Day: 11/27/2012

Building on India’s Success on Polio.

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More than 26 million children were born in India last year, many of them in remote parts of the country or in areas of poverty, poor sanitation and weak infrastructure.

Yet, nearly every one of these children received vaccines that protected them against polio.

Today, on World Polio Day, we recognize India’s achievement.  The country has not seen a case of polio in more than 18 months. This is a tremendous blow against a disease that has crippled and killed countless Indian children. India’s success is one of the biggest public health achievements in recent history. It has brought us closer than ever to eradicating the disease. There are now only three countries where natural polio transmission continues: Pakistan, Afghanistan and Nigeria.

India’s success against polio is a model of remarkable progress against all odds. It shows that even in the toughest circumstances—despite poverty, high birth rates, a large population and hard-to-reach migrant communities—polio can be defeated. It also provides a lesson that overcoming polio can pave the way to reach nearly every child with immunizations and protect them against other vaccine-preventable diseases.

Political commitment has been critical to India’s achievement. In 2009, when India had the highest number of polio cases in the world, the polio program implemented an aggressive strategy to target highest-risk populations, which was supported by all levels of government. India has also contributed significant financial resources to end polio: by 2013, the government will have invested $2 billion to defeat polio, supplemented by assistance from external partners. The program has ensured that more than 170 million children are vaccinated in two national polio immunization campaigns each year.

To reach nearly every child with polio vaccines, India used innovative strategies. India has implemented a system to track newborns to ensure they are reached with polio vaccines and other health interventions. Health workers have worked tirelessly to vaccinate children wherever they were— around brick kilns, on trains and boats and on the Pakistani border.  The government has partnered with traditional and religious leaders to convince parents to have their children vaccinated, and social mobilizers  have effectively delivered these messages across the country.

India can now apply the lessons learnt from the polio eradication effort to effectively provide routine immunizations to all, including children who live in remote areas beyond the reach of adequate healthcare facilities. Nomadic families are among the most challenging populations to reach. By using local community workers and mapping technology, India’s polio program identified nomadic settlements in the states of Bihar and Uttar Pradesh and was able to reach these communities not just with polio vaccines, but with routine immunizations that protect against a range of diseases.

India’s polio program has built a robust surveillance network consisting of 33,700 reporting sites, an army of 2.5 million vaccinators that are deployed during national immunization days, and effective strategies to vaccinate children in the country’s farthest reaches. The program also manages measles immunization campaigns and surveillance for other diseases, and delivers other health services to children.

Reaching this polio milestone provides a tremendous opportunity for India to strengthen its routine immunization and ensure that every child is protected from vaccine-preventable diseases.

Vaccines are cost-effective tools that can save lives and India is the world’s largest producer of these powerful low-cost vaccines. Yet, nineteen million children in developing countries, including in India, still do not receive life-saving vaccines that parents in wealthy nations take for granted, such as immunizations to protect against severe diarrhea and pneumococcal disease.

On World Polio Day, it is important to recognize India’s impressive achievement on polio. It provides a model for Nigeria, Pakistan and Afghanistan to stop the disease. And it demonstrates that with sufficient political commitment and funding, India and other countries can provide life-saving vaccines to all children who need them, wherever they are.

Seth Berkley, M.D., is a global advocate on the power of vaccines and CEO of the GAVI Alliance, a public-private partnership that focuses on promoting vaccination for children. GAVI last year worked with the Indian government to roll out vaccines to protect children against five life-threatening diseases in one shot. A medical epidemiologist by training, Dr. Berkley is also the founder and former President and CEO of the International AIDS Vaccine Initiative.

Source: http://blogs.wsj.com

 

 

 

 

 

More protected from meningitis A.

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In the West African country of Benin this week, mothers will bind their youngest children to their backs with bright pieces of cloth. Shopkeepers will pull closed the metal doors that secure their businesses. Young people will mount their bicycles or motor scooters and join the migration toward the local health center, village meeting place, or perhaps a simple table set up under the biggest shade trees.

In 2010, mothers and babies in Burkina Faso lined up to receive vaccine against meningitis A. Photo: PATH/Gabe Bienczycki.

