Researchers have identified inherited genetic variants that may predict the loss of one copy of a woman’s two X chromosomes as she ages, a phenomenon known as mosaic loss of chromosome X, or mLOX. These genetic variants may play a role in promoting abnormal blood cells (that have only a single copy of chromosome X) to multiply, which may lead to several health conditions, including cancer. The study, co-led by researchers at the National Cancer Institute, part of the National Institutes of Health, was published in Nature.
To better understand the causes and effects of mLOX, researchers analysed circulating white blood cells from nearly 900 000 women across eight biobanks, of whom 12% had the condition. The researchers identified 56 common genetic variants – located near genes associated with autoimmune diseases and cancer susceptibility – that influenced whether mLOX developed. In addition, rare variants in a gene known as FBXO10 were associated with a doubling in the risk of mLOX.
In women with mLOX, the investigators also identified a set of inherited genetic variants on the X chromosome that were more frequently observed on the retained X chromosome than on the one that was lost. These variants could one day be used to predict which copy of the X chromosome is retained when mLOX occurs. This is important because the copy of the X chromosome with these variants may have a growth advantage that could elevate the woman’s risk for blood cancer.
The researchers also looked for associations of mLOX with more than 1,200 diseases and confirmed previous findings of an association with increased risk of leukemia and susceptibility to infections that cause pneumonia.
The scientists suggest that future research should focus on how mLOX interacts with other types of genetic variation and age-related changes to potentially alter disease risk.
The South African Medical Association has for years raised concerns about the criminalisation of medical errors, stressing that current legal practices may undermine patient safety and deter doctors from performing high-risk procedures.
Individual healthcare workers or teams of healthcare workers, like all other people, sometimes make unintentional errors. Though public recognition of the problem may be lacking, there is substantial scientific literature recording and describing the issue. In its landmark “To err is human” report published in 1999, the United States Institutes of Medicine wrote that “the problem is not bad people in health care – it is that good people are working in bad systems that need to be made safer”.
Medical errors can take many forms – from diagnostic and surgical, to medication and device and equipment. Pinning down a definition is hard although two formulations in academic literature are: “the failure of a planned action to be completed as intended or the use of a wrong plan to achieve an aim” and “unintentional deviation from safe practice”. Some argue against the use of the term “errors”, given that it stigmatises those who make “errors”.
A variety of approaches have been used to reduce medical errors. One of the most striking is the use of aeroplane-style checklists before and during surgery – with one such checklist having been backed by the World Health Organization. A review of such checklists published in the British Medical Journal in 2012 concluded that “surgical checklists represent a relatively simple and promising strategy for addressing surgical patient safety worldwide”.
Error v negligence
While the terms medical errors and medical negligence are often used interchangeably, they are in fact quite distinct, explains Professor Ames Dhai, SAMA’s vice chairperson and former director of the Steve Biko Centre for Bioethics at Wits University, in an interview with Spotlight.
“Medicine is exceedingly complex and errors do unfortunately occur from time to time (in most instances no harm comes from them). In most instances, the error cannot be attributed to the ‘fault’ of a person and is just a consequence of the procedure or other systemic factors.” The element of “fault”, Dhai says, is what distinguishes errors from medical negligence. Medical negligence occurs, she says, when the standard of care fails to meet the expected standard of the reasonable doctor in that discipline under the prevailing circumstances, leading to the patient suffering harm.
“If the ‘fault’ is deemed to be intentional, one is no longer negligent, and [therefore] potentially guilty of murder (the distinction being negligence vs intent),” Dhai explains.
“To be clear, doctors who are grossly negligent or reckless need to be held accountable. However, nearly all doctors don’t fall into this category. They are ethical, caring, and only want the best for their patients,” she says.
According to SAMA, due to a lack of proper, transparent structures to investigate, explain, account, and resolve instances of medical errors, families understandably turn to the criminal justice system for answers and accountability. This means some cases end up in court.
One high-profile case is that of paediatric surgeon Professor Peter Beale, who faces multiple charges, including three counts of murder and two of fraud, linked to the deaths of three children between 2012 and 2019. The state claims the deaths were caused by wrongful and negligent actions and unnecessary procedures by Beale.
But SAMA argues that the criminal justice system, designed for addressing criminal acts, is not the most suitable mechanism to navigate the complexities of medical practice. They stress that their concerns about charging, prosecuting, and convicting doctors in no way seek to minimise the impact of such devastating events on the families and loved ones involved.
“Instead, we are worried that criminalisation of bona fide medical errors and adverse events is an unsuitable response that would do little to prevent future tragedies and may in fact lead to other unwanted consequences that would be detrimental to both the profession and patients,” explains SAMA chairperson Dr Mvuyisi Mzukwa. He argues that criminalising errors would potentially ensure that they will be concealed and unreported, adding that “by hindering disclosure and reporting, one stifles opportunities to learn from errors and improve the system”.
But not everyone agrees. Dr Siraaj Khan, a lecturer at the Steve Biko Centre for Bioethics, describes the relevant law as straight-forward and says it is not in need of reform. “I think we need to differentiate being charged with medical negligence in a criminal court and being held liable or found guilty at the end of the day. And you’ll see that there are very few instances where a medical practitioner is actually found guilty,” he says. “So in my opinion, the law as it stands doesn’t require any intervention.”
