Archive for month: May, 2024

The World Health Organization (WHO) has granted prequalification to a new dengue vaccine, TAK-003, on 10th of May this year. This marks TAK-003 as the second dengue vaccine to receive such endorsement from the WHO which is next in line to the earlier prequalification of the CYD-TDV vaccine developed by Sanofi Pasteur.

TAK-003 is a live-attenuated vaccine that was developed by the Japanese pharmaceutical company Takeda. It contains weakened versions of the four serotypes of the virus responsible for causing dengue. This innovative vaccine has been specifically recommended by the WHO for children who were of 6 to 16 years and were living in regions with a high burden of dengue and intense transmission rates. The vaccination schedule requires two doses that are administered three months apart.

Dr. Rogerio Gaspar, WHO Director for Regulation and Prequalification, emphasized the importance of this development that the prequalification of TAK-003 is an critical step in the expansion of global access to dengue vaccines, as it is now eligible for procurement by UN agencies including UNICEF and PAHO. With only two dengue vaccines to date prequalified, the research look forward to more vaccine developers coming forward for assessment which can ensure vaccines reach all communities who are in need.

The availability of TAK-003 is particularly crucial as dengue fever continues to pose a major public health challenge throughout the globe. Dengue is a vector-borne disease transmitted by the bite of an infected mosquito. This can lead to severe dengue which is a potentially lethal complication. Currently, an estimated 100 to 400 million dengue cases occur annually across the globe with 3.8 billion people living in dengue-endemic countries. These regions are predominantly located in Asia, Africa and the Americas.

The urgency for effective dengue prevention measures is elucidated by the worrisome statistics from 2023, when the WHO Region of the Americas reported 4.5 million dengue cases and 2300 deaths. Experts warn that climate change and urbanization are likely to exacerbate the spread of dengue by potentially increasing the number of cases and expanding the geographic range of the disease.

The inclusion of TAK-003 in the WHO prequalification list signifies a positive advancement in the global fight against dengue. This can enhance the widespread use of the vaccine through procurement by international agencies by ensuring broader access to this vital preventive measure. Overall, the prequalification of TAK-003 offers hope for better protection and reduced incidence of this debilitating disease.

Reference:

WHO prequalifies new dengue vaccine. (n.d.). Who.int. Retrieved May 16, 2024, from https://www.who.int/news/item/15-05-2024-who-prequalifies-new-dengue-vaccine

A recent study published in the Clinical Infectious Diseases journal highlight the complex impacts of administering azithromycin to women during labor. The randomized trial helps to understand the effects of intrapartum azithromycin on the prevalence of bacterial carriage and antibiotic resistance with significant implications for maternal and infant health.

The study included pregnant women who received either a 2g dose of azithromycin or a placebo during labor. The study analyzed the presence and antibiotic resistance of Escherichia coli (E. coli) and Klebsiella pneumoniae (K. pneumoniae) in various samples taken from both mothers and infants. These samples included rectal swabs (RS), nasopharyngeal swabs (NPS), breast milk, and recto-vaginal swabs (RVS). The bacteria were isolated using microbiological methods and their antibiotic susceptibility was tested with an E-test. The study used prevalence ratios (PR) with 95% confidence intervals (CIs) to compare outcomes between the two groups.

The key findings of this study were;

Reduction in Carriage: Infants whose mothers received azithromycin had a lower prevalence of E. coli in their rectal swabs at both six days (63.0% vs. 75.2%; PR 0.84, CI 0.75-0.95) and 28 days (52.7% vs. 70.4%; PR 0.75, CI 0.64-0.87) post-intervention.

Increase in Resistance: However, these infants showed a higher prevalence of azithromycin-resistant E. coli at both six days (13.4% vs. 3.6%; PR 3.75, CI 1.83-7.69) and 28 days (16.4% vs. 9.6%; PR 1.71, CI 1.05-2.79).

Increase in Carriage: The study found a higher prevalence of K. pneumoniae in the rectal swabs of infants in the azithromycin group at six days (49.6% vs. 37.2%; PR 1.33, CI 1.08-1.64) and 28 days (53.6% vs. 32.9%; PR 1.63, CI 1.31-2.03) post-intervention.

Increase in Resistance: There was also a notable rise in azithromycin-resistant K. pneumoniae at day 28 in the intervention group (7.3% vs. 2.1%; PR 3.49, CI 1.30-9.37).

The study found no significant differences in the other sample types (NPS, breast milk, RVS) regarding bacterial carriage and resistance. While intrapartum azithromycin effectively reduced the carriage of E. coli in infants, it also led to an increased carriage and resistance of K. pneumoniae and elevated azithromycin resistance in both bacteria. These results illuminate the need for a careful evaluation of the benefits and potential long-term impacts of using azithromycin during labor. 

