MSF

Dementia Risk and HRT; Gut Alterations and Alzheimer’s; Prescription Opioids and MS

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News and commentary from the world of neurology and neuroscience

Hormone replacement therapy (HRT) was associated with an increased dementia risk in a population-based, longitudinal study in Taiwan. (Neurology)

Post-9/11 U.S. veterans with a history of traumatic brain injury (TBI) were more likely to develop cardiovascular disease than veterans without a TBI history. (JAMA Neurology)

Gut microbiota alterations were seen in Alzheimer’s dementia patients in Kazakhstan, with correlations found between disease severity and certain fecal bacteria. (Scientific Reports)

A meta-analysis reported evidence of a likely causal relationship between a reduction of brain amyloid and less cognitive and functional decline in Alzheimer’s patients. (Alzheimer’s & Dementia)

A woman born without a left temporal lobe described her life as a research subject and her quest to understand brains like hers. (New York Times)

Prophylactic levetiracetam (Keppra) appeared to prevent acute seizures in intracerebral hemorrhage, a small trial showed. (Lancet Neurology)

Prescription opioid use was more common in multiple sclerosis (MS) patients than in those without MS, with mood and anxiety disorders tied to longer opioid use. (Journal of Neurology, Neurosurgery & Psychiatry)

The FDA approved a first-in-market 10 mg midazolam autoinjector to treat status epilepticus in adults, Rafa Laboratories announced.

Coma may be more prevalent in the U.S. than the U.K., crowdsourcing data suggested.

Brainwaves of a Dying Man; Omicron, MS, and COVID Vax; CRISPR Treatment Shows Effect

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News and commentary from the world of neurology and neuroscience

Brain scan images with NeuroBreak in the center.

Electroencephalography (EEG) recordings from the dying human brain of an 87-year-old man with seizures and cardiac arrest found coordinated low- and high-frequency activity near death, which researchers speculated may represent a “last recall of life.” (Frontiers in Aging Neuroscience)

Patients with multiple sclerosis on ocrelizumab (Ocrevus) showed robust T-cell responses recognizing spike proteins from Delta and Omicron variants after mRNA COVID-19 vaccination, which increased after a third dose. (JAMA Neurology)

Researchers identified how TDP-43 protein depletion, which is associated with almost all amyotrophic lateral sclerosis (ALS) cases and half of frontotemporal dementia cases, corrupts genetic instructions for the neuronal protein UNC13A. (Nature)

Novelist Amy Bloom discussed her husband’s Alzheimer’s diagnosis and his decision to end his life. (New York Times)

An investigational CRISPR therapy reduced serum transthyretin protein by up to 93% in a phase I study of people with hereditary transthyretin amyloidosis with polyneuropathy, Intellia Therapeutics announced.

Neurofilament light had the highest accuracy in predicting neurologic outcome in people with hypoxic ischemic brain injury 48 hours after return of spontaneous circulation, a meta-analysis showed. (JAMA Neurology)

Children living in areas with higher air pollution due to fine particulate matter had an increased risk of developing ADHD. (Environmental International)

Higher stages of memory impairment using the Free and Cued Selective Reminding Test were associated with Alzheimer’s pathology in older adults with normal cognition. (Neurology)

The fractal nature of tics may help estimate tic severity and treatment effectiveness and could differentiate typical from functional tics. (Journal of the Royal Society Interface)

Around the world, doctors are seeing young patients with sudden onset of tics. Is this the first disorder spread by social media?

