Day: July 1, 2022

Categories : Medical Research & TechnologyTags :

Junior Doctors Get the Chance to Train with ‘Holographic’ Patients

On By ModernMedia
From left to right: Junior doctor Aniket Bharadwaj with trainers Dr Ruby Woodard and Dr Jonny Martin, diagnosing a hologram patient. Credit: University of Cambridge

A new effort from Cambridge University brings medical training in ‘mixed reality’ one step closer with modules that allow student doctors to interact with a ‘holographic’ patient.

Traditional simulation has numerous costs including maintaining simulation centres, their equipment and the faculty and staff hours to operate the labs and hire and train patient actors. This new technology could provide more flexible, cost-effective training that can be accessed all over the world.

HoloScenarios is a new training application based on life-like holographic patient scenarios, is being developed by Cambridge University Hospitals NHS Foundation Trust (CUH), in partnership with the University of Cambridge and US tech company GigXR. The first module focuses on common respiratory conditions and emergencies.

“Mixed reality is increasingly recognised as a useful method of simulator training,” said project leader Dr Arun Gupta, consultant anaesthetist at CUH and director of postgraduate education at CUH.

“As institutions scale procurement, the demand for platforms that offer utility and ease of mixed reality learning management is rapidly expanding,” he said. 

Learners wearing mixed-reality headsets can interact with each other and a multi-layered, medically accurate ‘holographic’ patient. This creates a unique environment to learn and practice vital, real-time decision making and treatment choices.

Medical instructors with their own headsets can make changes on the fly, by changing patient responses or introducing complications – whether in person in a teaching group or over the internet.

Learners can also watch, contribute to and assess the holographic patient scenarios from Android, iOS smartphone or tablet. This means true-to-life, safe-to-fail immersive learning can be accessed, delivered and shared across the world, with the technology now available for license to learning institutions everywhere.

Professor Riikka Hofmann at Cambridge’s Faculty of Education is leading an analysis of the technology as a teaching method.

“Our research is aimed at uncovering how such simulations can best support learning and accelerate the adoption of effective mixed reality training while informing ongoing development,” said Prof Hofmann.

“We hope that it will help guide institutions in implementing mixed reality into their curricula, in the same way institutions evaluate conventional resources, such as textbooks, manikins, models or computer software, and, ultimately, improve patient outcomes.”

Junior doctor Aniket Bharadwaj is one of the first to try out the new technology. “Throughout medical school we would have situations where actors would come in an act as patients. With the pandemic a lot of that changed to tablet based interactions because of the risk to people of the virus,” he said.

“Having a hologram patient you can see, hear and interact with is really exciting and will really make a difference to student learning.”

The first module features a hologram patient with asthma, followed by anaphylaxis, pulmonary embolism and pneumonia. Further modules in cardiology and neurology are in development.

Delivered by the Gig Immersive Learning Platform, HoloScenarios aims to centralise and streamline access and management of mixed reality learning, and encapsulate the medical experience of world-leading doctors at CUH and across the University of Cambridge.

Source: University of Cambridge

Categories : Metabolic DisordersTags :

Just Looking at a Meal Triggers Inflammation

On By ModernMedia
A hamburger
Photo by Ilya Mashkov on Unsplash

Insulin is released just by the sight and smell of a meal, but now, researchers report in Cell Metabolism that this insulin release depends on a short-term inflammatory response that takes place in these circumstances. In overweight individuals, however, this inflammatory response is so excessive that it can impair insulin secretion.

Even the anticipation of a forthcoming meal triggers a series of responses in the body. Insulin is released in this neurally mediated (or cephalic) phase of insulin secretion.

Meal stimulates immune defence

Until now, it was unclear how the sensory perception of a meal generated a signal to the pancreas to ramp up insulin production. Now, researchers from the University of Basel and University Hospital Basel have identified an important piece of the puzzle: an inflammatory factor known as interleukin 1 beta (IL1B), which is also involved in the immune response to pathogens or in tissue damage.

“The fact that this inflammatory factor is responsible for a considerable proportion of normal insulin secretion in healthy individuals is surprising, because it’s also involved in the development of type 2 diabetes,” explained study leader Professor Marc Donath from the Department of Biomedicine and the Clinic of Endocrinology.

Chronic inflammation damaging the insulin-producing cells of the pancreas is one of the causes of type 2 diabetes. This is another situation in which IL1B plays a key role – in this case, it is produced and secreted in excessively large quantities. Thus, researchers are investigating whether inhibiting IL1B could be a treatment for diabetes.

Short-lived inflammatory response

Circumstances are different when it comes to neurally mediated insulin secretion: “The smell and sight of a meal stimulate specific immune cells in the brain known as the microglia,” said study author Dr Sophia Wiedemann, resident physician for internal medicine. “These cells briefly secrete IL1B, which in turn affects the autonomic nervous system via the vagus nerve.” This system then relays the signal to the pancreas.

