Year: 2026

SA has a “Bogus Doctor” Problem

Under South African law, no one may practise medicine unless they have the proper training and are officially registered. Photo by Usman Yousaf on Unsplash

By Elna Schütz

Bogus medical practitioners threaten the health of patients and undermine trust in doctors. The problem might be growing, but so is the fight against it.

“If you’re in the hands of an unqualified person, you’re as well as dead, and we think it is not fair for the country,” Dr Magome Masike tells Spotlight.

He is the Registrar of the Health Professions Council of South Africa (HPCSA), which is responsible for the registration of medical doctors and other health professionals in South Africa.

The controversy over bogus doctors gained widespread attention in late 2023 when it was discovered that ‘TikTok doctor’ Matthew Lani lied about being a medical doctor. In his videos, Lani was often seen in scrubs and wearing a stethoscope, impersonating a medical doctor. Although he was arrested at Helen Joseph Hospital in Johannesburg, the National Prosecuting Authority eventually decided not to prosecute.

The term bogus doctor has become a shorthand for any medical practitioner who is working without being properly qualified or registered by the HPCSA. In practice, being “bogus” can also apply to physiotherapists, interns, or anyone else practising medicine.

The misrepresentation may include using fraudulent certificates, using another practitioner’s registration, or being suspended or erased from the register. It can involve someone who studied but did not fully qualify, or has not kept up to date with their registration. Masike gives the example of the child of a registered practitioner who decides to take on their parent’s practice after their death without themselves being registered.

It is an ongoing problem. In the beginning of February, the HPCSA says it facilitated the arrest of a woman working at a medical facility in Midrand, north of Johannesburg, allegedly without being correctly registered to practice medicine.

Bogus qualifications are part of the larger problem of healthcare fraud. According to research in a report by risk management services firm D-Finitive, it is estimated that this fraud overall costs African countries more than USD50 billion in 2012. In the South African private sector, that comes to about R22-28 billion a year. The report explains that beyond bogus practitioners, there is a problem with similar fraud, like doctors billing more clients than is realistic, manipulating diagnostic and procedural codes, or deceased doctors billing the government for decades after their death. At times, this type of fraud is reportedly executed by syndicates.

“While the majority of practitioners are honest and committed to patient care, it takes only a small number of bad actors, whether unregistered impostors or credentialed professionals abusing the system, to inflict widespread damage,” says Dr Katlego Mothudi, Managing Director of the Board of Healthcare Funders (BHF).

A substantial problem

Masike says that from March 2024 to February 2025, 49 bogus practitioners were caught and arrested. From April to December 2025, that number was at 17. Even though these numbers do not suggest a year-on-year increase, Masike says that overall, the numbers are increasing.

The HPCSA’s annual report for 2024/2025 shows that 589 investigations into unregistered persons were concluded in the year in question. Over the past five years, 3 708 complaints were received.

The majority of bogus practitioners who have been caught were operating in economic hubs of the Western Cape, Gauteng, and KwaZulu-Natal, Masike says. “Bogus people want money, so they go where there’s money,” he explains. However, while the trend tends urban, he says rural communities also fall prey to scammers.

“A notable pattern is that many of these individuals use or forge the details of legitimately registered practitioners,” Masike says.

It is, of course, unclear how many unlicensed practitioners are not yet caught. “We can tell you the problem is bigger than we think,” Masike says. The problem, he says, is sector-wide and stretches across different health professions, with most of these illegal practices occurring in the private sector. Masike adds that bogus doctors often work with a network of others, for example, those who supply unregistered or fake medicines.

Mothudi also says that the problem is growing. “Medical schemes are seeing a rise in suspicious provider activity picked up through claims analysis and credential verification processes,” he says. This may include practitioners misrepresenting their registration status, practising outside their approved scope, or using the registration details of legitimate practitioners to submit claims.

Risk to patients

Catching and prosecuting bogus practitioners is crucial because they can pose a direct danger to unsuspecting patients. “Unregistered medical doctors, like other health professionals, pose severe risks to patients, including serious physical harm, injury, and misdiagnosis which may lead to death, due to their lack of necessary training, ethical standards and relevant qualifications,” warns Foster Mohale, the spokesperson for the National Department of Health.

