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Archive for category: E-News

E-News

Traditional Indian medicines can cause membranous nephropathy

, 26 August 2020/in E-News /by 3wmedia

Membranous nephropathy (MN) is a progressive kidney disease which is characterized by the accumulation of immune complexes within the kidney. It often leads to a so-called nephrotic syndrome with proteinuria, hypoalbuminemia, and edema, it can even result in kidney failure. MN can occur without any known causes (primary MN), but can also be acquired via other diseases. Antibodies against phospholipase A2 receptor (PLA2R) are highly specific for the primary form of the disease, but do not occur in secondary forms.
An Indian working group published five cases of nephrotic syndrome caused by MN with evidence of chronic mercury poisoning due to consumption of traditional Indian medicines such as Siddha and Ayurveda. The article was published in “Clinical Kidney Journal” (ckj), an official journal of the ERA-EDTA, in June 2018, and is the first report of its kind showing that traditional Indian medicines can cause MN, proven by renal biopsy. All patients received this kind of medicine and the index patients were seronegative for antibodies against phospholipase A2 receptor (PLA2R), giving evidence that they did not suffer from the primary form of the disease.
Very few cases of mercury-induced MN have been reported in the literature so far and most known cases have developed due to traditional Chinese medicine, skin-lightening creams, inhalation containing mercury and hair dye containing mercury. Traditional Indian medicines have so far not been “on the radar”, although mercury has been an ingredient in several traditional medicines such as Ayurveda, Unani, Siddha, Tibetan and Chinese medicines. Traditional Indian medicines are sold over the Internet and have found a global market. However, these drugs sold by some traditional medicine manufacturers may not be rigorously tested for the contents and their sale is not regulated. However, despite the widespread consumption of traditional Indian medicines, no renal toxicity has been reported so far. According to the authors of this case report, it might be possible that it is underreported due to a lack of awareness among physicians and nephrologists or to a lack of knowledge: very often, patients do not even mention that they are taking traditional medicines in addition to what their family doctor or nephrologist prescribes.
The authors suggest that mercury poisoning should be considered in patients with anti-PLA2R antibody-negative MN, and that these patients should be asked, if they had taken traditional Indian medicines.
“The publication of these case reports is important. It shows that seemingly harmless traditional medicine can harm people a lot and that it is high time that controls and regulations concerning the ingredients of any medicine are needed”, explains ckj editor-in-chief, Professor Alberto Ortiz. “As long as there are no quality controls for substances used in traditional medicine, we have to warn our patients: Mercury poisoning can lead to MN as well as to many other severe health problems, because it is affecting the brain, the gut and the kidneys.”
www.era-edta.org 

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Telemedicine may increase patients’ satisfaction with their medical care

