Month: September 2024

Categories : Obstetrics & Gynaecology Respiratory DiseasesTags : Leave a comment

Higher Odds of Miscarriage, Needing Fertility Treatment for Women with Asthma

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Credit: Pixabay CC0

Women who are being treated for asthma are more likely to miscarry and need fertility treatment to get pregnant, according to a large study presented at the European Respiratory Society (ERS) Congress in Vienna, Austria. The study also suggests that most women with asthma are able to have babies.

The study was presented by Dr Anne Vejen Hansen from the department of respiratory medicine at Copenhagen University Hospital, Denmark.

She said: “Asthma is common in women of reproductive age. Previous studies have shown that it takes women with asthma longer to get pregnant than those without asthma when undergoing fertility treatment, and that asthmatic women who succeed in getting pregnant have more often had fertility treatment than non-asthmatic women. But most existing studies are on women who have actually got pregnant, so we wanted to examine fertility outcomes on a national scale, to also include those that might not become pregnant at all.”

The team analysed reproductive outcomes for all Danish women born from 1976 to 1999, following them from 1994 to 2017. In total, 769,880 women were included and followed; anyone who took anti-asthma medication on a regular basis was classified as asthmatic.

They found that women with asthma experienced a higher degree of foetal loss compared to women without asthma (17.0% vs. 15.7%) and more use of fertility treatment (5.6% vs. 5.0%). However, the proportion who subsequently gave birth was 77% in women with and without asthma, suggesting that asthma does not seem to affect the number of live births.

Dr Vejen Hansen said: “We found that women fulfilling the definition of asthma had a higher rate of foetal loss and an increased use of fertility treatment. The more severe the asthma and the more flare ups the women experienced, the more likely they were to need fertility treatment. Why this is, is not clear. It might be related to systemic inflammation throughout the body, including women’s reproductive organs.

“But the numbers also show that these same women who redeem asthma medication still have as many live births in the end as women who don’t. This suggests that most women with asthma probably do manage to become pregnant and have babies in the end.

“We also plan to investigate the possible effect of male asthma on fertility, and, therefore, have another similar registry-based study in the pipeline.”

Professor Lena Uller is Chair of the ERS group on Airway Pharmacology and Treatment and Head of the Respiratory Immunopharmacology research group at Lund University, Sweden, and was not involved in the research. She said: “It’s reassuring that women seem to have the same live birth rate regardless of their asthma. However, the results also indicate that women with asthma should take into consideration potential reproductive challenges in their family planning. If women with asthma are worried about their fertility, they should speak to their doctor.

“The results of this study also underscore the importance of managing asthma in reproductive-aged women. The fact that the more severe the asthma, the more the problems with fertility, suggests that uncontrolled asthma is the problem and we should be helping women to get their asthma under control.”

Source: European Respiratory Society

Categories : Ethics and LawTags : Leave a comment

SIU Takes Aim at Ballooning Dodgy Medical Litigation that is Costing the Government Billions

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Photo by Scott Graham on Unsplash

By Sandiso Phaliso for GroundUp

Payments of medical related legal claims (medico-legal) against the Department of Health ballooned to R2.7-billion in 2023. In 2013, it was R265-million. This is according to the Special Investigating Unit (SIU) when it briefed the Standing Committee on Public Accounts (SCOPA) last week.

SIU head advocate Andy Mothibi told SCOPA it found evidence of collusion between attorneys, touts, nurses and doctors, in both public and private healthcare. Some law firms also withdrew claims when the SIU started investigating them. This had stopped about R3-billion in fraudulent claims, he said.

Claims under investigation included those targeting families with children born with cerebral palsy, false claims of medical malpractice in state hospitals, and collusion between state healthcare workers and rogue lawyers to unlawfully secure private medical records to initiate claims against the government.

They uncovered cases of agents of rogue law firms impersonating officials of the South African Social Security Agency to secure powers of attorney on behalf of victims by claiming to be securing them social grants. He said they found two attorneys pursuing identical claims for the same individual in two different courts, and for vastly different amounts, in one case for R7.5-million and R25-million for the same patient and same condition

Mothibi said the health sector experienced an explosion of medical practice litigation cases in 2015, directed against health institutions and individual medical practitioners in both public and private practice.

