Women at risk of pregnancy loss who need a specialist surgical procedure could benefit from a single-stranded suture thread to reduce risk of infection, results from the C-STICH clinical trial found which were published in The Lancet.
The trial involved more than 2000 expectant mothers who needed a procedure called a cerclage, where a purse string suture is placed around the cervix during their pregnancy. Women were randomly allocated to have the surgical procedure performed using either a single stranded thread or a braided thread.
Researchers tested whether there would be any difference in miscarriage or stillbirth, due to an increased risk of infection, from using a braided suture thread. The research shows that single stranded sutures could potentially improve outcomes for mothers at risk of preterm birth.
The team, led by researchers from the University of Birmingham and Birmingham Women’s and Children’s Hospital, found that the mothers treated with single stranded threads had no differences in pregnancy loss or preterm birth but reported fewer instances of infection and sepsis. This could have important implications for the health outcomes of mothers and babies who are treated with a cervical cerclage in their pregnancy.
Dr Vicky Hodgetts-Morton, NIHR Clinical Lecturer in Obstetrics at the University of Birmingham and Birmingham Women’s Hospital explained the implications of the trial results. Dr Hodgetts-Morton said:
“Preterm birth is a significant problem, complicating approximately one in ten pregnancies around the world. The consequences of preterm birth may be significant with some babies being born too early to survive, and those that survive are at increased risk of health complications. One cause for preterm birth is cervical insufficiency, occurring in 0.5% to 1% of pregnant women for which the placement of a vaginal cervical cerclage can be an effective treatment.
“Suture thread choice has the potential to improve how well a cerclage works in preventing miscarriage, stillbirth and preterm birth. Both single stranded and braided threads are commonly used to perform cerclages and our findings show no differences in pregnancy loss and preterm birth. The C-STICH trial results did show an increased risk of infections in labour and around the time of delivery with braided threads and this supported our hypothesis that a single stranded thread could reduce the risk of infection developing during the pregnancy.”
A pilot study published in the journal Discover Mental Health suggests that virtual reality simulation of imagined realities using realistic avatars of the participants can aid substance use disorder recovery by lowering the risk of relapse rates and increasing their future self-connectedness.
The Indiana University researchers have recently received over $4.9 million from the National Institutes of Health and launched an IU-affiliated startup company to test and further develop the technology.
Led by Brandon Oberlin, an assistant professor of psychiatry at the IU School of Medicine, IU researchers have built a virtual environment using “future-self avatars” to help people recover from substance use disorders. These avatars are life-sized, fully animated and nearly photorealistic. People can converse with their avatars, who speak in their same voice using personal details in alternate futures.
“VR technology is clinically effective and increasingly common for treating a variety of mental health conditions, such as phobias, post-traumatic stress disorder and post-operative pain, but has yet to find wide use in substance use disorders intervention or recovery,” A/Prof Oberlin said. “Capitalising on VR’s ability to deliver an immersive experience showing otherwise-impossible scenarios, we created a way for people to interact with different versions of their future selves in the context of substance use and recovery.”
“This experience enables people in recovery to have a personalised virtual experience, in alternate futures resulting from the choices they made,” Oberlin said. “We believe this could be a revolutionary intervention for early substance use disorders recovery, with perhaps even further-reaching mental health applications.”
The technology is particularly well-suited for people in early recovery, when relapse risk high, because the immersive experiences can help them choose long-term rewards over immediate gratification by deepening connections to their future selves, he said.
In the past five months, A/Prof Oberlin’s team was awarded numerous grants. These will be used to support clinical trials that test efficacy on relapse prevention, brain activation and other important elements related to substance use disorder treatment, A/Prof Oberlin said. For example, one study will deliver virtual reality experiences remotely via wireless headsets for participants to use at home, as remote delivery of mental health interventions addresses a pressing need for people unable or unwilling to engage in an in-person clinical setting.
According to a recent study published in Frontiers in Cardiovascular Medicine, the risk of developing myocarditis is seven times higher with a COVID infection than with the COVID vaccine, by scientists. Patients with myocarditis can experience chest pains, shortness of breath or an irregular heartbeat. In severe cases, the inflammation can lead to heart failure and death.
“Our findings show that the risk of myocarditis from being infected by COVID is far greater than from getting the vaccine,” said Dr Navya Voleti, a resident physician at Penn State College of Medicine. “Moving forward, it will be important to monitor the potential long-term effects in those who develop myocarditis.”
