Inside Diagnostics - Fall 2014 (EN) by nal von minden GmbH

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Inside Diagnostics Autumn 2014

SNAIL FEVER BATH SALTS

A hidden killer

Intoxication at the click of a mouse

MALARIA KILLS Serious yet preventable :

In this issue

P R I Z E D R AW

e 10 More on pag

Rapid Tests Laboratory Diagnostics Laboratory Service Consulting & Service

Inside Diagnostics

Forword

Dear readers, The summer is already over but in this new issue we will be focusing on travel. Our trip begins with a journey to the tropics to learn about Malaria. We will cover in detail the important information like symptoms, global spread, diagnosis, treatment and future malaria research. Next up is a trip to West Africa where we will focus on the need for rapid diagnosis to combat the Ebola virus that is causing widespread devastation across the region. We will discuss how rapid diagnosis in this outbreak is essential in a region where many countries lack local laboratories with the capability to diagnose Ebola infections. We will then stay in Africa as we talk about Bilharzia, also known as Ě?snail feverĚ?, a disease which infects milli-

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ons of people through fresh water sources in Africa and areas of South Asia and South America. Our final stop on this global journey is in China where we will examine the relationship between an increase in diabetes and the ever-expanding economy. Finally, I wish to make you aware that we can now provide you with tests to diagnose almost all of the topics we are covering. So please feel free to contact us if you are interested in finding out more. I hope you will enjoy reading this exotic issue.

With warm regards, Nicolas Kennof

Click here and subscribe in one easy step! Executive editor: Inside Diagnostics Nicolas Kennof Tel.: 0941 29010-36 inside-diagnostics@nal-vonminden.com

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Inside Diagnostics

Contents Themes Malaria �� 4 Snail fever �� 8 Strep B �� 12 Ebola �� 13 Diabetes in China �� 14 Bath Salts �� 15 Pimp my brain �� 16 nvm Inside Prize Draw ��10 Medica 2014 ��18 Short News ��19 Contact/Medical Man ��20 MALARIA | Page 4

Malaria, also known as swamp fever or tertian Malaria, is a potentially fatal epidemic disease caused by Plasmodium protozoa. The female Anopheles mosquito is responsible for the transmission of the disease among the populatio. Article on page 4.

Flag Inside Diagnostics nal von minden GmbH Customer Magazine Contact: nal von minden GmbH Nicolas Kennof Friedenstraße 32 93053 Regensburg Chief Editor: Nicolas Kennof Editors: Torsten Winkler, Kristina Sambs, Raffaela Seiband, Christopher Beiderbeck, Anne Kaiser, Andrea Kreuzer, Jacob James, Martina Kastenmaier, Jodie Baker, Alexandre Lages, Miguel Estevez, Lukas Eder, Katharina Anna Haney inside-diagnostics@nal-vonminden.com Layout: Martina Kastenmaier, Kasia Orlowska

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Tropical Medicine Malaria

Malaria kills Serious yet preventable! (AMI, 2014) Malaria, also known as swamp fever or tertian Malaria, is a potentially fatal epidemic disease caused by Plasmodium protozoa. The female Anopheles mosquito is responsible for the transmission of the disease among populations, causing around 200 to 500 million cases of Malaria each year. Malaria is responsible for a high number of deaths - which, although difficult to accurately calculate, is estimated to be between 1 and 3 million per annum. There are five species of pathogens that can cause Malaria in humans: • Plasmodium falciparum – Malaria tropica is known to be the most dangerous species for humans, with a poor prognosis and high rate of complications and mortality if left untreated. However, it has an excellent prognosis if diagnosed early and treated adequately. It is responsible for the majority of infections in Africa. • Plasmodium vivax and Plasmodium ovale – Both pathogens cause Malaria Tertian and are responsible for producing hypnozoites. The disease caused by P. vivax is the most common and also has a high mortality rate. P. ovale is generally less hostile and rarely fatal. • Plasmodium malariae – This pathogen caused Malaria Quantan the infection by this Plasmodium species is the least severe and very rarely fatal, but can cause a chronic disease with recurrent infections for many years if untreated. • Plasmodium knowlesi – Plasmodium knowlesi is closely related to Plasmodium vivax. It causes Malaria in primates, but can also cause serious infections in humans.

The main clinical symptoms include: • Headache (noted in virtually all patients with Malaria) • Paroxysm of fever (40 – 41⁰C), shaking chills, sweats and yellowish skin • Cough • No appetite • Fatigue • Arthralgia • Malaise • Myalgia There are other less common symptoms such as: • Anorexia and lethargy • Diarrhea • Nausea and vomiting • Jaundice Most patients with Malaria have no specific physical changes, but splenomegaly (increased in spleen volume) may be present. Severe Malaria is manifested as the following: • Cerebral Malaria (sometimes with coma) • Severe anemia • Respiratory abnormalities, for instance: metabolic acidosis, associated respiratory distress, and pulmonary edema; signs of Malarial hyperpneic syndrome include alar flaring, chest retraction, use of accessory muscles for respiration, and abnormally deep breathing. • Renal failure (typically reversible) Often the acute febrile attacks manifest in patients infected by different types of Malaria in the following intervals:

Signs and Symptoms

Pathogen Type

Regularity (cyclical fever)

Patients infected with Malaria usually become symptomatic some weeks after infection (8 to 25 days), although the incubation period may vary depending on host factors and the causative species. However, symptoms in individual cases may be delayed further.

P. vivax and P. ovale Malaria)

→

The first manifestations of the disease, which are identical in the various forms of malaria, are similar to the symptoms of viral diseases such as influenza, or gastroenteritis.

