LIFE AFTER MED SCHOOL: WHAT YOU NEED TO KNOW BEFORE LEAVING MEDICAL SCHOOL

 EPISODE 1 

How ironic is it that after spending nearly a decade in the fore walls of medical school, medical graduates leave school and yet remain bereft of information that are crucial to them succeeding in the real world.

The truth remains that there are as many reasons people enter into medical school to study medicine as there are to choose whether or not to practice the profession following graduation. It is common to hear medical students give "passion for helping people or desire to save lives" as their reason for choosing to study medicine after secondary (high) school, and many indeed confess to have found themselves in medical school as a result of parental influences and pressures, while others just loved having the "Dr" title before their names. 

Continue READING HERE

Ebola Response On Track -WHO

Medic-ALL (19:12:2014) Via MedPage Today

The response to the Ebola epidemic is on track to meet U.N. targets, the World Health Organization said in a mildly optimistic midweek situation report.
By New Year's Day, the agency said, the three hardest-hit countries will likely have the capacity to isolate and treat all cases and to bury all Ebola victims "safely and with dignity."

Guinea, Liberia, and Sierra Leone all now have more available beds than reported patients, the WHO said, although they are not distributed evenly and some regions still have "serious shortfalls." By the same token, each country has enough safe burial teams to handle all people known to have died from Ebola; however, some regions might lack enough capacity.

The U.N. goals are to have 100% of new patients under treatment by Jan. 1 and all known Ebola victims buried safely. Isolating patients breaks the chain of transmission, while safe burials -- avoiding unprotected contact with the highly infectious body of an Ebola victim -- avoid an important risk factor for new cases.
The agency also had a brighter picture of the incidence of cases, suggesting there are signs that the epidemic in Sierra Leone might be starting to slow -- even though the country reported 327 new confirmed cases in the week ending Dec. 14.
Most of the cases are in the western part of the country, with the capital, Freetown, accounting for 125 of the new cases. Teams began house-to-house searches in Freetown yesterday, seeking hidden Ebola patients, according to the BBC.
The searches are part of the so-called Western Area Surge, which aims to get Ebola patients into treatment and also to raise the number of available beds in the capital, the WHO said.

In Guinea, there has been no evident pattern in recent weeks, with the number of new confirmed cases each week fluctuating between 75 and 148. For the week ending Dec. 14, there were 76.
In Liberia, on the other hand, incidence is falling, with only six districts reporting new confirmed or probable cases in the week ending Dec. 14, although data are missing for much of the week.
The cumulative Ebola toll worldwide, to Dec. 14, is 18,603 confirmed, probable, and suspected cases in five affected countries (Guinea, Liberia, Mali, Sierra Leone, and the U.S.) and three previously affected countries (Nigeria, Senegal, and Spain), the agency said.

The U.S. has not had a new Ebola case since Craig Spencer, MD, was reported to be be cured Nov. 9; the country can be declared free of the disease Sunday, which will be 42 days after Spencer tested negative.
Mali also appears to have controlled the disease; all of the contacts of the country's eight confirmed and probable Ebola patients (six of whom died) have now passed the 21-day incubation period without developing the disease.


The last patient tested negative for the disease Dec. 6.

The WHO also reported, for the first time, population-based Ebola rates for Guinea, Liberia, and Sierra Leone:

In Guinea, there have been 22 reported cases and 14 deaths per 100,000 people, with a cumulative total of 2,416 cases and 1,525 fatalities.

Liberia has had 197 reported cases and 83 deaths per 100,000 population, with a total of 7,790 cases and 3,290 deaths.

And Sierra Leone has had 145 cases and 36 deaths per 100,000 people, for a total of 8,356 cases and 2085 deaths.

Meanwhile, researchers are reporting that laboratory tests show that 53 existing and approved drugs have the effect of blocking ebolavirus entry to target cells.

