Next-day discharge after C-section may be okay: study

(Reuters) – Some women who deliver their babies by cesarean section may be able to check out of the hospital the next day without raising their risk of problems, according to a Malaysian study.

The study, which appeared in the journal Obstetrics & Gynecology, looked at 360 women in Malaysia, who were randomly assigned to go home either one or two days after having a C-section.

Both groups were equally satisfied with their care, and the women who were discharged sooner seemed to have no more problems with breastfeeding or mental well-being.

“Day 1 discharge compared with day 2 discharge after a planned cesarean delivery resulted in equivalent outcomes,” wrote lead author Peng Chiong Tan, at the University of Malaya in Kuala Lumpur.

Those results don’t mean that hospitals should start discharging women the day after a C-section, but they do suggest that a next-day discharge is something women can talk about with their doctors, researchers said.

In the United States, where C-sections are done in about one-third of births, women typically stay in the hospital for three to four days after the procedure. That compares with about two days for women who deliver vaginally.

In the past, there were concerns about insurers pushing mothers to leave the hospital before they’re ready. That led to a 1996 law requiring insurers to pay for a 48-hour hospital stay after a vaginal delivery and a 96-hour stay after a C-section.

Still, the American College of Obstetricians and Gynecologists (ACOG) says a shorter stay after a C-section is an option if the baby is ready to go home, though the mother should meet certain requirements first such as normal blood pressure, no signs of infection and adequate pain control.

At Tan’s hospital in Malaysia, women who have a C-section are routinely told to expect just a two-day stay, and some providers there have discharged new mothers the day after.

Tan’s team randomly assigned the 360 women having a planned C-section to go home either one or two days after delivering. In the end, 16 percent of the women in the day-after group were not discharged that early, because either they or their babies were having problems.

But when they did go home the day after, there didn’t seem to be a greater risk of difficulties. When the women were interviewed two weeks later, 87 percent were happy with their discharge timing.

The same was true for almost 86 percent of women who went home two days after their C-section.

While the findings would likely extend to women in other countries too, these Malaysian women typically went home to a lot of support – often, an extended family network, Tan said.

“Where this support is not available, next-day hospital discharge may not be associated with the same degree of satisfaction, acceptability and good outcome as we have found,” she added.

SOURCE:http://bit.ly/TzbGoz

(Reporting from New York by Amy Norton at Reuters Health; editing by Elaine Lies)

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Twin explosions strike southern Syrian city

BEIRUT (AP) — Syria‘s state-run news agency says two large explosions have struck the southern city of Daraa, causing multiple casualties and heavy material damage.

SANA did not immediately give further information or say what the target of Saturday’s explosions was.

The Britain-based Syrian Observatory for Human Rights says the blasts went off near a branch of the country’s Military Intelligence in Daraa.

The Observatory, which relies on a network of activists on the ground, says the explosions were followed by clashes between regime forces and rebels fighting to topple President Bashar Assad.

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Ohio teen gets prison for life in Craigslist murders

AKRON, Ohio (Reuters) – Seventeen-year-old Brogan Rafferty was sentenced to life in prison without parole Friday for his role in the killing of three men, two of whom were lured by a Craigslist ad promising work on an Ohio farm.

Rafferty was 16 when he was arrested in November 2011, but was tried as an adult. He was convicted late last month in the murders of David Pauley, 51, of Norfolk, Virginia; Ralph Geiger, 56, of Akron, Ohio; and Timothy Kern, 47, of Massillon, Ohio.

Rafferty also got 10 years for the attempted murder of Scott Davis, who was shot in the arm while escaping after meeting Rafferty and alleged triggerman Richard Beasley.

Prosecutors called the teen an apt pupil to Beasley, 53, who is also charged in the murders.

Rafferty testified that he was terrified of the man he had considered a father figure and spiritual adviser after he saw Beasley shoot Geiger in the head execution-style.

