Publisher Health

A pioneering study, published in Scientific Reports, found that the Parkinon’s gene PINK1 is important for the generation of dopamine-producing neurons throughout life, and is not just responsible for the premature death of these neurons The international research, led by University of Sheffield’s Neuroscience Institute, used two model systems to examine how neurons are produced throughout our lifetime Parkinson’s disease is a relentlessly progressive neurodegenerative disorder that affects around 145,000 people in the UK A gene defect linked to Parkinson’s disease may not only cause the early death of neurons, but also impair the process that generates neurons in the brain throughout our lifetime, a new study has revealed.
The international study, led by the University of Sheffield’s Neuroscience Institute, may have a significant impact on the future treatment of Parkinson’s patients who develop the illness due to PINK1 defect or similar gene defects.
The development of novel treatments and therapies to slow down disease progression, halt or reverse Parkinson’s may now focus on enhancing the generation of new dopamine-producing neurons, rather than just trying to protect these neurons from dying later.
The findings, published today (23 March 2021) in Scientific Reports, used two model systems to measure how inactivation of the PINK1 gene affects dopamine-producing neurons in the adult brain.
Dopamine-producing neurons are the most severely affected brain cells in Parkinson’s disease. It is typically thought that Parkinson’s genes, such as PINK1, cause early death of these neurons, with symptoms developing when neuron numbers fall. However, here, researchers found that a deficiency in PINK1 resulted in fewer dopamine-producing neurons being made throughout life.
Professor Oliver Bandmann, Professor of Movement Disorders Neurology at the Sheffield Institute for Translational Neuroscience (SITraN), said: “Neurogenesis is the process by which new neurons are formed in the brain. Recent evidence suggests that this process is ongoing throughout life but the relevance of this is poorly understood in neurodegenerative disorders such as Parkinson’s disease.”
“We know that mutations in the PINK1 gene cause an early onset, inherited form of Parkinson’s disease. If we can further our understanding about the impact of this genetic mutation on the dopamine-producing neurons we can develop new therapeutic approaches that aim to mitigate those effects.”

The company is preparing to apply for emergency authorization from the Food and Drug Administration. But the shot may not be needed in the United States.[Update: Federal health officials raised questions about the AstraZeneca trial results after they were announced. Read more here.]The coronavirus vaccine developed by AstraZeneca and the University of Oxford provided strong protection against Covid-19 in a large clinical trial in the United States, completely preventing the worst outcomes from the disease, according to results announced on Monday.Although no clinical trial is large enough to rule out extremely rare side effects, AstraZeneca reported that its study had turned up no serious safety issues. Government officials and public health experts expressed hope that the results would improve global confidence in the vaccine, which was shaken this month when more than a dozen countries, mostly in Europe, temporarily suspended the shot’s use over concerns about possible rare side effects.The trial, involving more than 32,000 participants, was the largest test of its kind for the shot. The AstraZeneca vaccine was 79 percent effective over all in preventing symptomatic infections, higher than observed in previous clinical trials, the company announced in a news release. The trial also showed that the vaccine offered strong protection for older people, who had not been as well represented in earlier studies.The fresh data may have arrived too late to make much difference in the United States, where the vaccine is not yet authorized and unlikely to become available before May. By then, federal officials predict, there will be enough vaccine doses for all of the nation’s adults from the three vaccines that have already been authorized.Even so, the better-than-expected results are a heartening turn for AstraZeneca’s shot, whose low cost and simple storage requirements have made it a vital piece of the drive to vaccinate the world.The results could also help ease concerns about the AstraZeneca vaccine in Europe. In an effort to boost waning public confidence, many European political leaders have gotten the injections in recent days.