Year: 2021

Categories : COVID Obstetrics & GynaecologyTags :

Delta Variant Causes Pregnancy Complications

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Pregnant women have been a population of concern for physicians since the beginning of the COVID pandemic, and early on the frequency of caesarean delivery, preterm birth and pregnancy-related hypertension was reported to be increased in pregnant women who developed severe or critical illness from the novel coronavirus.

In May and June this year, there was a lull in COVID cases and hospitalisations, to the relief of physicians at the University of Alabama at Birmingham Hospital and their pregnant patients. However, the Delta variant soon caused a rise in cases, hospitalisations and deaths across the US state of Alabama. Along with this there was a seemingly higher number of pregnant patients with COVID in hospitals and intensive care units than in previous surges.

“We saw an alarming increase in pregnant patients hospitalised with the Delta variant in July and August,” said Akila Subramaniam, MD, associate professor in UAB’s Division of Maternal-Fetal Medicine. “Even more, many of our patients were delivering pre-term because of the effects of the virus on these women.”

Researchers tracked admission rates and maternal and neonatal outcomes of pregnant COVID patients at UAB Hospital from March 22, 2020, to Aug. 18, 2021. Outcomes were compared between pre-Delta and Delta groups, with preliminary findings seriousindicating  morbidity and adverse outcomes associated with the Delta variant and pregnancy.

Prior to the Delta variant, UAB Hospital saw the highest admission of pregnant women with active COVID in July 2020. A total of 28 pregnant patients were admitted that month, three of whom were admitted to the intensive care unit. In comparison, 39 pregnant patients, with 11 in ICU, were hospitalised in just the first 18 days of August.

“Pregnant women are a high-risk population with low-vaccination rates overall,” said Jodie Dionne, MD, associate director of UAB Global Health in the Center for Women’s Reproductive Health and associate professor in the Division of Infectious Diseases. “There is misinformation circulating that causes doubt in the vaccines or downplays the effect of the virus. This study highlights how dangerous contracting the virus, especially the Delta variant, can be for the mom and baby.”

From the study’s early findings, the UAB researchers emphasize recommendations from the Society of Maternal-Fetal Medicine, the American College of Obstetricians and Gynecologists, and the Centers for Disease Control and Prevention to vaccinate pregnant patients to mitigate severe perinatal morbidity and mortality.

The findings were published in the journal of Obstetrics and Gynecology.

Source: University of Alabama at Birmingham

Categories : NeurologyTags :

Long Stays in Space can Cause Brain Injury

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Source: Wikimedia Commons

A study of five Russian cosmonauts who had stayed on the International Space Station (ISS) reveals that extended time in space causes signs of brain injury. The study is published in the scientific journal JAMA Neurology. 

Scientists followed five male Russian cosmonauts working on the permanently manned International Space Station (ISS), in an orbit 400km above the surface of the Earth.

Early on in spaceflight history, extended time in zero gravity was found to result in muscle atrophy and bone loss. More recently, changes in vision were discovered during long flights, a potentially serious hazard. The vision changes were ascribed to increased cerebral pressure caused by the lack of gravity no longer pulling fluid into the lower extremities. On Earth this is similar to lying with a head-down tilt, causing fluids to pool in the upper body and head.

Blood samples were taken from the cosmonauts, whose mean age was 49, 20 days before their departure to the ISS, where they had an average stay of 169 days.

After landing on Earth, follow-up blood samples were taken one day, one week, and about three weeks after landing. Concentrations of three of the biomarkers analysed – NFL, GFAP and the amyloid beta protein Aβ40 – were increased after their stay in space. The peak readings did not occur simultaneously after the men’s return to Earth, but their biomarker trends nonetheless broadly tallied over time.

“This is the first time that concrete proof of brain-cell damage has been documented in blood tests following space flights. This must be explored further and prevented if space travel is to become more common in the future,” said Henrik Zetterberg, professor of neuroscience and one of the study’s two senior coauthors.

”To get there, we must help one another to find out why the damage arises. Is it being weightless, changes in brain fluid, or stressors associated with launch and landing, or is it caused by something else? Here, loads of exciting experimental studies on humans can be done on Earth,” he continued.

Changes also seen in magnetic resonance imaging (MRI) of the brain after space travel add evidence to the notion of spaceflight causing brain injurt. Clinical tests of the men’s brain function that show deviations linked to their assignments in space further support this, but the present study was too small to investigate these associations in detail.

Prof Zetterberg and his coauthors are currently discussing follow-up studies.

