Month: October 2021

Categories : GastrointestinalTags :

Gut Microbes and Antibiotics Impact Inflammatory Pain

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C difficile. Source: CDC

A study in rats showed that gut microbiomes and antibiotic use could modulate inflammatory pain.

Published in The Journal of Pain, the study examined the impact of antibiotics on the gut microbiome and how antibiotic use can alter inflammatory pain in subjects with or without access to exercise.

According to Glenn Stevenson, Ph.D., professor of psychology within the School of Social and Behavioral Sciences, this is the first publication to assess how antibiotic-induced changes to the gut microbiome impact inflammatory pain distal to the gut (in the limbs, for example).

The study determined the effects of vancomycin on inflammatory pain-stimulated and pain-depressed behaviours in rats, which was induced with formalin. Oral vancomycin administered in drinking water attenuated pain-stimulated behaviour, and prevented formalin pain-depressed wheel running. Faecal microbiota transplantation produced a non-significant trend toward reversal of vancomycin’s effect on pain-stimulated behaviour. Vancomycin depleted Firmicutes and Bacteroidetes gut populations while partially sparing Lactobacillus species and Clostridiales. The vancomycin treatment effect was associated with an altered profile in amino acid concentrations in the gut.

The results indicate that manipulation of the gut microbiome may be one method to attenuate inflammatory pain amplitude. Additionally, results indicated that the antibiotic-induced shift in gut amino acid concentrations may be a causal mechanism for this reduction in pain.

The research for this study took four years to complete, Prof Stevenson said, adding that the link between amino acids and pain reduction is “highly novel.”

Source: University of New England

Categories : COVIDTags :

Gauteng Vaccination Goals Under Threat

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Image by Quicknews

Gauteng Premier David Makhura has stated that the province is not vaccinating enough people, which he acknowledged jeopardises its ambitious plans of having 70% of the population vaccinated by year end.

In a media briefing on Monday regarding the province’s vaccination rollout, he revealed that of Sunday, 5.3 million vaccines have been administered. More than 2.6 million people in Gauteng have been fully vaccinated. Gauteng’s infection rate has stabilised, with the number of active cases having fallen to approximately 1000. 

The Premier said that as things currently stand, there are still 4.4 million people in Gauteng that have to be vaccinated by the end of December. Makhura said that while they are still focussed on the target, it is becoming difficult to achieve, given the low numbers of people coming in for vaccinations.

“We are not retreating on our target of 70%, but the idea that we will meet 70% by mid-December is becoming a target that is elusive. The vaccination rate per day in Gauteng, on average during the week we are just between 52 and 58 000. We have fallen below the mid 60 000 daily vaccination rate. In September, we were doing extremely well. We were getting around 65-75 000.”

Based on last week’s total of 313 790 vaccinations, with 11 weeks in the year that would mean only about 3.5 million vaccinations administered – let alone persons fully vaccinated with a second dose. Concerns had been voiced at the end of September about flagging vaccination rates in South Africa as a whole.

Makhura also highlighted the low turnout of people in the province’s townships.

“Our townships are lagging behind. The substantial vaccinations are happening in more suburban areas, and the townships are lagging behind. Those townships in the south, Orange Farm and Palestine, we have the lowest number of vaccinations in the south of Johannesburg, that’s where we have 11% vaccination in terms of just single doses,” he said. 

Professor Bruce Mellado, of the Gauteng Provincial Command Council, said that, there was still a need to be cautious, especially with big events on the horizon, such as the municipal elections, saying:

“While the situation in the Gauteng Province remains stable and low risk, the risk of a fourth wave is very, very high. In fact, we predict that the fourth wave will hit sometime between November and January as we expect a number of super-spreader events to follow in a row. That’s something we have to have in mind.”

“We should not be confused or misled by the fact that we are currently in a situation of low risk, but that can change quite rapidly,” Prof Mellado cautioned.

Source: The South African

Categories : COVIDTags :

High-dose Heparin Reduces Mortality in Moderately-ill COVID Patients

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SARS-CoV-2 viruses (yellow) infecting a human cell. Credit: NIH

A high dose of heparin, an inexpensive and globally available medication, reduces mortality risk in hospitalised, moderately-ill COVID patients, suggests a new study led by St. Michael’s Hospital.

Appearing in the BMJ, the RAPID Trial compared a high, therapeutic dose of heparin to a prophylactic low dose for patients with moderate COVID and elevated d-dimer levels admitted to hospitals. D-dimers are protein fragments produced when a blood clot gets dissolved; higher levels indicate increased clotting risks.

