New research from Rice University finds that antidepressants may actually reduce negative memories in individuals suffering from depression while improving overall memory function. The study, appearing in Frontiers in Human Neuroscience, examines how antidepressant use in depressed individuals affects memories, both good and bad.
Stephanie Leal, an assistant professor of psychological sciences, is the study’s lead author. She said the study’s main finding about the link between antidepressants and memories was an important one, because there is still much to be learned about how these drugs work.
“While antidepressants have been around since the 1950s, we still don’t really know how they work,” Leal said. “They only work about 50% of the time, and users often have to go through multiple types of antidepressants to get to a place where they actually feel like the drugs are beneficial. We don’t fully understand how these drugs reduce depressive symptoms and why they are so often ineffective. That’s a big problem.”
The study’s results suggest that antidepressants, when effective, can shift memory dynamics toward healthy function, Leal said.
“How antidepressants affect cognition is a hugely understudied area of research,” she said. “By measuring how antidepressants impact memory, we can use this information to better select treatments depending on people’s symptoms of depression.”
The study included 48 participants ages 18–35. All individuals were surveyed and had been actively taking antidepressants (regardless of the type of antidepressant and diagnosis) for at least one month prior to participation in the study. Researchers are conducting a follow-up study is to examine how the brain responds to antidepressants.
Cedars-Sinai investigators have shown that redo transcatheter aortic valve replacement (TAVR) procedures are both safe and effective when compared with situations in which patients with similar risk profiles undergo the same procedure for the first time.
The novel findings, which appear in The Lancet,are significant because recent randomised clinical trials have shown that TAVR is a meaningful treatment option for both younger and lower-risk surgical patients.
“We now know that redo TAVR with balloon-expandable valves may be a reasonable treatment for failed TAVR procedures in select patients,” said Raj Makkar, MD, Cedars-Sinai’s vice president of Cardiovascular Innovation and Intervention and the study’s senior author. “This is increasingly important, as the patients treated with TAVR are younger than they were a decade ago, meaning they will likely need a repeat procedure at some point in their lifetime.”
At both the 30-day post-procedure mark and at one year, Makkar’s team found no difference between redo TAVR or first-time TAVR in terms of death or stroke rates.
“Our findings also suggest that redo TAVR was associated with a significant improvement in quality of life,” said Makkar, who is also the associate director of the Smidt Heart Institute at Cedars-Sinai, director of the Interventional Cardiology Division in the Department of Cardiology, and the Stephen R. Corday, MD, Chair in Interventional Cardiology.
Transcatheter aortic valve replacement is a procedure that replaces a diseased aortic valve with a man-made valve. The procedure is now the standard treatment for patients with symptomatic severe aortic valve stenosis (narrowing of the artery).
The research team accessed a national database of all consecutive patients undergoing commercial TAVR in the US. Among the 350 591 patients who underwent TAVR between November 2011 and December 2022, 1320 individuals required redo procedures. The patients who underwent a repeat procedure had a mean age of 78 years old. About 58% were male and 42% female.
“Fixing damaged valves is something in which we excel at the Smidt Heart Institute,” said Eduardo Marbán, MD, PhD, professor and executive director of the Smidt Heart Institute. “Our finding that TAVR can be redone safely is yet another step in establishing this as the default technology for aortic valve disease.”
Interventionalists in the Smidt Heart Institute at Cedars-Sinai have successfully completed more than 6000 minimally invasive transcatheter aortic valve replacements to date, with more than 650 performed in fiscal year 2022.
Every year, respiratory syncytial viruses (RSV) cause countless respiratory infections worldwide. For infants, young children and people with pre-existing conditions, the virus can be life-threatening and so clinicians are always on the look-out for ways to reduce infections. New research published in the Journal of Hospital Infection shows that, when used correctly, alcohol-based hand sanitisers and commercially available surface disinfectants provide good protection against transmission of the virus via surfaces.
