Bacterial pneumonia

STUTTGART, Germany—The country’s center-left Social Democrats are limping towards what could be their worst postwar election result this Sunday, opinion polls suggest, condemning them to a period in opposition.

Demoralized and divided, Germany’s oldest party is in serious trouble after 11 bruising years in power in two different coalitions, with even the country’s federation of trade unions refusing to offer its traditional support.

When the SPD’s Gerhard Schroeder was first elected chancellor in 1998, the party won 40.9 percent of the national vote. This time around, opinion polls indicate it is on course to notch up something like 25 percent.

In contrast, Chancellor Angela Merkel’s center-right Christian Democrats (CDU), the SPD’s current partners in an unhappy “grand coalition,” are riding high in the polls at between 35-39 percent.

And with surveys indicating that Merkel will be able to ditch the SPD and instead form a government with the pro-business Free Democrats (FDP) after the election on September 27, a period of opposition for the SPD looms.

“It’s all over,” Wolfgang, 50, told AFP at a party rally in the southern city of Stuttgart last week, a gathering marked by a distinct whiff of resignation.

“If we score 28 percent it will be amazing,” agreed civil servant Sybille Kirschbaum, 54, worse than the SPD’s postwar record low of 28.8 percent recorded back in 1953, the year before Merkel was born.

The party’s problems date in part back to Schroeder’s time in office from 1998 to 2005, when he governed in a coalition with the ecologist Greens that introduced a barrage of painful social security and labor market reforms.

These were seen among many of the party’s rank and file as a betrayal of the SPD’s socialist principles, sending many into the arms of what in a short space of time has become a new force in national politics: the far-left Die Linke.

This new party, a collection of disaffected SPD members and former communists from the old East Germany, is now represented in 11 of Germany’s 16 state parliaments and is polling at around 12 percent nationally.

It has also poached SPD voters by being the only party calling for an immediate withdrawal of Germany’s 4,200 troops in Afghanistan—a deployment that begun under Schroeder and which the SPD continues to support.

The SPD works with Die Linke to form state coalitions, but at federal level the party leadership has made it clear that this is taboo.

Governing with Merkel has also made it hard for the SPD to score points against the CDU, even with Germany crippled by its worst recession since 1945—something that normally could be expected to boost the left.

This problem is nowhere more evident than when it comes to the SPD’s candidate to replace Merkel, Frank-Walter Steinmeier, deputy chancellor and foreign minister in the “grand coalition.”

“Government successes are attributed to Merkel, not to Steinmeier,” political scientist Nils Diederich told AFP.

MANILA, Philippines—In spite of all the hoity toity and fancy restaurants that have mushroomed in the metro, at the end of the day when you want to grab a beer and grub with your friends, the restaurant of choice is still either Dencio’s, Grilla, Gerry’s Grill, or the like. The drink of choice: light beer. The chow of choice: pulutan, with or without rice.

The bestseller, international approval be damned, is still brain food! No, not food that’s good for the brain but food concocted from brain, a.k.a. sisig. Sisig is a Filipino delicacy traditionally made from parts of a pig’s head: the brains, ears, snout, and cheeks (although other recipes include liver, heart, tongue, and/or buttocks). Other people condemn this delicacy (yuck, utak!) but if you eat other parts of a pig anyway, why not the brain?

At Dencio’s, they lay out a tray beside your table so that they can move the sisig from a bowl onto the sizzling plate right before your eyes. So the sisig is sizzling hot when it is served and you get a whiff of what you’re about to enjoy.

The way sisig is cooked is quite interesting. It goes through a process of boiling, then grilling or broiling, then frying. Various recipes show that after taking out the pig’s facial hair, if any, you boil the parts, mixing in peppercorn, bay leaves, salt, and pepper (others use pineapple juice) until tender. Drain and dry then grill or broil (except the ears, which become tough if broiled). Chop and fry, mixing with soy sauce, vinegar, salt, and pepper. Then serve hot, best on a sizzling plate, with the option to top with a raw egg.

