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Thailand is one of the 22 countries designated as high TB-burden by the World Health Organization (WHO). To improve TB prevention, diagnosis, treatment, and program management, CDC works with the Thai MoPH providing assistance to WHO and other countries throughout the region. A recent multi-country study led to a simple clinical algorithm that health personnel can use to help detect TB in HIV-positive persons. CDC is currently working with Thailand, Cambodia, and Vietnam to assess the impact of new diagnostic techniques and approaches to prevent the spread of TB in health care settings.

Global Disease Detection (GDD)

Working with the Thailand MoPH, Ministry of Agriculture and Cooperatives, and other partners, GDD addresses the threat of emerging infectious diseases in Thailand and South East Asia by responding to public health emergencies; strengthening laboratory capacity and biosafety; implementing multidisciplinary approaches to disease detection and response; and modeling laboratory-based surveillance for high-burden diseases like pneumonia, TB, and invasive bacterial infections. GDD has supported Thailand’s response to MERS-CoV (Middle East Respiratory Syndrome Coronavirus) through human surveillance and the regional response to influenza A (H7N9) through enhanced animal surveillance.  As one of ten Regional GDD Centers around the world, GDD-Thailand works with WHO and ministries of health to strengthen core capacity requirements (e.g., laboratory, surveillance, response and human resources) for implementation of the International Health Regulations.

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CDC recently marked 30 years of collaboration with the Thailand Ministry of Public Health. This collaboration has produced new disease prevention and intervention strategies that have had significant global impacts. From the establishment in 1980 of the Field Epidemiology Training Program to current efforts to meet the growing challenges of drug-resistant malaria, TB, HIV, emerging infectious diseases, border health, and noncommunicable diseases, CDC’s work with Thailand protects Thais and Americans from major health threats. infections and improve the quality of life of people living with HIV, CDC works closely with the Thai MoPH to develop model approaches and expand prevention, surveillance, and care and treatment of HIV. This technical assistance helps the Thai MoPH improve laboratory infrastructure, strategic information, HIV care quality, interventions for men who have sex with men (MSM), and care and treatment of children infected with HIV. CDC Thailand also serves as the Asia Regional Office (ARO), supporting Laos and providing technical assistance to other countries in the region, often including Thai government partners in the collaborations. CDC works to improve HIV programs by building country capacities needed to mount and sustain an effective national HIV response. These activities support a data-driven, evidence-based approach that is tailored to the unique characteristics of the local epidemic for maximum health impact and the most efficient use of resources.CDC also works with the Thai MoPH to conduct studies of HIV incidence and risk behaviors and evaluates biomedical and behavioral interventions to prevent HIV infection. Current research activities focus on people who inject drugs MSM. CDC also helped establish a clinic for MSM in Bangkok that provides a model for the integration of HIV research and prevention services.

Non-Communicable Diseases (NCDs)

CDC is working with the Thai MoPH to help address NCDs.  One key project involves working with the Thailand Behavioral Risk Factor Surveillance System (BRFSS) team on building Thailand’s capacity for NCD surveillance.  This involves instruction on population sampling and conducting a demonstration project in Sukothai Province on surveillance data on hypertension.  Another project aims to better understand salt and fat consumption in Thailand and to develop strategies to address this problem (e.g., food reformulations, education campaigns).

Immigrant, Refugee, and Migrant Health

CDC aims to stop the spread of infectious diseases among immigrants, refugees, international travelers, and other mobile populations that cross international borders. This program oversees the content and quality of medical screening of U.S.-bound immigrants and refugees and assists Thailand in improving the health of refugees and migrants within Thailand’s borders. With approximately half of the 75,000 refugees legally admitted into the U.S. arriving from Asia, this regional program supports disease surveillance among the U.S.-bound populations and helps prevent the introduction of infectious diseases into the U.S. 

