Bird Flu Mutates

by The Associated Press

(London) Mutations in the bird flu virus have been found in two infected people in Egypt, in a form that might be resistant to the medication most commonly used to treat the deadly disease, the World Health Organization says.

The mutations in the H5N1 virus strain were not drastic enough to make the virus infectious enough to spark a pandemic, WHO officials said. But more such mutations could prompt scientists to rethink current treatment strategies.

Samples taken from two bird flu patients in Egypt - a 16-year-old girl and her 26-year-old uncle - were not as responsive as regular H5N1 viruses to Tamiflu, a drug also know as oseltamivir that is used to treat the disease, the officials said.

The girl and her uncle died in late December, as did the man's 35-year-old sister, although she has not yet been confirmed as having had H5N1. The three - who lived together in Gharbiyah province, 50 miles northwest of Cairo - fell ill within days of one another after being exposed to sick ducks.

"Based on the information we have, we can't yet rule out human-to-human transmission," said Dr. Fred Hayden, a WHO bird flu and antivirals expert. "We need to better understand the dynamics of this outbreak."

Although people have passed the virus on to other people, such infections are rare, and most patients have been infected by direct contact with sick birds.

Scientists fear, however, that the virus could mutate into a form more easily passed between people, which could spark a flu pandemic.

The drug-resistant strains found in Egypt likely developed after the patients were hospitalized and treated with Tamiflu, with the virus responding directly to the drug, Hayden said. It was not proven, however, that that was the case, and a more worrying scenario would be if drug-resistant strains were already circulating among birds.

Although Tamiflu remains the drug of choice to treat H5N1, experts may have to consider other options if they find more resistant viruses.

Because flu viruses evolve constantly, mutations are only worrisome if they make the virus more infectious, lethal or drug-resistant.

"What the resistance tests look for are markers associated with antiviral resistance," though finding the markers did not necessarily mean Tamiflu would not work, said Dr. Angus Nicoll, flu director at the European Centre for Disease Prevention and Control.

Hayden said the mutations found in Egypt were different from Tamiflu-resistant H5N1 viruses found in patients two years ago in Vietnam. The Vietnamese strains were definitely resistant to Tamiflu, whereas the Egyptian viruses have only proven they are not as susceptible to the drug, he said.

Tamiflu-resistant viruses such as those found in Vietnam are often treatable with an older, less expensive class of antivirals, known as amantadanes. Some bird flu virus strains from Indonesia and China have also proven susceptible to amantadanes.

H5N1 first hit Egypt last year, and has since infected 18 people, 10 of whom have died.

Since the H5N1 outbreak first began in late 2003, it has decimated the Asian poultry industry and infected at least 265 people worldwide, 159 of whom have died, according to WHO.

Flu Epidemic Plan

by The Associated Press

(Atlanta, Georgia) In the worst case of a global flu epidemic, schools would close for three months and public events would be canceled.

In the most optimistic scenario, people merely would be told to wash their hands and stay home if they feel sick.

Those are the options the government plans to consider depending on the strength of a possible deadly flu epidemic. And the options would be graded like hurricanes: The worst case would be Category 5. The least-threatening outlook, Category 1.

Federal officials last week released a grading system for flu pandemics. The steps were taken to give the public some help in deciding how anxious to get if a deadly new flu appears in the United States.

The government also is releasing a wave of radio and TV spots to remind people not to be complacent about a potential contagion.

"As avian influenza slips from the headlines, people may begin to believe that the threat is no longer real," said U.S. Secretary of Health and Human Services Mike Leavitt, in a Thursday press conference in Atlanta.

The system has been eagerly awaited by state and local health officials, who will have to make many of the decisions about how to control the impact of the next pandemic flu.

Federal officials say they don't expect a vaccine will be available for such a virus until at least six months into a pandemic. On Thursday, Leavitt granted companies protection from lawsuits for vaccines against the bird flu virus.

Under his declaration, all H5N1 vaccines developed through a grant, contract or cooperative agreement would be protected through all production stages from testing to use. The protection would run through February 2010.

And although the U.S. government has enough medicine for more than 22 million people, it's not clear that they will work against whatever virus emerges, and it's doubtful that will be enough if many of America's 300 million residents becomes ill.

So health officials plan to rely on old-fashioned measures ranging from home quarantine to closing schools and postponing sporting events. But those measures can increase a pandemic's economic fallout, and even have unintended consequences. Closing schools, for example, can keep adults home from work to care for children. And it doesn't help if older kids are sneezing on each other at the mall.