Mothibi said in one case a claimant demanded R70-million for a supposedly botched circumcision at a Limpopo hospital when no circumcision had been performed.

Read the SIU presentation to Parliament

In 2017, the SIU started targeting provinces with the highest share of claims. At that stage, the Eastern Cape’s contingent liability for medico-legal claims was R15.9-billion; in Gauteng, it was R21.2-billion.

In the Eastern Cape, most medico-legal claims emanated from one Johannesburg-based law firm, Nonxuba Attorneys Incorporated. In five years, from 2012 to 2017, the firm submitted 44 claims totaling R497-million against the provincial health department. Nine claims for children born with cerebral palsy were identical each demanding R15-million.

“This was suspicious and indicated a lot of cut-and-paste on the part of this legal firm,” said Mothibi.

The company has, according to Mothibi’s presentation, been charged.

We have been unable to get hold of Nonxuba Attorneys and Business Day has previously reported that the company’s owner, Zuko Nonxuba, has been suspended from legal practice.

Also, in the Mthatha High Court claims increased from 46 to 529 between 2010 and 2016. There was collusion, said Mothibi, between some officials in the Office of the State Attorney, whereby out-of-court settlements for hefty sums were entered into without the mandate or even the knowledge of the department.

MP Veronica Mente-Nkuna (EFF) wanted to know the names of the legal firms implicated besides Nonxuba Attorneys and what the legal bodies have done about their operating licences.

She asked why the Department of Health had not conducted its investigations before the claims were paid. Who was responsible for the loss of money through these fraudulent claims, she asked.

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

Read the original article

Categories : GeneticsTags : Leave a comment

Carriers of Sickle Cell are at Increased Risk for Certain Conditions

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Sickle cell disease. Credit: National Institutes of Health

Individuals that have sickle cell trait, who did not which increases the risk of blood clots, a risk that is the same among diverse human populations that may not traditionally be associated with sickle cell disease. The study provides estimated clinical risks for people with sickle cell trait, which can inform clinical practice guidelines.

The study, published in Blood Advances, was led by researchers at National Human Genome Research Institute (NHGRI), part of NIH, The Johns Hopkins University School of Medicine, Baltimore, and the company 23andMe, South San Francisco, California. The researchers examined the largest and most diverse set of people with sickle cell trait to date, which includes data from over 19 000 people of various ancestral backgrounds with sickle cell trait. 

While people with sickle cell trait typically do not have any associated health complications, they are carriers for sickle cell disease. In rare cases, sickle cell trait has been found to be a risk factor for health complications such as muscle breakdown, presence of blood in the urine and kidney disease.

Previous research investigating the relationship between sickle cell trait and blood clots have only included individuals of African genetic ancestry and self-identified Black participants because of the incorrect assumption that the genetic carrier state only affects those who identify as Black or African American. While sickle cell trait in the United States is most prevalent in individuals who self-identify as Black or African American, individuals from all ancestral backgrounds may have sickle cell trait. Sickle cell trait is often found in individuals living in or from West and Central Africa, Mediterranean Europe, India and the Middle East.

“Because sickle cell trait is often associated with people who identify as Black or African American, it is not widely studied in other populations, a bias that has led to unintended harm for those with sickle cell trait,” says Vence Bonham Jr, J.D., who co-led the study and serves as acting deputy director and associate investigator at NHGRI. “In particular, the racialisation of sickle cell trait has resulted in biased estimations of health risks. The results of our study will help clinicians properly contextualise the risk of blood clots amongst people with sickle cell trait without unintended bias.”  

Individuals in this study are part of the 23andMe research program and have volunteered to participate in the research online and provided informed consent, which includes allowing their de-identified data to be analysed and subsequently shared with research collaborators. Using data from this research cohort, which consists of over four million participants, researchers calculated the risk of blood clots in the veins, also known as venous thromboembolism. Through statistical analyses, participants were grouped based on their genetic similarities into genetic ancestry groups. The study found that people with sickle cell trait have a 1.45-fold higher risk of venous thromboembolism than those without sickle cell trait, a risk that is similar across all studied genetic ancestry groups.

To help clinicians estimate the risk of blood clots in people with sickle cell trait in comparison to other genetic carrier states, the researchers analysed risk in people who are carriers for Factor V Leiden, a well-known inherited blood-clotting disorder. The study found that carriers for Factor V Leiden, which is more prevalent in people of European genetic ancestries, had an even higher risk of venous thromboembolism than people with sickle cell trait.

