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Many drugs being used to treat Malaria in disease ridden areas could be substitutes, or could even be fake.

The Lancet Infectious Disease Journal reported that up to 42% of the Malaria drugs used in Southeast Asia or Sub-Saharan Africa could be ineffective, being either counterfeit medication, a substitute medication or just a placebo.

The governments of the countries where these ineffective drugs were discovered are being urged to regulate drug production more strictly.

People along the borders of Thailand and Myanmar have been found to carry a Malarial parasite that is immune to the best anti-Malarial drugs available, called artemisinin combination therapy, or ACT.  In Cambodia, drug resistant Malarial parasites were also discovered.  These new cases showing up along the borders of Thailand and Myanmar are different in the fact that it is a different parasite these patients are carrying.

“Anti-malarial control efforts are vitally dependent on artemisinin combination treatments,” says  Anne-Catrin Uhlemann and David Fidock of Columbia University.  “Should these regimens fail, no other drugs are ready for deployment, and drug development efforts are not expected to yield new antimalarials until the end of this decade.”

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When most Americans imagine Tuberculosis, they think of a disease that was active over 100 years ago.  They imagine people coughing, becoming frail and being sent to warm, dry climates as the disease progressed.  It was then often called “consumption” or “white plague”.  It is a bacterial infection that invades the lungs and destroys the lung tissue.  The bacteria can be spread when people cough, and is airborne.  

Bacille Calmette Guerin (BCG) is the vaccine that is now in use to protect against tuberculosis. It was first used in 1921.  BCG was first used as a vaccine in 1921. It was given to infants orally. Since 1921, this has been the standard treatment against TB and has been used extensively.  Today, it is estimated that more than 1 billion people have received BCG.  

A startling new finding has many people concerned:  Documentation of a “totally drug resistant strain of TB” has been found in India.  Last week, the World Health Organization convened to discuss these findings and to determine if a new classification must be added to the first TB description:  this new classification would be ‘totally drug-resistant TB,’ or TDR-TB. This means the disease has changed from one that could be treated with a six month course of antibiotics, to the emergence of MDR-TB, then extensively drug-resistant TB (XDR-TB). The most disturbing aspect of these new discoveries, says Lucica Ditiu of the WHO’s Stop TB Partnership, is the fact that drug-resistant TB ‘is a totally man-made disease.'”

Bacteria, while simple creatures, are highly adaptable and can evolve to resist the drugs meant to destroy them. Mycobacterium tuberculosis is no exception.  In many areas of the world, TB is a major problem due to lack of vaccination and inability of the people of certain countries to obtain the antibiotics needed to cure them.  To explain this new strain of TB as being man made:  if a person has access to the TB antibiotic, and begins taking the recommended course, then stops for whatever reason—lack of access to the medicine, becoming too ill to travel to obtain the medicine, or simply feeling better and stopping the course of treatment on their own—the bacteria still present in their bodies begins to adapt to fight the antibiotic introduced.  This leaves the person uncured of the original infection, and now able to transmit a new strain of the adapted bacteria to others. 

 Dr Zarir Udwadia, a specialist in TB at the Hinduja National Hospital in Mumbai, recently published a paper in the Clinical Infectious Diseases journal examining four cases of TDR-TB. He told Reuters that he has now seen 12 cases of TB where all known TB drugs were applied and none were successful. Three of the 12 cases are already dead.

The powerful TB drugs he tested on each patient, one after another, were first line treaments–isoniazid, rifampicin and streptomycin, and then a range of second line drugs like moxifloxacin, kanamycin and ethionamide. Each medicine did not work.

“If you add it all up, they were resistant to 12 drugs in total,” said Udwadia.

TB can lie dormant in a patient for many years before showing signs of infection.  As TB can now be considered an untreatable disease, the world needs to gear up for epidemic that may be crippling.

 

 

The best medicine is prevention.  In this tradition, the city of St. Louis has began an initiative to inspect pregnant women’s home for lead paint.  Babies that are brought in for medical treatment after showing signs of lead exposure have already incurred damage.  To prevent this malady, St. Louis wants to stop the problem before it starts.

About 250,000 children are brought in for treatment of lead poisoning symptoms each year in the US. Experts say that the actual rate of exposure may be double that.  Exposure to lead can cause learning disabilities and behavioral problems that effect children throughout their lives.

The Federal Centers for Disease Control and Prevention say that there are an estimated 24,000 homes and apartments that have dangerously high levels of lead in the paint on their walls.  Having homes and apartments tested for the presence of lead paint is costly and is usually out of the reach of budgets of young people starting families.  In St. Louis, an initiative has begun that would allow women who were pregnant to apply to have their home tested for the presence of lead for free.  This is called the Heavy Metal Project, and it aims to protect the unborn from encountering lead in their living spaces.

This project is being greeted with enthusiasm by the recipients, but not everyone is happy.  When the homes are inspected, if they are found to have lead in the window casings, the windows must be replaced, which runs around $6,500.  If the paint only contains lead and the windows are safe, this means an investment of $1000.  While these figures may not seem prohibitive, the Federal Government has cut funding for testing for the presence of lead and State Governments are scrambling to figure out how to provide testing of home to all the women who have applied.

The World Health Organization released an official statement on Thursday that urged women who have been receiving birth control injections in Africa to continue with this course of action, in spite of the possible increased risk of HIV transmission the shots may encourage.

The number one birth control method in Africa is the hormone shot.  It is a discreet method, and will last months without the burden of pills or creams.  In spite of it’s efficacy, The WHO also suggests that when one partner is infected with HIV condoms should always be used.  There was a study conducted by the Lancet Infectious Diseases that linked the birth control shot to increased (almost doubled)  rates of HIV infection when one partner is already infected with HIV.  This pits African countries in a difficult position.  Unintended pregnancies can be very dangerous and should be avoided.  It is a difficult choice whether someone should be more concerned over an unwanted pregnancy or becoming infected with HIV.

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