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Friday, May 10, 2024
Coronavirus

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A recent study has revealed that an antibody-based blockade might effectively treat cytokine release syndrome (CRS) and alleviate severe cases of COVID-19.

A team of researchers at the Osaka University and Osaka Habikino Medical Center in Japan conducted the recent study. They have now published their findings in the journal Proceedings of the National Academy of Sciences.

The global race to develop a vaccine for SARS-CoV-2 continues. In the meantime, researchers are looking for ways to effectively treat COVID-19, testing both existing drugs and new, experimental therapies.

Because scientists do not fully understand the mechanisms behind severe COVID-19, many doctors are treating it by following the sepsis treatment guidelines.

Could cytokines be the solution?

In this recent study, the scientists focused on cytokines. These are a group of small proteins that modulate the immune response to trauma, infection, and conditions such as cancer.

Among other things, cytokines activate inflammation, which is part of the healing process.

Sometimes, the body releases an excess of cytokines. This causes excess inflammation, which can damage tissues. This response is called a cytokine storm.

Cytokine storms, or CRS, occur in a number of conditions, including multiple sclerosis, pancreatitis, and COVID-19.

Without treatment, CRS can cause multiple organ failure and, sometimes, death.

The body releases various cytokines during CRS, including interleukin (IL)-2, IL-6, IL-8, IL-10, interferon-gamma, monocyte chemotactic protein-1 (MCP-1), and tumor necrosis factor-alpha. However, there are no specific immunotherapies for its treatment.

High levels of several specific cytokines

“Despite knowing which cytokines are involved, there is still no specific immunotherapy for CRS, and treatment is limited to supportive care,” says study lead author Sujin Kang.

“To better understand the molecular mechanisms of CRS pathogenesis,” she adds, “we first studied the cytokine profiles of 91 patients diagnosed with CRS associated with bacterial sepsis, acute respiratory distress syndrome, or burns.”

The researchers found that all three groups of people had similar cytokine profiles.

Specifically, the researchers measured high levels of IL-6, IL-8, IL-10, and MCP-1, as well as a protein called plasminogen activator inhibitor-1 (PAI-1). This protein can cause small blood clots in vessels in the lungs and other organs.

PAI-1 levels significantly higher

Previous studies have shown that increased PAI-1 levels are linked to more severe cases of pneumonia, which is a leading cause of death among people with COVID-19.

“Examination of cytokine profiles in severe COVID-19 patients revealed an increase in IL-6 early in the disease process, causing release of PAI-1 from blood vessels,” says senior study author Tadamitsu Kishimoto, a professor at the Osaka University Immunology Frontier Research Center.

“Interestingly, PAI-1 levels were significantly higher in COVID-19 patients with severe respiratory impediment.”

Higher levels of IL-6 were associated with higher levels of the other cytokines and PAI-1. Therefore, the researchers believe that IL-6 signaling might be an important driver of CRS.

Arthritis drug decreases PAI-1

To investigate the role of IL-6 in CRS, the researchers gave the participants injections of a human monoclonal antibody-based drug called tocilizumab (Actemra), which blocks IL-6 signaling. The Food and Drug Administration (FDA) have approved tocilizumab as a treatment for rheumatoid arthritis.

The results showed that when people with severe COVID-19 received tocilizumab, the levels of PAI-1 decreased in the blood. Also, the drug alleviated symptoms and improved critical illness in those with severe COVID-19.

Overall, the researchers conclude that IL-6 signaling blockade with the anti-inflammatory medication tocilizumab may reveal new therapeutic opportunities for the treatment of both CRS and the severe respiratory complications of COVID-19.

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A recent study shows that it is relatively rare for COVID-19 patients to return to the hospital within 2 weeks of discharge. Individuals with high blood pressure or chronic obstructive pulmonary disease (COPD) were the most likely to require readmission.

As the COVID-19 pandemic continues, many hospitals remain under severe pressure.

To identify ways to relieve some of this pressure and improve patient care, researchers at the Icahn School of Medicine at Mount Sinai, New York, NY, compared COVID-19 patients who returned to the hospital with those who did not.

All those included in the study were patients at one of five hospitals in New York City between February 27 to April 12, 2020.

The researchers searched electronic health records for return visits to hospital emergency departments and outpatient clinics within 14 days of discharge.

Out of 2,864 discharged patients, 103 (3.6%) returned for emergency care. In total, the hospitals readmitted 56 patients.

Half of all the patients who returned to the hospital did so because they were experiencing breathing difficulties, which was the most common complication. Other complications included chest pain (6%), other pain (6%), altered mental status (5%), falls (5%), and skin or soft-tissue infections (5%).

Patients who returned to the hospital were significantly more likely to have hypertension (36% vs. 22.1%) and COPD (6.8% vs. 2.9%) than those who did not go back.

Surprisingly, say the researchers, there was no apparent association between the patients’ age and their likelihood of readmission.

Differences in original care

The original length of stay of people who went back to the hospital was significantly shorter than patients who did not return. Patients who returned had initially been in the hospital for a median of 4.5 days. Patients who did not return had been in the hospital for a median of 6.7 days.

Individuals who went back to the hospital were also less likely to have received anticoagulant drugs to help prevent dangerous blood clotting. However, this result was not statistically significant.

Of the 56 patients who went back to the hospital, 51 (91.1%) went home, three died, and two remained in the hospital at the time of the analysis.

The study features in the latest issue of the Journal of General Internal Medicine.

The authors conclude:

“Many healthcare facilities remain stretched beyond capacity. Readmissions following hospitalization for COVID-19 have the potential to exacerbate this burden and may represent a missed opportunity to provide optimal care. As the evolution of COVID-19 remains uncertain, characterization of the clinical course of patients who re-present after discharge is important with potential to inform discharge planning and post-discharge care.”

Keeping patients well

The peak of the COVID-19 outbreak in New York City (NYC) may have passed, says co-author Dr. Anuradha Lala, but several areas are now seeing a second wave of cases.

“While caring for patients during the peak of the pandemic in NYC, our focus was on safe and efficient discharge to make room for new patients and prevent additional exposure,” she says.

“As we move into a phase where COVID-19 is no longer a novel disease, we must transition our attention to the post-acute phase to understand how to keep patients well and out of the hospital.”

Dr. Benjamin Glicksberg, another of the study’s authors, adds: “These findings may help clinical practitioners optimize discharge strategies in the short-term, and suggest the need for future studies on tailored monitoring to decrease the risk of hospital returns.”

The authors acknowledge that their study’s relatively small sample size limited its statistical power and prevented them from controlling for other variables that could have affected the results.

Also, they were unable to collect data on possible readmissions to hospitals outside the Mount Sinai Health System or account for patients who may have died at home following discharge.

