Untreatable Antibiotic-Resistant Strains of Gonorrhoea Are Going Global

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The World Health Organisation (WHO) has issued a warning over the rise of resistant strains of the infectious bacteria responsible for gonorrhoea.

Superbugs are bad news at the best of times, but with little on the horizon by way of potential treatments for this common sexually transmitted infection (STI), we could very well be rewinding the clock on venereal disease.

The warning follows the discovery of several patients in France, Japan, and Spain who harboured strains of Neisseria gonorrhoeae that wouldn’t respond to any antibiotics.

WHO medical officer Teodora Wi predicts there are plenty more to come.

“These cases may just be the tip of the iceberg, since systems to diagnose and report untreatable infections are lacking in lower-income countries where gonorrhoea is actually more common,” says Wi.

Gonorrhoea is one of the most common pathogens passed around through sexual contact, largely thanks to the fact it’s often asymptomatic, meaning people often don’t even know they have the bacteria.

Decreased use of condoms and a rise in travel also contribute greatly to its spread, with an estimated 78 million people infected annually.

The bacteria not only infect the genitals of men and women, but can be found in the tissues of the throat and rectum as well, and lead to complications including infertility and increased susceptibility to catching HIV.

Since the 1930s, bacterial STIs such as gonorrhoea, chlamydia, and syphilis have been treated with a simple course of antibiotics.

“The best time to have had gonorrhoea was the eighties, since there were many drugs to treat it with,” US director of the Centre for Disease Dynamics, Economics and Policy Ramanan Laxminarayan told Nature.

While non-symptomatic cases go untreated, in the absence of an on-the-spot diagnosis kit, doctors also have a tendency to assume STI based on reported symptoms alone, prescribing antibiotics regardless of the presence of infection.

The decades since have seen an increasing number of so-called superbugs – bacteria that have acquired a resistance to numerous antibiotics.

New research has found widespread resistance to several types of antibiotics commonly prescribed for gonorrhoea.

All but 3 percent of countries surveyed between 2009 and 2014 reported Neisseria gonorrhoeae with a resistance to a common and inexpensive antibiotic called ciprofloxacin. About 66 percent of countries reported resistance to a last-resort group of antibiotics called extended-spectrum cephalosporins (ESCs).

That’s seriously bad news, since in many countries ESCs are the only option left for treating gonorrhoea.

If we’re hoping for a miracle cure to pop up soon, we’ll be disappointed. There’s nothing much in the pipeline, with only 3 candidates being tested – one at the end of a phase 3 trial, and two that have just completed phase 2 trials.

The WHO has been vocal in the past about the reluctance of commercial companies to invest in pharmaceuticals where there is little hope of profit.

Following the 2014 outbreak of Ebola, an epidemic which claimed around 5000 lives, WHO director general Margaret Chan cited profit as the reason vaccines were slow in being developed.

“A profit-driven industry does not invest in products that cannot pay,” said Chan.

Similarly, antibiotics aren’t always appealing candidates for commercial pharmaceutical companies, since – somewhat ironically – bacteria can develop a resistance to them.

The WHO has joined forces with the Drugs for Neglected Diseases initiative to launch the Global Antibiotic Research and Development Partnership in order to address this dire issue.

“In the short term, we aim to accelerate the development and introduction of at least one of these pipeline drugs, and will evaluate the possible development of combination treatments for public health use,” says the partnership director Dr Manica Balasegaram.

Even if we develop more accurate and rapid diagnostic techniques and new antibiotics, prevention is far better than any cure.

The WHO will be publishing its research in PLOS Medicine prior to the STI & HIV World Congress in July.

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CDSCO, IPC collaborate to audit 5 AMCs to strengthen PvPI in the country

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In order to review the functioning of Adverse Drug Monitoring Centres (AMCs) in Gujarat, Central Drugs Standard Control Organisaion (CDSCO), Western Zone in collaboration with Indian Pharmacopoeia Commission (IPC) have audited 5 medical institutions in Gujarat with assessment on aspects like SOPs and causality assessment.

