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Medscape
a day ago
- Health
- Medscape
Early, Aggressive BP Lowering Tied to Better ICH Outcomes
Initiating intensive blood pressure (BP) lowering within a few hours of intracerebral hemorrhage (ICH) was associated with better neurologic outcomes, fewer serious adverse events, and better mortality compared to the more conservative standard treatment, new research confirmed. Best results were found when treatment was administered within 3 hours of ICH symptoms, a pooled analysis of the four Intensive BP Reduction in Acute Cerebral Hemorrhage Trials (INTERACT1-4) showed. While current guidelines set a target systolic BP of < 180 mm Hg within 1 hour of ICH symptom onset, the intensive treatment systolic target is < 140 Hg within 1 hour. The new findings were published online on June 18 in The Lancet Neurology . Timing Dependent? In addition to evaluating the safety and efficacy of early intensive treatment for ICH, the investigators also aimed to assess the impact of treatment timing. The INTERACT1-3 studies included 10,269 adults with acute ACH who presented within 6 hours of symptom onset and had a systolic BP of > 150 mm Hg. INTERACT4 included 1043 patients with suspected acute stroke who had a systolic BP of ≥ 150 mm Hg within 2 hours of symptom onset. In addition, 1029 study participants had a hemorrhagic form of stroke. All were randomly assigned to receive either intensive or guideline recommended BP-lowering treatment with locally available BP drugs within 1 hour. Scores on the modified Rankin scale were used to determine functional recovery, the primary outcome measure for the pooled analysis. Additionally, a CT substudy of nearly 3000 INTERACT participants was conducted to measure hematoma volume. Mean systolic BP rates at 1 hour were significantly lower for the intensive treatment group compared to the guideline group (149.6 mm Hg vs 158.8 mm Hg, respectively; P < .0001). Poor physical function, defined as a modified Rankin scale score of 3-6 at the end of follow-up, was significantly less likely after intensive BP lowering (odds ratio [OR], .85; P = .0001). The intensive group also had reduced odds of neurologic deterioration within 7 days compared to the guideline group (OR, .76; P = .0002), as well as lower odds of any serious adverse event (OR, .84; P = .0003) or death (OR, .83; P = .002). CT substudy results showed no significant effect on either relative or absolute hematoma growth in the first 24 hours from intensive vs guideline treatment. However, when intensive BP lowering was initiated within 3 hours of symptom onset, functional recovery was improved and hematoma growth was reduced in almost 25% of the patients with serial CT scans, investigators noted. Patients with mild-to-moderate severity, as measured by ICH scores, had even greater reductions in hematoma growth after early intensive BP-lowering treatment. The new pooled analysis of all four INTERACT trials confirms findings from INTERACT4, presented at the 2024 European Stroke Organization Conference Annual Meeting and reported by Medscape Medical News . 'Time Is Brain' In an accompanying editorial, David J. Werring, PhD, Department of Translational Neuroscience and Stroke, University College London Queen Square Institute of Neurology, London, noted that several previous studies showed no benefit of BP lowering in acute ischemic stroke, 'probably because acutely elevated blood pressure has a role in maintaining brain perfusion.' However, the pathophysiology of stroke from ICH 'is different, with a major role for hematoma expansion within the first few hours, a therapeutic target which might be reduced' by intensive BP lowering, he wrote. Still, Werring noted that possible benefits need to be weighed against possible risks; and he pointed out several study limitations, such as the low severity of ICH overall and the inclusion of INTERACT3 data, which may have introduced confounding from BP lowering being just one component of its treatment 'bundle,' alongside strict glucose control and anticoagulant reversal. 'Notwithstanding these important limitations, the data presented make a compelling case for ultra-early intensive blood pressure reduction as a potentially useful intervention to improve outcomes in people with acute ICH,' he wrote, adding that more research is needed. 'Meanwhile, the clear message from this meta-analysis is that earlier treatment is better, meaning that, once again, time is brain for patients with ICH,' Werring concluded.
