Infection remains a major complication when implants such as screws and plates are embedded into people during procedures like joint replacement surgery and spinal fusion surgery. Most infections occur because the devices’ titanium implant surfaces have poor antibacterial and osteoinductive properties, despite titanium possessing the highest biocompatibility of all metals.
Assistant Professor Rahim Rahimi at Purdue University has developed a process which immobilises silver onto the implant surfaces of titanium orthopaedic devices to improve their antibacterial properties and cellular integration. The process can be implemented onto many currently utilised metal implant surfaces.
The antibacterial efficacy of laser-nanotextured titanium surfaces with laser-immobilised silver was tested against both gram-positive (Staphylococcus aureus) and gram-negative (Escherichia coli) bacteria. The surfaces retained efficient and stable antimicrobial properties for more than six days. The laser-nanotextured titanium surfaces also provided a 2.5-fold increase in osseointegration properties compared with a pristine titanium implant surface.
“The first step of the two-step process creates a hierarchical nanostructure onto the titanium implant surface to enhance the bone cells’ attachment,” A/Prof Rahimi said. “The second step immobilises silver with antibacterial properties onto the titanium implant surface.
“The technology allows us to not only immobilise antibacterial silver compounds onto the surface of the titanium implants but also provide a unique surface nanotexturing that allows better settle attachment mineralisation.
“These unique characteristics will allow improving implant outcomes, including less risk of infection and fewer complications like device failure.”
A/Prof Rahimi said the traditional method to address infections caused by implanted orthopaedic devices often utilises antibiotics or other surface modifications that have their own associated complications.
“Long-term antibacterial protection is not possible with these traditional drug coatings because a large portion of the loaded drug is released in a short time,” Rahimi said. “There also is often a mixture of microbes that are found in implant-associated infection; it is essential to choose a bactericidal agent that covers a broad spectrum.”
It’s estimated that the majority of the expected 73% increase in the global demand for meat by 2050 will come from sub-Saharan Africa (SSA). Since human and environmental health concerns are likely to become more prominent with this increased consumption, plant-based meat alternatives have been touted as a possible alternative. But it may take some time before consumers in the region substitute their juicy steak of chicken wings for a vegan burger.
A review on plant-based meat alternatives in SSA published recently in Scientific African shows that before there can be any large-scale adoption of plant-based meat products in the region, we will first have to determine the social implications of eating less meat, the barriers to eating plant-based meat analogues, consumers’ acceptance of these products, and strategies that could get people to supplement their meat intake with plant-based alternatives. Plant-based meat analogues are foods designed to mimic the appearance, flavour, and texture of meat products. These can include, among others, burgers, sausages, nuggets, mince and meatballs.
The review was conducted by Omamuyovwi Gbejewoh and Dr Jeannine Marais from the Department of Food Science at Stellenbosch University and Dr Sara Erasmus from the Food Quality & Design Group at Wageningen University & Research in The Netherlands. They examined the available literature on the production and consumption of plant-based meat alternatives by searching the Web of Science and Scopus databases for academic papers and Google for news or popular articles.
Ahead of World Food Day on 16 October, the researchers say their review has shown that there are certain barriers to consumers’ acceptance of plant-based meat analogues even though worldwide, plant-based meat product sales accounted for $12.1 billion in 2019 and are likely to increase by 15% to reach $27.9 billion by 2025 and $149 billion by 2029. They do point out, however, that different versions of plant-based meat products have been available in South Africa and the rest of SSA over the past 25 years.
Barriers
“Consumers’ preference for meat is the most significant barrier to eating plant-based meat products or following a plant-based diet. In addition, meat has important socio-cultural connotations such as status, power, hierarchy, and subjugation of others.
“For example, studies in Zambia revealed that eating and sharing of meat, and even the type of meat that is served connote economic prosperity, power and respect. Chicken was more popular for regular consumption and entertaining guests because it is more readily accessible and relatively cheaper. On the other hand, beef is reserved for important visitors and landmark celebrations as it usually implies wealth because it is more expensive and usually eaten by well-to-do households.