Beasley allegedly enticed Geiger with the offer of a non-existent caretaker job, killed him, stole his identity, and then drew other victims by posting the bogus job on Craigslist.

Rafferty, wearing prison stripes with hands clasped in front of him, told the court Friday that Beasley an “evil, deceitful cruel murderer,” but admitted the he bore some responsibility.

“I was involved, I didn’t like it, and now I see there were many options I couldn’t see then that I see now, but I can’t make anything better and I’m sorry,” he said.

Judge Lynn Callahan called Rafferty’s case “heartbreaking” but said she did not accept that he had no way out of his situation.

“You embraced the evil, you studied it,” she said. She said Rafferty had been dealt “a lousy hand in life,” but she found nothing in the case that could be chalked up to the recklessness of youth.

“You could have been so much more; you are so intelligent,” the judge told Rafferty.

During the trial, jurors heard testimony that the teen helped dig graves for some of the men and was found in possession of guns and knives stolen from them after Beasley shot them.

Beasley’s trial is scheduled in the same courtroom for January 7. He faces the death penalty if convicted. Both Rafferty’s and Beasley’s attorneys are under a gag order and are not permitted to talk to the media.

Under Ohio law, juveniles older than 15 who are charged with a serious offense and crimes that involve a firearm are sent to adult court for trial.

Last summer, a U.S. Supreme Court decision struck down mandatory life sentences for juveniles. The high court found that judges and juries passing sentence on juvenile murders must weigh mitigating circumstances, including the youth’s role and family background.

A 2005 Supreme Court decision made it unconstitutional to execute anyone under the age of 18.

Rafferty’s attorney Jill Flagg objected to his sentence and will appeal.

In other incidents involving Craigslist and other social media, people advertising goods for sale or responding to ads have been attacked and killed.

In 2009, a former medical student was accused of killing a masseuse he met through Craigslist. In February, two men in Tennessee were accused of killing a man and a woman for “unfriending” the daughter of one of the suspects on Facebook.

(Reporting by Kim Palmer; Editing by Mary Wisniewski and Eric Walsh)

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Justin Bieber and Selena Gomez have broken up, reports say

LOS ANGELES (Reuters) – Pop star Justin Bieber and his girlfriend, Selena Gomez, a Disney actress and singer, have broken up, ending a relationship that made them one of Hollywood’s most high-profile young couples, media reports said.

Bieber, 18, and Gomez, 20, disclosed their relationship in February 2011 when they appeared together at an Oscar night party after months of rumors of their dating.

E! Online late on Friday was the first to report the split, with other media outlets including US Weekly and People also saying the relationship was over. The reports cited unnamed sources close to the couple.

Representatives for Bieber and Gomez did not returns calls or emails on Saturday.

Bieber has released two No. 1 albums in just over a year – the holiday-themed “Under the Mistletoe” and his latest, “Believe.” In September, he topped Billboard’s “21 Under 21″ list of top young musical acts. It was his second year in a row with the title.

Gomez rose to fame as a teenager in the Walt Disney Co television series “Wizards of Waverly Place” and has enjoyed success as a pop singer.

(Reporting By Alex Dobuzinskis; Editing by Greg McCune and Peter Cooney)

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Boehringer Ingelheim to start late-stage hepatitis C drug trial

BOSTON (Reuters) – Boehringer Ingelheim said on Saturday it plans to initiate a late-stage clinical trial of its experimental hepatitis C treatment following promising results from earlier studies.

The company announced final data from a mid-stage trial of its treatment regimen which showed that 69 percent of patients in the study were free of the virus 12 and 24 weeks following the end of treatment.

Hepatitis C is a blood-borne infectious disease of the liver that can lead to liver failure and transplant.

Historically, hepatitis C has been treated with pegylated interferon and ribavirin, but treatment lasts as long as 48 weeks and interferon is associated with flu-like side effects.

