Friday, 5 October 2012

Crimean-Congo Viral Haemorrhagic Fever case in Glasgow


Crimean-Congo Viral Haemorrhagic Fever case in Glasgow

GartnavelThe patient is being treated at the specialist Brownlee unit at Gartnavel General Hospital

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A man is being treated in complete isolation in Glasgow after being confirmed as having Crimean-Congo Viral Haemorrhagic Fever.
The 38-year-old man is said to be in a critical condition in the city's specialist Brownlee unit.
He was admitted to hospital less than three hours after returning to Glasgow on Emirates flight EK027 from Dubai.
The tick-borne tropical disease, which is rare in Western Europe, is fatal in up to 30% of cases.
The Brownlee unit at Glasgow's Gartnavel General Hospital specialises in infectious diseases.
NHS Greater Glasgow and Clyde said the risk of person-to-person transmission of the virus is extremely low.
However, as a precautionary measure those who have been in close contact with the patient are being contacted to ensure that there has been no transmission.

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We are confident that his close contacts subsequently within the city were minimal”
NHS Greater Glasgow and Clyde
This includes tracing three of his fellow passengers on the flight from Dubai to Glasgow which arrived at 12:35 on Tuesday.
They were seated in close proximity to him on the flight. The three passengers are being contacted directly as a precaution to ensure that there has been no transmission.
The risk to all other passengers on the flight is said to be very low, but if they have any concerns they should contact NHS24 on 08000 85 85 31for advice.
A spokesman for the health board said: "Given the fact that this man went into the care of the NHS within three hours of his flight arrival in Glasgow and travelled directly home via private transport from the airport we are confident that his close contacts subsequently within the city were minimal.
"We have also identified all NHS staff, airport and airline staff who have had contact with the patient and any necessary follow-up action will be taken."
Dr Syed Ahmed, the board's Consultant in Public Health, said the virus can only be transmitted by direct contact with infected blood or body fluids. It is not transmitted through the air.
He added: "Crimean Congo Viral Haemorrhagic Fever (CCHF) is a widespread tick-borne viral disease.
"It is not common in Western Europe but is endemic in parts of eastern and southern Europe, central Asia, Africa, the Middle East and the Indian subcontinent.
"As soon as laboratory sampling confirmed that the patient was suffering from this virus all the appropriate agencies were informed."
Body fluids
CCHF is a widespread tick-borne viral disease, a zoonosis of domestic animals and wild animals, that may affect humans.
Outbreaks of illness are usually attributable to contact with blood or body fluids from infected animals or people.
The onset of CCHF is sudden, with initial signs and symptoms including headache, high fever, back pain, joint pain, stomach pain, and vomiting.
Red eyes, a flushed face, a red throat, and petechiae (red spots) on the palate are common.
Symptoms may also include jaundice, and in severe cases, changes in mood and sensory perception.
As the illness progresses, large areas of severe bruising, severe nosebleeds, and uncontrolled bleeding at injection sites can be seen, beginning on about the fourth day of illness and lasting for about two weeks.
Crimean-Congo hemorrhagic fever is found in Eastern Europe, particularly in the former Soviet Union.
It is also distributed throughout the Mediterranean, in northwestern China, central Asia, southern Europe, Africa, the Middle East, and the Indian subcontinent.

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Wednesday, 3 October 2012

expert consultant surgeon,Dr Syed Naqvi

Expert tells probe into surgeon’s treatment of mum-of-13 ‘straightforward operation went wrong’
AN expert consultant surgeon told an inquiry probing the treatment of a mother-of-13 who died that she had been booked in for a "straightforward" operation which "went wrong".By Louise Hogan 
Syed Naqvi is facing 11 allegations of professional misconduct and/ or poor professional performance

