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B12 deficiency: The sign around the eyes that may be warning that levels are low

The body's extremities are a well-known site for complications associated with low levels because they are sensitive to touch.

If levels remain suboptimal for long periods, pins and needles or burning sensations may occur.

This is because the sheath that surrounds and protects the nerves becomes damaged, which leads to peripheral neuropathy.

Other symptoms linked to B12 deficiency include fatigue, pale skin, weight loss, pins and needles and a sore red tongue. 

Although the extremities are typically the first areas of the body to pick up on nerve damage, signs may occasionally arise around the eyes too.

According to the health body Medical Daily: "Eye twitching and eyelid spasms are also signs that could help pinpoint vitamin B12 deficiency."

This uncomfortable twitching, scientifically known as eye blepharospasm, can occur in the eye or in other areas surrounding the eye.

Research states that the condition can be reversed, with some evidence suggesting that administration of B12 may help.

In the journal Neurology India, researchers wrote: "[...] Blepharospasm can be a rare manifestation of vitamin B12 deficiency, which is reversible with therapy.

"Vitamin B12 levels and homocysteine levels should be tested in patients with blepharospasm in whom there is no obvious cause for blepharospasm."

The authors went on to stress that although the condition can be a manifestation of vitamin B12, it remains a rare one.

Low to treat B12 deficiency

B12 is naturally found in animal products, so people who eat enough fish, meat, eggs, and dairy will rarely be deficient.

Those with a dietary deficiency, however, will sometimes be offered supplementation.

Others who are unable to absorb the nutrient naturally may be given a B12 infection to top up levels.

B12 infections can only be administered under prescription in the UK. 

Reference: Daily Express: Solen Le Net 

Cancer cells strengthen by sucking mitochondria out of immune cells using ‘tiny tentacles’, study finds

Cancer cells gain strength by forming “tiny tentacles” that suck the power out of immune cells, a recent study that could help develop new drug targets against the malignant disease has suggested.

The research, published in the journal Nature Nanotechnology, found that cancer cells disarm their potential attackers in the immune system by extending ultra-small tentacles that reach into immune cells and pull out their powerpack, the mitochondria.

“Cancer kills when the immune system is suppressed and cancer cells are able to metastasise, and it appears that nanotubes can help them do both,” Shiladitya Sengupta, the study’s co-author and co-director of Brigham’s Center for Engineered Therapeutics in the US, said in a statement.

In the research, scientists co-cultured breast cancer cells and immune cells, such as T cells, and found using cutting-edge microscopy techniques that the two cells were physically connected via tiny tendrils with widths mostly in the 100 nanometre to 1,000 nanometre range, several thousand times smaller than the width of a single human hair.

The researchers then stained mitochondria, which provide energy for cells, from the T cells with a fluorescent dye. They could see that the mitochondria, stained bright green, were pulled out of the immune cells through the nanotubes, and into the cancer cells.

 National Cancer Institute: Breast tumor cell in a free-floating environment

“By carefully preserving the cell culture condition and observing intracellular structures, we saw these delicate nanotubes and they were stealing the immune cells’ energy source,” study co-corresponding author Hae Lin Jang from Brigham’s Center for Engineered Therapeutics said.

“This is a completely new mechanism by which cancer cells evade the immune system and it gives us a new target to go after,” added Dr Sengupta, who is also a co-founder and owns equity in drug development companies Vyome Therapeutics, Akamara Therapeutics and Invictus Oncology, and receives fees from firms Famygen and Advamedica.

The scientists then injected an inhibitor of nanotube formation into mouse models used for studying lung cancer and breast cancer.

They reported a significant reduction in tumour growth, adding that the inhibitor could prevent the cancer cells from hijacking mitochondria.

“Inhibiting the nanotube assembly machinery significantly reduced mitochondrial transfer and prevented the depletion of immune cells,” they wrote.

The scientists have called for further research in animal models to test the potential therapeutic benefits of inhibiting the formation of these nanotubes.

“Based on our observations, there is evidence that an inhibitor of nanotube formation could be combined with cancer immunotherapies and tested to see if it can improve outcomes for patients,” Dr Saha added.

Reference: Independent: Vishwam Sankaran 

Huge spike in people left to die at home and not found for ‘weeks’ during pandemic

The number of people who were left to die at home and not found for “weeks” saw a huge spike during the Covid-19 pandemic, the first study of its kind has shown.

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Research examining post-mortems found cases of markedly decomposed bodies increased by 70 per cent between the year before and after the UK went into lockdown on March 23, 2020. 

Every severely decomposed person that died at home included in the analysis lived alone, the study by pathologists at Imperial College Healthcare Trust, published in the journal Clinical Pathology, stated.

Some of the deaths that occurred in private homes during the pandemic would have normally happened in hospital, the authors concluded, but had some of the patients been treated in hospital it is possible “they would not have died at all”.

