tag:blogger.com,1999:blog-84898215965596064362024-03-13T01:51:48.499+00:00Microbial MuzzzingsComment on microbial happenings and developmentsProf Mark Fielderhttp://www.blogger.com/profile/12245402309773464551noreply@blogger.comBlogger27125tag:blogger.com,1999:blog-8489821596559606436.post-31722072129873843792014-06-17T17:05:00.000+01:002014-06-17T17:05:42.952+01:00Well, we appear to be back almost by popular demand!!<span style="font-family: Arial,Helvetica,sans-serif;">Hello Folks - it has been a fair while but we are back! several people have asked where they can see the public engagement work I do and the comments to media. Well if you come to this blog you will see the comments and work I do. It is not all there yet but I have made a start. Hope you find it useful</span><br />
<span style="font-family: Arial,Helvetica,sans-serif;"><br /></span>
<span style="font-family: Arial,Helvetica,sans-serif;">Cheers</span><br />
<span style="font-family: Arial,Helvetica,sans-serif;"><br /></span>
<span style="font-family: Arial,Helvetica,sans-serif;">Mark</span>Prof Mark Fielderhttp://www.blogger.com/profile/12245402309773464551noreply@blogger.com0tag:blogger.com,1999:blog-8489821596559606436.post-72673592244984221292014-06-17T17:00:00.003+01:002014-06-17T17:00:47.700+01:00Alert after Legionnaires’ disease case in baby<!--[if gte mso 9]><xml>
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<br />
<div class="xpressreleasebodytext">
<span style="font-family: "Arial","sans-serif"; font-size: 11.0pt; mso-bidi-font-weight: bold;">Following the determination of a case of neonatal
Legionnaires Disease Public Health England have issued a press release
explaining the situation. I have commented for the Science Media Centre and
that appears at the bottom of the piece.</span></div>
<div class="xpressreleasebodytext">
<b><span style="color: red; font-family: "Arial","sans-serif"; font-size: 11.0pt;">For immediate release: <br />
Tuesday 17 June, 2014</span></b><span style="font-family: "Arial","sans-serif";"></span></div>
<div class="xmsonormal">
<b><span style="font-family: "Arial","sans-serif"; font-size: 18.0pt;"><br /></span></b><span style="font-family: "Arial","sans-serif";"></span></div>
<div class="xmsonormal">
<b><span style="font-family: "Arial","sans-serif";"> </span></b><b><span style="font-family: "Arial","sans-serif"; font-size: 14.0pt;">PHE advises temporary
suspension of heated home birthing pools filled in advance of labour in home
settings</span></b><span style="font-family: "Arial","sans-serif";"></span></div>
<div class="xpressreleasebodytext" style="line-height: 115%; text-align: justify;">
<span style="font-family: "Arial","sans-serif"; font-size: 11.0pt; line-height: 115%;"> Public
Health England (PHE) and NHS England have temporarily advised against the home
use of birthing pools with built-in heaters and recirculation pumps,
potentially filled up to two weeks in advance of the birth. This follows a
single case of Legionnaires’ disease identified in a baby born in this specific
type of birthing pool at home. The baby is currently receiving intensive care
treatment in hospital.</span><span style="font-family: "Arial","sans-serif";"> </span><span style="font-family: "Arial","sans-serif"; font-size: 11.0pt; line-height: 115%;">Samples
taken from the heated birthing pool used have confirmed the presence of Legionella bacteria, which cause Legionnaires’ disease. Tests are ongoing to
establish if it is the same strain which infected the baby.</span><span style="font-family: "Arial","sans-serif";"> </span><span style="font-family: "Arial","sans-serif"; font-size: 11.0pt; line-height: 115%;">This is the first reported
case of Legionnaires’ disease linked to a birthing pool in England, although there
have been two cases reported internationally some years ago. </span><span style="font-family: "Arial","sans-serif";"></span></div>
<div class="xpressreleasebodytext" style="line-height: 115%; text-align: justify;">
<span style="font-family: "Arial","sans-serif";"> </span><span style="font-family: "Arial","sans-serif"; font-size: 11.0pt; line-height: 115%;">NHS England has today
issued a Patient Safety Alert </span><span lang="EN" style="font-family: "Arial","sans-serif"; font-size: 11.0pt; line-height: 115%; mso-ansi-language: EN;">rapidly
notifying the healthcare system – and specifically midwives – to the possible
risks associated with the use of these heated birthing pools at home. The alert
recommends that heated birthing pools, filled in advance of labour and where
the temperature is maintained by use of a heater and pump, are not used for
labour or birth. In the meantime, a full risk assessment into their use is
being carried out.</span><span style="font-family: "Arial","sans-serif";"></span></div>
<div class="xpressreleasebodytext" style="line-height: 115%; text-align: justify;">
<span lang="EN" style="font-family: "Arial","sans-serif"; font-size: 11.0pt; line-height: 115%; mso-ansi-language: EN;"> </span><span style="font-family: "Arial","sans-serif"; font-size: 11.0pt; line-height: 115%;">The majority of birthing pools used at
home are filled from domestic hot water systems at the time of labour – these
birthing pools</span><span lang="EN" style="font-family: "Arial","sans-serif"; font-size: 11.0pt; line-height: 115%; mso-ansi-language: EN;"> do not pose the same
risk and are excluded from this alert. </span><span style="font-family: "Arial","sans-serif"; font-size: 11.0pt; line-height: 115%;">There are no concerns about
these types of pools as long as pumps are used solely to empty the pool </span><span lang="EN" style="font-family: "Arial","sans-serif"; font-size: 11.0pt; line-height: 115%; mso-ansi-language: EN;">and not for recirculation of warm water.</span><span style="font-family: "Arial","sans-serif";"></span></div>
<div class="xpressreleasebodytext" style="line-height: 115%; text-align: justify;">
<span lang="EN" style="font-family: "Arial","sans-serif"; font-size: 11.0pt; line-height: 115%; mso-ansi-language: EN;"> </span><span style="font-family: "Arial","sans-serif"; font-size: 11.0pt; line-height: 115%;">Professor Nick Phin, PHE’s head of
Legionnaires’ disease, said: “This is an extremely unusual situation, which we
are taking very seriously. As a precaution, we advise that </span><span lang="EN" style="font-family: "Arial","sans-serif"; font-size: 11.0pt; line-height: 115%; mso-ansi-language: EN;">heated birthing pools, filled in advance of labour and
where the temperature is then maintained by use of a heater and pump,<span style="color: black;"> a</span></span><span style="color: black; font-family: "Arial","sans-serif"; font-size: 11.0pt; line-height: 115%;">re not used in the home
setting, while we investigate further and until definitive advice on
disinfection and safety is available.</span><span style="font-family: "Arial","sans-serif";">
</span><span style="color: black; font-family: "Arial","sans-serif"; font-size: 11.0pt; line-height: 115%;">“We do not have concerns about purchased or hired pools that are
filled from domestic hot water supplies at the onset of labour, provided that
any pumps are used solely for pool emptying. </span><span style="color: black; font-family: "Arial","sans-serif";">“PHE and relevant local authorities are investigating
the infection control measures required for this type of birthing pool and
local authorities will be working with the small number of companies who supply
these heated birthing pools for use at home.” </span><span style="font-family: "Arial","sans-serif";"></span></div>
<div class="xmsolistparagraph" style="line-height: 115%; text-align: justify;">
<span style="color: black; font-family: "Arial","sans-serif"; font-size: 11.0pt; line-height: 115%;"> Louise Silverton, director for midwifery at the Royal
College of Midwives, said: “Women planning birth at home using a traditional
pool that is filled when the woman is in labour or using a fixed pool in an NHS
unit are not affected by this alert and should not be concerned. Birthing pools
in hospitals are subject to stringent infection control procedures and
monitoring. Home birthing pools filled during labour come with disposable
liners and are only in place for a relatively short time period, reducing
opportunity for bacterial growth.</span><span style="font-family: "Arial","sans-serif";"></span></div>
<div class="xmsolistparagraph" style="line-height: 115%; text-align: justify;">
<span style="color: black; font-family: "Arial","sans-serif"; font-size: 11.0pt; line-height: 115%;"> “Any women with concerns about using home birthing pools
should contact their midwife or local maternity unit.”</span><span style="font-family: "Arial","sans-serif";"></span></div>
<div class="xmsonormal" style="line-height: 115%; text-align: justify;">
<span style="color: red; font-family: "Arial","sans-serif";"> </span><span lang="EN" style="font-family: "Arial","sans-serif"; font-size: 11.0pt; line-height: 115%; mso-ansi-language: EN;">Legionnaires’ disease is extremely rare in childhood,
with only one case in children aged 0-9 years reported in England
between1990-2011.The infection does not spread from person-to-person – people
become infected with the bacteria through inhalation of contaminated water
droplets</span><span style="font-family: "Arial","sans-serif"; font-size: 11.0pt; line-height: 115%;">.
</span><span style="font-family: "Arial","sans-serif";"></span></div>
<div class="MsoNormal" style="text-align: justify;">
<br /></div>
<div class="MsoNormal" style="text-align: justify;">
<b style="mso-bidi-font-weight: normal;"><span style="font-family: "Arial","sans-serif";">Prof Mark Fielder,
Professor of Medical Microbiology at Kingston University and Hon General
Secretary of the Society for Applied Microbiology.</span></b></div>
<div class="MsoNormal" style="text-align: justify;">
<span style="font-family: "Arial","sans-serif";">The
recent report of a baby being treated in intensive care following the diagnosis
of Legionnaries Disease is an unfortunate and very rare occurrence. The case
has been reported by Public Health England they have already advised against a specific
type of birthing pool with built in heaters and recirculation pumps. The
specific type of pool implicated can be filled in advance of labour and the
temperature is maintained by the heater and pump. Birthing pools that are
filled from domestic hot water systems at the time of labour do not appear to
possess the same risk factors and are not included under the current exclusion.
This single case does represent a rare occurrence indeed this is the first case
reported in England, there were two other cases reported internationally in
past years. The infection is caused by a bacteria called <i style="mso-bidi-font-style: normal;">Legionella pneumophilia</i> which can be found commonly in water
sources and at low levels it is harmless. The organism can be controlled effectively
if the water is cooled to below 20oC or heated to above 60oC. This type of
treatment coupled with general good hygiene in terms of keeping water free of
impurities will help to keep the organism under control.</span></div>
<div class="MsoNormal">
<br /></div>
Prof Mark Fielderhttp://www.blogger.com/profile/12245402309773464551noreply@blogger.com0tag:blogger.com,1999:blog-8489821596559606436.post-30391685518162713632014-06-17T16:54:00.003+01:002014-06-17T16:54:41.790+01:00<div style="text-align: justify;">
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<w:LsdException Locked="false" Priority="39" SemiHidden="true"
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<w:LsdException Locked="false" Priority="39" SemiHidden="true"
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<w:LsdException Locked="false" Priority="39" SemiHidden="true"
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<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
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<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
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<w:LsdException Locked="false" Priority="19" QFormat="true"
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<w:LsdException Locked="false" Priority="31" QFormat="true"
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<w:LsdException Locked="false" Priority="32" QFormat="true"
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<w:LsdException Locked="false" Priority="33" QFormat="true" Name="Book Title"/>
<w:LsdException Locked="false" Priority="37" SemiHidden="true"
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<w:LsdException Locked="false" Priority="39" SemiHidden="true"
UnhideWhenUsed="true" QFormat="true" Name="TOC Heading"/>
<w:LsdException Locked="false" Priority="41" Name="Plain Table 1"/>
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<w:LsdException Locked="false" Priority="43" Name="Plain Table 3"/>
<w:LsdException Locked="false" Priority="44" Name="Plain Table 4"/>
<w:LsdException Locked="false" Priority="45" Name="Plain Table 5"/>
<w:LsdException Locked="false" Priority="40" Name="Grid Table Light"/>
<w:LsdException Locked="false" Priority="46" Name="Grid Table 1 Light"/>
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<w:LsdException Locked="false" Priority="48" Name="Grid Table 3"/>
<w:LsdException Locked="false" Priority="49" Name="Grid Table 4"/>
<w:LsdException Locked="false" Priority="50" Name="Grid Table 5 Dark"/>
<w:LsdException Locked="false" Priority="51" Name="Grid Table 6 Colorful"/>
<w:LsdException Locked="false" Priority="52" Name="Grid Table 7 Colorful"/>
<w:LsdException Locked="false" Priority="46"
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<div class="xmsonormal" style="text-align: justify;">
<b><span style="font-family: "Arial","sans-serif";">Wednesday
4 June 2014 </span></b></div>
<div class="xmsonormal" style="text-align: justify;">
<br /></div>
<div class="xmsonormal" style="text-align: justify;">
<span style="font-family: "Arial","sans-serif";">Following
the emergence of the outbreak of what transpired to be <i style="mso-bidi-font-style: normal;">Bacillus cereus</i> in parenteral feed, Public Health England released the
following press release</span><b><span style="font-family: "Arial","sans-serif";">.</span></b></div>
<div class="xpressreleaserefnoanddate" style="text-align: justify;">
<span style="color: red; font-family: "Arial","sans-serif";">For immediate release</span><span style="font-family: "Arial","sans-serif";"></span></div>
<div class="xpressreleaserefnoanddate" style="text-align: justify;">
<span style="color: red; font-family: "Arial","sans-serif";">Wednesday 4 June, 2014</span><span style="font-family: "Arial","sans-serif";"></span></div>
<div class="xpressreleasebodytext" style="text-align: justify;">
<b><span style="font-family: "Arial","sans-serif"; font-size: 18.0pt;">Investigation into<i> Bacillus cereus</i> infections </span></b><span style="font-family: "Arial","sans-serif";"></span></div>
<div class="xmsonormal" style="line-height: 115%; text-align: justify;">
<span style="font-family: "Arial","sans-serif";">Public
Health England (PHE) and the Medicines and Healthcare products Regulatory
Agency (MHRA) can confirm they are investigating 15 cases of blood poisoning
(septicaemia) caused by a bacteria known as <i>Bacillus cereus</i>. The
affected babies were in neonatal intensive care units at a small number of
hospitals in England. </span></div>
<div class="xmsonormal" style="line-height: 115%; text-align: justify;">
<span style="font-family: "Arial","sans-serif";">Many
of the babies were premature and very vulnerable and one baby has sadly died
but the others are responding to antibiotic treatment.</span></div>
<div class="xmsonormal" style="line-height: 115%; text-align: justify;">
<span style="font-family: "Arial","sans-serif";">Investigations
are ongoing but so far indications show that the cases have been strongly
linked with a number of batches of a particular form of intravenous liquid
called parenteral nutrition which was given to the babies. This contains a
variety of nutrients that are delivered directly into the babies’ bloodstream
when they have problems ingesting food via their mouth. This batch of product
is manufactured by ITH Pharma Limited. </span></div>
<div class="xmsonormal" style="line-height: 115%; text-align: justify;">
<span style="font-family: "Arial","sans-serif";">Because
this type of nutrition is given into the bloodstream of vulnerable babies and
adults it is manufactured under strictly controlled aseptic conditions.
