Day: December 8, 2022

Categories : Cardiovascular DiseaseTags : Leave a comment

Statins Found to Reduce Intracerebral Haemorrhage Risk

On By ModernMedia
Credit: American Heart Association

People taking statins may have a lower risk of having an intracerebral haemorrhage (ICH), according to a new study published in the journal Neurology.

It has been suggested that statins increase the risk of ICH in people with a history of stroke, which has led to a precautionary principle of avoiding statins in patients with prior intracerebral haemorrhage. Recent research suggests that such prescribing reticence may be unfounded and potentially harmful when considering the well-established benefits of statins.

“While statins have been shown to reduce the risk of stroke from blood clots, there has been conflicting research on whether statin use increases or decreases the risk of a person having a first intracerebral haemorrhage,” said study author David Gaist, MD, PhD, of the University of Southern Denmark in Odense. “For our study, we looked at the lobe and non-lobe areas of the brain to see if location was a factor for statin use and the risk of a first intracerebral haemorrhage. We found that those who used a statin had a lower risk of this type of bleeding stroke in both areas of the brain. The risk was even lower with long-term statin use.”

The lobe area of the brain includes most of the cerebrum, including the frontal, parietal, temporal and occipital lobes. The non-lobe area primarily includes the basal ganglia, thalamus, cerebellum and brainstem.

For the study, researchers looked at health records in Denmark and identified 989 people, average age 76, who had an ICH in the lobe area of the brain. They were compared to 39 500 matched controls.

They also looked at 1175 people, average age of 75, who had an ICH in the non-lobe parts of the brain. They were compared to 46 755 matched controls. Prescription data was used to determine information on statin use.

Of the total participants, 6.8% who had a stroke had been taking statins for five or more years, compared to 8.6% of those who did not have a stroke.

After adjusting for factors such as hypertension, diabetes, and alcohol use, researchers found that people currently using statins had a 17% lower risk of having a stroke in the lobe areas of the brain and a 16% lower risk of stroke in the non-lobe areas of the brain.

In addition, longer use of statins was associated with a lower risk of stroke in both areas of the brain. With more than five years of statin use, people had a 33% lower risk of having a stroke in the lobe area of the brain and a 38% lower risk of stroke in the non-lobe area of the brain.

“It’s reassuring news for people taking statins that these medications seem to reduce the risk of bleeding stroke as well as the risk of stroke from blood clots,” Gaist added. “However, our research was done in only the Danish population, which is primarily people of European ancestry. More research should be conducted in other populations.”

Source: American Academy of Neurology

Categories : HIV Obstetrics & GynaecologyTags : Leave a comment

Even in Low-income Countries, ARVs Stop Maternal HIV Transmission

On By ModernMedia
Pregnant with ultrasound image
Source: Pixabay

Antiretroviral drugs almost completely reduce the risk of mothers passing on HIV infection to their children, even in a low-income country with a high HIV incidence such as Tanzania, according to a new study in The Lancet HIV.

UNAIDS estimates that 11% of children born to HIV-positive mothers in Tanzania are infected with HIV, during childbirth or via breast milk. But the new study suggests this figure is actually much lower.

The researchers, from Karolinska Institutet in Sweden, examined more than 13 000 HIV-positive, pregnant women, at several health centres in one of Africa’s largest cities, Dar es Salaam, in Tanzania. The women were offered antiviral treatment through maternity care between 2015 and 2017.

Only 159 infants were infected 

The women were followed for 18 months after giving birth when most of them had stopped breastfeeding. When the researchers examined the mothers’ children, they discovered that only 159 of the more than 13 000 infants had been infected with HIV by the age of 1.5 years, translating to a risk of 1.4%, taking into account a margin of error.

The risk of infection was more than twice as high among women who sought care late in pregnancy or had advanced HIV. Conversely, the risk of infection was only 0.9% in those who had already received HIV treatment when they became pregnant. 

“HIV transmission from mother to child can in principle be stopped completely with modern antiviral drugs. But so far it has not been demonstrated in low-income countries in Africa with a high incidence of HIV infection,” says Goodluck Willey Lyatuu, physician and postdoctoral researcher, also at the Department of Global Public Health at Karolinska Institutet and first author of the study.

Early diagnostics are important 

The study is limited by challenges that may be typical in low-resource health systems, such as incomplete follow-up and missing data, and that risk factors such as stigma linked to HIV are rarely or never routinely investigated.

“But it is one of the largest cohort studies published from Africa on the risk of HIV transmission from mother to child where the baby is followed until the end of the breastfeeding period,” says says Anna Mia Ekström, clinical professor of global infectious disease epidemiology with a focus on HIV at the Department of Global Public Health at Karolinska Institutet and corresponding author of the study.