The result is a classic Filipino sizzling plate of slightly sweet (from the soy sauce), salty (from the pork), and sour (from the vinegar) flavors with alternating soft (brain) and crunchy (ears, onions) textures.

Other restaurants, however, have taken to using other ingredients other than a pig’s head. At Cheevs in Greenhills, the restaurant’s creative director has created lengua sisig. This has all the glories of the classic sisig, but instead of being chewy and crunchy, the texture is soft because it uses pig’s tongue, and therefore does not have the gnawy texture of the ear cartilage. It is sisig refined.

At TJ’s, a couple of restaurants down from Cheevs, they serve bagnet sisig. This is also like your regular sisig served hot on a sizzling plate lined with margarine or butter, but the difference is the crunch of popped pig skin, care of the bagnet. This is deliriously good, especially with pale pilsen, because of the very crunchy effect of the bagnet against the slightly salty and sour mix of the sisig. Meanwhile, Dencio’s is promoting their bangus sisig, which is interesting too, given the use of the milkfish’s skin, which adds crunch.

Not down for sisig? The range of pulutan nowadays is amazing. You can go for the ol’ gambas and calamares—but why bore yourself? Cheevs offers sinuglaw, which is inihaw (sinugba) na baboy with kinilaw (fresh fish in vinegar). Does that sound weird? Yes, but it tastes amazing. The concoction offers you the best of Pinoy flavors: the sourness of the kinilaw, with the bite of the vinegar lingering on your tongue; then the savory taste of the inihaw na baboy tempering the vinegar. Plus, there is a twist of duck egg, which adds a bit more saltiness and adds dimension to the texture of the dish. If you are a fan of Filipino cooking, I promise you will love every bite of this. It is an invention that must be lauded by the act of repetitive consumption.

Other concoctions? Dencio’s offers Sizzling Tiyan ng Bangus. Who can resist milkfish fat? It is loaded with garlic bits on top. Other restaurants funk up their pizza. TJ’s goes so far as to offer bagnet pizza. Although it’s really not a good pizza (not a good crust, tomato paste too pasty) and not a great use of bagnet either. The bagnet should stick to the sizzler. I guess for pizza, we can stick to Shakey’s.

WHEN you see a person taking out a cigarette, and without lighting it, starts to puff away, and you see the end of it is glowing bright blue, then you know you are looking at the latest technological advance in drug delivery.

The “Super Smoker” electronic cigarette is battery operated, manufactured in Belgium, which “delivers a nicotine dose without tobacco, tar or any burning.” The gadget uses a nicotine gel vaporizing atomizer, and

the battery lasts for 24 hours before recharging. Equivalent to about 4 cigarette sticks, the cartridges come in Zero, Light (1.8 mg), Normal (2.4 mg), and Menthol, good for about 30 inhalations. The starter kit costs $139 and the pack of 24 cartridges costs $18.95.

This product, with a concept that started in China in 2004, while not approved by the US- Food and Drug Administration as yet, appears to provide an effective aid to smokers who want to quit and eliminate for the non-smokers the exposure risk to second-hand smoke. This fashionable “cigarette” device might even find other application as a delivery system for medications, like insulin for diabetics, or Viagra for male erectile dysfunction.

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BARIATRIC Surgery (surgery for obesity) may also confer the metabolic and health benefits to people who are only moderately or mildly obese, or even nonobese individuals, according to several reports presented at the recent annual convention of the American Society for Metabolic and Bariatric Surgery in Grapevine, Texas.

Heretofore, the National Institute of Health (NIH) guidelines recommended bariatric surgery “only for patients with a body mass index greater than 40 kg/meter square or those with BMI greater than 35 with type 2 diabetes or other obesity–related comorbidities” (co-existing medical conditions).

