When Janice* began to have trouble with her short-term memory, she and her husband became concerned.

“My dad had been diagnosed with Alzheimer’s disease in his early 60’s, so I had a pretty good view of what it looked like,” says Janice. “I spoke to my family doctor and was later referred to Sunnybrook.”

Janice, who is now in her mid-seventies, was then assessed by Dr. Sandra Black, renowned cognitive neurologist and Scientific Director of the Dr. Sandra Black Centre for Brain Resilience and Recovery at Sunnybrook Research Institute.

After a series of tests, Janice was diagnosed with Mild Cognitive Impairment. The condition is defined when there is a memory problem or other cognitive complaints by the person or their family, but the person is still able to carry out all activities of daily living. MCI can include problems with memory, word finding or way finding, concentration, problem solving insight and judgment.

Dr. Black’s team, which embeds research into care, offered Janice participation in an observational study called the Brain Eye Amyloid Memory (BEAM) study, which provided a detailed eye exam, cognitive testing, mood and daily function questionnaires, and a quantitative brain scan using Magnetic Resonance Imaging (MRI) and Positron Emission Tomography (PET). After participating in BEAM, Janice was found to have amyloid deposits in her brain, and diagnosed with MCI due to early-stage Alzheimer’s disease.

Living with early-stage Alzheimer’s disease

For Janice, living with early-stage Alzheimer’s disease means she now relies more heavily on her husband for support, and spends a lot of her time doing whatever she can to slow down the disease.

“We eat a Mediterranean diet, have switched to non-alcoholic wine, and spend time walking outdoors and exercising in our home gym,” says Janice. Previous research suggests that physical activity and exercise have the potential to lessen amyloid buildup in the brain, while also decreasing inflammation. “We also aim to get 7-8 hours of sleep each night.”

Janice knows the importance of staying engaged with friends and keeping her brain stimulated, using apps like Duolingo and Wordle regularly.

“We’re planning a trip to Paris shortly, so I’ve been practicing my French every day.”

Joining a clinical trial

Janice and her husband with Dr. Sandra Black, cognitive neurologist and Scientific Director of the Dr. Sandra Black Centre for Brain Resilience and Recovery at Sunnybrook Research Institute.

As part of her efforts to potentially slow down the disease, Janice enrolled in a pharmaceutical clinical trial at Sunnybrook investigating a potential new antibody therapy aimed at blocking the tau tangle formation that co-occurs with amyloid plaques in Alzheimer’s disease. At the Dr. Sandra Black Centre for Brain Resilience and Recovery, researchers are actively involved in several trials testing biomarkers (including in the blood and eyes), as well as new potentially disease-modifying treatments for Alzheimer’s disease and other dementias.

The trial Janice is participating in is a double-blinded randomized control trial, meaning that she and the research team are unaware if she is receiving a placebo or the experimental therapy, which is currently being tested for efficacy and safety.

“My hope is potential therapies like these will slow down the disease for me or others. You can’t be unrealistic, but you can be hopeful.”

She visits Sunnybrook with her husband each month for an infusion, and is closely monitored by the clinical trials team, which sometimes includes assessments like cognitive testing, brain imaging, EKGs, and blood work as well.

Although she doesn’t know if the infusions are helping her, she remains positive. “If things don’t get too much worse, we could handle it. We’re doing everything we can.”

Janice’s advice for other people facing a similar situation?

“As soon as you notice something is off, try to save yourself and your family by doing everything you can. Don’t try to hide it. [This disease] is not going to go easy on you, but there is a lot you can do — don’t give up.”

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After living with the symptoms of depression and post-traumatic stress disorder (PTSD) for more than a decade, Sarah* had tried numerous medications, electroconvulsive therapy (ECT), and was engaged in psychotherapy, but at a certain point nothing was working.

“I did everything right and I was trying my best to live a productive life [despite my symptoms], but I was struggling,” says Sarah.

Triggers or reminders of Sarah’s past traumas would lead to feelings of crippling fear, dissociation and depression that would make it difficult to get through the day.

“I was constantly jumpy and on high alert, trying to avoid situations that would bring back memories,” says Sarah. “I consistently withdrew from people and my world became really, really small.”

