Migraine Patients Who Experience Aura May Have A Two-Fold Increased Risk For Ischemic Stroke

A systematic review and meta-analysis of case-control and cohort studies finds that patients with migraine with aura have a two-fold increased risk for ischemic stroke compared to non-migraineurs. This association does not appear among migraineurs without aura[i]. Migraine with aura is often characterized by visual disturbances such as flashes of light, zigzagging patterns or even blind spots, which are then followed by a migraine attack. A migraine aura may sometimes also present with other sensations, such as numbness or tingling in parts of the body and speech problems.[ii]

Results of the studies are being presented this week at the 14th International Headache Congress (IHC) hosted in Philadelphia by the American Headache Society (AHS).

The authors also found that the increased risk among migraineurs with aura was further magnified for migraineurs less than 45, smokers and women using oral contraception.

The analysis was done by a team of researchers from Brigham and Women’s Hospital, Boston; Harvard School of Public Health, Boston; Albert Einstein College of Medicine, Bronx, NY; Merck and Co., Inc., Whitehouse Station, NJ; Montefiore Headache Center, Bronx, NY; INSERM Unit 708, Paris, France; Pierre et Marie Curie University, Paris, France; and University Hospital Essen, Germany.

“Our purpose was to pool and analyze existing data to investigate the association between migraine and risk of stroke as well as other cardiovascular events,” said Markus Schuerks, M.D., M.Sc., lead author of the analysis. “We found that patients who experience migraine with aura have a two-fold increased risk for ischemic stroke, although we did not find any overall association between any migraine and myocardial infarction or death due to cardiovascular disease,” he said.

“Beyond its pain and debilitating side effects, migraine holds real risks associated with other disorders, including stroke,” said Fred Sheftell, M.D., AHS president. “This meta-analysis further validates the disease burden that migraine sufferers must bear and dramatically underscores the need for more research in migraine diagnosis and treatment.”

More than 400 scientific papers are to be presented during the IHC/AHS meeting which is expected to draw some 1,200 migraine specialists and scientists from around the globe. The meeting is the world’s largest professional conference on migraine and headache-related diseases.

[i] Migraine and cardiovascular disease: a systematic review and meta-analysis
Schuerks M1,9, Rist PM1,2, Bigal ME3,4, Lipton RB3,5,6, Buring JE1,2 and Kurth T1,2,7,8 1Division. of Preventive Medicine, Brigham and Women’s Hospital, Boston, MA, USA; 2Department of Epidemiology, Harvard School of Public Health, Boston, MA, USA; 3Neurology, Albert Einstein College of Medicine, Bronx, NY, USA; 4Merck Research Laboratories, Merck and Co., Inc., Whitehouse Station, NJ, USA; 5Department of Epidemiology
and Population Health, Albert Einstein College of Medicine, Bronx, NY, USA; 6Montefiore Headache Center, Albert Einstein College of Medicine, Bronx, NY, USA; 7Neuroepidemiology, INSERM Unit 708, Paris, France; 8Faculty of Medicine, Pierre et Marie Curie University, Paris, France; 9Neurology, University Hospital Essen, Essen, Germany

[ii] MayoClinic, March 3, 2009.

International Headache Society

Stroke Diagnosis And Care Could Be Improved By New 3-D Ultrasound

Using 3-D ultrasound technology they designed, Duke University bioengineers can compensate for the thickness and unevenness of the skull to see in real-time the arteries within the brain that most often clog up and cause strokes.

The researchers believe that these advances will ultimately improve the treatment of stroke patients, whether by giving emergency medical technicians (EMT) the ability to quickly scan the heads of potential stroke victims while in the ambulance or allowing physicians to easily monitor in real time the patients’ response to therapy at the bedside.

The results of the latest studies were reported online in the journal Ultrasound in Medicine & Biology. The research was supported by the National Institutes of Health and the Duke Translational Medicine Institute, with assistance from the Duke Echocardiography Laboratory.

“To our knowledge, this is the first time that real time 3-D ultrasound provided clear images of the major arteries within the brain,” said Nikolas Ivancevich, graduate student in Duke’s Pratt School of Engineering and first author of the paper. “Also for the first time, we have been able overcome the most challenging aspect of using ultrasound to scan the brain – the skull.”

The Duke laboratory, led by biomedical engineering professor Stephen Smith, has a long track record of modifying traditional 2-D ultrasound – like that used to image babies in utero – into more advanced 3-D scans, which can provide more detailed information. After inventing the technique in 1991, the team has shown its utility in developing specialized catheters and endoscopes for imaging the heart and blood vessels.

