This illustration depicts a 3D computer-generated image of a group of Gram-positive, Streptococcus pneumoniae bacteria. The artistic recreation was based upon scanning electron microscopic (SEM) imagery. Credit: CDC on Unsplash
A concerning increase in global rates of severe invasive infections becoming resistant to key antibiotics has a team of infectious disease researchers at the Houston Methodist Research Institute studying a recently emerged strain of bacteria, Streptococcus dysgalactiae subspecies equisimilis (SDSE). SDSE infects humans via the skin, throat, gastrointestinal tract and female genital tract to cause infections ranging in severity from pharyngitis to necrotising fasciitis. The findings of this study are described in a paper appearing in the journal mBio.
Though closely related to group A streptococcus (also commonly known as Streptococcus pyogenes), which has been very well studied, little is known about SDSE.
“Given its great emerging importance to human health, our limited understanding of SDSE molecular pathogenesis is remarkable,” said Jesus M. Eraso, PhD, an assistant research professor of pathology & genomic medicine with Houston Methodist and lead author on the study.
To close this knowledge gap, the Houston Methodist team used a sophisticated integrative approach to study 120 human isolates of a particular SDSE subtype, called stG62647. They analysed the subtype’s genome, where the information of its DNA is stored, its transcriptome, which provides a snapshot of the complete gene expression profile at the time the SDSE cells were collected, and its virulence, which refers to the degree of damage it causes to its host. The stG62647 SDSE strains are important to study because they have been reported to cause unusually severe infections, and understanding the relationships and interplay between these three entities gave the researchers a richer understanding of how it causes disease.
The data from this integrative analysis provided much new data about this important emerging human bacterial pathogen and are useful in vaccine research. It also raised many new questions and generated new hypotheses to be studied in this ongoing line of investigation.
Whether supine, all-fours position, sitting upright or squatting – women adopt different birthing positions during childbirth. But until now, how the final birthing position affects the satisfaction of the woman giving birth had not been known. Researchers in Germany investigated the relationship. In particular, they also took into account whether the choice of birthing position was voluntary. The results, which appear in Archives of Gynecology and Obstetrics, showed that having the choice counted the most for mothers’ satisfaction.
Around three quarters of those surveyed were lying during the birth and were particularly dissatisfied if they felt that they had not made this choice themselves. But if the expectant mothers had chosen the supine or lateral supine position themselves, the position actually tended to make them more satisfied.
For a long time, the supine position was the most common birth position in Western countries, giving obstetricians unhindered access to the woman and child. In various cultures, however, upright birthing positions, such as sitting or squatting, are also widespread. Which position is best for expectant mothers and the unborn child is controversial in the literature.
“Until today, international guidelines usually only recommend that women should adopt their preferred birthing position,” explains Prof Dr Nadine Scholten, professor in psychosomatic and psycho-oncological health services research at the University of Bonn. With regard to birthing positions, the German guideline also states that women should adopt the position that seems most comfortable to them. However, they should also be encouraged to adopt an upright position in the final phase of birth.
“In reality, whether they ultimately lie, sit or squat depends on the wishes of the expectant mothers themselves, but also on the suggestions of the midwives, obstetricians and sometimes necessary medical measures,” explains Prof Dr Brigitte Strizek, Director of the Clinic for Obstetrics and Prenatal Medicine at the University Hospital Bonn (UKB).
Focus on women’s satisfaction
A team led by Prof Scholten, who carried out the study at the Institute for Medical Sociology, Health Services Research and Rehabilitation Research (IMVR) at the University of Cologne and the UKB, wanted to find out which birthing position women were most satisfied with afterwards. Almost 800 mothers were asked about their final birthing position and how satisfied they were with the birth overall using an anonymous questionnaire. All of the data analysed here was from women who had given birth vaginally in a hospital without the use of a vacuum extraction or forceps, and who had given birth eight to twelve months previously at the time of the survey. In their study, the researchers also asked about the satisfaction of the mothers – depending on whether the birth position was freely chosen or not. The reasons for not choosing a free position were also asked.
It was found that over three quarters of mothers gave birth to their child lying on their side or on their back. Of these women, up to 40% stated that they had not chosen the birth position voluntarily. “The most common reason given by respondents was instructions from medical staff,” explains Prof Scholten, first and corresponding author. The most common position assigned by obstetricians was the supine position. It was striking that women were more satisfied with their birth if they were allowed to choose the position voluntarily – especially if they chose the supine position themselves. Women who were not free to choose their birthing position were particularly dissatisfied if the medical staff specified this and not the CTG to record the heart rate of the unborn child and labour activity or the epidural, the anaesthetic to relieve pain, prevented the desired position.
