Body

ARLINGTON HEIGHTS, IL - (MAY 24, 2018) - Although allergies affect more than 50 million Americans, they are occasionally misunderstood and can be seen as a minor condition. An article published in Annals of Allergy, Asthma and Immunology, the scientific journal of the American College of Allergy, Asthma and Immunology (ACAAI) shows allergies can have serious, far-reaching consequences, especially on adolescent sufferers.

"The emotional burden of hay fever can be huge for adolescents" says allergist Michael Blaiss, MD, ACAAI Executive Medical Director and study lead author. "Three of the studies in our review examined how adolescents are emotionally affected by hay fever (allergic rhinitis) and hay fever with eye allergies (allergic rhinoconjunctivitis). They found adolescents with hay fever had higher rates of anxiety and depression, and a lower resistance to stress. The adolescents also exhibited more hostility, impulsivity and changed their minds often."

The article identified 25 studies that examined the effects of hay fever and hay fever with eye allergies in adolescents (10-17 years of age) and analyzed symptoms, impact on daily activities, emotional aspects, impact on sleep, educational burden and treatment burden.

"Our review highlights that allergy symptoms can be different in adolescents than in adults or children," says Dr. Blaiss. "Lack of sleep or poor sleep are both huge issues for adolescents, and it can be made worse by the symptoms of hay fever with or without eye allergies. Poor sleep can have a negative impact on school attendance, performance and academic achievement."

The studies indicated that hay fever with or without eye allergies can negatively impact aspects of daily life that include driving and reading ability and can have a negative effect on psychological function. Adolescents may be particularly vulnerable because they may be embarrassed by their symptoms, may be learning to drive and are at a crucial point in their school career.

"Adolescents aren't 'big children' or 'small adults,'" says Dr. Blaiss. "They have very specific needs, and allergists can help relieve symptoms that can cause suffering. Adolescence is an important developmental period and controlling symptoms can help with daily activities such as homework and sports practices."

To find an allergist near you who can help create a personal plan to for your teen with allergies and asthma, use the ACAAI allergist locator.

Further evidence that obese people who are seriously ill could have a better chance of survival than their normal weight counterparts is presented at this year's European Congress on Obesity in Vienna, Austria (23-26 May).

The study, by Jeroen Molinger. Erasmus MC, University Medical Center Rotterdam, Netherlands, and colleagues suggests that obese people could potentially have a better. chance of survival during intensive care stay because the extra weight causes an adaptive response of the muscle, which in turn results in higher muscle quality; and lower rates of damaging muscle wasting.

While obesity and overweight are associated with an increased risk of death in the general population, a decrease in mortality has been reported in specific disease conditions. This so called 'obesity paradox' of critical illness refers to better survival with a higher body mass Index (BMI).

Hyper-catabolism -- the body breaking itself down -- in the acute phase of the critical illness is presumed to be an adaptive response providing the essential fuel for energy production in vital organs. However, when this hypercatabolic state persists it may result in muscle wasting and muscle weakness. Skeletal muscle quality is recognised as a marker of function in healthy individuals and critically ill patients. To determine muscle histology on an ICU; a muscle biopsy is normally needed. However, this procedure is invasive and does not give a result of the whole muscle. In this new study, by using a new non?invasive ultrasound technology, assessment of muscle histology and morphology, the authors aimed to study muscle quality in obese and non?obese critically ill patients.

In the total group of 26 patients, nine were defined as obese by a body mass index higher than 30kg/m2. In this obese subgroup, the wasting patterns were distinctly different than the non?obese group, when comparing sepsis and neurotrauma. The obese group had a higher muscle quality index corrected by muscle thickness in regard to the non?obese. The speed of wasting, as defined in decline in muscle quality, was also lower in the first 4?5 days in the obese group in comparison with the non?obese.

The authors conclude: "Critically ill patients with obesity seem to have higher muscle quality, as measured by ultrasound at the point of admittance to intensive care compared to non?obese patients. This might be the metabolic protective shield also described as the 'obesity paradox'."

Data from 3.7 million hospital admissions for sepsis from 1,000 US hospitals*, presented at this year's European Congress on Obesity in Vienna, shows that patients who are overweight or obese are more likely to survive than those who are normal weight. The study is by Dr Yu-Jiun Lin, Taipei Medical University Hospital, Taipei City, Taiwan, and Dr Jon Wolfshohl, Department of Emergency Medicine, John PeterSmith Hospital, Fort Worth, TX, USA, and colleagues.

About 25 % of adults admitted to intensive care units in the United States(US) have overweight and obesity, and sepsis is a common cause for admission. Although obesity reduces overall lifespan, it is unclear whether it also impacts the outcome of critically ill patients in general, or with sepsis specifically. Previous studies have delivered mixed results on mortality rates of patients of patients in intensive care based on their weight.

