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By George HerdBBC News Jones family Nesta Jones died more than a month after being admitted to hospital A hospital consultant was “duty bound” to rely on the conclusion of specialists that a patient’s knee was not infected, an inquest has heard. Nesta Jones, 77, died in Ysbyty Gwynedd in Bangor, Gwynedd, after developing pneumonia shortly after the infection was confirmed. Consultant Mahdi Jibani told the hearing in Caernarfon he suspected infection. But several orthopaedic doctors all said she did not have septic arthritis. Mrs Jones, a retired teacher from Valley, Anglesey, had a knee replacement in 2015, due to rheumatoid arthritis. Her family told the hearing they believe multiple opportunities were missed to diagnose the source of the infection. Mrs Jones was taken to Ysbyty Gwynedd in Bangor by ambulance on 31 March 2017 after being found seriously ill at home by her family GP. Mr Jibani told the inquest he had been in charge of her care when she was first admitted to the hospital’s Hebog ward. He told the coroner that tests showed she had a bacterial infection caused by the staphylococcus aureus bug, and he initially suspected the knee as the prime candidate for the location. He put Mrs Jones on antibiotics to treat it, and referred her case to the orthopaedic team. “Multiple other doctors suspected septic arthritis, but none of these are experts in that field,” Mr Jibani said. ‘Acute kidney injury’ “But others who are, including orthopaedic surgeons, gave us the opinion that it was not septic arthritis, and I am duty bound to respect that opinion.” Mrs Jones finally underwent a procedure on 3 May to draw fluid from her knee, which had a prosthetic replacement joint. Surgeons discovered pus in the knee, and consultant Mr Jibani told the inquest that it confirmed the presence of septic arthritis. Following the procedure to examine the knee, Mrs Jones developed pneumonia and her condition rapidly deteriorated. She died in May 2017, a month after being admitted to hospital Questioned by the legal team for the Betsi Cadwaladr University Health Board, Mr Jibani described Mrs Jones as a patient with complex health conditions, including heart disease and an acute kidney injury. “Looking back, it was never on the cards that she would recover,” he told the hearing. The inquest is continuing. BBC in other languages Copyright 2023 BBC. All rights reserved. The BBC is not responsible for the content of external sites. Read about our approach to external linking. Beta Terms By using the Beta Site, you agree that such use is at your own risk and you know that the Beta Site may include known or unknown bugs or errors, that we have no obligation to make this Beta Site available with or without charge for any period of time, nor to make it available at all, and that nothing in these Beta Terms or your use of the Beta Site creates any employment relationship between you and us. The Beta Site is provided on an “as is” and “as available” basis and we make no warranty to you of any kind, express or implied. In case of conflict between these Beta Terms and the BBC Terms of Use these Beta Terms shall prevail. Innovation

By John Ely Senior Health Reporter For Mailonline Published: 11:00 EST, 29 November 2023 | Updated: 11:05 EST, 29 November 2023

Sign up for our free Health Check email to receive exclusive analysis on the week in health Get our free Health Check email Newborn babies could be at a higher risk of a deadly bacterial infection carried by their mothers than previously thought. Group B Strep or GBS is a common bacteria found in the vagina and rectum which is usually harmless. However, it can be passed on from mothers to their newborn babies leading to complications such as meningitis and sepsis. NHS England says that GBS rarely causes problems and 1 in 1,750 babies fall ill after contracting the infection. However, researchers at the University of Cambridge have found that the likelihood of newborn babies falling ill could be far greater. Researchers have developed a new PCR test to check for the bacteria They claim one in 200 newborns are admitted to neonatal units with sepsis caused by GBS. Pregnant women are not routinely screened for GBS in the UK and only usually discover they are carriers if they have other complications or risk factors. The team reanalysed data from its previous study which found GBS in the placenta of about 5% of women prior to labour. The cohort included 436 babies born full-term, with the team confirming their findings in a second group of 925 pregnancies. Jane Plumb, co-founded charity Group B Strep Support with her husband Robert after losing their middle child to the infection in 1996. She said: “This important study highlights the extent of the devastating impact group B Strep has on newborn babies, and how important it is to measure accurately the number of these infections. “This research suggests that the number of preventable infections may be ten times higher than previously thought, each one having a significant impact on babies and their families. “Inadequate data collected on group B Strep is why we recently urged the Government to make group B Strep a notifiable disease, ensuring cases would have to be reported. “Without understanding the true number of infections, we may not implement appropriate prevention strategies and are unable to measure their true effectiveness.” The bacteria is usually harmless but can lead to infection in some cases Dr Francesca Gaccioli, of the department of obstetrics and gynaecology at the University of Cambridge, said the team’s findings – published in Nature Microbiology – “profoundly changes the risk/benefit balance of universal screening”. The research team has developed a new polymerase chain reaction (PCR) test which looks for the presence of the bacteria. Professor Gordon Smith, head of obstetrics and gynaecology at the University of Cambridge, said: “Using this new test, we now realise that the clinically-detected cases of GBS may represent the tip of the iceberg of complications arising from this infection. “We hope that the ultra-sensitive test developed by our team might lead to viable point-of-care testing to inform immediate neonatal care.” The study was funded by the Medical Research Council and supported by the National Institute for Health Research (NIHR) Cambridge Biomedical Research Centre.

