Tag: 8/7/21

Categories : Pain ManagementTags :

Muscle Relaxants Largely Ineffective for Low Back Pain, Study Finds

On By ModernMedia
Photo by Sasun Bughdaryan on Unsplash

Though muscle relaxant drugs are largely widely prescribed to treat low back pain, they are largely ineffective, suggests an analysis of the latest evidence published by The BMJ.

While the evidence shows that muscle relaxants might reduce pain in the short term, the effect is too small to be considered clinically meaningful, and there is an increased risk of side effects.

However, the researchers stressed that the certainty of evidence is low, necessitating large trials to resolve uncertainties around the use of these drugs for back pain.

Low back pain is a global public health problem and muscle relaxants (a broad class of drugs that include non-benzodiazepine antispasmodics and antispastics) are a commonly prescribed treatment. Prescriptions in England last year exceeded 1.3 million, and in the US more than 30 million. Yet clinical practice guidelines around the world provide conflicting recommendations for their use.

To cast light on the matter, researchers in Australia investigated the effectiveness, acceptability, and safety of muscle relaxants compared with placebo, usual care, or no treatment in adults with non-specific low back pain.

The team analysed 31 randomised controlled trials involving over 6500 participants. Though the trials were of varying quality, the researchers were able to assess the certainty of evidence using the recognised GRADE system.

They set a difference of at least 10 points on a 0 to 100 point scale for pain and disability to be the smallest clinically important effect, which is a threshold used in other low back pain studies.

Very low certainty evidence showed that, compared with controls, non-benzodiazepine antispasmodic drugs might reduce pain intensity at two weeks or less for patients with acute low back pain. However, the effect is less than 8 points on a 0-100 point scale, therefore not meeting common thresholds to be clinically meaningful.

Little to no effect of non-benzodiazepine antispasmodics on pain intensity was seen at 3-13 weeks or on disability. Additionally, low and very low certainty evidence also showed that non-benzodiazepine antispasmodics might increase the risk of adverse events (typically, dizziness, drowsiness, headache and nausea) and might have little to no effect on treatment discontinuation compared with controls. The effect of muscle relaxants on long term outcomes was not evaluated in any of the trials.

The researchers acknowledged some limitations of the analysis, despite its using the best available evidence, and noted that some, but not all, individuals could gain a worthwhile benefit due to the modest overall effect. The low to very low certainty of evidence does not allow any firm recommendations, they cautioned.

Source: News-Medical.Net

Journal information: Cashin, A.G., et al. (2021) Efficacy, acceptability, and safety of muscle relaxants for adults with non-specific low back pain: systematic review and meta-analysis. BMJ. doi.org/10.1136/bmj.n1446.

Categories : Diet and NutritionTags :

Meat Substitutes Don’t Offer the Same Nutrition as Meat

On By ModernMedia
Photo by Ilya Mashkov on Unsplash

A study comparing meat and plant-based burger patties has found significant differences in nutritional content.  

As plant-based foods have improved in quality and availability, some have achieved a taste and texture remarkably similar to real beef, and they may even seem nutritionally equivalent in terms of items such as vitamins, fats and protein, based on their nutritional information labels.

But a Duke University research team’s deeper examination of the nutritional content of plant-based meat alternatives, using an analysis known as ‘metabolomics,’ shows they’re still quite different.  

Manufacturers of meat substitutes have gone to great trouble to make their plant-based products as meaty as possible, such as adding leghemoglobin, a plant-derived iron-carrying molecule to simulate bloodiness. Indigestible fibres like methyl cellulose thicken the texture of the meat substitutes. And to bring the plant-based meat alternatives up to the protein levels of meat, they use isolated plant proteins. Some meat-substitutes also add vitamin B12 and zinc to further replicate meat’s nutrition.

However, many other components of nutrition do not appear on the labels, and that’s where the products differ widely from meat, according to the study, which appears this week in Scientific Reports.

The metabolites that the scientists measured are building blocks of the body’s biochemistry, crucial to the conversion of energy, signaling between cells, building structures and tearing them down, and a host of other functions. There are expected to be more than 100 000 of these molecules in biology and about half of the metabolites circulating in human blood are estimated to be derived from our diets.

