Software engineer gets first successful intestinal transplant

NEW DELHI: Himanshu's long wait for food has finally come true after more than two years' wait that involved being hospitalized 11 times, undergoing six surgeries and suffering from serious infections thrice.

Himanshu, a 30-year-old software engineer who has had better luck than the 23-year-old Delhi gang-rape victim Nirbhaya, has become India's first recipient of a successful intestinal transplant.

Had Nirbhaya lived long, she too would have ultimately needed one.

Back in 2009, Himanshu had complained of severe stomach ache. An emergency laparotomy was conducted and doctors found that he was suffering from thrombosis (blockage) of the main vein of his intestine (superior mesenteric vein) which resulted in loss of blood supply to most of his intestine.

Subsequently, 95% of his small intestine (usually six metres long) had to be removed, leaving him with just 28 cm of it. This saved his life, but also meant that he would never be able to eat solid food orally.

The small intestine is where 90% of the digestion and food absorption occurs. Chemical digestion with enzymes and bile acids take place here which breaks down food into a form that can be absorbed and then sent to various tissues of the body. Once broken down, the nutrients are absorbed by small intestines' inner walls into the blood stream.

Doctors at Gurgaon's Medanta Medicity evaluated and counseled Himanshu for an intestinal transplant and put him on the waiting list.

Himanshu waited for two years before he got lucky with a matched organ. On November 24, 2012, doctors found a perfect match.

A 20-year-old patient who had passed away had the same blood group and was fit to donate.

Dr A S Soin, who headed the team of 30 doctors from Medanta which conducted the surgery, said, "During the surgery, we removed most of Himanshu's remaining small intestine and a part of the large intestine to make space for the new intestine. This was necessary as his abdominal cavity had shrunk due to the missing bowel over the past three years. The new small intestine was transplanted, joining the blood vessels to the recipient's and the ends of the new intestine to the existing proximal and distal bowel."

"I had to re-learn how to eat normally and understand the signals of satiety. Even the 'khichdi' given to me tasted divine," said Himanshu. He said that is now off TPN for the past 10 days, and can eat normally.

According to the doctors, joining the vessels was the first challenge as both the artery and the main vein of the intestine were clotted.

"This necessitated grafting of extra conduits to the aorta and the portal vein to construct new source of blood supply for the transplanted intestine. The joining of the blood vessels is always difficult in such cases due to the curled up nature of bowel which makes it likely for the vessel joints to twist, which can destroy the transplanted bowel rapidly. We kept the last 20 cm portion of the new intestine diverted to open on the abdominal wall to enable repeated endoscopy and biopsy of the intestine for possible rejection," said Soin.

Two weeks after the surgery, Himanshu was given food through a tube into his small intestine after which oral feeding was resumed.

According to Dr R Mohanka the main challenge after the surgery was the post-operative management since intestinal transplants reject easily, much more than any other organ.

This necessitated large doses of immune suppressant medication - approximately three times than used in liver transplants.

"This makes the chances of developing infection very high. Hence, a totally sterile, a zero-infection zone was provided for Himanshu's care. Another problem with such patients is the difficulty of differentiating rejection and infection since both produce the same symptoms. The differentiation is vital as the treatment of both conditions are different. A peculiar problem with intestinal transplants is that as soon as there is any inflammation, rejection or infection of the bowel, its wall becomes permeable to the bacteria that normally reside within the bowel, and these escape out into the abdominal cavity and blood-stream causing life-threatening systemic infection," he said.

Dr Randhir Sud added that they monitored the transplanted intestine for rejection by a special technique called magnification endoscopy which was conducted 14 times along with biopsies during his hospital stay.

"While the risk of rejection is lower now than in the first six weeks, it can develop later too. This means that this monitoring must continue for at least six months," he added.

According to Dr Soin, the most common causes of intestinal failure in adults are short bowel syndrome that results from extensive bowel removal due to blood clots in major veins or arteries of intestine, major abdominal trauma or, inflammatory bowel diseases like Crohn's disease.

Many people with short bowel syndrome, like Himanshu, are dependent on TPN to supply their daily nutrition. Administered in the hospital or at home, intravenous nutrition usually requires a central venous catheter, which can lead to chronic/repeated infections.

Over time, the intravenous nutrition solution also carries risk of venous thrombosis and liver toxicity and jaundice.

