Higher rates of brain metastases in patients with inflammatory breast cancer, a rare subtype of breast cancer, have been observed in studies, but detailed information is lacking. Now, a new study published in CANCER indicates that patients inflammatory breast cancer face a higher risk that their cancer will metastasise to the brain.
To provide insights into the incidence and risk factors for brain metastases in this patient population, Laura E.G. Warren, MD, and colleagues analysed data on 372 patients with stage III inflammatory breast cancer and 159 with stage IV inflammatory breast cancer.
Over a median follow-up of five years, the incidence of brain metastases at one, two, and five years was 5%, 9%, and 18% among patients who presented with stage III disease, and 17%, 30%, and 42% among those with stage IV disease. Patients with triple-negative breast cancer faced a particularly high risk, and when they did experience brain metastases, their survival time was shorter than those with hormone receptor–positive or HER2-positive breast cancer who experienced brain metastases. Higher risks of brain metastases were also seen in patients whose cancer had metastasised to other parts of the body besides the brain, especially when this occurred at a young age.
“The relatively high incidence of brain metastases seen in the study population highlights the need for future research on the potential role for surveillance brain imaging for high-risk patients. There is an open, phase II, single arm study at Dana-Farber Cancer Institute examining this question,” said Dr. Warren. “It also emphasises the need to obtain brain imaging in patients with inflammatory breast cancer presenting with neurologic symptoms given the high incidence of brain metastases in this population.” Most patients in this study who were diagnosed with brain metastases had neurologic symptoms, but because some patients may have undetected, asymptomatic brain metastases, the true incidence in patients with inflammatory breast cancer is likely even higher than what Dr Warren and her colleagues observed.
An accompanying editorial notes that when considering whether to implement routine brain imaging tests in patients with inflammatory breast cancer, it will be important to determine whether earlier detection of brain metastases leads to improvements in both survival and quality of life.
Infection remains a major complication when implants such as screws and plates are embedded into people during procedures like joint replacement surgery and spinal fusion surgery. Most infections occur because the devices’ titanium implant surfaces have poor antibacterial and osteoinductive properties, despite titanium possessing the highest biocompatibility of all metals.
Assistant Professor Rahim Rahimi at Purdue University has developed a process which immobilises silver onto the implant surfaces of titanium orthopaedic devices to improve their antibacterial properties and cellular integration. The process can be implemented onto many currently utilised metal implant surfaces.
The antibacterial efficacy of laser-nanotextured titanium surfaces with laser-immobilised silver was tested against both gram-positive (Staphylococcus aureus) and gram-negative (Escherichia coli) bacteria. The surfaces retained efficient and stable antimicrobial properties for more than six days. The laser-nanotextured titanium surfaces also provided a 2.5-fold increase in osseointegration properties compared with a pristine titanium implant surface.
“The first step of the two-step process creates a hierarchical nanostructure onto the titanium implant surface to enhance the bone cells’ attachment,” A/Prof Rahimi said. “The second step immobilises silver with antibacterial properties onto the titanium implant surface.
“The technology allows us to not only immobilise antibacterial silver compounds onto the surface of the titanium implants but also provide a unique surface nanotexturing that allows better settle attachment mineralisation.
“These unique characteristics will allow improving implant outcomes, including less risk of infection and fewer complications like device failure.”
A/Prof Rahimi said the traditional method to address infections caused by implanted orthopaedic devices often utilises antibiotics or other surface modifications that have their own associated complications.
“Long-term antibacterial protection is not possible with these traditional drug coatings because a large portion of the loaded drug is released in a short time,” Rahimi said. “There also is often a mixture of microbes that are found in implant-associated infection; it is essential to choose a bactericidal agent that covers a broad spectrum.”
It’s estimated that the majority of the expected 73% increase in the global demand for meat by 2050 will come from sub-Saharan Africa (SSA). Since human and environmental health concerns are likely to become more prominent with this increased consumption, plant-based meat alternatives have been touted as a possible alternative. But it may take some time before consumers in the region substitute their juicy steak of chicken wings for a vegan burger.
