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Categories : Diseases, Syndromes and Conditions HIV UncategorizedTags :

High Burden of Uncontrolled Disease in KwaZulu-Natal

On By ModernMedia
Photo by Hush Naidoo on Unsplash

A comprehensive health-screening program has found a high burden of poorly controlled or uncontrolled disease KwaZulu-Natal, along with a high incidence of undiagnosed diseases.

The study, published in The Lancet Global Health, found that four out of five women over 30 had a chronic health condition, and that the HIV-negative population and older people had the highest burden of undiagnosed or poorly controlled non-communicable diseases such as diabetes and hypertension. The study was conducted at the Africa Health Research Institute (AHRI).

Study co-leader Emily Wong, MD, at AHRI in Durban, said: “The data will give AHRI researchers and the Department of Health critical indicators for where the most urgent interventions are needed,” Dr Wong said. “The research was done before COVID, but it has highlighted the urgency of diagnosing and treating people with non-communicable diseases — given that people with uncontrolled diabetes and hypertension are at higher risk of getting very ill with COVID.” 

HIV-associated tuberculosis infections are particularly prevalent in Durban. Dr Wong of the University of Alabama works there to understand the impact of HIV infection on tuberculosis pathogenesis, immunity and epidemiology. In sub-Saharan Africa, 15 years of intense public health efforts that increased access to antiretroviral therapy has resulted in decreased AIDS mortality and raised life expectancy. As a result, there is an increasing priority to address other causes of disease, including tuberculosis and non-communicable diseases.

Over 18 months, health workers screened 17 118 people aged 15 years and older via mobile camps within 1 kilometre of each participant’s home in the uMkhanyakude district. They found high and overlapping burdens of HIV, tuberculosis, diabetes and hypertension among men and women.

While the HIV cases were largely well diagnosed and treated, some demographic groups  still had high rates of undiagnosed and untreated HIV, such as men in their 20s and 30s. In contrast, the majority of people with tuberculosis, diabetes or hypertension were either undiagnosed or not well controlled. Of particular concern was the high rates of undiagnosed and asymptomatic tuberculosis discovered, as it remains one of the leading causes of death in South Africa.

“Our findings suggest that the massive efforts of the past 15 years to test and treat for HIV have done very well for that one disease,” Dr Wong said. “But in that process, we may have neglected some of the other important diseases that are highly prevalent.”

The mobile camps screened for diabetes, high blood pressure, nutritional status (obesity and malnutrition), and tobacco and alcohol use, as well as HIV and tuberculosis. The tuberculosis screening component included high-quality digital chest X-rays and sputum tests for people who reported symptoms or had abnormal X-rays. Clinical information was combined with 20 years of population data from AHRI’s health and demographic surveillance research. Using a sophisticated data system combined with artificial intelligence to interpret the chest X-rays, AHRI’s clinical team examined the information in real time, referring people to the public health system as needed.

The study found that: 

  • Half of the participants had at least one active disease, and 12 percent had two or more diseases. Diabetes and hypertension incidences were 8.5 percent and 23 percent, respectively.
  • One-third of the people were living with HIV, but this was mostly well diagnosed and treated. A particularly high burden of HIV, high blood pressure and diabetes was seen in women.
  • For tuberculosis, 1.4 percent of the people had active disease, and 22 percent had lifetime disease. About 80 percent of the undiagnosed tuberculosis was asymptomatic, with higher rates of active tuberculosis seen in men.
  • Several disease patterns varied by geographical location — eg, the highest HIV burden was seen near main roads, while higher rates of tuberculosis and non-communicable diseases were seen in more remote areas.

Source: University of Alabama at Birmingham

Journal information: Wong, E. B., et al. (2021) Convergence of infectious and non-communicable disease epidemics in rural South Africa: a cross-sectional, population-based multimorbidity study. The Lancet Global Health. doi.org/10.1016/S2214-109X(21)00176-5.

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SA on The Brink of Third Wave, Says Health Department

On By ModernMedia
COVID heat map. Photo by Giacomo Carra on Unsplash

The health department called the increasing number of COVID cases across South Africa “worrying” on Wednesday night, adding that although close, the requirements had not yet been met for a third wave.

In a statement, the department said that it had observed an increase in the weekly number of new cases over the past seven and 14 days compared to the previous corresponding periods. Increases have been seen in all provinces — particularly the North West and Gauteng. There was also an increase in the number of COVID-related deaths over the past seven days.

However the department maintained that these increases had not yet met the requirements of the “resurgence threshold”. Dr Zweli Mkhize however said that numbers would not go down unless containment measures were put in place.