Some viruses are known to remain infectious for a long time on surfaces. To determine this period for RSV, the Ruhr-University Bochum virology team examined how long the virus persists on stainless steel plates at room temperature. “Even though the amount of infectious virus decreased over time, we still detected infectious viral particles after seven days,” says Dr Toni Luise Meister. “In hospitals and medical practices in particular, it is therefore essential to disinfect surfaces on a regular basis.” Five surface disinfectants containing alcohol, aldehyde and hydrogen peroxide were tested and found to effectively inactivate the virus on surfaces.
RSV is easier to inactivate than some other viruses
Hand sanitisers recommended by the WHO also showed the desired effect. “An alcohol content of 30 percent was sufficient: we no longer detected any infectious virus after hand disinfection,” said Toni Luise Meister. RSV is thus easier to render harmless than some other viruses, such as mpox (formerly monkeypox) virus or hepatitis B virus.
Still, most infections with RSV are transmitted from one person to another, via airborne droplets. The risk of contracting the virus from an infected person decreases if that person rinses their mouth for 30 seconds with a commercial mouthwash. The lab tests showed that three mouthwashes for adults and three of four mouthwashes designed specifically for children reduced the amount of virus in the sample to below detectable levels.
“If we assume that these results from the lab can be transferred to everyday life, we are not at the mercy of seasonal flu and common cold, but can actively prevent infection,” concludes Toni Luise Meister. “In addition to disinfection, people should wash their hands regularly, maintain a proper sneezing and coughing etiquette, and keep their distance from others when they’re experiencing any symptoms.”
South Africa is not the only country faced with a flight of doctors over working conditions. According to a survey of UK medical students published by BMJ Open, one in three plan to leave the National Health Service (NHS) – either to practise abroad or to stop practising medicine entirely. Of those who plan to go abroad, nearly half plan on never returning.
The responses indicate that pay, work-life balance, and working conditions are the key drivers behind the decisions to leave.
The UK has 3.2 doctors for every 1000 people, ranking 25th among the Organisation for Economic Co-operation and Development (OECD) countries. This figure also represents the lowest number of doctors per head among European countries in the OECD, note the researchers.
In response to the shortage of doctors amid rising healthcare demand, the British government has opened new medical schools and expanded the student capacity of existing ones. But without addressing the issue of retention, increasing the number of medical students is unlikely to provide a sustainable long-term solution, they point out.
In a bid to understand current career intentions after graduation and on completion of the 2-year Foundation Programme, the researchers surveyed 10 486 medical students, around 25.5% of the total, from across 44 UK medical schools between January and March 2023.
The survey included sections on intended career immediately after graduation and after foundation training (if applicable), as well as the factors influencing decision-making.
Respondents’ average age was 22; around two thirds (66.5%) were women. All students were asked their career intentions after graduation with most (8806; 84%) saying they planned to complete both years of the UK’s foundation training after graduating.
But around 1 in 10 (10.5%;1101) intended to complete year 1 of foundation training and then emigrate to practise medicine: completion of the first year of foundation training provides doctors with full registration with the UK’s medical regulator (GMC), which is recognised internationally.
Another over 2% (220) planned to emigrate to practise medicine immediately after graduation while just over 1% (123) intended to take a break or undertake further study.
Just over 1% of respondents (132) planned to complete their first foundation year and then leave the profession, while just under 1% (104) intended to leave medicine permanently immediately after graduation.
Among the 8806 respondents intending to complete both foundation years, nearly half (49%;4294) planned to enter specialty training in the UK immediately afterwards.
Around a fifth (21%;1859) intended to enter a ‘non-training’ clinical job in the UK such as junior clinical fellowship or clinical teaching fellowship, or working as a locum doctor).
A further 23.5% (2071) intended to emigrate to practise medicine abroad, while around 6% (515) planned to take a break or undertake further study. Just 67 planned to leave medicine permanently after completion of year 2 of foundation training.
Around half (49.5%;1681) planned to return to UK medicine after a few years, while nearly 8% (267) intended to return after completion of their medical training abroad. But 42.5% (1444) indicated no intention to return.