The exercise is an initiative taken by IPC to generate awareness in medical institutions to put in place effective surveillance system for detection of Adverse Drug Reactions (ADRs). IPC is the National Coordination Centre (NCC) for Pharmacovigilance Programme of India (PvPI).

CDSCO under the Union health ministry had initiated a nation-wide PvPI in July 2010. Dr Y K Gupta is credited to have started PvPI in 2010 at AIIMS with support from CDSCO and government of India. This got further expanded and for administrative reasons was shifted to Ghaziabad based IPC.

PvPI leads with 0.82 points as per quality completeness score of Individual Case Safety Reports (ICSR) as against the global average of 0.55 accounted on a quarterly basis for a total of 150 countries including India which contribute to the global PvP database.

ICSR as part of ADRs are reported from all over the country to NCC-PvPI, which also work in collaboration with the global ADR monitoring centre (WHO-UMC), Sweden to contribute in the global ADRs data base.

Uppsala Monitoring Centre was the first WHO Collaborating Centre to be established for pharmacovigilance when, in 1978, the scientific and technical responsibility of the WHO Programme for International Drug Monitoring was transferred to Sweden.

The WHO Programme for International Drug Monitoring is a group of more than 150 countries that share the vision of safer and more effective use of medicines. UMC has been responsible for the technical and operational aspects of the programme since 1978.

IPC has also signed an Memorandum of Understanding (MoU) with NABH following which around 600 National Accreditation Board for Hospitals and Healthcare providers (NABH) accredited hospitals have also started reporting ADRs as part of their pharmacovigilance activities mandated by the government.

Pharmacovigilance (PV) is a science that relates to detection, assessment, understanding and prevention of adverse affects or any other drug related problem. To track adverse drug reactions (ADRs) in Indian population, Union health ministry launched PvPI which has outreach all over the country but only a small portion of healthcare professionals have formal training in PV.

Keeping this in view, IPC has also started “Skill Development Programme on Basics and Regulatory Aspects of Pharmacovigilance” from January 2017 onwards. The programme aims to enhance the knowledge and skill of qualified pharmacovigilance professionals working for ensuring better patient safety as per the requirement of Schedule Y of Drugs and Cosmetics Act, 1940.

The skill development initiative will encourage process of creating a registry of skills, enable and mobilize a large number of healthcare professionals to take up training and acquire requisite skills for employment apart from capacity building and strengthening of Qualified Person for Pharmacovigilance (QPPv) as per the requirement of the schedule Y of D&C Act.

In August 2016, Drug Controller General of India (DCGI) had issued a circular stipulating the deadline at January 1, 2018 for upgrading skill sets of persons employed in their units.

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Chocolate Boosts Your Brain Power, New Study Finds

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Italian scientists have found that a daily dose of cocoa acts as a dietary supplement to counteract different types of cognitive decline.

They found regularly eating cocoa was linked to improvements in working memory and visual information processing and cocoa could be particularly beneficial for certain people.

Cocoa, is the dried and fermented bean from the cocoa tree used to make delicious chocolate treats. Cocoa has been studied extensively because, well, who wouldn’t want that job.

Over the years, it has been found that a range of naturally occurring chemicals in the cocoa bean have therapeutic effects.

For example, polyphenols in dark chocolate were found to increase calmness and contentedness and flavanols were able to reverse age-related memory decline.

Before you start using this an excuse to scoff as much chocolate as humanly possible, just remember that chocolate also contains theobromine, a toxic chemical. Though to be at risk of poisoning yourself, you’d have to eat about 85 full sized chocolate bars.

Despite the large number of claims about the health benefits of cocoa, there are only a limited number of randomised trials and the literature is a mixed bag of results.

In this study, the team looked through the literature for effects of acute and chronic administration of cocoa flavanols on brain activity and, more specifically, what happens if you do this over a long period of time.

The studies used to perform the review mainly required the subjects to consume a low, medium or large amount of cocoa in the form of a chocolate drink or bar for a period of between five days and three months.

The scientists found that there was enough evidence to support the health claims attributed to cocoa, and, in particular, the flavanol compounds it contains.

They noticed enhancements in working memory performance and improved visual information processing after consuming cocoa flavanols. The benefits varied depending on the demographic being tested.

