Autism Overdiagnosed? Possibly, Because Many Children Seem To "Outgrow" It

Autism Spectrum Disorders (ASD) come with several neurodevelopmental signs and symptoms which overlap other conditions - it is possible that some early ASD diagnoses are wrong, especially among children who no longer meet the criteria for ASD as they get older, researchers from the Johns Hopkins Bloomberg School of Public Health wrote in the journal Pediatrics. The authors add that it is not easy for doctors to diagnose between several possibilities early in life.

Andrew W. Zimmerman, MD. and team set out to determine what the relationship might be between co-occurring conditions and changes in ASD diagnoses. They gathered information from the National Survey of Children's Health 2007, and found that those who still had a diagnosis of ASD tended to have either severe or moderate learning disability or developmental delays, compared to those whose initial ASD diagnosis was changed when they got older. The authors were comparing children who had had a diagnosis of ASD at age 3 to 5 years with the same children when they were older who still had an ASD diagnosis, and those who did not.

Those aged 6-11 years with a current ASD diagnosis - these patients were more likely at an earlier age to have had a speech difficulty, or/and severe or moderate anxiety, compared to their counterparts whose diagnoses subsequently changed.

Those aged 12-17 years with a current ASD diagnosis - these patients were found to be more likely to have severe or moderate speech problems or (mild) epilepsy (seizures) compared to those who no longer have an ASD diagnosis.

Hearing problems - those with past hearing problems are more likely to still have an ASD diagnosis later on, compared to those who did not have hearing problems, the authors added.

Multiple co-occurring conditions - those with multiple co-occurring conditions when they were small are more likely today to still have an ASD diagnosis, compared to the other children. Multiple in this text means at least two.

In an Abstract in the same journal, the authors concluded:

"These findings suggest that the presence of co-occurring psychiatric and neurodevelopmental conditions are associated with a change in ASD diagnosis. Questions remain as to whether changes in diagnosis of an ASD are due to true etiologic differences or shifts in diagnostic determination."

What Is Glaucoma? What Causes Glaucoma?

Glaucoma is a disease of the eye in which fluid pressure within the eye rises - if left untreated the patient may lose vision, and even become blind. The disease generally affects both eyes, although one may have more severe signs and symptoms than the other.

There is a small space in the front of the eye called the "anterior chamber". Clear liquid flows in-and-out of the anterior chamber, this fluid nourishes and bathes nearby tissues. If a patient has glaucoma, the fluid does not drain properly - it drains too slowly - out of the eye. This leads to fluid build-up, and pressure inside the eye rises. Unless this pressure is brought down and controlled, the optic nerve and other parts of the eye may become damaged, leading to loss of vision.

There are two main types of glaucoma,open angle and closed angle (angle closure) glaucoma. The fluid in the eye flows through an area between the iris and cornea, where it escapes via the trabecular meshwork - "angle" refers to this area. The trabecular meshwork is made of sponky tissue lined by trabeculocytes. Fluid drains into s set of tubes, known as Schlemm's canal, from which they flow into the blood system.

Closed Angle Glaucoma (acute angle-closure glaucoma) can come on suddenly, and the patient commonly experiences pain and rapid vision loss. Fortunately, the symptoms of pain and discomfort make the sufferer seek medical help, resulting in prompt treatment which usually prevents any permanent damage from occurring.

Primary Open Angle Glaucoma (chronic glaucoma) - progresses very slowly. The patient may not feel any symptoms; even slight loss of vision may go unnoticed. In this type of glaucoma, many people don't get medical help until some permanent damage has already occurred.

Low-tension glaucoma - this is another form that experts do not fully understand. Even though eye pressure is normal, optic nerve damage still occurs. Perhaps the optic nerve is over-sensitive or there is atherosclerosis in the blood vessel that supplies the optic nerve.

Pigmentary glaucoma - this type generally develops during early or middle adulthood. Pigment granules, which arise from the back of the iris, are dispersed within the eye. If these granules build up in the trabecular meshwork, they can undermine the flow of fluids in the eye, leading to a rise in eye pressure. Running and some other sports can unsettle the granules, which get into the travecular meshwork.

How a person with healthy vision sees


How a person with advanced vision loss from glaucoma sees the same thing

Glaucoma has been called the silent thief of sight

According to Medilexicon's medical dictionary:

Glaucoma is "A disease of the eye characterized by increased intraocular pressure, excavation, and atrophy of the optic nerve; produces defects in the field of vision and eventual blindness."