“The results from the U.S. trial of the Oxford-AstraZeneca vaccine give strong evidence that the vaccine is both safe and highly effective,” Matt Hancock, the British health secretary, said on Monday. “Vaccines are our way out of this, so when you get the call, get the jab.”How the Oxford-AstraZeneca Vaccine WorksAn adenovirus helps prime the immune system to fight the coronavirus.Regulators in Europe initiated a safety review of AstraZeneca’s vaccine this month after a small number of people who had recently been inoculated developed blood clots and abnormal bleeding. The trial did not turn up any sign of such problems, although some safety issues can be detected only in the real world, once a drug or vaccine has been given to millions of people.AstraZeneca said on Monday that it would continue to analyze the new data and prepare to apply in the coming weeks for emergency authorization from the Food and Drug Administration. The vaccine has already been approved in more than 70 countries, but clearance from American regulators would bolster its global reputation.Because the United States already has ample supply of vaccines from the three other manufacturers, however, F.D.A. regulators are unlikely to move on the accelerated timeline that they did with other vaccines.In November, Oxford and AstraZeneca reported that the vaccine was 70 percent effective across studies in Britain and Brazil. But those results were hard to interpret. The findings looked much different in participants who received the first dose of the vaccine at a strength that was not initially planned and then got their second dose many weeks later than originally intended. There were also relatively few older people in those trials. As a result, some public health experts and U.S. health officials viewed those studies as insufficient to tell how well the vaccine worked.“This was a very big, well-powered study that I think confirms now that this vaccine is a good vaccine,” said Dr. Anthony S. Fauci, the nation’s leading infectious-disease expert. He added that it was premature to say what the vaccine’s role would be in the United States.AstraZeneca has said it will release 30 million doses to the United States as soon as it receives authorization. Tens of millions of those doses are already ready to be shipped or close to it. U.S. officials have agreed to send four million of the doses to Canada and Mexico, in exchange for doses later in the future.Two-thirds of participants in the clinical trial were given the vaccine, with doses spaced four weeks apart, and the rest received a saline placebo. Volunteers were recruited from Chile and Peru in addition to the United States.The results announced on Monday were based on 141 Covid-19 cases that had turned up among the volunteers in the clinical trial.None of the volunteers who got the vaccine developed severe symptoms or had to be hospitalized. Five participants who were given the placebo developed severe Covid-19 by the time the interim data were analyzed, and more cases have since turned up in that group, Menelas Pangalos, an AstraZeneca executive, said at a news conference on Monday.Participants who received the vaccine in the trial had no increased risk of blood clots or related illnesses. And a specific search turned up no cases of cerebral venous sinus thrombosis — blood clots in the brain that can result in dangerous bleeding — that raised some of the most serious concerns in Europe.“Because of the slight battering the AstraZeneca vaccine has taken over the last few weeks — and particularly in the last week or two in Europe — new data showing it is safe and effective is, if you’ll excuse the phrase, a good shot in the arm,” said Michael Head, a senior research fellow in global health at the University of Southampton in Britain.The vaccine worked well across ethnicity and age groups, AstraZeneca said. And the vaccine was 80 percent effective in about 6,000 trial volunteers over age 65 — findings likely to quell concerns about insufficient clinical trial data on how well the vaccine works in older people.Even if the vaccine is not used in the United States, receiving emergency authorization from the F.D.A. — whose rigorous review process is considered the global gold standard — would be an important milestone for AstraZeneca.