Two critical with swine flu in Hong Kong

AFP/File – People are pictured wearing masks as they visit a hospital in Hong Kong, in 2009. Two people were in …

HONG KONG (AFP) – Two people were in critical condition in a Hong Kong hospital suffering from swine flu, health officials said Friday, a year and a half after an outbreak killed more than 80 people in the city.

The Chinese financial centre is nervous about infectious diseases, following the outbreak of the SARS virus in 2003, which killed 300 people in the city and a further 500 around the world.

Hong Kong, a city of seven million, has some of the world's most densely populated neighbourhoods, prompting a panicked response from many residents over news of a disease outbreak. Some wear surgical masks to avoid infection.

The city's health department said that the deadly influenza had claimed 83 lives since an outbreak in 2009.

Authorities appeared wary of raising the alarm over the latest cases, with a senior public health official telling RTHK radio there were no plans to shut schools, as the city did in 2009 which drew criticism about an official overreaction.

But there are worries the disease could spread over the next few weeks in the run up to Lunar New Year, when hundreds of millions of Chinese travel across the country to celebrate with families.

On Friday, a spokeswoman for the Queen Elizabeth Hospital told AFP "a 21-year-old female is in critical condition after contracting swine flu".

The student, who had returned to Hong Kong from mainland China after falling ill, was admitted to hospital on January 11 and transferred to intensive care on Tuesday, the spokeswoman told AFP. She later confirmed the woman has leukemia.

Also Tuesday, a two-year-old girl was placed in the hospital's intensive care unit after she contracted the disease, the spokeswoman said, adding that she remains in critical condition.

Authorities in the nearby gambling hub of Macau have confirmed a 47-year-old woman was in critical condition with the disease.

Swine flu has killed more than 18,400 people and affected practically all parts of the world since it was uncovered in Mexico and the United States in April 2009, according to the World Health Organization.

In August last year, the agency said swine flu had "largely run its course", declaring an end to the pandemic.

In May 2009, Hong Kong health authorities quarantined around 300 guests and staff at a hotel where the carrier, a Mexican national, had briefly stayed, while education chiefs ordered all primary schools to be closed for two weeks over fears about the illness spreading.

In July 2009, a Philippine maid became the city's first swine flu fatality.

Last month, Hong Kong lowered its public health warning on influenza, weeks after announcing its first human case of bird flu since 2003.

Hong Kong was the site of the world's first major outbreak of bird flu among humans in 1997, when six people died of a mutation of the virus, which is normally confined to poultry.

by Joyce Woo

FDA to consider Alzheimer's test for living patients

One of the many frustrations of Alzheimer’s disease is the difficulty in pinpointing just who has it. According to published research, as many as one in five people told they have Alzheimer’s are mislabeled. A definitive diagnosis can  be made only after death, by an autopsy that reveals a distinctive buildup – known as amyloid plaques – in the patient’s brain. This week, however, the FDA will consider a new diagnostic test that may be able to identify those plaques through PET scans – a type of brain scan – on living patients.

In a small study run by Avid Radiopharmaceuticals and made public Tuesday in the Journal of the American Medical Association , PET scans identified the telltale plaques in 97 % of patients who actually had them, as determined by a subsequent autopsy. The 35 patients in this part of the study were terminally ill, and agreed to both a brain scan and an autopsy.

The researchers also performed PET scans on presumably healthy people to try to ensure that the test could tell the difference. It could. Of 74 young and healthy people tested, none had scans indicating Alzheimer’s.

Before performing a PET scan, a doctor or technician injects the patient with a radioactive dye that can be detected by the imaging equipment. The particular dye used in this test was developed by Avid and is known as Florbetapir F 18. Chief Executive Officer Dr. Daniel Skovronsky says Florbetapir F 18 binds tightly to the amyloid proteins – making them visible to the scanner – but doesn’t bind to other tissue.

According to Skovronsky, diagnosis of Alzheimer’s still depends on a clinician who can evaluate a patient’s overall condition, but he says the test with Florbetapir could be especially useful as a tool to rule out Alzheimer’s. In that scenario, a patient who shows symptoms of dementia would be given a PET scan; a negative result would push her physician to consider other conditions.

A second paper in JAMA suggests that a simple, low-cost blood test can tell whether a person is at risk for cognitive decline, which is a precursor to Alzheimer’s.

During a span of 10 years, researchers checked the blood of 997 elderly people in Memphis, Tennessee and Pittsburgh, Pennsylvania, testing for two types of proteins that are associated with Alzheimer’s. They re-tested each person at 1-year, 3-year, 5-year, 8-year and 10-year intervals. Patients with lower levels were significantly more likely to suffer cognitive decline over time.

Researchers also found that patients with more “cognitive reserve” while healthy, are less likely to decline. “Cognitive reserve” is measured in various ways – for example, by years of school attended, or performance on intelligence tests.  The researchers say it may be that people with higher intelligence or more education are able to better compensate for functions lost to early cognitive decline.

