Year: 2020

Categories : COVIDTags : Leave a comment

No Lockdown May Worsen Economies

On By ModernMedia

In an article for The Conversation, Michael Smithson of the Australian National University argues that far from there being a toss-up between saving lives with a lockdown, and protecting the economy by keeping a country open, lockdown may in fact protect the economy.

Some arguments even leaned towards Indeed, US Treasury Secretary Steve Mnuchin said in June, “I think we’ve learned that if you shut down the economy, you’re going to create more damage.”

The choice of whether to implement lockdown has been a particularly difficult choice to make for South Africa, beset by deep inequality. Its lockdown caused its economy to shrink by 51% in the second quarter.

Economic and COVID data from 45 countries was sourced for analysis. The data has two outliers; namely China, which implemented a very effective early lockdown, and India, which implemented a strict lockdown that became very ineffective as time went by.

Consumer expenditure, an important indicator of economic activity, was negatively correlated with COVID cases, indicating that the economy fared better with attempts to suppress the virus (at least temporarily).

In European countries, GDP was positively correlated with COVID cases, indicating that economic activity itself drove up the rate of COVID cases. 

The article’s conclusions do have some limitations. The economic data were drawn from the second quarter, and COVID cases were taken as of June 30, but the pandemic hit different countries at different times. 

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Gauteng to Brace for Second COVID Wave in January

On By ModernMedia

Speaking at a memorial for healthcare workers who have died from COVID, acting MEC of Health Jacob Mamabolo says that the Gauteng health department is expecting a second wave of the virus in January.

Gauteng, which represents 30.1% of all cumulative COVID cases nationwide, is expected to see a resurgence on the back of holiday festivities and travel, based on modelling information supplied to the provincial command council.

“We need to be reminded that the battle with Covid-19 is not yet over. We are still in the outbreak stage and not in the post-Covid-19 period yet. Here in Tshwane we still have hotspots and areas that are of great worry such as Atteridgeville, Sunnyside, Ga-Rankuwa and Mamelodi,” said Mamabolo.

He further added that alcohol consumption would lead to people being discouraged in following the COVID health and safety rules, and that staff were already exhausted from a long year of fighting the disease. He added that it was necessary that extra staff were approved for the fight in the coming year.    Source: Rekord East

Categories : Ageing Pain ManagementTags : Leave a comment

New Drug Relieves Rheumatoid Arthritis Pain

On By ModernMedia

A new drug, otilimab, has shown effectiveness in treating rheumatoid arthritis (RA). Otilimab is a human monoclonal antibody which inhibits granulocyte-macrophage colony-stimulating factor (GM-CSF). GM-CSF is a large driver of immune-mediated inflammatory conditions.

The drug is currently being tested on its ability to suppress inflammation, tissue damage and pain in RA sufferers.

A multicentre, dose-ranging trial conducted with the drug. Participants were administered subcutaneous injections with one of five different dosages of otilimab (22.5 mg, 45 mg, 90 mg, 135 mg, or 180 mg) or placebo weekly for five weeks. Thereafter, they received injections once every two weeks for one year. The results showed a rapid reduction in tenderness and swelling, and a very high reduction in pain.

The study was unusual in that it offered an escape arm. It is often difficult to recruit participants when they know they may be receiving a dummy injection, and so if, after 12 weeks the participants  on the placebo arm derived no benefit, they were transferred to the highest dose arm of 180mg.

Source: Medical Xpress

Journal information: Christopher D Buckley et al, Efficacy, patient-reported outcomes, and safety of the anti-granulocyte macrophage colony-stimulating factor antibody otilimab (GSK3196165) in patients with rheumatoid arthritis: a randomised, phase 2b, dose-ranging study, The Lancet Rheumatology (2020). DOI: 10.1016/S2665-9913(20)30229-0

Categories : New Compounds and Treatments Skeletal SystemTags : Leave a comment

Osteoporosis Drug Enhances Natural Bone Formation

On By ModernMedia

A new osteoporosis drug, NaQuinate, that treats osteoporosis by enhancing its response to weight bearing, has completed its first human clinical trial. 

NaQuinate is a naphthoquinone carboxylic acid, and is found naturally as a Vitamin K metabolite. It has been shown in mouse models that NaQuinate responds synergistically to mechanical loading, building bone density. In a separate trial, the efficacy of NaQuinate is being evaluated against that of bisphosphonates without loading and anabolics with loading.

