Day: July 25, 2022

Categories : Diseases, Syndromes and Conditions Healthcare Politics and RegulationsTags :

Despite Disagreement, WHO Sounds Highest Alert for Monkeypox

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On 22 July, World Health Organisation (WHO) director general Dr Tedros Adhanom Ghebreyesus declared the global spread of monkeypox a Public Health Emergency of International Concern (PHEIC) – a move which went against the recommendation of a special committee. This was the first time since the PHEIC’s inception in 2005 that it had done so. The special committee’s reluctance to recommend a PHEIC has previously drawn criticism from public health experts.

The 21 July meeting of WHO’s Emergency Committee, did not reach a consensus on whether to declare the growing monkeypox outbreak a PHEIC; a narrow majority voting against doing so. But Dr Tedros invoked a PHEIC at a press conference the next day in Geneva. “We have an outbreak that has spread around the world rapidly, through new modes of transmission, about which we understand too little and which meets the criteria in the International Health Regulations,” he said.

Data presented during the meeting including modelling which showed the basic reproduction number (R0) to be above 1 among gay or bisexual men, and below 1 in other groups. For example, in Spain, the estimated R0 is 1.8, in the United Kingdom 1.6, and in Portugal 1.4.

In June, the committee first recommended against declaring a PHEIC , which was roundly criticised by epidemiologists and global health experts. Dr Tedros reconvened the group this week and asked it to reconsider the question. Nine members were against declaring a PHEIC and six in favour, Dr Tedros said at the press conference.

According to Science, the Thursday meeting of the expert panel was followed by tense exchanges via email and text messages between its participants.

One of the objections to a PHEIC was that few deaths had been caused by the disease so far and was not spreading in the general population. Another was that a PHEIC could possibly lead to further stigmatisation of men who have sex with men (MSM), the group primarily affected.

Many gay rights and sexual health advocates were for the PHEIC, as it would help raise awareness and help protect the most at-risk group of MSM.

“Although I’m declaring a public health emergency of international concern, for the moment, this is an outbreak that’s concentrated among men who have sex with men, especially those with multiple sexual partners,” Dr Tedros said. “That means that this is an outbreak that can be stopped with the right strategies in the right groups.”

Those who push for declaring a PHEIC also cited the rising number of monkeypox cases (over 15 000) and the countries affected (70), and that many cases are likely still not being picked up. The virus could also potentially establish itself permanently worldwide – indeed, the CDC reported that two children in the US had been infected.

Sources familiar with the deliberations of the committee said the votes for a PHEIC were driven by those with expertise in monkeypox and LGBT health, and those against by more generalist global heath voices.

According to Science, sources familiar with the committee’s deliberation said that those in favour of a PHEIC had monkeypox and LGBT health expertise, and those against were from a global health standpoint.

While a PHEIC can give the WHO some extra powers, it is the loudest level of alert it can sound. Since its creation in 2005, PHEIC has been declared six times: for outbreaks of H1N1 influenza, polio, Zika, COVID (ongoing), and twice for Ebola outbreaks (one ongoing).

Source: Science.org

Categories : Diet and Nutrition GenderTags :

Women Could Counteract Effects of Dietary Salt with Potassium

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Banana
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By increasing the amount of potassium-rich foods in their diets, women could reduce the negative effects of salt, according to a study published today in European Heart Journal. However, this association was not observed in men.

“It is well known that high salt consumption is associated with elevated blood pressure and a raised risk of heart attacks and strokes,” said study author Professor Liffert Vogt of Amsterdam University Medical Centers, the Netherlands. “Health advice has focused on limiting salt intake but this is difficult to achieve when our diets include processed foods. Potassium helps the body excrete more sodium in the urine. In our study, dietary potassium was linked with the greatest health gains in women.”

The study included 11 267 male and 13 696 female participants of the EPIC-Norfolk study, which recruited 40 to 79 year-olds from general practices in Norfolk, UK, between 1993 and 1997. Participants completed a questionnaire on lifestyle habits, blood pressure was measured, and a urine sample was collected. Urinary sodium and potassium served as an estimate for dietary. Participants were divided into tertiles according to sodium intake (low/medium/high) and potassium intake (low/medium/high).

