HPV tied to throat cancers: study

NEW YORK (Reuters Health) - A sexually transmitted infection usually thought of in connection to cervical cancer is also tied to a five times greater risk of cancer of the vocal chords or voice box, a new report suggests.
Combining the results of 55 studies from the past two decades, Chinese researchers found 28 percent of people with laryngeal cancers had cancerous tissue that tested positive for human papillomavirus (HPV).
But that rate varied widely by study, from no throat cancer patients with HPV to 79 percent with the infection.
"We're finding that HPV appears to be linked to a number of squamous cell carcinomas of the head, neck and throat," said Dr. William Mendenhall, a radiation oncologist from the University of Florida in Gainesville who didn't participate in the analysis.
However, he told Reuters Health, "I think the risk of HPV on laryngeal cancer is probably relatively low. Most of the patients we see currently that come in with laryngeal cancer have a strong history of cigarette smoking, also heavy drinking."
Along with tobacco and alcohol, having a poor diet and exposure to certain chemicals can increase a person's risk of laryngeal and other head and neck cancers.
The American Cancer Society estimates 12,360 people will be diagnosed with laryngeal cancer in the United States in 2012 and that there will be 3,650 deaths from the disease.
Along with their larger review, researchers led by Dr. Xiangwei Li, from the Chinese Academy of Medical Sciences and Peking University Medical College in Beijing, analyzed 12 studies that compared cancerous and non-cancerous tissues from a total of 638 patients. They found the cancerous throat tissue had 5.4 times the odds of testing positive for HPV infection, compared to non-cancerous tissue.
The analysis was published last week in the Journal of Infectious Diseases.
Mendenhall said that of all head and neck cancers, HPV seems to play the biggest role not in laryngeal cancer, but in cancer of the tonsils and back of the tongue.
However, he added, "the exposure is probably decades earlier. Someone who develops a base of tongue cancer when they're 50, they probably were exposed to the virus years before, in their teens or 20s."
At least half of sexually-active people get HPV at some point in their lives, according to the Centers for Disease Control and Prevention (CDC), but the virus is usually cleared by the immune system. Only some of the 40-plus HPV strains have been tied to cancer.
Based on the current findings, it's difficult to know how many of the laryngeal cancers in the original studies were actually caused by the virus, researchers said.
But Mendenhall said extending HPV vaccination to boys and young men, as the CDC has recommended, "will hopefully reduce at least some of these HPV-related cancers."

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Uncircumcised boys and men may face more UTIs

NEW YORK (Reuters Health) - Infections of the kidney, bladder and urethra happen in uncircumcised baby boys at ten times the rate of circumcised boys, and over a lifetime uncircumcised men are four times more likely to experience one, according to a new analysis of past research.
Urinary tract infections (UTIs) are most common in boys' first year of life, and circumcision was already known to make a difference in their risk, but how much and whether that carried through to adulthood was unclear, Australian researchers say.
They found that circumcision "provides considerable protection and over the lifespan makes about a three- to four-fold difference by our prediction, which is quite striking in public health terms," lead study author Brian Morris, professor of molecular medical science at the Sydney Medical School, University of Sydney, told Reuters Health.
Morris and a colleague examined 22 studies published between 1987 and 2012 that included a total of 407,902 males across the globe, a quarter of whom were uncircumcised.
Breaking down the results by age, they calculated that the likelihood of a UTI between birth and one year of age is 9.9 times higher in uncircumcised boys compared to circumcised boys. Between ages 1 and 16, uncircumcised boys are at 6.6 times higher risk, and after age 16 their risk is 3.4 times that of uncircumcised men.
Based on those findings, the researchers projected that doctors could prevent one UTI with every four circumcisions, "which is astronomical," Morris said.
The younger the infant, the more serious a UTI can be, the researchers note in their report, which is published in the Journal of Urology. Side effects of a UTI in infants can include kidney scarring, fever, pain and blood infections.
Health experts have mostly framed circumcision as a public health preventive measure focused on HIV and other sexually transmitted diseases.
In August, the American Academy of Pediatrics for the first time stated that the health benefits of circumcision outweigh the risks, but added that the decision to circumcise a child remains with parents.
The U.S. Centers for Disease Control and Prevention is currently evaluating the potential health impact of circumcision, according to a spokeswoman, but any recommendations that come of that will also be voluntary, she said.
The estimated health benefit Morris and his colleague found was several times larger than what was projected in two previous studies, which suggested 111 or 195 circumcisions would be needed to prevent one case of UTI in the first year of life.
One expert questioned the new findings based on the methods Morris' team used.
Zbys Fedorowicz, director of the Bahrain branch of the UK Cochrane Centre, a non-profit organization that evaluates medical studies, said that the 22-study analysis combined different types of studies and the researchers failed to assess their quality.
"It doesn't mean to say that these guys are necessarily wrong, it's just that we don't know because the methodological approach that they used isn't thorough enough, it's not transparent, it's not reproducible and it's not clear," Fedorowicz said.
In November, Fedorowicz and colleagues published a report concluding that no existing study that examined the risk of urinary tract infections and circumcision was of high enough quality for any recommendation.
Dr. Robert Van Howe, clinical professor of pediatrics at the Michigan State University College of Human Medicine and vocal critic of circumcision, also found the new study problematic.
Van Howe said that diagnostic criteria for urinary tract infections differ between researchers and that the cost/ benefit analysis of circumcision as a preventive tool for infections doesn't add up.
At $200 each circumcision, preventing one urinary tract infection would cost $40,000, "which you can treat with an $18 antibiotic; it's overkill," Van Howe said.
"You would think we have long lists for dialysis in men because they're not circumcised, but it just isn't a problem, it's fear mongering," Van Howe told Reuters Health.
A middle ground might be to let boys decide for themselves at age 14 or 16 to become circumcised, Van Howe suggested. "You can leave this choice up to the person who has to live with the consequences," Van Howe said.
Morris maintains that the study sends "a really strong signal for advocacy of circumcision as a public health intervention in reducing these various - and in many cases very serious - conditions over the lifetime.

