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Health & Fitness (239)

KAMPALA, Uganda (AP) -- Goaded by journalists who wanted a clear view of her face, the Ugandan nurse looked dazed and on the verge of tears. The Ugandan press had dubbed her "the killer nurse," after the HIV-infected medical worker was accused of deliberately injecting her blood into a two-year-old patient.

The 64-year-old nurse, Rosemary Namubiru, was charged with attempted murder, denied bail and sent to jail in an unusual case that many here saw as a horrifying example of the lax hospital standards believed to be prevalent in this East African country.

But in the course of her trial - on the revised charge of criminal negligence - the nurse is attracting sympathy and emerging as the apparent victim of rampant stigma in a country that until recently was being praised as a global leader in fighting AIDS and promoting an open attitude toward the disease.

The nurse, while attempting to give an injection to a distraught child on Jan. 7, accidentally pricked her finger with a needle, according to AIDS-Free World, an international advocacy group that has been monitoring the ongoing trial. After bandaging her finger she returned to administer the injection, apparently using the contaminated needle. Uncertain about whether the same needle was used, the child's mother "became concerned about the possibility that her child had been exposed to HIV," the group said. After a test showed the nurse was HIV positive, she was arrested and prosecutors argued against giving her bail on the grounds that she posed a grave danger to the public.

If convicted, the nurse faces seven years in jail and would be the first Ugandan medical worker to be sentenced under a colonial-era law against negligent acts likely to lead to the spread of an infectious disease.

The child who may have been exposed to HIV was given post-exposure treatment and will be tested again for HIV in coming days, according to lawyers and activists familiar with the case.

Namubiru's trial has consequences for the rights of people with HIV and AIDS, say AIDS activists in Uganda and abroad. Uganda, which achieved global attention in the 1990s for its efforts to stem the spread of the disease, has about 1.5 million people living with HIV out of a total population of 36 million. Activists note that it's virtually impossible to find a Ugandan family that hasn't been affected by the disease since it was first reported here in the 1980s. Yet stigma toward people suffering from AIDS persists, shocking activists.

The nurse's case illustrates "the failure of both the media and the prosecutor's office to act responsibly" and could set "a dangerous precedent and could have grave consequences for the fundamental rights of people living with HIV and AIDS in Uganda and beyond," said AIDS-Free World, in a statement.

Namubiru shouldn't be on trial and her case should simply have been referred to the Uganda Nurses and Midwives Council, a statutory body charged with protecting the public from unsafe nursing practices, said Dorah Kiconco, a Ugandan lawyer who runs a watchdog group called the Uganda Network on Law, Ethics and HIV/AIDS.

"She was working and she got into a bad accident and it should have been treated as such," Kiconco said. "She's on trial because of her HIV status."

Jane Kajuga, a spokeswoman for Uganda's public prosecutor, defended the decision to press charges, saying there's evidence a crime was committed.

The Global Commission on HIV and the Law said the nurse's "life has been ruined. No matter the outcome of the trial, the panorama of ferociously intemperate accusation will haunt her and her family forever."

Uganda's HIV rate has been rising in recent times, confounding officials who succeeded in reducing the prevalence from 18 percent in 1992 to 6.4 percent in 2005. Now the rate stands at 7.3 percent, according to the most recent survey by Uganda's Ministry of Health. Ugandan health officials say more married couples are getting infected, in part because of what campaigners have dubbed a "sexual network" in which married people keep secret lovers. Billboards in Kampala, the Ugandan capital, urge couples to "put your love to the test" by testing for HIV.

Ugandan President Yoweri Museveni last year publicly tested for HIV in a bid to spark similar action among reluctant Ugandans. Although being HIV positive no longer spells a death sentence, even for poor Ugandans, public knowledge of one's HIV-positive status can destroy a life. A Ugandan man who worked in the presidential palace as a gardener recently accused his bosses of firing him after they discovered that he was infected with HIV.

Ugandan Maj. Rubaramira Ruranga, one of few officials who have publicly revealed they have HIV in a bid to discourage stigma, said the case against the nurse proves that "stigma still rages on" in Uganda.

"If I were her I would be very angry, I would feel isolated and I would feel dejected," he said. "She was brutalized."

