Smileband health topics

As the shocking figures were released a leaked internal memo warned last night that the NHS is not ready to deal with a swine flu epidemic because of 'muddled' emergency plans and time-wasting bureaucracy.

A senior trust executive condemned some crisis measures as 'contradictory' and 'a complete waste of time'.

The creation of Tamiflu vouchers - a key weapon in the Government's fight against the killer flu - could in fact slow the distribution of the antiviral drugs, the correspondence said.

Rather than setting up a costly process that asks people to download vouchers from the internet, existing prescription forms would distribute Tamiflu just as quickly, it suggested. 

The leaked memo was penned by a senior official responsible for crisis planning and was not meant for the public domain.

In it, the official criticised the Government’s 'muddled thinking' in advising health authorities how to implement the new phase, in which people get diagnoses by contacting a national call centre.

Instructions for the so-called new phase were described as 'a total fudge'.

Chief Medical Officer Sir Liam Donaldson said yesterday that 14 had died so far of what was believed to be swine flu. 

He would not give details of where the five latest cases were. All had underlying health problems. 

Sir Liam said there were 335 people in hospital in England with swine flu of whom 43 are in critical care. 

Laboratory tests showed that yesterday there were 9,718 confirmed cases in the UK. This was just behind Mexico, with 10,262 cases. The U.S. is in the lead with 33,902 confirmed cases. However, Sir Liam admitted it was unknown how many in the UK were suffering from the virus as many would be treating themselves at home rather than contacting their GP. 

We do know something about the people seeking help from the NHS but there will be many other people who look after themselves,' he said. 

He said latest data from 100 GP surgeries around England showed that about 27,000 people per week were being diagnosed as having a flu-like illness. Of these, an estimated 8,000 will have swine flu. 

The number of flu cases being seen every week works out at 51.9 per 100,000 people. 

However, in London the rate is 180 per 100,000 - just short of the 200 cases that denotes an epidemic. In the West Midlands the rate is 140 per 100,000 cases. 

Smileband health topics

What is complex regional pain syndrome (CRPS)?

Complex regional pain syndrome (CRPS) is a condition that can cause pain, swelling and discolouration in one of your limbs. There are different types of CRPS which may be referred to as reflex sympathetic dystrophy (RSD), Sudek’s syndrome or causalgia. 

What are the symptoms of complex regional pain syndrome (CRPS)?

Complex regional pain syndrome (CRPS) usually affects one arm or leg, causing a burning, stabbing or stinging pain, extreme sensitivity and sometimes colour or temperature changes.  

What causes complex regional pain syndrome (CRPS)?

We don’t know the exact cause of complex regional pain syndrome (CRPS), but a fracture or other injury often seems to act as a trigger.   

How is complex regional pain syndrome (CRPS) diagnosed?

Doctors mainly base a diagnosis of complex regional pain syndrome (CRPS) on your symptoms and an examination, although you may need some tests to rule out other conditions.    

What treatments are there for complex regional pain syndrome (CRPS)?

Complex regional pain syndrome (CRPS) can be difficult to treat. Drug treatment and sympathetic blocks are aimed at controlling your pain and rehabilitation will help you to use your affected limb as fully as possible. 

Self-help and daily living for complex regional pain syndrome (CRPS)

Exercising little and often, and eating a well-balanced diet are good for your general health, but it's also important to tackle any anxiety that complex regional pain syndrome may cause.

Smileband health topics

Tick-borne relapsing fever (TBRF) is most commonly caused by Borrelia hermsii, but can be caused by at least 14 other Borrelia species.

 

Relapsing fever is a systemic spirochetal disease in which periods of fever lasting 2–7 days alternate with afebrile periods of 4–14 days; the number of relapses varies from 1 to 10 without treatment. Febrile periods are often associated with shaking chills, sweats, headache, muscle and joint pain, and can be associated with a rash. Photophobia, eye pain, dizziness, dry cough, nausea, vomiting, or lack of appetite can also occur. Each febrile period terminates by a crisis (abrupt symptom change). Symptoms can be more severe without treatment.

 

TBRF occurs in the western U.S. and is usually linked to sleeping in rustic, rodent-infested cabins in mountainous areas and high elevations.

 

Arizona 5 year median: 1 cases

 

Transmission

Transmission occurs when an individual is bitten by an infected tick. Transmission can also occur mother to child in pregnant women.

Incubation period is 2 to 18 days. Isolation Precautions

Tick-borne relapsing fever is not directly transmitted person-to-person. 

Standard precautions are recommended in healthcare settings. 

