Ukraine war: Kyiv transforms surgical hospital into battleground medical facility


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Russia’s bloody invasion of Ukraine has forced the staff to transform Kyiv’s largest hospital, Clinical Hospital #8, into a battleground medical facility, according to a recent Wall Street Journal report.

Dermatologists cardiologists now assist with triaging wounded patients arriving from artillery rocket barrages as the hospital sits within 10 miles of the battleground, the paper noted. 

The staff are numb to the air raid sirens because they are so frequent to take seriously anymore, don’t wear face masks because of the constant background noise of fighting as they try to talk to communicate, per the Journal.

“Of course we are not what we used to be, but neither is the rest of the country,” said Dr. Igor Khomenko, the hospital director. 

Pregnant women a nurse (R) wait in a basement of maternity hospital as sirens warning for air raids in Mykolaiv, on March 14, 2022. – Almost half of the 49 women have had to give birth in the basement since 24 February. Mykolaïv is the scene of violent clashes, as Russian troops want to break down this last lock before the large port of Odessa, 130 km further west on the Black Sea.
(Photo by BULENT KILIC/AFP via Getty Images)

He worked for 30 years as a military surgeon, but quit earlier this year to become a civilian, yet his hope for a quiet civilian life was dashed when two weeks after he quit the military, the Russian invasion began, per the Journal.

BIDEN’S IMPULSIVE WORDS CONTINUE TO TERRIFY INSTEAD OF CONSOLE US 

“I tried civilian life it didn’t last long,” he noted, who now sleeps on a couch in his office away from his wife who has taken refuge far away from the battlefield.

He reduced his hospital staff by half canceled elective surgeries, so 200 hospital beds would be free for patients wounded by the war, the paper said.

The hospital cases are a window into war tactics as they evolve – initially they were primarily gunshot wounds as gun battles rage, but as the war has progressed, more patients are arriving with shrapnel wounds concussions, as both sides suffer from blast explosions from a distance, according to the news report.

But even though the hospital’s location is so close to the fighting, Khomenko notes it has one advantage – the wounded can go directly from the battlefield to the operating room. 

EDS NOTE: GRAPHIC CONTENT - A dead body of a woman resident lies in the center park of the town of Irpin, some 25 km (16 miles) northwest of Kyiv, Friday, March 11, 2022. Kyiv northwest suburbs such as Irpin Bucha have been enduring Russian shellfire bombardments for over a week prompting residents to leave their home.

EDS NOTE: GRAPHIC CONTENT – A dead body of a woman resident lies in the center park of the town of Irpin, some 25 km (16 miles) northwest of Kyiv, Friday, March 11, 2022. Kyiv northwest suburbs such as Irpin Bucha have been enduring Russian shellfire bombardments for over a week prompting residents to leave their home.
(AP Photo/Efrem Lukatsky)

This bypasses the traditional way the wounded are treated in war, where usually they first get treated on the battlefield as fighting continues, then mobile field hospitals while they await their opportunity to be transported to a surgical hospital for definitive care.

Khomenko describes one case: After a man was shot through the heart, the hospital staff saved his life by cracking his chest open sewing the hole shut before the patient could bleed to death.

He told the paper he operated on the man plugged the hole in his heart with his own index finger while it continued to pump to make sure the man didn’t bleed out.

Recently the Journal reported another example of Ukrainians suffering due to the unprovoked invasion. After the glass windows of the hospital shook from a large thud from a Russian missile, elderly civilians with bloody faces soon wobbled to the hospital entrance, with bandages on their heads.

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After nurses helped the patients release their padded jackets as pieces of glass hidden in folds of their clothing pierced the floor, they wheeled them to the operating room on steel gurneys, where doctors painstakingly used tweezers to remove the shards of glass out of one man’s face, hands buttocks, all while the patient lay on his stomach, clenching his fist in agony. 

Prokhorenko said he has delivered medicine to women children

Prokhorenko said he has delivered medicine to women children
(Oleksandr Prokhorenko)

But it wasn’t over. The wounds then had to be stitched up, the paper noted.

“They tell me to come back to Gaza, that Ukraine is too dangerous,” said Dr. Makhmud Akmad, the hospital’s leading vascular surgeon who was born in Gaza, but came to Ukraine to study medicine stayed after meeting a fellow student who he later married. 

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“I tell them that I will stay here, Ukraine is my home now.”