A review on plant-based meat alternatives in SSA published recently in Scientific African shows that before there can be any large-scale adoption of plant-based meat products in the region, we will first have to determine the social implications of eating less meat, the barriers to eating plant-based meat analogues, consumers’ acceptance of these products, and strategies that could get people to supplement their meat intake with plant-based alternatives. Plant-based meat analogues are foods designed to mimic the appearance, flavour, and texture of meat products. These can include, among others, burgers, sausages, nuggets, mince and meatballs.
The review was conducted by Omamuyovwi Gbejewoh and Dr Jeannine Marais from the Department of Food Science at Stellenbosch University and Dr Sara Erasmus from the Food Quality & Design Group at Wageningen University & Research in The Netherlands. They examined the available literature on the production and consumption of plant-based meat alternatives by searching the Web of Science and Scopus databases for academic papers and Google for news or popular articles.
Ahead of World Food Day on 16 October, the researchers say their review has shown that there are certain barriers to consumers’ acceptance of plant-based meat analogues even though worldwide, plant-based meat product sales accounted for $12.1 billion in 2019 and are likely to increase by 15% to reach $27.9 billion by 2025 and $149 billion by 2029. They do point out, however, that different versions of plant-based meat products have been available in South Africa and the rest of SSA over the past 25 years.
Barriers
“Consumers’ preference for meat is the most significant barrier to eating plant-based meat products or following a plant-based diet. In addition, meat has important socio-cultural connotations such as status, power, hierarchy, and subjugation of others.
“For example, studies in Zambia revealed that eating and sharing of meat, and even the type of meat that is served connote economic prosperity, power and respect. Chicken was more popular for regular consumption and entertaining guests because it is more readily accessible and relatively cheaper. On the other hand, beef is reserved for important visitors and landmark celebrations as it usually implies wealth because it is more expensive and usually eaten by well-to-do households.
“Other studies found that different ethnic groups in South Africa have various meat cuisines made from different types of domesticated and free-roaming wild animals.”
The researchers add that price is another significant barrier to the adoption of plant-based meat.
“In South Africa, for example, plant-based meat alternatives are considered expensive niche products associated with status and class.”
When it comes to the environmental and health risks associated with eating meat from domesticated animals regularly, the researchers point out that while consumers will acknowledge these risks, they are still unlikely to eat less meat. This phenomenon is known as the “meat paradox”.
‘Halo effect’
“Our review has shown that the ‘halo effect’ (consumers’ perception that plant products are more environmentally friendly) afforded to plant-based meat is not completely warranted because researchers are (un)knowingly discounting the processed nature of meat alternatives in any environmental or health risk assessment.”
“While the reduced environmental impacts of meat alternatives are apparent, a ‘cradle to grave’ environmental assessment needs to be carried out to ensure that the environmental burden is not shifted to other stages of the production cycle.”
The researchers say the review also found that plant-based meat products are similar in nutrient composition to meat, although differences in essential nutrients warrants caution.
“In terms of nutritional composition between traditional meat and meat alternatives, there is inconclusive evidence on which is healthier.”
According to them, the available literature is replete with strategies to reduce traditional meat consumption and to try plant-based meat alternatives. These include, among others, meatless days, partially substituting traditional meat with plant-based ingredients (e.g., “hybrid burgers”), cultural and lifestyle changes, food labelling, consumer education, and taxes on traditional meat or subsidies on plant-based meat.
“However, some of these strategies are not without drawbacks. For instance, food labels on the health and environmental benefits of plant-based meat may contain too much information that could confuse the consumer.
“If consumers in SSA are to be convinced to eat less meat and/or substitute it for plant-based alternatives, the latter should not be marketed as a replacement for traditional meat products but as a complement. Marketing strategies should be tailored to different sections of consumers because such a contextual approach is bound to provide more favourable and long-term results than a ‘one- size-fit-all strategy.”
The researchers emphasise the need for a comprehensive environmental and health impact assessment of meat alternatives in the region.
It has been suggested in a number of studies that eating a healthy diet may reduce a person’s risk of dementia. A new study published in the journal Neurology has found, however, that both the conventionally recommended diet and the Mediterranean diet are not linked to a reduced risk of dementia.