“Other studies found that different ethnic groups in South Africa have various meat cuisines made from different types of domesticated and free-roaming wild animals.”
The researchers add that price is another significant barrier to the adoption of plant-based meat.
“In South Africa, for example, plant-based meat alternatives are considered expensive niche products associated with status and class.”
When it comes to the environmental and health risks associated with eating meat from domesticated animals regularly, the researchers point out that while consumers will acknowledge these risks, they are still unlikely to eat less meat. This phenomenon is known as the “meat paradox”.
‘Halo effect’
“Our review has shown that the ‘halo effect’ (consumers’ perception that plant products are more environmentally friendly) afforded to plant-based meat is not completely warranted because researchers are (un)knowingly discounting the processed nature of meat alternatives in any environmental or health risk assessment.”
“While the reduced environmental impacts of meat alternatives are apparent, a ‘cradle to grave’ environmental assessment needs to be carried out to ensure that the environmental burden is not shifted to other stages of the production cycle.”
The researchers say the review also found that plant-based meat products are similar in nutrient composition to meat, although differences in essential nutrients warrants caution.
“In terms of nutritional composition between traditional meat and meat alternatives, there is inconclusive evidence on which is healthier.”
According to them, the available literature is replete with strategies to reduce traditional meat consumption and to try plant-based meat alternatives. These include, among others, meatless days, partially substituting traditional meat with plant-based ingredients (e.g., “hybrid burgers”), cultural and lifestyle changes, food labelling, consumer education, and taxes on traditional meat or subsidies on plant-based meat.
“However, some of these strategies are not without drawbacks. For instance, food labels on the health and environmental benefits of plant-based meat may contain too much information that could confuse the consumer.
“If consumers in SSA are to be convinced to eat less meat and/or substitute it for plant-based alternatives, the latter should not be marketed as a replacement for traditional meat products but as a complement. Marketing strategies should be tailored to different sections of consumers because such a contextual approach is bound to provide more favourable and long-term results than a ‘one- size-fit-all strategy.”
The researchers emphasise the need for a comprehensive environmental and health impact assessment of meat alternatives in the region.
It has been suggested in a number of studies that eating a healthy diet may reduce a person’s risk of dementia. A new study published in the journal Neurology has found, however, that both the conventionally recommended diet and the Mediterranean diet are not linked to a reduced risk of dementia.
The Mediterranean diet features a high intake of vegetables, legumes, fruits, fish and healthy fats such as olive oil, and a low intake of dairy products, meats and saturated fatty acids. “Previous studies on the effects of diet on dementia risk have had mixed results,” said study author Isabelle Glans, MD, of Lund University. “While our study does not rule out a possible association between diet and dementia, we did not find a link in our study, which had a long follow-up period, included younger participants than some other studies and did not require people to remember what foods they had eaten regularly years before.”
For the study, researchers identified 28 000 people from Sweden. Participants had an average age of 58 and did not have dementia at the start of the study. They were followed over a 20-year period. During the study, participants filled out a seven-day food diary, a detailed food frequency questionnaire and completed an interview. By the end of the study, 1943 people, or 6.9%, were diagnosed with dementia, including Alzheimer’s disease and vascular dementia.
Researchers examined how closely participants’ diets aligned with conventional dietary recommendations and the Mediterranean diet. After adjusting for age, gender, and education, researchers did not find a link between following either a conventional diet or the Mediterranean diet and a reduced risk of dementia. Dr Glans noted that further research is needed to confirm the findings.
Nils Peters, MD, of the University of Basel in Switzerland, who wrote an editorial accompanying the study, said, “Diet on its own may not have a strong enough effect on memory and thinking, but is likely one factor among others that influence the course of cognitive function. Dietary strategies will still potentially be needed along with other measures to control risk factors.” A limitation of the study was the risk of participants misreporting their own dietary and lifestyle habits.
Having jobs be replaced by robots is a common fear for workers in all sectors of the economy. Working alongside robots may contribute to job burnout and workplace incivility, but self-affirmation techniques could help alleviate fears about being replaced by these machines, according to research published online in the Journal of Applied Psychology [PDF].
