Category: Uncategorized

Categories : UncategorizedTags :

Vitamin D to Treat COVID: No Time for Perfect Evidence

On By ModernMedia

An Op-Ed in MedPage Today highlights the evidence for the potential role of vitamin D in the fight against COVID. Low vitamin D levels are being linked to COVID fatality and ICU admission.

Some 40% of the US population is vitamin D deficient, while in Africa, some 20% are thought to be vitamin D deficient. With South Africa’s seasonal variations, vitamin D levels in adults and children may be adequate in summer and autumn but deficient in the winter, even given its ethnically diverse population.

The article reviews the evidence in favour of and against administering Vitamin D as an acute treatment. Causality can be inferred from correlational data by satisfying various criteria which includes consistency, specificity, temporality, and dose-responsiveness. This same approach was used to draw the link between lung cancer and smoking in 1964.
Studies have shown some striking associations between vitamin D sufficiency and COVID outcomes. In a study of 154 patients, patients with vitamin D deficiency (serum 25-OH-D <20 ng/mL) had a fatality rate of 21%, compared to a rate of 3% for those with higher levels. Firming up the case for causation, there is some randomised experimental data.

In a study of 76 COVID patients in Spain, 1 of 50 of patients who were given open-label calcifediol, a potent vitamin D analogue, were admitted to ICU whilst 13 of 26 who did not receive vitamin D were admitted to ICU.
Nursing homes in France often give vitamin D injections, and a quasi-experimental study showed that only 10% of nursing home residents receiving vitamin D progressed to severe COVID, compared to 31% who were not.

The authors conclude that doctors cannot always wait for perfect evidence as they have a duty of care, and given vitamin D’s safety profile, the evidence for its protective role should be acted upon.
Source: MedPage Today

Categories : UncategorizedTags :

Oncologist Forgives $650 000 in Patient Debts

On By ModernMedia

An oncologist in the United States has forgiven $650 000 in patients’ debts. After 30 years of business, Dr Omar Atiq closed down his Arkansas cancer treatment centre last year. He had previously engaged a debt collector company to chase up clients’ outstanding bills.

“Over time I realised that there are people who just are unable to pay,” Dr Atiq said to ABC’s Good Morning America. “So my wife and I, as a family, we thought about it and looked at forgiving all the debt. We saw that we could do it and then just went ahead and did it.”

Dr Atiq is originally from Pakistan, and founded the Arkansas Cancer Clinic in 1991.”We thought there was not a better time to do this than during a pandemic that has decimated homes, people’s lives and businesses and all sorts of stuff,” Dr Atiq said, quoted by the Arkansas Democrat-Gazette.

When sending his Christmas greeting card to patients, he wrote, “The Arkansas Cancer Clinic was proud to serve you as a patient. Although various health insurances pay most of the bills for [the] majority of patients, even the deductibles and co-pays can be burdensome. Unfortunately, that is the way our health care system currently works. The clinic has decided to forego all balances owed to the clinic by its patients. Happy Holidays.”
In the view of the president of the debt collection company he engaged, Dr Atiq is “a very caring individual”.

Bea Cheesman, of RMC of America, said, “He’s always been extremely easy to work with as a client. It’s just a wonderful thing that he and his family did in forgiving this debt because the people with oncology bills do have more challenges than the bulk of the population.”Dr Atiq approached the Arkansas Medical Society to ensure there was nothing improper about the move.

Source:BBC News

Categories : UncategorizedTags :

Antibiotic Overuse by Children’s Hospitals Contributing to Antibiotic Resistance

On By ModernMedia

Children’s hospitals may be contributing to antibiotic resistance by overprescription of antibiotics, according to a recent study.

The study, conducted by the University of Alabama at Birmingham (UAB),   found that in 51 children’s hospitals across the United States, rates of antibiotic administration ranged from 22% to 52%. Approximately a quarter of children receiving antibiotics were receiving them incorrectly. This adds to a growing body of evidence that points to antibiotics overuse and misuse by children’s hospitals – which ought to know better.Study co-author, Dr Jason Newland said, “There’s no doubt: We’ve seen some extra use of antibiotics, The impact of the pandemic on antibiotic use will be significant.

“The study’s numbers are likely an underestimate since the research involved 32 children’s hospitals already working together on proper antibiotic use. Newland said the US’ more than 250 children’s hospitals need to improve. Even though COVID fears have reduced the numbers of children’s hospital visits, antibiotics are still being prescribed via telemedicine.

“I hear a lot about antibiotic use for the ‘just in case’ scenarios,” said Dr Joshua Watson, at Nationwide Children’s Hospital in Ohio. “We underestimate the downsides.”

