Man Wins Suit Over Sex Addiction












A French man who claimed a Parkinson’s drug turned him into a gambling and gay sex addict has been awarded 197,000 euros in damages, the French Press Agency reported.


Didier Jambart, 52, of Nantes, France, sued the pharmaceutical giant GlaxoSmithKline in 2011, claiming the drug, Requip, caused him to lose 82,000 euros gambling on the Internet. He said he also became addicted to gay sex and risky sexual encounters. He said he was raped after starting the drug in 2003 and attempted suicide eight times.












“It’s a great day,” Jambart, who was accompanied by his wife during the emotional ruling, told the French Press Agency. “It’s been a seven-year battle with our limited means for recognition of the fact that GSK lied to us and shattered our lives.”


Parkinson’s disease destroys neurons deep within the brain that release the “feel-good” neurotransmitter dopamine. Requip belongs to a class of drugs called dopamine agonists that relieve Parkinson’s symptoms — such as shaking, stiffness, slowness and trouble balancing — by activating dopamine receptors. But the drugs have side effects that, while rare, can be serious.


“There are plenty of reports of people developing side effects from Parkinson’s drugs, such as hypersexuality, gambling and excessive shopping,” Dr. David Standaert of the Center for Neurodegeneration and Experimental Therapeutics at the University of Alabama at Birmingham told ABC News when the lawsuit was filed. “It’s uncommon, but very dramatic when it happens.”


Up to 17 percent of people with Parkinson’s disease who take dopamine agonists exhibit an impulse control disorder, according to a 2010 study published in the Archives of Neurology.


“It can be devastating for those people,” said Dr. Mark Stacy, the Duke University neurologist who first linked the drugs to gambling in 2000. “And I think that because of the embarrassing nature of the complaint, it’s a bit amplified.”


Jambart is not the first Parkinson’s patient to sue a drug maker over these symptoms. In 2008, a court in Minneapolis awarded Gary Charbonneau $ 8.2 million in a suit against the makers of Mirapex, Pfizer and Boehringer Ingelheim. And in 2010, more than 100 patients in Australia sued Pfizer and Aspen Pharmacare — the makers of Cabaser and Permax respectively — over sex and gambling addictions.


“Dopamine is a reward signal,” Standaert said, adding that certain illicit drugs, such as cocaine and methamphetamine, act on dopamine receptors. Standaert said he has met patients who have gambled or shopped away hundreds of thousands of dollars. “In certain individuals who seem sensitive to this, these dopamine agonists really make them overcome their normal inhibitions… They lose their moral compass.”


Compulsive behaviors such as pathological gambling and hypersexuality are now listed as side effects on the drugs’ package inserts. But Jambart claimed this wasn’t the case when he starting taking Requip in 2003. By the time he stopped taking Requip in 2005, he had already been demoted at work and suffered psychological trauma because of his addictions, his lawyers told the French Press Agency.


In the United States, GSK added warnings about unusual behaviors to the Requip package insert in July 2005 and expanded them in 2006, company spokeswoman Mary Anne Rhyne told ABC News at the time the lawsuit was filed.


“We urge patients to talk to their doctor before deciding to stop or start taking any medicine,” she said. “Anyone receiving treatment with dopamine agonists who notices unusual behaviors, such as new or increased gambling urges, increased sexual urges or other intense urges should talk to their doctor.”


Standaert stressed that while the drug’s side effects are “colorful and serious,” they’re very rare.


“These are very useful medications,” he said. “People shouldn’t be frightened, they should just know about the risks.”


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U.N. recognizes Palestinian state, U.S. objects

UNITED NATIONS (Reuters) - The 193-nation U.N. General Assembly on Thursday overwhelmingly approved the de facto recognition of the sovereign state of Palestine after Palestinian President Mahmoud Abbas called on the world body to issue its long overdue "birth certificate."


The U.N. victory for the Palestinians was a diplomatic setback for the United States and Israel, which were joined by only a handful of countries in voting against the move to upgrade the Palestinian Authority's observer status at the United Nations to "non-member state" from "entity," like the Vatican.


Britain called on the United States to use its influence to help break the long impasse in Israeli-Palestinian peace talks. Washington also called for a revival of direct negotiations.


