Jack Stevenson on how he copes with his severe asthma
Jack Stevenson has severe asthma.
He can never leave the house without his inhaler, and his asthma can be triggered by many triggers including his allergies to peanuts, pollen, any furry animals and birds.
His mum Sharon said: “Every time we have to go out of the house we have to take his medication and I am on call 24 hours a day for problems.”
Air purifier
The family has enrolled on a trial being run at St. Mary’s Hospital, London, part of Imperial College Healthcare NHS Trust.
For the next year Jack, aged 14, from Southend, will have an air purification machine fitted above his bed to clean the air while he sleeps.
The machine removes dust particles and cleans the air of allergens.
Although Jack is not sure whether he has the real 2,000 Airsonett machine or a dummy version, his nights have been less disrupted.
“I am having deeper sleeps and I wake up less tired.
“Before I got the machine I used to wake up most nights and was then tired at school the next day,” he said.
New trial
St, Mary’s are hoping to recruit over 70 children, aged over seven for the trial.
Research nurse Heather Hannah, said preliminary results from a Swedish study of 28 patients had found people using the machine had been able to reduce medication.
“They also reported they were able to do sport better and sleep better, which was really good,” she said.
The air shower cleans the air at night
“And their rhinitis, inflammation of the nose, symptoms improved a lot.
“So we are really looking at not just whether their asthma improves and whether they use less medication, but also whether their sleep is better as this makes a massive difference for the parents as well as the children.
“We are looking for children whose asthma is fairly bad and are on steroid inhalers, we are also looking for children who are allergic to cat and dog hair and dust mites.”
Trial hopes
Each child taking part in the trial will have a machine fitted in their bedroom. Two out of three will get the real machine, while rest will get the dummy version. Each child will be asked to keep a diary and will be closely monitored by doctors.
Skin tests are used to see what substances trigger asthma attacks
Paediatrician Dr Bob Boyle said previous studies had shown clean air can be beneficial to health.
“Most childhood asthma is caused in part by allergy and in an ideal world you would avoid the allergic dust mites.
“In some older Italian studies children with asthma were taken to the Alps, where there are no dust mites and their asthma got better.
“No one has been able to achieve this to date. Even if you vacuum and clean your carpets a lot your child is still exposed.
“This study allows us to provide remarkably pure air at night, which should have an effect on their asthma,” he said.
But asthma groups are dubious that the new system can work.
Dr Elaine Vickers, research relations manager at Asthma UK said she has doubts.
“Dust and other particles in the air can trigger asthma symptoms in some people.
“However, despite the ability of air cleaning devices to remove such particles, studies have so far failed to provide convincing evidence that they improve asthma symptoms.”
Children from all over the UK will be considered for the trial. Families wanting to take part should ring 07872 850262.
The scientists who discovered HIV will share the Nobel prize for medicine with the expert who linked human papillpoma virus (HPV) to cervical cancer.
French team Françoise Barré-Sinoussi and Luc Montagnier were recognised for their groundbreaking work in uncovering the virus responsible for Aids.
Harald zur Hausen, of Germany, received the prize for making the link between the HPV and cervical cancer.
More than 25 million people have died of HIV/AIDS since 1981.
Globally, over 33 million people are living with HIV.
Following medical reports of a new immunodeficiency syndrome in 1981, Professor Barre-Sinoussi and Dr Montagnier were the first to identify HIV as the culprit.
In its citation, the Nobel Assembly said their discovery was vital in enabling scientists to begin to understand the biology of a virus which continues to pose a huge public health threat throughout the globe.
Global importance
Their work led to development of methods to diagnose infected patients and to screen blood products, which has limited the spread of the pandemic.
It has also led to new treatments.
There is still no cure for HIV. However, for many the disease is no longer an imminent death sentence thanks to the major advances in research and drug development over recent years.
With treatment, people with HIV can live for decades with the condition.
However, HIV medicines are not widely available in many poor countries around the world.
The citation said: “Never before has science and medicine been so quick to discover, identify the origin and provide treatment for a new disease entity.
“Successful anti-retroviral therapy results in life expectancies for persons with HIV infection now reaching levels similar to those of uninfected people.”
