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News Article | February 27, 2017
Site: www.eurekalert.org

Australian scientists have discovered the first evidence of genes that cause Macular Telangiectasia type 2 (MacTel), a degenerative eye disease which leads to blindness and is currently incurable and untreatable Australian scientists have discovered the first evidence of genes that cause Macular Telangiectasia type 2 (MacTel), a degenerative eye disease which leads to blindness and is currently incurable and untreatable. The team's findings established five key regions -- or loci -- in the genome most likely to influence a person's risk of developing MacTel. The finding will enable researchers to better understand the disease and look for ways to prevent or stop its progression. The study, published today in Nature Genetics, was an international collaboration led by bioinformaticians Professor Melanie Bahlo and Dr Thomas Scerri at Melbourne's Walter and Eliza Hall Institute of Medical Research. MacTel is a rare and complex disease that mainly affects people from the age of 40 onwards. The disease causes abnormal growth of blood vessels in the macula -- located in the middle of the retina. Patients experience a loss of central vision crucial for tasks requiring focus, such as driving or reading, with no treatment available to stop progression of the disease. Professor Bahlo said the study involved detailed genetic analysis of MacTel patients from around the world, including Australia, using genome wide association studies (GWAS). "We analysed more than six million genetic markers and identified five regions, called loci, across the genome that had similar patterns in people with the disease, but not the healthy individuals," Professor Bahlo said. "These five genetic risk loci are our treasure map, telling us where to 'keep digging' in order to discover the specific genes implicated in MacTel," she said. Professor Bahlo said the team worked with collaborators in London and New York to analyse the genetic data from 476 people with MacTel and 1733 controls (people without the disease). "We were thrilled when our results were corroborated by two further independent validation studies," she said. The analysis also revealed that people with the MacTel genetic risk loci identified in the study had changes in their metabolism, specifically in their glycine and serine levels. Professor Bahlo said this meant there could be a significant relationship between the level of glycine and serine in the body, and onset of the disease. "Though the exact link between the disease and glycine and serine is yet to be confirmed, the connection is an exciting clue to help us further explore metabolic abnormalities in people with MacTel," Professor Bahlo said. Dr Scerri said the team's work highlighted crucial points of interest that, with further investigation, could help researchers find a way to prevent the progression of the disease. "We are continuing to explore the genetic data to try to identify the specific genes involved, and the precise genetic variations that are leading to the disease," Dr Scerri said. President of the Lowy Medical Research Institute that sponsored the research Professor Martin Friedlander said the work represented a significant advancement in efforts to understand the cause of MacTel. "We are working to develop treatments effective in preserving vision in patients with this disease," he said. The research was supported by the Lowy Medical Research Institute, The Genomics Core Facility at the University of Utah School of Medicine, participants of the MacTel Project, the National Eye Institute, the Wellcome Trust, the British Heart Foundation, Diabetes UK, the National Institute for Health Research, Moorfields Biomedical Research Centre, Victorian State Government Operational Infrastructure and Support Scheme, and the National Health and Medical Research Council.


