Month: September 2023

Sep 05

Weight loss drug semaglutide linked to better heart health, but high costs may limit its impact

Semaglutide, a weight loss drug recently linked to key cardiovascular benefits for obese and overweight patients, may have a limited impact due to its significant price tag. At least, that’s the perspective of Airfinity, a disease forecasting company that uses predictive health data to anticipate how certain developments could impact the market at large. Back in August, Novo Nordisk, which sells subcutaneous treatments of semaglutide 2.4 mg under the brand name Wegovy, shared initial findings from the SELECT trial that suggested the medication could help obese and overweight patients reduce their risk of a major adverse cardiovascular event (MACE) by up to 20%. Weeks later, researchers at ESC Congress 2023, the annual meeting of the European Society of Cardiology, presented research on semaglutide’s potential to improve outcomes among certain heart failure patients. The team at Airfinity focused on those early SELECT trial results, estimating that 63 patients would need to be treated with semaglutide over a three-year period to prevent one heart attack, stroke or cardiovascular death. Because the current Wegovy price tag is $1,350 per month, researchers wrote that the cost of treating those 63 patients would be approximately $1.1 million—and that’s even after considerable rebates were included.

Sep 05

Renin Angiotensin Inhibitors Reduce Thrombotic Adverse Effects in Chronic Myeloproliferative Neoplasms

