What is MERS? What you need to know

Middle East respiratory syndrome coronavirus (MERS-CoV), previously known as novel coronavirus (nCoV), is a viral respiratory illness, which was first reported in Saudi Arabia, in 2012. The source of MERS is currently unknown, though it is likely to have originated from an animal.

The MERS virus is currently spreading in South Korea. This, in combination with the fact that coronaviruses can often mutate, is leading to increased fears it could become a pandemic.

MERS-CoV is dissimilar to other coronaviruses; there is currently no vaccine.

Most confirmed cases of MERS-CoV have displayed symptoms of severe acute respiratory illness. Approximately 36% of reported patients with MERS have died.

Contents of this article:

1. MERS Outbreak updates
2. What is MERS-CoV?
3. What causes MERS-CoV?
4. Signs and symptoms
5. Who is most at risk?
6. Tests and diagnosis
7. Treatment and prevention
8. Confirmed cases and deaths

You will also see introductions at the end of some sections to any recent developments that have been covered by MNT's news stories. Also look out for links to information about related conditions.

Fast facts on MERS

Here are some key points about MERS-CoV. More detail and supporting information is in the main article.

• MERS-CoV was first reported in Saudi Arabia in 2012.
• MERS-CoV belongs to the coronavirus family.
• All cases have been linked to countries in and neighboring the Arabian Peninsula.
• Cases of MERS-CoV reported in other countries were travel-related and first developed in the Middle East.
• It is thought mammals play a role in the transmission of the virus - bats and camels remaining a high contender.
• In addition to humans, strains of MERS-CoV have been identified in camels in Qatar, Egypt and Saudi Arabia, and in a bat in Saudi Arabia.
• Doctors describe MERS-CoV as a flu-like illness with signs and symptoms of pneumonia.
• Sufferers of MERS-CoV will generally develop severe acute respiratory illness. Some people have reported mild respiratory illness with others showing no symptoms.
• There are no specific treatments for patients who become ill with MERS-CoV infection.
• Out of the confirmed cases of MERS-CoV, 36% have been fatal.

MERS Outbreak updates

June 5, 2015

In light of the recent outbreak of Middle East respiratory syndrome coronavirus (MERS-CoV), WHO and the Republic of Korea's Ministry of Health and Welfare will conduct a joint mission in the Republic of Korea.

This joint mission is to gain information and review the situation in the Republic of Korea including the epidemiological pattern, the characteristic of the virus and clinical features.

Based on current data and WHO's risk assessment, there is no evidence to suggest sustained human-to-human transmission in communities and no evidence of airborne transmission.

June 2, 2015

The outbreak of MERS-CoV in the Republic of Korea continues to evolve. The Republic of Korea's first, or "index", case was confirmed on May 20, 2015.

To date, contact tracing has identified a total of 25 laboratory-confirmed cases, including the index case and among health care workers caring for him, patients who were being cared for at the same clinics or hospitals, and family members and visitors. Two of these confirmed cases have been fatal.

June 2, 2015

A total of 1,179 laboratory-confirmed cases of human infection with MERS-CoV have been reported to WHO since 2012, including at least 442 deaths.

What is MERS-CoV?

MERS-CoV belongs to the coronavirus family. Human coronaviruses were first classified in the mid 1960s. The coronavirus subgroups are referred to as alpha, beta, gamma and delta. There are currently six coronaviruses that can affect humans including:

MERS-CoV belongs to the coronavirus family. Human coronaviruses were first classified in the mid 1960s. MERS-CoV was first reported in 2012 in Saudi Arabia.

Alpha coronaviruses

• Human coronavirus 229E
• Human coronavirus NL63 (HCoV-NL63, New Haven coronavirus).

Beta coronaviruses

• Human coronavirus OC43
• Human coronavirus HKU1
• SARS-CoV
• Middle East respiratory syndrome coronavirus (MERS-CoV).

Coronaviruses typically infect one species type or those that are closely related. However, SARS-CoV infects both humans and animals including monkeys, Himalayan palm civets, raccoon dogs, cats, dogs, and rodents.

The common cold is a virally related syndrome. It is connected to over 100 separate viruses, including human coronavirus.

MERS-CoV is a species in lineage C of the genus beta coronavirus, which presently includes tylonycteris bat coronavirus HKU4 and pipistrellus bat coronavirus HKU5.