Haoma Medica’s Chief Medical Officer, Dr Cenk Oguz, said: ”We are delighted that the first-in-human study has completed its last dosing. There were no significant safety or tolerability concerns up to the highest doses tested which underlines our expectation that NaQuinate is safe and well tolerated.”
Haoma Medica’s CEO,  Dr Steve Deacon, said:”Our pre-clinical research has revealed an exciting feature of NaQuinate where it appears to have the capacity to work in harmony with the body’s natural response to weight bearing exercise to synergistically enhance bone formation when and where required – now that would be a ‘smart’ drug. Together with the safety data from this first-in-human study, this supports the potential that NaQuinate treatment could provide a safe, novel and smart therapeutic approach to bone disorders like osteoporosis and better maintain healthy skeletal aging.”

Source: PR NewsWire

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APPs Can Contribute More in Emergency Departments

On By ModernMedia

A recent study investigated how advanced practice providers (APPs) are being underutilised in emergency department settings.

The study, published in Academic Emergency Medicine concluded that, in comparison to ED physicians,  APPs such as physician assistants and registered nurse anaesthetists, see fewer complex patients and generate less value per unit hour.

The study, which investigates the impact of APPs in the ED on productivity, flow, safety, and experience, is the first of its kind.

However, the study suggests that APPs can be better integrated into EDs, minimising any adverse impact on ED flow, clinical quality, or patient experience. Furthermore, APPs, currently used for low-acuity cases, can add value with independent assessment of critical ED cases.

Source: News-Medical.Net

Journal information: Pines, J. M., et al. The Impact of Advanced Practice Provider Staffing on Emergency Department Care: Productivity, Flow, Safety, and Experience, Academic Emergency Medicine (2020) doi.org/10.1111/acem.14077

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New Minimally Invasive Way to Sample Interstitial Fluid

On By ModernMedia

A new method to extract dermal interstitial fluid (ISF) for analysis has been reported. ISF contains a large number of biomarkers which can be used for diagnosis.

The minimally invasive process uses an array of almost invisibly small needles, approximately one quarter of a millimetre long. These were pressed to the skin and suction applied. Care needed to be taken so that the needles did not poke into microcapillaries in the skin and thus contaminate the sample with blood. 

Blood is often used for testing, comprising some 6% of the human body’s fluids, but some 10 000 compounds are found in ISF and 12% of the chemicals are not found in the blood. With the technique, the researchers were also able to measure the effects of glucose and caffeine, which are dynamically active. Traditional methods used to extract are quite invasive; using a needle to withdraw ISF from a vacuum-induced blister, or surgically inserting tubes underneath the skin.

Although the procedure is still time consuming, taking some 20 minutes per patient, it compares to the ~40 minutes required to form a vacuum blister in some ISF sampling protocols. The small needle injuries healed within a day, and there was minimal irritation.

This form of testing could have many applications, such as skin toxicological studies and monitoring glucose levels.

The journal article has been published in Science Translational Medicine.

Source: News-Medical.Net

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Gut Microbiota Have Large Effects on Immune System

On By ModernMedia

For the first time, immune cells in the bloodstream have been shown to be affected by the makeup of gut microbiota.

In recent years, there has been increased interest in gut microorganisms and their influence on human health, partly as a result of improvements in the ability to study them. Much prior understanding of gut microbiota on the immune system comes from animal studies; this study was able to examine the effects in humans. This study used data from allogeneic stem cell and bone marrow transplants (BMTs), where the patient’s blood formation system is destroyed by radiation or chemotherapy and replaced with stem cells from a donor’s bone marrow. The patient is given antibiotics until the transplanted cells are able to re-establish the immune system, the gut microbiota being destroyed in the process and then re-establishing once the antibiotics are withdrawn. Over a period of ten years, a multidisciplinary team with the Memorial Sloan Kettering Cancer Center took blood and faecal samples from BMT patients.

Study author Dr Joao Xavier said, “Our study shows that we can learn a lot from stool—biological samples that literally would be flushed down the toilet. The result of collecting them is that we have a unique dataset with thousands of datapoints that we can use to ask questions about the dynamics of this relationship.”
“The parallel recoveries of the immune system and the microbiota, both of which are damaged and then restored, gives us a unique opportunity to analyse the associations between these two systems,” lead author Dr Jonas Schluter said.

A higher diversity of microbiota was shown to lower the risk of death following a BMT, and a lower diversity increased the risk of graft-versus-host disease, a potentially fatal condition where the transplanted marrow attacks the host’s body.

“Because experiments with people are often impossible, we are left with what we can observe,” Dr. Schluter noted. “But because we have so many data collected over a period of time when the immune system of patients as well as the microbiome shift dramatically, we can start to see patterns. This gives us a good start toward understanding the forces that the microbiota exerts on the rebuilding of the immune system.”

Source: Medical Xpress

Journal information: Jonas Schluter et al. The gut microbiota is associated with immune cell dynamics in humans, Nature (2020). DOI: 10.1038/s41586-020-2971-8

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Questions Raised over Oxford’s Unusual Vaccine Regimen

On By ModernMedia

The recent announcement of the Oxford’s and AstraZeneca’s vaccine trial being 70% effective up to 90% effective has raised some pointed questions.