Investigations with the company have identified an incident that might have
caused the contamination. Investigations into this by the MHRA are ongoing and
inspectors from the MHRA are visiting the manufacturing plant.</span></div>
<div class="xmsonormal" style="line-height: 115%; text-align: justify;">
<span style="font-family: "Arial","sans-serif";">The
product has a short shelf life and although it is unlikely that any stock from
the day of contamination incident remains (it expired on 02/06/14). The MHRA has
issued a Class 1 drug alert to support the manufacturer’s recall of the product
this afternoon.</span></div>
<div class="xmsonormal" style="line-height: 115%; text-align: justify;">
<span style="font-family: "Arial","sans-serif";">Although
the affected product was only issued to a limited number of neonatal units an
alert has been issued to all neonatology units across the UK to make them aware
of the incident. Doctors have been given advice on what steps they need
to take to identify any potential cases of infection and how to dispose of
affected stock. </span></div>
<div class="xmsonormal" style="line-height: 115%; text-align: justify;">
<i><span style="font-family: "Arial","sans-serif";">Bacillus
cereus</span></i><span style="font-family: "Arial","sans-serif";"> is a bacteria
found widely in the environment in dust, soil and vegetation. Most surfaces
would be likely to test positive for the presence of the bacteria. <i>Bacillus
cereus</i> produces very hardy spores and in the right conditions these will
grow. The spores can produce a toxin which causes illness. </span></div>
<div class="xmsonormal" style="line-height: 115%; text-align: justify;">
<span style="font-family: "Arial","sans-serif";">Professor
Mike Catchpole, PHE incident director, said: “This is a very unfortunate
incident and PHE have been working closely with the MHRA to investigate how
these babies could have become infected. Given that the bacteria is widely
spread in the environment we are continuing to investigate any other potential
sources of infection. However all our investigations to date indicate that the
likely source of the infection has been identified. We have acted quickly to
investigate this issue alongside the MHRA and we have taken action to ensure
that the affected batches and any remaining stock of this medicine is not being
used in hospitals.”</span></div>
<div class="xmsonormal" style="line-height: 115%; text-align: justify;">
<br /></div>
<div class="xmsonormal" style="line-height: 115%; text-align: justify;">
<span style="font-family: "Arial","sans-serif";">Adam
Burgess, the MHRA’s manager of the Defective Medicines Reporting Centre, said:</span></div>
<div class="xmsonormal" style="line-height: 115%; text-align: justify;">
<span style="font-family: "Arial","sans-serif";">“Patient
safety is our top priority and we are working alongside PHE to establish what
has happened. We have sent inspectors to the manufacturer’s facility to carry
out a detailed and rigorous inspection and we have ensured that the potentially
affected medicine is recalled.”</span></div>
<div class="xmsonormal" style="text-align: justify;">
<br /></div>
<div class="xmsonormal" style="text-align: justify;">
<span style="font-family: "Arial","sans-serif"; mso-bidi-font-weight: bold;">I was called upon by the BBC news channel to undertake a live news
interview where I explained the origins of the organism. Essentially we are
dealing with an environmental spore forming Gram positive rod that apparently
got into the feed being given to these very unwell premature babies. The feed was
being given straight into the blood stream as they children were apparently not
able to ingest or digest in the normal manner. The actions of the MHRA, PHE and
the company involved limited the outbreak and protected many more patients. One
should not comment too much more whilst the investigation is being carried out
as speculation is not helpful at this time. We must of course recognise the tragedy
of the situation where a child has lost their life – our thoughts go out to the
childs family and loved ones. One does also have to remember that we are
dealing with very unwell children and indeed only modern medical technology was
sustaining their lives. It is good to see that the surviving children are
responding well to the antibiotics being administered.</span></div>
<div class="xmsonormal" style="text-align: justify;">
<br /></div>
<div class="xmsonormal" style="text-align: justify;">
<span style="font-family: "Arial","sans-serif"; mso-bidi-font-weight: bold;">I was also interviewed on several radio stations re-iterating the points
above getting out to L<span style="color: black;">BC</span></span><span style="color: black; font-family: "Arial","sans-serif";"> radio,<span style="mso-bidi-font-weight: bold;"> BBC Radio Asia </span> and across the
BBC regional radio news network, where interviews were carried on <span style="mso-bidi-font-weight: bold;">BBC Radio Humberside</span>, <span style="mso-bidi-font-weight: bold;">BBC Radio York</span>, <span style="mso-bidi-font-weight: bold;">BBC Radio Devon</span>, <span style="mso-bidi-font-weight: bold;">BBC Radio Somerset</span>, <span style="mso-bidi-font-weight: bold;">BBC Radio Wiltshire</span>, <span style="mso-bidi-font-weight: bold;">BBC Radio Norfolk</span>, <span style="mso-bidi-font-weight: bold;">BBC Three Counties Radio</span> (covering
Bedfordshire, Hertfordshire and Buckinghamshire) and <span style="mso-bidi-font-weight: bold;">BBC Radio Kent.</span></span></div>
<div class="xmsonormal" style="text-align: justify;">
<span style="color: black; font-family: "Arial","sans-serif"; mso-bidi-font-weight: bold;">The following comment was then released by the
Science Media Centre :</span></div>
<div class="xmsonormal" style="text-align: justify;">
<b><span lang="EN-US" style="font-family: "Arial","sans-serif"; mso-ansi-language: EN-US;">Prof Mark Fielder, Professor of Medical Microbiology,
Kingston University, said:</span></b><span style="font-family: "Arial","sans-serif";"></span></div>
<div class="xmsonormal" style="text-align: justify;">
<span lang="EN-US" style="font-family: "Arial","sans-serif"; mso-ansi-language: EN-US;">“The recent <i>Bacillus cereus</i> outbreak linked to
parenteral feed has left 14 premature babies with septicaemia and sadly one
other has lost their life. There is an ongoing investigation to establish
exactly how this feed might have become contaminated and in the meantime there
has been a product recall to prevent any further infection. Public Health
England and the MHRA have acted quickly to both identify the organism
responsible and to put measures in place to protect the public. The occurrence
of a further three cases, whilst distressing, was to some extent expected as
patients who might have earlier received contaminated material develop
symptoms. It remains the case that the outbreak is likely to have been
contained and very few (if any) further cases will be seen.”</span><span style="font-family: "Arial","sans-serif";"></span></div>
<div class="MsoNormal" style="text-align: justify;">
<br /></div>
<div class="MsoNormal" style="text-align: justify;">
<span style="font-family: "Arial","sans-serif";">Since this
comment went out we have seen three more babies become infected, which is not
completely unexpected but nonetheless sad. Why not completely unexpected? Well
although the infected material was withdrawn some feed may have been still in
the ‘system’ or small amounts delivered to patients so it may have a taken a
while for infections to become apparent. Sadly one more baby died but as I understand
it this child had other unrelated complications. It would appear that to date
no further loss of life has occurred and that this outbreak is now controlled.</span></div>
Prof Mark Fielderhttp://www.blogger.com/profile/12245402309773464551noreply@blogger.com0tag:blogger.com,1999:blog-8489821596559606436.post-51835319597371332792014-06-17T16:28:00.001+01:002014-06-17T16:28:13.692+01:00<!--[if gte mso 9]><xml>
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<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
Name="List"/>
<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
Name="List Bullet"/>
<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
Name="List Number"/>
<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
Name="List 2"/>
<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
Name="List 3"/>
<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
Name="List 4"/>
<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
Name="List 5"/>
<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
Name="List Bullet 2"/>
<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
Name="List Bullet 3"/>
<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
Name="List Bullet 4"/>
<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
Name="List Bullet 5"/>
<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
Name="List Number 2"/>
<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
Name="List Number 3"/>
<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
Name="List Number 4"/>
<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
Name="List Number 5"/>
<w:LsdException Locked="false" Priority="10" QFormat="true" Name="Title"/>
<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
Name="Closing"/>
<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
Name="Signature"/>
<w:LsdException Locked="false" Priority="1" SemiHidden="true"
UnhideWhenUsed="true" Name="Default Paragraph Font"/>
<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
Name="Body Text"/>
<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
Name="Body Text Indent"/>
<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
Name="List Continue"/>
<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
Name="List Continue 2"/>
<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
Name="List Continue 3"/>
<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
Name="List Continue 4"/>
<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
Name="List Continue 5"/>
<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
Name="Message Header"/>
<w:LsdException Locked="false" Priority="11" QFormat="true" Name="Subtitle"/>
<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
Name="Salutation"/>
<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
Name="Date"/>
<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
Name="Body Text First Indent"/>
<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
Name="Body Text First Indent 2"/>
<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
Name="Note Heading"/>
<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
Name="Body Text 2"/>
<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
Name="Body Text 3"/>
<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
Name="Body Text Indent 2"/>
<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
Name="Body Text Indent 3"/>
<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
Name="Block Text"/>
<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
Name="Hyperlink"/>
<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
Name="FollowedHyperlink"/>
<w:LsdException Locked="false" Priority="22" QFormat="true" Name="Strong"/>
<w:LsdException Locked="false" Priority="20" QFormat="true" Name="Emphasis"/>
<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
Name="Document Map"/>
<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
Name="Plain Text"/>
<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
Name="E-mail Signature"/>
<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
Name="HTML Top of Form"/>
<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
Name="HTML Bottom of Form"/>
<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
Name="Normal (Web)"/>
<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
Name="HTML Acronym"/>
<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
Name="HTML Address"/>
<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
Name="HTML Cite"/>
<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
Name="HTML Code"/>
<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
Name="HTML Definition"/>
<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
Name="HTML Keyboard"/>
<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
Name="HTML Preformatted"/>
<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
Name="HTML Sample"/>
<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
Name="HTML Typewriter"/>
<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
Name="HTML Variable"/>
<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
Name="Normal Table"/>
<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
Name="annotation subject"/>
<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
Name="No List"/>
<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
Name="Outline List 1"/>
<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
Name="Outline List 2"/>
<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
Name="Outline List 3"/>
<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
Name="Table Simple 1"/>
<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
Name="Table Simple 2"/>
<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
Name="Table Simple 3"/>
<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
Name="Table Classic 1"/>
<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
Name="Table Classic 2"/>
<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
Name="Table Classic 3"/>
<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
Name="Table Classic 4"/>
<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
Name="Table Colorful 1"/>
<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
Name="Table Colorful 2"/>
<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
Name="Table Colorful 3"/>
<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
Name="Table Columns 1"/>
<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
Name="Table Columns 2"/>
<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
Name="Table Columns 3"/>
<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
Name="Table Columns 4"/>
<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
Name="Table Columns 5"/>
<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
Name="Table Grid 1"/>
<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
Name="Table Grid 2"/>
<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
Name="Table Grid 3"/>
<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
Name="Table Grid 4"/>
<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
Name="Table Grid 5"/>
<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
Name="Table Grid 6"/>
<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
Name="Table Grid 7"/>
<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
Name="Table Grid 8"/>
<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
Name="Table List 1"/>
<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
Name="Table List 2"/>
<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
Name="Table List 3"/>
<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
Name="Table List 4"/>
<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
Name="Table List 5"/>
<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
Name="Table List 6"/>
<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
Name="Table List 7"/>
<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
Name="Table List 8"/>
<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
Name="Table 3D effects 1"/>
<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
Name="Table 3D effects 2"/>
<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
Name="Table 3D effects 3"/>
<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
Name="Table Contemporary"/>
<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
Name="Table Elegant"/>
<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
Name="Table Professional"/>
<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
Name="Table Subtle 1"/>
<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
Name="Table Subtle 2"/>
<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
Name="Table Web 1"/>
<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
Name="Table Web 2"/>
<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
Name="Table Web 3"/>
<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
Name="Balloon Text"/>
<w:LsdException Locked="false" Priority="39" Name="Table Grid"/>
<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
Name="Table Theme"/>
<w:LsdException Locked="false" SemiHidden="true" Name="Placeholder Text"/>
<w:LsdException Locked="false" Priority="1" QFormat="true" Name="No Spacing"/>
<w:LsdException Locked="false" Priority="60" Name="Light Shading"/>
<w:LsdException Locked="false" Priority="61" Name="Light List"/>
<w:LsdException Locked="false" Priority="62" Name="Light Grid"/>
<w:LsdException Locked="false" Priority="63" Name="Medium Shading 1"/>
<w:LsdException Locked="false" Priority="64" Name="Medium Shading 2"/>
<w:LsdException Locked="false" Priority="65" Name="Medium List 1"/>
<w:LsdException Locked="false" Priority="66" Name="Medium List 2"/>
<w:LsdException Locked="false" Priority="67" Name="Medium Grid 1"/>
<w:LsdException Locked="false" Priority="68" Name="Medium Grid 2"/>
<w:LsdException Locked="false" Priority="69" Name="Medium Grid 3"/>
<w:LsdException Locked="false" Priority="70" Name="Dark List"/>
<w:LsdException Locked="false" Priority="71" Name="Colorful Shading"/>
<w:LsdException Locked="false" Priority="72" Name="Colorful List"/>
<w:LsdException Locked="false" Priority="73" Name="Colorful Grid"/>
<w:LsdException Locked="false" Priority="60" Name="Light Shading Accent 1"/>