MSF helps care for people injured by tsunami in Indonesia

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An MSF midwife checks the vital signs of a patient at the health center in Labuan, Indonesia. He is one of the patients being treated at the center after a tsunami hit coastal areas along the Sunda Strait on the night of December 22. INDONESIA 2018
At least 222 people have been killed and 843 injured in Indonesia after a tsunami hit coastal areas along the Sunda Strait on Saturday night, according to the country’s National Agency for Disaster Management (BNPB).
Doctors Without Borders/Médecins Sans Frontières (MSF) head of mission in Indonesia, Daniel von Rège, who is currently in the affected area to coordinate support for health interventions, provided this update:
“Since early 2018, MSF has had an adolescent health project in Indonesia supporting the Ministry of Health in Labuan and Carita in Pandeglang district, one of the areas most severely hit by the tsunami following an eruption of Anak Krakatoa volcano late on the evening of December 22, 2018. The MSF teams in Pandeglang responded to the influx of patients on the morning of December 23 as both injured people and [dead] bodies were brought in to the health centers. With support from the MSF country coordination team, which arrived a few hours later, MSF liaised with the health center teams, prioritizing immediate needs.
As the most severe cases were being referred to bigger hospitals in the area and the deceased were being managed by local authorities, MSF supported the exhausted health workers by ensuring proper case management of injured people, infection control and hygiene standards, as well as material support. During the course of the day, more injured people and dead bodies arrived which needed immediate attention—and we expect this to continue over the next few days.
MSF has a permanent presence in Pandeglang district, and we will continue to support the national efforts as long as needed.”

Bangladesh: Diphtheria Outbreak Threatens Rohingya Refugees

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Diphtheria is re-emerging in Bangladesh, where more than 655,000 Rohingya have sought refuge since August 25, fleeing a campaign of targeted violence in Myanmar. As of December 21, Doctors Without Borders/Médecins Sans Frontières (MSF) has seen more than 2,000 suspected cases in its health facilities and the number is rising daily. The majority of patients are between five and 14 years old.

Diphtheria, a contagious bacterial infection known to cause airway obstruction and damage to the heart and nervous system, has been long forgotten in most parts of the world thanks to increasing rates of vaccination. The fatality rate increases without the diphtheria antitoxin (DAT). With global shortages of DAT and the limited quantity that arrived in Bangladesh just over a week ago, the likelihood of a public health emergency looms, threatening a population that has fled the threat of violence and is now faced with another: the outbreak of disease.

“I was very surprised when I got that first call from the doctor at the clinic telling me that he had a suspected case of diphtheria,” says Crystal Crystal VanLeeuwen, MSF emergency medical coordinator for Bangladesh. “‘Diphtheria?’ I asked, ‘Are you sure?’ When working in a refugee setting you always have your eyes open for infectious, vaccine-preventable diseases such as tetanus, measles and polio, but diphtheria was not something that was on my radar.”

If patients don’t receive DAT early on in the progression of their illness, the toxin continues to circulate in the body. This can cause damage to the nervous, cardiac and renal systems weeks after the initial recovery period.

“The first suspected case we identified was a woman around 30 years old,” explains VanLeeuwen. “She came to our health facility in early November and we treated her with antibiotics. She left the clinic, only to return to us over five weeks later. Then she had numbness in her arms, could barely stand or walk and had difficulty swallowing. It is too late to give her DAT at this stage.”

As of today, there are only less than 5,000 vials of DAT globally. “There is not enough of the medication to treat all of the people in front of you who need it and we are forced to make extremely difficult decisions,” says VanLeeuwen.  “It becomes an ethical and equity question.”

The emergence and the spread of diphtheria show how vulnerable Rohingya refugees are. The majority of them are not vaccinated against any diseases, as they had very limited access to routine health care in Myanmar. Diphtheria is transmitted by droplets and spreads easily in the refugee settlements where people live in overcrowded conditions, with shelters squeezed up against each other and families with as many as 10 people living in one very small space.

MSF has responded to the rapid spread of diphtheria by converting one of its mother and child inpatient facilities in Balukhali makeshift settlement and a new inpatient facility near Moynarghona into diphtheria treatment centers.
MSF also has set up a treatment center in Rubber Garden, previously a transit center for new arrivals. The total bed capacity will grow to 415 beds by December 25.

To prevent the further spread of the disease, our teams are also doing tracing and treatment of people who might have come in contact with the disease in the community. As soon as a case is identified, a team visits the family, gives them antibiotics and searches the area for additional cases for referral and treatment.