In this new research, the authors determined the impact of being overweight and obese on sepsis patients. Using the Nationwide Readmission database of the US from 2013 to 2014, they identified patients hospitalised with sepsis. Hospitalised patients with sepsis were categorised into normal, overweight (BMI ?25 and

Computer modelling was then used to estimate the association between body weight and 30?day in?hospital mortality. A total of 3,712,764 sepsis hospitalisation episodes fulfilled the inclusion criteria, of which 52,101 were overweight, 511,140 were obese, and 3,149,523 were normal weight.**

Compared with normal weight patients, overweight patients were 23% less likely to die and obese patients 22% less likely to die from admission to hospital for sepsis. 30?day readmission rate were also slightly lowered for overweight and obese patients, but total cost of hospital stay were highest in obese patients (see abstract table 1)

To investigate whether there was a differential risk of 30?day mortality among different obese populations (based on income, type of infection, and severity of sepsis). However, the effect of obesity on mortality was consistent among these different subgroups.

The authors conclude: "Using a large and nationally representative sample of over 1,000 hospitals in the US, we found that increase in BMI was significantly associated with improved survival and lowered readmission among hospitalized patients with sepsis. Our results suggest that BMI may be used for risk stratification of patients with sepsis."

Laws should not force women to risk death and injury by having a baby, according to a QUT legal academic who has says abortion can be decriminalised without society and governments making a moral judgement.

Dr Andrew McGee, a researcher in medical law and ethics with the QUT Law School, said there were two major grounds for decriminalisation - women's right to reject the health risk of pregnancy and the 'stalemate' regarding abortion's moral acceptability.

Abortion is a crime for women and doctors in Queensland, but a Law Reform Commission review is underway into 'modernising' the state's laws relating to the termination of pregnancy.

Overseas, Ireland is set to vote on an abortion referendum tomorrow, May 25.

In a new paper published in The Australian and New Zealand Journal of Obstetrics and Gynaecology, Dr McGee and his co-authors, Dr Melanie Jansen and Dr Sally Sheldon, argue that, despite decades of debate, advocates and opponents of abortion have been unable to demonstrate conclusively that either side's view is false, or agree on when life starts.

They believe that this impasse means morality should be taken out of the equation, with law-makers instead recognising that pregnancy is a risk for any woman and that women should have the legal right to reject that risk.

"Because there is an ongoing absence of political and popular consensus about the issue in our society, we believe the law should adopt a minimalist, morally neutral position by not imposing criminal sanctions for abortion, the authors write in the ANZJOG paper.

"We emphasise that to accept that abortion should be decriminalised for this reason is not to adopt the view that abortion is morally acceptable, but rather to recognise that there is no basis for the law to criminalise abortion as an act which has not conclusively been demonstrated to be morally unacceptable."

The researchers say moral debates often neglect the risk to life and significant permanent changes and injury to the body from pregnancy.

"We argue that a woman should not be compelled to take these risks by laws prohibiting abortion, when no conclusive argument exists against the morality of abortion," they write.

"The actual physical delivery of a baby in childbirth is not a simple process by which the child seamlessly slides into existence outside the womb. On the contrary, childbirth is dramatic, risky and sometimes, traumatic, both physically and mentally, for the mother ... In addition to these risks, are others such as the risks associated with induced labour, spinal and/or epidural anaesthetic and caesarean section. We believe that there is a meaningful sense in which a woman is putting her life and health at risk in delivering a baby.

"Although the risk of death occurring is small in first-world jurisdictions, the risk is not zero... If a woman does not want to proceed with a pregnancy, it is reasonable for the woman to cite risks such as these even if, statistically, the risk is low."

DALLAS, May 23, 2018 -- Patients with heart failure who felt socially isolated were much more likely to die or be hospitalized than more socially connected patients, according to new research in Journal of the American Heart Association, the Open Access Journal of the American Heart Association/American Stroke Association.

More than 6 million U.S. adults are estimated to have heart failure and that number continues to rise. In an earlier study, these researchers found that social isolation may increase the risk of depression and anxiety. However, little is known about the possible connection between patients' feelings of social isolation, risk of death and use of medical care.

In this study, researchers surveyed 1,681 patients (average age 73, mostly white, 53 percent men) about their sense of loneliness or isolation. All the patients - residents of 11 counties in southeastern Minnesota - had been diagnosed with heart failure between January 2013 and March 2015.

About 6 percent of the heart failure patients reported a high level of perceived social isolation. Researchers compared the heart failure patients reporting high perceived social isolation with those reporting low perceived social isolation. They found those in the high perceived social isolation group had:

3.7 times or more increased risk of death;

1.7 times increased risk of hospitalization; and

1.6 times higher risk of emergency department visits.

"Our study found a patient's sense of feelings of loneliness or isolation, may contribute to poor prognosis in heart failure," said study senior author Lila Rutten, Ph.D., professor of health services research at the Mayo Clinic in Rochester, Minnesota. "Healthcare providers may aid their heart failure patients by implementing a valid, reliable and brief screening tool to help identify those who are experiencing social isolation."

This study may not apply to other populations, as it lacks racial and geographic diversity. There was also limited follow-up and patients who felt less socially isolated may have been more likely to respond.

PHILADELPHIA -- Social media often features celebrities drinking cocktails, boozy how-to posts, and party pictures. This is the environment American teens are immersed in every day, with 71 percent of teens using more than one social media site, spending an average of nine hours a day using media. Despite the popularity of social media and alcohol-filled posts, little is known about the influence social media activity can have on teen and young adult and drinking behaviors.

