Taiwan

HK confirms first H7N9 bird flu case

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A vendor weighs a live chicken at the Kowloon City Market on 12 April 2013 in Hong Kong. Local authorities have stepped up the testing of live poultry imports from China to include a rapid test for the H7N9 "bird flu" virus

Hong Kong has suspended the import of live chickens from some China farms


  • Hong Kong has confirmed its first case of the new strain of the H7N9 bird flu in a domestic worker from Indonesia.

The worker, 36, recently travelled to Shenzhen in the mainland and came into contact with live poultry. She is in critical condition, officials say.

H7N9 has infected more than 100 people since it emerged earlier this year.

The case in Hong Kong is a sign that the virus may be spreading beyond mainland China, where most infections have been reported, and Taiwan.

The World Health Organization (WHO) had said there was “no evidence of sustained human-to-human transmission”, but also described H7N9 as an “unusually dangerous virus”.

At least 139 human cases of H7N9 have been confirmed, including 45 deaths, WHO says in a statement dated 6 November.

At least one case was confirmed in Taiwan in April.

Dr Ko Wing-man, Hong Kong’s food and health secretary, confirmed the territory’s first H7N9 case late on Monday.

He said that the patient “has a history of travelling to Shenzhen, buying a chicken, slaughtering and eating the chicken”.

“She is now in critical condition at Queen Mary Hospital,” he said, adding that four people in close contact with her were showing signs of flu-like symptoms.

Hong Kong is now on public health alert and has suspended the import of live chickens from some farms across the border with the mainland.

H7N9 is a type of influenza virus that normally circulates among birds and has not until recently been seen in people, the WHO says.

“There is no indication thus far that it can be transmitted between people, but both animal-to-human and human-to-human routes of transmission are being actively investigated,” the organisation adds.

‘Unpredictable pandemics’ warning

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The world needs to be prepared for “unpredictable pandemics” from viruses making the leap from animals to people, scientists in Taiwan say.

Their warning follows the first reported case of a common bird flu, H6N1, being detected in a woman, earlier this year.

The patient recovered and no other cases have been detected.

But the Lancet Respiratory Medicine report said “intensive” monitoring of bird flu was needed.

In May 2013, the first human case of an H6N1 bird flu was detected in a woman in Taiwan. One of her neighbours bred ducks, geese and chickens – although the precise source of the infection has not been detected.

Many sub-types of influenza, such as those that cause seasonal flu or the swine flu pandemic, are known to infect people, but H6N1 is not one of them.

The report, by the Centres for Disease Control in Taiwan, said: “The occurrence of a human case of H6N1 infection shows the unpredictability of influenza viruses.

Influenza

“Our report highlights the need for influenza pandemic preparedness , including intensive surveillance for ever evolving avian influenza viruses.”

Prof Wendy Barclay, from Imperial College London, said these infections may have happened in the past but improved technology had meant this one had been discovered.

She said: ” Is this a truly new thing or are we now just better at seeing it?”

She told the BBC she expected far more of these cases to be reported in the next few years as more hospitals were geared up to look for novel bird flus.

Prof Barclay added: “This is a single case with no evidence of human transmission, but as always we should keep an eye on it and do studies to see how close it is to being able to spread between humans.”

Giant fast-moving huntsman spider with a nasty bite lands in UK

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Stowaway! Giant fast-moving huntsman spider with a nasty bite lands in UK .

A speedy seven inch spider with a nasty bite gave workers at a British warehouse a fright after it arrived from Asia.

The huntsman spider, described as an arachnophobe‘s worst nightmare, reached East Sussex after stowing away in a shipping container packed with BMX parts in Taiwan.

Stunned staff at Seventies BMX Distribution in St Leonards-on-Sea were unpacking the delivery boxes when they caught sight of the arachnid, which would have been locked up for around six weeks as it travelled thousands of miles.

Warehouse manager Joe Woodburn said: “My mate saw it on the box I was holding. He froze and couldn’t get his words out fast enough.

“It was as big as the palm of my hand. We managed to get it into a big plastic container where we kept it while we called the RSPCA.

“I thought it was plastic at first as it wasn’t moving, but the minute it was in the sunlight it started to warm up and it was running around and jumping up the side of the box.

