Test To Speed up Meningitis Fight

The most dangerous form of meningitis can kill within hours - but doctors think they have developed the best way to identify it early.The "predictive model" developed by the Health Protection Agency could clear the way for the right treatment to be given quickly.

It uses a combination of blood tests and symptoms to help identify bacterial meningitis.

Charities welcomed the model, while calling for further testing.

Meningitis is an inflammation in the membranes surrounding the spinal cord and brain. It is most often caused by either bacterial or viral infection.

Knowing which is which can make a big difference to the best treatment.

Bacterial meningitis needs antibiotic treatment as soon as possible - and it is often prudent to give these drugs to close family members as well.

Rash

There are tests to identify the cause of meningitis, the best known being a lumbar puncture to obtain spinal fluid for analysis.

However, this does not always yield clear-cut results.

The new model has a simple set of three criteria which helps doctors tell the difference without having to wait for conclusive spinal fluid results.

Researchers found them by examining 385 confirmed meningitis cases over a 12-month period.
The first two criteria are blood tests positive for two specific chemicals associated with bacterial meningitis, the third is the presence of the "classic" meningitis rash of spots which do not disappear when pressed with a glass.

The three results are combined to provide a score which then tells the doctor how likely bacterial meningitis is.

Dr Toyin Ejidokun, a consultant in communicable disease at the HPA, said: "The total score allows a treating clinician to simply and quickly assess the likelihood of whether or not the case is bacterial meningitis by checking it against the predictive probabilities we have developed.

"While further testing needs to take place to test the accuracy of the model, it offers the prospect of a rapid predictive tool to help clinical and public health management of suspected bacterial meningitis cases."

'Step forward'

Steve Dayman, the chief executive of Meningitis UK, said the protocol was "an excellent step forward".

He said: "It's vital that the differentiation between bacterial and viral meningitis is made straight-away because the bacterial form can kill in less then four hours. Quick treatment can mean the difference between life and death.

"In the absence of a vaccine to protect against all forms of meningitis, this new model could help to save precious lives."

Experts said people should still be vigilant for the warning signs of meningitis to maximise the chances of recovery.

Although not every patient has every symptom, common signs include a combination of "classic rash", suddenly appearing high fever, a severe and worsening headache, stiff neck, vomiting, joint and muscle pain, a dislike of bright lights, very cold hands and feet, and severe drowsiness.

A spokesman for the Meningitis Research Foundation said: "Early detection of meningitis and septicaemia is critical when treating these diseases, every second matters.

"We welcome all research and development to identify meningitis early so treatment of antibiotics can be administered as soon as possible to prevent the worst outcome."

However, she said that doctors should stick with existing protocols for diagnosing and treating meningitis until the new version had been fully tested.

Chest Compressions Alone Can Save Lives

Chest compressions prior to defibrillation are just as good as immediate treatment with an electrical defibrillator for out-of-hospital cardiac arrest, according to a new research study. In some respects, chest compression may even be better, particularly with regard to one-year survival, Dr. Pascal Meier of the University of Michigan and colleagues reported in BMC. "Based on our study, current guidelines emphasizing early defibrillation still are important," Meier said in a statement. "However, since the outcomes with the chest compression-first approach were not inferior and might be even better in the long-term, and in case of longer response times, this study may have an impact on future guidelines." Still, survival rates for out-of-hospital cardiac arrest are low, hovering at about 7.6 percent over the last 30 years, the researchers noted. Current guidelines recommend immediate electrical defibrillation for this type of cardiac arrest. But some recent studies have shown an advantage for earlier treatment with chest compressions before defibrillation. So to compare the effects of compression-first versus defibrillation-first on outcomes for out-of-hospital cardiac arrest, the researchers conducted a review of the literature, and came up with four randomized controlled trials totaling 1,503 patients. They found no differences between the approaches in terms of the rate of return of spontaneous circulation, survival to hospital discharge or favorable neurologic outcomes. There was, however, a trend toward an advantage for one-year survival that didn't reach statistical significance. The proportion of patients able to leave the hospital after cardiac arrest with chest compression first was 11 percent compared with 8.6 percent of those treated with defibrillation first, the researchers wrote. There was also a trend for better outcomes among patients with a response interval greater than five minutes that pointed to the superiority of chest compression-first approach, but again, the finding was not significant. But the researchers emphasized that the study was not sufficiently powered to detect this relationship, which should be explored further.

Statins may cut arthritis risk, study suggests

Taking statins may reduce the risk of rheumatoid arthritis, a study suggests.