A ground-breaking clinical trial: deep brain stimulation for PTSD

In early 2020, Sarah was referred to a clinical trial at Sunnybrook investigating a new approach for treatment-resistant PTSD called deep brain stimulation (DBS). DBS is a type of brain surgery that directly targets dysfunctioning brain circuits. It involves inserting thin electrodes into brain structures that are responsible for associated symptoms and electrically stimulating them with a pacemaker-like device, which is implanted in the chest.

Researchers at Sunnybrook had launched a first-in-Canada phase I trial investigating the therapy.

“When I learned about DBS, I didn’t have any hope but I was willing to try anything,” says Sarah. “I thought best case scenario – maybe this research will be able to help someone else.”

Finding hope after deep brain stimulation

During the procedure, Sarah remembers a moment when the surgical team stimulated a certain part of the brain: “it immediately seemed brighter in the room. That was the first indicator, something changed in that moment, and it gave me a little bit of hope.”

The weeks after surgery when the device was turned on, Sarah’s friends and family began noticing a change.

“I didn’t feel significantly different right away, but my family members said they saw a sparkle in my eyes like there was life in me again,” says Sarah.

In the year following surgery, she had landed a new job and applied to nursing school.

“DBS changed my life. I was finally starting to think about the future again.”

Sarah notes that she has seen significant improvement in her quality of life, but it “wasn’t magic and takes a lot of work”. She still experiences symptoms from time to time.

“I’m doing really well, but it doesn’t mean every day is perfect. Something can trigger me, but the difference is, now I notice it and move on. It doesn’t mess me up for hours. I can come back from it.”

A new lease on life

Sarah says one of the most powerful things about DBS is how it reaffirmed her mental illness as physiological. “When I would get my levels adjusted, I would see a change. It wasn’t about how hard I was trying or what was happening around me. It’s beyond my control. That was really powerful.”

Two years post-surgery, Sarah is doing well. She’s now in nursing school and this year had the opportunity to come back to Sunnybrook as part of her clinical nursing rotation.

“[Before DBS], I was frozen, living in a constant state of fear. Now, I feel free and present,” says Sarah.

“It’s so surreal. Two years ago, I would have never imagined I’d be here.”

Read more: Deep brain stimulation (DBS) shown to be safe in treating post-traumatic stress disorder

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In a recently published preclinical study, Dr. Isabelle Aubert, senior scientist at Sunnybrook Research Institute and postdoctoral researcher Dr. Kristiana Xhima successfully used focused ultrasound to non-invasively deliver a therapeutic in the brain, targeting brain cells affected by Alzheimer’s disease and improving cognition.

The study has been published in the journal BRAIN.

This is the first study to demonstrate that repeated focused ultrasound blood-brain barrier modulation in the basal forebrain is safe in the presence of Alzheimer’s pathology, and when combined with a growth factor-related therapeutic, can lead to therapeutic effects. Focused ultrasound harnesses the power of sound waves to transiently open the blood-brain barrier, a protective barrier that prevents toxins or potentially helpful therapeutics in the bloodstream from entering the brain.

This promising research comes at an urgent time. It is estimated that more than 600,000 Canadians are currently living with dementia. According to a recent report from the Alzheimer’s Society of Canada, rates of dementia, including Alzheimer’s disease, are projected to rise to nearly 1 million people in Canada by 2030. Below, Drs. Aubert and Xhima discuss how their breakthrough research is an important advancement on the road to developing effective therapeutic approaches for the disease.

Dr. Aubert and Dr. Xhima

What was the impetus behind your study?

Dr. Aubert: This preclinical study was a follow-up to our previous proof-of-concept study that used MRI-guided focused ultrasound to non-invasively deliver a type of growth factor-related therapeutic (D3) to brain cells called cholinergic neurons, which are important for learning and memory and most vulnerable in Alzheimer’s disease. D3 stimulates important signaling mechanisms in brain cells that are related to the tropomyosin receptor kinase A (TrkA) pathway. The TrkA pathway is critical for neuroprotection, plasticity and survival of cholinergic neurons; engaging it with D3 promotes the resilience of brain cells against Alzheimer’s pathology.