MERS-CoV is a species in lineage C of the genus beta coronavirus, which presently includes tylonycteris bat coronavirus HKU4 and pipistrellus bat coronavirus HKU5. Although it features in the same subgroup, MERS-CoV is different from the coronavirus that caused severe acute respiratory virus (SARS) in 2003. One parallel between MERS-CoV and SARS is that they both are similar to coronaviruses found in bats.

MERS-CoV appears most closely to resemble the not-yet-classified viruses from insectivorous European and African bats in the Vespertilionidae and Nycteridae families.

All cases have been linked to countries in and neighboring the Arabian Peninsula including:

• Bahrain
• Iraq
• Iran
• Israel
• Jordan
• Kuwait
• Lebanon
• Oman
• Palestine
• Qatar
• Saudi Arabia
• Syria
• United Arab Emirates (UAE)
• The West Bank
• Yemen.

Cases of MERS-CoV reported in other countries were travel-related and first developed in the Middle East. Countries that have declared cases are:

Middle East

• Egypt
• Iran
• Jordan
• Kuwait
• Lebanon
• Oman
• Qatar
• Saudi Arabia (KSA)
• United Arab Emirates (UAE)
• Yemen.

Europe

• Austria
• France
• Germany
• Greece
• Italy
• Netherlands
• Turkey
• United Kingdom.

Africa

• Algeria
• Tunisia.

Asia

• China
• Republic of Korea
• Malaysia
• Philippines.

Americas

• US.

What causes MERS-CoV?

The cause of MERS-CoV is not yet fully understood. Although not confirmed, the infection could be primarily zoonotic in nature, with limited human-to-human transmission. It is thought mammals play a role in the transmission of the virus - bats and camels remaining a high contender.

It is thought mammals play a role in the transmission of the virus - bats and camels remaining a high contender.

In addition to humans, strains of MERS-CoV have been identified in:

• Camels in Qatar, Egypt and Saudi Arabia
• A bat in Saudi Arabia.

MERS-CoV antibodies were found in camels across Africa and the Middle East, indicating that they had previously been infected with MERS-CoV or a closely related virus.

Researchers from three centers in the United States and two in Saudi Arabia conducted complete genetic sequences for MERS-CoV isolates generated from five camels, the results verified them identical to published sequences of human isolates.

Goats, cows, sheep, water buffalo, swine and wild birds have been tested for antibodies to MERS-CoV; none have yet been detected.

The findings above support the hypothesis that camels are a probable source of infection transfer to humans, while bats may be the ultimate reservoir of the virus. The high infectious dose would require very close contact between an infected camel and humans for instigation of human MERS-CoV infection by camels. It has been suggested the virus could infect humans by air, via camel milk or meat.

Experts have commented that although the respiratory route of transmission is the most likely, the paper has exhibited that MERS-CoV can survive in raw camel milk marginally longer than milk of other species, proposing the foodborne path of transmission should be investigated further.

Recent developments on MERS-CoV causes

MERS may have started in bats in Saudi Arabia

Researchers have discovered what they believe could be the animal origin of Middle East respiratory syndrome (MERS) - after examining a bat in Saudi Arabia near where the first person was infected with the mystery virus.

MERS coronavirus: are camels the carrier?

A European study published gives the first hint that camels could be a reservoir for the mysterious MERS virus.

Signs and symptoms of MERS

The most common signs and symptoms of MERS-CoV are:

• Fever 100 degrees F or higher
• Cough
• Breathing difficulties
• Chills
• Chest pain
• Body aches
• Sore throat
• Malaise - a general feeling of being unwell
• Headache
• Diarrhea
• Nausea/Vomiting
• Runny nose
• Renal (kidney) failure
• Pneumonia.

Doctors describe it as flu-like illness with signs and symptoms of pneumonia. Early reports described symptoms as similar to those found in SARS-CoV (severe acute respiratory syndrome) cases. However, SARS infections did not cause renal failure, unlike MERS-CoV.

Sufferers of MERS-CoV will generally develop severe acute respiratory illness. Some people have reported mild respiratory illness with others showing no symptoms.

Who is most at risk?

The following groups of people are more susceptible to MERS-CoV infections and complications:

• Patients with chronic diseases, such as diabetes, chronic lung disease and heart conditions
• The elderly
• Organ transplant recipients who are on immunosuppressive medications
• Other patients whose immune systems are weak, such as cancer patients undergoing treatment.