“This is an important step forward for scanning the vessels of the brain through the skull, and we believe that there are now no major technological barriers to ultimately using 3-D ultrasound to quickly diagnose stroke patients,” said Smith, senior author of the paper.

“I think it’s safe to say that within five to 10 years, the technology will be miniaturized to the point where EMTs in an ambulance can scan the brain of a stroke patient and transmit the results ahead to the hospital,” Smith continued. “Speed is important because the only approved medical treatment for stroke must be given within three hours of the first symptoms.”

Ultrasound devices emit sound waves and then create images by calculating the angle of the waves as they bounce back.

For their experiments, the Duke team studied 17 healthy people. After injecting them with a contrast dye to enhance the images, the researchers aimed ultrasound “wands,” or transducers, into the brain from three vantage points – the temples on each side of the head and upwards from the base of the neck. The temple locations were chosen because the skull is thinnest at these points.

Ivancevich took this approach one step further to compensate for the thickness and unevenness of the skull in one subject.

“The speed of the sound waves is faster in bone than it is in soft tissue, so we took measurements to better understand how the bone alters the movement of sound waves,” Ivancevich explained. “With this knowledge, we were able to program the computer to ‘correct’ for the skull’s interference, resulting in even clearer images of the arteries.”

The key to obtaining these images lies in the design of the transducer. In traditional 2-D ultrasound, the sound is emitted by a row of sensors. In the new design, the sensors are arranged in a checkerboard fashion, allowing compensation for the skull’s thickness over a whole area, instead of a single line.

The 3-D ultrasound has the benefit of being less expensive and faster than the traditional methods of assessing blood flow in the brain – MRI or CT scanning, Ivancevich said. Though 3-D ultrasound will not totally displace MRI or CT scans, he said that the new technology would give physicians more flexibility in treating their patients.


Other Duke members of the team were Gianmarco Pinton of Pratt, and Duke University Medical Center division of neurology researchers Heather Nicoletto, Ellen Bennett and Daniel Laskowitz.

Source: Richard Merritt

Duke University

Defra Unveils Further Bovine TB Test Improvements, USA

Animal Health and Welfare Minister Ben Bradshaw has today announced further action to enhance testing for bovine tuberculosis (TB) in cattle.

These new measures include:

– details of how the gamma interferon blood test will be used more extensively alongside the skin test to improve the sensitivity of the testing regime and speed up the identification of more infected animals;

– a report on Bovine TB testing procedures in England and Wales, and;

– the conclusions of the Chief Veterinary Officer’s review into the fall in the number of new TB incidents in Great Britain.

“Our cattle testing programme is a crucial part of our efforts to reduce bovine TB,” said Mr Bradshaw. “The tuberculin test is, and will remain, central to TB cattle controls, but we can improve our testing regime by making greater use of the gamma interferon blood test.

“Therefore, from October we will treble the number of gamma interferon tests that are carried out and target them on those herds where they will deliver the greatest impact,” he said.

“The tuberculin test is effective when carried out properly. DNV Consulting’s report on our current procedures provides welcome assurance about the overall effectiveness of the national testing programme. However, some of the evidence about the degree to which individuals depart from testing procedures highlights a need for corrective action.

“The State Veterinary Service will be reviewing existing training procedures and tightening up the management of both its own staff and private vets contracted to carry out TB testing. I would urge the veterinary profession to work with us to raise the standard of TB testing in GB.”

Details of how the gamma interferon blood test for bovine TB will be introduced across England and Wales from October are available below.

Chief Veterinary Officer Debby Reynolds was asked by Mr Bradshaw in June to undertake a review of the apparent fall in the number of new TB incidents. She has concluded that there has been a real reduction in the number of new TB incidents, but that it is too early to determine whether this is a temporary phenomenon or likely to become a sustained trend.

Dr Reynolds has considered whether the switch in tuberculin supply from that manufactured by the Veterinary Laboratories Agency to that purchased from Holland could have caused this reduction.

She has concluded that the small difference in performance between the two tuberculins is not significant enough on its own to have had such a significant impact, particularly against the background of the evidence in the DNV Consulting report about the variation in the way the test is carried out.

Further analysis will be carried out to try to reduce the level of uncertainty around these conclusions.

– Gamma interferon research
– DNV Consulting’s review
– Debby Reynolds’ report

Potential Health Implications For Smoke-Related Chemical Discovered In The Atmosphere

Cigarette smoking, forest fires and woodburning can release a chemical that may be at least partly responsible for human health problems related to smoke exposure, according to a new study by NOAA researchers and their colleagues.

