Articles

Winter is coming – the flu too

27/09/2017

When again the earth’s northern axis is tilting away from the sun and the days are getting shorter, we know that winter is not far. With the cold season come runny noses, coughs and sneezes and the flu.

What is flu?

Flu is a communicable disease caused by the Influenza virus that spreads via direct contact and airborne droplets. The virus has two main subtypes, A and B. Type A causes more severe symptoms and is responsible for pandemics. B is less virulent, it just lingering around, mainly towards the end of winter.

Unlike a cold, flu symptoms come on quickly including fever and aching muscles. It knocks the toughest out; too unwell to continue any regular activities, you need to rest in bed. Particularly in the frail and elderly, it can cause severe illness or even death.

Flu Virus

Flu symptoms include:

• sudden fever
• dry cough
• a sore throat, runny or blocked nose
• headache
• tiredness & weakness
• chills
• aching muscles, limbs or joints
• diarrhoea or abdominal pain
• nausea and vomiting
• difficulty sleeping
• loss of appetite

The flu vaccine

Every year, before the flu season, healthcare providers offer vaccination against this illness, primarily for people who are most at risk. The vaccine consists of protection against a mix of viruses from both subtypes. Scientists at the WHO figure out each year what the likely pathological strains will look like and release a recommendation for a vaccine for the Northern and Southern Hemisphere. Thie vaccine for the flu 2017/2018 in Europe and the US will be the same as the one used in Australia.

The vaccine is undoubtedly the best measure to protect from the flu. Even if it does not match the current virus entirely, it can provide partial protection.

Prediction for 2017/2018

The flu season typically starts in the southern hemisphere, while we are busy sunbathing, it finds the first casualties in Australia and then moves slowly northbound to reach us in November/December. It is more often than not the same strain of the virus.
This year Australia has suffered a severe flu epidemic caused by Influenza A(H3N2), infecting 2.5 times more people than the previous year and with double the fatalities.

In our flu season, we see the same features as the southern hemisphere, which would lead us to expect a higher than average epidemic in Europe and the USA. Unpredictability, however, is typical for viral outbreaks. But if Australia’s large number of flu cases is a reflection on the efficiency of this year’s flu vaccine, our hospitals better brace themselves and get some winter wards ready.
How to prevent the flu?

When you got the flu

If you get the flu and you’re an active, healthy adult you are going to feel too unwell for up to seven days, and you are unable to continue your usual activities; there is usually no need to visit a general practitioner.

Consider visiting your doctor if:

• aged 65 years or over
• during pregnancy
• long-term medical condition
• weakened immune system
• unusual symptoms like chest pain, shortness of breath or start coughing up blood

also if symptoms do not improve after a week or if they are getting worse

 

Keep up to date with the current flu situation:

 

 

Influenza virus

Pre-exposure Prophylaxis for Lyme disease

26/09/2017

Is vaccination against Lyme disease soon a reality?

With every outdoor season come the worries about tick bites and tick bite related diseases. Online search relating to Lyme disease (or Borreliosis), peak sawtoothlike every year in June/July.
This infectious disease was recently in the limelight when a famous Pop Star contracted it and started to raise awareness. The other reason Lyme keeps cropping up in the news is the steady rise of infected ticks both in the US and Europe.
Lyme’s is a multisystem disease caused by a bacterium called Borrelia Burgdorferi that is transmitted by tick bites.

Scientists at University of Massachusetts have discovered an antibody that specifically targets Borrelia and has been very successful in mice; in their own words, “it is 100 percent effective.”

This antibody is not actually a vaccine, where the human body is triggered to develop immunity against a pathogen, it is a pre-exposure prophylaxis (PrEP), a lab-produced immunoglobulin that will be injected into the bloodstream and with a limited time of effectiveness.

Iv Immunoglobulins as PrEP

Immunoglobulins provide very effective treatment but notoriously expensive to produce, to use it as a prophylactic agent is novel, and it needs to be seen how long its effectiveness in the human immune system lasts. For 200 bucks a pop, this might be an option for the middle-class hiker, roaming more freely through nature. However, I doubt this will reduce the cases of Lyme disease significantly or herald the eradication of Borreliosis.
I can see it though as a first line – within 24 h of tick bite – treatment/prevention in the future.

Pembrolizumab – immunotherapy for gastric cancer

25/09/2017

After encouraging results in treating melanoma, lung and kidney, immunotherapy enters the realm of gastric malignancies.

The FDA has approved Pembrolizumab, (Keytruda) by Merk, for use as a third-line treatment for locally advanced or metastatic adenocarcinoma of the stomach and gastro-oesophageal junction that express programmed death receptor-ligand 1 (PD-L1).

Immunotherapy tries to elicit the mechanisms how cancer cells can hide from the immune system. It aims to help our immune system in recognising a tumour and facilitating the natural immune response that is believed to be more efficient than any drug could ever be.

