Liberian man who died in Nigeria tests positive for Ebola

A Liberian man who died in Nigeria's megacity of Lagos on Friday has tested positive for the deadly Ebola virus, the country's health minister has confirmed.

The man, who was in his 40s, collapsed on arrival in Lagos, a city of 21 million people, on Sunday, and was taken from the airport and put in isolation in a local hospital.

Nigerian Health Minister Onyebuchi Chukwu said all ports of entry in the country are now on "red alert" and health officials are investigating all people who had contact with the deceased.​

Earlier on Friday, a Nigerian official in Geneva said the man died while under quarantine.

"The Liberian came in and he was quarantined at the airport and not allowed to go to the city. While he was quarantined he passed away. Everyone who has had contact with him has been quarantined," he told Reuters.

Ebola, one of the world's deadliest diseases, has killed 660 people across Guinea, Liberia and Sierra Leone since it was first diagnosed in February. There have been 1,093 cases to date in West Africa's first outbreak, according to the UN health agency.

The Liberian man is the first case on record of Ebola in Nigeria, Africa's biggest economy and, with 170 million people, its most populous country. 

"He departed on the plane initially with no symptoms, he reported being symptomatic on arrival. I understand that he was vomiting and he then turned himself over basically, he made it known that he wasn't feeling well. Nigerian health authorities took him and put him in isolation," World Health Organization spokesman Paul Garwood said earlier on Friday. 

Ebola victim from Sierra Leone on the run

Also on Friday, Sierra Leone officials appealed for help to trace the first known resident in the capital with Ebola whose family forcibly removed her from a Freetown hospital after testing positive for the deadly disease.

Radio stations in Freetown, a city of around 1 million inhabitants, broadcast the appeal on Friday to locate the woman.

"Saudatu Koroma of 25 Old Railway Line, Brima Lane, Wellington," the announcement said. "She is a positive case and her being out there is a risk to all. We need the public to help us locate her."

Koroma, 32, a resident of the densely populated Wellington neighbourhood, had been admitted to an isolation ward while blood samples were tested for the virus, said health ministry spokesman Sidi Yahya Tunis. The results came back on Thursday.

"The family of the patient stormed the hospital and forcefully removed her and took her away," Tunis said. "We are searching for her."

Fighting one of the world's deadliest diseases is straining the region's weak health systems, while a lack of information and suspicion of medical staff has led many to shun treatment.

Dozens with Ebola unaccounted for

Earlier this year, a man in Freetown tested positive for Ebola although he is believed to have caught it elsewhere.

According to health ministry data and officials, dozens of people confirmed by laboratory tests to have Ebola are now unaccounted for in Sierra Leone, where the majority of cases have been recorded in the country's east.

While international medical organizations have deployed experts to the field in an attempt to contain the outbreak, WHO said poor health infrastructure and a lack of manpower were hindering their efforts.

"We're seeing many of these facilities simply don't have enough people to provide the constant level of care needed," Garwood told a news briefing in Geneva on Friday.

There is no cure or vaccine for Ebola, which causes diarrhea, vomiting and internal and external bleeding. It can kill up to 90 per cent of those infected, although the mortality rate of the current outbreak is around 60 per cent.

The West African outbreak is the first time that Ebola, which was first discovered in what is now Democratic Republic of Congo in 1976, has appeared in heavily populated urban areas and international travel hubs.

Cases have already been confirmed in Conakry and Monrovia, the capital cities of Guinea and Liberia.

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Vancouver street youth face 'alarmingly' high risk of hepatitis C

A drug user prepares heroin bought on the street at a supervised injection clinic in Vancouver. (Darryl Dyck/Canadian Press)

Vancouver street youth face an alarmingly high risk of hepatitis C infection because of a high incidence of injection drug use, according to a new study published in the British Medical Journal.

The B.C. Centre for Excellence in HIV/AIDS tracked youth aged 14 to 26 over the course of six years.

Of 940 people recruited between September 2005 and November 2011, 100 tested positive for the disease at the outset.

Of the people 512 who tested negative at the beginning and showed up for at least one subsequent visit, 56 were positive in follow-up tests — 10.9 per cent.

And of those 512 youth, 166 — about 32 per cent — reported prior use of injection drugs.

"We found that the risk for (hepatitis C virus) acquisition among street youth in this setting was alarmingly high, and that intravenous drug injection remains a primary risk factor," said the study, led by Dr. Scott Hadland.

The study was also the first to look at the risk of hepatitis infection from injecting opioids like oxycodone and morphine, which is on the rise throughout North America.

It found that while the risk of infection is elevated by the injection use of heroin, cocaine and crystal meth, it does not appear to increase with opioid injection.

The researchers acknowledged that there was a relatively small number of youth in the study who engaged in prescription opioid misuse, which could have limited the ability to measure risk in opioid users.

