Tag: 5/1/21

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Antibiotic Overuse by Children’s Hospitals Contributing to Antibiotic Resistance

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Children’s hospitals may be contributing to antibiotic resistance by overprescription of antibiotics, according to a recent study.

The study, conducted by the University of Alabama at Birmingham (UAB),   found that in 51 children’s hospitals across the United States, rates of antibiotic administration ranged from 22% to 52%. Approximately a quarter of children receiving antibiotics were receiving them incorrectly. This adds to a growing body of evidence that points to antibiotics overuse and misuse by children’s hospitals – which ought to know better.Study co-author, Dr Jason Newland said, “There’s no doubt: We’ve seen some extra use of antibiotics, The impact of the pandemic on antibiotic use will be significant.

“The study’s numbers are likely an underestimate since the research involved 32 children’s hospitals already working together on proper antibiotic use. Newland said the US’ more than 250 children’s hospitals need to improve. Even though COVID fears have reduced the numbers of children’s hospital visits, antibiotics are still being prescribed via telemedicine.

“I hear a lot about antibiotic use for the ‘just in case’ scenarios,” said Dr Joshua Watson, at Nationwide Children’s Hospital in Ohio. “We underestimate the downsides.”

Dr Shannon Ross, an associate professor of paediatrics and microbiology at UAB, said that not all doctors have been taught the correct use of antibiotics. Regarding this overuse, she said, “Many of us don’t realize we’re doing it. It’s sort of not knowing what you’re doing until someone tells you.”
Unnecessary antibiotic use is a problem, and the pandemic “has thrown a little bit of gas on the fire,” said Dr Mark Schleiss, a paediatrics professor at the University of Minnesota Medical School.

“It’s irresponsible,” said Christina Fuhrman, who almost lost her infant daughter to a Clostridium difficile infection, and who now advocates for correct antibiotic use. Along with parents begging for antibiotics in paediatricians’ offices, the situation is “creating a monster.”
Many studies have attested to the rise of C. diff in children, which causes gastrointestinal problems. A 2017 study found that cases of a certain multidrug-resistant Enterobacteriaceae type rose 700% in American children in just eight years. And a steady stream of research points to the stubborn prevalence in kids of the better-known MRSA, or methicillin-resistant Staphylococcus aureus.

“It’s getting more and more worrisome,” said Ross. “We have had patients we have not been able to treat because we’ve had no antibiotics available.”

Source: News-Medical.Net

Journal information: Tribble A, Lee B, Flett K et al. Appropriateness of Antibiotic Prescribing in United States Children’s Hospitals: A National Point Prevalence Survey. Clinical Infectious Diseases. 2020;71(8):e226-e234. doi:10.1093/cid/ciaa036 

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Unmedicated Autism Associated With Substance Abuse

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A Taiwanese study has shown that individuals diagnosed with untreated autism spectrum disorder (ASD) have higher rates of substance abuse compared to those on treatment.

The researchers used inpatient and outpatient data of 6 599 individuals with ASD who had at least 3 outpatients visits for ASD, drawn from the Taiwan National Health Insurance Research Database. They found an increased risk of substance use disorder (SUD) among those who were not receiving medication for ASD (adjusted hazard ratio 2.33, 95% CI 1.89-2.87). The risk for drug abuse was three times higher, and the risk for alcohol abuse was two times higher.

Additionally, those with comorbid SUD had over a three times greater risk of death over a follow-up period of 8.1 years.Those taking psychotropic agents had a 40% reduction for SUD risk when taking one agent, and a 63% reduction with a multiagent.

There were several comorbidities of psychiatric disorders seen in patients with ASD, such as intellectual disability, attention deficit hyperactivity disorder, tic disorder, epilepsy, obsessive-compulsive disorder, mood disorder, anxiety disorder, and impulse control disorder. However, individuals with ASD had a higher risk of SUD even compared with matched controls with the same comorbidities. SUD risk was highest with certain comorbidities; untreated ASD with comorbid tic disorder was 6 times higher; with a comorbid impulse control disorder, it was five times higher.

The researchers stated that these are critical findings, but of limited use due to the “umbrella term” of substance use disorder, and further studies will be needed to examine the specific types of drug use amongst individuals with ASD. Future research could investigate whether non-pharmaceutical treatments such as behavioural therapy had the same effect.They conclude that screening  individuals with ASD for SUD is important, given the findings of the study.

Source: MedPage Today

Journal information: Huang J, Yang F, Chien W, et al. Risk of Substance Use Disorder and Its Associations With Comorbidities and Psychotropic Agents in Patients With Autism. JAMA Pediatr. Published online January 04, 2021. doi:10.1001/jamapediatrics.2020.5371

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Brown Fat May Protect Against Multiple Chronic Diseases

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Brown fat, which is found around the neck and shoulders, was once thought only to be beneficial to newborns, but has more recently been thought to have beneficial health effects in humans. However, it has been challenging to study since it is so deeply buried.

