Clues to bird flu epidemic
Friday August 15th, 2008
Training of health workers and distribution of antiviral drugs are the key to preventing an epidemic of bird flu virus among humans, according to an analysis of the world's worst outbreak.
Researchers have published an analysis of events in Indonesia which has suffered at least 127 cases of human bird flu infection over a three year period. Some 103 patients died.
Several steps could be put in place to improve diagnosis and treatment, according to the report, published by The Lancet.
This includes asking questions about whether sick people have been exposed to poultry or birds.
Following the publication British researchers spoke of their hope of developing a portable diagnosis kit.
The work is being done at Nottingham Trent University with backing of some £2.3m in EU cash.
Writing in the Lancet, Dr Toni Wandra, of the Indonesian health ministry, says: "Early case identification and treatment with oseltamivir is key to addressing the high case-fatality rate in Indonesian cases.
"There is a clear need to identify definite causes for high-case fatality…While additional research is done we propose the following strategies to provide early diagnosis and prompt treatment to improve quality of case management. Poultry surveillance is being stepped up, and active human case finding by local health centres and village officials is being instituted in areas of poultry deaths."
They add: "Finally, all health-care workers should be trained in case management of early H5N1 influenza, and should be equipped with oseltamivir to enable timely administration."
British experts Professor Sheila Bird, of the Medical Research Council, and Professor Jeremy Farrar, of Oxford University, call for urgent action to prevent the risk of an epidemic.
They write: "Consideration needs to be given now—not in the teeth of a pandemic, and not deflected by either proprietary defensiveness or opportunistic profiteering — to gauging the comprehensiveness of national surveillance for human H5N1 cases, and to ensuring the analysability of a minimum dataset on the exposures and clinical course of every confirmed case of human H5N1."
Lancet On-line August 14 2008
Eye disease may indicate heart disease risk
Thursday August 14th, 2008
Scientists have found that a common eye problem is linked to risk of death from heart disease.
Retinopathy, or disease of the retina - the light-sensitive part inside the inner layer of the eye - is common among people with diabetes but can affect anyone.
Researchers say it may also provide an early warning sign of heart disease.
Dr Jie Jin Wang of the University of Sydney, Australia, and colleagues measured the rate of retinopathy among 2,967 adults, of whom 199 were diagnosed with diabetes.
They found a higher risk of retinopathy among diabetics, approximately 29 per cent, compared with ten per cent of those without diabetes.
Participants were followed for 12 years to monitor deaths from coronary heart disease. Analysis showed that those with diabetes and moderate retinopathy were more than six times as likely to die of coronary heart disease as those without retinopathy.
Participants without diabetes were 50 per cent more likely to die of coronary heart disease if they had retinopathy, "equivalent to the same level of risk conferred by a diagnosis of diabetes alone", report the researchers in the journal Heart.
They say that this finding is important, because up to one in ten people without diabetes may have retinopathy. "A finding of retinopathy in people with or without diabetes may signal increased coronary heart disease risk," they write.
Why retinopathy and heart disease are linked is not yet clear, they add, but they suggest it may be that retinopathy indicates a more generalised disease of small blood vessels and inflammation.
The researchers say that retinopathy should be routinely assessed to help identify people who may be at increased risk, and these individuals should be monitored for heart disease symptoms.
Liew, G. et al. Retinopathy predicts coronary heart disease mortality. Heart, published online August 12, 2008.
Dairy intake linked to adolescent bone health
Wednesday August 13th, 2008
New research underlines the importance of a daily intake of dairy products for children.
Dr Lynn Moore of Boston University School of Medicine, USA, and colleagues set out to examine the relationship between childhood dairy intake and adolescent bone health. They looked at 106 children taking part in the Framingham Children's Study.
The children were between three and five years old at the start of the study. For a year their parents kept regular food diaries for each child.
During adolescence, the participants' bone health was assessed by doctors. Results showed that those who had eaten an average of two or more servings of dairy per day when younger had higher levels of bone mineral content and bone density.
Their average bone mineral content was 175g higher than those who had consumed less than two servings of dairy per day. This effect did not seem to be linked to factors known to influence normal bone development, such as growth, body size or exercise level.
Findings will be published in the Journal of Pediatrics. Dr Moore said that other sources of protein were also important.
