Day: September 19, 2023

Categories : Obstetrics & GynaecologyTags :

New Intrauterine Device Rapidly Controls Postpartum Haemorrhage

On By ModernMedia
Photo by Jonathan Borba on Unsplash

A study led by Columbia University obstetricians has shown that a new intrauterine device can rapidly control postpartum haemorrhage, a major cause of severe maternal morbidity and death, in real-world situations.

“Our findings show that the device is an important new tool in managing postpartum bleeding,” says Dena Goffman, MD, professor of obstetrics and gynaecology at Columbia University and senior author of the study, which is published in the journal Obstetrics & Gynecology.

“We had previously shown that the device worked well with patients who were experiencing relatively minor bleeding, so it’s really reassuring to see that the device worked almost as well among a wider range of patients and when used by many different doctors.”

Overall, the device succeeded in controlling haemorrhage in 93% of vaginal deliveries and 84% of caesarean deliveries.

Major cause of severe maternal morbidity and death

Shortly after birth and delivery of the placenta, the uterus contracts and closes off the blood vessels that nourished the placenta. Failure of the uterus to contract after delivery can result in prolonged and excessive blood loss, which may necessitate blood transfusions, ICU admission, or surgery to try to stop the bleeding and, if needed, removal of the uterus.

“Less than 10% of people who give birth will have excessive postpartum bleeding, but when it happens, it can get really serious really fast,” says Goffman, who co-authored the most recent guidelines from the American College of Obstetrics and Gynecology for the treatment of postpartum haemorrhage.

Current treatment options not ideal for all patients

To stop excessive bleeding, clinicians usually start by manually stimulating the uterus and giving medications that help the uterus contract, but some of these drugs are not safe for patients with hypertension or asthma. When medication fails or isn’t an option, patients may be treated with a balloon-like tamponade device that is inserted into the uterus and controls bleeding by placing pressure on the uterine wall.

Balloon tamponade devices have a high success rate, but this treatment has an impact on the patient and family experience. “The balloon often stays in the uterus for 12 to 24 hours until the uterus is well-contracted, and during that time the patient can’t sit up in bed, can’t walk around, can’t easily care for the baby,” Goffman says.

New device approved in 2020

In 2020, the FDA approved a new intrauterine device to control postpartum bleeding that uses low-level suction to promote uterine contractions.

“With postpartum haemorrhage being one of the most preventable causes of maternal morbidity and mortality, practice-changing innovation was needed to better equip our teams and care for our patients,” says Mary D’Alton, MD, chair of the Department of Obstetrics & Gynecology at Columbia University Vagelos College of Physicians and Surgeons and national leader of the clinical trial that first tested the safety and efficacy of the device.

In that initial trial, which led to FDA approval, the device controlled bleeding in a median of 3 minutes among 106 patients experiencing relatively minor blood loss after childbirth and was removed about 3 hours after insertion. Most patients in the trial delivered vaginally. The trial also excluded patients with preterm births < 34 weeks.

Highly effective in real-world conditions

The current study, which included more than 800 patients giving birth at 16 hospitals, was designed to study the effectiveness of the new device outside of a controlled clinical trial. One third of the patients in the new study had a caesarean, and 50 patients had a preterm birth < 34 weeks.

Median blood loss volume before device insertion was also higher in the new study, reflecting a greater range in blood loss, with some patients losing substantial amounts of blood (up to 3000mL). Most patients had been treated with medications to manage postpartum bleeding prior to device insertion.

Treatment with the new device was successful in 93% of patients who had a vaginal birth and 84% of patients who had a caesarean birth (similar to efficacy with intrauterine balloon devices). For most patients, the device brought bleeding under control in five minutes. Treatment success rates were higher in patients with less blood loss prior to device insertion.

Next steps

The researchers say that early recognition of postpartum hemorrhage and timely intervention are crucial in managing the condition and preventing potentially life-threatening complications.

“Postpartum haemorrhage is a treatable condition,” Goffman says. “Delivery teams need to be attuned to recognising it quickly and managing it in a seamless and sequential manner before a patient experiences significant blood loss.”

