Migrant public-health emergency creates a political emergency: Lawmakers must act

 A tent city at Creedmoor Psychiatric Center is not the answer to the migrant crisis any more than is a migrant shelter on Randall’s Island that will cost New York taxpayers $20 million a month.

The only way for politicians to approach this mess is the way we approach every national disaster, both natural and manmade: We must accept this as the national security problem it is and officially declare it a public health emergency.

We need all hands on deck. A public-health disaster for New York City is by definition a public-health disaster for New York state.

The governor needs to recognize this immediately and pony up some state-owned land for temporary residences.

We are talking about sanitation and hydration and communicable diseases.\\After months of complaints about poor access to showers at many shelters, the city just awarded a Florida company a $20 million contract for shower trailers.

In fact, the migrant-health crisis is a public health crisis for the entire country.

A migrant shelter on Randall’s Island that will cost New York taxpayers $20 million a month.

AP

Where are President Joe Biden, the National Guard and the Federal Emergency Management Agency?

The Centers for Disease Control and Prevention must be involved, too, because one of its primary functions is to ensure public health and safety throughout the country.

Down at the border, Pinal County, Ariz., Sheriff Mark Lamb told one of us that Border Patrol and local agencies have seen everything from tuberculosis, hepatitis and COVID to dengue fever, chicken pox and sexually transmitted infections.

There is emerging evidence we will see a resurgence of vaccine-preventable diseases including measles and polio from migrants who are unvaccinated.

And measles vaccination rates have already been declining.

Chuck Schumer is saying he’s trying to secure more funds to help New York City and state deal with the influx of migrants.

CNP / Polaris

Multiple drug-resistant tuberculosis and sexually transmitted infections are also on the rise, and migrants represent a source of these infections.

Pair the migrant influx with partial treatment of tuberculosis with over-the-counter antibiotics in Mexico, and prepare for even more drug-resistant cases.

Chagas disease has been found in at least 4% of migrants traveling from Central America to Europe, and though this disease is not generally contagious from person to person, it can cause significant heart and other complications that put a further strain on our healthcare system.

What about Senate Majority Leader Chuck Schumer? Is he doing enough?

The answer is no.

Joe Biden has been blasted over his lack of action to deal with the migrant crisis.

CNP / Polaris

Meeting with officials in upstate Orleans County recently, Schumer certainly talked a good game, saying he’s trying to secure more funds to help New York City and state deal with the influx of migrants.

“Ultimately we need some kind of answer at the border and the real answer is bipartisanship,” he said, insisting he’s going to use his clout among senators to “make them do what they have to do as opposed to just verbiage.”

Actually, his statements sounded all too much like more verbiage — especially when you consider Schumer also said that some solutions must come at the administrative rather than legislative level and he’s against reassigning Custom and Border Protection agents from the northern to the southern border.

We don’t agree with the senator and feel that some of our trusted CBP agents in the north should be moved to the dire southern border.

But whether they come from the Canadian border or not, one thing’s certain: We need more security, more federal agents, more skilled and courageous border agents of some kind to help secure the border. Did someone say build a wall?

Schumer and House Minority Leader Hakeem Jeffries announced recently that FEMA will send $104 million of additional funds to “asylum seekers” in New York City.

This is just another Band-Aid on the problem when the real issue remains that politicians should not use American kindness as an excuse to undermine national security and ultimately extend public-health risks.

Bickering and hyperventilating over the use of the word “asylum” obfuscate the truth. This is Schumer’s and others’ political reality.

But the people of New York and America at large are interested in a more fundamental truth: that people bringing contagious diseases into our country put themselves and others at risk, straining a health-care system that is still battered from the COVID pandemic beyond its capacity to cope.

Marc Siegel, MD, is a clinical professor of medicine and medical director of Doctor Radio at NYU Langone Health and a Fox News medical analyst. Andrew Stein, a Democrat, served as New York City Council president, 1986-94.

https://nypost.com/2023/08/16/the-migrant-public-health-emergency-creates-a-political-emergency-lawmakers-must-act/

US FDA approves French drugmaker Ipsen's rare bone disorder drug

 The U.S. Food and Drug Administration (FDA) on Wednesday approved French drugmaker Ipsen's drug for a rare bone disorder, making it the first treatment available to patients with the condition that causes abnormal bone growth.

