Month: November 2020

Breast Cancer Patients in Public Healthcare System Face Great Obstacles

In an in-depth article, the Daily Maverick reports on the huge challenges that breast cancer sufferers face in obtaining treatment from the public healthcare sector in South Africa.

A diagnosis might take up to six months, whereas one can be obtained in a space of weeks in private healthcare. Breast reconstructions are not available under public healthcare, forcing the survivor to find some way of hiding the disfigurement. The critical drug trastuzumab is classed as an unfunded mandate even in the Western Cape. Yet in the private sector, it is a prescribed minimum benefit. There are language barriers for patients, and a lack of palliative care medicines upon discharge. They also are not connected online, and cannot engage with initiatives such as Pinktober. In a country beset by gender-based violence and inequality, women’s health often is not a priority.

The remedy still lags very far behind. Since its inception in 2017, The Breast Cancer Control Policy has not been implemented anywhere in South Africa. In order to implement this policy, registered nurses have their job descriptions updated to include a primary modality of breast cancer screenings.

The COVID pandemic has set back progress even further, with care being postponed and many hospices being forced to close.

Chinese Doctors Imprisoned for Illicit Organ Trade

In China, doctors were among six people jailed for illegally harvesting organs in the country’s Anhui province. 

The liver and kidneys of 11 people were removed, after tricking the families of the deceased into thinking they were performing approved organ donations. Organs for transplant in China are in extremely short supply, especially after the practice of harvesting organs from executed prisoners was ended following global criticism and concerted effort in 2015.

Shi Xianglin, son of one the deceased whose organs had been removed, became suspicious when examining the paperwork and local records. He alerted the authorities, and the six were sentenced in July. The case only came to light when Mr Shi spoke to the media about it.

Source: BBC News

New Multi-cancer Blood Test Offered by NHS

A new blood test developed by the California-based Grail company tests for DNA methylation, and is supposedly able to screen for over 50 cancer types this way.

The NHS is to offer the test to 165 000 people from the middle of next year, with 140 000 screened through their medical records and the remaining 25 000 through referrals from suspected symptoms. It is hoped that widespread screening and early detection will drastically improve cancer survival rates, consequently easing pressure on healthcare services.

Lawrence Young, a professor of molecular oncology, at Warwick University, said the Galleri test was one of several novel blood tests being developed to spot cancer early on. “A publication from the Circulating Cell-free Genome Atlas consortium examining the Galleri test in 6 689 participants has generated very encouraging results in more than 50 different cancers at different stages of development.”

However, there was disagreement from some cancer experts regarding Galleri’s  potential effectiveness. Paul Pharoah, a professor of cancer epidemiology, at Cambridge University, said that it was premature for the NHS to embrace an unproven test. He said, “The Galleri blood test is a test that might be able to detect cancer in the blood in individuals with early cancer, though the evidence that it does this effectively is weak,” Pharoah said. According to him, only a single published paper on the tests was available, wherein they detected a mere 25% of early-stage cancers and under half of late-stage cases.

Source: The Guardian

No Lockdown May Worsen Economies

In an article for The Conversation, Michael Smithson of the Australian National University argues that far from there being a toss-up between saving lives with a lockdown, and protecting the economy by keeping a country open, lockdown may in fact protect the economy.

Some arguments even leaned towards Indeed, US Treasury Secretary Steve Mnuchin said in June, “I think we’ve learned that if you shut down the economy, you’re going to create more damage.”

The choice of whether to implement lockdown has been a particularly difficult choice to make for South Africa, beset by deep inequality. Its lockdown caused its economy to shrink by 51% in the second quarter.

Economic and COVID data from 45 countries was sourced for analysis. The data has two outliers; namely China, which implemented a very effective early lockdown, and India, which implemented a strict lockdown that became very ineffective as time went by.

Consumer expenditure, an important indicator of economic activity, was negatively correlated with COVID cases, indicating that the economy fared better with attempts to suppress the virus (at least temporarily).

In European countries, GDP was positively correlated with COVID cases, indicating that economic activity itself drove up the rate of COVID cases. 