The researchers found that people with sickle cell trait have a higher risk of pulmonary embolism than those without sickle cell trait.

While previous studies have demonstrated that in individuals with sickle cell trait, the risk of blood clots occurring in the lungs is higher than the risk of clots occurring only in the legs, this study supports the link more definitively with a larger sample size.

“This study, therefore, provides important insights about patterns of venous blood clots and suggests a unique mechanism of blood clotting in people with sickle cell trait,” said Rakhi Naik, M.D., clinical director for the Division of Hematology at Johns Hopkins University, Baltimore, who co-led the study. “Knowing the risks of blood clots in people with sickle cell trait is important for situations such as surgeries or hospitalizations, which add to the risk of developing serious blood clots.”

Source: NIH/National Human Genome Research Institute

Categories : Diseases, Syndromes and Conditions VaccinesTags : Leave a comment

Research on the Hepatitis C Virus Reveals its Mysteries

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Hepatitis C virus. Credit: Scientific Animations CC4.0

Around 58 million people suffer from chronic inflammation caused by the hepatitis C virus, and 300 000 people die from the disease every year. So far, no treatment has successfully managed to reduce the global prevalence of hepatitis C, prompting scientists to start looking for a vaccine. But limited knowledge of the protein complex that enables the virus to infect the cells has made this difficult.

A new study by a cross-disciplinary research team at the University of Copenhagen is about to change that. It is out now in the journal Nature.

“We are the first ever to identify the protein complex at the surface of the hepatitis C virus that enables it to bind to our cells,” says Associate Professor Jannick Prentø.

“This knowledge of the structure of the protein complex will enable us to design vaccine candidates that can prevent the virus from infecting the cells,” says Postdoc Elias Augestad.

The protein complex helps the virus bind to the cells. In the corona virus, it is a so-called spike protein with the well-known spikes. In the hepatitis C virus, the structure is different, but the function of the protein complex is the same.

Paves the way for vaccine development

The study can be considered a blueprint for HCV vaccine development. Scientists hope to be able to use the new knowledge to develop a vaccine which will make the immune system produce antibodies that bind effectively to the surface of the hepatitis C virus and thus render it harmless.

“Expressing and cleaning up the protein complex is extremely difficult, which is why it has not been done before. The structure of these proteins on the surface of the hepatitis C virus makes them extremely vulnerable. Researchers did not know what they were dealing with, and therefore, whenever someone tried to reproduce these protein structures in the lab they would fall apart before they could get a chance to study them,” says Associate Professor Jannick Prentø.

“But we managed to describe their structure, and this has enabled us to reproduce these protein complexes outside the cell and study them closely,” says Associate Professor Pontus Gourdon.

Source: University of Copenhagen

Categories : Respiratory DiseasesTags : Leave a comment

24hrs Oxygen Therapy for Hypoxaemia no Better than 15hrs

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Photo by Samuel Ramos on Unsplash

There were no differences in quality of life, symptoms, hospital admissions or mortality between a group of patients with pulmonary disease and low oxygen levels in the blood that received oxygen therapy at home for 24 hours a day, and a group that received the same therapy for 15 hours a day, according to a study in the New England Journal of Medicine.

“This has considerable significance for patients with chronic obstructive pulmonary disease and other pulmonary diseases who are undergoing long-term oxygen therapy at home,” says study leader Magnus Ekström of Lund University.

Every year, there are about a million patients in the US alone with severe sub-optimal oxygen levels who begin oxygen therapy at home. The patient must wear a nasal oxygen mask 24 hours a day, which is often felt to be restrictive and burdensome. In addition, the gas is cold and dry, which may cause problems such as dryness, ulcers and inflammation of the airways. Using the equipment may also be perceived as stigmatising by patients.

The aim of the therapy is to prolong life, but its application differs and the scientific evidence for the therapy’s efficacy has been inadequate. 

In a randomised, controlled large multicentre study, the researchers have now examined the effect of different durations of oxygen therapy on important health outcomes. A total of 241 patients with chronic and severely low oxygen levels in the blood from 20 different clinics in Sweden were randomised to receive oxygen therapy for either 24 hours a day or 15 hours a day. The patients were followed for one year, and all completed the study. There was a high level of compliance with the prescribed daily therapy duration.  

