Not just antibiotic abuse, corruption, low health spend also fuel superbugs

superbugs,antibiotic abuse,micro-organisms resistant

Superbugs — disease-causing bacteria and micro-organisms resistant to conventional medicines — aren’t caused just by overuse of antibiotics but also by poor sanitation, unsafe water, higher income and education (because these improve access), corruption and low public health spending, even hotter weather, according to a new study.

Overuse and misuse of antibiotics have long been believed to fuel antimicrobial resistance (AMR), but new research shows that simply lowering consumption is not enough. Poor sanitation, corruption and low public health spending have a bigger role in pushing up drug-resistant infections in low-income and middle-income countries (LMICs), including India, according a study published in Lancet Planetary Health.

“Lowering of antibiotic consumption is not sufficient because the spread of resistant strains and resistance genes are the dominant contributing factor,” said study co-author Ramanan Laxminarayan from the Princeton Environmental Institute, University of Princeton, US.

“Providing sanitation, clean water and good governance, increasing public health expenditure and better regulating the private health sector are all necessary to reduce antimicrobial resistance,” added Laxminarayan.

“This is not to say that antibiotic consumption should not be lowered; it is an important factor to lower AMR when all these other correlations have been fixed. Simply reducing consumption will not enough when the resistant gene is out there, we must stop transmission by fixing all the above,” he said.

Quantifying the effects of improving the indices with the most potential for reducing antimicrobial resistance, the study found E coli resistance levels fall by 18.6% for every one standard deviation improvement in the infrastructure index. Additionally, there was a 5.5% decrease in E coli resistance levels if the governance index was improved by one standard deviation.

“In India, antibiotics are used most often to treat diarrhoea and upper respiratory tract infections, both of which can be reduced by improving sanitation, providing clean water, adopting personal hygiene and getting vaccinated,” said Kamini Walia, senior scientist and programme officer ( antimicrobial resistance), Indian Council of Medical Research.

Even temperature has a role to play. The warmer the country, the higher its antimicrobial resistance levels, found the study. Studies in the past, including one published in Nature Climate Change in May, have linked higher local temperatures and population densities with more antibiotic resistance in common bacterial strains.

“Warm temperatures offer more potential for bacteria to multiply and transfer antimicrobial resistance, as do higher insect populations, which also spread resistant bacteria. It’s worrying for countries like India, which are recording more hot days,” said Laxminarayan.

Other factors that pushed up antimicrobial resistance in LMICs were higher income, education and a high number of private clinics. “Along with increasing online sales and misuse of antibiotics as an infection control and growth factor in animals, higher income and education help to improve access and raise the risk of overuse. India has to improve regulation and create models for sanitation and hygiene, including in animal and poultry breeding,” said Walia.

“Containing antimicrobial resistance needs a multi-pronged approach, there is no magic bullet,” Laxminarayan said


Type 2 diabetes risk shoots up after losing a night’s sleep

Sleep,Type 2 diabetes,Diabetes

Being deprived of sleep for just six hours or a single night may affect the liver’s ability to produce glucose and process insulin, increasing the risk of metabolic diseases such as fatty liver and Type-2 diabetes, warns a study. Sleep deprivation has been associated with eating more, moving less, and having a higher risk of developing Type-2 diabetes.

However, it was not clear whether glucose intolerance was due to the changes in food intake or energy expenditure or to the sleep deprivation itself,” explained a team of researchers from Toho University in Japan. In the study done over mice, blood glucose levels were found significantly higher in the sleep deprivation group than controls after one six-hour session of wakefulness.

Triglyceride (fat) levels and the production of glucose in the liver also increased in the sleep deprivation group after a single wake period. Elevated liver triglycerides are associated with insulin resistance, or the inability of the body to process insulin properly. In addition, lack of sleep changed the expression of enzymes that regulate metabolism in the liver in the sleep deprivation group.

These findings suggest that intervention studies designed to prevent sleep deprivation-induced hepatic steatosis and insulin resistance should be performed in the future, the researchers noted.

For the study, published in the American Journal of Physiology — Endocrinology and Metabolism, the team examined two groups of mice. One group was kept awake for six hours each night (“sleep deprivation”), while the control group was allowed to sleep as desired. The team offered unlimited high-fat food and sugar water — mimicking lifestyle-related food choices that people make — to both groups prior to the study. During the sleep/wake period, the animals also had limited opportunity for physical activity.


This new therapy could boost the immune system’s ability to fight skin cancer

Skin cancer,Cancer,Skin cancer study

Scientists say they have identified a molecule that can be added to a cancer vaccine to boost the immune system’s ability to fight skin cancer.

A study, published in the journal PNAS, found that adding the molecule called Diprovocim to an existing vaccine can draw cancer-fighting cells to tumour sites.

Experiments in mice with melanoma suggest the therapy could increase chances of recovery in cases where a drug therapy alone is not working, researchers said.

Melanoma is a form of skin cancer that arises when pigment-producing cells – known as melanocytes – mutate and become cancerous.

“This co-therapy produced a complete response – a curative response – in the treatment of melanoma,” said Dale Boger, a professor at the Scripps Research Institute in the US.

The vaccine also prompts the immune system to fight tumour cells should they ever return, a capability that could prevent cancer recurrence, researchers said.

“Just as a vaccine can train the body to fight off external pathogens, this vaccine trains the immune system to go after the tumour,” Boger said.

