11-07-2019
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HEALTH<br />
THURSDAy,<br />
JULy <strong>11</strong>, <strong>2019</strong><br />
5<br />
Magnetic resonance of a medulloblastoma in a child's brain.<br />
Rodrigo de Oliveira Andrade<br />
Brazilian researchers have developed a<br />
low-cost method of classifying the most<br />
common malignant brain tumour in<br />
children, which they say can help<br />
medics diagnose and treat the<br />
condition. Medulloblastoma, a tumour<br />
of the central nervous system, affects<br />
one in every 200,000 children and<br />
adolescents worldwide and represents<br />
20 per cent of all childhood brain<br />
tumours.<br />
The World Health Organisation<br />
(WHO) divides the disease into four<br />
molecular subgroups according to<br />
their clinical and molecular<br />
characteristics. Categorising patients<br />
into one of these groups helps<br />
oncologists choose an appropriate<br />
treatment, with some groups<br />
requiring more aggressive therapy<br />
than others. However, low- and<br />
middle-income countries cannot<br />
afford to routinely use modern<br />
sequencing platforms to carry out<br />
this molecular classification.<br />
Gustavo Alencastro Cruzeiro, a<br />
geneticist at the University of São<br />
Paulo's Ribeirão Preto Medical School<br />
and lead developer of the method, said<br />
it was "faster and cheaper" than similar<br />
techniques used in developed<br />
countries. He said it costs US$26 per<br />
sample analysis compared with an<br />
average of US$60 for tests used in<br />
richer countries. "It should make this<br />
new method widely available in lowand<br />
middle-income countries, helping<br />
oncologists make rapid clinical<br />
decisions," he added.<br />
To develop the new method,<br />
researchers analysed 92 samples of<br />
frozen medulloblastoma' tissue<br />
gathered from children and young<br />
adults up to 24 years old undergoing<br />
treatment in three hospitals in the state<br />
of Sao Paulo.<br />
They extracted ribonucleic acid<br />
(RNA) sequences from each sample<br />
and converted them into stable<br />
complementary DNA (cDNA), which<br />
was processed using a technique called<br />
real-time polymerase chain reaction<br />
(PCR), which amplifies the signal of<br />
genes activated by the multiplication of<br />
cDNA molecules.<br />
This allowed researchers to identify a<br />
Photo: Reytan<br />
New method to classify brain<br />
tumour in children<br />
set of 20 genes associated with all four<br />
of the medulloblastoma molecular<br />
subgroups: SHH, WNT, Group 3 and<br />
Group 4. By using algorithm<br />
assessment and bioinformatic analysis<br />
techniques, the team identified the<br />
minimal number of genes needed to<br />
molecularly classify medulloblastoma,<br />
without losing accuracy.<br />
"We found that a set of six<br />
differentially expressed genes would be<br />
sufficient to distinguish SHH and WNT<br />
from the other two subgroups", said<br />
Cruzeiro. Roger Chammas, an<br />
oncologist at University of São Paulo<br />
School of Medicine, who was not part of<br />
the team, said the method was<br />
"undoubtedly a step forward," as it<br />
allowed for more cost-effective<br />
diagnosis.<br />
But he cautioned that it would take<br />
time for the new method to become<br />
available in hospitals. "We are now<br />
trying to obtain financial support for<br />
opening a start-up focused on<br />
childhood and central nervous system<br />
tumours," he said. "This will allow the<br />
achievement of molecular classification<br />
at the national level."<br />
How human's deepest<br />
fears being exploited<br />
Medicine dispensing innovation<br />
wins engineering prize<br />
Sally Nyakanyanga<br />
The innovator of a smart locker<br />
system designed to dispense<br />
medicines to patients in less than 36<br />
seconds has won the <strong>2019</strong> Africa<br />
Prize for Engineering Innovation.<br />
Public health institutions are<br />
resource-constrained and healthcare<br />
workers are overwhelmed, resulting<br />
in them being unable to attend to<br />
patients faster.<br />
South Africa alone has close to five<br />
million patients on anti-retroviral<br />
treatment and collecting their refills<br />
monthly, according to the WHO.<br />
Patients collecting chronic medicines<br />
wait for close to four hours at public<br />
health centres, says Neo Hutiri, a 31-<br />
year-old South African engineer who<br />
invented the innovation called Pelebox.<br />
"Pelebox takes pressure off medical<br />
teams and gives patients on chronic<br />
medicines valuable time back, ensuring<br />
the collection process is tracked and<br />
auditable," explains Hutiri. "This is the<br />
highest stamp of approval that our<br />
innovation could have hoped for. As an<br />
engineer, building a socially-minded<br />
