South Africa’s Health Department said that it was preparing to vaccinate 5.5 million people over the age of 60 by October.
Phase two will commence from mid-May to the end of October, and Health Minister Zweli Mkhize visited hospitals in Mitchells Plain to assess its readiness for the expanded rollout. The Health Department is aiming to vaccinate as many people before a possible third wave.
Dr Mkhize said that plans to inoculate 16 million people during phase two remained on track.
“After that, after October of course everybody else who has not been vaccinated will have to come in, starting with those who will be in congregate settings and risk and so on.”
Dr Mkhize said that all the paperwork and contracts with Johnson & Johnson and Pfizer had been concluded. However, the use of the J&J vaccine is still waiting on an ethics committee’s signoff for the South African Health Products Regulatory Authority’s (Sahpra) recommendation to allow resumption of that vaccine’s trial.
Last week, the SA trial was temporarily stopped after regulators in the US paused the J&J vaccine rollout in that country after six women developed a rare blood clot. Sahpra has now recommended a conditional lifting of the suspension, although its US counterpart is expected to take two weeks to assess the clot problem.
Dr Boitumelo Semete-Makokotlela at Saphra said that the protocol would now have to be altered and safety regulations tightened.
“The screening and monitoring of the participants, particularly those with high risks of blood clotting,” Dr Semete-Makokotlela said. “Secondly, the safe management and immediate management of any participants who may present with any vaccine-induced thrombosis.”
An innovative new nanomedicine has been developed that wraps up tumours in a micromesh net, conforming to the surface of tumor masses and efficiently delivering drugs.
The scientists at the IIT (Istituto Italiano di Tecnologia (Italian Institute of Technology) who developed the mesh described it in the journal Nature Nanotechnology.
Brain tumors are rare but they are some of the most aggressive and difficult to treat. In particular, glioblastoma multiforme (GBM), which is a grade 4 glioblastoma has the most severe prognosis: the average survival is just over 12 months and only 5% of the patients survive beyond 5 years.
GBM typically affects men and women between 45 and 75 years of age. Furthermore, unlike other malignancies, there has been no significant diagnostic and therapeutic improvements for this malignancy over the past 30 years. In fact, both the incidence of new cases and the number of deaths has remained practically unchanged. The only therapeutic strategy currently used is based on surgery, which consists of removing a part of the tumor mass and reducing intracranial pressure, followed by radiotherapy and/or chemotherapy.
The biomedical system developed by IIT and its collaborators can play a very important role in the fight against the disease, representing a possible effective alternative to the few pharmacological treatments used to date.
The microMESH is a micrometric-scale polymeric net, made from biodegradable materials and wraps around the tumour mass, enclosing it. In fact, the micrometric thick polymeric fibers are very flexible and are arranged to form regular openings, which are also on the same scale as cancer cells. This unique feature allows the microMESH to achieve a closer interaction with the tumor mass, increasing the therapeutic efficacy.
Its structure consists of two separate compartments in which different drugs can be loaded which are released towards the tumor mass in an independent, precise, and prolonged fashion. Combining different therapies: chemotherapy, nanomedicine, and immunotherapy enables the microMESH to ‘attack’ glioblastoma.
This work has been carried out by a team led by Prof Paolo Decuzzi, head of the IIT Laboratory of Nanotechnology for Precision Medicine, in collaboration with the Neural Stem Cell Biology Laboratory of Dr Rossella Galli at the San Raffaele Hospital in Milan and a team led by Prof Gerald Grant at the Lucile Packard Children’s Hospital of Stanford University.
The group will continue to develop the microMESH by integrating different types of drugs and therapies to tackle other types of tumors. In the short term, their major objective will be to validate the technology on glioblastoma patients.
A tech startup is pioneering wearable health technology derived from spacesuit technology.
Maarten Sierhuis, a NASA alum, commented to Rachna Dhamija, a tech veteran and his future cofounder saying, “If your dad would just wear a space suit, I could monitor him”. Both had ageing parents with health issues.
