Yasmira Castano felt she had a fresh chance at life when she received a kidney transplant almost two decades ago. The young Venezuelan was able to finish high school and went on to work as a manicurist.

But late last year, Castano, now 40, was unable to find the drugs needed to keep her body from rejecting the organ, as Venezuela’s health care system slid deeper into crisis following years of economic turmoil.

On Christmas Eve, weak and frail, Castano was rushed to a crumbling state hospital in Venezuela’s teeming capital, Caracas. Her immune system had attacked the foreign organ and she lost her kidney shortly afterward.

Now, Castano needs dialysis three times a week to filter her blood. But the hospital attached to Venezuela’s Central University, once one of South America’s top institutions, frequently suffers water outages and lacks materials for dialysis.

“I spend nights not sleeping, just worrying,” said Castano, who weighs around 77 pounds (35 kg), as she lay on an old bed in a bleak hospital room, its bare walls unadorned by a television or pictures.

Her roommate Lismar Castellanos, who just turned 21, put it more bluntly.

“Unfortunately, I could die,” said Castellanos, who lost her transplanted kidney last year and is struggling to get the dialysis she needs to keep her body functioning.

The women are among Venezuela’s roughly 3,500 transplant recipients. After years leading normal lives, they now live in fear as Venezuela’s economic collapse under President Nicolas Maduro has left the once-prosperous OPEC nation unable to purchase sufficient foreign medicine or produce enough of its own.

Some 31 Venezuelans have seen their bodies start to reject their transplanted organs in the last month due to lack of medicine, according to umbrella health group Codevida, a nongovernmental organization.

At least seven have died due to complications stemming from organ failure in the last three months.

A further 16,000 Venezuelans, many hoping for an elusive transplant, are dependent on dialysis to clean their blood — but here, too, resources and materials are sorely lacking.

Nearly half of the country’s dialysis units are out of service, according to opposition lawmaker and oncologist Jose Manuel Olivares, a leading voice on the health crisis who has toured dialysis centers to assess the scale of the problem.

‘Straight to the cemetery’

In the last three weeks alone, seven people have died due to lack of dialysis, according to Codevida, which staged a protest to decry the critical drug shortages.

Once-controlled diseases like diphtheria and measles have returned, due partly to insufficient vaccines and antibiotics, while Venezuelans suffering chronic illnesses like cancer or diabetes often have to forgo treatment.

Hundreds of thousands of desperate Venezuelans, meanwhile, have fled the country over the past year, including many medical professionals.

Amid a lack of basics like catheters and crumbling hospital infrastructure, doctors who remain struggle to cope with ever scarcer resources.

“It’s incredibly stressful. We request supplies; they don’t arrive. We call again and they still don’t arrive. Then we realize it’s because there aren’t any,” said a kidney specialist at a public hospital, asking to remain anonymous because health workers are not allowed to speak publicly about the situation.

Venezuela’s Social Security Institute, tasked with providing patients with drugs for chronic conditions, did not respond to a request for comment.

Terrified transplant patients are indebting themselves to buy pricey medicine on the black market, begging relatives abroad to funnel drugs into the country or dangerously reducing their daily intake of pills to stretch out stock.

Larry Zambrano, a 45-year-old father of two with a kidney transplant, resorted to taking immunosuppressants designed for animals last year.

Guillermo Habanero and his brother Emerson both underwent kidney transplants after suffering polycystic kidney disease.

Emerson, a healthy 53-year-old former police officer, died in November after a month without immunosuppressants.

“If you lose your kidney, you go to dialysis but there are no materials. So you go straight to the cemetery,” said Habanero, 56, who runs a small computer repair shop in the poor hillside neighborhood of Catia.

Blaming Maduro, who blames sanctions

A Reuters reporter went to the Health Ministry to request an interview, but was asked at the entrance to give her contact details instead. No one called or emailed.

Reuters was also unable to contact the Health Ministry unit in charge of transplants, Fundavene, for comment. Its website was unavailable. Multiple calls to different phone numbers went unanswered. An email bounced back and no one answered a message on the unit’s Facebook page.

Maduro’s government has said the real culprit is an alleged U.S.-led business elite seeking to sabotage its socialist agenda by hoarding medicine and imposing sanctions.

“I see the cynicism of the right-wing, worried about people who cannot get dialysis treatment, but it’s their fault: They’ve asked for sanctions and a blockade against Venezuela,” Socialist Party heavyweight Diosdado Cabello said in recent comments on his weekly television program.

