Body

20 percent of the middle-aged UK South Asian population may have a very severe vitamin D deficiency, a new study in the British Journal of Nutrition reports. Such deficiency can lead to health problems such as osteomalacia (softening of the bones) and other chronic diseases.

Vitamin D helps regulate the amount of calcium and phosphate in the body, which are needed to maintain bone health. Deficiencies of the vitamin has been linked to increased risks of developing hypertension, respiratory infections, cardiovascular disease and some cancers.

In the largest study of its kind, researchers from the University of Surrey, using data from the UK Biobank, investigated the vitamin D status of 6,433 South Asian people (Bangladeshi, Indian and Pakistani) aged 40-69 years old living in the UK. Although UK Biobank data cannot be used to formally estimate the true prevalence of vitamin D deficiency in a population it provides a snapshot of the situation.

Researchers found that 20 percent of the UK Biobank South Asians had a very severe deficiency (

Lead author Dr Andrea Darling, Post-Doctoral Research Fellow at the University of Surrey, said: "It is very concerning to see how vitamin D deficient the UK South Asian population are.

"Measures such as increasing vitamin D intake, through diet or supplementation, as well as increasing sunlight exposure (within safe limits) can help raise vitamin D levels. Public health interventions are needed to prevent and treat vitamin D deficiency in these communities".

The Surrey team also identified several factors which could affect vitamin D deficiency amongst the community including geographic location and BMI. Vitamin D levels varied by geographic location, with South Asians living in Scotland having low levels (19nmol/L), as did those living in Northern England, Midlands and Wales (19-20nmol/L). London and the South East had slightly higher levels (24-25nmol/L) but deficiency was still very prevalent.

BMI was also identified as an indicator of vitamin D deficiency. Individuals who were classified as being overweight were 32 per cent more likely of being deficient and those with obesity had a 51 percent higher chance of being deficient than those who were of normal or underweight. High BMI levels were particularly prevalent amongst the Indian and Pakistani individuals. Researchers believe that a reduction in BMI of those who are overweight and obese could be beneficial in reducing levels of vitamin D deficiency.

Professor Sue Lanham-New, Head of the Department of Nutritional Science, at the University of Surrey, said: "Our findings show in our research sample, that those from Pakistani communities, aged between 40 - 59 years old, who have a high body mass index, have the highest risk of having a vitamin D deficiency. This puts them at increased risk of developing non-communicable diseases such as some cancers and compromises their skeletal health. The identification of those most vulnerable to vitamin D deficiency will hopefully lead to targeted public health campaigns to address this issue."

Is my heart beating slightly fast? Is a heart attack coming? I didn't sleep as much as I thought I had last night - is that bad for my heart?

Health apps and fitness watches can shed considerable light on how our bodies work and make recommendations for a healthy lifestyle.

However, self-measuring can have a downside too, according to a new study that examined the experiences of 27 heart patients who used 'Fitbit' fitness watches to measure their sleep, heart rates and physical activity.

Although the 28-74 year-old heart patients learned more about their illnesses and were motivated to exercise during the six months that they wore the watches, they also became more anxious, explains Tariq Osman Andersen, an assistant professor at the University of Copenhagen's Department of Computer Science and one of the researchers behind the study:

"Our study shows that, overall, self-measurements are more problematic than beneficial when it comes to the patient experience. Patients begin to use the information from their Fitbits just as they would use a doctor. However, they don't get help interpreting their watch data. This makes them unnecessarily anxious, or they may learn something that is far from reality," he says.

Generates insecurity and anxiousness

Along with two other researchers from the University of Copenhagen and the company Vital Beats, Tariq Osman Andersen examined patients with cardiac arrhythmia and pacemakers through 66 qualitative interviews.

They conclude that, overall, there are two points that include both the pros and cons of using Fitbit watches:

-More information calms, but also awakens doubt

Patients have a sense that they are becoming more in tune with their overall health, but they link the information to their heart disease, for which there is no safe basis. For example, if they see that they aren't sleeping as much as they should be, they become uncomfortable and fear that this may exacerbate their illness. Similarly, they often link fast hearts rate with an increased risk of heart attack.

"Conversely, the Fitbit watch can be calming, if data shows that you are sleeping well and have a low heart rate. The problem is that you cannot use data directly related to heart disease because the watch is designed for sports and wellness, as opposed to managing disease," explains Tariq Osman Andersen.

-Patients gain the courage to exercise, while simultaneously experiencing feelings of guilt

Another aspect of the Fitbit watch with both positive and negative aspects, is exercise. On one hand, patients were motivated to be active, but at the same time, the app revealed when patients did not attain the recommended 10,000 daily steps, which made many of them feel guilty.

"The Fitbit watch is not designed for heart patients, so they should not necessarily follow the same recommendations for exercise as those who are in good health," explains Tariq Osman Andersen.

Help needed for interpretation

The use of health apps like the Fitbit watch is part of a growing trend to measure the health of, among others, those with chronic illnesses. According to Tariq Osman Andersen, they offer great promise:

"There is a tremendous potential in engaging patients outside the hospital by allowing them to manage their illnesses through health apps like the Fitbit watch," he explains.

