Mosquitoes can spread the flesh-eating Buruli ulcer. Here’s how you can protect yourself
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Each year, more and more Victorians become sick with a flesh-eating bacteria known as Buruli ulcer. Last year, 363 people presented with the infection, the highest number since 2004.
But it has been unclear exactly how it spreads, until now. New research shows mosquitoes are infected from biting possums that carry the bacteria. Mozzies spread it to humans through their bite.
What is Buruli ulcer?
Buruli ulcer, also known as Bairnsdale ulcer, is a skin infection caused by the bacterium Mycobacterium ulcerans.
It starts off like a small mosquito bite and over many months, slowly develops into an ulcer, with extensive destruction of the underlying tissue.
While often painless initially, the infection can become very serious. If left untreated, the ulcer can continue to enlarge. This is where it gets its “flesh-eating” name.
Thankfully, it’s treatable. A six to eight week course of specific antibiotics is an effective treatment, sometimes supported with surgery to remove the infected tissue.
Where can you catch it?
The World Health Organization considers Buruli ulcer a neglected tropical skin disease. Cases have been reported across 33 countries, primarily in west and central Africa.
However, since the early 2000s, Buruli ulcer has also been increasingly recorded in coastal Victoria, including suburbs around Melbourne and Geelong.
Scientists have long known Australian native possums were partly responsible for its spread, and suspected mosquitoes also played a role in the increase in cases. New research confirms this.
Our efforts to ‘beat Buruli’
Confirming the role of insects in outbreaks of an infectious disease is achieved by building up corroborating, independent evidence.
In this new research, published in Nature Microbiology, the team (including co-authors Tim Stinear, Stacey Lynch and Peter Mee) conducted extensive surveys across a 350 km² area of Victoria.
We collected mosquitoes and analysed the specimens to determine whether they were carrying the pathogen, and links to infected possums and people. It was like contact tracing for mosquitoes.
Cameron Webb (NSW Health Pathology)
Molecular testing of the mosquito specimens showed that of the two most abundant mosquito species, only Aedes notoscriptus (a widespread species commonly known as the Australian backyard mosquito) was positive for Mycobacterium ulcerans.
We then used genomic tests to show the bacteria found on these mosquitoes matched the bacteria in possum poo and humans with Buruli ulcer.
We further analysed mosquito specimens that contained blood to show Aedes notoscriptus was feeding on both possums and humans.
To then link everything together, geospatial analysis revealed the areas where human Buruli ulcer cases occur overlap with areas where both mosquitoes and possums that harbour Mycobacterium ulcerans are active.
Stop its spread by stopping mozzies breeding
The mosquito in this study primarily responsible for the bacteria’s spread is Aedes notoscriptus, a mosquito that lays its eggs around water in containers in backyard habitats.
Controlling “backyard” mosquitoes is a critical part of reducing the risk of many global mosquito-borne disease, especially dengue and now Buruli ulcer.
You can reduce places where water collects after rainfall, such as potted plant saucers, blocked gutters and drains, unscreened rainwater tanks, and a wide range of plastic buckets and other containers. These should all be either emptied at least weekly or, better yet, thrown away or placed under cover.
Cameron Webb (NSW Health Pathology)
There is a role for insecticides too. While residual insecticides applied to surfaces around the house and garden will reduce mosquito populations, they can also impact other, beneficial, insects. Judicious use of such sprays is recommended. But there are ecological safe insecticides that can be applied to water-filled containers (such as ornamental ponds, fountains, stormwater pits and so on).
Recent research also indicates new mosquito-control approaches that use mosquitoes themselves to spread insecticides may soon be available.
How to protect yourself from bites
The first line of defence will remain personal protection measures against mosquito bites.
Covering up with loose fitted long sleeved shirts, long pants, and covered shoes will provide physical protection from mosquitoes.
Applying topical insect repellent to all exposed areas of skin has been proven to provide safe and effective protection from mosquito bites. Repellents should include diethytolumide (DEET), picaridin or oil of lemon eucalyptus.
While the rise in Buruli ulcer is a significant health concern, so too are many other mosquito-borne diseases. The steps to avoid mosquito bites and exposure to Mycobacteriam ulcerans will also protect against viruses such as Ross River, Barmah Forest, Japanese encephalitis, and Murray Valley encephalitis.
