An Acta Paediatrica analysis of data for extremely preterm babies (born before 24 weeks) found that most had neurodevelopmental disorders and/or other diagnoses during childhood and were referred for habilitational care.
In the Swedish study of 383 children from 2007 to 2018, 75% had neurodevelopmental disorders (including speech disorders, intellectual disabilities, attention deficit hyperactivity disorder, autism spectrum disorders, visual impairment, cerebral palsy, epilepsy, and hearing impairment).
More boys than girls had intellectual disabilities (45% versus 27%) and visual impairment (25% versus 14%). Fifty-five percent of children were referred for habilitation services, and 88% had additional diagnoses such as asthma and short stature.
“Due to improved medical care, an increasing number of extremely preterm infants survive. Our study shows that a large proportion of the most immature new survivors suffer from persisting somatic and neurodevelopmental disorders,” said senior author Ann Hellström, MD, PhD, of Gothenburg University.
A better understanding of the long-term consequences of preterm birth will assist clinicians and healthcare systems in optimising care. “Awareness of the lifelong needs of these children is also necessary for society at large to provide adequate resources and support for the tiniest of our children and their families,” said lead author Eva Morsing, MD, PhD of Lund University.
At-home monitoring of blood oxygen levels is a safe way for people with COVID to see if their condition is deteriorating, putting them in need emergency and hospital care, according to new research.
Pulse oximeters are readily available, relatively inexpensive devices. Studies have shown that a drop in blood oxygen levels is a critical indicator that a COVID patient’s health is deteriorating.
The study, published in Lancet Digital Health, carried out the first extensive evidence review of pulse oximetry and its potential in home monitoring for people with COVID.
Thirteen studies involving almost 3000 participants across five countries, were analysed, most of which were carried out during the first pandemic wave.
The investigators found that home oxygen monitoring, with medical guidance, was a safe and effective ‘safety net’ for who were ill with COVID at home, picking up early signs of deterioration and escalating care where necessary, thereby reducing the burden on strained clinical resources.
There was however a note of caution due to the lack of research on darker-skinned patients, in whom oximetry may be less accurate than in lighter-skinned people.
The researchers proposed some key recommendations to help standardise the practice of at-home oximetry for COVID monitoring.
The study makes the recommendation the use of a defined cutoff point in blood oxygen levels (92%), which will enable healthcare professionals to determine when a patient needs to go to hospital for treatment, or whether they can rule out the need for further care at the time.
Dr Ahmed Alboksmaty, Research Associate from the Institute of Global Health Innovation, said: “Throughout the pandemic, concern among the public has shifted from ‘Have I got COVID?’ to ‘If I got COVID, do I need to go to hospital?’. Our study shows that people with COVID can safely keep an eye on their blood oxygen levels at home using pulse oximetry. If their oxygen levels drop below a certain point, then this indicates that they need to seek professional medical care.
“Pulse oximetry is easy to self-use, affordable in cost, widely available, and as we have shown, a useful way to identify health deterioration in COVID patients.”
Some smartphones and mobile apps can also measure blood oxygen levels, which the researchers identify as a potentially widely accessible monitoring tool. However, though some studies have shown similar accuracies to conventional oximeters, the researchers say there is not enough evidence to support their use.
Current knowledge gaps also included insufficient data on whether pulse oximetry can improve the health outlook for patients.
Dr Ana Luisa Neves, Advanced Research Fellow from the Institute of Global Health Innovation, said: “Our research has demonstrated how the use of pulse oximetry in remote patient monitoring could help ease the strains on health systems during the COVID pandemic. However, it’s vital to ensure that the current lack of research in racially and ethnically diverse populations is addressed. It’s therefore critical to provide support to ensure this technology reduces, rather than entrenches, existing health inequalities.”
Nursing home residents with diabetes are at high risk of having hypoglycaemia if their diabetes is overtreated, finds a new study published in the Journal of the American Geriatrics Society. The research suggests that many residents of nursing homes continue to receive insulin and other medications that increase hypoglycaemia risk even after blood tests suggest overtreatment.
