Friday 28 August 2015

Five million adults in England 'at risk of diabetes'

Five million adults in England 'at risk of diabetes'

  • 26 August 2015
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  • From the sectionHealth
Blood test
Image captionPublic Health England analysed blood-sugar levels to estimate the number of people at risk of developing type-2 diabetes
Up to five million people in England are at risk of developing type-2 diabetes, according to new data from Public Health England.
Type-2 diabetes is closely linked to diet and obesity and affects about 3.2 million people across the UK.
The NHS says diabetes causes 22,000 early deaths and costs the health service more than £8bn each year.
But health experts believe more than a quarter of people can reduce the risk of developing the condition.
Diabetes arises when the body loses the ability to use or make insulin, a hormone that helps regulate the amount of sugar in blood.
Public Health England (PHE) says its latest analysis shows about five million adults in England are now pre-diabetic, also known as non-diabetic hyperglycaemia.
That means they are at risk of developing type-2 diabetes.
Public Health England says its calculations have produced the most accurate and robust estimate so far.
Last year, research published in the British Medical Journal suggested a much higher figure - one third of all adults in England - and the charity Diabetes UK quotes a UK-wide figure of about 18 million people at risk of developing diabetes.
But these calculations used a broader definition of pre-diabetes than that used in this latest analysis.
Some doctors have questioned the value of the pre-diabetic diagnosis, arguing that only a small number - perhaps one in 10 - will go on to develop diabetes.

Diet and exercise

But the NHS is preparing to roll out a diet, weight loss and exercise programme that has been shown to reduce the diabetes risk for a quarter of those who take it up.
PHE chief executive Duncan Selbie said people needed support if they were to combat the risk posed by type-2 diabetes.
"We know how to lower the risk of developing type-2 diabetes: lose weight, exercise and eat healthily, but it's hard to do it alone," he said.
"PHE's evidence review shows that supporting people along the way will help them protect their health, and that's what our prevention programme will do."
Diabetes UK chief executive Barbara Young said it was important to warn people about a condition that could have devastating complications such as blindness, amputations and early death.
"As well as helping to reduce the human cost of type-2 diabetes, this would also go a long way to helping to reduce costs to the NHS," she said.
"The NHS spends 10% of its entire budget managing diabetes And unless we get better at preventing type-2 diabetes, this figure will rise to unsustainable levels."

Related

Brain cells 'burn out' in Parkinson's disease

Brain cells 'burn out' in Parkinson's disease

Parkinson's disease: computer artwork of neurones
Brain cells in Parkinson's disease exhaust themselves and die prematurely, burning out like an "overheating motor", an early study suggests.
Canadian researchers say the findings might help explain why only small parts of the brain are affected in the disease.
Parkinson's is caused by a loss of nerve cells in certain areas of the brain - but why these cells are vulnerable has been a mystery.
The work appears in Current Biology.

Tremor and stiffness

An estimated 127,000 people in the UK have Parkinson's disease, which can lead to a pronounced tremor, slow movement, and stiff and inflexible muscles.
In this paper, scientists from the University of Montreal studied the disease in mice cells.
They found, unlike other similar brain cells, neurons most often involved in Parkinson's disease were complex and had many more branches.
The cells also had much higher energy requirements, producing more waste products as they met this need.
Researchers suggest it is the accumulation of these waste products that triggers cell death.
Prof Louis-Eric Trudeau said: "Like a motor constantly running at high speed, these neurons need to produce an incredible amount of energy to function.
"They appear to exhaust themselves and die prematurely."
The team hope this finding may help create better experimental models of Parkinson's and identify new treatments.

'Rekindle interest'

They suggest, for example, that medication could one day be developed to help reduce the energy requirement of cells or increase their energy efficiency.
Dr Arthur Roach, at the charity Parkinson's UK, said:"Out of the billions of cells in the brain, it is always the same small group that degenerate and die in Parkinson's. We don't know why only these cells are affected.
"This study provides strong support to the idea that it is the unique structure and function of these cells that makes them especially susceptible to a damaging process called oxidative stress.
"We hope that this study will rekindle interest in the approach, and even lead to new treatments based on the most up-to-date ideas about oxidative stress."

