Month: September 2022

Categories : Diseases, Syndromes and ConditionsTags :

Early Sensing of Malaria in the Brain Leads to Cerebral Malaria

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Colourised scanning electron micrograph of red blood cell infected with malaria parasites, which are colourised in blue. The infected cell is in the centre of the image area. To the left are uninfected cells with a smooth red surface. Credit: National Institute of Allergy and Infectious Diseases, NIH

A recent study published in PNAS revealed that endothelial cells in the brain are able to sense the infection by the malaria parasite at an early phase, triggering the inflammation underlying cerebral malaria. This discovery identified new targets for adjuvant therapies that could restrain brain damage in initial phases of the disease and avoid neurological sequelae.

Cerebral malaria is a severe complication of infection with Plasmodium falciparum, the most lethal of the parasites causing malaria. This form of the disease manifests through impaired consciousness and coma and affects mainly children under 5, being one of the main causes of death in this age group in countries of Sub-Saharan Africa. Survivors are frequently affected by debilitating neurological sequelae, such as motor deficits, paralysis, and speech, hearing, and visual impairment.

To prevent certain molecules and cells from reaching the brain, which would disturb its normal functioning, endothelial cells forming a tight barrier between the blood and this organ. Cerebral malaria results from an unrestrained inflammatory response to infection which leads to significant alterations in this barrier and, consequently, neurological complications.

Over the last years, specialists in this field have turned their attention to a molecule, named interferon-β, which seems to be associated with this pathological process. So called for interfering with viral replication, this highly inflammatory molecule has two sides: it can either be protecting or cause tissue destruction. It is known, for example, that despite its antiviral role in COVID-19, at a given concentration and phase of infection, it can cause lung damage. A similar dynamic is thought to occur in cerebral malaria. However, we still don’t know what leads to the secretion of interferon-β, nor the main cells involved.

The present study revealed that endothelial cells in the brain play a crucial role, being able to sense the infection by the malaria parasite at an early phase. These detect the infection through an internal sensor which triggers a cascade of events, starting with the production of interferon-β. Next, they release a signalling molecule that attracts cells of the immune system to the brain, initiating the inflammatory process.

To reach these conclusions, researchers used mice that mimic several symptoms described in human malaria and a genetic manipulation system that allowed them to delete this sensor in several types of cells. When they deleted this sensor in brain endothelial cells, the animals’ symptoms were not as severe with lower mortality. They then realised these brain cells contributed greatly to the pathology of cerebral malaria. “We thought brain endothelial cells acted in a later phase, but we ended up realising that they are participants from the very beginning”, explained Teresa Pais, a post-doctoral researcher at the IGC and first author of the study. “Normally we associate this initial phase of the response to infection with cells of the immune system. These are already known to respond, but cells of the brain, and maybe other organs, also have this ability to sense the infection because they have the same sensors.”

But what really surprised the researchers was the factor activating the sensor and triggering this cell response. This factor is nothing more nothing less than a by-product of the activity of the parasite. Once in the blood, the parasite invades the host’s red blood cells, where it multiplies. Here, it digests haemoglobin, a protein that transports oxygen, to get nutrients. During this process, a molecule named haeme is formed and it can be transported in tiny particles in the blood that are internalised by endothelial cells. When this happens, haeme acts as an alarm for the immune system. “We weren’t expecting that haeme could enter cells this way and activate this response involving interferon-β in endothelial cells”, the researcher confessed.

This six-year project allowed the researchers to identify a molecular mechanism that is critical for the destruction of brain tissue during infection with the malaria parasite and, with that, new therapeutic targets. “The next step will be to try to inhibit the activity of this sensor inside the endothelial cells and understand if we can act on the host’s response and stop brain pathology in an initial phase,” explained principal investigator Carlos Penha Gonçalves. “If we could use inhibitors of the sensor in parallel with antiparasitic drugs maybe we could stop the loss of neuronal function and avoid sequelae which are a major problem for children surviving cerebral malaria.”

Source: Instituto Gulbenkian de Ciência (IGC)

Categories : COVID GenderTags :

Low Testosterone may be a Risk Factor for Severe COVID

On By ModernMedia
Testosterone molecule
Model of a testosterone molecule. Source: Wikimedia CC0

Among men with COVID, those with low testosterone levels are more likely to become seriously ill and be hospitalised than men with normal levels of the hormone, according to a study which appears in JAMA Network Open.

