Month: November 2024

Categories : Cancer Immune SystemTags :

Chronic Activation of the Innate Immune System can Unleash Cancer

On By ModernMedia
Photo by Sangharsh Lohakare on Unsplash

Along with defending against pathogens, the body’s innate immune system helps to protect the stability of our genomes in unexpected ways that have important implications for the development of cancer, researchers at Memorial Sloan Kettering Cancer Center (MSK) are discovering.

In a pair of recent papers, scientists in the lab of molecular biologist John Petrini, PhD, showed that innate immune signaling plays a key role in maintaining genome stability during DNA replication. Furthermore, the researchers showed that chronic activation of these immune pathways can contribute to tumour development in a mouse model of breast cancer.

Not only do the findings add vital insights to our understanding of fundamental human biology, says Dr Petrini, they may also shed new light on tumour initiation and present potential opportunities for new therapies.

“Living organisms have evolved complex pathways to sense, signal, and repair damaged DNA,” he says. “Here we’re learning new things about the role of the innate immune system in responding to that damage – both in the context of cancer and also in human health more generally.”

How Chronic Activation of the Innate Immune System Can Lead to Cancer

The newest paper, led by first author Hexiao Wang, PhD, a postdoctoral fellow in the Petrini Lab, and published in Genes & Development, reveals a connection between innate immune signaling and tumour development in breast tissue. And, Dr Petrini says, the data suggest that when instability arises in the genome, chronic activation of the innate immune system can greatly increase the chances of developing cancer.

The study focused on a protein complex called the Mre11 complex, which plays a pivotal role in maintaining the stability of the genome by sensing and repairing double-strand breaks in DNA.

To study how problems with the Mre11 complex can lead to cancer, the team manipulated copies of the protein in mammary tissue organoids (miniature lab-grown model organs) and then implanted them into laboratory animals.

When oncogenes (genes known to drive cancer) were activated in these mice, tumors arose about 40% of the time, compared with about 5% in their normal counterparts. And the tumors in the mice with mutant Mre11 organoids were highly aggressive.

The research further showed that the mutant Mre11 led to higher activation of interferon-stimulated genes (ISGs). Interferons are signaling molecules that are released by cells in response to viral infections, immune responses, and other cellular stressors.

They also found that the normally tightly controlled packaging of DNA was improperly accessible in these organoids — making it more likely that genes will get expressed, when they otherwise would be inaccessible for transcription.

“We actually saw differences in the expression of more than 5600 genes between the two different groups of mice,” Dr Petrini says.

And strikingly, these profound effects depended on an immune sensor called IFI205.

When the organoids were further manipulated so they would lack IFI205, the packaging of DNA returned almost to normal, and the mice developed cancer at essentially the same rate as normal mice.

“So what we learned is that problems with Mre11 – which can be inherited or develop during life like other mutations – can create an environment where the activation of an oncogene is much more likely to lead to cancer,” Dr Petrini says. “And that the real lynch pin of this cascade is this innate immune sensor, IFI205, which detects that there’s a problem and starts sending out alarm signals. In other words, when problems with Mre11 occur, chronic activation of this innate immune signaling can significantly contribute to the development of cancer.”

New Understandings Could Pave the Way for Future Treatments

The work builds on a previous study, led by Christopher Wardlaw, PhD, a former senior scientist in the Petrini Lab, that appeared in Nature Communications.

That study focused on the role of the Mre11 complex in maintaining genomic integrity. It found that when the Mre11 complex is inactive or deficient, it results in the accumulation of DNA in the cytoplasm of cells and in the activation of innate immune signaling. This research primarily looked at the involvement of ISG15, a protein made by an interferon-stimulating gene, in protecting against replication stress and promoting genomic stability.

“Together, these studies shed new light on how the Mre11 complex works to protect the genome when cells replicate, and how, when it’s not working properly, it can trigger the innate immune system in ways that can promote cancer,” D. Petrini says.

By shedding light on the interrelationships between these complex systems and processes, the researchers hope to identify new strategies to prevent or treat cancer, he adds, such as finding ways to short-circuit the increased DNA accessibility when Mre11 isn’t working properly.