“We get containers like this all the time and we have always joked that one day we’d open one up to find some kind of ferocious animal in there, but I never expected to find a spider as big as this.”

RSPCA inspector Zoe Ballard, who was called out to deal with the animal, said she had never come across anything like it before and admitted she was not the biggest fan of the creepy-crawly.

“I got the call through as collection of a tarantula, but as soon as I saw it I knew it wasn’t a tarantula,” she said.

“I managed to secure the spider in the container and took it to the RSPCA’s wildlife centre nearby, but I must admit I was worried all the way that it would get out and escape in my van.”

The spider has now been rehomed at Drusillas Zoo Park in Alfriston, near Eastbourne, but RSPCA inspector Tony Woodley said it does not generally pose a big threat.

“Huntsman spiders can give you a nasty bite, but they aren’t likely to cause too much harm unless you suffer an allergic reaction,” he said.

“However, because they are so big and they run around so quickly, they are probably an arachnophobe’s worst nightmare.

“Spiders can survive a long time without food and water. The cold is going to be the main problem for them, but it probably survived the journey because the weather has been fairly mild.”

Underwater wi-fi given test run.

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University of Buffalo underwater wi-fi testing team
The team dropped two 40lb (18kg) sensors into a lake near Buffalo

Researchers have tested an “underwater wi-fi” network in a lake in an attempt to make a “deep-sea internet”.

The team, from the University of Buffalo, New York, said the technology could help detect tsunamis, offering more reliable warning systems.

They aim to create an agreed standard for underwater communications, to make interaction and data-sharing easier.

Unlike normal wi-fi, which uses radio waves, the submerged network technology utilises sound waves.

Radio waves are able to penetrate water, but with severely limited range and stability. Sound waves provide a better option – as demonstrated by many aquatic species such as whales and dolphins.

Wireless communication underwater has been possible for some time, but the problem lies in getting separate systems used by different organisations to communicate with each other.

The US National Oceanic and Atmospheric Administration (NOAA), for instance, uses acoustic waves to send data from tsunami sensors on the sea floor to buoys on the surface.

However due to infrastructure differences, this data cannot be shared quickly with other information gathered by the US Navy.

‘Unprecedented ability’

Therefore, the University of Buffalo team is attempting to create a shared standard.

“A submerged wireless network will give us an unprecedented ability to collect and analyse data from our oceans in real time,” said Tommaso Melodia, lead researcher.

“Making this information available to anyone with a smartphone or computer, especially when a tsunami or other type of disaster occurs, could help save lives.”

The test was carried out at Lake Erie, near Buffalo. The research team dropped two 40lb (18kg) sensors into the water – and were then able to use a laptop to transmit information to them.

In future, the team hopes the sensors could be used to help detect and solve environmental issues. With a shared standard, different research groups with varied equipment could potentially combine their data gathering efforts with greater ease, and in real-time.

More details of the team’s work will be presented at a conference for underwater networking to be held in Taiwan next month.

Certain Antibiotics Tied to Blood Sugar Swings in Diabetics.

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Diabetes patients who take a certain class of antibiotics are more likely to have severe blood sugar fluctuations than those who take other types of the drugs, a new study finds.

The increased risk was low but doctors should consider it when prescribing the class of antibiotics, known as fluoroquinolones, to people with diabetes, the researchers said. This class of antibiotics, which includes drugs such as Cipro(ciprofloxacin), Levaquin (levofloxacin) and Avelox(moxifloxacin), is commonly used to treat conditions such as urinary tract infections and community-acquired pneumonia.

One expert said the study should serve as a wake-up call for doctors.

“Given a number of alternatives, physicians may consider prescribing alternate antibiotics … in the place of fluoroquinolones (particularly moxifloxacin) to patients with diabetes,” said Dr. Christopher Ochner, assistant professor of pediatrics and adolescent medicine at the Icahn School of Medicine at Mount Sinai, in New York City. “In general, this study demonstrates that closer attention needs to be paid to particular drug-condition interactions.”

The study included about 78,000 people with diabetes in Taiwan. The researchers looked at the patients’ use of three classes of antibiotics: fluoroquinolones; second-generation cephalosporins (cefuroxime, cefaclor, or cefprozil); or macrolides (clarithromycin or azithromycin).