The article’s conclusions do have some limitations. The economic data were drawn from the second quarter, and COVID cases were taken as of June 30, but the pandemic hit different countries at different times. 

Gauteng to Brace for Second COVID Wave in January

Speaking at a memorial for healthcare workers who have died from COVID, acting MEC of Health Jacob Mamabolo says that the Gauteng health department is expecting a second wave of the virus in January.

Gauteng, which represents 30.1% of all cumulative COVID cases nationwide, is expected to see a resurgence on the back of holiday festivities and travel, based on modelling information supplied to the provincial command council.

“We need to be reminded that the battle with Covid-19 is not yet over. We are still in the outbreak stage and not in the post-Covid-19 period yet. Here in Tshwane we still have hotspots and areas that are of great worry such as Atteridgeville, Sunnyside, Ga-Rankuwa and Mamelodi,” said Mamabolo.

He further added that alcohol consumption would lead to people being discouraged in following the COVID health and safety rules, and that staff were already exhausted from a long year of fighting the disease. He added that it was necessary that extra staff were approved for the fight in the coming year.    Source: Rekord East

New Drug Relieves Rheumatoid Arthritis Pain

A new drug, otilimab, has shown effectiveness in treating rheumatoid arthritis (RA). Otilimab is a human monoclonal antibody which inhibits granulocyte-macrophage colony-stimulating factor (GM-CSF). GM-CSF is a large driver of immune-mediated inflammatory conditions.

The drug is currently being tested on its ability to suppress inflammation, tissue damage and pain in RA sufferers.

A multicentre, dose-ranging trial conducted with the drug. Participants were administered subcutaneous injections with one of five different dosages of otilimab (22.5 mg, 45 mg, 90 mg, 135 mg, or 180 mg) or placebo weekly for five weeks. Thereafter, they received injections once every two weeks for one year. The results showed a rapid reduction in tenderness and swelling, and a very high reduction in pain.

The study was unusual in that it offered an escape arm. It is often difficult to recruit participants when they know they may be receiving a dummy injection, and so if, after 12 weeks the participants  on the placebo arm derived no benefit, they were transferred to the highest dose arm of 180mg.

Source: Medical Xpress

Journal information: Christopher D Buckley et al, Efficacy, patient-reported outcomes, and safety of the anti-granulocyte macrophage colony-stimulating factor antibody otilimab (GSK3196165) in patients with rheumatoid arthritis: a randomised, phase 2b, dose-ranging study, The Lancet Rheumatology (2020). DOI: 10.1016/S2665-9913(20)30229-0

Osteoporosis Drug Enhances Natural Bone Formation

A new osteoporosis drug, NaQuinate, that treats osteoporosis by enhancing its response to weight bearing, has completed its first human clinical trial. 

NaQuinate is a naphthoquinone carboxylic acid, and is found naturally as a Vitamin K metabolite. It has been shown in mouse models that NaQuinate responds synergistically to mechanical loading, building bone density. In a separate trial, the efficacy of NaQuinate is being evaluated against that of bisphosphonates without loading and anabolics with loading.

Haoma Medica’s Chief Medical Officer, Dr Cenk Oguz, said: ”We are delighted that the first-in-human study has completed its last dosing. There were no significant safety or tolerability concerns up to the highest doses tested which underlines our expectation that NaQuinate is safe and well tolerated.”
Haoma Medica’s CEO,  Dr Steve Deacon, said:”Our pre-clinical research has revealed an exciting feature of NaQuinate where it appears to have the capacity to work in harmony with the body’s natural response to weight bearing exercise to synergistically enhance bone formation when and where required – now that would be a ‘smart’ drug. Together with the safety data from this first-in-human study, this supports the potential that NaQuinate treatment could provide a safe, novel and smart therapeutic approach to bone disorders like osteoporosis and better maintain healthy skeletal aging.”

Source: PR NewsWire

APPs Can Contribute More in Emergency Departments

A recent study investigated how advanced practice providers (APPs) are being underutilised in emergency department settings.

