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Cancer: Signs you should never ignore - ‘Thousands risking their lives', warns NHS chief

Cancer is the second leading cause of death globally, accounting for an estimated 9.6 million deaths in 2018. The large group of diseases can start in almost any organ of the body when abnormal cells grow uncontrollably. The cancer burden has continued to grow globally over the past decade, however, the widespread disruption caused by COVID-19 has exacerbated concerns that many people will now be diagnosed with more advanced cancer. 

According to Cancer Research UK, one in two people in the UK born after 1960 will be diagnosed with some form of the disease during their lifetime.

NHS England chief executive Amanda Pritchard warned that thousands of people could be risking their lives by delaying seeking medical help.

She said: "It's incredibly important that people recognise the common symptoms that can signal a cancer diagnosis. It's vital that they take action by making an appointment with their GP that could ultimately save their life.

"Please don't delay and come forward to get yourself checked. We would rather see you sooner when any cancer could be easier to treat."

Key symptoms There are more than 200 different types of cancer and symptoms vary largely for each kind.According to Cancer Research UK, some key signs of cancer include:

• Croaky voice, hoarseness or a cough that won't go away - mMouth or tongue ulcer that lasts longer than three weeks - Coughing up blood
• A change in the bowel habit, such as constipation, looser poo or pooing more often.- Blood in your poo - Unexplained vaginal bleeding, including after sex, between periods or after menopause
• Blood in your pee - Problems peeing - Breathlessness - Difficulty swallowing - Persistent heartburn or indigestion - Appetite loss - Persistent bloating
• Very heavy night sweats 0 Appetite loss - Fatigue - Unexplained weight loss - Unexplained pain or ache - An unusual lump or swelling anywhere on the body
• A new mole or changes to a mole  - A sore that won't heal

The NHS is encouraging anyone with any of the above signs to visit their GP for a potentially life-saving check-up.

The warning comes as NHS England said that tens of thousands of people may be putting off seeking help because they do not want to add to extra pressure on GP surgeries and hospitals.

Moreover, recent survey results highlighted widespread ignorance of some cancer signs, with nearly two in three people oblivious to the fact that discomfort in the abdomen for three weeks or more is a possible sign of cancer.

Campaigns on television and social media are set to explain which symptoms could be a sign of cancer. 

Reference: Daily Express: Solen Le Net

Trainee doctor facing jail after ‘horrendous’ acid attack on fellow medic

A trainee doctor is facing jail after he admitted spraying sulphuric acid into the face of a fellow medic, leaving her with catastrophic and life-changing injuries.

Milad Rouf, 25, had been friends with Rym Alaoui since studying medicine alongside her at Cardiff University.

He later gave her a management role at the online medical website he launched.

But in May, Rouf turned up at her home in Brighton wearing a mask and sprayed concentrated acid into her face.

The 25-year-old, who was in her first year of postgraduate medical training at the Royal Sussex County Hospital, suffered appalling injuries to her face and chest.

She was rushed to the same hospital where she had been working and was treated by shocked colleagues.

Dr Alaoui remained in hospital for more than two months and will require reconstructive surgery.

No explanation given for attack

Rouf, who is yet to explain why he launched the attack, appeared at Lewes Crown Court on Monday, where he pleaded guilty to a single charge of “maliciously throwing or casting” sulphuric acid at the young doctor.

He admitted spraying the “corrosive liquid” with the intent to burn, maim, disable or disfigure her.

Wearing a white shirt and black trousers, Rouf stood impassively in the dock as the charge was read to him.

Asked how he pleaded, he said “guilty” before bowing his head.

Judge Christine Laing QC said she was mindful of the “extreme nature of this offence”.

“Given the serious nature of this offence, I have to consider all options. I also have to consider the question of dangerousness,” she said.

The court heard a full psychiatric report had been carried out and would be available on sentencing.

The attack happened on Steine Garden, a small residential cul-de-sac opposite Brighton Magistrates Court, in May.

Dr Alaoui, who was on a day off from work, is understood to have answered a knock on the front door of her shared house.

When she opened the front door, she was confronted by someone wearing a mask and sunglasses who then sprayed her with the liquid.

Colleagues ‘distressed’ by incident

Bystanders called an ambulance and Dr Alaoui, who was screaming in shock and pain, was treated at the scene before being rushed to hospital, where whe was treated by colleagues whom she worked alongside. One medic commented on social media, saying staff at the hospital had been shocked and “distressed” by the “tragic attack”.

Neighbours said the young woman suffered horrendous injuries and was seen being taken to an ambulance with a blanket over her head.