In our first proof-of-concept study, we had found that D3 combined with focused ultrasound efficiently stimulated key survival and neuroprotective pathways, and in the short-term, helped to restore brain cell communication (also known as neurotransmission). Yet for clinical translation and impact, it was critical for us to study whether focused ultrasound combined with D3 could rescue cognitive function – the rationale and goal of the current study.

What did your current study find?

Dr. Xhima: In this preclinical study, we demonstrated the therapeutic potential of D3 in a preclinical model of Alzheimer’s and showed its impact on learning, memory and cognitive flexibility. The D3 therapeutic agent, like many promising therapeutics, does not have the properties required to efficiently cross the blood-brain barrier (BBB) and reach its targets deep in the brain. To overcome this challenge, we coupled the intravenous administration of the therapeutic drug D3 with MR-guided focused ultrasound to non-invasively, locally and transiently increase BBB permeability in key brain regions for the effective delivery of D3 from the blood to the brain.

Following brain delivery of the therapeutic agent with focused ultrasound, performance in cognitive tasks was improved. The treatment of focused ultrasound with the therapeutic D3 led to enhanced neurotransmission in cholinergic neurons, which are highly vulnerable to injury in Alzheimer’s disease. We also observed beneficial effects on brain regeneration – new brain cells were formed in the hippocampus, an area of the brain that plays a major role in learning and memory, and amyloid plaques, common in Alzheimer’s, were reduced in targeted brain areas.

What could these results mean for patients and clinicians in the future?

Dr. Aubert: Although still early-stage, this work is an important and fundamental step in the development of potential treatments for the disease. The results also open the door for many other regenerative agents, that normally do not cross the BBB, to be tested and delivered using this drug-delivery platform. This is the first study to demonstrate that a growth-factor related agent delivered to the basal forebrain and associated cortical and hippocampal areas repeatedly using focused ultrasound BBB modulation is safe and can lead to therapeutic effects in the presence of Alzheimer’s pathology. These results provide a major step forward in terms of drug delivery that can be very promising for clinical translation.

Dr. Xhima: Another key feature of this preclinical research is that we tested focused ultrasound delivery of a TrkA-stimulating agent in the presence of established Alzheimer’s pathology. In contrast to many previous studies, here we showed that this therapeutic approach rescued cognition and improved Alzheimer’s related pathologies once they were already established, similar to how patients would present in the clinic. The beneficial effects of the treatment were also broad with respect to several key systems affected in Alzheimer’s disease. This makes us very hopeful about this therapeutic approach because it certainly represents an important step forward for potential clinical development.

What’s the next step in this work?

Dr. Xhima: The improvements in cognitive function we saw in the preclinical models studied lasted for several weeks, which raises the question: how often will treatment need to be repeated for therapeutic effects that can last over months and years?

Dr. Aubert: In addition to this, we’re interested in taking an exploratory approach to look at other molecular pathways in the brain that could also be affected by this treatment, since our results went beyond what was expected with target engagement on cholinergic neurons alone.

It’s important to note that this research is still at an early stage and has not yet moved to clinical trials. We are hopeful that this fundamental research will translate into the clinic in the near future, as we continue to explore therapeutic options to stop degeneration and promote regeneration in Alzheimer’s disease and dementia.

Hear Dr. Aubert and Dr. Xhima discuss their findings in further scientific detail on the BRAIN podcast, the official podcast of Brain and Brain Communications.

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Dr. Lesley Gotlib Conn

As a medical anthropologist working at one of Canada’s busiest hospitals, Dr. Lesley Gotlib Conn examines important aspects of health care delivery like communication and care transitions, and uses theories and methods from her anthropological training to improve care experiences and outcomes for patients, families, and health-care providers. She also examines the experiences and perceptions of trainees.

“We recently published the results of a study examining North American surgical residents’ attitudes toward the educational value of caring for injured older adults,” says Dr. Gotlib Conn, an associate scientist in the Tory Trauma Research Program at Sunnybrook Research Institute and Associate Director of SHARE. “A major finding of the research was that trainees reported less interest in learning about geriatric trauma care as they progressed through their training. This has important implications for the future of surgical training and care, since surgeons will be increasingly needed to treat the growing population of injured older adults.”