A person who is 5 feet 6 inches tall and weighs 248 pounds (112.7 kilos) has a BMI of 40, and a person with that same height who tips the scale at 217 pounds (98.6 kilos) has a BMI of 35. (Calculate your own body mass index by visiting www.nhlbisupport.com/bmi/)

Dr. Jenny J. Choi of Columbia University Medical Center , New York, and others are challenging the NIH guidelines, noting that new studies have “consistently shown marked benefits of obesity surgery” in patients with lower BMI, even among those who are nonobese, like the potential for reversing diabetes type 2 and concomitant improvement in co-existing

morbidities such as hypertension, sleep apnea, hyperlipidemia, stress incontinence, gastro-esophageal reflux, and even depression.

The minimally invasive laparoscopic adjustable gastric banding (LAGB) is the procedure recommended for moderate to mild obesity, and the gastric bypass for the morbid obesity.

The prevalence of metabolic syndrome of 38 percent has dropped to 3 percent at two years among those who had LAGB, compared to 24 percent in the medically treated patients. With the mean BMI of 33.1, the banded group showed a drop in their BMI to 25.8 in two years. The mean fasting blood sugar dropped from 207 mg/dL to 114 mg/dL and the HbA1c dropped from 8.5 to 5.9 percent at 26 months, allowing the patients to stop their anti-diabetic medications permanently. There was a significant improvement in the quality of life as well in the LAGB group.

In another study, conducted at the Texas Children’s Hospital in Houston, findings showed that obese

adolescents (average age 16 and average BMI of 60 kg/m square), lost 58 percent of their weight in oneyear and 60 percent at year two. The surgery also improved comorbidities, like 82 percent improvement among those with insulin resistance and 45

percent among those with sleep apnea. Some of these children were also cured of their type 2 diabetes after surgery.

These encouraging studies will be put to task by more extensive research now ongoing to confirm their veracity and effectiveness for the general population.

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WHEN a chronic heavy smoker suddenly loses the urge to smoke and quits smoking effortlessly, it may mean the person already has cancer of the lungs.

Why this unusual pattern happens in a certain group of long-term smokers is not clearly know.

The researchers at the World Conference on Lung Cancer in San Francisco reported that “It has been well-documented that lung cancer patients often stop smoking shortly before their diagnosis,” and even before any symptoms develop.

According to Dr. Barbara Campling, a medical oncologist with the University of Pennsylvania in Philadelphia, this has led to the medical speculation “that in some cases, spontaneous smoking cessation may be a presenting feature of lung cancer, possibly caused by tumor secretion of a factor interfering with nicotine addiction.”

In a study of three groups (former smokers with lung caner, former smokers with prostate cancer and former smokers with heart attack), the Philadelphia Veterans Medical Center found out that former smokers with prostate cancer had stopped smoking an average of 23 years before their diagnosis; 10 years for those former smokers with heart attack; and quitting 2.7 years before diagnosis for those previous smokers with lung cancer.

A typical example of this group of smokers was “someone who had smoked a pack of cigarettes a day for 50 years and wakes up one day and forgets to light a cigarette… and realizes they don’t need it anymore,” stated Dr. Campling.

Let me make it very clear that quitting is NOT the cause of cancer. Smoking cigarettes is. We are reporting this study to emphasize once more that smoking is a proven health hazard and a potential killer, and that quitting now while it is still hard to quit, while the craving is still strong, is the best time to kick the habit… before cancer develops.

Kemp’s desire to become a pediatrician bloomed early in life. His mother, Peggy Kemp, now 84, was a nurse in a children’s rehabilitation hospital.

“She taught me the impact on families when bad things happen to kids and the importance of those kids having fun in their lives,” he says. “When my brothers and I would go to see her at work, we saw how much fun she had with kids who were very unlucky.”

Kemp also was influenced by one of his clinical professors at Creighton University School of Medicine, Warren Bosley, M.D.