Primary glaucoma - this means we do not know what the cause was.

Secondary glaucoma - the condition has a known cause, such as a tumor, diabetes, an advanced cataract, or inflammation.

What are the signs and symptoms of glaucoma?

A symptom is something the sufferer experiences and describes, such as pain, while a sign is something others can identify, such as a rash or a swelling.

The signs and symptoms of primary open angle glaucoma and acute angle-closure glaucoma are quite different.

Signs and symptoms of primary open-angle glaucoma

• Peripheral vision is gradually lost. This nearly always affects both eyes.
• In advanced stages, the patient has tunnel vision

Signs and symptoms of closed angle glaucoma

• Eye pain, usually severe
• Blurred vision
• Eye pain is often accompanied by nausea, and sometimes vomiting
• Lights appear to have extra halo-like glows around them
• Red eyes
• Sudden, unexpected vision problems, especially when lighting is poor

What risk factors are linked to glaucoma?

A risk factor is something that raises the risk of developing a condition or disease. For example,obesity is a risk factor for diabetes type 2 - obese people have a higher risk of developing diabetes.

• Old age - people over the age of 60 years have a higher risk of developing the disease. For African-Americans, the risk rises at a younger age.
• Ethnic background - East Asians, because of their shallower anterior chamber depth, have a higher risk of developing glaucoma compared to Caucasians. The risk for those of Inuit origin is considerably greater still. People of African-American descent are three to four times more likely to develop the disease compared to American whites. Females are three times as likely to develop glaucoma as males.
• Some illnesses and conditions - people with diabetes or hypothyroidism have a much higher chance of developing glaucoma.
• Eye injuries or conditions - some eye injuries, especially severe ones, are linked to a higher glaucoma risk. Retinal detachment, eye inflammations and eye tumors can also cause glaucoma to occur.
• Eye surgery - some patients who underwent eye surgery have a higher risk of glaucoma.
• Myopia - people with myopia (nearsightedness) have a higher risk of glaucoma.
• Corticosteroids - patients on long-term corticosteroids have a raised risk of developing several different conditions, including glaucoma. The risk is even greater with eyedrops containing corticosteroids.

Diagnosing glaucoma

Eye-pressure test - the doctor uses a tonometer, a device which measures intraocular pressure (pressure inside the eye). Some anesthetic and a dye is placed in the cornea, and a blue light is held against the eye to measure pressure. This test can diagnose ocular hypertension; a risk factor for open-angle glaucoma.

A patient in front of a tonometer

The doctor also measures corneal thickness, because it affects how the pressure inside the eye is interpreted.

Gonioscopy - this examines the area where the fluid drains out of the eye. It helps determine whether the angle between the cornea and the iris is open or blocked (closed).

Perimetry test - also known as a visual field test. It determines which area of the patient's vision is missing. The patient is shown a sequence of light spots and asked to identify them. Some of the dots are located where the person's peripheral vision is; the part of vision that is initially affected by glaucoma. If the patient cannot see those peripheral dots, it means that some vision damage has already occurred.

Optic nerve damage - the ophthalmologist (eye doctor) uses instruments to look at the back of the eye, which can reveal any slight changes which may also point towards glaucoma onset.

What are the treatment options for glaucoma?

Treatments involve either improving the flow of fluid inside the eye, reducing its production, and something both. Damage caused by glaucoma is irreversible. Even the disease itself cannot be completely cured. However, regular check-ups and proper treatment can considerably slow down the progression of the disease, and even prevent further loss of eyesight.

Eyedrops - in the majority of cases, initial treatment includes eyedrops. Compliance is vital for best results and to prevent undesirable side effects - this means following the doctor's instructions carefully. Examples of eyedrops include:

• Prostaglandin analogues - these medications have prostaglandin-like compounds as their active ingredient. They increase the outflow of the fluid inside the eye. Some patients may experience reddening and stinging of the eyes, photophobia, some swelling around the rim of the eye, as well as darkening of the iris. The color of the eyelids may also change, and there may be blurred vision. Examples include Xalatan (latanoprost) and Lumigan(bimatroprost).
• Beta blockers - these medication reduce the amount of fluid the eye produces. Some patients may experience breathing problems, hair loss, fatigue, depression, memory loss, a drop in blood pressure, and/or impotence. Examples of such medications include timolol, betaxolol and metipranolol.
  
