ANSWERING THE CALL-a poem

African_Sunset_Kenya

I see the owls.
And hawks carrying off chickens roosted in trees for the night
But my crows have returned to their winter housing

Wonder what they might like for feed

Though the winds did take down their tree in which they nested in over winter
For as long as I have been here.
For 22 years I’ve watched and waited.

Yesterday a good dozen gathered in a tree that overlooked their old home
Now gone
I wonder will they rebuild or do they time share in nests of other birds
Like the owl and hawk do.
Is the crow it’s third time share
So who is going to rebuild their home

What can I do?

-Written by Karen Kloepping
Printed and posted 11.1.2014 by kind permission and with great respect.

Advertisements

Ebola Virus Disease and the Variable Febrile and Subjective Response

I am going to West Africa soon with full knowledge of the risks to ourselves but the purpose of screening is to contain further transmission of the disease. There is no screening checkbox for “not feeling right”. Subjective fever.
Always a good topic as to what constitutes fever. We all remember the days when “normal” was 98.6 degrees F. Now, with digital read outs, Harrison’s textbook of internal medicine defines a fever as’ “a morning oral temperature of >37.2 °C (>98.9 °F) or an afternoon oral temperature of >37.7 °C (>99.9 °F) while the normal daily temperature variation is typically 0.5 °C (0.9 °F).”

Additionally, so we are all on the same page, we would really like to have it as close to the “core body temperature” as possible but, in reality, most of us don’t want an esophageal probe every time we feel uneasy, so we do need another way that best approximates our own, individual core body temperature. Only you know what that is.

Also the manner in which it is measured and observed by another is critical in its accuracy. A rectal thermometer is the best, then oral (mouth closed!), temporal artery (not across the forehead, not a strip), then tympanic in that order. A lot of variability. Because of that, and my soap-box statement is I am weary of “check-box” medical history taking, a blanket check box that specifies a single number to fit every single individual is simply thoughtless.

Let’s take a scenario of infection.

image

Image 1. Clinical course of single patient found to have been infected by the Tai Forest Ebolavirus (TAFV). His temperature varies during the viremia stage.

Continue reading

LIFE SIMPLY FINDS A WAY

Here's the script.  There are so many great quotes in series here. Had to get the script and share it. From Jurassic Park:

MALCOLM
John, the kind of control you're attempting is not possible.  If there's one thing the history of evolution has taught us, it's that life will not be contained. Life breaks free.  It expands to new territories.  It 
crashes through barriers.  Painfully, maybe even..dangerously, but and...
well, there it is.

WU
You're implying that a group of composed entirely of females will breed?

MALCOLM
I'm simply saying that life - - finds a way.

(Later in the script)

MALCOLM
Don't you see the danger, John, inherent in what you're doing here?  Genetic power is the most awesome force ever seen on this planet.  But you 
wield it like a kid who's found his dad's gun.
-I'll tell you.

MALCOLM (cont'd)
The problem with scientific power you've used is it didn't require any 
discipline to attain it.  You read what others had done and you took the next step.  You didn't earn the knowledge yourselves, so you don't take 
the responsibility for it.  You stood on the shoulders of geniuses to 
accomplish something as fast as you could, and before you knew what you 
had, you patented it, packages it, slapped in on a plastic lunch box, and now you want to sell it.
HAMMOND
You don't give us our due credit. Our scientists have done things no one
could ever do before. 

MALCOLM 
Your scientists were so preoccupied with whether or not they could that 
they didn't stop to think if they should.

No way around statistics in that biology does what it does so well. It simply finds a way.

Another Reason Not to Sleep with Swine. Cases of Novel Swine Influenza On the Rise. Triple reassortment influenza A(H3N2) viruses of swine origin with the Pandemic H1N1 virus

On August 3, 2012, Robert Lowes reported in Medscape News information from the center of Disease Control (CDC) regarding the number of people infected with the novel swine influenza A(H3N2)v  virus.— There have been  29 afflicted with the virus, with 12 new cases reported this week.

