Ear infection update: Another reason to have your kids get their shots

NYTimes has an article about the huge decrease in ear infections, due to giving babies a pneumonia vaccine

there was a Scandanavian study 20 yrs back that insisted we didn't need to treat them with antibiotics, but given the complications, we usually did anyway.

Why? Because in the Scandanavian study, they followed up cases and only treated them if the infection persisted.

In my practice, with lower class rural folks or on "the Res" that was not something that was practical. So better to overtreat than risk a complication.

What was the first game changer was the H Flu vaccine, a common cause of ear infections and meningitis.

Then came the pneumonia vaccine.

Soon we not only saw fewer ear infections but fewer cases of draining ears and meningitis. How fewer cases? Well, so few that I lost my skill in doing spinal taps in squirming toddlers and had to ask the pediatrician to do it. (if you do fewer than 6 procedures a year, you should drop the procedure, unless you can practice it on a dummy, as in CPR training).

It also has to do with other practices: Breast feeding not only increases the kid's immune system, but it keeps kids away from the custom of putting them to bed with a bottle, leading to both ear infections and bottle teeth in toddlers.

The reason goes back to the parents and the good decisions they’re making, to immunize their children, to breast-feed their children, to not smoke around their children,” Dr. Byington said. “It’s parents making these good decisions for their kids, and it’s paying off.”

and yes, even poor parents will take the cigarettes outside.

Alas, in poor rural area, another risk factor is the wood stove...not the stove per se, but the mold on the wood sitting by the stove, and the ashes in the atmosphere when you cleaned it out, and of course the fumes when you went outside.

But I don't know of any scientific studies on this off the top of my head...it's just something docs in rural areas "know".

Neanderthal extinction: rewrite the books

There are various theories why the Neanderthals went extinct, most of them implying that aggressive newcomers pushed the off their hunting grounds to genocide.

But the latest theory wonders if the newcomers brought in new infectious disease did them in, in the same way that infectious disease caused millions of indigenous Amerindians to die after the Spanish arrived.

. “Humans migrating out of Africa would have been a significant reservoir of tropical diseases. For the Neanderthal population of Eurasia, adapted to that geographical infectious disease environment, exposure to new pathogens carried out of Africa may have been catastrophic,” Charlotte Houldcroft of the University of Cambridge told The Guardian. 

this was sort of ignored because "experts" insisted that cavemen didn't have infectious disease, and only after en settled down in houses with a pig in the parlor did disease become a problem.

Now there is a question if disease could have been there all along.

Archeology org link

UKGuardian has more details.

The DNA suggestion that sexual relationships might have occured also suggests STD's like herpes simplex might be behind the problem. But they also note TB in there.

the problem: This is only theory. Awaiting proof...

The STD syphillis came into Europe with Colombus' sailors (who when out of work went to Italy, had fun with the lovely ladies of Naples who then entertained the German mercenaries, if I remember the history correctly)

But what about those pre 1492 cases of syphillis found in a few skeletons?

I always assumed it was Yaws, a related disease, but now that DNA suggests some Norwegians and/or Icelanders have Amerindian female ancestry, the theory is that maybe the Vikings brought back not only Amerindian women but syphillis, and that was the source of why a few pre 1492 cases were found.

From Science Frontiers

Recently, however, several additional syphilitic skeletons were dug up at a medieval friary in northeastern Britain. The earliest of these bones date back to about 1300. In fact, the new evidence suggests that there was a geographically limited mini-epidemic of syphilis in Britain about this time. Columbus was now off the hook, but who should be hung on it instead? The Vikings, of course. Viking merchants began visiting this part of England about 1300. And it is now admitted that the Vikings had made it to the New World source of the disease circa 1000. Case closed!? (Malakoff, David; "Columbus, Syphilis, and English Monks," Science. 289:723, 2000.)

The DNA article LINK 

I like the part that she came "Voluntarily or non voluntarily": Both Indians and Vikings routinely captured women to use as slaves, a job that included sexual work. Some of course would later marry and be accepted into society, (hence the high amount of Celtic genes in Icelanders)

ZIKA

NYT has a long article on Zika

if Zika came from Africa why didn't it affect babies there is one question comes to mind.

I suspect it is because, like Rubella, you caught it as a child, and became immune, so by the time you got pregnant you couldn't catch the disease.