In mouse models, brown fat is known to be thermogenic, significantly improving glucose and lipid homeostasis, but in humans its role in metabolism and cardiovascular disease was still unclear. The prevalence of brown fat is difficult to measure in humans, since the only noninvasive way to detect it is with expensive PET scans. However, radiologists have to distinguish brown fat from tumours in PET scans, and this provided a valuable resource to establish the prevalence of brown fat in the population. The researchers used 134 529 PET scans of 52 487 patients.

Brown fat was found in some 10% of the population, which may be an underestimate since individuals undergoing the scans were told to avoid cold, exercise and caffeine, which are all known to increase the activity of brown fat.

“For the first time, it reveals a link to lower risk of certain conditions,” said Paul Cohen, Assistant Professor at The Rockefeller University Hospital. “These findings make us more confident about the potential of targeting brown fat for therapeutic benefit.”

Despite this new evidence, exactly how brown fat contributes to health is still unclear, although there are some clues. Brown fat uses glucose to generate energy, and this may help lower blood glucose levels. The role hat brown fat plays in hypertension, which is tightly connected to the hormonal system, is less clear.”We are considering the possibility that brown fat tissue does more than consume glucose and burn calories, and perhaps actually participates in hormonal signaling to other organs,” Cohen says.

The researchers plan to investigate the biology of brown fat, such as by looking for genetic variations to explain why some have it and others do not, which may lead to pharmacological treatments.

“The natural question that everybody has is, ‘What can I do to get more brown fat?'” Cohen said. “We don’t have a good answer to that yet, but it will be an exciting space for scientists to explore in the upcoming years.”

Source: Medical Xpress

Journal information: Becher, T., Palanisamy, S., Kramer, D.J. et al. Brown adipose tissue is associated with cardiometabolic health. Nat Med (2021). doi.org/10.1038/s41591-020-1126-7

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New “Spray-on” Wound Dressing Mimics Skin

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A new kind of burn dressing developed by an Israeli company, Nanomedic, is being used in Israel, Europe and India, and applies a flexible dressing without contact.

Called “Spincare”, it is contactless and is sprayed on by an applicator. Normal burn dressings are difficult to apply because they can cause so much pain.The breathable “skin substitute” is flexible, which is important for allowing movement for wound rehabilitation, and is also easy for patients to apply. Unlike traditional wound dressings, it also allows patients to shower, and, being translucent, allows clinicians to inspect the wound without having to remove the dressing.

The technology is based on “electrospinning“, where electricity is applied to a solution to make nanofibres. Electrospinning had mostly been used to produce air filters, but it was only until the 1990s that the technology began to acquire other applications. Though the technology has been used in medical applications before, this is the first time such a device small enough to use at a patient’s bedside has been developed.

It is effective at treating shallow burns, but less effective for deep burns, according to the manufacturer. It also has applications in areas such as facial wound dressings, where traditional bandages are cumbersome, This new technology comes at a time when there is debate in wound care management, as to whether frequent replacement of dressing for checking purposes is in fact counterproductive. This new technology would join other types of wound dressing increasingly being used that require fewer changes.

Source: The Guardian

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SA Scientists Warn Local COVID Variant May Resist Vaccine

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South African scientists have said that there is a “reasonable concern” that the South African strain of SARS-CoV-2 may have greater resistance to current vaccines, and underscored the need for global vaccination.

Speaking to the BBC,  Prof Shabir Madhi, who has led vaccine trials in South Africa, explained, “It’s a theoretical concern. A reasonable concern… that the South African variant might be more resistant.” 

The South African variant has mutated far more than the UK variant, raising the possibility that it may be able to evade the antibodies that typically fight coronavirus.

Prof Helen Rees, a vaccine expert at Wits University, said, “Fortunately, should further modifications of the vaccine be required to address the new variants, some of the vaccine technologies under development could allow this to be done relatively rapidly.”

South African scientists recently pushed back against the notions that the SA variant was more transmissible than the UK one, or that it is more deadly. Explaining the reason for the flight restrictions from South Africa, UK Health Secretary Matt Hancock has stated that he believed it was more infectious than the UK variant, saying “This is a very, very significant problem […] and it’s even more of a problem than the UK new variant.”
The UK variant has a “transmission advantage” of 0.4 to 0.7, leading to reproduction numbers of 1.4 to 1.8.Prof Madhi said laboratory tests would determine whether current vaccines would be effective against this variant in a few weeks.

Source: BBC News