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Ablation Superior to Drugs in Treating Persistent AFib

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Large international clinical trials show an innovative procedure outperforms drugs for advanced atrial fibrillation

Pexels Photo by Freestocksorg

A minimally invasive heart procedure may be a better first-line treatment than medication for people living with advanced forms of atrial fibrillation (AFib), according to a major international clinical trial led by researchers at the UBC Faculty of Medicine.

For decades, most patients with AFib have been treated with medications first. Procedures like catheter ablation – a minimally invasive technique used to correct faulty electrical signalling in the heart – have typically been reserved for patients whose symptoms persist despite drug therapy. While recent research has suggested ablation may be a more effective initial treatment for early-stage disease, it has also been unclear whether this is true for patients with more advanced disease, who tend to be older, have more underlying health conditions and face higher risks overall.

Published in The New England Journal of Medicine, the new study shows starting with ablation can lead to better outcomes for patients with advanced forms of AFib.

“Traditionally, we’ve taken a stepwise approach, starting with medications and moving to procedures later,” said Dr Jason Andrade, clinical professor at UBC’s faculty of medicine and investigator at the Centre for Cardiovascular Innovation. “What this trial shows is that, even in patients with more advanced AFib, earlier intervention with ablation can provide substantial benefits and better control of the disease.”

A different way to treat the heart

The study focused on patients with persistent AFib, a more serious form in which the abnormal rhythm lasts longer and is more difficult to treat.

Researchers randomly assigned patients to receive either catheter ablation as their initial treatment or standard anti-arrhythmic drug therapy.

During catheter ablation, physicians guide thin, flexible tubes through blood vessels into the heart. Once in place, they eliminate the areas of heart tissue responsible for triggering and sustaining the abnormal electrical signals.

In this study, researchers used a newer technique called pulsed field ablation, which delivers short bursts of electrical energy to precisely target heart tissue.

“You can think of it as resetting the heart’s electrical system,” said Dr. Andrade. “Instead of using heat or freezing, this approach uses carefully controlled pulses to interrupt abnormal signals while minimising damage to surrounding tissue.”

After one year, patients who underwent ablation were significantly more likely to remain free of abnormal heart rhythms than those who started with medication. The overall risk of serious adverse events was similar between the two groups.

“Patients with more advanced atrial fibrillation are inherently more complex,” said Dr Andrade. “Even in this higher-risk group, starting with ablation can offer better control of the condition.”

A decade of reshaping global care

The findings build on more than a decade of research led by Dr Andrade and his team that has helped transform how AFib is treated worldwide.

Earlier landmark trials from this group demonstrated that catheter ablation could be used as a first-line treatment in patients with early-stage AFib. In addition, these studies were the first to demonstrate that catheter ablation was a disease-modifying therapy, significantly slowing the progression of the disease.

Those discoveries helped shift clinical practice globally, with physicians increasingly offering ablation earlier in a patient’s care.

Together, the program of research has redefined how AFib can be treated across its full course, from early to more advanced stages, giving patients and clinicians clearer guidance on when to consider ablation.

“Our goal is to give patients and clinicians the evidence they need to make the best decision for each individual,” said Dr Andrade. “This study fills an important gap for a group of patients where the answer hasn’t been clear.”

Source: The University of British Columbia

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Hydraulic Brain: Body Motion Linked to Fluid Movement in the Brain

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Abdominal contractions are tightly linked to gentle brain movements that help circulate CSF

Using microCT scanning, which allows for high-resolution imaging of an organism’s internal structures, and other imaging techniques, researchers found that a network of veins serve as a mechanical connection between the abdominal cavity and the brain. Here, the veins in red run through the interior of a vertebrae and around the spine.  Credit: Provided by Patrick Drew and team/Penn State. All Rights Reserved.

The brain is more mechanically connected to the body than previously appreciated, scientists reported in Nature Neuroscience. Through a study using mice and simulations, the team found a potential biological mechanism underlying why exercise is thought to benefit brain health: abdominal contractions compress blood vessels connected to the spinal cord and the brain, enabling the organ to gently move within the skull. This swaying facilitates the surrounding cerebrospinal fluid to flow over the brain, potentially washing away neural waste that could cause problems for brain function.

According to Patrick Drew, professor of engineering science and mechanics, of neurosurgery, of biology and of biomedical engineering at Penn State, the work builds on previous studies detailing how sleep and neuron loss can influence how and when cerebrospinal fluid flushes through the brain.

