H5N1

MSF in Nigeria: Parched Pulka searches for water

Via MSF.org: Nigeria: Parched Pulka searches for water. Excerpt:

Hauwa is determined. She will not go home − a makeshift tent − with an empty jerry can. She has to cook, bathe and feed her family. Nothing is possible if she cannot fill her jerry can today.  

Hauwa, like others in the camp for internally displaced people (IDPs) in Pulka, Borno state, north-east Nigeria, is struggling to cope with an acute water shortage. Long queues of bright yellow and orange water containers surround the numerous water points in the Pulka camps which continue to receive people fleeing conflict. 

Crowds, mostly women, jostle to get their mugs under the mouths of the hand pumps. Bits of cut-out plastic bottle have been shaped into funnels for jerry cans and other narrow top containers. Every inch gained in the melee counts; every drop in the bucket increases the chance of survival in the excruciating dry heat. 

International standards for humanitarian aid recommend that people have access to between 15 and 20 litres of water every day in emergency conditions. For IDPs in Pulka, this is a distant dream.  

“It is difficult to get even a container of water; sometimes we have to wait all day without getting any. We have to beg our neighbours,” says Hauwa. Displaced people like her are almost completely dependent on humanitarian assistance for survival. 

Community members have come together to dig wells. Men are hard at work dredging soil elsewhere in the camp. Nearby, a young boy is collecting brown, muddy water from a puddle formed by thin streams flowing from newly dug wells. Nothing goes to waste in Pulka, there is not enough to waste. The population of Pulka tripled from less than 20,000 before the conflict in April 2014 to an estimated 65,000 residents at present. 

The lack of sufficient water, both for drinking and personal hygiene, has resulted in medical issues like skin diseases and outbreaks of water-borne diseases. Between February and March 2018, MSF recorded a 45 percent increase in incidences of acute watery diarrhoea in Pulka.

Saudi Arabia: 1,038 cases of scabies diagnosed in Mecca

Thanks to Ali AlAhmed for alerting me to this outbreak. Via Gulf Daily News Online: KSA: 1038 cases of scabies diagnosed in Mecca.

The number of people who were diagnosed with scabies in the province of Mecca rose to 1038.  

The Directorate of Health Affairs in Mecca said that 394 cases were found at schools. The medical teams have reported 25 other cases over the past 24 hours.  The increasing cases of scabies led the authorities to shut 33 schools for boys and girls in Mecca.   

Closed schools are expected to reopen on Sunday but students diagnosed with scabies will stay at home for up to two weeks.  

Education Minister Dr. Ahmed Al-Essa toured three government schools in Mecca and followed up efforts to deal with the situation.

Bangladesh: Summary of MSF operations in Cox’s Bazar

Via MSF.org, a report that gives us some idea of the scope of the Rohingya disaster: Bangladesh: Summary of MSF operations in Cox’s Bazar. The summary:

Number of health facilities: 10 health posts; 4 primary health centres (open around the clock); and five inpatient health facilities (providing 24-hour secondary healthcare).  

Number of staff: To respond to the fastest-growing refugee crisis in the world, MSF’s team in Cox’s Bazar has increased 10-fold in the past six months to more than 2,800 staff – the majority of them Bangladeshi nationals. 

Number of patients: Over the past 6 months, our teams carried out 351,421 outpatient and 8,135 inpatient consultations.  

Main morbidities: Respiratory infections, diarrhoeal diseases, skin diseases – all related to poor living conditions.  

Water and sanitation: This is key to prevent the spread of disease. Activities include drilling boreholes and tube wells, installing a gravity-fed water supply system, trucking in water, desludging old latrines, constructing new sustainable latrines, doing bucket chlorination and distributing domestic water filters. 

Mental health services: This has been scaled up, with more counsellors added to existing teams, services available at additional health posts, and training outreach workers to provide basic psychosocial support.  

Outreach: Teams focus on health promotion, outbreak prevention, alert and response, while a surveillance team gathers demographic, nutritional, mortality and natality indicators, covering 80% of the refugees’ settlements. The teams also do active case-finding and referral to health facilities for diagnosis and treatment, as well as defaulter tracing and mobilisation for vaccination. An all-female team spreads messages about sexual and reproductive health in the community.

'Sweating' blood: Mysterious case leaves Canadian experts searching for answers

Via The Guardian: 'Sweating' blood: mysterious case leaves Canadian experts searching for answers. Excerpt:

The case left doctors perplexed: a 21-year-old Italian woman with no gashes or skin lesions arrived at a medical ward, where she described years of sweating blood from her face and the palms of her hands.  

The bleeding would often start while she was sleeping or during physical activity and could last anywhere from one to five minutes. While the intensity of the bleeding seemed to increase with stress, she couldn’t single out any obvious trigger.  

