A new study, presented today at the AATS 101st Annual Meeting, shows an association between decreased survival at five years and leaving an atrial communication at biventricular repair of unbalanced AVSD after adjusting for other known risk factors.During repair of atrioventricular septal defect (AVSD), surgeons may leave an atrial level shunt when they have concerns about postoperative pulmonary hypertension, a hypoplastic right ventricle (RV), hypoplastic left ventricle (LV), or as part of their routine practice.
The study sought to determine factors associated with mortality after biventricular repair of AVSD.
The study included 581 patients enrolled from 31 Congenital Heart Surgeons’ Society (CHSS) institutions from Jan. 1, 2012 – June 1, 2020. Parametric multiphase hazard analysis was used to identify factors associated with mortality.
A random-effect model was used to account for possible inter-institutional variability in mortality.An atrial fenestration was placed during biventricular repair in 23 per cent of patients.
Overall, the five-year survival after the repair was 91 per cent.
The atrial fenestration group had an 83 per cent five-year survival compared to 93 per cent in the non-fenestrated group.
According to Connor Callahan, the John W. Kirklin/David Ashburn Fellow of the Congenital Heart Surgeons’ Society Data Center and the University of Toronto, General Surgery Resident at Washington University/Barnes-Jewish Hospital, “Atrial fenestration was associated with reduced long-term survival in our study. As a result of these findings, institutions and surgeons that routinely use fenestration may reevaluate its role in their practice.”While leaving an atrial communication at biventricular repair of unbalanced AVSD is associated with significantly reduced long-term survival after adjusting for other known risk factors, it is unknown whether this association is causal or related to unmeasured factors, or a combination of both.
The impact of fenestration can optimally be derived from a randomized clinical trial in the future.
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Benefits of deworming for expectant mothers to their infants
Researchers from Syracuse University, the World Health Organization, and SUNY Upstate (The State University of New York Upstate Medical University) measured the impact of deworming medicine during pregnancy on the subsequent risk of neonatal mortality and low birthweight.
The study has been conducted on 95 Demographic Health Survey data collected on more than 800,000 births and the results are published in the current issue of the journal PLoS Neglected Tropical Diseases.
More than 25% of the world’s population (greater than 1.5 billion people) face the burden of soil-transmitted helminth (STH) infections, a species of an intestinal parasite whose eggs develop in the soil before finding a new host.
The main cause of this high infection rate is lack of access to adequate sanitation facilities (toilets) and the consequent contamination of the environment with human faeces. While universal access to adequate sanitation is one of the sustainable development goals, parasite burdens are still causing harm. Fortunately, deworming medicines are highly effective and safe.
When women receive deworming medicine during pregnancy, we find two specific benefits for the baby: first, the risk of neonatal mortality (a baby’s death within the first 4 weeks of life) decreases by an estimated 14%; second, the odds of low birthweight are an estimated 11% lower in countries with the lower transmission of soil-transmitted helminths. These results vary somewhat by transmission rate across different countries.
Given the low cost of deworming medicine and fundamental health advantages, these findings call for an increased global effort toward the widescale distribution of deworming medicine for pregnant women. Global effort toward reducing STH infections is affordable, and the benefits far outweigh the program costs.
A recent study has found that mothers receiving deworming treatment during pregnancy reduce by 14% the risk of their child dying within the first four weeks after birth. Another benefit is that treating pregnant women with anthelminthic medicines can avoid low birth weight.
The study, conducted on 95 Demographic Health Survey datasets and collected on more than 800 000 births, utilised birth histories to measure the impact of routine deworming medicine during antenatal care on subsequent neonatal mortality and low birth weight for births between 1998 and 2018 in 56 lower-income countries.
“Pregnant women who received deworming medication were associated with a 14% reduction in risk for neonatal mortality, with no difference between high and low transmission countries,” said Bhavneet Walia of the Department of Public Health, Syracuse University, New York, USA.
“We also found that in countries with low transmission of soil-transmitted helminths, the deworming treatment decreased the odds of low birth weight by 11%, although these somewhat varied in relation to transmission rates across different countries,” Bhavneet added.
Routine deworming during antenatal care decreases the risk of neonatal mortality and low birth weight: a retrospective cohort of survey data (to hyperlink) authored by Syracuse University, the World Health Organization (WHO) and SUNY Upstate is published in the journal, PLoS Neglected Tropical Diseases.
The researchers matched births on the probability of receiving deworming during pregnancy. They then modelled birth outcomes with the matched group to estimate the effect of deworming during antenatal care after accounting for various risk factors. They also tested for effect modification of soil-transmitted helminth prevalence on the impact of deworming during antenatal care.