Using a custom mass spectrometer designed by the researchers, the NOAA-led team was able get the first look at levels of the chemical, isocyanic acid, in the atmosphere. Isocyanic acid has been difficult to detect with conventional measurement techniques.

“We found isocyanic acid in a number of places, from air in downtown Los Angeles and air downwind of a Colorado wildfire, to cigarette smoke,” said Jim Roberts, lead author of the new paper and a chemist with NOAA’s Earth System Research Laboratory in Boulder, Colo. “We also demonstrated that it dissolves readily in water, which means that humans can be exposed directly if it gets into eyes or lungs.”

The health effects of such exposure are not fully known. In the body isocyanic acid, described by the chemical formula HNCO, is part of a biochemical pathway linked with cataracts and inflammation that can trigger cardiovascular disease and rheumatoid arthritis. Until now, the acid had not been measured in air outdoors or in tobacco smoke.

The research team made four separate measurements of HNCO: in the air in urban Los Angeles; in the air in Boulder downwind of the fall 2010 Fourmile Canyon wildfire; in laboratory burning experiments at high concentrations; and in cigarette smoke. The team also made the first measurements of the acid’s ability to dissolve in water, which determines the chemical’s tendency to dissolve into moist tissues in the body.

“There are literally billions of people in the world who burn biomass for cooking and heating,” Roberts said. “If these indoor fires release similar levels of isocyanic acid as the fires we studied in the laboratory, families could be exposed to high levels of the chemical.”

Roberts and colleagues from NOAA and University of Colorado at Boulder’s Cooperative Institute for Research in Environmental Sciences, the, North Carolina Agricultural and Technical State University and the University of Montana published their paper in the May 17 edition of the Proceedings of the National Academy of Sciences.

The research project started in the Missoula Fire Sciences Laboratory, where scientists burned brush, tree branches and other vegetation, to better understand the air quality effects of wildfires. They used a new, specialized instrument – a mass spectrometer built by Roberts and several colleagues – to measure the amounts of a suite of organic acids, which are emitted by burning vegetation. Such acids are involved in chemistry that can degrade air quality.

During simulated wildfires in the Montana laboratory, levels of HNCO approached 600 parts per billion volume (ppbv). The HNCO was a few thousand times less concentrated in both the air in Los Angeles during a time without recent fires, and in the air in Boulder when the Fourmile Canyon fire was burning upwind.

At about 1 ppbv, the research team calculated that enough HNCO would dissolve into exposed tissues – lungs and eyes – that those tissues could be vulnerable to “carbamylation,” part of the chemical process triggering inflammation and cataract development. People could experience higher exposure to HNCO near wildfires or in indoor environments where coal, wood or other biomass is burned for heating or cooking. The health effects of chronic exposure to lower-level amounts isocyanic acid, such as those found in the California and Colorado air are not known.

The extreme sensitivity of the new instrument to low concentrations of HNCO made it impossible to quantify the very high levels of isocyanic acid in cigarette smoke.

“We conclude that tobacco-derived HNCO needs to be measured more extensively and potential exposure to it quantified,” the scientists wrote, adding that the acid is not currently listed as a “harmful” or “potentially harmful” constituent in tobacco products or smoke.

In their paper, researchers noted other sources of atmospheric HNCO, including pollution-control equipment that is being introduced in California and Europe to reduce emissions by diesel trucks. The systems are designed to reduce nitrogen oxides, which contribute to air quality problems, but they emit HNCO as a by-product. This new source could increase human exposure to the chemical in urban areas.

Moreover, climate change is expected to bring hotter temperatures and drier conditions to some regions of the world, with accompanying increases in biomass burning, including wildfire. “We may be facing a future of higher amounts of HNCO in the atmosphere,” said Roberts. “It is fortunate that now we can measure it.”


Other authors of the new paper, “Isocyanic acid in the atmosphere and its possible link to smoke related health effects,” are Patrick R. Veres, Anthony K. Cochran, Carsten Warneke, Ian R. Burling, Robert J. Yokelson, Brian Lerner, Jessica B. Gilman, William C. Kuster, Ray Fall, and Joost de Gouw.

Katy Human
NOAA Headquarters

No Pacemakers In The Brain May Explain Cot Death – Subset Of Cells In The Brain Appear Essential For Gasping

The mystery of cot death may be explained by new research published online in Nature Neuroscience (Sunday 12 February 2006).