Source: Karolinksa Institutet

Categories : Diet and NutritionTags : Leave a comment

Potatoes not Linked to Type 2 Diabetes – Rather, it’s Their Preparation

On By ModernMedia
Photo by Clark Douglas on Unsplash

Potatoes have long been perceived as having negative health impacts, such as possibly increasing the likelihood of developing Type 2 diabetes. New research published in Diabetes Care has shown while spuds may not have all the same benefits as some other vegetables – such as lowering risk of Type 2 diabetes – health issues associated with potatoes may actually be due to their preparation.

In the long-term Danish Diet, Cancer and Health study, more than 54 000 people reported their dietary intake.

A recent analysis of this study led by Dr Nicola Bondonno from ECU’s Nutrition and Health Innovation Research Institute, found people who consumed the most vegetables had a 21% lower risk of developing Type 2 diabetes than those who consumed the least amount of vegetables.

PhD candidate Pratik Pokharel carried out work on the analysis and said while potatoes didn’t have the same impact on Type 2 diabetes, they also didn’t have any negative effect.

“In previous studies, potatoes have been positively linked to incidence of diabetes, regardless of how they’re prepared – but we found that’s not true,” Mr Pokharel said.

“When we separated boiled potatoes from mashed potatoes, fries or crisps, boiled potatoes were no longer associated with a higher risk of diabetes: they had a null effect.”

Mr Pokharel said underlying dietary patterns were the key.

“In our study, people who ate the most potatoes also consumed more butter, red meat and soft drink – foods known to increase your risk of Type 2 diabetes,” he said.

“When you account for that, boiled potatoes are no longer associated with diabetes. It’s only fries and mashed potatoes, the latter likely because it is usually made with butter, cream and the like.”

Eat your veggies

Mr Pokharel said findings from the study indicate vegetables could play a key role in reducing Type 2 diabetes, as people who ate a lot of leafy greens and cruciferous vegies such as spinach, lettuce, broccoli and cauliflower had a significantly lower risk of developing the condition.

He said the relationship between vegetables and diabetes should be incorporated into public dietary guidelines – as should the benefits of eating potatoes.

“The finding that vegetables lower diabetes risk is crucial for public health recommendations, and we shouldn’t ignore it,” he said.

“Regarding potatoes, we can’t say they have a benefit in terms of type 2 diabetes, but they also aren’t bad if prepared in a healthy way.

“We should separate potatoes and other vegetables in regard to messaging about disease prevention but replacing refined grains such as white rice and pasta with potatoes can improve your diet quality because of fibre and other nutrients found in potatoes.”

Putting it into practice in the kitchen

Mr Pokharel said people should be advised to increase their vegetable intake – and they could include potatoes, so long as they left out some of the unhealthy extras such as butter, cream and oil.

“Potatoes have fibre and nutrients, which are good for you,” he said.

“People talk about carbs being bad, but it’s more about the type of carbs you’re having; compared to something like white rice, boiled potatoes are a good quality of carbohydrate.”

Source: Edith Cowan University

Categories : COVIDTags : Leave a comment

Prone Positioning in COVID Reduces the Need for Endotracheal Intubation

On By ModernMedia
Photo by Samuel Ramos on Unsplash

COVID patients hospitalised for acute respiratory distress syndrome (ARDS) are less likely to need endotracheal intubation with prone positioning, but evidence is inconclusive for other outcomes such as mortality, suggests an in-depth analysis of the latest evidence published by The BMJ.

Since the 1970s, prone positioning has been standard care for patients with severe ARDS as it encourages a larger part of the lung to expand, enabling bigger breaths. 

Usually, it is done for critically ill patients who are sedated and intubated. But in February 2020, reports emerged of possible benefits from prone positioning of awake COVID and it was widely adopted. 

Since then, several studies have examined its effectiveness in awake COVID patients , but results have been conflicting.

To try and resolve this uncertainty, researchers trawled databases for randomised trials comparing awake prone positioning to usual care for adult COVID patients with hypoxaemic respiratory failure.

They found 17 suitable trials, 12 with no bias risk, involving 2931 non-intubated patients who were able to breathe unassisted and who spent an average of 2.8 hours per day lying prone.

The primary outcome was endotracheal intubation, and secondary outcomes included mortality, ventilator-free days, intensive care unit (ICU) and hospital length of stay, change in oxygenation and respiratory rate, and adverse events.

High certainty evidence from a pooled analysis of 14 trials showed that awake prone positioning reduced the risk of endotracheal intubation compared with usual care (24.2% with awake prone positioning vs 29.8% with usual care). On average, awake prone positioning resulted in 55 fewer intubations per 1000 patients.

However, high certainty evidence from a pooled analysis of 13 trials evaluating mortality did not show a significant difference in mortality between the two groups (15.6% with awake prone positioning vs 17.2% with usual care), but the study may have lacked statistical power to detect a difference.

Awake prone positioning did not significantly affect other secondary outcomes either, including, ventilator-free days, ICU or hospital length of stay, based on low and moderate certainty evidence.

