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Early use of antivirals key in H1N1 flu: WHO

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Early use of antivirals key in H1N1 flu: WHO

Early use of antivirals is effective in treating H1N1 flu and health authorities must be vigilant for signs of drug resistance, the World Health Organisation said on Friday.

Drug-resistant pandemic flu viruses have appeared infrequently so far and there is no evidence they are spreading, but further cases are likely, the WHO said on its website.

Growing international experience showed the importance of the early use of oseltamivir, manufactured as Tamiflu by Roche Holding and Gilead Sciences, or zanamivir, an inhaled medicine produced as Relenza by GlaxoSmithKline in swine flu cases,” the WHO said.

“The experience of clinicians, including those who have treated severe cases of pandemic influenza, and national authorities, suggests that prompt administration of these drugs following symptom onset reduces the risk of complications and can also improve clinical outcome in patients with severe disease,” the Geneva-based U.N. agency said.

“This experience further underscores the need to protect the effectiveness of these drugs by minimizing the occurrence and impact of drug resistance,” it said.

Most people who contract pandemic influenza suffer only mild symptoms before recovery without treatment, but children, pregnant women and those with some existing health conditions are vulnerable to a more severe attack or even death.

The WHO, which declared H1N1 a global pandemic in June, says one third of the world’s population of nearly seven billion people could catch it.

The risk of resistance is higher in patients who suffer from weak immune systems and have already been treated with oseltamivir, it said.

It is also high in people who are treated with the antivirals as a prophylactic — as a precaution after exposure to someone with influenza, but nevertheless develop the disease.

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Psychic Surgery – Conclusion

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Psychic Surgery – Conclusion

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Psychic surgery

Psychic surgery is a procedure typically involving the apparent creation of an incision using only the bare hands, the apparent removal of pathological matter, and the seemingly spontaneous healing of the incision.

Psychic surgery has been condemned in many countries as a form of medical fraud. It has been denounced by the US Federal Trade Commission as a “total hoax “and the American Cancer Society maintains that psychic surgery may cause needless death by keeping the ill away from life-saving medical care.Medical professionals and skeptics consider it sleight of hand and any positive results a placebo effect.

It first appeared in the Spiritualist communities of the Philippines and Brazil in the mid-1900s, and it has taken different paths in those two countries.

Procedure

Although psychic surgery varies by region and practitioner, it usually follows some common lines. Without the use of a surgical instrument, a practitioner will press the tips of his/her fingers against the patient’s skin in the area to be treated. The practitioner’s hands appear to penetrate into the patient’s body painlessly and blood seems to flow. The practitioner will then show organic matter or foreign objects apparently removed from the patient’s body, clean the area, and then end the procedure with the patient’s skin showing no wounds or scars.

Most cases do not involve actual surgery although some practitioners make real incisions. The practitioners are using sleight of hand techniques to produce blood or blood-like fluids, animal tissue or substitutes, and/or various foreign objects from folds of skin of the patient as part of a confidence game for financial benefit of the practitioner.

Two psychic surgery practitioners provided testimony in an Federal Trade Commission trial that, to their knowledge, the organic matter apparently removed from the patients usually consists of animal tissue and clotted blood. In regions of the world where belief in evil spirits is prevalent, practitioners will sometimes exhibit objects, such as glass, explaining that the foreign bodies were placed in the patient’s body by evil spirits.

History

Accounts of psychic surgery started to appear in the Spiritualist communities of the Philippines and Brazil in the mid-1900s.

Philippines

In the Philippines, the procedure was first noticed in the 1940s, when performed routinely by Eleuterio Terte. Terte and his pupil Tony Agpaoa, who was apparently associated with the Union Espiritista Christiana de Filipinas (The Christian Spiritist Union of the Philippines), trained others in this procedure.

In 1959, the procedure came to the attention of the U. S. public after the publication of Into the Strange Unknown by Ron Ormond and Ormond McGill. The authors called the practice “fourth dimensional surgery,” and wrote “[we] still don’t know what to think; but we have motion pictures to show it wasn’t the work of any normal magician, and could very well be just what the Filipinos said it was — a miracle of God performed by a fourth dimensional surgeon.”

Alex Orbito, who became well-known in the U. S. through his association with actress Shirley MacLainewas one said practitioner of the procedure. On June 14, 2005, Orbito was arrested by Canadian authorities and indicted for fraud.

Psychic surgery made U.S. tabloid headlines in March 1984 when comedian Andy Kaufman, diagnosed with large cell carcinoma (a rare lung cancer), traveled to the Philippines for a six-week course of psychic surgery. Practitioner Jun Labo claimed to have removed large cancerous tumors and Kaufman declared to believe the cancer had been removed. Kaufman died from renal failure as consequence of a metastatic lung cancer, on May 16, 1984.

Brazil

The origins of the practice in Brazil are obscure; but by the late 1950s several “spiritual healers” were practicing in the country. Many of them were associated with Kardecism, a major spiritualistic movement in Brazil[, and claimed to be performing their operations merely as channels for spirits of deceased medical doctors. Others were following practices and rituals known as “Umbanda”, a shamanic ritualistic religion with mediumistic overtones inherited from the African slaves brought to the country in colonial times.

Medical and legal criticism

In 1975, the Federal Trade Commission declared that “‘psychic surgery’ “is nothing but a total hoax”.” Judge Daniel H. Hanscom, when granting the FTC an injunction against travel agencies promoting psychic surgery tours, declared: “Psychic surgery is pure and unmitigated fakery. The ‘surgical operations’ of psychic surgeons … with their bare hands are simply phony.”

