For some Zimbabwe children with heart disease, a rare lifeline restores hope
Hashtags
Try Our AI Features
Explore what Daily8 AI can do for you:
Comments
No comments yet...
Related Articles
Medscape
an hour ago
- Medscape
Cardiac Biomarker Flags Preeclampsia Before Onset
Preeclampsia is a serious multisystem disorder that typically manifests as hypertension and proteinuria after 20 weeks' gestation. The condition is multifactorial and involves placental, immunological, genetic, vascular, and maternal factors. In Spain, preeclampsia affects about 1%-3% of pregnancies and, if not detected and managed early, can have severe or fatal consequences for both the mother and fetus. Screening First-trimester screening identifies patients at risk for early preeclampsia, defined as onset before 34 weeks of gestation, but there is no routine screening in the second or third trimester to detect late preeclampsia. Standard first-trimester assessment combines maternal history, such as age, BMI, personal and family history of preeclampsia, diabetes, chronic hypertension, blood pressure measurement, uterine artery Doppler, and maternal blood testing for placental growth factor and pregnancy-associated plasma protein A. These data were entered into the Fetal Medicine Foundation algorithm to estimate the probability of preterm preeclampsia (before 37 weeks); an estimated probability of > 1% typically prompts low-dose aspirin (150 mg/day). Preeclampsia is diagnosed from 20 weeks' gestation onward based on sustained elevated systolic blood pressure ≥ 140 mm Hg or diastolic blood pressure ≥ 90 mm Hg on two readings at least 4 hours apart with signs of organ dysfunction such as proteinuria, renal or hepatic impairment, neurologic or hematologic complications, or evidence of uteroplacental dysfunction identified by clinical exam, laboratory tests, or ultrasound. 'Both clinical symptoms and test results can be nonspecific, which increases the risk for misdiagnosis,' said Carmen Garrido Giménez, MD, PhD, Clinical Head of Obstetrics at the Hospital de la Santa Creu i Sant Pau in Barcelona, Spain, and a researcher with the Women and Perinatal Health Research Group at the Institut de Recerca Sant Pau (IR Sant Pau), Barcelona. 'The soluble fms-like tyrosine kinase 1 to placental growth factor (sFlt-1/PlGF) angiogenic ratio is highly useful for ruling out preeclampsia, but elevated values can also appear in other placental disorders,' said Madalina Nicoleta Nan, MD, Specialist in Clinical Biochemistry at the Hospital de la Santa Creu i Sant Pau and researcher in Clinical Biochemistry at IR Sant Pau, who discussed the findings with Univadis Spain , a Medscape Network platform. However, its limited availability in many laboratories, especially in emergency departments, hampers its systematic application in clinical practice beyond tertiary hospitals. As clinical signs and standard tests can be nonspecific, researchers have explored alternative or complementary biomarkers. One promising avenue is the use of cardiovascular biomarkers, given the bidirectional link between cardiovascular diseases and preeclampsia. 'Women with cardiovascular risk factors, such as chronic hypertension, diabetes, obesity, or kidney disease, are more likely to develop preeclampsia, and a history of preeclampsia increases the risk for cardiovascular disease. Researchers have therefore evaluated the role of cardiovascular biomarkers, particularly natriuretic peptides, B-type natriuretic peptide (BNP), and N-terminal pro-BNP (NT-proBNP), for the early detection and risk for preeclampsia,' explained Garrido Giménez and Nan. Most studies using this approach have focused on whether these markers are elevated in women with clinically confirmed preeclampsia, with higher levels observed in earlier and more severe cases of preeclampsia. None have compared their performance with that of the sFlt-1/PlGF ratio, which is the most specific diagnostic standard. The researchers also did not assess the ability of these markers to predict preeclampsia in the week before clinical diagnosis. Study Insights A multicenter prospective study led by the Hospital de la Santa Creu i Sant Pau and the IR Sant Pau, with collaborators at four other Catalan hospitals, assessed whether NT-proBNP could predict the onset of early preeclampsia within 1 week of assessment in women with clinical suspicion at 24 weeks of gestation. The study enrolled 316 pregnant women from March 2018 to December 2020 (mean maternal age, 34 years; 86.4% Caucasian); 74 women (23.4%) developed preeclampsia. The study found that NT-proBNP levels increased sharply in the days before symptom onset, making it a potential early warning marker. Levels of 116 pg/mL or higher predicted early preeclampsia with 90.9% sensitivity and 94.3% specificity. This performance matched that of the sFlt-1/PlGF ratio, the current standard test; however, NT-proBNP offers the advantage of being less expensive and more widely available. These results were unexpected. 'We knew the cardiac biomarker would be elevated in women with preeclampsia because of its link to cardiovascular dysfunction,' said the physicians. 