Month: January 2021

Categories : COVID Medical Industry VaccinesTags : 1 Comment

Johnson & Johnson is Behind on Vaccine Production

On By ModernMedia

Despite releasing promising data on its COVID vaccine, Johnson & Johnson may fall up to two months behind on its vaccine production schedule, Politico reported. The company is still committed to releasing the trial data on its 45 000 participants by the end of January to pave the way for approval.

If approved, as seems likely, the vaccine would be extremely beneficial for vaccination efforts as it would only require a single dose to confer protection and also would not require sub zero refrigeration, greatly simplifying vaccination efforts.

The company’s effort is part of the Operation Warp Speed initiative to vaccinate the US population as fast as possible, with a goal of vaccinating 80% of the country’s 330.7 million population by the end of June. The previous goal to distribute 20 million doses by the end of 2020 had already fallen short owing to insufficient production.

The co-director of Operation Warp Speed, Moncef Slaoui, hinted at a production slowdown, telling the media that the company was expecting to produce “single-digit million” doses by the second half of February. “We’re trying to make that number get as close to a double-digit number as possible, and then a larger number in March and a much larger number in April,” he added.

Johnson & Johnson had previously made a pledge to deliver 12 million doses by the end of February and as many as 100 million by June.

Despite the delay, there is good news in that initial data from 400 participants shows that the vaccine is safe and has a 90% efficacy in establishing antibodies, with immunity for most subjects established 29 days after the shot and lasting at least 57 days. Adverse reactions were reported to be be mild, and younger subjects were more likely to report them, with one subject experiencing a brief, mild fever.

Source: Politico

Categories : COVIDTags :

Telemedicine Promising for Visits After Low-Risk Surgery

On By ModernMedia

A pair of reports suggests that modern communication methods may be appropriate for post-surgery recovery, albeit at the risk of exacerbating the downsides of any language barriers and digital literacy.

In the midst of the COVID pandemic, telemedicine uptake and use has been greatly expanded by health care providers. In one small trial, cut short by COVID, researchers investigated whether telemedicine was an adequate form of patient follow-up after low-risk surgery.

The video-based post-discharge visits were as effective in terms of getting patients to return to the hospital within 30 days for a hospital encounter. The video visits were half an hour shorter but provided patients with the same amount of time with their surgeons.

However, out of 1645 individuals screened, many participants were excluded due to language difficulties, and 50 were excluded due to a “technology barrier”.

Caroline Reinke, MD, MSHP, of Carolinas Medical Center in Charlotte, North Carolina, and her team wrote, “Patients and clinicians should be reassured that the critical visit portion, time together discussing medical needs, is preserved. This information will help surgeons and patients feel more confident in using video-based virtual visits.”

Reinke and her team noted that COVID cut the study short: “Although we did not reach target enrollment, noninferiority was demonstrated for postdischarge virtual visits in our study sample and was further supported via a simulation model.”

In another study, Marie-Laure Cittanova, MD, PhD, of Clinique Saint Jean de Dieu in Paris, and her team compared using SMS to contact patients as opposed to calling them. When contacted after being told to expect a contact throughout the following day, 46.2% of patients were reachable by phone, compared to 85.3% by SMS.

Patients expressed similar levels of satisfaction with the SMS service, which was significantly cheaper than using phone calls. However, the single-centre study lacked generalisability.

Source: MedPage Today

Journal information (primary source): Harkey K, et al “Postdischarge virtual visits for low-risk surgeries: a randomized noninferiority clinical trial” JAMA Surg 2021; DOI: 10.1001/jamasurg.2020.6265.

Journal information (secondary source): Cittanova M, et al “Association of automated text messaging with patient response rate after same-day surgery” JAMA Surg 2021; DOI: 10.1001/jamanetworkopen.2020.33312.

Categories : COVIDTags :

WHO Team Arrives in China for COVID Origin Investigations

On By ModernMedia

Following months of negotiations, and then a list minute hiccough when two team members were denied entry last week, a team of 10 specialists from the WHO arrives in China to carry out their investigations into the origins of COVID.

China, through rapid action and total lockdowns, managed to clamp down on the coronavirus outbreak inside its borders, preventing it from spreading significantly outside of Wuhan, while in Wuhan itself, life has largely returned to normal. In recent weeks, however, new cases have been appearing in Hebei province around Beijing and in Heilongjiang province in the northeast.

Just before travelling, team leader Peter Ben Embarek told AFP news agency that it “could be a very long journey before we get a full understanding of what happened”.

He cautioned against expecting instant results, saying, “I don’t think we will have clear answers after this initial mission, but we will be on the way,” he said.

For a number of months, China has been saying that the virus may not have originated in Wuhan. There has been a lot of unsubstantiated speculation that the SARS-CoV-2 might have been accidentally released from a lab.

