Bird flu outbreak hits second Dutch farm, exports to remain frozen

Police tape and warning signs are seen outside a duck farm in Nafferton, northern England November 17, 2014. REUTERS/Phil Noble

Police tape and warning signs are seen outside a duck farm in Nafferton, northern England November 17, 2014.

Credit: Reuters/Phil Noble


(Reuters) – A second Dutch farm was hit by an outbreak of bird flu, the government said on Thursday, prompting the destruction of 43,000 chickens and prolonging crippling restrictions on trade in the world’s leading egg exporter.

A three-day, nation-wide ban on the transportation of all poultry, eggs and related farm products was extended until Sunday, a statement said.

The measures have already led to tens of millions of euros (dollars) in losses. Industry groups had warned that an extension could bankrupt smaller producers.

Infections have also been discovered on farms in Germany and, this week, Britain.

The infection announced on Thursday was of the H5 strain, the government said, but it was unclear if it was the highly-contagious H5N8 virus discovered last week at a farm 20 km (12 miles) away.

Like in the previous outbreak, authorities imposed a 10 km exclusion zone around the farm in Ter Apel, in the central Netherlands, and were testing four nearby farms for the virus.

The first case in the Netherlands was reported last weekend in the village of Hekendorp, prompting the culling of 150,000 laying hens.

Authorities have yet to determine conclusively whether there is a link between the Dutch, German and British outbreaks, or whether they are related to infected birds in Asia.

Experts have said they suspect that all are connected and believe wild birds may have carried the disease to Europe and introduced it into commercial flocks.

The German and the first Dutch outbreak are of the H5N8 strain, which is highly contagious in birds. H5N8 has never been found in humans, unlike H5N1, which has killed 400 people mostly in Asia and the Middle East since 2003 and caused a global scare.

There can be no exports of poultry products as long as the transportation ban is in place, and the latest measures could lead to a supply shortage.

With a population of less than 17 million, the Netherlands is the world’s second largest exporter of agricultural products after the United States, selling $79 billion euros ($99 billion) of agricultural goods abroad last year.

Around 2,000 businesses, with more than 100 million chickens, export more than 6 billion eggs a year. The Netherlands is also the leading exporter of poultry meat in the European Union.

(Reporting By Anthony Deutsch and Thomas Escritt; Editing by Jeremy Gaunt)

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TNF inhibitors may increase cancer risk in the eye, researchers report

One of the family of drugs prescribed for rheumatoid arthritis and other inflammatory conditions is called TNF inhibitors. They act by dampening part of the immune system called tumor necrosis factor (TNF). In one of the balancing acts of medicine, the anti-inflammatory action of the drug also increases the risk for other conditions, in this case, a rare form of eye cancer, uveal melanoma. Mayo Clinic researchers make the case and alert physicians in an article in Mayo Clinic Proceedings.

Mayo researchers studied three patients — two women and a man — who were treated for inflammatory disease and developed melanoma tumors in one eye within a year to two of taking TNF inhibitors. While this type of condition is probably rare, according to the researchers, there might be an increased risk if the patient has a pre-existing nevus (freckle of the eye). The women had inflammatory bowel disease; the man had rheumatoid arthritis. The studies occurred between 2009 and 2013.

Researchers say that patients considered for treatment with TNF inhibitors should first be given an eye exam to determine eye health, and any with existing conditions, such as choroidal nevus (lesions on the eye), should be monitored regularly to determine if any issues are developing.

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The above story is based on materials provided by Mayo Clinic. The original article was written by Bob Nellis. Note: Materials may be edited for content and length.

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Hip replacement an excellent option for young juvenile arthritis patients

When you think of hip replacement surgery, you generally envision an older adult with painful osteoarthritis. But the procedure is also used for younger patients with juvenile idiopathic arthritis (JIA) whose joints have been severely damaged by the disease.

A new study by Hospital for Special Surgery (HSS) researchers finds that total hip replacement (THR) is an excellent option for patients under age 35 when conservative treatments fail to provide relief.

The study, presented at the American College of Rheumatology annual meeting on November 16, found that hip replacement lasted at least 10 years in 85 percent of JIA patients. Twenty years out, 50 percent of the patients needed a revision surgery, or second hip replacement.

Juvenile idiopathic arthritis is a common rheumatologic disease in children that often persists into adulthood. It frequently affects the hip joint, and total hip replacement is the standard treatment to relieve pain and restore mobility when nonsurgical treatments no longer help.

“The surgery in this patient population, although performed by only a small number of specialized orthopedic surgeons nationwide, is life-changing for JIA patients,” said Mark P. Figgie, M.D., senior author of the study and chief of the Surgical Arthritis Service at HSS. “Joint replacement can free patients from a life of unrelenting pain. It can enable those in a wheel chair to walk again. Patients can go back to school or work and get their lives back.”

