Publisher Health

Individuals living with Type 1 diabetes must carefully follow prescribed insulin regimens every day, receiving injections of the hormone via syringe, insulin pump or some other device. And without viable long-term treatments, this course of treatment is a lifelong sentence.
Pancreatic islets control insulin production when blood sugar levels change, and in Type 1 diabetes, the body’s immune system attacks and destroys such insulin-producing cells. Islet transplantation has emerged over the past few decades as a potential cure for Type 1 diabetes. With healthy transplanted islets, Type 1 diabetes patients may no longer need insulin injections, but transplantation efforts have faced setbacks as the immune system continues to eventually reject new islets. Current immunosuppressive drugs offer inadequate protection for transplanted cells and tissues and are plagued by undesirable side effects.
Now a team of researchers at Northwestern University has discovered a technique to help make immunomodulation more effective. The method uses nanocarriers to re-engineer the commonly used immunosuppressant rapamycin. Using these rapamycin-loaded nanocarriers, the researchers generated a new form of immunosuppression capable of targeting specific cells related to the transplant without suppressing wider immune responses.
The paper was published today (Jan. 17), in the journal Nature Nanotechnology. The Northwestern team is led by Evan Scott, the Kay Davis Professor and an associate professor of biomedical engineering at Northwestern’s McCormick School of Engineering and microbiology-immunology at Northwestern University Feinberg School of Medicine, and Guillermo Ameer, the Daniel Hale Williams Professor of Biomedical Engineering at McCormick and Surgery at Feinberg. Ameer also serves as the director of the Center for Advanced Regenerative Engineering (CARE).
Specifying the body’s attack
Ameer has been working on improving the outcomes of islet transplantation by providing islets with an engineered environment, using biomaterials to optimize their survival and function. However, problems associated with traditional systemic immunosuppression remain a barrier to the clinical management of patients and must also be addressed to truly have an impact on their care, said Ameer.

Dementia in a person in their 30s, 40s or 50s poses special challenges, starting with getting a diagnosis.Many people aren’t overly concerned when an octogenarian occasionally forgets the best route to a favorite store, can’t remember a friend’s name or dents the car while trying to parallel park on a crowded city street. Even healthy brains work less efficiently with age, and memory, sensory perceptions and physical abilities become less reliable.But what if the person is not in their 80s but in their 30s, 40s or 50s and forgets the way home from their own street corner? That’s far more concerning. While most of the 5.3 million Americans who are living with Alzheimer’s disease or other forms of dementia are over 65, some 200,000 are younger than 65 and develop serious memory and thinking problems far earlier in life than expected.“Young-onset dementia is a particularly disheartening diagnosis because it affects individuals in the prime years,” Dr. David S. Knopman, a neurologist at the Mayo Clinic in Rochester, Minn., wrote in a July 2021 editorial in JAMA Neurology. Many of the afflicted are in their 40s and 50s, midcareer, hardly ready to retire and perhaps still raising a family.Dementia in a younger adult is especially traumatic and challenging for families to acknowledge, and many practicing physicians fail to recognize it or even suspect it may be an underlying cause of symptoms.“Complaints about brain fog in young patients are very common and are mostly benign,” Dr. Knopman told me. “It’s hard to know when they’re not attributable to stress, depression or anxiety or the result of normal aging. Even neurologists infrequently see patients with young-onset dementia.”Yet recent studies indicate that the problem is far more common than most doctors realize. Worldwide, as many as 3.9 million people younger than 65 may be affected, a Dutch analysis of 74 studies indicated. The study, published in JAMA Neurology in September, found that for every 100,000 people aged 30 to 64, 119 had early dementia. The accompanying editorial by Dr. Knopman called young-onset dementia “an underappreciated problem.” Its diagnosis, Dr. Knopman wrote, is often delayed, and knowledge about its management is “in short supply as well.”The various causes of early-onset dementiaThe Dutch study found that overall, Alzheimer’s disease was the most common cause of young-onset dementia. But when symptoms developed before age 50, early-onset Alzheimer’s was a less likely explanation than two other causes: vascular dementia and frontotemporal dementia.Vascular dementia results from a blockage or injury to blood vessels in the brain that interfere with circulation and deprive the brain of oxygen and nutrients. Its most common symptoms, in addition to memory problems, are confusion, difficulty concentrating, trouble organizing thoughts or tasks, and slowed thinking.In frontotemporal dementia, portions of the brain that lie behind the forehead and ears shrink, resulting in dramatic personality changes, socially inappropriate or impulsive behavior and emotional indifference. Movement and memory