“To consumers reading nutritional labels, they may appear nutritionally interchangeable,” said Stephan van Vliet, a postdoctoral researcher at the Duke Molecular Physiology Institute who led the research. “But if you peek behind the curtain using metabolomics and look at expanded nutritional profiles, we found that there are large differences between meat and a plant-based meat alternative.”

The researchers compared 18 samples of a popular plant-based meat alternative to 18 grass-fed ground beef samples from a ranch in Idaho. The analysis of 36 carefully cooked patties found that 171 out of the 190 metabolites they measured varied between beef and the plant-based meat substitute.

The beef contained 22 metabolites that the plant substitute did not, while the plant-based substitute contained 31 metabolites that meat did not. The greatest distinctions occurred in amino acids, dipeptides, vitamins, phenols, and types of saturated and unsaturated fatty acids found in these products.

A number of important metabolites were found only in beef, or in greater quantities, including creatine, spermine, anserine, cysteamine, glucosamine, squalene, and the omega-3 fatty acid DHA. “These nutrients have potentially important physiological, anti-inflammatory, and or immunomodulatory roles,” the authors wrote in the paper.

“These nutrients are important for our brain and other organs including our muscles” van Vliet said. “But some people on vegan diets (no animal products), can live healthy lives – that’s very clear.” Besides, the plant-based meat alternative contained several beneficial metabolites not found in beef such as phytosterols and phenols.

“It is important for consumers to understand that these products should not be viewed as nutritionally interchangeable, but that’s not to say that one is better than the other,” said van Vliet, who eats a plant-heavy diet which still includes meat. “Plant and animal foods can be complementary, because they provide different nutrients.”

More research is needed, he said, to determine whether the presence or absence of particular metabolites in meat and plant-based meat alternatives have any short- or long-term effects.

No funding was received to perform this work.

Source:  Duke University School of Nursing

Categories : LungTags :

Dual Drug Therapy a First for Sleep Apnoea

On By ModernMedia
Photo by Mert Kahveci on Unsplash

In a first, researchers have hit upon a combo of two existing medications to reduce the severity of sleep apnoea in people by at least 30 percent.

Millions of people around the world are affected by sleep apnoea, a condition where the upper airway from the back of the nose to the throat closes repetitively during sleep, restricting oxygen intake and causing people to wake as often as 100 times or more per hour.

Those with untreated sleep apnoea have a higher risk of developing cardiovascular disease, dementia and depression, and are two to four times more likely to crash a car than the general population. There are no approved drug therapies to treat the condition despite nearly three decades of research, and until now, the main therapy for sleep apnoea involves wearing a mask to bed, or Continuous Positive Airway Pressure Therapy (CPAP). However, many people find it uncomfortable and half the people that try it find it hard to tolerate. Second line therapies, such as mouthguards fitted by dentists, can be unpredictable and expensive.

Prior studies had shown that two classes of medication, reboxetine and butylbromide, were able to keep muscles active during sleep in people without sleep apnoea, and assist breathing ability.

Researchers used a multitude of recording instruments to measure whether reboxetine and butylbromide could successfully target the main causes of sleep apnoea.

This included balancing the electrical activity of muscles around the airway, preventing the throat from collapsing during sleep, and improving the regulation of carbon dioxide and breathing.

Results from the study, published in the Journal of Physiology, showed these medications did in fact increase the muscle activity around participants’ airways, with the drugs reducing the severity of participants’ sleep apnoea by up to one third.

Almost everyone studied had some improvement in sleep apnoea. People’s oxygen intake improved, their number of breathing stoppages was a third or more less. These new findings allow researchers to further refine these types of medications so that they have even greater benefit than what has currently been found.

Senior author Professor Danny Eckert, Director of Adelaide Institute for Sleep Health at Flinders University commented: “We were thrilled because the current treatment options for people with sleep apnoea are limited and can be a painful journey for many.

“Next, we will look at the effects of these and similar medications over the longer term. We will assess whether we can harness the benefits of one drug without needing to use them both.

“Equally, we will test whether these treatments can be combined with other existing medications to see if we can improve their efficacy even more,” he says.

