Tuesday 5th May 2015- The Scientist: Restored Sight Fades After Gene Therapy

‘Patients with Leber’s congenital amaurosis (LCA), a genetic blindness disorder caused by a mutation in the retinal pigment epithelium 65 (RPE65) gene that encodes a rhodopsin-making enzyme, were the first to test the theory that gene therapy could restore sight. In 2007, surgeons injected a viral vector carrying an unmutated copy of RPE65 into one eye of each patient, many of whom experienced a heightened sensitivity to light within just a few days. But now, that improved vision is fading, suggesting that this original therapy may not lead to the permanent fix many were hoping for, trial researchers reported in published this week (May 3) in The New England Journal of Medicine (NEJM).’

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Restored Sight Fades After Gene Therapy

Tuesday 5th May 2015- The Guardian: Interpol alert over diet pills that left Eloise Parry dead

‘Global police agency issues alert about tablets containing 2,4-Dinitrophenol – which make metabolism soar and cause people to ‘burn up from within’’

‘Interpol has issued a global alert over diet pills that last month claimed the life of a 21-year-old woman from Shropshire.

The world police agency cited the case of Eloise Parry, as well as that of a Frenchman left seriously ill, as it raised the alarm over tablets containing the compound 2,4-Dinitrophenol .

Parry died at Royal Shrewsbury hospital last month after taking tablets she bought online. Police believe they included a quantity of the industrial chemical, known as DNP.

An Interpol orange notice – which warn of imminent threats – has been sent to police forces in 190 countries at the request of French interior ministry. The agency declared an “imminent threat” to consumers from DNP, which is used as a pesticide and has also been used in explosives.

The notice warns of increasing demand for the substance, particularly in bodybuilding circles. Online distributors have tried to mask its supply from customs and police by labelling it as the spice turmeric, because it looks similar, Interpol said.

A statement from the agency added: “Although usually sold in yellow powder or capsule form, DNP is also available as a cream. Besides the intrinsic dangers of DNP, the risks associated with its use are magnified by illegal manufacturing conditions.’

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Interpol alert over diet pills that left Eloise Parry dead

May 2015- The Lancet: Chronic myeloid leukaemia: time to push for a cure?

‘In recent years, molecular research and targeted therapies have led to a revolution in the treatment of cancers, leading to the promise of precision medicine, and greatly improved outcomes. Patients with chronic myeloid leukaemia (CML) have benefited from the development of imatinib and subsequent second-generation tyrosine-kinase inhibitors (TKIs), which have completely changed how treatment is given and have helped many patients live longer than those treated before the development of TKIs.’

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Chronic myeloid leukaemia: time to push for a cure?

Tuesday 5th May 2015- The Guardian: British mothers twice as likely to die in childbirth as Polish women

‘Britain, where women are twice as likely to die in pregnancy and childbirth as those in Poland, Austria or Belarus, comes 24th in Save the Children’s annual list’.

‘Women in the UK are more than twice as likely to die in pregnancy and childbirth as those in Poland, Austria or Belarus, according to Save the Children.

For the third year in a row the UK failed to make the top 10 of the charity’s annual State of the World’s Mothers report, coming 24th – up from 26th last year – in the list of the world’s best places to be a mother.

A child born in the UK is also more than twice as likely to die before the age of five as in Iceland or Luxembourg. The UK has a child mortality rate of 4.6 per 1,000 births, while Iceland’s rate is 2.1 and Luxembourg’s 2.0 per 1,000 births.

The UK, which has not made the top 10 since 2012, also came behind debt-stricken Greece as well as Spain, Slovenia and Israel. Norway topped the list while Finland and Iceland came in at second and third.

The US is behind the UK in 33rd place. The report found that women in the US have a one in 1,800 lifetime risk of maternal death – the worst performance of any developed country in the world.

In a ranking of child survival in 25 capital cities in the world’s wealthiest countries, Washington DC came last. The next worst were Vienna in Austria and Bern in Switzerland.’

‘The 2015 report found that women in the UK face a one in 6,900 lifetime risk of maternal death. In Poland the figure was much lower at one in 19,800, while in Austria it was one in 19,200 and one in 45,200 in Belarus.

Obesity, IVF, social deprivation, multiple pregnancies as well as increased maternal age and poorer access to healthcare, especially in some ethnic minority communities and among asylum seekers, are linked with high-risk pregnancies in the UK.’

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British mothers twice as likely to die in childbirth as Polish women

Tuesday 5th May 2015- World Health Organisation: WHO/UNHCR issue new guide on mental health in humanitarian emergencies

‘Worldwide close to 80 million people are currently impacted by humanitarian emergencies arising from natural disasters and armed conflicts, such as those in the Central African Republic, South Sudan, Syrian Arab Republic, Yemen, and more recently, Nepal. WHO estimates 5% to 10% of these people suffer from a mental health condition such as depression as a result of the emergency.

