Thursday, 23 February 2012

UK Universities Given £5.1 million to Collaborate on Fungal Infections

Invasive fungal infections are responsible for around 1.5 million deaths worldwide each year.
Professors Gordon Brown, Neil Gow and Al Brown
Yet fungal infections are poorly understood and have much less public awareness than diseases caused by bacteria, viruses and parasites.
Now the University of Aberdeen has been awarded £5.1M from the Wellcome Trust to lead a major UK collaboration which will take a ‘laboratory bench to hospital bedside’ approach to tackle the problem.
The Aberdeen Fungal Group - the biggest fungal research group in Britain and one of the largest in the world – will head the new 'Medical Mycology and Fungal Immunology Consortium' which will also be supported by scientists at Imperial College London and the Universities of Newcastle, Manchester, Birmingham, Kent, Exeter and other UK institutions.  The Consortium’s aims include:
·         Taking research from the lab into the clinic and pharmaceutical industry to develop better diagnostics and more effective treatments for fungal infections
·         Leading a research and training programme, harnessing UK expertise, to better understand fungal infections and immunity to these diseases and to train a new generation of scientists and clinicians
·         Promoting greater public awareness of fungal infections using channels such as You Tube and the web.
Professor Neil Gow, Chair in Microbiology at the University of Aberdeen, is Director of the Consortium.  He said: "People are very familiar with superficial fungal infections, such as ringworm and athlete’s foot, which affect approximately a quarter of the world’s population and are usually easily treated.
“Fungal infections of the mouth and genitals are also common – thrush is estimated to affect 75 million women each year while oral infections are common in babies and denture wearers. Again these can be treated relatively easily in healthy patients.
“However invasive fungal infections - infections in the major organs of the body - are associated with high mortality rates.
“Immunocompromised patients, such as cancer, trauma and HIV patients; and people who have undergone bone and organ transplants, are more susceptible to fungal infection.
“For example, a patient who contracts septicaemia caused by the fungal pathogen Candida, has only a 60% chance of surviving it despite the use of anti-fungal drugs. The fungal pathogenCryptococcus has a 40% mortality rate too, and with Aspergillus this mortality rate is increased to 70%.
“These kinds of infections are sometimes known as ‘the disease of the diseased’, and yet the study and awareness of fungal infections lags behind studies of other classes of microbe that cause disease.
“New strategies are desperately required to combat these life-threatening fungal infections.”
Professor Al Brown, a chair in Microbiology at the University of Aberdeen and Co-Director, said: "There are a number of different fungal pathogens but the big four that pose the most risk areCandidaAspergillus, Pneumocystis and Cryptococcus.
“Each year Candida is estimated to cause 400,000 life-threatening systemic infections of the body’s major organs.
"We need better treatment for fungal infections, better ways of diagnosing the problem and better understanding of its immunology and pathology and those are the challenges our consortium will tackle.”
Professor Gordon Brown, Sixth Century Chair in Immunology at the University of Aberdeen and Co-Director, added: "There are more than one million cases of Cryptococcus infections per year in Sub-Saharan Africa and these claim more lives than AIDS-associated tuberculosis.
"Other fungal species cause major endemic problems in developing countries where local expertise in fungal pathology is often limited.
“The award from the Wellcome Trust will enable the Consortium to promote national and international collaborations to enhance the understanding and treatment of fungal infections in developing and developed countries.”
Professors Gow, Brown and Brown together with Professor Mihai Netea at Radboud University Nijmegen Medical Center, Nijmegen, The Netherlands, spent two years developing and refining plans for the Consortium before seeking funding from the Wellcome Trust.
Professor Ian Diamond, Principal and Vice-Chancellor of the University of Aberdeen, added: “The Wellcome Trust Strategic Award is the single biggest award ever granted in the UK to the field of medical mycology and fungal immunology.
“It places the University of Aberdeen at the heart of a major research and training consortium that will deliver a new generation of clinical and research scientists to fight these devastating infections.”
The Consortium will also create 10 international PhD studentships, three clinical PhD studentships and six postdoctoral research assistant posts that will be spread across UK institutions.

Notes to Editors

Professor Neil Gow, Professor Al Brown and Professor Gordon Brown are available for interviews and photographs. To arrange, contact Jennifer Phillips on 01224 273174.
The Aberdeen Fungal Group is the largest research group in the UK specialising in medical mycology and fungal immunology and comprises around 50 research staff.
About the University of Aberdeen:
The University of Aberdeen is a centre of excellence for life sciences. Translational research is a particular strength for the University as its health campus is based on one of the largest teaching hospital sites in Europe.

Issued by the Communications Team, Office of External Affairs, University of Aberdeen, King's College, Aberdeen. Tel: (01224) 272014.