Out of the confirmed cases of MERS-CoV, 36% have been fatal.

Tests and diagnosis

The polymerase chain reaction (PCR) test is used to detect and diagnose infectious disease and can confirm positive cases of MERS-CoV by means of a sample from the patient's respiratory tract.

A blood test can determine if an individual has previously been infected, by testing for MERS-CoV antibodies.

Recent developments on MERS-CoV diagnosis from MNT news

WHO: two confirmed US MERS cases, but still 'no public health emergency'

For the first time, the US has been confronted with two confirmed cases of the Middle East Respiratory Syndrome virus. Though public health officials are taking great steps to prevent spread of the illness, the World Health Organization say the conditions for a Public Health Emergency of International Concern have "not yet been met."

Difference Identified Between MERS-CoV And SARS

Research has identified the key differences between the Middle East respiratory syndrome coronavirus (MERS-CoV) and SARS.

CDC concludes Indiana MERS patient did not spread virus to Illinois business associate

After completing additional and more definitive laboratory tests, CDC officials have concluded that an Indiana MERS patient did not spread the virus to an Illinois associate during a business meeting they had before the patient became ill and was hospitalized.

Treatment and prevention

According to the US Centers for Disease Control and Prevention (CDC) and WHO (World Health Organization), there are no specific treatments for patients who become ill with MERS-CoV infection.

Most confirmed cases of MERS-CoV have displayed symptoms of severe acute respiratory illness, 36% of these patients have died.

All doctors can currently do is provide supportive medical care to help relieve the symptoms. Supportive care means providing treatment to prevent, control or relieve complications and side effects, as well as attempting to improve the patient's comfort and quality of life. Supportive care (supportive therapy) does not include treating or improving the illness/condition.

Travel advice has been provided to reduce the risk of MERS-CoV infection amongst travelers, which includes information such as:

• There is an increased chance of illness for those travelers with pre-existing chronic conditions
• There is an increased chance of illness for travelers suffering from flu and traveller's diarrhea
• Frequent hand-washing is advised with soap and water
• Avoid undercooked meat or food prepared under unhygienic conditions
• Ensure fruit and vegetables are properly washed before consumption
• If a traveller develops acute respiratory illness with fever, they should minimize close contact with others, wear a medical mask, sneeze into a sleeve, flexed elbow or tissue (making sure it is disposed of properly after use)
• If during 14 days after returning from travel acute respiratory illness with fever develops; medical attention should be sought immediately
• All cases should be reported to the local health authorities; they monitor for MERS-CoV.

While MERS-CoV is contagious, the virus does not appear to pass between humans without close contact, for example, caring for a patient without protective precaution. Therefore, guidance should be pursued from a health care professional if symptoms materialize.

With so little still known about the virus strain, any advice or recommendation should be considered temporary and subject to change.

Confirmed cases and deaths

The following figures are the total number of MERS-CoV cases and deaths as of June 9, 2015 as reported by WHO.

Total cases confirmed by the World Health Organization (WHO):

No. of cases	No. of deaths	Fatality %
1,236	445	36%

Recent developments on MERS-CoV treatment from MNT news

MERS lab strain could lead to vaccine

Scientists have developed a strain of the Middle East respiratory syndrome coronavirus (MERS-CoV) that could be used to develop a vaccine against the deadly pathogen.

Enzyme discovery holds promise for SARS, MERS vaccine

A study led by researchers from Purdue University in West Lafayette, IN, details a way of disabling a part of the virus involved in severe acute respiratory syndrome that allows it to hide from the immune system - a finding that may lead to the development of a vaccine against the disease.

The research team says their findings may also lead to the creation of a vaccine against Middle East respiratory syndrome (MERS) - a virus related to severe acute respiratory syndrome (SARS).

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Molecular mechanisms within fetal lungs initiate labor

Researchers have identified two proteins in a fetus' lungs responsible for initiating the labor process, providing potential new targets for preventing preterm birth. They discovered that the proteins SRC-1 and SRC-2 activate genes inside the fetus' lungs near full term, leading to an inflammatory response in the mother's uterus that initiates labor.

