritis kicked up. That is friends to friends.

In these cases, it is bought from street dealers who are known.

--------------

one note: it's nice to say give non opioids to people for pain.

I take a lot of NSAIDS for various problem in the past, and now for osteoarthritis.

But the dirty little secret is that these pills have side effects on the kidney (and heart) and cause bleeding ulcers if you take a lot, or even at normal doses in the elderly. Long review article from AgingDis:

Table 1

NSAIDs’ common adverse effect profile.
Gastrointestinal toxicity•Dyspepsia
•Gastroduodenal ulcers
•GI bleeding and perforation
Cardiovascular adverse effects•Edema
•Hypertension
•Congestive heart failure
•Myocardial infarction
•Stroke and other Thrombotic events
Nephrotoxicity•Electrolyte imbalance
•Sodium retention
•Edema
•Reduce glomerular filtration rate
•Nephrotic syndrome
•Acute interstitial nephritis
•Renal papillary necrosis
•Chronic kidney disease

-------------
update: Article from the PhilInquirer (9-2017) about Chinese illicit drug business in the Philippines.

here the main problem is "Shabu" aka meth.


Whether the Senate inquiry amounts to substantive amendments to Republic Act No. 9165 (or the Comprehensive Dangerous Drugs Act of 2002) remains to be seen. But the probe highlights the fact that China, President Duterte’s newfound ally, is the biggest exporter of shabu and its precursors not only to the Philippines but also to other countries.
Known in the trade as “cooks” and “chemists,” meth production experts are flown into the Philippines from China by drug syndicates to work in laboratories like the one recently dismantled on Mount Arayat in Pampanga.
Synthetic drug manufacturers in China have been able to ply their trade due to the country’s large and loosely monitored chemical industry.
One report said the lack of regulatory practices in China has made it easy for crime syndicates to divert chemicals with legitimate uses, such as fertilizer, pesticides and medicine, toward the production of addictive drugs.

Read more: http://opinion.inquirer.net/107267/drugs-china-bigger-threat-ph#ixzz590s2SJ37 Follow us: @inquirerdotnet on Twitter | inquirerdotnet on Facebook


Sunday, February 18, 2018

Flu or bird flu in Yemen?

AlJ has a report about people dying of "birdflu" in Yemen.

Already dealing with severe malnutrition and a cholera epidemic, many people in Yemen are now dying from what is thought to be bird flu.
As the country faces this new health crisis, hospitals remain critically short of resources after years of conflict has caused the country's health system to crumble.
yup things are a mess, but I suspect this is ordinary flu, which has caused quite a few deaths in the USA where people are well nourished.

We had birds infected with bird flu awhile back here in the Philippines, and had to kill a lot of chicken and quail.

People in close contact to dead birds or meat can catch the virus. A couple hundred cases a year.

The real danger is if the virus mutates and causes person to person transmission: That could result in a catastrophe similar to 1918 Spanish flu epidemic.

Since the reports are few, and we don't have lab confirmation or headlines elsewhere, I suspect it is ordinary flu.

LINK

but flutrackers site does have this discussion.

they are blaming stray dogs, and indeed flu can spread via dogs andstray cats, this might either be true or just a rumor because of the Muslim hatred of dogs as disease spreaders.

link

 The Asian H5N1 virus is a specific, very infections influenza strain that is deadly to birds. H5N1 first cropped up in Southeast Asia, causing huge fatalities in poultry. It has been documented in people, pigs, domestic and wild cats and, rarely, dogs. How the virus gets into mammals isn’t clear; they may become infected by eating contaminated birds or coming into contact with their bodily fluids. It also isn’t clear how bird flu affects dogs; reports range from no symptoms to fever to respiratory problems to death

Sunday, February 11, 2018

defunding medical needs, or a way to cut the bloated system?