The researchers studied 465 patients in hospitals around the world and found that while the therapeutic dose of heparin was not associated with a significant reduction in the study’s primary outcome, a composite of death, the need for mechanical ventilation or admission to intensive care, the dosing of heparin did reduce all-cause death in moderately-ill COVID patients admitted to hospital by 78%.

“Our study confirms therapeutic heparin is beneficial in patients who are on the ward with COVID, but other studies suggest it could be harmful for patients who are in critical care,” said Dr. Peter Jüni, Director of the Applied Health Research Centre at St. Michael’s and co-lead of the study.

Therapeutic doses of heparin are used for deep vein thrombosis or pulmonary emboli, whereas prophylactic, or lower, doses are used for patients admitted to Internal Medicine wards to prevent blood clotting while they are in hospital.

Several trials have investigated using blood thinners in COVID patients due to heightened inflammation and clotting in blood vessels caused by the virus. Dr. Michelle Sholzberg, Head of the Division of Hematology-Oncology and Director of the Coagulation Lab at St. Michael’s, and co-lead on the study, hopes this research contributes to a change in treatment guidelines for COVID patients.

“This is a once-in-a-million opportunity – heparin is inexpensive, globally available, and exists in every single hospital pharmacy cabinet right now,” she said. “It’s an opportunity to rapidly repurpose a drug available around the world.”

In particular, she said, the treatment could make a difference in areas where vaccine availability or coverage continues to be limited. Heparin is included in the WHO’s list of essential medicines.

The researchers hope to learn more from the data collected by analysing it further to address new questions, and are also considering revisiting patient outcomes to understand whether these therapies reduce the odds of long COVID.

Source: Unity Health

Categories : Diseases, Syndromes and ConditionsTags :

How Antibody Treatment for MIS-C Works

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Source: NCI on Unsplash

The depletion of neutrophils could be how intravenous immune globulin (IVIG) is able to treat multisystem inflammatory syndrome in children (MIS-C).

MIS-C is a rare condition that usually affects school-age children who initially had only mild COVID symptoms or no symptoms at all. The researchers also found that IVIG works in a similar manner for treating Kawasaki disease, another rare inflammatory condition that affects children and shares symptoms with MIS-C. 

MIS-C is marked by severe inflammation of two or more parts of the body, including the heart, lungs, kidneys, brain, skin, eyes and gastrointestinal organs. Its symptoms overlap with Kawasaki disease, and treatments for MIS-C are partly guided by what is known about the treatment of Kawasaki disease. IVIG, which is made up of antibodies purified from blood products, is a common and effective treatment for heart complications caused by Kawasaki disease. For MIS-C patients, however, IVIG alone does not always resolve symptoms, and healthcare providers may need to prescribe additional anti-inflammatory drugs.

In order to better understand how IVIG works and to improve treatments for children with MIS-C, researchers profiled immune cells from patients with MIS-C or Kawasaki disease. The team sampled cells before treatment began as well as 2 to 6 weeks after patients received IVIG, and found that neutrophils from these patients were highly activated and a major source of interleukin 1 beta (IL-1β), a driver of inflammation. After IVIG treatment, these activated neutrophils were significantly depleted in patients with MIS-C or Kawasaki disease.

The study authors believe their findings are the first to explain why IVIG is effective for both conditions. More work is needed however to understand how IVIG causes cell death in these activated neutrophils and why certain patients with MIS-C require additional anti-inflammatory treatments.

The findings appear in the Journal of Clinical Investigation.

Source: National Institutes of Health

Categories : Mental HealthTags :

Depression Genes Result in More Physical Symptoms

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Source: Andrew Neel on Unsplash

People who have a higher genetic risk of clinical depression are more likely to experience physical symptoms such as chronic pain, fatigue and migraine, researchers have found.

Depression is a serious disorder with lifetime risks of poor health, according to Dr Enda Byrne from UQ’s Institute for Molecular Bioscience.

“A large proportion of people with clinically-diagnosed depression present initially to doctors with physical symptoms that cause distress and can severely impact on people’s quality of life,” Dr Byrne said.

“Our research aimed to better understand the biological basis of depression and found that assessing a broad range of symptoms was important.

“Ultimately, our research aimed to better understand the genetic risks and generate more accurate risk scores for use in research and healthcare.”

