Month: July 2024

Categories : UncategorizedLeave a comment

New Clue in Cancer’s Obesity Paradox could Yield Immunotherapy Gains

On By ModernMedia
Source: Pixabay CC0

Obesity is a well-known cancer risk – but is also known to increase the likelihood of immunotherapy success. A new discovery from Vanderbilt University Medical Center-led research team may explain why – and how this could lead to improved treatment for non-obese patients as well. The findings, published in Nature, reveal that obesity increases the frequency of macrophages in tumours and induces their expression of the immune checkpoint protein PD-1 – a target of cancer immunotherapies. 

“Obesity is the second leading modifiable risk factor for cancer, behind only smoking, and obese individuals have a greater risk for worse outcomes. But they also can respond better to immunotherapy,” said Jeffrey Rathmell, PhD, Cornelius Vanderbilt Professor of Immunobiology and director of the Vanderbilt Center for Immunobiology. “How is it that there can be this worse outcome on one hand, but better outcome on another? That’s an interesting question.” 

Postdoctoral fellow Jackie Bader, PhD, led the studies to examine the influence of obesity on cancer and to explore this “obesity paradox” – that obesity can contribute to cancer progression but also improve response to immunotherapy. 

In a mouse model, the researchers found striking differences between the macrophages isolated from tumours in obese versus lean mice. While the protein PD-1 is an immunotherapy target normally thought to act on T cells, they discovered that the macrophages in tumours from obese mice expressed higher levels of PD-1, and that PD-1 acted directly on the macrophages to suppress their function. 

In tumour samples from patients with kidney cancer, the researchers also found PD-1-expressing macrophages, and in human endometrial tumour biopsies from patients before and after 10% weight loss, they showed that PD-1 expression on tumour-associated macrophages decreased following weight loss. 

“We were very fortunate to have collaborators that provided us with samples from the same patients before and after weight loss that reinforced the findings from our mouse models,” Bader said. 

Blocking PD-1 with an immunotherapy drug in the mouse models increased tumour-associated macrophage activity, including their ability to stimulate T cells. 

‘Team macrophage’

Cancer immunotherapy studies have largely focused on T cells, because they are the immune cells that can kill cancer cells, Bader and Rathmell said. But macrophages play important roles in influencing what T cells do. 

“I’ve always been ‘team macrophage,’” Bader said. “Macrophages are thought of as being like a garbage truck: They clean up the mess. But they have a huge spectrum of activity to enhance the immune response, and they’re more plastic and manipulatable than other immune cells, which makes them really interesting.” 

The presence of more macrophages expressing PD-1 in tumours in an obese setting provides a mechanistic explanation for the obesity paradox, Bader and Rathmell said. Increased PD-1 expression suppresses immune surveillance by macrophages, subsequently suppressing the killer T cells and allowing tumours to grow (the increased cancer risk of obesity). PD-1 blockade with immunotherapy allows the increased number of PD-1-expressing macrophages to act (the enhanced response to immunotherapy). 

Currently, immune checkpoint inhibitors work in only 20–30% of patients.  

“We clearly want to find ways to make immunotherapies work better, and in the obese setting, they naturally work better,” Rathmell said. “Understanding how these processes are working biologically may give us clues about how to improve immunotherapy in general.” 

The findings also suggest that examining levels of PD-1-expressing tumour macrophages may help identify patients who will respond better to immunotherapy. 

“It could be that the greater the proportion of PD-1-expressing macrophages a tumour has, the better the response to immunotherapy will be,” Rathmell said. 

Source: Vanderbilt University

Categories : Diet and NutritionTags : Leave a comment

For Healthy Adults, Regular Multivitamins don’t Reduce Mortality Risk

On By ModernMedia
Photo from Pixabay CCO

A large analysis of data from nearly 400 000 healthy US adults followed for more than 20 years has found no association between regular multivitamin use and lower risk of death. The study, led by researchers at the National Institutes of Health’s National Cancer Institute, was published in JAMA Network Open.

Many adults in the United States take multivitamins with the hope of improving their health. However, the benefits and harms of regular multivitamin use remain unclear. Previous studies of multivitamin use and mortality have yielded mixed results and been limited by short follow-up times.

To more deeply explore the relationship between long-term regular multivitamin use and overall mortality and death from cardiovascular disease and cancer, the researchers analysed data from three large, geographically diverse prospective studies involving a total of 390 124 US adults who were followed for more than 20 years. The participants included in this analysis were generally healthy, with no history of cancer or other chronic diseases.