<w:LsdException Locked="false" Priority="61" Name="Light List Accent 1"/>
<w:LsdException Locked="false" Priority="62" Name="Light Grid Accent 1"/>
<w:LsdException Locked="false" Priority="63" Name="Medium Shading 1 Accent 1"/>
<w:LsdException Locked="false" Priority="64" Name="Medium Shading 2 Accent 1"/>
<w:LsdException Locked="false" Priority="65" Name="Medium List 1 Accent 1"/>
<w:LsdException Locked="false" SemiHidden="true" Name="Revision"/>
<w:LsdException Locked="false" Priority="34" QFormat="true"
Name="List Paragraph"/>
<w:LsdException Locked="false" Priority="29" QFormat="true" Name="Quote"/>
<w:LsdException Locked="false" Priority="30" QFormat="true"
Name="Intense Quote"/>
<w:LsdException Locked="false" Priority="66" Name="Medium List 2 Accent 1"/>
<w:LsdException Locked="false" Priority="67" Name="Medium Grid 1 Accent 1"/>
<w:LsdException Locked="false" Priority="68" Name="Medium Grid 2 Accent 1"/>
<w:LsdException Locked="false" Priority="69" Name="Medium Grid 3 Accent 1"/>
<w:LsdException Locked="false" Priority="70" Name="Dark List Accent 1"/>
<w:LsdException Locked="false" Priority="71" Name="Colorful Shading Accent 1"/>
<w:LsdException Locked="false" Priority="72" Name="Colorful List Accent 1"/>
<w:LsdException Locked="false" Priority="73" Name="Colorful Grid Accent 1"/>
<w:LsdException Locked="false" Priority="60" Name="Light Shading Accent 2"/>
<w:LsdException Locked="false" Priority="61" Name="Light List Accent 2"/>
<w:LsdException Locked="false" Priority="62" Name="Light Grid Accent 2"/>
<w:LsdException Locked="false" Priority="63" Name="Medium Shading 1 Accent 2"/>
<w:LsdException Locked="false" Priority="64" Name="Medium Shading 2 Accent 2"/>
<w:LsdException Locked="false" Priority="65" Name="Medium List 1 Accent 2"/>
<w:LsdException Locked="false" Priority="66" Name="Medium List 2 Accent 2"/>
<w:LsdException Locked="false" Priority="67" Name="Medium Grid 1 Accent 2"/>
<w:LsdException Locked="false" Priority="68" Name="Medium Grid 2 Accent 2"/>
<w:LsdException Locked="false" Priority="69" Name="Medium Grid 3 Accent 2"/>
<w:LsdException Locked="false" Priority="70" Name="Dark List Accent 2"/>
<w:LsdException Locked="false" Priority="71" Name="Colorful Shading Accent 2"/>
<w:LsdException Locked="false" Priority="72" Name="Colorful List Accent 2"/>
<w:LsdException Locked="false" Priority="73" Name="Colorful Grid Accent 2"/>
<w:LsdException Locked="false" Priority="60" Name="Light Shading Accent 3"/>
<w:LsdException Locked="false" Priority="61" Name="Light List Accent 3"/>
<w:LsdException Locked="false" Priority="62" Name="Light Grid Accent 3"/>
<w:LsdException Locked="false" Priority="63" Name="Medium Shading 1 Accent 3"/>
<w:LsdException Locked="false" Priority="64" Name="Medium Shading 2 Accent 3"/>
<w:LsdException Locked="false" Priority="65" Name="Medium List 1 Accent 3"/>
<w:LsdException Locked="false" Priority="66" Name="Medium List 2 Accent 3"/>
<w:LsdException Locked="false" Priority="67" Name="Medium Grid 1 Accent 3"/>
<w:LsdException Locked="false" Priority="68" Name="Medium Grid 2 Accent 3"/>
<w:LsdException Locked="false" Priority="69" Name="Medium Grid 3 Accent 3"/>
<w:LsdException Locked="false" Priority="70" Name="Dark List Accent 3"/>
<w:LsdException Locked="false" Priority="71" Name="Colorful Shading Accent 3"/>
<w:LsdException Locked="false" Priority="72" Name="Colorful List Accent 3"/>
<w:LsdException Locked="false" Priority="73" Name="Colorful Grid Accent 3"/>
<w:LsdException Locked="false" Priority="60" Name="Light Shading Accent 4"/>
<w:LsdException Locked="false" Priority="61" Name="Light List Accent 4"/>
<w:LsdException Locked="false" Priority="62" Name="Light Grid Accent 4"/>
<w:LsdException Locked="false" Priority="63" Name="Medium Shading 1 Accent 4"/>
<w:LsdException Locked="false" Priority="64" Name="Medium Shading 2 Accent 4"/>
<w:LsdException Locked="false" Priority="65" Name="Medium List 1 Accent 4"/>
<w:LsdException Locked="false" Priority="66" Name="Medium List 2 Accent 4"/>
<w:LsdException Locked="false" Priority="67" Name="Medium Grid 1 Accent 4"/>
<w:LsdException Locked="false" Priority="68" Name="Medium Grid 2 Accent 4"/>
<w:LsdException Locked="false" Priority="69" Name="Medium Grid 3 Accent 4"/>
<w:LsdException Locked="false" Priority="70" Name="Dark List Accent 4"/>
<w:LsdException Locked="false" Priority="71" Name="Colorful Shading Accent 4"/>
<w:LsdException Locked="false" Priority="72" Name="Colorful List Accent 4"/>
<w:LsdException Locked="false" Priority="73" Name="Colorful Grid Accent 4"/>
<w:LsdException Locked="false" Priority="60" Name="Light Shading Accent 5"/>
<w:LsdException Locked="false" Priority="61" Name="Light List Accent 5"/>
<w:LsdException Locked="false" Priority="62" Name="Light Grid Accent 5"/>
<w:LsdException Locked="false" Priority="63" Name="Medium Shading 1 Accent 5"/>
<w:LsdException Locked="false" Priority="64" Name="Medium Shading 2 Accent 5"/>
<w:LsdException Locked="false" Priority="65" Name="Medium List 1 Accent 5"/>
<w:LsdException Locked="false" Priority="66" Name="Medium List 2 Accent 5"/>
<w:LsdException Locked="false" Priority="67" Name="Medium Grid 1 Accent 5"/>
<w:LsdException Locked="false" Priority="68" Name="Medium Grid 2 Accent 5"/>
<w:LsdException Locked="false" Priority="69" Name="Medium Grid 3 Accent 5"/>
<w:LsdException Locked="false" Priority="70" Name="Dark List Accent 5"/>
<w:LsdException Locked="false" Priority="71" Name="Colorful Shading Accent 5"/>
<w:LsdException Locked="false" Priority="72" Name="Colorful List Accent 5"/>
<w:LsdException Locked="false" Priority="73" Name="Colorful Grid Accent 5"/>
<w:LsdException Locked="false" Priority="60" Name="Light Shading Accent 6"/>
<w:LsdException Locked="false" Priority="61" Name="Light List Accent 6"/>
<w:LsdException Locked="false" Priority="62" Name="Light Grid Accent 6"/>
<w:LsdException Locked="false" Priority="63" Name="Medium Shading 1 Accent 6"/>
<w:LsdException Locked="false" Priority="64" Name="Medium Shading 2 Accent 6"/>
<w:LsdException Locked="false" Priority="65" Name="Medium List 1 Accent 6"/>
<w:LsdException Locked="false" Priority="66" Name="Medium List 2 Accent 6"/>
<w:LsdException Locked="false" Priority="67" Name="Medium Grid 1 Accent 6"/>
<w:LsdException Locked="false" Priority="68" Name="Medium Grid 2 Accent 6"/>
<w:LsdException Locked="false" Priority="69" Name="Medium Grid 3 Accent 6"/>
<w:LsdException Locked="false" Priority="70" Name="Dark List Accent 6"/>
<w:LsdException Locked="false" Priority="71" Name="Colorful Shading Accent 6"/>
<w:LsdException Locked="false" Priority="72" Name="Colorful List Accent 6"/>
<w:LsdException Locked="false" Priority="73" Name="Colorful Grid Accent 6"/>
<w:LsdException Locked="false" Priority="19" QFormat="true"
Name="Subtle Emphasis"/>
<w:LsdException Locked="false" Priority="21" QFormat="true"
Name="Intense Emphasis"/>
<w:LsdException Locked="false" Priority="31" QFormat="true"
Name="Subtle Reference"/>
<w:LsdException Locked="false" Priority="32" QFormat="true"
Name="Intense Reference"/>
<w:LsdException Locked="false" Priority="33" QFormat="true" Name="Book Title"/>
<w:LsdException Locked="false" Priority="37" SemiHidden="true"
UnhideWhenUsed="true" Name="Bibliography"/>
<w:LsdException Locked="false" Priority="39" SemiHidden="true"
UnhideWhenUsed="true" QFormat="true" Name="TOC Heading"/>
<w:LsdException Locked="false" Priority="41" Name="Plain Table 1"/>
<w:LsdException Locked="false" Priority="42" Name="Plain Table 2"/>
<w:LsdException Locked="false" Priority="43" Name="Plain Table 3"/>
<w:LsdException Locked="false" Priority="44" Name="Plain Table 4"/>
<w:LsdException Locked="false" Priority="45" Name="Plain Table 5"/>
<w:LsdException Locked="false" Priority="40" Name="Grid Table Light"/>
<w:LsdException Locked="false" Priority="46" Name="Grid Table 1 Light"/>
<w:LsdException Locked="false" Priority="47" Name="Grid Table 2"/>
<w:LsdException Locked="false" Priority="48" Name="Grid Table 3"/>
<w:LsdException Locked="false" Priority="49" Name="Grid Table 4"/>
<w:LsdException Locked="false" Priority="50" Name="Grid Table 5 Dark"/>
<w:LsdException Locked="false" Priority="51" Name="Grid Table 6 Colorful"/>
<w:LsdException Locked="false" Priority="52" Name="Grid Table 7 Colorful"/>
<w:LsdException Locked="false" Priority="46"
Name="Grid Table 1 Light Accent 1"/>
<w:LsdException Locked="false" Priority="47" Name="Grid Table 2 Accent 1"/>
<w:LsdException Locked="false" Priority="48" Name="Grid Table 3 Accent 1"/>
<w:LsdException Locked="false" Priority="49" Name="Grid Table 4 Accent 1"/>
<w:LsdException Locked="false" Priority="50" Name="Grid Table 5 Dark Accent 1"/>
<w:LsdException Locked="false" Priority="51"
Name="Grid Table 6 Colorful Accent 1"/>
<w:LsdException Locked="false" Priority="52"
Name="Grid Table 7 Colorful Accent 1"/>
<w:LsdException Locked="false" Priority="46"
Name="Grid Table 1 Light Accent 2"/>
<w:LsdException Locked="false" Priority="47" Name="Grid Table 2 Accent 2"/>
<w:LsdException Locked="false" Priority="48" Name="Grid Table 3 Accent 2"/>
<w:LsdException Locked="false" Priority="49" Name="Grid Table 4 Accent 2"/>
<w:LsdException Locked="false" Priority="50" Name="Grid Table 5 Dark Accent 2"/>
<w:LsdException Locked="false" Priority="51"
Name="Grid Table 6 Colorful Accent 2"/>
<w:LsdException Locked="false" Priority="52"
Name="Grid Table 7 Colorful Accent 2"/>
<w:LsdException Locked="false" Priority="46"
Name="Grid Table 1 Light Accent 3"/>
<w:LsdException Locked="false" Priority="47" Name="Grid Table 2 Accent 3"/>
<w:LsdException Locked="false" Priority="48" Name="Grid Table 3 Accent 3"/>
<w:LsdException Locked="false" Priority="49" Name="Grid Table 4 Accent 3"/>
<w:LsdException Locked="false" Priority="50" Name="Grid Table 5 Dark Accent 3"/>
<w:LsdException Locked="false" Priority="51"
Name="Grid Table 6 Colorful Accent 3"/>
<w:LsdException Locked="false" Priority="52"
Name="Grid Table 7 Colorful Accent 3"/>
<w:LsdException Locked="false" Priority="46"
Name="Grid Table 1 Light Accent 4"/>
<w:LsdException Locked="false" Priority="47" Name="Grid Table 2 Accent 4"/>
<w:LsdException Locked="false" Priority="48" Name="Grid Table 3 Accent 4"/>
<w:LsdException Locked="false" Priority="49" Name="Grid Table 4 Accent 4"/>
<w:LsdException Locked="false" Priority="50" Name="Grid Table 5 Dark Accent 4"/>
<w:LsdException Locked="false" Priority="51"
Name="Grid Table 6 Colorful Accent 4"/>
<w:LsdException Locked="false" Priority="52"
Name="Grid Table 7 Colorful Accent 4"/>
<w:LsdException Locked="false" Priority="46"
Name="Grid Table 1 Light Accent 5"/>
<w:LsdException Locked="false" Priority="47" Name="Grid Table 2 Accent 5"/>
<w:LsdException Locked="false" Priority="48" Name="Grid Table 3 Accent 5"/>
<w:LsdException Locked="false" Priority="49" Name="Grid Table 4 Accent 5"/>
<w:LsdException Locked="false" Priority="50" Name="Grid Table 5 Dark Accent 5"/>
<w:LsdException Locked="false" Priority="51"
Name="Grid Table 6 Colorful Accent 5"/>
<w:LsdException Locked="false" Priority="52"
Name="Grid Table 7 Colorful Accent 5"/>
<w:LsdException Locked="false" Priority="46"
Name="Grid Table 1 Light Accent 6"/>
<w:LsdException Locked="false" Priority="47" Name="Grid Table 2 Accent 6"/>
<w:LsdException Locked="false" Priority="48" Name="Grid Table 3 Accent 6"/>
<w:LsdException Locked="false" Priority="49" Name="Grid Table 4 Accent 6"/>
<w:LsdException Locked="false" Priority="50" Name="Grid Table 5 Dark Accent 6"/>
<w:LsdException Locked="false" Priority="51"
Name="Grid Table 6 Colorful Accent 6"/>
<w:LsdException Locked="false" Priority="52"
Name="Grid Table 7 Colorful Accent 6"/>
<w:LsdException Locked="false" Priority="46" Name="List Table 1 Light"/>
<w:LsdException Locked="false" Priority="47" Name="List Table 2"/>
<w:LsdException Locked="false" Priority="48" Name="List Table 3"/>
<w:LsdException Locked="false" Priority="49" Name="List Table 4"/>
<w:LsdException Locked="false" Priority="50" Name="List Table 5 Dark"/>
<w:LsdException Locked="false" Priority="51" Name="List Table 6 Colorful"/>
<w:LsdException Locked="false" Priority="52" Name="List Table 7 Colorful"/>
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<w:LsdException Locked="false" Priority="1" SemiHidden="true"
UnhideWhenUsed="true" Name="Default Paragraph Font"/>
<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
Name="Body Text"/>
<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
Name="Body Text Indent"/>
<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
Name="List Continue"/>
<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
Name="List Continue 2"/>
<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
Name="List Continue 3"/>
<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
Name="List Continue 4"/>
<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
Name="List Continue 5"/>
<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
Name="Message Header"/>
<w:LsdException Locked="false" Priority="11" QFormat="true" Name="Subtitle"/>
<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
Name="Salutation"/>
<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
Name="Date"/>
<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
Name="Body Text First Indent"/>
<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
Name="Body Text First Indent 2"/>
<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
Name="Note Heading"/>
<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
Name="Body Text 2"/>
<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
Name="Body Text 3"/>
<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
Name="Body Text Indent 2"/>
<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
Name="Body Text Indent 3"/>
<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
Name="Block Text"/>
<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
Name="Hyperlink"/>
<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
Name="FollowedHyperlink"/>
<w:LsdException Locked="false" Priority="22" QFormat="true" Name="Strong"/>
<w:LsdException Locked="false" Priority="20" QFormat="true" Name="Emphasis"/>
<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
Name="Document Map"/>
<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
Name="Plain Text"/>
<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
Name="E-mail Signature"/>
<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
Name="HTML Top of Form"/>
<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
Name="HTML Bottom of Form"/>
<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
Name="Normal (Web)"/>
<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
Name="HTML Acronym"/>
<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
Name="HTML Address"/>
<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
Name="HTML Cite"/>
<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
Name="HTML Code"/>
<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
Name="HTML Definition"/>
<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
Name="HTML Keyboard"/>
<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
Name="HTML Preformatted"/>
<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
Name="HTML Sample"/>
<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
Name="HTML Typewriter"/>
<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
Name="HTML Variable"/>
<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
Name="Normal Table"/>
<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
Name="annotation subject"/>
<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
Name="No List"/>
<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
Name="Outline List 1"/>
<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
Name="Outline List 2"/>
<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
Name="Outline List 3"/>
<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
Name="Table Simple 1"/>
<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
Name="Table Simple 2"/>
<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
Name="Table Simple 3"/>
<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
Name="Table Classic 1"/>
<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
Name="Table Classic 2"/>
<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
Name="Table Classic 3"/>
<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
Name="Table Classic 4"/>
<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
Name="Table Colorful 1"/>
<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
Name="Table Colorful 2"/>
<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
Name="Table Colorful 3"/>
<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
Name="Table Columns 1"/>
<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
Name="Table Columns 2"/>
<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
Name="Table Columns 3"/>
<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
Name="Table Columns 4"/>
<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
Name="Table Columns 5"/>
<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
Name="Table Grid 1"/>
<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
Name="Table Grid 2"/>
<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
Name="Table Grid 3"/>
<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
Name="Table Grid 4"/>
<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
Name="Table Grid 5"/>
<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
Name="Table Grid 6"/>
<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
Name="Table Grid 7"/>
<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
Name="Table Grid 8"/>
<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
Name="Table List 1"/>
<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
Name="Table List 2"/>
