Published in IJCP July 2019
News and Views
July 12, 2019 |

Clinical Practice Guidelines 2019

Acute lower gastrointestinal bleeding: 10 Key Takeaways

This year, the British Society of Gastroenterology released clinical practice guidelines on the diagnosis and management of acute lower gastrointestinal (GI) bleeding published online April 8, 2019 in the BMJ.

Here are 10 key takeaways from the guidelines.

  1. Patients who present with low GI bleeding should be first categorized as unstable (shock index >1) or stable. The Oakland score can be used to categorize stable bleeds as minor or major. Patients with minor self-terminating bleed (Oakland score ≤8) can be discharged for urgent outpatient investigation, if there are no indications for hospitalization. But patients with major bleed should be hospitalized for colonoscopy on the next available list.
  2. Before planning endoscopic or radiological therapy, localize the site of bleeding quickly and least invasively via CT angiography in hemodynamically unstable patients or those who have shock index >1 after initial resuscitation and/or in whom active bleeding is suspected.
  3. If no source of bleeding can be identified on initial CT angiography in hemodynamically unstable patients, an upper GI endoscopy should be performed immediately. Gastroscopy may be the first investigation when patient stabilizes after initial resuscitation.
  4. If a source of bleeding is found on CT angiography, a catheter angiography with a view to embolization should be done at the earliest. Centers with a 24/7 interventional radiology service should be capable of performing catheter angiography for hemodynamically unstable patients within 60 minutes of admission.
  5. Patients should not proceed to emergency laparotomy unless an exhaustive effort has been made to localize the source of bleeding using radiologic and/or endoscopic modalities.
  6. Restrictive red blood cell (RBC) thresholds (Hemoglobin [Hb] trigger 70 g/L and Hb concentration target of 70-90 g/L post transfusion) should be used in clinically stable patients who need RBC transfusion. The trigger and target should be 80 g/L and 100 g/L, respectively in patients with a history of cardiovascular disease.
  7. Interrupting warfarin therapy at presentation is recommended. In patients with low thrombotic risk, warfarin should be restarted at 7 days after hemorrhage. In patients with high thrombotic risk (i.e., prosthetic metal heart valve in mitral position, atrial fibrillation with prosthetic heart valve or mitral stenosis, <3 months after venous thromboembolism), low molecular weight heparin (LMWH) should be considered at 48 hours after the bleeding.
  8. Permanently discontinue aspirin for primary prophylaxis of cardiovascular events. But, restart aspirin for secondary prevention, if stopped, as soon as hemostasis is achieved.
  9. Routine stopping of dual antiplatelet therapy with a P2Y12 receptor antagonist and aspirin is not recommended in patients with coronary stents in situ; a cardiologist should be part of the management team. Continue aspirin if P2Y12 receptor antagonist is interrupted in unstable hemorrhage; restart P2Y12 receptor antagonist within 5 days.
  10. Direct oral anticoagulant therapy should be interrupted at presentation. Treatment with inhibitors such as idarucizumab or andexanet should be considered for life-threatening hemorrhage in patients on direct oral anticoagulants. Restart direct oral anticoagulant drug treatment at a maximum of 7 days after the bleeding.

(Source: Oakland K, Chadwick G, East JE, et al. Diagnosis and management of acute lower gastrointestinal bleeding: guidelines from the British Society of Gastroenterology. Gut. 2019;68(5):776-89).

Evaluate Gait Speed as a ‘Vital Sign’ to Predict Prognosis in Older Adults with Blood Cancers

Gait speed is an easily obtained ‘vital sign’ that accurately identifies frailty and predicts survival and unplanned hospital visits regardless of age, cancer or treatment type, or other factors among older patients with hematologic cancers, according to a new study published June 5, 2019 in the journal Blood. This association was found to be strongest in those with non-Hodgkin lymphoma.

For every 0.1 meter per second decrease in gait speed, the risk of dying, unexpectedly going to the hospital, or ending up in the emergency room increased by 22%, 33% and 34%, respectively.

Every 5 kg decrease in grip strength was associated with worse survival, but not hospital or ED use.

Monitoring gait speed not only helps to recognize individuals who are frail and may fare worse, it also identifies people who are in much better shape than expected based on age alone.