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Monday, 14 April 2014 10:41
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LONDON (AP) -- Two new studies describe the latest achievements in growing body parts in a lab and transplanting them into people, this time with nostrils and vaginas.

Windpipes, bladders, blood vessels and other structures have previously been created in part from a patient's own cells and then implanted. Eventually, scientists hope to tackle more complicated things like lungs and kidneys with this strategy, which is aimed at avoiding rejection of transplanted organs.

The latest experiments were published online Friday in the journal Lancet.

"They both show that by using fairly simple tissue engineering techniques, you can get real tissue forming where it's supposed to," said Dr. Martin Birchall, of The Ear Institute at University College London, who co-authored an accompanying commentary. He said the simple methods could be useful for making other body parts, including joint cartilage, bowels and the esophagus.

One experiment involved four teenage girls in Mexico who were born without vaginas because of a rare disorder. Currently, surgeons use tissue grafts to create vaginas for such patients, but that method carries a risk of complications.

The experimental results were reported by Dr. Anthony Atala of the Wake Forest University School of Medicine in Winston-Salem, North Carolina, with researchers there and at the Metropolitan Autonomous University in Mexico City. Atala said the procedure might also prove useful for replacing vaginas removed because of cancer, and repairing or replacing the organ after an injury.

For the experiment, researchers took a tissue sample less than half the size of a postage stamp from the patients' genitals. They multiplied cells from this tissue in the lab, seeded them onto a biodegradable scaffold and molded it into the right size and shape for each patient before implantation.

The first surgery was done in 2005, and the Lancet report provides a follow-up of the patients for an average of nearly seven years. The women report normal levels of sexual functioning, without any long-term complications. It is not known whether the women could get pregnant; only two have wombs, Atala said.

One of the women, in a video provided by the Mexican university, said she felt fortunate "because I have a normal life." The university didn't identify the woman.

In the other experiment, Swiss scientists built new outer nostrils for five patients who had skin cancer on their noses. When surgeons removed the tumor, they also took a tiny bit of nose cartilage. They grew the cells for four weeks in the lab to make a small flap. That was then implanted onto their nose and covered with skin from their foreheads. Normally, cartilage is taken from the patient's ear or ribs to recreate the nostril.

Ivan Martin of University Hospital Basel, the study's senior author, said none of the patients reported any side effects by one year after surgery, and all were satisfied with their new nostrils.

"Now that we have demonstrated this is safe and feasible, we can use (this technique) for more complicated clinical needs," he said, adding that the same approach is being tested in people to supply knee cartilage. He said scientists were slowly gaining more expertise in making body parts, but predicted it could take another couple of decades before the process becomes mainstream.

"It's not a trivial thing to engineer a functional tissue," he said.

---

Malcolm Ritter reported from New York.

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Online:

WWW.LANCET.COM

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Friday, 11 April 2014 07:52
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Police officers who receive crisis intervention training are taught how to recognize when someone with serious mental illness might be having a psychiatric crisis. Considering the overall circumstances, police look for these behaviors in a subject:

- Behavior that doesn't fit the circumstance (example: laughing at a funeral)

- Non-verbal and easily distracted

- Bizarre and disjointed thinking (delusions, hallucinations)

- Suicidal

- Normal coping skills are failing or not evident

- Unaware of self; dirty, disheveled, malodorous

- Unaware of surroundings and possible risk to personal safety

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Source: Donald Kline, Montgomery County Emergency Service in Pennsylvania

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Thursday, 10 April 2014 06:56
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LONDON (AP) -- Three years ago, doctors reported that zapping a paralyzed man's spinal cord with electricity allowed him to stand and move his legs. Now they've done the same with three other patients, suggesting their original success was no fluke.

Experts say it's a promising development but warn that the experimental treatment isn't a cure. When the implanted device is activated, the men can wiggle their toes, lift their legs and stand briefly. But they aren't able to walk and still use wheelchairs to get around.

"There is no miracle cure on the way," said Peter Ellaway, an emeritus professor of physiology at Imperial College London, who had no role in the study. "But this could certainly give paralyzed people more independence and it could still be a life-changer for them."

In a new study published Tuesday in the British journal Brain, researchers gave an update on Rob Summers, of Portland, Oregon, the first to try the treatment, and described successful results for all three of the other men who have tried it. All had been paralyzed from below the neck or chest for at least two years from a spinal cord injury.

