Portable MRI machines, an emerging technology that makes medical imaging accessible even in remote locations, detected ischaemic strokes in 90% of patients scanned, according to a study appearing in the journal Science Advances.
In previous studies, portable MRI devices have demonstrated they can also detect haemorrhagic as well as ischaemic strokes, helping clinicians make crucial life-saving treatment decisions quickly in remote areas for patients who lack ready access to major hospitals with expensive stationary MRI machines, the authors say.
“This is the first systematic evidence you can detect ischaemic strokes using portable, bedside devices,” noted Kevin Sheth, professor of neurology and neurosurgery at Yale School of Medicine and co-corresponding author of the study.
Outcomes for stroke patients improve dramatically the quicker they receive treatment. But access to stationary MRI machines is limited for those who live far away from major hospitals or in developing countries. And even stroke patients who have access to major hospitals often have to wait for scans with stationary MRIs because of heavy demand for the equipment. Portable scans can be used at a patient’s bedside, in ambulances, or in remote clinics, Dr Sheth said.
In addition, quickly differentiating between different types of stroke is crucial for determining proper treatment, the researchers say. Ischaemic strokes are usually treated with blood thinners. But that course of treatment is dangerous for those who experience haemorrhagic strokes or strokes in which there is bleeding in the brain.
Analysing portable MRI scans from 50 patients at Yale New Haven Hospital, the Yale and Harvard researchers found that the results largely confirmed ischaemic stroke diagnoses made by stationary MRIs. For 45 of those patients, the portable MRI detected blood clots as small as 4mm in size.
Over time, antidepressant use is not associated with significantly better health-related quality of life, compared to people with depression who do not take the drugs, according to a new study reported in PLOS ONE.
Depression disorder is known to have a significant impact on the health-related quality of life (HRQoL) of patients. While studies have shown the efficacy of antidepressant medications for treatment of depression disorder, these medications’ effect on patients’ overall well-being and HRQoL remains controversial.
Researchers used data on adult patients with depression drawn from the 2005-2015 United States’ Medical Expenditures Panel Survey (MEPS), a large longitudinal study that tracks the health services that Americans use. There were 17.47 million adult patients diagnosed with depression each year over the study, with two years of follow-up, and 57.6% of these received treatment with antidepressant medications.
Use of antidepressants was associated with some improvement on the mental component of SF-12 – the survey tracking health-related quality of life. However, when this positive change was compared to the change in group of people who were diagnosed with depressive disorder but did not take antidepressants, there was no statistically significant association of antidepressants with either the physical (p=0.9595) or mental (p=0.6405) component of SF-12. In other words, the change in quality of life seen among those on antidepressants over two years was not significantly different from that seen among those not taking the drugs.
The study was not able to separately analyse any subtypes or varying severities of depression. Future studies should investigate the use of non-pharmacological depression interventions used in combination with antidepressants, said the researchers.
The authors noted that, “Although we still need our patients with depression to continue using their antidepressant medications, long-term studies evaluating the actual impact for pharmacological and non-pharmacological interventions on these patients’ quality of life is needed. With that being said, the role of cognitive and behavioural interventions on the long term-management of depression needs to be further evaluated in an effort to improve the ultimate goal of care for these patients; improving their overall quality of life.”
NYU School of Global Public Health researchers have found that some cannabis edibles have a striking resemblance to popular snack foods such as Doritos, and may be easily confused for them, especially by young children, finds a new study published in Drug and Alcohol Dependence.
These “copycat” edibles also have levels of the psychoactive ingredient tetrahydrocannabinol or THC that far exceed the limits set by cannabis regulations in US states.
“At first glance, most of the packages look almost exactly like familiar snacks. If these copycat cannabis products are not stored safely, there is the potential for accidental ingestion by children or adults,” said Associate Professor Danielle Ompad, lead author of the study.
Edibles are a popular and growing segment of the cannabis market. In states where cannabis use is legal, more than half (56%) of cannabis users consume edibles.
Some edibles that use similar branding and imagery to mimic popular snack foods have been highlighted by the media. These copycat cannabis products are a public health concern given that people – including children – could mistake them for snacks and accidentally consume them. From 2017 to 2019, US Poison Control Centers handled nearly 2000 cases of young children ages 0 to 9 consuming edibles.
To gain a deeper understanding of copycat edibles, the researchers collected hundreds of photos of cannabis products and analysed their packaging, including branding, names, imagery, and THC content. Looking at the photos for 267 edibles, they found that 8% (22 photos) closely resembled 13 different snack products.
Twelve of the products were candies or sweet snacks (fruit chews, fruit snacks, rice and marshmallow treats, and gummies) and one was a salty snack (chips). Eight of the 13 packages used the exact brand or product name of the original product; the remaining five used names that were similar (for instance, “Stoner Patch Dummies” instead of “Sour Patch Kids”). Seven of the packages used the same cartoon or brand character as the original product.
Most US states that have legalised cannabis limit the amount of THC in edibles, generally 5–10mg of THC per dose and 100mg per package. According to the packaging information, these edibles contained an average of 459mg of THC with a range of 300 to 600 mg per package, far exceeding the maximum limits.
“While each package is likely intended to include multiple doses, few packages indicate the serving size or number of servings,” said Dr Ompad. “Moreover, if we’re considering 10mg a standard dose, these products could contain an alarming 30 to 60 doses per package.”
The findings highlight the risk that these copycat products could be attractive to children, given the colourful packaging and use of familiar branding and characters.
“Policies to prevent cannabis packaging from appealing to children haven’t stopped copycat products from entering the market — nor have food brands taking legal action against cannabis companies for copyright infringement,” said Dr Ompad. “People who purchase edibles that look like snack foods should store them separately from regular snacks and out of reach of children.”
