Disability treatment – Philippine Cerebral Palsy http://philippinecerebralpalsy.org/ Wed, 21 Sep 2022 11:34:10 +0000 en-US hourly 1 https://wordpress.org/?v=5.9.3 https://philippinecerebralpalsy.org/wp-content/uploads/2021/11/cropped-icon-32x32.png Disability treatment – Philippine Cerebral Palsy http://philippinecerebralpalsy.org/ 32 32 Epigenetic treatment promotes spinal cord regeneration in mice https://philippinecerebralpalsy.org/epigenetic-treatment-promotes-spinal-cord-regeneration-in-mice/ Wed, 21 Sep 2022 08:16:28 +0000 https://philippinecerebralpalsy.org/epigenetic-treatment-promotes-spinal-cord-regeneration-in-mice/

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“Epigenetic therapy supports spinal cord regeneration in mice”




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Currently, spinal cord injuries have no effective treatment. Physical rehabilitation can help patients regain some mobility but, for severe cases, results are extremely limited by the inability of neurons in the spine to regenerate naturally after injury.

However, new research conducted by Professor Simone Di Giovanni and published in the journal PLOS Biology shows that weekly treatments with an epigenetic activator can promote the regrowth of sensory and motor neurons in the spinal cord when given to mice 12 weeks after severe injury.

The researchers used a small molecule called TTK21 to activate genetic programming that induces the regeneration of axons (nerve fibers) in neurons. TTK21 alters the epigenetic state of genes by activating the CBP/p300 family of co-activator proteins. The team tested the TTK21 treatment in a mouse model of severe spinal cord injury. The mice lived in an enriched environment that gave them the opportunity to be physically active, as is encouraged in human patients.

Treatment started 12 weeks after severe spinal cord injury and lasted 10 weeks. The researchers found several improvements after the TTK21 treatment compared to the control treatment. The most notable effect was greater sprouting of axons in the spinal cord. They also found that the retraction of motor axons above the point of injury stopped and the growth of sensory axons increased. These changes were likely due to the observed increase in regeneration-related gene expression.

Although the approach is still far from being tested on human patients, the researchers say their initial findings are encouraging. The next step will be to further enhance these effects and induce the regenerating axons to reconnect to the rest of the nervous system so that the animals can regain their ability to move easily.

Professor Di Giovanni commented: “This work shows that a drug called TTK21, when administered systemically once a week after chronic spinal cord injury (SCI) in animals, can promote neuronal regeneration. and an increase in synapses necessary for neuronal transmission.

“This is important because chronic spinal cord injury is an incurable condition where neural regeneration and repair fail. We are currently exploring the combination of this drug with strategies that bridge the spinal cord gap, such as biomaterials, as possible avenues to improve disability in patients with IBS.

Reference: Muller F, Virgilis FD, Kong G, et al. CBP/p300 activation promotes axon growth, sprouting, and synaptic plasticity in experimental chronic spinal cord injury with severe disability. Organic PLOS. 2022;20(9):e3001310. doi:10.1371/journal.pbio.3001310

This article was republished from the following materials. Note: Material may have been edited for length and content. For more information, please contact the quoted source.

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Epigenetic treatment improves spinal cord regeneration in mice after severe injury https://philippinecerebralpalsy.org/epigenetic-treatment-improves-spinal-cord-regeneration-in-mice-after-severe-injury/ Tue, 20 Sep 2022 20:16:08 +0000 https://philippinecerebralpalsy.org/epigenetic-treatment-improves-spinal-cord-regeneration-in-mice-after-severe-injury/

Researchers, led by Simone Di Giovanni, PhD, Chair of Restorative Neuroscience at Imperial College London, tested a small molecule called TTK21 – which alters the epigenetic state of genes by activating the CBP/p300 family of proteins co- activators – in a mouse model of severe spinal cord injury. After TTK21 treatment, gene activation resulted in greater axonal outgrowth, regenerative signaling, and synaptic plasticity than control treatment.


While spinal cord injury (SCI) currently has no effective treatment, the researchers conclude that their work “provides direct evidence that clinically appropriate pharmacological CBP/p300 activation can promote the expression of genes associated with axonal regeneration and growth in chronic SCI with severe neurological impairment.”


Di Giovanni said in a statement that TTK21 administered systemically once weekly after chronic spinal cord injury in animals “may promote neuronal regrowth and an increase in synapses necessary for neuronal transmission” and that researchers are “currently exploring combining this drug with strategies that bridge the spinal cord gap such as biomaterials as possible avenues to improve disability in patients with IBS.”


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Copyright © 2022 scienceboard.net ]]> Treatment Validation Platforms Can Reduce Care Variation and Promote Health Equity https://philippinecerebralpalsy.org/treatment-validation-platforms-can-reduce-care-variation-and-promote-health-equity/ Mon, 19 Sep 2022 15:33:02 +0000 https://philippinecerebralpalsy.org/treatment-validation-platforms-can-reduce-care-variation-and-promote-health-equity/

Quality health care should be accessible to all, but systemic inequalities are insurmountable barriers for too many people seeking to access needed care and services. The National Library of Medicine lists a wide range of dimensional factors, including social, economic, environmental, and structural disparities among and between demographic groups that negatively affect people’s living conditions, access to health care, and status. general health.

In addition to their impact on health outcomes, inequalities are costly and highly inefficient. The annual cost associated with addressing health inequities in Black, Hispanic, and Asian American communities is staggering, ranging from $54 billion to $61 billion.

The shadow of health inequalities reaches into chronic diseases, including heart disease, cancer, stroke, obstructive lung disease and diabetes. One hundred and thirty-three million Americans suffer from at least one chronic disease, which causes more than 1.7 million deaths per year. The CDC reports that chronic diseases are the primary driver of total annual health care spending of $4.1 trillion in the United States.

In addition, economic productivity suffers from the weight of inequalities in care. When calculating total expenditures – including direct costs paid by individuals, families, insurance companies and employers and indirect costs associated with work absences, lost wages and economic productivity – the cost chronic disease reaches $3.7 trillion annually, or about 19.6% of the gross domestic product of the United States.

