Month: February 2024

Excessive Protein Consumption Increases Atherosclerosis Risk

Cardiovascular pitfalls to increasing protein intake discovered

Image by Scientific Animations, CC4.0

University of Pittsburgh School of Medicine researchers discovered a molecular mechanism by which excessive dietary protein could increase atherosclerosis risk. The study, published in Nature Metabolism, combined small human trials with in vitro human and mouse cell experiments.

It showed that consuming over 22% of dietary calories from protein can lead to increased activation of immune cells that play a role in atherosclerotic plaque formation, driving the disease risk.

Furthermore, the scientists showed that one amino acid, leucine, seems to have a disproportionate role in driving the pathological pathways linked to atherosclerosis, or stiff, hardened arteries.

“Our study shows that dialling up your protein intake in pursuit of better metabolic health is not a panacea. You could be doing real damage to your arteries,” said senior and co-corresponding author Babak Razani, MD, PhD, professor of cardiology at Pitt.

“Our hope is that this research starts a conversation about ways of modifying diets in a precise manner that can influence body function at a molecular level and dampen disease risks.”

According to a survey of an average American diet over the last decade, Americans generally consume a lot of protein, mostly from animal sources.

Further, nearly a quarter of the population receives over 22% of all daily calories from protein alone.

That trend is likely driven by the popular idea that dietary protein is essential to healthy living, says Razani.

But his and other groups have shown that overreliance on protein may not be such a good thing for long-term health.

Following their 2020 research, in which Razani’s laboratory first showed that excess dietary protein increases atherosclerosis risk in mice, his next study in collaboration with Bettina Mittendorfer, PhD, a metabolism expert at the University of Missouri, Columbia, delved deeper into the potential mechanism and its relevance to the human body.

To arrive at the answer, Razani’s laboratory, led by first-authors Xiangyu Zhang, Ph.D., and Divya Kapoor, M.D., teamed up with Mittendorfer’s group to combine their expertise in cellular biology and metabolism and perform a series of experiments across various models, from cells to mice to humans.

“We have shown in our mechanistic studies that amino acids, which are really the building blocks of the protein, can trigger disease through specific signaling mechanisms and then also alter the metabolism of these cells,” Mittendorfer said.

“For instance, small immune cells in the vasculature called macrophages can trigger the development of atherosclerosis.”

Based on initial experiments in healthy human subjects to determine the timeline of immune cell activation following ingestion of protein-enriched meals, the researchers simulated similar conditions in mice and in human macrophages, immune cells that are shown to be particularly sensitive to amino acids derived from protein.

Their work showed that consuming more than 22% of daily dietary calories through protein can negatively affect macrophages that are responsible for clearing out cellular debris, leading to the accumulation of a “graveyard” of those cells inside the vessel walls and worsening of atherosclerotic plaques overtime.

Interestingly, the analysis of circulating amino acids showed that leucine, an amino acid enriched in animal-derived foods like beef, eggs and milk, is primarily responsible for abnormal macrophage activation and atherosclerosis risk, suggesting a potential avenue for further research on personalized diet modification, or “precision nutrition.”

Razani is careful to note that many questions remain to be answered, mainly: What happens when a person consumes between 15% of daily calories from protein as recommended by the USDA and 22% of daily calories from protein, and if there is a ‘sweet spot’ for maximising the benefits of protein (such as muscle gain) while avoiding kick-starting a molecular cascade of damaging events leading to cardiovascular disease.

The findings are particularly relevant in hospital settings, where nutritionists often recommend protein-rich foods for the sickest patients to preserve muscle mass and strength.

“Perhaps blindly increasing protein load is wrong,” Razani said.

“Instead, it’s important to look at the diet as a whole and suggest balanced meals that won’t inadvertently exacerbate cardiovascular conditions, especially in people at risk of heart disease and vessel disorders.”

Razani also notes that these findings suggest differences in leucine levels between diets enriched in plant and animal protein might explain the differences in their effect on cardiovascular and metabolic health.

“The potential for this type of mechanistic research to inform future dietary guidelines is quite exciting,” he said.

Source: University of Pittsburgh

Can Yoga Effectively Treat Chronic Back Pain?

Photo by Sasun Bughdaryan on Unsplash

New research published in the Journal of Orthopaedic Research suggests that the physical postures, breathing exercises, and mindfulness practices of yoga may benefit individuals with back pain.

