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Unmedicated Autism Associated With Substance Abuse

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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

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Brown Fat May Protect Against Multiple Chronic Diseases

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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

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New “Spray-on” Wound Dressing Mimics Skin

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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

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SA Scientists Warn Local COVID Variant May Resist Vaccine

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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 

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Interviews Reveal Most Important ICU Outcomes for Patients and Family

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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.

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Media Imagery Should Match the Safety Message

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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

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2020 Saw Huge Growth in Metformin Recalls

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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

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COVID Vaccinations for Those Who Have Recovered?

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As mass COVID vaccination programmes get underway around the world, an Op-Ed in MedPage Today debates whether people who have recovered from COVID should receive a vaccination.

Even given that there are over 200 vaccines in development, with a typical 7% success rate for vaccines, the 80-95% efficacy reported for the various vaccines being administered and the numbers of successful vaccines is a great outcome. Despite this, considering the great difficulty in producing enough vaccines for the world, should perhaps people who recovered from COVID not receive the vaccine, as they now are protected by a level of immunity?

The perspectives of immunology and bioethics indicate why such a person should also be vaccinated. There would be no difference in vaccinating a person who has had COVID to a person who has recovered then been re-exposed or re-infected. In both cases, a rapid immune response will be mounted in either individual, and either will be asymptomatic or present with mild, manageable symptoms. A re-exposure to the SARS-CoV-2 virus or receiving a vaccine might strengthen such a person’s immunity to future COVID infections.The immune system maintains an immunological library in our lymphatic system which stores memory lymphocytes (B cells) that respond to any past infection encountered by an individual. On a second or third exposure to a particular pathogen, these B cells are mobilised and rapidly prevent re-infection. Vaccines are designed to mimic a viral exposure without eliciting a dangerous viral infection. B cells don’t cause illness, only prompting the immune system, mitigating the infection.
Furthermore, vaccinations confer additional protections beyond just that of the disease which they are meant to protect against. There are abundant data that shows that vaccinations against measles, influenza, or TB generate lymphocytes that even help protect vaccinated individuals against COVID. In one theory on why young children do not present with severe COVID, standard childhood vaccinations are believed to  boost their overall level of immunity.

With so many factors complicating vaccine administration, it is best not to add yet another wrinkle, and there is also no information to suggest that vaccinating someone who has recovered from a virus will cause harmful effects. On the contrary, re-exposure to a virus or a subsequent vaccination against that virus could generate superior lymphocytes to combat further infection.

Source:MedPage Today

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New Year Sees SA Hospitals Battling for Resources Amid COVID Surge

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As the new year begins, South African hospitals are struggling as unprecedented numbers of COVID cases in the second wave are pushing resources to the limit. Hospitals are having to cope with the situation even as their own workers are off sick or self-isolating.

Last week, at least one province was reported to have reached out to the army to request additional personnel to help cope with the additional burden. Wester Cape premier Alan Winde said the province was recruiting an additional 1 300 health care workers (HCWs)In a weekly media briefing, KwaZulu-Natal premier Sihle Zikalala stated on Sunday that a total of 8 723 public sector HCWs had been infected with COVID since the start of the pandemic.

“Of the total infected, 98 have sadly succumbed to the disease. The majority of the infected health-care workers are nurses,” he said. HCWs are also struggling with burnout and illness.  Experts had long been predicting the impact the second wave would have on South Africa’s already weakened health infrastructure. As of Sunday, 3rd January, there were a total of 167 492 active cases in the country.  

Dr Kams Govender, who works west of Durban, said: “What we are experiencing now is just the tremor, the tsunami is yet to come in mid January. It’s hit us hard and it’s going to hit us even harder then. We are physically and emotionally exhausted, and worse, losing our health-care colleagues every single day. But still we push on and show up and pray for better days where there is more light than darkness.”

The hospital at Prince Mshiyeni Memorial Hospital (PMMH) in Umlazi, KZN, was reported to be full and bodies had to be taken to funeral homes within 48 hours.

One nurse at PMMH said, “The hospital is full, the Covid wards are full, the normal wards are full. There are no beds for our outpatients, they lie in the passage on stretchers waiting for beds. The Covid patients will be placed with one another in a consultation room. We try to separate them but it’s not a proper place for patients to be in because there are no beds, just the stretchers. We are running out of oxygen points because there are so many patients that need oxygen. We tend to prioritise who needs it more, but right now everyone needs it.”
Source: Sowetan Live

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WHO Team Barred from Entry into China

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According to the World Health Organization, its team sent to China to investigate the origins of COVID were denied entry.

Conveying his disappointment at the team being barred from entry into China due to visas not being issued, WHO Director-General Tedros Adhanom Ghebreyesus said, “today, we learned that Chinese officials have not yet finalized the necessary permissions for the team’s arrival in China.”

Addressing the media in Geneva, he continued, “I’m very disappointed with this news, given that two members had already begun their journeys and others were not able to travel at the last minute, but had been in contact with senior Chinese officials.”

“But I have been in contact with senior Chinese officials. And I have once again made it clear that the mission is a priority for WHO and the international team.” He added, “We are eager to get the mission underway as soon as possible.” 

The experts were to investigate the origins of the SARS-CoV-2 virus in Wuhan.  The team of 10 will be led by Peter Ben Embarek, WHO’s expert on zoonoses – diseases that cross over the species barrier into humans from animals.

Dr Michael Ryan, the emergencies chief at WHO, said the understanding was that the team would begin the deployment from Tuesday, and that two of its members had begun travelling to China, with one member already turned back due to visa issues while the other was still in transit.

“We did not want to put people in the air unnecessarily if there wasn’t a guarantee of their arrival in China being successful,” said Ryan. “Dr Tedros has taken immediate action and has spoken with senior Chinese officials and has fully impressed upon them the absolute critical nature of this.”
“We hope that this is just a logistical and bureaucratic issue that can be resolved very quickly,” he continued.

According to the The Financial Times, Hua Chunying, the Chinese foreign ministry spokesperson, on Wednesday said, “Tracing the source [of the virus] is a complicated issue. To ensure that the international team’s work progresses smoothly, they must go through the necessary procedures.”

Source: The Independent