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Treatment with antivirals such as interferons may significantly improve virus clearance and reduce levels of inflammatory proteins in COVID-19 patients, according to a new study in Frontiers in Immunology. Researchers conducting an exploratory study on a cohort of confirmed COVID-19 cases in Wuhan found that treatment with interferon (IFN)-α2b significantly reduced the du-ration of detectable virus in the upper respiratory tract and reduced blood levels of interleukin(IL)-6 and C-reactive protein (CRP), two inflammatory proteins found in the human body.
The findings show potential for the development of an effective antiviral intervention for COVID-19, which is an ongoing global pandemic caused by the novel coronavirus, SARS-CoV-2.

"Interferons are our first line of defence against any and all viruses - but viruses such as corona-viruses have co-evolved to very specifically block an interferon response", says lead author Dr Eleanor Fish of the Toronto General Hospital Research Institute & University of Toronto's Department of Immunology, adding: "This informs us of the importance of interferons for the clearance of virus infections. Treatment with interferon will override the inhibitory effects of the virus."

Fish says that the research team considered IFN-α therapy for COVID-19 after they demonstrated interferons had therapeutic benefits during the SARS outbreak of 2002 and 2003. "My group conducted a clinical study in Toronto to evaluate the therapeutic potential of IFN-α against SARS. Our findings were that interferon treatment sped up the resolution of lung abnormalities in patients treated with interferon compared with those not treated with interferon" says Fish.

In this study, the authors examined the course of disease in a cohort of 77 individuals with con-firmed COVID-19 admitted to Union Hospital, Tongii Medical College, Wuhan, China, between January 16th and February 20th 2020. The individuals evaluated in this study consisted of only moderate cases of COVID-19, as none of the patients required intensive care or oxygen supple-mentation or intubation. Patients were either treated with IFN-α2b, arbidol (ARB), which is a broad-spectrum antiviral, or a combination of IFN-α2b plus ARB, and viral clearance was defined as two consecutive negative tests for virus at least 24 hours apart, from throat swab samples.

The researchers demonstrated a significantly different rate of viral clearance for each treatment group and notably, IFN-α2b treatment accelerated viral clearance by approximately 7 days. Treatment with IFN-α2b, whether alone or in combination with ARB, accelerated viral clearance when compared to ARB treatment alone. IFN treatment was also demonstrated to significantly reduce circulating levels of IL-6 and CRP, whether alone or in combination with ARB. The influence of age, co-morbidities and sex did not negate the effects of IFN treatment on viral clearance times or on the reduction in the inflammatory proteins IL-6 and CRP.

Despite the study's limitations of a small, non-randomised cohort, the work provides several important and novel insights into COVID-19 disease, notably that treatment with IFN-α2b accelerated viral clearance from the upper respiratory tract and also reduced circulating inflammatory biomarkers, hinting at functional connections between viral infection and host end organ damage by limiting the subsequent inflammatory response in the lungs of patients.

Fish argues, "Rather then developing a virus-specific antiviral for each new virus outbreak, I would argue that we should consider interferons as the 'first responders' in terms of treatment. Interferons have been approved for clinical use for many years, so the strategy would be to 'repurpose' them for severe acute virus infections."

As an uncontrolled, exploratory study, Fish says a randomized clinical trial is a crucial next step: "A clinical trial with a larger cohort of infected patients that are randomized to treatment with interferon-alpha or to a placebo would further this research".

In the meantime, the findings from this study are the first to suggest therapeutic efficacy of IFN-α2b as an available antiviral intervention for COVID-19, which may also benefit public health measures by shortening the duration of viral clearance and therefore slowing the tide of the pandemic.

DALLAS, May 15, 2020 -- Low-income adults in the United States were significantly less likely to be screened for cardiovascular disease (CVD) or receive counseling for CVD risk factors, according to research presented today at the American Heart Association's Quality of Care & Outcomes Research Scientific Sessions 2020. The virtual conference, to be held May 15-16, is a premier global exchange of the latest advances in quality of care and outcomes research in cardiovascular disease and stroke for researchers, health care professionals and policymakers.

Heart-health screenings, including routine blood pressure and cholesterol checks, and counseling to improve diet, increase exercise or smoking cessation are important for lowering the risk for CVD. For decades, studies have confirmed markers of socioeconomic status such as income are associated with cardiovascular disease; however, the association between income level and the utilization of CVD preventive services is not well understood.

"With the goal of encouraging clinicians and health care providers to be aware of health disparities, we set out to determine how patients at different income levels utilize services to prevent cardiovascular disease," said lead study author Andi Shahu, M.D., M.H.S., an internal medicine resident physician at The Johns Hopkins Hospital in Baltimore.

Using patient data from the nationally representative Medical Expenditure Panel Survey (2006-2015), researchers included 32,862 adults with diagnosed CVD and 185,081 adults with no CVD diagnosis. Of the total, 36% of individuals were in the "high income" category (400% or more of the federal poverty level [FPL]); 29% were in the "middle income" category (200%-400% of the FPL); 16% were in the "low income" category (125%-200% of FPL); and 19% were in the "poor/very low income" category (

Among the statistically significant results, researchers found when compared with "high income" participants:

Participants without CVD who were categorized as "low income" were 58% less likely to get their cholesterol checked within the last five years and 55% less likely to get their blood pressure checked within the past two years;

Participants without CVD who were categorized as "poor/very low income" were 64% less likely to have had their cholesterol checked within the last five years and 59% less likely to have had their blood pressure checked within the past two years;

Participants with CVD who were categorized as "low income" were 66% less likely to get their cholesterol checked within the last five years or their blood pressure checked within the past two years; and

Participants with CVD who were categorized as "poor/very low income" were 67% less likely to have had their cholesterol checked within the last five years and 68% less likely to have had their blood pressure checked within the past two years

"The significant gap in access to preventive care among lower income populations is incredibly worrisome. Preventive care, including regular cholesterol screenings and blood pressure monitoring, are essential to reducing heart disease and stroke," said Shahu. "Additionally, socioeconomic disparities are often made even worse during times of crisis, such as the current COVID-19 pandemic, because vulnerable populations are often disproportionately impacted both medically and economically. The American people need to know these types of disparities cannot be fixed in the doctor's office alone. They must be addressed using city-level, state-level or even nationwide interventions, and public health policies must align to support these interventions."

