News
WHO warns that MERS coronavirus could cause a global pandemic. Amid growing concerns about the increasing number of confirmed cases of the Middle East Respiratory Syndrome coronavirus (MERS-CoV), the World Health Organization (WHO) has advised healthcare workers worldwide to be on the alert for symptoms of the often-fatal disease. “There have been several examples where the virus has moved from one country to another through travelers,” a WHO spokesperson indicated. “Consequently, all countries in the world need to ensure that their healthcare workers are aware of the virus and the disease it can cause and that, when unexplained cases of pneumonia are identified, MERS-CoV should be considered.”
As of mid-June the disease, which is related to the Severe Acute Respiratory Syndrome (SARS) that arose in Saudi Arabia in 2012, had been confirmed by lab testing in 55 people—40 in Saudi Arabia, and smaller numbers in Jordan, Qatar, the United Arab Emirates, Tunisia, the United Kingdom, France, and Italy. Thirty-one patients have died. The source of the virus has not been identified, and there are increasing indications that it can spread among people who are in close contact with an infected individual. The WHO has not yet released guidance for travelers.
Influenza
A double dose of oseltamivir offers no added benefit in severe influenza. Giving double doses of the antiviral drug oseltamivir (Tamiflu) offers no clinical advantages over a standard dose for patients admitted to the hospital with severe influenza infection, according to a randomized trial published in the British Medical Journal. This first study to look at the effectiveness of higher doses of oseltamivir in cases of severe flu infection has implications for global guidelines on clinical management and stockpiling drugs for pandemic preparedness, including the current outbreak of the H7N9 virus.
Studies have shown that early treatment with oseltamivir benefits patients with uncomplicated flu infection and improves survival in patients with severe infection. This has led some to recommend double doses for patients with severe infections.
The study involved 326 patients with severe flu infection at 13 hospitals in Indonesia, Singapore, Thailand, and Vietnam. Most were children under the age of 15.
Patients were given either a standard dose or a double dose of oseltamivir for five days. Their virus levels were monitored for the duration of the treatment. The findings revealed no difference in virus levels at day five between the treatment groups.
Cancer
Abnormalities in HER2 gene have been found in wide variety of advanced cancers. The HER2 growth-factor gene is known to be overactive in breast and gastroesophageal cancers. Now, irregularities in the gene’s expression have been found in 14 different advanced solid tumors. The results of a study that was presented last month at the annual meeting of the American Society of Clinical Oncology provided hope that some of these tumors might benefit from the three anti-HER2 therapies now in clinical use.
In the study, a genetic screen was conducted of more than 182 genes and 14 genetic rearrangements known to be linked to cancer in 2,223 tumor specimens. Twenty different advanced solid cancers were represented. Researchers found HER2 alterations in 14 types of solid tumors, including 29% of esophageal, 20% of uterine, 14% of breast, 12% of stomach, and 6% of all lung cancer samples. They also found HER2 irregularities varied widely: 4.9% of specimens had 116 different HER2 alterations. That included 58% with amplifications, 25% with substitutions, 14% with insertions/deletions of DNA, 2% with splice site variants, 2% with translocations, and 5% with multiple alterations.
Anti-HER2 therapies such as Herceptin can also treat HER2 mutations, and may also help block HER2 that is altered in the ways seen in the study.
Prenatal Testing
Non-invasive first trimester blood test reliably detects Down syndrome. New research has found that routine screening using a non-invasive test that analyzes fetal DNA in a pregnant woman’s blood can accurately detect Down syndrome and other genetic fetal abnormalities in the first trimester. The research suggests that the test is superior to currently available screening strategies and could reshape standards in prenatal testing.
Current screening for Down syndrome, or trisomy 21, and other trisomy conditions includes a combined test done between the 11th and 13th weeks of pregnancy, which involves an ultrasound screen and a hormonal analysis of the pregnant woman’s blood. A study by Kypros Nicolaides, MD, of King’s College London, and colleagues is the first to prospectively demonstrate the feasibility of routine screening for trisomies 21, 18, and 13 by cfDNA testing. Testing done in 1,005 pregnancies at 10 weeks had a lower false positive rate and higher sensitivity for fetal trisomy than the combined test done at 12 weeks. Both cfDNA and combined testing detected all trisomies; the estimated false-positive rates were 0.1% and 3.4%, respectively.
A second study by the group, which included pregnancies undergoing screening at three UK hospitals between 2006 and 2012, found that effective first-trimester screening for Down syndrome could be achieved by cfDNA testing contingent on the results of the combined test done at 11 to 13 weeks. The strategy detected 98% of cases, and invasive testing was needed for confirmation in less than 0.5% of cases.
Healthcare Issues
One in five Americans report visiting the emergency room at least once in the past year. In 2011, 20% of U.S. adults reported at least one emergency room visit in the past year, and 7% reported two or more visits, according to Health, United States, 2012, the government’s annual report on Americans’ health. The report, which compiles health data from state and federal health agencies and the private sector, is now available at www.cdc.gov/nchs.
Among some interesting statistical details: In 2009-2010, cold symptoms were the most common reason for ER visits by children (27%); injuries were the most common reason for visits by adults (14%). Between 2000 and 2010, 35% of visits included an x-ray, while the use of advanced imaging scans (CT or MRI) increased from 5% to 17% of visits. In 2009-2010, 81% of visits were discharged for follow-up care as needed, 16% ended with the patient being admitted to the hospital, and 2% ended with the patient leaving without completing the visit. And, in 2009-2010, 59% of visits (excluding hospital admissions) included at least one drug prescribed at discharge.