If history is any indication, nearly everyone between the ages of 1 and 29 in Benin will get in line for MenAfriVac®, a vaccine that has eliminated deadly meningitis A in the first countries to receive it. By the end of this year’s vaccination campaigns, we expect that some 100 million people in ten countries will be protected from a disease that regularly sweeps through the 26 countries of the African meningitis belt in epidemics that can kill tens of thousands.

In the years to come, as more countries introduce the vaccine and more people line up to receive it, we expect those epidemics will end.

A shot worth having

The people of Benin are planning a celebration to welcome MenAfriVac®. Officials will parade, dignitaries will speak, and it’s likely a group will be escorted to the front of the crowd to receive the first doses. Nearly two years ago—in the musically named Ouagadougou, the capital city of Burkina Faso—I watched as other children proudly marched before different dignitaries, endured the first shots of the first MenAfriVac® vaccination campaign, dried their tears, and resumed chasing each other around the city’s main square, thrilled to be outside on such a sunny and optimistic morning.

At PATH, we created a counter to keep track of the people receiving vaccinations in Burkina Faso, Cameroon, Nigeria, Chad, and an expanding list of countries where people once feared death and disability brought by meningitis A. We’re unabashedly proud that the vaccine was developed by the Meningitis Vaccine Project (MVP), a collaboration between PATH and the World Health Organization that involved partners on four continents.

Those partners, including manufacturer Serum Institute of India, Ltd., worked together to bring a badly needed vaccine to Africa in less than a decade and at a price that’s a fraction of the cost of most new vaccines. MenAfriVac® costs less than 50 cents a dose—an affordable price for low-income countries and just one of the vaccine’s remarkable attributes.

The latest good news: herd immunity

While the people of Benin are getting their shots this week, a few members of the Meningitis Vaccine Project team are in Atlanta, at the annual meeting of the American Society of Tropical Medicine and Hygiene. They’re announcing the latest good news about MenAfriVac®, including research that suggests that in Burkina Faso, the bacteria causing meningitis A have disappeared from the noses and throats of those too old or too young to have received the vaccine—what public health officials call herd immunity. They’re also announcing that the vaccine has proven to be stable without refrigeration for up to four days—a major advantage in regions without reliable access to electricity.

Source: PATH

Tests find malaria vaccine useful.

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A malaria vaccine tested on infants in seven African countries has shown a protective effect that is small but possibly enough to prove useful in areas where the infection is a serious threat to children.

The vaccine, known officially as RTS,S/AS01, reduced by 33 percent the number of cases of malaria suffered by infants in the year after they were immunized, according to a study presented in South Africa on Friday and published online by the New England Journal of Medicine.

The actual number of infections was small. About 2.3 percent of babies not getting the vaccine suffered a case of severe malaria in their first year. The vaccine reduced that by one-third.

Preventive measures and better treatment have driven down malaria mortality over the past 20 years. Nevertheless, the mosquito-borne infection still causes about 216 million cases of illness and 655,000 deaths — almost all of them of African children — each year.

“If you broadly implement this across sub-Saharan Africa, it is going to prevent millions of cases and save thousands of lives,” said David Kaslow, director of the malaria vaccine initiative at the Program for Appropriate Technology in Health (PATH), a nonprofit group in Seattle that is helping run the vaccine trials.

One of the more successful tools against malaria is the insecticide-treated bed net. Studies have shown that consistently sleeping under one reduces cases of malaria by 25 to 75 percent. About 85 percent of the children in the vaccine study slept under a net, so they were substantially protected. In addition, indoor spraying with long-lasting pesticides — another preventive tool — was common in four of the 11 study areas.

The study enrolled infants in Kenya, Tanzania, Mozambique, Malawi, Ghana, Burkina Faso and Gabon. Malaria transmission differed greatly from place to place. In the worst area, babies averaged two bouts of malaria a year. In the site with the least transmission, the figure was one-hundredth that rate.

About 6,500 babies were randomly assigned to get the malaria vaccine or an unrelated one that helps prevent bacterial meningitis. By design, twice as many were assigned to the malaria vaccine as to the other one. The malaria vaccine was given in three shots a month a part, starting at two months of age.

At least one episode of severe malaria occurred in 2.3 percent of the babies getting the meningitis vaccine, compared with 1.5 percent in those getting the malaria vaccine.