The investigators also looked for any emergency-room visits or hospitalizations for severe blood sugar swings among the patients in the 30 days after they started taking the antibiotics.

The results showed that patients who took fluoroquinolones were more likely to have severe blood sugar swings than those who took antibiotics in the other classes. The level of risk varied according to the specific fluoroquinolone, according to the study, which was published in the journal Clinical Infectious Diseases.

The incidence of hyperglycemia (high blood sugar) per 1,000 people was 6.9 for people taking moxifloxacin, 3.9 for levofloxacin and 4.0 for ciprofloxacin. The incidence of hypoglycemia (low blood sugar) was 10 per 1,000 for moxifloxacin, 9.3 for levofloxacin and 7.9 for ciprofloxacin.

The incidence of hyperglycemia per 1,000 people was 1.6 for those taking the macrolide class of antibiotics and 2.1 for those on cephalosporins. The incidence of hypoglycemia per 1,000 people was 3.7 for macrolides and 3.2 for cephalosporins.

“Our results identified moxifloxacin as the drug associated with the highest risk of hypoglycemia, followed by levofloxacin and ciprofloxacin,” wrote Dr. Mei-Shu Lai, at National Taiwan University, and colleagues.

They said doctors should consider other antibiotics if they have concerns that patients might experience severe blood sugar swings.

“The study … does not prove a causal connection between particular fluoroquinolones and blood sugar dysregulation,” Ochner said. But he believes that it provides evidence that people with diabetes may be at special risk from moxifloxacin in particular.

“If moxifloxacin is to be prescribed to diabetic patients, there should be some additional expected benefit that justifies the increase in incurred risk,” Ochner said.

But another expert said there could be other explanations for why people on fluoroquinolones had more blood sugar fluctuations.

“It is hard to draw conclusions that fluoroquinolones themselves are the culprit, as all of these patients had infections, and infection can lead to hypo- or hyperglycemia in persons with diabetes,” said Dr. Alyson Myers, an endocrinologist at North Shore University Hospital in Manhasset, N.Y.

“In addition, those in the fluoroquinolone group were more likely to have chronic kidney disease or steroid use – the former can increase rates of hypoglycemia and the latter can increase rates of hyperglycemia,” Myers said. “Another confounding factor would be the type of diabetes treatments that patients were receiving, as sulfonylureas and insulin are both associated with greater risks of hypoglycemia than other diabetes medications.”

Source: Drugs.com

Risk of Severe Dysglycemia Among Diabetic Patients Receiving Levofloxacin, Ciprofloxacin, or Moxifloxacin in Taiwan.

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Background. Observational studies and fatal case reports raise concern about the safety of severe dysglycemia associated with fluoroquinolone use. The objective of this study was to assess the risk of severe dysglycemia among diabetic patients who received different fluoroquinolones.

Methods. In a population-based inception cohort study of diabetic patients covering the period from January 2006 to November 2007, outpatient new users of levofloxacin, ciprofloxacin, moxifloxacin, cephalosporins, and macrolides orally were identified. Study events were defined as emergency department visits or hospitalization for dysglycemia within 30 days following the initiation of antibiotic therapy. Results were analyzed with adjusted multinomial propensity score.

Results. A total of 78 433 diabetic patients receiving the antibiotics of interest were included in the study. The absolute risk of hyperglycemia per 1000 persons was 6.9 for moxifloxacin and 1.6 for macrolides. In contrast, the risk of hypoglycemia was 10.0 for moxifloxacin and 3.7 for macrolides. The adjusted odds ratios (AORs) and 95% confidence intervals (CIs) of levofloxacin, ciprofloxacin, and moxifloxacin compared with macrolides were 1.75 (1.12–2.73), 1.87 (1.20–2.93), and 2.48 (1.50–4.12), respectively, for hyperglycemia and 1.79 (1.33–2.42), 1.46 (1.07–2.00), and 2.13 (1.44–3.14), respectively, for hypoglycemia. Patients taking moxifloxacin faced a significantly higher risk of hypoglycemia than those receiving ciprofloxacin. A significant increase in the risk of hypoglycemia was also observed among patients receiving moxifloxacin concomitantly with insulin (AOR, 2.28; 95% CI, 1.22–4.24).

