Year: 2021

Categories : CancerTags :

Mastectomies Significantly Impact Quality of Life in Young Women

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Many young women with breast cancer choose mastectomies but afterwards experience a persistent decline in their sexual and psychosocial well-being, according to new research reported in JAMA Surgery.

In surveys conducted after patients underwent breast cancer surgery, significant quality of life (QoL) impacts were seen with mastectomies, with a greater extent of surgery worsening the QoL outcomes. The findings are important in light of recent trends towards younger women with breast cancer opting for bilateral mastectomies for unilateral breast cancer when breast conserving surgery was also an option.

“Historically, it was felt that 75 percent of breast cancer patients should be eligible for breast conserving surgery. Over time, however, more women, particularly young women, are electing to have a mastectomy,” said study lead author Laura Dominici, MD, a surgeon at Dana-Farber Brigham Cancer Center. “They frequently offer peace of mind as the reason for their decision – even though research shows that unless a woman has a genetic predisposition to breast cancer, she has a very low risk of developing cancer in the healthy breast.”

In this study, 560 participants, 40 and younger with breast cancer, filled in a patient reported outcomes survey known as BREAST-Q, an average 5.8 years after diagnosis.

Compared to those who had breast-sparing surgery, patients who had a mastectomy scored significantly lower in three QoL measures – satisfaction with the appearance of their breasts, psychosocial well-being, and sexual well-being. The results were consistent regardless of whether one or both breasts were removed, and that most had breast reconstruction surgery.

  • For breast satisfaction, patients who had breast-conserving surgery had an average BREAST-Q score of 65.5, compared with 54.6 in the bilateral mastectomy group.
  • For psychosocial well-being,  patients who had breast-conserving surgery had an average BREAST-Q score of 75.9, compared with 65.1 in the bilateral mastectomy group.
  • For sexual well-being, patients who had breast-conserving surgery had an average BREAST-Q score of 57.4, compared with 53.4 for the unilateral mastectomy group and 46.2 for the bilateral mastectomy group.

A fourth area examined by the survey, physical function, showed no difference between the groups. Women with financial challenges tended to have lower scores in all four categories.

“The decision of whether to have a mastectomy or breast-conserving surgery should be a shared decision between patients and their doctors,” Dr Dominici added. “Particularly when talking to young women, who are likely to have a long period of survivorship, it’s important that we as clinicians discuss the potential impacts of mastectomy on their quality of life. As our study indicates, those impacts are not insignificant and persist years into the future.”

The study’s main limitation is that it was not randomised, and quality of life was only evaluated at a single time point. Dr Dominici added there was no information about women’s quality of life prior to the study, which could have infuenced their decision making and their quality of life after surgery.

Source: Dana-Farber Cancer Institute

Categories : Medical Research & TechnologyTags :

Muscles are Timekeepers for the Liver

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Photo by RF._.studio from Pexels

Researchers have found that skeletal muscles play a large part in regulating the liver’s biological clock. The findings were published in Science Advances.

The circadian rhythm is coordinated by the brain at a general level, but each organ or tissue is also subjected to specific regulation, adjusting to time to optimise their processes. However it was not known how the liver “knows” whether it is day or night.

The liver’s main role is digestion, mainly of fats and sugars: the brain is the main consumer of sugar while skeletal muscle is the main consumer of fat.

Scientists at IRB Barcelona discovered a surprising relationship: that it is skeletal muscle which regulates liver function and determines fat metabolism. Skeletal muscle accomplishes this by secreting a that is transported to the liver through serum is responsible for modulating around 35% of the metabolic functions of the liver. The remaining basal functions of this organ and others related to carbohydrate metabolism are independent of muscle activity and are regulated by the basal circadian rhythm from the brain.

“It’s a very nice discovery because it is the first demonstration of the need for communication between the circadian clocks of tissues and organs outside the brain, and we can see that this communication between muscle and liver is altered by aging,” said study leader Dr Salvador Aznar-Benitah at IRB Barcelona. “When we get older, cells stop obeying the biological clock and begin to perform functions in a non-optimal manner, leading to errors that cause tissues to age.”

