more_vertOn June 22, 2018, the European Commission issued an updated list of communicable diseases to be covered by epidemiological surveillance in the EU. This list now includes Lyme neuroborreliosis, the neurological manifestation of Lyme borreliosis, which is caused by tick-borne Borrelia burgdorferi sensu lato infection. The decision authorises the European Centre for Disease Prevention and Control (ECDC) to begin monitoring the EU-wide distribution of Lyme neuroborreliosis cases.
Preference: Infectious Diseases and Parasitology
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[The Lancet Commissions] Advancing global health and strengthening the HIV response in the era of the Sustainable Development Goals: the International AIDS Society—Lancet Commission
Inspired by unprecedented improvements in human health and development in recent decades, our world has embarked on a quest that only a generation ago would have been considered unreachable—achieving sustainable health and development for all. Improving the health and wellbeing of the world’s people is at the core of the Sustainable Development Goals (SDGs), reflected in targets that call for ending the epidemics of AIDS, tuberculosis, and malaria; achieving enormous improvements in maternal and child health; and tackling the growing burden of non-communicable diseases (NCDs).
[Correspondence] The how: a message for the UN high-level meeting on NCDs
This September’s UN General Assembly high-level meeting (HLM) on non-communicable diseases (NCDs) provides a strategic opportunity to propel the response—from “where do we want to be” to “how do we get there”.
[Editorial] Genome editing: proceed with caution
Philosophically interrogating peoples’ motives and aims in matters of procreation leads to controversy and emotionally charged debates. Introducing ideas about genome editing and its implications broadens discussions about human reproduction from fertility clinics and prospective parents to organisations and governments worldwide. 40 years after the first baby was born by in-vitro fertilisation, the game changing technique of CRISPR-Cas9, which enables precise alterations of DNA sequences in living cells, has once again sparked heated argument about the use of interventions selecting for traits and against diseases of human beings.
[Correspondence] Reducing NCDs globally: the under-recognised role of environmental risk factors
This month, the WHO Independent High-Level Commission on Non-Communicable Diseases (NCDs) published a set of recommendations to accelerate progress towards achieving the Sustainable Development Goals Target 3.4 for reducing NCDs by 2030.1 Unfortunately, this globally important report had a major omission: recognising the detrimental role of environmental risk factors, beyond the conventional behavioural factors (tobacco and alcohol use, physical inactivity, and unhealthy diet), in enhancing global NCD burden and health inequality.
[Perspectives] Ahmed Salim Saif Al-Mandhari: bridge-builder from Oman
“I am a family physician, I am a human being. These two concepts are my main driving force towards whatever I do at all levels as a leader of an organisation”, says Ahmed Al-Mandhari, who became Regional Director of the WHO Regional Office for the Eastern Mediterranean (EMRO) on June 1, 2018. Taking the helm at WHO EMRO, he says, “is a big shift and a major decision in my life”. The post had been vacant since the sudden death of Mahmoud Fikri, a United Arab Emirates national, in October, 2017. During the campaign for WHO EMRO Regional Director, Al-Mandhari set out the challenges ahead: “Our region is really passing through a very critical era, marked by increasingly expanded natural and man-made crises and characterised by severe socio-political and economic instability, weak health systems, insufficient financial resources, unbalanced workforce, an upsurge of old and new communicable diseases, and increasing burden of non-communicable diseases.” In his acceptance speech, he emphasised that every effort must be made to find appropriate solutions to these challenges, particularly for displaced populations and refugees.
Vitamin D not the brain protector some believe it is
Scientists have failed to find solid clinical evidence for vitamin D as a protective neurological agent, according to new research published in Nutritional Neuroscience.
South Australian researchers believe that vitamin D is unlikely to protect individuals from multiple sclerosis, Parkinson’s disease, Alzheimer’s disease or other brain-related disorders.
“Our work counters an emerging belief held in some quarters suggesting that higher levels of vitamin D can impact positively on brain health,” said lead author Krystal Iacopetta, PhD candidate at the University of Adelaide.
“Past studies had found that patients with a neurodegenerative disease tended to have lower levels of vitamin D compared to healthy members of the population.
“This led to the hypothesis that increasing vitamin D levels, either through more UV and sun exposure or by taking vitamin D supplements, could potentially have a positive impact. A widely held community belief is that these supplements could reduce the risk of developing brain-related disorders or limit their progression.
