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Gonorrhea Becoming More Resistant to One Antibiotic: CDC

One of several antibiotic treatment options for the sexually transmitted disease gonorrhea seems to be losing its effectiveness, U.S. health officials warn in a new report.HealthDay news image

The U.S. Centers for Disease Control and Prevention’s latest tracking suggests that although resistance to the antibiotic treatment cefixime went down between 2011 and 2013, it started to creep back up in 2014.

The good news is that cefixime isn’t usually the first drug of choice for treating gonorrhea infections. The CDC’s most recent guidelines for gonorrhea treatment (issued in 2012) recommend only using cefixime when the preferred option — ceftriaxone-based combination therapy — isn’t available. And the CDC’s new report doesn’t indicate any recent waning in the effectiveness of that combination therapy.

Still, indications of antibiotic resistance among any gonorrhea treatment is considered troubling, the study authors said.

“It is essential to continue monitoring antimicrobial susceptibility and track patterns of resistance among the antibiotics currently used to treat gonorrhea,” said study lead author Dr. Robert Kirkcaldy, an epidemiologist in the CDC’s division of STD prevention in Atlanta.

“Recent increases in cefixime resistance show our work is far from over,” he said.

The study findings are published as a research letter in the Nov. 3 issue of the Journal of the American Medical Association.

The CDC noted that gonorrhea is spread during unprotected vaginal, anal or oral sex. The sexually transmitted infection is particularly common among youth and young adults between the ages of 15 and 24.

Many people have no symptoms when infected. When symptoms do occur, they may include a painful or burning sensation when urinating; painful, swollen testicles and discolored discharge from the penis among men. In women, symptoms may include increased vaginal discharge and vaginal bleeding between periods. Rectal infections may spark soreness, itching, bleeding, discharge, and painful bowel movements, the CDC said.

If gonorrhea goes untreated, “serious health complications” can result, Kirkcaldy said. Those can include chronic pelvic pain, infertility and life-threatening ectopic pregnancy — an abnormal pregnancy that occurs outside of the uterus. In rare cases, gonorrhea can spread to your blood or joints, causing a potentially life-threatening infection, the CDC warned.

But when identified, antibiotics can provide an effective cure for those with gonorrhea.

The new CDC study looked at treatment outcomes among male gonorrhea patients who had been treated at public clinics across the United States between 2006 and 2014.

More than 51,000 samples were gathered across 34 cities. About one-third were collected in the western United States and one-third collected in the South. A little more than a quarter of the samples were drawn from men who either identified as gay or bisexual, the study said.

The investigators found that the CDC’s 2012 shift away from recommending cefixime and toward ceftriaxone-based combination therapy had a profound impact: while the combination therapy had been given to less than 9 percent of the patients in 2006, that figure shot up to nearly 97 percent by 2014.

Alongside that shift, the team found that cefixime-resistance went up from 0.1 percent in 2006 to 1.4 percent in 2011, and then back down to 0.4 percent in 2013. But by 2014 resistance trended upward to 0.8 percent, the research revealed.

What does this mean? “Trends of cefixime susceptibility have historically been a precursor to trends in ceftriaxone,” said Kirkcaldy. “So it’s important to continue monitoring cefixime to be able to anticipate what might happen with other drugs in the future.”

Dr. Kirsten Bibbins-Domingo, co-vice chair of the U.S. Preventive Services Task Force in Rockville, Md., emphasized the importance of routine screening.

“The task force recommends screening for gonorrhea in sexually active women age 24 years or younger, and in older women who are at increased risk for infection,” she said.

The task force doesn’t advocate for or against screening for men, saying more research is needed to prove effectiveness. However, Kirkcaldy said that the “CDC recommends an annual gonorrhea screening for high-risk sexually active women and for sexually active gay, bisexual, and other men who have sex with men.”


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What Is Naloxone And How Can It Help Save Drug Users Who Overdose?

Naloxone, commonly known as Narcan, is a medicine that temporarily reverses the effects of opioid drugs such as heroin, morphine and oxycodone. If a person overdoses on an opioid, administering naloxone can help revive them.

Naloxone has been widely used in hospital emergency departments and many ambulance services since the 1970s. It has been shown to be remarkably safe, reliable and effective.