The researcher’s results show that the liver does not independently regulate the metabolism of fats and that it is muscle that sends the message that it is time to switch on fatty acid metabolism and how it should go about this. “We didn’t expect to find this connection between the liver and muscle because it wasn’t known previously, but, on second thought, it makes complete sense that fat management is coordinated by one of its main consumers,” said Dr Aznar-Benitah. Carbohydrate metabolism meanwhile is dependent on the basal coordination exercised by the brain.

Source: Institute for Research in Biomedicine (IRB Barcelona)

Categories : Skeletal SystemTags :

Osteoclast Signalling Could Yield Osteoporosis Treatments

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A new discovery about a signalling function in osteoclasts suggests a potential treatment target for osteoporosis and for bone loss from rheumatoid arthritis.

The findings from University of Virginia School of Medicine researchers and their collaborators help us understand why osteoclasts begin to break down more bone than the body replaces.

“Bone degradation and subsequent repair are fine-tuned through complex interactions between the cells that degrade the bone – osteoclasts – and those that produce new bone matrix. Simple elimination of osteoclasts is, therefore, not always the best approach to treat pathologic bone loss. Instead, we found a ‘signalling node’ in osteoclasts that regulates their function in degrading the bone, but doesn’t reduce osteoclast numbers,” said researcher Sanja Arandjelovic of UVA’s Department of Medicine and UVA’s Carter Immunology Center.

With further research, it may be possible for scientists to one day be able to develop drugs that target the signalling node to prevent or treat bone loss. This discovery also helps explain why some previous attempts to develop osteoporosis treatments produced disappointing results.
Researcher Kodi Ravichandran, chair of UVA’s Department of Microbiology, Immunology and Cancer Biology and director of UVA’s Center for Cell Clearance, noted the potential of the findings to inform efforts to develop better treatments for osteoporosis: “In this study,” he said, “we identified previously unappreciated factors that contribute to osteoclast function that are truly exciting and open up new avenues to pursue.”

The researchers have found an important contributor, a cellular protein called ELMO1, which promotes the activity of the bone-removing osteoclasts. Osteoclasts are critical for bone health, as they normally remove just enough to stimulate new bone growth. The problem arises when the osteoclasts become too aggressive and remove more bone than the body makes, resulting in bone mass loss.

This excessive bone degradation is likely influenced by genetic factors, the researchers say. They note that many of the genes and proteins linked to ELMO1 have been previously associated with bone disorders and osteoclast function.

Encouragingly, the researchers were able to prevent bone loss in lab mice by blocking ELMO1, including in two different models of rheumatoid arthritis. That suggests clinicians may be able to target the protein in people as a way to treat or prevent bone loss caused by osteoporosis and rheumatoid arthritis, the researchers say.

They note that prior efforts to treat osteoporosis by targeting osteoclasts have had only mixed success, and they offer a potential explanation for why: Osteoclasts not only remove bone, but play a role in calling in other cells to do bone replacement. As such, targeting ELMO1 may offer a better option than simply waging war on the osteoclasts.

“We used a peptide to target ELMO1 activity and were able to inhibit degradation of the bone matrix in cultured osteoclasts without affecting their numbers,” Ravichandran said. “We hope that these new osteoclast regulators identified in our study can be developed into future treatments for conditions of excessive bone loss such as osteoporosis and arthritis.”

Source: University of Virginia

Categories : Cardiovascular DiseaseTags :

High Fat Dairy Intake not Tied to CVD Risk

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In a study of countries with high dairy consumption, higher intakes of dairy fat, as measured by bloodstream levels of fatty acids, had a lower risk of cardiovascular disease (CVD) compared to those with low intakes. Higher intakes of dairy fat were not linked to an increased mortality risk.

In a study published in PLoS Medicine, researchers combined results from 4000 Swedish adults with those from 17 similar studies in other countries, creating the most comprehensive evidence to date on the relationship between this more objective measure of dairy fat consumption, risk of  and death.

Dr Matti Marklund from The George Institute for Global Health, Johns Hopkins Bloomberg School of Public Health, and Uppsala University said that with rising dairy consumption around the world, a better understanding of the health impact was needed.

“Many studies have relied on people being able to remember and record the amounts and types of dairy foods they’ve eaten, which is especially difficult given that dairy is commonly used in a variety of foods.