'We did not expect the predictive performance to match that of the angiogenic factor ratio (sFlt-1/PlGF) when the diagnosis was imminent. This short-term equivalence suggests the biomarker could serve as a complementary or alternative diagnostic option where angiogenic markers are unavailable.' This predictive value could enable closer monitoring of at-risk women and allow timely preventive measures, such as administering corticosteroids to accelerate fetal lung maturation or hospital admission when necessary. Detection of Complicated Cases Beyond early preeclampsia, NT-proBNP also predicted complicated cases involving fetal growth restriction, placental abruption, or stillbirth, with a performance similar to that of the sFlt-1/PlGF ratio. The sensitivity for these complications was 84.2%, and the specificity was 91.4%, supporting the potential for broader clinical use. This integrated approach could be especially valuable in obstetric pathology or intermediate care units, where anticipating complications may improve both maternal and fetal outcomes. Clinical Translation The study aimed to assess whether NT-proBNP could serve as a diagnostic alternative in settings lacking access to more specific markers, such as the sFlt-1/PlGF ratio, which is typically limited to tertiary hospitals. However, the physicians said, 'NT-proBNP cannot replace the angiogenic ratio, which is more reliable for ruling out preeclampsia in the longer term.' For NT-proBNP to become a real diagnostic tool, 'further prospective studies in diverse populations are needed to validate the proposed cutoff value. Trials incorporating NT-proBNP into diagnostic and clinical decision-making processes are required to determine its application in the early diagnosis of preeclampsia and improved clinical management. Standardized protocols and integration into existing clinical guidelines are also essential,' said the physicians. 'We are now studying whether combining NT-proBNP with the sFlt-1/PlGF ratio can improve the prediction of preeclampsia and maternal-fetal complications. We are also considering the possibility of randomized trials to assess the clinical utility of this biomarker in decision-making, although expanding this research beyond Spain is not currently planned,' the physicians concluded. Elisa Llurba reported receiving consulting fees from the Spanish advisory board of Roche Diagnostics. The other authors declared having no conflicts of interest.
Forbes
an hour ago
- Forbes
Neurosurgery Awareness Month: So How Do You Become A Neurosurgeon?
Neurosurgeons perform intricate surgeries on the brain, spine, and the different peripheral nerves as they course throughout the body. They meticulously open a patient's skull to stop bleeding vessels, remove tumors with precision measured in millimeters and strategically reshape the spine to correct conditions like scoliosis, restoring alignment and enhancing the patient's quality of life. In essence, neurosurgeons transform lives through their expertise. But how do they achieve such mastery? How are neurosurgeons made? Step 1: Get Into Medical School Each medical school has variations in its prerequisites, but all require a strong foundation in the sciences. This includes courses such as the notoriously recondite organic chemistry as well as biology, general chemistry, and physics. These courses must not only be completed but mastered, as applicants need to distinguish themselves among peers pursuing the same rigorous curriculum, all with the same goal. Competition for medical school acceptance can be stiff. My alma mater, Georgetown University School of Medicine, for example had 14,480 applicants in 2024 for a class of around 200, with an acceptance rate of 2.89%. The average GPA was 3.76, achieved while tackling the most demanding courses. Grades serve as only the baseline hurdle. In addition to academic excellence, applicants must distinguish themselves outside the classroom through leadership, extracurricular activities, and meaningful exposure to clinical medicine. These accomplishments are essential for standing out in the highly competitive medical school admissions process. Step 2: Do Well In Medical School And Match In A Neurosurgery Residency Medical school spans four years, with the first two years focused primarily on classroom-based learning and the latter two emphasizing clinical, patient-centered training. Upon graduation, students earn the title of medical doctor but lack any specialization. Each student's unique interests and strengths guide their choice of specialty, with subsequent training varying significantly. Residency provides the specialized training in a chosen field of medicine. Residencies range from three years for some specialties to five years for others, with neurosurgery requiring the longest commitment—a grueling seven-year program known for its intensity. Aspiring neurosurgeons must excel in their preclinical years, perform exceptionally during clinical rotations, and achieve high scores on national exams. Research is also critical, as is participation in audition rotations—commonly called "away rotations"—at other university hospitals. To secure a neurosurgery residency, students need compelling letters of recommendation from neurosurgeons at their home institution and from others across the country. Ultimately, neurosurgery faculty evaluate candidates by asking critical questions: Is this individual someone we want to train as a neurosurgeon? Can they handle