Month: February 2021

Categories : HospitalsTags :

Life-saving Benefits of Telemedicine in ICUs

On By ModernMedia

A study in Cleveland, USA, showed that at hospitals without 24/7 on-site intensivists, those that had intensivists available to deliver telemedicine had lower ICU mortality rates.

Presented at the Society of Critical Care Medicine’s virtual 50th Critical Care Congress, Cleveland Clinic intensivist Dr Chiedozie Udeh, commented that the COVID pandemic has thrust ICU telemedicine into the spotlight.

“In an ideal world, patients would have an intensivist at the bedside 24/7, but the reality is that even if we had all of the money in the world, we don’t have enough trained professionals to do the job,” Udeh said.

Out of patients treated at one of nine hospitals within the Cleveland Clinic Health System, patients receiving ICU telemedicine were 18% less likely to die and were discharged 2 days sooner than patients who received traditional ICU care, without 24/7 on-site intensivist care.  

The unadjusted 30-day mortality among the telemedicine patients was 5.5%, while in the standard care group it was significantly higher at 6.9%.ICU length of stay was significantly shorter in the ICU telemedicine group, as was the length of total hospital stay.

Udeh said that an intensivist monitoring patients via telemedicine has access to relevant data and can perform the same functions as an on-site clinician, short of physical contact. Intensivists can monitor multiple patients and have two-way communication with bedside nurses. Dedicated software is available, including tools to identify deteriorating patients needing care.

Speaking to MedPage Today, Udeh said ICU telemedicine offers an intermediate treatment strategy between large academic centres with 24/7 on-site intensivist care, and smaller hospitals without such care. More research is needed to understand how telemedicine leads to reduced mortality, he added.

“If I had to speculate I would imagine this would probably be due to patients’ receiving more timely needed interventions,” he said.

“We think these findings provide further reassurance about the value of ICU telemedicine, particularly in light of our collective experience in 2020,” said Udeh. “With the COVID-19 pandemic, telemedicine in general assumed greater prominence.”

CU telemedicine can benefit both large hospital systems and smaller, individual hospitals, he said.

“Smaller hospitals may have no intensivist at all or they may have only one,” he said. He added that, according to one recent survey, about half of US hospitals do not have an intensivist on staff.

ICU telemedicine still has considerable expenses associated with it, however; at $50 000 per bed in first year costs, it may be hard to justify for resource-constrained hospitals.

Source: MedPage Today

Presentation information: Udeh CI, et al “ICU telemedicine and clinical risks associated with 30-day mortality: a retrospective cohort study” SCCM2021.

Categories : COVIDTags :

Viral Load Drives the Transmission of COVID

On By ModernMedia

Knowing what factors drive the transmission of COVID is crucial to informing schemes to contain and adapt to its spread.

There is abundant data on location and duration of exposure to COVID, but there is precious little on any other factors, the researchers noted.

The SARS-CoV-2 virus is detectable in respiratory tract samples 1-2 days before symptom onset, and can continue for several weeks afterward. But the detection of viral RNA is not necessarily related to infectiousness, and no studies had established the connection between viral load and COVID transmission, although viral load had been linked to COVID mortality.

The researchers used linked index cases of COVID to determine that viral load was the principle factor behind COVID transmission, and is the largest such study to date. This emphasises the need for initiating proper contact tracing.

The researchers conducted a post-hoc analysis of 314 cases during the initial COVID wave in Spain, of whom 90% (282) had at least one close contact, resulting in a total of 753 contacts. Viral load was the key indicator of COVID transmission.

The overall secondary attack rate (proportion of COVID-positive contacts) during the study period was 17%. However, this rate varied from 12% when the viral load of the index case was lower than 1×10⁶ copies per mL, to 24% when it was 1×10¹⁰ copies per mL or higher.

Running multivariate analyses, the researchers found no association between sex, age, diabetes, cardiovascular disease, or respiratory disease and the risk of or time to developing symptomatic COVID. There was a significant association of incubation time with initial viral load, increasing from five days among patients with a high viral load to seven days among participants with a low viral load.

The researchers wrote: “Taken together, our results indicate that the viral load, rather than symptoms, might be the predominant driver of transmission.”