Researchers say the reasons for the disparities are still not completely understood, and further studies are required to develop solutions to reduce and prevent health disparities.

DUARTE, Calif. -- For years, surgeons have operated on pancreatic cancer patients to remove what they thought was a localized tumor only to discover that the disease had spread to other, inoperable parts of the body. Now, a City of Hope molecular scientist thinks he may have found a way to prevent ineffective surgeries and prolong the lives of these patients.

Unlike breast, skin or prostate cancer, there is no standard-of-care screening test for pancreatic cancer. And because the pancreas is situated deep within the abdominal cavity, today's imaging technology often doesn't see the pancreatic tumors and are not sensitive enough to detect the minority of cancer cells that have already spread to lymph nodes.

"If we know beforehand that these pancreatic cancer patients have lymph node metastases, we probably would not perform surgery because it's complicated, expensive and, most importantly, patients with lymph node spread don't do well after surgery," said Ajay Goel, Ph.D., M.S., A.G.A.F., chair of the Department of Molecular Diagnostics and Experimental Therapeutics at City of Hope and lead author of the new study.

"Instead, we would likely first treat the patient with chemotherapy to kill all the loose-hanging cells in the lymph nodes and then surgically remove the cancer from the pancreas."

On average the five-year survival rate for people with pancreatic cancer is only 10%, according to the National Cancer Institute. While pancreatic cancer is expected to account for about 3% of all cancer cases in 2020, it likely will be responsible for nearly 8% of cancer deaths this year.

The researchers say City of Hope is the first to perform a comprehensive, genome-wide analysis to identify a novel microRNA biomarker that can be used to detect lymph node metastases in patients with pancreatic ductal adenocarcinoma, which makes up about 80% of all pancreatic cancer cases.

Published in the journal Gastroenterology this month, the study identified microRNA, a type of gene, that is highly expressed in people with metastatic pancreatic cancer. With more investigation, doctors could one day use this biomarker to practice precision medicine. In other words, a simple biopsy would help doctors understand each patient's particular disease and empower them to select the most appropriate treatment and disease management strategies for that patient.

"Lymph node metastasis status remains one of the most important predictors of survival in patients undergoing curative resection and is considered to be of tremendous clinical significance for risk stratification and therapeutic decision-making," according to the study.

To find the novel biomarker, the scientists analyzed data in three public datasets. Then they tested and validated their hypothesis using 373 samples that included pancreatic ductal adenocarcinoma specimens, samples collected from patients before surgery and biopsies taken prior to any chemotherapy treatment. The median follow-up was 5.5 years in the testing or training cohort and 2.8 years for the validation cohort.

It turns out that there are six distinct genes or microRNAs at play: miR-155-5p, miR-196b-5p, miR-365a-5p, miR-629-5p, miR-675-3p and miR-92b-3p. A quality assurance test showed that the scientists' proposed screening test had an accuracy level of 78%.

"This may not seem like a high percentage but in a clinical setting, especially when we don't currently have a pancreatic cancer screening tool, this accuracy level has few equals," Goel said.

Now that Goel and colleagues have created the proof-of-concept biopsy screening test for the presence of lymphatic metastasis in pancreatic cancer, they want to develop the first blood draw test that they hope will identify when pancreatic cancer has spread to lymph nodes. A blood screening test is a less invasive way to deliver personalized therapy. He's already working on it and says more potential clinical innovations are coming soon.

DALLAS, May 15, 2020 -- Patients who receive home health care after a heart attack are less likely to be readmitted to the hospital within 30 days after discharge, according to research presented today at the American Heart Association's Quality of Care & Outcomes Research (QCOR) Scientific Sessions 2020. The QCOR Scientific Sessions is a virtual event in 2020, to be held May 15-17, and is a premier global exchange of the latest advances in quality of care and outcomes research in cardiovascular disease and stroke for researchers, health care professionals and policymakers.

Home health care, such as nursing and physical therapy, is a vital support tool to transition patients after hospital discharge. In the United States, only a small proportion of patients receive home health care after a heart attack, and these patients are mostly older, female or have underlying health conditions.

"Little is known regarding the impact of home health care on heart attack patients," said Muhammad Adil Sheikh, M.B.B.S., clinical assistant professor and hospitalist at the University of Michigan Medical School in Ann Arbor, Michigan. "Since patients who receive home health care tend to be older and sicker than others, and these characteristics themselves can lead to hospital readmission, we wanted to investigate the impact of home health care alone on readmission."

The study used the National Readmission Database to identify more than 400,000 patients who were treated for a heart attack and discharged from the hospital either with or without home health care. Researchers found that 9.4%, or 38,215 patients, received home health care. Among the findings, patients who received home health care after a heart attack:

were an average age of 77, compared to the average age of 60 for patients who did not receive home health care;

were more likely to have previous underlying health conditions, such as diabetes, heart failure, chronic lung disease, chronic kidney disease, high blood pressure and/or vascular disease;

however, after adjusting for the above factors, home health care patients were 11% less likely to be readmitted to a hospital within 30-days of discharge compared to those who did not receive home healthcare.