“When I did an elective with him, I saw how his attitude toward what he was doing was so lighthearted,” he says. “His patients were sick, but his attitude was ‘We’re in this to serve the patient, we’re in this to have some fun with what we’re doing, and my job is to see to it that the kid gets back to being a kid.’”

Kemp took that attitude to heart, says Alan L. Schwartz, Ph.D., M.D., the Harriet B. Spoehrer Professor and head of the Department of Pediatrics.

“Jim Kemp is a superior clinician, a state-of-the-art expert in both pulmonary diseases of children and sleep disorders, an engaging bedside teacher and a critical thinker and scholar,” Schwartz says. “He is always asking deep questions of pathophysiology and how to minimize disease burden on children.”

In the mid-1970s, on the Pine Ridge Indian Reservation in southwest South Dakota, two separate confrontations between the government and activists known as the American Indian Movement left four FBI agents and three American Indians dead.

As part of a U.S. Public Health Service scholarship, Kemp went to the Indian Health Service at Pine Ridge in 1979 as a pediatrician fresh from residencies at SSM Cardinal Glennon Children’s Medical Center in St. Louis and Baylor College of Medicine in Houston. As a South Dakota native, Kemp felt called to serve in his home state.

“Pine Ridge was a place with a long tradition of adventurous physicians who wanted to be in exciting places,” says Kemp, professor of pediatrics and a pulmonologist at St. Louis Children’s Hospital. “It was very interesting, but it was dangerous also — it was a very violent place.”

Some of the patients he saw were distrustful of him and the other physicians at Pine Ridge.

“They thought if we were any good we’d be practicing in the suburbs someplace,” he says.

But the reservation’s people, the Oglala Sioux, had serious and complicated health problems that required good physicians.

“I’d done residencies in large urban areas, and in this place, I saw every single problem I’d seen as a resident — congenital heart disease, septic shock, premature births — but I was in the middle of a place where the nearest substantial hospital was 120 miles away,” he says. “I was 29, and I was it.”

Ever wonder how your eyes adjust during a blackout? When we go from light to near total darkness, cells in the retina must quickly adjust. Vision scientists at Washington University School of Medicine in St. Louis have identified an intricate process that allows the human eye to adapt to darkness very quickly. The same process also allows the eye to function in bright light.

The discovery could contribute to better understanding of human diseases that affect the retina, including age-related macular degeneration, the leading cause of blindness in Americans over 50. That’s because the disease and the pathway the researchers have identified both involve cells called cone cells.

Age-related macular degeneration may be modulated, perhaps, through this pathway we’ve identified in the retina, says principal investigator Vladimir J. Kefalov, Ph.D. Deficiencies in this pathway affect cone cells, and so does macular degeneration, so it’s possible that if we could enhance activity in this pathway, we could prevent or reverse some of that damage to cone cells.

The retina’s main light-sensing cells are called rods and cones. Both use similar mechanisms to convert light into vision, but they function differently. Rods are highly sensitive and work well in dim light, but they can quickly become saturated with light and stop responding. They don’t sense color either, which is why we rarely see colors in dim light. Cones, on the other hand, allow us to see colors and can adapt quickly to stark changes in light intensity.

The researchers began with studies of salamanders because their cone cells are abundant and easy to identify. Cones rely on light-sensing molecules that bind together to make up visual pigments. The pigments get destroyed when they absorb light and must be rebuilt, or recycled, for the cone cells to continue sensing light. After exposure to light, key components of pigments called chromophores can leave the cells and travel to the nearby pigment epithelium near the retina. There the chromophore is restored and returned to the photoreceptor cells.

Earlier this year, the research team removed the pigment epithelium layer in salamander retinas, so that pigment molecules could not be recycled that way. Then they exposed retinal cells both to bright light and to darkness. The rods no longer worked, but the cones continued to function properly, even without the eye’s pigment epithelium.

Exposure to bright light destroyed visual pigments in rods, and those cells could not recycle chromophores, says principal investigator Vladimir J. Kefalov, Ph.D., assistant professor of ophthalmology and visual sciences. Pigments in cones, by contrast, quickly regenerated and continued to detect light even without the pigment epithelium, so it was clear a second pathway was involved.