It is also possible, the study said, that opioid users may not be as entrenched in the local drug scene and, therefore, may not associate frequently with hepatitis-positive drug users.

Either way, the excessive risk of infection among street youth requires specific prevention and mitigation strategies, the study found.

The street youth are a marginalized and difficult-to-reach population, Hadland wrote.

There are challenges to providing maintenance programs such as methadone to the population, and harm reduction services such as needle exchanges and safe injection sites may not effectively target younger users, he said in the study.

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E-cigarette market on fire while scientists wage heated debate

Electronic cigarette use is skyrocketing, revenue has reached the billions of dollars, legislators are talking about — and enacting — regulations, and more and more research is published every month.

But the jury is still out on their safety, and whether they are a gateway to smoking.

Earlier this week, the New York Times highlighted a growing concern that the tobacco industry is taking over the business and targeting kids with flavours that sound like candy as well as advertisements featuring cartoon characters or celebrities.

Meanwhile, the less reliable Daily Mirror in Britain focussed on the danger of explosions when e-cigarettes are plugged into the wrong charger, citing half a dozen examples to back up its worries.

For those not up on this newest trend, an e-cigarette includes a battery, heating coil and a cartridge containing e-juice. That's the liquid that may or may not contain nicotine and which gets vaporized when the battery powers the coil to heat up the liquid.

The vapor gets drawn up by the wick when someone inhales, and there is no smoke, so it's called vaping.

The pros and cons of vaping are hotly debated by scientists, and there is a wide range of experience among those who have tried it.

Vaping may increase smoking

For some, like Anna Camara, it may even lead to increased smoking.

Some smokers have successfully turned to e-cigarettes to help them stop smoking, while others blame e-cigarettes for an increase in the amount they smoke. (Richard Vogel/Associated Press)

Last year, an acquaintance she would see at the off-leash area for dogs in a Toronto park persuaded Camara, an eight-cigarette-a-day smoker, to follow her example and abandon smoking for vaping.

Camara invested $80 in the technology and the e-juice, with nicotine, but felt that vaping wasn't delivering enough nicotine to satisfy her need. So she would also smoke a cigarette.

She calculated that vaping would be cheaper than smoking, but it didn't help her to quit, and it also irritated her throat. (She had tried to quit before by using a nicotine patch, but found it too strong.)

In the end, she blames the vaping experience for doubling the number of cigarettes she smokes to about 16 a day.

On the other hand

E-cigarette proponents claim that because the physical act of vaping more closely resembles smoking, and because the nicotine intake can be adjusted, it should be a better tool to help a smoker quit the habit.

That's what Winnipegger Matt Clinch found. He says e-cigarettes are "fantastic."

In 20 years of puffing, he was up to a pack a day. But then he tried e-cigarettes and hasn't had a smoke in seven weeks.

He says he feels better, he isn't out of breath as much as he was and food is starting to taste better.

"It's as close to smoking as you can get without lighting up and smelling like an ashtray."

He says the battery charge lasts him until dinner time and then he has to charge the unit for four hours, which he calls "a good thing, because it keeps me from over-using it."

Cheaper than cigarettes

Clinch also likes the fact that the juice comes in a variety of flavours and levels of nicotine, because "it makes cutting back your nicotine intake easier, without really realizing that you're cutting back."

The e-juice in e-cigarettes comes in a variety of flavours and levels of nicotine. (CBC)

He estimates the start-up costs of vaping as equivalent to a carton of cigarettes. But now he's down from spending $17 a day on cigarettes to 75-80 per cent less buying e-juice.

Nick Cooke, a Canadian living in Nicaragua, is discovering the same thing.
He has been using a vaporizer for a little more than a year and says vaping is "way less worse for me than the 30 to 40 cigarettes I used to smoke each day.

"It's odourless and smokeless for the people around me, so it's no problem to have a puff in a restaurant or bar or airport boarding lounge."

Cooke also can have just one or two drags on the e-cigarette and then set it aside.

He says that even in Nicaragua, where cigarettes are cheap ($1.75 for a pack of 20), he's saving money by vaping.

"The only disadvantage is not always having a lighter in my pocket, which comes in handy during power outages."

Doubts about safety

In Canada, selling e-cigarettes with nicotine or those with a health claim is not authorized, though selling e-cigarettes or e-juice without nicotine is legal.

In an email to CBC News, Health Canada said, "To date there is not sufficient evidence that the potential benefits of e-cigarettes in helping Canadians quit smoking outweigh the potential risks."

Some manufacturers design their e-cigarettes to look like the real thing. (CBC)

In order to get a vaping product authorized, Health Canada requires a company "to provide evidence of safety, quality and effectiveness" - a regulatory hurdle that is "among the most restrictive in the world," according to an editorial last year in the Canadian Medical Association Journal. (It wants e-cigarettes to be regulated as pharmaceutical rather than tobacco products.)