"Since hospital readmissions are costly due to the expenses associated with hospitalization, using home health care after discharge for heart attack patients can reduce health care costs for patients and medical systems," said Sheikh. "We found that home health care after hospital discharge was associated with lower 30-day readmission rates, and patients who received home health care are older, female or have underlying medical conditions. These patients are likely to benefit the most from home health care, and this service should be utilized more often to potentially reduce hospital readmission rates."

Deprivation, living in a densely populated area, ethnicity, and chronic kidney disease associated with a positive test for COVID-19 in primary care

Previous studies have focused on the risk of severe COVID-19 in hospital cases; this new study identifies risk factors for testing positive for COVID-19 using electronic health record data from GP practices

Older age, being male, deprivation, living in a densely populated area, ethnicity, obesity, and chronic kidney disease are associated with a positive test for COVID-19, according to results from 3,802 people tested for SARS-CoV-2 (including 587 positive tests) in the UK. The observational study was conducted in between Jan 28 and April 4 using routine electronic health records data from GP practices across England (UK), and results are published in The Lancet Infectious Diseases journal.

Study author Professor Simon de Lusignan from the University of Oxford, and Director of the Royal College of GPs Surveillance Centre, UK, says: "While clear trends have emerged from hospital data for the people with severe symptoms, the risk of infection among the general population remains a grey area. It's important to know which groups in the wider community are most at risk of infection so that we can better understand SARS-CoV-2 transmission and how to prevent new cases." [1]

The authors note that other socio-economic factors, which were not measured in this study, may also be linked with SARS-CoV-2 infection, such as employment in high risk jobs, education, income, and differences in access to healthcare and testing among ethnic groups. Further research is needed to understand these associations.

Hospital-based studies have reported that being older, male, and having underlying health conditions such as hypertension and diabetes, are associated with having more severe complications of COVID-19. The new analysis identifies that some of these factors are also associated with testing positive for SARS-CoV-2. However, there were some notable differences. For example, most underlying health conditions did not significantly increase susceptibility to infection and the analysis found a link between smoking and lower likelihood of a positive test result [2]. The authors believe this is due to confounding factors, rather than indicating a protective effect, and they warn that the result should not encourage people to continue or take up smoking.

Professor de Lusignan says: "This result does not indicate that smoking protects against infection, and there are many potential alternative explanations - such as smoking hampering the sensitivity of the SARS-CoV-2 test, or people who smoke being more likely to have an ongoing cough so being more likely to be tested despite not having the virus. As well as the well-documented harms to overall health from smoking, there is potential for smoking to increase the severity of COVID-19 disease, and so our findings should not be used to conclude that smoking prevents SARS-CoV-2 infection, or to encourage ongoing smoking." [1]

The authors analysed data from 587 people with positive results and 3,215 with negative results, collated by GP practices in England who are part of the Royal College of General Practitioners Research and Surveillance Centre primary care network.

Among adults, those aged 40 to 64 years were at the greatest risk of testing positive for SARS-CoV-2 (18.5% tested positive, 243 out of 1,316 people), compared with children aged up to 17 years (4.6%, 23 of 499). Among 1,612 men, 18.4% (296) tested positive, compared with 13.3% (291/2,190) of women.

Compared with people of white ethnicity, of whom 15.5% (388 of 2,497) tested positive, the proportion of people of black ethnicity testing positive were much higher, at 62.1% (36 of 58 people). This finding remained significant after adjusting for comorbidities such as high blood pressure and diabetes, the prevalence of which is increased in black ethnic groups. The authors say that these results should be interpreted with caution, as there were small numbers of people from England's minority ethnic groups in the study.

There was a large difference between people living in the most and least deprived areas. Of 668 people in the most deprived areas, 29.5% (197) tested positive, compared with 7.7% (143 of 1,855) in the least deprived areas. People in urban areas were more at risk than those in rural areas. Of 1,816 people tested in urban areas, 26.2% (476) tested positive, while in rural areas 5.6% tested positive (111 of 1,986).

The only clinical conditions significantly associated with a positive test were chronic kidney disease and obesity. Of 207 people with chronic kidney disease, 32.9% (68) tested positive, compared with 14.4% (519/3,595) without kidney disease. While 20.9% of people who were obese tested positive (142/680), compared with 13.2% (171/1,296) people of normal weight.

Co-author Dr Gayatri Amirthalingam, from Public Health England, says: "With each day that passes our knowledge of COVID- 19 improves. This analysis of primary care outcomes of individuals testing positive for virus is an important contribution to our wider understanding of how COVID-19 is affecting people of different demographic groups. This study, which uses data from the Oxford RCGP Research and Surveillance Centre, will also inform PHE's ongoing Review into Factors Impacting Health Outcomes from COVID-19 that is to be completed by the end of May. This review will also analyse hospitalisations and mortality, including excess mortality, to provide further insight on how COVID-19 may be having a disproportionate impact on different groups. It will also determine the impact of occupation (including healthcare workers) where data is available."

The authors caution that some of the findings may reflect selection bias, as the study only included people who had a test for SARS-CoV-2 performed through routine NHS services. Some groups of people may be more or less likely to get tested in the first place, and this could have impacted the study results. They suggest that a larger population survey is urgently needed to confirm which groups are most at risk. They also note that although people in the study were tested using the gold standard for SARS-CoV-2 diagnosis, RT-PCR, some positive cases could have been missed, for example if people were tested when they had a small viral load.

