Day: March 8, 2021

Categories : Pain ManagementTags :

Review Finds Antidepressants Are Ineffective for Low Back Pain

On By ModernMedia

A systematic review of studies on antidepressants for low back pain has shown that they are no more effective than placebo, but still could have even more serious side effects. 

Explaining the study, lead author Michael Ferraro, doctoral candidate at University of New South Wales (UNSW) Medicine & Health and Neuroscience Research Australia (NeuRA), said:  “Antidepressants are commonly prescribed to treat the symptoms of low back pain. However, prescription rates for antidepressants to manage low back pain are increasing worldwide, despite unclear evidence to support their efficacy and safety and conflicting advice in clinical guidelines.”

Across 17 studies with over 2500 participants, the researchers looked at differences in outcomes for pain, safety, function and depressive symptoms between people taking antidepressants and placebos. 

“We found that treating low back pain with antidepressants failed to lead to reductions in what patients might consider important benefits for pain or function,” Mr Ferraro said.

“We also discovered that people taking antidepressants for low back pain are more likely to stop treatment and experience side effects and might even experience more serious side effects.
“If people are taking antidepressants for low back pain and have any concerns about their treatment, they should consult their medical physician for advice.”

These results bring into question no less than six international guidelines that recommend the use of antidepressants for low back pain. In particular, the US has a guideline for duloxetine, a serotonin and norepinephrine reuptake inhibitor, chronic low back pain treatment.
“We believe the US recommendation for duloxetine could be reconsidered in light of our findings,” he said. “Ongoing recommendations for the use of antidepressants to treat low back pain are concerning, particularly given the increased risk of side effects.”

The low quality of the studies in general limited their findings, but no clear benefits of using antidepressants for low back pain could be identified.
“It is difficult to estimate the true effects of such medicines being used to treat low back pain. The majority of the studies were considered to be at high risk of bias and interestingly, the studies which showed the most promise were industry-sponsored. We recommend future research focuses on other types of medicines that may provide benefit to adults with low back pain, as well as non-pharmacological treatments, such as physiotherapy and exercise,” said Mr Ferraro.

Source: News-Medical.Net

Journal information: Ferraro, M.C., et al. (2021) Efficacy, acceptability, and safety of antidepressants for low back pain: a systematic review and meta-analysis. Systematic Reviews. doi.org/10.1186/s13643-021-01599-4.

Categories : Cardiovascular DiseaseTags :

Central Retinal Artery Occlusion Needs to be Treated as A Stroke

On By ModernMedia

The American Heart Association published a new scientific statement, “Management of Central Retinal Artery Occlusion,” which laid out the best methods to treat what is effectively a small stroke in the eye.

A central retinal artery occlusion (CRAO) is a rare (1 in 100 000 people) form of acute ischaemic stroke arising from a blockage of blood flow to the main artery of the eye. It causes painless, immediate vision loss in the impacted eye from which less than 20% of people will recover from.

“Central retinal artery occlusion is a cardiovascular problem disguised as an eye problem. It is less common than stroke affecting the brain but is a critical sign of ill health and requires immediate medical attention,” said the chair of the statement writing committee Brian C Mac Grory, MBBCh, BAO, MRCP, an assistant professor of neurology and staff neurologist at the Duke Comprehensive Stroke Center at Duke University School of Medicine. “Unfortunately, a CRAO is a warning sign of other vascular issues, so ongoing follow-up is critical to prevent a future stroke or heart attack.”

In a comprehensive review of the literature, committee members from a variety of specialties summarised the state of the science in this condition. They noted that a lack of clinical trials results in physicians not recognising the problem, including that it is a type of stroke, resulting in inaction and differing methods of diagnosis and treatment.

“We know acute CRAO is a medical emergency requiring early recognition and triage to emergency medical treatment,” said Dr Mac Grory. “There is a narrow time window for effective treatment of CRAO and a high rate of serious related illness. So, if a person is diagnosed in a doctor’s office or another outpatient clinic, they should be immediately sent to a hospital emergency department for further evaluation and treatment.”

CRAOs can be caused by problems with carotid arteries, the blood vessels in the neck, but there is also evidence CRAOs could be caused by heart problems such as atrial fibrillation.

CRAO risk factors include age and the presence of cardiovascular risk factors such as type 2 diabetes, smoking, and obesity. 

Currently, the literature suggests that intravenous tissue plasminogen activator (tPA) treatment, a “clot buster” also used for brain strokes, could be effective. However, to be effective and safe tPA must be administered within 4.5 hours of the onset of symptoms

Hyperbaric oxygen and intra-arterial alteplase, were also noted as showing potential but requiring further study. Hyperbaric oxygen can result in an improvement if done within 24 hours of the CRAO event. Other possible treatments needing further research icnclude breaking up clots with novel thrombolytics and using novel neuroprotectants (substances capable of preserving brain function and structure) in concert with other treatments to restore blood flow in the blocked artery.

Since there is potential for future strokes or even heart attacks, patients should undergo screening and treatment of vascular risk factors as a matter of urgency. CRAOs are complex to treat and manage, requiring the joint effort of a team of specialists.

Secondary prevention (including monitoring for complications) must be a collaborative effort between neurologists, ophthalmologists, cardiologists and primary care clinicians. Risk factor modification includes lifestyle and pharmacological interventions.

Source: News-Medical.Net

Journal information: Grory, B. M., et al. (2021) Management of Central Retinal Artery Occlusion: A Scientific Statement From the American Heart Association. Stroke. doi.org/10.1161/STR.0000000000000366.