Conclusions. Diabetics using oral fluoroquinolones faced greater risk of severe dysglycemia. The risk of hypoglycemia varied according to the type of fluoroquinolone administered, and was most commonly associated with moxifloxacin.

Source: cid.oxfordjournals.org


Glaucoma: Sleep Apnea May Raise Risk.

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Patients with sleep apnea were 1.67 times more likely to develop glaucoma than patients without apnea, according to a study that compared more than 1000 apnea patients with more than 6000 age-matched participants. The study was published in the August issue of Ophthalmology.

Ching-Chun Lin, MA, from the Graduate Institute of Biomedical Informatics, College of Medical Science and Technology, Taipei Medical University, Taiwan, and colleagues relied on data from the Taiwan Longitudinal Health Insurance Database 2000, matching 1012 apnea patients aged 40 years and older with 6072 control patients of similar age, sex, and urbanization. A patient was considered to have apnea only if there were a record of him or her undergoing a sleep study. The researchers counted a glaucoma diagnosis only if the patient were prescribed medication.

“The fact that the authors required this [evidence of diagnosis] really increases the validity of their results,” Ahmad A. Aref, MD, assistant professor of ophthalmology, University of Illinois Eye and Ear Infirmary, Chicago, told Medscape Medical News. Dr. Aref, who authored a review on glaucoma and sleep earlier this year was not involved in the current study.

“Armed now with this study, clinicians should start to question their patients about sleep apnea,” Dr. Aref said. “I would treat it like other established risk factors for glaucoma, such as having a family member with glaucoma, or having high eye pressure, or being of African-American race. I would start to think seriously about grouping sleep apnea with those more established risk factors.”

Lin and colleagues found that the incidence rate of open-angle glaucoma among patients diagnosed with apnea was 11.26 per 1000 person years (95% confidence interval [CI], 8.61 – 14.49) compared with 6.76 per 1000 person years (95% CI, 5.80 – 7.83) for patients without an obstructive sleep apnea (OSA) diagnosis.

The adjusted hazard ratio (HR) for a glaucoma diagnosis within 5 years of being diagnosed with apnea was 1.67 (95% CI, 1.30 – 2.17; P < .001) after adjusting for monthly income, geographic region, diabetes, hypertension, heart disease, obesity, hyperlipidemia, renal disease, hypothyroidism, and number of outpatient visits for ophthalmologic care.

The adjusted HR for a glaucoma diagnosis among women in the 5 years after a sleep apnea diagnosis was 1.55 (95% CI, 1.04 – 2.31). For men, the adjusted HR was 1.45 (95% CI, 1.02 – 2.16).

“This study gives the most evidence to date that sleep apnea is a risk factor for OAG,” Parag Gokhale, MD, from Virginia Mason Medical Center, Seattle, Washington, told Medscape Medical News in an email. Dr. Gokhale, the spokesman for the American Academy of Ophthalmology, was not involved in the current research. Among the study’s strengths, he said, was the researchers’ decision to control for other possible causes of glaucoma, something several previous studies failed to do.

In this study, participants in the OSA group had higher levels of hypertension (P < .001), diabetes (P < .001), heart disease (P < .001), hyperlipidemia (P < .001), obesity (P < .001), renal disease (P < .001), and migraine (P < .001), the researchers found. Prevalence of hypothyroidism was equal in each group.

W. Christopher Winter, MD, medical director, Martha Jefferson Hospital Sleep Medicine Center, Charlottesville, Virginia, says this study should influence sleep specialists to include eye health in the list of concerns for apnea patients.

“With the risk [for glaucoma] 3 to 5 years out as high as it is, recommending a baseline eye exam would be a good thing. Eye exams, if your vision is good, usually fall by the wayside. I think I would add that,” Dr. Winter said.

The authors noted several limitations to the current study including a lack of severity information, such as apnea-hypopnea index scores or respiratory disturbance index scores, which would have allowed them to determine whether risk for glaucoma increased with the severity of the sleep apnea.

