Articles by "Health"
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May 30, 2017
A new stem cell study reveals the impact of cigarette harm to unborn babies.
A new stem cell study reveals the impact of cigarette harm to unborn babies.
Scientists discovered that the mixture of chemicals in cigarettes is especially harmful to developing liver cells.

They developed a method of studying the consequences of maternal smoking on liver tissue using embryonic stem cells.

The team, led by the University of Edinburgh, also discovered that the cigarette chemicals affect fetuses differently depending on their gender.

Throughout their research they used pluripotent stem cells - cells which have the ability to transform into other cell types - to build fetal liver tissue.

Liver cells were exposed to the noxious chemicals found in cigarettes, including specific substances known to flow in fetuses when mothers smoke.

The study revealed that a chemical cocktail - similar to that found in cigarettes - harmed fetal liver health more than individual components.
Lasting harm

Dr David Hay from the University of Edinburgh's centre for regenerative medicine, said that cigarette smoke is known to have damaging effects on the fetus, but appropriate tools to study this in a very detailed way are lacking.

This new approach means that there are now sources of renewable tissue that will allow us to understand the cellular effect of cigarettes on the unborn fetus.

The liver is essential in clearing dangerous substances and plays a major role in regulating metabolism.

Smoking cigarettes, which contain around 7,000 chemicals, can harm fetal organs and may do lasting harm.

Male tissue demonstrated liver scarring while female tissue showed more damage to cell metabolism.
This work is part of an ongoing project to understand how cigarette smoking by pregnant mothers has harmful effects on the developing feetus. - Prof Paul Fowler, director of the institute of medical sciences at the University of Aberdeen
These discoveries shed light on fundamental differences in damage between male and female fetuses.
The study is published in the journal Archives of Toxicology.
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May 23, 2017
Major cholera outbreak feared in Yemen
A huge cholera epidemic is feared in Yemen, according to charity Save the Children.
This month alone almost 250 people have died of the disease, with hundreds of suspected cases being reported every day, it says.

The World Health Organization said the water-borne illness is spreading at a startling rate in the war-ravaged country.

Sanaa has been the worst affected area and last week a state of emergency was declared in the in the rebel-held capital last week.

Save the Children believes thousands of people could die of the easily treatable disease, and said more than two million malnourished children are particularly at risk.

Cholera is transmitted through contaminated water and food.

Symptoms include acute diarrhoea and vomiting. Those who are ill with cholera can become very sick and, when it is left untreated, death can occur within hours.

Charity Médecins Sans Frontières (MSF), which has set up cholera treatment centres in the country, also fears the outbreak will spiral out of control.
Before the outbreak, the health system was already overstretched and people's health needs were already huge.
To bring the outbreak under control, it won't be enough simply to treat those people who reach medical facilities. We also need to address the source of the disease, by improving water and sanitation and working in communities to prevent new cases. - Ghassan Abou Chaar, MSF's head of mission in Yemen.
According to the WHO fewer than 45% of health facilities are fully functioning in Yemen, with almost 300 damaged or destroyed in fighting between forces loyal to President Abdrabbuh Mansour Hadi - who is backed by a Saudi-led multinational coalition - and those allied to the Houthi rebel movement.

Save the Children urged all the sides in the conflict to end restrictions on the import of aid immediately.

More than eight million people lack access to drinking water and sanitation in the nation.

Over 8,000 people - mostly civilians - have been killed and close to 44,500 others injured since the conflict in Yemen escalated in March 2015, as stated by the UN.

The fighting has also left almost 19 million people in need of humanitarian assistance.
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May 18, 2017
Ebola will cost 10 million dollars in the DRC, according to the WHO
According to the World Health Organisation a new outbreak of Ebola in the Democratic Republic of the Congo (DRC) will cost $10 million to fight, and it could take months because the victims are in a very remote and disrupted part of the country.
At least 20 people are sick with the virus and three have been killed, WHO officials said. They are the first deadly case — a 39-year-old man — a person who cared for him and a man who drove him on a motorcycle to seek help.

Dr. Peter Salama of the WHO told a news conference that the area has only 20 kilometres (12 miles) of paved roads and virtually no functioning telecommunications.

As of now the full extent of the outbreak remains unkown.

The WHO needs governments to help it and the Democratic Republic of the Congo fix airstrips, roads and set up clinics — and all that just to even get a grip on how bad the outbreak is, Salama said. Work is ongoing to get approval and facilities in place to use an experimental Ebola vaccine in the region.