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What is alopecia? Jada Pinkett Smith joke sparks interest in the autoimmune disorder


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Alopecia is no laughing matter, Will Smith’s slap of Chris Rock, though some critics called it inappropriate, sent Rock that message, after Rock laughingly targeted wife Jada Pinkett Smith’s look during the Oscars on Sunday.

Jada Pinkett Smith has been outspoken about having the autoimmune disease known as alopecia, which creates patchy hair loss. 

Pinkett Smith decided to shave her head bald due to alopecia, according to her social media account. Alopecia is a type of autoimmune disease where the individual’s body mistakenly attacks the hair follicles causing hair to fall out, health experts told Fox News.

WILL SMITH’S SON REACTS TO CHRIS ROCK SLAP OVER JADA PINKETT SMITH: ‘AND THAT’S HOW WE DO IT’

Dr. Emma Guttman, the chair of the Department of Dermatology for Mount Sinai Health System director of Mount Sinai’s Alopecia Center of Excellence in New York City, explained to Fox News that alopecia has a lifetime prevalence of approximately 2% equally affects men women all races.

“It often starts from one or two patches but in up to 20% of patients it progresses to involve the entire body hair (universalis) or totalis (entire scalp hair),” Guttman told Fox News. “It is also highly prevalent in children, bringing much distress to the children the entire family. It is a highly devastating disease emotionally as losing hair has a tremendous impact on the well-being the way we see ourselves.”

Will Smith Jada Pinkett Smith arrive at the Oscars on Sunday, March 27, 2022, at the Dolby Theatre in Los Angeles.
(Jordan Strauss/Invision/AP)

Guttman also told Fox News this condition is more common in patients with eczema or asthma or other allergic manifestations. The dermatologist also said it can be seen in individuals who have a family history of alopecia.

Health experts explained on the Mount Sinai Center’s website that hair loss may also follow a significant event in one’s life such as pregnancy, illness or trauma that the area where the hair falls out may appear round smooth. Other symptoms may include an itching sensation or pitting of the fingernails, according to the health experts.

INCREASED CANCER RISK ASSOCIATED WITH ARTIFICIAL SWEETENERS, STUDY SAYS

Guttman told Fox News, “There are currently no FDA approved treatments for patients with alopecia areata, but there are several targets that were identified by us others which are now targeted in clinical trials.”

The experts at Mount Sinai’s center explained on their website that research in this area is looking at the person’s immune system stated “we discovered the role of the type 2 lymphocytes in alopecia areata, which has opened new avenues for research treatment.”

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Treatment approaches vary depending on the severity of the disease, physicians told Fox News. The Mount Sinai specialists stated on the website that milder cases of alopecia areata may get better on their own but more severe cases may require treatment, including corticosteroids, which can be either topically applied or administered through an injection. Experts wrote they are currently exploring other treatments that include the use of biologics JAK inhibitors, (Janus kinase inhibitors, an enzyme inhibitor used in certain inflammatory conditions some cancers, according to health experts).

The Food Drug Administration headquarters in Washington on Jan. 13, 2020.

The Food Drug Administration headquarters in Washington on Jan. 13, 2020.

“Recently, after extensive research, we identified a novel possible treatment for alopecia areata patients, which we adapted from the eczema world,” Guttman further stated to Fox News. The physician said they formed a unique center for alopecia areata that “will bring under one roof state-of-the-art research to identify new targets, together with the latest clinical trials unique clinical trials to Mount Sinai as well as excellent patient care.”

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Guttman said the group aims to find a cure for alopecia areata in partnership with the patients with pharma companies.



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CRISPR: US biofirm plans to gene-edit cats so they don’t trigger allergies


Pet cats can cause allergies

Shutterstock / Pormezz

The two genes for the protein mainly responsible for allergic reactions to cats have been deleted from cat cells using CRISPR gene editing. It is a first step towards creating hypoallergenic cats, says US-based company InBio.

“The estimated timeline for this is several years,” says Nicole Brackett, who leads the CRISPR cat team at InBio.

About 15 per cent of people have allergic reactions to cats. The main cause of this is a small protein called Fel d 1 that is secreted by salivary skin glands. It is spread over cats’ fur when felines clean themselves can become airborne as the fur dries. What, if anything, Fel d 1 does for cats isn’t known.