Analysis of data for 723 men who tested positive for COVID, mostly in 2020 before vaccines were available, indicated that low testosterone is an independent risk factor for COVID hospitalisation, similar to diabetes, heart disease and chronic lung disease.

They found that men with low testosterone who developed COVID were 2.4 times more likely to require hospitalisation than men with hormone levels in the normal range. Further, men who were once diagnosed with low testosterone but successfully treated with hormone replacement therapy were no more likely to be hospitalised for COVID than men whose testosterone levels had always tested in the normal range.

The findings, by researchers from the Washington University School of Medicine in St. Louis and Saint Louis University School of Medicine, suggest that treating men with low testosterone may help protect them against severe disease and reduce the burden on hospitals during COVID waves.

“It is very likely that COVID is here to stay,” said co-senior author Abhinav Diwan, MD, a professor of medicine at Washington University. “Hospitalizations with COVID are still a problem and will continue to be a problem because the virus keeps evolving new variants that escape immunization-based immunity. Low testosterone is very common; up to a third of men over 30 have it. Our study draws attention to this important risk factor and the need to address it as a strategy to lower hospitalisations.”

Prof Diwan and co-senior author Sandeep Dhindsa, MD, an endocrinologist at Saint Louis University, had previously shown that men hospitalised with COVID have abnormally low testosterone levels. However, severe illness or traumatic injury can cause a temporary drop in hormone levels, so causation cannot be proved in data from men already hospitalised with COVID. Data were needed for men with chronically low testosterone before COVID infection.

Profs Diwan, Dhindsa and colleagues identified 723 men whose testosterone levels had been measured between Jan. 1, 2017, and Dec. 31, 2021, and who had documented cases of COVID in 2020 or 2021. In some cases, testosterone levels were measured after the patient recovered from COVID. Since low testosterone is a chronic condition, men who tested low a few months after recovering from COVID probably had low levels before as well, Prof Dhindsa said.

The researchers identified 427 men with normal testosterone levels, 116 with low levels, and 180 who previously had low levels but were being successfully treated, meaning that they were on hormone replacement therapy and their testosterone levels were in the normal range at the time they developed COVID.

“Low testosterone turned out to be a risk factor for hospitalisation from COVID, and treatment of low testosterone helped to negate that risk,” Prof Dhindsa said. “The risk really takes off below a level of 200 nanograms per decilitre, with the normal range being 300 to 1000 nanograms per decilitre. This is independent of all other risk factors that we looked at: age, obesity or other health conditions. But those people who were on therapy, their risk was normal.”

Men with low testosterone levels can experience sexual dysfunction, depressed mood, irritability, difficulty with concentration and memory, fatigue, loss of muscular strength and a reduced sense of well-being overall. When a man’s quality of life is clearly diminished, he is typically treated with testosterone replacement therapy. When the symptoms are mild, though, doctors and patients may hesitate to treat.

The two main concerns related to testosterone therapy are an increased risk of prostate cancer and heart disease. Testosterone is well known to boost prostate cancer, but for heart disease, the evidence for risk is more ambiguous. A large clinical trial on the relationship between heart health and testosterone supplementation is expected to be completed soon.

“In the meantime, our study would suggest that it would be prudent to look at testosterone levels, especially in people who have symptoms of low testosterone, and then individualise care,” said Prof Diwan, whose specialty is cardiology. “If they are at really high risk of cardiovascular events, then the doctor could engage the patient in a discussion of the pros and cons of hormone replacement therapy, and perhaps lowering the risk of COVID hospitalisation could be on the list of potential benefits.”

Since this study is observational, it only suggests that boosting testosterone levels may help men avoid severe COVID, Diwan cautioned. A clinical trial would be needed to demonstrate conclusively whether such a strategy works.

Source: Washington University School of Medicine

Categories : HIV Obstetrics & GynaecologyTags :

Dolutegravir-based ART is Better for Pregnant Individuals with HIV-1

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pregnant woman holding her belly
Source: Anna Hecker on Unsplash

Dolutegravir-based antiretroviral therapies (ART) for HIV-1 are more effective for pregnant individuals than some other ART regimens commonly used in the US and Europe, according to a study available online in NEJM.