The list includes a wide range of drug classes: microtubule inhibitors, estrogen receptor modulators, antihistamines, antipsychotics, pump/channel antagonists, anticancer drugs, and antibiotics, according to Adolfo Garcia-Sastre, PhD, of the Icahn School of Medicine at Mount Sinai Hospital in New York City, and colleagues.
But more experiments will be needed to understand how useful any of the compounds might be, Garcia-Sastre and colleagues cautioned in Emerging Microbes and Infections.

The work is a positive step, commented Ben Neuman, PhD, of England's University of Reading, who was not part of the study.
The research "extends the list of drugs that are safe to use in people, and have been shown to interfere with Ebola in the lab," he said. But, he added, "it takes a lot to stop Ebola and none of the drugs identified in this study has been shown to protect an experimental animal yet."

"We now have a longer list of things that might work, but the list of things that definitely will work still unfortunately stands at zero," Neuman said.
Indeed, there is little evidence of efficacy even for the drugs that have been used experimentally during this current outbreak, according to the European Medicines Agency, which is conducting a continuing review of them.

The agency is looking at such medicines as brincidofovir, favipiravir, TKM-100802, and ZMapp -- all used to treat one or more patients -- but there is nothing to be said so far about their efficacy, according to an interim report.
"Treatments for patients infected with the Ebola virus are still in early stages of development," an agency spokesman said in a statement. "We encourage developers to generate more information on the use of these medicines in the treatment of Ebola patients."

Ref: World Health Organization
Photo Credits
Medpage today
in.pharmatechnologists.com
seattletimes.com

The Reason Future Doctors are choosing Medicine have Changed

Medic-ALL (16:12:2014)

By an Anonymous American Medical Student

Why would anyone want to become a doctor?  Seriously.  Think about it, because this is a very important question for the future of healthcare in our country.

The future of medicine is somewhat unclear in this age of healthcare reform, but we do know a few things. Physician compensation is currently falling while lawsuits and malpractice premiums are rising.  Doctors must see many more patients in a day to maintain their salary, all while dealing with more paperwork in their limited time.  The hours are often long and the training is challenging.  Students must attend four years of medical school after college plus an extra three to seven years of residency depending on their chosen specialty.  So, why on earth would the best and the brightest young minds want to pursue a career in medicine, especially when they’ll be expected to pay in upwards of $200,000 for their education?

As a second year medical student I’m proud to report that the reasons our future doctors are choosing medicine have changed.  The decision is no longer made because of prestige or money, as it commonly was in the past.  Some of our nation’s best students are choosing medicine primarily because they care about others.   I’m not saying that older physicians don’t care about others, but they entered medicine under much different circumstances than what we face today.  Ask any pre-med student who’s shadowed a doctor and the majority will tell you that they were encouraged to choose a different career path.  There are plenty of kind and compassionate doctors out there, but there are also many who went into medicine for the money and recognition.  Personally, I was told that I should become a plumber, “because it pays better and medicine isn’t what it used to be.”

Yet, according to the American Association of Medical Colleges, the number of applicants to medical school has been steadily increasing for the past ten years, and students are choosing medicine despite all the challenges.  They see the challenges that our healthcare system faces and they’re excited to start working on solutions.  As of 2010, there were over 47,000 medical student members of the American Medical Association (AMA), showing their interest in shaping the future of healthcare policy.

So what does all this mean for the future of healthcare?  Overall, we’re going to see more and more doctors who are compassionate and who chose medicine for the right reasons.  These doctors will understand the challenges that are facing them and they will be prepared to fight for the interests of their patients, whether their opponent is an insurance company or a congressman.  That is why I’m optimistic about the future of healthcare.

Courtesy: Kevinmd

Conjoined Twins Sharing a Heart delivered in Atlanta!

Medic-ALL (05:12:2014)

A set of conjoined male twins sharing a heart, torso, arms and legs, were born, early Thursday in an Atlanta hospital, in the United States, marking a medical rarity as many such babies do not survive delivery

Asa and Eli Hamby - who can never be separated as they share a heart and circulatory system - were welcomed into the world at 7.32am(EST) via a pre-planned (elective) Caeserean section to parents Robin (Mum) and Michael (Dad) and according to a dedicated 'Hamby Twins' Facebook page are healthy and well.