Khan points out that if a medical doctor makes an error, it doesn’t automatically mean that they are negligent. The error has to be one that a reasonable doctor in the position of that particular medical doctor would not have made. Only if the standard falls short of the reasonable expert in that position will the conduct be criminalised, and that needs to be proven beyond a reasonable doubt in a criminal court. “So it’s a higher standard than that used in a civil court,” says Khan. “In a civil court, if there’s an action for medical negligence, it just needs to be proven on a balance of probabilities. Whereas if you charge a doctor with culpable homicide, for example, the standard of negligence needs to be proven beyond a reasonable doubt in a criminal court.”
But Dhai is critical of the status quo. She argues that the law, as it stands and as it is applied, may hamper patient safety and the achievement of a safety culture (where systems thinking, rather than individual blame, is applied to learn from incidents to create better systems and provide safer care). “The criminal justice system often ignores systemic factors to instead target the individual who happened to hold the scalpel when the incident occurred,” she says.
“The environment of fear and the threat of litigation and criminal proceedings may also disincentivise doctors from practicing in high-risk specialties or operating on complex and difficult cases, thereby impeding access to much-needed care,” Dhai adds. Khan acknowledges the argument that criminalising medical errors encourages defensive medicine, but, “on the other hand”, he says, “the counter-argument is that if we do criminalise this, it sets the standard and it would require doctors to act with more prudence when performing these operations”.
Gross negligence
SAMA’s position is that the threshold for criminal proceedings should be elevated from negligence to gross negligence and recklessness. As pointed out by Larisse Prinsen, a senior law lecturer at the University of the Free State, in an article published by The Conversation, gross negligence is the standard in countries such as New Zealand, Australia, and England. SAMA also says that investigators and the National Prosecuting Authority (NPA) should be specially trained to fully appreciate the complexities involved in medical errors and adverse events. The NPA is responsible for criminal prosecutions in South Africa.
Photo by Tingey Injury Law Firm on Unsplash
In addition to increasing the threshold for prosecution from negligence to gross negligence or recklessness, Dhai argues that there is much more that needs to be done. This includes better application of the law, including better complaint management, alternative dispute resolution, and support for affected patients and health practitioners.
Changes to the relevant laws might well be on the way.
The South African Law Reform Commission (SALRC) has confirmed to Spotlight that they “received a request from a coalition of various healthcare-related bodies asking that the SALRC conduct an investigation to review the law of culpable homicide and the application thereof in a healthcare setting”. According to the SALRC, the request was approved by the Minister of Justice and Correctional Services on 27 June 2023 and the research is underway as “Project 152 Criminal Liability of Healthcare Professionals”.
Though much of SAMA’s current spotlight is on criminalisation of medical errors, South Africa does also have a much wider challenge of medico-legal claims against provincial health departments. Most of these claims are for alleged medical negligence relating to birth-related complications, particularly cerebral palsy. Though amounts paid out are a small fraction of total claims, they nevertheless amount to hundreds of millions per year and are a severe strain on provincial health budgets. A bill aimed at addressing state liability in such cases was introduced in the last parliament, but has not been passed. The SALRC has for several years also been looking at the issue of medico-legal claims and published a discussion paper on the matter in November 2021, though more than two years later, their final report on the matter has not yet been published.
What about the HPCSA?
The Health Professions Council of South Africa (HPCSA) regulates health professions in the country. This involves, among others, managing the licensing of doctors.
As explained in an article by the Medical Protection Society’s Dr Yash Naidoo, less serious complaints made to the HPCSA are handled through a process of mediation. If complaints are more serious, or if mediation fails, a formal complaints process kicks in. In some cases, this can turn into a formal professional conduct inquiry.
“When a matter proceeds to a formal inquiry, that is when costs – money and time – start to escalate,” writes Naidoo.
“Think of the inquiry as you would a typical courtroom matter on television. The complainant is represented by the HPCSA’s pro forma complainant, and the practitioner is the respondent who may have their own legal representation. Each party can call witnesses and the inquiry itself can take a day or more – depending on the number of witnesses and the complexity of the matter.”
As Naidoo explains, penalties can range from a caution or reprimand to large fines or removal from the register (which amounts to the person no longer being allowed to work as a health professional).
Speaking to Spotlight, HPCSA’s Acting Head of Division Corporate Affairs, Priscilla Sekhonyana, says that the HPCSA has a dedicated line for lodging complaints and investigating authority and committees for adjudication of matters. “The HPCSA has committees of experts in place to adjudicate on matters and all rules of natural justice inclusive of fairness are observed.”
She says the council has engaged with various parties on the criminalisation of medical errors. The HPCSA respects the laws of the country, Sekhonyana says, but she also notes that practitioners are starting to be discouraged from engaging in what may be perceived as risky procedures. “The HPCSA has had engagements with the National Prosecuting Authority on the matter and unfortunately, the situation has remained the same. However, should there be activities aimed at legal reform, the HPCSA will participate in that process and make its views known at that juncture,” she says.
Spotlight made several attempts to get comment from the National Department of Health on the criminalisation of medical errors. The department had not provided a response by the time of publishing.
A lifesaving package including early detection and bundled treatment for women who have post-partum haemorrhage has been found to incur minimal additional cost according to new analysis from 78 hospitals around the world.