Despite recent breakthroughs, Dr Byrne said it was difficult to find more genetic risk factors because of the range of patient ages, their symptoms, responses to treatment and additional mental and physical disorders.

“Previous genetic studies have included participants who report having seen a doctor for worries or tension – but who may not meet the ‘official’ criteria for a diagnosis of depression,” Dr Byrne said

Published in JAMA Psychiatry, the study analysed data from more than 15 000 volunteers who provided details of their mental health history, depression symptoms and a DNA sample using a saliva kit.

“We wanted to see how genetic risk factors based on clinical definitions of depression differed – from those based on a single question to those based on a doctor’s consultation about mental health problems,” Dr Byrne said.

The study found that participants with higher genetic risk for clinical depression are more likely to experience physical symptoms such as chronic pain, fatigue and migraine.

 “It is also linked to higher rates of somatic symptoms – that is, physical symptoms that cause distress and can severely impact on people’s quality of life,” Dr Byrne said.

“Our results highlight the need for larger studies investigating the broad range of symptoms experienced by people with depression.”

Source: University of Queensland

Categories : COVIDTags :

Nearly 4 in 10 Swedish COVID Patients in ICUs had Obesity

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Photo by Siora Photography on Unsplash

People with obesity were overrepresented among adults in Sweden in intensive care for COVID during the first wave of the pandemic, with over twice the proportion as compared to the general population. 

The study, appearing in PLOS One, used  the Swedish Intensive Care Registry (SIR) tp the researchers identified all patients with COVID who were admitted to ICUs in Sweden during the initial wave of the pandemic, in spring and summer 2020. Where height and weight data were missing from SIR, this was supplemented directly from the ICUs and also through the Nationwide Passport Register.

Though people with obesity were identified early on as a risk group that was affected especially severely by COVID, this study contributes to a new, more detailed picture.

A total of 1649 individuals with COVID from ICUs around Sweden were included. All the participants were aged 18 and over; three-quarters were men; and pregnant women were excluded.

The results show that patients with obesity (BMI of 30 kg/m2 or more) were overrepresented among those with COVID receiving intensive care in Sweden, which was 39.4 %, compared to 16% in the general population .

A high BMI increased the risk of both serious illness with long stays in intensive care and of death. A link was found between BMI over 30 and a 50% increase in mortality risk, compared with the normal-weight group. Among those who survived, a BMI over 35 was associated with a more than doubled risk of intensive care for over 14 days. These analyses have been adjusted for age, gender, comorbidity, and state of health at ICU arrival.

“For individuals with COVID who are in intensive care, obesity means an increased risk of death, and among those who survive, obesity boosts the risk of intensive care lasting more than 14 days,” explained first author Lovisa Sjögren, researcher at Sahlgrenska Academy, University of Gothenburg. “Based on our results, obesity should be included as an important risk factor in COVID. Patients with obesity who suffer from COVID should be monitored closely.”

The study is based on the Swedish Intensive Care Register, and Dr Sjögren points out that high-quality registers are a basic precondition for studies of this type to be feasible.

Senior author Jenny M Kindblom, Associate Professor at University of Gothenburg added: “Some international studies have shown a connection between high BMI and the risk of becoming severely ill with COVID. We can now show this in a Swedish context, and with the advantage of having a fully up-to-date BMI value for every patient,” said.

At an early stage during the pandemic, the researchers who conducted the study were in touch with HOBS, a Swedish patient organisation for people living with overweight and obesity. Many members were concerned that a high BMI would elevate the risk of serious illness in COVID.

“At the time, there were no publications in the field, and the study was initiated to enable us to answer patients’ questions. We now hope as many people as possible will take the opportunity to get vaccinated, and that health services include BMI – as a risk factor and perhaps choose to exercise special vigilance in monitoring patients with obesity who are suffering from COVID,” said Prof Kindblom.

Source: University of Gothenburg

Categories : Ethics and LawTags :

Surveys Reveals Mistrust over Facial Recognition Tech in Healthcare

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Photo by cottonbro from Pexels

Most people have deep reservations about the use of facial recognition technologies in healthcare settings, a survey has found.

Facial recognition technologies – often used to unlock a phone or in airport security – is becoming increasingly common in everyday life, but how do people feel about this?