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The use of antibiotics in individuals with COVID-19 may result in increased antimicrobial resistance (AMR). This can involve bacteria becoming resistant to antibiotics. The effects may be felt among the wider population and have toxic consequences for the environment.

This is the main takeaway of new research conducted by a team from the University of Plymouth and the Royal Cornwall Hospitals Trust, both in the United Kingdom. The findings appear in the Journal of Antimicrobial Chemotherapy.

COVID-19 has created major problems for social and healthcare systems worldwide, and the spread of AMR is one possible consequence.

Although antibiotics are not used to treat diseases caused by viruses, patients hospitalized due to the coronavirus infections may receive a combination of these medications to prevent secondary bacterial infections. This may have serious effects on AMR.

“Common with other hospitalized patients in the U.K. and other countries, the majority of our patients with COVID symptoms were prescribed antibiotics because it is very difficult to know whether a patient presenting with symptoms of COVID has an overlying bacterial infection or not,” says Neil Powell, an author of the research and consultant pharmacist at the Royal Cornwall Hospitals Trust.

The concern about resistance has led the World Health Organization (WHO) to discourage the use of antibiotics for mild cases of COVID-19, though they still recommend their use for people with severe COVID-19 who have a risk of secondary bacterial infections and death.

Negative impact on the environment?

The present research revealed that the increased use of antibiotics during the pandemic may also be placing an added burden on wastewater treatment works.

The team noted that this could lead to raised levels of antibiotics within the U.K.’s rivers and coastal waters, which may in turn result in a rise in AMR.

This would be particularly serious in receiving waters of these works that serve large hospitals or emergency hospitals, where there are high concentrations of COVID-19 patients.

Data from UK emergency hospitals

To perform a comprehensive environmental safety assessment that addresses potential risks to fish populations and related food webs, the researchers estimated the antibiotic loads entering the wastewater treatment works.

This involved analyzing patient numbers in emergency hospitals set up temporarily around the country and taking into account the associated treatment works’ capacity and available river water dilution for the emergency hospital and associated town.

The researchers employed environmental impact data from previous research and modeling tools developed by the U.K. water industry. For illustrative purposes, they focused on a single U.K. emergency hospital: Harrogate, which has a capacity of 500 beds.

The National Institute for Health and Care Excellence COVID-19 guidelines recommend that patients with the virus receive the antibiotics doxycycline, amoxicillin, or a combination of others if their doctors suspect that a bacterial infection is present.

However, the guidelines also recommend not administering or stopping the antibiotics if no bacterial infection is found.

With these points in mind, the researchers predicted the possible effects of different scenarios involving antibiotic use during the COVID-19 pandemic — having all hospital beds occupied and having 70% or 95% of the patients receiving either doxycycline or amoxicillin.

It is important to note that amoxicillin is used to treat a wide range of bacterial infections, including pneumonia, throat infections, and skin and ear infections.

Amoxicillin and AMR — an environmental concern?

Thomas Hutchinson, a professor of environment and health at the University of Plymouth and the senior author of the research, says, “The data for amoxicillin indicated that while there was little threat of direct impacts on fish populations and other wildlife, there is a potential environmental concern for selection of AMR if at 100% capacity.”

“From our previous research, we know that significant quantities of commonly prescribed drugs do pass through treatment works and into our water courses,” adds Sean Comber, a professor of environmental chemistry at the university and the article’s lead author.

“By developing a greater understanding of their effects, we can potentially inform future decisions on prescribing during pandemics, but also on the location of emergency hospitals and wider drug and waste management,” says Prof. Comber.

Mathew Upton, a co-author and professor at the university’s School of Biomedical Sciences, concludes: “Antibiotics underpin all of modern medicine, but AMR is an issue that could impact millions of lives in the decades to come.” The author goes on to comment on the significance of the research.

“Currently, the COVID-19 pandemic is causing immense suffering and loss of life across the globe, but AMR has been — and will remain — one of the most significant threats to global human health. We conducted this study so that we can begin to understand the wider impact of global pandemics on human health.” – Prof. Mathew Upton

Finally, says Prof. Upton, “It is clear that mass prescribing of antibiotics will lead to increased levels in the environment, and we know that this can select for resistant bacteria. Studies like this are essential so that we can plan how to guide antibiotic prescription in future pandemics.”

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Although the sun has been quite scorching and temperature low, especially in the evenings, making many people to be indoors so as to keep warm. To avoid coming down with health conditions such as cold associated with this type of weather, medical experts have advised that necessary precautions be taken.

Children are especially vulnerable, as they easily succumb to certain ailments brought about by the weather. So, parents have been advised to ensure their children are well cared for, to protect against common cold.

To avoid the discomfort instigated by these ailments, some of the recommended safety measures include eating healthy foods that contain lots of vitamins, going to bed early, as well as wearing appropriate and comfortable clothes.

Former President, Association of Resident Doctors at the Lagos State University Teaching Hospital, Dr. Olubunmi Omojowolo, said common cold could be diagnosed by certain symptoms.

He said: “If your doctor suspects you have a bacterial infection or other condition, he or she may order a chest x-ray or other tests to exclude other causes of the signs and symptoms. Commonly used cold remedies include pain relievers.

“For a fever, sore throat and headache, many people turn to acetaminophen, tylenol, or other mild pain relievers. Acetaminophen should be used for the shortest time possible, and people should follow label directions to avoid side effects.

“It is important to use caution, when giving aspirin to children or teenagers. Children and teenagers recovering from chickenpox or flu-like symptoms should never take aspirin, which has been linked to Reye’s syndrome, a rare but potentially life-threatening condition in children.

“Consider giving your child over-the-counter (OTC) pain medications designed for infants or children. These include acetaminophen, children’s Tylenol, ibuprofen, children’s Advil and children’s Motrin, among others, to ease symptoms.

“Adults can use decongestant drops or sprays for up to five days, as prolonged use could cause rebound symptoms. Children younger than six years should not use decongestant drops or sprays.”

A Family Physician, Dr. Chukwuma Ogunbor, said the Food and Drug Administration (FDA) and the American Academy of Pediatrics strongly kick against giving OTC cough and cold medicines to children younger than four years, as they may be harmful.

He said: “There is no good evidence that these remedies are beneficial or safe for children. It is not typically recommended that you give cough or cold medicines to an older child, but if you do, follow the label directions. Do not give your child two medicines with the same active ingredient, such as an antihistamine, decongestant or pain reliever.

“Too much of a single ingredient could lead to an accidental overdose.

You may know that cold and flu season is here with us, but that does not make it easier, when you see your little one struggling with a cough and stuffy nose. Children under the age of five, and particularly under two years are, at high risk during cold and flu season.”

He explained that colds and flus are viral infections. And antibiotics won’t help to clear up infection. However, there are steps that can be taken to help children feel better, while their immune system battles the virus.