Healing touch of family, friends aids recovery

(CNN) -- A thumbs up. Two opened eyes. A smile. These simple signs of recognition from U.S. Rep. Gabrielle Giffords kept hope alive for her recovery from a bullet to the head January 8. And later this week, her parents have told family members and friends in an e-mail, she'll be moved to Houston, Texas, to begin aggressive rehab with a team of medical specialists.

Giffords opened her eyes for the first time January 12, and one of her doctors, Dr. Michael Lemole, said the "unexpected familiarity" of having close friends visit might have helped her progress. She still has a long journey ahead in recovery, but the support of family, friends and onlookers across the country is evident.

Astronaut Mark Kelly, Giffords' husband, has been by the congresswoman's side since the shooting. He told ABC's Diane Sawyer he will be there holding Giffords' hand as many days as it takes, "whatever it takes."

Patients, their families and health care professionals tell CNN that having loved ones present and actively encouraging recovery can make a profound difference.

Shawna Shearer believes it's true, as she said in her iReport. Her husband Andrew, 31, broke both knees and femurs and suffered several small strokes in May in a head-on car crash. For two months, he remained unconscious, but he was never alone. His wife, mother and father took turns staying with him; his father slept in the waiting room many nights.

"I tried to stay as positive as I could," Shawna Shearer, 28, said. "I remember when Andrew opened his eyes, and it was amazing to us."

Although there are no hard data to suggest that having family and friends around can help a brain trauma victim regain consciousness or brain function, it is true that familiar voices have special access to the brain, says Dr. Lee Schwamm, associate professor of neurology at Harvard Medical School and vice chairman of neurology at the Massachusetts General Hospital.

It's as if there's a little police officer inside your brain deciding which signals are allowed to go through and which are not, Schwamm said. And the officer gives privileged access to familiar voices, even with significant injury to the brain and reduced consciousness.

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Shawna Shearer hoped for signs that she and the rest of the family were getting through to Andrew. But when he first woke up, it was hard to tell what, if anything, he could understand of what others said, Shawna said. Then, he started following family members with his eyes. By August, he could nod his head for "yes."

Andrew Shearer told CNN he doesn't remember anything that happened between the day of the accident and around August or September, but appreciates the "tremendous help" that the mere presence of his family members brought.

Randie Alf, 28, experienced that, too. In December, she had an aortic dissection and fell unconscious for two days. Her large family, spread out across the United States, banded together to visit, pray and post updates on Facebook.

"When I 'awoke' I wasn't sure when it was and I was still not making too much sense, but I knew where I was and who was with me, my mom and dad and my cousin and my aunts and my friends. And day by day I got stronger in both mind and body," Alf wrote in her iReport.

"I had such a wide array of people thinking about me. I definitely believe that those people are a lot of the reason I got better so quickly," she told CNN.

Alf stayed in the hospital for two weeks, mostly in the ICU. She is staying with her parents during her recovery. Her younger sister, some cousins and many friends are also close by.

Kimberly Glassman, chief nursing officer for NYU Langone Medical Center, has witnessed many occasions of unconscious patients waking up amid the support of families, and believes they have an important role to play in recovery.

"When we have been able to speak to patients who have been in that state and woken up, it's very common for them to say that they heard people talking to them, they could feel people touching them," she said.

It's equally helpful for the families to feel as though they are doing something useful and meaningful for their loved one in the ICU, Glassman said. Being at the bedside of the patient may not only transfer familiar signals of touch and sound, but also means a lot to the family members.

Andrew Shearer is still recovering, currently in in-patient rehabilitation. From the strokes, he has complications with mobility, and a lower speed of cognitive processing, but no difficulty speaking. His wife and children are looking into moving somewhere where he can move around easier than in their condo, as he mostly uses a wheelchair.

"If you've got people at your side encouraging you, you have such an advantage over isolated and withdrawn patients who have to do that journey alone," Schwamm said.

Kelly is already prompting his wife to have expectations for a speedy turnaround: "I told her she's going to be walking in two weeks," he told Sawyer. "It's good to have a goal, and she's a very goal-oriented person."

There are perhaps more subtle ways that family support can also facilitate a recovery: A vested interest on the part of the patient's relatives and friends can help the hospital staff feel more connected to the patient also. At Massachusetts General Hospital, families of admitted intensive care unit patients are invited to make posters with photos so that hospital staff members have a better sense of who they are. If the family believes in the patient, the staff may be a little more hopeful than they might have otherwise.

"When families give up on the patient's recovery, I think the health care team may do the same," Schwamm said.

Alf and Andrew Shearer both recommend that family and friends of someone in the hospital try to be there for the patient as much as possible. Even if you can't be there physically, phone calls and cards do help, Alf said.

In fact, nurses such as Glassman will put the phone up to an unconscious patient's ear if a family member can't be there in person. They'll read every card sent to these patients who can't read themselves.

"I would encourage families to be hopeful, to be present, and to really keep hope alive in their heart," Schwamm said. "We do see patients like Ms. Giffords, and we see them often."