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Update May 2018


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Health & Wellbeing
 

May 19, 2018 - May 25, 2018

WHO: Saturated fat should be less than 10 percent of diet

 

The WHO recommends cutting down on
saturated fats in your diet. (AP Photo/Kirsty Wigglesworth)

London (AP) — The World Health Organization is taking on the battle of the bulge, saying that saturated fats shouldn’t make up more than 10 percent of a person’s diet.

In its first draft guidelines on fat intake, the U.N. health agency said to avoid piling on the pounds, both adults and children should ensure that no more than 10 percent of their calories come from saturated fat.  That type of fat is found butter, milk, meat, eggs and chocolate, among other items.

WHO said only 1 percent or less of calories should be from transfats, commonly found in baked and fried foods, processed foods and cooking oils.

WHO’s draft advice largely matches similar nutritional guidelines in Britain and the U.S.  The agency says it will consider external comments before the recommendations are finalized.


Kids with rare rapid-aging disease get hope from study drug

This March 2017 photo shows Carly Kudzia, 7, with her mother, Heather Unsinger, in Whitehouse, Ohio. (Heidi Bisbee via AP)

Lindsey Tanner

Chicago (AP) — Children with a rare, incurable disease that causes rapid aging and early death may live longer if treated with an experimental drug first developed for cancer patients, a study suggests.

The small, preliminary study isn’t proof the drug works and it found only a small benefit: Treated children with the disease progeria were more likely than others to survive during the two-year study.  But some kids taking the drug in this and other studies have lived into their late teens.  Researchers and others say the results suggest a potential breakthrough for a heartbreaking condition that typically kills kids before they reach adulthood.

“Anything we can do to try to provide them hope of a longer life is well worth doing and well worth celebrating,” said Dr. Francis Collins, director of the United States National Institutes of Health, who was not part of the new study.  A geneticist, Collins led laboratory experiments that in 2003 identified the genetic basis for the disease, formally known as Hutchinson-Gilford progeria.

Among 27 children with progeria who got the drug lonafarnib, one died during the 2007-2010 study.  That’s compared with nine of 27 untreated children with the disease.  Thirteen of the treated children are still alive; most began taking other experimental drugs too.

“For the first time ever we have a drug that is shown to extend lifespan for children with progeria,” said lead author Dr. Leslie Gordon of Brown University.  Her son was a study participant and died in 2014 at age 17.

The study, conducted at Boston Children’s Hospital, was unusually designed, comparing children given the drug with other progeria patients worldwide who weren’t enrolled in the study.  The untreated kids were matched as closely as possible with study participants by age, gender and other characteristics, but they weren’t a standard control group and didn’t receive dummy medication.

That design weakens the study conclusions, said Dr. Howard Worman, a Columbia University biologist. “You really cannot say anything ‘worked’ without a contemporary placebo control.”

The children in the study were also involved in earlier research testing the same drug combined with two others.  Within a period of about five years, survival was extended by about 19 months.  It wasn’t clear if all three drugs or just one or two of them contributed to the improvement. Lonafarnib also appeared to reduce blood vessel damage.

Average life expectancy for progeria children is about 14 years.  Though many die younger, usually from heart attacks or strokes, some lonafarnib-treated kids have lived to their late teens.

For parents, who want to see their children grow up, that sliver of extra time is a bittersweet blessing.

“If you’re a mom and you’re told that life expectancy is 13 years, that 1.6 years is gold,” said Heather Unsinger.  Her 7-year-old daughter, Carly, was a study participant and has been taking lonafarnib since age 3.  “But it’s really hard to jump up and down.”

Affected children are typically small, bald and fragile-looking but intellectually normal.  Carly “has full-throttle dreams” and envisions becoming an art teacher one day, her mom said.

Other kids “always think I’m a baby,” Carly said.  But “I’m a regular kid.”

Progeria is caused by a mutation in a gene that regulates production of a protein that helps shape and support the nucleus of cells throughout the body.  In normal aging, the protein accumulates in cells but in children with progeria, an abnormal buildup occurs that severely damages cells.  Lonafarnib helps block that abnormal buildup.

The disease affects about 1 in 20 million people.  It is a chance mutation and isn’t inherited.  Affected children are born looking healthy, but fail to grow normally, lose body fat and hair and develop aged-looking skin, stiff joints and diseased arteries.