News Article | February 21, 2017
Site: www.eurekalert.org

A one-off bowel screening test reduces the risk of developing bowel cancer by more than one third and could save thousands of lives, according to a study published in The Lancet*. The researchers, funded through a Medical Research Council (MRC) and National Institute for Health Research (NIHR) partnership** and Cancer Research UK, found that the test - which examines the lower part of the large bowel - prevented more than half of potential bowel cancers from developing in that area and two thirds of deaths were avoided. Bowel scope uses a tiny camera attached to a thin flexible tube to examine a specific part of the bowel but was still found to prevent 35 per cent of bowel cancers overall and to prevent 40 per cent of deaths. The team followed more than 170,000 people for 17 years on average and more than 40,000 had the bowel scope test. It is the longest study ever done on the effectiveness of the test. Bowel scope can stop cancer before it starts by finding small growths, called polyps, on the bowel wall. If left untreated polyps may become cancerous, but those found during bowel scope can usually be removed there and then. Professor Wendy Atkin, Cancer Research UK's bowel screening expert and lead author based at Imperial College London, said: "We know the bowel scope test has huge benefits for older people. Although no screening test is perfect, this study shows that bowel scope is effective in reducing cancer deaths for at least 17 years. "Bowel cancer can be prevented. And the bowel scope screening test is a great way to reduce the number of people diagnosed with the disease so it's vital that no one misses out on the opportunity to get the test." Julie Sharp, Cancer Research UK's head of health information said: "Like other types of screening, bowel scope is meant for people without symptoms. It's a great way to help reduce the number of people developing or dying from bowel cancer, but it can't pick up everything. "So it's still important to take part in the rest of the bowel screening programme and not ignore the home testing kits when they arrive. And whatever your screening history tell your doctor if you notice any unusual or lasting changes such as blood in your poo or a change in bowel habit."*** The government estimates that the bowel scope test will take at least another three years before it will be offered to everyone eligible across England. The test is offered to people at age 55. Governments in Scotland, Wales and Northern Ireland have not yet committed to introducing this test as part of their own bowel screening programmes. Emma Greenwood, Cancer Research UK's director of policy, said: "In England the government has committed to rolling out this test but there is a shortage of trained staff to carry it out. A training scheme is underway but it's important that there are enough newly trained specialists to meet the growing demand for these life-saving tests." For media enquiries please contact Fiona Dennehy in the Cancer Research UK press office on 020 3469 6770 or, out-of-hours, the duty press officer on 07050 264 059.


MIRAMAR, FL, February 14, 2017-- E-Z-C Pak, the first physician formulated tapered immune support pack targeting inappropriate antibiotic use in colds and flu was awarded the prestigious 2017 Buyer's Choice Award at the ECRM National Cold and Cough Retail Buyer's Conference. The award is sponsored annually by media outlet Drug Store News and voted on by retail buyers and category managers of the largest retail pharmacy, food and drug chains, and independent pharmacy distributors in the United States.Formulated utilizing the best available clinical data, EZC Pak is an over the counter immune support supplement composed of certified organic Echinacea, Zinc, and Vitamin C created by California physician Sarath Malepati, MD, out of concern for growing antibiotic resistance and medical complications resultant from inappropriate antibiotic prescribing patterns. "Per a 2014 WebMD survey, 95% of US prescribers admit to writing antibiotics when unclear of their necessity. The number one cited reason is patient expectation. According to the Centers for Disease Control and Prevention (CDC), over half of antibiotic prescriptions written are unnecessary. This problematic interaction is fueling antibiotic resistance and our growing superbug crisis in the healthcare system," Dr. Malepati commented. EZC Pak is designed to help reduce inappropriate antibiotic prescriptions while educating patients and maintaining patient satisfaction."Incorporating EZC Pak into clinical practice, we have cut antibiotic prescriptions in patients who do not meet criteria for an antibiotic at initial presentation to less than 5% with a greater than 90% patient satisfaction score," Malepati said. EZC Pak is a National Partner of the CDC Get Smart About Antibiotics Initiative."We are deeply honored that EZC Pak has been recognized by the nation's top pharmacy retailers and distributors with this award. The recognition speaks to the growing awareness and participation of the retail sector in collaborating with health care professionals to spread awareness and stem the tide of inappropriate antibiotic use across our communities. We will continue to work in close collaboration with the retail sector, health care system, and government agencies to solve this complex problem together," Dr. Malepati said.About Drug Store News:Drug Store News is a leading industry media outlet in drug store and pharmacy news covering business, retailers, supplier information, and financial data. For more information, please visit http://www.drugstorenews.com About Sarath Malepati, MD:Dr. Malepati is a former faculty member of Georgetown University School of Medicine and health care policy fellow at the National Institute for Health Care Management, where his research focused on how flaws in the design and delivery of health care contribute to patient disease and public health problems. Dr. Malepati is the current Medical Director of the PPC Group, a California-based health products team focused on improving patient care and public health. The PPC Group works to develop simple solutions for common health care problems that support closing the knowledge gap between clinicians and patients.About EZC Pak:EZC Pak is the first physician formulated Immune Support Pack composed of certified organic Echinacea, Zinc, and Vitamin C designed to reduce inappropriate antibiotic use. EZC Pak is available online at ezcpak.com and a growing number of medical offices, academic centers, pharmacies, and related retail outlets. For more information, please visit http://ezcpak.com