In most countries, including Australia, naloxone is only available in the community on prescription. But since the mid-1990s, clinicians and advocates have called for regulators to make naloxone more widely available to opioid users, their peers and family members who might be present or nearby when an overdose occurs.

Earlier this month Australia’s Therapeutic Goods Administration (TGA) heeded this advice and recommended rescheduling naloxone to allow over-the-counter (OTC) purchase of single-use pre-filled syringes through pharmacies.

It is likely that from February 2016 Australia will become the second country (after Italy in 1995), to have naloxone formally available without a prescription.

Prescription Take-Home Naloxone Programs

Take-home naloxone programs involving supply through prescription have successfully operated in Australia since April 2012, when a program was launched in the Australian Capital Territory. This was soon followed by programs in New South Wales, Western Australia, Victoria and South Australia.

A recent evaluation found that over two years, the ACT program reversed 57 overdoses. The program trained more than 200 participants (mostly opioid users) in overdose-prevention and management, and naloxone administration.

A 2010 survey of naloxone programs operating in the United States since 1996 found that 53,000 kits containing naloxone were distributed through 188 programs across 16 US states. This distribution was reported to have resulted in over 10,000 successful overdose reversals.

Growing international research on implementation of take-home naloxone programs provides further evidence that people who are at risk for overdose and other bystanders are willing and able to be trained to prevent overdoses and administer naloxone.

Recent research shows that even very brief minimal training in using the medicine can be all that is needed to safely administer naloxone.

There is no evidence that wider availability of naloxone leads to riskier or more widespread drug use.

In 2014 the World Health Organization recommended that people likely to witness an overdose should have access to naloxone.

How Does Naloxone Reverse Overdoses?

When a person has an opioid overdose, they lose consciousness and their breathing can slow and even eventually stop. This results in damage to the brain and other organs and, eventually, death.

Most opioid overdoses occur among experienced users. People are most at risk of overdose when their opioid tolerance drops after a period of abstinence or reduced opioid use, such as after prison release, or if they use other drugs such as alcohol or sleeping pills in addition to the opioids.

Research shows that most overdose deaths occur more than an hour after last injection and that others, such as friends or family, are usually nearby.

However, in most fatal cases, tragically, there is no intervention before death. This is primarily because most people are ill-equipped to respond to overdose (wrongly) assuming, for example, that the deep snoring or gurgling associated with impending respiratory collapse means that the person can be left to “sleep it off”.

But opioid overdose can be managed by monitoring the person, maintaining their airway, providing ventilation (with rescue breathing), basic life support and calling an ambulance.

Naloxone administration can greatly assist in reversing overdose by helping to quickly restart normal breathing.

Naloxone has a very specific action in reversing the effects of opioid intoxication. It does not produce any intoxication itself and has no effect on people who don’t have opioids in their system.

In an emergency situation, naloxone is typically administered by injection into a muscle. It can also be provided in a device so it can be sprayed into the nostrils, but naloxone is not licensed for nasal use in Australia.

Taking The Next Step

While over-the-counter access to naloxone will be an important step in facilitating wider access to the medicine, a number of measures will be needed to expand naloxone availability sufficiently to have a significant impact on the rate of lethal overdoses in the community.

Work will be done over the next few months to make the naloxone product packaging and instruction materials suitable for lay people buying it over-the-counter. Systems must also be developed to train people in how to use the medicine, such as through brief advice from pharmacy staff.

Naloxone is not a silver bullet for preventing overdose deaths. But its wider availability should be one important component of an effective strategy to prevent opioid overdose fatalities. The rescheduling of naloxone in Australia will set a new precedent for other countries and will help save lives for years into the future.


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Protein discovery promises to improve mapping of brain tumors

One of the problems with removing brain tumors is ensuring no cancerous tissue remains so they do not regrow. Now, a new study promises to reduce this problem – scientists have discovered a way to highlight a protein on brain scans so the edges of a tumor can be seen more clearly.
mri scanner
Researchers have found a promising way to show the edges of brain tumors in MRI scans more clearly.

The study, which offers scientists the most complete picture of brain tumors yet, is the work of a team from the University of Oxford in the UK, and was presented on Monday at the National Cancer Research Institute (NCRI) Cancer Conference 2015, in Liverpool, UK.

The edges of a tumor contain the most invasive cancercells. For surgery or radiation therapy to succeed, doctors need good maps that show not only where the tumor sits in the brain, but also where its edges are – a clear delineation between cancerous and healthy tissue.