But for health apps to have an effect, patients need help interpreting data related to sleep, heart rate and exercise habits, according to the research team behind the study:

"We believe it is time to think in terms of 'collaborative care', where both patient and clinicians benefit from the new health data and are thereby able to work together to manage and treat chronic diseases. This requires that we create a digital platform in which clinicians and patients can jointly interpret data from, for example, fitness watches, without creating unnecessary additional work for clinicians," concludes Tariq Osman Andersen.

magnetic resonance imaging is becoming increasingly popular as a method of diagnosing diseases. Standard scanners are multifunctional, making it possible to cut down on the costs of specialized equipment. On the other hand, this leads to images of lower quality, especially when relatively small areas need to be examined. A group of Russian scientists, including ITMO University researchers, has proposed a system that can be used to update existing MRI scanners. It will allow conducting breast MRI using standard scanners without specialized equipment. A paper presenting the results of the work was published in Nature Communications.

Magnetic resonance imaging (or MRI) is especially useful in diagnostics of breast cancer at its early stages. "Compared to an X-ray or ultrasound examination, an MRI scan allows us to precisely localize the tumor, which affects the accuracy of the diagnosis," explains Alena Shchelokova, first co-author of the paper and research associate at ITMO's Faculty of Physics and Engineering.

However, despite the possibilities opened to medical specialists by MRI, this method is rarely used to produce breast scans because apart from the scanner itself, this procedure requires additional specialized equipment.

At the heart of every standard MRI scanner is a large coil used to excite magnetic resonance in the human body. Its size is comparable to that of the human body, and the coil itself is sometimes referred to as the birdcage. This coil that excites protons in the human body, while the responding magnetic resonance signal is received by another, smaller coil located in the vicinity of the organ that is of particular interest to the clinicians. This second coil allows them to produce a high-quality image of the organ under examination.

"There are two key processes in MRI: excitation and signal reception," says Alena Shchelokova. "The birdcage coil cannot provide an MR image with sufficient contrast and signal-to-noise ratio because it is big and located far from the specific area under examination. That's why small dedicated coils are used as receiving antennas for each organ. Usually, medical centers are only equipped with a limited number of these local coils, and the breast coil is rarely found among them. Thus, we only found this dedicated coil in a single medical center in St. Petersburg."

A group of scientists, including ITMO University researchers, has suggested another approach to the problem. The novel concept of targeted clinical MRI applied to breast imaging is based on a local redistribution and passive focusing of the radiofrequency magnetic field of the large body coil through electromagnetic coupling with an additional dielectric resonator surrounding the target area. The resonator itself is made from a special type of ceramics produced by a company in St. Petersburg. This new ceramic material has high dielectric permittivity and extremely low dielectric losses. If set to work in the frequency of the scanner, it localizes and increases the magnetic field in the breast, while the excitation and reception of the signal are conducted by the body coil. At the same time, the device doesn't generate or receive the signal, but only serves the purpose of focusing the field in a specific place and then transmitting the energy of excited protons pointwise to the large coil.

Thanks to the fact that the electromagnetic field is now concentrated inside the area of interest, the power of the body coil can be sufficiently turned down. Consequently, this MR examination becomes safer for patients than the standard one.

The device itself is also cheaper than the specialized receive coil for the breast provided by manufacturers. Additionally, it doesn't need to be connected to the scanner with a complex system of wires. It is completely wireless and doesn't have so many fragile parts. Moreover, the resonator is compatible with all models of standard clinical scanners, while the standard receive coils need to be purchased from the same manufacturer that produced the scanner.

A new Boston University School of Public Health (BUSPH) study shows that weight loss between early adulthood and midlife lowers arthritis risk, and found no evidence of any persistent risk of arthritis for people who were heavier earlier in life and then lost weight.

The study, published in the journal Arthritis Care & Research, also estimates that nearly a quarter of arthritis cases in the U.S., corresponding to 2.7 million people, are attributable to excess weight.

"Policies that address the social and structural factors that promote weight gain are urgently needed. Our findings suggest that such measures could have a significant impact on reducing the incidence of arthritis, a leading cause of disability and chronic pain in the US," says study corresponding author Dr. Andrew Stokes, assistant professor of global health at BUSPH.

"Although weight loss could represent a viable way to reduce arthritis risk at the individual level, we found that the best solution at the population level would be to prevent weight gain," says study lead author and BUSPH alumna Kaitlyn Berry, who was a research fellow at BUSPH while working on the study and is now at the University of Minnesota School of Public Health.

The researchers used data from the National Health and Nutrition Examination Survey (NHANES) on adults 40-69 years old, to categorize individuals based on the changes in their body mass indices (BMI) from early adulthood to mid-life, and analyzed the association between these BMI trajectories and the risk of developing an arthritis condition within 10 years.

Of the 13,669 people in the study, 3,603 developed an arthritis condition. Compared with those who had a BMI in the "normal" range in both early adulthood and middle age, those who went from the "normal" range to the "overweight" or "obese" ranges, those who went from the "overweight" range to the "obese" range, and those whose BMIs were in the "obese" range at both points were all significantly more likely to develop arthritis conditions.

On the other hand, those whose BMIs went from the "obese" down to the "overweight" range had a significantly lower risk of developing arthritis compared to those whose BMI remained in the "obese" range. Additionally, those who lost weight had the same likelihood of developing arthritis as those whose BMIs stayed in the "overweight" range.

"These findings highlight the need for lifelong public health measures to prevent obesity at younger ages as an important step to curb later life musculoskeletal and joint health problems such as osteoarthritis. This is particularly important as musculoskeletal pain is a leading cause of disability globally," says study co-author Dr. Tuhina Neogi, professor of epidemiology at BUSPH, professor of medicine at the Boston University School of Medicine, and chief of rheumatology at Boston Medical Center.