“There was an increase in new cases from 8593 cases in the preceding seven days (April 26-May 2) to 12 531 cases in the past seven days (May 3-9), constituting a 46% increase. The 14-day comparisons also showed that the cases increased from 17 017 in the preceding 14 days to 21 124 cases in the past 14 days, an overall 24% increase. All provinces showed a positive percentage increase, with Northern Cape 68% up in the past seven  days followed by Gauteng at 63%, Limpopo at 47%, North West at 42% and Western Cape at 39%.

“The new Covid-19 related deaths increased by 18.22% in the past seven days (May 3-9) to 318 from 269 in the preceding seven days (April 26-May 2). However, the 14-day comparison showed the deaths decreased by 28.93% to 587 in the past 14 days compared to 826 in the preceding 14 days. The cumulative case fatality ratio is 3.43% (54 735 of 1 596 595),” the department said.

Hospital admissions fortunately “have not shown an increase”. As of Wednesday, the detection rate for COVID tests was 7.45%. Adam Lowe, a member of the ASSA COVID working group, said that based on modelling and historical parallels, three scenarios are possible for a third wave: an early, less severe, wave in May driven by school holidays; a later, more severe third wave; or a sudden and severe, but unlikely, third wave.

“As much as these figures are worrying, our resurgence dashboard, which was developed by the South African Covid-19 Modelling Consortium, which is updated thrice a week, still shows that we have not as a country reached a resurgence threshold, though some districts in the country are fast approaching the threshold,” the department said.

The department of health added that it was working with provinces to update their resurgence plans, which mainly focus on case management, contract tracing, oxygen availability, bed capacity, respiratory support equipment and human resources.

It also said that the main drivers of the new wave will be one or both of the resurgence of new variants and growing fatigue to measures such as social distancing and masking. Genomic surveillance is being conducted to catch the emergence of new variants.

“So we want to assure South Africans that we have not yet hit the third wave, however we are at risk and we hence need to be on heightened vigilance,” the department said.

Source: Times Live

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Suicide and Self-harm Risk Increased After ICU Stay

On By ModernMedia

A new study shows that being admitted to an intensive care unit (ICU) is linked to a small increased risk of future suicide or self-harm after discharge.

The findings show that survivors of critical illness who later died by suicide or had self-harm events had a tendency to be younger, with a history of psychiatric illness, and had received invasive life support. These results are particularly important in light of the large number of ICU survivors due to the COVID pandemic.  The study was published in The BMJ.

The researchers stressed that while the overall risk is still very low, knowledge of these factors “might allow for earlier intervention to potentially reduce this important public health problem.”

Survival after critical illness is associated with important effects, including muscle weakness, reduced exercise capacity, fatigue, cognitive impairment, pain, and financial hardship. Evidence is piling up that shows that ICU survivors have higher rates of psychiatric illness. Some 17–44% of ICU survivors have psychiatric symptoms. However it is yet not known whether that results in an elevated risk of suicide and self-harm.

Researchers in the Canada and the US therefore set out to analyse the association between survival from critical illness and suicide or self-harm after hospital discharge.

For their study, the researchers drew on health records for 423 000 adult ICU survivors in Ontario, Canada from 2009 to 2017.

They matched health records for 423 000 adult ICU survivors (average age 62 years, 39% women) with 3 million non-ICU hospital survivors with similar risk factors for suicide in Ontario, Canada from 2009 to 2017.

The researchers took into account possible confounding factors such as  age, sex, mental health history, and previous hospitalisation for self-harm.

Among ICU survivors, it was found that 0.2% of patients died by suicide compared with 0.1% of non-ICU hospital survivors.

Self-harm was seen in 1.3% of  ICU survivors compared with 0.8% of non-ICU hospital survivors.

ICU survivors were found to have a 22% higher risk of suicide compared with non-ICU hospital survivors risk of self-harm was 15% higher. The increased risk was greatest after discharge, and persisted in a reduced manner for several years afterward.

Younger ICU survivors (ages 18-34), were most likely to be at risk for suicide, along with those with pre-existing diagnoses of depression, anxiety or PTSD, and those who received invasive procedures such as mechanical ventilation or mechanical blood filtration due to kidney failure in the ICU.

This is a large study involving a cohort of consecutive ICU survivors from an entire population, with minimal missing data. However, given the observational design, the researchers cannot rule out the possibility that other unmeasured factors may have affected their results, and say these associations require further study.
Despite being a large cohort study from an entire population with little missing data, because it is an observational design the researchers cannot rule out the possibility of unknown factors affecting their results. However, the links do warrant further study.