Among 7422 nursing home residents, most had blood test results at the start of the study suggesting tight control of their blood sugar levels, and most were on insulin. Only 27% of overtreated and 19% of potentially overtreated residents at baseline had their medication regimens deintensified within 2 weeks.
Long-acting insulin use and hyperglycaemia ≥300 mg/dL before index HbA1c were associated with increased odds of continued overtreatment. Severe functional impairment (MDS-ADL score ≥ 19) was associated with decreased odds of continued overtreatment Hypoglycaemia was not associated with decreased odds of overtreatment.
The researchers suggested that deprescribing initiatives targeting residents at high risk of harms and with low likelihood of benefit, such as those with history of hypoglycaemia, or high levels of cognitive or functional impairment are most likely to identify nursing home residents most likely to benefit from deintensification.
“I hope this work lays the foundation for future projects that promote appropriate deintensification of glucose lowering medications in nursing home residents,” said lead author Lauren I. Lederle, MD, of the San Francisco VA Medical Center.
Researchers have identified the fast-acting dissociative anaesthetic ketamine has significant potential as a treatment for mental health conditions. First manufactured more than 50 years ago, ketamine is often used in veterinary and emergency medicine. It also has a history of being an illicit party drug.
In a recent study published in the British Journal of Psychiatry, the research team found ketamine to have significant anti-depressant and anti-suicidal effects. They also found evidence that even more benefits.
Led by Psychology Professor Dr Zach Walsh and doctoral student Joey Rootman, the research team arrived at this conclusion after analysing more than 150 worldwide studies on the effects of sub-anaesthetic ketamine doses for the treatment of mental illness.
“We found strong evidence that indicates ketamine provides rapid and robust anti-depressant and anti-suicidal effects, but the effects were relatively short-lived,” explained Rootman. “However, repeated dosing appeared to have the potential to increase the duration of positive effects.”
The study also provides limited evidence to suggest a possible use for ketamine in the treatment of other disorders, such as eating disorders, problematic substance use, post-traumatic stress and anxiety.
“What our research provides is an up-to-date overview and synthesis of where the knowledge on ketamine is at right now,” said Rootman. “Our results signal that ketamine may indeed have a broader spectrum of potential applications in psychiatric treatment—and that tells us that more investigation is needed.”
This study serves as a foundation for fellow researchers looking to design ketamine-related projects and offers valuable data for clinicians considering using ketamine with their patients.
The results also help to satisfy the public’s appetite for information on innovative and emerging psychiatric treatments, said Dr Walsh, explaining that the review provides a relatively compact document with evidence regarding which ketamine treatments may be helpful for diverse diagnoses.
With many people experiencing mental health disorders, Dr Walsh said that “the reality is that existing treatments don’t work for everyone. As a result, many Canadians are curious about new approaches to help with these serious conditions.”
Overall, while Dr Walsh acknowledges research into other treatment areas is just beginning, he finds the preliminary evidence encouraging.
“We need a lot more information on how these interventions could work – for example, administering the drug is only a part of treatment. We need to figure out what amount and type of psychotherapy would best compliment the drug intervention to really maximise potential benefits,” he explained. “With that being said, it is a truly exciting time for ketamine research. If it can deliver the relief that early evidence suggests it can, this could be among the most significant developments in mental health treatment in decades.”
Researchers at the University of Waterloo have developed a new form of magnetic resonance imaging (MRI) that makes cancerous tissue glow in medical images. This innovation could enable more accurate detection and tracking of cancer over time.
“Our studies show this new technology has promising potential to improve cancer screening, prognosis and treatment planning,” said first author Professor Alexander Wong.
Irregular packing of cells leads to differences in the way water molecules move in cancerous tissue compared to healthy tissue. The new technology, called synthetic correlated diffusion imaging, highlights these differences by capturing, synthesising and mixing MRI signals at different gradient pulse strengths and timings.