UT Southwestern researchers found that the proteins SRC-1 and SRC-2 activate genes inside the fetus' lungs near full term, resulting in an increased production of surfactant components, surfactant protein A (SP-A), and platelet-activating factor (PAF). Both SP-A and PAF are then secreted by the fetus' lungs into the amniotic fluid, leading to an inflammatory response in the mother's uterus that initiates labor.

Credit: © Noel Powell / Fotolia

Researchers at UT Southwestern Medical Center have identified two proteins in a fetus' lungs responsible for initiating the labor process, providing potential new targets for preventing preterm birth.

Previous studies have suggested that signals from the fetus initiate the birth process, but the precise molecular mechanisms that lead to labor remained unclear. UT Southwestern biochemists studying mouse models found that the two proteins − steroid receptor coactivators 1 and 2 (SRC-1 and SRC-2) -- control genes for pulmonary surfactant components that promote the initiation of labor. Surfactant is a substance released from the fetus' lungs just prior to birth that is essential for normal breathing outside the womb.

"Our study provides compelling evidence that the fetus regulates the timing of its birth, and that this control occurs after these two gene regulatory proteins − SRC-1 and SRC-2 − increase the production of surfactant components, surfactant protein A and platelet activating factor," said senior author Dr. Carole Mendelson, Professor of Biochemistry, and Obstetrics and Gynecology at UT Southwestern.

"By understanding the factors and pathways that initiate normal-term labor at 40 weeks, we can gain more insight into how to prevent preterm labor," said Dr. Mendelson, Director of the North Texas March of Dimes Birth Defects Center at UT Southwestern.

Each year about one in every nine infants in the United States is born preterm (before 37 weeks), according to the Centers for Disease Control and Prevention. Premature birth can cause brain hemorrhage and respiratory distress for babies, as well as long-term conditions such as cerebral palsy, chronic lung disease, and impaired vision.

The study, which appears in the Journal of Clinical Investigation, was supported by the National Institutes of Health and a Prematurity Research Initiative grant from the March of Dimes Foundation.

UT Southwestern researchers found that the proteins SRC-1 and SRC-2 activate genes inside the fetus' lungs near full term, resulting in an increased production of surfactant components, surfactant protein A (SP-A), and platelet-activating factor (PAF). Both SP-A and PAF are then secreted by the fetus' lungs into the amniotic fluid, leading to an inflammatory response in the mother's uterus that initiates labor.

The current study showed that a deficiency of both SRC-1 and SRC-2 inside the fetus' lungs drastically decreased the production of SP-A and PAF, causing a one- to two-day labor delay in mouse models, comparable to a three- to four-week labor delay in women.

Researchers further found that injecting either SP-A or PAF into the amniotic fluid of the deficient mice allowed the mothers to deliver on time. Together, the findings further define the underlying molecular mechanisms by which fetuses control the timing of birth.

Future research will include defining how fetal signals are transmitted to the mother's uterus, and relating these findings to the causes of preterm labor.

The study was conducted with current and former UT Southwestern researchers, including first author Dr. Lu Gao; Dr. Elizabeth Rabbitt; Dr. Jennifer Condon; Dr. Nora Renthal; Dr. John Johnston; Dr. Matthew Mitsche; and researchers from the Institut de Génétique et de Biologie Moléculaire et Cellulaire, France, and Baylor College of Medicine in Houston.

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Story Source:

The above post is reprinted from materials provided by UT Southwestern Medical Center. Note: Materials may be edited for content and length.

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Do newborns delivered by C-section face higher risk of chronic health problems later in life?

The evidence as to whether newborns delivered by C-section are more likely to develop chronic diseases later in life has been examined by investigators. The authors of a new study find that their evidence warrants concerns that C-section may lead to worse long-term child health.

Cesarean section is sometimes a medical necessity, or even an emergency. But it is increasingly a choice made in cooler moments, and the request is growing globally. At the same time, while repeat cesarean is not necessarily medically indicated for women with otherwise low obstetrical risk, there is a 90% repeat cesarean rate among women giving birth who have had a prior cesarean, in the US.

Credit: © Vivid Pixels / Fotolia

A new paper in the British Medical Journal by Jan Blustein, MD, PhD, of New York University's Wagner School and a professor of Medicine and Population Health at NYU School of Medicine and Jianmeng Liu of Peking University examines the evidence as to whether newborns delivered by C-section are more likely to develop chronic diseases later in life. While the jury is still out and research is ongoing, recent studies underscore the need for health care providers to discuss with expectant parents the risk of babies born through cesarean section developing obesity, asthma, and diabetes, according to the paper by Blustein and Liu.