Cameron Webb, Clinical Associate Professor and Principal Hospital Scientist, University of Sydney; Peter Mee, Adjunct Associate Lecturer, School of Applied Systems Biology, La Trobe University; Stacey Lynch, Team Leader- Mammalian infection disease research, CSIRO, and Tim Stinear, Professor of Microbiology, The University of Melbourne
This article is republished from The Conversation under a Creative Commons license. Read the original article.
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Fatigue? Unexplained weight gain and dry skin? Could it be Hashimoto’s disease?
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Maybe you feel worn out. Perhaps you’re also having trouble losing weight. Generally, you just don’t feel 100%.
Could it be Hashimoto’s disease? This common autoimmune thyroid disorder is when your immune system (which fights off viruses and bacteria), mistakenly attacks a part of your body. In this case, it’s your thyroid – a gland located at the base of your neck – and can cause low thyroid hormones levels (hypothyroidism).
Hypothyroidism affects one in 33 Australians and Hashimoto’s is one of the most common thyroid conditions in first-world countries.
While symptoms can be subtle, untreated Hashimoto’s can cause long-term problems with your heart, memory and fertility. Here is what you need to know.
What happens when you have Hashimoto’s?
Your thyroid gland is a butterfly-shaped gland in the neck. It is essential in regulating things like muscle function, digestion, metabolism, the heart and lungs. In children, thyroid hormones are also needed for normal growth and development.
Hashimoto’s thyroid disease, named after the Japanese doctor who discovered it in 1912, is also known as Hashimoto’s thyroiditis or chronic lymphocytic thyroiditis. The disease can cause the immune system to mistakenly produce proteins called antibodies (thyroid peroxidase and thyroglobulin). These can cause inflammation and long-term damage to the thyroid gland. Over time, as thyroid tissue is inflamed and/or destroyed, there can be a decrease in the production of thyroid hormones (hypothyroidism).
Hashimoto’s can present subtly at first. If you only have antibodies with no change in thyroid levels, it is likely you won’t have any symptoms.
However, as the disease progresses, you may experience fatigue, weight gain (or difficulty losing weight), increased sensitivity to the cold, constipation, dry skin, muscle aches, irregular or heavy menstrual cycles, enlarged thyroid (goitre) and occasionally hair loss, including at the ends of your eyebrows.
What causes Hashimoto’s thyroid disease?
Several risk factors can contribute to the development of Hashimoto’s including:
genetic risk – your risk is higher if you have family members with Hashimoto’s
gender – women are up to ten times more likely than men to develop the disease
age – you are more likely to develop the disease from 30 to 50 years of age
autoimmune condition – having another autoimmune condition like systemic lupus, Type 1 diabetes and celiac disease increases your risk
excessive iodine intake and radiation exposure may also increase risk in people who are already genetically at greater risk.
What are the long-term risks?
Long-term, untreated Hashimoto’s thyroiditis can cause heart issues, higher cholesterol levels, nerve damage (peripheral neuropathy), reduced cognition and infertility.
In pregnancy, Hashimoto’s has a higher risk of pre-eclampsia (high blood pressure affecting several organs), premature birth, placental abruption (when the placenta separates from the inner wall of the uterus before birth) and, in severe cases, pregnancy loss.
The disease has also been linked with an increased risk (but low incidence) of the lymphocytes of the thyroid turning into cancer cells to cause thyroid lymphoma.
How is Hashimoto’s diagnosed?
Diagnosis can be confirmed with a blood test to check thyroid levels and antibodies.
Thyroid peroxidase antibodies are commonly present but about 5% of patients test antibody-negative. In those people, diagnosis depends on the thyroid levels, clinical presentation and ultrasound appearance of general inflammation. An ultrasound may not be required though, especially if the diagnosis is obvious.
Three hormone levels are tested to determine if you have Hashimoto’s.
Thyroid stimulating hormone (TSH) is produced by the brain to speak to the thyroid, telling it to produce two types of thyroid hormones – T3 and T4.
If you have either relative or absolute thyroid hormone deficiency, a test will show the stimulating hormones as high because the brain is trying to get the thyroid to work harder.
Hashimoto’s thyroiditis under the microscope. Antibodies against thyroid peroxidase and thyroglobulin were elevated.