Israeli researchers looked at 1.8m patients and found fewer incidents of the joint condition among those who took the cholesterol-busting drugs.

It was thought statins could ease symptoms in those already diagnosed by stopping the over-production of tissue between the joints.

But the Maccabi Healthcare Services Research Institute study suggested they could stop it developing altogether.

The team discovered 2,500 cases of rheumatoid arthritis, the debilitating inflammation of the joints which affects about one in 100 people.

Heart and joints

They found that those people who were on statins, now commonly prescribed to prevent heart attacks, were 50% less likely to develop the condition than those who were not regularly taking the drugs.

The relationship in this trial between adherence to statin therapy and incidence of rheumatoid arthritis is unclear, but the work builds on existing knowledge.

However, the researchers acknowledged that the work, published in the journal PLOS Medicine, now needed to be confirmed in other populations.

Jane Tadman, of Arthritis Research UK, said: "Our own published research and that of researchers in Japan has shown a modest but significant effect on inflammation in rheumatoid arthritis, and this latest piece of research adds further evidence of this link.

"We now need larger clinical trials to confirm further that statins can reduce the risk of developing rheumatoid arthritis."

MS activity alters with seasons, US researchers say

Brain scans of patients compared with weather patterns at the time showed higher levels of disease activity in the spring and summer.

The US researchers said the findings had implications for testing new medicines, which may show up different results depending on the time of year.

It is not clear why warmer weather would have this effect.

Other studies have shown that vitamin D from exposure to sunlight may have a protective effect against MS - a long-term inflammatory condition of the central nervous system.

For the study, researchers compared MRI brain scans of 44 people taken from 1991 to 1993 to daily temperature, solar radiation and precipitation measurements over the same time.

The adults in the study, who had untreated MS, had eight weekly scans followed by eight scans every fortnight then six monthly check-ups - an average of 22 scans per person.

After one year, 310 new brain lesions were found in 31 people, they reported in Neurology.

The lesions were up to three times more likely to appear in the warmer spring and summer months.

Further analysis also showed that there was a link between both new disease activity and intensity of disease activity and the warmer months.

Trial results

Study leader Dr Dominik Meier, from Brigham and Women's Hospital in Boston, said: "Not only were more lesions found during the spring and summer seasons, our study also found that warmer temperatures and solar radiation were linked to disease activity."

He pointed out that clinical trials often use MRI (magnetic resonance imaging) to assess the effectiveness of a drug and studies commonly last between six and 12 months, which may have implications for how effective a new medication seems.

In an accompanying editorial Dr Anne Cross, from Washington University School of Medicine, added: "This is an important study because it analyses records from the early 1990s, before medications for relapsing MS were approved, so medicines likely could not affect the outcome.

"Future studies should further explore how and why environmental factors play a role in MS."

Dr Susan Kohlhaas, research communications officer at the MS Society, said more research was needed.

But added: "This small study is intriguing and, if validated in larger studies, has the potential to influence the way clinical trials are designed."

Fear of Falling Linked to Future Falls in Elderly

August 20, 2010 — Seniors who have an irrationally high fear of falling are at increased risk for future falls, irrespective of their actual physiological risk, according to a new study published online today by the British Medical Journal.

"Both falls and fear of falls can substantially reduce quality of life and independence and so contribute to the placement of an elderly person into institutionalized care," write Kim Delbaere, PhD, from the University of New South Wales, Sydney, Australia, and colleagues. "However, the complex nature of psychological risk factors for falling and the limited background information on this phenomenon hamper its inclusion in falls prevention programmes."

Excessive fear of falling can cause seniors to limit their participation in physical and social activities, so that they become physically deconditioned, socially isolated, and depressed. In contrast, an inappropriately low fear of falling can cause seniors to take risks that are beyond their true ability to cope, the authors write.

The aim of this study was to expand understanding about irrational fear — either too much or too little — and to study its effect on the risk for future falls.

The study included 500 seniors aged 70 to 90 years living in Sydney. Their mean age was 77.9 years, and 54% were women. All underwent extensive medical, physiological, and neuropsychological assessment.

The investigators used the Physiological Profile Assessment (PPA) to determine participants' physiological (actual) fall risk and the Falls Efficacy Scale International to determine their perceived risk of falling. Participants were followed up monthly for falls for 1 year.

The researchers found that actual and perceived fall risk were both independent predictors of future falls. The risk for falls significantly increased with a higher PPA score (odds ratio [OR], 1.31; 95% confidence interval [CI], 1.06 - 1.61; P = .011) and a higher Falls Efficacy Scale International score (OR, 1.05; 95% CI, 1.02 - 1.08; P = .001).