  Patients with certain lung conditions, such as emphysema or bronchitis may be prescribed a different medication. Diabetes patients who are taking insulin may also be prescribed an alternative drug.
• Carbonic anhydrase inhibitors - these also reduce fluid production in the eye. Side effects may include nausea, eye irritation, dry mouth, frequent urination, tingling in the fingers/toes, and a strange taste in the mouth. Examples include brinzolamide and dorzolamide.
• Cholinergic agents - also known as miotic agents. They help the fluids flow out of the eye. Side effects may include pain in and around the eye, myopia, blocked nose, some digestive problems, increased sweating and/or salivation, blurred vision, and ache around the eyebrows. Examples include pilocarpine and carbachol.
Sympathomimetic drugs - these reduce the production of fluid in the eye, as well as increasing their flow out of the eye. An example is dipivefrin, an epinephrine (adrenaline) compound. Some patients may experience painful and red eyes. Make sure your doctor knows if you suffer from heart disease or hypertension (high blood pressure).

If eyedrops are not effective enough, the doctor may prescribe an oral carbonic anhydrase inhibitor. Side effects are less if they are taken during meals. Initial side effects may include tingling in the fingers and toes and frequent urination - however, after a few days they usually resolve. Much less commonly, there is also a risk of rashes, kidney stones, stomachache, weight loss, impotence, fatigue, and a strange taste when consuming fizzy drinks.

Surgery - if drugs don't work, or if the patient cannot tolerate them, surgical intervention may become an option. The aim of surgery is usually to bring down the pressure inside the eye. Examples of surgery may include:

• Trabeculoplasty - a high-energy laser beam is used to unblock clogged drainage canals, making it easier for the fluid inside the eye to drain out. This procedure nearly always reduces inner eye pressure. However, the problem may come back.
• Filtering surgery (viscocanalostomy) - if nothing else works, including high-beam energy laser surgery, the patient may need a filtering procedure, usually a type of trabeculectomy. The surgeon creates an opening in the white of the eye and removes a small piece of the trabecular meshwork. This allows the eye fluid to leave through the opening.
• Drainage implant (aqueous shunt implant) - this option is sometimes used for children or those with secondary glaucoma. A small silicone tube is inserted into the eye to help it drain out fluids better.

Acute angle-closure glaucoma - this condition is treated as a medical emergency. Pressure-reducing medications are administered immediately. A laser procedure is usually carried out which creates a tiny hole in the iris, allowing fluids to pass into the trabecular meshwork - this procedure is called an iridotomy. Even if only one eye is affected, the doctor may decide to treat both, because this type of glaucoma often affects the other eye too.

Complications of glaucoma

Loss of eyesight is the most common complication. The earlier a patient is diagnosed with glaucoma, the better his/her outlook.

Some Women Orgasm During Exercise

Some women reach orgasm during exercise, especially those that involve the core abdominal muscles, researcher Debby Herbenick, and J. Dennis Fortenberry, M.D., both from Indiana University, wrote in the journal Sexual and Relationship Therapy. Exercises most likely to be associated with female orgasms are abdominal exercises, weight lifting, spinning/biking, and climbing poles or ropes, the author added.

The researchers explain that "coregasm" - reaching an orgasm from exercising the core abdominal muscles - has been mentioned in the media for some time. However, they add that the findings in this latest study are new.

Herbenick said:

"The most common exercises associated with exercise-induced orgasm were abdominal exercises, climbing poles or ropes, biking/spinning and weight lifting. These data are interesting because they suggest that orgasm is not necessarily a sexual event, and they may also teach us more about the bodily processes underlying women's experiences of orgasm."

Herbenick, and Fortenberry carried out online surveys which included 124 adult females who said they had had an orgasm while exercising, known as EIO (exercise-induced orgasm), and another 246 who reported having experienced exercise-induced sexual pleasure (EISP). They were aged form 18 to 63 years, the majority of whom were either married or in a relationship. Approximately 69% of them said they were heterosexual.


The most common exercises associated with exercise-induced orgasm were abdominal exercises

The researchers found that:

• Approximately 40% of those who had experienced an orgasm or sexual pleasure during exercise had done so at least ten times


• Those who reached orgasm while exercising said they felt self-conscious when exercising in public places.