A failure to ‘gasp’ has long been proposed as the basis for sudden infant death syndrome, or cot death. A team at the University of Bristol has discovered a subset of cells in the brain that have the ability to self-generate nervous impulses, which appear essential for gasping. These cells have been termed ‘pacemakers’.

Professor Julian Paton who heads up the research team at Bristol University said: “Our studies resolve a 15-year long controversy by showing that pacemaker cells in the brain appear responsible for gasping but not normal breathing. Importantly, cot death has been proposed to result from a failure of autoresuscitation and gasping.”

Using a unique experimental set-up developed in Bristol, Paton combined forces with two other world leaders in respiration – Dr. Jeffrey Smith (NIH, USA) and Professor Walter St.-John (Dartmouth, USA) – to discover how gasping works. They found that many different types of brain cells are essential for normal breathing, but only a small subset of these is required for gasping or autoresuscitation.

If normal breathing should stop, this backup system is activated to induce gasping. This restores oxygen supplies and kick-starts the heart beat so that normal breathing can resume.

“A very important aspect of this work is that we have discovered a mechanism within the brain that allows autoresuscitation of both breathing and the heart beat to come about when oxygen levels are critically low,” said Dr. Smith.

Paton and colleagues found that these pacemaking cells were dependent upon a unique protein that forms a tiny hole or pore within the membrane of the cells. When oxygen levels are low this pore opens wider to allow the passage of sodium ions into the cell and provides a way in which gasping can occur automatically.

The team showed that when this pore was blocked it eliminated pacemaking and the ability to gasp. Consequently, the heart would fail and death would be inevitable. This raises the intriguing possibility that a genetic defect in this special protein found in pacemaking cells could prevent gasping.

St.-John commented: “Our findings are exciting they demonstrate that emergency breathing, or gasping, is regulated by different mechanisms than those for normal breathing. This result explains why gasping is such a powerful mechanism for autoresuscitation..”

Cherry Lewis
University of Bristol

Effective Malaria Medications Not Getting Through To People Who Need Them Most

Alarmingly few African patients with malaria are getting existing effective treatment that could cure them in a few days, says Doctors Without Borders/Mйdecins Sans Frontiиres (MSF). Four years after the World Health Organization (WHO) issued a global recommendation for countries to switch from old malaria treatments to artemisinin-based combination therapies, or ACTs, and two years after the Global Fund decided to fund ACTs, MSF teams are witnessing government-run health facilities still giving patients old malaria medicines instead of a treatment that works.

In the West African country of Guinea, malaria is the leading cause of death, accounting for over 15 percent of all deaths recorded in the country’s health facilities. “Here in the town of Dabola, we manage to provide ACTs and we see our patients cured after three days, but just 40 km down the road the situation is dramatically different – people aren’t getting the best treatment although officially, the government changed the protocol a year ago,” said Dr. Barbara Maccagno, medical coordinator for MSF in Guinea. MSF estimates that less than one percent of all malaria patients in the country are getting ACTs today.

Guinea is by no means an isolated case. In Zambia, MSF estimates that a mere 11 percent of all patients presenting with malaria are receiving ACTs. MSF teams in several African countries report similar experiences. In Sudan, Kenya, Malawi, Cфte d’Ivoire, and Sierra Leone, the ministries of health are still using chloroquine or sulfadoxine-pyrimethamine, drugs known to be largely ineffective in many areas due to resistance and no longer recommended as first-line treatment.

Nearly 40 African countries or territories have adopted ACTs as their national treatment protocol for malaria to date. Of these, however, over 70 percent are either not deploying the policy at all or are implementing it very slowly. This is due to a combination of obstacles such as lack of political will and financial and human resources; lack of training for health workers and the resulting poor recognition of the benefits of ACTs among the communities; shortages of ACTs of assured quality; the fact that health workers do not have access to rapid diagnostic tests; and poor access to health care in general. Therefore malaria, a curable disease, continues to kill a child every 30 seconds.

“The lack of coordinated support to countries by WHO’s malaria program, the Roll Back Malaria partnership, and by donors such as the US President’s Malaria Initiative, has hampered the procurement and distribution of ACTs at country level to date,” said Dr. Prudence Hamade, head of the MSF’s malaria working group. “In addition, the Global Fund is a pure funding agency and has not been able to help countries with the actual ACT implementation process.” Out of the $208 million allocated by the Global Fund for ACTs since 2002, only about 30 percent has actually been used for procurement of this recommended treatment.