Source: Memorial Sloan Kettering Cancer Center

Categories : UncategorizedTags :

How does Work-related Stress Compromise Cardiovascular Health?

On By ModernMedia
Photo by Tim Gouw on Unsplash

In a large multi-ethnic group of adults in the United States without cardiovascular disease, those with work-related stress were more likely to have unfavourable measures of cardiovascular health. The findings are published in the Journal of the American Heart Association.

For the analysis, investigators assessed data collected between 2000 and 2002 for 3579 community-based men and women aged 45–84 years enrolled in the Multi-Ethnic Study of Atherosclerosis. Cardiovascular health was determined based on seven metrics – smoking, physical activity, body mass index, diet, total cholesterol, blood pressure, and blood glucose – with each metric contributing zero points, one point, or two points if in the poor, intermediate, or ideal range, respectively, for a range of 0–14 points.

Work-related stress, which was assessed through a questionnaire, was reported by 20% of participants. After adjusting for potentially influencing factors, individuals with work-related stress, had 25% and 27% lower odds of having average (9–10 points) and optimal (11–14 points) cardiovascular health scores, respectively, compared with individuals without work-related stress.

“To address the public health issue of work-related stress and its detrimental effects on cardiovascular health, future research should prioritise the use of longitudinal studies to identify the mechanisms underlying this association,” said first author Oluseye Ogunmoroti, MD, MPH, of Emory University and senior author Erin Michos, MD, MHS, of Johns Hopkins University. “Additionally, conducting thorough workplace intervention studies is essential for the development and implementation of effective stress management strategies that can enhance employee well-being and improve cardiovascular health.”

Source: Wiley

Categories : Cardiovascular Disease PaediatricsTags :

Breaking up Sedentary Time with Light Exercise Lowers BP

On By ModernMedia
Photo by Victoria Akvarel on Pexels

More than six sedentary hours per day from childhood through young adulthood may cause an excess increase of 4mmHg in systolic blood pressure, a new study shows. Continuously engaging in light physical activity (LPA) significantly mitigated the rise in blood pressure – while longer bouts of more vigorous exercise . The results were published in the prestigious Journal of Cachexia, Sarcopenia and Muscle.

In the present study, a collaboration between the Universities of Bristol and Exeter, and the University of Eastern Finland, 2513 children drawn from the Children of the 90s cohort were followed up from age 11 until 24 years. At baseline, the children spent six hours per day sedentary, six hours per day engaging in LPA, and approximately 55 minutes per day in moderate-to-vigorous physical activity (MVPA). At follow-up in young adulthood, nine hours per day were spent sedentary, three hours per day in LPA, and approximately 50 minutes per day in MVPA. 

The average blood pressure in childhood was 106/56mmHg which increased to 117/67mmHg in young adulthood, partly due to normal physiological development. Persistent increase in sedentary time from age 11 through 24 years was associated with an average of 4mmHg excess increase in systolic blood pressure. Participating in LPA from childhood lowered the final level by 3mmHg, but engaging in MVPA had no blood pressure-lowering effect. 

“Furthermore, when 10 minutes out of every hour spent sedentary was  replaced with an equal amount of LPA from childhood through young adulthood in a simulation model, systolic blood pressure decreased by 3mmHg and diastolic blood pressure by 2mmHg. This is significant, as it has been reported in adults that a systolic blood pressure reduction of 5mmHg decreases the risk of heart attack and stroke by ten percent,” says Andrew Agbaje, an award-winning physician and associate professor (docent) of Clinical Epidemiology and Child Health at the University of Eastern Finland.

The current study is the largest and the longest follow-up of accelerometer-measured movement behaviour and blood pressure progression in youth in the world. Measurements of blood pressure, sedentary time, LPA and, MVPA were taken at ages 11, 15, and 24 years. The children’s fasting blood samples were also repeatedly measured for low-density lipoprotein cholesterol, high-density lipoprotein cholesterol, triglycerides, glucose, insulin, and high-sensitivity C-reactive protein. Heart rate, socio-economic status, family history of cardiovascular disease, smoking status as well as dual-energy X-ray absorptiometry measured fat mass and lean mass were accounted for in the analyses. 

