Medical Bulletin 25/ November/ 2024
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Here are the top medical news for the day:
Can AI Be Used to Treat Infections More Accurately?
New research from the Centres for Antimicrobial Optimisation Network (CAMO-Net) at the University of Liverpool has shown that using artificial intelligence (AI) can improve how we treat urinary tract infections (UTIs), and help to address antimicrobial resistance (AMR).
Traditional UTI diagnostic tests, known as antimicrobial susceptibility testing (AST), uses a one-size-fits-all approach to determine which antibiotics are most effective against a specific bacterial or fungal infection. This new research, published in Nature Communications, proposes a personalised method, using real-time data to help clinicians target infections more accurately and reduce the chance of bacteria becoming resistant to antibiotic treatment.
The researchers used AI to test prediction models for 12 antibiotics using real patient data and compared personalised AST with standard methods. The data-driven personalised approach led to more accurate treatment options, especially with WHO Access antibiotics, known for being less likely to cause resistance.
Dr Alex Howard, a consultant in medical microbiology at the University of Liverpool and researcher on the Wellcome Trust funded CAMO-Net said: “This research is important and timely for World AMR Awareness Week because it shows how combining routine health data with lab tests can help keep antibiotics working. By using AI to predict when people with urine infections have antibiotic-resistant bugs, we show how lab tests can better direct their antibiotic treatment. This approach could improve the care of people with infections worldwide and help prevent the spread of antibiotic resistance.”
The results of this study represent a significant step forward in addressing AMR. By prioritising WHO access category antibiotics and tailoring treatment to individual susceptibility profiles, the personalised AST approach not only improves the efficiency of the testing process but also supports global efforts to preserve the effectiveness of critical antibiotics.
Reference: Howard, A., Hughes, D.M., Green, P.L. et al. Personalised antimicrobial susceptibility testing with clinical prediction modelling informs appropriate antibiotic use. Nat Commun 15, 9924 (2024). https://doi.org/10.1038/s41467-024-54192-3
Early Postmenopausal Women May Not Have Cognitive Effects to Short-term MHT
Short-term menopausal hormone therapy (MHT) did not have long-term cognitive effects when given to women in early postmenopause, according to a study published in the open-access journal PLOS Medicine.
While MHT can offer relief from the challenging symptoms of menopause, many women and doctors are hesitant to start MHT due to safety concerns. Previous research has linked one form of hormone therapy to mild cognitive impairment and dementia in women older than 65 years of age, prompting research on the importance of age and timing of therapy on cognitive impairment. Other studies have suggested that transdermal estrogen may have long-term cognitive benefits.
In the Kronos Early Estrogen Prevention Study (KEEPS), women in early postmenopause with good cardiovascular health were randomized to receive one of two types of MHT (oral or transdermal estrogen) or placebo. At the end of four years, no cognitive benefit or harm was seen in those who received MHT compared to the placebo group. However, long-term cognitive effects of MHT are still understudied.
In this new follow-up study—the KEEPS Continuation Study—researchers revisited participants nearly ten years later to repeat a series of cognitive tests. Among 275 women, although MTH failed to protect against cognitive decline, short-term MHT also had no long-term negative cognitive impact.
The authors add, “For women in menopause and the health care providers caring for them, getting direct, clear and evidence-based information about menopausal hormone therapy is challenging. And they need data to guide their decisions.”
Reference: Gleason CE, Dowling NM, Kara F, James TT, Salazar H, Ferrer Simo CA, et al. (2024) Long-term cognitive effects of menopausal hormone therapy: Findings from the KEEPS Continuation Study. PLoS Med 21(11): e1004435. https://doi.org/10.1371/journal.pmed.1004435
Can Human Heart Heal Itself?
After severe heart failure, the ability of the heart to heal by forming new cells is very low. However, after receiving treatment with a supportive heart pump, the capacity of a damaged heart to repair itself with new muscle cells becomes significantly higher, even higher than in a healthy heart. This is according to a new study from Karolinska Institutet in Sweden published in the journal Circulation.
Researchers at Karolinska Institute have now discovered that after an injury, the rate of cell renewal is even lower than in a healthy heart. Standard-of-care for patients with advanced heart failure is a surgically implanted pump that helps propel blood, a so-called left ventricular assist device (LVAD).
Surprisingly, the researchers found that patients with such a heart pump, who have shown significant improvement in their heart function, can regenerate heart muscle cells at a rate more than six times higher than in healthy hearts.
“The results suggest that there might be a hidden key to kick-start the heart’s own repair mechanism”, says Olaf Bergmann, senior researcher at the Department of Cell and Molecular Biology at Karolinska Institutet and last author of the paper.
The mechanism behind the effect is still unknown and there is not yet any hypothesis to explain it.
“It is difficult to say. In the existing data we cannot find an explanation for the effect, but we will now continue to study this process at a cellular and molecular level,” says Olaf Bergmann.
The findings open the possibility of developing new therapies for patients with serious heart conditions that stimulate the heart’s ability to repair itself after damage. This way, patients wouldn’t have torely only on heart transplants or other kinds of long-term mechanical support.
“This offers some hope that the recovery after a heart incident can somehow be boosted,” says Olaf Bergmann.
Reference: https://doi.org/10.1161/CIRCULATIONAHA.123.067156
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