HPV
Professor zur Hausen was praised by the Nobel committee for going “against current dogma” to discover that HPV infection caused cervical cancer.
HPV can be detected in 99.7% of all women with cervical cancer, and persistant infection with the virus is estimated to be responsible for more than 5% of all cancers worldwide.
Professor zur Hausen’s work helped others to develop vaccines against HPV, which are now routinely given to millions of teenage girls in many countries to prevent cervical cancer.
Professor zur Hausen, 72, received half of the prize with Professor Barré-Sinoussi, 61, and Dr Montagnier, 76, splitting the other half.
Ulcerative colitis is caused by inflammation in the intestines
Genetic variations which predispose people to a common inflammatory bowel condition have been uncovered by a team of German and UK researchers.
It was known that ulcerative colitis, which affects around 100,000 people in the UK, runs in families.
Now researchers have linked the condition with the gene that encodes for interleukin 10 (IL10) - a compound which regulates inflammation.
IL10 therapy has been tested in early studies, Nature Genetics reported.
Ulcerative colitis normally appears in people aged 15-30 and symptoms include bloody diarrhoea, abdominal pain, a frequent need to go to the toilet and weight loss.
Although symptoms can be mild, it can kill in severe cases if surgery is not performed in time.
Individuals with first-degree relatives who are affected are known to be at higher risk, but the individual genes involved had not been determined.
In the latest study, scientists scanned the whole genome in more than 1,000 people with the condition and 800 healthy controls.
Among a few gene differences, they found key variations in genetic regions directly alongside the IL10 gene.
Some early studies, mainly in mice, have already looked at IL10 for colitis therapy but negative findings had prompted researchers to look elsewhere.
“In light of these results, systemic or topical delivery of IL10 should be worthy of consideration for clinical trials,” said study leader Professor Stefan Schreiber.
He added that further research on this area of the genome in colitis patients may point to as yet unknown drug targets.
Crohn’s disease
The administration of interleukin 10 to individuals with colitis has been reported to have a positive effect in initial studies, although this potential therapy has not been assessed more thoroughly.
Professor Jack Satsangi a gastroenterology expert at the University of Edinburgh said previous research on IL10 as a treatment had focused on another inflammatory bowel condition, Crohn’s disease.
“It may be that it didn’t work in Crohn’s disease but it’s worth pursuing in ulcerative colitis,” he said.
“There are also issues about whether it should be delivered systemically - orally, intravenously - or directly into the gut.
“There is certainly an unmet need for treatments so there is mileage in this.”
Professor Jonathan Rhodes, an expert in colitis based at the University of Liverpool, added that the study would help to unpick what was causing the condition - at least in some patients.
“It makes much firmer the hypothesis that there is an underlying defect in the immune system,” he said.
Hospitals have been warned not to over-dilute cleaning chemicals amid fears that this could boost antibiotic resistance in bacteria.
A US study published in the journal Microbiology found bugs that survive disinfectant contact can become harder to kill.
They evolve new defences which allow them to “pump” cleaning chemicals and antibiotics out of their system.
A UK expert said it was important that cleaning guidance was followed closely.
The NHS has recently met a target for the reduction of MRSA cases, but the rise of antibiotic resistance remains a problem.
Doctors have been told to use antibiotics sparingly, as overuse can allow harmful bacteria to develop resistance, but the new research suggests that some cleaning chemicals may also cause a problem.
The researchers at the Department of Veterans Affairs Medical Center in Detroit exposed Staphylococcus aureus bacteria to low concentrations of a wide range of antiseptic and antibacterial solutions, many of which are in common use in hospitals and the home.
They found that because the bacteria were not killed by the chemicals, they began to mutate into new strains.
These strains frequently had a higher number of “efflux pumps”, a feature found on the surface of their cells which allows them to get rid of toxic molecules.
These were not tailored just to remove the disinfectant molecules, but also designed to get rid of some antibiotics, such as ciprofloxacin.
No watering down
Dr Glenn Kaatz, who led the study, said that if bacteria in hospitals were exposed to “biocides” - antibacterial chemicals - repeatedly, they could build up this resistance, and even contribute to hospital-acquired infections.