There were 138 votes in favor, nine against and 41 abstentions. Three countries did not take part in the vote, held on the 65th anniversary of the adoption of U.N. resolution 181 that partitioned Palestine into separate Jewish and Arab states.


Thousands of flag-waving Palestinians in the West Bank and the Gaza Strip set off fireworks and danced in the streets to celebrate the vote.


The assembly approved the upgrade despite threats by the United States and Israel to punish the Palestinians by withholding funds for the West Bank government. U.N. envoys said Israel might not retaliate harshly against the Palestinians over the vote as long as they do not seek to join the International Criminal Court.


If the Palestinians were to join the ICC, they could file complaints with the court accusing Israel of war crimes, crimes against humanity and other serious crimes.


U.S. Secretary of State Hillary Clinton called the vote "unfortunate and counterproductive," while the Vatican praised the move and called for an internationally guaranteed special status for Jerusalem, something bound to irritate Israel.


The much-anticipated vote came after Abbas denounced Israel from the U.N. podium for its "aggressive policies and the perpetration of war crimes," remarks that elicited a furious response from the Jewish state.


"Sixty-five years ago on this day, the United Nations General Assembly adopted resolution 181, which partitioned the land of historic Palestine into two states and became the birth certificate for Israel," Abbas told the assembly after receiving a standing ovation.


"The General Assembly is called upon today to issue a birth certificate of the reality of the State of Palestine," he said.


Israeli Prime Minister Benjamin Netanyahu responded quickly, condemning Abbas' critique of Israel as "hostile and poisonous," and full of "false propaganda.


"These are not the words of a man who wants peace," Netanyahu said in a statement released by his office. He reiterated Israeli calls for direct talks with the Palestinians, dismissing Thursday's resolution as "meaningless."


ICC THREAT


A number of Western delegations noted that Thursday's vote should not be interpreted as formal legal recognition of a Palestinian state. Formal recognition of statehood is something that is done bilaterally, not by the United Nations.


Granting Palestinians the title of "non-member observer state" falls short of full U.N. membership - something the Palestinians failed to achieve last year. But it does have important legal implications - it would allow them access to the ICC and other international bodies, should they choose to join.


Abbas did not mention the ICC in his speech. But Palestinian Foreign Minister Riyad al-Maliki told reporters after the vote that if Israel continued to build illegal settlements, the Palestinians might pursue the ICC route.


"As long as the Israelis are not committing atrocities, are not building settlements, are not violating international law, then we don't see any reason to go anywhere," he said.


"If the Israelis continue with such policy - aggression, settlements, assassinations, attacks, confiscations, building walls - violating international law, then we have no other remedy but really to knock those to other places," Maliki said.


In Washington, a group of four Republican and Democratic senators announced legislation that would close the Palestinian office in Washington unless the Palestinians enter "meaningful negotiations" with Israel, and eliminate all U.S. assistance to the Palestinian Authority if it turns to the ICC.


"I fear the Palestinian Authority will now be able to use the United Nations as a political club against Israel," said Republican Senator Lindsey Graham, one of the sponsors.


Abbas led the campaign to win support for the resolution, which followed an eight-day conflict this month between Israel and Islamists in the Gaza Strip, who are pledged to Israel's destruction and oppose a negotiated peace.


The vote highlighted how deeply divided Europe is on the Israeli-Palestinian conflict.


At least 17 European nations voted in favor of the Palestinian resolution, including Austria, France, Italy, Norway and Spain. Abbas had focused his lobbying efforts on Europe, which supplies much of the aid the Palestinian Authority relies on. Britain, Germany and many others chose to abstain.


The traditionally pro-Israel Czech Republic was unique in Europe, joining the United States, Israel, Canada, Panama and tiny Pacific Island states likes Nauru, Palau and Micronesia in voting against the move.


'HOPE SOME REASON WILL PREVAIL'


Peace talks have been stalled for two years, mainly over Israeli settlements in the West Bank, which have expanded despite being deemed illegal by most of the world. There are 4.3 million Palestinians in the West Bank and Gaza.


After the vote, U.S. Ambassador to the United Nations Susan Rice called for the immediate resumption of peace talks.


"The Palestinian people will wake up tomorrow and find that little about their lives has changed save that the prospects of a durable peace have only receded," she said.


She added that both parties should "avoid any further provocative actions in the region, in New York or elsewhere."


