Tag: 24/1/22

Categories : Ageing Neurodegenerative DiseasesTags :

How Many Intervention Sessions to Prevent Cognitive Decline?

On By ModernMedia
Image by Mar Lezhava on Unsplash

Physical activity, diet and cognitive stimulation are all known to be good interventions for the prevention of Alzheimer’s disease and dementia. Now an international team of researchers has determined that only about a dozen intervention sessions are all that were needed to observe an improvement in cognition.

Until now, the number of sessions or “doses” needed for optimal effect has been unknown. Published in Alzheimer’s & Dementia: The Journal of the Alzheimer’s Association, the study led by Université de Montréal psychology professor Sylvie Belleville showed that between 12 and 14 sessions were all that were needed to boost cognitive ability, though the gain observed levelled off with more sessions.

“In pharmacological studies, every effort is made to define an optimal treatment dose needed to observe the expected effects, “ said Prof Belleville,  a neuropsychologist and researcher at the research centre of the UdeM-affiliated Institut universitaire de gériatrie de Montréal. “This is rarely done in non-pharmacological studies, especially those on the prevention of cognitive decline, where little information is available to identify this dose.

“Defining an optimal number of treatment sessions is therefore crucial.,” she continued. “Indeed, proposing too few sessions will produce no noticeable improvement effects, but too many sessions is also undesirable as these interventions are costly. They are costly both for the individual who follows the treatments, in terms of time and involvement, and for the organisation offering these treatments.”

The study is based on a secondary analysis of data from the three-year Multidomain Alzheimer Preventive Trial (MAPT) and examined 749 participants who received a range of interventions aimed at preventing cognitive decline. These interventions included dietary advice, physical activity and cognitive stimulation.

In their research, Prof Belleville’s team noted that people’s individuality should be considered when determining the optimal treatment dose.

In their study, the researchers gauged the effects of the sessions in terms of each participant’s age, gender, education level, and cognitive and physical condition. The relationship between the “dose” each received and their cognitive improvement was then analysed.

The findings revealed an increase with dose followed by a plateau effect after 12 to 14 sessions. However, participants with lower levels of education or more risk factors for frailty did benefit from more sessions.

The researchers concluded that it’s important to pinpoint an optimal dose and to customise the treatment for each individual. Not only is “dosage” an important component of behavioural interventions, it can also provide valuable information in resource-constrained settings, helping public-health agencies develop effective prevention programs and offer guidance to older adults and clinicians.

Source: University of Montreal

Categories : Medical IndustryTags :

SA Healthcare Bolstered With Vaccine Lab Investment and Loans

On By ModernMedia
Photo by Louise Reed on Unsplash

Last week, South African healthcare received a double shot in the arm with the opening of a local vaccine manufacturing facility and the approval of a World Bank loan to bolster social safety nets and health systems.

On Wednesday, President Cyril Ramaphosa and health technology billionaire Dr Patrick Soon-Shiong officially opened a new vaccine manufacturing facility in Brackenfell, Western Cape.

The South African-born entrepreneur has been strongly supporting local healthcare, with R3 billion invested to help SA share vaccine technology with the rest of Africa. His company, ImmunityBio, is developing a T-cell based universal COVID vaccine, currently in Phase III trials in SA. The same adenovirus vector technology it uses is also being tested in cancer vaccines.

“It has been a dream of mine, since I left the country as a young physician, to bring state-of-the-art, 21st century medical care to SA and to enable the country to serve as a scientific hub for the continent,” Dr Shoon-Siong had previously said. The technology transfer will help “establish much-needed capacity and self-sufficiency.”

The hub will transfer technology, know-how and materials for DNA, RNA, adjuvant vaccine platforms and cell therapies to SA.

“There is no reason we couldn’t make 500 million doses a year,” said Dr Soon-Shiong, who is also a Wits alumnus. “Subject to the raw material being available.”

He said he wants to tap the country’s expertise on prevalent diseases such as HIV and cervical cancer. “There are fantastic scientists with deep knowledge about these diseases,” he said. “More so than in America because they see these patients every day.”

President Ramaphosa and Dr Soon-Shiong also launched the Coalition to Accelerate Africa’s Access to Advanced Healthcare, which aims to drive the development of innovative therapeutics and ensure the continent is prepared for future pandemics.

The coalition aims to manufacture a billion doses of the COVID vaccine by 2025 and to develop treatments for conditions including cancer, COVID, tuberculosis and HIV.

South Africa also received approval from the World Bank for a US$750 million COVID relief loan aimed at reducing the worst of the pandemic’s impact on the poor.

