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Study: 7 in 10 appendicitis patients treated with antibiotics avoid surgery

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Oct. 5 (UPI) — Antibiotics and surgery are both good options for treating appendicitis, according to a study published Monday in the New England Journal of Medicine that found 7 in 10 patients treated with the drugs ultimately avoid surgery.

“About three in 10 patients in the antibiotic group ultimately underwent an appendectomy within 90 days,” study co-principal investigator Dr. David Flum said in a statement.

“There were advantages and disadvantages to each treatment, and patients will value these differently based on their unique characteristics, concerns, and perspectives,” said Flum, professor and associated chair of surgery at the University of Washington School of Medicine.

The Comparison of the Outcomes of antibiotic Drugs and Appendectomy is the largest study to date comparing antibiotics for appendicitis to appendectomy, which is a surgery to remove the appendix, researchers said.

The goal of the study is to help nearly 300,000 people who visit the hospital each year for appendicitis-related issues choose the treatment that would be best for them with support from the evidence in the study.

Inflammation of the appendix, usually occurring in the teens or 20s, is the most common cause of acute abdominal pain requiring surgery though some mild cases are treated with antibiotics alone.

The study involved 1,552 participants from 25 sites across 14 states, researchers said. One month after treatment, participants rated their general health as about the same in both groups.

In the antibiotics group, about 71% did not have surgery within three months, and participants in the antibiotic group missed missed about 3 1/2 fewer days of work.

However, more participants in the antibiotics group needed to visit an emergency room or urgent care clinic within three months, 9%, compared with the surgery group, at 4%.

When surgery is successful, the appendix is fully removed, but with the antibiotics, appendicitis can come back and researchers said they will determine how often that happens in follow-up reports.

For every 100 participants in the antibiotics group, there were about eight unexpected problems. By comparison, in the surgery group, there were about four such problems.

The higher rate of problems in the antibiotics group was related to participants with an appendicolith, which is a calcified deposit within the appendix. These participants had a higher rate of having surgery within three months at 41% compared to the overall group rate for participants using antibiotics of 29%.



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Depressed teens may struggle in school

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By about age 16, teens diagnosed with depression have substantially lower educational attainment, a new British study finds.

Targeted educational support might be of particular benefit to teens from poor backgrounds and boys, but all children with depression can benefit from such help, the study authors suggested.

For the study, the researchers used British health and education records to identify nearly 1,500 kids under 18 years of age with depression. Typically, their depression was diagnosed around age 15. Their educational attainment was compared with a group of young people who were not depressed.

Among students with a diagnosis of depression, 83% reached expected educational attainment at ages 6 to 7, but only 45% hit more advanced thresholds in English and math by age 15 to 16. Researchers said that’s much lower than the 53% who met the threshold locally and nationwide.

“Previous research has found that, in general, depression in childhood is linked to lower school performance,” said researcher Alice Wickersham, a doctoral student at NIHR Maudsley Biomedical Research Centre of King’s College London.

But young people who developed depression in secondary school typically showed a performance decline on the General Certificate of Secondary Education (GCSE) exams. The exams — taken by most pupils at about age 15 to 16 in England, Wales and Northern Ireland — dovetailed with the time of diagnosis for many young people.

The pattern appeared to be consistent across different genders, ethnicities and economic groups, Wickersham said in a research center news release.

“While it’s important to emphasize that this won’t be the case for all teenagers with depression, it does mean that many may find themselves at a disadvantage for this pivotal educational milestone,” Wickersham said.

“It highlights the need to pay close attention to teenagers who are showing early signs of depression. For example, by offering them extra educational support in the lead up to their GCSEs, and working with them to develop a plan for completing their compulsory education,” she added.

Researcher Dr. Johnny Downs, senior lecturer in child and adolescent psychiatry at King’s College London, said the findings have two key policy implications.

“It demonstrates just how powerful depression can be in reducing young people’s chances at fulfilling their potential, and provides a strong justification for how mental health and educational services need to work to detect and support young people prior to critical academic milestones,” he said.

The findings were published online Oct. 8 in the British Journal of Psychiatry.

More information

For more about teens and depression, head to the U.S. National Institute of Mental Health.

Copyright 2020 HealthDay. All rights reserved.



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Study: New bedside test means faster diagnosis, treatment of COVID-19

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Oct. 8 (UPI) — A rapid, bedside test for COVID-19 delivers results in less than two hours, meaning that appropriate treatment can be initiated earlier for those already hospitalized because of their symptoms, according to a study published Thursday by The Lancet Respiratory Medicine.