In a paper published in Nature Medicine, a team of researchers working on the E-MOTIVE trial conducted an economic analysis to establish whether a package of interventions to objectively identify and treat post-partum haemorrhage (PPH) was cost effective.
Over 200 000 women from hospitals in Kenya, Nigeria, Tanzania and South Africa were included in the economic analysis of E-MOTIVE, with hospitals being randomly assigned to either the intervention or usual care groups. The intervention resulted in more than 1000 fewer PPH cases compared to the usual care group. The additional cost for E-MOTIVE was estimated to be, on average, an extra $0.30 per patient after adjustments for clinical factors including the proportion of patients with a clinical primary outcome event at each hospital, as well as for cluster and time-period considerations.
The economic analysis explored a range of costs for a key component of the E-MOTIVE package which is a calibrated blood collection drape, used for all women in the intervention group used to objectively measure blood loss. The analysis found that when the cost of the drape is around 1 USD, the average cost per patient could be comparable to usual care.
The cost of delivering the E-MOTIVE intervention could then be, on average, equivalent to usual care, which would represent a significant health benefit for women around the world
Professor Tracy Roberts
Tracy Roberts, Professor of Health Economics at the University of Birmingham and corresponding author of the study said:
“E-MOTIVE is clearly a cost-effective intervention for what is a lifesaving treatment for thousands of women around the world who may experience severe bleeding in childbirth. Our analysis of the E-MOTIVE trial shows that the costs incurred in delivering the package of treatments and the drape are on average minimal and represent really good value for money”.
“The drape forms a key part of the E-MOTIVE package, and should E-MOTIVE be widely adopted and the cost of drapes reduced to below $1, the economic benefits could be even more apparent. The cost of delivering the E-MOTIVE intervention could then be, on average, equivalent to usual care, which would represent a significant health benefit for women around the world.”
60% reduction in heavy bleeding
E-MOTIVE being found cost-effective comes after the publication of a landmark study published that found a 60% reduction in heavy bleeding for women experiencing PPH.
Postpartum haemorrhage (PPH) – defined as the loss of more than 500 mL of blood within 24 hours after birth – is the leading cause of maternal mortality worldwide. It affects an estimated 14 million women each year and results in around 70 000 deaths – mostly in low and middle-income countries – equivalent to 1 death every 6 minutes.
The study found that objectively measuring blood loss using a simple, low-cost collection device called a ‘drape’ and bundling together WHO-recommended treatments – rather than offering them sequentially – resulted in dramatic improvements in outcomes for women. Severe bleeding – when a woman loses more than a litre of blood after birth – was reduced by 60%, and they were less likely to lose their life.
There was also a substantial reduction in the rate of blood transfusions for bleeding, which is of particular importance in low-income countries where blood is a scarce and expensive resource.
Professor Arri Coomarasamy, who led the E-MOTIVE trial and is the Co-Director of the WHO Collaborating Centre on Global Women’s Health at the University of Birmingham said:
“This new approach to treating postpartum haemorrhage could radically improve women’s chances of surviving childbirth globally, helping them get the treatment they need when they need it.
“Time is of the essence when responding to postpartum bleeding, so interventions that eliminate delays in diagnosis or treatment should be gamechangers for maternal health. With this latest study showing that E-MOTIVE is extremely cost effective, and following WHO recommending the treatment bundle we hope that the intervention can quickly become the standard of care that will save many lives around the world.
As financial pressures continue to mount globally, it’s imperative to acknowledge the profound impact that financial stress can have on mental health. Whether it’s struggling to pay bills, dealing with debt, or worrying about job security, these are all real-life examples of financial stressors that can significantly impact our mental well-being. Recent studies conducted by reputable organisations such as the South African Depression and Anxiety Group (SADAG) and Sanlam shed light on the alarming correlation between these financial strains and mental wellness. In light of this, we aim to provide insights and guidance to help you manage financial stress and improve your overall well-being.
According to SADAG’s online survey, conducted to assess the impact of the pandemic on South Africans’ mental well-being, a staggering 46% of respondents identified financial stress and pressure as significant contributors to their mental health challenges. Similarly, Sanlam’s report revealed that 57% of respondents cited financial stress as the primary factor affecting their mental well-being, with young individuals aged 18-24 being particularly vulnerable.
In light of these findings, it’s important to recognise the empowering role of proactive financial management in safeguarding mental wellness. Effective financial management can significantly reduce the stress associated with financial uncertainties, contributing to better mental health. By making use of available tools and resources, individuals can gain valuable insights and guidance to manage their finances and budgets more effectively, ultimately supporting their overall well-being.
Speaking on the importance of financial tools and resources, Lerato Thwane, Head of e-Commerce, shares her insights. “Amidst the challenges posed by financial stress, it’s essential for individuals to have access to tools and resources that can provide clarity and support. Through XDS, we empower consumers, giving them the control they need to navigate their financial journey confidently, ultimately promoting financial stability and mental well-being. XDS offers a comprehensive range of products and services to support individuals at every stage of their financial lifecycle. These include credit reports and financial guidance.”