People with mental health disorders rarely have access to specialized health workers trained in assessing and managing their conditions. WHO and the United Nations High Commissioner for Refugees (UNHCR) have therefore produced a Mental health Gap Action Programme Humanitarian Intervention Guide (mhGAP-HIG), so non-specialist health workers can better identify, assess and manage mental health needs.

The new guide provides practical, first-line management recommendations for mental, neurological and substance use conditions. Contents include modules on assessing and managing conditions such as acute stress, grief, moderate-severe depressive disorder, post-traumatic stress disorder, epilepsy, and harmful use of alcohol and drugs.’

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WHO/UNHCR issue new guide on mental health in humanitarian emergencies

Monday 4th May 2015- The Guardian: Pregnant 10-year-old rape victim denied abortion by Paraguayan authorities

‘Paraguayan authorities have ruled out abortion for a pregnant 10-year-old girl who was allegedly raped by her stepfather, unless she develops complications that put her life in danger.

Despite a plea from the girl’s mother and an international outcry, senior medical officials in Asunción told the Guardian that more than 22 weeks into the pregnancy, there are no health risks that would allow doctors to circumvent the Catholic country’s stringent anti-abortion laws.

“Right now, there is no reason to interrupt the pregnancy,” Lida Sosa, director of healthcare programs at the ministry of public health and wellness, said. “In fact, given the stage of the pregnancy, it’s even more dangerous for the girl to undergo a procedure [to abort] without a well-considered medical, obstetrical evaluation.”’

‘After doctors revealed the girl was pregnant, her mother asked them to perform an abortion, but this is forbidden in Paraguay unless the pregnancy has life-threatening complications.

The girl was taken to a shelter and her mother was imprisoned on 27 April and accused of failing in her duty of care. A judge is considering a further charge of being an accomplice in the rape. The stepfather is on the run.’

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Pregnant 10-year-old rape victim denied abortion by Paraguayan authorities

May 2015 Journal- The Lancet (Global Health): Safety and efficacy of alternative antibiotic regimens compared with 7 day injectable procaine benzylpenicillin and gentamicin for outpatient treatment of neonates and young infants with clinical signs of severe infection when referral is not possible: a randomised, open-label, equivalence trial

‘Background: Severe infections remain one of the main causes of neonatal deaths worldwide. Possible severe infection is diagnosed in young infants (aged 0–59 days) according to the presence of one or more clinical signs. The recommended treatment is hospital admission with 7–10 days of injectable antibiotic therapy. In low-income and middle-income countries, barriers to hospital care lead to delayed, inadequate, or no treatment for many young infants. We aimed to identify effective alternative antibiotic regimens to expand treatment options for situations where hospital admission is not possible.

Methods:We did this randomised, open-label, equivalence trial in four urban hospitals and one rural field site in Bangladesh to determine whether two alternative antibiotic regimens with reduced numbers of injectable antibiotics combined with oral antibiotics had similar efficacy and safety to the standard regimen, which was also used as outpatient treatment. We randomly assigned infants who showed at least one clinical sign of severe, but not critical, infection (except fast breathing alone), whose parents refused hospital admission, to one of the three treatment regimens. We stratified randomisation by study site and age (<7 days or 7–59 days) using computer-generated randomisation sequences. The standard treatment was intramuscular procaine benzylpenicillin and gentamicin once per day for 7 days (group A). The alternative regimens were intramuscular gentamicin once per day and oral amoxicillin twice per day for 7 days (group B) or intramuscular procaine benzylpenicillin and gentamicin once per day for 2 days, then oral amoxicillin twice per day for 5 days (group C). The primary outcome was treatment failure within 7 days after enrolment. Assessors of treatment failure were masked to treatment allocation. Primary analysis was per protocol. We used a prespecified similarity margin of 5% to assess equivalence between regimens. This study is registered withClinicalTrials.gov, number NCT00844337.

Findings:Between July 1, 2009, and June 30, 2013, we recruited 2490 young infants into the trial. We assigned 830 infants to group A, 831 infants to group B, and 829 infants to group C. 2367 (95%) infants fulfilled per-protocol criteria. 78 (10%) of 795 per-protocol infants had treatment failure in group A compared with 65 (8%) of 782 infants in group B (risk difference −1·5%, 95% CI −4·3 to 1·3) and 64 (8%) of 790 infants in group C (−1·7%, −4·5 to 1·1). In group A, 14 (2%) infants died before day 15, compared with 12 (2%) infants in group B and 12 (2%) infants in group C. Non-fatal relapse rates were similar in all three groups (12 [2%] infants in group A vs 13 [2%] infants in group B and 10 [1%] infants in group C).

Interpretation: Our results suggest that the two alternative antibiotic regimens for outpatient treatment of clinical signs of severe infection in young infants whose parents refused hospital admission are as efficacious as the standard regimen. This finding could increase treatment options in resource-poor settings when referral care is not available or acceptable.’