They conclude that all cases should be considered potential transmitters of the virus. They also suggest viral load assessment in patients with large numbers of contacts, and risk stratification by time to symptom appearance based on viral load. 

Source: News-Medical.Net

Journal information: Marks M, et al. Transmission of COVID-19 in 282 clusters in Catalonia, Spain: a cohort study. The Lancet Infectious Disease, 2021. DOI: https://doi.org/10.1016/S1473-3099(20)30985-3, https://www.thelancet.com/journals/laninf/article/PIIS1473-3099(20)30985-3/fulltext

Categories : CancerTags :

New Ultrasonic Tumour Therapy

On By ModernMedia

A new technique has been developed that uses ultrasound to vapourise encased nano-droplets, at the tumour site. This technology could be used to image the tumour, damage it or even deliver chemotherapy drugs with precision.

Existing applications of ultrasound therapy include thermal excitation of tissues, for example to dilate blood vessels, and creating cavitation to break up kidney stones. Ultrasonic toothbrushes have also been shown to remove dental plaque with better efficiency than conventional toothbrushes, and about the same as that of mechanical electrical toothbrushes. Micrometre-sized droplets, encased in a stabilising shell, can already be visualised with ultrasound, but these are too large to enter tumours. Nanometre-sized droplets can do so, however.

Vapourisation is tricky to control in reality, since the process requires a point of nucleation. The researchers demonstrated an efficient way to achieve vapourisation: by applying a frequency at the exact resonant frequency of the droplet, the pressure inside suddenly drops and the liquid vapourises. This is much the same principle as shattering a crystal glass by bombarding it with sound at its resonant frequency.

The researchers used hydrofluorocarbons,  which have a very low boiling point,   for the droplets. The resonance of the droplet being six times higher makes vapourisation much easier. The speed of sound of the droplet fluid being lower than the speed of sound in the bodily fluids surrounding it.
This resonant droplet vapourisation technology has a number of possible medical applications. The bubbles from the bursting droplets could be used to physically damage the tumour. Or, the droplets could contain chemotherapy drugs and made to break open precisely inside the tumour and reducing exposure of the rest of the body.

Source: News-Medical.Net

Journal information: Lajoinie, G. et al. (2021) High-Frequency Acoustic Droplet Vaporization is Initiated by Resonance’ by Guillaume Lajoinie, Tim Segers, and Michel Versluis. Physical Review Letters. doi.org/10.1103/PhysRevLett.126.034501.

Categories : Injury & Trauma TransplantsTags :

First Successful Face and Double Hand Transplant

On By ModernMedia

Doctors in New York have performed the world’s first successful face and double hand transplant.

The patient, 22 year-old Joe DiMeo, had suffered burns over 80% of his body in a 2018 crash, resulting in his fingers being amputated. His eyelids and lips were also amputated. He had been driving home from a night shift when he fell asleep at the wheel and his car crashed, bursting into flames. He spent four months in a burns unit, much of it in an induced coma. After 20 reconstructive surgeries, he still had only limited use of his hands and face.

In a 23-hour operation, doctors attached the donor’s face and hands. He then spent 45 days in ICU, then a further two months in hospital. Mr DiMeo learned to open his new eyelids and move his hands, and is now spending up to five hours a day in rehab.

Eduardo Rodriguez, director of the Face Transplant Program, said: “We wanted to give him not only an operation that made him look better, but it ultimately had to work ideally, especially with the hands.” He added that Mr DiMeo is the most motivated patient he had met.

The doctors waited to ensure that the transplant had taken before calling it successful. While a face and double hand transplants had been performed before, one patient died from complications and the other had to have their hands amputated when they failed to thrive.

Hand transplants have progressed a great deal since the first successful one in 1998. Enormous strides have been made in immunosuppression since then, requiring fewer drugs with less resultant toxicity and side effects. There is also a protocol for using donor bone marrow and stem cells to modulate the immune system in place of typical immunosuppression.

Mr Dimeo says that he can now exercise and make breakfast unaided.

“This is a once-in-a-lifetime gift, and I hope the family can take some comfort knowing that part of the donor lives on with me,” Mr Dimeo said. “My parents and I are very grateful that I’ve been given this second chance.”