Dr Zanele Bikitsha, National Vice Chairperson of the South African Medical Association, cautions that if bogus doctors are performing procedures, it will likely be in settings that are not appropriate or sterile.

“They’re not going to go to a registered facility, because they know they’ll be caught, so this puts patients in danger as well.”

While some operate on a cash basis, Mothudi says that submitting claims to medical schemes is attractive because it allows for much larger and repeatable payouts. “In some cases, bogus practitioners submit claims using stolen, borrowed or fraudulently obtained practice numbers belonging to legitimately registered healthcare professionals,” he says. “In other instances, they collude with registered providers who allow their credentials to be misused in exchange for payment.”

Knowing the signs

While the HPCSA undertakes compliance inspections, there are some clear signs that might help the public spot a bogus practitioner. Firstly, it is a legal requirement to have registration information easily visible in a practitioner’s practice and on the letterhead of documents or prescription notes.

Members of the public can also look up a doctor’s credentials. All registered practitioners should be listed in the HPCSA’s digital register online, which is publicly searchable. With as little as the practitioner’s surname, the system lets users search for registered practitioners.

Masike points out that a trained doctor tends to take an extensive medical history and make a systemic or wide-reaching inquiry. He recommends that patients look out for how doctors speak and whether they use and are able to explain medical terminology.

Complaints can be filed with the HPCSA’s Inspectorate, including anonymously. Their call centre is at 0123389300/1 and they can be e-mailed at office@hpcsa.co.za. Suspicious practitioners may also be reported to hospitals, the Department of Health, SAMA or other medical organisations.

Processing the problem

Complaints typically lead to an investigation by the HPCSA Inspectorate, which works together with other entities, such as the South African Health Products Regulatory Authority (SAHPRA), the Office of Health Standards Compliance, the Special Investigating Unit (SIU), and the South African Police Service.

Masike explains that the investigation tends to lead to a clandestine operation and involves the police arresting the suspects. He adds that police recently assigned specific staff members to focus on these cases. He says that once the case goes to court, there is a conviction rate of around 77%, although this may have changed. “Many of the cases from 2023 to 2025 remain before the courts, and therefore updated conviction statistics are not yet available.”

Practising medicine without proper training and registration is in contravention of Section 17(1) of the Health Professions Act, 56 of 1974. Typical sentences for such fraud include fines, such as R12 000, or around two years imprisonment. In one 2017 case, a man who had treated almost a thousand patients over six years was sentenced to 20 years’ imprisonment by the Mahikeng High Court in the North West.

Bikitsha says there are other systemic changes that could help catch the problem earlier on. “If you are still paper-based, you are at risk,” she says, referring to the way that hospitals and institutes tend to verify the qualifications of most interns, locums and medical practitioners. She argues that upgrading to biometrics and digital systems would decrease the risk of fraud.

Another step forward is simply to increase public awareness and education, so that patients know the risks.

Masike concurs. “We need society to stand up to this,” he says. “We need a participating community to get rid of this malaise, otherwise it will continue forever.”

Republished from Spotlight under a Creative Commons licence.

Read the original article.

New Research Sheds Light on the Biological Roots of Anxiety

The largest genetic study of anxiety disorders to date has identified 58 genetic variants associated with anxiety, most of which have not been identified before now.

Photo by Joice Kelly on Unsplash

In the largest genetic study of anxiety disorders to date, new research from the Institute of Psychiatry, Psychology & Neuroscience (IoPPN) at King’s College London, in partnership with Texas A&M and the Institute of Psychiatric Phenomics and Genomics (IPPG) at LMU Munich, has identified 58 genetic variants associated with anxiety, most of which have not been identified before now.

The research, published in Nature Genetics, confirmed that, rather than being driven by a single “anxiety gene”, anxiety disorders are influenced by numerous genetic variants from across the genome, with each contributing a small effect.

The researchers compared the genetic data of 120 000 people diagnosed with an anxiety disorder to almost 730 000 people without.