Health activists blame what they see as Maduro’s inefficient and corrupt government for the medical crisis and contend that government announcements of more imports for dialysis are totally insufficient.

Despite his unpopularity, Maduro is expected to win a new six-year term in an April 22 presidential election. The opposition is likely to boycott the vote, which it has already denounced as rigged in favor of the government.

Maduro has refused to accept food and medicine donations, despite the deepening health care crisis. Health activists and doctors smuggle in medicines, often donated by the growing Venezuelan diaspora, in their suitcases, but it is far from enough.

In the decaying hospital and dialysis center visited by Reuters, patients clamored for humanitarian aid.

Dolled up for her birthday and surrounded by cakes, the 21-year-old Castellanos took selfies with her friends and spoke excitedly about one day returning to dance, one of her passions.

But fears for her future permeated the room. A hospital worker stopped by to wish Castellanos many more birthday celebrations, but her worried face betrayed doubts.

“Other countries need to help us,” Castellanos said.
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Sea levels will rise between 0.7 and 1.2 meters (27-47 inches) in the next two centuries even if governments end the fossil fuel era as promised under the Paris climate agreement, scientists said Tuesday.

Early action to cut greenhouse gas emissions would limit the long-term rise, driven by a thaw of ice from Greenland to Antarctica that will re-draw global coastlines, a German-led team wrote in the journal Nature Communications.

Sea-level rise is a threat to cities from Shanghai to London, to low-lying swaths of Florida or Bangladesh, and to entire nations such as the Maldives in the Indian Ocean or Kiribati in the Pacific.

By 2300, the report projected that sea levels would gain by 0.7-1.2 meters, even if almost 200 nations fully meet goals under the 2015 Paris Agreement, which include cutting greenhouse gas emissions to net zero in the second half of this century.

Ocean levels will rise inexorably because heat-trapping industrial gases already emitted will linger in the atmosphere, melting more ice, it said. In addition, water naturally expands as it warms above four degrees Celsius (39.2°F).

The report also found that every five years of delay beyond 2020 in peaking global emissions would mean an extra 20 centimeters (8 inches) of sea-level rise by 2300.

“Sea level is often communicated as a really slow process that you can’t do much about … but the next 30 years really matter,” lead author Matthias Mengel, of the Potsdam Institute for Climate Impact Research, told Reuters.

Governments are not on track to meet the Paris pledges.

Global emissions of carbon dioxide, the main greenhouse gas emitted by burning fossil fuels, rose last year after a three-year plateau.

And U.S. President Donald Trump, who doubts that human activities are the prime cause of warming, plans to quit the Paris deal and instead promote U.S. coal, oil and natural gas.

‘Brink of inundation’

Maldives Environment Minister Thoriq Ibrahim, who chairs the 44-member Alliance of Small Island States, said Tuesday’s findings showed a need for faster action to cut emissions, especially by rich nations.

“Unfortunately, the study confirms what small island nations have been saying for years: Decades of procrastination on climate change have brought many of us to the brink of inundation,” he told Reuters.

Professor John Church, of the Climate Change Research Center at the University of New South Wales, who was not involved in the study, said 100 million people now live within one meter of the high tide mark.

“More people are moving to live within the coastal zone, increasing the vulnerable population and infrastructure,” he said in a statement. “Adaptation to sea-level rise will be essential.”
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More than 100,000 malaria cases went untreated when Liberia’s health care system buckled under the 2014-2015 Ebola outbreak, according to a new study.

The research, published in the journal PLOS Medicine, shows how the toll of the Ebola outbreak goes beyond the 11,000 killed in West Africa by the virus itself. Basic health care took a major hit as well.

Ebola kills about half of the people it infects. It causes flu-like symptoms, followed by vomiting and diarrhea, and can lead to internal and external hemorrhaging. The disease spreads through contact with an infected person’s bodily fluids. 

The countries of West Africa were ill-equipped to deal with the 2014-15 outbreak. Many clinics lacked the most basic tools for dealing with the disease, including latex gloves and face masks. 

“Rightfully so, people were afraid to go to the clinic because they might get Ebola when they’re at the clinic,” said study lead author Brad Wagenaar at the University of Washington.

Wagenaar and colleagues found that by four months into the epidemic, clinics were delivering one-third to two-thirds fewer basic services, which he described as a “huge, dramatic decrease.” 

‘Huge, dramatic decrease’

The researchers studied monthly data on health visits from 379 clinics outside the capital, Monrovia, from 2010 through 2016. 