Winnipeg-based Theravape Inc. is one of about a dozen established juice-makers in Canada.

It is just Eden Sorrell and two friends working there and they manufacture and sell wholesale at least 13 different flavours of e-juice.

Their best sellers include lychee, menthol and tobacco. Sorrell describes the tobacco flavor as "transitional."

E-juice containing nicotine gets poured into a vaping device at the Henley Vaporium in New York. (Frank Franklin II/Associated Press)

All their flavours can come with or without nicotine, and the nicotine can come in different strengths. Theravape e-juice sells for about $1 a millilitre.

Asked about Health Canada's policy, Sorrell explains that e-cigarettes with nicotine are "not authorized for sale but not prohibited. It's a grey market item."

He says his company doesn't get hassled by Health Canada "because it's actually marketed as a chemical consumer product, not as a health-care product."

Sorrell, who also works as a nurse, and is a non-smoker, explains that "it takes longer for nicotine to hit your bloodstream from a vape than it does from a cigarette, because it's being absorbed through the mucous membranes in the mouth, not within the lungs."

Tobacco industry dominates

One of the issues under debate among scientists is whether vaping could serve as a so-called gateway to smoking.

Sorrell says Theravape is "not here to start new habits" and he is unaware of any non-smokers trying their product.

Nevertheless a concern in the medical community is that e-cigarettes will be "a Trojan horse that will allow the tobacco industry to reverse decades of global progress in reducing smoking prevalence," says the CMAJ editorial.

"The tobacco industry sees a future where e-cigarettes accompany and perpetuate, rather than supplant tobacco use," the editorial adds.

The tobacco industry dominates the e-cigarette industry. In the U.S., a company called Blu eCigs accounts for almost half of all e-cigarettes sold, and it is in the process of being acquired by Imperial Tobacco.

Tobacco industry-owned Blu eCigs accounts for almost half of all e-cigarettes sold in the U.S. (AFP/Getty Images)

The tobacco industry also dominates the e-cigarette industry in Europe, where vaping is more popular.

In the British documentary, "The Rise of the E-cigarette," Kingsley Wheaton, a director at British American Tobacco (which sells Vype e-cigarettes), says e-cigarettes "provide a substantially safer alternative to smoking a traditional cigarette."

Although that may sound like a good reason to stop smoking, there is intense debate among scientists around the world about whether vaping will lead to smoking cessation.

In May, 53 public health specialists wrote to the World Health Organization, arguing that e-cigarettes could provide what they called tobacco harm reduction because, in vaping, nicotine is consumed in a low-risk, non-combustible form and doesn't draw tar and toxic gases into the lungs the way smoking tobacco does.

That started a vigorous scientific exchange, starting with a rebuttal from 129 other public health and medical authorities, then a reply from the first group.

Reading those three letters gives an understanding of the debate, and its intensity.

The points in contention include the safety of the liquid, the safety of the second-hand vapor, and whether e-cigarettes are just another way of perpetuating smoking.

They don't debate the harms of the nicotine. By now that's pretty well understood.

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ReWalk Robotics exoskeleton helps paraplegics to walk

A robotic exoskeleton that allows some people with spinal cord injuries to walk upright has been approved for use by Health Canada and the U.S. Federal Drug Administration.

The ReWalk was designed by a paraplegic inventor, Dr. Amit Goffer, who was seeking a better solution to life in a wheelchair, says Larry Jasinski, CEO of ReWalk Robotics.

Dr. Goffer's invention was an exoskeleton that provides powered hip and knee motion to enable individuals with a spinal cord injury to stand upright and walk, Jasinski explained in an interview with CBC's The Lang & O'Leary Exchange.

"Given that he was paralyzed himself, I think his understanding of what he was creating was greater than any of us would have developed independently," he said.

Improvements in motion sensing technology and the advent of improved computers and batteries helped create a more natural form of motion that is not so difficult to learn for paraplegic users, Jasinski said.

A man in Germany demonstrates walking with a ReWalk robotic exoskeleton. (Argo Technologies)

"What Dr. Goffer did, he took the concept of using a motion sensor where the person can use their own body to tell this thing how to walk," he said.

"It's the combination of the sensor which communicates to the very elaborate software program that mimics human walking., When you take a step it's heel to toe, just like you and I walk down the hallway and this natural motion is important because it is efficient ...and it is also better for your body to use your joints in natural motion."

The ReWalk is already approved for use in Asia and Europe, received Health Canada approval for home use at the beginning of the year and FDA approval in May.

It sells for about $69,500 US, a cost ReWalk Robotics hopes both public and private sector insurers will eventually agree to shoulder.

"We believe the reduction in medications, as users and patients get healthier and reduced complications for someone who might be confined to a wheelchair will allow this system to pay for itself," Jasinski said.

ReWalk, based in Massachusetts and a unit of Argo Technologies, has competitors in creating robotics for paraplegics, among them Ekso Bionics.