Source: University of Flinders

Categories : COVID Ethics and LawTags :

Why the ‘Lab Leak’ Scenario Was Shouted Down

On By ModernMedia
SARS-CoV-2 virus. Source: Fusion Medical Animation on Unsplash

For most of 2020, the notion that SARS-CoV-2 may have originated in a lab in Wuhan, China, was regarded as a debunked conspiracy theory, only embraced by some conservative media supportive of President Donald Trump. But in early 2021 that all changed, and today most outlets across the political spectrum agree that the ‘lab leak’ scenario deserves serious investigation.

An investigation by The BMJ uncovered a concerted campaign by researchers with funding on pandemic-potential virus research to label ‘lab leak’ scenarios as a conspiracy, effectively stifling journalism and investigation into the topic for over a year. One of the leaders of this was Peter Daszak, president of EcoHealth Alliance, a non-profit organisation which received millions in grants for pandemic preparedness research. EcoHealth Alliance subsequently subcontracted work out to the Wuhan laboratories.

Almost from the outset of the pandemic, a February 2020 statement in the Lancet coauthored by Daszak effectively ended the debate. “We stand together to strongly condemn conspiracy theories suggesting that covid-19 does not have a natural origin.” 

“It’s become a label you pin on something you don’t agree with,” said Nicholas Wade, a science writer who has worked at Nature, Science, and the New York Times. “It’s ridiculous, because the lab escape scenario invokes an accident, which is the opposite of a conspiracy.” 

But hostility to the scenario continued to grow. Filippa Lentzos, codirector of the Centre for Science and Security Studies at King’s College, London, told the Wall Street Journal, “Some of the scientists in this area very quickly closed ranks.” She added, “There were people that did not talk about this, because they feared for their careers. They feared for their grants.”

Daszak wrote an essay for the Guardian in June 2020 attacking the former head of MI6 for saying that the pandemic could have “started as an accident,” and continued to receive support from coauthors of the letter. 
But Daszak’s role in drawing up the statement in the Lancet was revealed in November 2020 in emails obtained through freedom of information requests.

“Please note that this statement will not have EcoHealth Alliance logo on it and will not be identifiable as coming from any one organization or person,” wrote Daszak in a February email, while sending around a draft of the statement for signatories. He also considered omitting his name from the statement to reduce potential negative exposure. A number of the 27 co-signatories omitted reporting their ties to EcoHealth Alliance.

Richard Ebright, professor of molecular biology at Rutgers University in New Jersey and a biosafety expert, considered scientific journal to be complicit in helping to clamp down on talk of a lab leak. “That means Nature, Science, and the Lancet,” he said. Along with dozens of other academics, he has been pushing back against the conspiracy theory labelling of the lab leak scenario.

“It’s very clear at this time that the term ‘conspiracy theory’ is a useful term for defaming an idea you disagree with,” said Ebright, referring to journalists and scientists making use of the term to attack others. “They have been successful until recently in selling that narrative to many in the media.”

Daszak enjoyed more support after then-President Trump cancelled EcoHealth Alliance’s National Institutes of Health funding, and the lab leak scenario remained buried for most of the year. It only resurfaced when a January 2021 New York magazine published an article detailing a possible lab leak scenario, in the face of stiff criticism. The tide began to turn when the World Health Organization investigation (which included Daszak) produced a report which attracted criticism for effectively ruling out the lab leak scenario in the face of almost a complete lack of evidence, such only being allowed a few hours’ worth of supervised access to the Wuhan labs. When Donald Trump lost the Presidential office, the criticism suddenly lost its greatest means for shutting down challenges — its mere association with its most widely-known and disliked proponent. 

Citing an intelligence report, the Wall Street Journal, recently reported that three Wuhan Institute of Virology researchers were admitted to hospital in November 2019. When President Joe Biden ordered an investigation into the scenario, it marked a slow turn-around in media coverage. Many outlets started backtracking their previously publicised viewpoints or adding qualifying statements, justifying them as simply a matter of tracking a “scientific consensus” which, they say, has now changed. Vox posted an erratum noting, “Since this piece was originally published in March 2020, scientific consensus has shifted.”

In recent weeks, a number of high profile scientists who once denigrated the idea that the virus could have come from a lab have made small steps into demanding an open investigation of the pandemic’s origin.

In a recent interview, NIH director Francis Collins said, “The Chinese government should be on notice that we have to have answers to questions that have not been answered about those people who got sick in November who worked in the lab and about those lab notebooks that have not been examined.” He added, “If they really want to be exonerated from this claim of culpability, then they have got to be transparent.”

