Friday, September 25, 2009

Letter Warns About Tricky Dosing With Liquid Tamiflu for Kids

Letter Warns About Tricky Dosing With Liquid Tamiflu for Kids
Published: Friday, September 25, 2009 | 6:45 AM ET
Canadian Press

(HealthDay News) - Doctors warn that parents across the country could give the wrong dose of Tamiflu to their children as treatment for the H1N1 swine flu because the dosing instructions don't always coincide with the measurement markings on the syringe that comes with the liquid medication.

The warning letter, penned by scientists from Northwestern University Feinberg School of Medicine in Chicago, Emory University in Atlanta and Weill Cornell School of Medicine in New York City and published online Wednesday in the New England Journal of Medicine, also urges doctors and pharmacists to be on the lookout for this potential dosing mismatch and to help parents figure out exactly how much Tamiflu to give their child.

The authors cite a case that they say is probably happening all over the United States: The parents of a 6-year-old girl diagnosed with the H1N1 virus received a prescription for Tamiflu Oral Suspension that told them to give her three-fourths of a teaspoon of the medicine two times a day. However, the dosing syringe inside the box was marked in milligrams. The confused parents, both of whom are health professionals, had to figure out how to convert the measurement, something most parents would find too daunting to do.

"It's an egregious error that there is a conflict in the prescription labeling instructions and the dosage device that comes in the exact same box. It's incredibly confusing to parents," letter co-author Michael Wolf, an associate professor of medicine and learning sciences at Northwestern University Feinberg School of Medicine, said in a news release from the university. "Tamiflu is one of the main courses of treatment right now for H1N1, and it is being widely used among children, even infants."

The letter's authors recommend that all pharmacies and physicians be instructed to ensure that the prescription label instructions for use are in the same dosing units as those on the measurement device.

"Parents being prescribed Tamiflu for their children need to make sure they understand exactly how to take it at the time they pick it up at the pharmacy," lead letter author Dr. Ruth Parker, a professor of medicine at Emory, said in the release.

Wolf warned that an overdose could be toxic, and an underdose could be ineffective.

And even more complex calculations might be necessary now that the U.S. Food and Drug Administration has approved Tamiflu for off-label use among children under the age of 1, because the syringe doesn't include small enough measuring increments for these youngest patients.

"We need to have a better system for ensuring there are standardized directions for administering drugs to children," letter co-author Dr. Alastair Wood, a professor of medicine and pharmacology at the Weill Cornell School of Medicine in New York City, said in the news release. "We need to move to a system where all doses are given in the same units, preferably milliliters."

Meanwhile, a report released Thursday supports recent U.S. Centers for Disease Control and Prevention recommendations not to use negative rapid test results for management of patients that may be infected with the pandemic swine flu virus.

Researchers in Connecticut assessed the performance of the rapid influenza diagnostic test (RIDT) used during outbreaks of pandemic influenza A (H1N1) at two schools in Greenwich in May 2009. Of the 63 people tested at Greenwich Hospital, infection was confirmed in 49 patients.

The results of the RIDT were compared with the reverse transcription-polymerase chain reaction assay. A low sensitivity of 47 per cent was found for the rapid test. This poor performance couldn't be explained by the clinical features of the patients or by the timing of the specimen collection, said Dr. James R. Sabetta, of the Greenwich Department of Health and the Connecticut Department of Public Health, and colleagues.

While a positive rapid test for influenza is helpful, a negative test doesn't rule out pandemic swine flu, the researchers said.

The report appears in the Sept. 25 issue of the Morbidity and Mortality Weekly Report, published by the CDC.

More information

The CDC has more about H1N1 flu.

SOURCES: U.S. Centers for Disease Control and Prevention, news release, Sept. 24, 2009; Northwestern University, news release, Sept. 23, 2009

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Wednesday, September 23, 2009

Seasonal flu shot may increase H1N1 risk: early data

Seasonal flu shot may increase H1N1 risk: early data
Last Updated: Wednesday, September 23, 2009 | 4:01 PM ET Comments0Recommend1
CBC News

Preliminary research suggests the seasonal flu shot may put people at greater risk for getting swine flu, CBC News has learned.

"This is some evidence that has been floated; it hasn't been validated yet, it's very preliminary," cautioned Dr. Don Low, microbiologist in chief at Mount Sinai Hospital in Toronto.

"This is obviously important data to help guide policy decision. How can we best protect people against influenza?"

It's important to validate the information to make sure it's not just a fluke, and that the observation is confirmed elsewhere such as in the Southern Hemisphere, which just completed its seasonal flu season, Low added.

The four Canadian studies involved about 2,000 Canadians in Ontario, Quebec, British Columbia and Alberta, sources told CBC News. Researchers found people who had received the seasonal flu vaccine in the past were more likely to get sick with the H1N1 virus.