The next step for the company is to establish training centres in Canada and the U.S. where potential users can try the device and train on it if they believe it is a good fit for them.

There are some limitations – people aren't able to walk on snow, ice or soft sand – but they can take on stairs and uneven ground.

"Right now the primary limitations are people learning to use it properly and we have enough users now in the U.S. and starting in Canada, Europe and Asia.  The rewalkers as we call them, they learn from each other about how to use it better," Jasinski said.

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Placebos may be just as effective as acetaminophen for lower back pain

Acetaminophen, a painkiller universally recommended to treat people with acute low back pain, does not speed recovery or reduce pain from the condition, according to the results of a large trial published on Thursday.

A study published in The Lancet medical journal found that the popular pain medicine was no better than placebo, or dummy, pills for hastening recovery from acute bouts of low back pain or easing pain levels, function, sleep or quality of life.

Researchers said the findings challenge the universal endorsement of acetaminophen — also known as paracetamol — as the first choice painkiller for lower back pain. Tylenol is one popular brand name of the drug in North America. 

"We need to reconsider the universal recommendation to provide paracetamol as a first-line treatment," said Christopher Williams, who led the study at the University of Sydney in Australia.

Lower back pain is the leading cause of disability worldwide. In the United States alone, costs relating to the condition are estimated to be more than $100 billion US a year.

Currently, every back pain treatment guideline in the world recommends acetaminophen as the first-line analgesic and Williams said this was despite the fact that no previous studies have provided robust evidence that it works in this condition.

Painkiller vs. placebo

Tim Salomons, a pain expert at Britain's University of Reading whose own research has found that cognitive behavioural therapy could be used to treat chronic pain, said this latest study showed the challenge of treating the condition.

"It is vitally important we continuously challenge conventional wisdom about treating pain," he said in an emailed comment. "Even though paracetamol has a good safety profile, every drug has side effects. If the drug is not doing what it is being prescribed to do, pain patients might be better off without."

'It is vitally important we continuously challenge conventional wisdom about treating pain.'- Pain expert Tim Salomons

In Williams' trial, 1,652 people from Sydney with acute low back pain were randomly assigned to receive up to four weeks of acetaminophen, either in regular doses three times a day, or as needed, or to receive placebos. All those involved received advice and reassurance and were followed up for three months.

The results showed no difference in the number of days to recovery between the treatment groups — with the average time to recovery coming out at 17 days for each of the groups given acetaminophen, and at 16 days for the placebo group.

Acetaminophen had no effect on short-term pain levels, disability, function, sleep quality, or quality of life, the researchers said, and the number of patients reporting negative side effects was similar in all groups.

Back pain different from other pain?

Christine Lin, an associate professor at the George Institute for Global Health and the University of Sydney who also worked on the study, said the reasons for acetaminophen failing to work for lower back pain were not well understood.

"While we have shown that paracetamol does not speed recovery from acute back pain, there is evidence that paracetamol works to relieve pain for a range of other conditions, such as headaches, some acute musculoskeletal conditions, tooth ache and for pain straight after surgery," she said in a statement about the findings.

"What this study indicates is that the mechanisms of back pain are likely to be different from other pain conditions, and this is an area that we need to study more."

Experts who were not directly involved praised the study but cautioned that guidelines should nevertheless not be changed on the basis of a single piece of research.

"More robust and consistent evidence, including verification of the results in other populations, is needed," Bart Koes and Wendy Enthoven from the Erasmus Medical Centre in the Netherlands wrote in a Lancet commentary.

They also called for more studies on whether other simple analgesics could add extra benefits on top of giving advice and reassurance to patients.

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E-cigarette market on fire while scientists wage heated debate

Electronic cigarette use is skyrocketing, revenue has reached the billions of dollars, legislators are talking about — and enacting — regulations, and more and more research is published every month.

But the jury is still out on their safety, and whether they are a gateway to smoking.

Earlier this week, the New York Times highlighted a growing concern that the tobacco industry is taking over the business and targeting kids with flavours that sound like candy as well as advertisements featuring cartoon characters or celebrities.

Meanwhile, the less reliable Daily Mirror in Britain focussed on the danger of explosions when e-cigarettes are plugged into the wrong charger, citing half a dozen examples to back up its worries.

For those not up on this newest trend, an e-cigarette includes a battery, heating coil and a cartridge containing e-juice. That's the liquid that may or may not contain nicotine and which gets vaporized when the battery powers the coil to heat up the liquid.

The vapor gets drawn up by the wick when someone inhales, and there is no smoke, so it's called vaping.

The pros and cons of vaping are hotly debated by scientists, and there is a wide range of experience among those who have tried it.

Vaping may increase smoking

For some, like Anna Camara, it may even lead to increased smoking.