There have been sporadic outbreaks of Ebola in various parts of Africa since 1976.
The first and only epidemic was in 2014-2016 in Guinea, Liberia and Sierra Leone — a part of the continent where Ebola had never been seen before. It infected at least 28,000 people and killed more than 11,000 before it was brought under control.
The DRC is now experiencing its eighth Ebola outbreak.
We believe that the DRC's government has strong experience … and a proven track record of handling Ebola outbreaks -Dr. Peter Salama.
An new vaccine developed to fight Ebola was tried out in West Africa but the cases were not enough to show its efficacy. That vaccine has not yet been approved by any government authority but Salama said it could be used under compassionate use circumstances if the DRC government agrees.
But it will be hard to get it to the affected area in the north of the country because of the lack of roads and electricity. The vaccine must be kept at -80 degrees C.
Salama recognises that this will be a huge challenge.
Of important notice the christian terrorist group, Lord's Resistance Army, has been operating in the area, WHO added.

In spite of the problems, Médecins Sans Frontières, a nonprofit aid group, has already set up a treatment center, said Dr. Matshidiso Moeti, WHO regional director for Africa.
I have been very encouraged by this rapid reponse -Moeti told a news conference.
She said, polio vaccination teams were already in place, giving everyone a head start. Moeti said that they have been the people who are leading surveillance in the country. 
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May 16, 2017
colorful condoms
Two compounds usually found in wild plants could create good alternatives to emergency contraceptives - if scientists find out where to get them in large amounts.
Chemicals from dandelion root and the "thunder god vine" plant have been used in traditional medicines for a long time.

Now, Californian researchers have found they can also be used to block fertilisation.

However the compounds existed at such low levels in plants that the cost of extraction was too high, the US team said.

In tests, chemicals called pristimerin and lupeol stopped fertilisation by stopping human sperm from whipping its tail and propelling itself into the woman's egg.

The chemicals acted like "molecular condoms", the study authors wrote in the journal Proceedings of the National Academy of Sciences.

That is, they successfully blocked progesterone - which triggers the sperm's forceful swimming - but didn't damage the sperm.

It doesn't kill sperm basal motility. It is not toxic to sperm cells; they still can move

Said Polina Lishko, assistant professor of molecular and cell biology from the University of California, Berkeley.

"But they cannot develop this powerful stroke, because this whole activation pathway is shut down."

Lupeol is found in plants such as dandelion root, mango and aloe vera, while pristimerin is from the tripterygium wilfordii plant (also known as "thunder god vine") and is used in traditional Chinese medicine.

The researchers discovered that the chemicals worked at very low doses and had no side-effects either, unlike hormone-based contraceptives.

They reached the conclusion that the compounds could possibly be used as an emergency contraceptive, before or after intercourse, or as a permanent contraceptive via a skin patch or vaginal ring.

Prof Lishko and her colleagues will now begin to test how well these chemicals work in primates, whose sperm cells work in a similar way to humans.

However further studies will be needed, and it might take years before this new contraceptive becomes available to humans.
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May 10, 2017
Painkillers spilled on a table

A new study suggests there could be a link between taking high doses of common anti-inflammatory painkillers, such as ibuprofen and naproxen, and heart attacks.
The paper, published in The British Medical Journal, builds on a previous body of work that had linked these drugs to heart problems.

The research suggests the risk could be greatest in the first 30 days of use.

Scientists however say the findings are not clear cut. They claim that factors besides the pills could be involved.

In the study an international team of scientists analysed data from 446,763 people to try to understand when heart problems might arise.

They focused on people prescribed non-steroidal anti-inflammatory drugs (such as ibuprofen, celecoxib and naproxen) by doctors rather than those who bought the painkillers over the counter.

After studying the data from Canada, Finland and the UK, researchers suggest that taking these painkillers to treat pain and inflammation could increase the risk of heart attacks even in the first week of use.

The risk was seen to be especially in the first month when people were taking high doses (for example more than 1200mg of ibuprofen a day) .Kevin McConway, emeritus professor of statistics at The Open University, said the paper revealed a possible relationships between Nsaid painkillers and heart attacks, but that more reasons could be involved.

Despite the large number of patients involved, some aspects do still remain pretty unclear.

It remains possible that the painkillers aren't actually the cause of the extra heart attacks.

 An example given by the professor is that if someone was prescribed a high dose of a painkiller because of severe pain, and then had a heart attack the following week, it would be "pretty hard" to tell whether the heart attack had been caused by the painkiller or by the source of the pain that led to the purchase of these drugs.