“Our research explains how just moving around might serve as an important physiological mechanism promoting brain health,” said Drew, corresponding author on the paper. “In this study, we found that when the abdominal muscles contract, they push blood from the abdomen into the spinal cord, just like in a hydraulic system, applying pressure to the brain and making it move. Simulations show that this gentle brain movement will drive fluid flow in and around the brain. It is thought the movement of fluid in the brain is important for removing waste and preventing neurodegenerative disorders. Our research shows that a little bit of motion is good, and it could be another reason why exercise is good for our brain health.”

Drew, who also holds the title of associate director of the Huck Institutes of the Life Sciences, explained how in a hydraulic system, a pump creates pressure that drives fluid flow. In this case, the pump is the abdominal contraction – which can be as light as the tensing prior to sitting up or taking a step. The contraction puts pressure on the vertebral venous plexus, a network of veins that connect the abdominal cavity to the spinal cavity, causing the brain to move.

The researchers used two-photon microscopy — which allows for high-definition imaging of living tissue — to observe the brain shifting in the moments before the mouse moved, but right after the tightening of the abdominal muscles needed to spur the body into further movement. On the left, the brain, in green, sits during a stationary moment, while the image on the right shows the brain during movement.  Credit: Provided by Patrick Drew and team/Penn State. All Rights Reserved.

The researchers visualised the process in moving mice with two advanced imaging technologies: two-photon microscopy, which allows for high-definition imaging of living tissue, and microcomputed tomography, which enables high-resolution 3D examination of whole organs. They observed the brain shifting in the moments before the mouse moved, but right after the tightening of the abdominal muscles needed to spur the body into further movement.

To confirm that it was abdominal contractions rather than other movement that acted as the pump, the researchers applied gentle and controlled pressure to the abdomens of lightly anaesthetised mice. With no other movement other than a localised mechanical pressure less than a human would experience with a blood pressure cuff, the mice’s brains shifted.

“Importantly, the brain began moving back to its baseline position immediately upon relief of the abdominal pressure,” Drew said. “This suggests that abdominal pressure can rapidly and significantly alter the position of the brain within the skull.”

With the abdominal contraction-brain movement link confirmed, Drew said the next step was to understand the fluid’s movement in the brain and if the brain’s movement could induce fluid flow. However, there previously were no existing imaging techniques to visualize the rapid, nuanced dynamics of such fluid flows.

“Luckily, our interdisciplinary team at Penn State was able to develop these techniques, including conducting the imaging experiments of living mice and creating computer simulations of fluid motion,” Drew said. “That combination of expertise is so important for understanding these types of complicated systems and how they impact health.”

Francesco Costanzo, professor of engineering science and mechanics, of biomedical engineering, of mechanical engineering and of mathematics, led the computational modelling.

“Modelling fluid flow in and around the brain offers unique challenges because there are simultaneous, independent movements, as well as time-dependent, coupled movements. Accounting for all of them requires accounting for the special physics that happens every time a fluid particle crosses one of the many membranes in the brain,” Costanzo said. “So, we simplified it. The brain has a structure similar to a sponge, in the sense that you have a soft skeleton and fluid can move through it.”

By simplifying the geometry of the brain to that of a sponge, Costanzo explained that the team could model how fluid flows through a structure with varied spaces, like wrinkles in the brain, or pores in the sponge.

“Keeping with the idea of the brain as a sponge, we also thought of it as a dirty sponge – how do you clean a dirty sponge?” Costanzo asked. “You run it under a tap and squeeze it out. In our simulations, we were able to get a sense of how the brain moving from an abdominal contraction can help induce fluid flow over the brain to help clear waste products.”

Drew emphasised that while more work is needed to understand the full implications in humans, this study suggests that body movement may help to cycle cerebrospinal fluid around and in the brain, removing waste and helping to protect against neurodegenerative disorders associated with waste buildup.

“This kind of motion is so small. It’s what’s generated when you walk or just contract your abdominal muscles, which you do when you engage in any physical behaviour. It could make such a difference for your brain health,” Drew said.

By Ashley WennersHerron

Source: Pennsylvania State University

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Joint Effort is Key to Sustainable Healthcare Reform

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By Gale Shabangu, Chairperson, Hospital Association of South Africa (HASA)

Recently, President Cyril Ramaphosa made an important decision: to pause the promulgation of the National Health Insurance (NHI) Act until the Constitutional Court has ruled on the pending challenges to Parliament’s role in passing the Act. In doing so, he affirmed that due process must guide reform.