Her condition has been documented by two physicians from the University of Florence in Italy in the latest issue of the Canadian Medical Association Journal. 

The condition – which had begun about three years before she sought medical help – had taken a toll on her mental health, wrote doctors Roberto Maglie and Marzia Caproni. “Our patient had become socially isolated owing to embarrassment over the bleeding and she reported symptoms consistent with major depressive disorder and panic disorder.” 

They prescribed her anti-anxiety medications, but the bleeding continued. After a round of tests and observations ruled out the possibility that she was faking the condition, she was diagnosed with hematohidrosis, a rarely reported condition in which patients spontaneously sweat blood through unbroken skin. 

Doctors treated her with propranolol, a heart and blood pressure medication, which reduced the bleeding but failed to eliminate it completely. 

Jacalyn Duffin, the Canadian medical historian and haematologist who wrote a commentary that accompanies the report, said she was initially sceptical. “My first thought was, is this real? Could it be fake?” The mystery deepened after she canvassed her senior haematology colleagues and found that not one of them had ever come across such a case.  

Duffin then delved into the medical literature, managing to turn up more than two dozen similar cases reported around the world in the past 15 years or so.  

In many of these, researchers had carefully documented the tests they had carried out to eliminate the possibility of other bleeding disorders and the evidence they had found to suggest the presence of blood in the sweat ducts. “I came to the conclusion that it’s plausible and that it’s possible,” said Duffin. 

The majority of these cases involved young women or children. Many of the reports documented that the bleeding was preceded by emotional trauma, such as witnessing violence at home or at school. In all of the patients, the condition was transient, lasting anywhere from a month to four years.  

Little else – from its causes to how to halt the bleeding – is known, said Duffin. Some have hypothesised the condition could be caused by blood coagulation disorders or a rupture of the smaller blood vessels within tissues.

Dirty water use puts nearly a billion at risk - study

Via Thomson Reuters: Dirty water use puts nearly a billion at risk - study.

Untreated wastewater from cities is used to irrigate 50 percent more farmland worldwide than previously thought, leaving some 885 million people exposed to the risk of diseases, including diarrhoea and cholera, a study said on Wednesday.  

Crops covering almost 36 million hectares - an area roughly the size of Germany - are irrigated with water from rivers and lakes used by cities within 40 km (25 miles) upstream to discharge sewage, according to an international team of researchers.  

About 80 percent of these crops - 29 million hectares - are in countries with very limited wastewater treatment, such as China, India, Pakistan, Mexico and Iran, according to the paper published in the journal Environmental Research Letters. 

The study was the first to use remote sensing and geographic information systems (GIS) for its data analysis, improving on earlier estimates based on case studies and guesswork, researchers said. 

Untreated wastewater, even when diluted, poses health risks for both farmers and consumers, said Pay Drechsel, one of the authors.  

"In wastewater we have a lot of faecal contaminants from excrement," Drechsel, a scientist at the International Water Management Institute (IWMI), told the Thomson Reuters Foundation by phone.  

Farm workers can get skin infections from contact with contaminated water, while consumers are at risk of contracting worms, diarrhoea and even cholera from vegetables eaten raw, he said. 

Pollution from human and animal waste affects nearly one in three rivers in Latin America, Asia and Africa, and some 3.4 million people die each year from diseases associated with pathogens in water, according to the United Nations.

Older adults aren’t taking vaccinations seriously enough

Via The Globe and Mail, a New York Times News Service report: Older adults aren’t taking vaccinations seriously enough. Excerpt and then a comment:

Louise Abate first noticed an itchy tingle near her hairline. The pain started a day or two later as a blistering rash swept down from her scalp onto her forehead. “My eye was so swollen I couldn’t open it,” she said.  

Shingles: Abate, 76, a retired casino supervisor in Rio Rancho, N.M., had the disease twice before, in her 60s, but the episode three years ago hit particularly hard. 

Long after the rash healed, which took about three weeks, she suffered the complication called postherpetic neuralgia – lingering nerve pain that can last for months or even, as in her case, years. “I get up every day, and it’s there,” she said. “I go to sleep, and it’s there.” 

She had heard something about a shingles vaccine, but “I really didn’t pay attention,” Abate said. And she is hardly unusual. 

It is a continuing and vexing public-health problem: People once vigilant about vaccinating their children are not nearly as careful about protecting themselves as they age, even though diseases such as influenza, pneumonia and shingles (also known as herpes zoster) are particularly dangerous for older people. 

“Trying to prevent these common and often debilitating conditions is incredibly important for older adults,” said Dr. Carolyn Bridges, associate director for adult immunization at the Centers for Disease Control and Prevention. Yet, in the CDC’s 2014 and 2015 reports on vaccination coverage, she said, “we really didn’t see much change.” 