All cats produce Fel d 1, but a 2019 study found that levels in saliva vary greatly among typical domestic cats. It is often claimed that some specific breeds are less likely to trigger allergies, but no scientific studies have confirmed this.

Fel d 1 consists of two different subunits, there are two genes – called CH1 CH2 – encoding each subunit. When Brackett her colleagues compared the sequences of the CH1 CH2 genes in domestic cats with those in other cat species such as lions, tigers, cougars fishing cats, they found many changes.

Because the sequence of genes with key functions tends to change little if at all, this suggests that Fel d 1 isn’t essential. The only way to find out for sure, however, will be to see what happens to cats that cannot produce any Fel d 1.

Next, the team deleted either the CH1 or the CH2 gene from cat cells growing in culture using the CRISPR genome editing technique. The next step will be to delete all copies of the two genes at once, to confirm that this prevents cells making the Fel d 1 protein. Only then the team will try to create cats that lack the genes.

“[We have] no particular cat breeds in mind at the moment,” says Brackett.

In the 2000s, at least two other companies announced plans to modify moggies to eliminate Fel d 1, but neither managed it. However, achieving this is now more feasible thanks to the development of CRISPR in 2012.

Some other companies are exploring alternative ways of reducing Fel d 1, such as a vaccine that makes cats produce antibodies that mop up Fel d 1 before it is secreted.

Journal reference: The CRISPR Journal, DOI: 10.1089/crispr.2021.0101

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First ever gene therapy gel corrects epidermolysis bullosa skin condition


People with recessive dystrophic epidermolysis bullosa, a genetic condition that causes widespread skin blistering, have been successfully treated by inserting new collagen genes into their skin

Health



28 March 2022

A skin sample from someone with epidermolysis bullosa. Two layers of the skin, the epidermis the dermis, have become separated because there is no collagen between them

ISM/SCIENCE PHOTO LIBRARY

A rare genetic skin condition has been corrected for the first time using a gene therapy that is applied to the skin.

About 1 in 800,000 children in the US are born with a severe condition called recessive dystrophic epidermolysis bullosa that makes their skin extremely fragile prone to tearing blistering.

“It is very painful,” says Vincenzo Mascoli, 22, who travelled from Italy to the US to have the gene therapy. He had open wounds all over his body, including one covering his entire back that had been there since he was 2 years old. “Sometimes I also get blisters in my eyes have to keep my eyes closed, sometimes I get blisters in my throat that make it difficult to eat – I can only have liquid food then,” he says.

Mascoli other people with the condition have fragile skin because they have a faulty version of a collagen gene called COL7A1. That means their skin can’t produce the collagen proteins needed to give it structure strength.

Peter Marinkovich at Stanford University in California his colleagues developed a way to insert normal COL7A1 genes into the skin of such individuals so they can start producing collagen properly.

They did this by engineering herpes simplex virus to deliver COL7A1 genes into skin cells. This virus is normally known as the cause of cold sores, but it was modified so it couldn’t replicate or cause disease. “All it does is go into the cell deliver the gene,” says Marinkovich.

The gene therapy was then incorporated into a gel so it could be applied to the skin. It was tested in a late-stage clinical trial in the US involving 31 children adults with recessive dystrophic epidermolysis bullosa, including Mascoli.

For each participant, the gene therapy gel was applied to one of their wounds an inactive gel applied to another to compare the difference. The treatment was repeated weekly until the wounds closed.

After three months, 71 per cent of the wounds treated with the gene therapy had completely healed, compared with 20 per cent of those treated with the inactive gel, there were no serious side effects.

Mascoli’s large back wound was treated with the gene therapy it is now 95 per cent closed. “The gene therapy was very good for my back. Now, I can have a bath without it burning my skin,” he says. “I hope I will be able to use it on the rest of my body.”

Marinkovich has been trying to develop a treatment for epidermolysis bullosa for more than 25 years. He says it is “so nice to finally have something to offer this patient population. Up until now, they’ve had nothing, there have been no specific therapies.”

A US company called Krystal Biotech has partnered with Marinkovich his colleagues to develop the gene therapy will apply in the next few months for approval from the US Food Drug Administration to make it available to patients.

A major advantage of the treatment is that it can be shipped anywhere used off the shelf, says Marinkovich.

The effects aren’t permanent because skin cells that take up the new COL7A1 genes naturally die off get replaced, so the gel must be reapplied approximately every six months, he says.