In the new study, Kefalov did the same experiments in cells from mice, primates and humans with the same result.

To learn how cones were able to recycle pigments without pigment epithelium, Kefalov’s team has focused on a particular type of cell in the retina. Called Muller cells, these cells support and interact with rods and cones. The researchers treated mouse retinas with a chemical that destroyed the Muller cells, then exposed the retina to bright light, followed by darkness.

When we blocked the function of Muller cells, the retinal visual pathway could not function because cones ran out of photopigment and could not adapt to dark, Kefalov says.

The new paper, published in the journal Current Biology, suggests Muller cells are key to this pathway in mammals, including humans.

When those cells function properly, cones in the mouse, primate and human retinas are able to function in bright light and adapt to darkness, independently of the pigment epithelium, Kefalov says.

He says this discovery means it may one day be possible to manipulate this pathway in the retina to improve vision when the other pathway, involving pigment epithelium, has been interrupted by injury or disease, such as age-related macular degeneration.

CHICAGO – As health reform legislation moves forward in Congress, a new American Medical Association (AMA) online videoVideo Clip aims to answer physicians’ questions on leading elements of health reform important to patients and physicians.

“The new video aims to reach a wide audience of physicians by answering key questions about health reform,” said AMA President J. James Rohack, MD. “Throughout the summer, the AMA reached out to physicians in tele-town hall meetings to set the record straight on the benefits of health-system reform, and this video answers the frequently asked questions.”

AMA board members — physicians elected by their peers — answered questions to help broaden physicians’ understanding of the evolving health-reform issues in a format that would not add a burden to the many demands on physicians’ time.

Many physicians expressed concern about Medicare cuts that threaten seniors’ access to care, and AMA board members explain that repeal of the flawed Medicare physician payment formula is included in the House bill and must be a part of health reform. The AMA emphasizes its support of medical liability reforms that increase patient access and help slow health care spending, and board members note that the administration has taken an important first step to address the cost of defensive medicine by allowing states to implement alternative reforms. Other topics addressed in the video include how to strengthen the physician workforce and optimize quality of care through health reform.

“Physicians are working for a better health system for their patients,” said Dr. Rohack. “The AMA is committed to communicating with America’s physicians and patients and providing critical information during this historic health reform debate.”

The possible health risks of food additives are the subject of fierce controversy.

Most food additives are considered safe.

All additives in the UK and Europe are controlled by law, and can only be used following stringent tests and approval by an independent committee of scientists and medical experts.

However, some scientists have linked additives – particularly tartrazine or E102 – to hyperactivity in children, allergies, asthma, migraines and even cancer.

The British Nutrition Foundation (BNF) believes more research is needed before any firm link is established between additives and allergic reactions. But it does not rule out the possibility.

Sarah Schenker, a nutrition scientist for the BNF, said: “Some additives, especially some of the colourants, have been linked with hyperactivity in children, but the evidence is very ancedotal.

“There have been no properly controlled trials or tests looking at the effect of additives.

“The public should not be worried about additives because they have all been rigorously tested before they are allowed to be added to foods.”

Dr Schenker said that if people noticed a reaction they should simply cut the offending item out of their diet.

However, according to The Center for Science in the Public Interest (CSPI), a US organisation that campaigns for food safety, many additives should be avoided for health grounds.

Aspartame concern

The sugar substitute Aspartame is sold commercially as Equal and Nutrasweet.

One out of 20,000 babies is born without the ability to metabolise phenylalanine from any dietary source. Phenylalanine is a naturally occurring essential amino acid found in all protein (including mother’s milk) and is one of the two amino acids in aspartame.

All children are screened for phenylketonuria at birth and any found with it have to follow a strict diet for the rest of their lives, controlling the amount of protein they consume.