Typically resulting from viral infection, myocarditis is a known complication of SARS-CoV-2 infection, and heart complications have been associated with mRNA COVID vaccination – particularly myocarditis in teenage boys. However, the relative risk of myocarditis due to vaccines and infections had not been clearly established.
The researchers conducted the largest study to date on the risk of developing myocarditis as a result of SARS-CoV-2 infection vs experiencing inflammation after COVID vaccination. The researchers compared vaccinated and unvaccinated COVIP patients to uninfected controls. The myocarditis risk was 15 times higher in COVID patients, regardless of vaccination status, compared to individuals who did not contract the virus.
Next, the researchers separately compared the rates of myocarditis in those who received the vaccines to those in unvaccinated individuals. According to the findings, the rates of myocarditis in people who were vaccinated against COVID were only twofold higher than in unvaccinated people.
Based on all the findings, the researchers concluded that the risk of myocarditis due to COVID was seven times higher than the risk related to the vaccines.
Investigators conducted a systematic review and meta-analysis of 22 studies published worldwide from December 2019 through May 2022. The studies included nearly 58 million patients who reported cardiac complications and belonged to one of two groups: the 55.5 million who were vaccinated against COVID compared to those who were not vaccinated (vaccination group), and the 2.5 million who contracted the virus compared to those who did not contract the virus (COVID group).
In the vaccination group, the researchers separately compared the risk of myocarditis for various COVID vaccines. The median age of the study population was 49 years; 49% were men; and the median follow-up time after infection or COVID vaccination was 28 days.
The researchers found that among those diagnosed with myocarditis after receiving the vaccine or having COVID, the majority (61%) were men. Of patients diagnosed with myocarditis in both vaccination and COVID groups, 1.07% were hospitalised and 0.015% died.
“COVID infection and the related vaccines both pose a risk for myocarditis. However, the relative risk of heart inflammation induced by COVID infection is substantially greater than the risk posed by the vaccines,” said Dr. Paddy Ssentongo, a resident physician in the Department of Medicine at Penn State Health Milton S. Hershey Medical Center and the lead author of the study. “We hope our findings will help mitigate vaccine hesitancy and increase vaccine uptake.”
Locked fingers, known as ‘trigger finger’, are more common among people with diabetes than in the general population, finds a study published in Diabetes Care. A study led by Lund University in Sweden shows that the risk of being affected increases with hyperglycaemia.
Trigger finger means that one or more fingers, often the ring finger or thumb, ends up in a bent position that is difficult to straighten out. It is due to the thickening of tendons, which bend the finger, and their connective tissue sheath, which means that the finger becomes fixed in a bent position towards the palm. It is a painful condition that can often be treated with cortisone injections, but sometimes requires surgery.
“At the hand surgery clinic, we have noted for a long time that people with diabetes, both type 1 and type 2, are more often affected by trigger finger. Over 20 percent of those who require surgery for this condition are patients who have, or will develop, diabetes,” says Mattias Rydberg, doctoral student at Lund University, resident physician at Skåne University Hospital and first author of the study.
To study whether blood sugar dysregulation increases the risk of trigger finger, the researchers examined two registers. The prevalence of trigger finger in the general population 1–1.5%, but is 10-15% among those who have diabetes, particularly in type 1 diabetes.
The study added to the evidence for a link between blood sugar and trigger finger. Hyperglycaemia increased the risk of being affected by trigger finger among both men and women in the groups with type 1 diabetes and type 2 diabetes. The group of men with the worst regulated blood sugar (HbA1c > 64) had up to 5 times as high a risk of being affected than men with well-regulated (HbA1c < 48) blood sugar.
“However, we can’t know for certain if any of the groups seek healthcare more often than others which could be a factor that affects the results,” said Mattias Rydberg.
The mechanism, or mechanisms, behind the increased risk are unknown, but there are theories that high blood sugar makes both the flexor tendons and their connective tissue sheaths thicker, thus causing them to lock more easily. It was previously known that those with unregulated blood sugar are more prone to nerve entrapments in the hand.
“It is important to draw attention to the complications from diabetes and how they can arise in order to discover them early, which enables faster treatment and thus a better outcome. In addition to nerve compressions and trigger finger, there may also be a link with thickening of the connective tissue in the palm (Dupuytren’s contracture), impairment of joint movement and the risk of arthritis at the base of the thumb. The mechanisms behind these complications probably differ in the case of diabetes. The results of this study are interesting, as we can show that blood sugar dysregulation has a connection with the development of trigger finger,” said Lars B. Dahlin, professor at Lund University and consultant in hand surgery at Skåne University Hospital.
Future research will measure the effectiveness of operating on patients with diabetes who are affected by trigger finger.
