Medical Articles 2013: Anatomy and Diseases in Human
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Concern raised about finance scheme for malaria drugs


Concern raised about finance scheme for malaria drugs  The charity Oxfam has cast doubt on an international scheme that aims to boost the provision of the most effective treatment for malaria.

 The UK government has contributed L70m to the Affordable Medicines Facility for malaria (AMFm).

 Oxfam says there is no evidence the programme has saved the lives of the most vulnerable people.

 The body behind the AMFm says an independent study shows it has improved access and reduced drug prices.

 The scheme was introduced three years ago by the Global Fund to Fight Aids, TB and Malaria.

 It acts as a global subsidy to provide greater access to combination therapy for malaria, particularly through private-sector drug retailers in developing countries.

 The idea is to reduce the use of older treatments that carry a higher risk of resistance, and to untap the potential of the private sector in reaching remote communities.

 More than 200 million people contract malaria every year and 655,000 die from the disease - most of them are young children.

 The scheme is being piloted in seven countries including Kenya, Ghana and Nigeria. Its future will be considered at a meeting of the Global Fund's board next month.

 Oxfam has criticised it as "risky and dangerous".

 The charity's senior health policy advisor, Dr Mohga Kamal Yanni, said: "It is dangerous to put the lives of sick children in the hands of a shopkeeper with no medical training, and to pursue a scheme that doesn't help those people who need it the most.

 "There is no cheap option or short cut to combat malaria.

 "The AMFm is a dangerous distraction from genuine solutions like investing in community health workers, who have slashed the number of malarial deaths in countries such as Zambia and Ethiopia.

 "The Global Fund board must act on the evidence and put a stop to the AMFm now."

 The Global Fund said Oxfam's claims were "simply untrue".

 In a statement, it said: "Some Western aid groups oppose a pragmatic approach that includes any involvement of the private sector.

 "But the reality of this programme is that it is getting life-saving medicine to people who need it most from the private sector outlets where they already seek treatment.

 "Before the launch of AMFm, life-saving malaria treatments cost up to 20 times as much.

 "An extensive study has shown that AMFm has increased availability and reduced prices for high quality anti-malarial drugs."

 The UK's Department for International Development (DfID) allocated L40m to the scheme in its first two years, and boosted it by L31.6m this year. AMFm is also supported by the Canadian government and the Bill and Melinda Gates Foundation.

 A DfID spokesman said: "DfID is helping to halve the number of malaria deaths in the most badly affected countries by 2015 in a number of ways, including improving access and availability of life-saving drugs.

 "Studies have shown that quality drugs have got through to remote areas - and that more vulnerable groups, including children under five in rural areas and from the poorest backgrounds, are now being reached."

X-ray imaging tricks increase resolution and cut dose


X-ray imaging tricks increase resolution and cut dose  An international research team has proposed a way to make high-resolution, 3D images of breast tissue while reducing the delivered X-ray dose.

 Breast tissue is particularly susceptible to X-ray radiation so 3D scanning is generally not employed.

 Now a team reporting in Proceedings of the National Academy of Sciences suggests a different form of X-rays and a new image analysis approach.

 However, new compact X-ray sources are needed to bring the idea to the clinic.

 Taken together, the two improvements lead to high-resolution 3D images while reducing the delivered dose to just 4% that of standard "computed tomography" (CT) scans.

 A cancer charity called the work "a promising step" toward earlier, more accurate breast cancer diagnosis.

 A phenomenally successful technique in X-ray scanning over the past half-century, CT scans are made with a number of X-ray images taken from various angles that are analysed to yield a 3D view.

 The approach is reserved for the imaging of parts of the body for which these multiple X-ray exposures is deemed safe, generally excluding "radiosensitive" breast tissue.

 Instead, what is known as dual-view mammography is employed, producing two conventional X-ray images of the breast - a methodology that is known to miss 10-20% of tumours.

 One to watch

 Recent years have seen growth in the use of what is called phase contrast imaging, which measures not only how much X-ray light gets through tissue, but also in a sense how long it takes to get there. This yields a far clearer picture of subtle changes in density that can show tumours.

 Now researchers from the US and Germany working at the European Synchrotron Radiation Facility in France have refined the phase contrast approach using what they call equally sloped tomography.

 The improvement is in the mathematics used to analyse X-ray images - instead of taking a number of images at evenly spaced angles around a sample, EST takes images at irregular angle intervals and uses improved equations to reconstruct the 3D representation.

 Co-author of the study Paola Coan of Ludwig Maximilians University explained that an analogy of the process is a watch.

 "Instead of having a hand that measures every second, we have a hand that follows a certain scheme, the first hand movement is 1.2 seconds, then 0.7 then maybe 0.9, but at the end, thanks to EST, we still measure perfectly the minute," she explained to BBC News.