“If we can sort out what causes the damage, the biomarkers we’ve developed may help us find out how best to remedy the problem,” Prof Zetterberg said.

Source: University of Gothenburg

Categories : Mental HealthTags :

Simple Talking Therapy Relieves Loneliness in Elderly

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A simple form of talking therapy, delivered telephonically by trained support workers, successfully reduced loneliness in older people left isolated during the pandemic, according to initial results from a new study.

The intervention lasted for eight weeks and was designed in partnership with older people. People were contacted weekly and were encouraged to maintain their social contacts and to stick to a daily schedule, which included both routine and enjoyable activities.

The intervention developed in the BASIL-C19 (Behavioural Activation in Social Isolation) study lasted for eight weeks and was designed in partnership with older people who had direct experience of social isolation, loneliness and depression during the pandemic.  

The importance of social connection was highlighted by the COVID pandemic and its restrictions. Pre-pandemic research identified 1.4 million older adults in England as experiencing significant loneliness with impacts on their mental health.  Research since the pandemic shows that rates of loneliness and depression have increased, particularly for those who were self-isolating.

A team of leading researchers and clinicians anticipated the impacts of the pandemic on mental health and re-focussed their research expertise to examine the psychological impact of enforced isolation, disruption to daily routines, loss of social contact and loneliness.

They designed a very brief telephone delivered intervention to combat depression and loneliness.  Older people appreciated the offer of telephone contact and they found the intervention to be helpful in maintaining daily routines and social contact.

In the preliminary results, published in PLOS Medicine, the research team found evidence of improved mental health, and a strong indication that loneliness rates were substantially reduced in the first three months. A much larger trial follow-on trial is now currently recruiting over 600 older people and is the largest study ever undertaken to tackle loneliness and depression in this way.  

Source: University of York

Categories : Substance UseTags :

Medicinal Plant Extract Could Quell Opioid Epidemic

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In a bid to tackle the global opioid crisis, researchers have found that a Chinese medicinal plant extract can prevent morphine tolerance and dependence while also reversing opiate addiction. The researchers published their results in Pharmaceuticals.

For over two decades, opioid analgesic overprescription has driven a wave of misuse and consequent drive overdose deaths around the world, with the number of drug overdose deaths tripling in the US from 1997 to 2017. The COVID pandemic has only worsened the opioid epidemic. Fortunately, the documented effects of YHS, the extract of the plant Corydalis yanhusuo, could help curb the opioid epidemic.

“It is critical that we decrease the use and abuse of opiates,” said Olivier Civelli, PhD, professor of pharmaceutical sciences at the UCI School of Pharmacy & Pharmaceutical Sciences and corresponding author. “To help achieve this goal, we are proposing the use of this therapeutic plant. When used in animals, the Corydalis extract prevents pain and the negative effects of opiate use. The next step would be to test it with humans.”

The overprescription of opioid analgesics stemmed from treatment of chronic pain requiring repeated opioid administrations. This ultimately leads to tolerance, physical dependence, and addiction.

One possible solution involves a co-medication that maintains the analgesic benefits of opioids while preventing their adverse liabilities. The study showed that YHS, when co-administered with morphine, inhibits morphine tolerance, dependence and addiction. 

In Chinese traditional medicine, YHS has been used as an analgesic for centuries. It is considered safe and readily available for purchase.
“Opiate tolerance is of utmost importance to opiate users,” ProfvCivelli said. “They need to constantly increase the need of opiates to reach the same analgesic response. This is what leads to opiate overdose. YHS prevents opiate tolerance, so there is less need to increase opiate consumption.”

Source: University of California, Irvine

Categories : COVIDTags :

Kenya’s Waves Driven by Socio-economic Differences and Variants

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By combining COVID surveillance data with population mobility data from smartphones, infectious disease modellers have explained the evolution of the first three COVID waves to hit Kenya. 

Sequential waves of transmission through different socio-economic groups, followed by infection boosted by the introduction of new variants.

In order to forecast future outbreaks, the team had to develop a model to explain current waves. The work brought together COVID antibody survey data, PCR case data, genomic variant data and Google mobility data, seeking to find an explanation to the waves of COVID in Kenya. The aim was to then provide policy-based forecasts on future waves in the country based on the model findings.