To answer this, researchers surveyed more than 4000 US adults and found that a significant proportion of respondents considered the use of facial image data in healthcare across eight varying scenarios as unacceptable (15–25%). Taken with those that responded as unsure of whether the uses were acceptable, roughly 30–50% of respondents indicated some degree of concern for uses of facial recognition technologies in healthcare scenarios. In some cases, using facial image data  – such as to avoid medical errors, for diagnosis and screening, or for security – was acceptable to the majority. However over half of respondents did not accept or were uncertain about healthcare providers using this data to monitor patients’ emotions or symptoms, or for health research. 

In the biomedical research setting, most respondents were equally concerned over use of medical records, DNA data and facial image data in a study.

While there was a wide range of demographics among respondents, their perspectives on these issues did not differ. 

“Our results show that a large segment of the public perceives a potential privacy threat when it comes to using facial image data in healthcare,” said lead author Sara Katsanis, Research Assistant Professor of Pediatrics at Northwestern University Feinberg School of Medicine. “To ensure public trust, we need to consider greater protections for personal information in healthcare settings, whether it relates to medical records, DNA data, or facial images. As facial recognition technologies become more common, we need to be prepared to explain how patient and participant data will be kept confidential and secure.”

Senior author Jennifer K Wagner, Assistant Professor in Penn State’s School of Engineering Design, Technology, and Professional Programs adds: “Our study offers an important opportunity for those pursuing possible use of facial analytics in healthcare settings and biomedical research to think about human-centeredness in a more meaningful way. The research that we are doing hopefully will help decision-makers find ways to facilitate biomedical innovation in a thoughtful, responsible way that does not undermine public trust.”  

The research team hopes to conduct further research to understand the nuances where public trust is lacking. The findings were published in PLOS One.

Source: Ann & Robert H. Lurie Children’s Hospital of Chicago

Categories : Pain ManagementTags :

Topical Medication Trumps Opioids for Knee Osteoarthritis Pain

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Photo by Matthias Zomer from Pexels

In treating knee osteoarthritis pain, topical medication for pain relief is safer and more effective than opioids, according to a new meta-analysis.

The paper, which appears in BMJ, compared the benefits and harms of different doses of commonly prescribed treatments for hip and knee osteoarthritis, including oral non-steroidal anti-inflammatory drugs (NSAIDs), topical NSAIDs, opioids, and acetaminophen (Tylenol). The meta-analysis looked at 192 large, randomised clinical trials with a total of over 102 000 participants.

Researchers found, regardless of preparation or dose, opioids did not significantly relieve pain for osteoarthritis patients. They also found that topical Diclofenac – known to consumers as Voltaren – is effective in treating knee osteoarthritis.

The topical treatment, which can be purchased over-the-counter, is generally safer than oral NSAIDs and should be considered as first-line pharmacological treatment for knee osteoarthritis, the study authors say. Osteoarthritis affects millions of Canadians.

Study lead author, Dr. Bruno R. da Costa, Acting Director of the Applied Health Research Centre (AHRC) at the Li Ka Shing Knowledge Institute of St. Michael’s Hospital, stated that recent clinical practice guidelines recommend the lowest possible dose to minimise the risk of adverse events.

However, he said, “it is currently unclear what the lowest but still effective doses of these drugs are. Osteoarthritis affects more than 4.6 million people in Canada. Our findings allow physicians, patients, or their caregivers to have a better understanding of which of these treatments at their lowest doses would be safest while still being effective.”

“Although there is robust evidence about the harmful effects of opioids, and international concerns around the opioid epidemic, opioids remain among the most prescribed drugs for osteoarthritis pain in Canada, the United States, the United Kingdom and Australia.”

Dr da Costa said that none of the opioid interventions, regardless of dose, seemed to have a clinically relevant effect on pain or physical function. Opioids should therefore only play a secondary role in osteoarthritis treatment, when conventional treatment is exhausted.

What was most surprising was that maximum recommended daily doses of opioids do not have an effect in osteoarthritis pain that patients would consider relevant. They did not see an association between higher opioid doses and greater pain relief.

Lower doses of topical diclofenac (Voltaren) also have a similar beneficial effect to the most effective oral NSAIDs in knee osteoarthritis – an important finding as some patients with gastrointestinal complaints and other comorbidities. Adverse events of topical NSAIDs are minimal. The topical diclofenac trials had only knee osteoarthritis, and in hip osteoarthritis the depth is likely too great for any benefit.

The next step is to better understand the safety of oral NSAIDs in patients with comorbidities, and long-term use on an as-needed-basis with varying versus fixed daily doses. It would also be useful to identify if there are patients who have exhausted treatment options but could benefit from opioids or acetaminophen.

