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Britain hit by MONKEYPOX: Two patients in Wales catch virus

Two cases of the rare monkeypox virus have been confirm in the UK, Matt Hancock has revealed.

Giving evidence to MPs today on the handling of the pandemic, the health secretary casually said the killer virus had been spotted.

Public Health Wales subsequently confirmed in a statement that two people from the same household in North Wales picked up the virus abroad and were admitted to hospital in England. 

It confirmed that one of the people infected with monkeypox is still in hospital, but did not give further details of their location or condition.

Monkeypox is a rare viral disease which causes a blistering skin rash and feverish, flu-like symptoms. It is caused by a virus spread by monkeys, rats, squirrels and other small mammals.

The illness can spread between people either by skin-to-skin contact, coughs and sneezes or by touching contaminated clothes or bedding. 

Discussing the trace and isolation system, Mr Hancock said it was 'essentially built for very important, but very small outbreaks'.

'As health secretary you are dealing with these sorts of outbreaks all the time. I am currently dealing with a monkeypox outbreak and cases of drug-resistant TB and that is absolutely standard,' he said. 

The Welsh health body said it and Public Health England are monitoring the two cases of the virus. 

'The index case was acquired overseas, and the two cases are members of the same household. Both cases were admitted to a hospital in England, where one currently remains.

'Monitoring and follow-up of the cases and their close contacts are undertaken as part of normal practice, and the risk to the general public is very low.' 

Cases of monkeypox were identified in the UK for the first time in 2018 when three people caught the infection in separate instances in Cornwall, Blackpool and Liverpool. 

Around one in 10 people who become ill with monkeypox will die and most deaths from the virus occur in younger age groups, according to the World Health Organization. But human-to-human contact is 'relatively limited', it said.

Richard Firth, a consultant in health protection at Public Health Wales, said 'confirmed cases of monkeypox are a rare event in the UK, and the risk to the general public is very low'.

Emily Craig Health Reporter For Mailonline  18 hrs ago

Post-menopausal women report periods coming back after having Covid vaccine

Some post-menopausal women are suffering unexpected periods after receiving a dose of the coronavirus vaccine, scientists say.

Researchers are investigating the reports to see if the disruption to the menstrual cycle is caused by the jabs.

No proof has yet been found linking the inoculations to the unusual reproductive symptoms, but a growing body of anecdotal evidence has led scientists to begin probing the reports.

Professor Tim Spector, an epidemiologist at King’s College London, said earlier this month that the symptom-tracker app ZOE was monitoring reports of period-related side-effects.

“At the moment there are just a few hundred of these, which given that we have over about 6,000 women who have been reporting, is a small number,” he said.

“But we are taking it seriously and we are going to start asking more questions in the report.”

More data was needed in order to determine if the link was real or “just a statistical quirk”, he said.

Dr Kate Clancy, a medical anthropologist at the University of Illinois, wrote on Twitter about her own experience of unusually heavy blood flow after receiving the Moderna vaccine.

A colleague told me she has heard from others that their periods were heavy post-vax. I'm curious whether other menstruators have noticed changes too? I'm a week and a half out from dose 1 of Moderna, got my period maybe a day or so early, and am gushing like I'm in my 20s again.

— Dr. Kate Clancy 🏳️‍🌈 (@KateClancy) February 24, 2021

She noted that less than two weeks after her first dose, her period arrived earlier than anticipated. Hundreds of women with similar tales shared their own sequence of events.

Dr Clancy subsequently set up a survey dedicated to the issue to see if there is a scientifically robust relationship, but has yet to release any information on the findings.  

Clinicians believe that even if there is a link between a person’s periods and a recent injection, it is unlikely to have any impact on fertility. 

Dr Victoria Male, a reproductive immunologist at Imperial College London, told the BBC that vaginal bleeding following vaccination was not unusual. 

She says the immune response to a vaccine, which is identical to when the body identifies a pathogen, causes myriad chemical signals to be produced and released into the bloodstream to fend off the foreign invader.

The immune system also plays a significant role in the monthly curation of a womb lining in preparation for pregnancy. Under normal conditions, this lining sheds on a monthly basis if an egg fails to be fertilised. However, the extra chemicals produced following vaccination can disturb this process and result in premature shedding.

Dr Male says this could be the mechanism behind the abnormal menstruation symptoms and it will not increase the risk of miscarriage.

Dr Sue Ward, vice-president at the Royal College of Obstetricians and Gynaecologists, told The Telegraph: “We”re aware some women have been reporting a change to their period cycle or symptoms during the pandemic.