The study, led by Harvard T.H. Chan School of Public Health researchers, showed that pregnant individuals who took dolutegravir-based regimens had a high probability of being virally suppressed at delivery. No differences were seen in adverse birth outcome risks (preterm birth, low birth weight, small for gestational age, or neonatal death) between dolutegravir-based regimens and the other contemporary regimens.

“Globally, a dolutegravir-based regimen is currently recommended for treating HIV, and this is the first study to directly compare regimens including dolutegravir to other antiretroviral regimens, such as raltegravir-based regimens, that are also listed as ‘Preferred’ in US perinatal guidelines,” said senior research scientistKunjal Patel, lead author of the study.

Dolutegravir, is a newer antiretroviral part of a once-a-day regimen that has been shown to be more effective, easier to tolerate, and less likely to create new drug resistance in people with HIV-1. However, limited data have been available about its effectiveness and safety in pregnancy compared with regimens that commonly have been used during pregnancy in the US and Europe.

In the current observational study, the researchers compared dolutegravir use in pregnancy with atazanavir/ritonavir, darunavir/ritonavir, and raltegravir antiviral regimens that are currently classified as “Preferred” for use in pregnancy in the US About half of the participants started ART before conception. At delivery, 96.7% of pregnancies of participants who received dolutegravir were virally suppressed, whereas those of participants who took atazanavir/ritonavir or raltegravir had viral suppression of 84.0% and 89.2%, respectively.

“We think the observed differences are due to dolutegravir’s ability to rapidly decrease viral loads and its ease of use as part of a once-daily regimen that’s available as a fixed-dose combination,” said Patel. “Our results highlight the continual need for systematic studies that compare new antiretroviral regimens with those already in clinical practice to help inform the evolution of guidelines and clinical practice over time.”

Source: Harvard T.H. Chan School of Public Health

Categories : Respiratory DiseasesTags :

Bronchodilators Don’t Ease Smoking-related Respiratory Symptoms in non-COPD Patients

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Anatomical model of lungs
Photo by Robina Weermeijer on Unsplash

A study published in the New England Journal of Medicine have found that dual bronchodilators do little to help people who do not have chronic obstructive pulmonary disease (COPD), but who do have respiratory symptoms and a history of smoking.

Millions of people who smoke or used to smoke and have some symptoms of COPD have been prescribed bronchodilators.

“We’ve assumed these medications worked in patients who don’t meet lung function criteria for COPD, but we never checked,” said MeiLan K. Han, MD, a principal investigator and first author of the study. “We now know these existing medications don’t work for these patients.”

According to scientists, the implications are significant. First, they show the importance of diagnosing lung conditions through spirometry, a lung function test Dr Han noted is underutilised in clinical practice. Second, they show the need for new, effective therapies for patients without COPD.

Inhalers have long been the primary go-to treatment for these patients, she explained, because doctors either assume a patient has COPD, or else that their smoking-related symptoms could be helped by the inhalers. But while tobacco smoking causes a large spectrum of lung damage, the study showed bronchodilator therapy only helps patients with enough lung damage that would result in abnormal spirometry readings.

In the 12-week, randomised, double-blinded study, which was part of the Redefining Therapy in Early COPD for the Pulmonary Trials Cooperative (RETHINC), researchers enrolled 535 adults with symptoms of COPD, ages 40–80. Participants used an inhaler twice daily that contained either medication or a placebo.

By the end of the trial, some adults in the medication and placebo groups saw slight respiratory improvements, eg coughed less, produced less phlegm, or felt less winded, which was assessed through the St. George’s Respiratory Questionnaire. However, the researchers found no significant differences between those receiving medication or placebo. They reported 56% (128 of 227) of participants who received the medication saw respiratory symptom improvements, compared to 59% (144 of 244) of those who took the placebo.

According to Dr Han, these data underscore the need to change the standard practice, which is not doing spirometry and just treating patients with the same COPD medications and expecting to see improvement.

Antonello Punturieri, MD, PhD, program director of NHLBI’s Chronic Obstructive Pulmonary Disease/Environment Program, said spirometry testing should be used for any patient who shows signs of COPD, airflow obstruction, or who has a history of cigarette smoking. Though spirometry readings are used during about one-third of medical visits related to COPD, roughly half of patients who would meet criteria for COPD go undiagnosed.