, 26 August 2020/in E-News /by 3wmedia

Cardiovascular disease pervades Appalachia, yet many Appalachians live far from any heart and vascular specialist. Follow-up doctor’s visits in the weeks after cardiovascular surgery can involve hours-long drives down narrow, winding roads.
A recent study led by Albeir Mousa, a professor in the West Virginia University School of Medicine, suggests telemedicine may improve these patients’ satisfaction with their postoperative care as well as their quality of life.
With telemedicine, a healthcare provider can use a computer, tablet or other electronic device to remotely evaluate their patients’ symptoms, diagnose illnesses or injuries, and prescribe treatments. They can also field their patients’ questions.
The 30 participants in Mousa’s study were recovering from vascular surgery. In each case, the surgeon made an incision in the patient’s groin to access the arteries that needed rebuilding or rerouting. Whether the incisions healed without complications was the study’s focus.
Sixteen patients received tablets with Enform—a telemedicine app developed by TeleMed 2020 Inc.—that facilitated communication with nurses managing their care. As part of an in-home monitoring kit, patients also received thermometers, blood pressure cuffs, scales and devices to measure blood oxygen saturation levels.
Each day, patients who had been discharged from the hospital weighed themselves, took their temperature, measured their pulse and blood pressure, and determined their blood oxygen levels using the Enform app. They completed a wellness and symptom tracking quiz that included questions like “How is your pain today?” Each week they answered satisfaction and emotional wellness questions as well. These data, along with photos of the surgical incision sites that patients captured with the app—were made available to the patients’ care team.
Care managers, in turn, logged into the telemedicine platform daily to review the information patients had submitted from their homes. Cares managers received notifications of abnormalities, such as blood pressure spikes and fevers. Based on the information they gathered, the care managers intervened, answered patients’ questions about symptoms or wound care, called in prescriptions, scheduled appointments with physicians, and modified care plans based on consultations with the medical director.
Meanwhile, the other 14 participants had standard-of-care treatment. They received no monitoring equipment, tablet or telemedicine app.
After 30 days, the researchers made a number of comparisons between the two groups. For example, were wound infections more common in one group than the other? Did one group require more hospital readmissions? How did members of each group rate their own well-being? Were they happy with the postoperative care they received?
Hospital-readmission and wound-infection rates did not differ significantly between groups. The researchers attribute this fact to the study’s small sample size. But patients in the telemedicine group scored better on measures of their physical function, mental health and role limitations due to physical health problems. In addition, the vast majority of patients who used the app found it intuitive to use. Using a five-point scale to measure ease of use, 91 percent of patients gave it a score of 4 or 5. A similar percentage of patients said the app enriched the quality of care they received.
Likewise, the telemedicine patients’ scores on quality-of-life assessments surged more dramatically between the study’s beginning and end.
Patients assigned to the telemedicine group lived an average of 60 miles from their vascular care center. Almost a third of them lived more than 77 miles away and had to drive for two to three hours to get there.
“Telemedicine would save a lot of headache in Appalachia—in areas where people don’t even have the money to get in the car to get to the hospital,” said Mousa, who teaches surgery at the WVU Health Sciences Charleston Campus.
He envisions that, one day, patients will be able to download a cell phone app that provides these telemedicine services. That way, they won’t even need a tablet. “Each household has at least one cell phone, and most likely, it’s a smartphone.”
“You’re getting the same service,” he said, “but with a very minor hassle for the patient and the physician.”

West Virginia University
medicine.hsc.wvu.edu/News/Story?headline=wvu-researchers-find-telemedicine-may-increase-patients-satisfaction-with-their-medical-care

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International Day of Radiology 2018 to focus on cardiac imaging

, 26 August 2020/in E-News /by 3wmedia

The International Day of Radiology (IDoR) will be celebrated for the seventh time on November 8, this year focusing on cardiac imaging.
Cardiac imaging is a fast-growing subspecialty of diagnostic radiology that plays a huge part in the assessment and management of heart patients throughout the world. Cardiac radiologists – the experts in charge – supervise or perform imaging examinations, using technology such as computed tomography (CT) and magnetic resonance imaging (MRI), and then interpret the resulting images to diagnose and monitor a wide range of diseases of the heart.
For IDoR 2018, we are highlighting the increasingly important role of radiologists in cardiac care, contributing to the diagnosis, pre-procedural work-up and follow-up of patients with a wide variety of cardiac pathology, from coronary artery disease and leaky heart valves to defects in the size and shape of the heart.
To underline the significance of cardiac imaging in various regions of the world and to show its current place in today’s medical healthcare spectrum, the ESR has conducted numerous interviews with experts throughout Europe, Latin America and Asia, as well as with individuals from Canada, South Africa and Egypt.
The stunning IDoR 2018 poster can again be downloaded on the IDoR website; this year it is available in 30 languages, covering a great variety from Icelandic to Nepalese.
A publication on this year’s main theme is currently in the making; books from previous years on emergency radiology, breast imaging, pediatric imaging, brain imaging and thoracic imaging are still available for download on the IDoR website.
As in previous years, more than 160 radiology-related professional societies from around the world will participate in the International Day of Radiology, holding a range of different events to celebrate, such as public lectures, department open days, conferences, and press events.
The International Day of Radiology was launched in 2012 and is a joint initiative of the European Society of Radiology (ESR), the Radiological Society of North America (RSNA) and the American College of Radiology (ACR). It is an annual event held with the aim of building greater awareness of the value that radiology contributes to safe patient care, and improving understanding of the vital role radiologists play in the healthcare continuum.
November 8, the day that Wilhelm Conrad Röntgen discovered the existence of x-rays in 1895, was chosen as a day of action and awareness. The organizers hope to alert the world to the stunning medical, scientific and even artistic possibilities of medical imaging, the essential role of the radiologist as a part of the healthcare team in countless medical scenarios, and the high educational and professional standards required of all staff working in medical imaging.