A new study published in Journal of General Internal Medicine found that 30% of people treated for COVID developed ‘Long COVID’. Risk of Long COVID was greater in people with a history of hospitalisation, diabetes, and higher BMI; and less in organ transplant recipients and those not on private health insurance. Surprisingly, ethnicity, older age, and socioeconomic status were not linked to the syndrome despite the link to greater risk of severe illness and mortality.
Of the 309 people with long COVID studied, the most persistent symptoms were fatigue and shortness of breath (31% and 15%, respectively) in hospitalised persons, and loss of sense of smell (16%) in outpatients.
The incidence and risk factors of Long COVID, and even how to define the syndrome, have remained unclear throughout the pandemic. The researchers sought evaluate its association with demographics and clinical characteristics in order to devise the most effective treatments.
The study examined 1038 people enrolled in the UCLA COVID Ambulatory Program from April 2020 to February 2021. Of those, 309 developed Long COVID, determined by them reporting persistent symptoms on questionnaires 60 or 90 days after infection or hospitalisation.
Potential weaknesses in the study include the subjective nature of how patients rated their symptoms, the limited number of symptoms the researchers evaluated, and limited information about patients’ pre-existing conditions.
“This study illustrates the need to follow diverse patient populations longitudinally to understand the Long COVID disease trajectory and evaluate how individual factors such as pre-existing co-morbidities, sociodemographic factors, vaccination status and virus variant type affect type and persistence of Long COVID symptoms,” said Dr Sun Yoo, health sciences assistant clinical professor at UCLA. “Studying outcomes in a single health system can minimise variation in quality of medical care. Our study also raises questions such as: Why were patients with commercial insurance twice as likely to develop Long COVID than patients insured through Medicaid? Because persistent symptoms can be subjective in nature, we need better tools to accurately diagnose Long COVID and to differentiate it from exacerbations of other emerging or chronic conditions. Finally, we need to ensure equitable access to outpatient Long COVID care.”
A new short course of treatment for HIV-associated cryptococcal meningitis is as effective as the longer, standard one, and is better tolerated, according to a real-world study in the New England Journal of Medicine.
The international study involved a randomised trial in southern and eastern Africa. This new ‘one-dose’ approach offers a practical, easier-to-administer and better tolerated treatment for HIV-associated cryptococcal meningitis in Africa, the researchers said.
Cryptococcal meningitis causes a serious disease in immunosuppressed people living with HIV, with around 180 000 cryptococcal meningitis-related deaths each year, mostly in sub-Saharan Africa. Current treatments are either a 7 or 14-day course of amphotericin-B, combined with either oral antifungal tablets or oral fluconazole.
This new trial investigated whether a single high dose of liposomal amphotericin-B (L-AmB, Ambisome) paired with two oral antifungals, fluconazole and flucytosine, was as effective at reducing deaths as the currently recommended WHO first-line treatment based on seven days of Amphotericin-B therapy.
Dr Melanie Alufandika-Moyo, study author and the lead research doctor at the Malawi-Liverpool Wellcome Unit, said: “Cryptococcal meningitis is the most common type of adult meningitis in much of Africa. Without effective treatment, infection progresses quickly, often resulting in deaths. Current treatment requires prolonged hospitalisation, intensive nursing care and costly laboratory monitoring which can be expensive for the healthcare system and the patient. Amphotericin-B can also cause kidney damage and blood problems.
“We urgently need new ways of treating the disease, so it’s fantastic that we were able to show a new streamlined treatment, requiring just one intravenous infusion, is as effective and less dangerous for patients.”
More than 800 adult patients with a first episode of HIV-associated cryptococcal meningitis, from five countries in southern and eastern Africa, took part in the trial.
Half received, and half received standard care. After 10 weeks, 25% (101/407) of people in the AmBisome arm died compared to 29% (117/407) in the control arm – this is among the lowest mortality rate reported from a major cryptococcal meningitis trial in Africa, despite more than a quarter of participants presenting with very severe disease.
Drug-related toxicity was significantly lower in the new ‘one-dose’ AmBisome arm. Anaemia occurred in 13% of AmBisome participants compared to 39% in the control arm, with more participants in the control arm needing blood transfusions. Far less drug related kidney toxicity was observed in the one dose AmBisome arm than in the control arm.
AmBisome, a liposomal formulation of amphotericin-B, was suspected to be an effective cryptococcal meningitis treatment as it is less toxic and can be given in large doses that remain in the brain for some time. A single, high-dose of AmBisome had previously been shown to be effective at clearing Cryptococcus from around the brain, which prompted the real-world trial.
Professor Tom Harrison from St George’s, University of London, who co-led the trial with Professor Joe Jarvis from the London School of Hygiene & Tropical Medicine and Botswana Harvard AIDS Institute Partnership, said: “These exciting results represent the culmination of a long programme of collaborative work to optimise antifungal drug combinations and reduce deaths from this terrible infection, and provide the strong evidence needed for policymakers to decide how cryptococcal meningitis should be treated going forward.
“Fortunately, with the support of advocates and funders, Ambisome and flucytosine are now becoming more available, which is essential to enable wide-scale implementation of this novel treatment regimen.”
Professor Joe Jarvis, the lead author of the study, said: “The results of this trial have the potential to transform how cryptococcal meningitis is treated and the management of advanced HIV-related disease in sub-Saharan Africa. It has far fewer significant side effects, which is obviously hugely important, and has the potential to prevent a large number of deaths in low-resource settings by being both easier to administer and cost-effective.”
Study imitations included the current lack of access to Ambisome and flucytosine, the key components of this novel treatment regimen, in many low-resource settings. To address this, an additional five years funding has been received.
