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The State of Multiple Sclerosis Therapy and Trends in Thinking: Robert K. Shin, MD – Neurology Live

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WATCH TIME: 5 minutes

“As we’ve seen at AAN and other meetings, data using different biomarkers, whether it’s optical coherence tomography, serum neurofilament light, other biological markers, volumetric MRI, other more investigational MRI markers—what’s the common theme? We’re seeing that neurodegeneration occurs from the beginning of the disease process, if not probably before the patient’s even aware or the providers are even aware of the diagnosis. I would say, rather than two different stages, we now see them almost as overlapping. We see that there is a progressive neurodegenerative component that is occurring, as best we can tell, probably from the beginning of the disease process that is punctuated by relapses.”

In the three decades since the first multiple sclerosis (MS) therapeutics were introduced in the 1990s, much progress has been made in developing effective and disease-modifying therapies (DMTs) for the disease. Now, even more novel approaches, such as those targeting Bruton tyrosine kinase (BTK) inhibition, or those with varied dosing options, are being explored to improve upon other aspects of disease management—particularly quality of life.

Despite this progress in improving treatments, though, many patients still utilize older drugs. Often, this can be related to their disease status, or to reduce the risk of unwanted adverse effects, or other reasons. Shared decision-making between patient and physician helps to result in a goal of treatment: optimization. That has also driven conversations about induction vs escalation strategies for the use of DMTs, and although the field appears to lean more toward induction—beginning with aggressive, high-efficacy treatment—a furthered understanding of the disease pathology has somewhat muddied the waters.

For Robert K. Shin, MD, professor of neurology, MedStar Georgetown University Hospital, the conversation about the state of treatment for MS is reflective of a shift in thinking from the field. In a conversation with NeurologyLive®, he spoke about the changes in thinking that have occurred since the 1990s and what trends are appearing in the approach to disease management.

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First reported case of a person getting COVID from a cat – Nature.com

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Cats can catch and transmit SARS-CoV-2.Credit: Vachira Vachira/NurPhoto/Getty

First there were sneezing hamsters, now sneezing cats. A team in Thailand reports the first solid evidence of a pet cat infecting a person with SARS-CoV-2 — adding felines to the list of animals that can transmit the virus to people.

Researchers say the results are convincing. They are surprised that it has taken this long to establish that transmission can occur, given the scale of the pandemic, the virus’s ability to jump between animal species, and the close contact between cats and people. “We’ve known this was a possibility for two years,” says Angela Bosco-Lauth, an infectious-disease researcher at Colorado State University in Fort Collins.

Studies early in the pandemic found that cats shed infectious virus particles and can infect other cats. And over the course of the pandemic, countries have reported SARS-CoV-2 infections in dozens of pet cats. But establishing the direction of viral spread — from cat to person or from person to cat — is tricky. The Thai study “is an interesting case report, and a great example of what good contact tracing can do”, says Marion Koopmans, a virologist at the Erasmus University Medical Center in Rotterdam, the Netherlands.

The feline finding, published in Emerging Infectious Diseases1 on 6 June, came about by accident, says co-author Sarunyou Chusri, an infectious-disease researcher and physician at Prince of Songkla University in Hat Yai, southern Thailand. In August, a father and son who had tested positive for SARS-CoV-2 were transferred to an isolation ward at the university’s hospital. Their ten-year-old cat was also swabbed and tested positive. While being swabbed, the cat sneezed in the face of a veterinary surgeon, who was wearing a mask and gloves but no eye protection.

Three days later, the vet developed a fever, sniffles and a cough, and later tested positive for SARS-CoV-2, but none of her close contacts developed COVID-19, suggesting that she had been infected by the cat. Genetic analysis also confirmed that the vet was infected with the same variant as the cat and its owners, and the viral genomic sequences were identical.

Low risk

Researchers say that such cases of cat-to-human transmission are probably rare. Experimental studies have shown that infected cats don’t shed much virus, and shed for only a few days, says Leo Poon, a virologist at the University of Hong Kong.

Still, Chusri says it is worth taking extra precautions when handling cats suspected of being infected. People “should not abandon their cats, but take more care of them”, he says.

Other animals suspected of infecting people include farmed mink in Europe and North America, pet hamsters in Hong Kong and wild white-tailed deer in Canada. Adding cats to the list “expands our understanding of the zoonotic potential of this virus”, says Poon.

But researchers say these are all rare events and animals don’t yet play a significant part in spreading the virus. “Humans are clearly still the major source of the virus,” says Bosco-Lauth.

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WHO warns of monkeypox risk to kids, pregnant people if spread continues – CBC News

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The World Health Organization said “sustained transmission” of monkeypox worldwide could see the virus begin to move into high-risk groups, such as pregnant people, immunocompromised people and children.

WHO said on Wednesday it is investigating reports of infected children, including two cases in the United Kingdom, as well as following up reports in Spain and France. None of the cases in children have been severe.