“Without rapid steps to ensure that effective drugs actually reach the people who need them, governments’ decisions remain virtual and end up having no meaning for those who were supposed to benefit from them,” said Dr. Karim Laouabdia, director of MSF’s Campaign for Access to Essential Medicines. “Giving patients chloroquine against malaria is as ineffective as giving them a placebo – medically and ethically. It is just wrong. We know implementing ACTs is no easy task, but noone should be allowed to drag their feet in making sure these life-saving drugs get to all those who need them.”

In 2005, MSF treated approximately 1.8 million malaria patients in 40 countries in Africa, Asia and Latin America. MSF has been advocating for ACTs since 2001 and uses them consistently in its programs worldwide. Malaria is a parasitic disease that is spread by mosquitoes and kills over one million people a year, mostly in Africa.


Cancer-Like Response Triggered From Embryonic Stem Cells By Forsyth Scientists

Scientists from The Forsyth Institute, working with collaborators at Tufts and Tuebingen Universities, have discovered a new control over embryonic stem cells’ behavior. The researchers disrupted a natural bioelectrical mechanism within frog embryonic stem cells and trigged a cancer-like response, including increased cell growth, change in cell shape, and invasion of the major body organs. This research shows that electrical signals are a powerful control mechanism that can be used to modulate cell behavior.

The team of Forsyth Institute scientists, led by Michael Levin, Ph.D., Director of the Forsyth Center for Regenerative and Developmental Biology, have identified a new function for a potassium (KCNQ1) channel, mutations of which are known to be involved in human genetic diseases such as Romano-Ward and Jervell-Lange-Nielsen syndromes. The team interrupted the flow of potassium through KCNQ1 in parts of the Xenopus frog embryo. This resulted in a striking alteration of the behavior of one type of embryonic stem cell: the pigment cell lineage of the neural crest. When mutated, these pigment cells over-proliferate, spread out, and become highly invasive of blood vessels, liver, heart, and neural tube, leading to a deeply hyper-pigmented tadpole.

The body’s natural biophysical signals, driven by ion transporter proteins and resulting in endogenous voltage gradients and electric fields, have been implicated in embryonic development and regeneration. The data in this study, which was published in the Proceedings of the National Academy of Sciences on October 13, 2008, have not only elucidated a novel role for the KCNQ1 channel in regulating key cell behaviors, but for the first time have also revealed the molecular identity of a biophysical switch by means of which neoplastic-like properties can be conferred upon a specific embryonic stem cell sub-population. These data reveal that key properties of embryonic stem cells can be controlled through bioelectrical signals, identify transmembrane voltage potential as a novel regulator of neural crest function in embryonic development, and demonstrate that potassium flows can be an important aspect of cellular environment, which is known to regulate both cancer and stem cells.

“In regenerative medicine, a key goal is to control the number, position, and type of cells,” said the paper’s first author, Junji Morokuma, Ph.D. “This research is especially exciting because it shows the importance of electrical signals for changing cell behavior, identifies a new role in developmental and cell biology for the KCNQ1 ion channel, and strengthens the link between stem cells and tumor cells. Added Doug Blackiston, Ph.D., paper co-author, “In the future, this work may lead to a greater understanding of the causes of cancer and ways to potentially halt its metastasis, as well as suggesting new techniques by which stem cells may be controlled in biomedical applications.”


Michael Levin, Ph.D., is a Senior Member of the Staff in The Forsyth Institute and the Director of the Forsyth Center for Regenerative and Developmental Biology. Through experimental approaches and mathematical modeling, Dr. Levin and his group examine the processes governing large-scale pattern formation and biological information storage during animal embryogenesis. The lab investigates mechanisms of signaling between cells and tissues that allow a living system to reliably generate and maintain a complex morphology. The Levin team studies these processes in the context of embryonic development and regeneration, with a particular focus on the biophysics of cell behavior.

This work was supported by grants from The National Institutes of Health, The American Heart Association, The National Highway Traffic Safety Administration and the March of Dimes.

The Forsyth Institute is the world’s leading independent organization dedicated to scientific research and education in oral health and related biomedical sciences.

