Here's another reason to eat your broccoli: UCLA researchers report that a naturally occurring compound found in broccoli and other cruciferous vegetables may help protect against respiratory inflammation that causes conditions like asthma, allergic rhinitis and chronic obstructive pulmonary disease.
Published in the March edition of the journal Clinical Immunology, the research shows that sulforaphane, a chemical in broccoli, triggers an increase of antioxidant enzymes in the human airway that offers protection against the onslaught of free radicals that we breathe in every day in polluted air, pollen, diesel exhaust and tobacco smoke. A supercharged form of oxygen, free radicals can cause oxidative tissue damage, which leads to inflammation and respiratory conditions like asthma.
"This is one of the first studies showing that broccoli sprouts — a readily available food source — offered potent biologic effects in stimulating an antioxidant response in humans," said Dr. Marc Riedl, the study's principal investigator and an assistant professor of clinical immunology and allergy at the David Geffen School of Medicine at UCLA.
"We found a two- to three-fold increase in antioxidant enzymes in the nasal airway cells of study participants who had eaten a preparation of broccoli sprouts," Riedl said. "This strategy may offer protection against inflammatory processes and could lead to potential treatments for a variety of respiratory conditions."
The UCLA team worked with 65 volunteers who were given varying oral doses of either broccoli or alfalfa sprout preparations for three days. Broccoli sprouts are the richest natural source of sulforaphane; the alfalfa sprouts, which do not contain the compound, served as a placebo.
Rinses of nasal passages were collected at the beginning and end of the study to assess the gene expression of antioxidant enzymes in cells of the upper airways. Researchers found significant increases of antioxidant enzymes at broccoli sprout doses of 100 grams and higher, compared with the placebo group.
The maximum broccoli sprout dosage of 200 grams generated a 101-percent increase of an antioxidant enzyme called GSTP1 and a 199-percent increase of another key enzyme called NQO1.
"A major advantage of sulforaphane is that it appears to increase a broad array of antioxidant enzymes, which may help the compound's effectiveness in blocking the harmful effects of air pollution," Riedl said.
According to the authors, no serious side effects occurred in study participants receiving broccoli sprouts, demonstrating that this may be an effective, safe antioxidant strategy to help reduce the inflammatory impact of free radicals.
Riedl notes that more research needs to be done to examine the benefits of sulforaphane for specific respiratory conditions. It is too early to recommend a particular dosage.
Riedl recommends including broccoli and other cruciferous vegetables as part of a healthy diet.
The study was supported by the National Institutes of Health, the National Institute of Environmental Health Sciences and the U.S. Environmental Protection Agency.
Other study authors include Dr. Andrew Saxon of the Hart and Louis Lyon Laboratory, division of clinical immunology and allergy in the department of medicine at the David Geffen School of Medicine at UCLA, and Dr. David Diaz-Sanchez of the human studies division of the U.S. Environmental Protection Agency.
Adapted from materials provided by University of California - Los Angeles, via EurekAlert!, a service of AAAS.
May 31, 2009
Children Can Complete Treatment For Peanut Allergies And Achieve Long-term Tolerance, Studies Suggest
A carefully administered daily dose of peanuts has been so successful as a therapy for peanut allergies that a select group of children is now off treatment and eating peanuts daily, report doctors at Duke University Medical Center and Arkansas Children's Hospital.
"It appears these children have lost their allergies," says Wesley Burks, MD, Chief of the Division of Pediatric Allergy and Immunology at Duke. "This gives other parents and children hope that we'll soon have a safe, effective treatment that will halt allergies to certain foods."
Long-term tolerance in children with peanut allergies was documented for the first time by the presence of key immunologic changes, according to researchers at Duke and Arkansas Children's Hospital who presented their findings at the American Academy of Asthma and Immunology meeting in Washington, DC March 15.
This procedure is not currently recommended for patients as it has not been fully tested, and it should never be attempted without full medical supervision.
Tests of several immunologic indicators suggest the body builds tolerance quickly.
"At the start of the study, these participants couldn't tolerate one-sixth of a peanut," Burks said. "Six months into it, they were ingesting 13 to 15 peanuts before they had a reaction."
About four million Americans have food allergies, and allergies to tree nuts and peanuts are the most common. Life-threatening reactions can occur from exposure to even a trace amount of peanuts, and nearly half of the 150 deaths attributed to food allergies each year are caused by peanut allergies.
Duke and Arkansas Children's Hospital began enrolling patients in studies five years ago to determine if incremental doses of peanut protein could change how the body's immune system responds to its presence. The doses start as small as 1/1000 of a peanut. Eight to 10 months later, the children are ingesting the equivalent of up to 15 peanuts per day. The children stay on that daily therapy for several years and are monitored closely.
Nine of the 33 children participating in the study have been on maintenance therapy for more than 2.5 years. After a series of food challenges, four of those children were taken off the treatment and continue to eat peanuts. Some have been off treatment for more than a year. Doctors keep tabs on any potential changes in their immune system via skin, blood and immune studies.
One of the tests used in the study looks at immunoglobulin E (IgE), a protein the body makes in response to peanut allergens. "If you have it, you're likely allergic, if you don't, you aren't," explained Burks. Children in this study generally started with IgE levels greater than 25. "At the end of the study, their peanut IgEs were less than 2 and have remained that way since we stopped the treatment," he said.
Because the pool of children now off treatment is so small, Burks says it's hard to say whether these children simply outgrew their allergies or if the therapy did something to enhance that outcome. The next step is a blinded study in which children on treatment are compared to a control group. First year results were presented at the meeting by Stacie M. Jones, MD, a pediatric allergist at Arkansas Children's Hospital. So far, the oral immune therapy appears to be working.
"We see initial desensitization effects of the treatment are real," Burks says. "Those children are now able to eat up to 15 peanuts with no reaction, but the children not on treatment have symptoms early on in the study."
Despite the news, Burks insists this research is still ongoing and cautions parents and professionals against trying any version on their own. "In my clinic, I would do the same things I've always done. Once diagnosed with a food allergy, I would recommend they avoid the food. We have to wait for the studies to show the treatment is safe, and to see desensitization start to work. We also want to know the therapy works long term."
Burks also cautions that some people are too sensitive to peanut allergens to be able to undergo the therapy.
The studies were funded by the National institute of Health, the Food Allergy and Anaphylaxis Network, Food Allergy Project, Gerber Foundation and the Robins Family Foundation.
Adapted from materials provided by Duke University Medical Center.
"It appears these children have lost their allergies," says Wesley Burks, MD, Chief of the Division of Pediatric Allergy and Immunology at Duke. "This gives other parents and children hope that we'll soon have a safe, effective treatment that will halt allergies to certain foods."
Long-term tolerance in children with peanut allergies was documented for the first time by the presence of key immunologic changes, according to researchers at Duke and Arkansas Children's Hospital who presented their findings at the American Academy of Asthma and Immunology meeting in Washington, DC March 15.
This procedure is not currently recommended for patients as it has not been fully tested, and it should never be attempted without full medical supervision.
Tests of several immunologic indicators suggest the body builds tolerance quickly.
"At the start of the study, these participants couldn't tolerate one-sixth of a peanut," Burks said. "Six months into it, they were ingesting 13 to 15 peanuts before they had a reaction."
About four million Americans have food allergies, and allergies to tree nuts and peanuts are the most common. Life-threatening reactions can occur from exposure to even a trace amount of peanuts, and nearly half of the 150 deaths attributed to food allergies each year are caused by peanut allergies.
Duke and Arkansas Children's Hospital began enrolling patients in studies five years ago to determine if incremental doses of peanut protein could change how the body's immune system responds to its presence. The doses start as small as 1/1000 of a peanut. Eight to 10 months later, the children are ingesting the equivalent of up to 15 peanuts per day. The children stay on that daily therapy for several years and are monitored closely.
Nine of the 33 children participating in the study have been on maintenance therapy for more than 2.5 years. After a series of food challenges, four of those children were taken off the treatment and continue to eat peanuts. Some have been off treatment for more than a year. Doctors keep tabs on any potential changes in their immune system via skin, blood and immune studies.
One of the tests used in the study looks at immunoglobulin E (IgE), a protein the body makes in response to peanut allergens. "If you have it, you're likely allergic, if you don't, you aren't," explained Burks. Children in this study generally started with IgE levels greater than 25. "At the end of the study, their peanut IgEs were less than 2 and have remained that way since we stopped the treatment," he said.
Because the pool of children now off treatment is so small, Burks says it's hard to say whether these children simply outgrew their allergies or if the therapy did something to enhance that outcome. The next step is a blinded study in which children on treatment are compared to a control group. First year results were presented at the meeting by Stacie M. Jones, MD, a pediatric allergist at Arkansas Children's Hospital. So far, the oral immune therapy appears to be working.
"We see initial desensitization effects of the treatment are real," Burks says. "Those children are now able to eat up to 15 peanuts with no reaction, but the children not on treatment have symptoms early on in the study."
Despite the news, Burks insists this research is still ongoing and cautions parents and professionals against trying any version on their own. "In my clinic, I would do the same things I've always done. Once diagnosed with a food allergy, I would recommend they avoid the food. We have to wait for the studies to show the treatment is safe, and to see desensitization start to work. We also want to know the therapy works long term."
Burks also cautions that some people are too sensitive to peanut allergens to be able to undergo the therapy.
The studies were funded by the National institute of Health, the Food Allergy and Anaphylaxis Network, Food Allergy Project, Gerber Foundation and the Robins Family Foundation.
Adapted from materials provided by Duke University Medical Center.
Some Neural Tube Defects In Mice Linked To Enzyme Deficiency
Women of childbearing age can reduce the risk of having a child born with a neural tube defect such as spina bifida by eating enough folate or folic acid. However, folate prevents only about 70 percent of these defects.
New research using mice at Washington University School of Medicine in St. Louis confirms the importance of another nutrient, inositol, to protect against the development of neural tube defects.
A research team led by Monita Wilson, Ph.D., found neural tube defects in some mouse embryos from female mice genetically modified to have low levels of ITPK1, an enzyme involved in the metabolism of inositol, a compound important for neural development and function. The finding suggests that inositol depletion is linked to these birth defects.
The research is published May 25 in the Proceedings of the National Academy of Sciences Early Edition.
In humans, neural tube defects usually occur during the first three to four weeks of pregnancy, before most women know they are pregnant. Certain cells in an embryo form the neural tube, which becomes the foundation of the brain, spinal cord and the bone and tissue surrounding it. A defect forms if the tube does not close properly.
The two most common neural tube defects are spina bifida and anencephaly. Spina bifida affects 1,500 to 2,000 babies born in the United States annually, causing paralysis, spine abnormalities, incontinence and other problems. Anencephaly occurs when the head end of the neural tube fails to close, resulting in the absence of a major portion of the brain, skull and scalp. That condition is fatal.
Wilson, research assistant professor of medicine, and her collaborators created genetically modified mice to have low levels of one of the inositol kinases, then took a close look at their embryos during each day of the 21-day gestation period.
"Because of the short gestation period, a mouse embryo looks very, very different from day to day," Wilson says. "When we looked at the mutant embryos, between the ninth and 12th days of gestation, we noticed that about 12 percent to 15 percent had spina bifida and exencephaly, similar to anencephaly in humans."
Some of the mutant mouse embryos had kyphoscoliosis or other skeletal deformities.
That led the team to consider that there are birth defects that don't respond to folic acid but may respond to inositol treatment, says Wilson, whose research is being funded by the National Institutes of Health and the Children's Discovery Institute at Washington University and St. Louis Children's Hospital.
"Previous animal studies suggest that administration of inositol can further reduce the incidence of neural tube defects, but the mechanism for the protective effect of inositol remains an enigma," says David B. Wilson, M.D., Ph.D., an associate professor of pediatrics and of developmental biology at Washington University and senior author of the study. "By studying these mice we hope to gain insight into the role of inositol in normal and abnormal embryonic development and on gene-nutrient interactions that underlie neural tube defects in humans."
A few studies of human mothers with low inositol levels have shown an increased risk of having children with spina bifida. A clinical trial is under way in the United Kingdom in which women who have a history of one or more pregnancies with neural tube defects and wish to become pregnant again are given folic acid plus inositol or folic acid and a placebo.
Next, Wilson and her colleagues plan to give the genetically modified mice increased doses of inositol to determine if that can prevent these neural tube defects.
New research using mice at Washington University School of Medicine in St. Louis confirms the importance of another nutrient, inositol, to protect against the development of neural tube defects.
A research team led by Monita Wilson, Ph.D., found neural tube defects in some mouse embryos from female mice genetically modified to have low levels of ITPK1, an enzyme involved in the metabolism of inositol, a compound important for neural development and function. The finding suggests that inositol depletion is linked to these birth defects.
The research is published May 25 in the Proceedings of the National Academy of Sciences Early Edition.
In humans, neural tube defects usually occur during the first three to four weeks of pregnancy, before most women know they are pregnant. Certain cells in an embryo form the neural tube, which becomes the foundation of the brain, spinal cord and the bone and tissue surrounding it. A defect forms if the tube does not close properly.
The two most common neural tube defects are spina bifida and anencephaly. Spina bifida affects 1,500 to 2,000 babies born in the United States annually, causing paralysis, spine abnormalities, incontinence and other problems. Anencephaly occurs when the head end of the neural tube fails to close, resulting in the absence of a major portion of the brain, skull and scalp. That condition is fatal.
Wilson, research assistant professor of medicine, and her collaborators created genetically modified mice to have low levels of one of the inositol kinases, then took a close look at their embryos during each day of the 21-day gestation period.
"Because of the short gestation period, a mouse embryo looks very, very different from day to day," Wilson says. "When we looked at the mutant embryos, between the ninth and 12th days of gestation, we noticed that about 12 percent to 15 percent had spina bifida and exencephaly, similar to anencephaly in humans."
Some of the mutant mouse embryos had kyphoscoliosis or other skeletal deformities.
That led the team to consider that there are birth defects that don't respond to folic acid but may respond to inositol treatment, says Wilson, whose research is being funded by the National Institutes of Health and the Children's Discovery Institute at Washington University and St. Louis Children's Hospital.
"Previous animal studies suggest that administration of inositol can further reduce the incidence of neural tube defects, but the mechanism for the protective effect of inositol remains an enigma," says David B. Wilson, M.D., Ph.D., an associate professor of pediatrics and of developmental biology at Washington University and senior author of the study. "By studying these mice we hope to gain insight into the role of inositol in normal and abnormal embryonic development and on gene-nutrient interactions that underlie neural tube defects in humans."
A few studies of human mothers with low inositol levels have shown an increased risk of having children with spina bifida. A clinical trial is under way in the United Kingdom in which women who have a history of one or more pregnancies with neural tube defects and wish to become pregnant again are given folic acid plus inositol or folic acid and a placebo.
Next, Wilson and her colleagues plan to give the genetically modified mice increased doses of inositol to determine if that can prevent these neural tube defects.
May 29, 2009
10 Cosmetic Procedures You Should Avoid part 2
<< read part 1
Buttock Implants
While many people hit the gym and suffer through crash diets to attain a smaller behind, there are others who actually seek out surgical solutions for a larger, rounder butt.
For these people, cosmetic surgery can offer buttock implants. Unlike breast implants, which are filled with either silicone gel or saline, buttock implants are solid slabs of silicone, positioned beneath the fibrous lining of the buttock muscles.
The result is a rounder, more voluminous rear end. But this result comes at a price for many patients.
"We don't really have the same demand for buttock implants in our part of the world as you see elsewhere," Roth noted. "And that may be a good thing. There is a high rate of problems with these implants."
Among these problems is an increased risk of infection. This is because in order to hide the incision from plain view, surgeons will often place it between the buttocks, perilously close to the anus and the germs that reside there.
And even after the incisions have healed, the implants are situated in an area of the body that endures its share of daily abuse.
"Just logically, if you think about what you're doing -- putting an implant into an area that you sit on -- it stands to reason that there is a very significant rate of problems with these devices," Roth said.
Made Up for Life: Tattooed Makeup
While many women may dream of skipping their makeup routine in the morning, for those who opt for permanently tattooed makeup, the reality can be more like a nightmare than anything else.
"I have had more than my share of patients who ask me to remove the permanent makeup tattoo that someone else gave them, and I will tell you that they're difficult to take away," Roth said.
Much of this difficulty in removing these tattoos is owed to the fact that the areas that are tattooed are some of the most delicate tissues of the face -- namely, the inner folds of the eyelids and the lips. And even with today's complement of high-tech tattoo removal lasers, there is never a guarantee that the tattoos will disappear completely.
This is especially bad news for those who have received botched jobs from untrained practitioners. But even for those who get what they want in the short term, their long-term satisfaction with the job may still be in question.
"If you don't like the results, you may still be stuck with them. And even though you might like the result in the short term, fashions change."
Extreme Facial Procedures
As the images of more than a few celebrities can attest, extreme facial procedures can have a dramatic impact on one's appearance -- and not always in a good way.
Dr. Gregory H. Branham, associate professor and chief of facial plastic and reconstructive surgery at Washington University in Saint Louis, said he treats a number of patients who want a revision of previous work done on their faces. Sometimes, he said, this previous work involved facial liposuction in which the natural fat pads of the face are sucked out. While these patients likely hoped for a sexier, more angular appearance, what they usually got was a hollow, "Cruella deVille" kind of look.
Another procedure he sees regularly is the skin lift -- a relic of 1970s-era cosmetic surgery in which the skin was pulled taut to eliminate wrinkles.
