Day: September 23, 2022

Categories : Cardiovascular DiseaseTags : Leave a comment

Switch to Tenecteplase for Ischaemic Strokes Improves Outcomes and Lowers Costs

On By ModernMedia
Credit: American Heart Association

A newer, faster-administration clot-busting drug called tenecteplase outperforms the traditional treatment for ischaemic strokes in several key areas, including better health outcomes and lower costs, according to a new study published in the journal Stroke.

The 15-month study was led by a team of neurologists at Dell Medical School at The University of Texas at Austin.

“The Dell Med Neurology Stroke Program was one of the first in the United States to make this change,” said Steven Warach, MD, lead author of the study . “Based on even the earliest results from this study, other experts across the country were convinced and made the switch from alteplase to tenecteplase at their own stroke centres, including at Ascension hospitals nationwide.” 

The vast majority of strokes of the 800 000 strokes in the US (about 87%) each year are ischaemic.

Both tenecteplase and alteplase are federally approved for use in dissolving clots in blocked heart arteries. But the newer drug tenecteplase is also being used by clinicians, off-label, to treat ischaemic strokes, because clinical trials in stroke suggest that it may be at least as good as alteplase and it is easier to administer. Tenecteplase is administered by a single five- to 10-second intravenous injection. The researchers compared its performance with the standard drug for stroke, alteplase, which is injected over 60 minutes.

“When it comes to treating patients with a stroke, every second matters,” said Warach, who is also a professor of neurology at Dell Med. “The shorter preparation and injection time with tenecteplase not only eliminates a lot of dosing errors related to alteplase, but it’s also more efficient. We were able to deliver the clot-busting medicine more quickly after patients arrived in the emergency department, and for patients who needed to be transferred to another hospital for more advanced care after receiving the clot buster, we were able to initiate the transfer sooner in those treated with tenecteplase.”

For patients who come into the emergency department after a stroke, Warach’s study found that the “door-to-needle” time (from patients’ arrival to treatment) was on average six minutes quicker with tenecteplase. And for patients who also required a thrombectomy, the surgical removal of a blood clot causing the stroke, tenecteplase slashed to the time to transferring the patient to a thrombectomy-capable stroke centre by 25 minutes.

Researchers also saw improvements in clinical outcomes for patients given tenecteplase, including:

  • A 5% increase in patients who were able to walk independently at time of hospital discharge to home.
  • A 4% decrease in occurrences of bad events such as brain haemorrhages, discharge to hospice care or death.

The third major improvement: cost. The research team found that tenecteplase treatment cost the hospitals about US$ 2500 less than alteplase per patient.

Source: EurekAlert!

Categories : COVID Metabolic DisordersTags : 1 Comment

Is COVID Really Causing New-onset Type 1 Diabetes in Young People?

On By ModernMedia
Diabetes - person measures blood glucose
Photo by Photomix Company from Pexels

New research on Scottish data has found SARS-CoV-2 infection is linked to an increased incidence of new-onset type 1 diabetes in under-35s – but only in the first month after infection, likely due to increased testing as well as COVID bringing forward the progression of diabetes.

The study, presented at this year’s European Association for the Study of Diabetes (EASD) Annual Meeting, linked data on COVID tests results to the Scottish diabetes register for the period between March 2020 and November 2021, and tested whether this period of COVID infection was associated with an increased risk of diabetes.

“Our findings call into question whether a direct association between COVID and new-onset type 1 diabetes in adults and children exists”, says co-lead author Professor Helen Colhoun from Public Health Scotland and the University of Edinburgh, Scotland. “One recent report by researchers at the US Centers for Disease Control and Prevention (CDC), analysing two large insurance-claim databases of those under age 18, found that children with COVID were 2.5 times as likely to be diagnosed with diabetes over a month after infection than those who were never infected. If replicated, this is going to create a large number of people with newly diagnosed diabetes and might also alter the risk–benefit balance for COVID vaccination in young children. Importantly, we did not confirm that finding.”

In type 1 diabetes, which usually appears during childhood or adolescence, the immune system attacks insulin-producing cells, but it is not known why. One theory is that the immune system may be triggered by a viral infection and then accidentally also attacks insulin-producing cells. It has also been suggested that viral infections may increase the rate of progression of type 1 diabetes in people who still have normal blood sugar levels.

In this study, Prof Colhoun and colleagues linked individual-level data on PCR-confirmed SARS-CoV-2 infections from the Electronic Communication of Surveillance Database, which captures all PCR tests for COVID-19 nationally, with precise dates of all new type 1 diabetes diagnoses from the national register in Scotland (that is updated daily).

During the study period a confirmatory PCR test was mandatory for all those with a positive lateral flow test.

The important aspect of this study is the exact dates of diabetes diagnosis were available, unlike in some earlier studies, ensuring that the time sequence of COVID and type 1 diabetes could be established.

Between March 2020 and November 2021, a total of 365 080 children and adults had at least one detected SARS-CoV-2 infection, and 1074 were diagnosed with type 1 diabetes.