“The results of our in-depth review and an analysis of all the scientific literature, however, indicates that this is not the case and that there is no convincing evidence supporting vitamin D as a protective agent for the brain.”
The research was based on a systematic review of more than 70 pre-clinical and clinical studies, investigating the role of vitamin D across a wide range of neurodegenerative diseases.
Ms Iacopetta believes the idea of vitamin D as a neuro-related protector has gained traction based on observational studies as opposed to evaluation of all the clinical evidence.
“Our analysis of methodologies, sample sizes, and effects on treatment and control groups shows that the link between vitamin D and brain disorders is likely to be associative – as opposed to a directly causal relationship,” she said.
“We could not establish a clear role for a neuroprotective benefit from vitamin D for any of the diseases we investigated.”
The university’s Professor Mark Hutchinson said the outcome of the research was important, as it was based on an extremely comprehensive review and analysis of current data and relevant scientific publications.
“We’ve broken a commonly held belief that vitamin D resulting from sun exposure is good for your brain,” Professor Hutchinson said.
Vitamin D is also commonly known as the sunshine vitamin, but Professor Hutchinson said there may be evidence that sun exposure – or UV light – could impact the brain beneficially, in ways other than that related to levels of vitamin D.
“There are some early studies that suggest that UV exposure could have a positive impact on some neurological disorders such as multiple sclerosis,” he said.
“We have presented critical evidence that UV light may impact molecular processes in the brain in a manner that has absolutely nothing to do with vitamin D.
“We need to complete far more research in this area to fully understand what’s happening. It may be that sensible and safe sun exposure is good for the brain and that there are new and exciting factors at play that we have yet to identify and measure.
“Unfortunately, however, it appears as if vitamin D, although essential for healthy living, is not going to be the miracle ‘sunshine tablet’ solution for brain-disorders that some were actively hoping for.”
Researchers involved in this systematic review are affiliated with the University of Adelaide, the University of South Australia and the ARC Centre of Excellence for Nanoscale BioPhotonics (CNBP).
The research paper can be found at: https://doi.org/10.1080/1028415X.2018.1493807
CHRIS JOHNSON
NHS birthday protests
The NHS has turned 70, sparking large-scale public protests at the level of underfunding and privatisation of England’s national health service.
On July 5, 1948, Britain’s then Health Secretary Aneurin Bevan (from Labour’s post-war government of Clement Attlee) launched the National Health Service at Manchester’s Park Hospital.
That hospital is now known as Trafford General Hospital and the National Health Service simply as the NHS.
On its 70th birthday this month, tens of thousands of patients, public and NHS staff marched on Westminster in protest at the state of the service.
Although UK’s current Conservative Party Government has pledged another £20 billion (Aus$35.8 billion) to the NHS over the next four years, the growing concern is that much of that money will be given to private companies.
During the 2016-17 financial year, a total of £7.1 billion was given to private companies for NHS clinical contracts. Since 2013, a massive £25 billion has been awarded to non-NHS providers through a tendering process allowed under the Health and Social Care Act, which came into force that year.
Analytic studies are revealing increasing problems with the private sector services being provided, causing alarm among patients and political watchers.
Accounts of patient neglect, mismanagement, and endless waiting periods are reported daily.
Outsourcing of NHS services remains highly controversial.
Labour leader Jeremy Corbyn has called for an end to privatisation and for NHS staff not to be sub-contracted to private companies.
He addressed the protesting crowds, suggesting that profits sometimes end up in international tax havens.
“I don’t pay my taxes for someone to rip off the public and squirrel the profits away,” he said.
Prime Minister Theresa May has defended the NHS, hailing it as a huge success and insisting its future was secured with the extra government funding.
Protests were held around the same time of a service of celebration at Westminster Abbey for NHS staff, as well as thousands of tea parties around the country to mark the 70th anniversary.
Yet while some politicians, staff and patients hailed the NHS as a “unifying ideal” for the British people, critics demanded answers to the system’s management failures and funding shortfalls.
The official line celebrating the milestone, stated on the NHS70 website, is: “Over the last 70 years, the NHS has transformed the health and wellbeing of the nation and become the envy of the world.
“The NHS has delivered huge medical advances and improvements to public health, meaning we can all expect to live longer lives.
“It is thanks to the NHS that we have all but eradicated diseases such as polio and diphtheria, and pioneered new treatments like the world’s first liver, heart and lung transplant.