Source: Jennifer Kelly

Forsyth Institute

DeCODE Discovers A Gene Linked To Risk Of Kidney Stones And Osteoporosis

A discovery by scientists at deCODE genetics (Nasdaq: DCGN) and academic colleagues from Iceland, the Netherlands and Denmark has pointed to a common biological mechanism contributing to both kidney stones and decreased bone mineral density (BMD). About 60% of the population carry two copies of a single-letter variation in the human genome (SNP) on chromosome 21, putting them at roughly 65% greater likelihood of developing kidney stones than those who carry no copies. This single variant may thus account for more than a quarter of the incidence of kidney stones, and in women carriers it is also associated with decreased BMD at the hip and spine.

The SNP is in the gene encoding claudin 14 (CLDN14), a protein expressed in the kidney and one of a family of membrane proteins that regulate the passage of ions and small solutes between cells. As calcium is a key component both of most kidney stones and of bone, the deCODE team examined the relationship between CLDN14 and the metabolism of calcium. The results suggest that the SNP may be contributing to increased calcium excretion in urine, a major risk factor for kidney stones and also a sign of bone loss.

“This is an exciting finding because it uncovers a highly plausible common biological mechanism leading to two diseases. This offers a potentially attractive new pathway for drug discovery, and the next task is to build on our understanding of how this SNP increases risk of these diseases and how this pathway could be targeted therapeutically to address this risk. As ever, deCODEme subscribers will see this new variant in their profiles, and we look forward building on this discovery,” said Kari Stefansson, CEO of deCODE.

About kidney stones

Kidney stones are small crystals formed of dissolved minerals, mainly calcium, that form in the kidneys. Smaller stones can simply be passed through urination, though larger ones can block the urinary tract, causing considerable pain and bleeding. Kidney stones affect some 5% of women and 10% of men in the industrialized world. Larger stones can be detected with ultrasound screening and broken up to facilitate passage, though the recurrence rate is high.

deCODE would like to thank all those who participated in this study, as well as the collaborating clinicians and scientists from the Landspitali University Hospital in Reykjavik, Iceland; Radboud University Nijmegen Medical Centre in Nijmegen, Netherlands; Nordic Bioscience A/S in Herlev, Denmark; and the Center for Clinical and Basic Research A/S in Ballerup, Denmark.

About deCODE

deCODE is a bio-pharmaceutical company developing drugs and DNA-based tests to improve the treatment, diagnosis and prevention of common diseases. Its lead therapeutic programs, which leverage the company’s expertise in chemistry and structural biology, include DG041, an antiplatelet compound being developed for the prevention of arterial thrombosis; DG051 and DG031, compounds targeting the leukotriene pathway for the prevention of heart attack; and DG071 and a platform for other PDE4 modulators with therapeutic applications in Alzheimer’s disease and other conditions. deCODE is a global leader in human genetics, and has identified key variations in the genome (SNPs) conferring increased risk of major public health challenges from cardiovascular disease to cancer. Based upon these discoveries deCODE has brought to market a growing range of DNA-based tests for gauging risk and empowering prevention of common diseases. Through its CLIA-registered laboratory, deCODE offers deCODE T2(TM) for type 2 diabetes; deCODE AF(TM) for atrial fibrillation and stroke; deCODE MI(TM) for heart attack; deCODE ProstateCancer(TM) for prostate cancer; deCODE Glaucoma(TM) for a major type of glaucoma; and deCODE BreastCancer, for the common forms of breast cancer

Any statements contained in this presentation that relate to future plans, events or performance are forward-looking statements within the meaning of the Private Securities Litigation Reform Act of 1995. These forward-looking statements are subject to a number of risks and uncertainties that could cause actual results, and the timing of events, to differ materially from those described in the forward-looking statements. These risks and uncertainties include, among others, those relating to our ability to obtain sufficient financing to continue as a going concern, our ability to develop and market diagnostic products, the level of third party reimbursement for our products, risks related to preclinical and clinical development of pharmaceutical products, including the identification of compounds and the completion of clinical trials, our ability to form collaborative relationships, the effect of government regulation and the regulatory approval processes, market acceptance, our ability to obtain and protect intellectual property rights for our products, dependence on collaborative relationships, the effect of competitive products, industry trends and other risks identified in deCODE’s filings with the Securities and Exchange Commission, including, without limitation, the risk factors identified in our most recent Annual Report on Form 10-K and any updates to those risk factors filed from time to time in our Quarterly Reports on Form 10-Q or Current Reports on Form 8-K. deCODE undertakes no obligation to update or alter these forward-looking statements as a result of new information, future events or otherwise.