The rare and extremely risky pregnancy was carried through to 37 weeks and Robin and Michael traveled from Alabama to Atlanta's Northside Hospital for specialist care.

Born with two heads, but sharing one body, the condition Asa and Eli have is known as dicephalic parapagus - an extremely unusual form of conjoinment, affecting only one-in-a-million births.

Shortly after the birth of the twins however, the Mother of the babies was told there was a slight issue with her sons' heart, but that they are doing well.

"There is an issue with the right side of the heart. The left side is perfect. The right side has like an extra atrium and an extra ventricle, and there's two aortas. One of the arteries is like switched, not in the right place because of having extra ones, but he said that their vital signs are stable,' said the mum to the Ledger Enquirer (a local newspaper).

Conjoined twins generally occur once in every 200,000 live births and most do not survive, according to the University of Maryland Medical Center. About 40 to 60 percent are stillborn, and about 35 percent live only one day.

The newborn brothers were given medication for their joint heart and intubated to help them breathe, Michael Hamby told the Columbus Ledger-Enquirer newspaper on Thursday morning.

Ebola: Poorer Economies Lose Out

Medic-ALL (23:11:2014) by Kayode Kuku

Having devoted a good percentage of posts on this blog to news on the ravaging impact of the Ebola virus epidemic over the last couple of months, the varying degrees of successes achieved in containing the deadly disease in different parts of the world seems to point indispuatably but not entirely to the inequality in healthcare systems.

Now we know that Ebola had been in existence as early as nearly 4 decades ago, with outbreaks in Sudan and Zaire occurring between June and November 1976. But asides from laymen hearing of "Ebola" in some Hollywood movies or medical students reading a few lines about the disease in their medicine notes, not even the March 2014 outbreak in Guinea  reported by the World Health Organization attracted any real attention either from the media or the World's biggest economies. It can easily be inferred by the closest observers that Ebola in Africa was not taken seriously until it entered into the commercial capital of one of Africa's biggest economies and one of the World's Biggest crude oil producing countries in Nigeria.

About a week following the entry of the Ebola-infected Liberian into Nigeria in July 2014, The WHO On 8 August 2014, the declared the epidemic to be an international public health emergency. Urging the world to offer aid to the affected regions, the Director-General said, "Countries affected to date simply do not have the capacity to manage an outbreak of this size and complexity on their own. I urge the international community to provide this support on the most urgent basis possible. This was after about 4 months of the disease ravaging the West African countries of Guinea, Sierra Leone and Liberia with death toll rising, about 1000 as at early August.


The truth is that the disease which is said to have entered into West Africa in December 2013, had unfortunately hit , "3 of Africa's Poorest economies" (to borrow the CNBC Africa headline from September 2014). The reality of this is that Ebola choose countries whose contributions to the Global Gross Domestic Product could easily be considered negligible by most. In a blog post in August "The Economics of Ebola",
The Liberian Finance Minister, cited the international aid of $200 million recieved via the specially set-up Ebola Fund established by the World Health Organization and World Bank in August to provide support for the 3 West African Countries. The question is how much attention would the the deadly disease have received if the countries affected were some of the region's biggest economies.

The disease however continues to have huge economic impacts even in this so-called poor economies with Ebola itself directly costing the governments of these countries increasingly. The factors  contributing to the growing cost of Ebola include direct costs of the illness (government spending on health care) and indirect costs, such as lower labor productivity as a result of workers being ill, dying or caring for the sick.

But the majority of the costs stem from the higher costs of doing business within countries or across borders. These are largely due to “aversion behavior”, or changes in the behavior of individuals due to fear of contracting the disease, which has also left many businesses without workers, disrupted transportation and led to restrictions on travel for citizens from the afflicted countries.

According to the latest World Bank group report, if the Ebola epidemic is contained by the end of 2014, the economic impacts on West Africa, including on Guinea, Liberia and Sierra Leone, could be lessened and economies would begin to recover and catch up quickly. If the crisis continues into 2015 as predicted, slower growth could cost the region $32.6 billion over 2014 and 2015 and lead to much higher levels of poverty.

