Archive for September, 2014
(4.5 stars with 766 Ratings)
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- 2 cups plain whole-milk yogurt
- 1½ tablespoon chia seeds
- 1 tablespoon agave syrup, plus more
- Cocoa nibs, sunflower seeds, and/or toasted coconut (for serving)
It provides rapid information on drug resistance that takes up to six weeks using standard methods, US scientists report in the journal, Nature Communications.
The bacteria emit a unique gas signature within 10 minutes of exposure to an inhaled antibiotic in rabbits.
TB infects 8.6m people each year worldwide and kills 1.3m, second only to HIV.
Early diagnosis and treatment are a priority in the global fight against TB, according to the World Health Organization.
Optimally treating somebody the best you can at the time of that single encounter, so someone can go home with the right set of tablets, would be really, really useful”
Dr Graham TimminAssociate Professor at the University of New Mexico
The new research used an inhaled form of isoniazid – an antibiotic commonly used to treat the disease – which is activated by a TB enzyme.
The test exploits the fact that this enzyme is unique to TB, said Dr Graham Timmins, Associate Professor at the University of New Mexico, US, who led the research.
“We realised that we could actually look at the conversion of isoniazid to its active form by monitoring one of the labelled gases that’s given off during its activation,” he explained.
The researchers gave a special molecularly-labelled form of isoniazid to laboratory rabbits.
In the presence of TB, labelled nitrogen gas was released from the lungs and detected by a machine called a mass spectrometer.
A positive result indicates that TB bugs are present and suggests they are susceptible to isoniazid.
TB is very difficult to treat, requiring at least six months of treatment with multiple drugs.
Failure to complete treatment has contributed to the rise of multidrug-resistant TB (MDR-TB), accounting for 30% of cases in some countries.
For many years diagnosis of TB relied on a lengthy wait for the bacteria to grow in a culture of the patient’s sputum.
“If you do it by culture, it can take a month to six weeks before you get a result,” said Dr Timmins.
In the last few years a new DNA detection technique called GeneXpert has been endorsed by the World Health Organization.
From a sample of sputum it can detect whether a sample contains TB and whether it is is resistant to one of the key drugs, rifampicin, in about three hours.
But for full drug resistance information the patient has to wait longer.
“Optimally treating somebody the best you can at the time of that single encounter, so someone can go home with the right set of tablets, would be really, really useful,” said Dr Timmins.
The new breath test samples the whole lung for what is hoped will be greater sensitivity, in a wider range of patients, with results available almost instantly.
“It’s a clever idea,” said Dr Ruth McNerney, senior lecturer at the London School of Hygiene and Tropical Medicine.
The test could “add a bit more certainty” to the diagnosis of MDR-TB, and “it’s worth pursuing, definitely,” she said.
At present the breath test only detects isoniazid sensitivity. It will therefore need to be used in combination with other tests.
“This is just the start of the program we want to instigate,” said Dr Timmins.
The next step will be to show that the tests work in humans in a clinical setting.
“Lots of good ideas fail when you put them into the clinic,” conceded Dr Timmins.
Eye surgeons in Mali travel long distances in extreme heat on motorbikes visiting remote villages to try and eliminate one of the leading causes of preventable blindness.
They go from village to village and treat anyone with the advanced stages of trachoma, a bacterial infection, before it causes irreversible blindness. Trachoma is common in children and the women who care for them. It is infectious and is spread by coming into direct contact with the discharge produced from the eyes or nose of an infected person through contaminated objects such as towels. Flies also transfer the bacteria from the discharge.
The locally trained health workers upload their findings by mobile phone to a central system. They report the number of people they screen for the disease, the surgeries they carry out, and the number of follow-up consultations they provide.
Here in the remote village of N’Korobougou, in the western region of Koulikoro, Boubacar Fomba diagnoses a 68-year-old woman with trichiasis, the advanced stage of trachoma, where the infection has become so bad that the eyelashes have turned inwards, painfully scratching the eyeball with every blink. “I started having pain and itching there about 20 years ago,” says Kany Doumbia, who earns a living through agriculture and gardening.