“Survivors of critical illness have increased risk of suicide and self-harm, and these outcomes were associated with pre-existing psychiatric illness and receipt of invasive life support,” they wrote.

“Knowledge of these prognostic factors might allow for earlier intervention to potentially reduce this important public health problem,” the authors concluded.

Source: News-Medical.Net

Journal information: Fernando, S.M., et al. (2021) Suicide and self-harm in adult survivors of critical illness: population based cohort study. BMJ. doi.org/10.1136/bmj.n973.

Categories : COVID General Interest UncategorizedTags :

Nurse Recounts His Year on the Frontlines

On By ModernMedia
Stethoscope. Photo by Robert Ruggiero on Unsplash

One year into the first case of COVID being detected in South Africa, one nurse recounts the hardships he and other healthcare workers have faced as they battled against the pandemic.

Lebohang Nkoana, a nurse on the frontline at Thelle Mogoerane Hospital in Vosloorus, Ekurhuleni, spoke to IOL of his experiences.

“When Covid-19 came, no one knew what to expect,” said Nkoana, who has been a nurse for eight years and is also a branch secretary for the Democratic Nurses Organisation of SA.

“It was devastating because we were already short-staffed. At first, we were resistant. We did not want to work with Covid-19 patients

“We were just using normal non-sterile gloves. Then we stopped working for two days as we did not want to risk our lives and also because we were not fully informed about the disease.”

Like many in the first days of the pandemic, he was forced to work without adequate PPE. Lack of regulation and price gouging had also worsened the PPE situation during the early days of the pandemic.

“There was no PPE, no increment, nothing. I had to use what I had at my disposal to protect myself and render a service.

“I went into a Covid ward to save lives, but in the process, exposed myself.”

Mr Koana contracted COVID during the course of his duty, and lost 19 of his colleagues to the disease, with little in the way of support for his trauma. He is also stigmatised in his community, as people assume that he has COVID. He also fears for his wife and two children.

“I am not scared for myself, because as a nurse, I took an oath. I am scared for my children. If I bring the virus home and it kills my wife, who will take care of our children?”

Source: IOL

Categories : Uncategorized

Exercise can Block Muscle Wasting from Chronic Inflammation

On By ModernMedia

In yet another discovery pointing to the benefits of physical activity, human muscle has been shown to stave off the destructive effects of chronic inflammation through exercise.

“Lots of processes are taking place throughout the human body during exercise, and it is difficult to tease apart which systems and cells are doing what inside an active person,” said Nenad Bursac, professor of biomedical engineering at Duke. “Our engineered muscle platform is modular, meaning we can mix and match various types of cells and tissue components if we want to. But in this case, we discovered that the muscle cells were capable of taking anti-inflammatory actions all on their own.”

Inflammation can be beneficial, such as a low-level response which clears out debris and helps regeneration, or it can be detrimental, such as the lethal COVID cytokine storms. Chronic inflammation as in arthritis or sarcopenia can be damaging as it takes away the ability of muscle to contract, resulting in weakening.

One inflammatory molecule in particular, interferon gamma, has been shown to be associated in many different types of muscular wasting. Interferon gamma is primarily produced by T lymphocytes and natural killer (NK) cells.

“We know that chronic inflammatory diseases induce muscle atrophy, but we wanted to see if the same thing would happen to our engineered human muscles grown in a Petri dish,” said Zhaowei Chen, a postdoctoral researcher in Bursac’s laboratory and first author of the paper. “Not only did we confirm that interferon gamma primarily works through a specific signaling pathway, we showed that exercising muscle cells can directly counter this pro-inflammatory signaling independent of the presence of other cell types or tissues.”

To determine if interferon gamma was the true culprit, Berac and Chen grew contractile human muscle tissue in vitro, then flooded it with interferon gamma over seven days. As predicted, the muscle shrank and lost strength,

They then applied interferon gamma again, but this time electrically stimulating the muscle to contract. They expected the simulated exercise to result in some muscle regrowth as seen in their previous studies, but to their surprise, the muscle suffered almost no effect from the chronic inflammation.They demonstrated that exercise blocked a particular molecular pathway as used in a pair of drugs to treat rheumatoid arthritis, tofacitinib and baricitinib, which produce the same anti-inflammatory effect.