Patients with essential thrombocythemia and polycythemia vera (PV) who also had arterial hypertension experienced a higher cumulative incidence of thrombotic adverse effects (AEs) compared with those without hypertension and fewer thrombotic complications following treatment with renin‑angiotensin system (RAS) inhibitors, according to findings from a retrospective study published in Annals of Hematology. In the overall cohort of patients with myeloproliferative neoplasms (MPNs; n = 404), treatment with RAS inhibitors conferred a protective effect from thrombotic AEs (HR, 0.46; 95% CI, 0.21-0.98; P = .04), including those with a thrombotic high-risk score (n = 272; HR, 0.49; 95% CI, 0.24-1.01; P = .04). Moreover, patients with essential thrombocythemia and a thrombotic high-risk score experienced an especially defined benefit following treatment with RAS inhibitors (HR, 0.27; 95% CI, 0.07-1.01; P = .03). “The main goal of managing MPNs is to prevent thrombotic incidents,” study authors wrote. “The results indicated that patients [with MPNs] had a significantly higher risk [4.9-fold] of arterial thrombosis than the healthy controls. We found a protective association between the use of RAS inhibitors and the reduction in thrombotic AEs in our cohort of patients [with MPNs].” To conduct their study, investigators collected data from patients diagnosed with PV or essential thrombocythemia by WHO 2016 classification who were treated at the Hematology Unit of the Businco Hospital in Cagliari, Italy, from November 2000 through August 2021. Patients with PV were stratified by low risk of developing thrombosis (age < 60 years and no history of thrombosis) and high risk of developing thrombosis (age ≥ 60 years or a history of thrombosis). Patients with essential thrombocythemia were stratified by International Prognostic Score for Essential Thrombocythemia score, cardiovascular risk factors, age over 60 years, thrombosis history, and the presence of a JAK2 V617F mutation. Study authors also collected clinical data at the time of diagnosis, including constitutional symptom, performance status, hemoglobin, white blood cell counts, and the presence of somatic driver gene mutations among other data. Patients had PV (n = 133) or essential thrombocythemia (n = 271). The median age at diagnosis was 63 years (range, 17-98) and the median follow-up was 5.5 years (range, 0-24) in the overall population. Most patients had comorbidities at diagnosis (70%) and a high thrombotic risk score (67.3%). Cardiovascular AEs experienced before (66.3%) MPN diagnosis included ischemic heart disease (7.7%), peripheral arterial disease (3.5%), cerebrovascular event (6.9%), atrial fibrillation (6.2%), deep vein thrombosis (4.7%), and other (4.2%); after diagnosis, thrombotic AEs (15.0%) that occurred were ischemic heart disease (3.5%), peripheral arterial disease (2.9%), cerebrovascular event (3.7%), and deep vein thrombosis (4.4%). Advertisement Most patients also had a positive mutational status (89.3%), including mutations in JAK2 V617F (78.5%), calreticulin (8.9%), and MPL (1.5%); 48.2% of patients also had essential thrombocythemia JAK2 V617F positivity. The therapies received for MPNs were low-dose aspirin (72.3%), phlebotomy (30.0%), cytoreduction therapy (62.9%), and IFN-2a (0.2%). Median values were 10.5 × 103 /μL (range, 1.0-96.1) for leukocytes, 15.0 g/dL (range, 7.0–15.0) for hemoglobin, and 696 × 103/μL (range, 87–2320) for platelets. Median hematocrit was 48% (range, 29.0%-77.0%). Investigators noted that “there was a significant difference in the JAK2 V617F mutation status within the group of patients [with essential thrombocythemia] with hypertension (27% vs 21.2%, P = .01).” Most patients in the study had hypertension (53.7%) and in this subgroup, patients had PV (n = 78/217) and essential thrombocythemia (n = 139/217). Those with positive mutational status (n = 197/217) had JAK2 V617F (n = 182/217), calreticulin (n = 12/217), MPL (n = 3/217), and essential thrombocythemia– positive JAK2 V617F (n = 109/217) mutations. Median values were 10.9 × 103/μL (range, 1.09-19.2) for leukocytes, 15.2 g/dL (range, 10.4-21.0) for hemoglobin, and 720 × 103/μL (139–1170) for platelets. Median hematocrit was 47.6% (range, 33.1%-69.0%). The majority of patients with hypertension had cardiovascular AEs before being diagnosed with an MPN (n = 216/217) including ischemic heart disease (n = 20/217), peripheral arterial disease (n = 7/217), cerebrovascular event (n = 19/217), atrial fibrillation (n = 15/217), deep vein thrombosis (n = 11/217), and other (n = 9/217); after diagnosis, 39 patients experienced thrombotic AEs; these included ischemic heart disease (n = 10/217), peripheral arterial disease (n = 6/217), cerebrovascular event (n = 12/217), and deep vein thrombosis (n = 11/217). Additionally, patients with hypertension underwent prior hypertension therapy with a RAS inhibitor (n = 147/217) including angiotensin receptors blockers (n = 87/217), angiotensin-converting enzyme inhibitors (n = 59/217), and inhibitors without association (n = 116/217). Calcium antagonists were given to 52 patients and other agents including thiazide diuretics, beta-blockers, and doxazosin were given to 101 patients. Patients with hypertension also received treatment with low-dose aspirin (148/217), phlebotomy (70/217), cytoreduction therapy (159/217) and IFN-2a (1/217) as therapy for their MPN. Additional findings showed that the cumulative incidence of thrombotic AEs over 15 years was significantly higher among patients with hypertension (66.8% ± 10.3%) compared with those without (38.5% ± 8.4%; HR, 1.83; 95% CI, 1.08-3.1). Findings from a multivariate analysis also revealed that hypertension (HR, 1.8; 95% CI, 0.983-3.550; P = .05) and PV diagnosis (HR, 3.5; 95% CI, 1.928-6.451; P < .001) were both associated with an increased risk of developing thrombotic AEs. Considering only patients with MPNs and hypertension, diagnosis of PV displayed a predictive role in developing thrombotic AEs (HR, 4.4; 95% CI, 1.92-10.09; P < .01). “In conclusion, to improve the treatment of patients with MPNs, it is crucial to pay close attention to their cardiovascular risk factors, as these factors play a significant role in the complications of the disease. A more targeted approach could provide more effective and personalized care for patients with MPNs. Although the study’s retrospective nature poses limitations, the robust connections between the RAS system and hematological disorders make it crucial to conduct a more comprehensive analysis of the effects of RAS inhibitors on MPNs,” investigators wrote in summary. Reference Mulas O, Mola B, Costa A, et al. Renin-angiotensin inhibitors reduce thrombotic complications in essential thrombocythemia and polycythemia vera patients with arterial hypertension. Ann Hematol. Published

