People with multiple sclerosis can show signs of something wrong five years before the onset of disease, much earlier than previously thought, according to a new analysis of health records from people with the condition.

The new research is a first step to identifying red flags to help doctors screen for the disease and start interventions earlier. This could point researchers in a new direction for finding the root cause of the disease.

‘Proving that people with multiple sclerosis have already changed their behaviour in the five years before even the earliest medical recognition of the condition is very important because it means we have to look beyond those five years to understand how it is caused,’ said Helen Tremlett, senior author of the study and a professor in the department of medicine at the Djavad Mowafaghian Centre for Brain Health.

Multiple sclerosis is thought to be an autoimmune disease where the body attacks the protective coating, known as myelin, around brain cells. Once a person is diagnosed with multiple sclerosis, a physician will try to pinpoint the onset of the disease, sometimes known as the patient’s first demyelinating event, and can include problems with vision or motor control.

The researchers examined health records of 14,000 people with multiple sclerosis from B.C., Saskatchewan, Manitoba and Nova Scotia over a 20-year period and compared them to the health records of 72,000 people without the disease. They were looking for something called a prodrome, an early set of symptoms that can indicate the onset of a disease.

Prodromes have been identified for other neurological conditions like Alzheimer’s and Parkinson’s diseases. The recognition of these prodromes has provided clues about how the diseases might begin and has stimulated new research into causes or triggers.

This study of patients from across Canada revealed that there is a phase where people begin to show symptoms before multiple sclerosis is medically recognized. During this phase patients tend to visit their physicians, be admitted to a hospital and fill prescriptions more than the general population.

‘There’s something going on here that makes this population of people unique,’ said Jose Wijnands, first author of the manuscript, a postdoctoral fellow and a Michael Smith Foundation for Health Research trainee.

‘When other degenerative brain diseases have a prodrome, it suggests that something may be happening,’ said Tremlett. ‘We hope to uncover what this might be in multiple sclerosis.’

Going forward, the team of researchers will try to understand why these patients had been using the health-care system differently, and whether there are trends in illnesses reported and prescriptions filled that point to a specific set of symptoms that doctors could use to help identify multiple sclerosis earlier.

University of British Columbia news.ubc.ca/2017/04/21/medical-history-reveals-multiple-sclerosis-begins-to-impact-patients-sooner/

A new University of Alberta study showed that around-the-clock care from senior physicians helped reduce major complications in cardiac surgery patients as compared to receiving care from resident physicians. The study examined the results of more than 3,000 Alberta patients at the University of Alberta Hospital and Mazankowski Alberta Heart Institute.  Around-the-clock care from senior physicians helped reduce major complications in cardiac surgery patients as compared to receiving care from resident physicians, according to a new University of Alberta study.
Researchers found that patients who received 24/7 intensivist physician care had a seven per cent lower risk (26% vs 19%) of experiencing major complications and a nearly-four per cent lower chance (5.3% vs 1.6%) of cardiac surgical intensive care unit (ICU) readmission. Patients also experienced less time receiving mechanical ventilation and fewer surgical postponements.
The study examined the results of more than 3,000 Alberta patients at the University of Alberta Hospital and Mazankowski Alberta Heart Institute. Half were cared for at night by resident physicians over a seven-year period (2006-2013), with the other half cared for by dedicated in-house intensivist physicians over a period of 17 months (2013 and 2014).
“There have previously been large studies [examining this issue in general ICU units] and they have not found any benefit to taking residents away or adding staff physicians,” said study author Marc Benoit, a fellow in cardiology at the University of Alberta. “But we thought the cardiac ICU here might be different because the patients are more complex. Someone with a heart transplant who is sick is different than a standard hospital patient.”
“With more senior staff in-house at night, people were taken off the ventilators faster and we think there probably was more attention to detail for infection prevention. That is a possible explanation.”
Benoit stressed the findings were observational and that it cannot definitively be said that the change in staffing model was responsible for the outcomes. While the findings seem to support the use of senior physicians in specialized cardiac surgery ICUs, Benoit also notes that each hospital has unique circumstances and that careful thought needs to be put into the staffing of each of them.
“When looking at this issue of nighttime staffing, we need to consider the patient population. So maybe it’s not beneficial to keep senior physicians in-house in every single ICU, but it might be in some more complex units,” said Benoit.
“It is worth thinking about. Staffing patterns and care models can have very important effects on patient outcomes.”

