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Flesh-eating bacteria that can kill in 2 days spreads in Japan
Most drug deaths due to 'polysubstance' use, EU report
Synthetic opioids continue to concern European drug agencies. A new report states that 'polydrug' use is leading to new health risks. Data on cannabis since Germany's legalization, however, is still sparse. The top takeaway from the European Drug Report 2024 : Drug users in Europe are increasingly using more than one drug at the same time — a practice known as "polydrug" or "polysubstance" use. And synthetic opioids remain a top-level concern for drug monitoring and drug addiction agencies. These trends may or may not be voluntary as potent synthetic opioids are often being mis-sold or mixed with medicines and other drugs, and cannabis products are being adulterated with synthetic cannabinoids — so users don't always know what they are taking. Polydrug use is the use of two or more psychoactive substances, licit or illicit, simultaneously or sequentially. Substances may be sold that contain one or more drugs other than the one the purchaser was expecting, either in a mixture with the substance they intended to buy or even as a replacement for it. (Source: Understanding Europe's drug situation in 2024 — key developments/European Drug Report 2024) "Polydrug use can increase the risk of a drug overdose," stated the report, published by the European Monitoring Centre for Drugs and Drug Addiction (EMCDDA) on June 11, 2024. "The majority of fatal overdoses involve the use of more than one substance […] cannabis was the drug most commonly reported in the cases of polydrug use toxicity." Heroin is still the most commonly used illicit opioid in Europe. Cocaine use is second only to cannabis. Synthetic opioids play a smaller role in Europe than they do in North America, according to the report, but their use is increasing in Europe, too. And they are "often highly potent and carry a significant risk of poisoning and death." Six out of seven new synthetic opioids reported for the first time to the EU Early Warning System (EWS) in 2023 were nitazenes.  EU Drug Reports lacks data on synthetic opioids By its own admission, and despite its 177-page heft, the report lacked data in a number of key areas essential for assessing public health effects and measures to curb addiction rates and drug overdoses. Take nitazenes, for example: The report stated that in 2023, nitazenes were associated with a "sharp rise" in deaths in Estonia and Latvia and with localized poisoning outbreaks in France and Ireland.  But nitazenes and similar substances are not always detected in routine post-mortem toxicology tests in some countries, "so associated deaths may be under-estimated." That means that the EMCDDA simply isn't getting the data it needs, especially when EU states fail to check for new and evolving drugs on the market. "As drug consumption patterns are becoming ever more complex, there is also a growing need to improve our understanding of how changes in patterns of polydrug use are impacting on mortality," stated the report. Another key area that lacked data was the impact of cannabis legalization. This is striking against two facts stated by top-level speakers at an EMCDDA briefing: Ylva Johanssen, European Commissioner for Home Affairs said: 'After cannabis, cocaine is the second most common drug used in the EU.' Alexis Goosdeel, EMCDDA Director said that the concentration of THC, the psychoactive element in cannabis resin had 'doubled in the last ten years' and it continues to rise, according the written report. Average THC was at 22.8% in the year 2022. The report suggests that 'any policy development in this area' meaning legalization or toleration of cannabis, for instance 'should be accompanied by an assessment of the impact of any changes introduced. This sort of evaluation will depend on the existence of good baseline data; underlining again the need to improve our monitoring of current patterns of use of Europe's most commonly consumed illicit drug.' The EMCDDA's 'national focal point' in Germany is the 'Deutsche Beobachtungsstelle für Drogen und Drogensucht" (DBDD), or the German observation office for drugs and drug addiction. DBDD Director Eva Hoch told DW that the issue of missing baseline data — an agreed "starting point" from which to evaluate any changes or developments — could affect Germany's ability to evaluate the impact of its legalizing cannabis in April 2024. 'German researchers said a year ago that the scientific evaluation should start before the legalization, because we need that baseline data,' said Hoch. Cannabis consumption had been on the rise for a decade before legalization, said Hoch, and this needed to be taken into account to properly track the impact of legalization. 'The picture is cracked in Germany,' said Hoch. 'There are many anecdotes on the internet and social media, but we don't have systematic data. It's unclear how the law has been adopted across the country's 16 federal states […]. There is no systematic data on the immediate impact of the new law we can't say whether cannabis consumption has increased in the two months since legalization or whether demand has increased, or whether there have been more traffic accidents since legalization in April.' Those factors are just the start. Studies in the US and Canada had shown, said Hoch, that there were more than 100 factors that can help evaluate the effect of cannabis legalization. The German government had planned to evaluate the impact of the legalization of cannabis, she said, but that process had yet to start, and there was no sign of when it would begin.
