People with diabetes who maintain intensive, low blood sugar levels are significantly less likely to suffer heart attacks and coronary heart disease, new research published in The Lancet has shown.

By undertaking a meta-analysis which pooled information from five large trials, researchers at the University of Cambridge were for the first time able to provide reliable evidence linking intensive blood sugar level (or glucose) control with fewer heart attacks.

The research, funded by the British Heart Foundation, pointed to a 17 % reduction in heart attacks and a 15 % reduction in coronary heart disease. However, the study found a more modest trend towards reduction in strokes with intensive control of glucose levels compared to standard care. Importantly, in contrast to smaller studies which had suggested possible harm from better blood sugar control, there were no adverse effects on deaths from any cause.

It is well documented that diabetics are at increased risk of heart disease. Even though patients can reduce their risk by maintaining healthy blood pressure levels and cholesterol reduction, the risk remains high.

Dr Kausik Ray of the University of Cambridge, lead author of the study, said: "Previous studies have been inconclusive, leaving diabetics and their doctors unsure as to whether maintaining lower blood sugar levels actually benefitted the patients. Although additional research needs to be conducted, our findings provide insight into the importance of improving glucose levels which should include lifestyle changes as well as medication."

The five trials involved more than 33,000 individuals, including 1497 heart attack cases, 2,318 cases of coronary heart disease, and 1227 strokes. In order to assess the possible risk of various heart conditions, Dr Ray and his team analyzed the data collected on the glucose levels in blood, specifically a long-term marker of glucose control called HbA1c. In healthy individuals, HbA1c levels average between 4-5%. However, diabetics often have levels above 6.5%.

In the present study, those taking a standard treatment maintained a HbA1c level of 7.5%. Individuals who underwent intensive treatment to lower their blood sugar level were 0.9% lower than those who underwent standard treatment (average 6.6%), thereby dramatically reducing their risk of disease in large blood vessels.

Professor Peter Weissberg, Medical Director at the British Heart Foundation said: "It is well established that carefully controlling blood sugar in people with diabetes can help prevent disease in small blood vessels that leads to kidney failure and blindness. This collective analysis of several large clinical trials suggests that careful blood sugar control also protects against heart attacks and strokes, the major causes of death in people with diabetes.

Half of all patients who undergo myocardial infarction are experiencing onerous fatigue four months after the infarction. The patients who are most fatigued are those who perceive the infarction as a sign of chronic illness, those who experience the illness as difficult to control, and those who believe that the illness has a large impact on their life. These are the conclusions of a thesis presented at the Sahlgrenska Academy.

Just over 200 persons completed a questionnaire one week after they had experienced an infarction and again four months later. Many of the patients were also interviewed.

Around half of the patients stated that they felt onerous fatigue four months after the infarction. One third of the patients exhibited expressed fatigue, while one fifth also exhibited symptoms of depression. "Many people experienced the fatigue as new, and different. It was not related to physical effort or a lack of rest; it occurred unpredictably and could not be attributed to any definite cause", says nurse Pia Alsén, author of the thesis.

Improvements in treatment during the acute phase of a myocardial infarction have lead to significantly more patients surviving, and to shorter periods of hospitalisation. However, medical treatment is not sufficient on its own to ensure a good long-term prognosis. Patients must also change their lifestyle, and many of them do not manage to carry out the changes that are needed. Further, some patients do not participate in the rehabilitation programmes that are available.

"The patients' perception of their illness can be crucial in determining whether they benefit from this part of the treatment or not. A better understanding of the patients' perceptions of their illness can enable us to adapt the information individually for each patient, and encourage more patients to enter the follow-up programmes", says Pia Alsén.

More patients perceived their illness to be chronic four months after the infarction. "The perception that the condition was a chronic one depended on the extent to which the patients reflected over what had happened. Those who were unwilling to examine causes and correlations perceived the infarction as an isolated event", says Pia Alsén.

A further factor that influenced the patients' perceptions of their illness was whether they felt that they could influence the illness themselves, or whether they placed their trust in medication and other external factors. The patients' belief that they could take control of their situation through such measures as changes in lifestyle decreased after four months.

New Delhi, June 7 (IANS) India Sunday reported two fresh cases of swine flu taking the total number of confirmed people infected with the virus to 10 so far, health officials said.

Those who tested positive for influenza A (H1N1) include a 25-year-old man who sat in close proximity to a techie who had returned from the US May 31 with the infection.

'The man travelled with the techie by British Airways flight BA 277 May 31. All his close contacts are being traced and would be quarantined,' said a health ministry official.

Of the 10 cases, seven are from Hyderabad, which also reported the first case in the country May 16.

A 35-year-old man who reached Delhi from New York June 2 has also tested positive for the flu.

'He developed flu like symptoms two days after reaching Delhi and tested positive for it. The man is on home quarantine and his contacts have been provided with medicine,' the official said.

The 28-year-old techie who arrived from Philadelphia May 31 had gone home after his arrival at the airport. He later developed high fever and approached the Chest Hospital in Hyderabad June 2. The next day he tested positive for H1N1 influenza.

India reported its first swine flu infection May 16 - that of a 23-year-old man who travelled by Emirates Airline from New York to Hyderabad via Dubai. He has now been discharged after treatment.

Meanwhile three suspect cases -- one each at Cochin, Delhi and Kolkata - have been isolated at the identified health facility.

Health screening of passengers coming from the affected countries is continuing at 21 international airports and over 1.3 million passengers have been screened so far.

Samples of 176 persons have been tested of which 10 have been tested positive for Influenza A (H1N1). The Central Rapid Response Team is assisting Andhra Pradesh for instituting public health measures that need to be taken in the event of a cluster reporting.

