Santo Domingo.- The demand for medical care for feverish patients with suspected dengue remained high in emergency and hospitalization areas yesterday. Healthcare centers and medical staff continued to experience significant pressure due to the influx of patients seeking treatment, with many requiring hospitalization.

Over the course of 24 hours, 76 patients were admitted to hospitals in Greater Santo Domingo, as reported by the National Health Service (SNS).

The Robert Reid Cabral Children’s Hospital admitted 16 patients with suspicious dengue symptoms, bringing the total number of admissions to 78 by mid-morning. Four of these patients were in intensive care. Additionally, in the early morning hours, seven patients with a confirmed dengue diagnosis were still awaiting available beds, and this number increased as more patients arrived at the emergency area.

In terms of prevention, state institutions, along with volunteers and collaborators, conducted extensive mobilization efforts over the weekend. The goal was to eliminate breeding sites for the Aedes aegypti mosquito, which is the carrier of the dengue virus and breeds in clean water, including containers found in yards and streets.

Out of the 74 patients in the wards with suspected dengue at the Reid Cabral hospital, eight had confirmed cases of the disease. Four of these confirmed cases were in the Intensive Care Unit and were reported to be in stable condition. Fortunately, there were no reported deaths due to dengue at the health center in the last 24 hours.

The Reid Cabral hospital is the second-largest pediatric center in the country that has admitted a significant number of patients with suspected dengue this year, following the emergence of the epidemic.

With over 2.5 million users, PAHO's Virtual Campus for Public Health celebrates 20 years of operation 

Oscar Reyes

30 Oct 2023

SOURCE: AP – The only cure for painful sickle cell disease today is a bone marrow transplant. But soon there may be a new cure that attacks the disorder at its genetic source.

On Tuesday, advisers to the Food and Drug Administration will review a gene therapy for the inherited blood disorder, which in the U.S. mostly affects Black people. Issues they will consider include whether more research is needed into possible unintended consequences of the treatment.

If approved by the FDA, it would be the first gene therapy on the U.S. market based on CRISPR, the gene editing tool that won its inventors the Nobel Prize in 2020.

The agency is expected to decide on the treatment in early December, before taking up a different sickle cell gene therapy later that month.

Dr. Allison King, who cares for children and young adults with sickle cell disease, said she’s enthusiastic about the possibility of new treatments.

“Anything that can help relieve somebody with this condition of the pain and the multiple health complications is amazing,” said King, a professor at Washington University School of Medicine in St. Louis. “It’s horribly painful. Some people will say it’s like being stabbed all over.”

The disorder affects hemoglobin, the protein in red blood cells that carries oxygen. A genetic mutation causes the cells to become crescent-shaped, which can block blood flow and cause excruciating pain, organ damage, stroke and other problems.

Millions of people around the world, including about 100,000 in the U.S., have the disease. It occurs more often among people from places where malaria is or was common, like Africa and India, and is also more common in certain ethnic groups, such as people of African, Middle Eastern and Indian descent. Scientists believe being a carrier of the sickle cell trait helps protect against severe malaria.

Current treatments include medications and blood transfusions. The only permanent solution is a bone marrow transplant, which must come from a closely matched donor without the disease and brings a risk of rejection.

No donor is required for the one-time gene therapy, “exa-cel,” made by Vertex Pharmaceuticals and CRISPR Therapeutics. This new treatment involves permanently changing DNA in a patient’s blood cells.

The goal is to help the body go back to producing a fetal form of hemoglobin — which is naturally present at birth but then switches to an adult form that’s defective in people with sickle cell disease.

When patients undergo the treatment, stem cells are removed from their blood and CRISPR is used to knock out the switching gene. Patients get medicines to kill off other flawed blood-producing cells and then are given back their own altered stem cells.

The treatment has been tested in a relatively small number of patients thus far, the nonprofit Institute for Clinical and Economic Review said in an evidence report.