Dr. Gotlib Conn first became interested in education research while working on her PhD which explored the social construction of gender and sexuality in a psychiatric teaching clinic. Her research explored, in part, how learners and trainees in the clinic were socialized to think about gender and sexuality in medical ways. “The study of doctors’ and health professionals’ socialization has a long history in anthropology and sociology and that is what drew me into the field of education research,” says Dr. Gotlib Conn.

Now in her tenth year as a scientist at Sunnybrook, Dr. Gotlib Conn is proud to be advancing education research with SHARE. “At Sunnybrook we are fortunate to have a diverse and highly collaborative group of education researchers who are focused on understanding and improving learning, teaching and clinical training across many health professions. Every year I am more and more impressed by the caliber of the education research that is proposed to our grant competition and presented during rounds and at our annual symposium.” 

Dr. Giovanna Sirianni

As a family physician with a focused practice in palliative care, empathy is a core competency for Dr. Giovanna Sirianni.

Among her many education research interests, she is particularly focused on developing communication skills and the provision of compassionate care, which is in part why she co-created the About Empathy podcast, a healthCARE podcast that focuses on patient, caregiver and health-care provider stories.

“Podcast guests discuss their personal stories, while myself and my co-hosts reflect on those stories to help enable and support empathic interactions in the health-care community,” says Dr. Sirianni. “Our team has undertaken a qualitative exploration of the podcast’s role in education from the perspective of medical students, residents and faculty members.”

The podcast’s role in medical education is just one of many projects Dr. Sirianni is working on at any given time. “Whenever I’m developing a new curricular intervention, assessment method or project, I try to approach each initiative through a scholarly lens to help question, evaluate and eventually disseminate,” says Dr. Sirianni, who is also an Assistant Professor and Enhanced Skills Residency Program Director in the Department of Family and Community Medicine in the Temerty Faculty of Medicine at the University of Toronto.

Her passion for education research is inspired by many of the physicians, teachers and scientists she’s had the opportunity to work with throughout her career. “They modeled the importance of asking provocative questions about our approach to medical education and not accepting the status quo,” says Dr. Sirianni. “They also helped demystify the world of academia and made it accessible for me to feel like I had a place in education research too.”

Dr. Sirianni says that spirit is supported at Sunnybrook, in particular through Sunnybrook’s Education Advisory Council, via their yearly grant program that funds education research projects. “This is a tangible and practical way that we recognize and move forward the work of educators, scholars and researchers.”

The post Get to know SHARE: Meet two Sunnybrook education researchers appeared first on Your Health Matters.

A new study, published this week, from Sunnybrook senior scientist Dr. Donald Redelmeier explores how an available simple diagnosis can skew complex medical decision making.

“Occam’s razor is the traditional idea that simple explanations should be preferred over more convoluted theories,” says Dr. Redelmeier, who is also a Sunnybrook staff physician and Canada Research Chair in Medical Decision Making. “Yet this idea has rarely been subjected to experimental testing for evidence-based medicine.”

Dr. Redelmeier and his co-author Dr. Eldar Shafir from Princeton University were interested in testing the concept in the context of the COVID-19 pandemic. “We hypothesized that an available alternative explanation might lead individuals to underestimate the likelihood of a COVID-19 diagnosis,” says Dr. Redelmeier.

The study asked community members and health-care professionals to judge the chances of COVID-19 in a hypothetical patient through a set of different surveys. Each survey provided a succinct description of a hypothetical patient scenario, suggestive of COVID-19. Each scenario was formulated in two versions randomized to participants, differing only in whether an alternative diagnosis was present or absent.

“Through scenarios involving a spectrum of risk, we found that respondents judged the probability of COVID to be much lower in the presence of another diagnosis, such as influenza or strep throat, compared with when an alternative diagnosis was absent,” says Dr. Redelmeier. This contradicts available microbiological evidence.

“The bias can lead individuals to mistakenly lower their judged likelihood of COVID or another disease when an alternate diagnosis is present. In turn, underestimating the risk of COVID infection might reduce a patient’s willingness to seek care and a clinician’s willingness to investigate a medical diagnosis.”

Dr. Redelmeier adds that the results suggest an available simple diagnosis can lead to premature closure and a failure to fully consider additional serious diseases.