Lonafarnib was initially developed as a potential cancer treatment but without much success.  Schering Plough/Merck supplied the study drug; the research was paid for by the Progeria Research Foundation.


May 12, 2018 - May 18, 2018

Dutch probe ‘appalling’ euthanasia of dementia patient

In this April 10, 2001 file photo, thousands demonstrate outside Dutch government buildings as the Upper House of Parliament debates the legalization of euthanasia at The Hague, Netherlands. In 2018, the Netherlands is one of five countries that allow doctors to kill patients at their request, and one of two, along with Belgium, that grant the procedure for people with mental illness. (AP Photo/Serge Ligtenberg, File)

Maria Cheng

In a rare series of moves, Dutch authorities are investigating whether doctors may have committed crimes in five euthanasia cases, including the deaths of two women with advanced Alzheimer’s disease.

In one of the Alzheimer’s cases, which prosecutors began probing in September, a physician drugged the patient’s coffee without her knowledge and then had the woman physically restrained while delivering the fatal injection. The ongoing criminal investigation is the first since the Netherlands made it legal for doctors to kill patients at their request in 2002.

Dutch prosecutors announced they were examining four other cases last month, including the death of another Alzheimer’s patient who “lacked the capacity to express her own will,” according to a statement from the prosecutor’s office. A spokesperson said that specific criminal charges, if any, would be determined only after the investigations are finished. Several legal experts said that if doctors were found to have killed patients without their explicit request, potentially they could be charged with murder.

The investigations highlight the difficulties doctors face in handling euthanasia requests for those who later develop dementia. Mental decline can eventually make patients unable to understand the significance of their earlier demand to be killed, and as their brain changes, so can their personality and desires.

“If you made a living will when you were competent and asked for euthanasia, do we attach more weight to a decision you made when you were competent, or to your present situation where you’re no longer yourself and are no longer asking to die?” said Johan Legemaate, a professor of health law at the University of Amsterdam.

The Netherlands is one of five countries that allow doctors to kill patients at their request, and one of two, along with Belgium, that grant the procedure for people with mental illness. For those with late-stage dementia, euthanasia is still possible if the person made a written demand specifying the conditions under which they want to be killed and if other criteria are met, namely if the doctor agrees the patient is suffering unbearably with no prospect of improvement.

Whether Dutch authorities prosecute the doctors in the two Alzheimer’s cases being investigated will likely set a course for how the increasing numbers of people with dementia who seek euthanasia will be handled.

Since 2002, more than 55,000 patients have been lawfully killed by a doctor. About 6,500 cases were reported last year, of which 166 involved people with dementia. In the vast majority of these cases, the patients were still in the early stages of the disease and were competent to make a request for euthanasia.

The case investigators began scrutinizing in September involved a 74-year-old woman who had renewed her living will about a year before she died, according to a detailed report issued by a Dutch regional euthanasia review committee.

She wrote that she wanted to be euthanized “whenever I think the time is right.” Later, the patient said several times in response to being asked if she wanted to die: “But not just now, it’s not so bad yet!” according to the report.

The committee wrote that when the doctor surreptitiously slipped a sedative into the patient’s coffee, she took away the patient’s chance to physically protest her death. When the doctor began administering barbiturates to end the patient’s life, the woman tried to get up and the doctor asked her family to hold her down.

The doctor said she was fulfilling a written request the patient made for euthanasia years earlier and that since the patient was not competent, nothing the woman said during her euthanasia procedure was relevant.

“Even if the patient had said at that moment: ‘I don’t want to die,’ the physician would have continued,” the committee wrote, citing the doctor’s testimony. Given the clear signs the patient was struggling to protest her death, the committee said the doctor should have stopped.

“On the morning of the euthanasia, when her family was present, the patient was even making plans to go out to eat with them,” the report said.

The examining judge will soon hear witnesses and receive expert reports before deciding whether to charge the doctor with a crime in the case.

Among the four remaining cases, one other suspicious euthanasia death is also being examined by the prosecutor’s office in The Hague and three other cases are being investigated in the northern and eastern parts of the country.

The 2016 case has divided opinion even among those who support assisted dying.