Prevention for Patients

• Avoid sleeping in rodent infested buildings
• Inspect buildings on a regular basis for rodent activity
• Eliminate rodent nesting areas
• Use proper food and waste handling practices that eliminate food sources for rodents
• Rodent–proof cabin/buildings by sealing holes in foundation and walls and use screens to prevent rodent entry

Public Health Actions
Public health will conduct an epidemiological investigation on a case or suspect case. 

Smileband health topics

Rickettsia parkeri rickettsiosis is an emerging tick-borne disease that has been identified in remote areas of Southern Arizona. R. parkeri is similar to Rocky Mountain spotted fever, but symptoms are milder. Infection is treatable with doxycycline.
Illness is characterized by the development of an eschar (dark necrotic scab) at the site of the tick bite and may be accompanied by:

• fever
• headache
• malaise
• myalgia
• rash (initially macular, then may appear more vesicular)

Transmission
R. parkeri is spread by the bite of an infected tick.
The incubation period is days to weeks.  

Isolation Precautions
Standard precautions are recommended in healthcare settings.
Prevention for Patients
Reduce contact with ticks:

• use insect repellent
• wear long sleeves and pants
• avoid wooded areas and brushy areas with high grass
• perform thorough tick checks after spending time outdoors
• use tick prevention on pets

Smileband general news

Former Wigan defender Juan Carlos Garcia has died at the age of 29 following a battle with leukaemia, the League One club have announced. Garcia had been diagnosed with the illness in early 2015 and remained in England until returning to his native Honduras towards the end of last year.

He had joined Latics from Olimpia on a three-year contract in 2013, following the path previously taken by fellow Honduras internationals Maynor Figueroa, Wilson Palacios and Hendry Thomas. Though he would make just one appearance for Latics, against Manchester City in the League Cup, he featured in two of his country's games at the 2014 World Cup.

Wigan chairman David Sharpe said on wiganathletic.com: 'This is such tragic news and we send our deepest condolences as a club to Juan Carlos' family and friends who have had to sit by and watch this sad story unfold over the past few years.

'We have offered what support we can but, despite the best possible treatment at Christie's Hospital, Juan Carlos has tragically not been able to beat this terrible illness.

'At just 29 years old, he was far too young to be taken and our thoughts are with his family at this sad time.'

Wigan will hold a one minute silence for Garcia prior to Saturday's fixture with Peterborough. 

Smileband health topics

Listeriosis is a serious infection usually caused by eating food contaminated with the bacterium Listeria monocytogenes. In adults, invasive disease manifests most commonly as meningitis or bacteremia; infection during pregnancy may result in fetal loss, neonatal meningitis or bacteremia. Infections in healthy persons may appear as self-limiting diarrheal illness or mild flu-like illness.

 

Listeria tends to multiply in refrigerated foods that have been contaminated. Foods implicated in outbreaks include unpasteurized milk, soft cheeses, deli meats, prepared meats like hot dogs, and raw fruits and vegetables such as cantaloupe.

 

In Arizona on average there are 10 cases reported each year.

 

Arizona 5 year median: 6 cases

 

Transmission

Listeria can be transmitted through ingestion of contaminated foods or through contact with infected animals or birds. Person-to-person transmission has also been reported in nosocomial outbreaks. Transmission may occur from mother to child or during delivery.

Incubation period is typically 2 to 3 weeks.

Lab Tests & Specimen Info

Test*	Specimen
Culture	CSF, Blood,  Amniotic Fluid,  Placenta, Meconium, Vaginal Secretions, Respiratory, Skin,  Mucous Swab, or Stool

 Isolation Precautions

Standard precautions are recommended in healthcare settings. 

Prevention for Patients
The guidelines recommended for the prevention of listeriosis are similar to those used for other foodborne illnesses.

• Wash hands, knives, countertops, and cutting boards after handling and preparing uncooked foods.
• Be aware that Listeria monocytogenes can grow in foods in the refrigerator. Use an appliance thermometer, such as a refrigerator thermometer, to check the temperature inside your refrigerator. The refrigerator should be 40°F or lower and the freezer 0°F or lower.
• Clean up all spills in your refrigerator right away–especially juices from hot dog and lunch meat packages, raw meat, and raw poultry.
• Clean the inside walls and shelves of your refrigerator with hot water and liquid soap, then rinse.

Thoroughly cook raw food from animal sources, such as beef, pork, or poultry to a safe internal temperature.

Smileband general news

Cancer is a modern, man-made disease caused by environmental factors such as pollution and diet, a study review by University of Manchester scientists has strongly suggested. Finding only one case of the disease in the investigation of hundreds of Egyptian mummies, with few references to cancer in literary evidence, proves that cancer was extremely rare in antiquity. The disease rate has risen massively since the Industrial Revolution, in particular childhood cancer – proving that the rise is not simply due to people living longer. 