Researchers suggest that gait speed should be used as a routine part of medical assessments along with other vital signs to improve patient assessment, prognostication and individualization of care.

Collaboration Between France and WHO to Realize the Vision of the WHO Academy

Emmanuel Macron, President of the French Republic and Dr Tedros Adhanom Ghebreyesus, WHO Director-General met at WHO Headquarters in Geneva and signed a Declaration of Intent to establish the WHO Academy that will revolutionize lifelong learning in health.

The Academy aims to reach millions of people with innovative learning via a state-of-the-art digital learning experience platform at a campus in Lyon and embedded in the six WHO regions. The WHO Academy Lyon hub will feature high-tech learning environments, a world-class health emergencies simulation center and collaboration spaces for learning co-design, research and innovation...(WHO)

One-in-Five Suffers Mental Health Condition in Conflict Zones: UN Figures

More than one-in-five people living in conflict-affected areas suffers from a mental illness, according to a new report based on UN figures, prompting the WHO to call for increased, sustained investment in mental health services in those zones.

Around 22% of those affected, suffer depression, anxiety or post-traumatic stress disorder, according to an analysis of 129 studies published in The Lancet.

The study also shows that about 9% of conflict-affected populations have a moderate to severe mental health condition; substantially higher than the global estimate for these mental health conditions in the general population...(UN)

New Guidelines Issued on Sexually Transmitted Infections

Updated guidelines on sexually transmitted infections (STIs) address a number of dermatologic manifestations that are not always included in recommendations from other specialty groups, delegates heard at the World Congress of Dermatology 2019.

Diagnosing and treating genital lumps and lacerations are necessary, said Marco Cusini, MD, from the Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico in Milan, who was onsite representing the International Union Against Sexually Transmitted Diseases (IUSTI), which recently issued the guidance (J Eur Acad Dermatol Venereol).

An important aspect of the updated IUSTI guidelines is that they urge doctors to be mindful of several high-risk populations. Sex workers, gay men and transgender people are all at risk for STIs. The update expands information on how to treat transgender patients.

TAVR on Bicuspid Valves may Carry Early Risks

People with bicuspid aortic stenosis had an early disadvantage for stroke after getting transcatheter aortic valve replacement (TAVR) with a balloon-expandable valve, researchers found from the TVT Registry.

While post-TAVR mortality rates were similar between Sapien 3 recipients with two- and three-leaflet anatomy, early stroke was more common with bicuspid valves before reaching statistical equivalency at 1 year.

The bicuspid group also experienced significantly more procedural complications requiring open heart surgery (0.9% vs. 0.4%), according to a group led by Raj Makkar, MD, of Cedars-Sinai Medical Center in Los Angeles, in a preliminary report in JAMA.

No Link Between HIV Infection and Contraceptive Methods, Says Study

A large clinical research study conducted in four African countries found no significant difference in risk of human immunodeficiency virus (HIV) infection among women using one of three highly effective, reversible contraceptive methods - depot medroxyprogesterone acetate (DMPA) intramuscular, levonorgestrel implant and a copper-bearing intrauterine device (IUD). Published in the Lancet, the study showed that each method had high levels of safety and effectiveness in preventing pregnancy, with all methods well-accepted by the women using them.

“These results support making available to women and girls a broad choice of effective contraceptive methods that empower them to make informed decisions about their own bodies - including if and when to have children,” said Dr James Kiarie, from the Dept. of Reproductive Health and Research at the WHO…(WHO)

Yemen: Maternal and Newborn Health “on the Brink of Total Collapse”, UNICEF Alerts

After more than 4 years of grinding conflict in Yemen, health care for mothers and their babies is “on the brink of collapse”, the UN Children’s Fund (UNICEF) warned in a report that highlights the difficulties of childbirth and parenting in a war zone.

According to UNICEF, 1 woman and 6 newborns die every 2 hours from complications during pregnancy or childbirth. The years of intense fighting in the country have contributed to limited access to crucial health care, with only 3 out of 10 births taking place in regular health facilities.