“We have earlier shown that elevated blood pressure and hypertension in adolescence increase the risk of premature cardiac damage in young adulthood. The identification of childhood sedentariness as a potential cause of elevated blood pressure and hypertension with LPA as an effective antidote is of clinical and public health significance. Several MVPA-based randomised controlled trials in the young population have been unsuccessful in lowering blood pressure. We noted an MVPA-induced increase in muscle mass enhanced a physiologic increase in blood pressure explaining why earlier MVPA-based randomised clinical trials were unsuccessful,” says Agbaje.

Source: University of Eastern Finland

Categories : Cardiovascular Disease ExerciseTags :

Even Moderate Amounts of Exercise May Reduce Risk for Atrial Fibrillation

On By ModernMedia
Photo by Robert Ruggiero on Unsplash

Adding an extra hour every week of physical activity may lower the chance of developing the most common type of irregular heartbeat (arryhthmia) by 11%, a new study shows.

Led by researchers at NYU Langone Health, the investigation focused on atrial fibrillation. While past studies have linked exercise to reduced risk of this type of arrhythmia, nearly all of these analyses have relied on participants’ often inaccurate estimates of their own activity levels, the authors say.

To avert this flaw, the current study team used data recorded from the fitness tracker Fitbit to objectively measure physical activity in more than 6000 men and women across the United States. The results showed that those with higher amounts of weekly physical activity were less likely to develop atrial fibrillation. Notably, the researchers say, even modest amounts of moderate to vigorous exercise, which can range from taking a brisk walk or cleaning the house to swimming laps or jogging, were associated with reduced risk.

Specifically, study participants who averaged between 2.5 and 5 hours per week, the minimum amount recommended by the American Heart Association, showed a 60% lower risk of developing atrial fibrillation. Those who averaged greater than 5 hours had a slightly greater (65%) reduction.

“Our findings make clear that you do not need to start running marathons to help prevent atrial fibrillation and other forms of heart disease,” said preventive cardiologist Sean P. Heffron, MD, the study senior author. “Just keeping moderately active can, over time, add up to major benefits for maintaining a healthy heart,” added Dr Heffron, an assistant professor in the Department of Medicine at NYU Grossman School of Medicine.

Dr. Heffron notes that in the sole earlier study that used activity monitors to investigate atrial fibrillation, researchers provided Fitbit-style monitors to the participants and tracked them for only a week, an approach that may not have accurately captured their normal workout habits. The new investigation, which the authors say is the largest of its kind to date, assessed participants for a full year and included only those who already owned the devices.

A report on the findings will be presented at the annual meeting of the American Heart Association on November 16.

From data collected as part of the All of Us Research Program, the authors of the current study assessed physical activity in the subset (6086 people) who used a Fitbit device and permitted their Fitbit and electronic health records to be linked to their All of Us data. The team tracked activity information for a year as a baseline and then followed up for another five years to identify those who were diagnosed with atrial fibrillation. The researchers also took into account factors known to contribute to the condition, such as age, sex, and a history of high blood pressure.

“These results highlight the value of Fitbits and similar monitors in medical research,” said study lead author Souptik Barua, PhD, an assistant professor in the Department of Medicine at NYU Grossman School of Medicine. “By offering an objective way to measure exercise for years at a time, these tools can provide deeper insight into how different patterns of activity can impact health.”

For example, says Dr Barua, the research team next plans to explore whether working out in the morning or at night may have different effects on heart health.

He cautions that since many Fitbit owners in the study were college-educated White women, the investigation assessed a less-diverse group than that of the overall All of Us population. The program is now providing free devices to participants in underrepresented communities for future investigations.

Dr. Barua also cautions that the study was not designed to tell whether exercise alone directly reduced the risk of atrial fibrillation, nor to detect how that might come about or what other factors, such as income or educational status, might be in play in the reduced risk. However, the association between exercise “doses” and the development of the condition in the study participants was strong.