Thwane continues: “Research has shown that financial stability is closely linked to mental well-being. When individuals have control over their finances and feel secure about their future, they experience lower levels of stress and anxiety. This, in turn, can lead to improved overall mental health, better relationships, and increased productivity in other areas of life. Financial literacy is an important part of achieving financial security. A clear understanding of how to manage money and the basics of budgeting can help individuals gain control over their finances and feel more empowered.”
To improve your financial management skills and overall well-being, consider seeking professional help such as financial counselling. Additionally, accessing your XDS credit profile and score on Splendi can help you better understand your financial status. These resources offer valuable guidance to boost financial literacy, develop healthier money habits, and secure your financial future.
About Mettus
Mettus is a collective of intelligence companies offering end-to-end data solutions. Established in August 2022 through a private equity-backed management buyout, Mettus is home to three established brands across the fast-growing and in-demand data and technology markets. Our specialities include credit bureau services, background screening and vetting, data platforms and analytics.
At XDS, customer value and lifecycle management have largely replaced old-fashioned credit management as tools to minimise risk and improve profitability within a business.
With this in mind, we are committed to providing smarter and more technologically advanced information solutions to credit grantors and other data users so that they can make better decisions regarding the granting of credit to new customers. We maintain the highest standards of integrity relating to data privacy, confidentiality, and information quality, and we comply fully with all relevant legislation, such as the National Credit Act. We seek to build long-term partnerships with our customers as we help them to grow their businesses.
A clinical trial on a two-drug therapy for methamphetamine use disorder reduced use of the highly addictive drug for up to 12 weeks after initiation of treatment.
Participants in the ADAPT-2 clinical trial who received a combination of injectable naltrexone plus extended-release oral bupropion (NTX+BUPN) had a 27% increase in methamphetamine-negative urine tests, indicating reduced usage. By contrast, the placebo group had an 11% increase in negative tests.
“These findings have important implications for pharmacological treatment for methamphetamine use disorder. There is no FDA-approved medication for it, yet methamphetamine-involved overdoses have greatly increased over the past decade,” said Michael Li, assistant professor-in-residence of family medicine at UCLA and the study’s lead author.
Methamphetamine use has continued growing over the years around the world, increasing from 33 million people in 2010 to 34 million in 2020. Overdose deaths from the drug have jumped fivefold in the US from 2012 to 2018, and are followed by Canada and Australia in increases.
To curb the ongoing crisis, the National Institute on Drug Abuse (NIDA) Clinical Trials Network has supported various trials, including the ADAPT-2 trial, to test the effects of different pharmacological treatments for methamphetamine use disorder. ADAPT-2 was carried out from May 23, 2017 to July 25, 2019 across the eight trial sites that included UCLA. It included 403 participants, with 109 assigned to the drug combo group and the rest to the placebo group in the first stage.
The latest findings are the second stage of the multi-site trial. The earlier stage had demonstrated that the two-drug combination worked at six weeks, but the unanswered question was whether the intervention remained efficacious over a longer period.
In the second stage, the researchers conducted urine tests on the participants at weeks seven and 12, and again post-treatment at weeks 13 and 16 comparing the group on NTX+BUPN with the placebo group.
There is a need for further research to determine whether the drug treatment effect lasts longer than 12 weeks and yields further methamphetamine use reductions, the researchers write.
“Prior stimulant use disorder treatment trials suggest that change in use is gradual (consistent with our findings), unlikely to result in sustained abstinence in a typical 12-week trial, and dependent on treatment duration,” they write. “This warrants future clinical trials to quantify changes in MA use beyond 12 weeks and to identify the optimal duration of treatment with this medication.”
A number of radiation therapy graduates, who must by law complete the Department of Health’s Internship and Community Service Programme in order to practise medicine, say they have been waiting for nearly six months to be placed in hospitals.
They have finished their four-year studies and now need to complete a year-long internship, referred to as Comserve, in order to register and practice as medical professionals. Their primary role is to administer radiation treatment to patients with cancer.
The community service programme is administered by the National Department of Health.
“We are left in limbo, not sure when we will receive a post,” a graduate from the Western Cape, who wished to be anonymous, told GroundUp. He said that they’ve been told since the beginning of the year by Comserve officials that they are engaging with provinces to secure them placements.
He shared correspondence that said he was not yet allocated a position “due to the unavailability of funded posts”.
He said that it was “frustrating” that they are required by law to do Comserve yet the department cannot find them posts.
“We are all stressed out … We still have bills to pay from university. We are squatting with our parents. We were promised we were going to have a job after studying and now we can’t apply for other jobs. Our hands are cut off. We can’t do anything,” he said.
He said he knew of about nine other radiation therapists also waiting for placements.
Another graduate, from KwaZulu-Natal, said the lack of placement risked creating a backlog when next year’s graduates need to do Comserve.
“At the end of the day, our cancer patients are going to suffer … They need us and we have trained specifically to help them,” she said.
The failure to place graduates is happening despite staff shortages in radiation oncology departments in Gauteng.
On 30 April activists from SECTION27, Cancer Alliance and the Treatment Action Campaign (TAC) as well as cancer patients marched to the offices of the Gauteng department of health demanding that millions of rands set aside for radiation treatment be used.
In an open letter addressed to health MEC Nomantu Nkomo-Ralehoko, the organisations provided a backlog list of about 3000 patients awaiting radiation oncology treatment.