In the largest study of its kind, the researchers collaborated with medical experts at the Lunenfeld-Tanenbaum Research Institute, several Toronto hospitals and the Ontario Institute for Cancer Research to apply the technology to a cohort of 200 patients with prostate cancer.
The synthetic correlated diffusion imaging was found to be better at delineating significant cancerous tissue than current imaging technique, making it a potentially powerful addition to the toolbox for doctors and radiologists.
“Prostate cancer is the second most common cancer in men worldwide and the most frequently diagnosed cancer among men in more developed countries,” said Prof Wong. “That’s why we targeted it first in our research.
“We also have very promising results for breast cancer screening, detection, and treatment planning. This could be a game-changer for many kinds of cancer imaging and clinical decision support.”
A newly published study has identified a key regulatory mechanism in inflammation that may lead to new targets for resolving that inflammation –and the inflammation of patients with sepsis, cancer and COVID.
In the journal PNAS, scientists reported their discovery of a regulatory pathway for immune response after infection or injury, such as burns. Dysregulation of this pathway could differentiate those who are at risk of fatal sepsis or help identify targets to resolve this unregulated inflammation.
“We are very excited about the findings in this paper and the far-reaching impacts it could have on understanding a key regulatory step in the immune response,” said co-lead author Cindy McReynolds, who holds a doctorate in pharmacology and toxicology.
In a rodent model, the research team found that the metabolites of linoleic acid formed by the enzyme, soluble epoxide hydrolase (sEH), drive damaging inflammation after injury. These metabolites, known as lipid mediators, regulate inflammation, blood pressure and pain. Drugs that inhibit the sEH enzyme and reduce inflammation could lead to better outcomes.
“Our previous work identified that these same lipid mediators were up-regulated in severe COVID infections, and we are now finding that these compounds play a role in modulating the immune response so that the body is unable to fight infection or respond properly to trauma without leading to a potentially fatal overreaction,” said Dr McReynolds.
“This dysregulation has fatal consequences in serious diseases such as COVID, cancer, sepsis, burn, where fatality rates can be as high as 40 percent in severe cases,” she said. “An understanding of these pathways can help identify patients at risk of developing serious disease or identify new therapeutic targets for treatment.”
“The immunological disbalance we see in many cases of severe burn injury, trauma and sepsis pose a huge clinical challenge as we lack the understanding of how to diagnose and treat it,” explained co-lead author Dr Christian Bergmann. “With this work, we reveal an important mechanism how immune cells are functionally disabled by sEH-derived metabolites of linoleic acid.”
“The natural compounds we are studying in this paper are metabolites of linoleic acid (LA), an essential fatty acid the body needs in very small amounts to survive and is only available through the diet,” Dr McReynolds elaborated. “At lower concentrations, these metabolites are necessary for regulating thermogenesis and heart health but promote inflammation at higher concentrations. LA is more stable and much cheaper than longer chain polyunsaturated fatty acids, so heavily processed foods have higher LA content to increase shelf-life. Additionally, agricultural practices, such as feeding animals corn-based diets, have increased LA in meats and dairy products.”
“As a result, we are consuming the highest amount of linoleic acid and have the highest recorded concentration of LA in our fatty tissue in human history,” McReynolds said. “As our bodies respond to stress or disease, we metabolise LA into the regulatory metabolites that were monitored in this paper. At higher concentrations, the immune system was unable to properly respond to infection, thereby promoting a sustained immune response. These observations are important in inflammatory-driven diseases, such as sepsis and COVID, but could also be important in understanding many of the increased chronic diseases we are seeing in our population.”
Scanning Electron Micrograph of Pseudomonas aeruginosa. Credit: CDC/Janice Carr
A study has found that much higher doses of antibiotics are needed to eliminate a bacterial infection of the airways when certain other microbes are present. This helps explain why treatment often fails to treat respiratory infections in people with diseases such as cystic fibrosis.