The Mediterranean diet features a high intake of vegetables, legumes, fruits, fish and healthy fats such as olive oil, and a low intake of dairy products, meats and saturated fatty acids. “Previous studies on the effects of diet on dementia risk have had mixed results,” said study author Isabelle Glans, MD, of Lund University. “While our study does not rule out a possible association between diet and dementia, we did not find a link in our study, which had a long follow-up period, included younger participants than some other studies and did not require people to remember what foods they had eaten regularly years before.”
For the study, researchers identified 28 000 people from Sweden. Participants had an average age of 58 and did not have dementia at the start of the study. They were followed over a 20-year period. During the study, participants filled out a seven-day food diary, a detailed food frequency questionnaire and completed an interview. By the end of the study, 1943 people, or 6.9%, were diagnosed with dementia, including Alzheimer’s disease and vascular dementia.
Researchers examined how closely participants’ diets aligned with conventional dietary recommendations and the Mediterranean diet. After adjusting for age, gender, and education, researchers did not find a link between following either a conventional diet or the Mediterranean diet and a reduced risk of dementia. Dr Glans noted that further research is needed to confirm the findings.
Nils Peters, MD, of the University of Basel in Switzerland, who wrote an editorial accompanying the study, said, “Diet on its own may not have a strong enough effect on memory and thinking, but is likely one factor among others that influence the course of cognitive function. Dietary strategies will still potentially be needed along with other measures to control risk factors.” A limitation of the study was the risk of participants misreporting their own dietary and lifestyle habits.
Having jobs be replaced by robots is a common fear for workers in all sectors of the economy. Working alongside robots may contribute to job burnout and workplace incivility, but self-affirmation techniques could help alleviate fears about being replaced by these machines, according to research published online in the Journal of Applied Psychology [PDF].
Researchers found that workers in the United States and parts of Asia feel job insecurity from robots, even in industries where robots aren’t being used, and those fears may not be justified, said lead researcher Kai Chi Yam, PhD, an associate professor of management at the National University of Singapore.
“Some economists theorise that robots are more likely to take over blue-collar jobs faster than white-collar jobs,” Dr Yam said. “However, it doesn’t look like robots are taking over that many jobs yet, at least not in the United States, so a lot of these fears are rather subjective.”
Researchers conducted experiments and analysed data from participants in the US, Singapore, India and Taiwan.
Working with industrial robots was linked to greater reports of burnout and workplace incivility in an experiment with 118 engineers employed by an Indian auto manufacturing company.
An online experiment with 400 participants found that self-affirmation exercises, where people are encouraged to think positively about themselves and their uniquely human characteristics, may help lessen workplace robot fears. Participants wrote about characteristics or values that were important to them, such as friends and family, a sense of humour or athletics.
“Most people are overestimating the capabilities of robots and underestimating their own capabilities,” Dr Yam said.
Fears about job insecurity from robots are common. The researchers analysed data about the prevalence of robots in 185 U.S. metropolitan areas along with the overall use of popular job recruiting sites in those areas (LinkedIn, Indeed, etc). Areas with the highest robot use also had the highest rates of job recruiting site searches, even though unemployment rates weren’t higher in those areas. The researchers theorised that people in these areas may have felt more job insecurity because of robots, but that there could be other reasons, such as people seeking new careers or feeling dissatisfied with their current jobs.
Another experiment comprised 343 parents of students at the National University of Singapore who were randomly assigned to three groups. One group read an article about the use of robots in businesses, the second group read a general article about robots, and the third read an unrelated article. Then the participants were surveyed about their job insecurity concerns, with the first group reporting significantly higher levels of job insecurity than the two other groups.
While some people may have legitimate concerns about losing their jobs to robots, some media coverage may be unnecessarily heightening fears among the general public, Dr Yam said.
“Media reports on new technologies like robots and algorithms tend to be apocalyptic in nature, so people may develop an irrational fear about them,” he said.
Nirmatrelvir-ritonavir (Paxlovid) is often given to heart disease patients with symptomatic COVID to prevent progression to severe disease – but it can interact with some previously prescribed medications. A review paper published in the Journal of the American College of Cardiology examines the potential drug-drug interactions (DDIs) between Paxlovid and commonly used cardiovascular medications, as well as potential options to mitigate severe adverse effects.
