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Extensively drug-resistant gonorrhoea: risk of further dissemination within and across Europe

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The study by Eyre et al. in the Eurosurveillance edition of 7 March 2019 reported on two cases of ceftriaxone-resistant Neisseria gonorrhoeae with intermediate resistance to azithromycin diagnosed in England. The two female patients presented in October and November 2018 and developed symptoms following unprotected sex with UK residents, the first during holiday in Ibiza and the second with a man who had been in Ibiza with links to the same sexual network as the first case.

Cultures from both cases yielded N. gonorrhoeae resistant to ceftriaxone, cefixime, tetracycline, penicillin and ciprofloxacin and with intermediate resistance to azithromycin. The isolates were sensitive to spectinomycin and had low MIC values for gentamicin and ertapenem suggesting susceptibility to these agents, although breakpoints are not defined. The first case was treated successfully with intramuscular ceftriaxone and oral azithromycin according to UK national treatment guidance at the time.

The second case failed treatment with ceftriaxone intramuscularly and later with intramuscular gentamicin and oral azithromycin, but eventually cleared infection following treatment with ertapenem intravenously 1 g once daily for three days. The second case also had unprotected oral and protected vaginal sex with a male partner when her symptoms initially improved following treatment with ceftriaxone and her partner tested positive with nucleic acid amplification test at the pharynx (pharyngeal culture and urine NAAT were negative). Since it was considered likely that he was infected by the second case, the partner was successfully treated with ertapenem intravenously.

The isolates were sequenced and shown to be indistinguishable and comparisons with previously reported ceftriaxone-resistant isolates indicated that they were part of the FC428 clone that likely originated in Southeast Asia or China before spreading to multiple countries.

ECDC comment

Infections with multidrug- and extensively drug-resistant N. gonorrhoeae that are part of the FC428 or other clones have been reported from several countries worldwide in the last two years. In 2018, ECDC published a rapid risk assessment on three cases that were diagnosed in Australia and England, two of whom had links to Southeast Asia. Additionally, cases have been reported in Canada, Denmark, France and Ireland. Some of these cases reported sexual intercourse with new partners while travelling in Asian countries. However, for the case reported in France and the two recent infections in the UK, it is likely that transmission happened in Europe.

This development is of concern as it is likely that the detected cases represent only a small proportion of the real burden caused by these multidrug-resistant clones. A large proportion of gonorrhoea cases are asymptomatic and additionally, some could be cleared spontaneously. In these situations, opportunities for detecting these strains and stopping transmission will be missed. Although both the cases in the current report were UK residents, the links to Ibiza, a popular destination for young Europeans, suggest that there is a risk of further dissemination of this strain within and across Europe.

These reports highlight the importance of EU/EEA Member States adopting the measures included as options for response in the ECDC rapid risk assessment and response plan to control multidrug-resistant N. gonorrhoeae that include:

  • strengthening surveillance for antimicrobial-resistant gonorrhoea
  • implementation of treatment failure monitoring; and
  • ensuring that gonorrhoea infections are managed appropriately according to national or European treatment guidelines, including the implementation of test of cure for all cases and effective partner notification.

Sexual health clinicians also need to be informed by public health institutes of this threat in order to be aware of possible cases.

However, effective response to the threat of drug-resistant gonorrhoea depends on a global approach. Strengthened surveillance and case management in regions where these strains are likely to have originated from is crucial in order to limit further spread.

Although both recently reported cases in the UK were successfully treated with ertapenem, use of the drug is not ideal. As mentioned by the authors, this approach may lead to the development of carbapenem resistance in other organisms where carbapenems are used for the treatment of multidrug-resistant infections.

In addition, sexual health clinics are not generally set up for gonorrhoea treatment with intravenous antibiotics for multiple days. New treatment options are urgently needed that are effective at all relevant anatomical sites.

Source: https://www.ecdc.europa.eu/en/news-events/extensively-drug-resistant-gonorrhoea-risk-further-dissemination-within-and-across

Blockchain

Blockchain and crypto will challenge current finance, Nigeria VP says

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Nigeria’s vice president, Yemi Osinbajo, delivered a speech at an economic summit on Friday in which he spoke positively of crypto and blockchain. 

“There is no question that blockchain technology generally, and cryptocurrencies in particular, will in the coming years, challenge traditional banking, including reserve banking, in ways that we cannot yet imagine,” Osinbajo said on Friday during the Central Bank of Nigeria, or CBN, Bankers’ Committee Economic Summit. “We need to be prepared for that seismic shift, and it may come sooner than later,” he said.

The Nigerian vice president also noted the broadness of the crypto industry, mentioning decentralized finance, or DeFi, in the mix. “Decentralized finance, using smart contracts to create financial instruments, in place of central financial intermediaries, such as banks or brokerages, is set to challenge traditional finance,” he said. 