This study, titled, “Implant Survival and Patient-Reported Outcomes after Total Hip Arthroplasty in Young Patients with JIA,” evaluated the longevity of implants in JIA patients ages 35 or younger who underwent hip replacement at Hospital for Special Surgery.

“This study followed one of the largest cohorts of patients with JIA to see how they fared 10 years and 20 years after total hip replacement,” said Ishaan Swarup, M.D., an orthopedic surgery resident at HSS. “It is also one of the few studies to look at patient-reported measures, such as pain and the ability to perform activities of daily living.”

Patient characteristics and implant data were collected by a retrospective chart review and follow-up surveys were conducted. Kaplan-Meier survival analysis was performed to evaluate how long the implant lasted, and the hip disability and osteoarthritis outcome score (HOOS) was used to describe patient-reported outcomes.

Data were collected for 56 patients. Forty-one patients had undergone bilateral hip replacement, while 15 individuals had only one side replaced, for a total of 97 hip replacement surgeries. The mean time for follow-up was 12 years. The 10-year and 20-year implant survival was 85 percent and 50 percent, respectively.

The researchers found that hip replacement in patients who were 25 or older lasted longer compared to THR in younger patients. There were no other significant differences in implant longevity based on gender or the use of custom versus standard implants.

Male patients reported better outcomes with respect to activities of daily living, and patients who had received custom hip implants did worse in their reporting of pain and the ability to perform daily activities.

“We were not surprised that the patients who received custom implants had lower scores, since the very fact that they needed a custom implant meant they had more severe joint deformities and more severe disease,” Dr. Figgie explained.

“We concluded that overall, hip replacement is an excellent treatment option for young JIA patients with reasonable long-term implant survival and favorable patient-reported outcomes after surgery,” Dr. Swarup said.

Although a good treatment, Dr. Figgie noted that the longevity of the implants needs to be improved, especially since the patients are so young. “The next step will be to evaluate which factors affect how long the implants last and work on improving implant design and durability,” he said.

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The above story is based on materials provided by Hospital for Special Surgery. Note: Materials may be edited for content and length.

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Gene therapy found effective in hemophilia B


(Reuters Health) – Ten patients with severe hemophilia B have remained cured of the inherited bleeding disorder for as long as three years thanks to gene therapy, according to a new report on the technique in the New England Journal of Medicine.

The study updates an earlier one from 2011, in which six volunteers were successfully treated with various doses of the treatment that uses a virus to insert genetic material into the liver. The four additional patients received the highest dose.

“I believe that, scientifically, this is ready for prime time,” the chief author, Dr. Andrew Davidoff of St. Jude Children’s Research Hospital in Memphis, Tennessee, told Reuters Health in a telephone interview.

The problem, he said, is that the genetically engineered virus that delivers the cure “is really a bear to make” and better methods to produce the treatment are desperately needed. To engineer enough virus to treat the 10 patients required six months of work.

Davidoff and his colleagues found that the higher the dose of the engineered virus, the more factor IX the body produced. Factor IX is a protein crucial to blood clotting and is defective in hemophilia B patients.

The researchers used an adeno-associated virus or AAV, which infects the liver without causing apparent illness.

The therapy seemed to have no serious side effects and is designed to eliminate the need to give patients injections of factor IX every two or three days at a cost of about $250,000 per year.

The treatment produced factor IX levels in a range of 1 percent to 6 percent of normal. But even a few percentage points can be enough to prevent dangerous bleeding. A single infusion was sufficient.

For the six high-dose recipients, the factor IX level averaged 5.1 percent, “which resulted in a reduction of more than 90 percent in both bleeding episodes and the use of prophylactic factor IX concentrate,” the research team wrote.

“I think it’s going to have a big impact. The study showed both safety and efficacy and the side effects were minimal,” said Dr. Timothy Nichols, who heads the Francis Owen Blood Research Laboratory at the University of North Carolina and was not involved in the study.

“This is a single shot of medicine given to patients who are treating themselves two or three times a week,” he told Reuters Health by phone. “Suddenly, they don’t have to take the medicine anymore.”

Worldwide, about 1 in 25,000 men are born with hemophilia B each year. It is less common than hemophilia A, which is caused by a problem with a different protein and affects about 1 in 5,000 men.

Because the genetic code for the clotting factors is carried on the X chromosome, and males don’t have a backup copy of that chromosome as women do, the condition is almost exclusively a disease of men.

Nichols said most people with hemophilia would be “very eager to consider the treatment and move forward if production issues can be resolved.”

“Hopefully (the new results) will be a catalyst for us and others to find a more effective way to produce AAV,” Davidoff said. “In fact, we’re in discussions with other companies in terms of investing in our research for improving production.”

SOURCE: bit.ly/1t6duWb New England Journal of Medicine, online November 19, 2014.

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Gene therapy found effective in hemophilia B


(Reuters Health) – Ten patients with severe hemophilia B have remained cured of the inherited bleeding disorder for as long as three years thanks to gene therapy, according to a new report on the technique in the New England Journal of Medicine.