Additional studies comparing the new device with other treatments for postpartum haemorrhage are being planned to determine if using the device earlier produces better outcomes.

“Until we have more data, we’re using the new intrauterine device after medications have been tried,” Goffman says. “But for patients with underlying conditions who cannot be treated with one or more of our available medications, the device is a critically important tool to have.”

Source: Columbia University Irving Medical Center

Categories : GastrointestinalTags :

Silent but Violent: Taurine-consuming Bacteria Protects the Gut with Toxic Gas

On By ModernMedia
Photo by Pablo Stanic on Unsplash

Researchers have discovered a new intestinal bacterim that feeds exclusively on taurine and produces the foul-smelling gas hydrogen sulfide. The results, currently published in Nature Communications, show that Taurinivorans muris protects against Klebsiella and Salmonella, two important pathogens.

Chemical warfare in the gut

One of the ways the gut microbiome helps regulated health is in contributing to the levels of hydrogen sulfide – the toxic gas responsible for foul-smelling farts. Having small amounts of hydrogen sulfide in the gut is a good thing; in fact, it’s essential for a number of physiological processes, and can even protect against pathogens. Hydrogen sulfide-producing microbes in the gut may help “choke out” oxygen-dependent pathogens such as Klebsiella, making it harder for them to colonise. However, excessive levels can have negative consequences and have been associated with gut inflammation and damage to the intestinal lining.

Taurine plays yet another a role

The bacterium Bilophila wadsworthia is one of the most important taurine utilizers in humans. In the current study, researchers led by Alexander Loy at CeMESS, the Centre for Microbiology and Environmental Systems Science of the University of Vienna, have discovered a new genus of hydrogen sulfide-producing bacteria in the mouse intestine. “The bacterium we described has a rather unbalanced diet,” explains Loy, “it specialises in consuming taurine.” Taurine is a semi-essential amino acid, synthesised in small amounts in the liver but mostly obtained through the diet – especially meat, dairy and seafood. 

Like hydrogen sulfide, taurine is implicated in a plethora of physiological processes. Recent studies have found a link between taurine and healthy ageing – it seems this nutrient may stave away age-related disease. In light of these findings, the discovery of a new gut microbe that feeds exclusively on taurine (aptly named Taurinivorans muris) is another piece of an exciting puzzle. “By isolating the first taurine degrader in the mouse gut, we’re one step closer to understanding how these gut microbes mediate animal and human health” explains Huimin Ye, lead author of the study. 

To access sufficient taurine in the gut, however, Taurinivorans muris needs the help of other gut microbes to release it from bile acids. Taurine-containing bile acids are produced in the liver and are increasingly released into the intestine during a high-fat diet to help our body digest fats. The activities of the bacteria in the intestine in turn influence the bile acid metabolism in the liver. The results of the Viennese researchers therefore also contribute to a better understanding of these complex interactions in bile acid metabolism, which has an impact on processes and diseases throughout the body.

Taurine-degrading microbes choke out pathogens

One of the most important functions of the symbiotic microbes in the gut is to defend against pathogens. The microbiome has a versatile arsenal of protective mechanisms – and utilising taurine to create hydrogen sulfide is one of them. “Hydrogen sulfide may suppress the oxygen-dependent metabolism of some pathogens,” explains Ye. In the present study, the researchers found that Taurinivorans muris has a protective role against Klebsiella and Salmonella, two important gut pathogens. “The protective mechanism of Taurinivorans muris against pathogens may be via hydrogen sulfide but is essentially not yet fully understood” adds Alexander Loy. Taurine is one of the most important sources of hydrogen sulfide production in the gut. The study thus generates basic knowledge on the physiological interactions between the different gut microbes and their hosts, which is necessary to develop new microbiome-based therapies.

Source: EurekAlert!