He said: “Keep your child hydrated to help reduce cold and flu symptoms, and make them feel better. Fever can result in dehydration. Your child may not feel as thirsty as, he or she normally would, and may be uncomfortable when drinking. So, it’s important to encourage him or her to drink plenty of fluids.

“Dehydration can be very serious in babies, especially if they’re under three months. Call your pediatrician, if you suspect your baby is dehydrated. Some signs may include no tears when crying, dry lips, soft spots that seem sunken in, decreased activity and urinating less than three to four times in 24 hours.

“Attempt to breastfeed infants more frequently than usual. Babies may be less interested in breastfeeding, if they’re sick. So, you may have to give several short feeding sessions for them to consume enough fluid.

“Ask the doctor if an oral rehydration solution like pedialyte is appropriate. Remember that you should not give little ones sports drinks. Older children have more hydration options, which may include sports drinks, popsicles, juice, broth and flat white soda.”

According to him, medicated nasal sprays are not recommended for young children. However, there are several easy ways to clear up a stuffy nose without medication.

“Use a cool mist humidifier in the child’s room,” he said. “This will help break up mucus. Be sure to carefully clean the humidifier between uses to keep mould from developing in the machine.

“Another option is using a saline nasal spray or drops, which make thin mucus easier to blow out or remove with a bulb syringe. This is especially helpful before feeding and bedtime.”

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All research works certainly have a purpose behind them but not all of them can be described as appropriate and rightly directed. A research work is purposeful and appropriate when its outcome can be used to solve problems of national development. National Development is the ability of a country to improve the social welfare of the people by providing social amenities like good education, infrastructures, medical care, and social services while is the process of arriving at dependable solutions to problems through the planned and systematic collection, analysis and interpretation of data.

The developed countries have taken great strides to ensure that their citizens enjoy good amenities and that is why we have emigration of our people to Europe and United States of America as they have developed a system that takes care of all inhabitants. These countries are the leaders in scientific breakthroughs, technological and infrastructural development.

Conversely, the developing countries, as exemplified by Nigeria, are still backward in their developmental efforts and struggling with basic needs of life. They have problems with virtually everything and they depend on the developed countries for infrastructures, medical care and education of their citizens.

National development is very critical to the survival and growth of any nation and according to Kothari Commission (1964-66), it lies on six basic features which include confidence in nation, continuous rise in standard of living of the masses, reduction of unemployment, equal opportunities for social, political and economic development, good and impartial administration and mutual understanding and sense of cooperation amongst masses. A country is said to be developed when it is able to provide a qualitative life for its citizens, there is equitable distribution of wealth, provision of good healthcare, education, housing and other essential services that improves individual and collective quality of life.

Quite regrettably, Nigeria has failed to meet up with the development strides that can make it to be classified as a developed nation. In the last six decades, Nigeria keeps on battling with the problems of development in spite of huge human, material and natural resources in her possession. We have failed to meet up in all the indices of development and our rating remains very low even among the nations that are less endowed. The failure of Nigeria cannot be ascribed to lack of development plans. We have them in abundance.

Two years after independence, we had the first National Development Plan Policy, which was formulated between 1962 and 1968 with the objectives of development opportunities in health, education, employment and improving access to the opportunities created. This plan failed due to lack of resources as only 14% of the expected external funding was received and the civil war which led to the collapse of the first republic. The second National Development Plan (1970 -1974) came after the civil war and priorities were on agriculture, industry, transport, manpower, defence, electricity, communication, water supply and provision of social services.

We really do not need to argue about the success or failure of this plan. The third plan was for the period between 1975 and 1980 and was more ambitious than the previous ones as there was emphasis on rural development, reactivation of the agricultural sector and so on but like its predecessor, it failed to achieve the set targets. The 4th development plan (1981 – to 1985) aimed to achieve improvements in the living conditions of the people with targeted increase in the real income of the average citizen, more even distribution of income among individuals and a reduction in the level of unemployment and underdevelopment. Unfortunately, like the previous ones before it, the objectives of the plan were not achieved. The enormous wealth from oil exploration was not invested to build a viable industrial base for the country. Our leaders forgot the eternal words of Ernest Agyemang Yeboah that ‘They that milk the cow everyday without feeding it well must never complain about how it keeps growing lean’.

All the programmes that were launched to herald these plans ended up in failure from ‘Operation Feed the Nation’ to ‘Green Revolution’. The various strategies that were adopted to put the country on the path of development did not produce any concrete result. These strategies include the Structural Adjustment Program (SAP), Vision 2020, National Economic Empowerment and Development Strategy (NEEDS) and others including the slogan from the current administration with Vision 2020 have not achieved anything that development connotes. We need to ask ourselves why these development plans have failed and what are the factors that are responsible for the failure. To start with, there is lack of executive capacity for the implementation or execution of the plans that are usually painstakingly drawn up. The people entrusted with the implementation usually lack the requisite authority or they are out- rightly incompetent. The plans are usually drawn up without consultation that will address the need of the people from bottom up.

There is no good governance and development plans become a mirage and unachievable as it takes good leadership to translate ideas into reality. For most of our leaders, there is no sense of commitment. According to Mimiko (1998), the leaders are only interested in access to power and privileges and not development. There is high level of corruption and indiscipline in all Government agencies and departments, which serve as a bottleneck to the execution of development plans.

How will a good plan become successful in the hands of corrupt executors?
The Nigerian economy is monolithic in terms of foreign exchange earning. The country rises and falls according to the dictates of the foreign oil market. Today, we are in trouble because of the low price of crude oil. If we recall that in the 1950s and the 1960s, agriculture was the mainstay of the economy but this was neglected as soon as we discovered oil in commercial quantities. Our economy is not diversified and that is why we suffer from dislocations and lack of sustainable development. It is not a surprise then that today Nigeria has one of the worst health indices in the world. We have failed in all measurements of development, which are Gross Domestic Product (GDP), Gross National Income (GNP), Life expectancy, Education index, Mean years of schooling index and Income Index put together as Human Development Index (HDI). From the UNDP’s

2018 report, Nigeria’s HDI value was 0.534, which put in the country in the low human development category and positioning of 158 out of 189 countries. The most annoying thing is that this rating falls below that of Democratic Republic of Congo (HDI = 0. 459), Ethiopia (HDI = 0.470) and the entire sub-Saharan Africa at 0.507. For the same measurement, the Life expectancy at birth and the mean years of schooling was 54.3 years and 6.5 years respectively compared with Congo (60.4 & 6.8), Ethiopia (66.2 & 2.8) and Sub-Saharan Africa (61.2 & 5.7).

Clearly, Nigeria has sub-optimised her potential in terms of development. We have failed to provide the requisite leadership for Africa to move forward after the horrendous years of slavery and colonisation. The most worrisome aspect is: who cares? Certainly not the current leadership at all levels.

Research is man’s ability to creatively or innovatively create new things that galvanise society into developmental strides.