“In more recent times, we have seen innovations like mechanical thrombectomy to improve stroke survival, bionic eyes to restore sight, and surgical breakthroughs such as hand transplants.”
CHRIS JOHNSON
(File photo)
I nearly died from sepsis – and ignorance of this condition is killing millions
A visit to family in Glasgow for Christmas in 2015 nearly had a tragic ending for me. Two days earlier I had been repairing the lock on my garden gate, when I scratched my hand on a nail. By the time I arrived in Glasgow I was feeling unwell. Twenty-four hours later I was in University Hospital Hairmyres in a coma. I had developed sepsis. My family were told that I had almost no chance of surviving the night.
I woke from my coma three months later and spent another year getting back to full health. I’m one of the lucky ones. Sepsis affects more than 30m people a year worldwide and kills an estimated 6m people, of whom nearly 2m are children. Of those who do survive, 40% will have post-sepsis syndrome, which leaves them with lasting physical and mental symptoms.
Sepsis starts with a viral or bacterial infection, usually of the lungs, abdomen or urinary tract, but it can also begin in a whole host of other ways, including a scratch (as happened in my case) or a bite. It’s not the bug that causes the potentially life-threatening condition, however, it’s the body’s response to the infection. A complex cascade of events is triggered to fight an infection – in sepsis, this process becomes uncontrolled, rapidly accelerating and resulting in the failure of vital organs in the body, including the kidneys, heart and lungs.
Like a match being lit, a tiny spark at one end of the match head spreads out rapidly, the flame grows quickly and the match is destroyed by the flame, unless it’s blown out in time. The “flame” of sepsis in a body moves very quickly, and if my brother had not spotted those critical signs in time, or my treatment in the hospital had been delayed by even an hour, I would have died.
Sepsis symptoms can include pale and mottled skin, severe breathlessness, severe shivering or severe muscle pain, not urinating all day, nausea or vomiting. If you or someone you know has one or more of these symptoms, you should call the emergency services immediately and ask: “Could it be sepsis?”
Anyone can get sepsis, although research suggests that people with a vitamin D deficiency have a higher risk of contracting sepsis than most. Vitamin D deficiency has also been linked to an increased risk of getting an infection, which may then go on to cause sepsis.
Promising avenues
Unfortunately, while it may be possible to treat the original infection with antibiotics, there is no specific cure for sepsis – only the symptoms can be treated. New research, however, shows that metformin, a drug used to treat type 2 diabetes, can reduce the impact of sepsis by limiting the body’s immune reaction and protecting it from damage by free radicals (oxygen-rich molecules that can damage cells).
Sherry Yates Young/Shutterstock.com
Other promising research suggests that gene therapy may prove important in tackling sepsis, by targeting a protein produced in the body called NF-kB, which malfunctions during sepsis. If successful, these and other treatments in development have the potential to save lives and reduce the long-term impact of the disease on survivors.
The latest research seems promising, but the greatest defence we have against sepsis is awareness of the condition in medical professionals and the public. But at the moment awareness is alarmingly low across the world.
Surveys suggest that only 40% of people in Australia have heard of sepsis and only one-third of this group are able to identify a single symptom. Figures are even lower in Brazil where only 14% of the public know what it is. And, although campaigning in the UK and Germany has created an awareness in over 60% of people, knowledge of the warning signs is still limited.
As you’d expect, awareness is higher among healthcare professionals – but there is a need for greater education within this group. A definite diagnosis is often difficult, and efforts are being made to establish clear guidance for healthcare workers across the world, including the roll-out of an internationally recognised protocol called Sepsis6.
With time, scientific research may provide new treatments – but in the short term, greater awareness of the condition among the public and medical professionals is likely to have the biggest effect on saving lives and minimising harm. So always ask: “Could it be sepsis?”
Michael J Porter, Lecturer in Molecular Genetics, University of Central Lancashire
This article was originally published on The Conversation. Read the original article.
[Perspectives] Gout
As he tried to evoke the agonies of his gout-stricken patients in the first century CE, the Greek physician Aretaeus of Cappadocia did not mince his words: “No other pain is more severe than this, not iron screws, nor cords, nor the wound of a dagger, nor burning fire.” Like osteoarthritis, like dental caries, gout is one of many chronic diseases that, in the words of the historians Roy Porter and George Rousseau, “are not in themselves fatal, but incurable, typically debilitating, sometimes crippling and inordinately painful”.