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Polio: All you need to know about the viral disease
At its worst, polio causes paralysis: 'Polio Paul' Alexander had to spend 70 years in an iron lung after surviving the disease as a child. Children are still at risk in Pakistan and Afghanistan, where polio is endemic. Polio is a very contagious viral disease caused by the poliovirus. It can cause permanent disability and even death, especially in children under the age of five. There are two types of polio present in the world today: Wild poliovirus and vaccine-derived poliovirus. The latter originates from an oral polio vaccine, known as the Sabin vaccine, or OPV.  Wild poliovirus has been eradicated in most countries, aside from Afghanistan and Pakistan. Vaccine-derived poliovirus has been found in Yemen and central Africa. Both the wild and the vaccine-derived forms have three types of viruses — types 1, 2 and 3. Although vaccine-derived polio can take the form of any of the three types, type 1 is the only remaining form of wild poliovirus. Types 2 and 3 were declared eradicated in 2015 and 2019. Although all wild poliovirus types can cause the same symptoms, there are differences in how damaging they can be, and immunity to one type does not protect against the other types. What are the symptoms? Most people infected with polio are asymptomatic. Around one in four people experience flu-like symptoms, such as a sore throat, fever, headaches or stomach pain. Generally, these symptoms go away on their own after two to five days.  Although rare, a very small percentage — less than 1% — of people infected with the poliovirus experience very dangerous symptoms, such as permanent paralysis, which can lead to a permanent disability, and even death when the virus affects the muscles required for breathing. Sometimes children that seem to have fully recovered can later, as adults, develop post-polio syndrome, which is characterized by new muscle pain, weakness or even paralysis. How is polio transmitted? The virus infects a person's intestines and throat. It can survive there for many weeks. It spreads through a community via contact with an infected person's respiratory droplets or feces. In places with poor sanitation, the virus can also contaminate food and drinking water. Infected people can spread the virus to others right before symptoms appear and until up to two weeks after. Where is polio present today? Polio has not yet been eradicated worldwide — the wild form of the virus still exists in Afghanistan and Pakistan. And although Africa has been considered free of wild polio since August 2020, imported cases were reported in Malawi and Mozambique .  In July 2022, the US reported its first case of vaccine-derived polio in a decade. Vaccine-derived poliovirus was also detected in sewage samples in the UK and Israel. It was a "stark reminder that if we do not deliver our goal of ending polio everywhere, it may resurge globally," said WHO Director-General Tedros Adhanom Ghebreyesus at the time. More than a hundred countries have been declared polio-free thanks to the development of polio vaccines in the middle of the 20th century and aggressive global innoculation campaigns. What are the two types of polio vaccine? There is no cure for polio, but there are vaccines for preventing the disease: The oral polio vaccine (OPV) and inactivated polio vaccine (IPV). The oral polio vaccine is administered as an oral liquid and has been key for international eradication because it protects the individual and stops the virus from spreading. The OPV uses live but weakened forms of the poliovirus that are modified not to cause disease in the person taking the vaccine. But if the OPV-weakened virus is able to stay alive and circulate in places with poor sanitation, such as in wastewater, where there is a high number of unvaccinated people, it can mutate back into a disease-causing form of the virus. The inactivated polio vaccine is given as an injection and is extremely effective at protecting the receiver from serious disease. Because it's inactivated, it cannot cause vaccine-derived poliovirus. However, unlike the OPV, it doesn't stop the spread of the virus if the person is already infected. The OPV is cheaper than IPV and does not need to be administered by a health professional. But more and more countries are using IPV, because of the risk of vaccine-derived poliovirus. There are some types of care that can help with symptoms caused by polio, like bed rest, painkillers, breathing assistance and physical therapy.
