A woman with Systemic Lupus Erythematosus. Source: Wikimedia CC0
Researchers have found that topical mupirocin is effective in reducing rashes caused by systemic lupus erythematosus. Instead of directly lowering inflammation, the treatment kills bacteria that promote it. The findings are published in Arthritis & Rheumatology.
Cutaneous lupus erythematosus is a common manifestation of systemic lupus erythematosus, caused by the autoimmune conditions. The condition is characterised by rashes on various parts of the body including the face and scalp, hair loss and scarring of the skin.
The standard treatment for cutaneous lupus erythematosus is using immunosuppressants and biologic drugs to reduce inflammation. While the medications can be helpful, many patients with systemic lupus erythematosus already take several drugs and are looking for alternatives to pills.
J. Michelle Kahlenberg, MD, PhD, a professor of internal medicine in the Division of Rheumatology at University of Michigan Health led a team of researchers investigating topical mupirocin which is one such alternatives.
This trial was based on Kahlenberg’s previous discovery that cutaneous lupus rashes are often colonised with a common skin bacteria, Staphyloccous areus, also known asstaph, and contributes to inflammation in the rashes. Mupirocin kills this type of bacteria.
The study randomly selected systemic lupus erythematosus patients currently experiencing cutaneous lupus erythematosus flares to treat their skin lesions with mupirocin or with an inactive control, petrolatum jelly.
Samples from the nose and lesional skin were used to determine baseline and post treatment Staphylococcus abundance and microbial community profiles. Paired samples collected prior to treatment with the topical solution and seven days after treatment showed decreases in lesional staphylococcus aureusin the mupirocin treated samples.
Importantly, the reduction in staph also was accompanied by a reduction in inflammatory signals, including interferon-driven gene expression, in the lesions.
“In addition to decreasing the inflammation by decreasing lesional staphylococcus aureus, the mupirocin treatment also lowered skin monocyte levels, which are important in driving cutaneous lupus,” said Kahlenberg.
Mupirocin is a prescription treatment, and while this early study showed signs of decreasing inflammation, the study wasn’t designed to see if it can decrease the rash of cutaneous lupus erythematosus.
“Additional larger studies are needed to determine whether topical antibiotics will be helpful to make rashes go away,” Kahlenberg said.
“However, this is an exciting first step to show that there may be additional treatments that can improve inflammation beyond our usual immunosuppressant and biologic drugs.”
An international clinical trial has found three new safe and effective drug regimens for tuberculosis that is resistant to rifampin, the most effective of the first-line antibiotics used to treat TB. The research, published in the New England Journal of Medicine, was led by researchers at Harvard Medical School and other members of the endTB project.
The newly identified regimens take advantage of recently discovered drugs to expand the treatment arsenal and give physicians new ways to shorten and personalise treatment, minimise side effects, and treat patients using only pills instead of daily injections. They also offer alternatives in case of drug intolerance, medication shortages or unavailability, or drug resistance, the researchers said.
The endTB trial is one of four recent efforts to use randomised controlled trials to test new, shorter, less toxic regimens for drug-resistant TB. endTB uses two new drugs – bedaquiline and delamanid — which, when brought to market in 2012-2013, were the first new TB medicines developed in nearly 50 years.
To find shorter, injection-free drug combinations for people infected with TB resistant to rifampin, endTB tested five new, all-oral 9-month regimens using the two new drugs in combination with older medications.
A third drug, pretomanid, received emergency authorisation from the FDA for specific use within a regimen against highly drug-resistant TB in 2019, after the endTB clinical trial was underway, and is not included in the regimens used in these trials.
Trial regimens were considered effective if they performed at least as well as the control group, which received a well-performing standard of care composed in accordance with a stringent interpretation of World Health Organization (WHO) recommendations.
The three successful new regimens were successful for between 85 and 90% of patients, compared with 81% success for people in the control group. The control group was treated with longer treatments, which also included the recently discovered medicines.
The trial launched in 2017 and enrolled 754 patients across seven countries: Georgia, India, Kazakhstan, Lesotho, Pakistan, Peru, and South Africa. The goal was to improve treatment for patients with tuberculosis resistant to rifampin. The WHO estimates that some 410 000 people become sick with rifampin-resistant TB each year, including people who have multidrug-resistant TB (MDR-TB). Only 40% are diagnosed and treated, 65%of them successfully.