"While I do not perform these procedures I have seen patients come into my practice with broken or failed sutures that are extruding and need to be retrieved," Branham said. "I have not seen good long-term results with these, and they are generally quite expensive when you compare them to a conventional face-lift or even a mini-lift that is a surgical procedure with more promise of a longer lasting result."
But the ravages of bad facial procedures are not confined to surgery alone. Another extreme facial procedure, the CO2 laser peel, leaves patients with a scabby, red face that takes weeks to heal. While these patients eventually enjoy a smoother complexion once the healing is over, there are a number of alternative procedures available today that can give much the same result -- without the intense pain and downtime.
Combination Mastopexy/Breast Implant
What do you get when you combine two tried-and-true plastic surgery techniques in a single operation?
If the procedures in question are a breast lift, or mastopexy, and a breast augmentation, the chances are decent that you could get more complications than you bargained for.
"A mastopexy, or breast lift, with simultaneous breast augmentation [has] one of the highest sources of malpractice suits," said Dr. Henry Kawamoto, clinical professor of plastic surgery at UCLA and director of the UCLA Craniofacial Clinic.
The reason for all the problems is clear when the aim of each procedure is considered. While mastopexy is often aimed at breast reduction -- essentially tightening up the tissues of the breast to eliminate a flabby, loose appearance -- the aim of breast augmentation is the exact opposite.
So while surgeons performing both procedures may start by removing the excess skin on the breasts during the mastopexy operation, they may find themselves stretching the remaining skin in order to accommodate the breast implants that they put in later.
Aside from the complications that arise due to the combination of the two procedures, patients also face the normal risks that go with each individual surgery -- risks that include the possibility of infection, implant exposure, asymmetry of the breasts, loss of nipple sensation, the inability to breast-feed, healing problems and other complications.
Any Procedure by Untrained Hands
With the explosion in the popularity of cosmetic surgery in the past two decades has come another explosion in the number of people who are willing to perform these operations.
But not every doctor has the training necessary to perform these procedures. Indeed, many of the proprietors for whom cosmetic procedures represent a lucrative part of their business do not even hold a medical degree.
"Probably everyone has heard of the itinerant practitioner who performs procedures in a hotel room for bargain basement prices and then is nowhere to be found when complications arise," Branham said.
So what is the key to avoiding such practitioners? Do your homework, said Branham -- and don't rush into surgery before you know everything you need to about your surgeon.
"You should see the doctor ahead of time and not the day of the procedure except in unusual circumstances," Branham said. "This allows you the time and opportunity to check out the doctor and his or her credentials and see the facility for yourself without the stress of an imminent procedure."
And when in doubt, don't go through with the procedure.
"We have a saying," Roth said. "You never regret the operation you don't do."
Buttock Implants
While many people hit the gym and suffer through crash diets to attain a smaller behind, there are others who actually seek out surgical solutions for a larger, rounder butt.
For these people, cosmetic surgery can offer buttock implants. Unlike breast implants, which are filled with either silicone gel or saline, buttock implants are solid slabs of silicone, positioned beneath the fibrous lining of the buttock muscles.
The result is a rounder, more voluminous rear end. But this result comes at a price for many patients.
"We don't really have the same demand for buttock implants in our part of the world as you see elsewhere," Roth noted. "And that may be a good thing. There is a high rate of problems with these implants."
Among these problems is an increased risk of infection. This is because in order to hide the incision from plain view, surgeons will often place it between the buttocks, perilously close to the anus and the germs that reside there.
And even after the incisions have healed, the implants are situated in an area of the body that endures its share of daily abuse.
"Just logically, if you think about what you're doing -- putting an implant into an area that you sit on -- it stands to reason that there is a very significant rate of problems with these devices," Roth said.
Made Up for Life: Tattooed Makeup
While many women may dream of skipping their makeup routine in the morning, for those who opt for permanently tattooed makeup, the reality can be more like a nightmare than anything else.
"I have had more than my share of patients who ask me to remove the permanent makeup tattoo that someone else gave them, and I will tell you that they're difficult to take away," Roth said.
Much of this difficulty in removing these tattoos is owed to the fact that the areas that are tattooed are some of the most delicate tissues of the face -- namely, the inner folds of the eyelids and the lips. And even with today's complement of high-tech tattoo removal lasers, there is never a guarantee that the tattoos will disappear completely.
This is especially bad news for those who have received botched jobs from untrained practitioners. But even for those who get what they want in the short term, their long-term satisfaction with the job may still be in question.
"If you don't like the results, you may still be stuck with them. And even though you might like the result in the short term, fashions change."
Extreme Facial Procedures
As the images of more than a few celebrities can attest, extreme facial procedures can have a dramatic impact on one's appearance -- and not always in a good way.
Dr. Gregory H. Branham, associate professor and chief of facial plastic and reconstructive surgery at Washington University in Saint Louis, said he treats a number of patients who want a revision of previous work done on their faces. Sometimes, he said, this previous work involved facial liposuction in which the natural fat pads of the face are sucked out. While these patients likely hoped for a sexier, more angular appearance, what they usually got was a hollow, "Cruella deVille" kind of look.
Another procedure he sees regularly is the skin lift -- a relic of 1970s-era cosmetic surgery in which the skin was pulled taut to eliminate wrinkles.
"While I do not perform these procedures I have seen patients come into my practice with broken or failed sutures that are extruding and need to be retrieved," Branham said. "I have not seen good long-term results with these, and they are generally quite expensive when you compare them to a conventional face-lift or even a mini-lift that is a surgical procedure with more promise of a longer lasting result."
But the ravages of bad facial procedures are not confined to surgery alone. Another extreme facial procedure, the CO2 laser peel, leaves patients with a scabby, red face that takes weeks to heal. While these patients eventually enjoy a smoother complexion once the healing is over, there are a number of alternative procedures available today that can give much the same result -- without the intense pain and downtime.
Combination Mastopexy/Breast Implant
What do you get when you combine two tried-and-true plastic surgery techniques in a single operation?
If the procedures in question are a breast lift, or mastopexy, and a breast augmentation, the chances are decent that you could get more complications than you bargained for.
"A mastopexy, or breast lift, with simultaneous breast augmentation [has] one of the highest sources of malpractice suits," said Dr. Henry Kawamoto, clinical professor of plastic surgery at UCLA and director of the UCLA Craniofacial Clinic.
The reason for all the problems is clear when the aim of each procedure is considered. While mastopexy is often aimed at breast reduction -- essentially tightening up the tissues of the breast to eliminate a flabby, loose appearance -- the aim of breast augmentation is the exact opposite.
So while surgeons performing both procedures may start by removing the excess skin on the breasts during the mastopexy operation, they may find themselves stretching the remaining skin in order to accommodate the breast implants that they put in later.
Aside from the complications that arise due to the combination of the two procedures, patients also face the normal risks that go with each individual surgery -- risks that include the possibility of infection, implant exposure, asymmetry of the breasts, loss of nipple sensation, the inability to breast-feed, healing problems and other complications.
Any Procedure by Untrained Hands
With the explosion in the popularity of cosmetic surgery in the past two decades has come another explosion in the number of people who are willing to perform these operations.
But not every doctor has the training necessary to perform these procedures. Indeed, many of the proprietors for whom cosmetic procedures represent a lucrative part of their business do not even hold a medical degree.
"Probably everyone has heard of the itinerant practitioner who performs procedures in a hotel room for bargain basement prices and then is nowhere to be found when complications arise," Branham said.
So what is the key to avoiding such practitioners? Do your homework, said Branham -- and don't rush into surgery before you know everything you need to about your surgeon.
"You should see the doctor ahead of time and not the day of the procedure except in unusual circumstances," Branham said. "This allows you the time and opportunity to check out the doctor and his or her credentials and see the facility for yourself without the stress of an imminent procedure."
And when in doubt, don't go through with the procedure.
"We have a saying," Roth said. "You never regret the operation you don't do."
10 Cosmetic Procedures You Should Avoid part 1
The Potential Aesthetic Benefits of Some Procedures Aren't Worth the Risk
By DAN CHILDS
ABC News Medical Unit
A recent report suggests that despite worries over an economic downturn, Americans are still spending money on procedures intended to make them look better. The annual report, issued last week by the American Society of Plastic Surgeons, showed that the number of cosmetic procedures performed continued its steady rise last year to a total of nearly 12 million.
"The report tells me Americans are devoted to looking and feeling their best," ASPS president Dr. Richard A. D'Amico said in a statement on the report. "High demand continues for less invasive and relatively less expensive procedures, but there were also promising rebounds in some surgical procedures."
But while consumers continue to flock to doctors in the hopes of improving their appearance, plastic and cosmetic surgeons and dermatologists say there are a number of procedures of which consumers should be especially wary.
The entries listed here represent 10 cosmetic procedures that -- for most people, at least -- are least likely to offer results that justify their risks.
A Jab to Dissolve Fat? Mesotherapy and Lipodissolve
Several cosmetic surgeons and dermatologists agree that if there is one procedure to avoid when shopping for a slimmer look, it's one called lipodissolve -- a shot that is purported to dissolve away stubborn fat deposits.
This shot is often part of "mesotherapy" -- a shallow injection of a cocktail of substances using a fine needle.
"There is really not a single scientific study to show that it definitely works," said Dr. Malcolm Roth, director of plastic surgery at Maimondes Medical Center in Brooklyn, N.Y. "Are these chemicals safe when injected into fat? And what happens to this fat? Where does it go?
And Dr. Carolyn Jacob, a board certified dermatologist in Chicago, calls lipodissolve the most ill-advised treatment available today.
"This is a non-FDA approved use of a material called lipostabil, which can dissolve fat and other structures," she said. "However, it can cause pain, swelling, hard lumps, ulceration of the skin, and contour irregularities."
"None of the pharmaceuticals used for injection are FDA approved," said Dr. Susan Kaweski at the Aesthetic Arts Institute of Plastic Surgery in San Diego. "There have been no double-blinded studies revealing the mechanism of diffusion of solutions following injection, the precision and control of fat destruction by the chemicals or the long- and short-term effects of the drugs."
Despite the dangers of the procedure, the growing number of clinics offering lipodissolve is a testament to its continued legal status in the United States. Still, the procedure is banned for cosmetic purposes in Brazil and other countries.
"Most physicians performing this procedure do not have training in liposuction, plastic surgery or dermatologic surgery," Jacob says. "Even dentists are doing it."
A Sexier Step: Cosmetic Foot Surgery
Those who desire cosmetic surgery from top to toe should be no strangers to cosmetic foot surgery -- a collection of surgical and minimally invasive procedures designed to yield a sexier foot.
Despite the continued popularity of these procedures, which involve everything from filler injections to round out angles to total surgical reshaping of the foot, doctors have been warning consumers away from cosmetic foot surgery for years.
"The public needs to be aware of the risks associated with these procedures," said the American Orthopaedic Foot and Ankle Society President Dr. Glenn B. Pfeffer. "Women need to know what they are getting into."
He noted that the trend toward the practice of cosmetic surgery raises serious concern when one considers the risks of surgery on painless feet. "Complications can include infection, nerve injury, prolonged swelling of a toe, and even chronic pain with walking," Pfeffer said.
Not surprisingly, the sector of consumers that tends to be the most enthused at the prospect of better-looking feet are women who hope to adorn their feet with the latest in strappy, high-heeled fashions.
And the procedures involved run the gamut from filler injections to full-blown surgery to reshaping the foot. The American Orthopaedic Foot and Ankle Society noted that surgery to shorten the toes or narrow the feet are favorite options in this category. Some practitioners will also inject the fat pad of the feet with collagen or other substances -- again, solely to change the appearance of the feet.
Permanent Filler Injections
Injectable fillers, simply put, are special gels that are injected into the skin to plump up lips, push out wrinkles and fine lines -- in short, "fill out" spaces in the face where a bit of extra volume is needed.
Most of the fillers that are on the market today are temporary -- that is, after a certain amount of time they are absorbed into the body and the results are lost. This group of fillers includes the natural filler collagen, as well as a number of newer gels such as hyaluronic acid.
But some fillers are designed to stick around in the body for longer periods of time. These fillers, appropriately termed permanent fillers, include liquid silicone and the product known as Aquamid.
Though tantalizing to some consumers who would prefer to pay for fillers once rather than shell out for repeat procedures, such fillers have also been known to lead to a number of complications, including irreversible binding with tissues and a tendency to "drift," which can lead to a distorted appearance.
Roth said that the problems become even more severe in the event of a botched job.
"I do not do permanent fillers," Roth said. "Even with temporary fillers, once it's injected, even though it's going to go away, you're stuck with unsatisfactory results until it goes away. Permanent fillers don't go away."
But despite widespread disapproval among cosmetic surgeons and dermatologists, many consumers still seek out permanent filler injections.
"Silicone is still being used by some practitioners," Roth said. "I have seen three people in the last year who had silicone injections administered by nonphysicians."
Injection for Breast Augmentation
What if getting bigger breasts was as simple as getting a shot?
The idea is not a new one, and it stands to reason that pumping the breasts full of fat or fillers would offer an alternative to breast implant surgery -- all without the scars.
Traditionally, doctors performing such procedures have used the fat harvested from other areas of the body, such as the buttocks and thighs. By purifying this fat and reinjecting it into the breasts, they say, they can offer their patients a safe enhancement using the body's own spare materials.
But in reality, the procedure is not nearly as simple as it appears.
"On the surface, the concept of using liposuction to remove unwanted fat from one's own thighs and buttocks, and then injecting it into the breasts to make them larger, has appeal," the American Society for Aesthetic Plastic Surgery noted in a past statement on the procedure. "However, aesthetic surgeons certified in plastic surgery have long maintained that injection of fat, or any substance, into or behind the breast tissue can be potentially dangerous."
Dangerous, because there exists the potential for the reinjected fat to calcify, creating a scarred mass buried within the breast tissues. These calcifications can either mask or mimic the presence of breast cancer. And since between 7 and 14 ounces of fat are needed for the enlargement of a breast, there is no shortage of relocated fat to make the detection of breast cancer difficult, or even impossible.
More recently, a procedure referred to as the "boob jab" has made headlines by using artificial fillers to accomplish the same goal of bigger breasts. Specifically, the procedure requires the injection through the armpit of a temporary filler called Macrolane directly into the breast.
The procedure costs $4,000, and the results are temporary. And some doctors worry that this technique, too, could make it more difficult for current screening tests to detect breast cancer.
Cosmetic Leg Lengthening Surgery
How far would you go for a few more inches of height? For some, the quest for a more impressive stature leads them to a painful procedure that involves breaking both legs -- and using devices with screws attached to their legs to gradually extend their bones.
It's an extreme procedure to be sure. Yet, the technique is widely known in China and other Asian countries, where young professionals seek out the procedures to give themselves an edge in the business world.
But the procedure is also well known in the United States. Robert Rozbruch, the director of the Institute for Limb Lengthening and Reconstruction in New York, told ABC News that he does not approve of leg lengthening for cosmetic purposes as a new cosmetic surgery trend. And the patients who come to his center can only receive the surgery after extensive psychological testing.
"Orthopedic surgeons don't do cosmetic surgery," Rozbruch told ABC News. "It's not in our normal routine. We do this for a guy who is maybe [5 foot 2] or [5 foot 3] and well adjusted but being short is something that is very disturbing to them. When you talk to them you can feel the pain they go through."
But the results don't come cheap. Costs of the procedure generally top out at $120,000. For an average height gain of 3 inches, that's $40,000 per inch.
For those of a very short stature, the results may be worth the price tag and the pain. But Roth said the procedure is a poor choice if vanity is the main motivation.
"For purely cosmetic surgery purposes, I certainly would never let somebody in my family have that done," Roth said.
next>>>
By DAN CHILDS
ABC News Medical Unit
A recent report suggests that despite worries over an economic downturn, Americans are still spending money on procedures intended to make them look better. The annual report, issued last week by the American Society of Plastic Surgeons, showed that the number of cosmetic procedures performed continued its steady rise last year to a total of nearly 12 million.
"The report tells me Americans are devoted to looking and feeling their best," ASPS president Dr. Richard A. D'Amico said in a statement on the report. "High demand continues for less invasive and relatively less expensive procedures, but there were also promising rebounds in some surgical procedures."
But while consumers continue to flock to doctors in the hopes of improving their appearance, plastic and cosmetic surgeons and dermatologists say there are a number of procedures of which consumers should be especially wary.
The entries listed here represent 10 cosmetic procedures that -- for most people, at least -- are least likely to offer results that justify their risks.
A Jab to Dissolve Fat? Mesotherapy and Lipodissolve
Several cosmetic surgeons and dermatologists agree that if there is one procedure to avoid when shopping for a slimmer look, it's one called lipodissolve -- a shot that is purported to dissolve away stubborn fat deposits.
This shot is often part of "mesotherapy" -- a shallow injection of a cocktail of substances using a fine needle.
"There is really not a single scientific study to show that it definitely works," said Dr. Malcolm Roth, director of plastic surgery at Maimondes Medical Center in Brooklyn, N.Y. "Are these chemicals safe when injected into fat? And what happens to this fat? Where does it go?
And Dr. Carolyn Jacob, a board certified dermatologist in Chicago, calls lipodissolve the most ill-advised treatment available today.
"This is a non-FDA approved use of a material called lipostabil, which can dissolve fat and other structures," she said. "However, it can cause pain, swelling, hard lumps, ulceration of the skin, and contour irregularities."
"None of the pharmaceuticals used for injection are FDA approved," said Dr. Susan Kaweski at the Aesthetic Arts Institute of Plastic Surgery in San Diego. "There have been no double-blinded studies revealing the mechanism of diffusion of solutions following injection, the precision and control of fat destruction by the chemicals or the long- and short-term effects of the drugs."