If any of these complications occur, an intestinal transplant is considered, explained Soin. "My son had been on TPN for almost two years. It cost us close to Rs 40,000 to 50,000 per month. The transplant, through costly, has given us some hope for a better future," said J P Singh, the patient's father. Himanshu said he was feeling much better post-surgery, and could digest khichdi.

According to Dr Naresh Trehan, chairman of Medanta, about 2,000-2,500 people suffer intestinal failure annually in India, who need permanent TPN or intestinal transplant.

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FDA proposes sweeping new food safety rules

WASHINGTON (AP) — The Food and Drug Administration on Friday proposed the most sweeping food safety rules in decades, requiring farmers and food companies to be more vigilant in the wake of deadly outbreaks in peanuts, cantaloupe and leafy greens.

The long-overdue regulations are aimed at reducing the estimated 3,000 deaths a year from foodborne illness. Just since last summer, outbreaks of listeria in cheese and salmonella in peanut butter, mangoes and cantaloupe have been linked to more than 400 illnesses and as many as seven deaths, according to the Centers for Disease Control. The actual number of those sickened is likely much higher.

The FDA's proposed rules would require farmers to take new precautions against contamination, to include making sure workers' hands are washed, irrigation water is clean, and that animals stay out of fields. Food manufacturers will have to submit food safety plans to the government to show they are keeping their operations clean.

Many responsible food companies and farmers are already following the steps that the FDA would now require them to take. But officials say the requirements could have saved lives and prevented illnesses in several of the large-scale outbreaks that have hit the country in recent years.

In a 2011 outbreak of listeria in cantaloupe that claimed 33 lives, for example, FDA inspectors found pools of dirty water on the floor and old, dirty processing equipment at Jensen Farms in Colorado where the cantaloupes were grown. In a peanut butter outbreak this year linked to 42 salmonella illnesses, inspectors found samples of salmonella throughout Sunland Inc.'s peanut processing plant in New Mexico and multiple obvious safety problems, such as birds flying over uncovered trailers of peanuts and employees not washing their hands.

Under the new rules, companies would have to lay out plans for preventing those sorts of problems, monitor their own progress on those safety efforts and explain to the FDA how they would correct them.

"The rules go very directly to preventing the types of outbreaks we have seen," said Michael Taylor, FDA's deputy commissioner for foods.

The FDA estimates the new rules could prevent almost 2 million illnesses annually, but it could be several years before the rules are actually preventing outbreaks. Taylor said it could take the agency another year to craft the rules after a four-month comment period, and farms would have at least two years to comply — meaning the farm rules are at least three years away from taking effect. Smaller farms would have even longer to comply.

The new rules, which come exactly two years to the day President Barack Obama's signed food safety legislation passed by Congress, were already delayed. The 2011 law required the agency to propose a first installment of the rules a year ago, but the Obama administration held them until after the election. Food safety advocates sued the administration to win their release.

The produce rule would mark the first time the FDA has had real authority to regulate food on farms. In an effort to stave off protests from farmers, the farm rules are tailored to apply only to certain fruits and vegetables that pose the greatest risk, like berries, melons, leafy greens and other foods that are usually eaten raw. A farm that produces green beans that will be canned and cooked, for example, would not be regulated.

Such flexibility, along with the growing realization that outbreaks are bad for business, has brought the produce industry and much of the rest of the food industry on board as Congress and FDA has worked to make food safer.

In a statement Friday, Pamela Bailey, president of the Grocery Manufacturers Association, which represents the country's biggest food companies, said the food safety law "can serve as a role model for what can be achieved when the private and public sectors work together to achieve a common goal."

The farm and manufacturing rules are only one part of the food safety law. The bill also authorized more surprise inspections by the FDA and gave the agency additional powers to shut down food facilities. In addition, the law required stricter standards on imported foods. The agency said it will soon propose other overdue rules to ensure that importers verify overseas food is safe and to improve food safety audits overseas.

Food safety advocates frustrated over the last year as the rules stalled praised the proposed action.

"The new law should transform the FDA from an agency that tracks down outbreaks after the fact, to an agency focused on preventing food contamination in the first place," said Caroline Smith DeWaal of the Center for Science in the Public Interest.