News Article | February 17, 2017
Site: www.eurekalert.org

The researchers from Imperial College London analysed 20 pharmacies that were available for UK citizens to access online. This is one of the few studies to have examined the online availability of antibiotics and to have explored the potential effects on public health. The research is published in Journal of Antimicrobial Chemotherapy. Antibiotics are classed as prescription only medicines in the UK, meaning they cannot legally be sold to consumers without a valid prescription. In the study, the researchers found that although online versions of UK high street pharmacies were compliant with prescription regulations, 80 per cent of the online pharmacies surveyed let customers choose their dosages, the duration and choice of antibiotic treatments. This can lead to serious side effects in patients and increases the risk of antimicrobial resistance. Antimicrobial resistance is one the biggest threats to global health, food security, and development today, according to the World Health Organization (WHO).The study was carried out by academics from Imperial College London's NIHR Health Protection Research Unit for Healthcare Associated Infections and Antimicrobial Resistance, and Imperial College Healthcare NHS Trust. The team carried out their research by entering the search term 'buy antibiotics online' into Google and Yahoo. The team recognise that the study is a 'snapshot' of the online pharmacy industry, but it does provide insights into how it operates. The 20 pharmacies at the top of the search were analysed by the team. Dr Sara Boyd, a co-author and NIHR Academic Clinical Fellow in Infectious Diseases and Microbiology at Imperial, said: "These findings are a real concern, and raise several important issues regarding antibiotic resistance and patient safety with online pharmacies." All online medicine vendors selling to UK consumers must by law register with both the Medicines and Healthcare products Regulatory Agency (MHRA) and the General Pharmaceutical Council (or the Pharmaceutical Society of Northern Ireland). However, the researchers found that 75 per cent of online pharmacies included in the study lacked evidence of the appropriate registration status required by law. In other findings, the researchers discovered that 45 per cent of the online pharmacies analysed did not require a prescription from the patient. Only 30 per cent of websites in the survey asked consumers to complete a health questionnaire prior to purchase. Seventy per cent of the websites provided information on the safe usage of prescription medications, including potential side effects or adverse reactions when combined with other drugs. Professor Alison Holmes, of Imperial's Department of Medicine, added: "Improper use of antibiotics can mean that infections are not being treated appropriately, or that people are being unnecessarily exposed to antibiotics. This allows bacteria to become resistant to drugs that once killed them. As a result, it is essential that antibiotics are prescribed only when they are needed." Although a small study, the authors say that the research offers insight into the increasing use of the internet for a variety of purposes, including buying antibiotics. Dr Boyd said: "The way patients interact with healthcare is constantly evolving, and shifts in consumer behaviour mean more people are purchasing their goods online. Our study paves the way for larger, more thorough research into this worrying new trend so that we can ensure patient safety and promote the responsible use of antibiotics in all areas of healthcare provision." Martin Astbury, President of the Royal Pharmaceutical Society, said: "Unnecessary antibiotic use can result in serious side effects in individuals and has a major impact on wider public health by increasing antibiotic resistance. We cannot support access to antibiotics through a web form until the standards for prescribing by private providers reflect the standard of face to face consultations in the NHS. Those involved in supplying medicines online should ensure their processes are as robust as possible." All online pharmacies identified as illegally selling antibiotics to patients within the UK were reported to the Medicines and Healthcare products Regulatory Agency (MHRA), who promptly responded. The researchers are working together with numerous stakeholders to improve patient safety and antibiotic stewardship in this area. Anyone with a concern concerns about an online pharmacy should contact the MHRA directly. The study was partially funded by the National Institute for Health Research Health Protection Research Unit in Healthcare Associated Infections and Antimicrobial Resistance at Imperial College London, in partnership with Public Health England and Imperial College Healthcare NHS Trust.