Despite the dangers of the procedure, the growing number of clinics offering lipodissolve is a testament to its continued legal status in the United States. Still, the procedure is banned for cosmetic purposes in Brazil and other countries.
"Most physicians performing this procedure do not have training in liposuction, plastic surgery or dermatologic surgery," Jacob says. "Even dentists are doing it."
A Sexier Step: Cosmetic Foot Surgery
Those who desire cosmetic surgery from top to toe should be no strangers to cosmetic foot surgery -- a collection of surgical and minimally invasive procedures designed to yield a sexier foot.
Despite the continued popularity of these procedures, which involve everything from filler injections to round out angles to total surgical reshaping of the foot, doctors have been warning consumers away from cosmetic foot surgery for years.
"The public needs to be aware of the risks associated with these procedures," said the American Orthopaedic Foot and Ankle Society President Dr. Glenn B. Pfeffer. "Women need to know what they are getting into."
He noted that the trend toward the practice of cosmetic surgery raises serious concern when one considers the risks of surgery on painless feet. "Complications can include infection, nerve injury, prolonged swelling of a toe, and even chronic pain with walking," Pfeffer said.
Not surprisingly, the sector of consumers that tends to be the most enthused at the prospect of better-looking feet are women who hope to adorn their feet with the latest in strappy, high-heeled fashions.
And the procedures involved run the gamut from filler injections to full-blown surgery to reshaping the foot. The American Orthopaedic Foot and Ankle Society noted that surgery to shorten the toes or narrow the feet are favorite options in this category. Some practitioners will also inject the fat pad of the feet with collagen or other substances -- again, solely to change the appearance of the feet.
Permanent Filler Injections
Injectable fillers, simply put, are special gels that are injected into the skin to plump up lips, push out wrinkles and fine lines -- in short, "fill out" spaces in the face where a bit of extra volume is needed.
Most of the fillers that are on the market today are temporary -- that is, after a certain amount of time they are absorbed into the body and the results are lost. This group of fillers includes the natural filler collagen, as well as a number of newer gels such as hyaluronic acid.
But some fillers are designed to stick around in the body for longer periods of time. These fillers, appropriately termed permanent fillers, include liquid silicone and the product known as Aquamid.
Though tantalizing to some consumers who would prefer to pay for fillers once rather than shell out for repeat procedures, such fillers have also been known to lead to a number of complications, including irreversible binding with tissues and a tendency to "drift," which can lead to a distorted appearance.
Roth said that the problems become even more severe in the event of a botched job.
"I do not do permanent fillers," Roth said. "Even with temporary fillers, once it's injected, even though it's going to go away, you're stuck with unsatisfactory results until it goes away. Permanent fillers don't go away."
But despite widespread disapproval among cosmetic surgeons and dermatologists, many consumers still seek out permanent filler injections.
"Silicone is still being used by some practitioners," Roth said. "I have seen three people in the last year who had silicone injections administered by nonphysicians."
Injection for Breast Augmentation
What if getting bigger breasts was as simple as getting a shot?
The idea is not a new one, and it stands to reason that pumping the breasts full of fat or fillers would offer an alternative to breast implant surgery -- all without the scars.
Traditionally, doctors performing such procedures have used the fat harvested from other areas of the body, such as the buttocks and thighs. By purifying this fat and reinjecting it into the breasts, they say, they can offer their patients a safe enhancement using the body's own spare materials.
But in reality, the procedure is not nearly as simple as it appears.
"On the surface, the concept of using liposuction to remove unwanted fat from one's own thighs and buttocks, and then injecting it into the breasts to make them larger, has appeal," the American Society for Aesthetic Plastic Surgery noted in a past statement on the procedure. "However, aesthetic surgeons certified in plastic surgery have long maintained that injection of fat, or any substance, into or behind the breast tissue can be potentially dangerous."
Dangerous, because there exists the potential for the reinjected fat to calcify, creating a scarred mass buried within the breast tissues. These calcifications can either mask or mimic the presence of breast cancer. And since between 7 and 14 ounces of fat are needed for the enlargement of a breast, there is no shortage of relocated fat to make the detection of breast cancer difficult, or even impossible.
More recently, a procedure referred to as the "boob jab" has made headlines by using artificial fillers to accomplish the same goal of bigger breasts. Specifically, the procedure requires the injection through the armpit of a temporary filler called Macrolane directly into the breast.
The procedure costs $4,000, and the results are temporary. And some doctors worry that this technique, too, could make it more difficult for current screening tests to detect breast cancer.
Cosmetic Leg Lengthening Surgery
How far would you go for a few more inches of height? For some, the quest for a more impressive stature leads them to a painful procedure that involves breaking both legs -- and using devices with screws attached to their legs to gradually extend their bones.
It's an extreme procedure to be sure. Yet, the technique is widely known in China and other Asian countries, where young professionals seek out the procedures to give themselves an edge in the business world.
But the procedure is also well known in the United States. Robert Rozbruch, the director of the Institute for Limb Lengthening and Reconstruction in New York, told ABC News that he does not approve of leg lengthening for cosmetic purposes as a new cosmetic surgery trend. And the patients who come to his center can only receive the surgery after extensive psychological testing.
"Orthopedic surgeons don't do cosmetic surgery," Rozbruch told ABC News. "It's not in our normal routine. We do this for a guy who is maybe [5 foot 2] or [5 foot 3] and well adjusted but being short is something that is very disturbing to them. When you talk to them you can feel the pain they go through."
But the results don't come cheap. Costs of the procedure generally top out at $120,000. For an average height gain of 3 inches, that's $40,000 per inch.
For those of a very short stature, the results may be worth the price tag and the pain. But Roth said the procedure is a poor choice if vanity is the main motivation.
"For purely cosmetic surgery purposes, I certainly would never let somebody in my family have that done," Roth said.
next>>>
May 24, 2009
Post Pregnancy Article
Keeping Children’s Health
Some of the common diseases suffered by children is nearly one-time attack on our children. Thus infectious diseases and need to recognize how handling. Handling also helps not only healing, but also can prevent the occurrence of further complications.
Disease which is often suffered by babies, according to Dr. Kishore RJ, child specialist doctor who practice in Ibu dan Anak Hospital in Jatinegara Hermina, Jakarta, among others, fever, infection channels the breath, and diarrhea. “But that often make parents take their children immediately treatment is a fever and diarrhea. If the cough-cold usually can still be delayed,” he said.
Fever is not a disease, but symptoms of a disease. Such as cough and runny nose, sore throat, diarrhea, infections of the alimentary tract, or infection channels the breath. In the book Overcoming Health Disorders in Children, essay dr. Anies from the Medical Faculty of Diponegoro University, Semarang, increase in body temperature also occurred frequently during the first growing teeth. Body temperature will also boast obtained after DPT immunization (diphtheria, pertussis, and tetanus), but only lasts about 24 hours.
Children said a fever, when the body temperature above 37.5 degrees Celsius. If that happens, sleep off children in the room air-conditioned wind or oneself, if any "Wearing thin clothing. Do not be covered with a thick blanket unless the child is shivering as the body temperature will increase," said Kishore.
It is wise if the house is always available anti-fever medication before the child was brought to a doctor. Regular paracetamol use and safe for children and babies. In addition to medication anti-fever, dr. Anies encourage children to drink more when given the fever fell ill. Can water, milk, orange juice, or tea. Those way children will be easy to sweat so the body temperature decreases. Wipe sweat on his body with wet towels, powdering entire body, and replace with dry clothes that feel fresh.
To lower the temperature the body can be assisted with the compress brow with wet cloth or towel. During the body temperature is still high, still need to compress. Efforts to lower the body temperature are necessary to prevent the occurrence of convulsions or step.
Diarrhea is accompanied by reduction in body fluids (dehydration), cough with shortness of breath, symptoms of asthma; although the direction is not asthma, or infection of the lower part of the channel the breath, and dengue fever, according to Kishore, need to get special treatment.
Food generally causes diarrhea. Caused food poisoning or bacteria in the food. If the toxic food, the main symptoms of vomiting, and diarrhea followed. If the bacteria in food, usually vomiting and diarrhea first.
In his book, dr. Anies mentioned, diarrhea is the emergency situation must be so by others before dehydration condition occurs, the first with a lot of drinking. The provision of fruit juice and milk powder suspended. However, mother’s milk still proceeds.
If diarrhea occurs repeatedly, the child will lose a lot of fluids, even a number of important minerals, such as sodium, potassium, and chloride. When the development, can occur so that the body fluid imbalance arising dehydration. Conditions such as this is the most feared although diarrhea recovers on their own basically.
Signs of dehydration include children crying without tears, dry mouth and lips, always feel thirsty. Urine out a little and dark colored, sometimes does not come out at all. Also, buried or sunken eyes. Marked dehydration in the baby can be seen through the crown into the concave. Also, child-headed, pale skin elasticity, or the body is reduced, and the former does not nip back to normal quickly.
To overcome this, children need to be given fluids as much as possible. "No solution should oralit. Can be sweet tea, water, salt sugar, juice, soup. Starch water is effective enough for the baby to have diarrhea. It is also far better than the oralit contain starch as glucose polymer that is easily absorbed," said Kishore.
Sugar salt solution made the comparison with two tsp sugar and half teaspoon salt to a glass of white water. This solution, according to dr. Anies, provided at least half a glass every time the child vomit or defecate. Also can be one tablespoon per five minutes, until the child can move small to normal.
Water quickly digested than the starch, also containing glucose level is high enough, which will facilitate the absorption of electrolyte. In addition, two types of flour poliglukosa in starch can cause fesses more compact. Benefits of water starch are another protein, which is 7 - 10%. Oralit while the salt does not contain protein. The use of starch as a water "diarrhea medications," according to Dr. Anies, is not harmful to the baby though.
When your babies start drinking fresh milk?
Most doctors’ child specialist recommends waiting until your children aged 12 months to give milk powder. First, milk powder does not meet the vitamin and ion sufficient for growth in your child early. Second, introducing milk powder to your baby's early will cause allergy or irritation on your baby's stomach contents, such as word Debby Demory-Luce, RD, an instructor at the Central Research Pregnancy Nutrition and Health, Houston, United States. If your child has started very obese, try to change the pattern of drinking milk as early as possible, so he will get more nutrition from food, not from milk powder or mother’s milk.
At the time your child is aged 9 months, he should not drink more than 16 to 20 oz per day of mother’s milk. If you are ready to introduce milk powder on your child, give it 4 oz in a small cup at the time he was eating. Most children do not realize that milk regular drinking is a different taste. But if you see signs of irritation or allergy your child such as diarrhea or vomiting, consult your doctor immediately at, which might give the suggestion to use other alternative is to drink only soy milk.
Stimulate the child since in the womb
Since I know that pregnant and I started to buy and read several books related to the pregnancy, especially since children's education in the womb. Since the age of five months of pregnancy I started listening to classical music with him and also tried to take my son chat. Each morning and night before bed my husband to read a chapter and verse of holy Al-Qur’an for the fetus, the result of every night if his father not yet greets to him, my fetus will move continuously. But if getting in chat and he greets movement in the womb will be reduced and be quiet so I can rest. And when listening in the classical music he certainly seems to respond to the backlash he understands that this is my music.
Me and my husband is also usual to invite him to play before sleep, we usually call this game with the name "football" that is, to stimulate him to kick feet of where the husband or my hands are placed, it was initially difficult but slowly he will understand that he is being invited mother and play by his father.
Some tips to improve the quality and quantity of mother’s milk.
1. Since turn of the seventh month of pregnancy should be diligent to compress breast with warm water every bath morning and afternoon each 10 minutes to one breast. After giving birth use hot-cold compress alternately.
2. Many drink and consume liquids. Do not forget to consume milk.
3. Use a small towel placed between the bra and breast. Try to always wear sleeved shirt.
4. Drinking chicken broth: 1 / 2 kg chicken + 1 / 4 kg ginger (pressed), 4 stem ginger (pressed), 1 fruit lemon (take water), 1 liter of water, salt. The whole boiled until approximately 10 minutes. Drink before and after breastfeeding. This is done every day for at least the exclusive care.
5. Eat nutritious food. Avoid eating too late.
6. Consume “katuk” leaf vegetables and beans.
7. Rest enough. Keep emotional stability. Try to always cheerful, hold and maintain a positive spirit breastfeeding.
Skin problems commonly found in baby
Skin is one of the most visible sign of the baby's health and welfare and should be given the same attention to other aspects of infant health. With relatively little effort, some skin problems such as listed here that is common to babies can be prevented.
The scaling
Gland excessive perspiration who works in the scalp can cause a fleck of skin, known as the crust.
- To prevent this, wash the skin with baby shampoo is specially formulated to be mild and gentle enough to use on your baby
- wash carefully to remove all remaining shampoo.
- Polishing baby oil on the skin with a soft baby's head and leave you some time to remove skin fleck hard, so easily removed.
Dry skin
Your baby's skin easily becomes dry and more dry skin, the less effective it is to protect the effects are dangerous.
- Set the temperature and humidity inside your home.
- Protect your baby from the blowing wind.
- Keep your baby's skin remains moist to prevent dryness and maintain skin moisture by using the right baby cream, lotion or oil.
Abrasions
There is friction between baby's clothes and skin where the skin rub against each other as mutual armpit or buttocks fold the baby can cause abrasions.
- Blow-dry your baby thoroughly after the bath and give special attention to the fold.
- Avoid the rough cloth material, rough and tight.
- Use powder or cream on the skin to reduce friction and keep the baby you will be comfortable.
Heat rash (prickly heat)
On a hot-weather temperature, pore-pore in the skin of your baby can be closed and cause a small pustule.
- Do not leave your baby with too enrobe excessive wear or heat room temperature baby excessive.
- Make sure the baby is quite loose-fitting clothing.
- Clean your baby regularly to remove excess perspiration.
Milk rash
White dots that come on the small face, neck and the top of the chest is very common among the babies fed mother’s milk. Type of rash is normal and will disappear without any treatment.
Nappy rash
Nappies make the area warm and humid, which is ongoing direct touch with the baby's skin. Area that is humid and warm, triggering the growth of bacteria. Abrasions caused by the friction of skin protectors decrease the effectiveness of the diaper rash. There are several ways to reduce or prevent problems in the skin area is smooth.
Buttocks to keep skin healthy and comfortable baby:
- Change nappies as often as possible
- Clean your baby's buttocks with a mop with a soft baby and dry carefully between the fold every time you change the diaper.
- When cleaning the boots baby, make sure to wipe from the front of the back. This will steer the dirt from the area and prevent infection of genitalia.
- Wipe cream to protect skin protector.
- Use nappies or nappy-use that can absorb moisture from the skin of a baby making baby dry.
- When you wash the nappies, clean them carefully so that all the detergent is gone.
Changes in hormone
The characteristic rash with white blotch on the nose, cheeks and forehead, may arise from the absorption of the hormone you receive the baby when he is still in your womb. This is quite normal and will disappear themselves.
3 Tips Overcoming Diarrhea in Children
Give food in a small amount but the frequency with which more often. Avoid giving foods that contain lots of gas, such as onion or nuts.
Avoid giving liquids to drink soda or a juice drink, and milk. To replace the fluid out, sauce from a thick potato soup will be enough to help.
Give yogurt to prevent the occurrence of diarrhea and to help recovery if a child has been exposed.
Restore muscle elasticity Vagina
I, a mother aged 20 years of 2 children aged 2 years and 3.5 months. My fear of sex between husband and me was the presence of a small bit too early. Is there a method that can restore the elasticity musculature my vagina?
Indeed, the birth of children can lead to came loose musculature around the vulva is normal as we know with muscle pubococcigeus (PC). To solve this problem, have found a Kegel exercise is simple enough, so easy to do. Only the necessary diligence to do so. Exercises should be done several times a day, for about 6 weeks. This exercise does not need a special time, that is, can be done anywhere, even while washing clothes or cooking.
Kegel exercises consist of 3 phases. First, you must first recognize the existence of the musculature, and this function works. While urinating, while sitting on the toilet, try to stop urinating with musculature increase this and then back to normal again, so that the urine back smoothly. When you have stop and drop back, then you have successfully identified the musculature and how it works.
The next stage was conducted similar to the first stage, with musculature increase release this again after some time. This step can be performed without the needs to urinate are. Make some time in the day, after that, you try to do the same third stage, with a similar practice but do longer and harder. This is also done several times a day for a certain period of time also. After approximately 1 - 2 weeks, I hope your condition has been restored again.
May 23, 2009
Pregnancy Article
Positive Thinking during Pregnancy
I want to share my experiences during pregnancy and birth to our first daughter. Thinking positive is very helpful during pregnancy and birth, when I was a lot of input the child's first pregnancy is also very difficult childbirth does not like the second and third. I fear to imagine it once more birth later, my mother said “that will be slight stomach upset more 2 night and days”.
I telling to my husband all my fearing and my husband always support and suggest me for positive thinking, thinking of pleasant matter and do not assume pregnancy is burden, I also consume healthy food during pregnancy and do activities as usual when not yet pregnancy, I also work, managing house even I have time to out town until 4 times when my pregnancy old age 7 months, and I feel very fit, even when bearing I only two hour feel pain in the stomach and afterwards my daughter born. For the mother of thinking many positive because idea will good influence of our physical and also bounce.
During pregnancy a concern
Pregnancy moment come in your life, arise happy feeling which the no anticipated, but sometimes bliss that you feel "annoyed" by some feeling worry. As a result, condition of our emotion goes with the stream to affect. Following several things which often worrying by pregnant mother.