It appears that the disease was transmitted by either direct or indirect contact with pigs infected with the swine influenza virus. Most of these were children as adults may have a preexistent immunity. Of the 12 swine influenza cases from this week, 10 were patients who had been exposed to pigs at a county fair in Butler County, Ohio. Another patient was from Hawaii that worked with pigs. The CDC has identified a few cases of human-to-human transmission, and the agency is closely monitoring the virus to see whether it mutates into a version more easily spread among humans in lieu of its similarity to theM2 protein of the pandemic H1N1 influenza virus.

The viral M2 matrix protein (light blue) is responsible for entry of the viral ssRNA into the cytoplasm upon infection.

“We want to understand why we’re seeing more cases than we have in the past,” said Dr. Bresee from the CDC. Possible explanations include a change in the virus’ genetic makeup, more human interaction with sick pigs during summer county fairs, or an increased effort to look for this novel virus.

“We expect that additional cases will be identified,” he added. “We also expect some of the cases might be severe.” The symptoms are similar to the seasonal virus, making the diagnosis difficult.

The swine influenza virus is designated A(H3N2)v, with the “v” standing for variant. The variance is in the “M” gene from the pandemic 2009 influenza A(H1N1) virus which codes for matrix proteins in the viral shell.  The pandemic H1N1 virus has found its way into the nation’s pig herds, leading to the alteration of the A(H3N2) virus that circulates among these animals. The concern is that that by acquiring the M gene from the 2009 H1N1 virus, the H3N2v viruses may be more transmissible from pigs to people and from person-to-person. Using phylogenetic analysis, Nelson in June, 2012 reported it appears the pM (pandemic matrix) gene segment reassorted with multiple lineages of the H1 virus. Additionally, the N2 segment of all H3N2v viruses isolated from humans is derived from a genetically distinct N2 swine that was acquired by reassortment with seasonal human H3N2 viruses in 2001-2002, rather than from the N2 that is associated with the 1998 H3N2 swine lineage. This is the reason for the concern for a pandemic threat with this virus. So far, in vivo testing has detected no increased virulence in A(H3N2)v or rH3N2p viruses.

At least we still have access to the influenza vaccine. That should keep us protected, right? Think again. There is a general misconception about currently available vaccines, the benefits of which, Michael Osterholm from the Center for infectious Disease Research and Policy at the University of Minnesota has stated, have been grossly oversold. “They’re not nearly as effective as we’ve told the public they are,” he says, and he backs that claim with the findings of a meta-analysis he and colleagues conducted last year. The seasonal vaccine was effective in only 59% of patients age 18-65 years. The swine influenza A(H3N2)v virus is also different enough from the prior human H3N2 virus  to make it impervious to the seasonal vaccine requiring another vaccine to be developed before the next pandemic.

Since 2000, another concern is that the influenza A virus has shown a substantial increase in amantadine-resistant strains, most of which have a substitution at amino acid position 31 in the M2 gene. These drugs inhibit the M2 matrix protein needed to get viral ssRNA into the cytoplasm. They work against influenza A strains only, and resistance to the drugs evolves quickly. As a consequence, by the 2009-2010 flu seasons, virtually all strains of both H3N2 and H1N1 had developed resistance.

 

References:

  1. Efficacy and effectiveness of influenza vaccines: a systematic review and meta-analysis . Osterholm MT, Kelley NS, Sommer A, Belongia . Lancet Infect Dis. 2012 Jan;12(1):36-44. Epub 2011 Oct 25
  2. Pathogenicity and transmission in pigs of the novel A(H3N2)v influenza virus isolated from humans and characterization of swine H3N2 viruses isolated in 2010-2011. Kitikoon P, Vincent AL, Gauger PC, Schlink SN, Bayles DO, Gramer MR, Darnell D, Webby RJ, Lager KM, Swenson SL, Klimov A.  J Virol. 2012 Jun;86(12):6804-14. Epub 2012 Apr 4
  3. Evolution of Novel Reassortant A/H3N2 Influenza Viruses in North American Swine and Humans, 2009-2011. Nelson MI, Vincent AL, Kitikoon P, Holmes EC, Gramer MR. J Virol. 2012 Aug;86(16):8872-8. Epub 2012 Jun 13
  4. Cases of Novel Swine Influenza Surging. Lowes, Robert. Medscape News, August 3, 2012
  5. Center for Disease Control. http://www.cdc.gov/flu/swineflu/influenza-variant-viruses-h3n2v.htm)