It is a reminder that healthcare reform is not a race to the finish line, but a journey that requires careful pacing, broad consultation and respect for the voices of South Africans. Reform at this scale is like tending a vast garden: every seed must be planted with foresight, every path cleared with care, so that the harvest nourishes all.

Families already feel the strain of rising costs – electricity, food, borrowing – and medical contributions that climb steadily. Yet even in this pressure, there is resilience. South Africans have always found ways to adapt, to share, to build together. Healthcare reform must honour that spirit, ensuring affordability is not a privilege but a shared foundation.

The private healthcare system is a necessary and valuable part of the scaffolding of our healthcare system, sustaining capacity that millions rely on. Unfinished reforms, such as risk equalisation, mandatory membership, and base benefit packages, remain like bridges half‑built. Completing them would stabilise participation and strengthen the entire ecosystem.

If private participation declines, demand does not vanish – it shifts. Public hospitals, already carrying immense responsibility, would feel the weight. Yet here lies the opportunity: to recognise that public and private healthcare are not adversaries but allies. The public sector anchors universal access; the private sector provides funded capacity that absorbs demand and sustains innovation. Together, they form a single ecosystem, each part vital to the whole.

Healthcare reform is about weaving our systems together into a fabric strong enough to carry us all.

As the President recently noted, readiness is central to bringing legislation into effect. Readiness is not bureaucracy – it is the heartbeat of reform. It signals that change must be feasible, not forced; sustainable, not symbolic. That is a hopeful message, because it means reform will be paced by practicality, not politics.

The path forward is clear and promising: complete outstanding reforms in medical schemes, strengthen risk pooling, invest in primary care and prevention, and sequence structural changes responsibly. These steps are not obstacles – they are stepping stones toward a healthier, more equitable South Africa.

Healthcare reform is a national undertaking and a shared responsibility. Government, funders, providers, employers and civil society are all custodians of this commitment. What matters now is how we act, with realism, collaboration and a clear focus on strengthening what already works.

Equitable access to quality healthcare is our shared goal. Achieving it requires evidence, readiness, and respect for complementarity. With stability, sustainability and collaboration as our compass, South Africa can build a healthcare system that is workable and inspiring – a system that reflects the resilience, dignity and hope of its people.

Healthcare requires stewardship. With stability, sustainability, and collaboration guiding reform, South Africa can build a system that works for everyone. And with optimism guiding reform, I believe we can build a system that works for everyone – today, tomorrow and for generations to come.

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Innovative Surgery Cuts Ovarian Cancer Risk by Nearly 80% 

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New research shows that Canadian-developed surgical procedure dramatically reduces rates of the most lethal gynaecological cancer

Fallopian Tubes. Credit: Scientific Animations CC4.0 BY-SA

A prevention strategy developed by Canadian researchers reduces the risk of the most common and deadly form of ovarian cancer by nearly 80%, according to a new study published today in JAMA Network Open.

The strategy, known as opportunistic salpingectomy (OS), involves proactively removing a person’s fallopian tubes when they are already undergoing a routine gynaecological surgery such as hysterectomy or tubal ligation, commonly called “having one’s tubes tied”.

British Columbia in Canada became the first jurisdiction in the world to offer OS in 2010, after a team of researchers from UBC, BC Cancer and Vancouver Coastal Health designed the approach when it was discovered that most ovarian cancers originate in the fallopian tubes rather than the ovaries. OS leaves a person’s ovaries intact, preserving important hormone production so there are minimal side effects from the added procedure.

The new study, led by a B.C.-based international collaboration called the Ovarian Cancer Observatory, provides the clearest evidence yet that the Canadian innovation saves lives.

“This study clearly demonstrates that removing the fallopian tubes as an add-on during routine surgery can help prevent the most lethal type of ovarian cancer,” said co-senior author Dr Gillian Hanley, an associate professor of obstetrics and gynaecology at UBC. “It shows how this relatively simple change in surgical practice can have a profound and life-saving impact.”

New hope against a deadly cancer

Ovarian cancer is the most lethal gynaecological cancer. Approximately 3100 Canadians are diagnosed with the disease each year and about 2000 will die from it.

There is currently no reliable screening test for ovarian cancer, meaning that most cases are diagnosed at advanced stages when treatment options are limited and survival rates are low.

The OS approach was initially developed and named by Dr Dianne Miller, an associate professor emerita at UBC and gynaecologic oncologist with Vancouver Coastal Health and BC Cancer. She co-founded B.C.’s multidisciplinary ovarian cancer research team, OVCARE.