The researchers analysed the association between potassium intake and blood pressure after adjusting for age, sex and sodium intake. Potassium consumption (in grams per day) was associated with blood pressure in women — as intake went up, blood pressure went down. When the association was analysed according to sodium intake (low/medium/high), the relationship between potassium and blood pressure was only observed in women with high sodium intake, where every 1 gram increase in daily potassium was associated with a 2.4mmHg lower systolic blood pressure. In men, there was no association between potassium and blood pressure.

During a median follow-up of 19.5 years, 13 596 (55%) participants were hospitalised or died due to cardiovascular disease. The researchers analysed the association between potassium intake and cardiovascular events after adjusting for confounding factors. In the overall cohort, people in the highest tertile of potassium intake had a 13% lower risk of cardiovascular events compared to those in the lowest tertile. When men and women were analysed separately, the corresponding risk reductions were 7% and 11%, respectively. The amount of salt in the diet did not influence the relationship between potassium and cardiovascular events in men or women.

Professor Vogt said: “The results suggest that potassium helps preserve heart health, but that women benefit more than men. The relationship between potassium and cardiovascular events was the same regardless of salt intake, suggesting that potassium has other ways of protecting the heart on top of increasing sodium excretion.”

The WHO-recommened adult intake is at least 3.5 grams of potassium and less than 2 grams of sodium (5 grams of salt) per day. Foods rich in potassium include vegetables, fruit, nuts, beans, dairy products and fish.

Professor Vogt concluded: “Our findings indicate that a heart healthy diet goes beyond limiting salt to boosting potassium content. Food companies can help by swapping standard sodium-based salt for a potassium salt alternative in processed foods. On top of that, we should all prioritise fresh, unprocessed foods since they are both rich in potassium and low in salt.”

Source: European Society of Cardiology

Categories : Cancer TransplantsTags :

Excellent Outcomes for Shrinking Liver Cancer Tumours Before Transplant

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Photo by Piron Guillaume on Unsplash

Shrinking liver cancer tumours in order to allow the patient to qualify for a liver transplant leads to excellent 10-year post-transplant outcomes, according to the findings of a new study published in JAMA Surgery. The results validate current US policies around transplant eligibility.

Selection of patients with hepatocellular carcinoma (HCC), the most common form of liver cancer, for transplant has been guided for more than two decades by standards known as the Milan criteria. The Milan criteria state that transplantation should be performed in those with a single tumour of 5cm or less in diameter or three tumours that are each 3cm or less in diameter, have no macrovascular invasion, and no metastasis. Over time, the rising incidence of HCC and mortality rates in the United States have led to refinements to the selection policy, shifting the focus to guidelines that also incorporate tumour biology, response to bridging therapies, and waiting times for patients within and beyond the Milan criteria.

One aspect of the current criteria is known as downstaging: the process of applying liver directed therapy to tumours too big for the Milan criteria with the hope of reducing them to the suggested size. Downstaging is now an option in selecting suitable liver transplant candidates with initial tumors that exceed the criteria. However, liver cancer can recur after transplantation, either within or outside the liver. The treatment options of patients who have recurrence post transplantation is limited and prognosis is poor.

In this cohort study, a retrospective multicentre analysis of prospectively collected data was conducted for 2645 adults who had undergone liver transplant for HCC at five centres between January 2001 and December 2015. The outcomes of 341 patients whose disease was downstaged to fit within the Milan criteria were compared with those in 2122 patients whose disease always fit within the criteria and 182 patients whose disease was not downstaged.

The 10-year post-transplant survival and recurrence rates were, respectively, 52.1% and 20.6% among those whose disease was downstaged; 61.5% and 13.3% in those always within the criteria; and 43.3% and 41.1% in those whose disease was not downstaged.

“Our study validates national policy on downstaging prior to transplantation and shows the clear utility benefit for transplantation prioritisation decision-making,” said Parissa Tabrizian, MD, co-lead author on the study. “These results can increase the level of recommendations for the downstaging policy on a global basis. It also demonstrates that surgical management of HCC recurrence after transplantation is associated with improved survival in well-selected patients and should be pursued. The study also supports expanding the policy of downstaging applied to guidelines in Europe and Asia.”

