Tuesday, 22 January 2013

Long-term aspirin 'blindness


People who regularly take aspirin for many years, such as those with heart problems, are more likely to develop a form of blindness, researchers say.
A study on 2,389 people, in the journal JAMA Internal Medicine, showed aspirin takers had twice the risk of "wet" age-related macular degeneration.
The disease damages the 'sweet spot' in the retina, obscuring details in the centre of a patient's field of vision.
The researchers said there was not yet enough evidence to change aspirin use.
Taking low doses of aspirin every day does reduce the risk of a stroke or heart attack in patients with cardiovascular disease. There are even suggestions itcould prevent cancer.
One in 10 people in the study, conducted at the University of Sydney, were taking aspirin at least once a week. On average the participants were in their mid-60s.
Eye tests were performed after five, 10 and 15 years.

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The evidence is now accumulating about the association of aspirin and wet AMD, however, it is not overwhelming at this point”
Macular Society
By the end of the study, the researchers showed that 9.3% of patients taking aspirin developed wet age-related macular degeneration (AMD) compared with 3.7% of patients who did not take aspirin.
Their report said: "The increased risk of [wet] AMD was detected only after 10 or 15 years, suggesting that cumulative dosing is important.
"Given the widespread use of aspirin, any increased risk of disabling conditions will be significant and affect many people."
Wet AMD is caused by blood vessels growing in the wrong place. They cause swelling and bleeding which damages the retina.
The process can happen very quickly with vision being damaged in days. Age, smoking and a family history are the main risk factors.
High-risk
There are already known risks of aspirin such as causing internal bleeding. The research team suggest the risk of damaging eyesight "may also need to be considered".
They acknowledge that for most patients there is "insufficient evidence" to change how aspirin is prescribed.
However, they suggested using the drug may need to be reappraised in high-risk patients such as those with wet AMD in one eye already.
Prof Jie Jin Wang, an expert in vision research at Sydney University in Australia, said this was something doctors might want to discuss with high-risk patients.
The Macular Society said: "The evidence is now accumulating about the association of aspirin and wet AMD, however, it is not overwhelming at this point.
"For patients at risk of cardio-vascular disease, the health risks of stopping or not prescribing aspirin are much higher than those of developing wet AMD.
"Patients who are taking aspirin because their doctor has prescribed it should not stop taking it without consulting their doctor first."
Matthew Athey, from the RNIB charity, said any concerns should be discussed with a family doctor.
"However, this is interesting research as age-related macular degeneration (AMD) is the leading cause of sight loss in the UK, and this study could contribute to our understanding about why some people may develop 'wet' type macular degeneration.
"Further research is needed to clarify and investigate some of the issues raised in the study, however this association may be valuable for doctors in the future when considering aspirin for their patients."
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Meningitis B vaccine


A vaccine to protect children against one of the most common and deadly forms of meningitis has been licensed for use in Europe.
The Bexsero vaccine licensed by the European Commission is the first to cover meningococcal B meningitis - until now vaccines had protected against only some of the bacterial types involved.
About 1,870 people contract meningitis B each year and one in 10 die.
The UK is yet to roll out the jab.
The Joint Committee on Vaccination and Immunisation (JCVI) which provides vaccination advice to the government plan to meet in June when they will discuss the vaccine and whether to add it to the list of vaccines routinely offered to young children.
Meningitis UK said: "We urge the JCVI and UK government to introduce the new MenB vaccine to the childhood immunisation schedule as soon as possible. Every day of unnecessary delay in introducing this vaccine will cost lives. We must not allow children to die from this disease if it can be prevented."
Now it is licensed in the UK and other EC countries, it could potentially be bought and used by healthcare providers.

Meningitis

  • Inflammation of membranes covering brain and spinal cord
  • It can be caused by viruses or bacteria
  • Meningitis B is the most common cause of bacterial meningitis in the UK
  • It can also cause septicaemia
  • There are a number of vaccines that can prevent many cases of viral and bacterial meningitis, including MMR, Meningitis C, PCV and DTaP/IPV/Hib vaccination
About a quarter of all survivors of meningitis B are left with life altering after-effects, such as brain damage or limb loss.
Children under the age of five are the most at risk from the bacterial infection, which leads to inflammation of the brain and spinal cord.
Experts say the jab is likely to be effective against 73% of the different variations of meningitis B.
A vaccine against the less common meningitis C has been administered since 1999 and is now widely given to babies in the first year of their life.
It has led to a large fall in the number of cases in people under the age of 20.
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Saturday, 19 January 2013

Self-help books 'treat depression'


Prescribing self-help books on the NHS is an effective treatment for depression, a study suggests.
Patients offered books, plus sessions guiding them in how to use them, had lower levels of depression a year later than those offered usual GP care.
The effect was seen in addition to the benefits of other treatments such as antidepressants, Scottish researchers report in the journal Plos One.
Such an approach may help the NHS tackle demand for therapy, they said.
More than 200 patients who had been diagnosed with depression by their GP took part in the study, half of whom were also on antidepressant drugs.
Some were provided with a self-help guide dealing with different aspects of depression, such as being assertive or overcoming sleep problems.
Patients also had three sessions with an adviser who helped them get the most out of the books and plan what changes to make.
After four months those who had been prescribed the self-help books had significantly lower levels of depression than those who received usual GP care.