idor2018.com
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New method helps make orthotopic brain-tumour imaging clearer and faster

, 26 August 2020/in E-News /by 3wmedia

Nowadays, tumours inside the complex central nervous system remain one of the most challenging cancers to diagnose.
Different from conventional brain-imaging techniques, nearinfrared (NIR) fluorescence imaging demonstrates particular merits including being non-hazardous, offering fast feedback, and having higher sensitivity.
A research team led by Prof. ZHENG Hairong from the Shenzhen Institutes of Advanced Technology (SIAT) of the Chinese Academy of Sciences, in collaboration with Prof. LIU Bin from the University of Singapore, reported the first NIR-II fluorescent molecule with aggregation-induced-emission (AIE) characteristics for dual fluorescence and photoacoustic imaging.
Fluorescence imaging in the second NIR window (NIR-II), compared with the first NIR window (NIR-I), exhibits salient advantages of deeper penetration and higher spatiotemporal resolution, owing to further reduced photon scattering, absorption, and tissue autofluorescence in biological tissues.
Scientists designed a new donor-acceptor (D-A)-tailored NIR-II emissive AIE molecule, and formulated dots showed a high NIR-II fluorescence quantum yield up to 6.2%, owing to the intrinsic aggregation-induced emission nature of the designed molecule.
The AIE dots have been successfully used for dual NIR-II fluorescence and NIR-I photoacoustic imaging for precise non-invasive brain-tumour diagnosis. Based on the same dots, the experiments revealed that NIR-II fluorescence imaging showed a high resolution.
Meanwhile, NIR-I PA imaging intrinsically exhibited higher penetration depth than that of NIR-II fluorescence imaging, which allowed clear delineation of tumour depth in the brain.
The synergetic bimodal imaging with targeting c-RGD-decorated bright AIE nanoparticles showed precise brain-tumour diagnosis with good specificity and high sensitivity, which yielded a high S/B of 4.4 and accurately assessed the depth of tumour location inside brain tissue.
The study demonstrates the promise of NIR-II AIE molecules and their dots in dual NIR-II fluorescence and NIR-I photoacoustic imaging for precise brain cancer diagnostics.

EurekAlert
www.eurekalert.org/pub_releases/2018-06/caos-nmh060818.php

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Machine learning can be used to predict which patients require emergency admission

, 26 August 2020/in E-News /by 3wmedia

Machine learning – a field of artificial intelligence that uses statistical techniques to enable computer systems to ‘learn’ from data – can be used to analyse electronic health records and predict the risk of emergency hospital admissions, a new study from The George Institute for Global Health at the University of Oxford has found.
The research suggests that using these techniques could help health practitioners accurately monitor the risks faced by patients and put in place measures to avoid unplanned admissions, which are a major source of healthcare spending.
‘There were over 5.9 million recorded emergency hospital admissions in the UK in 2017, and a large proportion of them were avoidable,’ said Fatemeh Rahimian, former data scientist at The George Institute UK, who led the research.
‘We wanted to provide a tool that would enable healthcare workers to accurately monitor the risks faced by their patients, and as a result make better decisions around patient screening and proactive care that could help reduce the burden of emergency admissions.’
The study, of 4.6 million patients from 1985 to 2015, was conducted using linked electronic health records from the UK’s Clinical Practice Research Datalink. A wide range of factors was taken into account, including age, sex, ethnicity, socioeconomic status, family history, lifestyle factors, comorbidities, medication and marital status, as well as the time since first diagnosis, last use of the health system and latest laboratory tests.
Using more variables combined with information about their timing, machine learning models were found to provide a more robust prediction of the risk of emergency hospital admission than any models used previously.
‘Our findings show that with large datasets which contain rich information about individuals, machine learning models outperform one of the best conventional statistical models,’ Rahimian said. ‘We think this is because machine learning models automatically capture and ‘learn’ from interactions between the data that we were not previously aware of.’
Whether machine learning models can lead to similarly strong improvements in risk prediction in other areas of medicine requires further research.