Research by the National Heart, Lung, and Blood Institute found that differences in disease burden cut across racial/ethnic groups, socioeconomic status, and place of residence. For instance:

  • High blood pressure is recorded at higher rates in black and Hispanic adults
  • Rural populations have increased rates of death from heart disease, stroke, and chronic lower respiratory diseases compared to urban populations
  • Children from low-income families suffer from increased rates of asthma
  • Black Americans are more likely to die from asthma-related causes than Caucasian Americans

Access to quality, evidence-based health care, whether it is treatment for chronic conditions, urgent care services or a routine check-up, should be available to everyone. The problem is large-scale and urgent – ​​and without a silver bullet, solutions will have to be multifaceted and multilayered. The evolution of technology can be a key part of the solution. With the ability now to harness evidence and treatment protocols with the most desired outcomes, resources and care can be directed at scale to the populations most in need.

Optimize processing at scale

One way to address inequities is to ensure that every patient receives the most up-to-date standard of care through the use of treatment validation technology.

Treatment validation platforms can not only ensure best treatment practices, but they also enable consistent care and identify it effectively. Designed to optimize results, these platforms help providers bypass time-consuming (and often costly) trial and error methods while coordinating in real time with payers. They enable providers to intelligently and automatically compare thousands of evidence-based, nationally approved clinical trials and treatment options, while enabling payers to more quickly validate and accept treatment regimens via shared and trusted evidence-based resources. Saving time and guaranteeing the optimal treatment are imperative.

Treatment validation platforms can be used in autoimmune diseases where early diagnosis and effective treatment can help avoid later debilitating chronic effects of the disease, such as disability due to arthritis or cardiovascular complications lupus. Arthritis diagnosis and care is an area where providers, especially primary care practitioners, can implement advanced evidence-based treatment decisions, creating greater consistency in care throughout simultaneously reducing unnecessary or less effective treatments and the costs associated with them.

The majority of arthritis patients do not see their rheumatologist. Instead, they use primary care providers, such as family doctors, internists, nurse practitioners and physician assistants. The main contributor to work disability, an estimated 25.7 million adults are limited in their daily activities due to the effects of arthritis. Identified as the second leading cause of employee healthcare costs, arthritis results in 172 million missed workdays and $304 billion in lost income and medical expenses annually.

Treatment validation supports fairness

Treatment validation technology offers a way to advance equity in care. Regardless of the patient’s geography or healthcare system, these platforms provide consistent and rapid treatment validation, supporting consistent and improved outcomes while reducing overall expenses.

Treating arthritis, as well as other chronic conditions, can help level the playing field with systematic, evidence-based treatment. While it does not address societal factors that make populations more vulnerable to disease, it can ensure provider decisions align with evidence-based protocols. This can translate into providers responding to the patient’s diagnosis with appropriate and validated care. Although better treatment does not decrease the incidence of disease, it can help reduce disparities in care. It is a valuable tool and an essential step in the long journey towards equitable health for all.

Tiffany Avery, MD is Chief Medical Officer of NantHealth.

With intravenous immunoglobulin (IVIG) and subcutaneous immunoglobulin (SCIG) available for patients with chronic inflammatory demyelinating polyneuropathy (CIDP), researchers have identified a need for information to help clinicians and patients choose the optimal approach.

A recently published article in the Journal of Neurological Sciences considerations described for pharmacokinetics, administration procedures, adverse events, patient variables, and cost.

CIDP is an acquired neurological condition characterized by weakness and impaired sensory function progressing over 2 months or more, loss or reduction of deep tendon reflexes, and electrophysiological signs of peripheral nerve demyelination. Effective diagnosis and treatment early in the disease are essential to avoid irreversible disability.

IVIG is used both as a first-line treatment and as a maintenance treatment option for patients with CIDP. Other first-line treatments with proven efficacy include corticosteroids and plasmapheresis. Additionally, the FDA approved SCIG in 2018 for patients with CIDP, opening new treatment options for maintenance therapy. However, researchers have identified a need for more information on the differences between IVIG and SCIG.

The efficacy of IVIG has been established in 5 randomized placebo-controlled trials conducted between 1993 and 2008. Based on these trials, clinicians have high-quality evidence that IVIG is safe and effective for the induction and maintenance treatment of CIDP. In particular, the ICE study found that patients receiving IVIG reported significant improvements in the physical functioning, physical role, social functioning, and mental health domains of a quality of life assessment.

The efficacy and safety of SCIG as maintenance therapy was established in the Polyneuropathy and Treatment with Hizentra (PATH) study of 172 IVIG-dependent patients with CIDP. Participants were randomly assigned to receive SCIG 0.2 g/kg per week, which is 40% less than the IVIG trial, or 0.4 g/kg per week, which is 20% more than the IVIG trial , or placebo for 24 weeks.

The primary endpoint was the proportion of patients who relapsed or withdrew from the study for any reason during the 24-week treatment period. Those who relapsed during SC treatment were rescued with IVIG and arrested.

In the placebo arm, 63% of patients relapsed or withdrew from the study, compared to 39% in the low dose group and 33% in the high dose group. When only relapse was considered, 56% of placebo-treated patients relapsed over the 24-week period, compared with 33% of low-dose patients and 19% of high-dose patients.

Among patients receiving SCIG treatment, 53% reported a preference for SCIG compared to 39% of patients in the placebo group. Reasons for this preference included increased independence and fewer adverse effects (AEs). Eighteen percent of patients receiving SCIG said they preferred their previous IVIG treatment.

It is also important to consider pharmacokinetics, AE profiles, site of care, patient preference variables, and economics.

After an IVIG infusion, the concentration of immunoglobulin G (IgG) peaks within minutes and decreases approximately by half over the next 2-3 days. Following this rapid equilibration, IgG is catabolized with first-order kinetics and a half-life of 21-30 days.