There is no doubt that the inadequacies of the health-care systems in the three most-affected countries help to explain how the Ebola outbreak got this far. Spain spends over $3,000 per person at purchasing-power parity on health care; for Sierra Leone, the figure is just under $300. The United States has 245 doctors per 100,000 people; Guinea has ten. The particular vulnerability of health-care workers to Ebola is therefore doubly tragic: as of November 18th there had been 588 cases among medical staff in the three west African countries, and 337 deaths. The hope for these countries therefore lies in the hands of some of the world's bigger economies (who may not necessarily benefit in anyway from the epidemic stricken countries) to help their healthcare sysytem and invariably the "receeding" economy.

Refs: The Economics of Ebola (Medic-ALL blog)

The Economist 

TheWorldBank.org

Sadly, Doctor loses Ebola Battle, Dies in Omaha

Medic-ALL (17:11:2014) Courtesy New York Times 

WASHINGTON — This time, the challenge of Ebola was much steeper for the doctors and nurses at Nebraska Medical Center, one of a handful of hospitals specially designated to handle cases of the deadly virus in the United States.

Unlike the two Ebola patients they had successfully treated earlier this year at the hospital’s biocontainment unit in Omaha, the man who arrived from Sierra Leoneon Saturday, Dr. Martin Salia, was in extremely critical condition. Dr. Salia, a legal permanent resident of the United States who had been working as a surgeon in Sierra Leone, died early Monday morning, barely into his second day of treatment, but almost two weeks into his illness.

The Late Dr Martin Saila

“Even the most modern techniques that we have at our disposal are not enough to help these patients once they reach a critical threshold,” said Dr. Jeffrey P. Gold, chancellor of the University of the Nebraska Medical Center, the hospital’s academic partner.

Dr. Philip Smith, the medical director of the biocontainment unit, said that Dr. Salia, 44, had initially been tested for Ebola in Freetown, the capital of Sierra Leone, on Nov. 7, but that the test came back negative. He was retested there on Nov. 10, at which point the results were positive. Dr. Smith said such false negatives were not uncommon early in the illness.

Dr. Daniel W. Johnson, a critical care specialist at Nebraska Medical Center, said that Dr. Salia’s kidneys had stopped functioning and that he was laboring to breathe when he arrived at the hospital late Saturday afternoon after a 15-hour flight. Doctors quickly tried two treatments they had used on their other Ebola patients: an experimental antiviral drug and a plasma transfusion from theblood of an Ebola survivor, which researchers believe may provideantibodies against the virus.

But Dr. Salia was already so ill that within hours of his arrival at the hospital, he needed continuous dialysis to replace his kidney function. By the pre-dawn hours of Sunday, he was in respiratory failure and needed a ventilator, Dr. Johnson said on Monday. Around the same time, he added, Dr. Salia’s blood pressure plummeted.

“He progressed to the point of cardiac arrest, and we weren’t able to get him through this,” Dr. Johnson said at a news conference in Omaha. “We really, really gave it everything we could.”

Dr. Smith said he did not know how Dr. Salia had contracted the virus. “He worked in an area where there was a lot of Ebola disease, much of it probably unrecognized,” Dr. Smith said, “and there were many opportunities for him to have contracted it.”

In the frenetic neighborhood of Kissy, on the eastern end of Freetown, an eerie quiet hung over the United Methodist Hospital on Monday as news spread that Dr. Salia had died. He was the chief medical officer and the only surgeon at United Methodist Kissy Hospital, according to United Methodist News Service.

Leonard Gbloh, the administrator of the hospital, said he did not think Dr. Salia could have contracted Ebola there.

“We have not been taking Ebola patients here” he said. “And we had stringent control measures in place to prevent it entering.”

The hospital even stopped all surgical work several months ago as a precaution, Mr. Gbloh said. Now, the hospital is being decontaminated and several staff members who came into contact with Dr. Salia after he fell ill are in quarantine there.

Victory over Ebola-Like Virus in Uganda!