Lower socio-economic groups have been identified as vulnerable to SARS-CoV-2 in the global South due to living in densely populated informal settlements, with reduced access to sanitation, and relying on daily mobility for informal employment. In contrast, those from higher socio-economic groups with job security can work from home, physically distance and readily access water and sanitation, thereby decreasing transmission.
The modelling results show that differences in mobility and contact rates between high and low socio-economic groups within Kenya explain the differences between the first and second waves. In the initial phase of the epidemic (from March 2020), individuals in high socio-economic groups could reduce their mobility and contact rates, but individuals in lower socio-economic groups could not. This resulted in transmission among individuals in lower socio-economic groups that was observed as the first wave in urban centres. As these individuals recovered from infection and became immune, at least temporarily, the first wave ended.

By the onset of the second wave (from October 2020), individuals in high socio-economic groups had increased their contact rates and mobility. This led to transmission among individuals in the high socio-economic groups, and also involved rural as well as urban areas. The second wave then appeared to end as individuals cleared the virus and became immune, at least for the time being. However, the advent of the more infectious Beta and Alpha variants resulted in a third wave among both high and low socio-economic groups (from March 2021).

 In many other African countries, there have been multiple waves that are not fully explained by timing of restrictions, and as they have similar urban socio-economic groupings, the researchers speculate that these explanations may have wider applicability. Understanding the causation of such multiple waves is critical for forecasting hospitalisation demand and the likely effectiveness of interventions including vaccination strategy.

Dr Samuel Brand from the University of Warwick said: “This is one of the first studies to consider detailed predictions of the dynamics of COVID across multiple waves in tropical sub-Saharan Africa. We believe this sets a new standard for the type of public health modelling work that can be conducted in real-time in developing countries.”

Dr John Ojal of KEMRI-Wellcome Trust Research Programme said: “There are highly detailed modelling studies of this nature in High Income Countries, but there have been none previously in tropical sub-Saharan Africa.”

The study has been published in the journal Science.

Source: University of Warwick

Categories : Mental HealthTags :

A Daily Dose of Sunshine Improves Mood and Sleep Quality

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Getting a daily dose of sunlight can improve a person’s mood and sleep quality, a new study has found.

A research team led by Monash University PhD student Angus Burns and Associate Professor Sean Cain conducted a study published in the upcoming December issue of the Journal of Affective Disorders.

The study examined 400 000 participants in the UK Biobank programme, and found that a lack of daytime light exposure was a risk factor for depressive symptoms, poor mood, and insomnia.

Burns said that most light and health-related messaging focusses on avoiding light at night, as it disrupts the circadian rhythm, but this study highlights the importance of getting enough daylight to ensure our bodies function optimally.

“In this study, we observed that the greater time spent in outdoor light during the day was associated with fewer depressive symptoms, lower odds of using antidepressant medication, better sleep and fewer symptoms of insomnia,” Burns said.

“These results may be explained by the impacts of light on the circadian system and the direct effects of light on mood centres in the brain.”

Associate Professor Cain said a few small changes to a person’s daily routine could help improve their mood, sleep, and energy levels.

“People now spend most waking hours in intermediate, artificial lighting conditions, due to reduced sunlight exposure and relatively bright night-time light exposure,” he said.

“In this study, we observed that greater time spent in outdoor light was associated with better mood outcomes, better quality sleep, and ease of wakening.

“Insufficient exposure to daytime light could be a key factor contributing to poor mood and sleep outcomes in depressive disorders. My general advice for everyone is simple: when the sun is out, get as much light as you can, but after it sets, keep it dark. Your body will thank you.”

Source: Monash University

Categories : Obstetrics & GynaecologyTags :

Black US Women at Increased Risk of Birth Complication

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Black US women are more likely than their white counterparts to experience a serious complication during labour or delivery, particularly due to systemic inflammation.

Systemic inflammation was one of four categories identified by the researchers when they looked for patterns in patients who experienced severe maternal morbidity (SMM) – an unexpected outcome of labour and delivery resulting in significant short- or long-term health consequences, including death. 

Women can experience multiple complications or events associated with SMM such as kidney failure and eclampsia. The study found these complications or events can occur within four categories: systemic inflammation (includes shock, abnormal blood clotting, adult respiratory distress syndrome [ARDS] and ventilation); cardiovascular events (includes kidney failure, eclampsia and cerebrovascular events such as aneurysm); admission to the intensive care unit; and haemorrhage leading to blood transfusion.

Black women were found to be at higher risk than white women in all four SMM categories, with the highest proportion experiencing SMM due to systemic inflammation.