Palestinian Prime Minister Salam Fayyad said he hoped all sides would use the vote to push for new breakthroughs in the peace process.


"I hope there will be no punitive measures," Fayyad told Reuters in Washington, where he was attending a conference.


"I hope that some reason will prevail and the opportunity will be taken to take advantage of what happened today in favor of getting a political process moving," he said.


Britain's U.N. ambassador, Mark Lyall Grant, told reporters it was time for recently re-elected U.S. President Barack Obama to make a new push for peace.


"We believe the window for the two-state solution is closing," he said. "That is why we are encouraging the United States and other key international actors to grasp this opportunity and use the next 12 months as a way to really break through this impasse."


(Additional reporting by Andrew Quinn in Washington, Noah Browning in Ramallah, Jeffrey Heller in Jerusalem, Robert Mueller in Prague, Gabriela Baczynska and Reuters bureaux in Europe and elsewhere; Editing by Eric Beech and Peter Cooney)


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Rapper PSY wants Tom Cruise to go ‘Gangnam Style’












BANGKOK (AP) — The South Korean rapper behind YouTube’s most-viewed video ever has set what might be a “Mission: Impossible” for himself.


Asked which celebrity he would like to see go “Gangnam Style,” the singer PSY told The Associated Press: “Tom Cruise!”












Surrounded by screaming fans, he then chuckled at the idea of the American movie star doing his now famous horse-riding dance.


PSY’s comments Wednesday in Bangkok were his first public remarks since his viral smash video — with 838 million views — surpassed Justin Bieber‘s “Baby,” which until Saturday held the record with 803 million views.


“It’s amazing,” PSY told a news conference, saying he never set out to become an international star. “I made this video just for Korea, actually. And when I released this song — wow.”


The video has spawned hundreds of parodies and tribute videos and earned him a spotlight alongside a variety of superstars.


Earlier this month, Madonna invited PSY onstage and they danced to his song at one of her New York City concerts. MC Hammer introduced the Korean star at the American Music Awards as, “My Homeboy PSY!”


Even President Barack Obama is talking about him. Asked on Election Day if he could do the dance, Obama replied: “I think I can do that move,” but then concluded he might “do it privately for Michelle,” the first lady.


PSY was in Thailand to give a free concert Wednesday night organized as a tribute to the country’s revered King Bhumibol Adulyadej, who turns 85 next month. He paid respects to the king at a Bangkok shopping mall, signing his name in an autograph book placed beside a giant poster of the king. He then gave an outdoor press conference, as screaming fans nearby performed the pop star’s dance.


Determined not to be a one-hit wonder, PSY said he plans to release a worldwide album in March with dance moves that he thinks his international fans will like.


“I think I have plenty of dance moves left,” he said, in his trademark sunglasses and dark suit. “But I’m really concerned about the (next) music video.”


“How can I beat ‘Gangnam Style’?” he asked, smiling. “How can I beat 850 million views?”


___


Associated Press writer Thanyarat Doksone contributed to this report.


Asia News Headlines – Yahoo! News


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Adele’s “21″ sells 10 million, Rihanna leads Billboard












LOS ANGELES (Reuters) – British singer and Grammy darling Adele reached the 10 million sales mark in the United States on Wednesday with her heartbreak album “21″ becoming the first by British woman to reach the milestone, Nielsen SoundScan said.


“21,” released in February 2011, produced the hits “Someone Like You” and “Rolling In The Deep” and became the top-selling album of 2011. Earlier this year, Adele swept the Grammy Awards with six, including song, record and album of the year.












“21″ became the third album to cross 10 million in 2012, along with Linkin Park‘s “Hybrid Theory” and Usher’s “Confessions.” But it is the only album to reach the milestone in less than two years in the last decade, Nielsen said.


“What an incredible honor,” Adele said in a statement. “A huge, huge thank you to my American fans for embracing this record on such a massive level.”


“21″ will receive the diamond certification from the Recording Industry Association of America, marking its 10 million milestone, joining the ranks of albums by artists such as Michael Jackson, The Beatles and Madonna.


Adele‘s unique talent is a gift to music fans, and her success is certainly cause for a celebration of Diamond magnitude,” Cary Sherman, RIAA’s chairman & CEO, said in a statement.


