Friday, 28 November 2014

yellow fever

Early sign of yellow fever could lead to new treatment

MacaquesScientists analysed the gene activity in macaques after they were infected with yellow fever

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Picking up early signs of yellow fever, an infectious disease which can be fatal, could lead to a new treatment and better diagnosis, a study said.
Writing in the journal PLOS Neglected Tropical Diseases, US scientists looked at the virus in macaques, in the first study in primates for more than 20 years.
They found out how the virus damages the body and which genes it disrupts.
The World Health Organisation (WHO) said the study was encouraging.
The virus, endemic in tropical areas of Africa and Latin America, can cause jaundice and kidney failure and mainly targets the liver.
It kills 50% of people infected if they are not treated, the WHO said. There are around 200,000 cases of the infection every year.

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This research work is at an early stage and, although encouraging, will need additional work in both animal models and on human beings ”
No approved drug
Researchers at the University of California, Riverside, gave 20 macaques yellow fever. A control group were given the virus and the vaccine, to compare the results.
The study said within 24 hours of the virus, 90% of the animal's lymphocytes, or white blood cells, had been lost in all 20 animals, leaving it vulnerable to infection.
Yellow fever does not present in humans until quite a late stage, said lead author Ilhem Messaoudi in California, and there are no approved drugs to treat it, meaning early diagnosis is crucial for survival as it allows for rehydration and supportive care.
She said it was extremely challenging to get the vaccine to people in remote areas who need it and that it was not safe for babies and the elderly.
The loss of white blood cells occurred before changes in the liver, the study found, meaning if this translated to humans, doctors could spot it earlier and the chances of survival could be improved.
'Quick analysis?'
Researchers also looked at the macaques' genes and 800 were found to have been switched on within 72 hours of the initial infection, compared to the control group.
Twenty-five percent of the monkeys survived the infection, said Ms Messaoudi. She said she would now be looking at what it was, genetically, in those animals that made them survive, with a view to developing a drug.
She said: "Can we use gene expression as a diagnostic in the clinic - could we run a quick analysis on patients' white blood cells and determine which infected person is at high or low risk?
"Supportive care would follow for all patients, but it would change the dynamics of how aggressive the treatment needs to be."
William Augusto at the WHO said: "This research work is at an early stage and, although encouraging, will need additional work in both animal models and on human beings to better estimate its implications in terms of diagnostics and antiviral therapy."

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A&E care 'still unsafe'

Medway Maritime Hospital A&E care 'still unsafe', CQC says

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A Kent hospital's A&E department is still failing to protect patients from "inappropriate or unsafe" care, a health watchdog has said.
The Care Quality Commission (CQC) said assessment of patients at Medway Maritime Hospital "remained flawed".
The CQC's deputy chief inspector of hospitals, Edward Baker, said it was the hospital that caused them the "most concern".
The hospital said it had made a number of changes since the CQC inspection.
Inspectors highlighted confusion over the movement of patients from the A&E department, which is in special measures, to wards in the hospital.
Inspectors found one patient was at the A&E department at the hospital in Gillingham for more than 12 hours, and was then assigned to a ward bed only to be told later it was no longer available.
Another patient remained in a trolley for nine hours, when policy said all patients should be transferred to a bed within six hours of arrival.
The report, following an inspection on 26 August, said: "We have taken enforcement action against Medway Maritime Hospital to protect the health, safety and welfare of people using this service."

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We realise the challenges before us”
Dr Phillip BarnesMedway NHS Foundation Trust
An earlier inspection at the hospital, which was put into special measures in July 2013, found a "crisis situation" with bloodstained walls, overcrowding and potentially life-threatening unsafe practices.
'Lack of leadership'
The CQC wrote to Medway NHS Foundation Trust in July, resulting in an action plan being devised.
In its latest report, the commission said: "The pace of change remained slow; the ability to introduce change was hindered by the continued lack of leadership within the department.
Medway Maritime HospitalThe hospital trust has been in special measures since July 2013
"However, we were reassured that the trust was in the process of appointing experienced nurses to lead the workforce as well as commissioning external specialists in emergency medicine to help improve the safety of the department.
"We have judged that the trust continues to fail to ensure that patients are protected from the risks of receiving care or treatment that is inappropriate or unsafe."
The trust said: "Two new emergency care consultants took post in September and October, there is now a dedicated head of nursing in the department and three new emergency care matrons will all be in post by 2 December."
A spokesman said work was under way to "improve patient flow" and "alleviate congestion in the emergency department".
A new children's emergency department is due to open in December.
Dr Phillip Barnes, acting trust chief executive, said: "We realise the challenges before us and are fully committed to providing the high quality of care our patients deserve."