“Instead, we measured blood levels of certain fatty acids, or fat ‘building blocks’ that are found in dairy foods, which gives a more objective measure of dairy fat intake that doesn’t rely on memory or the quality of food databases,” he added.

“We found those with the highest levels actually had the lowest risk of CVD. These relationships are highly interesting, but we need further studies to better understand the full health impact of dairy fats and dairy foods.”

Sweden has one of the world’s highest consumption of dairy. An international team of researchers assessed dairy fat consumption in 4150 Swedish 60-year-olds by measuring blood levels of a particular fatty acid that is mainly found in dairy foods and therefore can be used to reflect intake of dairy fat.

The participants were then followed up for an average of 16 years, recording heart attacks, strokes and other serious circulatory events, and all cause mortality.

After adjustment for other known CVD risk factors including things like age, income, lifestyle, dietary habits, and other diseases, the CVD risk was lowest for those with high levels of the fatty acid (which reflects a high intake of dairy fats). Those with the highest levels had no increased all-cause mortality risk.

These findings highlight the uncertainty of evidence in this area, which is reflected in dietary guidelines, noted  Dr Marklund.

“While some dietary guidelines continue to suggest consumers choose low-fat dairy products, others have moved away from that advice, instead suggesting dairy can be part of a healthy diet with an  emphasis on selecting certain dairy foods — for example, yoghurt rather than butter — or avoiding sweetened dairy products that are loaded with added sugar,” he said.

Combining these results with 17 other studies with a total of almost 43 000 participants from the US, Denmark, and the UK confirmed these findings in other populations.

“While the findings may be partly influenced by factors other than dairy fat, our study does not suggest any harm of dairy fat per se,” Dr. Marklund said.

Lead author Dr Kathy Trieu from The George Institute for Global Health pointed out that consumption of some dairy products, especially fermented products, have been shown to be linked to cardiovascular benefits.

“Increasing evidence suggests that the health impact of dairy foods may be more dependent on the type — such as cheese, yoghurt, milk, and butter — rather than the fat content, which has raised doubts if avoidance of dairy fats overall is beneficial for cardiovascular health,” she said.

“Our study suggests that cutting down on dairy fat or avoiding dairy altogether might not be the best choice for heart health.”

“It is important to remember that although dairy foods can be rich in saturated fat, they are also rich in many other nutrients and can be a part of a healthy diet. However, other fats like those found in seafood, nuts, and non-tropical vegetable oils can have greater health benefits than dairy fats,” Dr Trieu added.

Source: The George Institute for Global Health

Categories : COVIDTags :

SA Daily COVID Vaccination Rate Plummets

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The daily COVID vaccination rate in South Africa plunged this week, prompting fears that the vaccination drive may be losing steam. This comes amid criticism around insufficient  information about vaccinations in more remote and impoverished communities.

Just 159 542 doses were administered on 20 September, the lowest weekday total since 13 August, when 147 307 jabs were given, according to government statistics.

That falls short of its target of 300 000 daily doses (which is yet to be obtained), and also the lowest since 18-to-35 year-olds became eligible for vaccines on 1 September.

As of Wednesday, 22 September South Africa has administered 16.56 million doses, but only 8.23 million of the country’s almost 40 million adults are fully vaccinated. Of those fully vaccinated, about 44% are the single-dose Johnson & Johnson vaccines.

To achieve 70% coverage of the adult population by December, a further 18 million adults will need to be vaccinated, noted health minister Dr Joe Phaahla.

In an address to the media on Friday, 17 September, Dr Phaahla said that the government is still focused on adult vaccinations, with the main priority being the 50 and older age group ahead of a possible year-end fourth wave. Dr Phaahla also noted the South African health regulator’s approval of Pfizer’s COVID vaccine for use for children 12 years and older, saying that the policy of vaccination of under 18s would be revisited based on the total number of adults vaccinated by the end of October.

“Even though we know the Pfizer vaccine has been approved [for children], we want to remain focused on the high-risk people as of now.

“If we can reach 70% of the 50+ age group when the next wave comes, our hospitals will not be as overwhelmed as they have been.”

Dr Phaahla added that the government is aware of pressure from schools for vaccinations of children. Other factors to be taken into account are the local government elections on 1 November — a possible super-spreader event — and a surplus vaccine supply to enable targeting under 18s.