“This bias occurs because risk factors such as crowded living spaces, lapses in hand hygiene, and poverty are risk factors for COVID infection, as well as for other diseases such tuberculosis. After diagnosing a patient with COVID, for example, a clinician might pause and check — is that really everything?”

He adds that as patients are living longer with multiple diagnoses occurring together, an over-reliance on Occam’s razor can contribute to misplaced complacency and discourages the search for additional contributing factors.

“The bias may be important to recognize for the COVID-19 pandemic, other diseases, and for the next disease outbreak.”

The post Can an easy excuse lead people to underestimate a COVID-19 diagnosis? appeared first on Your Health Matters.

Samiha’s impressive dedication both inside and outside of the pool has helped her achieve success, but she says she wouldn’t be where she is without support and credits ongoing mentorship to her success, especially throughout her education.

“It takes a lot of people to raise a successful physician,” says Samiha, who is a participant of the Sunnybrook Program to Access Research Knowledge for Black and Indigenous Medical Students or SPARK. “I’ve always wanted to practice medicine and conduct research, but as a young person coming to North America from Egypt on my own, I faced many barriers. My experience emphasizes the importance of mentorship.”

At 16, Samiha left Egypt to attend Grand Canyon University, where she was awarded a full undergraduate scholarship for swimming. After three years in the U.S, Samiha wanted a stable place to call home for the long educational journey ahead of her. She applied for permanent residency in Canada and began her master’s in epidemiology at the University of Calgary.

“Before coming to Canada, I cold-emailed about 70 supervisors before connecting with Dr. Kirsten Fiest at the University of Calgary.” says Samiha. “It was through her mentorship that I learned how to learn. She provided me with unique opportunities, connections and accommodations, such as a flexible schedule while I was fasting for Ramadan. She also helped me navigate the simple things nobody tells you how to do as a 19-year-old in a new country, like getting a health card.”

A unique mentorship program: SPARK

Fast forward to today, Samiha is a second-year medical student at the University of Toronto and a participant of SPARK. “Seeing the impact mentorship had on my master’s education, I knew it would be important to find strong mentors throughout my medical school experience as well,” says Samiha. “I was connected to Dr. Jill Tinmouth, who introduced me to SPARK.”

The program, which launched in the Fall of 2021, provides a highly supported experience for University of Toronto Black and Indigenous medical students to explore research. It prioritizes student experience and mentorship, providing each student with career and community mentors in addition to their research supervisor.

“The program leads, Drs. Jill Tinmouth, Mireille Norris and Nick Daneman often say, ‘Be yourself. We trust you.’ It’s very unique to this program,” says Samiha. “SPARK allows you a safe space to be honest about who you are and where you come from.”

Samiha explains another unique aspect of the program is its approach to matching students with supervisors. During the application process, the mentor provides a statement of interest and students rank their preferred projects based on their goals and preferences.

“SPARK is really a pioneer in their approach built on mutual respect and collaboration — they trust the student to choose the project and the mentor.”

Building confidence

Samiha is currently working with research supervisor Dr. Rob Fowler, senior scientist and Chief of the Tory Trauma Program.

“Dr. Fowler has been extremely welcoming, providing me time to get to know the environment and enabling me to choose a research question I’m extremely passionate about,” says Samiha. “He has helped me overcome many of the insecurities I didn’t realize I had, allowing me to feel supported and consider opportunities even beyond medicine.”

In addition to the research experience and mentorship she expects to gain, Samiha says the experience is already giving her confidence and strength that will enhance her learning in the classroom and the clinic.

“I’ve had so many doubts in my journey and the mentors around me have really motivated me to keep going.”

For other students, Samiha shares this advice, “It’s okay to ask for help. It’s part of the process. There’s a lot you can learn from a great mentor.”

The post The impact of mentorship: meet medical student Samiha Mohsen appeared first on Your Health Matters.

“This experience confirmed my interest in healthcare, communication disorders and aging.”

Dr. Bouvier is a Postdoctoral Fellow in the Bulbar Function Lab at Sunnybrook Research Institute (SRI), under the supervision of scientist Dr. Yana Yunusova.

Her speech acoustics research is helping to advance early detection and monitoring of bulbar signs in Amyotrophic Lateral Sclerosis (ALS), a progressive and debilitating neurodegenerative disease. June is ALS Awareness Month.

