Health

Cardiac 'bruising' predicts worse heart attack

 

UK researchers say they have found a new way to tell if a heart attack is more severe and might cause lasting harm - by looking for bruising or bleeding in the heart muscle.

Patients with this sign on scans more often develop serious problems like heart failure, says the Glasgow team.

It's hoped the discovery could help with preventing such complications.
Half a million UK people have heart failure and heart attacks are the leading cause.
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 Global antibiotics 'revolution' needed

A global revolution in the use of antimicrobials is needed, according to a government backed report.

Lord Jim O'Neill, who led the Review on Antimicrobial Resistance, said a campaign was needed to stop people treating antibiotics like sweets.

It is the first recommendation in the global plan for preventing medicine "being cast back into the dark ages".

The report has received a mixed response with some concerned that it does not go far enough.

Superbugs, resistant to antimicrobials, are estimated to account for 700,000 deaths each year.

But modelling up to the year 2050, by Rand Europe and auditors KPMG, suggests 10 million people could die each year - equivalent to one every three seconds.

The report brings together eight previous interim reports that recommended:

• An urgent and massive global awareness campaign as most people are ignorant of the risks
• Establishing a $2bn ($1.4bn) Global Innovation Fund for early stage research
• Improved access to clean water, sanitation and cleaner hospitals to prevent infections spreading
• Reduce the unnecessary vast antibiotic use in agriculture including a ban on those "highly critical" to human health
• Improved surveillance of the spread of drug resistance
• Paying companies $1bn (£0.7bn) for every new antibiotic discovered
• Financial incentives to develop new tests to prevent antibiotics being given when they will not work
• Promoting the use of vaccines and alternatives to drugs

The review said the economic case for action "was clear" and could be paid for using a small cut of the current health budgets of countries or through extra taxes on pharmaceutical companies not investing in antibiotic research.

Lord Jim O'Neill, the economist who led the global review, said: "We need to inform in different ways, all over the world, why it's crucial we stop treating our antibiotics like sweets.

"If we don't solve the problem we are heading to the dark ages, we will have a lot of people dying.

"We have made some pretty challenging recommendations which require everybody to get out of the comfort zone, because if we don't then we aren't going to be able to solve this problem."

Eight years of hell

It is hoped the measures will prevent more people going through experiences like Emily Morris from Milton Keynes.

She has regular urinary tract infections that do not respond to some antibiotics and could cause kidney damage or even death.

She says: "With every sting and every pain, my heart sinks at the thought of how many antibiotics I have left to use this time.

"I've had the struggle of living with a resistance to antibiotics for nearly eight years of my life...there is a clear need for new antibiotics."

Pharma challenge

Exactly how to encourage the drugs industry to make new antibiotics has been a long running problem - there has not been a new class of antibiotics discovered since the 1980s.

A new antibiotic would be kept on the shelf for use in emergencies so a company could never make back its huge research and development costs.

John Rex, from the antibiotics unit at AstraZeneca, said a new way of paying for drugs, as proposed in the report, was needed.

He argued: "Such models should recognise antibiotics as the healthcare equivalent of the fire extinguisher - they must be available on the wall at all times and have value even when used only infrequently."

Not enough

But Dr Grania Brigden, from the charity Médecins Sans Frontières, said: "This report is an important first step in addressing this broad market failure, it does not go far enough."

MSF said infections resistant to drugs were a threat to their work around the world from the war-wounded in Jordan to newborns in Niger.

Dr Brigden added: "The O'Neill report proposes considerable new funding to overcome the failures of pharmaceutical research and development, but the proposals do not necessarily ensure access to either existing tools or emerging new products.

"Instead, in some cases, the report's solution is simply to subsidise higher prices rather than trying to overcome them."

Magic mushrooms 'promising' in depression

A hallucinogenic chemical in magic mushrooms shows promise for people with untreatable depression, a short study on just 12 people hints.

Eight patients were no longer depressed after the "mystical and spiritual" experience induced by the drug.

The findings, in the Lancet Psychiatry, showed five of the patients were still depression-free after three months.
Experts cautiously welcomed the findings as "promising, but not completely compelling".
There have now been calls for the drug to be tested in larger trials.

Untreatable

At the start of the trial, nine of the patients had at least severe depression and three were moderately depressed.

In one patient, symptoms had lasted for 30 years.
All of them had tried at least two different treatments for depression, without success.
One had tried 11. 

The study, at Imperial College London, initially gave patients a low dose of psilocybin, the hallucinogenic chemical in magic mushrooms, to test for safety. 

They were then given a very high dose equivalent to "a lot of mushrooms", the researchers said.
The psychedelic experience lasted up to six hours, peaking after the first two, and was accompanied by classical music and followed by psychological support.

Dr Robin Carhart-Harris, one of the researchers, said: "These experiences with psilocybin can be incredibly profound, sometimes people have what they describe as mystical or spiritual-type experiences."

Most patients had a rapid dip in their depressive symptoms, with predictable side-effects including anxiety, nausea and headaches.

Dr Carhart-Harris said: "Seeing effect sizes of this magnitude is very promising, they are very large effect sizes in any available treatment for depression.
"We now need larger trials to understand whether the effects we saw in this study translate into long-term benefits."

Fellow researcher Prof David Nutt said thoughts could become locked in an overly self-critical and negative mode in depression, and it was thought the drug acted as a "lubricant for the mind" that "liberates" the patient.

He said psilocybin targeted the receptors in the brain that normally responded to the hormone serotonin, which was involved in mood.
However, the study is anything but clear-cut.

It is short, in a small number of people and has no placebo group.
Larger trials use dummy, sugar pills or placebos so they can account for the enigmatic "placebo effect" in which people can get better when they think they are being treated. 

The researchers told the BBC "it is possible" all the improvement was down to the placebo effect although the duration of the benefit and change in outlook suggested something else was going on.
Dr Carhart-Harris said "this isn't a magic cure, we shouldn't infer too much" until larger trials had taken place.
Prof Nutt said simply being able to perform the study using the hallucinogenic drug was a "landmark", as he criticised the "Kafkaesque" restrictions that had made the research difficult. 

Prof Nutt, who was fired as the government's drugs adviser for his outspoken views, said red tape had meant "it cost £1,500 to dose each patient, when in any sane world it might have cost £30".

Prof Philip Cowen, from the University of Oxford, said: "The key observation that might eventually justify the use of a drug like psilocybin in treatment-resistant depression is demonstration of sustained benefit in patients who previously have experienced years of symptoms despite conventional treatments, which makes longer-term outcomes particularly important. 

"The data at three-month follow-up, a comparatively short time in patients with extensive illness duration, are promising, but not completely compelling."

The research was backed by the Beckley Foundation and the UK's Medical Research Council.