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March 22nd, 2012 posted by Paul Rega, MD, FACEP March 22, 2012 @ 6:16 am

Toulouse suspect dead.

The suspect in seven killings in and around the southern French city of Toulouse is dead according to numerous media reports.  Several police offices sustained injuries.

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March 22nd, 2012 posted by Paul Rega, MD, FACEP @ 3:38 am

NOAA: River Flood Outlook Map


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March 22nd, 2012 posted by Paul Rega, MD, FACEP @ 3:37 am

NOAA: Today’s Weather Map


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March 22nd, 2012 posted by Paul Rega, MD, FACEP @ 3:25 am

Toulouse suspect: Is he still alive? No one is sure of anything just yet…..


NY Times

March 22, 2012
In 2nd Day of Standoff, French Officials Hope Shooting Suspect Is Still Alive

TOULOUSE, France — “A 23-year-old Frenchman who claimed responsibility for the killings of four men and three children in this region, officials said, remained barricaded on Thursday in a in Toulouse apartment surrounded by hundreds of police officers as a top official said he hoped the suspect was still alive……..[T]here had been several unexplained gunshots and no contact with the man during the night, raising the possibility that the suspect might have committed suicide……… The suspect was identified as Mohammed Merah, 23, a former garage mechanic of Algerian descent who had made trips to Afghanistan and Pakistan, and said that he had been trained by Al Qaeda……..

Mr. Merah was holed up in an apartment building in the quiet neighborhood of Côte Pavée Thursday morning, in a standoff that has gone on for more than 30 hours………

French officials have indicated that the police will make every effort to take him alive.

In the first six hours of the standoff, which began before dawn on Wednesday, the suspect fired several heavy volleys at officers trying to enter his apartment, wounding two, though neither seriously. ……….”


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March 22nd, 2012 posted by Paul Rega, MD, FACEP @ 3:11 am

WHO: Childhood TB neglected, despite available remedies


Childhood TB is a hidden epidemic

21 March 2012 | Geneva -Tuberculosis (TB) often goes undiagnosed in children from birth to 15 years old because they lack access to health services – or because the health workers who care for them are unprepared to recognize the signs and symptoms of TB in this age group. With better training and harmonization of the different programmes that provide health services for children, serious illness and death from TB could be prevented in thousands of children every year, WHO and Stop TB Partnership said today.

Childhood TB a hidden epidemic

“We have made progress on TB: death rates are down 40% overall compared to 1990 and millions of lives have been saved,” said Dr Mario Raviglione, Director of the WHO Stop TB Department. “But unfortunately, to a large extent, children have been left behind, and childhood TB remains a hidden epidemic in most countries. It is time to act and address it everywhere”.

Most families who are vulnerable to TB live in poverty and know little about the disease and how to obtain care for it. All too often, when an adult is diagnosed with TB, no attempt is made to find out whether children in the household also have the disease. This is a crucial step, since most children catch TB from a parent or relative. Any child living with a TB patient and that has an unexplained fever and failure to thrive may have the disease and should be evaluated by a health worker for TB. Those who are not ill with TB should be protected against the disease through preventive therapy with the drug isoniazid. Those who are ill should receive treatment.

Low cost solutions to treat and cure

“Two hundred children die from TB every day. Yet it costs less than 3 cents a day to provide therapy that will prevent children from becoming ill with TB and 50 cents a day to provide treatment that will cure the disease,” said Dr Lucica Ditiu, Executive Secretary of the Stop TB Partnership. “But before we can give prevention or treatment we have to find the children at risk of TB, and this will only happen if governments, civil society and the private sector work together. From now on let us agree: It is unconscionable to let a single child die of TB.”

TB can be hard to diagnose

Another problem is that TB can be hard to diagnose. While high-income countries now use sophisticated childhood molecular tests to detect TB, most developing countries still use a method developed 130 years ago. The patient must cough up a sample of sputum, which is then checked under the microscope for the bacteria that cause TB. Young children generally are unable to produce a sample. Even if a child with active TB succeeds in providing a sample, it often contains no detectable bacteria.

Recent studies have shown, however, that when health programmes do start looking for children with TB, they find far more cases than expected. In Karachi, Pakistan, in 2011, researchers trained community members in the Korangi and Bin Qasim Towns to use an electronic score card on a mobile phone to find people who needed a TB test and then accompany them to the hospital or clinic. One result was a 600% increase in detection of pulmonary TB among children. Another recent study in Bangladesh found that the number of children found to have TB more than trebled when workers at 18 community health centres received special training on childhood TB.