Because the study population was so large and included lengthy follow-up and extensive information on demographics and lifestyle factors, the researchers were able to mitigate the effects of possible biases that may have influenced the findings of other studies. For example, people who use multivitamins may have healthier lifestyles in general, and sicker patients may be more likely to increase their use of multivitamins.

The analysis showed that people who took daily multivitamins did not have a lower risk of death from any cause than people who took no multivitamins. There were also no differences in mortality from cancer, heart disease, or cerebrovascular diseases. The results were adjusted for factors such as race and ethnicity, education, and diet quality. 

The researchers noted that it is important to evaluate multivitamin use and risk of death among different kinds of populations, such as those with documented nutritional deficiencies, as well as the potential impact of regular multivitamin use on other health conditions associated with aging.

Source: NIH/National Cancer Institute

Categories : Healthcare Politics and RegulationsTags : Leave a comment

Motsoaledi’s Return could Work, but he Needs a DG who can Say “No Minister”

On By ModernMedia

By Marcus Low

In some respects, Dr Aaron Motsoaledi was the right person for the job when he was appointed as South Africa’s Minister of Health in 2009. But in 2024, the healthcare context in the country looks very different. Spotlight editor Marcus Low asks what we might expect from this new chapter with Motsoaledi in the top health job.

When Dr Aaron Motsoaledi first became South Africa’s Minister of Health in 2009, the number one task in front of him was clear. He had to rapidly expand the country’s HIV testing and treatment programme.

Over the next decade, he did exactly that. When he left the health portfolio in 2019, there were around 5.1 million people on HIV treatment in the country – roughly six times the 850 000 there were in 2009. Driven largely by this expansion in the HIV treatment programme, life expectancy in the country increased from 58.4 years when he started to 64.9 when he left.

But while Motsoaledi largely succeeded on HIV and tuberculosis, there was a sense that he was not a details man and struggled to see through important health system reforms. He never got on top of fundamental challenges like healthcare worker shortages and poor governance in provincial health departments. That is why we were cautiously optimistic when Motsoaledi was replaced by Dr Zweli Mkhize in 2019. We thought it likely that Mkhize would be better at turning rhetoric into actual reform. As it turned out, any hopes of that happening were derailed first by the COVID-19 pandemic, and then more definitively by the Digital Vibes scandal.

The return

In a recent editorial considering possible health ministers after South Africa’s 2024 national elections, we argued that President Cyril Ramaphosa might feel that he can get more out of Motsoaledi back in the health portfolio than at home affairs, where we think it is fair to say he struggled. Even so, hearing Ramaphosa read out Motsoaledi’s name on Sunday night came as a surprise. Our money was on Dr Joe Phaahla staying in the job – as it turns out, he was demoted to again serve as Deputy Minister of Health.

What to make of all of it?

From one perspective, Motsoaledi’s return is understandable. He is a close and loyal ally of Ramaphosa and therefore someone the President would want to keep in his Cabinet. He is a medical doctor who knows the health portfolio. He is a staunch supporter of National Health Insurance (NHI) and his impassioned leadership style is probably considered an asset by the President.

If one considers the Health Minister’s number one task to be the implementation of NHI, and if one sees the implementation of NHI to be an essentially political process, then you can see a case for Motsoaledi’s return.

But even if one accepts this line of argument, it does come with some kinks that are hard to straighten out. For one, the NHI Act is now law and the political battle has thus, to some extent, already been won, and it is time to move from the broad strokes of political rhetoric, that Motsoaledi excels at, to the detail of implementation, which hasn’t been his strong point. And, to the extent that the political battle surrounding NHI has been reopened due to the ANC losing its parliamentary majority, the type of leadership required now will involve building consensus beyond just the ANC, and arguably more challenging for Motsoaledi, making strategic concessions such as allowing a greater role for medical schemes than envisaged in the NHI Act.

But all that only really matters if one accepts the premise that implementing NHI should be the top priority for the Minister of Health.

There is an argument that implementing NHI will take many years and there are much more urgent healthcare issues that need to be dealt with right away. The harsh reality is that provincial health budgets have been shrinking, healthcare worker shortages remain acute, governance in provincial health departments is often a disgrace, and health sector corruption remains a far from solved problem.

