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Pancreatic cancer may be able to be detected in stool samples, study finds

Scientists might be able to detect pancreatic cancer by observing microorganisms in stool samples, research suggests.

A 3D illustration showing the pancreas. Pic: iStock

The study, which was part-funded by Worldwide Cancer Research, found 27 microbial species in stool samples could highlight people at high risk of the most common form of pancreatic cancer.

The 27 microbes could be used to distinguish between people without cancer and those with both the advanced and early stages of the disease.

Microorganism markets

The study found some microorganisms were abundant in the stool samples of cancer patients, while others were depleted.

The microbiome - a collection of fungi, bacteria and viruses inside the human body - is known to interact with the immune system.

Pancreatic cancer can be difficult to treat and is deadly, with one in four surviving one year or more after diagnosis.

Developing a screening test

The study, published in the journal Gut, involved 136 people. Of those, 57 had pancreatic cancer (25 early stage and 32 advanced), 50 without cancer acted as controls, and 29 patients had chronic pancreatitis.

Experts from the Spanish National Cancer Research Centre (CNIO) and the European Molecular Biology Laboratory (EMBL) said it was "feasible" for a screening test to be developed using stool samples that could help detect pancreatic cancer.

A patent has been applied for to develop a pancreatic diagnostic kit that would rapidly detect the microorganisms.

'An effective, non-invasive diagnosis'

Dr Helen Rippon, chief executive of Worldwide Cancer Research, said: "This new breakthrough builds on the growing evidence that the microbiome - the collection of microorganisms that live side by side with the cells inside our body - is linked to the development of cancer.

"What's amazing about this discovery is that the microbiome of stool samples from patients could be used to help diagnose pancreatic cancer early.

"Early detection and diagnosis are just as important an approach to starting new cancer cures as developing treatments.

"This research provides hope that an effective, non-invasive way to diagnose pancreatic cancer early is on the horizon."

Reference: Sky News: Samuel Osborne, news reporter

David Bennett dies two months after receiving a pig heart transplant

Reference: Bang Showbiz 

Paracetamol overdose: what you need to know

Chinnapong - Getty Images Paracetamol overdose can result in liver damage, liver failure and death. Find out how much paracetamol is safe, the symptoms of overdose and treatments.

Paracetamol is the most common drug taken in overdose in the UK. Almost 100,000 people attend Accident and Emergency departments each year after having taken a paracetamol overdose, and around half of these are admitted for treatment. 

When taken in a normal dose, paracetamol is a safe and effective drug used to relieve pain and reduce fevers. Too high a dose however can result in liver damage, liver failure and death. Over the last ten years, there have been approximately 200 deaths each year from paracetamol poisoning in England and Wales.

Just a few paracetamol tablets over the recommended dose can potentially cause fatal liver damage, and there may be no symptoms until it is too late for treatment to help. There is an antidote for paracetamol poisoning and it is most effective within eight hours of the overdose, so getting help early is essential.

Paracetamol dosage

The recommended adult dose of paracetamol is 1 gram, four times a day. Each tablet of paracetamol contains 500 milligrams so this equates to two tablets four times a day with a maximum daily dose of 4 grams or eight tablets. At least four to six hours should be left between doses.

You should not take more than this recommended dose. Some overdoses are taken intentionally as an act of self-harm but many are accidental. Taking a few extra tablets each day over a number of days could push you into harmful toxic levels and result in liver damage and possibly death.

If you have taken more than the recommended dose you should attend Accident and Emergency to be assessed as soon as possible.

How much paracetamol is an overdose?

Paracetamol is mainly cleared from the body by the liver. The liver can only cope with so much paracetamol at one time. A substance called glutathione is needed to neutralise the toxic break down components of paracetamol. If the glutathione runs out, then the toxic substances build up and damage liver cells. An adult body can produce enough glutathione to safely clear 4 grams of paracetamol every 24 hours which is why it is the recommended dose. Taking more than this amount risks permanent and even fatal liver damage.

There are other factors which determine how much paracetamol your body can safely deal with and these include:

• Weight. The safe doses of paracetamol for children vary according to their body weight and a very light adult may be easily pushed into toxic levels.
• Liver disease. Pre-existing liver conditions may reduce the ability of the liver to clear paracetamol.
• Alcohol abuse. Long term alcohol misuse can reduce liver function.
• Medications. Some medications increase the risk of liver damage from paracetamol including carbamazepine, phenobarbital, phenytoin, ketoconazole and rifampicin.