problems typically develop later in the course of the disease. According to the Mayo Clinic, frontotemporal dementia often begins between the ages of 40 and 65 and may be misdiagnosed as a psychiatric problem.Lewy body disease is another cause of dementia in younger adults. It is associated with abnormal deposits of a protein called alpha-synuclein in the brain that affects brain chemistry and leads to behavioral, thought and movement problems. Most of the symptoms are similar to those seen in other dementias, and additional symptoms like hallucinations may resemble schizophrenia, but the decline in brain function occurs significantly faster. A distinguishing symptom of Lewy body dementia is having violent dreams and attempting to act them out, Dr. Knopman said.Alzheimer’s disease remains the most common cause of dementia in younger as well as older adults. There is an inherited form of Alzheimer’s that typically arises at younger ages, but those cases account for fewer than 10 percent of young-onset disease. Most cases of Alzheimer’s occur sporadically, for unknown reasons, though genetic factors may increase risk.People with Alzheimer’s typically have a buildup of abnormal substances — tau and beta-amyloid proteins — in the brain. Early symptoms include impaired memory, language problems, difficulty concentrating and finishing tasks, poor judgment and visual or spatial deficits that result in problems like driving errors and getting lost. Brain scans may show a loss of brain cells and an impaired ability to metabolize glucose that is indicative of degenerative brain disease.Probably the most publicized factor known to increase the risk of early dementia is repeated head injuries like those experienced by professional boxers, football and soccer players, and sometimes by military veterans.Once brain cells are injured or lost, there’s no going back. So preventing head injuries is the best possible protection at the moment. Many parents these days try to discourage youngsters from playing sports like football, in which repeated head injuries are common. However, proper and consistent use of helmets and not heading the ball in soccer can limit their risk of head injuries. Dr. Knopman said he’s less concerned with elementary school children playing such sports; the risk of developing dementia at a young age from repeated head trauma is much greater among those who played Division 1 football or became professional boxers.Among older adults in general, the same inflammatory factors associated with atherosclerosis, the clogging and hardening of the arteries that nourish the heart, can also afflict blood vessels that feed the brain. Body-wide inflammation linked to diabetes and heart disease can cause brain changes that promote dementia.Diagnosis of early-onset dementiaAccurately diagnosing young-onset dementia can be difficult and time-consuming and should start with a detailed medical history, Dr. Knopman said. “If doctors don’t ask the right questions, families may fail to mention a telltale symptom like violent dreams.”A thorough cognitive assessment of the person’s memory and language difficulties is critical, he said. Does the person stumble over words or say “white” when he means “black”? Neuropsychological tests can detect subtle difficulties with memory, visual, cognitive and executive functions.A brain scan is needed to rule out the possibility that a tumor is causing the person’s cognitive symptoms. A spinal tap and analysis of the spinal fluid can reveal elevated levels of tau and beta-amyloid proteins in the brain. An M.R.I. can depict shrinkage in specific parts of the brain. And a glucose PET scan can uncover abnormal patterns of sugar uptake in various parts of the brain that can help distinguish between Alzheimer’s disease, Lewy body dementia and frontotemporal dementia. “Different degenerative brain diseases have specific patterns of glucose uptake,” Dr. Knopman said.As with older dementia patients, it’s essential to keep young people with dementia safe. They should no longer drive, operate dangerous equipment, including the stove, or be left alone. All should wear an identifying tag day and night that alerts others to their condition.

Disrupting circadian rhythms, which change naturally on a 24-hour cycle, has been implicated in heart disease, but it is unclear how it leads to the condition. A research team at Baylor College of Medicine and collaborating institutions investigated the function of the protein Rev-erbα/β, a key component of the circadian clock, on heart disease development in animal models and human patients.
The team reports in the journal Circulation that Rev-erbα/β in cardiomyocytes mediates a normal metabolic rhythm that enables the cells to prefer lipids as a source of energy during the animal’s resting time, daytime for mice. Removing Rev-erbα/β disrupts this rhythm, reduces the cardiomyocytes’ ability to use lipids in the resting time and leads to progressive dilated cardiomyopathy and lethal heart failure.
“We studied how the Rev-erbα/β gene influenced the metabolism of the heart by knocking it out specifically in mouse cardiomyocytes,” said co-corresponding author Dr. Zheng Sun, associate professor of medicine, section of endocrinology, diabetes and metabolism and of molecular and cellular biology at Baylor. “Lacking the gene resulted in progressive heart damage that led to heart failure.”