The study’s researchers, whose findings are published in The ISME Journal, say that even a low level of one type of microbe in the airways can have a significant impact on the response of other microbes to antibiotics.
The results highlight the need to consider the interaction between different species of microbe when treating infections with antibiotics – and to adjust dosage accordingly.
“People with chronic infections often have co-infection with several pathogens, but the problem is we don’t take that into account in deciding how much of a particular antibiotic to treat them with. Our results might help explain why, in these people, the antibiotics just don’t work as well as they should,” said Thomas O’Brien, PhD candidate and co-first author.
Chronic bacterial infections such as those in the human airways are very difficult to cure using antibiotics. Although these types of infection are often associated with a single pathogenic species, the infection site is frequently co-colonised by a number of other microbes, most of which are not usually pathogenic in their own right.
Treatment options usually revolve around targeting the pathogen, and take little account of the co-habiting species. However, these treatments often fail to resolve the infection. Until now scientists have had little insight into why this is.
To get their results the team developed a simplified model of the human airways, containing artificial sputum designed to chemically resemble the real thing, packed with bacteria.
The model allowed them to grow a mixture of different microbes, including pathogens, in a stable way for weeks at a time. This is a novel approach, as usually one pathogen will rapidly outgrow the others and spoil the experiment. It enabled the researchers to replicate and study poly-microbial infections in the laboratory.
The three microbes used in the experiment were the bacteria Pseudomonas aeruginosa and Staphylococcus aureus, and the fungus Candida albicans – a combination often found in the airways of cystic fibrosis patients.
The researchers treated this microbial mix with colistin, which kills P. aeruginosa effectively. But when the other pathogens were present alongside P. aeruginosa, the antibiotic didn’t work.
“We were surprised to find that an antibiotic that we know should clear an infection of Pseudomonas effectively just didn’t work in our lab model when other bugs were present,” said Wendy Figueroa-Chavez at the University of Cambridge, joint first author of the paper.
The same effect happened when the microbial mix was treated with fusidic acid – an antibiotic that specifically targets Staphylococcus aureus, and with fluconazole, which specifically targets C. albicans.
The researchers found that significantly higher doses of each antibiotic were needed to kill bacteria when it was part of poly-microbial infection, compared to when no other pathogens were present.
“All three species-specific antibiotics were less effective against their target when three pathogens were present together,” said Professor Martin Welch at the University of Cambridge, senior author of the paper.
Currently, antibiotics are usually only lab tested against the targeted pathogen, to determine the lowest effective dose. But when the same dose is used to treat infection in a person it is often ineffective, and this study helps to explain why. The new model system will enable the effectiveness of potential new antibiotics to be tested against a mixture of microbe species together.
Poly-microbial infections are common in the airways of people with cystic fibrosis. Despite treatment with strong doses of antibiotics, these infections often persist long-term. Chronic infections of the airways in people with asthma and chronic obstructive pulmonary disorder (COPD) are also often poly-microbial.
Genetically analysing the Pseudomonas in their lab-grown mix, the researchers were able to pinpoint specific mutations that give rise to this antibiotic resistance. The mutations were found to arise more frequently when other pathogens were also present.
Comparison with the genetic code of 800 samples of Pseudomonas from around the world revealed that these mutations have also occurred in human patients who had been infected with Pseudomonas and treated with colistin.
“The problem is that as soon as you use an antibiotic to treat a microbial infection, the microbe will start to evolve resistance to that antibiotic. That’s what has happened since colistin started to be used in the early 1990’s. This is another reminder of the vital need to find new antibiotics to treat human infections,” said Prof Welch.
Minimally invasive hysterectomy for patients with early cervical cancer resulted in significantly worse outcomes compared with open surgery, according a clinical trial’s final analysis, a result which confirmed initial findings.
The Laparoscopic Approach to Cervical Cancer (LACC) trial compared disease-free survival (DFS) and overall survival (OS) at 4.5-year follow-up from the initial 631 patients who were randomised to open surgery or to MIS.