solution was important to me and this<br />
award is a nudge that we are in the right<br />
direction." Hutiri received the first<br />
prize of £25,000 (about US$31,000)<br />
from the Royal Academy of<br />
Engineering, the founder of the<br />
competition.<br />
"Pelebox will improve healthcare for<br />
everyone using and working in a<br />
severely strained public healthcare<br />
system," adds John Lazar, one of the<br />
competition's judges, in a statement<br />
released this month (4 June) by the<br />
Royal Academy of Engineering.<br />
According to Hutiri, his team started<br />
working on the project in 2015 but the<br />
first unit became operational in 2017<br />
and was pilot-tested in 2018.<br />
"Each Pelebox unit has 72-99 doors<br />
and can serve 1,200 patients per<br />
month," Hutiri says. The innovation,<br />
according to Hutiri, shows that science<br />
in Africa can now drive a digitally<br />
connected Africa particularly to inspire<br />
young people by elevating the<br />
standards of applied science and how<br />
they can shape innovations.<br />
Patient Dhliwayo-Chiunzi, a<br />
biotechnologist at the Harare Institute<br />
of Technology in Zimbabwe, tells that<br />
Medicine displayed in a pharmacy.<br />
the Pelebox is a needed innovation,<br />
which has incorporated aspects of<br />
patient privacy to a large extent.<br />
"You realise the Pelebox operates like<br />
those food dispenser machines, hence<br />
it is quite user-friendly," Dhliwayo-<br />
Chiunzi explains. She advises patients<br />
using the Pelebox to access their<br />
medications at designated times to<br />
ensure that they take their medicines as<br />
expected. Hutiri tells that six Pelebox<br />
units have been installed at public<br />
hospitals in South Africa, with 42 units<br />
expected to be available by the end of<br />
the year partly through a contract with<br />
the South African government.<br />
Photo: Anouk Delafortrie<br />
How much does the<br />
world trust vaccines?<br />
Health Desk<br />
Public trust in vaccination is on shaky<br />
ground. Earlier this year, the WHO<br />
named 'vaccine hesitancy' one of its top<br />
ten threats to global health, defining<br />
hesitancy as "the delay in acceptance or<br />
refusal of vaccines despite the<br />
availability of vaccination services".<br />
Health experts fear that when people<br />
question whether vaccines are safe or<br />
effective, they may decide not to<br />
vaccinate themselves or their children -<br />
and that puts everyone at higher risk.<br />
There is some evidence on how people<br />
feel about vaccines, but until now<br />
health experts had few details about<br />
these views in different parts of the<br />
world. Do most parents believe<br />
vaccination is safe, effective, and<br />
important for their children? And how<br />
do their views relate to how much they<br />
trust scientists and health<br />
professionals?<br />
This interactive visualisation<br />
explores these questions through the<br />
Wellcome Global Monitor - the first<br />
study of public attitudes to science and<br />
health on a global scale. Questions over<br />
how public views on vaccination are<br />
changing are more pressing than ever.<br />
If enough people decide against<br />
getting a vaccine, outbreaks become<br />
more common and diseases more<br />
difficult to control. If people lose<br />
confidence in vaccination, they are<br />
more likely to opt against it. It's a<br />
decision that can affect not only their<br />
own health but that of others around<br />
them.<br />
This is because each person that gets<br />
immunised adds to a collective or 'herd'<br />
immunity that can stop a disease from<br />
spreading - but only if a large enough<br />
number of people get the vaccine. How<br />
large is 'large enough'? It depends on<br />
the disease. For measles, 90-95 per<br />
cent of the population needs to be<br />
vaccinated for this collective immunity<br />
to work. For polio, which is less<br />
contagious, it takes 80-85 per cent.<br />
This loss of vaccine confidence is<br />
reflected in a global resurgence of<br />
measles, with a 30 per cent rise in cases<br />
from 2016 to 2017. Outbreaks have also<br />
become more common, as seen in<br />
Brazil, India and the United States. The<br />
loss of confidence has been fuelled by<br />
anti-vaccination theories that began<br />
with a false claim of a link with autism.<br />
Globally, about eight out of 10 people<br />
have confidence in the safety of<br />
vaccines. Though encouraging, this also<br />
means one in five people question<br />
vaccine safety.<br />
And it's the pockets of scepticism<br />
that matter, according to Heidi Larson,<br />
director of the Vaccine Confidence<br />
Project who was involved in the study.<br />
Confidence is lowest in Eastern and<br />
Western Europe, where just over half<br />
the population agrees that vaccines are<br />
