Bacteria killing virus – this can be helpful to fight some of the superbugs!

http://www.medicalnewstoday.com/articles/267573.php

Bacteria killing virus – this can be helpful to fight some of the superbugs!

We are constantly looking for the ways and means to fight the superbugs. Now there seems to be a potential new victory in the war against antibiotic-resistant "superbugs" lies in the discovery of specific viruses that eat bacteria - called bacteriophages. Researchers in the UK have isolated certain phages, which have been shown to target the infectious hospital bug Clostridium difficile. C. diff, as the superbug is known, is responsible for 250,000 infections in the US each year and results in 14,000 deaths, the researchers say. Causing excess medical costs of $1 billion each year, finding a solution to this problem is one of both medical and economic importance. Dr. Martha Clokie, from the University of Leicester's Department of Infection, Immunity and Infection, has been studying how naturally occurring bacteriophages - which means "eaters of bacteria" - could serve as an alternative to antibiotics. Though Dr. Clokie gives credit to the important role antibiotics have played in saving lives, she says new treatments are needed: "Less than a century following their discovery, the future impact of antibiotics is dwindling at a pace that no one anticipated, with more and more bacteria out-smarting and 'out-evolving' these miracle drugs. This has re-energized the search for new treatments."Unlike antibiotics, Dr. Clokie says phages "are specific in what they kill," noting that they usually infect only one specific species or strain of bacteria.By injecting their DNA into the bacterium, she notes that phages then replicate and cause the bacterial cell to "burst open." Once the dead bacterium is opened, the phages can then repeat the process on other host cells. Maintaining gut bacteria balance: What is so remarkable about the research team's finding is that they were able to isolate and characterize 26 distinct phages - the biggest set of C. diff phages that are currently known.These phages infect strains of C. diff that are "clinically relevant," and they have been proven to be effective against 90% of the strains currently seen in the UK. Dr. Clokie says:"C. diff bacteria primarily affect our digestive system. Whilst relatively innocuous in individuals with a healthy gut flora, they pose a serious threat when our natural digestive environment is disrupted or depleted, such as after chronic antibiotic use." She notes that the ability of phages to only infect and kill a specific type of bacteria is "particularly important" when dealing with C. diff infections, because keeping the balance of gut bacteria "greatly reduces the chance of relapse."Clinical trials soon, Dr. Clokie's phages have been licensed by a US biopharmaceutical company called AmpliPhi Biosciences Corporation, and together, they aim to have a mixture of C. diff phages ready for phase I and II clinical trials in the near future. The company, which has developed phage-based therapeutics, is funding further development and testing of these phages. Dr. Clokie and colleagues from the University of Leicester will work with scientists from the University of Glasgow in Scotland to analyze the efficacy of the phages in treating infections. The work has been predominantly funded by the Medical Research Council (MRC), and Dr. Des Walsh, head of Infections and Immunity at the MRC, says that Dr. Clokie "has established an impressive collection of phage viruses and has developed strong partnerships to translate her research into potential new treatments for Clostridium difficile infection."

"Ultimately," says Dr. Clokie, "I hope this will pave the way for a greater use of bacteriophages in the wider, global fight against antibiotic-resistant bacteria." When asked how long until patients might begin to see benefits from her research, Dr. Clokie told  "If all goes well," she added, "we could see a product in 5-10 years."

Atherosclerotic intracranial arterial stenosis: risk factors, diagnosis, and treatment

Intracranial stenosis before and after angioplasty

Vascular surgeons are treating the extracranial carotid artery stenosis, neurosurgeons and interventionists are treating the intracranial stenotic lesions to reduce the cerebral ischemia which can lead to stroke. In india, intra cranial lesions are more common than the extra cranial artery lesions. So, the number of endarterectomies performed are less in India and few centers are providing these services. The recent developments in proving best medical therapies certainly reduced the risk of stoke in hypertensive patients, Diabetic people.
Intracranial atherosclerosis is one of the most common causes of stroke worldwide and is associated with a high risk of recurrent stroke. New therapeutic approaches to treat this high-risk disease include dual antiplatelet treatment, intensive management of risk factors, and endovascular therapy. Early data from randomised trials indicate that aggressive medical therapy is better than stenting for prevention of recurrent stroke in high-risk patients with atherosclerotic stenosis of a major intracranial artery. Nevertheless, there are subgroups of patients who remain at high risk of stroke despite aggressive medical therapy. Further research is needed to identify these high-risk subgroups and to develop more effective treatments. Non-invasive vascular imaging methods that could be used to identify high-risk patients include fractional flow on magnetic resonance angiography (MRA), quantitative MRA, and high-resolution MRI of the atherosclerotic plaque. Alternative therapies to consider for future clinical trials include angioplasty alone, indirect surgical bypass procedures, ischaemic preconditioning, and new anticoagulants (direct thrombin or Xa inhibitors).
http://www.thelancet.com/journals/laneur/article/PIIS1474-4422(13)70195-9/abstract
 

