A study by researchers at the University of Southampton shows that antibiotics may be an effective treatment for acute non-complicated appendicitis in children, instead of surgery.

The condition, which causes the appendix – a small organ attached to the large intestine – to become inflamed due to a blockage or infection, affects mainly children and teenagers. Appendicitis is currently treated through an operation to remove the appendix, an appendicectomy, and it is the most common cause of emergency surgery in children.

The review, led by Nigel Hall, Associate Professor of Paediatric Surgery at the University of Southampton, assessed existing literature published over the past 10 years that included 10 studies reporting on 413 children who received non-operative treatment rather than an appendectomy.

It shows that no study reported any safety concern or specific adverse events related to non-surgical treatment, although the rate of recurrent appendicitis was 14 per cent.

Mr Hall, who is also a Consultant Paediatric and Neonatal Surgeon at Southampton Children’s Hospital, commented: ‘Acute appendicitis is one of the most common general surgical emergencies worldwide and surgery has long been the gold standard of treatment. But it is invasive and costly, not to mention extremely daunting for the child concerned and their family. Our review shows that antibiotics could be an alternative treatment method for children. When we compared the adult literature to the data in our review it suggested that antibiotic treatment of acute appendicitis is at least as effective in children as in adults. This now needs to be explored more widely.’

The review says that longer term clinical outcomes and cost effectiveness of antibiotics compared to appendicectomy require further evaluation, preferably as large randomised trials to reliably inform decision making.

University of Southampton www.southampton.ac.uk/news/2017/01/antibiotics-appendicitis.page

Simultaneous injections of the radiopharmaceuticals fluorine-18 fluorodeoxyglucose (18F-FDG) and 18F-sodium fluoride (18F-NaF) followed by quantitative scanning significantly improves image quality and detection of bone metastases at a lower dose, according to research presented at the 2017 Annual Meeting of the Society of Nuclear Medicine and Molecular Imaging (SNMMI).
“For certain patients with breast and prostate cancer who require evaluation of metastatic disease, a single PET/MR exam can provide more accurate information with less radiation dose in one procedure that is more convenient for patients and potentially less costly for the healthcare system,” said Andrei Iagaru, MD, associate professor of radiology and division chief, Nuclear Medicine and Molecular Imaging, Stanford University School of Medicine in Stanford, Calif.  
Dual-agent PET/MR is further supported by time of flight, a quantitative feature of modern PET image reconstruction that approximates the position where photons are created as radioactive agents decay, which translates into finer image quality.
For this study, researchers prospectively enrolled 55 cancer patients—39 men with prostate cancer and 17 women with breast cancer, ages 34 to 85, in line for conventional bone scan to determine the spread of their disease. All participants were administered simultaneous injections of the imaging agent 18F NaF for the evaluation of bone turnover and FDG for increased metabolic activity and/or inflammation.
After injection, scientists performed PET/ MRI scans with time of flight capability and compared the results with conventional technetium 99m-methyl diphosphonate (99mTc MDP) bone scintigraphy. Results of the study showed improved detection of prostate and breast cancer that had metastasized to bone. Dual-agent PET/MR pointed to bone metastases in 22 patients who were also found positive for metastases with conventional bone scan. In addition, PET/MR detected more bone metastases in 14 patients when compared to the conventional bone scan, which caught only one lesion that was not detected by PET/MR.
Researchers concluded that PET/MR found a greater extent of metastases and, as an added benefit, significantly reduced the required radiation dose from the injected agents—80 percent less from 18F-NaF and 67 percent less from 18F-FDG.

Society of Nuclear Medicine and Molecular Imaging www.snmmi.org/NewsPublications/NewsDetail.aspx?ItemNumber=24410