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Pharmacy Blames Cleaners in Meningitis Outbreak

Jan 4, 2013 11:41am

Credit: Minnesota Department of Health/AP Photo

The pharmacy at the heart of the fungal meningitis outbreak says a cleaning company it hired should share the blame for the tainted steroid injections that caused more than 600 illnesses in 19 states, killing 39 people.

Click here to read about the road to recovery for fungal meningitis victims.

The New England Compounding Pharmacy, which made the fungus-tainted drugs, sent a letter to UniFirst Corp., which provided once-a month cleaning services to the Framingham, Mass., lab, “demanding” it indemnify NECC for the meningitis outbreak, according to a UniFirst filing with the Securities and Exchange Commission.

“Based on its preliminary review of this matter, the company believes that NECC’s claims are without merit,” UniFirst wrote in its quarterly filing.

The New England Compounding Center recalled 17,000 vials of tainted steroid injections on Sept. 26 before recalling all drugs and shutting down on Oct. 6.

The Food and Drug Administration investigated NECC’s lab and found that a quarter of the steroid injections in one bin contained “greenish black foreign matter,” according to the report.  The FDA also identified several cleanrooms that had bacterial or mold overgrowths.

UniFirst’s UniClean business cleaned portions of the NECC cleanrooms to NECC’s specifications and using NECC’s cleansing solutions, UniFirst spokesman Adam Soreoff said in a statement. It provided two technicians once a month for about an hour and a half.

“UniClean was not in any way responsible for NECC’s day-to-day operations, its overall facility cleanliness, or the integrity of the products they produced,” Soreoff said. “Therefore, based on what we know, we believe any NECC claims against UniFirst or UniClean are unfounded and without merit. ”

Click here for our fungal meningitis outbreak timeline, “Anatomy of an Outbreak.”

NECC was not immediately available for comment.

The House of Representatives subpoenaed Barry Cadden, who owns NECC,  to a hearing in Washington, D.C. on Nov. 14. He declined to testify when members of Congress pressed him on his role in ensuring that the drugs his company produced were safe and sterile.

“On advice of counsel, I respectfully decline to answer on the basis of my constitutional rights and privileges including the Fifth Amendment of the Constitution of the United States,” he said at the hearing.

Members of Congress also questioned whether the FDA could have prevented the outbreak.

Compounding pharmacies, which are intended to tailor drugs to individuals with a single prescription from a single doctor, are typically overseen by state pharmacy boards rather than the FDA because they are so small. However, in 2006, the FDA issued a warning letter to NECC, accusing it of mass-producing a topical anesthetic cream, and jeopardizing another drug’s sterility by repackaging it.

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Syria rebels in push to capture air base

AZAZ, Syria (Reuters) - Rebels battled on Thursday to seize an air base in northern Syria, part of a campaign to fight back against the air power that has given President Bashar al-Assad's forces free rein to bomb rebel-held towns.

More than 60,000 people have been killed in the 21-month-old uprising and civil war, the United Nations said this week, sharply raising the death toll estimate in a conflict that shows no sign of ending.

After dramatic advances over the second half of 2012, the rebels now hold wide swathes of territory in the north and east, but are limited in exerting control because they cannot protect towns and villages from Assad's helicopters and jets.

Hundreds of fighters from rebel groups were attempting to storm the Taftanaz air base, near the northern highway that links Syria's two main cities, Aleppo and the capital Damascus.

Rebels have been besieging air bases across the north in recent weeks, in the hope this will reduce the government's power to carry out air strikes and resupply loyalist-held areas.

A rebel fighter speaking from near the Taftanaz base overnight said the base's main sections were still in loyalist hands but insurgents had managed to infiltrate and destroy a helicopter and a fighter jet on the ground.

The northern rebel Idlib Coordination Committee said the rebels had detonated a car bomb inside the base.

The government's SANA news agency said the base had not fallen and that the military had "strongly confronted an attempt by the terrorists to attack the airport from several axes, inflicting heavy losses among them and destroying their weapons and munitions".

Rami Abdulrahman, head of the opposition-aligned Syrian Observatory for Human Rights which monitors the conflict from Britain, said as many as 800 fighters were involved in the assault, including Islamists from Jabhat al-Nusra, a powerful group that Washington considers terrorists.

Taftanaz is mainly a helicopter base, used for missions to resupply army positions in the north, many of which are cut off by road because of rebel gains, as well as for dropping crude "barrel bombs" of explosives on rebel-controlled areas.

