In a new research perspective published in Oncoscience, researchers from Germany discuss the diagnosis and management of postoperative wound infections in the head and neck area. Key topics include patient risk factors, the importance of sterilisation, and the most common complications.
In everyday clinical practice at a department for oral and maxillofacial surgery, a large number of surgical procedures in the head and neck region take place under both outpatient and inpatient conditions. The basis of every surgical intervention is the patient’s consent to the respective procedure. Particular attention is drawn to the general and operation-specific risks.
Particularly in the case of soft tissue procedures in the facial region, bleeding, secondary bleeding, scarring and infection of the surgical area are among the most common complications/risks, depending on the respective procedure. In their new perspective, researchers Filip Barbarewicz, Kai-Olaf Henkel and Florian Dudde from Army Hospital Hamburg in Germany discuss the diagnosis and management of postoperative infections in the head and neck region.
“In order to minimise the wound infections/surgical site infections, aseptic operating conditions with maximum sterility are required.”
Furthermore, depending on the extent of the surgical procedure and the patient‘s previous illnesses, peri- and/or postoperative antibiotics should be considered in order to avoid postoperative surgical site infection. Abscesses, cellulitis, phlegmone and (depending on the location of the procedure) empyema are among the most common postoperative infections in the respective surgical area. The main pathogens of these infections are staphylococci, although mixed (germ) patterns are also possible.
“Risk factors for the development of a postoperative surgical site infection include, in particular, increased age, smoking, multiple comorbidities and/or systemic diseases (eg, diabetes mellitus type II) as well as congenital and/ or acquired immune deficiency.”
Recent studies suggest that probiotics may offer a protective effect against hypertension, but how gut microbiota can regulate blood pressure has remained something of a mystery. Now a study published in mSystems showed that two probiotics, Bifidobacterium lactis and Lactobacillus rhamnosus, returned blood pressure in hypertensive mouse models to normal levels. The researchers also tracked how those probiotics altered the animals’ gut microbial mix over 16 weeks, identifying specific microbes and metabolic pathways that may help explain the protective effect.
“Accumulated evidence supports an antihypertensive effect of probiotics and probiotic fermented foods in both in vitro and in vivo experiments,” said computational biologist Jun Li, PhD, at the City University of Hong Kong. Her team worked with that of microbiologist Zhihong Sun, PhD, at Inner Mongolia Agricultural University, on the study. “So, we believed that the dietary intake of probiotic foods would well supplement traditional hypertension treatment.”
Previous studies have connected the rising rates of hypertension worldwide to increasing consumption of sugar. It likely boosts blood pressure through many mechanisms, such as increased insulin resistance or salt retention, but in recent years researchers have also investigated sugar’s effect on the gut microbiome.
In the new study, the researchers tested the two probiotic strains on mice that developed hypertension after consuming water mixed with fructose. Over the course of 16 weeks, they measured the animals’ blood pressures every 4 weeks. They found that fructose-fed mice that received either probiotic showed significantly lower blood pressures than those fed a high fructose diet and not treated with probiotics.
In addition, the researchers found no difference between the blood pressure readings of fructose-fed mice that received probiotics and a control group of mice that only drank water. According to Li, that suggests probiotic interventions would maintain blood pressure at normal levels.
The researchers used shotgun metagenomic sequencing to probe connections between the altered gut microbiota and the change in blood pressure. They found that a high-fructose diet in the mice led to an increase in Bacteroidetes and a decrease in Firmicutes bacteria; however, treatment with probiotics returned those populations to those found in the control group. In addition, the analysis identified new microbial signatures associated with blood pressure: Increased levels of Lawsonia and Pyrolobus bacteria, and reduced levels of Alistipes and Alloprevotella, were associated with lower blood pressure.
The researchers are now planning a large clinical trial to see if the protective effect of probiotics extend to people with hypertension. “Probiotics present a promising avenue in preventive medicine,” Sun said, “offering potential in regulating hypertension and reshaping our approach to cardiovascular health.”
A pair of recently published studies from researchers at UCLA Health suggest that measuring changes in how pupils react to light could help predict recovery from depression and personalise transcranial magnetic stimulation (TMS) treatment of major depressive disorder.