Writing in a linked Comment, lead author Dr Rachel Jordan (who was not involved in the study) from the University of Birmingham, UK, says: "What is fundamentally clear is that whatever the specific risk factors, the COVID-19 pandemic exacerbates existing socioeconomic inequalities, and this needs both exploration and mitigation in the coming months and years. As the UK prepares to loosen lockdown measures, knowing who is most at risk of infection is vital. This study highlights the more susceptible subgroups among those with relevant symptoms, although we cannot be sure why they are more susceptible. Population-level studies with testing among random samples of the general population (irrespective of symptoms), as well as accurate antibody tests of past infection, are urgently needed."

WASHINGTON - A percutaneous transcatheter therapy for congenital heart disease (CHD) patients with severe pulmonary regurgitation (PR) has been slow to materialize, in comparison to transcatheter pulmonary valve (TPV) therapy for a dysfunctional surgical RV-PA conduit which was first implanted twenty years ago as the Melody TPV. Findings from the Medtronic Harmony TPV Pivotal Trial were presented today during the SCAI 2020 Scientific Sessions Virtual Conference and showed favorable outcomes utilizing the device in patients with severe PR.

Pulmonary regurgitation occurs when a patient has a leaky pulmonary valve, which allows flow back into the right ventricle heart chamber before it gets to the lungs for oxygen. This usually occurs after failure over time of a surgical correction of obstruction of the right ventricular outflow tract (RVOT).

The Harmony TPV is a self-expandable covered frame with a porcine pericardial valve inside that accommodates the larger right ventricular outflow tract (RVOT) of patients with congenital defects who develop severe PR after surgical repair. The TPV is available in 22- and 25-mm sizes with differences in frame size and length. An Early Feasibility Study (EFS) with TPV 22 showed high procedural success, safety, and favorable device performance through three years.

The Pivotal Trial is ongoing at 12 sites in the United States, Canada, and Japan. Patients with severe PR on echocardiography or PR fraction ?30% by magnetic resonance imaging and an indication for surgical placement of a RV-pulmonary artery conduit or prosthetic PV were eligible. Forty patients were implanted and ten patients subsequently received a modified version of the TPV 25. The primary safety endpoint is freedom from procedure- or device-related mortality at 30 days. The primary effectiveness endpoint is acceptable hemodynamic function at six months, defined as mean RVOT gradient ?40 mmHg on echocardiography, PR fraction

The investigators reported that the median age of patients in the study was 28 years old with 92% having a diagnosis of. Tetralogy of Fallot. The primary indication for intervention was severe PR in 94%, while 6% had moderate PR. The femoral vein was used in 94% of the patients to deliver the Harmony TPV. Freedom from procedure- or device- related mortality at 30 days was 100%. The measured efficacy for the Pivotal Trial (a composite of acceptable hemodynamics and no catheter interventions) was 89% and increased to 91% when including the EFS patients (versus a performance target of 75%, meeting the primary efficacy endpoint). Freedom from TPV dysfunction was 89% at 6 months. At six months, the mean RVOT gradient remained low at 14.6mmHg, while residual significant PR was only 6% with only 3% having moderate paravalvular leak (PVL). The Harmony TPV Pivotal Trial met its intended safety and efficacy goals

"Until recently, the only option for a patient that had severe PR after previous open heart surgery was to return to the operating room for another open heart surgical procedure, either a bioprosthetic Pulmonary Valve replacement or an RV-PA conduit," said John P. Cheatham, MD, Interventional Cardiologist in The Heart Center at Nationwide Children's Hospital , and Professor Emeritus at The Ohio State University in Columbus, OH. Dr. Cheatham also serves as the lead Principal Investigator of the Harmony Trials. "The Harmony TPV therapy finally offered a non-surgical option to treat severe PR and restore pulmonary valve competence."

Abstract #10994 "Primary Outcomes of the Harmony Transcatheter Pulmonary Valve Pivotal Trial." SCAI 2020 Scientific Sessions Virtual Conference, May 14-16, 2020.

WASHINGTON - Ten-year follow-up results of the U.S. Investigational Device Exemption (IDE) Trial of the Melody transcatheter pulmonary valve (TPV) were presented today during the SCAI 2020 Scientific Sessions Virtual Conference. Findings showed favorable outcomes for long-term function, safety, and efficacy for congenital patients who underwent Melody valve implantation within an existing dysfunctional right ventricular outflow tract (RVOT) conduit or bioprosthetic pulmonary valve.

The study evaluated the safety and performance of the Melody TPV at 10-year follow-up in the IDE cohort (n=150). TPV dysfunction, defined as reoperation, catheter reintervention, or hemodynamic dysfunction (ie. moderate or greater pulmonary regurgitation [PR] and/or mean RVOT gradient >40 mmHg) was assessed. Safety outcomes included serious device-related adverse events, stent fracture, catheter reintervention, surgical conduit replacement, and death.

The investigators reported that the median age of patients in the study was 19 years old; 71 patients were younger than 18 years. Tetralogy of Fallot was the original diagnosis in 51% of the patient population. The primary indication for intervention was PR in 53%, RVOT obstruction in 26%, and both in 21% of patients. Discharge mean RVOT gradient was 17 mmHg (3-36).

At 10 years of follow-up:

Freedom from all-cause mortality was 90%.

Freedom from surgical reintervention was 79% and freedom from catheter intervention was 72%.

Freedom from TPV dysfunction, the primary endpoint of the study and a composite outcome of freedom from reintervention and hemodynamic dysfunction was 54% at 10 years; results align with contemporary long term surgical series with similar patient populations.

When freedom from TPV dysfunction was stratified by age, a significant difference was observed. While 65% of adults were free of TPV dysfunction, only 47% of pediatric age patients met the endpoint.

