Saturday, February 28, 2015

Capture of a Drug Lord Is a Small Win in Mexico

Servando GómezCredit
MEXICO CITY — The Mexican police captured the leader of the Knights Templar drug gang on Friday, a victory against the brutal group but one that experts say will make little difference in the larger battle against criminal organizations that are rapidly splintering.
The gang leader, Servando Gómez — known as La Tuta, or the Teacher — was one of the most-wanted kingpins in the country. Officials had thought that he was hiding in a remote part of Michoacán, his home state. But he was captured in the early morning hours in the state capital, Morelia, without a shot.
His arrest is unlikely to bring peace to Michoacán, where the federal police and soldiers have weakened the Knights Templar only to have smaller groups arise, fight over territory and branch out to kidnapping and extortion. The pattern has been repeated across Mexico as the government of President Enrique Peña Nieto arrests and kills kingpins such as Joaquín Guzmán Loera, the leader of the powerful Sinaloa cartel. He was arrestedin February 2014.
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Mr. Benítez said that corruption allowed drug trafficking to flourish, but that the government had “not decided to fight corruption because that would mean fighting against itself, against the sick part of itself.”
Before his arrest, Mr. Gómez, 49, relished the limelight, taunting the government by conducting interviews from hiding and releasing videos in which he talked about his close relationships with Michoacán’s political bosses.
A former teacher who is also wanted in the United States for methamphetamine and cocaine trafficking, Mr. Gómez rose through the ranks of a gang known as La Familia. As its leaders were killed, the gang renamed itself the Knights Templar, and its violence prompted frustrated citizens to form vigilante groups.
The national government sent contingents of police officers and soldiers to Michoacán in January 2014 to try to restore calm. The effort succeeded in flushing out many of Mr. Gómez’s top lieutenants, but he remained at large and continued to release videos. He even granted an interview to Channel 4 of Britain, which filmed him handing out cash in one town.
In one video, Mr. Gómez was shown drinking beer and chatting with the son of the former governor of Michoacán, Fausto Vallejo. The governor stepped down after a photograph of his son Rodrigo Vallejo with Mr. Gómez appeared in newspapers. Rodrigo Vallejo said he had been kidnapped and forced to meet with Mr. Gómez.
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Mr. Murillo Karam was criticized for initially accepting the military’s explanation of an episode in the town of Tlatlaya in June in which soldiers killed 22 people suspected of being gang members. The military said they had all died in a gun battle with the soldiers, but news reports raised doubts about the account and prompted a federal investigation. Mexico’s human rights commission found that at least 12 of the suspects had been killed execution style. Eight soldiers have been charged in the case, three of them with murder.
In the highly visible case of 43 students from a rural teachers’ college in Guerrero State who disappeared in September, Mr. Murillo Karam first dismissed the matter as an ordinary crime to be dealt with by local prosecutors. After the federal government took over the investigation, Mr. Murillo Karam said the police had arrested the students on the mayor’s orders and turned them over to a drug gang, which killed them and burned their bodies. But critics say the inquiry has relied too heavily on confessions.
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Thursday, February 26, 2015

Researchers Warn on Anesthesia, Unsure of Risk to Children

Photo
Dr. Randall Flick, pediatric anesthesiologist at the Mayo Clinic Children's Center, gives anesthesia to an infant for a minor surgical procedure. CreditMayo Clinic
Faced with mounting evidence that general anesthesia may impair brain development in babies and young children, experts said Wednesday that more research is greatly needed and that when planning surgery for a child, parents and doctors should consider how urgently it is required, particularly in children younger than 3 years.
In the United States each year, about amillion children younger than 4 have surgery with general anesthesia, according to the Food and Drug Administration.
So far, the threat is only a potential one; there is no proof that children have been harmed. The concern is based on two types of research. Experiments in young monkeys and other animals have shown that commonly used anesthetics andsedatives can kill brain cells, diminish learning and memory and cause behavior problems. And studies in children have found an association between learning problems and multiple exposures to anesthesia early in life — though not single exposures.
But monkeys are not humans, and association does not prove cause and effect. Research now underway is expected to be more definitive, but results will not be available for several years.
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original article