The company said its drug, Sohonos, was approved in adults and pediatric patients with fibrodysplasia ossificans progressiva (FOP), a rare genetic connective tissue disorder that causes progressive loss of mobility and reduced life expectancy.

The regulator approved use of the drug in girls aged 8 years and above, and 10 years and above in boys.

Sohonos tablets will be sold at an estimated annual list price of $624,000 based for 5mg (dose) per day, the company told Reuters, adding that dose may vary based on an individual's weight and disease state.

The drug approval is based on data from a late-stage study, which showed a 54% reduction in the volume of new abnormal bone formation in patients compared to standard of care.

The approval puts Ipsen ahead of other drugmakers such as Regeneron Pharmaceuticals, which is also developing an experimental drug, garetosmab, for the disorder and expects to seek U.S. health regulator's approval in 2024.

Currently, FOP patients rely on high doses on steroids at the start of a 'flare-up', which entail unpredictable episodes of soft tissue swelling, pain, reduced movement and stiffness.

FOP occurs in about 1 in 1,600,000 newborns, according to U.S. government data, and about 800 people worldwide are known to have the disease.

Ipsen is also developing another FOP drug licensed from Blueprint Medicines Corp called BLU-782. It has been boosting its rare disease portfolio by helping develop a string of drugs licensed from other smaller developers.Sohonos will have a boxed warning for embryo-fetal toxicity and premature epiphyseal closure, which can lead to stunted growth and deformities in bone.

https://www.yahoo.com/news/us-fda-approves-ipsens-rare-194220734.html

Levonorgestrel emergency contraceptive more effective when taken with anti-inflammatory med

 Taking piroxicam, an anti-inflammatory medication commonly used for arthritis pain, at the same time as the levonorgestrel emergency contraceptive pill after unprotected sex prevents significantly more pregnancies compared to taking levonorgestrel alone, according to a randomized controlled trial published in The Lancet.

Two types of emergency contraceptive pills—containing either levonorgestrel or ulipristal acetate—are the most widely used emergency contraception method in most countries, with the levonorgestrel pill available in more countries than the ulipristal acetate pill. Both contraceptives work by preventing or delaying ovulation and neither are effective post-ovulation.

The accepted effectiveness of levonorgestrel is based on the results of a trial from 1998 in which levonorgestrel prevented 95% of expected pregnancies when taken within 24 hours of unprotected sex, 85% if taken within 25–48 hours, and 58% if taken within 49–72 hours. However, more recent research suggests the efficacy of levonorgestrel might be lower.

"The levonorgestrel emergency contraceptive pill is one of the most popular choices of emergency contraception in many parts of the world, so finding out that there is a widely available medication which increases levonorgestrel's efficacy when they are taken together is really exciting," said Dr. Sue Lo from the Family Planning Association of Hong Kong, a co-investigator of the study.

First author of the study Dr. Raymond Li from The University of Hong Kong added, "Our study is the first to suggest that a readily available and safe medication taken at the same time as the levonorgestrel pill can prevent more pregnancies than levonorgestrel alone. We hope these results will lead to further research and ultimately changes in clinical guidelines to enable women around the world to access more effective emergency contraception."

The study took place at a major community sexual and reproductive health service in Hong Kong between August 2018 and August 2022. Women who required levonorgestrel emergency contraception within 72 hours of unprotected sex were randomized to receive a single supervised dose of levonorgestrel 1.5 mg plus either piroxicam 40 mg or a placebo pill.

The participants and the attending health care professionals did not know which group received which treatment. A follow up appointment was scheduled one to two weeks after the next expected period. During the appointment, if a normal period had not occurred by that time, a pregnancy test was carried out. The proportion of pregnancies prevented out of those expected was calculated based on an established model published in 1998.