The study's lead author, Claudia Angeli of the Kentucky Spinal Cord Research Center at the University of Louisville, said she believes the device's zapping of the spinal cord helps it to receive simple commands from the brain, through circuitry that some doctors had assumed was beyond repair after severe paralysis.

Dustin Shillcox, 29, of Green River, Wyoming, was seriously injured in a car crash in 2010. Last year, he had the electrical device surgically implanted in his lower back in Kentucky. Five days later, he wiggled his toes and moved one of his feet for the first time.

"It was very exciting and emotional," said Shillcox. "It brought me a lot of hope."

Shillcox now practices moving his legs for about an hour a day at home in addition to therapy sessions in the lab, sometimes wearing a Superman T-shirt for inspiration. He said it has given him more confidence and he feels more comfortable going out.

"The future is very exciting for people with spinal cord injuries," he said.

The study's other two participants - Kent Stephenson of Mount Pleasant, Texas and Andrew Meas of Louisville, Kentucky - have had similar results.

"I'm able to (make) these voluntary movements and it really changed my life," Stephenson said. He said the electrical device lets him ride on an off-road utility vehicle all day with his friends and get out of the wheelchair.

"I've seen some benefits of (the device) training even when it's turned off," he added. "There have been huge improvements in bowel, bladder and sexual function."

The new study was paid for by the U.S. National Institutes of Health, the Christopher and Dana Reeve Foundation and others.

Experts said refining the use of electrical stimulators for people with paralysis might eventually prove more effective than standard approaches, including medicines and physical therapy.

"In the next five to 10 years, we may have one of the first therapies that can improve the quality of life for people with a spinal cord injury," said Gregoire Courtine, a paralysis expert at the Swiss Federal Institute of Technology in Lausanne, who was not part of the study.

Ellaway said it was unrealistic to think that paralyzed people would be able to walk after such treatment but it was feasible they might eventually be able to stand unaided or take a few steps.

"The next step will be to see how long this improvement persists or if they will need this implant for the rest of their lives," he said.

The National Institutes of Health is investing in more advanced stimulators that would better target the spinal cord as well as devices that might work on people who are paralyzed in their upper limbs.

----

Online:

Journal: WWW.BRAIN.OXFORDJOURNALS.ORG

Foundation: WWW.CHRISTOPHERREEVE.ORG

© 2014 THE ASSOCIATED PRESS. ALL RIGHTS RESERVED. THIS MATERIAL MAY NOT BE PUBLISHED, BROADCAST, REWRITTEN OR REDISTRIBUTED. Learn more about our PRIVACY POLICY and TERMS OF USE.

Tuesday, 08 April 2014 09:31
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LONDON (AP) -- In a north London hospital, scientists are growing noses, ears and blood vessels in the laboratory in a bold attempt to make body parts using stem cells.

It is among several labs around the world, including in the U.S., that are working on the futuristic idea of growing custom-made organs in the lab.

While only a handful of patients have received the British lab-made organs so far- including tear ducts, blood vessels and windpipes - researchers hope they will soon be able to transplant more types of body parts into patients, including what would be the world's first nose made partly from stem cells.

"It's like making a cake," said Alexander Seifalian at University College London, the scientist leading the effort. "We just use a different kind of oven."

During a recent visit to his lab, Seifalian showed off a sophisticated machine used to make molds from a polymer material for various organs.

Last year, he and his team made a nose for a British man who lost his to cancer. Scientists added a salt and sugar solution to the mold of the nose to mimic the somewhat sponge-like texture of the real thing. Stem cells were taken from the patient's fat and grown in the lab for two weeks before being used to cover the nose scaffold. Later, the nose was implanted into the man's forearm so that skin would grow to cover it.

Seifalian said he and his team are waiting for approval from regulatory authorities to transfer the nose onto the patient's face but couldn't say when that might happen

The potential applications of lab-made organs appear so promising even the city of London is getting involved: Seifalian's work is being showcased on Tuesday as Mayor Boris Johnson announces a new initiative to attract investment to Britain's health and science sectors so spin-off companies can spur commercial development of the pioneering research.