TMS is a safe, non-invasive therapy that uses magnetic fields to stimulate parts of the brain involved in mood regulation. While TMS is proven effective, not all patients respond equally well to the therapy. The ability to predict who will benefit most could allow doctors to better customise and target treatments.
In two recent studies, UCLA scientists found that the pupil’s response to light before treatment correlated with improvements in depression symptoms over the course of therapy. Pupil size reflects activation of the autonomic nervous system, which controls involuntary functions and is negatively impacted in people with depression.
The first study, appearing in the Journal of Affective Disorders, reports on outcomes for 51 patients who underwent daily TMS sessions. Before receiving treatment, researchers measured the patients’ baseline pupillary constriction amplitude, or CA: how much the pupil shrinks when exposed to light. The pupil’s constriction is an indicator of parasympathetic nervous system function. The researchers found a significant association between baseline pupil constriction amplitude and symptom improvement, indicating that a greater constriction amplitude at baseline was associated with a better outcome. In other words, those with larger pupil constriction in response to light at baseline showed greater symptom improvement over their full treatment.
The second study, published in Brain Stimulation, went further and compared patients who were treated for depression with one of two common TMS protocols: 10Hz stimulation and intermittent theta burst stimulation (iTBS). In 10Hz stimulation, magnetic pulses are delivered in a continuous and relatively high-frequency stimulation. iTBS is a faster form of stimulation with bursts of three pulses at 50Hz, repeated with short breaks between bursts. This pattern is thought to mimic the natural rhythm of certain brain activities.
The researchers found that people with slower pupillary constriction had significantly greater improvement in depression after 10 sessions if they received iTBS rather than 10Hz treatment.
“These results suggest we may be able to use a simple test of the pupil to identify who is most likely to respond to electromagnetic stimulation of the brain to treat their depression,” said researcher Cole Citrenbaum, lead author of both studies.
Tailored TMS treatments
The researchers propose that measuring pupillary reactivity before starting TMS could guide treatment selection. “Additionally, we may be able to tailor the frequency of stimulation to the individual patient to maximise their benefit from treatment,” Citrenbaum said.
“At the present time, about 65% of patients treated with TMS have a substantial improvement in their depression,” said Dr Andrew F. Leuchter, senior author of both studies. “Our goal is to have more than 85% of patients fully recover from depression. As we better understand the complex brain activity underlying depression, we move closer to matching patients with the treatments that ensure their full recovery. Pupil testing may be one useful tool in reaching this goal.”
The studies add to growing evidence on the benefits of biologically-based personalization in treating major depression. UCLA researchers plan further trials to confirm the value of pupillometry in optimizing transcranial magnetic stimulation.
Dr Nicoline Potgieter at the Paediatric and Special Needs Dental Care Unit
The landscape of paediatric dental care in South Africa is poised for a significant transformation, marked by the launch of the nation’s first specialised Paediatric and Special Needs Dental Care Unit. This pioneering initiative, a result of the dedicated efforts of the Department of Paediatric Dentistry of the University of the Western Cape (UWC), The Provincial Government of the Western Cape (PGWC) and Rotary Club, is set to revolutionise Paediatric Dentistry in South Africa. It promises enhanced efficiency, a reduction in anxiety for young patients and a sharpened focus on providing dedicated oral health services to children and especially children with special health care needs.
Working towards the acknowledgment of Paediatric Dentistry as a specialty in South Africa, the need for a dedicated, specialised, child-friendly facility was identified – particularly in the Western Cape. This project stands as a steadfast response to establish such a paediatric dental unit, promising to positively impact service delivery to the children of the Western Cape.
Dalene Swart, President of the Rotary Club of Bellville, is passionate about this transformative initiative. She underscores the present scenario wherein young patients often undergo dental procedures under general anaesthesia.
“The establishment of a dedicated paediatric dentistry surgery unit, equipped with the latest materials and state-of-the-art equipment, not only enhances service quality but also serves as an invaluable training ground for postgraduate students,” she says.
However, the impact transcends mere smiles; it represents a pivotal advancement in South African healthcare, focused on the oral health of children. This project is expected to increase treatment capacity in the field of Paediatric Dentistry, thereby alleviating the workload of local healthcare professionals. It will also foster disease prevention and treatment programmes, bolster healthcare systems, and in time, significantly reduce the burden of disease and need for care under general anaesthesia.