During his previous stint as health minister, Motsoaledi faced many of these problems and, while he often said the right things, the bluster wasn’t ever really backed up with a sustained programme of reform. To be sure, there were important successes like the establishment of the Office of Health Standards Compliance and attempts to revitalise health facilities, but when it comes to the fundamentals of having a well-managed healthcare system with enough healthcare workers, the picture was bleak when he left the health ministry in 2019 and it remains so today. In short, there is a view, only reinforced by his struggles at home affairs, that Motsoaledi is not the right person to have in charge if you want to implement the complex, systemic reforms required to sustainably address South Africa’s urgent healthcare problems.

That may be a bit harsh. Ministers are after all politicians and their roles are meant to be political. While it certainly helps to have ministers who are serious about, and committed to the details of implementation, they should be working in conjunction with government departments and directors-general (DGs) in particular. It certainly hasn’t helped our Health Ministers that our National Department of Health has often been overstretched and arguably lacking in strong leadership.

One underlying problem here is that over the last two decades, South Africa’s DGs and heads of provincial government departments for that matter, have too often been yes-men or people appointed as a political favour. While that may in some ways make a minister or MEC’s life easier, it does not make for good governance when a DG or a head of department is a walk-over. Ministers need to lead on policy, but have DGs and deputy DGs who are trusted and empowered to get on with implementation.

One criticism of Motsoaledi’s previous stint in the job is that even though he had a good DG in Precious Matsoso and a few decent deputy DGs, rather than shield them from the political crises of the day, he drew them into those crises. One expert we spoke to this week suggests that Motsoaledi loved the limelight and wouldn’t let others lead while another charged him with not being hands-on enough – maybe the key insight is that those things might all have been true to some extent.

Either way, given Motsoaledi’s strengths and weaknesses and the very complex health challenges South Africa faces, it is now more important than ever that as Minister he leads on political and policy matters, but gives the actual administration the space to lead on implementation. For that to work, he will need a DG who is not just another politician or cadre, but one who is an excellent manager and implementer, and maybe above all, who has the guts to say “no minister” when he or she needs to.

*Low is editor of Spotlight.

Note: Spotlight is editorially independent and is not affiliated with, nor does it endorse any political parties. Spotlight is a member of the South African Press Council.

Republished from Spotlight under a Creative Commons licence.

Read the original article.

Categories : Metabolic DisordersTags : Leave a comment

Combining Weight Loss and Blood Sugar Control is the Best Diabetes Protection

On By ModernMedia
Photo by Photomix Company on Pexels

People with prediabetes are advised to reduce their weight in order to prevent the development of diabetes. For the first time, new research shows that people achieve the best diabetes protection when they reduce their weight and at the same time normalise blood sugar regulation with lifestyle changes and medication. In an article published in Diabetologia, the authors argue that the normalisation of blood sugar levels in prediabetes should be included as a therapeutic goal in the guidelines in order to improve the prevention of type 2 diabetes.

Diabetes is widespread and is associated with an increased risk of a number of life-threatening complications such as stroke, heart attack and kidney failure. “In order to prevent the development of the disease, early therapies are already important in the prediabetes stage, a preliminary stage of type 2 diabetes. Our results can be used to change the goals of these early lifestyle interventions in order to reduce the overall development rates of diabetes,” explains first author Reiner Jumpertz-von Schwartzenberg.

Prediabetes drastically increases the risk of diabetes

Prediabetes is diagnosed when there is no manifest type 2 diabetes yet, but the fasting blood sugar is already elevated and glucose tolerance is impaired. To prevent prediabetes from becoming diabetes, affected patients are advised to reduce their weight. US guidelines from the American Diabetes Association (ADA), for example, recommend reducing body weight by at least 7%. This recommendation is based on the DPP study.

The research team from the University Tübingen and the National Institute of Diabetes and Digestive and Kidney Diseases in the US, investigated whether this weight loss is sufficient, or whether it is not better to prevent diabetes by also reducing blood sugar levels such that prediabetes goes into remission.

Prevention through one-year lifestyle intervention

They analysed data from 480 people with prediabetes who participated in the US Diabetes Prevention Program (DPP) and had lost at least 7% of their body weight through a one-year lifestyle intervention. In 114 of them, prediabetes also went into remission during the intervention, meaning that their fasting blood sugar, glucose tolerance and HbA1c had normalised. However, the majority of the 366 study participants had not managed to significantly improve their blood sugar regulation despite successfully losing weight. Their prediabetes was not in remission at the end of the intervention.