“This case is appalling,” said Dr. Boudewijn Chabot, a euthanasia advocate who was involved in a historic case at the Supreme Court that helped set the legal conditions for the procedure. He said the euthanasia of the Alzheimer’s patient “goes beyond the law as we understand it.”

Some physicians said it was problematic to kill people with late-stage dementia because it’s hard to know what their wishes truly are.

Dr. Amanda Thompsell, chair of old-age psychiatry at Britain’s Royal College of Psychiatrists, said it can be risky to assume how much a dementia patient is suffering mainly by observing them. “If the person says they don’t want something, then we have to accept that,” she said.

Other experts said that it can be ethical to act without patients’ full understanding, such as when they are covertly given medicine, if it helps the patient or if it is consistent with what the patient wanted.

“You respect the patient’s choice, in a situation where nothing else can be done to help,” said Suzanne van de Vathorst, an associate professor of medical ethics and philosophy at Erasmus University in Rotterdam.

Ghislaine van Thiel, a medical ethicist at Utrecht University Medical School, said she would be surprised if Dutch prosecutors don’t take the 2016 Alzheimer’s case to trial.

“We are definitely crossing a line if we’re overruling the wishes of incompetent patients to live, because a will to live is your basic, fundamental right,” she said. “This is such a big discussion that we need the consideration of the courts to set standards on how the law views the rights of people with dementia and how we should consider their wishes.”


May 5, 2018 - May 11, 2018

US experts back marijuana-based drug for childhood seizures

On Thursday, April 19, 2018, a panel of Food and Drug Administration health advisers recommended approval of Epidiolex, moving the closely watched medication closer to the U.S. market. (AP Photo/Kathy Young, File)

Matthew Perrone

Washington (AP) - A medicine made from the marijuana plant moved one step closer to U.S. approval Thursday after federal health advisers endorsed it for the treatment of severe seizures in children with epilepsy.

If the Food and Drug Administration follows the group’s recommendation, GW Pharmaceuticals’ syrup would become the first drug derived from the cannabis plant to win federal approval in the U.S.

The 13-member FDA panel voted unanimously in favor of the experimental medication made from a chemical found in cannabis - one that does not get users high. The panelists backed the drug based on three studies showing that it significantly reduced seizures in children with two rare forms of childhood epilepsy.

“This is clearly a breakthrough drug for an awful disease,” said panel member Dr. John Mendelson, of the Friends Research Institute in Baltimore, Maryland.

The drug carries a potential risk of liver damage, but panelists said doctors could monitor patients for any signs. More common side effects included diarrhea, vomiting, fatigue and sleep problems.

FDA regulators are due to make their decision by late June. Approval would technically limit the drug, called Epidiolex, to patients with hard-to-treat forms of epilepsy. But doctors would have the option to prescribe it for other uses and it could spur new pharmaceutical research and interest into other cannabis-based products.

More than two dozen states allow marijuana use for a variety of ailments, but the FDA has not approved it for any medical use. The FDA has approved synthetic versions of another cannabis ingredient for other medical purposes.

Several patients and parents at Thursday’s meeting spoke about the benefits of Epidiolex. Sam Vogelstein, 16, said he experienced daily seizures - at times more than 100 per day - before enrolling in a study of the drug.

“I just went to South Africa for two weeks without my parents on a school trip,” said Vogelstein, who lives in Berkeley, California. “I would not have been able to do that if I had not tried this medication.”

It’s not yet clear why the medicine reduces seizures.

Epidiolex is essentially a pharmaceutical-grade version of cannabidiol, or CBD oil, which some parents have used for years to treat children with epilepsy. CBD is one of more than 100 chemicals found in the cannabis plant and it doesn’t contain THC, the ingredient that gives marijuana its mind-altering effect.

CBD oil is currently sold online and in specialty shops across the country, though its legal status remains murky. Most producers say their oil is made from hemp, a form of cannabis that contains little THC and can be legally farmed in a number of states for clothing, food and other uses.

It’s unclear how FDA approval of a CBD drug would affect products already on the market. Executives for the British drugmaker GW Pharmaceuticals say their goal is to provide a more standardized, research-backed version.

“We’re not looking to impact the availability of other products on the market,” GW executive Steve Schultz said before the meeting. “Our goal is to provide an additional option for patients and physicians who desire a purified version of CBD for treatment of seizures.”