This creativity or innovativeness is anchored on research, which is best described as the careful examination of an object and situation for the purpose of effecting societal development and improvement. It is a systematic work undertaken to increase the stock of knowledge including knowledge of humanity, culture and society, and the use of this stock of knowledge to define new applications (OECD, 2012). According to Duncan Macdonald, ‘The common facts of today are the products of yesterday’s research’. Research has also been described as a ‘systematic and objective search for knowledge, to establish theories and prove the truth of ideas, hypotheses and assumptions’. These definitions or descriptions hold for all manners of research whether social, educational or scientific. It is a search, according to Lucky Osaretin Odia (2013), which requires cares and diligence for new facts.

In a seminal paper, Lucky Osaretin Odia (2013), asked four questions to link research work with national development. These questions are: i) Is a nation’s level of development a function of research initiative structure? ii): Is a nation’s degree of progress a function of its research administrative efficiency? iii): Does the pattern/quality of research funding determine a nation’s level of development? iv): Does a nation’s level of investment on research and development determines its pace of advancement in science and technology? All these questions were answered in affirmative through a thoroughly conducted research.

*The article is a keynote address titled “Purposeful pharmaceutical research and national development” and delivered by Dr. Lolu Ojo at the 18th Annual National Conference of the Nigeria Association of Pharmacists in Academia (NAPA) on Monday, August 24 2020. Ojo is a Fellow of the Pharmaceutical Society of Nigeria (FPSN) and Chief Executive Officer (CEO) of Merit Healthcare Limited

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Nigeria and indeed the African continent was on Tuesday August 25 certified Wild Polio Virus (WPV) free by the World Health Organisation (WHO). Although the virus that once paralysed tens of thousands of children has been ‘eradicated’ on the African continent, a minor strain, circulating Vaccine Derived Polio Virus (cVDPV), still infects hundreds.

Africa announced that it has stamped out wild poliovirus after a three-decade campaign against a disease that once paralysed 75,000 children on the continent every year.

The achievement is a major step toward ridding the globe of the virus that causes the disabling and sometimes deadly disease of polio.

Nigeria was in 2015 removed from the list of countries endemic to polio that is still reporting cases leaving only Afghanistan and Pakistan.

Nigeria’s documentation to be declared polio free was on Thursday, June 18, 2020, accepted by the African Regional Commission for the Certification of Poliomyelitis Eradication (ARCC). The implication of this is that Nigeria has gone through the final process of Wild Polio Virus (WPV) eradication and certification and was officially declared WPV free by the WHO on August 25, 2020.

Indeed, Nigeria recorded this breakthrough in polio elimination despite the activities of Boko Haram and the significant increase in Wild Polio Virus type one (WPV1) cases globally in 2019.

The feat is significant in the face of many challenges including the poor access to children in some parts of the country due to insecurity, poor health seeking behaviour of Nigerians, vaccine hesitancy, malnutrition, poor sanitation, and inadequate funding for Primary Health Care (PHC), especially at State and Local Government Area (LGA) levels.

Nigeria made history on August 21, 2019, when she achieved three years without a case of WPV. The last WPV case was isolated in a child in Borno State on August 21, 2016.

The polio-free certification was after careful assessment of the risk of missed transmission in inaccessible areas of Borno, and other countries in the region where there is lack of confidence in surveillance.

The WHO, for the first time on September 25, 2015, delisted Nigeria from the polio-endemic list after interrupting transmission for 12 months beginning from July 24, 2014. Unfortunately, 25 months later, on August 21, 2016, another case of WPV was discovered.

The country’s giant strides in the area of polio elimination was credited to an incredible resilience within the National Primary Health Care Development Agency (NPHCDA) rank and file to fight any outbreak; and the country is now four years without any case of Wild Polio Virus (WPV) and was certified polio free officially, by the WHO, on August 25, 2020.

Dr. Faisal Shuaib, a medical doctor and public health specialist, is the Executive Director (ED)/ Chief Executive Officer (CEO) of the National Primary Health Care Development Agency (NPHCDA) Abuja.

Shuaib in an interview with The Guardian among other things said the Coronavirus disease (COVID19) pandemic had brought very challenging situations in the entire health systems and economies of nations including Nigeria and this has also affected the Polio Eradication Initiative (PEI) efforts in all countries.

What is the significance of the Nigeria being officially certified polio free by the WHO? Shuaib said: “This is indeed an historic day, a day of triumph in our close to three decades of fight against polio, and very significant for Nigeria because we have been removed from the list of countries still circulating WPV and therefore we have restored our pride of place in the committee of nations.

“It also means that sacrifices we have made as a nation for close to thirty years and the huge resources we have committed jointly with our partners in the fight against polio has not been in vein. It is also significant that President Muhammadu Buhari has delivered on his promise to deliver a polio free Nigeria.”

On how the country was able to achieve this feat despite all the changes especially the security challenges in northern Nigeria, the NPHCDA boss said: “We got the right resources from government and development partners, we got the right support from Mr. President, the Honourable Minister of Health (HMH), the state governors, Nigerians, and we got full alignment and support from our traditional leaders especially the Northern Traditional Leaders Committee on Polio Eradication Initiative (PEI)/Routine Immunisation (RI)/Primary Health Care (PHC) led by His Eminence the Sultan, Alhaji Muhammad Saad Abubakar, we got the right support also from our security agencies, we also got the right people in our agency in the in the right places at the right time.”

On the fear of possible resurgence of WPV, Shuaib said: “Yes our great country was almost WPV free in 2016 when we had resurgence of cases from among the trapped children in the insurgency ravaged northeast zone. Therefore the fear of resurgence is real and we have taken a number of steps to prevent this. Deepening our collaboration with the military and security Agencies to expand access to these children is one, and our innovations to reach inaccessible children in all the settlements in these areas is another. We are also determined to maintain our watertight Acute Flaccid Paralysis (AFP) surveillance in Nigeria through application of technology to improve detection of cases in all areas in order not get any surprises.”

On what is being done to ensure that the country remains polio free, the public health physician said: “We will continue our current drive at strengthening Routine Immunisation (RI), which is a key component of polio eradication and is yielding very positive results. We will also maintain our certification standard AFP surveillance system all of which will be sustained under a very strong, revitalized Primary Health Care (PHC) system, which is the main focus of this administration to be able to achieve Universal Health Coverage for all Nigerians. We are also putting a very strong surveillance at our borders and crossing points – sea land and air to ensure that individuals coming from polio endemic countries are fished out and vaccinated in order to prevent importations of all forms of polio viruses.”