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In Search of a Better Condom

It's hard to believe, but the condom is still the only way to protect against pregnancy and HIV at the same time. But researchers say they believe they can develop a kind of 21st-century contraceptive that offers superior protection against pregnancy and sexually transmitted diseases and that people will like enough to use consistently.
A paper describing early work on the project was published earlier this month in the journal PLoS One. The research team, led by Kim Woodrow at the University of Washington, received a grant of nearly $1 million last month from the Bill & Melinda Gates Foundation to pursue the research.
The product is an electrically spun cloth with nanometer-sized fibers that can dissolve to release drugs, such as medications that prevent pregnancy and HIV infection. The drug-eluting fibers represent "multipurpose prevention technology," a method that simultaneously prevents sexually transmitted infections and unintended pregnancy through a combined physical and chemical barrier.
MORE: HIV Vaccine Under Study May Last A Lifetime
"Condoms and vaginal rings and IUDs have been around for a very long time," Cameron Ball, a co-author of the paper and graduate student in bioengineering, told TakePart. "People would like more options. No one option will be the silver bullet. The idea is to have multiple options that people can choose for their lifestyle."
Improved methods to protect against STDs and pregnancy are needed in both developing and developed countries. The spermacide nonoxynol-9 is highly effective at pregnancy prevention but promotes vaginal inflammation, which then increases the risk of STD transmission.
"What we're hoping to provide is a method of drug delivery that could be used with a variety of drug compounds," Ball says. "There are multiple products in the development pipeline to address this need. These are largely vaginal rings, but vaginal rings are limited in what they are able to deliver. They deliver compounds that are less water soluble. Using fibers allows you to work with multiple drugs with different properties. You can have combinations of pharmaceutical agents that you couldn't necessarily have with a vaginal ring or with a condom."
MORE: HIV-Positive Women Benefit from Human Papillovirus Vaccination
During electrospinning, an electric field is used to launch a charged fluid jet through the air to create extremely delicate nanometer-scale fibers that stick to a collection plate. (One nanometer is about one 25-millionth of an inch.) The stretchy fibers are the platform for delivering medications in the same way that drugs are delivered through pills or gels. The fibers can also carry larger molecules, such as proteins and antibodies, that are hard to deliver through other methods. So far, the team has created a fabric that serves as a physical barrier to block sperm or to release drugs, such as contraceptives and antiviral medications.
The fabric dissolves within minutes, which is considered a benefit because it offers immediate and discreet protection. But the approach also allows for controlled release of multiple compounds, Ball says. Last year, a study aimed at preventing heterosexual HIV transmission using a gel with the drug tenofovir failed—the likely result of the drug's strength fading by the time of sex.
"If you can have a longer-lasting gel with nanoparticles, that would be beneficial," Ball says. "We're trying to fill a niche in terms of product lifespan."
MORE: Ob-Gyns: Sell 'The Pill' Over The Counter
The cloth could be inserted directly into the body or used as a coating on vaginal rings or other products, Ball says. While the primary goal of the research is for products that can be used in places like Africa, where HIV transmission is especially high,  the technology could appeal to a wide range of societies and cultures.
"You could have fibers that stay in place for longer or be shaped in the shape of a diaphragm," he says. "You could include herpes medication. Herpes prevention is somewhat controversial—it's not clear whether taking herpes medications prophylactically will help prevent the spread of the virus. That is another application, potentially.