Wednesday October 03 2012
Dr Syed Naqvi, who was a consultant surgeon at the Mid West Regional Hospital in Ennis, has been called before a Medical Council fitness to practise hearing on 11 allegations in relation to the care of Tina Sherlock (39).
Mrs Sherlock was 17 weeks pregnant with her 14th child when she visited the emergency department of the hospital on June 22, 2008, complaining of pain in her right side. Medical staff considered she may be suffering from an inflamed gall bladder – it was not until November, almost five-months later, that she was diagnosed with appendicitis following CT scan results.
She lost the baby girl in July. Mrs Sherlock died from multi-organ failure due to sepsis on December 10, 2008 – this followed three operations at the hospital.
The expert witness for the Medical Council, UK consultant surgeon Anthony Peel, was critical of numerous aspects of the operations.
Mr Peel said the first operation carried out by Mr Naqvi at the hospital on November 22, 2008 “should have been a straightforward procedure” but something “went wrong”. Mr Naqvi operated to remove the ‘mass’ in the appendix shown in the CT scan, and a part of her upper bowel was removed. The inquiry heard there was leaking of bowel contents from the wound following the surgery.
Mr Peel said there were two reasons for the leaking to occure either “poor technique” in the operation or “disease in the bowel itself”, and he pointed out there were no signs of bowel disease.
The expert witness said a CT scan should have carried out to try and identify the problem or source of the leak before two follow-on operations.
The inquiry heard the patient would have had to be transferred for the CT scan of her stomach area to the Mid Western Regional Hospital, Dooradoyle, Limerick as there was no CT scan at the Ennis hospital.
Mr Peel said he believed the failure to arrange the CT scan to identify the problem before the second operation on December 3, 2008, amounted to professional misconduct.
Eileen Barrington, SC for Mr Naqvi, said consultants at Ennis had been complaining about the lack of a CT facility at the hospital for a number of years and it was a “lengthy process” to obtain a CT scan from Limerick.
Ms Barrington said Mrs Sherlock’s symptoms had indicated a “wound infection” and the surgeon was operating on that basis. However, Mr Peel argued the vomiting, pain and level of leaking from the wound may have indicated there was a “more serious problem” and a CT scan should have been obtained.
The inquiry heard that prior to their retirement two of Mr Naqvi’s consultant colleagues had written to the Minister for Health and Medical Council seeking advice about the lack of consultant staff and inadequate facilities.
In September 2009, the A&E at Ennis was closed following a probe by HiQA.
The inquiry heard Mr Naqvi would be defending all the allegations of professional misconduct and/or poor professional performance.
The inquiry continues.
- Louise Hoga

Martina Sherlock, Childers Road, Ennis, died on 10 December, 2008, after three operations.
Ennis consultant surgeon Syed Naqvi is facing 11 allegations of professional misconduct and/ or poor professional performance.
The surgeon, who qualified in Pakistan, has worked in Ireland since 1985.
Ms Sherlock was 17 weeks pregnant when she first attended the Mid-Western Regional Hospital, Ennis, complaining of abdominal pain on her right side.
The inquiry has heard she was wrongly diagnosed with an inflamed gallbladder.
She had a miscarriage on 15 June due to septicaemia, after transfer to the Mid-Western Regional Maternity Hospital, Limerick.
It was not until 18 November following a CT scan organised at the Mid-Western Regional Hospital, Dooradoyle, that appendicitis was diagnosed.
Ms Sherlock underwent three operations under Dr Naqvi at Ennis on 21 November, 3 December and 8 December.
It is alleged that the surgeon performed an inappropriate operation on 8 December, that he failed to arrange CT scans, failed to make provision for a transfusion, failed to ensure Ms Sherlock was adequately resuscitated after the last operation, and failed to arrange for her transfer to Limerick regional in good time.
Senior counsel for Dr Naqvi, Eileen Barrington told the inquiry that doctors at Ennis hospital have written to the Council to say safety was at risk due to the absence of a CT scanner and other equipment.
Doctors had to send patients to Limerick regional for such scans.
Giving expert evidence today for the Medical Council, London surgeon Anthony Peel said what should have been a straightforward procedure on 21 November went wrong.
Mr Peel said that after the first operation on 21 November, Dr Naqvi should have organised a CT scan for Mrs Sherlock.
He said doctors have to battle hard to get what patients need and a CT scan in this case was mandatory.
Following an investigation by the Health Information & Quality Authority in late 2008, the hospital was found to be unsafe for acute emergency care and the Emergency Department was closed.
This is the second day of the inquiry, which is scheduled for three days.
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Monday, 1 October 2012

new deadly Salmonella


Monday, 1 October 2012

new deadly Salmonella


HIV 'made' new deadly Salmonella - study

By James GallagherHealth and science reporter, BBC News
SalmonellaA new strain of deadly Salmonella may have emerged in the wake of HIV

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An epidemic of a deadly strain of Salmonella has swept across the whole of Africa by "taking advantage" of the spread of HIV, according to an international team of researchers.
Their study, published in Nature Genetics, is the first to identify the separate cases as a single epidemic.
One in four people in Africa infected with the strain died.
It is thought to be the first time a single strain of an infection has spread so widely in the wake of HIV.
Cases of this form of invasive non-typhoidal Salmonella have been recognised in Africa for more than a decade. It causes fever, headaches, respiratory problems and sometimes death.