Thursday, 16 February 2012

Antifungal drug resistance, an update from AAA meeting

The recent 5th Advances Against Aspergillosis meeting saw a turning point in the recognition of Aspergillus resistance research.
Relatively few researchers have been studying drug resistance in Aspergillus. Much of the recent work on patient samples has been conducted by the teams in Manchester (UK) and Nijmegen (The Netherlands), who both see a particularly high frequency of resistance against the azole antifungals voriconazole, itraconazole and posaconazole - the most common drugs used to treat aspergillosis. But other groups have argued that these are isolated hot-spots, and resistance is not of concern to patients elsewhere.
However there are increasing reports of resistance cases around the globe, and it has now been observed across Europe, North America, Asia and Australasia. Unfortunately however, many centres still do not routinely check for resistance, so it may be under-reported.
As well as few centres testing for resistance, the problem is also complicated because many samples from patients with aspergillosis do not grow Aspergillus in culture, making it difficult to test for resistance. However a recent report from Manchester describes the use of a new technology which is able to detect resistance in a patient sample, even when Aspergillus does not grow. In that study, resistance was identified in over half of patients samples where Aspergillus DNA was detected but it did not grow, suggesting it may be much more common than believed. Furthermore, in these patient cases, resistance would not have been identified otherwise, so this may be an important future diagnostic tool.
During the recent 5th Advances Against Aspergillosis meeting there was a whole session devoted to resistance, with several speakers commenting that it is 'a significant emerging clinical problem'. This will hopefully raise its profile further, and encourage other researchers to check for resistance in their own centres. This greater recognition could help secure more funding that will aid us gaining a better understanding of the extent of the problem, and what measures we can put in place to help minimise it.

Friday, 10 February 2012

WikiProject Medicine: a Useful Tool for Medical Education?

There is an ongoing discussion amongst doctors in the 'heavyweight' medical press about the advantages and disadvantages of using the medical information found on the open source, openly edited encyclopaedic web resource Wikipedia.

 Wikipedia is run by a non-profit charity in the US and is available in several languages.

It is essentially written by its own readers, everyone writing about subjects that lie within their own areas of expertise and which they feel should be included in the encyclopaedia. Naturally at first there are disagreements about what is written in a particular article and after one author has finished another is free to alter or comment the article. After several rounds of debate a consensus is reached, references are linked in and the level of editing drops considerably as an article stabilises.

The net effect has been to provide articles (nearly 4 million English articles at the last count) that are arrived at via collaboration, albeit in a system where we have little idea of the status or reliability of the authors in question. The articles can be constantly updated as new information crops up.

 In practice Wikipedia does have an active panel of moderators who work to limit obvious acts of vandalism and misinformation - many changes have to conform to an editorial policy and while anyone can make a change those changes are checked quite quickly - within hours in my experience.

 This is all very well and has been a highly successful approach, largely consigning encyclopaedias produced in more traditional ways to the past

Pretty much anyone who uses the internet does so to look for information. Most use Google to find that information and Google ranks Wikipedia articles very highly, increasing the numbers of readers Wikipedia has and therefore the number of editors & authors. This 'virtuous circle' has helped form a very effective free, collaborative tool that is highly comprehensive and does pretty well with regards to accuracy and detail. Articles tend to be written from the 'non-expert' point of view and are easy to understand for the average man in the street.

 But what of subject that may ultimately put our lives at risk? Medical information has been the subject of a special sub-category of Wikipedia for some time - WikiProject:Medicine. The goal of this project is given here:
To produce reliable and neutral information on medical conditions, diagnosis and treatment in a readable and standardized format. It aims to deal with these diseases in every context, from molecular biology, symptomatology and diagnosis to therapeutical issues and historical and geopolitical ramifications. To this end, the WikiProject will collaborate with other WikiProjects relating to the health sciences.
There is much debate. One author contends that there is something to be gained in working with Facebook on this project, not least that it attracts 150 million viewers a month, arguing that this impetus could be harnessed by improving quality guidelines a little and with more involvement from moderators on 'unstable' pages.
There is a feeling that as long as contributors remain anonymous there will be a problem of verification of quality - but the involvement of laypeople is a good thing opening up many subjects to a wider audience in plainer English and may act as useful feedback from laypeople as to what is an important issue for ordinary people, bringing doctors back into writing for the needs of their patients.

Once suitable safeguards are in place this resource could become even more successful across the world, English speaking and otherwise, especially where money and facilities are minimal. It is already estimated that 70% of junior doctors (and the vast majority of medical students) use Wikipedia more than once per week, in its own way validating much of what is written.
Wikipedia is simple to use, simple to read and provides short clear summaries that are as useful to doctors & teachers as they are to the layperson. The writing is on the virtual 'wall' - there is a huge amount to be gained from engaging with this massively successful enterprise.

Other articles in the medical media on the use of Wikipedia:

Tuesday, 7 February 2012

Mold Remediation Products - None Completely Effective

A recent research paper describes testing a range of ten products sold to remove and remediate mould and mycotoxin.