How about the issue of circulating vaccine-derived polio virus (cVDPVs) that continues to exist? What is the implication for the quest to eliminate polio globally? The epidemiologist said: “Nigeria is currently surrounded by countries with cVDPVs, for over six months now we have had cases, the last case in our country was January 2020, which is as a result of challenges with the environment, where children who have been vaccinated with Monovalent Oral Polio Vaccine Type2 shed the viral particles in the environment which now interact with other pathogens and becomes virulent especially when children that have not completed their RI got infected. These aren’t part of the process for WPV certification and our great Agency is committed with other partners to address the environmental challenges and stop the circulation of CVDPVs.

“The fact is there is still Afghanistan and Pakistan circulating WPV and therefore the risk of importations is still there in all countries globally so we will ensure as I mentioned that all persons coming from endemic countries are vaccinated through our special interventions strategy of polio vaccinations at borders and crossing points.”

On the relationship between polio and COVID-19, Shuaib said the relationship is that they are viral illnesses and structurally they look similar, their modes of transmission clinical manifestations and infectivity or rate of spread are very different. He said COVID19 spreads much faster and affects individuals of all ages and the pandemic had brought very challenging situations in the entire health systems and economies of nations including Nigeria. He said this has also affected the Polio Eradication Initiative (PEI) efforts in all countries.

Shuaib said the situation therefore calls for urgent measures to stop the ravaging effects of the COVI19 infections in Nigeria. “We as an Agency had to develop and emergency COVID19 preparedness and response plan for PHC health facility and community levels, we had to develop COVID19 training manuals for preparedness and response at PHC and community levels within a very short span of time. Currently we are training more than 200,000 frontline PHC worker and community volunteers to be able to have the requisite knowledge to deliver the continuum of package of PHC services and prevent the already happening community transmission of COVID19 in all the states of the federation. We are also ensuring that PHC workers are kitted with basic Personal Protective Equipment (PPEs) to be able to provide services in all our PHC centres; these include polio vaccinations,” he said.

Shuaib said the greatest challenge they face in the COVID19 pandemic is delivery of PHC services including polio vaccinations. “Health care workers (HWs) are vulnerable and are afraid of clients and clients are afraid of HWs for contracting COVID19 infections but what we have done as I have already highlighted has restored confidence in the system,” he said.

The public health physician recommended that Nigerians should strictly adhere to COVID19 Infection Prevention and Control (IPC) guidelines in order to break the cycle of transmission and flatten the curve, as the country might be approaching another high transmission season.

On concerns that vaccine phobia is setting in again worldwide even in Nigeria, Shuaib said it is deeply concerning that Nigerians have started pushing back and resisting on the issue of COVID19 vaccine even before trials began in some countries due some fear on the imaginary conspiracy theories that have been debunked. Generally vaccine phobia has been around for a very long time and we will continue to engage segments of society to address the fears of our people as we have always done for other vaccines that protects people from vaccine-preventable diseases (VPDs).

On why Nigeria is not part of the ongoing clinical trials of COVID-19 vaccines just like Egypt and South Africa, Shuaib said there is a laid down process for clinical trails for any vaccine or therapeutic product and FMoH is handling that issue and they will let Nigerians know when the process is completed.

WHO’s director for Africa, Dr. Matshidiso Moeti, on Monday, said: “Future generations of African children can live free of wild poliovirus.” He said 1.8 million cases of polio-related paralysis had been prevented over the past 24 years.

But, according to a report published in New York Times, the victory has a hollow note.

Every year, hundreds of people across Africa are still being infected with circulating vaccine-derived poliovirus, which can infect people in areas where there is only partial vaccination. African cases of the vaccine-derived strain, which results in the same symptoms as the wild kind, increased to 320 last year from 68 in 2018, and could rise again in 2020 because many vaccination campaigns were paused during coronavirus lockdowns.

The polio-free certification applies to what the WHO calls the Africa region — one of its six global zones of operation — and it excludes North Africa. But no North African country has recorded a case of wild poliovirus since 2004, so the whole continent is now considered free of it.

The 46 presidents of the region (there would have been 47, but the president of Mali was recently deposed in a coup) celebrated along with supporters of polio eradication efforts; among them the Microsoft founder Bill Gates and the Nigerian billionaire Aliko Dangote, on a video conference call on Tuesday.

The United States has been free of wild polio since 1979. The Global Polio Eradication Initiative started in 1988, with the aim of eradicating polio worldwide by the year 2000.

Nigeria was a major sticking point on the African continent. After northern Nigeria boycotted the vaccine in 2003 because of rumors about its safety, an outbreak there spread to 20 countries in five years.

A huge effort was initiated to change minds about the vaccine, and by 2015, it seemed that the situation was under control and rumors sufficiently squashed. But then, in 2016, four new cases of wild poliovirus were reported.

The state they came from, Borno, in northeastern Nigeria, was the site of a vicious insurgency by the extremist group Boko Haram, and getting to the people living there was extremely difficult, both because of the danger and because the Nigerian authorities frequently denied access for aid workers.

But after the four cases surfaced, the global health infrastructure swung into action. Nigeria’s president instructed the military to work with the vaccination teams. A mammoth effort began, using satellite imagery, data analysis and daring methods of getting to seemingly impossible-to-reach children.

WHO’s polio eradication coordinator for the Africa region, Dr. Pascal Mkanda, said: “There’s no program like the global eradication program. There’s no program which uses so much data, so much innovation.”

When the military told them an area was safe, they would start a campaign there within 48 hours. More than 800,000 children were vaccinated this way in 2016. Others were vaccinated at markets on the edge of Boko Haram-occupied territory, when they came to buy provisions. When they went back to their communities, Mkanda said, the vaccine went through their digestive systems and out into the environment, and other children, who had not been inoculated, could then pick it up and also become immune.

Circulating vaccine-derived poliovirus spreads in the same way, except that the virus mutates over time and causes polio.

For example, say vaccinators go to a village to inoculate children.

The children line up by the church or market and get some drops squeezed into their mouths. The drops include a live but weakened version of the virus, which attaches to receptors in the intestines and is absorbed. The weakened virus cannot cause paralysis but teaches the child’s immune system to create antibodies that will fight the real thing if it were to come along.

If some children do not get the message that day, or their parents distrust the vaccine and keep them home, or the vaccinators have to leave early, they may still benefit. If any stool from vaccinated children contaminates local drinking water — or even a puddle that a child might splash in and then ingest — the virus can immunize other children, too.

Very rarely, however, the vaccine virus can mutate back into something resembling the wild kind. If that vaccine-derived mutation keeps spreading because nearby villages are not fully vaccinated, it can, in a few cases — about one infection in 200 — paralyse people.

The name of the polio strain may give the impression that people contract it from vaccinations, but that is not the case.

Director of the Vaccine Confidence Project at the London School of Hygiene and Tropical Medicine, Heidi Larson, said: “It is not very well-named.” There has been talk of altering the name to something less misleading, she said, but any change would probably take too long.