<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
Name="Table List 3"/>
<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
Name="Table List 4"/>
<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
Name="Table List 5"/>
<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
Name="Table List 6"/>
<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
Name="Table List 7"/>
<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
Name="Table List 8"/>
<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
Name="Table 3D effects 1"/>
<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
Name="Table 3D effects 2"/>
<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
Name="Table 3D effects 3"/>
<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
Name="Table Contemporary"/>
<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
Name="Table Elegant"/>
<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
Name="Table Professional"/>
<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
Name="Table Subtle 1"/>
<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
Name="Table Subtle 2"/>
<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
Name="Table Web 1"/>
<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
Name="Table Web 2"/>
<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
Name="Table Web 3"/>
<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
Name="Balloon Text"/>
<w:LsdException Locked="false" Priority="39" Name="Table Grid"/>
<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
Name="Table Theme"/>
<w:LsdException Locked="false" SemiHidden="true" Name="Placeholder Text"/>
<w:LsdException Locked="false" Priority="1" QFormat="true" Name="No Spacing"/>
<w:LsdException Locked="false" Priority="60" Name="Light Shading"/>
<w:LsdException Locked="false" Priority="61" Name="Light List"/>
<w:LsdException Locked="false" Priority="62" Name="Light Grid"/>
<w:LsdException Locked="false" Priority="63" Name="Medium Shading 1"/>
<w:LsdException Locked="false" Priority="64" Name="Medium Shading 2"/>
<w:LsdException Locked="false" Priority="65" Name="Medium List 1"/>
<w:LsdException Locked="false" Priority="66" Name="Medium List 2"/>
<w:LsdException Locked="false" Priority="67" Name="Medium Grid 1"/>
<w:LsdException Locked="false" Priority="68" Name="Medium Grid 2"/>
<w:LsdException Locked="false" Priority="69" Name="Medium Grid 3"/>
<w:LsdException Locked="false" Priority="70" Name="Dark List"/>
<w:LsdException Locked="false" Priority="71" Name="Colorful Shading"/>
<w:LsdException Locked="false" Priority="72" Name="Colorful List"/>
<w:LsdException Locked="false" Priority="73" Name="Colorful Grid"/>
<w:LsdException Locked="false" Priority="60" Name="Light Shading Accent 1"/>
<w:LsdException Locked="false" Priority="61" Name="Light List Accent 1"/>
<w:LsdException Locked="false" Priority="62" Name="Light Grid Accent 1"/>
<w:LsdException Locked="false" Priority="63" Name="Medium Shading 1 Accent 1"/>
<w:LsdException Locked="false" Priority="64" Name="Medium Shading 2 Accent 1"/>
<w:LsdException Locked="false" Priority="65" Name="Medium List 1 Accent 1"/>
<w:LsdException Locked="false" SemiHidden="true" Name="Revision"/>
<w:LsdException Locked="false" Priority="34" QFormat="true"
Name="List Paragraph"/>
<w:LsdException Locked="false" Priority="29" QFormat="true" Name="Quote"/>
<w:LsdException Locked="false" Priority="30" QFormat="true"
Name="Intense Quote"/>
<w:LsdException Locked="false" Priority="66" Name="Medium List 2 Accent 1"/>
<w:LsdException Locked="false" Priority="67" Name="Medium Grid 1 Accent 1"/>
<w:LsdException Locked="false" Priority="68" Name="Medium Grid 2 Accent 1"/>
<w:LsdException Locked="false" Priority="69" Name="Medium Grid 3 Accent 1"/>
<w:LsdException Locked="false" Priority="70" Name="Dark List Accent 1"/>
<w:LsdException Locked="false" Priority="71" Name="Colorful Shading Accent 1"/>
<w:LsdException Locked="false" Priority="72" Name="Colorful List Accent 1"/>
<w:LsdException Locked="false" Priority="73" Name="Colorful Grid Accent 1"/>
<w:LsdException Locked="false" Priority="60" Name="Light Shading Accent 2"/>
<w:LsdException Locked="false" Priority="61" Name="Light List Accent 2"/>
<w:LsdException Locked="false" Priority="62" Name="Light Grid Accent 2"/>
<w:LsdException Locked="false" Priority="63" Name="Medium Shading 1 Accent 2"/>
<w:LsdException Locked="false" Priority="64" Name="Medium Shading 2 Accent 2"/>
<w:LsdException Locked="false" Priority="65" Name="Medium List 1 Accent 2"/>
<w:LsdException Locked="false" Priority="66" Name="Medium List 2 Accent 2"/>
<w:LsdException Locked="false" Priority="67" Name="Medium Grid 1 Accent 2"/>
<w:LsdException Locked="false" Priority="68" Name="Medium Grid 2 Accent 2"/>
<w:LsdException Locked="false" Priority="69" Name="Medium Grid 3 Accent 2"/>
<w:LsdException Locked="false" Priority="70" Name="Dark List Accent 2"/>
<w:LsdException Locked="false" Priority="71" Name="Colorful Shading Accent 2"/>
<w:LsdException Locked="false" Priority="72" Name="Colorful List Accent 2"/>
<w:LsdException Locked="false" Priority="73" Name="Colorful Grid Accent 2"/>
<w:LsdException Locked="false" Priority="60" Name="Light Shading Accent 3"/>
<w:LsdException Locked="false" Priority="61" Name="Light List Accent 3"/>
<w:LsdException Locked="false" Priority="62" Name="Light Grid Accent 3"/>
<w:LsdException Locked="false" Priority="63" Name="Medium Shading 1 Accent 3"/>
<w:LsdException Locked="false" Priority="64" Name="Medium Shading 2 Accent 3"/>
<w:LsdException Locked="false" Priority="65" Name="Medium List 1 Accent 3"/>
<w:LsdException Locked="false" Priority="66" Name="Medium List 2 Accent 3"/>
<w:LsdException Locked="false" Priority="67" Name="Medium Grid 1 Accent 3"/>
<w:LsdException Locked="false" Priority="68" Name="Medium Grid 2 Accent 3"/>
<w:LsdException Locked="false" Priority="69" Name="Medium Grid 3 Accent 3"/>
<w:LsdException Locked="false" Priority="70" Name="Dark List Accent 3"/>
<w:LsdException Locked="false" Priority="71" Name="Colorful Shading Accent 3"/>
<w:LsdException Locked="false" Priority="72" Name="Colorful List Accent 3"/>
<w:LsdException Locked="false" Priority="73" Name="Colorful Grid Accent 3"/>
<w:LsdException Locked="false" Priority="60" Name="Light Shading Accent 4"/>
<w:LsdException Locked="false" Priority="61" Name="Light List Accent 4"/>
<w:LsdException Locked="false" Priority="62" Name="Light Grid Accent 4"/>
<w:LsdException Locked="false" Priority="63" Name="Medium Shading 1 Accent 4"/>
<w:LsdException Locked="false" Priority="64" Name="Medium Shading 2 Accent 4"/>
<w:LsdException Locked="false" Priority="65" Name="Medium List 1 Accent 4"/>
<w:LsdException Locked="false" Priority="66" Name="Medium List 2 Accent 4"/>
<w:LsdException Locked="false" Priority="67" Name="Medium Grid 1 Accent 4"/>
<w:LsdException Locked="false" Priority="68" Name="Medium Grid 2 Accent 4"/>
<w:LsdException Locked="false" Priority="69" Name="Medium Grid 3 Accent 4"/>
<w:LsdException Locked="false" Priority="70" Name="Dark List Accent 4"/>
<w:LsdException Locked="false" Priority="71" Name="Colorful Shading Accent 4"/>
<w:LsdException Locked="false" Priority="72" Name="Colorful List Accent 4"/>
<w:LsdException Locked="false" Priority="73" Name="Colorful Grid Accent 4"/>
<w:LsdException Locked="false" Priority="60" Name="Light Shading Accent 5"/>
<w:LsdException Locked="false" Priority="61" Name="Light List Accent 5"/>
<w:LsdException Locked="false" Priority="62" Name="Light Grid Accent 5"/>
<w:LsdException Locked="false" Priority="63" Name="Medium Shading 1 Accent 5"/>
<w:LsdException Locked="false" Priority="64" Name="Medium Shading 2 Accent 5"/>
<w:LsdException Locked="false" Priority="65" Name="Medium List 1 Accent 5"/>
<w:LsdException Locked="false" Priority="66" Name="Medium List 2 Accent 5"/>
<w:LsdException Locked="false" Priority="67" Name="Medium Grid 1 Accent 5"/>
<w:LsdException Locked="false" Priority="68" Name="Medium Grid 2 Accent 5"/>
<w:LsdException Locked="false" Priority="69" Name="Medium Grid 3 Accent 5"/>
<w:LsdException Locked="false" Priority="70" Name="Dark List Accent 5"/>
<w:LsdException Locked="false" Priority="71" Name="Colorful Shading Accent 5"/>
<w:LsdException Locked="false" Priority="72" Name="Colorful List Accent 5"/>
<w:LsdException Locked="false" Priority="73" Name="Colorful Grid Accent 5"/>
<w:LsdException Locked="false" Priority="60" Name="Light Shading Accent 6"/>
<w:LsdException Locked="false" Priority="61" Name="Light List Accent 6"/>
<w:LsdException Locked="false" Priority="62" Name="Light Grid Accent 6"/>
<w:LsdException Locked="false" Priority="63" Name="Medium Shading 1 Accent 6"/>
<w:LsdException Locked="false" Priority="64" Name="Medium Shading 2 Accent 6"/>
<w:LsdException Locked="false" Priority="65" Name="Medium List 1 Accent 6"/>
<w:LsdException Locked="false" Priority="66" Name="Medium List 2 Accent 6"/>
<w:LsdException Locked="false" Priority="67" Name="Medium Grid 1 Accent 6"/>
<w:LsdException Locked="false" Priority="68" Name="Medium Grid 2 Accent 6"/>
<w:LsdException Locked="false" Priority="69" Name="Medium Grid 3 Accent 6"/>
<w:LsdException Locked="false" Priority="70" Name="Dark List Accent 6"/>
<w:LsdException Locked="false" Priority="71" Name="Colorful Shading Accent 6"/>
<w:LsdException Locked="false" Priority="72" Name="Colorful List Accent 6"/>
<w:LsdException Locked="false" Priority="73" Name="Colorful Grid Accent 6"/>
<w:LsdException Locked="false" Priority="19" QFormat="true"
Name="Subtle Emphasis"/>
<w:LsdException Locked="false" Priority="21" QFormat="true"
Name="Intense Emphasis"/>
<w:LsdException Locked="false" Priority="31" QFormat="true"
Name="Subtle Reference"/>
<w:LsdException Locked="false" Priority="32" QFormat="true"
Name="Intense Reference"/>
<w:LsdException Locked="false" Priority="33" QFormat="true" Name="Book Title"/>
<w:LsdException Locked="false" Priority="37" SemiHidden="true"
UnhideWhenUsed="true" Name="Bibliography"/>
<w:LsdException Locked="false" Priority="39" SemiHidden="true"
UnhideWhenUsed="true" QFormat="true" Name="TOC Heading"/>
<w:LsdException Locked="false" Priority="41" Name="Plain Table 1"/>
<w:LsdException Locked="false" Priority="42" Name="Plain Table 2"/>
<w:LsdException Locked="false" Priority="43" Name="Plain Table 3"/>
<w:LsdException Locked="false" Priority="44" Name="Plain Table 4"/>
<w:LsdException Locked="false" Priority="45" Name="Plain Table 5"/>
<w:LsdException Locked="false" Priority="40" Name="Grid Table Light"/>
<w:LsdException Locked="false" Priority="46" Name="Grid Table 1 Light"/>
<w:LsdException Locked="false" Priority="47" Name="Grid Table 2"/>
<w:LsdException Locked="false" Priority="48" Name="Grid Table 3"/>
<w:LsdException Locked="false" Priority="49" Name="Grid Table 4"/>
<w:LsdException Locked="false" Priority="50" Name="Grid Table 5 Dark"/>
<w:LsdException Locked="false" Priority="51" Name="Grid Table 6 Colorful"/>
<w:LsdException Locked="false" Priority="52" Name="Grid Table 7 Colorful"/>
<w:LsdException Locked="false" Priority="46"
Name="Grid Table 1 Light Accent 1"/>
<w:LsdException Locked="false" Priority="47" Name="Grid Table 2 Accent 1"/>
<w:LsdException Locked="false" Priority="48" Name="Grid Table 3 Accent 1"/>
<w:LsdException Locked="false" Priority="49" Name="Grid Table 4 Accent 1"/>
<w:LsdException Locked="false" Priority="50" Name="Grid Table 5 Dark Accent 1"/>
<w:LsdException Locked="false" Priority="51"
Name="Grid Table 6 Colorful Accent 1"/>
<w:LsdException Locked="false" Priority="52"
Name="Grid Table 7 Colorful Accent 1"/>
<w:LsdException Locked="false" Priority="46"
Name="Grid Table 1 Light Accent 2"/>
<w:LsdException Locked="false" Priority="47" Name="Grid Table 2 Accent 2"/>
<w:LsdException Locked="false" Priority="48" Name="Grid Table 3 Accent 2"/>
<w:LsdException Locked="false" Priority="49" Name="Grid Table 4 Accent 2"/>
<w:LsdException Locked="false" Priority="50" Name="Grid Table 5 Dark Accent 2"/>
<w:LsdException Locked="false" Priority="51"
Name="Grid Table 6 Colorful Accent 2"/>
<w:LsdException Locked="false" Priority="52"
Name="Grid Table 7 Colorful Accent 2"/>
<w:LsdException Locked="false" Priority="46"
Name="Grid Table 1 Light Accent 3"/>
<w:LsdException Locked="false" Priority="47" Name="Grid Table 2 Accent 3"/>
<w:LsdException Locked="false" Priority="48" Name="Grid Table 3 Accent 3"/>
<w:LsdException Locked="false" Priority="49" Name="Grid Table 4 Accent 3"/>
<w:LsdException Locked="false" Priority="50" Name="Grid Table 5 Dark Accent 3"/>
<w:LsdException Locked="false" Priority="51"
Name="Grid Table 6 Colorful Accent 3"/>
<w:LsdException Locked="false" Priority="52"
Name="Grid Table 7 Colorful Accent 3"/>
<w:LsdException Locked="false" Priority="46"
Name="Grid Table 1 Light Accent 4"/>
<w:LsdException Locked="false" Priority="47" Name="Grid Table 2 Accent 4"/>
<w:LsdException Locked="false" Priority="48" Name="Grid Table 3 Accent 4"/>
<w:LsdException Locked="false" Priority="49" Name="Grid Table 4 Accent 4"/>
<w:LsdException Locked="false" Priority="50" Name="Grid Table 5 Dark Accent 4"/>
<w:LsdException Locked="false" Priority="51"
Name="Grid Table 6 Colorful Accent 4"/>
<w:LsdException Locked="false" Priority="52"
Name="Grid Table 7 Colorful Accent 4"/>
<w:LsdException Locked="false" Priority="46"
Name="Grid Table 1 Light Accent 5"/>
<w:LsdException Locked="false" Priority="47" Name="Grid Table 2 Accent 5"/>
<w:LsdException Locked="false" Priority="48" Name="Grid Table 3 Accent 5"/>
<w:LsdException Locked="false" Priority="49" Name="Grid Table 4 Accent 5"/>
<w:LsdException Locked="false" Priority="50" Name="Grid Table 5 Dark Accent 5"/>
<w:LsdException Locked="false" Priority="51"
Name="Grid Table 6 Colorful Accent 5"/>
<w:LsdException Locked="false" Priority="52"
Name="Grid Table 7 Colorful Accent 5"/>
<w:LsdException Locked="false" Priority="46"
Name="Grid Table 1 Light Accent 6"/>
<w:LsdException Locked="false" Priority="47" Name="Grid Table 2 Accent 6"/>
<w:LsdException Locked="false" Priority="48" Name="Grid Table 3 Accent 6"/>
<w:LsdException Locked="false" Priority="49" Name="Grid Table 4 Accent 6"/>
<w:LsdException Locked="false" Priority="50" Name="Grid Table 5 Dark Accent 6"/>
<w:LsdException Locked="false" Priority="51"
Name="Grid Table 6 Colorful Accent 6"/>
<w:LsdException Locked="false" Priority="52"
Name="Grid Table 7 Colorful Accent 6"/>
<w:LsdException Locked="false" Priority="46" Name="List Table 1 Light"/>
<w:LsdException Locked="false" Priority="47" Name="List Table 2"/>
<w:LsdException Locked="false" Priority="48" Name="List Table 3"/>
<w:LsdException Locked="false" Priority="49" Name="List Table 4"/>
<w:LsdException Locked="false" Priority="50" Name="List Table 5 Dark"/>
<w:LsdException Locked="false" Priority="51" Name="List Table 6 Colorful"/>
<w:LsdException Locked="false" Priority="52" Name="List Table 7 Colorful"/>
<w:LsdException Locked="false" Priority="46"
Name="List Table 1 Light Accent 1"/>
<w:LsdException Locked="false" Priority="47" Name="List Table 2 Accent 1"/>
<w:LsdException Locked="false" Priority="48" Name="List Table 3 Accent 1"/>
<w:LsdException Locked="false" Priority="49" Name="List Table 4 Accent 1"/>
<w:LsdException Locked="false" Priority="50" Name="List Table 5 Dark Accent 1"/>
<w:LsdException Locked="false" Priority="51"
Name="List Table 6 Colorful Accent 1"/>
<w:LsdException Locked="false" Priority="52"
Name="List Table 7 Colorful Accent 1"/>
<w:LsdException Locked="false" Priority="46"
Name="List Table 1 Light Accent 2"/>
<w:LsdException Locked="false" Priority="47" Name="List Table 2 Accent 2"/>
<w:LsdException Locked="false" Priority="48" Name="List Table 3 Accent 2"/>
<w:LsdException Locked="false" Priority="49" Name="List Table 4 Accent 2"/>
<w:LsdException Locked="false" Priority="50" Name="List Table 5 Dark Accent 2"/>
<w:LsdException Locked="false" Priority="51"
Name="List Table 6 Colorful Accent 2"/>
<w:LsdException Locked="false" Priority="52"
Name="List Table 7 Colorful Accent 2"/>
<w:LsdException Locked="false" Priority="46"
Name="List Table 1 Light Accent 3"/>
<w:LsdException Locked="false" Priority="47" Name="List Table 2 Accent 3"/>
<w:LsdException Locked="false" Priority="48" Name="List Table 3 Accent 3"/>
<w:LsdException Locked="false" Priority="49" Name="List Table 4 Accent 3"/>
<w:LsdException Locked="false" Priority="50" Name="List Table 5 Dark Accent 3"/>
<w:LsdException Locked="false" Priority="51"
Name="List Table 6 Colorful Accent 3"/>
<w:LsdException Locked="false" Priority="52"
Name="List Table 7 Colorful Accent 3"/>
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<span style="font-family: Arial,Helvetica,sans-serif;"><b><span style="font-size: 18.0pt; line-height: 150%;"><span style="font-size: small;"> 28th March 2013</span></span></b></span></div>
<div class="xmsonormal" style="line-height: 150%;">
<span style="font-family: Arial,Helvetica,sans-serif;"><b><span style="font-size: 18.0pt; line-height: 150%;">Cases of TB in domestic cats and cat-to-human transmission –
risk to public very low</span></b></span></div>
<span style="font-family: Arial,Helvetica,sans-serif;">
Following news reports about the potential for pet
cats to be able to transmit TB to patients a comment was called for to put some
perspective on the stories. Below are the links to the stories : <a href="https://owa.kingston.ac.uk/owa/redir.aspx?C=9053876aecaf47c5a39f7615845b3bdd&URL=http%3a%2f%2fwww.bbc.co.uk%2fnews%2fhealth-26766006" target="_blank">http://www.bbc.co.uk/news/health-26766006</a> and <a href="https://owa.kingston.ac.uk/owa/redir.aspx?C=9053876aecaf47c5a39f7615845b3bdd&URL=http%3a%2f%2fwww.dailymail.co.uk%2fhealth%2farticle-2590699%2fTwo-British-people-contract-tuberculosis-contact-cat-recorded-cases-cat-human-transmission.html" target="_blank">http://www.dailymail.co.uk/health/article-2590699/Two-British-people-contract-tuberculosis-contact-cat-recorded-cases-cat-human-transmission.html</a>)</span><br />