P. malariae

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Every 48 hours (tertian

P. falciparum → Recurrent fever every 36 - 48 hours (tertian Malaria); or less pronounced fever, continuous and irregular →

Every 72 hours (quartan Malaria)

Tropical Medicine Malaria

Malaria

Main causes of illness and global spread Localised mainly in tropical and sub-tropical regions, Malaria mainly affects South American, African and Asian countries. P. falciparum and P. malariae species are found across the world, whereas P. vivax is uncommon in the African continent. P. ovale is present in Africa and in some areas of Asia and Oceania. Little is known regarding P. knowlesi, although it has been observed in SE Asia. The main factors attributed to the increase and spread of Malaria are: • • • • • • • •

Climate instability Increasing international travel Global warming Insecticide resistance Civil wars Resistance to anti-malarial drugs HIV infection Among others

Diagnosis and criteria for relocation

kills!

• Serological diagnosis, by chromatographic immunoassay for in-vitro diagnosis (rapid tests) or ELISA to detect anti-Malaria antibodies (IgM/IgG) or an antigen of the Plasmodium parasite. • Molecular Diagnosis, by PCR. • Microscopic Diagnosis, by blood smear. The patient history should include information about the following aspects: • • • •

Recent or remote travel to endemic areas. Immune status, age, and pregnancy status. Allergies or other medical conditions. Medication currently being taken.

nal von minden GmbH has efficient rapid tests for the reliable determination of infection by Malaria, allowing the initiation of a more effective treatment. The tests developed in this area play an important role as an aid in the timely detection of the disease. Rapid tests for the diagnosis of Malaria most marketed by nal von minden GmbH are:

Diagnosis It is essential to perform an effective Malaria diagnosis and, nowadays, there are a number of different methods for the diagnosis of the disease, such as:

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Tropical Medicine Malaria

Article Number 472001 → 475030 → 472009 →

Description NADAL® Malaria Test Ag P.f. NADAL® Malaria Test 4 Species NADAL® Malaria Antibody Test

Criteria for Relocation The standard criteria for hospitalisation usually include: • Clinical symptoms compatible with Malaria, but negative Plasmodium result

If positive results are obtained from the rapid tests, we recommend conducting an assessment using ELISA tests for confirmation of results. ELISA tests that nal von minden GmbH provides are: Article Number Eli-6913 → Eli-6128 →

Description LUCIO® Malaria Antibody ELISA LUCIO® Malaria Antibody total ELISA

The following blood studies should be requested: • Blood culture • Platelet count • Liver function • Renal function • Electrolyte concentrations (especially sodium) • Monitoring of parameters suggestive of haemolysis (haptoglobin, lactic dehydrogenase [LDH], reticulocyte count) • In select cases, rapid HIV testing • White blood cell count: less than 5% of Malaria patients have leucocytosis; thus, if leucocytosis is present, the differential diagnosis should be broadened

• If the patient has cerebral Malaria, glucose level to rule out hypoglycaemia

• P. falciparum in the non-immune; deleting complications • Altered state of consciousness, hypoglycaemia, renal failure, respiratory failure • Pregnancy • Concomitant diseases Treatment The first effective treatment for Malaria came from the bark of the cinchona shrub (which can be found on the slopes of the Andes, mainly in Peru), which contains Quinine.

• Haemoglobin concentration

• If the patient is to be treated with primaquine, glucose-6-phosphate dehydrogenase (G6PD) level

• High parasitaemia

There is currently no effective vaccine against Malaria, although there are efforts to develop it. Various drugs for the prevention of Malaria in travellers who travel to countries where the disease is endemic are available. A series of anti-malarial drugs are also available. headache The treatments followed nowadays are mainly with

fever

the following pharmacological therapy:

anorexia dizziness

• Chloroquine, quinine mefloquine, Halofantrine

nausea lethargy

•

Pyrimethamine, sulphonamides

• Artemisinin

fatigue

• Tetracycline, Clindamycin

cough joint pain

muscle pain

symptoms

• Primaquine (hypnozoites eradication) – P. vivax and P. ovale Severe cases are treated with Quinine administered intravenously or intramuscularly. It can also be trea-

jaundice

Diarrhea

AMI - Assistência Médica Internacional (2014). Dia Mundial da Malária: Doença mata uma criança a cada 30 segundos. Gabinete de Imprensa. URL: http://www. ami.org.pt/default.asp?id=p1p211p212p12&l=1 [accessed on 07.04.2014].

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Emilio V. Perez-Jorge and Thomas E. Herchline (2014). Malaria. URL: http://emedicine.medscape.com/article/221134-overview [accessed on 07.04.2014]. Gozze, Amanda Begosso (2012). Epidemiologia da malária de fronteira agrícola: factores associados à infecção e doença em estudo de base populacional na Amazónia rural brasileira. URL: www.teses.usp.br/teses/.../AmandaBegossoGozze_Mestrado_Corr.pdf ‎ accessed on 07.04.2014].