In the last decade, mounting evidence has linked seizure-like activity in the brain to some of the cognitive decline seen in patients with Alzheimer’s disease. Patients with Alzheimer’s disease have an increased risk of epilepsy and nearly half may experience subclinical epileptic activity – disrupted electrical activity in the brain that doesn’t result in a seizure but which can be measured by electroencephalogram (EEG) or other brain scan technology.
In a recent feasibility study, clinician-scientists at Beth Israel Deaconess Medical Center (BIDMC) tested an anti-epileptic drug for its potential impact on the brain activity of patients with mild Alzheimer’s disease. The team, led by Daniel Z. Press, MD, of the Berenson-Allen Center for Non-invasive Brain Stimulation at BIDMC, documented changes in patients’ EEGs that suggest the drug could have a beneficial effect.
“In the field of Alzheimer’s disease research, there has been a major search for drugs to slow its progression,” said Press, an Instructor of Neurology in the Cognitive Neurology Unit at BIDMC and an Associate Professor of Neurology at Harvard Medical School. “If this abnormal electrical activity is leading to more damage, then suppressing it could potentially slow the progression of the disease.”
In this double-blind within-subject study, a small group of patients with mild Alzheimer’s disease visited BIDMC three times. At each visit, patients were given a baseline (EEG) to measure the electrical activity in the brain. Next, patients were given injections containing either inactive placebo or the anti-seizure drug levetiracetam, at either a low dose (2.5 mg/kg) or a higher dose (7.5 mg/kg). Neither patients nor medical professionals knew which injections patients were receiving, but each patient eventually got one of each type, in a random order.
After receiving the injection, patients underwent another EEG, then magnetic resonance imaging (MRI) – which measures blood flow in the brain, another way to quantify brain activity and determine where in the brain it is taking place. Finally, patients took a standardized cognitive test, designed to measure memory, executive functioning, naming, visuospatial ability and semantic function – capabilities all affected by Alzheimer’s disease.
In the seven patients able to complete the study protocol successfully, Press and colleagues analysed changes in their EEGs. (Blood flow analysis from the MRI data is still underway.) Overall, higher doses of the anti-seizure drug appeared to normalize abnormalities seen in the patients’ EEG profiles. That is, researchers saw overall increases in brain wave frequencies that had been abnormally low in Alzheimer’s disease patients prior to receiving the higher dose of levetiracetam, and, likewise, saw decreases in those that had been abnormally high.
“It’s worth noting, we did not demonstrate any improvement in cognitive function after a single dose of medication in this study,” said Press. “It’s too early to use the drug widely, but we’re preparing for a larger, longer study.”

Beth Israel Deaconess Medical Center
www.bidmc.org/News/PRLandingPage/2017/June/Press-Anti-Epilepsy-Alzheimers.aspx

Patients with hypertrophic cardiomyopathy are urged to take it easy. But new research shows they might benefit from moderate aerobic exercise.
Exercise for cardiovascular disease patients.
As one of the most common causes of sudden cardiac death in young people, hypertrophic cardiomyopathy can push patients into sedentary lifestyles.

Current guidelines recommend people with HCM, the most common genetic cardiovascular disease, limit intense exercise because of concerns over triggering ventricular arrhythmias. But new Michigan Medicine research finds there may be reason to re-evaluate the guidelines.

‘We are challenging the idea that exercise is dangerous for these patients,’ says senior author Sharlene Day, M.D., a Michigan Medicine cardiologist and associate professor. ‘And we show that it can actually be beneficial.’

University of Michigan researchers collaborated with colleagues at Stanford University and the VA Palo Alto Health Care System for the study, released in JAMA and presented as a late-breaking clinical trial at the American College of Cardiology’s annual Scientific Session.

The preliminary study announced a small but statistically significant increase in exercise capacity in HCM patients who underwent moderate-intensity exercise training.

The general population is encouraged to stay active to maintain good health and reduce the risk of cardiovascular events. Yet because of the risk of sudden cardiac death, people with HCM are told not to participate in competitive sports.

But there isn’t a global consensus on whether it’s safe for those with HCM to participate in recreational activities, such as jogging. Surveys have revealed most patients with HCM reduce their activity levels after diagnosis, becoming less active than the general population.

First author Sara Saberi, M.D., says providers need data to guide their recommendations so they don’t become coloured by emotion.

‘We have those images entrenched in our brains of young, healthy athletes collapsing suddenly in the middle of a competition, and these devastating events trigger a visceral response,’ says Saberi, a Michigan Medicine cardiologist and assistant professor. ‘But by limiting exercise, we’re creating another set of health problems that stem from obesity, like coronary heart disease, diabetes, obstructive sleep apnoea, depression and anxiety.’

Saberi’s team studied 136 patients with HCM between ages 18 and 80. For 16 weeks, members of one group were told to continue with their usual level of physical activity while the other group members were given individualized exercise plans the researchers created.