To learn how Rev-erbα/β mediated its effects, the team analyzed gene and protein expression and a comprehensive panel of metabolites and lipids, during both the awake and sleep hours. They found that the Rev-erbα/β gene is highly expressed only during the sleep hours, and its activity is associated with fat and sugar metabolisms.
“The heart responds differently to different sources of energy, depending on the time of the day,” explains co-corresponding author Dr. Lilei Zhang, assistant professor of molecular and human genetics and of molecular physiology and biophysics at Baylor. “In the resting phase, which for humans is at night and for mice in the day, the heart uses fatty acids that are released from fats as the main source of energy. In the active phase, which is during the day for people and at night for mice, the heart has some resistance to dietary carbohydrates. We found that without Rev-erbα/β, hearts have metabolic defects that limit the use of fatty acids when resting, and there is overuse of sugar in the active phase.”
“We suspected that when Rev-erbα/β knockout hearts cannot burn fatty acids efficiently in the resting phase, then they don’t have enough energy to beat. That energy deficiency would probably lead to changes in the heart that resulted in progressive dilated cardiomyopathy,” said Sun, a member of Dan L Duncan Comprehensive Cancer Center.

The Omicron coronavirus variant is moving much faster than researchers can, worsening a longstanding problem: The agency must make tough decisions with scant data.The Centers for Disease Control and Prevention was long revered for its methodical and meticulous scientific approach. Agencies in other nations modeled themselves after the world’s most highly regarded public health authority, even adopting the name.At the outset of the pandemic, the C.D.C. moved at its accustomed pace. But this time, with a novel virus moving so quickly, the country paid a price: Testing and surveillance lagged as the agency tried to implement dated approaches with creaky infrastructure. Officials were late to recommend masking, in part because federal scientists took too long to recognize that the virus was airborne.Now the contagious Omicron variant is pushing the C.D.C. into uncharted territory. Because decisions must be made at a breakneck pace, the agency has issued recommendations based on what once would have been considered insufficient evidence, amid growing public concern about how these guidelines affect the economy and education.The agency’s director, Dr. Rochelle P. Walensky, has sometimes skipped much of the traditional scientific review process, most recently in shortening the isolation period for infected Americans.After the Trump administration’s pattern of interference, President Biden came to office promising to restore the C.D.C.’s reputation for independence and rigorous science. The challenge now for Dr. Walensky is figuring out how to convey this message to the public: The science is incomplete, and this is our best advice for now.For a bureaucracy staffed primarily by medical professionals, the change has not been easy.In recent interviews, some officials at the C.D.C. privately described the decisions as demoralizing, and worried about Dr. Walensky’s increasing reliance on a small group of advisers and what they saw as the White House’s heavy political influence on her actions.Yet others outside the agency commended Dr. Walensky for short-circuiting a laborious process and taking a pragmatic approach to managing a national emergency, saying she was right to move ahead even when the data was unclear and agency researchers remained unsure.There are policy considerations in a pandemic that are “not the sole purview of C.D.C.,” said Dr. Richard E. Besser, who served as interim chief of the agency during the H1N1 influenza virus outbreak of 2009. But, he added, “I think we need some more clarity” when policy and economics drive agency recommendations.As of Sunday, more than 800,000 Americans on average are infected daily, according to data gathered by The New York Times. Many schools and businesses are struggling to remain open; hospitals in nearly two dozen states are nearing capacity.At the end of December, Dr. Walensky announced that infected Americans would need to isolate for only five days, not 10, if they were no longer experiencing symptoms, and that a negative test result would not be required to end the isolation period.Critics complained that the virus might spread as contagious people were allowed to return to offices and schools. Many pointed out that the research supporting a shortened isolation period for Omicron infections was scant.But the recommendation had an important advantage: It could help keep hospitals, businesses and schools afloat through the worst of the Omicron surge.The recommendations for isolation are “basically correct,” said Dr. Thomas R. Frieden, who led the agency under President Barack Obama. “The problem is, they were not explained.”Dr. Walensky and the C.D.C. declined requests for comment on new tensions in the agency’s decision-making. But the director has frequently cited rapidly evolving science as justification for recommendations that proved to be confusing or unpopular.Testifying before the Senate on Tuesday, Dr. Walensky said that the agency’s new recommendations for shortened isolation periods represent “swift science-based action to address the very real possibility of staffing shortages.”It is has been something of a mantra for the director.Last March, the C.D.C. said that schoolchildren could safely sit three feet apart in classrooms, instead of six feet, although