The study, published in Academic Emergency Medicine concluded that, in comparison to ED physicians,  APPs such as physician assistants and registered nurse anaesthetists, see fewer complex patients and generate less value per unit hour.

The study, which investigates the impact of APPs in the ED on productivity, flow, safety, and experience, is the first of its kind.

However, the study suggests that APPs can be better integrated into EDs, minimising any adverse impact on ED flow, clinical quality, or patient experience. Furthermore, APPs, currently used for low-acuity cases, can add value with independent assessment of critical ED cases.

Source: News-Medical.Net

Journal information: Pines, J. M., et al. The Impact of Advanced Practice Provider Staffing on Emergency Department Care: Productivity, Flow, Safety, and Experience, Academic Emergency Medicine (2020)

New Minimally Invasive Way to Sample Interstitial Fluid

A new method to extract dermal interstitial fluid (ISF) for analysis has been reported. ISF contains a large number of biomarkers which can be used for diagnosis.

The minimally invasive process uses an array of almost invisibly small needles, approximately one quarter of a millimetre long. These were pressed to the skin and suction applied. Care needed to be taken so that the needles did not poke into microcapillaries in the skin and thus contaminate the sample with blood. 

Blood is often used for testing, comprising some 6% of the human body’s fluids, but some 10 000 compounds are found in ISF and 12% of the chemicals are not found in the blood. With the technique, the researchers were also able to measure the effects of glucose and caffeine, which are dynamically active. Traditional methods used to extract are quite invasive; using a needle to withdraw ISF from a vacuum-induced blister, or surgically inserting tubes underneath the skin.

Although the procedure is still time consuming, taking some 20 minutes per patient, it compares to the ~40 minutes required to form a vacuum blister in some ISF sampling protocols. The small needle injuries healed within a day, and there was minimal irritation.

This form of testing could have many applications, such as skin toxicological studies and monitoring glucose levels.

The journal article has been published in Science Translational Medicine.

Source: News-Medical.Net

Gut Microbiota Have Large Effects on Immune System

For the first time, immune cells in the bloodstream have been shown to be affected by the makeup of gut microbiota.

In recent years, there has been increased interest in gut microorganisms and their influence on human health, partly as a result of improvements in the ability to study them. Much prior understanding of gut microbiota on the immune system comes from animal studies; this study was able to examine the effects in humans. This study used data from allogeneic stem cell and bone marrow transplants (BMTs), where the patient’s blood formation system is destroyed by radiation or chemotherapy and replaced with stem cells from a donor’s bone marrow. The patient is given antibiotics until the transplanted cells are able to re-establish the immune system, the gut microbiota being destroyed in the process and then re-establishing once the antibiotics are withdrawn. Over a period of ten years, a multidisciplinary team with the Memorial Sloan Kettering Cancer Center took blood and faecal samples from BMT patients.

Study author Dr Joao Xavier said, “Our study shows that we can learn a lot from stool—biological samples that literally would be flushed down the toilet. The result of collecting them is that we have a unique dataset with thousands of datapoints that we can use to ask questions about the dynamics of this relationship.”
“The parallel recoveries of the immune system and the microbiota, both of which are damaged and then restored, gives us a unique opportunity to analyse the associations between these two systems,” lead author Dr Jonas Schluter said.

A higher diversity of microbiota was shown to lower the risk of death following a BMT, and a lower diversity increased the risk of graft-versus-host disease, a potentially fatal condition where the transplanted marrow attacks the host’s body.

“Because experiments with people are often impossible, we are left with what we can observe,” Dr. Schluter noted. “But because we have so many data collected over a period of time when the immune system of patients as well as the microbiome shift dramatically, we can start to see patterns. This gives us a good start toward understanding the forces that the microbiota exerts on the rebuilding of the immune system.”

Source: Medical Xpress

Journal information: Jonas Schluter et al. The gut microbiota is associated with immune cell dynamics in humans, Nature (2020). DOI: 10.1038/s41586-020-2971-8