“From our experience at the clinic, surgery goes well and there are few complications, but it takes a little longer for patients with type 1 and type 2 diabetes to regain full movement and function. We want to investigate this hypothesis further. Another interesting idea is to see if trigger finger could be a warning signal for type 2 diabetes. It is far from all who are affected by trigger finger that have diabetes, but it would be interesting to see if by using modern registers we can discover those who are in the risk zone for developing diabetes,” concluded Mattias Rydberg.
A study in the Journal of Hospital Medicine found that the general public does not have a good grasp of the medical jargon that physicians typically use in their introductions to patients. They found speciality names and seniority titles are sources of misunderstanding.
“Jargon is pervasive in medicine and the opportunity for misunderstanding due to this terminology begins the instant that physicians introduce themselves to patients,” explained Emily Hause, MD, MPH, a paediatric rheumatology fellow at the U of M Medical School. “We found that most people can’t define specialty names nor correctly rank medical seniority titles. Physicians should describe their medical specialty and role on the patient’s care team in plain language to help reduce this source of potential confusion.”
Volunteer participants at the 2021 Minnesota State Fair completed an electronic survey that measured their knowledge of medical specialties and titles. Of the 14 specialties included in the survey, six specialties were correctly defined by less than half of the respondents:
Neonatologists: 48%
Pulmonologists: 43%
Hospitalists: 31%
Intensivists: 29%
Internists: 21%
Nephrologists: 20%
When asked to rank medical roles, only 12% of participants correctly placed these titles in order: medical student, intern, senior resident, fellow and attending.
Further research is suggested to survey knowledge on additional specialties and obtain more demographic information.
As work hours increase, new doctors are at greater risk of depression, according to a study in the New England Journal of Medicine. Working 90 or more hours a week was associated with changes in depression symptom scores three times larger than the change in depression symptoms among those working 40 to 45 hours a week.
Additionally, compared to those working normal hours, those working more hours had greater odds of scores equating to moderate to severe depression.
By means of advanced statistical methods, the researchers emulated a randomised clinical trial using data on more than 17 000 first-year medical residents, accounting for many other factors in the doctors’ personal and professional lives. Less than 5% met the criteria for moderate to severe depression.
They found a “dose response” effect between hours worked and depression symptoms, with an average symptom increase of 1.8 points on a standard scale for those working 40 to 45 hours, ranging up to 5.2 points for those working more than 90 hours. They conclude that, among all the stressors affecting physicians, working a large number of hours is a major contributor to depression.
The data come from the Intern Health Study, based at the Michigan Neuroscience Institute and the Eisenberg Family Depression Center. Each year, the study recruits new medical school graduates to take part in a year of tracking of their depressive symptoms, work hours, sleep and more while they complete the first year of residency, also called the intern year.
The impact of high numbers of work hours
Though the interns in the study reported a wide range of previous-week work hours, the most common work hour levels were between 65 to 80 hours per week.
The authors say their findings point to a clear need to further reduce the number of hours residents work each week on average.
“This analysis suggests strongly that reducing the average number of work hours would make a difference in the degree to which interns’ depressive symptoms increase over time, and reduce the number who develop diagnosable depression,” said Amy Bohnert, PhD, the study’s senior author and a professor at the U-M Medical School. “The key thing is to have people work fewer hours; you can more effectively deal with the stresses or frustrations of your job when you have more time to recover.”
Yu Fang, MSE, the study’s lead author and a research specialist at the Michigan Neuroscience Institute, notes that the number of hours is important, but so are the training opportunities that come from time spent in hospitals and clinics. “It is important to use the time spent at work for supervised learning opportunities, and not low-value clinical service tasks,” she says.
Information about alcohol abuse gathered during the COVID lockdown may prompt further changes to the Liquor Amendment Bill, says the Department of Trade, Industry and Competition. The Bill has been on hold since 2018.
The Bill seeks to amend the National Liquor Act of 2003, by tightening alcohol restrictions and advertising and regulating where alcohol is sold.
Spokesperson Bongani Lukhele said the Bill was under review by the department.
“During the Covid-19 pandemic, it became more apparent that the problem of liquor abuse is quite huge in South Africa and requires more concerted measures, and that the Bill may not address the scale of the problem as the problem requires a concerted effort in government,” said Lukhele.
He said the department would reintroduce the bill to Parliament. Lukhele said as well as legislation to address liquor use, there was a need for health, education and behaviour issues to be addressed as well.
“Provincial laws must also be reviewed as it impacts directly on the retail trade,” Lukhele added.