Source: NYU Langone Health / NYU Grossman School of Medicine

Categories : OphthalmologyTags :

Why Some Patients Respond Poorly to Wet Macular Degeneration Treatment

On By ModernMedia
Retina showing reticular pseudodrusen. Although they can infrequently appear in individuals with no other apparent pathology, their highest rates of occurrence are in association with age-related macular degeneration (AMD), for which they hold clinical significance by being highly correlated with end-stage disease sub-types, choroidal neovascularisation and geographic atrophy. Credit: National Eye Institute

A new study from researchers at Wilmer Eye Institute, Johns Hopkins Medicine explains not only why some patients with wet age-related macular degeneration (or “wet” AMD) fail to have vision improvement with treatment, but also how an experimental drug could be used with existing wet AMD treatments to save vision.

Wet AMD, one of two kinds of AMD, is a progressive eye condition caused by an overgrowth of blood vessels in the retina. Such blood vessels – caused by an overexpression of a protein known as VEGF that leads to blood vessel growth – then leak fluid or bleed and damage the retina, causing vision loss.

Despite the severe vision loss often experienced by people with wet AMD, less than half of patients treated with monthly eye injections, known as anti-VEGF therapies, show any major vision improvements. Additionally, for those who do benefit with improved vision, most will lose those gains over time.

Now, in the full report published November 4 in the Proceedings of the National Academy of Sciences, the Wilmer-led team of researchers share how such anti-VEGF therapies may actually contribute to lack of vision improvements by triggering the overexpression of a second protein. Known as ANGPTL4, the protein is similar to VEGF, as it can also stimulate overproduction of abnormal blood vessels in the retina.

“We have previously reported that ANGPTL4 was increased in patients who did not respond well to anti-VEGF treatment,” says Akrit Sodhi, MD, PhD, corresponding author and associate professor of ophthalmology at the Johns Hopkins University School of Medicine and the Wilmer Eye Institute. “What we saw in this paper was a paradoxical increase of ANGPTL4 in patients that received anti-VEGF injections – the anti-VEGF therapy itself turned on expression of this protein.”

The team compared VEGF and ANGPTL4 levels in the eye fluid of 52 patients with wet AMD at various stages of anti-VEGF treatment. Prior to anti-VEGF injections, patients with wet AMD had high levels of ANGPTL4 and VEGF proteins. After treatment, their VEGF levels predictably decreased, yet ANGPTL4 levels rose higher, indicating ANGPTL4 remained active following the anti-VEGF injections and the treatments contributed to an increase in ANGPTL4. Such ANGPTL4 activity can lead to blood vessel overgrowth and lack of vision improvement.

The team then investigated ways to bridge the gap between patients with increased ANGPTL4 following anti-VEGF treatments by testing the experimental drug 32-134D in mice with wet AMD. The drug decreases levels of a third protein, HIF-1, known to be involved in wet AMD and diabetic eye disease for its role in switching on VEGF production. Researchers believed the HIF-inhibitor 32-134D would have a similar effect on ANGPTL4 following anti-VEGF treatment, since ANGPTL4 production is also turned on by HIF-1.

In mice treated with 32-134D, the team observed a decrease in HIF-1 levels and VEGF, as well as decreased levels of ANGPTL4 and blood vessel overgrowth. Mice treated only with anti-VEGF therapies corroborated the team’s findings in human patients: levels of VEGF were lower, yet ANGPTL4 levels rose, preventing anti-VEGF therapies from fully working to prevent blood vessel growth (and vision loss). Researchers also determined that combining 32-134D with anti-VEGF treatments prevented the increase in HIF-1, VEGF and ANGPTL4. This treatment combination was more effective than either drug alone, showing promise for treating wet AMD.

“This work exposes a way to improve anti-VEGF therapy for all patients and potentially help a subset of patients with wet AMD who still lose vision over time despite treatment,” Sodhi says. “Our hope is that this [project] will further the three goals we have related to wet AMD: make current therapies as effective as possible, identify new therapies, and prevent people from ever getting wet AMD.”