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Venezuelans on edge amid shifting news on Chavez

CARACAS, Venezuela (AP) — Supporters and opponents of President Hugo Chavez alike nervously welcomed the new year Tuesday, left on edge by shifting signals from the government about the Venezuelan leader's condition three weeks after cancer surgery in Cuba.
With rumors swirling that Chavez had taken a turn for the worse, Vice President Nicolas Maduro said in a televised interview in Cuba that he had met with the president twice, spoken with him and planned to return to Venezuela on Wednesday.
Maduro said Chavez faces "a complex and delicate situation." But Maduro also said that when he talked with the president and looked at his face, he seemed to have "the same strength as always."
"All the time we've been hoping for his positive evolution. Sometimes he has had light improvements, sometimes stationary situations," Maduro said in the prerecorded interview, which was broadcast Tuesday night by the Caracas-based television network Telesur.
"I was able to see him twice, converse with him. He's totally conscious of the complexity of his post-operative state and he expressly asked us ... to keep the nation informed always, always with the truth, as hard as it may be in certain circumstances," Maduro said.
Chavez has not been seen or heard from since the Dec. 11 operation, and officials have reported a series of ups and downs in his recovery — the most recent, on Sunday, announcing that new complications from a respiratory infection had put the president in a "delicate" state.
Speculation has grown since Maduro announced those latest troubles, which were a sharp shift from his remark nearly a week earlier that the president had been up and walking.
In Tuesday's interview, Maduro did not provide any new details about Chavez's complications. But he joined other Chavez allies in urging Venezuelans to ignore gossip, saying rumors are being spread due to "the hatred of the enemies of Venezuela."
He didn't refer to any rumors in particular, though one of them circulating online had described Chavez as being in a coma.
Political opponents of Chavez have complained that the government hasn't told the country nearly enough about his health.
Maduro's remarks about the president came at the end of an interview in which he praised his government's programs at length, recalled the history of the Cuban revolution and touched on what he called the long-term strength of Chavez's socialist Bolivian Revolution movement.
He mentioned that former Cuban President Fidel Castro had been in the hospital, and praised Cuba's government effusively. "Today we're together on a single path," Maduro said.
Critics in Venezuela sounded off on Twitter while the interview was aired, some saying Maduro sounded like a mouthpiece for the Cuban government. In their online messages, many Chavez opponents criticized a dearth of information provided by Maduro, accusing him of withholding key details about Chavez's condition. Opposition politicians have demanded that the government provide the country with a full medical report.
Even some of his supporters said on Tuesday that they wished they knew more.
"We're distressed by El Comandante's health," said Francisca Fuentes, who was walking through a downtown square with her grandchildren. "I think they aren't telling us the whole truth. It's time for them to speak clearly. It's like when you have a sick relative and the doctor lies to you every once in a while."
Chavez has been fighting an undisclosed type of pelvic cancer since June 2011. He has declined to reveal the precise location of the tumors that have been surgically removed. The president announced on Dec. 8, two month after winning re-election, that his cancer had come back despite previous surgeries, chemotherapy and radiation treatment.
"There's nothing we can do except wait for the government to deign to say how he is really," said Daniel Jimenez, an opposition supporter who was in a square in an affluent Caracas neighborhood.
Jimenez and many other Venezuelans say it seems increasingly unlikely that Chavez can be sworn in as scheduled Jan. 10 for his new term.
Venezuelans rang in 2013 as usual with fireworks raining down all over the capital of Caracas. But some of Chavez's supporters had long faces as they gathered in Bolivar Plaza on Monday night holding pictures of the president. A government-sponsored New Year's Eve celebration there had been called off, and instead his supporters strummed guitars and read poetry in Chavez's honor.
Maduro didn't discuss the upcoming inauguration plans, saying only that he's hopeful Chavez will improve.
Chavez has been in office since 1999 and was re-elected in October, three months after he announced that his latest tests showed him to be cancer-free. If he dies or is unable to continue in office, the Venezuelan Constitution says a new election should be held within 30 days.
Before his operation, Chavez acknowledged he faced risks and designated Maduro as his successor, telling supporters they should vote for the vice president if a new presidential election was necessary.
The vice president said that Chavez "has faced an illness with courage and dignity, and he's there fighting, fighting."
"Someone asked me yesterday by text message: How is the president? And I said, 'With giant strength,'" Maduro said. He recalled taking Chavez by the hand, saying "he squeezed me with gigantic strength as we talked.