The goal of drugmakers now, including Boehringer, Vertex Pharmaceuticals Inc, Gilead Sciences Inc and Bristol-Myers Squibb Co is to develop products that do not need to be combined with interferon. Most analysts consider Gilead to currently be at the forefront of the race.

Full results from Boehringer’s trial, known as SOUND-C2, were presented at the annual meeting of the American Association for the Study of Liver Diseases in Boston. Preliminary data were presented earlier this year.

Boehringer’s trial tested a combination of BI-201335, a protease inhibitor, BI-207127, a polymerase inhibitor, and ribivirin.

Boehringer is a privately held company headquartered in Ingelheim, Germany.

(Reporting By Toni Clarke; Editing by Marguerita Choy)

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FBI probe of Petraeus began with 'suspicious emails'

WASHINGTON (Reuters) - The FBI investigation that led to the discovery of CIA Director David Petraeus' affair with author Paula Broadwell was sparked by "suspicious emails" that initially did not contain any connection to Petraeus, U.S. law enforcement and security officials told Reuters on Saturday.

But the CIA director's name unexpectedly turned up in the course of the investigation, two officials and two other sources briefed on the matter said.

It was "an issue with two women and they stumbled across the affair with Petraeus," a U.S. government security source said.

The Washington Post reported on Saturday that the FBI probe was triggered when Broadwell sent threatening emails to an unidentified woman close to the CIA director.

The woman went to the FBI, which traced the threats to Broadwell and then uncovered explicit emails between Petraeus and Broadwell, the Post said.

Attempts by Reuters and other news media to reach Broadwell, an Army reserve offer and author of a biography of Petraeus, have not been successful.

The FBI and CIA declined comment on Saturday.

Many questions in the case remain unanswered publicly, including the identity of the second woman; the precise nature of the emails that launched the FBI investigation; and whether U.S. security was compromised in any way.

Nor is it clear why the FBI waited until Election Day to tell U.S. Director of National Intelligence James Clapper, who oversees the CIA and other intelligence agencies, about its investigation involving Petraeus.

The CIA director announced his resignation suddenly on Friday, acknowledging an extramarital affair and saying he showed "extremely poor judgment.

The developments likely ended the public career of one of the United States' most highly regarded generals, who was credited with helping pull Iraq out of civil war and led U.S. and NATO troops in Afghanistan.

Meanwhile, new details emerged on Saturday about developments in the final days leading to Petraeus' departure from atop the CIA.

Clapper was notified by the FBI on Tuesday evening about 5 p.m. - just as returns in the U.S. presidential election were about to come in - about "the situation involving Director Petraeus," a senior intelligence official said. Clapper and Petraeus then spoke that evening and the following morning.

WHITE HOUSE NOTIFIED WEDNESDAY

"Director Clapper, as a friend and a colleague and a fellow general officer, advised Director Petraeus that he should do the right thing and he should step down," the official said.

Clapper is a retired Air Force lieutenant general; Petraeus served nearly four decades in the U.S. Army.

On Wednesday, Clapper notified the National Security Council at the White House that Petraeus was considering resigning and President Barack Obama should be informed, the official said.

U.S. law enforcement and intelligence officials agreed to discuss the Petraeus matter only on condition of anonymity because of the issue's sensitivity and because it is the subject of a law enforcement investigation.

Once Petraeus' name turned up in the investigation, the importance of the FBI inquiry was immediately escalated, as investigators became concerned the CIA chief somehow might have been compromised, the law enforcement official said.

However, the official and two sources briefed on the matter said no evidence has turned up suggesting Petraeus had become vulnerable to espionage or blackmail. At this point, it appears unlikely that anyone will be charged with a crime as a result of the investigation, the official said.

The FBI investigation began fairly recently - months ago rather than years ago, when Petraeus would still have been in uniform as one of the U.S. Army's top field commanders, the official said.