This is important not only in order to remove all the cancerous tissue, but also because the most invasive cells are at the edge of a tumor, as one of the researchers, Cancer Research UK scientist Nicola Sibson, a professor in the Institute for Radiation Oncology at Oxford, explains:

“If we can’t map the edge of the tumor, surgery and radiotherapy often fail to remove aggressive tumor cells – and the brain tumor can grow back.

Currently, on magnetic resonance imaging (MRI) scans, you can see where the brain tumor is, but its edges are blurred. This is because the MRI spots leaky blood vessels inside the tumor. But on the edges of the tumor, the blood vessels are intact, so they do not show as clearly on the scans.

Highlights edges of both primary and secondary brain tumors

Now, for the first time, Prof. Sibson and her team have discovered a useful protein inside the blood vessels at the invasive edge of brain tumors.

In tests on rats, they showed it is possible to use the protein to define the edges of both primary and secondary tumors on MRI scans.

The protein – called VCAM-1 – is released as part of an inflammatory response caused by the brain tumor. The researchers developed a special dye that recognizes and sticks to the protein. The dye highlights the protein – and thus the edges of the tumor – on MRI scans.

An added advantage, note the researchers, is that the protein is on the inside of the vessels, so the dye can access it from the bloodstream.

Prof. Sibson concludes:

“This research shows that we can improve imaging of brain tumors, which could help both surgeons and radiotherapists with more effective treatment.”

Every year, around 256,000 people worldwide are diagnosed with cancer in the brain or another part of the central nervous system. In the UK, where the study was conducted, this figure is around 9,700, or 27 people a day.

“Brain cancers continue to have very poor survival rates,” says Harpal Kumar, chief executive of Cancer Research UK, which co-funded the study with the Medical Research Council. Kumar adds:

“The holy grail would be to be able to completely remove brain tumors with the help of this new imaging technique – reducing recurrence of the disease and saving more lives.”


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Sperm whales’ clicks suggest the animals have culture The whales appear to learn sounds to socialize, similar to the way humans learn language

sperm whale

Sperm whales love to chitchat. They talk to each other in clicks. Now, scientists say, those clicks hold hints that the whales have culture.

Culture is a way of life passed on from generation to generation through learning. “There’s a lot of debate if culture is exclusive to humans or if you can find it in animals, too,” says Maurício Cantor. He is a biologist at Canada’s Dalhousie University in Halifax, Nova Scotia. Earlier research had suggested that dolphins, primates, birds and a few other wild animals have culture. Sperm whales should be added to that list, Cantor and his colleagues now argue in the September 8 Nature Communications.Sperm whales can make some of the deepest dives of all the animals in the sea. They can plunge up to 2,250 meters (7,380 feet) below the ocean’s surface. And they can stay underwater for nearly 90 minutes. When diving, the whales send out loud clicks and listen for the echoes that bounce back after the clicks hit something close by. This is calledecholocation. It’s the animal equivalent of sonar, and the whales use it to hunt — mainly for large squid. But when the whales are not hunting, they use those clicks to chat with each other.

Females and their calves do most of the talking. Tens of thousands of them hang out in the warm waters of the South Pacific Ocean. They usually swim in small units of 12 or so moms, grandmas, aunts and friends. These gals all work together to raise their pod’s babies.

These units are part of larger groups of 30 to 300 whales, which belong to even larger communities, called clans. Individuals in each clan talk to each other using distinct patterns of clicks. These varying patterns are similar to dialects in human speech. A dialect is a regional pattern in speech. People in Boston, Mass., and Dallas, Tex., both speak English, for example. Yet they may use words differently or give them a different pronunciation. Those differences reflect their regional dialects.

Cantor and his colleagues wanted to know how the whales got their distinct dialects. The researchers followed groups of whales around the Galápagos Islands, off South America. Along the way, they recorded the whales’ identities and behaviors. The scientists logged the whales’ sounds and tracked with which other groups these sperm whales interacted.

Back in their lab, the scientists loaded all of these data into a computer. Then they programmed it to test different ways the whale dialects could have developed over thousands of generations. Perhaps the dialects developed by chance. Or there might have been some innate bits of sound passed from mom to baby through DNA. The computer program ruled out both of those scenarios. Instead, the analysis showed that the whales had to have learned their distinct dialects from the other whales around them.Scientists refer to this as social learning.