“The degree to which changing hormone levels will affect someone is often informed by her psychological wellbeing at that time.

“We know that life events can make PMS symptoms feel worse and something as all-consuming and life-changing as a global pandemic could result in women experiencing their periods differently.

“Anecdotally some women are reporting heavier periods after receiving the Covid-19 vaccine and we would support more data collection in this area.”

The MHRA, the regulatory body responsible for assessing the safety of drugs and vaccines in the UK, monitors side-effects from the Covid-19 vaccines with its “Yellow Card” scheme.

An MHRA spokesperson told The Telegraph: “All Yellow Card reports of suspected side effects are evaluated, together with all other sources of evidence, by a team of safety experts to identify any new safety concerns.

“The current evidence does not suggest an increased risk of menstrual irregularities following vaccination with a Covid-19 vaccine.”

Reference: The Telegraph: Joe Pinkstone  2 days ago

A tragic death is a reminder that unnecessary tests have the potential to cause harm

Between the end of my specialist oncology training and finding a proper job, I undertook a common rite of passage by earning an income as a locum doctor. A community practice was looking for a physician to supervise various forms of cardiac testing and welcomed my flexibility. A qualified technician did most of the work; my job was to ask brief questions and stand by for an emergency. I felt like the mundane attendant that I was paid to be.

One day, a pleasant middle-aged man arrived. 

“Tell me why you’re here”, I began.

“No idea, love.”

At my frown, he added helpfully, “I guess my doctor would know.”

The referral had no clinical details. Probing the man’s history revealed no significant risk factor. Yet, he was there, eager to be done and return to work. I felt I had no choice in the matter.   

After his uneventful test, he whistled and walked away, but even though I’d been only incidental in the decision-making chain, I nonetheless felt responsible. Every test had the potential to go wrong. Every test costs the taxpayer. Every test should have a clinical rationale.

I sought out the chief physician to broach the observation that a fraction of the tests I was supervising did not seem to have a clear clinical indication, hoping he would disprove me, but instead he was alarmed.

He was merely a service provider, he intoned. If he started to question the rationale for testing, he would alienate his customers, namely other doctors. I was deflated but with more experience, I might have predicted that sometimes, the most expedient solution to an ethical dilemma is to get rid of the person who thinks it a dilemma. That was the last shift I worked.

Nearly two decades later, my own heart skipped a beat when I read about the death of a woman following a cardiac screening test offered by her employer.

At the inquest into the mother-of-two’s death, the Coroners Court of Victoria heard that Peta Hickey was a 43-year-old senior executive with no cardiac history who underwent a CT angiogram, a test to detect coronary artery abnormalities, offered by her workplace in 2019 following a colleague’s near-fatal cardiac arrest. The workplace outsourced its corporate health program to a company that engaged another company. According to the inquest, Hickey was never assessed by a doctor including the one whose electronic signature was on the referral. The doctor told the coroner he didn’t add his signature to the paperwork.

The quest for improvement is real and urgent

On the day of her scan, the inquest heard that the radiologist could not contact the referring doctor to fill in the absent medical history. He proceeded with injecting the contrast dye, which induced an anaphylactic reaction. Eight days later, Ms Hickey died from multiorgan failure.

This unthinkable outcome yields salutary lessons for professionals and their patients. In this era of wellness, everyone wants an easy way to pre-empt disease and its consequences. A fitness trainer I spoke to could not understand my refusal to recommend a “head to toe” CT scan. After all, wasn’t it good to be safe? Yes, I replied: by coming off the energy drinks and anabolic steroids.

With the profusion of medical tests marketed as convenient and non-invasive, it is tempting to consider them as the alternative to the time-tested advice of eating, exercising and resting in moderation. It is difficult for many people to understand how anything labelled medical could be harmful to health, but there is abundant evidence that unnecessary tests have the potential to cause harm.

When South Korea introduced a national screening program for certain cancers, many providers tagged on a thyroid ultrasound for less than US$50 as part of a wellness check. Thyroid cancer diagnosis went up 15-fold in 20 years while mortality remained stable, according to a study in the New England Journal of Medicine. An estimated one third of adults harbour tiny thyroid papillary cancers that remain asymptomatic through life. But virtually everyone in South Korea who was incidentally diagnosed with thyroid cancer underwent major surgery or radioactive iodine treatment, each carrying the risk of serious complications. All it took to expose these unaware patients to the risk of harm was the offer of a cheap test.

This is why it’s so important for doctors to properly understand the benefits and hazards of a screening test before recommending it to patients.