It could even have been due to something entirely unrelated according to him.

For most people who have no heart conditions these findings may be of minimal importance, but for those at higher risk, perhaps they should consider carefully with their doctor if a high dose of painkillers would be appropriate for them under their individual circumstances.
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May 09, 2017
EpiPens should work at least a while past expiration dates
EpiPen auto-injection epinephrine pens manufactured by Mylan NV pharmaceutical company for use by severe allergy sufferers are seen in Washington, U.S.
It’s worth a shot to use an expired EpiPen, if that’s all you have, a new study suggests.
SOURCE: Annals of Internal Medicine, online May 8, 2017.
For more than four years past their stamped expiration dates, the handheld injectors retained high-enough concentrations of epinephrine to in all likelihood prevent potentially fatal allergic reactions, the study found.

The manufacturer advises patients to replace the life-saving EpiPen devices annually. Worried that surging EpiPen prices make yearly replacement unaffordable for many families, pharmacist F. Lee Cantrell analyzed 40 expired EpiPens and EpiPen Juniors.

Cantrell, who directs the California Poison Control System in San Diego, found that the auto-injectors did lose potency over time. Even 50 months past expiration, however, the EpiPens retained 84 percent of epinephrine concentrations - enough to prevent anaphylactic shock, he said in a phone interview.

“In every pen we tested there was enough to give what would be considered a therapeutic dose,” said Cantrell, lead author of a letter published Monday in the Annals of Internal Medicine.

“If my kid’s having a life-threatening reaction, and I had no alternative, absolutely I would use it without hesitation,” he said. “I don’t think there’s a physician in the world who would rebut that.”

Dr. Kao-Ping Chua, a pediatrician and professor at the University of Chicago, agreed, though he stressed his belief that it is crucial to replace expired EpiPens with in-date ones.

At the same time, he joined Cantrell in calling on regulators and Mylan, the EpiPen manufacturer, to re-evaluate the product’s life span.

“I think the whole process of expiration dating in the United States needs to be revisited and potentially revised,” Cantrell said. “The results could be enormous cost savings to consumers.”

Mylan has filed an application with the U.S. Food and Drug Administration for a new EpiPen formulation, which would extend the product’s shelf life, Julie Knell, Mylan’s senior director for global product communications, said in an email. She said she could not reveal anything more about the confidential application.

In September, Mylan CEO Heather Bresch told the U.S. House Committee on Oversight and Government Reform that the drug-maker hopes to offer an EpiPen with a 24-month shelf life within a year.

Mylan came under fire beginning last year for raising the price of a pair of EpiPens to more than $600 from $100 in 2008.

EpiPens currently expire 18 months after the date of manufacture. But a number of pharmacists have told Cantrell that they do not receive the devices until six months after they were manufactured, putting the injectors into patients’ hands with less than one year left until they need to be replaced.

In September, Mylan announced it had agreed to a $465 million settlement with the U.S. Justice Department over how the drug was classified for government buyers.

Patients’ out-of-pocket spending for EpiPens climbed 535 percent from 2007 to 2014, another recent study found. The number of annual EpiPen prescriptions nearly tripled during the same period.

The expiration dates stamped on EpiPens reflect “the final day, based on quality control tests, that a product has been determined to be safe and effective when stored under the conditions stated in the package insert,” Knell said. “Given the life-threatening nature of anaphylaxis, patients are encouraged to refill their EpiPen Auto-Injector upon expiration, approximately every 12 to 18 months.”

People with severe allergies to things like peanuts, shellfish, bees or penicillin might be prescribed EpiPens to keep on hand for emergencies. Untreated anaphylactic shock can be fatal because blood pressure can drop suddenly and airways can narrow, making breathing difficult.

For parents with high-deductible insurance or high copayments, the choice of whether to buy a $600 pack of EpiPens for an allergic child or food can be challenging and distressing, said Cantrell and Chua, who was not involved in the new study.

“All of this comes back to the price,” Chua said in a phone interview. “Why is Mylan putting us as patients into a position where we have to decide between doing the best thing for our children versus paying $600, which is money that can’t go towards rent?”

“I don’t think anyone should be relying on an expired EpiPen if they have a choice,” he said. But, he added: “If all you have is an expired EpiPen, and you need it, then use it. It’s better than nothing.”

SOURCE: Annals of Internal Medicine, online May 8, 2017.
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May 06, 2017
Doctor preparing for surgery

A Bangladeshi child born with a third leg attached to her pelvis is returning home after a successful surgery in Australia.

