More people die after surgery than from HIV, TB, and malaria combined

Agencies
February 2, 2019

London, Feb 2: Nearly 4.2 million people around the world die every year within 30 days after surgery, more than those who die from HIV, tuberculosis, and malaria combined, according to a study.

The analysis, published in a research letter to The Lancet journal, found that half of the postoperative deaths occur in low and middle-income countries (LMICs).

There is also a significant unmet need for surgery in LMICs and researchers at the University of Birmingham in the UK believe that if operations were provided for all patients who need them the number of global post-operative deaths would increase to 6.1 million.

The researchers estimate that the number of people who die each year from HIV, tuberculosis, and malaria combined is 2.97 million, way less than post-operative deaths.

The Lancet Commission on Global Surgery identified that 313 million surgical procedures are performed each year, but little is known about the quality of surgery globally, as robust postoperative death rates are available for only 29 countries, researchers said in a statement.

The team analysed available information to estimate how many people around the world die after operations -- based on surgical volume, case-mix and postoperative death rates adjusted for country income.

"Surgery has been the 'neglected stepchild' of global health and has received a fraction of the investment put into treating infectious diseases such as malaria," said Dmitri Nepogodiev, Research Fellow at the University of Birmingham.

"Although not all postoperative deaths are avoidable, many can be prevented by increasing investment in research, staff training, equipment, and better hospital facilities," Nepogodiev said.

"To avoid millions of more people dying after surgery, the planned expansion of access to surgery must be complemented by investment into improving the quality of surgery around the world," he said.

Surgery saves lives and can transform patients' quality of life, but this study shows that a large number of patients die in the immediate postoperative period.

"As efforts continue to increase access to surgery around the world, there is also an urgent need for research to improve the quality and safety of surgery," said Professor Dion Morton from the University of Birmingham.

The researchers project that expanding surgical services to address unmet need would add another 1.9 million post-operative deaths in LMICs each year.

Based on 4.2 million deaths, 7.7 per cent of all deaths globally occur within 30 days of surgery, researchers said.

This figure is greater than that attributed to any other cause of death globally except ischaemic heart disease and stroke, they said.

At present, around 4.8 billion people worldwide lack timely access to safe and affordable surgery and it is estimated that there is an annual unmet need for 143 million procedures in LMICs.

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News Network
February 22,2020

Feb 22: The subjective feeling of well-being experienced by many people with the practice of meditation is associated with specific changes in the brain, according to a study which may lead to better clinical recommendations of the practice.

The study, published in the journal Brain and Cognition, examined the effects of the technique known as Transcendental Meditation (TM), which consists of the silent repetition of a meaningless sound.

In the study, the researchers from the IMT School for Advanced Studies Lucca in Italy, enrolled 34 healthy young volunteers and divided them in two groups.

They said the first group practised TM 40 minutes per day in two sessions of 20 minutes each, one in the morning and the other in the evening.

The second group, the scientists said, did not change its daily routine.

Using questionnaires, they also measured the anxiety and stress levels of all the participants at the beginning of the study, as well as the subjects' ability to manage stressful situations.

According to the researchers, the participants were also subjected to a functional magnetic resonance imaging (fMRI) brain scan, in order to measure the organ's activity at rest, and changes in the excitation among different cerebral areas.

They repeated the tests after three months, at the end of the study.

According to the study, the levels of anxiety and stress perceived by the subjects who followed the meditation program were significantly reduced in comparison with those of the volunteers who did not practice TM.

"Magnetic resonance imaging also shows that the reduction of anxiety levels is associated with specific changes in the connectivity between different cerebral areas, such as precuneus, left parietal lobe and insula, which all have an important role in the modulation of emotions and inner states," said study co-author Giulia Avvenuti from the IMT School for Advanced Studies Lucca.

"In the control group, instead, none of these changes was observed. The fact that Transcendental Meditation has measurable effects on the 'dialogue' between brain structures involved in the modulation of affective states opens new perspectives for the understanding of brain-mind relationships," said Pietro Pietrini, IMT School's Director, and co-author of the study.

"It also extends the results of recent research suggesting that drugs therapies and psychotherapy leverage on the same biological mechanism," Pietrini said.

According to the researchers, even a few months of practice of TM can have positive effects which can be correlated with measurable changes in the brain.