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Chavez's VP says ailing leader still 'delicate'

CARACAS, Venezuela (AP) — Venezuela's vice president is returning home Wednesday from a visit with Hugo Chavez in Cuba and says the ailing president's condition remains "delicate" three weeks after his cancer surgery.
With rumors swirling that Chavez had taken a turn for the worse, Vice President Nicolas Maduro said Tuesday that he had met with the president twice and had spoken with him.
"He's totally conscious of the complexity of his post-operative state and he expressly asked us ... to keep the nation informed always, always with the truth, as hard as it may be in certain circumstances," Maduro said in the prerecorded interview in Havana, which was broadcast Tuesday night by the Caracas-based television network Telesur.
Both supporters and opponents of Chavez have been on edge in the past week amid shifting signals from the government about the president's health. Chavez has not been seen or heard from since the Dec. 11 operation, and officials have reported a series of ups and downs in his recovery — the most recent, on Sunday, announcing that he faced new complications from a respiratory infection.
Maduro did not provide any new details about Chavez's complications during Tuesday's interview. But he joined other Chavez allies in urging Venezuelans to ignore gossip, saying rumors were being spread due to "the hatred of the enemies of Venezuela."
He didn't refer to any rumors in particular, though one of them circulating online had described Chavez as being in a coma.
Maduro said Chavez faces "a complex and delicate situation." But Maduro also said that when he talked with the president and looked at his face, he seemed to have "the same strength as always."
"All the time we've been hoping for his positive evolution. Sometimes he has had light improvements, sometimes stationary situations," he said.
Maduro's remarks about the president came at the end of an interview in which he praised Venezuelan government programs at length, recalled the history of the Cuban revolution and touched on what he called the long-term strength of Chavez's socialist Bolivarian Revolution movement.
He mentioned that former Cuban President Fidel Castro had been in the hospital, and praised Cuba's government effusively. "Today we're together on a single path," Maduro said.
Critics in Venezuela sounded off on Twitter while the interview was aired, some saying Maduro sounded like a mouthpiece for the Cuban government. In their messages, many Chavez opponents criticized Maduro for the dearth of information he provided, accusing him of withholding key details about Chavez's condition.
Chavez's political opponents have complained that the government hasn't told the country nearly enough about his health, and have demanded it provide the country with a full medical report.
Even some of his supporters say they wished they knew more.
"We're distressed by El Comandante's health," said Francisca Fuentes, who was walking through a downtown square with her grandchildren Tuesday. "I think they aren't telling us the whole truth. It's time for them to speak clearly. It's like when you have a sick relative and the doctor lies to you every once in a while."
Chavez has been fighting an undisclosed type of pelvic cancer since June 2011. He has declined to reveal the precise location of the tumors that have been surgically removed. The president announced on Dec. 8, two month after winning re-election, that his cancer had come back despite previous surgeries, chemotherapy and radiation treatment.
"There's nothing we can do except wait for the government to deign to say how he is really," said Daniel Jimenez, an opposition supporter who was in a square in an affluent Caracas neighborhood.
Jimenez and many other Venezuelans say it seems increasingly unlikely that Chavez can be sworn in as scheduled Jan. 10 for his new term. If he dies or is unable to continue in office, the Venezuelan Constitution says a new election should be held within 30 days.
Before his operation, Chavez acknowledged he faced risks and designated Maduro as his successor, telling supporters they should vote for the vice president if a new presidential election was necessary.
Maduro didn't discuss the upcoming inauguration plans, saying only that he is hopeful Chavez will improve.
The vice president said that Chavez "has faced an illness with courage and dignity, and he's there fighting, fighting."
"Someone asked me yesterday by text message: How is the president? And I said, 'With giant strength,'" Maduro said. He recalled taking Chavez by the hand: "He squeezed me with gigantic strength as we talked.