It is important to note that the optimal pharmacokinetic parameters for the treatment of CIDP are unknown. Although pharmacokinetic parameters are important considerations for optimizing immunoglobulin efficacy, the authors stated that many questions remain.

The key principle of pharmacokinetics is that the dose and treatment intervals needed to achieve and maintain a given clinical response vary widely from individual to individual. Identifying these differences can help clinicians take advantage of the differences between SCIG and IVIG pharmacokinetics.

The most common IVIG-related systemic AEs are headache and nausea. Many IVIG AEs can be managed with adequate hydration and medication, such as antihistamines, acetaminophen, and corticosteroids, as well as slowing the infusion rate or switching to another IVIG preparation. Systemic AEs of SCIG are similar, although the frequency and severity of SCIG infusions are generally less than with IVIG.

Since SCIG requires no IV access, patients with difficult IV access may be good candidates for SCIG. The most common AE reported and unique to SCIG is local reactions at the infusion site, such as redness, itching or swelling.

Currently, patients with CIDP can receive immunoglobulin therapy in a hospital clinic, doctor’s office, stand-alone infusion clinic, or at home. Although IVIG is supervised by a nurse, most SCIG maintenance regimens can be administered by the patient or caregiver without the need for other medical support personnel. Patients can travel with their SCIG, eliminating the need to be near an infusion center or other facility at a fixed interval.

Surveys have also revealed that patients appreciate the convenience, autonomy and home administration associated with the SCIG. However, the weekly handling of needles and medical equipment without the help of a trained healthcare professional can be limiting for some patients, especially those with upper limb disabilities.

Finally, the authors noted that the economics of IVIG versus SCIG for CDIP are not well understood. A hypothetical cost analysis showed that the low-dose SCIG regimen resulted in a savings of $900 over the IVIG regimen ($8,248 vs. $9,131 over 3 weeks). However, when the high-dose SCIG regimen is required, the costs to the payer would almost double. These results are also consistent with results from European analyses, demonstrating that the cost of the immunoglobulin formulation is often the main driver of the overall cost of treating CIDP, according to the study.

With all of these considerations in mind, the authors emphasized the need to accommodate individual patient needs and preferences. The decision to use SCIG or IVIG should be tailored to the patient’s disease characteristics, treatment goals, and lifestyle. Although there is no “best” way to determine which route of administration is best, healthcare providers are uniquely positioned to educate patients and help them make the best decision.

REFERENCE

Allen JA, Gelinas DF, Freimer M, Runken MC and Wolfe GI. Administration of immunoglobulins for the treatment of CIDP: IVIG or SCIG? Journal of Neurological Sciences; November 9, 2019. Accessed September 13, 2022. https://www.jns-journal.com/article/S0022-510X(19)30429-0/fulltext

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Abandoning inpatient eating disorder treatment at UIHC is a failure https://philippinecerebralpalsy.org/abandoning-inpatient-eating-disorder-treatment-at-uihc-is-a-failure/ Sun, 18 Sep 2022 12:00:00 +0000 https://philippinecerebralpalsy.org/abandoning-inpatient-eating-disorder-treatment-at-uihc-is-a-failure/

Books about eating disorders are seen on a shelf in an office of the Department of Behavioral Health Services at the University of Iowa Hospitals and Clinics in Iowa City on Wednesday, Sept. 14, 2016. (Adam Wesley/The Gazette)

I have worked exclusively in the area of ​​eating disorders for over 15 years as a registered dietitian. There are issues with UICH dropping the eating disorders program to “broaden mental health needs” according to Dr Peggy Nopoulos.

With most mental illnesses, there are times when a person can do well on an outpatient basis and times when they need to be hospitalized or attend PHP to stabilize. Eating disorders as a mental illness also utilize levels of care ranging from inpatient to outpatient care. All these levels are distinct and offer different services.

UIHC is literally the only hospital in the state of Iowa to treat inpatient eating disorders. With the loss of this program, Iowans who suffer from eating disorders will not receive any type of service in their most desperate and sickest times. There are many other hospitals and clinics that deal with other mental health disorders such as depression and anxiety that a patient can visit, but not eating disorders.

Eating disorders are very complex diseases: Eating disorders have the second highest death rate of any mental health disorder, surpassed only by opioid addiction.(1) Among those struggling against anorexia; 1 in 5 deaths is by suicide.(2) There is a significantly higher risk of obsessive-compulsive disorder in people with eating disorders.(3) People with bulimia nervosa, binge eating, or any binge eaters have significantly higher rates of PTSD. than people without an eating disorder.(4) 32-39% of people with anorexia nervosa, 36-50% of people with bulimia nervosa, and 33% of people with binge eating disorder are also diagnosed with the disorder major depressive illness.(5) 48-51% of people with anorexia nervosa, 54-81% of people with bulimia nervosa, and 55-65% of people with binge eating are also diagnosed with an anxiety disorder.(6 ) Traumatized people with eating disorders show high levels of dissociative symptoms, such as the inability to remember the traumatic event.(7)

Eating disorders are associated with some of the highest levels of medical and social disability of all psychiatric disorders. (8) Closing the program when the people of Iowa need it to stay open seems very irresponsible and short-sighted of the university. I agree that the eating disorder patient has a longer length of stay than other mental health patients due to their complexity, but does he not deserve care or is he too expensive to treat and therefore consumable?

As a teaching hospital, cutting out some of the most complex mental health patients is a disservice to medical residents and students, as it diminishes the knowledge and experience they will bring to their communities once their residency ended.

It is a complete failure for the state of Iowa to eliminate the inpatient program when no other program like it exists in the state. Nowhere in the mission, vision, or core values ​​set forth by the UIHC does it say that it will meet the needs of the people of Iowa. That needs to change because Iowa taxpayer dollars help support the UIHC.

Sue Clarahan, RD, LD is a Registered Dietitian with over 40 years of experience in the dietetics field, the last 15 years working exclusively with eating disorders. Her experience includes advising clients in home, hospital and clinical settings. She was recognized as Iowa’s Registered Dietitian of the Year in 2007 and was named EDCIowa Volunteer of the Year in 2018.