Penn Medicine researchers, led by Brenda Curtis, PhD, an assistant professor of Psychology in Psychiatry in the Perelman School of Medicine at the University of Pennsylvania, reviewed data on these topics and found a statistically significant relationship and moderate effect sizes between alcohol related social media engagement and both alcohol consumption and alcohol-related problems. The meta-analysis findings were published in Alcoholism: Clinical and Experimental Research this week.

Curtis and colleagues identified 19 articles for the meta-analysis, representing data from more than 9,000 social media users across Facebook, Twitter, Instagram, and Snapchat. The analysis examined associations between young adults' alcohol-related social-media activity--defined as posting, liking, commenting on, and viewing of alcohol-related content on social media--and their reported drinking behaviors and problems. The drinking measures evaluated included alcohol consumption and problems such as regret after drinking, blacking out, and sustaining injuries while drinking.

About 57 percent of young adults and 9.2 percent of adolescents consumed alcohol in the past month. Despite the pervasive use of social media and alcohol consumption by young adults, little is known about the potential influence engagement with social media can have on this group's drinking patterns and risk of alcohol-related problems.

"Substance use, particularly alcohol, is frequently displayed on social media sites--this normalizes drinking for teens and young adults," Curtis said. "To date, reviews have considered drinking behavior in relation to risky behavior, such as binge drinking, or advertising content, rather than focusing on alcohol-related social media engagement. This meta-analysis allowed us to examine the relationship between alcohol-themed social media activity and alcohol consumption or alcohol-related problems in young adults."

Through evaluating the selected data, Curtis and team uncovered a moderate strength of relationship across all 19 studies. The analysis showed a correlation between alcohol-related social media engagement and alcohol consumption. Additionally, the research showed a statistically significant relationship between social media engagement and alcohol-related problems. However, the direction of these associations remains unknown.

"Further research to necessary so we can better understand the cause and relationship between social media and alcohol consumption," Curtis said. "This is especially important given that social-media sites can expose adolescents and young adults to alcohol content and marketing. This exposure may increase the likelihood of their drinking. Additional research can help determine the causal direction of these associations, which could provide opportunities for social-media-based interventions with young drinkers that incorporate machine learning, aimed at reducing alcohol consumption and alcohol-related issues."

The privilege to operate in a specialist asthma clinic allows for a light to be shed on the persistence of the many pitfalls in the management of this condition, which continue despite the recommendations of the numerous authoritative guidelines produced and spread in the last decades. Asthma heterogeneity and variability make it extremely difficult to be optimally managed, also in a specialist environment.

Many factors contribute to overcomplicate things: correct diagnosis and, if necessary, a differential one (e.g. COPD, vocal cord disfunction, congestive heart failure, emotional dyspnea, for example); characterization and education of the so-called poor perceiver; creation of a partnership with the patient; etc...

In other words, it is necessary to spend time on every single patient and his/her particular form of asthma and to formulate a more or less stringent plan of follow-up. That being said, it appears clear how the role of physicians is particularly challenging in managing comfortably this complexity and the burden produced by it. Overcoming these obstacles will be the result of knowledge, dedication, constancy and acquired experience. A recent National Institute for Health and Care Excellence (NICE) guideline suggests the best practice in asthma management directly to general practitioners assuming however that "putting recommendations into practice can take time".(1)

Almost all patients with a suspect of asthma will have their first evaluation in a primary care setting (2). But a single general practitioner physician will not regularly observe, in his daily practice, such a patient. Concurrently, it is unclear how many spirometry tests he will do in a month: possibly not enough to guarantee an acceptable level of expertise in such a key role test (3,4). It will likely be very difficult to acquire the optimal background level appropriate to smoothly manage asthma condition - especially in such a busy, diverse and eclectic environment (5).

The few considerations just briefly exposed make it reasonable to assume that, paradoxically, it could be better, in future guidelines on the topic, to typify when a respiratory physician - taking into account the local health system - can refer an asthmatic patient to the primary care colleague (and not vice versa) (6).

Even healthy weight boys have become less fit over the past 20 years, according to new research being presented at this year's European Congress on Obesity (ECO) in Vienna, Austria (23-26 May). The study, which tested the aerobic fitness of normal and obese 11-year-old boys from Malaga, Spain in 1996 and again in 2016, highlights the need for a shift in focus towards child fitness and away from just their weight.

The less efficient the heart, the more it has to beat per minute to pump blood around the body. Heart rate recovery, the speed at which the heart rate returns to normal after exercise, is an indicator of physical fitness and the risk of cardiovascular diseases such as heart disease and stroke. Individuals in better cardiovascular condition tend to have lower heart rates during peak exercise, and return to their resting heart rate more quickly after physical activity. A recent study showed that children with higher body mass index (BMI) have slower heart rate recovery, suggesting a possible link between healthy body weight and faster heart rate recovery.