Source:

Getanda, P., Jagne, I., Bognini, J. D., Camara, B., Sanyang, B., Darboe, S., Sambou, E., Barry, M., Kassibo, K., Cham, A., Mendy, H., Singateh, B. K. J., Ndure, E., Rouamba, T., Bojang, A., Bottomley, C., Howden, B. P., D’Alessandro, U., … Tinto, H. (2024). Impact of Intrapartum Azithromycin on the Carriage and Antibiotic Resistance of Escherichia coli and Klebsiella pneumoniae in Mothers and their Newborns: a sub-study of a Randomized Double-Blind Trial Conducted in The Gambia and Burkina Faso. In Clinical Infectious Diseases. Oxford University Press (OUP). https://doi.org/10.1093/cid/ciae280

Recently published study discussed in the research paper is a systematic review and meta-analysis focusing on the impact of extracorporeal carbon dioxide removal (ECCO2R) on gas exchange and respiratory settings in critically ill adults with respiratory failure. The review included a comprehensive database search for observational studies and randomized controlled trials (RCTs) targeting adult ICU patients undergoing ECCO2R. The primary outcomes assessed included changes in gas exchange and ventilator settings 24 hours after ECCO2R initiation, mortality, length of stay, ventilation days, and adverse events. A total of 49 studies encompassing 1672 patients were included in the analysis, with key findings indicating a significant decrease in PaCO2, plateau pressure, and tidal volume, as well as an increase in pH across all patient groups, with an overall 19% adverse event rate. In ARDS and lung transplant patients, the PaO2/FiO2 ratio increased significantly while ventilator settings were variable, and “higher extraction” systems were found to reduce PaCO2 and respiratory rate more efficiently. However, the available RCTs did not demonstrate a mortality benefit but did show a significantly longer ICU and hospital stay associated with ECCO2R. The review concluded that ECCO2R effectively reduces PaCO2 and acidosis, allowing for less invasive ventilation, and “higher extraction” systems may be more efficient to achieve this goal. However, as RCTs have not shown a mortality benefit but have shown an increase in adverse events, ECCO2R’s effects on clinical outcome remain unclear. The study emphasizes the need for future studies targeting patient groups that may benefit from ECCO2R and highlights potential limitations and risks associated with ECCO2R, especially in the context of adverse events.

Key Points

1. The analysis included 49 studies with 1672 patients and found that ECCO2R led to a significant decrease in PaCO2, plateau pressure, and tidal volume, as well as an increase in pH. In specific patient groups like ARDS and lung transplant patients, the PaO2/FiO2 ratio increased significantly with variable effects on ventilator settings, and “higher extraction” systems were found to reduce PaCO2 and respiratory rate more efficiently. However, the available RCTs did not demonstrate a mortality benefit, and there was a 19% adverse event rate associated with ECCO2R.

2. The review concluded that ECCO2R effectively reduces PaCO2 and acidosis, allowing for less invasive ventilation, and “higher extraction” systems may be more efficient. However, the overall effects on clinical outcomes remain unclear, and there is a need for future studies targeting patient groups that may benefit from ECCO2R while considering potential limitations and risks associated with adverse events.

Reference –

Stommel, AM., Herkner, H., Kienbacher, C.L. et al. Effects of extracorporeal CO2 removal on gas exchange and ventilator settings: a systematic review and meta-analysis. Crit Care 28, 146 (2024). https://doi.org/10.1186/s13054-024-04927-x

It’s no secret that the Mediterranean diet is good for your health. Already recommended to reduce the risks of bowel cancer, heart disease, and dementia, new research from the University of South Australia shows that the Mediterranean diet can also reduce symptoms of stress and anxiety.

Conducted in partnership with the University of the Sunshine Coast, researchers assessed the impact of a Mediterranean diet on mental health among 294 older Australians (aged 60+) finding that it reduced the severity of anxiety and stress, independent of age, gender, sleep, and BMI.

Additionally, they identified that specific elements of the diet – fruit, nuts, legumes, and a low consumption of sugar-sweetened drinks (less than 250mL per day) – reduced the severity of anxiety and stress.

Globally, anxiety is the most common mental health disorder affecting more than 301 million people. In Australia, one in four people will experience anxiety during their lifetime.

Leading dietitian and UniSA researcher Dr Evangeline Mantzioris says that the Mediterranean diet can play a significant role in improving mental health and quality of life.

“Globally, we’re facing an unprecedented ageing population, yet despite this longevity, many people continue to struggle with their health and wellbeing,” Dr Mantzioris says.

“Lifestyle behaviours, including diet quality, are gaining more attention as modifiable risk factors for poor mental health, with the Mediterranean diet endorsed for reducing chronic disease risk and supporting healthy ageing.

“In this study we showed that when older people adhered to a Mediterranean diet, their symptoms of stress and anxiety declined – and that this occurred regardless of their age, gender, BMI or how much sleep and exercise they were getting.

“It’s a big tick for the Mediterranean diet – through a relatively easy lifestyle change, people can markedly improve their stress and anxiety levels – who wouldn’t want to give it a go.”

A Mediterranean diet includes plenty of fresh fruit and vegetables, wholegrains and seeds, nuts, legumes, and olive oil. Fish and seafood should be incorporated at least twice a week, while dairy and lean proteins can be eaten daily in smaller portions. The diet encourages infrequent consumption of red meats and processed foods.

Reference:

Nutrients 2024, 16(3), 366; https://doi.org/10.3390/nu16030366

Pulmonary hypertension (PH) is a condition characterized by high blood pressure in the arteries of the lungs, which can lead to various complications, including cardiohepatic syndrome (CHS). CHS, or congestive hepatopathy, results from hepatic congestion due to PH.