"Children who consumed two or more servings of dairy and four ounces of meat or other non-dairy protein had bone mineral contents over 300 grams higher than those children with lower intakes of both dairy and other proteins," she explained.
She added: "Dairy is a key source of proteins, calcium, and other micronutrients including phosphorus and vitamin D. Parents can promote healthy bone development during adolescence by making dairy a regular part of their child's diet."
However, recent studies have cast doubt on the link between children's calcium intake and later bone health.
Moore, L. L. et al. Effects of Average Childhood Dairy Intake on Adolescent Bone Health. The Journal of Pediatrics, 2008.
Epidural safe, slightly improves survival
Tuesday August 12th, 2008
Epidural anaesthesia is safe for patients undergoing intermediate to high-risk surgery, other than cardiac surgery, says a study published in The Lancet today.
But the Canadian study found people given epidurals for anaesthesia or pain-killing had only a very slightly increased rate of survival over those who were not.
Dr Duminda Wijeysundera, from Toronto General Hospital and University of Toronto and colleagues studied a quarter of a million patients selected for elective non-cardiac surgery between 1994 and 2004.
Twenty-two per cent of patients received epidural and the procedure was associated with a small reduction in 30-day mortality (1.7 per cent) compared with patients who had not had epidural (two per cent).
In other words, 477 patients had to have had epidural to avert one death.
Dr Wijeysundera said the study did not provide compelling evidence that epidural improved postoperative survival.
"Nonetheless, our results support the safety of perioperative epidural anaesthesia when used for indications other than improving survival - for example, improving postoperative pain relief or preventing postoperative lung complications," Dr Wijeysundera said.
In an accompanying comment, Dr Michael Barrington and Dr David Scott, of St Vincent's Hospital, Melbourne, Australia, said the clear benefit of epidural anaesthesia was improved analgesia.
"Pain after major surgery can be severe, and we think that in many cases pain relief alone is an unambiguous clinical indication for postoperative epidural analgesia".
The Lancet. DOI:10.1016/S0140-6736(08)61121-6
Sardines boost eye health
Monday August 11th, 2008
A helping of oily fish once a week may help to protect against blindness in old age, British researchers have reported.
Eating fish is linked to a 50 per cent reduction in the risk of getting "wet" age-related macular degeneration, according to a study at the London School of Hygiene and Tropical Medicine
The condition is the main cause of blindness in elderly in European countries.
Researchers said the findings only applied to oily fish such as sardines and tuna and not to white fish such as cod.
The study, published in the American Journal of Clinical Nutrition, involved comparing the eating habits of some 105 patients with another 2,000 healthy people.
Researcher Professor Astrid Fletcher said: "This is the first study in Europeans to show a beneficial association on wet AMD from the consumption of oily fish and is consistent with results from studies in the USA and Australia.
"Two three ounce servings a week of oily fish, such as salmon, tuna or mackerel, provides about 500 mg of DHA and EPA per day".
DHA and EPA are two omega three fats found in oily fish. Three ounces is about 85 grammes.
American Journal of Clinical Nutrition, Vol. 88, No. 2, 398-406, August 2008
New smoking gene found
Monday August 11th, 2008
Cigarette smokers may be lured into the habit by their genes, according to new findings.
The gene problem occurs at the time of the first puff, researchers believe.
People who take up the habit may do so because they get a buzz from their first cigarette. Others may never smoke again because they react badly.
Researchers have pin-pointed a gene called CHRNA5 as being responsible for the different reactions.
Reporting in the journal Addiction, they say smokers are eight times as likely as others to have a variation in this gene. The gene was linked in particular to smokers who said their first cigarette gave them a "pleasurable buzz".
The study compared smokers with people who had smoked between 1 and 100 cigarettes in their lives.
Researcher Professor Ovide Pomerleau, of the University of Michigan, USA, said: "It appears that for people who have a certain genetic makeup, the initial physical reaction to smoking can play a significant role in determining what happens next.
"If cigarette smoking is sustained, nicotine addiction can occur in a few days to a few months. The finding of a genetic association with pleasurable early smoking experiences may help explain how people get addicted — and, of course, once addicted, many will keep smoking for the rest of their lives."
Addiction, doi:10.1111/j.1360-0443.2008.02279.x
Printer friendly page