Categories : Mental Health PaediatricsTags :

ADHD Medication Errors have Increased Nearly 300%

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Photo by Annie Spratt on Unsplash

In a new study published in Pediatrics, researchers investigated the characteristics and trends of out-of-hospital attention-deficit/hyperactivity disorder (ADHD) medication errors among children and teenagers reported to US poison centres from 2000 through 2021. Their results showed that the number of medication errors increased by nearly 300%, with over half resulting from an accidental double dosage.

ADHD is among the most common paediatric neurodevelopmental disorders. In 2019, nearly 10% of children in the US had a diagnosis of ADHD, roughly half of whom currently have a prescription for ADHD medication.

According to the study by at the Center for Injury Research and Policy and Central Ohio Poison Center at Nationwide Children’s Hospital, the annual number of ADHD-related medication errors increased 299% from 2000 to 2021. During the study period, there were 87 691 medication error cases involving ADHD medications as the primary substance among this age group reported to poison centres, yielding an average of 3985 individuals annually. In 2021 alone, 5235 medication errors were reported. The overall trend was driven by males, accounting for 76% of the medication errors and by the 6–12-year-old age group, accounting for 67% of the errors. Approximately 93% of exposures occurred in the home.

Among medication errors involving ADHD medications as the primary substance, the most common scenarios were:

  • 54% – “Inadvertently taken/given medication twice”
  • 13% – “Inadvertently taken/given someone else’s medication”
  • 13% – “Wrong medication taken/given”

“The increase in the reported number of medication errors is consistent with the findings of other studies reporting an increase in the diagnosis of ADHD among US children during the past two decades, which is likely associated with an increase in the use of ADHD medications,” said Natalie Rine, PharmD, co-author of the study and director of the Central Ohio Poison Center at Nationwide Children’s Hospital.

In 83% of cases, the individual did not receive treatment in a health care facility; however, 2.3% of cases resulted in admission to a health care facility, including 0.8% to a critical care unit. In addition, 4.2% of cases were associated with a serious medical outcome. Some children experienced agitation, tremors, seizures, and changes in mental status. Children under age 6 were twice as likely to experience a serious medical outcome and were more than three times as likely to be admitted to a health care facility than 6–19-year-olds.

“Because ADHD medication errors are preventable, more attention should be given to patient and caregiver education and development of improved child-resistant medication dispensing and tracking systems,” said Gary Smith, MD, DrPH, senior author of the study and director of the Center for Injury Research and Policy at Nationwide Children’s Hospital. “Another strategy may be a transition from pill bottles to unit-dose packaging, like blister packs, which may aid in remembering whether a medication has already been taken or given.”

Although prevention efforts should focus on the home setting additional attention should be given to schools and other settings where children and adolescents spend time and receive medication.

Source: Nationwide Children’s Hospital

Categories : Diseases, Syndromes and Conditions HospitalsTags :

The Greater Clostridioides Difficile Threat may Come from Within

On By ModernMedia
Clostridioides difficile. Credit: CDC

Despite strenuous control efforts, hospital-acquired infections still occur – the most common of which is caused by the bacterium Clostridioides difficile, which creates lingering spores and resists alcohol-based hand sanitisers. Surprising findings from a new study in Nature Medicine suggest that the burden of C. diff infection may be less a matter of hospital transmission and more a result of characteristics associated with the patients themselves.

The study team, led by Evan Snitkin, PhD; Vincent Young, MD, PhD; and Mary Hayden, MD, leveraged ongoing epidemiological studies focused on hospital-acquired infections that enabled them to analyse daily faecal samples from every patient within the intensive care unit at Rush University Medical Center over a nine-month period.

Arianna Miles-Jay, a postdoctoral fellow in Dr Snitkin’s lab, analysed 1141 eligible patients, and found that a little over 9% were colonised with C. diff. Using whole genome sequencing at U-M of 425 C. difficile strains isolated from nearly 4000 faecal specimens, she compared the strains to each other to analyse spread. But she found that, based on the genomics, there was very little transmission.