Of the 836 women followed up, there was one pregnancy among the 418 women who took piroxicam and levonorgestrel and seven pregnancies among the 418 women who had the placebo and levonorgestrel. The percentage of expected pregnancies without contraception was estimated at 4.5% (19/418) in both groups. Therefore, the percentage of pregnancies prevented following piroxicam- levonorgestrel co-treatment was 95% (18/19), compared with 63% (12/19) in those who took levonorgestrel and placebo.

There were no significant differences in the rates of side effects between those receiving piroxicam and placebo co-treatment.

Professor Kristina Gemzell-Danielsson from the Karolinska Institute, another co-investigator, explained that "levonorgestrel prevents pregnancy by blocking or postponing the luteinizing hormone surge, which disrupts the ovulatory process. Piroxicam might work by targeting a different type of hormone—prostaglandins. Prostaglandins facilitate several reproductive processes including ovulation, fertilization, and embryo implantation."

"Therefore, we speculate that piroxicam may provide a contraceptive effect both pre-ovulation (by blocking the ovulatory process) and post-ovulation (by preventing the implantation of the embryo), however our trial did not investigate piroxicam's mechanism of action and further studies are required to confirm this."

The authors acknowledge some limitations of the study, including the generalizability of the findings to other settings. As the study excluded women with current or recent use of hormonal contraception, as well as those with more than one episode of unprotected sex before taking emergency contraception, it is not certain whether the piroxicam-levonorgestrel co-treatment will be equally effective when applied to women in those circumstances.

Writing in a linked Comment, Dr. Erica Cahill from Stanford University School of Medicine, who was not involved in the study, said, "Overall, this study suggests that anyone administering levonorgestrel 1.5 mg as emergency contraceptive pills should consider the addition of 40 mg piroxicam orally, as it improves efficacy with minor side-effects."

"These conclusions might not apply to all patients, as this study was limited by a specific population, with participants being mostly of Asian ethnicity and weighing less than 70 kg. Given that levonorgestrel emergency contraception is less effective in people with obesity, the efficacy shown here might not be generalizable to patients with higher BMIs."

More information: Oral emergency contraception with levonorgestrel plus piroxicam: a randomised double-blind placebo-controlled trial, The Lancet (2023). www.thelancet.com/journals/lan … (98)05145-9/fulltext

https://medicalxpress.com/news/2023-08-levonorgestrel-emergency-contraceptive-pill-effective.html

Risk of cancer death after low-dose ionizing radiation underestimated: nuclear industry

 Prolonged exposure to low-dose ionizing radiation is associated with a higher risk of death from cancer than previously thought, suggests research tracking the deaths of workers in the nuclear industry, published in The BMJ.

The findings should inform current rules on workplace protection from low-dose radiation, say the researchers.

To date, estimates of the effects of radiation on the risk of dying from cancer have been based primarily on studies of survivors of atomic bombs dropped on Japan at the end of the Second World War.

These estimates are used to set the level of protection required for workers regularly exposed to much lower doses of radiation in the nuclear industry and other sectors such as health care.

But the latest data from the International Nuclear Workers Study (INWORKS) suggest that risk estimates, based on the acute exposures among atomic bomb survivors to an extremely high dose of radiation, may underestimate the cancer risks from exposure to much lower doses of ionizing radiation delivered over a prolonged period in the workplace.

The researchers therefore tracked and analyzed deaths among 309,932 workers in the nuclear industry in the UK, France, and the US (INWORKS) for whom individual monitoring data for external exposure to ionizing radiation were available.

During a monitoring period spanning 1944 to 2016, 103,553 workers died: 28,089 of these deaths were due to solid cancers, which include most cancers other than leukemia.

The researchers then used this information to estimate the risk of death from solid cancers based on workers' exposure to radiation 10 years previously.

They estimated that this risk increased by 52% for every unit of radiation (Gray; Gy) workers had absorbed. A dose of one Gray is equivalent to a unit of one Joule of energy deposited in a kilogram of a substance.

But when the analysis was restricted to workers who had been exposed to the lowest cumulative doses of radiation (0-100 mGy), this approximately doubled the risk of death from solid cancers per unit Gy absorbed.

Similarly, restricting the analysis only to workers hired in more recent years when estimates of occupational external penetrating radiation dose were more accurate also increased the risk of death from solid cancer per unit Gy absorbed.