“Awareness of the presence of drug-drug interactions of Paxlovid with common cardiovascular drugs is key. System-level interventions by integrating drug-drug interactions into electronic medical records could help avoid related adverse events,” said Sarju Ganatra, MD, senior author of the review.
He continued: “The prescription of Paxlovid could be incorporated into an order set, which allows physicians, whether it be primary care physicians or cardiology providers, to consciously rule out any contraindications to the co-administration of Paxlovid. Consultation with other members of the health care team, particularly pharmacists, can prove to be extremely valuable. However, a health care provider’s fundamental understanding of the drug-drug interactions with cardiovascular medications is key.”
In December 2021, Paxlovid received emergency use authorisation from the US Food and Drug Administration as an oral antiviral agent for the treatment of symptomatic, non-hospitalised adults with mild to moderate COVID infection who are at high risk for progression to severe disease. Patients with heart disease and other risk factors, including diabetes, high blood pressure, chronic kidney disease and smoking make up a large portion of the high-risk population for whom Paxlovid is beneficial.
According to the authors, Paxlovid has been shown to be very effective in patients with existing heart disease, but it has significant DDIs with commonly used cardiovascular medications, highlighting the importance for all clinicians to be familiar with these DDIs. As there is limited clinical information regarding DDI-related adverse events, the authors used existing knowledge and data regarding how therapies like Paxlovid typically react with other medications to provide guidance regarding potential interactions and the associated likely consequences based on the degree of interaction.
The review provides an in-depth overview of a variety of cardiovascular medications used to treat many forms of heart disease. Five of the most important cardiovascular drug interactions with Paxlovid to be aware of include:
Anti-arrhythmic agents
Many anti-arrhythmic agents are metabolised in a way that increases plasma levels when co-administered with Paxlovid. While it may be possible to start Paxlovid after 2–2.5-day temporary discontinuation of the anti-arrhythmic agents, this may not be feasible from a practical standpoint. Clinicians are advised to consider alternative COVID therapies and avoid co-administration of these agents with Paxlovid. Sotalol, another anti-arrhythmic agent, is renally cleared and does not interact with Paxlovid.
Antiplatelet agents and anticoagulants
Antiplatelet agents are used for the treatment of coronary artery disease, particularly if a patient has received a stent. Aspirin and prasugrel are safe to co-administer with Paxlovid. There is an increased risk of blood clots when Paxlovid is given alongside clopidogrel and an increased risk of bleeding when given with ticagrelor. When possible, these agents should be switched to prasugrel. If patients have contraindication to taking prasugrel, then co-administration of Paxlovid should be avoided and alternative COVID therapies should be considered.
Anticoagulants such as warfarin may be co-administered with Paxlovid but require close monitoring of clotting factors in bloodwork. The plasma levels of all direct oral anticoagulants increase when co-administered with Paxlovid, therefore dose adjustment or temporary discontinuation and use of alternative anticoagulants may be required.
Certain statins
Co-administration of simvastatin or lovastatin with Paxlovid can lead to increased plasma levels and subsequent myopathy and rhabdomyolysis, a condition in which the breakdown of muscle tissue releases a damaging protein into the bloodstream. These agents should be stopped prior to initiation of Paxlovid. A dose reduction of atorvastatin and rosuvastatin is reasonable when co-administered with Paxlovid. The other statins are considered safe when given along with Paxlovid.
Ranolazine
Plasma concentration of ranolazine, used to treat angina and other heart-related chest pain, is exponentially increased in the presence of CPY450 inhibitors like Paxlovid, thereby increasing the risk of clinically significant QT prolongation and torsade de pointes (a type of arrhythmia). Co-administration of Paxlovid is therefore contraindicated. Temporary discontinuation of ranolazine is advised if prescribing Paxlovid.
Immunosuppressive agents
The plasma levels of immunosuppressive agents prescribed for patients who have undergone heart transplantation exponentially rise to toxic levels when co-administered with Paxlovid. Temporary reduction of dosing of immunosuppressive agents would require frequent monitoring and be logistically difficult. Therefore, alternative COVID therapies should be considered in these patients.
The authors conclude awareness and availability of other COVID therapies enable clinicians to offer alternative treatment options to patients who are unable to take Paxlovid due to DDIs.