Promoting smoking cessation a primary way to prevent COPD or COPD-like symptoms, the study noted. About one in four current or former smokers without COPD have reported having shortness of breath. In addition to encouraging smoking cessation, doctors can help patients who do not meet lung-function criteria of COPD by working with them to address any other underlying issues, such as overweight and obesity, heart failure, or other lung issues.

“In the meantime, research should be focused on finding new treatments for them,” Dr Han explained. “The next question is, can we develop more targeted therapies for these patients who are on the milder end of the spectrum?”

“Because cough and mucus production show up prominently among these patients, we believe therapies that target mucus production in the airways may be effective,” said Prescott G. Woodruff, MD, a principal investigator and senior author of the study.

Some of these therapies are already in development, and data from other studies may offer insight into the biological causes of excessive airway mucus, which could help point to additional therapies.

Source: NIH/National Heart, Lung and Blood Institute

Categories : Ethics and Law Medical IndustryTags :

Private Equity Firms Acquire Medical Practices and Squeeze Them for Profit

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Photo by Marek Studzinski on Unsplash

New research has found that private equity firms that acquire physician-owned medical practices seem to be imposing measures to squeeze out more profits. After their acquisition by private equity firms, the clinics saw more patients and billed more for visits among a large, commercially insured population, according to a study published in JAMA Health Forum.

Researchers from Oregon Health & Science University and other institutions examined a total of 578 US physician practices specialising in dermatology, gastroenterology and ophthalmology that were acquired by private equity firms from 2016 to 2020.

“The reason this is of concern to patients and policymakers is that private equity is often driven by profit margins of 20% or more,” said senior author Jane M. Zhu, MD, assistant professor of medicine in the OHSU School of Medicine. “To do that, they have to generate higher revenues or reduce costs. Increasing private equity in these physician practices may be a symptom of the continuing corporatisation of health care.”

While it is unclear whether these practices hurt clinical outcomes for patients, the findings raise concerning parallels with the rapid growth of private equity acquisition of nursing homes and hospital systems.

“Private equity investment in nursing homes has been associated with an increase in short-term mortality and changes to staffing,” the authors wrote, citing previous research.

In the new study, researchers found an increase in the overall number of patients seen in these clinics. The study also reviewed commercial insurance claims data that showed an increased share of visits longer than 30 minutes, even though the complexity of cases remained similar to cases prior to being bought out.

“These billing patterns could mean more efficient documentation of services provided, or it could mean upcoding or up-charging insurance companies to make more money,” Asst Prof Zhu said.

She believes more evidence is needed about how private equity impacts practice patterns.

Recently, the same study team found that ~5% of US physicians are currently employed by private equity-owned practices. Researchers cited quality of care and patient satisfaction as key areas for future research as this trend continues.

“Private equity ownership of physician practices has added a distinctly private and market-driven influence to the broader trends in corporate consolidation of physicians by health systems and insurers,” they concluded. “This study contributes evidence for potential overutilisation and higher spending of care that will be important for policymakers to monitor.”

Source: Oregon Health & Science University

Categories : Diseases, Syndromes and ConditionsTags :

Fixing The Protein Behind Huntington Disease

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Genetics
Image source: Pixabay

An international research effort has developed a new strategy to treat Huntington disease, which demonstrated that converting the disease-causing protein to its disease-free form results in it still retaining its original function. This discovery, published in the Journal of Clinical Investigation Insight, provides new avenues to approach Huntington disease.

Huntington disease is a rare neurodegenerative disorder with a worldwide prevalence of 2.7 per 100 000. Huntington’s disease is a dominantly inherited neurodegenerative disease and is caused by a mutation in a protein called ‘huntingtin’, which adds a distinctive feature of an expanded stretch of glutamine amino acids called polyglutamine to the protein. The patients would suffer a decade of regression before death, and, thus far, there is no known cure for the disease.

The cleavage near the stretched polyglutamine in mutated huntingtin is known to be the cause of the Huntington disease. However, as huntingtin protein is required for the development and normal function of the brain, it is critical to specifically eliminate the disease-causing protein while maintaining the ones that are still normally functioning. The research team showed that huntingtin delta 12 – the converted form of huntingtin that is resistant to developing cleavages at the ends of the protein, known to be the cause of Huntington disease – alleviated the disease’s symptoms while maintaining the functions of normal huntingtin.

