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Friday, April 4, 2014

Global Partners Pledge $240 Million to Fight Neglected Tropical Diseases

Global Partners Pledge $240 Million to Fight Neglected Tropical Diseases
APRIL 3, 2014

Uniting to Combat NTDs, a partnership of foundations, global health organizations, and pharmaceutical companies, has announced commitments totaling $240 million to fight neglected tropical diseases (NTDs) that disproportionately affect the world's most vulnerable populations.
A new commitment of $120 million by a group of the partners of will be used to combat soil-transmitted helminths (STH), intestinal worms that are among the most common cause of infections in poor children. The funding includes commitments of $50 million from the Children's Investment Fund Foundation to provide technical assistance to national deworming programs; $50 million from the Bill & Melinda Gates Foundation to explore the feasibility of interrupting transmission and mitigating the risks of drug resistance; $8 million over five years from the Buenos Aires-based nonprofit Mundo Sano to test strategies for deworming and develop combination treatments; and $4.5 million from Vitamin Angels to scale deworming with Vitamin A distributions and  implementation support.
In addition, Dubai Cares will design programs that integrate nutrition, deworming, and water, sanitation, and hygiene (WASH) interventions in schools; WaterAid will deliver WASH programs in NTD-endemic areas; and the World Food Programme will work to ensure deworming interventions are provided as part of school feeding programs.
The World Bank also announced that it is committing $120 million from the International Development Association, its fund for the poorest countries, to support NTD control and elimination programs across Africa, including support for school-based deworming programs.
Spearheaded by the Gates Foundation and launched two years ago to support efforts to meet the World Health Organization's control, elimination, and eradication targets for ten specific NTDs by 2020, the Uniting to Combat NTDs effort also includes the U.S. Agency for International Development, the UK Department for International Development, more than a dozen pharmaceutical companies, and a number of nongovernmental organizations. In conjunction with the announcement of the new commitments, the partnership released a report highlighting the progress made over the past two years.
"We're taking the 'neglect' out of neglected tropical diseases, thanks to the commitment of partners from across the public and private sectors," said Gates Foundation co-chair Bill Gates. "Pharmaceutical companies are providing drugs free of charge, endemic countries are scaling up integrated screen-and-treat programs for multiple diseases, and donors are delivering essential funding. If we stay focused, we can reach the London Declaration's 2020 goals and help provide millions with access to health."

"Global Partners Are Taking the 'Neglect' Out of 'Neglected Tropical Diseases'." Uniting to Combat Neglected Tropical Diseases Press Release 04/02/2014.

Educational Perspective

I will always continue to support the advancement of research and research funding of tropical diseases.This is very good news because of the status of the worlds economy. Now integrated international governmental support is needed to achieve the goals and objectives.

Wednesday, September 25, 2013

Community-Associated MRSA Incidence on the Rise in Children

Community-Associated MRSA Incidence on the Rise in Children

Jenni Laidman
Sep 23, 2013

Community-associated (CA) invasive methicillin-resistantStaphylococcus aureus (MRSA) is on the rise in children, particularly in infants younger than 90 days and in black children, according to a report published online September 23 in Pediatrics.
The study, by Martha Iwamoto, MD, MPH, from the Centers from Disease Control and Prevention (CDC), Atlanta, Georgia, and colleagues, was in sharp contrast to a recent studyshowing steep declines in adult cases of hospital-onset and healthcare-associated community-onset MRSA and a slight drop in community-associated infection.
In the current analysis, Dr. Iwamoto and colleagues used laboratory-confirmed MRSA cases in the Active Bacterial Core Surveillance database of 9 geographic regions representing some 4.4 million children younger than 18 years to track the increased risk for MRSA in children.
Incidence of CA-MRSA in children rose from 1.1 case per100,000 children in 2005 to 1.7 cases per 100,000 in 2010, with a modeled yearly increase, adjusted for race and age, of 10.2% (95% confidence interval [CI], 2.7% - 18.2%; P = .007).
Age-, race-, and sex-adjusted MRSA rates were higher among infants aged 3 to 90 days in 2010, at 43.9 cases per 100,000 children, compared with older infants and children (2.0 cases per 100,000 children). The adjusted incidence of invasive MRSA among black children was higher than among children of other races, with 6.7 cases per 100,000 in 2010 for black children compared with 1.6 cases per 100,000 for children of other races. The authors reported no significant trends for healthcare-associated community onset and hospital-onset cases.
"The household is the major vehicle of spread for MRSA strains now," Robert Daum, MD, principal investigator at the University of Chicago MRSA Research Center in Illinois, told Medscape Medical News. Dr. Daum was not involved with the current study. "A decade and a half ago the epidemiology of MRSA underwent a huge change. It's become a community pathogen and arises in patients with no exposure to healthcare."
He continued, "People think MRSA is a problem with dirty hospitals, but not anymore. And it hasn't been for a decade and a half now. Healthcare-associated MRSA [infections] are decreasing in number. And that's been exciting to watch. But now we have to understand that we need a targeted program to help people in households reduce the spread."
"The increase in rates of CA-MRSA in children is concerning," the study authors write. "Current prevention strategies for CA-MRSA focus on education and behavior change aimed at improving hygiene, and it is unknown whether these strategies are effective or have been widely adopted."
Of 876 pediatric MRSA cases analyzed, the researchers found that 298 (35%) were hospital-onset, 196 (23%) were healthcare-associated community-onset, and 363 (42%) were CA.
Median age at the time of infection was 2.1 years (range, 0 days - 17 years), with 39% of cases occurring among infants younger than 1 year. Most (91%) children with MRSA were hospitalized. Fifty-three cases (6%) resulted in death.
Sixty-eight percent (565/834) of children with invasive MRSA had an underlying medical condition, including prematurity (19%), a dermatologic condition such as eczema or abscesses (18%), asthma (8%), congenital disorder (4%), renal disease (2%), and malignancy (2%).
More than 80% of the hospital-onset and healthcare-associated community-onset MRSA cases were in patients with underlying conditions compared with half of the CA cases. The proportion of CA infections was greatest in children aged 5 to 10 years of age, at 71% (92) of the 130 infections in that age group.
The authors and Dr. Daum have disclosed no relevant financial relationships.