WHO says more contaminated medicinal syrups found in new regions
The World Health Organization on Thursday said several contaminated syrups and suspension medicines had been identified in countries in the WHO regions of the Americas, the Eastern Mediterranean, South-East Asia and the Western Pacific. The affected products were manufactured by Pharmix Laboratories in Pakistan, the WHO said, and were first identified in the Maldives and Pakistan. Some of the tainted products have also been found in Belize, Fiji and Laos. Pharmix was not immediately available for comment. The medicines, liquids containing active ingredients to treat various conditions, contained unacceptable levels of the contaminant ethylene glycol, WHO said. The alert is the latest in a line of warnings from WHO about similarly contaminated medicines made in India and Indonesia, which were linked to the deaths of around 300 children worldwide last year. No adverse events have been reported to the WHO regarding the Pakistan-made syrups, the agency's statement said, but it urged countries to step up vigilance and test products made by the company between December 2021 and December 2022. The contamination was found in Alergo syrup in a routine examination by the Maldives Food and Drug Authority in November, and confirmed by the Australian regulator. A follow-up inspection at Pharmix manufacturing facilities, conducted by the Drug Regulatory Authority of Pakistan, found that a number of other products were also contaminated. It has ordered the company to stop making all oral liquid medicines and issued a recall alert in November. A total of 23 batches of Alergo syrup, Emidone suspension, Mucorid syrup, Ulcofin suspension and Zincell syrup are affected, the WHO said. Only Alergo so far has been found outside Pakistan. The contamination levels ranged from 0.62% to 0.82%, compared to the accepted level of not more than 0.10%, according to the alert. The products are variously designed to treat allergies, coughs and other health issues. "The substandard products referenced in this alert are unsafe and their use, especially in children, may result in serious injury or death," the WHO warned.   Source: REUTERS
US to end mpox state of public health emergency
The mpox public health emergency was declared over the summer, as the country struggled to contain the soaring number of infections. However, cases have receded since, with vaccination going strong. The United States will likely end in late January the state of public health emergency declared last summer over the large number of mpox cases. Over 29,000 people were infected in the outbreak. However, cases shrank in recent weeks, after an effective vaccination strategy. The virus was initially known as monkeypox, but the WHO changed this name to mpox earlier this week, as it searched for a "neutral, non-discriminatory, and non-stigmatizing" name. Mpox in the US is most common among men who had sex with infected men. How did the US contain the virus? The US struggle to contain the mpox outbreak started to recede in August, after the declaration of the public health emergency. The White House tasked two top health officials, Robert Fenton and Dr. Demetre Daskalakis, with leading the response. The new strategy centered around targeting local clinics and Pride events with the two-dose Jynneos vaccine. The virus has killed 17 people to date in the US. The Health and Human Services Secretary Xavier Becerra said on Friday that the department expected there will no need to renew the emergency declaration on January 31. "But we won't take our foot off the gas,  we will continue to monitor the case trends closely and encourage all at-risk individuals to get a free vaccine,'' Becerra said. How serious is mpox? In July, the WHO declared the worldwide mpox outbreak a Public Health Emergency of International Concern (PHEIC). Typical mpox symptoms include a rash, headache, fever and chills, among others. The WHO has urged gay and bisexual men to limit their number of sexual partners in order to prevent the spread of the disease. Though endemic to Africa, mpox has spread to several parts of the world this year, claiming lives.    