Dr Nicoline Potgieter, president of the South African Association of Paediatric Dentistry and course coordinator for the Masters programme in Paediatric Dentistry at UWC, emphasises the enduring plight of the children in South Africa, who are in dire need of expert oral health care. “It is important to note, oral health directly impacts general health which directly impacts quality of life. It is our responsibility to provide the basic health care needs of our children. The technological advances incorporated into the unit, support minimally invasive techniques and preventative dentistry and the environment is focused on making the dental visit more pleasant for the child patient. Hopefully this is the first of many dedicated paediatric and special needs units across South Africa!”
This project, scheduled for full implementation by the end of October 2023, is the outcome of a collaboration between dedicated Rotary Club participants and the Tygerberg Oral Health Centre, which is a joint platform between UWC and PGWC. It seamlessly aligns with the UWC mission to train paediatric dentists as specialists in South Africa, reaffirming the institution’s commitment to community health and well-being. Similarly, it aligns with PGWC that is dedicated to high quality service rendering to all patients. Under this initiative, the first paediatric dentists will receive specialised training each year, while hundreds of children will benefit from disease prevention and interventions.
The project, funded with a capital expenditure of R1.2 million, draws support from various sources, including cash contributions from the Rotary Club of Bellville, Rotary Foundation and six other Rotary Clubs from the UK, USA and Canada. A significant portion of the funds raised was allocated to state-of-the-art essential dental equipment, consumables, and building materials.
Swart concludes by underlining that this project transcends immediate community needs for specialised paediatric dental care; it is about advancing medical care in South Africa and laying the groundwork for the long-term sustainability and transformation of dental care needs. This is why it enjoys unwavering support from local Rotarians.
Research on adding a long-acting nonsteroidal anti-inflammatory drug (NSAID) to an oral emergency contraceptive pill (also known as the morning-after pill) showed that it increases the effectiveness of pregnancy prevention. The study findings were recently published in The Lancet.
Emergency contraception is a contraceptive method that can be used to prevent an unintended pregnancy when a regular contraceptive method fails or is not used. It can be in the form of an oral emergency contraceptive pill or the insertion of a copper intrauterine contraceptive device (Cu-IUD). The oral levonorgestrel emergency contraceptive pill is one of the most popular choices of emergency contraception and is widely used in most countries. It was pioneered by a clinical trial in Hong Kong led by HKUMed’s Professor Ho Pak-chung, published in 1993. However, all contraceptive methods have a failure rate. Hence, the research team is continuing its efforts to explore more effective options.
Prostaglandins mediate a number of biological processes, including inflammatory responses. In the reproductive system, prostaglandin is an important mediator of processes like ovulation, fertilisation and embryo implantation. The research team postulated that adding a medication that blocks prostaglandin synthesis may have an additional complementary effect in achieving contraception.
The collaborative research team, including members of LKS Faculty of Medicine of the University of Hong Kong (HKUMed), as well as The Family Planning Association of Hong Kong (FPAHK) and Sweden’s Karolinska Institutet, conducted the world’s first randomised, placebo-controlled trial on the use of piroxicam, an NSAID used to treat arthritis pain, which blocks prostaglandin production in the body, in combination with the levonorgestrel emergency contraceptive pill. The findings revealed that with the new combination regimen, only one out of 418 women became pregnant, while seven out of another 418 women receiving levonorgestrel and a placebo became pregnant. The results showed that the percentage of pregnancies prevented by piroxicam-levonorgestrel co-treatment (94.7%) was significantly higher than that of the levonorgestrel emergency contraceptive pill alone (63.4%). There was no significant difference in the occurrence of adverse effects, including changes to the menstrual bleeding pattern and stomach ache following intake of the two regimens.
Significance of the study
Chief-investigator Dr Raymond Li Hang-wun, from HKUMed, said, “Our study is the first to find that piroxicam, a readily available medication, taken at the same time as the levonorgestrel pill can prevent more pregnancies than levonorgestrel alone. We hope these findings will lead to further research and ultimately changes in clinical guidelines to enable women around the world to access more effective emergency contraception.”