Sep 05

Kumbh Mela: Antibiotics and the world’s biggest gathering in India

Getty Images By Soutik Biswas India correspondent What does the biggest gathering of humanity on Earth have to do with antibiotics? Quite a bit, evidently. Researchers from US-based institutes, supported by Lakshmi Mittal and Family South Asia Institute at Harvard University and Unicef, have found that clinics at India’s Kumbh Mela, a Hindu festival and the world’s largest religious gathering, have prescribed an excessive amount of antibiotics to the tens of thousands of pilgrims, primarily arriving with respiratory tract infections. The more antibiotics are used, the higher the risk of developing what doctors refer to as “antimicrobial resistance”. This occurs when bacteria change over time and become resistant to drugs designed to combat and treat infections they cause. Consequently, doctors face a surge in antibiotic-resistant “superbug infections”. India facing a pandemic of resistant superbugs The World Health Organisation (WHO) says this poses a major “global threat” to public health. Such resistance directly caused 1.27 million deaths worldwide in 2019, according to The Lancet, a medical journal. The toll is projected to rise to 10 million deaths per year by 2050, says the WHO. Antibiotics – which are considered to be the first line of defence against severe infections – did not work on most of these cases. India has the highest rate of human antibiotic use in the world. Antibiotic-resistant neonatal infections alone are responsible for the deaths of nearly 60,000 newborns each year. Researchers say use of antibiotics was exacerbated during the Covid-19 pandemic. Getty Images The weeks-long Kumbh Mela occurs in four Indian cities. The pilgrims take a holy dip in the river waters on the banks of the cities where the festival is held. The US-based researchers gathered data from some 70,000 patients who turned up at more than 40 clinics at two editions of the festival in 2013 and 2015 held in the cities of Prayagraj – also known as Allahabad – and Nashik. More than 100 million pilgrims attended the two festivals. In Prayagraj in 2013, the patients had a median age of 46 years and most of them were men. Their common symptoms included fever, cough, runny nose, muscle pain, and diarrhoea. Concerns over superbug among India Covid patients Researchers found that more than a third of patients at the clinics were prescribed antibiotics. In Prayagraj, nearly 69% of the patients reporting upper respiratory tract infections received antibiotics at the free state-run clinics at the festival site. “This is an alarmingly high rate, given that the vast majority of upper respiratory tract infections are viral in nature,” the researchers say in a recently published paper. Getty Images Researchers found that entering a clinic at the Kumbh Mela for any reason carried a one-in-three likelihood of walking out with a prescription for antibiotics. If you sought help for a runny nose, the probability increased to two in three. “When antibiotics were prescribed, there appeared to be little rhyme or reason to guide their selection,” the researchers said. Their findings align with earlier estimates of antibiotic prescription rates in India, which typically range from 39% to 66% in outpatient settings. The researchers conceded that doctors at the Kumbh Mela’s crowded clinics faced significant challenges, including high patient volumes, limited time and a lack of comprehensive patient diagnostic information. Drug-resistant infections killing millions – study Each clinic sees hundreds of patients a day, doctor-patient encounters are cursory and patients expect to be prescribed medicines for their aliments. Doctors spent less than three minutes on average with each patient, “often prescribing antibiotics without examining the patient”. The choice and dosage of antibiotics “appeared arbitrary”. Official protocols allowed a three-day supply of antibiotics along with a recommendation for a follow-up visit. However, researchers observed that, with a few exceptions, the vast majority of pilgrims only made a day trip to the festival and returned home. Getty Images The researchers have recommended a number of measures to cut back prescription of antibiotics in the upcoming festivals. They say that most people who turn up at the clinics do not need the attention of a physician. So, they recommend that mid-level health providers, medical students and community health workers identify patients and implement triage. Fewer patients would reduce fatigue among the doctors. The clinics should be beefed up with adequate diagnostics such as laboratory or radiology services. Lack of diagnostics, they believe, could lead to over-prescription of antibiotics. Also, doctors needed to be educated more in antibiotic use and the policy of providing a three-day antibiotic dose should be re-examined. “Public health preparedness and response seems to be marked by a string of missed opportunities,” said Satchit Balsari, one of the researchers and an assistant professor of emergency medicine at Harvard Medical School. India HIV patients in ‘drugs shortage’ pain The 2013 festival in Prayagraj was one of the first mass gatherings to have cloud-based near real time disease surveillance. The Nashik edition in 2015 replaced paper-based records with digital tablets, laying the foundation for continuous epidemiological surveillance. “In both instances, there was little institutional memory that could either expand the intervention to all primary clinics, or even leverage it during the [coronavirus] pandemic,” Prof Balsari told me. He said the 2025 festival in Prayagraj could lay the foundation for functional digital health infrastructure that does three simple tasks – identify the diseases in the city based on clinical, laboratory and drug utilisation and sewage data. Experts believe India needs to strengthen regulations around prescribing antibiotics. – and the world’s largest gathering of humanity would be a good starting point. BBC News India is now on YouTube. Click here to subscribe and watch our documentaries, explainers and features. Read more India stories from the BBC: ‘Wrong number’ couple fight India deportation India’s Moon lander and rover put in ‘sleep mode’ Long wait for justice after India cough syrup deaths The new generation taking over from Asia’s richest man India launches its first mission to observe the Sun ‘Any story could be your last’ – India’s Kashmir press crackdown Related Topics