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Agencies
May 19,2020

Researchers have found that patients with peripheral artery disease or stroke were less likely to receive recommended treatments to prevent heart attack than those with coronary artery disease. All three are types of atherosclerotic cardiovascular disease.

Depending on the location of the blockage, atherosclerosis increases the risk for three serious conditions: coronary artery disease, stroke and peripheral artery disease.

"Our study highlights the need for public health campaigns to direct equal attention to all three major forms of atherosclerotic cardiovascular disease," said senior study author Erin Michos from the Johns Hopkins University in the US.

"We need to generate awareness among both clinicians and patients that all of these diseases should be treated with aggressive secondary preventive medications, including aspirin and statins, regardless of whether people have heart disease or not," Michos added.

Since atherosclerosis can affect arteries in more than one part of the body, medical guidelines are to treat coronary artery disease, stroke and peripheral artery disease similarly with lifestyle changes and medication, including statins to lower cholesterol levels and aspirin to prevent blood clots.

Lifestyle changes include eating a healthy diet, being physically active, quitting smoking, controlling high cholesterol, controlling high blood pressure, treating high blood sugar and losing weight.

What was unclear was if people with stroke and peripheral artery disease received the same treatments prescribed for those with coronary artery disease.

This study compared more than 14,000 US adults enrolled in the 2006-2015 Medical Expenditure Panel Survey, a national survey of patient-reported health outcomes and conditions, and health care use and expenses.

Slightly more than half of the patients were men, the average age was 65, and all had either coronary artery disease, stroke or peripheral artery disease.

These individuals were the representative of nearly 16 million US adults living with one of the three forms of atherosclerotic cardiovascular disease.

Compared to participants with coronary artery disease, participants with peripheral artery disease were twice more likely to report no statin use and three times more likely to report no aspirin use.

Additionally, people with peripheral artery disease had the highest, annual, total out-of-pocket expenditures among the three atherosclerotic conditions.

The findings showed that participants with stroke were more than twice as likely to report no statin or aspirin use.

Moreover, those with stroke were more likely to report poor patient-provider communication, poor health care satisfaction and more emergency room visits.

"Our study highlights a missed opportunity for implementing life-saving preventive medications among these high-risk individuals," Michos said.

The study was presented in the virtual conference at the American Heart Association's Quality of Care & Outcomes Research Scientific Sessions 2020.

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Agencies
June 10,2020

Early treatment with the antiviral drug remdesivir has been found to reduce viral load and prevent lung disease in macaques infected with SARS-CoV-2 that causes COVID-19, according to a study.

The findings, published in the journal Nature on Tuesday, support the early use of remdesivir treatment in patients with COVID-19 to prevent progression to pneumonia.

Researchers from the National Institutes of Health in the US noted that remdesivir has broad antiviral activity and has been shown to be effective against infections with SARS-CoV and MERS-CoV in animal models.

The drug is being tested in human clinical trials for the treatment of COVID-19, they said.

Researcher Emmie de Wit and colleagues investigated the effects of remdesivir treatment in rhesus macaques, a recently established model of SARS-CoV-2 infection.

Two sets of six macaques were inoculated with SARS-CoV-2.

One group was treated with remdesivir 12 hours later -- close to the peak of virus reproduction in the lungs -- and these macaques received treatment every 24 hours until six days after inoculation.

In contrast to the control group, the researchers found that macaques that received remdesivir did not show signs of respiratory disease, and had reduced damage to the lungs.

Viral loads in the lower respiratory tract were also reduced in the treated animals; viral levels were around 100 times lower in the lower-respiratory tract of remdesivir-treated macaques 12 hours after the first dose, they said.

The researchers said that infectious virus could no longer be detected in the treatment group three days after initial infection, but was still detectable in four out of six control animals.

Despite this virus reduction in the lower respiratory tract, no reduction in virus shedding was observed, which indicates that clinical improvement may not equate to a lack of infectiousness, they said.

Dosing of remdesivir in the rhesus macaques is equivalent to that used in humans, the researchers noted.

They cautioned that it is difficult to directly translate the timing of treatment used in corresponding disease stages in humans, because rhesus macaques normally develop only mild disease.

However, researchers said the results indicate that remdesivir treatment of COVID-19 should be initiated as early as possible to achieve the maximum treatment effect.

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