Choity Khatun, aged three, was born with caudal twinning, meaning that part of a twin had developed in her pelvis.

Australian surgeons spent months figuring out how to remove the additional limb and reconstruct her pelvic area.

The charity Children First Foundation helped bring Choity from her Bangladeshi village into Australia.

Head of surgery at Monash Children's Hospital in the state of Victoria, Dr Chris Kimber, said Choity's case was very rare and the surgery had been "daunting".
The operation is sort of determined by the individual and you have to spend a lot of time trying to analyse what's there and then plan a procedure that takes that into account
He told the Australian Broadcasting Corporation.

The Australian team held considerable discussions with doctors in Bangladesh, who had already performed some surgery.

The team had to decide whether further surgery was even possible or beneficial before she was brought to Australia last year.
Doctors in Bangladesh had removed part of the leg "but she was still left with a large mass sitting there in her pelvis between her two normal legs", Dr Kimber said.
Because there's part of a twin in there, she had two rectums, two vaginas, potentially two anuses - double bits that were growing into a very abnormal area.


After a long planning process, the team commenced the surgery in November.

They removed what was left of the leg and carried out reconstruction work to ensure that little Choity was continent.

Dr Kimber said the child, who is partially blind, was now walking and running around, and had put on weight.

He said she might need further corrective surgery during her teenage years but would be able to return home to Bangladesh with her mother "without medication or surgical aids".

Her mother, Shima Khatun, told Australian media on Thursday that she was looking forward to going home to her family and watch her daughter play.
Everything is good now… she can play like other babies… she is the same [as them]
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May 06, 2017
Thin woman measuring her stomach

France has passed a new law banning extremely thing models from the catwalk.

 From now on models must provide a doctor's certificate indicating their overall physical health, with special attention given to their body mass index (BMI) - a measure of weight in relation to height.

The health ministry says the aim is to fight eating disorders and unrealistic ideals of beauty.

Photos that are digitally altered will also have to be labelled from 1 October.

Pictures where models' appearances have been manipulated will need to be marked photographie retouchée (English: retouched photograph).

A previous version of the bill included a minimum BMI for models, prompting protests from French modelling agencies.

But the final version, backed by the National Assembly, allows doctors to decide whether a model is too thin by taking into account their weight, age, and body shape.

Employers breaking the law could face fines of up to 75,000 euros and up to six months in jail.
Exposing young people to normative and unrealistic images of bodies leads to a sense of self-depreciation and poor self-esteem that can impact health-related behaviour
Said France's Minister of Social Affairs and Health, Marisol Touraine, in a statement on Friday.

France is not the first country to legislate on underweight models - Italy, Spain and Israel have all taken similar steps previously.

Anorexia affects between 30,000 to 40,000 people in France, 90% of whom are women.
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May 05, 2017
Needle with blood

For the first time scientists have been able to eliminate HIV from the issue of living animals.
The virus from the tissue of a group of mice (which had been transplanted with human cells that were infected with HIV) was completely eliminated by a team of researchers at Lewis Katz School of Medicine, part of Temple University.
The next stage would be to repeat the study in primates
Said co-senior study investigator Kamel Khalili.

He has also indicated that the eventual goal will be clinical trials on human patients.The researchers claim this is a world first, saying that to their knowledge, this study is the first to demonstrate the effective excision of HIV-1 proviral DNA from the host genome in pre-clinical animal models [using this method].
Dr Wenhui Hu, of Temple University, said the new study built on earlier research but was “more comprehensive”.

We confirmed the data from our previous work and have improved the efficiency of our gene-editing strategy.

We also show that the strategy is effective in two additional mouse models, one representing acute infection in mouse cells and the other representing chronic, or latent, infection in human cells.

The virus is known for killing the cells it infects, leaving the host open to various new infections, that while harmless to an average healthy individual, could prove deadly to an HIV infected patient.

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April 24, 2017 ,
Disease detectives say they're still stumped by what causes a rare, polio-like paralyzing condition in kids and say they don't have a No. 1 suspect.

They've tested kids with acute flaccid myelitis for more than 250 different viruses and say no single one appears to be a major cause of the condition, which can leave patients disabled for months.

CDC Still Stumped by Cause of Mystery Paralysis in Kids
Bailey Sheehan, 8, of Portland, Ore., is one of about 300 kids nationwide who suffered a strange, polio-like muscle weakness once suspected to be linked to a distant relative of polio called EV-D68.
Not only that, but they can't say who's more at risk or how cases tend to progress, Tracy Ayers of the Centers for Disease Control and Prevention told a meeting of the CDC's Epidemic Intelligence Service.