While there has been success in Africa, there has been an increase in cases of wild poliovirus since 2018 in Afghanistan and Pakistan, where vaccinators are threatened with violence, and often killed.

Moeti said: “We need to look immediately at the most difficult circumstances, the most disadvantaged people, the most vulnerable people, the hardest to reach people — because that’s where we end up with the struggles at the end.”

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A study suggests that influenza viruses can spread through the air not only in droplets — which a person who has the virus releases when they talk, cough, or sneeze — but also on microscopic dust particles.

Seasonal flu outbreaks are responsible for the deaths of hundreds of thousands of people worldwide every year. In a pandemic, such as the 1918 Spanish flu pandemic, millions can lose their lives.

In order to reduce transmission, scientists need to understand exactly how influenza viruses spread from person to person.

Experts have assumed that the droplets produced when a person with the virus breathes, talks, coughs, or sneezes are solely responsible for the airborne transmission of viruses.

But a new study suggests that dust, fibers, and other microscopic particles can also transmit influenza viruses through the air, with far-reaching implications for preventing and controlling outbreaks.

“It’s really shocking to most virologists and epidemiologists that airborne dust, rather than expiratory droplets, can carry influenza virus capable of infecting animals,” says Professor William Ristenpart of the Department of Chemical Engineering at the University of California Davis (UC Davis).

Prof. Ristenpart is one of the authors of the new study, along with scientists at UC Davis and the Icahn School of Medicine at Mount Sinai, NY. The findings appear in the journal Nature Communications.

“The implicit assumption is always that airborne transmission occurs because of respiratory droplets emitted by coughing, sneezing, or talking,” he adds.

“Transmission via dust opens up whole new areas of investigation and has profound implications for how we interpret laboratory experiments, as well as epidemiological investigations of outbreaks.”

People can contract viruses by touching contaminated objects, such as doorknobs, toys, towels, and used tissues. Scientists call these contaminated objects fomites. The researchers believe that aerosolized fomites, or contaminated dust particles, can also carry viruses.

Experiments found that the influenza virus remained viable on materials, such as paper tissues and on guinea pigs’ bodies, for long enough to become airborne on dust particles. They showed that these particles could then transmit the infection to new hosts.

In their experiments, they found that the influenza virus remained viable on materials such as paper tissues and the bodies of guinea pigs for long enough to become airborne on dust particles. They showed that these particles could then transmit the infection to new hosts.

Bursts of particles

First, the scientists used a device called an aerodynamic particle sizer to sample the air from a cage containing a guinea pig.

The device revealed that the animal generated airborne particles ranging in size from 0.3 to 20 micrometers (or thousandths of a millimeter) in bursts of about 1,000 particles per second whenever it moved.

Healthy anesthetized animals exhaled only 0.10 to 0.18 particles per second, and anesthetized animals with influenza generated 0.5 particles per second.

This suggested that dust, rather than respiratory droplets, accounted for the vast majority of particulate matter released into the air while the animals were active.

To test whether these particles were likely to become contaminated with the virus, the researchers infected guinea pigs with a strain of influenza. Two days later, swabs of their fur, ears, paws, and cages all yielded viable virus.

Next, the researchers investigated whether aerosolized fomites from one animal could infect another. To do this, they applied a solution of flu virus particles to guinea pigs’ bodies using a paintbrush.

Crucially, scientists had previously infected these animals with this strain of flu, so they were immune to reinfection. This meant they would not breathe out virus-laden droplets.

When the researchers placed these cages near those containing guinea pigs still susceptible to the virus, 3 out of 12 of these animals developed the infection.

“Thus, we conclude that airborne particulate matter from a non-respiratory source can transmit influenza virus through the air to a susceptible host,” the researchers write.

Paper tissues

In their final experiment, the researchers investigated whether the dust from an inanimate source, namely a contaminated paper tissue, could carry viable virus particles.

The scientists applied a solution of the virus to the tissues and allowed them to dry out for 30-45 minutes. They then crumpled, folded, and rubbed the tissues next to the aerodynamic particle sizer, which recorded the release of around 900 particles a second.

They found that the particles, which were small enough for inhalation, carried a virus that was still capable of infecting cell cultures in the lab.

“These results show that dried influenza virus remains viable in the environment, on materials such as paper tissues and on the bodies of living animals, long enough to be aerosolized on non-respiratory dust particles that can transmit infection through the air to new mammalian hosts.” – Sima Asadi, et al

The researchers emphasize that scientists will need to carry out further research in people and other animal models to confirm their results.

If confirmed, scientists may be able to apply the discovery to other viral respiratory infections, including SARS-CoV-2, the virus that causes COVID-19.

In April, Medical News Today reported on a study that took place in hospitals during the COVID-19 outbreak in China. It found that the highest levels of airborne viral RNA were in rooms where healthcare workers removed personal protective equipment.

This hints that removing contaminated clothing might aerosolize the virus, the authors of the new study write.

“In light of our experiments, we conclude that the contribution of aerosolized fomites to respiratory virus transmission in both humans and animal models requires further scientific consideration and rigorous investigation.”

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New research has found that dry heat from an electric cooker can effectively sanitize N95 masks.

A new study has found that electric cookers in the home can effectively sanitize N95 respirators, which are key pieces of personal protective equipment (PPE) in the current COVID-19 pandemic.

These findings, which appear in the journal Environmental Science & Technology Letters, could help relieve the pressure on the limited supply of N95 respirators, which are usually single-use items.

The importance of PPE

A key part of the world’s effort to mitigate the spread of COVID-19 is the use of PPE.

COVID-19 typically spreads when a person expels droplets carrying the new coronavirus, SARS-CoV-2, from their mouth or nose.

If the droplets come into contact with another person, there is a chance that they will gain access to their respiratory tract, where the virus will infect cells to cause disease.

PPE can take the form of gowns, visors, gloves, and masks. It forms a barrier between people and is crucial for care workers and clinical staff who may be in close contact with people with SARS-CoV-2.

The sudden emergence and rapid spread of the new coronavirus have created a huge demand for PPE. This demand has, in many cases, outstripped supply. This means that many carers and clinical staff who need the equipment are having to make do with substandard products or without any PPE at all.

This not only puts carers’ lives at risk but also significantly increases the chances of the virus spreading, thereby also endangering other people’s lives.

Masks are an important part of PPE; they both protect the wearer from infection and stop the wearer from spreading the virus to others. The gold standard in masks is N95 respirators, which not only block droplets but can also block 95% of fine particles — hence the name N95.

N95 masks are one of the mask types that the World Health Organization (WHO) recommend for use in COVID-19 intensive care units, indicating their efficacy.

As study co-author Prof. Thanh Nguyen, of the University of Illinois at Urbana-Champaign, points out, “A cloth mask or surgical mask protects others from droplets the wearer might expel, but a respirator mask protects the wearer by filtering out smaller particles that might carry the virus.”

