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Multi-drug resistant malaria spreading rapidly in Asia: Lancet study

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resistance to two first-line antimalarial drugs has spread rapidly from Cambodia to neighbouring countries in Southeast Asia, according to a study published in The Lancet Infectious Diseases journal.


Researchers from the Wellcome Sanger Institute and University of Oxford in the UK found that descendants of one multi-drug resistant strain are replacing the local parasite populations in Vietnam, Laos and northeastern Thailand.


The team, including researchers from Mahidol University in Bangkok, also found the resistant strain has picked up additional new genetic changes, which may be enhancing resistance even further.


The study reveals the importance of ongoing genomic surveillance to inform public health control strategies, researchers said.


Global efforts to eliminate malaria could be threatened by any delays in detecting and acting on the spread of resistance, they said.


Malaria is caused by Plasmodium parasites which are spread through mosquito bites.


The World Health Organization estimates that nearly 220 million people were infected in 2017, causing at least 400,000 deaths, with children under the age of five in sub-Saharan Africa at most risk, researchers said.


Malaria can be treated when caught early enough, but the parasite is becoming resistant to antimalarial drugs in many areas, especially Southeast Asia, putting elimination efforts at risk.


Over the last decade, the first-line treatment for malaria in many areas of Asia has been a combination of two powerful antimalarial drugs — dihydroartemisinin and piperaquine — otherwise known as DHA-PPQ.


However, a previous study identified a strain of malaria that had become resistant to this treatment.


Researchers found that this resistant strain, named KEL1/PLA1 because of its combination of genetic mutations that cause resistance, had spread across Cambodia under the radar between 2007 and 2013.


This highlighted an urgent need to follow up and determine how far this resistance had then spread and if it had evolved further, and eventually understand which drugs would work against current malaria parasites in Southeast Asia.


The team sequenced and analysed the DNA of 1,673 Plasmodium falciparum parasites, taken from the blood of malaria patients between 2008 and 2018.


Their analysis, focusing on the KEL1 and PLA1 gene variants, revealed that the situation had got much worse after 2013.


The multidrug resistant KEL1/PLA1 parasites had spread internationally, in some regions making up more than 80 per cent of the parasites analysed.


“We discovered that the multi-drug resistant KEL1/PLA1 malaria strain had spread aggressively, replacing local malaria parasites, and had become the dominant strain in Vietnam, Laos and northeastern Thailand,” said Roberto Amato, from the Wellcome Sanger Institute.


“Our large-scale genomic approach demonstrates how surveillance can provide crucial information to malaria control programmes, supporting them in evaluating available treatment options,” Amato said.


The spread is likely to have occurred because resistant parasites had an evolutionary advantage, as DHA-PPQ was the first-line treatment in most of these areas.


This killed other malaria strains but was less effective against KEL1/PLA1 malaria.


The researchers discovered that not only had this resistant strain spread geographically, but it had evolved and picked up new mutations in the chloroquine resistance transporter gene (crt).


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Sick hospital workers often expose patients to contagious illness

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Hospital workers often come to work with contagious respiratory illnesses, against the recommendations of public regulators, a Canadian study suggests.


Nearly all of the 2,093 care workers in the study who had such symptoms came to work at some point while sick.


For the study, published in the Journal of Infection Control & Hospital Epidemiology, nurses, doctors, and support staff at nine across Canada filled in online illness diaries during four flu seasons, recording symptoms such as a runny or stuffy nose, fever, cough or scratchy throat.


Of the 1,036 participants who had contagious respiratory illnesses during the study period, 52% reported working on every scheduled day of work and 94.6% reported working at least one day of their illness.


The most common reason given for working while sick was that the illness seemed mild and manageable. Compared to other care workers, physicians were more likely to work while sick and nurses were less likely.


But nurses who thought their managers expected them to show up unless they were too sick were more likely to feel obligated to work.


For most people, in fact, feeling obligated was a driving factor behind their decision to come to work sick, as was their perceptions of what managers expected from them. Younger workers, and workers without paid sick leave, were more likely to say they could not afford to stay home.


“It is only by knowing these reasons that managers and employers can take steps to mitigate the risk of infection to other people,” said Brenda Coleman, senior study author of the study from the Dalla Lana School of Public Health, University of Toronto, in email to Reuters Health. Eleven percent of the hospital workers said they had come to work even while feeling miserable because they had “things to do.” Physicians were under-represented in the study, and self-reporting of the illnesses may also confound the results, the authors acknowledge in their report.