Adele, 24, is enjoying the success of her latest single “Skyfall,” the official theme song for the James Bond film of the same name. It has sold more than 2 million copies worldwide. The singer also gave birth to her first child earlier this year.


On the Billboard 200 chart this week, R&B star Rihanna scored her first No. 1 album with “Unapologetic,” selling 238,000 copies.


She held off new entries from “American Idol” winner Phillip Phillips, who landed at No. 4 with his debut album “The World From the Side of the Moon,” and country-rock singer Kid Rock, who rounded out the top five with his latest album “Rebel Soul.”


(Reporting By Piya Sinha-Roy Editing by Jill Serjeant, Grant McCool and Andre Grenon)


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Cutting consultations led to more Medicare spending












NEW YORK (Reuters Health) – Medicare unintentionally spent more money on doctor’s-office visits in 2010, the year it introduced a simplified fee schedule, according to a new study.


Researchers found that the U.S. government-run insurance for the elderly paid an average of $ 40 more per beneficiary after it stopped paying for consultations with specialists and increased its payments for regular doctors’ visits – even though the goal had been to break even while streamlining fee categories.












“It’s important to emphasize the increase is – as far as we know right now – just a onetime change… We don’t know if this change will last or if the growth rate will go back to what it was,” said the study’s lead author Zirui Song of Harvard Medical School in Boston.


Before the change, Medicare paid doctors about $ 125 for a consultation of “medium complexity,” about $ 92 for a standard first-time office visit and about $ 61 for seeing a regular patient.


Specialists, such as surgeons and obstetrician-gynecologists, typically billed for the more expensive consultations and family doctors, known as primary care physicians, billed for the cheaper office visits.


The income gap between specialists and family doctors is often cited as one reason that medical students choose not to go into primary care, which many fear will cause a doctor shortage within the next decade.


One study from 2010 found that family doctors earn as little as half what their colleagues who specialize in areas such as surgery and oncology take home. (see Reuters Health story of October 25, 2010 here: http://reut.rs/O2mVG9)


By making both family doctors and specialists charge for office visits rather than consultations, the Centers for Medicare and Medicaid Services (CMS) may have leveled the playing field somewhat, but the agency intended the policy change to be “neutral” in cost terms.


To see if that was the result, Song and his collaborators, who include a chairman of the Medicare Payment Advisory Commission, analyzed 2.2 million Medicare patients’ claims made from 2007 through 2010.


The study used a Thomson Reuters database and one of the co-authors is a Thomson Reuters employee.


The researchers, who published their findings in the Archives of Internal Medicine, found that Medicare paid about $ 628 annually per patient from 2007 through 2009.


After the change in 2010, the program paid about $ 668 per patient – a 6.5 percent jump.


Most of the increase can be explained by Medicare’s higher payments for office visits, they conclude, but not all of it. Doctors also started charging Medicare for more “complex” office visits.


The characterization of a patient visit is somewhat subjective, the authors explain in their report. A simple visit might involve a 10-minute exam and “straightforward” attention to a specific problem, whereas a “high-complexity” visit might last 60 minutes, entailing exhaustive history taking, examination and “decision-making.”


“You might say just from a third-party perspective, simply changing the fee schedule should not have an effect on how sick a patient is… but physicians were coding at a higher level,” Song told Reuters Health.


As for specialists being paid more than family doctors, the researchers found the change did help to narrow the payment gap.


Of the 6.5 percent extra Medicare expenditure in 2010, about $ 6 of every $ 10 went to family doctors and the rest to specialists.


“It was a noble effort on the CMS’ part to try and change incentives to improve the payment disparity between primary care physicians and specialists,” said Dr. Patrick O’Malley, an internist at the Uniformed Services University of the Health Sciences in Bethesda, Maryland.


But O’Malley told Reuters Health that “meddling” with fees will not solve the broader problems facing primary care, including high expectations for family doctors, increasingly complex patients and the worsening doctor shortage.


In an editorial accompanying the study, O’Malley says that doctors across specialties and organizations need to help fix these problems.


“It’s not only up to primary care providers alone to fix the primary care problem; it’s up to every physician to be responsible for helping to fix it,” he writes.


“I think it’s going to be a process of incremental change. I’m hoping the Affordable Care Act will move us in the right direction, but I think we will also hit rock bottom, where we’ll see ourselves in a desperate state,” O’Malley said.