"WHAT IS THE FAULT OF THE CHILDREN?"

Near Minakh, another northern air base that rebels have surrounded, government forces have retaliated by regularly shelling and bombing nearby towns.

In the town of Azaz, where the bombardment has become a near nightly occurrence, shells hit a family house overnight. Zeinab Hammadi said her two wounded daughters, aged 10 and 12, had been rushed across the border to Turkey, one with her brain exposed.

"We were sleeping and it just landed on us in the blink of an eye," she said, weeping as she surveyed the damage.

Family members tried to salvage possessions from the wreckage, men lifting out furniture and children carrying out their belongings in tubs.

"He (Assad) wants revenge against the people," said Abu Hassan, 33, working at a garage near the destroyed house. "What is the fault of the children? Are they the ones fighting?"

Opposition activists said warplanes struck a residential building in another rebel-held northern town, Hayyan, killing at least eight civilians.

Video footage showed men carrying dismembered bodies of children and dozens of people searching for victims in the rubble of the destroyed building, shouting "God is greatest". The provenance of the video could not be independently confirmed.

In addition to their tenuous grip on the north, the rebels also hold a crescent of suburbs on the edge of Damascus, which have come under bombardment by government forces that control the center of the capital.

On Wednesday, according to opposition activists, dozens of people were incinerated in an inferno caused by an air strike on a petrol station in a Damascus suburb where residents were lining up for precious fuel.

The civil war in Syria has become the longest and bloodiest of the conflicts that rose out of uprisings across the Arab world in the past two years.

Assad's family has ruled for 42 years since his father seized power in a coup. The war pits rebels, mainly from the Sunni Muslim majority, against a government supported by members of Assad's Shi'ite-derived Alawite minority sect and some members of other minorities who fear revenge if he falls.

The West, most Sunni-ruled Arab states and Turkey have called for Assad to leave power. He is supported by Russia and Shi'ite Iran.

(Additional reporting by Khaled Yacoub Oweis in Amman and Dominic Evans in Beirut; Writing by Peter Graff; Editing by Ruth Pitchford)

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Relief for Google as US ends monopoly probe

WASHINGTON: US regulators Thursday closed a lengthy antitrust probe into Google, saying there was not enough evidence to show the Internet giant manipulated its search results to harm its competitors.

The Federal Trade Commission said it lacked a legal basis to bring a monopoly abuse case against Google for "search bias," as alleged by some rivals, but won commitments from the tech titan to end its "most troubling" practices on search and advertising.

FTC chairman Jon Leibowitz said the action concludes a year-and-a-half probe of the Internet giant, accused by rivals of abusing its market dominance.

Many of Google's critics "wanted the Commission to go further in this investigation and regulate the intricacies of Google's search engine algorithm," Leibowitz said.

The FTC "exhaustively investigated allegations that Google unfairly manipulated its search engine results to harm its competitors," but found the evidence did not support an enforcement action, he said.

"The facts weren't there under the law we apply," he Leibowitz added.

Even though some rivals dislike Google search, "it doesn't violate the American antitrust laws," he said.

Still, Google made "enforceable commitments" to change some practices criticised by rivals in a voluntary settlement.

Leibowitz said Google had "committed to stop the most troubling of its business practices related to Internet search and search advertising."

Google agreed to stop misappropriating or "scraping" the content of rivals that makes it appear as if it were from Google and to drop contractual restrictions that limited the ability of small businesses to advertise on competing search engines, he said.

In a separate patent case, Google agreed to an FTC order "to stop seeking to exclude competitors using essential patents," mainly from Motorola, which Google purchased, the FTC chief said.

The action in Washington leaves unclear the outcome of a similar probe by the European Commission into Google's alleged monopoly abuse.

The European Union said last month it was still seeking commitments from the US firm that it abused its dominant market position in Internet search.

Google's chief legal officer David Drummond said of the FTC decision: "The conclusion is clear: Google's services are good for users and good for competition."

Drummond added, "We've always accepted that with success comes regulatory scrutiny. But we're pleased that the FTC and the other authorities that have looked at Google's business practices... have concluded that we should be free to combine direct answers with Web results. So we head into 2013 excited about our ability to innovate for the benefit of users everywhere."

Leibowitz said Google's commitments are "binding" and "enforceable" because the company made a written pledge to the federal regulatory agency. Any violation of those promises could result in fines, he said.