“We think it will be very risky to be all over and start just vaccinating people everywhere. Let’s manage the schools,  and keep on pushing the elderly to get vaccinated.”

On Wednesday, 22 September, there were 2967 new COVID cases, with a case positivity rate of 7%. The total number of vaccinations on that day was slightly higher, but only stood at 187 003, short of the government’s goal of 300 000 per day. Of these, 110 847 were fully vaccinated, 45.3% from J&J doses.

Source: BusinessTech

Categories : Antibiotics Obstetrics & GynaecologyTags :

Azithromycin Protects Pregnancies in Countries with Malaria

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A review has found that the common antibiotic azithromycin taken during pregnancy reduces low birth weight and premature births in countries where malaria is endemic.

The systematic review of 14 studies in African and Asia, published in The Lancet EClinicalMedicine, found that azithromycin, reduced low birth weight and prematurity but didn’t lower infant deaths, infections and hospital admissions.

Azithromycin, an inexpensive antibiotic widely used to treat chest and ear infections, has been specifically used in the past in pregnancy to treat STIs and, alongside other antimalarial drugs, to prevent adverse consequences of malaria on maternal and foetal outcomes and caesarean wound infections.

Murdoch Children’s Research Institute (MCRI) researcher Dr Maeve Hume-Nixon said it was not clear whether azithromycin would improve perinatal and neonatal outcomes in non-malaria endemic settings, and the potential harm on stillbirth rates needed further investigation.

Dr Hume-Nixon said these findings emphasised the importance of similar MCRI-led research currently being done in Fiji.

“This review found that there was uncertainty about the potential benefits of this intervention on neonatal deaths, admissions and infections, and potential harmful effects on stillbirth despite biological reasons why this intervention may have benefits for these outcomes,” she said.

“Therefore, results from studies like ours underway in Fiji will help to better understand the effect of this intervention on these outcomes.”

The Bulabula MaPei study is a randomised controlled clinical trial testing if azithromycin given to women in labour, prevents maternal and infant infections.

Globally, infections account for 21% of 2.4 million neonatal deaths per year and 52% of all under-five deaths, disproportionately occurring in low- and middle-income countries.

About five million cases of pregnancy-related infections occur in mothers each year as well, resulting in 75 000 maternal deaths.

MCRI Professor Fiona Russell said the large clinical trials in Africa and Asia, along with the MCRI-led trial in Fiji, were likely to inform global policy related to maternal child health and hopefully benefit infants and mothers around the world.

“Administration of azithromycin during labour may be a cheap and simple intervention that could be used to improve neonatal death rates in low and middle-income countries, alongside strengthening of maternal child health services,” she said. “This study, together with other large clinical trials, will add to evidence for the consideration of new international maternal and child health guidelines.”

Source: Murdoch Childrens Research Institute

Categories : CancerTags :

Added Salt Found to Suppress Tumours in Mice

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Source: Pixabay CC0

A new study has found that adding salt to the diet of lab mice can suppress the growth of cancerous tumours.

Dietary salt reduction has been stressed by clinicians for many years, as research has shown that a high-sodium diet can result in inflammation, high blood pressure and an increased heart attack risk. Researchers from the Translational Health Science and Technology Institute wondered if the inflammation resulting from a high-salt diet could also confer positive health benefits, such as fighting cancerous tumours. 

To find out, the researchers fed two groups of mice with implanted melanoma tumours either a normal diet or a high-sodium diet (4.0% sodium chloride above normal diet) and then measured the differences in tumour suppression abilities between the two groups. They found that the mice on the high-sodium diet had an increase in Bifidobacterium probiotics, leading to an increase in natural killer cells that attack cancerous tumors. They also found an increased ability to inhibit PD-1 proteins which have been found to prevent T cells from attacking tumours.

On close examination, it was found that the high-sodium diet caused the gut barrier to be leakier, enabling the movement of Bifidobacteria from the gut to tumour locations. In addition, they found that once the Bifidobacteria arrived at a tumour, crosstalk between them and the immune cells engaged in attacking the tumour improved the success of the attack.

