A healthy stool is usually solid, soft, and brown. While diarrhea is unpleasant, it is not usually a sign of something serious. Red or bloody diarrhea, however, may be a sign of an underlying health problem.
Diarrhea occurs when digested food material and water pass through the intestines too quickly. Instead of having time to form a solid mass, the material passes through in a liquid form.
Red diarrhea may be alarming, but stool color can help a person determine the cause of their symptoms. In this article, we look at the possible causes and treatment, as well as what other stool colors mean.
Six causes of red diarrhea:
- Dysentery: Diarrhea with blood is called dysentery. The most common causes of dysentery are Shigella bacteria or Entamoeba histolytica, a type of parasite. These can cause severe infections that inflame the intestines enough to result in bleeding.
- Red foods: Foods that are naturally red or contain red food coloring can turn the stool red. Red diarrhea might occur if the food that a person eats causes food poisoning or irritates the stomach. Foods that can turn stool red include beets, cranberries, red candy, red frosting, red licorice, tomatoes, and tomato sauce.
- Gastrointestinal (GI) bleeding: A range of conditions can result in GI bleeding, including colon polyps, inflammatory bowel disease (IBD), or gastric cancer. These conditions can cause significant blood loss that may turn diarrhea red.
- Hemorrhoids: Hemorrhoids are swollen blood vessels that occur inside the rectum and anus. They are a common cause of rectal bleeding and red diarrhea.
- Medications: The side effects of some medications may cause red stool. They can also irritate the stomach and potentially lead to diarrhea. Medications that cause red stools include liquid antibiotics.
- Anal fissure: Sometimes a scratch in the rectal area called an anal fissure can cause the stool to appear bloody. In this case, it may only be a small amount of bright red blood.
Other stool colors
Looking at stool color can often help a person determine what is causing their gastrointestinal symptoms.
Stool can come in a range of colors and have a variety of causes:
- Black stools: Tarry, black stools or stools the consistency of coffee grounds can indicate potential gastrointestinal (GI) bleeding. Black diarrhea can sometimes point to an upper GI bleed because the blood has had more time to travel through the GI tract and darken. Certain foods, such as licorice or high quantities of grape juice, may also turn stool black.
- Green stools: Green stools may be due to the presence of bile in the stool. Taking iron supplements can also cause stool to become dark green.
- Pale stools: Pale or clay-colored stools may indicate stones in the bile duct that empty from the gallbladder. If a person observes dark urine as well, this is a further sign that the gallbladder or liver could be the underlying cause. Some antacids that contain aluminum hydroxide can also cause pale stools.
- Yellowish, greasy stool: Yellow stool may be a sign of an infection or a malabsorption disorder, such as celiac disease.
When a person has diarrhea, they can lose a significant amount of fluid via their stool. When this happens, a person can become dehydrated.
A person should drink small sips of water or an electrolyte-replacement beverage regularly to help replace the lost water.
Diarrhea is often a way in which the body gets rid of an unwanted virus. Instead of prescribing medications that would slow the intestines and cause the body to retain the bacteria for longer, doctors may encourage a person to allow the diarrhea to run its course.
However, prolonged diarrhea may require additional treatments, such as intravenous fluids and medications to reduce cramping in the bowels.
In more severe cases of dysentery, a person may be given antibiotics or amoebicidal medications, or both if the exact cause is unknown.
If a person’s red diarrhea is due to GI bleeding, they may require a blood transfusion until the body can produce more blood. This procedure takes place in the hospital, and the person will need to remain there until their blood count is within a normal range.
If a person thinks red diarrhea is due to their medication, they should speak to a doctor about possible alternatives.
If red diarrhea is the result of dysentery or infection, a person can take steps to prevent it in the future.
Ways to help prevent red diarrhea include:
- Thoroughly cleaning all food preparation areas.
- Cooking foods thoroughly, as raw foods are more likely to carry Shigella bacteria.
- Drinking bottled or boiled water when traveling to a foreign country.
- Avoiding sexual contact with a person with an active shigellosis infection or who has recently been ill with the Shigella virus.
- Not swallowing water used for recreational purposes, such as water from a lake or river.
- Washing hands frequently with soap and water, especially after touching contaminated surfaces or changing a diaper.
- Avoiding food dyes known to cause red diarrhea can also help to keep this symptom at bay.
When to see a doctor
Bloody diarrhea may be a sign of a medical emergency, so a person should see a doctor as soon as possible.
A person should also see a doctor if they have the following symptoms in addition to red diarrhea:
- diarrhea that lasts more than 2 weeks
- a fever that is 101°F or higher
- severe diarrhea that lasts longer than 2 days
- pain or cramping that gets worse with time
While diarrhea is not always a cause for concern, severe or persistent bleeding may be a medical emergency. Anyone who is concerned about their red stool should speak to a doctor as soon as possible.
The world is facing multiple health challenges. These range from outbreaks of vaccine-preventable diseases like measles and diphtheria, increasing reports of drug-resistant pathogens, growing rates of obesity and physical inactivity to the health impacts of environmental pollution and climate change and multiple humanitarian crises.
To address these and other threats, 2019 sees the start of the World Health Organization’s new 5-year strategic plan – the 13th General Programme of Work. This plan focuses on a triple billion target: ensuring 1 billion more people benefit from access to universal health coverage, 1 billion more people are protected from health emergencies and 1 billion more people enjoy better health and well-being. Reaching this goal will require addressing the threats to health from a variety of angles.
Here are 10 of the many issues that will demand attention from WHO and health partners in 2019.
Air pollution and climate change
Nine out of ten people breathe polluted air every day. In 2019, air pollution is considered by WHO as the greatest environmental risk to health. Microscopic pollutants in the air can penetrate respiratory and circulatory systems, damaging the lungs, heart and brain, killing 7 million people prematurely every year from diseases such as cancer, stroke, heart and lung disease. Around 90% of these deaths are in low- and middle-income countries, with high volumes of emissions from industry, transport and agriculture, as well as dirty cookstoves and fuels in homes.
The primary cause of air pollution (burning fossil fuels) is also a major contributor to climate change, which impacts people’s health in different ways. Between 2030 and 2050, climate change is expected to cause 250 000 additional deaths per year, from malnutrition, malaria, diarrhoea and heat stress.