The researchers found that significantly fewer people in the group that had lost weight and achieved prediabetes remission developed manifest diabetes thereafter. The additional remission of prediabetes resulted in a relative risk reduction for the development of diabetes of 76% compared to those who had not achieved normalisation of their blood sugar levels. The absolute risk reduction was higher than 10%.

“In the group with additional remission of prediabetes, there was even no type 2 diabetes at all in the first 4 years after the lifestyle intervention,” reports last author Andreas Birkenfeld. “In the group that had ‘only’ lost weight, however, some study participants did develop manifest diabetes during that period.”

Jumpertz-von Schwartzenberg and Birkenfeld draw a clear conclusion: “Our results show that remission of prediabetes brings a further significant benefit in addition to weight reduction. We therefore advocate that the goal of prediabetes remission should be included in the objectives of the practice guidelines in order to significantly improve the prevention of type 2 diabetes.”

The study was conducted by researchers from the Institute for Diabetes Research and Metabolic Diseases of Helmholtz Munich at the University of Tübingen, a partner in the German Center for Diabetes Research (DZD), together with US colleagues in the renowned “Diabetes Prevention Program (DPP)”.

Source: University of Tübingen

Categories : AntibioticsTags :

Treatment with a Mixture of Antimicrobial Peptides can Impede Antibiotic Resistance

On By ModernMedia

Pseudomonas exposed to mixtures instead of single peptides did not gain resistance

A common infection-causing bacteria was much less likely to evolve antibiotic resistance when treated with a mixture of antimicrobial peptides rather than a single peptide, making these mixtures a viable strategy for developing new antibiotic treatments. Jens Rolff of the Freie Universitat Berlin, Germany, and colleagues report these findings in a new study publishing July 2nd in the open-access journal PLOS Biology.

Antibiotic-resistant bacteria have become a major threat to public health. The World Health Organization estimates that 1.27 million people died directly from drug-resistant strains in 2019 and these strains contributed to 4.95 million deaths. While bacteria naturally evolve resistance to antibiotics, misuse and overuse of these drugs has accelerated the problem, rendering many antibiotics ineffective. One emerging strategy to combat antibiotic resistance is the use of antimicrobial peptides, which are chains of amino acids that function as broad-spectrum antimicrobial compounds and are key components of the innate immune system in animals, fungi and plants.

In the new study, researchers investigated whether antimicrobial peptide mixtures synthesised in the lab could reduce the risk of the pathogen Pseudomonas aeruginosa from evolving antimicrobial resistance, compared to exposure to a single antimicrobial peptide. They found that using antimicrobial peptide mixtures carried a much lower risk of the bacteria developing resistance. The mixtures also helped prevent the bacteria from developing cross-resistance to other antimicrobial drugs, while maintaining – or even improving – drug sensitivity.

Overall, the findings suggest that the use of antimicrobial peptide mixtures is a strategy worth pursuing in the search for new, longer-lasting treatments for bacteria. The researchers suspect that using a cocktail of multiple antimicrobial peptides creates a larger set of challenges for bacteria to overcome, which can potentially delay the evolution of resistance, compared to traditional antibiotics. Furthermore, these cocktails can be synthesized affordably, and previous studies have shown them to be non-toxic in mice.

Lead author Bernardo Antunes adds, “Even after four weeks of exposure, a usual treatment duration for Pseudomonas infections, we could not find resistance against our new random peptide, but against other antimicrobials.”

Provided by PLOS

Categories : CancerTags : Leave a comment

Chemo Drug may Cause Significant Hearing Loss in Longtime Cancer Survivors   

On By ModernMedia
Photo by Brett Sayles

An interdisciplinary study led by researchers at the University of South Florida and Indiana University has uncovered significant findings on the long-term effects of one of the most common forms of chemotherapy on cancer survivors.

Published in JAMA Oncology, the study tracked a cohort of testicular cancer survivors who received cisplatin-based chemotherapy. The team followed the patients for an average of 14 years, revealing that 78% experience significant difficulties in everyday listening situations, negatively impacting their quality of life. This collaborative research is the first to measure real-world listening challenges and hearing loss progression in cancer survivors over a long period of time.

“It’s important that we understand the real-world effects of patients’ sensory problems and if we can understand that, then we can develop better therapeutic strategies and preventive measures to improve the long-term quality of life for cancer survivors,” said Robert Frisina, distinguished university professor and chair of the USF Department of Medical Engineering.