81% of patients were free from TPV-related endocarditis, while 76% were free from any endocarditis events. Annualized incidence rates, with over 1100 patient-years of follow-up, show rates of 2.96 for any endocarditis and 2.00 for TPV-related infection. These annualized rates have dropped somewhat compared with endocarditis incidence published several years ago when there was 7-years of follow-up in the three combined Melody regulatory trials.

The Melody valve fulfills its intended design goal of prolonging the useful life of surgically implanted RVOT conduits and bioprosthetic valves and reducing the lifetime burden of repeat open-heart operations.

"Having long-term data now available is an important milestone especially for the pediatric patient population who are growing and changing so rapidly during a ten-year period," said Thomas K. Jones, M.D., director of cardiac catheterization at Seattle Children's in Seattle, Wash. "While the data reinforces the longevity, durability, and efficacy of the Melody TPV, it will also serve as a study model for future evaluations of novel pediatric congenital heart disease technologies."

The investigators conclude that this data set is a unique contribution to understanding the natural history of TPV replacement for patients with dysfunctional RVOT. The study also provides a model for future evaluations of novel technologies and overcoming challenges in study design and execution in populations with congenital heart disease.

COVID-19 can cause serious cardiovascular complications including heart failure, heart attacks and blood clots that can lead to strokes, emergency medicine doctors report in a new scientific paper. They also caution that COVID-19 treatments can interact with medicines used to manage patients' existing cardiovascular conditions.

The new paper from UVA Health's William Brady, MD, and colleagues aims to serve as a guide for emergency-medicine doctors treating patients who may have or are known to have COVID-19. The authors note that much attention has been paid to the pulmonary (breathing) complications of COVID-19, but less has been said about the cardiovascular complications that can lead to death or lasting impairment.

"In writing this article, we hope to increase emergency physicians' knowledge and awareness of this new pathogen and its impact on the cardiovascular system," said Brady, of UVA's Department of Emergency Medicine. "As we encounter more and more patients with COVID-19-related illness, we are increasing our understanding of its impact on the body in general and the cardiovascular system in particular. The rate of learning on this area is amazingly rapid. Information continues to change weekly, if not daily."

COVID-19 and Heart Failure

Heart failure is a particular concern in patients with COVID-19. One study, the article authors note, found that almost a quarter of COVID-19 patients - 24% - were suffering acute heart failure when they were first diagnosed with the coronavirus. (This doesn't mean that 24% of all COVID-19 patients will suffer heart failure. The authors state that it remains unclear if the heart failure was the result of COVID-19 specifically or if the virus was worsening undiagnosed heart failure.)

Of the patients with heart failure, nearly half were not known to have high blood pressure or cardiovascular disease.

Strokes and Other Concerns

The paper also notes that COVID-19, and other diseases that cause severe inflammation throughout the body, increase the risk that fatty plaque built up in the blood vessels will rupture, leading to heart attacks and stroke. Influenza and certain other viruses have been associated with increased risk of plaque ruptures within the first week after the disease was diagnosed, the authors state in their review of the available COVID-19 medical literature.

Finally, the authors describe potential drug interactions in COVID-19 patients. For example, the highly publicized malaria drug hydroxychloroquine can interact with medications designed to regulate heart rhythm, in addition to causing heart damage and worsening cardiomyopathy. Remdesivir, an antiviral that is the only COVID-19 treatment authorized by the FDA, can cause low blood pressure and abnormal heart rhythm. It's important for doctors to bear these interactions in mind when treating patients with COVID-19, the authors note.

"As we gain more experience with this new pathogen, we realize that its adverse impact extends beyond the respiratory system," Brady said. "We will continue to learn more about COVID-19 and the most optimal means of managing its many presentations."

Findings Published

The article has been published online by the American Journal of Emergency Medicine. In addition to Brady, it was written by Brit Long, MD, of Brooke Army Medical Center; Alex Koyfman, MD, of the University of Texas Southwestern Medical Center; and Michael Gottlieb, MD, of Rush University Medical Center.

A team of researchers at McMaster University has developed a reliable and accurate blood test to track individual fat intake, a tool that could guide public health policy on healthy eating.

Establishing reliable guidelines has been a significant challenge for nutritional epidemiologists until now, because they have to rely on study participants faithfully recording their own consumption, creating results that are prone to human error and selective reporting, particularly when in the case of high-fat diets.

For the study, published in the Journal of Lipid Research, chemists developed a test, which detects specific non-esterified fatty acids (NEFAs), a type of circulating free fatty acid that can be measured using a small volume of blood sample.

"Epidemiologists need better ways to reliably assess dietary intake when developing nutritional recommendations," says Philip Britz-McKibbin, professor in the Department of Chemistry & Chemical Biology at McMaster University and lead author of the study.

"The food we consume is highly complex and difficult to measure when relying on self-reporting or memory recall, particularly in the case of dietary fats. There are thousands of chemicals that we are exposed to in foods, both processed and natural," he says.

The study was a combination of two research projects Britz-McKibbin conducted with Sonia Anand in the Department of Medicine and Stuart Phillips in the Department of Kinesiology.

Researchers first assessed the habitual diet of pregnant women in their second trimester, an important development stage for the fetus. The women, some of whom were taking omega-3 fish oil supplements, were asked to report on their average consumption of oily fish and full-fat dairy and were then tested with the new technology. Their study also monitored changes in omega-3 NEFAs in women following high-dose omega-3 fish oil supplementation as compared to a placebo.

Researchers were able to prove that certain blood NEFAs closely matched the diets and/or supplements the women had reported, suggesting the dietary biomarkers may serve as an objective tool for assessment of fat intake.

