Tag: 18/8/26

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Workers’ Pesticide Exposure Linked to 60-70% Heightened ALS Risk

On By ModernMedia

Increased risk of amyotrophic lateral sclerosis (ALS) associated with herbicides, insecticides
Men exposed to these chemicals may be twice as likely to develop ALS as unexposed men

Photo by Arjun Mj on Unsplash

Workplace exposure to pesticides (herbicides and insecticides) is linked to a 60-70% heightened risk of the most common form of motor neuron disease – amyotrophic lateral sclerosis, or ALS for short, finds a synthesis of the available evidence, published online in Occupational & Environmental Medicine.

Men who have been exposed to these chemicals may be twice as likely to develop the condition as those who haven’t been, the analysis indicates.

Although still relatively rare, the incidence of ALS – a progressive and rapidly fatal neurodegenerative disease for which there is no cure – has increased in recent years, note the researchers.

White the short term neurotoxic effects of pesticides, particularly insecticides, have been known for decades, there’s not a great deal of evidence on their potential long term neurotoxicity, they add.

In a bid to strengthen the evidence base, the researchers scrutinised research databases for relevant studies, including peer reviewed theses and scientific reports, on workplace exposure to pesticides and ALS, published between 1990 and 2025.

Eight case-control studies involving a total of 1734 cases of ALS, and 3 studies involving 457 cases of unspecified motor neuron disease, were retained for pooled data analysis from 767 initially screened articles.

This showed that compared with no exposure, any workplace exposure to pesticides was associated with a 60% heightened risk of ALS, based on the pooled data from 6 studies.

And based on the results of 3 studies, any exposure to high levels of pesticides was associated with a near tripling in risk compared with no pesticide exposure, whereas any exposure to lower levels was associated with a doubling in risk.

Compared with no exposure, exposure to herbicides was associated with a 70% heightened risk of developing the disease; exposure to either insecticides or fungicides was associated with a 60% heightened risk.

In studies that reported risk estimates stratified by sex, the pooled data analysis showed that exposed men were twice as likely as unexposed men (3 studies) to develop ALS.

But no increased risk was apparent in women who had been exposed to pesticides compared with those who hadn’t been.

The researchers highlight various limitations to their findings: the small number of available primary studies and their crude assessment of exposure, generally based on answers to a few limited questions.

“To strengthen the evidence on risk factors for ALS, primary studies particularly need methodological improvements on exposure assessment, on the selection of reference groups, and on adjustment for potential confounders, including analysis for interactions between risk factors,” they emphasise.

But they conclude: “The findings of this review add to the evidence that occupational exposure to pesticides may increase the risk of ALS and should encourage the implementation of interventions aimed at reducing exposure during occupational pesticide use.”

Source: The BMJ Group

Categories : VaccinesTags : Leave a comment

Sepsis Survivors Don’t Respond to Vaccines in the Same Way

On By ModernMedia
Image from Rawpixel

People who have survived intensive care unit admission with sepsis don’t respond to vaccines in the same way as those who haven’t had sepsis, according to new clinical trial results. The findings suggest that more work is needed to understand why the vaccine-related immune response is altered in sepsis survivors, so that vaccination programmes can be tailored to reduce sepsis survivors’ risk of infections and improve long-term health outcomes.

Sepsis survivors can have a weakened or altered immune system, which can increase the risk of new infections and death. Fifteen per cent of sepsis survivors die within a year of leaving hospital, with a further six to eight per cent dying every year over the next five years.

The VACIRiSS trial, led by King’s College London and Guy’s and St Thomas’ NHS Foundation Trust and funded by the National Institute for Health and Care Research (NIHR), found that a vaccine that helps protect against serious illnesses like pneumonia and meningitis in the general population did not reduce the risk of future infections or re-hospitalisations in adults who had survived sepsis.

The findings were published in Science Translational Medicine.

The long-term health impacts of sepsis survivors may not be receiving enough attention in health care. In the UK, one in three sepsis survivors are re-hospitalised within 90 days, with the majority of these re-hospitalisations from infections, and one in six patients are no longer alive at the end of the first year after recovering from sepsis. Despite this, there is no routine long-term follow up care for sepsis survivors in the NHS.