In October 2018, WHO held its first ever Global Conference on Air Pollution and Health in Geneva. Countries and organizations made more than 70 commitments to improve air quality. This year, the United Nations Climate Summit in September will aim to strengthen climate action and ambition worldwide. Even if all the commitments made by countries for the Paris Agreement are achieved, the world is still on a course to warm by more than 3°C this century.
Noncommunicable diseases, such as diabetes, cancer and heart disease, are collectively responsible for over 70% of all deaths worldwide, or 41 million people. This includes 15 million people dying prematurely, aged between 30 and 69.
Over 85% of these premature deaths are in low- and middle-income countries. The rise of these diseases has been driven by five major risk factors: tobacco use, physical inactivity, the harmful use of alcohol, unhealthy diets and air pollution. These risk factors also exacerbate mental health issues, that may originate from an early age: half of all mental illness begins by the age of 14, but most cases go undetected and untreated – suicide is the second leading cause of death among 15-19 year-olds.
Among many things, this year WHO will work with governments to help them meet the global target of reducing physical inactivity by 15% by 2030 – through such actions as implementing the ACTIVE policy toolkit to help get more people being active every day.
Global influenza pandemic
The world will face another influenza pandemic – the only thing we don’t know is when it will hit and how severe it will be. Global defences are only as effective as the weakest link in any country’s health emergency preparedness and response system.
WHO is constantly monitoring the circulation of influenza viruses to detect potential pandemic strains: 153 institutions in 114 countries are involved in global surveillance and response.
Every year, WHO recommends which strains should be included in the flu vaccine to protect people from seasonal flu. In the event that a new flu strain develops pandemic potential, WHO has set up a unique partnership with all the major players to ensure effective and equitable access to diagnostics, vaccines and antivirals (treatments), especially in developing countries.
Fragile and vulnerable settings
More than 1.6 billion people (22% of the global population) live in places where protracted crises (through a combination of challenges such as drought, famine, conflict, and population displacement) and weak health services leave them without access to basic care.
Fragile settings exist in almost all regions of the world, and these are where half of the key targets in the sustainable development goals, including on child and maternal health, remains unmet.
WHO will continue to work in these countries to strengthen health systems so that they are better prepared to detect and respond to outbreaks, as well as able to deliver high quality health services, including immunization.
The development of antibiotics, antivirals and antimalarials are some of modern medicine’s greatest successes. Now, time with these drugs is running out. Antimicrobial resistance – the ability of bacteria, parasites, viruses and fungi to resist these medicines – threatens to send us back to a time when we were unable to easily treat infections such as pneumonia, tuberculosis, gonorrhoea, and salmonellosis. The inability to prevent infections could seriously compromise surgery and procedures such as chemotherapy.
Resistance to tuberculosis drugs is a formidable obstacle to fighting a disease that causes around 10 million people to fall ill, and 1.6 million to die, every year. In 2017, around 600 000 cases of tuberculosis were resistant to rifampicin – the most effective first-line drug – and 82% of these people had multidrug-resistant tuberculosis.
Drug resistance is driven by the overuse of antimicrobials in people, but also in animals, especially those used for food production, as well as in the environment. WHO is working with these sectors to implement a global action plan to tackle antimicrobial resistance by increasing awareness and knowledge, reducing infection, and encouraging prudent use of antimicrobials.
Ebola and other high-threat pathogens
In 2018, the Democratic Republic of the Congo saw two separate Ebola outbreaks, both of which spread to cities of more than 1 million people. One of the affected provinces is also in an active conflict zone.
This shows that the context in which an epidemic of a high-threat pathogen like Ebola erupts is critical – what happened in rural outbreaks in the past doesn’t always apply to densely populated urban areas or conflict-affected areas.
At a conference on Preparedness for Public Health Emergencies held last December, participants from the public health, animal health, transport and tourism sectors focussed on the growing challenges of tackling outbreaks and health emergencies in urban areas. They called for WHO and partners to designate 2019 as a “Year of action on preparedness for health emergencies”.
WHO’s R&D Blueprint identifies diseases and pathogens that have potential to cause a public health emergency but lack effective treatments and vaccines. This watchlist for priority research and development includes Ebola, several other haemorrhagic fevers, Zika, Nipah, Middle East respiratory syndrome coronavirus (MERS-CoV) and Severe Acute Respiratory Syndrome (SARS) and disease X, which represents the need to prepare for an unknown pathogen that could cause a serious epidemic.
Weak primary health care
Primary health care is usually the first point of contact people have with their health care system, and ideally should provide comprehensive, affordable, community-based care throughout life.
Primary health care can meet the majority of a person’s health needs of the course of their life. Health systems with strong primary health care are needed to achieve universal health coverage.
Yet many countries do not have adequate primary health care facilities. This neglect may be a lack of resources in low- or middle-income countries, but possibly also a focus in the past few decades on single disease programmes. In October 2018, WHO co-hosted a major global conference in Astana, Kazakhstan at which all countries committed to renew the commitment to primary health care made in the Alma-Ata declaration in 1978.
In 2019, WHO will work with partners to revitalize and strengthen primary health care in countries, and follow up on specific commitments made by in the Astana Declaration.
Measles, for example, has seen a 30% increase in cases globally. The reasons for this rise are complex, and not all of these cases are due to vaccine hesitancy. However, some countries that were close to eliminating the disease have seen a resurgence.
The reasons why people choose not to vaccinate are complex; a vaccines advisory group to WHO identified complacency, inconvenience in accessing vaccines, and lack of confidence are key reasons underlying hesitancy. Health workers, especially those in communities, remain the most trusted advisor and influencer of vaccination decisions, and they must be supported to provide trusted, credible information on vaccines.
In 2019, WHO will ramp up work to eliminate cervical cancer worldwide by increasing coverage of the HPV vaccine, among other interventions. 2019 may also be the year when transmission of wild poliovirus is stopped in Afghanistan and Pakistan. Last year, less than 30 cases were reported in both countries. WHO and partners are committed to supporting these countries to vaccinate every last child to eradicate this crippling disease for good.