LIVERPOOL, 21-Feb-2017 — /EuropaWire/ — Researchers from the University of Liverpool have found that the annual number of estimated number of norovirus cases annually in the UK is approximately 800,000 greater than previously estimated. Norovirus is the commonest cause of gastrointestinal disease across all age groups worldwide. The majority of cases experience a mild, self-limiting illness and few cases tend to consult primary healthcare. Those that do might not be sampled, leading to huge under-diagnosis and under-reporting. The low infectious dose of norovirus means that people not exhibiting symptoms (asymptomatic) can potentially contribute to ongoing transmission. The Second Study of Infectious Intestinal Disease in the community (IID2 study) in the UK estimated the community incidence of norovirus to be 47/1000 population, which equates to around three million cases a year, at a cost to cases and the health service of up to £106million. The IID2 study estimated the number of cases who were symptomatic. Using a modified measure of estimating positivity for norovirus, researchers from the National Institute for Health Research Health Protection Research Unit (NIHR HPRU) in Gastrointestinal Infections at the University of Liverpool increases the estimation of the population burden of norovirus infection by around 26%, equating to 3.7 million norovirus infections annually. The results of this study, which have been published in the journal Vaccine, also suggests that around 6% of the population and around 18% of children aged less than five years are affected by norovirus each year. Dr John Harris, said: “With possible vaccines on the horizon for norovirus, having a good estimate of the total burden of norovirus infection, as well as symptomatic disease will be useful in helping to guide vaccination policy when candidate vaccines become available.” The research was funded by the NIHR HPRU in Gastrointestinal Infections at the University of Liverpool in partnership with Public Health England; University of East Anglia; University of Oxford and the Institute of Food Research. The full study, entitled ‘Re-assessing the total burden of norovirus circulating in the United Kingdom population’, can be found here.


News Article | February 16, 2017
Site: www.chromatographytechniques.com

The discovery of the 'molecular switch' that causes inflammatory bowel disease (IBD) and Celiac disease, could lead to more effective new treatments for these life-changing auto-immune conditions, according to research from scientists at King's College London and University College London. For the first time, researchers have a specific target for the treatment of these conditions by identifying an immune molecule called T-bet as the key control point that regulates this genetic risk in specific diseases. The discovery has been published in the journal PLoS Genetics. T-bet plays an important role in coordinating the body's immune responses. In patients with IBD, T-bet behaves abnormally, causing the immune reaction which leads to the development of the condition. A great deal of work has been done on the genetic predisposition to autoimmune disease over the past 10 years. However, it has been very difficult to develop effective treatments because a large number of genes each make a very small contribution to the development of these diseases. "Our research outlines a specific focus for the development of new treatments for these diseases which have such a profound effect on sufferers," said Graham Lord, co-senior author on the study and firector of the National Institute for Health Research Biomedical Research Centre.