• About 20% of those who experienced orgasm while they exercised said they were not able to control their experience


• The majority of those who reached orgasm during exercise said they were not having any sexual fantasy or thinking about an attractive person during their experience


• In the EIO group, 51.4% said they reached orgasm in connection with abdominal exercises they had done during the previous ninety days


• 26.5% of those in the EIO group linked their experience to weight lifting


• 20% of the EIO women associated their experience to yoga


• 15.8% of the EIO females linked their experience to bicycling


• 13.2% of the EIO women connected their experience to hiking/running


• The most likely abdominal exercise to produce a female orgasm was the "captain's chair". The exerciser rests her elbows on padded arm rests with her back against a support - her legs hang free - she raises her knees upwards towards her chest several times.

Herbenick says that nobody is sure what mechanisms are involved during exercise to induce an orgasm or sexual pleasure. Future studies, hopefully, will be able to determine that.

The authors hope that women who experience either orgasm or sexual pleasure during exercise may feel, after reading about this study, that their responses are normal experiences.

Whether or not specific exercises may help improve a female's sexual experiences was not an aim of this study. The authors caution readers to make no assumptions until other more specific studies have been carried out.

Herbenick wrote:

"It may be that exercise - which is already known to have significant benefits to health and well-being -- has the potential to enhance women's sexual lives as well."

Even though they had not set out to determine how common orgasms or sexual pleasure are during exercise among women, the authors believe it is not rare - in just five weeks they managed to recruit 370 adult females who had such experiences.

Herbenick said:

"Magazines and blogs have long highlighted cases of what they sometimes call 'coregasms. But aside from early reports by Kinsey and colleagues, this is an area of women's sexual health research that has been largely ignored over the past six decades."

Which Blood Pressure Treatments Work?

Blood pressure treatments aimed at preventing complications, such as heart attacks and strokes, work best if the doctor takes into account your body mass index (BMI), researchers from State University of New York's Downstate Medical Center reported inThe Lancet today.

The authors suggest that generally, obese patients respond best to diuretic medications, which should not be used with non-obese people with hypertension (high blood pressure), because of a considerably higher risk of cardiovascular events.

The researchers added that calcium channel blockers work well with either thin or fat people, as well as those of normal weight.

Research leader, Michael Weber, from the State University of New York's Downstate Medical Center, said:

"These findings could change the way high blood pressure (hypertension) is treated and should be of practical help to clinicians in selecting the type of combination treatment most likely to benefit individual patients. Importantly, they suggest that hypertension in obese and lean patients is probably mediated by different forms of underlying disease processes."

Weber and team set out to compare two drug combinations commonly used to treat hypertension over the long-term in patients at high risk of heart disease:

• Benazepril (ACE inhibitor) plus the diuretic hydrochlorothiazide
And

• Benazepril plus amlodipine (calcium channel blocker)

The team gathered and analyzed data from the international ACCOMPLISH trial. They grouped 11,482 patients into three BMI categories - normal weight, overweight, and obese. The ACCOMPLISH trial focused on comparing the same two hypertension treatment drug combinations.

The researchers found that:

• Diuretic combination - those with a normal BMI had 68% more cardiovascular events than those with a high BMI


• Calcium channel blocker combination - the treatment was equally effective in all BMI categories. Moreover, heart-related events were 43% lower than in the diuretic combination group among those with normal weight, and 24% less among overweight patients.

Among the obese patients, both treatments work equally well - the authors added that outcomes were similar too.

Weber believes that:

"Higher cardiovascular event rates in lean patients reported in hypertension clinical trials might have reflected the types of antihypertensive treatments that were used. Diuretic-based regimens seem to be a reasonable choice in obese patients in whom excess volume provides a rationale for this type of treatment, but thiazides are clearly less protective against cardiovascular events in patients who are lean.

Our observations might not be fully generalisable to all types of treatments...since they were driven predominantly by findings in one (the diuretic-based) of our two treatment groups."

Linked comment says diuretic-based treatment not ideal for obese patients

Franz Messerli from Columbia University College of Physicians and Surgeons in New York and Sripal Bangalore from New York University School of Medicine, New York wrote:

"If the indication is hypertension, amlodipine-based treatment should be used irrespective of body size. Conversely, if the indication is prevention or treatment of left-ventricular dysfunction, a diuretic based regimen should be used, again irrespective of body size.