The study population included children as well as people infected with HIV or hepatitis C, both common in populations with high rates of TB. In another innovation, women who became pregnant while on treatment were included in the endTB trial. These groups are often excluded from clinical trials. In a special report published in August 2024, the WHO added the three noninferior regimens from the endTB trial to the list of treatment options for rifampin-resistant and multidrug-resistant TB (MDR-TB) treatment; the recommendations extend to these neglected groups as well as to pregnant women.
With recent efforts to end patent exclusivity on bedaquiline, two of the endTB regimens and the WHO-recommended pretomanid-containing regimen can all be purchased for less than $500, an access target set by activists more than 10 years ago, which has only just now been achieved. All of these innovations together mean the new shortened, all-oral regimens are available to more people than ever.
Photo by Pixabay: https://www.pexels.com/photo/view-of-operating-room-247786/
Increased use of ventilation and air cleaners, designed to mitigate the spread of viral infections in hospitals, is likely to have unpredictable effects and may cause viral particles to move around more, according to a new study from researchers at UCL and UCLH.
In the study, published in Aerosol Science & Technology, researchers investigated the effect of using built-in mechanical ventilation and portable air cleaners (PACs)1 upon the spread of airborne particles, which are similar to those breathed out by a person with a viral respiratory infection such as SARS-CoV-2 or influenza.
The team tracked the movement of airborne particles around a typical hospital outpatients’ clinic at UCLH in central London using an aerosol generator and particle counters2. A variety of scenarios were simulated, including particle movement to a neighbouring room, throughout the whole clinic, and from one room to another room at the far side of the clinic.
They also tested whether factors such as closing doors, or the position of ventilation and PACs within a room, had an effect on the spread of particles.
The researchers found that while use of built-in ventilation and PACs can reduce particle spread in some scenarios, in some experiments the use of PACs increased aerosol spread by up to 29% between neighbouring rooms. Built-in ventilation potentially increased aerosol migration across the clinic by up to 5.5 times more than if no ventilation was used.
Professor Laurence Lovat, senior author of the study from UCL Surgery & Interventional Science and UCLH, said: “The COVID-19 pandemic really highlighted the risk of picking up airborne viral infections in hospitals, which naturally led to efforts to reduce this risk. In many hospitals, the use of ventilation systems and portable air cleaners has increased.
“While the urgency of the situation demanded a rapid response, since then we’ve been studying precisely how viral particles move around in real spaces and have been surprised by what we’ve found.
“Putting air cleaners in rooms led to unexpected increases in the circulation of aerosols in some cases, but it took months to understand what we were seeing. Each scenario produced different, unexpected results, depending on the spaces and airflow sources involved.
“Even at UCLH, a modern hospital built less than 20 years ago, airflow patterns were not predictable. In older hospitals, which often have natural draughts, the situation would likely be even more complex.”
The study concluded that using airflow devices in hospitals to try to limit the movement of airborne pathogens requires careful consideration of airflow dynamics and device placement to reduce the risk of exacerbating the problem.
The clinic where the experiments took place consisted of a large central waiting room (154 m3,split into A and B for the purpose of the study), eight surrounding consulting rooms and a nurses’ station (all approximately 35 m3). The clinic was connected via a permanently open passageway to a corridor leading to the rest of the hospital. Experiments took place at night and weekends when no staff or patients were present.
A number of experiments were conducted by placing aerosol generators dispersing saline solution in certain rooms, with particle detectors sited in other rooms to track the movement of particles around the clinic.
In one experiment, the researchers simulated particle spread from a medical professional or patient in one consulting room to a neighbouring room. A baseline measurement was taken in the consulting room with the aerosol source when all doors were open and no ventilation or PACs were in use.
Closing the room door that contained the source was found to reduce particle spread significantly and closing both room doors reduced it by 97%.
But when doors were opened and large PACs in the adjacent waiting room were turned on, the spread to the neighbouring consulting room increased by 29%. When small desktop PACs were added to both consulting rooms and the nurses’ station, the spread was lower than the baseline, but only slightly.
Dr Jacob Salmonsmith, first author of the study and an Honorary Research Fellow from UCL Mechanical Engineering, said: “The results of this experiment might seem counterintuitive if you take the view that changing the air in a room more often reduces the spread of viral particles.