1. Chesney, E., Goodwin, GM and Fazel, S. (2014). Risks of all-cause and suicide mortality in mental disorders: a meta-review. Global Psychiatry, 13(2), 153-160.

2. Papadopoulos, FC, A. Ekbom, L. Brandt and L. Ekselius. “Excess mortality, causes of death and prognostic factors in anorexia nervosa.” The British Journal of Psychiatry 194.1 (2008): 10-17.

3. Altman, SE and Shankman, SA (2009). What is the association between obsessive-compulsive disorder and eating disorders? Journal of Clinical Psychology, 29, 638-646.

4. Dansky, BS, Brewerton, TD, O’Neil, PM, & Kilpatrick, DG (1997). The National Women’s Study: Relationship Between Victimization and Post-Traumatic Stress Disorder and Bulimia Nervosa. International Journal of Eating Disorders, 21, 213-228.

Hudson, JI, Hiripi, E., Pope, HG, Jr., & Kessler, RC (2007). The prevalence and correlates of eating disorders in the replication of the National Comorbidity Survey. Biol Psychiatry, 61(3), 348-358. doi:10.1016/j.biopsych.2006.03.040

5. Hudson JI, Hiripi E, Pope HG Jr and Kessler RC. (2007). The prevalence and correlates of eating disorders in the replication of the National Comorbidity Survey. Biological Psychiatry, 61(3):348-58.

“NIH Expenditure by Category – NIH Research Portfolio Online Reporting Tools (Report).” United States National Library of Medicine. United States National Library of Medicine, July 3, 2017. Web. Jan 11, 2018.

Milos, G., Spindler, A., Buddeberg, C. and Crameri, A. (2003). Axis I and II comorbidity and treatment experiences in subjects with eating disorders. Psychother and Psychosom, 72(5), 276-285.

6. Hudson JI, Hiripi E, Pope HG Jr and Kessler RC. (2007). The prevalence and correlates of eating disorders in the replication of the National Comorbidity Survey. Biological Psychiatry, 61(3):348-58.

NIH Categorical Spending -NIH Research Portfolio Online Reporting Tools (RePORT).” US National Library of Medicine. US National Library of Medicine, July 3, 2017. Web. January 11, 2018.

Ulfvebrand, S., Birgegard, A., Norring, C., Hogdahl, L. and von Hausswolff-Juhlin, Y. (2015). Psychiatric comorbidity in women and men with eating disorders results from an extensive clinical database. Psychiatry Res, 230(2), 294-299.

7. Brewerton, TD (2004). Eating disorders, victimization and comorbidity: principles of treatment. In TD Brewerton (Ed.), Clinical Handbook of Eating Disorders: An Integrated Approach (pp. 509-545). New York: Marcel Decker.

Brewerton, TD, Dansky, BS, Kilpatrick, DG and O’Neil, PM (1999). Bulimia nervosa, PTSD and forgetfulness results from the National Women’s Study. In LM Williams & VL Banyard (Eds.), Trauma and Memory (pp. 127-138). Durham: Sage.

8.Klump KL, Bulik CK, Kaye W, Treasure J, Tyson E. Eating Disorders Academy Position paper: Eating disorders are serious mental illnesses. Int J Eat Disord. 2009 Mar;42(2):97-103. doi: 10.1002/eat.20589.

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Young woman survives brain hemorrhage caused by cancer treatment https://philippinecerebralpalsy.org/young-woman-survives-brain-hemorrhage-caused-by-cancer-treatment/ Fri, 16 Sep 2022 21:03:00 +0000 https://philippinecerebralpalsy.org/young-woman-survives-brain-hemorrhage-caused-by-cancer-treatment/

Lake Charles, LA (KPLC) – If learning she had cancer wasn’t enough, a young woman in her prime was nearly killed by the drugs used to save her.

Ali Bello thinks being in the right place at the right time saved his life. She was 23 and living her dream – a new job, good friends and having a good time – until the unthinkable happened.

“I came home one night and realized I had this headache,” Ali said.

Ali was diagnosed with leukemia, and after a week of chemo, she developed severe headaches and vomiting.

A CT scan showed bleeding in his brain.

“I had just had my chemo treatment and had thrown up in one of the bedpans and felt terrible,” she said.

“It was because of his cancer and the chemotherapy drugs he was given to try to cure his cancer,” said his neurosurgeon, Babak Jahromi, MD of Northwestern Medicine.

Rescue drugs did not reduce the pressure.

“Because the bleeding was so heavy, things happened very, very quickly. She was slipping deeper into a coma to a point where she was close to death,” Jahromi said.

Ali nearly died twice that night. Jahromi said he performed skull flap surgery faster than he had ever done before, removing a large portion of his skull to make room for his brain to swell and hopefully , recover without further damage.

Ali had to relearn how to use the left side of her body, and after several weeks she was able to resume chemo. Today, two years later, Ali is cancer free.

“I think it would be great to get my life back and be able to do things on my own and get back to my running and my boxing and all those things that I love,” Ali said.

“From someone who was near death to now being able to do laps in a pool, despite his disability, it’s just a miracle,” Jahromi said.

Ali is still recovering from his brain hemorrhage. She takes occupational therapy and physiotherapy classes and works with a personal trainer three times a week, all with the eventual goal of coming back and living on her own.

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WPATH removes age limits from transgender treatment guidelines https://philippinecerebralpalsy.org/wpath-removes-age-limits-from-transgender-treatment-guidelines/ Fri, 16 Sep 2022 19:34:54 +0000 https://philippinecerebralpalsy.org/wpath-removes-age-limits-from-transgender-treatment-guidelines/

Long-awaited global guidelines on transgender care have been scrapped, with no recommendations on age limits for treatment and surgery in adolescents, but acknowledging the complexity of caring for these adolescents amid the lack of research longitudinal study on the impact of gender transition.