Their analysis of the data notably highlighted the role of several genes involved in GABAergic signalling; a key system that regulates brain activity.

“Anxiety disorders arise from the interplay of genetic vulnerability and life experience. At a time when rates of anxiety are rising rapidly in our young people, by identifying robust genetic signals offering novel insight into the biological foundations of these debilitating disorders, this research helps move the field toward more precise and effective approaches to prevention and care.” 

Professor Thalia Eley, Professor of Developmental Behavioural Genetics at King’s IoPPN and one of the study’s senior authors

While the research provides a biological basis for anxiety, the researchers do not advocate for the use of genetic testing to diagnose anxiety.

Professor John Hettema, from the Department of Psychiatry at Texas A&M University Naresh K. Vashisht College of Medicine, another of the study’s senior authors said, “Anxiety disorders and their underlying sources of genetic risk have been understudied compared to other psychiatric conditions, so this study substantially advances this critical knowledge.”

Prof Jürgen Deckert, Julius Maximilians University, Würzburg, Germany wrote “The results of the study provide evidence for a role of several previously unknown molecular pathways in the etiology of anxiety, beyond the previously identified GABAergic system. They will provide the basis for future studies in cell culture, animal models and humans which will contribute to a better understanding of the neurobiology of anxiety and as a consequence to innovative and individualized therapies.”

Genome-wide association study of major anxiety disorders in 122,341 European ancestry cases identifies 58 loci and highlights GABAergic signaling (DOI 10.1038/s41588-025-02485-8) (Eley, Mattheisen, Hettema et al) was published in Nature Genetics.  

Source: King’s College London

How Does Lifetime Alcohol Consumption Affect Colorectal Cancer Risk?

Results from a cancer screening trial indicate that consistent heavy alcohol intake and higher average lifetime drinking are associated with increased risk.

Photo by Apolo Photographer on Unsplash

Studies have demonstrated a link between alcohol consumption and an elevated risk of colorectal cancer. New research now reveals that higher lifetime alcohol consumption is also associated with a higher risk, especially for rectal cancer, and that quitting drinking can lower a person’s risk. The findings are published by Wiley online in CANCER, a peer-reviewed journal of the American Cancer Society.

When investigators analysed data on US adults enrolled in the National Cancer Institute (NCI) Prostate, Long, Colorectal, and Ovarian (PLCO) Cancer Screening Trial who did not have cancer at baseline, they observed that 1679 colorectal cancer cases occurred among 88 092 participants over 20 years of follow-up.

Current drinkers with an average lifetime alcohol intake of ≥ 14 drinks per week (heavy drinkers) had a 25% higher risk of developing colorectal cancer and a 95% higher risk of developing rectal cancer compared with those with an average lifetime alcohol intake of < 1 drink per week (light drinkers).

When further considering drinking consistency, heavy drinking throughout adulthood was linked to a 91% higher risk of colorectal cancer compared with consistent light drinking. In contrast, no evidence of increased colorectal cancer risk was observed among former drinkers, and former drinkers had lower odds of developing noncancerous colorectal tumours, or adenomas (which may go on to become cancerous) than current drinkers averaging < 1 drink per week, suggesting that alcohol cessation may lower individuals’ risks. These data were limited, however.

The association between alcohol consumption and increased risks observed in this and other studies might be explained by carcinogens produced from alcohol metabolism or alcohol’s effects on gut microbes. Additional studies are needed to test whether these mechanisms are involved.

“Our study is one of the first to explore how drinking alcohol over the life course relates to both colorectal adenoma and colorectal cancer risk. While the data on former drinkers were sparse, we were encouraged to see that their risk may return to that of the light drinkers,” said co–senior author Erikka Loftfield, PhD, MPH, of the NCI, part of the National Institutes of Health.

Source: Wiley

New Device Sprays Antibiotics Deep into Wounds

The new device sprays mist to treat deep wound infections without causing kidney damage

Hongmin Sun demonstrating the new device.

A University of Missouri researcher has unveiled a safer, smarter way to fight drug-resistant infections. Hongmin Sun, an associate professor in the School of Medicine, demonstrated that a spray-mist device can deliver last-resort antibiotics directly into infected tissue without the harmful side effects often caused by delivery via the bloodstream.