The trial had two treatment arms, one receiving two full doses of the AZD1222 vaccine and a half dose plus a full dose, with the doses being administered 28 days apart. The “half dose then full dose”  treatment arm reported the 90% protection. The problem was that the trial was never meant to have such an arm. 

It was noticed that some participants were only receiving a half dose because they were experiencing fewer effects than expected such as arm pain and headache. This was subsequently corrected so that they would still receive the full dose on the second administration.

Of particular concern is that the “90% effectiveness” is based on a much smaller subset of the trial participants, with a correspondingly higher statistical uncertainty. So much so that there is statistical overlap with their lower effectiveness of 62% quoted for the two full doses. Furthermore, the participants were from the initial stages of the vaccine trial, where they were aged 18-55 and therefore have little applicability to the results of the main trial which included older age groups as well. 

The details of exactly why the half-measure doses came to be administered in the first place have not been revealed by Oxford or AstraZeneca. Meanwhile in the US, a Phase III of the trial is being rolled out with 40 000 participants, and the “half dose then full dose” regimen may be included – however, uncertainty about it and whether it isn’t a statistical fluke will have to be cleared up first.

Source: Ars Technica

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Simple New Method to Improve Time Release of Drugs

On By ModernMedia

Researchers have developed a new method to measure the release of drugs over time, using a simple method.

OxyContin, containing the opiate oxycodone, was intended to offer 12-hour pain relief. Instead, in some patients it dissolved much more quickly, causing them to take it more frequently and ultimately become addicted. But assessing how a drug dissolves in the body is surprisingly tricky. Drug dissolution has to be measured under laboratory conditions that come as close as possible to mimicking what happens in the body.

Corresponding author William Grover, associate professor of bioengineering at the Marlan and Rosemary Bourns College of Engineering explains: “We directly measured dissolution profiles of single drug granules, which are the little spheres you see when you open up a capsule. We accomplished this using a vibrating tube sensor, which is just a piece of glass tubing bent in the shape of a tuning fork.”

Many factors influence the way a drug is dissolved in the body, such as the chemical composition and pH of the fluid, the patient’s sex and their metabolism. Meals taken also have a strong impact: taking a fatty meal increases the amount of oxycodone released from OxyContin by 25%.

Pharmaceutical companies simulate these conditions in test vessels to build a profile of how the drug works over time, but this has its drawbacks. The position of tablets in the vessels can affect dissolution rates; equipment can become clogged; the process is very time-consuming and they only provide brief snapshots over time.

The new approach takes a radically different approach, measuring the mass of a drug granule as it dissolves. This is accomplished by changes in the resonant frequency, which can be measured over time instead of being sampled.

Using the technique on three proton-pump inhibitors, the researchers found considerable variations between name-brand and generic formulations of the drugs, affecting the rate at which the drugs are absorbed by patients.

“Our technique is much cheaper and easier to perform than conventional methods, and that enables pharmaceutical companies to do more tests in a wider variety of conditions,” said Grover. “We can also easily see differences in dissolution between individual particles in a drug. That should help pharmaceutical companies improve and monitor the consistency of their manufacturing processes.”

Source: Medical Xpress

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AI Solutions Are No Magic Bullet Against COVID

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A leading researcher in the field of medical image analysis has cautioned against the rush to provide AI solutions to the COVID pandemic, arguing that the need to help out must not compromise scientific principles.

Prof Hamid Tizhoosh, head of KIMIA Lab, Faculty of Engineering at the University of Waterloo wrote a piece on Medical-News.Net where he laid out the problems involved in such “quick fix” solutions.

He explains that AI researchers often make “toy” datasets which they use to experiment with in their own labs. In the middle of the pandemic, it is difficult to collaborate with radiographers who have their hands full dealing with COVID patients’ images.

AI research requires the acquisition and curation of large amounts of high-quality data, and currently there is an absence of this. While there are still few publicly available X-ray images or CT images of COVID patients’ lungs, they are beginning to crop up on the internet. AI researchers and enthusiasts are scraping together these images for their data sets and supplementing them with those of pneumonia patients, which are much more readily available. The results of their AI work are being released in papers that are not peer reviewed, yet some claim to be authoritative solutions.

Tizhoosh draws attention to the validity of this data. In one instance, he saw that the data included a pneumonia case from a paediatric patient. He cautions that, “AI is neither a ventilator nor a vaccine nor a pill; it is extremely unlikely that the exhausted radiologists in Wuhan, Qom or Bergamo download the Python code of our poorly trained network (using insufficient and improper data and described in quickly written papers and blogs) to just obtain a flawed second opinion.”

He concludes that the AI developments must come after appropriate images are made available by hospitals, that ethics approval is received and the data is properly de-identified.