The World Professional Association of Transgender Health (WPATH) released its latest Standards of Care (SOC) 8 at the opening of its annual meeting today in Montreal.

It is “the most comprehensive set of guidelines ever produced to help healthcare professionals around the world support transgender and gender-diverse adults, adolescents and children who are taking steps to live their lives of authentic way,” wrote WPATH President Walter Bouman, MD. , PhD, and WPATH President Elect Marci Bowers, MD, in a press release.

The SOC8 is the first updated guidance on the treatment of transgender people in 10 years and appears online in the International Journal of Transgender Health.

For the first time, the association has written a chapter dedicated to transgender and gender-diverse adolescents — separate from the chapter on the child.

The complexity of treating adolescents

WPATH officials said this was due to the exponential growth in adolescent referral rates, more research into adolescent gender diversity care, and the unique developmental and care issues of this age group.

Until recently, there was little information regarding the prevalence of gender diversity among adolescents. Studies of high school samples indicate much higher rates than previously thought, with reports of up to 1.2% of participants identifying as transgender and up to 2.7% or more (for example, 7% to 9%) experiencing some level of self-reporting. gender diversity, says WPATH.

The new chapter “applies to adolescents from the onset of puberty until the legal age of majority (in most cases 18)”, it specifies.

However, WPATH stopped short of recommending lowering the age at which young people can receive cross-sex hormone therapy or gender-affirming surgeries, as previously decreed in draft guidelines. This project suggested that young people could receive hormone therapy at age 14 and surgeries for a double mastectomy at age 15 and for genital reassignment at age 17.

The exception was phalloplasty – surgery to build a penis in female to male individuals – which, according to WPATH, should not be performed before the age of 18 due to its complexity.

Now, the final SOC8 emphasizes that every transgender adolescent is unique and that decisions should be made on an individual basis, with no recommendations on specific ages for any treatment. This could be interpreted in several ways.

SOC8 also acknowledges the “very rare” regret of people who transitioned to the opposite sex and then changed their minds.

“[Healthcare] Providers can consider the possibility that an adolescent may regret gender-affirming decisions made during adolescence, and that a young person may want to stop treatment and return to live in the gender role assigned at birth in the future . Providers can discuss this in a spirit of collaboration and trust with the adolescent and their parents/guardians before beginning gender-affirming medical treatments,” he says.

WPATH, further, emphasized the importance of counseling and supporting regretful patients, many of whom “expressed difficulty finding help during their detransition process and said their detransition was an isolating experience. during which they received neither sufficient nor appropriate support”.

Although it does not give a specific figure on the overall regret rate, in its chapter on surgery, WPATH estimates that 0.3% to 3.8% of transgender people regret gender-affirming surgery.

The SOC8 also acknowledges that “a pattern of unequal ratios by assigned sex has been reported in gender clinics, with patients assigned at birth beginning care 2.5 to 7.1 times more frequently” than patients assigned to a male at birth.

And WPATH states in SOC8 that another phenomenon is the growing number of adolescents seeking care who had not previously experienced or expressed gender diversity during childhood.

He goes on to quote the 2018 paper by Lisa Littman MD, MPH, now president of the Institute for Comprehensive Gender Dysphoria Research (ICGDR). Littman coined the term “rapid onset gender dysphoria (ROGD)” to describe this phenomenon; SOC8 refrains from using this phrase, but acknowledges that “for a selected subgroup of young people, sensitivity to social influence impacting gender may be an important differential to consider”.

The SOC8 recommends that before considering any medical or surgical treatment, healthcare professionals “undertake a comprehensive biopsychosocial assessment of adolescents who present with gender identity issues and seek transition-related medical/surgical care. “.

And he specifically mentions that transgender adolescents “exhibit high rates of autism spectrum disorder (ASD)/characteristics,” and notes that “other neurodevelopmental presentations and/or mental health issues may also be present (e.g., ADHD [attention-deficit/hyperactivity disorder]intellectual disability and psychotic disorders).

Who uses WPATH to guide care? It’s “a big unknown”

WPATH is an umbrella organization with branches in most Western countries, such as USPATH in the United States, EPATH in Europe, and AUSPATH and NZPATH in Australia and New Zealand.

However, it is not the only organization to publish guidance on caring for transgender people; several specialties support this patient population, including, but not limited to: pediatricians, endocrinologists, psychiatrists, psychologists and plastic surgeons.

The extent to which any medical professional or professional body follows WPATH’s advice is extremely varied.

“There is nothing that binds clinicians to the SOC, and the SOC is so broad and vague that anyone can say they follow it, but according to their own biases and interpretations,” Aaron Kimberly, a trans man and mental health clinician from the Gender Dysphoria Alliance said Medcape Medical News

In North America, some clinics practice full “informed consent” without an assessment or order on the first visit, Kimberly said, while others do full assessments.

“I think SOC should be watched. It shouldn’t just be people going rogue,” said Erica Anderson, a clinical psychologist in Berkeley, Calif., former USPATH president and former WPATH member, who is transgender herself. Medscape Medical News. “The reason there are standards of care is because hundreds of scientists have weighed in – is it perfect? ​​No. We have a long way to go. But you can’t just ignore everything we know and leave the people make their own decisions.”

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Many older people may not be getting the intensive treatment they need for their blood pressure https://philippinecerebralpalsy.org/many-older-people-may-not-be-getting-the-intensive-treatment-they-need-for-their-blood-pressure/ Fri, 16 Sep 2022 14:23:40 +0000 https://philippinecerebralpalsy.org/many-older-people-may-not-be-getting-the-intensive-treatment-they-need-for-their-blood-pressure/
(eclipse_images/E+ via Getty Images)

Less than 30% of older people who need more intensive treatment for high blood pressure actually get it, according to new research. And the problem can get worse.

Nearly half of American adults – about 116 million people – have high blood pressure, also known as hypertension. When not properly controlled, it can lead to serious health problems, including heart attack, stroke, and kidney disease.