Source: The Korea Advanced Institute of Science and Technology (KAIST)

Categories : Cardiovascular Disease GenderTags :

New Guidelines for CVD Rehabilitation for Women

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Photo by Stephen Andrews on Unsplash

All over the world, women with cardiovascular disease (CVD) generally experience worse outcomes and are less likely to attend prevention and rehabilitation programmes than men. An expert panel has developed a clinical practice guideline endorsed by 24 clinical societies worldwide to provide guidance to the cardiac rehabilitation community on how to deliver more effective women-focused programming. The guideline appears in the Canadian Journal of Cardiology.

“It has long been established that women are significantly less likely to access and complete cardiac rehab (CR), and that their outcomes are often poorer, despite greater need than men,” explained lead author Sherry L. Grace, PhD, a professor at the University of Toronto. “Accordingly, ‘women-focused’ models of CR have been developed to better engage women and optimise their outcomes. There is now sufficient evidence on women-focused CR to make recommendations to the CR community.”

The clinical practice guideline provided by the International Council of Cardiovascular Prevention and Rehabilitation (ICCPR) offers guidance to the CR community on how best to design programs for women with CVD, including stroke and peripheral arterial disease (PAD), and how to increase their engagement, with the goal of optimising women’s health outcomes. Cost, resource implications, feasibility, and patient preferences are foremost considerations in the recommendations.

The ICCPR identified women-focused CR researchers through a review of the scientific literature and programs offering women-focused CR around the world as identified through ICCPR’s Global Audit. Individuals and programs that consented to participate formed a writing and consensus panel including experts with diverse geographic representation who are multidisciplinary healthcare providers, a policymaker, and patient partners. This group drafted and reviewed the recommendations. The draft then underwent external review from CR societies internationally and was posted online for public comment before finalisation. One third of the studies identified in the review that formed the basis for the guideline came from Canada, which is considered to be a leader in women-focused CR.

The guideline presents 15 recommendations relating to referral (ie, automatic plus encouragement), setting (eg, choice of delivery mode, environment, tailoring, and staff training), and delivery (eg, session timing options, preferred form of exercise, psychosocial assessment and care, and education on women and heart disease). When adopted, these recommendations and the associated tools compiled can feasibly support some degree of women-focused CR as part of any program.

Key recommendations are:

  • Women should be systematically referred to CR to reduce bias and encouraged to attend before hospital discharge through two-way fulsome discussion to overcome gender-related barriers.
  • Particular considerations when developing a woman’s tailored rehab plan include considering their contextual and full clinical history, such as any mental health and psychosocial issues, menopausal status, frailty, cancer history, and concerns about urinary incontinence, falls risk/osteoporosis, as well as autoimmune conditions.
  • All programmes should offer women-focused programming, comprising as many of the definitional elements of women-focused CR as possible. Where resources are limited, this could include offering, for example, some women-only virtual education or exercise sessions or peer support programs.
  • Women should be given a choice in participating in a centre-based (clinical or community) or home-based setting, delivered in a women-friendly environment, and their needs/preferences should be taken into consideration when formulating their programs.
  • Programs should include a strong psychosocial component, choice of exercise modalities, as well as specific education on women and CVD. The psychosocial needs of women should be assessed and addressed in an evidence-based manner (eg, social support, relationship health, depression, anxiety, stress, socioeconomic issues, informal caregiving activities).

“For the first time, there are a consensus definition and recommendations for women-focused CR, so it is hoped now that many programmes will incorporate these elements into their programmes,” said Prof Grace. “If implemented, more women may engage in CR, and as a result have significantly greater quality and quantity of life.”

Source: Elsevier

Categories : Cancer Obstetrics & GynaecologyTags :

Possible Cancer Risk for Children Born from Frozen Embryos

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Photo by Pavel Danilyuk

A new study suggests the possibility that children born after use of a fertility procedure known as frozen-thawed embryo transfer may have a slightly higher risk of cancer than children born through other means. The researchers presented their findings in PLOS Medicine.

In assisted reproductive technology (ART) a doctor may immediately transfer a fertilised embryo to the uterus, or, in a practice that is increasing worldwide, the embryo might be frozen and later thawed before implantation. Prior research suggests that children born after frozen-thawed transfer may have higher short-term risk of certain medical issues than children born after fresh embryo transfer. However, potential long-term medical risks have been less clear.