In the case of morbid obesity, however, this neurally mediated phase of insulin secretion is disrupted. Specifically, by the initial excessive inflammatory response, as explained by doctoral candidate Kelly Trimigliozzi, who carried out the main part of the study in collaboration with Dr Wiedemann.

“Our results indicate that IL1B plays an important role in linking up sensory information such as the sight and smell of a meal with subsequent neurally mediated insulin secretion – and in regulating this connection,” Prof Marc Donath said.

Source: EurekAlert!

Categories : COVIDTags :

Long COVID Risk only Slightly Lower after Vaccination

On By ModernMedia
Man wearing mask with headache
Source: Usman Yousaf on Unsplash

Vaccination only reduces the risk of long COVID after infection by only about 15%, according to a study of more than 13 million people published in Nature Medicine. That’s the largest cohort that has yet been used to examine how much vaccines protect against the condition, but it is unlikely to end the uncertainty as other studies have produced conflicting results.

Studying long COVID has been challenging not least because of how hard it is to define from its constellation of symptoms. Even its prevalence has been hard to determine, with some studies suggesting it occurs in 30% of people after COVID infections. But nephrologist Ziyad Al-Aly and colleagues conducted a study of about 4.5 million people treated at US Department of Veterans Affairs (VA) hospitals, and the findings suggested that the number is 7% overall and lower than that for those who were not hospitalised.

Another mystery has been whether long COVID is less likely to occur after a breakthrough infection. But Al-Aly’s team now looked at VA health records from January to December 2021, including those of about 34 000 vaccinated people who had breakthrough SARS-CoV-2 infections, 113 000 people who had been infected but not vaccinated and more than 13 million people who had not been infected.

These results indicated only 15% a reduction of Long COVID in vaccinated individuals, a marked contrast to previous, smaller studies which suggested much higher protection rates. It’s also a departure from another large study, which used self-reported data from 1.2 million UK smartphone users and found that vaccination halved the risk of long COVID.

The authors of the latest study also compared symptoms such as brain fog and fatigue in vaccinated and unvaccinated people for up to six months after they tested positive for SARS-CoV-2. The team found no difference in type or severity of symptoms between those who had been vaccinated and those who had not. “Those same fingerprints we see in people who have breakthrough infections,” Al-Aly said.

In the US alone there have been over 83 million COVID infections, he noted. If even a small percentage of those turn into long COVID, “that’s a staggeringly high number of people affected by a disease that remains mysterious”.

Such limited protection means putting vulnerable people such as the immunocompromised at risk if measures such as masking are withdrawn. “We’re literally solely reliant, now almost exclusively, on the vaccine to protect us and to protect the public,” said Al-Aly. “Now we’re saying it’s only going to protect you 15%. You remain vulnerable, and extraordinarily so.”

“Generally speaking, this is horrifying,” said David Putrino, a physical therapist at Mount Sinai Health System in New York City who studies long COVID. While he praises the study, he notes that it is limited because it does not break the data down by key factors, such as medical history. “These are very important questions we need answers to,” Putrino says. “We don’t have any really well constructed studies just yet.”

Steven Deeks, an HIV researcher at the University of California, San Francisco, points out that the study includes no data from people infected during the period when the Omicron variant was causing the majority of infections. “We have no data on whether Omicron causes long COVID,” he says. The findings, he adds, “apply to a pandemic that has changed dramatically”.

Deeks added, that the results do highlight the need for more research on long COVID, and for accelerated development of therapies. “We don’t have a definition, we don’t have a biomarker, we don’t have an imaging test, a mechanism or a treatment,” he said. “We just have questions.”

Source: Nature

Categories : Ageing HIVTags :

HIV Infection Found to Accelerate Ageing Process

On By ModernMedia
HIV Infecting a T9 Cell. Credit: NIH

Within just two to three years of infection, HIV causes an “early and substantial” impact on ageing in infected people, accelerating epigenetic changes and telomere shortening associated with normal ageing, according to a study in iScience.

The findings suggest that new HIV infection may act to reduce an individual’s life span by five years compared to an uninfected person.

“Our work demonstrates that even in the early months and years of living with HIV, the virus has already set into motion an accelerated ageing process at the DNA level,” said lead author Elizabeth Crabb Breen, a professor emerita at UCLA. “This emphasises the critical importance of early HIV diagnosis and an awareness of ageing-related problems, as well as the value of preventing HIV infection in the first place.”

In previous studies, HIV and antiretroviral treatment has been observed to accelerate age-related conditions such as cardiovascular and renal disease, grail and cognitive impairment.

