Sharapova’s drug in widespread use
The use of meldonium – the substance taken by tennis star Maria Sharapova – is widespread among elite athletes, reveals research published online in the British Journal of Sports Medicine. The findings, which draw on information volunteered by athletes and individual medical teams, and lab data on anti-doping tests from the Baku 2015 European Games, indicate that up to 490 athletes may have been taking meldonium during the competition. The research, which was carried out on behalf of the European Olympic Committees, contributed to the World Anti-Doping Agency (WADA) taking the decision to ban the use of meldonium in competitive sport as of 1 January this year. “Meldonium … is an inhibitor of carnitine synthesis and is reported to have cardioprotective and anti-ischaemic effects. It has been used in a variety of disorders including for the management of ischaemic heart disease and ischaemic cerebrovascular disturbances … There appears to be some evidence that meldonium may benefit exercise performance in rodents, but specific studies to evaluate potential effect on performance specifically in elite athletes have not been identified … Adverse effects reported by the manufacturers of meldonium include headache, agitation, tachycardia, allergic skin reactions and dyspepsia. Serious adverse effects, which pose a significant risk to health or life after taking meldonium, have not been found in scientific literature. The seemingly safe clinical profile of this substance, coupled with the perception that it may have some effect in enhancing recovery or performance are all confounding reasons why the drug may be routinely prescribed in young and otherwise healthy athletes.”

Low-cost, quick TB test boon to African HIV patients
A low-cost, easy to use urine test to diagnose tuberculosis (TB) among patients with HIV could help reduce the TB death rate of HIV-positive patients in hospital, according to a new study published in The Lancet. In Africa, nearly 40% of all adult deaths related to HIV or AIDS are due to TB, but almost half of the TB cases remain undiagnosed and untreated before death. The authors of the study, which was conducted in 10 hospitals in sub-Saharan Africa, say that if implemented more widely, this low-cost intervention could save thousands of lives per year. Diagnosis of TB usually includes taking a chest x-ray and microbiological examination of sputum. However, for severely ill patients with TB and HIV, it can be hard to produce sputum and alternative approaches (sputum induction or alternative invasive sampling) are often unavailable. The LAM urine-test detects a glycolipid molecule (lipoarabinomannan), which is linked to TB. It provides a result in 25 minutes and each test costs about US$2.66. The research team randomly allocated 2528 patients with HIV from 10 hospitals in four countries in sub-Saharan Africa to receive either routine testing (smear, Xpert MTP/RIF and culture) as well as the LAM urine-test (LAM group, 1257 patients) or routine testing alone (no-LAM group, 1271 patients). Eight weeks after being discharged from hospital, 21% (261) of patients in the LAM group had died compared to 25% (317) of patients in the no-LAM group – an absolute reduction of 4%. A greater proportion of patients in the LAM group (648; 52%) were treated for TB than in the no-LAM group (598; 47%). And, of those who started TB treatment, a higher proportion of patients were treated in the first 3 days in the LAM group (513/648; 79%) compared to the no-LAM group (413/598; 69%).

Brown fat keeps blood sugar in check
Australian scientists have shown that brown fat – a special type of fat that burns energy to produce heat – may also help to keep blood sugar steady in adults. Researchers at Sydney’s Garvan Institute of Medical Research measured brown fat activity and blood glucose continuously in real time in study participants, and found that individuals with more brown fat had smaller fluctuations in blood sugar. Their work has been published in Cell Metabolism. The research team studied a group of 15 healthy adults over 12 hours. They found that blood glucose levels and heat production by brown fat were closely related, tracking together over time. Importantly, participants who had larger deposits of brown fat had less fluctuation in blood glucose – and blood glucose fell after each peak of brown fat activity surge. In contrast, brown fat activity rose only in response to an increase in blood glucose among those with less brown fat, and interestingly, their glucose fluctuations were greater. Notably, individuals with no detectable brown fat had the widest fluctuations in blood glucose. The study used a simple and non-invasive technique to measure brown fat activity: a small thermometer placed over the collarbone of participants.