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Cell-derived nanoparticles have been garnering increased attention due to their ability to mimic many of the natural properties displayed by their source cells. This top-down engineering approach can be applied toward the development of novel therapeutic strategies owing to the unique interactions enabled through the retention of complex antigenic information. Herein, we report on the biological functionalization of polymeric nanoparticles with a layer of membrane coating derived from cancer cells. The resulting core–shell nanostructures, which carry the full array of cancer cell membrane antigens, offer a robust platform with applicability toward multiple modes of anticancer therapy. We demonstrate that by coupling the particles with an immunological adjuvant, the resulting formulation can be used to promote a tumor-specific immune response for use in vaccine applications. Moreover, we show that by taking advantage of the inherent homotypic binding phenomenon frequently observed among tumor cells the membrane functionalization allows for a unique cancer targeting strategy that can be utilized for drug delivery applications.

Keywords: Nanomedicine, biomimetic nanoparticle, cellular membrane, cancer immunotherapy, targeted drug delivery, homotypic targeting.   The anti-cancer drug binds to cancerous cells' membrane protein, known as dehydroorotate dehydrogenase (DHODH).

The researchers analysed how fats, which are the building blocks of cell membranes, and drugs bind to DHODH. 

Study author Dr Erik Marklund, from Uppsala University, said: 'Our simulations show the enzyme uses a few lipids as anchors in the membrane.

'When binding to these lipids, a small part of the enzyme folds into an adapter that allows the enzyme to lift its natural substrate [the substance an enzyme acts on] out of the membrane.

'It seems the drug, since it binds in the same place, takes advantage of the same mechanism.'  

Potential for more selective treatments 

Study author Sir David Lane, from the Karolinska Institute, in Sweden, added: 'The study helps to explain why some drugs bind differently to isolated proteins and proteins that are inside cells.

'By studying the native structures and mechanisms for cancer targets, it may become possible to exploit their most distinct features to design new, more selective therapeutics

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Terminally ill Noel Conway has won the first stage of his Court of Appeal bid to challenge a ruling he says denies him a 'peaceful and dignified' death. The 68-year-old retired lecturer, from Shrewsbury, says he feels 'entombed' by motor neurone disease and wants medics to be able to help him die when he has just six months left to live.

He lost a High Court fight in October last year to allow him to bring about his death in the way he wishes.

But he was given the go-ahead for a full hearing at the Court of Appeal today by Sir Ernest Ryder and Lord Justice Underhill.

Sir Ernest said: 'Having given the matter the consideration that we have, we believe it appropriate to give permission.'

The judges made their decision based on documents submitted by Mr Conway's legal team, without hearing any oral representations.

Sir Ernest said the court will give reasons for its decision later today. He previously asked for a declaration that the Suicide Act 1961 is incompatible with Article 8 of the European Convention on Human Rights, which relates to respect for private and family life, and Article 14, which protects from discrimination.

But his case was rejected by High Court judges in October last year.

Reacting to today's ruling, Mr Conway said: 'I am pleased that my case will now proceed to the Court of Appeal.

'I brought this case not only for myself but on behalf of all terminally-ill people who believe they should have the right to die on their own terms.

'Our voices deserve to be heard.

'I have accepted that my illness will rob me of my life, but how it ends should be up to me. 

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When I talk with patients and families about a new diagnosis of epilepsy, part of that discussion almost always involves the future. How long will medications be needed? How will we know if or when it is safe to stop medications? Will epilepsy be a life-time condition or concern? Epilepsy can have a spectrum of severity. Some people with epilepsy have only a couple of seizures in a lifetime, whereas others may have multiple seizures every day. Overall, though, the outlook is bright.

Epilepsy most commonly develops during childhood, but can start at any age. Seizures can happen to newborns, or even in rare cases, prior to birth. The good news is that if your child is diagnosed with epilepsy, his or her chances of gaining good seizure control is excellent. 

About two thirds of children with epilepsy will have their seizures well-controlled on either the first or second medication they are prescribed. For kids, there is about a 75 percent likelihood of becoming seizure-free within two years. The chance of becoming seizure-free is best in children who do not have a known cause of epilepsy, do not have a family history of epilepsy and are developmentally normal with a normal neurological exam and EEG.