Salomé Meyer of the Cancer Alliance says there are radiation oncology staff shortages in Charlotte Maxeke Johannesburg Academic Hospital and Steve Biko Academic Hospital.
Both graduates GroundUp spoke to had applied to Charlotte Maxeke for their Comserve year.
In December 2023, the national department stated that nearly 10 400 Comserve applications were received. Of these just shy of 9400 applicants “were successfully placed, and this includes medical doctors, nurses, pharmacists and other health professionals at health facilities throughout the country”.
National Department of Health spokesperson Foster Mohale sent GroundUp an incoherent and incomplete WhatsApp response. “We only know those who were placed. We can’t tell those who were not placed because we are not sure of their career plans,” he wrote.
Asked about staff shortages, Mohale wrote that the department “prioritises all critical posts using limited budget”.
The Gauteng Department of Health did not respond to our questions about radiology therapist Comserve placements and staff shortages in its hospitals, despite committing to do so and repeated follow-ups.
Post-COVID-19, there has been a notable increase in vaccine fatigue and apathy, influenced significantly by social media.1 Higher trust in social media correlates with increased vaccine hesitancy, driven by the widespread dissemination of vaccine misinformation and conspiracy theories on these platforms.1 This has significantly impacted public perceptions and trust regarding vaccinations.1
Recently, statistics have indicated a notable increase in pertussis cases in South Africa. In December 2022, the National Institute for Communicable Diseases (NICD) reported a total of 408 cases countrywide.2 Most of these cases occurred in children younger than five years old as parents might not return to their healthcare professional to have their children vaccinated after six weeks of age.2
Pertussis is a vaccine-preventable disease
Recent research concluded that immunisation with the pertussis vaccine during pregnancy prevented 65% of pertussis infections through 6 months of age.3 These results indicate that maternal pertussis vaccination protects infants from infection during a period of greatest vulnerability to severe morbidity and mortality.3 The findings support the infant health benefits of recommendations to administer a dose of pertussis vaccine near 28 weeks of gestational age.3
Health authorities in South Africa have emphasised the importance of vaccination to control pertussis outbreaks.4 Immunity following vaccination lasts for approximately 5-6 years, necessitating booster doses.4 Episodic increases in pertussis cases occur in vaccinated populations every 3-5 years, making the completion of childhood primary series Tdap (tetanus, diphtheria, and acellular pertussis) vaccine and boosters important for prevention.4 The NICD also recommends vaccination of healthcare workers and pregnant women to reduce transmission to neonates and other vulnerable populations.4
“2024 marks the 50th anniversary of the Expanded Programme on Immunisation (EPI),” says Dr Lourens Terblanche, Vaccines Medical Head at global pharmaceutical company, Sanofi South Africa. “Every country has a national immunisation programme, and vaccines are universally recognised as best practice in terms of efficacy, tolerability, cost impact and successful public health interventions to prevent fatalities and enhance the quality of life. As we celebrate the lifesaving impact of EPI, we also need to strengthen routine immunisation initiatives, especially for pregnant women.”
Effective protection for children with Tdap vaccination
South Africa’s national immunisation schedule provides vaccinations against various diseases free of charge at state clinics, starting from birth, followed by additional doses at set times during a child’s early years.
“It is crucial to prioritise the health and well-being of patients, especially during critical stages such as pregnancy and childhood,” says Terblanche. “We urge all healthcare professionals to encourage pregnant women to receive their vaccinations timeously, and to ensure that their children’s vaccinations are up to date. Proactive efforts can significantly reduce the risk of vaccine-preventable diseases for mothers and children, safeguarding their health and the health of our communities.”
Terblanche reiterates that pertussis has the potential to cause serious and sometimes deadly complications in the paediatric population. “The majority of cases of pertussis occur in infants less than 2-3 months old, and the highest number of deaths are also seen in this age group. The situation is complicated by the fact that vaccinating infants themselves against pertussis can only start from 6 weeks of age, which is why strategies to protect them in this window of vulnerability is so important.”
Sanofi, in partnership with the National Department of Health, is urging healthcare providers throughout South Africa to encourage pregnant women to have the Tdap vaccination. Tdap vaccine Adacel is an integral component of preventive healthcare and is approved for use in individuals aged 10 through 64. This vaccine provides protection against pertussis, tetanus and diphtheria.5
Immunological response and efficacy
Adacel stimulates the immune system to produce antibodies that are specific to the toxins produced by tetanus and diphtheria bacteria, as well as the cells of the Bordetella pertussis bacteria. “This action provides a critical defensive shield against these diseases, with immunity that is significantly more robust and longer-lasting than natural immunity,” says Terblanche.
Adacel is indicated for immunisation during the third trimester of pregnancy to prevent pertussis in infants younger than 2 months of age.5
The first dose of Adacel is administered at least 5 years after the last dose of DTaP or Td.5
Adacel is approved for a repeat vaccination as soon as 8 years after the initial Tdap dose.5
Adacel for tetanus-prone wound management may be administered as early as 5 years after a previous dose of a tetanus toxoid-containing vaccine.5
“Adacel can help a pregnant woman to create antibodies against the bacteria that cause pertussis, and these are passed to her baby before birth,” says Terblanche.