Dengue, a mosquito-borne disease that causes flu-like symptoms and can be lethal and kill up to 20% of those with severe dengue, has been a growing threat for decades.
A high number of cases occur in the rainy seasons of countries such as Bangladesh and India. Now, its season in these countries is lengthening significantly (in 2018, Bangladesh saw the highest number of deaths in almost two decades), and the disease is spreading to less tropical and more temperate countries such as Nepal, that have not traditionally seen the disease.
An estimated 40% of the world is at risk of dengue fever, and there are around 390 million infections a year. WHO’s Dengue control strategy aims to reduce deaths by 50% by 2020.
The progress made against HIV has been enormous in terms of getting people tested, providing them with antiretrovirals (22 million are on treatment), and providing access to preventive measures such as a pre-exposure prophylaxis (PrEP, which is when people at risk of HIV take antiretrovirals to prevent infection).
However, the epidemic continues to rage with nearly a million people every year dying of HIV/AIDS. Since the beginning of the epidemic, more than 70 million people have acquired the infection, and about 35 million people have died. Today, around 37 million worldwide live with HIV. Reaching people like sex workers, people in prison, men who have sex with men, or transgender people is hugely challenging. Often these groups are excluded from health services. A group increasingly affected by HIV are young girls and women (aged 15–24), who are particularly at high risk and account for 1 in 4 HIV infections in sub-Saharan Africa despite being only 10% of the population.
This year, WHO will work with countries to support the introduction of self-testing so that more people living with HIV know their status and can receive treatment (or preventive measures in the case of a negative test result). One activity will be to act on new guidance announced In December 2018, by WHO and the International Labour Organization to support companies and organizations to offer HIV self-tests in the workplace.
Every day around 93% of the world’s children under the age of 15 years (1.8 billion children) breathe air that is so polluted it puts their health and development at serious risk. Tragically, many of them die: WHO estimates that in 2016, 600,000 children died from acute lower respiratory infections caused by polluted air.
A new WHO report on Air pollution and child health: Prescribing clean air examines the heavy toll of both ambient (outside) and household air pollution on the health of the world’s children, particularly in low- and middle-income countries. The report is being launched on the eve of WHO’s first ever Global Conference on Air Pollution and Health.
It reveals that when pregnant women are exposed to polluted air, they are more likely to give birth prematurely, and have small, low birth-weight children. Air pollution also impacts neurodevelopment and cognitive ability and can trigger asthma, and childhood cancer. Children who have been exposed to high levels of air pollution may be at greater risk for chronic diseases such as cardiovascular disease later in life.
“Polluted air is poisoning millions of children and ruining their lives,” says Dr Tedros Adhanom Ghebreyesus, WHO Director-General. “This is inexcusable. Every child should be able to breathe clean air so they can grow and fulfil their full potential.”
One reason why children are particularly vulnerable to the effects of air pollution is that they breathe more rapidly than adults and so absorb more pollutants.
They also live closer to the ground, where some pollutants reach peak concentrations – at a time when their brains and bodies are still developing.
Newborns and young children are also more susceptible to household air pollution in homes that regularly use polluting fuels and technologies for cooking, heating and lighting
“Air Pollution is stunting our children’s brains, affecting their health in more ways than we suspected. But there are many straight-forward ways to reduce emissions of dangerous pollutants,” says Dr Maria Neira, Director, Department of Public Health, Environmental and Social Determinants of Health at WHO.
“WHO is supporting implementation of health-wise policy measures like accelerating the switch to clean cooking and heating fuels and technologies, promoting the use of cleaner transport, energy-efficient housing and urban planning. We are preparing the ground for low emission power generation, cleaner, safer industrial technologies and better municipal waste management, ” she added.
- Air pollution affects neurodevelopment, leading to lower cognitive test outcomes, negatively affecting mental and motor development.
- Air pollution is damaging children’s lung function, even at lower levels of exposures
- Globally, 93% of the world’s children under 15 years of age are exposed to ambient fine particulate matter (PM2.5) levels above WHO air quality guidelines, which include the 630 million of children under 5 years of age, and 1.8 billion of children under 15 years
- In low- and middle-income countries around the world, 98% of all children under 5 are exposed to PM2.5 levels above WHO air quality guidelines. In comparison, in high-income countries, 52% of children under 5 are exposed to levels above WHO air quality guidelines.
- More than 40% of the world’s population – which includes 1 billion children under 15 – is exposed to high levels of household air pollution from mainly cooking with polluting technologies and fuels.
- About 600’000 deaths in children under 15 years of age were attributed to the joint effects of ambient and household air pollution in 2016.
- Together, household air pollution from cooking and ambient (outside) air pollution cause more than 50% of acute lower respiratory infections in children under 5 years of age in low- and middle-income countries.
- Air pollution is one of the leading threats to child health, accounting for almost 1 in 10 deaths in children under five years of age.
WHO’s First Global Conference on Air Pollution and Health, which opens in Geneva on Tuesday 30 October will provide the opportunity for world leaders; ministers of health, energy, and environment; mayors; heads of intergovernmental organizations; scientists and others to commit to act against this serious health threat, which shortens the lives of around 7 million people each year. Actions should include:
- Action by the health sector to inform, educate, provide resources to health professionals, and engage in inter-sectoral policy making.
- Implementation of policies to reduce air pollution: All countries should work towards meeting WHO global air quality guidelines to enhance the health and safety of children. To achieve this, governments should adopt such measures as reducing the over-dependence on fossil fuels in the global energy mix, investing in improvements in energy efficiency and facilitating the uptake of renewable energy sources. Better waste management can reduce the amount of waste that is burned within communities and thereby reducing ‘community air pollution’. The exclusive use of clean technologies and fuels for household cooking, heating and lighting activities can drastically improve the air quality within homes and in the surrounding community.
- Steps to minimize children’s exposure to polluted air: Schools and playgrounds should be located away from major sources of air pollution like busy roads, factories and power plants.
Although most colds in children don’t cause serious complications, they can cause anxiety in parents and caregivers. And colds are among the top reasons children visit a doctor. Both non-prescription (over-the-counter) and prescription medicines are available to treat cough and cold symptoms. But most children will get better on their own and may not need medicine.
