Scientists have identified a genomic "signature" in circulating blood that reveals exposure to common upper respiratory viruses, like the cold or flu, even before symptoms appear.

The tell-tale viral signature reflects a set of subtle but robust changes in genes that are activated as the body responds to infection. The signal from the signature is strong enough in symptomatic individuals to clearly reveal whether their infection is viral or bacterial. It can also discriminate between who has a viral infection and who does not - all from a single tube of blood.

"This work is still in a relatively early phase of discovery, but we are optimistic that these findings may lead to a whole new way of diagnosing infectious disease," says Geoffrey Ginsburg, M.D., Ph.D., director of Duke University's Center for Genomic Medicine in the Institute for Genome Sciences & Policy and the senior author of the study appearing in the journal Cell Host & Microbe.

Researchers say the discovery could lead to dramatic changes in the way doctors care for the millions of people who develop upper respiratory infections every year. Ginsburg says the symptoms of a cold, the flu or pneumonia can appear similar, but right now, doctors can't tell what the patient really has until laboratory tests are conducted, and that can take days.

"Until results are in, treatment is pretty much a best guess. Knowing exactly which pathogen is involved is important because it affects the urgency of response and the type of treatment," says Ginsburg. "This approach could lead to more precise, informed and tailored therapy - essentially, personalized care for infectious disease. That's better for the patient and better for public health, in general."

Christopher Woods, M.D., an associate professor of medicine at Duke and the Chief of the Infectious Disease Section at the Durham Veterans Administration Medical Center, says a quick test to determine the real cause of disease has other benefits, too. "It could mean more appropriate use of antibiotics. Overuse of antibiotics can lead to the emergence of drug-resistant pathogens, and no one wants to see more of that."

The discovery is based upon the fact that the body's immune system starts responding very quickly and in a highly specific manner when exposed to a viral pathogen as opposed to a bacterial one. "A detailed reading of that response, using gene expression data, reveals what type of pathogen the person is reacting to," says Aimee Zaas, M.D., M.H.S., an infectious diseases physician at Duke and the lead author of the study.

Zaas and colleagues recruited 57 healthy volunteers who agreed to be inoculated with either a live cold virus (rhinovirus), the respiratory syncytial virus, or the influenza A virus. Researchers first took detailed baseline measures of genomic profiles in participants' blood, nasal fluid, breath and urine, and then inoculated the volunteers with one of the three viruses. They waited to see who became sick, and noted when symptoms first appeared, measuring markers of biological response at multiple time points after exposure. Volunteers were quarantined during the time they were infectious.

The research team studied changes in gene expression patterns in the participants' blood and identified 30 genes - many of which were already known to be active in the body's response to viral infections - whose expression patterns changed only among those who became symptomatic.

Investigators tested this "acute respiratory viral signature" in an independently acquired data set of gene expression patterns among people infected with influenza A and found that the signature was able to clearly distinguish with 100 percent accuracy between individuals who were infected and those who were not.

The researchers say the acute viral response signature may be applicable only to people who have healthy immune systems. "We would need to show that this approach also works in patients with underlying immune deficiencies before we could offer it as a potential diagnostic tool for everyone," says Zaas.

The number of people to die of swine flu in India has risen to six with the death of a number of patients over the weekend, health officials say.

Six patients are reported to be in a serious condition in the western city of Pune, which has recorded more cases than anywhere else in India.

A number of schools in the country have been shut temporarily over fears of children contracting the disease.

Officials say there are more than 800 cases of the H1N1 flu strain in India.

The virus is thought to have killed almost 800 people around the world.

A 53-year-old doctor of indigenous medicine and a four-year-old boy died in hospitals in western Pune and southern Chennai cities early on Monday, taking the number of deaths caused by swine flu to six.

Over the weekend, three people died of the flu in western India - a 43-year-old businessman who was visiting Ahmedabad city in Gujarat state; a 42-year-old teacher in Pune city; and a 53-year-old woman in Mumbai city.

Last Monday, a 14-year-old girl became the first person in the country to die of swine flu.

Rising concerns

Health officials say that the country had enough stocks of the anti-flu drug Tamiflu.

However, panic is growing among the people with swine flu deaths making it to the front pages of newspapers and main TV news.

Several schools in western Indian and the capital, Delhi, have closed temporarily as fears grow about children contracting the flu.
A shop owner wearing a mask in Mumbai
Panic is growing among the people with swine flu fears rising

In Delhi, where some 228 cases have been confirmed, health officials say that the people are panicking "because the symptoms of swine flu and common influenza are similar".

As the number of flu deaths rise in the country, health officials have asked people not to panic.