The Hindu
2 days ago
- Health
- The Hindu
Study of gut genomes finds how antibiotic resistance can differ between genders
A recent study analysing gut genomes found that trends of antibiotic resistance differ between genders. For instance, in high-income countries, women may have more antibiotic-resistant genes, while in low- and middle-income countries, men may have more. Led by researchers at the University of Turku, Finland, the study analysed over 14,600 gut genomes from across 32 countries, taken from a publicly available dataset. Study findings Antibiotic resistance, in which infection-causing germs become immune to the drugs designed to kill them, is a significant public health challenge and is estimated to claim over 39 million lives in the next 25 years, a study published in The Lancet journal in September 2024 said. Furthermore, differences in antibiotic resistance related to gender were found to emerge in adulthood. "This suggests that lifestyle, biological differences or healthcare-related factors may influence these differences more in adulthood than in childhood," author Katariina Parnanen, a postdoctoral researcher at the University of Turku said. "We observed that the association between ARG (antibiotic resistant gene) load and gender was inverted between HICs (high-income countries) and LMICs (low- and middle-income countries): women had higher ARG load in HICs and lower ARG load in LMICs than men," the authors wrote in the study published in the journal npj biofilms and microbiomes. The findings also reveal that in high-income countries, women had an average of nine per cent higher amount of genes related to antibiotic resistance compared to men. Women may be more frequently exposed to antibiotics, bacteria resistant to antibiotics, or are more often carriers of resistant bacteria, the researchers suggested. Additionally, women in these countries were found to have a slightly higher diversity of antibiotic resistance genes compared to men, suggesting a broader variation in resistance in the gut microbiomes, the team said. "Understanding gender differences in antibiotic resistance is key to designing equitable and effective healthcare interventions. Our study will lay the groundwork for further research to reduce health inequalities related to antibiotic resistance," Parnanen said. The researchers also found a strong association between age and country of residence and the number and diversity of genes involved in antibiotic resistance. These were particularly high in infants and the oldest age group, they said. High antibiotic use was associated with higher resistance gene loads and greater diversity. High levels of resistance were also found in low-income countries, which may be explained by factors such as poor hygiene and sanitation, the team said. "Our data-driven analyses shed light on global, gendered antibiotic resistance patterns, which may help guide further research and targeted interventions," the authors wrote. The study used data publicly available from datasets 'Sequence Read Archive' (SRA) and European Nucleotide Archive (ENA).
The Star
4 days ago
- Health
- The Star
This disease is costing Asean billions
DENGUE is no longer a seasonal nuisance – it has become a year-round public health crisis in Asean, with rising infection rates, unpredictable outbreaks, and worsening economic consequences. According to the Asean Bio-diaspora Virtual Centre and the World Health Organisation, more than 800,000 cases were reported in Asean countries in 2024, with Indonesia, Malaysia, the Philip-pines, and Thailand recording some of the highest numbers. But beyond the hospital wards, dengue is draining our economies. A 2021 study published in The Lancet estimated the economic burden of dengue in South-East Asia exceeds US$1bil (RM4.7bil) annually, factoring in healthcare costs, lost productivity, school absenteeism, and vector control efforts.
New Indian Express
4 days ago
- Politics
- New Indian Express
Rising refugee crisis amid collapse of global moral order
With the rise of populist nationalism and majoritarianism, the displaced are facing an unprecedented pushback around the world. Last week, the Lancet pointed out that one in every eight people in the world is on the move today, driven by economic, political, demographic, environmental and socio-cultural forces. However, even as migration—including movement propelled by climate emergencies—is emerging as one of the biggest concerns in the 21st century, the rights and lives of refugees are coming under inhumane pressure. In this context, it is a solemn moment to remember that, stung by the partition's humongous refugee crisis, India has not ratified either the 1951 Refugee Convention, which serves as the principal legal document defining refugee status, or the 1967 Protocol that removed geographic and time-based limitations on the status. These treaties flowed from 1948's Universal Declaration of Human Rights, the high-minded document that underlined the newly-formed UN's purpose. Today, with its resolutions observed more in breach, the warnings of its secretary-general ignored and the funding of its agencies gutted, the UN system is becoming increasingly comatose. The Lancet pointed out that the World Health Organization's Health and Migration Programme faces an uncertain future barely five years after being set up; the health journal warned of the devastating consequences of its closure for millions of refugees around the world.
Middle East Eye
5 days ago
- Politics
- Middle East Eye
Opinion: By allowing Israel to bomb Iran, Trump is pushing Tehran to go nuclear
US President Donald Trump's decision to allow Israel to attack Iran is the worst miscalculation a US president has made since George W Bush invaded Iraq. Bush's decision heralded eight years of conflict in Iraq, killed at least 655,000 people, according to The Lancet, spawned an extreme group of Takfiri militants in the Islamic State group and brought a major state to the verge of collapse from which it has yet to recover 14 years on. Trump's decision could yet prove to be more calamitous. Allowing Israeli Prime Minister Benjamin Netanyahu to attack Iran, when US envoys were engaged in negotiations with Tehran, places the US presidency on the same level of trustworthiness as Al Capone or Joaquin "El Chapo" Guzman. This is the way you behave if you are in charge of a drug cartel, not a global power. US President Donald Trump shakes hands with Israeli Prime Minister Benjamin Netanyahu as he departs the White House in Washington, DC, on 7 April 2025 (AFP)