For the elderly, it turns out that long term ingestion of cocoa flavanols improved attention, mental processing, working memory and verbal fluency and was most beneficial in those who had mild cognitive impairments or the beginnings of memory loss.

“This result suggests the potential of cocoa flavanols to protect cognition in vulnerable populations over time by improving cognitive performance,” wrote the researchers from the University of L’Aquila in Italy, including Valentina Socci and Michele Ferrara.

For healthy people, without the beginnings of memory loss, cocoa could also enhance normal cognitive functioning and have a protective role on cognitive performance. The researchers admit that you have to push the healthy subjects a little harder before that benefit starts to become significant.

One demographic in particular benefited from cocoa.

For women, eating cocoa after a night of total sleep deprivation counteracted the cognitive impairment associated with no sleep. Promising results for people that suffer from chronic sleep deprivation or work different shift patterns.

But how exactly does cocoa help with brain power?

The researchers aren’t completely sure, but do have some ideas.

“If you look at the underlying mechanism, the cocoa flavanols have beneficial effects for cardiovascular health and can increase cerebral blood volume… This structure is particularly affected by ageing and therefore the potential source of age-related memory decline in humans.”

So should you start shovelling chocolate into your mouth? Perhaps, but it comes with an obvious warning.

“Regular intake of cocoa and chocolate could indeed provide beneficial effects on cognitive functioning over time,” say the researchers.

“There are, however, potential side effects of eating cocoa and chocolate. Those are generally linked to the caloric value of chocolate, some inherent chemical compounds of the cocoa plant such as caffeine and theobromine, and a variety of additives we add to chocolate such as sugar or milk.”

Despite the risk of gaining a few extra kilograms, the scientists are happy to listen to their own advice and conduct a little bit of self-experimentation.

“Dark chocolate is a rich source of flavanols. So, we always eat some dark chocolate. Every day.”

I can’t think of health advice I’d be happier to listen to.

The findings were reported in Frontiers in Nutrition.

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Siddha drug ‘Nilavembu Kudineer’ popular in Kerala as an effective medicine for dengue fever

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The Siddha herbal drug, ‘Nilavembu Kudineer’, which became popular in Tamil Nadu as the best remedy for dengue fever and chikungunya, is being distributed in Kerala now by the Siddha practitioners to check spread of all kinds of fevers, especially the vector-borne diseases.

The drug is distributed in all the medical camps set up in various government Siddha dispensaries and in centres of national health mission (NHM) and National Ayush Mission (NAM) as part of control measures for the menacingly increasing dengue and chikungunya virus infections. The physicians of the traditional Siddha system are distributing the herbal decoction in the wake of its efficacy proved in Tamil Nadu when there was outbreak of influenza and mosquito-borne diseases two years ago. The medicine is also given to the people coming along with the patients as a preventive.

Dr. Vivek Andrews, medical officer at the NHM Siddha dispensary at Aruvikkara in Thiruvananthapuram district, said the medicine contains nine herbal ingredients, which have antipyretic, anti-inflammatory, antiviral, and immunomodulatory actions. It reduces symptoms associated with fever such as headache, body pain, muscle pain, loss of energy, fatigue, weakness etc. It is also effective for reducing joint pain, joint swelling, muscle pain, headache and rashes associated with chikungunya infection. Further, it can be taken as a preventive medicine for dengue fever and chikungunya.

In Tamil Nadu, whenever fever is spread, government hospitals in the state usually distribute NIlavembu Kudineer to the patients visiting there. Now it has got wide popularity among patients and physicians as the best remedy for dengue fever and influenza.

According to information received from the ISM directorate in Kerala, the drug is given to the patients in almost all the 49 Siddha medical centres and in the special medical camps run by the local bodies. It is provided in liquid and powder forms.

Kerala has 8 Siddha dispensaries and one Siddha hospital under the state government. Besides, 8 Siddha units are working separately at Ayurveda hospitals as part of annual health project of the ISM. There are 28 dispensaries under NHM and 4 Siddha units under NAM. Currently, all the districts in Kerala have Siddha dispensaries.