“There were no differences between the groups regarding hospital admission or the risk of dying. And again, when we compare self-reported quality of life and physical activity, symptoms and fatigue between the groups, we see no differences or indication of advantages if oxygen is used for more than 15 hours a day,” says Magnus Ekström, researcher in respiratory and palliative medicine at Lund University.

 The results differ from previous studies conducted in the 1970s, which suggested that therapy for 24 hours a day could increase the survival rate. 

“The older studies were small and only included patients with chronic obstructive pulmonary disease, not least because it is difficult to recruit such seriously ill individuals for a randomised study. Also, the patients included in the older studies differ from those who start oxygen therapy at home nowadays. The strength of this study is  that we have been able to include twice as many patients, and that it represents the reality nowadays in which many of those receiving oxygen therapy at home are older, also have cardiovascular diseases and are women,” says Josefin Sundh, adjunct senior lecturer at Örebro University and pulmonologist at the University Hospital in Örebro, who was co-leader of the study.

“The group treated with oxygen 15 hours a day received this during the night when, in general, oxygenation is poorer. The results show that it seems to be safe for this type of patient to be without oxygen for quite a large part of the day. This is important as it may reduce the side effects of the therapy and mean that the patients can adapt it more to their everyday life,” says Magnus Ekström.

The researchers based the study on data from Swedevox, the Swedish National Registry for Respiratory Failure. 

The researchers are now moving on to examine whether therapy using a high flow rate of warmed-up, more humidified oxygen at night can improve prognoses and patient well-being.

Source: Lund University

Categories : HospitalsTags : Leave a comment

Does Giving Lifestyle Advice Really Work?

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Photo by Cottonbro on Pexels

Healthcare professionals are increasingly giving advice to patients on how to improve their health, but there is often a lack of scientific evidence if this advice is actually beneficial. This is according to a study from the University of Gothenburg, which also guides towards more effective recommendations.

The researchers do not criticise the content of the advice – after all, it is good if people lose weight, stop smoking, eat a better diet or exercise more. But there is no evidence that patients actually do change their lifestyle after receiving this advice from healthcare professionals.

“There is often a lack of research showing that counselling patients is effective. It is likely that the advice rarely actually helps people,” says study lead author Minna Johansson, Associate Professor at Sahlgrenska Academy at the University of Gothenburg and General Practitioner at Herrestad’s Healthcare Center in Uddevalla.

Few pieces of advice are well-founded

The study, published in the Annals of Internal Medicine, was conducted by an international team of researchers. They have previously analysed medical recommendations from the National Institute for Health and Care Excellence (NICE) in the UK. This organisation is behind 379 recommendations of advice and interventions that healthcare professionals should give to patients, with the aim of changing their lifestyle.
 
In only 3% of cases there were scientific studies showing that the advice has positive effects in practice. A further 13% of this advice had some evidence, but with low certainty. The researchers also reviewed additional guidelines from other influential institutions around the world and found that these often overestimate the positive impact of the advice and rarely take disadvantages into account.
 
“Trying to improve public health by giving lifestyle advice to one person at a time is both expensive and ineffective. Resources would probably be better spent on community-based interventions that make it easier for all of us to live healthy lives,” says Minna Johansson, who also believes the advice could increase stigmatisation for people with, eg, obesity.

Showing the way forward

Today’s healthcare professionals would not be able to give all the advice recommended while maintaining other care. The researchers’ calculations show that in the UK, for example, five times as many nurses would need to be hired, compared to current levels, to cope with the task.
 
The study also presents a new guideline to help policy makers and guideline authors consider the pros and cons of the intervention in a structured way before deciding whether or not to recommend it.
 
Victor Montori, Professor of Medicine at the Mayo Clinic in the United States is a co-author of the study:
“The guideline consists of a number of key questions, which show how to adequately evaluate the likelihood that the lifestyle intervention will lead to positive effects or not,” says Victor Montori.

