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Quebec hospital may remove child’s breathing tube despite parents’ objection: court

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MONTREAL — A Montreal children’s hospital can permanently remove a breathing tube from a child who has been in a coma since June, despite his parents’ objections, a Quebec Superior Court judge has ruled.

The Sainte-Justine hospital went to court after the five-year-old boy’s parents refused to consent to the procedure unless the hospital planned to restore the tube if things went wrong.

The hospital argued that the child, identified only as “X” in the ruling, can breathe on his own and that the breathing tube is now causing more harm than good.

Justice Bernard Jolin wrote in his ruling Tuesday that the parents’ objections to the procedure are not in the child’s best interest and are based on their hope that God will miraculously bring him back to the state he was in before he fell into a swimming pool.

“It is true that extubating carries a risk of death for X, but in light of the evidence, this risk arises much more from his condition than the extubating itself,” Jolin wrote.

The child has been in a coma since June 12 after he was found at the bottom of the family pool. He had been in the water for between 15 and 20 minutes.

He has been on a breathing tube since his admission to hospital, but doctors have recommended since June 16 that it be removed because “it is likely to cause serious, even fatal damage,” the judge wrote.

The hospital argued that removing the tube could allow the child to return home and to receive physical therapy, but that delaying the removal will limit the chances of that happening.

Jolin found that the parents’ opposition to the procedure is based on their religious faith and a lack of trust in the medical team — including the belief that the hospital wants to take him off the tube to save money.

The parents also believe they have seen an improvement in the child and that the mother believes he is “very aware of his surroundings,” which the judge said “deviates from a proper perspective of reality.”

“Some will appreciate the parents’ unconditional love for their child and their relentless fight to keep him alive. Despite all the empathy it may feel, the court concludes that the parents’ refusal to consent to the plan is not justified and is contrary to X’s best interest,” he wrote.

Evidence presented in court showed that the time the child spent under the water caused serious and irreversible brain damage.

The hospital said Thursday it will wait until the parents decide whether to appeal the decision before removing the tube. Patrick Martin-Ménard, a lawyer for the parents, said they are studying the decision and have not yet decided on an appeal.

“It’s been very difficult to go all the way to the court, for a court decision about their child, when they would have been open to alternatives earlier on had there been a proper discussion and collaboration,” he said in an interview Thursday. “But what we have seen, unfortunately, for a very long period of time, has been an attempt to impose a decision on the parents by Sainte-Justine.”

He said the consequences of removing the tube remain unclear and that those consequences could require reintubation, which is not allowed under the court order.

This report by The Canadian Press was first published Nov. 3, 2022.

 

Jacob Serebrin, The Canadian Press

Health

Whooping cough is at a decade-high level in US

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MILWAUKEE (AP) — Whooping cough is at its highest level in a decade for this time of year, U.S. health officials reported Thursday.

There have been 18,506 cases of whooping cough reported so far, the Centers for Disease Control and Prevention said. That’s the most at this point in the year since 2014, when cases topped 21,800.

The increase is not unexpected — whooping cough peaks every three to five years, health experts said. And the numbers indicate a return to levels before the coronavirus pandemic, when whooping cough and other contagious illnesses plummeted.

Still, the tally has some state health officials concerned, including those in Wisconsin, where there have been about 1,000 cases so far this year, compared to a total of 51 last year.

Nationwide, CDC has reported that kindergarten vaccination rates dipped last year and vaccine exemptions are at an all-time high. Thursday, it released state figures, showing that about 86% of kindergartners in Wisconsin got the whooping cough vaccine, compared to more than 92% nationally.

Whooping cough, also called pertussis, usually starts out like a cold, with a runny nose and other common symptoms, before turning into a prolonged cough. It is treated with antibiotics. Whooping cough used to be very common until a vaccine was introduced in the 1950s, which is now part of routine childhood vaccinations. It is in a shot along with tetanus and diphtheria vaccines. The combo shot is recommended for adults every 10 years.

“They used to call it the 100-day cough because it literally lasts for 100 days,” said Joyce Knestrick, a family nurse practitioner in Wheeling, West Virginia.

Whooping cough is usually seen mostly in infants and young children, who can develop serious complications. That’s why the vaccine is recommended during pregnancy, to pass along protection to the newborn, and for those who spend a lot of time with infants.

But public health workers say outbreaks this year are hitting older kids and teens. In Pennsylvania, most outbreaks have been in middle school, high school and college settings, an official said. Nearly all the cases in Douglas County, Nebraska, are schoolkids and teens, said Justin Frederick, deputy director of the health department.

That includes his own teenage daughter.

“It’s a horrible disease. She still wakes up — after being treated with her antibiotics — in a panic because she’s coughing so much she can’t breathe,” he said.

It’s important to get tested and treated with antibiotics early, said Dr. Kris Bryant, who specializes in pediatric infectious diseases at Norton Children’s in Louisville, Kentucky. People exposed to the bacteria can also take antibiotics to stop the spread.

“Pertussis is worth preventing,” Bryant said. “The good news is that we have safe and effective vaccines.”

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AP data journalist Kasturi Pananjady contributed to this report.

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The Associated Press Health and Science Department receives support from the Robert Wood Johnson Foundation. The AP is solely responsible for all content.

The Canadian Press. All rights reserved.

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Scientists show how sperm and egg come together like a key in a lock

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How a sperm and egg fuse together has long been a mystery.

New research by scientists in Austria provides tantalizing clues, showing fertilization works like a lock and key across the animal kingdom, from fish to people.

“We discovered this mechanism that’s really fundamental across all vertebrates as far as we can tell,” said co-author Andrea Pauli at the Research Institute of Molecular Pathology in Vienna.

The team found that three proteins on the sperm join to form a sort of key that unlocks the egg, allowing the sperm to attach. Their findings, drawn from studies in zebrafish, mice, and human cells, show how this process has persisted over millions of years of evolution. Results were published Thursday in the journal Cell.

Scientists had previously known about two proteins, one on the surface of the sperm and another on the egg’s membrane. Working with international collaborators, Pauli’s lab used Google DeepMind’s artificial intelligence tool AlphaFold — whose developers were awarded a Nobel Prize earlier this month — to help them identify a new protein that allows the first molecular connection between sperm and egg. They also demonstrated how it functions in living things.

It wasn’t previously known how the proteins “worked together as a team in order to allow sperm and egg to recognize each other,” Pauli said.

Scientists still don’t know how the sperm actually gets inside the egg after it attaches and hope to delve into that next.

Eventually, Pauli said, such work could help other scientists understand infertility better or develop new birth control methods.

The work provides targets for the development of male contraceptives in particular, said David Greenstein, a genetics and cell biology expert at the University of Minnesota who was not involved in the study.

The latest study “also underscores the importance of this year’s Nobel Prize in chemistry,” he said in an email.

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The Associated Press Health and Science Department receives support from the Howard Hughes Medical Institute’s Science and Educational Media Group. The AP is solely responsible for all content.

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