News Article | February 15, 2017
Site: www.eurekalert.org

Vitamin D supplements protect against acute respiratory infections including colds and flu, according to a study led by Queen Mary University of London (QMUL) Vitamin D supplements protect against acute respiratory infections including colds and flu, according to a study led by Queen Mary University of London (QMUL). The study provides the most robust evidence yet that vitamin D has benefits beyond bone and muscle health, and could have major implications for public health policy, including the fortification of foods with vitamin D to tackle high levels of deficiency in the UK. The results, published in the BMJ, are based on a new analysis of raw data from around 11,000 participants in 25 clinical trials conducted in 14 countries including the UK, USA, Japan, India, Afghanistan, Belgium, Italy, Australia and Canada. Individually, these trials yielded conflicting results, with some reporting that vitamin D protected against respiratory infections, and others showing no effect. Lead researcher Professor Adrian Martineau from QMUL said: "This major collaborative research effort has yielded the first definitive evidence that vitamin D really does protect against respiratory infections. Our analysis of pooled raw data from each of the 10,933 trial participants allowed us to address the thorny question of why vitamin D 'worked' in some trials, but not in others. "The bottom line is that the protective effects of vitamin D supplementation are strongest in those who have the lowest vitamin D levels, and when supplementation is given daily or weekly rather than in more widely spaced doses. "Vitamin D fortification of foods provides a steady, low-level intake of vitamin D that has virtually eliminated profound vitamin D deficiency in several countries. By demonstrating this new benefit of vitamin D, our study strengthens the case for introducing food fortification to improve vitamin D levels in countries such as the UK where profound vitamin D deficiency is common." Vitamin D - the 'sunshine vitamin' - is thought to protect against respiratory infections by boosting levels of antimicrobial peptides - natural antibiotic-like substances - in the lungs. Results of the study fit with the observation that colds and 'flu are commonest in winter and spring, when levels of vitamin D are at their lowest. They may also explain why vitamin D protects against asthma attacks, which are commonly triggered by respiratory viruses. Daily or weekly supplementation halved the risk of acute respiratory infection in people with the lowest baseline vitamin D levels, below 25 nanomoles per litre (nmol/L). However, people with higher baseline vitamin D levels also benefited, although the effect was more modest (10 per cent risk reduction). Overall, the reduction in risk of acute respiratory infection induced by vitamin D was on a par with the protective effect of injectable 'flu vaccine against 'flu-like illnesses. Acute respiratory infections are a major cause of global morbidity and mortality. Upper respiratory infections such as colds and 'flu are the commonest reason for GP consultations and days off work. Acute lower respiratory infections such as pneumonia are less common, but caused an estimated 2.65 million deaths worldwide in 2013. Vitamin D supplementation is safe and inexpensive, so reductions in acute respiratory infections brought about by vitamin D supplementation could be highly cost-effective. The study was conducted by a consortium of 25 investigators from 21 institutions worldwide* and funded by the National Institute for Health Research. Joel Winston, Public Relations Manager (School of Medicine and Dentistry) Queen Mary University of London j.winston@qmul.ac.uk Tel: +44 (0)20 7882 7943 / +44 (0)7970 096 188 * Institutions involved in the research: Edmond and Lily Safra Children's Hospital (Tel Hashomer, Israel), Geisel School of Medicine at Dartmouth (NH, USA), Harvard School of Public Health (Boston, MA, USA), Jikei University School of Medicine (Tokyo, Japan), Karolinska Institutet (Stockholm, Sweden), Massachusetts General Hospital (Boston, MA, USA), McMaster University (Hamilton, Ontario, Canada), Medical University of Lodz (Poland), QIMR Berghofer Medical Research Institute (Queensland, Australia), Queen Mary University of London (UK), The Pennsylvania State University (Hershey, PA, USA), Università degli Studi di Milano (Milan, Italy), Universitair ziekenhuis Leuven (Belgium), University of Auckland (New Zealand), University of Birmingham (UK), University of Colorado School of Medicine (Aurora, CO, USA), University of Delhi (India), University of Otago (Christchurch, New Zealand), University of Tampere (Finland), University of Tasmania (Australia), Winthrop University Hospital (Mineola, NY, USA). Research paper: 'Vitamin D supplementation to prevent acute respiratory infections: systematic review and meta-analysis of individual participant data'. Martineau et al. BMJ 2017 Queen Mary University of London (QMUL) is one of the UK's leading universities, and one of the largest institutions in the University of London, with 23,120 students from more than 155 countries. A member of the Russell Group, we work across the humanities and social sciences, medicine and dentistry, and science and engineering, with inspirational teaching directly informed by our research. In the most recent national assessment of the quality of research, we were placed ninth in the UK (REF 2014). As well as our main site at Mile End - which is home to one of the largest self-contained residential campuses in London - we have campuses at Whitechapel, Charterhouse Square, and West Smithfield dedicated to the study of medicine, and a base for legal studies at Lincoln's Inn Fields. We have a rich history in London with roots in Europe's first public hospital, St Barts; England's first medical school, The London; one of the first colleges to provide higher education to women, Westfield College; and the Victorian philanthropic project, the People's Palace at Mile End. Today, as well as retaining these close connections to our local community, we are known for our international collaborations in both teaching and research. QMUL has an annual turnover of £350m, a research income worth £125m (2014/15), and generates employment and output worth £700m to the UK economy each year. The National Institute for Health Research (NIHR) is funded by the Department of Health to improve the health and wealth of the nation through research. The NIHR is the research arm of the NHS. Since its establishment in April 2006, the NIHR has transformed research in the NHS. It has increased the volume of applied health research for the benefit of patients and the public, driven faster translation of basic science discoveries into tangible benefits for patients and the economy, and developed and supported the people who conduct and contribute to applied health research. The NIHR plays a key role in the Government's strategy for economic growth, attracting investment by the life-sciences industries through its world-class infrastructure for health research. Together, the NIHR people, programmes, centres of excellence and systems represent the most integrated health research system in the world. For further information, visit the NIHR website (http://www. ).