Dr Shannon Ross, an associate professor of paediatrics and microbiology at UAB, said that not all doctors have been taught the correct use of antibiotics. Regarding this overuse, she said, “Many of us don’t realize we’re doing it. It’s sort of not knowing what you’re doing until someone tells you.”
Unnecessary antibiotic use is a problem, and the pandemic “has thrown a little bit of gas on the fire,” said Dr Mark Schleiss, a paediatrics professor at the University of Minnesota Medical School.

“It’s irresponsible,” said Christina Fuhrman, who almost lost her infant daughter to a Clostridium difficile infection, and who now advocates for correct antibiotic use. Along with parents begging for antibiotics in paediatricians’ offices, the situation is “creating a monster.”
Many studies have attested to the rise of C. diff in children, which causes gastrointestinal problems. A 2017 study found that cases of a certain multidrug-resistant Enterobacteriaceae type rose 700% in American children in just eight years. And a steady stream of research points to the stubborn prevalence in kids of the better-known MRSA, or methicillin-resistant Staphylococcus aureus.

“It’s getting more and more worrisome,” said Ross. “We have had patients we have not been able to treat because we’ve had no antibiotics available.”

Source: News-Medical.Net

Journal information: Tribble A, Lee B, Flett K et al. Appropriateness of Antibiotic Prescribing in United States Children’s Hospitals: A National Point Prevalence Survey. Clinical Infectious Diseases. 2020;71(8):e226-e234. doi:10.1093/cid/ciaa036 

Categories : UncategorizedTags :

Unmedicated Autism Associated With Substance Abuse

On By ModernMedia

A Taiwanese study has shown that individuals diagnosed with untreated autism spectrum disorder (ASD) have higher rates of substance abuse compared to those on treatment.

The researchers used inpatient and outpatient data of 6 599 individuals with ASD who had at least 3 outpatients visits for ASD, drawn from the Taiwan National Health Insurance Research Database. They found an increased risk of substance use disorder (SUD) among those who were not receiving medication for ASD (adjusted hazard ratio 2.33, 95% CI 1.89-2.87). The risk for drug abuse was three times higher, and the risk for alcohol abuse was two times higher.

Additionally, those with comorbid SUD had over a three times greater risk of death over a follow-up period of 8.1 years.Those taking psychotropic agents had a 40% reduction for SUD risk when taking one agent, and a 63% reduction with a multiagent.

There were several comorbidities of psychiatric disorders seen in patients with ASD, such as intellectual disability, attention deficit hyperactivity disorder, tic disorder, epilepsy, obsessive-compulsive disorder, mood disorder, anxiety disorder, and impulse control disorder. However, individuals with ASD had a higher risk of SUD even compared with matched controls with the same comorbidities. SUD risk was highest with certain comorbidities; untreated ASD with comorbid tic disorder was 6 times higher; with a comorbid impulse control disorder, it was five times higher.

The researchers stated that these are critical findings, but of limited use due to the “umbrella term” of substance use disorder, and further studies will be needed to examine the specific types of drug use amongst individuals with ASD. Future research could investigate whether non-pharmaceutical treatments such as behavioural therapy had the same effect.They conclude that screening  individuals with ASD for SUD is important, given the findings of the study.

Source: MedPage Today

Journal information: Huang J, Yang F, Chien W, et al. Risk of Substance Use Disorder and Its Associations With Comorbidities and Psychotropic Agents in Patients With Autism. JAMA Pediatr. Published online January 04, 2021. doi:10.1001/jamapediatrics.2020.5371

Categories : UncategorizedTags :

Brown Fat May Protect Against Multiple Chronic Diseases

On By ModernMedia

Brown fat, which is found around the neck and shoulders, was once thought only to be beneficial to newborns, but has more recently been thought to have beneficial health effects in humans. However, it has been challenging to study since it is so deeply buried.

In mouse models, brown fat is known to be thermogenic, significantly improving glucose and lipid homeostasis, but in humans its role in metabolism and cardiovascular disease was still unclear. The prevalence of brown fat is difficult to measure in humans, since the only noninvasive way to detect it is with expensive PET scans. However, radiologists have to distinguish brown fat from tumours in PET scans, and this provided a valuable resource to establish the prevalence of brown fat in the population. The researchers used 134 529 PET scans of 52 487 patients.

Brown fat was found in some 10% of the population, which may be an underestimate since individuals undergoing the scans were told to avoid cold, exercise and caffeine, which are all known to increase the activity of brown fat.