Source: John Hopkins Medicine

Categories : Dermatology Environmental EffectsTags :

Air Pollution Exposure may be Associated with Eczema

On By ModernMedia

Data from hundreds of thousands of U.S. adults suggests that each zip code increase of 10 µm/m3 in PM2.5 levels is associated with a doubling in eczema rates among residents

Photo by Kouji Tsuru on Pexels

People living in areas with higher levels of air pollution are more likely to have eczema, according to a new study published November 13, 2024 in the open-access journal PLOS ONE by Dr Jeffrey Cohen of Yale School of Medicine, USA.

The prevalence of eczema has increased globally with industrialisation, suggesting a possible contribution from environmental factors. In the new study, researchers used data from the U.S. National Institutes of Health All of Us Research Program, covering hundreds of thousands of U.S. adults. The current study included 286 862 people for whom there was available demographic, zip code and electronic health record data.

Overall, 12 695 participants (4.4%) were diagnosed with eczema. After controlling for demographics and smoking status, people with eczema were more likely to live in zip codes with high levels of fine particulate matter, or PM2.5, in the air. For every increase of 10 µm/m3 in average PM2.5 air pollution in their zip code, people were more than twice as likely to have eczema.

The authors conclude that increased air pollution, as measured by PM2.5, may influence the risk of developing eczema, likely through its effects on the immune system.

The authors add: “Showing that individuals in the United States who are exposed to particulate matter are more likely to have eczema deepens our understanding of the important health implications of ambient air pollution.”

Provided by PLOS

Categories : IT in HealthcareTags :

Is AI a Better Doctors’ Diagnostic Resource than Traditional Ones?

On By ModernMedia

With hospitals already deploying artificial intelligence (AI) to improve patient care, a new study has found that using Chat GPT Plus does not significantly improve the accuracy of doctors’ diagnoses when compared with the use of usual resources. 

The study, from UVA Health’s Andrew S. Parsons, MD, MPH and colleagues, enlisted 50 physicians in family medicine, internal medicine and emergency medicine to put Chat GPT Plus to the test. Half were randomly assigned to use Chat GPT Plus to diagnose complex cases, while the other half relied on conventional methods such as medical reference sites (for example, UpToDate©) and Google. The researchers then compared the resulting diagnoses, finding that the accuracy across the two groups was similar.

That said, Chat GPT alone outperformed both groups, suggesting that it still holds promise for improving patient care. Physicians, however, will need more training and experience with the emerging technology to capitalise on its potential, the researchers conclude. 

For now, Chat GPT remains best used to augment, rather than replace, human physicians, the researchers say.

“Our study shows that AI alone can be an effective and powerful tool for diagnosis,” said Parsons, who oversees the teaching of clinical skills to medical students at the University of Virginia School of Medicine and co-leads the Clinical Reasoning Research Collaborative. “We were surprised to find that adding a human physician to the mix actually reduced diagnostic accuracy though improved efficiency. These results likely mean that we need formal training in how best to use AI.”

Chat GPT for Disease Diagnosis

Chatbots called “large language models” that produce human-like responses are growing in popularity, and they have shown impressive ability to take patient histories, communicate empathetically and even solve complex medical cases. But, for now, they still require the involvement of a human doctor. 

Parsons and his colleagues were eager to determine how the high-tech tool can be used most effectively, so they launched a randomized, controlled trial at three leading-edge hospitals – UVA Health, Stanford and Harvard’s Beth Israel Deaconess Medical Center.

The participating docs made diagnoses for “clinical vignettes” based on real-life patient-care cases. These case studies included details about patients’ histories, physical exams and lab test results. The researchers then scored the results and examined how quickly the two groups made their diagnoses. 

The median diagnostic accuracy for the docs using Chat GPT Plus was 76.3%, while the results for the physicians using conventional approaches was 73.7%. The Chat GPT group members reached their diagnoses slightly more quickly overall – 519 seconds compared with 565 seconds.