Having worked for 12 years as a senior research scientist at NASA, Sierhuis used sensors and artificial intelligence (AI) to monitor astronauts in space. When astronauts go on spacewalks, their spacesuits contain various sensors that monitor their vitals, with the data being sent to NASA and distributed to the flight surgeon, biomedical engineers, and others. The ground-based crew uses that information to guide its support efforts—perhaps a reminder to drink some water and avert dehydration, or to take a short break to lower heart rate. This technology—called the Brahms Intelligent Agent platform—was licensed to Ejenta from NASA. Now, hospitals and health systems are using it to help better their patient care.
“When we started the company, we just had a very strong conviction that our parents deserve the same level of care NASA provides its astronauts,” Dhamija said.
Ejenta integrates wearable and home sensors that gather data from patients with AI-driven virtual assistants. Using a chat function, patients can use the platform to exchange messages with these assistants, called “intelligent agents” by Ejenta, right from their homes. Clinicians can securely access patient information from the Ejenta platform to better inform their care decisions.
Advances in cloud computing enabled the technology to be adapted from space to the Earth. Ejenta’s founders use a cloud infrastructure to securely collect, store and analyse health data.
Ejenta—whose name is a Bengali slang term for “agents”— is one of them. The company, which was founded in 2012, originally focused on government-related work, including projects for NASA. However, in the last four years, Ejenta evolved into a digital health company. Dhamija said the company’s AI-driven technology is what makes Ejenta unique from other digital health startups.
“There are a lot of healthcare devices available to consumers, but what’s missing is AI and the automation that can turn this data into insights a doctor can use—actionable data to make care more preventative and more proactive,” she said.
Ejenta uses its NASA technology to take data from wearable Internet of Things (IoT) devices and at-home sensors to monitor a patient’s health. Patients can interact with their assistant via text or voice and ask questions like, “What medication do I need to take with breakfast?”and receive an appropriate answer.
A clinical trial with Ejenta by one of the country’s largest healthcare providers, saw heart failure readmissions dropped by 56%. Readmissions come are costly for both patients and the healthcare system, so this application can save considerable amounts of money as well as improving the patient’s quality of life. Ejenta, in separate clinical trials, also contributed to improved outcomes for women who had high-risk pregnancies, reducing risk for gestational diabetes, preterm birth and cesarean sections. These successes were made possible by years of difficult development.
“We had a big challenge adapting our solution, which was originally designed to monitor 12 astronauts in space, to scale up to support thousands of patients across a number of different customer types and a number of different health conditions while still being HIPAA compliant,” Dhamija said.
However, by leveraging Amazon Webs Servers (AWS) as its cloud provider, Ejenta was able to scale up. Dhamija said her team chose AWS because it offers both flexibility and scalability in a secure cloud environment, which is critical when dealing with healthcare data. Ejenta wanted a “cloud provider that had a reputation for providing HIPAA-compliant services our customers would trust,” she said.
Ejenta was part of the Alexa Accelerator, an Amazon programme to help companies incorporate voice technology into their innovations. Before entering the programme, Ejenta had used Alexa to support improved diabetes care management for patients. It continued this work during the accelerator.
“Alexa is one of the only voice-based solutions that gave us the ability to engage customers, whether it’s patients or their family, with voice and do it in a HIPAA-compliant way,” Dhamija said.
Ejenta’s participation in the accelerator led to its involvement in AWS Connections, a program that introduces startups to large organisations that have specific technological or business needs. Through this programme, Ejenta is developing a health and communication management system for astronauts in deep space to relay health informationa and communicate with their families.
“It’s translational, meaning it can be applied for both Earth and space,” Dhamija said. “If you look at some of the problems we face on Earth or space, they do inform each other, so the goal is to have our Earth-based work inform space, and vice versa.”
A study from Kanazawa University in Japan has shown that leg swelling can be reduced in the elderly as the muscle pumping action of the leg is as effective in people of all ages.