Once a child becomes seizure-free, sometimes the medication can be stopped. In fact, about half of children diagnosed with epilepsy are eventually able to come off of seizure medications. Once medication is stopped, many kids do very well in the long term. However, sometimes seizures do come back days, months or even several years later. Neurologists can provide some statistical information about the outlook for remaining seizure free off of medication, and will typically do an EEG to help inform that conversation. 

A new diagnosis of epilepsy for your child can be very distressing, but it is important to remember that life will eventually get back to normal. It may not be the same normal you or your family experienced prior to the epilepsy diagnosis, but with enough time, education and support from your physician and your loved ones, it will get better.

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Japanese flu – or Yamagata – is a particular strain of influenza B.

The bug is said to be less serious than Aussie flu – or H3N2 which is also sweeping the country – but more contagious.

The flu, which originated in Yamagata, Japan, has already made its presence known in Ireland and Greater Manchester, and doctors are urging parents to have their kids vaccinated.

Children are especially susceptible to this type of flu as they are “super spreaders” – meaning they transfer the virus to a greater number of people than the average infected host.

They are also deemed by experts to be “super shredders” – meaning that their immune systems can’t distinguish between what makes them ill and what will kill them – causing their body to excrete more of the virus.

The bug has already overtaken Aussie flu in Ireland – and reportedly accounts for around 60-70% of confirmed flu cases. 

What are the symptoms of Yamagata?

Symptoms of Yamagata flu are similar to those of an ordinary flu, but can be more severe.

Those who have Yamagata may experience extreme fatigue, and most people will experience headaches and muscle soreness.

Nasal congestion, runny noses and sore throats are also common.

Some may experience a dry cough as well. Other symptoms include fever, vomiting and/or diarrhoea.

According to the Medical University of South Carolina symptoms of Yamagata are more severe and sudden than other respiratory diseases.

Symptoms will generally start to disappear within a week. If symptoms persist, or worsen, you should contact your GP. 

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Parasitic Infections

I. Problem/Condition

Medical parasitology is primarily concerned with organisms that infect the human host and may cause symptomatic or asymptomatic diseases. Three main classes of parasites cause disease in humans: protozoa - microscopic organisms that live in the blood or stool, helminths-multi-cellular organisms that can either cause systemic tissue invasive infection or establish infection in the gut, and ectoparasites that burrow in the skin causing prolonged infections (weeks to months).

Although the prevalence of parasitic infections in the US is not as widespread of a problem as the rest of the world, there are pockets of infection in the Mississippi Delta, disadvantaged urban areas, near the US-Mexico borderlands, and Appalachia where these infections cluster with poverty and presumably poor sanitation. Moreover, these infections can remain underdiagnosed if the clinician does not think of parasitic diseases in immigrants/travellers from areas of the world which are endemic for these infections.

US health professionals should be aware of the five "neglected parasitic infections" - Chagas disease, toxocariasis, cysticercosis, toxoplasmosis, and trichomoniasis that have been targeted by as public health priorities based on the large number of people affected, the severe morbidity caused and the availability of treatment and prevention.

Lastly, physicians should be cognizant of "delusional parasitosis" characterized by the fixed belief of being infested with parasites against all medical evidence to prevent unnecessary medical work-up for parasitic infection. Details of this disorder are beyond the scope of this chapter, but have been summarized in several excellent reviews.

II. Diagnostic Approach

Consideration of parasitic infection and further work-up is determined primarily by whether the patient is an immigrant from, or has recently travelled to a region endemic for parasites. The differential diagnosis in these patients vs. someone who has never travelled outside the US is broader. A good clinical history and focused physical examination can narrow the diagnosis and prevent unnecessary testing.

Common symptoms warranting consideration of specific parasitic infections in the immigrant/returning traveller are presented first. A distinction should be made between parasitic infections that can present as severe acute illness and those that cause more chronic disease. Important geographical considerations to keep in mind are:

• Chloroquine resistant falciparum malaria should be assumed in a patient suspected of having malaria unless the patient is from Central America west of the Panama Canal, Haiti, the Dominican Republic, and most of the Middle East.
• Chagas disease has not been reported to occur in Africa or Asia.
• Of the filarial infections, onchocerciasis has been eliminated in most of Latin America except Venezuela and Brazil.
• Loasis (eye worm infection) is not reported in Latin America.

