Year: 2015

LONDON (TIP): Doctors in Britain have performed the first organ transplants from a new born in the UK.

In what is being called a milestone in neonatal care, a six-day-old baby girl’s kidneys and liver cells were given to two separate recipients after her heart stopped beating.

The baby girl suffered severe oxygen starvation and massive brain damage in the womb that left her completely unresponsive and unable to move when she was delivered at term by emergency caesarean.

A significant proportion of new-borns who die in neonatal units could be potential organ donors, and could therefore save the lives of other sick patients, but current guidelines make it very difficult for donors to be identified.

New guidelines from the Royal College of Paediatrics and Child Health are expected shortly, and these should help to standardise an approach to organ donation among new-borns, the doctors said.

They go on to hope that the guidance will kick start a new way of thinking about neonatal organ donation.

“We hope that neonatal units across the UK will actively start thinking about this noble cause, which makes the grieving family’s journey easier, and has the potential to transform another life,” they conclude.

The donation involved the kidneys, which were transplanted into a patient with renal failure, and liver cells
(hepatocytes), which were transfused into a further recipient.

The donor was a girl born at term after an emergency caesarean section in the neonatal unit of Hammersmith Hospital, London.

She weighed just over three kg, but was very sick, and it became clear that her brain had been starved of oxygen for a period during the pregnancy.

Treatment made no difference, and repeated examinations showed that she was unable to make any spontaneous movement, did not respond to any stimuli, and had fixed and dilated pupils.

The parents and clinicians involved in her care discussed the possibility of organ donation, when it became clear that she would not survive.

The parents then gave their consent for their daughter’s kidneys and liver cells to be used for the benefit of other sick patients.

Six days after she was born, and with death confirmed, these tissues were retrieved with the help of an experienced surgeon from the National Organ Retrieval Service.

“It is due to the extreme generosity of the parents and wonderful professional collaboration between the neonatal team and the organ donation team that this process was successful,” write the authors.

“This case has set a milestone in the care of new-borns in the UK,” they add.

Medics said the surgery was incredibly difficult and intricate. The kidneys at this stage of life are around 5 cm long.

LONDON (TIP): A revolutionary device – a paper clip sized implant which is inserted between the artery and vein in the upper thigh have been found to tremendously lower blood pressure among patients with uncontrolled high blood pressure. Queen Mary University of London has developed a device called Coupler which has been found to be more beneficial compared to those treated with usual drug measures.

The procedure of putting the implant lasts around 40 minutes under local anaesthetic.

Researchers led a randomised, blinded endpoint clinical trial with patients from multiple European Centres of Hypertension Excellence – including the Barts Blood Pressure Clinic at Barts Health NHS Trust in east London -all of whom had resistant high blood pressure and had not responded to at least three types of drug treatment.

The team compared the effects of the Coupler versus usual medical treatment in 83 patients of whom 44 received the ROX Coupler therapy.

Patients who received the Coupler experienced a significant and durable reduction in blood pressure.

There was also a reduced number of hypertensive complications and hospital admissions for high blood pressure crises. Dr Melvin Lobo, lead author sad “This is an entirely new and highly promising concept in high blood pressure treatment. Existing drugs focus on hormonal or neurological regulation of blood pressure, and newer treatments such as renal denervation are uniquely centred on the renal nervous system. The Coupler effectively targets the mechanical aspects of how blood circulation works – so it’s a totally new approach to controlling blood pressure. The Coupler also highlights the importance of arterial stiffness as a major cause of resistant high blood pressure and it targets this issue both safely and successfully.

February 16th, 2014 (VOA) An aggressive form of HIV has been discovered in Cuba. It develops into full-blown AIDS within just three years. Researchers said the progression happens so fast that treatment with antiretroviral drugs may come too late.

Professor Anne-Mieke Vandamme said Cuban health officials first alerted her about the aggressive form of AIDS. They asked for help in finding out what was happening.

“We have a collaborative project with Cuba and the Cuban clinicians had noticed that they recently had more and more patients who were progressing much faster to AIDS than they were used to [seeing]. In this case, most of these patients had AIDS even at diagnosis already,” she said.

Vandamme is a full medical professor at the University of Leuvan in Belgium. She and her team studied more than 70 patients and divided them into various groups. One group was made up of those who developed AIDS quickly.

“So this group of patients that progressed very fast, they were all recently infected. And we know that because they had been HIV negative tested one or a maximum two years before,” she said.

She said that on average, without treatment, HIV infection takes 5 to 10 years to become full-blown AIDS. That’s determined by the scarcity of CD-4 immune cells and the number of opportunistic infections a patient has.

Usually, she said, a fast progression of HIV to AIDS is more a result of the patient’s weak immune system rather than the particular subtype of HIV involved. What’s happening in Cuba is different.

“Here we had a variant of HIV that we found only in the group that was progressing fast. Not in the other two groups. We focused in on this variant [and] tried to find out what was different. And we saw it was a recombinant of three different subtypes,” she said.

This new form of HIV is a combination of sub-types A, D and G. It’s been named CRF19.

Vandamme said, “Another thing was that they had much more virus in their blood than the other patients. So, what we call the viral load was higher in these patients. “

The patients with the aggressive form of HIV also had higher levels of a molecule called RANTES. It’s released as part of the immune response and raises the alarm about infection.

Researchers have determined why this form of HIV progresses to AIDS so quickly. Vandamme said for infection to take place, HIV has to attach itself to a cell at – what she calls – anchor points. In medical terms they’re called co-receptors.

Vandamme said, “There are two types of co-receptors that HIV can use: CCR5 or CXCR4. And in the normal progression of the HIV to AIDS it often happens that the virus switches co-receptor. It almost always starts with using CCR5 and then it switches to CXCR4 after many years. And once it switches the progression to AIDS goes very fast.”

But instead of taking many years to switch co-receptors, the new form of HIV in Cuba does it less than three years.

Vandamme says the inclusion of HIV subtype D in the new variant may be key. It contains an enzyme that enables HIV to reproduce in greater numbers – and it takes proteins from other subtypes and uses them in new virus particles.

The good news is that the aggressive form of HIV responds to most antiretroviral drugs. The bad news is people may not realize they have full-blown AIDS until it’s too late for therapy to do any good.

Vandamme said the variant has been seen before in Africa, but there were very few such patients and it does not appear to be spreading there. However, it is in wide circulation now in Cuba and now can be easily studied. So, there may be an African link, but further study is needed.

She said it’s vital for people having unprotected sex with multiple partners to be tested for HIV early and often.