Meanwhile, lobby groups are growing impatient with delays in the implementation of the bill.
Maurice Smithers, director of the Southern African Alcohol Policy Alliance in South Africa, said the Liquor Act had been reviewed in 2015 and found to be inadequate and inconsistent with the World Health Organisation’s Global Strategy to reduce the harmful use of alcohol. The Global Strategy suggests three priorities: reducing the availability of alcohol, increasing its cost, and limiting or banning marketing.
As a result, changes were proposed in the Liquor Bill, drafted in 2016, including:
restricting advertising of alcohol on public platforms;
increasing the legal drinking age from 18 to 21 years;
regulating specific trading days and hours for alcohol to be distributed and manufactured; and
placing liability on alcohol retailers and manufacturers for harm related to the contravention of regulations.
The amendments also propose banning alcohol advertising on radio and television at certain times and on billboards less than 100 metres away from junctions, street corners and traffic circles.
The bill was approved by Cabinet for public comment in 2016.
Smithers told GroundUp that the socio-economic and health problems associated with alcohol would worsen over time if the Bill and other legislation was not passed.
“The overall cost to society of such harm will continue to burden the state and divert resources from other delivery areas. Some specific consequences are that petrol stations are now applying for licences, something they would not be able to do if the bill were passed.”
“The current proposals in the Basic Education Laws Amendment Bill which will allow schools to have alcohol at schools and at school functions off school premises for fund-raising purposes would also not be allowed if the bill were passed,” said Smithers.
Basic Education Minister Angie Motshekga has said the department supports zero tolerance of alcohol at schools, but schools do sell alcohol during fund-raising and do hire out halls for functions where alcohol is consumed. She said the clauses in the Basic Education Laws Amendment Act are intended only to regulate this.
Onesisa Mtwa, innovation manager at the DG Murray Trust, told GroundUp that stronger regulations were necessary to address and reduce harmful patterns of consumption such as heavy and binge drinking.
In its 2018 Global Survey on Alcohol and Health, the WHO indicated that in 2016, South African drinkers over the age of 15 years consumed, on average, 64.6 grams of pure alcohol per day.
The data further showed that South African drinkers over 15 years old consumed 29.9 litres of pure alcohol in a year —the third highest consumption in Africa.
Citing a 2017 by economics-based consulting firm Genesis Analytics, Mtwa said the Bill could reduce alcohol consumption by between 3.2% and 7.4% which would, in turn, reduce public health costs by R1.9 billion per year.
“Despite the industry’s claims that this Bill will destroy the industry,” Mtwa said, the impact assessment suggested that South Africa’s gross domestic product would drop by less than 1%.
A study by the University of Cape Town and the Medical Research Council found that alcohol bans during COVID were strongly associated with a large drop in unnatural deaths (murders, vehicle collisions, suicides and accidents).
Researchers looked at death data during alcohol restrictions and curfews under the national lockdown from the end of December 2019 to late April 2021. The drop in unnatural deaths associated with a full alcohol ban ranged from 42 deaths per day under a curfew of 4 to 7 hours to 74 per day under hard lockdown.
Mtwa said implementing the bill would need “extensive” national and provincial cooperation.
“Some areas of regulation such as retail sales and liquor licences lie with provinces, while liability issues, manufacturers and the drinking age would be regulated by the national government. This highlights the need for a whole-of-government approach to reducing alcohol-related harm,” she adds.
Smithers said although the bill is not a silver bullet, it would send a signal to society that the government is serious about addressing the issue of alcohol-related harm.
“It’s not a perfect bill and it won’t result in a perfect act, but it is a step in the right direction,” he said.
A new longitudinal study of more than 23 million people in the US concludes that some commonly used and abused drugs pose previously unidentified risks for the development of atrial fibrillation (AF). The results appeared in the European Heart Journal.
The researchers analysed data from diagnostic codes from every hospital admission, emergency room visit and medical procedure in California for the years 2005 through 2015, identifying nearly one million people without preexisting AF, but who later developed AF during these years.
They found 132 834 patients used cannabis, 98 271 used methamphetamine, 48 700 used cocaine, and 10 032 used opiates. In the study, the researchers found that marijuana users had a 35% increased likelihood of later developing AF.
“Despite exhibiting a weaker association with incident AF than the other substances, cannabis use still exhibited an association of similar or greater magnitude to risk factors like dyslipidaemia, diabetes mellitus, and chronic kidney disease. Furthermore, those with cannabis use exhibited similar relative risk of incident AF as those with traditional tobacco use,” the study authors reported.