Pulmonary embolism after endovenous thermal ablation of the saphenous vein.

Semin Vasc Surg. 2013 Mar;26(1):14-22. 

Pulmonary embolism after endovenous thermal ablation of the saphenous vein.

Rosales-Velderrain A, Gloviczki P, Said SM, Hernandez MT, Canton LG, Kalra M.

Division of Vascular and Endovascular Surgery, Mayo Clinic, 200 1(st) Street, SW, Rochester, MN 55905.

Pulmonary embolism (PE) after venous procedures is fortunately rare. Our goal was to analyze the data of patients who developed PE after endovenous thermal ablation and phlebectomy for varicose veins and to review the literature on this subject. We report on three patients who developed PE after radiofrequency ablation of the great saphenous vein and mini phlebectomy for symptomatic primary lower-extremity varicose veins. Early postoperative duplex scans confirmed successful closure of the great saphenous vein in all. One patient presented with chest pain and dyspnea, one with blood-tinged sputum, and the third with symptoms of saphenous thrombophlebitis. Two patients had PE from the saphenous vein thrombus and the third had gastrocnemius vein thrombosis extending into the popliteal vein. One had previous deep vein thrombosis. Computed tomography of the chest confirmed PE in all. Two patients were treated with anticoagulation, but the third patient with small PE declined such treatment. One patient underwent temporary inferior vena cava filter placement because of recurrent PE. In conclusion, PE is very rare but it can occur after endovenous thermal ablation of lower-extremity varicose veins. Selective thrombosis prophylaxis and preoperative counseling of the patients about signs and symptoms of deep vein thrombosis and PE are warranted for early recognition and rapid treatment. 

Is it difficult to choose the cost effective mode of treatment for aortic aneurysms after the introduction of the endovascular therapies for the aneurysms?

The Cost of open and endovascular repair of the aortic aneurysms is comparable?

It is generally felt that the Endovascular vascular repairs of the aortic aneurysms is more expensive than the open repair in India. The duration of the hospital stay and other services are considered to be less expensive in India than in the other countries. There are some studies published in the EJVES and JVS saying that the Endovascular repair may be better than open in terms cost saving!  It may be surprising to some of us in India. 

The cost of the Endoprosthesis is more than Rs. 3,50,00 to 10,00,000 depending on the number of devices and hard ware used during the procedures. The multinational companies are trying to provide the necessary supports by extending concessions in some cases. 

In many Governments hospitals the surgeons don’t have privileges to enter the cath labs and at the same these procedures are not supported financially in government hospitals. So, majority of the cath lab procedures are done in private sector in our country. There are few govt. general hospitals performing these procedures maintaining a balance between the cost and the outcomes. We strongly feel that the Govt. should propose to establish the cath labs accessible to all the doctors treating the patients through endovascular methods. There is also need for the hybrid operation theatres to facilitate the minimally invasive operations to reduce the morbidity and mortality.  

VAC study group from USA says that Endovascular repair is a cost-effective alternative to open repair in the US VA healthcare system for at least the first two years Eur J Vasc Endovasc Surg. 2012 Dec;44(6):543-8. Stroupe KT et al say that In a multicenter randomized trial, endovascular AAA repair resulted in lower cost and better survival than open repair after the initial hospitalization for repair; but after 2 years, survival, quality of life, and costs were not significantly different between the two treatments. J Vasc Surg. 2012 Oct;56(4):901-9. Routine use of endovascular repair in patients also eligible for open repair does not result in a QALY gain at 1 year postoperatively, provides only a marginal overall survival benefit, and is associated with a substantial, if not prohibitive, increase in costs. Prinssen M et al J Vasc Surg. 2007 Nov;46(5):883-890.