“The benefits of these results will mainly be for the rest of the world, where confidence in the AstraZeneca vaccine has been eroded,” said Stephen Evans, a professor of pharmacoepidemiology at the London School of Hygiene and Tropical Medicine.Although it is difficult to compare vaccines tested in different clinical trials at different points in the pandemic, the new results put AstraZeneca’s shot in the company of other leading vaccines.AstraZeneca’s vaccine can be stored for six months when refrigerated. Unlike the messenger RNA vaccines from Pfizer and Moderna, it uses an older approach similar to that of the shot from Johnson & Johnson. A delivery vehicle — a weakened version of a chimpanzee adenovirus — is used to transport coronavirus genes into human cells. That is meant to train the immune system to fight off attacks from the real coronavirus.A number of key data points that American regulators will need to scrutinize the vaccine were missing from the company’s news release.It was unclear, for example, how up to date the data are. If the analysis was conducted on data from a month or two ago, it is possible that a more current look would present a different picture of the vaccine’s effectiveness and safety. The company will provide the F.D.A. with a more comprehensive, recent set of data than what AstraZeneca disclosed on Monday.AstraZeneca’s relationship with U.S. authorities has been fraught since last year, when senior health officials believed the company was not forthright about the design of its clinical trials, its results and safety issues. That skepticism carried over to last week, when senior officials at a number of federal health agencies had grown even more suspicious.An analysis by the independent safety monitoring board helping to oversee the U.S. trial was delayed several times because the board had to ask for revised reports from those handling trial data on behalf of the company, according to a person familiar with the matter who was not authorized to discuss it publicly.It is often the case that such boards “can request new or clarifying analyses of data from the trial,” an AstraZeneca spokeswoman said. “This would enable them to ensure the robustness of their determinations.”Still, the holdup with the data again tested American officials’ trust in the company. Suspicion intensified so much last week that some government officials and vaccine experts were speculating about whether the company was sitting on its results or working to frame them in a more flattering light.In fact, the company did not yet have its results until this past weekend, Dr. Pangalos said.Sharon LaFraniere

According to federal officials, an independent panel of medical experts said the promising results announced by the company on Monday may have relied on “outdated information.”Federal health officials said early Tuesday that results from a U.S. trial of AstraZeneca’s Covid-19 vaccine may have relied on “outdated information” that “may have provided an incomplete view of the efficacy data,” casting doubt on an announcement on Monday that had been seen as good news for the British-Swedish company as well as the global vaccination drive.In a highly unusual statement released after midnight, the National Institute of Allergy and Infectious Diseases said that the data and safety monitoring board, an independent panel of medical experts under the National Institutes of Health that has been helping to oversee AstraZeneca’s U.S. trial, had notified government agencies and AstraZeneca late Monday that it was “concerned” by information the company had released that morning.The institute urged AstraZeneca to work with the monitoring board “to review the efficacy data and ensure the most accurate, up-to-date efficacy data be made public as quickly as possible.”AstraZeneca did not immediately return a request for comment early Tuesday.In a news release on Monday announcing the results of the U.S. trial, the company said that the vaccine it developed with the University of Oxford was 79 percent effective against Covid-19, higher than observed in previous trials, and completely prevented the worst outcomes from the disease. The long-anticipated results were seen as encouraging global confidence in the vaccine, which was shaken this month when more than a dozen countries, mostly in Europe, temporarily suspended the shot’s use over concerns about possible rare side effects.In recent days, the monitoring board’s analysis was delayed several times because the board had to ask for revised reports from those handling trial data on behalf of the company, according to a person familiar with the matter who was not authorized to discuss it publicly.Companies sponsoring drug or vaccine trials typically wait for the monitoring board to run analyses and conclude that the study has yielded an answer before they announce trial results. During the trial, an unblinded statistical analysis group that is walled off from the company acts as an intermediary to handle data requests and many other interactions with the monitoring board.Company executives are blinded to the results of the study until the monitoring board reports their study data back to them. The monitoring board ultimately conveyed the results of the study to AstraZeneca in a meeting over the weekend, leading to the company’s announcement Monday morning.An AstraZeneca spokeswoman, whom the company declined to name, said last week that it was “completely incorrect” that the trial data had formatting problems or had not been submitted to the monitoring board in a clean fashion.