Excluding deaths from cancers of the lung and lung cavity, which might be linked to smoking or occupational exposure to asbestos, had little effect on the strength of the association.

The researchers acknowledge some limitations to their findings, including that exposures for workers employed in the early years of the nuclear industry may have been poorly estimated, despite their efforts to account for subsequent improvements in dosimeter technology—a device for measuring exposure to radiation.

They also point out that the separate analysis of deaths restricted to workers hired in more recent years found an even higher risk of death from solid cancer per unit Gy absorbed, meaning that the increased risk observed in the full cohort wasn't driven by workers employed in the earliest years of the industry. There were also no individual level data on several potentially influential factors, including smoking.

"People often assume that low dose rate exposures pose less carcinogenic hazard than the high dose rate exposures experienced by the Japanese atomic bomb survivors," write the researchers. "Our study does not find evidence of reduced risk per unit dose for solid cancer among workers typically exposed to radiation at low dose rates."

They hope that organizations such as the International Commission on Radiological Protection will use their results to inform their assessment of the risks of low dose, and low dose rate, radiation and ultimately in an update of the system of radiological protection.

More information: Cancer mortality after low dose exposure to ionising radiation in workers in France, the United Kingdom, and the United States (INWORKS): cohort study, The BMJ (2023). DOI: 10.1136/bmj-2022-074520

https://medicalxpress.com/news/2023-08-cancer-death-exposure-low-dose-ionizing.html

How old are you, really? AI can tell your true age by looking at your chest

 What if "looking your age" refers not to your face, but to your chest? Osaka Metropolitan University scientists have developed an advanced artificial intelligence (AI) model that utilizes chest radiographs to accurately estimate a patient's chronological age. More importantly, when there is a disparity, it can signal a correlation with chronic disease.

These findings mark a leap in medical imaging, paving the way for improved early disease detection and intervention. The results are published in The Lancet Healthy Longevity.

The research team, led by graduate student Yasuhito Mitsuyama and Dr. Daiju Ueda from the Department of Diagnostic and Interventional Radiology at the Graduate School of Medicine, Osaka Metropolitan University, first constructed a deep learning-based AI model to estimate age from chest radiographs of healthy individuals.

They then applied the model to radiographs of patients with known diseases to analyze the relationship between AI-estimated age and each disease. Given that AI trained on a single dataset is prone to overfitting, the researchers collected data from multiple institutions.

For the development, training, internal and external testing of the AI model for age estimation, a total of 67,099 chest radiographs were obtained between 2008 and 2021 from 36,051 healthy individuals who underwent health check-ups at three facilities. The developed model showed a correlation coefficient of 0.95 between the AI-estimated age and chronological age. Generally, a correlation coefficient of 0.9 or higher is considered to be very strong.

To validate the usefulness of AI-estimated age using chest radiographs as a biomarker, an additional 34,197 chest radiographs were compiled from 34,197 patients with known diseases from two other institutions.

The results revealed that the difference between AI-estimated age and the patient's chronological age was positively correlated with a variety of chronic diseases, such as hypertension, hyperuricemia, and chronic obstructive pulmonary disease. In other words, the higher the AI-estimated age compared to the chronological age, the more likely individuals were to have these diseases.

"Chronological age is one of the most critical factors in medicine," stated Mitsuyama. "Our results suggest that chest radiography-based apparent age may accurately reflect health conditions beyond chronological age. We aim to further develop this research and apply it to estimate the severity of chronic diseases, to predict life expectancy, and to forecast possible surgical complications."

More information: Yasuhito Mitsuyama et al, Chest radiography as a biomarker of ageing: artificial intelligence-based, multi-institutional model development and validation in Japan, The Lancet Healthy Longevity (2023). DOI: 10.1016/S2666-7568(23)00133-2

https://medicalxpress.com/news/2023-08-ai-true-age-chest.html

NYC parents ‘alarmed’ over DOE silence about migrant kids in school ahead of Sept. 7 start date

 New York City public school kids will return to the classroom in three weeks, but with slim details available about the plan for some 18,000 migrant students and an impending bus strike, parents are starting to panic.