The study updates an earlier one from 2011, in which six volunteers were successfully treated with various doses of the treatment that uses a virus to insert genetic material into the liver. The four additional patients received the highest dose.

“I believe that, scientifically, this is ready for prime time,” the chief author, Dr. Andrew Davidoff of St. Jude Children’s Research Hospital in Memphis, Tennessee, told Reuters Health in a telephone interview.

The problem, he said, is that the genetically engineered virus that delivers the cure “is really a bear to make” and better methods to produce the treatment are desperately needed. To engineer enough virus to treat the 10 patients required six months of work.

Davidoff and his colleagues found that the higher the dose of the engineered virus, the more factor IX the body produced. Factor IX is a protein crucial to blood clotting and is defective in hemophilia B patients.

The researchers used an adeno-associated virus or AAV, which infects the liver without causing apparent illness.

The therapy seemed to have no serious side effects and is designed to eliminate the need to give patients injections of factor IX every two or three days at a cost of about $250,000 per year.

The treatment produced factor IX levels in a range of 1 percent to 6 percent of normal. But even a few percentage points can be enough to prevent dangerous bleeding. A single infusion was sufficient.

For the six high-dose recipients, the factor IX level averaged 5.1 percent, “which resulted in a reduction of more than 90 percent in both bleeding episodes and the use of prophylactic factor IX concentrate,” the research team wrote.

“I think it’s going to have a big impact. The study showed both safety and efficacy and the side effects were minimal,” said Dr. Timothy Nichols, who heads the Francis Owen Blood Research Laboratory at the University of North Carolina and was not involved in the study.

“This is a single shot of medicine given to patients who are treating themselves two or three times a week,” he told Reuters Health by phone. “Suddenly, they don’t have to take the medicine anymore.”

Worldwide, about 1 in 25,000 men are born with hemophilia B each year. It is less common than hemophilia A, which is caused by a problem with a different protein and affects about 1 in 5,000 men.

Because the genetic code for the clotting factors is carried on the X chromosome, and males don’t have a backup copy of that chromosome as women do, the condition is almost exclusively a disease of men.

Nichols said most people with hemophilia would be “very eager to consider the treatment and move forward if production issues can be resolved.”

“Hopefully (the new results) will be a catalyst for us and others to find a more effective way to produce AAV,” Davidoff said. “In fact, we’re in discussions with other companies in terms of investing in our research for improving production.”

SOURCE: bit.ly/1t6duWb New England Journal of Medicine, online November 19, 2014.

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Cuban doctor with Ebola is stable, fever reduced: official


(Reuters) – The Cuban doctor who contracted Ebola while treating patients in Sierra Leone was in stable condition with a reduced fever and no further complications, a Cuban health official said Wednesday.

The doctor, Felix Baez, 43, cannot recall any mistake in procedure that could have led to him catching the virus from a patient, said Jorge Perez, director of the tropical diseases hospital where Cuban doctors train for their Ebola missions.

Baez, a specialist in internal medicine, is the first Cuban known to have contracted Ebola, which has killed at least 5,450 people since March in the worst outbreak of the disease on record.

“He’s doing fine. He’s lost a little appetite but otherwise has no complications at the moment,” Perez told Reuters a few hours before he was due to travel to Geneva to help with Baez’s case.

Baez, who is married with two children, was due to arrive in Geneva late Thursday, Perez said.

Some 165 Cuban doctors and nurses have gone to Sierra Leone for six-month missions, with another 53 in Liberia and 38 in Guinea.

The Cuban commitment has won international praise as more substantial than contributions from many wealthy countries.

A Geneva doctor specializing in infectious diseases will organize Baez’s care in a special hospital room separate from other wards at University Hospital, the Swiss Federal Office of Public Health said.

British and Cuban doctors treating Baez in Sierra Leone reduced his fever from 39 degrees Celsius (102.2 degrees Fahrenheit) to 37 degrees C (98.6 degrees F) using the drug duralgina, said Perez, who has reviewed medical reports on Baez and has spoken to his supervisor in Sierra Leone.

“He sent information saying he doesn’t remember how or where, doesn’t know what his mistake may have been in getting infected,” Perez said.

Doctors and nurses wear protective, full-body suits when treating Ebola patients with strict procedures on how to remove them. The Cubans trained for their mission for three weeks in Cuba and another 15 days upon arriving in West Africa.

Baez, who normally works at a military hospital in Havana, was one of 15,000 volunteers for the Ebola mission and one of 465 who received training.

“Be strong, Dad, everything’s going to be all right,” the doctor’s elder son, second-year medical student Alejandro Baez, said via official website CubaSi. “All of Cuba is waiting for you.”

Baez also has an 18-month-old son, Felix Luis.

(Reporting by Daniel Trotta; Additional reporting by Stephanie Nebehay in Geneva; Editing by Jonathan Oatis)

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