Year: 2020

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COVID Antibodies in Children without the Disease

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One case in Australia of children producing COVID antibodies while being exposed to their parents were ill with the disease has shed light into the way children appear to remain largely unaffected by it.

The parents of three children fell ill after attending a wedding, developing COVID with all the normal symptoms. Fortunately, they did not require hospitalisation but the whole family was tested for COVID. To the amazement of clinicians, the test for all three children came back negative, as did a subsequent re-test. The two older children had mild symptoms of COVID.
“It was jaw-droppingly amazing because they’d spent a week and a half with us while we were COVID-positive,” said their mother, Leila Sawenko.

Intrigued, researchers asked the family to come back for a series of tests. While polymerase chain reaction (PCR) tests failed to detect SARS-CoV-2, saliva samples showed SARS-CoV-2 antibodies. The children’s cytokine levels remained low, consistent with their lack of symptoms. 

Researchers believe that, unlike their parents, the children’s immune system staged such an effective response that viral replication was severely restricted. 

“The discordance between the virological PCR results and clinical serological testing, despite an evident immune response, highlights limitations to the sensitivity of nasopharyngeal PCR and current diagnostic serology in children,” wrote the researchers.

Source: Science Alert

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Ovarian Cancer Risk not Raised by Fertility Treatments

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Existing research has thus far indicated that women who used assisted reproduction technologies (ART) were at greater risk for ovarian cancer and non-malignant borderline ovarian tumours resulting from overstimulation of the ovaries.

The tumours were proposed to be caused by excess sex hormones and disruption of ovarian tissue from multiple punctures. A pair of meta-analyses in 2013 indicated that women who used reproductive technologies were at increased risk of ovarian cancer, but no causative link was established; infertility itself could have caused the increased risk.

Researchers in the Netherlands used a database of 30 625 women who received ovarian stimulation for ART between 1983 and 2001 and 9 988 women who were infertile but did not use ART. These were linked to the Netherlands Cancer Registry and the Dutch Pathology Registry to check for invasive and borderline ovarian cancers.

Though there was an increase in ovarian cancer in women who had received ART, the increase was due to women who had received ART but not been able to fall pregnant: not having had a pregnancy has shown to be a risk factor for ovarian cancer.

Source: Medical Xpress

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Many HIV Deaths in Africa Due to Interrupted Care

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An article written for The Conversation explores the reasons why, in an era of antiretroviral therapy (ART), so many people around the world are still dying of HIV.

Despite fierce resistance under Thabo Mbeku’s leadership, ART became widely available in South Africa. Yet in 2019, despite the world’s largest ART programme with 71% coverage, there were still 72 000 HIV-related deaths in South Africa. 

Medecins Sans Frontieres (MSF) supports hospitals across Africa in treating people with HIV, but because patients present with advanced HIV up to a third die during their hospital stay.

HIV is a lifelong disease, and requires lifelong treatment. Some struggle to take tablets on a daily basis, risking drug resistance.

People with advanced HIV now typically have interrupted or failing treatment. MSF-funded studies in Kenya and the DRC showed that only 20-35% of patients with advanced HIV had never received ART.

The “Welcome Back Services” provided by Medecins Sans Frontieres in Khayelitsha, Cape Town are an example of getting patients who have lapsed back into care.

In deprived settings, TB is the leading cause of death for people with HIV, along with cryptococcal meningitis and bacterial infection. These are all treatable if caught in time; cryptococcal meningitis effectively has a zero survival rate but mortality can be reduced by 40% when treated with flucytosine and amphotericin B. By testing patients before they reach the stage where hospitalisation is necessary, survival rates can be greatly improved.

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Algorithm-driven Treatment Lowers LDL-c, Blood Pressure

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Clinicians working at Brigham and Women’s Hospital in the US treated patients with the aid of digital tools and an algorithm which calculated the titration of medication for pharmacists.

Over 5000 patients were enrolled into the study, entering either the cholesterol control program, the hypertension program, or both. Of those in the cholesterol program, 35% had established atherosclerotic cardiovascular disease (ASCVD); 25% had diabetes without ASCVD; and 31% had a low-density lipoprotein cholesterol (LDL-c) >190 mg/dL. 