Of those favouring emigration immediately after graduation, just under 81% didn’t intend to return to the UK. This fell to 60% (661) among those planning to emigrate after completing year 1 of foundation training and 29% (605) among those planning to emigrate after year 2.
Among the 2543 medical students expressing a preference for destination country, Australia was the most commonly mentioned (42.5%), followed by New Zealand (18%), the USA (10.4%) and Canada (10.3%).
In total, around a third of medical students (32.5%;3392) plan to leave the NHS within 2 years of graduating, either to practise abroad or to pursue other careers.
Remuneration at junior level, work-life balance, lack of autonomy over choice of training location, and the working conditions of doctors in the NHS were cited as the most important factors for those respondents intending to emigrate to continue their medical career.
These reasons were also given by those planning to abandon medicine altogether, with nearly 82% of them also listing burnout as an important or very important reason.
Only just over 17% of all respondents said they were satisfied or very satisfied with the overall prospect of working in the NHS.
Intention doesn’t necessarily translate into action, and minds may change, say the researchers. And while the 25% response rate is relatively large, that still means a substantial proportion of the medical student body weren’t surveyed.
But they highlight: “This study highlights that an alarming proportion of surveyed medical students intend to leave the profession or emigrate to practise medicine,” emphasise the researchers, “representing a potential loss of valuable medical talent.”
They continue: “The findings of this study emphasise the urgency of addressing the factors that are driving the exodus of doctors from the NHS and suggest that increased recruitment of medical students may not provide an adequate solution to staffing challenges.
“The causes of the problem are complex, and finding a solution will require a multifaceted approach. Steps could include improving work-life balance, increasing salaries, addressing the growing competition for specialty training posts and promoting greater flexibility in career pathways.”
They conclude: “Undoubtedly, the continued loss of skilled professionals from the NHS represents a significant concern, so it is critical to consider means of reversing this trend.”
Blood pressure among patients diagnosed with hypertension appeared to slightly increase and rates of systolic blood pressure being controlled during an outpatient visit appeared to slightly decrease during winter months, according to a new study presented at the American Heart Association’s Hypertension Scientific Sessions 2023.
Previous research has found that blood pressure varies with the seasons of the year, most of which is systolic blood pressure. The study authors sought to understand whether blood pressure control, defined in this study as less than 140/90mmHg among patients with hypertension, varied by season.
“Despite the smaller degree of systolic blood pressure variation in comparison to previous studies on seasonality in blood pressure, we were surprised to observe a large degree of change in blood pressure control between winter and summer months,” said lead study author Robert B. Barrett, a software engineer at the American Medical Association in Greenville, South Carolina. “Individuals with hypertension or values near the range of hypertension may benefit from periodic blood pressure monitoring and improvements in physical activity and nutritional patterns during winter months to offset adverse effects from seasonal blood pressure changes.”
The researchers reviewed electronic health records for 60 676 adults treated for hypertension between July 2018 and June 2023 at six health care centres. Each participant remained on their originally prescribed classes of antihypertensive drugs throughout the review period. The centres ranged from small health centres or clinics to large academic medical centres. Seasonal blood pressure readings were analysed to assess variations in blood pressure control during the northern hemisphere’s winter vs summer months (December through February vs June through August, respectively) as part of an American Medical Association-supported, quality-improvement program for clinicians and health care centres. Study participants were an average age of 62 years old; 52.3% identified as white race; 59.7% identified as female.
The analysis of the health records found that, on average, participants’ systolic blood pressure increased by up to 1.7mmHg in the winter months compared to the summer months. In addition, they found that blood pressure control rates decreased by up to 5% during the winter months.
Future directions for investigation might include analysing the frequency of heart disease and deaths during each season, the authors noted.
The study’s limitations include that the electronic health records did not capture a complete health history for each participant and that information collected for each patient was retrieved only from the institution where they were treated.