SOURCE: http://bit.ly/11cDCDk and http://bit.ly/Se1HFR Archives of Internal Medicine, online November 26, 2012.


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No more government contracts for BP

WASHINGTON (Reuters) - The U.S. government banned BP Plc on Wednesday from new federal contracts over its "lack of business integrity" in the 2010 Deepwater Horizon oil spill, possibly imperiling the company's role as a top U.S. offshore oil and gas producer and the No. 1 military fuel supplier.


The suspension, announced by the Environmental Protection Agency, comes on the heels of BP's November 15 agreement with the U.S. government to plead guilty to criminal misconduct in the Gulf of Mexico disaster, the worst offshore oil spill in U.S. history. The British energy giant agreed to pay $4.5 billion in penalties, including a record $1.256 billion criminal fine.


BP and its affiliates are barred from new federal contracts until they demonstrate they can meet federal business standards, the EPA said. The suspension is "standard practice" and BP's existing U.S. government contracts are not affected, it said.


The EPA acted hours before a government auction of offshore tracts in the Gulf of Mexico, a region where BP is the largest investor and lease-holder of deep-water tracts and hopes for further growth. BP is also the top fuel supplier to the U.S. military, the largest single buyer of oil in the world.


Suspension of contracts could give the government leverage to pressure BP to settle federal and state civil litigation that could top $20 billion if a court finds BP was grossly negligent in the Deepwater Horizon disaster.


An EPA official said government-wide suspensions generally do not exceed 18 months, but can continue longer if there are ongoing legal cases.


In a statement, BP said it has been in "regular dialogue" with the EPA, and that the agency has informed BP that it is preparing an agreement that "would effectively resolve and lift this temporary suspension." The EPA has notified BP that the draft agreement will be available soon, BP said.


U.S. operations accounted for more than 30 percent of BP's pre-tax profits in the third quarter, and the United States accounts for about a fifth of BP's global oil production.


The U.S. military has been a reliable customer of BP's jet fuel and other refined products. As recently as September, BP affiliates won two military fuel contracts worth as much as $1.37 billion, according to a website that tracks U.S. military contracts.


The EPA's action is a sign that all federal contractors will be held to high standards, said Scott Amey, general counsel for the Project on Government Oversight, a private watchdog group.


"BP had years to improve its business ethics and is paying the price for its inaction," Amey said.


On November 15, BP Finance Director Brian Gilvary told investors on a conference call that any blanket ban could force the company to rethink its entire U.S. business.


The Justice Department says it intends to prove in a court case set to get underway in February 2013 that BP was grossly negligent under the Clean Water Act, a claim the company has adamantly denied.


"The critical question is whether this a shot across BP's bows to get settlement, or a more sustained stance, in which case the importance of the context is underlined" by Gilvary's comments, said Peter Hutton, an analyst with RBC Capital Markets.


The EPA's suspension will not impair BP's ability to produce oil and gas from existing U.S. assets, said Pavel Molchanov, an analyst with Raymond James & Associates Inc in Houston.


"BP's supply contract of fuels to the Pentagon might be at risk, but of course BP could supply other customers if this supply contract is not renewed," Molchanov said in a research note.


BP and the U.S. government likely worked out a deal on the timing of the suspension before BP agreed to sign off on the November 15 criminal plea deal, said Samuel Buell, a Duke University Law School professor and former federal prosecutor.


"It's just inconceivable to me that BP's lawyers ... would have entered into that agreement last week without the issue of a suspension or debarment having been addressed," Buell said.


BP did not participate in Wednesday's federal auction of 20 million acres (8 million hectares) of drilling tracts in the Gulf of Mexico, one of BP's biggest oil production regions globally.


One long-time critic of BP applauded the decision.


"After pleading guilty to such reckless behavior that killed men and constituted a crime against the environment, suspending BP's access to contracts with our government is the right thing to do," U.S. Rep. Edward Markey, a Democrat from Massachusetts, said in a statement.


BP's U.S.-traded shares closed flat, while London-traded shares were down less than 1 percent at 427 pence.


