Research on moose suggests that arthritis in humans may be related to early nutritional deficiencies.
Clues to Arthritis in Underfed Moose
By PAM BELLUCK
Poor nutrition early in life led to arthritis in more than 50 percent of the moose studied in one region of the northern United States, research over the past 50 years has shown. Collecting bones of more than 4,000 moose, researchers discovered that out of 1,200 carcasses they analyzed, more than half had arthritis, virtually identical to the human kind.
That could mean, scientists say, that some people’s arthritis can also be linked in part to nutritional deficits, in the womb and possibly throughout childhood.
The moose conclusion bolsters a growing body of research connecting early development to chronic conditions like osteoarthritis, which currently affects 27 million Americans, up from 21 million in 1990.
Osteoarthritis’ exact cause remains unknown, but it is generally thought to stem from aging and wear and tear on joints, exacerbated for some by genes. Overweight or obese people have greater arthritis risk, usually attributed to the load their joints carry, and the number of cases is increasing as people live longer and weigh more.
But studies of moose on Isle Royale in Lake Superior, along with human research, suggests arthritis’ origins are more complex, probably influenced by early exposure to nutrients and other factors while our bodies are developing. Even obesity’s link to arthritis probably goes beyond extra weight, experts say, to include eating the wrong things.
Nutrients, experts say, might influence the composition or shape of bones, joints or cartilage. Nutrition might also affect hormones, the likelihood of later inflammation or oxidative stress, even how a genetic predisposition for arthritis is expressed or suppressed.
“Osteoarthritis starts way before the person knows it, way before their knee hurts or their hand hurts,” said Dr. Joanne Jordan, director of the Thurston Arthritis Research Center at the University of North Carolina. “It’s very clear that we’re going to have to start looking back” at “things in the early life course.”
Such research could lead to nutritional steps people can take to protect against osteoarthritis, a condition that is often painful or debilitating, and according to federal data, costs billions of dollars annually in knee and hip replacements alone.
“It would be helpful to know if we want to make sure pregnant moms are taking certain vitamins or if you need to supplement with such and such nutrition,” said Dr. David Felson, an arthritis expert at Boston University School of Medicine.
“The moose guy is right in that we probably should study weight or some other nutritional factor almost through adolescence when the bones or joints have stopped forming.”
The “moose guy” is Rolf Peterson, a Michigan Technological University scientist on the Isle Royale project, which began in 1958. For half the year, Dr. Peterson and his colleagues are the only humans allowed on the 72-kilometer-long island, part of a national park. The arthritic moose were often small, measured by the length of the metatarsal bone in the foot. Small metatarsals indicate poor early nutrition, and scientists determined that the arthritic moose were born during times when food was scarce, so their mothers could not produce enough milk.
Dr. Peterson said if the arthritis were caused by excess wear and tear on the moose’s joints, that would have meant that times of food scarcity occurred when the moose were already grown, since the extra wear would have happened to moose walking farther to find edible plants. But the arthritic moose had had plentiful food as adults.
Studying nutrition in people is much more complicated than in moose. Dr. Peterson said the early moosehood developmental window occurred in utero through 28 months, but humans’ developmental time frame lasted into the teens. Some experts say prenatal nutrition is most critical; others see roles for nutrients after birth and beyond.
“Up until the growth plates close, which is through adolescence and even early adulthood, the effects of nutrition are magnified,” said Dr. Constance R. Chu, director of the Cartilage Restoration Center at the University of Pittsburgh, who said nutrients might affect the number of healthy cells in cartilage and its thickness.
“But in my opinion, it’s relevant throughout life,” she added.
Nutrients may affect the makeup of bones and cartilage.
DMG cuts the target price to 23 cents from 30 cents after slashing the FY10 earnings estimate to $4.7 million from $16 million to reflect weak 2Q10 results and higher-than-expected start-up costs.
But it keeps the Buy call, saying “revenue is expected to pick up strongly in FY11, with full-year contribution from its new medical centres in China”.
The group also intends to introduce its medical services to other major cities in China.
Healthway Medical said it will be investing 38 million yuan ($7.6 million) to operate and manage medical facilities in Shanghai and Hangzhou.
Meanwhile, the group reported that its second quarter net profit declined 97 per cent to $121,000 from $4.3 million a year.
This is on the back of lower revenue compared to last year.
Last year, Singapore saw the height of the H1N1 epidemic, which had boosted Healthway Medical’s bottomline.