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Depression saps people's motivation and makes it hard to believe change is possible”
Prof Christopher Williams
A year later, those in the self-help group were more likely to be keeping on top of their depression.
Study leader Prof Christopher Williams, from the University of Glasgow, who also wrote the books called Overcoming Depression and Low Mood, said the guided sessions were the key to getting people engaged.
The sessions can be delivered in general practice without referral to a specialist, taking pressure off waiting lists.
In Scotland, a telephone support service has now been set up to help support those using the books, which can be freely copied and disseminated, he added.
"We found this had a really significant clinical impact and the findings are very encouraging," he said.
"Depression saps people's motivation and makes it hard to believe change is possible."
The challenge for the NHS, where self-help books are already used in many places, is how to implement this model so people have easy supported access in primary care, he said.
'Worth investing in'
There has been huge investment in better treatment for depression in the UK in recent years with the Improving Access to Psychological Therapies programme in England set up to widen access.
It has been estimated this approach could save the NHS up to £272m and the wider public sector £700m.
But, says Prof Williams, despite the huge levels of investment, it is just not possible to refer everyone with depression to mental health services.
Dr Paul Blenkiron, consultant in adult psychiatry at Leeds and York Partnership NHS Foundation Trust, said the results showed that guided self-help is effective and is "something the NHS should be investing in".
He is currently advising on behalf of the Royal College of Psychiatrists, on a National Books On Prescription Scheme, to be rolled out across UK public libraries this year.
Thirty books, including the one used in the study, have been selected.
But Dr Blenkiron said self-help would not be suitable for everyone: "The key thing is that the person is committed to doing some work."
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Leprosy bacteria use 'biological alchemy'


Infectious bacteria have for the first time been caught performing "biological alchemy" to transform parts of a host body into those more suited to their purposes, by a team in Edinburgh.
The study, in the journal Cell, showed leprosy-causing bacteria turning nerves into stem cells and muscle.
The authors said the "clever and sophisticated" technique could further therapies and stem-cell research.
Experts described the discovery as "amazing" and "exciting".
Alchemists may have failed to morph base metals into gold, but a team at the University of Edinburgh has shown that bacteria can transform parts of the body into something more valuable to them.
It is a feat that scientists have already achieved in the laboratory. Skin cells have been transformed into flexible stem cells that can become any of the body's building blocks from heart muscle to brain cells.
One of the researchers, Prof Anura Rambukana, said: "Our body's cells can be manipulated and why would a bacterium not take advantage of that?"
Master manipulators
Experiments on mice and cells grown in the laboratory showed the leprosy bug infected nerve cells. Then over a period of a few weeks the bacteria began to subvert the nerves for their own ends. The chemistry of the cells changed and they became stem cells.

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The ability of bacteria to convert one mammalian cell type to another is 'alchemy' by nature on a grand scale”
Prof Chris MasonStem cell scientist
These can grow and spread around the body, unlike the static nerves.
"This is a stem cell that is generated by the body's own tissue so the immune system does not recognise it and they can get any place they want without being attacked," said Prof Rambukana.
Those cells could lodge inside muscle and become muscle cells.
"We realised, 'Wow, this is something very, very striking'.
"It's the first time a bacterial infection has been shown to make stem cells, that's the big thing here."
'Alchemy'
He hopes the findings will increase understanding of leprosy and lead to new ways of developing stem cells - which have been touted as future treatments for a range of diseases.
Prof Rambukana also believes it is "probable" that other species of bacteria would have evolved the same ability to reprogramme their host.
Prof Chris Mason, a specialist in stem cell research at University College London, said: "The ability of bacteria to convert one mammalian cell type to another is 'alchemy' by nature on a grand scale.
"Whilst this amazing discovery is in a mouse model, it highlights the extraordinary complexity of the interactions between mammals and bacteria and the ingenuity of scientists to uncover disease mechanisms that a decade ago would have been beyond science fiction.
"The next essential step is to translate this valuable piece of knowledge into tangible benefits for patients - a process that may take a decade before its relevance to clinical medicine is fully understood."
Prof Diana Lockwood, from the London School of Hygiene and Tropical Medicine, said: "Their finding that bacteria can reprogramme cells is very interesting and exciting."
However, she cautioned that there was "quite a gap between this and clinical leprosy and I don't think it's going to lead to new treatments".
Dr Rob Buckle, head of regenerative medicine at the Me Redical Research Council, said: "This discovery is important not just for our understanding and treatment of bacterial disease, but for the rapidly progressing field of regenerative medicine."
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