The researchers were surprised at how well Chat GPT Plus alone performed, with a median diagnostic accuracy of more than 92%. They say this may reflect the prompts used in the study, suggesting that physicians likely will benefit from training on how to use prompts effectively. Alternately, they say, healthcare organisations could purchase predefined prompts to implement in clinical workflow and documentation.

The researchers also caution that Chat GPT Plus likely would fare less well in real life, where many other aspects of clinical reasoning come into play – especially in determining downstream effects of diagnoses and treatment decisions. They’re urging additional studies to assess large language models’ abilities in those areas and are conducting a similar study on management decision-making. 

“As AI becomes more embedded in healthcare, it’s essential to understand how we can leverage these tools to improve patient care and the physician experience,” Parsons said. “This study suggests there is much work to be done in terms of optimising our partnership with AI in the clinical environment.”

Following up on this groundbreaking work, the four study sites have also launched a bicoastal AI evaluation network called ARiSE (AI Research and Science Evaluation) to further evaluate GenAI outputs in healthcare. Find out more information at the ARiSE website.

Source: University of Virginia Health System

Categories : Healthcare Politics and RegulationsTags :

The NHI Act: a Flawed Execution of a Laudable Idea

On By ModernMedia

By Prelisha Singh, Partner, Martin Versfeld, Partner and Alexandra Rees, Senior Associate, Webber Wentzel

Robust contestation on how to best fulfil the fundamental rights of South Africans complements and strengthens our constitutional democracy. Recent debate has centred on the effective realisation of the right to access healthcare, which the state is required progressively to realise for all South Africans, irrespective of their background and income.

The right to access healthcare came into sharp focus on 15 May 2024, when President Cyril Ramaphosa signed the National Health Insurance (NHI) Act into law, prompting the initiation of constitutional challenges by concerned stakeholders. The most recent of these was filed on 1 October 2024 in the North Gauteng High Court, Pretoria by the South African Private Practitioners Forum (SAPPF), represented by Webber Wentzel.

According to the government, the NHI Act is intended to generate efficiency, affordability and quality for the benefit of South Africa’s healthcare sector.

An assessment of South Africa’s current healthcare landscape shows a stark difference between private and public healthcare. The country has a high quality, effective private healthcare offering. However, it is currently inaccessible to the many South Africans who cannot afford private care or medical aid payments. Public healthcare, on the other hand, is understaffed, poorly managed and plagued by maladministration and limited facilities.

The NHI Act has been positioned as the vehicle to address this disparity and a desire to take steps towards achieving universal healthcare in South Africa. But a closer reading of the Act highlights numerous problems with its content and implementation design. The absence of clarity, detail or guidance contained in the Act makes it impossible to assess how the Act will actually be implemented (or, by extension, what the effects of this implementation will be).

This is particularly concerning given that years have passed since the economic assessments, on which the Act was based, were undertaken. Also problematic is the apparent lack of consideration given by the government to submissions made by affected stakeholders during multiple rounds of constitutionally required public participation.

SAPPF underscores these deficits in seeking both to have the President’s decision to assent to the Act reviewed and set aside, and the Act itself declared unconstitutional.

President Ramaphosa was obliged, in terms of sections 79 and 84(2)(a) to (c) of the Constitution, not to assent to the Act in its current form. Section 79 requires the President to refer back to Parliament any bill that he or she believes may lack constitutionality. In this case, it is difficult to conceive how the President, or any reasonable person in the President’s position could not have had doubts regarding the constitutionality of the NHI Bill. The decision by the President to sign unconstitutional legislation into law, instead of referring it back to Parliament for correction, is also irrational.

The President’s duty properly to have referred the NHI Bill back to Parliament is affirmed by the fact that the President is enjoined, by section 7(2) of the Constitution, to respect, protect, promote and fulfil the rights contained in the Bill of Rights.

SAPPF’s application demonstrates that the NHI Act, in its current form, infringes upon the rights to access healthcare services, to practice a trade, and to own property. Patients, including those using private healthcare, will be forced to use a public healthcare system that currently fails to meet its key constituents’ needs. Practitioners’ rights to freedom of trade and profession will be infringed upon, and the property rights of medical schemes, practitioners, and financial providers will be unjustifiably limited.