Some cough and cold medicines also have serious side effects, such as slowed breathing, which can be life-threatening, especially in infants and young children, so it’s important to know when your child needs medication and when they can do without it.
The U.S. Food and Drug Administration wants you to be aware of the following information about use of medicines for cough and colds in children:
- The FDA doesn’t recommend over-the-counter (OTC) medicines for cough and cold symptoms in children younger than 2 years old.
- Prescription cough medicines containing codeine or hydrocodone are not indicated for use in children younger than 18 years old. Codeine and hydrocodone are opioids that are available in combination with other medicines, such as antihistamines and decongestants, in prescription medicines to treat cough and symptoms associated with allergies or the common cold for adults.
- Caregivers should also read labels on OTC cough and cold products, because some might contain codeine.
Here are some other tips on how to safely treat your child’s cough and cold.
Relieving Cold and Cough Symptoms
There’s no cure for the common cold, a viral infection that can’t be treated with antibiotics. Typically, a cold will run its course in a week or two, and children will usually get better on their own, without medication. For older children, some non-prescription medicines can help relieve the symptoms of a cold—but won’t change the natural course of the cold or make it go away faster.
Coughs are a normal symptom of a cold and help the body clear the mucus out of the airway and protect the lungs. Non-drug treatments for coughs include drinking plenty of fluids, especially warm drinks to soothe the throat.
When to Call a Doctor
Not every sniffle or cough merits a trip to the doctor’s office. When in doubt, parents should call their health care provider.
For all children, call a doctor if you see any of these symptoms:
- A fever in an infant 2 months or younger
- A fever of 102 degrees or higher at any age
- Blue lips
- Labored breathing, including nostrils widening with each breath, wheezing, fast breathing, the ribs showing with each breath or shortness of breath
- Not eating or drinking, with signs of dehydration (such as decreased urination)
- Excessive crankiness or sleepiness
- Persistent ear pain
- If the cough lasts for more than three weeks
- If the child is getting worse
These symptoms can signal that your child may have something more serious than a cold.
What to Do About Fever and Other Symptoms Associated With a Cold
Fever helps the body fight off an infection and does not always need to be treated. But if your child is uncomfortable because of fever or other symptoms of a cold, there are alternatives to cough and cold medicine to help them feel more comfortable. They include:
- A clean cool-mist vaporizer or humidifier in a small area near the child’s bed can help moisten the air and decrease the drying of the nasal passages and throat.
- For infants with a stuffy nose, use saline or saltwater drops/spray to moisten nasal passages and loosen mucus. Then clean the nose with a bulb syringe or other suction tool designed for infants.
- Acetaminophen or ibuprofen can help reduce fever, aches and pains. Take care to use the correct dose, consulting a health care provider for patients younger than age 2.
Giving the Right Dose of Medicine
How can you be sure to give the correct dose? Follow the directions on the “Drug Facts” label. The FDA encourages drug manufacturers to provide a dosing instrument, such as a syringe or a cup, marked with the correct measurements. Use them—and not household spoons or tools from other medications—to measure medication.
If you have questions, ask a pharmacist or your health care provider. They can tell you which dosing instrument to use, how much medication to give, and how often based on the Drug Facts label.
In the United States, adults average about three colds per year, and children have colds even more often. You might be tempted to give your children pain relievers, decongestants and other medications for a cold. But often it’s best to fight this common childhood illness with rest and care, using medications only when the symptoms are too uncomfortable or make it difficult for the patient to breathe or sleep.
Those Sunday crossword puzzles may not prevent the aging brain from slowing down — but they might protect it in a different way, a new study suggests.
Researchers looked at the “use it or lose it” theory on brain health. The concept holds that mentally engaging activities — from reading to crosswords to board games — may help the brain resist dementia later in life.
But they did, on average, score higher on standard tests of mental sharpness. That means that while they did decline over time, they did so from a higher “starting point,” the researchers explained.
“The results indicate that a lifetime of engagement lifts you to a high point from which you decline, and that can be considered as passive cognitive reserve,” said lead researcher Roger Staff, of the University of Aberdeen in Scotland.
“Starting from a high point,” he said, “will mean that the threshold at which you are considered impaired will be farther into the future.”
“Cognitive reserve” can be seen as the brain’s ability to find alternative ways to get things done. In theory, a person with greater cognitive reserve may be able to withstand pathological changes in the brain for a longer time before showing signs of dementia.
“The idea is that yes, you’ll decline — but the higher the level you start from, the more years you’ll have with good functioning,” said Keith Fargo, director of scientific programs and outreach for the Alzheimer’s Association.
Fargo, who was not involved in the study, saw the results in a positive light — agreeing that they support the cognitive reserve hypothesis.
However, he said, they do not actually prove that study participants’ penchant for puzzles directly boosted their brain power.
That takes “intervention trials,” Fargo said — where people would be randomly assigned to engage in certain mentally stimulating activities or not.
The Alzheimer’s Association is launching a trial, dubbed POINTER, that will test the effects of mental stimulation along with other lifestyle changes — including exercise, social engagement and better control of health conditions such as high blood pressure and diabetes.
It will look at whether those measures can protect mental function in older adults at increased risk of decline.
The latest study included nearly 500 older British adults who had all taken the same intelligence test when they were about 11 — back in the 1940s. Starting at the age of 64, they answered questions about whether they engaged in intellectually stimulating activities, such as solving puzzles, playing board games, reading or going to museums.
They also took standard tests of memory and thinking over the next 15 years — up to five times.
Overall, the study found, people who liked to challenge their minds were no less likely to show mental decline over time. But they did perform better on the memory and thinking tests — especially those who enjoyed problem-solving activities like puzzles.
That was true even when the researchers factored in childhood intelligence and education level.
The results were published Dec. 10 in the BMJ journal.
Staff agreed that the findings do not prove a cause-and-effect link. But, he said, they do support the importance of feeding the mind — ideally starting early in life.
“Have a hungry mind,” Staff advised. “It’s like money in the cognitive bank.”
But is it ever “too late” for older adults to take up chess or crosswords?