The polymer material Seifalian uses for his organ scaffolds has been patented and he's also applied for patents for their blood vessels, tear ducts and windpipe. He and his team are creating other organs including coronary arteries and ears. Later this year, a trial is scheduled to start in India and London to test lab-made ears for people born without them.

"Ears are harder to make than noses because you have to get all the contours right and the skin is pulled tight so you see its entire structure," said Dr. Michelle Griffin, a plastic surgeon who has made dozens of ears and noses in Seifalian's lab.

"At the moment, children who need new ears have to go through a really invasive procedure involving taking cartilage from their ribs," Griffin said, adding that taking fat cells from patients' abdomens to add to a lab-made ear scaffold would be far easier than the multiple procedures often necessary to carve an ear from their ribs. Griffin added they plan to eventually create an entirely synthetic face but must first prove their polymer scaffolds won't accidentally burst out of the skin.

"Scientists have to get things like noses and ears right before we can move onto something like a kidney, lungs or a liver, which is much more complicated," said Eileen Gentleman, a stem cell expert at King's College London, who is not involved in Seifalian's research.

"Where Seifalian has led is in showing us maybe we don't need to have the absolutely perfect tissue for a (lab-made) organ to work," she said. "What he has created is the correct structure and the fact that it's good enough for his patients to have a functional (windpipe), tear duct, etc. is pretty amazing."

Some scientists predicted certain lab-made organs will soon cease to be experimental.

"I'm convinced engineered organs are going to be on the market soon," said Suchitra Sumitran-Holgersson, a professor of transplantation biology at the University of Gothenburg in Sweden. She has transferred lab-made blood vessels into a handful of patients and plans to offer them more widely by 2016, pending regulatory approval. Still, she acknowledged doctors will have to watch closely for any long-term side effects, including the possibility of a higher cancer risk.

Seifalian estimated about 10 million pounds ($16 million) has gone into his research since 2005 but said he hoped lab-made organs would one day be available for a few hundred dollars.

"If people are not that fussy, we could manufacture different sizes of noses so the surgeon could choose a size and tailor it for patients before implanting it," he said. "People think your nose is very individual and personal but this is something that we could mass produce like in a factory one day."

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Tuesday, 08 April 2014 09:29
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WASHINGTON (AP) -- An experimental drug has shown encouraging results in treating advanced breast cancer in an early clinical trial, pharmaceutical giant Pfizer reported Sunday.

Pfizer, the world's second largest drugmaker, said the drug prevented breast cancer from worsening for 20.2 months in a trial involving 165 patients. Current medications do so for 10.2 months. The drug, known as palbociclib, is among a new class of cancer drugs that target specific proteins to block tumors.

The outcome wasn't as positive as some initial results reported earlier in the tests, said University of Michigan business professor Erik Gordon, who studies the biomedical industry but isn't affiliated with the trial.

But, he added, "there's been a lot of hope surrounding this class of cancer drugs, and this keeps that hope alive."

Wall Street analysts have been closely watching the tests given the potential market for palbociclib. Breast cancer is the most common cancer to strike women.

"It's good news, but some investors are disappointed, because they expected more," Gordon said. In earlier results, the drug had kept the cancer from worsening for 18 additional months, rather than 10.

The results were presented by the lead researcher, Dr. Richard S. Finn, associate professor of medicine at UCLA, during the annual meeting of the American Association of Cancer Research in San Diego.

The drug will likely need to undergo broader testing with more patients before the Food and Drug Administration will approve it. The FDA sometimes accelerates approval for drugs that show promise.

Other companies, including Eli Lilly and Novartis, have similar medications that are also in clinical trials.

Pfizer's fledgling cancer drug business has been a recent bright spot for the company, which has many older drugs that will soon lose patent protection.

© 2014 THE ASSOCIATED PRESS. ALL RIGHTS RESERVED. THIS MATERIAL MAY NOT BE PUBLISHED, BROADCAST, REWRITTEN OR REDISTRIBUTED. Learn more about our PRIVACY POLICY and TERMS OF USE.

Monday, 07 April 2014 06:54
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WASHINGTON (AP) -- Here's more fallout from the health care law: Until now, customers could walk into an insurance office or go online to buy standard health care coverage any time of year. Not anymore.
 