There is some evidence to suggest toxic levels of this substance in the blood can result in mental retardation.

Scientists are also investigating a possible link between aspartame and changes in brain function.

People have reported dizziness, headaches, epileptic-like seizures, and menstrual problems after consuming aspartame.

Other additives highlighted by the CSPI include:

* Caffeine: linked to peptic ulcers, insomnia, nervousness and birth defects.

* Monosodium Glutamate (MSG): linked to heaches, tightness in the chest, and a burning sensation in the forearms and back of the head.

* Nitrite and Nitrate: Meat preservatives that can form powerful cancer causing chemicals when heated.

* Saccharin: linked to cancer is laboratory animals.

Inadequate sexual function in women is a complex problem that can have many different causes.

It is estimated that up to 40% of women suffer from sexual dysfunction. This might be caused by physical illness, but is often linked to psychological factors.

The symptoms of sexual dysfunction can include lack of sexual desire, an inability to enjoy sex, insufficient vaginal lubrication, or, even if sexually aroused, a failure to achieve an orgasm.

The female equivalent of impotence is known as Female Sexual Arousal Disorder (FSAD).

When men and women become sexually aroused, their genitals become engorged with blood.

In women this normally results in:

* Enlargement of the clitoris and surrounding tissues (comparable to a male erection)
* Secretion of vaginal lubrication
* Relaxation and widening of the vaginal opening to permit intercourse.

FSAD patients have the desire to have sex but their genital area fails to respond in the normal way, making sex painful or impossible.

The plot has thickened when it comes to China and bird flu.

It appears one of the researchers who reported that a Chinese man may have died from avian influenza before anyone else in China was known to have the disease, has denied trying to retract the article.

Dr. Wu Chun Cao of the State Key Laboratory of Pathogens and Biosecurity in Beijing says that e-mails bearing his name sent to the The New England Journal of Medicine were not written or sent by him.

The case has caused grave concern and the authenticity of the letter sent to the journal reporting the case is critical.

The letter reinforced widely held suspicions there were earlier and more human bird flu cases in China than authorities ever admitted to.

The prestigious journal says it received an e-mail signed with the researcher’s name that requested the letter reporting the case be withdrawn from publication.

Wu has since telephoned the journal’s editors and sent a fax denying he ever made any such request.

Wu, a senior scientist in China, was one of eight researchers who reported in the journal that a 24-year-old man who died of pneumonia in November 2003 and was at first suspected as a SARS victim may have in fact died of avian influenza as all tests were negative for SARS.

Tests of his tissue were however positive for the influenza virus, and genetic sequencing later showed it to be H5N1 avian influenza and genetically similar to viruses taken from Chinese chickens in various provinces in 2004.

SARS first broke out in China’s southern Guangdong province in 2002 and spread as far as Canada before it was brought under control in 2003.

It killed almost 800 people out of the 8,000 known to have been infected.

At the time flu experts assumed the then-mysterious respiratory illness sickening people in China was H5N1 avian influenza, which broke out in Hong Kong in 1997 and then disappeared.

Influenza experts say flu viruses rarely just disappear and had been waiting for its return, which was reported in 2003.

The H5N1 avian flu virus spread from China and across most of Asia, reaching parts of Europe and Africa.

While it remains a disease of birds, it occasionally infects people and has to date killed 130 in nine countries.

Experts believe it could cause the next influenza pandemic and several research labs and companies are rushing to develop a vaccine against H5N1 just in case.

The timing of the death is crucial because scientists believe that the A(H5N1) avian flu virus had percolated in China’s chickens for many years, but it was not until last November that the government admitted to having a human case; it has officially reported 19 cases and 12 deaths.

Had the information been available earlier lives may have been saved and thousands of birds reprieved from death by disease or culling.

In 2003, China covered up dozens of SARS deaths for months after the epidemic began there.

The World Health Organization has asked the government to explain the discrepancy.

The letter is published in the New England Journal of Medicine.