The results are part of a series compiled by the agency, Childbirth and parenting in a war zone…(UN)

Fecal Transplants may Transmit Deadly Drug-resistant Infections, FDA Warns

The US Food and Drug Administration (FDA) alerted health care providers and patients that fecal microbiota for transplant (FMT) may transmit multidrug-resistant organisms, leading to serious or life-threatening infections. In a safety communication, the FDA said two immunocompromised adults who received FMT developed invasive bacterial infections caused by extended-spectrum beta-lactamase (ESBL)-producing Escherichia coli. One of the patients died…(Medscape)

Restless Legs Syndrome Tied to Gut Health

Preliminary research suggests an association between small intestine bacterial overgrowth (SIBO) and restless legs syndrome (RLS), supporting emerging research linking gut microbial health to sleep health.

While the study is ongoing and recruitment just beginning, the researchers found SIBO in all 7 RLS patients studied to date. The study was presented at SLEEP 2019: 33rd Annual Meeting of the Associated Professional Sleep Societies.

Novel Sickle Cell Drug Improves Hemoglobin Characteristics

For sickle cell disease, novel oral agent voxelotor improved hemoglobin characteristics in the phase III HOPE trial.

Levels of normal hemoglobin levels rose >1.0 g/dL from baseline at week 24 - a degree associated with significantly decreased rates of multiorgan failure and death in natural history studies, and considered a “response” - for 51% of patients randomized to the 1,500 mg of voxelotor group compared with 7% of those on placebo (p < 0.001) in the intention-to-treat analysis for the primary endpoint. The findings were published online in the New England Journal of Medicine.

Meeting of the International Health Regulations (2005) Emergency Committee for Ebola Virus Disease in DRC

The meeting of the Emergency Committee convened by the WHO Director-General under the International Health Regulations (IHR) (2005) regarding Ebola virus disease in the Democratic Republic of the Congo (DRC) took place on June 14, 2019.

The Committee expressed its deep concern about the ongoing outbreak, which, despite some positive epidemiological trends, especially in the epicentres of Butembo and Katwa, shows that the extension and/or reinfection of disease in other areas like Mabalako, presents, once again, challenges around community acceptance and security.

It was the view of the Committee that the outbreak is a health emergency in DRC and the region but does not meet all the three criteria for a PHEIC under the IHR. While the outbreak is an extraordinary event, with risk of international spread, the ongoing response would not be enhanced by formal Temporary Recommendations under the IHR (2005)…(WHO)

Federal Officials Seized Adulterated Dietary Supplements from Life Rising Corporation due to Poor Manufacturing Practices

At the request of the US FDA, US Marshals seized more than 3,00,000 containers of dietary supplements, including tablets, capsules and teas from Life Rising Corporation. The seized goods consisted of more than 500 products bearing brand names Life Rising, Holicare or HopeStream, and are valued at approximately $3.5 million.

The FDA inspection at Life Rising found that its dietary supplements were prepared, packed and/or held under conditions that violated Current Good Manufacturing Practice (CGMP) regulations. Among other observed deficiencies, the company failed to establish product specifications for the identity, purity, strength and composition of each finished batch of dietary supplement, and for limits on certain types of contamination, to ensure the quality of the supplement... (FDA)

Gabapentinoids Tied to Suicidal Behavior and Unintentional Overdose

Gabapentinoid prescriptions were associated with an increased risk of suicidal behavior and unintentional overdose, a population cohort study in Sweden showed.

The risks were strongest for people who were prescribed pregabalin over gabapentin, especially among young people, reported Seena Fazel, MD, of the University of Oxford in England, and colleagues in The BMJ.

IL-17a Drug Rescues Many Refractory Psoriatic Arthritis Cases

Despite having been treated with numerous regimens, including multiple attempts with biologic agents, many patients with psoriatic arthritis benefited from a 6-month course of secukinumab in a “real-world” analysis reported at the European Congress on Rheumatology.

Among 177 heavily pretreated patients, 47% achieved remission or low disease activity as measured by the DAPSA (Disease Activity in Psoriatic Arthritis) score, reported Maria Martin-Lopez, MD, of Hospital Universitario 12 de Octubre in Madrid.

Amid Measles Outbreak, New York Ended Religious Exemptions for Vaccines

Amid a measles outbreak, New York required schoolchildren to be vaccinated, even if parents have religious objections.

Gov. Andrew Cuomo signed a legislation that removes nonmedical exemptions from school vaccination requirements.