POlio vaccines

LINK

three types of polio virus

Type 2 polio is essentially eradicated, but the type 2 attenuated virus in the vaccine can mutate to cause polio in one out of a million cases. Most of the cases traced back to the vaccine are of type 2 virus (and I should note most of  in cases were not in the kids immunized but in playmates who didn't get the vaccine, ocaretakers etc. who had no immunity to polio or had weakened immune systems due to malnutrition, cancer, pregnancy etc).

But to put it into perspective: there were 32 cases of paralysis from the vaccine last year.

so the hope is that the oral vaccine will work just as well with fewer paralysis cases.

RABIES

cross posted from my usual blog.

Rabies is around in the Philippines, so anyone bitten by a strange dog gets a series of shots.

Our dogs get their rabies shots, so usually we just reassured those bitten by George, the Killer Lab, but once tiny PuffPuff bit the massage therapist treating Joy, and his shots were out of date, so we had to pay for treatment.

No, I never saw a case in Africa: The protocol there was to go to an area, give all the dogs their rabies shots and paint their rumps, and then put out fresh meat and have a sniper shoot any dog without a paint jobs. After independence, alas, when bullets and snipers got expensive, some countries ended up with epidemics.

Here in the Philippines, the vets go to rural area to give the dogs the shots, and locals kill stray dogs. The local clinic will arrange for you to get the shots at a minimum cost, or you can pay 20 dollars  to buy the vaccine at the pharmacy and give the shots yourself.

In the USA, however, bat bites are a major cause of rabies. I once blew the budget of a small local township where I worked after a young girl got bitten by a bat when she opened a pantry door. Since bats don't usually attack, we had to assume it was rabid.

Nowadays, the regimine is anti globulin and three shots of the vaccine. Back then, it was 24 shots of the vaccine....by shot 12 she was getting local reactions and we started running out of places to give the shots. Ouch.

Cats also can carry rabies, as can racoons.
I remember when we had an outbreak and had to get the cats rabies shots: we took three cats in our cat carrier, and they got lose. Catfight!

Rabies is fatal. Usually you keep them comfortable with deep sedation until they die. So if you are traveling to a high risk area, or might be in contact with rabid animals, you are advised to get the shot.

But a few cases of people who had never been vaccinated beforehand have lived. LINK LINK

treatment is inducing a coma and using a breathing machine, while giving rabies globulin and anti virals. Even with this very expensive treatment, few live.

SCI AM article describes treatment.

The Milwaukee protocol via Wikipedia

Willoughby's goal was to put Giese into an induced coma to essentially protect her from her brain, with the hope she would survive long enough for her immune system to produce the antibodies to fight off the virus. Giese was given a mixture of ketamine and midazolam to suppress brain activity, and the antiviral drugs ribavirin and amantadine, while waiting for her immune system to produce antibodies to attack the virus.^[6] Giese was brought out of the coma after six days, once signs of the immune system's progress became apparent.
After infection[edit]After 31 days in the hospital, Giese was declared virus-free and removed from isolation. The extent of brain damage she had suffered was of initial concern, but while she had suffered some, the disease (and treatment) seemed to have left her cognitive abilities largely intact. She spent several weeks undergoing rehabilitation therapy and was discharged on January 1, 2005.^[9] By early 2005, she was able to walk on her own, had returned to school, and started driver's education, indicating a successful recovery.^[10]

only 5 patients out of 36 survived using this protocol.

and there is a suggestion that the drug ketamine has anti rabies virus properties.

Ketamine is used to induce anesthesia, and works without depressing respiration or blood pressure. Alas, often adults who got it also got terrible nightmares, so now it is used in the USA only to put one to sleep (e.g. in Caesarian sections, where you dont want a baby half asleep from mom's anesthesia and you can't or don't have time to do a spinal). They also use it for kids for things like minor fracture setting, because unlike adults, kids don't get nightmares.

In Africa, we used it when we couldn't do a spinal anesthesia or local anesthetic block: because we didn't have a trained anesthetist. We put it in an IV, and gave it until the patient stopped moving, then slowed it down to start surgery. When the patient started moving again, we increased the rate a bit. Only one problem: Once we needed something, so the guy watching the drip (who was our floor scrubber) went out to get it, and the patient started hypoventillating and turning blue. No nurse either, so I had to break scrub and stop the drip. Luckily his breathing came right back, so I didn't have to intubate him.