Chronic lower-limb oedema (CLO) — the permanent accumulation of fluid in the leg — often occurs in elderly people. The condition leads to various physical and mental problems, including difficulty in walking or moving, fatigue and anxiety. Lack of physical activity, associated with a decrease in muscle pump action is one of the causes of CLO.
Leg muscles can act as a blood pump: when contracted, the muscle squeezes veins together, forcing blood to flow. But it was not known whether muscle pump action changes as people age had not been thoroughly investigated. Now, Junko Sugama from Kanazawa University and colleagues have addressed this issue. In addition, they studied the effect of leg posture on the muscle pump action.
For their study, the researchers recruited 76 healthy volunteers, categorised into young, middle-aged and old, with average ages of 24, 47 and 72 years, respectively. To investigate blood flow and visualise the morphology of muscles and veins at a given position along the leg, the researchers used MRI cross-section images at 21 positions in the calf region.
To assess the effect of leg motion, subjects were asked to perform plantar flexion (pointing the foot downwards) every 2 seconds for a minute, and MRI images were taken before and after the exercise. This procedure was repeated over three different body positions: supine, sitting and standing.
The scientists found that for all postures, blood flow increased after the exercise, implying that the latter promotes muscle pump action. The blood flow velocity was observed to increase most for the standing posture (90-135%), followed by the supine (55-90%) and sitting (30-40%) postures. No age difference was seen in the flow changes, however the elderly patients had exercise habits, the researchers pointed out.
The researchers suggested that nurse measurement of muscle pump action is useful for deciding whether intervention exercise is necessary to prevent CLO but an easier measurement tool than MRI is needed.
Additional studies are needed, such as adapting the measurement equipment so that it can be applied to elderly people with reduced mobility. The scientists nevertheless concluded that for their set of subjects, “no difference was found in the changes in muscle pump action with age”, and that “elderly people may be able to maintain their muscle pump action when they have exercise habits”.
Journal reference: Fujii, T., et al. (2021) Gravity magnetic resonance imaging measurement of muscle pump change accompanied by aging and posture. Japan Journal of Nursing Science. doi.org/10.1111/jjns.12407.
A new study has confirmed that combining two different blood thinners doesn’t necessarily improve outcomes.
The new publication examined the minimal pros and the serious cons of combining a daily aspirin with a drug from the newer class of direct oral anticoagulants (DOACs) which include apixaban, dabigatran, edoxaban and rivaroxaban.
Patients were taking DOACs to prevent strokes from non-valvular atrial fibrillation or for the treatment of venous thromboembolic disease (deep vein thrombosis or pulmonary embolism). The included patients lacked another reason to take aspirin, such as a recent history of a heart attack or having had a heart valve replacement. One-third of those taking DOACs
“The patients on combination therapy were more likely to have bleeding events but they weren’t less likely to have a blood clot,” said lead author Jordan Schaefer, MD, an assistant professor of internal medicine and a haematologist at the University of Michigan. “Therefore, it’s important that patients ask their doctors if they should be taking aspirin when they are prescribed a direct oral anticoagulant.”
Combination therapy with an anticoagulant and an antiplatelet may be appropriate for people who have had a recent heart attack, recent coronary stent placement or bypass surgery, prior mechanical valve surgery or known peripheral artery disease, among other conditions, according to co-author Geoffrey Barnes, MD, MSc, an assistant professor of internal medicine and a vascular cardiologist at the Michigan Medicine Frankel Cardiovascular Center.
For the others, “combination therapy may not be happening intentionally; rather, the addition of aspirin might get overlooked because it’s not in any one specialist or general care provider’s territory,” Prof Barnes said.
There are many situations where an aspirin and DOAC combination has been insufficiently studied, and Prof Schaefer added that they are planning a larger, lengthier study since there were insufficient blood clots during the study to assess aspirin’s potential benefit.
Profs Schaefer and Barnes had also previously reported increased adverse outcomes for patients receiving both aspirin and warfarin, which is not a DOAC.