This strategy relegates diuretics to third-line agents for treatment of hypertension, except in patients at risk of heart failure - a position recognised in the latest UK guidelines."

Five-Pronged Assessment Tool Measures Postsurgical, Clinical, And Social Outcomes Of Facial Transplant Operations

Facial transplant operations are often portrayed as dramatic before-and-after stories but new research shows that the procedures' real long-term impact may sometimes be underreported, explained researchers from The Johns Hopkins Hospital, Baltimore, MD. An analysis of patient outcomes data found that a recently developed standard scoring system called "the FACES score" - which measures a patient's ability to return to a normal life - has not been fully utilized for some patients who have already undergone facial transplants, accord-ing to reconstructive surgeons who presented study results at the 2012 American College of Surgeons Annual Clinical Congress. 

"Facial transplants are not just about reconstructive surgery," explained Chad Gordon, DO, assistant professor of surgery at The Johns Hopkins Hospital and clinical director of the hospital's facial transplant program, which launched in August 2012. "The face represents so much to someone's life. It's about taking someone isolated from society and putting him or her back into society. We're spending millions to research and perform face transplants, but we don't know if patients are getting back into society. Are they getting jobs? Are they able to live on their own? Or are they still socially disabled?" 

To date, only 19 face transplants have been performed worldwide. When Dr. Gordon's team looked at postsurgical FACES data on all 19 patients, only eight had complete reports - three from the U.S., three from France, and two from Spain. "Surprisingly, we found that many of the reports were incomplete," Dr. Gordon said. "We have no idea if these patients found a job, got married, or are living on their own." With the lack of reporting, patient outcomes of face transplant procedures cannot be properly assessed and patients may not be receiving the best postoperative followup and care. Better return-to-society reporting, could help surgeons under-stand and improve upon the procedure's success, he said. Furthermore, better reporting can help us to reassess the reconstructive surgeon's role in patient care - from the time the operation is performed - to the patient's return to normal life, he explained. 

In December 2008, Dr. Gordon was on the Cleveland Clinic surgical team that per-formed the nation's first facial transplant on a woman who had been shot in the face by her husband. After that operation proved successful, Dr. Gordon developed a five-pronged assess-ment tool called the FACES score to screen future patients. The FACES assessment was also designed to measure postsurgical clinical and social outcomes based on five criteria: functional status, aesthetic deformity, comorbidities, exposed tissue, and surgical history. 

Functional status measures how well the person performs in society, as well as whether the person leads a functional life, such as being self-sufficient and maintaining relationships. While comorbidity criterion considers how well vital organs work, particularly the liver and kidneys, aesthetic deformity looks at the severity of the facial injury and the patient's other health conditions, along with lifestyle habits that could lead to health conditions (for example, smoking or excessive drinking). The final two measures look at exposed tissue - or how deep the facial wound is - and surgical history. Patients who have already had numerous operations usually have accumulated a lot of scar tissue, which makes the facial transplant more complex. An overall score of 45 or higher indicates an ideal face transplant candidate. "Patient selection is a key to success," Dr. Gordon explained. 

The mean presurgical FACES score for the eight patients who had complete reports was 29.3. Following the operation, the score dropped to 16.4. "The purpose for the screening tool is to identify patients with higher FACES scores, meaning those who needed surgical treatment the most," Dr. Gordon explained. "By their scores going down, it tells you that the scoring system is working, and the transplant was successful." Among the five subcriteria, aesthetic deformity and exposed tissue proved to be statistically significant. Mean scores dropped from 9.33 and 7.77 to 1.13 and 0, respectively. Dr. Gordon said the other three criteria that proved to not be statistically significant are likely due to the small number of patients included in the study. 

The dearth of long-term outcomes data signals a need for surgeons to rethink their role in patient care for this patient population. "Surgeons are taught to talk about what the problem was and how we fixed it," Dr. Gordon explained. "But we're not taught to look at the functional effects, the psychosocial benefits. I know it sounds cliché, but we need to look at the whole person. As reconstructive surgeons, we need to evaluate more critically the psychosocial and functional benefits of face transplantation, in addition to the obvious reconstructive benefits," he said. 

Considering outcomes beyond clinical measures could mean that surgical societies, medical care centers, and donor registries have to make a deliberate, joint effort to track facial transplant patients, Dr. Gordon said. "Then, when there are doubts about taking these extra steps, we can show there are huge benefits to following these patients long after their operations are completed," he concluded. 