Death from any cause, including malaria, was rare. It occurred in 1.5 percent of the babies who got the malaria vaccine and 1.3 percent in those who got the meningitis vaccine.

Meningitis was twice as likely in the malaria-vaccine babies. Whether that was because they didn’t get the meningitis vaccine or happened by chance is unknown.

A study of the same vaccine in children 5 to 17 months of age was reported last year. It found a bigger protective effect — about 50 percent.

The vaccine is made by GlaxoSmithKline. The company has said the price of the vaccine will cover the cost of its production and a 5 percent margin, which will be reinvested in research on other vaccines for tropical diseases.

Source: http://www.washingtonpost.com

 

 

Oral lixivaptan effectively increases serum sodium concentrations in outpatients with euvolemic hyponatremia.

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Hyponatremia is the most common electrolyte disorder in clinical practice. Its incidence increases with age and it is associated with increased morbidity and mortality. Recently, the vaptans, antagonists of the arginine vasopressin pathway, have shown promise for safe treatment of hyponatremia. Here we evaluated the efficacy, safety, and tolerability of oral lixivaptan, a selective vasopressin V2-receptor antagonist, for treatment of nonhospitalized individuals with euvolemic hyponatremia (sodium less than 135 mmol/l) in a multicenter, randomized, double-blind, placebo-controlled, phase III study. About half of the 206 patients were elderly in a chronic care setting. Of these patients, 52 were given a placebo and 154 were given 25–100 mg per day lixivaptan, titrated based on the daily serum sodium measurements. Compared with placebo (0.8 mmol/l), the serum sodium concentration significantly increased by 3.2 mmol/l from baseline to day 7 (primary efficacy endpoint) with lixivaptan treatment. A significantly greater proportion of patients that received lixivaptan achieved normal serum sodium (39.4%) by day 7 relative to placebo (12.2%). Overall, lixivaptan was considered safe and well-tolerated. Thus, oral lixivaptan can be safely initiated in the outpatient setting and effectively increases serum sodium concentrations in outpatients with euvolemic hyponatremia.

Source: Kidney International

 

 

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November is National Diabetes Month.

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In the United States, 26 million are living with diabetes and 79 million more have prediabetes. Now is the time to Take Charge of your diabetes.

Unless we make changes in how we live and eat, forty years from now we may have two or three times as many people with diabetes as we do now. That means somewhere between one out of three and one out of five adults would have diabetes. Right now, about one out of nine adults has diabetes.

Diabetes is a serious disease that affects almost every part of your body and can shorten your life. Some complications you can get because of diabetes are kidney disease, heart disease, stroke, eye disease, and having to have a leg or foot amputated. If you already have diabetes, you can still do a lot to keep from getting complications from diabetes.

Here are some important steps you can take to control diabetes:

  • Talk to your doctor about how to manage your blood sugar level, your blood pressure, and your cholesterol levels.
  • Stop or don’t start smoking or using any kind of tobacco.
  • Do what you can to keep from getting sick. If you have diabetes, you are more likely to get sick and you may get sicker than a person without diabetes. Also, when you’re sick, it’s hard to keep your blood sugar under control. Here are some things you can do to improve your chances of staying well. Get a flu shot. A person with diabetes is more likely to get really sick or even die from pneumonia or the flu (influenza) than a person who doesn’t have diabetes. If you or someone in your family has type 1 or type 2 diabetes, it is very important to get a flu shot. Make sure you ask for the flu shot—not the nose spray, which doesn’t help as much. CDC recommends that every person six months old and older get a flu shot. Also, ask your doctor if you should get a pneumonia shot. The shot is not appropriate for everyone.
  • Don’t ever use someone else’s insulin pen or any other device that draws blood. You can get a virus from the other person if you do.
  • Make sure you are physically active. Physical activity can help you control your weight, blood sugar, and blood pressure, as well as raise your “good” cholesterol and lower your “bad” cholesterol.
  • Do something like walking quickly, gardening, dancing, jogging, or jumping rope at least 150 minutes a week to get yourself moving.
  • At least two days a week, also do other kinds of activity to make your muscles stronger.

Things to Do to Help Keep Yourself from Getting Type 2 Diabetes

If you have prediabetes, there’s good chance you will have type 2 diabetes within three to six years. A person with prediabetes has a blood sugar level that is higher than normal, but not high enough to be diagnosed as diabetes. CDC estimates that 79 million people in the United States—one out of three adults—has prediabetes.