Researchers know that theoretically when people are exposed to bacteria or a virus, it can stimulate the immune system to create antibodies that facilitate the entry of another strain of the virus. Dengue fever is one example, Low said.
No seasonal flu shot?

The latest finding raises questions about the order in which to get flu shots.

Across Canada, public health authorities are fiercely debating the idea of shortening, delaying or scrapping their seasonal flu vaccination campaign in favour of mass inoculation against H1N1.

The main reason is because the H1N1 may be dominant strain of influenza circulating when the fall flu season hits, meaning it could be a waste of time and resources to mount a seasonal flu vaccine campaign.

Health authorities in Quebec say they might scrap or delay seasonal flu shots and carry out mass vaccinations against just the H1N1 swine flu virus instead. In the meantime, the province has paused the launch of its seasonal flu shots.

"For the moment, it's on hold," Karine White, a media relations liaison with Quebec's Ministry of Health and Social Services, told The Canadian Press.

"You can imagine the people over the age 65 who are relatively protected against H1N1, it may make perfect sense for them to get the seasonal vaccine. People who are younger than that, if we don't see a lot of seasonal flu, probably the pandemic vaccine's the way to go. But we're going to make that crystal clear to people," said Dr. Michael Gardam, director of infectious diseases prevention and control at the Ontario Agency for Health Protection and Promotion.

Seasonal flu could appear after Christmas, said Dr. David Scheifele, director of the vaccine evaluation centre at B.C. Children's Hospital in Vancouver.

'39 Pounds of Love' star dies at 41

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The Jerusalem Post Internet Edition

'39 Pounds of Love' star dies at 41
Sep. 22, 2009

Ami Ankilewitz, the subject of an award-winning documentary who braved a debilitating illness for 41 years, finally succumbed to it on Sunday.

Ankilewitz was born with Spinal Muscular Atrophy - an extremely rare and often fatal condition that limits physical growth and movement.

Despite a prediction from a doctor that he would live for only six years, Ankilewitz continued to survive and succeed. Due to his medical condition, he weighed only 39 pounds (17.7 kg.) as an adult and had use of only one finger during his life.

In 2005, Dani Menkin directed the documentary about Ankilewitz titled 39 Pounds of Love.

The documentary centers on Ankilewitz's quest across America to make peace with his brother and confront the doctor who predicted his early death. Along the way, he visits the Grand Canyon and rode a Harley-Davidson motorcycle, one of his life's dreams and passions.

The film won the Best Documentary category at the Ophir Awards given out by the Israeli Academy of Film, and at the Palm Beach International Film Festival. It was also screened in the United States to critical praise.

Ankilewitz continuously strived to live an active, normal lifestyle despite his immobility. In recent years, he drove an Alfa Spider convertible, became an outstanding handgun target shooter and even tried to join the IDF. He enjoyed going to bars and clubs, travelling and having "the time of his life" with his friends.

"I think a person like me would have much more motivation... for the simple reason that it would be much more important for me to prove that I could be as efficient as everyone else," Ankilewitz wrote on his personal Web site.

With his index finger, he was also an avid 3D animator, creating computer animation to tell his personal stories of love.

And it was love that was at the center of Ankilewitz's life.

"For me it [love] is more than just a word. It is the essence of our existence," he once said.

Throughout his life, Ankilewitz viewed his disability as an advantage.

"I'm lucky that I am what I am," he said. "I rephrase to myself as a 'what' for the simple reason that science hasn't yet found a definition for me that would be suitable in my mind. It could have been worse. I could have been 'normal.' I have the freedom to be whoever I want. I do not think people should look at me as a hero. Instead, they should think of themselves and put themselves in my position and think what other options do I have. It's either live or die, and I chose not to die."

In remembrance of his life, 39 Pounds of Love was shown in Tel Aviv on Tuesday night. His funeral was held at Kibbutz Givat Hashlosha, east of Petah Tikva, on Sunday night.

Sunday, September 20, 2009

Shira Goes Riding For Her First Time

Shira was turned down as a good candidate by the Cowichan and Vancouver Island Riding For The Disabled Associations. Their policies and candidate requirements are very limited here and don't serve the majority of disabled people. Upon further investigation I interviewed more people turned down by the Associations than those that get to ride. Purely psychological reasons for riding and the joy of riding are not criteria to be accepted into the program. Sometimes these programs are more of an ego boost for the people that run them than they are programs for the disabled and what it can mean for the person riding. Luckily I can ride and have researched enough so that my wife and I could take Shira riding and give her the joy and experience of riding horses. During Shira's ride she didn't stop saying, "Yeehaw, Yahoo" and when the ride was finished she exclaimed, "I Win!" You win Shira you munchkin and Sammy you are a great big brother and good rider!!