“As is often the case,” the spokeswoman said, monitoring boards “can request new or clarifying analyses of data from the trial. This would enable them to ensure the robustness of their determinations.”Dr. Eric Topol, a clinical trials expert at Scripps Research in San Diego, said it was “highly irregular” to see such a public display of friction between a monitoring board and a study sponsor, which are typically in close concordance.“I’ve never seen anything like this,” he said in an interview after the institute’s statement was released. “It’s so, so troubling.”AstraZeneca’s relationship with the U.S. authorities has been fraught since last year, when senior health officials believed the company was not being forthright about the design of its clinical trials, its results and safety issues. That skepticism carried over to last week, when senior officials at a number of federal health agencies grew suspicious about why AstraZeneca had not announced data from its U.S. study.That U.S. trial, which involved more than 32,000 participants, was the largest test of its kind for the shot. The results AstraZeneca released on Monday were from an interim look at the data after 141 Covid-19 cases had turned up among volunteers.The company did not disclose how up-to-date the data are. If the analysis was conducted on data from a month or two ago, it is possible that a more current look would present a different picture of the vaccine’s effectiveness and safety. The company has said it will provide the Food and Drug Administration with a more comprehensive, recent set of data than what it disclosed on Monday. Although no clinical trial is large enough to rule out extremely rare side effects, AstraZeneca reported that its study turned up no serious safety issues.The fresh data may have arrived too late to make much difference in the United States, where the vaccine is not yet authorized and is unlikely to become available before May. By then, federal officials predict, there will be enough vaccine doses for all of the nation’s adults from the three vaccines that have already been authorized: Pfizer-BioNTech, Moderna and Johnson & Johnson.Even so, the better-than-expected results were seen as a heartening turn for AstraZeneca’s shot, whose low cost and simple storage requirements have made it a vital piece of the drive to vaccinate the world.The results were also thought to ease concerns about the AstraZeneca vaccine in Europe. Regulators there said last week that the shot was “safe and effective,” having conducted a review after a small number of people who had recently been inoculated developed blood clots and abnormal bleeding. The U.S. trial did not turn up any sign of such problems, although some safety issues can only be detected in the real world, once a drug or vaccine has been widely used.Many millions of people have received the AstraZeneca shot worldwide, including more than 17 million in Britain and the European Union, almost all without serious side effects. In an effort to increase public confidence, many European political leaders have gotten the injections in recent days. The AstraZeneca vaccine has also been administered in the past week to leaders in South Korea, Taiwan and Thailand.AstraZeneca said on Monday that it would continue to analyze the new data and prepare to apply in the coming weeks for emergency authorization in the United States. The vaccine has already been approved in more than 70 countries, but clearance from American regulators would bolster its global reputation.The statement from the infectious disease institute comes after a series of miscues and communication blunders by AstraZeneca dating to last year that have eroded American officials’ trust in the company.Last summer, at least some top F.D.A. officials learned only from news reports that AstraZeneca had paused its Phase ⅔ vaccine trial in Britain after a participant developed neurological symptoms. Then in September, after another participant in the British study fell ill with similar symptoms, AstraZeneca halted its trials globally but failed to promptly notify the U.S. authorities.The U.S. study was ultimately paused for seven weeks last fall, in part because AstraZeneca was slow to provide the F.D.A. with evidence that the vaccine had not caused the neurological symptoms. Investigators ultimately concluded that the illnesses could not be linked to the vaccine. Still, the delay was a key reason that AstraZeneca fell so far behind the three other manufacturers whose vaccines have been granted emergency authorization in the United States.