The move, which came despite opposition from anti-vaccination activists and religious freedom advocates, put New York alongside other states that do not allow nonmedical exemptions: California, Mississippi, West Virginia and Maine…(CNN)

Leuprorelin Depot Handling Errors Prompt EMA Review

Reports of handling errors with depot formulations of leuprorelin (leuprolide acetate) prompted the Pharmacovigilance Risk Assessment Committee (PRAC) of the European Medicines Agency (EMA) to launch a review.

The reports indicate that “handling errors during preparation and administration can cause some patients to receive insufficient amounts of their medicine, thus reducing the benefits of treatment,” the EMA said in a news release.

The review only covered depot formulations that are given by injection under the skin or into a muscle and that release the active substance slowly over 1 to 6 months. These products include implants as well as powders and solvents for the preparation of injections…(Medscape)

Incivility in ORs Linked to Diminished Clinical Performance

Research on anesthesiology residents exposed to incivility in a simulated operating room (OR) environment indicates that rudeness in the OR has a negative impact on clinician performance.

The recent research published in BMJ Quality & Safety exposed anesthesiology residents to an impatient surgeon-actor in a simulated OR hemorrhage scenario. Compared to a control group of residents who were not exposed to an impatient surgeon-actor, the experimental residents scored lower on all four performance metrics in the study: vigilance, diagnosis, communication and patient management.

Father’s Smoking During Pregnancy Tied to Asthma in Kids

Children who are exposed to tobacco smoke from their fathers while they are in the womb may be more likely than those who are not to develop asthma by age 6, according to a study of chemical changes to DNA.

While prenatal smoke exposure has long been linked to an increased risk of childhood asthma, the current study offers fresh evidence that it’s not just a pregnant mother’s smoking that can cause harm. The findings are published in Frontiers in Genetics.

FDA Approves New Treatment for Pediatric Patients with Type 2 Diabetes

The US FDA approved liraglutide injection for treatment of pediatric patients 10 years or older with type 2 diabetes. Liraglutide is the first non-insulin drug approved to treat type 2 diabetes in pediatric patients since metformin was approved for pediatric use in 2000. The drug has been approved to treat adult patients with type 2 diabetes since 2010... (FDA.)

Researchers Find Way to Convert Type A Blood to Type O

Researchers have found a way to use a pair of enzymes from a human gut bacterium to convert type A to the universal donor type O blood, according to a report published in Nature Microbiology.

The researchers say the high activity and specificity of these enzymes “make these very promising candidates for cost-efficient implementation into the already existing automated routines of blood collection, processing and storage, with major implications for the flexibility of our blood supply and possible applications in organ transplantation.”

Necrotizing Infections Rise with Warming Oceans, Study Shows

As ocean temperatures increase, serious Vibrio vulnificus infections are on the rise in previously nonendemic areas, according to a case series published online in Annals of Internal Medicine. This emerging Vibrio risk in nonendemic areas means clinicians need to be aware of the infection, especially if they have never seen a case in their practice. The bacterium typically lives in warm seawater.

WHO Offers a New Tool and Sets a Target to Accelerate Action Against Antimicrobial Resistance

WHO has launched a global campaign urging governments to adopt a tool to reduce the spread of antimicrobial resistance, adverse events and costs.

The AWaRe tool was developed by the WHO Essential Medicines List to contain rising resistance and make antibiotic use safer and more effective. It classifies antibiotics into three groups – Access, Watch and Reserve – and specifies which antibiotics to use for the most common and serious infections, which ones should be available at all times in the healthcare system, and those that must be used sparingly or preserved and used only as a last resort. The new campaign aims to increase the proportion of global consumption of antibiotics in the Access group to at least 60%, and to reduce use of the antibiotics most at risk of resistance from the Watch and Reserve groups...(WHO)

UN Environment Agency Tackles Climate Change One Bite at a Time

If we all change the way we eat, we can make significant progress in the fight against climate change. This was the message from the` UN environment agency (UNEP) on Sustainable Gastronomy Day - June 18, as it launched a new campaign to encourage healthy and sustainable food choices.