Source: Unity Health

Categories : Medical Research & TechnologyTags :

Dental Acid Damage Imaged in Real Time

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Source: Unsplash CC0

Researchers have developed a new technique to improve understanding of how acid damages teeth over time at the microstructural level, creating a clear picture of how the damage happens. 

Dentine forms the main bulk of human teeth and supports the enamel, which covers the crown surface, helping to make teeth strong and resilient, but acids from dental plaque can cause tooth decay affecting the dental structure’s integrity. This research aims to develop knowledge that leads to new treatments that can restore the structure and function of dentine.

Using in situ synchrotron X-ray microtomography to scan dentine samples while they were being treated with acid, researchers built clear 3D images of dentine’s internal structure with sub-micrometre resolution (a micrometre being one-thousandth of a millimetre). By analysing these images over the six hours of the experiment, the researchers conducted the first-ever time-resolved 3D study (otherwise known as 4D studies) of the dentine microstructural changes caused by acid.

The study, published in Dental Materials, shows that acid dissolves minerals in different structures of dentine at different rates. 

Research leader Dr Tan Sui, Senior Lecturer in Materials Engineering at the University of Surrey, known for her work creating improved bio-inspired materials, said:

“Relatively little is known about how exactly acid damages the dentine inside our teeth at a microstructural level. This new research technique changes that and opens the possibility of helping identify new ways to protect dental tissues and develop new treatments.”

Source: University of Surrey

Categories : CancerTags :

Investigation of Cannabidiol Oil for Lung Cancer Suggested

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Photo by Harrison Haines on Pexels

In BMJ Case Reports, doctors suggest investigating the use of cannabidiol (‘CBD’) oil as a potential lung cancer treatment, after dealing with a daily user whose lung tumour shrank in the absence of conventional treatment.

The body’s own endocannabinoids are involved in various processes, including nerve function, emotion, energy metabolism, pain and inflammation, sleep and immune function.

Cannabinoids are chemically similar to these, and can interact with signalling pathways in cells, including cancer cells. While they have been studied for use as a primary cancer treatment, there have been inconsistent results.

Despite treatment advances, survival rates for non-small cell lung cancer remain low at around 15% five years after diagnosis, with average survival without treatment is about seven months.

The authors describe the case of a woman in her 80s, a pack-a-week smoker diagnosed with non-small cell lung cancer. The woman also had mild chronic obstructive pulmonary disease (COPD), osteoarthritis, and hypertension, for which she was taking various drugs.

Her tumor was 41 mm in size at diagnosis, with no evidence of local or further spread, so was suitable for conventional treatment of surgery, chemotherapy, and radiotherapy. But the woman refused treatment, so was placed under ‘watch and wait’ monitoring, which included regular CT scans every 3-6 months.

These showed that the tumor was progressively shrinking, reducing in size from 41 mm in June 2018 to 10 mm by February 2021, equal to an overall 76% reduction in maximum diameter, averaging 2.4% a month, say the report authors.

When contacted in 2019 to discuss her progress, the woman revealed that she had been taking CBD oil as an alternative self-treatment for her lung cancer since August 2018, shortly after her original diagnosis.

She had done so on the advice of a relative, after witnessing her husband struggle with the side effects of radiotherapy. She reported consistently taking 0.5 ml of the oil, two to three times a day.

According to the supplier, the main active ingredients were Δ9-­tetrahydrocannabinol (THC) at 19.5%, cannabidiol at around 20%, and tetrahydrocannabinolic acid (THCA) at around 24%.

The supplier also said that she should avoid hot food or drinks when taking the oil as she might otherwise feel stoned. The woman reported reduced appetite since taking the oil but had no other obvious ‘side effects’. There were no other changes to her prescribed medications, diet, or lifestyle, and she continued smoking throughout.

The authors cautioned that this is just one case report, with only one other similar case reported, and it is unclear which of the CBD oil ingredients might have been helpful.

“We are unable to confirm the full ingredients of the CBD oil that the patient was taking or to provide information on which of the ingredient(s) may be contributing to the observed tumour regression,” they pointed out.

They further emphasised that, “although there appears to be a relationship between the intake of CBD oil and the observed tumuor regression, we are unable to conclusively confirm that the tumor regression is due to the patient taking CBD oil.”

The authors concluded that, “more research is needed to identify the actual mechanism of action, administration pathways, safe dosages, its effects on different types of cancer and any potential adverse side effects when using cannabinoids.”

Source: News-Medical.Net