- Worry to hurt fetus. You often have cold feet and hesitate in doing previous several things represent routine activity. For example have athletics or correlate intimately. Also, you worry if various sigh can cause miscarriage, like pain in bone at flank area or stomach.
- Worry to face childbirth. Although childbirth is a natural process which at the same time amaze and have become natural to a woman to experiencing it, but often pregnant mother cannot eliminate to feel worry and fear in face of the birth process. Believe it that you really sure with all this, hence slowly will grow bravery in yourself.
- Worry to apply fair. Many mothers worry, she can not be able to apply fair to the first child after his brother born. In fact, many also are not able to share time and attention on the party.
You can overcame your worries, if you have a strong determination for control emotion and does not dissolve in linger. Because anything that you experienced during pregnancy is normal and experienced by the other pregnant women.
Pregnancy and higher libido
If you are pregnant there are two possibilities related to your sexual passion, or even increased with the drastic decline. Both influenced hormone estrogen, but the explanation of why a woman can increase the other decreases is very psychological and individual nature. Family harmony, psychological background and some other things could be for.
But not that which will be discussed but whether reasonable if you are pregnant but the passion and desire to be intimate more incentive, and many opinions stating that it could be dangerous to the fetus.
According to an obstetrician, a decrease or increase sexual passion that is normal. If you experience increased sexual passion mare pregnant, according to obstetrician because the condition can be your relationship healthy and mutually satisfying. Especially the first trimester if you skip frustrating, no wonder if the sex is hot because it is likely to achieve your orgasm easier.
However, sometimes a problem because it appears the man or you do not have the same desire. Sometimes men think intimate relationships can harm the fetus, so they are extra careful and refrain. This of course is not convenient for you.
You need not be concerned if the problem is, in principle, because masturbation not prohibited and it is important that you will not hurt you or baby. If you like and want to use a vibrator, it is valid only for not placed in the vagina. Lubricants such as jelly or astroglide are also good. Unless you have a tendency of premature birth, you must hold the various things that cause orgasm including masturbation and intimate relationships.
Without Labor Pains
No need to worry if you can not withhold pain during childbirth. Because, with a special technique, the pain appears to be minimized. Pain during labor can cause increased blood pressure, heart rate increased, and the concentration of the prospective mother during childbirth to be disturbed, especially if the mother does not hold pain. All of that can be bad effect on the smooth confinement. Well, normal childbirth with the help of Intrathecal Labor Analgesia (ILA) to help the woman who does not grin and bear pain when injected with pain killer drugs.
Such as what is and what side effects? Following explanation of. Susilo, Sp. An, from the medical specialist anastesi Jatinegara Hermina Hospital, Jakarta, on the techniques ILA.
Side effect and how.
Labor with the help of ILA done by obstetrician and anastesi doctor who inject drugs into the fluid in the spinal cord of the mother, who then works to eliminate pain. Medicine itself does not affect the fetus in the womb. "Drugs that work directly on the nerve just that, so do not be merged to the blood vessel and into the body of the baby," said doctor Susilo. Drugs are injected into the spine to the spinal cavity, with the position of the mother to sit or lie in italics. This is different from the technique of epidural drugs injected into the epidural cavity.
Injection drugs during labor do go on the start of the stage 3, marked with the occurrence of contraction many times accompanied by pain. After the drug is working, usually the mother will feel musculature spine weak and a little sleep, but still in a state of conscious. In some mothers, uterus contraction can be slowed temporarily, but most of the general improvement of the contraction pattern. The rest, the process of childbirth, such as running other normal childbirth.
Side effects arising from the ILA labor can be spelled with a very mild condition and does not affect the fetus. Although rare, some side effects that may occur are nausea, vomiting, decrease blood pressure, and the itch-itch light that is easily overcome. "All that can be prevented, for example, by giving anti-nausea drugs and vomiting before giving fluids." said Dr. Susilo.
Bitter experience with the Coffee
After I read the article on the effect of caffeine fetus in the womb, I get the answer what happened to me the dead fetus in the womb when the age 6 months. At that time the doctors who handle me, can not give me the answer why the fetus is not moving in sudden and declared not a soul again.
I was a habitue coffee, I can drink coffee 3 cups a day. But I try to reduce during pregnancy, and the doctor allow. Every time I drink a cup of coffee, the fetus is not a sudden move for one day but its tomorrow moving again. Several days before the death of my fetus, I drink more than one glass of coffee a day and its tomorrow until 5 next days, I did not feel fetus move and my doctor says fetus died in the womb.
Hopefully this experience becomes to valuable input to other mothers.
Important Nutrition Period of Pregnancy.
Is it true that pregnant women should eat two portions with the times more than the ordinary woman? In terms of the quality of the answer is yes. But in terms of quantity is not the answer. In foods, pregnant women should consider the nutritional value of food consumed, either for himself or fetus in the womb.
Nutritional needs will continue to increase, especially after entering the second trimester of pregnancy. Because at the time, the growth of fetus takes place very quickly. Do not wonder if the mother's body weight also increased rapidly succession. This is different from the first trimester of pregnancy. At this time the growth of fetus is not yet so rapid, so that the nutrient needs also not optimal.
In the last two months of pregnancy, the baby brain is developing quickly. At this period, nutrients required for the development of brain and nerve network of the baby. Try to eat every 4 hours once. Even if you are not hungry, it's likely your baby is hungry.
Another thing to attention, despite increased appetite, keep on eating patterns with balanced nutrition. Do not eat carelessly.
Pregnant women should avoid high-calorie foods such as chocolate and ice cream. Keep in mind the ideal body weight increase during pregnancy is in the range of 10-15 kg.
In the following table can be major components of nutrition and the adequacy of the recommended (RDA) of the Food Nutrition Board, National Research Council:
Recommended Dietary Allowance 9th Ed. Washington DC, National Academy Sciences, 1980:
3 Main Composition
Women's daily needs of the age of 19 – 50
Additional daily needs of women during:
Pregnant breastfeeding
Protein (g) 44 +30 +20
Substance Iron (mg) 18 +30-60 +30-60
Calcium (mg) 800 +400 +400
Food with balanced nutrition can be obtained from carbohydrate and fat as a source of oxygen, as a source of protein substances builders, as well as vitamin and mineral substances as a regulator. As a source of energy that resulted in a calorie, carbohydrate can be obtained from cereal, tubers. Meanwhile, as a source of protein substances can be obtained from the developer of meat, fish, eggs, nuts, and as a source of the substances, vitamins and minerals can be obtained from fruits and vegetables. Additional vitamins, good B complex, vitamin A, vitamin C, vitamin D, and vitamin E are needed to improve maternal fitness.
Vitamin B complex found in the cereal, grains, nuts, green vegetables, yeast, eggs, and dairy products. Vitamin B complex is useful for maintaining the nervous system, muscles and heart to function normally.
Vitamin D is useful for bone formation and growth of your baby. Source found in the fish liver oil, yellow egg and milk.
Vitamin E useful for the formation of red blood cells healthy. Eat institutions grains, especially wheat, beans, vegetable oil and green vegetables.
Acid folat useful for the development of the nervous system and blood cells, and many are on the dark green vegetables such as spinach, cabbage and broccoli flowers. In the fruit, acid folat there are many in the citrus, banana, carrot and tomato. A Folat acid need during pregnancy is 800 mcg per day, especially in the first 12 weeks of pregnancy. Folat lack of acid can disrupt the formation of the brain, and congenital defects in the central nervous system and brain fetus.
Substance iron required pregnant women to avoid anemia, there are many on the greens (like spinach, cabbage, cassava leaves, papaya leaves), meat and liver.
One of the foods with a complete nutrient is milk. Milk contains calcium for growing bones and teeth fetus, and to protect pregnant women from the disease osteoporosis (porous bones). If calcium needs of pregnant women are not enough, the lack of calcium will be taken from her mother's bones. Other sources of calcium that are green vegetables and beans.
In addition, milk also contains many vitamins, such as vitamins A, D, B2, B3, and vitamin C. Substances-vitamin is also found in the processed milk products, such as cheese, ice cream, yoghurt.
Foods that should be avoided
There are several types of food that should be avoided by pregnant women, because the seeds carry the possibility of disease or parasite that is particularly dangerous to the fetus. Types of seeds disease / parasites which endanger the fetus and is involved in food:
Listeria
Can cause miscarriage, the baby is born dead, or blood poisoning. Listeria monocytogenes bacteria found in the lot:
- Poultry products (including eggs), fish or beef is half cooked processed.
- Salad, fruit and vegetables are not washed clean, especially when eaten in raw state.
- Some type of soft cheese, like Brie, Camembert, Blue Cheese and other cheeses made from goat or sheep milk.
Bacteria E. Coli
Often found in processed meat are half cooked, and did not experience the milk pasteurize. Poison can damage the intestine and kidney.
Salmonella and Toksoplasma.
To avoid this type of bacterial infection, you should not consume meat and eggs are half-cooked.
Pregnant woman food
Needs food for pregnant women is much higher than the demand for women not pregnant,
food purposes are:
- For the growth of fetus in the womb.
- To maintain the health and strength of the body of the mother alone.
- To have that injury healed in confinement perceptivity childbed.
- For a reserve for lactation period
How:
1. Mother should eat three times a day regularly.
2. Dishes must be composed of material nutriment comprising: staple food, pilaff, vegetables and fruits grown and drink 1 glass of milk every day.
3. Use a wide range of food there.
4. Choose a variety of fresh food.
How much food is needed?
When the condition of the mother is not subject to the large amount of food or which can be eaten as is listed in the appendix. However, when an interruption occurs during pregnancy it can be arranged as follows:
1. On tree semester I:
At the age of 1-3 months of pregnancy likely decrease body weight. This is due to the interference dizziness, nausea and even vomiting. Therefore, it is recommended but small portions of food frequently. The form of dry food
2. On tree semester II:
Improve maternal appetite, eating the food provided: 3 x 1 a day plus food distraction. Pilaff animal food such as eggs, fish, meat, the heart is very good and useful to avoid anemia.
3. On tree semester III:
- Food must be tailored to the circumstances of the mother.
- When pregnant women have excess weight, the staple food and flour was reduced, and increase vegetables and fresh fruits to avoid constipation.
4. When pregnancy occurs poisoned (swelling in the feet) then do not add salt in cooking daily.
How much you need each day?
Name of Material, Weight Gram Household Size
Rice 300 4cups rice
Meat 75 3 pieces
Vegetables 300 3 glass
Fruit 200 2 pieces
Milk 200 1 glass
Sugar 10 1 tablespoon
Oil 25 5 tablespoon
Interlude twice.
Nutritional value
- Calories: 2500 - Fat: 82
- Protein: 85 - H.A. : 414
Distribution of food in a day:
Time Type of Food Amount (gram) Size
Morning.
Rice 200 1 ¼ glass
Meat 50 1 piece
Egg 25 ½ egg
Vegetables 50 ½ glass
Oil 10 1 tablespoon
Sugar 10 1 tablespoon
10 o’clock
Milk 200 1 glass
Sugar 10 1 glass
Lunch
Rice 250 1 ¼ glass
Meat 50 1 piece
Egg 50 1 egg
Vegetables 75 ¾ glass
Oil 15 1½ tablespoon
Fruit 100
16:00 o’clock
mung bean porridge 25 2 tablespoon
Sugar 15 1½ tablespoon
Dinner
Rice 250 1 ¼ glass
Meat 50 1 piece
Egg 25 ½ egg
Vegetables 75 ¾ glass
Fruit 100
Important message for pregnant women
- Pregnant mother should eat and drink more than when not pregnant.
- To prevent anemia during pregnancy the mother must eat a lot of food iron source, such as green vegetables, green beans, red beans and other beans, eggs, fish, and meat.
- Do not forget to drink anti-anemia drugs every day.
- To help prevent teeth fall out and fragile bones, pregnant women should eat lots of calcium containing.
- Identify the symptoms of anemia (Anemia) during pregnancy, namely:
pale, dizzy, weak vision, etc.
- During pregnancy eat a wide range of food in sufficient amounts.
- If the mother is less appetite, eat fresh food, such as: fruit, juice, vegetables nodes, etc.
- Avoid the prohibition against food, because it will harm the mother's health.
- Avoid smoking and drinking liquor, because it will endanger the safety of mother and fetus.
- Do not forget self-examined to obstetrician, so that the mother and fetus remain healthy.
Caffeine effects on Pregnancy
Caffeine is one of the substances used in medicine and in everyday foods that can be obtained easily, such as, in the coffee, chocolate, tea and many soft-drinks, caffeine in various foods and beverages are not even considered as a drug, but it can affect / improve the heart rate. With high doses, caffeine can cause irritation in the alimentary tract, and the feeling of pulse.
Caffeine can also cause increased hormone epinephrine, and the mother and fetus stress. Increased epinephrine this measure will reduce the flow of blood to the uterus, thus reducing the flow of oxygen and nutrients to the fetus. The average person in the United States consumed 206 to 210 milligram caffeine per day or about 1.5 cup of coffee. While pregnant women there average 144 mg get coffee every day. Caffeine taken by pregnant women that, not only can cross placenta bloodstream and enter the fetus. This occurred due to heart the fetus have not been able to process caffeine as quickly as her mother, so the caffeine will stay in the circulatory system in the fetus a long time.
Damaged teeth between mother & fetus
"Mother pregnant with a chronic toothache or birth weight infants at risk for low birth weight (BBLR) because of delayed growth", according to Heather JARET Therefore, from the University of North Carolina at Chapel Hill, United States in a presentation at the International Association for dental research. Dr. Steven Offenbacher, Director of the Center of Oral and Systemic Diseases at the University explained that the risk is strong, with the same risk as a result of smoking or alcohol.
Experts explore the relationship between gum disease in which the baby was born with low body weight, as the events during the 5-6 years. Research done by checking the teeth and oral health in 850 pregnant women, the age of twenty-years. before the age of 26 weeks of pregnancy. After that review back in time 48 hours after childbirth. This research also takes into account controls and the various risks, such as age, smoking status and early childbirth was ever experienced before.
The research found that the increased risk of low birth weight infants and the major growth if the fetus is less visible interference in the tooth and gum is mild. Risk is significant if the disease becomes more serious teeth. Direct relationship between gum disease and affect the baby teeth are not yet clearly known, but estimated that this related to the response of the swollen gum. Also there is no research to prove that the treatment of disease in the gum can reduce the negative effects on the fetus. Even so, with this research we suggest more attention to oral and dental health during pregnancy in progress.
Excessive vomiting, it is not yet known
Until now, excessive vomiting in early pregnancy, or known by the term hyperemesis gravidarum is unknown cause. However, the condition is suspected to relate the increased hormones estrogen.
Unlike the pregnancy in general, this interference can usually lasts until the twentieth week of pregnancy, marked by nausea and uncontrollable vomiting almost twenty times every day. As a result, lost appetite and weakness due to loss of body fluids.
Even though there are allegations can increase the risk of a miscarriage, such as general condition is more dangerous to the mother. The mother may experience dehydration that can result in fatal if not treated properly. Dehydration can cause damage to liver and kidney organ. Usually, the doctor will give injections and medicine to address them.
And, to alleviate the symptoms that appear, try eating a small amount in the course but often. Also, reduce sweet foods and fatty and greasy that it will aggravate the situation. To reduce nausea, which in the soda water mixed with a bit of juice you can try.
I want to share my experiences during pregnancy and birth to our first daughter. Thinking positive is very helpful during pregnancy and birth, when I was a lot of input the child's first pregnancy is also very difficult childbirth does not like the second and third. I fear to imagine it once more birth later, my mother said “that will be slight stomach upset more 2 night and days”.
I telling to my husband all my fearing and my husband always support and suggest me for positive thinking, thinking of pleasant matter and do not assume pregnancy is burden, I also consume healthy food during pregnancy and do activities as usual when not yet pregnancy, I also work, managing house even I have time to out town until 4 times when my pregnancy old age 7 months, and I feel very fit, even when bearing I only two hour feel pain in the stomach and afterwards my daughter born. For the mother of thinking many positive because idea will good influence of our physical and also bounce.
During pregnancy a concern
Pregnancy moment come in your life, arise happy feeling which the no anticipated, but sometimes bliss that you feel "annoyed" by some feeling worry. As a result, condition of our emotion goes with the stream to affect. Following several things which often worrying by pregnant mother.
- Worry to hurt fetus. You often have cold feet and hesitate in doing previous several things represent routine activity. For example have athletics or correlate intimately. Also, you worry if various sigh can cause miscarriage, like pain in bone at flank area or stomach.
- Worry to face childbirth. Although childbirth is a natural process which at the same time amaze and have become natural to a woman to experiencing it, but often pregnant mother cannot eliminate to feel worry and fear in face of the birth process. Believe it that you really sure with all this, hence slowly will grow bravery in yourself.
- Worry to apply fair. Many mothers worry, she can not be able to apply fair to the first child after his brother born. In fact, many also are not able to share time and attention on the party.
You can overcame your worries, if you have a strong determination for control emotion and does not dissolve in linger. Because anything that you experienced during pregnancy is normal and experienced by the other pregnant women.
Pregnancy and higher libido
If you are pregnant there are two possibilities related to your sexual passion, or even increased with the drastic decline. Both influenced hormone estrogen, but the explanation of why a woman can increase the other decreases is very psychological and individual nature. Family harmony, psychological background and some other things could be for.
But not that which will be discussed but whether reasonable if you are pregnant but the passion and desire to be intimate more incentive, and many opinions stating that it could be dangerous to the fetus.