Patho/Wikimedia Commons, CC BY-SACan it be treated?
The management of Hashimoto’s depends on the severity of the thyroid levels. Up to 20% of the population can have antibodies but normal thyroid levels. This is still Hashimoto’s thyroid disease, but it is very mild and does not require treatment. There is no current treatment to reduce antibody levels alone.
Because thyroid peroxidase antibodies increase the risk of abnormal thyroid levels in the future, regular thyroid testing is recommended.
When the thyroid stimulating hormone is high with normal thyroid hormone levels it is termed “subclinical hypothyroidism”. When it is paired with low hormone levels it is called “overt hypothyroidism”. The first is a mild form of the disease and treatment depends on the degree of stimulating hormone elevation.
Overt hypothyroidism warrants treatment. The main form of this is thyroid hormone replacement therapy (levothyroxine) with the dose of the drug adjusted until thyroid levels are within the normal range. This is usually a lifelong treatment but, once the dose is optimised, hormone levels usually remain relatively stable.
In some people with very enlarged thyroid glands causing compressive symptoms (such as difficulty swallowing or breathing), thyroidectomy (surgical removal of the thyroid) is considered.
Hashimoto’s thyroiditis is a common condition caused by your body’s immune system incorrectly damaging to your thyroid and can go undetected. Long-term, untreated, it can cause issues with your heart, cognition, and fertility. It can be diagnosed with a simple blood test. Speak to your doctor if you have any concerns as early diagnosis and treatment can help prevent complications.
Aakansha Zala, The University of Queensland
This article is republished from The Conversation under a Creative Commons license. Read the original article.
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Are Brain Chips Safe?
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Ready For Cyborgization?
In yesterday’s newsletter, we asked you for your views on Brain-Computer Interfaces (BCIs), such as the Utah Array and Neuralink’s chips on/in brains that allow direct communication between brains and computers, so that (for example) a paralysed person can use a device to communicate, or manipulate a prosthetic limb or two.
We didn’t get as many votes as usual; it’s possible that yesterday’s newsletter ended up in a lot of spam filters due to repeated use of a word in “extra ______ olive oil” in its main feature!
However, of the answers we did get…
- About 54% said “It’s bad enough that our phones spy on us, without BCI monitoring our thoughts as well!”
- About 23% said “Sounds great in principle, but I don’t think we’re there yet safetywise”
- About 19% said “Sign me up for technological telepathy! I am ready for assimilation”
- One (1) person said “Electrode outside the skull are good; chips on the brain are bad”
But what does the science say?
We’re not there yet safetywise: True or False?
True, in our opinion, when it comes to the latest implants, anyway. While it’s very difficult to prove a negative (it could be that everything goes perfectly in human trials), “extraordinary claims require extraordinary evidence”, and so far this seems to be lacking.
The stage before human trials is usually animal trials, starting with small creatures and working up to non-human primates if appropriate, before finally humans.
- Good news: the latest hot-topic BCI device (Neuralink) was tested on animals!
- Bad news: to say it did not go well would be an understatement
The Gruesome Story of How Neuralink’s Monkeys Actually Died
The above is a Wired article, and we tend to go for more objective sources, however we chose this one because it links to very many objective sources, including an open letter from the Physicians’ Committee for Responsible Medicine, which basically confirms everything in the Wired article. There are lots of links to primary (medical and legal) sources, too.
Electrodes outside the skull are good; chips on/in the brain are bad: True or False?
True or False depending on how they’re done. The Utah Array (an older BCI implant, now 20 years old, though it’s been updated many times since) has had a good safety record, after being used by a few dozen people with paralysis to control devices:
How the Utah Array is advancing BCI science
The Utah Array works on the same general principle as Neuralink, but the mechanics of its implementation are very different:
- The Utah Array involves a tiny bundle of microelectrodes (held together by a rigid structure that looks a bit like a nanoscale hairbrush) put in place by a brain surgeon, and that’s that.
- The Neuralink has a dynamic web of electrodes, implanted by a little robot that acts like a tiny sewing machine to implant many polymer threads, each containing its own a bunch of electrodes.
In theory, the latter is much more advanced. In practice, so far, the former has a much better safety record.
I am right to be a little worried about giving companies access to my brain: True or False?
True or False, depending on the nature of your concern.