Source: BBC News

Categories : COVIDTags :

Pfizer Vaccine 90% Effective After a Single Dose

On By ModernMedia

A study from the University of East Anglia (UEA) reported that the Pfizer vaccine provides “very high” protection after a single dose.

The researchers drew on Israeli data, where the vaccine had been widely administered, and found that the vaccine was 90% effective at 21 days after the initial dose. This supports the plan that the UK and other nations have of delaying a second dose to achieve maximum coverage. However, they also noted that infection rates increased eight days after the first dose, which they attribute to people becoming less cautious as a result of the vaccination. The study is available on the medRxiv preprint server, and has not been peer reviewed, as it is a rapid response to the ongoing COVID pandemic.

Lead researcher and COVID expert Prof Paul Hunter, from UEA’s Norwich Medical School, said: “A second dose of the Pfizer vaccine would normally be given 21 days or more after the first to top up and lengthen the effect of the first dose.

“But here in the UK, the decision was made to delay the timing of the second injection until 12 weeks after the first.

“The logic behind this is to protect more people sooner and so reduce the total number of severe infections, hospitalisations, and deaths.

“But this decision caused criticism from some quarters due in part to a belief that a single injection may not give adequate immunity.”

Prof Hunter explains the motivation for the study was previous flawed research on the Pfizer vaccine, also using Israeli data. But the study did not consider effectiveness past day 18.

The researchers observed that case incidence rose up til day eight by which time it had doubled, then fell. Prof Hunter said: “We found that the vaccine effectiveness was still pretty much zero until about 14 days after people were vaccinated. But then after day 14 immunity rose gradually day by day to about 90 percent at day 21 and then didn’t improve any further. All the observed improvement was before any second injection.

“This shows that a single dose of vaccine is highly protective, although it can take up to 21 days to achieve this.”

Although the vaccine’s effectiveness beyond this is not known, it still supports the UK’s decision to space out vaccine doses, Prof Hunter concluded.

Source: Medical Xpress

Journal information: “Estimating the effectiveness of the Pfizer COVID-19 BNT162b2 vaccine after a single dose. A reanalysis of a study of ‘real-world’ vaccination outcomes from Israel” is published on the medRxiv pre-print server: www.medrxiv.org/content/10.110 … 021.02.01.21250957v1

Categories : COVID HospitalsTags :

UK Teen Awakens from 10 Month Coma, Unaware of Pandemic

On By ModernMedia

A British teenager who has been in a coma for 10 months, has awakened but is still largely unaware of the scale of the COVID pandemic. 

Joseph Flavill, 19, was hit by a car while walking on 1 March 2020, which was three weeks before the UK entered into its first national lockdown. Having suffered a traumatic brain injury, he has since been in a coma but is now making a slow recovery and is responsive. Ironically, he has caught COVID twice while in hospital but had recovered both times.

His aunt, Sally Flavill Smith, told the Guardian: “He won’t know anything about the pandemic as he’s been asleep for 10 months. His awareness is starting to improve now but we just don’t know what he knows.

“I just don’t know where to start with it. A year ago if someone had told me what was going to happen over the last year, I don’t think I would have believed it. I’ve got no idea how Joseph’s going to come to understand what we’ve all been through.”

He is now able to respond to commands, such as touching his left or right ear, respond with yes/no by blinking, and is able to smile.

His family had trained to explain in video calls why they can’t see him in person due to COVID restrictions, but had not tried to convey the scale of the pandemic. She says that they will try to explain it to him when they are able to visit him in person. His mother was able to see him in December, wearing full PPE, but he was not as aware as he is now. The family has put together a fundraiser to help his recovery.

Source: The Guardian

Categories : Diet and NutritionTags :

Eating Grapes Protects against Sunburn

On By ModernMedia

Compounds found in the humble grape may offer a protective effect against the sun’s damaging UV radiation, a new study has found.

Researchers from University of Alabama at Birmingham’s (UAB) Department of Dermatology found that healthy adult participants who ate freeze-dried powdered grapes for 14 days achieved a 74.8% increase in natural skin protection. 