Tropical Medicine Malaria

ted with artesunate, a derivative of artemisinin administered in combination with a second anti-malarial, such as mefloquine, whose efficacy is superior to quinine in both children and adults. However, the parasite has developed resistance to some anti-malarial drugs. In a 2010 randomised study done in 11 African centers, children (age < 15 years) with severe P. falciparum infection (Malaria Tropica) had a lower risk of mortality after treatment with IV artesunate, as compared with IV quinine. Development of comas, seizures, and post-treatment hypoglycaemia were also less common in patients treated with artesunate. When taking a decision about treatment, it is essential to consider the possibility of co-infection with more than one species of Malaria. Reports of P. knowlesi infection indicate that co-infection is common. The four major classes of drugs currently used for the treatment of Malaria include related quinoline, antifolates, artemisinin and antimicrobial compounds. There is not a drug that can eradicate all forms and life cycles of the parasite. Therefore, patients are often simultaneously prescribed one or more classes of drugs to combat the infection by Malaria. The treatment regimens are dependent on the location of the infection, likely Plasmodium species and severity of disease evidenced. Below is a summary of general recommendations for the treatment of Malaria: • P. falciparum – Quinine-based therapy is with quinine (or quinidine) sulfate plus doxycycline or clindamycin or pyrimethamine-sulfadoxine; alternative therapies are artemetherlumefantrine, atovaquone-proguanil, or mefloquine • P. falciparum – Malaria with known chloroquine susceptibility (only a few areas in Central America and the Middle East) – Chloroquine • P. vivax and P. ovale – Chloroquine plus primaquine; however, a 2012 study of Indonesian soldiers demonstrated that primaquine combined with newer nonchloroquine anti-malari-

als killed dormant P. vivax parasites and prevented Malaria relapse; the combination of dihydroartemisinin-piperaquine with primaquine had 98% efficacy against relapse, suggesting that this regimen could become a useful alternative to primaquine plus chloroquine, the clinical utility of which is being threatened by worsening chloroquine resistance. • P. malariae – Chloroquine • P. knowlesi – Recommendations same as those for P. falciparum malaria Research Researchers are still looking for an effective vaccine against Malaria. The first promising studies which demonstrated the potential for the possibility of a vaccine were conducted in 1967 by inoculating mice with live attenuated sporozoites by radiation, which offered significant protection against subsequent injections with normal sporozoites. Since the 1970s there has been considerable effort to develop a similar immunisation strategy in humans. Prevention and recommendations The transmission of the disease can be controlled through the prevention of mosquito bites, by using mosquito nets and insect repellents, or by eradication measures such as the use of insecticides or draining stagnant waters. Individuals traveling to areas where Malaria is endemic should receive accurate information about prevention strategies and anti-protozoa drugs. The links listed below can gather more information about Malaria, trips abroad and insect bites: 1. http://www.emedicinehealth.com/malaria/article_ em.htm 2. http://www.emedicinehealth.com/foreign_travel/article_em.htm 3. http://www.emedicinehealth.com/insect_bites/article_em.htm

AL, ME

PAHO - Pan American Health Organization (2014). Dia Mundial da Malária: „Mantenha o progresso, salve vidas: Invista no Controle da Malária”. URL: http://www.paho.org/bireme/index.php?option=com_content&view=article&id=162%3Adia-da-malaria-nas-americas-qmantenha-o-progresso-salve-vidas-invista-no-controle-da-malariaq&catid=15%3Aops-wdc&Itemid=73&lang=pt [accessed on 07.04.2014].

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Tropical Medicine Snail fever

Snail fever

A hidden killer Schistosomiasis, also known as bilharzia or snail fever, is the second most economically significant parasitic disease in the world. It is caused by Schistosoma worms that infect fresh water snails. The disease is spread through contact with water sources such as rivers and lakes that may be home to a population of infected freshwater snails. Due the fact that many people living in developing countries are exposed to contaminated water regularly, the disease is widespread and it is believed that there are around 240 million people currently infected worldwide, mainly in Africa, Asia and S.America. Whilst fast diagnosis of the disease normally means prompt, problem-free treatment, people who do not have access to effective medical care or those suffering from malnutrition or dehydration, are at major risk of a severe infection which could be potentially fatal. It is estimated anywhere up to 200,000 people per year die from bilharzia. For this reason alone, education strategies, snail control measures and fast diagnosis are vitally important. With a rapid diagnosis, a single dose of Praziquantel is generally all that is required to prevent the disease becoming fatal. Prevention of infection through prophylactic treatment and education on the risks of swimming, bathing and drinking from potential infected water will also help to bring down the total number of infections and fatalities and eventually reduce the economic burden of this infection. Infection Currently there are 5 known Schistosoma parasites that can cause bilharzia. Schistosoma mansoni is present throughout Africa and is often found in the great lakes and rivers of southern and sub-Saharan Africa as well as the Nile valley in Egypt and Sudan. There is also a risk of S. mansoni infection in a few South American countries, namely Brazil, Suriname and Venezuela, and a low risk of infection through certain areas of the Caribbean such as Dominican Republic, Guadeloupe, Martinique and Saint Lucia. S. haematobium has a similar infection area throughout Africa as S. mansoni although it can also be found in the Mahgreb region of North Africa and also in a few areas of the Middle