In the study, 10 women with and 11 without chronic low back pain underwent an 8‐session yoga program over 4 weeks, with the first session conducted in a clinic and the rest delivered with a tele‐approach. Women with chronic low back pain experienced a significant decrease in pain intensity, as assessed through a 10-point visual analogue scale (an average pain of 6.80 at the start, dropped to 3.30 after the sessions) and through a spine-related measure called the flexion–relaxation phenomenon, which is often absent or disrupted in people with low back pain  (5.12 at the start versus 9.49 after the sessions).

The findings suggest yoga can positively impact the neuromuscular response during trunk flexion and pain perception in individuals with chronic low back pain.

“It was interesting to show the role that yoga might play in the management of chronic back pain,” said corresponding author Prof Alessandro de Sire, MD, of the University of Catanzaro “Magna Graecia” and University Hospital “Renato Dulbecco,” in Italy.

The authors noted that further research is warranted to assess yoga’s long‐term effects.

Source: Wiley

First HIV Antiretrovirals Manufactured in Space Delivered Back to Earth

For the first time, commercial pharmaceuticals produced using the zero gravity of outer space have been returned to Earth. After being stuck in space waiting for clearance to land, a capsule containing the small but extremely valuable cargo of HIV antiretrovirals landed in the desert in the US state of Utah. Drugs produced this way have been shown to have higher purity and often improved biokinetics, but have been too costly to produce until now.

In June 2023, Varda Space Industries launched a miniature pharmaceuticals factory into orbit atop a partially reusable SpaceX rocket. The tech startup actual had its inception just before the COVID pandemic took hold, with the aim of using zero gravity to produce ultra-pure pharmaceuticals.

Following in the tradition of Founders Fund-founded startups, they chose a name from J.R.R. Tolkien’s Lord of the Rings: Varda, the Queen of the Stars. Initially, the startup did not have space-based factories in mind.

But the COVID lockdown forced the founders to sit at home and do some reading, which is where they hit upon research into producing ultra-pure materials. It turns out that, in chemistry, gravity has significant effects somewhere between the microscopic scale and the atomic scale. This has beneficial applications in all manner of processes like crystal formation in drug manufacturing.

Antiviral Drug Polarized crystals (photographed through a microscope) of the drug 2-3 dideoxyadenosine, also known as ddA, a drug that is closely related to AZT or azidothymidine. The antiviral effect of ddA against HIV was discovered at the National Cancer Institute. Credit: Larry Ostby (Photographer), National Cancer Institute, National Institutes of Health

Onboard the small space factory is a pharmaceutical manufacturing system designed to produce ritonavir, an antiretroviral which was initially used to treat HIV. This early antiretroviral has a number of notorious gastrointestinal and metabolic side effects. In 1998, there was a major production crisis when it was discovered that were production defects in the the oral form stemming from crystallisation problems.

Nowadays, ritonavir has been surpassed by newer antiretroviral drugs for the treatment of HIV but has been investigated for cancer treatment and during the pandemic received emergency use authorisation for COVID treatment. The samples used in

Producing drug proteins in space is nothing now, having been done since the 1970s – however, these were for research purposes in developing drugs. It is only now that rocket launch costs have dropped to the point where it has become possible to use the unique environment of outer space to manufacture high-value products.

The capsule and factory is specially designed to be recovered and reused to minimise costs, as are the rockets nowadays. This has only been possible thanks to rockets becoming vastly cheaper. NASA’s space shuttle cost $65 400 for each kilogram of cargo launched into space. Today, SpaceX’s Falcon 9 rocket costs a mere 4% of that, and prices are set to fall even further.

Such breakneck technological development was bound to run into a snag – this one consisting of red tape. The agency that regulates commercial air and spaceflight, the Federal Aviation Administration (FAA) gave Varda a licence for their payload to be launched, but not for it to re-enter. The vast majority of satellites don’t have to worry about that, simply burning up in the atmosphere when they can no longer function. The FAA is obviously concerned about a large module returning intact but out of control.

Eventually, after more than six months of delays and looking at alternatives such as landing in Australia instead, Varda was able to secure a re-entry permit for 21st February.

