Archive for category: News

Sweden: A recent cohort study has explored the potential link between first-trimester exposure to tetracycline antibiotics and the risk of major congenital malformations (MCMs) in newborns. Tetracyclines, a class of antibiotics commonly used to treat bacterial infections, have been previously associated with a range of potential side effects, including concerns about fetal development when used during pregnancy.

A new study from Uganda provides the first evidence to date that resistance to a lifesaving malaria drug may be emerging in the group of patients that accounts for most of the world’s malaria deaths: young African children suffering from serious infections. The study, presented today at the Annual Meeting of the American Society of Tropical Medicine and Hygiene and published in the Journal of the American Medical Association (JAMA), documented partial resistance to the malaria drug artemisinin in 11 of 100 children, ages 6 months to 12 years, who were being treated for “complicated” malaria, that is, malaria with signs of severe disease caused by the malaria parasite Plasmodium falciparum.

Also, 10 patients who were thought to have been cured suffered a repeat malaria attack within 28 days from the same strain of malaria that caused the original infection, suggesting that the initial treatment did not fully kill the infecting parasites.

“This is the first study from Africa showing that children with malaria and clear signs of severe disease are experiencing at least partial resistance to artemisinin,” said Chandy John, MD, MS, director of the Indiana University School of Medicine Ryan White Center for Infectious Diseases and Global Health, who is a co-author of the study along with colleagues Ruth Namazzi and Robert Opoka from Makerere University in Kampala in Uganda, Ryan Henrici from University of Pennsylvania, and Colin Sutherland from London School of Hygiene & Tropical Medicine.

John, who is a former ASTMH president said, “It’s also the first study showing a high rate of African children with severe malaria experiencing a subsequent malaria episode with the same strain within 28 days of standard treatment with artesunate, a derivative of artemisinin, and an artemisinin combination therapy (ACT).”

The arrival of artemisinin therapies some 20 years ago was a major advance in the global fight against malaria due to their power to rapidly cure infections — and because malaria parasites had developed resistance to other drugs. In 2008, there were reports from Cambodia noting partial resistance to artemisinin. By 2013 there was evidence that in some patients, the drug was completely failing. In the last few years, there has been increasing evidence that artemisinin resistance has now spread from that region into East Africa. The prospect of artemisinin losing its efficacy is particularly alarming for Africa and especially for African children. The region accounts for 95% of the 608,000 people who die from malaria each year and a large majority of malaria deaths in Africa are children under 5.

While all of the children in the study eventually recovered, 10 of them were infected with malaria parasites that harbor genetic mutations that have been linked to artemisinin-resistance in Southeast Asia. The study noted that while these mutations have been documented in Africa in less severe cases, this was the first time they have been seen in parasites that were causing complicated malaria in hospitalized African children. The term “complicated” malaria is used to define cases where the disease is at risk of causing potentially life-threatening complications, like severe anemia or brain-related problems known as cerebral malaria.

John said that researchers classified patients as suffering from partial resistance based on the World Health Organization’s defined half-life cutoff for parasite clearance of more than five hours, meaning requiring more than five hours to reduce a patient’s parasite burden by 50%. Two children required longer than the standard maximum of three days of artesunate therapy because they failed to clear their parasites with three days of therapy. He said longer treatment times increase the risk of poor outcomes. Also, he said that in Southeast Asia, the path to broadly resistant malaria parasites started with evidence of partial artemisinin resistance, and the concern is that pattern will be repeated in sub-Saharan Africa.

The Ugandan children in the study received what is considered to be the gold standard for treating complicated malaria infections: an intravenous infusion of artesunate followed by oral treatment with an ACT that combines another derivative of artemisinin, a drug called artemether, with the malaria drug lumefantrine.

John said the relatively high number of recurrent cases raises concerns that the efficacy of lumefantrine also may be declining. The drug is paired with artemether to make it harder for parasites to develop artemisinin resistance and also because lumefantrine stays in the body longer than artemether. Therefore, it can kill any remaining parasites not cleared by the shorter-acting artemisinin.

John said the study emerged from ongoing work in Uganda that is investigating outcomes of children who experience episodes of severe malaria. He said researchers pivoted to a focus on drug resistance because they noticed some children appeared to be slower to respond to the infusion of artesunate followed by an oral ACT.

“The fact that we started seeing evidence of drug resistance before we even started specifically looking for it is a troubling sign,” John said. “We were further surprised that, after we turned our focus to resistance, we also ended up finding patients who had recurrence after we thought they had been cured.”

Reference:

New study provides first evidence of African children with severe malaria experiencing partial resistance to world’s most powerful malaria drug, American Society of Tropical Medicine and Hygiene, Meeting: 2024 Annual Meeting: American Society of Tropical Medicine and Hygiene.

A new study found that pregnant people in Massachusetts who made multiple unscheduled hospital visits during their pregnancy were 46 percent more likely to experience severe maternal morbidity than those who sought limited or no emergency care during pregnancy.

Frequent hospital visits during pregnancy could be a sign that a pregnant person will encounter life-threatening complications during or after pregnancy, according to a new study led by Boston University School of Public Health (BUSPH) and Cityblock Health.

Published in JAMA Network Open, the study found that, among nearly 775,000 pregnant people in Massachusetts, 31 percent of these individuals had at least one unscheduled emergency visit to the hospital, and 3.3 percent had four or more unscheduled hospital visits. The latter group was nearly 50 percent more likely to experience severe maternal morbidity (SMM), which encompasses a range of complications during labor or childbirth that can lead to poor maternal outcomes such as aneurysms, eclampsia, kidney and heart failure, and sepsis.