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East. The other three species are more localised in their infection areas with S. japonicum found in Indonesia and certain parts of China and South East Asia, S. mekongi restricted to Cambodia and Laos and finally S. intercalatum in a few areas of Central and Western Africa. Anybody who is exposed to areas of contaminated freshwater is at risk from infection by Schistosoma parasites. Although Schistosomiasis is not spread directly through swallowing contaminated water, the act of drinking often means that a person’s lips and mouth may come into contact with infected water and therefore drinking contaminated water can also be a route of infection. Prevention and Control Avoidance of swimming or bathing in freshwater found in regions at risk from schistosomiasis is the easiest way to prevent infection. If there is a need to drink or bathe in potentially contaminated water, it should be boiled for at least 1 minute before use. It is important to note that Iodine treatment may not be sufficient to kill all parasites. In the case of accidental contact with a contaminated source, vigorous towel drying has been shown to reduce the risk of infection, however it is not wise to rely on this method to prevent infection and any accidental contact should be brought to the attention of a health care provider for further testing. Progression of Infection Schistosoma parasites are zoonotic and their lifecycle relies on the infection of both freshwater snails and their human host. The infection is spread between water sources through infected human urine or fecal excrement. Once in the water they infect the freshwater snails and complete part of their life cycle before being released again, where they are now ready to re-infect humans. The parasites can survive for around 48hrs outside of a host vector in water. When they come into contact with a human, Schistosoma parasites are capable of penetrating the host’s skin. The infection then progresses over the course of several weeks as the parasite migrates through the host’s body. The life cycle is fairly complex and takes place in various parts of the host’s body with maturation taking place in the blood system of the

Tropical Medicine Snail fever

host. Once matured, the worms are able to mate and produce eggs which are excreted either in the hostâ&#x20AC;&#x2122;s urine or feces. If the infected host defecates or urinates in water sources that are inhabited by freshwater snails, the parasite is able to infect the snails again and complete its lifecycle. Clinical Symptoms The clinical symptoms of Schistosomiasis are not a result of the parasites but rather as a result of the immune response directed towards them. Symptoms take at least a few days to appear and initially result in the development of a rash. If left untreated, symptoms can advance to include fever, chills and muscle aches within a month or two. A lack of access to healthcare may leave the infection completely untreated. This causes what is known as chronic schistosomiasis. Symptoms of chronic schistosomiasis include abdominal pain, an enlarged liver and blood in stool or urine samples. In some rare cases, eggs can become lodged in

certain areas of the body leading to inflammation, scarring, seizures, paralysis or spinal cord damage. Diagnosis Diagnosis of schistosomiasis is fairly straight forward with either a stool or urine sample. Occasionally eggs may be passed into the urine in small amounts and it may be more beneficial to carry out a serological test instead. Rapid point of care urine tests are now available to detect circulating cathodic antigens (CCAs) in samples and can give a diagnosis within 20 minutes. Further in-depth lab analysis may be required for patients with extremely low egg numbers. Treatment In most cases a single dose of Praziquantel is enough to treat an infection. In certain cases a course of Praziquantel over 1-2 days may be required to eliminate infection of all species. Current research is looking into a potential vaccine but as of yet no suitable candidate has been released. JJ

www.fotolia.de ÂŠ volkerladwig

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nvm inside Prize Draw

Join in &

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Dear reader,

Thank you to all those that look part in our competition in the last issue. We congratulate Ms Claudia L from Celle, who sent us this great photo with her prize. This issue, we offer you again the opportunity to win a great prize.

Malaria is transmitt ed through the bit a) a bat e of…

b) a female Anoph eles Mosquito c) from Jiminy Crick et.

Good luck!

Participate under the following link: http://goo.gl/Qru V82 Or send an E-Mail to: gewinnspiel@nal-v onminden.com

Your Inside Diagnostics team The prize is a green CREATIVE D100 Docking Station... • Wireless audio transmission to compatible Bluetooth devices (mobile phones, netbooks and other mobile Bluetooth devices) and convenient music control • Powered by 4 AA batteries for true mobility • The two in the rear bass speakers include large 3 „ full-range drivers. Enjoy rich, dynamic bass • Built-in AUX input for connecting to other audio devices

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Signature Conditions of Participation 1. The Promoter is nal von minden GmbH. 2. To enter simply fill in your details on the form here above and fax it to +49 941 290 10-50 or send it by post to: nal von minden GmbH, Christopher Beiderbeck, Friedenstrasse 32, 93053 Regensburg, Germany. Participation is also possible by email; please send an email with your answer and your complete address with the subject line as “Prize Draw” to gewinnspiel@nal-vonminden.com. You also can participate online: http://goo.gl/QruV82. The winner will be chosen at random and be drawn from those who have entered the correct answer. 3. This prize draw is open to European residents aged 18 years or over, with the exception of employees of the Promoter, their families, agents and anyone else connected with this promotion. Only one entry per person. No entrant may win more than one prize. 4. No purchase necessary to enter the prize draw and the participation is free. By entering the prize draw each entrant agrees to be bound by these terms and conditions. Entries must be received by the 14th November 2014. 5. The winner will be notified via email or post and will receive the prize by post. 6. Prizes are subject to availability. In the event of unforeseen circumstances, the Promoter reserves the right (a) to substitute alternative prizes of equivalent or greater value and (b) in exceptional circumstances to amend or foreclose the promotion without notice. No correspondence will be entered into. 7. The prize is a CREATIVE D100 Docking station. No cash or prize alternatives will be offered. The winner‘s entitlement to the prize is not transferable. 8. The Promoter shall not be responsible for damages, losses or liabilities of any kind, including without limitation, direct, indirect or consequential loss or damages arising out of or in relation to the prize draw. 9. Any liability for damages of nal von minden GmbH and their officers, employees and agents in connection with the competition, irrespective of the legal reason, is, as far as legally permissible, limited to cases of intent or gross negligence. 10. The promoter’s decision in respect of all matters to do with the competition will be final and no correspondence will be entered into. Legal recourse is excluded.