Co-investigator Dr Sue Lo Seen-tsing, from FPAHK, said, “The levonorgestrel pill was registered in Hong Kong in 2002 and has been used safely since then. Locally, emergency contraceptives must be prescribed by healthcare providers, who assess which emergency contraceptive method is the most suitable in each case. Contraceptive counselling should be provided to help women seeking emergency contraception understand that it cannot replace regular contraceptives and to motivate them to use the latter. Since there is still a small failure rate, a follow-up visit is important. The levonorgestrel emergency contraception pill should be taken within 72 hours after unprotected sex; the earlier it is taken, the more effective it is.”
It is often enlightening for us at Spotlight to ask how and why certain services differ in the ways they do between the private and public healthcare sectors.
Take something as simple as needing medical help when you have a flu that just won’t go away. As a private sector patient, I’d call my GP’s office and make an appointment. Providing I get there on time, chances are I would at most be asked to wait for 10 or 20 minutes in a comfortable waiting room. By contrast, at many public healthcare facilities, you are not able to make an appointment, and often have to wait for long hours in a poorly ventilated and overcrowded waiting area and will likely end up seeing a nurse rather than a GP.
Some aspects of such differences are understandable, albeit deeply problematic. The shortage of doctors is much more acute in the public sector than in the private sector. There is a moral imperative to address this imbalance, but as previously argued, the current NHI plans are just one way to address it.
Why some public healthcare facilities still do not use appointment systems is harder to explain. Even if some users prefer to queue rather than to have appointments, it is odd that all facilities do not at least have hybrid systems with some appointments and some queueing. Having appointment systems is not rocket science and doesn’t have to cost millions.
There are, of course, other examples. As a private healthcare user, it is relatively trivial for me to get a six-month chronic medication script from my GP and to arrange for the medicines to be delivered to my home. Though there has been significant progress in this direction in the public sector, many people still find it hard to get scripts and collect their medicines.
Of course, differences in available resources are a large part of what is going on here, but it is not the whole story. As a private healthcare user, my needs, my preferences, and my time are generally respected in a way that seems rare in the public sector. To be clear, there are many committed healthcare workers in the public sector who show exemplary respect for their patients, but at a systemic level, as in the decision not to have appointment systems or not to allow for extended medicine refills, people’s time and needs are being disregarded.
Apart from the risk of corruption and mismanagement, much of the middle-class resistance to NHI may well have to do with the fear that people who can now access private healthcare services will become subject to precisely this kind of systemic indifference to their needs. And indeed, while the rhetoric around NHI has often been about ideals like the need for greater social solidarity, we haven’t really seen a vision presented of NHI as offering better, more respectful, and more personalised healthcare.
But, with a bit of flexibility, this could change.
Consider annual checkups. Rather than asking public sector patients to go to overcrowded clinics with long queues for tests, why not give public sector users the option of getting their basic screening tests for HIV, TB, hypertension, and diabetes done at private sector pharmacies along the lines of Discovery Health’s Annual Health Checkup. Of course, data systems will have to be developed to support this and it will have to be budgeted for, but the extra convenience will no doubt make a big difference for many and could help with early detection of these diseases. (We previously wrote about the idea of such an expanded annual checkup programme here.)
Getting the state to pay for such checkups at private sector pharmacies is not exactly NHI as set out in the bill, but the idea certainly shares some DNA.
To be fair, there are at least some exceptions that show such innovation is possible. Maybe most notably, these days many public sector patients can collect their chronic medicines at private pharmacies or other pickup points. Though still a work in progress, the evolution of the public sector medicines distribution system shows that we need not wait for the NHI Bill before taking steps to make things easier and more convenient for users.
In addition, with the NHI pilot projects we have seen at least some awareness that there is a need to try new things and learn from them. Unfortunately, on the whole the NHI pilot projects didn’t meaningfully pilot the key aspects of NHI, and where they did, as with GP contracting, it didn’t go well. And here one gets to the rub. From the outside one gets the impression that those who wanted to run pilots we could actually learn from lost out to those who consider the pilots just another step toward building political support for NHI.