(Additional reporting by Andrew Callus in London, Ayesha Rascoe in Washington, Joshua Schneyer in New York and Kristen Hays in Houston; Writing by Chris Baltimore; Editing by John Wallace, Grant McCool, Andrew Hay and Marguerita Choy)


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Rugby-England add flyhalf Burns to squad for All Blacks’ test












LONDON, Nov 27 (Reuters) – England called up uncapped Gloucester flyhalf Freddie Burns on Tuesday to their squad for Saturday’s test against New Zealand in place of the injured Toby Flood.


Flood sustained ligament damage to a big toe during the 16-15 loss to South Africa at Twickenham last Saturday.












Owen Farrell, whose last start was in the first test in South Africa this year, is set to replace Flood in the starting XV against the world champions.


Lock Courtney Lawes, who missed England’s first three tests of the November series because of a knee injury, has also been included in the 23-man squad. Two other locks, Mouritz Botha and Tom Palmer, have been omitted.


After beating Fiji in their opening match, England have lost to Australia and the Springboks and now face a daunting match against the All Blacks who are unbeaten in 20 tests since the start of their victorious World Cup campaign last year.


“For those in Saturday’s squad the message is clear – last week we went toe to toe with the second best team in the world and felt we should have won,” England head coach Stuart Lancaster said in a statement.


“Now we have a chance to take on the number one side in front of a passionate Twickenham crowd, who have been fantastic throughout the Internationals, and it is a challenge we will meet head on.” (Reporting by John Mehaffey; Editing by Ken Ferris)


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Ex-Elmo puppeteer faces new sex-with-minor allegation












NEW YORK (Reuters) – The puppeteer formerly behind the “Sesame Street” character Elmo faces a new accusation of having sex with an underage boy, a week after a similar allegation prompted him to resign from the iconic public television children’s program.


In a lawsuit filed Tuesday in U.S. District Court in Manhattan, a man identified only as John alleges Kevin Clash engaged in oral sex and other sex acts with him when John was 16 years old. The suit seeks at least $ 75,000 in damages.












The suit alleges the incident occurred in either 2000 or 2001 when John, who is from Florida, visited New York for modeling opportunities. John came to know Clash, then 40, through a telephone chat line for gays on which Clash claimed to be a 30-year-old named Craig, according to the suit.


John returned to New York when he turned 18, and he and Clash renewed the relationship, the lawsuit said.


“Mr. Clash believes the lawsuit has no merit,” Clash’s publicist, Risa B. Heller, said in an emailed statement.


It is the latest charge levied against Clash, now 52, who resigned on November 20 from Sesame Workshop, the company behind “Sesame Street,” after nearly 30 years on the show.


His resignation came the same day Cecil Singleton filed a claim seeking more than $ 5 million in damages from Clash. Singleton claims he met the then-32-year-old puppeteer in 1993 in a gay chat room when he was 15.


It added that on numerous occasions over a period of years Clash engaged in sexual activity with Singleton.


The newest allegation comes about two weeks after another man recanted his claims that Clash had sex with him when he was 16 years old. The man later said the relationship was consensual.


Clash had denied the allegations and acknowledged a past relationship with his first accuser. He added the pair were both consenting adults at the time.


The Elmo character debuted on “Sesame Street” in 1979, 10 years after the show premiered and introduced the now-iconic characters Big Bird, Bert and Ernie, Oscar the Grouch and Cookie Monster, among others, to American children.


While Clash was the third performer to animate the child-like shaggy red monster, Sesame Workshop credits him with turning Elmo into the international sensation he became.


(Reporting by Dan Burns; Editing by Paul Thomasch and Cynthia Osterman)


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Flu Symptoms Drove Boston Mayor to Hospital












When Boston Mayor Thomas Menino ended his vacation in Italy short this fall and checked into a Boston hospital complaining of a respiratory infection, it led doctors to find and treat a blood clot in his leg, a fracture in his back, an infection around the fracture and type 2 diabetes.


Cold and flu symptoms from respiratory infections can be a hassle, but sometimes that fever and cough can be good for just getting people to the doctor.












“That’s why every patient needs a careful evaluation because every once in a while, what the patient thinks is the flu or reports as the flu is not,” said Dr. William Schaffner, chairman of preventative medicine at Vanderbilt University in Tennessee. “I would say 99 percent of people who present to the emergency room and doctor’s office with symptoms of influenza – that is cough, fever and the like – are certainly going to have influenza.”