"This is a major victory for Google," said Greg Sterling, an analyst with Sterling Market Intelligence who blogs at Search Engine Land.

"The search bias argument was always one of the hardest and most unconvincing parts of any potential case against Google -- though it's the issue competitors probably care most about."

Sterling said EU regulators "arguably have a stronger negotiating position than the FTC. The Europeans also seem more intent on exacting bigger concessions from Google than the FTC. Yet a full-blown antitrust action against the company in Europe is unlikely."

Google has close to 70 per cent of the search market in the United States, and more in some other markets.

According to the research firm eMarketer, Google had around 75 per cent of US Internet search advertising revenues and 93 per cent in the mobile search ad market.

- AFP/jc

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Congress leader held for Bodo woman's 'rape'

GUWAHATI: A prominent Congress leader of the state was arrested on Thursday on the charge of allegedly raping a 40-year-old Bodo woman who's a mother of two at her home at Salbari in Chirang district in the Bodo Territorial Autonomous Districts (BTAD) area.

The accused, Bikramsing Brahma, is alleged to have committed the crime on Wednesday night at the victim's house where stayed overnight. But it was only on Thursday morning that the victim's husband raised a hue and cry, after which the villagers caught him and beat him up in public before handing him over to police. Assam Police IGP GP Singh said, "Brahma has been arrested on the charge of rape."

The victim's husband filed the FIR, based on which the arrest was made. He alleged in his FIR that Brahma was in touch with his family for the last three months and had been promising them contracts for government schemes. The victim has undergone a medical test and has been taken to her residence where police security has been provided. Police said that victim has not been brought to police station to keep her identity concealed.

The state unit of the Congress suspended Brahma from the party immediately after getting the report. Pradesh Congress Committee spokesman Ranjan Bora said, "As Brahma has been arrested, we have decided to suspend his party membership. He was earlier a chief coordinator of the BTC coordination committee of Congress but the committee was dissolved two years back. Since then, he was an ordinary member of the party."

A Bodo himself, Brahma was the Congress candidate from Sapaguri assembly constituency in Baksa district in the 2011 state assembly election, which he lost. Police have started investigating the case and are waiting for the medical report, which would take a couple of days, to move forward.

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CDC: 1 in 24 admit nodding off while driving

NEW YORK (AP) — This could give you nightmares: 1 in 24 U.S. adults say they recently fell asleep while driving.

And health officials behind the study think the number is probably higher. That's because some people don't realize it when they nod off for a second or two behind the wheel.

"If I'm on the road, I'd be a little worried about the other drivers," said the study's lead author, Anne Wheaton of the Centers for Disease Control and Prevention.

In the CDC study released Thursday, about 4 percent of U.S. adults said they nodded off or fell asleep at least once while driving in the previous month. Some earlier studies reached a similar conclusion, but the CDC telephone survey of 147,000 adults was far larger. It was conducted in 19 states and the District of Columbia in 2009 and 2010.

CDC researchers found drowsy driving was more common in men, people ages 25 to 34, those who averaged less than six hours of sleep each night, and — for some unexplained reason — Texans.

Wheaton said it's possible the Texas survey sample included larger numbers of sleep-deprived young adults or apnea-suffering overweight people.

Most of the CDC findings are not surprising to those who study this problem.

"A lot of people are getting insufficient sleep," said Dr. Gregory Belenky, director of Washington State University's Sleep and Performance Research Center in Spokane.

The government estimates that about 3 percent of fatal traffic crashes involve drowsy drivers, but other estimates have put that number as high as 33 percent.

Warning signs of drowsy driving: Feeling very tired, not remembering the last mile or two, or drifting onto rumble strips on the side of the road. That signals a driver should get off the road and rest, Wheaton said.

Even a brief moment nodding off can be extremely dangerous, she noted. At 60 mph, a single second translates to speeding along for 88 feet — the length of two school buses.

To prevent drowsy driving, health officials recommend getting 7 to 9 hours of sleep each night, treating any sleep disorders and not drinking alcohol before getting behind the wheel.

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Online:

CDC report: http://www.cdc.gov/mmwr

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Sandy Hook Parents Cope With Students' Return

Sandy Hook parents put their children on school buses this morning and waved goodbye as the yellow bus rolled away, but this first day back since the pre-Christmas massacre is anything but normal for the families of Sandy Hook Elementary School.