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More than 70% of fresh chickens being sold in the UK are contaminated with the Campylobacter bug

Supermarket chickens: 70% affected by food bug

fresh chicken

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More than 70% of fresh chickens being sold in the UK are contaminated with the Campylobacter bug, the Food Standards Agency (FSA) has revealed.
The figure is higher than in previous tests, which suggested a 59% contamination rate.
The highest rate was found in chickens being sold by Asda. Tesco was found to have relatively low rates of contamination.
Asda said it was disappointed, but was working hard to find a solution.
It is the first time that individual retailers have been named by the FSA, in an attempt to improve standards.
The agency said the results showed that there was still "a long way to go" before consumers are protected from the bug.
However, it reassured consumers by saying that Campylobacter is easily killed by thorough cooking.
Campylobacter is the biggest cause of food poisoning in the UK, responsible for 280,000 cases a year, and around 100 deaths.
Poultry is responsible in the majority of these cases.

Consumer advice on chicken

chicken pieces
  • Cover it in the fridge
  • Place it on the bottom shelf
  • Do not wash raw chicken
  • Wash utensils after preparation
source: FSA
Low risk
In its latest study, the FSA tested just under 2,000 fresh chickens.
When measured at the highest levels of contamination, it found that Asda was the worst offender, with 28% of its chickens having a concentration of more than 1,000 colony-forming units per gram.
Marks and Spencer was the next worst, with 22% of its birds contaminated.
Tesco, with an 11% contamination rate, was the only one of the major retailers with a better record than the industry average.
"These results show that the food industry, especially retailers, need to do more to reduce the amount of Campylobacter on fresh chickens," said Steve Wearne, the director of policy at the FSA.
"If chicken is cooked thoroughly and preparation guidelines are properly followed, the risk to the public is extremely low," Mr Wearne added.
Other advice from the FSA includes:
  • Covering raw chicken and storing it at the bottom of the fridge, so juices cannot drip on to other food
  • Not washing raw chicken, which can spread germs through splashing
  • Washing utensils and surfaces used to prepare raw chicken
Some experts believe roasting chicken inside a bag is also useful, as it eliminates skin contact.

Supermarket chickens: rates of contamination

Retailer% samples with Campylobacter% samples with high-level Campylobacter
Asda
78%
28%
Co-op
73%
19%
M&S
67%
22%
Morrison's
69%
21%
Sainsbury's
69%
14%
Tesco
64%
11%
Waitrose
69%
16%
Others
76%
25%
Source: FSA
New technology
Asda said it welcomed the transparency of the FSA's findings, but said it was already working on new technical solutions to reduce contamination.
"We take campylobacter seriously and it goes without saying that we're disappointed with these findings," said an Asda spokesperson.
"There is no 'silver bullet' to tackle this issue, but along with other retailers, we're working hard to find a solution," he added.
Among the new solutions being worked on is SonoSteam, being trialled by Asda across its poultry suppliers.
The technology uses steam to kill bacteria on the surface of the chicken during processing.
Marks and Spencer has developed a five-point plan of interventions along the food chain to tackle the issue.
The British Poultry Council said there was little statistical difference between the retailers, which have "levels in the same range".
Professor Chris Elliott, director of the Institute for Global Food Security, who led a government inquiry into food safety, said he was satisfied that enough was now being done to tackle the issue.
"I'm not aware of any region in the world working harder to find solutions to this problem but in my opinion, having looked at all the evidence, there is no quick fix," he said.
Further tests will now be carried out by the FSA, particularly on chickens sold by smaller retailers and butchers.