In these situations, the safe daily amount of paracetamol will be reduced, you may even be advised to avoid it altogether – check with your doctor.

Any amount of paracetamol over the recommended dose could be classed as an overdose. Staggered overdoses, where people take more than the recommended dose over a period of hours or days can cause harm in the same way that sudden, large overdoses can. Sometimes people take a small amount over the recommended dose every day with no intention of harming themselves, just to help ease their pains. This is called a therapeutic excess and can still be harmful. There may be no symptoms until liver damage is already established so the presentation to a doctor can be late and the condition irreversible.

Buying paracetamol

Paracetamol was first made available over the counter in the UK in 1963. Due to concern over the number of deaths from paracetamol overdoses, the Government placed restrictions on how much you could buy in one go. Reducing the amount to a maximum purchase of 8 grams (16 tablets) made it harder to overdose. Over the following ten years, the number of deaths from paracetamol poisoning fell by 43 per cent. The requirement for paracetamol to be sold in blister packs also made overdosing more difficult.

Many products such as flu remedies and painkillers contain paracetamol. Always read the label carefully.

Paracetamol overdose symptoms

You may feel sick or have abdominal pain but the alarming thing about paracetamol overdose is that there may not be any symptoms for up to 12 days after ingestion. People are often unaware of this fact and of the dangers of paracetamol in excess so they may not seek medical help. When they do they may already have liver damage and treatment may not be successful.

Liver damage can happen within a few days of paracetamol overdose. The symptoms and signs of liver damage include:

• Nausea
• Vomiting
• Pain and tenderness in the right upper abdomen
• Confusion
• Jaundice (yellow tinged skin)
• Low blood sugar (hypoglycaemia)
• Unexpected bleeding (normal blood clotting is impaired)
• Encephalopathy (damage to the brain)

Paracetamol overdose treatment

There is an antidote to paracetamol and accessing this as soon as possible is essential. The drug N-acetylcysteine is given intravenously (through a vein). It protects the liver from damage, this may work via increasing glutathione levels. It is most effective within 8 hours of an overdose but can be used up to and occasionally beyond 24 hours.

• N-acetylcysteine is given to people who have a certain level of paracetamol in their blood stream.
• Blood tests for paracetamol levels are taken four hours after the overdose and the result is plotted on a graph to see if it falls above the treatment line.
• Sometimes in the case of large overdoses or staggered overdoses, treatment with N-acetylcysteine will be started before the blood results are back.
• N-acetylcysteine may also be given after 24 hours if signs of liver damage such as liver tenderness, jaundice or abnormal liver blood tests are present.

If someone presents to Accident and Emergency within one hour of ingesting a significant amount of paracetamol, they may be treated with activated charcoal. This is taken in liquid form and binds to paracetamol in the gastrointestinal tract reducing the amount which is absorbed.

Doctors will discuss cases of paracetamol overdose with the National Poisons Information Service if there is any doubt as to whether treatment is required.

Other treatments

Around 1 in 500 paracetamol overdoses result in liver failure. Liver failure can be fatal and the only cure is a liver transplant. The British Liver Trust say that emergency liver transplantation is uncommon and only 20 to 30 are carried out each year in the UK.

If someone is very unwell with an overdose they may require treatment in an intensive care unit. It is common for people to take a variety of different medications when they overdose and each can have its own complications and treatments.

Everyone who has been admitted to hospital with an overdose needs to be seen by the psychiatric team before they are discharged home. Understanding why they took the overdose and what help and support they need is essential. It may be the first time the person has admitted they aren’t coping. It is important to ensure they are not at risk from harming themselves again and have ongoing treatment arranged for their mental health.

There is ongoing research to find new treatments for paracetamol overdose that will be effective beyond the eight-hour window that current treatment with N-acetylcysteine offers.

Last updated: 14-10-2020: Reference: Netdoctor: Dr Juliet McGrattan (MBChB)

The magic of mushrooms: how they connect the plant world

Joe Perkins, like most gardeners, has typically been more animated by what’s going on above the ground than below it. The quality of the soil was important, no question, but what was really going on down there felt mysterious and impenetrable. As for fungi, it usually meant one thing in a garden, and that wasn’t good news.

