Specific Ebola Treatment May have Prevented Thousands of Deaths in Sierra Leone

The introduction of thousands of Ebola treatment beds by the UK and Sierra Leone governments and NGOs prevented an estimated 57,000 Ebola cases and 40,000 deaths in Sierra Leone, according to new research published in the Proceedings of the National Academy of Sciences.

The UK played a leading role in the response to the crisis in Sierra Leone. This focused on increasing the number of available treatment beds which isolated the ill to prevent further infections in the community, changing behavior so people suspected of having Ebola sought treatment early, and making burials safe.

Lead author Dr Adam Kucharski, Lecturer in Infectious Disease Epidemiology at the London School of Hygiene & Tropical Medicine, said: “Our findings show the unprecedented local and international response led to a substantial decline in Ebola transmission. Given the rapid growth of the outbreak in Sierra Leone, if those beds hadn’t been in place to isolate the ill and avert further infections, the epidemic could have been much worse.”

London School of Hygiene and Tropical Medicine

Figures from the World Health Organization state there have been 13,945 reported cases of Ebola in Sierra Leone to date [1], with an estimated 70% of infections resulting in death during 2014 [2]. With many cases in Sierra Leone potentially going unreported, the real figure is likely to be much higher.

Between September 2014 and February 2015, more than 1,500 treatment beds were introduced in Ebola holding centers and community care centers, and a further 1,200 in Ebola treatment units, to support the overstretched health system in Sierra Leone.

Using mathematical models, researchers estimated the potential impact additional treatment beds had in bringing about the decline of the Ebola outbreak. They separated out the effect of beds from other factors that reduced transmission, such as behavior change, community engagement, improved case finding and increase in safe burials.

Taking into account both reported and presumed unreported cases, the researchers say 57,000 Ebola cases were prevented up to February 2015 as a direct result of the introduction of treatment beds. Given that the Ebola case fatality rate in Sierra Leone was near 70%, the researchers estimate this averted 40,000 deaths.

However, they estimate that had the beds been introduced just one month earlier, an additional 12,500 reported and unreported cases could have prevented. If only 60% of Ebola cases were reported (as has been stated in field studies), this figure equates to 7,500 reported cases [3] – more than half of the total number of cases recorded by the World Health Organization.

Study co-author Professor John Edmunds of the London School of Hygiene & Tropical Medicine, said: “There has been much criticism of the international community’s slow response to the Ebola outbreak. Our analysis suggests putting treatment beds in place just one month earlier could have further reduced the size of the outbreak and potentially saved thousands of more lives. The way we prepare for, and respond to, future outbreaks of Ebola and other infectious diseases needs to be strengthened.”

Beginning in December 2013, the world’s largest ever Ebola epidemic primarily affected Liberia, Guinea and Sierra Leone in West Africa. Liberia has recently been declared Ebola free, while Guinea and Sierra Leone have very few cases left.

The study authors have played an active role throughout the Ebola crisis, providing data to assist governments and NGOs in planning their response. The London School of Hygiene & Tropical Medicine is involved in many aspects of the ongoing Ebola response, including clinical trials of vaccines and convalescent plasma treatment, and work to strengthen global response to infectious disease epidemics.

This new research by Dr Kucharski and colleagues was funded by the Research for Health in Humanitarian Crises (R2HC) Programme, managed by Enhancing Learning and Research for Humanitarian Assistance (ELRHA). The £8 million R2HC program is funded equally by the Wellcome Trust and DFID.

The researchers chose to focus on the impact of beds due to limited available data on other control measures in some districts of Sierra Leone. They note that with better data on the timing and role of different interventions – both clinical and non-clinical – it would be possible to obtain more accurate estimates about the precise contribution of different factors to the decline of the epidemic.

-MFP News Services

Extreme Weight Loss Tactics of Professional Athletes Create Alarm From Doctors

United Kingdom – Cage fighters are indulging in potentially dangerous behaviors in a bid to lose large amounts of weight in the shortest possible time before a fight, reveal doctors in a snapshot survey of preferred slimming tactics, published online recently in the British Journal of Sports Medicine.


Mixed martial arts, often referred to as cage fighting, became popular with western audiences in the early 1990s via the Ultimate Fighting Championship (UFC). It has since become one of the world’s fastest growing sports and is now broadcast to around 130 countries and 800 million households worldwide.

There are 11 different competitive weight classes, but athletes aim to compete at the lowest possible weight, usually achieved by chronic dehydration methods, such as saunas, sweat suits, diuretics–pills that boost fluid loss–and hot baths.

In September 2013 a Brazilian cage fighter died after attempting to shed 20% of his body weight–equivalent to 15 kg–in just 7 days.

And there have been several recent cases of fighters who were forced to withdraw from competition or retire as a result of the symptoms/health problems induced by repeated rapid weight loss tactics.

To find out if UK cage fighters were also putting their health at risk, the researchers carried out a snapshot survey of 30 athletes competing in five different weight classes.

They describe their findings as “alarming.”

Two thirds (67%) of the sample engaged in a previously unreported practice known as ‘water loading’ which involves cutting back on salt intake and dramatically increasing water consumption to around 23 litres over three days.

This was done in the belief that it would trigger ‘flushing mode’ and prompt excess urine output.