Since it is used for animal anesthesia, some has been diverted to get high as a "club drug".

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Headsup AnneAlthouse

zika update

cdc report

the risk to the general population is low, about 1percent: for high risk women who have positive lab tests and went to get screening the risk was higher:29 percent. But because Ultrasound screening is not sensitive to milder cases, the percentage is probably underestimated.

ncreasing epidemiologic, clinical, laboratory, and pathologic evidence supports a link between Zika virus infection during pregnancy and adverse pregnancy and birth outcomes, including pregnancy loss, microcephaly, and brain and eye abnormalities (12–16). A critical knowledge gap for health care providers counseling women is the level of risk for adverse pregnancy and birth outcomes associated with Zika virus infection. That risk is currently unknown, but two recent studies might be informative. A retrospective analysis of the 2013–2014 Zika virus outbreak in French Polynesia identified eight fetuses and infants with microcephaly; using mathematical modeling, it was estimated that microcephaly affected approximately 1% of fetuses or infants born to women infected with Zika virus during the first trimester of pregnancy (17). In a recent study from Brazil, among 42 women with laboratory-confirmed Zika virus infection at any time during pregnancy who underwent prenatal ultrasonographic studies, 12 (29%) had abnormal findings; these included microcephaly, intracranial calcifications, other brain abnormalities, abnormal cerebral artery flow, intrauterine growth restriction, and fetal death (16). Further studies are underway to better estimate this risk but it is important to recognize that microcephaly caused by viral destruction of brain tissue is likely to be part of a spectrum of neurological damage; the percentages in both studies may substantially underestimate the proportion of infants affected.

CDC estimates how to make all the women in Puerto Rico stop having babies because hey they are at risk.

 after all a lot of their pregnancies are "unintended" i.e. unplanned (in a culture where laissez faire is the approach to babies).

Approximately 715,000 women aged 15–44 years reside in Puerto Rico, and there were approximately 34,000 births in 2014 (3). A 2008 hospital-based survey of postpartum women in Puerto Rico indicated that 65.5% of pregnancies were unintended in Puerto Rico, compared with 51% in a probability sample of the general U.S. population (the 50 U.S. states and the District of Columbia), according to the 2008 National Survey of Family Growth (4,9). In 2014, among women aged 15–19 years, the birth rate was almost twice as high (40/1,000) in Puerto Rico as in the U.S. overall (24/1,000) (3).

they go into a lot of detail and then do note that their estimates are based on old and sometimes biased (cherry picked population) data. But hey, Zika will probably make more women want to contracept.

Am I the only one who thinks the zika hysteria is being manipulated to scare women? Population control people are taking advantage of the problem to push their agenda.

No I am not being hard hearted: where is the hysteria about cytomegalovirus in Puerto Rico causing birth defects?

Transmission of CMV infection may occur throughout life, chiefly via contact with infected secretions.^[16] In the developed world, CMV is the most common congenital viral infection. An overall rate of congenital CMV transmission of approximately 1% (ranging from 0.25–2%, depending on the population studied) has been estimated in newborn infants in the developed world in most reviews. This translates to about 80,000 congenital CMV infections per year in the United States and Europe.

Where is the hysteria about cocaine damage to fetuses? Or Fetal Alcohol syndrome?

CDC report on FAS:

Gender neutral bathrooms? The Pee on the toilet seat problem

To gender neutral bathrooms, I say depends

To letting men into a woman's bathroom, I say bah humbug.

If there is a single room, often it is used by either sex.

But "bathrooms" mean many stalls.

a single room bathroom can and often is "unisex". No problem. Often these unisex bathrooms have a urinal on the wall, a place to wash your hands, and a nice solid lock on the door.

But for larger bathrooms, privacy is different.

Women have periods, for example, and often are embarrassed about it.

A decent woman's bathroom should have a couch for those with their periods to lay down on, and have larger disposal wastebaskets inside the stalls for pads etc. They also have vending machines for these things.

There are mirrors over the wash basins, to check out one's hair and makeup.

But since fixing one's makeup tends to slow down those who just want to wash their hands, a high quality women's bathroom often have a separate area for women to sit and apply makeup, outside the area where routine hand washing is done.

Men often wonder what takes women so long when they go to the rest room: This is why. Also, a lot of gossip goes on while you are applying mascara etc.