Raised Blood Pressure is the Leading Risk Factor for Death in Australia

Hypertension has contributed at least 44% to CVD deaths over thirty years, more than dietary factors and tobacco

Raised blood pressure has been the leading risk factor for death in Australia for the past three decades, according to a study published February 21, 2024, in the open-access journal PLOS ONE led by Alta Schutte and Xiaoyue Xu from The George Institute for Global Health and UNSW, Sydney, with colleagues across Australia. It is also the main contributor to deaths from cardiovascular disease (CVD) specifically.

Raised blood pressure has long been recognized as a contributing factor to CVD and death, but is not always prioritized in national health plans. In this study, researchers focused on Australia, which lags behind other high-income countries in hypertension control. Data on how raised blood pressure compares to other risk factors for CVD burden – and how this changes over time – can help to guide public health agendas and inform the effectiveness of public health policies.

Researchers analysed epidemiologic data from the Global Burden of Disease (GBD) study between 1990 and 2019 to determine the leading risk factors associated with both all-cause and CVD deaths, over time and between gender and age groups. The GBD study provides data on nearly 400 diseases and 87 risk factors across 204 countries.

They found that while the contribution of raised blood pressure to these outcomes declined early in the study period (from around 54% to around 44%), it persisted as the leading risk factor for all-cause and CVD deaths. Dietary factors and tobacco use rounded out the top three risk factors. These findings strongly align with the recently established National Hypertension Taskforce of Australia, which aims to improve Australia’s blood pressure control rates from 32% to 70% by 2030 (Hypertension – Australian Cardiovascular Alliance []). The research findings further advocate for the prioritisation of blood pressure control on the public health agenda.

Differences by gender and age were also seen. For example, the contribution of raised blood pressure to stroke-related deaths in males aged 25–49 years were higher than other age groups, exceeding 60% and increasing steeply over time.

The study reinforces the importance of blood pressure control and awareness. The researchers hope that the data will urge policymakers to prioritise blood pressure control efforts in Australia and will provide insight into age groups and populations that would benefit from more targeted action.

The authors add: “There is no doubt that raised blood pressure has remained the leading risk factor for all-cause and cardiovascular deaths in Australia across the past three decades. Our findings support actions to strengthen primary care and to improve the prevention, detection, treatment and control of raised blood pressure, with the goal of significantly reducing all-cause and cardiovascular deaths in Australia over the next decade.”

“Movies” with Colour and Music Visualise Brain Activity Data in Beautiful Detail

Novel toolkit translates neuroimaging data into audiovisual formats to aid interpretation

Simple audiovisualisation of wide field neural activity. Adapted from Thibodeaux et al., 2024, PLOS ONE, CC-BY 4.0

Complex neuroimaging data can be explored through translation into an audiovisual format – a video with accompanying musical soundtrack – to help interpret what happens in the brain when performing certain behaviours. David Thibodeaux and colleagues at Columbia University, US, present this technique in the open-access journal PLOS ONE on February 21, 2024. Examples of these beautiful “brain movies” are included below.

Recent technological advances have made it possible for multiple components of activity in the awake brain to be recorded in real time. Scientists can now observe, for instance, what happens in a mouse’s brain when it performs specific behaviours or receives a certain stimulus. However, such research produces large quantities of data that can be difficult to intuitively explore to gain insights into the biological mechanisms behind brain activity patterns.

Prior research has shown that some brain imaging data can be translated into audible representations. Building on such approaches, Thibodeaux and colleagues developed a flexible toolkit that enables translation of different types of brain imaging data – and accompanying video recordings of lab animal behaviour – into audiovisual representations.

The researchers then demonstrated the new technique in three different experimental settings, showing how audiovisual representations can be prepared with data from various brain imaging approaches, including 2D wide-field optical mapping (WFOM) and 3D swept confocally aligned planar excitation (SCAPE) microscopy.

The toolkit was applied to previously-collected WFOM data that detected both neural activity and brain blood flow changes in mice engaging in different behaviours, such as running or grooming. Neuronal data was represented by piano sounds that struck in time with spikes in brain activity, with the volume of each note indicating magnitude of activity and its pitch indicating the location in the brain where the activity occurred. Meanwhile, blood flow data were represented by violin sounds. The piano and violin sounds, played in real time, demonstrate the coupled relationship between neuronal activity and blood flow. Viewed alongside a video of the mouse, a viewer can discern which patterns of brain activity corresponded to different behaviours.