In a recent study, researchers worked with an industry partner to use a needle-free device to treat methicillin-resistant Staphylococcus aureus (MRSA), a dangerous bacterium that has become resistant to many common antibiotics.

The device successfully delivered the common last-resort antibiotic vancomycin deep into infected tissue without typical side effects such as kidney damage. Unlike topical creams or ointments that are easily wiped away or bloodstream delivery that risks organ damage, the spray-mist technology pushed the medicine through the skin to successfully treat the infection.

Sun collaborated with former Mizzou researcher Lakshmi Pulakat, now a professor of medicine at Tufts University, and Droplette Inc. to use the patented device for antibiotic delivery. The findings pave the way for future clinical trials as researchers seek FDA approval.

The team is hopeful the spray-mist device might one day be used in wound care in challenging settings.

“Whether it’s people with diabetic foot ulcers or soldiers hurt in battle, we wanted to come up with a new approach to treat these severely infected wounds in a more targeted way,” Sun said. “This can be a game-changing therapy for treating those with severely infected wounds.”

Pulakat said the technology is an example of compassionate care.

“This method of delivering last-resort antibiotics could prevent countless amputations and help save lives,” she said. “Dr. Sun is an internationally recognized expert in the field of pathogenic microbiology, and our collaboration with an industry partner has helped make this translational research possible.”

The study, “Preventing nephrotoxicity of vancomycin and attenuating deep tissue infections by methicillin-resistant Staphylococcus aureus via needle-free drug delivery by the Droplette micromist technology device” was published in Military Medicine.

By Brian Consiglio

Source: University of Missouri

Exposure to Burn Injuries may have Played Key role in Shaping Human Evolution

Photo by sena keçicioğlu

Humans’ exposure to high temperature burn injuries may have played an important role in our evolutionary development, shaping how our bodies heal, fight infection, and sometimes fail under extreme injury, according to new research.

For more than one million years, the control of fire has powered human success, from cooking and heating to technology and industry, driving genetic and cultural evolution and setting us apart from all other species. But this relationship has also exposed humans to high temperature injuries at a scale unmatched in the natural world. 

Humans burn themselves – and survive burns – with a frequency likely much greater than any other animal. Most animals avoid fire completely, while in contrast, humans live alongside fire and most humans will experience minor burns throughout their lives. 

A new study published in BioEssays, led by Imperial College London researchers, suggests that this increased exposure to burn injuries may have driven notable genetic adaptations which differentiated humans from other primates and mammals. This may also explain both beneficial and maladaptive responses to severe burn injury. 

Burn injuries exist on a spectrum of severity, with most small injuries healing on their own while severe burns can lead to lifelong disability or death. Burns damage the skin, the body’s main protective barrier against infection, sometimes over large areas of the body. The longer the skin is damaged, the greater the risk that bacteria can enter the body and cause overwhelming infection. 

The researchers argue that natural selection would have favoured traits that helped humans survive small to moderate burns. These may include faster inflammation, faster wound closure (to prevent infection) and stronger pain signals. 

However, while these traits are helpful for less severe injuries, they can become harmful for large burns, which may explain why modern humans can experience extreme inflammation, scarring, and organ failure from major burns. 

Using comparative genomic data across primates, the researchers found examples of genes associated with burn injury responses which show signs of accelerated evolution in humans. These genes are involved in wound closure, inflammation and immune system response – likely helping to rapidly close wounds and fight infection; a major complication after burn injury, particularly before the widespread use of antibiotics. 

These findings support the theory that exposure to burn injuries may have been a notable force on the evolution of humans. 

Dr Joshua Cuddihy, lead author for the study, and Honorary Clinical Lecturer in Imperial’s Department of Surgery and Cancer, said: “Burns are a uniquely human injury. No other species lives alongside high temperatures and the regular risk of burning in the way humans do.  

“The control of fire is deeply embedded in human life — from a preference for hot food and boiled liquids to the technologies that shape the modern world. As a result, unlike any other species, most humans will burn themselves repeatedly over their lifetime, a pattern that likely extends back over a million years to our earliest use of fire.