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Bacteriology Strep B

Group B streptococci

Danger to the unborn baby! There are two types of streptococci. Group A streptococci, responsible for scarlet fever and group B streptococci, a strain of bacteria which infects the gut and genital tract. Whilst group A bacteria is rarely life-threatening; a group B infection can be more critical, especially in the context of pregnancy and child birth. The infection is not a problem for the pregnant woman but it may be dangerous for the unborn baby. Bacteria can transfer to the amniotic fluid and there is also potential for the baby to become infected at birth. The consequences of infection can include pneumonia, meningitis or septicemia. How does the patient know whether she carries group B streptococci? A group B streptococcal infection has no symptoms and the bacteria are completely harmless to the woman. It is therefore unlikely for one to be aware of the condition without being tested. If a patient wants to know if she has a group B streptococcal infection, it is therefore essential for her and the unborn baby to undergo a test at a gynecologist‘s office. What does the expectant mother need to know about group B streptococci during her pregnancy? A group B streptococcus test is not yet included in maternity policy guidelines but it is available as an optional service if desired. The professional association of German gynecologists, as well as most resident gynecologists, recommend such screening because transmission to the baby can be life-threatening for the newborn. The screening is usually carried out by means of a vaginal smear between the 36th and 37th week of pregnancy. Should the result be positive, antibiotics are administered during labour to protect the baby.

Infected with group B streptococci: What’s next? There is no reason to panic. The diagnosis will be clear in the maternity notes, and doctors can quickly respond and take the appropriate action. During labour, the pregnant woman is given antibiotics via a cannula and immediately after birth the baby will be examined to find out if it is infected with group B streptococci. Ideally, treatment should begin four hours before the baby is born. It is therefore important to have a detailed conversation with the gynecologist before labour in order to protect the baby against a possible infection. Doctors recommend screening for group B streptococci A simple test can provide certainty for the baby and for the pregnant woman. Without this measure, around two out of every thousand babies could be infected during birth. Professor Klaus Friese, vice president of the German Society of Gynecology and Obstetrics says that the mortality rate of newborns has dropped by 50 percent in countries where the test is carried out as a standard, such as in the USA. However in Germany, pregnant women must usually bear the full cost themselves as the test is seen as an individual health service choice. Therefore, most health insurance companies will only cover the costs, that range from 20€ to 50€, if an infection is suspected. For the detection of Streptococcus B, the following rapid test is available from nal von minden: Artikel-Nr. 232001 RS

Is a planned caesarean birth a suitable alternative? A caesarean section is useful only if it is done before the onset of labour or the rupture of the membranes. In such cases, the woman in labour also does not require antibiotics. However if an emergency c-section is required, then bacteria may still be transmitted to the baby despite the caesarean section. In such cases, antibiotics are administered and the baby is examined for streptococci after birth.

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www.istockphoto.com © naumoid

Tropical Medicine Ebola

Ebola

The need for rapid diagnosis in Ebola outbreak The worst Ebola outbreak in history is currently causing a health disaster in West Africa. The extent of the current outbreak has caught international health organisations almost completely off guard. Before 2014, widespread Ebola outbreaks in West Africa were virtually unheard of with the majority of past outbreaks being contained to small areas of Central Africa. From humble beginnings in a small hospital in Guéckédou in the south of Guinea, Ebola has spread widely across the region with infections reported in Guinea, Liberia, Nigeria and Sierra Leone. Ebola virus disease is one of the most virulent diseases known and can be fatal with a case fatality rate that can often reach 90%. The current survival rate (47%) of the 2014 outbreak is higher than previous outbreaks, although the limitations of local health systems to cope with an outbreak of this severity are apparent. The 2014 outbreak has been attributed to the most virulent of the 5 known species of Ebola, Zaire ebolavirus. Transmission of Zaire ebolavirus is through close contact with bodily fluids of an infected host. It is not known where the virus that started this recent outbreak originated from but it is believed that fruit bats, particularly those species of the genera Hypsignathus monstrosus, Epomops franqueti and Myonycteris torquata, may be responsible. Local customs such as the consumption of bat meat and traditional burial rituals such as the washing of dead bodies may have directly contributed to its transmission into humans and its subsequent rapid spread across the region. International health agencies such as the World Health Organisation (WHO) have expressed the urgent need to control

and contain the current outbreak. The recent transmission of Ebola into major cities such as Lagos, Nigeria has increased the fear of the disease spreading outside of Africa, potentially into Europe and Asia. The UN healthy agency has recently urged all affected countries to start closely monitoring and screening passengers travelling through international airports, major border crossings and sea ports to help prevent it spreading outside of its current borders. The rapid and effective diagnosis of Ebola infections is vital for ensuring patients can receive the correct medical treatment as soon as possible and to make sure these patients are quarantined before they are able to spread the disease onto others. The lack of local laboratories with the capability of diagnosing Ebola infections means that rapid in-vitro diagnosis may be able to play a huge role in gaining control of this devastating disease. Having the ability to accurately screen suspected patients within 15 minutes could be the difference we need to win the current battle against Ebola. Diagnosis of Ebola is difficult because many of the symptoms resemble those of other common diseases such as malaria. Traditional diagnosis methods such as ELISA and PCR take many hours and in some cases days to give doctors the information they require. Using a rapid test that can detect Ebola antigens in the blood of a suspected patient can offer preliminary screening diagnosis in less than 15 minutes, therefore giving infected people access to medical treatment fast. Fast diagnosis is going to be absolutely essential if we wish to prevent the death toll from rising and to contain the spread of Ebola across Africa and beyond. AK,KH

http://medtechviews.eu/article/ebola-epidemic-how-diagnostics-can-help-future-health-emergencies http://www.economist.com/news/international/21612157-spread-ebola-west-africa-deeply-troubling-region-and-world-fever http://www.theguardian.com/society/2014/aug/18/ebola-who-urges-screening-in-affected-countries http://www.who.int/csr/disease/ebola/en/ http://www.who.int/csr/don/2014_08_19_ebola/en/ • http://www.who.int/csr/don/2014_08_20_ebola/en/ http://www.nejm.org/doi/full/10.1056/NEJMoa1404505#t=article