The ketogenic (keto) diet may lower testosterone levels in women with polycystic ovary syndrome (PCOS), according to a new paper published in the Journal of the Endocrine Society. The diet also appeared to lower follicle-stimulating hormone (FSH) levels, which may thereby improve the chances of ovulating. These improvements in hormonal balance could help alleviate fertility problems.
PCOS is the most common hormone disorder in women, affecting 7–10% of women of childbearing age. It can cause infertility and raises the risk of developing diabetes, obesity and other metabolic health problems.
Women with PCOS have at least two of these signs:
Elevated levels of testosterone and other androgen hormones associated with male reproduction,
Irregular periods, and
Large ovaries with many small follicles.
The keto diet is a high fat, low carbohydrate diet that has shown promising effects in women with PCOS. Studies have shown that it may help women lose weight and maintain weight loss, improve their fertility, optimise their cholesterol levels and normalise their menstrual cycles.
“We found an association between the ketogenic diet and an improvement in reproductive hormone levels, which influence fertility, in women with PCOS,” said study author Karniza Khalid, MBBS, MMedSc, of the Ministry of Health Malaysia in Kuala Lumpur, Malaysia. “These findings have important clinical implications, especially for endocrinologists, gynaecologists and dieticians who, in addition to medical treatment, should carefully plan and customise individual diet recommendations for women with PCOS.”
The researchers conducted a meta-analysis of clinical trials in women with PCOS on the keto diet and examined the diet’s effects on their reproductive hormones (FSH, testosterone and progesterone) and weight change.
They found women with PCOS who were on the keto diet for at least 45 days saw significant weight loss and an improvement in their reproductive hormone levels. Their FSH ratio was lower, which means they may have a better chance of ovulating. The women also had lower testosterone levels, which could help with excess hair growth and other symptoms of excess male sex hormones.
Researchers in Japan have shown that the commonly prescribed antipsychotic drug aripiprazole helps reduce sleep disruptions in patients with certain psychiatric disorders by improving their natural entrainment to light and dark cycles. Their findings are published in Frontiers in Neuroscience.
Many patients with psychiatric conditions, such as bipolar disorder and major depressive disorder, frequently experience disruptions in their sleep–wake cycles. Research has shown that the administration of aripiprazole, a commonly prescribed antipsychotic drug, alleviates the symptoms of circadian sleep disorders in these patients. This improvement may be attributed to the effects of aripiprazole on the circadian central clock, specifically the hypothalamic suprachiasmatic nucleus (SCN), which regulates various circadian physiological rhythms, including the sleep–wake cycle, in mammals. However, the precise mechanism through which aripiprazole addresses these sleep disorder symptoms remains elusive.
Researchers from the University of Tsukuba have discovered that aripiprazole can directly affect the mammalian central circadian clock; specifically, it can modulate the photic entrainment in mice. Located in the hypothalamic suprachiasmatic nucleus (SCN), the central circadian clock comprises clock neurons that synchronize with each other, maintaining a roughly 24-hour rhythm. Simultaneously, SCN is receptive to external inputs like light, aligning itself with the environmental light-dark cycle. The researchers have found that aripiprazole disrupts the synchronization among the clock neurons in the SCN, heightening the responsiveness of these neurons to light stimuli in mice. Additionally, aripiprazole influences intracellular signalling within the SCN by targeting the serotonin 1A receptor, a prominent receptor in the SCN.
These findings suggest that the efficacy of aripiprazole in alleviating circadian rhythm sleep disorder symptoms in psychiatric patients might be attributed to the modulation of the circadian clock by the drug. This study expands the potential clinical usage of aripiprazole as a treatment for circadian rhythm sleep disorders.
Children of a parent with alcohol or drug use disorder have a greater risk of intellectual disability, even if the problem only lies with the father, researchers from Karolinska Institutet report. According to the study, which is published in the journal eClinicalMedicine, preventive measures should be directed at both parents.
A woman’s consumption of alcohol during pregnancy has been well established as increasing the risk of the child developing. Research from Karolinska Institutet now shows that all forms of substance abuse, both in the mother and the father, and not only during pregnancy, can constitute a risk factor.