They found measles vaccinations dropped by 67 percent. Anti-malarial treatment fell by 61 percent. Thirty-five percent fewer pregnant women came in for their first pre-natal visits.

It took more than a year-and-a-half for all services to return to pre-outbreak levels. 

Lost opportunities

In that time, more than three-quarters of a million clinic visits were lost, the researchers estimate, based on extrapolations from pre-outbreak trends. 

That includes more than 5,000 births at health care facilities, in a country with one of the world’s highest rates of maternal death, along with a loss of 100, 000 malaria treatments. These figures, Wagenaar adds, suggest a loss of other services that may have a long-term impact, such as distributing bed nets and spraying houses with insecticides.

“Some of these other things didn’t happen during the Ebola outbreak because the health system and other partners were busy with other issues,” he said. “And now, the cases have been increasing.”

Malaria cases were 50 percent higher in December of 2017 than they were before the Ebola epidemic.

Wagenaar says the research highlights how more attention must be devoted to maintaining basic services during a health emergency. The data his group analyzed could be used in other outbreaks to prioritize services that have been overlooked. 

Funding for public health systems

And after the emergency, funding should focus on strengthening public health systems. 

“We know that this epidemic happened in Liberia due to multiple factors, but one being the public sector ministry of health system has been underfunded,” he said, adding that remains the case.

Donors earmarked funds for strengthening the health system, he said. But, “that money never really materialized,” he added.
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A precision nutrition approach to weight loss didn’t hold up in a study testing low fat versus low carb depending on dieters’ DNA profiles.

Previous research has suggested that a person’s insulin levels or certain genes could interact with different types of diets to influence weight loss.

 

Stanford University researchers examined this idea with 600 overweight adults who underwent genetic and insulin testing before being randomly assigned to reduce fat or carbohydrate intake.  

Gene analyses identified variations linked with how the body processes fats or carbohydrates, which the researchers thought would make them more likely to lose weight on a low-fat or low-carb diet.    

 

But weight loss averaged about 13 pounds over a year, regardless of genes, insulin levels or diet type. Also, some people lost as much as 60 pounds and others gained 15 pounds – more evidence that genetic characteristics and diet type appeared to make no difference.

What seemed to make a difference was healthful eating. Participants on both diets who consumed the fewest processed foods, sugary drinks, unhealthy fats and ate the most vegetables lost the most weight.

The results suggest that “precision medicine is not as important as eating mindfully, getting rid of packaged, processed food” and avoiding unhealthy habits like eating while watching television, said lead author Christopher Gardner.

 

The study was published Tuesday in the Journal of the American Medical Association.

 

Participants had 22 health education classes during the study and were encouraged to be physically active, but the focus was on what they ate. They were advised to choose high-quality foods but were not given suggested calorie limits nor were they provided with specific foods. Results are based on what they reported eating.

During the first two months, dieters in each group were told to limit carbohydrates or fats to 20 grams daily, about the amount that’s in 1 1/2 slices of whole wheat bread and a handful of nuts respectively. They were allowed to increase that to more manageable levels during the rest of the study.

Fat intake in the low-fat group averaged 57 grams during the study versus 87 grams beforehand; carb intake in the low-carb group averaged 132 grams versus 247 grams previously. Both groups reduced their daily calorie intake by an average of about 500 calories.

 

The study was well-conducted but because participants were not provided with specific foods and self-reported their food choices, it wasn’t rigorous enough to disprove the idea that certain genes and insulin levels may affect which types of diets lead to weight loss, said Dr. David Ludwig, a Boston Children’s Hospital obesity researcher.

Dr. Frank Hu, nutrition chief at Harvard’s School of Public Health, has called precision nutrition a promising approach and said the study wasn’t a comprehensive test of all gene variations that might affect individual responses to weight loss diets.

 

“In any weight loss diets, adherence to the diet and the overall quality of the diet are probably more important than any other factors,” Hu said.

 
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The United Nations children’s agency has declared Pakistan as the riskiest country for newborns, saying that out of every 1,000 babies born in Pakistan, 46 die before the end of their first month.

UNICEF released the findings Tuesday as part of its global awareness campaign to demand and deliver solutions on behalf of the world’s newborns.

Pregnant women are much less likely to receive assistance during delivery in Pakistan, where 14 skilled health professionals are available for every 10,000 people, according to the report.

It acknowledged the percentage of mothers who give birth in a health facility in Pakistan increased from 21 percent to 48 percent between 2001 and 2013. It also noted the proportion of women giving birth with a skilled attendant during the same period more than doubled from 23 percent to 55 percent.