The price the UK government was prepared to pay to save lives during the COVID-19 pandemic was far lower than in many other developed nations, a study has revealed.

In a cross-country comparison across nine nations - Belgium, the US, Germany, Korea, Italy, Denmark, China, New Zealand and the UK - researchers used epidemiological modelling to calculate how many lives were lost through delaying lockdown, estimating that a UK lockdown date just three days earlier would have saved 20,000 lives.

They then linked those policy decisions to the financial cost lockdown had on GDP, resulting in a 'price of life' estimate - the amount of money governments were willing to pay to protect their citizens' lives, reflected in the economic activity sacrificed.

The price of life in the UK was among the lowest at around $100,000, and lower still once under-reporting of COVID-19 deaths is accounted for. In contrast countries that were quicker to go into lockdown, such as Germany, New Zealand and South Korea, put a price on life in excess of $1million.

"Price of life estimates are of critical importance given that government intervention has the ability to save life, yet trades off against other goods," said lead author Ben Balmford, from the University of Exeter Business School.

"Comparing across countries those who pursued an early lockdown strategy reveal themselves to be willing to pay a high price to save their citizen's lives, only rejecting prices above $1m.

"However, some countries, those which imposed lockdown relatively late-on in their respective pandemics, were clearly only willing to pay far less."

The study addressed why countries have suffered such huge variations in death tolls and established how the timing of lockdowns impacted on mortality rates, complementing the official Covid-19 statistics with excess mortality data and taking into account socio-economic and demographic factors such as age, population density and income inequality.

Modelling mortality across the countries before simulating changes in the date of lockdown, the researchers calculated that 20,000 lives in the UK would have been saved by imposing lockdown three days earlier.

Even further delays would have cost yet more lives: 32,000 extra people would have died had lockdown come in three days later than it did; while a delay of 12 days would have cost more than 200,000 extra lives.

Similarly high figures were observed in other countries that acted relatively late - such as Italy - highlighting how earlier governmental action would have saved many more lives.

Price of life was then calculated using estimates of the financial cost of lockdown on GDP, comparing IMF forecasts pre-lockdown to the most recent figures and teasing apart the amount of GDP loss that comes from the effects of lockdown policy, as opposed to other factors.

Imposing lockdown earlier on in a country's outbreak means saving more lives, but at a higher cost to the economy. This means countries that delayed their lockdowns such as the UK, US and Italy are revealed to price the lives of their citizens relatively low (at around $100,000) whereas the price of life in Germany, a country very similar to the UK in terms of GDP per capita, was $1.03m - around an order of magnitude higher.

For those countries whose governments acted quickest - South Korea and New Zealand - and whose response to date has been deemed most successful, the price of life was $6.7m and $11.6m respectively.

"Seemingly, much like a bird in the hand, cash flowing through the market is worth much more than value passing through wellbeing, at least to some countries," said Balmford.

"By choosing not to impose lockdowns three days earlier, governments rejected saving more lives when the price was relatively high.

"The same logic reveals them to have accepted the implied price of life from a delay - they would rather bear the cost in terms of GDP than as further human lives lost."

Children living with HIV can now benefit from an adapted, simpler combination therapy. In combination therapy, two or three medicines are used simultaneously to inhibit HIV. One of those agents is dolutegravir. Thanks to research at Radboud university medical center, it is now clear that the use of one, widely available, pill of dolutegravir in children yields equally good treatment results as a combination of several, less readily available pills of that drug. Especially in countries where the number of infections is high and good care is less accessible, this makes it easier to treat children. These results, published today in the scientific journal The Lancet HIV, are included in the World Health Organization (WHO) treatment guidelines.

1.7 million children live with HIV

Approximately 1.7 million children worldwide are infected with HIV (the human immunodeficiency virus, which can cause AIDS), 1.2 million of whom live south of the Sahara. These children need lifelong medication to inhibit the virus, in order to prevent disease, death and infection from others. However, it is estimated that in 2018, only 56% of HIV-infected children had access to proper medication. In addition, the effect in children and teenagers is less desirable than in adults.

It was already known that the drug dolutegravir, in combination with other drugs, is a good treatment for all HIV-infected adults, because it effectively inhibits virus growth and the virus doesn't quickly develop resistance. Moreover, it is a safe and cheap tool, and widely available: from high to low income countries, an important starting point for WHO to equate healthcare in different countries.

Lack of access to good treatment

It is also known that treatment options for children often lag behind those for adults. In the case of HIV-inhibiting treatments, children over 12 years of age and 40 kg received the same dose of dolutegravir as adults (one 50 mg pill daily). But younger children, or those of a lower weight, had to take two or more pills a day, but of a lower amount (10mg and 25mg), a dosage not approved by all drug agencies.

Professor David Burger: "This led to problems, because these lower dosages are not easily available in low and middle-income countries. As a result, national programs could not be started properly and the risk of errors in dosage and intake increased. In addition, this medication was not appropriate for small children under 20 kilos. In short, there was a need to achieve a simpler and more practical dosage of dolutegravir for children."

