Tag: 30/8/22

Categories : Cardiovascular Disease Diseases, Syndromes and ConditionsTags :

Array of Autoimmune Disorders Linked to Cardiovascular Disease

On By ModernMedia
Source: Wikimedia Commons CC0

A new epidemiological study published in The Lancet shows that patients with autoimmune disease have a substantially higher risk (between 1.4 and 3.6 times depending on which autoimmune condition) of developing cardiovascular disease (CVD) than people without an autoimmune disorder. This excess risk is comparable to that of type 2 diabetes, a well-known risk factor for cardiovascular disease.

Although earlier research has suggested associations between various different autoimmune disorders and a higher risk of cardiovascular disease, these studies were often too small and limited to selected autoimmune or selected cardiovascular conditions to draw conclusive evidence on the necessity of CVD prevention among patients with autoimmune disease.

At the annual congress of the European Society of Cardiology, researchers presented the outcome of a thorough epidemiological investigation into possible links between 19 of the most common autoimmune disorders and CVD. The research shows for the first time that cardiovascular risks affect autoimmune disease as a group of disorders, rather than selected disorders individually.

The whole cardiovascular disease spectrum

In the study, the authors show that the group of 19 autoimmune disorders they have studied accounts for about 6% of cardiovascular events. Importantly, excess cardiovascular risk was visible across the whole cardiovascular disease spectrum, beyond classical coronary heart disease, including infection-related heart disorders, heart inflammation, as well as thromboembolic and degenerative heart disorders, suggesting the implications of autoimmunity on cardiovascular health are likely to be much broader than originally thought. Furthermore, the excess risk was not explained by traditional cardiovascular risk factors such as age, sex or smoking. Another noteworthy finding: the excess risk is particularly high among patients with autoimmune disorders under 55 years and suggests that autoimmune disease is particularly important in causing premature cardiovascular disease, with the potential to result in a disproportionate loss of life years and disability.

The study was based on UK electronic health with data from about one-fifth of the current UK population. The researchers assembled a cohort of patients newly diagnosed with any of the nineteen autoimmune disorders. They then looked at the incidence of twelve cardiovascular outcomes – an unprecedented granularity that was made possible by the very large size of the dataset – in the following years, and they compared it to a matched control group. The risk of developing CVD for patients with one or more autoimmune disorders was on average 1.56 times higher than in those without autoimmune disease. The excess risk also rose with the number of different autoimmune disorders in individual patients. Among the disorders with the highest excess risk were systemic sclerosis, Addison’s disease, lupus and type I diabetes.

Need for targeted prevention measures

The results show that action is needed, said Nathalie Conrad, lead author of the study. “We see that the excess risk is comparable to that of type 2 diabetes. But although we have specific measures targeted at diabetes patients to lower their risk of developing cardiovascular disease (in terms of prevention and follow-up), we don’t have any similar measures for patients with autoimmune disorders.” Conrad also noted that the European Society of Cardiology guidelines on the prevention of cardiovascular diseases, do not yet mention autoimmunity as a cardiovascular risk factor, only mentioning specific disorders such as lupus, nor do they list any specific prevention measures for patients with autoimmune disease.

Conrad hopes the study will raise awareness among patients with autoimmune disease and clinicians involved in the care of these patients, which will include many different specialties such as cardiologists, rheumatologists, or general practitioners. ‘We need to develop targeted prevention measures for these patients. And we need to do further research that helps us understand why patients with an autoimmune disorder develop more cardiovascular diseases than others, and how we can prevent this from happening.’

The underlying mechanisms are still poorly understood. Conrad said: “The general hypothesis is that chronic and systemic inflammation, which is a common denominator in autoimmune disorders, can trigger all sorts of cardiovascular disease. Effects of autoimmune disease on connective tissues, small vessels, and cardiomyocytes, and possibly some of the treatments commonly used to treat autoimmunity are also likely to contribute to patients’ cardiovascular risk. This really needs to be investigated thoroughly.”

Source: KU Leuven

Categories : Metabolic DisordersTags :

Early Diabetes, Hypertension Accelerates Development of Glaucoma

On By ModernMedia
Credit: National Eye Institute

Developing Type 2 diabetes or hypertension earlier in life is linked to the earlier development of the most common form of glaucoma, according to a study published in Clinical Ophthalmology. These findings could lead to better screening protocols for primary open-angle glaucoma (POAG), the leading cause of irreversible blindness worldwide, which makes up nearly 90% of all cases of glaucoma.

“Currently, we lack the tools to cure glaucoma, but with enough advanced notice, we can preserve patients’ vision. Early detection of glaucoma is the key to better control of intraocular pressure and preventing blindness,” said study leader Karanjit Kooner, MD, PhD, MBA, Associate Professor of Ophthalmology at UTSW.

Tens of millions of people have POAG around the globe. Because this disease has few symptoms in its earliest stages, Dr. Kooner explained, patients are frequently diagnosed in its later stages when vision has already been permanently damaged. Although researchers have identified several risk factors for POAG – including Type 2 diabetes, hypertension, migraines, and obstructive sleep apnoea — how they might influence the onset of POAG is not well understood.