<div class="xmsonormal">
</div>
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<br /></div>
<div class="xmsonormal">
<span style="font-family: Arial,Helvetica,sans-serif;"><b>Here is my comment given to the media:</b></span></div>
<span style="font-family: Arial,Helvetica,sans-serif;">
Prof Mark Fielder, medical microbiologist Kingston
University, Hon Gen Sec Society for applied Microbiology.</span><br />
<div class="xmsonormal">
<br /></div>
<br />
<div class="xmsonormal" style="text-align: justify;">
<span style="font-family: Arial,Helvetica,sans-serif;"> The recent report of <i>Mycobacterium bovis</i> infection in
cats is a highly unusual situation and we currently have no evidence that this
occurrence has spread. With this is mind the risk to the public and pet owners
remains very low. Having said that we should, as a precautionary measure, take
the advice of the PHE in that people who have been in contact with an animal
with a known infection should see their doctor just to ensure they have not been
exposed.</span></div>
Prof Mark Fielderhttp://www.blogger.com/profile/12245402309773464551noreply@blogger.com0tag:blogger.com,1999:blog-8489821596559606436.post-2905154424169545602014-06-17T16:17:00.003+01:002014-06-17T16:17:50.208+01:00<!--[if gte mso 9]><xml>
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<br />
<div class="xmsonormal" style="margin-bottom: 0.0001pt;">
<span style="font-size: small;"><span style="font-family: Arial,Helvetica,sans-serif;"><b><span>Mon 1<sup>st</sup> July 2013</span></b></span></span></div>
<div class="xmsoplaintext">
<br /></div>
<div class="xmsonormal" style="margin-bottom: .0001pt; margin-bottom: 0cm;">
<span style="font-family: Arial,Helvetica,sans-serif;"><b><u>Scientists comment on TB test-positive
cattle entering the food chain</u></b></span></div>
<div class="xmsonormal" style="margin-bottom: 0.0001pt; text-align: justify;">
<span style="font-family: Arial,Helvetica,sans-serif;">A Story
emerged that suggested that meat in the food chain was positive for the
bacteria <i style="mso-bidi-font-style: normal;">Mycobacterium bovis </i>the
cause of Bovine TB). This story had the potential to cause some level of
distress to people and as such needed comment that added a sense of reality and
realism into a potentially scaremongering story. My colleague Prof Nigel Brown
(President of SGM) and I both commented to the media as follows:</span></div>
<div class="xmsonormal" style="margin-bottom: 0.0001pt; text-align: justify;">
<span style="font-family: Arial,Helvetica,sans-serif;"><b><span lang="EN-US" style="color: black; mso-ansi-language: EN-US;">Professor Nigel Brown,
President, Society for General Microbiology, said:</span></b></span></div>
<div class="xmsonormal" style="margin-bottom: 0.0001pt; text-align: justify;">
<span style="font-family: Arial,Helvetica,sans-serif;"><span lang="EN-US" style="color: black; mso-ansi-language: EN-US;">TB is usually
transmitted by direct contact with a living animal, or drinking TB-infected,
unpasteurised milk. Catching TB from meat is highly unlikely, particularly as
the primary infected organs, such as lungs and liver, are removed from the food
chain. Cooking the meat to at least 60 degrees C will kill the TB bacterium,
removing any chance of infection. I would be happy to eat meat from TB-infected
cattle, and people should not be unduly concerned.</span></span></div>
<div class="xmsonormal" style="margin-bottom: 0.0001pt; text-align: justify;">
<span style="font-family: Arial,Helvetica,sans-serif;"><span lang="EN-US" style="color: black; mso-ansi-language: EN-US;">One of the main reasons
for TB testing of cattle is to eliminate TB from dairy herds, as it is possible
to catch TB from infected, unpasteurised milk. Cows may be milked before their
TB infection is known, and I strongly recommend that people do not drink raw
milk.</span></span></div>
<div class="xmsonormal" style="margin-bottom: 0.0001pt; text-align: justify;">
<span style="font-family: Arial,Helvetica,sans-serif;"><b><span lang="EN-US" style="color: black; mso-ansi-language: EN-US;">My comments were</span></b></span></div>
<div class="xmsonormal" style="margin-bottom: 0.0001pt; text-align: justify;">
<span style="font-family: Arial,Helvetica,sans-serif;"><b><span lang="EN-US" style="color: black; mso-ansi-language: EN-US;">Professor Mark Fielder,
General Secretary, Society for Applied Microbiology, said:</span></b></span></div>
<div class="xmsonormal" style="margin-bottom: 0.0001pt; text-align: justify;">
<span style="font-family: Arial,Helvetica,sans-serif;"><span lang="EN-US" style="color: black; mso-ansi-language: EN-US;">We would not expect
infective material from animals to enter the food chain. There are processes in
place from farm to supermarket to ensure the safety of meat reaching our
plates, including examination of carcasses by a vet. So even if an animal with
TB was slaughtered for food, it is extremely unlikely to be prepared for
consumption by humans or other animals. If an animal with TB were to find its
way into the food chain, regular good practice for handling and cooking meat
ought to be sufficient to kill any bacteria still present.</span><span lang="EN-US" style="color: black;"></span></span></div>
<div class="xmsonormal" style="margin-bottom: 0.0001pt; text-align: justify;">
<span style="font-family: Arial,Helvetica,sans-serif;"><b>The BBC put
a useful Q&A page on their webpage too</b></span></div>
<div class="xmsonormal" style="margin-bottom: 0.0001pt; text-align: justify;">
<span style="font-family: Arial,Helvetica,sans-serif;"><a href="https://owa.kingston.ac.uk/owa/redir.aspx?C=9053876aecaf47c5a39f7615845b3bdd&URL=http%3a%2f%2fwww.bbc.co.uk%2fnews%2fhealth-23125201" target="_blank">http://www.bbc.co.uk/news/health-23125201</a></span></div>
Prof Mark Fielderhttp://www.blogger.com/profile/12245402309773464551noreply@blogger.com0tag:blogger.com,1999:blog-8489821596559606436.post-48724128796001062922014-06-17T16:06:00.000+01:002014-06-17T16:06:04.191+01:00<!--[if gte mso 9]><xml>
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<br />
<div class="xmsonormal">
<b><u><span style="font-family: "Arial","sans-serif";">Scientists
comment on the US Food and Drug Administration statement on antibacterial soap</span></u></b><span style="font-family: "Arial","sans-serif";"></span></div>
<div class="xmsonormal">
<span style="font-family: "Arial","sans-serif"; mso-bidi-font-weight: bold;"> Tuesday 17 December 2013</span></div>
<div class="xmsonormal">
<br /></div>
<div class="xmsonormal" style="text-align: justify;">
<span style="font-family: "Arial","sans-serif"; mso-bidi-font-weight: bold;"> There have been some reports in the media about the use of
antibacterials in over the counter soaps and their potential effects on health
and bacterial resistance. See the links below for the story and my take on the
issues raised are thereafter, story links:<b> </b></span><span style="font-family: "Arial","sans-serif";">http://www.bbc.co.uk/news/world-us-canada-25405037
and <a href="http://www.dailymail.co.uk/news/article-2524701/FDA-say-antibacterial-soaps-pose-health-risks.html">http://www.dailymail.co.uk/news/article-2524701/FDA-say-antibacterial-soaps-pose-health-risks.html</a></span></div>
<div class="xmsonormal" style="text-align: justify;">
<br /></div>
<div class="xmsonormal" style="text-align: justify;">
<b style="mso-bidi-font-weight: normal;"><span style="font-family: "Arial","sans-serif";">My comments on the story:</span></b></div>
<div class="xmsonormal" style="text-align: justify;">
<br /></div>
<div class="xmsonormal" style="text-align: justify;">
<span style="font-family: "Arial","sans-serif";">“Whilst
there is some evidence that bacteria have developed resistance to antimicrobial
chemicals such as triclosan (amongst others) in the laboratory, this has not
been reproducibly observed in the clinical or home based settings. What is
clear is that there is a knowledge gap here that needs to be further studied to
ensure we have a full understanding of how any changes may occur to effectively
limit the potential of the emergence of antibiotic resistance in the future. We
need to fully determine whether or not the inclusion of antimicrobial chemicals
in ‘over the counter’ products provides any real benefit or greater efficacy
when compared to what might be termed as ‘traditional’ products.</span></div>
<div class="xmsonormal" style="text-align: justify;">
<br /></div>
<div class="xmsonormal" style="text-align: justify;">
<span style="font-family: "Arial","sans-serif";">“Concerns
regarding the inclusion of antimicrobial agents in ‘over the counter’ products
such as soaps, is not new and the question has recently been raised again by
the FDA. Some of these concerns relate to the possible development of
antibiotic cross-resistance in some bacteria. Historically, the development of
resistance following the inclusion of chemicals such as triclosan in products
has been of limited concern. This is largely due to the broad spectrum activity
of the chemical coupled with the targeting of multiple bacterial targets. This,
in general terms, means that development of resistance is more difficult.
However some studies have called this thinking into question following
observations that certain bacterial components (an enzyme called enoyl</span><span style="font-family: "Cambria Math","serif"; mso-bidi-font-family: "Cambria Math";">‐</span><span style="font-family: "Arial","sans-serif";">acyl carrier protein reductase) can be
affected by the action of the chemical. It has been suggested that the
overproduction of this enzyme, blocking the transfer of triclosan into the cell
or active pumping of the chemical out of the cell all might help lead to
resistance to triclosan occurring. Another interesting observation is that at
higher concentrations of chemicals such as triclosan work against several
bacterial cell targets, but at lower concentrations (below those that are
normally routinely used) the chemical becomes more selective in its targets.</span></div>
<div class="xmsonormal" style="text-align: justify;">
<br /></div>
<div class="xmsonormal" style="text-align: justify;">
<span style="font-family: "Arial","sans-serif";">“The link
between chemicals like triclosan and antibiotic resistance have been examined
and the findings suggest that, typically, the use of triclosan (at the correct
concentration) was effective against many bacteria, with the exception of <i>Pseudomonas
aeruginosa</i>, which is naturally resistant to the action of triclosan. Some
studies have shown that in the laboratory the exposure to chemicals such as
triclosan might help decrease bacterial sensitivity to some antibiotics in some
strains. However, this correlation has not been reported in studies from a
clinical setting, nor has it been shown in the home setting. Some laboratory
based studies have shown that isolates of <i>Salmonella</i> species and <i>E.
coli</i> have shown evidence of cross- resistance between antibiotics and
antimicrobials used in the clinical setting. However, the study notes that this
has not been confirmed in the clinical setting. So it is clear, especially in
light of the ongoing concern with antibiotic resistance that we need to study
any potential link with antimicrobial chemicals and the development of any
antibiotic resistance.”</span></div>
Prof Mark Fielderhttp://www.blogger.com/profile/12245402309773464551noreply@blogger.com0tag:blogger.com,1999:blog-8489821596559606436.post-65192680476217745472014-06-17T15:59:00.002+01:002014-06-17T15:59:33.455+01:00A Rapid Blood Test to Diagnose Sepsis could be on the way<div style="text-align: justify;">
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<span style="font-family: "Arial","sans-serif"; font-size: 10.0pt; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: EN-GB;">17 th
OCTOBER 2013</span></div>
<div class="MsoNormal" style="line-height: normal; margin-bottom: .0001pt; margin-bottom: 0cm;">
<b style="mso-bidi-font-weight: normal;"><span style="font-family: "Arial","sans-serif"; font-size: 10.0pt; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: EN-GB;">Rapid blood test to diagnose sepsis at the bedside
could save thousands of lives, study suggests</span></b></div>
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<br /></div>
<div class="MsoNormal" style="line-height: normal; margin-bottom: .0001pt; margin-bottom: 0cm;">
<span style="font-family: "Arial","sans-serif"; font-size: 10.0pt; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: EN-GB;">Edited (by me) PLOSone Press release</span></div>
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<span style="font-family: "Arial","sans-serif"; font-size: 10.0pt; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: EN-GB;">Researchers
at King’s College London have identified a biomarker – a biological
‘fingerprint’ – for sepsis in the blood, and showed it could be possible to diagnose
the condition within two hours by screening for this biomarker at a patient’s
bedside. Sepsis (sometimes referred to as ‘blood poisoning’) is a
life-threatening condition that arises when the body’s inflammatory response to
a bacterial infection injures its own tissues and organs. Costing the NHS over
£2billion annually, the condition kills more people than breast and bowel
cancer combined (approximately 37,000 a year). Rapid diagnosis and treatment
with antibiotics saves lives, but as there are currently no biomarkers in
clinical use to enable fast diagnosis, it can take up to two days to analyse
samples in the laboratory.<span style="mso-spacerun: yes;"> </span></span></div>
<div class="MsoNormal" style="line-height: normal; margin-bottom: .0001pt; margin-bottom: 0cm;">
<br /></div>
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<span style="font-family: "Arial","sans-serif"; font-size: 10.0pt; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: EN-GB;">Published
on the 16th October 2013 in the journal PLOS ONE and funded by both Guy’s and
St Thomas’ Charity and the National Institute for Health Research (NIHR)
Biomedical Research Centre at Guy’s and St Thomas’ NHS Foundation Trust and
King’s College London, this study highlights a possible biomarker for the rapid
diagnosis of sepsis. The work was performed in collaboration with Cepheid,
developer of the GeneXpert, which is capable of performing rapid molecular
detection.</span></div>
<div class="MsoNormal" style="line-height: normal; margin-bottom: .0001pt; margin-bottom: 0cm;">
<span style="font-family: "Arial","sans-serif"; font-size: 10.0pt; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: EN-GB;">Researchers
at King’s and Cepheid, a molecular diagnostics company, took samples of blood
from three groups of patients; those with sepsis, patients with other Systemic
Inflammatory Response Syndrome (that does not respond to antibiotics), and
healthy patients. From the blood samples they were able to amplify small
amounts of RNA into large quantities to see which particular microRNAs were
increased. By using this method, the team found that a certain group of
microRNAs were more active in the sepsis patients than in the other groups,
highlighting a potential biomarker for the condition. </span></div>
<div class="MsoNormal" style="line-height: normal; margin-bottom: .0001pt; margin-bottom: 0cm;">
<span style="font-family: "Arial","sans-serif"; font-size: 10.0pt; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: EN-GB;">The study
was replicated with a large group of Swedish patients with severe sepsis, which
validated the results. By using this method of screening and analysing the
blood in both studies, the researchers were able to diagnose sepsis within two
hours, with 86% accuracy. </span></div>
<div class="MsoNormal" style="line-height: normal; margin-bottom: .0001pt; margin-bottom: 0cm;">
<span style="font-family: "Arial","sans-serif"; font-size: 10.0pt; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: EN-GB;">Symptoms
of sepsis are similar to other types of Systemic Inflammatory Response Syndrome
(SIRS), yet only sepsis responds to antibiotics. It is therefore important for
clinicians to be able to distinguish sepsis from other types of SIRS as
administering antibiotics in non-sepsis cases can add pressure to the development
of antibiotic resistance. Professor Lord said: “Not only would an accurate
diagnostic test improve outcomes for patients, but it would contribute to
tackling the ongoing problem of antibiotic resistance by allowing clinicians to
distinguish between SIRS and sepsis and diagnose these severe conditions more
accurately.”</span></div>
<div class="MsoNormal" style="line-height: normal; margin-bottom: .0001pt; margin-bottom: 0cm;">
<span style="font-family: "Arial","sans-serif"; font-size: 10.0pt; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: EN-GB;">Plans for
a randomised clinical trial are underway at King’s College London and Guy’s and
St Thomas’ NHS Foundation Trust, part of King’s Health Partners Academic Health
Sciences Centre.</span></div>
<div class="MsoNormal" style="line-height: normal; margin-bottom: .0001pt; margin-bottom: 0cm;">
<br /></div>
<div class="MsoNormal" style="line-height: normal; margin-bottom: .0001pt; margin-bottom: 0cm;">
<b style="mso-bidi-font-weight: normal;"><span style="font-family: "Arial","sans-serif"; font-size: 10.0pt; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: EN-GB;">My Response and take on the Story </span></b></div>
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<span style="font-family: "Arial","sans-serif"; font-size: 10.0pt; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: EN-GB;">This work