The US Centers for Disease Control and Prevention advises workers to take seven days off or consider temporary reassignment if they have a fever and respiratory symptoms.


The research team suggests that changing sick leave policies and cultural norms could help reduce the risk of disease transmission from sick health care workers to patients.


Also needed, the researchers say, is an understanding of how to balance the costs and risks of absenteeism by sick workers against the costs and risks of illness transmission associated with working while ill.


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First two cases of Ebola confirmed in Congo’s South Kivu: Officials

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A woman and her child were the first two cases confirmed with in Congo’s South Kivu region this week, opening a new front in the fight against the outbreak.


Health officials said on Friday that the latest cases were more than 700 km (430 miles) south of where the outbreak was first detected.


has killed at least 1,900 people in Democratic Republic of Congo over the past year. This is the second biggest toll ever and militia violence combined with local resistance have made the outbreak harder to contain.


The 24-year-old woman had been identified as a high-risk contact of another case in Beni, more than 700 km north, last month, according to a government statement issued on Friday.


She travelled by bus, boat and road with her two children to Mwenga, in South Kivu, where she died on Tuesday night, according to a slide from a presentation by health officials.


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Research shows how nordic walking may benefit breast cancer patients

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Nordic walking, an aerobic activity performed with walking poles similar to ski poles, may benefit patients with breast cancer, according to a review of existing research.


The low-impact exercise improved swelling, physical fitness, disability and quality of life, the study authors conclude in the European Journal of Cancer Care.


“The main strategy in rehabilitation for women with is a change of habits, where physical exercise is a fundamental tool,” said study co-author Jorge Torres of the Faculty of Educational Sciences and Sports at the University of Vigo in Pontevedra, Spain.


“It’s not easy to turn a sedentary person into an amateur athlete, so sports such as Nordic walking are accepted more easily,” Torres told Reuters Health by email, particularly since the activity doesn’t require expensive equipment, can be done in a group with others, and is easy to learn.


Introduced in the 1980s as a summer training exercise that was similar to cross-country, or Nordic, skiing, Nordic walking became more widespread in the 2000s. It’s now part of some exercise-based rehabilitation programs, especially in Northern Europe where it is more common, Torres noted.


He also owns a personal training company, Vigo Entrena, that creates physical activity programs for people with specific needs, including injuries, obesity, pregnancy, postpartum and women with breast cancer, and he specializes in Nordic walking training.


To see if this form of exercise helps women treated for to reduce side effects like arm swelling, and offers other benefits of exercise, Torres and his colleagues analyzed nine studies. Four studies were randomized controlled trials comparing Nordic walking to other activities; the other studies focused on specific effects of Nordic walking.


Periods of exercise in the studies ranged from 30 to 80 minutes and were performed on one to five days a week for up to 12 weeks.


In eight of the nine studies, Nordic walking had a positive effect on a number of symptoms, including lymphedema, fitness, upper-body strength, disability and perceptions of pain and swelling.


A handful of studies also showed improvements in depression, self-efficacy for managing pain and improvements in physical activity levels. They didn’t find any adverse effects, and the study participants seemed to stick with the programs.


The biomechanical gesture of Nordic walking, compared to just walking, seemed to counteract some of the side effects that can come from cancer treatment, such as shoulder-arm mobility and postural problems, the study team writes.


“(Many) health professionals and therapists do not realize that there are contraindicated exercises during breast cancer rehabilitation and that alternatives such as Nordic walking can be very effective,” Torres said.


“Nordic walking is a structured form of physical activity which nowadays has been shown to be ‘more complete’ than basic walking,” said Marco Bergamin of the University of Padova in Italy, who wasn’t involved in the research review.


“Another important point that is less stressed by these authors: quality of life,” Bergamin said in an email. “Nordic walking gives huge benefits because breast cancer patients are survivors, and from a socio-psychological point of view, that really impacts their life.”


Future studies should also investigate the intensity, frequency, duration, and length of exercise needed to help breast cancer patients, said Lucia Cugusi of the University of Cagliari in Italy, who also wasn’t involved in the review.


“What is most evident is the growing interest of the scientific community in tracking the needs, interests and preferences of patients,” Cugusi said by email.


“Offering them novel forms of physical activity that are both effective and engaging has become one of the new and stimulating research fields in cancer therapy and management.”


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