Modern PC Bathrooms often have a "baby" area to change a diaper (but the couch doubles for this in a traditional bathroom, as does the flat area at the end of the washbasin area in days).

But here is the problem no one wants to discuss: we have to sit down.

Now, the dirty little secret is that women don't like to sit on a place where someone else has sat. Often they don't sit on the seat, which is often wet after flusing or worse, from the previous person. Yes, there is toilet paper and seat covers, but not in most bathrooms, and often these things clog up the bowl or quickly fill the trash hamper.

But most restrooms don't have these things, so it means partly undressing and doing your thing while trying not to sit on the seat which is "dirty" (even when it looks clean, women think it is "dirty").

And so often women simply don't go at all.

We docs see a lot of problems with these women who tend toward UTI's getting cystitis because they are traveling and don't drink water because they hate using a strange (read "dirty") bathroom.

This also complicates the life of those taking diuretics, aka "water pills". Many of my patients would skip the diuretic when they shopped, and end up in the emergency room with lungs full of fluid that night.

Another thing annoys me about this PC bullying: if you let transvestites use the bathroom, who would know? A good transvestite is not a threat. He/she usually looks and acts like a woman (often with exaggerated femininity, but a woman). So many women would simply not notice he was a she. He/she might even ask if anyone is bothered if he/she uses the place, and those who I know are very clean.

So what if a person is "transgender" and in "transition".

Again, why should one notice?

The fact that it is noticed, and women are noticing, is the problem. It means that they are not women. Meaning they have a mental problem and are now trying to force their mental problem on us.

And now that the latest fad is "transgender", it's become an epidemic some gay activists have decided their "rights" overrule our rights.

 So why do the the other 99.4 percent of us have to bow down, leave behind our modesty and give into the tyranny of political correctness?

maybe because the rights of these few misbeguided folks are not the ultimate aim. The ultimate aim is to make the entire country "gender neutral". Hence the government has an interest in pushing Catholic sisters to provide contraception and abortifactive medicines, because hey, a pregnant lady is nature's way of saying men and women are different.

That is why the next step if the claim is that we shouldn't have separate bathrooms at all.

Right now, the most prominent advocates for gender neutral bathrooms seem to be transgender individuals and allies. But efforts to integrate toilets have been carried out by different groups over time, and could also benefit diverse constituencies, particularly when we're talking about fully enclosed unisex toilet facilities. Such restrooms would be useful for parents of opposite-sex young children, adult caregivers of opposite-sex older parents, Muslims who perform ritual ablutions, transgender individuals, women who routinely face longer public restroom wait times, men whom "potty parity" laws have left with longer wait times, and anyone who's ever been inconvenienced because their assigned bathroom was undergoing cleaning with no alternative available. 

Most of what he cites would not be made better by unisex bathrooms.

Right now, a simple request at the door would allow a man to help his wife into the handicapped stall if she is wheelchair bound. Similarly, a simple request will allow a man to ask a passing woman to check on his spouse with Alzheimer's who got lost.

But what about women worrying about boys in the men's room? Why should we worry? Well, again the reason is left out: Perverts. If my son is abused in a man's bathroom or sees open sex there, maybe what should be done is to arrest the perverts. Do things get better by letting the perverts do their thing in our restrooms?

The "potty paradigm" referred to also can be gotten around with a request: We women once just opened the empty men's room door and stood guard so we could use it when our group was running behind.

As for Muslims doing ritual ablution: You mean Muslim ladies would feel comfortable washing their feet in front of a man? I have no problem with letting Muslims use the handicapped area to do ablutions (most handicapped toilet stalls have sinks inside the stalls).

In short, for a fake reason (not to hurt the feelings of a protected group) the rest of us are supposed to lose our modesty over exposing our bodily functions to a strange person of the opposite sex.

finally, the real problem no one wants to talk about:

Men's rooms have urinals. Women's do no.

Would a  unisex toilet have urinals, forcing men to urinate in front of women, or would they just force all the men to wait in line like women usually do, to use the stall for this.

Now the dirty little secret that all married women know is that men sometimes don't lift the toilet seat, and/or forget to put it down again.

so it's not a "civil rights" issue: the issue is pee on the toilet seat, and that a lot of women will avoid using the rest room at all because they are too embarrassed to do so.