Professor Manu Shankar-Hari, Professor of Critical Care Medicine at King’s College London and Principal Investigator on the trial

Sepsis, a misfiring of immune responses to infection, can cause failure of vital organs and death if not treated quickly. Globally, it’s estimated that there are about 166 million sepsis cases and 21 million deaths from sepsis each year. Those who survive (approximately 145 million patients globally every year) are at increased risk of long-term ill health, including from recurrent infections.

While sepsis survivors may receive vaccinations as part of established vaccination programmes (such as flu or pneumonia vaccinations for older adults), vaccinations are not part of standard of care for sepsis survivors.

In the trial, 214 sepsis survivors were randomly assigned to receive a vaccine, called PCV13, or a placebo injection. Participants were followed up for a year to see whether the vaccine reduced their risk of re-hospitalisation with infection or death.

Overall, the vaccine did not reduce re-hospitalisation with infection or death in sepsis survivors. While blood tests showed that many participants did produce immune responses to the vaccine, the responses varied widely from person to person. The differences in vaccine responses were linked to factors such as age, body weight, sex, and levels of altered immune system before vaccination.

The findings suggest that established vaccination programmes may need to be modified to provide better protection to sepsis survivors. However, more needs to be done to understand the varied responses in sepsis survivors to inform what changes are needed.

Source: King’s College London

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Using Chilled Platelets Could Safely Expand Life-Saving Supply to Bleeding Patients

On By ModernMedia
Photo by Marcelo Leal on Unsplash

In a thoughtfully designed, adaptive clinical trial, University of Pittsburgh School of Medicine physician-scientists demonstrated that the United States could triple to quadruple the supply of platelets available to help save bleeding patients of all ages and extend the life-saving therapy into rural regions and community hospitals. Platelets are the component of blood that encourage clotting, plugging cuts and tears in blood vessels and stemming blood loss. 

Results from the Chilled Platelet Study (CHIPS) trial were announced Aug 17 in JAMA and under consideration by the US Food and Drug Administration and multiple other countries to revise regulations for use of refrigerated platelets stored for up to 21 days in actively bleeding patients. 

Of the 2.5 million room-temperature platelet units collected per year in the United States, roughly 10% to 20% are wasted due to the short shelf life, costing hospitals $300 million, according to recent research in the journal Hematology. 

“Our findings could result in major international public health benefits,” said lead author Philip Spinella, professor of surgery and of critical care medicine in Pitt’s School of Medicine and codirector of Pitt’s Trauma and Transfusion Medicine Research Center. “This is incredibly transformative and will dramatically improve the availability of platelets while also reducing waste, allowing hospitals that aren’t in major cities to afford to keep this life-saving blood product on hand for bleeding patients.” 

Currently, donated platelets are conventionally stored at room temperature with a five- to seven-day shelf life. Early studies conducted half a century ago in healthy volunteers led regulators to believe that refrigerating platelets to extend their shelf life made them less effective.  

Recent preclinical studies indicated the opposite, though, so Spinella and colleagues designed CHIPS to safely test using refrigerated platelets stored for increasing amounts of time up to 21 days. The trial enrolled 1000 paediatric and adult patients undergoing cardiac surgery at 27 sites in the United States and Australia from December 2021 to March 2025.  

The patients were randomised to receive either standard, room-temperature platelets stored for less than seven days or chilled platelets. At every 200 participants treated, independent data analysts looked at the results. If the chilled platelets were performing just as well as room temperature, they’d add up to another five days to the age of the chilled platelets used and enrol another 200 participants, up to a maximum of 21 days.  

The research team discovered that platelets refrigerated for up to three weeks were just as effective at treating bleeding as room-temperature platelets stored for up to one week. Since it can take two days for blood banks to process donations, the finding holds the potential to extend the lifespan of platelets for use in controlling bleeding by almost four-fold. 