Patients having surgery at Valley Regional Hospital (VRH) will get a sense of warmth and comfort through specialized warming systems being used to enhance patient safety and care. The initiative stemmed from Nova Scotia Health’s participation in the National Surgical Quality Improvement Program (NSQIP), which collects information on patients 30 days after their surgeries and uses the data on surgical outcomes to highlight areas for improvement and best practices to share and spread. Regulating patient’s body temperatures before, during and after their surgeries, was flagged by NSQIP and Perioperative (surgical) Services teams as being one of many key factors in overall efforts to prevent surgical site infections. During surgery, a patient’s body temperature can decrease below normal levels. This is called hypothermia and not only can patients experience discomfort from shivering, but it also places them at a higher risk for surgical site infections, blood loss and other negative outcomes. A steady core body temperature between 36°C to 38°C is considered normal, or normothermia in medical terms. Normothermia is proven to reduce surgical site infections, the need for pain medication and can also help reduce stress and anxiety. Since December, Valley Regional Hospital has been using special warming systems to help maintain and monitor patients’ temperatures and offer them a sense of comfort before, during, and in their recovery from surgery. The normothermia system consists of a warming gown attached to a small blower that circulates warm air to the patient 30 minutes before their surgery. The patient is continually warmed with a blanket during their surgery, and in recovery is connected to a portable system where they can safely control the temperature settings after waking up. “When patients wake up after surgery, keeping them warm is one way to reduce their risk of infection but also increases their comfort and care,” says Amy Rockwell, the NSQIP surgical clinical nurse reviewer at Valley Regional Hospital, who has been part of the initiative to bring the warming system to surgical patients. “Patients love the warming blankets. Having surgery can be stressful, but we find our patients wake up calmer after surgery. They are not shivering and feel like they have some sense of control in the recovery room,” says Rockwell. “Because normothermia decreases the need for anxiety medications and pain medications in the recovery room, it can often lead to quicker discharge times as well, since patients are not as drowsy and their vital signs are normal.” In her role, Rockwell spends a lot of time reviewing charts for information on patient outcomes and connecting with patients following their surgery. “Complications such as infections can result in patient discomfort, patients having to return to hospital, or visits to an emergency department or primary care clinics, so it important that our team works towards solutions that can reduce these occurrences and provide better care.” The warming systems are widely used in many Nova Scotia Health facilities currently and are being rolled out in other facilities across the province. Currently, the system is being used for patients undergoing scheduled surgeries longer than 30 minutes and Rockwell is already noticing improved patient outcomes. “It is rewarding for our teams to see initiatives like this one have a direct benefit for our patients. We have a wonderful team that care for patients and their families, and we are proud to be using our data to drive healthcare projects like this one that contribute to the well-being of Nova Scotians.” Quality improvement initiatives like these are part of Nova Scotia Health’s overall efforts to help patients get better results from their surgery and improve access to surgical care. Preventing infections helps reduce the time patients spend in hospital, the need to readmit patients to hospital, and visits to other services, saving vital healthcare resources to improve access and care for all.