To contain the spread of the diseases, the most important measure is to ensure vaccination coverage in the shortest possible time. The Bangladeshi Ministry of Health and Family Welfare, with the support of other entities, has started a mass vaccination campaign, which MSF is supporting by setting up fixed points in our health posts.

Serious Challenges Remain

An unvaccinated person gains immunity after a minimum of two vaccines, administered four weeks apart. However, the Rohingya community knows little or nothing about the benefit of vaccines. Less than a month ago, the Rohingya participated in a mass measles vaccination campaign. Many do not understand why they would need another vaccine.  Communication with the affected population is key to ensuring good vaccination coverage.

MSF is also trying to ensure that all newly arrived refugees are vaccinated before they are relocated to the camps. Yet, given the length of time required to complete the course of diphtheria vaccination and the shortage of space to shelter the Rohingya temporarily, the challenges are enormous.

As a medical humanitarian organization, MSF also faces a dilemma in responding to the most urgent patient needs. “Even before the diphtheria [outbreak], there was a severe lack of inpatient bed capacity. Now we have had to convert those scarcely available beds into dedicated treatment and isolation areas for diphtheria patients only,” says Crystal VanLeeuwen. “The women and children who previously had access to the facility no longer have this as an option. This is also creating a strain on the space and staffing available in non-diphtheria inpatient facilities that have taken on these patients. The teams have been adapting to the rapidly changing situation, but we all face new challenges each day.”

“These diphtheria cases come on top of an ongoing outbreak of measles and the huge load of general and emergency health needs of this many people,” says Pavlos Kolovos, MSF head of mission for Bangladesh.
“[The Rohingya] are already vulnerable, coming with almost no vaccination coverage. Now they are living in an extremely densely populated camp, with poor water and hygiene conditions. Until those problems are addressed and improved, we will continue to face further disease outbreaks—and not just of diphtheria.”

EU States’ Dangerous Approach to Migration puts Asylum in Jeopardy Worldwide

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Refugees arrive on the Greek island of Kos after the dangerous journey across the Mediterranean.

June 16, 2016

MSF Will No Longer Accept Funds from EU Member States and Institutions

BRUSSELS, JUNE 17, 2016—The international medical humanitarian organization Doctors Without Borders/Médecins Sans Frontières (MSF) today announced that it will no longer accept funds from the European Union and its member states, in opposition to their damaging migration deterrence policies and intensifying attempts to push people and their suffering away from European shores. This decision will take effect immediately and will apply to MSF’s projects worldwide.

Three months into an agreement struck between the EU and Turkey, which European governments are claiming as a success, people in need of protection are paying the true cost of the deal. On the Greek islands, more than 8,000 people, including hundreds of unaccompanied minors, have been stranded as a direct consequence of the EU-Turkey deal. They have been living in dire conditions in overcrowded camps, sometimes for months. While they fear a forced return to Turkey, they are deprived of essential legal aid, their one defense against collective expulsion. The majority of these families, whom Europe has legislated out of sight, have fled conflict in Syria, Iraq, and Afghanistan.

“For months MSF has spoken out about a shameful European response focused on deterrence rather than on providing people with the assistance and protection they need,” said Jerome Oberreit, MSF international secretary general. “The EU-Turkey deal goes one step further, placing the very concept of ‘refugee’ and the protection it offers in danger.”

Last week the European Commission unveiled a new proposal to replicate the EU-Turkey logic across more than 16 countries in Africa and the Middle East. These deals would impose trade and development aid cuts on countries that do not stem migration to Europe or facilitate forcible returns, and reward those that do. Among these potential partners are Somalia, Eritrea, Sudan, and Afghanistan, four of the top 10 refugee generating countries, according to the United Nations.

“Is Europe’s only offer to refugees that they stay in countries they are desperate to flee? Once again, Europe’s main focus is not on how well people will be protected, but on how efficiently they are kept away,” said Oberreit.