Click here to read about cold- and flu-fighters.


Menino, 69, arrived at Brigham and Women’s Hospital on Oct. 25, complaining of fatigue and a cough, and doctors described him as “extremely washed out” with some “malaise.” In addition to the respiratory infection, doctors found a blood clot that traveled from Menino’s leg to his lungs.


Respiratory illnesses, like the one that initially drove Menino to seek medical attention, can often range from mild to severe, Schaffner said.


“He was feeling poorly enough to end what was supposed to be a very pleasant vacation, and when he got here, he was very weak and very washed out,” Dr. Dale Adler, Menino’s doctor, said during a press conference in mid-November.


Doctors can usually tell whether flu-like symptoms are the result of a respiratory infection or something else soon after the patient is admitted. If not, they can perform a series of tests to find out.


Click here to read about flu fact and fiction.


(The flu can lead to other ailments, the most common of which is pneumonia, or an infection of the lungs, Schaffner said.


About 1.1 million pneumonia patients were hospitalized and discharged in 2009, according to the latest data from the Centers for Disease Control and Prevention. On average, they stayed in the hospital 5.2 days.)


Weeks later, Menino was still in the hospital. Although his illness and clot had been resolved, he was complaining of back pain, which doctors discovered was the result of a compression fracture and an infection around the fracture.


Finally, doctors discovered that Menino had underlying type 2 diabetes, which may have contributed to the infection, Menino’s doctor said during a press conference on Monday.


It’s not clear how Menino’s initial flu-like symptoms tied into his other ailments, but doctors said they are positive about his prognosis. The mayor relocated to a rehabilitation center on Monday.


“It is a run of bad luck,” Morris said of Menino. “He will rebound from this.”


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Protesters pack Tahrir Square, dispute Morsi

CAIRO (AP) — The same chants used against Hosni Mubarak were turned against his successor Tuesday as more than 200,000 people packed Egypt's Tahrir Square in the biggest challenge yet to Islamist President Mohammed Morsi.


The massive, flag-waving throng protesting Morsi's assertion of near-absolute powers rivaled some of the largest crowds that helped drive Mubarak from office last year.


"The people want to bring down the regime!" and "erhal, erhal" — Arabic for "leave, leave" — rang out across the plaza, this time directed at Egypt's first freely elected president.


The protests were sparked by edicts Morsi issued last week that effectively neutralize the judiciary, the last branch of government he does not control. But they turned into a broader outpouring of anger against Morsi and his Muslim Brotherhood, which opponents say have used election victories to monopolize power, squeeze out rivals and dictate a new, Islamist constitution, while doing little to solve Egypt's mounting economic and security woes.


Clashes broke out in several cities, with Morsi's opponents attacking Brotherhood offices, setting fire to at least one. Protesters and Brotherhood members pelted each other with stones and firebombs in the Nile Delta city of Mahalla el-Kobra, leaving at least 100 people injured.


"Power has exposed the Brotherhood. We discovered their true face," said Laila Salah, a housewife at the Tahrir protest who said she voted for Morsi in last summer's presidential election. After Mubarak, she said, Egyptians would no longer accept being ruled by an autocrat.


"It's like a wife whose husband was beating her and then she divorces him and becomes free," she said. "If she remarries she'll never accept another day of abuse."


Gehad el-Haddad, a senior adviser to the Brotherhood and its political party, said Morsi would not back down on his edicts. "We are not rescinding the declaration," he told The Associated Press.


That sets the stage for a drawn-out battle that could throw the nation into greater turmoil. Protest organizers have called for another mass rally Friday. If the Brotherhood responds with demonstrations of its own, as some of its leaders have hinted, it would raise the prospect of greater violence after a series of clashes between the two camps in recent days.


A tweet by the Brotherhood warned that if the opposition was able to bring out 200,000 to 300,000, "they should brace for millions in support" of Morsi.


Another flashpoint could come Sunday, when the constitutional court is to rule on whether to dissolve the assembly writing the new constitution, which is dominated by the Brotherhood and its Islamist allies. Morsi's edicts ban the courts from disbanding the panel; if the court defies him and rules anyway, it would be a direct challenge that could spill over into the streets.


"Then we are in the face of the challenge between the supreme court and the presidency," said Nasser Amin, head of the Arab Center for the Independence of the Judiciary and the Legal Profession. "We are about to enter a serious conflict" on both the legal and street level, he said.