Cesarean section is sometimes a medical necessity, or even an emergency. But it is increasingly a choice made in cooler moments. C-section on mothers' request is growing globally. At the same time, while repeat cesarean is not necessarily medically indicated for women with otherwise low obstetrical risk, there is a 90% repeat cesarean rate among women giving birth who have had a prior cesarean, in the US.

While cesarean and vaginal deliveries are both associated with well-known acute risks, recent studies link C-section to long-term child chronic disease. The authors review this evidence from a variety of sources. These include observational studies where researchers locate large samples of children, assess the extent of disease, and look back to see how the children were delivered. They also include a clinical trial, in which mothers were prospectively randomized to undergo cesarean or vaginal delivery. The authors find that the evidence warrants concerns that C-section may lead to worse long-term child health.

These risks have yet to be mentioned in clinical guidelines, which are the official documents that are used to educate doctors and midwives. "It's time to update the guidelines to include information about possible risks to long-term child health," comments Dr. Blustein.

She acknowledges that the evidence linking cesarean to worse child health is not unequivocal. "It is clear that cesarean-born children have worse health, but further research is needed to establish whether it is the cesarean that causes disease, or whether other factors are at play," Dr. Blustein says. "Getting definitive answers will take many years of further research. In the interim, we must make decisions based on the evidence that we have. To me, that evidence says that it is reasonable to believe that cesarean has the potential for long-term adverse health consequences for children."

"It takes awhile for research findings to reach clinicians and patients," says Blustein. "This research isn't widely known. It is time for that to change, so that doctors, midwives and patients can weigh the risks and benefits of elective cesarean, and decide accordingly."

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Story Source:

The above story is based on materials provided by NYU Langone Medical Center. Note: Materials may be edited for content and length.

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Scientists 'incredibly excited' by asthma treatment breakthrough

A breakthrough study has uncovered a potential root cause of asthma and a drug that reversed symptoms in lab tests. The finding brings hope to the 300 million asthma sufferers worldwide who are plagued by debilitating bouts of coughing, wheezing, shortness of breath and tightness in the chest.

While the breakthrough will be welcomed by all asthma sufferers, it will particularly excite the 1 in 12 patients who do not respond to current treatments.

The study - led by Cardiff University in the UK - reveals for the first time that the calcium-sensing receptor (CaSR) plays a key role in causing the airway disease.

The team used human airway tissue from asthmatic and nonasthmatic people and lab mice with asthma to reach their findings.

In the journal Science Translational Medicine, they describe how manipulating CaSR with an existing class of drugs known as calcilytics reversed all symptoms.

Calcilytics block the calcium-sensing receptor and were originally developed for the treatment of osteoporosis - a condition that makes bones more likely to break - also referred to as "brittle bone disease."

One of the crucial study results is that the symptoms the drug reversed include airway narrowing, airway twitchiness and inflammation - all of which make breathing more difficult.

Daniela Riccardi, principal investigator and a professor in Cardiff's School of Biosciences, describes their findings as "incredibly exciting," because for the first time they have linked airway inflammation - which can be triggered for example by cigarette smoke and car fumes - with airway twitchiness. She adds:

"Our paper shows how these triggers release chemicals that activate CaSR in airway tissue and drive asthma symptoms like airway twitchiness, inflammation, and narrowing. Using calcilytics, nebulized directly into the lungs, we show that it is possible to deactivate CaSR and prevent all of these symptoms."

While the finding is likely to be welcomed by all asthma sufferers, it will particularly excite the 1 in 12 patients who do not respond to current treatments and who account for around 90% of health care costs associated with the disease.

Could be treating asthma patients in 5 years - huge implications for other airway diseases

Calcilytics were first developed about 15 years ago for the treatment of osteoporosis, but while they proved safe and well tolerated in trials, results have been disappointing in patients with osteoporosis.

However, the fact they have already been developed and tested gives researchers the unique opportunity to repurpose them and hugely reduce the time it usually takes to bring a new drug to market.