The researchers then split the study participants into 4 groups — vigorous, anxious, stoic, and aware — according to the disparity between their actual and perceived risk.

Most of the participants had an accurate perception of their risk of falling. Those in the vigorous group, who had low actual and perceived fall risk, were considered at low risk for future significant falls, and those in the aware group, who had high actual and perceived fall risk, were deemed to be at high risk for future significant falls.

However, about a third of the study cohort either underestimated or overestimated their risk for falls.

The anxious group had a low actual risk but high perceived risk; this was related to depressive symptoms (P = .029), neurotic personality traits (P =.026), and decreased executive functioning (P = .010).

In contrast, the stoic group had a high actual but low perceived fall risk, which was protective against falling and was related through a positive outlook on life (P = .001) and continuation of physical activity and community participation (P = .048).

"Overall, it seems that high levels of perceived fall risk may lead to future falls, independent of physiological risk, and that the disparity between physiological and perceived fall risk contributes to fall risk mainly through psychological pathways," the study authors write. "This indicates that measures of both physiological and perceived fall risk should be included in fall risk assessments."

Limitations of the study include the use of the PPA, which is an estimate and may result in measurement error, and the fact that the data used to develop the psychological profiles of the participants were self-reported, the authors note. Also, the population studied were healthy community-dwelling elders; results, therefore, cannot be generalized to those with cognitive impairment or others at particularly high risk of falling such as patients with Parkinson’s disease.

They conclude that fall risk assessments should include measures of both actual and perceived risk, and that this may assist in designing specific interventions to prevent falls in the elderly.

The study was supported by the Australian National Health and Medical Research Council.

Green leafy veg 'may cut diabetes risk'

A diet rich in green leafy vegetables may reduce the risk of developing diabetes, UK research says.

In an analysis of six studies into fruit and vegetable intake, only food including spinach and cabbage was found to have a significant positive effect.

A portion and a half a day was found to cut type 2 diabetes risk by 14%, the British Medical Journal (BMJ) reports.

But experts urged people to continue to aim for five portions of fruit and vegetables a day.
The researchers from Leicester University reviewed data from the studies of 220,000 adults in total.

They found that eating more fruit and vegetables in general was not strongly linked with a smaller chance of developing type 2 diabetes but "there was a general trend in that direction".

Yet when it came to green leafy vegetables, which the researchers said also includes broccoli and cauliflower, the risk reduction was significant.

The team calculated that a daily dose of 106g reduced the risk of diabetes by 14% - a UK "portion" is classed as 80g.

It is not clear why green leafy vegetables may have a protective effect but one reason may be they are high in antioxidants, such as vitamin C and another theory is that they contain high levels of magnesium.

Study leader Professor Melanie Davies, professor of diabetic medicine at the University of Leicester, said the message to eat five portions of fruit and vegetables a day remains an important one.

But she added: "People like very specific health messages.

"We know that intake of fruit and vegetables is important, but this study suggests that green leafy vegetables seem to be particularly important in terms of preventing diabetes."

The team are now planning a study in people at high risk of developing the condition to see if increasing their intake of vegetables like spinach and kale can help to reduce their chances of being diagnosed with diabetes.

Fruit and veg

In 2008/09, the National Diet Nutrition Survey showed that, although fruit and vegetable intake has risen over the past decade, only a third of men and women eat the recommended five-a-day.

In an accompanying editorial in the BMJ, Professor Jim Mann from the University of Otago in New Zealand, stressed that the message of increasing overall fruit and vegetable intake must not be lost "in a plethora of magic bullets," even though green leafy vegetables clearly can be included as one of the daily portions.

Dr Iain Frame, director of research at Diabetes UK said: "We already know that the health benefits of eating vegetables are far-reaching but this is the first time that there has been a suggested link specifically between green leafy vegetables and a reduced risk of developing type 2 diabetes."

But he warned the evidence was limited and it was too early to isolate green leafy vegetables and present them alone as a method to cut the chances of developing the condition.

"We would be concerned if focusing on certain foods detracted from the advice to eat five portions of fruits and vegetables a day, which has benefits in terms of reducing heart disease, stroke, some cancers and obesity as well as type 2 diabetes."

Diabetes UK is currently funding research into whether fermentable carbohydrates found in foods such as asparagus, garlic, chicory and Jerusalem artichokes could help weight loss and prevent Type 2 diabetes.