Journal information: “Adverse Events Associated with the Addition of Aspirin to DOAC Therapy Without a Clear Indication,” JAMA Internal Medicine. DOI: 10.1001/jamainternmed.2021.1197
The US Consumer Product Safety Commission (CPSC) has put out a warning for owners of the popular Peloton Tread+ exercise machine following “multiple incidents of small children and a pet being injured beneath the machines.”
The warning comes weeks after Peloton CEO John Foley said a child died in an accident related to the machine. “While we are aware of only a small handful of incidents involving the Tread+ where children have been hurt, each one is devastating to all of us at Peloton, and our hearts go out to the families involved,” he said in a statement.
As a result, the CPSC launched an investigation into the treadmill, one that the commission says remains ongoing. The commission reported that it is aware of 38 other non-fatal safety incidents involving the device. In the commission’s view, the Peloton Tread+ “poses serious risks to children for abrasions, fractures, and death” resulting from “children becoming entrapped, pinned, and pulled under the rear roller of the product.”
The announcement included a video of a child seemingly pulled underneath the treadmill while playing behind the machine.
The CPSC is advising those with children at home to stop using the Peloton Tread+ treadmill immediately and says that the hazard the machine imposes “cannot be avoided simply by locking the device when not in use.”
“Peloton has not yet agreed to do a recall or a stop sale,” Consumer Product Safety Commission spokesperson Joe Martyak told NPR. He continued, “We hope that will change.”
Generally, product recalls are done on a voluntary basis by companies, in concert with government.
Peloton responded to the CPSC, saying the warning was “inaccurate and misleading.”
“Like all motorized exercise equipment, the Tread+ can pose hazards if the warnings and safety instructions are not followed,” the company said. In response to further questions from NPR about a possible recall, a spokesperson for the company said “a recall has never been warranted.”
The spokesman added that, “The Peloton Tread+ is safe when operated as directed and in accordance with the warnings and safety instructions.”.
A new study has found that ultra-processed foods (aka junk food) impacts bone quality, showing how damaging these can be especially in younger children.
The Hebrew University study provides the first comprehensive analysis showing the manner in which such foods impact skeletal development.
Junk foods go through many processing stages, and contain non-dietary ingredients. They are easily accessible, can be eaten without preparation and fairly cheap, and their increasing presence in diets is contributing to worldwide obesity with its associated metabolic impacts.
Children tend to like junk food. As much as 70% percent of their caloric consumption are estimated to come from ultra-processed foods. While numerous studies have reflected on the overall negative impact of junk food, few have focused on its direct developmental effects on children, particularly young children.
Studying lab rodents with skeletons in post embryonic growth stages, they found that those exposed to ultra-processed foods suffered from stunted growth and compromised bone strength. With histological examination, high levels of cartilage were found in the epiphyseal plates at the end of bones. The RNA genetic profiles of cartilage cells exposed to ultra-processed food also showed signs of impaired boned development.
In order to understand how eating habits might impact bone development, the researchers replicated this kind of food intake for the rodents. “We divided the rodents’ weekly nutritional intake—30% came from a ‘controlled’ diet, 70% from ultra-processed foods,” said Monsonego-Ornan. They found that the rodents experienced bone density moderate damage though there were fewer signs of cartilage buildup in their growth plates. “Our conclusion was that even in reduced amounts, the ultra-processed foods can have a definite negative impact on skeletal growth.”
Children and adolescents eat junk foods in great quantities, with half of American minors eating junk food daily. Monsonego-Ornan added. “When Carlos Monteiro, one of the world’s leading experts on nutrition, said that there is no such thing as a healthy ultra-processed food, he was clearly right. Even if we reduce fats, carbs nitrates and other known harmful substances, these foods still possess their damaging attributes. Every part of the body is prone to this damage and certainly those systems that remain in the critical stages of development.”
Journal information: Janna Zaretsky et al. Ultra-processed food targets bone quality via endochondral ossification, Bone Research (2021). DOI: 10.1038/s41413-020-00127-9
The development projects of new antibiotic treatments are falling behind, despite increasing awareness of the antibiotic resistance threat, according to a recently released report by the World Health Organization.