Fargo said there’s not enough evidence to answer that question. But, he stressed, research does suggest that adults can help protect their brain health through various lifestyle choices.
Those include exercising regularly, eating healthfully, not smoking, getting enough sleep — and, yes, staying mentally active.
And if you don’t like puzzles, find something else that uses your mental skills in a fun way.
“Most people do get some enjoyment from challenging themselves,” Fargo said.
Autism and attention-deficit/hyperactivity disorder (ADHD) are so closely linked that they not only run in families, but each increases the risk of the other in future siblings, a new study finds.
Younger siblings of children with autism have a 30-fold increased relative risk they’ll be diagnosed with autism themselves. They’re also nearly four times as likely to be diagnosed with ADHD, researchers reported.
The reverse also holds, if not as strongly. Later-born siblings of children with ADHD have 13 times increased odds of being diagnosed with ADHD and are more than four times as likely to be diagnosed with an autism spectrum disorder (ASD), the findings showed.
“This really provides support for the idea that there are shared familial — probably genetic — mechanisms that underlie these two conditions and link them together,” said lead researcher Meghan Miller.
However, the overall risk of a younger sibling being diagnosed with either condition remains low, added Miller. She is an assistant professor and licensed clinical psychologist with the University of California-Davis MIND Institute, in Sacramento.
“Most of these younger siblings did not develop either of these diagnoses,” Miller said. “Although the odds are increased, most of the younger siblings do not end up with autism or ADHD.”
Prior research has shown that both autism and ADHD run in families, and experts have suspected that either one might increase the risk of the other within a family, the study authors said.
To investigate this further, Miller and her colleagues classified almost 15,200 children based on whether an older sibling had been diagnosed with autism or ADHD. The pool included 730 kids who had an older sibling with ADHD, 158 who had an older sibling with autism, and almost 14,300 with no diagnoses in their immediate family.
The investigators then tracked the children to see whether they developed either neurodevelopmental disorder.
In younger siblings of children with autism, about 12 percent also developed autism and about 3.8 percent developed ADHD, Miller said.
For younger siblings of kids with ADHD, about 12 percent developed ADHD and 1.9 percent developed autism.
Dr. Andrew Adesman is chief of developmental and behavioral pediatrics with Cohen Children’s Medical Center in New Hyde Park, N.Y. He said, “Simply put, these results suggest that families that have a child with either ADHD or ASD are at increased risk of having a child with one or the other condition.”
Parents and pediatricians need to track a wider range of symptoms in the younger brothers and sisters of a child diagnosed with either ADHD and autism, Miller and Adesman said.
“We should broaden what we’re monitoring for. Not only should we be monitoring for symptoms of autism in the younger siblings of children with autism, but we also should be monitoring for attention problems or self-regulation problems as well, and vice-versa,” Miller said.
The findings were published online Dec. 10 in JAMA Pediatrics.
Cases of uterine cancer are charting a slow but steady rise among American women, and so are deaths from the disease, new statistics show.
Looking at federal health data, researchers from the U.S. Centers for Disease Control and Prevention found that “during 1999-2015, uterine cancer incidence rates increased 12 percent, about 0.7 percent per year, on average.”
More than two-thirds (68 percent) of cases involved cancers of the endometrium, the lining of the uterus.
Uterine cancers are often curable if detected early, but late detection often means the tumor has spread and can become fatal. According to the new CDC study, deaths due to uterine cancer have also risen steadily, at an average increase of 1.1 percent per year.
That means that between 1999 and 2016, “uterine cancer death rates increased 21 percent,” wrote researchers led by S. Jane Henley, of the CDC’s Division of Cancer Prevention and Control.
Why the increases? One expert had a theory.
“In general, uterine cancers are the result of excess circulating estrogens that occur when a woman is overweight and has completed the menopause,” said Dr. Benjamin Schwartz. He directs obstetrics and gynecology at Northwell Health’s Southside Hospital in Bay Shore, N.Y.
“Since the obesity epidemic worsened over the years studied, it is not a surprise then that the incidence of uterine cancers also continued to rise,” Schwartz said.
Henley and the CDC team agreed. Overweight or obese women “are approximately two to four times as likely to develop endometrial cancer as are women with healthy weight,” they pointed out.
The new report shows that some groups have been hit harder by uterine cancers than others. Most notably, black women had a much higher increase in cases than the general population — a 2.4 percent annual rise, adding up to a total 46 percent increase in cases between 1999 and 2016.
Rates for Hispanic women were also significantly higher than the average, the report found.
Again, obesity may be a factor, Henley’s group said. While 2013-2016 statistics showed that 40 percent of all U.S. women were obese, that number rose to 56 percent among black women and 49 percent among Hispanics, the researchers noted.
All of this means that “public health efforts to help women achieve and maintain a healthy weight and obtain sufficient physical activity,” would help bring uterine cancer numbers down, the CDC team said.
Earlier detection of these cancers would help save lives, especially for minority women.
The study found that while 8 percent of uterine tumors among women generally were detected only after they had spread to other tissues, that number doubled to 16 percent among black women.
That may have led to a near-doubling of fatal uterine cancers among black women. On average, 5 out of every 100,000 U.S. women now die from uterine cancer, the study found, but the rate for black women is 9 out of every 100,000.
“The data shows clearly that the earlier the cancer is caught, the easier it is to cure,” according to Schwartz.
Certain symptoms can alert women to a potential problem.
According to the CDC researchers, “an important early symptom of uterine cancer is abnormal vaginal bleeding, including bleeding between periods or after sex or any unexpected bleeding after menopause.” This symptom occurs in 9 out of 10 uterine cancer cases, they said.
Dr. Jennifer Wu is an obstetrician-gynecologist at Lenox Hill Hospital in New York City. She agreed that “patients need to know that they should always discuss abnormal uterine bleeding with their doctors.”
And despite the new numbers, Wu stressed that advances in treatment are making uterine cancer much less lethal than before.
“Treatments for uterine cancer have improved,” Wu said. “Uterine cancers can be treated with minimally invasive surgery such as laparoscopy and robotics, and patients can now have quicker recoveries from these types of surgery.”
The new research was published Dec. 7 in the CDC journal Morbidity and Mortality Weekly Report.