Scarlet fever and streptococcal infections – What are they? What is a Streptococcal infection? These infections are caused by several strains of bacteria – the most common are streptococcus A and streptococcus B. These infections are extremely common and frequently responsible for sore throats experienced by millions of us every year. Most group A streptococcal bacteria cause relatively mild skin and throat infections, and are responsible for common conditions such as: strep throat (sore throat) impetigo (localised infection of the skin producing pus-filled blisters) cellulitis (infection of the skin, fat and underlying tissues) erysipelas (inflammation of the upper layers of the skin) tonsillitis (severe throat infection particularly impacting the tonsils) scarlet fever (infection causing sore throat, fever and rash) These infections are common and usually resolve quickly with antibiotics. It is rare for these infections to cause serious illness. If you or your child present with one of these infections contact your GP and get treatment early. It is not necessary to go to A&E. Invasive streptococcal infection However, Group A streptococcal bacteria can get into the blood, deep muscle or fat tissue and cause what are known as invasive streptococcal infections. These can be extremely serious and life threatening and are responsible for some of the following conditions: bacteraemia (blood infection) – which can lead to Sepsis endocarditis (heart lining infection) meningitis (brain and spinal cord inflammation) peritonitis (intestinal inflammation) urinary tract infection necrotising fasciitis (death of tissue under the skin which usually requires surgery) streptococcal toxic shock syndrome (infection causing low blood pressure and injury to organs such as the kidneys, liver and lungs – similar to Sepsis) Some people are natural carriers of streptococcal bacteria on their skin or in their throat, vagina, bladder or rectum. However, carriers do not usually develop an infection from this. How is it passed on? Streptococcal bacteria are spread by person-to-person contact with someone with an infection or less likely a carrier. Streptococcal bacteria can also spread in droplets from the nose or throat of someone with an infection. More rarely, streptococcal bacteria can enter the body in food contaminated with the bacteria – usually milk and milk products, and eggs. Invasive streptococcal infections develop when bacteria gets past the body’s natural defences such as a break in the skin. Health conditions that reduce immunity to infection make invasive infections more likely, so people with chronic illnesses like cancer, diabetes and kidney disease, and those who use medications such as steroids, are at greater risk. However invasive streptococcal infections can be a complication of other streptococcal conditions such as Scarlet Fever and so parents should be vigilant for early signs that their child may be getting worse or becoming seriously ill. Preventing the spread of Streptococcus The spread of bacteria can be reduced by good hand washing, especially after coughing and sneezing, before preparing foods and before eating. Cuts, grazes and other wounds should be kept clean and watched for signs of infection, including swelling, redness, pus and pain in the area of the wound. If you see any of these signs, you should visit your GP. What will the doctor do? Streptococcal infections are diagnosed by testing a swab from the throat, or by a blood or urine test. In all three cases, the test checks for the presence of streptococcal bacteria. Infections are treated with antibiotics. Invasive streptococcal infections usually require intravenous antibiotics given directly into a vein. The patient will need to be admitted to hospital and may require intensive care. Invasive infections that affect soft tissue, bone or muscle may require surgery. Early treatment improves the outlook greatly, but some invasive streptococcal infections and some group B streptococcal infections can be fatal. All strains of streptococcal bacteria can cause complications such as rheumatic fever (infection affecting the heart and joints) and glomerulonephritis (kidney inflammation). Sometimes Public Health will advise that all close contacts of people with streptococcal infection are given antibiotics. Streptococcus A infection is also responsible for Scarlet Fever and there has been a recent surge in cases of this infection post pandemic. Recognising if your child might have a streptococcal infection There are lots of viruses that cause sore throats, colds and coughs circulating. These should resolve without medical intervention. However, children can on occasion develop a bacterial infection on top of a virus and that can make them more unwell. As a parent, if you feel that your child seems seriously unwell, you should trust your own judgement. Contact NHS 111 or your GP if your child/baby is: getting worse feeding or eating much less than normal not drinking and not passing much urine is under 3 months and has a temperature of 38°C, or is older than 3 months and has a temperature of 39°C or higher feels hotter than usual when you touch their back or chest, or feels sweaty your child is very tired or irritable Call 999 or go to A&E if your child: is having difficulty breathing – you may notice grunting noises or their tummy sucking under their ribs there are pauses when your child breathes your child’s skin, tongue or lips are blue is floppy and will not wake up or stay awake isn’t drinking and hasn’t had a wee or a wet nappy in the last 12 hours they have mottled skin and their limbs are abnormally cold What are the symptoms? Streptococcal bacteria cause a wide range of infections. Each infection produces different symptoms. Symptoms of the most common streptococcal infection – strep throat – include: sore, red throat fever, headache swollen lymph nodes (lumps) in the neck and under the jaw Good hand and respiratory hygiene are important for stopping the spread of many bugs. By teaching your child how to wash their hands properly with soap for 20 seconds, using a tissue to catch coughs and sneezes, and keeping away from others when feeling unwell, they will be able to reduce the risk of picking up or spreading infections. Scarlet fever Scarlet