According to an obstetrician, a decrease or increase sexual passion that is normal. If you experience increased sexual passion mare pregnant, according to obstetrician because the condition can be your relationship healthy and mutually satisfying. Especially the first trimester if you skip frustrating, no wonder if the sex is hot because it is likely to achieve your orgasm easier.
However, sometimes a problem because it appears the man or you do not have the same desire. Sometimes men think intimate relationships can harm the fetus, so they are extra careful and refrain. This of course is not convenient for you.
You need not be concerned if the problem is, in principle, because masturbation not prohibited and it is important that you will not hurt you or baby. If you like and want to use a vibrator, it is valid only for not placed in the vagina. Lubricants such as jelly or astroglide are also good. Unless you have a tendency of premature birth, you must hold the various things that cause orgasm including masturbation and intimate relationships.
Without Labor Pains
No need to worry if you can not withhold pain during childbirth. Because, with a special technique, the pain appears to be minimized. Pain during labor can cause increased blood pressure, heart rate increased, and the concentration of the prospective mother during childbirth to be disturbed, especially if the mother does not hold pain. All of that can be bad effect on the smooth confinement. Well, normal childbirth with the help of Intrathecal Labor Analgesia (ILA) to help the woman who does not grin and bear pain when injected with pain killer drugs.
Such as what is and what side effects? Following explanation of. Susilo, Sp. An, from the medical specialist anastesi Jatinegara Hermina Hospital, Jakarta, on the techniques ILA.
Side effect and how.
Labor with the help of ILA done by obstetrician and anastesi doctor who inject drugs into the fluid in the spinal cord of the mother, who then works to eliminate pain. Medicine itself does not affect the fetus in the womb. "Drugs that work directly on the nerve just that, so do not be merged to the blood vessel and into the body of the baby," said doctor Susilo. Drugs are injected into the spine to the spinal cavity, with the position of the mother to sit or lie in italics. This is different from the technique of epidural drugs injected into the epidural cavity.
Injection drugs during labor do go on the start of the stage 3, marked with the occurrence of contraction many times accompanied by pain. After the drug is working, usually the mother will feel musculature spine weak and a little sleep, but still in a state of conscious. In some mothers, uterus contraction can be slowed temporarily, but most of the general improvement of the contraction pattern. The rest, the process of childbirth, such as running other normal childbirth.
Side effects arising from the ILA labor can be spelled with a very mild condition and does not affect the fetus. Although rare, some side effects that may occur are nausea, vomiting, decrease blood pressure, and the itch-itch light that is easily overcome. "All that can be prevented, for example, by giving anti-nausea drugs and vomiting before giving fluids." said Dr. Susilo.
Bitter experience with the Coffee
After I read the article on the effect of caffeine fetus in the womb, I get the answer what happened to me the dead fetus in the womb when the age 6 months. At that time the doctors who handle me, can not give me the answer why the fetus is not moving in sudden and declared not a soul again.
I was a habitue coffee, I can drink coffee 3 cups a day. But I try to reduce during pregnancy, and the doctor allow. Every time I drink a cup of coffee, the fetus is not a sudden move for one day but its tomorrow moving again. Several days before the death of my fetus, I drink more than one glass of coffee a day and its tomorrow until 5 next days, I did not feel fetus move and my doctor says fetus died in the womb.
Hopefully this experience becomes to valuable input to other mothers.
Important Nutrition Period of Pregnancy.
Is it true that pregnant women should eat two portions with the times more than the ordinary woman? In terms of the quality of the answer is yes. But in terms of quantity is not the answer. In foods, pregnant women should consider the nutritional value of food consumed, either for himself or fetus in the womb.
Nutritional needs will continue to increase, especially after entering the second trimester of pregnancy. Because at the time, the growth of fetus takes place very quickly. Do not wonder if the mother's body weight also increased rapidly succession. This is different from the first trimester of pregnancy. At this time the growth of fetus is not yet so rapid, so that the nutrient needs also not optimal.
In the last two months of pregnancy, the baby brain is developing quickly. At this period, nutrients required for the development of brain and nerve network of the baby. Try to eat every 4 hours once. Even if you are not hungry, it's likely your baby is hungry.
Another thing to attention, despite increased appetite, keep on eating patterns with balanced nutrition. Do not eat carelessly.
Pregnant women should avoid high-calorie foods such as chocolate and ice cream. Keep in mind the ideal body weight increase during pregnancy is in the range of 10-15 kg.
In the following table can be major components of nutrition and the adequacy of the recommended (RDA) of the Food Nutrition Board, National Research Council:
Recommended Dietary Allowance 9th Ed. Washington DC, National Academy Sciences, 1980:
3 Main Composition
Women's daily needs of the age of 19 – 50
Additional daily needs of women during:
Pregnant breastfeeding
Protein (g) 44 +30 +20
Substance Iron (mg) 18 +30-60 +30-60
Calcium (mg) 800 +400 +400
Food with balanced nutrition can be obtained from carbohydrate and fat as a source of oxygen, as a source of protein substances builders, as well as vitamin and mineral substances as a regulator. As a source of energy that resulted in a calorie, carbohydrate can be obtained from cereal, tubers. Meanwhile, as a source of protein substances can be obtained from the developer of meat, fish, eggs, nuts, and as a source of the substances, vitamins and minerals can be obtained from fruits and vegetables. Additional vitamins, good B complex, vitamin A, vitamin C, vitamin D, and vitamin E are needed to improve maternal fitness.
Vitamin B complex found in the cereal, grains, nuts, green vegetables, yeast, eggs, and dairy products. Vitamin B complex is useful for maintaining the nervous system, muscles and heart to function normally.
Vitamin D is useful for bone formation and growth of your baby. Source found in the fish liver oil, yellow egg and milk.
Vitamin E useful for the formation of red blood cells healthy. Eat institutions grains, especially wheat, beans, vegetable oil and green vegetables.
Acid folat useful for the development of the nervous system and blood cells, and many are on the dark green vegetables such as spinach, cabbage and broccoli flowers. In the fruit, acid folat there are many in the citrus, banana, carrot and tomato. A Folat acid need during pregnancy is 800 mcg per day, especially in the first 12 weeks of pregnancy. Folat lack of acid can disrupt the formation of the brain, and congenital defects in the central nervous system and brain fetus.
Substance iron required pregnant women to avoid anemia, there are many on the greens (like spinach, cabbage, cassava leaves, papaya leaves), meat and liver.
One of the foods with a complete nutrient is milk. Milk contains calcium for growing bones and teeth fetus, and to protect pregnant women from the disease osteoporosis (porous bones). If calcium needs of pregnant women are not enough, the lack of calcium will be taken from her mother's bones. Other sources of calcium that are green vegetables and beans.
In addition, milk also contains many vitamins, such as vitamins A, D, B2, B3, and vitamin C. Substances-vitamin is also found in the processed milk products, such as cheese, ice cream, yoghurt.
Foods that should be avoided
There are several types of food that should be avoided by pregnant women, because the seeds carry the possibility of disease or parasite that is particularly dangerous to the fetus. Types of seeds disease / parasites which endanger the fetus and is involved in food:
Listeria
Can cause miscarriage, the baby is born dead, or blood poisoning. Listeria monocytogenes bacteria found in the lot:
- Poultry products (including eggs), fish or beef is half cooked processed.
- Salad, fruit and vegetables are not washed clean, especially when eaten in raw state.
- Some type of soft cheese, like Brie, Camembert, Blue Cheese and other cheeses made from goat or sheep milk.
Bacteria E. Coli
Often found in processed meat are half cooked, and did not experience the milk pasteurize. Poison can damage the intestine and kidney.
Salmonella and Toksoplasma.
To avoid this type of bacterial infection, you should not consume meat and eggs are half-cooked.
Pregnant woman food
Needs food for pregnant women is much higher than the demand for women not pregnant,
food purposes are:
- For the growth of fetus in the womb.
- To maintain the health and strength of the body of the mother alone.
- To have that injury healed in confinement perceptivity childbed.
- For a reserve for lactation period
How:
1. Mother should eat three times a day regularly.
2. Dishes must be composed of material nutriment comprising: staple food, pilaff, vegetables and fruits grown and drink 1 glass of milk every day.
3. Use a wide range of food there.
4. Choose a variety of fresh food.
How much food is needed?
When the condition of the mother is not subject to the large amount of food or which can be eaten as is listed in the appendix. However, when an interruption occurs during pregnancy it can be arranged as follows:
1. On tree semester I:
At the age of 1-3 months of pregnancy likely decrease body weight. This is due to the interference dizziness, nausea and even vomiting. Therefore, it is recommended but small portions of food frequently. The form of dry food
2. On tree semester II:
Improve maternal appetite, eating the food provided: 3 x 1 a day plus food distraction. Pilaff animal food such as eggs, fish, meat, the heart is very good and useful to avoid anemia.
3. On tree semester III:
- Food must be tailored to the circumstances of the mother.
- When pregnant women have excess weight, the staple food and flour was reduced, and increase vegetables and fresh fruits to avoid constipation.
4. When pregnancy occurs poisoned (swelling in the feet) then do not add salt in cooking daily.
How much you need each day?
Name of Material, Weight Gram Household Size
Rice 300 4cups rice
Meat 75 3 pieces
Vegetables 300 3 glass
Fruit 200 2 pieces
Milk 200 1 glass
Sugar 10 1 tablespoon
Oil 25 5 tablespoon
Interlude twice.
Nutritional value
- Calories: 2500 - Fat: 82
- Protein: 85 - H.A. : 414
Distribution of food in a day:
Time Type of Food Amount (gram) Size
Morning.
Rice 200 1 ¼ glass
Meat 50 1 piece
Egg 25 ½ egg
Vegetables 50 ½ glass
Oil 10 1 tablespoon
Sugar 10 1 tablespoon
10 o’clock
Milk 200 1 glass
Sugar 10 1 glass
Lunch
Rice 250 1 ¼ glass
Meat 50 1 piece
Egg 50 1 egg
Vegetables 75 ¾ glass
Oil 15 1½ tablespoon
Fruit 100
16:00 o’clock
mung bean porridge 25 2 tablespoon
Sugar 15 1½ tablespoon
Dinner
Rice 250 1 ¼ glass
Meat 50 1 piece
Egg 25 ½ egg
Vegetables 75 ¾ glass
Fruit 100
Important message for pregnant women
- Pregnant mother should eat and drink more than when not pregnant.
- To prevent anemia during pregnancy the mother must eat a lot of food iron source, such as green vegetables, green beans, red beans and other beans, eggs, fish, and meat.
- Do not forget to drink anti-anemia drugs every day.
- To help prevent teeth fall out and fragile bones, pregnant women should eat lots of calcium containing.
- Identify the symptoms of anemia (Anemia) during pregnancy, namely:
pale, dizzy, weak vision, etc.
- During pregnancy eat a wide range of food in sufficient amounts.
- If the mother is less appetite, eat fresh food, such as: fruit, juice, vegetables nodes, etc.
- Avoid the prohibition against food, because it will harm the mother's health.
- Avoid smoking and drinking liquor, because it will endanger the safety of mother and fetus.
- Do not forget self-examined to obstetrician, so that the mother and fetus remain healthy.
Caffeine effects on Pregnancy
Caffeine is one of the substances used in medicine and in everyday foods that can be obtained easily, such as, in the coffee, chocolate, tea and many soft-drinks, caffeine in various foods and beverages are not even considered as a drug, but it can affect / improve the heart rate. With high doses, caffeine can cause irritation in the alimentary tract, and the feeling of pulse.
Caffeine can also cause increased hormone epinephrine, and the mother and fetus stress. Increased epinephrine this measure will reduce the flow of blood to the uterus, thus reducing the flow of oxygen and nutrients to the fetus. The average person in the United States consumed 206 to 210 milligram caffeine per day or about 1.5 cup of coffee. While pregnant women there average 144 mg get coffee every day. Caffeine taken by pregnant women that, not only can cross placenta bloodstream and enter the fetus. This occurred due to heart the fetus have not been able to process caffeine as quickly as her mother, so the caffeine will stay in the circulatory system in the fetus a long time.
Damaged teeth between mother & fetus
"Mother pregnant with a chronic toothache or birth weight infants at risk for low birth weight (BBLR) because of delayed growth", according to Heather JARET Therefore, from the University of North Carolina at Chapel Hill, United States in a presentation at the International Association for dental research. Dr. Steven Offenbacher, Director of the Center of Oral and Systemic Diseases at the University explained that the risk is strong, with the same risk as a result of smoking or alcohol.
Experts explore the relationship between gum disease in which the baby was born with low body weight, as the events during the 5-6 years. Research done by checking the teeth and oral health in 850 pregnant women, the age of twenty-years. before the age of 26 weeks of pregnancy. After that review back in time 48 hours after childbirth. This research also takes into account controls and the various risks, such as age, smoking status and early childbirth was ever experienced before.
The research found that the increased risk of low birth weight infants and the major growth if the fetus is less visible interference in the tooth and gum is mild. Risk is significant if the disease becomes more serious teeth. Direct relationship between gum disease and affect the baby teeth are not yet clearly known, but estimated that this related to the response of the swollen gum. Also there is no research to prove that the treatment of disease in the gum can reduce the negative effects on the fetus. Even so, with this research we suggest more attention to oral and dental health during pregnancy in progress.
Excessive vomiting, it is not yet known
Until now, excessive vomiting in early pregnancy, or known by the term hyperemesis gravidarum is unknown cause. However, the condition is suspected to relate the increased hormones estrogen.
Unlike the pregnancy in general, this interference can usually lasts until the twentieth week of pregnancy, marked by nausea and uncontrollable vomiting almost twenty times every day. As a result, lost appetite and weakness due to loss of body fluids.
Even though there are allegations can increase the risk of a miscarriage, such as general condition is more dangerous to the mother. The mother may experience dehydration that can result in fatal if not treated properly. Dehydration can cause damage to liver and kidney organ. Usually, the doctor will give injections and medicine to address them.
And, to alleviate the symptoms that appear, try eating a small amount in the course but often. Also, reduce sweet foods and fatty and greasy that it will aggravate the situation. To reduce nausea, which in the soda water mixed with a bit of juice you can try.
May 21, 2009
Erasing Autism
Scientists are closing in on the genes linked to autism. So why is Ari Ne'eman so worried?
It's spring in Washington, and Ari Ne'e-man, with his navy suit and leather brief-case on wheels, is in between his usual flurry of meetings. Ne'eman is a master networker, a guy you'd think was born in a campaign office and bred in the halls of the Capitol. He's fluent in policy-speak and interacts seamlessly with high-level officials (he's just had lunch with the acting vice chair of the Equal Employment Opportunity Commission) and inquisitive reporters alike. He's formal but sociable and has a well-timed sense of humor. He also has a problem with velvet. I knew this about Ne'eman—he'd mentioned it when we first started talking more than a year ago—but now, in a D.C. coffee shop, he gets into the sensory details. His father used to drive a car that had fuzzy velvet-like cushioning, and it made Ne'eman crazy to sit in it. "I'd wince because I'd think about how it would feel to get that under your fingernails," he says. I think I see him shudder at the memory.
Ari Ne'eman is 21 years old and has Asperger syndrome, a high-functioning diag-nosis on the wide-ranging autism spectrum. Ne'eman's velvet aversion is triggered somewhere deep in his brain, a brain that he happens to relish. He doesn't want anybody to mess with or, God forbid, cure his Asperger's. It's who he is, who he's always been. It's why he's had ob-sessive interests since toddlerhood. At 2½, he saw a dinosaur skeleton at New York's American Museum of Natural History and announced, "That's a pterodactyl." From there he fixated on baseball, reciting players' names and stats ad nauseam, whether or not anyone was listening—a behavior experts call perseveration. Later it was constitutional law. His friend Ben DeMarzo remembers driving with Ne'eman and two other classmates one high-school weekend. DeMarzo and the others wanted to listen to music—the Beatles were a favorite—but Ne'eman had other plans. "Ari made us listen to Supreme Court oral arguments. It was brutal," DeMarzo tells me. He was outnumbered—how'd he win? I ask. DeMarzo laughs. "Ari always wins," he says.
He certainly puts up a fight. Ne'eman is officially studying political science at the University of Maryland, Baltimore County, but he also runs the Autistic Self-Advocacy Network, a nonprofit he founded in 2006, the year after he graduated from high school. The task he has taken on is daunting and controversial: he wants to change the way the world views autism. Autism is not a medical mystery that needs solving, he argues. It's a disability, yes, but it's also a different way of being, and "neurodiversity" should be accepted by society. Autistic people (he prefers this wording to "people with autism," a term many parents use, because he considers the condition intrinsic to a person's makeup) must be accommodated in the classroom and workplace and helped to live independently as adults—and he is pushing to make this happen for everyone on the spectrum. They should also be listened to. "We're having a nation-al conversation about autism without the voices of people who should be at the center of that conversation," he says.
Ne'eman's network has local chapters in 15 states, and he works closely with organizations like the EEOC and the American Association of People With Disabilities. Neurodiversity activists see their mission as a fight for civil rights, and Ne'eman and others are willing to stir un-rest. "Ari's very straightforward," says Lee Grossman, head of the Autism Society of America, who supports many of Ne'eman's efforts. "He tells it like it is from his perspective." Ne'eman has taken on powerful organizations, specifically Autism Speaks, the largest science and advocacy group in the country, be-cause he believes they rely on fearful stereotypes and focus their research too heavily on what causes autism as opposed to improving quality of life for autistic people today. Last year he helped stop an edgy "ransom notes" ad campaign created by New York University's Child Study Center to raise awareness about autism. One said, "We have your son" and are "driving him into a life of complete isolation." It was signed "Asperger Syndrome." Ne'eman was appalled. "There's a misperception that autism is some thief in the night that takes a normal child and places an autistic child in its place," he says. "That's not true."