The analysis found no association between SARS-CoV-2 infection and new-onset type 1 diabetes 30 days or more after infection, or in those aged younger than 16 years, contrary to several previously reported studies.

However, the researchers did find that children and adults with a first positive SARS-CoV-2 test were 2.5 times as likely to be diagnosed with diabetes within 30 days of infection compared to those who did not have a previous registered infection; this risk was more than three times higher in those younger than 16 years.

But the authors stress strong arguments against a causal effect of COVID underlying this association.

Further analyses investigating the pattern of COVID- testing in relation to type 1 diabetes diagnosis found an increased frequency of SARS-CoV-2 testing in the days before and after diabetes presentation, for both negative and positive results. This suggests, says the authors, that the association may partly be explained by higher detection of infection at this time.

The authors also note that the average time from the onset of type 1 diabetes symptoms to diagnosis under 16s in England is around 25 days. So, it is likely that many of those who tested positive for COVID-19 within 30 days of a diabetes diagnosis already had type 1 diabetes at the time of infection.

No link was found between between COVID vaccination status and new-onset type 1 diabetes in adults (few children were vaccinated during the study period), providing further evidence against a causal effect of SARS-CoV-2 infection on the development of diabetes.

The researchers also looked at trends in type 1 diabetes incidence in Scottish children aged 0–14 years before and during the pandemic, finding that the incidence in 2020–2021 was around 20% higher than the 7-year average for 2015–2021.

However, they point out that based on estimates from England, the time course of the increase in diabetes incidence in those aged 0–14 years predated most of the cumulative incidence of SARS-CoV-2 infection in this age group (June 2021 onwards), suggesting no causal link between COVID and rates of diabetes.

“Our findings show that causes other than COVID infection itself need to be considered in relation to the increased incidence of type 1 diabetes”, said co-lead author Professor Paul McKeigue from Public Health Scotland and the University of Edinburgh, Scotland. “We need to consider what has happened regarding the spread of viruses such as enteroviruses during the pandemic, and whether there are any other environmental factors, such as sunlight exposure and vitamin D levels, that might have altered during lockdown that might also be relevant.”

The authors note that although their study was large, further analyses with more recent data is needed, and that the delay in mass testing meant many COVID cases in the young went undetected.

Source: EurekAlert!

Categories : Allergies COVIDTags : Leave a comment

Food Allergies may Protect Some against COVID

On By ModernMedia
Image from Pixabay

A recent study in the journal Frontiers in Immunology may explain why some cases of COVID are asymptomatic: common foods, vaccines, bacteria and viruses may all prime the immune system to attack SARS-CoV-2 due to bearing similar antigens to the virus. The study paves the way for new immunotherapies or vaccines that lead to stronger immunity against COVID.

Proteins present in bacteria, human cells, vaccines, and even foods may all share similarities with those in SARS-CoV-2. The researchers behind this latest study hypothesised that similarities between SARS-CoV-2 and other common proteins may affect our susceptibility to the virus.

After the initial infection by a pathogen has passed, T and B cells retain a memory of it, ready to rapidly produce more antibodies if needed. Food allergies are a result of the immune system targeting the proteins in what are otherwise harmless substances.

Testing antibody cross-reactions

Could such an ‘immune memory’ to proteins we have encountered in our past underlie immune resistance and reduced susceptibility to Covid-19? To begin to test this hypothesis, these researchers investigated whether antibodies that target proteins in the SARS-CoV-2 virus could also bind to proteins in other agents, such as foods or common bacteria.

The researchers tested the ability of these antibodies to bind to 180 different proteins from common foods, two different vaccines, and 15 bacterial and viral proteins. The antibodies reacted most strongly with a common gut bacterium called E. faecalis and a vaccine against diphtheria, tetanus, and pertussis. Interestingly, they also reacted very strongly against proteins found in common foods, including broccoli, roasted almonds, pork, cashews, milk, soy, and pineapple.    

Eat for immunity?

Unfortunately, you will likely not be able to eat your way to COVID immunity. ‘Immunity’ against a food type, for instance, is typically characterised by a food allergy. “Usually only people with leaky gut can make antibodies against food, so I wouldn’t actually recommend eating foods that give you leaky gut, because this would give you a whole new set of problems,” said Dr Aristo Vodjani of Cyrex Laboratories in Arizona, lead author on the study.

Indeed, the researchers caution that although these agents could potentially provide some protection from SARS-CoV-2, they are no replacement for current vaccines. Further studies are also needed to confirm that these proteins do indeed confer some protection, and if so, whether it is mediated through a short-lived antibody response or a longer-term memory cell response.

The findings may shed some light on our variable responses to COVID infection. With more research, these results could lead to more effective treatments or better vaccines against the virus. Another application may lie in assessing an individual’s susceptibility to the virus before they have even been infected. 

Source: EurekAlert!

Categories : Diseases, Syndromes and ConditionsTags : Leave a comment

Eye Infection Risk Greatly Increased for Wearers of Reusable Contact Lenses

On By ModernMedia
Photo by Lensabl on Unsplash

People who wear reusable contact lenses are nearly four times as likely as those wearing daily disposables to develop a rare sight-threatening eye infection, Acanthamoeba keratitis (AK), according to new research. The study, published in Ophthalmology, identifies multiple factors that increase the risk of AK, including reusing lenses or wearing them overnight or in the shower.