Thursday 27 August 2015

Blood test 'detects cancer relapse'

Blood test 'detects cancer relapse'

Breast cancer cells
A blood test may be able to save lives by finding cancers that have started to grow again after treatment, a study suggests.
Scientists at the Institute of Cancer Research in London found traces of breast cancer eight months before doctors would normally have noticed.
In the trial, the test found 12 cancers out of the 15 women who relapsed.
Experts said there was still some way to go before there was a test that could be used in hospitals.
Surgery to remove a tumour is one of the core treatments for cancer.
However, a tumour starts from a single cancerous cell. If parts of the tumour have already spread to another part of the body or the surgeon did not remove it all then the cancer can return.

Relapse

Fifty-five patients who were at high risk of relapse because of the size of the tumour were followed in the study published in Science Translational Medicine.
The scientists analysed the mutated DNA of the tumour and then continued to search the blood for those mutations.
Fifteen patients relapsed and the blood test gave advanced warning of 12 of them.
The other three patients all had cancers that had spread to the brain where the protective blood-brain barrier could have stopped the fragments of the cancer entering the bloodstream.
The test detected cancerous DNA in one patient who has not relapsed.
Breast cancer in the blood
Image captionCancerous tissue can be detected when it enters the bloodstream
None of the women in the study were told that cancerous material had been detected as it would have been unethical to base decisions on such an unproven prototype.
But the hope is that detecting cancer earlier means treatments including chemotherapy can start sooner and improve the odds of survival.
Dr Nicholas Turner, one of the researchers, told the BBC News website: "The key question is are we identifying that these women are at risk of relapse early enough that we could give treatments that could prevent the relapse?
"That is unknown from this research and we hope to address it in future studies.
"[But] we're really talking about a principle that could potentially be applied to any cancer that has gone through initial treatment for which there's a risk of relapse in the future."

More work needed

The analysis of the blood is relatively cheap. However, investigating the DNA of the tumour for mutations in the first place is still expensive.
The price is coming down as the field of cancer medicine moves from treating tumours in whichever part of the body they are discovered, towards drugs that target specific mutations in tumours.
Dr Nick Peel, from Cancer Research UK, said: "Finding less invasive ways of diagnosing and monitoring cancer is really important and blood samples have emerged as one possible way of gathering crucial information about a patient's disease by fishing for fragments of tumour DNA or rogue cancer cells released into their bloodstream.
"But there is some way to go before this could be developed into a test that doctors could use routinely, and doing so is never simple."

Friday 12 June 2015

Prion diseases can be passed on by eating infected tissue

Thursday June 11 2015
The practice of brain eating lead to an epidemic of kuru – a CJD-like disease
CJD is caused by prions (abnormally folded proteins)
“Eating brains helped Papua New Guinea tribe become disease resistant,” The Daily Telegraph reports.
Some of the Fore people, who used to eat the brains of dead relatives as a mark of respect, may have developed resistance to prion diseases such as Creutzfeldt Jacob disease (CJD).
Prion diseases occur in humans and animals, and are caused by a build-up of abnormally folded proteins in the brain. Prion diseases can be passed on by eating infected tissue, such as beef that has been exposed to prions. This is known as bovine spongiform encephalopathy (BSE, or “mad cow disease”). There is currently no cure for prion diseases.
A tribe in Papua New Guinea were nearly wiped out by a prion disease called kuru. The infection was spread as a result of their tradition of eating the brains of deceased relatives at their mortuary feasts. Some people were resistant to the infection, and this was thought to be due to a mutation called V127 in the gene encoding the prion protein.
This study used genetically modified mice to test whether this genetic mutation was protective against kuru and CJD. The tests showed that mice with this genetic mutation were indeed resistant to these prion diseases.
The results suggest that this mutation could be responsible for the kuru resistance seen in the survivors. It is hoped this finding may eventually help to develop effective treatments for prion diseases, but much more research will be needed to get to that point.

Prions

Prions are abnormally folded proteins, which, like viruses, bacteria and fungi, can cause infections, which are (to the best of our knowledge) universally fatal.
Unlike viral, bacterial, fungi or human cells, prions do not contain a nucleus (a core of genetic material). This had led to some debate as to whether we can actually classify a prion as a living organism.
Prions are extremely tough and can withstand extreme heat and cold, and are resistant to all antimicrobial medications. They can also survive in dead tissue. 

Where did the story come from?