For privacy: current BCI devices have quite simple switches operated consciously by the user. So while technically any such device that then runs its data through Bluetooth or WiFi could be hacked, this risk is no greater than using a wireless mouse and/or keyboard, because it has access to about the same amount of information.
For safety: yes, probably there is cause to be worried. Likely the first waves of commercial users of any given BCI device will be severely disabled people who are more likely to waive their rights in the hope of a life-changing assistance device, and likely some of those will suffer if things go wrong.
Which on the one hand, is their gamble to make. And on the other hand, makes rushing to human trials, for companies that do that, a little more predatory.
Take care!
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Why Diets Make Us Fat – by Dr. Sandra Aamodt
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It’s well-known that crash-dieting doesn’t work. Restrictive diets will achieve short-term weight loss, but it’ll come back later. In the long term, weight creeps slowly upwards. Why?
Dr. Sandra Aamodt explores the science and sociology behind this phenomenon, and offers an evidence-based alternative.
A lot of the book is given over to explanations of what is typically going wrong—that is the title of the book, after all. From metabolic starvation responses to genetics to the negative feedback loop of poor body image, there’s a lot to address.
However, what alternative does she propose?
The book takes us on a shift away from focusing on the numbers on the scale, and more on building consistent healthy habits. It might not feel like it if you desperately want to lose weight, but it’s better to have healthy habits at any weight, than to have a wreck of physical and mental health for the sake of a lower body mass.
Dr. Aamodt lays out a plan for shifting perspectives, building health, and letting weight loss come by itself—as a side effect, not a goal.
In fact, as she argues (in agreement with the best current science, science that we’ve covered before at 10almonds, for that matter), that over a certain age, people in the “overweight” category of BMI have a reduced mortality risk compared to those in the “healthy weight” category. It really underlines how there’s no point in making oneself miserably unhealthy with the end goal of having a lighter coffin—and getting it sooner.
Bottom line: will this book make you hit those glossy-magazine weight goals by your next vacation? Quite possibly not, but it will set you up for actually healthier living, for life, at any weight.
Click here to check out Why Diets Make Us Fat, and live healthier and better!
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Is TikTok right? Can adding a teaspoon of cinnamon to your coffee help you burn fat?
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Cinnamon has been long used around the world in both sweet and savoury dishes and drinks.
But a new TikTok trend claims adding a teaspoon of cinnamon to your daily coffee (and some cocoa to make it more palatable) for one week can help you burn fat. Is there any truth to this?
Evannovostro/Shutterstock Not all cinnamon is the same
There are two types of cinnamon, both of which come from grinding the bark of the cinnamomum tree and may include several naturally occurring active ingredients.
Cassia cinnamon is the most common type available in grocery stores. It has a bitter taste and contains higher levels of one of the active ingredient cinnamaldehyde, a compound that gives cinnamon its flavour and odour. About 95% of cassia cinnamon is cinnamaldehyde.
The other is Ceylon cinnamon, which tastes sweeter. It contains about 50-60% cinnamaldehyde.
Does cinnamon burn fat? What does the research say?
A review of 35 studies examined whether consuming cinnamon could affect waist circumference, which is linked to increased body fat levels. It found cinnamon doses below 1.5 grams per day (around half a teaspoon) decreased waist circumference by 1.68cm. However, consuming more than 1.5g/day did not have a significant effect.
A meta-analysis of 21 clinical trials with 1,480 total participants found cinnamon also reduced body mass index (BMI) by 0.40kg/m² and body weight by 0.92kg. But it did not change the participants’ composition of fat or lean mass.
Another umbrella review, which included all the meta-analyses, found a small effect of cinnamon on weight loss. Participants lost an average of 0.67kg and reduced their BMI by 0.45kg/m².
The effect appears small. Radu Sebastian/Shutterstock So overall, the weight loss we see from these high-quality studies is very small, ranging anywhere from two to six months and mostly with no change in body composition.
The studies included people with different diseases, and most were from the Middle East and/or the Indian subcontinent. So we can’t be certain we would see this effect in people with other health profiles and in other countries. They were also conducted over different lengths of time from two to six months.
The supplements were different, depending on the study. Some had the active ingredient extracted from cinnamon, others used cinnamon powder. Doses varied from 0.36g to 10g per day.