Source: University of Gothenburg

Categories : Cancer Metabolic DisordersTags : Leave a comment

The Outcomes of Cancer Therapies and BMI Have a Complex Relationship

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Risk of mortality during cancer treatment in relation to BMI. For non-small cell lung cancer treatment, immunotherapy seems to pose less risk for persons under a certain BMI, while conventional chemotherapy appears optimal for persons who might be overweight or obese. Credit: Osaka Metropolitan University

While being overweight increases the risk of developing lifestyle-related diseases, there is a phenomenon known as the obesity paradox where a decreased risk of death has been seen during cancer therapy. However, that paradox might not hold true for all cancer therapies, an Osaka Metropolitan University team reports in JAMA Network Open, a publication of the American Medical Association.

Led by graduate student Mr Yasutaka Ihara and Professor Ayumi Shintani of the Graduate School of Medicine’s Department of Medical Statistics, the team used a Japanese administrative claims database of more than 500 000 lung cancer patients and examined the relation between body mass index (BMI) and the risk of mortality during immunotherapy and conventional chemotherapy.

Focusing only on patients with advanced non-small cell lung cancer, the team found that the higher the BMI, the lower the risk of mortality when undergoing both immunotherapy and chemotherapy, though it does a U-turn around a BMI of 24. Patients with a BMI under 28 showed lower risk of mortality when undergoing immunotherapy compared to conventional chemotherapy, but for those at or over that figure, the risk increases with immunotherapy while it continues to get lower with chemotherapy.

“Immunotherapy might not always be the optimal treatment method for obese patients with advanced non-small cell lung cancer, so the use of conventional chemotherapy should also be considered,” Mr. Ihara stated. “In addition to BMI, age, hormones, and gut microbiota have been reported as factors that influence the effectiveness of immunotherapy. Evaluation of whether immunotherapy or conventional chemotherapy improves survival in the presence of these factors is expected to contribute to the development of precision medicine.”

Source: Osaka Metropolitan University

Categories : Cancer Immune SystemTags : Leave a comment

How Cancer Reprograms Immune Cells to Join the Enemy

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Squamous cancer cell being attacked by cytotoxic T cells. Image by National Cancer Institute on Unsplash

Cancer has been described as “a wound that does not heal,” implying that the immune system is unable to wipe out invading tumour cells. A new discovery reported in PNAS confirms that a key molecule can reprogram immune cells into turncoats that promote cancer growth.

Studying the behaviour of these “pro-tumour” immune cells is important because they could be targets for therapies that block their harmful activity, said Minsoo Kim, PhD, corresponding author of the study and a research leader at the Wilmot Cancer Institute.

Kim led a team of scientists investigating the dynamic interactions that occur between cells in the tumor environment, and the underlying factors that cause the harmful transformation of immune cells from good to bad.

They found that PAF (platelet-activating factor) is the key molecule that controls the destiny of the immune cells. PAF not only recruits cancer-promoting cells, but it also suppresses the immune system’s ability to fight back. In addition, they found that multiple cancers rely on the same PAF signals.

“This is what could be most significant,” said Kim. “Because if we find a treatment that could interfere with PAF, it could potentially apply to many types of cancer.”

Much of the team’s work focused on pancreatic cancer cells. It is one of the most deadly cancers, with a five-year survival rate of about 12%, and is notoriously hard to treat because pancreatic tumours are surrounded by a toxic stew of proteins and other tissues that protect the cancer from the immune system’s natural role to attack invaders. They also studied breast, ovarian, colorectal, and lung cancer cells, using advanced 3D imaging technology to watch the behaviour of immune cells as they swarmed to the cancerous region.

Source: University of Rochester Medical Center

Categories : Antibiotics GastrointestinalTags : Leave a comment

Antibiotic Usage can Damage the Intestine’s Protective Mucus Layer

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Source: CC0

Researchers at Umeå University and Tartu University have found that a history of repeated antibiotic use causes defects in the normally protective mucus barrier of the gut, due to antibiotic-driven alterations in the microbiota. In a further study in a different collaboration, the researchers found a bacteria-independent mechanism through which antibiotics can damage the mucus barrier directly.

The results have been published in the scientific journals Gut Microbes and Science Advances.

“Together, these two studies suggest that antibiotics can damage the mucus layer through at least two independent mechanisms, and that they may have long-lasting effects through an altered gut bacteria. This further supports the notion that antibiotics should be administered in a responsible manner,” says Björn Schröder, Docent in Infection Biology in the Department of Molecular Biology at Umeå University.