Positive trends in pandemic statistics in the United States are easy to distrust. After all, the country went through two false dawns last year, in the late spring and then again in the late summer, when declines in case reports prefaced even darker days. Each time, the apparent good news prompted relaxations and reopenings that helped bring on the next wave.So it is no surprise that public health experts are wary about the latest flattening in the curve of the pandemic, from the steep decline in cases seen in late January and February to something like a plateau or slight decline more recently. With more contagious virus variants becoming prevalent, they fear the good news could be ending and a fourth wave might be building.That said, there are positive signs:Daily death reports, which stayed stubbornly high long after the post-holidays surge, have finally come down sharply, to levels not seen since mid-November. As of Monday, the nation had averaged 1,051 newly reported Covid deaths a day over the past week; the average had hovered around 3,000 for weeks over the winter.Some recent hot spots have made major progress — notably Los Angeles, whose mayor, Eric Garcetti, said on CBS on Sunday that he had “not felt this optimism in 12 months.” The city and surrounding county, where cases in some areas leapt 450 percent over the holidays and hospitals became so swamped that some turned away ambulances, now has a test positivity rate of about 1.9 percent, and in an important shift, new case reports have fallen among people experiencing homelessness.Vaccinations are becoming more accessible by the week, as states receive more doses and open up eligibility, in some cases to include all adult residents. The number of doses administered nationwide each day is rising, and the country surpassed President Biden’s initial goal to have administered 100 million shots on March 19, almost six weeks ahead of schedule.The question now is which will prevail: the positive effects of trends like these or the negative effects of looser behavior and the evolution of the virus into more dangerous forms?It’s still “a race between vaccinations and variants,” Dr. Ashish Jha, dean of the Brown University School of Public Health, said on Twitter. Like other experts, he cautioned: “Opening up too fast helps the variants.”Listen to ‘The Daily’: A Food Critic Loses Her Sense of SmellA Times restaurant critic is on a quest to regain a crucial ability after Covid-19.

In the fall, after Samar Khan came down with a mild case of Covid-19, she expected to recover and return to her previous energetic life in Chicago. After all, she was just 25, and healthy.But weeks later, she said, “this weird constellation of symptoms began to set in.”She had blurred vision encircled with strange halos. She had ringing in her ears, and everything began to smell like cigarettes or Lysol. One leg started to tingle, and her hands would tremble while putting on eyeliner.She also developed “really intense brain fog,” she said. Trying to concentrate on a call for her job in financial services, she felt as if she had just come out of anesthesia. And during a debate about politics with her husband, Zayd Hayani, “I didn’t remember what I was trying to say or what my stance was,” she said.By the end of the year, Ms. Khan was referred to a special clinic for Covid-related neurological symptoms at Northwestern Memorial Hospital in Chicago, which has been evaluating and counseling hundreds of people from across the country who are experiencing similar problems.Now, the clinic, which sees about 60 new patients a month, in-person and via telemedicine, has published the first study focused on long-term neurological symptoms in people who were never physically sick enough from Covid-19 to need hospitalization, including Ms. Khan.The study of 100 patients from 21 states, published on Tuesday in The Annals of Clinical and Translational Neurology, found that 85 percent of them experienced four or more neurological issues like brain fog, headaches, tingling, muscle pain and dizziness.“We are seeing people who are really highly, highly functional individuals, used to multitasking all the time and being on top of their game, but, all of a sudden, it’s really a struggle for them,” said Dr. Igor J. Koralnik, the chief of neuro-infectious diseases and global neurology at Northwestern Medicine, who oversees the clinic and is the senior author of the study.The report, in which the average patient age was 43, underscores the emerging understanding that for many people, long Covid can be worse than their initial bouts with the infection, with a stubborn and complex array of symptoms.This month, a study that analyzed electronic medical records in California found that nearly a third of the people struggling with long Covid symptoms — like shortness of breath, cough and abdominal pain — did not have any signs of illness in the first 10 days after they tested positive for the coronavirus. Surveys by patient-led groups have also found that many Covid survivors with long-term symptoms were never hospitalized for the disease.In the Northwestern study, many experienced symptoms that fluctuated or persisted for months. Most improved over time, but there was wide variation. “Some people after two months are 95 percent recovered, while some people after nine months are only 10 percent recovered,” said Dr. Koralnik. Five months after contracting the virus, patients estimated, they felt on average only 64 percent recovered.

