DAILY MAIL: GBP 6 -million for Cerebral Palsy

Legal firm IRWIN MITCHELL UK & SPAIN Location(s): Leeds Tel. 0870 1500 100 Fax. 0113 234 3322 PARTNER Rachelle Mahapatra "I have been the head of clinical negligence at the Leeds office since 1995 acting for patients in claims against doctors and hospitals. I am particularly interested in mistakes made surrounding the delivery of unborn babies causing injury sometimes serious to the baby or their mother, complications of abdominal surgery and late diagnosis of cancer. The department in Leeds covers all aspects of clinical negligence.-2421722/ Parents-schoolgirl-8-suffered-brain-damage-birth-staff-failures-win-multimillion-pound-payout.html

DAILY MAIL: HEPATITIS E

HEPATITIS E - UK: PORK SAUSAGES, ALERT ************************************** A ProMED-mail post ProMED-mail is a program of the International Society for Infectious Diseases Date: Sun 15 Sep 2013 Source: The Daily Mail, Mail-online, Health [edited] As many as one in 10 sausages is infected with a potentially deadly virus that causes liver damage, scientists warn. They are concerned that rising numbers of Britons are being struck down with hepatitis E after eating contaminated pork. The infection was once considered very rare, but cases have risen by nearly 40 per cent in a year, and there were 657 in 2012. The virus usually causes only relatively mild symptoms such as sickness, a temperature and muscle pain, which clear up by themselves within a month. But it can be fatal for the elderly, cancer victims, pregnant women and others with existing liver problems. Around one in 50 of those infected will die, rising to one in 5 pregnant women, according to statistics. Experts say sausages have to be cooked at 70 C (158 F) for at least 20 minutes to kill the virus, but they say that most Britons do not leave them in the oven for this long. Tests have showed that it can survive at 60 C after an hour. A report published last week by the Department for Environment, Food, and Rural Affairs says 10 per cent of sausages recently sampled were found to contain the virus. It states that there is increasing evidence that hepatitis E, which is common in the developing world, where it is usually transmitted through contaminated water, is a food-borne infection and adds that it is increasingly being recognised as a major disease. All forms of hepatitis cause swelling of the liver, which in severe cases can cause severe damage to the organ, liver cancer and death. More than half of those infected with hepatitis E are men over 50, who are more susceptible as they tend to drink more and their livers are weaker. The virus is particularly harmful for pregnant women who catch it in the final 3 months of their pregnancy because it can lead to acute liver failure, and one in 5 expectant mothers who catch the virus will die. Dr Harry Dalton, a consultant at the Royal Cornwall Hospital in Truro and one of Britain's leading experts on hepatitis E, said: "This is emerging as a serious problem. About 85 per cent of British pigs carry the virus, which is quite hardy. Sausages have to be cooked at 70 C for 20 minutes to kill it, and that is longer than most sausages ever get cooked. Anyone cooking with sausages or other pork products should take stringent hygiene precautions including washing their hands and cleaning work surfaces." Sausages are regarded as the most dangerous product, as they often contain liver meat and traces of pig's blood as well as a casing from the animal's intestine. -- Communicated by: ProMED-mail [The following is the DEFRA statement entitled: "Hepatitis E and detection in pork and pork products," , referred to in the above press report. "There has been recent publicity about hepatitis E infection in humans. This relates to an increase in 2010-11 in the proportion of cases of hepatitis E diagnosed where there is no history of travel by the affected person. A recent publication (Berto and others, 2012) reported PCR detection of hepatitis E virus in 13 percent of pig faeces and 3 percent of pig livers at slaughter and 10 percent of pork sausages at retail. Whether virus is infective at these different stages was not established. The report of an extensive case control study in humans is expected in 2013 and may identify risk factors and assist in determining whether there is evidence to support the putative link with consumption of pork and pork products. In the meantime, a multi-agency, joint-funded abattoir survey of pigs, expected to be conducted in early 2013, will seek to establish the prevalence of infection in slaughter pigs in the UK. This is highlighted here as an issue which may cause adverse publicity for the pig industry at what is already a difficult time." See: . Hepatitis E is a liver disease caused by hepatitis E virus: a non-enveloped, positive-sense, single-stranded ribonucleic acid virus. Hepatitis E virus is transmitted usually mainly through contaminated drinking water. It is usually a self-limiting infection and resolves within 4-6 weeks. Occasionally, a fulminant form of hepatitis develops (acute liver failure), which can lead to death. The hepatitis E virus is transmitted mainly through the faecal-oral route due to faecal contamination of drinking water. Other transmission routes have been identified, which include: foodborne transmission from ingestion of products derived from infected animals, transfusion of infected blood products, and vertical transmission from a pregnant woman to her fetus. The incubation period following exposure to the hepatitis E virus ranges from 3-8 weeks, with a mean of 40 days. The period of communicability is unknown. Typical signs and symptoms of hepatitis include: jaundice (yellow discolouration of the skin and sclera of the eyes, dark urine and pale stools, anorexia (loss of appetite), an enlarged, tender liver (hepatomegaly), abdominal pain and tenderness, nausea and vomiting. Overall population mortality rates from hepatitis E range from 0.5 to 4.0 percent. Fulminant hepatitis occurs more frequently during pregnancy. Pregnant women are at greater risk of obstetrical complications and mortality from hepatitis E, which can induce a mortality rate of 20 percent among pregnant women in their 3rd trimester. Cases of chronic hepatitis E infection have been reported in immunosuppressed people. Reactivation of hepatitis E infection has also been reported in immunocompromised people. (From: ). Previously, ProMED-mail reported cases of hepatitis E in France associated with undercooked pork sausage meat. - Mod.CP