Self-determination not always given in the delivery room
“The number of women who did not choose the birth position themselves is particularly striking, as is the associated lower level of satisfaction with the birth,” summarises co-author Prof Strizek. However, the team cannot confirm whether an increased voluntary choice of birth position in the future would result in fewer women giving birth in the supine position. “In order to increase women’s subjective satisfaction with their birth experience, they should be given the opportunity to adopt their preferred position,” appeals lead author Prof Scholten. “The first step is to increase the awareness of medical staff and empower women to understand and better communicate their preferences.”
Prof Strizek adds: “If a certain position would be advantageous for the woman giving birth from a medical point of view, we as obstetric teams need to explain this better to the women so that they rarely have the feeling that they have not determined the birth position themselves.”
US county-level data point to specific pesticides that may increase prostate cancer incidence and death.
Photo by Arjun Mj on Unsplash
Researchers have identified 22 pesticides consistently associated with the incidence of prostate cancer in the United States, with four of the pesticides also linked with prostate cancer mortality. The findings are published by Wiley online in CANCER, a peer-reviewed journal of the American Cancer Society.
To assess county-level associations of 295 pesticides with prostate cancer across counties in the United States, investigators conducted an environment-wide association study, using a lag period between exposure and prostate cancer incidence of 10–18 years to account for the slow-growing nature of most prostate cancers. The years 1997–2001 were assessed for pesticide use and 2011–2015 for prostate cancer outcomes. Similarly, 2002–2006 were analysed for pesticide use and 2016–2020 for outcomes.
Among the 22 pesticides showing consistent direct associations with prostate cancer incidence across both time-based analyses were three that had previously been linked to prostate cancer, including 2,4-D, one of the most frequently used pesticides in the United States. The 19 candidate pesticides not previously linked to prostate cancer included 10 herbicides, several fungicides and insecticides, and a soil fumigant.
Four pesticides that were linked to prostate cancer incidence were also associated with prostate cancer mortality: three herbicides (trifluralin, cloransulam-methyl, and diflufenzopyr) and one insecticide (thiamethoxam). Only trifluralin is classed by the Environmental Protection Agency as a “possible human carcinogen,” whereas the other three are considered “not likely to be carcinogenic” or have evidence of “non-carcinogenicity.”
“This research demonstrates the importance of studying environmental exposures, such as pesticide use, to potentially explain some of the geographic variation we observe in prostate cancer incidence and deaths across the United States,” said lead author Simon John Christoph Soerensen, MD, of Stanford University School of Medicine. “By building on these findings, we can advance our efforts to pinpoint risk factors for prostate cancer and work towards reducing the number of men affected by this disease.”
Naked Prosthetics enables ‘life after amputation’ for 28-year-old Nelisiwe Nare
On the 18th of June 2020, a seemingly ordinary day at the office took a different turn for 28-year-old Nelisiwe Nare. At the time, Nare was based in the Northern Cape where she worked in the mining industry as a Process Engineer. That night, Nare’s hand got caught between a rotating drum and a lip plate of a magnetic separator. As a result of severe tissue damage, the ring and middle fingers on Nare’s right hand were amputated.
“When I awoke from surgery, the first thing I did was check my hand – only to realise that my fingers were no longer there,” says Nare. What followed was a long journey of healing, physical therapy and planning for the future.
Resilient and self-motivated, with a firm belief that anything is possible, Nare was determined to find a prosthetic that would enable her to return to as normal a life as possible. “My goal was to find a functional prosthetic. I was less concerned with hiding my injury or that my fingers had been amputated. My focus was on function, more than anything else.” This is why the usual aesthetic prosthetic hands that were on offer were not an option as they would not provide the functionality she was looking for.
At that time, there was nothing available on the local market that met Nare’s needs. After extensive research, she came across Naked Prosthetics – a provider of functional devices for partial hand and finger amputees. “Their devices were cool, functional, and unlike anything else I had seen. They aligned perfectly with the functional experience I was looking for.”
Nare was put in touch with her prosthetist who worked closely with Naked Prosthetics to understand the exact nature of Nare’s injury, type of amputation, her goals for the device and exactly how she hoped to use it. This included exact measurements and casting as well as being able to select her colour of choice.
