Saudi MERS data review shows big jump in number of deaths

A man with mask speaks on his mobile phone in Jeddah May 29, 2014. Saudi Arabia is working with international scientific organisations to improve its response to a deadly new virus that has killed 186 people in the kingdom, its acting health minister Adel Fakieh told Reuters on Wednesday. REUTERS/Mohamed Alhwaity


(Reuters) – Saudi Arabia announced a jump of nearly 50 percent in deaths from a new virus on Tuesday after re-examining old data that also showed the number of infections since 2012 was a fifth higher than previously reported.

The increase in total confirmed cases of Middle East Respiratory Syndrome (MERS) to 688 from 575, and the rise in deaths from the virus to 282 from 190, came in a review of data ordered by the Health Ministry last month.

The sharp increase in deaths now attributed to MERS, which causes coughing, fever and pneumonia in some, means the mortality rate from the virus in Saudi Arabia is now 41 percent, instead of the 33 percent previously thought.

However, the ministry said that although the total number of historical cases had risen, the rate of infection in the most recent outbreak appeared to be slowing.

Of the total, 53 patients were still being treated, while 353 had recovered, the statement said.

“While the review has resulted in higher total number of previously unreported cases, we still see a decline in the number of new cases reported over the past few weeks,” Tariq Madani, head of the Health Ministry’s scientific advisory board, was quoted as saying in an emailed statement.

NEW MEASURES

The Health Ministry said it had put in place new measures to make sure better data gathering, reporting and transparency were being observed, including standardisation of testing and better guidelines for labelling and storing samples.

On Monday, acting health minister Adel Fakieh announced he had relieved deputy minister Ziad Memish from his post. Fakieh was appointed in April after King Abdullah sacked his predecessor Abdullah al-Rabeeah following a new MERS outbreak. [ID:nL6N0OK2LI]

Saudi authorities, including Memish, had been criticised by some international scientists for their handling of the crisis, including what they saw as a lack of collaboration with specialist laboratories offering to help investigate the outbreak. [ID:nL6N0O73SL]

“Clearly any backward look will push the total numbers up but that does not signify any change in the virus, only previous under-reporting,” said Ian Jones, a virologist at Britain’s University of Reading.

“Infectious disease does not respect country, cultural or religious boundaries, so absolute clarity and the adoption of best practice for isolation and treatment are the most effective means of minimising numbers until such time as the source and route of infection are identified and avoided,” he added.

The Health Ministry said on Sunday it had set up a new command and control centre to tackle MERS and any future public health crisis more effectively.

The new centre will work with the World Health Organisation and the Centre for Disease Control, it said.

(Additional reporting by Kate Kelland in London; Editing by Tom Heneghan)

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Being bilingual 'slows brain ageing'








LanguagesLearning a second language could improve reading and intelligence skills


Learning a second language can have a positive effect on the brain, even if it is taken up in adulthood, a University of Edinburgh study suggests.

Researchers found that reading, verbal fluency and intelligence were improved in a study of 262 people tested either aged 11 or in their seventies.

A previous study suggested that being bilingual could delay the onset of dementia by several years.

The study is published in Annals of Neurology.

The big question in this study was whether learning a new language improved cognitive functions or whether individuals with better cognitive abilities were more likely to become bilingual.

Dr Thomas Bak, from the Centre for Cognitive Ageing and Cognitive Epidemiology at the University of Edinburgh, said he believed he had found the answer.

Using data from intelligence tests on 262 Edinburgh-born individuals at the age of 11, the study looked at how their cognitive abilities had changed when they were tested again in their seventies.

The research was conducted between 2008 and 2010.

All participants said they were able to communicate in at least one language other than English.

Of that group, 195 learned the second language before the age of 18, and 65 learned it after that time.


Strong effects

The findings indicate that those who spoke two or more languages had significantly better cognitive abilities compared to what would have been expected from their baseline test.

The strongest effects were seen in general intelligence and reading.

The effects were present in those who learned their second language early, as well as later in life.

Dr Bak said the pattern they found was “meaningful” and the improvements in attention, focus and fluency could not be explained by original intelligence.

“These findings are of considerable practical relevance. Millions of people around the world acquire their second language later in life. Our study shows that bilingualism, even when acquired in adulthood, may benefit the aging brain.”

But he admitted that the study also raised many questions, such as whether learning more than one language could also have the same positive effect on cognitive ageing and whether actively speaking a second language is better than just knowing how to speak it.

Dr. Alvaro Pascual-Leone, professor of medicine at Harvard Medical School in Boston, US, said: “The epidemiological study provides an important first step in understanding the impact of learning a second language and the ageing brain.