Morsi and his supporters say the decrees were necessary to prevent the judiciary from blocking the "revolution's goals" of a transition to democracy. The courts — where many Mubarak-era judges still hold powerful posts — have already disbanded the first post-Mubarak elected parliament, which was led by the Brotherhood. Now it could also take aim at the Islamist-led upper house of parliament.


Morsi's decrees ban the judiciary from doing so and grant his decisions immunity from judicial review. Morsi also gave himself sweeping powers to prevent threats to the revolution, stability or state institutions, which critics say are tantamount to emergency laws. These powers are to remain in effect until the constitution is approved and parliamentary elections are held, not likely before spring 2013.


Opponents say the decrees turn Morsi — who narrowly won last summer's election with just over 50 percent of the vote — into a new dictator, given that he holds not only executive but also legislative powers, after the lower house of parliament was dissolved.


Tuesday's turnout was an unprecedented show of strength by the mainly liberal and secular opposition, which has been divided and uncertain amid the rise to power of the Brotherhood over the past year. The crowds were of all stripes, including many first-time protesters.


"Suddenly Morsi is issuing laws and becoming the absolute ruler, holding all powers in his hands," said Mona Sadek, a 31-year-old engineering graduate who wears the Islamic veil, a hallmark of piety. "Our revolt against the decrees became a protest against the Brotherhood as well."


"The Brotherhood hijacked the revolution," agreed Raafat Magdi, an engineer who was among a crowd of some 10,000 marching from the Cairo district of Shubra to Tahrir to the beat of drums and chants against the Brotherhood. Reform leader Mohammed ElBaradei led the march.


"People woke up to (Morsi's) mistakes, and in any new elections they will get no votes," Magdi said.


Many in the crowd said they were determined to push ahead with the protests until Morsi retreats. A major concern was that Islamists would use the decree's protection of the constitutional assembly to drive through their vision for the next charter, with a heavy emphasis on implementing Shariah, or Islamic law. The assembly has been plagued with controversy, and more than two dozen of its 100 members have quit in recent days to protest Islamist control.


"Next Friday will be decisive," protester Islam Bayoumi said of the upcoming rally. "If people maintain the same pressure and come in large numbers, they could manage to press the president and rescue the constitution."


A fellow protester, Saad Salem Nada, said of Morsi: "I am a Muslim and he made me hate Muslims because of the dictatorship in the name of religion. In the past, we had one Mubarak. Now we have hundreds."


Even as the crowds swelled in Tahrir, clashes erupted nearby between several hundred protesters throwing stones and police firing tear gas on a street leading to the U.S. Embassy. Clouds of tear gas hung over the area, where clashes have broken out for several days, fueled by anger over police abuses.


A photographer working for the AP, Ahmed Gomaa, was beaten by stick-wielding police while covering the clashes. Police took his equipment and Gomaa was taken to a hospital for treatment.


Rival rallies by Morsi opponents and supporters turned into brief clashes in the Mediterranean city of Alexandria, where anti-Morsi protesters broke into the local office of the Muslim Brotherhood, throwing furniture out the windows and trying unsuccessfully to set fire to it. Protesters also set fire to Brotherhood offices in the city of Mansoura.


Morsi's supporters canceled a massive rally planned for Tuesday in Cairo, citing the need to "defuse tension." Morsi's supporters say more than a dozen of their offices have been ransacked or set ablaze since Friday. Some 5,000 demonstrated in the southern city of Assiut in support of Morsi's decrees, according to witnesses there.


So far, there has been little sign of a compromise. On Monday, Morsi met with the nation's top judges and tried to win their acceptance of his decrees. But the move was dismissed by many in the opposition and the judiciary as providing no real concessions.


Saad Emara, a senior Muslim Brotherhood member, said Morsi will not make any concessions, especially after the surge of violence and assaults on Brotherhood offices.


Emara accused the opposition "of resorting to violence with a political cover," claiming that former ruling party and Mubarak-era businessmen were hiring thugs to attack Brotherhood offices with the opposition's blessing.


"The story now is that the civilian forces are playing with fire. This is a dangerous scene."


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Associated Press writer Hamza Hendawi in Cairo contributed to this report.

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