To answer this question, Dr Kooner and his colleagues collected data from the medical records of 389 of his patients with POAG. The researchers found no link between migraines and/or obstructive sleep apnoea and the age of POAG onset. However, the researchers found that the age of Type 2 diabetes and/or hypertension diagnosis was significantly linked with the onset of POAG – the earlier patients presented with either or both of these conditions, the earlier they tended to develop POAG.

Dr Kooner noted that both Type 2 diabetes and hypertension are diseases that affect blood vessels of both the optic nerve and retina, thus potentially causing changes that predispose patients to POAG, another condition with a vascular root. If these connections hold up in future research, he said, Type 2 diabetes and hypertension could be added to the list of factors that can trigger POAG screening — including a family history of POAG, elevated intraocular pressure, and Black race — and lead to earlier diagnosis of POAG, preserving patients’ vision and quality of life.

Source: UT Southwestern Medical Center

Categories : Diseases, Syndromes and Conditions HospitalsTags :

Toss Out Hospital Sinks Colonised by MDRO, Evidence Suggests

On By ModernMedia
Methicillin-resistant Staphylococcus aureus (MRSA) bacteria. Credit: CDC

An outbreak of a pandrug-resistant nosocomial pathogen was interrupted by not using hospital sinks during COVID, according to Basma Mnif, Professor of Microbiology at Habib Bourguiba University Hospital of Sfax, Tunisia. In her presentation at the 14th SAFHE Southern African Healthcare Conference, she said that infection control methods to eradicate the pathogen failed and that other research indicated it was necessary to replace the sinks entirely.

Multidrug-resistant organisms (MDRO) are a growing threat in hospitals, especially to critically ill patients.

Over 2017 to 2021, 90 critically ICU patients in a Tunisian hospital were infected with pandrug-resistant Proteus mirabilis strains. This is the first known long-term outbreak by pandrug-resistant P. mirabilis strains.

P. mirabilis is an uncommon nosocomial pathogen causing opportunistic infections. P. mirabilis survives well in the natural environment and is increasingly implicated in nosocomial outbreaks worldwide.

The all-cause mortality rate in the infected was 47%, with patients ranging in age from 16 to 78 years. The average length of stay before infection was 23.56 days.

An outbreak was recognised in April 2017, and IDC measures were taken to contain it. The outbreak was suppressed but reoccurred in July and December. Analysis revealed overlapping ICU stays of infected patients, suggesting horizontal, intra-ICU transmission. Lab analysis of phenotypes revealed two clones, A and B, both with drug resistance genes, to which a third clone was added in 2018. This Clone C proved to have resistance to all known antibiotics.

During the COVID pandemic in 2020, hospital sinks were not used and enhanced infection prevention interventions were deployed. This period coincided with a complete absence of P. mirabilis infections. The outbreak resumed in 2021, with the same three clones causing infections in patients.

“The outbreak intermission during COVID could be related to the enhanced protection measures implemented during this period,” Prof Mnif noted, “but we think that the sinks are in fact the reservoirs of these MDRO, and must in fact be removed and replaced, and the chemical disinfection that we had performed was not sufficient to control the outbreak.”

The outbreak highlighted the need for proper infection control protocols. Hospital wastewater is a major source of outbreaks, Prof Mnif pointed out. A study found that “over the past 20 years, there have been 32 reports of carbapenem-resistant organisms in the hospital water environment.”

She said when it came to replacing the sinks, hospitals should “respect FGI guidelines, especially in having sufficient depths of the sink, deep enough to prevent splashing.” Having sufficient pressure and splash reduction measures such as splash guards are also important, Prof Mnif added.

Although there are CDC guidelines to help prevent colonisation, there is no clear strategy for eradication for when a sink is colonised. There is likely genetic interchange between organisms in biofilms, something which needs to be investigated further, as well as means of eradication.

Categories : Mental Health PaediatricsTags :

Half of Moms of Autistic Children Have High Depressive Symptoms

On By ModernMedia
Woman with depression
Photo by Sydney Sims on Unsplash

About 50% of all mothers of children with autism spectrum disorder (ASD) had raised levels of depressive symptoms over 18 months, while rates were much lower (6% to 13.6%) for mothers with neurotypical children in the same period, according to a new study in Family Process.

Additionally, thought past studies suggest that having a parent with depression increases the child’s risk of mental health and behaviour problems, this study found something different.

“We found mothers’ higher symptoms of depression did NOT predict increases in children’s behaviour problems over time, including among families with a child with autism who experience a lot of stress,” said first author and UCSF Assistant Professor Danielle Roubinov. “That was surprising and good news.”

“Being the parent of a child with special needs is inherently challenging every day,” noted senior author UCSF Professor Elissa Epel. “It is a prototypical example of chronic stress, which is why we have been focusing on caregiving moms in our studies that examine effects of stress on health.”

“We already know from this sample that mothers with more depression tend to have signs of faster biological aging, such as lower levels of the anti-aging hormone klotho and older immune cells, on average,” added Prof Epel. “Here, we wanted to understand the impact of their depression on their child, and vice versa.”