Indian PM Manmohan Singh has asked the health ministry to step up preparedness against the disease and coordinate with state governments to help stop the disease spreading.

"All state governments have been asked to set up their own swine flu helplines, create more quarantine wards not only in their hospitals but also in the big private hospitals," federal Health Minister Ghulam Nabi Azad said.

The BBC's Soutik Biswas in Delhi says though the number of swine flu deaths in India was still low, there are concerns over the ability of the badly-run and under equipped government hospitals to handle the rising tide of patients.

Also, the 12 swine flu testing centres in India will not be sufficient if the number of cases rise sharply, our correspondent says.

"We need to work out a public-private partnership between the hospitals to tackle the flu. We need to take the people, doctors and media into confidence so panic does not spread," federal Junior Health Minister Dinesh Trivedi.

Last week, the World Health Organization announced that the first swine flu vaccines are likely to be licensed for use in the general population in September.

The swine flu (H1N1) virus first emerged in Mexico in April and has since spread to 74 countries.

During the 5th International AIDS Society (IAS) Conference on HIV Pathogenesis, Treatment and Prevention meeting in Cape Town, South Africa, scientists "renewed the call for more immediate and urgent effort to be directed towards HIV prevention amid the dominance of treatment interventions and the world-wide search for a quick fix vaccine, which many agree, is years away," Health-e/allAfrica.com reports (Thom, 7/22).

Data was presented from ongoing trials of microbicides and Pre-Exposure Prophylaxis trials, including a Phase III trial on the microbicide Pro2000 involving more than 9,389 women and an "adherence and drug absorption study" that looks at "whether antiretrovirals (ARVs) can be used effectively for HIV prevention in the form of a applicator gel or a pill that can be taken orally once a day - also known as PrEP.

The Times of Zambia/allAfrica.com examines the announcement by scientists representing the Microbicide Trials Network at the conference about plans for a large-scale microbicide clinical trial involving about 5,000 women from Zambia, Uganda, Malawi, Zimbabwe and South Africa. The trial is expected to take about three and half years, with results available in 2012, a co-chair of the study said.

François Venter, president of the Southern African Clinicians Society, "said though the research shows promise there are numerous issues that need to be addressed," the Health-e/allAfrica.com writes, including accessibility of products and the "uncertainty on whether developing countries will be able to afford providing PrEP to patients not yet infected when they are currently struggling to provide treatment to those already infected".

Executive director at the Center for Evaluation Research and Surveys at the National Institute of Public Health in Mexico, "said greater emphasis needed to be placed on getting value from investments," which would require "a shift in thinking from a short-term emergency response to a more efficient, long-term approach." An analysis of 28 "completed biomedical prevention trials" revealed "only four, including three trials of male circumcision, have reported significant efficacy," according to Robert Gray of Johns Hopkins, who "argued for conducting fewer trials, but with a greater investment in rigor and quality,".

An estimated 200 people die each year in the U.S. after being struck by lightning. An extremely brief but intense hit delivers more than 10 million volts and is fatal in about 30 percent of cases. Recent lightning strikes in Newark resulted in one death and three injuries.

Most survivors have significant complications. Half of people struck by lightning will suffer rupture of the tympanic membrane in the ear. Many go on to develop cataracts.

"Lightning presents a grave risk of death," warns Shreni Zinzuwadia, M.D., an emergency department physician at UMDNJ-The University Hospital and instructor of surgery at the UMDNJ-New Jersey Medical School. "Cardiac or respiratory arrest may result from being hit by lightning."

There are other dangers outside of a direct hit, she added, from three additional types of strikes.

A side strike happens when lightning jumps from its initial point of contact to the victim. "For example, if you seek protection under a tree, which is one of the worst places to be during a storm, the lightning can hit the tree then jump to you, a better conductor of electricity since humans are mostly salty water," she explained. "This kind of strike can kill the tree and the person."

A contact strike occurs when lightning hits an object the person is holding or wearing, such as a watch or eyeglasses.

The other type of strike - step potential happens when a current traveling through the ground goes up your leg, travels through you and then goes down the other leg and back into the ground. "That is why Boy Scouts practice standing on one leg during a storm," she explained. "They are attempting to decrease the likelihood that the current will go through them by having only one foot on the ground."

Prevention begins by seeking cover at the start of a storm. "Lightning seems to be concentrated at the forefront of a storm," according to Zinzuwadia, "so there tends to be a greater risk of being hit by lightning at the beginning of a storm."