The onset of bulbar dysfunction, which includes symptoms such as speech and swallowing difficulties, marks a turning point in the progression of ALS as the development of these symptoms are associated with a reduction in quality of life and life expectancy.

“The development of effective assessment tools targeting bulbar dysfunction in ALS is urgently needed to improve timely access to clinical care, intervention strategies and clinical trials.”

Dr. Bouvier’s research uses speech recordings and machine learning to develop artificial intelligence (AI)-based technologies for the early detection and tracking of bulbar ALS. Similar work has been done among English-speaking populations, and her goal is to develop the world’s first AI-based diagnostic algorithm for Quebec French, to help with the early detection of bulbar ALS in the French-speaking population.

“By developing this tool, I hope to help reduce the existing gaps in knowledge and care between English and French speakers.”

The Bulbar Function lab at SRI provides the ideal setting to execute this study, which leverages deep strengths in AI, machine learning and acoustic analyses of speech. The close collaborations of the lab with nation-wide and international ALS clinics are also helping advance the project.

“Research in the field of ALS is of particular interest to me because it allows me to combine many of my research interests — to collaborate closely with healthcare professionals, to contribute to the establishment of better health care access, assessment and care, and to improve the quality of life for patients,” explains Dr. Bouvier.

“Helping families better understand and facilitate care for their loved ones with neurodegenerative disease is at the heart of my motivation to do this research.”

The post Advancing ALS research with speech acoustics: Meet Postdoctoral Fellow Liziane Bouvier appeared first on Your Health Matters.

In late 2021, a research team from Sunnybrook Research Institute and key collaborators detected SARS-CoV-2 infection among deer in Québec. Since then, deer in other provinces have also tested positive. The virus has already been detected in deer in the United States as well, with a study in late 2021 showing SARS-CoV-2 antibodies in 40 per cent of blood samples collected from deer in Illinois, Michigan, New York and Pennsylvania. It’s not currently known how the virus was transmitted to deer, although there do not appear to be overt signs of illness in the animals.

This work is part of a national research collaboration established in 2020 to detect and characterize SARS-CoV-2 activity in wildlife, led by government and academic scientists including Dr. Samira Mubareka, virologist and infectious diseases physician, and post-doctoral fellow Dr. Jonathon Kotwa, both at Sunnybrook, alongside collaborators at the Canadian Food Inspection Agency (CFIA), the Public Health Agency of Canada, the Canadian Wildlife Health Cooperative (CWHC), Environment and Climate Change Canada (ECCC), le Ministère des Forêts, de la Faune et des Parcs (QC), the Ministry of Northern Development, Mines, Natural Resources and Forestry (ON), University of Guelph, Carlton University and Trent University. In total, the group is analyzing thousands of samples from a variety of wildlife.

Below Dr. Mubareka and Dr. Kotwa discuss the importance of monitoring SARS-CoV-2 in wildlife and the implications the recent findings may have on the course of the pandemic.

Why is it important to closely monitor the prevalence of COVID-19 in wildlife?

Dr. Mubareka: The emergence and rapid spread of SARS-CoV-2 has sparked concerns of spillover from humans to susceptible wildlife populations, raising the possibility that new wildlife species could ultimately serve as virus reservoirs, allowing the virus to continue to mutate even after humans have reached immunity.

Dr. Jonathon Kotwa (left) and Dr. Samira Mubareka (right) are part of a team detecting and characterizing SARS-CoV-2 activity in wildlife.

Through a collaborative effort between academic and governmental research groups, surveillance of SARS-CoV-2 in wildlife is ongoing in Canada and is conducted using a One Health approach. One Health recognizes that human health and the health of other animals are interconnected and emphasizes the importance of a coordinated and collaborative approach to achieve the best outcomes for all species.

What can the discovery of SARS-CoV-2 in Canadian wildlife tell us about the future of the pandemic?

Dr. Kotwa: The results of our surveillance work are helping us understand where to look for the virus in wildlife. We have learned that as the pandemic progresses and new variants emerge, the host range of this virus is broadening and shifting. If the virus finds a host, other than humans, where it can circulate and adapt in a sustained fashion (what’s known as a reservoir), the likelihood of eradicating the virus is unfortunately, quite low. This really emphasizes the importance of continued surveillance of the virus in Canadian wildlife.

