‘AI doctor’ could boost survival in sepsis patients

Agencies
October 23, 2018

London, Oct 23: Scientists have created an artificial intelligence (AI) system that could help treat patients with sepsis by predicting the best treatment strategy. The system developed by researchers from Imperial College London in the UK analysed the records of about 100,000 hospital patients in intensive care units and every single doctor’s decisions affecting them. The findings, published in the journal Nature Medicine, showed the AI system made more reliable treatment decisions than human doctors.

The system, called AI Clinician, could be used alongside medical professionals, to help doctors decide the best treatment strategy for patients, researchers said. Sepsis can cause a drastic drop in blood pressure which can leave organs deprived of blood flow and oxygen, and can ultimately lead to multiple organ failure and death. To raise blood pressure and keep the heart pumping, doctors give extra fluids, usually in the form of a salt solution, as well as medication that tightens blood vessels and raises blood pressure, called vasopressors.

Researchers looked back at US patient records from 130 intensive care units over a 15 year period to explore whether the AI system’s recommendations might have been able to improve patient outcomes, compared with standard care. The researchers now hope to trial the system in intensive care units in the UK. “Sepsis claims six million lives worldwide — so we desperately need new tools at our disposal to help patients,” said Aldo Faisal from Imperial College London.

“Our new AI system was able to analyse a patient’s data –such as blood pressure and heart rate — and decide the best treatment strategy. We found that when the doctor’s treatment decision matched what the AI system recommended, they had a better chance of survival,” Faisal said. To help doctors decide which approach would boost a patient’s chance of survival, the research team created an AI system that would assess a patient’s vital signs and recommend the best treatment approach. The system analysed the medical records of 96,000 US patients with sepsis in intensive care units.

Using a process called reinforcement learning — where robots learn how to make decisions and solve a problem — the AI Clinician went through each patient’s case and worked out the best strategy of keeping a patient alive. The system calculated 48 variables including age, vital signs and pre-existing conditions. It then predicted the best treatment strategy for each patient with sepsis. The results revealed that 98 per cent of the time, the AI system matched or was better than the human doctors’ decision, researchers said.

The study also found that mortality was lowest in patients where the human doctor’s doses of fluids and vasopressor matched the AI system’s suggestion. However, when the doctor’s decision differed from the AI system, a patient had a reduced chance of survival. The team found when the doctor’s decision varied from the AI Clinician’s suggestion, it was on average to administer too much fluid and too little vasopressor but importantly it varied between individual patients.

“The AI Clinician was able to ‘learn’ from far more patients than any doctor could see in a lifetime,” said Anthony Gordon, a professor at Imperial College London. “It has learnt from 100,000 patients and ‘remembered’ them all equally whereas doctors are always susceptible to recall bias, where they particularly remember recent cases or unusual cases,” Gordon said.

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Agencies
January 11,2020

Europe, Jan 11: Researchers have revealed the people who drink tea at least three times a week have healthy years of life and longer life expectancy.

The research was published in the European Journal of Preventive Cardiology, a journal of the European Society of Cardiology (ESC).

Dr Xinyan Wang, who is the author of the study, said: "Habitual tea consumption is associated with lower risks of cardiovascular disease and all-cause death. The favourable health effects are the most robust for green tea and for long-term habitual tea drinkers."
The analysis that was conducted included about 100,902 participants of the China-PAR project2 with no history of heart attack, stroke, or cancer.

Participants were classified into two groups: Habitual tea drinkers and never or non-habitual tea drinkers and followed-up for a median of 7.3 years.

The analyses estimated that 50-year-old habitual tea drinkers would develop coronary heart disease and stroke 1.41 years later and live 1.26 years longer than those who never or seldom drank tea. Compared with never or non-habitual tea drinkers, the habitual tea consumers had a 20 per cent lower risk of incident heart disease and stroke, 22 per cent lower risk of fatal heart disease and stroke, and 15 per cent decreased risk of all-cause death.

The potential influence of changes in tea drinking behaviour was suspected in a subset of 14,081 participants with assessments at two-time points. The average duration between the two surveys was 8.2 years, and the median follow-up after the second survey was 5.3 years.

Habitual tea drinkers who maintained their habit in both surveys had a 39 per cent lower risk of incident heart disease and stroke, 56 per cent lower risk of fatal heart disease and stroke, and 29 per cent decreased risk of all-cause death compared to consistent never or non-habitual tea drinkers.

Senior author Dr Dongfeng Gu said: "The protective effects of tea were most pronounced among the consistent habitual tea drinking group. Mechanism studies have suggested that the main bioactive compounds in tea, namely polyphenols, are not stored in the body long-term. Thus, frequent tea intake over an extended period may be necessary for the cardioprotective effect."

In a subanalysis by type of tea, drinking green tea was linked with approximately 25 per cent lower risks for incident heart disease and stroke, fatal heart disease and stroke, and all-cause death. However, no significant associations were observed for black tea.
Dr Gu noted that a preference for green tea is unique to East Asia.