Instapundit linked to a NYPost article on 7 ways to stop a plague.

don't bother to read it: it is a WAGD (we're all gonna die) post with an agenda:

Sadly, epidemic prevention doesn’t currently seem to be a priority for the US government. In February, the CDC announced they would need to cut their global disease-prevention efforts by 80 percent due to lack of funding.

all over the internet: WAPO here.

one wonders if this is true, or similar to the "Banned words" kerfuffle a couple months ago that turned out to be fake news.

what was cut was an Obamacare part of the funding.

and it seems to be do gooder stuff for bureaucrats to implement programs to investigate stuff that affect people.

as in bloated bureaucracy where most of the funding goes to pencil pushers, and good folks spend a lot of time in meetings and in "documentation" or "writing proposals".

reminds me of the IHS: We had two docs, six nurses, two in lab and one in x ray, eight in medical records, and an office full of a dozen bureaucrats to process paperwork so our people could get care.

and I saw the same number of people a day (about 20) that I saw in private practice, where I had a secretary and a nurse (and later, a part time typist).

to hire someone took months of paperwork, as if people could sit around that long and not get other job offers.

I would apply for Educational grants, and find that they would pay for it two days before the conference was scheduled, and in one conference, sponsored by a government office, I didn't find I had been accepted until the week afterward, because of the delay in processing my paperwork. (I learned quickly to go to regular CME meetings and pay for it myself and hope I would be reimbursed, and then put up with the lecture by the bureaucrat why this was wrong).

The months to find replacements of medical personnel meant msot of these clinics were short on people who actually worked with patients, so we were always overworked.

as for prevention programs: Yup. we had them.

So, for example, to get money to set up a diabetic teaching program, you had to write a complicated proposal and send it upstream and wait...and wait... and finally you got funding, maybe, for a dietician to come and give a couple of talks.

Then you had to do paperwork to get the dietician hired, taking into consideration if they had dibs on the job because they worked for the government or if they had a CDIB card.

Ditto for equipment and repairing stuff...the clinic took 3 years to get a new badly needed extension, and we couldn't use the defribrillator when we got it because it hadn't been okayed by the electrical expert (a good idea, but why so long?).

To Know A Fly is a humorous novel about scientific research, and shows that even 50 years ago, how much time was wasted in getting money:
It is believed in some quarters that to become a successful modern biologist requires a college education and a substantial grant from the Federal Government. The college education not infrequently is as useful for acquiring proficiency in the game of Grantsmanship as it is for understanding biology.
No self-respecting modern biologist can go to work without money for a secretary, a research associate, two laboratory assistants, permanent equipment, consumable supplies, travel, a station wagon for field collecting, photographic supplies, books, animals, animal cages, somebody to care for the animals, postage, telephone calls, reprints, and last, but by no means least, a substantial sum (called overhead) to the university to pay for all the stenographers hired to handle all the papers and money transactions that so big a grant requires.
as to how to handle an epidemic:

Here is an article on SARS, which was stopped by old fashioned ways.

I am not in favor of cutting funding needed to prevent disease, and am worried that the bureaucrats will decide to cut needed personel instead of cutting all those paper pushers and excessive regulations that cost a lot of money and cut productivity.

and don't tell me that good people in the government bureaurocracy wouldn't do that to poor people.

I was told that one reason we were so understaffed and underequipped on one New Mexico reservation was because the government decided it was only 30 miles to a civilian hospital, so there was no reason we needed a hospital instead of a clinic (the fact that the civilian hospital was over a 7000 foot mountain pass didn't matter, nor that often our patients had to drive 30 miles to get to us because they weren't allowed to go there by themselves for care, without our okay.)

So for three months, we had to send every x ray over that mountain pass because our x ray tech quit (you couldn't put out an ad for a new tech before the final day of work, you know: then it took a lot of paperwork to find someone... yes, they could have hired a temporary replacement but no money).

oh yes: And we had to close the place for two weeks after our boiler exploded, which meant no heat. In the wintertime.

Casinos and tribal take over have helped all of this a bit, but anyone who is in love with single payment medicine should just ask their local Native American about it.

so ignore the kerfuffle and wait and see what happens.

But I worry, not that there will not be funding, but that the entrenched bureaucrats will deliberately do something to make a disaster.

But the, after working for the government, I am cynical in this.

Saturday, February 3, 2018

Rabies

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