However, Dr Adam Fraise, a consultant in infection control at Birmingham University Hospitals NHS Trust, said that the important thing was for cleaning staff to use chemicals in the recommended concentrations, and not to water them down more than required.
He said: “Biocides are not like antibiotics, in which the dose has to be kept at a level which is non-toxic to the patient.
“They can be used in very very high concentrations, and provided this happens, then bacteria will be killed, and therefore not have the opportunity to acquire this resistance.
“There are guidelines for cleaning staff about this in the NHS, and they need to be followed.
“However, there is an argument that you should be using these chemicals sparingly anyway around the ward, as there is some debate whether they are actually any more effective than simple detergents at reducing hospital infections.”
Testicular cancer has a high cure rate if caught early
A study has concluded that one dose of chemotherapy is the best way to cure testicular cancer in many patients.
Doctors already offer either carboplatin or radiotherapy, but scientists needed long-term trial results to see which was the best.
The Medical Research Council project found that the drug offered a similar relapse rate - but far fewer side effects.
A leading expert said it could one day reduce the need for testicle removal.
Several hundred men are diagnosed with testicular cancer each year in the UK.
The vast majority are “seminomas”, affecting the sperm-producing cells in the testicle, and almost half of these are caught at an early stage.
These patients have their affected testicle removed, and are then offered either a single dose of carboplatin chemotherapy, a longer regime of radiotherapy, or the option to have no extra treatment with a higher risk of the cancer returning.
Radiotherapy can have severe side effects, while people undergoing this type of chemotherapy can resume their normal lives much more quickly.
The study, led by Southampton University, followed almost 1,500 patients, 904 given radiotherapy, and 573 carboplatin.
The rate of relapse in both groups was roughly the same, and lead researcher Dr Ben Mead said the results were “reassuring” and that carboplatin was the better option.
“Giving patients a carboplatin injection rather than radiotherapy is less unpleasant with fewer long-term risks.
“The initial results of the trial looked encouraging, but we needed to follow patients for another four years before we knew for sure that they had been cured.”
Although practice was changing in Europe to include carboplatin, in many other parts of the world, including the US, radiotherapy remains standard treatment, and Dr Mead said he hoped this would now change.
Extra benefits
The results are to be presented on Monday at a cancer conference in Birmingham, and Professor Peter Johnson, from Cancer Research UK, said that this cancer had proved to be a “success story” in terms of treatment research.
“This trial shows that chemotherapy can cure early stage seminoma, so that men diagnosed with the disease can be successfully treated with fewer side-effects.”
Professor Tim Oliver, from the Bart’s and the London Medical School, said that another advantage of carboplatin was that by treating the whole body rather than one area, the small risk of another testicular cancer emerging in the other testicle was also reduced.
This was borne out by the study, which found just two out of 573 patients on carboplatin experiencing this, compared with 15 out of 904 in the radiotherapy group.
He said: “The question now is whether you can approach testicular cancer in a different way, and, rather than remove the whole testicle automatically, carry out a ‘lumpectomy’ in very much the same way as in breast cancer.
“We are looking for funding to investigate whether this could work.”
Women do not end up with the best form of contraception for them because of false beliefs and fears, a snapshot survey of Scottish women suggests.
The poll of 55 women, published in a family planning journal, found anxiety about weight-gain deterred many from long-acting hormonal contraception.
The coil and implants were rejected because women did not want examinations or invasive procedures.
Many chose the Pill just because their peers had done so, the survey found.
Both the Department of Health and the Scottish authorities are actively promoting long-acting contraceptives, because they are reliable and have few side-effects.
Guidelines say that all women should be offered them when they visit a GP asking about contraception.
However, research suggests they are not popular, with only one in 10 women reporting having used them in the past year, less than a quarter of the number using either oral contraceptives or condoms.
Weight fear
The study of 55 women, published in the Journal of Family Planning and Reproductive Health Care, was carried out by sexual health specialists in southern Scotland to try to find out why women felt this way.