However, the researchers also found that a low-sodium diet worked in conjunction with several cancer-fighting drugs, showing an increased ability to reduce tumour growth. Since the researchers hypothesised that Bifidobacteria were responsible for the tumour immunity of a high-sodium diet, they performed faecal transplants from mice on a high-sodium diet to those on a normal diet and found that it also improved their ability to fight tumour growth.

The study was published in Science Advances.

Source: MedicalXpress

Categories : Diseases, Syndromes and ConditionsTags :

Diabetes Linked to Tuberculosis Risk

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Scanning electron micrograph of Mycobacterium tuberculosis bacteria, which cause tuberculosis. Credit: National Institute of Allergy and Infectious Diseases, National Institutes of Health

Diabetes status may play a role in the risk for developing tuberculosis, suggests a new study reported in JAMA Network Open.

Diabetes and tuberculosis are two major problems for South Africa; an estimated 15% of the population 25 and over have type 2 diabetes, and the burden of tuberculosis was 774 per 100k population in 2012.

In the population-based study from Korea, adults with diabetes had a 48% greater risk for developing tuberculosis compared with adults without diabetes.

This increased tuberculosis risk also appeared to be tied to the duration of diabetes, with risk increasing the longer the person had diabetes:

  • New-onset diabetes: aHR 1.32 (95% CI 1.23-1.42)
  • Diabetes duration less than 5 years: aHR 1.45 (95% CI 1.36-1.54)
  • Diabetes duration 5 or more years: aHR 1.57 (95% CI 1.48-1.66)

The tuberculosis risk also seemed to be dependent on blood glucose levels. Individuals with impaired fasting glucose only, that is, blood glucose levels of 100-125 mg/dL but no diabetes diagnosis, did not appear to have an elevated risk of contracting tuberculosis.

However, those with new-onset diabetes in the highest decile of fasting blood glucose levels (202 mg/dL or higher) had a 79% greater risk for tuberculosis than those with lower glucose levels (fasting plasma glucose of 126-128 mg/dL).

The researchers noted that a previous study looking at this association found about a 2.2-fold increased risk of tuberculosis in patients with diabetes, including those with a fasting plasma glucose level over 130 mg/dL.

“Diabetes appears to be associated with increased risk of lower respiratory tract infection, including TB [tuberculosis], and to have a profound adverse effect on TB treatment outcomes,” the researchers explained. “Even though TB is more associated with other immunosuppressive states, such as human immunodeficiency virus infection, because of the greater numbers, diabetes remains an important factor associated with TB incidence at the population level.”

For the cohort study, the researchers drew upon data from the Korean National Health Insurance System database. Only patients without a history of tuberculosis were included. Besides a history of tuberculosis, other exclusion criteria included diagnoses of anaemia, cancer, and end-stage renal disease.

Individuals who had diabetes the longest tended to be older, have obesity, and possess more comorbidities like chronic kidney disease, chronic obstructive pulmonary disease, ischaemic heart disease, stroke, and dyslipidaemia.

During a median follow-up of about 8 years, 0.6% of the cohort were identified.

A study limitation was that fasting plasma glucose levels were only monitored once at baseline, and that changes in glucose level after treatment was over were not taken into consideration.

“Nevertheless, it is likely that patients whose diabetes status progressed as a result of poor glucose control during the follow-up duration would have a higher risk of TB,” the researchers wrote.

The link with tuberculosis was stronger in male patients, they noted: “The exact mechanism for this phenomenon is not fully explainable — testosterone could be a reason.”

Source: MedPage Today

Categories : PaediatricsTags :

Better Outcomes in Children Receiving Living Donor Liver Transplants

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A new study from Children’s Hospital Los Angeles pooled examining outcomes for 8000 paediatric patients across four continents revealed that children receiving living donor liver tissue for transplants have a far lower risk of serious complications.

With medical advances and the liver’s fantastic regeneration capacity, healthy individuals can donate a portion of their liver. While many countries now exclusively perform living donor liver transplants, in the United States, only 8% of liver transplants are from living donors, such as those done by Children’s Hospital Los Angeles.