University of Oxford www.ox.ac.uk/news/2018-11-21-machine-learning-can-be-used-predict-which-patients-require-emergency-admission

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Many rectal STIs in women missed by genital testing only

, 26 August 2020/in E-News /by 3wmedia

Testing women for the presence of sexually transmitted infections (STIs) only at the urogenital site will miss approximately 20% of STIs in women who report having receptive anal intercourse, a STD surveillance network study indicates.
“As an obstetrician-gynecologist, I thought it would be interesting to analyse data from women who report having receptive anal intercourse and see what the rates of chlamydia and gonorrhea might be,” Eloisa Llata, MD, MPH, Centers for Disease Control and Prevention, Atlanta, Georgia, said in podcast prepared by the journal, Obstetrics & Gynecology.
“We found that about one in five women who reported having receptive anal intercourse will only be infected at the rectal site, so if we only screen women with a urine-based approach, we are going to miss these women and the opportunity to stop transmission,” she added.
“So this study underscores the need to ascertain a comprehensive sexual history for all patients, male and female, in order to identify risky behaviours and to test accordingly,” Llata emphasized.
The researchers collected and analysed data from the STD Surveillance Network involving 10 state and local health jurisdictions for all visits between January 2015 and December 2016.
The researchers included 94,094 visits made to STD clinics in five jurisdictions in the analysis.
A total of 7.4% of women presenting for care during a 2-year interlude reported having receptive anal intercourse.
Some 94.1% of women were tested for Chlamydia trachomatis at the urogenital site, whereas 94.5% were tested for Neisseria gonorrhea at the same site.
Fewer women, at 76.9%, were tested for the same two STIs at the rectal site.
C trachomatis positivity was 9.1%, and N gonorrhea positivity was 5.4% among women tested only at the genital site.
Results differed among women who were tested only at the rectal site. In this subgroup of women, C trachomatis was detected in 26.7% of samples and N gonorrhea in 6.1% of them.
Investigators then identified infection rates for each of the two STIs separately in women who were tested at both the genital and rectal sites.
Analysis of this subgroup of women found that 10.4% of women tested positive for C trachomatis; of these, 20.9% of women were positive for the infection at the genital site only, whereas 58.6% of women tested positive at both the genital and rectal sites.
Another 20.5% of women were positive for C trachomatis only at the rectal site.
For women who were tested at both the genital and rectal site for N gonorrhea, 4.5% of women had been infected with the STI.

MedScapehttps://tinyurl.com/y7hayez8

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Brachytherapy for cervical cancer a net loss for hospitals, study finds