To better understand these risks, Nona Sargisian of the University of Gothenburg, Sweden, and colleagues analysed medical data from nearly 8 million children in Denmark, Finland, Norway, and Sweden. Of these, 171 744 were born after the use of ART, and of these, 22 630 were born after frozen-thawed transfer.

Analysis showed that children born after frozen-thawed embryo transfer were at higher risk of cancer than children born after fresh embryo transfer and those without ART. When analysed as a single group (ie, those born after frozen-thawed transfer and fresh embryo transfer), however, the use of any type of ART did not have an increased risk of cancer. The most common types of cancer seen in this study were leukaemia and tumours of the central nervous system.

The researchers stress caution in interpreting the results due to the low number of cancer cases (48) in children born from frozen-thawed embryo transfer.

Nonetheless, the findings may raise concerns about frozen-thawed embryo transfer. Future research will be needed to confirm a possible link between the procedure and increased risk of cancer, as well as any biological mechanisms that may underlie such risk.

Coauthor Ulla-Britt Wennerholm added, “A higher risk of cancer in children born after frozen-thawed embryo transfer in assisted reproduction, a large study from the Nordic countries found. The individual risk was low, while at a population level it may have an impact due to the huge increase in frozen cycles after assisted reproduction. No increase in cancer was found among children born after assisted reproduction techniques overall.”

Source: EurekAlert!

Categories : HospitalsTags :

Operation Dudula Harasses Immigrants outside Kalafong Hospital

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Police were present at Kalafong Hospital in Tshwane on Wednesday after the Gauteng Health Department obtained an interdict to prevent members of Operation Dudula from threatening immigrants. Photo: Mosima Rafapa

Members of Operation Dudula were outside Kalafong provincial hospital in Tshwane on Wednesday, shouting at immigrant patients and employees. Police were present, enforcing the court interdict obtained last week by the Gauteng Health Department against the threats.

A security guard who did not want to give his name said for most of August Operation Dudula members had been operating outside the hospital, until the Gauteng Department of Health obtained a court interdict last Friday.

“They greeted patients who were of a dark skin colour one by one, to check which language they spoke and to listen to their accent. The local language here is Tswana or Pedi. If they found that you don’t know those languages, they turned you away,” said the security officer, whose station is not far from the pedestrian entrance.

Since 4 August, Operation Dudula has been trying to deny access to patients and employees from other countries.

“I’m here at 5:30 in the morning. Just before 8am this morning, a member of Operation Dudula was speaking through a loudspeaker saying they don’t want makwerekwere. On Monday, they checked their ID documents before people could enter the hospital. Today, they were about five or six of them outside. I think they wanted to scare people away because they just stood there until the police arrived,” he added.

Last Friday, the Gauteng MEC for Health obtained a court interdict against the members from threatening or denying access to patients and employees. The interdict was pinned to the notice board outside the hospital.

When GroundUp arrived just after 10am, a handful of Operation Dudula members were still gathered outside. Some were shouting that foreigners should leave.

Chairperson of Operation Dudula in Atteridgeville and regional coordinator in Greater Tshwane Elias Makgwadi said they were picketing outside the hospital entrance to get management to enforce the hospital’s admission rules and not admit “illegal foreign nationals”.

“We are saying, enforce your own rules. If illegal foreign nationals have been admitted to hospitals they must be discharged to law enforcement officers and immigration officers. That’s why we’re here, ” said Makgwadi.

Members of the Economic Freedom Fighters (EFF) put up a tent outside the hospital entrance and started chanting songs. Provincial spokesperson Phillip Makwala told the crowd: “Operation Dudula is acting as doctors, they are interfering with the process of the South African Police Service and the immigration office.”

Police officers were stationed outside the hospital.

Verrah Frace, from Zomba in Malawi, condemned the xenophobia. She works as a domestic worker in Laudium, west of Pretoria. Frace, who had come to visit her sick sister, said it was painful to see what Operation Dudula was doing.

“I came to South Africa in 2019 to look for a job because we are very poor back in Malawi. We are in South Africa to earn a living,” said Frace.

GroundUp heard a hospital employee wearing a pharmacy tag praising the Operation Dudula members. “These people get our medicine for free. They get everything for free. You guys are helping us. You are doing a great job,” said the employee before going back inside the hospital.