As part of its #ActNow initiative, a global call to individual action on climate change, professional and aspiring chefs were challenged to share dishes that were not only delicious, but good for people and the planet, with an emphasis on reducing meat and promoting plant-based diets...(UN)

Convicted Physicians Received Message of Support from World’s Doctors

On behalf of millions of physicians globally, the World Medical Association (WMA) delivered an open message of support to all Turkish doctors, and in particular to those sentenced to prison, for declaring in a press release that “war is a public health problem’. In an open letter, WMA leaders denounced ‘the pervasive obstruction campaign” by the Turkish state against doctors and declared: “We are shocked and deeply disturbed by the recent decision of the Criminal Court of Ankara which condemned TMA’s Central Council members to prison sentences for their call for peace. This is pure aberration”.

The public statement “War is a Public Health Problem” was issued as a press release on January 24, 2018 by 11 doctors as members of the Central Council of Turkish Medical Association...(WMA)

Osteoporosis Drugs may Help Oldest, Sickest Women Most

Frail, very elderly women with osteoporosis may benefit the most from osteoporosis drugs, according to a study published online in JAMA Internal Medicine.

Women older than 80 years with osteoporosis and multiple medical problems or poor prognosis had more than triple the risk for hip fracture in the next 5 years, compared with women in the same age group who had increased fracture risk but no osteoporosis.

“Clinicians should consider the initiation of drug treatment to prevent fracture in late-life women with osteoporosis (bone mineral density [BMD] T-score -2.5 or below) and multiple comorbidities, as this group of women may derive the greatest absolute benefit of treatment in preventing future hip fractures,” author Kristine Ensrud, MD, MPH, University of Minnesota, Minneapolis, said.

Novel Agent Shows Promise as First Possible Therapy for Achondroplasia 

The results are preliminary, but a novel investigative agent has shown promise in a small trial in children for the treatment of achondroplasia, the most common form of human dwarfism.

A phase 2, proof of concept study found that treatment with vosoritide, a recombinant C-type natriuretic peptide analogue, demonstrated a favorable safety profile and efficacy at a dose of 15 µg/kg. The findings were published online in the New England Journal of Medicine.

WHO Flags Critical Funding Gap, Calls for Political Parties to Join Fight Against Ebola

The Ebola outbreak in the DRC will only end with bipartisan political cooperation and community ownership, according to the WHO’s Director-General, Dr Tedros Adhanom Ghebreyesus. He was speaking to Member States in Geneva after returning from a visit to DRC, where he reviewed the health response and met with leaders from multiple sectors to galvanize their commitment.

WHO’s funding needs for the response are US$98 million, of which US$44 million have been received, leaving a gap of US$54 million. The funding shortfall is immediate and critical: if the funds are not received, WHO will be unable to sustain the response at the current scale…(WHO)

Cardiac MRI Safely Reduces Invasive Tx for Stable Angina

A noninvasive approach to imaging for stable angina in patients with risk factors for coronary artery disease (CAD) reduces invasive treatment without greater risk of a major cardiac event, the MR-INFORM trial showed.

A strategy of myocardial-perfusion cardiovascular MRI led to revascularization for 35.7% of patients, whereas the rate was 45.0% for those who had invasive angiography and measurement of fractional flow reserve (FFR).

Only 48.2% of the MRI group ended up with invasive angiography (compared with nearly the entire FFR group), despite a pretest likelihood for CAD of 75%, Eike Nagel, MD, of Goethe University Frankfurt, Germany, and colleagues reported online in the New England Journal of Medicine.

CARMELINA: Linagliptin Safe in Diabetes Across Age, Renal Groups

In patients with type 2 diabetes and either cardiovascular disease or impaired kidney function, the dipeptidyl peptidase 4 (DPP-4) inhibitor linagliptin demonstrated cardiovascular safety, no increased risk of hospitalization for heart failure and “reassuring” kidney safety including a reduction in albuminuria - across renal function and age groups - over 2.2 years. These findings, from the Cardiovascular and Renal Microvascular Outcome Study With Linagliptin (CARMELINA) outcome trial, showed that safety of the agent can be extended to older patients and those with worse kidney function, researchers report.

The findings were presented at the American Diabetes Association (ADA) 2019 Scientific Sessions.

New Multi-Partner Trust Fund Launched to Combat Antimicrobial Resistance Globally

Noordwijk, the Netherlands: In a major boost to combat one of the gravest risks to global health, a dedicated funding vehicle allowing partners to devote resources to accelerate global action against Antimicrobial Resistance (AMR) was unveiled at a Ministerial Conference. 