Once funding is secured, the team hopes to be testing the drugs on humans within the next 2 years. Prof. Riccardi concludes:

"If we can prove that calcilytics are safe when administered directly to the lung in people, then in 5 years we could be in a position to treat patients and potentially stop asthma from happening in the first place."

The researchers believe their findings about the role of CaSR in airway tissue could have important implications for other respiratory conditions such as chronic obstructive pulmonary disease (COPD), chronic bronchitis. There are currently no cure for these diseases, which predictions suggest will be the third biggest killers worldwide by 2020.

In the following video, Prof. Riccardi and colleagues talk about their findings and a patient with asthma describes her excitement about the potential implications.

Asthma UK, the Cardiff Partnership Fund and the Biotechnology and Biological Sciences Research Council (BBSRC) helped finance the study.

Last month, Medical News Today learned of another important study that uncovered new clues about overproduction of mucus in asthma and COPD in the behavior of ion channels - membrane-sited proteins that help regulate the flow of charged particles in and out of cells.

The researchers, from Washington University School of Medicine in St. Louis, believe their findings will lead to treatments for a range of diseases including asthma, COPD, cystic fibrosis and even certain cancers.

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Antibiotic No Better For Coughs, Uncomplicated Chest Infections Than No Medication

Amoxicillin, the antibiotic doctors often prescribe for persistent coughs caused by uncomplicated chest infections such as bronchitis, is no more effective at easing symptoms than no medication at all, even in older patients. This was the finding of the largest randomised placebo controlled trial of antibiotics for lower respiratory tract infections (LRTI) done to date.

The study, which was led by the University of Southampton in the UK, is from the GRACE (Genomics to Combat Resistance against Antibiotics in Community-acquired LRTI in Europe) consortium and was funded by the European Community's Sixth Framework Programme.

A paper on the findings appears in the 19 December online issue of The Lancet Infectious Diseases.

First author Paul Little, Professor of Primary Care Research at Southampton, says in a statement:

"Patients given amoxicillin don't recover much quicker or have significantly fewer symptoms."

In fact, he adds, using amoxicillin to treat patients with respiratory infections who don't have pneumonia could not only be ineffective, but might actually harm them.

"Overuse of antibiotics, which is dominated by primary care prescribing, particularly when they are ineffective, can lead to side effects such as diarrhea, rash, vomiting and the development of resistance," he explains.

The European Centre for Disease Prevention and Control (ECDC) recently put out a statement saying that antibiotic resistance remains a major threat to public health around the world, and for the large part, the cause is misuse of antibiotics.

Chest infections, also known as lower respiratory tract infections (LRTI), are one of the most common acute illnesses treated in primary care settings in developed countries.

There is a lot of controversy about whether LRTI, especially in older people, should be treated with antibiotics, especially since viruses are thought to cause most of them, and previous studies have shown inconsistent results.

A recent study presented at CHEST 2012, the annual meeting of the American College of Chest Physicians, also suggests antibiotics are not successful in treating cough due to the common cold in children.

For this latest GRACE study, the researchers recruited 2,061 adults attending primary care practices with straightforward mild chest infections. The practices were located in 12 European countries: England, Wales, Netherlands, Belgium, Germany, Sweden, France, Italy, Spain, Poland, Slovenia, and Slovakia.

The participants were randomly assigned to be prescribed either amoxicillin or a placebo, to be taken three times a day for seven days.

The prescribing general practitioners (GPs) assessed their patients' symptoms at the start of the study period, and the patients also filled in diaries of their daily symptoms.

When they analyzed this data, the researchers found there was little difference in how severe the symptoms were or how long they lasted for, between the amoxicillin and placebo groups.

Even in those aged 60 and over with no other illnesses, antibiotics seemed to offer little benefit over placebo.

Patients in the antibiotic group reported significantly more side effects, including rash, nausea and diarrhea.

The researchers did conclude, however, that while most people seem to get better on their own, there is a small number of patients who do benefit from antibiotics, and "the challenge remains to identify these individuals," says Little.

In an accompanying commentary, Philipp Schuetz, from the University of Basel in Switzerland, notes:

"Little and colleagues have generated convincing data that should encourage physicians in primary care to refrain from antibiotic treatment in low-risk patients in whom pneumonia is not suspected."

However, the question remains, he says, of whether this "one-size-fits-all approach can be further improved".