Group revenue for the three-month period ended June dipped 12.3 per cent to $21.4 million from $24.5 million in the same period last year.
Its income was further impacted by expected lower patient load for its new centres in Singapore.
“While many new centres and specialists are in the ramping-up phase, which has resulted in lower earnings, they are now showing month-on-month improvement,” said the company’s managing director, Dr Wong Weng Hong.
Going forward, Healthway Medical said it is fully focused on growing its revenues and managing costs.
Healthway’s shares dipped 0.5 cents to close at 18 cents on Friday.
— Catalist-listed Healthway Medical Corporation is setting its sights to expand in China as it plans to open more than 20 medical clinics in Shanghai.Julie Quek
So the game now is to keep bacteria at bay. Hygiene is an obvious weapon. Better cleaning, hand gels and stern warnings to staff and public alike have helped reduce infection rates in hospitals. But Professor Richard James, director of the centre for health care infections at the University of Nottingham, warns that bugs don’t stay in hospitals (the NDM 1— producing bacteria appears widespread in India, passed through contaminated water, in which people bathe, wash clothes and defecate).
“The worry is once these organisms are out in the community,” says James.
“There probably is some need for public education about infection and, for instance, kitchen hygiene when you are cooking. People of my generation were taught a lot about washing your hands before every meal. It was automatic that it was done. A lot of that has gone.”
Beyond that, there is a real need to conserve those antibiotics we have.
Like oil, he points out, antibiotic usefulness is finite. And the cost of drug resistance is not reflected in the price of the drug. “If you consider antibiotic sensitivity as a resource like oil, you want to maintain that by introducing a tax,” he says. It would be worldwide and the proceeds could fund new drug development.
But should you tax life-saving drugs, especially in poor countries?
“If you don’t do anything, there won’t be any antibiotics anyway,” says James starkly. “At least it is a suggestion of something that could be done.”
Walsh’s paper shows that no country can pull up the drawbridge. “It illustrates the importance of considering health issues as a world issue — how antibiotics are prescribed and controlled in one part of the world can very rapidly have consequences elsewhere,” says Christopher Thomas, professor of molecular genetics at the University of Birmingham.
Sadly, the fact is that many people have still got their heads in the sand.
In the battle for survival of the fittest between human beings and bacteria, it looks as though the best we are going to get is a draw — if we are lucky.
The Guardian
Sarah Boseley is the health editor of The Guardian. She has won a number of awards for her work on HIV/Aids in Africa, including the One World Media Award and the European section of the Lorenzo Natali prize, awarded by the European Commission.
“You safeguard the patient from bacteria leaking into the body cavity,” he says. If you lose the ability to treat these infections, appendix operations would carry the same risk as they did before Fleming discovered penicillin in 1928.
It may not be over yet, he says, but “we are certainly scraping the bottom of the barrel to find antibiotics that are effective against some of the infections.”
Running out is not the only issue, he says. When somebody has a severe infection — say blood poisoning — causing a high fever, a hospital clinician will dispatch blood samples to the lab to find out exactly what he is dealing with. But that takes time. “He will start you on antibiotics because that will kill infection within 48 hours,” says Livermore. “So during 48 hours, you are being treated blind.
The more resistant your bacteria are, the less likely the antibiotic is going to work.”
Studies have shown, he says, that the chances of dying from hospital pneumonia or septicaemia (blood poisoning) are twice as high if the bacteria are drugresistant, rising in the case of pneumonia from 20 to 30 per cent to 40 to 60 per cent.
For a long time now, doctors have known they were in a race to stay a few steps ahead of the rapidly growing resistance of bacterial infections to antibiotics.
Ten years ago, the so-called superbug MRSA caused front-page panic.
Hospital patients were picking up Staphylococcus aureus infections that were resistant to the hitherto powerful antibiotic methicillin. An all-out war against MRSA has reduced the threat of what are known as Gram-positive bacteria. Hospital hygiene has been massively stepped up and, in response in part to public anxiety, pharmaceutical companies have put money into finding new antibiotics for these infections.
But it’s like putting a finger in a hole in the dam, only to find the water surges out somewhere else. Bacteria are great survivors. The biggest threat now, experts believe, is from multi-drug-resistant Gram-negative bacteria, such as NDM1- producing enterobacteriaceae and an enzyme called KPC which has spread in the US (and in Israel and Greece) which also gives bacteria resistance to the most powerful group of antibiotics we (once) had.
“It is a war of attrition. It is naive to think we can win.” says Livermore.