“I remember the day I was able to collect my device,” continues Nare. That she was able to write on paper and type on a laptop on her very first use of the device was amazing and an experience in itself. “It’s a testament to how these devices are designed with movement, purpose and hand function in mind,” enthuses Nare.
“It allows me to do many of the things I used to do and is exactly what I had hoped for. As someone who spends a lot of time working on a laptop, the device has made a huge difference. Without it, my hand would very quickly tire, to the point where I’d feel like something was missing.”
Össur South Africa recently announced the availability of Naked Prosthetics to the local market. “The loss of a finger can be severely debilitating, impacting one’s ability to carry out seemingly ordinary yet essential everyday tasks – let alone the potential impact on one’s career and professional life,” says Dewald Grey, a Prosthetic Clinical Specialist with Össur South Africa. The resulting lack of mobility is also not limited to the area of amputation only, with many amputees experiencing a loss of mobility beyond the area of amputation. 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.
“We aim to provide finger and partial-hand amputees with functional, high-quality solutions that seamlessly integrate into their lives and empower them to live a life without limitations – resuming employment and engaging in the activities they love,” says Grey.
“I believe prosthetics is one of the most evolving areas in the medical field,” Grey continues. “The use of 3D printing and precision engineering has led to highly advanced, functional prosthetic fingers. We also have different types of finger prosthetics for different needs – each one tailored precisely to the individual user’s amputation and specific hand structure.”
“I love my device. I’m grateful to have had the opportunity to access something that has shown me that amputation isn’t the end but, rather, a new beginning. Plus, I look super cool wearing it and it opens up opportunities for me to share my story and challenge stereotypes,” continues Nare. Her advice to anyone facing a similar injury, “no matter the extent of your amputation, it’s important to realise that life doesn’t stop when you lose your fingers.”
“Embrace what was and what’s to come, your amputation, scars, failures, stares and figuring it out! Embrace the ignorance, awkwardness and kindness. Most importantly of all, embrace the superhuman strength that comes with limb loss. My life before the amputation doesn’t compare to what it is now. I am more confident, I know there’s nothing I can’t do, and I am functional.”
Nare is currently exploring the land of the emirates while pursuing her Master of Management degree in Digital Business at Wits Business School.
There is no difference in the effectiveness of the two most commonly used methods for administering medication during out-of-hospital cardiac arrest, according to a large new clinical study published in NEJM.
This is shown in a large new clinical study from Aarhus University and Prehospital Services, Region Midtjylland, which compared two ways of accessing the bloodstream: a standard needle in a vein (venous catheter) and a so-called intraosseous needle, which is inserted into the bone marrow.
“When a person suffers cardiac arrest outside the hospital, it is crucial to quickly access the bloodstream to administer life-saving medication. We investigated which method is best,” explains Lars Wiuff Andersen, professor and physician at the Department of Clinical Medicine, Aarhus University, Prehospital Services, Region Midtjylland, and Aarhus University Hospital.
Venous catheter or intraosseous needle?
Until now, healthcare professionals have preferred using a venous catheter, but it can be difficult to place as veins may collapse during cardiac arrest.
The intraosseous needle, inserted either into the shinbone or upper arm, can be faster and easier to use in an emergency.
Therefore, it’s interesting to investigate the effectiveness of both methods, explains Lars Wiuff Andersen.
The study, based on data from nearly 1500 cardiac arrest patients across Denmark, showed that about 30 percent of patients in both groups had their blood circulation restored.
“The two methods proved to be equally effective in restoring blood circulation and saving lives. There was no difference in the patients’ survival or quality of life,” explains Mikael Fink Vallentin, associate professor at the Department of Clinical Medicine and Prehospital Services, Region Midtjylland, and co-lead author of the study.
May change guidelines
According to the researchers behind the study, the results may impact future guidelines, which previously recommended venous catheters as the first choice.
However, Lars Wiuff Andersen notes that it is too early to say exactly how the guidelines will change.
“Our data must be considered alongside a large clinical trial from the UK, which is being published simultaneously with our study. Combined, these two trials will likely influence guidelines for cardiac arrest treatment, but a thorough review of the results will be needed,” he says.
More unanswered questions
There are still several unanswered questions, especially regarding whether specific groups of cardiac arrest patients benefit more from one method than the other.
The researchers are continuing to analyse and compare their own data with data from the UK trial.
The Danish research team has already planned a new, large clinical trial to investigate which method is best for delivering electric shocks during cardiac arrest.
“We hope to gain even more answers on how to best save lives in cardiac arrest in the future,” says Lars Wiuff Andersen.