Most Americans older than 65 get an annual flu shot, but the proportion actually declined a few percentage points last season to about 63 per cent. The CDC estimates that of the 226,000 people hospitalized for flu in an average year, 50 per cent to 70 per cent are older than 65; so are the great majority of those who die from it. “Older adults take the brunt,” Bridges said.  

Similarly, in 2014, about 61 per cent of older adults had received one or both of the two pneumococcal vaccines, which protect against pneumococcal infections that can lead to pneumonia and meningitis. That represented no improvement, leaving millions of older people still vulnerable.  

About 58 per cent of older people had been vaccinated against tetanus during the past 10 years, but only 14 per cent had received the recommended dose of the Tdap vaccine against tetanus, diphtheria and whooping cough. It is especially important for grandparents and others who have contact with infants too young to be vaccinated. 

And elders have been particularly slow to take advantage of the shingles vaccine. The U.S. Food and Drug Administration approved it a decade ago and the CDC recommends it for those older than 60, including those who’ve already had shingles.  

Coverage has climbed steadily, but in 2014 had still reached only 31 per cent of those older than 65. As with nearly all of these vaccines, older whites were more likely to have been vaccinated than blacks, Hispanics or Asians.

My wife came down with shingles just over a week ago. She'd been vaccinated, but her immunity wore off. (I finally got the shot last year.) It's extremely painful and exhausting, even though she started antivirals the same day the rash appeared. She'll be getting another vaccination soon, and I'm planning the same thing in two or three years.

MSF in Haiti: Health status two months after Hurricane Matthew, in the hardest-hit provinces

Via MSF.org: Haiti: Health status two months after Hurricane Matthew, in the hardest-hit provinces. Excerpt:

Port-au-Prince - It has now been two months since Hurricane Matthew devastated southwest Haiti, and thousands of people are still without adequate food, safe drinking water and shelter. 

Médecins Sans Frontières (MSF) is concerned about the deterioration of living conditions, particularly in the departments of Grand'Anse, Sud and Nippes, all of which were affected by the hurricane. 

In the Sud and Grand'Anse departments, MSF has set up mobile clinics to assess the general health of children living in the area. Chiara Burzio, the MSF medical coordinator, said that in the last week MSF mobile clinics had "examined and treated 163 children under five who presented with respiratory complications, 60 per cent of whom were suffering from upper respiratory tract infections and 5 per cent of whom had pneumonia or bronchitis". These complications are mostly related to a lack of insufficient shelter, in addition to cold nights spent in the mountains. The other children who came to the clinic had diarrhea and skin infections caused by inadequate access to clean water. 

Accessing safe drinking water was already a problem for most Haitian communities, and it only worsened in the wake of the hurricane. Pipe networks were destroyed, and water reservoirs filled with sand. Stuart Garman, the MSF project coordinator, explained that "the lack of actors working to improve water and sanitation in Baradères after the hurricane forced MSF to take emergency action to repair the water supply network and distribute Aquatabs to 10,000 families living in the area". We had been working in the area since 2010 treating cholera. 

Many families who lost their homes in the hurricane are still living in temporary shelters such as schools, and they face pressure from local communities who are demanding that authorities evacuate the structures. With nowhere to go, these people need a long-term housing solution. 

In the last week, MSF’s Cholera Treatment Centre in Port-à-Piment has admitted seven new patients per day, some of whom have come from neighbouring areas to seek care. This is a spike in new cases compared to the last three weeks of November. Patients arrive at the oral rehydration centres that MSF opened in the mountains and are then transferred to the cholera treatment centre in one of two special ambulances. 

On 4 October, a 20-bed cholera treatment centre was opened by MSF and the Ministry of Health in Baradères, Nippes. Since then, MSF has treated more than 190 cholera patients in the Port-au-Prince metropolitan area, and one of its monitoring and rapid response teams is currently stationed on the Island of Gonave to respond to the increase in cholera cases and deaths.  

Recently though, MSF teams have begun to close the emergency projects they opened two months ago in Nippes. Fortunately, the cholera epidemic never developed as measures were taken to prevent it.

Vietnam: Patients with bizarre skin disease have high liver enzyme

Via Saigon Giai Phong: Patients with bizarre skin disease have high liver enzyme.

Head of Dermatology unit in the general Hospital in the central province of QUang Ngai Dr. Le Thi Bich Lien said that the health condition two patients with bizarre skin disease has become worse with high liver enzyme. 

46 year old Dinh Van Nguyen and 21 year old Dinh Van Hoa in Son Ba Commune in the mountainous district Son Ha had the strange skin disease. They were rushed to the hospital; however, after four day treatment, their health condition did not abate; their liver enzyme increased five-fold higher than normal people. 