Pediatrics. Published online September 23, 2013. Abstract
Educational Perspective:
It is very important to continue to educate the public about MRSA. All medical educators can help by continually providing this information to ALL educational stakeholders.

Saturday, August 10, 2013

Cocoa Consumption Boosts Cognition

Cocoa, Even With Few Flavonoids, Boosts Cognition
Pauline Anderson
Aug 08, 2013

          Drinking cocoa, whether rich in flavonoids or not, appears to boost the effect of blood flow on neuronal activity in the brain, known as neurovascular coupling (NVC).
A new study shows not only that drinking flavonoid-rich or flavonoid-poor cocoa improves NVC but also that higher NVC is associated with better cognitive performance and greater cerebral white matter structural integrity in elderly patients with vascular risk factors.
As researchers search for ways to detect dementia at the earliest possible stage, the study results could pave the way for using NVC as a biomarker for vascular function in those at high risk for dementia, said lead author Farzaneh A. Sorond, MD, PhD, Department of Neurology, Stroke Division, Brigham and Women's Hospital, Boston, Massachusetts.
"Our study shows that NVC is modifiable and can be enhanced with cocoa consumption," said Dr. Sorond The study is published online August 7 in Neurology.
Tight Correlation
The double-blind proof-of-concept study included 60 community-dwelling participants, mean age 72.9 years. About 90% of the participants were hypertensive, but with well-controlled blood pressure, and half had diabetes mellitus type 2 with reasonably good control. Three quarters were overweight or obese.
Participants were randomly assigned to 2 cups a day of cocoa rich in flavonoids (609 mg per serving) or cocoa with little flavonoids (13 mg per serving). Diets were adjusted to incorporate the cocoa, each cup of which contained 100 calories. Participants were also asked to abstain from eating chocolate.
Researchers measured cerebral blood flow in these participants using transcranial Doppler ultrasonography. Among other things, they documented changes in the middle cerebral artery and blood flow velocity at rest and in response to cognitive tasks (NVC).
The study showed that NVC was tightly correlated with cognition; scores for Trail making Test B, a test of executive function, were significantly better in those with intact NVC (89 seconds vs 167 seconds; P = .002). Participants with intact NVC also had significantly better performance on the 2-Back Task, a test for both attention and memory (82% vs 75%; P = .02).
"The higher you increase your blood flow during a cognitive task, the better your cognitive performance," commented Dr. Sorond, adding that this is something that has never been shown before.
NVC was also correlated with cerebral white matter structural integrity. Higher NVC was associated with overall less white matter macro- and micro-structural damage. In general, those with intact NVC had a greater volume of normal white matter and smaller volume of white matter hyperintensities, higher fractional anisotropy, and lower mean diffusivity in the normal white matter and WMH.
Therapeutic Target
These results suggest that NVC could be an important therapeutic target. But before NVC can be considered a biomarker, it has to be shown to be changeable, and the clinical importance of the modification must be shown.
To that end, the study authors opted to use cocoa. They could have chosen many other potential modifiers but chose cocoa because the literature has shown the beneficial effects of cocoa on brain health and also because it's something that many people enjoy, said Dr. Sorond.
The study found that blood pressure, blood flow, and change in NVC were not significantly different between the 2 cocoa groups. In the combined cocoa groups, 30-day blood pressures were not significantly different from baseline (P > .5).
In contrast, response to cocoa differed significantly depending on NVC status. Cocoa had a significant effect on NVC in those with impaired (<5%) coupling at baseline. Of those with impaired NVC, 89% responded to 30 days of cocoa consumption and increased NVC compared with only 36% of those with intact NVC (P = .0002). In those with impaired baseline coupling, cocoa consumption was associated with an 8.3% (P < .0001) increase in NVC at 30 days.
The effect of cocoa consumption on Trail B scores was also significantly dependent on NVC status.
The authors were surprised at the lack of effect of flavonoids because previous research had indicated a dose-response with respect to cognitive performance. It could be something other than flavonoids in the cocoa, possibly caffeine, that improves NVC, or it could be that the 13 mg in the low-flavonoid cocoa group was enough to have an effect.