SCOTLAND: LEGIONELLA LONGBEACHAE from compost

] Date: Fri 13 Sep 2013 Source: This Is Jersey/Jersey Evening Post [edited] A health board is investigating 4 cases of the infection [due to] _Legionella longbeachae_ linked to gardening compost. 2 patients are being treated in intensive care while 2 more have been discharged from hospital, NHS Lothian said. The 4 people affected are keen gardeners between the ages of 62 and 84. Dr Richard Othieno, NHS Lothian consultant in public health and chair of the incident management team, said: "This type of _Legionella_ is quite rare in that unlike other strains it has never been identified in man-made water systems, like cooling towers. We are working with experts to trace the source of the infection and samples of the compost have been sent for testing. We know that all of the 4 cases are keen gardeners and had purchased different products containing compost prior to acquiring the infection. Gardening is a healthy hobby but there are risks and it is important that people take some simple precautions when working in their garden or with gardening products. I would like to add further reassurance that the risk to the wider public is low." The symptoms of _Legionella longbeachae_ [infection] include headaches, diarrhoea, or a dry cough followed by pneumonia. Most people recover after treatment with antibiotics but those with underlying medical problems are more vulnerable, the health board said. It is not known exactly how the infection is passed from compost to people but health experts assume it is through breathing in very small dust particles or drops of contaminated water. The infection is not transmitted from person to person. Anyone handling garden materials such as potting mix, mulches, composts, or garden soils is advised to open bags carefully, wear gloves and keep doors to greenhouses or sheds open when potting plants or filling hanging baskets. Gardeners are also advised to wear a mask if the air is dusty, particularly indoors, and to wash their hands immediately after using compost and before smoking. There is no link between the current cases and the outbreak of [infection due to] _Legionella pneumophila_ in southwest Edinburgh in 2012, NHS Lothian said.

PLASMA CELL CANCER CLASSIFICATION from "LEUKEMIA"