Actions to improve TB care

WHO and the Stop TB Partnership point to three key actions needed to improve TB care and prevent TB deaths in children:

Children at special risk of TB

TB most commonly affects the lungs, but it also can affect other parts of the body. Infants and young children are at special risk of having severe, often fatal forms of TB, such as TB meningitis, which can leave them blind, deaf, paralysed or mentally disabled. Children are just as vulnerable as adults to developing – or becoming infected with – drug-resistant forms of TB that require a lengthy, costly treatment with often severe side effects.

At least half a million babies and children become ill with TB each year and as many as 70 000 are estimated to die of the disease. Children under 3 years of age and those with severe malnutrition or compromised immune systems are at greatest risk for developing TB.

The only vaccine currently available for TB is the Bacillus Calmette-Guérin (BCG), which offers limited protection against severe forms of TB, such as TB meningitis, in young children. BCG does not create lifelong protection against pulmonary TB, and is unsafe for use in children living with HIV. Scientists are actively searching for a fully effective vaccine to protect children and adults against all forms of TB.

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March 22nd, 2012 posted by Paul Rega, MD, FACEP @ 3:08 am

Twin Cities to test postal workers in the delivery of meds during a disaster


May 6, 2012: Operation Medicine Delivery

Testing the use of postal teams to deliver emergency medicine.

Image associated with Operation Medicine Delivery.On May 6, U.S. Postal Service volunteers will make an unusual Sunday morning run through selected Twin Cities neighborhoods. Their mission: Leave a simulated supply of medicine – in the form of an empty pill bottle – at each mailing address.

This event will be part of a test called Operation Medicine Delivery. The purpose is to see how fast postal teams can deliver medicine to homes in an emergency.

The May 6 event is only a test! We have no reason to believe a real emergency will happen that day – or that one is imminent.

A plan for using the postal service to deliver emergency medicine in the Twin Cities has been in place since early 2010. The Postal Plan is a joint project of MDH, the U.S. Department of Health and Human Services, CDC, the U.S. Postal Service, and local public health, law enforcement and emergency management agencies.

This will be the first “real world” test of the Postal Plan in Minnesota. Here are a few facts about the Postal Plan – and the May exercise:

What if we had a real emergency?


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March 22nd, 2012 posted by Paul Rega, MD, FACEP @ 3:03 am

Short-term effects of daily aspirin on cancer incidence, mortality, and non-vascular death


Short-term effects of daily aspirin on cancer incidence, mortality, and non-vascular death: analysis of the time course of risks and benefits in 51 randomised controlled trials
Prof Peter M Rothwell FMedSci,Jacqueline F Price MD,Prof F Gerald R Fowkes FRCPE,Prof Alberto Zanchetti MD,Maria Carla Roncaglioni PhD,Prof Gianni Tognoni MD,Robert Lee MSc,Prof Jill FF Belch MD,Michelle Wilson BSc,Ziyah Mehta DPhil,Prof Tom W Meade FRS
The Lancet – 21 March 2012
DOI: 10.1016/S0140-6736(11)61720-0

Alongside the previously reported reduction by aspirin of the long-term risk of cancer death, the short-term reductions in cancer incidence and mortality and the decrease in risk of major extracranial bleeds with extended use, and their low case-fatality, add to the case for daily aspirin in prevention of cancer.

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March 22nd, 2012 posted by Paul Rega, MD, FACEP @ 3:00 am

aspirin’s effects on cancer metastasis


Effect of daily aspirin on risk of cancer metastasis: a study of incident cancers during randomised controlled trials
Prof Peter M Rothwell FMedSci,Michelle Wilson MSc,Jacqueline F Price MD,Prof Jill FF Belch MD,Prof Tom W Meade FRS,Ziyah Mehta PhD
The Lancet – 21 March 2012
DOI: 10.1016/S0140-6736(12)60209-8

That aspirin prevents distant metastasis could account for the early reduction in cancer deaths in trials of daily aspirin versus control. This finding suggests that aspirin might help in treatment of some cancers and provides proof of principle for pharmacological intervention specifically to prevent distant metastasis.

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March 22nd, 2012 posted by Paul Rega, MD, FACEP @ 2:58 am

ASA on Cancer chances both long-term and metastasis


Effects of regular aspirin on long-term cancer incidence and metastasis: a systematic comparison of evidence from observational studies versus randomised trials
Annemijn M Algra BSc,Prof Peter M Rothwell FMedSci
The Lancet Oncology – 21 March 2012
DOI: 10.1016/S1470-2045(12)70112-2

Observational studies show that regular use of aspirin reduces the long-term risk of several cancers and the risk of distant metastasis. Results of methodologically rigorous studies are consistent with those obtained from randomised controlled trials, but sensitivity is particularly dependent on appropriately detailed recording and analysis of aspirin use.

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