Tumors Continue Growing Even When Cells Get Old

Based on the knowledge that cancer cells grow indefinitely, the general belief is that senescence could act as a barrier againsttumor growth and has the potential of being used as a cancer treatment. 

According to findings published in the 19th January issue of the open-access journalPLoS Computational Biology, a collaboration between a cancer biologist from the University of Milano, Italy, and two physicists, from the National Research Council of Italy and from Cornell University, has shown that although cell senescence occurs spontaneously in melanoma cells, it does not stop their growth, which is sustained by a small population of cancerstem cells. 

The study examines the association between melanoma and senescence, which is the normal process in which cells decline and eventually stop duplicating after reaching maturity. 

The researchers observed the long-term evolution of melanoma cell populations by monitoring the number of senescent cells, and discovered a slowing in growth with the majority of the cells turning senescent after three months. However, growth did not stop and was eventually resumed at its initial rate until the senescent cells had nearly disappeared. 

The researchers applied a mathematical model of the experimental data using the cancer stem cell hypothesis, in which a sub-group of cancer cells multiply indefinitely, and therefore remain unaffected by senescence. These cancer stem cells produce a larger population of cancer cells, which are only able to replicate a certain number of times. The results of the model achieved an indirect confirmation that cancer stem cells are present in melanoma, an issue that remains to be controversial in the cancer research community. 

The researchers conclude that even though a large percentage of cancer cells are susceptible to senescence, inducing senescence is unlikely to provide a successful therapeutic strategy because these cells are not important for tumor growth. The say however, that the indirect evidence of cancer stem cells in melanoma could potentially enable the development of new strategies for the treatment of specific types of cancer. 

However, the strong resistance to drug induced senescence that may be found in the cancer stem cells will present a major challenge. Based on this study, treatment of tumors would concentrate on targeting only these cancer stem cells, instead of every single cancerous cell. 

10 Neglected Tropical Diseases - Target For End Of Decade

The aim is to eliminate or at least control 10 neglected tropical diseases by 2020 - it is a public and private partnership, including 13 drug companies, the UK, US and United Arab Emirate Governments, the World Bank, The Bill & Melinda Gates Foundation, and some other worldwide organizations.

The partners aim to work together to eliminate neglected tropical diseases (NTDs) in countries where they are endemic. They have pledged to liaise closely with affected countries. According to WHO (World Health Organization), 1.4 billion people are affected by the ten NTDs; the majority of them live in the poorest countries in the world.

In an official announcement made today at the Royal College of Physicians, London, the partners said they would combat NTDs by:

• Expanding or at least sustaining drug donation programs so that demand is met right through to the end of 2020.
• Share knowhow and new active ingredients to speed up R&D of new medications.
• The allocation of over $785 million to improve R&D efforts and support drug distribution and implementation programs.
• The endorsement of the "London Declaration on Neglected Tropical Diseases". The Declaration promises a new level of commitment and collaboration in the tracking of progress.

Bill Gates, co-chair of the Bill & Melinda Gates Foundation, said:

"Today, we have joined together to increase the impact of our investments and build on the tremendous progress made to date. This innovative approach must serve as a model for solving other global development challenges and will help millions of people build self-sufficiency and overcome the need for aid."

The Gates Foundation says it is donating $363 million over the next five years towards NTD product and operational research.

WHO has published its guide on how best to combat NTDs in a new report, called "Accelerating work to overcome the global impact of neglected tropical diseases - A roadmap for implementation" (PDF). The document lays out what target are achievable by 2020.

Dr. Margaret Chan, Director-General of the WHO:

"The efforts of WHO, researchers, partners, and the contributions of industry have changed the face of NTDs. These ancient diseases are now being brought to their knees with stunning speed. With the boost to this momentum being made today, I am confident almost all of these diseases can be eliminated or controlled by the end of this decade."

The partners have pledged more funds to close the shortfall gap in the drive to eradicate the following NTDs by 2020:

• Blinding trachoma
• Chagas disease
• Guinea worm disease
• Leprosy
• Lymphatic filariasis
• River blindness
• Schistosomiasis
• Sleeping sickness
• Soil-transmitted helminthes
• Visceral leishmaniasis

River blindness (onchocerciasis) is endemic in some parts of the world. In this picture, children are leading blind adults


Sir Andrew Witty, CEO of GlaxoSmithKline, said on behalf of the partners from the pharmaceutical industry:

"Many companies and organizations have worked for decades to fight these horrific diseases. But no one company or organization can do it alone. Today, we pledge to work hand-in-hand to revolutionize the way we fight these diseases now and in the future."