The Tripartite - a joint effort by the Food and Agriculture Organization (FAO), the World Organization for Animal Health (OIE) and the WHO, launched the AMR Multi-Partner Trust Fund, which is being supported by an initial contribution of US$5 million from the Government of the Netherlands. The AMR Trust Fund has a 5-year scope, through 2024, and aims to scale up efforts to support countries to counter the immediate threat of AMR…(WHO)

FDA Expands Approval of Treatment for Cystic Fibrosis to Include Patients Ages 6 and Older

The US FDA has expanded the indication for a combination of tezacaftor/ivacaftor tablets for treatment of pediatric patients ages 6 years and older with cystic fibrosis who have certain genetic mutations. Last year, the FDA approved the combination to treat patients ages 12 and older who had the same specific genetic mutations. The approval for children as young as 6 years old provides an important treatment option for younger patients, and also provides more context on the safety and dosing specific to this population…(FDA)

Expected Shortage of TB Tests Prompts New CDC Recommendations

The CDC issued new recommendations for tuberculosis (TB) skin testing in response to the anticipated 3- to 10-month nationwide shortage of a purified-protein derivative (PPD) tuberculin antigen approved by the US FDA for tuberculin skin tests (TSTs).

The report was published in MMWR. The CDC’s recommendations were intended to address the potential decrease in TB testing because of the shortage.

CDSCO Issues Alert for Security Risk to Certain Medtronic Insulin Pumps

Vide a notice File No: 29/Misc/03/2019-DC (100) dated July 2, 2019, the Central Drugs Standard Control Organization (CDSCO) has issued a medical device alert for some insulin pumps manufactured by Medtronic.

The MiniMed™ Paradigm™ series insulin pumps (MMT-715, MMT-712, MMT-722, MMT-754) are designed to communicate using a wireless radio frequency (RF) with other devices such as a blood glucose meter, glucose sensor transmitters and CareLink™ USB devices. Security researchers have identified potential cybersecurity vulnerabilities related to these insulin pumps.

An unauthorized person with special technical skills and equipment could potentially connect wirelessly to a nearby insulin pump to change settings and control insulin delivery.

The CDSCO has advised the following actions for Medical Directors/Health care professionals, Distributors and the Users and Staff involved in the management of patients.

  • Check to see if the model and software version of your insulin pump is affected.
  • Talk to your health care provider about a prescription to switch to a model with more cybersecurity protection.
  • Keep your insulin pump and the devices that are connected to your pump within your control at all times whenever possible.
  • Do not share your pump serial number.
  • Be attentive to pump notifications, alarms and alerts.
  • Monitor your blood glucose levels closely and act appropriately.
  • Immediately cancel any unintended boluses.
  • Connect your Medtronic insulin pump to other Medtronic devices and software only.
  • Disconnect the USB device from your computer when you are not using it to download data from your pump.

The alert comes a week after the US FDA issued a warning to patients and health care providers that certain Medtronic MiniMed insulin pumps are being recalled due to potential cybersecurity risks… (Source: CDSCO)

Malaria to be Made Notifiable Disease

Monsoons bring welcome relief from the scorching heat, but they also bring with them a host of illnesses, notably dengue, Chikungunya.

In a meeting held to review the preparedness for prevention and control of vector-borne diseases (malaria, dengue and chikungunya) in the national capital, the Union Health Minister, Dr Harsh Vardhan urged the state government and the Mayors to work towards making hospitals, schools and government buildings 'Vector-Free'.

He also suggested that Malaria should be made a notifiable disease, which was assured by the Delhi Health Minister.

In the meeting, it was also suggested that all hospitals, including the private ones, should appoint a nodal person for vector-borne diseases to ensure that the Government and private interventions and efforts to prevent/cure vector-borne diseases are in tandem. The focus should be on active case finding of cases and reduction of vectors.

What each doctor can do

  • Ask every suspected case of dengue, chikungunya or malaria to trace the mosquito breeding site in the vicinity of 50 houses.
  • Surgical strikes on all the mosquitoes in the vicinity of identified cases can make the difference.