They found two of the biggest things that put women off particular types of contraception were unfounded fears that they would harm their long-term fertility, and, in the shorter term, that they would make them put on weight.
One younger woman said: “With a long-term method, you’d worry what it was doing to your insides.”
Others said that intrauterine devices such as a coil were out of the question because of the need to have it inserted by a doctor.
“I hate the idea of a stranger poking around down there,” said one.
The thought of an implant sitting under the skin was off-putting for some of the women.
Peer choice
Others told the survey that they had gone to the GP and asked for “the Pill” simply because their friends were using it, rather than going to ask about the right contraception for them.
One of the women told the researchers: “Everyone was on the Pill, so that’s what I asked for - she just gave it to me.”
Specialists said that while women’s fears of medical examinations or implants might not be easily overcome, the survey suggested that the term “long-acting” used when promoting some forms of contraception could be creating false fears.
Professor Anna Glasier, from Sexual Health NHS Lothian, said: “We are shooting ourselves in the foot by saying they are long-acting, and we need to emphasise that they don’t impair fertility, and the majority of them don’t affect weight.
“Doctors tend to focus on medical problems, whereas women are actually more worried about their weight, their skin and their chances of being able to have children in the future.”
Neither the newer contact lenses that allow more oxygen into the eye nor daily disposable lenses have reduced the risk of a dangerous eye infection as hoped, according to two new studies.
Whatever the type of lens, sleeping with them in is the biggest risk factor for a painful infection of the cornea called microbial keratitis, the researchers also found.
“If you wear any of these lenses overnight, you have five times the risk of infection,” says John Dart, DM, a consultant ophthalmologist at Moorfields Eye Hospital in London. He is the lead author of one study and co-author of the other.
“These are the first well-designed studies to look at daily disposables and the newer silicone hydrogel lenses,” Dart tells WebMD. The silicone hydrogel lenses were introduced in 1999 in the hope that by improving oxygen transmission to the cornea, which has no blood supply of its own, it would decrease infection risk, he says. Daily disposables, introduced in 1999, were also thought to be protective against infection because they’re not exposed to lens cases, which can be contaminated.
But neither of the studies, published in the October issue of Ophthalmology, found that to be true, Dart says.
However, Dart says, it’s important to put the risk in perspective. “The risk of getting microbial keratitis is actually overall not large,” he says. It affects about 1 in 2,000 contact lens wearers. But it can cause vision loss, sometimes permanently.
Contact Lenses & Infection Risk: The U.K. Study
In the study led by Dart, the researchers evaluated 367 contact lens wearers with microbial keratitis, 1,069 hospital patients who wore contact lenses but had no contact lens-related disorders, and 639 contact lens wearers in the general populations.
The hospital patients answered a questionnaire and the control patients in the general population were interviewed by telephone from late 2003 to 2005, Dart says.
Daily disposable wearers had 1.5 times higher risk of microbial keratitis than those who wore soft lenses that were replaced every one to four weeks, and those who wore rigid gas-permeable lenses had the least risk of infection.
“Gas-permeable lenses are safer than any other type of lenses,” Dart says, although he adds that they are not a popular choice among contact lens wearers, who tend to find them uncomfortable.
Even though the daily disposable wearers had more risk of infection than those who wore reusable soft lenses, vision loss from the infection was less likely to occur in the daily disposable lens wearers. None of the daily disposable lens wearers lost vision beyond 20/40, he says.
“It’s safer to use a daily disposable [than a reusable],” Dart says, “because the type of bugs you get are less nasty.” Reusable lenses must be disinfected and stored, and “lens cases harbor nasty bacteria in some patients,” he says.
Some brands were associated with more infections than others, Dart found, but he says most of the contact lenses he studied have probably been redesigned since the study was done.
Contact Lenses & Infection Risk: The Australian Study
In the second study, a team led by Fiona Stapleton, PhD, of the University of New South Wales, interviewed 285 contact lens wearers who had microbial keratitis and 1,798 lens wearers without the infection.
After looking at the type of lenses worn, wearing patterns, and other factors, they estimated the annual incidence for the infection.
They also found that new lens materials haven’t reduced infection. Overnight use was the strongest risk factor for infection, just as in the U.K. study.