Cisplatin is commonly used in chemotherapy treatments for a variety of cancers, including bladder, lung, neck and testicular. It is administered intravenously and affects various parts of the body. However, the ears are particularly vulnerable as they have little ability to filter out the drug, causing it to become trapped. This leads to inflammation and the destruction of sensory cells that are critical for coding sound, causing permanent hearing loss that can progressively get worse well after cisplatin treatments are completed.

Lead author Victoria Sanchez, associate professor in the USF Health Department of Otolaryngology Head & Neck Surgery, said that despite the known risks, there’s a nationwide lack of routine hearing assessments for patients undergoing chemotherapy. “Most patients still do not get their hearing tested prior to, during or after chemotherapy. Our study highlights the need for regular auditory evaluations to manage and mitigate long-term hearing damage.”

The research team found higher doses of cisplatin led to more severe and progressing hearing loss, especially in patients with risk factors, such as high blood pressure and poor cardiovascular health. They also experienced increased difficulty hearing in common environments, such as a loud restaurant.

“It will be critically important to follow these patients for life. Their current median age is only 48 years, and eventually they will enter the years at which age-related hearing loss also begins to develop,” said Dr. Lois B. Travis, Lawrence H. Einhorn Professor of Cancer Research at Indiana University School of Medicine and a researcher at the IU Melvin and Bren Simon Comprehensive Cancer Center. This research is part of The Platinum Study, an ongoing research effort led by Dr. Travis and funded by the National Cancer Institute to study cisplatin-treated testicular cancer survivors.

The hope is that this study will inspire further investigation into alternative chemotherapeutic protocols and preventive measures, such as FDA-approved drugs to prevent or reduce hearing loss.

“This research gives oncologists the information they need to explore alternative treatment plans that could reduce the long-term side effects, such as altering the dosages and timing of the cisplatin in the treatment, when that could be an appropriate option,” Frisina said.

Innovative solutions, such as Pedmark, a new FDA-approved injection that mitigates cisplatin-induced hearing loss in children, represent promising steps forward, according to Frisina.

“We want to protect our hearing or treat a hearing loss if hearing damage occurs,” Sanchez said. “Hearing allows us to connect to the world we love. Staying connected through conversations with family and friends, enjoyment of music and entertainment, staying safe and finding pleasure in our vibrant surroundings. Promoting optimal hearing for overall wellness is essential for healthy living.”

According to the American Cancer Society, in addition to cisplatin, other platinum chemotherapy drugs, such as carboplatin, cause damage to the cochlea in the inner ear and lead to hearing loss. The risk of damage is greater with higher doses of chemotherapy.

Source: University of San Francisco

Categories : Expert Opinion Medical IndustryTags : Leave a comment

Building a Culture of Wellness by Fostering a Healthy and Financially Secure Workforce

On By ModernMedia
Photo by RDNE Stock project

By James White, Sales Director at Turnberry Management Risk Solutions

Celebrating Corporate Wellness Awareness Week by highlighting the vital role that companies play in fostering employee health and well-being is not just a matter of timing; it’s a matter of necessity. A healthy workforce is a productive workforce, and a focus on wellness goes beyond just physical health.

This is particularly relevant given that the magnitude of medical expenses has shifted over the years. While common illnesses like influenza pose a threat, the bigger concern lies in hospital stays and unexpected medical procedures. These events can leave employees with significant financial burdens, impacting their well-being and productivity.

The role of employers in mitigating costs

While encouraging healthy lifestyles through fitness programmes and mental health support is vital, ensuring financial security in the face of unforeseen medical expenses is equally important. Employers play a significant role in ensuring their workforce has access to adequate healthcare. Traditionally, medical aid cover has been a common employment benefit, but rising costs have made it less affordable for some employers and their employees. Nevertheless, employers can still help by offering their people assistance through:

  • Understanding medical aid options: A knowledgeable broker can guide employers through the complexities of medical aid options. This includes explaining the benefits, limitations, and potential shortfalls associated with each plan.
  • Considering primary healthcare: For employees who cannot afford comprehensive medical aid, primary healthcare plans are short-term insurance products that offer access to doctors, specialists, and medication, often with capped benefits for private hospital visits.
  • Offering gap cover: Gap cover bridges the gap between medical aid payouts and the actual costs charged by specialists and hospitals, acting as a financial safety net to provide peace of mind for employees facing unforeseen medical expenses.