The authors note that their toolkit is not a substitute for quantitative analysis of neuroimaging data. Nonetheless, it could help scientists screen large datasets for patterns that might otherwise have gone unnoticed and are worth further analysis.

The authors add: “Listening to and seeing representations of [brain activity] data is an immersive experience that can tap into this capacity of ours to recognise and interpret patterns (consider the online security feature that asks you to “select traffic lights in this image” – a challenge beyond most computers, but trivial for our brains)…[It] is almost impossible to watch and focus on both the time-varying [brain activity] data and the behavior video at the same time, our eyes will need to flick back and forth to see things that happen together. You generally need to continually replay clips over and over to be able to figure out what happened at a particular moment. Having an auditory representation of the data makes it much simpler to see (and hear) when things happen at the exact same time.”

  1. Audiovisualisation of neural activity from the dorsal surface of the thinned skull cortex of the awake mouse.
  2. Audiovisualisation of neural activity from the dorsal surface of the thinned skull cortex of the ketamine/xylazine anaesthetised mouse.
  3. Audiovisualisation of SCAPE microscopy data capturing calcium activity in apical dendrites in the awake mouse brain.
  4. Audiovisualisation of neural activity and blood flow from the dorsal surface of the thinned skull cortex of the awake mouse.

Video Credits: Thibodeaux et al., 2024, PLOS ONE, CC-BY 4.0

More Practical Solutions for SA’s Health Future 

Health funding options towards Universal Health Coverage

Photo by Khwanchai Phanthong on Pexels

The funding required to initiate and sustain the National Health Insurance (NHI) project, aimed at achieving Universal Health Coverage for South Africa, has healthcare industry experts and some of the country’s leading economists raising fundamental questions about its financial viability as outlined in the NHI Bill.

“South Africa needs actionable solutions now to broaden healthcare access and improve affordability however, with the current debt to GDP ratio and many demands on the public purse, it is difficult to see how the State could afford to finance the NHI alone, as outlined in the NHI Bill,” said Craig Comrie, chairperson of the Health Funders Association (HFA).

“The existing regulatory framework could offer a more viable springboard to achieve the aims of Universal Health Coverage sooner through collaborative healthcare initiatives that improve healthcare access for all South Africans.”

He points out the substantial financial commitment demanded by the NHI, noting that an initial allocation of more than R20 billion has already been disbursed. “This allocation, which is merely the tip of the iceberg, accentuates the magnitude of the financial hurdle that lies ahead for the country and its people if the NHI Bill is enacted in its current form,” Comrie says.

“In the current economic climate marked by reduced GDP and tax collections, financing the NHI presents an impossible task for National Treasury, particularly with the exclusion of private health funding collaboration.

“We are therefore urging the Presidency to prioritise the exploration of alternative pathways towards realising Universal Health Coverage in South Africa. There is a critical, urgent need to reassess and redirect vital resources towards more pressing national priorities than the NHI’s potentially unsustainable framework.

“This is a heavy financial burden for the South African taxpayer to shoulder, particularly at this time, with cost projections ranging from R200 billion to a staggering R500 to R800 billion annually if fully implemented. This exorbitant sum, dwarfing recent and future government bailouts, presents an insurmountable challenge given our economic downturn and diminished tax revenue,” asserts Comrie.

The HFA, a professional body representing the majority of medical schemes in South Africa, proposes leveraging the existing regulatory framework to expedite Universal Health Coverage through collaborative healthcare initiatives, emphasising the urgency of exploring viable alternatives.

Comrie also addresses the limitations of tax increases as a revenue solution, emphasising the strain it not only places on families but on the broader economy.

“While NHI implementation may be decades away, we recognise that immediate action is imperative to enhance affordability and access to quality healthcare. We, therefore, must prioritise exploring sustainable solutions rooted in economic viability,” he urges.

“At this stage, realistic timelines for NHI implementation will be decades away, and in the meantime, there is much we could be doing to improve affordability and access to quality healthcare for more South Africans. A good starting place would be to finalise the Low Cost Benefit Options framework and ensure regular reviews of Prescribed Minimum Benefits [PMBs].

Highlighting the current ambiguity surrounding NHI services and the staggering cost projections, Comrie stresses the critical need for clarity from the Minister of Finance.