To investigate this further, José Carlos Fernández García from Malaga University in Spain and colleagues recruited 11-year-old boys from schools in Malaga-132 healthy weight boys and 72 obese boys in 1996, and 213 normal weight boys and 139 obese boys in 2016-to compare aerobic fitness over time. The boys wore a heart rate monitor during a shuttle run test (bleep test), requiring them to run 20 metres between two points until they could no longer do it before the bleep sounded. Pulse beats per minute (BMP) were recorded at the end of the test and every minute during recovery.

Results showed that healthy weight boys in 2016 were markedly less fit than their predecessors in 1996-running an average (median) of 5.1 shuttles in 1996 and 4.8 in 2016. In contrast, over 20 years significant differences in the shuttle run test were not seen in obese boys (4.2 vs 4.1).

Importantly however, both normal and obese boys showed much lower cardiac efficacy and worse heart rate recovery at the end of the test and throughout recovery in 2016 compared to 1996 (see table). For example, in 2016 normal boys' average heart rate at the end of the test fell from 181 bpm to 147 bpm after 1 minute to 136 bmp after 2 minutes; whereas in 1996 average heart rate was 198 bmp at the end of the beep test, and fell to 155 bmp after 1 minute and to 133 bmp after 2 minutes.

The researchers conclude by calling for more initiatives to increase fitness levels in children: "Our results suggest that measuring BMI alone may not be enough to monitor children's future health and reinforce the need for promoting physical activity, especially aerobic fitness, to improve the capacity of the heart and lungs and better post-exercise recovery."

They add: "We know that most children do not take part in enough physical activity, compared to current WHO recommendations of at least 60 minutes of moderate-to-vigorous exercise every day such as swimming, football, or dancing."

The authors note some limitations, including that the study represents a small regional sample, so the findings might not be generalisable to the rest of Spain, or other countries. They also highlight that they only collected data from two years, which might over or underestimate levels of fitness; and they did not account for sociodemographic or lifestyle factors which could explain reasons for the changes seen. However, they point out that: "the sample studied is very specific (boys aged 11 years old), and it was distributed among all the socioeconomic levels of a geographical area quite similar to those of Western countries. The normal distribution of the data in the sample allows us to orient ourselves towards where the cardiac and aerobic behaviours of these children are heading."

Washington, DC (May 22, 2018) -- Increasingly, liver transplant centers are changing a long-standing practice of delaying potentially life-saving liver transplantation for patients with severe alcoholic hepatitis until after they stopped drinking alcohol for six months, according to a new study scheduled for presentation at Digestive Disease Week® (DDW) 2018.

Study implications

"Liver transplant for severe alcoholic hepatitis is being increasingly accepted, with positive outcomes, and the hope is that more and more patients will be evaluated for transplants," said Saroja Bangaru, MD, chief resident in internal medicine at the University of Texas Southwestern Medical Center, Dallas, and co-author of the study. "The hope is that survival rates are encouraging enough for centers, so that even more of them will reverse past practices."

Severe alcoholic hepatitis has an extremely high mortality rate. The primary treatment option has been the use of steroids, predominantly prednisolone. But, many patients do not respond to steroids, and a significant percentage of them will die within three months.

Historically, centers would not perform transplants until patients had stopped drinking for six months due to concerns about a return to drinking after transplant. Additionally, there was a perceived high risk that patient's continued drinking would cause them to miss medical appointments and failure to take their immunosuppressant medications, which prevent organ rejection, all of which could contribute to transplant failure.

Only in recent years have limited studies begun to show greater success for transplants for severe alcoholic hepatitis, Bangaru said. These studies have also shown that a variety of other factors -- aside from recent drinking -- influence whether a patient relapses. These include whether the patient has good social support, suffers from psychiatric ailments and accepts that they have an alcohol problem. "These studies suggest that predicting risk of relapse is much more complicated than just duration of abstinence," Bangaru said.

Study design and results

Researchers gathered data from 45 transplant centers, of which 23 said they were now performing such transplants. Among those, 17 centers reported that patients had a one-year survival rate of more than 90 percent, which is higher than that reported in several previous studies.

The survey found that centers have become more willing to perform transplants, as long as patients are carefully screened. Researchers reported that centers use highly selective criteria in approving candidates for transplant, assessing their medical history, social support system and whether they have additional health problems, particularly psychiatric disorders.

"If patients are selected well, according to these criteria, it allows for the excellent survival that we are seeing post-transplant," Bangaru said. Past policy has done a disservice to those patients who were previously unaware that they had liver disease. "Some patients come in for the first time with severe alcoholic hepatitis, and no one has ever told them to stop drinking. Because they are not eligible for transplant, they have a really high mortality rate."

The survey also concluded that most transplant centers had "inadequate" post-transplant support for patients. While most offered the services of social workers, only a limited number provided psychiatric or group therapy support that could be very important in helping patients avoid relapse and further medical problems.

Next steps

Dr. Bangaru said further study is needed to encourage more transplants, in particular a controlled clinical trial that follows survival rates over one, three and five years, along with an assessment of rates of alcoholic relapse.

New research from various cities in the world presented at this year's European Congress on Obesity in Vienna, Austria (23-26 May) demonstrate that if current trends continue, almost a quarter (22%) of the people in the world will be obese by 2045 (up from 14% in 2017), and one in eight (12%) will have type 2 diabetes (up from 9% in 2017).