Categories : COVIDTags :

Molnupiravir Performs Well Versus COVID in Early Trials

On By ModernMedia

Pharmaceutical giant announced on Saturday that its antiviral drug molnupiravir significantly reduced viral load in COVID patients.

Delivering the information to infectious disease experts, the company said that the drug caused the drop in viral loads five days after administration to COVID patients.

“At a time where there is unmet need for antiviral treatments against SARS-CoV-2, we are encouraged by these preliminary data,” said Wendy Painter, chief medical officer of the US firm, Ridgeback Biotherapeutics, which developed the drug in concert with Merck.

Merck had stopped development of two vaccine candidates earlier on, but has been pressing ahead with two possible treatments for COVID.

The experimental drug, also known as EIDD-2801, is currently in its Phase 2a trials. It would need to complete the third phase trials to gain approval. Molnupiravir was originally developed to treat influenza viruses, and its mechanism of action is thought to be through inducing RNA transcription errors in viruses, leading to a transcription catastrophe. This mechanism also inherently creates a significant barrier for viral escape from the drug.

The clinical trials enrolled 202 participants with COVID, who were not hospitalised. There were no safety alerts for the drug, and the four serious adverse events that did occur were not considered to be associated with the drug, Ms Painter said.

William Fischer, lead investigator of the study and a professor of medicine at the University of North Carolina said that these were promising results, adding: “If supported by additional studies, (they) could have important public health implications, particularly as the SARS-CoV-2 virus continues to spread and evolve globally.”

The company is testing another drug in clinical trials, MK-711, preliminary results for which have indicated a 50% drop in viral load in mild and severe COVID patients.

Source: Medical Xpress

Categories : Gender HospitalsTags :

UK Says ‘Strong Evidence’ of Gender Health Gap Exists

On By ModernMedia
Woman in a hospital bed. Photo by Andrea Piacquadio from Pexels.

As an inquiry into the disparity of health service provision to women begins this week, Ministers in the UK say there is “strong evidence” of a gender gap.

The Women’s Health Strategy will speak to women and girls over the next 12 weeks on a variety of issues, ranging from maternity care to mental health.

Nadine Dorries, minister for women’s health, said: “Women’s experiences of healthcare can vary and we want to ensure women are able to access the treatment and services they need.

“It’s crucial women’s voices are at the front and centre of this strategy so we understand their experiences and how to improve their outcomes.”

Patients have told the BBC they have felt overlooked in conditions like endometriosis, or procedures such a pelvic floor mesh.

There is less knowledge on female conditions and their treatment among clinicians. Despite the fact that they make up half of the population, female conditions are often considered a ‘niche’ area. Research shows that a large part of the problem is due to the fact that clinical trials have  failed to take into account gender. Eight out of ten drugs that were withdrawn in the US between 1997 and 2000 were as a result of side effects in women.
While campaigners have welcomed the view, they say that it is still vital to listen to women’s views and act on them.

Gill Walton, chief executive of the Royal College of Midwives, said: “We know that placing women at the centre of their own care not only improves outcomes in pregnancy, but also improves a woman’s experience of birth and maternity care.”

Mika Simmons, co-chair of the Ginsburg Women’s Health Board, filmmaker, and host of The Happy Vagina podcast, said: “Every single woman I speak to, myself included, has experienced either misunderstanding or loss as a direct result of slow or inaccurate diagnosis of their health concerns.

“I am delighted that this – the gender health gap – which grew out of a severe lack of historical research into women’s health issues, is not only finally being acknowledged but that steps are being taken to right size it.”

Source: BBC News

Categories : Medical Research & TechnologyTags :

Faster 3-D Bioprinting A Step Closer to Printing Whole Organs

On By ModernMedia

With the demonstration of a new type of more rapid 3-D bioprinting, University at Buffalo engineers have taken a step closer to the fabrication of whole organs.

In a video of the process, a hand emerges over a matter of seconds from a vat of liquid almost as if out of a science fiction movie. In reality, the video was sped up from its original duration of 19 minutes, but even this is a quantum leap ahead of the six or so hours such a process previously took. 
“The technology we’ve developed is 10-50 times faster than the industry standard, and it works with large sample sizes that have been very difficult to achieve previously,” said co-lead author Ruogang Zhao, PhD, associate professor of biomedical engineering.

The new method involves a 3-D printing technology called stereolithography and hydrogels. Hydrogels have applications in wound dressings, contact lenses and hygiene products, as well as scaffolds for tissue engineering.

Scaffolds are particularly important in 3-D bioprinting, and the team has spent a great deal of its time and effort on these in order to come up with an optimised solution for its fast, accurate 3-D printing technique.
“Our method allows for the rapid printing of centimeter-sized hydrogel models. It significantly reduces part deformation and cellular injuries caused by the prolonged exposure to the environmental stresses you commonly see in conventional 3-D printing methods,” said the other co-lead author, Chi Zhou, PhD, associate professor of industrial and systems engineering.

This method is readily suited for the printing of cells with embedded networks of blood vessels. It is expected that this emerging technology will be key to producing whole 3-D printed organs and tissue.

Source: Medical Xpress

Journal information: Nanditha Anandakrishnan et al, Fast Stereolithography Printing of Large‐Scale Biocompatible Hydrogel Models, Advanced Healthcare Materials (2021). DOI: 10.1002/adhm.202002103
https://medicalxpress.com/news/2021-03-rapid-3d-method-3d-printed.html