“Previous studies have reported the higher the number of SMM complications or events a woman experiences, the higher the likelihood of death, but our study is the first to look at how these complications and events group together and their association with outcomes,” said lead author Andrea Ibarra, MD, MS, assistant professor of anesthesiology and perioperative medicine at the University of Pittsburgh School of Medicine. “We determined characteristics such as race, obesity and diabetes can identify which women are at higher risk of severe events, including death, in the various categories. That insight can spur efforts to develop new obstetric protocols and guidelines to improve care.”

Researchers reviewed records of 97 492 deliveries at one institution between 2008 and 2017 and determined that 2666 (2.7%) included an SMM event, with 49 women dying within a year of delivery. They found 44% of the deliveries associated with SMM were pre-term. Black women had higher rates of SMM (4.1%) than white women (2.4%).

Risk factors for all-category SMM included race, having pre-existing diabetes or having preeclampsia. Caesarean delivery was an additional risk factor for the haemorrhage category. Additional risk factors relating to women who fell in the systemic inflammation category were depression and social determinants, including low income or not graduating from high school.

“This research is crucial because most maternal morbidity is preventable,” said Dr Ibarra. “By identifying factors that put women at high risk of developing SMM complications or events, we can allocate more resources toward perinatal care.”

The findings were presented at the ANESTHESIOLOGY® 2021 annual meeting.

Source: American Society of Anesthesiologists

Categories : Pain ManagementTags :

Electroacupuncture Spares Opioids for Knee Replacement Pain Relief

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Patients who have electroacupuncture during total knee replacement surgery report less pain and need far fewer opioids to manage their discomfort. In the study, 65% of patients who received acupuncture during surgery were able to have a low-dose or opioid-free postoperative experience, compared to 9% of patients outside of the study.

The results of the study were presented at the ANESTHESIOLOGY® 2021 annual meeting. 

“Total knee replacements are one of the most common operative procedures in the United States and often very painful, so there’s a great need to explore non-opioid pain relief techniques for this type of surgery,” said lead author Stephanie Cheng, MD, DABMA, assistant attending anaesthesiologist at the Hospital for Special Surgery and assistant professor of clinical anaesthesiology at Weill Cornell Medicine. “Acupuncture is extremely safe and can help reduce pain with few unwanted side effects, but it has not been well researched as part of surgical anesthesia.”

The study enrolled 41 patients who had primary total knee replacement, all of whom received the institution’s standard opioid-sparing multimodal analgesic protocol, with the addition of electroacupuncture, which is a modified form of traditional acupuncture that applies a small electric current to thin needles that are inserted at known acupuncture points on the body. The acupuncture was administered during surgery by Dr Cheng, who is board-certified in medical acupuncture, to eight specific points in the ear to provide targeted pain relief in the knee.

With the addition of acupuncture, the majority of patients had reduced postoperative opioid use, compared to historical controls, while 65% of patients either maintained a low-dose opioid regimen of 15 oxycodone pills or less (57.5%) or remained completely opioid-free (7.5%) from induction of anaesthesia to 30 days post-surgery. Historically, only 9% of patients outside of the study were able to maintain a low-dose or opioid-free regimen post-surgery. Thirty days after surgery, all patients discontinued opioid use.

“Our study shows that if a trained medical acupuncturist is available to perform acupuncture in the operating room, it can help patients with postoperative pain recovery,” said Dr Cheng. “Most studies fail to incorporate nontraditional techniques, such as acupuncture, to help decrease the dependence on opioid medications for postoperative pain control.”

Low-dose perioperative opioid consumption is key to mitigating the opioid epidemic and opioid misuse by patients. Dr Cheng pointed out that with acupuncture being commonly used outside of the hospital as an effective therapy for pain management and treatment for a range of health issues and symptoms, it’s time to consider its benefits inside the hospital as well. “Additional research is needed to further define acupuncture’s effects and encourage its use in all aspects of disease treatment.”

Source: American Society of Anesthesiologists

Categories : VaccinesTags :

Good Uptake of Flu Jabs for Children in Procedures

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Offering an influenza vaccination to children about to have surgery and general anaesthesia  at a US children’s hospital resulted in a great increase in flu vaccinations there. In their findings presented at the ANESTHESIOLOGY® 2021 annual meeting, the researchers also posited that this raised vaccination awareness.

“The ongoing threat of a simultaneous COVID pandemic and seasonal flu epidemic makes the widespread use of flu vaccines more important than ever,” said Tyler Morrissey, MD, lead author of the study and assistant professor of pediatric anesthesiology, Department of Anesthesiology, University of Colorado School of Medicine, Aurora. “Our research shows that having a standardised process for getting children vaccinated for flu while under anaesthesia during surgery provides a ‘teachable moment’ and opportunity to educate families on the importance of flu vaccination, and may be a model for other childhood vaccinations while under anaesthesia, including the COVID vaccine.”