is potentially quite exciting as the rapid diagnosis of fast moving diseases
such as sepsis is of great importance. In medicine, an early intervention in
these cases can often result in a much improved result for the patient. With
this in mind, any improvements or aids to the diagnosis of such diseases are to
be welcomed, especially when the tests are rapid and potentially able to be of
use at the point of care. The results reported in the paper are very
encouraging in that a reliable discrimination between sepsis and systemic
inflammatory response syndrome can be achieved, which in turn can help point
clinicians towards the most appropriate treatments to administer. Further
studies will be required to increase patient numbers sampled and so that the
full potential of this</span></div>
<div class="MsoNormal" style="line-height: normal; margin-bottom: .0001pt; margin-bottom: 0cm;">
<span style="font-family: "Arial","sans-serif"; font-size: 10.0pt; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: EN-GB;">test can
be realised. </span></div>
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<br /></div>
<div class="MsoNormal" style="line-height: normal; margin-bottom: .0001pt; margin-bottom: 0cm;">
<span style="font-family: "Arial","sans-serif"; font-size: 10.0pt; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: EN-GB;">Professor
Mark Fielder, Medical Microbiologist, Kingston University</span></div>
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<span style="font-family: "Arial","sans-serif"; font-size: 10.0pt; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: EN-GB;">London.</span></div>
<div class="MsoNormal" style="line-height: normal; margin-bottom: .0001pt; margin-bottom: 0cm;">
<br /></div>
Prof Mark Fielderhttp://www.blogger.com/profile/12245402309773464551noreply@blogger.com0tag:blogger.com,1999:blog-8489821596559606436.post-40413594408871931532013-03-11T10:34:00.001+00:002013-03-11T11:04:09.143+00:00Antimicrobial Resistance poses 'catastrophic threat', say Chief Medical Officer - my take on the story.<!--[if gte mso 9]><xml>
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<a href="http://antibiotic-action.com/wp-content/themes/pmix/images/ww02.gif" imageanchor="1" style="clear: left; float: left; margin-bottom: 1em; margin-right: 1em;"><img border="0" rel="<a href='http://antibiotic-action.com'>http://antibiotic-action.com/wp-content/themes/pmix/images/ww02.gif</a>" src="http://antibiotic-action.com/wp-content/themes/pmix/images/ww02.gif" /></a>There is an important medical need that must be confronted
and tackled to prevent modern medicine slipping back in time. This need is to
address the specter of antimicrobial resistance which is potentially reaching catastrophic
proportions. This has been highlighted in the recent report by the chief government
medical officer Prof Dame Sally Davies. Dame Sally reports on the ‘discovery
void’ that appears to be present<span style="mso-spacerun: yes;"> </span>with
very few antibiotics being developed in the past twenty years and this
contrasts new infectious diseases that have been described nearly every year in
the last thirty years!</div>
<div class="MsoNormal">
Dame Sally’s report highlights the importance of looking
after the antibiotics we currently have and supporting their use with improved
hygiene and better prescribing policies making sure we only use antibiotics
when there is a need. It is important to remember that antibiotics do not work
against infectious agents such as viruses and it is vital to target the correct
bacteria with an appropriate antibiotic.</div>
<div class="MsoNormal">
This sort of action will help us tackle the next generation
of hospital acquired infections<span style="mso-spacerun: yes;">
</span>including the newly described strains of pneumonia causing <i style="mso-bidi-font-style: normal;">Klebsiella</i> strains.</div>
<div class="MsoNormal">
The report indicates that, Antimicrobial resistance now
needs to be put on the national risk register as a major concern and bought to
the attention of politicians and policy makers. There needs to be better
surveillance across the NHS and around the world to monitor the situation as it
develops further. There needs to be collaboration between healthcare and
pharmaceutical companies to tackle the so called ‘discovery void’ and create
new drugs and preserve the current ones.</div>
<div class="MsoNormal">
We need to monitor antibiotic usage and policy globally in
both human and animal healthcare to help develop new drugs and re-enforce the
need for good antibiotic stewardship so that what are currently referred to as
routine infections do not become life threatening.</div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
Please also consider signing the petition on the Antibiotic action Website (http://antibiotic-action.com/) and follow Antibiotic action on Twitter @theurgentneed</div>
<div class="MsoNormal">
<a href="http://antibiotic-action.com/wp-content/themes/pmix/downloads/antibioticactionlogo_medium.jpg"><img src="http://antibiotic-action.com/wp-content/themes/pmix/images/logo_thumb.gif" /><img rel="<a href='http://antibiotic-action.com'>http://antibiotic-action.com/wp-content/themes/pmix/images/wb04.gif</a>" src="http://antibiotic-action.com/wp-content/themes/pmix/images/wb04.gif" /></a></div>
<div class="MsoNormal">
Further information on this story can be found:</div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
http://www.bbc.co.uk/news/health-21737844</div>
<div class="MsoNormal">
http://www.bbc.co.uk/news/health-21702647</div>
<div class="MsoNormal">
http://www.standard.co.uk/news/health/chief-medical-officer-antibiotic-resistance-as-dangerous-as-terrorism-8528556.html</div>
<div class="MsoNormal">
http://www.guardian.co.uk/society/2013/jan/23/antibiotic-resistant-diseases-apocalyptic-threat </div>
Prof Mark Fielderhttp://www.blogger.com/profile/12245402309773464551noreply@blogger.com0tag:blogger.com,1999:blog-8489821596559606436.post-84467312923943130042013-03-06T10:20:00.001+00:002013-03-06T10:20:43.347+00:00Impending catastrophe with antibiotic resistance- The Importance of
Antibiotic Action: the arms race!CDC has reported upon the importance of the emergence and subsequent control of the so called CRE (Carbapenem-Resistant Enterobacteriaceae) strain of drug resistant organisms. These organisms are now a major concern worldwide and the CDC reports that urgent action is needed to halt the spread of these organisms and indeed control them! <br />
<br />
The HPA website reports that the Carbapenems such as imipenem, meropenem as well as ertapenem show the most consistent activity against have the most consistent activity against Enterobacteriaceae. These drugs are not inactivated by AmpC or extended-spectrum ß-lactamases which contrasts with the 3rd and 4th generation cephalosporins.<br />
<br />
It is clear we need to closely monitor the development of this type of resistance and its subsequent spread. Strong prescribing diligence is a must to help preserve these drugs and their use.<br />
<br />
In the UK, Antibiotic Action supported by the British Society for Antimicrobial Chemotherapy is taking a leading role in highlighting the Importance and indeed danger of losing effective antimicrobial therapy in general medicine. Indeed the WHO stated in 2009 that antimicrobial resistance is one of the greatest threats to human health - sadly this has not improved but actually worsened in the intervening time. We really do need to act and act now. As Margaret Chan from the WHO has stated, even current routine surgical procedures could become life threatening without the support of effective antibiotic treatment.<br />
<br />
Please join Antibiotic Action and pledge your support (http://antibiotic-action.com/) - we need you!<br />
<br />
Relevant articles;<br />
<br />
http://www.cdc.gov/media/releases/2013/p0305_deadly_bacteria.html<br />
<br />
http://www.hpa.org.uk/webc/HPAwebFile/HPAweb_C/1248854054416Prof Mark Fielderhttp://www.blogger.com/profile/12245402309773464551noreply@blogger.com0tag:blogger.com,1999:blog-8489821596559606436.post-55095857051445453952013-03-06T09:38:00.001+00:002013-03-06T09:38:56.395+00:00CDC warns of drug-resistant EnterobacteriaceaeThis article has been reproduced entirely from the website below via the excellent Jo Tarrants Infection Update website. <br />
<br />
This is a really interesting article and worth a read, article originated by Lisa Schnirring on the 5th March<br />
<br />
http://www.cidrap.umn.edu/cidrap/content/other/resistance/news/mar0513resistant.html<br />
<br />
CDC warns of drug-resistant Enterobacteriaceae Lisa Schnirring Staff WriterMar 5, 2013 (CIDRAP News) – Federal officials today warned of a new type of antibiotic-resistant threat that is more dangerous than methicillin-resistant Staphylococcus aureus (MRSA), but could be curbed now with prompt action from health leaders, healthcare workers, and even patients, they say.Carbapenem-resistant Enterobacteriaceae (CRE), seen primarily in patients who have been exposed to hospital settings, are "nightmare bacteria" that pose a triple threat, according to the US Centers for Disease Control and Prevention (CDC).CRE, which include two common digestive system organisms, Klebsiella pneumoniae and Escherichia coli, are resistant to nearly all antibiotics, have a high mortality in invasive infections, and can spread resistance genes to other bacteria in patients' bodies, CDC officials said.Tom Frieden, MD, MPH, the CDC's director, said in a briefing today, "It's not often that scientists come to me and say we need to sound an alarm. The good news is we have an opportunity to prevent further spread."CDC officials said they're basing their warnings on data from three surveillance systems, including one that showed the proportion of CRE among all Enterobacteriaceae increased from 1.2% in 2001 to 4.2% in 2011. Another showed an increase from 0% in 2001 to 1.4% in 2010. The agency published the findings today in a Vital Signs report in Morbidity and Mortality Weekly Report (MMWR).The CDC saw the percentage of CRE infections increase most for Klebsiella, which spiked from 1.6% in 2001 to 10.4% in 2011 in one database. "That's a very troubling increase," Frieden said.The CDC also found that almost 200 hospitals and acute-care long-term care facilities treated at least one patient infected with CRE from a catheter-associated urinary tract infection or a central-line–associated bloodstream infection.Risks appear to be highest in patients with complex medical problems or who are in long-term care settings, according to the agency. The rate of CRE-affected facilities varied from 3.9% among short-term-care facilities to 17.8% among long-term-care facilities.So far 42 states have reported at least one case, and as yet there's no sign that CRE has spread beyond patients who had extensive hospital exposure, Frieden said. "It's not as widespread as MRSA, and it's important we keep it that way," he said.He said, however, that CDC officials are encouraged by dramatic reductions in CRE rates in facilities that are using a toolkit the CDC released in 2012 aimed at preventing the infections."Doctors, hospital leaders, and public health must work together now to implement CDC’s 'detect and protect' strategy and stop these infections from spreading," Frieden said.Steps include identifying patients who have CRE infections through lab alerts, keeping healthcare teams informed when patients who have CRE infections are transferred in and out of facilities, observing contact precautions during care, setting aside special rooms to care for CRE patients, removing temporary devices such as catheters as soon as possible, and carefully monitoring antibiotic use.Frieden urged patients and their loved ones to insist that health workers wash their hands and to ask if catheters and intravenous lines can be removed as soon as possible. Two other approaches could include chlorhexidrine baths for patients and the development of advanced molecular detection systems, he added.Arjun Srinivasan, MD, associate director for healthcare-associated infection prevention programs at the CDC, said though active CRE surveillance is under way, its presence can vary by region, so there is no one-size-fits-all strategy. New York City, for example, has been battling CRE for several years, he said.The Vital Signs report said the percentage of hospitals reporting CRE was highest in the Northeast and among larger and teaching hospitals.Health departments can play a vital role in reducing the CRE threat by bringing health facilities together to keep providers informed about disease patterns and ways to detect and prevent the infections, Srinivasan said. "We're all in this together."Frieden said so far six states mandate reporting of CRE cases: Colorado, Minnesota, North Dakota, Oregon, Tennessee, and Wisconsin. Others are considering mandatory reporting.Prof Mark Fielderhttp://www.blogger.com/profile/12245402309773464551noreply@blogger.com0tag:blogger.com,1999:blog-8489821596559606436.post-68541439671631984502011-12-09T20:49:00.000+00:002011-12-09T20:49:42.767+00:00Salmonella able to form 'evil twins' to evade the immune system!The gram negative bacteria of the <i>Salmonella </i>spp. has demonstrated another fantastic trick in it armoury according to a group of researchers from the University of Washington, ass reported in PNAS this week.<br />
<br />
The paper describes some really elegant work on the ability of this common food poisoning associated organism to produce two froms of the organism as it undergoes division events. One of the forms produces the normal flagella projection, used to make the organism motile, whilst other clones do not posses these projections and as such are immotile. So essentially what we have is genetically identical bacteria within which phenotypic variance is seen. One of the lead researchers Prof Brad Cookson is reported on the Science Daily Blog site as saying that the organisms ability to be genetically identical but differ in appearance is of great use to pathogenic bacteria such as the salmonellas. This diversity apparently increases the chances of some of the clones surviving in the ever changing environment of the host. The ability to swim is a potentially important survival trait especially when one considers an environment such as the intestine. The group describe the discovery of the YdiV protein which appears to control whether the flagella are produced. The researchers report that salmonella strains that lack the YdiV protein are seemingly unable to repress flagellin production and as such these mutants appear to be less infectious. This is a really interesting paper and well worth a read!<br />
<br />
The paper citation is : <br />
<br />
<div class="MsoNormal" style="line-height: normal; margin-bottom: .0001pt; margin-bottom: 0cm;"> Stewart MK, Cummings LA, Johnson ML, Berezow AB, Cookson BT.</div><div class="MsoNormal" style="line-height: normal; margin-bottom: .0001pt; margin-bottom: 0cm;"> Regulation of phenotypic heterogeneity permits Salmonella evasion of the host caspase-1 inflammatory response. <i style="mso-bidi-font-style: normal;">Proc Natl Acad Sci U S A</i>. 2011 Dec 5. [Epub ahead of print]</div><br />
You can get more information on Salmonella Spp., and this paper from the folowing sources:<br />
<br />
http://www.hpa.org.uk/Topics/InfectiousDiseases/InfectionsAZ/Salmonella/<br />
<br />
http://www.sciencedaily.com/releases/2011/12/111208092715.htm <br />
<br />
http://www.microbeworld.org/index.php?option=com_jlibrary&view=article&id=7945&utm_source=twitterfeed&utm_medium=twitter&utm_campaign=twitterProf Mark Fielderhttp://www.blogger.com/profile/12245402309773464551noreply@blogger.com0tag:blogger.com,1999:blog-8489821596559606436.post-46751884075666279832011-12-09T20:46:00.000+00:002011-12-09T20:46:16.524+00:00Influenza Season - its not too late to vaccinate!Well its flu season again and we still need to protect ourselves. The publicity of Influenza A H1N1 has somewhat faded but the virus is still active along with the other strains of seasonal flu that may be present. As such it is important to remember the importance of protecting yourself via a flu vaccination. This has been recently highighted by the commencement of National Flu week (4th-10th December) as advertised by the CDC in the USA. This may have come from the States but it is a timely reminder to use here in Europe of the importance of this infectious disease. Whilst we are all potentially vulnerable to influenza, there are members of our communities that are at particular risk and these may fall into the following groups:<br />
<br />
<ul><li>Pregnant women</li>
<li>Children younger than 5, but especially children younger than 2 years old</li>
<li>People 65 years of age and older</li>
<li>People of any age with certain chronic medical conditions</li>
</ul> (list copied from the CDC Site)<br />
<br />
So my short heartfelt message to you is get yourself vaccinated, I decided I did not have time last year and both my Wife and I caught flu and spent a truly miserable christmas - this year we have gone and had our vaccnes as this is the single most effective way of not catching the flu!<br />
<br />
<br />
<br />
Have a look at the CDC website : http://www.cdc.gov/Features/FightTheFlu/?s_cid=tw_cdc1063<br />
and the HPA website in the UK for more information http://www.hpa.org.uk/Topics/InfectiousDiseases/InfectionsAZ/Influenza/<br />
<br />