Medic-ALL (14:11:2014)

In what can be regarded as another "win" for humans over the recently "more popular" viral haemorragic diseases, authorities in the east African country of Uganda reported that the country was now free of Marburg, a virus similar to Ebola in many respects, after no new cases had been reported for more than a month after a hospital worker died of the disease in the capital, Kampala. The declaration by the United Nations Health Agency comes after a 42-day Surveillance period.

The virus is transmitted through bodily fluids or by handling infected wild animals, Marburg starts with a severe headache followed by hemorrhaging and kills in 80 percent or more cases within about a week. There is no vaccine or specific treatment for the virus.

A total of 197 people were in contact with the healthcare worker, but none of them were found to have been infected, Junior health minister Sarah Opendi told a news conference.

Opendi said 42 days was the minimum period of monitoring before an outbreak is declared contained, and there had been no new cases reported since the death in Kampala on Sept. 28.

"This implies that the Marburg outbreak in the country has been completely controlled," she said.

The worst outbreak of Ebola on record has killed nearly 5,000 people - all but a handful in West Africa's Guinea, Liberia and Sierra Leone - since March.

Marburg disease virus (MVD) (formerly known as Marburg haemorrahagic fever) was first identified in the 1967 epidemics in Marburg (hence the name) and Frankfurt in Germany and Belgrade in the former Yugoslavia following importation of infected monkeys from Uganda.

Uganda, according to the Health Minister of the country, in 2012, endured an outbreak of Marburg that killed 9 of the 18 people infected

Ref: WHO Global Alert and Response

Medic-ALL.Inc 2014

U.S free of Ebola case as New York Doctor is Cleared!

Washington Post (10:11:2014) by Mark Berman

The doctor who contracted Ebola in West Africa before returning to New York City has been declared free of the virus, hospital officials announced Monday. This news means that 41 days after the first Ebola diagnosis in the United States, there are no known cases of the virus in the country.

Craig Spencer, 33, who had been treating Ebola patients in Guinea, was diagnosed with Ebola on Oct. 23. Bellevue Hospital Center in New York City, where Spencer was being treated, confirmed in a statement Monday that he “has been declared free of the virus.” Spencer will be discharged on Tuesday, according to the hospital. (News of his release was first reported Monday by theNew York Times.)

Spencer’s diagnosis created concerns in New York, as the news of his illness was followed by the revelation that he visited a popular restaurant and coffee shop, rode multiple subway lines and went to a bowling alley and bar in Brooklyn. As city officials preached caution and calm,“disease detectives” fanned out to visit the places Spencer had gone and visit the people with whom he had interacted.

After returning to New York, Spencer had been self-monitoring and taking his temperature. He reported a fever of 100.3 degrees on Oct. 23, two days after he began feeling sluggish, and was taken to the hospital and isolated. He was the fourth person diagnosed with Ebola in the United States and the only one of this group to contract the disease after treating patients overseas. (Other people responding to the epidemic in West Africa have been diagnosed and brought back to the country for treatment.)

His diagnosis also sparked a panic among authorities, as the governors of New York and New Jersey hurriedly announced that they would quarantine any medical workers returning from West Africa, a highly-criticized move that went against the advice of public-health officials. This drama spilled up the East Coast, as a nurse who had treated patients in West Africa (and had no symptoms of Ebola) was quarantined in New Jersey and had a prolonged confrontation with authorities in Maine over her treatment.

The first person diagnosed in this country, Thomas Duncan, was a Liberian man who contracted it before flying to Texas in September; two nurses who treated Duncan were infected during his hospitalization. Duncan died eight days after he was diagnosed, becoming the only person to die from Ebola in the United States, while the Texas nurses who contracted Ebola were both treated and declared safe. The news that Spencer was cleared came three days after the last person being monitored for Ebola in Texas was also cleared, ending the Ebola saga there.

More than 350 people were being actively monitored by the New York City health department for Ebola as of last week, the department said in a statement. Most of these people had traveled to New York City from Liberia, Guinea or the Sierra Leone, but that number also included Bellevue staff members treating Spencer and lab workers who took his blood.