Previous research has shown the consequences of short-term antibiotic treatments on the intestinal environment, but it is less clear how repeated antibiotic use in past years can affect our guts.

To address this question, Björn Schröder and his group at Umeå University teamed up with a research group at Tartu University in Estonia, who have built a deeply characterised cohort of individuals that provided stool samples and health records.

The researchers selected individuals who had taken at least five courses of antibiotics in the past, but not within six months before the stool collection, and compared their microbiota composition to individuals who had not taken any antibiotics within the last 10 years.

“The analysis revealed changes to the gut bacteria composition, even though the antibiotics were taken a long time ago. These results indicate that repeated antibiotic use has a lasting effect on gut bacteria composition that can persist at least months after the last treatment,” says Kertu-Liis Krigul, PhD student at Tartu University.

After transplantation of the human microbiota into mice and using specialised methods to analyse the mucus function in the gut, the researchers found that the function of the mucus layer was disrupted in mice transplanted with bacteria from humans with a history of repeated antibiotic use. Expansion of the mucus was reduced, and the mucus layer became penetrable, allowing bacteria to move closer to the intestinal lining.

“Looking at the bacteria present in the gut in more detail, we could see that bacteria known to feed on the mucus layer were present at higher levels in these mice. This further supports a role for the gut bacteria in determining how well the mucus barrier can function,” says Rachel Feeney, PhD student at the Department of Molecular Biology at Umeå University.

A separate study carried out in another international collaboration, further showed that antibiotics can also directly disrupt the mucus barrier in a gut bacteria-independent manner.

By giving the antibiotic vancomycin to normal and ‘bacteria-free’ mice, the researchers were able to show that this antibiotic can act directly on the mucus barrier, independent of the gut bacteria. Complementary experiments on intestinal tissue were carried out at Umeå University and showed that the antibiotic could disrupt the mucus expansion within a few minutes of application.

Source: Umeå University

Categories : CancerTags : Leave a comment

How, When and Where: Sex Matters in Melanoma Development

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Photo by Rfstudio on Pexels

Melanoma rates differ consistently between men and women in terms of the ages at which melanomas occur and the locations on the body where they occur. Over time, melanoma rates have increased in both men and women, but the trends differ by body site. A new study in the Journal of Investigative Dermatology, published by Elsevier, presents the findings from a large-scale, long-term melanoma data analysis investigating incidence trends by age, sex, and anatomic site.

Lead investigator David C. Whiteman, MBBS, PhD, Cancer Control Group, QIMR Berghofer Medical Research Institute, and Faculty of Medicine, The University of Queensland, Brisbane, Australia, explains, “There has been a general observation in numerous populations that melanomas appear to arise at different rates in men and women. We decided to investigate this observation rigorously and assess whether these differences have been constant through time or across generations by using large-scale data from population registries to investigate long-term melanoma trends in men and women.”

The research team analysed more than 40 years of melanoma data from Queensland, Australia, the USA, and Scotland. These three populations were chosen because historically they have had high (Queensland), moderate (USA), and low (Scotland) rates of melanoma. Over time, the rates of melanoma increased in all three populations, especially among women. In women in all populations, melanomas arise most commonly on the limbs, whereas in men, melanomas arise most commonly on the trunk and head and neck. In both sexes, there has been a steady increase in melanomas on the head and neck with increasing age.

Researchers found that in virtually all investigated populations, women experience higher rates of melanoma than men in early life (up to age ~45 years), but men develop melanomas at higher rates than women later in life (from ages ≥ 65 years). Furthermore, these sex-specific trends reflect complex patterns of incidence across body sites that vary consistently with age. Thus, in early life, women experience higher rates of lower limb melanomas than men, which persists into older ages. Also, on the upper limbs, women experience substantially higher rates than men from young ages until middle age (45–64 years), after which men experience higher rates. In contrast, on the head and neck and the trunk, melanomas occur at higher incidence in men than in women early in life. On all body sites, the rate at which melanoma incidence rises with age is much more rapid for men than for women.

The study confirms that men and women experience melanoma in different ways. While this is most likely driven by different patterns of sun exposure between men and women, there appear to be inherent differences in the ways in which melanomas develop at different body sites in women compared with men. Understanding the underlying biological differences could provide important clues about the etiology of this enigmatic cancer.

Source: Elsevier