Be SafeProf Mark Fielderhttp://www.blogger.com/profile/12245402309773464551noreply@blogger.com0tag:blogger.com,1999:blog-8489821596559606436.post-5459132314593033192011-12-09T20:44:00.002+00:002011-12-09T20:44:28.524+00:00The other or Forgotten Malaria!Looking at a tweet the other day from the Nature News Blog I was intriuged by the title "A new map of the 'other' malaria" heading an article about <i>Plasmodium vivax </i>as opposed the more comonly reported <i>P. falciparum</i>. The article states that the P. vivax is almost the forgotten sister to falicparum malaria and that global eradification programs may well need to pay more attention to the activities of this parasite. So have a read of the article and see what you think!<br />
Here is the URL <span style="font-family: "Times New Roman","serif"; font-size: 10.5pt; mso-ansi-language: EN-GB; mso-bidi-language: AR-SA; mso-fareast-font-family: "Times New Roman"; mso-fareast-language: EN-GB;"><a href="http://t.co/uiTXDVl6">http://t.co/uiTXDVl6</a></span>Prof Mark Fielderhttp://www.blogger.com/profile/12245402309773464551noreply@blogger.com0tag:blogger.com,1999:blog-8489821596559606436.post-8750429431323990812011-06-03T17:28:00.002+01:002011-06-03T17:28:35.729+01:00The new strain of E. coli O104 in Germany!<!--[if gte mso 9]><xml> <w:WordDocument> <w:View>Normal</w:View> <w:Zoom>0</w:Zoom> <w:TrackMoves/> <w:TrackFormatting/> <w:PunctuationKerning/> <w:ValidateAgainstSchemas/> <w:SaveIfXMLInvalid>false</w:SaveIfXMLInvalid> <w:IgnoreMixedContent>false</w:IgnoreMixedContent> <w:AlwaysShowPlaceholderText>false</w:AlwaysShowPlaceholderText> <w:DoNotPromoteQF/> <w:LidThemeOther>EN-GB</w:LidThemeOther> <w:LidThemeAsian>X-NONE</w:LidThemeAsian> <w:LidThemeComplexScript>X-NONE</w:LidThemeComplexScript> <w:Compatibility> <w:BreakWrappedTables/> <w:SnapToGridInCell/> <w:WrapTextWithPunct/> <w:UseAsianBreakRules/> <w:DontGrowAutofit/> <w:SplitPgBreakAndParaMark/> <w:DontVertAlignCellWithSp/> <w:DontBreakConstrainedForcedTables/> <w:DontVertAlignInTxbx/> <w:Word11KerningPairs/> <w:CachedColBalance/> </w:Compatibility> <w:BrowserLevel>MicrosoftInternetExplorer4</w:BrowserLevel> <m:mathPr> <m:mathFont m:val="Cambria Math"/> <m:brkBin m:val="before"/> <m:brkBinSub m:val="--"/> <m:smallFrac m:val="off"/> <m:dispDef/> <m:lMargin m:val="0"/> <m:rMargin m:val="0"/> <m:defJc m:val="centerGroup"/> <m:wrapIndent m:val="1440"/> <m:intLim m:val="subSup"/> <m:naryLim m:val="undOvr"/> </m:mathPr></w:WordDocument> </xml><![endif]--><!--[if gte mso 9]><xml> <w:LatentStyles DefLockedState="false" DefUnhideWhenUsed="true"
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<div class="MsoNormal">The strain of verotoxin producing <i>Escherichia coli</i> (VTEC) O104 that is currently being seen is a really very unusual serogroup. Currently it is clear that actual source of the outbreak is the cause of considerable debate, it certainly requires more work to establish where the organism came from. There have been suggestions that this particular strain of VTEC O104 is an entirely new strain, this has not yet been formally proven. However it is clear that the organism associated with this outbreak is a VTEC O104 and does have an unusual set of virulence factors.</div><div class="MsoNormal">It would appear at present that salad vegetables, particularly lettuce and cucumbers appear to be closely involved with the outbreak of the infection in Germany. At the present time there are no food associated links with the infection in the UK. There have been cases reported in the UK and to my knowledge these have all been linked with recent travel to Germany, although this situation may change over time.</div><div class="MsoNormal">The spread of the infection can essentially be slowed by the use of good hygiene practices in limiting person to person spread. Food hygiene is of equal importance and cleaning of foodstuffs and good hand washing practices are required. This is equally true for salad vegetables and fruit; these items should be washed and cleaned to help remove surface organisms. The peeling and cooking of fruit and vegetables will also help in the removal of potentially pathogenic organisms. An important feature to remember is that good hygiene is of great importance and something as simple as hand washing can break the cycle of infection and so help stop the spread of the organism.</div>Prof Mark Fielderhttp://www.blogger.com/profile/12245402309773464551noreply@blogger.com1tag:blogger.com,1999:blog-8489821596559606436.post-33299203134686100822011-02-17T17:25:00.000+00:002011-02-17T17:25:09.500+00:00Scientists talking to the media!Look at this fantastic blog entry on the Birmingham Skeptics by S<i>f</i>AMs Dr Lucy Harper (http://brumskeptics.blogspot.com/2011/02/scientists-need-to-talk.html or <!--[if gte mso 9]><xml> <w:WordDocument> <w:View>Normal</w:View> <w:Zoom>0</w:Zoom> <w:TrackMoves/> <w:TrackFormatting/> <w:PunctuationKerning/> <w:ValidateAgainstSchemas/> <w:SaveIfXMLInvalid>false</w:SaveIfXMLInvalid> <w:IgnoreMixedContent>false</w:IgnoreMixedContent> <w:AlwaysShowPlaceholderText>false</w:AlwaysShowPlaceholderText> <w:DoNotPromoteQF/> <w:LidThemeOther>EN-GB</w:LidThemeOther> <w:LidThemeAsian>X-NONE</w:LidThemeAsian> <w:LidThemeComplexScript>X-NONE</w:LidThemeComplexScript> <w:Compatibility> <w:BreakWrappedTables/> <w:SnapToGridInCell/> <w:WrapTextWithPunct/> <w:UseAsianBreakRules/> <w:DontGrowAutofit/> <w:SplitPgBreakAndParaMark/> <w:DontVertAlignCellWithSp/> <w:DontBreakConstrainedForcedTables/> <w:DontVertAlignInTxbx/> <w:Word11KerningPairs/> <w:CachedColBalance/> </w:Compatibility> <w:BrowserLevel>MicrosoftInternetExplorer4</w:BrowserLevel> <m:mathPr> <m:mathFont m:val="Cambria Math"/> <m:brkBin m:val="before"/> <m:brkBinSub m:val="--"/> <m:smallFrac m:val="off"/> <m:dispDef/> <m:lMargin m:val="0"/> <m:rMargin m:val="0"/> <m:defJc m:val="centerGroup"/> <m:wrapIndent m:val="1440"/> <m:intLim m:val="subSup"/> <m:naryLim m:val="undOvr"/> </m:mathPr></w:WordDocument> </xml><![endif]--><!--[if gte mso 9]><xml> <w:LatentStyles DefLockedState="false" DefUnhideWhenUsed="true"
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</style> <![endif]--><span lang="EN" style="font-family: "Calibri","sans-serif"; font-size: 11pt;"><a href="http://bit.ly/ereg1z" target="_blank" title="http://brumskeptics.blogspot.com/2011/02/scientists-need-to-talk.html/">http://bit.ly/ereg1z</a></span>), its fantastic have a look see!Prof Mark Fielderhttp://www.blogger.com/profile/12245402309773464551noreply@blogger.com0tag:blogger.com,1999:blog-8489821596559606436.post-80137125638106946812010-11-10T12:30:00.003+00:002011-02-17T17:37:11.601+00:00Communicating microbiology to non specialist audiencesGot this from a Tweet by Cesar Sanchez (@TwistedBacteria), really good article by the excellent Bernard Dixon, perhaps we should all take note!<br />
<br />
<a href="http://www.microbemagazine.org/index.php/10-2010-animalcules-and-forum">http://www.microbemagazine.org/index.php/11-2010-animalcules-and-forum</a><br />
<br />
Hmm this link seems to be broken, works if you type it into the URL bar - strange!!<br />
<br />
Try the magazine home page and navigate from there - sorry....Prof Mark Fielderhttp://www.blogger.com/profile/12245402309773464551noreply@blogger.com0tag:blogger.com,1999:blog-8489821596559606436.post-51607177480663317222010-11-10T12:18:00.000+00:002010-11-10T12:18:37.384+00:00Anthrax Heroin – it is still here.<div style="font-family: Arial,Helvetica,sans-serif;"><!--[if gte mso 9]><xml> <w:WordDocument> <w:View>Normal</w:View> <w:Zoom>0</w:Zoom> <w:TrackMoves/> <w:TrackFormatting/> <w:PunctuationKerning/> <w:ValidateAgainstSchemas/> <w:SaveIfXMLInvalid>false</w:SaveIfXMLInvalid> <w:IgnoreMixedContent>false</w:IgnoreMixedContent> <w:AlwaysShowPlaceholderText>false</w:AlwaysShowPlaceholderText> <w:DoNotPromoteQF/> <w:LidThemeOther>EN-GB</w:LidThemeOther> <w:LidThemeAsian>X-NONE</w:LidThemeAsian> <w:LidThemeComplexScript>X-NONE</w:LidThemeComplexScript> <w:Compatibility> <w:BreakWrappedTables/> <w:SnapToGridInCell/> <w:WrapTextWithPunct/> <w:UseAsianBreakRules/> <w:DontGrowAutofit/> <w:SplitPgBreakAndParaMark/> <w:DontVertAlignCellWithSp/> <w:DontBreakConstrainedForcedTables/> <w:DontVertAlignInTxbx/> <w:Word11KerningPairs/> <w:CachedColBalance/> </w:Compatibility> <w:BrowserLevel>MicrosoftInternetExplorer4</w:BrowserLevel> <m:mathPr> <m:mathFont m:val="Cambria Math"/> <m:brkBin m:val="before"/> <m:brkBinSub m:val="--"/> <m:smallFrac m:val="off"/> <m:dispDef/> <m:lMargin m:val="0"/> <m:rMargin m:val="0"/> <m:defJc m:val="centerGroup"/> <m:wrapIndent m:val="1440"/> <m:intLim m:val="subSup"/> <m:naryLim m:val="undOvr"/> </m:mathPr></w:WordDocument> </xml><![endif]--><!--[if gte mso 9]><xml> <w:LatentStyles DefLockedState="false" DefUnhideWhenUsed="true"
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</style> <![endif]--> </div><div class="MsoNormal" style="font-family: Arial,Helvetica,sans-serif; line-height: normal;"><span style="font-size: 12pt;"></span></div><div class="MsoNormal" style="font-family: Arial,Helvetica,sans-serif; line-height: normal;"><span style="font-size: 12pt;">Following reports from Scotland in January and May 2010 about the presence of <i>Bacillus anthracis</i>, the causative agent of anthrax in Heroin, the BBC website reports the death of a drug user in Kent. According to the Health Protection Agency this represents the fifth case of a person becoming ill via this route. The case was described as ‘sad’ by Dr Mathi Chandrakumar from the Kent Health Protection Unit, who added that the risk of person to person spread of this disease, in this particular circumstance was extremely unlikely. Infection with Anthrax is now recognised as one of a number of risks facing intravenous drug users.</span></div><div class="MsoNormal" style="font-family: Arial,Helvetica,sans-serif; line-height: normal;"><span style="font-size: 12pt;">Importantly those at risk are advised that people should be vigilant for the symptoms of Anthrax infection. These include swelling and redness around the injection site, general feeling of being unwell such as a raised temperature, chills or a severe headache and breathing difficulties. On a positive note if identified early the infection can often be treated successfully with antibiotics, this can be life saving – but early recognition is the key.</span></div><div class="MsoNormal" style="font-family: Arial,Helvetica,sans-serif; line-height: normal;"><span style="font-size: 12pt;">I would completely agree with this assessment. The route of infection in these cases is clear and based around a very specific action. It is completely different to the situation experienced by people who are involved with the processing of hides. In the case of an intravenous drug user, where the heroin appears to be contaminated, the organism is likely to be introduced directly into the bloodstream where vegetative organisms can grow and spores germinate.</span></div><div class="MsoNormal" style="font-family: Arial,Helvetica,sans-serif; line-height: normal;"><span style="font-size: 12pt;">More can be read on the BBC Website (<a href="http://www.bbc.co.uk/news/uk-england-kent-11685984">http://www.bbc.co.uk/news/uk-england-kent-11685984</a>) and the health protection agency website (<a href="http://www.hpa.org.uk/ProductsServices/LocalServices/SouthEast/SouthEastPressReleases/Kent/seast101103anthraxupdate/">http://www.hpa.org.uk/ProductsServices/LocalServices/SouthEast/SouthEastPressReleases/Kent/seast101103anthraxupdate/</a>)</span></div>Prof Mark Fielderhttp://www.blogger.com/profile/12245402309773464551noreply@blogger.com0tag:blogger.com,1999:blog-8489821596559606436.post-78469236977354891232010-11-10T11:52:00.001+00:002010-11-10T11:53:20.198+00:00Cholera is not respecting national boundaries!<div class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt;"><span style="font-family: "Arial","sans-serif"; font-size: 10pt;">According to the ProMed Mail site, first reports of suspected cases of cholera are appearing in the Dominican Republic. Reports indicate that a 43 year old man in the Dominican Republic is being treated in Barahona University hospital. The patient is thought to be a business man who has recently returned from Haiti and he represents the third suspected case, if confirmed, in the Dominican Republic. </span></div><div class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt;"><span style="font-family: "Arial","sans-serif"; font-size: 10pt;">The situation continues to develop.</span></div><div class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt;"><br />
</div><div class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt;"><span style="font-family: "Arial","sans-serif"; font-size: 10pt;">(</span><a href="http://www.promedmail.org/pls/apex/f?p=2400:1001:2214615575705944::NO::F2400_P1001_BACK_PAGE,F2400_P1001_PUB_MAIL_ID:1000,85752">http://www.promedmail.org/pls/apex/f?p=2400:1001:2214615575705944::NO::F2400_P1001_BACK_PAGE,F2400_P1001_PUB_MAIL_ID:1000,85752</a><span style="font-family: "Arial","sans-serif"; font-size: 10pt;">) </span></div>Prof Mark Fielderhttp://www.blogger.com/profile/12245402309773464551noreply@blogger.com0tag:blogger.com,1999:blog-8489821596559606436.post-55855018565212414152010-11-09T16:56:00.002+00:002010-11-09T16:56:35.906+00:00Has Cholera reached Port au Prince?<!--[if gte mso 9]><xml> <w:WordDocument> <w:View>Normal</w:View> <w:Zoom>0</w:Zoom> <w:TrackMoves/> <w:TrackFormatting/> <w:PunctuationKerning/> <w:ValidateAgainstSchemas/> <w:SaveIfXMLInvalid>false</w:SaveIfXMLInvalid> <w:IgnoreMixedContent>false</w:IgnoreMixedContent> <w:AlwaysShowPlaceholderText>false</w:AlwaysShowPlaceholderText> <w:DoNotPromoteQF/> <w:LidThemeOther>EN-GB</w:LidThemeOther> <w:LidThemeAsian>X-NONE</w:LidThemeAsian> <w:LidThemeComplexScript>X-NONE</w:LidThemeComplexScript> <w:Compatibility> <w:BreakWrappedTables/> <w:SnapToGridInCell/> <w:WrapTextWithPunct/> <w:UseAsianBreakRules/> <w:DontGrowAutofit/> <w:SplitPgBreakAndParaMark/> <w:DontVertAlignCellWithSp/> <w:DontBreakConstrainedForcedTables/> <w:DontVertAlignInTxbx/> <w:Word11KerningPairs/> <w:CachedColBalance/> </w:Compatibility> <w:BrowserLevel>MicrosoftInternetExplorer4</w:BrowserLevel> <m:mathPr> <m:mathFont m:val="Cambria Math"/> <m:brkBin m:val="before"/> <m:brkBinSub m:val="--"/> <m:smallFrac m:val="off"/> <m:dispDef/> <m:lMargin m:val="0"/> <m:rMargin m:val="0"/> <m:defJc m:val="centerGroup"/> <m:wrapIndent m:val="1440"/> <m:intLim m:val="subSup"/> <m:naryLim m:val="undOvr"/> </m:mathPr></w:WordDocument> </xml><![endif]--><!--[if gte mso 9]><xml> <w:LatentStyles DefLockedState="false" DefUnhideWhenUsed="true"
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<div class="MsoNormal" style="line-height: normal;"><span style="font-family: "Arial","sans-serif"; font-size: 12pt;">It would appear that cholera has reached the Haitian capital of Port au Prince. It has been reported on the Sky News website and via Reuters that the first isolated cases have been seen in the city. It is reported that a young child of 3 years has the disease and that he had not left the city for the past year. It is reported that he is currently being treated in hospital for dehydration, vomiting and diarrhoea. </span></div><div class="MsoNormal" style="line-height: normal;"><span style="font-family: "Arial","sans-serif"; font-size: 12pt;">Suggestions are currently that Hurricane Tomas may have contributed to the appearance o0f the disease in the capital due to the increased flow of the Artibonite river which burst its banks at the weekend. This is one of the suspected sources of the infection. The fear voiced by Health Authorities is that the disease could now infiltrate the various camps inside the capital. A further 100 suspected cases of cholera in city residents are currently being investigated.</span></div>Prof Mark Fielderhttp://www.blogger.com/profile/12245402309773464551noreply@blogger.com0tag:blogger.com,1999:blog-8489821596559606436.post-84618365505977913652010-11-08T16:26:00.002+00:002010-11-09T17:10:15.318+00:00Latest Shooting Up report has an HIV focus and is published on the HPA Website.<div style="font-family: Arial,Helvetica,sans-serif;"><br />
</div><div class="MsoNormal" style="font-family: Arial,Helvetica,sans-serif; line-height: normal;"><b><span style="font-size: 12pt;"></span></b><span style="font-size: 12pt;"></span></div><div class="MsoNormal" style="font-family: Arial,Helvetica,sans-serif; line-height: normal;"><span style="font-size: 12pt;">The latest instalment of the annual <i>Shooting up</i> report has been published by the Health protection agency (HPA) and is focussed on HIV infection</span></div><div class="MsoNormal" style="font-family: Arial,Helvetica,sans-serif; line-height: normal;"><span style="font-size: 12pt;">The report starts with a timely reminder of the list of bacteria and viruses that are particularly important when considering intravenous drug abusers (IVDA), these include, <i>Clostridium botulinum</i>, Grp A streptococci and potentially community acquired MRSA as well as viral agents such as HIV and Hepatitis C. </span></div><div class="MsoNormal" style="font-family: Arial,Helvetica,sans-serif; line-height: normal; margin-bottom: 0.0001pt;"><span style="font-size: 12pt;">The report states that the prevalence of HIV amongst IVDU is quite low with rates of 4.1% in London and 0.6% in Scotland and are at a level 1.5% across the UK. It was also noted HIV prevalence in IVDU has increase from 0.7 to 1.5% in the last decade returning to levels seen in the early 1990s. On a personal note I wonder if we have lost the momentum in getting the message across to the public at large?</span></div><div class="MsoNormal" style="font-family: Arial,Helvetica,sans-serif; line-height: normal; margin-bottom: 0.0001pt;"><br />