Sep 05

Blood Brothers

| Magazine Feature | By Yosef Herz | September 5, 2023 The Renewal movement celebrates 1,000 Jews who’ve gone under the knife to save a life Photos: Langsam Photography, Naftoli Goldgrab Early Morning Action ATfour thirty-two a.m. on a crisp Monday morning, the parking lot at the 7-Eleven convenience store located just off Route 9 in Old Bridge, New Jersey, is just starting to show signs of a new day’s activity after a long night. An elderly man walks out of the store, breakfast in hand, and nods gently to the fellow entering. Drivers park abruptly, make their hurried purchases, and then get back on the road. There are no exuberant greetings here, no loud phone calls; the customers seem to obey the unwritten rule of thou shall not disturb the peace so long as it lasts. One midsize SUV in the parking lot, though, stands in proud defiance. Its speakers are humming with incessant ringing, audible even to those outside. The rule-breaking SUV’s driver, Rabbi Moshe Gewirtz, serves as the director of Renewal, the trailblazing organization that facilitates kidney transplants within the frum community, and the 7-Eleven is an almost daily early morning stop for him. It’s a 20-minute drive from his Marlboro, New Jersey, home and on the way to all the area’s major hospitals. Most importantly, the store is conveniently situated just 30 minutes from the frum enclave of Lakewood — making it the perfect spot for him to meet kidney donors who need a ride to the hospital, chauffeured to the 7-Eleven by a volunteer for Renewal, where Moshe awaits and takes them the rest of the way. Today’s surgery, taking place in the Hackensack University Medical Center, a world-class hospital located a stone’s throw from Manhattan, is a milestone for the Renewal team — it’s the organization’s 1,000th lifesaving procedure. I join Moshe in his car so I can shadow him for the day and get a front-seat view how one Yid literally gives the gift of life to another. At four thirty-five a.m., we’re back on the road, Waze set to Hackensack’s transplant unit, and two steaming cups of exceptionally strong brewed coffee ensconced in each of the cup holders. But aside from the java, there are no hints of the wee hour. Moshe’s phone is constantly dinging with notifications and calls coming in from members of Renewal’s team. A text message comes in from a coordinator to confirm tomorrow’s surgery appointments; he takes a call from Rabbi Menachem Friedman, the director of Renewal national, who is arranging rides for patients and family members to the various hospitals; Mendy Reiner, chairman of Renewal, is checking in on the status of today’s transplant; and Rabbi Josh Strum, Renewal’s director of outreach, wants to touch base about getting their army of volunteers proper instructions on where to deliver Renewal’s famous care packages. In between the calls, Moshe finds a few minutes to share some of his background with me. The journey to his position as Renewal’s director started off with his own kidney donation. He had been working as a kiruv rabbi for the Monmouth Torah Links organization when he was first exposed to Renewal’s lifesaving activities. “I arrived at a routine doctor’s appointment in Lakewood with several minutes to spare before the appointment,” he remembers, “and I saw some people gathered around a sign that said ‘Renewal Event.’ I was vaguely familiar with the organization and decided to listen in on what they were talking about. “Two doctors were presenting on the concept of kidney donation, and I remember hearing them say that when someone donates a kidney, their health is uncompromised while for the recipient — the one in need of a kidney, it’s literally a new lease on life. They described it as replacing a broken car part with a brand new one — and one that will im yirtzeh Hashem last him many years.” Intrigued, Moshe filled out the paperwork, had his cheek swabbed by the Renewal volunteer, and left to see his doctor. Sometime later, he was notified that he was actually a match, and subsequently donated his kidney to a young Jewish mother who was suffering from renal failure. “I remember sitting in the hospital bed,” he says, “and my coordinator handed me thank you letters from my recipient’s family. I was too worn out to read them, but one of them stuck out.” It was a letter written in big, childish scrawl containing a simple message: Thank you for saving my Mommy’s life, now she can be alive at my bar mitzvah next year. Thank you, Dovid, age 12 The next year Moshe attended 13-year-old Dovid’s bar mitzvah. Over time, Moshe became an active member of Renewal’s “donor circle,” volunteering and speaking for the organization along with other past kidney donors, and when Renewal was looking to expand its team, the organization reached out to the young, dynamic rabbi. Together with Chana Greenfeld, he served for the past three years as a donor coordinator, helping ensure a smooth, pampering process for donors, and last year was tapped to serve as the organization’s director. Yet even as his responsibilities within the organization grew, Moshe never gave up his donor coordination position, something typical of Renewal staff members, who feel privileged to be on site in the hospital, stewarding donor and recipient through what can be a daunting monthslong process, culminating in the day of the transplant. As if to prove the point, our conversation is interrupted by a call that visibly excites Moshe — it’s this morning’s kidney donor. “Reb Moshe!” the donor exclaims, “we’re here at the hospital. Where should we go?” “Sit tight,” Moshe says. “I have to make sure you’re cleared to go in.” He quickly dials the recipient’s wife, explaining that he has to ensure that the donor and recipient do not see each other before the surgery. “It’s very intense to see the person who will be cut open to save you,” Moshe says,