There is hope, though. If you have prediabetes, research shows that you can slow down or keep from getting type 2 diabetes by losing weight and becoming active. For example, a person who weighs 200 pounds needs to lose about 10 to 14 pounds. (If you weigh more than that, you need to lose more weight. If you weigh less, you need to lose less weight.) You also need to become physically active for at least 150 minutes per week. Just doing these things can slow down or keep you from getting type 2 diabetes by nearly 60%.

Source:CDC

Selective serotonin reuptake inhibitors (SSRIs) for stroke recovery.

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Abstract

BACKGROUND:

Stroke is the major cause of adult disability. Selective serotonin reuptake inhibitors (SSRIs) have been used for many years to manage depression. Recently, small trials have demonstrated that SSRIs might improve recovery after stroke, even in people who are not depressed. Systematic reviews and meta-analyses are the least biased way to bring together data from several trials. Given the promising effect of SSRIs on stroke recovery seen in small trials, a systematic review and meta-analysis is needed.

OBJECTIVES:

To determine whether SSRIs improve recovery after stroke, and whether treatment with SSRIs was associated with adverse effects.

SEARCH METHODS:

We searched the Cochrane Stroke Group Trials Register (August 2011), Cochrane Depression Anxiety and Neurosis Group Trials Register (November 2011), Cochrane Central Register of Controlled Trials (CENTRAL) (The Cochrane Library 2011, Issue 8), MEDLINE (from 1948 to August 2011), EMBASE (from 1980 to August 2011), CINAHL (from 1982 to August 2011), AMED (Allied and Complementary Medicine) (from 1985 to August 2011), PsycINFO (from 1967 to August 2011) and PsycBITE (Pyschological Database for Brain Impairment Treatment Efficacy) (March 2012). To identify further published, unpublished and ongoing trials we searched trials registers, pharmaceutical websites, reference lists, contacted experts and performed citation tracking of included studies.

SELECTION CRITERIA:

We included randomised controlled trials that recruited stroke survivors (ischaemic or haemorrhagic) at any time within the first year. The intervention was any SSRI, given at any dose, for any period. We excluded drugs with mixed pharmacological effects. The comparator was usual care or placebo. In order to be included, trials had to collect data on at least one of our primary (dependence and disability) or secondary (impairments, depression, anxiety, quality of life, fatigue, healthcare cost, death, adverse events and leaving the trial early) outcomes.

DATA COLLECTION AND ANALYSIS:

We extracted data on demographics, type of stroke, time since stroke, our primary and secondary outcomes, and sources of bias. For trials in English, two review authors independently extracted data. For Chinese papers, one review author extracted data. We used standardised mean differences (SMD) to estimate treatment effects for continuous variables, and risk ratios (RR) for dichotomous effects, with their 95% confidence intervals (CIs).

MAIN RESULTS:

We identified 56 completed trials of SSRI versus control, of which 52 trials (4059 participants) provided data for meta-analysis. There were statistically significant benefits of SSRI on both of the primary outcomes: RR for reducing dependency at the end of treatment was 0.81 (95% CI 0.68 to 0.97) based on one trial, and for disability score, the SMD was 0.91 (95% CI 0.60 to 1.22) (22 trials involving 1343 participants) with high heterogeneity between trials (I(2) = 87%; P < 0.0001). For neurological deficit, depression and anxiety, there were statistically significant benefits of SSRIs. For neurological deficit score, the SMD was -1.00 (95% CI -1.26 to -0.75) (29 trials involving 2011 participants) with high heterogeneity between trials (I(2) = 86%; P < 0.00001). For dichotomous depression scores, the RR was 0.43 (95% CI 0.24 to 0.77) (eight trials involving 771 participants) with high heterogeneity between trials (I(2) = 77%; P < 0.0001). For continuous depression scores, the SMD was -1.91 (95% CI -2.34 to -1.48) (39 trials involving 2728 participants) with high heterogeneity between trials (I(2) = 95%; P < 0.00001). For anxiety, the SMD was -0.77 (95% CI -1.52 to -0.02) (eight trials involving 413 participants) with high heterogeneity between trials (I(2) = 92%; P < 0.00001). There was no statistically significant benefit of SSRI on cognition, death, motor deficits and leaving the trial early. For cognition, the SMD was 0.32 (95% CI -0.23 to 0.86), (seven trials involving 425 participants) with high heterogeneity between trials (I(2) = 86%; P < 0.00001). The RR for death was 0.76 (95% CI 0.34 to 1.70) (46 trials involving 3344 participants) with no heterogeneity between trials (I(2) = 0%; P = 0.85). For motor deficits, the SMD was -0.33 (95% CI -1.22 to 0.56) (two trials involving 145 participants). The RR for leaving the trial early was 1.02 (95% CI 0.86 to 1.21) in favour of control, with no heterogeneity between trials. There was a non-significant excess of seizures (RR 2.67; 95% CI 0.61 to 11.63) (seven trials involving 444 participants), a non-significant excess of gastrointestinal side effects (RR 1.90; 95% CI 0.94 to 3.85) (14 trials involving 902 participants) and a non-significant excess of bleeding (RR 1.63; 95% CI 0.20 to 13.05) (two trials involving 249 participants) in those allocated SSRIs. Data were not available on quality of life, fatigue or healthcare costs.There was no clear evidence from subgroup analyses that one SSRI was consistently superior to another, or that time since stroke or depression at baseline had a major influence on effect sizes. Sensitivity analyses suggested that effect sizes were smaller when we excluded trials at high or unclear risk of bias.Only eight trials provided data on outcomes after treatment had been completed; the effect sizes were generally in favour of SSRIs but CIs were wide.

AUTHORS’ CONCLUSIONS:

SSRIs appeared to improve dependence, disability, neurological impairment, anxiety and depression after stroke, but there was heterogeneity between trials and methodological limitations in a substantial proportion of the trials. Large, well-designed trials are now needed to determine whether SSRIs should be given routinely to patients with stroke.

Source: PubMed

 

Prevent the Spread of Norovirus.

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Norovirus causes about 20 million gastroenteritis cases each year in the United States. There’s no vaccine to prevent infection and no drug to treat it. Wash your hands often and follow simple tips to stay healthy.

Noroviruses are a group of related viruses. Infection with these viruses affects the stomach and intestines and causes an illness called gastroenteritis (GAS-tro-en-ter-I-tis; inflammation of the stomach and intestines).

Anyone Can Get Norovirus

Anyone can be infected with noroviruses and get sick. Also, you can get norovirus illness more than once during your life. The illness often begins suddenly. You may feel very sick, with stomach cramping, throwing up, or diarrhea.

Noroviruses are the most common cause of gastroenteritis in the United States. CDC estimates that each year more than 20 million cases of acute gastroenteritis are caused by noroviruses. That means about 1 in every 15 Americans will get norovirus illness each year. Norovirus is also estimated to cause over 70,000 hospitalizations and 800 deaths each year in the United States.

Many Names, Same Symptoms

You may hear norovirus illness called “food poisoning” or “stomach flu.” It is true that food poisoning can be caused by noroviruses. But, other germs and chemicals can also cause food poisoning. Norovirus illness is not related to the flu (influenza), which is a respiratory illness caused by influenza virus.

Symptoms of norovirus infection usually include diarrhea, throwing up, nausea, and stomach cramping.

Other, less common symptoms may include low-grade fever, chills, headache, muscle aches, and general sense of fatigue.

Norovirus illness is usually not serious. Most people get better in 1­ to 2 days. But, norovirus illness can be serious in young children, the elderly, and people with other health conditions; it can lead to severe dehydration, hospitalization and even death.

You may get dehydrated if you are not able to drink enough liquids to replace the fluids lost from throwing up or having diarrhea many times a day. Symptoms of dehydration include a decrease in urination, a dry mouth and throat, and feeling dizzy when standing up. Children who are dehydrated may also cry with few or no tears and be unusually sleepy or fussy.

The best way to prevent dehydration is to drink plenty of liquids. Oral rehydration fluids are the most helpful for severe dehydration. But other drinks without caffeine or alcohol can help with mild dehydration. However, these drinks may not replace important nutrients and minerals that are lost due to vomiting and diarrhea.