Symptomatic presentations of diseases endemic to the US are presented separately.

a. The immigrant/traveller with exposure to a parasite endemic region

Fever

Fever is probably the most common nonspecific complaint and the most important infection to assess and rule out in this population is malaria. Since malaria caused by Plasmodium falciparum can be severe and cause complications, prompt workup and assessment of parasite burden in the blood is warranted. Important information is patient's country of origin/travel, duration of symptoms (Plasmodium vivax and Plasmodium ovale can relapse after months to years if not treated with radical cure).

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What is Parkinson’s disease?

Parkinson’s disease is a chronic (long-term) neurological condition. It is progressive and symptoms worsen over time. It is named after Dr James Parkinson who first described the condition in 1817.

People with Parkinson’s disease experience a loss of nerve cells in the part of their brains responsible for controlling voluntary movements. This part of the brain is called the substantia nigra (a small cluster of cells deep in the centre of the brain within an area called the basal ganglia). The nerve cells in the substantia nigra usually produce a chemical called dopamine which helps transmit messages from the brain to the rest of the body via the central nervous system (the brain and spinal cord). As these cells are lost, people with Parkinson’s disease experience a loss of dopamine and the messages controlling movement stop being transmitted efficiently.

Parkinson’s disease is more common as people get older but it can affect younger adults. Men tend to be affected in slightly higher numbers than women.

What causes Parkinson’s disease?

We do not know what causes Parkinson’s disease. There is some evidence to suggest that there is a genetic factor which increases the risk of Parkinson’s disease within some families. Also, there might be an increased risk if people have come into contact with a particular toxin (poison) or toxins found in the environment via pesticides and other chemicals used in agriculture. The specific toxin or toxins have not yet been identified but there is ongoing research into this possible cause.

What are the symptoms?

Each person is affected differently by Parkinson’s disease and no two people will experience exactly the same symptoms. The impact of Parkinson’s disease can be unpredictable and it is common for people to have good days and bad days.

The main symptoms of Parkinson’s disease are:

• tremor (involuntary trembling or shaking movements; the most common symptom)
• rigidity (stiffness)
• slowness of movement (bradykinesia)
• balance problems
• problems with posture (particularly a tendency to stoop forwards)

Other possible symptoms include difficulty initiating movement (for example, when getting up from a chair), a shuffling gait when walking, and freezing when trying to move (especially in confined spaces such as doorways). People might experience a loss of facial expression, speech problems (softened voice, slurred speech), swallowing problems, bowel and bladder problems, difficulties at night (discomfort in bed, cramps, disturbed sleep pattern) and tiredness during the day. Skin can become greasy and people might experience excessive sweating. Sexual problems are common. People often experience depression and anxiety. Another common symptom is small handwriting (micrographia).

Other less common symptoms can include pain and memory problems.

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A woman who was sexually assaulted by a hospital cleaner as she lay helpless in bed on morphine says the ordeal left her scared to leave her own home. The victim, now 27, was an in-patient at Wythenshawe Hospital in Manchester when Ahmed Ismail, now 44, groped her as she lay drowsy in bed.

Ismail, who was working as a cleaner at the time, carried out a second sex assault the following day.

The woman, speaking this week after a compensation payout settlement, said she is still scared to leave her home four years after the assaults in 2014.

She said: 'I'm so nervous. I am scared to go out and will only do things like go to the supermarket when somebody can come with me.

'I used to be really bubbly and, as I come from a very large family, I'd always wanted that myself. There's no way I can imagine that happening now.

'I used to be admitted to Wythenshawe Hospital regularly for an ongoing problem. Now I just take oral antibiotics because I'm too scared to go in hospital as an in-patient.'

Ismail was employed at the time by Sodexo as an agency worker.

Law firm Slater and Gordon, which represented the woman in a civil case against both the hospital trust and Sodexo, said she had been 'failed at so many levels'. She has now secured a five-figure sum in compensation. The hospital trust have now apologised and say that safety of patients 'is our utmost priority'.

Lawyer Kim Harrison said the victim, from south Manchester, had reported a previous incident involving Ismail to the hospital a month before she was assaulted. 

