Improving diagnosis and treatment for individuals with autism has been the focus of a growing body of research. New information from these studies led the American Academy of Child and Adolescent Psychiatry to revise key parameters for evaluating and treating autism. Researchers led by Yale Child Study Center director Dr. Fred Volkmar have published the new practice parameters.
‘Early diagnosis of children with autism spectrum disorders means treatments will be introduced that lead to more positive outcomes for children,’ said Volkmar the Irving B. Harris Professor of Psychiatry, Pediatrics, and Psychology at the Yale School of Medicine.
According to the parameters, clinicians should routinely look for symptoms of autism spectrum disorder in young children undergoing developmental assessments, and in all psychiatric evaluations. If significant symptoms are detected, clinicians should then co-ordinate a careful medical, psychological, and communication evaluation. These evaluations should differentiate between autism and a variety of developmental and other disorders, as well as intellectual and behavioural disabilities.
‘Our goal was advocacy for individuals with autism and their families, and to ensure that services are co-ordinated across clinical care,’ said Volkmar. ‘Our field is changing rapidly, and these parameters are meant to promote effective care and move professional medical methods closer to current practices.’
Volkmar and his co-authors reviewed abstracts from 9,481 research articles on autism that were published between 1991 and 2013. They then fully studied 186 of those articles based on their quality and ability to be applied more generally.
‘Treatment should involve a team approach,’ said Volkmar, who notes that under these treatment parameters, psychiatrists will closely co-ordinate diagnosis and treatment with teachers, behavioural psychologists, and speech and language pathologists, and look for commonly occurring conditions.
A key addition to the new parameters is a focus on how clinicians should address the use of non-traditional therapies, like chelation and secretin. Clinicians are urged to ask families if they are using alternative/complementary treatments and to discuss the therapies

The use of permanent brachytherapy, a procedure where radioactive sources are placed inside the prostate, into or near to the tumour, preserves erectile function in approximately 50% of patients with prostate cancer.
Brachytherapy works by giving a high dose of radiotherapy directly to the tumour, but only a very low dose to the surrounding normal tissues. Since erectile dysfunction (ED) can occur in up to 68% of patients who receive external beam radiotherapy for the condition, this is a significant improvement and the treatment should be offered to all patients, particularly those who are sexually active, the researchers say.
Dr Ren

Measuring variability of heart rate may identify premature infants at risk of developing narcotising enterocolitis, a serious inflammatory condition that can lead to death, according to Penn State College of Medicine researchers.

Narcotising enterocolitis, or NEC, may lead to destruction of the intestinal wall and vital organ failure. It affects 6 to 10 percent of premature infants within the first two weeks of life.

‘NEC is currently diagnosed by a combination of laboratory and radiology tests, usually done when the disease is already significant,’ said Kim Doheny, director of clinical research in newborn medicine and assistant professor of pediatrics. ‘Since NEC progresses so rapidly and the symptoms develop suddenly, a non-invasive biomarker that allows early detection of patients at risk is required as a matter of urgency.’

Heart rate fluctuates in the intervals between beats, and contributors to this fluctuation are measured through mathematical analysis. One of these contributors is the parasympathetic nervous system — the system that controls digestive responses and regulates the organs during rest — represented through measurement of high-frequency energy distribution. The researchers studied 70 infants born at 28 to 35 weeks within the first five to eight days of life. The babies were stable with no sign of illness.

The researchers then measured heart rate variability in the infants to test whether measuring the high-frequency component of heart rate variability may be used as a way to predict an infant’s NEC risk before disease onset.

Of the 70 infants studied, nine who later developed NEC had decreased high frequency in the heart rate variability, suggesting reduced parasympathetic nervous system activity. Of all the infants with a decreased high-frequency heart rate variability, 50 percent developed the disease. In contrast, 98 percent of those with a higher high-frequency value did not get the disease.

‘This shows that measuring high-frequency variability during this early critical window of postnatal development has value for identifying NEC risk at a time when symptoms are not evident and interventions to improve the parasympathetic nervous system activity can be given,’ said researcher R. Alberto Travagli, professor of neural and behavioral sciences. ‘This relatively simple, economical, and non-invasive method offers the opportunity to monitor at-risk infants more closely and to test the efficacy of emerging treatments.’

The researchers say future investigations should include a larger sample that also includes measurement of inflammation at the time heart rate variability is measured. Penn State College of Medicine

For the millions of people forced to rely on a plastic tube to eliminate their urine, developing an infection is nearly a 100 percent guarantee after just four weeks. But with the help of a little bubble-blowing, biomedical engineers hope to bring relief to urethras everywhere.
About half of the time, the interior of long-term urinary catheters become plagued by biofilms