Posts Tagged ‘Israel grossman attorney Information’

U.S. Is Home To 1.5 Million Undocumented Asian Immigrants

Uncategorized | Posted by Israel Grossman Attorney
Nov 28 2014

The majority of undocumented workers in the U.S. come from Latin America, but there are still huge numbers from elsewhere in the world. Renee Montagne talks to immigration attorney Muzaffar Chishti.

Article source: http://www.npr.org/2014/11/28/367154343/u-s-is-home-to-1-5-million-undocumented-asian-immigrants?utm_medium=RSS&utm_campaign=world

In Pakistan, Political Oratory Is Flourishing

Uncategorized | Posted by Israel Grossman Attorney
Nov 28 2014

Great political speech-making is dying out, thanks to the sound bite and the Tweet. But oratory’s essential for anyone vying for votes in Pakistan.

Article source: http://www.npr.org/2014/11/28/367154371/in-pakistan-political-oratory-is-flourishing?utm_medium=RSS&utm_campaign=world

Test Your Medical Smarts: Does This Patient Have Ebola?

Uncategorized | Posted by Israel Grossman Attorney
Nov 28 2014

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In a training session for health workers in West Africa run by WHO, Ebola survivors play the part of Ebola victims.

John W. Poole/NPR


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John W. Poole/NPR

In a training session for health workers in West Africa run by WHO, Ebola survivors play the part of Ebola victims.

In a training session for health workers in West Africa run by WHO, Ebola survivors play the part of Ebola victims.

John W. Poole/NPR

Ebola is elusive and stealthy, so a medical degree doesn’t automatically prepare a health worker to figure out if a new patient is a likely Ebola case.

The symptoms mimic other diseases. Fever, chills and vomiting could also signal malaria or maybe just a heavy night of drinking. If clinicians guess wrong, they might accidentally put an uninfected person into a treatment area with patients who have contracted the virus.

So before volunteer health workers head off to the Ebola treatment units of West Africa, they need training. A manual created by the IMAI-IMCI Alliance, a global health network, has seen heavy demand during the World Health Organization’s fall training surge. Groups like the U.S. Department of Defense and non-governmental organizations like Save the Children have also used it.

The IMAI-IMCI alliance shared the 128-page manual with Goats and Soda. And we’d like to share parts of it with our readers.

One section offers case histories to consider. Here are four samples: Can you figure out how to proceed?

Before we begin, here’s a quick review of Ebola.

Transmission: Patients are not contagious until symptoms appear, which can take 2 to 21 days. Exposure to bodily fluids — blood, spit, semen, breast milk, excrement — can pass on the disease. Fluids must contact a break in the skin or the eyes, nose or mouth.

Early symptoms: hiccups, sudden fever, weakness, headache, muscle pain, joint pain, loss of appetite, throat pain and difficulty swallowing.

Late symptoms: confusion, seizures, chest pain, diarrhea (watery or bloody), vomiting, rash, internal and external bleeding (appears in fewer than half of patients).

Gathering clues: Even if a patient doesn’t mention possible exposure, Ebola isn’t automatically ruled out. The manual notes that as the outbreak evolves and stigma mounts, the fear of being put in isolation increases. Patients might hide important information. A patient’s family, however, might tell a different story.

Case 1: The Woman From Gueckedou

A women in her 60s from Gueckedou town was brought by her older son to the treatment center with a 3-day history of fever, abdominal pain, and bloody diarrhea.

She reports that the symptoms all started around the same time and that she has had similar episodes in the past. She denied having any other symptoms or recent contact with sick or deceased persons.

The patient is from Gueckedou town, where no EVD [Ebola virus disease] cases have been detected in the past few weeks and denied travel outside the town limits in past months. When asked why she was brought to the treatment center, she responded that her son was concerned that she did not respond to treatment received at the local health facility.

She had high fever (39.5°C) and looked ill but was able to walk. No physical exam could be performed at the screening area.

Do you think she fits the case definition? What would you do next?

The manual says: The patient’s symptoms did not completely fit the case definition (acute fever and ≥ 3 symptoms in absence of a history of contact). Also, the start of fever at the same time as diarrhea is not typical. Usually fever precedes diarrhea and vomiting by a few days.

However, the fact that the older son brought her was suspicious that there was more than what they were telling us. She also looked very ill. EVD testing was offered and was positive.

A day later, we heard that she was connected to a [Ebola] cluster in a remote village:

Her youngest son was sent to help a pregnant family member harvest palm nuts. When he arrived at the community, the pregnant woman became sick with EVD. He helped carry her to a very remote community where the woman died. He came back to the first community where a few days later he started to feel unwell and was transferred to Gueckedou town.