He believes that other genetic skin disorders could also be corrected using gene therapies that can be applied to the skin. For example, Krystal Biotech is developing similar treatments for Netherton syndrome, which is caused by defective SPINK5 genes makes the skin scaly red, a type of congenital ichthyosis that is caused by faulty TGM1 genes also causes skin scaling.

Gene therapies are also being developed for non-skin conditions like amyotrophic lateral sclerosis age-related macular degeneration, but these are more complicated because new genes must be injected into cells near the spinal cord or the back of the eye, respectively, rather than simply being applied to the skin.

Journal reference: Nature Medicine, DOI: 10.1038/s41591-022-01737-y

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Encryption is key to data protection, but not all strategies look alike

Cyber threats against healthcare organizations have been ramping up in the past few years, with highly publicized ransomware attacks leading to weeks-long network shutdowns at some institutions.

Experts warn that the situation may only worsen as bad actors become more sophisticated – as some get a boost from state-sponsored entities.

Anurag Lal, CEO of NetSfere – which provides companies with security message-delivery capabilities – caught up with Healthcare IT News to discuss what he sees as the most pressing cyber threat, how organizations can protect themselves how his experience as director of the U.S. National BroadbTask Force helped shape his perspective on these issues.

Q. Why are healthcare organizations particularly vulnerable to attacks?

A. Healthcare organizations are more at risk for cyber threats for a number of reasons. One, their systems are typically outdated slower, less secure as a result. Additionally, the pandemic accelerated the digitization of the healthcare industry, an estimated 93% of healthcare organizations experienced some sort of data breach over the past two years.

These rushed transformation processes outdated systems, combined with less centralized workplaces due to remote hybrid work, create a large amount of risk for attacks.

Another reason healthcare organizations are more vulnerable is because their data is extremely valuable to hackers. Medical records billing info create a huge target on the back of healthcare systems. Stolen health records may sell [for] up to 10 times more than credit card information on the dark web.

Q. What steps can organizations take to protect themselves?

A. Communicating efficiently securely to protect patient company data should remain a top priority as healthcare organizations become more digital. When deploying new communication channels, both internally between employees with patients providers, encryption is key.

Not all encryption is the same, though. End-to-end encryption is the “gold standard” when it comes to safe communications, verifying that messages are protected through every step of the process.

It’s also important to educate employees on the dangers of phishing scams, as the majority of security breaches are a result of human error.

Q. On a related note, how can an organization be cognizant of protecting its communications with providers patients?

A. Similarly to protecting themselves, healthcare organizations can protect their communications with providers patients by modernizing communication channels ensuring compliance. Regulations like the Health Insurance Portability Accountability Act require healthcare organizations to follow specific (stringent) standards for Protected Health Information, including sensitive patient information like medical histories test results.

At the end of the day, the patient their information are the priority should be protected as such.

Q. What actions should the federal government be taking to address this threat?

A. The government should proactively implement safeguards to protect U.S. institutions from an inevitable cyber attack attempt.

One example is encouraging organizations to require Zero Trust Security end-to-end-encryption. The idea behind the Zero Trust Security model is to “never trust, always verify” to protect data intellectual property most securely. All resources are continuously authenticated, verified authorized.

As I mentioned earlier, with E2EE, data is encrypted on the sender’s system or device, only the intended recipient is able to decrypt read the message. Ensuring that business communication is locked down in this way applies zero trust principles to mobile messaging collaboration. 

Q. You were director of the U.S. National BroadbTask Force under the Obama administration. How did that experience help shape your perspective on these issues?

A. During my time working on the Task Force, I saw in real-time the very serious threats that exist saw how cyber-attacks affected other governments. For example, [bad actors linked to the] Russian government hacked the Ukrainian power grid, resulting in nationwide outages. Later, [they] installed malware on Ukraine’s accounting software, causing billions of dollars in damages.

Q. Do you have any predictions for the next few years in the cybersecurity sector?

A. I predict that cyber-attacks will become more technologically advanced, so our ability to protect organizations governments will need to become more advanced alongside them. This is evidenced by skyrocketing cyberattacks with 1,862  publicly reported breaches in the U.S. in 2021, up more than 68% from 2020.

Kat Jercich is senior editor of Healthcare IT News.
Twitter: @kjercich
Email: [email protected]g
Healthcare IT News is a HIMSS Media publication.





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