He emphasises that the HFA’s stance is firmly rooted in a deep commitment to quality healthcare and the implementation of sustainable solutions that can definitively grow accessibility. This mission necessitates prudent financial planning and a steadfast commitment to transparency in healthcare financing.

“With Treasury facing an impossible task to finance the NHI in its current proposed form, all alternatives must be considered. As a country, we cannot afford to gamble on a project lacking clear direction and financial viability.

“We advocate for a recalibration of priorities, urging policymakers to explore collaborative healthcare initiatives to deliver healthcare funding solutions within well-researched reforms including those indicated in the Health Market Inquiry.

“Now almost five years later, the reforms suggested by the Competition Commission have yet to be actioned. South Africans cannot wait decades for NHI implementation, and the real question is, can we afford to embark on this unproven and unrealistic model,” he asks.

“NHI is not the sole path to Universal Health Coverage, nor is it the most expedient. We must pursue reforms rooted in economic viability to safeguard healthcare assets and extend access. As the HFA continues to champion sustainable healthcare solutions, we affirm our commitment to preserve South Africa’s healthcare landscape for the benefit of all citizens,” he concludes.

South Korean Trainee Doctors Walk Out en Masse

Photo by Hush Naidoo on Unsplash

Physicians argue that trying to combat dwindling numbers with increased medical school places ignores the real problem: gruelling hours and low pay

At several major South Korean hospitals, thousands of doctors walked out on Tuesday, causing widespread disruption in a protest at the government’s plan to increase the numbers of medical school students, The New York Times reports.

On Monday, over 6000 doctors had submitted resignations at Seoul’s five hospitals and left at 6am on Tuesday, the Health Department reported. One of the hospitals had up a sign saying that its emergency department was only handling cardiac arrest cases; the other four were on “red alert”.

Government sources state that 7813 doctors had walked off the job, Reuters reports.

South Korea may have one of the most advanced healthcare systems in the world, but it is plagued by a critical shortage of doctors. The protestors, interns and residents, say that this shortage is confined to certain areas such as emergency medicine, which are poorly compensated by the government and insurance providers. Cosmetic medicine on the other hand, is highly profitable.

One survey found that doctors in training regularly work shifts longer than 24 hours and many work for more than 80 hours a week. (In South Africa, a 2012 study found that interns regularly put in 150–200 hours of overtime per month, working out to 80–90 hours a week.)

Other factors such as an ageing population are putting more and more strain on doctors.

Early this month, the government announced a plan to increase South Korea’s medical school admissions quota from 3000 to 5000. The Ministry of Health and Welfare regulates the licences to practice medicine. Doctors were immediately critical of the plan, protesting with placards saying things like “end of health care.”

Women Get the Same Exercise Benefits as Men, but with Less Effort

Photo by Ketut Subiyanto on Unsplash

A new study from the Smidt Heart Institute at Cedars-Sinai shows there is a gender gap between women and men when it comes to exercise. The findings, published in the Journal of the American College of Cardiology (JACC), show that women can exercise less often than men, yet receive greater cardiovascular gains.

“Women have historically and statistically lagged behind men in engaging in meaningful exercise,” said Martha Gulati, MD, director of Preventive Cardiology in the Department of Cardiology in the Smidt Heart Institute at Cedars-Sinai, the Anita Dann Friedman Chair in Women’s Cardiovascular Medicine and Research and co-lead author of the study.

“The beauty of this study is learning that women can get more out of each minute of moderate to vigorous activity than men do. It’s an incentivising notion that we hope women will take to heart.”

Investigators analysed data from 412,413 U.S. adults utilising the National Health Interview Survey database. Participants between the time frame of 1997 to 2019 – 55% of whom were female – provided survey data on leisure-time physical activity.

Investigators examined gender-specific outcomes in relation to frequency, duration, intensity and type of physical activity.

“For all adults engaging in any regular physical activity, compared to being inactive, mortality risk was expectedly lower,” said Susan Cheng, MD, MPH, the Erika J. Glazer Chair in Women’s Cardiovascular Health and Population Science, director of the Institute for Research on Healthy Aging in the Department of Cardiology in the Smidt Heart Institute, and senior author of the study.

“Intriguingly, though, mortality risk was reduced by 24% in women and 15% in men.”