A One-Way Street

Child behaviour problems predicted higher levels of maternal depression down the road, regardless of ASD status. The inverse effect was not seen, ie prior maternal depression didn’t predict later child behaviour problems.

Asst Prof Roubinov said that mothers of children with ASD need not feel guilty over their depressions impact on their children’s behaviours. “We hope these findings will reassure mothers that it’s both common to struggle with some depression in this high-stress situation of chronic caregiving, and that their depression likely isn’t making their child’s behavioural issues worse.”

Self-blame and guilt among parents of ASD children is common and predicts worsening depression and lower life satisfaction over time, the team’s past research shows.

In the current study, the researchers repeatedly measured maternal depression and children’s behaviour problems in 86 mother-child dyads across 18 months. Half of the mothers had children with ASD and half had neurotypical children. The children were aged 2–17 years old, with 75% being primary school age or younger.

Maternal depression was measured using the Inventory of Depressive Symptoms, a self-report scale completed by mothers. Child behaviour was measured through maternal report on the Child’s Challenging Behavior Scale, which focuses on externalising behaviours such as tantrums, aggression and defiance.

Few studies on maternal depression, child behaviour in ASD context

Bidirectional associations between maternal depression and child behaviour problems have been reported in prior research but few studies have examined these relationships in families with autism.

Families with autism tend to experience more marital conflict, lower relationship satisfaction, and many other challenges, said Ass Prof Roubinov, noting that a “stressful family environment may spill over onto family members” and changing their interactions. “We wanted to see whether the link between maternal and child mental health was different in the context of a high-stress family system, such as when a child has autism.”

Although the study acknowledged that families with a child with ASD experience high levels of stress, the authors were cautious to note that stress is not their only defining characteristic.

“Many mothers of children with autism also report high levels of emotional closeness and positive interactions with their children,” Asst Prof Roubinov said. “These are important experiences that supportive programs can build upon.”

The researchers offered mindfulness classes after the study to the participants to help manage parenting stress, and this improved their mental health.

It is important to experience and notice positive emotions and joy, despite having a more challenging life situation, said Prof Epel.

“Given the effects of chronic stress on health and mood, caregiving parents need extraordinary emotional support in addition to the special services for their child,” she said. “It’s as vital to provide support for parents’ mental health as it is for children’s mental health.”

Physicians should be on the lookout for parental distress and ready to offer resources for parents, especially for parents of special needs children, she said. The researchers said future studies should also look at associations between maternal depression and children’s internalising symptoms (eg, withdrawal, anxiety, emotional reactivity).

Source: University of California – San Francisco

Categories : Medical IndustryTags :

New Sanofi GM Poised to Transform Southern Africa Medical and Pharma Industry

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Kagan Keklik, General Manager South Africa & Country Lead, Sanofi South Africa

Johannesburg, 30 August 22: Kagan Keklik has taken the reigns as General Manager South Africa & Country Lead of multinational pharmaceutical and healthcare company, Sanofi, in South Africa, at a time when revolutionary technology and medical interventions are set to change lives across Africa.

With all the business acumen needed, a passion for science and expertise across several therapeutic areas and products, Keklik is already inspiring excellence in the 500 plus workforce that he leads in South Africa.

Keklik has over 20 years of experience in the pharmaceutical sector where the positions he has held have spanned from managing products to leading teams in the Middle East, Eurasia, and South Asia. He has been with Sanofi for nearly 13 years, making him well-poised to take the company to new heights.

“Sanofi is dedicated to finding answers for patients by developing breakthrough medicines and vaccines. Our purpose is to chase the miracles of science to improve the lives of patients, partners, communities and our own people. We provide potentially life-changing treatments and life-saving vaccines to millions of people as well as affordable access to our medicines in some of the world’s poorest countries,” says Keklik.

Keklik is excited about the potential of the South African market. “South Africa is considered the gateway to the African continent and is an important market for the Sanofi Group. The people are driven and dynamic and there are great opportunities for growth. We are passionate about knowledge and technology transfer to ensure the local manufacturing of medicines. We sincerely look forward to helping to make a difference and I look forward to working with my team to drive change in the region,” says Keklik.

Keklik is a great proponent for forging important alliances, such as the strategic partnership with South African manufacturer, Biovac, for the local manufacture of vaccines through the transfer of manufacturing excellence, skills, and knowledge.

Keklik’s vision takes this even further: “As a world leader in the development and delivery of vaccines, we fully support continued investment in localised manufacturing and the sustainability of local vaccine supply. Through long-term partnerships such as the one we have with Biovac, we can ensure that South Africa can be a manufacturing hub that will improve the distribution of vaccines into neighboring countries.”

Supported by a strong team, Keklik is enthusiastic about unlocking not only the potential of the region but also of Sanofi itself. He sees himself as a transformative leader and believes in inspiring and empowering individuals and teams to achieve the company’s goals. At the same time, he is prepared to push limits to make a difference in both the prescription and over-the-counter medication markets.

“We are focused on growth and believe this can be achieved if we lead with innovation and accelerate efficiencies. I’ll be focusing on these levers over the next few years to ensure Sanofi maintains its position as a leading healthcare company, not only in South Africa, but throughout the region,” says Keklik.