Epidemics of seasonal flu occur annually. Although the CDC recommends that everyone 6 months and older receive a yearly flu vaccine, during the 2019-20 flu season, the authors noted that vaccination rates were less than 50% for adults and 60% for children.

In the study, the authors hypothesised that the perioperative period when patients are undergoing anaesthesia for surgery would be a ‘teachable moment’ for flu vaccination, which they defined as an event motivating individuals to spontaneously adopt risk-reducing health behaviours.

In October 2020, a standardised ‘Best Practice Alert’ process was implemented to actively offer flu vaccinations to all paediatric patients having general anaesthesia at the hospital In the preanaesthetic area, a care team member received a computer alert then determined if the child was eligible, discussed vaccination benefits and obtained parental consent for the vaccine. The vaccine was then administered in the operating room (OR) after the induction of general anaesthesia. Prior to the 2020-21 season, flu vaccinations under anaesthesia were only offered upon patient or family request.

The researchers found the number of children receiving perioperative flu vaccinations increased by 3500% after implementation of the institution’s standardised protocol, compared to the previous year. During the 2019-20 flu season, only 30 perioperative vaccines were administered. Prior to the intervention during the 2020-21 flu season, only 30 vaccines were given over a six-week period (1 Sept.–16 Oct.).  However, after the intervention that same season, 1063 flu vaccines were administered over a 25-week period (16 Oct.–31 March), with no reported vaccine-related complications.
“We’re super encouraged to see so many parents agree to have their children vaccinated for flu while undergoing anaesthesia,” said Dr. Morrissey. “The CDC has recommended that flu vaccination be offered to children 6 months of age and older at every health care seeking opportunity. As physicians on the front lines of the COVID pandemic, this is another great opportunity for our specialty to make a significant impact on public health.” 

Source: American Society of Anesthesiologists

Categories : CancerTags :

Many Breast Cancer Patients Don’t Discuss Cannabis Use with Docs

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About half of US adults with breast cancer use cannabis as an adjunct to cancer treatment for symptom and side effect management. However, most don’t discuss their use of cannabis with their physicians, according to a new study.

Pain, fatigue, nausea, and other difficulties often arise from cancer and its treatment, and some patients turn to cannabis for relief of their symptoms. However, many physicians feel that they lack the necessary knowledge to discuss cannabis with their patients. Such knowledge is especially important now that cannabis use is becoming more widespread.

In a study published in CANCER, researchers reported the results of an anonymous online survey to examine cannabis use among adults who were diagnosed with breast cancer within five years and were members of the Breastcancer.org and Healthline.com online health communities.

The findings revealed that:

  • Of the 612 participants, 42% reported using cannabis for relief of symptoms, including pain, insomnia, anxiety, stress, and nausea/vomiting. Among those who used cannabis, 75% reported that it was extremely or very helpful at relieving their symptoms.
  • Nearly half (49%) of participants who used cannabis believed that medical cannabis can be used to treat cancer itself; however, its effectiveness against cancer is unclear.
  • Among those using cannabis, 79% had used it during treatment, which included systemic therapies, radiation, and surgery.
  • Participants reported using a wide range of different cannabis products known to vary in quality and purity.
  • Half of participants sought information on medical cannabis, and websites and other patients were ranked as the most helpful sources of information. Physicians ranked low on the list.
  • Among those who sought information on cannabis use for medical purposes, most were unsatisfied with the information they received.
  • Most participants believed cannabis products to be safe and were unaware that the safety of many products is untested.

“Our study highlights an important opportunity for providers to initiate informed conversations about medical cannabis with their patients, as the evidence shows that many are using medical cannabis without our knowledge or guidance,” said lead author Marisa Weiss, MD, of Breastcancer.org and Lankenau Medical Center near Philadelphia, Pennsylvania. “Not knowing whether or not our cancer patients are using cannabis is a major blind spot in our ability to provide optimal care, and as healthcare providers, we need to do a better job of initiating informed conversations about medical cannabis with our patients to make sure their symptoms and side effects are being adequately managed while minimising the risk of potential adverse effects, treatment interactions, or non-adherence to standard treatments due to misinformation about the use of medical cannabis to treat cancer.”

Dr Weiss added that patients should never use cannabis as an alternative to standard cancer treatment, and clinicians should inform patients about the safe and effective use of cannabis as an adjunct to their cancer treatment plan.

Source: Wiley