Representative Peter King, Republican chairman of the House of Representatives' Homeland Security Committee, said in an interview on MSNBC the FBI was "investigating or monitoring ... the director of the CIA for four or five months."

Several officials briefed on the matter said senior officials at the Pentagon, CIA and Congress knew nothing of the FBI's investigation of Petraeus until Thursday afternoon at the earliest, and some key officials were not briefed on the details until Friday.

There is no evidence at this time that anyone at the White House had knowledge of the situation involving Petraeus prior to the U.S. presidential election on Tuesday, which saw Obama elected to a second four-year term.

Another U.S. government security source said it was not until Friday afternoon that some members of the House and Senate intelligence oversight committees were notified about Petraeus' resignation by Clapper's office.

The congressional committees were told that it was a personal issue that Petraeus had to discuss with his wife. When pressed, a representative of the Office of the Director of National Intelligence said it involved another woman.

(Writing by Warren Strobel; Additional reporting by Doug Palmer and Matt Spetalnick; Editing by Todd Eastham)

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Syria opposition bloc elects Christian as leader

DOHA, Qatar (AP) — Syria‘s main opposition group in exile has elected a Christian Paris-based former geography teacher as its new president.

George Sabra said Friday that his election as head of the Syrian National Council is a sign that the opposition is not plagued by sectarian divisions.

Sabra says the SNC‘s main demand is to receive weapons from the international community. The U.S. and some other foreign backers of rebels fighting the regime of President Bashar Assad have so far refused to send weapons for fear they can fall into the wrong hands.

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Spotify to raise $100 million at $3 billion valuation – report

(Reuters) – Spotify is in the middle of a $ 100 million financing round that could value the music streaming company at just over $ 3 billion, the Wall Street Journal reported citing sources.

The Journal said Spotify would raise the fresh capital from multiple investors including Goldman Sachs. The WSJ report did not name any other investors.

Spotify has raised capital from outside investors several times since it set up shop in 2006, and was earlier reported to have been looking to secure a capital boost of about $ 200 million, at a valuation of about $ 4 billion.

Kleiner Perkins Caufield & Byers, Accel Partners and others have invested about $ 189 million in the company in its prior financing rounds.

The company has over 15 million active users and 4 million paying subscribers, for its on-demand service, which offers unlimited music streaming of some 18 million tracks.

(Reporting by Himank Sharma in Bangalore)

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Philip Roth says he’s done writing

NEW YORK (AP) — Exit, Philip Roth? Having conceived everything from turning into a breast to a polio epidemic in his native New Jersey, Roth has apparently given his imagination a rest.

The 79-year-old novelist recently told a French publication, Les inRocks, that his 2010 release “Nemesis” would be his last. Spokeswoman Lori Glazer of Houghton Mifflin Harcourt said Friday that she had spoken with Roth and that he confirmed his remarks. Roth’s literary agent, Andrew Wylie, declined comment.

Roth certainly produced, completing more than 20 novels over half a century and often turning out one a year. He won virtually every prize short of the Nobel and wrote such classics as “American Pastoral” and “Portnoy’s Complaint.”

His name will remain on new releases, if only because the Library of America has been issuing hardcover volumes of his work. Roth also is cooperating with award-winning biographer Blake Bailey on a book about his life.

The author chose an unexpected forum to break the news, but he has been hinting at his departure for years. He has said that he no longer reads fiction and seemed to say goodbye to his fictional alterego, Nathan Zuckerman, in the 2007 novel “Exit Ghost.”

Retirement is rarely the preferred option for writers, for whom the ability to tell stories or at least set down words is often synonymous with life itself. Poor health, discouragement and even madness are the more likely ways literary careers end. Roth apparently is fit and his recent novels had been received respectfully, if not with the awe of his most celebrated work.

“I don’t believe it,” Roth’s friend and fellow writer Cynthia Ozick said upon learning the news. “A writer who stops writing while still breathing has already declared herself posthumous.”

His parting words from “Nemesis”: “He seemed to us invincible.”