In 1990, the American Cancer Society stated that it found no evidence that “psychic surgery” results in objective benefit in the treatment of any medical condition, and strongly urged individuals who are ill not to seek treatment by psychic surgery.

The British Columbia Cancer Agency “strongly urges individuals who are ill not to seek treatment by psychic surgeon.”

While not directly hazardous to the patient, the belief in the alleged benefits of psychic surgery may carry considerable risk for individuals with diagnosed medical conditions, as they may delay or forgo conventional medical help, sometimes with fatal consequences.

Accusations of fraud

According to stage magician James Randi, psychic surgery is a sleight-of-hand confidence trick. He has said that in personal observations of the procedure, and in movies showing the procedures, he can spot sleight-of-hand moves that are evident to experienced stage magicians, but might deceive a casual observer. Randi has replicated the appearance of psychic surgery himself through the use of sleight-of-hand. Professional magicians Milbourne Christopher and Robert Gurtler have also observed psychic surgeons at work, and claimed to have spotted the use of sleight-of-hand. On his A&E show Mindfreak in the episode “Sucker,” illusionist Criss Angel performed “Psychic Surgery,” showing first-hand how it may be done (fake blood, plastic bags and chicken livers were used).

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Feet surgery

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Feet surgery

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The podiatric surgeon is taught to approach foot surgery by keeping the knowledge of normal foot function and biomechanics in mind. Because of the weightbearing nature of the foot, surgical procedures must be designed to be as stable as possible to withstand the forces of everyday standing and walking. Care is taken to understand the cause of the problem so as to provide a long-lasting cure, when possible. Greater than 99% of podiatric surgery is done in an outpatient setting such as a hospital outpatient department, a freestanding surgery center or in the podiatry office. Most procedures allow for immediate walking with a surgical sandal. Some procedures may require the use of a cane, crutches, or a cast. Specific surgical treatments for many common (and some less common) foot conditions will be discussed.


Flat Feet (Pes Planus)

Surgery for flat feet is generally reserved for the most symptomatic cases. Orthotics are often the first line course of treatment. Many people have what are referred to as “Flat Feet” but are relatively asymptomatic. Flat feet may result in significant foot pain and deformity because of excessive pronation which causes joint instability. Flat foot procedures are designed to provide for a more stable foot which pronates less. Most flat foot surgery is performed on patients in the adolescent age group. There are a large variety of specific surgical procedures that may be used. They may be grouped according to the region of the foot that is treated. Often, 2 or 3 procedures may be performed together from the different groups.

Rearfoot osteotomies
These are procedures which are designed to change the position of the heel into an inverted or supinated position (the opposite of everted and pronated which are found in flat feet.) An osteotomy is a surgical cut in the bone. Often, a wedge of bone is removed to change the angle of the heel bone (calcaneus).  Other procedures are transpositional and involve sliding of one part of the bone along the other part of the bone. (E.g. the Koutsogianis procedure). Other procedures involve adding a bone graft and opening the wedge to change the angle of the calcaneus.( E.g. the Evans Procedure). These osteotomies are generally held together with special screws, pins or bone staples and require a period of casting and immobilization for several weeks.

Medial column stabilizations
These procedures involve fusing two or more of the bones along the medial side (inner side) of the foot. Common fusion sites are the navicular and medial cuneiform.  These bones have often dropped in a flat foot and fusing them provides more stability. These osteotomies are generally held together with special screws, pins or bone staples and require a period of casting and immobilization for several weeks.

Tendon transfers
Sometimes the insertion sites of tendons are detached and then reattached to bones at different locations. The result is a dynamic stabilization. Repositioning of the tendons allows the muscles that pull them to exert their force in a more beneficial way to help support the arch. The Young tenosuspension procedure reattaches the Tibialis Anterior tendon to a better position beneath the medial arch where it can pull up on the arch to support it.

Tendon lengthening
Often, the Achilles tendon is tight and is a major deforming force contributing to flat foot conditions. A condition associated with a tight Achilles tendon is known as equinus. An Achilles tendon lengthening procedure is often effective at reducing this deforming force. The calf is made up of 2 gastrocnemius muscle bellies as well as the soleus muscle. The Achilles tendon attaches to all three. An Achilles tendon lengthening lengthens the whole group together. Sometimes, the gastrocnemius muscles are tight while the soleus is not. In this case, a gastrocnemius recession can be performed to lengthen only the gastrocnemius while leaving the soleus alone.

Arthroeresis
These are procedures in which a peg made of plastic or titanium is placed in front of a bone to limit its motion. A common location for placement of such a device is the Sinus Tarsi which is a cone-shaped space between the talus and calcaneus bones. The peg helps to limit pronation. This is often just a temporary measure with the peg left in for a few years and then removed.

Arthrodeses
An arthrodesis is a fusion of two bones. In addition to the medial column stabilization fusions discussed above, rearfoot bones may also be fused. Rearfoot fusions are generally reserved for the most severely deformed, arthritic and painful feet . A Triple Arthrodesis is a fusion of the Talo-calcaneal, Talo-navicular and Calcaneo-cuboid joints. This is one of the most complex foot surgeries performed since all three joints must be aligned and fused properly to achieve a satisfactory result. In addition, because motion in the rearfoot is eliminated, the ankle joint and other joints in the foot may be forced into compensating to provide additional motion which could result in future symptoms in those places. These fusions are generally held together with special screws, pins or bone staples and require a period of casting and immobilization for two or three months.

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