Two factors may be at play. First, green tea is a rich source of polyphenols which protect against cardiovascular disease and its risk factors including high blood pressure and dyslipidaemia. Black tea is fully fermented and during this process, polyphenols are oxidised into pigments and may lose their antioxidant effects. Second, black tea is often served with milk, which previous research has shown may counteract the favourable health effects of tea on vascular function.

Gender-specific analyses showed that the protective effects of habitual tea consumption were pronounced and robust across different outcomes for men, but only modest for women. Dr Wang said: "One reason might be that 48 per cent of men were habitual tea consumers compared to just 20 per cent of women. Secondly, women had a much lower incidence of, and mortality from, heart disease and stroke. These differences made it more likely to find statistically significant results among men."

She said: "The China-PAR project is ongoing, and with more person-years of follow-up among women the associations may become more pronounced."

In conclusion, the authors have found that randomised trials are required to validate the results and to illustrate nutritional guidelines and advice for lifestyle.

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Agencies
July 4,2020

The Union health ministry on Friday revised the dosage of anti-viral drug remdesivir to be administered to coronavirus patients in the moderate stage of illness from the earlier six days to five days as it issued an updated 'Clinical Management Protocols for COVID-19'.

The drug, administered in the form of injection, should be given at a dose of 200 mg on day one followed by 100 mg daily for four days (total five days), the new treatment protocols stated.

The Health Ministry on June 13 had allowed the use of remdesivir for restricted emergency use in moderate cases under "investigational therapies".

"Under emergency use authorisation, remdesivir may be considered for patients in moderate stage requiring oxygen support," the document stated.

It is not recommended for those with severe renal impairment and high level of liver enzymes, pregnant and lactating women, and those below 12 years, it said.

The ministry also okayed off-label application of tocilizumab, a drug that modifies the immune system or its functioning, and convalescent plasma for treating COVID-19 patients in the moderate stage of illness as "investigational therapies".

It also recommended hydroxychloroquine for patients during the early course of the disease and not for critically-ill patients.

On June 27, the ministry had included an inexpensive, widely used steroid dexamethasone in treatment protocols for COVID-19 patients in the moderate to severe stages of their illness among other therapeutic measures.

The ministry advised use of dexamethasone, which is already used in a wide range of conditions for its anti-inflammatory and immunosuppressant effects, as an alternative choice to methylprednisolone for managing moderate to severe cases of coronavirus infection.

India's COVID-19 cases soared by over 20,000 in a day for the first time taking the country's total tally to 6,25,544 on Friday while the death toll climbed to 18,213 with 379 new fatalities, according to the Union Health Ministry data updated at 8 am.

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Agencies
January 25,2020

Washington D.C., Jan 25: A new study conducted by a team of researchers reveals why individuals who have a history of early life adversity (ELA) are disproportionately prone to opioid addiction.

The study conducted examined how early adversities interact with factors such as increased access to opioids to directly influence brain development and function, causing a higher potential for opioid addiction.

The study was lead by UCI researchers and was published in Molecular Psychiatry.

Tallie Z. Baram, MD, PhD, the Danette Shepard Chair in Neurological Sciences at the UCI School of Medicine and one of the senior researchers for the study, was on the take that the widely known factor genetics that plays major role in addiction vulnerability, cannot be solely held responsible for the recent rise in opioid abuse.

To further clarify, the researchers simulated ELA in rats by limiting bedding and nesting materials during a short, postnatal period of time.

In female rats, this led to striking opioid addiction-like characteristics including an increased relapse- behaviour, for example.

As observed in addicted humans, the rats were willing to work very hard (pay a very high price) to obtain the drug.

Baram said: "Ultimately, we found that conditions during sensitive developmental periods can lead to vulnerability to the addictive effects of opioid drugs, especially in females, which is consistent with the prevalence of ELA in heroin-addicted women."

These findings can be used to highlight the importance given to sex differences in future ELA-related studies on opioid addiction, and in future prevention or intervention strategies being developed to address the growing opioid crisis.

The study conducted examined how early adversities interact with factors such as increased access to opioids to directly influence brain development and function, causing a higher potential for opioid addiction.

The study was lead by UCI researchers and was published in Molecular Psychiatry.

The study found that unpredictable, fragmented early life environments may lead to abnormal maturation of certain brain circuits, which profoundly impacts brain function and persists into adolescence and adulthood.

Tallie Z. Baram, MD, PhD, the Danette Shepard Chair in Neurological Sciences at the UCI School of Medicine and one of the senior researchers for the study, was on the take that the widely known factor genetics that plays major role in addiction vulnerability, cannot be solely held responsible for the recent rise in opioid abuse.

To further clarify, the researchers implanted ELA in rats by limiting bedding and nesting materials during a short, postnatal period of time.

In female rats, this led to striking opioid addiction-like characteristics including an increased relapse- behaviour, for example.

As observed in addicted humans, the rats were willing to work very hard (pay a very high price) to obtain the drug.

Baram said: "Ultimately, we found that conditions during sensitive developmental periods can lead to vulnerability to the addictive effects of opioid drugs, especially in females, which is consistent with the prevalence of ELA in heroin-addicted women."

These findings can be used to highlight the importance given to sex differences in future ELA-related studies on opioid addiction, and in future prevention or intervention strategies being developed to address the growing opioid crisis.

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