The research team then studied moderate to vigorous aerobic physical activity, such as brisk walking or cycling, and found that men reached their maximal survival benefit from doing this level of exercise for about five hours per week, whereas women achieved the same degree of survival benefit from exercising just under about 2 ½ hours per week.

Similarly, when it came to muscle-strengthening activity, such as weightlifting or core body exercises, men reached their peak benefit from doing three sessions per week and women gained the same amount of benefit from about one session per week.

Cheng said that women had even greater gains if they engaged in more than 2 ½ hours per week of moderate to vigorous aerobic activity, or in two or more sessions per week of muscle-strengthening activities.

The investigators note their findings help to translate a longstanding recognition of sex-specific physiology seen in the exercise lab to a now-expanded view of sex differences in exercise-related clinical outcomes.

With all types of exercise and variables accounted for, Gulati says there’s power in recommendations based on the study’s findings.

“Men get a maximal survival benefit when performing 300 minutes of moderate to vigorous activity per week, whereas women get the same benefit from 140 minutes per week,” Gulati said.

“Nonetheless, women continue to get further benefit for up to 300 minutes a week.”

Christine M. Albert, MD, MPH, chair of the Department of Cardiology in the Smidt Heart Institute and the Lee and Harold Kapelovitz Distinguished Chair in Cardiology, says concrete, novel studies like this don’t happen often.

“I am hopeful that this pioneering research will motivate women who are not currently engaged in regular physical activity to understand that they are in a position to gain tremendous benefit for each increment of regular exercise they are able to invest in their longer-term health,” said Albert, professor of Cardiology.

Source: Cedars-Sinai Medical Center

Getting the Most from AI in MedTech Takes Data Know-How

As a leader in Medical Technology innovation, InterSystems, a pioneer in healthcare data platform development, has learned, understood, and incorporated pivotal insights from its extensive experience in digital health solutions. That experience points up the need to give AI a strong foundation.

We understand the importance of leveraging AI to drive transformative change in healthcare. Our latest white paper, “Getting the Most from AI in MedTech Takes Data Know-How,” dives into the challenges and opportunities facing MedTech companies venturing into the realm of AI. From data cleanliness to privacy and security considerations, we address key issues that MedTech companies must navigate to succeed in today’s rapidly evolving healthcare landscape.

AI in MedTech Takes Data Know-How

The promise of AI in revolutionising MedTech is undeniable. AI in varying forms and degrees is forecasted to save hundreds of thousands of lives and billions of dollars a year. But here’s the catch- AI models are only as good as the data they’re built on. An AI application can sift through large amounts of data from various Electronic Health Record (EHR) environments and legacy systems and identify patterns within the scope of its model, but it can’t identify data that exists outside of those boundaries.

If one asks “What risk factors does the patient have for stroke?”, AI can only answer based on the information that’s there. Sometimes, things get lost in translation, and that’s why interoperability – the ability to exchange information in a way that ensures the sender and receiver understand data the same way is crucial.

InterSystems: Your Data Sherpa:

Ever wondered why some AI models in MedTech fall short? It’s all about the data. This means MedTech companies can’t just lean on their currently used standard but should consider all those in which relevant data is captured in the market or build on a platform that does.

With InterSystems by your side, you gain access to a treasure trove of healthcare data expertise. One of the benefits of our business is that it’s much broader than a single EHR. This means providing software solutions like The HL7® FHIR® (Fast Healthcare Interoperability Resources) offering a comprehensive view of patient data, accelerating development timelines, and delivering tangible results that showcase the value of your innovations.

Clean Data Is a Must

Data cleanliness is key in the world of AI. Pulling data from various sources presents its own set of challenges, from ensuring data cleanliness to reconciling discrepancies and omissions. Raw data is often messy, inconsistent, and filled with gaps like missing labels. If the data fed into an AI model is incomplete and error-ridden, the conclusions drawn from its analysis will be similarly flawed and suspect. Thus, maintaining high standards of data quality is essential to ensure the accuracy and effectiveness of AI-driven insights.

Henry Adams, Country Manager, InterSystems South Africa, says: “InterSystems advocates for robust preprocessing, cleaning, and labelling techniques to ensure data quality and integrity. Our platform keeps track of data lineage, simplifies labelling, and aggregates health data into a single, patient-centric model ready for analysis”.