“We have published large-scale studies showing the benefits of living donor liver transplantation in adults,” said Juliet Emamaullee MD, PhD, Research Director, Division of Abdominal Organ Transplantation, Children’s Hospital Los Angeles. “And we’ve observed the benefits in kids too. But we really wanted to evaluate it systematically, to provide evidence from around the world to back up what we’ve seen.”
The screened over 2500 studies, distilling relevant studies, compiling data from 8000 paediatric patients who had received either living or deceased donor livers. Results showed that a year after the procedure, children who had received living donor liver transplants had nearly twice the survival rate while the risk of organ rejection was nearly halved.

Living donor tissue for liver transplants has a number of benefits, which may explain some of the difference in outcomes. Patients may need to wait a shorter time as they do not need to wait for an appropriately sized deceased organ donor, a particular challenge for infants and toddlers, who make up over 50% of paediatric liver transplants. But the biggest advantage may be that patients can be healthier at the time of their procedure.

“When a liver becomes available, the basic rule is that it goes to the sickest child,” said Dr Kohli. “And that makes sense. We don’t want any child dying on the waiting list.” Unfortunately though, this means that children can be on the waiting list for years before getting a transplant. They can be very ill as a result at the time of transplant, possibly affecting how well a child does once they receive a new liver.

“These results are important and relevant for families,” said Dr Emamaullee. “Not all children are at a center that offers living donor liver transplant. Now we have the data to suggest that kids really should be offered this option. Families should have the chance to donate to their children rather than having to wait until an organ donor comes along.”

“As a paediatrician, I want children getting the best chance possible,” said Dr Kohli. “Studies like these inform our care. They show us how to do the best possible job for our kids.”

Source: Children’s Hospital Los Angeles

Categories : PaediatricsTags :

Early Developmental Intervention Dramatically Cuts Autism Risk

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A first-of-its-kind study has shown that parent-led therapy supporting the social development of babies with early autism signs greatly reduced the odds of a later autism. 

The research, led by CliniKids at the Telethon Kids Institute and published in JAMA Pediatrics, found that a diagnosis of autism at age three was only a third as likely in children who received the pre-emptive therapy (iBASIS-VIPP)compared to those who received usual treatment.

The findings were the first evidence showing that a pre-emptive intervention during infancy could result in such a significant improvement in children’s social development that they then fell below the threshold for an autism diagnosis.

Study leader Professor Andrew Whitehouse, Telethon Kids Institute, said: “The use of iBASIS-VIPP resulted in three times fewer diagnoses of autism at age three. No trial of a pre-emptive infant intervention, applied prior to diagnosis, has to date shown such an effect to impact diagnostic outcomes – until now.”

Professor Whitehouse said many therapies for autism tried to replace developmental differences with more ‘typical’ behaviours. Instead, iBASIS-VIPP attempts to work with each child’s unique differences, creating a social environment around the child helping them learn in a way optimised for them.

“The therapy uses video-feedback to help parents understand and appreciate the unique abilities of their baby, and to use these strengths as a foundation for future development,” said Professor Whitehouse. “By doing so, this therapy was able to support their later social engagement and other autistic-related behaviors such as sensory behaviors and repetitiveness, to the point that they were less likely meet the ‘deficit-focused’ diagnostic criteria for autism.”

“We also found increased parental sensitivity to their baby’s unique communication and an increase in parent-reported language development. Other general aspects of development were not affected.” The children falling below the diagnostic threshold still had developmental difficulties, but by working with each child’s unique differences, rather than trying to counter them, the therapy has effectively supported their development through the early childhood years.”

The four-year randomised clinical trial enrolled babies aged 9-14 months, all of whom having shown early behavioural signs of autism. Over five months, half received the video intervention, while a control group received current best practice treatment.

Eighty-nine children completed an assessment at the start of the study, at the end of the therapy period, and when they were two and three years of age. With the high prevalence of autism worldwide, the implications of the findings were enormous, said Professor Whitehouse. Around 2% of all children in Australia have an autism diagnosis.
“Autism is not typically diagnosed until three years of age, however, interventions commencing during the first two years of life, when the first signs of development difference are observed and the brain is rapidly developing, may lead to even greater impact on developmental outcomes in later childhood,” Professor Whitehouse said.

Professor Whitehouse said that a follow-up of study participants in later childhood, when autism behaviours may be more apparent, would be critical to determining the longer-term significance of the video intervention.

Source: Telethon Kids Institute