For children, serious respiratory infections are on the rise
Germany's public health agency reports more than 7 million cases of respiratory illnesses in a month. Babies and children have been infected by a virus that could threaten lives. Why are there so many cases this year? Doctors' offices across Germany are full of coughing, sniffing patients who don't just look miserable but probably feel that way, too.  According to the Robert Koch Institute, the country's public health agency, more than 7 million people have come down with various respiratory illnesses within a month. With cases skyrocketing in such a short stretch of time, doctors are barely able to cope. It's not unusual for cases of infectious disease to increase during the winter months. But this time around, the number is extremely high, and medical and care staff are reaching their limits. Altogether, researchers have identified around 200 different cold pathogens. Four of them are particularly rife in Germany and Europe at the moment, according to the Robert Koch Institute: influenza viruses, rhinoviruses, SARS-CoV-2 and the respiratory syncytial virus (RSV), which can be be dangerous particularly for babies and toddlers. RSV can lead to serious symptoms Many of the children who have been infected by the highly contagious RSV have been sent to the hospital for respiratory support. In some regions of Germany, pediatric wards are completely full. RSV is a common virus, and occurs on a seasonal basis. It can lead to bronchiolitis, which mainly affects children under the age of 2, causing their small airways to become inflamed and swell up. The airways become narrower, reducing air flow to and from the lungs, which can result in breathlessness and pneumonia. Mucus builds up in the fine bronchioles, the smaller branches of the airways, and can leave them seriously damaged. Fever and coughing are also typical of an RSV infection. Some children develop symptoms that resemble those of whooping cough, which can also lead to a life-threatening situation. Adults, for their part, tend to get over such infections without major problems — unless they have serious underlying medical conditions or an immune system that isn't functioning as well as it could. Lax COVID restrictions leading to more cold infections During the worst phases of the COVID-19 pandemic, infections by cold viruses — including RSV — were relatively rare. Most people observed the strict hygiene precautions put in place to stop the spread of COVID: frequent hand-washing, mask-wearing and social distancing. This made it considerably more difficult for viruses of all types to spread far and rapidly. This year, however, the anti-coronavirus measures aren't as strict, both in Germany and many other countries. Cold viruses don't need to overcome distance or face masks to spread their infection, and all those children who escaped infection during the pandemic are now getting sick, creating many more cases than there would be in a typical year. Many of the babies and toddlers who weren't infected two years ago are now getting sick this winter. The same goes for those who avoided illness last year, and the newborns who are just now experiencing their first wave of colds. All these cases are adding up, causing the overall number to explode. All these children have not previously had a chance to build up antibodies against RSV, or many other types of cold virus. Such antibodies help the body to fight off viruses and protect itself from pathogens. The hygiene measures to combat the coronavirus meant that the immune systems of babies and toddlers have, until now, never had to deal with cold viruses — making the current wave of infections all the more serious. What should parents look out for? A major alarm signal for parents is when a child has difficulty breathing, or makes rattling breath sounds. Whistling noises in the lungs or a sort of crackling can also be an indication of a respiratory illness, such as an RSV infection. The Robert Koch Institute has said that children with RSV often don't want to eat or drink, and may vomit. Tiredness can also be a symptom; children sometimes become apathetic and lose interest in everything. Where the symptoms come from exactly, how serious the illness is or whether it could even be life-threatening for a child are best assessed by medical experts. The most important thing to do in such a case is to go to a pediatric doctor, even if making an appointment isn't all that easy at the moment. The RKI has warned that the danger of infections is far from over, with worldwide case numbers possibly rising even further. France already made an emergency plan for a bronchiolitis epidemic in early November. Other countries may soon be forced to follow its example. This article has been translated from German.