Importantly, the findings also revealed that nearly half of the pregnant people who sought emergency care four or more times during their pregnancy visited multiple hospitals for evaluation. The resulting lack of consistent treatment to patients from any given hospital makes it difficult for hospital-based pregnancy programs to capture the true burden of prenatal and postpartum challenges that these patients experience.

The analysis is the first US-based assessment of an association between four or more emergency-care visits during pregnancy and risk of SMM. It builds upon a prior study by the researchers which found that 70 percent of people who had a pregnancy-associated death during postpartum also visited a hospital between the time they gave birth and the time they were hospitalized at death. As both SMM and maternal morbidity rates in the US remain the highest among wealthy countries, identifying these high-risk pregnant patients and understanding the extent of their prenatal health challenges can spur efforts to connect this population to other preventive care within their communities.

“When there is a poor maternal health outcome, there is a tendency to say, ‘If we only knew earlier,’says study lead author Dr. Eugene Declercq, professor of community health sciences at BUSPH. “Those in our study with repeated prenatal emergency visits are showing us clearly they’re at risk. Avoiding severe maternal morbidity isn’t something that only happens at the time of birth-it must start with the early identification of high-risk cases like these, followed by community-based support to avoid catastrophic outcomes for mothers and infants.”

For the study, Dr. Declercq and colleagues utilized data from a statewide database that linked unscheduled hospital visits-including trips to the emergency department as well as observational hospital stays-by 774,092 pregnant patients to births and fetal deaths in Massachusetts between October 2002 and March 2020.

About 18 percent of patients had one emergency visit to the hospital, nearly 7 percent had two visits, 3 percent had 3 visits, and 3.3 had four or more visits. About 44 percent of patients who sought emergency care four or more times during pregnancy visited more than one hospital. This group was 46 percent more likely to experience SMM than patients who sought less emergency care and visited fewer hospitals during their pregnancy. Patients were also more likely to seek emergency care during the first eight weeks and last eight weeks of their pregnancy.

The researchers also observed several racial, economic, and age-related disparities among the patients who used emergency care multiple times during their pregnancy. High utilization of unscheduled hospital care was most associated with women under 25 years old, Hispanic and non-Hispanic Black patients, and those who were born in the US, unmarried, or who had an additional health condition or opioid-related hospitalization in the year prior to their pregnancy. Some of these individuals have visited up to six different Massachusetts hospitals for emergency care, the researchers say.

“Our study shows for the first time that those who use the emergency room more during pregnancy are more likely to be people of color who are at significantly higher risk of experiencing a potentially life-altering morbidity event around the time of childbirth,” says study senior author Dr. Pooja Mehta, adjunct assistant professor of obstetrics & gynecology at BU’s Chobanian & Avedisian School of Medicine and vice president of population health at Cityblock Health. “We need to do much more than provide these individuals a follow-up prenatal visit; our actions have to be timely and address root causes and fragmentation in the system to impact the layers of structural racism that we already know contribute to maternal morbidity.”

The team hopes these findings bring attention to the high rates of emergency care visits driven by unmet needs—a public health issue that is not well documented—and encourage researchers, healthcare providers, policymakers, and reproductive health advocates to envision ways to strengthen or compensate for traditional prenatal care that falls short of meeting pregnant patients’ health needs. 

Reference:

Declercq ER, Liu C, Cabral HJ, Amutah-Onukagha N, Diop H, Mehta PK. Emergency Care Use During Pregnancy and Severe Maternal Morbidity. JAMA Netw Open. 2024;7(10):e2439939. doi:10.1001/jamanetworkopen.2024.39939

Brazil: A recent study has highlighted the benefits of a novel low-concentration hydrogen peroxide (HP) bleaching gel, which integrates nano-sized sodium trimetaphosphate (TMPnano) and fluoride. This innovative formulation aims to enhance teeth whitening while minimizing potential harm to tooth enamel.

Researchers have been unable to explain why after giving birth, Black patients are two to three times as likely to retain or gain additional weight compared to their white counterparts, even when pre-pregnancy weight and gestational-weight trajectories are comparable.

A first-of-its-kind study by University of Pittsburgh epidemiologists points to the stress of lived experiences with racism and gender-based discrimination as a possible explanation. The study was reported today in the American Journal of Epidemiology.

Since postpartum weight retention is associated with increased cardiovascular risk and other negative health outcomes that persist throughout one’s life, the new research suggests interventions that address the underlying stressors of discrimination could be an important complement to community and clinical interventions.

“Beyond individual choices and behavior, we have to account for an individual’s environment, because that can have an impact on health, too,” said lead author Dara Méndez, Ph.D., M.P.H., associate professor of epidemiology and associate director of the Center for Health Equity at Pitt Public Health. “Context matters, and lived experiences matter. How can we link people to appropriate services and support in the postpartum period, in light of exposure to stress and experiences of discrimination?”

As part of the Postpartum Mothers Mobile Study (PMOMS), researchers recruited 313 pregnant individuals between 2017 and 2020, following them from their second trimester through one year postpartum.

Study participants weighed themselves on a weekly basis using Bluetooth-enabled scales, and completed brief surveys via smartphone once a day, on average. Study participants were asked about everyday experiences, including daily experiences of stress and discrimination.

The surveys were administered using a method called ecological momentary assessment (EMA), which aims to capture data on thoughts and behaviors in real time, while the participant is in their natural environment. In addition, the study captured acute exposure to discrimination with major institutions such as applying for loans, interacting with teachers or academic advisors, searching for or retaining employment, and interacting with police, including being unfairly stopped, searched, questioned, threatened or abused.

Black participants retained 0.3 more pounds for every 10% increase in the number of days they experienced racial discrimination in the previous month. Gender discrimination was also associated with weight retention, with 0.4 more pounds retained per 10% increase in days with these experiences. These findings persisted even when pregnancy-health factors had been comparable to those of participants who experienced less racial and gender discrimination.