The IFPMA (International Federation of Pharmaceutical Manufacturers & Associations) has pledged approximately $1.4 billion treatments annually for those in need.

11 pharmaceutical companies and some DNDi (Drugs for Neglected Diseases initiative) collaborators are making their data available to libraries. They are also working together with database companies and libraries to develop WIPO Re:Search, a database of compounds, expertise and knowledge.

The Gates Foundation, The Children's Investment Fund Foundation, and The Carter Center and His Highness Sheikh Khalifa bin Zayed Al Nahyan, President of the United Arab Emirates, have said they are donating $40 million to The Carter Center. The UK Government's Department for International Development (DFID) has pledged £20 million (approx. $30 million) as long as others also donate, as part of a £195 target towards NTDs.

With the extra $89 million announced by USAID, the organization will have given $212 towards the elimination of DNDs.

The World Bank has announced an extension of its financial and technical support for African countries so that they can improve and strengthen their health systems and more effectively eliminate NTDs, or control them. The Bank also says it is, along with other partners, expanding a trust fund to address the problem of river blindness, as well as other NTDs which are endemic in Africa.

Stephen O'Brien, U.K. Minister for International Development, said:

"The world has come together to end the neglect of these horrific diseases which needlessly disable, blind and kill millions of the world's poorest. Britain and other partners are leading the way to provide critical treatments to millions of people, which allow children to attend school and parents to provide for their families so that they can help themselves out of poverty and eventually no longer rely on aid."

The declaration and pledges made today are in response to Working to overcome the global impact of neglected tropical diseases, a WHO 2010 report.

Some national governments where NTDs are widespread, such as Tanzania, Mozambique, Brazil and Bangladesh, said they will implement comprehensive plans to eradicate NTDs - they have pledged government-level commitment towards this ultimate goal.

Dr. Alexandre Manguele, Health Minister, Mozambique, said:

"From the moment the evidence of the very heavy burden of NTDs in Mozambique was understood, the government of Mozambique has taken action and continuously increased its commitment and investment to control or eliminate these diseases. With the resources pledged today in the context of this partnership the government of Mozambique feels ever more assured that the mission can be accomplished."

Examples of partner commitments pledged include:

• NTD drug program donors said they will continue to extend, or at least sustain the programs until 2020.
• Global Lymphatic Filariasis Elimination program - the Bill & Melinda Gates Foundation, Eisai, and Sanofi pledge to donate 120 million DEC tablets. This means supplies should be enough to last until the end of the decade.
• Chagas disease - Bayer says its donation of nifurtimox will double.
• DEC tablets for lymphatic filariasis - Eisai says its donation will extend to 2.2 billion tablets.
• Visceral leishmaniasis - Gilead's AmBisome donation for last year will continue (at cost). The company also pledges to continue investing in R&D and new technologies to help combat visceral leishmaniasis, as well as helping affected, resource-limited nations cope.
• Soil-transmitted helminthes - GSK (GlaxoSmithKline) says its albendazole donation will be extended to 400 million tablets annually for an extra five years (through 2020).
• Lymphatic filariasis - GSK's 600 million tablets per year will continue to the end of the decade.
• Soil-transmitted helminthes - J&J (Johnson & Johnson) says it will extend its 200 million per year mebendazole donations through to the end of this decade.
• River blindness and lymphatic filariasis - MSD says its ivermectin donations will continue through to 2020. The company is also looking into using ivermectin to combat other illnesses and conditions.
• Schistosomiasis (snail fever) - Merck KGaA says its 25 million current donation of praziquantel tablets will increase to 250 million annually. The company adds that this will continue indefinitely.
• Leprosy - Novartis says its commitment to provide rifampicin, clofazimine and dapsone will be extended.
• Blinding trachoma - Pfizer says it will continue donating azithromycin until 2020. The company will also donate the medication and placebo for childhood mortality studies.
• Sleeping sickness - Sanofi says it is extending its donations of eflornithine, melarsoprol and pentamidine. The company says it is also helping local in the logistical support so that patients get their medications free of charge.

