Thursday, January 26, 2023 |
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Welcome to Health Rounds! Today we look at findings from two studies published this week in prominent medical journals that highlight racial inequities in the accuracy of stroke risk prediction and in recognizing autism in kids without low IQs. In addition, we report on new laboratory data suggesting that instead of trying to develop ever more potent antibiotics to throw at drug-resistant bacteria, a better approach might be to attack the resistant bugs with engineered live biotherapeutic organisms. |
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The North Portico of the White House is illuminated in blue for Autism Awareness Day in April 2020. In the New York/New Jersey metropolitan area, the prevalence of autism in children without intellectual disability rose 500% between 2000 and 2016, researchers said today. Reuters/Tom Brenner |
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Stroke prediction tools work poorly in Black patients |
Widely-used tools for predicting the 10-year risk of a first stroke perform much more poorly in Black patients than in whites, despite the higher stroke rates in the Black population, researchers warned on Tuesday in JAMA. "It's much better to prevent a stroke than to deal with the consequences," said study leader Michael Pencina of Duke University in Durham, North Carolina. "There is a lot of value in stratifying patients into low-risk and high-risk groups so that we can focus more resources on those at higher risk, but the algorithms have to be unbiased," he said. "If we hope to erase the racial disparities in stroke incidence rates we can't be using formulas that perform worse in Black adults." Using data on more than 62,000 individuals, researchers compared the accuracy of three prominent stroke-risk prediction algorithms, including one recommended by the American Heart Association and the American College of Cardiology, and two machine learning algorithms. None of the tools was significantly more accurate than the others, and artificial intelligence provided no extra benefit, researchers reported. All of the algorithms exhibited poorer predictive results for Black individuals than white individuals. The most racially accurate tool was one based on patients' self-reporting of risk factors rather than on objective laboratory biomarkers. "We need to collect more information about patients to help us identify the risk factors that we may be missing," Pencina said. "Everyone says, 'Get more biomarkers' (to improve risk algorithms). But if self-reported data can be most accurate at risk stratification, as it was in this study, then let's go talk to the patients." He suggested that more patient outreach would help get those at highest risk into the doctor's office. "We need to shift from a medicinized approach to a community-based approach." |
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Autism prevalence up 500% in some NY/NJ children |
Autism spectrum disorder (ASD) remains underdiagnosed, particularly in children without intellectual disability and children who aren't white, according to a study from the New York-New Jersey metropolitan area. A false assumption about ASD is that it occurs alongside intellectual disabilities, said study leader Josephine Shenouda of Rutgers School of Public Health in a statement. "In this study," she said, "two-in-three children with autism had no intellectual disability whatsoever." Between 2000 and 2016, researchers studied seven cohorts of 8-year-olds, each consisting of about 30,000 children. During that period, the prevalence of ASD in children without intellectual disability (i.e., with an IQ score of 70 or greater) rose 500%, from 3.8 per 1,000 children to 18.9 per 1,000, they reported on Thursday in Pediatrics. Rates of ASD that also involved intellectual disability doubled, from 2.9 per 1,000 to 7.3 per 1,000. Shenouda said more research is needed to identify causes of the increases. "Better awareness of and testing for ASD does play a role," coauthor Walter Zahorodny of Rutgers New Jersey Medical School said in the statement. "But... a 500% increase in autism among kids without any intellectual disabilities – children we know are falling through the cracks – suggests that something else is also driving the surge." ASD without intellectual disabilities was 80% more common among children in affluent areas than in underserved areas, the researchers found. And Black children were 30% less likely than white children to be identified with ASD without intellectual disabilities. "Our findings underscore the likely presence of health disparities, especially among disadvantaged children," the researchers wrote. "Future work should focus on addressing (these) disparities." |
Antibiotic-resistant bacteria succumb to engineered rivals |
Harmless modified bacteria can help fight lung infections caused by drug-resistant bacteria, laboratory experiments suggest. Some types of Pseudomonas (or P.) aeruginosa, a leading cause of pneumonia acquired while in hospitals, are resistant to almost all currently available antibiotics, according to the U.S. Centers for Disease Control and Prevention. Testing their "living medicine" approach in mice, the researchers used an engineered form of the human lung bacteria Mycoplasma pneumoniae to "punch holes" in cell walls of the P. aeruginosa bacteria in the rodents' lungs, "providing crucial entry points for antibiotics to invade and clear infections at their source," study coauthor Maria Lluch of Spanish biotechnology company Pulmobiotics said in a statement. The treatment significantly reduced the amount of the bacteria in lungs, the degree of inflammation and the amount of pneumonia, and it doubled survival compared with no treatment, the researchers reported in Nature Biotechnology. In other experiments, the engineered strain dissolved P. aeruginosa biofilms – hard-to-treat slimy layers of cells that stick to each other and to surfaces – in breathing tubes of patients with ventilator-associated pneumonia, which typically has a high mortality rate. Much more work needs to be done before researchers can test the treatment in humans. Other "living medicine" applications under study by other research teams include the use of Staphylococcus epidermidis bacteria by Connecticut-based Azitra Inc, to fight skin conditions, and use of Lactococcus lactis by Maryland-based biotech Precigen Actobio to treat type 1 diabetes and celiac disease. This newsletter was edited by Bill Berkrot. |
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