Some smokers have successfully turned to e-cigarettes to help them stop smoking, while others blame e-cigarettes for an increase in the amount they smoke. (Richard Vogel/Associated Press)

Last year, an acquaintance she would see at the off-leash area for dogs in a Toronto park persuaded Camara, an eight-cigarette-a-day smoker, to follow her example and abandon smoking for vaping.

Camara invested $80 in the technology and the e-juice, with nicotine, but felt that vaping wasn't delivering enough nicotine to satisfy her need. So she would also smoke a cigarette.

She calculated that vaping would be cheaper than smoking, but it didn't help her to quit, and it also irritated her throat. (She had tried to quit before by using a nicotine patch, but found it too strong.)

In the end, she blames the vaping experience for doubling the number of cigarettes she smokes to about 16 a day.

On the other hand

E-cigarette proponents claim that because the physical act of vaping more closely resembles smoking, and because the nicotine intake can be adjusted, it should be a better tool to help a smoker quit the habit.

That's what Winnipegger Matt Clinch found. He says e-cigarettes are "fantastic."

In 20 years of puffing, he was up to a pack a day. But then he tried e-cigarettes and hasn't had a smoke in seven weeks.

He says he feels better, he isn't out of breath as much as he was and food is starting to taste better.

"It's as close to smoking as you can get without lighting up and smelling like an ashtray."

He says the battery charge lasts him until dinner time and then he has to charge the unit for four hours, which he calls "a good thing, because it keeps me from over-using it."

Cheaper than cigarettes

Clinch also likes the fact that the juice comes in a variety of flavours and levels of nicotine, because "it makes cutting back your nicotine intake easier, without really realizing that you're cutting back."

The e-juice in e-cigarettes comes in a variety of flavours and levels of nicotine. (CBC)

He estimates the start-up costs of vaping as equivalent to a carton of cigarettes. But now he's down from spending $17 a day on cigarettes to 75-80 per cent less buying e-juice.

Nick Cooke, a Canadian living in Nicaragua, is discovering the same thing.
He has been using a vaporizer for a little more than a year and says vaping is "way less worse for me than the 30 to 40 cigarettes I used to smoke each day.

"It's odourless and smokeless for the people around me, so it's no problem to have a puff in a restaurant or bar or airport boarding lounge."

Cooke also can have just one or two drags on the e-cigarette and then set it aside.

He says that even in Nicaragua, where cigarettes are cheap ($1.75 for a pack of 20), he's saving money by vaping.

"The only disadvantage is not always having a lighter in my pocket, which comes in handy during power outages."

Doubts about safety

In Canada, selling e-cigarettes with nicotine or those with a health claim is not authorized, though selling e-cigarettes or e-juice without nicotine is legal.

In an email to CBC News, Health Canada said, "To date there is not sufficient evidence that the potential benefits of e-cigarettes in helping Canadians quit smoking outweigh the potential risks."

Some manufacturers design their e-cigarettes to look like the real thing. (CBC)

In order to get a vaping product authorized, Health Canada requires a company "to provide evidence of safety, quality and effectiveness" - a regulatory hurdle that is "among the most restrictive in the world," according to an editorial last year in the Canadian Medical Association Journal. (It wants e-cigarettes to be regulated as pharmaceutical rather than tobacco products.)

Winnipeg-based Theravape Inc. is one of about a dozen established juice-makers in Canada.

It is just Eden Sorrell and two friends working there and they manufacture and sell wholesale at least 13 different flavours of e-juice.

Their best sellers include lychee, menthol and tobacco. Sorrell describes the tobacco flavor as "transitional."

E-juice containing nicotine gets poured into a vaping device at the Henley Vaporium in New York. (Frank Franklin II/Associated Press)

All their flavours can come with or without nicotine, and the nicotine can come in different strengths. Theravape e-juice sells for about $1 a millilitre.

Asked about Health Canada's policy, Sorrell explains that e-cigarettes with nicotine are "not authorized for sale but not prohibited. It's a grey market item."

He says his company doesn't get hassled by Health Canada "because it's actually marketed as a chemical consumer product, not as a health-care product."

Sorrell, who also works as a nurse, and is a non-smoker, explains that "it takes longer for nicotine to hit your bloodstream from a vape than it does from a cigarette, because it's being absorbed through the mucous membranes in the mouth, not within the lungs."

Tobacco industry dominates

One of the issues under debate among scientists is whether vaping could serve as a so-called gateway to smoking.

Sorrell says Theravape is "not here to start new habits" and he is unaware of any non-smokers trying their product.

Nevertheless a concern in the medical community is that e-cigarettes will be "a Trojan horse that will allow the tobacco industry to reverse decades of global progress in reducing smoking prevalence," says the CMAJ editorial.

"The tobacco industry sees a future where e-cigarettes accompany and perpetuate, rather than supplant tobacco use," the editorial adds.