200 Million Illicit Drug Users Worldwide

Illicit drug usage is practiced by approximately 200 million people globally, Australian researchers reported in the medical journal The Lancet. High-income nations have the highest rates, and disease burdens related to drugs are comparable to the health toll caused by alcohol consumption.

The authors explained that expert estimates of global illicit drug usage range from 142 to 271 million people - approximately 1 in every 20 people aged from 15 to 64 years.

Authors, Professor Louisa Degenhardt, National Drug and Alcohol Research Centre, University of New South Wales, Sydney, and the Burnet Institute, Melbourne, Australia; and Professor Wayne Hall, University of Queensland Centre for Clinical Research, Brisbane, Australia, wrote that the disease burden caused by illegal drug usage is very high in rich nations, for example, in Australia it is about the same as the burden caused by alcohol consumption, but significantly less than tobacco.

Because of the very nature of illicit drugs - they are illegal - it is difficult to gather accurate and reliable data and statistics. It is a serious challenge for health authorities and services to properly determine how many of their citizens are problem users, dependent, or being harmed by taking cocaine, amphetamines or cannabis. The authors explain that these are some of the unintentional negative consequences of making such drugs illegal.

The limitations in gathering accurate and reliable data on the related harms and health burdens attributable to inhalants, non-medical usage of benzodiazepines, or anabolic steroids means that their extents of use have never been properly estimated.

According to data the authors managed to collect, there are globally about:

• 125-203 million cannabis users
• 14-56 amphetamine users
• 14-21 cocaine users
• 12-21 opioid users
• Between 15 and 39 million problematic users of cocaine, amphetamines or opioids
• Between 11 and 21 million individuals inject their illicit drugs

Rates of illicit drug usage vary around the world:

• Cannabis usage - rates are highest in Australia and New Zealand (Oceania), with a 15% usage rate among 15 to 64 years olds
• Opioid usage (includes heroin) - rates are highest in the Middle East, with a usage rate that may be up to 1.4%
• Amphetamine usage - Oceania has the highest rate, about 2.8% of all 15 to 64 year-olds
• Cocaine - 1.9% of US citizens aged 15 to 64 year olds, the highest rate in the world
• Speed and crystal meth - Oceania has the highest rate, at about 2.8% of all 15 to 64 year-olds

The researchers emphasized that there is not one standard way of measuring illicit drug usage rates.

There are four main types of adverse health effects caused by using illicit drugs:

• The acute toxic effects - such as overdosing
• The acute effects of intoxication - such as violence or accidental injury
• The development of dependence 
• The effects on health on long-term sustained usage (sustained, chronic, regular use), such as physical disease.

Cannabis does not appear to cause overdose, blood-borne virus infections, or a noticeable number of deaths - it can cause some accidental deaths. However, dependency is widespread. The authors believe that cannabis also contributes to some mental disorders.

Opioids cause all four types of adverse health effects, the authors wrote. Approximately 1 in every 4 lifetime users develops dependency. Opioids also cause a considerable number of premature deaths, mainly due to overdosing, as well as accidents, violence, and suicides. A significant proportion of opioid users also take other drugs at the same time. The risk of developing HIV/AIDS and/or hepatitis is also higher among opioid users. An considerable number of regular opioid users become disabled, because of infections, liver disease and dependence.

Below are some more data the authors gathered from WHO (World Health Organization); in 2004, globally there were:

• 250,000 deaths attributed to illicit drug usage. This is still much lower than alcohol (2.25 million) and tobacco (5.1 million)
• Years of life lost - Illicit drug use, 2.1 million. Alcohol consumption, 1.5 million. The number is higher for illicit drug use because deaths linked to drug use occur at a much higher rate among young people, compared to death due to alcohol consumption (or even smoking tobacco).
• Disability Adjusted Life Years (DALYS) - Illicit drug use, 13 million. Alcohol consumption, 69 million. Tobacco, 57 million.

There are other burdens which are important but rarely reported, the authors stressed, such as:

• Stigma and discrimination
• The dangers of discarded drug injection equipment
• Violence between drug dealing gangs
• Violence and/or robbery/muggings that occur because of illicit drug dependence

Most reporting on the adverse events linked to illicit drug usage focuses mainly on drug dependence, and in particular, those who inject drugs.

The overall burden of illicit drug usage is considerably higher in high income countries than in developing nations