Common unforeseen medical expenses

  • Hospital stays: These can be particularly expensive, with costs varying depending on the condition and treatment required.
  • Specialist charges: Specialists often charge above the rates covered by medical aid plans, leaving patients with significant bills.
  • Emergency room visits: Even a seemingly minor trip to the ER can result in a hefty bill.

Addressing misconceptions about medical aid

Many employees believe that medical aid offers complete coverage. Brokers can help dispel this myth by explaining the intricacies of the available plan options, such as co-payments, network restrictions, and shortfalls. Some plans limit coverage to specific hospitals or providers, and employees need to be aware of these restrictions to avoid surprise costs, while certain medical aid plans require co-payments for specific procedures or medications, leaving employees with out-of-pocket expenses. Even with medical aid, specialists’ fees often exceed the amount reimbursed and gap cover addresses these shortfalls.

Financial security boosts workplace wellness

By offering (and even subsidising) a combination of medical aid, primary healthcare options, and gap cover, employers can significantly improve the well-being of their people. This is because financial security in the face of medical emergencies will reduce stress and boost morale. Employees with peace of mind regarding healthcare costs are more likely to be happy, productive, and less prone to absenteeism.

However, such assistance is more than simply offering access to such benefits. Employers need to ensure that their workforce can make informed decisions about the healthcare benefits available to them by partnering with a qualified broker. The broker can fulfil a vital educational role by conducting informative workshops to explain medical aid options and limitations and advocate for the value of gap cover.

It makes business sense to invest in a healthy workforce

By prioritising a holistic approach to employee wellness that encompasses both physical and financial health, companies can create a thriving workplace environment. Offering a more comprehensive benefits package that includes access to gap cover demonstrates a commitment to employee well-being, ultimately leading to a happier, healthier, and more productive workforce.

About Turnberry Management Risk Solutions

Founded in 2001, Turnberry is a registered financial services provider (FSP no. 36571) that specialises in Accident and Health Insurance, Travel Insurance, and Funeral Cover.

With extensive experience across healthcare and insurance industries in South Africa, Turnberry offers unsurpassed service to Brokers and clients. Turnberry’s gap cover products are available to clients on all medical aid schemes, as they are independently provided and are therefore transferable in the event of a change in the client’s medical aid scheme.

Turnberry is well represented nationally, with its Head Office based in Bedfordview, Johannesburg with Business Development Managers in Cape Town and Durban. The Turnberry Team’s focus on outstanding client service comes from having extensive knowledge and experience in the financial services sector and is underwritten by Lombard Insurance Company Limited. Lombard Insurance Company Limited is an Authorised Financial Services Provider (FSP 1596) and Insurer conducting non-life insurance business.

Categories : Healthcare Politics and RegulationsTags : Leave a comment

Gauteng Non-profit Organisations Reject Findings of Province’s Forensic Probe

On By ModernMedia

Six out of 13 drug rehabs previously funded by the Gauteng Social Development Department are now “under investigation”

Photo by Scott Graham on Unsplash

By Daniel Steyn and Masego Mafata

Non-profit organisations whose funding by the Gauteng Department of Social Development has been withdrawn say they are being unfairly punished for “frivolous” and “flimsy” findings made by forensic auditors.

Among the organisations concerned are women’s shelters, drug rehabilitation centres and organisations that provide meals and social work services to homeless people. Many say they have no choice but to scale down their services and even close their doors.

Only seven in-patient drug rehabilitation centres, out of 13 that received funding last year, will be receiving funds for the first two quarters of this financial year, the department confirmed to GroundUp on Wednesday. Six rehabs are under investigation, the department said. 

A manager at a children’s home told GroundUp earlier this week that they had to send a teenager struggling with substance use disorder back to their family because there were no state-funded in-patient drug rehabilitation centres available in the West Rand.

Forensic auditors were appointed by the department in 2023 to probe allegations of maladministration and fraud in the non-profit sector. The department’s budget for non-profit organisations is R1.9-billion for 2024/25, but Gauteng premier Panyaza Lesufi has promised it will be increased to R2.4-billion. Fourteen department officials have been suspended based on findings of forensic audits, the department has said.

The forensic audits were supported by outgoing MEC Mbali Hlophe. Hlophe has claimed several times that non-profit organisations in the province were “stealing from the poor” and that there has been extensive corruption in the sector.

A report provided by the department to the Gauteng Care Crisis Committee last week, on the orders of the Gauteng High Court, contains a list of 53 organisations that are under investigation, out of several hundred funded by the department.

Among the organisations on the list are Daracorp and Beauty Hub which received millions of rands in subsidies for training, while others have had their budgets cut.