The new guidelines, from the U.S. Centers for Disease Control and Prevention, don't spell out exactly what infection-control steps states should take. But they do give an idea.

For example, in a Category 1 pandemic, there's no need to dismiss schools. But in a 2 or 3, states should consider dismissing students for up to four weeks. In a 4 or 5, they should consider closing the schools for up to 12 weeks.

CDC officials said categories are important because until now many people have thought of pandemic flu in black and white terms: Either a deadly contagion is upon is, or it isn't.

"Not all pandemics are equally severe," Dr. Julie Gerberding, the CDC's director, said Thursday in unveiling the new guidelines.

The CDC copied the nation's hurricane ranking system to help people size up the situation and to help communities make what Gerberding called "real tough decisions" about when and how to cut back normal activities.

But not everything is covered in the new guidance. For example, it says little about whether sick people or healthy people should wear masks, and if they do, what kinds.

"It's not a simple matter," Gerberding said, adding that more detailed advice on masks should be coming out soon.

Flu pandemics can strike when a mutating flu virus shifts to a strain that people never have experienced. Scientists cannot predict when the next pandemic will arrive, although concern is rising that the Asian bird flu might trigger one if it starts spreading easily from person to person.

Most planning until now has focused on the worst-case scenario of an outbreak as severe as in 1918, when 50 million people worldwide died. But the 20th century's other two pandemics, in 1957 and 1968, were far less severe, claiming 2 million and 1 million lives, respectively.

The 1918 pandemic was a primary model for current pandemic flu planning. Dr. Howard Markel, a University of Michigan health historian, said he believes the government's new grading system might have made a difference back then.

Federal health officials put out guidance then, too, but cities varied on what steps they took, said Markel.

States still have leeway, of course, and neighboring states may institute different measures in a new pandemic. But if the government comes out with clear advice, it will probably be followed more closely than it was in 1918, when governmental power was more local, he said.

"The federal government telling a local or state health board to do something was not met with warmly," he said.

Diabetics Ignoring Doctors

by The Associated Press

(Denver, Colorado) Bad news when it comes to diabetics and exercise: Most people with Type 2 diabetes or at risk for it apparently ignore their doctors' advice to be active.

Fewer than 40 percent get exercise, a new study found, and the more in danger the patients are, the less likely they are to be active.

That's despite an earlier study that found nearly three-quarters of diabetics said their doctors had advised them to exercise. The patients who got the strongest warnings to get moving were the least likely to listen, according to research.

"People should exercise more, that story is out," said Dr. Elaine Morrato, who led both studies. "What we're saying is, 'Here's a high-risk population that can benefit from exercise, and they're even less likely to exercise.'"

Without exercise, Type 2 diabetics face complications ranging from nerve damage to high blood pressure.

Morrato, an assistant professor at the University of Colorado Denver with a doctorate in public health and epidemiology, said researchers surveyed more than 22,000 patients for the new survey. Results of the study appear in the February edition of the American Diabetes Association's journal Diabetes Care.

The federal Centers for Disease Control and Prevention estimates more than 20 million Americans have diabetes, about 90 percent of them Type 2, which is linked with obesity.

Dr. Larry Deeb, president of medicine and science at the American Diabetes Association, said by the time patients have Type 2 diabetes or are at risk of getting it, the deck is stacked against them. They may already have problems with mobility as a result of obesity or foot and circulatory disorders that make exercise difficult.

"We have to be careful not to blame the victims," he said. "There's a difference between being unable and being unwilling."

Even for the most disabled, there's hope, said author and fitness expert Charlotte Hayes, but health professionals must do more.

Hayes, who wrote "The I Hate to Exercise Book For People With Diabetes," said telling patients to exercise is different from telling them how.

Every step of exercise is important, she said. For those who can walk, a few steps a day helps. For those who can't, there are alternatives.

"We take a small-steps approach," she said.

The American Diabetes Association recommends people get at least 30 minutes of aerobic exercise, such as brisk walking, five times a week. But the association says for those who can't, there are benefits from even five minutes a day, along with everyday activities such as gardening or walking to work.

Morrato said she doesn't know the answer, only that the results of her study are disappointing.

"It is difficult to be optimistic about addressing the twin epidemics of obesity and diabetes without success in increasing physical activity in the population," her study concludes. "The results of this study provide very pessimistic data."