The autism spectrum itself, however, is a universe with multiple galaxies, including nonverbal toddlers who bite themselves and college grads who can't tell the differ-ence between sarcasm and seriousness. This complexity leads to passionate and conflicting viewpoints. Not everybody stands behind Ne'eman, and some adamantly op-pose his views. One major area of contention: scientific research, which includes the hunt for autism genes.
I knew Ne'eman had a surprising outlook on this and figured he'd have something to say about the recent news that scientists have found common gene variants that may account for up to 15 percent of all autism cases. This is big in a disorder that varies so enormously from one individual to the next. Environmental factors also play a role, but if scientists can test for specific genes—most of which have yet to be discovered—they may be able to intervene much sooner to help kids. One day they might even find a cure. This is exciting for parents who want to understand the roots of the disorder. Therapies—some helpful, some shams—vie for their attention and their pocketbooks, and they'd welcome better, more targeted treatments. But the new genetic advances concern Ne'eman. He doesn't believe autism can be, or should be, cured. His ultimate fear is this: a prenatal test for autism, leading to "eugenic elimination." If a test is developed one day, it will be used, he says. And that means people like him might cease to exist.
It's spring in Washington, and Ari Ne'e-man, with his navy suit and leather brief-case on wheels, is in between his usual flurry of meetings. Ne'eman is a master networker, a guy you'd think was born in a campaign office and bred in the halls of the Capitol. He's fluent in policy-speak and interacts seamlessly with high-level officials (he's just had lunch with the acting vice chair of the Equal Employment Opportunity Commission) and inquisitive reporters alike. He's formal but sociable and has a well-timed sense of humor. He also has a problem with velvet. I knew this about Ne'eman—he'd mentioned it when we first started talking more than a year ago—but now, in a D.C. coffee shop, he gets into the sensory details. His father used to drive a car that had fuzzy velvet-like cushioning, and it made Ne'eman crazy to sit in it. "I'd wince because I'd think about how it would feel to get that under your fingernails," he says. I think I see him shudder at the memory.
Ari Ne'eman is 21 years old and has Asperger syndrome, a high-functioning diag-nosis on the wide-ranging autism spectrum. Ne'eman's velvet aversion is triggered somewhere deep in his brain, a brain that he happens to relish. He doesn't want anybody to mess with or, God forbid, cure his Asperger's. It's who he is, who he's always been. It's why he's had ob-sessive interests since toddlerhood. At 2½, he saw a dinosaur skeleton at New York's American Museum of Natural History and announced, "That's a pterodactyl." From there he fixated on baseball, reciting players' names and stats ad nauseam, whether or not anyone was listening—a behavior experts call perseveration. Later it was constitutional law. His friend Ben DeMarzo remembers driving with Ne'eman and two other classmates one high-school weekend. DeMarzo and the others wanted to listen to music—the Beatles were a favorite—but Ne'eman had other plans. "Ari made us listen to Supreme Court oral arguments. It was brutal," DeMarzo tells me. He was outnumbered—how'd he win? I ask. DeMarzo laughs. "Ari always wins," he says.
He certainly puts up a fight. Ne'eman is officially studying political science at the University of Maryland, Baltimore County, but he also runs the Autistic Self-Advocacy Network, a nonprofit he founded in 2006, the year after he graduated from high school. The task he has taken on is daunting and controversial: he wants to change the way the world views autism. Autism is not a medical mystery that needs solving, he argues. It's a disability, yes, but it's also a different way of being, and "neurodiversity" should be accepted by society. Autistic people (he prefers this wording to "people with autism," a term many parents use, because he considers the condition intrinsic to a person's makeup) must be accommodated in the classroom and workplace and helped to live independently as adults—and he is pushing to make this happen for everyone on the spectrum. They should also be listened to. "We're having a nation-al conversation about autism without the voices of people who should be at the center of that conversation," he says.
Ne'eman's network has local chapters in 15 states, and he works closely with organizations like the EEOC and the American Association of People With Disabilities. Neurodiversity activists see their mission as a fight for civil rights, and Ne'eman and others are willing to stir un-rest. "Ari's very straightforward," says Lee Grossman, head of the Autism Society of America, who supports many of Ne'eman's efforts. "He tells it like it is from his perspective." Ne'eman has taken on powerful organizations, specifically Autism Speaks, the largest science and advocacy group in the country, be-cause he believes they rely on fearful stereotypes and focus their research too heavily on what causes autism as opposed to improving quality of life for autistic people today. Last year he helped stop an edgy "ransom notes" ad campaign created by New York University's Child Study Center to raise awareness about autism. One said, "We have your son" and are "driving him into a life of complete isolation." It was signed "Asperger Syndrome." Ne'eman was appalled. "There's a misperception that autism is some thief in the night that takes a normal child and places an autistic child in its place," he says. "That's not true."
The autism spectrum itself, however, is a universe with multiple galaxies, including nonverbal toddlers who bite themselves and college grads who can't tell the differ-ence between sarcasm and seriousness. This complexity leads to passionate and conflicting viewpoints. Not everybody stands behind Ne'eman, and some adamantly op-pose his views. One major area of contention: scientific research, which includes the hunt for autism genes.
I knew Ne'eman had a surprising outlook on this and figured he'd have something to say about the recent news that scientists have found common gene variants that may account for up to 15 percent of all autism cases. This is big in a disorder that varies so enormously from one individual to the next. Environmental factors also play a role, but if scientists can test for specific genes—most of which have yet to be discovered—they may be able to intervene much sooner to help kids. One day they might even find a cure. This is exciting for parents who want to understand the roots of the disorder. Therapies—some helpful, some shams—vie for their attention and their pocketbooks, and they'd welcome better, more targeted treatments. But the new genetic advances concern Ne'eman. He doesn't believe autism can be, or should be, cured. His ultimate fear is this: a prenatal test for autism, leading to "eugenic elimination." If a test is developed one day, it will be used, he says. And that means people like him might cease to exist.
May 19, 2009
When Flu Flies
Airplanes can transport disease quickly. What governments and individuals can do to protect themselves.
As the number of confirmed swine-influenza cases rises, so does global concern over the role aircraft could play in the disease's spread. The Centers for Disease Control and Prevention recommend all Americans cancel any nonessential travel to Mexico. The European Union made the same recommendation for citizens flying to both Mexico and the United States. Passengers coming from Mexico have been greeted with great caution in some locations. At Tokyo's airport, passengers were thermoscanned to check for fevers; at London's Heathrow, passengers waited aboard their plane for 45 minutes as health
"Certainly this outbreak has shown us again that the aircraft is a vehicle of infectious disease that spreads very rapidly throughout the world," says Mark Gendreau, an assistant professor of emergency medicine at Tufts University and vice-chairman of emergency medicine at Lahey Clinic in Burlington, Mass., who has written extensively on aviation medicine. NEWSWEEK's Sarah Kliff spoke with Gendreau about travel safety, why scanning passengers for fevers doesn't work and what every traveler can do ensure a healthier flight. Excerpts:
NEWSWEEK: What role do airplanes and air travelers play in international flu pandemics?
Mark Gendreau: One of my favorite quotes on this is [from Nobel laureate] Josh Lederberg ... He said, "The microbe that felled one child in a distant continent yesterday can reach yours today and seed a global pandemic tomorrow." This swine situation was brought to us by tourists who traveled to Mexico and then came back. Air travel is enormously important in terms of spreading infectious disease very rapidly.
So should we be cutting down on air travel? Or even barring travel from certain parts of Mexico completely?
Airport closures aren't going to stop this. Bottom line is the cat is already out of the bag, so it probably wouldn't make a big impact at this time. There was an observational study, published shortly after the terrorist attacks in 2001. They found that, since air travel largely came to a halt, there was a two-week delay in the flu season. It made the authors postulate that the two-week delay was a result of the markedly decreased air travel that occurred shortly before the flu season. What that tells us is that restricting travel won't stop it, although it might give us time to help mobilize resources and prepare a little bit better.
Tokyo's airport has begun screening passengers arriving from Mexico for swine flu, using thermoscanners to detect high body temperatures. How well does that work for preventing the spread of flu?
There was a meta-analysis of thermoscanner use that shows it didn't work well during the SARS outbreak because it had a lot of false negatives. It wasn't getting people who were symptomatic. Airport screening is going to get done, I guarantee it, but it typically doesn't work particularly well with flu. With flu, there's a time frame between when you get infected and become contagious. In that area, you don't know you're sick even though you're contagious. Thermoscanning in airports is not effective in picking up the people you want to.
As the number of confirmed swine-influenza cases rises, so does global concern over the role aircraft could play in the disease's spread. The Centers for Disease Control and Prevention recommend all Americans cancel any nonessential travel to Mexico. The European Union made the same recommendation for citizens flying to both Mexico and the United States. Passengers coming from Mexico have been greeted with great caution in some locations. At Tokyo's airport, passengers were thermoscanned to check for fevers; at London's Heathrow, passengers waited aboard their plane for 45 minutes as health
"Certainly this outbreak has shown us again that the aircraft is a vehicle of infectious disease that spreads very rapidly throughout the world," says Mark Gendreau, an assistant professor of emergency medicine at Tufts University and vice-chairman of emergency medicine at Lahey Clinic in Burlington, Mass., who has written extensively on aviation medicine. NEWSWEEK's Sarah Kliff spoke with Gendreau about travel safety, why scanning passengers for fevers doesn't work and what every traveler can do ensure a healthier flight. Excerpts:
NEWSWEEK: What role do airplanes and air travelers play in international flu pandemics?
Mark Gendreau: One of my favorite quotes on this is [from Nobel laureate] Josh Lederberg ... He said, "The microbe that felled one child in a distant continent yesterday can reach yours today and seed a global pandemic tomorrow." This swine situation was brought to us by tourists who traveled to Mexico and then came back. Air travel is enormously important in terms of spreading infectious disease very rapidly.
So should we be cutting down on air travel? Or even barring travel from certain parts of Mexico completely?
Airport closures aren't going to stop this. Bottom line is the cat is already out of the bag, so it probably wouldn't make a big impact at this time. There was an observational study, published shortly after the terrorist attacks in 2001. They found that, since air travel largely came to a halt, there was a two-week delay in the flu season. It made the authors postulate that the two-week delay was a result of the markedly decreased air travel that occurred shortly before the flu season. What that tells us is that restricting travel won't stop it, although it might give us time to help mobilize resources and prepare a little bit better.
Tokyo's airport has begun screening passengers arriving from Mexico for swine flu, using thermoscanners to detect high body temperatures. How well does that work for preventing the spread of flu?
There was a meta-analysis of thermoscanner use that shows it didn't work well during the SARS outbreak because it had a lot of false negatives. It wasn't getting people who were symptomatic. Airport screening is going to get done, I guarantee it, but it typically doesn't work particularly well with flu. With flu, there's a time frame between when you get infected and become contagious. In that area, you don't know you're sick even though you're contagious. Thermoscanning in airports is not effective in picking up the people you want to.
May 17, 2009
The Path of a Pandemic
How one virus spread from pigs and birds to humans around the globe. And why microbes like the H1N1 flu have become a growing threat.
Around Thanksgiving 2005 a teenage boy helped his brother-in-law butcher 31 pigs at a local Wisconsin slaughterhouse, and a week later the 17-year-old pinned down another pig while it was gutted. In the lead-up to the holidays the boy's family bought a chicken and kept the animal in their home, out of the harsh Sheboygan autumn. On Dec. 7, the teenager came down with the flu, suffering an illness that lasted three days. He visited a local clinic, then fully recovered, and nobody else in his family took ill.
This incident would hardly seem worth mentioning except that the influenza virus that infected the Wisconsin lad was unlike any previously seen. It appeared to be a mosaic of a wild-bird form of flu, a human type and a strain found in pigs.
It was an H1N1 swine influenza. Largely ignored at the time, the Wisconsin virus was a step along the evolutionary tree, leading to a virus that four years later would stun the world.
Flash-forward to April 2009, and young Édgar Enrique Hernández in faraway La Gloria, Mexico, suffers a bout of flu, found to be caused by a similar mosaic of swine/bird/human flu, also H1N1. And thousands of miles away in Cairo, the Egyptian government decides pigs are the source of disease, and orders 300,000 animals in the predominantly Muslim (therefore not pork-consuming) society slaughtered.
Each of these three incidents is related to the unfolding influenza crisis. It is the manner of human beings to seek blame during times of fear. Fingers are now pointing, either at the entire pig species Sus domestica, or at the nation of Mexico. Such exercises in blame are not only scientifically ill founded, ut are likely to prompt government actions that, at the very least, are useless and, at worst, harmful for efforts to control a pandemic.
We live in a globalized world, filled with shared microbial threats that arise in one place, are amplified somewhere else through human activities that aid and abet the germs, and then traverse vast geographic terrains in days, even hours—again, thanks to human activities and movements. If there is blame to be meted out, it should be directed at the species Homo sapiens and the manifest ways in which we are reshaping the world ecology, offering germs like the influenza virus extraordinary new opportunities to evolve, mutate and spread.
Back in 2005, the Wisconsin Division of Public Health hunted for sick pigs in Sheboygan County, but the animals the teenager had helped slaughter came from multiple farms across the area, and every farmer claimed his herd was healthy. The Wisconsin authorities forwarded blood samples from the infected teenager and his family to the Centers for Disease Control and Prevention in Atlanta. The CDC scientists discovered that the H1N1 virus had pieces of its RNA genetic material that matched a human flu first seen in New Caledonia in 1999, two swine types that had been circulating in Asia and Wisconsin for several years and an unknown avian-flu virus.
In 2006 the American Association of Swine Veterinarians reported that humans were passing their H1N1 viruses to pigs, causing widespread illness in swine herds, especially in the American Midwest. A year later at a county fair in Ohio an outbreak occurred, sickening many of the pigs, but not their human handlers. The cause was a type of H1N1 that was a close match to the Wisconsin strain, and may have been spread from human to pig.
Last year researchers from Iowa State University in Ames warned that pigs located in industrial-scale farms were being subjected to influenza infections from farm poultry, wild birds and their human handlers. Writing in The Journal of Infectious Diseases, Eileen Thacker and Bruce Janke said, "As a result of the constantly changing genetic makeup of individual influenza viruses in pigs, the U.S. swine industry is continually scrambling to respond to the influenza viruses circulating within individual production systems."
Something was changing. Pigs notoriously eat just about anything thrown their way, and rub up against each other frequently, readily passing infections within herds. Their stomachs are remarkably tolerant environs for microbes, which since ancient times have caused illness in humans who dined on raw or undercooked pork. Investigation of the 1918 influenza pandemic, which is now estimated to have killed up to 100 million people worldwide in 18 months, revealed that the viral culprit was a type H1N1 human flu that had infected pigs, and then circulated back to humans.
At the viral level, influenza is an awfully sloppy microbe that is in a constant state of mutation and evolution. Its genetic material is in the form of RNA (not DNA, as in humans), loosely collected into chromosomes. When a virus infects a cell, its chromosomes essentially fall apart into a mess, which is copied to make more viruses that then enter the bloodstream to spread throughout the body. Along the way in this copying process any other genetic material that may be lying about the cell is also stuffed into the thousands of viral copies that are made. If the virus happens to be reproducing this way inside a human cell, it picks up Homo sapiensgenetic material; from a chicken cell it absorbs avian genes; and from a pig cell it garners swine RNA. The jackpot events in influenza evolution occur when two different types of flu viruses happen to get into an animal cell at the same time, swapping entire chromosomes to create "reassorted" viruses.
What was infecting that teenager in Sheboygan was a triple reassortment, resulting in a new virus with bits of genes from three species of animals—one of them Homo sapiens.
But who pays attention to such things? Other than vets, pig farmers and the occasional virologist, not many people in public health, government or medicine usually give much thought to the four-legged viral mixing vessels that oink their way around family farms and vast industrial pork-production centers. Thacker and Janke's 2008 writing seems sadly prescient today: "Pigs would be an ideal mixing vessel for the creation of new avian/mammalian influenza viruses capable of causing novel diseases with the potential for producing pandemics in the human population … It is apparent that, in the U.S. swine industry, transmission of influenza viruses between swine and humans is fairly common and is bidirectional."
Nine months ago the Texas Department of State Health Services reported the case to the CDC of an individual who was exposed to ailing pigs. The Texan came down with flu, spread it to no one and was fine after a few days. In the patient's blood, CDC scientists found "a swine influenza A (H1N1) triple reassortant virus, A/Wisconsin/87/2005 H1N1," the same virus that infected the Sheboygan teenager three years earlier.
And then, this March, the outbreak of 2009 commenced. It might not have been noticed, frankly, if things unfolded in the same bird/human/swine manner as had previously evoked only humdrum attention in Wisconsin, Ohio and Texas. But this time, people died.
In mid-March the number of routinely reported influenza cases in several Mexican states suddenly spiked upward. At roughly the same time, public-health authorities in southern California spotted two separate cases of flu in children: a 10-year-old boy in San Diego County, and a 9-year-old girl in Imperial County. Though both children survived their illnesses, there was evidence that it had spread to family members, and samples of the children's blood were examined at the CDC in early April. Bingo: H1N1 triple-reassorted influenza. Meanwhile, in Mexico, more than 50 serious flu cases emerged over the same time period, and the government forwarded blood samples to Canada's top infectious-diseases lab in Winnipeg. The Canadians confirmed that the Mexican mystery virus was H1N1, and the potential pandemic saga unfolded.