But while organisations such as these have received large amounts of funding under questionable circumstances, the department has not provided evidence that this applies to all organisations on the list.

In May, almost two months into the new financial year, organisations flagged in the investigations started receiving letters informing them that they would not receive funding due to the findings made by the auditors. Some only received the letters in June.

When they requested clarity from the department, some received details in writing. But others were only given reasons for the suspension of their funding during a meeting with the department’s lawyers on Wednesday.

GroundUp spoke to representatives of five organisations who attended Wednesday’s meeting. They said the findings they were presented with on Wednesday were minor issues that should have been picked up by the department’s own monitoring and evaluation teams and would have been quickly resolved. They said they did not understand why a forensic audit was necessary.

The organisations have not received any funding from the department since the end of the financial year in March, and are battling to keep going.

“Flimsy and frivolous”

Derick Matthews, CEO of the Freedom Recovery Centre, which until March was funded for 52 beds for in-patient drug rehabilitation, told GroundUp that the allegations against the centre are “flimsy” and “frivolous”.

Matthews was told at Wednesday’s meeting that Freedom Recovery Centre had not submitted audited financial statements for 2022. GroundUp has seen evidence that he submitted the audited financial statements.

Matthews said the department had never before raised concerns about the organisation’s compliance with legislation. He said every quarter the department’s monitoring and evaluation officials would check the centre’s financial statements and that no concerns had ever been raised.

The auditors also found a “high turnover of security personnel” at Freedom Recovery Centre which was causing “instability in the organisation”. Matthews explained that this was because the security staff are employed from the centre’s skills development programme, through which a person who has been sober for a year works for three to six months at the centre.

“They are paid salaries from DSD funding. Our security is not working directly with the residents so they cannot impact the stability of the centre,” Matthews said.

The third finding against Freedom Recovery Centre was that staff members were being given “loans”. Matthews explained that sometimes when the department paid subsidies late, the centre would pay part of staff salaries from the tuck shop’s funds, which would later be deducted from their salaries.

Matthews says that they are in the process of discharging their last state-funded patients. “Both government-funded centres that we have been told to send people to during this crisis are full, they can’t help us. In the last week, I’ve received about 12 phone calls of people that needed urgent help and we can’t even help or intervene,” he said.

Representatives of other organisations GroundUp spoke to had similar concerns about the findings against them but did not want to be named for fear of victimisation.

They also raised concerns that their meeting on Wednesday was with only one department official and the department’s lawyers, while the organisations themselves did not have lawyers present.

They were told they have until Monday to provide evidence to dispute the allegations against them.

At the meeting on Saturday convened by Gauteng Premier Panyaza Lesufi, it was agreed that the organisations would receive an interim service-level agreement from the department by Monday, which would be finalised once the organisations were cleared. But not one organisation GroundUp spoke to has received an interim service-level agreement. Then on Wednesday they were told they will receive the agreements next week.

One organisation under investigation, Child Welfare Tshwane, was finally paid by the department last week after Gauteng High Court Judge Ingrid Opperman issued a directive that the organisation be paid to prevent harm to the beneficiaries.

GroundUp sent detailed questions to the Gauteng Department of Social Development, but we were told that the department will not be responding to media queries relating to the non-profit sector until further notice.

Republished

Read the original article

Categories : UrogenitalTags : Leave a comment

Cutting Down on Salt Levels Stimulates Kidney Regeneration

On By ModernMedia
Photo by Robina Weermeijer on Unsplash

A loss of salt and body fluid can stimulate kidney regeneration and repair in mice, according to a study published in The Journal of Clinical Investigation. This innate regenerative response relies on a small population of kidney cells in a region known as the macula densa (MD), which senses salt and exerts control over filtration, hormone secretion, and other key functions of this vital organ.

“Our personal and professional mission is to find a cure for kidney disease, a growing global epidemic affecting one out of seven adults, which translates to 850 million people worldwide…” said study leader Janos Peti-Peterdi, a professor of physiology, neuroscience and medicine at the Keck School of Medicine of USC. “Currently, there is no cure for this silent disease. By the time kidney disease is diagnosed, the kidneys are irreversibly damaged and ultimately need replacement therapies, such as dialysis or transplantation.”

To address this growing epidemic, Peti-Peterdi, first author Georgina Gyarmati, and their colleagues took a highly non-traditional approach. As opposed to studying how diseased kidneys fail to regenerate, the scientists focused on how healthy kidneys originally evolved.