However, these respirators are in short supply. Authorities in the United States do not recommend that the public wear N95 respirators. This is to prevent putting even more strain on the supply of the masks.

In light of this short supply, recent research has explored the viability of decontaminating N95 respirators, which manufacturers typically design for single use.

5 conditions for decontamination

In the new study, the researchers had five conditions for an effective decontamination process:

  1. It should kill a variety of viruses.
  2. It should not negatively affect the respirator’s filtration ability.
  3. It should still let the respirator maintain a tight fit against a person’s face.
  4. It should not leave harmful chemicals on the respirator.
  5. The process should be easily accessible.

According to study co-author Prof. Vishal Verma, also of the University of Illinois at Urbana-Champaign, “There are many different ways to sterilize something, but most of them will destroy the filtration or the fit of an N95 respirator.”

“Any sanitation method would need to decontaminate all surfaces of the respirator, but equally important is maintaining the filtration efficacy and the fit of the respirator to the face of the wearer. Otherwise, it will not offer the right protection.” – Prof. Vishal Verma

Based on these five conditions, the researchers speculated that dry heat may be able to successfully sterilize an N95 respirator. A variety of household appliances, including electric ovens and rice cookers, can produce dry heat without producing harmful chemicals and with a low risk of damaging filtration.

The researchers did three experiments:

  • The first was to determine the effectiveness of decontamination. It involved four viruses, including a coronavirus with a structure similar to that of SARS-CoV-2.
  • The second was to determine filtration.
  • The third was to determine fit.

50 minutes at 212ºF

After running a series of tests heating N95 respirators in a commercially available electric cooker, the researchers found that 50 minutes of dry heat at 212ºF (100ºC) could decontaminate the masks without reducing their effectiveness.

The electric cooker decontaminated the masks, inside and out, even more effectively than UV light.

“We built a chamber in my aerosol-testing lab specifically to look at the filtration of the N95 respirators, and [we] measured particles going through it,” says Prof. Verma.

“The respirators maintained their filtration capacity of more than 95% and kept their fit, still properly seated on the wearer’s face, even after 20 cycles of decontamination in the electric cooker.”

The researchers hope that their findings may be valuable for small clinical units that are unable to access enough N95 respirators or for members of the public who have an old N95 respirator at home.

The scientists have produced a video giving instructions on how to go about decontamination, pointing out that people should separate the respirators from the surface of the cooker using a towel. They also suggest that people stack multiple respirators together and decontaminate them all in one go.

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The authors of a recent study found that healthy older adults who took a daily, low dose of aspirin were at higher risk of receiving a diagnosis of advanced cancers and dying from cancer than those who took a placebo.

The findings raise the possibility that taking aspirin every day may make cancers worse once they have developed in this age group.

In recent years, there have been high hopes that taking a daily, low dose of aspirin might help protect older people from dementia, cognitive decline, and cancer.

Doctors widely prescribe daily aspirin to people at high risk of cardiovascular problems.

In addition, some clinical trials involving mostly middle-aged adults have found that aspirin may reduce the risk of developing cancer, especially colorectal cancer.

However, until recently, evidence for the drug’s use as a preventive treatment in otherwise healthy older people has been lacking.

A study originally published in March 2020 suggested that taking a daily low dose of aspirin did not protect older people from cognitive decline and dementia.

The latest study, which investigated the same cohort of individuals, reports that daily aspirin increases the risk of receiving a diagnosis of advanced cancers and cancer that has spread or metastasized.

The results found associations between daily aspirin and increased cancer mortality over the follow-up period.

The scientists published their findings in the Journal of the National Cancer Institute.

ASPREE trial

Researchers at Massachusetts General Hospital in Boston, the Berman Center in Minneapolis, MN, and Monash University in Melbourne, Australia, carried out the recent study.

They analyzed results from the Aspirin in Reducing Events in the Elderly (ASPREE) trial, which included 19,114 individuals living in Australia and the United States. None of the participants had cardiovascular disease, dementia, or physical disability at the start of the study.

Most participants were over 70 years of age, apart from African American and Hispanic participants in the U.S., who were over 65 years of age.

Researchers randomly assigned the participants to take either 100 milligrams of aspirin per day or a placebo.

An earlier analysis of outcomes in the two groups after a mean follow-up period of 4.7 years found a higher number of deaths from all causes in the aspirin group. Most of the excess deaths were due to cancer.

The latest study examined aspirin’s effect on cancer diagnoses and deaths as a result of cancer in greater detail.

Overall, 981 participants who were taking aspirin and 952 who were taking placebo developed cancer. This difference between the two groups was not statistically significant.

However, daily aspirin had associations with a 19% higher risk of metastatic cancer and a 22% higher risk of receiving a diagnosis of advanced cancer compared with a placebo.

The results also indicated that people in the aspirin group were at a higher risk of dying during follow-up due to advanced cancer.

“Deaths were particularly high among those on aspirin who were diagnosed with advanced solid cancers, suggesting a possible adverse effect of aspirin on the growth of cancers once they have already developed in older adults,” says senior author Dr. Andrew T. Chan of Massachusetts General Hospital and Harvard Medical School.

“Although these results suggest that we should be cautious about starting aspirin therapy in otherwise healthy older adults, this does not mean that individuals who are already taking aspirin — particularly if they began taking it at a younger age — should stop their aspirin regimen.” – Dr. Andrew T. Chan

In their paper, the researchers also point out that the increased cancer mortality risk associated with taking aspirin in their study equated to an extra 1.5 deaths per 1,000 person years. This is relatively small compared with the risk of mortality from other causes.

Blunted immune response?

Aspirin reduces inflammation in the body. The researchers write that one possible explanation for their finding may be that aspirin suppresses or “blunts” immune responses that are critical to controlling the growth and spread of cancer at later stages of its development.

They note that other research has found differences between the biology and behavior of tumors in older adults and younger individuals.

“These reports make it plausible that aspirin might also act differently, at the cellular or molecular level, in older individuals,” they write.

A meta-analysis of trials involving populations around 10 years younger than in ASPREE, published in 2019, found that taking daily low dose aspirin for around 5 years neither increased nor decreased cancer incidence or mortality.

Other research suggests that it may take at least 10 years of taking daily aspirin before there is a beneficial reduction in the incidence of colorectal cancer.

There may also be a delayed benefit in older people that only becomes apparent after a longer follow-up period. The authors of the current study write:

“Cancer molecular and genetic data give reason to suggest that the potential adverse impact of aspirin identified in ASPREE might be specific to this age group. The cohort continues to be followed to explore the possibility of a delayed reduction in cancer incidence and/or mortality that may emerge with longer-term observation.”

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A 1,000-year-old medieval remedy containing onion, garlic, wine, and bile salts could be used to treat diabetic foot ulcers that are resistant to antibiotics. United Kingdom (UK) scientists have turned to the natural historic remedy known as Bald’s eyesalve to fill a gap in the antibiotic market.

