Miscarriage

Women (and society) often believe it is something they did, or did not do, that caused the miscarriage. Early pregnancy tests mean that women often know they have miscarried when in earlier times it would have been put down to a late period. Much scientific research has gone into how common miscarriage is, and why it happens. An article in New Scientist brings together the latest findings.

• In 1975, researchers calculated that the number of babies born to married women in their 20's was 78% lower than expected. They proposed that miscarriages typically happen early and are a method of quality control. New research supports this theory.
• Today it is thought that for women in their early 30s, 60% of pregnancies end in miscarriage.
• The general population think miscarriages happen infrequently because they usually happen before the 12 week mark when it is socially acceptable to announce a pregnancy. Couples therefore often feel very alone and isolated when it happens to them.
• There is some evidence that stress, smoking and heavy alcohol consumption slightly increase the risk of miscarriage, as do conditions such as endometriosis and thyroid disorders, and infectious diseases like flu.
• But most miscarriages are unavoidable because they are caused by chromosomal errors in the embryo. The risk of miscarriages rise with maternal age as chromosomal abnormalities in embryos rises as women get older.
• Human embryos contain far more chromosomal errors than those of most mammals. Up to 80% of in-vitro fertilized embryos contain at least one chromosomally abnormal cell, and it is thought that the figure is probably similar for naturally conceived embryos. [The figure for mouse embryos is few than 10%.]
• Chromosomes contain all the genes needed to build a functioning human, so embryos with significant abnormalities usually don't survive. 
• Humans only have one child at a time so it is extra important that there are no abnormalities. [Animals with litters of 10 can afford to lose a couple and still have 8 live births.]
• An embryo starts burrowing into the endometrium (lining of the uterus) around 5 days after conception. It seems that endometrial cells usually flock to them and release chemicals that promote implantation and growth. But endometrial cells avoid embryos with chromosomal abnormalities and stop secreting the implantation chemicals. It is now estimated that about three-quarters of miscarriages occur at the implantation stage.

Whenever the miscarriage occurs, it is distressing, as many people start planning for the future as soon as they know they are pregnant. It can be a huge source of grief.

Understanding how the endometrium works as a gatekeeper may also explain the small proportion of couples who struggle to have children, either because they can't get pregnant or suffer repeated miscarriages. This might be that the endometrium sensor is programmed on a slightly wrong setting.

• If the sensor is overly selective, it will block the implantation of all embryos, leading to infertility.
• If it is overly receptive, it will let through embryos with chromosomal abnormalities, potentially resulting in later miscarriage or stillbirth.

Other factors may also govern the outcome. It has been noted that in the three to five months after traumatic events (such as New York September 11 attacks, or the Fukushima Daiichi nuclear disaster in Japan) birth records show there were fewer male births than usual in affected areas.

• Normally more males babies are born than female, as fewer survive infancy.
• But exposure to stressful events during pregnancy may promote the loss of male fetuses because males are more vulnerable in infancy than females. In very troubled times, stress may trigger a long-evolved process not to invest in a male that may not survive. 

One researcher feels there needs to be more education and public conversation about the true rate and causes of miscarriage, so couples aren't blindsided if it happens to them.

Source: Article Rethinking Miscarriage by Alice Klein in New Scientist, 8 Aug. 2020.

What Caused Brexit?

Who do I blame? Eight reasons we ended up in this Brexit mess. By Ian Jack

Who’s to blame? The problem is where to start.

1. De-industrialization. Jobs in UK manufacturing shrank from 7m to 5.1m between 1979 and 1986. More were lost in service industries. Of these losses, 94% were north of the line between the Wash and the Bristol Channel. Happening mostly during the Thatcher years, it has been wrongly attributed to government policy rather than the consequence of economic misfortune. Wealth and opportunity moved south. The social ruin was terrible. Skills were lost, traditions ended. Part of what it meant to be British disappeared. Nobody knew or seemed to care what was supposed to happen to places such as Oldham and Paisley.

2. Immigration. Both natives and immigrants need to revise ideas about where they live and the kind of people they are. As things started to settle after the 1950s influx, concerns were re-ignited with the 2004 Blair government decision to open the UK labour market to the eight new EU states, later conceded to be a mistake (only Sweden and Ireland did so as freely). In the first year 129,000 migrants turned up instead of the expected 5,000 to 13,000. “Nobody asked us!” said those who felt strongly about it (and then, in June 2016, somebody did ask.)