Many people who didn't sign up during the government's open enrollment period that ended Monday will soon find it difficult or impossible to get insured this year, even if they go directly to a private company and money is no object. For some it's already too late.
 
With limited exceptions, insurers are refusing to sell to individuals after the enrollment period for HealthCare.gov and the state marketplaces. They will lock out the young and healthy as well as the sick or injured. Those who want to switch plans also are affected. The next wide-open chance to enroll comes in November for coverage in 2015.
 
It's a little-noted consequence of President Barack Obama's health care overhaul, which requires nearly all Americans to be insured or pay a fine and requires insurers to accept people with health problems.
 
"I have people that can buy insurance, but the companies shut them down. They won't take the applications," insurance broker Steve Bobiak of Frackville, Pa., said. "We're a free country. You should be able to buy anything anytime you want."
 
Those who act now may still be able to get in, depending on where they live. Following the lead of the government marketplaces, some companies are extending off-marketplace sales for a week or a month to help people who hit snags trying to enroll by this week's deadline. Rules vary from state to state.
 
After those extensions, eligibility for coverage during 2014 is guaranteed only for people who experience certain qualifying life events, such as losing a job that provided insurance, moving to a new state, getting married, having a baby or losing coverage under a parent's health plan.
 
The federal law doesn't prevent companies from selling policies to everyone all year. But insurers consider it too risky now that the law prohibits them from rejecting people in poor health.
 
"If you didn't have an open enrollment period, you would have people who would potentially enroll when they get sick and dis-enroll when they get better," said Chris Stenrud, spokesman for insurer Kaiser Permanente. "The only insured people would be sick people, which would make insurance unaffordable for everyone."
 
Bobiak, whose NICA Benefits company helps people buy insurance in New Jersey, Ohio and Pennsylvania, said he learned only a couple of weeks ago that insurers were cutting off new policies.
 
"It's lousy communication out there," he said. "If we don't know, my God, how do they expect other people to know? It's terrible."
 
A survey by the Kaiser Family Foundation in mid-March found that 6 out of 10 people without insurance weren't aware of the marketplace deadline on March 31. The Obama administration, insurance companies and nonprofit groups scrambled to spread the word, often with messages that focused on the cost savings available to many people through the government marketplaces.
 
There wasn't much public discussion about people who prefer to buy policies outside the marketplaces, sometimes finding better deals or options more to their liking.
 
Health and Human Services spokesman Aaron Albright pointed to a cryptic note on the HealthCare.gov website: It says "in some limited cases some insurance companies may sell private health plans outside the marketplace and outside open enrollment" that satisfy the law's coverage mandate. It doesn't say how to find any companies doing that. Albright had no further comment.
 
Gary Claxton, a health law expert at the Kaiser Family Foundation, said it's "highly unlikely" that companies will offer such coverage after the deadline window fully closes. Some do still offer temporary plans, lasting from a month to a year. But those plans don't cover pre-existing conditions and don't get buyers off the hook for the law's tax penalty.
 
Nate Purpura, spokesman for eHealthInsurance.com, which sells policies from 200 companies across the nation, said at this point he knows of none planning to offer major medical insurance after this month, except to people with qualifying life events.
 
For people trying to get an off-marketplace plan through an open enrollment extension, some insurers are selling them through April 15, and others through the end of the month. Purpura said eHealth will offer such plans in at least some areas of these states: Arizona, California, Georgia, Hawaii, Louisiana, Maryland, Michigan, Nevada, New Mexico, Ohio, Oregon, Utah, Virginia and Washington state.
 
Kaiser Permanente will offer extensions that mirror the state or federal marketplace in the area where a plan is sold, Stenrud said. The federal marketplace extension for online enrollment is April 15. But Oregon, for example, is giving marketplace buyers until April 30.
 
After that, Stenrud said, without a qualifying life event, the door closes until Nov. 15.
 
---
 
Follow Connie Cass on Twitter at HTTPS://TWITTER.COM/CONNIECASS
 
© 2014 THE ASSOCIATED PRESS. ALL RIGHTS RESERVED. THIS MATERIAL MAY NOT BE PUBLISHED, BROADCAST, REWRITTEN OR REDISTRIBUTED. Learn more about our PRIVACY POLICY and TERMS OF USE.
Friday, 04 April 2014 08:41
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