Erin Milgram, the mother of a first grader and a fourth grader at Sandy Hook, told "Good Morning America" that she was going to drive behind the bus and stay with her 7-year-old Lauren for the entire school day.

"I haven't gotten that far yet, about not being with them," Milgram said. "I just need to stay with them for a while."

Today is "Opening Day" for Sandy Hook Elementary School, which is re-opening about six miles away in the former Chalk Hill school in Monroe, Conn.

Lauren was in teacher Kaitlin Roig's first grade class on Dec. 14 when gunman Adam Lanza forced his way into the school and killed 20 students and six staffers.

Roig has been hailed a hero for barricading her students in a classroom bathroom and refusing to open the door until authorities could find a key to open the door.

The 20 students killed were first-graders and the Milgrams have struggled to explain to Lauren why so many of her friends will never return to school.

Sandy Hook Elementary School: Ready to Return Watch Video

Newtown, Conn. Students Return to New Sandy Hook Watch Video

"She knows her friends and she'll also see on the bus... there will be some missing on the bus," Milgram said. "We look at yearbook pictures. We try to focus on the happy times because we really don't know what we're doing."

"How could someone be so angry?" Lauren's father Eric Milgram wondered before a long pause. "We don't know."

The school has a lecture room available for parents to stay as long as they wish and they are also allowed to accompany their children to the classroom to help them adjust. Counselors will be available throughout the day for parents, staff and students, according to the school's website.

The first few days will be a delicate balancing act between assessing the children's needs and trying to get them back to a normal routine.

"We don't want to avoid memories of a trauma," Dr. Jamie Howard told "Good Morning America." "And so by getting back to school and by engaging in your routines, we're helping kids to do that, we're helping them to have a natural, healthy recovery to a trauma."

Security is paramount in everyone's mind. There is a police presence on campus and drivers of every vehicle that comes onto campus are being interviewed.

"Our goal is to make it a safe and secure learning environment for these kids to return to, and the teachers also," Monroe police Lt. Keith White said at a news conference on Wednesday.

A "state-of-the-art" security system is in place, but authorities will not go into detail about the system saying only that the school will probably be "the safest school in America."

White said at a news conference today that the security presence would be evaluated on a day-by-day and week-by-week basis moving forward.

"We are trying to keep a balance," he said. "We don't want them [the students] to think that this is a police state. This is a school and a school first."

Every adult in the school who is not immediately recognizable will be required to wear a badge as identification, parent and school volunteer Karen Dryer told ABCNews.com.

"They want to know exactly who you are at sight, whether or not you should be there," Dryer said.

Despite the precautions and preparations, parents will still be coping with the anxiety of parting with their children.

"Rationally, something like this is a very improbable event, but that still doesn't change the emotional side of the way you feel," Eric Milgram said.

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Central African Republic rebels halt advance, agree to peace talks

DAMARA, Central African Republic (Reuters) - Rebels in Central African Republic said they had halted their advance on the capital on Wednesday and agreed to start peace talks, averting a clash with regionally backed troops.

The Seleka rebels had pushed to within striking distance of Bangui after a three-week onslaught and threatened to oust President Francois Bozize, accusing him of reneging on a previous peace deal and cracking down on dissidents.

Their announcement on Wednesday gave the leader only a limited reprieve as the fighters told Reuters they might insist on his removal in the negotiations.

"I have asked our forces not to move their positions starting today because we want to enter talks in (Gabon's capital) Libreville for a political solution," said Seleka spokesman Eric Massi, speaking by telephone from Paris.

"I am in discussion with our partners to come up with proposals to end the crisis, but one solution could be a political transition that excludes Bozize," he said.

Bozize on Wednesday sacked his Army Chief of Staff and took over the defense minister's role from his son, Jean Francis Bozize, according to a decree read on national radio, a day after publicly criticizing the military for failing to repel the rebels.

The advance by Seleka, an alliance of mostly northeastern rebel groups, was the latest in a series of revolts in a country at the heart of one of Africa's most turbulent regions - and the most serious since the Chad-backed insurgency that swept Bozize to power in 2003.

Diplomatic sources have said talks organized by central African regional bloc ECCAS could start on January 10. The United States, the European Union and France have called on both sides to negotiate and spare civilians.