Almost one in five (17%) of the fighters said they used commercial products to boost sweating either by stimulating the circulation or by blocking pores.

More than one in three (37%) took prescription and/or over the counter diuretics, while around one in 8 (13%) used intravenous lines and glycerol to encourage rehydration after the critical weigh-in–which usually occurs between 24 and 36 hours before a fight.

Around three quarters (73%) used nutritional supplements during their weight loss spree, although six out of 10 of them had no idea if these would be tested for banned substances.

All 30 fighters fasted completely or ate a low carb diet in the 3-5 days leading up to the weigh-in, so risking energy depletion, but only one in five (20%) sought dietary advice from a qualified sports dietician or nutritionist.

They said that most of their dietary advice was gleaned from coaches, other competitors and the internet.

Rapid and intensive dehydration increases the potential of blows to the head to damage brain tissue, because unlike boxing, trauma can occur after loss of consciousness. On average, 2.6 head blows are sustained after a cage fighting opponent has passed out.

Of further concern is the lack of any regulatory body for UK cage fighters, to set standards for the health and safety of athletes in competition and apply anti-doping procedures, the researchers add.

They make a raft of recommendations, including the introduction of additional weight classes to reduce the differences between them, shortening the time between weigh-in and competition, and more education for competitors on how to lose weight safely.

-MFP News Services

Specifci Brain Chemical May Aid Some Patients with Tourette Syndrome

A chemical in the brain could potentially be harnessed to help young people with Tourette Syndrome (TS) to overcome the physical and vocal tics associated with the neurological disorder, say researchers.

In a paper published in the journal Trends in Cognitive Sciences, academics from The University of Nottingham reviewed recent evidence that the neurochemical known as Gamma Aminobutyric acid (GABA) is responsible for dampening down the hyperactivity that causes the repetitive and involuntary movements and noises.

University of Notthingham

They found that increases in the production of GABA as a result of changes in the brain during adolescence may contribute to an improvement in symptoms for the majority of people with TS and could offer a new avenue for treatments that lead to targeted increases of the chemical in the areas of the brain that control motor function.

Professor Stephen Jackson, in the University’s School of Psychology, said: “This is potentially a very important finding. A widely held view has been that unwanted movements such as tics in Tourette syndrome are actively suppressed through the recruitment of frontal brain areas involved in volitional action and cognitive control. The finding that individuals with Tourette syndrome exhibit increased GABA in brain areas linked to the planning and selection of movements offers a more parsimonious account for how tics might be controlled in Tourette syndrome. Namely that motor excitability is reduced locally within brain motor areas through the operation of GABA-mediated ‘tonic inhibition’. This finding needs to be further replicated but if it proves to be a robust finding it may have important implications for therapies for neurodevelopmental disorders.”

TS is a neurological disorder affecting around one per cent for all school-age children, who are affected by an evolving series of chronic physical and vocal tics which develop over time and become increasingly worse.

While children with TS can often suppress their tics, it takes great effort and can be both uncomfortable and stressful and eventually builds up until the urge to tic becomes uncontrollable.

Tics are at their worst for people with TS aged between 11 and 14 years old, but for the majority begin to improve throughout adolescence and into early adulthood. For a substantial minority though (around 20 to 30 per cent) the tics continue and for some become increasingly severe and resistant to treatment.

Previously some researchers have thought that the successful control of tics comes about over time through the purposeful and continual effort to suppress them.

However, the Nottingham team – which also includes researchers from the Institute of Mental Health – believe it is more likely that tics improve as a result of the changes in brain structure and function that occur during adolescence.

Specifically, they believe that this could largely be attributed to the neurochemical GABA – the primary inhibitory transmitter found in the central nervous system, which plays the principle role in controlling the ‘excitability’ of neurons.

The brain’s neural circuits are established early during development, with milestones including the creation and migration of neurons, the formation of synapses – the pathways by which the neurons carry their electrical signals – and the strengthening of those synaptic connections.

These early developments produce brain networks with a balance of influences that will excite and inhibit the brain and a disruption to this natural order has been associated with a number of common neurodevelopmental disorders including TS.

GABA is the main inhibitory neurotransmitter in the brain and contributes to almost all functions.

Findings from previous research support the idea that TS is linked to changes in the levels and function of GABA in the brain. MRI studies have consistently shown a reduced level of GABA in the brains of those with TS and post-mortem studies have shown this decrease to be as much as 50 per cent.

GABA is believed to have an inhibitory function in the areas of the brain associated with higher motor function and that a decrease in this inhibiting factor leads to the tics experienced by people with TS.

A long-standing theory is that people with TS gain control over their tics by developing self-regulating techniques to compensate, which in turn lead to a physical ‘re-wiring’ within the neural pathways of the brain.

The Nottingham experts however believe that this new control may come as a result of a higher amount of GABA, which is being released in the brain during adolescents, and which inhibits the motor regions such as the Supplementary Motor Area.

The findings could offer a new avenue for treatments which mimic this inhibiting affect within the motor function areas of the brain and could potentially offer new hope for people with TS whose disorder stays with them into adulthood and has a devastating impact on their quality of life and their ability to make friends and maintain relationships.

-MFP News Services