3. Cultural dementia. Historian Professor David Andress argues that France, the US and Britain are all engaged in “particular forms of forgetting, mistaking and misremembering the past”. As a population we are older than we have ever been, but seem to focus on daydreams of the past and along the way stir up old hatreds, give disturbing voice to destructive rage and risk the collapse of our capacity for decisive, effective and just governance. One such daydream is the belief that the nations of the old empire are “queuing up” to sign trade deals with the country that once ruled them.

4. The Dam Busters. Difficult to explain but England has a curious fascination for an Anglocentric version of WW2, which has grown even as the event has receded, perpetuating old notions of difference and moral superiority. This leads us to …

5. English exceptionalism. Sitting at the top table of nations, punching above our weight, a freedom-loving people ever ready to fight faceless bureaucracies and red tape seem to be predominantly English ideas.

6. The playing fields of Eton. Their damaging contribution to contemporary British politics includes David Cameron, Boris Johnson and Jacob Rees-Mogg: a too-confident incompetent, an opportunist and a cartoon version of the ruling class.

7. The newspapers. While some blame poor education for the Brexit vote, and the electoral influence of newspapers may shrinking now, with their circulations, they are far more rabid (eg the Mail, the Sun and the Telegraph) in England than in Scotland, and inform far more of the public debate.

8. Complacency. During the 2014 Scottish referendum campaign, some voters opted for independence because they felt that in areas like Sunderland, people want to leave Europe. Independence could allow Scotland to stay in the EU. Few were as farsighted.

Source: The Guardian, 3 March 2018

https://www.theguardian.com/commentisfree/2018/mar/03/brexit-immigration-jobs-eton-europe

Dishwasher Tips

Once a week, clean the filter to remove any build up of food and grime so it does not get put back on to your plates. Wash the filter in the sink using a soft brush.

Every two months, fill a plastic jug with 500ml distilled white vinegar, place on the top rack and run the machine empty. This will reduce limescale and remove grime and smells.

Every two months, carefully remove spray arms. Use a piece of wire or skewer to poke through and unclog the holes in the arms.

If cutlery is touching, water and detergent won't circulate and clean. Place half the cutlery facing upwards in the cutlery basket, and the other half facing down. Keep knives pointing down for safety.

Load crockery face towards the water jet and spray arms to enable water and detergent to reach inside bowls.

Unload bottom rack first to prevent water sitting in cups or saucers on the top rack spilling on to dry dishes below.

Keep dishwasher salt and rinse aid topped up. The salt helps prevent limescale and boosts the cleaning power of the detergent. Rinse aid helps drying and avoiding streaks.

Source: feature in Good Housekeeping, April 2019

Death Rates in UK Compared to Covid-19 Deaths

What is the true rate of Covid-19 deaths in the UK?

Covid-19 accounts for an average of 11 of the 1,687 deaths in Britain every day, according to official statistics.

In comparison, 124 people died each day from flu and pneumonia in the week ending Sept. 4.

Heart disease – Britain’s biggest killer – accounted for 460 deaths every day last year, while cancer kills an average of 450 people per day.

Around 87,000 people die of dementia each year – about 240 a day. Lung disease accounts for 31,000 deaths, or 84 every day, while fatal accidents at home – often while doing DIY – lead to 16 deaths per day.

Every day 5 people die in road accidents across the UK, while infections (including C.difficile and stomach bugs) kill 5,691 a year, about 16 people a day.

Last year (2019), there were 5,691 deaths attributed to suicide, an average of 15 per day.

There were 2,958 stillbirths, 2,831 deaths in infants under one year, and 3,248 deaths in children under five in 2018.

Source: article in Daily Mail, 20 Sept. 2020

Covid-19 Interferon Beta Treatment

Preliminary results of a clinical trial suggest a new treatment for Covid-19 reduces the number of patients needing intensive care.

The treatment. Developed by Southampton-based biotech company Synairgen. Uses a protein called interferon beta which the body produces when it gets a viral infection. The protein is inhaled directly into the lungs of patients with coronavirus, using a nebuliser. The hope is that it will stimulate an immune response.

The double-blind trial involved 101 volunteers who had been admitted for treatment of Covid-19 infections at nine UK hospitals. Half were given the drug and half a placebo (an inactive substance).

Initial findings. Suggest that the treatment  cut the likelihood of a patient developed severe disease (e.g. requiring ventilation) by 79%. Patients were two to three times more likely to recover to the point that everyday activities were possible. Indications were that there were very significant reductions in breathlessness. The average time spent in hospital is reported to have been reduced to six days, down from an average of nine days.