On its current text, the Act could make South Africa the only open and democratic jurisdiction worldwide to impose a national health system that excludes by legislation private healthcare cover for those services offered by the state – notwithstanding the level or quality of case.

Concerns regarding the rights infringements in the NHI Act are exacerbated by its lack of clarity and the fact that crucial aspects of its implementation are relegated to regulations, with no clear guidance provided in the Act itself.

For example, section 49 provides that the NHI will be funded by money appropriated by Parliament, from the general tax revenue, payroll tax, and surcharge to personal tax. However, this stance does not reconcile with section 2, which provides that the NHI will be funded through ‘mandatory prepayment’, a compulsory payment for health services in accordance with income level. Crucially, the extent of the benefits covered by the NHI’s funding mechanism and its rate of reimbursement, which impact affordability and the provision of quality healthcare, remain unknown.

The Act is, at best, a skeleton framework, seemingly assented to in haste. It is conceptually vague to the extent that the rights it seeks to promote will, in fact, be infringed if implemented. This renders the Act irrational, in addition to its other constitutional defects.

The NHI Act represents a radical shift of unprecedented magnitude in the South African health care landscape. This should be – and is required to be – underpinned by meaningful public participation, up-to-date socio-economic impact assessments and affordability analyses and final provisions that provide a clear and workable framework for implementation.

It is not sufficient for these vital issues to be addressed after the fact. Further engagements with stakeholders and the solicitation of proposals by the government cannot be used to splint broken laws. Collaborative engagement, including the solicitation of inputs for meaningful consideration, should take place during the law-making process, not after its conclusion.

A shift of the magnitude proposed by the Act, absent compliance with the structures of the law-making process and adherence by the state to constitutional standards, including rights protections, would be detrimental to the entire healthcare sector – public and private – and not in the best interests of patients and practitioners.

Notwithstanding the legal contestation surrounding the Act, it and the laudable goals underlying it can also be a watershed. The achievement of universal health coverage is an opportunity for the different stakeholders in South Africa’s healthcare system to meaningfully collaborate and inform well-supported, factually informed, rational and genuinely progressive legislative steps by the state.

Given the questions surrounding the Act and the evident need it seeks to address, the space exists for healthcare stakeholders to align around shared goals and values. They can leverage their available resources to design a healthcare system that serves all of South Africa’s people fairly and equitably, using the significant existing resources invested in the country’s healthcare sector.

Categories : Cardiovascular Disease PaediatricsTags :

Adequate Sleep Significantly Reduces Hypertension Risk in Teens

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Photo by Eren Li

Adolescents who meet the recommended guidelines of nine to 11 hours of sleep per day were shown to have a significantly lower risk of hypertension, according to a new study from UTHealth Houston.  

Recently published in the Journal of the American Heart Association, the research revealed that adolescents had a 37% lower risk of developing incidents of high blood pressure by meeting healthy sleep patterns, and underscoring the importance of adequate sleep behaviour. The research further explored the impact of environmental factors potentially impacting sleep.  

“Disrupted sleep can lead to changes in the body’s stress response, including elevated levels of stress hormones like cortisol, which in turn can increase blood pressure,” said first author Augusto César Ferreira De Moraes, PhD, assistant professor in the Department of Epidemiology at UTHealth Houston School of Public Health. 

De Moraes and his team analysed data from 3320 adolescents across the US to investigate incidents of high blood pressure during nighttime sleep cycles. Scientists identified a rise in hypertension incidents over two data periods, 2018-2020 and 2020-2022, showing an increase from 1.7% to 2.9%. The data included blood pressure readings and Fitbit assessments, which measured total sleep time and REM sleep duration at night. The study’s design analysed covariates such as Fitbit-tracked sleep, blood pressure, and neighbourhood noise by residential geocodes, allowing for a thorough examination of environmental noise exposure for each participant. 

Neighbourhood/community noise was not significantly associated with the incidence of hypertension. Environmental factors, such as neighbourhood noise, point to the need for longer-term studies to investigate the relationship between sleep health and hypertension, particularly in relation to socioeconomic status, stress levels, and genetic predispositions. 

