Thursday 12th May 2016- The World Health Organisation:Rapid diagnostic test and shorter, cheaper treatment signal new hope for multidrug-resistant tuberculosis patients

‘New WHO recommendations aim to speed up detection and improve treatment outcomes for multidrug resistant tuberculosis (MDR-TB) through use of a novel rapid diagnostic test and a shorter, cheaper treatment regimen.

“This is a critical step forward in tackling the MDR-TB public health crisis,” said Dr Mario Raviglione, Director of WHO’s Global TB Programme. “The new WHO recommendations offer hope to hundreds of thousands of MDR-TB patients who can now benefit from a test that quickly identifies eligibility for the shorter regimen, and then complete treatment in half the time and at nearly half the cost.”’

‘At less than US$ 1000 per patient, the new treatment regimen can be completed in 9–12 months. Not only is it less expensive than current regimens, but it is also expected to improve outcomes and potentially decrease deaths due to better adherence to treatment and reduced loss to follow-up.

The conventional treatment regimens, which take 18–24 months to complete, yield low cure rates: just 50% on average globally. This is largely because patients find it very hard to keep taking second-line drugs, which can be quite toxic, for prolonged periods of time. They therefore often interrupt treatment or are lost to follow-up in health services.’

‘WHO’s recommendations on the shorter regimens are based on initial programmatic studies involving 1200 patients with uncomplicated MDR-TB in 10 countries . WHO is urging researchers to complete ongoing randomised controlled clinical trials in order to strengthen the evidence base for use of this regimen.’

‘The most reliable way to rule out resistance to second-line drugs is a newly recommended diagnostic test for use in national TB reference laboratories. The novel diagnostic test – called MTBDRsl – is a DNA-based test that identifies genetic mutations in MDR-TB strains, making them resistant to fluoroquinolones and injectable second-line TB drugs.’

‘This test yields results in just 24-48 hours, down from the 3 months or longer currently required. The much faster turnaround time means that MDR-TB patients with additional resistance are not only diagnosed more quickly, but can quickly be placed on appropriate second-line regimens. WHO reports that fewer than 20% of the estimated 480 000 MDR-TB patients globally are currently being properly treated.’

See:

Rapid diagnostic test and shorter, cheaper treatment signal new hope for multidrug-resistant tuberculosis patients

Tuesday 10th May 2016- The Independent: Cannabis arteritis: Australian man diagnosed with marijuana-related disease that can cause loss of limb

‘An Australian man who smokes up to a gram of cannabis per day has narrowly escaped amputation after becoming the first in the country to be diagnosed with a rare disease linked to cannabis use.

After an ulcer on his toe failed to heal, the man consulted Frankston Hospital in Melbourne, where he was diagnosed with cannabis arteritis, an extremely rare disease which causes a build-up of plaque around the arteries, thereby decreasing blood flow to the limbs.

The patient, who has not been identified, was treated with a balloon angioplasty, where a collapsed balloon, known as a balloon catheter, is placed in the area which is constricted in order to inflate it to a healthy size.’

‘He will also have to take aspirin, a blood thinner, for the rest of his life, according to reports in the Sunday Morning Herald.’

‘Cannabis arteritis occurs when the constriction of arteries reduces blood flow to the affected limbs, which can lead to death of cells, called necrosis. Severe cases of necrosis can lead to necessary amputation.’

‘Very similar symptoms can be seen in patients suffering from Bueger’s disease, which is strongly linked to tobacco use. ‘

‘Although fewer than 100 cases of the disease have ever been recorded, Dr Soon, of the Royal College of Australasian Surgeons, said medical professionals should still remain alert.

“Due to the increase in cannabis usage and the legalisation of medicinal cannabis, awareness of the condition is important and may become a growing problem in the future,” he told the Annual Scientific Congress.’

See:

Cannabis arteritis: Australian man diagnosed with marijuana-related disease that can cause loss of limb

Tuesday 10th May 2016- World Health Organisation: Human infection with avian influenza A(H5N6) virus – China

‘On 4 May 2016, the National Health and Family Planning Commission (NHFPC) of China notified WHO of an additional laboratory-confirmed case of human infection with avian influenza A(H5N6) virus.’