Diprovocim works as an “adjuvant,” a molecule added to a vaccine to fire up the body’s immune response. The molecule is easy to synthesise in the lab and easy to modify, which makes it attractive for use in medicine.

The researchers tested the vaccine design on mice with a form of notoriously aggressive melanoma.

All mice in the experiment were given the anti-cancer therapy anti-PD-L1. The mice were then split into three group: eight received the cancer vaccine, eight received the cancer vaccine plus Diprovocim, and eight received the cancer vaccine plus an alternative adjuvant called alum.

The researchers observed a 100% survival rate over 54 days in the mice given the cancer vaccine and Diprovocim. This was in contrast to a zero per cent survival rate in mice given only the cancer vaccine and a 25% survival rate in mice given the cancer vaccine with alum.

“It was exciting to see the vaccine working simultaneously with a cancer immunotherapy like anti-PD-L1,” said Boger.

Further experiments showed that using Diprovocim as an adjuvant boosts the vaccine’s cancer-fighting potential by stimulating the immune system to make cells called tumour-infiltrating leukocytes.


Tens of thousands of children in England rejected for mental health treatment

A little boy on his own in a school playground

More children than ever are seeking specialist mental health treatment in England but tens of thousands are being turned away despite evidence of self-harm or abuse, according to a report.

An investigation by the Education Policy Institute (EPI) found that referrals to children’s mental health services in England had increased by 26% over the last five years – but nearly one in four of those were rejected, meaning that at least 55,000 children were not accepted for treatment in 2017-18 alone.

Most of those were rejected because their condition was not regarded as serious enough to meet eligibility criteria – including young people who had experienced abuse or showed evidence of self-harm.

The report also found that even those who were accepted faced long delays in getting treatment. Children in London are having to wait more than two months on average, well above the government’s target of four weeks.

“This report shows a significant increase in demand for children’s mental health services over the last five years, even as many local authorities are having to cut back on the services they are providing. This is very worrying and could lead to increased access problems,” said David Laws, the former Liberal Democrat minister who now chairs the EPI.

The EPI collected the data through a series of freedom of information requests to child and adolescent mental health services (CAMHS) and local authorities. Responses were received from 54 out of 60 services and 111 of 152 local authorities.

Whitney Crenna-Jennings, the author of the report, said there was little evidence of any significant improvement in access to children’s mental services, although it does find a small reduction in the very longest waiting times.

“There continues to be a significant postcode lottery in the proportion of referrals accepted into specialist care and waiting times to treatment, with long waits in some areas,” the report notes, with the longest reported being 188 days.

The collected data showed that between a fifth and a quarter of children referred were deemed “inappropriate” for specialist treatment, with the most common reasons being that their condition was not suitable or serious enough.

“This bleak picture of vulnerable young people being turned away from specialist mental health services or facing long waiting times for treatment is all too familiar to schools,” said Anna Cole of the Association of School and College Leaders.

“The difficulty in accessing these vital services means that schools and teachers are frequently supporting and caring for young people in severe distress, even to the extent of having to take them to A&E because they have been unable to access timely specialist support.”

Treatment criteria vary widely between services and regions. In some cases children were turned down for support if they had not engaged with other services, if they only demonstrated difficulties at school, or if they displayed “normal” responses to traumatic events such as abuse or bereavement.

“Overwhelmingly, providers reported no or limited follow-up after a referral was deemed inappropriate – only a minority contacted other services deemed more appropriate and a small minority checked whether the young person had accessed other support,” the report found.

“The fact that self-harm is not always sufficient to trigger access to specialist services clearly signals that wider preventive services are needed.”

Paul Whiteman, the general secretary of the National Association of Head Teachers, said teachers were having to re-refer the majority of children who were turned down. “The reason given in most cases, that the problem is ‘not serious enough’, simply isn’t okay. Early intervention is vital when it comes to mental health,” he said.

“The government is taking steps to improve mental health services for children and young people, and its mental health green paper takes the right approach. But it is doesn’t go far enough quickly enough.

“New funding and training isn’t going to reach the vast majority of areas for more than five years. Children need help now.”

A quarter of local authorities said they had cut services related to young people’s mental and emotional wellbeing. Among the programmes cut were community-based early intervention services, school-based programmes to support children with mild or moderate mental health difficulties, and counselling and support for vulnerable young people.


Caffeine can help patients with kidney disease live longer


Consuming more caffeine may help reduce the risk of death for people with chronic kidney disease. In a new study, researchers hypothesised that caffeine consumption might be associated with lower mortality among participants with chronic kidney disease. The possible protective effect of caffeine might be related to effects at a vascular level as caffeine is known to promote the release of substances, such as nitric oxide, that improves the function of the vessel.

Chronic kidney disease is associated with increased health care costs and a higher risk of death. The prevalence of the disease is expected to continue to increase worldwide. One of the study’s lead authors, Miguel Bigotte Vieira, said, “Our study showed a protective effect of caffeine consumption among patients with chronic kidney disease. The reduction in mortality was present even after considering other important factors such as age, gender, race, smoking, and diet.”

“These results suggest that advising patients with kidney disease to drink more caffeine may reduce their mortality. This would represent a simple, clinically beneficial, and inexpensive option, though this benefit should ideally be confirmed in a randomised clinical trial,” added Vieira.

The author, therefore, emphasised that this observational study cannot prove that caffeine reduces the risk of death in patients with chronic kidney disease, but only suggests the possibility of such a protective effect.

The full findings are present in the journal Nephrology Dialysis Transplantation.