FATIGUE CAUSE NO. 1: NOT ENOUGH SLEEP
Lack of sleep causes fatigue, and can have a negative impact on your overall health and well-being.
Aim for seven to eight hours of sleep every night. Go to bed at the same time every night, and wake up at the same time each morning to keep yourself on schedule. Make sure your mattress is comfortable, the room is sufficiently dark and cool, and your cell phone and television is off. If you are still unable to sleep after making changes to your sleep environment, consult a doctor to rule out a sleep disorder.
FATIGUE CAUSE NO. 2: SLEEP APNEA
Sleep apnea is a serious sleep disorder where sufferers briefly stop breathing for short periods during sleep. Most people are not aware this is happening, but it can cause loud snoring, and daytime fatigue.
Being overweight, smoking, and drinking alcohol can all worsen the symptoms of sleep apnea. Lose weight if you are overweight, quit smoking, and avoid alcohol. Your doctor may also prescribe a CPAP device, which helps keep your airways open while sleeping.
FATIGUE CAUSE NO. 3: NOT ENOUGH FUEL
What you eat (or don’t eat) can affect how much you do or don’t sleep. Not eating enough, or eating foods that are not nutritious can cause fatigue. If you eat foods that cause spikes in your blood sugar, as soon as those sugars drop, you feel fatigued.
Eat a balanced diet, complete with fruits, vegetables, whole grains, and protein. Avoid or limit junk foods high in sugar and fat.
FATIGUE CAUSE NO. 4: ANEMIA
Iron deficiency anemia is a common cause of fatigue in women. Red blood cells (pictured) carry oxygen throughout the body, and iron is a main component of these cells. Without enough iron, your body may not be getting the oxygen it needs for energy. Women who experience heavy menstrual periods, or are pregnant may be at higher risk for iron deficiency anemia.
If you are anemic due to iron deficiency, you may be able to replenish your body’s iron through diet. Iron-rich foods include meats, beans, tofu, potatoes, broccoli, nuts, iron-enriched cereals, and brown rice. Talk to your doctor if you think you need iron supplements to determine the proper dosage.
FATIGUE CAUSE NO. 5: DEPRESSION
Depression causes sadness and anxiety, but it can also cause physical symptoms including fatigue, insomnia, aches and pains.
If you or someone you care about is depressed, seek medical attention. Depression may not resolve without treatment, and there are many treatments including therapy and medications that can help resolve symptoms.
FATIGUE CAUSE NO. 6: HYPOTHYROIDISM
The thyroid is a gland that regulates the metabolism, or how fast the body converts fuel into energy for your body’s functions. An underactive thyroid (hypothyroidism) causes fatigue, depression, and weight gain.
A blood test can confirm if a person has hypothyroidism. The good news is that the condition usually responds well to replacement thyroid hormones.
FATIGUE CAUSE NO. 7: CAFFEINE OVERLOAD
Most people take caffeine to help them perk up. In moderation, caffeine does improve alertness and energy. However, too much caffeine can cause jitteriness, increased heart rate or palpitations, high blood pressure, anxiety, and insomnia. In addition, after caffeine wears off, users can ‘crash’ and feel fatigued.
If you drink a lot of coffee, tea, or cola that contains caffeine, or take medications with caffeine, you will need to gradually wean yourself off these drinks, supplements, or medications. You may experience withdrawal symptoms if you suddenly eliminate caffeine entirely, so start slowly. First, start drinking more water and fewer caffeinated beverages every day.
FATIGUE CAUSE NO. 8: HIDDEN UTI
Common symptoms of urinary tract infections (UTIs) include pain or burning during urination, or the feeling or needing to urinate urgently or frequently. But UTIs can also cause fatigue and weakness.
If you suspect a UTI, see your doctor. The usual treatment for a UTI is antibiotics, which should cure the condition in a week or two, alleviating the fatigue and the other symptoms.
FATIGUE CAUSE NO. 9: DIABETES
Diabetes can cause fatigue with either high or low blood sugars. When your sugars are high, they remain in the bloodstream instead of being used for energy, which makes you feel fatigued. Low blood sugar (glucose) means you may not have enough fuel for energy, also causing fatigue.
If you are a person with diabetes, it is important to manage your disease. Your doctor will often recommend lifestyle changes including diet and exercise. You may also be prescribed insulin or other diabetes medications to help you control your blood sugar levels.
FATIGUE CAUSE NO 10: DEHYDRATION
We all know water quenches thirst, but did you know a lack of it could make you fatigued? By the time you feel thirsty, you’re already dehydrated.
While any liquid will help hydrate you, water is the best option. It’s free of sugar, calories, and caffeine. Most experts recommend about eight glasses per day, but you may need more if you exercise or live or work in a warm environment. If you’re well hydrated, your urine will be clear or pale yellow. If it’s darker, you may need more fluids.
FATIGUE CAUSE NO 11: HEART DISEASE
Have you found yourself fatigued by everyday activities such as shopping, cleaning, or climbing stairs? When the heart is less able to pump blood to all of the body’s tissues, it conserves resources by diverting blood from the limbs and instead sending it to the vital organs. This can cause fatigue and may be a sign of heart disease.
Heart disease is a serious condition and needs treatment, so talk to your doctor. There are lifestyle changes (for example, diet and exercise), medications, and physical therapy that can help you control your heart disease and help you get back to doing what you love.
FATIGUE CAUSE NO. 12: SHIFT WORK SLEEP DISORDER
Shift work can wreak havoc on your body’s 24-hour internal clock, or circadian rhythm. When you work nights or rotate shifts, your body doesn’t know when to be awake and when to sleep, which causes fatigue.
Daylight is often a cue to be awake. If you must sleep during the day, try to make your sleeping area as dark, cool, and quiet as possible. If you must work at night, keep your workplace brightly lit. Try to work night shifts all in a row and avoid frequently rotating shifts. Stay away from caffeine, and stick to a regular sleep-wake schedule as much as possible on days off.
FATIGUE CAUSE NO. 13: FOOD ALLERGIES
Food allergies can cause fatigue. Certain foods may contribute to chronic fatigue. If you feel sleepy after eating certain foods, it may be intolerance to that food.