Anthony Fauci, director of the National Institute of Allergy and Infectious Diseases, said Monday that people should be reassured by the fact that tried-and-true approaches, such as contact-tracing and active monitoring, have helped to prevent broader transmission of the disease in the United States.

“In fact, it has worked,” he said, noting that contacts of patients in Dallas have all been cleared and that people who interacted with Spencer so far appear healthy.

“That doesn’t mean we are not going to see another case; it’s possible we will,” he said. “[But] I think we are pretty well prepared.”

Medic-ALL.Inc.2014

Heart Failure: A Matter of The Heart

Medic-ALL (07:11:2014) by Kayode Kuku MB;BS

Each day of our lives almost 2,000 gallons of oxygen-rich blood is supplied to every living cell in our body to ensure their nourishment and continued living. This is made possible by a strategically located "pump of an organ" in the body called the Heart. The heart is truly an amazing organ, beating almost a 100,000 times every 24 hours, to deliver almost 65 million gallons in a lifetime.

The Heart provides the power needed for life. When it fails to pump blood at a rate sufficient to meet the body's requirements, the result is "heart failure". Heart failure does not mean that the heart has stopped working, it simply means that the heart is pumping less effective than normal. Hence, with heart failure, blood flows through the heart and body at a slower rate, there is an increase in pressure in the heart, the heart muscles stretch and/or thicken in order to accommodate more blood and the heart attempts to pump faster and blood vessels become narrow in order to meet up with the body's unmet demands. The heart muscles eventually weaken and are unable to pump as strongly.

Before the 1900s, very few people suffered from and even fewer died from heart failure. In the last decennia however, heart failure has become a huge burden all over the world, particularly in the Western world affecting millions and been the leading cause of hospitalization in persons over 65 years of age.

While the age of technology and importation of certain western "habits" have made life easier for millions all over the world, they have also made us prone to heart disease. Almost a lifetime ago, most people made their living through some sort of manual labor, walking was a major means of transportation and most daily tasks were done by hand. Statues were climbed (no elevators), carpets were swept and beat , laundry was scrubbed and butter was churned. Fresh foods consisting of mainly of fruits and vegetables, and home made delicacies were consumed. With the arrival of automation most manual labors were replaced or assisted by machinery. 

Modern conveniences made physical inactivity unneccessary and lifestyle "inconveniences" brought about changes in diet; Fried foods, like potato chips, hamburgers, and French fries became staples in many diets. The combination of a sedentary lifestyle and a seemingly "rich" diet led to an increase in clogged blood vessels, heart attacks and strokes, the heart failure and other heart diseases became a common occurrence. The rate of heart disease in fact increased sharply between 1940 and 1967, in what the World Health Organization described as the world's most serious epidemic. 

The field of Cardiology has grown tremendously over the years to meet the demands of heart failure. Various techniques and tools have also evolved to meet the increased need. Though, many causes of heart diseases are not always reversible, the signs and symptoms frequently can be treated with well established pharmacologic, dietary and therapeutic modalities.

The use of medications have proven consistently to not only improve the symptoms of heart failure, but also to reduce hospitalization and mortality. In addition, lifestyle and dietary modifications such as monitoring daily weight, reducing salt and fatty food intake, increasing functional activity , reducing alcohol intake, quitting smoking, regular medical check-ups and follow-ups.

Ref: WebMD

India Performs First Fetal Heart Surgery!

Medic-ALL (01:11:2014)

A team of 12 specialists  led by K. Nageshwar Rao, chief pediatric cardiologist at  Care Hospital in Hyderabad performed India’s first successful fetal heart surgery. The baby in the womb of a 25-year old Sirisha was diagnosed with  severe aortic valve obstruction that was causing failure of blood supply sue to interrupted pumping of left ventricle. It was also resulting in further damage in the form of leakage of mitral valve and shrinkage of left sided heart chambers.

The surgery was performed in the 27th week of pregnancy after a failed attempt at 26 weeks due to unfavourable fetal positioning. The blockage according to Dr. Rao , is said to have been reduced from 99percent to 60percent which is sufficient to allow normal development of the left ventricle.Further surgery such as balloon dilatation may however be carried out after birth.