In a briefing document released Friday before the advisory committee meeting, Vertex said 46 people got the treatment in the pivotal study. Of 30 who had at least 18 months of follow-up, 29 were free of pain crises for at least a year and all 30 avoided being hospitalized for pain crises for that long.

The company called the treatment “transformative” and said it has “a strong safety profile.”

Victoria Gray, of Mississippi, the first patient to test the treatment, shared her experience with researchers at a scientific conference earlier this year. She described suffering with terrible bouts of pain since childhood and receiving high-dose pain medications and sometimes blood transfusions. She described feeling she “was being reborn” the day she got the gene therapy.

Now, she’s able to run around with her kids and work a full-time job. “My children no longer have a fear of losing their mom to sickle cell disease,” she said.

But the FDA is asking an outside panel of gene therapy experts next week to discuss a lingering issue that often comes up when discussing CRISPR: the possibility of “off-target effects,” which are unexpected, unwanted changes to a person’s genome. The FDA is looking for advice on whether the company’s research on such effects was adequate to assess the risk or whether additional studies are needed. While the agency doesn’t have to follow the group’s advice, it often does.

If the treatment is allowed on the market, the company has proposed a post-approval safety study, product labeling outlining potential risks and continuing research.

The FDA is expected to decide on the second gene therapy for sickle cell, made by Bluebird Bio, before the end of the year. Bluebird’s treatment works differently. It aims to add functional copies of a modified gene, which helps red blood cells produce “anti-sickling” hemoglobin that prevents or reverses misshapen cells.

The companies have not released potential prices for either therapy, but the institute report said prices up to around $2 million would be cost-effective. By comparison, research earlier this year showed medical expenses for current sickle cell treatments, from birth to age 65, add up to about $1.6 million for women and $1.7 million for men.

King, the St. Louis doctor, acknowledged the new treatments would be expensive. “But if you think about it,” she said, “how much is it worth for someone to feel better and not be in pain and not be in the hospital all the time?”

The post A new cure for sickle cell disease may be coming. Health advisers will review it next week appeared first on Barbados Today.

One can never be too sweet, yes? Meanwhile, here is the latest grab bag of interesting items for you to peruse. We hope your day is productive and meaningful. And please do stay in touch. We appreciate the insights and tips. …

The U.S. Food and Drug Administration disclosed some safety concerns about an experimental CRISPR-based treatment for sickle cell disease, citing methods used to evaluate a risk of inadvertently making unwanted changes to patient DNA, STAT explains. None of the concerns suggest the agency is reluctant to approve the treatment, which was developed by Vertex Pharmaceuticals and CRISPR Therapeutics. FDA staff said the type of gene editing raises concerns about “off-target” unintended genomic alterations. The small genetic sample size used in a lab analysis may not be sufficient for safety assessment because it did not capture the diversity of the entire U.S. population for the disease.

The FDA warned consumers to not purchase or use certain eye drops from several brands because they may cause eye infection and in some cases possible vision loss, Reuters writes. The agency recommended against the use of 26 over-the-counter eye drop products mainly used to treat symptoms of dry eyes and provide relief against eye irritation. The eye drops are marketed by CVS Health, Rite Aid, and Cardinal Health, among others. The FDA also asked the manufacturer to recall all lots of the product after its investigators found insanitary conditions in the manufacturing facility.

Continue to STAT+ to read the full story…

Personnel from different institutions participated in the fumigation work, elimination of mosquito breeding sites, and orientation to the citizens to stop the epidemic outbreak of dengue affecting the country in the second stage of interventions at a national level, which will continue this Sunday, informed the Ministry of Public Health.

In addition, the operations included the distribution of water tank lids, chlorine, and educational material to sensitize the population on the importance of keeping their environment clean and preventing the formation of water accumulations that serve as breeding grounds for the mosquito that transmits the disease.