“If there is one thing better than curing cancer it’s never getting the cancer in the first place,” said Dr. Miller.

The new study is the first to quantify how much OS reduces the risk of serous ovarian cancer – the most common and deadly subtype of the disease. It builds on previous research demonstrating that OS is safe, does not reduce the age of menopause onset, and is cost-effective for health systems.

The study analysed population-based health data for more than 85 000 people who underwent gynaecological surgeries in B.C. between 2008 and 2020. The researchers compared rates of serous ovarian cancer between those who had OS and those who had similar surgeries but did not undergo the procedure.

Overall, people who had OS were 78% less likely to develop serous ovarian cancer. In the rare cases where ovarian cancer occurred after OS, those cancers were found to be less biologically aggressive. The findings were validated by data collected from pathology laboratories from around the world, which suggested a similar effect.

From B.C. innovation to global impact

Since its introduction in B.C. in 2010, OS has been widely adopted, with approximately 80 per cent of hysterectomies and tubal ligation procedures in the province now including fallopian tube removal.

Globally, professional medical organizations in 24 countries now recommended OS as an ovarian cancer prevention strategy, including the Society of Obstetrics and Gynaecology of Canada, which issued guidance in 2015.

“This is the culmination of more than a decade of work that started here in B.C.,” said co- senior author Dr. David Huntsman, professor of pathology and laboratory medicine and obstetrics and gynaecology at UBC and a distinguished scientist at BC Cancer. “The impact of OS that we report is even greater than we expected.”

The researchers say expanding global adoption of OS could prevent thousands of ovarian cancer cases worldwide each year.

“This is a powerful example of how UBC research is changing clinical practice worldwide and saving lives,” said Dr Sharmila Anandasabapathy, dean of the faculty of medicine and vice-president, health, at UBC. “It speaks to the strength of our researchers and clinicians working together to translate discovery into real-world impact for patients here at home and around the world.”

Extending OS to other abdominal and pelvic surgeries where appropriate could further increase the number of people who could benefit from the prevention strategy. B.C. recently became the first province to expand OS to routine surgeries performed by general and urologic surgeons through a project supported by the Government of B.C. and Doctors of BC.

“Our hope is that more clinicians will adopt this proven approach, which has the potential to save countless lives,” said Dr Huntsman. “Not offering this surgical add-on may leave patients unnecessarily vulnerable to this cancer.”

Brett Goldhawk

Source: University of British Columbia

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WHO Prequalifies First-ever Malaria Treatment for Infants

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Photo by Ekamelev on Unsplash

Ahead of World Malaria Day on 25 April, the World Health Organization (WHO) has announced a significant step forward in the fight against malaria with the prequalification of the first treatment developed specifically for newborns and young infants weighing between two and five kilograms. The prequalification designation indicates that the medicine meets international standards of quality, safety and efficacy, and will help to expand access to quality-assured treatment for one of the most underserved patient groups.

The newly prequalified treatment, artemether-lumefantrine, is the first antimalarial formulation designed specifically for the youngest malaria patients. Until now, infants with malaria have been treated with formulations intended for older children, which increase the risk of dosing errors, side effects and toxicity. WHO prequalification will enable public sector procurement, contributing to closing a long-standing treatment gap for some 30 million babies born each year in malaria-endemic areas of Africa.

“For centuries, malaria has stolen children from their parents, and health, wealth and hope from communities,” said Dr Tedros Adhanom Ghebreyesus, WHO Director-General. “But today, the story is changing. New vaccines, diagnostic tests, next-generation mosquito nets and effective medicines, including those adapted for the youngest, are helping to turn the tide. Ending malaria in our lifetime is no longer a dream – it is a real possibility, but only with sustained political and financial commitment. Now we can. Now we must.”

New prequalified tests

On 14 April 2026, WHO also prequalified three new rapid diagnostic tests (RDTs) designed to address emerging diagnostic challenges for malaria. The most common malaria RDTs for P. falciparum parasite work by detecting the protein, known as HRP2. But based on reported studies and surveys in 46 countries, some strains of the malaria parasite have lost the gene that makes this protein – so they become “invisible” to HRP2-based RDTs, leading to false-negative results. In countries in the Horn of Africa, up to 80% of cases were missed, leading to delayed treatment, severe illness, and even death.