The WHO revealed that none of the 43 antibiotics that are currently in clinical development sufficiently address the problem of drug resistance in the world’s most dangerous bacteria.
Dr Hanan Balkhy ,Assistant Director General on AMR, WHO said that, “The persistent failure to develop, manufacture, and distribute effective new antibiotics is further fueling the impact of antimicrobial resistance (AMR) and threatens our ability to successfully treat bacterial infections.”
All of the new antibiotics released onto the market in the past few decades have been variations of those developed in the 1980s.
The impact of AMR is most severely felt in resource-constrained settings and in vulnerable populations such young children. Bacterial pneumonia and bloodstream infections are some of the major causes of childhood mortality under age 5, and about 30% of neonates with sepsis die due to bacterial infections resistant to multiple first-line antibiotics.
WHO puts out its Antibacterial Pipeline Report every year, reviewing antibiotics under development. The report evaluates the potential of the candidates to address the most threatening drug-resistant bacteria outlined in the WHO Bacterial Priority Pathogens List (WHO PPL). Since it began in 2017, this list, which includes 13 priority drug-resistant bacteria, has informed and guided priority areas for research and development.
The 2020 report paints a picture of an almost stalled pipeline with only few antibiotics in recent years receiving regulatory approval. Most of these agents in development have little extra clinical benefit over current ones, with 82% of recently approved antibiotics being derivatives of previous ones with well-established drug-resistance, and drug resistance to these new ones is expected to emerge rapidly.
The review concludes that “overall, the clinical pipeline and recently approved antibiotics are insufficient to tackle the challenge of increasing emergence and spread of antimicrobial resistance”.
Speeding up development requires innovative approaches. For the first time. the 2020 WHO pipeline report includes a comprehensive overview of non-traditional antibacterial medicines, detailing 27 antibacterial agents in the pipeline. These range from antibodies to bacteriophages and therapies that boost the immune response and weaken bacterial effects.
The report notes that there are some promising products in different stages of development. However, only a fraction of these will ever make it to the market due to the economic and inherent scientific challenges in the drug development process. This, along with the small return on investment from successful antibiotic products, has limited the interest of major private investors and most large pharmaceutical companies.
Only a fraction of the promising products in the pipeline will make it to market because of financial and scientific obstacles in the development process.
The preclinical and clinical pipelines continue to be driven by small- and medium-sized companies, which often struggle to finance their products through clinical trials and approval.
The COVID pandemic has deepened the global understanding of the health and economic implications of uncontrolled disease, as well as funding gaps, including investments in R&D of antimicrobial medicines and vaccines, while also demonstrating that much can be achieved with political will and sufficient funding.
“Opportunities emerging from the COVID-19 pandemic must be seized to bring to the forefront the needs for sustainable investments in R&D of new and effective antibiotics,” said Haileyesus Getahun, Director of AMR Global Coordination at WHO. “Antibiotics present the Achilles heel for universal health coverage and our global health security. We need a global sustained effort including mechanisms for pooled funding and new and additional investments to meet the magnitude of the AMR threat.”
To address funding challenges in antibiotics development, WHO partnered with the Drugs for Neglected Diseases intitive (DNDi) to set up the Global Antibiotic R&D Partnership (GARDP) to develop promising treatments.
In addition, the WHO has been working closely with other non-profit funding partners such as the CARB-X to “push” and accelerate antibacterial research. Another important new initiative is the AMR Action Fund, a partnership by the European Investment Bank. pharmaceutical companies and philanthropies.
Researchers have found evidence suggesting that the P.1 COVID variant could be twice as transmissible as prior strains. The findings were published in the Journal Science.
The P.1 SARS-CoV-2 variant was first detected in four travellers from Brazil during a routine screening at Haneda airport, Tokyo. Manaus, the capital of the state of Amazonas in Brazil was the origin of the variant. According to preliminary investigations, the virus emerged late in 2020, beginning to spread in November and then quickly became the dominant strain. This prompted many to believe that it could reinfect those infected with the initial strain.