Simpler dosage leads to good results

The study initiated by Burger, together with Radboudumc-colleagues Pauline Bollen and Angela Colbers and colleagues from the Medical Research Council Clinical Trials Unit at University College London, focused on simplifying the dosage of dolutegravir that children should take every day, which should work equally well and should not cause any additional side effects. They did this by giving 62 HIV-positive children aged between 6 and 18 years from Uganda and Zimbabwe different doses of medicines, taking their weight into account. They were monitored for nearly half a year. The results show that one 50 mg pill of dolutegravir per day, the same dose as adults, works well in the children and that their body responds to the medicine in the same way as the more difficult dose to give. This benefits the treatment of the children.

As a result of this study, the World Health Organization amended the guidelines for treatment in HIV-positive children, and the Federal Drug Administration (FDA) recently approved this dosage.

Could where you live dictate how long you live? New research at Syracuse University's Maxwell School, published today in the Milbank Quarterly, shows Americans who live in so called blue states tend to live longer than those in red states, primarily due to state policies. Among the findings:

U.S. state policies since the 1980s have cut short American lives, particularly for women. U.S. life expectancy gains since 2010 would be 25% greater for women and 13% greater for men if states policies had not changed in the way they did, with many becoming more conservative.

Enacting more liberal state policies could raise U.S. life expectancy by over 2 years, whereas enacting more conservative state policies could reduce it by 2 years.

In the greatest gap between states, residents in Connecticut outlive their counterparts in Oklahoma by as many as seven years.

The study examined how state policy environments contributed to U.S. life expectancy trends from 1970 to 2014. It used information on 18 policy domains such as abortion and guns, each measured on a liberal-to-conservative scale, for every state and calendar year. The analysis then predicted U.S. life expectancy trends from all policy domains, controlling for characteristics of states and their residents.

"Americans die younger than people in other high-income countries," said Jennifer Karas Montez, sociology professor at Syracuse University's Maxwell School and lead author of the study. "This gap in life expectancy between the U.S. and other countries emerged in the 1980s and has grown ever since. Since that time, gaps in life expectancy between U.S. states also expanded. The difference between the highest and lowest life expectancy states has grown to 7.0 years--the largest ever recorded. These two trends are related: the dismal life expectancy trends of some states have been an anchor on overall U.S. life expectancy."'

For instance, between 1980 and 2017, life expectancy rose by just 2.2 years in Oklahoma (73.6 to 75.8 years) but 5.8 years in Connecticut (74.9 to 80.7 years). Life expectancy in Oklahoma now falls between that of Serbia and Brazil, while Connecticut falls between Denmark and Costa Rica.

The study found that Oklahoma and Connecticut differ in other ways. While these two states were diverging in life expectancy, they were also diverging in their policy orientation. Oklahoma made one of the largest transitions toward a conservative state policy environment among all 50 states. Conversely, Connecticut made one of the largest transitions toward a liberal state policy environment. This polarization in state policy environments has occurred across the U.S. and helps to explain the growing gap in life expectancy between states and the troubling trends in U.S. life expectancy since the 1980s.

Among the 18 policy domains studied, 10 strongly predict life expectancy. More liberal versions of those policies generally predict longer lives and more conservative versions generally predict shorter lives. This is especially the case for policies on tobacco, immigration, civil rights, labor (e.g., Right to Work laws, minimum wage), and the environment. For instance, by changing its labor laws from the most conservative to the most liberal orientation, a state could experience a large 1-year increase in life expectancy. State policies have particularly important consequences for women's life expectancy. This finding reflects the reality that state policies such as minimum wage, EITC, abortion laws, and Medicaid are more relevant for women's than men's lives.

According to Montez, "During the 1980s and after 2010, overall changes in state policies had a negative impact on U.S. life expectancy. After 2010, the small gains in U.S. life expectancy would have been 13% steeper among men and 25% steeper among women if state policies had not changed in the way that they did, with many becoming more conservative."

If all 50 states enacted either liberal or conservative policies, what would happen to U.S. life expectancy? "If all states enacted liberal policies across the 18 domains, our study estimated that U.S. life expectancy would increase by 2.8 years for women and 2.1 years for men," said Montez. "However, if all states enacted conservative policies, U.S. life expectancy would decline by 2.0 years for women and 1.9 years for men. If all states followed current national policy trends, there would continue to be little improvement in life expectancy. This is partly due to countervailing forces: gains in U.S. life expectancy associated with some national policy trends (e.g., toward liberal policies on the environment and civil rights) would be offset by losses associated with other trends (e.g., toward conservative policies on abortion and guns)."

Montez said that trends in state policies since the 1980s have cut short many lives. "Improving U.S. health and longevity requires changing many of those policies," said Montez. "In particular, it is essential to enact policies that protect the environment, regulate tobacco and firearms, and ensure labor, reproductive, and civil rights." But Montez believes e nacting these changes in state policies will not be easy. "On the contrary: policymakers in many states have put the interests of corporations and their lobbyists--particularly the American Legislative Exchange Council (ALEC)--and wealthy donors over the interests and health of their constituents."

To drive home her point, Montez points out Oklahoma, for example, is one of the most active states in terms of enacting the corporate-friendly and politically-conservative policies promoted by ALEC, while Connecticut is among the least active states.

"Policymakers and the public must recognize," she said, "that putting profits over people cuts lives short."

FAIRFAX, Va. -- Mortality rates after treatment of unruptured intracranial aneurysms have substantially decreased in the past decade, according to new findings presented today at the Society of NeuroInterventional Surgery's (SNIS) 17th Annual Meeting.