They also used the two different types of cinnamon – but none of the studies used cinnamon from the grocery store.
How could cinnamon result in small amounts of weight loss?
There are several possible mechanisms.
It appears to allow blood glucose (sugar) to enter the body’s cells more quickly. This lowers blood glucose levels and can make insulin work more effectively.
It also seems to improve the way we break down fat when we need it for energy.
Finally, it may make us feel fuller for longer by slowing down how quickly the food is released from our stomach into the small intestine.
What are the risks?
Cinnamon is generally regarded as safe when used as a spice in cooking and food.
However, in recent months the United States and Australia have issued health alerts about the level of lead and other heavy metals in some cinnamon preparations.
Lead enters as a contaminant during growth (from the environment) and in harvesting. In some cases, it has been suggested there may have been intentional contamination.
Some people can have side effects from cinnamon, including gastrointestinal pain and allergic reactions.
One of the active ingredients, coumarin, can be toxic for some people’s livers. This has prompted the European Food Authority to set a limit of 0.1mg/kg of body weight.
Cassia cinnamon contains up to 1% of coumarin, and the Ceylon variety contains much less, 0.004%. So for people weighing above 60kg, 2 teaspoons (6g) of cassia cinnamon would bring them over the safe limit.
What about the coffee and cocoa?
Many people may think coffee can also help us lose weight. However there isn’t good evidence to support this yet.
An observational study found drinking one cup of regular coffee was linked to a reduction in weight that is gained over four years, but by a very small amount: an average of 0.12kg.
Good-quality cocoa and dark chocolate have also been shown to reduce weight. But again, the weight loss was small (between 0.2 and 0.4kg) and only after consuming it for four to eight weeks.
So what does this all mean?
Using cinnamon may have a very small effect on weight, but it’s unlikely to deliver meaningful weight loss without other lifestyle adjustments.
We also need to remember these trials used products that differ from the cinnamon we buy in the shops. How we store and how long we keep cinnamon might also impact or degrade the active ingredients.
And consuming more isn’t going to provide additional benefit. In fact, it could increase your risk of side effects.
So if you enjoy the taste of cinnamon in your coffee, continue to add it, but given its strong taste, you’re likely to only want to add a little.
And no matter how much we’d like this to be true, we certainly won’t gain any fat-loss benefits by consuming cinnamon on doughnuts or in buns, due to their high kilojoule count.
If you want to lose weight, there are evidence-backed approaches that won’t spoil your morning coffee.
Evangeline Mantzioris, Program Director of Nutrition and Food Sciences, Accredited Practising Dietitian, University of South Australia
This article is republished from The Conversation under a Creative Commons license. Read the original article.
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Voluntary assisted dying is different to suicide. But federal laws conflate them and restrict access to telehealth
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Voluntary assisted dying is now lawful in every Australian state and will soon begin in the Australian Capital Territory.
However, it’s illegal to discuss it via telehealth. That means people who live in rural and remote areas, or those who can’t physically go to see a doctor, may not be able to access the scheme.
A federal private members bill, introduced to parliament last week, aims to change this. So what’s proposed and why is it needed?
What’s wrong with the current laws?
Voluntary assisted dying doesn’t meet the definition of suicide under state laws.
But the Commonwealth Criminal Code prohibits the discussion or dissemination of suicide-related material electronically.
This opens doctors to the risk of criminal prosecution if they discuss voluntary assisted dying via telehealth.
Successive Commonwealth attorneys-general have failed to address the conflict between federal and state laws, despite persistent calls from state attorneys-general for necessary clarity.
This eventually led to voluntary assistant dying doctor Nicholas Carr calling on the Federal Court of Australia to resolve this conflict. Carr sought a declaration to exclude voluntary assisted dying from the definition of suicide under the Criminal Code.
In November, the court declared voluntary assisted dying was considered suicide for the purpose of the Criminal Code. This meant doctors across Australia were prohibited from using telehealth services for voluntary assisted dying consultations.
Last week, independent federal MP Kate Chaney introduced a private members bill to create an exemption for voluntary assisted dying by excluding it as suicide for the purpose of the Criminal Code. Here’s why it’s needed.
Not all patients can physically see a doctor
Defining voluntary assisted dying as suicide in the Criminal Code disproportionately impacts people living in regional and remote areas. People in the country rely on the use of “carriage services”, such as phone and video consultations, to avoid travelling long distances to consult their doctor.