Impact of vaccination on global health
Today, vaccines have an excellent safety record and most “vaccine scares” have been shown to be false alarms.6 However, misguided safety concerns in some countries have led to a fall in vaccination coverage, causing the re-emergence of pertussis and measles.6
Vaccinations significantly reduce disease, disability, death, and health inequities globally:6
Public Health Impact: Vaccination has substantially lowered the incidence of diseases that were once prevalent and often fatal, contributing greatly to global health improvements comparable only to the provision of clean water.6
Economic Benefits: By reducing disease burden, vaccination cuts healthcare costs and promotes economic growth through lower morbidity and mortality rates.6
Global Disease Control: Successful vaccination programs have led to the eradication and control of numerous infectious diseases.6
Herd Immunity and Social Equity: Vaccination not only protects vaccinated individuals but also contributes to broader community health through herd immunity. This indirect protection is especially beneficial in low-income settings where direct vaccine coverage may not be comprehensive.6
Empowerment and Secondary Benefits: Beyond health, vaccination empowers women by enabling better family planning and increases educational and social opportunities through improved child survival rates.6
Reduction of Antibiotic Resistance: By preventing bacterial infections, vaccines reduce the need for antibiotics, thereby helping to slow the development of antibiotic-resistant strains.6
With Adacel, you can help make a difference in pertussis prevention. Let’s protect mothers, children and our communities and ensure everyone has the chance to lead a healthy life by getting vaccinated.
Tdap – tetanus, diphtheria, acellular pertussis
DTaP – diphtheria, tetanus, acellular pertussis
Td – tetanus, diphtheria
References
1. Carrieri V, Guthmuller S, Wübker A. Trust and COVID-19 vaccine hesitancy. Sci Rep. 2023 Jun 7;13(1):9245. doi: 10.1038/s41598-023-35974-z. PMID: 37286569; PMCID: PMC10245358. 2. Whooping Cough Cases Increase Rapidly, Officials Urge Vigilance. Health-e News. [Accessed 22 Apr 24]. Available from: https://health-e.org.za/2023/01/27/whooping-cough-cases-increase-rapidly-officials-urge-vigilance 3. Regan AK, Moore HC, Binks MJ, et al. Maternal Pertussis Vaccination, Infant Immunization, and Risk of Pertussis. Pediatrics. 2023;152(5):e2023062664. 4. Pertussis Preparedness: An update for Physicians, Accident & Emergency practitioners and Laboratorians. National Institute for Communicable Diseases. Centre for Respiratory Diseases And Meningitis. Revised December 2022. [Accessed 22 Apr 24]. Available from: https://www.nicd.ac.za/wp-content/uploads/2022/12/Pertussis-preparedness-and-alert-doc_12-Dec-2022_Final.pdf 5. Pertussis prevention starts here. Sanofi. [Accessed 22 Apr 24]. Available from: https://www.adacelvaccine.com/ 6. Andre FE, Booy R, Bock HL, et al. Vaccination greatly reduces disease, disability, death and inequity worldwide. Bull World Health Organ. 2008 Feb; 86(2): 140–146. Published online 2007 Nov 27. doi: 10.2471/BLT.07.040089.
A 3D map of the islet density routes throughout the healthy human pancreas. Source: Wikimedia CC0
Northwestern University researchers have developed a new antioxidant biomaterial that someday could provide much-needed relief to people living with chronic pancreatitis. The study was published in the journal Science Advances.
Before surgeons remove the pancreas from patients with severe, painful chronic pancreatitis, they first harvest insulin-producing tissue clusters, called islets, and transplant them into the vasculature of the liver. The goal of the transplant is to preserve a patient’s ability to control their own blood-glucose levels without insulin injections.
Unfortunately, the process inadvertently destroys 50–80% of islets, and one-third of patients become diabetic after surgery. Three years post-surgery, 70% of patients require insulin injections, which are accompanied by a list of side effects, including weight gain, hypoglycaemia and fatigue.
In the new study, researchers transplanted islets from the pancreas to the omentum – the large, flat, fatty tissue that covers the intestines – instead of the liver. And, to create a healthier microenvironment for the islets, the researchers adhered the islets to the omentum with an inherently antioxidant and anti-inflammatory biomaterial, which rapidly transforms from a liquid to a gel when exposed to body temperature.
In studies with mouse and non-human primates, the gel successfully prevented oxidative stress and inflammatory reactions, significantly improving survival and preserving function of transplanted islets. It marks the first time a synthetic antioxidant gel has been used to preserve function of transplanted islets.
“Although islet transplantation has improved over the years, long-term outcomes remain poor,” said Northwestern’s Guillermo A. Ameer, who led the study. “There is clearly a need for alternative solutions. We have engineered a cutting-edge synthetic material that provides a supportive microenvironment for islet function. When tested in animals, we were successful. It kept islet function maximised and restored normal blood sugar levels. We also report a reduction in units of insulin that animals required.”
“With this new approach, we hope that patients will no longer have to choose between living with the physical pain of chronic pancreatitis or the complications of diabetes,” added Jacqueline Burke, a research assistant professor of biomedical engineering at Northwestern and the paper’s first author.
‘Compromised quality of life’
For patients living without a pancreas, side effects such as managing blood-sugar levels can be a lifelong struggle. By secreting insulin in response to glucose, islets help the body maintain glycaemic control. Without functioning islets, people must closely monitor their blood-sugar levels and frequently inject insulin.