“When exercising, the muscle cells themselves were directly opposing the pro-inflammatory signal induced by interferon gamma, which we did not expect to happen,” Bursac said. “These results show just how valuable lab-grown human muscles might be in discovering new mechanisms of disease and potential treatments. There are notions out there that optimal levels and regimes of exercise could fight chronic inflammation while not overstressing the cells. Maybe with our engineered muscle, we can help find out if such notions are true,” Bursac concluded.

Source: Medical Xpress

Journal information: Z. Chen el al., “Exercise mimetics and JAK inhibition attenuate IFN-γ-induced wasting in engineered human skeletal muscle,” Science Advances (2020). advances.sciencemag.org/lookup … .1126/sciadv.abd9502

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Fatal Netcare Helicopter Crash to Be Investigated

On By ModernMedia

The Civil Aviation Authority has dispatched investigators to the crash site  of a Netcare helicopter on Thursday, in which five people including four health care professionals lost their lives.

The ECMO-equipped air ambulance, Netcare 1, was en route to Hillcrest in KZN to pick up a critically ill patient for transfer back to Milpark Hospital in Johannesburg. The helicopter went down near Bergville..

Netcare on Thursday released the names of those aboard:
Dr Kgopotso Rudolf Mononyane, an anaesthetist. Dr Mononyane had delayed the flight in order to try help to save the life of Jackson Mthembu, who unfortunately passed away from a COVID-related illness.
Curnick Siyabonga Mahlangu, a cardiothoracic surgeon.Mpho Xaba, a specialist theatre nurse for cardiothoracic and transplant.
The above three were all from Netcare Milpark Hospital.
Sinjin Joshua Farrance, an advanced life support paramedic at Netcare 911, Mark Stroxreiter, a helicopter pilot who worked for the National Airways Corporation.

Health Minister Zwile Mkhize said: “We’d like to convey our very sincere condolences to the families of all those doctors and pilot who lost their lives. We know their dedication, their hard work and their effort to try to save lives all the time.”

Dr Richard Friedland, chief executive officer of Netcare said: “We are shocked beyond words at the tragic loss of these healthcare heroes. The whole of Netcare falls silent as we bow our heads in tribute, respect, love and memory of our fallen colleagues and frontline heroes who have died in the line of duty.”

No cause for the accident has yet been identified, although videos from the scene show that wreckage was spread in a wide area. Unconfirmed reports from witnesses recounted a mid-air explosion, whilst a voice note circulating on social media claimed that the helicopter fell to the ground and exploded.

Source: IOL News

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South African 510Y.V2 COVID Strain Resistant to Previous Antibodies

On By ModernMedia

Results from a National Institute of Communicable Diseases (NICD) study shows that immunity gained against the initial strains of SARS-CoV-2 is blunted against the new 501Y.V2 strain that originated in South Africa.

The new variants which are more transmissible have mutations to their spike proteins that give the coronavirus its distinctive shape—and to which immune antibodies bind. Scientists have been concerned that the new strains may also escape vaccine containment, especially the E484K mutation, which has been observed in new strains found in Brazil and South Africa.

In the study, which is awaiting peer review, researchers took plasma from patients who had recovered from the original COVIDs, and tested those samples against the 501Y.V2 virus variant to measure antibody reaction. The virus was more resistant to these antibodies, which had been built up from previous infections. “Here we show that the 501Y.V2 lineage, which contains nine spike mutations and rapidly emerged in South Africa during the second half of 2020, is largely resistant to neutralising antibodies elicited by infection with previously circulating lineages,” said the researchers.

“This suggests that, despite the many people who have already been infected with SARS-CoV-2 globally and are presumed to have accumulated some level of immunity, new variants such as 501Y.V2 pose a significant re-infection risk.”

The researchers noted that these findings may have implications for those treated with convalescent plasma (a donor programme for which  is run by the South African National Blood Service). Additionally, there were “implications” for those vaccines that were developed based around an immune response to the virus’ spike proteins.

Vaccines may therefore have to be adjusted to account for the new spike mutation in order to retain effectiveness against variants possessing that mutation. The developers of the Oxford/AstraZeneca vaccine are already preparing to proactively adjust their vaccines to account for the new strains emerging around the world.

Commenting to the Science Media Centre, Lames Naismith, Director of the Rosalind Franklin Institute said that it was “not good news but it’s not unexpected.

“He said that real-world immune responses are more complicated than those of the blood plasma neutralising antibodies. “The vaccines do stimulate very strong responses, immunity is a sliding scale, it’s not an on/off switch,” he explained.

In another study posted online, it was reported that antibodies from recovered patients did mostly protect against B.1.1.7, the variant that originated in the UK.