Central African Republic is one of the least developed countries in the world despite its deposits of gold, diamonds and other minerals. French nuclear energy group Areva mines the country's Bakouma uranium deposit - France's biggest commercial interest in its former colony.

RELIEF IN BANGUI

News of the rebel halt eased tension in Bangui, where residents had been stockpiling food and water and staying indoors after dark.

"They say they are no longer going to attack Bangui, and that's great news for us," said Jaqueline Loza in the crumbling riverside city.

ECCAS members Chad, Congo Republic, Gabon and Cameroon have sent hundreds of soldiers to reinforce CAR's army after a string of rebel victories since early December.

Gabonese General Jean Felix Akaga, commander of the regional force, said his troops were defending the town of Damara, 75 km (45 miles) north of Bangui and close to the rebel front.

"Damara is a red line not to be crossed ... Damara is in our control and Bangui is secure," he told Reuters. "If the rebellion decides to approach Damara, they know they will encounter a force that will react."

Soldiers armed with Kalashnikovs, rocket propelled grenade launchers and truck-mounted machineguns had taken up positions across the town, which was otherwise nearly-abandoned.

Some of the fighters wore turbans that covered their faces and had charms strung around their necks and arms meant to protect them against enemy bullets.

Chad's President Idriss Deby, one of Bozize's closest allies, had warned the rebels the regional force would confront them if they approached the town.

Chad provided training and equipment to the rebellion that brought Bozize to power by ousting then-president Ange Felix Patasse, who Chad accused of supporting Chadian dissidents.

Chad is also keen to keep a lid on instability in the territory close to its main oil export pipeline and has stepped in to defend Bozize against insurgents in the past.

A CAR government minister told Reuters the foreign troop presence strengthened Bozize's bargaining position ahead of the Libreville peace talks.

"The rebels are now in a position of weakness," the minister said, asking not to be named. "They should therefore stop imposing conditions like the departure of the president."

Central African Republic is one of a number of countries in the region where U.S. Special Forces are helping local soldiers track down the Lord's Resistance Army, a rebel group which has killed thousands of civilians across four nations.

France has a 600-strong force in CAR to defend about 1,200 of its citizens who live there.

Paris used air strikes to defend Bozize against a rebellion in 2006. But French President Francois Hollande turned down a request for more help, saying the days of intervening in other countries' affairs were over.

(Additional reporting by Paul-Marin Ngoupana in Bangui and Jon Herskovitz in Johannesburg; Writing by Richard Valdmanis; Editing by Andrew Heavens and Janet Lawrence)

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After Newtown, Colombia firm makes bullet-proof kid clothes

BOGOTA: Miguel Caballero has been making bullet-proof clothes for politicians and other bigwigs for 20 years, but not for kids. The latest US school massacre has changed that.

This year he plans a line for children -- T-shirts, vests, and combination backpack-vests -- and geared toward the US market.

Caballero has made good money in his 22-year-old business with a factory on the outskirts of Bogota. He sells around 50,000 garments a year that go for about US$2,000 a piece, but the US market had been tough to crack.

Then, after a lone and deranged gunman killed 20 small children and six staffers at Sandy Hook Elementary School last month in Newtown, Connecticut, he started getting orders from very worried parents.

"We would answer that we do not make clothes for kids. But the emails kept coming," Caballero said.

So, in just a week, he designed garments and subjected them to ballistic tests. Now his factory is fitted to churn out a first lot of 1,800 bullet-proof garments for children and is waiting for firm orders.

Carolina Ballesteros, Caballero's director of research and development, said the impact of the Newtown shooting was huge because of the age of most of the victims: just six and seven.

Asked how you explain to a child that simply going to school can be so dangerous you have to wear a bullet proof vest, Ballesteros explained that her company's garments are not designed for everyday use.

Rather, they are for emergencies, to be handed out by teachers when needed.

The new line is tailored for kids aged 8 to 16, with prices ranging from US$200 to US$400, depending on the garment and its size.

Caballero's factory employs 235 people, and 95 per cent of its output is exported to 23 countries in the Middle East and Latin America.

The company makes uniforms for security forces and suits for public figures in many countries, she said.

"Three royal families in the Middle East are customers of ours. We made a bullet-proof kimono for the American actor Steven Seagal. Our experience is beyond question," Ballesteros said.

- AFP/jc

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