One said: “It all happened before I got home from work, but there was a real commotion with police and bystanders and an ambulance. I don’t know the lady who lives there, but by all accounts she was quite badly injured.”

Dr Alaoui, who was in her first year training as a junior doctor, was president of the Anaesthetics Society at Cardiff University, a role previously held by Rouf.

When he launched the DocBot online medical information platform in 2016, he offered Dr Alaoui a role on the management board.

The website is an online educational platform which aims to promote preventive medicine.

Rouf will be sentenced at Lewes Crown Court on October 7 and was remanded in custody. 

Reference: The Telegraph: Martin Evans

Does the explosion of the delta variant mean we need a new COVID-19 vaccine?

The rapid spread of the delta variant of SARS-CoV-2 has put more patients in hospital beds and led to reinstatements of mask mandates in some cities and states. The variant, which is more transmissible than previous variants, also seems more able to cause breakthrough infections in vaccinated people.

Fortunately, vaccines are forming a bulwark against severe disease, hospitalization and death. But with the specter of delta and the potential for new variants to emerge, is it time for booster shots — or even a new COVID vaccine? 

For now, public health experts say the far bigger emergency is getting first and second doses into people who haven't had a single shot. Most people don't need boosters to prevent severe illness, and it's not clear when or if they will. But companies are already looking into updating their vaccines for coronavirus mutations, and there is a good chance that third shots are coming soon for some people. Already, the Food and Drug Administration (FDA) and Centers for Disease Control and Prevention (CDC) have greenlighted booster shots for immunocompromised individuals. 

"I think we're looking at an inevitable move toward boosters, at least in higher-risk people like those of advanced age and obviously the immunocompromised," said Dr. Eric Topol, a professor of molecular medicine at The Scripps Research Institute in California.

Vaccine developers are working on the question of whether future COVID-19 shots will need to be tweaked for the delta variant, or other new variants. For now though, initial evidence hints that boosters of the original vaccine should add protection against delta. 

© Provided by Live Science Antibodies attack a coronavirus particle in this illustration.

Vaccine efficacy against delta

While all the COVID-19 vaccines in the U.S. are doing a fabulous job of preventing severe disease and death, it's clear that breakthrough infections are more common with this variant. Data on efficacy is still emerging, and efficacy is a moving target depending on a lot of factors. It's hard to make apples-to-apples comparisons between countries or hospital systems, said Jordi Ochando, an immunologist and cancer biologist at the Icahn School of Medicine at Mount Sinai. Different countries have different levels of vaccination, have used different vaccine mixes with different dose scheduling, and have different populations with different age stratification, comorbidities and levels of previous infection. 

Still, synthesizing data from different countries suggests the mRNA vaccines by Pfizer-BioNTech and Moderna are probably up to 60% or as low as 50% protective against infection with delta, Topol wrote on Twitter. That's right on the border of efficacy at which the Food and Drug Administration would approve a new COVID-19 vaccine. The J&J vaccine is probably less protective against symptomatic illness than a two-dose mRNA vaccine, based on studies finding that it elicits lower levels of neutralizing antibodies (which block the virus from entering cells).

Data is now emerging that the J&J vaccine likely prevents severe disease from delta as well. Though people with symptomatic breakthrough infections can spread the delta variant, the vaccines do still seem to reduce the likelihood of transmission by making any infection that does occur shorter. A study conducted in Singapore found that viral load started at similar levels in vaccinated and unvaccinated individuals who were infected with delta, but it dropped much faster in vaccinated individuals, beginning a steeper decline around day 5 or 6 of illness. This could mean that vaccination shortens the infectious period. However, more confirmation is necessary to show whether the Singapore results will hold up. The discovery that vaccinated people can have viable virus in their noses if infected is what made the CDC reverse its recommendation that vaccinated people did not need to wear masks.

Why delta can break through

It's not clear exactly why delta can break through vaccine-induced protection more frequently, but there may be multiple factors at play. One is that the antibodies that the vaccine elicits may not bind to the virus variant as well. Delta appears to have spike mutation proteins that make original coronavirus antibodies a worse fit, according to research published in Nature in July. This means that previously infected and vaccinated people have antibodies that aren't quite as protective against delta as they were against the original or alpha variants, said Yiska Weisblum, a postdoctoral researcher in retrovirology at The Rockefeller University in New York. 

Another possible reason for waning efficacy is that the immune system starts letting down its guard over time. This happens with the pertussis vaccine, which is why expectant parents and other adults who are going to be around unvaccinated newborns should get booster shots.