safe (50 and 59 per cent). It gets a little<br />
stronger in Northern<br />
But confidence in safety is at its<br />
highest in low-income regions. South<br />
Asia tops the chart at 95 per cent,<br />
followed by 92 per cent in East Africa.<br />
Across the African continent and Latin<br />
America, about 84 per cent of people<br />
surveyed agree that vaccines are safe.<br />
The figure is slightly lower across Asia<br />
(80 per cent) and in the Middle East<br />
(79 per cent).<br />
Published June <strong>2019</strong>, the study was<br />
based on nationally representative<br />
surveys of people aged 15 years or older<br />
in over 140 countries. More than<br />
140,000 people were asked questions<br />
about their views on vaccination, their<br />
trust in health professionals and in<br />
science, as well as how science benefits<br />
society. Before the questionnaire was<br />
rolled out it was tested across 10<br />
countries, in local languages. One<br />
reason was to make sure that everyone<br />
could understand the technical terms.<br />
To get a measure of scepticism about<br />
vaccination, researchers based their<br />
questions on an index developed by the<br />
Vaccine Confidence Project. According<br />
to Larson, the index was designed to get<br />
a better picture of the spectrum of<br />
views. The idea was to capture not just<br />
strong opinions for or against<br />
vaccination, but also the views of<br />
people in between who still question<br />
and look for answers.<br />
There is nothing in a vitamin drip that can't be got from a well-balanced diet.<br />
Photo : Alpgiray Kelem<br />
Rebecca Schiller<br />
Of couples trying for a baby, 84% will<br />
conceive naturally within the first year,<br />
others after a little more time, but the<br />
one in seven who continue to have<br />
problems are increasingly at the mercy<br />
of unproven "treatments" that promise<br />
to boost fertility for a hefty price tag.<br />
This week, intravenous wellness<br />
company Get A Drip was forced to<br />
withdraw a £250 "fertility boost" after<br />
the British Pregnancy Advisory Service<br />
highlighted the product's lack of proven<br />
benefits. It accused the company of<br />
"causing real damage to women's<br />
emotional wellbeing".<br />
The UK fertility industry is estimated<br />
to be worth more than £320m, and is<br />
growing all the time. An expensive<br />
vitamin drip (that contains ingredients<br />
that are all available - and more easily<br />
absorbed - in a balanced diet) is just the<br />
tip of the commercial fertility iceberg.<br />
The age at which men and women<br />
have their first child keeps rising, and<br />
the older they are, the less fertile. As the<br />
demand for fertility assistance grows,<br />
the chances of accessing NHS<br />
treatments diminish due to long<br />
waiting lists, the rationing of treatment<br />
and ever-narrowing eligibility criteria.<br />
The intense pressure to boost<br />
chances of conceiving naturally or<br />
make the most of a single shot at NHS<br />
treatment provides many opportunities<br />
for companies to exploit. In addition to<br />
a range of diet supplements and<br />
alternative therapies, private fertility<br />
clinics have been accused of profiting<br />
from unproven "add-on" treatments<br />
that can increase by thousands of<br />
pounds an already hefty bill for assisted<br />
conception.<br />
The Human Fertilisation and<br />
Embryology Authority (HFEA) found<br />
that 74% of private patients had bought<br />
add-on treatments. Its chair, Sally<br />
Cheshire, says: "The 'fertility drip' is<br />
just one more item on the list of myths<br />
that claim to increase or support<br />
fertility, targeting individuals who are<br />
often already going through emotional<br />
turmoil in their quest to conceive."<br />
The HFEA is working with the British<br />
Fertility Society to provide guidance to<br />
fertility clinics on how unproven<br />
treatments should be ethically<br />
introduced and it already offers a<br />
traffic-light system that rates add-on<br />
therapies by efficacy. Yet many of these<br />
commercial enterprises fall outside any<br />
hope of regulation.<br />
Some alternative treatments (such as<br />
acupuncture) have proven benefits for<br />
some - and can boost wellbeing and a<br />
sense of control at a stressful time.<br />
Sadly, desperation - especially in such<br />
an emotive area - will always be met<br />
with exploitation as well as support. For<br />
many couples, cheap lifestyle and diet<br />
changes, time, medical support where<br />
necessary and a more equal offer of<br />
NHS treatments will be far more<br />
effective than expensive treatments -<br />
whether they are dispensed in a<br />
shopping centre or by a white-coated<br />
professional in a clinic.<br />
More than 80 per cent of children were vaccinated in Bangladesh by 2014.<br />
Photo: Collected