Source: Ophthalmology

 

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,”san�9rf0� ��� east-font-family:”Times New Roman”; color:black’> ABCG2 (p<0.01), the group writes. In the 134 patients on atorvastatin, explainable blood-level variability was split between two polymorphisms in SLCO1B1 (p<0.01 and p<0.05, respectively) and the activity of cytochrome P3A (CYP3A). The analyses were adjusted for gender, age, body mass index, ethnicity, statin dose, and time from last dose, and echo a 2008 study which concluded that two SLCO1B1 variants were associated with simvastatin-related myopathy, as reported by heartwire . The screening concept is currently being applied to simvastatin therapy at least at one major center.

 

The group retrospectively tested their ideas, looking at the relationships between genotypic and clinical variables and statin dose, in a validation cohort of 579 patients taking either drug in a primary care setting in the US and at a referral clinic in Canada.

The group found that the transporter genotypes that raise statin concentrations were homogeneously distributed among patients taking a range of atorvastatin and rosuvastatin dosages. That is, the prescribing physicians, armed primarily with their clinical judgment to decide dosage levels, failed to achieve optimal dosing with respect to serum drug levels. But it seemed to be only patients receiving the highest dosages who showed higher-than-safe serum levels according to genotype- and age-based criteria.

“Although we didn’t quite get to the sample size we needed, it did seem like people with the wrong genetic makeup are more likely to stop a statin or switch to [another dyslipidemia drug],” Kim said, at least among patients on the highest statin dosages.

The group’s proposed management algorithm recommends a maximum statin dosage that will result in plasma concentrations below the 90th percentile (reflecting an assumption that 10% of patients will have statin-related muscle issues) based on patient age and transporter-related genotype.

The algorithm is based on data predominantly from whites; the group cautions that some other ethnicities, “particularly Asians,” have increased sensitivity to statins.

Source: medscape.com

 

Fluoroquinolones Linked to Dysglycemia in Patients with Diabetes.

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Fluoroquinolones are associated with increased risk for both hyperglycemia and hypoglycemia among patients with diabetes, compared with other antibiotics, according to a study in Clinical Infectious Diseases.

Researchers in Taiwan used national insurance claims data to identify roughly 78,000 outpatients with diabetes who received a new prescription for an oral antibiotic.

Within 30 days of starting the antibiotic, patients taking moxifloxacin, levofloxacin, or ciprofloxacin had 1.75 to 2.48 times the risk for hyperglycemia-related emergency department visits or hospitalizations, relative to patients taking macrolides. Risks were similarly elevated for episodes of hypoglycemia. Moxifloxacin was associated with the highest risk for dysglycemia.

The authors conclude: “Clinicians should consider these risks when treating patients with diabetes and prescribe fluoroquinolones cautiously.”

Source: Clinical Infectious Diseases article

Ultrasound Confirms Tube Position During Cardiopulmonary Resuscitation.

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In this small study, the positive predictive value of ultrasound to confirm endotracheal tube placement during active compressions was 98.8%.
Confirming correct endotracheal tube (ETT) placement during cardiopulmonary resuscitation (CPR) can be challenging. In a prospective observational study, researchers in Taiwan assessed the accuracy of real-time tracheal ultrasonography in 89 cardiac arrest patients (age range, 24–98 years) receiving emergency intubation during CPR. Patients with severe neck trauma, neck tumors, or history of neck surgery (including tracheotomy) were excluded. The gold standard for correct ETT placement was defined as bilateral auscultated breath sounds with good capnography waveform and exhaled carbon dioxide >4 mm Hg after at least 5 breaths.

Three senior emergency medicine residents supervised by experienced faculty performed tracheal ultrasonography during and immediately after ETT insertion, with most scans taking 10 seconds or less. Observation of a single air-mucosa interface with comet-tail artifact confirmed tracheal placement. Seven patients (7.8%) had esophageal intubations. Sensitivity, specificity, and positive and negative predictive values of tracheal ultrasound for identifying ETT position were 100%, 86%, 99%, and 100%, respectively.

COMMENT

Aspiration devices are the current standard for confirmation of tracheal tube placement during CPR when end-tidal CO2 is not detectable. Ultrasound shows promise in this setting, but the failure to identify 1 in 7 esophageal intubations is concerning. The key to establishing the value of ultrasound for tracheal tube confirmation lies in demonstration of its ability to detect 100% of esophageal intubations. We are not there yet.

Source: NEJM

Perfluorinated chemicals linked to mild hypothyroidism in women.