The company declined to comment on the price of the drug before the approval decision. Wall Street analysts estimate it could cost more than $25,000 per year.


UN health agency: Dengue vaccine shouldn’t be used widely

The World Health Organization says that the first-ever vaccine for dengue should mostly be given to people who have previously been infected with the disease. (AP Photo/Bullit Marquez, file)

Maria Cheng

London (AP) - The World Health Organization says the first-ever vaccine for dengue needs to be dealt with in “a much safer way,” meaning that the shot should mostly be given to people who have previously been infected with the disease.

In November, the vaccine’s manufacturer, Sanofi Pasteur, said people who had never been sickened by dengue before were at risk of developing a more serious disease after getting the shot.

After a two-day meeting this week, WHO’s independent vaccines group said it now had proof the vaccine should only be used “exclusively or almost exclusively in people who have already been infected with dengue.”

The U.N. health agency said a test should be developed so doctors would be able to quickly tell if people had previously been sickened by dengue - but the group acknowledged doing that so isn’t straightforward.

“We see significant obstacles in using the vaccine this way, but we are confident this also spurs the development of a rapid diagnostic test,” said Dr. Joachim Hombach, executive secretary of WHO’s expert group, during a news conference Thursday.

Sanofi said last year that doctors should consider whether people might have been previously infected with dengue before deciding whether they should risk getting immunized. The company said it expected to take a 100 million euro ($118 million) loss based on that news.

People who catch dengue more than once can be at risk of a hemorrhagic version of the disease. The mosquito-spread virus is found in tropical and sub-tropical climates across Latin and South America, Asia, Africa and elsewhere. It causes a flu-like disease that can cause joint pain, nausea, vomiting and a rash. In severe cases, dengue can result in breathing problems, hemorrhaging and organ failure.

About half the world’s population is at risk of dengue; WHO estimates that about 96 million people are sickened by the viral infection every year.

Following Sanofi’s announcement last year, the Philippines halted its dengue immunization program, the world’s first national vaccination program for dengue. The government also demanded a refund of more than 3 billion pesos ($59 million) from Sanofi and is considering further legal action.

In February, the Philippines said the vaccine was potentially linked to the deaths of three people: all of them died of dengue despite having received the vaccine.

The country imposed a symbolic fine of $2,000 on Sanofi and suspended the vaccine’s approval, charging that the drugmaker broke rules on how the shot was registered and marketed.

More than 730,000 children aged 9 and above in the Philippines have received at least one dose of the dengue vaccine, usually delivered in three doses.

There is no specific treatment for dengue and there are no other licensed vaccines on the market.


April 28, 2018 - May 4, 2018

CDC: Drug-resistant ‘nightmare bacteria’ pose growing threat

Pseudomonas aeruginosa bacteria, one of the germs that can evolve to resist antibiotics. “Nightmare bacteria” with unusual resistance to antibiotics of last resort were found more than 200 times in the United States last year. (CDC via AP, File)

Marilynn Marchione

“Nightmare bacteria” with unusual resistance to antibiotics of last resort were found more than 200 times in the United States last year in a first-of-a-kind hunt to see how much of a threat these rare cases are becoming, health officials said Tuesday.

That’s more than they had expected to find, and the true number is probably higher because the effort involved only certain labs in each state, officials say.

The problem mostly strikes people in hospitals and nursing homes who need IVs and other tubes that can get infected. In many cases, others in close contact with these patients also harbored the superbugs even though they weren’t sick - a risk for further spread.

Some of the sick patients had traveled for surgery or other health care to another country where drug-resistant germs are more common, and the superbug infections were discovered after they returned to the U.S.

“Essentially, we found nightmare bacteria in your backyard,” said Dr. Anne Schuchat, principal deputy director of the U.S. Centers for Disease Control and Prevention.

“These verge on untreatable infections” where the only option may be supportive care - fluids and sometimes machines to maintain life to give the patient a chance to recover, Schuchat said.

The situation was described in a CDC report.

Bugs and drugs are in a constant battle, as germs evolve to resist new and old antibiotics. About 2 million Americans get infections from antibiotic-resistant bacteria each year and 23,000 die, Schuchat said.

Concern has been growing about a rise in bacteria resistant to all or most antibiotics. Last year, public health labs around the country were asked to watch for and quickly respond to cases of advanced antibiotic resistance, especially to some last-resort antibiotics called carbapenems.