 PA Some of the deaths that occurred in private homes during the pandemic would have normally happened in hospital, the authors concluded, but had some of the patients been treated in hospital it is possible ‘they would not have died at all’ - PA

The authors said they hoped the findings would provoke discussion around palliative care at home in England and cases of people dying alone during the pandemic “that may have been preventable”.

It comes as official figures show more than 75,000 excess deaths occurred in private homes in England and Wales since the start of the pandemic, raising questions about the quality of end-of-life care.

System is failing people

Charities have said this new research, which examined around 260 post-mortems in London, “clearly shows a system failing people when they are most in need”.

“This excess in severe decomposition following death is generally a sign of the body not being found for a long time, in excess of at least a week,” study co-author Dr Theodore Estrin-Serlui, a trainee pathologist, told The Telegraph.

During the pandemic many people stayed away from the health service or found it more difficult to access treatment.

Concluding the study, the authors said it was possible to consider that “if these people had been in hospital ... maybe they would not have died at all, if their condition/illness was readily treatable”.

The researchers analysed 159 post-mortems carried out between March 2019 and March 2020 and found less than one in six (26, 16.4 per cent) of the deaths showed marked decomposition.

Of the 104 post-mortems analysed from between March 2020 and March 2021 more than a quarter (29, 27.9 per cent) showed marked decomposition - a 70.5 per cent increase on the previous year.

There were 38 per cent more deaths at home in the 2020/21 cohort and the frequency of severe decomposition in these deaths was up by almost a fifth (19 per cent), but the researchers said this result was not statistically significant.

Dr Sam Royston, director of policy and research at Marie Curie, said: “The pandemic has been a stress test for how well our health and care system works for people dying at home. And this data clearly shows a system failing people when they are most in need.”

People have died in pain

Three quarters of carers whose loved ones died at home during the pandemic said they had missed out on care, according to research by the charity.

“This means that people have died in pain, they have lacked care overnight and not had their symptoms fully managed. It means that families were left to struggle alone and now our own bereavement services are seeing the impact of this - supporting people who are showing signs of trauma,” he said.

Dr Estrin-Serlui said a limitation of the study is that the majority of in-hospital Covid-19 deaths over the last year did not require a post-mortem. “But it still highlights the fact that of the people dying at home, a lot of them were alone, and a lot of them were not being found for a long time,” he said.

“How a society respects its dead is a way of seeing how kind, caring and empathetic a society is. And if there are more people who live alone who are rotting [after they die], I think that unfortunately is an indictment, potentially, of the social structure that underpins our society,” he added. 

A Department for Health and Social Care spokesman offered their “deepest condolences” to anyone affected by loss during the pandemic.

“We are incredibly grateful to NHS staff, including district and community nurses and volunteers, who have worked tirelessly throughout the pandemic to deliver palliative and end-of-life care to people at the most difficult time of their lives,” said the spokesman.

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NHS trust fined record £2.5m over patient deaths

An NHS Trust has been fined more than £2.5 million over safety failings that lead to the deaths of two patients, the highest fine handed to a trust following a prosecution by the health watchdog.

The Dudley Group NHS Foundation Trust was prosecuted by the Care Quality Commission (CQC) following two separate incidents in which a mother-of-six and a 14-year-old girl, who were both suffering from sepsis, died after being "exposed to significant risk of avoidable harm".

Natalie Billingham, 33, died at Dudley's Russells Hall Hospital from multiple organ failure caused by a severe infection in March 2018. Kaysie-Jane Robinson, who had cerebral palsy, died in the same month after an inaccurate "early warning score" meant a sepsis screening tool was not triggered, Wolverhampton magistrates' court was told. 

The CQC said the care both patients received was undermined by the Trust's failure to address known safety failings, which had been repeatedly raised in the months before the deaths.

The Trust admitted two breaches of the 2008 Health and Social Care Act.

Passing sentence on the Trust, District Judge Graham Wilkinson fined it £2,533,332 and ordered it to pay a £38,000 contribution to the costs of the prosecution.

'Had the Trust reacted in a timely fashion, this double tragedy may not have unfolded'

Mr Wilkinson, who conceded that improvements in care had been made since the "dark days" of 2018, said: "One of the most significant features of the case when considering culpability was that the Trust had been inspected by the CQC in a series of unannounced visits during the months preceding this tragedy.

"What was found on each occasion clearly shocked the inspecting team of healthcare professionals.

"It was against this backdrop that Natalie and Kaysie-Jane were failed by the Trust.

"It is clear that had the Trust reacted to the concerns of the CQC in a timely fashion, then this double tragedy may not have unfolded."

In a statement issued after Friday's hearing, Diane Wake, the Trust's chief executive, said: "We are deeply sorry that our care did not meet the standards Kaysie-Jane, Natalie and their families had a right to expect.

"Today's hearing was an important step for the families in a long process. We want to apologise and offer our sincere condolences again to Kaysie-Jane and Natalie's families.

"Although it will offer the families little comfort, we have learned from the failings that led to Kaysie-Jane and Natalie's tragic deaths and made fundamental changes in the way our care is provided."

Reference: Telegraph reporters