He suggests perhaps one way to avoid the "toxic effects and costs" of antibiotics and "the development of resistance in the other patients", is to test for "specific blood biomarkers of bacterial infection", so as to "identify the few individuals who will benefit from antibiotics despite the apparent absence of pneumonia".

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Electronic Cigarettes Harm The Lungs

Electronic cigarettes, seen by many as a healthy alternative to tobacco smoking, do cause damage to the lungs, scientists from the University of Athens, Greece, explained at the European Respiratory Society's Annual Congress 2012, Vienna, on Sunday. Electronic cigarettes, also called e-cigarettes have also been marketed as effective smoking cessation devices.

Professor Christina Gratziou and team set out to determine what the short-term effects of smoking with e-cigarettes might be on different individuals, including those with no known health problems, as well as existing smokers with and without lung conditions.

They carried out experiments on 32 volunteers; of whom 8 were lifetime non-smokers and 24 were current regular smokers. Some of them had healthy lungs, while others lived with asthma or COPD (chronic obstructive pulmonary disease).
br> They were asked to use an electronic cigarette for 10 minutes, inhaling the vapors into their lungs. A spirometry test, as well as some others diagnostic procedures were used to measure their airway resistance. Airway resistance is used in respiratory physiology to measure the resistance of the respiratory tract to airflow coming in during inspiration (inhalation) and going out during expiration (exhalation).

They found that using an e-cigarette caused an instant increase in airway resistance that lasted for 10 minutes in the majority of the participants. Below are some of their findings:

• Non-smokers - even among lifetimes non-smokers, using an e-cigarette for ten minutes raised their airway resistance to 206% from 182% (mean average); the researchers described this as a "significant increase".


• Current regular smokers - among existing regular smokers, the spirometry tests revealed a significant rise in airway resistance to 220%, from 176% after using one e-cigarette for ten minutes.


• COPD and Asthma patients experienced no significant increase in airway resistance from using one e-cigarette for ten minutes.

Professor Christina Gratziou, who is Chair of the European Respiratory Society Tobacco Control Committee, said:

"We do not yet know whether unapproved nicotine delivery products, such as e-cigarettes, are safer than normal cigarettes, despite marketing claims that they are less harmful. This research helps us to understand how these products could be potentially harmful.

"We found an immediate rise in airway resistance in our group of participants, which suggests e-cigarettes can cause immediate harm after smoking the device. More research is needed to understand whether this harm also has lasting effects in the long-term. "The ERS recommends following effective smoking cessation treatment guidelines based on clinical evidence which do not advocate the use of such products."

What are electronic cigarettes (e-cigarettes)?

Electronic cigarettes, also known as vaporizer cigarettes and e-cigarettes, are devices that people use, often instead of tobacco cigarettes, that release doses of water vapor that may or may not include nicotine. E-cigarettes are powered by a small battery.

Manufacturers, distributors and marketers of electronic cigarettes say that they are an effective and healthier alternative to tobacco smoking, because the user does not inhale harmful tobacco smoke, which contains over 4,000 toxic chemicals.

Regular e-cigarette users say that the device offers them a similar sensation to tobacco-cigarette smoking. However, as there is no combustion involved - there is no smoke.

Electronic cigarettes are long tube-like devices that either look like tobacco cigarettes or biros (ballpoint pens). Most of them have replaceable cartridges; some are throwaway ones.

The user places the device between his lips and sucks in, this action activates a heating element that immediately vaporizes a liquid solution. The vapor is inhaled. Learning how to use an e-cigarettes, especially for a regular tobacco-smoker, is straightforward because the action is virtually identical to what is done when you smoke a tobacco cigarette.

A typical electronic cigarette has the following components:

• The mouthpiece - the replaceable cartridge is placed here. The user sucks or inhales from the mouthpiece.


• The atomizer - a heating element which vaporizes the liquid solution. The vapors are inhaled. In most devices, the atomizer needs to be replaced every three to six months.


• The battery - this is usually a rechargeable lithium-ion rechargeable battery. The battery is the power-source for the heating element. There is also some electronic circuitry in the device, such as the airflow sensor, a timed cutoff switch to prevent overheating, and a colored LED (light emitting diode) to indicate the device has been activated.

Electronic cigarettes are becoming increasingly popular, especially in Western Europe. It is estimated that many tens of millions of people worldwide are regular users.

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