The authorities focused on the sectors that have registered the highest incidence of dengue fever in different provinces of the country, including Santo Domingo, where members of the Military Commission of the Ministry of Public Works (Comipol) disinsected the facilities of the Cristo Redentor National Cemetery, applying larvicide in some 320 tombs and where they eliminated 37 mosquito breeding sites.

According to the latest figures provided by the health authorities, so far this year, 13 deaths have been confirmed due to dengue, and there are almost 14,100 suspected cases of the disease in the country.

Aside from early death, smoking is associated with the increased risk of lung disease, heart disease and cancers of various types including lung, head and neck, kidney, and breast. It is also associated with an increased incidence of male infertility, osteoporosis, infections, diabetes, and kidney disease. Unfortunately, in Jamaica we have the second highest incidence of smoking in the English-speaking Caribbean with 17 per cent of adults smoking, according to data from the World Health Organization. Aside from the health consequences of smoking, given its addictive nature, smokers in Jamaica spend a significant amount of their yearly income on cigarettes. As physicians, whenever we encounter a patient who is a current smoker, we advise that they discontinue cigarette smoking as there are multiple health benefits to be obtained. Many studies have demonstrated these improvements in health outcomes and importantly there does not appear to be an age at which stopping smoking is not associated with improved health.

The challenge for most smokers is then how to stop cigarette smoking as this activity is addictive. A common meme is that the easiest way to stop smoking is never to have started. We have made some progress in helping patients who are ready to quit smoking improve the odds of success. Nonetheless most people who are able to quit have tried and failed on multiple occasions. The ideal goal for most patients should be to stop smoking altogether as opposed to a reduction in the number of cigarettes smoked. It is true to say that reducing the number of cigarettes smoked does reduce the risk of some conditions eg, chronic obstructive lung disease and some cancers. However, for cardiac and vascular disease it is really all or none, as several studies have demonstrated the increased risk in non-smokers who are exposed to second-hand smoke.

Am I ready to stop smoking?

Probably the most important factor in successfully quitting cigarettes is the readiness of the smoker to stop. For the most part, until a patient is ready to stop there is not much that health-care personnel can do. There is some data that suggests that asking about smoking habits and counselling smoking cessation does have a small effect, so that for many physicians this is a routine part of practice. Given the additive nature of cigarettes it can be difficult for patients to find the willpower to stop smoking. For some patients, having a cardiac or vascular complication associated with cigarette smoking can improve the chance that they will quit. The percentage of smokers that stop smoking after a heart attack varies in different studies but can be as high as 40-50 per cent of patients. Studies have further demonstrated a 50 per cent reduction in the risk of subsequent heart attack if a patient can successfully discontinue the use of cigarettes. An important advantage that the hospitalised patient has is that they are forced to stop smoking while they are hospitalised and are commonly prescribed medication to reduce nicotine cravings and withdrawal symptoms.

What will happen when I stop?

Stopping cigarettes does make the smoker feel unwell because there are effects that occur secondary to nicotine withdrawal and effects that are related to psychological and physiological changes in the brain. Symptoms of nicotine withdrawal start almost immediately, peak about three to four days after smoking cessation and can last for about three to four weeks. These symptoms include difficulty sleeping, anxiety, constipation, mood changes and trouble thinking clearly. Nicotine replacement therapy can help reduce these symptoms. Weight gain is a common long-term consequence of stopping smoking with the average weight gain being 8 to 10 pounds. This does appear to be associated with increased food/caloric intake after smoking cessation. The issue of cravings or the psychological need to have a cigarette can persist for years after stopping and while medication can help some, some patients will tell us that these sensations/cravings never really go away.