“We are not doing well, despite strong evidence demonstrating the significant benefits of good blood pressure control in the elderly,” said Dr. Nicholas Chiu, lead study author and clinical researcher at Beth Israel. Deaconess Medical Center in Boston. “This is a major public health gap that needs to be addressed.”

Common in the elderly, high blood pressure is a leading cause of preventable death and an underestimated contributor to premature disability, according to the most recent American College Hypertension Care Guidelines. of Cardiology and the American Heart Association.

As of 2017, high blood pressure is defined by these organizations as a reading of 130 mmHg and above for systolic blood pressure, the “upper” number of a reading, or 80 and above for the diastolic measurement, or the “lower” number. “. The old definition was 140/90 and above.

For the new study, published Friday in the journal AHA Hypertension, researchers looked at a decade of national data from a sample of adults 60 and older who saw their primary care provider and had previously been diagnosed. of arterial hypertension. The research team focused on patients who underwent “appropriate antihypertensive intensification”, defined as the addition of an antihypertensive drug to their care for high blood pressure.

Based on office blood pressure measurements, treatment intensification was warranted in as many as 7,404 primary care visits captured in data from 2008 to 2018, representing up to 293 million visits nationwide. national.

To determine who had high blood pressure, the researchers used three varying blood pressure targets – those published by the ACC/AHA, the European Society of Cardiology and the American College of Physicians/American Academy of Family Physicians (ACP/ AAFP). The researchers also proposed their own overall measure that meets all three guidelines.

Appropriate intensification of medicine over the study period never exceeded 27.5%. This was by the most liberal measure, the all-inclusive test, for patients who had never taken medication for high blood pressure. By this same measure, only 15.3% of patients already on blood pressure medication had appropriate intensification.

In all three sets of published targets, the percentage of patients receiving appropriate treatment intensification decreased over the study period. More dramatically, within the ACP/AAFP goals, scaling up of appropriate treatment fell from nearly 25% of patients in 2008-2009 to around 15% in 2015-2018.

Chiu called on professional societies to use more uniform blood pressure targets. “That might provide a little more clarity” about what the best treatment strategy might be, he said.

Although the study did not address the reasons for the low numbers, lead author Dr. Kenneth Mukamal offered several theories, including doctors’ concerns that antihypertensive drugs could cause the elderly and elderly to fall. reluctance of patients to add more drugs which could have more side effects.

He also said it can be difficult for primary care providers to treat high blood pressure aggressively during a typical 15-minute visit.

“We’re trying to control not just blood pressure, but also cholesterol, diet and weight, and the documentation loads have also gotten heavier. In my own experience, it’s harder than ever to be a primary care physician,” said Mukamal, an associate professor of medicine at Beth Israel Deaconess Medical Center.

He said future studies are needed to find out what strategies will motivate healthcare professionals to better treat high blood pressure in older adults. One strategy, Mukamal said, could involve “tweaking medical record systems to automatically alert doctors to add medication when a person’s blood pressure is higher than we would like it to be.”

Dr Robert Brook, who was not involved in the new research, called it “an important study (that) highlights the remarkably high rates of treatment inertia in real-world clinical practice.”

“There is a need for innovative strategies,” said Brook, professor and director of cardiovascular disease prevention at Wayne State University in Detroit. “Growing evidence supports reducing or eliminating the mandatory role of physicians in the day-to-day management of uncomplicated hypertension. Algorithm-based care delivered by pharmacists or trained nurses or community health workers have been shown to improve blood pressure control in a variety of trials and pioneering programs.”

Patients also need to be more proactive and know their blood pressure at home and in the clinic, Brook said. “They should work with their provider and encourage them to make any necessary treatment changes to control blood pressure.”

If you have questions or comments about this American Heart Association News story, please email [email protected].

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NurOwn Treatment Shows Positive Results in Phase 2 Progressive Multiple Sclerosis Study https://philippinecerebralpalsy.org/nurown-treatment-shows-positive-results-in-phase-2-progressive-multiple-sclerosis-study/ Fri, 16 Sep 2022 11:05:13 +0000 https://philippinecerebralpalsy.org/nurown-treatment-shows-positive-results-in-phase-2-progressive-multiple-sclerosis-study/

BrainStorm Cell Therapeutics announced the peer-reviewed publication of its Phase 2 trial evaluating NurOwn (autologous mesenchymal stromal cells secreting neurotrophic factors [MSC-NTF] cells) to treat patients with progressive multiple sclerosis (MS), a disease for which a limited number of approved treatments.1.2

In total, results from the open-label, single-arm study (NCT03799718) showed clinically meaningful improvements on endpoints such as 25-foot Timed Walking Speed ​​(T25FW), 9-Hole Ankle Test (9HPT ), Multiple Sclerosis Walking Scale (MSWS), Symbol Digit Modality Test (SDMT), and Low Contrast Letter Acuity (LCLA). Improvements in NurOwn-treated patients were compared and confirmed with 48 matched controls from the Comprehensive Longitudinal Investigation of Multiple Sclerosis (CLMB) registry.

“We were delighted that early study results showed efficacy in patients with progressive MS,” said lead investigator Jeffrey Cohen, MD, director of the Mellen Center for MS Treatment and Research, Cleveland Clinic, in a press release.1 “There are both promising preliminary biological and clinical signals of a treatment effect that will require confirmation in a randomized trial.”

A total of 20 participants, aged 18 to 65, were enrolled in the Phase 2 trial, 17 of whom received the planned 3 NurOwn treatments. Eligible participants had no relapses for 6 months prior to screening, baseline Expanded Disability Status Scale (EDSS) scores were between 3.0 and 6.5, and had the ability to walk 25 feet in 60 seconds or less. After an approximately 10-week pretreatment period that included outpatient bone marrow aspiration to obtain mesenchymal cells for manufacturing, patients received intrathecal administrations of autologous MSC-NTF cells at weeks 0, 8, and 16, followed by a 12-week post-treatment. -period of observation of the treatment.