11/29/2023 Scientists Believe They Can Use One Vaccine to Study Others Each year, tuberculosis (TB) kills more people than any other infectious disease, falling out of the top spot only temporarily during the COVID-19 pandemic. Director of the Saint Louis University Center for Vaccine Development Daniel Hoft, M.D., Ph.D., works with colleagues in the lab. SLU File Photo. Despite TB’s wide reach and some lost progress during the COVID-19 pandemic, researchers believe it is possible to eradicate TB through advances in vaccine development and public health. To cross the finish line, scientists must find ways to test new vaccines rapidly to prevent TB infections more effectively. In a paper published in The Journal of Infectious Diseases, Daniel Hoft, M.D., Ph.D., director of the Saint Louis University Center for Vaccine Development, and colleagues from Saint Louis University, Emory University School of Medicine, The Emmes Company, LLC, the National Institute of Allergy and Infectious Diseases, part of the National Institutes of Health, and New York University Grossman School of Medicine, report a promising new approach to speed vaccine testing for TB. Hoft, who also serves as professor and chair of infectious diseases, allergy, and immunology at the Saint Louis University School of Medicine, sought data that could only be gathered by challenging the human immune system directly. This approach, Hoft hypothesized, could provide answers to some TB unknowns. For example, TB animal models do not fully mimic how the bacteria behaves in people, and vaccine developers do not have well-defined data about what TB immune responses offer optimal protection against the bacteria. To test new vaccines, infectious diseases researchers sometimes conduct human challenge studies to quickly learn about how well a vaccine candidate works against an infectious disease, such as influenza. In these studies, researchers first deliver an investigational vaccine or placebo to separate groups of healthy volunteers, and then intentionally infect study participants with a flu virus, all in carefully controlled settings and under close medical supervision, to determine whether the investigational experimental vaccine provides protection compared with the control group. This approach can be instrumental in generating data supporting the approval of novel vaccines. Mycobacterium tuberculosis, the bacteria that cause TB, however, is too dangerous for human challenge with the fully pathogenic bacteria. The team needed to find another, safer way to challenge the human immune system to find answers to their questions. Hoft found a workaround in the Bacillus Calmette-Guérin (BCG) vaccine. The most widely used vaccine in history, with more than 4 billion doses given to patients since 1921, the BCG vaccine contains a live but weakened version of the TB bacteria. The BCG vaccine is given to newborns to reduce their TB risk, but it is less effective against pulmonary TB and often wanes in effectiveness, providing little to no protection in adults. With the BCG vaccine, Hoft saw a chance to gather data about TB in a human study without the risk of exposing participants to full strength M. tuberculosis bacteria. To test this idea, the researchers gave 92 healthy adults the BCG vaccine, with participants receiving one of four different doses. With participants’ immune response to the BCG vaccine serving as a proxy for their exposure to a true infection, the researchers gathered much-needed data about how the immune system responds when it encounters TB. The team applied a battery of analysis methods to samples collected from the BCG challenge sites and blood, looking for associations between BCG at the injection site, and immune responses as well as gene expression changes in blood. The findings open up new doors for TB vaccine development. “Our findings are important for two reasons,” Hoft said. “First, this approach could enable us to screen new TB vaccines early in the pipeline and prioritize the most promising concepts, saving time and money.” “Second, we have a model to better determine what a new vaccine needs to do to protect against TB. We will be able to identify biomarkers indicating whether new vaccines could better protect someone against TB.” Among the findings that will help vaccine developers as they create new vaccines, The researchers determined that BCG challenge doses of up to 8 x 106 CFU were safe. They found that BCG at the challenge sites increases as the BCG dose increases. The researchers identified the most consistent and precise measure of BCG at challenge sites. Gene expression analysis found potential biomarkers of immunity that correlated with inhibition of BCG in people that may provide a TB protective signature. And they uncovered immunological and gene expression differences that could underlie the different risks of men and women developing active TB. This last point is an intriguing finding. Doctors have long observed that men appear to be more at risk of developing an active form of TB infection, but they do not know why. In this study, researchers found differences in the immune responses of men and women to the BCG challenge, a finding that parallels doctors’ observations with patients who develop the illness. Researchers hope this new model will help advance our understanding of why men and women have different levels of general immunity. Hoft is enthused by the study’s findings, which he says could provide a road map for future TB vaccine testing. “The BCG human challenge model is a promising approach for studying TB immunity,” Hoft said. “The new data will facilitate the vaccine development process, allowing us to make progress toward our ultimate goal of eradicating TB.” Research reported in this study was supported by the National Institute of Allergy and Infectious Diseases, part of the National Institutes of Health under award numbers HHSN272200800003C (SLU), HHSN272201300021I (SLU), HHSN272200800005C (Emory), and HHSN272201300018I (Emory). The content in this press release is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health. About the Saint Louis University Center for Vaccine Development Saint Louis University has been on the front lines in the fight against pandemics and global health crises for