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Venezuela opposition: Chavez secrecy feeds rumors

Venezuela opposition: Chavez secrecy feeds rumors
CARACAS, Venezuela (AP) — Venezuela's opposition demanded that the government reveal specifics of President Hugo Chavez's condition Wednesday, criticizing secrecy surrounding the ailing leader's health more than three weeks after his cancer surgery in Cuba.
Opposition coalition leader Ramon Guillermo Aveledo said at a news conference that the information provided by government officials "continues to be insufficient."
Chavez has not been seen or heard from since the Dec. 11 operation, and Vice President Nicolas Maduro on Tuesday said the president's condition remained "delicate" due to complications from a respiratory infection.
Chavez's elder brother, Adan, arrived in Havana on Wednesday, said Jorge Arreaza, the president's son-in-law and science minister. "We're meeting with him, Vice President Maduro and Attorney General Cilia Flores," Arreaza said in a message on Twitter.
"The medical team explains to us that President Chavez's condition continues to be stable within his delicate state," Arreaza said in another message, adding that Chavez "continues battling hard and he sends all his love to our people."
Maduro and other government officials have urged Venezuelans not to heed rumors about Chavez's condition.
Aveledo said the opposition has been respectful during Chavez's illness, and said that "the secrecy is the source of the rumors, which increase the uncertainty and cause distress."
"They should tell the truth," Aveledo said, noting that Maduro had pledged to provide full reports about Chavez's condition. He reiterated the opposition's call for the government to release a medical report and said all indications are that Chavez won't be able to be sworn in to begin a new term Jan. 10.
If Chavez can't take office on that date, Aveledo said the constitution is clear that the National Assembly president should then take over temporarily until a new election is held. He said what happens next in Venezuela should be guided by "the truth and the constitution."
If Chavez dies or is unable to continue in office, the Venezuelan Constitution says a new election should be held within 30 days.
With rumors swirling that Chavez had taken a turn for the worse, Maduro said on Tuesday that he had met with the president twice and had spoken with him.
"He's totally conscious of the complexity of his post-operative state and he expressly asked us ... to keep the nation informed always, always with the truth, as hard as it may be in certain circumstances," Maduro said in the prerecorded interview in Havana, which was broadcast Tuesday night by the Caracas-based television network Telesur.
Both supporters and opponents of Chavez have been on edge in the past week amid shifting signals from the government about the president's health. Officials have reported a series of ups and downs in his recovery — the most recent, on Sunday, announcing that he faced the new complications from a respiratory infection.
Maduro said on Tuesday that Chavez faces "a complex and delicate situation." But he also said that when he talked with the president and looked at his face, he seemed to have "the same strength as always."
The vice president said he planned to return to Caracas on Wednesday, though there was no confirmation of a return trip as of Wednesday night.
His remarks about the president came at the end of an interview in which he praised Cuba's government effusively and touched on what he called the long-term strength of Chavez's socialist Bolivarian Revolution movement. He mentioned that former Cuban President Fidel Castro had visited the hospital where Chavez was treated.
In Washington, the U.S. State Department said procedures under the Venezuelan Constitution should be followed if Chavez is no longer able to carry out his duties as president.
"We want to see any transition take place in a manner that is consistent with the Venezuelan Constitution, that any election be fully transparent, democratic, free and fair," State Department spokeswoman Victoria Nuland told reporters on Wednesday.
Asked if Chavez being out of the picture would make it easier to improve long-strained ties between Venezuela and the U.S., Nuland said, "Obviously we will judge our ability to improve our relationship with Venezuela based on steps they are able to take."
The U.S. Embassy in Caracas has been without an ambassador since July 2010. Chavez rejected the U.S. nominee for ambassador, accusing him of making disrespectful remarks about Venezuela's government. That led Washington to revoke the visa of the Venezuelan ambassador.
But recently U.S. and Venezuelan diplomats began high-level conversations aimed at improving relations, a U.S. government official said. The official spoke on condition of anonymity because he wasn't authorized to speak publicly about the matter.
The official confirmed recent reports that Roberta Jacobson, assistant secretary of state for Western Hemisphere affairs, spoke by telephone with Maduro in November and discussed ways of improving relations. He also confirmed that U.S. diplomat Kevin Whitaker had a subsequent conversation with Roy Chaderton, Venezuela's ambassador to the Organization of American States.
Venezuelan diplomats could not be reached to comment about those recent contacts with U.S. officials.
In Bolivia, meanwhile, President Evo Morales said he is concerned about his friend and ally.
"I hope we can see him soon," Morales said at a news conference Wednesday. "But it's a very worrying situation."
"I've tried to make contact with the vice president, and it's been difficult. I hope all of their aims are achieved to save President Chavez's life."
Before his operation, Chavez acknowledged he faced risks and designated Maduro as his successor, telling supporters they should vote for the vice president if a new presidential election were necessary.
Maduro didn't discuss the upcoming inauguration plans, saying only that he is hopeful Chavez will improve.
"Someone asked me yesterday by text message: How is the president? And I said, 'With giant strength,'" Maduro said. He recalled taking Chavez by the hand: "He squeezed me with gigantic strength as we talked."