The tobacco industry dominates the e-cigarette industry. In the U.S., a company called Blu eCigs accounts for almost half of all e-cigarettes sold, and it is in the process of being acquired by Imperial Tobacco.

Tobacco industry-owned Blu eCigs accounts for almost half of all e-cigarettes sold in the U.S. (AFP/Getty Images)

The tobacco industry also dominates the e-cigarette industry in Europe, where vaping is more popular.

In the British documentary, "The Rise of the E-cigarette," Kingsley Wheaton, a director at British American Tobacco (which sells Vype e-cigarettes), says e-cigarettes "provide a substantially safer alternative to smoking a traditional cigarette."

Although that may sound like a good reason to stop smoking, there is intense debate among scientists around the world about whether vaping will lead to smoking cessation.

In May, 53 public health specialists wrote to the World Health Organization, arguing that e-cigarettes could provide what they called tobacco harm reduction because, in vaping, nicotine is consumed in a low-risk, non-combustible form and doesn't draw tar and toxic gases into the lungs the way smoking tobacco does.

That started a vigorous scientific exchange, starting with a rebuttal from 129 other public health and medical authorities, then a reply from the first group.

Reading those three letters gives an understanding of the debate, and its intensity.

The points in contention include the safety of the liquid, the safety of the second-hand vapor, and whether e-cigarettes are just another way of perpetuating smoking.

They don't debate the harms of the nicotine. By now that's pretty well understood.

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Blood thinner for pregnant women not effective, study suggests

Pregnant women with clotting disorders are often prescribed a challenging and cringe-inducing treatment — daily doses of a blood-thinner injected into the abdomen — in a bid to prevent a miscarriage or other complications. But a long-term clinical trial has found that the widely used therapy is ineffective in most cases and puts women through unnecessary pain.

Up to one in 10 pregnant women are at risk of developing blood clots in their veins, a condition known as thrombophilia. Over the last 15 years, many doctors have treated women with an anticoagulant drug called low molecular-weight heparin (LMWH), with the idea that it could prevent blood clots in the placenta that can cause such complications as miscarriage, pre-eclampsia and underweight infants.

Over the course of the pregnancy, a woman could end up poking herself with needles up to 400 times, leaving a patchwork of bruises across the belly.

Heparin injections not only cause bruising, but they can also result in minor bleeding episodes involving the nose, gums or vagina. The treatment is also expensive, running to about $4,000 in total, a cost not covered by most provincial insurance plans.

Clotting increases risk of complications

The idea of using heparin began after studies showed that women with thrombophilia have an increased risk of pregnancy complications, said Dr. Marc Rodger, a hematologist and senior scientist at the Ottawa Hospital Research Institute.

"What's happened over the 15 years is it's gone from an idea to some early preliminary evidence that suggested that it worked to prevent blood clots in the placenta and hence pregnancy complications," he said. "It became standard of care in many institutions across the world — even before there was good solid evidence that comes from doing randomized trials."

'I'm very glad that we can now spare these women all those unnecessary needles.'- Dr. Marc Rodger, Ottawa Hospital Research Institute

Twelve years ago, Rodger began an international trial that enrolled women with a clotting disorder to see whether daily heparin shots indeed helped prevent pregnancy complications compared to getting no treatment.

"And its turns out it doesn't," said Rodger, who admitted to being somewhat surprised at the findings.

The study, published online Thursday in the Lancet, enrolled 292 women with thrombophilia, who were being seen by doctors at 36 centres in Canada, the U.S., Europe and Australia. Half were randomized to self-inject heparin — one needle per day for the first 20 weeks, then two daily for the balance of their pregnancy — while the other half, the control group, got no blood-thinner treatment.

"About 17 per cent of participants in the control group had complications and an almost identical percentage had complications in the blood-thinner group," said Rodger, adding that more than 80 per cent of women in both groups did not experience a major pregnancy complication.

"There was no difference between those who got the needles and those that didn't get the needles in terms of percentages that got complications." he said.

Among women who did have a complication, they were roughly evenly matched in both the treatment and control groups: eight per cent miscarried; six per cent had low birth-weight babies; four per cent had pre-eclampsia, a serious high blood-pressure disorder; and about one per cent developed a major blood clot that was treated with a blood-thinner.

"While I wish we could have shown that LMWH prevents complications, we actually proved it doesn't help," said Rodger. "However, I'm very glad that we can now spare these women all those unnecessary needles."

'It can be disillusioning'

Ottawa lawyer Allison McIntosh, 34, pinned her hopes on the injections during her third pregnancy, which followed two miscarriages. For about 10 weeks, she gave herself daily heparin needles, only to find out the treatment had been ineffectual when she miscarried for the third time.

"It was difficult after realizing that the injections didn't work," McIntosh, who was unavailable for an interview, said in a statement. "I thought that I was doing something to make a difference by giving myself the injections. I kind of lost hope after that experience."