She cannot be named for legal reasons. Ismail, from Hulme, was convicted of two counts of sexual assault in June 2015.

He denied the offences but was found guilty after a trial at Manchester Magistrates' Court and jailed for 18 months at Manchester Crown Court in April, 2016, after an appeal against his conviction was dismissed, the Crown Prosecution Service said.

He was ordered to sign the sex offenders' register for ten years and a Sexual Harm Prevention Order was also issued, banning him from working in any hospital or establishment where in-patients reside.

The woman, who cannot be named for legal reasons, said she decided to speak out about the attacks as a warning. She said: 'My client was failed at so many levels. As well as the man who attacked her, by the people she reported concerns to who failed to take adequate measures to protect her until after she had been assaulted on more than one occasion.

'If her original concerns had been treated more seriously, than perhaps the further assaults could have been prevented.

'It's crucial that lessons are learnt by the trust about how to handle reports of inappropriate behaviour at a much earlier stage.'

A spokesman for Manchester University NHS Foundation Trust (MFT), which runs Wythenshawe Hospital, said; 'We wish to again extend our sincere apologies to the patient involved.

'The safety and care of our patients is our utmost priority and we are deeply sorry that this incident took place on one of our hospital wards.

Ahmed Ismail was ordered to sign the sex offenders' register for ten years and a Sexual Harm Prevention Order was also issued

'Behaviour of this kind is completely unacceptable and is not tolerated. Following this incident, the Trust immediately launched an investigation to learn lessons that would prevent any further incidents of this nature.

'The learning from this investigation has been shared appropriately and we wish to reassure our patients, the public and our staff that any allegations of unlawful or inappropriate conduct are immediately and thoroughly investigated and the necessary action is taken accordingly.' 

A Sodexo spokesman has been contacted for comment by MailOnline. 

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A measles outbreak has spread to five regions in England, infecting 122 confirmed cases. West Yorkshire has the most sufferers with 34 people being struck down with the life-threatening infection, followed by 32 in the West Midlands, 29 in Liverpool and Cheshire, 20 in Surrey and Sussex, and seven in Greater Manchester.

Dr Mary Ramsey, head of immunisation at Public Health England, believes the measles outbreak in England has come from Europe as people travel to regions experiencing epidemics, such as Italy, Germany,  and Romania.

She adds that in order to avoid an epidemic in the UK, parents should vaccinate their children against measles, mumps and rubella (MMR). 

To prevent a measles outbreak, it is recommended that 95 per cent of the population is immunised against the infection.

Only 91.9 per cent of children were vaccinated against measles between 2015 and 2016 compared to 94.2 per cent in 2014 to 2015 and 94.3 per cent in 2013 to 2014, according to NHS immunisation statistics. 

The World Health Organization (WHO) claims people's fear of vaccines, along with complacency, means many, particularly young children, are unprotected. 

The decision by parents not to vaccinate their children could be attributed to disgraced gastroenterologist Andrew Wakefield's theory in 1995 that the MMR vaccine is linked to bowel disease and autism. His controversial views have since been widely discredited. Epidemics in Europe  

Earlier this year, the WHO warned measles was spreading across Europe in regions where vaccination rates are low, namely France, Germany, Italy, Poland, Romania, Switzerland and Ukraine. 

Data published in November last year by the European Centre for Disease Prevention and Control in the Communicable Disease Threat Report show that from January 2016 to November 2017, more than 19,000 measles cases were reported in the European Union, including 46 deaths.

The highest number of cases in 2017 were reported in Romania, where 7,759 people suffered, followed by Italy with 4,775 cases and Germany with 898 sufferers. Greece also experienced a measles outbreak, with at least 368 cases, and one death, since May 2017.

These outbreaks occurred due to insufficient vaccination levels. 

Dr Ramsay said: 'Due to ongoing measles outbreaks within Europe, we will continue to see imported measles cases in the UK in unimmunised individuals.

'This serves as an important reminder for parents to take up the offer of MMR vaccination for their children when offered at one year of age and as a pre-school booster at three years, four months of age.'