Whether waning immunity is likely to be a problem for COVID-19 vaccines is currently a hot topic among researchers. Israeli health authorities say they've seen an increase in breakthrough infections in people immunized in January versus March and are concerned about an uptick in more severe breakthrough cases in those 60 and older, according to Haaretz.

Data from an Israeli HMO published on the preprint server medRxiv before peer review found that 2% of people who requested a PCR test for any reason post-vaccination received a positive result. People vaccinated more than 146 days before being tested were twice as likely to experience a breakthrough infection. The vast majority of the cases in the study were delta. It's difficult to track waning immunity because you need to revisit the same group of people over time, tracking their infection status, Scripps' Topol told Live Science. That kind of data hasn't really emerged yet. But Topol said he's transitioned from skepticism over waning immunity to belief that it is occurring.

"It does look like there is a substantial interaction with delta finding people who are several months out from when they got fully vaccinated," Topol said. "It's a double hit. If you were six months out, and there is no delta, you're probably fine. The problem is this interaction."

Designing next-generation COVID vaccines

Delta's ability to infect the fully vaccinated raises questions about the best strategy going forward. One option would be to give a booster of the same vaccine, raising antibody levels to what scientists hope will be protective levels against delta. 

Vaccine manufacturers are also studying versions of the vaccines that update the spike protein targeted by their vaccines.

But trying to play catch-up with delta-specific vaccines might be akin to a game of whack-a-mole, said Dr. Krutika Kuppalli, an infectious disease specialist at the Medical University of South Carolina. There was talk of updating the mRNA vaccines with a spike protein specific to the alpha variant, Kuppalli told Live Science. Now, of course, alpha is vanishing on its own, being replaced by the far more transmissible delta.

"By the time [a new vaccine] might even be ready then we're on to the next one," Kuppalli said.

If delta has taught us anything, it's that ideally, a future SARS-CoV-2 vaccine wouldn't be delta-specific, but rather universal to all potential SARS-CoV lineages, Topol said. A universal vaccine could draw on similarities between the viruses — SARS-1, which emerged in 2003, is genetically 95% similar to SARS-CoV-2, after all — and be reverse-engineered to produce potent antibodies seen in some people infected with SARS viruses, Topol said.

"We could get there soon," Topol said. "That would hopefully be an enduring solution rather than an 'each Greek letter' solution." (Each new coronavirus variant of concern gets a new Greek letter name.)

Another promising notion is that of a needle-free, nasal spray vaccine against COVID-19. Nasal vaccines deliver directly to the spot where the virus lands and elicit immunity right in the mucous membrane that lines the nose. This mucosal immunity can combat the virus quickly, reducing viral replication in the nose, and thus tamping down viral shedding and transmission, University of Alabama at Birmingham researchers wrote July 23 in the journal Science.

A more immediate option might be to harness the advantages of having multiple approved vaccines, said Mount Sinai's Ochando. Mixing and matching vaccines seems to give an immunological boost over boosters of the same time, Ochando told Live Science, citing several papers published in The Lancet.

But even a booster of the original vaccine is likely to help improve immunity against delta. Weisblum and her colleagues have found that people who were infected with SARS-CoV-2 before delta became predominant and then got fully vaccinated have a broader array of antibodies than those who were only infected or those who were only vaccinated. This suggests that when the body sees some version of SARS-CoV-2 three times, it mounts a broader campaign against the invader — strong enough to take down even the delta variant. The researchers even tested these triple-strength antibodies against a spike protein mutated in the lab to resist antibodies from infection or vaccination and found that they conquered this multiple-mutant spike. 

"This data suggests that boosting definitely has the potential to increase the breadth of our antibody responses," Weisblum wrote in an email to Live Science. "It also suggests that boosting with the wild type original virus spike could be good enough (since the convalescent vaccinated individuals only saw the original spike), but updating the vaccine to mimic circulating or potentially emerging variants should increase the breadth of the response even more." 

An uncertain landscape

One reason the future of COVID-19 vaccines against new variants is hard to understand is that scientists aren't yet sure which immune cells best represent vaccine efficacy in the long term. Most studies now look at neutralizing antibodies. These are a good proxy for protection against infection, said Dr. Zain Chagla, an infectious disease specialist at McMaster University, but may not be as good a representation against protection against severe disease. That's because the immune system recruits a bevy of other cellular protectors such as B cells and T cells to fight once a virus invades. These defenses aren't as quick to the punch as neutralizing antibodies, but they can prevent an infection from turning serious.

