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Study links epidural in childbirth to slightly higher risk for autism

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Children whose mothers were given an epidural during labor may face a slightly heightened risk of autism, a large, new study suggests.

Researchers found that the rate of autism was a little higher among those kids, versus their peers whose mothers did not get epidural pain relief during childbirth: 1.9% versus 1.3%.

The reasons for the difference are not yet known. And experts stressed that the findings do not prove epidurals directly raise the odds of a future autism spectrum disorder, or ASD, diagnosis.

“I don’t think people should be panicked,” said senior researcher Anny Xiang, of Kaiser Permanente Southern California’s Department of Research and Evaluation.

For one, she said, the rates of ASD were low in both study groups.

Instead, the findings point to a need for more research to better understand what is going on, Xiang said.

Other experts agreed. Autism is a complex brain-based disorder, and it’s thought that many factors — before, during and after birth — may influence the risk, said Dr. Rahul Gupta, chief medical and health officer for the March of Dimes.

“It’s quite unlikely that just the drugs used in epidural would cause ASD,” he said.

Gupta pointed to a bigger-picture question: Women who did or did not have epidurals during delivery may have differed from each other in various ways that the study could not take into account: They may have had different exposures to infections, environmental toxins or medications during pregnancy, for example.

Gupta noted that a large U.S. government study, called SEED, is digging into potential risk factors for autism. It recently found an elevated risk among kids whose mothers were prescribed opioids painkillers shortly before they became pregnant.

When it comes to medications in general, Gupta said, researchers need to learn more about the possible effects during pregnancy.

Autism is a brain disorder that affects social skills, communication and behavior control. It affects about 1 in 54 children in the United States, according to the U.S. Centers for Disease Control and Prevention.

The disorder varies widely from one person to the next: Some children have milder problems with socializing and communicating, while others are profoundly affected — speaking little, if at all, and getting wrapped up in repetitive, obsessive behaviors.

Genes are thought to account for much of the risk of autism, but experts have long believed that environmental factors also play a role.

Past studies have looked at mode of delivery: Some have found that children born by cesarean section or labor induction have a higher risk of autism.

This latest study, published Oct. 12 in JAMA Pediatrics, is the first to look at epidural use and autism risk.

Xiang’s team scoured electronic medical records for nearly 148,000 children born at Southern California hospitals between 2008 and 2015. All were delivered vaginally, and about three-quarters were exposed to epidural analgesia.

Children in that exposed group had a somewhat higher rate of ASD diagnosis. The researchers used the medical records to try to account for other factors — including the mother’s age and education level, and health issues such as diabetes, obesity and smoking.

Even then, children exposed to epidural analgesia remained at 37% greater risk of ASD, compared to unexposed kids.

Xiang’s team also looked at one possible explanation: Epidurals can cause a fever and, in theory, that might affect newborns. But there was no clear link between moms’ fevers during labor and the risk of autism.

Several medical groups responded to the study, saying it “does not provide credible scientific evidence that labor epidurals for pain relief cause autism.”

The groups, including the American Society of Anesthesiologists and the American College of Obstetricians and Gynecologists, said women should not be scared away from opting for an epidural.

“Very low levels of these [epidural] drugs are transferred to the infant, and there is no evidence that these very low levels of drug exposure cause any harm to an infant’s brain,” the groups said.

Thomas Frazier, chief science officer for the advocacy group Autism Speaks, called the study “high-quality,” and said it will hopefully spur more research.

Frazier agreed there may be other explanations for the connection between epidural use and higher ASD risk — such as infections or other prenatal factors.

More information

Autism Speaks has more on ASD.

Copyright 2020 HealthDay. All rights reserved.



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Moderna says data show COVID-19 vaccine almost 95% effective

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Nov. 16 (UPI) — The COVID-19 vaccine under development by U.S. biotech firm Moderna is 94.5% effective in preventing infection, according to interim data the company published Monday.

Moderna said early analysis from its late-stage “COVE” clinical trial for its mRNA-1273 vaccine candidate was based on nearly 100 COVID-19 cases.

“This is a pivotal moment in the development of our COVID-19 vaccine candidate,” Moderna CEO Stephane Bancel said in a statement. “Since early January, we have chased this virus with the intent to protect as many people around the world as possible. All along, we have known that each day matters.

“This positive interim analysis from our Phase 3 study has given us the first clinical validation that our vaccine can prevent COVID-19 disease, including severe disease.”

Moderna said its COVE trial has found no serious side effects from the mRNA-1273 vaccine.

Bancel said the company will apply for emergency use authorization from the Food and Drug Administration to distribute the vaccine once it finishes compiling safety data later this month.

“These are obviously very exciting results,” Dr. Anthony Fauci, the nation’s top infectious diseases expert, said Monday. “It’s just as good as it gets — 94.5% is truly outstanding.”

Moderna’s results are similar to those published last week by drugmaker Pfizer, which said its vaccine has shown to be about 90% effective.

Other vaccines are being tested in late-stage trials by Johnson & Johnson, AstraZeneca and Novavax.

Fauci said last week a vaccine could be available to the most at-risk populations before the end of the year.



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Experimental herpes vaccine shows promise in lab trials

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Scientists are reporting early success with an experimental herpes vaccine that uses a genetically modified version of the virus.

The gene edit prevents the virus from performing its normal evasive maneuver: hiding out in nervous system cells in order to elude the immune system.

So far, the vaccine has only been tested in lab animals. But scientists hope the genetic tweak will eventually allow the vaccine to succeed where past ones have failed.