“This research paves the way for future causal studies of bilingualism and cognitive decline prevention.”

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Mental health beds 'crisis' warning








By Michael Buchanan
Social Affairs Correspondent, BBC News


Hospital bed


Pressure on mental health beds is so severe that some patients are having to be sectioned to secure necessary care, a survey of junior doctors suggests.

The Royal College of Psychiatrists questioned 576 trainees working in psychiatry across the UK.

The college said its findings suggested mental health services were approaching a “tipping point” and that the situation was “simply unacceptable”.

Ministers said inpatient beds should be available for those who needed them.

The survey also suggests that critically unwell patients are being sent home because no bed can be found for them.


Children moved

Investigations in recent months by BBC News and the online journal Community Care have highlighted that more than 1,700 mental health beds have been cut and that patients are travelling huge distances to access care.


A man on a bench with his head in hands

Sectioning someone under the Mental Health Act – denying them their liberty – should only be done when a person is a risk either to themselves or others. It is a legal process led by a social worker (an approved mental health professional) working alongside 2 doctors. A patient cannot be sectioned purely to secure a bed, but this survey suggests doctors are being influenced towards detaining someone if it’ll make it more likely a bed can be accessed.

The key findings include:

  • Some 18% said their decision to detain a patient under the Mental Health Act (section someone) had been influenced by the fact that doing so might make the provision of a bed more likely; 37% said a colleague’s decision had been similarly influenced
  • One-in-four said a bed manager had told them that unless their patient had been sectioned they would not get a bed
  • Almost 30% have sent a critically-ill patient home because no bed could be found
  • A third had seen a patient admitted to a ward without a bed
  • And 22% had been forced to send a child more than 200 miles from their families for treatment

Doctors also reported sending adult patients long distances to access care and admitting people into a bed belonging to another patient who had been sent home for a period of trial leave.


‘Very alarming’

One young psychiatrist, who did not want to be named, told BBC News that a patient had died as a result of not being able to secure a bed locally.

“The patient presented to us, they needed to be admitted, we couldn’t admit them locally, they were admitted to a hospital hundreds of miles away.

“The care they received was not what we’d have done and they died.”

The findings have been condemned by the college.


Norman LambMinister Norman Lamb said the NHS should treat mental and physical health services equally

Dr Howard Ryland, who oversees its psychiatric training described them as “very alarming”.

“People are beginning to recognise that there is a real crisis in mental health,” he added.

“This survey shows a picture of the very severe pressure that frontline staff are under in terms of securing the care that people need.

“The NHS doesn’t have the resources to cope with the ever increasing demand. The system doesn’t have the services to provide everyone with the care they need.”


‘Vulnerable’

His comments were supported by the Prof Bailey, president of the college, who said: “This survey provides further evidence that mental health services are approaching a tipping point.

“Continued cuts to services can only result in further distress and discomfort for patients, many of whom are young, vulnerable, some of whom are forced to receive care far from home. This situation is simply not acceptable.”

The mental health charity SANE called the situation a scandal.

Labour’s Shadow Health Minister Luciana Berger urged the government to take responsibility and “get to grips with this unacceptable failure before more lives are put at risk.”

In a statement, care minister Norman Lamb said: “It is not acceptable to detain someone under the Mental Health Act purely because they need an inpatient bed.

“Decisions about detention must always be taken in the best interests of patients at risk of harming themselves or others.

“Inpatient beds must always be available for those who need them. We are scrutinising local NHS plans to make sure they put mental health on a par with physical health.”

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Smoking and cancer gene 'deadly mix'








By James Gallagher
Health and science reporter, BBC News


Woman stubbing out cigarette


Smoking and the breast cancer risk gene BRCA2 combine to “enormously” increase the chance of developing lung cancer, a study of 27,000 people has suggested.

The research, published in the journal Nature, found the gene could double the likelihood of getting lung cancer.

And some men and women faced a far greater risk, a team at the Institute of Cancer Research in London said.

Cancer Research UK suggested drugs targeted at breast cancer may work in some lung cancers.

The links between variants of the BRCA genes and breast cancer are well established – a diagnosis led Hollywood actress Angelina Jolie to have a preventative double mastectomy – but it has also been linked with an increased risk of other cancers affecting women such as ovarian cancer and prostate cancer in men.

The study compared the genetic codes of people with and without lung cancer.

Smokers have 40 times the chance of developing lung cancer, but those with a BRCA2 mutation were nearly 80 times more likely, the analysis showed.

A quarter of those carrying the mutation, and who also smoke, will go on to develop lung cancer, the research team said.


Man smoking

“It is a massive increase in the risk of developing lung cancer,” said Prof Richard Houlston from the team.