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Venezuelan gov't: Chavez fighting lung infection

CARACAS, Venezuela (AP) — Venezuela's government says President Hugo Chavez is being treated for a respiratory deficiency after complications from a severe lung infection.
Information Minister Ernesto Villegas provided the update on the ailing president's condition Thursday night. He read from a statement saying that Chavez's lung infection had led to "respiratory deficiency" and required strict compliance with his medical treatment.
The government expressed confidence in the medical team treating Chavez in Cuba.

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Disputes brewing over Hugo Chavez's inauguration

CARACAS, Venezuela (AP) — President Hugo Chavez is due to be sworn in for a new term in less than a week and his closest allies still aren't saying what they plan to do if the ailing leader is unable to return from a Cuban hospital to take the oath of office.
The Venezuelan government on Thursday night described Chavez's lung infection as "severe" and said he is now being treated for "respiratory deficiency."
Chavez hasn't been seen or heard from since his Dec. 11 cancer surgery, and speculation has grown that his illness could be reaching its final stages. The president's elder brother Adan and National Assembly President Diosdado Cabello joined a parade of visitors who saw Chavez in Havana this week, and then returned to Caracas on Thursday along with Vice President Nicolas Maduro.
"In the past hours, we've been accompanying President Hugo Chavez and taking him the courage and strength of the Venezuelan people," Maduro said on television. Appearing next to Cabello visiting a government-run coffee plant in Caracas, he said they had been with Chavez together with the president's brother, his son-in-law Jorge Arreaza, Oil Minister Rafael Ramirez and Attorney General Cilia Flores.
Chavez's health crisis has raised contentious questions ahead of the swearing-in set for Jan. 10, including whether the inauguration could legally be postponed, whether Supreme Court justices might travel to Havana to administer the oath of office, and, most of all, what will happen if Chavez can't begin his new term.
The main fault lines run between Chavez's backers and opponents.
But while the president's allies so far appear united, analysts have speculated that differences might emerge between factions led by Maduro, Chavez's chosen successor, and Cabello, who is thought to wield power within the military and who would be in line to temporarily assume the presidency until a new election can be held.
Standing together on Thursday, Maduro and Cabello said they are more united than ever.
"We've sworn before commander Hugo Chavez, and we've ratified the oath today before commander Chavez, that we're going to be united, together with our people, with the greatest loyalty," Maduro said.
He and Cabello dismissed rumors of divisions waiting to erupt, calling such talk lies cooked up by their adversaries.
"They're going to spend 2,000 years waiting for that to happen," Cabello said, urging Venezuelans: "Don't fall for the opposition's rumors."
"We aren't going to betray the nation," Cabello added.
The former military officer has been making similar assurances on Twitter and suggesting that the socialist party has its plans for the coming days all thought out.
"We Chavistas are very clear on what we will do," Cabello said in one message.
But the plans of Chavez's allies remain a mystery.
The Venezuelan Constitution says the presidential oath should be taken Jan. 10 before the National Assembly, and officials have raised the possibility that Chavez might not be well enough to do that, without saying what will happen if he can't.
Information Minister Ernesto Villegas provided the latest update on Chavez's condition Thursday night.
"Chavez has faced complications as a result of a severe respiratory infection. This infection has led to respiratory deficiency that requires Commander Chavez to remain in strict compliance with his medical treatment," Villegas said, reading from a statement.
The government expressed confidence in Chavez's medical team and condemned what it called "a campaign of psychological warfare" in the international media regarding the president's condition.
Chavez said before his fourth cancer-related operation that if his illness prevented him from remaining president, Maduro should finish his current term and be his party's candidate to replace him in a new election.