Researchers found that workers in the United States and parts of Asia feel job insecurity from robots, even in industries where robots aren’t being used, and those fears may not be justified, said lead researcher Kai Chi Yam, PhD, an associate professor of management at the National University of Singapore.
“Some economists theorise that robots are more likely to take over blue-collar jobs faster than white-collar jobs,” Dr Yam said. “However, it doesn’t look like robots are taking over that many jobs yet, at least not in the United States, so a lot of these fears are rather subjective.”
Researchers conducted experiments and analysed data from participants in the US, Singapore, India and Taiwan.
Working with industrial robots was linked to greater reports of burnout and workplace incivility in an experiment with 118 engineers employed by an Indian auto manufacturing company.
An online experiment with 400 participants found that self-affirmation exercises, where people are encouraged to think positively about themselves and their uniquely human characteristics, may help lessen workplace robot fears. Participants wrote about characteristics or values that were important to them, such as friends and family, a sense of humour or athletics.
“Most people are overestimating the capabilities of robots and underestimating their own capabilities,” Dr Yam said.
Fears about job insecurity from robots are common. The researchers analysed data about the prevalence of robots in 185 U.S. metropolitan areas along with the overall use of popular job recruiting sites in those areas (LinkedIn, Indeed, etc). Areas with the highest robot use also had the highest rates of job recruiting site searches, even though unemployment rates weren’t higher in those areas. The researchers theorised that people in these areas may have felt more job insecurity because of robots, but that there could be other reasons, such as people seeking new careers or feeling dissatisfied with their current jobs.
Another experiment comprised 343 parents of students at the National University of Singapore who were randomly assigned to three groups. One group read an article about the use of robots in businesses, the second group read a general article about robots, and the third read an unrelated article. Then the participants were surveyed about their job insecurity concerns, with the first group reporting significantly higher levels of job insecurity than the two other groups.
While some people may have legitimate concerns about losing their jobs to robots, some media coverage may be unnecessarily heightening fears among the general public, Dr Yam said.
“Media reports on new technologies like robots and algorithms tend to be apocalyptic in nature, so people may develop an irrational fear about them,” he said.
Nirmatrelvir-ritonavir (Paxlovid) is often given to heart disease patients with symptomatic COVID to prevent progression to severe disease – but it can interact with some previously prescribed medications. A review paper published in the Journal of the American College of Cardiology examines the potential drug-drug interactions (DDIs) between Paxlovid and commonly used cardiovascular medications, as well as potential options to mitigate severe adverse effects.
“Awareness of the presence of drug-drug interactions of Paxlovid with common cardiovascular drugs is key. System-level interventions by integrating drug-drug interactions into electronic medical records could help avoid related adverse events,” said Sarju Ganatra, MD, senior author of the review.
He continued: “The prescription of Paxlovid could be incorporated into an order set, which allows physicians, whether it be primary care physicians or cardiology providers, to consciously rule out any contraindications to the co-administration of Paxlovid. Consultation with other members of the health care team, particularly pharmacists, can prove to be extremely valuable. However, a health care provider’s fundamental understanding of the drug-drug interactions with cardiovascular medications is key.”
In December 2021, Paxlovid received emergency use authorisation from the US Food and Drug Administration as an oral antiviral agent for the treatment of symptomatic, non-hospitalised adults with mild to moderate COVID infection who are at high risk for progression to severe disease. Patients with heart disease and other risk factors, including diabetes, high blood pressure, chronic kidney disease and smoking make up a large portion of the high-risk population for whom Paxlovid is beneficial.
According to the authors, Paxlovid has been shown to be very effective in patients with existing heart disease, but it has significant DDIs with commonly used cardiovascular medications, highlighting the importance for all clinicians to be familiar with these DDIs. As there is limited clinical information regarding DDI-related adverse events, the authors used existing knowledge and data regarding how therapies like Paxlovid typically react with other medications to provide guidance regarding potential interactions and the associated likely consequences based on the degree of interaction.
