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New transplant research aims to salvage infected donated organs

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Retired subway and bus driver Stanley De Freitas had just celebrated his 70th birthday when he started coughing, tiring easily and feeling short of breath. He was diagnosed with pulmonary fibrosis, a severe scarring of the lungs, and put on the wait list for a transplant.


“Life became unbearable. From the time I got up in the morning until when I went to bed at night, I struggled through every breath of air,” De Freitas, now 74, told Reuters by phone from his home in Toronto.


After two years, De Freitas was offered a lung, with one significant downside: The donor had hepatitis C.


In October 2017, he became the first patient enrolled in a just published study conducted at Toronto General Hospital testing a technique that aimed to flush out and inactivate the hepatitis C virus from donor lungs before a transplant.


The research comes amid a spike in available organs linked to the opioid overdose crisis, meaning many are contaminated by hepatitis C as the virus is commonly spread by sharing needles. Since it can easily infect an organ recipient, those organs are usually discarded despite the urgent need.


Data from the United Network for Organ Sharing (UNOS), which matches donors with recipients, shows that 97 percent of people waiting for a lung in the United States last year were unwilling to accept an organ from a donor who tested positive for hepatitis C.


While hepatitis C causes serious liver disease, the virus can be present in the blood in other organs.


Researchers are testing different approaches to salvage infected organs.


A study published in April showed that giving patients antiviral therapy just hours after transplant surgery can successfully attack the virus before it gains a foothold in the recipient.


Eliminating the virus prior to transplant would simplify the procedure for patients, said UNOS Chief Medical Officer David Klassen. It could also significantly cut down on wasted donor organs.


The technique used in Toronto, known as ex vivo lung perfusion, keeps organs “alive” outside the body by pumping them with a bloodless oxygenated liquid. They used ultraviolet C light to irradiate the solution, aiming to deactivate the hepatitis C virus and make it non-infectious.


Perfusion allows doctors to evaluate and potentially rehabilitate organs for transplant, and buys them more time than storage in ice boxes, which can cause tissue damage.


Toronto researchers used a solution from Sweden’s Xvivo Perfusion AB with the hospital’s own ex vivo lung perfusion system, a bubble-like machine made from off-the-shelf components and an intensive care ventilator.


The study of 22 patients, published in The Lancet Respiratory Medicine on Wednesday, had mixed results. Adding light therapy significantly decreased the amount of virus, but all but two of the patients contracted hepatitis C, which is now curable.


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Health

4 of 5 Indian children do not survive cancer. What led to this sorry state?

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How long does a cancer diagnosis take?


Six months, according to Bipin Jana, 45, whose eight-year-old son Parmeshwar has stage-4 Hodgkin’s lymphoma. That is how long it took the family, travelling 2,000 km across West Bengal, New Delhi and finally, Mumbai, to get an effective diagnosis and start treatment.


Parmeshwar is currently undergoing chemotherapy at the Tata Memorial Hospital (TMH), Mumbai, India’s foremost

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Health

Vitamins and omega-3 fatty acids may help children with autism

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Children with autism who take supplements of vitamins and omega-3 fatty acids may have fewer symptoms than kids who don’t, a research review suggests.


Researchers examined data from 27 trials involving a total of 1,028 children with autism spectrum disorder. Kids were randomly selected to take various dietary supplements, including vitamins or omega-3s, or to take a dummy pill instead.


Omega-3s and vitamin supplements were more effective than the placebo pill at improving several symptoms, functions, and clinical domains, researchers report in Pediatrics. Gains varied in the trials but included improved language and social skills, reduced repetitive behaviours, improved attention, less irritability and behaviour difficulties, and better sleep and communication.


“These results suggest that some dietary interventions could play a role in the clinical management of some areas of dysfunction specific to ASD,” said David Fraguas, lead author of the study and a researcher at Hospital General Universitario Gregorio Maranon and Universidad Complutense de Madrid in Spain.


Even though the analysis was based on controlled experiments — the gold standard for testing the effectiveness of medical interventions — the individual studies were too varied in what supplements they tested and how they measured results to draw any broad conclusions about what type or amount of supplements might be ideal for children with autism, researchers note in Pediatrics.


“The underlying mechanisms involved in the potential efficacy of dietary interventions in autism spectrum disorder are unknown, Fraguas said by email. “Our study does not assess this important question and current literature is inconclusive.”


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Depression, anxiety may cause patients to leave cardiac rehab programs

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Anxiety and depression are common among participants in cardiac rehab programs, and that poor mental health may cause them to drop out, a new study finds.


One in five patients in cardiac rehab after a heart attack or a procedure to open clogged coronary arteries may suffer from moderate to severe anxiety or depression, Australian researchers say.


And one in four of those with moderate depression, anxiety or stress symptoms may drop out of their cardiac rehabilitation programs, according to the report published in the European Journal of Preventive Cardiology.


“Health professionals need to provide extras support for those with co-morbid mental health symptoms to enable them to experience the full benefits of physical and mental health that cardiac rehabilitation programs offer,” said lead researcher Angela Rao, a PhD candidate at the University of Technology in Sydney.


“Cardiac rehabilitation programs do refer people to primary care for ongoig management if their psychological symptoms are severe or if people have mental health disorders,” Rao said in an email. “However, half of those with moderate symptoms remain depressed, anxious or stressed on completion of these programs and return to their usual environment without additional support.”


To take a closer look at the impact of mental health on cardiac rehab patients, Rao and her colleagues studied 4,784 heart patients treated at two Sydney hospitals between 2006 and 2017. All the patients completed mental health questionnaires upon entering the rehab programs.


Nearly one in five, 18 per cent, had symptoms of moderate to extremely severe depression. More than one in four, 28 per cent, had symptoms of moderate to extremely severe anxiety. And more than one in 10, 13 per cent, reported symptoms of moderate to severe stress.


Rehab appeared to improve mental health symptoms for some patients, but nearly half of those with moderate anxiety or depression symptoms did not show significant improvement by the end of the program. ”


While both Australian and American cardiology groups recommend that cardiac rehab patients be screened and referred for treatment of depression and anxiety, this advice is often not followed in Australia, Rao and colleagues reported. “Standard screening and referral procedures for depression are not standard practice during hospitalisation, and omission of screening varies between 29-68 per cent in CR programs,” they noted.


The new study should serve as a reminder to both patients and their doctors, said Mary Ann McLaughlin, director of Cardiovascular Health and Wellness at Mount Sinai Heart in New York City.


“Physicians should remember depression is a risk factor for cardiovascular disease,” McLaughlin said. “In general, we don’t screen for depression and anxiety as early as we should.”


The finding that 50 per cent of patients still have symptoms after rehab means physicians need to encourage patients to follow-up with a psychologist or psychiatrist, McLaughlin said.


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