“There is a subset of the population who are at very significant risk.

“The most important thing is reducing smoking; it is so bad for other diseases, as well as [increasing] the risk of lung cancer.”

Mutations to the BRCA genes stop DNA from repairing itself effectively.

“In the context of smoking there is such an enormous amount of DNA damage that any loss of DNA repair is going to be an issue,” Prof Houlston added.

The discovery could mean treatments that are being developed for breast cancer may also work in some cases of lung cancer.

“We’ve known for two decades that inherited mutations in BRCA2 made people more likely to develop breast and ovarian cancer, but these new findings show a greater risk of lung cancer too, especially for people who smoke,” said Prof Peter Johnson, Cancer Research UK’s chief clinician.

“Importantly this research suggests that treatments designed for breast and ovarian cancer may also be effective in lung cancer, where we urgently need new drugs.

“But, with or without one of these genetic flaws, the single most effective way to reduce the risk of lung cancer is to be a non-smoker.”

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Novartis skin cancer drug shrinks tumors in Phase II trial


(Reuters) – An experimental drug from Novartis markedly shrank tumors in patients with advanced basal cell carcinoma, the most common form of skin cancer, according to the results of a mid-stage study published on Sunday.

Basal cell carcinoma can be highly disfiguring and life-threatening in its advanced stages. The number of people with the illness is on the rise as the global population ages and people become increasingly exposed to ultraviolet rays.

The Phase II trial assessed the safety and efficacy of two oral doses of Novartis’ drug LDE225 in patients with locally advanced or metastatic basal cell carcinoma.

Results of the mid-stage study presented at the American Society of Clinical Oncology meeting in Chicago on Sunday found patients had marked and sustained tumour shrinkage after a median follow-up of 13.9 months, Novartis said.

Alessandro Riva, head of Novartis Oncology Development and Medical Affairs, said the data would form the basis for filings for approval with global health regulators.

(Reporting by Caroline Copley; editing by Jane Baird)

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Study may open new options for younger women with breast cancer


(Reuters) – The estrogen-blocking drug Aromasin worked better than the long-standing therapy tamoxifen at keeping cancers from returning in younger women with early stage breast cancer, a finding that may change the way the patients are treated, U.S. researchers said on Sunday.

Aromasin, a drug developed by Pfizer Inc that is sold generically as exemestane, is in a class of treatments called aromatase inhibitors that are typically used in post-menopausal women with low levels of estrogen.

Aromatase is an enzyme that converts the hormone androgen into small amounts of estrogen.

The drugs have largely been off-limits for younger women with working ovaries that produce estrogen.

In premenopausal women with hormone-sensitive cancers, the standard for preventing recurrence is five years of treatment with a drug called tamoxifen. For high-risk women, doctors in some countries recommend exemestane plus some form of therapy to shut down the ovaries, cutting off the supply of estrogen. That practice is not typically followed in the United States because there has not been enough evidence to show a benefit.

International researchers tested whether aromatase inhibitors combined with ovary-blocking treatments would do a better job than tamoxifen in two clinical trials involving 4,690 premenopausal women.

All women in the studies underwent some treatment to block the function of their ovaries, either through a drug called triptorelin, the surgical removal of the ovaries or the use of radiation. In addition, one group tested exemestane and the other tested tamoxifen.

A joint analysis of the two international trials known as SOFT and TEXT, presented at the American Society of Clinical Oncology, or ASCO, meeting in Chicago, showed exemestane did a better job of keeping cancer at bay when women’s ovarian function was suppressed, said Dr. Olivia Pagani of the Oncology Institute of Southern Switzerland.

Her study was presented at the meeting and will be published this week in the New England Journal of Medicine.

Dr. Clifford Hudis, a breast cancer expert and president of ASCO, said that with ovarian suppression, aromatase inhibitors offered an option for further cutting the risk of recurrence.

But some questions remain.

Although aromatase inhibitors showed a benefit in preventing recurrence, the researchers have yet to present data showing whether the treatment also extends survival compared with tamoxifen.

It is also still not clear whether shutting down the ovaries adds a benefit to women who are being treated with tamoxifen alone, which is the current standard of care in the United States.

“Based on these results, the answer is likely yes,” said Dr. Claudine Isaacs, co-director of the Breast Cancer Program at Georgetown Lombardi Comprehensive Cancer Center.

But she said suppressing ovarian function “is not negligible.” It puts women into menopause, accompanied by all of the side effects, including hot flashes, vaginal dryness, bone loss and possible increased risk for heart disease.

Results of that arm of the study are expected later this year.

(Reporting by Julie Steenhuysen; Editing by Peter Cooney)

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