Low Vitamin D in Early Childhood Predicts High BP in Adolescence

Deficiency or insufficient levels of vitamin D in early childhood predisposes children to greater risk of high blood pressure (BP) during later childhood and adolescence.

  • Compared to children born with adequate vitamin D levels, low vitamin D status at birth was associated with higher risk of elevated systolic BP at ages 3-18 years: OR 1.38 (95% CI, 1.01-1.87).
  • Low vitamin D status in early childhood was associated with a 1.59-fold (95% CI, 1.02-2.46) higher risk of elevated systolic BP at age 6-18 years.
  • Children with persistently low levels of vitamin D through early childhood was associated with higher risk of elevated systolic BP (OR, 2.04 [95% CI, 1.13-3.67]) at ages 3-18 years.

The prospective birth cohort study published in the journal Hypertension followed 775 children from birth to age 18 at the Boston Medical Center. Most lived in a low-income urban area, and about two-thirds were African American.

Based on their findings, the researchers suggest that screening and treatment of vitamin D deficiency with supplementation during pregnancy and early childhood may prevent or reduce high BP later in life.

Venezuela: More Than 2.8 Million People to Gain Access to Safe Drinking Water with UNICEF Support

More than 2.8 million people, including Venezuelan children, adolescents and families, will gain improved access to safe drinking water after a collaboration agreement signed between UNICEF and the Government of Venezuela.

As part of the agreement with the Ministry of Water, UNICEF will work on expanding the supply of safe drinking water through systems repair and extension, water-trucking and other alternative sources, strengthening of priority sanitation systems, and providing technical assistance and cooperation in water quality monitoring.

“Water is fundamental to families’ life and dignity. This agreement will help children and adolescents access safe water, which is critical to their survival and healthy development,” said María Cristina Perceval, UNICEF Regional Director for Latin America and the Caribbean… (UNICEF)

Most Older Adults with “Prediabetes” don't Develop Diabetes

Older adults with slightly elevated blood sugar, sometimes called “prediabetes”, usually don’t develop full-blown diabetes, a Swedish study suggests.

Researchers followed 2,575 men and women aged 60 and older without diabetes for up to 12 years. At the start of the study, 36% of the group did have higher-than-normal blood sugar levels that were still below the threshold for diabetes. Only 119 people, 13% of those who started out with elevated blood sugar, went on to develop diabetes. Another 204, or 22%, had blood sugar levels drop enough to no longer be considered prediabetic… (Reuters)

Opioids Overused in Acute Gout

Opioids were commonly given to patients as a treatment for acute gout attacks, despite the availability of other effective and appropriate therapies, a retrospective study found.

Among 456 patients who were discharged from the hospital or emergency department (ED) with a primary diagnosis of gout, 28.3% received an opioid prescription, according to Deepan S. Dalal, MD, of Brown University Warren Alpert School of Medicine in East Providence, Rhode Island, and colleagues.

While the median duration of the prescription was 8 days, one-quarter of these patients had prescriptions for 14 days or more, which exceeds gout attack’s normal expected length, the researchers reported in Arthritis Care & Research.

New Guideline for Trigeminal Neuralgia Released

All patients with trigeminal neuralgia (TN) should undergo MRI, a new guideline for diagnosing and treating this condition recommends.

The guideline, developed by a task force of the European Academy of Neurology (EAN), also recommends that neurovascular contact (NVC) should not be used to confirm a diagnosis of primary TN but to determine whether surgery is warranted. In addition, the guideline recommends carbamazepine and oxcarbazepine as first-line prophylactic treatments of TN. Highlights of the guideline were presented at the Congress of the European Academy of Neurology (EAN) 2019.


A Few Pathogens Account for Most Severe Pneumonias in African, Asian Kids

A short list of pathogens accounts for most cases of pneumonia requiring hospital admission in children without HIV infection from Africa and Asia, according to results from the PERCH study.

Researchers noted that pneumonia was most commonly due to viral pathogens (61.4%), with respiratory syncytial virus (RSV) causing the greatest number of cases (31.3%). Bacterial pathogens other than Mycobacterium tuberculosis accounted for 27.3% of cases. Other pathogens accounting for 5% or more of the etiological distribution included human rhinovirus, human metapneumovirus (HMPV) A or B, human parainfluenza virus (types 1-4 combined), Streptococcus pneumoniae, M. tuberculosis and Haemophilus  influenzae, the team reports in The Lancet.