NEJM

Anesthetic Neurotoxicity — Clinical Implications of Animal Models

Bob A. Rappaport, M.D., Santhanam Suresh, M.D., Sharon Hertz, M.D., Alex S. Evers, M.D., and Beverley A. Orser, M.D., Ph.D.
N Engl J Med 2015; 372:796-797February 26, 2015DOI: 10.1056/NEJMp1414786
Article
References
General anesthetic and sedative drugs are administered to millions of infants, toddlers, and preschool children each year to facilitate life-saving surgery and other essential surgical or medical procedures. In the past two decades, mounting data from animal and observational human studies have raised concerns that general anesthetics may cause neurotoxic changes in the developing brain that lead to adverse neurodevelopmental outcomes later in life. To address the growing concern about the potential adverse consequences of general anesthesia in young patients, in 2009 the Food and Drug Administration (FDA) established a public–private partnership with the International Anesthesia Research Society (IARS) called Strategies for Mitigating Anesthesia-Related Neurotoxicity in Tots, or SmartTots.1
In 2012, the FDA, SmartTots, and the American Academy of Pediatrics released a consensus statement that summarized the state of knowledge and presented several key recommendations. Although there were insufficient data at that time to draw any firm conclusions about an association between exposure to anesthetics and subsequent learning disabilities in children, the consensus statement recommended that elective surgical procedures performed under anesthesia be avoided in children less than 3 years of age. The statement also called for further research to better define the risk. Various nonclinical studies have been undertaken since then, and on the basis of their results, the consensus statement is now being revised to convey a heightened level of concern.
More specifically, since the original statement was released, new studies have confirmed that commonly used anesthetics and sedatives that either increase inhibitory γ-aminobutyric acid (GABA) receptor activity (e.g., propofol, etomidate, sevoflurane, desflurane, and isoflurane) or block excitatory glutamate receptors (e.g., ketamine) produce profound neurotoxic effects in laboratory animals.2 The injectable anesthetic propofol, most commonly used to induce a rapid loss of consciousness, causes apoptosis of neurons and oligodendrocytes in the brains of fetal and neonatal macaque monkeys.3 Similarly, the commonly used inhaled anesthetic isoflurane induces widespread apoptosis in the neonatal primate brain. The glutamate receptor antagonist ketamine, when administered as a single dose over a prolonged period (24 hours) during a sensitive phase of brain development, causes long-lasting deficits of memory and attention in primates.4 Studies involving species ranging from nematodes to nonhuman primates have revealed histologic changes and, in some cases, impaired performance on behavioral tests.2 Factors that influence the extent of injury include age at the time of drug exposure and cumulative anesthetic dose.2 Histologic changes include widespread apoptosis and cell death, a reduction in the number of synapses, changes in neuronal morphology, and impaired neurogenesis in the hippocampus.

Rats May Be Exonerated in European Plague, Say Scientists With a Gerbil Theory

Photo
Great gerbils might be the ultimate reservoir for bubonic plague a new study suggests. CreditNurian Kalchinov/Alamy
Scientists say they may have solved a centuries-old whodunit: Why did Europe experience outbreaks of bubonic plague over hundreds of years, starting with the Black Death of 1347 to 1353?
Maybe you can blame gerbils in Asia.
The disease is caused by a bacterium that lives in rodents. The general thought had been that once the germ arrived from Asia to kick off the Black Death, it settled into European rodents and periodically jumped to humans until it disappeared in the early 1800s.
But now, scientific sleuths are suggesting that the true source of those periodic outbreaks was Asia. Maritime trade may have inadvertently imported the disease repeatedly from its ultimate reservoir, great gerbils and other small mammals in Asia, they suggest.
"I don't think there was any sustainable reservoir in Europe," Nils Stenseth of the University of Oslo said Tuesday in an email.
He and his co-authors make their case in an article published Monday in Proceedings of the National Academy of Sciences.
They studied ancient tree rings that preserve fine-grained records of climate in Europe and Asia. Plague jumps from wild rodents to humans in response to climate shifts, and the scientists looked to see if they could match those shifts to the times of regional outbreaks.
They found no evidence of a European reservoir for the disease. But climate records from Asia told a different story.
The researchers identified 16 possible instances between 1346 and 1837 in which plague might have arrived at a European port from Asia. These events were consistently preceded by climate fluctuations in Asia, as recorded by tree rings from Pakistan, with a lag of about 15 years.
Camels, people and fleas in caravans passing through Asia could have picked up the germ and started it on its journey to Europe via trade routes, the researchers said.
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As Pot Becomes Legal in Washington, Congressional Republicans Warn City to Think Twice


Wednesday, February 25, 2015

Food Addictive?