Provided by The Guardian Photograph: Nature Picture Library/Alamy

“On a domestic level, our relationship and understanding of fungi in the past has very much been that it’s something about decay, it’s about disease, and it’s something that we don’t particularly want in our gardens,” says Perkins, a 45-year-old landscape architect based in Sussex, who won three awards at the RHS Chelsea Flower Show in 2019. “It’s fair to say that, as gardeners, we’ve not always fully understood – and I still don’t – the importance of these systems.”

What changed for Perkins was reading research by the American mycologist and fungi guru Dr Paul Stamets and British biologist Merlin Sheldrake’s 2020 revelatory book, Entangled Life. This year, the tech giant, now called Meta, has commissioned him to make another Chelsea garden and Perkins has decided to build an immersive environment that celebrates the symbiotic exchange between soil, fungi and plants.

“Our relationship with fungi is changing, and I think it will be an irreversible change,” he predicts. “You find yourself getting caught up in all the huge implications of it. It’s a totally separate kingdom to plants and animals, and it’s possibly the biggest kingdom about which we know very, very little. If you imagine how the Victorian plant hunters felt when they were discovering all these new plants back in the 18th and 19th century, it’s almost like that. It’s the new frontier, isn’t it?”

At this point, a glossary might be handy. “Fungi” is the overarching name for a kingdom of spore-producing organisms that feed on organic matter. “Mushrooms” are the fruiting bodies of fungi, the place where spores are produced. Mushrooms are sometimes compared to icebergs, because most of the activity is actually taking place under the surface, out of sight. Here, networks of “mycelium”, the vegetative part of the fungus, twist through the soil and make connections between plants. It’s now understood that more than 90% of plants depend on mycorrhizal fungi for improving their water and nutrient absorption, which has led to these networks being called the “Wood Wide Web”.

Jumping off from the theme of interconnectedness, Perkins’s upcoming Chelsea design will include a large timber pavilion, based on hexagonal structures that represent mycelium pathways, and feature two habitats: woodland edge and a stylised meadow. If you choose to look for them, Perkins makes plenty of nods to sustainability and the threats posed by climate change, but there will also be a vibrant colour scheme. “It has to be a beautiful garden as well, because it’s Chelsea,” he says.

Perkins’s new fascination with fungi and their mycorrhizal relationships with plants is not just theoretical; it has made an impact on how he gardens on a practical level, too. “The old advice was to get air into the soil and get rid of all the weeds and everything. And actually, the process of digging up through that surface layer just pulls apart all the mycelial connections. So, from my observations, I would say don’t do that. Leave the soil alone.”

Perkins has other radical, even hair-raising tips for gardeners. “Don’t be too tidy,” he says. “Some fungi are decomposers and they will take the dead plant material back into the soil and recycle it, and make it available to the other plants for nutrients. If you really don’t want to do that, at least leave some towards the back of the borders, so there are some opportunities for that to happen.”

Fungi, of course, is not only the horticulturist’s friend. These organisms are now finding innovative applications in fashion, health, technology and art. Also in construction: Biohm was founded in 2016 in Bermondsey, south London, by Ehab Sayed, a 31-year-old originally from Egypt. The company looks to the natural world for inspiration and its team of 20 is currently experimenting with more than 300 different strains of mycelium in an effort to “train” them to consume waste from food and building processes, even plastic, that would otherwise end up in landfill. Biohm has also developed mycelium insulation, which is competitive with traditional petrochemical and plastic-based construction materials in its thermal and acoustic properties, but safer and non-toxic.

Last year, Biohm received backing from Waitrose, which created a £1m grant from the sale of carrier bags, to fund its work on breaking down plastics using mycelium. Sayed suggests that the results – which will be “transformational” – are just two years away from being available at scale. “The sky’s the limit,” he says. “We’re exploring projects in outer space at the moment, seeing how we can grow mycelium in a vacuum, and looking at how we can break down toxins that have been completely irremediable.”

What really excites both Sayed and Perkins, though, is how little we know about fungi and its byproducts. It is believed that we have only documented 6% of all fungal species: there could be anywhere between 2.2m and 3.8m species in the world, which is up to 10 times greater than the estimated number of plant species. “What I love about mycelium is it’s the source of life, really,” says Sayed. “It’s what enables the cycles of nature to take place. There’s so much we have to learn from it and we’ve barely scratched the surface.” 

Reference: The Guardian: Tim Lewis