"We have tested for over 250 different organisms that could be causing this," Ayers told reporters. "We are also expanding to look at non-infectious diseases."

"After a decrease in 2015, acute flaccid myelitis cases increased during 2016 raising concerns of a resurgence," Ayers and colleagues wrote in a brief summary.

The CDC says that 138 people in 37 states had the condition in 2016, with five more cases reported so far this year. "Even with an increase in cases in 2016, acute flaccid myelitis remains a very rare disease (less than one in a million)," CDC added.

Ayers described the case of one Arizona child who became suddenly paralyzed.

"During the day she was fine but she was gradually not feeling good and by the time it came time to go to bed — the bed hurt," Ayers said. "Everything hurt to touch." The mother put the girl into the bath to relieve her pain and became worried when the girl's head went floppy. She rushed her to the emergency room and the muscle weakness worsened so much that the child was put on a ventilator to help her breathe.

There is no specific treatment for the condition. This child was regaining strength with physical therapy, Ayers said.

"This is such a brand-new disease that we don't know what the long term outcomes are," she said.

At first, doctors noted an association with a virus called EV-D68, a normally harmless enterovirus that causes common cold-like symptoms. But now that link is no longer clear, Ayers said.

West Nile virus can also cause it, as well as adenoviruses, which also cause common cold-like symptoms.

"EV-D68 specifically is one of the many enteroviruses that we tested for," she said.

The CDC has appealed to doctors to get blood and spinal fluid samples as soon as possible if there's suspicion of acute flaccid myelitis. The body can quickly fight off infections, leaving little evidence about what caused the condition.

"We need as much information as possible," Ayers said.

Symptoms of acute flaccid myelitis include sudden onset of weakness in the arms or legs, as well as drooping facial muscles, including the eyelids, and difficulty moving the eyes. Most patients must be hospitalized and a few have been completely paralyzed. The CDC has not reported any deaths.
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April 20, 2017 ,
Running May Be Socially Contagious
Our workouts may be shaped by what our (virtual) friends do

Can our workouts be shaped by what our friends do?

That question is at the heart of an important new study of exercise behavior, one of the first to use so-called big data culled from a large-scale, global social network of workout routines.

The researchers focused on running, because so many of the network participants were runners. And what they found suggests that whether and how much we exercise can depend to a surprising extent on our responses to other people’s training.

The results also offer some practical advice for the runners among us, suggesting that if you wish to improve your performance, you might want to become virtual friends with people who are just a little bit slower than you are.

There have been intimations for some time that aspects of our lifestyles and health can be contagious. Using data from surveys and postings on social media, scientists have reported that obesity, anxiety, weight loss and certain behaviors, including exercise routines, may be shared and intensified among friends.

But those studies had limitations, particularly related to the tendency of people to gravitate toward others who are like them. This phenomenon, which researchers call homophily, makes it difficult to tease out how friends influence each other’s lives. Many of these studies also relied on people’s notoriously unreliable estimations of their behavior, whether it involved eating or exercise.

The new study, published on Monday in Nature Communications, sought to avoid these pitfalls by turning to data from a worldwide social network devoted to sharing objectively measured exercise routines. (The network is not named in the study for contractual reasons, the researchers say.)

People who join this network upload data from an activity monitor, which precisely tracks their daily exercise regimens. They also become virtual friends with others in the network who seem like-minded. Friends then automatically share workout data.

The researchers, from the Massachusetts Institute of Technology’s Sloan School of Management, eventually gathered five years worth of data from about 1.1 million runners from across the globe. Cumulatively, those in the network had run almost 225 million miles during that time.

The identity of the individual runners was masked, but the researchers could tally exactly how often, far and fast each had gone every day for five years. They could similarly map out how often, far and fast their particular friends had run on those same and subsequent days.

Using this data, the researchers noted immediate correlations. Friends tended to display similar training routines day to day and year to year, even if they were separated geographically. But it remained unclear whether the runners were influencing one another’s distance and pace or just hanging out virtually with people who already ran like them. 

So the researchers next decided that they should also consider weather. Bad weather can dampen enthusiasm for exercise, the researchers reasoned, so if someone heads out in rotten weather on a day when friends elsewhere have run, the soggy runner presumably has been influenced by what his or her friends had been up to.

Consequently, the researchers also gathered five years’ worth of data from global weather stations and cross-correlated this massive database with information about the 1.1 million runners’ daily workouts.