It is worth noting that searches with phrases like “conspiracy theory”, “lab leak” and “Wuhan” do not turn up any relevant hits on The BMJ website, other than articles published this year which discuss the lab leak scenario seriously and credibly, or an article which discusses the more outlandish viral disinformation typical of the COVID pandemic typically seen in social media. Nor are there any articles with “Daszak” as an author.

Source: The BMJ

Categories : COVID GenderTags :

A Possible Explanation for Greater COVID Severity in Males

On By ModernMedia
SARS-CoV-2 viruses (yellow) on an infected cell. Source: NIAID

Researchers studying COVID patients have uncovered a metabolic pathway linked to immune responses only in male patients, a group known to be more likely to suffer severe cases and die of the disease.

Male COVID patients were more likely than female patients or healthy control subjects to have elevated levels of kynurenic acid, a product of amino acid metabolism, according to the study. High levels of kynurenic acid have been linked to several diseases, such as schizophrenia and HIV-related diseases.

They found that male patients with severe COVID cases were also more likely to have a high ratio of kynurenic acid to kynurenine, a byproduct of the amino acid L-tryptophan which is used to create the nutrient niacin.

“We know that men are at higher risk than women of contracting severe cases of COVID and that sex differences in the body’s immune responses present a compelling explanation for this phenomenon,” said Caroline Johnson, an assistant professor of epidemiology at Yale School of Public Health and senior author of the study. “We also know that immune responses are regulated in part by metabolites, and so these new findings offer a key window into the mechanisms underlying how this disease affects female and male patients differently.”

The team studied blood samples drawn from 22 female and 17 male patients at Yale New Haven Hospital after confirmation of COVID infection. They then compared these samples with samples from 20 uninfected health care workers.

The researchers positively identified 75 metabolites, which are molecular products of digestion and cellular processes. After adjusting for  age, body-mass index, sex, and other factors, the researchers identified 17 metabolites that were associated with COVID infection. Further analysis showed the strong relationship between high levels of kynurenic acid as well as high ratios of kynurenic acid to kynurenine in the male immune response and worse patient outcomes.

“Such sex-specific pathways provide major clues about how this disease infects and sickens individuals,” Prof Johnson said. “We can use this knowledge to create more effective treatments for this terrible disease and similar diseases.”

Source: Yale University

Categories : Mental HealthTags :

Psychedelic Compound Treats Depression by Growing Neural Connections

On By ModernMedia
Photo by Timothy Dykes on Unsplash

In a new study, researchers have shown that a single dose of psilocybin, a psychedelic compound with potential applications for depression, prompted long-lasting increase in connections between neurons in mice. 

For some people, psilocybin, an active compound in ‘magic mushrooms’, can produce a profound mystical experience. The psychedelic was a staple of religious ceremonies among indigenous populations of the Americas and is also a popular recreational drug. It has been the subject of some interest in treating depression. But exactly how it works in the brain and how long beneficial results might last is still unclear.
“We not only saw a 10% increase in the number of neuronal connections, but also they were on average about 10% larger, so the connections were stronger as well,” reported senior author Alex Kwan, associate professor of psychiatry and of neuroscience at Yale.

Earlier work had found promising evidence that psilocybin, as well as the anaesthetic ketamine, could decrease depression. This new study found that these compounds increase the density of dendritic spines, which are small protrusions found on nerve cells which aid in the transmission of information between neurons. The number of these neuronal connections are known to be reduced by chronic stress and depression.


Prof Kwan and first author Ling-Xiao Shao, a postdoctoral associate, imaged dendritic spines in high resolution with a laser-scanning microscope, and tracked them for multiple days in living mice. They found increases in the number of dendritic spines and in their size within 24 hours of administration of psilocybin. These changes were still evident a month later. Also, mice subjected to stress showed behavioural improvements and increased neurotransmitter activity after being given psilocybin.

It may be the novel psychological effects of psilocybin itself that spurs the growth of neuronal connections, Kwan said.

“It was a real surprise to see such enduring changes from just one dose of psilocybin,” he said.  “These new connections may be the structural changes the brain uses to store new experiences.”

Source: Yale University