For instance, they estimate that microbial keratitis occurred in 1.2 per 10,000 of those who wore daily-wear rigid gas-permeable lenses but in 25.4 per 10,000 of those who wore silicone hydrogel lenses overnight.
Other factors that increased the risk of infection included smoking, buying lenses over the Internet, wearing lenses beyond the recommended time spans, and improper hand cleaning before handling lenses.
Contact Lenses & Infection: Study Interpretations
Finding that the newer lens materials don’t reduce infection risk is disappointing, Dart writes.
Although experts thought that the lack of oxygen getting to the cornea was a factor in infections, the findings suggest that other factors may be more important, he says.
The lenses may reduce the turnover of skin cells on the front of the eye, for instance, Dart says, boosting infection risk.
The studies were funded from a variety of sources, including CIBA Vision USA, which makes a variety of contact lenses. One of the supporting organizations, The Vision Cooperative Research Center, receives a royalty on the sale of silicone hydrogel lenses.
Contact Lenses & Infection: Second Opinion
The findings about the risk of overnight wear come as no surprise to Thomas Steinemann, MD, a spokesman for the American Academy of Ophthalmology and professor of ophthalmology at Case Western Reserve University in Cleveland.
“That confirms what we have always known for years,” he says. “Sleeping in your lenses is not a good thing, even if they are continuous wear. It is a risk factor, probably the risk factor, for microbial keratitis-associated vision loss.”
“Don’t sleep in your contact lenses, ever,” he says. “That includes taking naps in them.”
Also important, he says, is to pay attention to lens hygiene. “Follow your eye care professional’s and manufacturer’s advice about cleaning,” he says.
Male teens with conduct disorder may have a dampened physical response to stress, and that finding may eventually lead to new treatments.
That’s according to Graeme Fairchild, PhD, of the psychiatry department at England’s Cambridge University.
In a new study, Fairchild and colleagues studied 165 male teens, 70 of whom had conduct disorder, which can include rule-breaking and aggressive, destructive, or deceitful behavior.
The teens provided saliva samples throughout the day, including after experiments designed to frustrate and provoke them (such as a playing a doomed-to-lose game with a taunting opponent).
The researchers measured levels of the stress hormone cortisol in the teens’ saliva samples, and they monitored the teens’ heart rates during the stress-inducing experiments.
Stress typically raises cortisol levels and heart rates. But in Fairchild’s study, heart rates and salivary cortisol levels didn’t spike as high in teens with conduct disorder, compared to the other teens.
But emotionally, it was a different story. Stress worsened the moods of all of the teens, regardless of conduct disorder.
The finding “suggests poorer coordination between emotional and physiological arousal” in male teens with conduct disorder while under stress, Fairchild and colleagues write.
It’s not clear from the study which came first - conduct disorder or less physical reactivity to stress. Past research on cortisol and conduct disorder has had mixed results, Fairchild’s team notes.
“If we can figure out precisely what underlies the inability to show a normal stress response, we may be able to design new treatments for severe behavior problems,” Fairchild says in a news release.
The study appears in the Oct. 1 edition of Biological Psychiatry.
By Jill McGivering BBC News One in three cigarettes in the world is smoked in China
A US study has suggested that more than 80 million people in China will die in the next 25 years as a result of lung disease.
The research says the vast majority of those premature deaths are preventable.
The study focused on the devastating impact of smoking and the widespread practice of burning wood or coal at home for cooking and heating.
The Harvard School of Public Health research looked at a 30-year period, spanning the last five and the next 25.
Respiratory disease is already a leading cause of death in China, but this latest study suggests a startling rise.
In the 30-year period, it calculates, about 83 million Chinese people will die prematurely of lung disease.
Intervention plea
That includes lung cancer and chronic obstructive pulmonary disease, an even bigger killer.
Most of these early deaths are preventable, it says, caused by smoking and the common practice of burning wood and coal in home stoves.
Prof Majid Ezzati, the study’s senior author, says dramatic intervention now by China’s government could save many millions of lives.