Worse, while blood cell increase and coagulation function disorder hence medical workers had to give them blood transfusion. Additionally, their other organs are damaged. 

Medical experts from the Quy Hoa Central Dermatology Hospital in Binh Dinh Province yesterday arrived in Quang Ngai to work with local health sector aiming to provide medical check-up to the locals. 

Medical workers advised people to eat safe rice instead of their traditional rice, eat nutritional supplements, vitamins and keep personal hygiene to improve their health condition. 

After a hiatus of about three years, the mysterious skin disease has re-occurred in the central Quang Ngai Province’s Son Ha District, with 12 new patients. In the end of 2014, the disease killed 25 people.

Vietnam: Bizarre skin disease re-occurs in Quang Ngai after three-year pause

Via Saigon Giai Phong: Bizarre skin disease re-occurs in Quang Ngai after three year pause.

Head of the Dermatology Ward of the General Hospital in the central province of Quang Ngai Dr. Le Thi Bich Lien August 18 said that the hospital is treating two people suffering the bizarre skin disease which was plaguing the province three years ago.   

The strange skin disease struck Son Ba Commune in Quang Ngai Province’s Son Ha District three years ago. Now it re-occurred on the two men who are father and son. Father Dinh Van Ngan, 70 and his 21 year old son Dinh Van Hoa were taken to the hospital on August 16 and 18. 

Dr. Lien said they just had skin damage on climbs while their health condition is stable. The hospital treats them as per the Ministry of Health’s guideline.  

Right after receiving the information of re-occurrence of the odd skin disease in Son Ha District, the Department of Health in Quang NGai Province send a delegation led by director Nguyen Tan Duc to arrive at the commune to inspect environment, daily activities, eating and drinking of locals. 

The disease has seen a 3-year hiatus. Now, it has five infection cases.

I posted several times in 2012 and 2013 about this skin condition, including this item in March 2013.

‘Second skin’ may reduce wrinkles, eyebags, scientists say

This item is off topic, but personal. Via The New York Times, an article by Gina Kolata: ‘Second Skin’ May Reduce Wrinkles, Eyebags, Scientists Say. Excerpt and then a comment:

The idea sounds like fantasy: an invisible film that can be painted on your skin and give it the elasticity of youth. Bags under the eyes vanish in seconds. Wrinkles disappear. 

Scientists at Harvard and M.I.T. have discovered that it is not fantasy at all. Reporting on Monday in the journal Nature Materials on pilot studies with 170 subjects, the researchers said a “second skin” composed of commonly used chemicals deemed safe by the Food and Drug Administration can accomplish that — and in small studies of it, so far no one has reported irritation or allergic reactions. 

Undereye bags are just the start. You can soak the film with sunscreen and protect yourself without worrying about sweat or water washing it away, researchers said. They expect it can be used to treat eczema, psoriasis and other skin conditions by covering dry itchy patches with a film that moistens and soothes. 

The chemicals are siloxanes — their basic form is one atom of oxygen linked to two atoms of silicon — which form polymers, long chains of repeating units. The researchers made a large collection of them by modifying molecular features such as the chain length to get the ones with the properties they wanted. 

Then they devised a two-step process. First, a polymer, a clear liquid, is applied. Its chains are not very strong, though, so the next step is applying a product that links them together. By modifying the chemistry of the chains, the researchers can alter the properties of the second skin, depending on how it will be used, making it more or less permeable, for example. A more permeable second skin might be used for undereye bags while a less permeable one might hold a medication in place. It can be removed with a solution that dissolves the polymer.

For the last 20 years or so, most of my health problems have had to do with my skin. "Nothing wrong with you but the packaging," my GP said more than once. (OK, the stroke was serious, but it got my attention and I dropped 30 pounds.)

I acquired psoriasis on my fingers in the 1990s and somehow outlived it. It was pretty gross while it lasted. Then I acquired contact dermatitis, which makes me effectively allergic to soap and shampoo, and very itchy. After baking me with ultraviolet for months, my dermatologist fired me. An allergist advised plain old moisturizer; now part of my morning routine is getting moisturizer all over myself. At least I can still wash my hands with soap; for everything else, it's a non-soap cleanser.

 

Worse yet, I've been literally thin-skinned for the last 20 years or more. Even a casual bump or scrape can produce a spectacular bruise or bleeding. (I'm now losing a fingernail due to an injury I didn't even notice.)

 

Living with this is all more tedious and annoying than depressing.The bags under my eyes are the least of my concerns. But something like this "second skin" would find me an eager customer, and I suspect I'd have to get in line for it.