Experts Publish Consensus Risk Classification For Multiple Myeloma Published: Sep 13, 2013 5:24 pm An international panel of multiple myeloma experts, known as the Inter­national Myeloma Working Group (IMWG), recently released a consen­sus statement on risk stratification for patients with multiple myeloma. Risk stratification refers to the classification of patients into different cate­gories based on likely disease outcome. The new IMWG risk stratification, for example, has three risk categories: low-risk, standard-risk, and high-risk. In the new system, determination of a patient’s risk classification is based on three factors: a patient’s disease stage according to the Inter­national Staging System (ISS); the presence of certain chromosomal abnormalities in the patient’s myeloma cells based on results of so-called FISH testing; and patient age. Patients who are ISS stage II or III and whose myeloma cells contain the translocation t(4;14) or the deletion del(17p13) are classified as high-risk. About 20 percent of patients are expected to fall in this category at the time of diagnosis, with median overall survival of two years from diagnosis. Patients who are ISS stage I or II, under the age of 55 years, and whose myeloma cells do not contain t(4;14), del(17p13), or 1q21 gain are classified as low-risk. About 20 percent of patients also are expected to fall in this category at diagnosis, with median overall survival of more than 10 years from diagnosis. The remaining 60 percent of patients are classified as standard-risk, with median overall survival of seven years from diagnosis. Despite agreeing on how to classify patients into low-risk, standard-risk, and high-risk groups, the expert panel does not recommend that their stratification be used to determine a myeloma patient’s initial therapy. Some major treatment centers – notably the Mayo Clinic – favor a “risk-adapted” approach to myeloma therapy, in which a myeloma patient’s initial therapy is guided by their risk classification. The expert panel, however, does not believe that such an approach is generally warranted at this time. In addition to the risk stratification described above and a discussion of risk-adapted therapy, the newly published consensus statement presents the experts’ current opinions on the need for risk stratification and explains the criteria that can be used for risk stratification. The Need For Risk Stratification According to the consensus statement, one of the foremost reasons for risk stratification is to inform a patient of his or her prognosis. It allows physicians to provide an expected survival time in answer to the patient’s question, “How long do I have to live?” (see related Beacon article on myeloma prognosis). Secondly, the experts argue that risk stratification may pave the way for risk-adapted therapy. In risk-adapted therapy, a patient’s treatment is tailored to their risk category. For example, high-risk patients receive more intensive treatment than low-risk patients (see related Beacon article). This approach aims to minimize side effects while maximizing the benefits of treatment. Risk-adapted therapy is commonly used for acute myeloid leukemia and Hodgkin lymphoma, diseases in which low-risk patients can be cured with non-intensive treatment. However, there is an argument that this approach does not apply to myeloma, since myeloma is still considered incurable. Instead, all myeloma patients should receive the most effective treatment available. The researchers suggest that the identification of low-risk myeloma patients, who are likely to live 10 years or longer, may strengthen the case for risk-adapted therapy in myeloma. The investigators also note that risk stratification provides a useful framework for testing new therapeutic strategies. For instance, they suggest that strategies without high-dose chemotherapy and stem cell transplantation can be tested for low-risk patients, while more potent strategies need to be tested for high-risk patients who have poor outcome with current treatment strategies. Factors That Can Be Used For Risk Stratification In order to arrive at meaningful risk stratification criteria, the experts considered a number of factors that have been found to be associated with poorer myeloma prognosis. They divided these risk factors into host-related factors (related to the patient) and tumor-related factors (related to the myeloma cells). Age The researchers conclude that the most important host-related factor in determining myeloma risk is age. Several previous studies have shown that younger age at myeloma diagnosis is strongly associated with longer survival (see related Beacon news and the Beacon’s recent article on multiple myeloma survival by race and age). Chromosomal Abnormalities And Gene Expression Profiles According to the consensus, the most important tumor-related risk factors are the presence of certain chromosomal abnormalities and the gene expression profile of the patient’s myeloma cells. Chromosomal abnormalities are changes in the structure of the cell’s genetic material. These changes can occur through deletions, insertions, duplications, or the movement of pieces of genetic material. The experts note that the translocation t(4;14) and the deletion del(17p13) are consistently associated with poor survival across a number of studies. The effects of the translocation t(14;16) and 1q21 gain on disease prognosis have remained controversial. However, the researchers note that the lack of 1q21 gain could be useful in identifying patients with good prognosis. Since a number of studies have revealed variations in prognosis even among individuals with chromosomal abnormalities, the experts conclude that the use of chromosomal abnormalities as a stand-alone risk factor may not be optimal. However, they suggest that combining information about chromosomal abnormalities with other factors could improve their prognostic value. Gene expression profiling simultaneously measures the activity of thousands of genes in a patient’s myeloma cells, creating a snapshot, or profile, of everything going on inside the cells. Previous studies have identified a number of gene expression profiles that are associated with poor disease prognosis. The experts note, however, that the clinical application of gene expression profiling remains limited due to three important factors: (1) the lack of a unified and standardized gene expression profile for myeloma cells, (2) the perception of a lack of reproducibility for the technique, and (3) the difficulty faced by physicians in analyzing and interpreting the complex data generated from gene expression profiling. To address the lack of a standardized profile, the IMWG is currently conducting a study that combines a number of known gene expression profiles to generate a unified set of profiles, which will then be tested. Disease Stage The International Staging System (ISS) uses a combination of b2-microglobulin levels and albumin levels in the blood to classify patients into three disease stages. Studies have shown that advanced disease stage is linked to poorer survival. The ISS, however, does not take chromosomal abnormalities into account. Based on more recent studies, the experts note in the consensus statement that a model that combines both ISS staging and chromosomal abnormalities could be more effective in predicting risk. They add that results from a recent IMWG analysis showed that ISS staging and the presence or absence of t(4;14) and del(17p13) can reliably segregate patients into three risk groups. Responsiveness Of Tumor To Treatment How a patient’s myeloma responds to treatment is a risk factor that can only be determined after treatment. According to the experts, not achieving at least a partial response to treatment – or at least a very good partial response to stem cell transplantation – is reflective of resistance to treatment and associated with poorer disease outcome. The experts state, however, that early relapse or an inability to maintain response to treatment is an indicator of very poor prognosis. Consensus Definition Of Risk Groups From among the various risk factors discussed above, the researchers sought to identify the most relevant factors to use for stratification. A study published by the IMWG in March showed that combining ISS stage with data about chromosomal abnormalities significantly improved risk assessment in myeloma. In particular, the study identified three key chromosomal abnormalities – t(4;14), del(17p13), and 1q21 gain, measured using the technique known as fluorescence in situ hybridization (FISH). The experts used the results of this previously published study to guide their final consensus risk stratification, which is as follows: High Risk – Patients who are ISS stage II/III and whose myeloma cells contain the translocation t(4;14) or the deletion del(17p13) are classified as high-risk. About 20 percent of patients are expected to fall in this category, with median overall survival of two years from diagnosis. Low Risk – Patients who are ISS stage I/II, under the age of 55 years, and whose myeloma cells do not contain t(4;14), del(17p13), or 1q21 gain are classified as low-risk. About 20 percent of patients are expected to fall in this category, with median overall survival of more than 10 years from diagnosis. Standard Risk – The remaining 60 percent of patients are classified as standard-risk, with median overall survival of seven years from diagnosis. The experts note that the two tumor-related factors used in the new stratification – ISS stage, which is based on b2-microglobulin and albumin levels in the blood, as well as the chromosomal abnormalities t(4;14), del(17p13), and 1q21 gain (measured using FISH) – are based on robust laboratory tests and are applicable to more than 90 percent of all myeloma patients. Experts Not Yet Ready To Recommend Risk-Adapted Therapy Despite the definition of what the experts believe is a robust risk stratification system for myeloma, the panel notes in its consensus statement that “We are still not in a position to recommend different treatments for patients in different risk groups.” Instead, the experts recommend that “all patients should receive the most optimal treatment tested in Phase 3 clinical trials and currently available,” with dose modification according to patient-related factors. The only exception stated in the consensus report is that the experts recommend the use of Velcade (bortezomib)-based initial and maintenance regimens for patients with t(4;14). The researchers made this recommendation based on several studies showing that Velcade-based treatment attenuates the increased risk associated with the t(4;14) abnormality. Although the experts do not recommend risk-adapted therapy at this time, they note that risk stratification can offer a useful framework for deciding among treatment options. For instance, they note that a low-risk patient could potentially choose a regimen with lower cost and toxicity, even if it was associated with slightly reduced efficacy. The researchers explain that such decisions are also dependent upon the treatment philosophy of the physician, who can take either a cure approach (aggressive treatment with the aim of achieving a complete response) or a control approach (less aggressive treatment with a focus on disease control and quality of life) toward treating the disease. The experts recommend that future studies should aim to further refine the risk groups defined in the consensus statement, based on the underlying biology of the myeloma cells. For further information, please see the consensus report in the journal Leukemia.