“From an evolutionary biology perspective, the primitive kidney structure of the fish turned into more complicated and more efficiently working kidneys to absorb more salt and water,” said Peti-Peterdi. “This was necessary for adaptation to the dry land environment when the animal species moved from the salt-rich seawater. And that’s why birds and mammals have developed MD cells and this beautiful, bigger, and more efficient kidney structure to maintain themselves and functionally adapt to survive. These are the mechanisms that we are targeting and trying to mimic in our research approach.”

With this evolutionary history in mind, the research team fed lab mice a very low salt diet, along with a commonly prescribed drug called an ACE inhibitor that furthered lowered salt and fluid levels. The mice followed this regimen for up to two weeks, since extremely low salt diets can trigger serious health problems if continued long term.

In the region of the MD, the scientists observed regenerative activity, which they could block by administering drugs that interfered with signals sent by the MD. This underscored the MD’s key role in orchestrating regeneration.

When the scientists furthered analysed mouse MD cells, they identified both genetic and structural characteristics that were surprisingly similar to nerve cells. This is an interesting finding, because nerve cells play a key role in regulating the regeneration of other organs such as the skin.

In the mouse MD cells, the scientists also identified specific signals from certain genes, including Wnt, NGFR, and CCN1, which could be enhanced by a low-salt diet to regenerate kidney structure and function. In keeping with these findings in mice, the activity of CCN1 was found to be greatly reduced in patients with chronic kidney disease (CKD).

To test the therapeutic potential of these discoveries, the scientists administered CCN1 to mice with a type of CKD known as focal segmental glomerulosclerosis. They also treated these mice with MD cells grown in low-salt conditions. Both approaches were successful, with the MD cell treatment producing the biggest improvements in kidney structure and function. This might be due to the MD cells secreting not only CCN1, but also additional unknown factors that promote kidney regeneration.

“We feel very strongly about the importance of this new way of thinking about kidney repair and regeneration,” said Peti-Peterdi. “And we are fully convinced that this will hopefully end up soon in a very powerful and new therapeutic approach.”

Source: Keck School of Medicine of USC

Categories : AntibioticsTags : Leave a comment

Which is Better? Prolonged vs Intermittent Infusion of β-Lactams in Sepsis

On By ModernMedia
Photo by Anna Shvets on Pexels

In adults with sepsis or septic shock, β-lactams are recommended by Surviving Sepsis Campaign guidelines, in a prolonged (after an initial bolus) rather than intermittent infusions – but owing to only moderate quality of evidence this is currently a weak recommendation. Now, a new systematic review and meta-analysis comparing the two approaches across multiple clinical trials has found a survival benefit for prolonged infusion The findings appear in JAMA.

To address whether prolonged infusions of β-lactams improve clinically important outcomes in critically ill adults with sepsis or septic shock, the study investigators searched medical databases for relevant randomised controlled trials comparing β-lactam infusion types in critically ill adults with sepsis or septic shock. The primary outcome was 90-day mortality, with secondary outcomes including intensive care unit (ICU) mortality and clinical cure.

In all, they found 18 eligible trials that included 9108 critically ill adults with sepsis or septic shock (median age, 54 years; 5961 men [65%]), 17 trials (9014 participants) contributed data to the primary outcome.

The pooled estimated risk ratio for all-cause 90-day mortality for prolonged infusions of β-lactam antibiotics compared with intermittent infusions was 0.86, with high certainty and a 99.1% posterior probability that prolonged infusions were associated with lower 90-day mortality. There was high certainty that prolonged infusion of β-lactam antibiotics was associated with a reduced risk of ICU mortality (risk ratio, 0.84) and moderate certainty of an increase in clinical cure (risk ratio, 1.16).

The findings were tempered with the authors’ understanding that, “Potential challenges associated with prolonged infusion administration, including drug instability and incompatibility with other intravenous medications, the need for a dedicated intravenous portal, and the potential effect on clinical workload, require some considerations before broad implementation. Future studies should determine the optimal duration of infusion when β-lactam antibiotics are administered as prolonged infusions.”

The authors concluded that, “Among adults in the intensive care unit who had sepsis or septic shock, the use of prolonged β-lactam antibiotic infusions was associated with a reduced risk of 90-day mortality compared with intermittent infusions. The current evidence presents a high degree of certainty for clinicians to consider prolonged infusions as a standard of care in the management of sepsis and septic shock.”