The study presented by Dr Alan Moses of Novo Nordisk Research and Development, Søborg, Denmark and Niels Lund of Novo Nordisk Health Advocacy, Bagsværd, Denmark and colleagues from the Steno Diabetes Centre, Gentofte, Denmark, and University College London, UK, also indicates that in order to prevent the prevalence of type 2 diabetes from going above 10% in 2045, global obesity levels must be reduced by 25%.

Population data for all countries in the world were obtained from the Non?communicable Disease Risk Factor Collaboration (a WHO database). For each country, the population was divided into age groups. From 2000-2014 (chosen because data is most reliable from 2000 onwards) the population in each age group was divided into body mass index (BMI) categories. For each country and age group, the share of people in each BMI class was projected. The diabetes risk for each age and BMI group was then applied, allowing estimations of diabetes prevalence for each country each year. The prevalence for each country was calibrated to match International Diabetes Federation's regional estimates thereby taking into account differences in way of life, nutrition and genetic disposition for diabetes.

In 2014, these three institutions collaborated to launch the Cities Changing Diabetes programme to accelerate the global fight against urban diabetes. The program began with eight cities: Copenhagen, Rome, Houston, Johannesburg, Vancouver, Mexico City, Tianjin, Shanghai. These have since been joined by a further seven cities: Beijing, Buenos Aires, Hangzhou, Koriyama, Leicester, Mérida and Xiamen. The programme has established local partnerships in these 15 cities to address the social factors and cultural determinants that can increase type 2 diabetes vulnerability among people living in their cities. Part of this work included projections of obesity and diabetes based on both current trends and on a global target scenario. The research has led to an increased understanding of the different challenges each city is faced with regarding genetic, environmental and social determinants of diabetes in that city.

The startling projections globally are that, based on current trends obesity prevalence worldwide will rise from 14% in 2017 to 22% in 2045. Diabetes prevalence will increase from 9.1% to 11.7% across the same period, placing further massive strain on health systems which already spend huge sums just to treat diabetes.

Although immediate action will not result in reversing the epidemic of diabetes and obesity quickly, it is essential to being work now to prevent new cases of obesity and diabetes. The authors' model suggests that, in order to stabilise global diabetes prevalence at 10%, obesity prevalence must fall steadily and in total by around a quarter, from the current level of 14% to just over 10% by 2045.

The authors note that the above numbers are for the 'global' scenario. Individual countries display individual trends and should have their own targets. For example, if current trends in the USA continue, obesity will increase from 39% in 2017 to 55% in 2045, and diabetes rates from 14% to 18%. To keep diabetes rates in the USA stable between 2017 and 2045, obesity must fall from 38% today to 28%. And in the United Kingdom, current trends predict that obesity will rise from 32% today to 48% in 2045, while diabetes levels will rise from 10.2% to 12.6%, a 28% rise. To stabilise UK diabetes rates at 10%, obesity prevalence must fall from 32% to 24%.

"These numbers underline the staggering challenge the world will face in the future in terms of numbers of people who are obese, or have type 2 diabetes, or both. As well as the medical challenges these people will face, the costs to countries' health systems will be enormous," says Dr Moses. "The global prevalence of obesity and diabetes is projected to increase dramatically unless prevention of obesity is significantly intensified. Developing effective global programs to reduce obesity offer the best opportunity to slow or stabilise the unsustainable prevalence of diabetes. The first step must be the recognition of the challenge that obesity presents and the mobilisation of social service and disease prevention resources to slow the progression of these two conditions."

He adds: "Each country is different based on unique genetic, social and environmental conditions which is why there is no 'one size fits all' approach that will work. Individual countries must work on the best strategy for them."

He concludes: "Despite the challenge all countries are facing with obesity and diabetes, the tide can be turned - but it will take aggressive and coordinated action to reduce obesity and individual cities should play a key role in confronting the issues around obesity, some of which are common to them all and others that are unique to each of them."

"Clinical guidelines, including the Global Initiative for Asthma, state that there is no role for antibiotics in asthma exacerbations unless there is strong evidence of lung infection," said lead study author Mihaela S. Stefan, MD, PhD, a research scientist at the Institute for Healthcare Delivery and Population Science and associate professor at the University of Massachusetts Medical School in Springfield.

Dr. Stefan noted that a prior study conducted by her research group found that 60 percent of patients received antibiotics without an indication of lung infection. "Nevertheless, few studies have assessed whether antibiotics could be beneficial in these patients," she added.

In the largest observational comparative effectiveness study to date, the researchers analyzed the medical records of patients hospitalized for asthma over a two-year period at 554 U.S. hospitals. They excluded patients with any potential reason for receiving antibiotics, including being diagnosed with a sinus infection, pneumonia, bronchitis, emphysema, sepsis or any other condition that should be treated with antibiotics.

Of the remaining 22,043 patients, 46.1 percent were treated with antibiotics within their first two hospital days. The researchers conducted several types of analyses. Using propensity-matched analysis, which they characterized as the most "robust," they found that those receiving antibiotics had:

longer hospital stays, 4.64 vs 3.4 days;

higher hospitalization costs, $6,427 vs. $5,387; and

a 55 percent higher risk of antibiotic-related diarrhea.