’65-year-old female living in Xuancheng City, Anhui province developed symptoms on 24 April. On 27 April, her condition worsened and she was admitted to a local hospital for treatment and is currently in critical condition. The patient’s clinical sample was confirmed to be A(H5N6) virus nucleic acid positive by the Chinese Center for Disease Control and Prevention (China CDC) on 2 May. She had exposure to live poultry before symptom onset. This is the first A(H5N6) case reported from Anhui province, China.’

This makes 20 cases of avian influenze A in China reported by the World Health Organisation in May 2016, 5 of which are now deceased.

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The following details are regarding the first 17 cases (which includes 5 deaths):

‘Onset dates range from 21 February to 20 March. Cases range in age from 26 to 86 years, with a median age of 60 years. Of these 17 cases, 11 (65%) are male. The majority (15 cases, 88%) reported exposure to live poultry, slaughtered poultry, or live poultry markets. The exposure history of one (1) case is unknown. One (1) case is linked to a cluster of two (2) cases reported earlier to WHO (see below).

Cases were reported from 6 provinces and municipalities: Anhui (4), Jiangsu (4), Fujian (3), Guangdong (3), Zhejiang (2) and Hubei (1).’

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The following details are regarding 2 additional cases discovered in April 2016:

‘Between 21 and 26 April 2016, the National Health and Family Planning Commission (NHFPC) of China notified WHO of 2 additional laboratory-confirmed cases of human infection with avian influenza A(H5N6) virus.’

• ‘A 35-year-old male living in [the]… Hubei Province… was admitted to hospital for treatment on 12 April and is currently in critical condition. The patient’s clinical sample was confirmed to be A(H5N6) virus nucleic acid positive by the Chinese Center for Disease Control and Prevention (China CDC) on 21 April. He had exposure to a live poultry market before symptom onset.’
• ‘An 11-year-old female living in Zhuzhou City, Hunan Province developed fever and cough on 11 April. As her symptoms worsened on 12 April, the patient was admitted to hospital for treatment. She is currently in stable condition. The patient’s clinical sample was confirmed to be A(H5N6) virus nucleic acid positive by the Chinese Center for Disease Control and Prevention (China CDC) on 24 April. She was exposed to live poultry before onset of the disease.’

Related Articles:

Human infection with avian influenza A(H5N6) virus – China

Human infection with avian influenza A(H5N6) virus – China [6th May 2016]

Human infection with avian influenza A(H7N9) virus – China [3rd May 2016]

Monday 9th May 2016- The Independent: Hundreds of passengers on UK cruise ship fall ill with norovirus

‘Hundreds of passengers on board a British cruise ship have fallen in with norovirus, health officials have confirmed.

At least 252 [of 919] passengers and eight [out of 502] members of staff on board the Balmoral’s “Old England to New England” cruise have fallen ill with the stomach virus since leaving Southampton last month.

Now on its way to the Canadian province of New Brunswick, the ship has undergone inspections by the US Centres for Disease Control and Prevention (CDC), according to the ship’s owners, Fred. Olsen Cruise Lines.

The company said in a statement: “Balmoral has now left the US and is due to arrive in Saint John, New Brunswick later today [9th May 2016]. At no point has Balmoral been quarantined in any port on this cruise, and is continuing as planned.”

“Fred. Olsen has been undertaking extensive sanitisation measures and cleaning of the ship, following the company’s strict illness containment and prevention plan.”’

‘Evidence of the norovirus was confirmed on board while the ship was docked in Baltimore last week, where experts from the CDC carried out an environmental health assessment to evaluate the outbreak.

Despite the CDC proposing action including increased cleaning and disinfection procedures, the number of incidences later soared to more than a quarter of those on board.’

 

‘On Monday [May 9], a Fred Olsen spokesperson said the number of guests who have been confined to their cabins with the virus had reduced to just 15 out of a total of 1,434 guests and crew members on board, but the figure is yet to be confirmed by health experts.’

‘In 2010, at least 310 people on board the Balmoral were reported to be suffering from a vomiting virus when the ship docked in Los Angeles.

A confirmed outbreak of the winter vomiting virus hit more than 100 people on the same ship during a cruise of Scotland in 2009.

The..[CDC]… has reported 10 outbreaks on ships docked in the US so far this year, compared with 12 for the entirety of 2015.