If you think you or someone you are caring for is severely dehydrated, contact your doctor. For more information on norovirus and dehydration, see norovirus treatment.

Norovirus Spreads Quickly

Norovirus can spread quickly from person to person in crowded, closed places like long-term care facilities, daycare centers, schools, hotels, and cruise ships. Noroviruses can also be a major cause of gastroenteritis in restaurants and catered-meal settings if contaminated food is served.

Norovirus and Food

Norovirus is a leading cause of disease from contaminated foods in the United States. Foods that are most commonly involved in foodborne norovirus outbreaks include leafy greens (such as lettuce), fresh fruits, and shellfish (such as oysters). However, any food item that is served raw or handled after being cooked can become contaminated with noroviruses.

The viruses are found in the vomit and stool of infected people. You can get it by

  • Eating food or drinking liquids that are contaminated with norovirus (someone gets stool or vomit on their hands, then touches food or drink).
  • Touching surfaces or objects contaminated with norovirus and then putting your hand or fingers in your mouth.
  • Having direct contact with a person who is infected with norovirus (for example, when caring for someone with norovirus or sharing foods or eating utensils with them).

People with norovirus illness are contagious from the moment they begin feeling sick until at least 3 days after they recover. But, some people may be contagious for even longer.

Norovirus: No Vaccine and No Treatment

There is no vaccine to prevent norovirus infection. Also, there is no drug to treat people who get sick from the virus. Antibiotics will not help if you have norovirus illness. This is because antibiotics fight against bacteria, not viruses. The best way to reduce your chance of getting norovirus is by following some simple tips.

Stop the Spread of Norovirus

Practice proper hand hygiene

Wash your hands carefully with soap and water, especially after using the toilet and changing diapers and always before eating or preparing food. If soap and water aren’t available, use an alcohol-based hand sanitizer. These alcohol-based products can quickly reduce the number of germs on hands in some situations, but they are not a substitute for washing with soap and water.

Take care in the kitchen

Carefully wash fruits and vegetables, and cook oysters and other shellfish thoroughly before eating them.

Do not prepare food while infected

People with norovirus illness should not prepare food for others while they have symptoms and for 3 days after they recover from their illness.

Clean and disinfect contaminated surfaces

After throwing up or having diarrhea, immediately clean and disinfect contaminated surfaces by using a bleach-based household cleaner as directed on the product label. If no such cleaning product is available, you can use a solution made with 5 tablespoons to 1.5 cups of household bleach per 1 gallon of water.

Wash laundry thoroughly

Immediately remove and wash clothing or linens that may be contaminated with vomit or stool. Handle soiled items carefully—without agitating them—to avoid spreading virus. If available, wear rubber or disposable gloves while handling soiled clothing or linens and wash your hands after handling. The items should be washed with detergent at the maximum available cycle length and then machine dried.

Source:CDC

 

 

 

 

Moderate Pulmonary Embolism Treated With Thrombolysis (from the “MOPETT“ Trial).

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The role of low-dose thrombolysis in the reduction of pulmonary artery pressure in moderate pulmonary embolism (PE) has not been investigated. Because the lungs are very sensitive to thrombolysis, we postulated that effective and safe thrombolysis might be achieved by a lower dose of tissue plasminogen activator. The purpose of the present study was to evaluate the role of this “safe dose“ thrombolysis in the reduction of pulmonary artery pressure in moderate PE. During a 22-month period, 121 patients with moderate PE were randomized to receive a “safe dose“ of tissue plasminogen activator plus anticoagulation (thrombolysis group [TG], n = 61 patients) or anticoagulation alone (control group [CG], n = 60). The primary end points consisted of pulmonary hypertension and the composite end point of pulmonary hypertension and recurrent PE at 28 months. Pulmonary hypertension and the composite end point developed in 9 of 58 patients (16%) in the TG and 32 of 56 patients (57%) in the CG (p <0.001) and 9 of 58 patients (16%) in the TG and 35 of 56 patients (63%) in the CG (p <0.001), respectively. The secondary end points were total mortality, the duration of hospital stay, bleeding at the index hospitalization, recurrent PE, and the combination of mortality and recurrent PE. The duration of hospitalization was 2.2 +/- 0.5 days in the TG and 4.9 +/- 0.8 days in the CG (p <0.001). The combination of death plus recurrent PE was 1 (1.6%) in TG and 6 (10%) in the CG (p = 0.0489). No bleeding occurred in any group, and despite a positive trend in favor of a “safe dose“ thrombolysis, no significant difference was noted in the rate of individual outcomes of death and recurrent PE when assessed independently. In conclusion, the results from the present prospective randomized trial suggests that “safe dose“ thrombolysis is safe and effective in the treatment of moderate PE, with a significant immediate reduction in the pulmonary artery pressure that was maintained at 28 months.