Privacy, Security, and Reliability: The Sweet Success!

Privacy and security are essential across industries, but they are even more critical for MedTech product developers. Handling sensitive patient data necessitates strict adherence to regulations like HIPAA and GDPR to safeguard patient confidentiality and comply with legal requirements. Beyond regulatory compliance, ensuring privacy and security is crucial for maintaining patient safety, preserving reputation and trust, and fostering collaboration within the industry.

To help MedTech companies comply with regulations and safeguard patient data, InterSystems’ platform meets needs across major deployments, such as a nonprofit health data network and uses techniques like redundant processing and queues built into the connective tissue of their software. Reliable connectivity solutions ensure seamless data exchange, even in the most demanding healthcare environments.

Charting the Course Forward

If you are a MedTech company still struggling to make sense of siloed healthcare data for your AI initiatives? We have the answers-collaboration with the right partner is essential for integrating AI into medical practices. An ideal partner understands the need for data acquisition, aggregation, cleaning, privacy, and security regulations. “With InterSystems as your partner and by your side, you can navigate the complexities of AI integration and drive transformative innovation in healthcare, making MedTech excellence easier to attain,” concludes Adams.

You can learn more about our support for MedTech innovation at

For more information or to download the guide, please visit!  

There is a ‘Worrying’ Resurgence of Sexually Transmitted Infections in Gauteng

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There’s a comeback of sexually transmitted infections (STIs) in South Africa and around the world. The Gauteng Department of Health recently reported an increase of newly acquired STIs, in particular gonorrhoea and chlamydia. This spike in cases call for management guidelines and awareness programmes to be reviewed, reports Ufrieda Ho.

A rise in reported cases of sexually transmitted infections in Gauteng in 2023 is a wake-up call that control and management strategies are not keeping pace with the growing disease burden in South Africa’s most populous province.

“The Gauteng information confirms the rise in STIs that we are seeing in South Africa and across the world, including in the United States and Canada,” said Dr Nomathemba Chandiwana, a director and principal scientist at Ezintsha Research Centre at Wits University. She is also a co-author of the 2022 guidelines on the management of sexually transmitted infections produced by the Southern Africa HIV Clinicians Society.

Chandiwana said any increase in STIs should raise alarms because it means “we simply don’t have control over the things we thought we had under control”.

The World Health Organization (WHO) in 2022 noted that countries reported low coverage for preventive, testing and treatment services related to  STIs, because of Covid-19 lockdown restrictions. The WHO confirmed that this had led to a “resurgence of STIs and the emergence of non-classical STIs [such as Shigella sonnei, hepatitis A, Neisseria meningitidis, Zika and Ebola] globally”. It also reported that currently more than 1 million new STIs are acquired around the world each day “posing a significant global health challenge”.

Since the middle of 2023, the WHO has pushed for low-cost point of care tests to be more readily available in low and middle income countries, saying this would improve screening and diagnosis, data collection and make STI services more effective. South Africa has not made such tests accessible, still relying on a syndromic approach, which is clinical diagnosis made by assessing a patient’s symptoms and other visible signs.

New public health threats

Chandiwana said a review of STI treatment and management guidelines is necessary because the rising numbers pose significant new public health threats. Of particular concern, she said, is that having  STIs pushes up a person’s risk to contract HIV, which is “a chronic and serious disease” as well as developing other long term or irreversible medical risks, including reproductive complications.

Earlier in February, the Gauteng Department of Health reported that the incidence of Male Urethritis Syndrome (MUS) in men aged 15 to 49 in the province had increased from 12% in 2020 to 15% in 2023. The department did not provide actual figures for the comparison, which is also somewhat complicated by the fact that in 2020 there were strict COVID-19 lockdowns and restrictions in place.

The department’s information from 2023 showed that 167 109 males aged 15 to 49 visited health facilities across the province from April to December. Of these patients, 67 400 (40% of the 167 109) were treated for MUS.

The diagnosis of MUS is an indicator of newly acquired STIs, in particular gonorrhoea and chlamydia, which according to the Gauteng Department of Health are the most prevalent STIs in South Africa.

Chandiwana said diagnosis of MUS in men and pelvic inflammatory disease (PID) among women, are made by assessing symptoms of pain, discomfort and genital discharge and sores. Conventionally, it’s treated with broad range antibiotics.