“Our research suggests that natural selection favoured traits that improved survival after smaller, more frequent burn injuries. However, those same adaptations may have come with evolutionary trade-offs, helping to explain why humans remain particularly vulnerable to the complications of severe burns.”

The control of fire has powered human success for more than one million years

The research was developed through a collaboration between burn injury experts, evolutionary biologists, and genetics experts at Imperial, Chelsea and Westminster Hospital NHS Foundation Trust, and Queen Mary University of London.

The study’s novel perspective on human evolution, which could reshape our understanding of modern burn care and human biology, was made possible through interdisciplinary collaboration between clinicians and researchers. 

Professor Armand Leroi, Professor of Evolutionary Developmental Biology in Imperial’s Department of Life Sciences, said: “What makes this theory of burn selection so exciting to an evolutionary biologist is that it presents a new form of natural selection – one, moreover, that depends on culture. It is part of the story of what makes us human, and a part that we really did not have any inkling of before.”

Yuemin Li, PhD student at Queen Mary University of London, said: “Our study provides compelling evidence that humans have unique adaptive mutations in several key genes associated with burn injury response. 

“These findings could allow us to explore in future research how genetic variations in different groups impact burn injury response, potentially explaining why some patients heal well or poorly after a burn.” 

Unlike other wounds from cuts or bites which would have also led to infections, the increased lifetime risk of burns experienced by humans and their hominin ancestors is unique as they are the only species to regularly experience burn injuries and survive them. 

The researchers’ findings could change how we study burn injuries, design treatments, and interpret complications of burns. It may also explain why translating results on burn injuries from animal models to humans is often ineffective. 

Declan Collins, Consultant in Plastic and Reconstructive Surgery at Chelsea and Westminster Hospital NHS Foundation Trust, said: “Understanding the evolutionary drivers that cause genetic change is an important step in burn research that will influence the way in which we look at scar formation and wound healing. 

“The genetic basis for scarring variation in humans and response to tissue injury is still poorly understood, and this work will provide new angles for future research.” 

Burn Selection: How Fire Injury Shaped Human Evolution’ by Joshua Cuddihy et al. is published in Bioessays.

By Conrad Duncan

Source: Imperial College London

Gap in Onset of Cardiovascular Disease Still Persists Between Sexes

Credit: American Heart Association

Historical data indicate that men develop coronary heart disease (CHD) 10 years before women. A recent study in the Journal of the American Heart Association indicates that this sex gap still remains.

Investigators analysed data from the Coronary Artery Risk Development in Young Adults (CARDIA) study, in which US adults aged 18–30 years enrolled in 1985–1986 and were followed through August 2020.

Among 5112 participants (54.5% female, 51.6% Black) with an average age of 24.8 years at enrolment and a median follow-up of 34.1 years, men had a significantly higher cumulative incidence of cardiovascular disease. They had higher cumulative incidence rates of the cardiovascular disease subtypes of CHD and heart failure compared with women, but no difference in stroke.

Men reached a 5% incidence of cardiovascular disease 7.0 years earlier than women (50.5 versus 57.5 years). CHD was the most frequent cardiovascular disease subtype, and men reached a 2% incidence 10.1 years earlier than women. There were no significant differences in the age at which men and women reached a 2% incidence for stroke (57.5 versus 56.9 years) or a 1% incidence for heart failure (48.7 versus 51.7 years)

Differences emerged in the fourth decade of life and were not explained after accounting for differences in cardiovascular health.

“Sex differences in cardiovascular disease risk are apparent by age 35, highlighting the importance of initiating risk assessment and prevention strategies in young adulthood,” said corresponding author Alexa Freedman, PhD, of the Northwestern University Feinberg School of Medicine.

Source: Wiley

Long COVID Brain Fog Far More Common in US than India, Other Nations

Large study of patients in the US, Colombia, Nigeria and India finds symptom burden highest in high-income countries

Photo by Usman Yousaf on Unsplash

Patients with long COVID-19 in the US report far higher rates of brain fog, depression and cognitive symptoms than patients in countries such as India and Nigeria, according to a large international study led by Northwestern Medicine.