The new tests address this issue by targeting a different parasite protein (pf-LDH) that the malaria parasite cannot easily shed. They provide a reliable, quality-assured alternative where HRP2-based tests are failing. WHO now recommends that countries switch to these alternative RDTs when more than 5% of cases are missed due to pf-hrp2 deletions. This ensures accurate diagnosis, appropriate treatment, and protects hard-won malaria control gains – especially for the most vulnerable communities.

Source: World Health Organization

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Participatory Democracy: What Will Be on the Line When the Country’s Highest Court Turns to NHI in May?

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Photo by Bill Oxford on Unsplash

By Sasha Stevenson

From 5–7 May, the Constitutional Court will hear two of the multiple challenges to the NHI Act. Sasha Stevenson, Executive Director of SECTION27, considers what will be on the line in these first potentially landmark cases that deal with the process that led to the Act.

The public discussion on National Health Insurance has gone from abstract; to alternatively excited or worried about implementation; to dizzying references to a range of court cases filed over the course of 2024 and 2025. It can be difficult to keep up with what NHI may mean for our health system and when the promised system reform may happen.

We may now be approaching a decisive moment, with the Constitutional Court set to hear two of the NHI challenges.

From 5–7 May 2026, the Constitutional Court will be hearing challenges brought by the Board of Healthcare Funders and the Premier of the Western Cape. These two challenges deal with public participation in the making of what is now the NHI Act.

In February 2026, parties challenging the constitutionality of specific sections of the NHI Act agreed with government to put their cases on hold, pending a decision of the Constitutional Court in the May 2026 public participation challenges. The parties bringing constitutional challenges include the South African Private Practitioners Forum, the Hospital Association of South Africa, the South African Medical Association, and the Health Funders Association, among others. They agreed to hold off because a decision of the Constitutional Court on public participation could make the constitutional challenges unnecessary.

So for now, all eyes are on the Constitutional Court, whose judges will decide whether government must go back to the drawing board and follow a different procedure, or whether it may go ahead (and face a slew of constitutional challenges).

The Western Cape’s case

The Western Cape government is challenging the NHI Act because it argues that consultation with the Western Cape government, over legislation that restructures health services provided by provinces, was lacking. They argue that the National Council of Provinces (NCOP) failed to respond to a request for an extension for the Western Cape to submit the outcome of its provincial consultation on the NHI Bill and its voting mandate, and then went ahead without the Western Cape documents.

The NCOP also did not, the Western Cape government alleges, consider or debate any proposed amendments to the NHI Bill arising from the public participation in other provinces. When the Western Cape government submission and public participation report came in, the NCOP merely confirmed its earlier decision to approve the Bill.

In essence, the Western Cape’s challenge is about the NCOP’s role of ensuring that provinces and their residents have a say in the making of new laws, and whether that role was properly played. It argues that the NCOP’s failure to play its constitutional role should result in the NHI Act being declared unconstitutional and invalid.

The Board of Healthcare Funders case

While the Western Cape challenge does not deal with public participation in the NHI law-making writ large, the Board of Healthcare Funders (BHF) case fills this gap.

The BHF argues that both the National Assembly and the NCOP failed to comply with their constitutional obligations to facilitate meaningful and effective public involvement in the NHI law-making process. The BHF contends that the public was not provided with sufficient information to allow for meaningful engagement (such as details about the costs and the benefits package of the NHI Fund); and that law makers were not open to persuasion in the participation process.

The BHF asks that the NHI Act is declared invalid and set aside.

Why should we care about public participation?

The Constitutional Court has held that “[i]t is apparent from the preamble of the Constitution that one of the basic objectives of our constitutional enterprise is the establishment of a democratic and open government in which the people shall participate to some degree in the law-making process.”

There was a huge amount of public participation in the law-making process for the NHI Act, with roadshows, written submissions and oral presentations. Government respondents in the BHF case point to the fact that 338 891 written submissions were made at various stages, and many oral presentations were heard by Parliament. Few could argue that, if you wanted to, you did not have a chance to have your say on the NHI Bill.

But is being able to say something enough?

In a constitutional democracy where citizens participate in law-making between elections as a way of directly influencing the law, if there is no chance of having that influence, merely being able to speak is insufficient.

There is, of course, no obligation on government to adopt proposed changes as a result of public participation. Parliament cannot be required to agree with all submissions, and the validity of a process does not turn on whether amendments were made to take into account submissions. But when few or no amendments are made, it inevitably raises eyebrows.