The EU-Turkey deal sets a dangerous precedent for other countries hosting refugees, sending a message that caring for people forced from their homes is optional and that they can purchase their way out of providing asylum. Last month, the Kenyan government cited European migration policy to justify its decision to close the world’s largest refugee camp, Dadaab, and send its residents back to Somalia. Likewise, the deal does nothing to encourage countries surrounding Syria, already hosting millions of refugees, to open their borders to those in need.

“Europe’s attempt to outsource migration control is having a domino effect, with closed borders stretching all the way back to Syria,” said Oberreit. “People increasingly have nowhere to turn. Will the situation in Azaz, Syria, where 100,000 people are blocked between closed borders and front lines, become the rule, rather than the deadly exception?”

The EU-Turkey deal’s financial package includes one billion euros in humanitarian aid. While there are undoubtedly needs in Turkey, which currently hosts close to three million Syrian refugees, this aid has been negotiated as a reward for border control promises, rather than being based solely on needs. This instrumentalization of humanitarian aid is unacceptable, MSF said.

“Deterrence policies sold to the public as humanitarian solutions have only exacerbated the suffering of people in need,” said Oberreit. “There is nothing remotely humanitarian about these policies, which cannot become the norm and must be challenged. MSF will not receive funding from institutions and governments whose policies do so much harm. We are calling on European governments to shift priorities. Rather than maximize the number of people they can push back, they must maximize the number they welcome and protect.”

MSF has been providing assistance to people crossing the Mediterranean Sea to Europe since 2002. In the last 18 months alone, MSF medics have treated an estimated 200,000 men, women, and children in Europe and on the Mediterranean Sea. The organization currently cares for refugees and migrants in Greece, Serbia, France, and Italy and on the Mediterranean, as well as in countries across Africa, Asia, and the Middle East.

MSF’s activities are mainly (92 percent) privately funded. Nevertheless, the organization is also involved in some financial partnerships with institutional donors for specific programs. In 2015, funding from EU institutions represented 19 million euros, while funding from EU member states represented 37 million euros. MSF also used 6.8 millions euros received from the Norwegian Government. In 2016, in addition to ECHO, MSF is involved in partnerships with nine European Union member states: Belgium, Denmark, Germany, Ireland, Luxembourg, Netherlands, Spain, Sweden, and the United Kingdom.

MSF Releases Internal Review of Kunduz Hospital Attack

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Debris litters the floor in one of the corridors of MSF’s Kunduz Trauma center.

November 05, 2015

KABUL/BRUSSELS/NEW YORK—The international medical humanitarian organization Doctors Without Borders/Médecins Sans Frontières (MSF) today released an internal document reviewing the October 3 airstrikes by US forces on its hospital in northern Afghanistan. The chronological review of the events leading up to, during, and immediately following the airstrikes reveal no reason why the hospital should have come under attack. There were no armed combatants or fighting within or from the hospital grounds.

The document, part of an ongoing review of events undertaken by MSF, is based upon sixty debriefings of MSF national and international employees who worked at the 140-bed trauma center, internal and public information, before and after photographs of the hospital, email correspondence, and telephone call records. At least thirty people were killed in the airstrikes, including 13 staff members, 10 patients and 7 unrecognizable bodies yet to be identified.

“The view from inside the hospital is that this attack was conducted with a purpose to kill and destroy,” said Christopher Stokes, MSF general director. “But we don’t know why. We neither have the view from the cockpit, nor the knowledge of what happened within the US and Afghan military chains of command.”

The initial findings of the MSF review firmly establish the facts from inside the hospital in the days leading up to and during the attack. The review includes the details of the provision of the GPS coordinates and the log of phone calls from MSF to military authorities in attempt to stop the airstrikes. MSF had reached an agreement with all parties to the conflict to respect the neutrality of the hospital, based on international humanitarian law.

“We held up our end of the agreement—the MSF trauma center in Kunduz was fully functioning as a hospital with surgeries ongoing at the time of the US airstrikes,” said Dr. Joanne Liu, international president of MSF. “MSF’s no-weapons policy was respected and hospital staff were in full control of the facility prior to and at the time of the airstrikes.”