Some 70% of the residents in the city were believed to have been infected during the initial infection period. After variant infections rose in Manaus, the P.1 variant soon spread throughout Brazil, and then to other countries—thus far, it has been detected in at least 37 countries.
The researchers used molecular clock analysis to determine that the virus had 17 identifiable mutations and that three spike protein mutations (N501Y, E484K and K417T) allowed the virus to bind more effectively to host cells. These also may help in evading antibodies, and the researchers also found that P.1 can evade immunity granted by prior strains.
In simulations, P.1 was 1.7 to 2.4 times more transmissible than the prior virus baseline, but whether this was due to longer persistence in the body or increased viral load could not be determined. Additionally, it could not be established if it increased disease severity or raised mortality rates. Though people inffected with the variant were 1.2 to 1.9 times as likely to die, this could have been a result of the severe strain the overburdened healthcare systems were experiencing in the city.
More work is needed to find out whether the P.1 strain can infect those infected with prior strains or have been vaccinated, the researchers said.
Journal information: Nuno R. Faria et al. Genomics and epidemiology of the P.1 SARS-CoV-2 lineage in Manaus, Brazil, Science (2021). DOI: 10.1126/science.abh2644
A US study uploaded onto the bioRxiv preprint server showed that pets with SARS-CoV-2 likely acquired the virus from humans.
This suggests that human-animal infection may actually occur much more frequently than previously thought – implying that infected individuals should limit their contact with animals. The paper is currently available on the bioRxiv* preprint server.
Both natural and experimental infections with SARS-CoV-2 have been demonstrated in various species of pets, which includes dogs, cats, hamsters, rabbits, and ferrets. Hamsters, cats and ferrets have been shown to transmit the virus to each other, and dogs are still weakly susceptible to the virus. However, natural infections of pets have almost always resulted from contact with a COVID-infected person.
Since pets share so much space with humans, this is a good use of the One Health approach, a transdisciplinary collaboration aiming for health outcomes through awareness of the interconnectedness between people, animals, plants and their mutual environment.
As part of a COVID household transmission investigation, researchers in the US conducted a One Health appraisal of SARS-CoV-2 infection in pet cohabitants as one of the earliest research endeavours in assessing risk and behavioral factors shared between people and pets.
The study was conducted between April and May of 2020, and mammalian pets from households with at least one individual with confirmed COVID were eligible for inclusion. Detailed descriptions of each animal’s residence were made.
Demographic and exposure information was obtained from all household members. At the same time, the pets were tested with the use of real-time reverse transcription-polymerase chain reaction (rRT-PCR) and neutralisation assays from oropharyngeal, nasal, rectal, fur, faecal, and blood samples.
The small sample size of this study made it difficult to analyse prevention measures in the home, so additional investigations are needed in order to determine the best methods to prevent human-pet COVID transmission.
All oropharyngeal, nasal, and rectal swabs from the tested animals tested negative when rRT-PCR was conducted; however, fur swabs from the one dog tested positive with the use of this molecular method at the first animal sampling. This is actually the first study to detect RNA of a virus from an animal’s fur.
Furthermore, in households where owners withs COVID lived with their pets, 20% had pets with serological evidence of prior SARS-CoV-2 infection, implying some secondary viral transmission. Four dogs and four cats from six households were found to have detectable neutralising antibodies against the virus.
In households with higher rates of human COVID infections, SARS-CoV-2 was more likely to be seen in pets, while much less common when owners limited interactions with their pets after they had developed COVID symptoms.
The authors stressed that it is still important for decision-makers to understand the role of animals in the epidemiology of the pandemic
“Our findings add to the growing body of evidence demonstrating SARS-CoV-2 transmission can occur between people and pets – most often from people to pets – and suggest this transmission may occur more frequently than previously recognized”, wrote the authors of the bioRxiv paper.