Of the 20 participants included, 2 dropped out due to adverse events related to the procedure, including feeling cold, muscle weakness and pyrexia in 1 patient and arachnoiditis in another. Two treated participants developed symptoms of low back pain and leg pain, considered serious treatment-related adverse events and consistent with a diagnosis of arachnoiditis. Both participants were treated with epidural cortisone injections and painkillers, and symptoms completely resolved in 1 participant, who then completed the third intrathecal treatment without recurrence of the IE. In the second case, the symptoms appeared only after the third intrathecal treatment and did not completely disappear.

A total of 19% (3 out of 16) of the pooled participants achieved a clinical response of 25% or greater in T25FW or 9HPT speed. In contrast, less than 5% of the matched CLIMB cohort achieved any of these predefined outcomes. Although data on MSWS was not collected by the CLIMB registry, 38% (6 out of 16) of NurOwn-treated patients showed at least a 10-point improvement from baseline in MSWS in 12 items . Additionally, 77% (10 out of 15) of patients showed at least a 3-point improvement in SDMT.

“Having this data peer-reviewed and published in the prestigious Multiple Sclerosis Journal is an important step in the evaluation of NurOwn in progressive MS,” said Chaim Lebovits, CEO of BrainStorm Cell Therapeutics, in a statement.1 “Thanks to their efforts and those of the BrainStorm team, we believe we are one step closer to providing a meaningful treatment option for people with progressive MS.”

Ongoing secondary and exploratory efficacy endpoint results showed that 47% (7 out of 15) of the treated cohort had at least 8 letter improvement in LCLA at the 1.25% contrast threshold, and 27% ( 4 of 15) had at least an 8-letter improvement at a contrast threshold of 2.5%. None of the participants with baseline EDSS scores less than 5.5 demonstrated an improvement of at least 1.0 point, while 30% (3 out of 10) of participants with baseline EDSS scores greater than 5, 5 showed an improvement of at least 0.5 points. From baseline to week 28, patients treated with MSC-NTF cells showed a median change of -0.05 feet/second in T25FW. MSWS-12 and EDSS showed no median change at the end of the treatment period.

NurOwn treatment resulted in consistent trends of increased percent change for cerebrospinal fluid neuroprotective factors such as vascular endothelial growth factor A, hepatocyte growth factor, neural cell adhesion molecule 1, follistatin, leukemia inhibitory factor, and fatuin-A, from baseline to week 16. Similarly, consistent trends for reduced percent change in inflammatory biomarkers such as monocyte chemoattractant protein-1 , soluble stromal cell-derived factor 1, osteopontin, and soluble CD27 were also observed. Neurodegenerative biomarkers such as neurofilament lumen, phosphorylated neurofilament heavy chain, and glial fibrillary acidic protein did not show consistent changes after treatment.

“This publication provides preliminary evidence for the potential of NurOwn to alter functional outcomes in progressive MS, which we believe merits further study,” said co-investigator Ralph Kern, MD, MHSc, chairman and director. of BrainStorm Cell Therapeutics, in a statement.1 “Furthermore, consistent changes in cerebrospinal fluid neuroinflammation and neuroprotection biomarkers reveal how NurOwn may impact disease mechanisms in progressive MS and are complementary to the biomarker results observed in our phase trial. 3 on ALS. broad applications and will strengthen BrainStorm’s efforts to provide much-needed solutions for patients with progressive MS, ALS and other neurodegenerative diseases.”

Most recently, in mid-August, following corrections to its Phase 3 trial that further improved results, the company announced that it would file a biologics license application for NurOwn to treat lateral sclerosis. amyotrophic, a decision that comes more than a year after the FDA. not recommended.3

REFERENCES
1. BrainStorm Cell Therapeutics announces peer-reviewed publication of results from the NurOwn Phase 2 progressive MS trial in the Multiple Sclerosis Journal. Press release. BrainStorm Cell Therapeutics. September 15, 2022. Accessed September 15, 2022. https://ir.brainstorm-cell.com/2022-09-15-BrainStorm-Cell-Therapeutics-Announces-Peer-Reviewed-Publication-of-Results-from-the- NurOwn-R-Phase-2-Progressive-MS-Trial-in-Multiple-Sclerosis-Journal
2. Cohen JA, Lublin, Kern R, et al. Evaluation of mesenchymal stem cell-secreting neurotrophic factor in progressive multiple sclerosis. Mult Scler J. Published online September 14, 2022. doi:10.1177/13524585221122156
3. BrainStorm Cell Therapeutics Announces Second Quarter 2022 Financial Results and Provides Company Update. Press release. BrainStorm Cell Therapeutics. August 15, 2022. Accessed September 15, 2022. https://ir.brainstorm-cell.com/2022-08-15-BrainStorm-Cell-Therapeutics-Announces-Second-Quarter-2022-Financial-Results-and-Provides- a-Corporate-Update
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“I had crippling depression – until I tried a new treatment” https://philippinecerebralpalsy.org/i-had-crippling-depression-until-i-tried-a-new-treatment/ Thu, 15 Sep 2022 10:30:53 +0000 https://philippinecerebralpalsy.org/i-had-crippling-depression-until-i-tried-a-new-treatment/

My heart was pounding as the doctor tilted my chair, tilting my head back while raising his feet. He was out of sight, as my head and eyes were turned forward, thanks to a long metal arm with a magnetic plate at the end, which he had fastened tightly against my scalp. I was about to undergo a new and emerging treatment for a serious mental illness called Transcranial Magnetic Stimulation (TMS).

“You will feel a pulsation where the magnet is and a corresponding tapping sound,” the doctor said. “Are you ready?”

I guess my answer would have been the same if he had asked, “How desperate are you to recover from your depression and anxiety?”

“I’ll do whatever it takes,” I said.

I had despaired of ever escaping the deep, lonely, cylindrical death spiral I had lived in for the past four years. “Isolating” is the psychological term. Of course I was still physically I lived with my husband and two young children in our home in Los Angeles, but I was virtually unreachable on more than a superficial level.