Prof Dale Fisher, chair of the global outbreak and response unit at the WHO, told the BBC that he hoped the rest of the world would regard this as a scientific visit. “It’s not about politics or blame but getting to the bottom of a scientific question,” he said.

When the WHO team arrives in China, they will still have to wait through a two week quarantine. Fabian Leendertz, a professor in the epidemiology of highly pathogenic microorganisms at Germany’s public health institute and working remotely with the team, says that their plan of action will be developed over the next two weeks while they are still in quarantine. The team is expected to look at the infamous wet market in Wuhan where it was originally believed the virus made the jump from animals to humans, as well as working with Chinese colleagues and local clinics to establish a picture of the virus’ origins.

Source: BBC News

Categories : UncategorizedTags :

Light Drinking Still Raises Atrial Fibrillation Risk

On By ModernMedia

Even light drinking is associated with an increased risk of atrial fibrillation (Afib) for both sexes, according to a large cohort study by Renate Schnabel, MD, of University Heart & Vascular Center Hamburg, and colleagues.

Drawing on five European cohorts totalling 100 092 participants, the researchers found that 12g of alcohol (one beer can) was associated with increased risk of Afib (Hazard Ratio 1.16, 95% Confidence Interval 1.11-1.22).  A small amount of alcohol (2g) per day was still marginally associated with an increase in Afib risk after 14 years (HR 1.02, 95% CI 1.0-1.04). The association remained after accounting for heart failure history and the cardiac biomarkers NT-proBNP and hs-troponin I, and there was no difference in results between males and females.

There was a J-shaped relationship observed, where drinking more than 20g per day was associated with increased risk.To date, there had been little information on the cardiac effects of chronic light drinking, and the results showed that lowering alcohol intake was an important part of managing Afib, it was noted in an accompanying editorial. It was also noted that these results needed further randomised trials.

The team acknowledged the study’s limitation on relying on self-reported alcohol consumption, and also cases of Afib not being detected. The editorial noted that the study did not state the absolute risk of Afib, which needed to be taken in consideration along with the benefits of low levels of alcohol consumption

Source: MedPage Today

Journal information (primary source): Csengeri D, et al “Alcohol consumption, cardiac biomarkers, and risk of atrial fibrillation and adverse outcomes” Eur Heart J 2021; DOI: 10.1093/eurheartj/ehaa953.

Journal information (secondary source): Wong JA and Conen D “Alcohol consumption, atrial fibrillation, and cardiovascular disease: finding the right balance” Eur Heart J 2021; DOI: 10.1093/eurheartj/ehaa955.

Categories : Ageing Diet and Nutrition Mental HealthTags :

Mediterranean-type Diets Protect Against Parkinson’s Disease

On By ModernMedia

Researchers at the University of British Columbia have shown that the Mediterranean diet and another diet based on it, have a strong link in protecting against Parkinson’s disease (PD). 

These two diets had previously been shown that they could protect against other neurodegenerative diseases. The Mediterranean‐DASH Intervention for Neurodegenerative Delay (MIND) diet combines aspects of the Mediterranean diet and the DASH diet which protects against hypertension. The MIND diet emphasises consumption of berries, as research shows that they protect against mental decline, eating leafy greens and poultry. The MIND diet also mostly does away with potato, milk and fruit (excluding berries).

Senior author Dr Silke Appel-Cresswell said, “There is a lack of medications to prevent or delay Parkinson’s disease yet we are optimistic that this new evidence suggests nutrition could potentially delay onset of the disease.”
Following the diets delayed the average onset of PD by 17.4 years in women, and 8.4 years in men.

Since PD already has a notable sex difference, with 60% of sufferers being men, despite their shorter average lifespan, the sex difference in response to the diets opens new avenues of research
“It drives home the connection between the gut and the brain for this disease,” Dr Brett Finlay said. “It also shows it’s not just one disease that healthy eating can affect, but several of these cognitive diseases.”

Source: Medical Xpress

Journal information: Avril Metcalfe‐Roach et al, MIND and Mediterranean Diets Associated with Later Onset of Parkinson’s Disease, Movement Disorders (2021). DOI: 10.1002/mds.28464

Categories : Allergies GastrointestinalTags :

Stomach Bugs Induce Irritable Bowel Syndrome

On By ModernMedia

Researchers have pinpointed a localised biological mechanism behind irritable bowel syndrome (IBS), a chronic gastrointestinal condition where eating certain foods causes subsequent abdominal pain or discomfort.

Around 20% of people experience IBS, and diets such as gluten-free ones provide some relief. However, the exact cause was unknown, as the patients did not have allergic responses nor did they have coeliac disease, causing many physicians to dismiss it as psychological.A healthy immune system tolerates foods, and the first link is understanding how the tolerance is removed. Previous work showed that there was a link between mast cells and food, and that blocking histamine in people with IBS relieved the symptoms.