Publication and peer review. Stock market rules required the company to report preliminary results, but they have not yet been published in a peer reviewed journal. As the full data has not been released, the BBC were unable to confirm the claims. While the trial was relatively small, the indication that the treatment benefits patients was strong.

Implications. If results are as reported, it will be an important new treatment for coronavirus infections.

• Many governments have indicated that they will work as fast as possible to get promising coronavirus treatments approved. This could include emergency approval.
• Another possibility is that more patients will be able to receive the treatment while being monitored to confirm it is safe and effective.
• If approved for use, the drug and the nebulisers used to deliver it would then need to be made in large quantities.
• Previous clinical trials by Synairgen show it can stimulate an immune response and the patients with asthma and chronic lung conditions can comfortably tolerate the treatment.
• The Synairgen team believes the drug could be even more effective at the early stages of infection.

Reported 20 July 2020. Have not found any further updates.

Source: Coronavirus: protein treatment trial 'a breakthrough' by Justin Rowatt, 20 July 2020. BBC website: https://www.bbc.co.uk/news/health-53467022.

Deaths From Other (Non-Covid-19) Causes

 Deaths from other causes

In a normal year, there is a predicted number of deaths (e.g. strokes, heart attacks, cancer and old age) plus excess winter deaths due to respiratory diseases (including flu), circulation diseases, and dementia and Alzheimers diseases. 

It is important to distinguish between these and Covid-19 deaths. In England and Wales, excess winter deaths were 34,300 in 2016-2017 and 23,200 in 2018-2019. Flu deaths worldwide range from 290,000 to 650,000 per year.

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Zinc

Zinc is an important part of our diet. It is found in meat, shellfish, dairy and some cereals. Most people get enough from a balanced diet.

Zinc is pivotal in would healing, keeping the protective skin barrier intact, and supporting the function of white blood cells.

Woman need about 7mg a day, men need about 9.5mg. Too much zinc can reduce copper absorption by the body, carrying a risk of anaemia and osteoporosis, so if you choose a supplement, stick to a maximum of 25mg per day.

It has been suggested that zinc can reduce the ability of some viruses to multiply, so there have been many studies looking at the effect of zinc lozenges on both preventing and treating the common cold. While results have been conflicting (partly due to uncertainty about the dose and type of lozenge) there is some evidence that they might speed recovery from colds.

It is still too early for reliable studies into its effect on the coronavirus, though it is possible that it might inhibit the action of some viruses.

Source: Health column in Good Housekeeping, June 2020.

Covid-19 Who is most at risk?

Who is most at risk?

Adults over the age of 60.

Age is one factor in whether someone dies from Covid-19. This is because past the age of 60, someone is more likely to have heart disease, cancers and other medical conditions such as diabetes, which mean the body is less able to fight off the infection. The proportion of Covid-19 deaths by age groups is:

• 90% are over 60. (52% are over 80 and 39.7% are between 60 and 79.)
• 7% are between 40 and 59, while 0.72% are between 20 and 39
• 0.077% are between 0 and 19.

Very few children become severely ill with the virus

Children of all ages may catch the disease but are likely to have milder symptoms and a lower chance of severe disease than adults. They are also less likely to pass on the infection. Australian researchers have identified a number of factors which may explain this.

• Children have strong undamaged cells in their blood vessels which prevent inflamation and clotting, and their blood clotting system is different.
• They have elevated levels of vitamin D.
• Their immune system is fast acting. They are more likely to be infected with other pathogens such as colds and and other germs picked up in the playground. This can build a strong natural immune system.
• They have often been recently vaccinated for other diseases, including MMR. This effectively 'trains' the immune system and keeps it 'firing on all cylinders'.
• They have fewer ACE2 receptors, which the virus uses to infect cells. ACE2 becomes more prevalent as they grow up.

However a coronavirus-related inflammatory syndrome occasionally occurs in children. Symptoms include high temperature, low blood pressure, a rash and difficulty breathing; some also had tummy pain, vomiting or diarrhoea, and inflammation of the heart and abnormal blood test results. Experts say these are signs the body becomes overwhelmed as it tries to fight of the infection.

People who are overweight or obese.

Obesity increases the risk of a number of diseases, (e.g. heart disease, cancer and type 2 diabetes). The more overweight, the more fat you carry, the less fit you are and the lower your lung capacity. So it's a bigger struggle to get oxygen into the blood and around the body, which impacts on the heart and blood flow. Being overweight, you also have a demand for more oxygen. This can be a serious problem during a respiratory infection like coronavirus; the obese body  becomes overwhelmed by the lack of oxygen. Overweight and obese people in intensive care are more likely to need assistance with breathing and support with kidney function.