CBS video
PLOS one article



Shire, Maker of Binge-Eating Drug Vyvanse, First Marketed the Disease

A 1954 advertisement for an methamphetamine-based appetite control drug called Opidice. Shire's new drug Vyvanse also uses a type of amphetamine.

The retired tennis player Monica Seles spent this month making the rounds of television talk shows, appearing on everything from “Good Morning America” to “The Dr. Oz Show” to share her personal struggle with binge eating.
“It took a while until I felt comfortable talking about it,” she said in a People magazine interview, explaining that she secretly devoured food for years while she was a professional athlete. “That’s one of the reasons I decided to do this campaign: to raise awareness that binge eating is a real medical condition.”
But that is not the only reason. Ms. Seles is a paid spokeswoman for Shire, which late last month won approval to market its top-selling drug, Vyvanse, to treat binge-eating disorder, a condition that once existed in the shadow of better-known disorders like anorexia and bulimia but was officially recognized as its own disorder in 2013 by the American Psychiatric Association.
As Shire introduces an ambitious campaign to promote Vyvanse but also to raise awareness about the disorder, some are saying the company is going too far to market a drug, a type of amphetamine, that is classified by the federal government as having a high potential for abuse. Shire’s track record is adding to the worry: The company helped put another once-stigmatized condition — attention deficit hyperactivity disorder — on the medical map and made billions of dollars from the sale of drugs, like Vyvanse and Adderall, to treat it. In recent years, federal officials have cited the company for inappropriately marketing Vyvanse and other A.D.H.D.drugs.
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Allergy Risk May Be Tied to How You Wash Your Dishes

A new study suggests that parents who wash their dishes by hand, rather than in a dishwashing machine, may unwittingly lower the likelihood that their children will develop allergies.
The new study, published in the journal Pediatrics, looked at whether a number of behaviors that expose children to bacteria early in life might protect them from developing allergies later on. The idea, known as the hygiene hypothesis, is that children raised in particularly sanitized environments are less likely to develop an immune tolerance to trivial threats.
The researchers followed roughly 1,000 young children and their parents living in the Gothenburg area of Sweden. They investigated behaviors like whether the parents fed their children foods purchased directly from farms, such as eggs, meat and unpasteurized milk. They looked into whether the children ate fermented foods, which have beneficial probiotic bacteria. And they looked into whether the parents washed their dishes by hand or used a dishwasher.
Then they examined whether the children had allergic conditions including asthma, eczema and hay fever. Ultimately, the researchers found that children raised in households where dishes were always washed by hand had half the rate of allergies. They also discovered that this relationship was amplified if the children also ate fermented foods or if the families bought food directly from local farms.
The findings demonstrated only an association, not cause and effect, so it was not clear whether these behaviors directly led to fewer allergies. But it may be the case that these behaviors expose children to innocuous bacteria, which can help strengthen their immune systems, said Bill Hesselmar, an assistant professor at the University of Gothenburg and lead author of the study.
Dr. Hesselmar said that while the sanitizing effect of dishwashing machines can be a good thing, the “less efficient” method of washing dishes by hand might leave behind some bacteria that could have benefits. But he said more research was needed to see if the relationship they found was real and, if so, what was causing it.
“It’s an interesting finding and very surprising,” he said. “But we have to see if we can confirm it.”
NYTimes article

Tuesday, February 24, 2015

Randomized Trial of Peanut Consumption in Infants at Risk for Peanut Allergy

NEJM
Video
The LEAP Trial. 
FIGURE 1
Enrollment and Randomization.

BACKGROUND

The prevalence of peanut allergy among children in Western countries has doubled in the past 10 years, and peanut allergy is becoming apparent in Africa and Asia. We evaluated strategies of peanut consumption and avoidance to determine which strategy is most effective in preventing the development of peanut allergy in infants at high risk for the allergy.

METHODS

We randomly assigned 640 infants with severe eczema, egg allergy, or both to consume or avoid peanuts until 60 months of age. Participants, who were at least 4 months but younger than 11 months of age at randomization, were assigned to separate study cohorts on the basis of preexisting sensitivity to peanut extract, which was determined with the use of a skin-prick test — one consisting of participants with no measurable wheal after testing and the other consisting of those with a wheal measuring 1 to 4 mm in diameter. The primary outcome, which was assessed independently in each cohort, was the proportion of participants with peanut allergy at 60 months of age.