Essentially, there was very little evidence that the strains of C. diff from one patient to the next were the same, which would imply in-hospital acquisition. In fact, there were only six genomically supported transmissions over the study period. Instead, people who were already colonised were at greater risk of transitioning to infection.

“Something happened to these patients that we still don’t understand to trigger the transition from C. diff hanging out in the gut to the organism causing diarrhoea and the other complications resulting from infection,” said Snitkin.

Hayden notes this doesn’t mean hospital infection prevention measures are not needed. In fact, the measures in place in the Rush ICU at the time of the study – high rates of compliance with hand hygiene among healthcare personnel, routine environmental disinfection with an agent active against C. diff, and single patient rooms were likely responsible for the low transmission rate. The current study highlights, though that more steps are needed to identify patients who are colonised and try to prevent infection in them.

Where did the C. diff come from? “They are sort of all around us,” said Young. “C. diff creates spores, which are quite resistant to environmental stresses including exposure to oxygen and dehydration…for example, they are impervious to alcohol-based hand sanitiser.”

However, only about 5% of the population outside of a healthcare setting has C. diff in their gut – where it typically causes no issues.

“We need to figure out ways to prevent patients from developing an infection when we give them tube feedings, antibiotics, proton pump inhibitors – all things which predispose people to getting an actual infection with C. diff that causes damage to the intestines or worse,” said Young.

The team next hopes to build on work on AI prediction for patients at risk of C. diff infection to identify patients more likely to be colonised and who could benefit from more focused intervention.

Said Snitkin, “A lot of resources are put into gaining further improvements in preventing the spread of infections, when there is increasing support to redirect some of these resources to optimise the use of antibiotics and identify other triggers that lead patients harbouring C. diff and other healthcare pathogens to develop serious infections.”

Source: Michigan Medicine – University of Michigan

Categories : General Interest Medical IndustryTags :

Wits Launches New PG Diploma in Innovation and Entrepreneurship

On By ModernMedia
Source: Unsplash CC0

Graduates and third year students are encouraged to apply for the new Postgraduate Diploma to drive business ownership and job creation. 

The University of the Witwatersrand (Wits) announced its Postgraduate Diploma in Innovation and Entrepreneurship. The diploma aims for graduates and third-year students in engineering, science, and health sciences to become catalysts for business ownership and job creation. Apply for the PG Dip in Innovation and Entrepreneurship before 30 November 2023. 

Professor Christo Doherty, the course coordinator says: “We particularly encourage candidates who are contemplating pursuing a Master’s or PhD in any of these fields, so they can embark on advanced degrees armed with the knowledge of how to commercialise their research. Graduates of this programme will have a wealth of career opportunities. Equipped with the aptitude and mindset for innovation and creation, they represent the future generation of entrepreneurs and job creators. They will not merely seek jobs; they will create them.”

The programme was developed and is led by the Wits Innovation Centre, and will bridge the gap between academic research and real-world innovation. It will empower students to translate their research into tangible solutions that drive meaningful change in society. The Diploma seeks to harness the entrepreneurial spirit of young scientists and engineers to ensure that their research outcomes do not languish on dusty shelves but ignite the flames of practical application. Professor Nithaya Chetty, the Dean of the Wits Faculty of Science says: “South African universities must now give attention to both discovery research and innovation. This is a novel diploma that will combine collaborative teaching and learning to fast-track researchers into careers as innovators and entrepreneurs”.

The PGDip in Innovation and Entrepreneurship is a multi-faculty initiative characterised by a hands-on approach, with a year-long research project at its core. Students will collaborate closely with an interdisciplinary team of lecturers, gaining invaluable insights and guidance throughout their journey. The curriculum covers critical subjects such as The Fundamentals of Business for Innovators, Innovation and the Commercialization of Research, Creating Ventures for Innovators, and Applying Design Thinking to Innovation. The programme’s objective is to expedite the transformation of students’ research and ideas into commercially viable endeavours or solutions with significant societal impact.

From 2025, the programme will expand to include humanities, commerce and other faculties. 

Read more about Innovation at Wits and the Wits Innovation Centre.