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Monday, 3 November 2014

NHS screening advice 'must improve'

NHS screening advice 'must improve'

Mammograms

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The NHS needs to get better at highlighting the dangers of screening for diseases such as cancer, say MPs.
Screening picks up diseases early to improve the odds of survival or improve quality of life.
But the practice also leads to "overdiagnosis" and people having treatment for conditions which would never have caused harm.
The Science and Technology Committee accused the NHS of "poor communication" on the issue.
Breast-cancer screening became hugely controversial in 2012. An independent review was set up to settle a fierce debate about whether the measure did more harm than good.
It showed that for every life saved, three women had treatment for a cancer that would never have proved fatal.
As a result the leaflets given to women offered a mammogram included more information to give them an "informed choice".
'Unnecessary treatment'
However, the Science and Technology Committee argues the lessons have not been learned by those overseeing other screening programmes.
Andrew Miller, the committee chairman, said: "While screening can increase the likelihood of curing, preventing or delaying the progression of disease for some patients, for others it may lead to false results, misdiagnosis and unnecessary treatment.
"More needs to be done to ensure that both the benefits and risks are clearly, and even-handedly, communicated so that people can make an informed choice about whether screening is right for them."
Conditions screened for include:
  • Abdominal aortic aneurysm
  • Diabetic retinopathy
  • Breast cancer
  • Cervical cancer
  • Bowel cancer
There are also newborn screening programmes, including hearing checks, as well as Down's syndrome and foetal anomaly screens during pregnancy.
Breast-cancer screeningBreast-cancer screening guidelines were changed to ensure patients had an informed choice
Mr Miller continued: "Producing accurate, concise and accessible public information on screening will always be challenging, but the UK National Screening Committee must ensure there is standard process across the NHS for achieving this and facilitating informed choice."
There are hopes that screening could be extended to other diseases such as ovarian cancer and eventually prostate cancer.
However, the committee said the barriers to new screening programmes "should remain high" due to the delicate balance of risk and benefits.
'Vitally important'
Prof Kevin Fenton,, director of health and wellbeing at Public Health England, which oversees the NHS screening programmes. said: "We welcome the findings of the Science and Technology Committee's report, which has identified a number of recommendations.
"We will now consider these recommendations in full."
The British Medical Association's Dr Richard Vautrey said: "Many GPs will share the Science and Technology Committee's concerns about health screening. As the BMA has repeatedly warned, it is vitally important that people being invited for screening fully understand the pros and cons of the procedure.
"Patients must also be aware that there is a risk that false positive results could lead to unnecessary and potentially harmful further investigations."
Cancer Research UK was involved in the independent review of breast-cancer screening.
Jessica Kirby, from the charity, said: "It's vitally important that all screening programmes are based on the best possible evidence so people can be confident that screening is only offered where the benefits outweigh the harms.
"The report highlights the importance of ensuring people get the best possible information so they can make the decisions that are right for them."

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genetic risks for autism ?

Study points to new genetic risks for autism

DNA sequenceThe study linked 33 genes to autism.

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A massive international study has started to unpick the "fine details" of why some people develop autism, researchers have said.
They looked at thousands of DNA samples from children with autism and their parents.
The results, in the journal Nature, linked 33 genes to the condition with many involved in brain development.
The National Autistic Society said we were still "a long way" from knowing the cause of autism.
The study suggested a number of different risk factors for the condition, according to the lead author of the paper Prof Joseph Buxbaum, from Icahn School of Medicine at Mount Sinai New York.
"The smoking gun is genetics - but there are quite a lot of different bullets in the gun," said Prof Buxbaum.
DNA analysis
Autism is a life-long disorder that affects people's ability to socialise, and those on the autism spectrum can find it difficult to interact with other people.
The researchers assessed 15,480 DNA samples to determine the impact of mutations to the DNA that are passed from parent to child as well as those that spring up spontaneously.
The study expanded the number of genes linked to autism up to 33.
Seven genes were completely new while 11 had not been classed as true risk genes due to lack of data. Fifteen of the genes were already known to be risky.
It also indicated that small, rare genetic mutations in 107 genes can contribute to the risk of autism.
More than 5% of the autistic people in the study had these non-inherited loss-of-function gene mutations.
'Finer detail'
The study should help to improve understanding of some of the causes of autism, said Prof David Skuse, head of the social communication disorders team at Great Ormond Street Hospital in London, and a contributor to the report.
"Up until now we've really not been able to understand the mechanisms that lead to autism," he said. "This [study] is getting down to much finer detail."
Prof Skuse added that the study could start to help families understand autism.
The National Autistic Society (NAS) said there were many gaps in autism knowledge.
Carol Povey, director of the NAS Centre for Autism, said: "Autism is a highly complex story of genes not only interacting with other genes, but with non-genetic factors too.
"Research like this helps us to understand the genetics involved in certain forms of autism and opens up the possibility of whole families gaining a better understanding of a condition they may share," she said.
"However, we are still a long way from knowing what causes autism. What people with the condition, their families and carers need most of all, is access now to the right kind of support to be able to lead full lives," she added.

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