the demands? Most importantly, can we trust them to care for a vulnerable patient population? As a nod to a familiar saying, the person who graduates last in their medical school class may be called "doctor," but they are highly unlikely to be called anyone's neurosurgeon. Step 3: Survive And Thrive In Neurosurgery Residency Neurosurgery residency is a remarkable yet formidable endeavor. The cases are often lengthier than those in other specialties, with exceptionally high stakes. This makes the hours long. Residents learn to care for critically ill patients, a process that demands intensive hours, extensive study outside of work to prepare for cases, and the emotional resilience to confront life-and-death situations daily. Neurosurgery offers the extraordinary power to save and transform lives, but it carries the sobering reality of the potential to cause harm. It's also very busy; it is not uncommon for a junior resident to oversee the care of 40 to 70 patients during a single night shift, underscoring the intense and demanding nature of neurosurgery training. Attrition rates reflect this intensity, varying from 2.6% in recent years to 10.98% between 2005 and 2010. The first year, known as the internship, serves as an introductory training period, historically focused on responsibilities outside the operating room. As training progresses, residents undertake junior and then senior rotations as well as dedicated research periods. The culminating year, called chief residency, is when neurosurgery trainees tackle the more complex cases and assume significant leadership roles in managing the neurosurgery service, ensuring they develop into safe, competent surgeons. All neurosurgeons receive comprehensive training in the large variety of neurosurgery including pediatric neurosurgery, tumors, spine, stroke and vascular neurosurgery, equipping them to handle the field's diverse challenges. Step 4: Become An Expert, Fellowship Training Upon completing residency, a surgeon is deemed a board-eligible neurosurgeon, qualified to practice independently and perform surgeries. However, some pursue additional fellowship training, typically lasting one year, or in rare cases, two years, extending their post-medical school training to eight or nine years, respectively. These fellowships allow surgeons to master the most challenging cases or develop advanced research expertise in a specific sub-specialty, such as pediatric neurosurgery, vascular neurosurgery, trauma neurosurgery, functional neurosurgery, complex spine surgery, minimally invasive spine surgery, or tumor and skull base neurosurgery. Surgeons seeking to advance the field through academic practice frequently pursue specialized fellowship training. For instance, I am fellowship-trained in complex spinal deformity, equipping me to handle difficult, long-duration spine reconstruction surgeries. My partners, who perform most other spine surgeries, refer these complex cases to me. And, my practice is actively engaged in several spine research projects. Similarly, while I manage brain tumor surgeries when on call, my partner, who is fellowship-trained in complex tumor surgery, specializes in meticulous microscopic procedures for challenging tumors in high-risk brain regions. I refer those difficult cases to him. This pattern extends to my colleague in pediatric neurosurgery and so on. Step 5: Pass The Neurosurgery Boards And Become A Board-Certified Neurosurgeon The certification process begins during residency, where prospective neurosurgeons must pass a written examination. Then, completing residency renders them board-eligible. After a few years in practice, neurosurgeons sit for the neurosurgery boards, marking the culmination of their training and education—and the definitive affirmation of their expertise as safe neurosurgical practitioners. Upon passing, they become board-certified and diplomats of the American Board of Neurological Surgery (ABNS). It typically takes three to four years in practice for neurosurgeons to undertake the oral board process. This rigorous evaluation involves masters of the field guiding the candidate through cases step by step, incorporating clinical scenarios, MRIs, X-rays, CT scans, and occasionally anatomical models. In essence, they are assessing: did the surgeon know what to do? Did he or she understand the differential diagnosis? Was he proficient in the anatomy? Did he know when to operate? Could he articulate the surgical procedure? How could he manage a hypothetical complication? Even more critically, candidates submit their actual performed cases, including clinical notes and pre- and post-operative imaging for over a hundred sequential cases. This serves as a quality and safety audit: are the candidates delivering safe and effective care? The process is fair yet demanding, as it must be to uphold the profession's standards. Step 6: Develop The Mindset Of Mastery: Continuous Learning in Neurosurgery Neurosurgery is a field shaped by new research and data-driven techniques. To succeed and be safe, a neurosurgeon must be a dedicated learner, consistently engaging with the latest journals and attending conferences to stay current. Equally vital is the capacity to shed ego and engage in daily, introspective reflection on the successes and shortcomings of their