International Day of Persons with Disabilities / HOW TO UNDERSTAND AND RESPECT PEOPLE WITH DISABILITIES- SOME ‘DOs and DON’Ts’
My elder brother, James, who was born in 1943 with a genetic chromosomal abnormality, Down Syndrome, and who had a severe learning disability, died in 1999 in the U.K. as a result of negligence.  He died of bronchial pneumonia because doctors who were treating him did not take the time and trouble to find out exactly what was wrong with him.  He had been suffering with diarrhoea and they treated him for that without properly examining him at the residential care home in which he lived.  He died because he was unable to communicate with the doctors and his carers supposedly trained to look after people with such difficulties.  His birthday, which he always celebrated with a lot of fun and laughter among friends, even going to a local pub for a drink, was 3rd December.  This date, therefore, has special significance for me, because, in most countries of the world, 3rd December is observed as the International Day of Persons with Disabilities.  It is only right to ask ourselves if we ever take time to understand the problems, the challenges, the feelings and the aspirations of those people who live among us who, as a result of a disability or disabilities, find their lives more difficult to handle than most of us.  When we meet people with disabilities, due to our lack of knowledge, we often feel awkward and embarrassed as we do not know how to react, what to do, or what to say. I am writing down some practical advice which may help in the understanding of how people with disabilities feel. I draw on my own personal experience of growing up with a brother with a severe learning disability and later in life having a son, now 46 years old, with a similar disability. These experiences and knowing many other people with disabilities who have become close personal friends, have enriched my life and my work. Having assisted, in 1990/91, for putting together the first preliminary draft of Bangladesh’s National Disability Policy, and having seen how slowly it made progress, I am well aware of how officialdom looks at the problems of the disabled. Although, 40 years ago, 1981 was observed as the International Year of Disabled Persons, the rights of persons with disabilities have always tended to be at the bottom of most governments’ budget plans, and so, it can only be stressed that much more work has to be done. Having said that, I am pleased to see that the Government in Bangladesh has been taking a much closer interest in the difficulties faced by persons with disabilities and that the Disability Welfare Act 2001 was amended and strengthened in Parliament through the Disability Rights and Protection Act, 2013. In addition, “Protection of Persons with Neuro-developmental Disability Trust Act, 2013” was also enacted. Significantly, multilateral, bilateral and INGO donors have now adopted the slogans ‘Leave Noone Behind’ and ‘Disability Inclusion’. 30 to 40 years ago all development programmes had to address issues related to women to be accepted by donors. So very many years later, the rights of people with disabilities are now, at last, recognized! My work over the years has been enriched by many friends in Bangladesh and elsewhere who have disabilities, and all the time I try to focus on the person and not on the disability and hopefully what I write below – and I first wrote most of these words 35 years ago - will help Government Ministers and government officials better understand what they have to do and how to relate to persons with disabilities. The best advice, however, is that if you do not know how to handle your relationship with a person with a disability, ask him or her for advice.  I hope these Do's and Don'ts will enrich the lives of those who read them and some of the millions of people with disabilities in Bangladesh. -Don't treat a person with one disability as if she/he is disabled in other ways. People tend to talk in simple single syllable words to people who use wheelchairs, they shout at the deaf, and often address a blind person through someone else. -Don't focus on a person's disability, focus on the person. -Do ask if you can help- and how to help-if it looks as if help might be needed. You may be shy about offering help. The disabled person may also be shy about asking for it. And don't be offended if your help is not needed-persons with disabilities usually like to be as independent as possible. And don't be put off from offering your help at another time. -Don't say "I wouldn't try that if I were you"-a disabled person is likely to be the best judge of what she/he can or cannot do. -Don't show pity and say, "I don't know how you manage; I'd die if I couldn’t walk." It is often hurtful and, under the guise of praise, reinforces the sense of being different. -Do treat children with disabilities as normally as possible-including not allowing them to misbehave. Disabled children need to learn the boundaries of acceptable behaviour, in their own society, just as other children do. -Do identify yourself straightaway. A blind person can't always place you by a 'hello'.  It's hard for her/him to reply warmly, 'hello', if she/he doesn't know who you are. So, give a name and context; "Hello, it's Tasneem.  