To this end, cancer researchers including some Australians, deserve credit for communicating their disappointment with results of a three-decade long study involving over 200,000 women, which found that ovarian cancer screening via a blood test and ultrasound led to early detection but no survival benefit.

Since ovarian cancer is almost always diagnosed at a late stage, and is associated with poor survival, the quest for improvement is real and urgent. But in language that the average patient can understand, the researchers explain that diagnosing ovarian cancer at an earlier stage does not change the point at which patients die because the cancer is inherently more aggressive. However, being seasoned researchers, they even-handedly point to the many recent advances in cancer treatment, including symptom management, targeted therapies and the promise of using evolving knowledge to build better screening tests and different trials. This is the language of professionalism, neither fuelling hype nor extinguishing hope. It is what every doctor should aspire to.

Patients have a right to expect information. One organisation, Choosing Wisely, has a list of five questions that every patient should commit to memory.

Do I need this test? What are the risks? Is there an alternative? What is the cost? What happens if I do nothing? 

Reference: The Guardian: Ranjana Srivastava  

Acid test: scientists show how LSD opens doors of perception

When Aldous Huxley emerged from a mescaline trip that veered from an obsession with the folds in his trousers to wonder at the “miraculous” tubularity of the bamboo legs on his garden chairs, he offered an opinion on how the drug worked.

Writing in The Doors of Perception, his 1954 book which took its name from a William Blake poem, Huxley declared that the psychedelic “lowers the efficiency of the brain as an instrument for focusing the mind on the problems of life”.

Even for Huxley, the assessment now seems remarkably prescient. In new research, scientists have found evidence that LSD, another psychedelic, lowers the barriers that constrain people’s thoughts. In doing so, it frees the mind to wander more easily and experience the world anew.

“Normally, our thoughts and incoming information are filtered by our prior experience,” said Parker Singleton, a PhD candidate at Cornell University in New York. “But if you take that filtering and suppression away, you are looking at the world with new eyes. You get a totally new perspective.”

Singleton and his colleagues set out to test the so-called Rebus model of psychedelics. Standing for “relaxed beliefs under psychedelics”, it frames the brain as a prediction engine. Under the model, the brain takes thoughts and information from the senses and shapes them according to its understanding of the world. This makes the brain highly efficient: armed with prior beliefs, the noise and uncertainty of perception and thought are swiftly hammered into coherent reality.

But the brain works differently on psychedelics. According to Rebus, substances like LSD weaken the influence of prior beliefs that the brain uses to make sense of the world. In one sense, the drugs rewind the brain’s clock to a time before it learned that walls tend not to move and furniture is rarely threatening. “You can imagine you might experience altered perceptions,” said Amy Kuceyeski, a senior author on the study at Cornell. “If your prior belief is that walls don’t move and your prior belief melts, then that wall may appear to move.”

The scientists analysed fMRI brain scans of people on placebo or LSD. These revealed four distinct states, or patterns of activity, that the brain switched between when the volunteers were resting in the scanner. Two of the brain states were largely driven by sensory parts of the brain, while the other two involved the kind of top-down processing the brain performs to make sense of the world. On LSD, the brain spent less time on higher-level processing and more on the sensory-driven activities.

By comparing scans of the brain on LSD versus placebo, the researchers found that the drug reduced the amount of energy the brain needed to switch from one brain state another. Dr Kuceyeski likens it to flattening the landscape over which the brain can roam. Normally, the brain’s activity is constrained by the mountains and valleys of our prior beliefs, but on LSD these obstacles are flattened out. “It allows us to move more freely and have more dynamic brain activity,” she said.

Writing in a preprint, which has yet to be peer-reviewed, the researchers go on to show how the distribution of a particular receptor called 5-HT2a, the primary target for LSD, enables the drug to have such a profound levelling effect.

David Nutt, professor of neuropsychopharmacology at Imperial College London, who was not involved in the research, said that “flattening the landscape” allowed parts of the brain to talk to each other for the first time since early childhood. “The whole process of child development and education is to take your brain, which is extremely malleable, and force it to be like everyone else’s brain. Under psychedelics, you go back to a state where bits of the brain that haven’t spoken since you were a baby can cross-talk. And it’s that increased connectivity that allows people to get new insights into old problems,” he said.

The ability of LSD to free up brain activity may explain why psychedelics can help people with depression, anxiety and other mental health disorders such as post-traumatic stress disorder. “In depression, people get locked into a way of thinking that is repetitive and ruminative. It’s like tramline thinking,” said Nutt. “Psychedelics disrupt those kinds of processes so people can escape from it.” 

Reference: The Guardian: Ian Sample Science editor