Thousands more American senior citizens with kidney disease are good candidates for transplants and could get them if physicians would get past outdated medical biases and put them on transplant waiting lists, according to a new study by Johns Hopkins researchers.
The Hopkins investigators estimate that between 1999 and 2006, roughly 9,000 adults over 65 would have been ‘excellent’ transplant candidates and approximately 40,000 more older adults would have been ‘good’ candidates for new kidneys. None, however, were given the chance.
‘Doctors routinely believe and tell older people they are not good candidates for kidney transplant, but many of them are if they are carefully selected and if factors that really predict outcomes are fully accounted for,’ says transplant surgeon Dorry L. Segev, M.D., Ph.D., an associate professor of surgery at the Johns Hopkins University School of Medicine and leader of the study. ‘Many older adults can enjoy excellent transplant outcomes in this day and age,’ he says, and should ‘be given consideration for this lifesaving treatment.’
Those ages 65 and older make up over one-half of people with end-stage renal disease in the United States, and appropriately selected patients in this age group will live longer if they get new kidneys as opposed to remaining on dialysis, Segev says. The trouble is, he adds, that very few older adults are even put on transplant waiting lists. In 2007, only 10.4 percent of dialysis patients between the ages of 65 and 74 were on waiting lists, compared to 33.5 percent of 18- to 44-year-old dialysis patients and 21.9 percent of 45- to 64-year-old dialysis patients.
Segev cautions that some older kidney disease patients are indeed poor transplant prospects, because they have other age-related health problems. But he says his team’s new findings, in addition to other recent research, show that new organs can greatly improve survival even in this age group.
Segev and his team constructed a statistical model for predicting how well older adults would be expected to do after kidney transplantation by taking into account age, smoking, diabetes and 16 other health-related variables. Using those data to define an ‘excellent’ candidate, the information was then applied to every person 65 and older on dialysis during the seven-year study period. The researchers also determined whether these candidates were already on the waiting list.
‘We have this regressive attitude toward transplantation in older adults,’ Segev says, ‘one based on historical poor outcomes in older patients, which no longer hold up. Anyone who can benefit from kidney transplantation should at least be given a chance. They should at least be put on the list.’ Johns Hopkins Medical Institutions

Teenagers could be given full protection against Meningitis B, a new vaccine trial suggests. The study, conducted in Chile, is the first large-scale trial of 4CMenB amongst adolescents.
Tests showed that two doses of pharmaceutical company Novartis