Previous efforts aimed at mothers
“Preventative measures, such as educating healthcare professionals and public health recommendations, have focused for decades on mothers with alcohol-related problems,” says Lotfi Khemiri, researcher at Karolinska Institutet. “Our findings highlight the importance of also directing such measures towards fathers with different types of substance use disorder.”
The study drew on data from Swedish registries with almost two million babies born between 1978 and 2002 and their parents. The researchers found that 1.2% of babies born to parents without such a disorder were diagnosed with an intellectual disability, compared with 3% of the babies who had one parent with a diagnosis related to a substance use disorder (alcohol or drug abuse).
Higher risk before birth
The elevated risk was greater if the parent had received a diagnosis before or during pregnancy rather than after birth. A substance use disorder diagnosis registered before birth was associated with more than twice the risk of intellectual disability in the baby, regardless of which parent had the diagnosis. The correlation was weaker but still statistically significant after adjustment of socioeconomic factors and psychiatric comorbidity in the parents.
“Since it was an observational study, we can draw no conclusions about the underlying mechanism, but we suspect that both genetic and environmental factors, including harmful effects of substance abuse on foetal development, may play a part,” says Dr Khemiri. “We hope that the results will contribute to the preventative efforts, as well as to the improved diagnosis of children with an intellectual disability and to timely intervention directed both to the child as well as parents in need of substance use disorder treatment.”
Alcohol a major risk factor
Intellectual disability was observed to be much more likely in alcohol-related problems during pregnancy, where the risk was five and three times higher depending on whether it was the mother or father who had the alcohol use disorder diagnosis.
In 2018 the first findings from a landmark tuberculosis (TB) vaccine trial were published in the New England Journal of Medicine. The experimental vaccine, called M72, was found to be roughly 50% effective in preventing pulmonary TB disease. It was the most promising finding for a new TB vaccine since the development of the BCG vaccine a century ago.
Since the study reported in the NEJM was only a phase 2B study, the results have to be confirmed in a phase 3 study before the vaccine can be considered for wider use. For a while, it seemed that the phase 3 study would never happen – that is, until a few months ago, two philanthropies, Wellcome and the Bill and Melinda Gates Foundation, announced that they would put up $550 million to get it done.
Meanwhile, on September 22, ministers, heads of state, and other officials from around the world will gather in New York for the second United Nations High-Level Meeting on TB. A draft declaration can be read here. The declaration is full of the kind of lofty rhetoric one would expect.
Yet, it is hard to avoid a sense that, for the most part, the emperor is wearing no clothes. After all, as one government representative after another read their speeches in New York, everyone in the room will know that it was not governments but two philanthropies who stepped up to ensure that arguably the most important TB trial of the decade goes ahead. When most needed, the groundswell of new government investment in TB research just wasn’t there.
The bigger picture
It is estimated that globally just over $1 billion was invested in TB research in 2021. In the preceding three years, the figure was hovering between $900 million and $1 billion. Astonishingly, $416 million (over 40%) of the $1 billion in 2021 was from the United States government. The second largest funder of TB research in the world is the Gates Foundation – which with its $113 million in 2021 invested more in TB research than any government except for the US. Together, these two entities account for more than half of all investment in TB research in 2021.
BRICS partners India and South Africa respectively invested $23.4 and $4.8 million in TB research in 2021. Both are classified as high TB burden countries.
At the 2018 UN High-Level Meeting on TB world leaders committed to provide $2 billion per year for TB research by the end of 2022. Figures for 2022 aren’t out yet, but given that the 2021 figure was only half the target, we are clearly not on track.
In addition, the target should probably be much higher if we are to have a good chance of getting the breakthrough diagnostics, treatments, and vaccines we will need to end TB. The Stop TB Partnership recently estimated that around $5 billion is needed for TB research per year from 2023 to 2030 – in other words, five times as much as the actual investment in 2021. This level of investment in TB research is needed because modelling suggests that with the currently available tools, we will at best see a relatively slow decline in TB rates in the coming years.