Deeb, who specializes in pediatrics, said the next generation is off to a better start. Children, he said, are taught nutrition and the benefits of physical activity. Now, families, local governments and school boards need to take action, while doctors need to follow up and find out if at-risk patients know where to get help.

"When you ask a family what they're doing, the answer is all about time. They know what's good for their families, but both parents are working, and sometimes the only time they have is to pick up fast food," he said. "They have to understand, your health depends on it.

"We can't give up." he said, "We will not give up."

Arthritis Costs U.S. $128B

by The Associated Press

(Atlanta, Georgia) The nation's costs for arthritis and related conditions rose to $128 billion in 2003, and the tab will continue to grow as the U.S. population gets older and heavier, the government said.

The 2003 costs, the latest data available, included $80.8 billion in direct costs, such as medical expenses, and $47 billion in indirect costs, such as lost wages, the Centers for Disease Control and Prevention said.

The total was a 48 percent increase over the 1997 figure of $86.2 billion cost, largely because government surveys identified 9 million more cases of arthritis or related conditions, the CDC said.

The CDC estimated that 46.1 million people were treated for arthritis and other rheumatic conditions in 2003, and 29.5 million of them lost earnings. The government estimates 8 million more people will suffer from arthritis between 2005 and 2015.

The government recommended lowering costs with widespread use of self-management programs, which teach patients how to manage their pain and continue working with the condition.

California had the largest costs from arthritis at $12.1 billion, followed by $8.7 billion in New York and Texas, and $7.6 billion in Florida.

Overdose Deaths On The Rise

by The Associated Press

(Atlanta, Georgia) Unintentional fatal drug overdoses in the United States nearly doubled from 1999 to 2004, overtaking falls to become the nation's second-leading cause of accidental death, behind automobile crashes, the government reported.

The number of accidental drug overdose deaths rose from 11,155 in 1999 to 19,838 in 2004, according to the Centers for Disease Control and Prevention.

The report was based on death certificates, which do not clearly detail which drugs played the greatest role. But CDC researchers said they believe sedatives and prescription painkillers like Vicodin and OxyContin were the chief cause of the increase.

OxyContin has been blamed for hundreds of deaths across the country in recent years, becoming such a scourge in Appalachia that it is known as "hillbilly heroin."

Deaths from falls climbed between 1999 and 2004 at a more modest rate, from 13,162 to 18,807, the CDC said. Motor vehicle crashes accounted for 40,965 fatalities in 1999 and 43,432 in 2004.

The South had one of the lowest fatal drug overdose rates in the nation in 1999, but it doubled by 2004. The South now ties the West for having the highest rate - about 8 per 100,000 population.

"This is the first study really to describe the large relative increases in poisoning mortality rates in rural states. Historically, the drug issue has been seen as an urban problem," said Dr. Len Paulozzi, a CDC epidemiologist.

The federal report, issued this week, noted that accidental drug overdoses remain most common in men and in people 35 to 54. But the most dramatic increases in death rates were for white females, young adults and Southerners

Other findings:

- The death rates for men remained roughly twice the rate for women, but the female rate doubled from 1999 to 2004 while the male rate increased by 47 percent.

- The rate for white women rose more dramatically than for any other gender group, to 5 deaths per 100,000 population.

- The rate of overdose deaths among teens and young adults, ages 15 to 24, is less than half that of the 35-to-54 group. But it rose much more dramatically, climbing 113 percent in the study years, to 5.3 deaths per 100,000 population.

About 50% of the deaths in 2004 were attributed to narcotics and hallucinogens, it includes heroin, cocaine and prescription painkillers like Vicodin and OxyContin.

Earlier research suggests that deaths from illegal drugs appear to be holding steady.

"There is a misperception that because a drug is a prescription medicine, it's safe to use for non-medical reasons. And clearly that is not true," said Dr. Anne Marie McKenzie-Brown, a pain medicine expert at Atlanta's Emory Crawford Long Hospital.

Magnetic Health Snare

by The Associated Press

(Washington) A novel machine designed to treat depression by zapping the brain with magnetic pulses shows no clear evidence of working, federal health advisers have concluded.

The device is called the Neurostar TMS, or transcranial magnetic stimulation, system. It uses magnetic energy to induce electrical currents in the region of the brain associated with mood.