In the case of the NHI Bill, while there were limited changes to the Bill when it went through the National Assembly, no changes at all were made following the NCOP public participation process. Given the hundreds of thousands of submissions, many of which were substantive, the small number of amendments is surprising. Particularly given that some submissions that were consistently made are now being conceded by the Department of Health, in public or in private. These include submissions related to the position of asylum-seekers, transitional provisions, and the role of medical aids.

SECTION27 and the Treatment Action Campaign made submissions at Draft Bill stage, before the National Assembly, and before the NCOP. As health activists and health rights lawyers, our submissions were carefully considered and proposed amendments to bring the Bill in line with the Constitution and the needs of healthcare users. Our experience was of MPs engaging to a very limited extent with the substance of the submissions, focusing rather on whether we were ‘for’ or ‘against’ the NHI, or their party’s position on it. It was an experience that brought into question how seriously real public participation was being taken.

The Constitutional Court will now be able to consider whether the public participation processes on the NHI Act were in line with the constitutional call for participatory democracy; or whether they were an unconstitutional tick box exercise. Its decision will determine if the NHI Act will be further scrutinised for substantive constitutionality through litigation, or if it should be returned to the legislature for further consideration and participation.

Either way, what NHI may mean for our health system is a question that may yet take some time to answer. On the other hand, what participatory democracy requires of parliament (arguably an even more consequential question) may soon be answered by the Constitutional Court.

*Stevenson is a human rights lawyer and executive director of SECTION27. SECTION27 is representing the Treatment Action Campaign in an application to be admitted as amicus curiae in a court case relating to the NHI.

Note: Spotlight is published by SECTION27, but is editorially independent – an independence that the editors guard jealously. Spotlight aims to deepen public understanding of important health issues by publishing a variety of views on its opinion pages. The views expressed in this article are not necessarily shared by the Spotlight editors.

Republished from Spotlight under a Creative Commons licence.

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Family Environment Shapes Life Outcomes Across Generations

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Source: CC0

Adopted children who have grown up in more favourable family environments than their siblings are at lower risk of mental health issues, criminality and social problems – benefits that, in some cases, extend to the next generation. These are the findings of a new study of Swedish siblings published in The BMJ.

Children who grow up in difficult family circumstances are at greater risk of experiencing problems later in life. These may include mental health issues, difficulties at school or criminal behaviour. 

To determine the extent to which these factors can be influenced, researchers at Karolinska Institutet studied pairs of siblings in Sweden where one sibling was adopted away from a high-risk family while the other remained with and grew up with their biological parents. This allowed them to compare the long-term effects of different family environments while taking genetic factors into account.

“Our study shows that a more favourable home environment can make a big difference, particularly for children who start life with clear risk factors,” says Erik Pettersson, associate professor at the Department of Medical Epidemiology and Biostatistics at Karolinska Institutet.

Followed over 12 000 siblings

The study is based on Swedish population registers and covers just over 12 000 full and half-siblings born between 1950 and 1980. All come from families where at least one parent had experienced some form of psychiatric or social issue, such as mental illness, criminality or attempted suicide, and where at least one child had been given up for adoption before the age of ten. Families who took in adopted children often had greater resources and higher socio-economic status.

The results show that the adopted children had a lower risk of mental illness, criminality and dependence on social security benefits as adults, compared to their siblings who grew up with their biological parents. They also performed better at school and, on average, attained a higher level of education. Furthermore, men who had been adopted performed better during military conscription, both on intelligence tests and in interviews measuring stress resilience and social adaptability.

May affect the next generation

The researchers also investigated whether these differences were passed on to the next generation. In total, nearly 22,000 children of the sibling pairs were studied. 

On average, the children of adopted siblings displayed higher functioning than their cousins, for example a lower risk of criminality and financial problems. The effects were weaker than in the previous generation, but pointed in the same direction.

“This suggests that improved living conditions benefit not only the individual, but also the next generation,” says Erik Pettersson.

Value of support measures

He emphasises that the results should not be seen as an argument for adoption, which is currently uncommon in Sweden. However, he believes the study highlights the value of interventions for children in vulnerable environments.

“Research into the effects of various support measures aimed at giving children a better upbringing is both limited and fragmented,” he says. “Some studies show significant long-term benefits; others show little or none at all. Our study suggests that the potential is considerable, even though we cannot say which measures are most important.” 