The target is herpes simplex virus, or HSV, which in humans includes HSV-1 and HSV-2. Both can cause genital herpes, though HSV-1 is best known for triggering cold sores.

Globally, a half-billion people aged 15 to 49 have a genital herpes infection, according to the World Health Organization.

Those figures alone show there is a “huge need” for a vaccine, said Gary Pickard, one of the researchers on the new study.

But beyond that, once HSV invades the body, it’s there to stay, said Pickard, a professor of neuroscience at the University of Nebraska-Lincoln School of Veterinary Medicine and Biomedical Sciences.

To evade the immune system, the virus works its way into nerve cells and remains there in a dormant state. It can periodically become active again, traveling to the skin and causing sores and other symptoms.

In addition to those flare-ups, HSV infection can sometimes lead to complications. Pregnant women can, rarely, pass it to their newborns, who can become very sick or die, said Terri Warren, a registered nurse and medical advisor to the American Sexual Health Association.

Genital sores, and active HSV infection, also leave people more vulnerable to contracting HIV.

“In some places,” Warren said, “it accounts for many cases of HIV.”

Genital herpes also exacts a psychological toll, she explained, because it’s a lifelong infection that people can transmit to their partners, even when they are symptom-free.

That’s why researchers have been trying for years to create a preventive vaccine — with no success thus far.

As Pickard explained, one issue is that some candidate vaccines use only a subset of HSV components, or antigens, to try to generate an immune response. And that may not be enough: One vaccine with that design failed to prevent HSV-2 infection in a clinical trial involving thousands of young women.

Some other experimental vaccines have used a live, weakened form of HSV, but have run into similar issues.

“They’ve essentially made the virus so ‘sick’ that it can’t illicit a strong immune response,” Pickard said.

The new approach, recently described in the journal npj Vaccines, might circumvent those problems.

For the study, the researchers tested a vaccine made with a live, weakened form of HSV-1 that has a key genetic edit: It prevents the virus from advancing into the nervous system, while allowing it to replicate outside nerve tissue, to draw an immune response.

In lab experiments with guinea pigs, the tactic showed promise.

Of 12 animals given skin injections of the vaccine, only one developed sores after being exposed to HSV-2. In contrast, sores cropped up in 10 of 12 guinea pigs given no vaccine, and in five of 12 given the vaccine that failed in the earlier, human clinical trial.

In addition, the modified vaccine cut the viral shedding period by more than half, from 29 days to about 13. That’s important, Pickard said, because in humans it’s the viral shedding that can transmit the infection, even when there are no sores present.

“The findings on viral shedding are positive,” agreed Warren, who was not involved in the research.

She said a big question is whether a version of the vaccine that uses HSV-2 — rather than HSV-1 — can be shown effective in animals.

The researchers are working on that. Pickard said they are encouraged by the fact that the current vaccine showed “cross-protection” against HSV-2: If anything, they anticipate that an HSV-2 version will be more effective.

The road to an approved vaccine, however, is a long and very expensive one.

The hope is to have a vaccine ready for initial, phase I human testing within a few years, according to Pickard.

More information

The American Sexual Health Association has more on herpes.

Copyright 2020 HealthDay. All rights reserved.



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New procedure shows promise for pain relief in shoulder, hip arthritis

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Nov. 16 (UPI) — A method of “stunning” nerves reduces pain by at least 70% in people with moderate to severe arthritis in their hip and shoulder joints, a study presented Monday during the annual meeting of the Radiological Society of North America found.

In the method, called cooled radio-frequency ablation, needles are placed on the main sensory nerves around the shoulder and hip joints, the researchers said.

The nerves, which cause the body to feel pain, are then treated with a low-grade current known as radio frequency that “stuns” them, slowing the transmission of pain to the brain, they said.

The procedure could help the need for potentially addictive opioid-based pain relievers in people with moderate to severe arthritis pain, the researchers said.

“We’re just scratching the surface here,” study co-author Dr. Felix M. Gonzalez said in a statement.

“We would like to explore efficacy of the treatment on patients in other settings like trauma, amputations and especially in cancer patients with metastatic disease,” said Gonzalez, a professor of radiology at Emory University School of Medicine in Atlanta.

Historically, people with moderate to severe pain related to osteoarthritis have had limited treatment options — including the injection of corticosteroids into the affected joints — that tend to grow less effective as the arthritis progresses and worsens, according to Gonzalez and his colleagues.

“Usually, over time patients become less responsive to these injections,” he said.

Without pain relief, patients with this form of arthritis face the possibility of joint replacement surgery, but many aren’t candidates for these procedures due to other, underling health reasons, the researchers said.

For this study, 23 people — 12 with shoulder pain and 11 with hip pain — with osteoarthritis underwent treatment, the researchers said.

All 23 study participants had pain become unresponsive to anti-inflammatory and corticosteroid treatment, they said.

After receiving cooled radio-frequency ablation, the participants completed surveys to measure their function, range of motion and degree of pain prior to and at three months following the procedure.

No procedure-related complications occurred, and participants in the hip and shoulder groups reported significant reductions in pain with corresponding increases in joint function after the treatment, the researchers said.

Based on survey responses, participants with shoulder pain reported an 85% decrease in pain and a 74% increase in function, on average, Gonzalez said.

Those with hip pain reported a 70% reduction in pain and a 66% gain in function, he said.

“Until recently, there was no other alternative for the treatment of patients at the end of the arthritis pathway who do not qualify for surgery or are unwilling to undergo a surgical procedure,” Gonzalez said.

“This procedure is a last resort for patients who are unable to be physically active and may develop a narcotic addiction,” he said.



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