Procaine Benzylpenicillin: After administration via a deep intramuscular injection, it is absorbed into the circulation slowly and hydrolysd to benzylpenicillin so used where prolonged low concentrations of benzylpenicillin is needed. Used to reduce pain and treat bacterial infections including anthrax, syphilis, respitatory tract infection (where oral medications cannot be used), strep throat, cellulitis and erysipelas. It is toxic to the ears’ sensory cells and is vestibulotoxic and in high dosages the procaine element can cause CNS abnormalities and seizures.

Gentamicin: It is an aminoglycoside and is given intravenously, intramuscularly or topically to treat Gram-negative infections (in the Gram staining method used to differentiate bacteria these organisms do not retain the violet stain) as it cannot be absorbed via the small intestine, however E-coli shows some resistance. It is also ototoxic and nephrotoxic. It could be argued that reluctance to use aminoglycosides like Gentamicin led to the use of broad spectrum antibiotics which resulted in MRSA and other antiobiotic-resistant bacteria.

Safety and efficacy of alternative antibiotic regimens compared with 7 day injectable procaine benzylpenicillin and gentamicin for outpatient treatment of neonates and young infants with clinical signs of severe infection when referral is not possible: a randomised, open-label, equivalence trial

Sunday 3rd May 2015- The Independent: UK skin cancer statistics ‘shocking’ as sun-worshippers ignore the dangers of exposure

‘The number of people suffering sunburn despite being aware of the dangers is “shocking”. Although more than eight out of 10 people are worried about skin cancer, 72 per cent have been burnt in the past year.

The new figures, being released by the British Association of Dermatologists (BAD) tomorrow to mark the start of Sun Awareness Week, reveal a dichotomy between widespread knowledge about skin cancer and an aversion to doing something to prevent it.

The risk of developing melanoma – the deadliest form of skin cancer – is more than doubled in those with a history of sunburn.

Doctors recommend that people check for signs of skin cancer on a monthly basis, yet 96 per cent of people fail to do this, according to BAD’s survey of more than a thousand Britons and 40 per cent never check themselves. Most people – 77 per cent – would not recognise signs of a melanoma.

Skin cancer is the most common cancer in Britain. More than 100,000 new cases of non-melanoma cancer and more than 13,000 new cases of melanoma are diagnosed each year. More than 2,100 Britons die from skin cancer every year. “With sunny days already making an appearance in parts of the UK, it is likely that this figure will remain high this year,” said Johnathon Major, spokesman for the British Association of Dermatologists.’

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UK skin cancer statistics ‘shocking’ as sun-worshippers ignore the dangers of exposure

Sunday 3rd May 2015- The Guardian: Premature-birth researchers appeal for photographs of newborn babies

‘Images to be used in app to help doctors determine gestational age of children born in isolated regions and reduce unnecessary deaths’

‘Parents are being asked to donate pictures of their newborn baby’s feet, eyes and ears to help create a ground-breaking app that could save the lives of hundreds of children born prematurely in developing countries every year.

Medical care for pregnant women in isolated areas of developing countries is often non-existent. This makes it impossible to determine the gestation of a baby which means countless premature children die because they haven’t received the specialist care they need.

Doctors at the University of Nottingham are collecting images of the feet, eyes and ears of babies at all stages of development from 23 weeks to 42 weeks. The images will be used to create a smartphone app called NeoGest that doctors in developing countries will use to scan the creases of the feet and the shape of the eyes of premature babies to determine how old they are.

Doctors can gauge maturity from the number and depth of feet creases in much the same way as botanists can tell the age of a tree from the rings in its trunk. This information can then help doctors determine whether newborns need specific care or feeding, or to be taken to hospital.’

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Premature-birth researchers appeal for photographs of newborn babies

Sunday 3rd May 2015- The Guardian: Most liver transplants by 2020 will be ‘linked to over-eating, not alcohol’

‘Most liver transplants are expected to be linked to over-eating rather than alcohol abuse by 2020, an expert has said.

Dr Quentin Anstee, a consultant hepatologist at Newcastle University and the Freeman hospital, warned that the UK faced a “major and growing challenge” as increasing numbers of Britons are diagnosed with non-alcoholic fatty liver disease.

A third of Britons are thought to have the condition, according to researchers, which is caused by people eating more than their livers can cope with.’

‘“There has been a shift in the entire population. The truth is that the man in the street is carrying a few more pounds than a decade ago. The rate of liver disease has increased 400% since the 1970s.

“It’s predicted that by the end of this decade, non-alcoholic fatty liver disease will be be the most common underlying reason why people are required to have liver transplants, overtaking alcohol.”’

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Most liver transplants by 2020 will be ‘linked to over-eating, not alcohol’