Source: Karolinska Institutet

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Common Fluid Treatments for Paediatric Sepsis Found to Have Similar Efficacy and Safety

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Trial found that balanced fluids and saline solution are equally effective for treating patients and reducing the risk of major adverse kidney events

Photo by Furkan İnce

A major study, led by researchers at Children’s Hospital of Philadelphia, Nemours Children’s Health, and Children’s National Hospital, found that different types of crystalloid fluid resuscitation were equally effective for staving off the most serious adverse kidney events after the treatment of paediatric patients with suspected septic shock. The findings of this large clinical trial are detailed in a study published by The New England Journal of Medicine and are being presented at the Pediatric Academic Societies (PAS) Meeting in Boston.

Sepsis is a life-threatening response to infection that causes organ failure. The combination of the body’s immune system and the infection together cause an abnormal response, which can prevent different organ systems from working normally. While many decades of research and improvements in clinical care have significantly improved outcomes for paediatric sepsis patients, about 1 in 10 children in the US with sepsis or septic shock are still at risk of dying.

In some previous multi-centre studies, researchers found that critically ill adults who received balanced crystalloid fluid – an intravenous (IV) treatment meant to exhibit similar properties to human plasma – resulted in lower risk of complications and death compared with a standard 0.9% saline IV solution. This prompted researchers to explore whether a similar study could determine whether one fluid treatment was superior for pediatric sepsis patients.

“We knew we were going to need thousands of patients to answer this question, which we knew would be a challenge,” said co-lead author Fran Balamuth, MD, PhD, an attending physician and Division Chief of Emergency Medicine at CHOP. “Yet we were excited to proceed because these fluids are inexpensive and universally available around the world, meaning that we wouldn’t have decades of waiting to take action once the study was complete; we could be pragmatic and take immediate action based on the results that we found.”

Because suspected cases of sepsis are uncommon among the general population, Balamuth, co-lead author Scott L. Weiss, MD, attending physician and Division Chief of Critical Care at Nemours Children’s Hospital, Delaware, and their colleagues required the collaboration of many hospitals to achieve the data standards needed for meaningful conclusions. For this, they collaborated with Nathan Kuppermann, MD, Executive Vice President and Chief Academic Officer of Children’s National Hospital and Director of the Children’s National Research Institute, who has a history of running successful clinical trials in acutely ill children, and served as the senior author.

“This trial demonstrates the power of large collaborative research networks to answer important clinical questions for children,” Kuppermann said. “By enrolling thousands of patients across multiple countries, we were able to provide the kind of evidence clinicians need to guide care for children with suspected septic shock.”

In the end, a total of 47 emergency departments across five countries were represented in the study, with more than 9000 patients enrolled who received either balanced fluid or 0.9% saline.

The primary outcome of the study was Major Adverse Kidney Events by 30 days (MAKE30), an important outcome for kidney injury that accounts for death, new renal replacement therapy or persistent renal dysfunction. The researchers found that MAKE30 occurred in 3.4% of patients enrolled in the balanced fluid group and 3.0% in the 0.9% saline ground. The study found biochemical differences in children treated with the two fluids, including a higher frequency of elevated blood chloride levels in the 0.9% saline group, and higher lactate levels in the balanced fluid group. Both groups had 23 median hospital-free days of 28, and there were no differences in mortality or other safety outcomes or adverse events. 

“This trial confirms that either balanced fluid or 0.9% saline are effective and safe for the initial resuscitation of children with suspected septic shock, and that a fluid strategy that reduces hyperchloraemia does not necessarily translate to improved patient outcomes,” said Weiss, an attending physician and Division Chief of Critical Care at Nemours Children’s Hospital, Delaware. “We also did not identify differences across subgroups. However, despite the large number of participants, it is important to note that we cannot exclude the possibility of benefit of one fluid or the other in a subset of children with the most severe illness.”

“A large trial like this definitively answers a question we’ve had in our field for many, many years,” Balamuth said. “In an emergency department with a child with suspected sepsis, you can treat the child with whichever fluid is readily available. And we think that’s great news for children around the world.”

Source: EurekAlert!

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Genetic Study in Indians Finds New Pathways Involved in Cardiometabolic Disease

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Study of 3000 Punjabi Sikhs may yield new targets for treating Type 2 diabetes and other disorders

Photo by Sangharsh Lohakare on Unsplash

A study conducted in an Indian population has identified new molecular pathways that contribute to cardiovascular disease, which had not been reported previously in studies of Europeans. Dharambir Sanghera of the University of Oklahoma Health Sciences Center, US, led the new study, which was published April 23rd in the open access journal PLOS Medicine.