“To my knowledge, this is the first study to look at marijuana use as a predictor of future atrial fibrillation risk,” said principal investigator Gregory Marcus, MD, MAS, a UCSF professor of Medicine with the Division of Cardiology.
AF is an abnormally disordered pumping rhythm arising from electrical disturbances in the atria. In severe cases of faulty atrial pumping, clots may form in the atria, and then break off into the bloodstream and cause deadly strokes. AF-related strokes cause more than 150 000 US deaths each year.
Unlike cocaine or methamphetamine use, both stimulants previously known to sometimes lead to sudden cardiac death due to profound disruptions in the orderly electrical signalling and pumping within ventricles there is no demonstrated mechanism whereby marijuana use causes heart arrhythmias.
A study published in PLOS ONE suggests that interacting with moderately active people is an important factor that could influence sedentary people into becoming more active. The researchers developed a mathematical model that takes into account the influence of social interactions on community exercise trends.
To help address shortfalls in people getting recommended levels of exercise, Ensela Mema of Kean University in Union, New Jersey, and colleagues drew on previous research showing that social interactions with peers can play a key role in boosting physical activity within a community. In line with that knowledge, they developed a mathematical model that simulates how social interactions can affect a population’s exercise trends over time. The model incorporates data from the US Military Academy.
The model simulations showed that, without social interactions, populations experienced a long-term decrease in physically active individuals, and sedentary behaviour began to dominate. However, when the simulations included social interactions between sedentary and moderately active people, sedentary populations became more physically active in the long term. Still, in simulations where moderately active people became more sedentary over time, overall physical activity trends plummeted.
While these simulations were not validated with real-world data, the researchers say they provide new insights that could inform public health efforts to boost community physical activity levels. The researchers outline a number of recommendations for such efforts, such as social activities designed to boost interactions between sedentary and moderately active people.
The researchers said that more research will be needed to better understand the balance between encouraging exercise among sedentary people while retaining activity levels in moderately active people.
The authors added: “We have traditionally directed physical activity interventions by engaging sedentary individuals to become more active. Our model suggests that focusing on the moderately active population to sustain their activity and increasing their interactions with sedentary people could stimulate higher levels of overall physical activity in the population.”
Using brain ‘organoids’, researchers at Karolinska Institutet have found that COVID infection results in damage from immune cells and gene expressions similar to those found in neurodegenerative disorders. Their findings were published in Molecular Psychiatry.
The findings could help to identify new treatments against persistent cognitive symptoms after a COVID infection.
Neurological symptoms in ‘long COVID’ have been widely reported but the underlying mechanisms for this remains unknown. To find out, the study’s researchers created brain organoids from human induced pluripotent stem (iPS) cells. The model differs from previous organoid models as the researchers also included the brain immune cells – microglia – in the model. In the infected models, microglia excessively engulfed synaptic structures and displayed upregulation of factors involved in phagocytosis. The developed model and the findings in the study could help to guide future efforts to target cognitive symptoms in the aftermath of COVID and other neuroinvasive viral infections.
Post-infection cognitive deficits
“Interestingly, our results to a large extent mimic what has recently been observed in mouse models infected with other neuroinvasive RNA viruses such as the West Nile virus. These viruses are also linked to residual cognitive deficits after the infection, and a persisting activation of microglia leading to an excessive engulfment of synapses, which has been suggested to drive these symptoms. Multiple studies have now also reported remaining cognitive symptoms after a COVID infection, as well as an increased risk of receiving a diagnosis of a disorder characterised by cognitive symptoms,” says co-first author of the study Samudyata, a postdoctoral fellow at Karolinska Institutet.
Connections to Parkinson’s and Alzheimer’s disease
Microglia also carry out important regulatory functions of the neuronal circuitries in the brain, one of which is engulfing unwanted synapses, a process that is believed to improve and maintain cognitive functions. However, excessive engulfment of synapses has been linked to both neurodevelopmental disorders, such as schizophrenia, as well as to neurodegenerative disorders including Alzheimer’s disease.
By sequencing genes in single cells, the authors could also study how different cell types in the model responded to the virus.
“Microglia displayed a distinct gene signature largely characterized by an upregulation of interferon-responsive genes, and included pathways previously linked to neurodegenerative disorders such as Parkinson’s and Alzheimer’s disease. This signature was also observed at a later time-point when the virus load was minimal,” says co-author of the study Susmita Malwade, a doctoral student at Karolinska Institutet.
The researchers will now study how different pharmacological approaches can reverse the observed changes in the infected models.