News Article | February 21, 2017
Site: www.rdmag.com

Screening methods for cardiovascular diseases such as heart attacks and strokes could be improved by measuring different biological signposts to those currently being tested, a new study led by researchers from King's College London suggests. Published in the Journal of the American College of Cardiology, the study could allow doctors to better predict the development of cardiovascular disease at an earlier stage. The research, which was supported by the National Institute for Health Research (NIHR) Biomedical Research Centre at Guy's and St Thomas' NHS Foundation Trust and King's College London, explored the role of a family of proteins called apolipoproteins. Currently, the main focus is on apolipoprotein A1 (apoA1), the main component of high-density lipoproteins (HDL) or 'good' cholesterol, and apolipoprotein B (apoB), which is present on low-density lipoproteins (LDL) or 'bad' cholesterol. However, for the first time, researchers have used a technology called mass spectrometry to measure an unprecedented number of apolipoproteins in a population-based study and discovered that another group of apolipoproteins might complement the signposts of good and bad cholesterol: apoE, apoC2 and apoC3. These apolipoproteins are associated with very low-density lipoproteins (VLDL) and predominantly linked to another type of fat called triglycerides. ApoE, apoC2 and apoC3 have shown a stronger association with cardiovascular disease than apoA1 and apoB, suggesting that currently some of the most predictive apolipoproteins are not measured in patients who may be at risk of cardiovascular disease. The findings could lead to a change in the way patients all over the world are screened for cardiovascular disease, a condition which affects seven million people and causes more than 160,000 deaths in each year in the UK. It could also pave the way for more personalised treatments. Lead author of the study Professor Manuel Mayr from King's College London said: "We directly compared the association of a broad panel of apolipoproteins to new onset of cardiovascular disease over a 10-year observation period, and found that while apoB was predictive, other apolipoproteins, namely apoE, apoC2 and apoC3, were even better. "These unexpected strong associations of VLDL-associated apolipoproteins with cardiovascular disease provide support to expanding the current measurements of apolipoproteins and to the concept of targeting additional apolipoproteins to reduce risk." The study identified apoC3 as a prime therapeutic target for lowering VLDL, which might reduce excess cardiovascular risk related to high VLDL.