A bedrock of modern medicine but in the near future, we’re going to have to learn to live without them
Sarah Boseley
In just a couple of generations, what once appeared to be miracle medicines have been beaten into ineffectiveness by the bacteria they were designed to knock out. Once, scientists hailed the end of infectious diseases. Now, the postantibiotic apocalypse is within sight.Lancet Infectious Diseases this week posed the question over a paper revealing the rapid spread of multi-drug-resistant bacteria.
Hyperbole? Unfortunately not.
The highly serious journal
“Is this the end of antibiotics?” it asked.
Doctors and scientists have not been complacent, but the paper by Professor Tim Walsh and colleagues takes the anxiety to a new level. Last September, Walsh published details of a gene he had discovered, called NDM1 (New Delhi Metallobeta-lactamase 1), which passes easily between types of bacteria and makes them resistant to almost all the powerful, last-line antibiotics called carbapenems.
This week’s paper revealed that NDM1 is widespread in India and has arrived as a result of global travel and medical tourism for, among other things, transplants, pregnancy and cosmetic surgery.
(The paper has triggered a storm of protest from India’s medical industry. Reports from India cited Indian doctors saying that the warnings about this drugresistant superbug were alarmist.)
Walsh disagrees: “This is potentially the end.
There are no antibiotics in the pipeline that have activity against NDM 1-producing enterobacteriaceae. We have a bleak window of maybe 10 years, where we are going to have to use the antibiotics we have very wisely, but also grapple with the reality that we have nothing to treat these infections with.”
And this is the optimistic view — based on the assumption that drug companies can and will get moving on discovering new antibiotics to throw at the bacterial enemy. Since the ’90s pharmaceutical companies have not shown a great deal of enthusiasm for difficult antibiotic research. Unlike with heart medicines, people take antibiotics for a week rather than life, and because resistance means the drugs become useless after a while, there is just not much money in it.
Dr Livermore, whose grandmother died for lack of infection-killing drugs in 1945, is director of the antibiotic resistance monitoring laboratory of the Health Protection Agency (HPA). Last year, the HPA put out an alert about NDM1, urging health professionals to report all suspect cases.
Livermore is far from sanguine about the future.
“A lot of modern medicine would become impossible if we lost our ability to treat infections,” he says. He is talking about transplant surgery, for instance, where patients’ immune systems have to be suppressed to stop them rejecting a new organ, leaving them prey to infections, and the use of immunosuppressant cancer drugs.
Mr Denis Pierard, a microbiologist from AZ VUB hospital in Brussels where the victim had been treated since June, told Belgian media that the man was infected by the bacteria while being treated in a hospital in Pakistan.
“He was involved in a car accident in Pakistan. He was hospitalised with a leg injury and then repatriated to Belgium, but he was already infected,” the doctor said.
Despite receiving powerful antibiotics, the patient died.
According to a report on Belgian TV channel
The superbug — a bacterial gene called New Delhi metallo-lactamase-1 (NDM-1) — was first identified last year in a Swedish patient admitted to hospital in India.
Professor Peter Collignon, Canberra Hospital’s head of infectious diseases department, said the superbug has infected three Australians, including one patient who had plastic surgery in Mumbai.
These patients were just the “tip of the iceberg”, said Dr Collignon, adding: “There may well be more because it’s difficult to pick up this particular gene unless you’ve got sophisticated testing.”
British scientists sparked an angry response from India when they said “medical tourists” to the subcontinent were among 37 people who were found to be infected.
“We strongly refute the naming of the enzyme ... and also refute that hospitals in India are not safe for treatment including medical tourism,” the Indian Health Ministry said.
The gene, which is found in a number of different bacteria, produces an enzyme that renders even very strong antibiotics ineffective.
Dr Collignon blamed the new bugs on the “abuse” of antibiotics in medicine and also in agriculture, saying some countries used them on billions of chickens, which develop bacteria and are then consumed by humans.
The professor, who sits on World Health Organisation panels on antibiotics, called for a worldwide crackdown on antibiotic use along with a major hygiene campaign to stop the bugs spreading.
Singapore’s Health Ministry said there has not been any case reported locally to date: “Our hospitals have a robust surveillance and infection control system (eg stringent hand hygiene practices, etc) in place and we will continue to monitor the situation closely.
Cooperation from all is needed to stop germs from spreading. We can help by having good personal hygiene practices such as proper and frequent hand washing, and observing the strict visitation policy of hospitals to prevent cross infection.”