“Intestinal worms impact the health of women and girls of reproductive age and this study supports the fact that treating pregnant women can be beneficial,” said Dr Antonio Montresor, Medical Officer, WHO Department of Control of Neglected Tropical Diseases.
He said, “WHO has long recommended the deworming women of reproductive age after their first trimester of pregnancy and in areas where the prevalence of worm infections is 20% or higher.”
Soil-transmitted helminths2 is transmitted by ingesting microscopic eggs that are passed in the faeces of infected people and disperse in the environment. Adult worms live in the intestines where they produce thousands of eggs each day. In areas that lack adequate sanitation, these eggs contaminate the soil.
More than 1.5 billion people, or 24% of the world’s population, are infected with soil-transmitted helminths. Infections are widely distributed in tropical and subtropical areas, with the greatest numbers occurring in sub-Saharan Africa, the Americas, China and East Asia.
Approximately 688 million girls and adult women of reproductive age live in areas that are endemic for intestinal worms, in more than 100 countries. The greatest number is found in sub-Saharan Africa, the Americas and Asia where reinfection is frequent in areas of high transmission.
WHO coordinates shipment of donated medicines to countries requesting them. They are then distributed freely by national disease control programs during mass treatment campaigns.
Periodic deworming should be available to children and to all pregnant women in endemic countries.
Deworming is not the only answer, however. A permanent solution can only be obtained by a substantial improvement in access to sanitation – a process that is normally slow and expensive.
With ANI inputs
CHANGES IN PROTEINS PLAY CRUCIAL ROLE IN AGEING KIDNEYS: STUDY
Studying protein changes in the kidneys as we age, as well as the transcription of genes into proteins, helps provide a full picture of the age-related processes that take place in these organs, says a recent study published in eLife.
Ageing causes many changes in the body and in essential organs such as the kidneys, which function less efficiently later in life. Age-related changes in the kidneys have mostly been reported by looking at the transcription of genes the process by which a segment of DNA is copied into RNA.
The current study suggests that this approach, combined with studying changes in proteins, gives us a better understanding of age-related changes in the kidney and may point to new approaches for treating age-related kidney dysfunction.
“Physiological changes in kidney function during ageing are well documented, but little is known about the underlying molecular processes that drive this loss of function,” explains first author Yuka Takemon, who was a research assistant at the Jackson Laboratory in Bar Harbor, Maine, US, when the study was carried out and is now a PhD student at the Michael Smith Genome Sciences Centre, University of British Columbia, Canada.
“Many previous studies of these physiological changes have looked at the transcription of genes into proteins by measuring messenger RNA (mRNA), but we wanted to see if we could gather more insights by combining this approach with studying protein levels in the kidney.”
In their study, Takemon and colleagues looked at age-related changes in kidney function in about 600 genetically diverse mice. They also measured changes in mRNA and proteins in kidney samples from about one-third of the animals.
They discovered an age-related pattern of changes in both mRNA and proteins in the mice that suggests the animals have increasing numbers of immune cells and inflammation in their kidneys, as well as decreased function in their mitochondria, which produce energy for the cells.
However, not all of the changes in proteins corresponded with changes in the mRNA, suggesting that some of the protein changes occur after the transcription of genes into RNA.
This could mean that older kidneys become less efficient at building new proteins, or that proteins are broken down more quickly in older kidneys. If further studies confirm this, it could mean that therapies or interventions that promote protein building or slow protein breakdown may be beneficial for treating kidney diseases associated with ageing.
“Our study suggests that mRNA measurements alone provide an incomplete picture of molecular changes caused by ageing in the kidney,” concludes senior author Ron Korstanje, Associate Professor at the Jackson Laboratory. “Studying changes in proteins is also essential to understanding these ageing-related processes, and for designing possible new approaches for treating age-related diseases.”
With ANI inputs
AIR POLLUTION LINKED TO HIGH BP, HEART DISEASES IN CHILDREN
A meta-analysis of 14 air pollution studies from around the world found that exposure to high levels of air pollutants during childhood increases the likelihood of high blood pressure in children and adolescents, and their risk for high blood pressure as adults, a new study finds. The findings are published in a special issue on air pollution in the Journal of the American Heart Association, an open-access journal of the American Heart Association.
Other studies look at: the effects of diesel exhaust on the muscle sympathetic nerve; the impact of pollutants on high blood pressure; rates of hospital readmission for heart failure among those exposed to high levels of ambient air pollution; and risk of stroke and heart attack after long-term exposure to high levels of particulate matter. The studies include health outcomes of people who were exposed to pollutants in the United States, China and Europe.
High blood pressure during childhood and adolescence is a risk factor for hypertension and heart disease in adulthood. Studies on air pollution and blood pressure in adolescents and children, however, have produced inconsistent conclusions.