“Social learning is the foundation of culture,” Cantor says. Because sperm whales learn their dialects from their extended family, there are cultural differences between clans. The clans actually exist because of those cultural differences, he says.

Luke Rendell is a biologist at the University of St. Andrews in Scotland. He was not involved in the study. He points out that the new finding is based on a computer model of how the sperm whale dialects came to be. A model, though, can only simulate the real world. It is not a direct observation of what actually occurred. “Like all models, it is wrong, but it is also useful,” Rendell says.

The model suggests whales have a bias for the sounds of their own clan members, which shapes their society, Rendell notes. This kind of conformity, or sticking with individuals who behave the same, is thought to underpin a lot of human culture. In non-humans, however, it is considered rare. Finding hints that it exists in sperm-whale clans “really starts to lift the lid on cultural processes in non-human societies,” he says.

Cantor notes that the scientists are not suggesting that the whales’ sounds or culture are as complex or diverse as human cultures are. But, he says, “Whale culture, like human culture, seems to be very important for the whales’ social structure.”

Power Words

(for more about Power Words, click here)

bias   The tendency to hold a particular perspective or preference that favors some thing, some group or some choice. Scientists often “blind” subjects to the details of a test so that their biases will not affect the result.

biology  The study of living things. The scientists who study them are known as biologists.

clan    A large family or group of families that have much in common, both genetically and culturally.

computer model A program that runs on a computer that creates a model, or simulation, of a real-world feature, phenomenon or event.

culture  (in social science) The sum total of typical behaviors and social practices of a related group of people (such as a tribe or nation). Their culture includes their beliefs, values, and the symbols that they accept and or use. It’s passed on from generation to generation through learning. Once thought to be exclusive to humans, scientists have recognized signs of culture in several other animal species, such as dolphins and primates.

dialect  A form of language or pattern of communication that is distinct to a specific place or a social group.

DNA  (short for deoxyribonucleic acid) A long, double-stranded and spiral-shaped molecule inside most living cells that carries genetic instructions. In all living things, from plants and animals to microbes, these instructions tell cells which molecules to make.

dolphins  A highly intelligent group of marine mammals that belong to the toothed-whale family. Members of this group include orcas (killer whales), pilot whales and bottlenose dolphins.

echolocation  (in animals) A behavior in which animals emit calls and then listen to the echoes that bounce back off of solid things in the environment. This behavior can be used to navigate and to find food or mates. It is the biological analog of the sonar used by submarines.

generation  A group of individuals born about the same time or that are regarded as a single group. Your parents belong to one generation of your family, for example, and your grandparents to another. Similarly, you and everyone within a few years of your age across the planet -are referred to as belonging to a particular generation of humans.

innate  Something such as a behavior, attitude or response that is natural, or inborn, and doesn’t have to be learned.

model A simulation of a real-world event (usually using a computer) that has been developed to predict one or more likely outcomes.

pod    (in zoology) The name given to a group of toothed whales that travel together, most of them throughout their life, as a group.

primate  The order of mammals that includes humans, apes, monkeys and related animals (such as tarsiers, the Daubentonia and other lemurs).

programming  (in computing) To use a computer language to write or revise a set of instructions that makes a computer do something. The set of instructions that does this is known as a computer program.

scenario   A possible (or likely) sequence of events and how they might play out.

simulate  (in computing) To try and imitate the conditions, functions or appearance of something. Computer programs that do this are referred to as simulations.

social learning  A type of learning in which individuals observe the behavior of others and modify their own behavior based on what they see.

social network  Communities of people (or animals) that are interrelated owing to the way they relate to each other.

sonar  A system for the detection of objects and for measuring the depth of water. It works by emitting sound pulses and measuring how long it takes the echoes to return.

sperm whale  A species of enormous whale with small eyes and a small jaw in a squarish head that takes up 40 percent of its body. Their bodies can span 13 to 18 meters (43 to 60 feet), with adult males being at the bigger end of that range. These are the deepest diving of marine mammals, reaching depths of 1,000 meters (3,280 feet) or more. They can stay below the water for up to an hour at a time in search of food, mostly giant squids.

zoology  The study of animals and their habitats. Scientists who undertake this work are known aszoologists.