— A Belgian man died from a drug-resistant “superbug” originating in South Asia, a doctor said on Friday. It is the first reported death from the bacteria, as fears it could spread worldwide were reinforced after three Australians who travelled to India were reportedly infected.RTBF, it was the second reported case of the bacteria in the country this year.
BREATH TEST can identify different types of CANCER, say scientists
LONDON
Their preliminary results, printed in the
The sensor used gold nanoparticles to detect levels of so-called volatile organic compounds, measured in a few parts per billion, that became more elevated in cancer patients.
The device could provide an early warning system that flags the disease before tumours become visible in X-rays.
The study examined the breath of 177 volunteers, including healthy people and patients already diagnosed with different stages of the four types of cancer.
However, further tests with larger samples will be needed to determine the strength of the link between breath and cancer detection.
“These results are interesting and show that there is the potential to develop a single breath test to detect these cancers,” said Dr Lesley Walker of the CancerActive charity in the United Kingdom.
“Strengthening the methods for early diagnosis of cancer, as well as improved treatments will have a significant impact on cutting death rates,” she added.
— Scientists working on a breath test to detect cancer said in research published yesterday that they are now able to identify different types of the disease.British Journal of Cancer monthly, showed that the sensors could distinguish whether a patient had lung, breast, bowel or prostate cancer, irrespective of age, gender or lifestyle.
New bacteria from South Asia could spread worldwide, study warns
LONDON
Many hospital infections that were already difficult to treat have become even more impervious to drugs due to a recently-discovered gene that can jump across different species of bacteria.
Worryingly, the New Delhi metallo-beta-lactamase- 1 bacteria (NDM-1) are resistant even to carbapenems, a group of antibiotics often reserved as a last resort for treatment for multi-drug resistant bugs.
Researchers said the bugs had been brought into Britain by patients who travelled to India or Pakistan for cosmetic surgery.
In the new study, led by Cardiff University’s Timothy Walsh and Madras University’s Karthikeyan Kumarasamy, researchers set out to determine how common NDM-1 was in South Asia and Britain, where several cases had turned up.
They found 44 cases — 1.5 per cent of those screened — in Chennai, and 26 in Haryana, both in India. They also found the superbug in Bangladesh and Pakistan, as well as 37 cases in Britain.
NDM-1 was mostly found in E coli and K pneumoniae.
It was impervious to all antibiotics except two — tigecycline and colistin.
Crucially, the NDM-1 gene was found on DNA structures, called plasmids, that can be easily copied and transferred between bacteria, giving the bug “an alarming potential to spread and diversify”.
“Unprecedented air travel and migration allow bacterial plasmids and clones to be transported rapidly between countries and continents,” the authors said.
The emergence of these new strains could become a serious global health problem as the major threat shifts towards a broad class of bacteria, they warned.
Professor Walsh said “there are no new antibiotics that are going to be available in 10 years’ time”.
— “Health tourists” flocking to South Asia have carried a new class of antibiotic-resistant superbugs to Britain, researchers reported yesterday, warning that the bacteria could spread worldwide.
That seems possible, for these pills are beginning to revolutionise abortion around the world, especially in poor countries. One result may be tens of thousands of women’s lives saved each year.
Five-sixths of abortions take place in developing countries, where poor sterilisation and training often make the procedure dangerous. Up to 70,000 women die a year from complications from abortions, according to the World Health Organisation.
But researchers are finding an alternative that is safe, cheap and very difficult for governments to restrict — misoprostol, a medication originally intended to prevent stomach ulcers.
“I feel like people must have felt when they discovered the nuclear bomb,” says Dr Beverly Winikoff, president of Gynuity Health Projects, a non-profit research institution on reproductive health. “This technology is world-shaking.”
This pharmaceutical approach is called “medical abortion”.
In the United States and Europe it typically consists of two sets of “M” pills. The first is mifepristone, formerly known as RU486, and then a day or two later the misoprostol.
Using the drugs in combination produces a miscarriage more than 95 per cent of the time in early pregnancy. But mifepristone is difficult to obtain in much of the world, because it is used only to induce abortions.
In contrast, misoprostol is very widely available and cannot easily be banned because it is also used for ulcers and can save the lives of women with postpartum haemorrhages.
Whatever one thinks of misoprostol for abortions, it also is a potential lifesaver for women who haemorrhage after childbirth.
Could the decades-long global impasse over abortion worldwide be overcome — by little white pills costing less than US$1 ($1.35) each?
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