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5 Ways a Post-Antibiotic Era Could Change Medicine

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For the first time ever, this month the United Nations General Assembly convened a high-level meeting on the topic of antibiotic resistance. At the meeting in Geneva, members committed to develop action plans to reduce antibiotic use.

The urgency for this rare meeting stems from news over the last few months, when we've seen the emergence of resistance to the antibiotic colistin in humans and pigs in the U.S. Colistin, an old drug, is one of our “last resort” antibiotics. Physicians have been reluctant to use it because it can be toxic, and because of their restraint, resistance to the drug hasn’t historically been much of an issue in people. But while its use was rare in the U.S., it was commonly used in agriculture in China. Resistance genes ended up on a plasmid (a piece of DNA that can “jump” between bacteria species) and due to travel and trade, is now in the U.S. This is alarming, as once resistance to an antibiotic evolves, we know it can spread very quickly.

Colistin resistance is far from our only problem. There are now many common bacteria already resistant to antibiotics or carrying a resistance gene that may jump between other bacterial species. Antibiotic resistance leads us to a cornucopia of abbreviations: MRSA, VRE, NDM-1: bacteria that are resistant to antibiotics (methicillin-resistant Staphylococcus aureus; vancomycin-resistant Enterococci) or carry a resistance gene that can jump between bacteria species (NDM-1), like the colistin resistance gene can (abbreviated MCR-1). Even gonorrhea infections are becoming untreatable. A report released earlier this year suggests that by 2050, antibiotic-resistant infections will kill more people each year than cancer.

The bottom line is that we’re losing our last effective antibiotics, and it will change the way medicine is administered in the future.

It can be hard to visualize the enormous impact antibiotic resistance will have, so here are five ways antibiotic resistance might change your life.

1. A SCRATCH COULD BECOME DEADLY.

Infectious disease journalist Maryn McKenna wrote about her great-uncle’s death at age 30, in 1938, five years before antibiotics became widely available. “Through one of the scrapes, an infection set in. After a few days, he developed an ache in one shoulder; two days later, a fever. His wife and the neighborhood doctor struggled for two weeks to take care of him, then flagged down a taxi and drove him fifteen miles to the hospital in my grandparents’ town. He was there one more week, shaking with chills and muttering through hallucinations, and then sinking into a coma as his organs failed. Desperate to save his life, the men from his firehouse lined up to give blood. Nothing worked.”

Though this was 80 years ago, this scenario could become common again. As the available drugs fail, any breach of the skin could once again result in a deadly, untreatable infection. Something as simple as gardening or getting a tattoo could be fatal.

2. MINOR ILLNESSES WON'T BE MINOR ANYMORE.

Infectious disease physician and researcher Eli Perencevich tells mental_floss, “The post-antibiotic era will be your sister or mother dying of a urinary tract infection or your brother dying of a simple appendicitis. But I can't offer a description of life cut short quite like Alfred Reinhart’s death."

As a medical student at Harvard, Reinhart had survived a bout of rheumatic fever at age 13, leaving him with a chance of developing rheumatic heart disease later in life. He was also concerned about the potential to develop a bacterial infection in his heart—which he tracked by keeping close watch on his own symptoms during his time in medical school. He meticulously documented his irregular heartbeats, heart murmurs, and faint skin rashes for months, telling his own doctors he was going to die. He continued to take notes on himself until two days before his death at age 24 from subacute bacterial endocarditis following rheumatic fever.

"Both conditions would be prevented or treated with antibiotics only a few short years later,” Perencevich says.

3. SURGERY WOULD BECOME NEARLY IMPOSSIBLE.

Even now, infections occur after 1 to 3 percent of surgeries. Most of these are still treatable with antibiotics, but about 3 percent still lead to death. Even surgeries many consider “routine” now could easily become complicated without antibiotics, such as Caesarean sections or knee replacements. Infectious disease physician Judy Stone tells mental_floss, “Joint replacements, which are now routine, would be enormously risky. Without effective antibiotics, 40 to 50 percent of patients undergoing hip replacement would develop infections, and approximately 30 percent would die.”

Something like a bone marrow or organ transplant, where the host’s immune system must be compromised to accept the new tissue, would no longer be possible at all; the risk of an untreatable infection would be too high. Stone notes this trend has already started. “I already regularly see men who develop sepsis following prostate biopsies," she says. "They are routinely given Cipro as antibiotic prophylaxis by their urologist, and the bacteria causing their bloodstream infections are now often resistant to Cipro.”

And “elective” surgeries, such as most cosmetic procedures? Forget about it.

4. ANTIBIOTICS COULD BE RATIONED OR ONLY AVAILABLE TO THOSE WITH MEANS.

It may sound far-fetched, but we’ve seen in recent months how easily critical medicines—EpiPens, insulin, treatments for HIV-associated infections, even acne creams—can quickly become financially out of reach. Because antibiotics are “community drugs”—use in anyone can affect how well they work in the whole population—as we find ourselves with fewer and fewer options available for treatment, the few remaining drugs may become strictly rationed—and expensive.

5. IT'S ALREADY HAPPENING.

In many developing countries, deaths from antibiotic-resistant infections are already far too common. In 2015, approximately 1.8 million people died of tuberculosis—in part because drugs weren’t available, and in part because their drugs did not work.

The grandfather of antibiotics, Alexander Fleming, famously predicted in his speech for the 1945 Nobel Prize in Physiology or Medicine, which he received for his discovery of penicillin, that in the future, penicillin might be misused and rendered ineffective. He was all too correct. By 1950, 40 percent of Staph bacteria found in hospitals were already resistant to penicillin.