The exercises were moderate, including walking, using an elliptical machine, jogging or biking, and excluding intervals or weight training. The participants began week one working out at least three times each week for 20 minutes. By the end of the program, they were working out four to seven times per week for up to an hour.

The exercise group participants experienced a small but statistically significant increase in peak VO2 max, a measure of exercise capability, after the 16 weeks. Reduced peak VO2 is common in HCM patients, and it correlates with mortality in HCM.

‘The findings show patients that follow an exercise prescription can actually train and improve their functional capacity,’ Saberi says.

In this preliminary study, neither group experienced any major adverse effects, such as death, appropriate shocks from an implantable cardioverter-defibrillator or sustained ventricular tachycardia.

Of note, there was also a statistically significant improvement in self-reported physical functioning in the exercise group compared with the usual-activity group.

‘The findings show patients that follow an exercise prescription can actually train and improve their functional capacity.’

Michigan Medicine labblog.uofmhealth.org/lab-report/moderate-exercise-may-be-beneficial-for-hcm-patients

EKF Diagnostics, the global in vitro diagnostics company, has published a guide to ‘Diabetes and HbA1c testing’ which can be found at EKF’s new Diabetes Portal (www.ekfdiagnostics.com/diabetes-portal.html). This new educational guide draws on EKF’s expertise in the diagnosis and monitoring of diabetes and associated conditions. It provides an overview of the global diabetes ‘epidemic’, symptoms and complications, through to discussion on methods for diagnosis and monitoring using both glucose and HbA1c testing, with consideration given to factors influencing their measurement.
Diabetes is a growing issue, particularly in developing countries, with five million people dying from diabetes related complications in 2015 alone. Although not an ‘epidemic’ in the conventional sense, there are currently 415 million people living with diabetes and this is predicted to grow to 642 million by 2040. Approximately 46% of people living with diabetes are doing so without a full and proper diagnosis with subsequent complications, and associated healthcare costs.
There are multiple options for the diagnosis of diabetes, most of which involve measuring the level of glycemic control a person exhibits. In addition to methods such as fasting plasma glucose and two-hour plasma glucose, another option is to use glycated hemoglobin (HbA1c) which reflects average plasma glucose over an 8-12 week period. As well as lab-based testing, WHO has approved HbA1c for diabetes diagnosis with a Point of-Care-Testing (POCT) device, providing the test is undertaken by a trained professional adhering to an appropriate External Quality Assurance scheme and using a methodology traceable to the IFCC reference method. POCT HbA1c testing gives a strong indication of both diabetes and pre-diabetes within a timeframe that enables immediate intervention.
Since it is not impacted by the same issues as blood glucose monitoring, HbA1c testing is fast becoming the preferred technique for diabetes and pre-diabetes diagnosis and monitoring. There are situations where use of HbA1c is not appropriate though. EKF’s new Guide includes discussion on both glucose and HbA1c testing and where factors may influence measurement of both diagnostic markers.
“The often ‘low to no’ maintenance approach to disease management of diabetes is not only dangerous but can also significantly contribute to ongoing healthcare costs. At present, approximately 12% of global health expenditure is spent on diabetes, and without significant changes to the way patients and health systems monitor glycemic control this will surely rise,” said Gavin Jones, Global Product Manager for Diabetes Care at EKF Diagnostics. “To enhance patient outcomes and reduce the cost for long-term healthcare of the diabetic and pre-diabetic population, we aim to improve patient access to diabetes care techniques, whatever their location. This can be achieved by providing affordable, easy-to-use POCT analysers and chemistry assays for both diabetes diagnosis and monitoring.”
EKF’s expertise and product range cover all aspects of diabetes care, from research and hospital laboratories to diabetes clinics, emergency rooms and GP surgeries. Products include the Biosen C-Line glucose analyser, which uses chip sensor technology to provide low cost, fast and lab accurate glucose results. Quo-Test and Quo-Lab point-of-care HbA1c analysers that deliver results meeting NGSP and IFCC POC requirements in four minutes. And lastly, to aid the diagnosis and monitoring of diabetes related conditions such as ketoacidosis, EKF offers Beta-Hydroxybutyrate LiquiColor Reagent and the handheld STAT-Site M β-HB strip-based analyser.
www.ekfdiagnostics.com