In Mexico, attention has focused on little Édgar Enrique Hernández, who is believed to have come down with the new flu on April 2. The blame for Hernández's infection is aimed at an American-owned industrial pig center located near the child's home in La Gloria. Residents had long complained about the stench and dust from the plant, and have eagerly named it as the source of the child's infection. It may be true that Hernández inhaled H1N1 from a pig, but because other cases emerged in March, the timing of the case is off: Édgar Hernández is not Patient Zero in the outbreak of 2009.
This virus has been evolving for a long time, no doubt aided in its transformation by the ecology of industrial-scale pig farming in North America. Some scientists say there are genetic elements in the virus that date back to an Indiana pig farm in 1987. In that sense, it is similar to the "bird flu," or H5N1, which surfaced in wild migratory water birds in southern China some time in the early 1990s and infected people in Hong Kong in 1997. As that virus has evolved over the past 12 years, it has taken advantage of large poultry farms, and major bird-migration centers, to spread rapidly and absorb new genetic material along the way. In 2005, as H5N1 spread to Siberia and Europe, the United Nations and the Bush administration mobilized cash, scientific expertise and the needed infrastructure to find and contain outbreaks, primarily by slaughtering infected chicken flocks.
In Indonesia, where the virus has spread to pigs and humans, it appears H5N1 can be passed, in rare cases, between people, and human infection is an extraordinarily dangerous event: 82 percent of infected Indonesians have succumbed to the flu virus. The global average mortality rate for H5N1 in people is 63 percent, which makes it one of the most fearsome microbes on earth.
Here, then, is where we stand.
We have a new virus in the world that appears to be very contagious between people, and possibly between swine and humans. It is, fortunately, treatable with the antiviral drugs Tamiflu and Relenza (oseltamivir and zanamivir), but it is resistant to the other major class of anti-flu drugs, amantadines. It is still evolving, and moving, and its ultimate trajectory cannot be seen right now. We do not yet know how deadly this virus is: while Mexico has been able to track down the numbers of dead and hospitalized H1N1 cases, it cannot determine just how many Mexicans have been infected with the virus since it started spreading there in late March. It's one thing to say that 150 people out of, perhaps, 10 million infected have died: that gives you a case fatality rate that is roughly what we see with normal, seasonal flu. (Each year, seasonal flu kills 36,000 people in the United States alone.) It's quite another story if Mexico's denominator is 5,000, for a case fatality rate of 3 percent--a full percentage point worse than the rate seen with the 1918 influenza. It is urgent that we discern the denominator.
We have a second, closely related H1N1 human virus in circulation around the world. Though widespread, it is not unusually lethal. Last year this virus developed full resistance to Tamiflu. It would be most disturbing if the 2008 H1N1 human virus were to reassort with the new swine/human virus, as we could then be facing a more drug-resistant pandemic strain of influenza, treatable only with the drug Relenza, which must be administered with an inhaleWe have a third, older pandemic in poultry, occasionally infecting humans, that involves the H5N1 virus. This pandemic has circulated long enough so that the virus has branched into several evolutionary trees, including forms that are drug-resistant. In Egypt, where it is common for urban families to raise chickens in their yards, H5N1 has caused a significant number of human cases, and its spread appears to be uncontrolled. The World Health Organization (WHO) is distressed by evidence that H5N1 is becoming less deadly for people. That could mean that the bird-flu virus is evolving toward a less-lethal form that is more capable of spreading between people.
It is supremely ironic, then, that the Egyptian government in late April started slaughtering the nation's 300,000 pigs as an alleged flu-control measure. The swine form of H1N1 may not be in Egypt as of this writing, but the chicken H5N1 most definitely is, and has to date infected 68 Egyptians, killing 23. Egypt has never carried out wholesale slaughter of poultry, as chicken is a staple of the national diet. Pork, in contrast, is consumed only by the minority Christian population. An Egyptian Islamist group has declared that swine flu is "God's revenge against infidels."
The Muslim Brotherhood in Egypt recently declared that the Cairo-based U.S. Naval Medical Research Unit (NAMRU), which has provided public-health work for the entire Middle East for decades, must be shut down, and Egypt must stop sending samples of H5N1 viruses that emerge in the country to the WHO. The Egyptian group, which holds seats in Parliament, is echoing sentiments first put forward by Indonesia's minister of health, Siti Supari, who has refused to share her country's H5N1 samples with the WHO since 2006. Supari is also trying to evict another NAMRU lab from Jakarta. On April 28, Supari declared that the new swine flu was genetically engineered and released in order to promote American pharmaceutical sales worldwide.
Two days later, Supari denied making such statements, though they were con-sistent with her longstanding claim that rich countries--particularly the United States--prey on poorer nations in the interest of drug-company profits. In heated negotiations with the World Health Organization and the U.S. government, Supari has insisted on the existence of "viral sovereignty," wherein nations own any viruses that they discover within their boundaries, have the right to refuse sharing them with the WHO or any other foreign entity and may demand all profits derived from vaccines and other products made from those viruses. Under this principle, Indonesia refuses to allow the outside world access to at least 50 H5N1 strains thought to have emerged in that country since 2005. Without access to the various viral strains, scientists cannot tell if H5N1 is evolving dangerous attributes in Indonesia, or whether the hideously high death rate in infected people there is due to some unique viral characteristics. Therefore, the principle of viral sovereignty directly imperils the entire global community--as well as Supari's own people. On April 30, the WHO repudiated another Supari claim: that Indonesians have special genetic or environmental traits that would keep them safe from the new swine flu.
Happily, Mexico has shown the world how a responsible nation can respond to a potential pandemic. By moving swiftly to shut down schools, entertainment and places of social congregation, Mexico—an already beleaguered economy—is facing dire financial consequences. But its dramatic actions may be saving Mexican lives, and slowing down the outbreak of 2009. In that sense, the world owes Mexico a big gracias.
Governments the world over would do well to pay attention to Mexico's response, and learn from it. Throughout Asia, governments have been pulling their old SARS-epidemic thermal monitors out of mothballs, and scanning people for evidence of fevers. That worked for SARS control because the SARS virus was almost exclusively contagious when people were running fevers. Not so with influenza: flu can be very contagious before the individual carrier has any symptoms at all, much less a fever.
Worse, some governments are banning pork products from the Americas, as if it were possible to get the flu from eating a cooked sausage. It is not.
A wiser set of pig-related actions would turn to the strange ecology we have created to feed meat to our massive human population. It is a strange world wherein billions of animals are concentrated into tiny spaces, breeding stock is flown to production sites all over the world and poorly paid migrant workers are exposed to infected animals. And it's going to get much worse, as the world's once poor populations of India and China enter the middle class. Back in 1980 the per capita meat consumption in China was about 44 pounds a year: it now tops 110 pounds. In 1983 the world consumed 152 million tons of meat a year. By 1997 consumption was up to 233 million tons. And the United Nations Food and Agriculture Organization estimates that by 2020 world consumption could top 386 million tons of pork, chicken, beef and farmed fish.
This is the ecology that, in the cases of pigs and chickens, is breeding influenza. It is an ecology that promotes viral evolution. And if we don't do something about it, this ecology will one day spawn a severe pandemic that will dwarf that of 1918.
Garrett is the senior fellow for global health at the Council on Foreign Relations, and a Pulitzer Prize-winning writer. She is the author of "The Coming Plague: Newly Emerging Diseases in a World Out of Balance" and "Betrayal of Trust: The Collapse of Global Public Health."
Around Thanksgiving 2005 a teenage boy helped his brother-in-law butcher 31 pigs at a local Wisconsin slaughterhouse, and a week later the 17-year-old pinned down another pig while it was gutted. In the lead-up to the holidays the boy's family bought a chicken and kept the animal in their home, out of the harsh Sheboygan autumn. On Dec. 7, the teenager came down with the flu, suffering an illness that lasted three days. He visited a local clinic, then fully recovered, and nobody else in his family took ill.
This incident would hardly seem worth mentioning except that the influenza virus that infected the Wisconsin lad was unlike any previously seen. It appeared to be a mosaic of a wild-bird form of flu, a human type and a strain found in pigs.
It was an H1N1 swine influenza. Largely ignored at the time, the Wisconsin virus was a step along the evolutionary tree, leading to a virus that four years later would stun the world.
Flash-forward to April 2009, and young Édgar Enrique Hernández in faraway La Gloria, Mexico, suffers a bout of flu, found to be caused by a similar mosaic of swine/bird/human flu, also H1N1. And thousands of miles away in Cairo, the Egyptian government decides pigs are the source of disease, and orders 300,000 animals in the predominantly Muslim (therefore not pork-consuming) society slaughtered.
Each of these three incidents is related to the unfolding influenza crisis. It is the manner of human beings to seek blame during times of fear. Fingers are now pointing, either at the entire pig species Sus domestica, or at the nation of Mexico. Such exercises in blame are not only scientifically ill founded, ut are likely to prompt government actions that, at the very least, are useless and, at worst, harmful for efforts to control a pandemic.
We live in a globalized world, filled with shared microbial threats that arise in one place, are amplified somewhere else through human activities that aid and abet the germs, and then traverse vast geographic terrains in days, even hours—again, thanks to human activities and movements. If there is blame to be meted out, it should be directed at the species Homo sapiens and the manifest ways in which we are reshaping the world ecology, offering germs like the influenza virus extraordinary new opportunities to evolve, mutate and spread.
Back in 2005, the Wisconsin Division of Public Health hunted for sick pigs in Sheboygan County, but the animals the teenager had helped slaughter came from multiple farms across the area, and every farmer claimed his herd was healthy. The Wisconsin authorities forwarded blood samples from the infected teenager and his family to the Centers for Disease Control and Prevention in Atlanta. The CDC scientists discovered that the H1N1 virus had pieces of its RNA genetic material that matched a human flu first seen in New Caledonia in 1999, two swine types that had been circulating in Asia and Wisconsin for several years and an unknown avian-flu virus.
In 2006 the American Association of Swine Veterinarians reported that humans were passing their H1N1 viruses to pigs, causing widespread illness in swine herds, especially in the American Midwest. A year later at a county fair in Ohio an outbreak occurred, sickening many of the pigs, but not their human handlers. The cause was a type of H1N1 that was a close match to the Wisconsin strain, and may have been spread from human to pig.
Last year researchers from Iowa State University in Ames warned that pigs located in industrial-scale farms were being subjected to influenza infections from farm poultry, wild birds and their human handlers. Writing in The Journal of Infectious Diseases, Eileen Thacker and Bruce Janke said, "As a result of the constantly changing genetic makeup of individual influenza viruses in pigs, the U.S. swine industry is continually scrambling to respond to the influenza viruses circulating within individual production systems."
Something was changing. Pigs notoriously eat just about anything thrown their way, and rub up against each other frequently, readily passing infections within herds. Their stomachs are remarkably tolerant environs for microbes, which since ancient times have caused illness in humans who dined on raw or undercooked pork. Investigation of the 1918 influenza pandemic, which is now estimated to have killed up to 100 million people worldwide in 18 months, revealed that the viral culprit was a type H1N1 human flu that had infected pigs, and then circulated back to humans.
At the viral level, influenza is an awfully sloppy microbe that is in a constant state of mutation and evolution. Its genetic material is in the form of RNA (not DNA, as in humans), loosely collected into chromosomes. When a virus infects a cell, its chromosomes essentially fall apart into a mess, which is copied to make more viruses that then enter the bloodstream to spread throughout the body. Along the way in this copying process any other genetic material that may be lying about the cell is also stuffed into the thousands of viral copies that are made. If the virus happens to be reproducing this way inside a human cell, it picks up Homo sapiensgenetic material; from a chicken cell it absorbs avian genes; and from a pig cell it garners swine RNA. The jackpot events in influenza evolution occur when two different types of flu viruses happen to get into an animal cell at the same time, swapping entire chromosomes to create "reassorted" viruses.
What was infecting that teenager in Sheboygan was a triple reassortment, resulting in a new virus with bits of genes from three species of animals—one of them Homo sapiens.
But who pays attention to such things? Other than vets, pig farmers and the occasional virologist, not many people in public health, government or medicine usually give much thought to the four-legged viral mixing vessels that oink their way around family farms and vast industrial pork-production centers. Thacker and Janke's 2008 writing seems sadly prescient today: "Pigs would be an ideal mixing vessel for the creation of new avian/mammalian influenza viruses capable of causing novel diseases with the potential for producing pandemics in the human population … It is apparent that, in the U.S. swine industry, transmission of influenza viruses between swine and humans is fairly common and is bidirectional."
Nine months ago the Texas Department of State Health Services reported the case to the CDC of an individual who was exposed to ailing pigs. The Texan came down with flu, spread it to no one and was fine after a few days. In the patient's blood, CDC scientists found "a swine influenza A (H1N1) triple reassortant virus, A/Wisconsin/87/2005 H1N1," the same virus that infected the Sheboygan teenager three years earlier.
And then, this March, the outbreak of 2009 commenced. It might not have been noticed, frankly, if things unfolded in the same bird/human/swine manner as had previously evoked only humdrum attention in Wisconsin, Ohio and Texas. But this time, people died.
In mid-March the number of routinely reported influenza cases in several Mexican states suddenly spiked upward. At roughly the same time, public-health authorities in southern California spotted two separate cases of flu in children: a 10-year-old boy in San Diego County, and a 9-year-old girl in Imperial County. Though both children survived their illnesses, there was evidence that it had spread to family members, and samples of the children's blood were examined at the CDC in early April. Bingo: H1N1 triple-reassorted influenza. Meanwhile, in Mexico, more than 50 serious flu cases emerged over the same time period, and the government forwarded blood samples to Canada's top infectious-diseases lab in Winnipeg. The Canadians confirmed that the Mexican mystery virus was H1N1, and the potential pandemic saga unfolded.
In Mexico, attention has focused on little Édgar Enrique Hernández, who is believed to have come down with the new flu on April 2. The blame for Hernández's infection is aimed at an American-owned industrial pig center located near the child's home in La Gloria. Residents had long complained about the stench and dust from the plant, and have eagerly named it as the source of the child's infection. It may be true that Hernández inhaled H1N1 from a pig, but because other cases emerged in March, the timing of the case is off: Édgar Hernández is not Patient Zero in the outbreak of 2009.
This virus has been evolving for a long time, no doubt aided in its transformation by the ecology of industrial-scale pig farming in North America. Some scientists say there are genetic elements in the virus that date back to an Indiana pig farm in 1987. In that sense, it is similar to the "bird flu," or H5N1, which surfaced in wild migratory water birds in southern China some time in the early 1990s and infected people in Hong Kong in 1997. As that virus has evolved over the past 12 years, it has taken advantage of large poultry farms, and major bird-migration centers, to spread rapidly and absorb new genetic material along the way. In 2005, as H5N1 spread to Siberia and Europe, the United Nations and the Bush administration mobilized cash, scientific expertise and the needed infrastructure to find and contain outbreaks, primarily by slaughtering infected chicken flocks.
In Indonesia, where the virus has spread to pigs and humans, it appears H5N1 can be passed, in rare cases, between people, and human infection is an extraordinarily dangerous event: 82 percent of infected Indonesians have succumbed to the flu virus. The global average mortality rate for H5N1 in people is 63 percent, which makes it one of the most fearsome microbes on earth.
Here, then, is where we stand.
We have a new virus in the world that appears to be very contagious between people, and possibly between swine and humans. It is, fortunately, treatable with the antiviral drugs Tamiflu and Relenza (oseltamivir and zanamivir), but it is resistant to the other major class of anti-flu drugs, amantadines. It is still evolving, and moving, and its ultimate trajectory cannot be seen right now. We do not yet know how deadly this virus is: while Mexico has been able to track down the numbers of dead and hospitalized H1N1 cases, it cannot determine just how many Mexicans have been infected with the virus since it started spreading there in late March. It's one thing to say that 150 people out of, perhaps, 10 million infected have died: that gives you a case fatality rate that is roughly what we see with normal, seasonal flu. (Each year, seasonal flu kills 36,000 people in the United States alone.) It's quite another story if Mexico's denominator is 5,000, for a case fatality rate of 3 percent--a full percentage point worse than the rate seen with the 1918 influenza. It is urgent that we discern the denominator.
We have a second, closely related H1N1 human virus in circulation around the world. Though widespread, it is not unusually lethal. Last year this virus developed full resistance to Tamiflu. It would be most disturbing if the 2008 H1N1 human virus were to reassort with the new swine/human virus, as we could then be facing a more drug-resistant pandemic strain of influenza, treatable only with the drug Relenza, which must be administered with an inhaleWe have a third, older pandemic in poultry, occasionally infecting humans, that involves the H5N1 virus. This pandemic has circulated long enough so that the virus has branched into several evolutionary trees, including forms that are drug-resistant. In Egypt, where it is common for urban families to raise chickens in their yards, H5N1 has caused a significant number of human cases, and its spread appears to be uncontrolled. The World Health Organization (WHO) is distressed by evidence that H5N1 is becoming less deadly for people. That could mean that the bird-flu virus is evolving toward a less-lethal form that is more capable of spreading between people.
It is supremely ironic, then, that the Egyptian government in late April started slaughtering the nation's 300,000 pigs as an alleged flu-control measure. The swine form of H1N1 may not be in Egypt as of this writing, but the chicken H5N1 most definitely is, and has to date infected 68 Egyptians, killing 23. Egypt has never carried out wholesale slaughter of poultry, as chicken is a staple of the national diet. Pork, in contrast, is consumed only by the minority Christian population. An Egyptian Islamist group has declared that swine flu is "God's revenge against infidels."