"Fat intake is among the most controversial aspects of nutritional public health policies given previously flawed low-fat diet recommendations, and the growing popularity of low-carb/high-fat ketogenic based diets" says Britz-McKibbin. "If we can measure it reliably, we can begin to study such questions as: Should pregnant women take fish oil? Are women deficient in certain dietary fats? Does a certain diet or supplement lead to better health outcomes for their babies?"

Researchers plan to study what impact NEFAs and other metabolites associated with dietary exposures during pregnancy, might have on childhood health outcomes in relation to the obesity, metabolic syndrome and chronic disease risk later in life.

(Jena, Germany) Photopharmacology investigates the use of light to switch the effect of drugs on and off. Now, for the first time, scientific teams from Jena, Munich, and New York have succeeded in using this method to control a component of cells that was previously considered inaccessible.

Present everywhere and now selectively controllable

"Up to now, there are no drugs available that target actin, because the protein is found everywhere in the body, for example in large quantities in the muscles," explains Prof. Hans-Dieter Arndt of Friedrich Schiller University Jena, Germany. "Such a substance would therefore have little to no targeted effect. However, our new compounds only exert activity on actin in areas where cells are exposed to the appropriate light," said Arndt, a researcher in organic chemistry.

Because actin is an essential component of the cell structure - more precisely of the cytoskeleton - individual cells can be selectively manipulated to an accuracy of as little as 10 micrometres. This technique can also be used to control the movement of selected cells. Arndt's international research team has reported on this in the renowned "Journal of the American Chemical Society".

Violet light switches on, green light switches off

In its research, the group synthesized a variant of a natural substance that in its natural form stiffens the very dynamic actin cytoskeleton in the organism. In the laboratory variant, the molecule was developed further, so that its structure changes when violet light falls on it. This increases the stabilising effect of this molecule. After a certain period of time, or when a green light is turned on, the structure reverts to its inactive basic form and the natural dynamics is restored.

After this substance, called Optojasp, is absorbed by cells in lab experiments, light can be used to control specifically the viability and mobility of individual cells - and also the communication of the cytoskeleton.

Looking ahead to potential future applications, Arndt says: "It is possible that this method could be used in the future to treat diseases of the eye or on the skin, i.e. of organs that can easily be exposed to light. This technique could also be of interest in the field of neuroregeneration. The aim here is often to encourage certain nerve cells to grow in preference to others." Arndt also sees potential to apply his method in immune cells that are highly mobile.

"A new tool for biology"

"Above all, I consider this to be a new and exciting tool for biology," says the Jena researcher. "These molecules should make it easier to study biological systems than with the help of light-sensitive proteins, which might be introduced by genetic engineering. With the Optojasps, the influence of actin dynamics can be studied directly - all you need to do is to add the compound, and irradiate!"

Now that the method has been shown to work, Arndt and his partners are working to optimise these molecules further and study them in greater detail.

CORVALLIS, Ore. -- Whether for convenience, cost or comfort, many people look to online resources for fitness and exercise information -- especially when faced with fitness center and gym closures during the COVID-19 pandemic.

Unfortunately, most internet-based recommendations for physical activity don't match up with the guidelines supported by national health organizations, a recent study from Oregon State University found.

"Online exercise advice is incomprehensible for many and incomplete for everybody," said researcher Brad Cardinal, a kinesiology professor in OSU's College of Public Health and Human Sciences. "There wasn't anything we came across that was a complete message, and for many people, they would be left out of it altogether."

The dearth of reliable physical activity information online exacerbates existing health inequities, Cardinal said, because the information often is tailored for people who are already active and comfortable in the exercise world. For those who are trying to initiate physical activity for the first time, such incomplete information could lead to accidents or injuries, as well as feelings of stigmatization and exclusion.

The study, published earlier this month in the Translational Journal of the American College of Sports Medicine, analyzed fitness recommendations in 72 web articles from four types of organizations: government, commercial sites, professional associations and voluntary health agencies. Researchers compared the information with the national Physical Activity Guidelines set by the U.S. Department of Health and Human Services.

The national guidelines advise adults to "move more and sit less" throughout the day. For "substantial health benefits," they say adults should complete 150 to 300 minutes (2.5 to 5 hours) of moderate aerobic activity, or 75 minutes of vigorous aerobic activity, each week, spread across several days. Additional health benefits can be gained by exercising more than 300 minutes. The guidelines also recommend adults do some moderate- or greater-intensity strength-training activity that involves all muscle groups at least two days a week.

"Moderate" aerobic activity means something like a brisk walk, Cardinal said -- about a pace of 3 or 4 miles per hour, when you can still comfortably hold a conversation.

The guidelines are mostly the same for adults ages 65 and older and for adults with disabilities or chronic conditions, but include the caveat that if people in these groups are unable to complete the full recommendations, they should be as "physically active as their abilities and conditions allow."

In their analysis, the researchers found that professional associations such as nationally accredited groups of health care providers were the best at sharing accurate information, including total recommended minutes, spreading exercise throughout the week, and explaining how the time recommendation shifts based on the intensity of the activity.

Across all four types of sites the researchers studied, recommendations were more likely to be correct on aerobic exercise; very few included correct or complete information on muscle-strengthening activity.

While the national guidelines focus on "hearts and lungs," most online advice focuses on "abs and buns," Cardinal said -- meaning the intent is more about improving appearance than about health.

His previous research has shown that online exercise messages also include a lot of hidden advertising, often for costly workout gear or "health food" products, which can add another perceived barrier to low-income folks trying to start exercising.

"For people who are inactive, and even people whose jobs include active labor but are hoping to develop an exercise routine, the online information was generally unhelpful," Cardinal said. "The majority of articles focused on those who were already involved in an exercise program." This finding was affirmed in another study that examined the same web articles' production quality.