Hopes of at last controlling malaria in Africa could be dashed by the emergence of poor-quality and fraudulent anti-malarial medicines, warn experts. Unless urgent action is taken both within Africa and internationally, they argue, millions of lives could be put at risk. In a study published, an international team of researchers report that some cases of medicines on sale in Africa have been deliberately counterfeited by criminals or are of poor quality because of factory errors. Both types are not only potentially harmful to the patient but also risk promoting the emergence of drug resistance among the parasites that cause malaria.
According to the World Malaria Report 2010, malaria killed an estimated 781 000 people in 2009, mainly young children and pregnant women. It is caused by parasites that are injected into the bloodstream by infected mosquitoes.
The most effective anti-malarial drugs are the artemisinin derivatives, which have the advantages over other anti-malarial drugs (such as chloroquine and mefloquine) of having few side-effects but the fastest action. Although the drugs have been used on their own as monotherapy, fears over the development of resistance mean that they are recommended for use in conjunction with one or more other drugs as artemisinin-based combination therapies, now recommended by the WHO as the first-line treatment for uncomplicated falciparum malaria globally.
There has been a dramatic rise in reports of poor-quality and counterfeit anti-malarials in Africa. To find out more about the different types of medicines circulating and what they contain, and to look for evidence of where they might have come from, the researchers examined anti-malarials – collected in 11 African countries between 2002 and 2010 – that they believed to be either counterfeit or substandard.
Analysis of the medicines showed that some counterfeits contained a mixture of wrong active pharmaceutical ingredients, some of which might initially alleviate malaria symptoms but would not cure malaria. Worse still, these unexpected ingredients could cause potentially serious side-effects, particularly if they were to interact with other medication that a patient was currently taking, such as anti-retroviral therapies for HIV.
Some of the counterfeits also contained small amounts of artemisinin derivatives, perhaps to try to ensure that the drug would pass simple authenticity tests. Taken at such low levels, the drug is unlikely to rid the body of malaria parasites, leading to the emergence of strains of the parasite resistant to artemisinin.
The researchers identified pollen found in some of the tablets, which indicated that the counterfeit medicines originated in eastern Asia. Indeed, in 2001, police in Guangzhou, China, arrested Nigerian and Chinese men for production of counterfeits of the anti-malarial halofantrine. No evidence of counterfeit pharmaceutical production in Africa was found in the pollen analysis; however, production facilities for packaging materials for counterfeit anti-malarials have been seized in Nigeria.
Dr Paul Newton from the Wellcome Trust-Mahosot Hospital-Oxford University Tropical Medicine Research Collaboration in Laos, who led the research, says: ‘Public health organisations must take urgent, co-ordinated action to prevent the circulation of counterfeit and substandard medicines and improve the quality of the medicines that patients receive. We must move finally away from the use of single drugs and towards the exclusive use of combination therapies.
‘The enormous investment in the development, evaluation and deployment of anti-malarials is wasted if the medicines that patients actually take are, due to criminality or carelessness, of poor quality and do not cure. Malaria can be readily treated with the right drugs of good quality, but poor-quality medicines – as well as increasing mortality and morbidity – risk exacerbating the economic and social impact of malaria on societies that are already poor. Wellcome Trust

Scientists have developed a new way to create electromagnetic Terahertz (THz) waves or T-rays – the technology behind full-body security scanners. The researchers behind the study say their new stronger and more efficient continuous wave T-rays could be used to make better medical scanning gadgets and may one day lead to innovations similar to the ‘tricorder’ scanner used in Star Trek.
In the study, researchers from the Institute of Materials Research and Engineering (IMRE), a research institute of the Agency for Science, Technology and Research (A*STAR) in Singapore, and Imperial College London in the UK have made T-rays into a much stronger directional beam than was previously thought possible, and have done so at room-temperature conditions. This is a breakthrough that should allow future T-ray systems to be smaller, more portable, easier to operate, and much cheaper than current devices.
The scientists say that the T-ray scanner and detector could provide part of the functionality of a Star Trek-like medical ‘tricorder’ – a portable sensing, computing and data communications device – since the waves are capable of detecting biological phenomena such as increased blood flow around tumorous growths. Future scanners could also perform fast wireless data communication to transfer a high volume of information on the measurements it makes.
T-rays are waves in the far infrared part of the electromagnetic spectrum that have a wavelength hundreds of times longer than those that make up visible light. Such waves are already in use in airport security scanners, prototype medical scanning devices and in spectroscopy systems for materials analysis. T-rays can sense molecules such as those present in cancerous tumours and living DNA, since every molecule has its unique signature in the THz range. They can also be used to detect explosives or drugs, for gas pollution monitoring or non-destructive testing of semiconductor integrated circuit chips.
Current T-ray imaging devices are very expensive and operate at only a low output power, since creating the waves consumes large amounts of energy and needs to take place at very low temperatures.
In the new technique, the researchers demonstrated that it is possible to produce a strong beam of T-rays by shining light of differing wavelengths on a pair of electrodes – two pointed strips of metal separated by a 100 nanometre gap on top of a semiconductor wafer. The structure of the tip-to-tip nano-sized gap electrode greatly enhances the THz field and acts like a nano-antenna to amplify the wave generated. In this method, THz waves are produced by an interaction between the electromagnetic waves of the light pulses and a powerful current passing between the semiconductor electrodes. The scientists are able to tune the wavelength of the T-rays to create a beam that is useable in the scanning technology.
Lead author Dr Jing Hua Teng, from A*STAR