 "With this mathematical trick we avoid interpolation and the image looks better - we even need to take fewer radiographs to reconstruct the computed tomography full image."

 Testing the approach at the ESRF with a whole mastectomied breast, the team showed that they could acquire images as sharp as those of conventional CT scans using just a quarter of the delivered X-ray dose.

 But they carried the work further by using the ESRF's capabilities to run the same test with higher-energy X-rays. Soft tissue is more transparent to these "harder" X-rays and therefore less radiation is absorbed.

 As members of the team showed in an article in Physics in Medicine and Biology in April, images of a quality comparable to standard CT can be acquired with harder X-rays corresponding to just a sixth the radiation dose.

 In combination, the techniques result in the resolution of a full CT scan while delivering a dose just 4% as large.

 "We've demonstrated that by combining X-rays at high energy plus this sophisticated CT reconstruction, we're able to perform a complete CT with high resolution, but with a dose that is much lower than than in conventional CT and potentially... lower than dual-view mammography," Prof Coan said.

 "This is an extraordinary result."

 However, she added that compact, high-quality X-ray sources capable of the higher-energy regime are still necessary to get the technique established in the clinical setting, a research effort that is underway for a number of industries.

 Emma Smith, Cancer Research UK's senior science information officer, said: "The results of this study show that powerful new technology could give doctors a more detailed image of the breast without increasing the dose of radiation."

 "This research is still at an early stage and the technique has not yet been tested to see if it's safe and effective in women, but it is a promising step towards doctors being able to spot breast cancer earlier."

Peru doctors 'to suspend strike over pay'


Peru doctors 'to suspend strike over pay'  Thousands of doctors in Peru have agreed to suspend a strike that has left many poor people without medical care for more than a month.

 The leader of the doctors' union, Cesar Palomino, said they would return to work while they consider government proposals for a pay rise.

 The doctors had complained that their pay was not increasing despite strong economic growth in Peru.

 The strike caused huge backlogs in hospitals and clinics.

 Peruvian media reported that the decision was taken shortly after the government threatened to cut the doctors' pay unless they returned to work.

 Some 1.5m medical appointments were missed because of the strike, the BBC's Mattia Cabitza reports from the Peruvian capital, Lima.

 He says it affected mostly low-income Peruvians, who cannot afford private health care.

 Unions have blamed economic policies pursued under President Ollanta Humala for blocking wage increases.

 The government - which has also faced a teachers' strike - has said pay must be based on performance.

 Mr Humala took office in July 2011 vowing to eradicate poverty and social exclusion.

Rise in child throat infections treated in hospital


Rise in child throat infections treated in hospital  Children admitted to hospital with throat infections have increased by 76% over the past 10 years, according to a study from Imperial College London.

 Writing in the Archives of Disease in Childhood, researchers found that most children were discharged after a short stay.

 This suggests that the severity of infection has not increased, they said.

 Pressures on doctors and a maximum waiting time in A&E could be the reason behind the increase in admissions.

 The study investigated hospital admission rates for children up to the age of 17 with acute throat infections between 1999 and 2010. They also looked at the number of tonsillectomies performed during that period.

 Researchers were concerned that the decline in tonsil removal operations in recent years had led to an increase in hospital admissions for severe tonsillitis.

 They found that admissions for throat infections rose from 12,283 in 1999 to 22,071 in 2010. The highest rates were among children aged between one and four years, followed by children aged under one.

 Over the same decade they found an increase of 115% in short hospital stays lasting less than two days. These accounted for most of the admissions.

 The researchers found no evidence of a link between tonsillectomy trends and admission rates for acute throat infections.

 One possible explanation is a large number of children being taken to A&E instead of to see their GP, especially if the infection flares up outside surgery hours. The researchers also suggest the introduction of a four-hour maximum waiting time in A&E, in 2002, may have led under-pressure doctors to admit children with less serious throat infections.

 Dr Elizabeth Koshy, lead study author from the school of public health at Imperial College London, said the rise in hospital admissions for this type of infection was concerning.

 Unnecessary

 "Our findings relating to short hospital stays suggest that many of the children admitted with acute throat infections could have been effectively managed in the community.

 "Our study highlights the need to urgently address the issue of healthcare access, with improved models of integrated care within primary and secondary care, to avoid potentially unnecessary hospital admissions for relatively minor infections in the future."

 Dr Koshy said that further research was needed to confirm that declining tonsillectomy rates were not associated with an increase in more severe throat infections rates.

 She added: "Tonsillectomy is a major and costly operation with potentially serious complications.

 "So it seems sensible for clinicians to maintain a high threshold for referring children with recurrent throat infections for tonsillectomy and restrict it to those children who are most severely affected by these infections."



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