News Article | February 22, 2017
Site: www.eurekalert.org

An innovative psychological treatment can help older people who are suffering from lower-severity depression, say researchers at the University of York -- it can also prevent more severe depression from developing An innovative psychological treatment can help older people who are suffering from lower-severity depression, say researchers at the University of York. It can also prevent more severe depression from developing. Depression is common amongst older people, with one in seven meeting the criteria for full-blown depression. Older people at the greatest risk of depression are those who suffer from loneliness and long-term illnesses, both of which affect this age group disproportionately. Being depressed can also make health problems worse and older people with depression are at an increased risk of dying. The CASPER clinical trial focussed on older people with lower-severity symptoms who are at the highest risk of becoming clinically depressed. CASPER is the largest-ever study of its kind and is reported in the Journal of the American Medical Association (JAMA). York based researchers showed that a simple and low-cost intervention reduced the symptoms of depression in older people (aged 65 and over). Those who received the intervention were also less likely to be more severely depressed after a year. Older people were also less anxious and had improved quality of life compared to people who just received care from their GP. "We developed our Collaborative Care intervention after consulting with older people and considering evidence about effective treatments for depression." said study manager, Kate Bosanquet, from the University of York's Department of Health Sciences. "We used a simple psychological approach known as behavioural activation. Older people were encouraged to re-engage with social activity and to find alternative ways of being mentally or physically active. This is important since people with depression commonly withdraw from these types of activities and this makes things worse." "Older people found Collaborative Care to be an acceptable way of accessing help,' said Della Bailey, one of the therapists working on the study. "We mostly worked with people over the telephone and found that participants appreciated this approach. This also meant that older people did not have to travel to hospital to receive psychological care." The study team, which also included researchers from the NHS, other universities and the Hull York Medical School are now planning to train NHS therapists in Collaborative Care to ensure that older people all over the UK can benefit from this intervention. "'This is the largest rigorous study of its kind and we are very grateful to the National Institute for Health Research, which funded our work, and to the hundreds of older people who participated in the study," said Chief Investigator, Professor Simon Gilbody. "'There is currently very little in the way of psychological treatment offered for older people. We hope that our research will improve the lives of older people throughout the UK."


News Article | February 17, 2017
Site: www.eurekalert.org

A study by researchers at the University of Southampton shows that antibiotics may be an effective treatment for acute non-complicated appendicitis in children, instead of surgery. The systematic review of existing literature is published in Pediatrics. The condition, which causes the appendix -- a small organ attached to the large intestine -- to become inflamed due to a blockage or infection, affects mainly children and teenagers. Appendicitis is currently treated through an operation to remove the appendix, known as an appendicectomy, and it is the most common cause of emergency surgery in children. The review, led by Nigel Hall, Associate Professor of Paediatric Surgery at the University of Southampton, assessed existing literature published over the past 10 years that included 10 studies reporting on 413 children who received non-operative treatment rather than an appendectomy. It shows that no study reported any safety concern or specific adverse events related to non-surgical treatment, although the rate of recurrent appendicitis was 14 per cent. Mr Hall, who is also a Consultant Paediatric and Neonatal Surgeon at Southampton Children's Hospital, commented: "Acute appendicitis is one of the most common general surgical emergencies worldwide and surgery has long been the gold standard of treatment. But it is invasive and costly, not to mention extremely daunting for the child concerned and their family. Our review shows that antibiotics could be an alternative treatment method for children. When we compared the adult literature to the data in our review it suggested that antibiotic treatment of acute appendicitis is at least as effective in children as in adults. This now needs to be explored more widely." The review says that longer term clinical outcomes and cost effectiveness of antibiotics compared to appendicectomy require further evaluation, preferably as large randomised trials to reliably inform decision making. To further this research Mr Hall and his team in Southampton, along with colleagues at St George's Hospital in Tooting, Alder Hey Children's Hospital in Liverpool and Great Ormond Street Hospital, are currently carrying out a year-long feasibility trial which will see children with appendicitis randomly allocated to have either surgery or antibiotic treatment. Mr Hall said: "In our initial trial, we will see how many patients and families are willing to join the study and will look at how well children in the study recover. "This will give us an indication of how many children we may be able to recruit into a future larger trial and how the outcomes of non-operative treatment compare with an operation." The study -- known as CONservative TReatment of Appendicitis in Children a randomised controlled Trial (CONTRACT) -- is being funded through a £483,000 grant from the National Institute for Health Research Health Technology Assessment Programme and co-ordinated by the University of Southampton's clinical trials unit in collaboration with the University of Bristol, the University of Liverpool and University College London.

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