Sep 05

Blood shortages spur ICTC, NHS to lead drive charge

#inform-video-player-1 .inform-embed { margin-top: 10px; margin-bottom: 20px; } #inform-video-player-2 .inform-embed { margin-top: 10px; margin-bottom: 20px; } September is National Sickle Cell Awareness Month, and a blood transfusion is the treatment most relied upon by those who suffer from the disease. The first blood drive of the fall semester at the Indian Capital Technology Center, occurred Sept. 5. The event happens on the campus four times a year. “We do them four times a year,” said Andrea McElmurry, health careers instructor at ICTC and coordinator of the drive. “We aim for 100 units each drive. Some drives are bigger, some are smaller. Usually, the fall drive is a good one for us because the students are getting back to school.” According to the American Red Cross, a single-car accident victim can potentially require up to 100 units of blood. The most common blood needed is Type O. “Our biggest need is always O, because O negative is that universal donor, and that’s always a big need, so anytime someone comes in with that type, we really like it,” McElmurry said. Oklahoma Blood Institute supplies all of the blood to local community hospitals. “We wanted to use [OBI] because it goes right back into our community,” said McElmurry. Blood drives occur at many Cherokee County locations. One is planned for Sept. 19 at Northeastern Health System, in the Human Resources building at 201 Terrace Circle, from 1:30-5:30 p.m. “There is a big blood shortage,” said Lacie Newman, education director at NHS. “OBI told us they are down to a two-day supply.” Those wanting to donate at the NHS event can go on www.obi.org and make an appointment, and walk-ins are welcome as well, said Newman. NHS holds a blood drive every month. On odd months, it is a one-day event, and on even months, the event takes place over two days. Individuals who donate one unit can only donate every 56 days, and those who do a double unit donation must wait 112 days. The next NHS drive after the September event, is Oct. 30-31. The times are 1:15-5 p.m. on Oct. 30, and from 9:30 a.m.-1:15 p.m. on Oct. 31. Prizes of a glow in the dark T-shirt and a pass to the Oklahoma City Zoo will be given out at the NHS Sept. 19 event. Aside from donating at a mobile unit or hospital, OBI encourages individuals to be a blood donation advocate for friends, coworkers and family. Starting a conversation with individuals in a person’s circle of acquaintances can overcome one of the most common reasons people don’t donate, which is nobody asked them to donate. Talking to your workplace leadership and sharing the importance of hosting a blood drive can start the wheels rolling on a plan to host a blood drive. Ronnie Jones, a long-time donor, waited for his turn to contribute at the ICTC drive. Jones is on the list of people who gets called whenever a drive is scheduled. “It’s a good feeling to possibly help somebody stay alive in an injury,” said Jones. Low iron is the most common reason a person could not donate, said McElmurry. “There are some [other] things when they [are screened] that could cause a person not to be able to donate, such as taking certain medications,” said McElmurry. McElmurry encourages people to come in and be screened to determine whether they meet the criteria for giving blood. Hooked up to a centrifuge machine, Blaine Howe, a student who plans to graduate in 2025, gave two units. “This is my first [time to give blood] in a while,” said Howe. Sophisticated machines extract components of a donor’s blood to treat patients battling diseases such as sickle cell, leukemia, and other diseases. Statistics from the American Cancer Society states that many patients sometimes need blood daily during chemotherapy treatments. A person can choose to give one or two units. Someone who donates a single unit of blood produces one pint of blood product. For those who are connected to the centrifuge machine, they give a double donation. “What they are able to do is take the person’s blood out and it goes through the machine,” said McElmurry. “The red blood cells are removed for OBI, and the [person] gets their plasma back, so they are able to donate twice as much of the usable red blood cell product.” Emmanuel Hewett is studying long-term health care. He had two reasons for giving blood, and the Oklahoma heat played into his second reason. Hewett is on the cross-country team. “Well, it can save like three lives. And I won’t lie, I kind of don’t want to run after school today, so this will get me out of that,” said Hewett. According to OBI, someone in the U.S. requires a blood transfusion every two seconds. The American Red Cross breaks it down further, stating that 29,000 units of red blood cells are required every day. #inform-video-player-3 .inform-embed { margin-top: 10px; margin-bottom: 20px; }

Sep 05

The Inner Circle Acknowledges, Dr. Nirat Beohar as a Pinnacle Life Member for his contributions to the fields of Interventional Cardiology and Medical Education