The Muslim Brotherhood in Egypt recently declared that the Cairo-based U.S. Naval Medical Research Unit (NAMRU), which has provided public-health work for the entire Middle East for decades, must be shut down, and Egypt must stop sending samples of H5N1 viruses that emerge in the country to the WHO. The Egyptian group, which holds seats in Parliament, is echoing sentiments first put forward by Indonesia's minister of health, Siti Supari, who has refused to share her country's H5N1 samples with the WHO since 2006. Supari is also trying to evict another NAMRU lab from Jakarta. On April 28, Supari declared that the new swine flu was genetically engineered and released in order to promote American pharmaceutical sales worldwide.
Two days later, Supari denied making such statements, though they were con-sistent with her longstanding claim that rich countries--particularly the United States--prey on poorer nations in the interest of drug-company profits. In heated negotiations with the World Health Organization and the U.S. government, Supari has insisted on the existence of "viral sovereignty," wherein nations own any viruses that they discover within their boundaries, have the right to refuse sharing them with the WHO or any other foreign entity and may demand all profits derived from vaccines and other products made from those viruses. Under this principle, Indonesia refuses to allow the outside world access to at least 50 H5N1 strains thought to have emerged in that country since 2005. Without access to the various viral strains, scientists cannot tell if H5N1 is evolving dangerous attributes in Indonesia, or whether the hideously high death rate in infected people there is due to some unique viral characteristics. Therefore, the principle of viral sovereignty directly imperils the entire global community--as well as Supari's own people. On April 30, the WHO repudiated another Supari claim: that Indonesians have special genetic or environmental traits that would keep them safe from the new swine flu.
Happily, Mexico has shown the world how a responsible nation can respond to a potential pandemic. By moving swiftly to shut down schools, entertainment and places of social congregation, Mexico—an already beleaguered economy—is facing dire financial consequences. But its dramatic actions may be saving Mexican lives, and slowing down the outbreak of 2009. In that sense, the world owes Mexico a big gracias.
Governments the world over would do well to pay attention to Mexico's response, and learn from it. Throughout Asia, governments have been pulling their old SARS-epidemic thermal monitors out of mothballs, and scanning people for evidence of fevers. That worked for SARS control because the SARS virus was almost exclusively contagious when people were running fevers. Not so with influenza: flu can be very contagious before the individual carrier has any symptoms at all, much less a fever.
Worse, some governments are banning pork products from the Americas, as if it were possible to get the flu from eating a cooked sausage. It is not.
A wiser set of pig-related actions would turn to the strange ecology we have created to feed meat to our massive human population. It is a strange world wherein billions of animals are concentrated into tiny spaces, breeding stock is flown to production sites all over the world and poorly paid migrant workers are exposed to infected animals. And it's going to get much worse, as the world's once poor populations of India and China enter the middle class. Back in 1980 the per capita meat consumption in China was about 44 pounds a year: it now tops 110 pounds. In 1983 the world consumed 152 million tons of meat a year. By 1997 consumption was up to 233 million tons. And the United Nations Food and Agriculture Organization estimates that by 2020 world consumption could top 386 million tons of pork, chicken, beef and farmed fish.
This is the ecology that, in the cases of pigs and chickens, is breeding influenza. It is an ecology that promotes viral evolution. And if we don't do something about it, this ecology will one day spawn a severe pandemic that will dwarf that of 1918.
Garrett is the senior fellow for global health at the Council on Foreign Relations, and a Pulitzer Prize-winning writer. She is the author of "The Coming Plague: Newly Emerging Diseases in a World Out of Balance" and "Betrayal of Trust: The Collapse of Global Public Health."
May 16, 2009
Disease and Terror
The swine-flu outbreak caught health officials completely by surprise—just as a bioterror attack would.
A complacent America, growing ever less concerned about the threat of pandemic bird flu, was startled last week by the sudden appearance of a major epidemic of swine flu in neighboring Mexico. Cases were soon reported from New York, California, Texas and Ohio, as well as France, New Zealand, Canada and Britain. So far, the apprehension and confusion about what to expect resembles the early days of the anthrax attacks of 2001, when a fine powder of weaponized anthrax bacteria showed up in the U.S. mail. Then, as now, health authorities were taken completely by surprise, and the public panicked out of all proportion to the actual threat.
The similarities between the flu and biological terrorism are not coincidental. In recent years the world has changed in ways that have made the threats of natural and man-made epidemics more and more alike. As we deal with the increasing prospects of a bioterrorist attack, we are also struggling with the challenge of emerging diseases: AIDS, pandemic strains of influenza and the "mad-cow disease" that terrified Britain only a decade ago. The way these threats unfold—and the responses they call for—are becoming ever more similar.
The central driver is the increasingly interconnected world we live in. Even the most remote areas of the planet can now be reached in less than 48 hours. Diseases now plaguing those in refugee camps, heavily populated and growing slums or the most remote tropical rainforests can, without warning, show up in far-flung towns and cities. A devastating hemorrhagic-disease epidemic in Africa or South America could rapidly become the hemorrhagic epidemic of Boston or Bordeaux. Even good clinicians rarely have the knowledge to diagnose and treat exotic tropical diseases. Until a month ago, our attention was focused on Asia—the source of the last two influenza pandemics, in 1957 and 1968—as the likely source for the next one. And yet it appeared in Mexico while we weren't looking.
A revolution in biology and medicine has recently given us powerful new tools to fight infectious diseases. It has also given us bioterrorism. The potential for terrorists to develop, grow and spread biological weapons has increased rapidly with the proliferation of knowledge and laboratories. As we discover the secrets of the cause and spread of disease, we are also finding ways of engineering a virus or bacterium to be more virulent or perhaps to evade antibiotics or vaccines. It's difficult to overstate the threat. As disastrous as the explosion of an atomic weapon would be, the strategic use of biological organisms such as smallpox, anthrax or plague could be even more devastating.
It is virtually impossible to stop or interdict terrorists bent on using biological weapons. The bioagents can be made in inexpensive labs, and are light and easily transported across borders without detection. A powder of anthrax or smallpox organisms would float as an invisible, odorless cloud, driven by breezes. Those unfortunate enough to inhale it would be unaware of the infection for days—and then suddenly develop a severe, disabling disease wholly unfamiliar to local physicians. As cases mount, health workers would isolate victims and distribute antibiotics or vaccines. The risk of panic would be great. In 2001, only 11 people inhaled anthrax and five died, but widespread fear of almost any powder led to the evacuation of hundreds of office complexes. What if hundreds had died?
The only way out of these potential catastrophes is to sharpen our health-care response. Rapid diagnosis and response are critical. We need to foster a greatly expanded international network of epidemiologists (so-called disease detectives) and laboratory scientists who continually investigate new outbreaks and look for better methods to diagnosis and treat diseases, wherever they might be occurring. States and communities play a pivotal role and are the basic foundation for combating major catastrophes, whether due to bioterrorism or pandemic influenza (or hurricanes or earthquakes, for that matter). Community organization and planning are key to success. Mayors, public-health authorities and hospitals need to plan how they will care for large numbers of patients and provide needed vaccines or drugs. Voluntary organizations such as the Red Cross must be part of the effort. The threat of a swine-flu pandemic is a good excuse to better organize and strengthen emergency plans. Other, even less pleasant surprises are in our future.
Henderson led the campaign at the World Health Organization to eradicate smallpox in 1980 and worked to address the 2004 bird-flu outbreak. His book "Smallpox: The Death of a Disease" will be published in June. He is currently professor of medicine and public health at the Center for Biosecurity at the University of Pittsburgh.
A complacent America, growing ever less concerned about the threat of pandemic bird flu, was startled last week by the sudden appearance of a major epidemic of swine flu in neighboring Mexico. Cases were soon reported from New York, California, Texas and Ohio, as well as France, New Zealand, Canada and Britain. So far, the apprehension and confusion about what to expect resembles the early days of the anthrax attacks of 2001, when a fine powder of weaponized anthrax bacteria showed up in the U.S. mail. Then, as now, health authorities were taken completely by surprise, and the public panicked out of all proportion to the actual threat.
The similarities between the flu and biological terrorism are not coincidental. In recent years the world has changed in ways that have made the threats of natural and man-made epidemics more and more alike. As we deal with the increasing prospects of a bioterrorist attack, we are also struggling with the challenge of emerging diseases: AIDS, pandemic strains of influenza and the "mad-cow disease" that terrified Britain only a decade ago. The way these threats unfold—and the responses they call for—are becoming ever more similar.
The central driver is the increasingly interconnected world we live in. Even the most remote areas of the planet can now be reached in less than 48 hours. Diseases now plaguing those in refugee camps, heavily populated and growing slums or the most remote tropical rainforests can, without warning, show up in far-flung towns and cities. A devastating hemorrhagic-disease epidemic in Africa or South America could rapidly become the hemorrhagic epidemic of Boston or Bordeaux. Even good clinicians rarely have the knowledge to diagnose and treat exotic tropical diseases. Until a month ago, our attention was focused on Asia—the source of the last two influenza pandemics, in 1957 and 1968—as the likely source for the next one. And yet it appeared in Mexico while we weren't looking.
A revolution in biology and medicine has recently given us powerful new tools to fight infectious diseases. It has also given us bioterrorism. The potential for terrorists to develop, grow and spread biological weapons has increased rapidly with the proliferation of knowledge and laboratories. As we discover the secrets of the cause and spread of disease, we are also finding ways of engineering a virus or bacterium to be more virulent or perhaps to evade antibiotics or vaccines. It's difficult to overstate the threat. As disastrous as the explosion of an atomic weapon would be, the strategic use of biological organisms such as smallpox, anthrax or plague could be even more devastating.
It is virtually impossible to stop or interdict terrorists bent on using biological weapons. The bioagents can be made in inexpensive labs, and are light and easily transported across borders without detection. A powder of anthrax or smallpox organisms would float as an invisible, odorless cloud, driven by breezes. Those unfortunate enough to inhale it would be unaware of the infection for days—and then suddenly develop a severe, disabling disease wholly unfamiliar to local physicians. As cases mount, health workers would isolate victims and distribute antibiotics or vaccines. The risk of panic would be great. In 2001, only 11 people inhaled anthrax and five died, but widespread fear of almost any powder led to the evacuation of hundreds of office complexes. What if hundreds had died?
The only way out of these potential catastrophes is to sharpen our health-care response. Rapid diagnosis and response are critical. We need to foster a greatly expanded international network of epidemiologists (so-called disease detectives) and laboratory scientists who continually investigate new outbreaks and look for better methods to diagnosis and treat diseases, wherever they might be occurring. States and communities play a pivotal role and are the basic foundation for combating major catastrophes, whether due to bioterrorism or pandemic influenza (or hurricanes or earthquakes, for that matter). Community organization and planning are key to success. Mayors, public-health authorities and hospitals need to plan how they will care for large numbers of patients and provide needed vaccines or drugs. Voluntary organizations such as the Red Cross must be part of the effort. The threat of a swine-flu pandemic is a good excuse to better organize and strengthen emergency plans. Other, even less pleasant surprises are in our future.
Henderson led the campaign at the World Health Organization to eradicate smallpox in 1980 and worked to address the 2004 bird-flu outbreak. His book "Smallpox: The Death of a Disease" will be published in June. He is currently professor of medicine and public health at the Center for Biosecurity at the University of Pittsburgh.
Men's Health
New Prostate Cancer Vaccine Shows Promise
There are many health concerns today when it comes to illnesses, but one of the number one health concerns for a man to consider is prostate cancer. There are already treatments available for this type of cancer, but now there is a new one to consider. Provenge, which an experimental treatment vaccine for advanced prostate cancer, has met researchers’ goal in a key trial that is needed to get FDA approval. This news was recently announced by Dendreon, which is the company that makes the vaccine Provenge.
Mitchell Gold, M.D. and the president and chief executive of Dendreon, said that they believe that this vaccine is truly a breakthrough for the prostate cancer community a testament to the promise of the field for cancer immunotherapies. Provenge is a biologic drug that is given by infusion to spur the immune system to help fight against advanced prostate cancer that does not respond to anti-androgen treatment.
In 2007, an FDA advisory panel recommended that the FDA approve the new vaccine Provenge. However, the FDA requested that more information be collected to see whether Provenge prolongs survival. This request led to a new study of approximately 512 men that has advanced prostate cancer. These men had metastatic, androgen-independent prostate cancer, which means their cancer had spread and it was not responding to the anti-androgen treatment.
In this study, the overall survival was significantly better for the men that were taking Provenge than those that were taking a placebo. The results of this study were “unambiguous” and “very consistent” with previous trials for Provenge, says Gold. Dendreon plans to submit the results of this study to the FDA in the fourth quarter of 2009, and after that the FDA will have approximately six months to review all of the material.
Gold stated that this new data can support the use of Provenge being used as a frontline treatment in men that have metastatic, androgen-independent prostate cancer. He also noted that no new side effects from the vaccine stood out in the recent study. In the previous trials conducted, the most common side effects in the men taking Provenge were headache, chills, shortness of breath, fever, tremor, fatigue, and vomiting, mainly at a low level and for one to two days following the infusion of the vaccine.
Gold said that most of the men would first have surgery or some other form of local therapy, then the anti-androgen therapy if their cancer recurred, and if their PSA levels rose after these steps, then the Provenge vaccine would come into play as potential treatment option for them if these others didn’t work. In the men that had prostate cancer, PSA or prostate-specific androgen levels are used to help gauge the success of the treatment for the cancer.
However, at this time Dendreon is not releasing any further details of this study until April 28th, when the findings of the study will be presented at the American Urological Association’s annual meeting held in Chicago. The technology that is used to make the Provenge vaccine may also prove to be useful against other forms of cancer as well, Gold says.
The American Cancer Society has also released a statement about the Provenge news. The statement was made by Otis W. Brawley, MD, and the chief medical officer at the American Cancer Society. Brawley stated that Dendreon’s announcement about the new study for vaccine Provenge has shown reason for optimism for a vaccine that has generated controversy for the past several years. “We have to respect the scientific process, an important part of which is a full disclosure and careful review and discussion of the data, which the company says will not be released until an upcoming medical meeting. One of the most important question’s we’ll be looking at will be the magnitude of the survival advantage; how much longer the men taking the vaccine lived compared to those on standard therapy. As with any new therapy, it will take a detailed analysis to fully understand the impact of this potential new treatment for patients with advanced prostate cancer. We look forward to the presentation of the study at the upcoming meeting.”
There are many health concerns today when it comes to illnesses, but one of the number one health concerns for a man to consider is prostate cancer. There are already treatments available for this type of cancer, but now there is a new one to consider. Provenge, which an experimental treatment vaccine for advanced prostate cancer, has met researchers’ goal in a key trial that is needed to get FDA approval. This news was recently announced by Dendreon, which is the company that makes the vaccine Provenge.
Mitchell Gold, M.D. and the president and chief executive of Dendreon, said that they believe that this vaccine is truly a breakthrough for the prostate cancer community a testament to the promise of the field for cancer immunotherapies. Provenge is a biologic drug that is given by infusion to spur the immune system to help fight against advanced prostate cancer that does not respond to anti-androgen treatment.
In 2007, an FDA advisory panel recommended that the FDA approve the new vaccine Provenge. However, the FDA requested that more information be collected to see whether Provenge prolongs survival. This request led to a new study of approximately 512 men that has advanced prostate cancer. These men had metastatic, androgen-independent prostate cancer, which means their cancer had spread and it was not responding to the anti-androgen treatment.
In this study, the overall survival was significantly better for the men that were taking Provenge than those that were taking a placebo. The results of this study were “unambiguous” and “very consistent” with previous trials for Provenge, says Gold. Dendreon plans to submit the results of this study to the FDA in the fourth quarter of 2009, and after that the FDA will have approximately six months to review all of the material.
Gold stated that this new data can support the use of Provenge being used as a frontline treatment in men that have metastatic, androgen-independent prostate cancer. He also noted that no new side effects from the vaccine stood out in the recent study. In the previous trials conducted, the most common side effects in the men taking Provenge were headache, chills, shortness of breath, fever, tremor, fatigue, and vomiting, mainly at a low level and for one to two days following the infusion of the vaccine.
Gold said that most of the men would first have surgery or some other form of local therapy, then the anti-androgen therapy if their cancer recurred, and if their PSA levels rose after these steps, then the Provenge vaccine would come into play as potential treatment option for them if these others didn’t work. In the men that had prostate cancer, PSA or prostate-specific androgen levels are used to help gauge the success of the treatment for the cancer.
However, at this time Dendreon is not releasing any further details of this study until April 28th, when the findings of the study will be presented at the American Urological Association’s annual meeting held in Chicago. The technology that is used to make the Provenge vaccine may also prove to be useful against other forms of cancer as well, Gold says.
The American Cancer Society has also released a statement about the Provenge news. The statement was made by Otis W. Brawley, MD, and the chief medical officer at the American Cancer Society. Brawley stated that Dendreon’s announcement about the new study for vaccine Provenge has shown reason for optimism for a vaccine that has generated controversy for the past several years. “We have to respect the scientific process, an important part of which is a full disclosure and careful review and discussion of the data, which the company says will not be released until an upcoming medical meeting. One of the most important question’s we’ll be looking at will be the magnitude of the survival advantage; how much longer the men taking the vaccine lived compared to those on standard therapy. As with any new therapy, it will take a detailed analysis to fully understand the impact of this potential new treatment for patients with advanced prostate cancer. We look forward to the presentation of the study at the upcoming meeting.”
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