The current patient in question took care of him. He eventually survived but she became ill. After asking again, she was sick with fever for 3-4 days before the diarrhea started.

Teaching point: In areas with high community resistance, patients often do not tell the truth about their symptoms and history. It is important to ask the family member for more information and to keep a high level of suspicion in order to not miss cases. When in doubt, test.

Case 2: The Anxious Young Man With Diarrhea

A young man in his 20s shows up at the treatment center and asks to be tested for EVD. He appears anxious and reports a history of headache, abdominal pain and diarrhea for the past 6 weeks with a notion of mild fever at the onset for 1-2 days. A thorough review reveals no history of contact with persons with EVD. He is presently afebrile [without fever].

How would you manage this patient?

The manual says: The patient was counseled on the signs and symptoms of EVD and transmission routes for Ebola virus. We explained that his symptoms were not consisted with EVD and that testing is not necessary. Nor would a negative test rule out future EVD.

Teaching point: Never test persons who do not fit the case definition (unless you suspect that the patient is lying).

Case 3: Three Girls Who Walk Into A Clinic

Three girls ages 7, 8 and 12 years from a community severely affected by EVD were followed as contacts of their mother who died of confirmed-EVD a week earlier.

They did not directly take care of sick or deceased family members or participate in the burials. When their mother fell sick, the children were placed with another unaffected family member. During the contact tracing period, the 7- and 8-year-olds reported fever since the day before. The 12-year-old felt unwell but denied fever. All three were taken to the treatment center where EVD testing was positive for the two younger girls (now at day 3 of illness) but negative for the 12 year old. However, the older girl began reporting fever shortly after the testing. All three girls had a positive malaria rapid diagnostic test.

How will you manage the three girls?

The manual says: The 7- and 8-year-old were admitted to the treatment center as confirmed cases, where they received supportive care for EVD as well as treatment for malaria. The 12-year-old was kept into the suspect case area and treated for malaria. Her fever continued and on day 2 of illness her EVD test was repeated and was positive.

Teaching point: The level of virus in EVD generally parallels the clinical status of the patient. A test can be negative in the very early stages of illness. If contacts or other persons with a high suspicion of EVD test negative, continued monitoring and retesting on day 3 of illness is warranted. Negative tests on very sick persons or after three days of illness reliably rule out EVD.

How were the children infected?

The manual says: Further discussion with family members revealed that, although the three girls did not get close to sick persons, they washed the clothes soiled with vomitus and stool at the river and probably got infected that way.

Although Ebola virus is not particularly stable in the environment (most evidence suggests that it is not viable for more than a few days) and fomite [contaminated surface] transmission is not commonly suspected, contact with fresh blood or bodily fluids, including on soiled clothing, should nevertheless be considered a risk factor.

Case 4: Lady With A Baby

A 9-month-old baby presented with high fever. The father died of EVD three weeks earlier. The mother and the baby have been followed as contacts. The mother has not been sick and has been breastfeeding the baby.

How would you manage the mother and child?

The manual says: The child was referred to the treatment center for EVD and malaria testing. Testing for EVD was negative but a malaria rapid diagnostic test came back positive. The baby received treatment for malaria and the fever resolved in 48 hours.

Teaching Point: Common diseases in the area continue to occur, in particular malaria, but also typhoid fever and many others. Malaria testing is recommended for all persons with acute febrile disease. Had this child not responded to malaria treatment, repeat testing for EVD at day 3 of illness would have been indicated to definitively rule out the disease. Also note that, as malaria is holoendemic in the region [essentially every individual in the population is infected] and many people, especially children, may have asymptomatic parasitemia [malaria infection without symptoms]. A positive malaria test should not be interpreted as excluding EVD. Testing for EVD should still be performed, especially if the child does not respond to anti-malarial drugs.

Article source: http://www.npr.org/blogs/goatsandsoda/2014/11/28/366790665/test-your-medical-smarts-does-this-patient-have-ebola?utm_medium=RSS&utm_campaign=world

Disabled Ship With Hundreds Of Migrants Aboard Towed To Crete

Uncategorized | Posted by Israel Grossman Attorney
Nov 27 2014

The Greek coast guard towed a crippled freighter with about 700 migrants on board to the island of Crete. It is the largest arrival of refugees to Europe in recent memory.