Medical schools and students alike have had to adapt to remote cadaver dissections and bedside-manner training via Zoom.Jerrel Catlett’s eyes narrowed on the large intestine, a gloppy, glow stick-like object whose color matched the stool stored inside of it. He chose to isolate the organ, and it expanded on his screen as the body parts surrounding it receded — the gall bladder bright green with bile, the ribs white and curved like half moons.“My old boss used to tell me that when I did this, I’d be so wowed by how complex the human body is,” said Mr. Catlett, 25, a first-year student at Icahn School of Medicine at Mount Sinai, gesturing to the image of a body on his laptop screen. “But it feels like there’s something missing from the experience right now.”For generations, medical students were initiated to their training by a ritual as gory as it was awe-inducing: the cadaver dissection. Since at least the 14th century, physicians have honed their understanding of human anatomy by examining dead bodies. But amid the coronavirus pandemic, the cadaver dissection — like many hands-on aspects of the medical curriculum — turned virtual, using a three-dimensional simulation software.Of the country’s 155 medical schools, a majority transitioned at least part of their first and second-year curriculums to remote learning during the pandemic. Nearly three-quarters offered lectures virtually, according to a survey by the Association of American Medical Colleges, and 40 percent used virtual platforms to teach students how to interview patients about their symptoms and take their medical histories. Though the cadaver dissection posed a trickier challenge, nearly 30 percent of medical schools, including Mount Sinai, used online platforms to teach anatomy.Though medical students in many states have been eligible for and able to receive the vaccines, some have not yet fully shifted back to in-person learning, with school administrators saying they preferred to wait until Covid case rates decline further. Some in-person training, like practicing clinical skills, has largely resumed.Medical schools adapted in the past year with inventive approaches to clinical training. Case Western Reserve University School of Medicine and Stanford used virtual reality technology to teach anatomy. The Vagelos College of Physicians and Surgeons at Columbia University offered students the opportunity to shadow doctors virtually, sitting in on tele-medicine appointments. And at Baylor College of Medicine last fall, students were assessed via video on giving physical exams by describing what actions they would be taking in person, according to Dr. Nadia Ismail, Baylor’s associate dean of curriculum: “Now I would hit you at this part of the knee and this is the reflex I would see.”The Keck School of Medicine, at the University of Southern California, opted to have faculty members dissect cadavers while wearing body cameras so students could watch remotely. The cadavers were also imaged using three-dimensional scanners, so students could practice manipulating the sorts of images produced by magnetic resonance imaging and CT scans.“When the faculty came up with this, I was like, ‘Oh my goodness, this is amazing,’” said Dr. Donna Elliott, vice dean for medical education at Keck. “These scanned, three-dimensional images approximate the type of imaging you’ll use as a clinician.”Educators are aware that for all the promise of new technologies, there’s a sense of loss for students who aren’t able to be in hospitals, classrooms and dissection laboratories in person. “The classroom of the medical school is the clinical environment, and it’s so stretched right now,” said Lisa Howley, senior director for strategic initiatives and partnerships at the A.A.M.C. “That worries me.”Students said they felt some frustration as they watched the pressures mount on frontline providers without any capacity to help. “We know more than the average person, but we feel generally powerless,” said Saundra Albers, 28, a second-year student at Columbia.Both faculty members and students realize that watching organs move on a laptop screen is not the same as removing them, one by one, from a human body. “A cadaver’s body parts wouldn’t look as smooth and perfect as they do on a screen,” Mr. Catlett said. “Let’s say the cadaver was an alcoholic, you might see liver cirrhosis with bumps and ridges covering the liver.”He and his classmates know that they missed a medical rite of passage: “We don’t get to feel what the tissues are like, or how hard the bones are.”Mr. Catlett and his classmates have now been offered vaccines, and they are beginning to resume some in-person activities, including meeting with patients for the first time this month. Their lectures are still online.Sarah Calove, 26, near her home in Castaic, Calif. late last year.Jenna Schoenefeld for The New York TimesSarah Serrano Calove, 26, is a second-year student at the University of Massachusetts Medical School, which offered a blend of in-person and virtual learning last semester. Since the start of medical school, Ms. Calove had been eager to practice interacting with patients — taking their medical histories and delivering news of diagnoses — so the transition to learning clinical skills on Zoom was a letdown.She was assigned to interview a medical actor, referred to as a standardized patient, about his financial troubles, an emotional conversation that she found awkward to conduct virtually.