The number of sunburns experienced over a lifetime increases the risk of skin cancer. Sunburns also cause skin damage, which has a cosmetic effect. Sunburns are marked by DNA damage triggering cell apoptosis, as well as the release of inflammatory markers such as prostaglandins, reactive oxygen species, and bradykinin in response to dimers formed by UV radiation. Prostaglandin E2 and histamine levels also rise after a sunburn.
Research in mouse models has shown that polyphenols, found in grapes as well as other fruits and vegetables, can reduce UV radiation damage, as well as reducing the production of inflammatory compounds. As such, this is the first research that shows the consumption of table grapes has a photoprotective effect against the sunburn response in adult humans. The subjects were also given a polyphenol compound, proanthocyanidin, as a topical extract to apply on their skin.

“Study results indicate that oral consumption of grapes has systemic beneficial effects in healthy adults,” said lead author Allen Oak, MD, a dermatologist in the UAB School of Medicine. “These benefits include inhibition of inflammation and repair of DNA damage.”

The preliminary findings also indicated that grapes may help reduce the risk of skin cancer as well, although this requires further research. 
“Grape consumption may act as an ‘edible sunscreen,'” Oak said. “This does not mean that grapes should be used in lieu of sunscreen, but they may offer additional protection which we are eager to continue learning more about. This research is exciting because our current findings provide building blocks for additional studies that may eventuate in an oral photoprotective product from a natural source.”

Source: Medical Xpress

Journal information: Allen S.W. Oak et al. Dietary table grape protects against UV photodamage in humans: 1. clinical evaluation, Journal of the American Academy of Dermatology (2021). DOI: 10.1016/j.jaad.2021.01.035

Categories : Neurodegenerative DiseasesTags :

Protein Synthesis Fix may Reverse Cognitive Decline in Alzheimer’s

On By ModernMedia

Restoring protein synthesis in the brain may reverse the cognitive decline associated with Alzheimer’s, according to a study by researchers from New York University (NYU) and the Federal University of Rio de Janeiro (UFRJ).

Current Alzheimer’s treatment research focuses on reducing the phenomena linked to the disease, such as amyloid plaques, neurofibrillary tangles, and neuroinflammation. The study aimed to determine whether restoring protein synthesis would also be beneficial.

“The synthesis of new proteins in the brain is essential for proper neuronal function and, notably, for memory consolidation. We and others have previously shown that impairments in brain protein synthesis contribute memory deficits in Alzheimer’s disease model mice, and that the brains of Alzheimer’s patients exhibit clear signs of impaired protein synthesis. We thus asked ourselves whether rescuing brain protein synthesis might be an approach to improve memory function in Alzheimer’s disease,” said co-senior author Sergio Ferreira, a professor at UFRJ.

“Given the complex nature of Alzheimer’s disease, identifying and targeting abnormal molecular pathways that effectively improve cognition has been challenging,” added co-senior author Eric Klann, a professor at NYU. “Our findings show that jump-starting protein synthesis in the brain can revive lost cognitive functions. We hope that this work can serve as a step forward in treating this devastating disease.”

Previous research found that a cellular quality control mechanism called the integrated stress response (ISR) was found to slow down protein synthesis to weed out problems like cancerous cells, but can get stuck in the ‘on’ position. In 2013, a drug called ISRIB was developed to reverse this (ISRIB stands for ISR InhiBitor). 

Previous research with ISRIB had shown positive results in restoring memory function in mice, months after traumatic brain injury (TBI), reversing cognitive impairments in Down Syndrome , preventing noise-related hearing loss, treating certain prostate cancers, and even cognitive enhancement in healthy animals.

The researchers determined that in Alzheimer’s patients, critical components of protein synthesis are depleted in the hippocampus. The researchers hypothesised that some cognitive function could be returned if protein synthesis was restored with ISRIB.  

The researchers used mice with Alzheimer’s-like conditions as a model. Testing the mice’s memory (eg with maze runs), they found memory function and hippocampal protein synthesis restored with ISRB. Restoration of hippocampal neural plasticity and memory functions was observed even in simulated advanced Alzheimer’s. 

The results indicate that restoring protein synthesis with drugs such as ISRIB, could work together towards reversing cognitive decline from Alzheimer’s in humans. 

Source: Medical Xpress

Journal information: “Correction of eIF2-dependent defects in brain protein synthesis, synaptic plasticity, and memory in mouse models of Alzheimer’s disease,” stke.sciencemag.org/lookup/doi … 26/scisignal.abc5429

Categories : Addiction PaediatricsTags :

Misuse of Psychiatric Meds Common in Teens

On By ModernMedia

A study into the use and misuse of psychoacttive drugs by US teens has found that about a fifth report misusing their prescribed medications.