there was virtually no research to back up the recommendation. But the move did make it easier for administrators to consider opening schools.In May, Dr. Walensky cited scientific data when she told vaccinated people that they could take off their masks and mingle freely, much to the consternation of experts who said that the move ignored the possibility of breakthrough infections. (Those arrived with the Delta variant.)In August, Dr. Walensky joined President Biden in supporting booster shots for all Americans, well before scientists at the Food and Drug Administration or at her own agency had a chance to review the data on whether they were needed.The most recent example, the isolation advice, left turmoil within the agency over the way in which it was established and announced.On the Sunday night after Christmas, Dr. Walensky called an emergency meeting of the agency’s Covid response leaders. She told them the agency would shrink the recommended isolation period and would drop a negative test result as a requirement for leaving isolation, according to an official familiar with the video call who spoke on condition of anonymity because the individual was not authorized to speak on the matter.The new guidance would be made public the next day, Dr. Walensky said, and officials were not to discuss it until then.National Guard members helped staff a virus testing site in Columbus, Ohio, on Thursday.Maddie McGarvey for The New York TimesStunned, the scientists scrambled to gather the limited data to support the recommendations and to rewrite the hundreds of pages on the agency’s website that touch on quarantine and isolation.Before publishing a new recommendation, federal researchers normally pore over data, write a draft and fine-tune it based on comments from others. There was so little evidence for shortened isolation — and even that was based mostly on the Delta variant — that the “science brief” that typically accompanies guidance was downgraded to a “rationale” document.Some researchers bristled at being left out of the decision-making process and were enraged by the agency’s public statement the next day that the change was “motivated by science.”While some believed the new five-day cutoff was arbitrary, they also knew of data suggesting that rapid tests might miss some Omicron infections, and so mostly agreed with Dr. Walensky’s decision not to require a negative test result before ending isolation.But when Dr. Walensky informed staff of the new recommendations in the emergency meeting on Dec. 26, they were far from ready. Over the next week, C.D.C. scientists struggled to adjust hundreds of guidance documents on the agency’s website.About 2,000 health officials, public health lab directors and epidemiologists at the state and city levels join a weekly call with C.D.C. officials.On the call on Monday, Dec. 27, just hours before the C.D.C. released its statement, state and local officials peppered agency scientists with questions about the plans for isolation guidance for the general public.The Coronavirus Pandemic: Key Things to KnowCard 1 of 4The latest Covid data in the U.S.

SharecloseShare pageCopy linkAbout sharingImage source, Getty ImagesNo woman in the world can have their period using just two disposable sanitary pads. A typical pack of eight is hardly enough, yet in Nigeria a sachet, or small plastic pouch, containing two pads are now being widely sold as an affordable option.In richer countries, the sachet may be considered a convenient, portable alternative, but in Nigeria it is seen as something more concerning.The appearance of the sanitary pads in these small packs was “mind-boggling”, according to women’s health activist Dr Chioma Nwakanma. They do not represent convenience but rather a more difficult choice as some women are no longer able to afford to cover their whole period.”Even when it was an eight-pack it was sometimes not enough, so now people buy the sachet and start picking what day to use it,” Dr Nwakanma told the BBC.”The options of what else to use – tissues and rags – are unsanitary and terribly unhygienic so it’s unimaginable what’s going on.” The proliferation of these sachets of essential goods and processed food items in Nigeria tells a story about what has happened to the cost of living.With annual inflation peaking at 18% in March last year, and food inflation reaching 23%, this rise in the cost of living has created what is being termed by some as a “sachet economy”.In addition to sanitary pads, everything from baby food to cooking oil to breakfast cereal can now be bought in smaller portions, which are more affordable as the dramatic price increases have outstripped wage rises.”I used to buy things in cartons so they last longer. Now I’ve started to buy whatever sachet is cheapest,” said Chika Adetoye, who is worried about being able to afford enough food for her three children.The sachet phenomenon began to be noticed towards the end of 2020 as photos were shared on social media of items that consumers believed had not been seen in small packs before, including Baileys cream liqueur.Everything eventually enters sachet here. Just hang me inside Danfo, make e complete. pic.twitter.com/l8J2bCsKLN— Tolúlọpé (@tolusaba) November 15, 2020