Study lead author Benjamin Scirica, MD, MPH, a cardiologist at Brigham and Women’s Hospital and associate professor of medicine at the Harvard School of Medicine, said, “To better control cholesterol and blood pressure, both of which are major cardiovascular risk factors, we need new end-to-end treatment solutions that improve patient identification, data collection, education and care delivery, including standardizing medication regimens. We are redefining treatment pathways to address persistent gaps in health care, overcome clinical inertia and address the problems of limited access to physicians by expanding remotely-delivered care.”

Patients with high LDL-c and/or hypertension were identified using electronic patient records, and received a digital blood pressure cuff for at-home monitoring. With the aid of the algorithm, pharmacists and support staff initiated and titrated medication.

For patients who completed the titration phase of the program, a 52mg/dL (42%) decrease in LDL-c was observed, while for all patients, LDL-c levels dropped by 24mg/dL (18%) and 14mmHg systolic and 6mmHg diastolic blood pressure drops were recorded. Patients in high-risk categories saw significant drops in LDL-c.

The research showed that efficient, effective care was possible, while simultaneously reducing the need for physical consultations. Such enabling technology allows access to care delivery to be significantly expanded.

Source: Science Daily

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Il-10 Found to be Involved in Alcoholism

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Researchers have discovered that the anti-inflammatory IL-10 plays a direct role in alcoholism. Neurological research into addiction and alcohol has focused on the amygdala, which plays a key role in drives, emotions and behaviours.

Alcoholism is a growing problem in need of effective treatment. Interleukin 10 (IL-10) is an immune protein that has strong anti-inflammatory properties and is known to protect the brain from inflammation resulting from disease or injury.

In the brains of mice which chronically used alcohol, the amount of IL-10 was lowered in the amygdala and did not correctly signal neurons, and so was partly responsible for alcohol consumption behaviours. This was despite the overall higher level of IL-10 throughout the brains of chronic alcohol using mice.

“We found that chronic alcohol exposure compromises brain immune cells, which are important for maintaining healthy neurons,” said first author of the study Reesha Patel, PhD. “The resulting damage fuels anxiety and alcohol drinking that may lead to alcohol use disorder.”

The researchers counteracted the decrease of IL-10 amounts and signalling in mice, and the mice’s excessive alcohol use declined, and a decrease in anxiety was also noted.

Marisa Roberto, PhD, a professor in Scripps Research’s Department of Molecular Medicine, led the research. She said, “We’ve shown that inflammatory immune responses in the brain are very much at play in the development and maintenance of alcohol use disorder. But perhaps more importantly, we provided a new framework for therapeutic intervention, pointing to anti-inflammatory mechanisms.”

Source: Medical Xpress

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Human Transmission in 2019 Outbreak of Deadly Chapare Virus

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In 2019, five people were infected and three died near the Bolivian capital La Paz by the Chapare virus. US Centers for Disease Control and Prevention (CDC) researchers detailed new clues to the mysterious disease that have recently been uncovered.

The Chapare virus is an arenavirus, like the deadly Lassa virus which, in West Africa, causes thousands of deaths every year. Similar to the Ebola virus, arenaviruses can produce a haemorrhagic fever, causing multiple organ damage. 

The researchers identified human transmission from patients to healthcare workers, and believe that blood, semen and other bodily fluids can transmit the disease.
Caitlin Cossaboom, DVM, PhD, MPH, an epidemiologist with the CDC’s Division of High-Consequence Pathogens and Pathology, said, “Our work confirmed that a young medical resident, an ambulance medic and a gastroenterologist all contracted the virus after encounters with infected patients–and two of these healthcare workers later died. We now believe many bodily fluids can potentially carry the virus.”

Viral DNA was found in the semen of one the survivors, raising the prospect of sexual transmission. Viral DNA was also found in rodents in the area, although the researchers cautioned that it did not necessarily represent a source. 

“The genome sequence of the RNA we isolated in rodent specimens matches quite well with what we have seen in human cases,” Cassaboom said.

By pooling resources, researchers were able to make rapid headway in identifying the disease. Gene sequencing technology quickly confirmed the virus as a match for the original 2004 outbreak.