“The World Bank budget support is coming at a critical time for us and will contribute towards addressing the financing gap stemming from additional spending in response to the COVID crisis,” said Dondo Mogajane, Director General of the National Treasury. “It will assist in addressing the immediate challenge of financing critical health and social safety net programs whilst also continuing to develop our economic reform agenda to build back better.”

Meanwhile, Health Minister Dr Joe Phaahla warned that South Africa will likely enter a fifth wave when cold temperatures in May, though what COVID variants may drive it remain to be seen.

Categories : Injury & TraumaTags :

K-Wires for Wrist Fractures on Par with Cast

On By ModernMedia
Photo by Cottonbro on Pexels


Using metal K-wires (aka ‘pins’) to hold broken wrist bones in place while they heal are no better than a traditional moulded plaster cast, finds a study published by The BMJ.

If the bone fragments in wrist fractures have displaced, they often require manipulation followed either by surgery to insert metal wires or plates, or a moulded cast as a non-surgical alternative, to hold the bones in place while they heal.

Surgery is expensive and carries risk for the patient, whereas a moulded plaster cast is cheaper but may not provide the same functional outcome.

To see which option is superior, researchers tracked the progress of 500 adults, average age of 60 and 83% female. with a displaced wrist fracture. Patients were randomly allocated to receive a cast (255) or surgical fixation with K-wires (245) after manipulation of their fracture. The primary outcome measure was the Patient Rated Wrist Evaluation (PRWE) score at 12 months, which included questions about pain, function and disability, and gave an overall score from 0 (best) to 100 (worst).

Secondary outcomes were PRWE score at three and six months, quality of life, and complications, including the need for later surgery.

Of the 79% of patients who completed the follow-up, no statistically significant difference was seen in the PRWE score at three, six or 12 months (average score 21.2 in the cast group compared with 20.7 in the K-wire group). Quality of life was similar.

However, one in eight patients with cast needed later surgery for loss of fracture position in the first six weeks after their injury compared with only one patient in the K-wire group.

Other complications were rare, with no evidence of a difference between the two groups (28 in the cast group compared with 22 in the K-wire group).

Limitations included the fact that neither the treating clinicians nor the participants could be blind to the interventions. Still, the researchers noted this was a large trial involving adults of all ages and the results are based on validated patient reported outcomes, reflecting the care provided across a healthcare system.

As such, they conclude: “Surgical fixation with K-wires did not provide better wrist function at 12 months compared with a moulded cast, indicating that a cast is an acceptable first line treatment following manipulation of a dorsally displaced fracture of the distal radius.”

They added: “Cast treatment avoids the expense and risks of surgical fixation for seven out of eight patients. However, careful follow-up is needed as one in eight patients treated with a cast required subsequent surgical intervention as the fracture reduction could not be maintained.”

Source: The BMJ

Categories : Medical Research & Technology Metabolic DisordersTags :

New Diabetes Management Device Combines Testing and Injection

On By ModernMedia
Photo by Lisa Fotios from Pexels

By combining blood glucose measurement with insulin administration in a single device, the complicated process of blood sugar management could be made easier for people with diabetes.

Patients with diabetes often use two types of insulin to control their blood sugar levels: long-acting insulin, which helps control glucose levels over a 24-hour period, and short-acting insulin, which is injected at mealtimes. Patients first measure their blood glucose levels with a glucose meter with a finger prick. They must also estimate how many carbohydrates are in their meal and combine this information with their blood glucose levels to calculate and inject the proper insulin dose.

Existing technologies such as continuous blood glucose monitors and insulin pumps can help with some parts of this process. However, these devices are not widely available, so most patients must rely on finger pricks and syringes. To this end, MIT researchers have developed devices to simplify the process, which they describe in the Journal of Controlled Release.

“Every day, many patients need to do this complicated procedure at least three times,” explained MIT postdoc Hen-Wi Huang. “The main goal of this project is to try to facilitate all of these complex procedures and also to eliminate the requirement for multiple devices. We also used a smartphone camera and deep learning to create an app that identifies and quantifies food content, which can aid in carbohydrate counting.”

The researchers came up with two all-in-one devices, both of which incorporate the new smartphone app. Using a photo, the app estimates the volume of food and carbohydrate content.

The first device that consolidates many of the existing tools that patients use now, including a lancet for drawing blood and glucose test strips. The device conveys blood glucose information to the smartphone app via Bluetooth, and the app works out the correct insulin dose, delivered via a needle in the same device.

“What our device is doing is automating the procedures to prick the skin, collect the blood, calculate the glucose level, and do the computation and insulin injection,” Dr Huang says. “The patient no longer needs a separate lancing device, glucose meter, and insulin pen.”

Many of the components included in this device are already FDA-approved, but the device has not been tested in human patients yet. Tests in pigs showed that the system could accurately measure glucose levels and dispense insulin.