As for the NHI Bill itself, the fact that the ANC and much of the portfolio committee on health, has been intent on reducing almost all discussion on the Bill to a simple for or against shows a clear disdain for meaningful engagement. Indeed, whatever its merits, the ANC’s version of NHI has become fundamentally associated with an overdose of ideology and an absence of curiosity and critical thinking.
But we don’t have to buy into the ANC’s sclerotic thinking.
There are many possible ways to reform and improve our healthcare system. Some will be affordable, some won’t. Either way, it would be foolish to simply turn our backs and pretend they are not there.
A new Japanese ecological study revealed that participation rates for Specific Health Checkups (SHC participation rates) had significant negative effects on standardised incidence rates (SIRs) of treated end-stage kidney disease (ESKD) and prevalence of chronic kidney disease (CKD). The findings support the importance of increasing SHC participation rates at the population level and encouraging people to undergo regular health checkups.
These factors were all relative to each of Japan’s administrative regions, known as prefectures. The findings were reported in Clinical and Experimental Nephrology.
“Japan has one of the highest incidence and prevalence rates of treated ESKD and substantial regional variation in the incidence of treated ESKD despite a uniform health care and insurance system and low ethnic and racial diversity,” said Dr Wakasugi, the corresponding author of the study. “Large variations have been observed by prefecture in participation rates for SHC, an annual health screening program introduced by Japan’s Ministry of Health, Labour and Welfare since 2008 to identify individuals requiring specific health guidance to reduce the number of people having or at risk for, metabolic syndrome.”
Using five sources of nationwide open data, the study revealed that SHC participation rates had significant direct negative effects on prefecture-specific standardised incidence rates (SIRs) and the prefecture-specific prevalence of CKD. Furthermore, through SHC participation rates, the ratio of nephrology specialists had a significant indirect negative effect on prefecture-specific SIRs, suggesting that a higher prefecture-specific ratio of nephrology specialists was associated with lower prefecture-specific SIRs. The structural equation modelling model explained 14% of the variance in prefecture-specific SIRs, indicating that prefecture-specific SHC participation rates can partially explain regional variation in prefecture-specific SIRs of treated ESKD.
“Our findings concord with the Neyagawa Health Checkups and Health Care in Kokuho Database study, which showed that men who did not attend health checkups and did not undergo a kidney test using dipstick urinalysis and/or serum creatinine measurement at medical facilities were at significantly higher risk of treated ESKD than those who attended checkups, especially among those aged ≥ 75 years,” said Dr Wakasugi. “Our findings provide evidence to support the importance of increasing SHC participation rates from a population-level perspective and encouraging people to undergo health checkups.”
The Department of Health has averted a standoff with nurses in the public sector with a last-minute agreement to pay nurses a temporary allowance to buy uniforms.
Nurses threatened to work in their own clothes if the department failed to provide them either with uniforms or with an allowance by 1 October. This plan was put on hold pending negotiations between unions and the health department.
Since 2005, nurses received an annual allowance to buy their uniforms. But this ended on 31 March this year after a new agreement was signed by the Public Health and Social Development Sectoral Bargaining Council. Under the new agreement, nurses would be provided with uniforms.
As a result, nurses did not get the usual allowance in April this year. Instead, they were supposed to be provided with uniforms by 1 October 2023.
The agreement stated that in the first year, the department must provide nurses with four sets of uniforms, one pair of shoes, and one jersey. In the second year, it must provide three sets of uniforms, one belt, and one jacket.
But then, at a last-minute meeting of the bargaining council in September, the department told unions that it would be unable to meet the 1 October deadline. It proposed to put on hold the supply of uniforms until 2024.
Spokesperson for the Democratic Nursing Association of South Africa (DENOSA) Sibongiseni Delihlazo said labour unions said that if the department was unable to supply the uniform by 1 October, they must pay nurses an allowance as previously.
If the department failed to provide uniforms or pay an allowance, DENOSA said, its 84,000 members would embark on an indefinite protest action by wearing their own clothes at work from 1 October.
Following the last-minute bargaining council meeting in September, a new agreement was signed on 4 October.
The bargaining council resolved that a temporary uniform allowance of R3,153 be paid to all qualifying nurses by 30 November 2023. The health department also agreed to provide nurses with uniforms by 1 September 2024.