The review provides an in-depth overview of a variety of cardiovascular medications used to treat many forms of heart disease. Five of the most important cardiovascular drug interactions with Paxlovid to be aware of include:
Anti-arrhythmic agents
Many anti-arrhythmic agents are metabolised in a way that increases plasma levels when co-administered with Paxlovid. While it may be possible to start Paxlovid after 2–2.5-day temporary discontinuation of the anti-arrhythmic agents, this may not be feasible from a practical standpoint. Clinicians are advised to consider alternative COVID therapies and avoid co-administration of these agents with Paxlovid. Sotalol, another anti-arrhythmic agent, is renally cleared and does not interact with Paxlovid.
Antiplatelet agents and anticoagulants
Antiplatelet agents are used for the treatment of coronary artery disease, particularly if a patient has received a stent. Aspirin and prasugrel are safe to co-administer with Paxlovid. There is an increased risk of blood clots when Paxlovid is given alongside clopidogrel and an increased risk of bleeding when given with ticagrelor. When possible, these agents should be switched to prasugrel. If patients have contraindication to taking prasugrel, then co-administration of Paxlovid should be avoided and alternative COVID therapies should be considered.
Anticoagulants such as warfarin may be co-administered with Paxlovid but require close monitoring of clotting factors in bloodwork. The plasma levels of all direct oral anticoagulants increase when co-administered with Paxlovid, therefore dose adjustment or temporary discontinuation and use of alternative anticoagulants may be required.
Certain statins
Co-administration of simvastatin or lovastatin with Paxlovid can lead to increased plasma levels and subsequent myopathy and rhabdomyolysis, a condition in which the breakdown of muscle tissue releases a damaging protein into the bloodstream. These agents should be stopped prior to initiation of Paxlovid. A dose reduction of atorvastatin and rosuvastatin is reasonable when co-administered with Paxlovid. The other statins are considered safe when given along with Paxlovid.
Ranolazine
Plasma concentration of ranolazine, used to treat angina and other heart-related chest pain, is exponentially increased in the presence of CPY450 inhibitors like Paxlovid, thereby increasing the risk of clinically significant QT prolongation and torsade de pointes (a type of arrhythmia). Co-administration of Paxlovid is therefore contraindicated. Temporary discontinuation of ranolazine is advised if prescribing Paxlovid.
Immunosuppressive agents
The plasma levels of immunosuppressive agents prescribed for patients who have undergone heart transplantation exponentially rise to toxic levels when co-administered with Paxlovid. Temporary reduction of dosing of immunosuppressive agents would require frequent monitoring and be logistically difficult. Therefore, alternative COVID therapies should be considered in these patients.
The authors conclude awareness and availability of other COVID therapies enable clinicians to offer alternative treatment options to patients who are unable to take Paxlovid due to DDIs.
Despite the fact that dysmenorrhoea is the leading cause of school absences for adolescent girls, few girls seek treatment. A review suggests that diet may be a key contributor, specifically diets high in meat, oil, sugar, salt, and coffee, which have been shown to cause inflammation. Results will be presented during The North American Menopause Society (NAMS) Annual Meeting in Atlanta, October 12-15, 2022.
Roughly 90% of adolescent girls experience menstrual pain. Most use over-the-counter medicine to manage the pain, with limited improvement. Evidence has highlighted that diets high in omega-3 fatty acids and low in processed foods, oil, and sugar reduce inflammation, a key contributor to menstrual pain.
This analysis was designed to study the effect of diet on menstrual pain and identify which foods contribute to it and which can reduce it. Research was conducted through a literature review that found multiple studies that examined dietary patterns that resulted in menstrual pain. In general terms, these studies found that diets high in omega-6 fatty acids promote inflammation and foods high in omega-3 fatty acids reduce it. The muscles in the uterus contract because of prostaglandins, which are active in inflammatory responses. When measuring the Dietary Inflammatory Index, it was found that those on a vegan diet (that excluded animal fat) had the lowest rates of inflammation.
“Researching the effects of diet on menstrual pain started as a search to remedy the pain I personally experienced; I wanted to understand the science behind the association. Learning about different foods that increase and decrease inflammation, which subsequently increase or reduce menstrual pain, revealed that diet is one of the many contributors to health outcomes that is often overlooked. I am hopeful that this research can help those who menstruate reduce the pain they experience and shed light on the importance of holistic treatment options,” said Serah Sannoh, lead author of the poster presentation from Rutgers University.