The WHO has reported about 21,940 confirmed cases of influenza A(H1N1) infection from 69 countries and 125 deaths till June 5.

Your immune system plays an important function in your health - it protects you against viruses, bacteria, and other toxins that can cause disease. In autoinflammatory diseases, however, the immune system goes awry, causing unprovoked and dangerous inflammation. Now, researchers from the National Institute of Arthritis and Musculoskeletal and Skin Diseases (NIAMS), part of the National Institutes of Health, and other institutions have discovered a new autoinflammatory syndrome, a rare genetic condition that affects children around the time of birth. The findings appear in the current issue of the New England Journal of Medicine.

The scientists have termed the new autoinflammatory syndrome DIRA (deficiency of the interleukin-1 receptor antagonist). Children with the disorder display a constellation of serious and potentially fatal symptoms that include swelling of bone tissue; bone pain and deformity; inflammation of the periosteum (a layer of connective tissue around bone); and a rash that can span from small individual pustules to extensive pustulosis that covers most of the patient's body. Most of the children begin to have symptoms from birth to 2 weeks of age.

"The beauty of this discovery is that the symptoms of this devastating disease can now be treated," said NIAMS director and immunodermatologist, Stephen I. Katz, M.D., Ph.D. "The abnormal inflammatory pathways seen in this disease may also help us understand other common diseases that share clinical features, such as psoriasis, as well as other autoinflammatory disorders."

"We knew when we saw these children that we were dealing with a previously unrecognized autoinflammatory syndrome. The clinical characteristics were distinct from other diseases we had seen before," said NIAMS researcher and lead author Raphaela Goldbach-Mansky, M.D., M.H.S. When her colleague, Dr. Ivona Aksentijevich, tested the first patient for genetic abnormalities, their suspicions were confirmed, and ultimately abnormalities were found in a number of other cases.

All the children had inherited mutations in IL1RN, a gene that encodes a protein known as interleukin-1 receptor antagonist (IL-1Ra). IL-1Ra binds to the same cell receptors as the inflammatory protein interleukin-1, and acts as a brake on this inflammatory protein. Without IL-1Ra, the children's bodies cannot control systemic inflammation that can be caused by interleukin-1.

The scientists identified nine patients from six families with DIRA in the Canadian province of Newfoundland, the Netherlands, Lebanon, and Puerto Rico. Those who were alive at the time of diagnosis - six in all - were treated with anakinra, a drug that is normally used for rheumatoid arthritis and is a synthetic form of human IL-1Ra. Although the patients were resistant to other medications such as steroids, most responded successfully and immediately to anakinra. "Our first patient had been unresponsive to several treatments, and his health care team had almost given up. But with anakinra, he was out of the hospital in 10 days and his symptoms resolved," Dr. Goldbach-Mansky said.

US researchers found that a drug made from the root of the hydrangea plant, which has for centuries been used in Chinese medicine, showed promising results in treating autoimmune disorders such as rheumatoid arthritis, multiple sclerosis, inflammatory bowel disease, type 1 diabetes, eczema and psoriasis.

The study was the work of researchers from the Program in Cellular and Molecular Medicine and the Immune Disease Institute at Children's Hospital Boston (PCMM/IDI), together with the Harvard School of Dental Medicine and is published in the 5 June issue of the journal Science.

An exciting new area in the field of autoimmune disease research is learning about the role of a particular immune system cell called the T helper 17 (Th17) which is genetically different from other types of CD4+ T cell like the Th1, Th2 and T-regulatory cells and appears to play a unique role in the part of the immune system that causes harm when it over-reacts.

The immune system is a complex of delicately balanced "seek and destroy" systems that recognize when something is wrong in the body and then trigger a response to repair the damage or eliminate foreign agents. However, when this delicate balance is disturbed, the responses switch on when there is nothing wrong, causing the immune system essentially to "attack" healthy tissue.

This is what happens in rheumatoid arthritis, where the overactive inflammatory response eventually destroys cartilage in the joints and even healthy tissue in places like the lungs or under the skin. Exactly how and why this happens is still a mystery, but the more scientist look into it, the more they discover that immune cells like the Th17 are involved in unique ways.

In this study, the authors report how a small molecule called halofuginone (extracted from hydrangea root) selectively stops Th17 cells being made, without affecting the other CD4+ T cells, thus showing how it might be possible to stop the immune system from over-producing harmful Th17 cell responses.

They also showed that halofuginone reduced disease symptoms in mice bred with autoimmune disorders.

In the body, cytokines cause Th17 cells to differentiate from other CD4+ T cells, but when the researchers collected cultured mouse CD4+ T cells along with the cytokines, they found that adding halofuginone made levels of Th17 go down significantly but not Th1, Th2 or T regulatory cells.

They also found a similar effect in cultured human CD4+ T-cells: halofuginone selectively stopped production of IL-17, the principal cytokine made by Th17 cells.

The reason this discovery is important is because there are currently no good treatments for autoimmune disorders because you can't get in there and turn down just the inflammatory process without also turning down the protective processes that for instance protect patients from infections.

The main treatments currently rely on antibodies that neutralize cytokines, the chemical messengers that T cells use to control immune fuction and inflammatory responses.

But antibodies are expensive, have to be injected and/or infused, and don't actually solve the root cause of the problem, they just mop up cytokines rather than stop them being produced in the first place. So patients have to keep coming back for infusions to keep the inflammation under control.

As a last resort you can give patients drugs that completely suppress the immune system but for obvious reasons this is very risky.