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It quite clearly parallels the emergence of HIV in Africa”
Prof Gordon DouganSanger Institute
The research team analysed the genetic code of 179 batches of Salmonella from different parts of Africa and the rest of the globe. Using techniques similar to a large-scale DNA paternity test, they were able to construct the strain's "family tree" and then how it spread.
It happened in two waves. The first started in south-eastern Africa about 52 years ago and the second wave started 35 years ago from the Congo Basin.
Prof Gordon Dougan, from the Sanger Institute in Cambridge in the UK, told the BBC: "It quite clearly parallels the emergence of HIV in Africa."
HIV attacks the immune system and leaves people more vulnerable to other infections. It is thought the strain of Salmonella Typhimurium took advantage of this weakness and spread. The research team said the bacterium was given the chance to "enter, adapt, circulate and thrive".
There is poor monitoring data for the disease across the whole of the continent, but Prof Dougan said it was affecting "thousands and thousands" of people and that 98% of adult cases were in people with HIV.

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It's actually quite a huge problem and it seems to be getting worse because there are many susceptible people, it's got a grip in Africa”
Prof Brendan WrenLondon School of Hygiene and Tropical Medicine
He said this spread of Salmonella Typhimurium had been different to that of other infections commonly associated with HIV, as it had been a single epidemic "people were completely unaware" of and there "were not really any other examples" of that happening.
Dr Melita Gordon, a gastro-enterologist at the University of Liverpool, said: "It's the first time this has been described right across a continent in such an obvious way."
She added: "The highest mortality associated with the disease is 80%. What's happened over the years is mortality has fallen down and down and down to between 20% and 25% as doctors inside Africa recognise it."
The genetic analysis also showed the strain was resistant to the first choice antibiotic, chloramphenicol, which means more expensive drugs would be needed to treat the infection.
It is thought that improving HIV treatment across Africa could reduce the prevalence of the Salmonella infection, as it would reduce the number of people with vulnerable immune systems. However, the researchers urged "vigilance" in case the Salmonella strain mutated again to become able to infect people with healthy immune systems.
Commenting on the study, Prof Brendan Wren, from the London School of Hygiene and Tropical Medicine, told the BBC: "It's actually quite a huge problem and it seems to be getting worse because there are many susceptible people, it's got a grip in Africa.
"HIV, I think it's fair to say, provided a springboard for it to take off."
However, he thought the disease was "near its peak" as HIV was more controlled in other continents giving it little room to spread.

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Sunday, 30 September 2012

Criticising hospital


Do hospitals cater for patients with special diets?

A hospital mealThe same hospital meal will not work for every patient
food is a British pastime. But what if you have a special dietary need, which is a necessity rather than a choice? Does hospital food cater for you?
Kathleen, 74, who lives in the Midlands, has had coeliac disease since she was about four years old. This means she cannot eat anything containing gluten, such as bread, cereals, pasta and cake. Even things like soups, sauces and sausages can be off limits.
When she was in hospital a few years ago, she was shocked by the food she was served.
"I was offered toast, but I can't eat that. I need gluten-free bread. They didn't have the porridge oats which I can eat, so I ended up with a boiled egg."
And the subsequent meals did not improve either, despite the fact Kathleen had confirmed she was coeliac when she was first admitted.