MIAMI SHORES, Fla., Sept. 5, 2023 /PRNewswire/ — Prominently featured in The Inner Circle, Dr. Nirat Beohar is acknowledged as a Pinnacle Life Member for his contributions to the fields of Interventional Cardiology and Medical Education. Dr. Beohar pursued higher education at the Maulana Azad Medical College in 1990 where he earned a Medical Degree. He relocated to the United States and attended Baylor College of Medicine where he completed a residency in Internal Medicine in 1994 and was a visiting fellow at the Laboratory of Molecular Cardiology at the National Heart, Lung, and Blood Institute. He then attended George Washington University where he finished his fellowship in cardiovascular disease in 1998 and concluded a second fellowship in Interventional Cardiology at the Feinberg Medical School in 1999. The doctor holds multiple board certifications from the American Board of Internal Medicine (ABIM) in Cardiovascular Disease; Interventional Cardiology; Nuclear Cardiology; CT Angiography; and Internal Medicine and notes that ABIM is a physician-led non-profit independent evaluation organization driven by doctors who want to achieve higher standards for better care in a rapidly changing world. He explained that cardiology is a branch of medicine that deals with the disorders of the heart, as well as some parts of the circulatory system. The field includes medical diagnosis and treatment of congenital heart defects, coronary artery disease, heart failure, valvular heart disease, and electrophysiology. He notes that cardiologists are doctors who diagnose, assess, and treat patients with diseases and defects of the heart and blood vessels (the cardiovascular system). A Fellow of the American College of Cardiology (FACC), Dr. Beohar asserts that he has devoted his career to the use and development of catheter-based therapies for the treatment of heart disease. He currently serves in many leadership positions including Vice Chief of the Columbia University Division of Cardiology at Mount Sinai Medical Center; Director of the hospital’s Cardiac Catheterization Lab; Medical Director of the hospital’s Structural Heart Disease Program; Director of the hospital’s Interventional Cardiology Fellowship Program; and a Professor at Columbia University Medical Center. The doctor is an expert in many specialties including implanting catheter-delivered heart aortic valves; treating complex coronary conditions, such as left main and multi-vessel disease as well as chronic total occlusions; and devices to close atrial septal defects; PFOs; and other intracardiac shunts. Dr. Beohar implants left ventricular assist devices such as the Tandem heart and Impella for patients in cardiogenic shock and is skilled in transseptal catheterization, a highly specialized technique used to access the left side of the heart to treat structural heart disease. He has also had experience with percutaneous therapies for peripheral vascular disease. Prior to his current posts, Dr. Beohar worked at Mount Sinai-Columbia; was an interventional cardiologist at Northwestern Memorial Hospital in Chicago; an Associate Professor of Medicine at Northwestern University’s Feinberg School of Medicine; and the Director of the Cardiac Catheterization Laboratory at the Veterans Administration Lakeside Hospital in Chicago. Dr. Beohar’s illustrious career has been punctuated by many awards and honors including the Top Doctor Award by Coral Gables Magazine in 2019. He is also highly sought after for his lectures to fellows and also assists with medical education in India. He would like to dedicate this honor in loving memory of his parents, Prakash C. and Sushma Beohar, and his mentors, Robert Bonow, MD, and Charles J. Davidson, MD. Contact: Katherine Green516-825-5634[email protected] View original content to download multimedia:https://www.prnewswire.com/news-releases/the-inner-circle-acknowledges-dr-nirat-beohar-as-a-pinnacle-life-member-for-his-contributions-to-the-fields-of-interventional-cardiology-and-medical-education-301918305.html SOURCE The Inner Circle