“While it’s true that air cleaners do remove viral particles from the air and can reduce overall spread, they can also have unintended consequences. In particular, this experiment suggests that larger air cleaners, which have larger exhaust vents that introduce their own air currents, can cause particles that haven’t been filtered out to spread further than they would have if the cleaner wasn’t there.
“In any given space you have complex interactions between many different air currents, such as ventilation, doors closing and people’s movement. Our findings indicate that the whole picture needs to be considered when choosing when and where to introduce air cleaners.”
In another experiment, the team observed highly complex patterns of particle spread when all consulting room doors were open.
This included one scenario where the highest concentrations of particles were detected in rooms furthest away from an aerosol source situated in a consulting room where a PAC was in operation. Particle levels in the room furthest from this aerosol source were 184% higher than average, while in the room directly opposite the source they were 68% below average.
There were also 247% more particles in the waiting room furthest away from the consulting room, where a PAC was in operation, than in the waiting room right next door to it. The nurses’ station had a higher concentration of particles than any room on the same side of the clinic as the room where the aerosol generator was situated.
Professor Andrea Ducci, an author of the study from UCL Mechanical Engineering, said: “Our experiments demonstrated that high volume of particles can be corralled into particular areas as a result of airflow dynamics. This obviously isn’t ideal, particularly if that place is a key location, such as the nurses’ station that staff members who’re treating patients will likely visit often during their shift.
“The good news is that we’re rapidly expanding our knowledge of this phenomenon. The project that we are currently working on aims to simulate the entire airflow within a clinic and assess the efficacy of different devices positioned in different locations. This will allow us to identify relatively simple interventions, such as better positioning of ventilation devices to reduce the spread of particles, thus decreasing the risk of picking up an infection in hospital.”
Given the unpredictability of how aerosol particles move around spaces and the difficulty in measuring them, the team are currently building an AI system to help to do this and hope to start testing within the next 18 months.
The authors say the study holds great promise to inform governmental action on ensuring that NHS standards for ventilation and infection are fit for purpose, in line with efforts to prevent future pandemics.
1 Portable air cleaners, or purifiers, are devices that filter dust and fine particles out of the air. The devices used in this study all conformed to the HEPA standard, meaning they are designed to filter out almost all (99.7%) of the fine particles that pass through them. The PACs placed in the waiting room were large (around the size of a kitchen bin) and the ones used in smaller room were around the size of a desktop lamp.
2 The aerosol particles were created from a harmless saline solution and disbursed at a constant rate by an aerosol generator at roughly the face height of a seated person (1.2 metres). The particles were designed to mimic those breathed out by a person with an airborne respiratory infection, such as influenza.
Flossing your teeth at least once a week may be linked to a lower risk of stroke caused by blood clotting and atrial fibrillation, according to a preliminary study to be presented at the American Stroke Association’s International Stroke Conference 2025. The meeting is in Los Angeles, Feb. 5-7, 2025, and is a world premier meeting for researchers and clinicians dedicated to the science of stroke and brain health.
“A recent global health report revealed that oral diseases – such as untreated tooth decay and gum disease – affected 3.5 billion people in 2022, making them the most widespread health conditions,” said study lead author Souvik Sen, MD, MS, MPH, chair of the Department of Neurology, Prisma Health Richland Hospital and the University of South Carolina School of Medicine in Columbia, South Carolina. “We aimed to determine which oral hygiene behaviour – dental flossing, brushing or regular dentist visits – has the greatest impact on stroke prevention.”
The Atherosclerosis Risk in Communities (ARIC) study, one of the first large-scale investigations of this kind in the US, assessed the home use of dental floss through a structured questionnaire of more than 6000 people. Among those who reported flossing, 4092 had not experienced a stroke, and 4050 had not been diagnosed with atrial fibrillation (AFib).
Participants were asked about their status regarding high blood pressure, diabetes, high cholesterol, smoking, body mass index, education, regular brushing and dentist visits. During the 25 years of follow-up, 434 participants were identified as having strokes, of which 147 were larger artery brain clots, 97 were heart-driven clots and 95 were hardening of the smaller arteries. Additionally, 1291 participants were noted to have experienced AFib.