“Our results suggest that the majority of vaccine responses should be effective against the B.1.1.7 variant,” concluded researchers from one the UK/Netherlands studies.

A separate study showed that the Pfizer/BioNTech vaccine also appeared to confer protection against that variant as well, with the authors concluding that it was “unlikely” that the B.1.1.7 variant could escape vaccine protection.

Source: Medical Xpress

Categories : COVID UncategorizedTags :

SA Government Aims for a Corruption-free Vaccine Programme

On By ModernMedia

In the past week, President Cyril Ramaphosa and health minister Zweli Mkhize have undertaken a publicity drive to demonstrate how the government is working to ensure a tightly controlled vaccine drive that is not plagued by corruption. This is to avoid a repeat of the corruption in PPE acquisition last year, with some R10.5 billion being investigated for looting, with an Auditor-General report finding some items being purchased at five times the going price.

These efforts include centralised transactions which involve the auditor-general looking out for any discrepancies. Vaccine acquisition and roll-out planning will be handled by the government, with the private sector being tapped for storage and distribution. “What we have done is to get the Treasury and the Department of Health’s office of the chief procurement officer to oversee any form of transaction that is going to happen.

“Right now the procurement of the vaccines is within government. It makes it easier because it’s a tight-knit set of people, the prices are known, the manufacturers are known, the deviation is specific and it’s not the same as what we had in PPE where there were so many vendors, suppliers and so many different prices,” he said.

Furthermore, there will be consultation with the Attorney General. “We are going to say [to the AG]… these are the risks we have identified and ask them to analyse our plans and see if there are further risks we must be aware of and how we can work together to prevent any risk of looting,” Mkhize said.

Medical aid schemes have voiced concerns over the process, having sourced vaccines for their members as well as contributing to the vaccination costs of those not covered by any medical aid scheme.

President Ramaphosa said that South Africa would have pre-paid like other countries to secure vaccines, even given the risks of them failing, if it had the funds to do so.

However, he affirmed that there are funds available to buy the vaccination scheme, saying: “we are going to have the money, it will come from Treasury. There is just no way we can say, when it comes to saving the lives of South Africans, that we don’t have the money. The money will be there. It has to be there to save the lives of South Africans. That one will be my bottom line.”

The Covax programme will provide a vaccine for 10% of the population in the second quarter of 2021, for which a deposit of R283 million has been paid. A further 1.5-million vaccine doses have been secured from AstraZeneca and 9-million from Johnson & Johnson (J&J). The J&J vaccine only requires a single dose to confer immunity, so should be able to cover 9 million people.

“J&J will be producing through Aspen here at home, and we are hoping to get the bulk of our supply from there, once the production starts,” said Ramaphosa.

Source: Times Live

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Light Drinking Still Raises Atrial Fibrillation Risk

On By ModernMedia

Even light drinking is associated with an increased risk of atrial fibrillation (Afib) for both sexes, according to a large cohort study by Renate Schnabel, MD, of University Heart & Vascular Center Hamburg, and colleagues.

Drawing on five European cohorts totalling 100 092 participants, the researchers found that 12g of alcohol (one beer can) was associated with increased risk of Afib (Hazard Ratio 1.16, 95% Confidence Interval 1.11-1.22).  A small amount of alcohol (2g) per day was still marginally associated with an increase in Afib risk after 14 years (HR 1.02, 95% CI 1.0-1.04). The association remained after accounting for heart failure history and the cardiac biomarkers NT-proBNP and hs-troponin I, and there was no difference in results between males and females.

There was a J-shaped relationship observed, where drinking more than 20g per day was associated with increased risk.To date, there had been little information on the cardiac effects of chronic light drinking, and the results showed that lowering alcohol intake was an important part of managing Afib, it was noted in an accompanying editorial. It was also noted that these results needed further randomised trials.

The team acknowledged the study’s limitation on relying on self-reported alcohol consumption, and also cases of Afib not being detected. The editorial noted that the study did not state the absolute risk of Afib, which needed to be taken in consideration along with the benefits of low levels of alcohol consumption

Source: MedPage Today

Journal information (primary source): Csengeri D, et al “Alcohol consumption, cardiac biomarkers, and risk of atrial fibrillation and adverse outcomes” Eur Heart J 2021; DOI: 10.1093/eurheartj/ehaa953.

Journal information (secondary source): Wong JA and Conen D “Alcohol consumption, atrial fibrillation, and cardiovascular disease: finding the right balance” Eur Heart J 2021; DOI: 10.1093/eurheartj/ehaa955.