The authors note that higher reported symptom burden in the US may reflect lower stigma and greater access to neurological and mental health care, rather than more severe disease.

The study, the first cross-continental comparison of long COVID neurological manifestations, tracked more than 3100 adults with long COVID evaluated at academic medical centres in Chicago; Medellín, Colombia; Lagos, Nigeria; and Jaipur, India.

Among patients who were not hospitalised during their COVID infections (the majority in the study), 86% in the US reported brain fog, compared with only 63% in Nigeria, 62% in Colombia and 15% in India. Rates of psychological distress showed a similar pattern: Nearly 75% of non-hospitalised patients in the US reported symptoms of depression or anxiety, compared with only 40% in Colombia and fewer than 20% in Nigeria and India.

“It is culturally accepted in the US and Colombia to talk about mental health and cognitive issues, whereas that is not the case in Nigeria and India,” said Dr Igor Koralnik, senior study author and chief of neuro-infectious disease and global neurology at Northwestern University Feinberg School of Medicine.

“Cultural denial of mood disorder symptoms as well as a combination of stigma, misperceptions, religiosity and belief systems, and lack of health literacy may contribute to biased reporting. This may be compounded by a dearth of mental health providers and perceived treatment options in those countries.”

The study was published in Frontiers in Human Neuroscience.

Additional key findings

  •        Brain fog, fatigue, myalgia (muscle pain), headache, dizziness and sensory disturbances (such as numbness or tingling) were the most common neurological symptoms across all countries
  •        Insomnia was reported by nearly 60% of non-hospitalised US patients, compared with roughly one-third or fewer of patients in Colombia, Nigeria and India
  •        Statistical clustering showed clear separation between high- and upper-middle-income (US, Colombia) and lower-middle-income (Nigeria, India) countries

Building on this work, Koralnik and his international collaborators are now studying cognitive rehabilitation treatments for long COVID brain fog in Colombia and Nigeria, using the same protocols developed for patients treated at the Shirley Ryan AbilityLab in Chicago.

By Ben Schamisso

Source: Northwestern University

Active Ingredient from Red Foxglove Helps with Heart Failure

Foxglove helps with heart failure: Cardiologists Professor Dr Udo Bavendiek (left) and Professor Dr Johann Bauersachs have scientifically proven the life-prolonging effect of digitoxin for the first time. Copyright: pixabay, Karin Kaiser/MHH

A multicentre study has demonstrated a clear positive effect of digitoxin in heart failure, which is derived from the red foxglove plant. Results from ten years of research involving more than 1200 participants have clearly confirmed the safety and efficacy of the cardiac glycoside in people diagnosed with heart failure with reduced ejection fraction.

Digitalis has been used to treat heart failure for more than 200 years. The drug digitoxin also belongs to this group of active ingredients known as cardiac glycosides. Although there were indications that digitalis was beneficial in heart failure, it has only now been scientifically proven that digitoxin has a significant positive effect in heart failure due to reduced pumping function and insufficient emptying of the left ventricle – known in medical terms as HFrEF (heart failure with reduced ejection fraction). For ten years, researchers led by Professor Dr Johann Bauersachs, Director of the Department of Cardiology and Angiology at Hanover Medical School (MHH), and senior physician Professor Dr Udo Bavendiek thoroughly investigated the safety and efficacy of the active ingredient in a clinical study involving more than 1200 participants.

The large-scale DIGIT-HF study coordinated by them, involving more than 50 centres in Germany, Austria and Serbia, has now been completed and delivers a clear result: adjunctive therapy with digitoxin reduces mortality and the number of hospitalisations for heart failure in patients with advanced HFrEF. The results have been published in the New England Journal of Medicine. At the same time, they were presented at the end of August 2025 at the European Society of Cardiology Congress in Madrid in the so-called Hot Line Session, where new clinical studies that promise significant changes in patient outcomes are presented.