</div><div class="MsoNormal" style="font-family: Arial,Helvetica,sans-serif; line-height: normal; margin-bottom: 0.0001pt;"><span style="font-size: 12pt;">Returning to the report there has been an increase in the uptake of HIV testing with up to three quarters of IVDUs report having had a test and about a third of IVDU patients still not aware of their status. A large proportion of HIV positive IVDU patients are involved with specialist treatment services.</span></div><div class="MsoNormal" style="font-family: Arial,Helvetica,sans-serif; line-height: normal; margin-bottom: 0.0001pt;"><br />
</div><div class="MsoNormal" style="font-family: Arial,Helvetica,sans-serif; line-height: normal; margin-bottom: 0.0001pt;"><span style="font-size: 12pt;">A number of IVDU patients report being infected with Hepatitis C (numbers equated to about a half of patients), whereas around a sixth presented with Hepatitis B infection. Bacterial infections such as sores or abscess were reported in approximately one patient in three. On a more positive note needle and syringe sharing appears to have generally fallen but still almost one in five patients reported the sharing of either syringes or needles.</span></div><div class="MsoNormal" style="font-family: Arial,Helvetica,sans-serif; line-height: normal; margin-bottom: 0.0001pt;"><span style="font-size: 12pt;"> </span></div><div class="MsoNormal" style="font-family: Arial,Helvetica,sans-serif; line-height: normal; margin-bottom: 0.0001pt;"><span style="font-size: 12pt;">One thing the report highlights is a continued need for education and investigation into sharing of needles and paraphernalia that increases the risk of the patient to potentially serious infections that may well be life threatening. We need to maintain and develop surveillance to inform decisions that feed into UK policy making.</span></div><div class="MsoNormal" style="font-family: Arial,Helvetica,sans-serif; line-height: normal; margin-bottom: 0.0001pt;"><br />
</div><div class="MsoNormal" style="font-family: Arial,Helvetica,sans-serif; line-height: normal; margin-bottom: 0.0001pt;"><span style="font-size: 12pt;">More detail can be seen on the HPA Website (<a href="http://www.hpa.org.uk/hpr/archives/2010/news4410.htm#idus09">http://www.hpa.org.uk/hpr/archives/2010/news4410.htm#idus09</a>) </span></div>Prof Mark Fielderhttp://www.blogger.com/profile/12245402309773464551noreply@blogger.com0tag:blogger.com,1999:blog-8489821596559606436.post-36594371179666312952010-11-08T08:30:00.003+00:002010-11-09T17:09:45.690+00:00The Changing situation in Haiti.<div class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt;"><span style="font-family: "Arial","sans-serif"; font-size: 12pt;">It is reported on ProMed Mail this week that the death toll in Haiti, associated with cholera has risen to 442 cases, with 105 new cases being reported since the 30<sup>th</sup> October. This represents a 40% increase in new cases. The health authority in Haiti reports a further 1978 people were admitted to hospital which gives a total number of cases at <i>circa</i> 6742.</span></div><div class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt;"><br />
</div><div class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt;"><span style="font-family: "Arial","sans-serif"; font-size: 12pt;">To use a direct quote from the ProMed Mail website: “The WHO warned last week that the outbreak is far from over and Haiti should prepare for the "worst-case scenario", cholera in the capital.”</span></div><div class="MsoNormal" style="line-height: normal; margin-bottom: 0.0001pt;"><span style="font-family: "Arial","sans-serif"; font-size: 12pt;">(<a href="http://www.promedmail.org/pls/apex/f?p=2400:1001:3112371949607186::NO::F2400_P1001_BACK_PAGE,F2400_P1001_PUB_MAIL_ID:1000,85637">http://www.promedmail.org/pls/apex/f?p=2400:1001:3112371949607186::NO::F2400_P1001_BACK_PAGE,F2400_P1001_PUB_MAIL_ID:1000,85637</a>)</span></div>Prof Mark Fielderhttp://www.blogger.com/profile/12245402309773464551noreply@blogger.com0tag:blogger.com,1999:blog-8489821596559606436.post-6000938960814362862010-11-06T08:38:00.001+00:002010-11-09T17:09:05.486+00:00A Fantastic Meeting to attend in January 2011 with the Society for Applied Microbiology.<div style="font-family: Arial,Helvetica,sans-serif;"><b>Wednesday 12 January.</b><br />
<b> Royal Society, Carlton House Terrace, London</b><br />
<b>Tea, coffee and registration</b> <b> </b><br />
<b>Chair: Geoff Hanlon</b><br />
<b>10.30-11.15 The Denver Russell Memorial Lecture. <i>Propionibacterium acnes</i>: an emerging pathogen </b>Peter Lambert, Aston University.<br />
<br />
<b>11.15-11.50 The gut flora and probiotics </b>George McFarlane, University of Dundee <b>11.50-12.25 An overview of the past 40 years in anaerobic microbiology</b> <br />
Mike Wren, UCH <b> </b><br />
<br />
<b>12.25-13.30 Lunch</b> </div><div class="bodytextwithpad" style="font-family: Arial,Helvetica,sans-serif;"><br />
<b>Session A: Probiotics</b></div><b style="font-family: Arial,Helvetica,sans-serif;">Chair: Martin Adams</b><span style="font-family: Arial,Helvetica,sans-serif;"> </span><b style="font-family: Arial,Helvetica,sans-serif;"> </b><br />
<b style="font-family: Arial,Helvetica,sans-serif;">13.30 -14.05 Probiotics and the elderly</b><span style="font-family: Arial,Helvetica,sans-serif;"> Ian Rowland, University of Reading </span><br />
<b style="font-family: Arial,Helvetica,sans-serif;">14.05- 14.40 Prebiotics </b><span style="font-family: Arial,Helvetica,sans-serif;">Bob Rastall, University of Reading </span><b style="font-family: Arial,Helvetica,sans-serif;"> </b><br />
<br />
<b style="font-family: Arial,Helvetica,sans-serif;">14.40-15.00 Tea and coffee </b><br />
<br />
<b style="font-family: Arial,Helvetica,sans-serif;">15.00-15.35 Probiotics. prebiotics and neonates</b><span style="font-family: Arial,Helvetica,sans-serif;"> Christine Edwards, University of Glasgow </span><br />
<b style="font-family: Arial,Helvetica,sans-serif;">15.35-16.10 Veterinary use of probiotics</b><span style="font-family: Arial,Helvetica,sans-serif;"> Roberto La Ragione, VLA </span><b style="font-family: Arial,Helvetica,sans-serif;"> </b><br />
<b style="font-family: Arial,Helvetica,sans-serif;">16.10-16.45 Safety of probiotics </b><span style="font-family: Arial,Helvetica,sans-serif;">Kevin Whelan, King's College London </span><br />
<div class="bodytextwithpad" style="font-family: Arial,Helvetica,sans-serif;"><br />
<b>Session B: Anaerobic microbiology</b></div><b style="font-family: Arial,Helvetica,sans-serif;">Chair: Mark Fielder</b><span style="font-family: Arial,Helvetica,sans-serif;"> </span><br />
<b style="font-family: Arial,Helvetica,sans-serif;">13.30-14.05 State of the art regarding clostridia</b> <span style="font-family: Arial,Helvetica,sans-serif;">Ian Poxton, University of Edinburgh </span><b style="font-family: Arial,Helvetica,sans-serif;">14.05-14.40 The exploitation of beneficial anaerobic microorganisms</b> <span style="font-family: Arial,Helvetica,sans-serif;">Nigel Minton, University of Nottingham </span><b style="font-family: Arial,Helvetica,sans-serif;"> </b><br />
<br />
<b style="font-family: Arial,Helvetica,sans-serif;">14.40-15.00 Tea and coffee</b><span style="font-family: Arial,Helvetica,sans-serif;"> </span><b style="font-family: Arial,Helvetica,sans-serif;"> </b><br />
<br />
<b style="font-family: Arial,Helvetica,sans-serif;">15.00-15.35 Anaerobes in compex polymicrobial diseases</b> <span style="font-family: Arial,Helvetica,sans-serif;">M. J. Woodward, Veterinary Laboratories Agency </span><b style="font-family: Arial,Helvetica,sans-serif;"> </b><br />
<b style="font-family: Arial,Helvetica,sans-serif;">15.35-16.10 An overview of identification of anaerobes, including latest developments </b><br />
<span style="font-family: Arial,Helvetica,sans-serif;"> Val Hall, Anaerobe Reference Laboratory, NPHS Microbiology Cardiff </span><br />
<span style="font-family: Arial,Helvetica,sans-serif;"> </span><b style="font-family: Arial,Helvetica,sans-serif;">16.10-16.45 Oral anaerobes:</b> <span style="font-family: Arial,Helvetica,sans-serif;">Peter Mullany, Eastman Dental Institute</span><br />
<br />
<span style="font-family: Arial,Helvetica,sans-serif;"> </span><b style="font-family: Arial,Helvetica,sans-serif;">Event organiser's contact details: Society for Applied Microbiology (<a href="http://www.sfam.org.uk/">www.sfam.org.uk</a>)</b><br />
<b style="font-family: Arial,Helvetica,sans-serif;">Tel: <span class="skype_pnh_print_container">+44 (0)1234 761752</span><span class="skype_pnh_container" dir="ltr"><span class="skype_pnh_mark"> </span><span class="skype_pnh_highlighting_inactive_common" dir="ltr" title="Call this phone number in United Kingdom with Skype: +441234761752"><span class="skype_pnh_dropart_span" title="Skype actions"> </span><span class="skype_pnh_textarea_span"><span class="skype_pnh_text_span"> +44 (0)1234 761752</span></span><span class="skype_pnh_right_span"> </span></span> </span> </b><br />
<b style="font-family: Arial,Helvetica,sans-serif;">Fax: +44 (0)1234 328330 </b><br />
<b style="font-family: Arial,Helvetica,sans-serif;">Email: <a href="mailto:meetings@sfam.org.uk">meetings@sfam.org.uk</a></b>Prof Mark Fielderhttp://www.blogger.com/profile/12245402309773464551noreply@blogger.com0tag:blogger.com,1999:blog-8489821596559606436.post-48409270251702395892010-11-06T08:30:00.000+00:002010-11-06T08:30:34.608+00:00Rates of TB highest for 30 years.<!--[if gte mso 9]><xml> <w:WordDocument> <w:View>Normal</w:View> <w:Zoom>0</w:Zoom> <w:TrackMoves/> <w:TrackFormatting/> <w:PunctuationKerning/> <w:ValidateAgainstSchemas/> <w:SaveIfXMLInvalid>false</w:SaveIfXMLInvalid> <w:IgnoreMixedContent>false</w:IgnoreMixedContent> <w:AlwaysShowPlaceholderText>false</w:AlwaysShowPlaceholderText> <w:DoNotPromoteQF/> <w:LidThemeOther>EN-GB</w:LidThemeOther> <w:LidThemeAsian>X-NONE</w:LidThemeAsian> <w:LidThemeComplexScript>X-NONE</w:LidThemeComplexScript> <w:Compatibility> <w:BreakWrappedTables/> <w:SnapToGridInCell/> <w:WrapTextWithPunct/> <w:UseAsianBreakRules/> <w:DontGrowAutofit/> <w:SplitPgBreakAndParaMark/> <w:DontVertAlignCellWithSp/> <w:DontBreakConstrainedForcedTables/> <w:DontVertAlignInTxbx/> <w:Word11KerningPairs/> <w:CachedColBalance/> </w:Compatibility> <w:BrowserLevel>MicrosoftInternetExplorer4</w:BrowserLevel> <m:mathPr> <m:mathFont m:val="Cambria Math"/> <m:brkBin m:val="before"/> <m:brkBinSub m:val="--"/> <m:smallFrac m:val="off"/> <m:dispDef/> <m:lMargin m:val="0"/> <m:rMargin m:val="0"/> <m:defJc m:val="centerGroup"/> <m:wrapIndent m:val="1440"/> <m:intLim m:val="subSup"/> <m:naryLim m:val="undOvr"/> </m:mathPr></w:WordDocument> </xml><![endif]--><!--[if gte mso 9]><xml> <w:LatentStyles DefLockedState="false" DefUnhideWhenUsed="true"
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</div><div class="MsoNormal" style="font-family: Arial,Helvetica,sans-serif;">According to the Health Protection Agency (HPA) in the UK there were 9040 news cases of Tuberculosis infection in 2009 which the highest figure since 9266 cases were reported in England and Wales in 1979, they also report that multi-resistant cases, resistant to the first line drug treatment has doubled. Figures from the HPA show that there were around 206 in 2000 and now show circa 390 cases in 2009, it is revealed that within these figures strains resistant to multiple antibiotics (MDR cases, multiple drug resistance) is still low at 1.2% but has risen over the last decade. What we have also seen is a rise of multidrug resistant cases from 28 in 2000 to 56 in 2009. </div><div class="MsoNormal" style="font-family: Arial,Helvetica,sans-serif;"><br />
</div><div class="MsoNormal" style="font-family: Arial,Helvetica,sans-serif;">One of the problems with TB infection is that the symptoms can often take sometime to manifest in the patient. Once identified treatment can also take some time. It is likely that infection will be treated for around six months and often with two or three drugs simultaneously. The MDR cases may take even longer to respond and be treated for around eighteen months or longer and the treatment can be complicated.</div><div class="MsoNormal" style="font-family: Arial,Helvetica,sans-serif;"><br />
</div><div class="MsoNormal" style="font-family: Arial,Helvetica,sans-serif;">It is worth noting that if TB is caught early it is treatable and we need to remain vigilant for cases and the potential sources of the infection remembering that some of the groups that need helps and should be monitored are perhaps in so called hard to reach populations</div><div class="MsoNormal" style="font-family: Arial,Helvetica,sans-serif;"><br />
</div><div class="MsoNormal" style="font-family: Arial,Helvetica,sans-serif;">I agree with and echo the word of Dr Paul Cosford from the HPA as reported on the Reuters website from where I took the following quote</div><div class="MsoNormal" style="font-family: Arial,Helvetica,sans-serif;">“TB is sadly not a disease of the past and the figures today serve as an important reality check," </div>Prof Mark Fielderhttp://www.blogger.com/profile/12245402309773464551noreply@blogger.com0tag:blogger.com,1999:blog-8489821596559606436.post-35557661883523509742010-11-06T08:02:00.001+00:002010-11-06T08:40:20.854+00:00Influenza H1H1 Swine Flu shows activity.The influenza A H1N1 virus has claimed a vicitm at the begining of the new 'flu season'. A eight year old ochid in Lurgan Nothern Ireland has, sadly, succumbed to the virus and this was reported in the last week. The child was apparently at a school for children with severe learning disabilities.A spokesperson from the Health Protection Agency said that the death was reminder of the fact that flu infections can causes very severe complications in those patients with underlying health conditions and that vaccinations against flu are strongly reccomended for vulnerable people of all ages.<br />
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The annual flu vaccination covers a range of the most likely flu variants that are predicted to be circulating and following the pandemic of 2009 the H1N1 swine flu strain is covered by this years annual vaccine. As the spokesperson from the PHA sayas, as reported by the BBC website, "We would advise all those who are eligible for flu immunisation to make sure they get it as soon as possible." I totally agree!<br />
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The re-emergence of Influenza A H1N1 is not a surprise and follows the expect natural cycle of flu infection, how many more cases we will see and how many will result in fatalities is quite difficult to accurately predict, but rest assured the Department of Health are watching and monitoring.<br />
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Another case was also reported in NI last week but this case was in an adult male and not linked to the fatal case.Prof Mark Fielderhttp://www.blogger.com/profile/12245402309773464551noreply@blogger.com0tag:blogger.com,1999:blog-8489821596559606436.post-30176299572529566592010-11-02T13:35:00.001+00:002010-11-09T17:04:07.020+00:00TRIM21 a molecule with real application potential!<div style="font-family: Arial,Helvetica,sans-serif;"></div><div class="MsoNormal" style="font-family: Arial,Helvetica,sans-serif;">Some really interesting research has been recently published examining how the immune system can interact with host cells. It was previously thought that antibodies could not enter cells and attack intracellular parasites such as viruses, however research published today indicates the contrary! Fantastic! Work published by the MRC group in Cambridge shows that antibodies are indeed able to move into cells and ‘tackle’ viruses that have already infected the host. It is thought that the antibody is internalised with the virus and the presence of this antibody triggers a response. Whilst this process will not work on all viral infections it certainly changes and enhances our previous knowledge greatly. Whilst at a relatively early stage the work does offer some promise for treatment of some viral infections in the future.</div><div class="MsoNormal" style="font-family: Arial,Helvetica,sans-serif;"><br />
</div><div class="MsoNormal" style="font-family: Arial,Helvetica,sans-serif;">The work centres around the TRIM21 protein, it appears that once the antibody has entered the cell a response is initiated mediated by TRIM21 which effectively routes the viral particle into a pathway designed to remove and destroy unwanted material. It is thought that this process happens fairly rapidly and may well have an effect before the viral agent has had an opportunity to have much of a pathogenic effect. Excitingly, it appears that increasing the concentration of TRIM21 increases the efficacy of the process, and this is what might have great potential in terms of treatment. We already have a number of antibacterial agents but surprisingly few anti-virals, an opinion also held by one of the researchers at the MRC in Cambridge, Dr Leo James.</div><div class="MsoNormal" style="font-family: Arial,Helvetica,sans-serif;"><br />
</div><div class="MsoNormal" style="font-family: Arial,Helvetica,sans-serif;">It is worth remembering that there are a great number of people killed by viral infections every year, estimates suggest that there are almost twice as many deaths than those attributed to cancer. As if to affirm that fact they remain the most difficult of infections to treat.</div><div class="MsoNormal" style="font-family: Arial,Helvetica,sans-serif;"><br />
</div><div class="MsoNormal" style="font-family: Arial,Helvetica,sans-serif;">A timely and promising story further affirming the chant that Science is vital! (<a href="http://scienceisvital.org.uk/">http://scienceisvital.org.uk/</a>)</div>Prof Mark Fielderhttp://www.blogger.com/profile/12245402309773464551noreply@blogger.com0