The study, Trends in Mortality and Morbidity after Treatment of Unruptured Intracranial Aneurysm in the United States, 2006-2016, analyzed data from 21,609 patients in the Nationwide Inpatient Sample (NIS) database across a 10-year period. The research compares two treatments for unruptured intracranial aneurysms: microsurgical clipping and endovascular embolization. Microsurgical clipping involves an open brain surgery, whereas endovascular embolization is a minimally invasive procedure.

Patients who underwent endovascular embolization had a significantly higher rate of favorable clinical outcome -- defined as discharge to home or acute rehabilitation facility -- compared to microsurgical clipping group (91% vs 74%) and an average of 3 days shorter hospital stay. The utilization of endovascular embolization has increased in the past decade.

"Our research indicates that treatment of unruptured brain aneurysm has become exceedingly safer over the last 10 years due to advancement in both microsurgical techniques and endovascular technology," said Dr. Shahram Majidi, lead author of the study and Assistant Professor of Neurosurgery, Neurology and Radiology at Icahn School of Medicine at Mount Sinai Hospital and Director of Cerebrovascular Services at Mount Sinai Brooklyn. "While overall clinical outcomes have been significantly improved, we found a higher rate of favorable hospital outcome and lower mortality rate among endovascularly treated patients compared to microsurgical clipping."

The research also found that the overall rate of in-hospital mortality decreased from 0.9% in 2006 to 0.2% in 2016. Overall, 83% of the patients had favorable clinical outcomes. Other independent predictors of in-hospital mortality included advanced age (80 years old and older) and the presence of multiple comorbidities. Moreover, women and African Americans had a lower chance of favorable clinical outcomes independent to the treatment modality.

Incorporating high-intensity interval training, or HIIT, into exercise programs for individuals with Down syndrome may help achieve critical health outcomes in a more time-efficient manner, according to an article written by researchers at the University of Georgia and Kennesaw State University.

Published in the American College of Sports Medicine journal, the article provides practical insights to better inform health and fitness professionals about Down syndrome, while also helping them design more effective exercise programs for people with the condition.

Down syndrome is one of the most prevalent birth disorders in the United States and is characterized by a variety of cognitive and physical difficulties, including intellectual disabilities, learning and memory issues, defects of the heart, respiratory issues, vision and hearing problems and more. According to the article, obesity rates approach 70% in this population, which can lead to even more negative health consequences.

Takes less time

"HIIT provides the same health benefits as aerobic exercise, but can take less time to provide those benefits," said Megan Ware, a doctoral student in the Mary Frances Early College of Education's department of kinesiology and co-author of the article. "The short, high-intensity exercises in HIIT also do not require long periods of sustained effort and can give people with DS better heart health, better control of body weight and better blood sugar and lipid levels."

HIIT is a form of interval training that alternates between short periods of intense exercise with less intense recovery periods that allow individuals to complete a similar amount of physical work, or even less, than a traditional exercise program. Since many individuals with Down syndrome have decreased attention spans, HIIT may be more effective and enjoyable than traditional modes of exercise.

"What makes HIIT really special is that it can be fun for people with DS, since their motivation to start or continue exercise can be low," said Ware. "HIIT can be structured to include various kinds of movements that keep engagement high during an exercise training session. This includes a combination of aerobic, strength and agility-based training movements. The variety can provide a different challenge and a variety of benefits."

Maintaining safety and reducing injuries are challenges professionals may face when helping people with Down syndrome perform HIIT, said Ware. However, these risks also apply to the general population and can be reduced with good instruction, modeling, proper equipment selection and proper supervision.

Allows more creativity

Furthermore, for individuals with Down syndrome who have greater balance deficits, HIIT may be safer in larger areas of the gym, where unobstructed exercises are performed. Because HIIT can be performed with a variety of equipment, such as a rower, elliptical machine and others, these workouts can be customized to the desire and specific health and physiological needs of the individual, while also achieving improvements in health outcomes.

"The bottom line is that exercise professionals can be more creative with exercise programming for people with Down syndrome by incorporating HIIT," said Ware. Additional tips for fitness professionals include familiarizing participants with every exercise in a given program, monitoring heart rate during exercise and providing a safe and comfortable exercise environment.

Photodynamic therapy can be an efficient ally to combat secondary infections in COVID-19 patients. Use of the technique, which combines light and a photosensitizing chemical substance to kill microorganisms in the respiratory tract, is advocated as a complementary treatment in a feature published in Photodiagnosis and Photodynamic Therapy and written by researchers affiliated with the Optics and Photonics Research Center (CEPOF ) in São Carlos, state of São Paulo, Brazil.

"COVID-19 can lead to complications that go beyond the virus, and we should also strive to find treatments for these other problems. Treating coinfections and secondary infections can improve the prognosis in severe cases, above all for patients who are intubated and face a higher risk of infection by other microorganisms such as the bacteria that cause pneumonia," said Vanderlei Bagnato , CEPOF's principal investigator.

CEPOF is a Research, Innovation and Dissemination Center (RIDC ) supported by São Paulo Research Foundation - FAPESP and hosted by the University of São Paulo (USP) in São Carlos.

The compounds used in photodynamic therapy interact with light to produce singlet oxygen, a highly reactive oxygen species that kills viruses and bacteria by oxidizing their membranes.

"When the patient inhales these substances, the drug can be activated with extracorporeal light, which then attacks pathogens in the airways," Bagnato said.