“Rural and community hospitals, for the most part, simply cannot justify keeping room temperature platelets in stock – they don’t see enough severely bleeding patients, so the waste would far exceed the benefit, something our nation’s fragile blood supply chain cannot accommodate,” said coauthor Michael Boisen, cardiothoracic anaesthesiologist and medical director of the UPMC Patient Blood Management Program, who served as principal investigator for UPMC’s CHIPS trial site. “So, if we can safely extend the shelf life of platelets and reduce the waste, imagine how many more people we could help.” 

More than 97% of platelets are donated through apheresis, where a donor’s blood runs from a tube in their arm to a machine that collects the platelets and returns the rest of the blood back to the donor–a time-consuming process. The age of platelet donors has steadily increased over the past decade and younger donors are not replacing the aging donor base fast enough to keep up with demand, according to data from Vitalant, which supplied the platelets for the study and is one of the nation’s largest nonprofit blood and biotherapies services providers.  

“About 15% of hospitals can experience one or more delayed platelet transfusions within any given month due to supply shortages,” said Ralph Vassallo, Vitalant’s chief medical and scientific officer. “A 21-day shelf life for cold-stored platelets will reduce outdate rates and ensure platelets are available on hospital shelves when a surge in need occurs.” 

In addition to the civilian applications, the findings could also benefit military personnel by making it more feasible to have platelets available in conflict areas, said Spinella, who is also associate medical director of Pitt’s Center for Military Medicine Research. 

A unique facet of the trial is that it included children and babies from the start. Usually, clinical trials that aren’t specific to paediatric populations will exclude children. 

“I believe it is unethical not to include children in a trial when there isn’t a rational biological reason to exclude them,” Spinella said. “Of the 1,000 participants in our trial, roughly a third were children—which makes sense because it is the very young who bleed the most from cardiac surgery and most frequently benefit from platelets. Our trial will hopefully motivate others to include children in their trials.” 

Additional authors are listed in the JAMA article.  

Source: University of Pittsburgh School of Medicine

Categories : CancerTags : Leave a comment

Study Finds the Optimal PSA Cutoff for Evaluating Prostate Cancer Treatment

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Real-world study reveals the precise level associated with patient prognosis.

Credit: Darryl Leja National Human Genome Research Institute National Institutes Of Health

After treatment for metastatic prostate cancer, a drop in prostate-specific antigen (PSA) levels in the blood is an indicator that the treatment is working. A recent real-world study indicates that reaching a PSA level below 0.2 ng/mL is an indicator of improved patient survival. The study is published by Wiley online in CANCER, a peer-reviewed journal of the American Cancer Society.

Multiple phase 3 clinical trials have shown that a PSA level below 0.2 ng/mL is the best cut-off for determining a patient’s prognosis. Real-world data are lacking, however, and physicians often use other metrics, such as percentage of PSA decline, to assess treatment response. To determine whether there is a PSA response target associated with the most favourable outcome in community-dwelling adults with metastatic prostate cancer, investigators analysed Veterans Health Administration data on 4890 patients who received testosterone deprivation therapy with or without other treatments in 2018–2023 for metastatic hormone-sensitive prostate cancer.

Over a median follow-up of approximately 2 years, 896 patients died. Patients whose PSA levels dropped below 0.2 ng/mL within 9 months of starting treatment were 54% less likely to die than patients whose levels did not drop this low, whether their PSA levels also decreased by at least 90% or not. Patients who had at least a 90% PSA decline but did not achieve a PSA of less than 0.2 ng/ml had no improvement in survival. The findings suggest that patients who do not experience a PSA drop below 0.2 ng/mL could be candidates for more aggressive treatments. Also, patients who received testosterone deprivation therapy plus another drug to further block testosterone were more likely to reach a PSA below 0.2 ng/mL.

“These data show that we need to target a PSA below 0.2 ng/ml as our metric of success to optimize outcomes for our patients with metastatic prostate cancer,” said corresponding author Stephen J. Freedland, MD, professor of Urology at Cedars-Sinai and Staff Physician at the Durham VA Medical Center.

Source: Wiley