Source:American Journal of cardiology

 

Scientists Find Evidence of Ancient Tsunami in Switzerland.

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Researchers say they’ve found good evidence that it has happened before. In the sixth century — the age of King Arthur, Mohammed and the bubonic plague — a bishop named Gregory of Tours noted an unusual event in Geneva. In 563, he wrote, a cascade of rocks plunged into the Rhone River, generating a  wave of water that “overwhelmed with a sudden and violent flood all that was on the banks as far as the city of Geneva,” over 40 miles away, according to the New York Times.

Historians reading Gregory’s story, which is backed up by other ancient texts, have suspected for quite some time that something akin to a tsunami had hit Lake Geneva.

Now, there may be science to prove it. On the bottom of the lake, nearly 1,000 feet down, researchers from the University of Geneva have discovered a massive, 16-foot deep deposit of sediment, six miles long and three miles wide. Taking samples from bits of wood and leaves stuck in the sludge, the scientists concluded that the sediment dates from between the late fourth and early seventh century. They suspect this may have been what was left of the rocky mass that Gregory reported nearly 1,500 years ago. Using computer simulations, they estimate that the effect of that much material plunging into the water would have caused a 26-foot high tsunami wave which would have reached Geneva in about 70 minutes.

What caused the rocks to fall into the river in the first place? It may have been an earthquake, say scientists. They also say lakeside dwellers should wipe that smug, not-tsunami-fearing look off their faces. “People think, ‘Oh, lucky us, we live near a lake — we don’t have any such threat,’ ” Dr. Guy Simpson of the University of Geneva told the New York Times. “This reminds people that hey, hang on, these things have happened in the past, and quite likely will happen again.”

Head on over to the New York Times website to check out a graphic illustrating how the Swiss tsunami may have unfolded. You can also listen to an interesting discussion with the article’s author, Henry Fountain, and find out what became of 6th century Geneva.

If you’re looking to bone up on ancient natural disasters, here’s a primer on a few lesser-known ones:

1. The Plague of Justinian

In 541-542 A.D., a tiny bacteria swept across the ancient world, killing as many as 100 million people. It’s named after Justinian, emperor of the Eastern Roman Empire at the time, who contracted the disease but did not die from it. We can all give thanks to Alexander Fleming for discovering that little mold penicillin in 1928 and ensuring this (probably) won’t happen again.

2. The Antioch Earthquake

The 6th century was not a great time for humanity in general. In 526 A.D., a devastating earthquake struck the city of Antioch, in present-day Turkey, killing some 250,000 people. The quake lifted the city’s port up by more than three feet and caused fires to break out, destroying what remained of the metropolis. Antioch, once a great outpost of the Byzantine Empire, was reduced to rubble in the disaster.

3. The Alexandria Tsunami

On July 21, 365 A.D., a magnitude 8.0 quake hit the island of Crete, generating a tsunami that swept across the Mediterranean towards the port city of Alexandria. The water pushed the port’s giant ships inland into the city and deposited them on top of buildings. Tens of thousands of people lost their lives.

4. Damghan Earthquake

This earthquake hit modern-day Iran on Dec. 22, 856 A.D., causing some 200,000 deaths, including 45,000 in the Persian city of Damghan.

5. Plague of Athens

During the Peloponnesian War (431-404 B.C.), Athens was struck down by a plague which may have wiped out as much as a third of the city-state’s population. Historians debate whether the epidemic contributed to Athens’ loss of the war to Sparta and the Peloponnesian league. In the city-state itself, however, the plague had a number of well-documented social effects. The Greek historian Thucydides recorded that it changed peoples’ attitudes toward the social order and money — with citizens spending and breaking the law with impunity.

Source: Time.com