Osinbajo’s speech, which included a number of other points, is posted on his YouTube channel. The Nigerian vice president also tweeted out a video clip highlighting of some of his crypto comments from his talk.

“The point I’m making, is that some of the exciting developments we see call for prudence and care in adopting them and these have been very well-articulated by our regulatory authorities,” he said, adding:

“But we must act with knowledge and not with fear. We must ensure that we are in a position to benefit and in a position to prevent any of the adverse side effects, or any of the possible, even criminal, acts that may arise in consequence of adopting or taking any of these options.”

The comments come in contrast to recent developments in Nigeria. Earlier in February, Nigeria forbade banking interactions with crypto exchanges, as per a ruling from its central bank. The CBN’s governor also called crypto assets illegitimate. Bitcoin recently traded at a significant premium in the region.

Source: https://cointelegraph.com/news/blockchain-and-crypto-will-challenge-current-finance-nigeria-vp-says

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‘Bitcoin could reach $1 million or $1, and may do both of those’

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While many analysts predict that either Bitcoin could increase to a million or fall to a dollar, a popular businessman and investor based in the US thinks that the asset could do both!

In a recent interview with Joe Kernen at CNBC’s Squawk Box, Internet analyst Henry Blodget of the dot com era fame said: 

Bitcoin could go to $1 million… it could also go to $1. And in fact it may do both of those

In addition, Blodget, who also served as the head of the global Internet research team at Merrill Lynch, is unconvinced about the asset’s value proposition. He claimed that Bitcoin as an inflationary hedge and the narrative surrounding its value as ‘digital gold’ were “stories”. He further added: 

But the stories that we tell about why relative to the value of gold or other currencies, they’re ludicrous.

In his opinion, Bitcoin can trade just about anywhere because it does not have any fundamental backing. He said that unlike traditional stocks, “which usually does have some relationship ultimately to a fundamental,” of a company, “Bitcoin doesn’t, so that means it can trade anywhere.”

The entrepreneur thinks that crypto exchange Gemini’s CEO Tyler Winklevoss could eventually be “exactly right,” in his forecast that the asset could surge to a million. However, Blodget said:

If people were to decide that for the next couple of hundred years Bitcoin is where you park your money when you take it out of the fiat system, OK, it’s possible.

Interestingly, while crypto Twitter and Bitcoin enthusiasts, in particular, called out the analyst’s criticism, they commended the interviewer’s counter-argument. CNBC’s Joe Kernen seemed to even “speak the language” of the crypto space as one twitter user named @HodlBells noted:  


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Source: https://ambcrypto.com/bitcoin-could-reach-1-million-or-1-and-may-do-both-of-those

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Crypto platform NetCents to offer users access to DeFi protocols thru Vesto

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NetCents, a cryptocurrency payments company, today announced it has signed an agreement with Vesto.io to pave the way for DeFi access in the NetCents platform.

Vesto, is a San Francisco-based company that has created a platform allowing users to choose from multiple DeFi protocols in a virtual supermarket. NetCents (with regulatory approval) intends on enabling a portal to the Vesto infrastructure from the NetCents wallet in order to facilitate user’s adoption of DeFi investing in an efficient and easy-to-understand interface.

“We have seen the DeFi space explode over the past year, but for it to reach the next level – the tools and the process has to be attainable by the novice crypto investor. We will be adding a layer of simplification to the process so that individuals can have their savings actually working for them without the complexity of the current platforms. Individuals have the right to lend their money at market-based rates instead of getting 1% interest on their savings that the commercial banks are offering.”
– Clayton Moore, NetCents Founder & CEO

LOI

The Letter of Intent  (LOI) contemplates a Joint Venture between parties and an option for NetCents to invest in Vesto and hold a significant ownership stake in the company at a future date.

Management of NetCents also informed investors that many of the concepts embraced by these DeFi platforms have not been vetted by the many authorities that regulate financial products. NetCents intends to work together with regulators to navigate this landscape and resolve it with a compliant product.

For Example: Fintech businesses seeking to bring a novel product or service to the market can seek regulatory relief through regulatory sandboxes such as the Ontario Securities Commission’s LaunchPad or the British Columbia Securities Commission’s SandBox.

Furthermore, businesses that distribute, trade, or advise in crypto assets that are securities are required to comply with securities laws (in particular, registration and prospectus requirements), which can be onerous. There are many exemptions for specific types of distributions, trades, and other activities and NetCents intends to research these exemptions rigorously. These exemptions, at a high level, may limit the types of investors that can participate or the investment amounts, or may require the preparation of disclosures to investors and filing of a disclosure document.

Source: https://www.cryptoninjas.net/2021/02/27/crypto-platform-netcents-to-offer-users-access-to-defi-protocols-thru-vesto/

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