“When you’re on Zoom, you can’t tell if the person is clenching their hands or shaking their legs,” she said. “For some of my classmates, the feedback was we had to show more empathy. But how am I supposed to make my empathy known through a computer screen?”Medical schools were often unable to arrange for students to practice their skills on medical actors last semester, because these actors tend to come from older, retired populations that are at heightened risk for Covid-19. Some schools, including the University of Massachusetts, had students conduct practice physical exams on their classmates, forgoing the parts of the exam that involve opening the mouth and looking into the nose.For Ms. Calove, being assessed on her physical exam skills was challenging because she could prepare only by watching videos, whereas any other year she would have had weeks of in-person practice.“Normally, you’d listen to lungs wheezing, feel an enlarged liver, find the edges of the abdominal aorta,” she said. “Listening to a heart murmur recording online is different than hearing it in person.”Still, she appreciated the school’s efforts to check in with her and her classmates about how they were faring as they adapted to partially remote learning.Some students pointed to a silver lining in their virtual medical training: They’ve become adept at speaking with patients about sensitive issues over video, a lesson very likely to prove essential as the field of tele-medicine expands. Through remote clerkships at schools like Sidney Kimmel Medical College at Thomas Jefferson University, medical students assisted hospital staff by following up virtually with patients who had been discharged earlier than usual because of the pandemic.“Other doctors got thrown into the deep end but we get to practice using this technology,” said Ernesto Rojas, a second-year student at University of California San Francisco School of Medicine. “We learned how to build rapport and ask the patient things like, ‘Are you in a place where you can talk privately?’”Students have also said they’ve felt particularly motivated to complete their training amid the pandemic. Medical school applications are up by 18 percent compared with this time last year, according to the A.A.M.C.For Prerana Katiyar, 22, a first-year medical student at Columbia, the first few months of medical school didn’t look anything like she had anticipated. She started the semester living in her childhood home in Fairfax, Va., where she shared lessons from her anatomy classes with her family over dinner. “When my dad said his abdomen hurt, I was able to talk to him about the quadrants of the abdomen,” Ms. Katiyar said.Halfway into the semester, she had an exciting update for her parents. “My skull finally arrived in the mail,” she said. Ms. Katiyar’s anatomy professor arranged for each student to order a plastic model of the skull.“Now I can see the bony landmarks and where the nerves are,” she continued. “I’m a very visual person so it’s been helpful to trace it with my finger.”

Tuberculosis remains a rare disease in the United States, but when it does occur, delays in diagnosing it often exceed recommendations by the World Health Organization, according to a new report by Harvard Medical School researchers published March 22 in The Lancet Infectious Diseases.
The typical, or median, delay in diagnosing an active case of TB was 24 days, according to the study, with the majority of delays ranging between 10 and 45 days. However, some delays were much longer — up to 250 days in certain cases. Unlike latent TB, in which the person who carries the TB bacterium has no symptoms and cannot infect others, people with active TB have symptoms and can transmit the infection to others.
The new analysis revealed that delayed diagnoses were linked to a higher likelihood of the infection being transmitted to household members. It also found a concerning link between delays in diagnosis and the risk for disease progression.
To minimize TB complications and prevent infection transmission, the WHO calls for initiating diagnostic workup and prompt treatment for all patients who have symptoms suggestive of active TB infection for two weeks or longer.
“The delays we found would be concerning under any circumstances, but they are unacceptable in a well-resourced health care system such as the United States,” said study senior investigator Maha Farhat, assistant professor of biomedical informatics in the Blavatnik Institute of Harvard Medical School and a pulmonary medicine physician at Massachusetts General Hospital.
While the new study was not designed to tease out the reasons behind the diagnostic delays, the researchers say one of the more likely drivers is lack of awareness among clinicians, possibly due to the rarity of TB in the United States. The classic TB presentation includes coughing up blood, fever, and night sweats, but TB can also presents with a range of symptoms that do not fit this textbook triad and can throw physicians off the scent, making prompt diagnosis challenging.