People with IBS often report their symptoms begin following a gastrointestinal infection, so the researchers reasoned that an infection associated with a particular type of food in the guy might sensitise the immune system to that food.The team fed mice with ovalbumin (an egg protein) and then infected them with a stomach bug. The mice were then fed ovalbumin again, and the researchers recorded elevated mast cell activation, histamine levels and digestive intolerance. In control mice who were fed with ovalbumin but who were not infected with the stomach bug, there was no response.

Breaking down the chain of events leading to the sensitisation, the researchers discovered that there was a localised immune response in the part of the guy infected by the bacteria, but did not produce the more generalised symptoms of a food allergy.  

Lead author Prof Guy Boeckxstaens, a gastroenterologist at KU Leuven thinks this may point to a spectrum of food-related immune disorders. He said, “At one end of the spectrum, the immune response to a food antigen is very local, as in IBS. At the other end of the spectrum is food allergy, comprising a generalised condition of severe mast cell activation, with an impact on breathing, blood pressure, and so on.”

When researchers injected IBS-associated food antigens into the intestinal walls of IBS patients, they observed localised reactions similar to what they saw in the mice, and there were no reactions in healthy patients. Larger clinical trials will be needed to confirm these observations.

“This is further proof that the mechanism we have unraveled has clinical relevance,”  Prof Guy Boeckxstaens said. “But knowing the mechanism that leads to mast cell activation is crucial, and will lead to novel therapies for these patients,” he goes on. “Mast cells release many more compounds and mediators than just histamine, so if you can block the activation of these cells, I believe you will have a much more efficient therapy.”

Source: Medical Xpress

Journal information: Local immune response to food antigens drives meal-induced abdominal pain, Nature (2021). DOI: 10.1038/s41586-020-03118-2 , www.nature.com/articles/s41586-020-03118-2

Categories : Mental HealthTags :

Depression May be Influenced by Metabolism

On By ModernMedia

A study by researchers from University of California San Diego School of Medicine and from the Netherlands, has shown that major depressive disorder (MDD) may be predicted by metabolism, in the form of certain metabolites.

MDD is one of the most common disorders, with a lifetime prevalence of 20.6% in the United States. For those with recurrent major depressive disorder (rMDD), the risk is 80% over five years.

MDD is characterised by any combination of feelings of sadness or hopelessness, anger or frustration, loss of interest, sleep disturbances, anxiety, slowed or difficulty thinking, suicidal thoughts and unexplained pain such as backaches.

“This is evidence for a mitochondrial nexus at the heart of depression,” said senior author Prof Robert K Naviaux, at UC San Diego School of Medicine. “It’s a small study, but it is the first to show the potential of using metabolic markers as predictive clinical indicators of patients at greatest risk—and lower risk—for recurring bouts of major depressive symptoms.”

Recruiting 68 participants who were in remission for rMDD and not on antidepressants, the researchers found a range of molecules in participants’ blood that were up to 90% predictive of relapse in 30 months. The most predictive molecules consisted of certain lipids and purines.

Purines are produced from molecules such as ATP and ADP (major cellular energy storage molecules), and also have a role in signalling in stressed cells.The researchers found that in subjects with rMDD, certain metabolites in six metabolic pathways resulted in the alteration of key cellular activities.

“The findings revealed an underlying biochemical signature in remitted rMDD that set diagnosed patients apart from healthy controls,” Naviaux said. “These differences are not visible through ordinary clinical assessment, but suggest that the use of metabolomics—the biological study of metabolites—could be a new tool for predicting which patients are most vulnerable to a recurrence of depressive symptoms.”

Source: Medical Xpress

Journal information: Roel J. T. Mocking et al. Metabolic features of recurrent major depressive disorder in remission, and the risk of future recurrence, Translational Psychiatry (2021). DOI: 10.1038/s41398-020-01182-w

Categories : GastrointestinalTags :

Faecal Transplants Safe in the Long Term for C. Diff Treatment

On By ModernMedia

A new study from the Mayo Clinic has provided more evidence for the safety and efficacy of faecal microbiota transplantation (FMT) in treating Clostridioides difficile infection (CDI).

Recruiting 609 patients diagnosed with CDI, 20% of whom were overweight or obese and 22.8% had inflammatory bowel disease (IBD), FMT was performed with a stool product from a common donor. At a short term follow-up, >60% of patients had diarrhoea, <33% had constipation, and 9.5% reported additional CDI episodes after one year. At long-term follow up (median 3.7 years), there 73 new diagnoses out of 477 patients, 13% had gastrointestinal problems, 10% had weight gain, and 11.8% had new unrelated infections.