The constitution says that if a president or president-elect dies or is declared unable to continue in office, presidential powers should be held temporarily by the president of the National Assembly, who is now Cabello. It says a new presidential vote should be held within 30 days.
Opposition leaders have argued that Chavez, who was re-elected to a six-year term in October, seems no longer fit to continue as president and have demanded that a new election be held within 30 days if he isn't in Caracas on inauguration day.
But some of Chavez's close confidants dismiss the view that the inauguration date is a hard deadline, saying Chavez could be given more time to recover from his surgery if necessary.
Cabello noted last month that the constitution says if a president is unable to be sworn in by the legislature, he may be sworn in by Supreme Court justices, who were appointed by the mostly pro-Chavez legislature.
"When? It doesn't say. Where? It doesn't say where," Cabello recently told a crowd of government supporters. His indication that the constitution does not specify where a president-elect should be sworn in by the Supreme Court has led to speculation that justices could travel to Cuba for the ceremony.
Opposition leaders chafe at the suggestion that Chavez could take office from a foreign country, saying the president made it clear before he left for the operation that his health was deteriorating by designating Maduro as his successor.
Aristobulo Isturiz, a state governor and leader of Chavez's United Socialist Party of Venezuela, said Thursday that if Chavez's swearing-in isn't held Jan. 10, it will be up to the Supreme Court to determine the place and date of the ceremony.
"The president has a right to recover," Isturiz said in remarks published by the state-run Venezuelan News Agency.
More than three weeks after Chavez's cancer surgery, government officials have been providing vague and shifting updates on his condition. Maduro announced over the weekend that Chavez had suffered complications due to a respiratory infection and was in "delicate" condition.
The vice president initially had said he would return from Cuba to Venezuela on Wednesday, but stayed another day while visiting Chavez along with Cabello and others.
Maduro said Chavez's respiratory problems "have seriously affected him."
Still, Maduro expressed hope: "In our hearts, we feel it, sooner rather than later we're going to see commander Hugo Chavez here in his homeland, here with us."
Caracas Mayor Antonio Ledezma, an opposition politician, proposed earlier Thursday that a commission travel to Cuba to determine the state of Chavez's health. He said the delegation should be made up of doctors, lawmakers and other officials such as state governors, including opposition leader Henrique Capriles.
"I'm not asking for permission to go to Cuba. I think it's our right to go there and see what's going on," Ledezma said in comments reported by the television channel Globovision. "Enough mysteries. Venezuela isn't a colony of Cuba."
Some of the brewing disagreements could begin to be aired Saturday, when the National Assembly, which is controlled by a pro-Chavez majority, convenes to select legislative leaders. That session will be held just five days before the scheduled inauguration day.
Law professor Vicente Gonzalez de la Vega agrees with Cabello's view that the constitution is ambiguous regarding the time and place of a swearing-in ceremony before the Supreme Court.
Supreme Court President Luisa Estella Morales said following Cabello's proposal last month that justices could rule on whether it's constitutional to postpone the date of the swearing-in ceremony. The issue has not yet been brought before the court, but Morales said Dec. 20 that the court could take up such issues if asked and would have the final word.
Before Chavez's inauguration date could be postponed, Gonzalez said, lawmakers would have to approve a 90-day extension of Chavez's "temporary absence" granted for his trip to Cuba for surgery. The president of the National Assembly would then be sworn in as an interim president for 90 days, said Gonzalez, a professor at the Central University of Venezuela.
In order for that to occur, though, Gonzalez said the Supreme Court would need to appoint a panel of doctors to examine Chavez to determine whether his health could improve and whether he might be capable of continuing his duties as president.
Opposition leader Ramon Guillermo Aveledo on Wednesday reiterated demands for the government to provide a full medical report.
He said sending a medical team to Cuba to assess Chavez's condition would be an option, if necessary. In the meantime, he said, "There are two keys here to facing this and any situation, which are the truth and the constitution."