Why then a High-Level Meeting?
One may well ask what the point is of UN High-Level Meetings if key commitments made at these meetings are not kept and if the further development of critical new tools like M72 remains dependent on support from philanthropists. But that would be to mistake these meetings for an end in themselves rather than merely a means to an end.
A meeting of this nature will always just be one small part of a larger puzzle in the fight against TB. The bigger question is how the momentum and political potential created by the High-Level Meeting can be leveraged to get more done in other arenas, especially back in people’s home countries.
Governments are accountable to the people who elected them. There are, of course, some international pressures and some issues of international law, but on something like TB, the most important accountability levers are all domestic. Ultimately, political parties, trade unions, and domestic civil society have much more power over what a government actually does or does not do than some politely expressed peer pressure in New York or Geneva.
Unfortunately, at least here in South Africa, political parties and trade unions have generally failed to hold government to account when it comes to TB – although our Department of Health has nevertheless made some good policy calls and our investment in TB research is decent given the size of our economy.
All of this is not to say that the UN High-Level Meeting on TB is not important – it most certainly is. It is just that it should not be mistaken for an end in itself. Governments, and especially those in countries where many people get TB and die of TB, must invest more in TB. We shouldn’t let leaders of these governments get away with saying they’ll put up the money in New York, but then forgetting all about it once they go back home.
NOTE:The Gates Foundation is mentioned in this article. Spotlight receives funding from the Gates Foundation. Spotlight is editorially independent, an independence that the editors guard jealously. Spotlight is a member of the South African Press Council.
People who had high blood pressure while lying flat on their backs had a higher risk of heart attack, stroke, heart failure or premature death, according to new research presented at the American Heart Association’s Hypertension Scientific Sessions 2023.
The autonomic nervous system regulates blood pressure in different body positions; but gravity may cause blood to pool when seated or upright, and the body is sometimes unable to properly regulate blood pressure during lying, seated and standing positions, the authors noted.
“If blood pressure is only measured while people are seated upright, cardiovascular disease risk may be missed if not measured also while they are lying supine on their backs,” said lead study author Duc M. Giao, a researcher and a 4th-year MD student at Harvard Medical School in Boston.
To examine body position, blood pressure and heart health risk, the researchers examined health data for 11 369 adults from the longitudinal Atherosclerosis Risk in Communities (ARIC) study. The data on supine and seated blood pressure was gathered during the enrolment period, ARIC visit 1, which took place between 1987–1989. Participants had their blood pressure taken while briefly lying down at a clinic. The average age of participants at that time was 54 years old; 56% of the group self-identified as female; and 25% of participants self-identified as Black race. Participants in this analysis were followed for an average of 25 to 28 years, up through ARIC visit 5, which includes health data collected from 2011–2013.
The researcher’s findings included:
16% of participants who did not have high blood pressure (130/80 mm Hg or higher) while seated had high blood pressure while lying supine (flat on their backs), compared to 74% of those with seated high blood pressure who also had supine high blood pressure.
In comparison to participants who did not have high blood pressure while seated and supine, participants who had high blood pressure while seated and supine had a 1.6 times higher risk of developing coronary heart disease; a 1.83 times higher risk of developing heart failure; a 1.86 times higher risk of stroke; a 1.43 times higher risk of overall premature death; and a 2.18 times higher risk of dying from coronary heart disease
Participants who had high blood pressure while supine but not while seated had similar elevated risks as participants who had high blood pressure while both seated and supine.
Differences in blood pressure medication use did not affect these elevated risks in either group.
“Our findings suggest people with known risk factors for heart disease and stroke may benefit from having their blood pressure checked while lying flat on their backs,” Giao said.
“Efforts to manage blood pressure during daily life may help lower blood pressure while sleeping. Future research should compare supine blood pressure measurements in the clinic with overnight measurements.”
The study’s limitations included that it focused on adults who were middle-aged at the time of enrolment, meaning the results might not be as generalizable to older populations, Giao said.