The BBC is not responsible for the content of external sites.View original tweet on TwitterBut as well as processed and manufactured goods, the price rises have also hit fresh produce.In the markets, stallholders say they are simply passing on the costs. They cannot remember the last time they had to pay this much to stock up.The hectic and noisy Oyingbo market in Lagos is a popular place to hunt for a bargain, but those are difficult to find now.A sack of the popular greens known as bitter leaf has doubled over the past year, stallholder Nancy Ike told the BBC.”Things are too expensive, people cannot afford it,” she said.In another sign of increasing hardship, it is now possible to buy individual slices of yam whereas once customers would only be offered the whole tuber.While doing her Christmas food shopping last month, Chioma Chukwu really noticed the difference.”Last year I came to the market with 20,000 naira ($48; £35). This year, I have 30,000″ but couldn’t buy as much, she said.Gloria Joseph-Raji, senior economist at the World Bank in Nigeria, links the high prices to recent government policies.In 2015, the country’s central bank issued a list of 41 items, including rice, margarine and tomatoes – as well as private jets and toothpicks – that would no longer be eligible for foreign exchange from official sources.The idea was to limit imports and encourage local production. Since then the authorities have expanded and modified the list, adding sugar and wheat last April.In a move to cut the smuggling that resulted, the country’s land borders were closed in 2019.”This recent high episode of inflation that we see actually started in 2019 and this was post-border closure,” Ms Joseph-Raji said.”That reduced the flow of food and other types of products that usually had come in through the borders to supplement domestic production.”‘Trade needs a boost’The borders were re-opened in December 2020 but there are still shortages.When demand exceeds supply, basic economic theory suggests that prices will rise.”Land borders are open but trade flows across the borders are still slow,” Ms Joseph-Raji said. “So whatever can be done to improve the trade flows… will contribute to driving down prices.”In the meantime the high prices are having a big impact on people’s lives. The World Bank estimates that by its measure the recent inflation pushed another seven million Nigerians into poverty. The total figure is now more than 100 million – roughly half the population.The increase in inflation may be past its peak, but it is unclear when it will fall to more manageable levels.In the meantime, the sachets will be here to stay as people try to stretch their family budgets to cover essentials from sanitary pads to vegetables.

Over half of the world’s population has received at least one dose of a Covid vaccine. Supply is still a big problem, especially in poorer countries where less than 10% of people are vaccinated. But even when vaccines are available, some remain hesitant to take them.BBC Reality Check’s health reporter Rachel Schraer answers some of your concerns – from pregnancy side effects to the speed at which vaccines were developed. Motion graphics by Jacqueline GalvinAdditional reporting by Fundanur Ozturk and Chiagozie Nwonwu

Dr. Vivek Murthy, the U.S. surgeon general, warned on Sunday that the Omicron surge of coronavirus cases had not yet peaked nationally, saying that the next few weeks would be very difficult in many parts of the country as hospitalizations and deaths rise.In an interview on CNN’s “State of the Union,” Dr. Murthy noted the “good news” of the plateaus and drops in known cases in the Northeast, especially in New York City and New Jersey.But “the challenge is that the entire country is not moving at the same pace,” he said, adding “we shouldn’t expect a national peak in the coming days.”“The next few weeks will be tough,” he said.The highly contagious Omicron variant has fueled an explosive surge of known cases, with an average of more than 800,000 new cases a day reported on Saturday, according to a New York Times database.Dr. Ashish Jha, dean of the Brown University School of Public Health, also expressed concerns that the next several weeks would overwhelm hospitals and staff. “Right now we’re at about 150,000 people in the hospital with Covid,” he said on “Fox News Sunday.” “That’s more than we’ve ever had. I expect those numbers to get substantially higher.”How cases, hospitalizations and deaths are trending in the U.S.This chart shows how three key metrics compare to the corresponding peak per capita level reached nationwide last winter.

Repeated exposure to major disasters does not make people mentally stronger, a recent study from the Texas A&M University School of Public Health found: individuals who have been repeatedly exposed to major disasters show a reduction in mental health scores.
Additionally, the research team found that the more experience the individuals had with such events, the lower their mental health was.
“We discovered the reverse of the adage ‘what does not kill you makes you stronger,'” said the study’s lead author Garett Sansom, research assistant professor in the Department of Environmental & Occupational Health at the School of Public Health.
Sansom and a team of Texas A&M researchers studied individuals from the Houston area, which is susceptible to hurricanes and flooding as well as industrial emergencies. The results of the study were published recently in the journal Natural Hazards.
From 2000 to 2020, Texas — one of the states most prone to natural disasters — experienced 33 Federal Emergency Management Agency (FEMA) declared major disasters. Many of these — hurricanes, winter weather, drought and flooding — impacted the Houston area. The area has also been impacted by emergencies such as explosions and chemical releases at nearby industrial facilities.
According to the research team, the combination of natural disasters and emergencies from industrial facilities presents a unique opportunity to observe the impacts.