Sep 05

One in three men infected with genital HPV globally, claims study

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Sep 05

Mohs Surgery Improves Outcomes Over WLE for Merkel Cell Carcinoma

A study on overall survival after Mohs micrographic surgery (MMS) for early-stage Merkel cell carcinoma (MCC) found MMS was associated with significant improvement compared with survival in patients who underwent conventional wide local excision (WLE). This national retrospective cohort study was published in JAMA Dermatology. The authors limited their analysis to Tumor 1/Tumor 2 (T1/T2) MCC because these tumors are more amenable to any surgical approach. “For those with localized disease, it is generally accepted that surgery is the most effective definitive treatment option,” they explained. “However, there is some controversy as to the optimal surgical approach for these cases.” MCC is a rare type of skin cancer with a propensity to rapidly metastasize to regional lymph nodes, in which current National Comprehensive Cancer Network guidelines recommend sentinel lymph node biopsy. This study compared the use of MMS with WLE to assess overall survival in patients with localized MCC with pathologically confirmed negative lymph nodes. Doctor screening a patient for skin cancer. The study included data from the National Cancer Database (NCDB) in adults with T1/T2 MCC who were diagnosed from January 1, 2004, to December 31, 2018, who had been treated with surgery. A total of 22,610 patients were identified. Patients were excluded if they had positive lymph node disease, were missing data on clinical lymph node status, had clinically negative distant metastatic disease, were not treated with surgical excision, without T1/T2 disease, and did not have confirmed pathologically negative lymph node(s). Furthermore, patients were excluded if they had other nonkeratinocyte malignant neoplasms or were diagnosed after 2019 because of a lack of survival data on these patients. Advertisement After exclusion, 2313 patients were met all inclusion criteria. The mean (SD) age of patients was 71 (10.6) years, with 1340 (57.9%) of them men. The statistical analysis showed excision with MMS had the best unadjusted survival, with mean (SE) survival rates of 87.4% (3.4%) at 3 years, 84.5% (3.9%) at 5-years, and 81.8% (4.6%) at 10 years compared with WLE, which had mean (SE) survival rates of 86.1% (0.9%) at 3 years, 76.9% (1.2%) at 5-years, and 60.9% (2%) at 10 years. Additionally, similar results were observed in patients who received narrow-margin excision, with mean (SE) survival rates of 84.8% (1.4%) at 3 years, 78.3% (1.7%) at 5 years, and 60.8% (3.6%) at 10 years. Multivariable survival analysis showed excision with MMS was associated with significant improved survival outcomes compared with WLE (hazard ratio [HR], 0.59; 95% CI, 0.36-0.97; P = .014). Furthermore, high-volume MCC centers were significantly more likely to use MMS over WLE compared with other centers (odds ratio [OR], 1.99; 95% CI, 1.63-2.44; P < .001) However, the researchers acknowledged some limitations to the study, such as being unable to collect data on locoregional recurrence of disease specific survival, the analysis was not controlled for patient immunosuppression status, and the MSS group had much fewer patients than in the WLE group. Furthermore, the researchers believe that further studies need to be done, given the lack of randomization and potential for selection bias. “These data suggest that MMS may provide a survival benefit in the treatment of localized MCC, although further prospective work studying this issue is required,” wrote the researchers. “Future directions may also focus on elucidating the benefit of adjuvant radiotherapy in localized cases treated with MMS.” Despite these limitations, the study shows the use of MMS may be a better treatment option for patients with early-stage MCC with pathologically confirmed negative regional lymph node disease, compared with WLE. Reference Cheraghlou S, Doudican NA, Criscito MC, Stevenson ML, Carucci JA. Overall survival after Mohs surgery for early-stage Merkel cell carcinoma. JAMA Dermatology. Published online August 23, 2023. doi:10.1001/jamadermatol.2023.2822

Sep 05

Lab data suggests new COVID booster will protect against worrisome variant

Enlarge this image Lab data suggests the new COVID-19 booster shots should protect against a variant that concerns scientists. The boosters should be widely available this fall at pharmacies, like the one seen in the Flatbush neighborhood of Brooklyn borough in New York City. Michael M. Santiago/Getty Images Michael M. Santiago/Getty Images Scientists have produced the first data indicating that a variant that has raised alarm is unlikely to pose a big new COVID-19 threat. Four preliminary laboratory studies released over the weekend found that antibodies from previous infections and vaccinations appear capable of neutralizing the variant, known as BA.2.86. “It is reassuring,” says Dr. Dan Barouch, who conducted one of the studies at the Beth Israel Deaconess Medical Center in Boston. When it was first spotted, BA.2.86 set off alarm bells. It contains more than 30 mutations on the spike protein the virus uses to infect cells. That’s a level of mutation on par with the original Omicron variant, which caused a massive surge. The concern was BA.2.86, while still rare, could sneak around the immunity people had built up and cause another huge, deadly wave. “When something heavily mutated comes out of nowhere … there’s this risk that it’s dramatically different and that it changes the nature of the pandemic,” says Benjamin Murrell, who conducted one of the other studies at the Karolinska Institute in Sweden. But Murrell and Barouch’s experiments, along with similar studies conducted by Yunlong Richard Cao at Peking University in China and by Dr. David Ho at Columbia University in New York, indicate BA.2.86, is unlikely to be another game-changer. “For BA.2.86 the initial antibody neutralization results suggest that history is not repeating itself here,” Murrell says. “Its degree of antibody evasion is quite similar to recently circulating variants. It seems unlikely that this will be a seismic shift for the pandemic.” The studies indicate that BA.2.86 doesn’t look like it’s any better than any of the other variants at evading the immune system. In fact, it appears to be even be less adept at escaping from antibodies than other variants. And may also be less efficient at infecting cells. “BA.2.86 actually poses either similar or less of an immune escape risk compared with currently circulating variants, not more,” Barouch says. “So that is good news. It does bode well for the vaccine.” The Food and Drug Administration is expected to approve new vaccines soon that target a more recent omicron subvariant than the original shots. And the Centers for Disease Control and Prevention would then recommend who should get them. While that subvariant, XBB.1.5, has already been replaced by others, it’s a close enough match for the new shots to protect people, scientists say. “I wish the booster was already out,” says Dr. Peter Hotez of the Baylor College of Medicine, noting that yet another wave of infections has already begun increasing the number of people catching the virus and getting so sick that they’re ending up in the hospital and dying. “We need it now.”