Are there ways to reduce the symptoms

Nicotine replacement therapy is generally short-term therapy that is designed to replace the nicotine that was obtained from the cigarette with nicotine that enters the body without the accompanying toxins that are produced by combustion of the cigarette leaf. There are several forms including gum, patches, nasal sprays, and lozenges. As a general rule the higher the number of cigarettes that are smoked on a daily basis is the higher the amount of nicotine that is needed initially. For most people nicotine replacement therapy is only necessary for a few weeks to few months after smoking cessation. Aside from nicotine replacement therapy there are some medications which are useful. Varenicline (Chantix) is a medication that both reduces nicotine withdrawal symptoms and also helps with symptoms of craving cigarettes. Bupropion (Wellbutrin) has also been shown to help with cigarette cravings.

Next week we will look at how to stop smoking.

Dr Ernest Madu, MD, FACC and Dr Paul Edwards, MD, FACC are consultant cardiologists for the Heart Institute of the Caribbean (HIC) and HIC Heart Hospital. HIC is the regional centre of excellence for cardiovascular care in the English-speaking Caribbean and has pioneered a transformation in the way cardiovascular care is delivered in the region. HIC Heart Hospital is registered by the Ministry of Health and Wellness and is the only heart hospital in Jamaica. Send correspondence to
info@caribbeanheart.com
or call 876-906-2107.

Family members say they do not believe the number of cases has decreased. On the contrary, they say that they know of more and more children with symptoms; they also say that spaces and beds in hospitals are scarce.

Johanna Santos, the grandmother of a nine-month-old baby, was waiting for news about her grandson outside the Hugo Mendoza Pediatric Hospital in Santo Domingo Norte after being admitted for several days with suspected dengue fever.

“Don’t pay any attention to the fact that dengue is decreasing. Dengue is ending; it is not decreasing at all. That is a lie,” said the lady. She insisted that there were no more beds available at the hospital due to the number of children hospitalized.

According to a hospital spokesman, yesterday morning, 82 patients remained in the center, which was at maximum capacity.

No beds

During the last few weeks, the number of patients in the hospitals continues to be alarming, while several health centers are at maximum capacity, and the lack of beds to attend to the infants is evident, according to parents.

Yoleidy Suarez, mother of a two-year-old boy admitted to the Robert Reid Cabral Children’s Hospital with dengue fever, indicated that although her little boy has received good care, she says that in the observation area, there are no beds.

“Upstairs (in internment) everything is fine, but downstairs, in observation, there are three and four children in a single bed,” Suarez said.

This information was corroborated by other people such as Maritza Rodriguez, aunt of a 14-year-old boy with the same disease, who assured that the emergency area has remained full.

Outside the Hugo Mendoza Hospital, several parents were waiting for news of their relatives admitted or attended by the Emergency Department. They indicated that the wards of the health center were also full of parents with their children.

“You can’t even get in here,” exclaimed a mother who came with her little girl who has sickle cell disease (sickle cell patient), referring to the fact that the place was overcrowded and that she would have to go to another health center.

Robert Reid

At the Robert Reid Cabral Hospital, in the morning hours, 33 patients had been admitted with symptoms of dengue fever.

According to a spokesman for the health center, 69 patients were still in the ward with a possible diagnosis of the disease, while eight were confirmed.

In the Intensive Care Unit (ICU), the center kept a total of four children hospitalized, all of whom were stable.

Alarming symptoms

Among the warning signs for parents coming to children’s hospitals are fever, vomiting, headache, and body aches, among other symptoms.

In addition to these febrile symptoms, children come to the centers with signs of respiratory viruses such as pneumonia or bronchopneumonia.

AbbVie today announced that the UK Medicines and Healthcare products Regulatory Agency has granted conditional Marketing Authorisation for Tepkinly® (epcoritamab) as a monotherapy for the treatment of adults with relapsed or refractory (R/R) diffuse large B-cell lymphoma (DLBCL), after two or more systemic therapies.

Georgetown Public Hospital Corporation (GPHC) on Friday announced a significant enhancement to its medical services by providing free knee and hip replacement surgeries, including revision procedures, free of cost to patients. The GPHC said following a proactive proposal from the hospital management to the Board of Directors, the decision to remove all charges for these ...