Israel Agaku, PhD, of Harvard School of Dental Medicine in Boston, and colleagues used data from a survey of adolescents aged 12-17 prescribed opioids, stimulants, tranquilizers, or sedatives, and found that 20.9% reported using them not as prescribed or directed. There has been considerable concern in recent years over whether adolescents in the United States were being overprescribed psychiatric medication, although a 2018 study concluded that they are not. However, as with adults, the prospect of misuse, possibly leading to substance use disorders is a concern.
Of these youths, 3.4% reported having substance misuse disorders, and this proportion increased to nearly half when youths were taking two or more prescribed medications.

Some 25% of 12-17 year olds reported receiving a psychiatric prescription in the past year. The most common psychoactive prescription in the past year was opioids in 19% of all youth, followed by stimulants (7.2%), tranquilisers (4.3%), and sedatives (2.2%). Tranquilisers were the most commonly misused (40.1%), with substance use disorder in 7%. Stimulants were misused by 24.2%, 3% having a substance use disorder.
Among adults aged 18-25, 41% had been prescribed and had used psychoactive medication, with a third saying they had used opioids in the past year, Similarly to the 12-17 age group, stimulants and tranquilisers were most likely to be misused. 

“The largely overlapping population profiles for medical use versus misuse indicates the high abuse liability of these prescription substances,” the researchers noted. “Having serious psychological distress was consistently associated with misuse of every assessed psychoactive prescription medication.”

The researchers suggested that an open-minded, collaborative approach by healthcare providers was the best approach to dealing with the situation.

“Rather than asking only about cigarette smoking, pediatric practitioners should screen for different commonly used substances, including ‘social use.’ Specifically asking youth and young adults if they have used certain substances, including occasional use, is important as those who use such substances infrequently or only occasionally may not self-identify as users if asked in generic terms,” the researchers explained.

Source: MedPage Today

Journal information: Agaku I, et al “Medical use and misuse of psychoactive prescription medications among US youth and young adults” Fam Med Com Health 2021; DOI: 10.1136/ fmch-2020-000374.

Categories : HIVTags :

Revolutionary HIV Prophylaxis Pill Rollout in SA

On By ModernMedia

Amidst the COVID pandemic and concerns about vaccines, the South African government is rolling out a gaming-changing pill that protects against contracting HIV.

Due to delays including COVID-19, the revolutionary HIV pre-exposure prophylaxis (PrEP) pill is currently only available at 36% of public healthcare facilities – but the impact as it is rolled it will be significant.

Yogan Pillay, Deputy Director for Communicable and Non-Communicable  Diseases, Prevention, Treatment and Rehabilitation at the National Department of Health, says the PrEP pill will be available at all public healthcare providers by the end of September this year.

The pill combines two antiretrovirals, tenofovir disoproxil fumarate and emtricitabine (TDF/FTC), and gives nearly complete protection against contracting HIV. Over the past 4 years, over 50 000 people received the pill during trials. Young women and adolescent girls aged 15 to 24 are at four times higher risk of contracting HIV than males the same age, and since they may not be in a position to negotiate condom use, PrEP allows them to reduce the risk of contracting HIV through sexual activity. The TDF/FTC pill takes seven days to achieve full protection, and should be continued to be taken 28 days after the last HIV exposure. Periodic HIV and kidney function tests will be administered after the first month.

“The PrEP targets in the National Strategic Plan (NSP) for HIV, TB and STIs 2017-2022 is 85 000,” said Pillay. “We do however estimate based on the uptake trend at the current PrEP sites that approximately 10.5% of HIV negative persons offered PrEP will take up PrEP.”

The TDF/FTC pill can be taken at any point of the day, with alcohol, and is compatible with the use of birth control pills and other contraceptives. The pill will be made available through the public sector to any HIV negative person with healthy kidneys willing to take it daily. The TDF/FTC pill can only be prescribed by NIMART (Nurse Initiated Management of Antiretroviral Therapy) trained nurses, not other nurses or clinical associates at this time.

Source: Spotlight