"It's good to reinforce the message for people who are active; it's good to give them encouragement. But if someone is new to this or has been away from physical activity for a while, the materials aren't really comprehensive for people," he said. "They're going to feel overwhelmed by them, and they're going to get an incomplete and inaccurate picture of what to do, and they could end up doing things wrong and potentially getting themselves hurt. The online resources might be doing more harm than good."

Lead author on the study was Jafrā D. Thomas, a 2019 Ph.D. graduate in kinesiology at OSU who is now an assistant professor at the California Polytechnic State University, San Luis Obispo.

DURHAM, N.C. -- Biomedical engineers at Duke University have devised a new imaging device capable of measuring both the thickness and texture of the various layers of the retina at the back of the eye. The advance could be used to detect a biomarker of Alzheimer's disease, potentially offering a widespread early warning system for the disease.

The results appear online on May 13 in the journal Scientific Reports.

"Previous research has seen a thinning of the retina in Alzheimer's patients, but by adding a light-scattering technique to the measurement, we've found that the retinal nerve fiber layer is also rougher and more disordered," said Adam Wax, professor of biomedical engineering at Duke. "Our hope is that we can use this insight to create an easy and cheap screening device that wouldn't only be available at your doctor's office, but at places like your local pharmacy as well."

Diagnoses of Alzheimer's disease are currently only made after a patient begins to show symptoms of cognitive decline. Even then, the only way to definitively determine that Alzheimer's was the cause is with expensive MRI and PET scans or through an autopsy. But if disease progress can be halted through early interventions such as drugs and mental exercise, patients can have a greatly improved quality of life. This is why researchers are looking for biomarkers that could be used as early warning signs of the disease.

One such potential biomarker comes from the retina, which is literally an extension of the brain and part of the central nervous system. Previous research has shown that Alzheimer's can cause structural changes to the retina, most notably a thinning of the inner retinal layers.

"The retina can provide easy access to the brain, and its thinning can be indicative of a decrease in the amount of neural tissue, which can mean that Alzheimer's is present," said Wax.

Other diseases such as glaucoma and Parkinson's disease, however, can also cause a thinning of the retina. Inconsistent test results might also come from differences between the machines most often used for these types of measurements, optical coherence tomography (OCT) devices, and how researchers use them.

In the new paper, Wax and his graduate student Ge Song show that the topmost layer of neurons in the retina of a mouse model of Alzheimer's disease exhibit a change in their structural texture. Combined with data on the changes in thickness of this layer, the new measurement could prove to be a more easily accessible biomarker of Alzheimer's.

"Our new approach can measure the roughness or texture of the nerve fiber layer of the inner retina," said Song. "It can provide a quick and direct way to measure structural changes caused by Alzheimer's, which has great potential as a biomarker of the disease."

OCT is the optical analogue of ultrasound. It works by sending waves of light into tissues and measuring how long they take to come back. While it is an extremely useful imaging technique commonly used to make a wide array of diagnoses, it has limitations.

To gather more data, Wax and Song added a measurement called angle-resolved low-coherence interferometry (a/LCI), which uses the angles of the scattered light to gather more information about the tissue's structure. By combining the two measurements, the researchers can extract both thickness and structural information about each layer of the retina.

"The a/LCI measurements complement the thickness measurements to improve the potential utility of more quantitative biomarkers for Alzheimer's," said Song. "You can't get textural and structural information about the retina with OCT alone. You need both imaging modalities. That's the key innovation."

The researchers are now working to incorporate this added ability into a low-cost OCT system that Wax is developing through a spinoff company called Lumedica. While traditional OCT machines weigh more than 60 pounds, take up an entire desk and cost anywhere between $50,000 and $120,000, Wax's design weighs four pounds, is about the size of a lunch box and, Wax expects, will be sold for less than $15,000.

The key to Wax's design is a 3D-printed part that uses symmetry to compensate for mechanical inconsistencies that can arise in traditional OCT devices because of things as small as a subtle shift in temperature. Song also has been working on a 3D-printed rotational prism, allowing the a/LCI to scan the entire retina.

"We're excited because this research shows a new way of using low-cost OCT technologies outside of simply screening for traditional retinal diseases," said Wax. "If we can use these devices as a window into early signs of neurodegenerative diseases, maybe we can help people get into an early intervention treatment program before it's too late."

The Washington Post's depiction of autism has shifted over the years from a focus on "cause and cure" toward one of acceptance and accommodation, say the authors of a study that examined 315 articles published from 2007 to 2017.

The findings, which appear in the current online edition of Disability and Society, suggest that media representations are changing to reflect new public attitudes generated in part by the autistic rights movement, say co-authors Noa Lewin, a 2018 graduate of the University of California, Santa Cruz, and Nameera Akhtar, a professor of psychology at UCSC.

"There's less focus on cause and a bigger focus on accommodation," said Lewin, whose undergraduate senior thesis was the basis of the study. "Coverage has shifted more toward how to make life better for autistic people and less on what is causing autism."

The paper, "Neurodiversity and Deficit Perspectives in the Washington Post's Coverage of Autism," is based on a content analysis of coverage beginning in 2007, before the putative link between the MMR vaccine and autism had been completely debunked. It ends 10 years later, when the neurodiversity rights movement had advanced understanding and awareness about the range of ways brains function and that variations from "normal" are not necessarily deficits. The researchers chose to examine the influential Washington Post because it is widely read by legislators and policy makers.

Akhtar, the corresponding author of the paper, is at the forefront of paradigm-shifting scholarship about autism and has called for greater understanding of autism. "The autism self-advocacy movement has been around for a while, but the idea that autism is something that should be accommodated rather than 'cured' is new for people who haven't been exposed to it," she said.