The standard COVID-19 test uses polymerase chain reaction, or PCR, technology, which amplifies small samples of DNA in order to identify the presence of virus in samples taken from an infected person’s nose or throat.

The PCR test requires samples to be sent to a centralized lab within the hospital for processing, typically takes more than 20 hours to produce results, the researchers said.

The enhanced speed of the bedside, or “point-of-care” tests, also means patients infected with the new coronavirus can be isolated earlier, reducing the risk for transmission to other patients and healthcare workers.

“Our findings are the first to suggest the clinical benefits of molecular point-of-care COVID-19 testing in hospitals, demonstrating reduced delays, bed moves and time in assessment areas, which all lead to better infection control,” study co-author Dr. Tristan William Clark, of Southampton General Hospital in England, said in a statement.

“We believe that [these] molecular [tests] should be urgently integrated … to reduce coronavirus transmission within hospitals to prevent the next wave of the pandemic overwhelming health services around the world,” Clark said.

Since the start of the global pandemic in March, healthcare systems worldwide have relied on PCR testing of patient samples in centralized hospital laboratories, an approach that is accurate, but also lengthy and resource intensive, according to Clark and his colleagues.

The longer time it takes to generate results with PCR testing means that patients often wait in mixed assessment rooms to be admitted to the correct COVID-19 or non-COVID ward, increasing the possibility of transmission, the researchers said.

However, with point-of-care tests, nasal and throat swab samples are collected and placed into small cartridges for analysis. Unlike PCR tests, which require specially trained lab personnel, the bedside tests can be performed by healthcare workers in the emergency room or other assessment area, they said.

For this study, Clark and his colleagues evaluated the QIA-stat-Dx point-of-care testing platform, manufactured by Dutch firm Qiagen, in 1,054 adults with COVID-19 symptoms being assessed in the acute medical unit and emergency department of Southampton General Hospital between March 20 and April 29.

Nose and throat swabs were taken from all patients and tested for COVID-19 infection, with 499 patients evaluated using the QIA-stat-Dx, while the rest were assessed using only PCR testing. All test results were confirmed using the standard PCR approach as well, the researchers said.

Among those tested with QIA-stat-Dx, 197, or 39%, were found to be positive for COVID-19, while 155, or 28%, of those evaluated by only PCR were positive for the virus, the data showed.

The point-of-care test produced results in roughly 1.7 hours on average, while PCR evaluation took approximately 21.3 hours per patient, according to the researchers.

After testing, patients were transferred to definitive COVID-positive or negative wards, a process that took eight hours in the QIA-stat-Dx group and 28.8 hours in the PCR-only group, the researchers said.

With the bedside testing, approximately 14% of patients were transferred directly to the correct ward immediately and bypassed the assessment area, they said.

In addition, the point-of-care test was found to be more than 99% accurate at correctly identifying those positive for the virus, according to the researchers.

Most of the patients found to have COVID-19 in the study were recruited into a separate clinical trial evaluating treatments for the virus, with those evaluated with QIA-stat-Dx enrolled in the second study two days faster, on average, than those assessed by PCR only, the researchers said.

“Recruiting patients into clinical trials remains an international priority throughout this pandemic and is vital to accelerating the search for effective treatments,” Clark said.

“This is especially true when researchers are investigating the potential of antivirals, which have to be administered at early disease stages to have the greatest benefit,” he said.



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Many using cannabis for pain still take opioids, study finds

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People using cannabis for pain may still be taking opioid painkillers, a new study suggests.

Researchers looked at cannabis and nonprescription opioid use among 211 individuals in the New York City area. Over 90 days, the investigators found that opioid use was at least as high when cannabis was used as when it wasn’t, regardless of participants’ pain levels.

“Our study is among the first to test opioid substitution directly, suggesting that cannabis seldom serves as a substitute for nonmedical opioids among opioid-using adults, even among those who report experiencing moderate or more severe pain,” said researcher Deborah Hasin. She’s a professor of epidemiology at Columbia University in New York City.

“In other words, our study suggests that cannabis is not an effective way to limit nonmedical opioid use,” Hasin added in a news release from the Society for the Study of Addiction.

In 2017, more than 2 million Americans suffered from opioid addiction, and more than 70,000 died from the painkillers, the researchers pointed out in background notes.

Opioid use — including nonmedical use of prescription opioids, synthetic opioids and heroin — is the main cause of overdose deaths. How cannabis may change nonmedical opioid use is critical to understanding how cannabis-based interventions can affect the opioid crisis, the researchers said.

The report was published Oct. 8 in the journal Addiction.

More information

For more on drug addiction, head to the U.S. National Institute on Drug Abuse.

Copyright 2020 HealthDay. All rights reserved.



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