“Since menstrual pain is a leading cause of school absenteeism for adolescent girls, it’s important to explore options that can minimise the pain. Something like diet modification could be a relatively simple solution that could provide substantial relief for them,” said Dr Stephanie Faubion, NAMS medical director.
Standing electric scooters, typically termed e-scooters, have been increasing in popularity over the past decade. According to a new research abstract presented during the 2022 American Academy of Pediatrics National Conference & Exhibition, e-scooter injuries among children are becoming much more common and increasingly severe.
The authors found hundreds of e-scooter injuries in the US between 2011-2020. The rate of hospital admittance for patients increased from fewer than 1 out of every 20 e-scooter injuries in 2011 to 1 out of every 8 requiring admittance into a hospital for care in 2020.
“The number of annual e-scooter injuries has increased from 2011 to 2020, likely due in some part to the rise in popularity of rideshare e-scooter apps,” said lead author Harrison Hayward, MD, Emergency Medicine fellow at Children’s National Hospital. “Our study has characterised the spectrum of injuries that occur in children, which helps emergency room doctors prepare for taking care of them and helps parents and families to practice better safety.”
Researchers examined a national database of paediatric e-scooter injuries that were seen in emergency departments at over 100 US hospitals from 2011–2020 to find out what kinds of injuries children were sustaining and if any trends existed. Over 10% of all patients had a head injury, including a concussion, skull fractures, and internal bleeding. The most common injuries were arm fractures (27%), followed by minor abrasions (22%) and lacerations needing stitches (17%). The average age was 11.1 years and 59% of patients were male. Admittance to a hospital rose from 4.2% in 2011 to 12.9% in 2020.
“Parents whose children are riding e-scooters need to know how best to be safe. To that end, helmets are a must, since over 10% of the reported cases were head injuries,” said Dr Hayward. “Children should absolutely be wearing helmets while riding an e-scooter. Research has broadly demonstrated that helmets save lives for bicycle riders, and we should think similarly about e-scooters.”
Using old medicines in new combinations shows promise for treating bowel cancer, a group of University of Auckland researchers has found. They published their findings in Molecular Cancer Therapeutics.
“While there have been advances in treatments for this disease in recent years, the development of new medicines is expensive and time-consuming,” lead researcher Professor Peter Shepherd explained. “As a possible solution to this problem, our group has been investigating whether using old drugs in new ways could provide a faster and cheaper way of treating this disease.”
The scientists investigated several cancer drugs that are coming off patent soon. When they combined two such drugs, they found greatly enhanced overall effectiveness in treating bowel, or colorectal, cancer in their lab-based studies.
Developments in our understanding of how cancers function have paved the way for this research, Prof Shepherd said.
“In recent years, research has led to a rapid increase in our understanding of how colorectal cancer develops. In particular, some sub-types of the disease rely on the development of small blood vessels and on proteins called BRAF and beta-catenin.
“The research group identified existing drugs that target these and investigated the possibility that combining them could have powerful anti-cancer effects.”
Their studies have shown strong promise for two older drugs. One is an anticancer drug called axitinib. The other is pyrvinium, a low-cost drug that was developed in the 1960s to treat threadworm, which the researchers believe could be reformulated for use in cancer treatment. In one set of studies, the researchers found that the efficacy of another older drug targeting BRAF, called vemurafenib, could be greatly enhanced by adding axitinib. Axitinib works by reducing the growth of small blood vessels.
Both these drugs are used in other contexts to treat other types of cancer and will soon be off patent and so the cost of using them in treatment will drop greatly, Prof Shepherd said.
In a second set of studies, the group found evidence that pyrvinium, which targets beta-catenin, could also increase the efficacy of vemurafenib.
Dr Khanh Tran who performed most of the experiments said, “This work suggests that existing drugs might be able to be repurposed to treat this type of cancer which could significantly reduce the cost of such therapy.”
