We asked Dr. John W. Mellors, chief of the Division of Infectious Diseases at the University of Pittsburgh School of Medicine, what he believes were the most important news developments in his field in 2016.
Here are his top three infectious disease newsmakers:
While the association of maternal Zika infection with fetal microcephaly was suggested in 2015, the data from the South American outbreak and prior French Polynesian outbreak have been sufficient only in this past year to show Zika as a cause of microcephaly. In addition to reports of sexual transmission, there was a case of non-sexual transmission, likely via tears or sweat, in a patient who died with high levels of Zika in the blood. Local transmission of Zika via mosquito bite has now occurred in the US in both in Florida and Texas.
Tenofovir alafenamide, a new formulation of tenofovir (a nucleoside inhibitor of HIV reverse transcriptase and part of many HIV treatment regimens), has been integrated into the first line-treatment guidelines for HIV patients. Multiple trials were published that demonstrated similar efficacy with the older formulation (tenofovir disoproxil fumarate), which improved rates of renal and bone toxicity. Given the need for lifelong therapy in HIV patients, this new agent may improve long-term health in these patients.
Hospital-acquired and ventilator-associated pneumonia guidelines
New guidelines for Hospital-Acquired Pneumonia (HAP) and Ventilator-Associated Pneumonia (VAP) were published by the Infectious Diseases Society of America and the American Thoracic Society. An important update was the exclusion of Healthcare-Associated Pneumonia (HCAP), which has been previously been included. This change may help prevent unnecessarily broad antibiotic use in many patients. In addition, an emphasis was placed on considering local resistance patterns in choosing the most appropriate initial antibiotics in these conditions.
Women and men with mild cognitive impairment have a new resource in Pittsburgh with the recently established Brain Training and Exercise (BRiTE) mind and body wellness program.
Participants engage with others affected in wide-ranging activities, including music, art, brain games and yoga training, all of which are designed to reduce frailty, increase strength and endurance and improve balance and stability.
While many resources are available for those with advanced cognitive diseases, the BRiTE program fills a void for people with mild cognitive deficits. The program allows them to continue with their active occupational and social lifestyles, while stimulating the brain and body and in the process, improving overall health and wellness.
A collaboration between the University of Pittsburgh and Grifols International, the BRiTE program is the first of its kind in the United States. The BRiTE team has been working with colleagues at Fundació ACE Barcelona Alzheimer Treatment and Research Center for nearly 20 years. This center pioneered a model of nonpharmacological programs to help stimulate cognitive, behavioral and physical functions to improve social and occupational functions.
Experts from the UPMC Comprehensive Pulmonary Hypertension Program are now using a new procedure aimed at improving the quality of life for chronic thromboembolic pulmonary hypertension (CTEPH) patients who aren’t responding to medication or are ineligible for surgery.
The UPMC CTEPH Program is one of only a few centers across the country to offer balloon pulmonary artery angioplasty (BPA) as a treatment option for CTEPH – a type of high blood pressure caused by chronic blood clots that affects arteries in the lungs and in the heart.
“The UPMC CTEPH Program is a specialized, multidisciplinary team of experts who come together to improve a patient’s survival and quality of life,” said Dr. Belinda Rivera-Lebron, director of the program. “CTEPH is a serious condition that affects our patient population, and this new procedure adds a treatment option for those who previously had very few alternatives.”
For the majority of patients who have suffered a blood clot, blood thinners are used to restore blood flow, which in turn improves breathing and exercise ability. However, in many patients, despite appropriate anticoagulation, their acute blood clots don’t resolve and progress to CTEPH. Others may develop it from multiple small clots over a long period of time, and some develop CTEPH with no history of acute blood clots.
The symptoms of CTEPH are similar to other types of PH: shortness of breath and a limited ability to exercise, according to the Pulmonary Hypertension Association. Other symptoms include a dry cough, chest pain and heart palpitations. As the disease progresses, patients may experience light-headedness or exercise-related dizziness. Abdominal and lower extremity swelling may develop as lung pressures increase and the right ventricle, which pumps blood into the lungs, begins to weaken.
Treatment for the disease includes medication for those ineligible for surgery and pulmonary thromboendarterectomy, a surgery that removes those chronic blood clots from the pulmonary artery.
Dr. Rivera-Lebron, who is also an associate professor of medicine in the University of Pittsburgh’s Division of Pulmonary, Allergy and Critical Care Medicine, and Dr. Catalin Toma, director of interventional cardiology at the UPMC Heart and Vascular Institute and assistant professor of medicine in Pitt’s Division of Cardiology, traveled to the Osaka Cardiovascular Hospital in Japan to learn from one of the world’s leading BPA experts, Dr. Takeshi Ogo. (more…)
Teen girls in Pittsburgh lag far behind the expected levels of physical activity for U.S. adolescent females, according to a new analysis based on a representative sample of that population. This study was led by researchers at the University of Pittsburgh School of Medicine and Graduate School of Public Health.
The findings, published online and in a coming print issue of Medicine & Science in Sports & Exercise—the journal of the American College of Sports Medicine—suggest that teenage girls living in urban settings may need additional, targeted opportunities for physical activity to achieve the levels reached by their suburban and rural counterparts.
“Sadly, we found that only about 5 percent of the hundreds of girls who participated in our study met the minimum daily activity level recommended by national and international health agencies,” said lead author Bonny Rockette-Wagner, Ph.D., director of physical activity assessment at Pitt Public Health. “Girls who were obese or had given birth in the last year were even less likely to achieve adequate levels of physical activity.”
To read more about the study, click here.
To raise awareness of preterm birth, graduates of the Magee-Womens Hospital of UPMC neonatal intensive care unit (NICU) recently reunited with their caregivers at a Day of Gratitude event hosted as part of the March of Dimes World Prematurity Day awareness campaign.
Families celebrated with cake and crafts, and the March of Dimes presented each NICU graduate with a purple superhero cape. Families with babies currently in the NICU also received hand-written notes containing words of encouragement from the former NICU families.
Tracy Brnusak, a nurse at Magee, organized the event to celebrate the NICU’s many success stories. Her own son Andy was born preterm at Magee, and he is now thriving in elementary school. Brnusak’s experience inspired her to switch roles at Magee and become a nurse in the NICU.
Approximately 15 million babies are born preterm each year. Even babies born a few weeks too soon can face serious health challenges and increased risk for lifelong disabilities including breathing problems, vision loss, cerebral palsy and developmental delays. The March of Dimes works with hospitals like Magee to raise awareness of preterm birth with the hope of reducing the number of families it effects.