AK is a type of microbial keratitis – a condition that results in inflammation of the cornea.

Eye infection from Acanthamoeba. Credit: CDC

Lead author, Professor John Dart (UCL Institute of Ophthalmology and Moorfields Eye Hospital NHS Foundation Trust) said: “In recent years we have seen an increase of Acanthamoeba keratitis in the UK and Europe, and while the infection is still rare, it is preventable and warrants a public health response.

“Contact lenses are generally very safe but are associated with a small risk of microbial keratitis, most commonly caused by bacteria, and which is the only sight threatening complication of their use. Given that an estimated 300 million people across the globe wear contact lenses, it is important that people know how to minimise their risks for developing keratitis.”

Contact lens use is now the leading cause of microbial keratitis in patients with otherwise healthy eyes in countries in the global north. While sight loss resulting from microbial keratitis is uncommon, Acanthamoeba, is one of the most severe causes and is responsible for about half of those contact lens users who develop sight loss after keratitis. Avoidable risks are associated with 90% of AK cases. The infection remains rare, affecting fewer than 1 in 20 000 contact lens wearers per year in the UK.

In AK, ,infection by Acanthamoeba, a cyst-forming microorganism, causes the cornea to become painful and inflamed. The most severely affected patients (a quarter of the total) end up with less than 25% of vision or become blind following the disease and face prolonged treatment. Overall, 25% of people affected require corneal transplants to treat the disease or restore vision.

For the study, the researchers recruited over 200 patients of Moorfields Eye Hospital who completed a survey, including 83 people with AK, and compared them with 122 participants who came to eyecare clinics with other conditions, who acted as a control group.

People who wore reusable soft contact lenses (such as monthlies) had 3.8 times the odds of developing AK, compared to people who wore daily disposable lenses. Showering with lenses increased AK risk by 3.3 times, while wearing lenses overnight increased risk by 3.9 times. Among daily disposable wearers, reusing their lenses increased their infection risk. Having had a recent contact lens check with a health professional reduced the risk.

With further analysis, the researchers estimated that 362% of cases in the UK, and potentially in many other countries, could be prevented if people switched from reusable to daily disposable lenses.

A recent study led by Prof Dart found that AK is increasing in prevalence in the UK. By reviewing incidence data from Moorfields Eye Hospital from 1985 to 2016, he and his team found an increase starting in 2000–2003, when there were eight to 10 cases per year, to between 36 and 65 annual cases at the end of the study period.

First author, Associate Professor Nicole Carnt (UNSW, Sydney, UCL Institute of Ophthalmology and Moorfields Eye Hospital) said: “Previous studies have linked AK to wearing contact lenses in hot tubs, swimming pools or lakes, and here we have added showers to that list, underlining that exposure to any water when wearing lenses should be avoided. Public pools and coastal authorities could help reduce this risk by advising against swimming in contact lenses.”

Prof Dart added: “Contact lens packaging should include information on lens safety and risk avoidance, even as simple as ‘no water’ stickers on each case, particularly given that many people buy their lenses online without speaking to a health professional.

“Basic contact lens hygiene measures can go a long way in avoiding infections, such as by thoroughly washing and drying your hands before putting in your lenses.”

Source: EurekAlert!

Categories : Neurodegenerative DiseasesTags : 1 Comment

Serious Infections Increase Alzheimer’s and Parkinson’s Risk

On By ModernMedia
Old man
Source: JD Mason on Unsplash

Infections needing hospitalisal treatment in early- and mid-life are associated with an increased subsequent risk of Alzheimer’s and Parkinson’s diseases, according to a population-based, case control study by published in PLOS Medicine. No such increase was seen for amyotrophic lateral sclerosis (ALS), however.

The study used Swedish data on individuals diagnosed with Alzheimer’s disease, Parkinson’s disease or ALS, from 1970–2016, as well as five matched controls per case. The analysis included more than 290 000 Alzheimer’s disease cases, 100 000 Parkinson’s disease cases and 10 000 ALS cases.

The results show that a hospital-treated infection five or more years before diagnosis was associated with a 16% increased risk of Alzheimer’s disease and a 4% higher risk of Parkinson’s disease. The associations only applied to individuals diagnosed before the age of 60, whereas no association was found for those diagnosed later in life.

Individuals with multiple hospital treatments for infections before age 40 was associated with the highest risk of disease, with more than doubled risk of Alzheimer’s disease and more than 40% increase in the risk of Parkinson’s disease.

No association was observed for ALS, regardless of age at diagnosis. Due to the observational nature of the study, no causal link could be established.

“These findings suggest that infectious events may be a trigger or amplifier of a pre-existing disease process, leading to clinical onset of neurodegenerative disease at a relatively early age,” said Jiangwei Sun, the study’s first author and postdoctoral researcher at Karolinska Institutet.

Source: Karolinska Institutet