Method: Manufacturer
  1. Ozone: Ozone-generator device Airmaster 
  2. Peroxide: ALRON Chemical Ltd. 
  3. Hot air: Black & Decker 
  4. Flaming: Commercially available burner 
  5. Steam: Karcher Ltd. 
  6. Boron-based chemical 1: Svenska reimpregnering Ltd. 
  7. Boron-based chemical 2: WSJ Sanitation Oy Ltd. 
  8. Ammonium chloride based chemical: BlOkleen Ltd. 
  9. Sodium hypochlorite based chemical: Colgate-Palmolive Ltd. 
  10. Drying
None were completely effective in removing all viable molds or mycotoxins, raising the point that none of these methods which are widely used in the remediation of buildings is completely effective. The authors suggest:
  1. that more research is needed to identify new protocols and/or sterilising substances in order to improve the end result of remediation
  2. manufacturers need to be under more obligation to prove the efficacy of their products under conditions that represent remediation more closely so as to get a genuine guide of the effectiveness of their product when in use
I would also suggest that this is a strong hint to move towards replacement of mouldy materials (particularly mouldy wood and plasterboard) rather than make attempts to clean them.

Monday, 6 February 2012

EU Tightens Limits of Mycotoxins in Food

Mycotoxins are highly toxic chemicals produced under some environmental conditions by a number of fungi. When growing crops in a field it is inevitable that the crop will be exposed to the fungi that produce mycotoxin but the toxins are only made if the crop happens to be affected by specific weather conditions so most crops are not effected while others can be heavily affected.
To counter the potential health problem if these toxins get into the food chain the EU sets strict limits to the amount permitted in food for humans and guidelines for animal feed and implements strict testing procedures to identify affected batches of grain.

More recently new countries have entered the EU with their own regulations and some countries have been arguing for even lower limits to permitted levels of mycotoxin, despite there being no evidence to suggest that existing permitted levels are toxic to humans.

The snag is that this is a careful balancing act between mycotoxin levels and farmer's incomes. As soon as a harvested crop is declared to have too much mycotoxin its monetary value drops. Therefore as soon as the EU reduces the permitted levels of mycotoxin in a crop there will be crops that will suddenly be worth less, even though the farmer has not changed how he grows the crop. The levels of mycotoxin vary according to weather conditions and thus tend to affect some countries more than others.

This news article features a representative of EU farmers resisting pressure on the EU to reduce permitted levels of some mycotoxins as this will cost their members money while at the same time having no apparent justification based on known health risks - perhaps this is part of a long term drive to reduce toxin levels in our food as far as is possible & feasible?

NOTE: Farmers Guardian article on same issue

Friday, 3 February 2012

Salt Caves Not Proven for Aspergillosis

Salt caves are generally disused salt mines that have been hollowed out of rock some distance below ground level, some of which are elaborately decorated and run for long distances underground becoming popular tourist attractions.
Other salt caves have started to take on a new, innovative function. Various stories believed to have originated from miners working in salt caves in Roman times have lead to a conception that visiting a salt cave is beneficial if you are suffering from respiratory problems. There are several claims of reduction in symptoms consistent with a reduction in lung tissue inflammation, some of which have been tested and are published in the scientific media 10 - 20 years ago.

Referred to as Halotherapy there is an assumption that people who visit a salt cave will tend to inhale very fine particles of salt (sodium chloride) deep into their lungs and that this can be a good thing for illnesses such as asthma and chronic obstructive pulmonary disease (COPD).

Despite this being used as a therapy in some parts of Europe and some reports appearing to confirm some beneficial effect (leading to several expensive therapy's being offered widely on the internet)  this is still a largely untested practice with few proven benefits - which isn't to say that it doesn't work for some but is a warning that those who try it shouldn't expect positive results.

Offering this type of therapy is very much the domain of those who seek to try to help vulnerable people but who offer no guarantees as to whether or not it will have any beneficial effect. It is not something that the major medical professional regulatory bodies currently support as illustrated by a recent case of malpractice brought against a doctor in Ireland.

In this report a qualified doctor had apparently helped set up a clinic to offer salt therapy and had set out to publicise this clinic using statements that made it appear that there were several proven benefits of using this clinic, including benefits to aspergillosis sufferers. The irish Medical Council  judged that he should not have been actively promoting this type of therapy in the way that he did and should not have been raising expectations unnecessarily as the benefits that he claimed for the therapy are unproven, finding him guilty of the lessor charge of poor professional conduct (not malpractice).

Wednesday, 1 February 2012

Newsbite: "Management of Chronic and Pulmonary Aspergillosis": Masterclass

An interactive masterclass on the "management of chronic and pulmonary aspergillosis" is now available to view on the Aspergillus Website - as presented at the 5th Advances against Aspergillosis conference in Istanbul on 26th- 28th of January 2012. Further notes and case histories to follow. more...

Newsbite: 5th Advances Against Aspergillosis - Abstracts, Posters & Slides

The Advances Against Aspergillosis conference has particular importance for this blog as it is the only international conference exclusively devoted to aspergillosis. We have now obtained all of the abstracts of poster presentations that took place at  the meeting and are collecting posters and slide presentations from speakers. Abstracts Presentations

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