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Wider use of antibiotics in those at highest risk will save more young babies lives, say experts.
Odette was sleeping rough in a park when she found out she was pregnant.
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After complaining to doctors about pain and difficulty passing urine over three days, a bladder stone just about the size of an ostrich egg was discovered inside a 64-year old patient.
The New England Journal of Medicine documented the discovery of the object weighing in at 770g.
The patient did not have a normal bladder, however. Over a decade earlier the patient had invasive bladder cancer that required his bladder to be removed.
His doctors subsequently constructed a bladder out of some intestinal tissue, called a neobladder.
After doctors physically examined the patient, they performed a scan which confirmed the presence of a stone.
Although the bladder stone is on the large side, it is actually not the biggest recorded bladder stone removed from an individual.
Doctors removed a stone weighing in at around 1.9 kg from a Brazilian man in 2003, according to the Guinness World Records.
Bladder stones normally aren’t more than a few centimetres in size.
Complications
Stones are formed by the crystalisation of salt in the urine. A stone found in the bladder may cause mild discomfort in the lower abdonimal region but may not always be detected without a medical examination as it does not usually cause any symptoms.
Further possible symptoms include nausea and vomiting, abdominal distention, chills, fever, and blood in the urine.
If the stone is large enough to block the flow of urine, bacteria become trapped in the urine, leading to a urinary tract infection (UTI). When stones block the urinary tract for a long time, urine backs up in the tubes inside the kidney, producing pressure that can distend the kidney and eventually cause damage.
The combination of obstruction and infection is regarded as an emergency because stones can cause permanent damage in the kidney within 24 to 36 hours.
Health bosses say bad winter in Australia and New Zealand should act as a warning for the UK.
Asthma is a chronic disease that can be difficult to treat.
But now a biologic drug in development to treat severe asthma reduces the rate of serious attacks by about two-thirds compared to a placebo drug, according to preliminary research findings.
Effective drugs available soon
If approved, the drug, tezepelumab, could join a group of costly medications that appear to offer relief when nothing else curbs respiratory distress.
“A new era has begun in which many new drugs are being developed for patients with severe asthma,” said Dr Elisabeth Bel, a professor of respiratory medicine at the University of Amsterdam in the Netherlands.
“Similar to what has happened for rheumatoid arthritis, I expect that in a few years effective treatments will be available for almost all patients with severe asthma,” said Dr Bel, author of a commentary accompanying the new study.
The study was published in The New England Journal of Medicine.
The new research was funded by the drug’s developers, Amgen and MedImmune, a subsidiary of AstraZeneca.
Inhalers not always effective
Asthma is a chronic lung disease. Dr Bel said an estimated 15% of asthma patients can’t control the disease with current inhaled medications.
“They have severe disease with persistent airway inflammation, which causes continuous symptoms of breathlessness and exercise intolerance,” Dr Bel said. This also puts them at risk of severe attacks for which they have to be hospitalised, she added.
In South Africa alone, 1.5% out of the estimated 3.9 million asthma sufferers die from this condition annually, according to statistics recently published on Health24.
Tezepelumab, an injectable drug, is a monoclonal antibody – a term that refers to how it’s made.
Drugs may not help all patients
Drugs in this category help many patients with severe asthma, but not all of them, Dr Bel said. That’s because the disease comes in different types, she explained.
The new study represents the second of three phases of research required before a drug can be approved in the United States. Researchers wanted to understand tezepelumab’s effects on asthma patients who’d suffered at least one asthma attack that required hospitalisation within the past year, or two attacks that forced physicians to increase their medication level.
The 584 study patients with severe asthma were non-smokers, aged 18 to 75, who used asthma inhalers. They were randomly divided into low-dose, medium-dose or high-dose groups, or assigned to take a sham (“placebo”) drug.
Improvement in lung function and asthma attacks
The researchers found that those on the drug had 61% to 71% fewer asthma attacks that required a hospital visit or change in medication dose than those who took a placebo.
Study co-author Dr Rene van der Merwe said, “Tezepelumab also demonstrated improvements in lung function at all doses, in asthma control at the two higher doses, and in quality of life across all treatment groups relative to placebo.” She’s a researcher with MedImmune.
The study “did not reveal any unexpected safety concerns,” said Dr Van der Merwe. Between 62% and 66% of the patients in the various groups reported side effects, and between 9% and 12% reported serious side effects.
The drug blocks a molecule that’s key to the development of swelling in the airway, Dr Bel said, “and is therefore effective in different subtypes of asthma.”
As a result, “the chances that the drug will work in severe asthma patients are higher than with the existing monoclonals that are more selective for a specific subtype of patients,” she said.
Dr Van der Merwe said it’s too early to estimate how much the drug may cost. A spokesperson for AstraZeneca also refused to discuss the cost.
Asthma management
Until this drug becomes available, the key to a good quality of life lies in controlling asthma symptoms. A treatment plan for asthma sufferers should include the following:
Image credit: iStock
Telephone lines to the Gauteng Health Department’s head office have been cut because Telkom has not been paid.
For the past few months it has been impossible for anyone to reach the health department staff at the head office on the landline, and staff have been unable to phone out.
Furniture and computers attached
Khaya Xaba, the spokesperson for the National Education Health and Allied Workers (NEHAWU), said the situation at the Department of Health was impacting badly on their members and the public in a negative way because services could not be rendered to the public and their members can’t perform their duties properly.
“The department needs a turnaround strategy and quickly before the entire system collapses,” said Xaba.
According to Xaba it has been quite a few weeks since the telephone lines were cut.
Last month the Sheriff of the Johannesburg High Court attached furniture and computers from the department following a R6.2-million medical negligence claim that the Department of Health had failed to pay.
The South African Board of Sheriffs (SABFS) confirmed to Health-e News that the Sheriff for Johannesburg Central, Marks Mangaba, had attached assets from the Department of Health.
No payment arrangements
“The attachment was a warrant of execution from O Joubert Attorney’s for judgement value for more than R6 million,” said Tasneem Hassan Bey, the communications officer at the SABFS.
“The furniture has been placed in storage and will be sold on instructions from the attorney, as both parties are still negotiating,” said Hassan Bey.
OJ Attorneys said the Gauteng Health Department has failed to make contact with them to make payment arrangements for their client’s claim or to arrange to get their furniture back.
OJ Attorneys said their next step will be to ask the court for a warrant to give them access to the health department’s bank accounts.
In July the National Health Laboratory Services (NHLS) employees embarked on a strike for better pay and benefits. It was made public that the NHLS is also owed a lot of money by the Gauteng Health Department, and because of this had been unable to meet the demands of its employees.
Questions not addressed
NHLS CEO Shabir Madhi told the Sunday Times they were owed more than R5 billion by various provinces – Gauteng has the largest outstanding debt and are currently paying only two-thirds of what they were consuming.
“We will be technically bankrupt by November [2017] should the provincial health departments not pay us 100% of what they are procuring from us,” he said.
Gauteng Health Department spokesman Prince Hamnca was contacted for comment on the department’s financial woes, and was asked for an update on their seized furniture and what progress had been made with regard to paying their NHLS debt.
He confirmed that the head office phone lines were not functioning but failed to address any of the other questions put forward by Health-e News.
“We can confirm that the landlines at central office have not been functional as result of payment related issues. The department has started discussions with Telkom to resolve the matter and they will be meeting before end of this week where we will present a payment plan,” said Hamnca in his brief written response.
He added that the separtment would like to apologise to the public for the inconvenience caused.
– Health-e News.
Image credit: iStock
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