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Discover Financial Services 4Q net income rises

Discover Financial Services on Thursday reported higher earnings for its fiscal fourth quarter, as users of its namesake credit card stepped up purchases and the company wrote off fewer unpaid balances.
Even so, the Riverwoods, Ill.-based company's results fell short of Wall Street expectations, and investors sent its shares down over 3 percent Thursday.
Discover, the nation's sixth-largest credit card issuer, said total loans, credit card loans and Discover card sales volume increased 6 percent in the quarter, which coincided with the tail end of the back-to-school shopping season and the ramp up to the December holidays — key periods when consumers traditionally spend more.
Discover card sales volume increased to $26.5 billion, while credit card loans at the end of the quarter totaled $49.6 billion. Private student loans rose 6 percent, while personal loans climbed 24 percent, the company said.
"Our strong receivables and sales growth results demonstrate the effectiveness of our marketing programs, consumers' preference for cash rewards and our acceptance and awareness initiatives," Chairman and CEO David Nelms said during a conference call with analysts.
While Discover's customers racked up more debt, more of them paid off credit card balances on time. The delinquency rate on credit-card loans over 30 days past due was 1.86 percent, an improvement of 53 basis points from a year earlier. The rate of charge-offs, when the company writes off unpaid credit card balances, dropped to a historic low of 2.29 percent.
"While the continued improvement in credit appears to be nearing an end, we don't believe we are at a point where charge-offs are poised to rise significantly," Nelms said.
Nationwide the rate of credit card payments at least 90 days overdue edged up in the third quarter to 0.75 percent, according to credit reporting agency TransUnion. The rate is coming off historically low levels, however.
Discover has traditionally had one of the lowest rates for default and delinquency in the credit card industry, the result of tighter lending standards and close monitoring of problem accounts.
The company has reported improvement in its customers' default and late-payment rates since the Great Recession, as cardholders moved to pay down debt and boost savings.
Late-payment rates tend to creep higher in the fall, particularly as cardholders spend more money on holiday shopping, travel and other expenses. The company said that seasonal factor led to a slight increase in its credit card loan delinquency rate between the third and fourth quarter.
While Discover's rates for late payments and defaults remain low, the company has been making more loans. As a result, it has been setting aside more funds to cover potential loan losses.
In the September-to-November quarter, Discover increased its provision for loan losses by 6 percent to $338 million, noting that was somewhat offset by a drop in the number of unpaid credit card balances that had to be written off.
Meanwhile Discover's payment-services business, which competes with Visa and MasterCard, saw dollar volume increase 13 percent in the latest quarter.
In a client note Thursday, RBC Capital Markets analyst Jason Arnold said Discover is benefiting from increased acceptance of its cards and favorable credit trends.
"We remain very enthused by Discover's fundamental position and believe the company remains well positioned for loan and (earnings per share) growth," wrote Arnold, who has a $50 price target on the stock.
For the period ended Nov. 30, Discover earned $541 million, or $1.07 per share. That compares with $513 million, or 95 cents per share, a year earlier.
Analysts surveyed by FactSet expected earnings of $1.12 per share.
Revenue climbed 11 percent to $2 billion, after interest expense. Wall Street forecast $1.96 billion.
Also on Thursday, Discover declared a dividend of 14 cents per share. It will be paid on Jan. 17 to shareholders of record on Jan. 3.
Discover shares fell $1.36, or 3.4 percent, to close at $38.41 Thursday. The stock is up 60 percent this year.

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RIM shares fall at the open after earnings

TORONTO (Reuters) - Research In Motion Ltd fell in early trading on Friday following the BlackBerry maker's Thursday earnings announcement, when the company outlined plans to change the way it charges for services.
RIM, pushing to revive its fortunes with the launch of its new BlackBerry 10 devices next month, surprised investors when it said it plans to alter its service revenue model, a move that could put the high-margin business under pressure.
Shares fell 16.0 percent to $11.86 in early trading on the Nasdaq. Toronto-listed shares fell 15.8 percent to C$11.74.

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