Sep 05

Ask A Vet: Do Purebred Dogs Need More Insurance Than Mixed Breeds? (2023)

Q: Are Purebred or Mixed-Breed Dogs Healthier? A: “While any breed of pet can become ill, some purebred dogs are closely inbred and can have a greater risk of developing genetic diseases or congenital issues that come from inbreeding,” said Dr. Liff. While every pet’s health is unique, purebred dogs have less genetic diversity than mixed-breed dogs and are generally at a higher risk for genetic or inherited medical conditions. Mixed-breed dogs have a more diverse genetic pool, so if one dog has a health issue, the chances are higher it will disappear in the next generation. Responsible breeders can reduce the risk of some of the more prevalent genetic diseases by doing specific disease testing before breeding a dog, but not all breeders invest the time and money to do this. Only buy from reputable breeders who test for common genetic diseases to ensure your puppy is healthy. Q: What Health Problems Do Purebred Dogs Have? A: Purebred dogs are at a higher risk for a variety of hereditary and congenital conditions. “Some examples are that Cavalier King Charles spaniels have a higher risk of heart disease, as do boxers, Great Danes and Doberman pinschers,” said Dr. Liff. “Doberman pinschers also often have a blood clotting disorder called Von Willebrand’s disease. Purebred poodles can have increased prevalence of epilepsy and Addison’s disease.” Hereditary conditions are genetically inherited, and may not appear until later life. Congenital defects develop while the pet is still in utero, and while these conditions are present at birth, they may not be apparent without a veterinary exam. Common hereditary conditions — Hip and elbow dysplasia, heart disease, epilepsy and certain eye conditions Common congenital conditions — Heart defects, liver abnormalities and cleft palate Q: Are Purebred or Mixed-Breed Dogs More Expensive To Own? A: Owning any pet is a big financial commitment. While the cost of owning a dog varies, popular breeds, such as French bulldogs, are expensive to purchase and are more prone to certain genetic disorders, which can increase their healthcare costs. Breed-related conditions can range from mild to severe and may require costly lifelong medical management (i.e., medication, rehabilitation or weight management) or surgical correction. Q: Are Purebred Dogs More Expensive To Insure? A: While breed is factored into the cost of coverage, pet insurance premiums are based on multiple other factors. “Insurance is typically based on the pet’s age, breed and size and the location in which you are seeking insurance, so it may not be as price sensitive by breed,” said Dr. Liff. “For example, a 100-pound, mixed-breed dog living in New York City would cost more to insure than a Havanese living in Cleveland, Ohio.” Q: Which Insurance Plans Are Best for Purebred Dogs? A: Dr. Liff recommends that all pets have accident and illness coverage with an 80% to 90% reimbursement rate and a minimum annual coverage limit of $25,000, whether they’re purebred or not. Additional wellness coverage can often save you money on preventive care, which can help keep your purebred dog healthy. When investigating pet insurance plans for your purebred dog, research hereditary or congenital conditions common to your pet’s breed, consider their health history and review each policy carefully to ensure your dog is well-protected. Q: Which Insurance Plans Are Best for Mixed-Breed Dogs? A: While mixed-breed dogs have a lower risk for genetic or inherited medical conditions, quality veterinary care, especially for unexpected illnesses and injuries, is expensive. The right pet insurance plan can cut the cost of all your mixed-breed dog’s health needs, from routine veterinary services to emergency care. Coverage and plan options — as well as cost — can vary widely depending on the provider and the specific policy, so it’s important to spend time researching your options to help you find the best pet insurance plan for your mixed-breed dog. Q: What Tips Do You Have For Owners of Purebred Dogs? A: “All pets — regardless of breed — need regular veterinary care to stay healthy,” said Dr. Liff. She advises following your veterinarian’s recommendations regarding your pet’s preventive care and annual diagnostics to monitor your pet’s health and identify problems before they become more serious. She also recommends keeping your pet up-to-date on their vaccinations and parasite screenings, and administering year-round flea, tick and heartworm preventives to protect your pet. Q: What Tips Do You Have for Owners of Mixed-Breed Dogs? A: Many pet insurance providers cover pets as young as 8 weeks old, so purchase pet insurance for your mixed-breed dog when they are young and healthy. Most pet insurance plans do not cover pre-existing conditions, and purchasing coverage for your young pet means your plan will likely cover future health conditions. Regardless of whether you bring a purebred or mixed-breed dog into your home and heart, you want to ensure they live a long, healthy life by your side. Purchasing a health insurance policy can help you provide for their medical needs, from routine to unexpected, so they stay in excellent health.