News in Brief

INTERPHONE study shows no increased risk of brain cancer
with mobile phone use

Results of the INTERPHONE study to assess brain tumour risk in relation to mobile telephone use concluded that there was no increase in risk of glioma or meningioma with use of mobile phones. The interview-based casecontrol study, published 17 May 2010 in International Journal of Epidemiology, looked at 2,708 glioma and 2,409 meningioma cases and matched controls in 13 countries. The researchers noted “there were suggestions of an increased risk of glioma at the highest exposure levels, but biases and error prevent a causal interpretation”. They added the possible effects of long-term heavy use of mobile phones require further investigation. Ref: doi:10.1093/ije/dyq079.

Living Human Digital Library releases first 3D dataset free for research use

Super Computing Solutions and the Computational Bioengineering Lab by the Istituto Ortopedico Rizzoli in Bologna, have released the first dataset that composes the Living Human Digital Library (LHDL) multiscale musculoskeletal data collection. By the end of this year the entire LHDL multiscale collection on LHDL Donor1 will be made available.

Visit: www.physiomespace.com access to download the data and use freely for non profit research.

Cholesterol levels vary with menstrual cycle

Researchers have shown that women’s cholesterol levels correspond with monthly changes in estrogen levels. This natural variation, they suggest, might indicate a need to take into account the phases of a woman’s monthly cycle before evaluating her cholesterol measures. On average, the total cholesterol level of the women in the study varied 19% over the course of the menstrual cycle. The researchers found that as the level of estrogen rises, high-density lipoprotein (HDL) cholesterol also rises, peaking at the time of ovulation. Reference: Journal of Clinical Endocrinology & Metabolism, doi:10.1210/jc.2010-0109

World first: WHO issues global standard paediatric drugs info

The first ever WHO Model Formulary for Children provides information on how to use over 240 essential medicines for treating illness and disease in children from 0 to 12 years of age. For the first time medical practitioners worldwide have access to standardised information on the recommended use, dosage, adverse effects, and contraindications of these medicines for use in children.
● Visit: www.who.int/childmedicines

26-floor Methodist Outpatient Center opens in Houston

The Methodist Hospital has opened one of the world’s largest outpatient centres – the Methodist Outpatient Center. The 148,000 sq m, 26-floor facility is the largest building in the Texas Medical Center in Houston dedicated solely to patient care where, among other novelties, the more than 310,000 patients expected annually will be greeted by patient navigators who assist them in getting to their appointments.

New CEO for US NIH

The Board of Directors of the Foundation for the US National Institutes of Health (FNIH), has named Dr Scott Campbell as its new executive director and chief executive officer. Dr Charles A. Sanders, FNIH chairman, said that given Dr Campbell’s experience and background in biomedical, programmatic and donor development, the Board was confident in his ability to take the NIH to the next level.

Gonorrhoea-causing bacteria becoming multidrug resistant

The rise of multidrug resistance in gonorrhoea-causing bacteria is threatening to make this sexually-transmitted infection extremely difficult to treat according to a British researcher who said some strains of the gonococcal bacteria are showing decreased sensitivity to the current antibiotics – ceftriaxone and cefixime.

World first Natural Orifice Translumenal Endoscopic Surgery

The Natural Orifice Surgery Consortium for Assessment and Research (NOSCAR) has completed the first transoral and transvaginal cholecystectomies (gallbladder removal) using Natural Orifice Translumenal Endoscopic Surgery (NOTES) in a multicenter human trial in the United States. In one patient the gallbladder was successfully removed through the mouth and in another the gallbladder was removed through the vagina. These human trials are the first in the world comparing oral and transvaginal to traditional laparoscopy and are considered a big step forward in the evolution of this revolutionary procedure.
 


New multi drug-resistant superbug starts global spread


Clinicians should be aware that patients who have recently received treatment in India or Pakistan could be infected with a new multi-drug resistant superbug called NDM-1 which is cause for growing concern in various parts of the world following an article published in The Lancet on 11 August 2010 about the dangers of this new superbug.

Cases of infection have been reported in the UK, US, Canada, Germany, Belgium and Australia with additional countries joining this list on a regular basis. In nearly all cases, infected patients had received treatment in India or Pakistan and returned to their home countries carrying the infection. There has been one reported death in Belgium in June by a patient infected by NDM-1. The victim was in a car accident during a trip to Pakistan. He was hospitalised with a major leg injury and then repatriated to Belgium but was already infected. Despite being administered colistin, a powerful antibiotic, the patient died, according to a Belgian doctor at the hospital where he was treated. The fear is that India, as a global hub for low-cost surgery, could spread the bug to patients who would then return to their countries and transfer it locally from patient to patient, thus spreading it rapidly around the world. Infections have already been passed from patient to patient in UK hospitals, according to a BBC News report.