Neuronetics Inc. believes those currents stimulate neurons in the region and relieve the symptoms of depression. The Malvern, Pa., company seeks clearance from the Food and Drug Administration to market the machine - something the panel's lukewarm reception may make less likely. The FDA isn't required to follow the advice of its outside experts, but it usually does.

A clinical trial of the device provided results that, in one analysis, suggested it's no better than sham treatment, according to FDA documents. Still, the FDA asked its neurological devices panel to review the overall safety and efficacy of the device.

Panelists said there was some suggestion the Neurostar works, but they called the effect marginal, borderline and questionable, an FDA spokeswoman said.

The company intends the device to be used by psychiatrists on an outpatient basis as an alternative to electroconvulsive therapy, or shock treatment, for the treatment of major depression. It would be used on depressed patients for whom therapy and antidepressants have not worked.

To gain federal approval, the FDA told Neuronetics that its device doesn't necessarily have to be as effective as shock treatment if it can be shown to be a safer treatment option. Shock therapy can cause memory and cognitive changes, as well as headaches and burns.

Panelists said there were no important safety issues with the Neurostar. But none of the experts said the device works as substantially well as does shock therapy.

Company spokesman Peter Anastasiou said the company was confident in its efficacy data.

"In our view, we showed efficacy in a very tough to treat patient population," Anastasiou said.

Cinnamon And Cholesterol: A Spice That Promises To be A Natural Cure

Did you know that cinnamon and cholesterol share an important relationship? That, in fact, cinnamon can be used as an effective treatment for persons with high cholesterol?

Researchers have been studying cholesterol and cinnamon and came to exciting results. One study (involving patients with Type II diabetes) showed that taking one gram per day of cinnamon (one-fourth of a teaspoon, twice daily) significantly lowered blood sugar, triglycerides, LDL, and total cholesterol.

Interestingly, cinnamon has a long history as a medicine. Its unique healing properties come from three types of components found in its bark. These are oils that contain cinnamaldehyde, cinnamyl acetate, and cinnamyl alcohol.

Cinnamon is an excellent source of manganese, fiber, calcium, and iron. Both the calcium and fiber in cinnamon can bind to bile salts and when bile is removed by fiber, the body breaks down cholesterol. It can be seen how cinnamon and cholesterol reduction go hand-in-hand.

It has been established that substances in plants have very strong biological effects and, in fact, plant derivatives are being researched in many places. It comes as no surprise that cholesterol and cinnamon are also being studied.

Phytochemicals or plant-based compounds have been discovered to render beneficial effects on various aspects of our physiology. Some of these are found in herbs and spices. In considering cinnamon and cholesterol, this spice may be of great value in maintaining healthy blood sugar and cholesterol levels.

In one study, cinnamon reduced blood lipid levels as well as blood glucose levels. Additionally, patients’ total cholesterol was reduced by 12–26%, LDL was reduced by 7–27%, and triglycerides were reduced by 23–30%. Cholesterol and cinnamon will continue to be evaluated—especially in relationship to those who have Type II diabetes.

In treating high cholesterol, statin drugs are commonly recommended. But they are not the miracle drugs they were once believed to be. Some experts are urging caution because of the potential for serious side effects. Statins work by changing liver function for lowering cholesterol; however, this does not lower levels naturally and statins can be toxic to the liver!

If you are interested in the relationship between cinnamon and cholesterol, you may also be looking for other natural treatments that balance and adjust cholesterol levels.

Natural remedies contain important plant-derived compounds and oils that have been clinically researched for their efficacy. A supplement will be formulated using specific ingredients that support the body.

For example, policosanol is a natural substance derived from sugar cane. Numerous trials have demonstrated that it can safely and effectively lower cholesterol. Policosanol reduces LDL and raises HDL and long term testing shows that patients have experienced no side effects.

Policosanol performs even better when it is combined with other compounds, such as beta-sitosterol (a plant sterol used for treating hypercholesterolemia); lecithin oil (for treatment of high cholesterol); oryzanol rice bran oil (containing beneficial phytosterols); green tea (with its powerful catechins); and vitamin E (used for treating atherosclerosis).

If you are researching cholesterol and cinnamon and the potential health benefits this spice may offer, it may prove helpful to consult a natural practitioner who is knowledgeable about the properties contained in natural substances.

Using herbs and plants for treating disease and for healing may well be the wave of the future. Cinnamon and cholesterol and other plant-based substances and their beneficial effects on disease processes will no doubt be scientifically established as more time goes by.