An enzyme called ACE2, present in cells, is the main way for the virus to enter the body. Higher levels of this are thought to be found in adipose (fatty) tissue, which could explain the higher risk of catching the disease and a higher risk of being ill with it.

The ability of the body to fight off the virus (the immune response) is not as good in people who are obese, due the inflammation driven by immune cells called macrophages which invade our fat tissue; they interfere with how our cells respond to infection. This can lead to a 'cytokine storm' - a potentially life-threatening over-reaction of the body's immune system which causes inflammation and serious harm.

And there can be challenges in managing these patients in intensive care: (a) it is more difficult to intubate them (put onto a ventilator); (b) to scan them because of weight limits and (c) they may be more tricky to turn, or prone, in order to relieve their breathing.

Men

Men are slightly more likely to die, but in some countries this is may be due to higher smoking rates in men which compromise lung function. New research shows that men have higher levels of the ACE2 receptor on cell surfaces, which binds to the new virus, allowing it to enter and infect cells. Men have a higher level of ACE2 found in the heart, kidneys and tissues lining blood vessels, and especially high levels in the testes. 

Black, Asian and Minority Ethnic (BAME) populations 

UK data (May 2020) suggests that 35% of critically ill patients are from BAME backgrounds. The following factors appear to be important.

Many BAME populations come from lower socioeconomic backgrounds and work in public-facing occupations (healthcare, cleaners, restaurant workers, transport and delivery workers and other public services). They are likely to be in inter-generational households, with more of the aged still at home, and religious activities with large numbers of attendees. Between 15% and 30% live in overcrowded households in contrast to just 2% of white British households.

They have an increased risk of certain diseases (e.g. diabetes and heart disease).  People from BAME backgrounds have more of a specific type of fat tissue which is prone to macrophage invasion (see section on obesity and the ACE enzyme), have elevated rates of diabetes, and may therefore be more vulnerable to the virus.

Pregnant women

Pregnant women may be at higher risk for severe infection but data is not yet available. 
Those with a pre-existing condition (e.g. high blood pressure, diabetes, heart disease and lung disease) are more likely to die.

People with disabilities that limit activity.

People (over the age of 9) with a disability that limits activity account for nearly 60% of UK Covid-19 deaths, but form only 16% of the population. (Study reported 18 Sept. 2020.)

Certain blood groups may be more likely to have severe infections

Ethnic and national populations can have different proportions of blood groups. Worldwide the rarest blood type is AB, while Rh negative blood types are found in 0.3% of Asian populations and 15% of European populations. Proportions can also differ within a country. In the UK, the ratio is O = 48%   A = 38%   B = 10%   AB = 3%. In southern England: O = 44%   A = 45%   B =  8%    AB = 3%.

A study in China (March 2020) found that the normal population ratio was A = 31%   B = 24%   AB = 9%   O = 34%, while the ratio for those with the virus was A = 38%   B = 26%  AB = 10%  O = 25%.  Researchers concluded that "blood group A had a significantly higher risk for Covid-19 compared with non-A groups, whereas blood group O had a significantly lower risk." (Their findings were published before peer review, so need to be treated with caution.) In the US, another study found a similar pattern but only among rhesus positive patients. NB. Susceptibility to infection does not necessarily equal risk to getting seriously ill. Other studies on infection rates and severity of illness relating to blood groups are currently in progress in several countries.

Another study of patients in Italy and Spain with Covid-19 respiratory failure found two genetic variants associated with the severity of their disease. One cluster of six genes had included genes that regulate ACE2. The other variant was the ABO blood group system. However, an analysis of medical data from thousands of people in the Boston area of the US found no association.

Note: Some other viruses are blood-group dependent. People with type A blood seem to be more susceptible to hepatitis B and HIV, while people with type O are somewhat protected against catching SARS.

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Covid-19 Diagnosis

Covid-19 Diagnosis

Have I got the virus?

The standard test uses a nasal swab (which can be self-administered) or a nose/throat area swab (done by trained healthcare workers). Current tests are thought to have up to 30% false negatives.

A study indicates that saliva collection may be easier to use and collects more viral material. The false negative rate appears to be better too (only 12%). Still to be confirmed by other studies.

Have I had the virus?

Antigen tests (which identify someone has had the infection) use a blood sample. These are still in development.

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