She explained South Africa’s guidelines to treatment and management is to make clinical decisions based on a patient’s symptoms and signs. “While this standard approach has worked, we are calling for a move to targeted diagnosis and targeted treatment. It’s because you want to know which STI someone has and to treat them for that particular disease,” said Chandiwana.

Different STIs can also result in different complications. Syphilis for instance, she said, can result in women giving birth to children who are deaf or blind or raises the risks for infertility. (Spotlight previously reported on congenital syphilis in South Africa in more depth here.)

“We also have STIs that are present but not visible, so asymptomatic STIs, including HPV (human papillomavirus­), which is the leading cause of cervical cancer in black women in South Africa,” Chandiwana said.

“Of course it’s complicated in a public healthcare system where we might not have lab services everywhere, and where there may be lab testing there is a long turnaround for results,” she added.

What to do

It means a multi-pronged approach is still necessary. This she said, has to include a shift from blaming and policing people’s sexual behaviour. Her comments are in response to Gauteng MEC for health and wellness Nomantu Nkomo-Ralehoko’s remarks in the same Gauteng Department of Health press release in which the MEC drew a link between a higher number of women coming forward to be initiated on Pre-Exposure Prophylaxis (PrEP) – an antiretroviral drug prescribed for HIV-negative people to stop HIV infection – and the higher recorded number of STIs. The MEC is quoted saying: “We believe that the high uptake of PrEP among women has led this group to having unprotected sex resulting in high incidence of MUS. The studies have reported that STI incidence is also high among young women receiving PrEP.”

Chandiwana dismissed the conclusion of a causal relationship. “PrEP is a very important tool because it’s something people can take to prevent HIV. But before we had PrEP it was not like people were using condoms – people were using nothing. So I disagree, the uptake of PrEP is not directly involved with the increase of STIs,” she said.

What’s needed instead, she said, is to ask why people are not using condoms more often and why South Africa is not creating STI friendly services that include differentiated care for key populations such as sex workers, men who have sex with men, or people who inject drugs. There should also be more peer navigators, services that are quick, efficient and confidential as well as investment and development of rapid testing kits, she added.

Preliminary findings from the Sixth South African National HIV Prevalence, Incidence, and Behaviour survey released by the Human Sciences Research Council in November indicated that condom use had dropped substantially among young people from 2017 to 2022. It did prompt MEC Nkomo-Ralehoko to call for more uptake of PrEP.  “We would like to encourage more males to get initiated on PrEP to protect themselves against STI. Additionally, both men and women who are on PrEP should use condoms to protect themselves against STIs, HIV and unwanted pregnancies,” she was quoted in the press release.

Role of medical male circumcision

Meanwhile, the NGO Right to Care is promoting voluntary medical male circumcision as another strategy to combat the rise in STI cases. “Uncircumcised men are more susceptible to STIs than men who are circumcised, especially STIs that cause ulcers or wounds,” said Dr Nelson Igaba, senior technical specialist for voluntary medical male circumcision at the NGO.

He described the Gauteng statistics as “worrying” and said it should be read as a prompt for more men to opt for circumcision. The NGO will connect men to their nearest public facility to have the procedure done for free. (They can be contacted at 082 808 6152.)

Dr Tendesayi Kufa-Chakezha, a senior epidemiologist at the Centre for HIV and STIs at the National Institute of Communicable Diseases (NICD), also homes in on the need for more awareness building.

“As a country we are not talking about STIs enough, among ourselves or with our children. More healthcare workers are needed and more training can be made available. We also need a massive campaign to educate communities on the causes of STI syndromes, symptoms, where to get treatment, types of treatments, complications and to go back to facilities if they don’t get better.”

Kufa-Chakezha said South Africa’s STI treatment guidelines do conform with existing WHO guidelines. She said the NICD regularly collects information and specimens from health facilities, which  allows them to determine the most common causes associated with the symptoms that are most commonly seen. The NICD uses these findings to inform the country’s STI management and treatment strategies that are based on diagnosis and treatment of the most prevalent STIs.

“If as a country we are not able to get more people with or without STI symptoms screened and treated, we will continue to have people acquiring STIs, developing symptoms associated with them, becoming ill and developing complications from them,” she added.

Republished from Spotlight under a Creative Commons 4.0 Licence.

Source: Spotlight