Other people with terminal illnesses, whether in regional or urban areas, may be suffering intolerably and unable to physically attend appointments with doctors.
The prohibition against telehealth goes against the principles of voluntary assisted dying, which are to minimise suffering, maximise quality of life and promote autonomy.
Some people aren’t able to attend doctors’ appointments in person.
Jeffrey M Levine/ShutterstockDoctors don’t want to be involved in ‘suicide’
Equating voluntary assisted dying with suicide has a direct impact on doctors, who fear criminal prosecution due to the prohibition against using telehealth.
Some doctors may decide not to help patients who choose voluntary assisted dying, leaving patients in a state of limbo.
The number of doctors actively participating in voluntary assisted dying is already low. The majority of doctors are located in metropolitan areas or major regional centres, leaving some locations with very few doctors participating in voluntary assisted dying.
It misclassifies deaths
In state law, people dying under voluntary assisted dying have the cause of their death registered as “the disease, illness or medical condition that was the grounds for a person to access voluntary assisted dying”, while the manner of dying is recorded as voluntary assisted dying.
In contrast, only coroners in each state and territory can make a finding of suicide as a cause of death.
In 2017, voluntary assisted dying was defined in the Coroners Act 2008 (Vic) as not a reportable death, and thus not suicide.
The language of suicide is inappropriate for explaining how people make a decision to die with dignity under the lawful practice of voluntary assisted dying.
There is ongoing taboo and stigma attached to suicide. People who opt for and are lawfully eligible to access voluntary assisted dying should not be tainted with the taboo that currently surrounds suicide.
So what is the solution?
The only way to remedy this problem is for the federal government to create an exemption in the Criminal Code to allow telehealth appointments to discuss voluntary assisted dying.
Chaney’s private member’s bill is yet to be debated in federal parliament.
If it’s unsuccessful, the Commonwealth attorney-general should pass regulations to exempt voluntary assisted dying as suicide.
A cooperative approach to resolve this conflict of laws is necessary to ensure doctors don’t risk prosecution for assisting eligible people to access voluntary assisted dying, regional and remote patients have access to voluntary assisted dying, families don’t suffer consequences for the erroneous classification of voluntary assisted dying as suicide, and people accessing voluntary assisted dying are not shrouded with the taboo of suicide when accessing a lawful practice to die with dignity.
Failure to change this will cause unnecessary suffering for patients and doctors alike.
Michaela Estelle Okninski, Lecturer of Law, University of Adelaide; Marc Trabsky, Associate professor, La Trobe University, and Neera Bhatia, Associate Professor in Law, Deakin University
This article is republished from The Conversation under a Creative Commons license. Read the original article.
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The Salt Fix – by Dr. James DiNicolantonio
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This book has a bold premise: high salt consumption is not, as global scientific consensus holds, a serious health risk, but rather, as the title suggests, a health fix.
Dr. DiNicolantonio, a pharmacist, explains how “our ancestors crawled out of the sea millions of years ago and we still crave that salt”, giving this as a reason why we should consume salt ad libitum, aiming for 8–10g per day, and thereafter a fair portion of the book is given over to discussing how many health conditions are caused/exacerbated by sugar, and that therefore we have demonized the wrong white crystal (scientific consensus is that there are many white crystals that can cause us harm).
Indeed, sugar can be a big health problem, but reading it at such length felt a lot like when all a politician can talk about is how their political rival is worse.
A lot of the studies the author cites to support the idea of healthy higher salt consumption rates were on non-human animals, and it’s always a lottery as to whether those results translate to humans or not. Also, many of the studies he’s citing are old and have methodological flaws, while others we could not find when we looked them up.
One of the sources cited is “my friend Jose tried this and it worked for him”.
Bottom line: sodium is an essential mineral that we do need to live, but we are not convinced that this book’s ideas have scientific merit. But are they well-argued? Also no.
Click here to check out The Salt Fix for yourself! It’s a fascinating book.
(Usually, if we do not approve of a book, we simply do not review it. We like to keep things positive. However, this one came up in Q&A, so it seemed appropriate to share our review. Also, the occasional negative review may reassure you, dear readers, that when we praise a book, we mean it)
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