Photodynamic therapy cannot be used to attack the novel coronavirus SARS-CoV-2 directly since it does not eliminate harmful microorganisms present in the bloodstream (only in the airways). However, researchers stress the importance of developing techniques to combat COVID-19 coinfections caused by bacteria and other viruses, avoid the need for intensive medical care, and minimize transmission of the disease to other people.

CEPOF has conducted several studies on the use of photodynamic therapy to treat pneumonia, skin cancer, and other diseases. "We're about to begin a study to evaluate the use of photodynamic therapy in cases of pneumonia in pigs. This stage precedes clinical trials in humans," Bagnato said.

The study will be conducted by CEPOF in partnership with researchers at the University of Toronto in Canada. "We hope it will be fast-tracked because, although we don't know for sure yet, it's quite likely that people who survive COVID-19 may be more prone to respiratory complications such as pneumonia because of the severe inflammation," Bagnato said. "We need to develop novel techniques and alternative treatments."

In the journal, the researchers note that "the propagation of opportunistic pathogens occurs mainly through the upper respiratory tract owing to natural colonization of the oropharynx" and that photodynamic therapy "can help not only to reduce the number of these microorganisms present in the oropharynx but also to prevent their penetration into the mucosal barrier" and hence their proliferation.

Findings from a research study, led by scientists at Henry Ford, published in the latest issue of Nature Communications suggest an enzyme could play an important role in the treatment of cancer and autoimmune diseases in the airway.

Histone deacetylases (HDACs) are enzymes that help modulate gene expression by removing acetyl groups from histone or non-histone proteins. Inhibition of HDACs is emerging as a promising approach to treat various types of malignant diseases and inflammatory disorders.

"The findings from this study show the key role HDAC3, one in the large HDAC family, plays in regulating lung macrophage development and homeostasis," said Qing-Sheng Mi, M.D., Ph.D., senior author of the study, senior scientist/professor, director of the Center for Cutaneous Biology and Immunology, Department of Dermatology, and director of Immunology Program of Henry Ford Cancer Institute. "Four pan-HDAC inhibitors have been approved by the FDA for anti-tumor therapy. However, due to common severe side effects of these pan-HDAC inhibitors, developing drugs with high selectivity for individual HDACs has become a priority for researchers."

"This study sheds light on HDAC3 as a potential therapeutic target for intervention in cancer and autoimmune diseases in the airway," said Li Zhou, M.D., co-senior author, associate scientist in the Center for Cutaneous Biology and Immunology at Henry Ford.

Lung alveolar macrophages are the innate immune cells residing in lung alveoli. They are important for the maintenance of homeostasis in the airways and are involved in the development of a variety of pulmonary diseases, including asthma and lung cancer.

"According to the findings of this study, the deletion of HDAC3 in mouse alveolar macrophages leads to significant impairment of alveolar macrophage development, maintenance, maturation and regeneration," said Yi Yao, Ph.D., the first author in the paper and a research instructor from Dr. Mi's laboratory.

More research is needed to better understand the underlying mechanism by which individual HDACs regulate immune cell development, maintenance and function. This knowledge will help with identifying potential therapeutic treatments.

"Our study may help bring HDAC3-inhibitor into clinical trial for lung cancer and inflammatory diseases," said Dr. Qing-Sheng Mi.

SILVER SPRING, Md.--Body mass index (BMI) is associated with the development of severe coronavirus disease 2019 (COVID-19) and admission to intensive care units (ICU) in African Americans, according to a single center, retrospective cross-sectional study published online in Obesity, the flagship journal of The Obesity Society. This is the first study that focuses specifically on the risk factors within an African-American population.

Age and comorbidities such as hypertension and diabetes have been well identified as risk factors for the development of severe disease. Obesity is also emerging as a risk factor for severe disease development. However, this study adds further evidence supporting the association that body mass index is connected with disease severity in the African-American population.

"It is of tremendous importance that we identify risk factors and those individuals who may be at increased risk for severe COVID-19 infection, so that we are able dedicate efforts towards supporting those most affected and in need," said Christine Bojanowski, MD, assistant professor in the Department of Medicine, Section of Pulmonary Diseases, Critical Care and Environmental Medicine at Tulane University Health Science Center in New Orleans, La. Bojanowski is the corresponding author of the study.

Bojanowski added "this study is of particular interest in response to emerging reports revealing the disproportionate impact of COVID-19 on the African American community in our country. Further inclusive research aimed at optimizing clinical care relevant to the African-American population is critical to ensure an equitable response to COVID-19."

Researchers included 158 confirmed COVID-19 positive African-American patients who presented to Tulane Medical Center between March 12 and April 9, 2020 in their study. Participants were identified through reported laboratory testing during the aforementioned time period. Researchers obtained individual patient data through retrospective, electronic medical record review.

To define and determine severe disease, participants had to require intensive care unit admission for COVID-19 related complications. In the study, this closely aligned with respiratory failure requiring mechanical ventilation.

Researchers found that 85 percent of the severe cases admitted to the ICU had respiratory failure requiring intubation and mechanical ventilation. ICU mortality for severe cases was 37 percent; however 21.7 percent of the participants were still intubated and requiring mechanical ventilation at the time of the study, which may impact and potentially increase this percentage.

In unadjusted and adjusted analysis, the factors most associated with ICU admission were age, BMI and lung disease.