Dr Tran added, “Since the drugs we used are already in use for other purposes, it makes it much easier to develop clinical trials to see how the findings of our studies will actually translate to improved outcomes for patients with this disease.”
According to new research published in the journal Aging and Disease, people with dementia are likely to have taken more than three medications for other health conditions in the five years directly before their diagnosis.
The study is the first to provide an in-depth exploration of the links between evolving polypharmacy and a dementia diagnosis. Researchers analysed the records of more than 33 000 dementia patients in Wales between 1990 to 2015.
Experts in e-health used machine learning techniques to identify potentially damaging patterns in a patient’s medicine usage, and how these patterns evolve in the run-up to diagnosis.
They found that in the 20 years leading up to them being diagnosed, the proportion of patients taking three or more medications rose from 5.5% (for the period 16 to 20 years prior to diagnosis) to 82.16% among those less than five years from a diagnosis.
Researchers also found that as the development towards dementia progressed, the patterns of polypharmacy shifted from being clearly distinct to being more closely associated with particular medical conditions.
And of those closest to their diagnosis, almost two-thirds (66.55%) were found to be taking multiple medicines for a combination of respiratory or urinary infections, arthropathies and rheumatism, and cardio-vascular disease. A further 22% of patients were found to be taking medicines for infections, arthropathies and rheumatism, cardio-metabolic disease and depression.
The study was supported by the Health Data Research UK and conducted by an international team of researchers from the University of Plymouth, Aptuit (an Evotec company), Swansea University Medical School, and the University of Oxford.
Study leader Professor Shangming Zhou at the University of Plymouth said: “Given the rise in dementia cases internationally, the need to understand how patterns of polypharmacy evolve before and after a dementia diagnosis are important for devising a safe treatment programme for each patient. Our aim in this study was to help doctors find ways to prescribe multiple items of dementia medication safely and without reducing their effectiveness. The use of machine learning has been vital in helping us understand how these patterns develop, and our hope is we can now use this knowledge to treat patients.”
It has previously been established that when multiple types of preventative medication are being prescribed, the benefits of the drugs may be reduced and the chances of harm from drug interaction and side effects increased.
Those requiring hospital treatment who are taking multiple medications are also known to have a higher likelihood of re-admission within three months after being discharged.
Cleveland Clinic researchers have identified metformin as a possible treatment for atrial fibrillation (AF). In the study, published in Cell Reports Medicine, researchers used advanced computation and genetic sequencing to determine that metformin’s targets overlap significantly with genes that are dysregulated in AF.
“Finding drugs or procedures to treat atrial fibrillation is difficult because of potential serious side effects,” said Mina Chung, MD, senior study author. “There is a significant need for new treatments for atrial fibrillation as there have been no new drugs approved in more than a decade.”
“It’s not that we’ve found a new drug target where it takes 20 years to test this in individuals,” said Jessica Castrillon Lal, first author and graduate student.
“We can cut off 10+ years in the drug development pipeline. We already have the information there. We just have to test it in a very computationally efficient way, such as artificial intelligence technology,” said Feixiong Cheng, PhD, co-senior study author.
The analysis found metformin targeted 30 genes associated with AF, with direct effects on gene expression for eight. Eight other candidate drugs surfaced in the analysis, but further testing and patient data review identified metformin as the most promising candidate.
Castrillon Lal conducts research in Dr Cheng’s lab, which uses network medicine approaches to find candidate drugs for repurposing, creating vast networks of molecular interactions. For this study, researchers narrowed down a list of 2800 FDA-approved treatments by analysing three data sources: a map of interactions between proteins called an “interactome”; a network of genes associated with atrial fibrillation; and each medicine’s molecular or genetic targets.
Atrial fibrillation is the most common type of heart arrhythmia in the world and can lead to complications, including stroke and heart failure. Treatments have been primarily directed toward trying to prevent the arrhythmia using drugs targeting the electrical system, including ion channels in the heart, or using catheter ablation to isolate the pulmonary veins where initiating beats of atrial fibrillation occur.
However, side effects, limited success and potential complications can limit these approaches.