What is PD-L1

PD-L1 is a molecule that can be found on cancer cells, it binds with PD-1, a receptor present on T cells and therefore plays a role in immune regulation. When the two molecules bind they transmit an inhibitory signal that reduces the proliferation of T cells or even causes their death; in other words, PD-L1 tells the immune system not to bother attacking it.

How does Pembrolizumab work?

The concept of PD-L1 inhibitors is to block this molecule and thus prevent it from binding to the T cells. In other words, blocking the inhibitory effect in order achieve activation of the immune response.

The results so far

Taking into account that this is treating a third-line gastric cancer, the figures for 6- and 12-month duration of response are not mind blowing but show some promising features. Larger numbers will help to get a clearer picture in the future.

Immunotherapy in solid tumours is always going to be harder to achieve, especially in the advanced stages. It will be interesting to see what results can be reached when using PD-L1 inhibitors in combination with other treatments and also how it will fare as an early treatment.

we need more Potassium

24/09/2017

The health benefits of Potassium

Convenience food is here to stay, so let’s make sure it also caters for the longevity of us consumers. Among many other nutritional disadvantages, our pick ’n nibble diet provides too much sodium (Na+) but not enough potassium (K+). Low potassium intake is associated with many diseases, including hypertension, cardiovascular disease, chronic kidney stone formation and low bone-mineral density.
Comparing our diet with our ancestors’, the Na+ to K+ ratio has inverted and is becoming sodium-dominant. The negative impact of high sodium intake on the blood pressure is a known fact and recommendations to a lower sodium consumption are part of every ‘lifestyle advice’ for prehypertensive patients. In recent studies, the focus of BP modulating electrolytes in our food has shifted to K+.
Potassium from fruits and vegetables has been found to lower blood pressure, especially if not accompanied by a high-sodium intake.

The physiology behind it

Our body has developed many mechanisms to keep electrolytes at a constant level. With regards to potassium this regulation happens mainly within the kidneys; if there is too much dietary intake, it will excrete the excess K+ via the urine.
Renal K+ excretion is regulated by Aldosterone, an adrenal hormone stimulated by high potassium levels in the blood. In exchange of an excreting potassium, Aldosterone leads to an increased absorption of sodium. Our textbooks teach us that a high potassium results in higher Sodium levels. These Aldosterone dominated models of K+ homeostasis are being questioned today. Several studies demonstrate that dietary K+ intake induces renal Na+ loss despite elevated plasma aldosterone. The underlying mechanisms are thought to include enhanced urine flow, reduced renal renin release, and negative Na+ balance. It may need a few more years of research until we discover the exact underlying physiology. In the meantime let’s focus on the evidence.
The relation between high Na+ levels and hypertension, on the other hand, is well established today. A lower Na+ load in our body means less plasma volume expansion and less stress on the heart and blood vessels; in other words a more normal blood pressure.

What does the WHO say

The World Health Organisation (WHO), based on a systematic review of several studies, recommends an increase in dietary potassium to help reduce blood pressure and risk of cardiovascular disease, stroke and coronary heart disease in adults.
The WHO suggests a potassium intake of at least 90 mmol/day (3510 mg/day) for adults, approximately the amount provided by ten bananas.

Yes, you can!

Scanning through foods in the supermarket for ‘yes you can’ rather than ‘ no you can’t’ is much more fun. But for this to happen, the manufacturers need to declare the potassium content on their labels.
I feel that one additional line on our labels is not too much to ask from our food producers, considering the long-term benefits this practice would provide.
Rather than harping on about the sodium vice, we should create the potassium virtue, after all, it follows the evidence.

encouraging Study results for Venetoclax

19/09/2017

Abbvie is coming up with some encouraging news from their phase III study evaluating the efficacy and safety of Venetoclax in combination with Mabthera/Rituxan compared to Bendamustine

Venetoclax or in brand name terms: Venclexta in the USA and Venclyxto in Europe, is an oral treatment consisting of a small molecule that, highly selectively, inhibits the BCL-2 protein.

The treatment is designed for patients who suffer from chronic lymphocytic leukaemia (the most common form of Leukaemia) having a specific chromosomal abnormality also known as the 17p depletion and who are not responding to the current treatment.

BCL-2  is part of a family of regulatory proteins involved in the regulation of programmed cell death (Apoptosis), either by inducing pro-apoptotic mechanism or inhibiting anti-apoptotic processes in the cell. BCL-2, in particular, is considered an important anti-apoptotic protein.

Some encouraging news for patients with CLL, will it do what Imatinib did for CML ?- time will tell!

World Sepsis Day 2017

17/09/2017

WHO calls for prevention of the life-threatening condition, especially for maternal and neonatal sepsis:

12 September 2017:

Still today, Sepsis presents as a life-threatening condition. It can arise when the body’s response to infection causes injury to its tissues and organs. Infections often complicate underlying diseases; sepsis is a final common pathway leading to death from communicable or non-communicable diseases. If sepsis develops during pregnancy, during or after giving birth, or in context of abortion, we speak of maternal sepsis. Sepsis in a newborn baby is called neonatal sepsis.