The superbug is actually a bacterium – or one of a number of types of bacteria – which carries an enzyme called NDM-1 or New Delhi metallo-beta-lactamase. NDM-1 makes ordinary bacteria such as E-coli and Klebsiella pneumoniae resistant to almost all antibiotics. It is thought to have arisen through the irrational use of antibiotics in India, where there is little drug control and where common antibiotics have become ineffective partly because people can buy them over the counter and self-medicate without completing a prescribed course. In the US, according to a 25 June 2010 US CDC Morbidity and Mortality Weekly Report, http://www.cdc.gov/mmwr/preview/ mmwrhtml/mm5924a5.htm?s_cid=mm5924a5 during the first half of this year, 3 isolates of Enterobacteriaceae, an E. coli, a Klebsiella pneumoniae, and an Enterobacter cloacae, were identified at CDC to carry NDM-1 which confers resistance to all beta-lactams except aztreonam (a monobactam). However, these isolates were also resistant to aztreonam. All 3 isolates were from patients who had received recent medical care in India.

The CDC recommends that current CDC infection control guidance for carbapenem (beta-lactam)-resistant Enterobacteriaceae also is appropriate for NDM-1–producing isolates. This includes recognising carbapenemresistant Enterobacteriaceae when cultured from clinical specimens, placing patients colonised or infected with these isolates in contact precautions, and in some circumstances, conducting point prevalence surveys or active-surveillance testing among other high-risk patients.

The CDC warns that clinicians should be aware of the possibility of NDM- 1–producing Enterobacteriaceae in patients who have received medical care in India and Pakistan, and should specifically inquire about this risk factor when carbapenem-resistant Enterobacteriaceae are identified

Timothy Walsh, lead author of The Lancet article and a professor of medical microbiology and antimicrobial resistance at Cardiff University in Wales is quoted by Reuters as saying that because of medical tourism and international travel in general “resistance to these types of bacteria has the potential to spread around the world very, very quickly. And there is nothing in the [drug development] pipeline to tackle it.”

Promed Mail quotes an article in the Indiabased Economic Times http://economictimes.indiatimes.com/ETCetera/ articleshow/6311130.cms which says researchers in a Mumbai hospital had reported the presence of a multi-drug resistant superbug in an article published in an Indian medical journal, months before The Lancet study that has caused an outrage in India’s medical fraternity and drawn criticism from the government who claim that the The Lancet is an attempt to take a swipe at India’s medical tourism industry. The newspaper reports that a team of researchers from Department of Medicine at P D Hinduja National Hospital and Medical Research Centre had in March this year warned about the superbug in the Journal of the Association of Physicians of India (JAPI). They found 22 instances of NDM-1 in 24 patients between August and November 2009 and remarked that "this high number in a relatively short span is a worrisome trend that compromises the treatment options with carbapenems.”

In a statement to Middle East Health on 20 August the WHO said that while multidrug resistant bacteria are not new and will continue to appear, this development requires monitoring and further study.

WHO strongly recommends that governments focus control and prevention efforts in four main areas:

● surveillance for antimicrobial resistance;

● rational antibiotic use, including education of healthcare workers and the public in the appropriate use of antibiotics;

● introducing or enforcing legislation related to stopping the selling of antibiotics without prescription; and

● strict adherence to infection prevention and control measures, including the use of hand-washing measures, particularly in healthcare facilities.



The International Year of the Nurse – 2010

Calling all nurses! 2010 is the International Year of the Nurse. It is also the centennial year of the death of the founder of modern nursing – Florence Nightingale (1820-1910).

To celebrate this historic milestone, the 2010 International Year of the Nurse is planned as a sustained public awareness initiative to actively involve the world’s nurses – estimated to be more than 15 million – in a celebration of commitment to bring health to their communities, locally and worldwide.

Visit the IYNurse 2010 website: www.2010iynurse.net to read nurse tributes and nurse stories and to find out more about the International Year of the Nurse. Nurses may also want to visit the Nightingale Initiative for Global Health, or NIGH, and the Nightingale Declaration – www.nightingaledeclaration.net. This is a grassroots, nurse-inspired movement to increase global public awareness about the priority of health and to empower nurses and concerned citizens to stand for a healthy world everywhere.