“If China manages to control tobacco through taxation, through health education, through advertising bans, and if it manages to get clean fuel to the 70% of its population who need cleaner fuels, or ways of burning their current fuels more cleanly, they have a lot of health gains to make.”
At the moment, one in three cigarettes lit in the world is smoked in China.
About half of Chinese men smoke, and there is concern the next trend will be an increase in smoking amongst women too.
That has not been factored into the study, and could boost the number of deaths still further.
The economy isn’t the only thing that’s sagging - so are faces, breasts and bellies as would-be cosmetic surgery patients increasingly opt against costly nips and tucks because of tough financial times.
Anecdotal reports and a recent unscientific survey from an industry trade group suggest many cosmetic surgeons have been seeing a drop-off in costly operations, some by as much as 30 percent or more.
Diane Lawyer, a software company manager in Atlanta, said belt-tightening has made her put off getting her eyes done, a procedure that would cost a few thousand dollars.
“I just can’t justify that right now,” she said.
Lawyer, 55, has started shopping at a discount grocery, rarely drives to save on gas, and loaned money to help keep her sister out of foreclosure.
“I lost $15,000 in the last two weeks on the stock exchange,” she said, referring to her dwindling 401K plan.
Dr. Alan Gold, president of the American Society for Aesthetic Plastic Surgery, said that for the past year, sagging business has been the talk of cosmetic surgeons.
“Everybody talks about it, nobody really has any numbers, so we polled our membership,” said Gold, whose suburban New York office is on Long Island.
Of about 700 doctors who responded to the April-May questionnaire, 53 percent said business is down, some by as much as 30 percent.
Dr. Patrick McMenamin, president-elect of the American Academy of Cosmetic Surgery, said he’s in regular contact with cosmetic surgeons who complain that business continued to slide through the summer - even before Wall Street’s recent nosedive.
“With this latest fiasco, many are probably down closer to 40 percent,” said McMenamin, a Sacramento, Calif., cosmetic surgeon who specializes in faces, breasts and liposuction.
For him, August “was terrible. I just did a lot less surgery.”
September’s always a slow month for cosmetic surgery, he said, so the economy’s impact was less palpable. “I have no idea where October is going.”
To attract patients, “We’ve reworked our mailing list and Web site, all facets of the business,” McMenamin said. He hasn’t lowered prices for procedures but says some doctors have.
While surgeries are down, McMenamin said he’s noticed an uptick in cheaper, less invasive options, including Botox injections and wrinkle fillers. So instead of shelling out $7,000 for a facelift, patients spend $1,000 for less dramatic results.
However, many Botox and filler patients are waiting longer than the usual three to four months between treatments, said Dr. Robert Singer of La Jolla, Calif.
Singer was reluctant to quantify the drop in his business, but said any cosmetic surgeon claiming business is great “is spinning and marketing.”
“There’s no question about it” that cosmetic surgeons around the country are feeling the pinch, said Dr. Edward Lack, who works in Chicago’s tony northern suburbs.
“We’re doing less invasive things and things that are less expensive,” Lack said.
And some who invested in office upgrades are worried. Cosmetic specialist Dr. Jim Matas of Orlando, Fla., said he took out a $100,000 mortgage last year to plushly renovate his condo-office. He’s been able to make the payments, but notes, “I still have that as an overhead cost that I didn’t have” before the economy’s big slide.
Orlando real estate appraiser David Ritter has been considering getting a $6,400 forehead lift from Matas. But Ritter was recently laid off and said he can only afford the surgery if he gets a sizable severance package.
“It’s a double-edged sword,” he said. “I need to do this because I’m 45 and competing with younger people” in a tough market.
Reliant in the past on Botox and wrinkle fillers, he feels pressure to look more youthful. “I always say it’s better to look good than to feel good, sometimes,” Ritter said.
Advertisement
The air shower cleans the air at night
Skin tests are used to see what substances trigger asthma attacks
HIV infects blood cells
Ulcerative colitis is caused by inflammation in the intestines
Disinfectants must be strong enough to kill bugs
Testicular cancer has a high cure rate if caught early
There are concerns younger girls could get access
One in three cigarettes in the world is smoked in China