There was no difference in treatment failure between those who received antibiotics and those who did not. Treatment failure was defined as the initiation of invasive or noninvasive mechanical ventilation, transfer to the intensive care unit after hospital day two, and in-hospital mortality or readmission for asthma exacerbation within 30 days of discharge.

"Our results strengthen the evidence that antibiotics should not be prescribed routinely in adult patients hospitalized with asthma," Dr. Stefan said, adding that all patients in the study had received systemic steroids and bronchodilators, the standard of care for patients experiencing an asthma exacerbation. "All hospitals should assess their practice in caring for patients hospitalized with asthma and increase their antibiotic stewardship."

She added that her research group is planning a qualitative study to understand why physicians use antibiotics in asthma.

Washington, D.C. (May 22, 2018) -- Ingestion of a blue dye tablet during bowel prep for colonoscopy could be a significant advance in the early detection of colorectal cancer (CRC). When used in conjunction with colonoscopy, the blue dye increased adenoma detection rate (ADR) by nearly 9 percent, according to a study scheduled for presentation at Digestive Disease Week® (DDW) 2018.

Study implications

Every year, nearly 137,000 people are diagnosed with CRC, and more than 50,000 people die from the disease. Yet, the disease is largely preventable with regular screening and is treatable with early detection. The challenge is that polyps are not always detected during screening -- many polyps are flat or subtle, making them difficult to identify and remove.

"Identification of cancerous and pre-cancerous lesions is of utmost importance to prevent CRC," said Alessandro Repici, MD, professor of gastroenterology and director of endoscopy at Humanitas University Medical School in Milan, Italy, and a primary investigator of the study. "Our study, which used the highest standard of care, allowed gastroenterologists to better detect and remove difficult-to-see polyps, which has great implications for further preventing this disease."

Study design

Researchers studied 1,205 patients scheduled for colonoscopy at 20 centers worldwide, with each patient randomly assigned to one of three groups: patients who received a full dose of the blue dye, oral delayed-release methylene blue, during the normal colonoscopy preparation process; patients who received a placebo during preparation; and a group of patients who received a half dose of the study drug. The third group was not part of the analysis but was included for masking purposes to make it harder for participating physicians to know which patients were in the active group.

Study results

In patients whose preparation included the full 200 mg dose of the oral delayed-release methylene blue, adenomas, or polyps, and carcinomas were found in 56.3 percent of patients. In the placebo group, which utilized the standard of care, adenomas and carcinomas were identified in 47.8 percent. Both groups were screened with the most up-to-date technology available with monitored withdrawal time and blinded second review to avoid execution bias. More flat and small lesions (less than 5 millimeters) were found in patients who used the full dose of the oral delayed-release methylene blue. Additionally, research showed that with the exception of blue feces and urine discoloration, which were expected effects, less than 6 percent of patients experienced mild adverse effects when taking the tablet.

"While utilizing blue dye to increase ADR is not a new concept, the fact that this technology now comes in tablet form is a major advance," Michael B. Wallace, MD, MPH, professor of medicine and director of the Digestive Disease Research Program at Mayo Clinic in Jacksonville, Florida, and a primary investigator on the Phase III trial. "Our research shows the oral delayed-release methylene blue provides gastroenterologists with a new means to improve their ADR with no additional inconvenience or safety risks to the patient and no supplemental time required to the endoscopist."

Previously, the blue dye had to be mixed by the providers on site, and then sprayed during the colonoscopy, which could be an imprecise, time-consuming and generally localized process. With the development of the tablet form, the majority of the dye releases in the colon in time for highlighting and detecting mucosal lesions during the colonoscopy.

Study investigators added that the use of Methylene Blue MMX or other technologies should never be considered a substitute for good colonoscopy technique.

Colorectal cancer screening saves lives. Colonoscopy is the only screening method that can screen for and prevent colorectal cancer. According to a study published in the New England Journal of Medicine, every 1 percent increase in the ADR corresponds to a 3 percent decline in the incidence of CRC and a 5 percent decline in CRC fatalities.

Washington, DC (May 22, 2018) -- An investigational new drug offers hope of relief for celiac disease patients who are inadvertently exposed to gluten while on a gluten-free diet. Findings of the first phase 2 study of a biologic immune modulator in celiac disease will be presented at the upcoming Digestive Disease Week® (DDW) 2018. Inadvertent exposure to gluten can be a frequent occurrence for celiac patients that triggers symptoms, such as pain in the gut and diarrhea, due to intestinal damage.

Study implications

Researchers found that the AMG 714 antibody, which blocks interleukin 15, an important mediator of celiac disease, leads to fewer symptoms following gluten exposure.

"It's important to note that this drug is being investigated for its potential to protect against modest contamination, not deliberately eating large amounts of gluten, like bread or pasta," said Francisco Leon, MD, PhD, the study director and consultant for Amgen. "Contamination, which can happen during food processing or packaging, during cooking, or due to inadequate labelling, is known to occur very frequently, despite following a gluten-free diet. Our hope is that this drug may allow celiac patients on a gluten-free diet to experience fewer gluten-triggered events."