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There should be a protocol of what to do when someone on a special diet comes in.”
Eileen SteinbockBritish Dietetic Association
"Lunch was fish fingers, which I couldn't eat because of the breadcrumbs. They asked me why I couldn't just pick them off.
"At dinner time they put gravy on my dinner and a Yorkshire pudding on the plate too. Because of the contamination risk, I couldn't eat any of it."
'Frustrating'
Kathleen is not just being fussy. She, like one in 100 people in the UK, cannot take gluten because it causes damage to the gut lining and triggers a reaction that makes the body's immune system attack its own tissues. This can lead to abdominal pain, chronic diarrhoea and nausea, although the symptoms can vary from person to person.
Even one breadcrumb can be enough to contaminate a whole plate of food.
"It was frustrating. In hospital I was supposed to be in a place full of medical experts - and yet there was this ignorance."
Across the country, hospitals' catering systems can differ significantly and the quality of the caterers can too. This means there is no standard approach to dealing with particular dietary needs.
Staff on the wards cannot be presumed to have heard of gluten-free diets and intolerances, or understand the consequences of eating the "wrong" things.
Even some hospital dieticians may not have the knowledge required to deal with particular diets.

WHAT IS COELIAC DISEASE?

Bread
  • It is an autoimmune disease
  • Gluten, which is found in wheat, barley and rye, triggers an immune reaction in people with it
  • Eating gluten damages the lining of the small intestine, and other parts of the body can be affected
  • It is thought one in 100 people in the UK have coeliac disease. but a lot are not diagnosed
  • There is no cure and the treatment is a lifelong gluten-free diet, but there is research to develop a vaccine
  • The effect of eating gluten varies from person to person but can include headaches, diarrhoea, stomach pains and lethargy
Golden triangle
Eileen Steinbock, from the British Dietetic Association's Food Counts group, which has looked at improving nutrition in hospitals, says what matters most is communication between caterers, dieticians and staff on the wards.
"It's like a golden triangle. If it's not working well, then they can't advise each other on what to cook, what food is suitable and what to serve."
The process should start when the patient is admitted, she says.
"There should be a protocol of what to do when someone on a special diet comes in. And when menus are planned, those diets should be thought about."
When a patient who is coeliac has a planned hospital admission, then it is easier to deal with their food needs than a patient who is admitted in an emergency. Often, their access to gluten-free food relies on the hospital caterers having a range of appropriate foods stored in a cupboard or freezer.
Ms Steinbock encourages patients to communicate their needs too.
"If a patient doesn't feel they are getting what they should be, they can always ask to see a dietician and speak to the caterers. They will be happy to come and talk to them."
Hospitals do not have a dietician on every ward all the time, so getting the message through can take a bit of perseverance.
New guidance
To try to improve the situation, the charity Coeliac UK has recently launched some training courses for caterers to help those working in kitchens in hospitals, care homes and big companies understand the dietary needs of a coeliac.
Sarah Sleet, chief executive of Coeliac UK, says hospital caterers became worried about labelling their food gluten-free after stricter criteria were introduced in January.
In turn, this led to more complaints from coeliac patients that they could not access gluten-free food. She says this is being solved thanks to a new policy that is now in place.
"All coeliacs have a right to have a gluten-free meal provided - it's a core part of your health. Not providing it is equivalent to denying someone their drugs - it's not a choice to be coeliac."
Ms Sleet does recognise, however, that catering for all special dietary needs is a complex problem to address. As a result, the charity has worked with the Hospital Caterers Association to come up with advice and guidance.
While some hospital caterers provide excellent catering for patients with particular diets, some still have a way to go before patients like Kathleen can rest easy in their hospital beds.
"Going into hospital is a stressful experience anyway," says Ms Sleet.
"It's even more worrying if the food in front of you is damaging - and not eating is not good for anyone's recovery."

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Thursday, 27 September 2012

Keith Vaz, said: "I do not believe it's a race issue but Mr Danczuk said: "It would be daft not to believe that race plays a part"