If the department fails to provide the uniforms by 1 September 2024, “the uniform allowance shall continue, considering the applicable inflation rate annually, as pronounced by the National Treasury in February”, the agreement read.
Using a deep learning algorithm, which is a kind of artificial intelligence (AI), researchers reporting have found that dihydroartemisinin (DHA), an antimalarial drug and derivative of a traditional Chinese medicine, could treat osteoporosis as well. Publishing their findings in ACS Central Science, the team showed that in mice, DHA effectively reversed osteoporosis-related bone loss.
In healthy people, there is a balance between the osteoblasts that build new bone and osteoclasts that break it down. Current treatments for osteoporosis primarily focus on slowing the activity of the ‘wrecking crew’ of osteoclasts. But osteoblasts, or more specifically, their precursors known as bone marrow mesenchymal stem cells (BMMSCs), could be the basis for a different approach. During osteoporosis, these multipotent cells tend to turn into fat-creating cells instead, but they could be reprogrammed to help treat the disease. Previously, Zhengwei Xie and colleagues developed a deep learning algorithm that could predict how effectively certain small-molecule drugs reversed changes to gene expression associated with the disease. This time, joined by Yan Liu and Weiran Li, they wanted to use the algorithm to find a new treatment strategy for osteoporosis that focused on BMMSCs.
The team ran their program on a profile of differently expressed genes in newborn and adult mice. One of the top-ranked compounds identified was DHA, a derivative of artemisinin and a key component of malaria treatments. Administering DHA extract for six weeks to mice with induced osteoporosis significantly reduced bone loss in their femurs and nearly completely preserved bone structure. To improve delivery, the team designed a more robust system using injected, DHA-loaded nanoparticles. Bones of mice with osteoporosis that received the treatment were similar to those of the control group, and the treatment showed no evidence of toxicity. In further tests, the team determined that DHA interacted with BMMSCs to maintain their stemness and ultimately produce more osteoblasts. The researchers say that this work demonstrates that DHA is a promising therapeutic agent for osteoporosis.
People who eat just two servings of red meat per week may have an increased risk of developing type 2 diabetes compared to people who eat fewer servings, and the risk increases with greater consumption, according to a new study in The American Journal of Clinical Nutrition. However, substituting plant or diary protein for red meat was associated with reduced risk of type 2 diabetes.
“Our findings strongly support dietary guidelines that recommend limiting the consumption of red meat, and this applies to both processed and unprocessed red meat,” said first author Xiao Gu, postdoctoral research fellow in the Department of Nutrition at Harvard T.H. Chan School of Public Health.
While previous studies have found a link between red meat consumption and type 2 diabetes risk, this study, which analysed a large number of type 2 diabetes cases among participants being followed for an extended period of years, adds a greater level of certainty about the association.
Type 2 diabetes rates are increasing rapidly in the US and worldwide. This is concerning not only because the disease is a serious burden, but it also is a major risk factor for cardiovascular and kidney disease, cancer, and dementia.
For this study, the researchers analysed health data from 216 695 participants from the Nurses’ Health Study (NHS), NHS II, and Health Professionals Follow-up Study (HPFS). Diet was assessed with food frequency questionnaires every two to four years, for up to 36 years. During this time, more than 22 000 participants developed type 2 diabetes.
The researchers found that consumption of red meat, including processed and unprocessed red meat, was strongly associated with increased risk of type 2 diabetes. Participants who ate the most red meat had a 62% higher risk of developing type 2 diabetes compared to those who ate the least. Every additional daily serving of processed red meat was associated with a 46% greater risk of developing type 2 diabetes and every additional daily serving of unprocessed red meat was associated with a 24% greater risk.
The researchers also estimated the potential effects of substituting one daily serving of red meat for another protein source. They found that substituting a serving of nuts and legumes was associated with a 30% lower risk of type 2 diabetes, and substituting a serving of dairy products was associated with a 22% lower risk.
“Given our findings and previous work by others, a limit of about one serving per week of red meat would be reasonable for people wishing to optimise their health and wellbeing,” said senior author Walter Willett, professor of epidemiology and nutrition.
In addition to health benefits, swapping red meat for healthy plant protein sources would help reduce greenhouse gas emissions and climate change, and provide other environmental benefits, according to the researchers.