The average BMI of participants was 33.2. The results also showed that participants with severe disease requiring ICU admission were older (62 years versus 55 years, p = 0.003) and had higher BMI (36.5 kg/m2 versus 31.9 kg/m2, p = 0.002).

The results confirmed that obesity is a significant determinant of disease severity in the African-American population. Researchers propose that a lower threshold be considered for BMI than the current Centers for Disease Control and Prevention recommendations that describe individuals with BMI greater than 40 as "high risk" for severe illnesses in COVID-19.

"Instead of stigmatization of black adults with obesity, this pandemic, a hopefully once-in-a-century health crisis, is a clarion call to decrease and eventually eliminate long-standing health disparities and underlying adverse societal structural factors," said Keith C. Ferdinand, MD, FACC, FAHA, FASPC, FNLA, FASPC, professor of medicine, Gerald S. Berenson Endowed chair in Preventive Cardiology, Tulane University School of Medicine, in a commentary about the study.

DALLAS, August 4, 2020 -- When people seek emergency care for shortness of breath, a routine electrocardiogram (ECG or EKG) enhanced by artificial intelligence (AI) is better than standard blood tests at determining if the cause is heart failure, according to new research published today in Circulation: Arrhythmia and Electrophysiology, an American Heart Association journal.

"Determining why someone has shortness of breath is challenging for emergency department physicians, and this AI-enabled ECG provides a rapid and effective method to screen these patients for left ventricular systolic dysfunction," said Demilade Adedinsewo, M.D., M.P.H., lead author of the study and chief fellow in the division of cardiovascular medicine at Mayo Clinic in Jacksonville, Florida.

The left ventricle supplies most of the heart's pumping power, so it is larger than the other chambers and essential for normal function. In left ventricular systolic dysfunction (LVSD), the left ventricle is weakened and must work harder to maintain adequate blood flow to the body.

In a typical year, about 1.2 million people go to emergency departments because they are short of breath. This year, the numbers are far higher because difficulty breathing is one of the hallmark symptoms of a COVID-19 infection. When heart problems are suspected, patients in the emergency department usually have an ECG performed - a quick, 10-second recording of the heart's electrical activity.

"An abnormal ECG raises concern about underlying cardiac abnormalities but are not specific for heart failure," Adedinsewo said.

Emergency department physicians also rely on blood levels of natriuretic peptides. These biomarkers are elevated in the blood when heart failure is present. However, these biomarker levels are also affected by obesity, age, kidney disease, severe infection, high blood pressure in the vessels that bring blood to the lungs (pulmonary hypertension), abnormal heart rhythms and a specific heart failure medication.

To create the AI-enhanced ECG, Mayo Clinic researchers used data on thousands of patients to train computers to distinguish between the ECG patterns of people ultimately diagnosed with LVSD and those without LVSD. In about 10 seconds, standard ECG recordings can be analyzed with the resulting AI software application to identify likely LVSD.

In this study, researchers tested the accuracy of the AI-enhanced ECG to identify LVSD in emergency room patients with shortness of breath compared to the results of biomarker blood tests. They applied the AI-enhancement to the ECGs of 1,606 patients (average age 68, 47% female, 91% white) who had received an ECG and blood testing in the emergency department, later followed by definitive testing using an echocardiogram.

Researchers found:

AI-enhanced ECG was better than standard blood tests in identifying which patients have severe LVSD (35% or less of blood in the heart pumped out with each contraction), with a performance measure of 0.89 vs. 0.80;

the AI-enhanced ECG was also good (performance measure 0.85) at identifying patients with less severe but abnormally low pumping ability (50% or less of the blood leaving the heart with each contraction); and

while several factors can influence blood test results, AI-enhanced ECG performed just as well in men and women and among patients in different age groups.

"AI-enhanced ECGs are quicker and outperform current standard-of-care tests. Our results suggest that high-risk cardiac patients can be identified quicker in the emergency department and provides an opportunity to link them early to appropriate cardiovascular care," Adedinsewo said.

AI-enhanced ECGs are not widely available. In May, the Food and Drug Administration granted emergency use authorization of the AI-enhanced ECG algorithm to screen for LVSD in people with confirmed or suspected COVID-19 disease.

The current study is limited by being a retrospective analysis of previous emergency department visits.

A new iron intervention study has determined which of the world's low-and-middle income countries would benefit from using iron-containing micronutrient powders to tackle childhood anaemia.

Using advanced computer simulation techniques, the study's findings include individual reports for 78 countries - predominantly in Africa, Asia and Latin America - showing where the use of micronutrient powders would offer a net benefit, and where the intervention could cause more harm than good.

This is vital information for governments aiming to efficiently and cost-effectively reduce the burden of anaemia in their countries.

Published in Lancet Global Health, the research was led by Walter and Eliza Hall Institute researcher Associate Professor Sant-Rayn Pasricha, who is also a haematologist at The Royal Melbourne Hospital. It involved an international consortium of experts from Queensland University of Technology, Imperial College London, and Emory University, the Centre for Disease Control and University of Pennsylvania in the US.

At a glance

It has long been global health policy to deliver iron-containing micronutrient powders to control anaemia in children, however, there is also data that the intervention exacerbates the risk of diarrhoea and malaria.

A new study has used sophisticated computer modelling to reveal that 54 out of 78 countries benefit from using micronutrient powders to combat anaemia. And that in 24 countries, the use of micronutrient powders causes more harm than good.