James Chasiya, from Magochi in Malawi, was at the hospital to see his wife who had given birth to a premature baby. He arrived in South Africa in 2014 and works as a plumber, living in one room in Laudium with his wife.

“Sometimes the piece jobs are hard to come by so I sell some of the furniture I have in order to pay rent. It’s not as easy living here as people think. We struggle. My wife works at a creche but it’s still hard. I’m undocumented so I can’t find a real job. There’s no way I can pay for a private hospital,” said Chasiya.

Head of Communication for the Gauteng Department of Health Motalatale Modiba had not responded to GroundUp’s questions by the time of publication.

The health department’s Motalatale Modiba said that the facility reported that operations are continuing as normal with no change in the number of patients.

“There is now increased police monitoring the situation. Patients are no longer obstructed from coming into the facility. The Department would like to assure patients that the hospital continues to render services to all who need such care,” he said.

Modiba said the department will not hesitate “to call law enforcement agencies to act against those that put the lives of patients and staff at risk”. He said the Department obtained a court interdict on 26 August from the High Court in Pretoria “to prevent a group of people from threatening, preventing and denying patients (deemed to be non-South African) and employees at Kalafong Hospital from accessing the facility to receive medical attention and to administer care respectively”.

Written by Mosima Rafapa

Republished from GroundUp under a Creative Commons Attribution-NoDerivatives 4.0 International License.

Source: GroundUp

Categories : Medical Research & Technology Metabolic DisordersTags :

Breakthrough in Development of an Oral Insulin Tablet

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Source: Danilo Alvesd on Unsplash

A team of researchers working on developing oral insulin tablets as a replacement for daily insulin injections have made a game-changing discovery, which they published in Scientific Reports. The University of British Columbia team found that it’s not so much the composition of the pill so much as where it’s absorbed.

Researchers have discovered that insulin from the latest version of their oral tablets is absorbed by rats in the same way that injected insulin is.

“These exciting results show that we are on the right track in developing an insulin formulation that will no longer need to be injected before every meal, improving the quality of life, as well as mental health, of more than nine million Type 1 diabetics around the world.” said Professor Anubhav Pratap-Singh, the principal investigator.

He said the inspiration behind the search for a non-injectable insulin comes from his diabetic father, who has had to inject insulin for the past 15 years.

According to Dr Alberto Baldelli, they are now seeing nearly 100% of the insulin from their tablets go straight into the liver. In previous attempts to develop a drinkable insulin, most of the insulin would accumulate in the stomach.

“Even after two hours of delivery, we did not find any insulin in the stomachs of the rats we tested. It was all in the liver and this is the ideal target for insulin – it’s really what we wanted to see,” said PhD candidate Yigong Guo, first author of the study.

Changing the mode of delivery

When it comes to insulin delivery, injections are not the most comfortable or convenient for diabetes patients. But with several other oral insulin alternatives also being tested and developed, the UBC team worked to solve where and how to facilitate a higher absorption rate.

The team instead developed a different kind of tablet that isn’t made for swallowing, but instead dissolves when placed between the gum and cheek.

This method makes use of the buccal mucosa to deliver all the insulin to the liver without wasting or decomposing any insulin along the way.

“For injected insulin we usually need 100iu per shot. Other swallowed tablets being developed that go to the stomach might need 500iu of insulin, which is mostly wasted, and that’s a major problem we have been trying to work around,” explained Yigong.

Most swallowed insulin tablets in development tend to release insulin slowly over two to four hours, while fast-release injected insulin can be fully released in 30–120 minutes.

“Similar to the rapid-acting insulin injection, our oral delivery tablet absorbs after half an hour and can last for about two to four hours long,” said Dr Baldelli.

Potential broad benefits

The study is yet to go into human trials, and for this to happen Prof Pratap-Singh says they will require more time, funding and collaborators. But beyond the clear potential benefits to diabetics, he says the tablet they are developing could also be more sustainable, cost-effective and accessible.

“More than 300 000 Canadians have to inject insulin multiple times per day,” Prof Pratap-Singh said. “That is a lot of environmental waste from the needles and plastic from the syringe that might not be recycled and go to landfill, which wouldn’t be a problem with an oral tablet.”

He explains that their hope is to reduce the cost of insulin per dose since their oral alternative could be cheaper and easier to make. Pills would be easier for diabetics as well, since currently their doses need to be kept cool.

Source: University of British Columbia