Researchers analysed stored blood samples from 102 men collected six months or less before they became infected with HIV and again two to three years after infection. They compared these with matching samples from 102 non-infected age-matched men taken over the same time period. All the men were participants in the Multicenter AIDS Cohort Study, an ongoing US study initiated in 1984.

The study examined how HIV affects epigenetic DNA methylation. Epigenetic changes are those made in response to the influence of outside factors such as disease that affect how genes behave without changing the genes themselves.

Five epigenetic measures of ageing were analysed – four of them are epigenetic ‘ clocks’, each of which uses a slightly different approach to estimate biological age acceleration in years, relative to chronologic age. The fifth measure assessed telomere length, which shorten with age and cell divisions.

Compared to non-infected controls, HIV-infected individuals showed significant age acceleration in each of the four epigenetic clock measurements – ranging from 1.9 to 4.8 years – as well as telomere shortening over the period beginning just before infection and ending two to three years after, in the absence of highly active antiretroviral treatment.

“Our access to rare, well-characterised samples allowed us to design this study in a way that leaves little doubt about the role of HIV in eliciting biological signatures of early ageing,” said senior author Professor Beth Jamieson. “Our long-term goal is to determine whether we can use any of these signatures to predict whether an individual is at increased risk for specific ageing-related disease outcomes, thus exposing new targets for intervention therapeutics.”

Study limitations included having only men as participants, with few non-white participants. The sample size was also too small to take into consideration later effects of highly active antiretroviral treatment or to predict clinical outcomes. Additionally, there presently is no consensus on what is normal ageing or how to define it, the researchers wrote.

Source: UCLA

Categories : Healthcare Politics and RegulationsTags :

Court Action to Stop Immigrants Being Denied Life-saving Healthcare

On By ModernMedia
Gavel
Photo by Bill Oxford on Unsplash

The rights of immigrant and undocumented women and children to access free healthcare in South Africa will be put to the test in a court challenge launched by SECTION27 in the Gauteng High Court in Johannesburg.

In December 2019, two-year-old Sibusiso Ncube died of poisoning after he was refused treatment at Charlotte Maxeke Hospital because his Zimbabwean mother could not instantly produce his birth certificate or pay R5000, says an affidavit in the court case.

This was not an isolated incident according to Umunyana Rugege, executive director of SECTION27.

“Since 2013, SECTION27 has been repeatedly approached by pregnant migrant women and children under six, who have been denied access to free health services. This is perpetuated through discriminatory subordinate laws and practices,” Rugege says in her affidavit.

“They have routinely been denied access to the health care services, or they are pressured into signing acknowledgements of debt and undertakings to pay for services.”

SECTION27 wants all the relevant ordinances and regulations scrapped. It also seeks an an order that the Minister of Health issue a circular to all provincial health departments recording that all pregnant or lactating women, and children under six, who are not members of medical aid schemes and who have not come to South Africa to obtain health care, be entitled to free health services at any public health establishment, irrespective of their nationality and documentation status.

Rugege says that while the National Health Act does not place any limitation on the right to free health services, there are a range of subordinate laws and practices implemented at hospitals that impose conditions requiring proof of nationality and financial means.

“These laws and practices are unlawful,” she says.

Rugege cited other examples, such as a pregnant asylum seeker who was denied treatment after she was injured in a robbery. She was told she had to pay R2000 before a “file could be opened” at Steve Biko Academic Hospital.

Two months later, when she was eight months pregnant and went to Charlotte Maxeke, she was told she had to pay R20 000 if she wanted treatment and give birth at the hospital. Only after SECTION27 intervened, was she given an appointment, but the night before it she lost her baby.

Another Zimbabwean woman whose child needed emergency surgery was forced to sign an admission of debt for more than R34 000 at the same hospital. Then when he needed further surgery, it was denied because of the outstanding debt. The woman was further told that she would have to pay R5000 for admission and R50 000 for the second surgery.

Again SECTION27 intervened. But in March, when the mother took him back for a checkup, a nurse addressed everyone in the queue and told them that foreign nationals would not be attended to if they did not have money to pay. The mother, and others, left without being seen.

The application is supported by the Jesuit Refugee Service, The Southern African HIV Clinicians Society, and Doctors Without Borders; all are expected to file affidavits soon. Rugege says these will highlight discriminatory institutional policies and systematic xenophobic practices and attitudes that have “detrimental and sometimes fatal consequences”.

“There is simply no coherent approach at different public health establishments … even within a single establishment, different officials treat patients differently,” she said. Access to health care depends on who is on duty that day. On “lucky days” people will gain access without any trouble.

The respondents – the MEC and Gauteng health department head, the Minister and Director-General of Health – have 15 days to file notices of opposition.

By Tania Broughton

This article is republished from GroundUp under a Creative Commons Attribution-NoDerivatives 4.0 International License.

Source: GroundUp