Diabetics at a higher risk of serious bacterial blood infection
Danish scientists have linked patients with diabetes with a heightened risk of blood infections from Staphylococcus aureus bacteria. Patients with diabetes are almost three times more susceptible to life-threatening S. aureus bacteraemia, according to a study published in the European Journal of Endocrinology. Researchers from Aalborg University Hospital and Aarhus University Hospital in Denmark analysed records of 30 000 people from four different medical registries in Denmark over a 12-year period. The team compared the risk of infection when taking into account different types of diabetes, how long patients had been diagnosed with the condition, and other associated complications of living with diabetes. Compared to patients without diabetes, people with type 1 diabetes were 7.2 times more at risk of S. aureus infection whereas people with type 2 were 2.7 times more at risk. Also more at risk were those suffering from other complications – such as heart and circulation problems and diabetic ulcers. Kidney problems associated with diabetes were one of the highest risk factors, with a 4.2 times increased risk. The risk of infection also increased with the number of years a patient had had diabetes – those who had it for 10 years or more were 3.8 times more at risk. The extent to which patients had control over their diabetes was also considered, with those with poor management of their diabetes showing a greater risk.

Genes a major cause of inflammatory diseases
A global study involving 50 different research centres and led by researchers at the Queensland University of Technology has found hundreds of genes which cause five common, hard-to-treat and debilitating inflammatory diseases, paving the way to new treatments for these conditions. Led by Brisbane’s QUT and Christian-Albrechts-University, Kiel, Germany, the results of the world-first study have been published in the international journal Nature Genetics. Co-senior author Professor Matthew Brown, from QUT’s Institute of Health and Biomedical Innovation, said they investigated ankylosing spondylitis, Crohn’s disease and ulcerative colitis (collectively known as inflammatory bowel disease), psoriasis, and primary sclerosing cholangitis. “Studying nearly 86 000 subjects from 26 countries, our researchers identified 244 genetic variants which control whether or not people develop these conditions, a large proportion of which were completely new findings. They found that for nearly all of these diseases the reason they frequently occur together in individuals is due to the different diseases sharing genetic risk factors, rather than one disease causing the other. For some diseases such as the common form of spinal arthritis, ankylosing spondylitis, the study roughly trebled the number of genes known to be involved. This research has pointed us to several different potential therapeutic targets for these diseases, for which there is a huge global need for better therapies.”

Rare gene mutation linked to schizophrenia
Mutations in a single gene that increase risk of schizophrenia and other neurodevelopmental disorders are reported in a study published this week in Nature Neuroscience. Jeffrey Barrett and colleagues sequenced the protein-coding regions of the genome from 8534 participants with and without schizophrenia from UK and Finnish populations and combined this with existing data from a Swedish study of 5074 participants also with and without schizophrenia, as well as 1078 more participants with schizophrenia from a collection of family studies. They found SETD1A, a gene that regulates changes to chromosomes that control gene expression, was the only gene across the entire genome to statistically have more damaging mutations in people with schizophrenia than in people without. Similar mutations in this gene were rare among another 45 376 participants without schizophrenia, whereas mutations in SETD1A were more frequent among 4281 other participants with severe developmental disorders that included intellectual disability.

Risks of adverse neonatal outcomes after ART similar in obese women
Assisted reproductive technology (ART) is associated with a higher risk of adverse neonatal outcomes, but obesity does not appear to adversely modify perinatal risks associated with ART, according to a study published in Obstetric Medicine. Researchers ran a population-based retrospective cohort study of all non-anomalous, live births in the US state of Ohio from 2007 to 2011, comparing differences in the frequency of adverse neonatal outcomes of women who conceived with ART versus spontaneously conceived pregnancies and stratified by obesity status. Primary outcome was a composite of neonatal morbidities defined as ≥1 of the following: neonatal death, Apgar score of <7 at 5 min, assisted ventilation, neonatal intensive care unit admission, or transport to a tertiary care facility. Rates of adverse neonatal outcomes were significantly higher for ART pregnancies than for spontaneously conceived neonates: non-obese 25% versus 8%, and obese 27% versus 10%. ART was associated with a similar increased risk for adverse outcomes in both obese and non-obese women even after adjustment for coexisting risk factors. This increased risk was driven by higher preterm births in ART pregnancies.

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