Limitations included lack of individual patient data, differences between the targeted and achieved duration of awake prone positioning, and variation in the definition and reporting of certain outcomes across studies.

But further sensitivity analysis supported these results, suggesting a high probability of benefit for the endotracheal intubation outcome and a low probability of benefit for mortality.

As such, the researchers conclude: “Awake prone positioning compared with usual care reduces the risk of endotracheal intubation in adults with hypoxemic respiratory failure due to covid-19 but probably has little to no effect on mortality or other outcomes.”

In a linked editorial, researchers point out that the benefits of prone positioning in COVID patients may be confined to those with more severe hypoxaemia and longer duration of prone positioning, so say it may be wise to focus efforts on these particular groups. 

Several unanswered questions remain, including the ideal daily duration of treatment, the level of hypoxaemia that should prompt prone positioning, and how best to improve patient comfort and encourage adherence, they write.

These questions may never be answered definitively in COVID patients as, fortunately, far fewer are experiencing hypoxaemic respiratory failure or critical illness, they explain.

“The pandemic should, however, renew interest and encourage further evaluation of awake prone positioning – an intervention that may benefit a wide range of patients with hypoxaemia,” they conclude.

Source: EurekAlert!

Categories : General Interest Substance UseTags : Leave a comment

Concourt did not Legalise Weed in the Workplace – Labour Court Rules

On By ModernMedia
Photo by Thought Catalog on Unsplash

By Tania Broughton

The decriminalisation of cannabis for private use does not include the workplace, a Johannesburg Labour Court judge has ruled.

Judge Connie Prinsloo, in a recent ruling, said submissions by the National Union of Metalworkers of South Africa (NUMSA) that the Constitutional Court had ruled that cannabis was no longer a “drug” but just a “plant or a herb” were wrong.

She said the Concourt “Prince” judgment in 2018 did not offer any protection to employees against disciplinary action should they contravene company policies or disciplinary codes.

She said the apex court had not said cannabis was no longer a drug, as the union had argued, but had merely allowed for its personal consumption, in private, by adults.

Read the full judgment here.

The case before Judge Prinsloo was a review of the dismissal of two PFG Building Glass employees in October 2020 who had tested positive for cannabis while on duty. The National Bargaining Council for the Chemical Industry had found their dismissal to be fair. The union said it was unfair since cannabis was not a drug according to the Constitutional Court.

The company, through its witnesses, presented evidence that being under the influence of alcohol or drugs within the workplace was an offence for which dismissal was the prescribed sanction for the first offence.

This was because the company took workplace safety very seriously and it had a moral and legal duty to ensure that the working environment was safe.

On site, there was gas, large forklifts, extremely hot processes and dangerous chemicals used to make heavy glass which could potentially cut or crush someone.

The company followed the Occupational Health and Safety Act and had a zero-tolerance policy towards alcohol and drugs.

Referring to evidence at the bargaining council, Judge Prinsloo said it had been suggested by the employees that the company was “sticking to the old stigmatisation” of cannabis, whereas the Constitutional Court, in the Prince judgment, had said it was “just a plant … a herb” and could be legally possessed and used.

Company representatives, however, said it was still recognised as a drug and an employee was not permitted to be on site under the influence of alcohol or drugs.

One of the dismissed employees, Mr Nhlabathi, testified that he had used cannabis three days before he reported to work on the day he tested positive. He said he had been employed since 2016 and had “been smoking dagga and doing his job properly”. He disputed that the alcohol and drug policy related to cannabis but only to “alcohol and substances”.

His colleague, Mr Mthimkhulu, also relied on the Constitutional Court judgment that “dagga was a herb and not a substance”. Both claimed they were not aware that they could be fired for testing positive for cannabis.

Judge Prinsloo said the arbitrator had accepted that the company had a zero tolerance policy and that it treated cannabis as a drug because it was a “mind altering substance”.

The arbitrator had said the Prince judgment did not overrule the provisions of the Occupational Safety Act.

Judge Prinsloo said it was evident that the union and the employees had confused issues relating to the decriminalisation of the use of cannabis in private and the rights of employers to take disciplinary action against an employee who contravened a disciplinary code.

The Prince judgment declared specific provisions of the Drugs and Trafficking Act to be inconsistent with the right to privacy and therefore invalid to the extent that they made the use or possession of cannabis in private, by an adult person, a criminal offence.

The Constitutional Court had held, however, that it was common cause that cannabis was a harmful drug.

“The court did not interfere with the definition of a drug, nor did it declare dagga to be a plant or a herb,” Judge Prinsloo said.

“The applicant’s understanding of the judgment was either very limited or totally wrong,” she said.

The company was entitled to set its own standards of conduct and dismissal was an appropriate sanction, she said, dismissing the review.

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

Source: GroundUp