“But despite these remarkable increases, largely the result of rapid urbanization and the proliferation of private sector providers not subject to satisfactory oversight, Pakistan’s very high newborn mortality rate fell by less than one quarter, from 60 in 2000 to 46 in 2016,” according to UNICEF’s findings.

Critics have long called for increasing the health budget in Pakistan, which spends less than one percent of its GDP on health services, as opposed to the World Health Organization benchmark of at least six percent of the GDP to ensure basic and life saving services.

Other countries

After Pakistan, the Central African Republic and war-shattered Afghanistan are the next most dangerous countries for newborns, according to UNICEF. Poverty, conflict and weak institutions in these countries are cited as primary reasons for the alarming number of newborn deaths.

Millions of young lives could be saved every year, the report noted, if mothers and babies had access to affordable, quality health care, good nutrition and clean water.

More than 80 percent of newborn deaths, the report said, are the result of premature birth, complications during labor and delivery, and infections such as sepsis, meningitis and pneumonia.

“But far too often, even these basics are out of reach of the mothers and babies who need them most.”

 
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Items discovered underwater caverns in eastern Mexico to reveal what is believed to be the biggest flooded cave on the planet

Archaeologists exploring the world’s biggest flooded cave in Mexico have discovered ancient human remains at least 9,000 years old and the bones of animals who roamed the Earth during the last Ice Age.

A group of divers recently connected two underwater caverns in eastern Mexico to reveal what is believed to be the biggest flooded cave on the planet, a discovery that could help shed new light on the ancient Maya civilization.

The Yucatan peninsula is studded with monumental relics of the Maya people, whose cities drew upon an extensive network of sinkholes linked to subterranean waters known as cenotes.

Researchers say they found 248 cenotes at the 347-km (216-mile) cave system known as Sac Actun, near the beach resort of Tulum. Of the 200 archaeological sites they have discovered there, around 140 are Mayan.

Some cenotes acquired particular religious significance to the Maya, whose descendants continue to inhabit the region.

Apart from human remains, they also found bones of giant sloths, ancient elephants and extinct bears from the Pleistocene period, Mexico’s Culture Ministry said in a statement.

The cave’s discovery has rocked the archaeological world.

“I think it’s overwhelming. Without a doubt it’s the most important underwater archaeological site in the world,” said Guillermo de Anda, researcher at Mexico’s National Anthropology and History Institute (INAH).

De Anda is also director of the Gran Acuifero Maya (GAM), a project dedicated to the study and preservation of the subterranean waters of the Yucatan peninsula.

According to the INAH, water levels rose 100 meters at the end of the Ice Age, flooding the cave system and leading to “ideal conditions for the preservation of the remains of extinct megafauna from the Pleistocene.”

The Pleistocene geological epoch, the most recent Ice Age, began 2.6 million years ago and ended around 11,700 years ago.

 
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Pollution is threatening the recently mapped Sac Actun cave system in the Yucatan Peninsula, a vast underground network that experts in Mexico say could be the most important underwater archaeological site in the world.

 

Subaquatic archaeologist Guillermo de Anda said the cave system’s historical span is likely unrivaled. Some of the oldest human remains on the continent have been found there, dating back more than 12,000 years, and now-extinct animal remains push the horizon back to 15,000 years.

 

He said researchers found a human skull that was already covered in rainwater limestone deposits long before the cave system flooded around 9,000 years ago.

 

De Anda said over 120 sites with Maya-era pottery and bones in the caves suggest water levels may have briefly dropped in the 216-mile (347-kilometer) -long system during a drought about 1,000 A.D. And some artifacts have been found dating to the 1847-1901 Maya uprising known as the War of the Castes.

 

Humans there probably didn’t live in the caves, de Anda said, but rather went down to them “during periods of great climate stress, to look for water.”

 

Sac Actun is “probably the most important underwater archaeological site in the world,” he said.

 

But de Anda said pollution and development may threaten the caves’ crystalline water.

Some of the sinkhole lakes that today serve as entrances to the cave system are used by tourists to snorkel and swim. And the main highway in the Caribbean coast state of Quintana Roo runs right over some parts of cave network. That roadway has been known to collapse into sinkholes.

 

Also, the cave with the stone-encased skull has high acidity levels, suggesting acidic runoff from a nearby open-air dump could damage skeletal remains.

 

The world’s other great underwater site, the sunken Egyptian city of Alexandria, is also threatened by pollution.
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