In the first nine months of the year, more than 5,770 samples were tested for these “nightmare bacteria,” as CDC calls them, and one quarter were found to have genes that make them hard to treat and easy to share their resistance tricks with other types of bacteria. Of these, 221 had unusual genes that conferred resistance. The cases were scattered throughout 27 states.

“Even in remote areas” this threat is real, because patients often transfer to and from other places for care, said Dr. Jay Butler, chief medical officer for the state of Alaska and past president of the Association of State and Territorial Health Officials.

Others in close contact with the infected patient then were tested, and 11 percent were found to be carrying the same superbugs even though they were not sick. This gives the bugs more of a chance to spread.

What to do? CDC suggests:

- Tell your doctors if you recently had health care in another country.

- Talk with them about preventing infections, taking care of chronic conditions to help avoid them, and getting vaccines to prevent them.

- Wash your hands regularly and keep cuts clean until healed.


Midlife ‘wealth shock’ may lead to death, study suggests

Cut stacks of $100 bills make their way down the line at the Bureau of Engraving and Printing Western Currency Facility in Fort Worth, Texas. Middle-aged Americans who experienced a sudden, large economic blow were more likely to die during the following years than those who didn’t. (AP Photo/LM Otero)

Carla K. Johnson

A big financial loss may shorten your life, a new study suggests.

Middle-aged Americans who experienced a sudden, large economic blow were more likely to die during the following years than those who didn’t. The heightened danger of death after a devastating loss, which researchers called a “wealth shock,” crossed socio-economic lines, affecting people no matter how much money they had to start.

The analysis of nearly 9,000 people’s experiences underscores well-known connections between money and well-being, with prior studies linking lower incomes and rising income inequality with more chronic disease and shorter life expectancy.

“This is really a story about everybody,” said lead researcher Lindsay Pool of Northwestern University’s medical school. Stress, delays in health care, substance abuse and suicides may contribute, she said. “Policymakers should pay attention.”

Overall, wealth shock was tied with a 50 percent greater risk of dying, although the study couldn’t prove a cause-and-effect connection. The study was published Tuesday in the Journal of the American Medical Association.

Researchers analyzed two decades of data from the Health and Retirement Study, which checks in every other year with a group of people in their 50s and 60s and keeps track of who dies.

About 1 in 4 people in the study had a wealth shock, which researchers defined as a loss of 75 percent or more in net worth over two years. The average loss was about $100,000.

That could include a drop in the value of investments or realized losses like a home foreclosure. Some shocks happened during the Great Recession of 2007-2009. Others happened before or after. No matter what was going on in the greater U.S. economy, a wealth shock still increased the chance of dying.

Women were more likely than men to have a wealth shock. Once they did, their increased chance of dying was about the same as the increase for men. Researchers adjusted for marital changes, unemployment and health status. They still saw the connection between financial crisis and death.

The effect was more marked if the person lost a home as part of the wealth shock, and it was more pronounced for people with fewer assets.

The findings suggest a wealth shock is as dangerous as a new diagnosis of heart disease, wrote Dr. Alan Garber of Harvard University in an accompanying editorial, noting that doctors need to recognize how money hardships may affect their patients.

The findings come at a time when U.S. life expectancy has dropped for two straight years.

“We should be doing everything we can to prevent people from experiencing wealth shocks,” said Dr. Steven Woolf, director of the Virginia Commonwealth University Center on Society and Health, who was not involved in the study.

What exactly to do, however, may take more research, said Katherine Baicker, dean of the Harris School of Public Policy at University of Chicago, who also was not involved in the study.

“We don’t yet know whether policies that aim to protect people’s savings will have a direct effect on mortality or not,” Baicker said. “But that’s not the only reason to try to protect people’s savings.”
 


DAILY UPDATEE

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HEADLINES [click on headline to view story]

WHO: Saturated fat should be less than 10 percent of diet

Kids with rare rapid-aging disease get hope from study drug


Dutch probe ‘appalling’ euthanasia of dementia patient


US experts back marijuana-based drug for childhood seizures

UN health agency: Dengue vaccine shouldn’t be used widely


CDC: Drug-resistant ‘nightmare bacteria’ pose growing threat

Midlife ‘wealth shock’ may lead to death, study suggests


 



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