Article source: http://www.npr.org/2014/11/27/366956607/disabled-ship-with-migrants-aboard-towed-to-crete?utm_medium=RSS&utm_campaign=world

OPEC Ministers To Consider Cuts To Oil Production

Uncategorized | Posted by Israel Grossman Attorney
Nov 27 2014

One of the most closely watched OPEC meeting in years takes place in Vienna on Thursday. Oil prices are at a four-year low and a push for a production cut is being stymied by Saudi intransigence.

Article source: http://www.npr.org/2014/11/27/366956642/opec-ministers-to-consider-cuts-to-oil-production?utm_medium=RSS&utm_campaign=world

Shakespeare Folio Found In Small-Town French Library

Uncategorized | Posted by Israel Grossman Attorney
Nov 27 2014

Copies of Shakespeare’s first folio are some of the rarest books in the world — only about 230 copies survive. Surprisingly, another copy has been rediscovered in a public library in northern France.

Article source: http://www.npr.org/2014/11/27/366956663/shakespeare-folio-found-in-small-town-french-library?utm_medium=RSS&utm_campaign=world

Hong Kong Police Arrest Protest Leaders, More Than 100 Others

Uncategorized | Posted by Israel Grossman Attorney
Nov 26 2014

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Police officers arrest a protester early Wednesday on a street in the Mongkok district of Hong Kong.

Anthony Kwan/Getty Images


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Police officers arrest a protester early Wednesday on a street in the Mongkok district of Hong Kong.

Police officers arrest a protester early Wednesday on a street in the Mongkok district of Hong Kong.

Anthony Kwan/Getty Images

Police in Hong Kong fired pepper spray and arrested scores of protesters overnight Tuesday into Wednesday as they cleared part of a pro-democracy protest camp, NPR’s Frank Langfitt reports.

The Associated Press put the total number arrested at more than 116, including Joshua Wong and Lester Shum, highly visible student-leaders of the protesters.

The camp being cleared was blocking a road in the Mongkok section of the city, a working-class neighborhood, The Associated Press reported, and local media said more than 4,000 officers were employed in the court-ordered removal, which had been requested by the city’s taxi drivers.

The main protest camp in the city’s downtown still holds more than 2,000 tents, Frank reports, despite the recent removal of a section of the camp that was in front of a major office building.

After two-months and with little change, many protesters now agree with the majority of Hong Kong’s citizens that the demonstrations should end, Frank reports, but a vocal minority is pushing the movement on.

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Protesters pack their belongings Wednesday ahead of an expected clearance by bailiffs and police at a pro-democracy protest site in the Mongkok district of Hong Kong.

Philippe Lopez/AFP/Getty Images


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Protesters pack their belongings Wednesday ahead of an expected clearance by bailiffs and police at a pro-democracy protest site in the Mongkok district of Hong Kong.

Protesters pack their belongings Wednesday ahead of an expected clearance by bailiffs and police at a pro-democracy protest site in the Mongkok district of Hong Kong.

Philippe Lopez/AFP/Getty Images

Article source: http://www.npr.org/blogs/thetwo-way/2014/11/25/366675657/hong-kong-police-arrest-protest-leaders-more-than-100-others?utm_medium=RSS&utm_campaign=world

Tax Fraud Case In Spain Lingers Against Barcelona Soccer Star

Uncategorized | Posted by Israel Grossman Attorney
Nov 26 2014

One of the world’s most famous soccer players, Lionel Messi, has broken 2 of the game’s greatest records in less than a week. But his future in Spain is clouded by a tax fraud case against him.

Article source: http://www.npr.org/2014/11/26/366729867/tax-fraud-case-in-spain-lingers-against-barcelona-soccer-star?utm_medium=RSS&utm_campaign=world

Why Fed Officials Are Concerned About Too Little Inflation

Uncategorized | Posted by Israel Grossman Attorney
Nov 26 2014

The U.S., Europe and Japan are seeing prices and wages rise more slowly than the 2 percent target that their central banks have set. Renee Montagne talks to David Wessel of the Brookings Institution.

Article source: http://www.npr.org/2014/11/26/366729939/why-fed-officials-are-concerned-about-too-little-inflation?utm_medium=RSS&utm_campaign=world

White House To Find Successor To Defense Secretary Hagel

Uncategorized | Posted by Israel Grossman Attorney
Nov 25 2014

Defense Secretary Chuck Hagel announced his resignation on Monday. He will stay on until his replacement is found. Why did Hagel resign, and what does it mean for the Obama administration’s policies?

Article source: http://www.npr.org/2014/11/25/366504662/white-house-to-find-successor-to-defense-secretary-hagel?utm_medium=RSS&utm_campaign=world