The best way to see if you are sensitive or intolerant of a certain food is an elimination diet. Eliminate suspected foods and see if there is an improvement in your energy levels. If you reintroduce the foods and the fatigue returns, the food just may be the cause. Talk to your doctor about the best way to go about an elimination diet.
FATIGUE CAUSE NO. 14: CHRONIC FATIGUE SYNDROME (CFS) AND FIBROMYALGIA
Chronic fatigue syndrome and fibromyalgia are conditions that can cause persistent, unexplained fatigue that interferes with daily activities for more than six months.
Both conditions are chronic and there is no one-size-fits-all treatment, but lifestyle changes can often help ease some symptoms of fatigue. Strategies include good sleep habits (limit caffeine, keep your bedroom dark and quiet), relaxation techniques, light exercise, pacing yourself, and eating a balanced diet.
FAST FIX FOR MILD FATIGUE
Some of us are simply tired with no medical cause. The good news is that exercise may give us a boost. Studies consistently show that people who engage in regular exercise feel less fatigue than those who don’t. When exercising for energy stay in the low to moderate exertion range, such as walking, yoga, or light resistance training to fight fatigue.
John A. Daller/ www.rxlist.com
Sandoz Inc. is voluntarily recalling one lot of Losartan Potassium Hydrochlorothiazide Tablets, USP 100mg/25mg to the consumer level. This product is being recalled due to the trace amount of an impurity, N-nitrosodiethylamine (NDEA) contained in the API Losartan, USP manufactured by Zhejiang Huahai Pharmaceutical Co. Ltd. Sandoz Inc. Losartan Potassium Hydrochlorothiazide product is manufactured by Lek Pharmaceuticals dd, Ljubljana, Slovenia. This impurity, which is a substance that occurs naturally in certain foods, drinking water, air pollution, and industrial processes, has been classified as a probable human carcinogen as per International Agency for Research on Cancer (IARC).
Losartan Potassium Hydrochlorothiazide Tablets, USP are indicated for the treatment of hypertension. It may be used alone or in combination with other antihypertensive agents. The product can be identified as Losartan Potassium Hydrochlorothiazide, 100 mg/25 mg tablets in 1000-countplastic bottles, NDC 0781-5207-10, Lot number JB8912; Exp. Date 06/2020. This product was distributed nationwide to distributors. The affected product was not distributed prior to October 8, 2018.
Sandoz Inc. is notifying its distributors by letter via overnight mail and patients by this public notification. Distributors and retailers that have product which is being recalled should immediately stop distribution of the identified lot above and quarantine any quantities remaining in your control and return the recalled product to the identified Reverse Distributor.
Patients with questions regarding this recall can contact Sandoz Inc. at 1-800-525-8747 Monday-Friday 8:30 AM – 5:00 PM (EST) or email firstname.lastname@example.org. Patients should contact their pharmacist or physician who can advise them about an alternative treatment prior to returning their medication. Patients who are on Losartan Potassium Hydrochlorothiazide should continue taking their medication, as the risk of harm to a patient’s health may be higher if the treatment is stopped immediately without any alternative treatment. Patients should contact their physician or healthcare provider if they have experienced any problems that may be related to taking or using Losartan Potassium Hydrochlorothiazide.
Adverse reactions or quality problems associated with the use of this product may be reported to FDA’s MedWatch Adverse Event Reporting program either by phone, on line, by regular mail or by fax.
- Complete and submit the report Online: www.fda.gov/medwatch/report.htm
- Regular Mail or Fax: Download form www.fda.gov/MedWatch/getforms.htm or call 1-800-332-1088 to request a reporting form, then complete and return to the address on the pre-addressed form, or submit by fax to 1-800-FDA-0178.
This recall is being made with the knowledge of the Food and Drug Administration.
This press release contains forward-looking statements within the meaning of the United States Private Securities Litigation Reform Act of 1995. Forward-looking statements can generally be identified by words such as “potential,” “can,” “will,” “plan,” “expect,” “anticipate,” “look forward,” “believe,” “committed,” “investigational,” “pipeline,” “launch,” or similar terms, or by express or implied discussions regarding potential marketing approvals, new indications or labeling for the investigational or approved products described in this press release, or regarding potential future revenues from such products. You should not place undue reliance on these statements. Such forward-looking statements are based on our current beliefs and expectations regarding future events, and are subject to significant known and unknown risks and uncertainties. Should one or more of these risks or uncertainties materialize, or should underlying assumptions prove incorrect, actual results may vary materially from those set forth in the forward-looking statements. There can be no guarantee that the investigational or approved products described in this press release will be submitted or approved for sale or for any additional indications or labeling in any market, or at any particular time. Nor can there be any guarantee that such products will be commercially successful in the future. In particular, our expectations regarding such products could be affected by, among other things, the uncertainties inherent in research and development, including clinical trial results and additional analysis of existing clinical data; regulatory actions or delays or government regulation generally; global trends toward health care cost containment, including government, payor and general public pricing and reimbursement pressures; our ability to obtain or maintain proprietary intellectual property protection; the particular prescribing preferences of physicians and patients; general political and economic conditions; safety, quality or manufacturing issues; potential or actual data security and data privacy breaches, or disruptions of our information technology systems, and other risks and factors referred to in Novartis AG’s current Form 20-F on file with the US Securities and Exchange Commission. Novartis is providing the information in this press release as of this date and does not undertake any obligation to update any forward-looking statements contained in this press release as a result of new information, future events or otherwise.
Sandoz is a global leader in generic pharmaceuticals and biosimilars. As a division of the Novartis Group, our purpose is to discover new ways to improve and extend people’s lives. We contribute to society’s ability to support growing healthcare needs by pioneering novel approaches to help people around the world access high-quality medicine. Our portfolio of approximately 1000 molecules, covering all major therapeutic areas, accounted for 2017 sales of USD 10.1 billion. In 2017, our products reached more than 500 million patients. Sandoz is headquartered in Holzkirchen, in Germany’s Greater Munich area.