However, this was marked by the appearance of additional medical conditions such as weight gain and irritable bowel syndrome, which the authors indicated should be investigated further. The study also did not use a standardised questionnaire for IBS, making those results harder to generalise, and there was no control group. However, administering questionnaires over an extended period to all participants instead of only a brief period shortly after FMT explains why there are fewer symptoms reported compared to other studies.  

A separate study with 207 patients receiving FMT showed 143 new diagnoses after the procedure, with a mean follow-up of 34 months. The researchers conducting this second study attribute the ability of FMT to reduce CDI to enhancements in CD4+ T cell and antibody-mediated immunity to C. difficile toxins such as TcdB.

“These results are important for the design of disease monitoring strategies and highlight that future study of how FMT influences pathogen specific immunity is warranted: specifically, determining if effectively restoring the TcdB specific cellular repertoire to healthy control proportions contributes to treatment success of FMT,” the researchers wrote.

These studies add to the growing body of evidence that show FMT combined with antibiotics is an effective way to treat CDI.

Source: MedPage Today

Journal information (first source): Saha S, et al. Long-term safety of fecal microbiota transplantation for recurrent Clostridioides difficile infection, Gastroenterol 2021; DOI: 10.1053/j.gastro.2021.01.010. 

Journal information (second source): Cook L, et al. Fecal microbiota transplant treatment for recurrent Clostridioides difficile infection enhances adaptive immunity to TcdB, Gastroenterol 2021; DOI: 10.1101/2020.06.05.20114876.

Categories : COVIDTags :

SinoVac’s Vaccine 50.4% Effective in Brazilian Trial

On By ModernMedia

The vaccine from Chinese pharmaceutical company Sinovac is only 50.4% effective, according to updated data from a Brazilian trial.

Sinovac’s vaccine uses inactivated virus particles to trigger an immune response. Both the Sinovac vaccine and the Oxford vaccine have requests for emergency use in Brazil which are expected to soon to be granted.

This new number is lower than what was suggested last week by Butantan Institute, which distributes 65% of the vaccines in the country, and is running the trials. They had reported that the vaccine was 78% effective in “mild-to-severe” COVID cases, but reported on Tuesday that this number had not included cases with very mild COVID symptoms.
Interim results from late stage trials in Turkey and Indonesia reported that SinoVac was 91.25% effective and 65.3% effective, respectively. 

All of these discrepancies show just how hard to it is to compare the effectiveness of vaccines as measured by different trials in different countries. Other countries only count cases of COVID which generate obvious symptoms; including cases which are almost asymptomatic will lower the reported effectiveness.

However, there has been concern that the Chinese vaccine trials have not been subject to the same level of scrutiny and transparency as those in the West. Conversely, claims that the Russian Sputnik vaccine has a 95% effectiveness have been met with some suspicion, especially given its haphazard roll-out, which combined a trial (now cut short) with a release for emergency use. 

Source:BBC News

Categories : Obstetrics & GynaecologyTags :

Onset of Morning Sickness Narrowed Down

On By ModernMedia

The onset of “morning sickness”, the nausea and vomiting that often occurs near the beginning of pregnancy and normally resolves at 12-14 weeks, has been narrowed down in a new study from researchers at the University of Warwick.

The cause of nausea and vomiting of pregnancy (NVP) had historically been ascribed to psychological conditions, but currently is believed to have a multifactorial basis, involving various genetic, endocrine and gastrointestinal factors.

The study involved 256 women who became pregnant, keeping a diary recording the onset of nausea and vomiting, their last menstruation and date of ovulation as measured by a urine test.Determining the date of the start of pregnancy as determined by the date of their last ovulation, the first onset of NVP was 8 to 10 days, compared to 20 to 30 days as measured from the date of their last menstruation.

Lead author Prof Roger Gadsby, Warwick Medical School, said: “The precise course of pregnancy sickness is unknown, but this research shows that it occurs at a specific developmental stage, in a specific timeslot. For researchers it narrows our focus in terms of where we look for the cause. If we know that symptoms occur in a very narrow window 8-10 days after ovulation, researchers can concentrate their efforts on that particular stage of development to find the cause of the condition, both anatomically and biochemically.”

Knowing that the onset of NVP has such a tight timeframe will help future research narrow down a biological cause behind it, and help generate targets for treatment development.

An unexpected outcome of the study was a very high prevalence of NVP of 94%, compared to the 80% calculated in prior research. This is explained by the fact that data were regularly collected from participants from before they became pregnant to 60 days after their last menstruation, as opposed to most studies asking women to recall symptoms after they became pregnant.

Prof Gadsby added, “What we’ve shown is that more people get symptoms of pregnancy sickness than has ever been shown before, and one of the reasons for that is that this research has picked up mild early symptoms that tend to fade by 7-8 weeks. In other studies those symptoms would have faded by the time the research started.”

Source: News-Medical.Net