Fred. Olsen said it was “co-operating fully with all the necessary maritime agencies and authorities, and will continue to make every effort possible to ensure the safety and well-being of all its guests and crew on board, which is of paramount ‎importance”.’

Related Articles:

Hundreds of passengers on UK cruise ship fall ill with norovirus

Balmoral cruise ship: Hundreds on board come down with norovirus- BBC News

Hundreds of UK cruise passengers fall ill in possible norovirus outbreak- The Guardian

Monday 9th May 2016- The Guardian: London HIV clinic fined £180,000 for revealing service users’ names

‘An NHS clinic in London has been fined £180,000 for a serious breach of the privacy of more than 700 users of an HIV service.

Patients and service users who were on the HIV clinic email list of 56 Dean Street, a Soho-based sexual health clinic, said at the time of the breach they were terrified it could leave them open to blackmail or public outing.

A staff error meant anyone receiving the September newsletter from the service could see the email addresses of all the other recipients.

Addresses had been wrongly entered into the “to” field instead of the “bcc” field, and 730 of the 781 email addresses contained recipients’ full names. Most of the recipients were HIV positive though a small number were not.

Chelsea and Westminster hospital NHS foundation trust, which runs the clinic, has been fined £180,000 after the Information Commissioner’s Office (ICO) found there had been a serious breach of the Data Protection Act, likely to have caused substantial distress.

The information commissioner, Christopher Graham, said it was “clear that this breach caused a great deal of upset to the people affected”.

Graham said the investigation revealed many people recognised other names on the list of recipients, because the clinic served a small area of London, and feared their own name would be recognised too.

The ICO investigation found the trust had previously made a similar error in March 2010, when a member of staff in the pharmacy department sent a questionnaire to 17 patients in relation to their HIV treatment. After the mistake, extra measures were put in place but no specialist training was implemented, the ICO found.

“The trust was quick to apologise for their mistake, and has undertaken substantial remedial work since the breach,” Graham said. “Nevertheless, it is crucial that the senior managers at NHS trusts understand the requirements of data protection law, and the serious consequences that follow when that law is broken.”’

Related Articles:

London HIV clinic fined £180,000 for revealing service users’ names

NHS trust fined for 56 Dean Street HIV status leak- BBC News

Monday 9th May 2016- The British Medical Association: BMA re-enters contract talks

‘The BMA will today re-enter talks with the Government over the junior doctors’ contract.

It comes after the Academy of Medical Royal Colleges called on both sides in the dispute to return to the table — with negotiations chaired by a third party.

Five days of ‘intensive talks’ from Monday to Friday are planned and ACAS chair Sir Brendan Barber will lead the negotiations.

BMA junior doctors committee chair Johann Malawana… said he hoped ‘real progress can be made’.

He said: ‘The BMA has agreed to re-enter talks with the Government on outstanding issues in this dispute, which include, but are not limited to, unsocial hours.

‘Junior doctors’ concerns extend far beyond pay, and our principle in talks will be to deliver a fair contract that does not discriminate against women or any other group, one which addresses the recruitment and retention crisis in the NHS and which provides the basis for delivering a world-class health service.

‘The BMA will also call for any contract offer — agreed or not — to be put to a referendum of junior doctors, as is usual following a contract negotiation.

‘We hope that with both parties back around the negotiating table, real progress can be made to end this dispute through talks.’’

The Telegraph:

‘Doctors are due to be moved onto the new contract over an 18-month period starting in August.

As it currently stands the new contract offers an average basic salary increase of 13.5 per cent and a 19% increase in the basic starting salary.

Those who work one in four Saturdays or more will receive a pay premium of 30 percent for all Saturday hours, however the BMA has demanded that any Saturday working, regardless of minimum number of days, attracts the premium rate.

Four strikes took place between January and early April, but they only affected routine and non-urgent care.

Last week’s two-day strike, however, was the first in the history of the NHS to affect all forms of care, including Accident & Emergency departments, intensive care and maternity units.’

Related Articles:

BMA re-enters contract talks

Junior doctors prepare for fresh talks over contracts- The Guardian

BMA agrees to re-enter talks over disputed junior doctor contracts- The Telegraph

British Medical Association to reopen contract talks with Jeremy Hunt- The Guardian

Junior doctors’ contracts: Fresh talks under way- BBC News