Roth’s interview appeared in French and has been translated, roughly, by The Associated Press. He tells Les inRocks that “Nemesis” was “mon dernier livre” (“My last book”) and refers to “Howard’s End” author E.M. Forster, and how he quit fiction in his 40s. Roth said he doesn’t plan to write a memoir, but will instead go through his archives and help ensure that Bailey’s biography comes out in his lifetime.

Explaining why he stopped, Roth said that at age 74 he became aware his time was limited and that he started re-reading his books of the past 20-30 years, in reverse order. He decided that he agreed with what the boxer Joe Louis had said late in life, that he had done the best he could with what he had.

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Getting A Handle On Malaria in the Americas

Malaria cases and deaths from the mosquito-borne disease have both declined substantially in the Americas, according to an update by the Pan American Health Organization (PAHO).

From 200 to 2011, cases dropped 59% and deaths declined 70%, PAHO reported Thursday  at its 6th Annual Malaria Day in the Americas Forum in Washingotn.

More than 541,000 confirmed malaria cases and 72 deaths from malaria were reported in 2011 in the region, PAHO says.

While the progress is impressive, it must continue, according to Dr. Socorro Gross, assistant director of PAHO.  ”We want to have zero cases and zero deaths,” she told those attending the forum.

RELATED: Fake Malaria Drugs Thwart Global Efforts to Treat Dangerous Diseases

Worldwide, malaria affects 250 million people each year, PAHO says. About 655,000 worldwide die of the disease annually.

The decline in the Americas (and elsewhere) is credited largely to the World Health Organization initiative known as T3.

The T3 initaitive includes testing, treating and tracking. Under it, officials in malaria-endemic countries are urged to move to universal access to both testing and treatment. They are encouraged to build stronger malaria surveillance systems.

Under T3, public health officials in countries with endemic malaria should test all suspected cases and treat confirmed cases with antimalarial drugs.

Each country is urged to have a surveillance system that will help them form policy and operations about malaria control.

At the forum, three countries were named this year’s Malaria Champions of the Americas: Brazil, Ecuador and Paraguay.

The countries were recognized for making significant strides against malaria.

Paraguay got the top honor. Its National Malaria Control Program was cited for reducing malaria burden by following the initiative.  As of 2011, the number of malaria cases reported there was down 99% compared to 2002. Paraguay last reported a malaria-related death in 1989.

The champions program was launched in 2008. It’s a joint effort of PAHO and WHO, the Pan American Health Education Foundation and the George Washington University Center for Global Health.

Despite the good news about declining cases and deaths in the Americas, officials at the forum repeatedly expressed the need for continued vigilance and control efforts.

In the Americas, more than 23 million people live in areas of malaria risk, says Dr. Don Tharpe, president of the Pan American Health Education Foundation.

It is easy to forget how malaria can ravage lives, he says. The elderly and infants are most vulnerable. The economic and educational fallout are both substantial.

Public health programs that include education, bed nets and other precautions as well as spraying can help reduce transmission, he says.

A parasite, Plasmodium, causes malaria, which is transmitted by the bites of mosquitoes infected by the parasite.

Malaria symptoms, which typically occur with in 10 to 15 days after the bite,  include headache, fever and vomiting.

RELATED: Cutting Rainforests Leads to More Malaria: Study

Untreated malaria can be life-threatening as it disrupts blood from getting to vital organs.

In many areas, the parasites have become resistant to many malaria medicines.

In the U.S., about 1,500 cases of malaria are diagnosed each year, according to the Centers for Disease Control and Prevention. Most of the cases area in  travelers returning from endemic areas.

The risk is greatest for travelers to sub-Saharan Africa, the CDC says. but the risk is present in any country with malaria.

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Kathleen Doheny is a Los Angeles journalist who writes about health. She doesn’t believe inmiracle cures, but continues to hope someone will discover a way for joggers to maintain their pace.

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