This systematic review and meta-analysis pooled information from 14 studies focused on the association between air pollution and blood pressure in youth. The large analysis included data for more than 350,000 children and adolescents (mean ages 5.4 to 12.7 years of age).
“Our analysis is the first to closely examine previous research to assess both the quality and magnitude of the associations between air pollution and blood pressure values among children and adolescents,” said lead study author Yao Lu, M.D., PhD, professor of the Clinical Research Center at the Third Xiangya Hospital at Central South University in Changsha, China, and professor in the department of life science and medicine at King’s College London.
“The findings provide evidence of a positive association between short- and long-term exposure to certain environmental air pollutants and blood pressure in children and adolescents.”
The meta-analysis concluded:
1. Short-term exposure to PM10 was significantly associated with elevated systolic blood pressure in youth (the top number on a blood pressure reading).
2. Periods of long-term exposure to PM2.5, PM10 and nitrogen dioxide were also associated with elevated systolic blood pressure levels.
3. Higher diastolic blood pressure levels (the bottom number on a blood pressure reading) were associated with long-term exposure to PM2.5 and PM10.
“To reduce the impact of environmental pollution on blood pressure in children and adolescents, efforts should be made to reduce their exposure to environmental pollutants,” said Lu. “Additionally, it is also very important to routinely measure blood pressure in children and adolescents, which can help us identify individuals with elevated blood pressure early.”
The results of the analysis are limited to the studies included, and they did not include data on possible interactions between different pollutants, therefore, the results are not generalisable to all populations. Additionally, the analysis included the most common and more widely studied pollutants vs. air pollutants confirmed to have a heart health impact, of which there are fewer studies.
With ANI inputs
Debunking common misconceptions about asthma
Doctors and health experts bust common myths surrounding the respiratory disease asthma.
According to The Global Burden of Disease Report, “In India, around 93 million people suffer from chronic respiratory diseases; out of this, around 37 million are Asthmatics.
India contributes to only 11.1% of the global asthma burden, however, it accounts for over 42% of all global asthma deaths making it the asthma capital of the world.” In these unprecedented times, the burden of lung diseases has increased manifold. As people get hit by the second wave, citizens are also getting hit by a great deal of misinformation around lung health. This is especially true for asthma wherein there are a lot of misconceptions. Let us dispel myths and fears regarding asthma and encourage those affected by this condition to live a healthy life.
Dr Avya Bansal, a Pulmonologist at Bombay Hospital, Mumbai explained “Asthma is a chronic respiratory disorder of the lungs in which there is inflammation (swelling) of the airways in the lungs. Due to this inflammation, the airways are narrowed, and the lungs become vulnerable to various allergens which act as triggers for an asthma attack. Dust, cold, pollen, furry pets, viruses air pollutants, and even emotional agitation act as triggers for an asthma attack. These attacks can be prevented via inhalation therapy which requires long term medication. The misconceptions that these medications are addictive is wrong and we need to counter them with the right awareness on asthma.”
Highlighting the importance of inhalers, Dr Vivek Nangia, Principal Director & Head, Institute of Respiratory, Critical Care & Sleep Medicine, Max Hospital, Saket, New Delhi points out that “Due to its chronic nature, asthma requires long term treatment and inhalers play a predominant part in leading a healthy life with asthma. Many patients frequently underutilise their medications or use their inhalers incorrectly, which at times cause them to discontinue treatment means stopping the very thing that is keeping the patient fit and healthy. Patients should always consult their doctor on asthma management and the use of inhalers. It should not be stopped without consultation.”
Although asthma is not curable, it is possible to gain control over it and lead a normal active life. Here the correct treatment and adherence to asthma management are crucial. GINA guidelines recommend inhalation therapy as the best and safest way to control asthma as it reaches the lungs directly and starts acting immediately.
Doctors list down the myths they encounter in their day to day practice and emphasise that people need to come together to uncover the misconception around asthma and inhalers.
Myth #1: Everyone with asthma experiences the same symptoms
Fact-Check: Asthma symptoms vary from person to person and it is important to watch them carefully for a correct diagnosis by the doctor.
Myth#2: Children outgrow their asthma
Fact-check: Asthma symptoms may improve with age, but it’s a lifelong condition. As a chronic condition, there is no cure for asthma and symptoms can resurface at any time.
Myth #3: Asthma can’t be fatal
Fact-Check: Lack of adherence can lead to worsening of the situation. Stopping inhalers without consulting doctors can be dangerous.
Myth#4: Asthma is contagious
Fact-Check: Asthma can be caused by both hereditary and environmental factors. It is not contagious.
Myth#5: Asthma is old age disease
Fact-Check: Asthma can affect people of any age
Myth#6: It’s not safe for people with asthma to exercise
Fact-check: Asthma is no reason to lead an inactive life. Many doctors encourage patients to be active. Many sports personalities have asthma and still lead an active life.