practice. This disciplined self-examination is the foundation for refining skills and advancing toward mastery. I frequently advise our trainees that the moment they believe they've executed a flawless surgery is when they are on the pathway to becoming dangerous. Progress in this exacting specialty demands humility and an unwavering commitment to self-improvement. The most exceptional neurosurgeons are those who maintain a rigorous, yet constructive, self-critical mindset, perpetually seeking ways to elevate their calling. The emotional weight of neurosurgery also imposes a formidable challenge. Complications, setbacks, and the daily reality of facing mortality rigorously test any surgeon's resilience. Yet, this resilience enables them to process these profound experiences, draw insights from adversity, and return home to their families with renewed clarity. It is not that uncommon, for example, for a neurosurgeon to inform a patient's spouse at 6:40 p.m. that his or her husband or wife will not survive a traumatic accident, only to embrace one's own spouse hours later. I have been summoned on an idle Sunday from moments of play with my four-year-old to perform urgent surgery on another family's young child. Navigating this emotional intensity alongside personal life requires a steadfast support system and a capacity to find purpose amid hardship. Step 7: Express Gratitude Neurosurgery is an extraordinary profession, it requires profound sacrifice, steadfast support, and an unwavering commitment to personal and professional growth. Our patients are truly inspiring. It is, undeniably, a calling. As Arthur Brooks articulates, a happy life hinges on three core elements: enjoyment, satisfaction, and purpose. Neurosurgery offers these in abundance.
News24
2 hours ago
- News24
Zambia mine disaster: Heavy metals found in water, clean-up yet to begin
Zambia's government sought to calm public pollution concerns stemming from a disaster at a copper mine six months ago, saying municipal drinking water is safe, even as laboratory tests showed excessive levels of heavy metals in some areas. 'The water is fit for consumption,' Green Economy and Environment Minister Mike Mposha told reporters in Lusaka, the capital, on Friday. Laboratory results received this week showed that pH acidity readings were within safe levels in water tested in the region surrounding the mine, he said. Still, there were elevated levels of manganese and zinc in four of the 23 places that were sampled. At one river site, manganese concentrations were 400 times the acceptable limit, according to a government report Mposha's ministry released on Friday. The partial collapse of a waste dam at the Sino-Metals Leach mine in Zambia's northern Copper province in February may have released 30 times more toxic sludge into the environment than previously reported, Drizit Zambia — appointed by Chinese state-owned SML to conduct an environmental audit of the accident — said in a June 3 letter. Mposha declined to comment on the assessment, saying he's yet to receive any such report officially. Drizit warned of persisting serious health risks from heavy metals contained in the spill, and described the incident as a 'large-scale environmental catastrophe.' Vulnerabilities around tailings storage have been in particular focus over the past decade after dam disasters at two Brazilian iron-ore mines owned by Vale SA, including a 2019 collapse that killed more than 272 people. Similar failures around the world over decades have resulted in deaths, destroyed property and caused massive environmental damage. The laboratory results released by Zambia's Mines Ministry on Friday showed lingering risks from the incident. Its report used samples from water and made no reference to tests of soil that Drizit says has been contaminated too. Heavy metals Dried sludge still cakes streams and riverbanks in the fallout zone, and seasonal rains that usually begin in November may wash this into river systems, together with the heavy metals still contained in the waste, according to Drizit. The cleanup after the accident has yet to begin. The government first needs to hire a company to carry out an independent environmental impact assessment of the damage that will instruct the restoration efforts. That process has faced months of delays after Sino-Metals terminated Drizit's contract to do the work, citing unspecified contractual breaches. Drizit declined to comment. 'This is very urgent,' Mposha said on Friday. 'We should not get into the rainy season, because that can complicate things.' Zambia is Africa's second-biggest copper producer, and plans to more than triple output to 3 million tons by early next decade. The Zambian government last week played down the danger from the spill, saying there was no cause for alarm as the 'immediate danger to human, animal and plant life has been averted.' At least 50,000 tons of highly acidic mine waste escaped when the dam burst, according to official reports. Drizit estimated that at least 1.5 million tons were lost from the dam system in total — enough to fill more than 400 Olympic-sized swimming pools. Sino-Metals has apologised to the government, distributed initial compensation to farmers directly impacted, and paid a fine of 1.5 million kwacha (about R1.1 million).