“Living without functional islets places a great burden on patients,” Burke said. “They must learn to count carbs, dose insulin at the appropriate time and continuously monitor blood glucose. This consumes much of their time and mental energy. Even with great care, exogeneous insulin therapy is not as effective as islets for maintaining glucose control.”
“It’s a compromised quality of life,” Ameer said. “Instead of multiple insulin injections, we would love to collect and preserve as many islets as possible.”
But, unfortunately, the current standard of care for preserving islets often leads to poor outcomes. After the surgery to remove the pancreas, surgeons isolate islets from the pancreas and transplant them to the liver through portal vein infusion. This intraportal perfusion procedure has several common complications. Islets in direct contact with blood flow undergo an inflammatory response, more than half of the islets die, and transplanted islets can cause dangerous clots in the liver. For those reasons, physicians and researchers have been searching for an alternate transplantation site.
In previous clinical studies, researchers transplanted islets to the omentum instead of the liver in order to bypass issues with clotting. To secure the islets on the omentum, physicians used plasma from the patients’ own blood to form a biologic gel. While the omentum appeared to work better than the liver as a transplantation site, several issues, including clots and inflammation, remained.
“There’s been significant interest in the research and medical communities to find an alternate islet transplantation site,” Ameer said. “The results from the omentum study were encouraging, but outcomes were varied. We believe that’s because the use of the patients’ blood and the added components required to create the biologic gel can affect reproducibility among patients.”
A citrate solution
To protect the islets and improve outcomes, Ameer turned to the citrate-based biomaterials platform with inherent antioxidant properties developed in his laboratory. Used in products approved by U.S. Food and Drug Administration for musculoskeletal surgeries, citrate-based biomaterials have demonstrated the ability to control the body’s inflammatory responses. Ameer set out to investigate whether a version of these biomaterials with biodegradable and temperature-responsive phase-changing properties would provide a superior alternative to a biologic gel obtained from blood.
In cell cultures, both mouse and human islets stored within the citrate-based gel maintained viability much longer than islets in other solutions. When exposed to glucose, the islets secreted insulin, demonstrating normal functionality. Moving beyond cell cultures, Ameer’s team tested the gel in small and large animal models. Liquid at room temperature, the material turns into a gel at body temperature, so it’s simple to apply and easily stays in place.
In the animal studies, the gel effectively secured the islets onto the omentum of the animals. Compared to the current methods, more islets survived, and, over time, the animals restored normal blood glucose levels. According to Ameer, the success is partially due to the new material’s biocompatibility and antioxidant nature.
“Islets are very sensitive to oxygen,” Ameer said. “They are affected by both too little oxygen and too much oxygen. The material’s innate antioxidant properties protect the cells. Plasma from your own blood doesn’t offer the same level of protection.”
Integrating into tissues
After about three months, the body resorbed 80-90% of the biocompatible gel. But, at that point, it was no longer needed.
“What was fascinating is that the islets regenerated blood vessels,” Ameer said. “The body generated a network of new blood vessels to reconnect the islets with the body. That is a major breakthrough because the blood vessels keep the islets alive and healthy. Meanwhile, our gel is simply resorbed into the surrounding tissue, leaving little evidence behind.”
Next, Ameer aims to test his hydrogel in animal models over a longer period of time. He said the new hydrogel also could be used for various cell replacement therapies, including stem cell-derived beta cells for treating diabetes.
Össur South Africa has announced the availability of Naked Prosthetics to the local market. This range of custom-made prostheses, precisely tailored to the user’s amputation and individual hand structure, positively impacts those with finger and partial-hand amputations by providing functional finger prostheses of high quality.
“Partial hand limb loss is the most prevalent of upper limb loss, with over 90% of upper limb amputations involving the fingers. Finger and partial-hand amputations also accounts for a significant number of amputations each year,” says Ernst van Dyk, Managing Director, Össur South Africa.
Whilst more common amongst working age men, finger and partial-hand amputations occurs regardless of gender or age. “The lack of mobility resulting from a finger and partial-hand amputation is not limited to the area of amputation only. Many amputees experience loss of mobility beyond the area of amputation,” stresses van Dyk. No fewer than 5% experience a resultant impairment of the entire body and as many as 75% of heavy manual labourers are unable to return to work.
“With Naked Prosthetics we are dedicated to positively impacting the lives of finger and partial-hand amputees. We aim to provide them with functional, high-quality solutions that seamlessly integrate into their lives and empower them to not only resume employment but, as importantly, to engage in the activities they love, thereby assisting them to live a life without limitations,” says van Dyk.
Naked Prosthetics’ innovative solutions, the result of strong research and development (R&D) efforts and manufacturing capabilities, has been recognised by Business Insider as one of the medical technologies that are changing people’s lives[1]. It currently offers four custom-designed devices that are fabricated to within millimetres of a patient’s unique anatomy to mimic the complex motion of a finger.
The PIPDriver is a body-controlled prosthesis designed for a finger amputation or limb difference on the proximal or distal phalanx. Its design is anatomically adapted to the proximal and distal interphalangeal joints for intuitive and natural movements. Benefits include improved functionality for everyday activities. It is easy to clean and care for, easy to put on and take off and has a cage-like structure that protects the residual finger. Its slim and smooth design allows the prosthesis to be worn on two or more adjacent fingers. It also includes a conductive tip option for touchscreen operation.