Mr.T.LeDUC site : WORLD DISEASE STATS & LIFE EXPECTANCY

http://www.worldlifeexpectancy.com/members.php World Life Expectancy is the latest in a series of Educational Experiences developed by LeDuc Media. The Site’s purpose is to stimulate meaningful research on this important subject through leading Academic Institutions worldwide, while displaying the data in ways the less informed visitor can understand and use. Gathering meaningful Life Expectancy data from every corner of the Globe is an expensive and time-consuming process and with the help of our sponsors, we intend to continue to make it available for free. Our goal is to assist people everywhere in living longer and more productive lives. In the short time the Site has been in existance it has received over 1,000,000 Visitors from 148 countries and is being used everyday by major universities, government institutions, corporations and even K-12 schools in local communities. We are especially pleased to see the number of Military organizations using the Site and are hopeful this trend will continue.

TORONTO: Canadian Cancer Research Alliance conference

The Canadian Cancer Research Alliance is proud to host the second Canadian Cancer Research Conference, taking place from Sunday November 3 to Wednesday November 6, 2013 at the Sheraton Centre Toronto Hotel in Toronto, Ontario. The conference will: Showcase the breadth and excellence of Canadian cancer research to both the research community and the public; Provide a single venue for researchers from across the cancer research spectrum and cancer sites; Expose researchers to new areas of cancer research, new techniques and infrastructures and facilities to support research; Allow for cross-fertilization between research disciplines; and Provide networking opportunities for researchers at all levels of their careers. The conference is targeted to all involved in cancer research from the lab to clinic to policy and will also incorporate special sessions for trainees and new principal investigators. We look forward to seeing you in November 2013! The conference will be conducted in English, which has become the international language of science.

UK: PRIVATE(charitable) BUCKINGHAM UNIVERSITY MEDICAL SCHOOL

http://www.buckingham.ac.uk/medicine/undergrad/mbchb MBChB after 4.5 years. 2 pre-med + 2.5 clinical. No limit to Overseas (non-EU) students. Oxbridge-style tutorials.