"I think there are effects of flavonol on brain blood flow no matter how low it is," said Dr. Sorond, adding that perhaps only a tiny amount is needed to activate an enzyme or some other trigger.
It's important to identify the component or mechanism, whatever it is, because just telling patients to drink cocoa could be risky, said Dr. Sorond. "Patients with diabetes or hypertension really don't need the extra sugar, extra calories, and extra fat that come with it."
Dr.Sorond thinks NVC could be measured in high-risk patients seen in the clinic. "I think this could be an easy, in-clinic quick test of vascular brain function that pertains to cognitive performance."The idea
l next step would be to carry out a larger study in patients with mild cognitive impairment that includes more detailed cognitive profiles and more control groups. "We need a cocoa arm; we need a caffeine arm; we need maybe other arms, to make sure that we understand this, and maybe look at some of the metabolites in the blood as a result of cocoa consumption that correlates with these things," said Dr. Sorond.
Remarkable First Step
In an accompanying editorial, Paul B. Rosenberg, MD, associate professor of psychiatry and behavioral sciences, Johns Hopkins School of Medicine, Baltimore, Maryland, and Can Ozan Tan, PhD, Harvard Medical School, Boston, write that in many ways, the study represents a "remarkable first step."
For one thing, it demonstrates the practical utility of a simple, inexpensive, and noninvasive technique for measuring NVC that has several advantages over functional MRI and other means of measuring blood brain flow during cognitive tasks.
In demonstrating a link between NVC and cerebral white matter structural integrity, the study provides an important validation for the association between vascular and cognitive function, according to Dr. Rosenberg.
The study demonstrates that NVC "hangs together" as a measure of vascular function, which could be used in studies targeting vascular interventions, said Dr. Rosenberg in an interview with Medscape Medical News. In this way, he added, the study is "promising for the development of new treatments for vascular dementia."
The study suggests that the vascular effects of cocoa are not due to its flavonol content, noted Dr. Rosenberg."It could be a placebo effect."
Dr. Rosenberg pointed out several strengths of the study, including its relatively large size for a pilot study and its "well-chosen" measures.
Among its weaknesses are that it's not a placebo-controlled study and the hypothesis that flavonoid-rich cocoa would work better than flavonoid-poor cocoa didn't pan out. The study may also not have been long enough, said Dr. Rosenberg. "It's nice to see a drug work for 30 days, but you really need a longer study."
The study didn't include patients with mild cognitive impairment who are at risk of developing dementia, which Dr. Rosenberg sees as another weakness. "It's one thing to show an effect in cognitively healthy older people; it's a very different thing to show an effect in people who have a brain disease," he said.
The Alzheimer's Association also sees weaknesses in the study. Not only is it a very small and very preliminary study, but it was also not well designed as a test of an intervention or therapy because it didn't include a control group for comparison with the group that drank cocoa, said Maria Carrillo, PhD, Alzheimer's Association vice president of medical and scientificrelationFuther, said Dr. Carrillo, it didn't appear that other factors that could possibly affect brain blood flow and/or cognition were controlled for, tracked, or accounted for in the study.
"There is no information on what else the 18 people with impaired cerebral blood flow did during the trial that might have improved their cerebral blood flow or cognitive performance: exercise, for example. A well-designed intervention trial anticipates, tracks, and accounts for these possible confounding factors to help ensure the credibility of the findings."Dr.Sorond has disclosed no relevant financial relationships. Dr. Rosenberg was supported by National Institute on Aging grants; has received research support from Merck, Lilly, Pfizer, and Functional Neuromodulation; and served as consultant to Jansen and Pfizer.
Neurology. Published online August 7, 2013. Abstract Editorial

Medscape Medical News © 2013  WebMD, LLC 
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Cite this article: Cocoa, Even With Few Flavonoids, Boosts Cognition. Medscape. Aug 08, 2013.
Educational Perspective:
I have consumed "Cocoa" all my life with a current study on the amounts needed for health benefits. Good news for everyone.