Patients, friends, family: The news of Robin Williams' death yesterday has me in awe. As a doctor I see many patients who have depression, and through medication and other means we are able to help them.
Please don't every be afraid to talk to me about feeling depressed. We can work together to find the right solution to make you feel better.
Rest in peace, Robin. You were a gift to the world.
-- Dr. Dale.
Friends and Family, please take a minute to educate yourself about MERS. - Dr. Dale
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By
Ashley Hayes
, CNN
updated 10:48 AM EDT, Wed May 14, 2014
http://www.cnn.com/2014/05/02/health/mers-5-things/index.html?hpt=he_c2
(CNN) -- MERS-CoV, short for Middle East Respiratory Syndrome coronavirus, first surfaced in Saudi Arabia in spring 2012.
As of Wednesday, 571 cases of MERS have been confirmed in 18 countries, according to the World Health Organization. Two of those cases were in the United States. There have been 171 deaths worldwide.
Here are five things you should know about MERS:
It's a coronavirus
MERS is in the same family of viruses as SARS (severe acute respiratory syndrome -- coronavirus) as well as the common cold. However, unlike SARS, which sickened more than 8,000 people in 2003 and killed 773 worldwide, MERS does not spread easily between humans -- at least not yet.
The virus acts like a cold and attacks the respiratory system, the Centers for Disease Control and Prevention has said. But symptoms, which include fever and a cough, are severe and can lead to pneumonia and kidney failure. Gastrointestinal symptoms such as diarrhea have also been seen, according to the WHO.
The average age of MERS victims is 51, officials say, although the ages range from 2 to 94.
Researchers don't know how MERS spreads
Although all MERS cases have been linked to six countries on the Arabian Peninsula, limited human-to-human transmission has been seen among people in close contact with patients, including health care workers.
Although such transmission appears to be limited, health officials are concerned about MERS because of its virulence -- it can be fatal in up to one-third of cases, Dr. Anne Schuchat, assistant surgeon general for the U.S. Public Health Service and director of the National Center for Immunization and Respiratory Diseases, said Friday.
"The virus has not shown to spread in a sustained way in communities," the CDC says on its website.
The WHO and CDC have not issued any travel warnings related to MERS, although the CDC suggests travelers to the Arabian Peninsula practice "enhanced precautions."
And "you are not considered to be at risk for MERS-CoV infection if you have not had close contact, such as caring for or living with someone who is being evaluated for MERS-CoV infection," according to the CDC website.
Camels appear to be a link in the MERS chain
Camels may be one clue. In a paper published earlier this week, researchers said they had isolated the live MERS virus from two single-humped camels, known as dromedaries. And in February, scientists published a finding that nearly three-quarters of camels in Saudi Arabia tested positive for past MERS exposure.
MERS was also found in a bat in Saudi Arabia, the CDC says.
"The way humans become infected from an animal and/or environmental source is still under investigation," the WHO said last month.
It may have a seasonal pattern
Officials have noted a surge in MERS cases this spring, and a similar increase was also seen last spring, Schuchat said on Friday. But they don't know whether the factors that lead to MERS may have a seasonal pattern, or whether the virus changes to become more easily transmissible.
There are no treatments and no vaccine
As of now, doctors can treat symptoms of MERS, such as fever or breathing difficulties, Schuchat said. However, there is no vaccine and no specific medicine, such as an antiviral drug, that targets MERS.
This is causing a lot of controversy. Some are saying it's a pill for "promiscuity" and poor self control, while others are saying it reduces the the chance of infection while also reducing overall costs to those infected. Share your thoughts...
-- Dr. Dale
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http://www.cnn.com/2014/05/15/health/truvada-hiv-recommendation/index.html?hpt=he_c2
By
Saundra Young
, CNN
updated 2:50 PM EDT, Thu May 15, 2014
(CNN) -- For years the message was simple: Use condoms to prevent HIV. But if you are at high risk of contracting the virus, health experts want you to consider an additional strategy -- taking a pill every day to reduce your chance of being infected.
New guidelines published by the Centers for Disease Control and Prevention say pre-exposure prophylaxis, or PrEP, should be taken daily by people who are at high risk for contracting HIV.
The recommendation is based on several large national and international studies, which were done in varying at-risk populations, such as gay and bisexual men, heterosexual couples where one person is HIV-positive (the other is not) and injection drug users.
The studies all showed that this drug can help reduce infection rates by more than 90% when taken daily.
"While a vaccine or cure may one day end the HIV epidemic, PrEP is a powerful tool that has the potential to alter the course of the U.S. HIV epidemic today," Dr.Jonathan Mermin, director of the CDC's National Center for HIV/AIDS, Viral Hepatitis, STD and TB Prevention, said in a statement.
"These guidelines represent an important step toward fully realizing the promise of PrEP. We should add to this momentum, working to ensure that PrEP is used by the right people, in the right way, in the right circumstances."
According to the guidelines, those circumstances would be anyone who:
• has had sex without a condom;
• is not infected with HIV but is in a sexual relationship with an HIV-infected partner;
• is a gay or bisexual man who has had a sexually transmitted disease within the last six months and is not in a mutually exclusive relationship with a recently tested HIV-negative partner;
• is a heterosexual man or woman who does not always use condoms when having sex with partners already at risk, and who isn't in a mutually exclusive relationship with a recently tested HIV-negative partner;
or
• has injected drugs or shared drug paraphernalia in the past six months
In 2012, the Food and Drug Administration approved Truvada, a pill that combines two antiretroviral drugs for the prevention of HIV. It was first approved in 2004 as an HIV treatment and is still the only FDA-approved medication for PrEP.
Truvada isn't cheap. A month's supply can cost you anywhere from $1,300 to $1,700, according to Drugs.com. But insurance may cover the bill.
To be effective, this pill must be taken every day.
Dr. Anthony Fauci, an immunologist who has been at the forefront of HIV/AIDS research for decades, called it a highly effective approach to preventing the spread of the virus that causes AIDS.
"(It's) one that benefits not only the individual patient at risk for HIV infection but also will help to reduce the number of new HIV infections across the United States," said Fauci, director of the National Institute of Allergy and Infectious Diseases at the National Institutes of Health. "It should be used together with -- and complementary to -- condoms and not as a substitute for condoms."
The new guidelines replace interim ones published two years ago; they provide a comprehensive place where doctors and patients can find information on PrEP and come with a supplement that provides checklists for physicians, giving them step-by-step support for dealing with patients who might be considered for prophylactic treatment.
"PrEP is a new approach to HIV prevention that requires continuing collaboration between patients and providers, as effectiveness requires adherence to daily medication and regular medical visits for monitoring, counseling and testing," said Dr. Dawn K. Smith, an epidemiologist in CDC's Division of HIV/AIDS Prevention who led the development of the guidelines.
"Individuals will have to decide with their doctor if PrEP is right for them, but for some, this may offer a much-needed strategy to help protect themselves from HIV infection."
There are 1.1 million people in the United States living with HIV, according to the CDC. An estimated nearly one in six do not know they're infected.
Men who have sex with men are the hardest hit -- while they make up 2% of the U.S. population, they account for 63% of all new infections each year, according to the CDC. Heterosexuals make up 25% of all new annual infections; 9% are injection drug users.
"HIV infection is preventable, yet every year we see some 50,000 new HIV infections in the United States," said Dr. Tom Frieden, the CDC's director, in a statement. "PrEP, used along with other prevention strategies, has the potential to help at-risk individuals protect themselves and reduce new HIV infections in the United States."