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Why Do Mosquitoes Bite You More Than Others?

Are you one of those people who’s been singled out for constant attack by mosquitoes? Ever felt like the designated bug decoy at a party? It does seem that those pesky biting insects have a preference for certain individuals, so the real question is: why you?

I wish there were a simple answer, but scientists have only isolated a few potential causes. It is likely that the full story remains to be elucidated – and may be related to small genetic variations in human odor. However, we do know that mosquitoes are attracted to carbon dioxide (that we expel as we breathe), and warmer skin temperatures. So I guess if you’re a heavy-breathing, hot-blooded person then you might need an extra layer of DEET? Or maybe hold your breath and wear a scuba suit when you’re in the presence of mosquitoes? Just kidding.

Interestingly, one small study notes that mosquitoes are more likely to land on people who are drinking beer. Since alcohol tends to cause vasodilation of blood vessels, the enhanced skin warmth could be a mosquito attractant. Others have postulated that tipsy people are slower at swatting off mosquitoes and are therefore more likely to be bitten.

My personal suspicion is that some of us react to mosquito proteins (injected when they bite us) more robustly than others. That means that while a mosquito’s bite may leave only a tiny, fleeting mark on one person, another might develop a large red hive that itches intensely. So if your immune system is hyper-reactive to mosquito proteins, you’re likely to suffer more from each bite that you receive. That alone could make you feel as if you’re being singled out by the nasty insects, when the reality is that others are being bitten just as frequently.

I guess the take home message here is that insect-repellent is still the best defense against mosquito bites, although some might argue that keeping a heavy-breathing, sweaty, beer-drinking guy nearby might provide an alternative decoy?

Enjoy your summer – and don’t scratch yourself to death!

Study Investigates The Role Of Fluid Resuscitation In Treatment Of Life-Threatening Infections

Dehydration is a common phenomenon in those suffering from infectious diseases, particularly if the diseases cause vomiting and/or diarrhea. We are all familiar with having the “stomach flu,” “traveler’s diarrhea,” or food poisoning. However, severe infections of all sorts can cause profound illness, debilitation, and fluid losses. In many developing countries, very large numbers of small children are afflicted with non-gastrointestinal infectious diseases that rapidly cause relatively large fluid losses, and therefore profound, life-threatening dehydration, which is manifested in part by dangerously low blood pressure and subsequent failure to deliver precious liquid, nutrients and oxygen to the tissues of the body. This is called “shock.”

The following discussion is cutting edge information, but not simplistic or necessarily easy to understand or apply. However, I have learned that my readers are often volunteers in settings where intensive care medicine must be applied, and want to read more than simple approaches to therapy. So, I am going to do my best to interpret for you what has recently been published in the New England Journal of Medicine in an article entitled “Mortality after Fluid Bolus in African Children with Severe Infection” (N Engl J Med 2011; 364:2483-95) written by Kathryn Maitland and her colleagues.

The focus of their investigation was Read more »

This post, Study Investigates The Role Of Fluid Resuscitation In Treatment Of Life-Threatening Infections, was originally published on by Paul Auerbach, M.D..

Counterfeit Drugs: A Growing Global Health Crisis

A resistant strain of bacteria –created by partially effective counterfeit antibiotics – doesn’t need a VISA and passport to get to the U.S.

-    Paul Orhii, National Agency for Food and Drug Administration and Control, Nigeria

I attended a conference in DC yesterday called, “The Global Impact of Fake Medicine.” Although I had initially wondered if homeopathy and the supplement industry would be the subjects of discussion, I quickly realized that there was another world of medical fraud that I hadn’t previously considered: counterfeit pharmaceuticals.

Just as designer goods have low-cost knock-offs, so too do pharmaceuticals and medical devices. Unfortunately, counterfeit medical products are a higher risk proposition – perhaps causing the death of hundreds of thousands of people worldwide each year.

It is difficult to quantify the international morbidity and mortality toll of counterfeit drugs – there have been no comprehensive global studies to determine the prevalence and collateral damage of the problem.  But I found these data points of interest (they were in the slide decks presented at the conference):

-    Pfizer Global Security raids resulted in seizure of 11.1 million counterfeit tablets, capsules and vials in 42 countries in 2008. Pfizer seizure of counterfeit drugs in 2008 were up 28.9% over 2007.

-    Within a 7 day period, 250 different Internet-based Viagra purchases were seized in a single mail center. After chemical testing, it was determined that 100% of the tablets were counterfeit.

-    Anti-malarial counterfeit tablets are common in East Asia and Africa, threatening to derail the US goal of decreasing malaria mortality by 50% in 15 countries. Chemical testing in Africa revealed that 20-67% of chloroquine failed content quality checks, and 75-100% of sulfadoxine-pyrimethamine tablets (for pregnant women) was not absorbable. Tests conducted in Cambodia in 2003 demonstrated that 27% of anti-malarials were counterfeit with quinine being 77% counterfeit and tetracycline 20% counterfeit.

-    Some “Canadian” mail order pharmaceutical prescriptions have very circuitous routes of manufacture, packaging, and delivery. One batch was manufactured in China transported to Dubai, then to London, then filled in Bahamas, sent to the UK, and then mailed to the US.

-    Counterfeit drugs are estimated to make up 30% of Kenya’s total pharmaceutical products, 20% of India’s, 10% of Russia’s, and <1% of US.

-    Most counterfeit medications found in the US supply chain seem to be introduced through Internet purchases.

-    The global active pharmaceutical ingredient production was estimated at $70 billion in 2008. China and India account for 60% of production

-    70% of all generic medications are manufactured in India. It is estimated that the Indian global generic business will grow to >$70 billion by 2009. India and China have much less stringent safety and regulatory standards, which provides fertile soil for counterfeiters.

-    25 years ago, most counterfeit medications were placebos. Today’s counterfeits have some active ingredients because sophisticated counterfeiters are looking for repeat business.

This conference provided a sobering account of the counterfeit pharmaceutical industry, tracking its exponential growth over the past two decades. That growth appears to be fueled by the outsourcing of pharmaceutical manufacturing plants to countries with limited regulatory oversight, and the sale of medications via the Internet.  So far, poor quality and contaminated prescription drugs are rarely found in US pharmacies – but that could certainly change. The FDA, US Department of Commerce, and US Agency for International Development are calling for an international public-private partnership to stem the tide of counterfeit drug manufacturing. But with little to lose (fines for counterfeit drug manufacturing are notoriously light) and much to gain (a slice of a multi-billion dollar industry), it’s unlikely that the counterfeiters are going anywhere anytime soon.


*This blog post was originally published at Science-Based Medicine*

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