The study was carried out by researchers from UCL Institute of Neurology and the Papua New Guinea Institute of Medical Research. It was funded by the UK Medical Research Council.
The study was published in thepeer-reviewed medical journal Nature.
As you would expect, talk of brain-eating cannibals caught most of the media’s attention (and ours as well), but some of the headlines gave a misleading impression.
For example, The Telegraph’s headline that “Eating brains helped Papua New Guinea tribe become disease resistant” is inaccurate. Brain eating did not cause the mutation in the gene that then provided resistance to the disease. In fact eating brains nearly wiped out the tribe as Kuru mainly affected women of childbearing age and children. The tribe was saved by stopping the cannibalism in the late 1950s.
The actual beneficial effect was due to what is called “selection pressure”. This is where people with certain characteristics help them to resist the disease, such as the mutation discussed in the study, as are more likely to survive and have children themselves, leading to more people carrying the mutation.

What kind of research was this?

This was an animal study involving mice. The researchers aimed to further their understanding of prion diseases, such as CJD.
Prion diseases occur in humans and animals, and are caused by an abnormal form of a naturally occurring protein called a prion. The faulty prions replicate and convert other proteins, in a chain reaction. The abnormal prions have a different shape to the normal protein; this makes them more difficult for the body to break down, so they accumulate in the brain. The prions cause progressive brain and nervous problems with communication, behaviour, memory, movement and swallowing. These problems eventually lead to death, and there is currently no cure.
There are different types of prion diseases. Some can be inherited, while others occur by chance through a genetic mutation, and others are passed on to other people during medical procedures using contaminated equipment or body parts, or through eating contaminated food. The disease can take years to develop.
One of these prion diseases is called kuru, and occurred in a remote area in Papua New Guinea. The disease was spread by the custom of eating the brain tissue of relatives after death. Previously, the researchers discovered that some of the people who survived had a genetic variation, which led to the production of a slightly different version of the prion protein. They thought this might be what was protecting these people from the kuru infection. People (and mice) carry two copies of every gene, one inherited from each parent. In these people, one of the copies of the gene carrying instructions for making the prion protein changed, which led to the protein having one of its building blocks (amino acids) altered from guanine (G) to valine (V). This change was called V127.
In this study, the authors wanted to test whether V127 stopped mice from getting prion diseases.

What did the research involve?

Mice were genetically engineered to have the human prion protein. The mice were generated to have the following versions of the prion protein genes:
  • two copies of the V127 prion protein gene
  • one copy of V127 and one normal copy (G127)
  • two copies of the normal G127 form of the gene
Each group of mice were individually injected into the brain with infectious tissue from different sources. The tissue used came from four people who had kuru, two people with variant CJD and 12 people with classical CJD.
The researchers then looked at which mice went on to develop the prion diseases.

Types of CJD

Different types of CJD include:
  • Sporadic CJD – this is the most common type of CJD, accounting for around 8 in every 10 cases, although it is still very rare; it is unknown what causes sporadic CJD.
  • Variant CJD – this is the type of CJD associated with bovine spongiform encephalopathy (BSE or “mad cow disease”), though not everyone exposed to BSE-infected meat will go on to develop vCJD.
  • Familial or inherited CJD – This very rare form of CJD is caused by an inherited mutation (abnormality) in the gene that produces the prion protein.

What were the basic results?

Mice with two copies of V127 were completely resistant to infection from all 18 human prion disease cases tested. Mice with one copy of V127 were resistant to kuru and classical CJD, but not variant CJD. Mice with both copies of the normal G127 gene were infected by all of the prion diseases tested.
Variant CJD is the form thought to be caused by consuming meat infected with bovine spongiform encephalopathy (BSE), while sporadic and familial CJD is not. These last two types are often grouped together as “classic CJD”.

How did the researchers interpret the results?

The researchers concluded that the V127 gene appears to give resistance to prion disease. They say that “understanding the structural basis of this effect may therefore provide critical insight into the molecular mechanism of mammalian prion propagation”. This could then lead to the development of treatments against such diseases.

Conclusion

This interesting piece of research has found that a mutation in the gene carrying the instructions for making the normal prion protein can prevent infection with prion diseases such as CJD and kuru in a mouse model.
This mutation had been initially found in survivors of the kuru prion disease in Papua New Guinea, so this supports the theory that this mutation could be why these people survived. The presence of the disease would have “naturally selected” people who carried any genetic variations or other characteristics that protected them from the disease. This means these people would be more likely to have children and pass on this resistance.
As this research was done on mice, the usual caveats apply: that the results may not be found in humans. However, it does support the findings we have from a natural disease epidemic in humans, and it would be unethical to carry out human experiments to test the theory.
This is not the first genetic variation linked to resistance to prion diseases, but adds to what is known about them. It is hoped this greater understanding may enable future research to develop effective treatments for prion diseases, as there are none at present.
If you or a relative have been affected by a prion disease, counselling is available at the National Prion Clinic. This can be in person or over the phone.
Analysis by Bazian. Edited by NHS ChoicesFollow Behind the Headlines on TwitterJoin the Healthy Evidence forum.