FDA clears way for world’s first-in-man clinical trial of
embryonic stem cellbased therapy


The US FDA has notified Geron Corporation, a US-based biopharmaceuticals company, that the clinical hold placed on the company’s Investigational New Drug (IND) application has been lifted and the company’s Phase I clinical trial of GRNOPC1 in patients with acute spinal cord injury may proceed. This enables the company to move forward with the world’s first clinical trial of a human embryonic stem cell (hESC)-based therapy in man.

The Phase I multi-centre trial is designed to establish the safety of GRNOPC1 in patients with “complete” American Spinal Injury Association (ASIA) Impairment Scale grade A subacute thoracic spinal cord injuries.

“Our goals for the application of GRNOPC1 in subacute spinal cord injury are unchanged – to achieve restoration of spinal cord function by the injection of hESC-derived oligodendrocyte progenitor cells directly into the lesion site of the patient’s injured spinal cord.

“Additionally, we are now formally exploring the utility of GRNOPC1 in other degenerative CNS disorders including Alzheimer’s, multiple sclerosis and Canavan disease,” said Thomas Okarma, PhD, MD, Geron’s president and CEO.

The clinical hold was placed following results from a single preclinical animal study in which Geron observed a higher frequency of small cysts within the injury site in the spinal cord of animals injected with GRNOPC1 than had previously been noted in numerous foregoing studies. In response to those results, Geron developed new markers and assays as additional release specifications for GRNOPC1. The company completed an additional confirmatory preclinical animal study to test the new markers and assays, and subsequently submitted a request to the FDA for the clinical hold to be lifted.

GRNOPC1, Geron’s lead hESC-based therapeutic candidate, contains hESCderived oligodendrocyte progenitor cells that have demonstrated remyelinating and nerve growth stimulating properties leading to restoration of function in animal models of acute spinal cord injury (Journal of Neuroscience, Vol. 25, 2005).

“We know that demyelination is central to the pathology of spinal cord injury, and its reversal by means of injecting oligodendrocyte progenitor cells would be revolutionary for the field. If found to be safe and effective, the therapy would provide a viable treatment option for thousands of patients who suffer severe spinal cord injuries each year,” commented Richard Fessler, MD, PhD, professor of neurological surgery at the Feinberg School of Medicine at Northwestern University.



WHO declares end to H1N1 pandemic

Speaking at a virtual press conference on 10 August Dr Margaret Chan, the directorgeneral of the World Health Organisation, said the new H1N1 virus has largely run its course and that the world is no longer in phase 6 of influenza pandemic alert. “Put simply,” she said, “the pandemic is over.”

“We are now moving into the postpandemic period,” she said. She reiterated that these were the views of the Emergency Committee, which met earlier the previous day. The Committee based its assessment on the global situation, as well as reports from several countries that are now experiencing influenza.

However, she warned that as we enter the post-pandemic period, this does not mean that the H1N1 virus has gone away. “Continued vigilance is extremely important, and WHO has issued advice on recommended surveillance, vaccination, and clinical management during the postpandemic period.

“Based on experience with past pandemics, we expect the H1N1 virus to take on the behaviour of a seasonal influenza virus and continue to circulate for some years to come. “Globally, the levels and patterns of H1N1 transmission now being seen differ significantly from what was observed during the pandemic. Out-of-season outbreaks are no longer being reported in either the northern or southern hemisphere. Influenza outbreaks, including those primarily caused by the H1N1 virus, show an intensity similar to that seen during seasonal epidemics,” Dr Chan said.

She said that during the pandemic, the H1N1 virus crowded out other influenza viruses to become the dominant virus. This is no longer the case. Many countries are reporting a mix of influenza viruses, again as is typically seen during seasonal epidemics. “Pandemics are unpredictable and prone to deliver surprises. No two pandemics are ever alike. This pandemic has turned out to be much more fortunate than what we feared a little over a year ago. This time around, we have been aided by pure good luck. The virus did not mutate during the pandemic to a more lethal form. Widespread resistance to oseltamivir did not develop. The vaccine proved to be a good match with circulating viruses and showed an excellent safety profile,” she said.

In reply to a question from Reuters about the implications for countries holding remaining stockpiles of oseltamivir vaccine Dr Chan reiterated that the virus was still sensitive to the vaccine. “So they would continue to be useful. And WHO strongly recommends where vaccines are available, high risk groups should be immunized.”

● WHO recommendations for the postpandemic period: www.who.int/csr/disease/swineflu/notes/briefing_20100810/en/index.html 
 

                                  
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