In their analysis, Lewin and Akhtar found that the Post's articles over time were more likely to talk about "neurodiversity" and to acknowledge the strengths of autistic people. Articles also began to describe accommodations for autistic people, and a few began to feature the voices of autistic people themselves--a trend Lewin, who is autistic, particularly appreciated.

"I remember one article about autism-related legislation that quoted a member of the Autistic Self-Advocacy Network (ASAN)," said Lewin, who links the increased visibility of people with autism to the broader disability-rights movement. "We tend to think of a disability as a medical tragedy, and we don't think about how attitudes, systemic ableism, and barriers contribute to that."

Although the paper's coverage over time gradually placed more emphasis on autistic skills and strengths, coverage continued to use negative terms to describe autistic people. For example, the terms "high functioning" and "low functioning" continue to appear, despite autistic advocates' preference for more specific language, such as "speaking" and "non-speaking." And the emphasis on strengths was on autistic people who can do things like speak conversationally and hold jobs.

"The Post's coverage reflected a widespread belief that having a disability is okay if you're able to fit into a neurotypical world or if it offers a special talent or skill with social value, like being really good with computers," said Lewin.

Akhtar is pleased to see media representations of autism changing, and she was delighted to collaborate with Lewin on the paper. "Autistic people should be involved in research about autism," she said. "I was happy to work with Noa and to gain this insider's perspective. I learned a lot. You learn to broaden your way of thinking by interacting with people with different experiences."

The world is currently facing a global pandemic without precedence. Looking at how leading research organizations and scientists across all disciplines are actively redeploying efforts to help identify and implement solution is encouraging and exciting to observe, the authors of the commentary say. "This does not mean, however, that we may lose sight of the challenges we are already facing and which are responsible for threatening the lives and quality of lives of billions of people. Delaying or putting at risk decades of intensive basic, translational and clinical research would be a risky course of action which may end up having the opposite effect," warns Prof. Matthias Tschöp, CEO at Helmholtz Zentrum München. "It is the duty of the research community to face the total of all current and future threats in a responsible and sustainable manner. We need to adjust the way we work together and take our learnings from the corona pandemic."

The threat of major diseases is growing

The commentary refers in particular to chronic diseases, such as diabetes and cancer, which remain leading causes of death and disability. For example, type 2 diabetes affects more than 400 million people worldwide today, and the closely correlated cardiovascular diseases remain the main cause of death in Western societies. Similarly, the number of newly-diagnosed cancer patients will increase annually from 18 million today to approximately 30 million in the year 2040.

Opportunities must be taken

According to the authors, the COVID-19 crisis has already changed the research community. Some of these changes and adaptations can be used to improve how we deal with other health challenges. International research teams are working together rather than in competition - across organization, disciplines and borders. Regulatory bodies have accelerated their processing and the sharing of critical data has been faster than ever.

"Based on what we have learned during the current COVID-19 crisis, smart, lasting, balanced and joint investments in improving our health as one global society are warranted. Ideally, all areas of biomedical research should benefit from this shift and be careful not to take a step back on our journey to prevent and eradicate many of the largest health threats worldwide," says Prof. Eleftheria Zeggini, Director of the Institute for Translational Genomics at Helmholtz Zentrum München.

The delayed response of U.S. policymakers to the COVID-19 pandemic comes as no surprise to University of Wyoming Professor Jason Shogren and several of his economist colleagues at other institutions.

That's because the threat of a catastrophic pandemic in 2014 -- the West African Ebola outbreak -- did little to change the perception of U.S. citizens regarding the importance of preparing for future outbreaks, according to research conducted by Shogren and his colleagues.

"The COVID-19 pandemic has revealed that the U.S. was as unprepared as experts feared, given the responses to the Ebola scare in 2014," the economists wrote in an article that has been accepted by EcoHealth, an international journal that addresses health and sustainability challenges, including public health practices. "This lack of attention to pandemic threats is especially disturbing given the current COVID-19 and any potential future pandemics that may also have very high transmission rates, including transmission before individuals become symptomatic."

Joining Shogren in the research were fellow UW economists David Aadland, David Finnoff and Alexandre Skiba, along with Jamison Pike and Peter Saszak, of the Ecohealth Alliance; and Kip Viscusi, from Vanderbilt University.

Before and after the 2014 Ebola outbreak -- which killed thousands of people in West Africa, harmed millions of people in that region and generated significant media coverage in the United States -- the researchers surveyed U.S. citizens to see if their concerns about a pandemic threat had increased, relative to risks from environmental disasters and terrorism.

They were surprised to find relative complacency regarding the threat of a pandemic among the hundreds of people surveyed in 2015. The findings were unexpected because long-standing evidence has shown that people's perceptions usually are distorted toward the most recent news items.

"The Ebola scare did not increase the demand for preparedness among the surveyed U.S. citizens," the economists wrote.

"Our results illustrate that people do not always use the most available information when evaluating relative risk. They still tend to undervalue risks believed to be remote and abstract, even after a scare like Ebola," the researchers added. "Once Ebola reached the U.S. and the media conveyed the possible outcomes of a global outbreak, a disease with no known cure and terrifying consequences for those infected, the reality of a pandemic outbreak did not significantly affect their views."

The economists did not address whether COVID-19 will make pandemic preparedness a higher priority among U.S. citizens -- that will have to be addressed in future research -- but they suggest that their findings following the Ebola outbreak should cause policymakers to not rely on public perception when it comes to disease threats.

"The present COVID-19 pandemic drives home the importance of these behavioral results and the necessity of taking stronger preventive measures than the public might consider necessary," the researchers wrote.