We met last week at Shahana’s house." -Do make a special effort to remember the name of a person who is blind. Beginning with her/his name is the only way of letting him know that you are talking to her/him. -Don't feel shy about saying things like "nice to see you" to a blind person. She/he may even say it back. It's impossible to avoid words connected with seeing-blind people aren't self-conscious about it and needn’t be. -Don't grab a blind person's arm unexpectedly. You'll startle her/him. In fact don't hold a blind person’s arm at all! Allow her/him to hold yours. She/he is then safely half a step behind you and so is forewarned of what your next move will be by the change in your position. -Don't say "here's a step”-say, "step up" or "step down." It's dangerous as well as embarrassing to be waving your foot in mid-air when the step actually leads down. Also if the step is exceptionally deep or shallow, do mention it. -Don't leave doors half open. Shut them all the way or open them flat against the wall. -Don't exclude a blind person from television. It gives her/him access to a world familiar to her/his sighted friends. -Don't exclude a blind friend from outdoor activities. Ask if she/he would like to shop with you instead of your doing it for her/him. -Don't chase a child away from a person with a learning disability (often, wrongly, referred to as 'mentally retarded') who might approach her/him.  It only perpetuates the feeling that there is something to be afraid and ashamed of if she/he reaches out to touch a child, take her/his hand and turn it into a friendly handshake-deflecting the attention away from the child and on to yourself -Don't be afraid of a person with a learning disability. Very few are violent-and if they are among people, you can assume that they are not violent. Avoidance and rejection are among the most commonly upsetting things to people with learning disabilities. -Do be honest and keep promises. Don't assume that a person with a learning disability doesn't understand or remember what you've said. As an example, my son Neil, now 46 years old, who has a severe learning disability, has a very good memory, an amazing sense of direction and a great sense of humour. -Do take time to listen to someone who is mentally ill-and don't assume that she/he has no knowledge or opinions of value. -Don't express pity for parents of 'retarded' children-their child is just as precious to them as any child is to any parent. -Don't give advice, except to point someone in the direction of professional help if none is being given and some help seems necessary. -Do remember that any practical help you offer may need to be given for a long period. -Don't tell a person who is mentally ill to "pull themselves together". If they could, they would. -Don't grab hold of a wheelchair without being asked. The occupant can easily be thrown out by an inexpert enthusiast. Remember to warn her/him if you are going to turn the chair round quickly. In fact, it's thoughtful to tell her/him whatever your next move is going to be. -Do check with the person in the wheelchair if the speed you are pushing her/him at is comfortable.  Too fast-it's unsettling. Too slow-it's plain boring. -Don't lift the wheelchair by the armrests-they'll probably come out in your hands. Do remember that the person may find it hard to hear what you are merrily chattering about-and since your voice, coming from behind, may not compete well with traffic noise. Also, from her/his vantage point, she/he may not be able to see what you are pointing to. -Do chat to a person in a stationary wheelchair with your head on the same level. It's embarrassing always literally to be "looked down upon" and uncomfortable always to be looking up. -Do ask her/him how to get a wheelchair up or down a flight of stairs-there are often simple mechanisms or techniques which the disabled person will know. -Do keep your face clearly visible when talking to a deaf person. Face the light. If you stand with your back to the light or window then you may be silhouetted, wiping out the details needed for lip reading. Don't move around-your deaf friend will miss words each time you turn your face. -Do not distort your face exaggeratedly to 'help' a lip-reader. The subtle signs she/he watches out for will be swamped by such contortions. And don’t shout-it doesn’t help and can distort hearing aids. -Do bear in mind that someone who is deaf may be nervous of going out in the dark.  Already denied one sense, she/he may be uneasy about being deprived of another. Indoors, make sure she/he has easy access to a safe light. And don't forget to take a torch if you go out at night with someone who is deaf-shine it on your face when you speak. -Don't remain silent if you can't make out what a deaf person is trying to say, or if her/his hearing aid is making a whistling noise. Be frank. How else is she/he expected to know? -Don't condescend. A deaf person's voice may sound strange. But there's no need to behave as if he she/he has a learning disability as well. -Do play music. People who are deaf can "hear" the beat through the vibrations. Deaf teenagers love records and dancing at discos-the louder the music the better.  ##