Tuesday 9 June 2015

blood pressure



 
 
content provided by NHS Choices

Wednesday 20 May 2015

Victorino Chua

Victorino Chua
The Filipino father-of-two was first arrested in January 2012
Nurse Victorino Chua, found guilty of murdering and poisoning patients at Stepping Hill Hospital, has been jailed for a minimum of 35 years.
Chua killed Tracey Arden, 44, and Derek Weaver, 83, at the hospital in Stockport by injecting insulin into saline bags and ampoules.
The father-of-two was convicted on Monday following a three-month trial.
Judge Mr Justice Openshaw described Chua as an "experienced nurse who used cunning" to poison patients.
He was found guilty of tampering with saline bags and ampoules while working on two acute wards at the hospital in Greater Manchester, in June and July 2011.
These were unwittingly used by other nurses, causing a series of insulin overdoses to mainly elderly victims.
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Relatives of Derek Weaver described Chua as 'evil' and said they were 'delighted' with the verdict
Detectives described Chua as a narcissistic psychopath.
His victims' families were at Manchester Crown Court as Chua was told he would serve at least 35 years in prison before being considered for parole.
Speaking outside court after the verdict, Mr Weaver's sister, Lynda Bleasdale, said: "My sister had a heart attack the day before Derek died. Seeing all the stress of it was obviously a contributory factor to that."
She said Chua "obviously enjoyed watching people suffer".
Gary Arden, whose sister Tracey was murdered by Chua, said he felt "surprisingly nothing" for his sister's killer.
He added: "He's been sentenced and the important thing is he's not able to do this to anybody else."
Tracey Arden and Derek Weaver
Chua was found guilty of murdering Tracey Arden and Derek Weaver
Judge Openshaw said it was "strikingly sinister and truly wicked" that Chua did not personally administer the insulin to most of the patients, so it was left to chance which of them were poisoned.
He said Chua poisoned Jack Beeley, 72, to "shut up a patient who he found particularly troublesome".
Grant Misell, 41, was left brain damaged after being poisoned, as the insulin overdose starved his brain of oxygen.
Chua was found not guilty of the murder of 71-year-old Arnold Lancaster but convicted of poisoning him in an act the judge described as "indescribably wicked".
In all, Chua was convicted of two murders, 22 counts of attempted grievous bodily harm, one count of grievous bodily harm, seven attempts of administering poison and one count of administering poison.
He received 25 life sentences in total and showed no emotion as he was taken down to the cells. Judge Openshaw said he would be 84 years old before he was eligible for parole.
Chua's letter
A handwritten letter, described as the "bitter nurse confession", was found in Chua's kitchen
Among the evidence produced by the prosecution was a self-penned letter found at Chua's home, in Stockport, after his arrest in January 2012 for changing prescription charts so patients would get dangerously incorrect amounts of drugs.
In the letter, described as "the bitter nurse confession" by Chua, he said he was "an angel turned into an evil person" and "there's a devil in me". He also wrote of having things he would "take to the grave".
Det Supt Simon Barraclough, who led the investigation for Greater Manchester Police, said Chua failed to show "any form of remorse" throughout the investigation and trial.
Even when being sentenced "there was not a flicker of emotion on his face, apart from what appeared to be just a general contempt for all the proceedings", he added.
'Great distress'
Investigations by police found inconsistencies in Chua's medical qualifications, which they raised with the Department of Health and the Home Office, as well as contacting the Nursing and Midwifery Council (NMC).
Concerns were also raised by a BBC investigation which revealed that fake nursing degrees were being sold in the Philippines for £20.
Nazir Afzal, who was responsible for prosecuting Chua, said the Stepping Hill case raised the "extremely worrying" prospect that many untrained foreign workers could be working in UK hospitals.
However, the NMC said a review of nurses who trained outside the European economic area - including 11,500 Filipino records - found just four with fraudulent qualifications in the last 10 years.
Chief executive Jackie Smith, said: "We checked every single record - I think that was a proportionate response to this one-off but very tragic and very serious event."
She said not all the records of other overseas countries had been checked, adding: "We took advice on what would be a sample of a review across the register that would give us confidence.
"There is no such thing as a fool-proof system - we are not a fraud agency - but do we have a system in place that doesn't just rely on documentation."
In a statement, Stockport NHS Foundation Trust said: "Our thoughts have been with the victims and their families throughout this time.
"We know they have suffered great distress but hope this sentence helps provide some closure for them in terms of seeing that justice has been served."