Among the 105 patients at the time of the airstrikes, MSF was treating wounded combatants from both sides of the conflict in Kunduz, as well as women and children.

“Some public reports are circulating that the attack on our hospital could be justified because we were treating Taliban,” said Stokes. “Wounded combatants are patients under international law, and must be free from attack and treated without discrimination. Medical staff should never be punished or attacked for providing treatment to wounded combatants.”

The MSF internal review describes patients burning in their beds, medical staff that were decapitated and had lost limbs, and others who were shot from the air while they fled the burning building.

“The attack destroyed our ability to treat patients at a time of their greatest need,” said Dr. Joanne Liu, international president of MSF. “A functioning hospital caring for patients cannot simply lose its protected status and be attacked.”

Providing Psychological Care in Syria: “Flashbacks, Nightmares, and Baby Clothes”.

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MSF135182-Audrey-Magis

 

Psychologist Audrey Magis recently returned home after spending two months working with Doctors Without Borders/Médecins Sans Frontières (MSF) in Syria, where she set up and ran a mental health program in one of MSF’s projects in the north of the country. Magis, who had previously worked for MSF in Gaza, Libya, and in a camp for Syrian refugees, explains how the war has affected people and what MSF is doing to help.

In most places I have worked, people are rather hesitant when I tell them that I am a psychologist. But in Syria, it was quite the opposite. People actually came and told me they needed my services. The war has been raging for two years and people have completely lost their bearings. At first, they would come and tell me about their social problems at home. Children are not going to school and so become disruptive. Adults are not working. People are living in tents or ten-up crowded into one room. But when you dig a little, you quickly find that most have experienced deeply traumatic events. Some have lost friends or family. Some have seen their home destroyed. Some have lived through bombing raids . . .

Loss of Identity

People have lost their identity. Older men cannot find their place in society and in the family. They have lost their job or stopped being a fighter. Maybe they have responsibility for a family but they have had to move house several times in quick succession.

“I don’t have to find them; they come and ask for help . . .”

I don’t have to find them; they come and ask for help, saying things like, “I’m starting to be violent towards my wife and children. Please help me, I cannot be like that.”

I have seen many women who are finding it increasingly hard to form a bond with their children. There are few contraceptives available, and a lot of women are becoming pregnant without really wanting to. They struggle to imagine their future with their child. I met several women in the final term of pregnancy who had prepared nothing—no cot, no baby clothes, no ideas for a name. People have lost their ability to project their lives into the future.

All the children are playing at war. You don’t see them playing with cars or other normal games; they pretend to shoot each other. I’ve seen kids throwing stones at donkeys, hurting animals. This is their way of expressing the pent up anger. I have also seen young men in their 20s, ex-fighters who have come to me with complaints about depression, traumatic stress, flashbacks, nightmares . . .

Loss of Meaning

A number of people have quietly told me that they no longer know what the war is about. They are terrified at the idea that they are fighting their neighbors, their friends . . . and they don’t know why anymore. At first there seemed to be some purpose, but two years on, that’s all gone. They just want it all to end so they can go home.

“People have lost their ability to project their lives into the future.”

Things have gone way beyond the breaking point. People are on automatic pilot. But somehow they manage to hold it all together. They cannot allow themselves to fall apart. They have developed an amazing ability to cope and keep going. To survive two years living through this, it’s impressive. The family and community support is enormous.

Not Going Mad

Sometimes just one session is enough. Some people just need to hear that what’s happening to them is normal, that they are not going mad. But there are other patients who I had to work with for longer. The idea is to set a clear objective with them, and to get there step by step with behavioral therapy. There is no time for long analysis sessions, but you can do very sound psychological work with these short-form therapy techniques.

A Child Born of War

I remember one patient, a woman who was six months pregnant. She came to the hospital asking for a premature delivery. There was no medical reason; she just wanted us to do a C-section and deliver her baby as soon as possible. She was very jumpy, very agitated.