The good news is wildlife surveillance will enable us to be proactive about emerging variants when they pop up in wildlife hosts to ensure we characterize them and study potential human and wildlife health implications. This way we can implement necessary public health measures if they pose any risk.

These findings also raise questions around how we interact with and impact the natural world. This virus really highlights how interconnected human and wildlife health are in our shared environment. By taking a One Health approach to our surveillance, we can take a step back and think about the bigger picture since it has direct bearing on the direction this pandemic may take.

What’s the next step in this research?

Dr. Mubareka: Next we plan to characterize the viruses from deer, continue with surveillance in wildlife species, and expand our knowledge of animal host response and immunity. Currently, it appears that deer do not develop disease. However, other mammals such as mink can become sick.

In addition, we do not know whether new variants will infect hosts that initially were not susceptible, potentially causing disease – this has already happened with the Alpha variant, which can now infect species of mice that the ancestral virus did not. We do not know whether new variants such as Omicron may do something similar, or how they will evolve in deer.

All of these efforts will continue to rely on strong collaboration and coordination. We’re fortunate to have a wonderful group of academic, government and community partners working together on this project. Going forward, it will be essential to continue to ensure wildlife surveillance, protection and conservation are integral parts of our public health programs.

The post What can the discovery of SARS-CoV-2 in Canadian wildlife tell us about the pandemic? appeared first on Your Health Matters.

The study, recently published in JAMA Surgery, looked at 1.3 million patients treated by nearly 3000 surgeons between 2007 and 2019 in Ontario, measuring adverse postoperative outcomes such as death, readmission and complications 30 days following a surgical procedure. The researchers analyzed associations between surgeon-patient sex concordance (male surgeon with male patient, female surgeon with female patient) or discordance (male surgeon with female patient, female surgeon with male patient). They looked at outcomes following 21 different procedures in a variety of surgical specialties.

“Previous research in the emergency care setting has shown that sex discordance, particularly among male physicians and female patients, can be associated with some adverse effects,” says Dr. Angela Jerath, one of the co-authors of the study and an anesthesiologist and scientist at Sunnybrook. “We were interested in exploring whether this was similarly the case in regards to surgical outcomes.”

The researchers found that female patients were 15% more likely to experience adverse outcomes following common surgical procedures when treated by a male rather than a female surgeon. When a male surgeon operated on a female patient – compared with a female surgeon – there was a 32 per cent increase in the likelihood of a female patient’s death in the 30 days following the procedure. In contrast, for male patients, there was no difference in outcomes whether they were treated by female surgeons or male surgeons.

Dr. Angela Jerath, co-author of the study and anesthesiologist and scientist at Sunnybrook Health Sciences Centre.

“These results are concerning because the sex of patients and surgeons should not result in differences in patient outcomes after surgery,” says Dr. Jerath. “As an anesthesiologist I know there are many excellent male surgeons who consistently have good outcomes. However, at a population level, the analysis does signal a concerning difference between male and female surgeons overall and its impact on patient outcomes, which needs to be explored.”

The researchers say more work is needed to determine the cause of the disparities. Dr. Christopher Wallis, who co-led the study explains it’s unlikely the findings are the result of technical difficulties between sexes. “Both male and female surgeons undergo the same technical medical training. The very large sample size and the examination of many different surgical specialties would have diluted any technical differences between male and female surgeons. We believe there are other complex factors at play,” says Dr. Wallis, a urologic oncologist in the Division of Urology at Mount Sinai Hospital and University Health Network.

The authors propose implicit sex biases, differing communication or interpersonal skills which may influence trust, and variations in decision making and clinical judgement as potential factors contributing to the disparities.

“Previous research has also shown that symptoms reported by female patients may be under-appreciated in the health care setting (particularly among male physicians). Thus, early symptoms of complications may be missed when they can be mitigated and instead manifest as more severe events,” says Dr. Wallis.

The researchers add the study highlights the need to diversify the workforce to better serve the patients they are treating. “This work really emphasizes the importance of changing the culture of medicine to promote the role of women in our field,” says Dr. Wallis.