According to the Federal Emergency Management Agency (FEMA), part of the U.S. Department of Homeland Security (DHS), individuals who hear thunder roar should go indoors because no place outside is safe when lightning is in the area. Stay indoors until 30 minutes have passed after you hear the last clap of thunder.

Once inside, FEMA advises that people avoid contact with corded phones and electrical equipment or cords; do not wash your hands, take a shower, wash dishes, or do laundry because plumbing and bathroom fixtures can conduct electricity; stay away from windows and doors; stay off porches; and do not lie on concrete floors or lean against concrete walls.

If you are outside during a storm, crouch down and try to touch as little of the ground as you can, Zinzuwadia suggests. "Even if you are hit by the current, the less contact there is between you and the ground, the less likely it is that all of your major organs will be hit," she says. "It increases your chances of survival."

What signs might indicate that a person has been struck by lightning? "You may see superficial burns on the skin or clothing may burst into flames or be torn away from the body," Zinzuwadia said. "A person may fall to the ground.

"People who are hit by lightning commonly die from ventricular fibrillation, asystole (cardiac arrest), or respiratory arrest," Zinzuwadia added. "Bystanders should immediately check for a pulse and spontaneous breathing."

If a person is in respiratory arrest has a pulse but is not breathing - provide rescue breaths until the victim resumes spontaneous breathing.

If the victim goes into cardiac arrest, where the heart just stops due to the impact of the massive electrical current, CPR should be administered, Zinzuwadia said. "Give cardiac compressions and provide respiratory support for them."

Do you intend on getting a healthy tan this summer? You may want to rethink your plans. Tan skin is the body's reaction to sun damage, along with freckles, wrinkles and brown spots. So unless your tan comes from a bottle, it's probably not healthy.

More than one million cases of skin cancer will be diagnosed in the United States this year, according to the American Cancer Society. And despite the countless public service announcements and media messages, the numbers continue to rise.

According to recent studies by both the American Academy of Dermatology and British Association of Dermatologists, people in their teens and early twenties are less likely than any other age group to use sun protection, despite the increasing risk among this demographic.

Many young people ignore the risk because they don't see the detrimental effects of the sun right away. Skin cancer often does not show up immediately. "Most skin cancers take years of cumulative sun exposure to form and reflect sun-worshipping behaviors of years past," says Tanya Futoryan, MD, medical director of the Westport Dermatology and Laser Center in Westport, Conn.

And it's not just young people who suffer the negative effects of the sun. It's only been over the last two decades, that we've learned, as a society, about the dangers of the sun. Millions of women who spent their childhoods basking in the sun are suffering the consequences as well.

"Although we are better educated now on sun protection, it takes a long time to adapt sunscreen use and sun avoidance into our every day lives," says Futoryan. "Every new generation has to be convinced of the dangers of sun damage."

There are three major types of skin cancer. Bad sunburns which include blistering increase a person's risk of melanoma, the most serious type of skin cancer. Long-term exposure to the sun increases the risk of all types of skin cancer including the less serious types: basal-cell and squamous-cell carcinoma.

The diagnosis of all types of skin cancer has increased and melanoma has become the most common cancer among young women aged 25-29, according to the Centers for Disease Control and Prevention in Atlanta, Ga.

While it's not entirely clear why the risk of skin cancer is skyrocketing in women, there are certainly a few clues. Alarming numbers of young people, mostly women, are using tanning beds in the United States. Study after study suggests that the UV rays at tanning salons are just as damaging as natural sunlight.

"In young women ages 15-29, the torso is the most common location for developing melanoma, which may be due to high risk tanning behavior," according to Francesco Fusco, MD, assistant clinical professor of dermatology at Mt Sinai School of Medicine NYC and an educational spokesperson for the Skin Cancer Foundation. "This is most likely due to increased UV exposure which includes natural as well as artificial UV light."

There is also strong evidence suggesting that young people continuously ignore the threat of skin cancer. According to results from a recent study conducted by the American Academy of Dermatology, only one in three American teenagers between the ages of 12 and 18 used sunscreen.

"While great advances have been made in early detection and prevention of skin cancer, it is important to educate young women about the importance of sun protection in the fight against skin cancer," says Futoryan.

Here are some tips on how to stay safe in the sun:

- Use sunscreen (with broad spectrum UVA/UVB protection) liberally when outdoors.

- Seek shade between 10 am and 4 pm large sun umbrellas work great.

- Wear sun-protective clothing; hats and longer pants, shirts with sleeves, sarongs and wraps.

- Use UV absorbing sunglasses to protect the eyes.

In addition to your own monthly skin checks, an annual head-to-toe skin examination by a dermatologist, or skin doctor, should be a routine part of your health maintenance.