Egyptian mummys

The data includes the first ever histological diagnosis of cancer in an Egyptian mummy by Professor Michael Zimmerman, a visiting Professor at the KNH Centre, who is based at the Villanova University in the US. He diagnosed rectal cancer in an unnamed mummy, an ‘ordinary’ person who had lived in the Dakhleh Oasis during the Ptolemaic period (200-400 CE).

Professor Zimmerman said: “In an ancient society lacking surgical intervention, evidence of cancer should remain in all cases. The virtual absence of malignancies in mummies must be interpreted as indicating their rarity in antiquity, indicating that cancer causing factors are limited to societies affected by modern industrialization”.

The team studied both mummified remains and literary evidence for ancient Egypt but only literary evidence for ancient Greece as there are no remains for this period, as well as medical studies of human and animal remains from earlier periods, going back to the age of the dinosaurs.

Evidence of cancer in animal fossils, non-human primates and early humans is scarce – a few dozen, mostly disputed, examples in animal fossils, although a metastatic cancer of unknown primary origin has been reported in an Edmontosaurus fossil while another study lists a number of possible neoplasms in fossil remains. Various malignancies have been reported in non-human primates but do not include many of the cancers most commonly identified in modern adult humans.

It has been suggested that the short life span of individuals in antiquity precluded the development of cancer. Although this statistical construct is true, individuals in ancient Egypt and Greece did live long enough to develop such diseases as atherosclerosis, Paget's disease of bone, and osteoporosis, and, in modern populations, bone tumours primarily affect the young. Another explanation for the lack of tumours in ancient remains is that tumours might not be well preserved. Dr. Zimmerman has performed experimental studies indicating that mummification preserves the features of malignancy and that tumours should actually be better preserved than normal tissues. In spite of this finding, hundreds of mummies from all areas of the world have been examined and there are still only two publications showing microscopic confirmation of cancer. Radiological surveys of mummies from the Cairo Museum and museums in Europe have also failed to reveal evidence of cancer.

As the team moved through the ages, it was not until the 17^th Century that they found descriptions of operations for breast and other cancers and the first reports in scientific literature of distinctive tumours have only occurred in the past 200 years, such as scrotal cancer in chimney sweeps in 1775, nasal cancer in snuff users in 1761 and Hodgkin’s disease in 1832.

The fathers of pharmacology

Professor David – who was invited to present her paper to UK Cancer Czar Professor Mike Richards and other oncologists at this year’s UK Association of Cancer Registries and National Cancer Intelligence Network conference – said: “Where there are cases of cancer in ancient Egyptian remains, we are not sure what caused them. They did heat their homes with fires, which gave off smoke, and temples burned incense, but sometimes illnesses are just thrown up.”

She added: “The ancient Egyptian data offers both physical and literary evidence, giving a unique opportunity to look at the diseases they had and the treatments they tried. They were the fathers of pharmacology so some treatments did work

“They were very inventive and some treatments thought of as magical were genuine therapeutic remedies. For example, celery was used to treat rheumatism back then and is being investigated today. Their surgery and the binding of fractures were excellent because they knew their anatomy: there was no taboo on working with human bodies because of mummification. They were very hands on and it gave them a different mindset to working with bodies than the Greeks, who had to come to Alexandria to study medicine.”

She concluded: “Yet again extensive ancient Egyptian data, along with other data from across the millennia, has given modern society a clear message – cancer is man-made and something that we can and should address.”

Smileband health topics

A new weekly HIV treatment was shown to work in animals in a new study, prompting its manufacturer to begin development of a pill for humans. HIV medications can now keep levels of the virus so low in people with the disease that they are undetectable and cannot be transmitted. 

But traditional therapies require taking many potent drugs, or getting frequent injections, so there has been a recent push in the medical community to develop therapies that need to be taken less frequently and from home. 

Massachusetts-based drug manufacturer Lyndra's most recent test of its treatment found that effective, oral doses of three HIV-fighting compounds could stay in the systems of animals for sustained periods of time, as proof of concept for the drug they are developing. Progress in medications for as well as social awareness and destigmatization of HIV have greatly improved quality of life for those living with it. 

In September of last year, that Centers for Disease Control and Prevention announced that those with undetectable viral loads - or levels of the infection - in their systems are now at 'effectively no risk' of transmitting the disease. 

The announcement was celebrated by the HIV positive community and put a sort of seal of approval on the efficacy of modern treatments. 

But, even as life spans continue to stretch for HIV positive people, the disease remains incurable, requiring a lifetime of treatment. 

Perhaps the biggest advancement in HIV treatment to come to market has been a single pill that combines the three key drug compounds used that combat the virus. 

The oral medication has to be taken every day, however, some studies have suggested that missing even two days of the pill can give the virus a window of opportunity to return to detectable levels. 