In the intention-to-treat population, DFS at 4.5 years – the study’s primary outcome – was 96.0% with the open surgery approach versus 85.0% with minimally invasive surgery (MIS), with similar DFS rates of 97.3% and 86.0% in the per-protocol analysis, reported Pedro T. Ramirez, MD, of the University of Texas MD Anderson Cancer Center in Houston.
“When we presented the data in 2018, the recurrence rate for MIS was four times higher than for open surgery,” Dr Ramirez said at the Society of Gynecologic Oncology annual meeting. “And after completion of 4.5 years follow-up on all of the patients, it still remains the same.”
Since the initial publication of his team’s findings in 2018, said Dr Ramirez, national and international guidelines have changed their recommendations and now consider open radical hysterectomy as the new standard approach for patients with early cervical cancer. This final analysis confirms that patients with early cervical cancer “should not undergo the minimally invasive approach outside of a clinical trial,” he said.
DFS events occurred in 43 patients in the MIS arm versus 11 patients in the open surgery arm/ Additionally, the MIS arm patients had worse disease-specific survival, cumulative local/regional recurrence and overall survival.
Researchers also found that progression-free survival (PFS) was worse for MIS compared with open surgery, with 48 patients in the MIS arm experiencing events compared with 12 in the open surgery arm, consistent with the 2018 findings.
Since the initial publication of his team’s findings in 2018, said Dr Ramirez, national and international guidelines have altered their recommendationsand now consider open radical hysterectomy as the new standard approach for patients with early cervical cancer. This final analysis confirms that patients with early cervical cancer “should not undergo the minimally invasive approach outside of a clinical trial,” he said.
The researchers also assessed outcomes by tumour size, conisation status, and carcinomatosis rates.
They found that 21% of MIS patients with tumours ≥ 2 cm had DFS events compared with about 5% of patients who had open surgery (HR 4.25).
Dr Ramirez emphasised that while the trial was not designed to answer the question of the effect of tumour size on surgical outcomes, “this highlights the fact that for larger tumours, there is clearly a disadvantage to minimally invasive surgery in terms of the difference in recurrence events.”
As for tumours less than 2 cm, the investigators found that no DFS events occurred among 65 patients who underwent open surgery versus seven DFS events among 75 MIS patients.
“It is important to highlight this because comments have been made that if patients have tumours less than 2cm, then perhaps it is appropriate to proceed with minimally invasive surgery,” Dr Ramirez pointed out.
Among those patients who did not have previous conisation, there were worse outcomes for those who underwent MIS. Among patients who did have a previous cone, there was no difference between the two arms.
When there were recurrences in the open surgery arm, no patients manifested with carcinomatosis versus 24% of patients in the MIS arm.
As the US state of Oregon becomes the first to permit psilocybin in clinical use, a new systematic evidence review reveals a lack of scientific research describing the interactions between widely used psychiatric medications and psychedelics like psilocybin and MDMA. The review was published in the journal Psychopharmacology.
The scarcity of data is problematic for people believed to benefit most from psychedelics: those with mental health conditions such as depression, anxiety and post-traumatic stress disorder.
“There’s a huge deficit in the scientific literature,” said lead author Aryan Sarparast, MD, assistant professor of psychiatry at the Oregon Health and Science University. “There’s a major incongruence between the public enthusiasm and exuberance with psychedelic substances for mental health issues – and what happens when they combine with the existing mental health treatments that we have now.”
The researchers decided to conduct the evidence review because they wanted to learn more about interactions between widely prescribed medications such as antidepressants and psychedelics, including MDMA and psilocybin.
They found a total of 40 studies dating back to 1958, including 26 from randomised controlled studies, 11 case reports and three epidemiologic studies.
Only one study was found that examined how psilocybin interacts with antidepressant medications. A/Prof Sarparast also noted that all of the clinical trials were conducted with healthy volunteers who were administered a psychiatric medication and a psychedelic at the same time – clearly showing a need for further research into combining pharmaceutical medications with psilocybin.