The history of fetal heart surgery dates back to April 1981, when the  first human open fetal heart surgery was carried out in the University of California , San Francisco under the direction of Dr Michael Harrison following extensive research with animal models by him and his research colleagues.

Ref: The Healthsite

         Iseeindia website

          Wikipedia 

WHAT YOU MUST KNOW BEFORE LEAVING MED SCHOOL!

My people are destroyed for lack of knowledge - Hosea 4v6 (Bible)

How ironic is it that after spending nearly a decade in the fore walls of medical school, medical graduates leave school and yet remain bereft of information that are crucial to them succeeding in the real world.

The truth remains that there are as many reasons people enter into medical school to study medicine as there are to choose whether or not to practice the profession following graduation. 

Read on HERE

Chikungunya: Yet Another Virus!

Medic-ALL  (24:10:2014) by Kayode Kuku MB;BS

At a time when the world is agog with the now very popular but deadly "Ebola virus disease", its outbreak in parts of West Africa and recent spread to the United States and Spain, some other parts of the world are having to contend with "Yet Another Viral" disease without a known cure.

The Chikungunya (pronunciation:/ chi-ken-gun-ye: meaning, that which bends over in the "Makonde" language of Tanzania and Mozambique) disease is caused by a mosquito-borne virus (meaning it is transmitted to people by mosquitoes).

The chikungunya virus was documented for the first time, last December in the islands of St Martin in the Caribbeans, even though it is believed to have existed in parts of Africa, Europe and Asia-Pacific regions for decades. The major symptoms of the disease include fever (usually over 39°C) and severe joint pain (causing infected persons to bend over), others may include muscle pain, headache, joint swelling, nausea, fatigue or rash. Occasional cases of eye, neurological, heart and gastrointestinal complications have been reported.

According to Dr Lyle Petersen of the Centre for Disease Prevention and Control (CDC), the virus has an incubation period (time between exposure to manifestation of first symptom) of about 3-7 days, with a range of about 2-12 days. The acute symptoms could resolve within 7 to 10 days but some patients could develop complications in the coming months.

Nearly 800,000 people have been infected with the Chikungunya virus in the Caribbeans, majority in the Dominican Republic. Jamaica declared a state of emergency last weekend with estimated reports of about 60 percent of the country's population down with the virus and almost 200 persons are documented to be infected with the disease in Canada according to Canadian Health officials. The United States recently reported its first locally-acquired case of the disease in a man in Florida.

                                                Distribution map of Chikungunya in the Americas

As of October 17, 2014, local transmission have been identified in 36 countries or territories in the Caribbeans, Central America, North America and South America, with a total of 759,742 suspected and 14,035 laboratory-confirmed cases have been reported from these areas (Updated data from Pan-American Health Organization).

The fear is that the disease may likely continue to spread throughout the Americas through infected people and mosquitoes as the mosquito which carries the virus in found in many parts of the region including the United States. Moreso, the chikungunya virus is new to the continent and many are not immune to it.

Furthermore, as has been the case with the "traveling Ebola" there is definitely the risk of the virus been imported to new areas by infected travelers. There is presently no vaccine nor medicine to prevent or treat the chikungunya virus disease. Travelers are advised to protect themselves when traveling to countries with the virus by preventing mosquito bites with use of insect repellents, insecticide-treated nets, wearing of long sleeves and pant and stay in places with air-conditioning or that use window or door screens.

Though it is estimated that up to 72%-97% of persons infected with the Chikungunya virus will develop clinical symptoms, Mortality is rare, except in older patients with underlying conditions!....not necessarily "Good" news ,but "Better" news.

Refs:
1.Centre for Disease Control and Prevention
2.CBC News

Resource: Dr. Patience Akahara

New York Doctor with Ebola after return from Guinea

By Ellen Wulfhorst and Sebastian Malo

NEW YORK (Reuters) - A doctor who worked in West Africa with Ebola patients was in an isolation unit in New York on Friday after testing positive for the deadly virus, becoming the fourth person diagnosed with the disease in the United States and the first in its largest city.