“Our study represents a solid confirmation that HCC patients effectively downstaged to Milan criteria have an outstanding median survival of 10 years, thus providing the rationale to adopt this policy on a global basis,” said Josep Llovet, MD, PhD, co-lead author on the study. “With this study clinical practice guidelines of management of HCC can recommend our approach with an acceptable level of evidence.”

Source: The Mount Sinai Hospital

Categories : AgeingTags : 1 Comment

Treatment of Rheumatoid Arthritis Before Disease Develops Yields Benefits

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Hand osteoarthritis
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A temporary treatment with methotrexate in the early stages of rheumatoid arthritis resulted in benefits for patients, according to research published in The Lancet. By temporarily prescribing methotrexate in the “pre-rheumatic phase,” patients experienced a reduction long-term joint inflammations, pain and physical limitations.

“At present, methotrexate is only prescribed to the patient following a rheumatoid arthritis diagnosis,” explained Annette van der Helm, Professor of Rheumatology at Leiden University Medical Centre. “But that is too late. By then, the disease is already considered chronic.” The researchers hope to prevent or reduce disease burden by giving methotrexate to patients likely to develop rheumatoid arthritis.

The researchers found that while the development of rheumatoid arthritis was not prevented by early treatment, diagnosis was delayed. Patients that had temporarily received methotrexate also reported less pain, morning stiffness and daily functioning impediments. Fewer joint inflammations were seen in MRI scans. “This is an important step towards reducing disease burden for this group of patients,” said Prof Van der Helm. “Moreover, it serves as initial evidence for initiating treatment in the ‘pre-rheumatic’ phase.”

The 8 year study included more than 230 patients. “All suffered from joint pain and inflammation, which could be seen on the MRI, and was thought to be a rheumatism precursor,” said PhD student Doortje Krijbolder. Rheumatologists are not certain whether this is truly the case, however. Pre-rheumatoid patients were treated with methotrexate or a placebo for one year, and a one year follow-up enabled researchers to see if the effects of the treatment persisted.

“This chronic disease is extremely burdensome to patients and their families. Our study is paving the way toward arthritis prevention,” said Prof Van der Helm. “To achieve this completely, greater understanding of the molecular processes underlying the chronic nature of rheumatoid arthritis is necessary.”

Source: Medical Xpress

Categories : General Interest Medical Research & TechnologyTags :

Prof Shabir Madhi Honoured at NSTF’s ‘Science Oscars’

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Credit: NSTF

Leading vaccinologist Professor Shabir Madhi received the Lifetime Award from South Africa’s prestigious ‘Science Oscars’ held by the National Science and Technology Foundation. He received the honour for his leadership in research on vaccines against life-threatening diseases in Africa and globally, and he has been at the cutting edge of research in this area since 1997.

As well as being the Dean of the Faculty of Health Sciences and Professor of Vaccinology at Wits, Prof Madhi is also the director of the South African Medical Research Council (SAMRC) Vaccine and Infectious Diseases Analytics Research Unit (Wits-VIDA); and is co-director of African Leadership in Vaccinology Expertise, Wits. During the COVID pandemic he became one of the most-cited expert by the media as the public looked to the healthcare sector for advice and guidance during this crisis.

A number of awards also went to those in the field of healthcare or who contributed to healthcare, an area especially marked by SA’s response to the COVID pandemic.

CEO of SA Health Products Regulatory Authority (SAHPRA), Dr Boitumelo Semete-Makokotlela, received the Management Award for successfully leading the authorisation of a number of COVID diagnostic tests, vaccines and therapies during the COVID.

The Network for Genomics Surveillance (NGS-SA) in SA received the Data for Research award for NGS-SA, which generated of genomic surveillance data of SARS-CoV-2 aimed at informing SA’s public health response to this virus. It was represnted by its co-founders, Dr Jinal Bhiman, Scientific Lead for Global Immunology and Immune Sequencing for Epidemic Response South Africa (GIISER-SA); and Professor Tulio de Oliveira, SU.

Other recipients in the field of healthcare included Dr Wynand Goosen, who received an Emerging Researcher aware for leadership of research in SA on the surveillance of zoonotic TB in domestic cattle and wild animals as potential infection sources in susceptible people in rural areas.