let down by poor end-of-life care

end of life
Thousands of dying patients are being let down by poor end-of-life care provision, the organisation that makes final decisions about NHS complaints in England has said.
The health ombudsman's report detailed "tragic" cases where people's suffering could have been avoided or lessened.
In one instance, a patient had suffered 14 painful attempts to have a drip reinserted during his final hours.
The government said improving end-of-life care was a priority.
The Parliamentary and Health Service Ombudsman has investigated 265 complaints about end-of-life care in the past four years, upholding just over half of them.

Catalogue of failings

Its Dying Without Dignity report said it had found too many instances of poor communication, along with poor pain management and inadequate out-of-hours services.
One mother told the ombudsman how she had had to call an A&E doctor to come and give her son more pain relief because staff on the palliative care ward he had been on had failed to respond to their requests.
In another case, a 67-year-old man's family learned of his terminal cancer diagnosis through a hospital note - before he knew himself. This "failed every principle of established good practice in breaking bad news", the report said.
"There was an avoidable delay in making a diagnosis," it added. "An earlier diagnosis would have meant opportunities for better palliative care."
Ombudsman Julie Mellor told Radio 4's Today the report made "very harrowing reading".
She also urged the NHS to learn lessons from the report, adding: "Our casework shows that too many people are dying without dignity.
"Our investigations have found that patients have spent their last days in unnecessary pain, people have wrongly been denied their wish to die at home, and that poor communication between NHS staff and families has meant that people were unable to say goodbye to their loved ones."

'Appalling cases'

Macmillan Cancer Support chief executive Lynda Thomas said: "The report cites heartbreaking examples of a lack of choice at the end of life that are totally unacceptable.
"If we are to improve the current situation, we will have to see a dramatic improvement in co-ordination of care, and greater integration of health and social care."
The chief inspector of hospitals at the Care Quality Commission, Prof Sir Mike Richards, said the organisation had seen examples of excellent end-of-life care, but also instances where it had not been given enough priority.
He said the CQC would continue to highlight those services that were failing.
A Department of Health spokesman said: "These are appalling cases - everyone deserves good quality care at the end of their lives.
"The five priorities for end-of-life care we brought in emphasise that doctors and nurses must involve patients and their families in decisions about their care, regularly review their treatment and share patients' choices to make sure their wishes are respected.
"NHS England is working on making these priorities a reality for everyone who needs end-of-life care."

Saturday 2 May 2015

Lower back pain

Lower back pain linked to chimpanzee spine shape

A chimpanzee walking on its knuckles
Chimpanzees are our closest primate relatives
People with lower back problems are more likely to have a spine similar in shape to the chimpanzee, our closest ape ancestor.
A lesion which forms in the disc between the bones of the spine is the reason for the differing shape.
It would have caused the vertebrae to change as humans evolved from using four legs to two legs.
The researchers say their findings could help doctors predict who may be at risk of back problems.
The study, published in BMC Evolutionary Biology, involved scientists from Scotland, Canada and Iceland.
The research team analysed the vertebrae of chimpanzees, orangutans and ancient human skeletons to investigate the relationship between the shapes of the bones of the spine, upright movement and the health of the human spine.
Prof Mark Collard, from the University of Aberdeen and Simon Fraser University in Canada, said they provided valuable insights into our ancestors' health and lifestyles.
lower back pain in humans
Back pain is a very common health issue in humans
The skeletons also provided information about how humans evolved to move on two "rear" legs.
"Our findings show that the vertebrae of humans with disc problems are closer in shape to those of our closest ape relatives, the chimpanzee, than are the vertebrae of humans without disc problems."
The research picked up that these individuals have a lesion called a Schmorl's node - a small hernia which can occur in the disc between the vertebrae.
Although there is not one cause for the node, it is thought to be linked to stress and strain on the lower back.
Evolution is not perfect, so over many thousands of years humans have not all adapted in the same way.
Prof Collard said: "Our study suggests that the pathological vertebrae of some people may be less well adapted for walking upright."
They say their findings could have benefits for modern health issues and be used as a predictive tool.

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