For their second device, the researchers wanted to come up with a system that would require just one needle prick. To achieve that, they designed a novel glucose sensor that could be incorporated into the same needle that is used for insulin injection.

The researchers designed a flexible electronic sensor that can be attached to the needle and measure glucose levels in the interstitial fluid, just below the surface of the skin. Once the needle penetrates the skin, it takes between five and 10 seconds to measure the glucose levels. This information is transmitted to the smartphone app, which calculates the insulin dose and delivers it through the inserted needle.

In tests in the pigs, the researchers showed that they could accurately measure glucose levels with this system, and that glucose levels dropped after insulin injection.

Because this device uses a novel type of glucose sensor, the researchers expect that it will require further development to get to a point where it could be tested in patients.

Source: MIT

Categories : COVID HospitalsTags :

Omicron Not ‘Mild’ for US, Experts Say

On By ModernMedia

In stark contrast to South Africa’s approach to COVID and the country’s experts characterising Omicron as “mild”, US experts have said that calling it “mild” ignores the harsh situation their country faces: record hospitalisations, sick children, other conditions being worsened by COVID, and staff shortages.

While Omicron’s odds of causing a person’s hospitalisation or death are lower, US numbers suggest that Omicron is, in fact, serious on a population level.

“What’s mild about hospitals at or near the breaking point? What’s mild about hundreds of healthcare workers per hospital out ill with COVID? What’s mild about 1.3 million cases in the U.S. just yesterday? What’s mild about the rising titer of burnout? What’s mild about an unprecedented number of children now ill and hospitalised with COVID?” Clyde Yancy, MD, chief of cardiology at Northwestern University’s Feinberg School of Medicine in Chicago, wrote in an email to MedPage Today.

“I think prudence would suggest that we reframe ‘mild’ and think more about ‘self-limited,'” he added. “We are likely at or near a plateau but how long will it last and how much more agony awaits?”

Americans were hospitalised in record numbers last week. “When there are many more people sick in large numbers – in millions – even if it’s a smaller percentage that’s going to be severely sick, that is going to result in large numbers in the hospitals,” said Biykem Bozkurt, MD, PhD, a cardiologist at Baylor College of Medicine in Houston.

While Omicron is still a threat for those unvaccinated or without previous infection, its high breakthrough rate is a cause for concern, especially in vulnerable people.

“Individuals who have breakthroughs after being vaccinated, including the elderly who have comorbid heart disease, are now flooding our emergency departments with decompensated cardiovascular diagnoses and a positive coronavirus test,” said cardiologist Jim Januzzi, MD, of Massachusetts General Hospital and Harvard Medical School in Boston.

As well as buckling healthcare systems, vulnerable and overlooked populations are being affected by Omicron even more.

Paediatric hospitalisations in the US reached a new peak in mid-January, with 20% of the entire pandemic’s hospitalisations of children happening in just two weeks in January. Over 1000 children have died from COVID by the CDC’s numbers, including 359 under five.

Moreover, patients on immunosuppressive medications may be less protected by the vaccines. “The labelling of the Omicron infection as ‘mild’ overlooks the important features and the messaging to the public,” rheumatologist Vaidehi Chowdhary, MBBS, MD, DM, of Yale School of Medicine in New Haven, Connecticut, wrote in an email to MedPage Today.

“Some patients who are on strong immunosuppressive medications do not have adequate vaccine titers and remain vulnerable,” she said, pointing out that there’s a shortage of monoclonal antibodies and antivirals, which means that this group must take extra precautions to ensure they aren’t infected in the first place.

Omicron’s impact on those who are immunosuppressed or have long COVID is not yet known, Dr Chowdhary noted. “For immunosuppressed patients, to minimise infections, many in-person appointments have been converted to telehealth or elective procedures deferred. The impact of these practices and their impact on overall patient health are not known.”

People living with disabilities and chronic illnesses continue to be faced with worsened infections, delaying consultations and difficulty accessing healthcare.

Then there are those whose infection has exacerbated their condition, whatever it may be. Omicron could be the thing that tips them over the edge, or that keeps them in the hospital for longer, experts have said. Examples seen include patients with blood clots having those clots exacerbated by COVID, and COVID-positive trauma patients having complications and longer recovery times.

Healthcare workers falling ill due to Omicron has seriously stressed US healthcare, with staff shortages have been reported in almost 20% of the country’s hospitals, leaving their already overworked colleagues to work extra.

Dr Januzzi’s hospital has been “completely full, with a huge number of individuals with COVID. So, we’re really at a breaking point where staff are getting sick. Patients and physicians alike are exhausted … the hope would be that we can get through this time and get to the other side of this.”

Source: MedPage Today