, 26 August 2020/in E-News /by 3wmedia

The evidence is clear: Cervical cancer is best treated with brachytherapy, a form of radiation therapy. Yet the use of this potentially lifesaving treatment has been declining, and a new study from the University of Virginia School of Medicine may explain why.
UVA researchers have determined that offering brachytherapy for locally advanced cervical cancer ends up costing hospitals money. After accounting for the costs and time involved, the researchers found that Medicare reimburses four times more per minute required for a less effective alternative than it does for brachytherapy. Ultimately, providing brachytherapy results in a net loss for the providing healthcare facility, the researchers determined. This can leave hospitals – particularly smaller hospitals that don’t do a lot of brachytherapy – in the lurch.
“Studies have time and time again shown that brachytherapy is the most important part of cervical cancer treatment, because it is essential to eradicating the tumour,” said Timothy Showalter, MD, a radiation oncologist at UVA Cancer Center. “A decline in brachytherapy utilization is associated with a higher rate of mortality in cervical cancer, so there’s a direct relationship.”
The problem stems partly from the amount of physician time brachytherapy requires: It takes 80+ percent more personnel time to administer brachytherapy than it does to deliver the increasingly popular alternative, external beam radiation. Both methods deliver radiation to the tumour, but brachytherapy delivers much greater doses in a much more targeted manner. Another key difference, the researchers found: Medicare reimbursement makes external beam radiation profitable, while brachytherapy is not.
Overall, the researchers determined that it costs hospitals more than twice as much to provide brachytherapy as it does to provide external-beam radiation. But the reimbursement doesn’t reflect that.
“Brachytherapy requires a lot of physician effort and expertise and reimburses poorly for that effort,” Showalter said. “I can certainly imagine how the comparatively poor reimbursement rates compared to external beam radiation could contribute in some environments to not establishing a service for brachytherapy or just not committing physician time to it.”
He noted that healthcare providers face a cold, hard truth when deciding whether to offer brachytherapy, or any other treatment: “If practices don’t run at least a profit greater than zero,” he said, “then they fold.”
The researchers concluded that hospitals that see a high volume of patients, such as UVA, are best equipped to provide brachytherapy – and to absorb the major resource commitment that comes with it. “My job specifically involves brachytherapy,” Showalter said. “We’re at this big hospital with all the equipment we need at the ready and a wonderful streamlined process that enhances the patient experience and reduces patients’ time on the table. That makes it easier to provide efficient and effective care.”

EurekAlerthttps://tinyurl.com/y9oqfbe4

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Cleveland Clinic study confirms no association between medications for chronic cardiac diseases and COVID-19

, 26 August 2020/in Corona News, E-News /by 3wmedia

Despite recent controversy suggesting that popular medications prescribed to lower blood pressure may increase the risk of infection by the novel coronavirus and lead to more severe outcomes in COVID-19, a retrospective study by Cleveland Clinic, Ohio, US, has supported the view that there is no foundation to these claims, although the researchers called for larger studies as the pandemic develops.
The medications in question are Angiotensin-converting enzyme (ACE) inhibitors and Angiotensin II receptor blockers (ARBs), both of which dilate blood vessels to increase the amount of blood pumped by the heart. The result is lowered blood pressure and increased blood flow, which helps to lower the heart’s workload and reduce the risk of heart failure. The medications are commonly prescribed in cases of coronary artery disease, heart failure, diabetes and hypertension (high blood pressure).
“Our analysis found no association between ACEI or ARB use and COVID-19 test positivity,” says Cleveland Clinic cardiologist Ankur Kalra, MD, the study’s corresponding author.
“These medications are important tools in the management of coronary artery disease, heart failure, diabetes and hypertension. As there may be a risk to withdrawing these agents, our findings support current professional society guidelines to not discontinue ACEI or ARB therapy in the context of the COVID-19 pandemic,” he added.
The Cleveland Clinic study looked at 18,472 individuals tested for COVID-19 at its locations in Florida and Ohio, with a mean age of 49 (± 21 years), and who were predominantly female (60%) and white (69%). Testing for COVID-19 was positive in 1,735 patients, or 9.4% of the total sample.
First study author Neil Mehta, MD of the Department of Medicine at the Cleveland Clinic Lerner College of Medicine, says: “Our findings with regard to clinical outcomes and measures of COVID-19 severity while on ACEI or ARB therapy give some reassurance. However, they must be interpreted with caution, due to the small sample size and the limitations of observational studies. They require replication and reanalysis in larger patient samples later in the course of the ongoing COVID-19 pandemic.”
A secondary analysis among COVID-19-positive patients showed no association between use of these medications and risk for mechanical ventilation.