The analysis found:
Flossing was associated with a 22% lower risk of ischaemic stroke, 44% lower risk of cardioembolic stroke (blood clots traveling from the heart) and 12% lower risk of AFib.
The associated lower risk was independent of regular brushing and routine dental visits or other oral hygiene behaviours.
Increasing the frequency of flossing had a greater chance of stroke risk reduction.
Flossing was also associated with a lower chance of cavities and periodontal disease.
Researchers were surprised by the reduction of irregular heartbeats, or AFib. AFib is the most common form of irregular heartbeat. It can lead to stroke, heart failure or other cardiovascular complications.
“Oral health behaviours are linked to inflammation and artery hardening. Flossing may reduce stroke risk by lowering oral infections and inflammation and encouraging other healthy habits,” Sen said. “Many people have expressed that dental care is costly. Flossing is a healthy habit that is easy to adopt, affordable and accessible everywhere.”
Study limitations include that data were based on answers to a questionnaire, and the 25-year follow-up appears to have focused on stroke and heart outcomes only. There was no follow-up concerning flossing or other oral behaviours over the years, Sen said.
Propranolol, a drug often used to treat hypertension and prevent migraines was associated with a reduction in ischaemic stroke risk among women – but not men – using the drug for migraine prevention, according to a preliminary study to be presented at the American Stroke Association’s International Stroke Conference 2025. The meeting is in Los Angeles, Feb. 5-7, 2025, and is a world premier meeting for researchers and clinicians dedicated to the science of stroke and brain health.
The beta blocker propranolol had a stronger protective effect for ischaemic stroke risk in women with migraine, particularly those without aura. The medication did not have the same protective effect on men.
Migraine headaches are common in the general population, but they occur three times more often in women than in men. This debilitating condition is associated with an increased risk of stroke. While the beta blocker propranolol can be used to prevent migraines, its effectiveness in reducing overall stroke risk is still uncertain.
“Migraine is an often-ignored risk factor for cardiovascular issues. Until recently, preventive treatments for people who have migraines were not available,” said lead study author Mulubrhan Mogos, PhD, MSc, FAHA, an assistant professor at Vanderbilt University School of Nursing. “Many women suffer from migraines, and it’s important to note that propranolol may be beneficial for these women, particularly those who experience migraine without aura. This is an important discovery for those dealing with migraines.”
Mogos also noted that migraine disproportionately affects women from historically under-resourced communities, and this disparity may impact the ability to achieve education goals or maintain stable employment, creating a vicious cycle. While new treatments have proven effective, they may not be accessible to women in these groups due to high costs.
For the study, researchers reviewed more than 3 million electronic health records from two large databases. In separate analyses, researchers identified people with migraine who developed stroke and a control group of those with migraine who did not develop stroke. They then assessed whether the individuals were treated with propranolol for migraine and whether that treatment had impacted stroke risk.
“We initially looked at overall stroke and then ischemic stroke specifically. We refined our analysis further by controlling for possible confounders and found the association is significant and stronger for ischaemic stroke,” Mogos said.
After adjusting for potential variables, such as demographics (age, sex, race), other conditions (high blood pressure, diabetes, etc) and hormonal factors (use of birth control, pregnancy – considered separately for each woman) that might affect results the analysis found:
Propranolol was significantly associated with a reduced risk of ischaemic stroke in women with migraine, particularly in those without aura. The risk of developing a stroke was 52% lower for women taking the medication in one database analysis and 39% lower in the other. No stroke risk reduction was seen in men in either analysis group.
The protective effect of propranolol was stronger for ischaemic stroke and in women with migraine without aura. Migraine aura can include disturbances, such as flashing lights, blind spots, zigzag patterns or seeing coloured spots. Other symptoms include tingling or numbness in the face or hands, difficulty speaking, dizziness or confusion.
Secondary analyses showed lower overall stroke rates in women taking propranolol at multiple time points in both databases.
“Our findings indicate that women and health care professionals should discuss the advantages of preventive migraine interventions. For under-resourced individuals who bear a greater burden from this condition and may lack access to new treatments, we must ensure these treatments are available to them. This approach can help reduce health disparities,” Mogos said.
The main limitation is that this was a review of past data using electronic health records, which may introduce biases, such as misclassification errors from reliance on ICD codes (codes used to classify and report health conditions and diseases). These findings highlight the need for studies that look forward in time to confirm these results.