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Higher serum concentrations of perfluorinated chemicals are associated with an increase in total triiodothyronine, total thyroxine and free thyroxine among women, according to researchers from Taiwan.

“Our study is the first to link perfluorinated chemical (PFC) levels in the blood with changes in thyroid function using a nationally representative survey of American adults,” researcher Chien-Yu Lin, MD, PhD, of En Chu Kong Hospital in Taiwan, said in a press release.

Researchers included data for 1,181 patients aged older than 20 years from the National Health and Nutrition Examination Survey in 2007-2008 and 2009-2010 to determine the relationship between serum PFCs and thyroid function.

Of 672 men and 509 women included in the study, men demonstrated a higher average concentration of PFC compounds compared with women. Furthermore, older age was associated with a greater concentration of perfluorooctanoate (PFOA), perfluorooctane sulfonate (PFOS) and perfluorohexane sulfonate (PFHxS). Mexican Americans displayed lower mean serum concentrations of PFOA, PFOS, PFHxS and perfluorononanoic acid (PFNA) compared with Hispanic whites and non-Hispanic blacks, according to researchers.

Data indicate the mean concentrations of PCFs were 4.15 ng/mL (95% CI, 4.02-4.29) for PFOA, 14.2 ng/mL (95% CI, 13.59-14.86) for PFOS, 1.54 ng/mL (95% CI, 1.48-1.59) for PFNA and 2 ng/mL (95% CI, 1.89-2.11) for PFHxS.

Based on these correlating concentrations of four PFCs, researchers decided to weigh data for sampling strategies and determined that a 1-unit increase in natural log-serum PFO was associated with an increase in serum T3 concentrations (6.628 ng/dL; 95% CI, 0.545-12.712) in women. A 1-unit increase in natural log-PFHxS also was associated with an increase in total T4(0.26 mcg/mL; 95% CI, 0.108-0.413) and total T3 (4.074 ng/dL; 95% CI, 2.32-5.916) in women, suggesting risk for mild hypothyroidism. However, natural log-free T4 decreased in men (0.016 ng/dL; 95% CI, –0.029 to −0.003), they wrote.

“Although some PFCs such as PFOS have been phased out of production by major manufacturers, these endocrine-disrupting chemicals remain a concern because they linger in the body for extended periods,” Lin said. “Too little information is available about the possible long-term effects these chemicals could have on human health.”

 

PERSPECTIVE

R. Thomas Zoeller

  • The study by Wen et al to be published in the Journal of Clinical Endocrinology and Metabolism explores the statistical relationship between several perfluorinated chemicals (PFCs) and measures of thyroid function in the human population, as revealed in the NHANES dataset.  Several features of this work are important. First, it is important to recognize that PFCs are employed in the production of many products that people use — from fabrics and furniture to some food wrappings. Second, these chemicals are very stable in the environment and are persistent.

Therefore, it is important to study the potential relationship between the ubiquitous exposure to these chemicals and endocrine effects such as altering thyroid function or thyroid hormone action. In this case, the reader may be somewhat perplexed by the findings. Serum total T4 and total T3 was higher in women with elevated PFCs but serum free T4 was lower in men with elevated PFCs. However, PFCs were not associated with serum TSH in men or women.

So, what does this mean and why is it important? Animal studies have demonstrated clearly that some chemicals — PFCs among them — appear to disconnect serum T4 from TSH. We do not know how this happens, but we need to be careful about ignoring data that currently don’t make sense to us, especially in the case of the thyroid because the regulation of thyroid hormone delivery to target cells and activation of the receptor is highly complex, requiring specific transporters, metabolic enzymes and transcriptional machinery. We are also finding in animal studies that various environmental chemicals can have very unexpected effects on thyroid hormone regulation and action.

Finally, the United States’ EPA’s Endocrine Disruptor Screening Program requires only that thyroid histology be performed — blood levels of hormones are not required, nor are endpoints of thyroid hormone action. This NHANES dataset provides a very small glimpse into the potential impacts of environmental chemicals on thyroid hormones and we know very little about how this may contribute to thyroid disease.

  • R. Thomas Zoeller, MS, PhD
  • Department of Biology
    University of Massachusetts – Amherst

 

Source: Endocrine Today