Over time, though, antibodies decline (if they didn't, your blood would turn into a sluggish goo of antibodies), while long-term immune cells such as memory B cells and plasma cells persist, ready to mount a new response should the virus reappear again. One challenge for assessing vaccine efficacy going forward will be figuring out which sorts of immune cells to measure to determine how protected someone is from disease after antibody levels decline.

For diseases like hepatitis and measles, researchers have determined a cutoff for an antibody level that provides protection, Chagla said. "As long as you're over that cutoff, it tends to predict success or failure better than just, 'higher is better,'" he said.

There may be a similar cutoff for coronavirus antibodies, but researchers don't know what it is yet.

The trouble with waiting for this data, Ochando said, is that scientists have to study reinfections as they happen. Allowing reinfections opens up the possibility of allowing for more transmission, severe illness and spread. Thus, boosters might be ethically necessary as a precaution, even without rigorous clinical trials delineating their efficacy, Ochando said.

If a third dose of an existing or new formulation of COVID-19 vaccine proves necessary, it doesn't necessarily follow that everyone will need a COVID-19 shot every six months to a year for the rest of their lives. Some vaccines, like the Hepatitis B vaccine, perform best with a 3-dose series, after which there's rarely a need for a booster. It might be that three doses of an mRNA shot at the right spacing will provide strong and long-lasting protection, Céline Gounder, an infectious disease specialist and epidemiologist at the New York University Grossman School of Medicine, said on Twitter.

Whatever the data ultimately shows about the need for boosters, the real bang for the vaccination buck still lies in first shots, not third shots, Kuppalli told Live Science. Facing COVID-19 unvaccinated is much more dangerous than facing it fully vaccinated, and the continued circulation of the virus around the globe just means more opportunity for mutations that could benefit the virus.

"Right now, the U.S. is the driver of the world delta wave, and we are the leading force of nurturing new variants, because it's out of control here," Topol said.

The danger of being unvaccinated is global. Worldwide, only 15.6% of people are fully vaccinated, according to Our World in Data. This has many health experts concerned that high-income countries will be busy handing out booster shots while the rest of the world burns. It's another ethical quandary, Ochando said. Distributing booster shots to the immunocompromised and elderly in wealthy countries makes sense, he told Live Science, but providing third shots to young, healthy people in rich countries is hard to swallow when only 2% of Africa's population has been fully vaccinated, according to the Africa Centres for Disease Control numbers.

Kuppalli agreed.

"I understand countries want to take care of their own, but I think we need leaders to step back and look at the global picture and look at why we are in this continued cycle and look at why these variants keep emerging," Kuppalli told Live Science. "And the reason the variants keep emerging is we are unable to keep the global rate of the virus down."  

Reference: Live Science :Stephanie Pappas

Una Healy to be on medication for the rest of her life as she's diagnosed with autoimmune disease

The Irish singing star was given the heads up that she may want to see a doctor after a music producer heard her voice as she was touring with her former group, The Saturdays.

Una, 39, had become well known for her “husky tone” but as her team became worried about her, she sought diagnosis.

Opening up about the diagnosis on an Instagram interview with Emm Gryner, she said: “I remember when I joined the Saturdays first, you probably hear it a lot on the early recordings, my voice was a lot huskier, now I do have a husky tone that comes out sometimes, like a rasp.

“But I found that it was happening more and more and I went in one day to demo a song we were doing with the girls and the producer went ‘ok, can you do that again’ he looked really worried."

The girls were all sent to the doctor for a visit, with Una being questioned about swelling around her throat.

She continued: “I felt like I was losing my voice, and the doctor came in and was examining all of us. Because we were all feeling down and I guess the stress of it all.

“And he kind of looked around my neck, and he was like 'you’ve a bit of swelling around your throat there. Have you ever had your thyroid examined?'

© Redferns via Getty Images Una is famous for her role in former girl group The Saturdays

“And I said no, so I had my blood checked to check how my thyroid levels were and it turned out I’ve an underactive thyroid, so I’m hyperthyroid.

“It’s an autoimmune disease called Hashimoto's.”

The star revealed that she will be taking the drug thyroxine for the disease but was sure to make it clear to fans that she was “totally healthy”.

Una has had two children since the diagnosis after previously expressing worry that the condition could make her infertile.

The illness is one where the thyroid gland gets attacked by the immune system, causing symptoms of fatigue, depression, infertility, weight gain and even the famous husky voice Una is known for.

Una successfully conceived after the diagnosis and is mother to nine year old Aoife and six year old Tadgh with former partner Ben Foden. 

Reference: OK :George Folger