The worst Ebola outbreak on record has killed at least 4,900 people and perhaps as many as 15,000, mostly in Liberia, Sierra Leone and Guinea, according to World Health Organization figures.

Only four Ebola cases have been diagnosed so far in the United States: Thomas Eric Duncan, who died on Oct. 8 at Texas Health Presbyterian Hospital in Dallas, two nurses who treated him there and the latest case, Dr. Craig Spencer.

Spencer, 33, who worked for Doctors Without Borders, was taken to Bellevue Hospital on Thursday, six days after returning from Guinea, renewing public jitters about transmission of the disease in the United States and rattling financial markets.

Three people who had close contact with Spencer were quarantined for observation - one of them, his fiancée, at the same hospital - but all were still healthy, officials said.

Mayor Bill de Blasio and Governor Andrew Cuomo sought to reassure New Yorkers they were safe, even though Spencer had ridden subways, taken a taxi and visited a bowling alley between his return from Guinea and the onset of his symptoms.

"There is no reason for New Yorkers to be alarmed," de Blasio said at a news conference at Bellevue. "Being on the same subway car or living near someone with Ebola does not in itself put someone at risk."

Health officials emphasized that the virus is not airborne but is spread only through direct contact with bodily fluids from an infected person who is showing symptoms.

After taking his own temperature twice daily since his return, Spencer reported running a fever and experiencing gastrointestinal symptoms for the first time early on Thursday. He was then taken from his Manhattan apartment to Bellevue by a special team wearing protective gear, city officials said.

He was not feeling sick and would not have been contagious before Thursday morning, city Health Commissioner Mary Travis Bassett said.

Owners of the bowling alley he visited said they had voluntarily closed the establishment for the day as a precaution. But the driver of the ride-sharing taxi Spencer took was not considered to be at risk, and officials insisted the three subway lines he rode before falling ill remained safe.

"We consider that it is extremely unlikely, the probability being close to nil, that there would be any problem related to his taking the subway system," Bassett said.

The U.S. Centers for Disease Control and Prevention (CDC) will confirm Spencer's test results within 24 hours, she said.

RESIDENTS, INVESTORS RATTLED

His case brings to nine the total number of people treated for the disease in U.S. hospitals since August, but just two - Duncan's nurses - contracted the virus in the United States.

The New York case surfaced days after dozens of people who were exposed to Duncan emerged from the 21-day incubation period with clean bills of health, easing a national sense of crisis that took hold when his nurses, Nina Pham and Amber Vinson, became infected.

"I'm really concerned," said Kiki Howard, 26, a student who lives on the block next to Spencer's home in Harlem. "There's a school at the end of the block. My main concern is for the safety of the children."

The health commissioner said Spencer's apartment was isolated and sealed off, noting, "I see no reason for the tenants in the apartment building to be concerned."

Still, there were signs that the latest Ebola case had unnerved investors. S&P futures fell 9 points or 0.45 percent. The dollar slipped against the euro and the U.S. 10-year Treasury rose, lowering its yield to about 2.24 percent.

The city health commissioner said Spencer completed work in Guinea on Oct. 12 and arrived at John F. Kennedy International Airport in New York on Oct. 17. His Facebook page, which included a photo of him clad in protective gear, said he stopped over in Brussels.

Spencer has specialized in international emergency medicine at Columbia University-New York Presbyterian Hospital in New York City since 2011.

Columbia, in a statement, said he has not been to work nor seen any patients since his return.

A woman named Morgan Dixon was identified on Spencer’s Facebook page as his fiancée. Her Linked-In profile said she worked in nonprofit management and international development with the Hope Program, a career development agency for homeless and welfare-dependent adults.

The CDC did not name Spencer but said he "participated in the enhanced screening" instituted for all travelers returning from Guinea, Liberia and Sierra Leone this month at five major U.S. airports - including Kennedy.

The doctor "went through multiple layers of screening and did not have a fever or other symptoms of illness", the CDC said in a statement.