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Society Diabetes

Diabetes in China

China’s Economic Growth causes Health Decline China, one of today’s economic superpowers, has seen its wealth rapidly climb from poverty to riches in the past 30 years. However, with increased affluence and excessive expenditure often come negative implications too. China has now landed itself in a diabetes epidemic and it is not looking to improve anytime soon. The Disease There are two main types of diabetes; Type 1 and Type 2. Type 1 diabetes occurs when insulin is unable to be produced by the body. The cause is unknown but it often affects children and young adults. In contrast, Type 2 diabetes occurs when the insulin produced is not enough or does not function properly. Although sometimes caused by family history or ethnic background, one of the main causes of Type 2 diabetes is being overweight. According to the BBC (2013) ‘changing lifestyles, rapid urbanisation and cheap calories in the form of processed foods’ are putting China’s population are great risk of Type 2 diabetes. Last year the Journal of the American Medical Association revealed that 11.6% of the Chinese population had the disease. In 1980 the rate of diabetes was less than 1%. Since 2007, 22 million more people living in China were diagnosed with diabetes (a figure equal to the total population of Australia). Now China is home to a total of 114 million diabetics, which is roughly a third of the world’s diabetic population. The Cause Experts are blaming this epidemic on two major factors; the introduction of high-calorie, westernised diets and the decrease of physical activity. This newly adopted, sedentary lifestyle has stemmed from major urbanisation. Agricultural labour is

being replaced with stationary factory jobs, more people are travelling by car and the typical Asian diet of rice, vegetables and meat is being replaced with cheap, fast food alternatives which are high in fat, sugar and salt. All of these factors combined are creating the perfect recipe for a national disaster. The Impact Although China is now enjoying economic prosperity, this diabetes epidemic will place great pressure on the country’s health systems. In 2012, China spent £10,6bn on tackling the issue and it is predicted diabetes may consume half of the annual health budget. Diabetes requires routine treatment, so expenditure to help battle the disease will be continuous. Medical implications are also severe. Diabetes can lead to an increased risk of stroke, heart disease, liver failure and other complications. It is also no help that Asians, on average, have a lower body weight in comparison to other ethnicities and so, are more prone to developing the disease when subject to just a small increase in what is medically deemed an appropriate weight for their bodies. The Diagnosis Unfortunately the diagnosis of diabetes is happening too late. The realisation that there is a problem only occurs after symptoms have prevailed. Although China’s healthcare is available to almost all of its population, screening and outpatients services for diabetes are not yet a priority. This lack of early diagnosis is a direct impact of this obstacle and now, 60% of diabetes patients in China are not aware of their condition. This is clear evidence that diagnosis will play a vital part to cease this epidemic. JB

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http://www.borreliose-gesellschaft.de/Texte/Leitlinien.pdf http://www.bfbd.de/de/bund/1.html http://www.lgl.bayern.de/suche/index.htm?q=borreliose http://www.rki.de/DE/Content/Infekt/EpidBull/Merkblaetter/Ratgeber_LymeBorreliose.html

Drug Rapid Tests Bath Salts

Bath salts

These high-potency intoxicants horrify even experienced doctors

Number and main groups of new psychoactive substances notified to the EU Early Warning System, 2005-13

For some years now, more and more articles about “bath salts” can be found in the media. But what exactly does this allegedly harmless term stand for? The collective term “bath salts“ is used for a series of drugs that are also known as synthetic cathinones. Cathinone can be extracted from Khat (Catha edulis) leafs and the derivatives of this natural substance are called synthetic cathinones. Among others, the synthetic cathinones Butylone, Ethcathinone, Methylenedioxypyrovalerone (MDPV) and Pyrovalerone are found in “bath salts” products so far. Where does the name „bath salts“ derive from? The drug manufacturers chose this name in order to mask the true purpose - the drug consumption - and are aimed at circumventing legal requirements by adding the note “not suitable for human consumption“. This is also where the often used term “legal highs“ comes from. Whereas in the beginning it was possible for the synthetic cathinones to be sold legally (especially over the Internet), many substances are now falling under the narcotics law and the production, distribution and acquisition are therefore illegal. How are „bath salts“ consumed, how do they take effect and what are the risks? In Germany “bath salts” have been in circulation for at least 6 years and in Europe they have been known for a long time. There has been little research on the synthetic cathinones that are contained in “bath salts”. However, it is proven that cathinones stimulate the organism. MDPV and some other substances affect the dopamine metabolism in a similar way to amphetamine. Methylone, on the contrary, affects the serotonin system and is comparable to MDMA. “Bath salts” are either snorted, injected or ingested and they are usually sold in the form of pills or as white or brown powder.