The study emphasises the importance of improved sleep behaviours and meeting recommendations. “Consistent sleep schedules, minimising screen time before bed, and creating a calm, quiet sleep environment can all contribute to better sleep quality,” advises Martin Ma, MPH, second author of the study and recent graduate of the school. “Although environmental noise didn’t directly affect hypertension in this study, maintaining a quiet and restful sleep environment is still important for overall well-being.” 

Source: University of Texas Health Science Center at Houston

Categories : Cancer NeurologyTags :

Early Radiotherapy Treatment of Vestibular Schwannomas Prevents Problems

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Photo by National Cancer Institute on Unsplash

Patients with a small cranial nerve tumour that can cause hearing loss, vertigo, imbalance and ringing in the ears have typically been watched rather than proactively treated, as the risks of early intervention were thought to outweigh the benefits. Now a study shows that even those patients benefit significantly from non-invasive stereotactic radiosurgery, led by UVA Health physicians has found. The findings were reported in Neurosurgery.

Doctors typically treat larger forms of the tumours, called vestibular schwannomas, while taking a “watch and wait” approach to smaller tumours that aren’t causing appreciable problems. But the new research, from UVA Health neurosurgeon Jason Sheehan, MD, PhD, and collaborators, could change how asymptomatic schwannomas are managed. Their findings demonstrated that stereotactic radiosurgery – a highly targeted form of radiation therapy – can prevent small tumours from growing over time while at the same time sparing patients from potentially irreversible problems in the future.

“This study and our recent Vestibular Schwannoma International Study of Active Surveillance versus Stereotactic Radiosurgery [VISAS] trial demonstrate that radiosurgery affords effective and durable tumour control while more often avoiding the neurological complications that come from watching a vestibular schwannoma,” Sheehan said. “Over time, Gamma Knife radiosurgery bends the curve of growth and problems that commonly arise from watching even the smallest of vestibular schwannomas.”

About vestibular schwannomas

Vestibular schwannomas are growths on a cranial nerve that connects the brain and inner ear. This nerve transmits information about head movements, helps us control our balance and allows us to hear. The growths, however, can disrupt the nerve’s important functions, causing hearing loss, unsteadiness, headaches, tinnitus (ringing in the ear), facial numbness/paralysis and other problems. 

Seeking to improve care for patients with these tumours, Sheehan and his team performed a trial through the International Radiosurgery Research Foundation looking at 261 adults with the smallest category of vestibular schwannomas. These were usually picked up early, and the patients often were high functioning and had the most to lose from tumour growth over time. Of the study participants, 182 received stereotactic radiosurgery, while 79 did not. 

The patients who underwent radiosurgery using the Gamma Knife system showed consistently better tumour control over time. In this group, 99% of the patients’ tumours either stayed the same size, grew very little (less than 25%) or shrank. This was true at 3 years, 5 years, and 8 years. Only one patient’s tumour significantly increased in size.

Tumour control was much worse among those who didn’t receive radiosurgery: 37% saw their tumours grow significantly at 3 years, 50% at five years, and 67% at eight years.

That difference was seen plainly in the symptoms the patients experienced. Radiosurgery was associated with a 54% lower rate of tinnitus, a 51% lower rate of cranial nerve deterioration and an 83% lower rate of vestibular dysfunction that causes dizziness and loss of balance. 

Even with Gamma Knife radiosurgery to treat the tumour arising from this very delicate neural structure, hearing was preserved similarly in both groups.

Sheehan, an expert in stereotactic radiosurgery and brain tumours, urges physicians to take note of the findings because tumour symptoms are often irreversible as the tumour grows. Acting early, before symptoms develop, could greatly improve patients’ long-term quality of life, he says.

“In brain surgery, particularly involving the hearing and balance nerve, our approach must be exceedingly refined,” he said. “This study shows that Gamma Knife radiosurgery substantially improves the future trajectory of vestibular schwannoma patients.”

Source: University of Virginia Health System