The study's findings include 78 individual reports that are readily available to inform country-specific policies that reduce the burden of anaemia in low-and-middle income countries.

Combatting iron deficiency

Dietary iron deficiency is considered the major cause of anaemia in children worldwide and iron-containing micronutrient powders, that can be mixed into food, are currently the main intervention recommended by the World Health Organization for combatting the widespread problem.

However, because iron is essential for certain pathogenic micro-organisms to thrive, there is data that the use of micronutrient powders may exacerbate the risk of diarrhoea and malaria in children, potentially causing more net harm than good.

Dr Pasricha said the international research team set out to answer the question of whether micronutrient powders offered a net overall benefit on health outcomes in children when the associated risks from infection were taken into account.

"In 54 of the 78 countries analysed, we saw a net benefit in the use of micronutrient powders to combat childhood anaemia in. In the remaining 24 countries, however, we found the use of micronutrient powders may actually cause a net harm."

Advanced computing

The findings point to the importance of not taking a blanket approach. The reports produced for each of the 78 different countries provide policymakers with accurate, actionable information that balances the expected benefits on anaemia reduction against possible risks of infection.

Associate Professor Pasricha said the study would not have been possible without advanced computing and the expertise of a multidisciplinary team including mathematicians, health economists, paediatricians and nutrition experts.

"It was an amazing team that came together to make this research possible. It was also really exciting to harness the power of cutting-edge computer simulation to make sense of data sets so large they would have taken more than 15,000 years to manually assess.

Through a comprehensive microsimulation analysis, the researchers were able to integrate huge amounts of data from each country on anaemia, malaria and diarrhoea, as well as health care and public health information. This enabled them to simulate potential outcomes for five million children per country and determine the net health benefit (or harm) and cost-effectiveness of using micronutrient powders in different settings from Mongolia to Madagascar.

We're incredibly proud of the resulting reports from this world-first study, said Associate Professor Pasricha.

"Our hope is that the reports are readily accessed and put to good use by leaders, policymakers and donors the world over to help countries save time, money and most importantly, lives in the fight against anaemia," he said.

The research was funded by the International Union of Nutrition Sciences.

The Myelodysplastic Syndromes Group of Josep Carreras Leukaemia Research Institute, led by Dr. Francesc Solé, has participated in the first international study that confirms that having two mutated copies of the TP53 gene, as opposed to a single mutated copy, is associated with a worse prognosis in patients diagnosed with myelodysplastic syndrome (MDS).

This study, published in the prestigious scientific journal Nature Medicine, has been conducted by researchers from the Memorial Sloan Kettering in the USA, involving 25 research centers in 12 countries and has been supervised by the international working group for the prognosis of MDS, whose aim is to develop new international guidelines for the diagnosis and treatment of this disease. This is a preliminary result in order to define a prognostic score based on molecular changes.

Considered the "guardian of the genome," TP53 is the most commonly mutated gene in cancer. The normal function of TP53 is to detect DNA damages and prevent cells from passing this damage to daughter cells. When TP53 is mutated, the protein resulting from this gene (called p53) can no longer perform this protective function and a cancer may be the result. In most cancers, TP53 mutations are associated with a worse prognosis, such as disease relapse, poor response to treatments and shorter survival.

TP53 exists in duplicate in each of our cells, just like all other genes: one copy from our mother and one copy from our father. Until now, it was not clear whether a mutation of a single copy of TP53 was enough to cause a worse prognosis of the disease, or whether mutations in both copies were necessary.

This study has confirmed for the first time that having the two mutated copies of the TP53 gene is associated with worse results for myelodysplastic syndromes (MDS), a group of blood cancers whose common characteristic is that the stem cells in the bone marrow, in charge of manufacturing all the blood cells, have a defect that makes them produce abnormal cells, unable to perform their usual functions, and in a lower quantity.

Dr. Solé, leader of the Josep Carreras Institute's Myelodysplastic Syndromes group, member of the Spanish Myelodysplastic Syndromes Group (GESMD) and member of the international working group for the prognosis of MDS, explains: "From the Josep Carreras Institute we have actively participated by providing more than a hundred samples from patients with the diagnosis of MDS, in the comparative analysis of cytogenetic (karyotype) results versus those obtained by mass sequencing, and in the final discussion of the findings obtained. The results of this study will allow a great advance in the diagnosis and treatment of myelodysplastic syndromes. Current guidelines do not consider genomic data, such as the mutational status of TP53 and other genes to assess prognosis in patients with MDS or to determine appropriate treatment for this disease. However, studies like this show that we should include this information to improve the diagnosis and treatment of patients".

By using new computational methods in a serie of 4,444 patients with MDS, the researchers found that a third of the patients with TP53 mutations had only a mutated copy of this gene. These patients had similar results to patients who did not have a TP53 mutation, that is to say good response to treatment, low rates of disease progression and long-term survival. However, two-thirds of patients had both mutated copies of TP53 and these patients had worse results, including resistance to treatment, rapid disease progression, and short-term survival.

In fact, the researchers found that the TP53 mutation status (0, 1, or 2 mutated copies of the gene), was the most important variable in predicting the clinical course of the disease.

Given the frequency of TP53 mutations in cancer, these results also advocate to examine the impact of one or two mutations on other types of cancer, both hematologic and solid tumors, and reveal the need of clinical trials specifically designed with these molecular differences.