Source: Eureka Alert

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Major Cardiovascular Events Cut by Use of Polypills

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Results presented in a late-breaking clinical trial presentation at the American Heart Association’s Scientific Sessions 2020 reported that large randomised trial demonstrated that a simple polypill (containing cholesterol and blood pressure control medication) could significantly reduce cardiovascular risk.

In the International Polycap Study (TIPS)-3, 5700 participants in 9 countries were given either the polypill, aspirin, the polypill plus aspirin or Vitamin D and monitored for five years for major cardiovascular events.

The polypill contained atenolol 100mg, ramipril 10mg, hydrochlorothiazide 25 mg, and simvastatin 40 mg.

The combination of polypill and aspirin reduced cardiovascular events by 31%, whilst aspirin alone had a 14% reduction and 21% with polypill alone.

Salim Yusuf, MD, BS, D Phil, co-author of the study said, “Aspirin should be prescribed with a polypill in primary prevention for patients at intermediate risk of heart disease. Our study results provide important data regarding the role of the polypill in preventing the development of heart disease.”

Source: News-Medical.Net

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Weight Link to COVID Risk Emphasised by CDC

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The Centers for Disease Control and Prevention (CDC) in the US has included in its coronavirus risk warning people who are considered overweight (a BMI of 25 to 29.9, obese is above 30).

Dr Donald Hensrud, director of the Mayo Clinic Healthy Living Program, explained that obesity already is associated with several complications – diabetes, high blood pressure, dyslipidaemia and cardiovascular disease.

Dr Hensrud said, “Now COVID-19 comes along, and we’ve got all the issues we had before plus some additional ones. Obesity is associated with low-grade inflammation and an effect on our immune system. This affects our susceptibility to COVID-19. People who are obese are more likely to develop COVID-19 and complications from it, including dying, than people who aren’t obese. In addition, people with diabetes and some of the other complications from obesity are also at increased risk. So obesity and its complications independently take the risks of COVID-19 and elevate them significantly.”

Dr Hensrud said that he noted patients of his had put on weight during lockdown due to comfort eating and staying at home without any exercise. In order to reduce their risk, people should resolve to eat a healthy diet and engage in exercise, although he cautioned that losing more than 10% body weight in six months can impact the immune system.

Source: Medical Xpress

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Promising Drug May Worsen Instead of Treat Multiple Sclerosis

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A drug, TEPP-46,  that is being assessed to treat multiple sclerosis (MS) may in fact be worsening the progression of the disease, wrote University of Virginia on the Medical Xpress website.

MS is a debilitating disease which affects over one million people in America, in which the immune system attacks the myelin sheath, creating a range of effects in sufferers, from muscle spasms to numbness.

Presently available drugs to treat MS often have unwanted side effects, such as weakening the immune system. Originally developed to fight cancer, TEPP-46 is small-molecule drug that targets the changes in cellular metabolism that occur in both cancer and MS. However, the drug has been shown to produce off-target effects. In the mouse model used by the researchers, the inflammation was directed away from the spinal cord and into the brain. The researchers believed that this was the result of the drug harmfully changing T cells, but could not explain why. 

“It was not at all what we expected,” said MS researcher Alban Gaultier, PhD, of University of Virginia. “The take-home message is that we should be very careful and do more fundamental research before we propose to take this to clinical trials.”

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Moderna COVID Vaccine Confers 94.5% Protection

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The BBC reports that, hot on the heels of Pfizer/BioNTech’s announcement of 90% protection conferred by their vaccine, Moderna has announced that their trial with 30 000 participants has achieved a 94.5% level of protection.

This is based on the first 95 participants to develop COVID, with only five having received the vaccine while the others received the placebo. Additionally, although 11 participants developed severe COVID, none came from the vaccine group.

Slight, short-lived adverse effects including headaches, fatigue and pain were reported after receiving the vaccine by patients. Prof Peter Openshaw, of Imperial College London commented, “These effects are what we would expect with a vaccine that is working and inducing a good immune response.”

Moderna’s vaccine also has an advantage over the Pfizer vaccine in that it can be stored at -20C for up to six months, and in a refrigerator for one month. This will significantly improve the logistics of its distribution, requiring a less intensive cold storage chain.