Source: deCODE genetics

Swine Influenza Daily Update: 22 July 2009, Wales

The NPHS influenza surveillance scheme, which records reports of diagnoses of flufrom more than 300 GP practices across Wales, shows low but increasing levels of influenza activity across Wales. Further detail can be found on the NPHS website: wales.nhs/sites3/page.cfm?orgid=457&pid=38241

The report from 20 July estimates there were 73.4 cases of a flu-like illness diagnosed by GPs out of every 100,000 people in Wales – this is the equivalent of 2,202 people in Wales contacting their GPs in the last seven days with flu like symptoms. Not all of these people will have swine flu and not everyone with flu like symptoms will contact their GP. It is expected that the proportion of influenza cases diagnosed that are due to swine flu will increase as the virus spreads in Wales.

The report also shows levels of influenza activity in each county of Wales. On 20 July, the rate of diagnosis of flu-like illness at a local level ranged from 27.6 per 100,000 people in Anglesey, to 141.1 per 100,000 people in Newport.

GPs are no longer being asked to swab people they suspect may have swine flu. Microbiology laboratories are therefore no longer testing mostpeople suspected of having swine flu.

There have been 77 laboratory confirmed cases in Wales with no new cases.
A total of 16 people with swine flu have been hospitalised in Wales, 15 of whom have been discharged.

No further details will be confirmed or denied about cases in order to protect their right to confidentiality.

The rates of GP consultations for flu-like illness across the UK are:

73.4 cases of flu like illness diagnosed by GPs in the previous seven days out of every 100,000 people in Wales (as of 20 July)
25 cases of flu like illness diagnosed by GPs out of every 100,000 people in Scotland (for the week ending 15 July) 86.8 cases of flu like illness diagnosed by GPs in the previous seven days out of every 100,000 people in England (for the week ending 12 July) 34.9 cases of flu like illness diagnosed by GPs out of every 100,000 people in Northern Ireland (for the week ending 10 July) 29 people in the UK with swine flu have died – 26 in England and 3 in Scotland. The majority had underlying health conditions.
There has been a total of 712 people hospitalised with swine flu – 652 in England, 44 in Scotland and 16 in Wales.

Swine flu cases have been confirmed in 135countries. For the latest international figures for the spread of swine flu, visit the website of the World Health Organization at www.who.int

Comment from the National Public Health Service for Wales
Dr Roland Salmon, Director of the Communicable Disease Surveillance Centre, National Public Health Service for Wales, said:

“The rise in numbers of people contacting their GP with flu like symptoms illustrates the spread of the disease across Wales. Not everyone however who has contacted their GP with flu like symptoms will have swine flu and not everyone with swine flu contacts their GP so it is difficult to accurately record the spread of the virus across Wales.

“Previously, we have been investigating and responding to individual cases. This has allowed us to learn about the virus, how it spreads and how it affects people. We have learnt that, in the majority of cases it is mild although proving severe for a small minority. Most people recover from infection without the need for hospitalisation or medical care.

“As the disease becomes more widespread in the UK we have changed our approach to focus on treatment, emphasising those people most at risk – people more likely to develop serious illness or complications. These are, particularly, the groups that we encourage to get vaccinated each winter, because they areat risk from seasonal influenza, together with pregnant women and children under 5.

“We advise people to practice good respiratory and hand hygiene to reduce the chance of catching or spreading the virus. If people think they may have flu and want to check their symptoms they can call the Swine Flu Information Line on 0800 1 513 513. If they are still concerned they should contact NHS Direct Wales on 0845 4647.

“People should not go to Accident and Emergency Departments or to their GP surgery as this may risk spreading the infection. It also places undue pressure on the emergency services.”

Public health advice and messages

If you have flu-like symptoms, stay at home. You can check your symptoms by calling the Swine Flu Information Line on 0800 1 513 513. If you are still concerned, contact NHS Direct Wales on 0845 4647. Do not go into your GP surgery or Accident and Emergency department unless you are advised to do so or are seriously ill, as you may spread the illness to others.

It is always good practice to follow respiratory and hand hygiene such as:
Covering your nose and mouth when coughing or sneezing, using a tissue when possible.
Disposing of dirty tissues promptly and carefully.
Maintaining good basic hygiene, for example washing hands frequently with soap and water to reduce the spread of the virus from your hands to face or to other people.
Cleaning hard surfaces (e.g. door handles) frequently using a normal cleaning product.
Helping your children follow this advice.


Although we are aware that facemasks were being given out to the public in Mexico, the available scientific evidence does not support the general wearing of facemasks by those who are not ill whilst going about their normal activities. We are, however, reviewing NHS supplies and stockpiles of facemasks for healthcare workers who are likely to come into regular contact with people who may have symptoms. The UK will receive an additional 227 million surgical facemasks and 34 million respirators. Wales will receive its proportionate share.