“For the first time, it reveals a link to lower risk of certain conditions,” said Paul Cohen, Assistant Professor at The Rockefeller University Hospital. “These findings make us more confident about the potential of targeting brown fat for therapeutic benefit.”

Despite this new evidence, exactly how brown fat contributes to health is still unclear, although there are some clues. Brown fat uses glucose to generate energy, and this may help lower blood glucose levels. The role hat brown fat plays in hypertension, which is tightly connected to the hormonal system, is less clear.”We are considering the possibility that brown fat tissue does more than consume glucose and burn calories, and perhaps actually participates in hormonal signaling to other organs,” Cohen says.

The researchers plan to investigate the biology of brown fat, such as by looking for genetic variations to explain why some have it and others do not, which may lead to pharmacological treatments.

“The natural question that everybody has is, ‘What can I do to get more brown fat?'” Cohen said. “We don’t have a good answer to that yet, but it will be an exciting space for scientists to explore in the upcoming years.”

Source: Medical Xpress

Journal information: Becher, T., Palanisamy, S., Kramer, D.J. et al. Brown adipose tissue is associated with cardiometabolic health. Nat Med (2021). doi.org/10.1038/s41591-020-1126-7

Categories : UncategorizedTags :

New “Spray-on” Wound Dressing Mimics Skin

On By ModernMedia

A new kind of burn dressing developed by an Israeli company, Nanomedic, is being used in Israel, Europe and India, and applies a flexible dressing without contact.

Called “Spincare”, it is contactless and is sprayed on by an applicator. Normal burn dressings are difficult to apply because they can cause so much pain.The breathable “skin substitute” is flexible, which is important for allowing movement for wound rehabilitation, and is also easy for patients to apply. Unlike traditional wound dressings, it also allows patients to shower, and, being translucent, allows clinicians to inspect the wound without having to remove the dressing.

The technology is based on “electrospinning“, where electricity is applied to a solution to make nanofibres. Electrospinning had mostly been used to produce air filters, but it was only until the 1990s that the technology began to acquire other applications. Though the technology has been used in medical applications before, this is the first time such a device small enough to use at a patient’s bedside has been developed.

It is effective at treating shallow burns, but less effective for deep burns, according to the manufacturer. It also has applications in areas such as facial wound dressings, where traditional bandages are cumbersome, This new technology comes at a time when there is debate in wound care management, as to whether frequent replacement of dressing for checking purposes is in fact counterproductive. This new technology would join other types of wound dressing increasingly being used that require fewer changes.

Source: The Guardian

Categories : UncategorizedTags :

SA Scientists Warn Local COVID Variant May Resist Vaccine

On By ModernMedia

South African scientists have said that there is a “reasonable concern” that the South African strain of SARS-CoV-2 may have greater resistance to current vaccines, and underscored the need for global vaccination.

Speaking to the BBC,  Prof Shabir Madhi, who has led vaccine trials in South Africa, explained, “It’s a theoretical concern. A reasonable concern… that the South African variant might be more resistant.” 

The South African variant has mutated far more than the UK variant, raising the possibility that it may be able to evade the antibodies that typically fight coronavirus.

Prof Helen Rees, a vaccine expert at Wits University, said, “Fortunately, should further modifications of the vaccine be required to address the new variants, some of the vaccine technologies under development could allow this to be done relatively rapidly.”

South African scientists recently pushed back against the notions that the SA variant was more transmissible than the UK one, or that it is more deadly. Explaining the reason for the flight restrictions from South Africa, UK Health Secretary Matt Hancock has stated that he believed it was more infectious than the UK variant, saying “This is a very, very significant problem […] and it’s even more of a problem than the UK new variant.”
The UK variant has a “transmission advantage” of 0.4 to 0.7, leading to reproduction numbers of 1.4 to 1.8.Prof Madhi said laboratory tests would determine whether current vaccines would be effective against this variant in a few weeks.

Source: BBC News 

Categories : UncategorizedTags :

Interviews Reveal Most Important ICU Outcomes for Patients and Family

On By ModernMedia

A University of Pennsylvania study has explored the important aspects and outcomes attributed to high quality ICU care by patients and their families.

These may not match the metrics assigned by healthcare providers, which could prompt reassessment, especially considering the increasing numbers of patients successfully discharged from the ICU, and in light of the COVID pandemic (although this study was conducted prior to this).ICU care is typically assessed in terms of mortality rates, durations of stay, ventilator-free days, infection rates and other data from patient health records. On discharge from an intensive care unit (ICU), efforts will often address physical and cognitive functioning, and grief and depression.