So where is Big Apple Schools Chancellor David Banks ahead of the first day of school on Sept. 7?

Based on multiple sources, NYC’s top educator and his fiancé, Sheena Wright, the city’s first deputy mayor, are currently vacationing in Martha’s Vineyard.

“Everyone needs a break, I get it but … but he is the leader of our school system,” Yiatin Chiu, a parent advocate in Brooklyn, told The Post.

“We are just weeks away from the start of the school year. As the symbolic leader of our school system, I’d like to hear that he’s as concerned as parents about what’s going to happen in our schools.”

The Department of Education boss’ break comes as City Hall sources warned the Big Apple was bracing for a huge, new wave of asylum-seeking students – causing parents to fret over what plans, if any, are in place to help schools cope. 

New York City parents have told The Post they are “alarmed” at the sparse details from the city Department of Education about the plan to place migrant children in city schools.

Photo by Spencer Platt/Getty Images

Chiu, whose daughter attends a south Brooklyn middle school, said parents have so far been met with radio silence about the expected influx of new migrant kids.

“Parents are alarmed,” she said.

“It’s really irresponsible if city agencies are not preparing superintendents or principals. It wouldn’t surprise me if they want to keep parents in the dark.”

She added: “The management of the schools needs to know what to do!”

Schools Chancellor David Banks is currently on vacation on Martha’s Vineyard ahead of the start of the school year.

Paul Martinka

Craig Slutzkin, a finance worker and member of the Community Education Council District 2, said he, too, hadn’t been told about “specific plans” but was expecting that work was going on behind the scenes.

“I would be hopeful that the DOE is actually making them, especially focusing on appropriate personnel who will be placed at the appropriate schools, for example: bilingual teachers where they are expecting to have a large population of asylum-seeking children,” said Slutzkin, whose son attends PS340 on West 17th Street.

“I’m a little concerned that we haven’t heard a lot from the DOE on this, but this is something they are probably trying to figure out before consulting.”

Another concerned Manhattan parent leader, who didn’t want to be named, fumed that the DOE’s failure to outline the specifics, including if extra Spanish-fluent teachers will be brought into schools in close proximity to migrant shelters, was akin to a “five-alarm fire.”

“I’ve been panicking about that myself, and we need answers with concrete steps and to know who’s going to be held responsible,” he said.

The father said parents have been writing to Banks to get answers, but claims they have “not been addressed and answered yet.”  

“It’s going to be an interesting first few weeks of school for schools that haven’t had to deal with the migrant crisis yet,” the dad warned.

There are 18,000 migrant students in the city’s public school system as of July, according to the mayor’s office.

Anthony Behar/Sipa USA

City officials confirmed Wednesday that DOE officials have been on-site at various emergency shelters across the five boroughs to help enroll thousands of migrant children in public schools.

The number of migrant kids enrolled in the city schools topped 18,000 as of July, Fabien Levy, the deputy mayor for communications, said during a Wednesday briefing on the asylum seeker crisis.

Ted Long, a top official at the city’s public hospital system, added that healthcare workers had also vaccinated 30,000 kids at shelters in advance of the new school year.

In addition to the migrant crisis, Banks warned during a parent advisory meeting last week that a potential school-bus-driver strike could also impact up to 150,000 city students as the school year begins amid ongoing negotiations with the Amalgamated Transit Union.

In that instance, the city has detailed contingency plans — including giving students MetroCards and “reimbursement for the use of alternative transportation” that could include “free ride-share.”

‘With so many emergencies happening and school starting in a few weeks, this is the worst time to be vacationing,” a City Hall source said, referring to both the migrant crisis and possible bus driver strike.

Banks, who sources say was poised to skip an in-person appearance at a Panel for Educational Policy meeting Wednesday night amid his vacation, didn’t immediately respond to The Post’s request for comment.

The DOE and City Hall also didn’t respond to The Post’s request for comment.

https://nypost.com/2023/08/16/nyc-parents-alarmed-over-doe-silence-on-migrant-plan-as-school-year-nears/