Study design

This randomized, double-blind, placebo-controlled, phase 2a study compared the effects of AMG 714 at two dose levels (150 mg and 300 mg) to a placebo among celiac disease patients over a 12-week period. The drug was administered six times by subcutaneous injection. A subset of patients received a high-dose gluten challenge of approximately 2.5 grams per day for 10 weeks. Another sub-group of patients, who showed mucosal atrophy at baseline, were found -- with novel stool and urine gluten detection tests -- to be exposed to hidden gluten contamination during their regular gluten-free diets and did not receive the additional gluten challenge.

Study results

The results show that AMG 714 reduced gluten-triggered effects in each of the two groups receiving the drug, compared to placebo. While AMG 714 did not fully prevent gluten-induced mucosal injury in the gluten challenge group, the primary endpoint of the study, a decrease in intestinal inflammation was observed, as well as a non-significant trend towards reduced intestinal damage in the non-challenge group. Reduction in symptoms was observed when patient-reported outcomes were assessed, especially for the group that took the larger 300 mg dose. While the placebo group experienced an increase in diarrhea, it was not seen in patients who took the drug. At week 12, none of the patients given the gluten challenge who took the 300 mg dose was deemed by the

principal investigator to have active disease, compared to one third of the placebo group. In the group that did not receive the gluten challenge, no symptoms associated with accidental gluten consumption were observed. Importantly, there were no serious adverse events or safety signals in the study. The most frequently reported adverse events related to the study drug included injection site reactions and pain, headache and upper respiratory tract infection. No dose-related trends were evident except for injection site reactions.

"A gluten-free diet has been the only treatment option for celiac disease patients to date, yet it is nearly impossible for them to avoid gluten entirely and indefinitely," said Markku Maki, MD, PhD, the principal investigator and a professor for the Faculty of Medicine and Biosciences at the University of Tampere in Finland. "An average of half of all celiac disease patients on a gluten-free diet continue to have mucosal inflammation or damage, and a third have recurrent symptoms. That is why we have been investigating medications to help prevent the consequences of hidden gluten."

Next steps

Dr. Leon and his collaborators also studied AMG 714 in refractory celiac disease type II, a lymphoma in the gut which complicates celiac disease in a small subset of patients. These data (abstract 616) will be presented during DDW on Monday, June 4, and are embargoed until 10:51 a.m. EDT.

People who are more active when commuting to work by walking or cycling could be cutting their relative risk of developing ischaemic heart disease or stroke by 11% and their relative risk of dying from these diseases by 30%, suggests a study published in the journal Heart.

Physical activity, including less vigorous forms such as walking and cycling, reduces

the risk of cardiovascular disease, but despite this well-known benefit, levels of activity are still low in many countries.

There are concerns that many peoples' lives involve increasingly sedentary occupations and little opportunity for leisure time physical activity. Thus, activity as part of a journey - such as the commute or for transport in general - can offer a comparatively easy way to integrate exercise into daily life.

Despite current clinical practice guidelines recommending physical activity, the benefits of active travel on mortality and morbidity are still unclear.

Therefore, a team of researchers from the University of Cambridge, London School of Hygiene & Tropical Medicine, and Imperial College London, set out to investigate the associations between using alternatives to the car which are more active for commuting and non-commuting purposes, and illness and mortality.

They used data on 358,799 participants in the UK Biobank, a national population based study designed to measure and track the health of adult residents of primarily urban areas in the UK.

Data was studied on these people between 2006 and 2010. People were followed up for an average of seven years. They were asked about their commute and non-commute travel and to detail whether they relied exclusively on the car or used alternative modes of transport that were more active at least some of the time.

Outcome measures used were incident and fatal cardiovascular disease (CVD), incident and fatal cancer, and all-cause mortality.

Approximately two-thirds of commuters relied exclusively on the car to travel to work, with more active travel patterns being more frequently reported for non-commuting travel.

Cycling was less prevalent, being mentioned by 8.5% and 7% of regular commuters for commuting and non-commuting travel, respectively, and by 4.8% of other participants.

Analysis of the data showed that regular commuters with more active patterns of travel on the commute had a 11% lower risk of incident cardiovascular disease (CVD) and 30% lower risk of fatal CVD.

Those regular commuters who also had more active patterns of commute and non-commute travel combined had an even lower risk of fatal CVD - 43% less risk.

Among people who were not regular commuters, more active patterns of travel were associated with an 8% lower risk of all-cause mortality.

This was an observational study, so no firm conclusions can be drawn about cause and effect, but the authors said their analysis had used a very large multicentre general population dataset, and had focused on feasible travel choices for commuting and non-commuting travel.

The authors took into account potential confounding factors, such as other physical activity, fruit and vegetable consumption and measures of socioeconomic status.

They also excluded participants who developed disease or died within two years of follow-up to reduce the likelihood of "reverse causation", meaning that those who have early signs of disease may be less active because of their illness and so more likely to travel by car.

They concluded that interventions that encourage people to make more use of public transport, walking and cycling could be more widely promoted, including by clinicians.