Angela Donatucci, of Ottawa, gives herself one of two daily injections of LWMH. (Ottawa Hospital Research Institute)

Now six months into her fourth pregnancy, having decided with her husband against the injections, McIntosh said she's not surprised to hear the treatment appears to have been disproven. "I feel sad for other people who are going through that process. It can be disillusioning for people if those injections are their only hope."

However, Rodger said there is one type of thrombophilia — called anti-phospholipid antibodies — for which blood thinners may be effective in preventing recurrent pregnancy loss, based on the findings of several clinical trials.

Angela Donatucci found out she carried the antibodies after two early miscarriages in the last two years, and she opted to go on the injections when she became pregnant a third time.

"I have a phobia of needles, so it was probably the last thing I was expecting to do," said Donatucci, 44, who's seven months' pregnant. "It's been OK because my husband's the one that administers them."

She started using a topical skin anesthetic that can relieve the ouch of the shots, but before discovering the existence of freezing, she admitted "it hurt."

"It's not pleasant. I wouldn't wish it on anybody to have to do this," Donatucci, whose abdomen is covered in bruises from her two daily injections, said Thursday from her Ottawa home. "I won't lie to you, there were times when I cried because I wished I were done with this."

But Donatucci believes the injections are working and have stopped her from having a third miscarriage.

"For me, knowing that I'm blessed and I'm hopefully going to make it to the end with a healthy baby, it's just a minor sacrifice."

Potential pushback

Rodger conceded the study's main conclusion may result in pushback from some doctors.

"There are people who are completely bought in in my community of experts in thrombosis (blood clots) and pregnancy complications. So yeah, this will come as a shock to them, and they may try to poke holes in it. We think we've done a good job with the study, but there may be calls for further research in smaller subgroups (of patients)."

In an accompanying commentary in the journal, Drs. Paul Gibson and Kara Nerenberg write that physicians' altruistic intentions to treat women at high risk of devastating pregnancy complications might have inadvertently caused them at least some minor harm.

"The (study) investigators should be congratulated for completing this much-needed, rigorous trial, which ... clearly shows that low molecular-weight heparin is ineffective in preventing a wide range of clinically important adverse pregnancy outcomes in women with thrombophilia," they write.

"Hopefully, these results will finally tip clinicians away from using the drug in this setting and motivate researchers to pursue other potentially effective preventive interventions."

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Vancouver street youth face 'alarmingly' high risk of hepatitis C

A drug user prepares heroin bought on the street at a supervised injection clinic in Vancouver. (Darryl Dyck/Canadian Press)

Vancouver street youth face an alarmingly high risk of hepatitis C infection because of a high incidence of injection drug use, according to a new study published in the British Medical Journal.

The B.C. Centre for Excellence in HIV/AIDS tracked youth aged 14 to 26 over the course of six years.

Of 940 people recruited between September 2005 and November 2011, 100 tested positive for the disease at the outset.

Of the people 512 who tested negative at the beginning and showed up for at least one subsequent visit, 56 were positive in follow-up tests — 10.9 per cent.

And of those 512 youth, 166 — about 32 per cent — reported prior use of injection drugs.

"We found that the risk for (hepatitis C virus) acquisition among street youth in this setting was alarmingly high, and that intravenous drug injection remains a primary risk factor," said the study, led by Dr. Scott Hadland.

The study was also the first to look at the risk of hepatitis infection from injecting opioids like oxycodone and morphine, which is on the rise throughout North America.

It found that while the risk of infection is elevated by the injection use of heroin, cocaine and crystal meth, it does not appear to increase with opioid injection.

The researchers acknowledged that there was a relatively small number of youth in the study who engaged in prescription opioid misuse, which could have limited the ability to measure risk in opioid users.

It is also possible, the study said, that opioid users may not be as entrenched in the local drug scene and, therefore, may not associate frequently with hepatitis-positive drug users.

Either way, the excessive risk of infection among street youth requires specific prevention and mitigation strategies, the study found.

The street youth are a marginalized and difficult-to-reach population, Hadland wrote.

There are challenges to providing maintenance programs such as methadone to the population, and harm reduction services such as needle exchanges and safe injection sites may not effectively target younger users, he said in the study.

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Top Ebola doctor in Sierra Leone contracts virus amid outbreak

The head doctor fighting an outbreak of the deadly Ebola virus in Sierra Leone has himself caught the disease, one of a growing list of medical workers infected while battling to halt its spread across West Africa.

A statement from the president's office said 39-year-old Sheik Umar Khan, a Sierra Leonean virologist credited with treating more than 100 Ebola victims, had been transferred to a treatment ward run by medical charity Doctors Without Borders.

A source at the ward confirmed that the doctor was alive and receiving treatment, but gave no details of his condition.

Khan has been hailed a "national hero" by the Health Ministry for his efforts to lead the fight against an outbreak that has killed 206 people in the West African nation.