Myth#7: Inhalers are addictive
Fact-check: Inhalers are NOT addictive, and they have been recognised and widely accepted as the mainstay of asthma management.
Myth#8: No symptoms mean no asthma
Fact-Check: symptom-free is NOT asthma free! Discontinuation of the medication may result in aggravation of the disease and chances are that symptoms may flare up anytime.
While encouraging an increased dialogue on the management of asthma, lets us mark World Asthma Day to directly resonate with an endeavour of not just enabling asthmatics with correct information, but by educating the general public to create a support system for asthmatics. Ongoing education is of paramount importance in chronic diseases like asthma. It is always advisable to consult a doctor.
Study on feasibility of heart transplantation using donation after cardiac death with NRP
A new study, presented today at the AATS 101st Annual Meeting, found that heart transplantation using donation after cardiac death (DCD) with normothermic regional perfusion (NRP) is feasible in the United States.Broader application of DCD heart transplantation has the potential to increase cardiac allograft availability by 20-30 per cent. Over a one-year period, from January 2020 to January 2021, eight heart transplants were performed using cardiopulmonary bypass (CPB) for immediate regional reperfusion and cardiac unloading to accomplish optimal myocardial salvage. All hearts were successfully resuscitated and weaned from CPB with no inotropic support and all were accepted for transplantation.
Post-transplant cardiac function was excellent in all recipients. Improving the number and quality of organs available for transplantation is a key objective that improves outcomes for patients. The DCD process has been used with success in the United Kingdom, Belgium and Australia. This study is the first to measure outcomes in the United States. “Our study addresses an important concept – the relative shortage of donors and the need for organs,” explained Dr Nader Moazami, Surgical Director of Heart Transplantation and Mechanical Circulatory Support at NYU Langone Health. “The DCD process taps into potential donors that have been used in the past for abdominal transplants but not for cardiac patients. We are excited about expanding the potential donor pool in the United States.”
Preliminary data shows that DCD heart transplant with CPB allows immediate reperfusion and complete unloading of the heart, correction of metabolic derangements and real-time in-situ assessment of the heart prior to acceptance. The post-transplant cardiac function has been excellent in all cases with excellent early survival. This approach is readily adaptable for more widespread use and will increase donor availability in the United States. During the study, six livers and 14 kidneys were recovered from the same donors, which could indicate success in increasing organ availability for non-cardiac patients as well.
Because the DCD process allows surgeons to resuscitate and assess the organ better before transplantation, the strategy should improve outcomes for patients. “This is the first study of DCD-NRP transplantation in the United States, and we already have many patients at least six months out from the transplant experiencing positive results,” explained Deane Smith, MD, Assistant Professor of Cardiothoracic Surgery and Surgical Director of the Adult ECMO Program at NYU Langone Health. “Using traditional methods, there is not an effective way to assess the heart on the pump, but using DCD-NRP, we can measure cardiac output and hemodynamics before a decision is made to accept the heart, and hopefully we will improve the quality of the other organs.
STUDY REVEALS PLANNED CESAREAN BIRTHS SAFE FOR LOW-RISK PREGNANCIES
New research shows that planned cesarean deliveries on maternal request are safe for low-risk pregnancies and may be associated with a lower risk of adverse delivery outcomes than planned vaginal deliveries.The study is published in CMAJ (Canadian Medical Association Journal). The study used province-wide data from the Better Outcomes Registry & Network (BORN), Ontario’s provincial birth registry. The authors analyzed data on 422,210 low-risk pregnancies over 6 years (2012 to 2018). There were 46,533 cesarean deliveries, of which 1827 (3.9%) were planned at the request of the mother; this proportion was unchanged during the years of study. Mothers who requested cesarean delivery were more likely to be White, to be aged 35 years or older, to have conceived by in vitro fertilization, to be delivering their first baby, and to live in a higher-income neighbourhood, among other characteristics.“Our finding that CDMR [cesarean delivery on maternal request] rates have remained stable in Ontario provides reassurance to those concerned about the potential contribution of CDMR to rising cesarean delivery rates,” writes Dr Darine El-Chaar, Department of Obstetrics, Gynecology and Newborn Care, The Ottawa Hospital, Ottawa, Ontario, with coauthors.Importantly, the findings also showed that cesarean deliveries that were performed following maternal request and vaginal deliveries were both safe delivery options for mother and baby, with planned cesarean deliveries on a maternal request being associated with a lower risk of adverse delivery outcomes for both the mother and the baby than planned vaginal births.The authors caution that research is needed to understand the potential longer-term effects of planned cesarean deliveries.
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