University of Alberta
www.ualberta.ca/medicine/news/2017/july/improving-cardiac-icu-outcomes-through-specialized-24-7-care

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

Researchers in Bristol found 8percent more patients died after 30 days if they were operated on between 24 and 36 hours after admission to hospital. The delay is thought to have caused 670 excess deaths in four years. Project leader Timothy Chesser said it was the ‘first time’ the benefits of early surgery had been revealed.

Data was collected by a team at Southmead Hospital from the National Hip Fracture Database, the largest such list in the world. The study focussed on 241,446 patients across England and Wales who were admitted to hospitals with hip fractures between January 2011 and December 2014, and the mortality rate for these patients 30 days after they were admitted.

Guidance issued by the National Institute for Health and Clinical Excellence in 2011 called for patients to be operated on either the same day, or the day after, hospital admission. But the new report says that even earlier surgery can improve outcomes for elderly patients who are often frail, with multiple medical problems.

‘We found 8percent more patients died if they were operated on between 24 and 36 hours compared to those given surgery within 24 hours, and the risk increased to 20percent for those receiving surgery after 48 hours,’ said Adrian Sayers, the lead author on the paper.

Timothy Chesser, the clinical lead of the research project, said early surgery was not advisable for every patient, but was beneficial in the majority of cases.

‘We have shown for the first time that early surgery is much better for patients,’ he said.

BBCwww.bbc.com/news/uk-england-bristol-39655669

Banning vaginal mesh implants would remove an important treatment for some women suffering from a prolapse, says the Royal College of Obstetricians and Gynaecologists. Some women benefit from the implants and should have a choice, it said.
The health watchdog NICE is expected to recommend that the implants be banned. Around 800 women are taking legal action against the NHS and mesh manufacturers, saying they have suffered from painful complications.
When a prolapse occurs, doctors sometimes insert a mesh into the wall of the vagina to act as scaffolding to support organs – such as the uterus, bowel and bladder – which have fallen out of place. Hundreds of women have reported problems with this plastic mesh, which is made of polypropylene.
Prof Linda Cordozo says banning vaginal mesh is not a good idea.  However another smaller device made from the same material, called a tape, which is used to stem the flow of urine from a leaking bladder, has a much lower risk of complications.
Prof Linda Cardozo, a surgeon at King’s College Hospital in London, said there was a misconception that all types of mesh were a problem. She explained that she was not in favour of banning the use of mesh for prolapses.
“I don’t think a total ban on anything is a good idea. It stifles the opportunity to offer the minority something that might benefit them,” she said.
Draft guidelines from NICE say the implants should only be used for research – and not routine operations.
But Prof Cardozo said that a ban would stop any further research as well.
“If mesh is banned, there will be no more clinical trials,” said the professor.
“Banning it is a retrograde step – we will go back to how we were a century ago when we couldn’t offer women a range of options.”
Prof Cardozo pointed out that artificial hips and knees were not perfect when they were first introduced, but thanks to further research and progress they ended up improving lives.
“We need to be very careful that [mesh] is used in the right women by the right doctors… who have explained the risk-benefit ratio and all other types of treatment,” she added.
Some doctors did not have the skills or training to put in vaginal meshes, and the devices have been overused, the professor has argued.
She also said the debate over vaginal mesh was making some women who had had surgery unnecessarily anxious.
“They are panicking because they believe something terrible may be happening inside their body as a result of tape or mesh, but most women are problem-free,” said Prof Cardozo.

BBChttps://tinyurl.com/ybmcbqz3