The results clearly showed that runners do influence one another, the scientists found. Over all, if one person ran for about 10 minutes more than usual on any given day, that runner’s friends would lengthen their workout by approximately three minutes, even if the weather was discouraging. Similarly, if a friend ran faster than usual, his or her friends would tend to pick up their pace in their runs that same day.

The effects were most pronounced, the researchers found, if one runner previously had been just a little slower or less in shape than a friend but now showed signs of overtaking a friend’s performance. The threat of falling behind would prod that friend to run a bit harder.

Gender also mattered. Men generally ran faster or longer if their male virtual friends had done likewise and also if their female friends had, although not to the same extent. But female runners seemed unaffected by male network friends. They altered their training routines almost exclusively in response to changes among their female friends.

In aggregate, these results indicate that, with caveats, “running can be socially contagious,” says Sinan Aral, the David Austin Professor of Management at M.I.T. who led the study.

The impacts “go beyond correlation to causation,” he says. “In general, if you run more, it is likely that you can cause your friends to run more.” 

But the findings apply only to people who already are runners, he adds, since the data he and his colleagues used described runners. They cannot tell us whether other types of exercise are equally catching or how to make exercise in general more palatable and contagious among inactive people.

Dr. Aral and his colleagues plan to use other social media data to study those questions soon. 
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April 19, 2017
Bacteriophages can potentially be used to combat antibiotic-resistant bacterial infections.
Bacteriophages can potentially be used to combat antibiotic-resistant bacterial infections.


Viruses that specifically kill bacteria, called bacteriophages, might one day help solve the growing problem of bacterial infections that are resistant to antibiotic treatment. Researchers at Baylor College of Medicine and the Michael E. DeBakey Veterans Affairs Medical Center have determined that phages can effectively reduce bacterial levels and improve the health of mice that are infected with deadly, antibiotic-resistant bacterial 'superbugs.' The study appears in Scientific Reports.

"Our research team set out to determine whether phages can be effective at killing a large group of bacteria that have become resistant to antibiotics and cause deadly diseases in people," said corresponding author Dr. Anthony Maresso, associate professor of molecular virology and microbiology at Baylor. "We are running out of available options to treat patients who have these deadly bacterial infections; we need new ideas."

When bacteria grow out of control, they can enter the blood stream and infect vital organs in the body. The body's immune system, an army of cells and molecules that fights back infections and other diseases, responds to the bacterial attack, defending the body from the infection. However, the immune response sometimes is excessive and can lead to tissue damage, organ failure and death, a process called sepsis. To end sepsis, bacterial growth has to stop. Antibiotic treatment usually can control bacterial growth and prevent the deadly consequences of sepsis, but increasing number of bacteria is becoming resistant to antibiotics.

According to the National Institute of General Medical Sciences, sepsis affects more than 1 million people in the United States every year. About 50 percent of patients with sepsis die; this outnumbers the U.S. deaths caused by prostate cancer, breast cancer and AIDS combined. The number of sepsis cases per year is increasing, which underscores the need for new strategies to fight bacterial infections.

In this study, the researchers investigated the possibility of recruiting phages in the fight against antibiotic-resistant bacteria, reviving the original idea of Felix d'Herelle, proposed in 1926.

"The driving force behind this project was to find phages that would kill 12 strains of antibiotic-resistant bacteria that were isolated from patients," said co-author Dr. Robert Ramig, professor of molecular virology and microbiology at Baylor. "As the virologist on the team, my first contribution was to go phage hunting."

Phage hunting

"I have a number of phages in my lab, but none of them killed the antibiotic-resistant E. coli we were working on -- the sequence type 131 currently pandemic across the globe," Ramig said.

Birds and dogs often carry the bacteria the researchers were interested in, and may be one environmental reservoir of these pathogens. They also carry phages specific for those bacteria. Ramig, Maresso and Sabrina Green, a graduate student in the Molecular Virology Program at Baylor, went phage hunting in local parks and bird refuges to collect avian and canine feces.

"We isolated a number of phages from animal feces," said Ramig. "No single phage would kill all the 12 bacterial strains, but collectively two or three of those phages would be able to kill all of those bacteria in cultures in the lab."

This good news allowed the researchers to move on to the next step -- determining whether the phages also would be able to kill the antibiotic-resistant bacteria in an animal model of sepsis.

A mouse model of human sepsis

One of the animal models the researchers worked with mimics how cancer patients develop potentially life-threatening infections during their cancer treatment.