Insomnia, disrupted sleep, and daily burnout are linked to a heightened risk of not only becoming infected with coronavirus, but also having more severe disease and a longer recovery period, suggests an international study of healthcare workers, published in the online journal BMJ Nutrition Prevention & Health.
Every 1-hour increase in the amount of time spent asleep at night was associated with 12% lower odds of becoming infected with COVID-19, the findings indicate.
Disrupted/insufficient sleep and work burnout have been linked to a heightened risk of viral and bacterial infections, but it’s not clear if these are also risk factors for COVID-19, say the researchers.
To explore this further, they drew on the responses to an online survey for healthcare workers repeatedly exposed to patients with COVID-19 infection, such as those working in emergency or intensive care, and so at heightened risk of becoming infected themselves.
The survey ran from 17 July to 25 September 2020, and was open to healthcare workers in France, Germany, Italy, Spain, the UK, and the USA.
Respondents provided personal details on lifestyle, health, and use of prescription meds and dietary supplements plus information on the amount of sleep they got at night and in daytime naps over the preceding year; any sleep problems; burnout from work; and workplace exposure to COVID-19 infection.

Infliximab, a powerful biologic that is used to treat inflammatory bowel disease (IBD), blunts the body’s immune response to COVID-19 infection, indicates research published online in the journal Gut.
This impaired response may boost susceptibility to recurrent COVID-19 and help drive the evolution of new variants of SARS-CoV-2, the virus responsible for the infection, warn the researchers.
Careful monitoring of IBD patients treated with infliximab will be needed after vaccination against COVD-19 to ensure they mount a strong enough antibody response to ward off the infection, they advise.
Infliximab belongs to a class of medicines called anti-tumour necrosis factor (anti-TNF) drugs. These drugs suppress the production of an inflammatory protein involved in the development of several conditions, including ulcerative colitis and Crohn’s disease which are types of inflammatory bowel disease.
Around 2 million people worldwide are treated with anti-TNF drugs, which are known to impair protective immunity following vaccination against pneumonia, flu, and viral hepatitis, as well as increasing the risk of serious infection, particularly respiratory infections.
Because of these risks, patients taking these drugs have been advised to shield during the coronavirus pandemic and/or take extra precautions to minimise their risk of catching COVID-19.

Almost 90 percent of infectious travelers could be detected with rapid SARS-CoV-2 tests at the airport, and most imported infections could be prevented with a combination of pre-travel testing and a five-day post-travel quarantine that would only lift with a negative test result, according to a computer simulation by UC San Francisco researchers.
The study offers much-needed data to airlines and states that have struggled through a year of the pandemic with little guidance on how to enable safe travel.
The issue is becoming more pressing as states reopen and travelers return to the skies. Data from the Transportation Security Administration show that air travel has been on the rise since the 2020-2021 holiday season, although it is still only one-third to one-half of what it was before the pandemic.
“This evidence could be useful to standardize testing and quarantine policy for COVID-19 at the airline, city and state level for travelers,” said Nathan Lo, MD, PhD, a resident physician and incoming faculty fellow in infectious diseases at UCSF and senior author of the paper, which was published March 22, 2021, in The Lancet Infectious Diseases. “Nothing will be perfectly safe, and travel will always pose a risk to the individual and for importation to states, but this is a way to substantially minimize the risk.”
The data in the study come from a large-scale computer simulation of how different combinations of testing and quarantine can prevent infectious travelers from spreading COVID-19. The model makes forecasts based on what is already known about how many people are likely to be infected on any given day, how long they are likely to be infectious and how likely different types of tests are to detect infectious people.
The study simulated the probability that 100,000 travelers would be infectious on any given day shortly before, during and after their trips, given a range of different pre-travel testing and post-travel quarantine-plus-testing strategies.