Although more research is needed, the authors say their advice to patients is to ensure they have a good, trusting relationship with their surgeon regardless of sex. “The patient-surgeon relationship is extremely important,” says Dr. Jerath. “Patients want to ensure they can openly discuss their questions and concerns before, during and after surgery.”

Read more about the research in The Guardian, U.S News, and CTV News.

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Dr. Rikke Kofoed and Dr. Isabelle Aubert

In a new study, postdoctoral researcher Dr. Rikke Kofoed and senior scientist Dr. Isabelle Aubert and their team at Sunnybrook Research Institute determined the feasibility and safety of two noninvasive methods for delivering gene therapy to the brain in a preclinical model of Alzheimer’s disease.

The study has been published in Molecular Therapy – Methods & Clinical Development.

Alzheimer’s disease is the most common form of dementia, which impacts more than 430,000 Canadians aged 65 years and older. Hallmarks of the neurodegenerative disease include “plaques” and “tangles” composed of toxic protein that develop in the brain and eventually prevent the production of nutrients and the transmission of signals that are necessary for the health of brain cells. Over time, this causes deficits in cell-to-cell communication and functions, leading to memory loss, confusion and difficulty reasoning. There is currently no effective treatment for the disease.

Researchers at Sunnybrook are interested in gene therapy as a potential treatment for Alzheimer’s disease and other disorders of the brain. Gene therapy can replace a gene that is missing or defective. Specific genes can also be added to allow brain cells to stay healthy, produce therapeutics, or generate new cells to curb the disease.

Although gene therapy shows promise in Alzheimer’s disease, the blood-brain barrier poses a challenge for delivering it to the brain. In this study, the research team evaluated two innovative methods to non-invasively deliver gene therapy across the blood-brain barrier: a) focused ultrasound combined with intravenous microbubbles, which increase the permeability of the blood-brain barrier at targeted sites, and b) modified gene carriers, which are capable of crossing the blood-brain barrier and delivering genes to brain cells.

Dr. Kofoed and Dr. Aubert share thoughts on their research.

Dr. Rikke Kofoed in the lab

What did your study find?

Dr. Kofoed: In this preclinical study, we found that depending on which delivery method is used (focused ultrasound or modified gene carriers), a unique distribution of genes is seen in the brain. These findings tell us that in the future, gene therapy can likely be tailored to achieve personalized deliveries of genes depending on disease stage and the type of therapeutic gene.

We also determined that these non-invasive delivery methods have a good safety profile and that the immune response triggered is similar to what is seen after gene delivery using brain surgery. Our findings suggest that the immune response to non-invasive gene delivery can be controlled, as it is currently done in the clinic for other gene therapy approaches.

What could these results mean for patients in the future?

Dr. Aubert: In the past, the delivery of therapeutic genes required invasive surgeries for patients with Alzheimer’s disease. ​Non-invasive and personalized gene delivery to the brain has the potential to increase beneficial clinical effects for the treatment of Alzheimer’s disease. Our preclinical study confirms that focused ultrasound and modified gene carriers are feasible strategies for gene delivery to the brain, and that their immunological effects can be controlled.

What’s next in this research?

Dr. Kofoed: In this study, we used an easily visible “reporter” gene to explore the potency of gene delivery. The next stage of our research will look to deliver a therapeutic gene to target Alzheimer-related pathology in a preclinical model. These studies will help us determine the therapeutic potential of our delivery strategy.

Dr. Aubert: Gene therapy has tremendous potential for the treatments of brain disorders. The current study and the next stage of our research are required steps to evaluate the safety and efficacy of gene therapy approaches. With colleagues and collaborators at Sunnybrook and other institutions, these approaches could one day be brought to patients to halt degeneration and promote brain health for conditions such as Alzheimer’s disease.

Key drivers of Sunnybrook’s research are funding agencies and philanthropic investment. This study was funded with support from the Alzheimer Society Research Program, the Carlsberg Internationalisation Fellowship, the Canada Research Chairs Program, Canadian Institutes for Health Research (CIHR), the Weston Brain Institute, the National Institute of Biomedical Imaging and Bioengineering of the National Institutes of Health and Temerty Chair in Focused Ultrasound Research. Additional funding was received from the FDC Foundation, the WB Family Foundation and Gerald and Carla Connor.

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