The synthetic cathinones produce feelings of increased energy, euphoria and increased talkativeness and libido. Drug users report that the effect is similar to amphetamine or ecstasy. More and more often you can also hear real horror stories regarding „bath salts“, such as from the United States of America, where two terrible incidents happened only days apart in spring 2012. For instance, in Miami, a drug user assaulted a homeless man on the street, beat him unconscious, and bit off most of his face above the beard, including his left eye, leaving him blind in both. Witnesses report that the drug user was acting like a “zombie” or a “mad dog”. Some examples show that the consumption of “bath salts” can be fatal. There is little scientific research on the exact impact, but a frequent single symptom is an increased aggressiveness, which is often associated with a severe psychosis including delusions. The MDPV rapid test For narcotics agents it has been difficult to keep up with prohibitions and analyses, as “bath salts” are constantly receiving new names and new varieties are being produced. In addition, it can be difficult to differentiate between „bath salts“ powder and drug mixtures which have not been explicitly prohibited. The remedy for these problems is a rapid test that will also be offered by the nal von minden GmbH in the near future. AK,KH

http://www.drugcom.de/drogenlexikon/buchstabe-b/?idx=241 (12.08.2014) http://www.spiegel.de/wissenschaft/medizin/rauschgift-badesalz-drogen-schockieren-us-mediziner-a-774905.html (12.08.2014) http://www.welt.de/vermischtes/weltgeschehen/article106403867/Macht-Badesalz-Menschen-zu-Kannibalen.html (12.08.2014) http://www.spiegel.de/wissenschaft/mensch/neues-rauschgift-schnelltests-sollen-badesalz-drogen-nachweisen-a-783440.html (12.08.2014) http://www.alternative-drogenpolitik.de/2014/05/27/steigende-potenz-und-neumeldungen-bei-den-neuen-psychoaktiven-substanzen/ (13.08.2014) http://www.kmdd.de/xist4c/web/Legal-Highs_id_262__dId_37170_.htm (13.08.2014)

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Drug Rapid Tests Pimp my brain

Pimp my brain

A little pill and its potential effect on education It‘s that time of the year again…a new school year has just begun and college students are starting their new term. For many pupils and students fear is ever-present and they ask themselves if they will be able to cope with the pressure to perform and to achieve good grades.

taking performance-enhancing and non-prescription pills without side effects. This high level of readiness is frightening – but perhaps not surprising - in a society in which the mental abilities of an individual are playing an increasingly important role.

We live in a society in which there are multiple opportunities for self-realisation and optimisation of processes, such as time management and efficiency gains, at all levels, Therefore, it is no big surprise that terms like „neuroenhancement“, „cognitive enhancement“ or „brain doping“ can be heard more and more often.

Other scholars, however, are less worried about this development. If the need for brain doping is so great, shouldn’t every person just be allowed to decide for themselves if they want to mentally dope themselves or not? The recently published responses of certain expert groups who recommend a liberal attitude towards brain doping under certain conditions, are considered irresponsible by many.

The term ´pharmacological neuroenhancement` refers to the attempt to improve certain aspects of our mental abilities such as memory, concentration, attentiveness, and alertness by medication. Brain doping, in contrast, refers to the abuse of prescription medicine and illegal drugs. The numbers of doping cases at German schools and universities are steadily increasing. Work pressure and stress are to be blamed for this, and according to a study by scientists from Mainz in 2013 as much as 20% of all students use performance-enhancing drugs. Many students are familiar with the situation: an important exam is imminent or an important research paper is due. It‘s late, far too late and they just cannot keep their eyes open anymore. The letters on the screen are blurred, there is no hope for sleep - it is just too important to keep going. When there is no more time for sleep and rest, the prospect of a little pill that helps to increase ones mental concentration is very tempting. The most common substances of abuse include methylphenidate (Ritalin®) that is used to treat ADHD, amphetamines, and modafinil (used in narcolepsy patients), all of which have been shown to enhance performance. In contrast, some other often abused substances, such as anti-dementia drugs or antidepressants have no detectable effect on healthy people. In 2010, the psychiatrist Klaus Lieb, Director of the Clinic for Psychiatry and Psychotherapy, University Medical Center Mainz, published a book exactly on this topic. In this book, he presented the results of a study with around 1,500 pupils and students from the states Hesse and Rhineland-Palatinate. More than 80% of those polled said that they would consider

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However, one thing is certain: no pill can make you smarter. It is true that some medications (such as Ritalin or modafinil) can compensate for short periods of inefficiency, as they are able to improve concentration and alertness. However, on the other hand, it has to be considered that we know too little about possible side effects and long-term damage in healthy people taking such pills. Performance enhancing medication may cause mental illnesses such as psychosis and they can be addictive, not to mention the unforeseeable consequential damages to the brain. In addition, it has to be assumed that not every person will handle performance enhancing drugs responsibly. Furthermore, being more alert does not always equal being more concentrated, and with increased alertness comes increased restlessness. The mind is usually only creative during periods of rest, when it is able to explore new ideas free from pressure and tension. Thus overall performance and productivity can be affected by such limited creativity as well. There is also the fact that these substances will assist only for a short period of time, because after two or three nights, the body still requires actual rest. You can dope yourself mentally for a short time but you will need an extended recovery period afterwards. The so-called smart pills or brain boosters could bring a multimillion sum deal for the pharmaceutical industry because the market of healthy people is just as large as the existing market. However, experts fear that it will not just be stimulants or concentration enhancers that people will buy. Already, there

Drug Rapid Tests Pimp my brain

More than 80%

said that they would

considered taking a performance-enhancing

freely available pill if there was no risk of any side effects.