No proof of effectiveness according to scientific standards to date

Our heart is a high-performance engine. It beats around 70 times per minute, pumping around five litres of blood through our vessels. In doing so, it supplies the body with vital oxygen and nutrients. If this pumping capacity is permanently reduced, physicians refer to this as chronic heart failure or cardiac insufficiency. Around four million people in Germany are affected. Symptoms include shortness of breath, low exercise tolerance, water retention, immobility and severe arrhythmia. The condition is one of the most common reasons for hospitalisation and even death. Until around 2020, digitalis preparations were still on the production list of major pharmaceutical companies. Currently, digitoxin is only produced as a generic drug. ‘However, it remains the most commonly used digitalis preparation in Germany – so far, however, without any scientifically proven evidence of its effectiveness,’ notes Professor Bavendiek.

Can also be used in cases of impaired kidney function

This has now been proven. ‘In the DIGIT-HF study, we examined patients who had exhausted all conventional treatment options,’ says Professor Bauersachs. ‘We were surprised ourselves that we were able to achieve such a significant improvement with the additional digitoxin treatment in these very well-treated study participants.’ The usual medications for heart failure include beta blockers and inhibitors of the renin-angiotensin-aldosterone system, which inhibit excessively activated hormone cascades and thus relieve the heart, as well as diuretics. Defibrillators, which are implanted in the patient’s body, also help against acute arrhythmias. Since 2021, so-called SGLT-2 inhibitors have also been used in Germany. These were originally approved for the treatment of type 2 diabetes, but also have positive effects in all forms of heart failure. Thanks to the DIGIT-HF study, digitoxin could now become another mainstay in the treatment of people diagnosed with HFrEF.

Previous clinical studies have been conducted almost exclusively with digoxin, another cardiac glycoside. However, digoxin can only be used to a limited extent in patients with impaired kidney function, which is often the case in patients with advanced heart failure, as it is excreted almost exclusively via the kidneys. ‘With digitoxin, however, the situation is different,’ explains Professor Bavendiek. This is because digitoxin is excreted via the liver and intestines to a greater extent in patients with impaired kidney function. The already approved drug is therefore also suitable for use in patients with pre-existing kidney weakness.

Safe and cost-effective

In addition, the results of the DIGIT-HF study dispelled fears that digitoxin is dangerous for certain groups of patients with heart failure and could lead to death. ‘When dosed correctly, digitoxin is a safe treatment for heart failure and is also suitable for controlling heart rate in atrial fibrillation when beta blockers alone are not sufficient,’ emphasises Professor Bavendiek. Another advantage of the drug sounds trivial, but is certainly interesting in view of rising healthcare costs: digitoxin costs just a few pence and is drastically cheaper than other drugs for heart failure. Based on the study data available to date, heart specialists have already developed recommendations for simple and safe dosing. Whereas 0.1 milligrams of digitoxin were often prescribed in the past, the current recommendations are 0.07 milligrams per day or even less. The DIGIT-HF study showed that this dosage reduced mortality and hospital admissions due to heart failure without any safety issues.

Source: Hannover Medical School (in German)

Rates of Autism in Girls and Boys May Be More Equal than Previously Thought

Study raises questions around why female individuals are diagnosed later than males

Photo by Ben Wicks on Unsplash

Autism has long been viewed as a condition that predominantly affects male individuals, but a study from Sweden published by The BMJ shows that autism may actually occur at comparable rates among male and female individuals.

The results show a clear female catch-up effect during adolescence, which the researchers say highlights the need to investigate why female individuals receive diagnoses later than male individuals.

The prevalence of autism spectrum disorder (ASD) has increased over the past three decades, with a high male-to-female diagnosis ratio of around 4:1.

The increase in prevalence is thought to be linked to factors including wider diagnostic criteria and societal changes (eg, parental age), whilst the high male to female ratio has been attributed to better social and communication skills among girls, making autism more difficult to spot. However so far no large study has examined these trends over the life course.

To address this, researchers used national registers to analyse diagnosis rates of autism for 2.7 million individuals born in Sweden between 1985 and 2022 who were tracked from birth to a maximum of 37 years of age.

During this follow-up period of more than 35 years, autism was diagnosed in 78,522 (2.8%) of individuals at an average age of 14.3 years.