Worldwide, rates of cardiometabolic disease, which includes obesity, Type 2 diabetes and heart disease, are on the rise, and South Asian people living abroad appear to be especially susceptible. Previous studies have looked for genes that influence the levels of various breakdown products of lipids in the blood and their connection to different diseases, but most of this research has been conducted in people of European ancestry.

In the new study, researchers looked at how genetics influenced the levels of 516 lipid metabolites in the blood of 3000 Punjabi Sikh individuals, in an effort to better understand how these genetic pathways contribute to disease in different ethnic groups. They compared their findings to previous results from more than 1 million Europeans and 15 000 individuals with Indian ancestry. The team identified new genetic pathways that link specific lipid metabolites to disease. Notably, they confirmed that one metabolite, LPC O-16:0, which is known to be involved with immune cell signaling and inflammation, influences Type 2 diabetes risk. They also identified a genetic variant that may protect Indians from developing heart disease by modulating levels of the metabolite PC 38:4.

These findings offer new insights into the diverse molecular origins of cardiometabolic disease and provide potential pathways to be explored for designing innovative therapies. The researchers conclude that including more non-European participants in this type of research would help in identifying distinct disease subtypes linked to different genetic pathways. These advances would likely be beneficial in clinical practice by enabling more personalised therapies and preventive strategies for people from different backgrounds.

The authors add, “This study reveals new genetic pathways and lipid markers that contribute to type 2 diabetes and heart disease, specifically emphasising how immune system signaling affects metabolic health. By identifying unique genetic signatures in Asian Indians, the research advocates for ancestry-specific medical approaches to address chronic immuno-vascular conditions in cardiometabolic disease.”

Provided by PLOS

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Vitamin D May Help Prevent Diabetes – Depending on Genetics

On By ModernMedia

New analysis of a major clinical trial finds supplementation reduced diabetes risk in prediabetic adults with certain variations in the vitamin D receptor gene

Photo by Michele Blackwell on Unsplash

Prediabetes is a condition marked by higher-than-normal blood sugar levels that often leads to type 2 diabetes. A new study finds that vitamin D may help delay or prevent that progression – but only in people with certain genetic variations.

The study, published today in JAMA Network Open, found that prediabetic adults with certain variations in the vitamin D receptor gene had a 19% lower risk of developing diabetes when taking a high daily dose of vitamin D.  

The researchers analysed data from the D2d study, a large, multi-site clinical trial that tested the effect of 4,000 units of vitamin D per day versus placebo in more than 2000 US adults with prediabetes to see if a daily high dose of vitamin D would lower the chance of these particularly high-risk individuals developing diabetes.

The original trial did not find a significant reduction in diabetes risk across all participants.  

“But the D2d results raised an important question: Could vitamin D still benefit some people?” said Bess Dawson-Hughes, M75, the study’s lead author and a senior scientist at the Jean Mayer USDA Human Nutrition Research Center on Aging at Tufts University. “Diabetes has so many serious complications that develop slowly over years. If we can delay the time period that an individual will spend living with diabetes, we can stop some of those harmful side effects or lessen their severity.”

Through an earlier analysis, the D2d research team found that blood levels of 40 to 50 ng/mL of 25-hydroxyvitamin D or higher were linked to substantial and progressively larger reductions in participants’ risk of developing diabetes.  

Vitamin D circulating in the blood is converted into its active form in the body before binding to the vitamin D receptor, a protein that helps cells respond to the vitamin. The researchers wondered whether genetic differences in this receptor might explain why some people benefited from vitamin D while others did not. The pancreas’s insulin-producing cells have vitamin D receptors, suggesting the vitamin may help influence insulin release and blood sugar control.  

For the new study, Dawson-Hughes and her colleagues analysed genetic data from 2098 trial participants who had consented to DNA testing according to two groups: participants who appeared to benefit from vitamin D supplementation and those who did not. They then compared response rates by subgroups of patients sorted according to three common variations in the vitamin D receptor gene. 

This analysis revealed that adults with the AA variation of the ApaI vitamin D receptor gene (about 30% of the study population) did not respond to daily treatment with a high dose of vitamin D, compared with placebo. In contrast, the analysis found that the same treatment in adults with the AC or CC variations of the vitamin D receptor gene saw a significantly reduced risk of developing diabetes compared with those taking a placebo. 

“Our findings suggest we may eventually be able to identify which patients with prediabetes are most likely to benefit from additional vitamin D supplementation,” said Dawson-Hughes. “In principle, this could involve a single, relatively inexpensive genetic test.”

By Genevieve Rajewski

Source: Tufts University