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New technique for minimally invasive lung cancer surgery

, 26 August 2020/in E-News /by 3wmedia

According to a new study, an ultrasonic vessel-sealing device can improve patient outcomes by reducing the incidence of thoracotomy conversion for VATS/robotic anatomical lung resection. The trial, which included patients in the United States, United Kingdom, and Canada, is the first to evaluate the use of ultrasonic sealing for lobectomy, the most common thoracic surgical procedure.
Technology device trials in thoracic surgery are uncommon, with this study being the first intraoperative device study in more than 20 years. 150 patients planned for VATS/robotic anatomical lung resection in seven centres were enrolled. PA Branches of 7mm or less were sealed and divided with an ultrasonic energy vessel-sealing device. The remainder of the lobectomy was performed according to surgeon preference. A total of 424 PA branches were divided; 239 with the ultrasonic vessel-sealing device, 181 with endostaplers, and 4 with endoscopic clips.
Intraoperative, in-hospital, and 30-day post-operative bleeding and complications were observed. 1.3 percent of the PA branches divided with the ultrasonic vessel-sealing device and 2.2 percent of PA branches divided with endostaplers bled intraoperatively. Among the patients with seal failures, one patient required conversion to thoracotomy for vascular repair in the ultrasonic energy group. There was no postoperative bleeding from divided PA branches with either sealing method. One patient was re-operated for hemothorax from a bleeding bronchial artery. Mean and median length of stay was 4.1 and 3.8 days, respectively. There was no mortality at 30-days.
Preliminary results appear to show that use of an ultrasonic sealing device can decrease the rate of conversion to thoracotomy, resulting in safer and less-invasive procedures.
Lead author, Moishe Liberman, MD, PhD, of the Division of Thoracic Surgery, University of Montréal, explains, "This is an exciting new application of technology to enable minimally invasive lung surgery for the benefit of patients today and in the future. By promoting less invasive procedures, we promote quicker healing and reduce risks, resulting in improved outcomes for patients."
EurekAlert www.eurekalert.org/pub_releases/2019-05/aaft-ntf050419.php

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Will Europe’s clampdown on faulty medical devices hurt patients?

, 26 August 2020/in E-News /by 3wmedia

When a Californian company founded by a U.S. veteran wounded in Afghanistan sought to register a new medical device this year, it turned to Europe before the United States. The European approvals system had long been quicker, the company said, but the introduction of new rules is changing all that.
 “Now it has flipped,” said Bill Colone, CEO of San Clemente-based Spinal Singularity, which hopes to launch a ‘smart’ catheter for men with spinal injuries or disease early next year after squeezing in its application under the old European rules.
Colone is part of a chorus of industry voices warning that a switch to stricter European rules governing medical devices, due to come into force a year from now, will slow or even halt the release of products in Europe that could transform patients’ lives.
Defenders of the regulations say they will not significantly complicate the process and are vital to prevent problems like rupturing silicone breast implants and debris from all-metal hip implants damaging tissue and bones.
Many patient advocates say the new rules do not go far enough to reform a European system in which a top U.S. official suggested in 2011 patients may be "guinea pigs" here. The comment drew a sharp response from the European Union, which still firmly rejects that characterization.
That transatlantic spat, and the subsequent evolution of medical device certification around the world, are part of a wider global struggle by governments to attract businesses seeking light-touch regulation without scaring off their voters.
The new medical devices rules agreed by the European Union in 2017 will tighten control of devices before they come to market, improve transparency and strengthen surveillance by national authorities, a European Commission spokesperson said.
The new system changes less than some proposals – which envisaged regulation by a public body, along U.S. lines, replacing the existing practice of certification by profit-making private firms.
But players in medical technology – which ranges from surgical implants to scans – say it is too burdensome and is being built too slowly, risking not only hampering innovation but also harming patients by interrupting supplies.
“Immediate action is needed now to avoid severe disruption of product supply to patients and hospitals,” seven European Associations said in a joint statement last week.
All 55,000 devices certified under the old directives have to be re-certified along with other products such as reusable scalpels, nasal saline sprays and dental imaging software.
The industry says there are not enough Notified Bodies – the private firms charged with certifying the safety of devices ranging from bandages to pacemakers, and that manufacturers may have to take products off the market or delay new launches.

Reuters https://tinyurl.com/yyqe7pp3

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