"More active patterns of travel were associated with a reduced risk of incident and fatal CVD and all-cause mortality in adults. This is an important message for clinicians advising people about how to be physically active and reduce their risk of disease," they said.

In an accompanying editorial, Dr April Mohanty of the VA Salt Lake City Health Care System in the USA, said: "This study provides further evidence to support efforts, including policies and guideline recommendations, that encourage active travel even if that is only possible for part of the journey."

Highlights:

Access to safe anaesthesia for essential surgery is a basic human right and should be available to all patients irrespective of their ability to pay.

5 billion of the world's 7 billion people do not have access to safe, timely and affordable surgery and anaesthesia when needed

The WHO-WFSA International Standards for A Safe Practice of Anaesthesia provide concrete standards that every healthcare facility and anaesthesia provider can follow across specific areas including; facilities, equipment and supplies, medications and intravenous fluids, monitoring, conduct of anaesthesia, and professional aspects.

The WHO-WFSA International Standards for a Safe Practice of Anaesthesia are an essential step on the road to universal access to safe anaesthesia as part of World Health Assembly resolution 68.15, UHC 2030 and SDG 3.

Disease Control Priorities 3, written by the World Bank, estimates that a global investment of just US$3 billion per year at the first level hospital level would achieve universal coverage of emergency and essential surgery and a return on investment of ten to one [2].

This month the World Federation of Societies of Anaesthesiologists (WFSA) launched an update of the International Standards For A Safe Practice of Anaesthesia, co-published with World Health Organization (WHO) for the first time as an official WHO guideline.

The standards are recommended for anaesthesia professionals throughout the world and are intended to provide guidance and assistance to anaesthesia professionals, their professional societies, hospital and facility administrators, and governments for improving and maintaining the quality and safety of anaesthesia care. They were first adopted by the WFSA on 13th June 1992, with revisions in 2008 and 2010. The latest version was published in May 2018 and was developed on behalf of both the WFSA and WHO.

The launch of the International Standards marks the increasing importance of surgery and anaesthesia within global health policy. Recent seminal papers have highlighted major discrepancies in the provision of safe anaesthesia and surgery worldwide [1, 2]. The Lancet Commission on Global Surgery estimated that five billion of the world's seven billion people do not have access to safe, affordable anaesthesia and surgical care when needed [1]. As the essential role of anaesthesia in the provision of surgical and obstetric care is not always understood by decision makers, the development of anaesthesia has often been given a lower priority than the development of surgery per se in the global health agenda. Yet, access to safe anaesthesia for essential surgery is a basic human right and should be available to all patients irrespective of their ability to pay.

On 22nd May 2015 the World Health Assembly passed the ground-breaking Resolution 68.15 entitled "Strengthening emergency and essential surgical care and anaesthesia as a component of universal health coverage"[3]; a potential game-changer for the 5 billion people. The launch of the updated International Standards for a Safe Practice of Anaesthesia supports this initiative by outlining concrete standards that every facility providing anaesthesia can follow in specific areas including; facilities and equipment, medications and intravenous fluids, monitoring, conduct of anaesthesia, and professional aspects.

Julian Gore-Booth, Chief Executive Officer of the WFSA, explained "Safe anaesthesia saves lives. These standards contribute to WFSA's goal of safe anaesthesia care for everybody and we are proud and delighted to have worked with WHO on our shared mission to include surgery and anaesthesia as a component of universal health coverage."

Professor Adrian Gelb, Secretary of the WFSA highlighted that "Every patient in every country deserves safe anaesthesia every time. This important WHO and WFSA endorsed set of standards takes an important step forward in clearly defining standards for every level of facility that provides general anaesthesia, deep or moderate sedation."

"It is the hope of both organizations that ministries of health and hospital administrators will strive to implement them, if they are not already achieving the described level," he added.

Dr Walter Johnson, Lead, WHO Emergency & Essential Surgical Care Programme, similarly highlighted the importance of the Standards and the collaboration adding, "The WHO-WFSA International Standards for a Safe Practice of Anaesthesia is an important milestone in the development of global quality initiatives for improved surgical, obstetric and anaesthesia service delivery platforms and health system strengthening."

"Worldwide, enormous disparities exist between high-income and low-income countries regarding risk of patient death from anaesthesia care. This international standard sets a reasonable, high standard to prevent unnecessary deaths due to unsafe practices, such as lack of monitoring, lack of essential medicines and lack of trained personnel," Dr Johnson explained. "This document will be extremely helpful to anaesthesia practitioners, all levels of health facilities, government policy makers, health and finance ministers, and other stakeholders seeking to optimize the delivery of safe anaesthesia care," he said finally.

The International Standards for a Safe Practice of Anaesthesia will be discussed at an unofficial side event during the World Health Assembly open to the public, taking place at the Geneva Press Club on Tuesday 22nd May 2018, 9-11am. The event entitled "Briefing: How Can We Scale-up Surgery and Anesthesia to Achieve UHCs", co-hosted by the WFSA, Nesta, and Lifebox, will highlight the important work being undertaken to support WHA Resolution 68.15, including the launch of the International Standards, the ten year anniversary of the WHO Safe Surgical Checklist, as well as the Surgical Equity Prize launched by Nesta.