are pills designed to enhance the cognitive performance by accelerating the thought process and by facilitating the transmission of signals between the frontal brain and nerve cells. So how can we define to what extent a cognitive performance enhancement is acceptable? Under what circumstances should it be allowed to enhance the ability of healthy individuals? What do the possibilities of neuroenhancements mean for equal opportunities? Or could these non prescription smart pills maybe even bring equality for people with naturally lower concentration skills, thus giving them a fair starting position? What pressure would be put on the general public if cognitive enhancements were socially accepted? Will we then be forced to optimise ourselves just to keep up with everyone else? Or shouldnâ&#x20AC;&#x2122;t our brain, the seat of thought and personality, rather remain entirely free from any external influence? These questions cannot be answered easily and have to be

Source: www.uni-mainz.de, www.spektrum.de, www.bernerzeitung.ch, www.ebs.edu

discussed thoroughly, especially if the increase in substance consumption continues. At this point we agree with Dr. Lieb, who says that no one should consume the currently available therapeutic drugs without a valid reason, unless they want to get a questionable increase in mental performance alongside an unpredictable risk of unwanted side effects. Personally, we recommend a very different kind of performance improvement: start studying on time, schedule adequate rest periods, do some exercise in between or relieve stress with yoga or tai chi exercises. Regular breathing exercises, for example, have a much more positive influence on the balance of the autonomic nervous system than any pill could ever have. In addition, adequate sleep is the only thing that ensures that what you have studied is retained in your memory. This being said, we wish all pupils and students a productive term! KS

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nvm inside Medica 2014

Medica 2014 12th â&#x20AC;&#x201C; 15th November

Visit us at

our booth stand 2A25! This year we once again offer a range of new product innovations in the field of in-vitro diagnostics! Get yourself informed and educated by our staff and discover our varied range of products. In addition to drug and medical rapid tests we also offer devices for fast and uncomplicated precise assay results. We invite you to visit us at this yearâ&#x20AC;&#x2DC;s MEDICA Trade Fair. We are looking forward to your visit!

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Your nal von minden Team

Further information under: www.nal-vonminden.com

nvm inside Short News

nal von minden

Short News

BATH SALTS As announced at the end of September, the European Commission has now issued a ban on the four psychoactive substances Methoxetamine, MDPV, 25I-NBOMe, and AH-7921. From now on, the distribution and production of these designer drugs will be handled as an offence. In this context, Martine Reicherts, the EU Justice Commissioner, declared that this ban will finally give them the criminal status which they deserve. EU countries must implement the prohibition within the next twelve months.

DIABETES World Diabetes Day takes place on November 14th each year. Launched in 1991, it was officially renamed „United Nations Diabetes Day“ at the end of 2006. Apart from World AIDS day, it is only the second day that is officially dedicated to a disease. The aim is to engage numerous people worldwide in diabetes awareness into order to advocate and to draw attention to the increasing levels of type 2 diabetes mellitus patients. November 14th was chosen as it marks the birthday of Frederick Banting. In 1921, Banting and Charles Best first conceived the idea which led to the discovery of insulin in humans.

http://www.toppharm.ch/gesundheit/aktuell/detail/ article/eu-verbietet-vier-gefaehrliche-designer-drogen. html (30.09.2014)

http://www.timeanddate.com/holidays/un/world-diabetes-day (02.10.2014)

Each year a new theme is chosen by the International Diabetes Federation. For 2014-2016 “Healthy Living and Diabetes” is the motto for the campaign. In 2014, the main focus is on eating a healthy breakfast and there will be many lectures and events on the subject of diabetes across more than 160 countries worldwide. http://www.welt-diabetes-tag.de/ (02.10.2014) http://www.idf.org/worlddiabetesday/about (02.10.2014) http://www.theguardian.com/theguardian/from-the-archive-blog/2013/nov/14/frederick-banting-diabetes-archive (02.10.2014)

EBOLA On page 13, we reported on the Ebola outbreak in West Africa. According to the CDC (Centre for Disease Control and Prevention), the first Ebola case in the US was diagnosed on 30th September 2014. The patient, who remains under quarantine, is currently being treated on a special ward at hospital in Dallas. He travelled from Liberia to Texas via Brussels to visit relatives and because the man did not seek treatment until six days after arriving in Texas, it is possible that he has infected others. US health officials are trying to track down and identify those who may have come into contact with the man. These people will then be monitored for three weeks to see if a fever develops. Despite the significance of the current situation, Dr Tom Frie-

http://www.spiegel.de/gesundheit/diagnose/ebola-erster-fall-in-den-usa-diagnostiziert-a-994721.html (01.10.2014)http://www.tagesschau.de/ausland/ebola-usa-107. html (02.10.2014)

den, the CDC director, is convinced that this case of Ebola is under control and that further outbreaks can be prevented. US politicians ask the public to not panic and emphasise that the American healthcare system is capable of bringing this outbreak under control ‟quickly and safely.“

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Discover our comprehensive product range! For all products and innovations please visit: www.nal-vonminden.com

The adventures of Medical Man A bathtub full of fun After such an exhausting day, there is nothing better than having a wonderful and warm bath!

Doctor Happy, overjoyed with what he has found, prepares his bath carefully…

… when medical man suspects something terrible!! What…?????????

Then, at the last second:

Stooooooooop!!!!!!

How naïve are you my friend? Are you falling into the same trap as all these teenagers who buy those harmlessly named drugs on the internet? You almost could have never got back to work!

That’s actually…???

Okay, no reason to scream at me! I just wanted a relaxing bath!!!

Pfff! Idiot! How did you get your PhD??

Rapid Tests Laboratory Diagnostics Laboratory Service Consulting & Service

www.nal-vonminden.com/inside-diagnostics

Rev 01 / IMAGE-DE / 01-13

Bath Salts! That looks good and gives me an idea!!

Oh what’s that??