The virus has now been identified in more than 50 new countries outside the countries in Africa where it is endemic. Cases are also rising in those countries, said WHO, calling for testing to be ramped up.

“I’m concerned about sustained transmission because it would suggest that the virus establishing itself and it could move into high risk groups including children, the immunocompromised and pregnant women,” said WHO chief Tedros Adhanom Ghebreyesus.

Sustained transmission is characterized by the World Health Organization as an illness that can transmit easily from one person to others in the population.

Monkeypox is usually mild, and is endemic in parts of western and central Africa. It is spread by close contact, so it is relatively easy to contain through measures such as self-isolation and hygiene. 

A monkeypox virus particle is seen in this coloured transmission electron micrograph. The World Health Organization is warning that the virus could pose a risk to vulnerable people if it continues to spread. (UK Health Security Agency/Science Photo Library)

There have been more than 3,400 cases of monkeypox and one death since the outbreak began in May, largely in Europe among men who have sex with men, according to a WHO tally. There have also been more than 1,500 cases and 66 deaths in countries this year where the disease more commonly spreads.

At least 275 cases of monkeypox have been confirmed in Canada. Those include 202 cases in Quebec, 67 cases in Ontario, four in Alberta and two in British Columbia.

The Public Health Agency of Canada (PHAC) declined to comment on WHO’s warning on Wednesday.

Health officials will likely face questions about Canada’s monkeypox response at a media conference scheduled for 11 a.m. ET on Thursday.

Not a global health emergency ‘at this stage’

WHO’s warning comes days after it said the global outbreak of the virus should be closely monitored, but does not warrant being declared a global health emergency.

In a statement Saturday, a WHO emergency committee said many aspects of the outbreak were “unusual” and acknowledged that monkeypox — which is endemic in some African countries — has been neglected for years.

“While a few members expressed differing views, the committee resolved by consensus to advise the WHO director general that at this stage the outbreak should be determined to not constitute” a global health emergency, WHO said in a statement.

WHO nevertheless pointed to the “emergency nature” of the outbreak and said controlling its spread requires an “intense” response.

The committee said the outbreak should be “closely monitored and reviewed after a few weeks.” But it said it would recommend a re-assessment before then if certain new developments emerge, such as cases among sex workers, spread to other countries or within countries that have already had cases, increased severity of cases or an increasing rate of spread.

The UN agency said it was also working on a mechanism to distribute vaccines more equitably, after countries including Britain and the United States suggested they were willing to share their stockpiled smallpox vaccines, which also protect against monkeypox.

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Heart Attack Drug Proves Effective at Treating Stroke – Technology Networks

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In the largest stroke clinical trial ever run in Canada, researchers have shown Tenecteplase (TNK), a safe, well tolerated drug, commonly used as a clot buster for heart attacks, is an effective treatment for acute ischemic stroke. Led by researchers with the University of Calgary at the Foothills Medical Centre and Sunnybrook Health Sciences Centre, fully affiliated with the University of Toronto, the study included 1600 patients at hospitals throughout Canada.

“It is truly an important finding that I share with my colleagues from coast to coast. Through this collaboration these findings could revolutionize stroke treatment throughout the world,” says Dr. Bijoy Menon, MD, professor at the University of Calgary, neurologist at the Foothills Medical Centre and co-principal investigator on the study. “Tenecteplase is known to be an effective clot dissolving drug. It is very easy to administer which makes it a game changer when seconds count to save brain cells,”

Based on current guidelines, Alteplase (tPA) is the recommended drug for acute ischemic stroke patients. The challenge is that the drug is more complex to administer. It takes up to an hour and requires an infusion pump that needs to be monitored. The pump can be cumbersome when transporting a patient within a hospital, or to a major stroke center for treatment.

“One of the reasons Tenecteplase is so effective is that in can be administered as a single immediate dose,” says Dr. Rick Swartz, MD, PhD, clinician-researcher at the University of Toronto, co-principal investigator, and stroke neurologist at Sunnybrook Health Sciences Centre. “That’s a big advantage, saving critical time and complication. TNK could potentially be administered wherever the patient is seen first, at a medical centre or small hospital,”

The AcT Trial compared TNK to tPA in a randomized trial. The results published in The Lancet show that TNK worked as well as, if not better than, the current recommended drug, tPA. TNK attaches itself to the clot for a longer period of time than tPA which means that blood flow is restored faster and for a longer period of time. Along with discovering a better way to treat acute ischemic stroke, the team also established a more cost effective, and efficient way to conduct clinical trials. 

Reference: Menon BK, Buck BH, Singh N, et al. Intravenous tenecteplase compared with alteplase for acute ischaemic stroke in Canada (AcT): a pragmatic, multicentre, open-label, registry-linked, randomised, controlled, non-inferiority trial. The Lancet. 2022;0(0). doi: 10.1016/S0140-6736(22)01054-6

This article has been republished from the following materials. Note: material may have been edited for length and content. For further information, please contact the cited source.

 

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