It is nearly impossible to accurately monitor how well HIV patients stick to their medication regimens, but a National Institutes of Health study done last year linked adherence to visits to care providers, and estimated that only about 57 percent of those who were diagnosed and connected with a provider kept with up with their appointments, suggesting they may not keep up with their medications either. 

'Because people with HIV require life-long antiretroviral therapy, a long-acting oral option that could be taken at home would make it easier for patients to adhere to their treatment regimen,' said Dr Andrew Bellinger, co-founder and chief scientific officer of Lyndra. 

Smileband health topics

Microsporidiosis is a disease caused by infection with microscopic organisms called microsporidia. Microsporidia are eukaryotic parasites that must live within other host cells in which they can produce infective spores. Microsporidiosis can cause infection of the intestine, lung, kidney, brain, sinuses, muscles, and eyes.

 

Intestinal symptoms that are caused by microsporidia infection include chronic diarrhea, wasting, malabsorption, and gallbladder disease. Symptoms of microsporidiosis primarily occur in people with immune-system deficiency, such as HIV-infected individuals and organ-transplant recipients.

 

Lung symptoms may include cough and difficult, labored breathing.

 

Transmission

Microsporidia spores are released from the stool and urine of infected animals. A number of animals, including insects, birds, and mammals, can serve as reservoirs of infection for microsporidia. These spores are then consumed or inhaled by humans. Isolation Precautions

Standard precautions are recommended in healthcare settings. 

Prevention for Patients
For patients with immune-system deficiency, frequent hand washing and limiting exposure to animals suspected of being infected with microsporidia is recommended.

Smileband health topics

What is Aussie flu?

Every winter there are a few strains circulating and Aussie flu or H3N2 is just one of them. It is an influenza A virus that appears to cause more severe infections in young children and the elderly. 

Most people will recover in about a week and won't need any specific treatment, apart from a bit of bed rest, some paracetamol or ibuprofen and drinking plenty of fluids. 

But for some - the very old, very young or people with pre-existing health conditions such as heart disease - flu can be deadly.

Is Aussie flu worse than other types of flu?

The UK is seeing a mix of flu types circulating including influenza B as well as the H3N2 strain. 

H3N2 is not new. It was around last winter too. 

Any strain of flu, including H3N2, can be dangerous for people who are vulnerable to it. 

Experience from last winter suggests the elderly are a high risk group for H3N2.

Influenza viruses are given different names based on their type - A, B and C. A is usually the most serious while C is usually a milder infection. They can be further subdivided according to the proteins that they carry on their surface. These are called H and N antigens. 

How bad is the situation in the UK?

Hospital admissions and GP visits for influenza have seen a sharp rise going into 2018, but are still comparable to the previous winter and are nowhere near as high as in 2008-09 when the swine flu pandemic hit the UK. 

Professor Paul Cosford, Medical Director, Public Health England said: "As we would expect at this time of year, flu levels have increased this week. Our data shows that more people are visiting GPs with flu symptoms and we are seeing more people admitted to hospitals with the flu. The vaccine is the best defence we have against the spread of flu and it isn't too late to get vaccinated."

What about the flu jab?

The vaccine is designed to protect against the type of flu circulating in any given season. 

Every year, the World Health Organization reviews the global situation and recommends which flu strains should go into the vaccine to be manufactured for the following season. 

This year's flu jab is designed to protect against H3N2 as well as some other strains.

How effective is it?

Vaccination is the best protection we have against flu.

But flu is unpredictable. Flu viruses constantly mutate and change, so it is a moving target to fight. 

Public Health England says typical effectiveness of the flu vaccine is 40-60%, which means that for every 100 people vaccinated, between 40 and 60 will be protected.

At risk people are advised to have annual flu jabs because flu strains can change from year to year, plus protection from the flu vaccine may wane after about six months.

Adults aged over 65, pregnant women and those with underlying health conditions are advised to get a free flu jab.

A flu nasal spray is available free to young children, who are thought to be the main spreaders of flu.

Why doesn't it stop all strains?

In general, current flu vaccines tend to work better against influenza B and influenza A/H1N1 viruses than H3N2, according to US experts at the Centres for Disease Control and Prevention.

And it's already known that flu vaccines may work less well in elderly people because they have weaker immune systems.

Dr Richard Pebody, from Public Health England, said: "This season's flu vaccine should be providing reasonable protection, similar to last winter. Last year the vaccine did not give quite as good protection for the elderly for H3N2. 

"That's something that we are watching closely to see if it is an issue this winter."

How the vaccines are made might also determine their effectiveness, according to research.

Flu vaccines used in the UK and in many other parts of the world are currently grown in chicken eggs and this process can be tricky.