"A number of cancer patients who undergo chemotherapy sometimes develop infections that come from bacteria that normally live in their own gut, usually without causing any symptoms," Green said. "Chemotherapy is intended to kill cancer cells, but one of the side effects is that it suppresses the immune system. A suppressed immune system is a major risk factor for infections with these bacteria, which sometimes also are multi-drug resistant."

Working in Maresso's lab, Green developed a mouse model in which healthy mice received antibiotic-resistant bacteria that colonize their intestinal tract. "These mice showed no sign of disease," Maresso said.

"But when the mice received chemotherapy," Green said, "the bacteria moved from their intestine to major organs -- this led to a fatal sepsis-like infection."

In this animal model in which the immune system cannot keep in check antibiotic-resistant bacteria, Green tested whether the phages were able to do so.

"When the phages are delivered into the animals, their efficacy in reducing the levels of bacteria and improving health is dramatic," Maresso said. "But that is not what is truly remarkable," he continued. "What is remarkable is that these 'drugs' were discovered, isolated, identified and tested in a matter of weeks, and for less money than most of us probably spend in a month on groceries."

Phages: an adaptable, specific drug

Phages are very specific for certain species or strains of bacteria, but can be made broadly acting via cocktails, if desired. Thus, unlike antibiotics, using phages may not be associated with some of the side effects observed, such as clearing beneficial intestinal microbiota. They also don't infect human cells.

Another advantage over antibiotics is that phages can evolve. Should resistance develop against one set of phages, new phages can be identified in the environment or evolved in the laboratory in a matter days.

"On the other hand, an antibiotic is a chemical; it cannot change in real time," Maresso said. "It may take years to develop a new antibiotic and at costs that can run in the billions. But a phage can evolve to efficiently kill a resistant strain and then be propagated. It gives me great personal satisfaction when I think of the irony of this -- the next anti-bacterial treatment may use the very same mechanisms bacteria have been using against us for 60-plus years now."

Co-author Dr. Barbara Trautner, associate professor and director of clinical research in the Department of Surgery, associate professor of medicine at Baylor and also a researcher with Center for Innovations in Quality, Effectiveness and Safety at the Michael E. DeBakey Veterans Affairs Medical Center in Houston, and Ramig previously published a paper in which they showed that it is possible to take advantage of the phages' ability to change to fight bacterial infections. "In summary, we took four phages that specifically attacked bacteria of the group Pseudomonas, and they would kill four of 26 of these bacterial strains. Then, we evolved the phages in the lab, and in a month the new ones could kill 22 of the 26," Ramig said.

"Envision the following possible future clinical scenario: a patient presents with antibiotic-resistant bacterial infection that is untreatable or only treatable with the most toxic of antibiotics. During the 48 hours it takes to identify the bacterial species and strain, physicians and scientists can go to a library of phages at hand, select those that are effective against this antibiotic-resistant bacterial strain and make a personalized cocktail of phages to treat the patient. Should resistance develop again, we will evolve another phage -- right back at them!" Maresso said. "There are many ways to kill bacteria, but I know of no other way that has the potential to evolve in real time like phages do. And it's the best 'green' medicine -- it's natural, safe thus far, relatively cheap and can be harnessed with the technical skills of a college biology major."

Whereas the upside may be high, there is still some caution. "Phages are not infallible medicines," reflects Maresso. "The host's immune system sometimes can neutralize their activity and some phages just don't work well in animals. But we understand very little about any of these dynamics compared to those of other classes of drugs. At the very least, I think the evidence supports the notion that we should be giving phages some experimental attention."


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April 17, 2017
The Cost of Not Taking Your Medicine
 
There is an out-of-control epidemic in the United States that costs more and affects more people than any disease Americans currently worry about. It’s called nonadherence to prescribed medications, and it is — potentially, at least — 100 percent preventable by the very individuals it afflicts.

The numbers are staggering. “Studies have consistently shown that 20 percent to 30 percent of medication prescriptions are never filled, and that approximately 50 percent of medications for chronic disease are not taken as prescribed,” according to a review in Annals of Internal Medicine. People who do take prescription medications — whether it’s for a simple infection or a life-threatening condition — typically take only about half the prescribed doses.

This lack of adherence, the Annals authors wrote, is estimated to cause approximately 125,000 deaths and at least 10 percent of hospitalizations, and to cost the American health care system between $100 billion and $289 billion a year.