Rochdale child sex trial: Case 'has race element', says MP

Simon DanczukSimon Danczuk, Labour MP for Rochdale, said: "I don't think it is a racial crime but race is involved."
Nine men have been jailed for being part of a child sex ring in Rochdale which groomed girls for sex.
Greater Manchester Police (GMP) said the case was about "adults preying on vulnerable young children" and not race.
The nine defendants, eight of Pakistani origin and one from Afghanistan, received sentences of between four and 19 years at Liverpool Crown Court.
Jailing them, Judge Gerald Clifton, said: "All of you treated (the victims) as though they were worthless and beyond any respect.
"One of the factors leading to that was the fact that they were not part of your community or religion."
Police maintained throughout the trial that the offences were sexually motivated and not racially motivated.
GMP Assistant Chief Constable Steve Heywood said: "It just happens that in this particular area and time, the demographics were that these were Asian men."
'Under the radar'
Mr Danczuk said: "There is a subculture of a small group of males that are Asian, that are collaborating to abuse young white girls who are vulnerable.
"The subculture is under the radar. Some people in communities are in denial about it but we need some home truths if we are going to address this.
"It would be daft not to believe that race plays a part."
Labour MP and chair of the Home Affairs Select Committee Keith Vaz, said: "I do not believe it's a race issue."
His belief, he said, was based on ACC Heywood's comments and evidence from the Deputy Children's Commissioner Sue Berelowitz.
She said the problem of men grooming young girls and boys for sex was not a problem confined to the Pakistani community and it was happening across every single religious and ethnic group.
"What we need to do is to have a far reaching investigation into these crimes and the causes of these crimes," said Mr Vaz.
Martin Narey, former head of the Prison Service, said: "Sex offenders are overwhelmingly white and I think there is evidence that those guilty of online grooming are overwhelmingly white but for this particular sort of crime, the street grooming and trafficking of girls in northern towns - Derby, Leeds, Blackpool, Blackburn, Oldham and Rochdale - there is disturbing evidence that Asians are overwhelmingly represented in the prosecutions for such offences."
'Emotive subject'
"Most Asians would abhor what we have seen in the Rochdale trial," he added.
Mr Narey, who is also a former chief executive of children's charity Barnardo's, said: "I spent my last two or three years in Barnardo's listening to people muttering about the reality of this but not wanting to say anything publicly."
IIrfan Chishti, from the Rochdale Council of Mosques, which represents 14 mosques in the town, said that to say street grooming was a racial issue was too simplistic.
"Race is one element in this case," he said. "But what I want to focus on is the many other issues, that of criminality, exploitation and the vulnerability of our young children."
Five girls gave evidence in the Rochdale case but police believe up to 47 may have been involved.
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NHS if it is to cope.


NHS 'could get worse from 2013'

By Nick Triggle
Health correspondent, BBC News
Surgical operationMinisters maintain the NHS is performing well despite the pressures

Changing NHS

Fresh fears are being raised in England that cuts will have to be made to the front line of the NHS if it is to cope.
The government has promised to protect the health service, but research by the King's Fund, based on interviews with 45 NHS finance chiefs, raises doubts.
The think tank said 19 expected care to get worse over the next few years and that 2013 could mark the turning point.
Meanwhile, a BBC survey of 1,005 people suggested 60% believed services would have to be cut.
The majority of the 45 NHS directors of finance who took part in the think tank's study said they were currently managing to make savings without harming care.
The King's Fund said these sentiments were supported by the latest performance statistics which showed the NHS was performing well.
Waiting times in A&E and for non-emergency operations, such as knee and hip replacements, had fallen slightly and were well within target, while hospital infections rates continued to drop.
'Strain on services'
But 2013 was seen as the year when it could start to unravel by many of the finance directors.

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There are signs that future years will be harder. The end of the public sector pay freeze next April may add to financial pressure and increase the strain on services”
John ApplebyKing's Fund
A total of 27 of the 45 managers who took part in the online questionnaire said there was now a high or very high risk that NHS would not meet its savings targets of £20bn by 2015.
Nineteen of the panel said they expected care to worsen over the next few years, with only eight believing it would get better.
The BBC poll, carried out by ComRes, asked members of the public in England a series of questions about the NHS.
Some 61% agreed that they expected the NHS would have to stop providing some treatments and services in the future due to rising costs and increasing demands.
Nearly three-quarters also said they did not trust the government with the health service.
Over half of respondents said it did not matter whether private firms provided care as long as it was free of charge - the government's reforms have come under heavy criticism amid a perception they would lead to greater private sector involvement.
NHS 'on track'
Prof John Appleby, chief economist at the King's Fund, said: "There are signs that future years will be harder.
"The end of the public sector pay freeze next April may add to financial pressure and increase the strain on services.
"The difficulty will be finding ways to absorb these costs without compromising the quality of care for patients."
But health minister Lord Howe maintained the NHS was "on track" to achieve its savings target.
He said £5.8bn was saved last year, while performance remained good.
"Waiting times have been kept low, infections have been reduced, there are more doctors, more diagnostic tests and more planned operations," he added.
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