Mr Fomba is part of a team working on a Sightsavers project to tackle a backlog of advanced cases in Mali. It is hoped that the disease can be eliminated in the West African nation by the end of next year – an aim made possible largely thanks to a multi-million dollar donation by the Conrad N Hilton Foundation.
The 10 surgeons in the team work across 10 different districts, each covering between 20km (12 miles) and 30km a day and conducting at least three operations each day. Poor communities in hot and dusty climates – where access to water is poor – are most affected by the disease.
During surgery the eyelid is rotated outwards, directing the eyelashes away from the eyeball – a procedure that takes as little as 10 minutes. Globally an estimated 8 million people suffer from the advanced stages of the disease and require surgery to prevent them from going blind. In Mali, an estimated 25,000 people need surgery before elimination is reached. The prevalence of the disease amongst children under nine has dropped to below 5%.
After the surgery, Ms Doumbia said she felt a real change because the pain she used to have had gone – and she was relieved that she would be able to continue to sell her garden produce in the nearest city, Ouelessebougou. “I had started to fear losing my sight because the pain became frequent and often my vision was blurred,” she said.
“We consult dozens of people per day,” Mr Fomba says. “And people come to us because they were recommended by other patients. That makes us feel proud.” Antibiotics are also prescribed to treat the infections – and the surgeons explain that facial cleanliness is one of the best ways to prevent the spread of the bacteria.
In the afternoon, each motorbike surgeon sets off for the next village where they will spend the night – so that another day of examinations and operations can begin early the next morning. Gallery by Javier Acebal for Sightsavers.
Umaru Fofana is in the Sierra Leone capital, Freetown
Sierra Leone’s President Ernest Bai Koroma has widened a quarantine to include another one million people in an attempt to curb the spread of Ebola.
The northern districts of Port Loko and Bombali, and Moyamba in the south, will in effect be sealed off immediately.
Nearly 600 people have died of the virus in Sierra Leone and two eastern districts have been isolated since the beginning of August.
The move follows a three-day nationwide lockdown that ended on Sunday night.
New figures released by the UN World Health Organization show that 2,917 people have died in the current Ebola outbreak in West Africa, with Sierra Leone, Liberia and Guinea worst affected.
Two eastern districts have already been isolated and the extension of the indefinite quarantine means more than a third of Sierra Leone’s 6.1 million population now finds itself unable to move freely.
During Sierra Leone’s three-day curfew, more than a million households were surveyed and 130 new cases discovered, the authorities say.
President Koroma said the move had been a success but had exposed “areas of greater challenges”, which was why other areas were being quarantined.
Only people delivering essential services can enter and circulate within areas under quarantine.
- Liberia with a 4.2m population: 51 doctors; 978 nurses and midwives; 269 pharmacists
- Sierra Leone with a 6m population: 136 doctors; 1,017 nurses and midwives; 114 pharmacists
In a televised address, the president acknowledged that the isolation would “pose great difficulties” for people.
“[But] the life of everyone and the survival of our country take precedence over these difficulties,” he said.
According to WHO, the situation nationally in Sierra Leone continues to deteriorate with a sharp increase in the number of newly reported cases in the capital, Freetown, and its neighbouring districts of Port Loko, Bombali, and Moyamba, which are now under quarantine.
|Country||Existing bed capacity||Newly funded beds||Extra beds required|
|SOURCE: WHO, 24 SEPTEMBER 2014|
Despite efforts to deploy more health workers and open new Ebola treatment centres in the worst-affected countries, there was still a significant lack of beds in Sierra Leone and Liberia, with more than 2,000 needed, WHO said.
The situation in Guinea appeared to be stabilising, with up to 100 new confirmed cases reported in each of the past five weeks, but it was still of grave concern, it said.
Ebola virus disease (EVD)
- Symptoms include high fever, bleeding and central nervous system damage
- Spread by body fluids, such as blood and saliva
- Fatality rate can reach 90% – but current outbreak has mortality rate of about 70%
- Incubation period is two to 21 days
- There is no proven vaccine or cure
- Supportive care such as rehydrating patients who have diarrhoea and vomiting can help recovery
- Fruit bats, a delicacy for some West Africans, are considered to be virus’s natural host