Former Surgeon General C. Everett Koop put it bluntly: “Drugs don’t work in patients who don’t take them.” This partly explains why new drugs that perform spectacularly well in studies, when patients are monitored to be sure they follow doctors’ orders, fail to measure up once the drug hits the commercial market.

More important, it explains why so many patients don’t get better, suffer surprising relapses or even die when they are given drug prescriptions that should keep their disorders under control.

Studies have shown that a third of kidney transplant patients don’t take their anti-rejection medications, 41 percent of heart attack patients don’t take their blood pressure medications, and half of children with asthma either don’t use their inhalers at all or use them inconsistently.

“When people don’t take the medications prescribed for them, emergency department visits and hospitalizations increase and more people die,” said Bruce Bender, co-director of the Center for Health Promotion at National Jewish Health in Denver. “Nonadherence is a huge problem, and there’s no one solution because there are many different reasons why it happens.”

For example, he said parents often stop their children’s asthma treatment “because they just don’t like the idea of keeping kids on medication indefinitely.” Although a child with asthma may have no apparent symptoms, there is underlying inflammation in the lungs and without treatment, “if the child gets a cold, it can result in six weeks of illness,” Dr. Bender explained.

When Dr. Lisa Rosenbaum, a cardiologist at Brigham and Women’s Hospital in Boston, asked patients who had suffered a heart attack why they were not taking their medications, she got responses like “I’m old-fashioned — I don’t take medicine for nothing” from a man with failing kidneys, peripheral vascular disease, diabetes and a large clot in the pumping chamber of his heart. Another common response: “I’m not a pill person.”

When Dr. Rosenbaum told her hairdresser that she was studying why some people with heart disease don’t take their medications, he replied, “Medications remind people that they’re sick. Who wants to be sick?” He said his grandmother refuses to take drugs prescribed for her heart condition, but “she’ll take vitamins because she knows that’s what keeps her healthy,” so he tells her that the pills he gives her each night are vitamins.

Other patients resist medications because they view them as “chemicals” or “unnatural.” One man told Dr. Rosenbaum that before his heart attack, he’d switched from the statin his doctor prescribed to fish oil, which unlike statins has not been proved to lower cholesterol and stabilize arterial plaque. 
 
“There’s a societal push to do things naturally,” she said in an interview. “The emphasis on diet and exercise convinces some people that they don’t have to take medications.”

Dr. Bender said, “People often do a test, stopping their medications for a few weeks, and if they don’t feel any different, they stay off them. This is especially common for medications that treat ‘silent’ conditions like heart disease and high blood pressure. Although the consequences of ignoring medication may not show up right away, it can result in serious long-term harm.”

Some patients do a cost-benefit analysis, he said. “Statins are cheap and there’s big data showing a huge payoff, but if people don’t see their arteries as a serious problem, they don’t think it’s worth taking a drug and they won’t stay on it. Or if they hear others talking about side effects, it drives down the decision to take it.”

Cost is another major deterrent. “When the co-pay for a drug hits $50 or more, adherence really drops,” Dr. Bender said. Or when a drug is very expensive, like the biologics used to treat rheumatoid arthritis that cost $4,000 a month, patients are less likely to take them or they take less than the prescribed dosage, which renders them less effective.

Dr. William Shrank, chief medical officer at the University of Pittsburgh Health Plan, said that when Aetna offered free medications to patients who survived a heart attack, adherence improved by 6 percent and there were 11 percent fewer heart attacks and strokes, compared with patients who paid for their medications and had an adherence rate of slightly better than 50 percent.

“There are so many reasons patients don’t adhere — the prescription may be too complicated, they get confused, they don’t have symptoms, they don’t like the side effects, they can’t pay for the drug, or they believe it’s a sign of weakness to need medication,” Dr. Shrank said. “This is why it’s so hard to fix the problem — any measure we try only addresses one factor.”

Still, there is hope for improvement, he said. Multiple drugs for a condition could be combined into one pill or packaged together, or dosing can be simplified. Doctors and pharmacists can use digital technology to interact with patients and periodically reinforce the importance of staying on their medication. 

With fear of side effects a common deterrent to adherence, doctors should inform patients about likely side effects when issuing a prescription. Failing that, patients should ask: “What, if any, side effects am I most likely to encounter?”

Forgetting to take a prescribed drug is a common problem, especially for those ambivalent about taking medication. Patients can use various devices, including smartphones, to remind them to take the next dose, or use a buddy system to make adherence a team sport. Dr. Shrank suggested making pill-taking a habit, perhaps by putting their medication right next to their toothbrush.

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