The MCPDriver is a body-driven prosthesis designed for a finger amputation or limb difference on the MCP joint (also known as the knuckle) of the index, middle, ring, and/or the little finger. It restores the original finger length, thereby helping to imitate natural gripping patterns and excels at restoring pinch, key, cylindrical and power grasps as well as grip stability. Its durable stainless-steel linkages and robust components allow the user to return to a highly demanding lifestyle. Benefits include a silicone pad that cushions the backplate for improved comfort, interchangeable silicone adjustment inserts that can be used to vary the volume and adjusting discs to obtain the best possible fit. Its natural abduction and adduction allow for intuitive use. As a result, the acclimatisation time after the initial fitting can be considerably reduced. It also includes the conductive tip option for touchscreen operation.
The ThumbDriver is a body-controlled prosthesis designed for an amputation or limb difference on the MCP joint of the thumb. It can restore two and three-point grips, enable secure gripping patterns with medium to large diameters and improve fine motor functions and skills. It features an adjustable preflex option that allows you to adapt the prosthesis according to the requirements of the task at hand. As a result, functional gripping patterns can be more easily attained.
The GripLock Finger is a passive and positionable prosthetic finger designed for a finger amputation or limb difference on the MCP joint of the index, middle, ring, and/or little finger. It is intended for use in conjunction with a custom-made socket adapted by a certified prosthetist. You can flex the finger to various degrees with your other hand or on a hard surface. Subsequently, you can release and fully extend the GripLock Finger by pressing the latch (lever arm) on the back or flexing the finger beyond the last locking position. It restores the original length, supports the use of both hands, prevents a misalignment of the metacarpal bone and provides a valuable tool to master everyday activities. GripLock Fingers can be combined with our MCPDriver, PIPDriver, and/or ThumbDriver.
Says Kai, a trained plant and machine operator who suffered the loss of his forefinger, middle and ring finger after a work-related accident. “Thanks to the precise adaptation to my individual anatomical conditions, the prosthesis is an irreplaceable everyday companion for me. When I come home at night, I take off the prosthesis in seconds – just like you kick off your shoes after a long day at work. I think it’s important to convey to other people in similar situations that a work accident like mine doesn’t have to mean the end of the world. You can come to terms with many situations and end up living a normal life.”
Similarly, Cara (an active member of the Finger and Partial Hand Amputee Peer & Support Group), lost two and a half fingers on her left hand due to an unforeseen accident. Prior to her accident, Cara was an avid yogi and enjoyed practicing inversions (yoga poses where the heart is higher from the ground than the head) and handstands. “I spent a year doing physical therapy to regain strength in my left hand, but I still felt as though I was struggling to hold and grip my mat as I practiced yoga,” she recalls. Every time she tried to balance her weight, she would fall backwards due to the lack of grip and support. Within one week of receiving her Naked Prosthetics PIPDrivers, Cara was able to hold a side plank during yoga. “You may feel hopeless in the moment, but it does get better. And you will be surprised at what you could learn. I am a different person now and I grew from the experience.”
“We are committed to helping digit amputees discover innovative and life-changing solutions. It’s all about function and getting people back to living full lives, without limitations,” continues van Dyk. “We believe our range of technologically advanced and custom-made prostheses helps to achieve exactly this and we are excited to be able to offer it to local amputees.”
Cleveland Clinic researchers found higher amounts of the sugar alcohol xylitol are associated with increased risk of cardiovascular events like heart attack and stroke. They confirmed the association in a large-scale patient analysis, preclinical research models and a clinical intervention study, published in the European Heart Journal.
Xylitol is a common sugar substitute used in sugar-free candy, gums, baked goods and oral products like toothpaste. Over the past decade, the use of sugar substitutes, including sugar alcohols and artificial sweeteners, has increased significantly in processed foods that are promoted as healthy alternatives.
The team, led by Stanley Hazen, MD, PhD, had also previously revealed a similar link between erythritol and cardiovascular risk last year. Xylitol is not as prevalent as erythritol in keto or sugar-free food products in the US but is common in other countries.
“This study again shows the immediate need for investigating sugar alcohols and artificial sweeteners, especially as they continue to be recommended in combatting conditions like obesity or diabetes,” said Dr Hazen. “It does not mean throw out your toothpaste if it has xylitol in it, but we should be aware that consumption of a product containing high levels could increase the risk of blood clot related events.”
In this new study, researchers identified that high levels of circulating xylitol were associated with an elevated three-year risk of cardiovascular events in an analysis of more than 3000 patients in the US and Europe. A third of patients with the highest amount of xylitol in their plasma were more likely to experience a cardiovascular event. To confirm the findings, the research team conducted pre-clinical testing and found that xylitol caused platelets to clot and heightened the risk of thrombosis. Researchers also tracked platelet activity from people who ingested a xylitol-sweetened drink versus a glucose-sweetened drink and found that every measure of clotting ability significantly increased immediately following ingestion of xylitol but not glucose.
The authors note that further studies assessing the long-term cardiovascular safety of xylitol are warranted. The research had several limitations, including that clinical observation studies demonstrate association and not causation.