A/Prof Sarparast said he is concerned that the lack of evidence will lead many providers to direct patients to taper off existing medications before being offered clinical psilocybin therapy. In Oregon rules are being drawn up to permit the clinical use of psilocybin products and services from next year.
Patients with mental health conditions might well benefit from psilocybin therapy, but A/Prof Sarparast said he is concerned about the implications of stopping existing psychiatric treatment in order to receive psilocybin services. Vulnerable people may end up being forced into choosing between their existing medical treatment or psilocybin services.
“That’s a very, very tough place to be,” A/Prof Sarparast said.
A considerable amount of important data exists that is not captured in a literature review related to real-world use, noted co-author Christopher Stauffer, MD, assistant professor of psychiatry in the OHSU School of Medicine and a physician-scientist at the VA Portland Health Care System.
“Psilocybin has been around in Western society since the late 1950s, before many of our psychiatric medications have existed,” A/Prof Stauffer said. “Nonetheless, people attempting to navigate Oregon’s psilocybin services in the context of ongoing psychiatric treatment should work closely with knowledgeable professionals.”
A study found that access to medical marijuana to treat pain, anxiety, or depression symptoms led to cannabis use disorder (CUD) in a significant minority of individuals while failing to improve their symptoms. The Massachusetts General Hospital (MGH) study was published in JAMA Network Open.
In the US, individuals are able to gain access to cannabis products using medical marijuana cards (MMCs), usually issued by a doctor. Researchers found the greatest risk of developing the addictive symptoms of CUD was in those seeking relief from anxiety and depression. This finding indicates the need for stronger safeguards over the dispensing, use, and professional follow-up of people who legally obtain cannabis through MMCs.
“There have been many claims about the benefits of medical marijuana for treating pain, insomnia, anxiety and depression, without sound scientific evidence to support them,” said lead author Jodi Gilman, PhD, with the Center for Addiction Medicine at MGH. “In this first study of patients randomised to obtain medical marijuana cards, we learned there can be negative consequences to using cannabis for medical purposes. People with pain, anxiety or depression symptoms failed to report any improvements, though those with insomnia experienced improved sleep.”
Dr Gilman was particularly disturbed by the fact that individuals with symptoms of anxiety or depression – the most common conditions which people seek medical cannabis for – were the ones most vulnerable to developing cannabis use disorder. CUD symptoms include a vicious circle of needing more cannabis because of growing tolerance, and seeking out cannabis to treat the psychological problems it causes.
“Medical” cannabis has surged in popularity in the US, as so far 36 of its 50 states have commercialised its use for myriad health conditions through medical marijuana cards. These cards require written approval of a licensed physician who, under the current system, is often not the patient’s primary care provider but rather a ‘cannabis doctor’ who may provide authorisation to patients with only a cursory examination, no recommendations for alternative treatments, and no follow-up. The medical marijuana industry effectively functions outside the regulations that apply to most fields of medicine.
The researchers started their trial in 2017 with 269 adults (average age of 37) who were interested in obtaining a medical marijuana card. One group was allowed to get MMCs immediately, while the second group, designed to serve as a control, was asked to wait 12 weeks before obtaining a card. Both groups were tracked over 12 weeks. The team found that the odds of developing CUD were nearly two times higher in the MMC cohort than in the wait list control group, and that by week 12, 10% of the MMC group had developed a CUD diagnosis, with the number rising to 20% in those seeking a card for anxiety or depression.
“Our study underscores the need for better decision-making about whether to begin to use cannabis for specific medical complaints, particularly mood and anxiety disorders, which are associated with an increased risk of cannabis use disorder,” said Dr Gilman. Regulation and distribution of cannabis to people with medical marijuana cards needs to be greatly improved, no matter the specific condition they are issued for. “There needs to be better guidance to patients around a system that currently allows them to choose their own products, decide their own dosing, and often receive no professional follow-up care.”