Assam Doctors' Leaves Canceled as Japanese Encephalitis Claims 49 Lives Across State

Assam government has canceled all leaves of doctors, paramedical staff and surveillance workers in order to deal with the outbreak of encephalitis that has claimed 49 lives across the state from January till July 5.

In an order issued by the Health and Family Welfare Department, all leaves of the government medical staff in the state were canceled in order to effectively deal with the present situation of rising acute encephalitis syndrome (AES)/Japanese encephalitis (JE) cases. To deal with rising number of cases of AES and JE, the government has decided to involve the private hospitals. "Critical AES/JE patients, who are admitted in the ICUs of private hospitals/nursing homes... will be extended a monetary support of up to Rs 1 lakh," the order stated... (News 18 – PTI)

Screen All Pregnant Women for GBS Colonization to Prevent Newborn Infections

The updated recommendations from the American Academy of Pediatrics (AAP) on management of infants at risk for group B streptococcal (GBS) disease support universal antenatal microbiologic-testing of pregnant women for the detection of maternal GBS colonization so that appropriate intrapartum antibiotic prophylaxis may be administered to prevent transmission of the bacteria from mother to the newborn before or during delivery as also recommended by the American College of Obstetricians and Gynecologists (ACOG).

Published online July 8, 2019 in the journal Pediatrics, the AAP recommendations for infant care include:

  • Administering antibiotic during childbirth, when indicated and as recommended by the ACOG to protect the newborn from transmission of GBS.
  • In evaluating the risk of GBS infection in the newborn, infants born at ≥35 0/7 weeks gestation and those born at ≤34 6/7 weeks gestation should be considered separately. Infants born at 34 6/7 weeks gestation are preterm and are at highest risk for early-onset sepsis, including GBS disease.
  • Early-onset GBS infection should be diagnosed by blood or cerebrospinal fluid culture.
  • Evaluation for late-onset GBS disease, which is associated with preterm birth, should be based on clinical signs of illness.
  • The preferred antibiotic for confirmed GBS disease in infants is penicillin G, followed by ampicillin.

A healthy pregnant woman might be colonized with no evident signs and symptoms of the illness. GBS infection in infants can be potentially fatal due to complications like sepsis, meningitis or pneumonia.

Heat Stress Spike Predicted to Cost Global Economy $2.4 Trillion a Year

An increase in heat stress at work linked to climate change is set to have a massive impact on global productivity and economic losses, notably in agriculture and construction, UN labor experts said.

Highlighting that the world’s poorest countries will be worst affected, particularly in West Africa and South-East Asia, the International Labour Organization (ILO) warned that the lost output will be equivalent to 80 million full-time jobs - or 2.2% of total working hours worldwide - during 2030.

The total cost of these losses will be $2.4 trillion every year, ILO’s Working On A Warmer Planet report maintains, based on a global temperature rise of only 1.5°C by the end of this century.

“The impact of heat stress on labor productivity is a serious consequence of climate change”, said Catherine Saget, Chief of Unit in the ILO’s Research Department and one of the main authors of the report. “We can expect to see more inequality between low and high-income countries and worsening working conditions for the most vulnerable.”

In the ILO report, heat stress is defined as generally occurring at above 35°C, in places where there is high humidity. Excess heat at work is an occupational health risk and in extreme cases can lead to heatstroke, which can be fatal.

Besides agriculture and construction, other at-risk sectors include refuse collection, emergency services, transport, tourism and sports, with southern Asian and western African States suffering the biggest productivity losses, equivalent to approximately 5% of working hours by 2030… (UN)

After Bihar, Assam on Alert for Japanese Encephalitis Outbreak

Following nearly 170 deaths from acute encephalitis syndrome (AES) in just 2 months in Bihar, Assam is now on alert for a Japanese encephalitis outbreak. At least 57 people have died in the last 3 months from Japanese encephalitis and 234 positive cases have been reported in the state in this fresh outbreak.

Over the past 3 months, Assam has also seen over 50 deaths due to AES. While the state's health establishment is on the highest alert, the biggest worry is that this time, cases have been reported from 26 out of Assam's 27 districts, and many new areas have become vulnerable to the killer disease, officials said... (NDTV.)