“A number of people have quietly told me that they no longer know what the war is about. They are terrified at the idea that they are fighting their neighbors, their friends… and they don’t know why anymore.”

I sat with her and we worked out that this was one baby too many, a child born of the war, and she felt that the baby was sapping all her energy. All she wanted to do was take anti-depressants, but she couldn’t because she was pregnant.

We worked out a plan of relaxation exercises. And we made a diary where she would write down when she felt tense and what had happened to cause the tension. And a few sessions later we moved on to preparing for the arrival of her baby.

At our last session she showed me the baby clothes for her soon-to-be-born baby. She hadn’t yet chosen a name, but she had made great strides and was ready. She was my last patient, my last session on my last day. I left the project with the sense that my time had been well spent.

Source: MSF newsletter

 

MSF Increases Medical Response to Syrian Conflict.

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Doctors Without Borders/Médecins Sans Frontières (MSF) is increasing its medical activities to help victims of the conflict in Syria. MSF is providing emergency and surgical treatment for the wounded as well as other medical care for people displaced from their homes within Syria and for refugees who have escaped to neighboring countries.

Inside Syria, MSF teams are striving to meet the needs of people caught up in the conflict, but restrictions and insecurity prevent the teams from extending their work or gaining an overview of the humanitarian and medical needs in all the affected regions.

Treating the Wounded in Syria

Over the past four months, MSF has opened four hospitals in northern Syria in areas controlled by armed opposition groups. In these hospitals, MSF teams are providing emergency medical treatment including surgery.

Since the end of June 2012, MSF teams have treated more than 2,500 patients and carried out about 550 surgical procedures. Many of these were for violence-related injuries including gunshot wounds, shrapnel wounds, open fractures, and explosive-related injuries. Women and children are among the patients, along with combatants from several opposition groups and government forces. As the conflict has evolved, the hospital activities have fluctuated in accordance with the ability of people to access health facilities.

Fighting has also displaced people from their homes. The population in one Syrian town where MSF is working has increased to 30,000 people over the last few months. Many of the displaced families are sheltering in schools and public buildings. In one site, MSF teams are providing people with clean water and are evaluating additional relief activities.

In response to the increasing medical needs in Syria and an overall lack of medical supplies, MSF has donated tons of medical and relief items to field hospitals and clinics in Homs, Idlib, Hama, and Deraa governorates and to the Syrian Red Crescent in Damascus.

Surgical Treatment for Syrian Refugees

MSF is also treating victims of violence from Syria in its surgical program in Amman, Jordan, which initially opened in 2006 to treat victims of the war in Iraq.

Over the past four months, approximately 45 percent of new patients admitted to the surgical hospital were Syrians. Between June 2011 and September 2012, 289 Syrian patients were admitted, half of whom underwent surgery. Psychological counseling and free accommodation are also provided for patients undergoing treatment. MSF medical liaison officers in Jordan have also visited the Zaatari refugee camp—home to 30,000 Syrian refugees—to identify wounded people requiring surgery.

Medical Aid for Refugees in Countries Bordering Syria

As the crisis in Syria intensifies, thousands of people are seeking refuge in neighboring countries. MSF is providing basic health care and conducting mental health consultations for Syrian refugees arriving in Iraq, Jordan, Lebanon, and Turkey.

Most Syrian refugees entering Lebanon have settled in the northern city of Tripoli. MSF is providing medical assistance in Tripoli, as well as in the Bekaa Valley, the main crossing point into Lebanon for people fleeing Syria. To date, MSF teams have conducted more than 11,600 medical consultations and more than 1,700 individual psychological consultations.

In northern Iraq, MSF is the main health care provider in Domeez Refugee Camp, where more than 15,000 people have settled. Since last May, MSF medical teams have provided more than 20,500 consultations.

In Turkey, MSF has been working in the border town of Kilis and in the capital, Istanbul, providing mental health support to civilians fleeing the conflict.

MSF remains committed to assisting all victims of the conflict and plans to expand its activities in Syria and surrounding countries.

Source: MSF newsletter.