The remedy targets biofilms – slimy layers made from a community of microbes – that show resistance to antibiotic drugs currently on the market.

The mixture’s bacteria-killing activity extends to five bacterial species commonly found in diabetic foot ulcers and other wounds, the researchers report.

Natural medieval potions such as Bald’s eyesalve could be an answer to antimicrobial resistance (AMR) – when bacteria adapt in response to modern antibacterial medicines.

Bald’s eyesalve is an ‘ancient-biotic’ that requires the combination of all ingredients for potent activity against bacterial strains. It includes bile salts, which are made in the liver to aid the digestion of fats but are also sold as supplements.

The recipe stems from Bald’s Leechbook, an Old English medical textbook likely compiled in the ninth century. The new was study published in the journal Scientific Reports.

Bacteria can exist either as individual planktonic cells or as a multicellular collective known as a biofilm. Biofilms are harder for antibiotic drugs to eradicate because they secrete a matrix made of sugar molecules, which form a kind of armour that acts as a physical and chemical barrier.

Biofilms are communities of microbial cells naturally accumulate on a variety of surfaces – from plastic medical equipment to the surface of the human body.

A biofilm essentially helps protect bacteria from antibiotics, making them much harder to treat.

Biofilm eradication often requires somewhere between 100 to 1,000 times higher antibiotic concentrations than the same bacteria growing planktonically – as individual free-floating cells – to be effective.

Biofilm infections of wounds (such as burns, diabetic foot ulcers), medical implants (artificial joints, catheters), the lungs (like cystic fibrosis) and other body sites impose a major health and economic burden.

Non-healing, infected foot ulcers, which can be a complication of diabetes, provide an especially sobering example and are particularly difficult to target using antibiotics.

Even if the infection is apparently successfully treated, there is a high chance of recurrence and an estimated 50 per cent of those affected die within five years of ulcer development.

“We have shown that a medieval remedy made from onion, garlic, wine, and bile can kill a range of problematic bacteria grown both planktonically and as biofilms,” said Dr. Freya Harrison from the University of Warwick.

“Because the mixture did not cause much damage to human cells in the lab, or to mice, we could potentially develop a safe and effective antibacterial treatment from the remedy.”

The University of Warwick worked with microbiologists, chemists, pharmacists, data analysts and medievalists at Nottingham and in the United States (U.S.).

Together, they reconstructed the 1,000-year-old medieval remedy containing onion, garlic, wine, and bovine bile salts, known as Bald’s eyesalve. Each of Bald’s eyesalve ingredients has known antimicrobial properties or compounds.

The garlic and onions used to make the mixture, which were purchased from supermarkets, had their outer skin removed and were finely chopped.

Equal volumes of garlic and onion were crushed together with a mortar and pestle for two minutes before being combined with equal volumes of organic dry white wine, (11% ABV, sourced from Avalon Vineyard in Shepton Mallet, Somerset) and bovine bile salts, which are usually given to help with the digestion of fats.

The mixture was stored in sterilised glass bottles in the dark at 7.2°F (4°C) for nine days, after which it was strained and centrifuged for five minutes and then filtered before being applied to bacteria.

The formula had promising antibacterial activity and caused low levels of damage to human cells, the team found.
It was found to eliminate five pathogens, including Staphylococcus aureus, which can cause serious infections like blood poisoning and toxic shock syndrome.

All five of the bacteria can be found in the biofilms that infect diabetic foot ulcers and can be resistant to antibiotic treatment.
These debilitating infections can lead to amputation to avoid the risk of the bacteria spreading to the blood, known as bacteremia.
Bald’s eyesalve remedy was effective against a range of Gram-negative and Gram-positive wound pathogens in planktonic culture.
This activity is maintained against the following pathogens grown as biofilms:
1. Acinetobacter baumanii – commonly associated with infected wounds in combat troops returning from conflict zones.
2. Stenotrophomonas maltophilia – commonly associated with respiratory infections in humans.
3. Staphylococcus aureus – a common cause of skin infections including abscesses, respiratory infections such as sinusitis, and food poisoning.
4. Staphylococcus epidermidis – a common cause of infections involving indwelling foreign devices such as a catheter, surgical wound infections, and bacteremia in immune-compromised patients.
5. Streptococcus pyogenes – causes numerous infections in humans including pharyngitis, tonsillitis, scarlet fever, cellulitis, rheumatic fever and post-streptococcal glomerulonephritis.

The team then conducted an assessment of whether any individual ingredient or the sulphur-containing compound allicin (from garlic) could explain its effectiveness.

Garlic contains a compound called allicin, which is produced when its cloves are crushed or chopped, and can be toxic in high concentrations.

The chemical compound is described as providing a natural antimicrobial defence by inhibiting activity of a key bacterial enzyme called Deoxy ribonucleic Acid (DNA) gyrase, which is needed for efficient cell division.

However, garlic alone has no activity against biofilms, and therefore the anti-biofilm activity of Bald’s eyesalve cannot be attributed to a single ingredient and requires the combination of all ingredients to achieve full activity.

Wine, bile or onion alone was also much less effective than the full remedy.
Curiously, wine possessed very limited antimicrobial activity, and could not kill S. aureus in biofilms.

Despite this, its absence from the full remedy was shown to cause a large drop in activity against S. aureus biofilms.

The role of wine in the full recipe may be more to do with its physical properties, such as its ethanol content or low pH.

Ethanol is a well-known extraction solvent and may allow better diffusion through biofilms, while the lower pH may activate pH-dependent anti-bacterial compounds.

Further work is needed to explain the exact combination of natural products responsible for the anti-biofilm activity.

“Most antibiotics that we use today are derived from natural compounds, but our work highlights the need to explore not only single compounds but mixtures of natural products for treating biofilm infections,” said Harrison.

“We think that future discovery of antibiotics from natural products could be enhanced by studying combinations of ingredients, rather than single plants or compounds.

“In this first instance, we think this combination could suggest new treatments for infected wounds, such as diabetic foot and leg ulcers.”
When considering natural products as a potential source of anti-biofilm agents, there’s the possibility that any success they have could rely on creating “a cocktail of different products,” the researchers say.

In previous research, Professor Christina Lee, from the School of English at the University of Nottingham, had examined Bald’s Leechbook, an Old English leather-bound volume in the British Library, to see if any of the remedies really worked.

The Leechbook is widely thought of as one of the earliest known medical textbooks and contains Anglo-Saxon medical advice and recipes for medicines, salves and treatments.

“Bald’s eyesalve underlines the significance of medical treatment throughout the ages,” Professor Lee said.“It shows that people in Early Medieval England had at least some effective remedies. “The collaboration which has informed this project shows the importance of the arts in interdisciplinary research.”

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