Now, we have an almost impossible task ahead of us—to preserve the antibiotics we still have by using best prescribing practices in hospitals and clinics, reducing unnecessary use in livestock, and working to develop novel ones before it’s too late.

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technology
Man Buys Two Metric Tons of LEGO Bricks; Sorts Them Via Machine Learning
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iStock // Ekaterina Minaeva

Jacques Mattheij made a small, but awesome, mistake. He went on eBay one evening and bid on a bunch of bulk LEGO brick auctions, then went to sleep. Upon waking, he discovered that he was the high bidder on many, and was now the proud owner of two tons of LEGO bricks. (This is about 4400 pounds.) He wrote, "[L]esson 1: if you win almost all bids you are bidding too high."

Mattheij had noticed that bulk, unsorted bricks sell for something like €10/kilogram, whereas sets are roughly €40/kg and rare parts go for up to €100/kg. Much of the value of the bricks is in their sorting. If he could reduce the entropy of these bins of unsorted bricks, he could make a tidy profit. While many people do this work by hand, the problem is enormous—just the kind of challenge for a computer. Mattheij writes:

There are 38000+ shapes and there are 100+ possible shades of color (you can roughly tell how old someone is by asking them what lego colors they remember from their youth).

In the following months, Mattheij built a proof-of-concept sorting system using, of course, LEGO. He broke the problem down into a series of sub-problems (including "feeding LEGO reliably from a hopper is surprisingly hard," one of those facts of nature that will stymie even the best system design). After tinkering with the prototype at length, he expanded the system to a surprisingly complex system of conveyer belts (powered by a home treadmill), various pieces of cabinetry, and "copious quantities of crazy glue."

Here's a video showing the current system running at low speed:

The key part of the system was running the bricks past a camera paired with a computer running a neural net-based image classifier. That allows the computer (when sufficiently trained on brick images) to recognize bricks and thus categorize them by color, shape, or other parameters. Remember that as bricks pass by, they can be in any orientation, can be dirty, can even be stuck to other pieces. So having a flexible software system is key to recognizing—in a fraction of a second—what a given brick is, in order to sort it out. When a match is found, a jet of compressed air pops the piece off the conveyer belt and into a waiting bin.

After much experimentation, Mattheij rewrote the software (several times in fact) to accomplish a variety of basic tasks. At its core, the system takes images from a webcam and feeds them to a neural network to do the classification. Of course, the neural net needs to be "trained" by showing it lots of images, and telling it what those images represent. Mattheij's breakthrough was allowing the machine to effectively train itself, with guidance: Running pieces through allows the system to take its own photos, make a guess, and build on that guess. As long as Mattheij corrects the incorrect guesses, he ends up with a decent (and self-reinforcing) corpus of training data. As the machine continues running, it can rack up more training, allowing it to recognize a broad variety of pieces on the fly.

Here's another video, focusing on how the pieces move on conveyer belts (running at slow speed so puny humans can follow). You can also see the air jets in action:

In an email interview, Mattheij told Mental Floss that the system currently sorts LEGO bricks into more than 50 categories. It can also be run in a color-sorting mode to bin the parts across 12 color groups. (Thus at present you'd likely do a two-pass sort on the bricks: once for shape, then a separate pass for color.) He continues to refine the system, with a focus on making its recognition abilities faster. At some point down the line, he plans to make the software portion open source. You're on your own as far as building conveyer belts, bins, and so forth.

Check out Mattheij's writeup in two parts for more information. It starts with an overview of the story, followed up with a deep dive on the software. He's also tweeting about the project (among other things). And if you look around a bit, you'll find bulk LEGO brick auctions online—it's definitely a thing!

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Health
One Bite From This Tick Can Make You Allergic to Meat
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We like to believe that there’s no such thing as a bad organism, that every creature must have its place in the world. But ticks are really making that difficult. As if Lyme disease wasn't bad enough, scientists say some ticks carry a pathogen that causes a sudden and dangerous allergy to meat. Yes, meat.

The Lone Star tick (Amblyomma americanum) mostly looks like your average tick, with a tiny head and a big fat behind, except the adult female has a Texas-shaped spot on its back—thus the name.

Unlike other American ticks, the Lone Star feeds on humans at every stage of its life cycle. Even the larvae want our blood. You can’t get Lyme disease from the Lone Star tick, but you can get something even more mysterious: the inability to safely consume a bacon cheeseburger.

"The weird thing about [this reaction] is it can occur within three to 10 or 12 hours, so patients have no idea what prompted their allergic reactions," allergist Ronald Saff, of the Florida State University College of Medicine, told Business Insider.

What prompted them was STARI, or southern tick-associated rash illness. People with STARI may develop a circular rash like the one commonly seen in Lyme disease. They may feel achy, fatigued, and fevered. And their next meal could make them very, very sick.

Saff now sees at least one patient per week with STARI and a sensitivity to galactose-alpha-1, 3-galactose—more commonly known as alpha-gal—a sugar molecule found in mammal tissue like pork, beef, and lamb. Several hours after eating, patients’ immune systems overreact to alpha-gal, with symptoms ranging from an itchy rash to throat swelling.

Even worse, the more times a person is bitten, the more likely it becomes that they will develop this dangerous allergy.

The tick’s range currently covers the southern, eastern, and south-central U.S., but even that is changing. "We expect with warming temperatures, the tick is going to slowly make its way northward and westward and cause more problems than they're already causing," Saff said. We've already seen that occur with the deer ticks that cause Lyme disease, and 2017 is projected to be an especially bad year.

There’s so much we don’t understand about alpha-gal sensitivity. Scientists don’t know why it happens, how to treat it, or if it's permanent. All they can do is advise us to be vigilant and follow basic tick-avoidance practices.

[h/t Business Insider]

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