Aurobindo Pharma Limited is voluntarily recalling 22 Batches of the drug substance Irbesartan due to the presence of an impurity, N-nitrosodiethylamine (NDEA). The impurity, which is a substance that occurs naturally in certain foods, drinking water, air pollution, and industrial processes, has been classified as a probable human carcinogen as per International Agency for Research on Cancer (IARC).
These 22 batches of Irbesartan drug substance were supplied to ScieGen Pharmaceuticals Inc., U.S. for the manufacturing of finished Irbesartan drug product (see attached annexure).
Aurobindo Pharma Limited has notified ScieGen Pharmaceuticals, Inc. of the recall and is arranging for the return of all available Irbesartan drug substance. Aurobindo Pharma Limited has further advised Sciegen Pharmaceuticals, Inc. to contact its distributors and retailers to return Irbesartan drug product and finished Irbesartan tablets that has been identified by Aurobindo Pharma Limited.
Patients should contact their pharmacist or physician who can advise them about an alternative treatment prior to returning their medication. Patients who are on Irbesartan should continue taking their medication, as the risk of harm to a patient’s health may be higher if the treatment is stopped immediately without any alternative treatment. Patients should contact their physician or healthcare provider if they have experienced any problems that may be related to taking or using Irbesartan.
Adverse reactions or quality problems associated with the use of this product may be reported to FDA’s MedWatch Adverse Event Reporting program either by phone, on line, by regular mail or by fax.
- Complete and submit the report Online: www.fda.gov/medwatch/report.htm
- Regular Mail or Fax: Download form www.fda.gov/MedWatch/getforms.htm or call 1-800-332-1088 to request a reporting form, then complete and return to the address on the pre-addressed form, or submit by fax to 1-800-FDA-0178.
Irbesartan batches Supplied to US Customers
|S.No||Manufacturing Batch Number||Dispatch Batch Number||Date of Manufacture||Date of Distribution||Retest/Expiry Date||Dispatch Qty||Name and Location of the Customer||NDEA Impurity Result ug/g|
|1||1601100782||1601101589||Jan-2016||Jan-2016||Dec-2016||90.29 Kg||Sciegen Pharmaceuticals INC, USA||0.23|
|2||1601100783||1601101590||Jan-2016||3l-Jan-2016||Dec-2016||59.61 Kg||Sciegen Pharmaceuticals INC, USA||0.28|
|3||1701111861||1701113404||l3-Sep-2017||7-0ct-2017||12-Sep-2020||88.48 Kg||Sciegen Pharmaceuticals INC, USA||0.47|
|4||1701112170||1701113405||l8-Sep-2017||7-0ct-2017||l7-Sep-2020||90.92 Kg||Sciegen Pharmaceuticals INC, USA||0.15|
|5||1701112501||1701113406||20-Sep-2017||7-0ct-2017||l9-Sep-2020||93.02 Kg||Sciegen Pharmaceuticals INC, USA||1.61|
|6||1701112056||1701113407||l3-Sep-2017||7-0ct-2017||l2-Sep-2020||88.82 Kg||Sciegen Pharmaceuticals INC, USA||0.53|
|7||1701112558||1701114283||2-0ct-2017||25-0ct-2017||l-Oct-2020||63.76 Kg||Sciegen Pharmaceuticals INC, USA||0.6|
|8||1701112558||1701114284||2-0ct-2017||25-0ct-2017||l-Oct-2020||27.06 Kg||Sciegen Pharmaceuticals INC, USA||0.6|
|9||1701I12559||1701114285||3-0ct-2017||25-0ct-2017||2-0ct-2020||91.82 Kg||Sciegen Pharmaceuticals INC, USA||0.45|
|10||1701112589||1701114286||6-0ct-2017||25-0ct-2017||5-0ct-2020||90.32 Kg||Sciegen Pharmaceuticals INC, USA||0.28|
|11||1701113300||1701114289||7-0ct-2017||25-0ct-2017||6-0ct-2020||91.32 Kg||Sciegen Pharmaceuticals INC, USA||0.32|
|12||1701113301||1701114291||8-0ct-2017||25-0ct-2017||7-0ct-2020||90.12 Kg||Sciegen Pharmaceuticals INC, USA||0.32|
|13||1701113302||1701114708||l7-0ct-2017||30-0ct-2017||l6-0ct-2020||80.82 Kg||Sciegen Pharmaceuticals INC, USA||0.85|
|14||1701113312||1701114709||20-0ct-2017||30-0ct-2017||19 Oct 2020||86.82 Kg||Sciegen Pharmaceuticals INC, USA||0.88|
|15||1701115460||1701117039||23-Nov-2017||2l-Dec-2017||22-Nov-2020||16.72 Kg||Sciegen Pharmaceuticals INC, USA||0.31|
|16||1701115974||1701117040||29-Nov-2017||2l-Dec-2017||28-Nov-2020||91.12 Kg||Sciegen Pharmaceuticals INC, USA||0.26|
|17||1701115460||1701117041||23-Nov-2017||2l-Dec-2017||22-Nov-2020||89.79 Kg||Sciegen Pharmaceuticals INC, USA||0.31|
|18||1701115738||1701117042||24-Nov-2017||21-Dec-2017||23-Nov-2020||90.42 Kg||Sciegen Pharmaceuticals INC, USA||0.38|
|19||1701115739||1701117043||25-Nov-2017||2l-Dec-2017||24-Nov-2020||89.79 Kg||Sciegen Pharmaceuticals INC, USA||0.44|
|20||1701115740||1701117044||26-Nov-2017||2l-Dec-2017||25-Nov-2020||93.42 Kg||Sciegen Pharmaceuticals INC, USA||0.34|
|21||1701115741||1701117045||27-Nov-2017||21-Dec-2017||26-Nov-2020||93.72 Kg||Sciegen Pharmaceuticals INC, USA||0.39|
|22||1701115742||1701117046||28-Nov-2017||21-Dec-2017||27-Nov-2020||93.62 Kg||Sciegen Pharmaceuticals INC, USA||0.31|
Remark: For Dispatch batch no. 1701114283 & 1701114284, Mother Batch is common 170111255 8
For Dispatch batch no. 1701117039 & 1701117041, Mother Batch is common 1701115460
Total No. of Mother Batches: 20
Total No. of dispatch Batches: 22.