Diagnosis rates increased with each five year age interval throughout childhood, peaking at 645.5 per 100,000 person years for male individuals at age 10-14 years and 602.6 for female individuals at age 15-19 years.

However, while male individuals were more likely to have a diagnosis of autism in childhood, female individuals caught up during adolescence, giving a male to female ratio approaching 1:1 by age 20 years.

This is an observational study and the authors acknowledge that they did not consider other conditions associated with autism, such as ADHD and intellectual disability. Nor were they able to control for shared genetic and environmental conditions like parental mental health.

However, they say the study size and duration enabled them to link data for a whole population and disentangle the effects of three different time scales: age, calendar period and birth cohort.

As such, they write: “These findings indicate that the male to female ratio for autism has decreased over time and with increasing age at diagnosis. This male to female ratio may therefore be substantially lower than previously thought, to the extent that, in Sweden, it may no longer be distinguishable by adulthood.”

“These observations highlight the need to investigate why female individuals receive diagnoses later than male individuals,” they conclude.

These findings align with recent research and seem to support the argument that current practices may be failing to recognise autism in many women until later in life, if at all, says Anne Cary, patient and patient advocate, in a linked editorial.

She notes that studies like this are essential to changing the assumption that autism is more prevalent in male individuals than in female individuals, but points out that as autistic female individuals await proper diagnosis, “they are likely to be (mis)diagnosed with psychiatric conditions, especially mood and personality disorders, and they are forced to self-advocate to be seen and treated appropriately: as autistic patients, just as autistic as their male counterparts.”

Source: BMJ Group

Could a Living Implant End Daily Insulin Injections?

The development of a self-regulating, implantable living technology that could offer hope for millions with diabetes and other chronic diseases

The crystal capsules developed by the researchers. They made the cover of Science Translational Medicine.

A pioneering study marks a major step toward eliminating the need for daily insulin injections for people with diabetes. The research introduces a living, cell-based implant that can function as an autonomous artificial pancreas, essentially a living drug that is long-term, thanks to a novel crystalline shield technology.

Once implanted, the system operates entirely on its own: it continuously senses blood-glucose levels, produces insulin within the implant itself, and releases the exact amount needed – precisely when it is needed. In effect, the implant becomes a self-regulating, drug-manufacturing organ inside the body, requiring no external pumps, injections, or patient intervention.

One of the study’s most significant breakthroughs addresses the longstanding challenge of immune rejection, which has limited the success of cell-based therapies for decades. The researchers developed engineered therapeutic crystals that shield the implant from the immune system, preventing it from being recognised as a foreign object. This protective strategy enables the implant to function reliably and continuously for several years.

The technology has already been successfully tested in a mouse model for effective and long-term regulation of glucose levels and in non-human primates for cell viability and functionality. These results represent a critical milestone and strongly support the potential for future translation to human patients.

From Postdoctoral Insight to Global Collaboration

The study was led by Assistant Professor Shady Farah of the Faculty of Chemical Engineering at the Technion – Israel Institute of Technology, in co-correspondence with MIT, and in collaboration with Harvard University, Johns Hopkins University, and the University of Massachusetts. Asst Prof Farah began developing the concept with colleagues in 2018 during his postdoctoral fellowship at MIT and Boston Children’s Hospital/Harvard Medical School, under the supervision of Prof Daniel Anderson and Prof Robert (Bob) Langer, a world leader in tissue engineering and co-founder of Moderna.

Today, the research continues in Asst Prof Farah’s laboratory at the Technion, in close collaboration with leading US institutions, including MIT, Harvard, the University of Massachusetts, Boston Children’s Hospital, and the Johns Hopkins University School of Medicine.

A Platform with Far-Reaching Potential

While the immediate focus is diabetes, the researchers emphasise that this implantable, closed-loop platform could be adapted to treat a wide range of chronic conditions requiring continuous delivery of biological therapeutics – including haemophilia and other metabolic or genetic diseases.

If successfully translated to the clinic, this technology could redefine how chronic diseases are treated, shifting from repeated drug administration to living, self-regulating therapies that work seamlessly from within.

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Source: TECHNION Israel Institute of Technology