Dr. Vivek said Nilavembu Kudineer is administered to patients suffering all kinds of diseases, two times a day for three to five days. Adults are given 60 ml and for children 30 ml of the decoction. He added that it could be taken twice a day for five days as a means to protect from fevers by improving immunity.

Siddha medicines are procured from the Chennai based Siddha cooperative pharmacy, Impcops. But, they are available in pharmacies dealing with Siddha formulations and at the Impcops outlet in Thiruvananthapuram. In private clinics, which number more than one hundred, the physicians themselves prepare the formulations by purchasing raw materials from villages in Tamil Nadu.

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Scientists Have Uncovered The Atomic Structure of a Key Alzheimer’s Protein For The First Time

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For the first time, scientists have revealed the chemical structure of one of the key markers of Alzheimer’s disease, capturing high-resolution images of the abnormal tau protein deposits suspected to be behind Alzheimer’s and other neurodegenerative conditions.

The results will now give scientists an unprecedented glimpse at how these harmful deposits function at a molecular level, and could lead to a number of new treatments to prevent them from forming – and in doing so, help to combat Alzheimer’s and dementia.

“This is a tremendous step forward,” says one of the team, Bernardino Ghetti from Indiana University.

“It’s clear that tau is extremely important to the progression of Alzheimer’s disease and certain forms of dementia. In terms of designing therapeutic agents, the possibilities are now enormous.”

In the new study, researchers led by the MRC Laboratory of Molecular Biology (LMB) in the UK extracted tau protein filaments from the brain of a deceased patient with a confirmed diagnosis of Alzheimer’s disease, and imaged them using a technique called called cryo-electron microscopy (cryo-EM).

23487236 tauTau protein filaments. Credit: Scheres Group MRC-LMB

Alzheimer’s disease is linked to the build-up of two kinds of abnormal protein deposits – tau filaments, which form inside nerve cells, and amyloid beta proteins, which builds up outside cells.

In healthy brains, tau acts as a stabiliser, but when the proteins become defective, they can form into bundles of tangled filaments, which are thought to impede communication between brain cells, leading to the neurodegeneration and reduced cognitive ability seen in conditions like Alzheimer’s disease.

Researchers have studied the tau protein’s involvement in Alzheimer’s for decades, but up until now, we’ve never been able to see tau filaments up so close – and the molecular insights afforded by the cryo-EM imaging performed here could mean the opportunities for drug discovery targeting tau is a whole new ball game.

“Drugs that could clear away clumps of protein in the brain are a key goal for researchers, but to directly affect these proteins, molecules that make up a drug need to latch on and bind to their surface,” explains the head of research at Alzheimer’s Research UK, Rosa Sancho.

“Knowing the precise shape of these complex protein structures is enormously valuable in guiding the development of targeted drugs.”

While there’s no shortage of research examining how abnormal tau and amyloid beta proteins function, it’s been unclear just how much artificial samples assembled in the lab differ from the structures that form in the lab.

Thanks to the tau structures obtained from the deceased patient, researchers now have the ability to investigate how abnormal filaments function at an atomic level in the human brain – and studying these tangles won’t only benefit Alzheimer’s research, the team says.

“This is a big step forward as far as tau goes but it is bigger than that,” neuroscientist Michel Goedert from LMB told James Gallagher at BBC News.

“This is the first time anybody has determined the high-resolution structure [from human brain samples] for any of these diseases. The next step is to use this information to study the mechanisms of neurodegeneration.”

We won’t know the full ramifications of this discovery until scientists have a chance to follow up on the new findings presented here, but it’s clear that this could be a major turning point in studying how to counter these harmful protein clumps, with Ghetti describing the result as one of the major discoveries of the last quarter century of Alzheimer’s research.

That said, it may take many more years (or even decades) for new treatments to ultimately come out of this – but at least we’re now a big step closer to that long-hoped-for eventuality, which before now may have been impossible.

“It’s like shooting in the dark – you can still hit something but you are much more likely to hit if you know what the structure is,” explains one of the team, LMB’s Sjors Scheres.

“We are excited – it opens up a whole new era in this field, it really does.”

The findings are reported in Nature.

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