Ebola has killed 632 people across Guinea, Liberia and Sierra Leone since an outbreak began in February, putting strain on a string of weak health systems facing one of the world's deadliest diseases despite waves of international help.

'Very strict procedure'

In a sign of the growing frustrations with the failure of region's governments to tackle the outbreak, a Liberian whose brother died from the disease set fire to the Health Ministry in protest on Wednesday.

There is no cure or vaccine for Ebola, which can kill up to 90 per cent of those infected, although the mortality rate of the current outbreak is around 60 per cent.

It was not immediately clear how Khan had caught the virus. His colleagues told Reuters that he was always meticulous with protection, wearing overalls, mask, gloves and special footwear.

Health workers carry the body of an Ebola virus victim in Kenema, Sierra Leone, June 25, 2014. The Ebola outbreak has killed 632 people in Guinea, Liberia and Sierra Leone since February, making it the largest and deadliest ever. (Umaru Fofana/Reuters)

Three days ago, three nurses working in the same Ebola treatment centre alongside Khan died from the disease.

Tarik Jasarevic, a spokesman for the World Health Organisation, said around 100 health workers had been infected by Ebola in the three countries, with 50 of them dying.

"Personal protection equipment is very hot. But there is a very strict procedure how you wear it, how you take it off, what can be re-used or not," he said.

Earlier this month, Samuel Muhumuza Mutoro, a senior Ugandan doctor working in Liberia died after treated infected patients.

'Afraid for my life'

The latest WHO figures, released on Saturday, showed that there were 19 new deaths and 67 new cases within the four days since its previous statement.

The Ebola outbreak started in Guinea's remote southeast and has since spread across the region's poorly controlled borders. Symptoms of the highly infectious disease are diarrhoea, vomiting and internal and external bleeding.

Part of Liberia's Health Ministry was destroyed on Wednesday when Monrovia resident Edward Deline set fire to the building in protest over the death of his 14-year-old brother from Ebola.

"The health (workers) here are not doing enough to fight this virus. They are taking this to be a money making thing while our people are dying," Deline told journalists after he was arrested by police.

Finda Marie Kamano, 33, reported extreme weakness, vomiting and dysentery, symptoms typical of those caused by the Ebola virus. When she arrives at the treatment centre in Conakry, Guinea, Kamano is seen by a nurse in a protective suit. (Sylvain Cherkaoui/MSF)

Local and international health workers face a combination of fear, suspicion and local traditions for burying the dead as they try to prevent Ebola spreading further.

During a Reuters visit to the Kenema treatment centre in eastern Sierra Leone in late June, Khan said he had installed a mirror in his office, which he called his "policeman," to check for holes in his protective clothing before entering an isolation ward.

Nevertheless, Khan said he feared Ebola. "I am afraid for my life, I must say, because I cherish my life," he said in an interview, showing no signs of ill health at the time.

"Health workers are prone to the disease because we are the first port of call for somebody who is sickened by disease. Even with the full protective clothing you put on, you are at risk."

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Anti-cancer drug romidepsin found to awaken hidden copies of HIV

AIDS researchers have had very preliminary success against a longstanding hurdle in the battle against HIV: awakening the many dormant copies of the virus that hibernate in the body and thus avoid eradication by the immune system.

The achievement comes from a pilot study in Denmark that had too few patients — just six — to be considered a major breakthrough. But it still points the way to how doctors could eventually succeed at flushing out HIV from its hiding spots in infected people's cells and eliminating it.

Ultimately, scientists hope that if all the dormant copies of the virus can be roused, they can then be eliminated using the current blend of anti-HIV drugs.

The latest research was presented yesterday at the International AIDS Conference in Melbourne, Australia, by Danish scientists.

Over a two-week span, they gave the anti-cancer drug romidepsin to six HIV-infected patients. It succeeded in ramping up production of HIV particles by two to four times more than normal in infected cells, a sign that dormant copies of the virus were reawakening. Five of the patients started to show detectable amounts of HIV in their blood.

However, it's not known how many copies of the virus stay dormant in the body, so it was impossible for the Danish team to say whether their method could possibly flush out all the so-called latent HIV.

The problem of dormant HIV — known as HIV reservoirs — is a reason a cure for the virus has remained so elusive.

The current crop of anti-HIV medicines block the virus from replicating in infected people, allowing their immune systems to attack it. But the immune system can't track down the latent copies of the virus. If someone infected with HIV stops taking their medication, the latent copies can reactivate and start spreading through the body again.

Current thinking is that if all that dormant HIV can be activated and pushed into the open, the immune system will be able to eliminate it and patients will effectively be disease-free.

Some previous efforts to try to reactivate HIV have not proved successful, however.

The latest findings were presented in Melbourne by study co-author Ole Schmeltz Sogaard of Aarhus University Hospital in Aarhus, Denmark.

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