Diana Daniele received TMS treatment and says the experience was transformative for her mental health.

During the first year of my depression and anxiety, I had lost my self-esteem and self-confidence, my autonomy not far behind; I dreaded going anywhere, especially alone. As the years passed with no real relief from my symptoms, I slipped into a deeper state of voluble self-loathing. I would have thoughts like: You caused your own depression, by not meditating properly or not exercising enough or eating mindfully. You lack character traits like courage, resilience, and strength to heal yourself. You are a revolting, weak and worthless loser and you deserve it.

My mind was so noisy, buzzing with self-blame and negative self-talk, that it was hard for me to talk about it. My husband noticed this, but as my depression got worse, it became harder for him to reach me.

I tried to deny the vicious thoughts in my head by spending a month confined to a convalescent home perched atop a cliff in Malibu, to no avail. Later, my psychiatrist recommended a popular outpatient program at UCLA Medical Center. As a Phi Beta Kappa graduate of UCLA, where I was also a sorority girl, I hoped I could find healing in my beloved alma mater. I found both purpose and camaraderie in participating in the program. It gave me something to get out of bed and I enjoyed getting to know the other program participants, whose struggles mirrored my own.

Halfway through the program, in a moment of madness – or, arguably, sanity – I confessed to my social worker that I had lied about the Beck Depression Inventory she had given me during of our weekly checks. In fact, I was having suicidal thoughts, and they were growing day by day.

She responded by accompanying me to the admissions department of Ronald Reagan Neuropsychiatric Hospital, which was only a building away. In front of the door of the psychiatric hospital, with its revolving light, its digicode and its padlock with chain, I panicked. What had I done? I grabbed my social worker like a scared toddler who doesn’t want her mom to leave her at preschool. She carefully removed my fingers from her arm and reminded me that I could leave as soon as I felt better, because I was a “voluntary admission”.

My team of doctors at UCLA declared me treatment resistant. I agreed because it didn’t matter what type of antidepressant or antipsychotic I was prescribed or how many therapy sessions I attended. I was no better. My GP urgently recommended electroconvulsive therapy or ECT, commonly known as shock therapy, to get me out of what he called an “almost psychotic state.” I actually underwent the invasive ECT treatments. Unfortunately, I did not feel any relief from my symptoms.

woman in hospital
Image of a woman in the hospital. Diana Daniele was declared “resistant to treatment” before discovering MSD.
iStock/Getty Images Plus

Turns out I wasn’t the only one resistant to treatment. One in five Americans suffers from mental illness, and up to 30% of them do not respond to the first treatment: antidepressants and psychotherapy.

About six months later, a dear friend told me that she had secured an appointment for me with her psychiatrist, who had helped her recover from her postpartum depression. While I strongly doubted that his psychiatrist could help me – coming, as he did, after quite a long list of qualified medical professionals who had already tried – I neither wanted to let my caring friend down, nor give up. myself.

My husband accompanied me to Dr. Sparago’s office for the appointment and sat with me during his comprehensive review of the many medications I had been prescribed over the past few years. We both heard him mumble something about how I “seemed like a candidate” and the words “new treatment option”. Our eyes met on the sofa. Hoping.

Dr. Sparago stood up and asked us to come with him to see the treatment room. It was small and windowless, with a reclining dental chair at its center. He bent down and grabbed a brochure from a lucite stand and showed us what looked like a “Just Say No” advertisement. Two brains were photographed side by side, one dark with muted gray and blue flecks, the other illuminated with gold, red and green. I expected the caption to say “This is your brain. This is your brain on drugs”, but instead it said “Normal brain” and “Depressed brain”. The normal brain had lights on, like a cozy house after dark with people inside, while the depressed brain was gray, muted, and without lights. Hopeless.

I felt my thoughts drift into their usual dark place and enjoyed Dr. Sparago touching my shoulder which brought me back to the present moment. It explained how TMS worked.

“TMS was approved in the United States in 2008 for use in treatment-resistant patients like you,” Dr. Sparago explained. “TMS uses a pulsed magnetic field – similar to that used in an MRI – to create an electrical current on the surface of the brain, which will reset your body’s mood regulation system.” Think about how turning off your smartphone and then restarting it will often “fix” a problem.

The following Monday, I was able to confirm insurance coverage and begin the TMS protocol, which involved half-hour sessions five days a week for six weeks between October and November 2018.

TMS didn’t hurt. But the tapping is quite strong and rhythmic, and always followed by a time of silence. There was a TV for watching Netflix, positioned at eye level which helped to pass the time. I was also warned that I might have a slight headache after the treatment, but I did not experience this.

While some TMS patients report a marked change in mood in just one week, my recovery was more gradual. I lived in almost complete emotional darkness, but as the days and weeks of TMS went on, I began to see rays of light appear.

Soon I found myself singing for my baby girl while we played, baking my son’s favorite apple pie to celebrate his flag football win, and looking forward to the time I could spend with my husband. -like. As the new year approached, I continued to enjoy life by reconnecting with friends and re-launching my PR consulting business.

Almost four years after starting treatment, I still do TMS once a month to maintain my incredible progress. The psychiatrist suggested the interview as an option, but only if I wanted it. I know a woman who did TMS for her postpartum depression. She does no maintenance and is still doing well. But I will continue to do it every month. It doesn’t hurt, there are no side effects and it only takes about 20 minutes. Insurance doesn’t pay for maintenance, however, and I realize I’m privileged to be in a position where I can afford to pay $75 a month for treatment.

I feel like myself again, but better. Because I now know that mental health is rooted in the physical: in the chemistry and circuitry of the brain. It wasn’t my fault; it had never been my fault. And with depression being the leading cause of disability worldwide, this knowledge is almost as vital as the cure.

Diana Daniele is a writer and publicist living in California. She is currently working on a dissertation. For more information, visit: dianadanieleauthor.com

All opinions expressed in this article are those of the author.

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