RESULTS

Among the 530 infants in the intention-to-treat population who initially had negative results on the skin-prick test, the prevalence of peanut allergy at 60 months of age was 13.7% in the avoidance group and 1.9% in the consumption group (P<0.001). Among the 98 participants in the intention-to-treat population who initially had positive test results, the prevalence of peanut allergy was 35.3% in the avoidance group and 10.6% in the consumption group (P=0.004). There was no significant between-group difference in the incidence of serious adverse events. Increases in levels of peanut-specific IgG4 antibody occurred predominantly in the consumption group; a greater percentage of participants in the avoidance group had elevated titers of peanut-specific IgE antibody. A larger wheal on the skin-prick test and a lower ratio of peanut-specific IgG4:IgE were associated with peanut allergy.

CONCLUSIONS

The early introduction of peanuts significantly decreased the frequency of the development of peanut allergy among children at high risk for this allergy and modulated immune responses to peanuts. (Funded by the National Institute of Allergy and Infectious Diseases and others; ClinicalTrials.gov number, NCT00329784.)

12 at Wesleyan University Are Hospitalized for Drug Overdoses

Wesleyan University in Connecticut. Some of the students involved were still in critical condition on Monday, officials said. Credit
Christopher Capozziello for The New York Times
MIDDLETOWN, Conn. — Late on Sunday morning, students at Wesleyan Universityreceived an email from a university official: Three students had been taken to hospitals, apparently for drug overdoses, and one was in critical condition.
But that was not the end of it. With one ambulance after another arriving on campus, the official sent out a second email just two hours later, saying three more students had been hospitalized and fearing there could be more.
“First, and most importantly, please check in with your friends immediately to make sure that they are okay,” said the email from Michael J. Whaley, the vice president for student affairs. “Do this right now!”
By the time the ambulances were through, 10Wesleyan students and two guests had been admitted to hospitals for possible overdoses on Molly, a club drug also known, sometimes in different forms, as MDMA or Ecstasy, and which has been linked to a number of overdoses and deaths in recent years.
Some of the students were in critical or serious condition on Monday, but college officials declined to give more specific details. By evening, five students were still hospitalized at Hartford and Middlesex Hospitals, with one expected to be discharged on Monday night, college officials said.
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Mark Neavyn, a toxicologist at Hartford Hospital, cautioned that there is effectively no such thing as a good batch of Molly, which is sometimes described as a “pure form of MDMA,” but is often adulterated.
MDMA can cause hyperthermia, or overheating, that leads to organ damage and sometimes death, and other substances often mixed with MDMA can exacerbate the effects, according to the National Institute on Drug Abuse.
“More often than not, the drug these kids have taken is not the drug they were looking for, and if they knew what was in it, they wouldn’t want to buy it,” Dr. Neavyn said.
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According to the National Institutes of Health, 12.8 percent of 18- to 25-year-olds have used MDMA, Ecstasy or Molly at some point in their lives. The Drug Abuse Warning Network, a federal health program, estimated that emergency room visits involving the drugs in patients younger than 21 more than doubled between 2005 and 2011.
In 2013, two people died of overdoses of Molly at the Electric Zoo music festival on Randalls Island in New York City. Their deaths came after a string of similar overdoses that year at dance festivals in Boston, Seattle, Miami and Washington.
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Friday, February 20, 2015

Nutrition Panel Calls for Less Sugar and Eases Cholesterol and Fat Restrictions


NYTimes



Photo
CreditAndrew Scrivani for The New York Times and Barton Silverman/The New York Times
A nutrition advisory panel that helps shape the country’s official dietary guidelines eased some of its previous restrictions on fat and cholesterol on Thursday and recommended sharp new limits on the amount of added sugar that Americans should consume.
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The panel singled out added sugars as one of its major concerns. Previous dietary guidelines have included warnings about eating too much added sugar, but for the first time the panel recommended that Americans limit it to no more than 10 percent of daily calories — roughly 12 teaspoons a day for many adults — because of its link to obesity and chronic disease.
Americans consume 22 to 30 teaspoons of added sugar daily, half of which come from soda, juices and other sugary drinks. The panel said sugary drinks should be removed from schools, and it endorsed a rule proposed by the Food and Drug Administration that would require a distinct line for added sugars on food nutrition labels, a change the food and sugar industries have aggressively fought.
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Eat food. Not too much. Mostly plants.
Michael Pollan Unhappy Meals