Control measures

Agreements have been signed between the UK Government and vaccine manufacturers to secure enough vaccine for the whole population. The first batches are expected in August with around 60 million doses by the end of the year – enough for 30 million people to be vaccinated – with more following after that.

The Welsh Assembly Government’s Health Emergency Preparedness Unit has issued guidance to Local Health Boards on anti-viral distribution. The unit is co-ordinating work on identifying appropriate collection points and the necessary arrangements to support this process.

Features of the outbreak

Based on assessment of all available information and following several expert consultations, the World Health Organization (WHO) declared the level of influenza pandemic alert at phase six on 11 June 2009.
Phase six indicates there is human-to-human spread of the virus in at least two countries in one World Health Organization region, with community level outbreaks in at least one other country in a different WHO region.

On 2 July the four UK nations agreed to move to the treatment phase in their response to the pandemic – treating people most at risk. Contact tracing and the use of antivirals preventively have been ended. GPs will now provide clinical diagnosis of swine flu cases rather than awaiting laboratory test results.

Further health information for the public on swine flu is available bilingually from nhsdirect.wales.nhs
Further information on swine flu and Pandemic Flu is available bilingually from nphs.wales.nhs
Further information from the Welsh Assembly Government response is available bilingually at wales

National Public Health Service for Wales (NPHS)

Keeping Safe In Emergencies By Giving Your Power Generator Some Space

To subdue the steaming heat of hurricanes or to thaw out during a blizzard, gasoline-powered, portable generators are a lifeline during weather emergencies when homes are cut off without electricity. But these generators emit poisonous carbon monoxide – a single generator can produce a hundred times more of the colorless, odorless gas than a modern car’s exhaust. New research from the National Institute of Standards and Technology (NIST) shows that to prevent potentially dangerous levels of carbon monoxide, users may need to keep generators farther from the house than previously believed – perhaps as much as 25 feet.

Up to half of the incidents of non-fatal carbon monoxide (CO) poisoning reported in the 2004 and 2005 hurricane seasons involved generators run within 7 feet of the home, according to the U.S. Centers for Disease Control and Prevention (CDC).

Carbon monoxide can enter a house through a number of airflow paths, such as a door or window left open to accommodate the extension cord that brings power from the generator into the house. While some guidance recommends 10 feet from open windows as a safe operating distance, NIST researcher Steven Emmerich says the “safe” operating distance depends on the house, the weather conditions and the unit. A generator’s carbon monoxide output is usually higher than an automobile’s, he says, because most generators do not have the sophisticated emission controls that cars do.

“People need to be aware that generators are potentially deadly and they need to educate themselves on proper use,” Emmerich says. With funding from CDC, NIST researchers are gathering reliable data to support future CDC guidance.

NIST building researchers simulated multiple scenarios of a portable generator operating outside of a one-story house, using both a test structure and two different computer models – the NIST-developed CONTAM indoor air quality model and a computational fluid dynamics model.

The simulations included factors that could be controlled by humans, such as generator location, exhaust direction and window-opening size, and environmental factors such as wind, temperature and house dimensions. In the simulations the generator was placed at various distances from the house and tested under different weather conditions.

“We found that for the house modeled in this study,” researcher Leon Wang says, “a generator position 15 feet away from open windows was not far enough to prevent carbon monoxide entry into the house.”

Winds perpendicular to the open window resulted in more carbon monoxide entry than winds at an angle, and lower wind speeds generally allowed more carbon monoxide in the house. “Slow, stagnant wind seems to be the worst case because it leads to the carbon monoxide lingering by the windows,” Wang explains. Researchers determined that placing the generator outside of the airflow recirculation regions near the open windows reduced carbon monoxide entry.

In the next phase of the study NIST will model a two-story house that researchers believe will interact with the wind differently. NIST researchers also have worked with the Consumer Product Safety Commission on related work. (See: “NIST to Study Hazards of Portable Gasoline-Powered Generators,” NIST Tech Beat, March 5, 2008.)

The generator study can be downloaded at fire.nist/bfrlpubs/build09/PDF/b09009.pdf.

* L. Wang and S.J. Emmerich. Modeling the Effects of Outdoor Gasoline Powered Generator Use on Indoor Carbon Monoxide Exposures. (NIST Technical Note 1637,) 2009.

Evelyn Brown

National Institute of Standards and Technology (NIST)