This research was aimed at improving the understanding of patient- and family-centred care. Researchers from the Palliative and Advanced Illness Research (PAIR) Center at the University of Pennsylvania conducted hour-long semi-structured interviews with 19 ICU survivors, as well as 30 family members of patients who had either survived or died in ICU.

The key aspects of quality care in the ICU experience were communication, patient comfort and sensing that the medical team’s care was exhaustive. The researchers noted that time and effort put into patient communication was highly valued, often leading patients feeling less alone and afraid. Communication and patient comfort were especially important during the ICU experience, and are delivered by high quality nursing care.

Key post-ICU outcomes were consistently given as survival, quality of life, physical functioning and cognitive functioning. Although survival alone was commonly seen by 25% of participants as a key ICU outcome, some outcomes were seen as worse than death by many. These included an inability to communicate, having a severe physical disability or dependence on machines, and living with severe or constant pain.

Source: Newswise

Journal information: Auriemma, C.L., et al. (2020) What Matters to Patients and Their Families During and After Critical Illness: A Qualitative Study. American Journal of Critical Care. doi.org/10.4037/ajcc2021398.

Categories : UncategorizedTags :

Media Imagery Should Match the Safety Message

On By ModernMedia

A new study at Ohio State University (OSU) has shown the importance of using matching imagery to reinforce social media safety messages. After viewing safety messages on social media posts, parents of young children were better able to recall important points such as how to put a baby safely to sleep when the posts’ images aligned with the message being delivered, the researchers found.

An example would be pictures of children wearing safety helmets in messages advising parents to ensure their children wear safety helmets when they ride bicycles. Liz Klein, associate professor of public health at OSU, said: “Many times, scientists and safety experts aren’t involved in decisions about social media for health agencies and other organizations, and we end up seeing images that have nothing to do with the safety message or, worse, images that contradict the guidance.”

“In this study, we were trying to understand how much those mismatches matter — do people understand the message even if the picture isn’t right? Does the picture really matter?” Klein said.

The researchers sought these answers by using eye-tracking technology to assess how 150 parents reacted to three posts with aligned messages and three with messages that were not aligned with the images. Their eyes lingered longer on the aligned posts – (5.3 seconds) than they did on the misaligned posts (3.3 seconds). Klein said that she understood that those managing social media accounts might be tempted to use attention-grabbing imagery over message-aligned imagery, but the research showed that alignment was more important. Additionally, after adjusting for health literacy and social media use, health safety knowledge recall was improved by 2.8% for each additional second spent in viewing the social media post.Klein said that there implications beyond safety messaging for children aimed at adults, to wider health and safety communication. “We need to pay more attention to how we communicate with the people we’re trying to influence with health and safety guidance. All of us can do a better job of thinking about how we use our social media accounts to contribute to better public health,” she said.

Source: Ohio State University

Categories : UncategorizedTags :

2020 Saw Huge Growth in Metformin Recalls

On By ModernMedia

The year 2020 saw huge numbers of metformin products being removed from shelves due to contamination concerns. Metformin is an antidiabetic agents used to treat type 2 diabetes mellitus, and comes as immediate-release and extended-release products.

In May 2020, the US Food and Drug Administration (FDA) announced that it had recommended certain extended-release metformin products to be removed from shelves, as they were contaminated with N-nitrosodimethylamine (NDMA), a potential carcinogen. This followed a December 2019 announcement that the FDA was aware of there being low levels of NDMA in metformin products outside of the US. Lab studies showed NDMA in US products in February, although the FDA only recommended voluntary recalls of metformin products on May 28. Participating in the recall of extended-release metformin were five companies, of which one, Apotex and Amneal, recalled all of its lots.

Whilst NDMA is ubiquitous in daily life, found in cured and grilled foods as well as contaminated water, the daily limit was set at 96ng, specifically because such a dose would lead to a 1 in 100 000 increase in cancer risk after 70 years of exposure.

Prompted by a report from a private laboratory stating that 16 of 38 metformin products tested exceeded the daily NDMA limit, the FDA released its own article in the journal American Association of Pharmaceutical Scientists, stating the reasoning behind its recommendation for voluntary recall. The FDA noted that its own testing only found eight products of the 38 exceeded the NDMA limit, and explained that N,N-dimethylformamide (DMF) conflated levels in mass spectrometry measurements.

However, this was followed in July by an additional set of recalls, and yet more in August and October. Separately, Sun Pharmaceuticals issued a recall for its relatively new extended-release oral suspension (brand name Riomet ER; 500 mg/5 mL) which had only received approval in February.However, none of the FDA’s recalls have extended to immediate-release metformin, which is the most commonly prescribed form of the drug.

Source: MedPage Today